a comparative study on the effect of agnikarma, matra basti ...

“A COMPARATIVE STUDY ON THE EFFECT OF

AGNIKARMA, MATRA BASTI WITH AND WITHOUT

SIRAVYADHA IN THE MANAGEMENT OF GHRIDRASI”

By

Dr. AKSHAY GANACHARI.

Dissertation Submitted to

The Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

In Partial fulfillment of the requirements for the Degree of

MASTER OF SURGERY (AYURVEDA)

In

SHALYA TANTRA

Under the guidance of

Dr. R C YAKKUNDI.M.S. (AYU)

DEPARTMENT OF POST GRADUATE STUDIES IN

SHALYA TANTRA

SHRI SHIVAYOGEESHWAR RURAL AYURVEDIC MEDICAL

COLLEGE & HOSPITAL. INCHAL – 591102

2017-2018

I

“A COMPARATIVE STUDY ON THE EFFECT OF AGNIKARMA, MATRA BASTI WITH

AND WITHOUT SIRAVYADHA IN THE MANAGEMENT OF GRIDHRASI’’

ACKNOWLEDGEMENT

The writing of this dissertation has been one of the most significant academic

challenges I have ever had to face. Without the support, patience and guidance of the following

people this study would not have been completed. It is to them that I owe my deepest gratitude.

I bow my head in the lotus feet of Parama Poojya Dr. Shri. Shivanand Bharati

Swamiji founder and president of our institution for his endless blessings on me. Then I would

like to thank S.S.B.E.Society’s our chairman Shri. D. B. Mallur sir for providing all the

required materials during my research period.

I would like to express my special thanks of gratitude to our Principal and CMO

Dr. G. Vinay Mohan sir for giving me the golden opportunity to this wonderful dissertation

on this topic, which also helped me in doing a lot of research and I came to know about so

many new things.

I would never have been able to finish my dissertation work without the guidance of

our Vice-Principal Dr. G. S. Hadimani sir. I am thankful to him for supporting me to complete

my dissertation.

I am highly indebted to HOD Dr. M D P Raju sir for his guidance and constant

supervision as well as for providing necessary information regarding the dissertation and also

for his support in completing the dissertation.

I would like to express my special thanks of immense gratitude to my Guide

Dr.R.C.Yakkundi sir, you have been a tremendous mentor for me. I would like to thank you

for encouraging my research and allowing me to grow as a researcher. Your advice on both

research as well as on my career have been priceless.

I am highly indebted with thanks of gratitude to our lectures

Dr. K H Pachanavar sir, Dr. M. B. Rudrapuri sir and Dr. Akshay Shetty sir for their

inspiration and proper guidance throughout my dissertation.

II



III



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

A.D - Arundutta

A. H. - Ashtanga Hridaya

A. S. - Ashtanga Sangraha

B. S. - Bhela Samhita

B.P. - Bhava Prakasha

B.R - Bhaisajya Ratnavali

Cha. - Charaka Samhita

C.D. - Chakradatta

Chi. - Chikitsasthana

Dal - Dalhan

G.N - Gada Nigraha

H.S - Harita Samhita

Kal. - Kalpasthana

K.K - Kalyankaraka

K. S. - Kashyapa Samhita

M. N. - Madhava Nidana

Ma. Kha - Madhyama Khanda

Ni. - Nidanasthana

Pu. Kha - Purva Khanda

R.R.S. - Rasaratna Samucchaya

Su. - Sutrasthana

Sha. - Sharirasthana

Sha.S - Sharangadhara Samhita

Si. - Siddhisthana

S.K.D - Shabdha Kalpa Druma

Ut.Kha - Uttartantra or Uttarakhanda

V.S - Vangasena

Vi. - Vimanasthana

Y.R - Yogartnakara

IV



LIST OF TABLES

Sl no. Tables Page no.

1 Aharaja Hetu (Guna Pradhan and Rasa Pradhana). 11

2 Aharaja Hetu (Matra Pradhan and Kala Pradhan). 11

3 Aharaja Hetu (Dravya Pradhan). 12

4 Viharaja Hetu. 13

5 Agantuja Hetu. 16

6 Anya Hetu. 16

7 Samanya Lakshana’s of Gridhrasi. 18

8 Vishesha Lakshana’s of Gridhrasi. 18

9 Vyavachhedak Nidana. 25

10 Showing Shakhagata Siras. 47

11 Showing Koshtagata Siras. 47

12 Showing Urdhvajatrugata Siras. 47

13 Sites of Siravyadha in different diseases. 49

14 Dahnaupakarna according to various Acharyas. 56

15 Derivations of Basti. 68

16 Types of Basti on the basis of Adhisthana. 69

17 Type of Sneha Basti according to the Dose. 70

18 Types of Basti according to number of Basti. 70

19 Basti Putaka Dosha and their Vyapad. 72

20 Description of Basti Netra. 72

21 Size of Basti Netra as per Charaka. 73

22 Size of Basti Netra as per Sushruta. 73

23 Basti Netra Dosha and their Vyapad. 74

24 Indication of Matra Basti. 75

25 Samyak Yoga, Ayoga and Atiyoga lakshanas of Anuvasana Basti

[Matra Basti].

78

V



26 Contents of Murcchita Tila Taila. 82

27 Guna and Karma of drugs used in PTGG. 84

28 Distribution of patients according to Sex. 101

29 Distribution of patients according to Age. 102

30 Distribution of patients according to Occupation. 103

31 Distribution of patients according to Religion. 104

32 Distribution of patients according to Socio-Economic Status. 105

33 Distribution of patients according to Marital Status. 106

34 The effect of Ruk on Group A. 107

35 The effect of Ruk on Group B. 107

36 The effect of Toda on Group A. 108

37 The effect of Toda on Group B. 109

38 The effect of Stambha on Group A. 110

39 The effect of Stambha on Group B. 111

40 The effect of Spandana on Group A. 112

41 The effect of Spandana on Group B. 112

42 The effect of SLR test on Group A. 113

43 The effect of SLR test on Group B. 114

44 Overall effect on Group A. 115

45 Overall effect on Group B. 116

46.A Comparative results of Group A and Group B. 117

46.B Comparative results of Group A and Group B. 117

46.C Comparative results of Group A and Group B. 118

VI



LIST OF FIGURES

Sl no. Figures Page no.

1 Incidence of Sex. 101

2 Incidence of Age. 102

3 Incidence of Occupation. 103

4 Incidence of Religion. 104

5 Incidence of Socio-Economic Status. 105

6 Incidence of Marital Status. 106

7 Showing effect on Ruk. 108

8 Showing effect on Toda. 110

9 Showing effect on Stambha. 111

10 Showing effect on Spandana. 113

11 Showing effect on SLR Test. 114

12 Result on Group A. 115

13 Result on Group B. 116

14 Comparative results of Group A and Group B. 118

LIST OF PHOTOS

Sl no. Name of Photos Page no.

1 Siravyadha Procedure. 158

2 Agnikarma Procedure. 159

3 Basti Karma 160

VIII

“A COMPARATIVE STUDY ON THE EFFECT OF AGNIKARMA, MATRABASTI

WITH AND WITHOUT SIRAVYADHA IN THE MANAGEMENT OF GHRIDRASI”

STRUCTURED ABSTRACT



BACKGROUND:

Gridhrasi is enumerated one among the Vata Nanatmaja and Samanyaja Vata Vikaras.

It is correlated with disease ‘Sciatica’ in modern science. In spite of tremendous advancement

in field of modern medicine, the management of Sciatica in contemporary science is still

limited and has a less favourable outcome and consumes more health resources.

Ayurvedic classics deal the disease with various therapeutic measures, amongst which

Siravyadha, Agnikarma and Matrabasti therapies was taken for clinical trial.

OBJECTIVES:

To Study the details of Gridhrasi in term of its aetio-pathogenesis clinical manifestation

with possible correlation to description available in Ayurveda and Modern text.

To evaluate and compare the efficacy of Agnikarma and Matrabasti with and without

Siravyadha in the management of Gridhrasi.

METHODS:

It is a comparative clinical study. In this, 60 patients were taken for the study and

divided into two different groups of 30 patients in each. The subjective and objective

parameters were observed before, after treatment and after follow up and were recorded in the

case proforma of Gridhrasi.

Group A – Treated by Siravyadha followed by Agnikarma and Matrabasti.

Group B – Treated by Agnikarma and Matrabasti without Siravyadha.

IX

“A COMPARATIVE STUDY ON THE EFFECT OF AGNIKARMA, MATRABASTI

WITH AND WITHOUT SIRAVYADHA IN THE MANAGEMENT OF GHRIDRASI”

RESULTS:

The collected data was statistically analysed and at the end of present study Group A

showed more significant results and Group B showed significant results after procedure but

symptoms were gradually reappeared after follow up.

INTERPRETATION AND CONCLUSION:

After comparing the results of both groups, Group A overall result is 72.49% and Group

B overall result is 66.68% Hence it can be concluded that Siravyadha followed by

Agnikarma and Matrabasti showed good results than Agnikarma and Matrabasti

without Siravyadha.

KEY WORDS:

Gridhrasi, Siravyadha, Agnikarma, Matrabasti.

1



INTRODUCTION



The main aim of the Medical Science is to provide better Health for each and every

Human being. Different Medical sciences with various principles and fundamentals are trying

their best for one common goal i.e. Health for all. To achieve this goal the Pathy should be able

to eliminate the disease and that to be without any side effects.

Ayurvedic approach towards the disease is holistic. It is a simple practical science of

life, its principles are universally applicable to each individual for daily existence. Ayurveda

speaks of every elements and facts of human life offering guidance that have been tested and

refined over many centuries to all those who speak about greater harmony, peace and longevity

of life.

Sushruta Samhita is one among the earliest known authentic treatise on Ayurveda.

It’s important treatise among all the other existing text of Ayurveda. It holds the important

place, since it is the only text now available for Shalya-Shalakya Tantra, an important branch

of Ayurveda. It is the most ancient document on this branch of Medical science not merely in

India but also of the whole world Sushrutacharya has been acknowledged as the Father of

Surgery. It is being studied since long by all Ayurvedic scholar and Western countries too, have

undertaken its study in the last two centuries and have admired the achievements of the

Surgeons of Ancient India. It has maintained its popularity as an indisputable testimony of

ancient Indian scientific achievements.

Each and every human beings desires to live happy and comfortable life, but it is not

possible owing to multifactor related with changing life styles, environmental factors etc. The

critical busy schedule, restless, anxiety, stress and strain. The constant work schedule in

improper sitting posture, continuous and over exertion, less sports activities, prolonged

travelling, exercise etc which in fact cause undue pressure on spinal cord and produce low

backache that invites sciatica. Although low backache is a common condition that affects as

many as 80-90% of people during their lifetime. True sciatica occurs in about 5% of cases1.

2



This Sciatic may be correlated with the disease “GRIDHRASI” stated in Ayurveda. In

various Samhita of Ayurveda, about Gridhrasi there are lots of references and it is elaborated

as a separate disease with specific management. The disease Gridhrasi comes under Nanatmaja

Vyadhi. Charakacharya quoted Gridhrasi in Vataja Nanatmaja Vyadhi2. Acharya Sushruta

mentioned Prakupita Vata by involving Kandara of Parshni and Pratyangini causes Kshepa of

the pada3. The Nidana and Samprapti of Gridhrasi has been described in Astanga Hrudaya4.

In modern view the above condition is described in which pain is experienced along the

course and in the distribution of sciatic nerve. It is now become well known even among the

laymen as “Sciatica’’.

In modern medicine for the management of sciatica various modalities are available

such as

- Conservative treatment.

- Epidural steroid injection.

- Peri-Radicular Infiltration.

- Surgical treatment.

All these are having their own complications and side effects. On the other hand all

these management tools are not affordable for the poor, particularly in developing countries.

In Ayurvedic texts, there are various methods used as a line of treatment some of

which are effective, simple, safe and cheap for the patients like

- Siravyadha.

- Agnikarma.

- Basti Karma.

- Snehana.

- Swedana.

- Oral medication.

3



Nowadays, Ayurvedic Para surgical procedures like Agnikarma, Siravyadha,

Ksharakarma and Jalaukavacharana are most popular in the society because of many research

works have been carried out regarding its efficiency and well known fruitful data available.

Acharya Sushruta has mentioned diseases, those are not relieved so quickly by

Snehanadi measures in this situation Siravyadha is an emergency management to achieve better

results5. He also mentioned Agnikarma Chikitsa in the management of Sira, Snayu, Sandhi,

Asthi Samprapti and Gridhrasi is formed by all these involved structures6.

Basti is the prime and most beneficial therapy for Vata Vyadhi Matrabasti is safe and

easy for administration even at OPD level7.

Pancha Tikta Guggulu Ghrita is indicated in Vata Vyadhi especially pain in Asthi,

Snayu and Majja as mentioned in Sahasrayoga8.

Keeping above all the points in mind as a scholar of Shalya Speciality. I was planned

to work on



1



INTRODUCTION



The main aim of the Medical Science is to provide better Health for each and every

Human being. Different Medical sciences with various principles and fundamentals are trying

their best for one common goal i.e. Health for all. To achieve this goal the Pathy should be able

to eliminate the disease and that to be without any side effects.

Ayurvedic approach towards the disease is holistic. It is a simple practical science of

life, its principles are universally applicable to each individual for daily existence. Ayurveda

speaks of every elements and facts of human life offering guidance that have been tested and

refined over many centuries to all those who speak about greater harmony, peace and longevity

of life.

Sushruta Samhita is one among the earliest known authentic treatise on Ayurveda.

It’s important treatise among all the other existing text of Ayurveda. It holds the important

place, since it is the only text now available for Shalya-Shalakya Tantra, an important branch

of Ayurveda. It is the most ancient document on this branch of Medical science not merely in

India but also of the whole world Sushrutacharya has been acknowledged as the Father of

Surgery. It is being studied since long by all Ayurvedic scholar and Western countries too, have

undertaken its study in the last two centuries and have admired the achievements of the

Surgeons of Ancient India. It has maintained its popularity as an indisputable testimony of

ancient Indian scientific achievements.

Each and every human beings desires to live happy and comfortable life, but it is not

possible owing to multifactor related with changing life styles, environmental factors etc. The

critical busy schedule, restless, anxiety, stress and strain. The constant work schedule in

improper sitting posture, continuous and over exertion, less sports activities, prolonged

travelling, exercise etc which in fact cause undue pressure on spinal cord and produce low

backache that invites sciatica. Although low backache is a common condition that affects as

many as 80-90% of people during their lifetime. True sciatica occurs in about 5% of cases1.

2



This Sciatic may be correlated with the disease “GRIDHRASI” stated in Ayurveda. In

various Samhita of Ayurveda, about Gridhrasi there are lots of references and it is elaborated

as a separate disease with specific management. The disease Gridhrasi comes under Nanatmaja

Vyadhi. Charakacharya quoted Gridhrasi in Vataja Nanatmaja Vyadhi2. Acharya Sushruta

mentioned Prakupita Vata by involving Kandara of Parshni and Pratyangini causes Kshepa of

the pada3. The Nidana and Samprapti of Gridhrasi has been described in Astanga Hrudaya4.

In modern view the above condition is described in which pain is experienced along the

course and in the distribution of sciatic nerve. It is now become well known even among the

laymen as “Sciatica’’.

In modern medicine for the management of sciatica various modalities are available

such as

- Conservative treatment.

- Epidural steroid injection.

- Peri-Radicular Infiltration.

- Surgical treatment.

All these are having their own complications and side effects. On the other hand all

these management tools are not affordable for the poor, particularly in developing countries.

In Ayurvedic texts, there are various methods used as a line of treatment some of

which are effective, simple, safe and cheap for the patients like

- Siravyadha.

- Agnikarma.

- Basti Karma.

- Snehana.

- Swedana.

- Oral medication.

3



Nowadays, Ayurvedic Para surgical procedures like Agnikarma, Siravyadha,

Ksharakarma and Jalaukavacharana are most popular in the society because of many research

works have been carried out regarding its efficiency and well known fruitful data available.

Acharya Sushruta has mentioned diseases, those are not relieved so quickly by

Snehanadi measures in this situation Siravyadha is an emergency management to achieve better

results5. He also mentioned Agnikarma Chikitsa in the management of Sira, Snayu, Sandhi,

Asthi Samprapti and Gridhrasi is formed by all these involved structures6.

Basti is the prime and most beneficial therapy for Vata Vyadhi Matrabasti is safe and

easy for administration even at OPD level7.

Pancha Tikta Guggulu Ghrita is indicated in Vata Vyadhi especially pain in Asthi,

Snayu and Majja as mentioned in Sahasrayoga8.

Keeping above all the points in mind as a scholar of Shalya Speciality. I was planned

to work on



5



HISTORICAL REVIEW

History is a part of description of any object. In this way before going in detail about

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

and Vata Vyadhi in general available till now beginning right from Vedic period. For the total

coverage of historical aspect, it has been divided into four sections viz. –

• Vedic Period • Pauranika Period

• Samhita Period • Sangraha Period

VEDIC PERIOD : (2500 BC to 500 BC)

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

not mentioned in many Vedas. However, in the Atharvaveda, the word ‘Vatikrita’ is mentioned.

Here, ‘Vatikrita’ word denotes Vata Vyadhi. In same Pippali1 and Visanika2 have been claimed

as ‘Vatikritasya’ Bhesaja and Vatikritanashini respectively.

PAURANIKA PERIOD :

In Garuda Purana, Ayurveda related subjects are described in details. In this treatise a

separate chapter is available as Vata Vyadhi Nidana where Gridhrasi is described as an entity.

SAMHITA PERIOD

Detailed description regarding Gridhrasi is available in different Samhitas.

Charaka Samhita:

Charaka Samhita is the first and foremost Ayurvedic source for the detailed description

of Gridhrasi.

In 20th chapter of Sutra Sthana – Maharogadhyaya, Gridhrasi is enumerated in 80 types

of Nanatmaja Vata Vyadhi3.

In 19th chapter of Sutra Sthana – Astodariya Adhyaya, description of two types of

Gridhrasi viz. Vataja and Vata-Kaphaja has been mentioned4.

In 5th chapter of Sutra Sthana, Matrashiteeya Adhyaya, Gridhrasi is indicated as an

indication of Taila Abhyanga in Pada5.

6



In 28th chapter of Chikitsa Sthana – Vata Vyadhi Chikitsa, the detailed symptomatology

and treatment of Gridhrasi have been given6.

Sushruta Samhita : (600 – 400 BC)

The pathogenesis and symptomatology have been mentioned in the 1st chapter of

Nidana “Vata Vyadhi Nidana”. He mentioned a symptom ‘Sakthikshepa Nigraha’

means unable to lift the leg straight as pain is produced if lifted as like SLR test in

modern medicine7.

In Chikitsa Sthana 5th chapter, Mahavatavyadhi Chikitsa8 and 8th chapter of Sharira

Sthana, Siravyadha Chikitsa for Gridhrasi is indicated9.

Ashtanga Sangraha : (4th century)

In Sutra Sthana 20th chapter “Doshabhediya Adhyaya”, Gridhrasi is included under 80

types of Vataja Vikaras10.

In Nidana Sthana 15th chapter“Vata Vyadhi Nidana”, Pathogenesis and

Symptomatology of Gridhrasi has been described11.

In Sutra Sthana 36th chapter, Siravyadha Chikitsa in Gridhrasi has been mentioned12.

Ashtanga Hridaya: (5th century)

In Nidana Sthana 15th chapter Vata Vyadhi Nidana Symptomatology and Pathogenesis

of Gridhrasi is described13.

In Sutra Sthana 27th chapter, Site of Siravyadha in Gridhrasi has been mentioned14.

Kashyapa Samhita: (7th Century)

In this Samhita, Gridhrasi is considered under 80 types of Vata Vikaras, but no details

are described15.

Bhela Samhita: (7th century)

26th chapter of this Samhita deals with Basti and Raktamokshana Chikitsa for

Gridhrasi16.

7



Madhava Nidana: (7th Century)

Madhavakara had mentioned some special features which are not mentioned by earlier

Acharyas. It includes Toda, Dehavakratha, Sphurana and Supthagatratha in the Janu and Sphik

are the lakshans of Vataja Gridhrasi. In addition to the Vataja Gridhrasi lakshans like

Vahnimardavata, Tandra, Mukhapraseka and Bhaktadvesha are present in Vata-kaphaja

Gridhrasi17.

Kalyanakaraka: (8th Century)

The 8th chapter termed as Vatarogadhikara deals with Pathology and Symptomatology

of Gridhrasi18 and its treatment is given in the 12th chapter named Vata Roga Chikitsa19.

Chakradatta: (12th Century)

This text deals with treatment part only under the heading of Vata Vyadhi Chikitsa

Some herbal preparation Snehana Chikitsa, Basti Chikitsa and Shastra Chikitsa are described

in detail20.

Arunadutta: (12th century)

Arunadutta, in his Sarvanga Sundari commentary on Astanga Hrudaya defines 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 (Sakthikshepaniigraha) 21.

Gadanigraha: (12th century)

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

In 4th chapter of Prayoga Khanda termed as Gutikadhikara22.

In 19th chapter of Kayachikitsa Khanda named as Vatarogadhikar describes Basti

Chikitsa for its treatment along with Agnikarma and Raktamokshana23.

Dalhana: (12th Century)

According to Dalhana, its commentary on Sushruta Samhita described Gridhrasi as

Randhini and the meaning of ‘Sakthikshepanigraha’24.

8



Vangasena: (12th Century)

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

Deepana, Pachana, Vamana, Virechana, Basti and Siravyadha should be done in Gridhrasi25.

Indu: (13th Century)

In Shashilekha commentary of Ashtanga Sangraha, Indu has described that in

Gridhrasi, the symptoms are similar to Vishwachi. If restricted movement and pain occurs in

upper limb, the disease is called as Vishwachi. Whereas pain and restricted movement occurs

in lower limb then it is termed as Gridhrasi26.

Sharangadhara Samhita: (13th Century)

In 7th chapter of Purva Khanda termed as Rogaganana, Gridhrasi is counted under 80

types of Nanatmaja Vata Vyadhi27.

Treatment of Gridhrasi is described in 2nd and 5th chapter of Madhyama Khanda28.

Rasaratna Samuchchaya: (13th Century)

30th chapter of Rasaratna Samuchchaya deals with treatment of Gridhrasi29.

Bhavaprakash: (16th Century)

Gridhrasi is considered under 80 Vata Vyadhies in Madhyam Khanda. Specific

treatment for Vata-Kaphaj Gridhrasi is mentioned30.

Yogaratnakara: (17th Century)

In Yogaratnakara symptomatology and classification of Gridhrasi has been

mentioned under Vata Vyadhi Nidana. Few preparations have also been described

which are useful in Gridhrasi31.

Bhaishajya Ratnavali: (18th Century)

In this text treatment of Gridhrasi is described as per Chakradatta32.

9



DISEASE REVIEW

VYUTPATTI:

In Ayurveda, diseases are named by different ways e.g. according to Dosha-Dushya

involved, according to symptoms etc. Here the word Gridhrasi is suggestive of the typical

character of pain and also the gait of the patient.

‘Gridhu’ is the dhatu which makes the word ‘Gridhra’ from which the world ‘Gridhrasi’

is derived.

The Gridhu dhatu means to desire, to covet, strive after greedily.

‘Karan’ pratyaya is added to this by ‘Sudhangridhibhyaha Kran’ & then by the lope of

K & N the word ‘Gridhra’ is derived.

Further, the derivation of the word Gridhrasi from Gridhra is as follows:

By the rule ‘Atonupasarge Kah’, Kah Pratyaya is added to Gridhra + Sho. Hence

forming Gridhrat + Sho + ka.

By lopa of ‘O’ and ‘K’, ‘Sh’ is replaced by rule ‘Dhatvadeh Shah Sah’ & in Female

gender ‘Angish’ Pratyaya is added to form the word ‘Gridhrasi’1.

NIRUKTI:

Gridhrasi is an illness predominantly affecting the ambulatory function of the patient

and the same is stressed in the derivation of the word Gridhrasi. Following derivations taken

from the different text books in Sanskrit literature substantiates the same.

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

The Sanskrit word Syaati Gachhati 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. Further the author of Amarasudha opines that this disease is characterized by morbidity

of Vata Dosha affecting the hip joint.

Gridhra is bird called as Vulture in English. This bird is fond of meat and he eats flesh

of an animal in such a fashion that he deeply pierce his beak in the flesh then draws it out

forcefully, exactly such type of pain occurs in Gridhrasi and hence the name2.

10



PARIBHASHA:

Gridhrasi is a Vata Vyadhi characterized by Stambha (stiffness), Toda (pricking pain),

Ruk (pain) and Spandana (frequents tingling). These above mentioned lakshans initially affect

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

posterior aspects of Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot) 3.

According to Acharya Sushruta there are two Kandara in the leg which gets afflicted.

The two Kandara include the one extending distally from the Parshni to the toes, and other

extending above from the Parshni to the Vitapa. These two Kandara when gets afflicted with

the Vata Dosha limits the extension of the leg. This disease is known as Gridhrasi4.

NIDANA:

All those factors pertains the ability of producing the disease as Nidana5.

Consideration of Nidana plays an important role in treating the disease. As the specific

causative factors for Gridhrasi, are not mentioned in the classics. All the Nidanas which are

causing Vata Vyadhi and Vata Prakopa are attributed as the aetiological factors of Gridhrasi.

The vitiation of Vata takes place in two ways as viz. Dhatukshaya and Margavarana6. Therefore

the Vata Prakopa Nidana can be summerizing accordingly as below.

Charaka and Bhavaprakasha clearly mention the causative factors of Vata Vyadhi, but

in Sushruta Samhita, Ashtanga Sangraha and Ashtanga Hridaya etc. the causes of Vata Vyadhi

have not been clearly described. However, in these texts the causative factors of provoked Vata

Dosha are available7.

Since Gridhrasi is considered as Nanatmaja type of Vata Vyadhi, the provocative

factors of Vata can also be taken as the causative factors for Gridhrasi.

All the etiological factors given either of Vata Vyadhi or Vata Prakopaka in the

Ayurvedic classics can be classified into four groups.

1. Aharaja Hetu 2. Viharaja Hetu

3. Agantuja Hetu 4. Anya Hetu

11



AHARAJA HETU:

Table no.1-AharajaHetu (Guna Pradhan and Rasa Pradhana):

Ahara Cha. Su. A.S. A.H. B.P. M.N. Y.R.

Guna Pradhana

Rukshanna

(ununctous diet)

+

+

+

+

+

+

+

Laghvannna

(light diet)

-

+

+

-

+

+

+

Gurvanna

(heavy diet)

-

-

+

+

-

+

+

Sheetanna

(cold diet)

+

-

+

-

-

+

+

Rasa Pradhan

Kashyanna (astringent

taste)

-

+

+

+

+

+

+

Katvanna

(acrid taste)

-

+

+

+

+

+

+

Tiktanna

(Bitter taste)

-

+

+

+

+

+

+

Table no.2 – Aharaja Hetu (Matra Pradhan and Kala Pradhan):

Aahara Cha. Su. A.S. A.H. B.P.

Matra Pradhan

Abhojana

(fasting)

+ +

-

-

-

Alpasna

(dieting)

+

-

+

+

-

12



Vishmashana

(Taking unequal food)

-

+

-

- -

Kala Pradhan

Adhyashana

(eatingbefore digestion

of previous meal

-

+

-

-

-

Jirnanta

(After digestion)

-

+

+

+

+

Pramitashana

(Taking food in

improper time)

-

-

+

+

+

Table no.3 – AharajaHetu (Dravya Pradhan):

Aahara Cha. Su. A.S A.H B.P

Dravya Pradhan

Adhaki

(Cajanus cajan)

-

+

-

-

-

Chanaka

(Cicer arietinum)

-

-

+

-

-

Harenu

(Pisum sativum)

-

+

-

-

-

Jambava

(Eugenia jambolena)

-

-

+

-

-

Kalaya

(Lathyrus sativus)

-

+

+

-

-

Kalinga

(Holarrhena antidysenterica)

-

-

+

-

-

Koradusha

(Paspalum scrobiculatum)

-

+

-

-

-

Masura

(Lens culinaris)

-

+

-

-

-

13



Mudga

(Phaseolus mungo)

-

+

-

-

-

Shaluka

(Nelumbium speciosum)

-

-

+

-

-

Shyamaka

(Setaria italica)

-

+

-

-

-

Tinduka

(Diospyros tomentosa)

-

-

+

-

-

Trunadhanya

(Grassy grain)

-

-

+

-

-

Tumba

(Lagenaria valgaris)

-

-

+

-

-

Varaka

(Carthamus tinctorius)

-

+

-

-

-

VIHARAJA HETU: Table no.4- Viharaja Hetu:

Vihar Cha. Su. A.S A.H B.P M.N

Ashmabhramana (whirling stone) - - + - - -

Ashmachalana (Shaking of stone) - - + - - -

Ashmaviksehpa (Throwing of

stone) - - + - - -

Ashmotkshepa

(pulling down stone) - - + - - -

Balavat vigraha (Wrestling with

Superior healthy one - + + - - +

Damyagaja nigraha (subduing

untameable elephant) cow & horse - - + - - -

Divasvapna

(day sleep) + + - - - +

Dukhasana (uncomfortable

sitting) + - - - - -

Dukhashayya (uncomfortable

sleeping) + - - - - +

Ghadhotsadana

(strong rubbing) - - + - - -

14



Kashtabhramana (whirling of

wood) - - + - - -

Kashtachalana (shaking of wood) - - + - - -

Kashta Vikshepa (throwing of

wood) - - + - - -

Kashtotkshepa

(pulling down wood) - - + - - -

Lohabhramana (whirling of metal) - - + - - -

Lohachalana

(Shaking of metal) - - + - - -

Lohavikshepa (Throwing of

metal) - - + - - -

Lohotkshepa

(Pulling down metal) - - + - - -

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

Shilachalana

(Shaking of rock) - - + - - -

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

Shilotkshepa

(Pulling down rock) - - + - - -

Bharaharana

(Head loading) - + + - - +

Vegadharana (Voluntary

suppression of natural urges) + + + + + +

Vegadeerana (forceful drive of

natural urges) - - + + - -

Vishamopchara (Abnormal

gestures) + - - - - +

Atigamana

(excessive walking) + - + - - -

Atihasya

(Loud laughing) - + + + - -

Atikharachapakarshana (Violent

stretching of the bow) - - + + - -

Atilanghana

(Leaping over ditch) + + + - - -

Atiplavana

(Excessive bounding) + + - - - -

Atiprabhashana (Continuous

talking) - - + + - -

Atipradhavana (Excessive

running) + + - - - +

Atiprajagarana (Excessive

awakening) + + + + + +

15



Atiprapatana

(Leaping from height) - + - - - +

Atiprapidanam (Violent pressing

blow) - + - - - +

Atipratarana (Excessive

swimming) - + + - - -

Atiraktamokshana (Excessive

bloodletting) - - - - + +

Atisrama

(over exertion) - - - - + +

Atisthana(standing for a long

period) - + - - - -

Ativyayama

(Violent exercise) + + + + + +

Ativyavaya(excessive sexual

intercourse) + + + + + +

Atiadhyayana (excessive study) - + + - - -

Atyasana (sitting for a long

period) - + - - - -

Atyuchchabhashana (speaking

loudly) - - - + - -

Gajaticharya (excessive riding on

Elephant) - - + + - +

Kriyatiyoga (excessive

purification Therapy) - - + + + -

Padaticharya (walking long

distances) - + - - - -

Rathaticharya (excessive riding on

Chariot) - + - - - +

Bhaya (fear) + - + + + -

Chinta (worry) + - + - - +

Krodha (Anger) + - - - - +

Mada (Intoxication) - - - - + -

Shoka (Grief) + - + + + +

Utkantha (Anxiety) - - + - - -

Abhra (cloudy season) - + - - - -

Aparahna (evenning) - + + + + -

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

Grishma (summer season) - - + + - -

16



Pravata (windy day) - + + - - -

Shishira (winter) - - - - + -

Sheetakala (early winter) - + - - + -

Varsha (rainy season) - + + - + -

AGANTUJA HETU:

External factors like trauma leading to Vata Prakopa have been under this heading.

Table no. 5 – AgantujaHetu:

Hetu Cha. Su. A.S A.H B.P M.N

Abhighata (trauma) + - - - - +

Gaja, Ustra, Ashva

sighrayanapatamsana

(Falling from speedy, running

elephant, camel and horse)

+ - - - - +

ANYA HETU:

All other causatives factors of the Prakopa of Vata which could not be included in any

of above classification have been presented under this heading.

Table no. 6 – Anya Hetu:

Vihara Cha. Su. A.S A.H B.P M.N

Ama

(undigested article)

+ - - - + -

Asrukshaya

(loss of blood)

+ + + - - +

Dhatukshaya

(loss of body elements)

+ - - - - +

Doshakshaya

(loss of excretor)

+ - - - - +

Rogatikarshana (emaciation

due to disease)

+ - - - - +

Gadakruta mamskshaya

(wasting due to disease)

- - - - + +

17



POORVARUPA:

Poorvarupa are those signs and symptoms which appear earlier to actual manifestation

of disease and may suggest the forthcoming illness8.

Thus, the symptoms of Gridhrasi such as Ruk, Toda, Spandana, Stabdhata, Tandra,

Arochaka etc. when manifested slightly can be called as Poorvarupa of Gridhrasi.

RUPA:

Vyakta Purvarupa is known as Rupa9. Symptoms play most important role in proper

diagnosis of the disease. Curability and incurability of the disease depends upon the severity

of the presenting symptoms. Rupa appears in the Vyaktavastha i.e., fifth Kriyakala of the

disease.

This is the unique stage of the illness, where in it is clearly recognizable as all its

characteristic signs and symptoms manifest. Pain starting from Sphik and radiating towards

Kati, Uruprishtha, Jaanuprishtha, Janghaprishtha and Pada in successive order, is the cardinal

symptom of Gridhrasi.

Two types of Gridhrasi are described in Samhitas, Vataja and Vata-kaphaja.

While decribing Gridhrasi, Acharya Charak has listed Ruk, Toda, Stambha and

Muhuspandana as the cardinal symptoms. 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 order10.

Also Sakthikshepanigraha is added to the list of cardinal signs by Acharya Sushruta and

Vagbhat11. Tandra, Gourav, Aruchi, Bhaktadwesha, Mukhapraseka etc. are the Lakshanas of

Vata-Kaphaja Gridhrasi. Some signs and symptoms like Dehasyapravakrata, Janu, Urusandhi

Sphurana etc. have been defined as Vataja Lakshanas by Bhavaprakash, Madhavnidan and

Yogaratnakar. Vangasena has also added pain in Payu as one of the symptoms.

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

distinct categories

a) Samanya Lakshanas

b) Vishesha Lakshanas

18



Different authors mentioned different Samanya Lakshanas of Gridhrasi and Lakshanas

of specific types of Gridhrasi.

These are tabulated as below:

Samanya Lakshanas:

Table no. 7 – Samanya Lakshana’s of Gridhrasi12.

Lakshanas Ch. Su. A.H A.S B.P M.N Y.R

Sphika Purva Kati - Pristha,

Uru, Janu, Jangha, Pada

Kramat Vedana

+

-

-

-

+

+

+

Ruk + - - - + + +

Toda + - - - + + +

Stambha + - - - + + +

Muhuspandana + - - - + + -

Sakthikshepanigraha - + - - - - -

Sakthiutkshepanigraha - - + + - - -

Vishesh Lakshanas: Table no.8 – Vishesha Lakshana’s of Gridhrasi:

Lakshanas Ch. Su. A.H A.S B.P M.N Y.R

A. Vataja Gridhrasi 13

Dehasyapravakrata - - - - + + +

Janusandhisphurana - - - - + + +

Urusandhisphurana - - - - + - -

Katisandhisphurana - - - - + + +

Janghasphurana - - - - - + -

Suptata - - - - + - +

B. Vata-Kaphaja 14

Tandra + - - - + + +

Gourava + - - - + - +

Aruchi + - - - - - +

Vahani Mardava - - - - + + +

Mukhapraseka - - - - + + +

Bhaktadwesha - - - - + + +

19



a) SAMANYA LAKSHANAS15:

These clinical manifestations are seen in both Kevala Vataja and Vata-kaphaja type of

Gridhrasi. Following are the Samanya Lakshanas of Gridhrasi.

Ruk (Pain):

In Gridhrasi Ruk or Shoola 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 Pada.

Non radiating pain felt at sites like Kati, Uru, Janu, Jangha and Pada region is also

considered as the symptom of Gridhrasi. This typical radiating pain involving the legs is

suggestive of Sciatic-syndrome in modern science where pain is felt along the course of the

Sciatic nerve.

Toda (Pricking pain):

Charaka and Madhava have stated this symptom. It is a pricking type of pain and may

be present along the sciatic nerve distribution. In modern medicine also, while mentioning the

signs and symptoms of Sciatica due to the lesion in L5 root, it has been described that sensory

impairment in the foot may also occur.

Stambha (Stiffness):

Stambha means feeling of tightness and rigidity throughout the leg. Arundatta defines

it as inability to flex the limbs. While Hemadri explains it as loss of movement. It is one among

the eighty Nanatmaja Vata Vyadhies. Especially the Sheeta and Ruksha Guna of Vata affects

the muscles of the leg hamparing the movements of leg. Also they are restricted due to pain,

especially flexion at the hip joint and extension at the knee joint.

Spandana (Twitching):

Spandana is a sensation of something throbbing or pulsating. This also occur throughout

the distribution of Gridhrasi Nadi (Sciatica nerve), which starts from Sphika (hip) and radiates

towards the Jangha (calf).

20



Sakthanaha Kshepanam Nigrhaniyat (SLR - Test):

Sushruta has mentioned this symptom commenting upon this, Dalhana says that the

Kandara restricting the movement of the limb is called Gridhrasi. The word ‘Kshepa’ means

Prasarana (extension). Acharya Vagbhatta has used the word ‘Utkshepana’ in the place of

‘Kshepa’ which means that the patient is unable to lift his legs (i.e flexion of the hip joint).

Arundatta has very clearly defined this by quoting the term “Pada Uddharne Ashakti” means

the patient is unable to elevate or lift the leg as like SLR Test in Sciatica.

b) VISHESHA LAKSHANAS:

The differtial symptoms of Gridhrasi that indicate either Vataja or Vata-kaphaja

Gridhrasi are described as Vishesha Lakshana. The predominance of Vata Dosha or Vatakapha

Dosha in the Samprapti of Gridhrasi leads to the manifestation of Vishesha Lakshana.

1] VATAJA GRIDHRASI16:

Here in the Samprapti of the Gridhrasi Vata Dosha is solely involved. Evidently there

will be no any association of Kapha Dosha in the Samprapti. Following are the Vishesha

Lakshana of Vataja Gridhrasi.

Dehasyapravakrata:

This sign is mentioned in Laghutrai but not is Brihatrai. Because of extreme pain felt

in the limb, the patient assumes a typical posture. He keeps his leg slightly flexed at the hip

and knee hence his body appears to be in tilted position mostly to the affected side. Because of

extreme pain, Stambha and Toda etc. the patient assumes a typical limping posture. The above

Lakshanas appear whenever the Vata is provoked in extreme degree.

Suptata:

This symptom is described only by Bhavaprakash and Yogaratnakar. Chakrapani

explains it as loss of movement of the leg and also loss of sensation. Supti is produced by

Sheeta Guna. As Vata and Kapha both possess the property of Sheeta Guna, both are

responsible for producing Supti. These are the paraesthesiaes in the affected limb.

21



2] VATA-KAPHAJA GRIDHRASI:

Involvement of Kapha Dosha in the Samprapti of Gridhrasi causes following unique

features17.

Tandra:

Tandra can be seen due to Tamo Guna, Vata and Kapha Doshas. The inability of the

sense organs to graspe their subject, fatigue without any work, heaviness of the body etc. are

the Lakshanas of Tandra. It is produced by Guru Guna of Kapha. Tandra is included under

Rasa Pradoshaja Vikaras and also under Vimshati Shleshma Vikara.

Gaurav:

Gourav means feeling of heaviness. It is due to Kapha dosha especially Guru Guna.

Patient feels heaviness all over the body especially in the leg. This makes the movement of the

leg difficult. Only Charak has mentioned this symptom.

Aruchi:

Charak, Madhava Nidan and Yogaratnakar have included this symptom. Here the

patient has proper appetite but he can’t enjoy the food due to loss of taste. Here mainly Bodhak

Kapha Dushti is found. Also, it is produced due to Rasa Dushti.

Vahni Mardava:

Sluggishness of the Jatharagni is due to impairment of both Abhyavaharana as well as

Jarana Shakti.

Mukha Praseka:

Excessive salivation in mouth is due to Kapha in association with Ama is known as

Mukha Praseka

Bhaktadvesha:

Patient of Gridhrasi develops aversion towards food, secondary to the sluggishness of

Jatharagni and Kaphadusti. Association of Ama is also contended in the causation of this

aversion towards food.

22



Staimitya:

Staimitya means inertness of the body, freezing sensation in the affected lower limb.

Staimitya means timidness or frozen sensation. Patient feels as if his lower extremities are

covered with wet cloth and this is due to Kapha vitiation.

UPASHAYA-ANUPASHAYA:

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

etiology or disease or which produce effect of contrary to them on the other hand Anupashaya

aggravates the disease. Satmya, Pathya and Upashaya considered to have same meaning. When

identical symptoms having two or more disease are meeting hostilely (or encountered) in such

conditions, disease could be best differentiated by adopting Upashaya.

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

as whether the disease is Urusthambha or Gridhrasi, to differentiate these two we can adopt

Upashaya. If symptoms aggravate on the application of oil, then we can consider it to be

Urusthambha and if the symptoms allevate then it can be consider it as Gridhrasi. The Nidana

mentioned for Vata Vyadhi are considered as Anupashaya for Gridhrasi.

SAMPRAPTI:

Specific Samprapti of Gridhrasi is not described in any of the classics being a Vata

Vyadhi its Samprapti can be understood on the similar lines of Vata Vyadhi.

In the Samprapti of Vata Vyadhi, Vata Prakopa takes place either by Dhatukshaya or

Margavarodha18. Acharya Charaka states that the Prakupita Vata settles in the Riktani Srotamsi

(Srotas depleted with Snehadi Guna) and produces Sarvanga and Ekanga Rogas (systemic and

localized diseases)19. Commenting on the word Riktani, Chakrapani states that Iktani means

Tuchhyani (Snehadi Gunashunyani) i.e. channels or Srotasas devoid of nutrients.

The Swaprakopaka and Dhatukshaya Nidanas causes Chaya of Vata in its main seat

Pakvashaya and further continuation of these leads to Vata Prakopa. The vitiated Vata travels

to Kati, Prishta and causes Sleshaka Kaphakshaya in the place. The Margavarodha Nidanas

like Kapha Prakopaka Nidanas, Rakta Prakopa and Granthi formed due to its own causes etc.

leads to Margavarodha i.e. obstruction to the roots of Gridhrasi Dhamani. Marmaghata Nidanas

i.e. injury of Kati, Prishta, Vamsha causes Vata Prakopa and thereby resulting in Snehadi Guna

Kshaya which further leads to Kha Vaigunya at the Kati Prishta Vamsha. Thus all above set of

Nidanas ultimately produces ‘Grishrasi’ as a disease.

23



Samprapti Ghatakas in summary:

Nidana - Vata Prakopaka Nidana.

Dosha - Vyana and Apana Vata, Kapha.

Dushya - Rasa, Rakta, Asthi, Majja, Sira, Kandara, Snayu.

Agni - Jatharagni and Dhatwagni.

Ama - Jatharagnijanya and Dhatwagnijanya.

Udhbhavasthana – Pakvashaya.

Sancharasthana - Rasayani’s.

Adhisthana - Pristha, Kati, Sphik.

Srotas - Rasa, Rakta, Mamsa, Meda, Asthi and Majjavaha Srotas.

Srotodushti Prakara - Sanga, Margavarodha.

Vyakta - Adhosakthi- Uru, Janu Jangha and Pada.

Rupa - Ruk, Toda, Stambha, Arochaka, Suptata, Bhaktadwesa,

Tandra, Gourava.

SAMPRAPTI OF VATAJA GRIDHRASI:

According to Charaka, the Vataja Gridhrasi is separately produced by Vata Prakopaka or Vata

Vriddhi having symptom of Stambha, Ruka, Toda and Muhuspandanam. Vata Prakopa Ahara

Vihara gives rise to aggravation of Vata and at the same time, Ruksha, Khara, Laghu, Sheeta,

Daruna, Vishada, Chala Guna of Vata suppresses the Snigdha, Guru, Mridu, Pichhil and Sandra

Guna of Kapha which leads to decrease of Sleshma. Decreased Sleshma in Kati-Pristha, Sakthi

and in Kandara in turn result into aggravation of Vata. This way, Vata located in Kandara and

produces the symptoms viz. Stambha, Ruka, Toda and Spandana in Kati, Pristha, Uru, Janu,

Jangha and Pada in respective order.

24



SAMPRAPTI OF VATA-KAPHAJA GRIDHRASI :

During the description of Vata-Kaphaja Gridhrasi, Acharya Charaka explained

symptoms i.e. Aruchi, Tandra and Gaurava in addition to the Vataja symptoms. Along with

Vata Prakopaka Nidana, Kapha Prakopaka Nidana gives rise to Agnimandya, which leads to

accumulation of Ama. This condition also affects the Agni of Rasa Dhatu, resulting in the

production of Kapha abundantly as it is Mala of Rasa Dhatu.

In this Samprapti, Prakupita Vata does not suppress the Kapha as explained in Vataja

type of Gridhrasi. Here Prakupita Vata also leads to Agnimandya and ultimately helps in

accumulation of Kapha. On the other hand Kha-Vaigunya occurs due to Nidana Sevana in Kati,

Pristha, Sakthi and Kandara. Thus, both vitiated Vata and Kapha by spreading get localized at

the place of Kha-Vaigunya. In the condition of Sthana-Sanshraya that vitiated Vata gets

masked (cloaked) by Kapha and produces symptoms of Vata-Kaphaja Gridhrasi.

VYAVACHHEDAKA NIDANA :

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.

In case of Gridhrasi, there is no confusion in diagnosis, because Gridhrasi shows a very

clear cut Lakshanas such as radiating pain in the lower extremities, but there are some diseases

which resembles with Gridhrasi. Diseases like Urustambha, Khalli, Kalayakhanja and

Vatakantaka can make confusion with Gridhrasi.

Urustambha is a disease affecting one or both the legs. In this disease the leg becomes

cold and painful. Symptoms like Toda, Sphurana, Stabdhata etc. are also found in Urustambha.

But Chhardi, Jwara etc are found in Urustambha which are absent in Gridhrasi. The typical

radiating type of pain is found in Gridhrasi only. Also, a patient of Gridhrasi will never have

such a strange feeling that the leg doesn’t belong to him, which is common in Urustambha20.

25



In Khalli the severity of pain will be more than Gridhrasi and is generally proximal in

nature21. Avaotana (crookedness) is a characteristic feature of Khalli, which is abscent in

Gridhrasi.

In Khanja and Pangu first and foremost symptom is paralysis which may be present

in sciatica only as late complication and no history of pain may be present22. Where as in

Gudagata Vata, in addition to pain in the foot and associated symptoms are Shosha, retention

of urine, faeces and flatus, flatulence, colic and formation of stone (Ashmari) may also be

present23.

Vatakantaka is a disease affecting Gulpha Sandhi and localised pain is the main

symptom24. In Gridhrasi, pain may be present at Gulpha Sandhi but the whole leg is affected

which is not seen in Vatakantaka.

Vitiated Vata when resides at Guda, produces obstruction in excretion of Vata, Mala,

Mutra. This is named as Gudagata vata25. Here also pain at Jangha, Uru, Trika Prishtha is found

but the typical pattern seen in Gridhrasi is absent.

In the Poorvarupas of Vatarakta, Sphurana, Toda, Supti at Janu, Jangha, Uru, Kati are

mentioned26 but these symptoms may be found in hands and are accompanied by other

symptoms such as excessive sweating or complete loss of sweating, itching, discolouration etc.

which are not found in Gridhrasi.

Table no.9 – Vyavachhedak Nidana:

Lakshana Gridhrasi Urustamba Khalli Vatakantaka Khanj Vatarakta

Sphik poorva

Kati kramat

Vvedana

+ - - - - -

Stamba + + - - - -

Ruk + + + + - -

Toda + + - + - +

Muhu

Spandana

+ - - - - +

Sakthi

Utkshepa

Nigraha

+ - - - - -

26



Janu

Sphurana

+ - - - - -

Dehasya

Pravakrata

+ - - - + +

Kati Sandhi

Sphurana

+ - - - + -

Stabdhata + + - - - -

Parshni

vedana

+ - - + - -

Difficulty in

walking

+ - - + - -

Supti + - - - - +

SADHYA-ASADHYATA :

It is essential to know the Sadhyasadhyata of a disease before the treatment. “A

physician who can distinguish between curable and incurable diseases and initiate the treatment

only with full knowledge regarding the different aspect of the therapeutics can certainly

accomplish his object of curing the disease”.

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

principles of Sadhyasadhyata can be applied to Gridhrasi27. 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.

In disease Gridhrasi, the vitiation occurs in the Sphika, Kati, Prishtha regions involving

the Sandhi and Sandhibandhana in these areas which will ultimately give rise to the vitiation

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

is Kashta Sadhya. Still however if the patient comes earlier for the treatment and if given

prompt proper treatment in sufficient dose and duration, then the patient is likely to be cured

or less likely to suffer from a subsequent attack of pain. In case the changes in the spinal joints

or an advanced nature of the disease or if the Gridhrasi Nadi got intense vitiation, then even

the best treatment is not likely to be cured.

27



UPADRAVAS28 :

Visarpa, Daha, Moorchha, Rukshata, Agnimandhya, Aruchi, Ksheena Bala Mamsa,

Pakshavadha, Bhagna, Suptata, Adhmana, Severe pain are Upadravas of Vata Vyadhi.

The Upadravas of the Gridhrasi are not described in the texts. In practice, the following

things may be considered as Upadravas.

Shotha Suptata

Bhagna Kampa

Adhmana

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

Gridhrasi being a Vata Vyadhi the general Vata Vyadhi Chikitsa can be adopted. The

specific treatment measures given by Acharyas are enumerated below-

Charaka has advised Basti Karma, Siravyadha and Agnikarma 29.

Sushruta specifies Siravyadha at Janu after flexion30.

Astanga Sangraha and Astanga Hridaya have also advised Siravyadha four Angula

above the Janu31. Chakradatta has elaborated the line of treatment of Gridhrasi32. He

points that Basti should be administered only after proper Agni Deepana, Pachana and

Urdhva Shodhana. He has mentioned the site of Siravyadha as four Angula below

Indrabasti Marma. To remove the Granthi in Gridhrasi a small operation with prior

Snehana and Swedna is described. He suggests Agni Karma at Kanishthika Anguli of

Pada if the disese is not relieving by the above treatment. Numerous Shaman Aushadhis

has been given like Churna of Dashamoola, Bala, Rasna, Guduchi and Shunthi along

with Eranda Taila. Decoctions of Sephalika or decoction of Panchamoola with Eranda

Taila and Trivrita Grita, Rasna Guggulu, Trayodashanga Guggulu, Saindhavadya Taila,

Kubjaprasarini Taila, also recipies like Eranda Phala Payasha.

Bhavaprakasha33 also advised Vamana and Virechana before administration of Basti.

For chronic cases the decoction of Sinhasya, Danti and Krutamalak along with Eranda

Taila is advised for the Gridhrasi patients who cannot walk. For Vata-Kaphaja Gridhrasi

he has prescribed Pippali Churna along with Gomutra and Erand Taila.

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Yogaratnakara has advised Siravyadha in the area of four Angula around Basti and

Mutreendriya, if this fails Agni Karma in the little finger of the leg is advised. He has

mentioned Mahavishagarbha Taila, Vajigandhadi Taila and Lasuna etc34.

Sharangadhara has described decoction of Dashamoola or Nirgundi with Puskaramoola

and Hingu, decoction of Rasnasaptaka, Mahanimba and Rasnakalka, Prasarini,

Mashadi Taila or Narayana Taila35.

Harita has advised Snehana, Swedana and Raktamokshana and if there is no response,

then Agni Karma four fingers above the Gulpha with iron rod is advised. He also

suggests different preparations for oral and local applications. Pathyapathya of Vata

Vikaras should be followed according to his opinion36.

Bhela has mentioned Sneha Unmardana and Sneha Basti, Raktamokshana and Mulaka

Taila, Sahacharadi Taila etc. for local application37.

Vangasena has given similar opinion regarding the necessity of Urdhva Shodhana

before Basti38.

Bhaisajya Ratnavali has narrated similar line of treatment to Chakradatta39.

PATHYA-APATHYA:

PATHYA – AHARA VIHARA40:

Ahara Dravyas having Madhur, Amla and Lavana Rasa, Snigdha, Ushna Guna and

Brimhana property should be consumed by the patient. Charaka, Bhaishajya Ratnavali have

the description of Pathyapathya in details.

AHARA:

Kulathi, Masha, Raktashali, Godhuma, Navina Tila, Purana Shalyodana, Amla,

Rasayukta Phala, Dadima, , Jambira, Draksha, Badara. Patola, Lasuna, Shigru, Kshira,

Navneeta, Ghrita, Mamsa Rasa, Dhanyamla, Mudga Yusha. Tila Taila, Sasharpa Taila, Eranda

Taila, Tambula, Ela, Kustha.

VIHARA:

Snigdha Swedana, Abhyanga, Basti, Shirobasti, Shirahsneha, Snaihik dhuma, Sneha

Nasya, Sneha Gandusha, Sukhoshna Parisheka, Samvahana are the Upakramas to be 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.

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APATHYA AHARA VIHARA41:

Those Ahara and Vihara which have adverse effects on body and are nonhomologatory

to body are called Apathya.

AHARA :

Chanak, Kalaya, Shyamak, Kangu,Nivar, Rajmashak, Mudga, all Trina Dhanyas,

Katthilaka, Bimbi, Nishpavabija, Kasheruka etc. should be avoided. Also Tadag, Tatini Jala,

Viruddhanna, Sheetambu. Dravyas having Kashaya, Katu and Tikta Rasa should not be

consumed by a patient having Vata Vyadhi.

VIHARA :

Indulgence in sex, excessive riding on vehicles, excessive walking, sleeping on hard beds

should be avoided. Ratri Jagarana, Chinta, Vegavidharana, Vaman, Shrama and Upavasa

should be avoided.

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SCIATICA – A MODERN CONCEPT

INTRODUCTION

Gridhrasi, in accordance to its sign and symptoms is compared to Sciatica in modern

medical science and many Ayurvedic authors also recently have corelated Gridhrasi as Sciatica.

Hence, the disease Sciatica will be discussed in detail in this section.

The term Sciatica is derived from the Greek word ischiadikos {ischion in French,

sciaticus in Latin} which gives the meaning pertaining to or located near the ischium.

Sciatica is a very painful condition in which pain starts from the buttock and radiates

into the lower extremity along its posterior or lateral aspect, more or less comprising of the

area of distribution of the Sciatic nerve. Sciatica is not a single disease entity its a symptom-

complex which is caused by any one of the several diseases affecting the Sciatic nerve or its

roots. However, among the galaxy of causative factors of Sciatica, prolapsed intervertebral disc

is the most common and thus many of the descriptions of pathophysiology and treatment of

Sciatica mostly centres on this single entity.

HISTORY OF THE DISEASE :

Modern knowledge of the disease Sciatica seems to be only four centuries old. First

time in 1608 Shakespeare William has wrote about Sciatica in his literature Limon of Athen –

IV (Armstrong J. R. 65). In 1764 an Italian Dominico described Sciatica as a one of the clinical

entity. In 1805, the full description of the anatomical structure of the disc and their pathological

changes were published by Virchow and Vanluschka. The close association between Sciatica

and low back pain was not properly recognized until 1864, when Lasegue – a Paris Neurologist

drew attention to the importance of Straight Leg Raising sign test in Sciatica. Later shown to

be due to more stretching of the Sciatic nerve. The characteristic posture of the patient with

Sciatica and Sciatic scoliosis were detaily described by Chartcot in 1888. In 1933, Mixter and

Barr pointed out that compression of cauda equina or nerve roots were caused due to herniation

of inter vertebral disc which is also a cause of unilateral Sciatica.

In the year 1941, lumbar disc protrusion was reported in the patients with relapsing of

low back ache and Sciatica by American neuro-surgeon Walter Dandy. Mental stress was also

suggested as a precipitating factor of low back pain by Lindbloom and Scott in 1952. In 1970

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Cotunnius Somenico, Nepolitan Anatomist described the condition Sciatica as neuralgia of the

Sciatic nerve. Neuralgia is a modern term for some what indefinite pain from moderate to

severe in the area supplied by one nerve. The term seems to have come in use about the

beginning of the 19th century, entering English from French. (Henry Alana Skinnre, 1949).

DEFINITION:

Irritation of the L4- L5 and first sacral roots, which form the Sciatic nerve, causes pain

that extends mainly down the Posterior and Anterolateral aspects of leg and into the foot termed

Sciatica.

The whole pathology of Sciatica circulates around sciatic nerve. Hence to understand

the disease thoroughly Anatomy and Physiology of Sciatic nerve has to be studied first.

ANATOMY & PHYSIOLOGY OF SCIATIC NERVE:

The Sciatic nerve is characterised by its largest diameter among all the nerves in the

human body and from its commencement it measures about 2 cm in diameter. The term Sciatic

is derived from the Greek work ‘ischiadikos’ meaning pertaining to the Ischium, and possibly

it has been named from its control over the muscles arising from the Ischial tuberosity. It is

also the largest branch of the sacral plexus origin and termination. It arises within the pelvic

cavity behind the parietal peritoneum and pelvic fascia as the largest branch from the sacral

plexus terminates at back of the thigh at a variable level by dividing into tibial and common

perennial branches.

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.

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COURSE & RELATIONS:

1) In the Pelvis:

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

2) In the Gluteal Region:

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

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

ischial tuberosity and the greater trochanter.

It has the following relations in the gluteal region:

a) Superficial (Posterior):

Gluteus maximus, posterior cutaneous nerve of the thigh.

b) Deep (Anterior):

Body of the Ischium and nerve to the Quadratus femoris.

Common tendon of the Obturator internus with the gemelli.

Quadratus femoris, Obturator externus, and Ascending branch of the Medial circumflex

Femoral artery.

The capsule of the hip joint which lies deep to the aforementioned muscles.

The upper transverse fibers of the adductors magnus.

c) Medial:

Inferior gluteal nerve and vessels.

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3) In the Thigh:

The Sciatic nerve enters from the back of the thigh at the lower border of the gluteus

maximus and runs vertically downward up to 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 nerves.

It has the following relations in the thigh:

a) Superficial (Posterior):

The Sciatic nerve lies deep to the long head of the biceps femoris.

b) Deep (Anterior):

The nerve lies on the adductor magnus muscle.

c) Medial:

The posterior cutaneous nerve of the thigh, the semi-membranosus and the semi-

tendinosus muscles.

d) Lateral:

Biceps femoris muscle.

BRANCHES:

The branches of the Sciatic nerve are as follows:

I. Articular:

These branches arise from the upper part of the nerve and supply to the hip joint,

perforating posterior part of its fibrous capsule posteriorly.

II. Muscular branches:

They are distributed to the flexors of the leg through the bicep femoris (long head),

semitendinosus and semimembranosus and a makes branch to the ischial part of the adductor

magnus all arising from the medial side of the nerve trunk and other fibers are derived from

the tibial division of the Sciatic nerve. The Sciatic nerve also supplies to the short head of the

biceps femoris, which arises from its lateral side and contains fibers from the common peroneal

division of the Sciatic nerve.

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III. Terminal branches:

Tibial and common peroneal nerves are the terminal branches of the Sciatic nerve. The

tibial nerve has its roots from L4, L5, S1, S2 and S3. The tibial nerve supplies gastrocnemius,

popliteus, plantaris and soleus as well as tibialis posterior, flexor digitorum longus and flexor

hallucis longus. The medial and lateral plantar nerves supply the small muscles of feet. Also it

supplies the muscles of the calf and sole of the foot, the joints of the ankle and foot, and the

skin of the distal half of the back of the calf, the heel and the plantar aspect of the foot and toes.

Owing to its deep position, the tibial nerve is rarely inured although wounds in the popliteal

fossa or post dislocation of the knee joint may damage it.

The common peroneal nerve is formed by the divisions of L4, L5, S1 and S2. It

descends along with the lateral margin of the popliteal fossa and passes into peroneus longus

where it divides into superficial and into the deep peroneal nerves. It also supplies the lateral

aspect of the thigh. The superficial peroneal supplies the peroneus longus and brevis and most

of the dorsum of the foot. The deep peroneal branch supplies tibialis anterior, extensor

digitorum longus, extensor hallucis longus, peroneus tertius and to the extensor digitorum

brevis and to ankle joint. The common peroneal is the most commonly injured nerve in the

lower limb because of its exposed part at the fibular neck. Injury here causes paralyses to all

the dorsiflexors and evertor muscles of the foot, resulting in foot drop. There is variable

cutaneous loss on the anterolateral aspect of the leg and dorsum part of the foot.

CAUSES OF SCIATICA:

As the Sciatic nerve is so long, irritation can occur at many points, and thus Sciatica

can occur due to a variety of pathological lesions.

Predisposing Causes:

a. Age: Sciatica is most common in the 3rd to 6th decade. But some of the authors says that it is

a disease of early and midlife. The maximum incidence is found in 3rd and 4th decade of life.

b. Sex: Frequeancy of sciatica is seen more in males as compared to females.

c. Occupational Factors: History of trauma or repeated stress such as liting heavy objects is

obtained in many cases causes regular pressure on the nerve such as in motor driving may

predispose to Sciatica.

d. Exposure to cold and damp weather is also one of the causative factor.

35



The etiology are grossly divided in the following manner:

A. True Sciatic Neuritis:

Ischemic necrosis in Diabetes Mellitus and Polyarteritis nodosa, Leprosy,

Neurofibromas, direct nerve injuries due to penetrating wounds like gunshot or misplaced

injections, claudication of Sciatic nerve causing compressive injury to the Sciatic nerve due to

emaciation or foetal head during delivery.

B. Trauma:

The trauma may be of sudden fall from heights, lifting heavy weight etc. Also repeated

trauma like digging, bending, lifting heavy loads when lumber spine is flexed, travelling in

jerky vehicles are some of the main factors. Postural factors such as sitting for long time in an

overstuffed chair, badly designed car or scooter seat, sleeping with back hyperextended, lying

flat on the hard surface under the influence of narcotics or coma plays an important role.

D. Mechanical pressures on nerve roots or nerves:

a) In the spinal cord - Tumors of cauda equina, arachnoiditis, rarely thrombosis, haemorrhage,

infection results in irritating meninges of the cord.

b) In the cord space - Protruded intervertebral disc, extramedullary tumors.

c) Intervertebral column - Spondylolithesis, prime bone tumor, rheumatoid arthritis,

secondary C.A, spondylosis, spondylotic spurs, stenosis of intervertebral canal and lateral

recess hypertrophy of apophyseal facets, arachnoiditis.

d) In the back - Fibrositis of posterior sacral ligament, compression where the nerve leaves

the pelvis.

e) In the thigh and buttock - Fibrositis, sacro-sciatic band, S.I.H. diseases, neurofibroma,

heamorrhage within or in the adjacent to nerve sheath in blood dyscrasias and anticoagulant

therapy.

f) In the pelvis - SI arthritis or strain hip diseases, tumors of lumbosacaral plexus (sarcoma,

lipoma) neoplasms.

36



Some of the other Causative factors like,

1) Traumatic causes.

2) Iatrogenic causes.

3) Spinal anaesthesia.

4) Gluteal injections (Gluteal abscess).

5) Metabolic disorders.

6) Genetic cause.

7) Improper postures.

8) Miscellaneous abnormalities.

SYMPTOMS OF SCIATICA:

In most of the cases, the onset is sub-acute and Sciatica is frequently preceded by

lumbar pain ‘lumbago’ which may have occurred intermittently for years.

A. Pain:

The Sciatic pain may immediately followed by an injury, such as a strain or fall or there

may be a latent interval of days or even weeks. After two or three days of pain in the lumbar

spine the pain radiates down to the back of one leg from the buttock to the ankle. It is often

possible to distinguish three elements in the pain.

1. Pain in the back, aching in character and intensified by spinal movements.

2. Pain deep in the buttocks and thigh, aching in character and also influenced by the posture

of the limb.

3. Pain radiates to the leg and feet and momentarily increased by coughing and sneezing. When

the first sacral root is compressed the pain radiates to the outer border of the foot. When the

pressure is upon the fifth lumbar root it spreads from the outer aspect of the leg to the inner

border of the foot. Generally the pain is intensified by stooping, sitting and walking. The patient

feels usually most comfortable lying in bed on the sound side with the affected leg slightly

flexed at the hip and knee. There is often a feeling of numbness, heaviness or deadness in the

leg, especially with the outer border of the foot.

37



B. Tenderness:

There will be a tenderness on pressure along the course of the Sciatic nerve i.e. the

sciatic notch, middle of the back of the thigh, popliteal space behind the head of the fibula and

external malleolus and in the sole of the foot.

C. Numbness and sensory impairment:

There is often a feeling of numbness, heaviness or deadness in the leg, especially along

the outer border of the foot. There is not much sensory loss, though there is often blunting of

light touch and pinprick over the outer half of the foot and the three toes and lower part of the

outer aspect of the leg when the first sacral root is involved.

D. Scoliosis:

Scoliosis is often associated with Sciatica, the lumbar spine being flexed towards the

affected side, less frequently towards the opposite side. Some rigidity of the lumbar spine is

usually present in L5 and also there may be a tender spot at the level of the fifth lumbar

transverse process (Roger and Bannister, 1984).

E. Tendon Reflexes:

Ankle jerk may be diminished or lost when the first sacral root is involved, while it is

preserved in case of fifth lumber root. If the fourth lumber root is involved, the knee jerk may

be diminished. The plantar reflex is flexor.

SIGNS IN SCIATICA:

I. SLR (Straight Leg Raising) Test:

The patient is asked to lie down in supine position completely now the raising of the

entire leg, with the knee joint fully extended, by holding the knee with one hand. Limitations

of raising is found in Sciatica, the degree of limitation being roughly proportional to the

severity of the pain. Restriction of SLR is usually much more seen in lesions affecting the nerve

roots than in purely skeletal affections. This test gives a useful indication of the severity of the

Sciatica and increased capacity for painless straight leg rising is a helpful objective measure of

improvement.

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II. Laseague’s Sign:

The knee and the hip joints are flexed to about 90° and then the leg is extended at the

knee joint with such extension, the patient will experiences pain in the thigh along the course

of the Sciatic nerve. At this stage one can passively dorsiflex the foot or even the great toe,

which is followed by further aggravation of pain.

III. Browstring Sign:

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

carries out SLR to the point at which the patient experiences some kind of discomfort in the

distribution of the Sciatic nerve. At this level the knee is allowed to flex, and the patient’s foot

is allowed to rest on the examiner’s shoulder. The test demands sudden firm pressure applied

to the popliteal nerve in the popliteal fossa.

IV. Sicard’s Sign:

The SLR test carried out with dorsiflexion of the big toe elicits severe pain.

V. Gower’s Sign:

Pain is aggravated due to passive dorsiflexion of the foot in the SLR test.

VI. Bragardis Sign:

The SLR test carried out with dorsiflexion of the foot causes greater pain.

VII. Naffziger’s Sign:

Pain is produced 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 diagnostic purpose of a disease.

DIAGNOSIS:

The diagnosis of the Sciatica is based on clinical diagnosis. It is made after a history

and physical examination before expensive testing such as MRI, C.T. Scan etc. When only a

patient fails to respond to conservative care and presents with severe neurological compromise.

Now investigation can be opted.

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INVESTIGATIONS :

A. Laboratory Investigations:

A complete blood count (C.B.C.), erythrocyte sedimentation rate (E.S.R. especially

helpful in screening for infection or myeloma). Measurement of serum protein, calcium

phosphate, uric acid, alkaline phosphate, acid phosphate (if one suspect metastasis, C.A.

prostate), tuberculin test, test for Rheumatoid arthritis factor, cerebrospinal fluid examination

(C.S.F. proteins raised in intraspinal neoplasm), serum protein electrophoresis (myeloma

proteins), agglutination test for brucella.

B. X-ray:

X-ray examination must be carried out in all the cases of Sciatica since many cases of

sciatic pain are associated with bony changes visible in radiographs.

C. C.T. Scan:

Computed tomography (CT) if combined with instillation of water soluble contrast

media provides excellent definition of a narrow canal, destructive lesions of vertebral bodies

and posterior elements or presence of paravertebral soft tissue mass. By appropriate

computerized reconstruction techniques can also identify disk herniation, sometimes with a

greater accuracy than the myelogram.

D. MRI:

In recent years MRI virtually replaces CT for the study of degenerative disc and its

relation to the adjacent roots and in definition of soft tissue alterations.

E. Myelogram:

Examination of the spinal canal with a contrast medium – myelogram may demonstrate

a filling defect and is only indicated if pain is persistent despite of adequate rest, immobilization

and surgical treatment is contemplated. Lumbar disc herniation and prolapse, lesions or

fissuring of annulus, protrusion of the lumbar posterior longitudinal ligaments, cyst on sacral

nerve roots, lumbar canal stenosis is often apparent on myelography. Epidurography can be

done for the diagnosis of intraspinal lesions not visualized by conventional myelography.

40



Injections of contrast medium directly into the intervertebral disc (discogram) is a procedure

but difficult to interpret and carries the risk of damage and infection.

F. Others:

Confirmation of proximal motor and sensory nerve root disease can be obtained by

nerve conduction studies, H & F response (H- reflexes of the tibialis posterior nerve and F-

reflexes of peroneous profunolus nerve) and electromyography (E.M.G.). Aortic arteriography,

intravenous pyelography and barium enema may be necessary to find out the aortic aneurism

or any pelvic or rectal pathology.

Differential Diagnosis of Conditions Causing Sciatica:

1. Disc Lesion:

Recurrent bouts of the lower back pain (lumbago) followed by unilateral Sciatica, or

pain first in the calf or thigh or both without any lumbar symptoms, Straight leg rising limited,

Neurological signs absent if small protrusion present, if large displacement compressing the

root severely pain occurs. A huge herniation may squeeze the root so hard that it becomes

anaesthetic from ischemia and the pain ceases; Straight leg raising becomes once again of full

range at the same time as cutaneous analgesia and loss of power and reflexes supervene.

2. Spondylolisthesis:

Signs of disc lesions can be seen together with lumbar deformity. When

spondylolisthesis causes intrinsic symptoms, there is backache after prolonged standing, or

bilateral Sciatica. X-ray taken with the patient standing postion is diagnostic.

3. Spondylosis:

There is often a history of chronic or intermittent spinal pain, recurrent sciatica with

osteoarthritis elsewhere in the spine. More than one root may be involved but objective

neurological signs were usually less prominent than in an acute disc prolapse. Spinal

radiographs shows variable disc space narrowing with osteophytic lipping and irregularity of

the facet joints. It is however important to remember the changes will be found in the majority

of aged spines so that the appearance can seen and may not account for symptoms.

41



4. Degenerative Disc Disease:

While disc degeneration is a natural phenomenon that occurs with aging process, in

some cases it can also lead to pain along the sciatic nerve. The condition is diagnosed when a

weakened disc results in excessive micro-motion at the corresponding vertebral level and

inflammatory proteins from inside the disc which can become exposed and irritate the

following area.

5. Piriformis Syndrome:

The patients of piriformis syndrome typically complaints of the sciatic pain, tenderness

in the buttock and more difficulty in sitting when compared to standing. Physical findings

include tenderness of buttock region, pain increases with adduction and negative S.L.R. test.

6. Secondary Deposit in Spine:

Gradually increasing central backache, tendency to radiate to lower limb soon to both.

Marked limitation of movements at lumber spine. SLR of full range though painful at the

extreme. Multiradicular sings in lower limbs, muscle weakness bilateral, unequal and marked.

7. Multiple Myeloma:

The complaints of the patient may he nonspecific but there may be a general lack of

well-being of the patient. Abnormalities on serum protein electrophoresis studied and presence

of Bence Jones proteinuria usually clinch the diagnosis. If the typical picture of multiple

‘punched out’ lesions is absent in radiographs, sternal puncture to obtain bonemarrow for

histology may be necessary in some cases.

8. Osteoarthritis:

Patient often complains of pain centered in the spine that is increased by motion and is

almost invariably associated with stiffness and limitation of motion. There is notable absence

of systemic symptoms such as fatigue, malaise and fever and the pain usually can be relieved

by taking rest. The severity of the symptoms often relates to the radiological findings. Pain

may be present when there are minimal findings on an X-ray and conversely, marked

osteophytic overgrowth with spur formation, ridging and bridging of vertebrae can be seen in

42



asymptomatic patients in middle and lateral life. In arthritis of hip joint, hip movements are

restricted and pain provoked by passive movements. Radiograph of pelvis is diagnostic.

9. Benign Spinal Tumour:

Progressive symptoms increases in neurological signs and are more severe and

progressive than disc lesion. The diagnosis should be done by C.S.F. examination.

PROGNOSIS :

In mild cases of Sciatica the stage of severe pain lasts for 2 to 3 weeks and the patient

recovers in a month or two, except that he may experience time to time aching in the course of

the leg and stooping may still excite some pain. In more severe cases there may be slight

improvement after several weeks, but the condition then becomes stationary and the patient

continues to suffer from considerable pain for a few months. Relapses are common. In some

cases they occur at frequent intervals, in others the second attack may be delayed until 10 or

more years after the first. Operation gives good results in 90 percent of cases operated upon,

but even after an operation a relapse may occur.

MANAGEMENT OF SCIATICA :

Type of treatment in any disease differs according to the onset, severity, duration and

most important is the causative factor of the disease, the minor disc prolapse is usually self-

limited, responding to simple conservative measures.

A) Conservative treatment:

Conservative treatment can be classified as below:

I. Rest:

The first essential of conservative management is rest in bed and avoidance of

movement which would prevent the recession of the disc in its corresponding space. The patient

is required to lie down on a hard mattress. Bony has suggested the extension of the spinal

column with exertion of a pull on the pelvis. A special apparatus has been advised and used in

some countries for this purpose. A plaster jacket has also been suggested by some.

43



II. Medications:

NSAIDs (Non-steroidal anti- inflammatory drugs), and other analgesics like

Paracetamol or Narcotics may be required for relief from severe pain. Muscle Relaxants or

Anti-depressants may also be useful in this cases

III. Immobilization and traction:

When rest in bed for two to three weeks failed, immediate relief is obtained by plaster

jacket which fixes the lumbar spine in slight extension. The patient who is allowed to walk

should wear this for three months or for longer period.

IV. Occupational Therapy and Physiotherapy:

The occupational therapist and physiotherapist both play an important educative role

advising on issues such as seating, desk/table height and sleeping on a firm mattress as

appropriate. Physiotherapist will teach the patient with low back pain, back protection

measures e.g. the correct way in which to lift weights and a range of exercise to strengthen the

supporting musculature of the back. There are a variety of other treatment modalities used by

physiotherapists e.g. heat or cold packs etc are also advised.

V. Epidural or para-radicular injections:

A Long-acting steroids with a Local anaesthetic is injected into the epidural space in

vicinity of the irritated nerve root. Its effect which lasts for about three weeks and is

recommended for sub-acute and chronic cases. It reduces the dependence on narcotics in

chronic cases.

VI. Transcutaneous electrical nerve stimulation (TENS) unit:

TENS unit is attached to the patient’s right belt line; it will stimulate electrode pads on

the patient’s low back and right thigh. Theoretically it closes gates in the CNS. By

transcutaneously sending an electrical impulses into the peripheral nerve, the large (fast

conducting) myelinated A-alpha nerve fibers are stimulated such that the smaller unmyelinated

C-fibers are blocked at the gate from transmitting their nociceptor impulses.

44



VII. Exercise:

Once the phase of acute pain has passed, gradual exercises are of considerable value in

improving the mobility of the affected portion of the spine and power in weakened muscles. In

the initial stages, exercises are limited to the stretching exercises which relieve muscle spasm

and improve spine mobility without subjecting the spine to excessive strain. Later, muscle-

strengthening exercises are introduced in gradual steps as tolerated by the patient. Strong

abdominal, back, pelvic and lower extremity muscles are important to maintain the spine in the

least stressful physiological position while sitting, standing, walking, and various other

activities and thus prevent any further degeneration of the discs.

B) SURGERY:

Successful surgical outcome depends 90% on proper patient selection and 10% on

surgical technique. Therefore, before considering surgical intervention, MRI, CT scan,

Myelogram or other useful investigations are must to localize the lesion.

I. The cauda equina syndrome (bladder and bowel involvement):

The acute massive disc herniation that causes bladder and bowel paralysis is usually a

sequestered disc that requires immediate surgical excision for the best prognosis.

II. Increasing neurological deficit:

In the face of progressing weakness, it is wised to intervene early with surgical excision

of the disc rupture.

Different Operative Techniques

a. Laminectomy and disc excision:

Earlier surgery was one of the choice but now it is no longer resorted to as it makes the

spine unstable.

b. Hemilaminectomy:

Here part of the lamina is removed. It is considered by many as extended fenestration

approach. If fenestration technique is properly done hemilaminectomy is not at all necessary.

45



c. Microscopic Lumbar Discetomy:

Using an operating microscope the disc can be excised through a very small incision

(<3.5 cm) with minimum damage to the structures and minimum blood loss. It is one of the

technically demanding procedure and gives excellent results if done in properly indicated cases

like a single level posterio-lateral disc prolapse. The patient can be discharged to home within

2 days and he/she can return back to his/her normal day today work faster. In short it can be

described as a less invasive, less painful more specific procedure giving maximum comfort to

the patient.

Chemonucleolysis:

Chemonucleolysis is the one line of treatment in disc herniation by a lysing agent.

Chymopapain enjoyed a decade of popularity, but the painful spasm that can accompany

injection and the complications of the occasional anaphylactic shock, cerebral haemorrhage

and paraplegia have directed many of its original advocates towards small doses and other

percutaneous techniques.

PREVENTIVE MEASURES:

Once the pain of Sciatica has passed, it can be prevented from reoccurring by exercise,

stretches and other measures.A complete personalized program can be developed by physical

therapist. Here are some of the steps that individual can take in the meantime.

Loss of weight where indicated.

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

back region.

Practice good posture.

Practice abdominal crunches.

Avoid sitting or standing for extended period of time.

Use proper sleeping posture.

Lift object safely – Always lift from a squatting position, using hips and legs to do the

heavy work.

Stretch – Sit in a chair and bend down towards the floor.Hold it for a 30 seconds then

release,or stop when he start to feels slight discomfort. Repeat it for 6 – 8 times.

High heels should be avoided.

46



SIRAVYADHA

Shodana is one of the procedures which takes out the doshas from the nearest

route of its vitiation is considered as best. Raktamokshana is the only shodhana procedure

where the vitiated doshas are taken out from the Shakhas by creating artificial route.

Acharya Susruta has mentioned that Siravydha karma is the half of Shalyatantra

Chikitsa like Bastikarma in the Kayachikitsa1. Rakta takes important role in spreading the

diseases by carrying the vikruta doshas. Raktamokshana by Siravyadha is considered to be

supreme as it drains out the vitiated Rakta and cures the disease.

ORIGIN OF SIRA2

The Siras present in the Human body are connected to the Nabhi and from there, these spread

to all places and nourish the body. Prana resides in the Siras of the Nabhi and Nabhi is the seat

of the Siras and Nabhi is surrounded by Siras similar to the axle hole being surrounded by

spokes.

NUMBER AND DISTRIBUTION OF SIRAS

Siras are 700 in number3 by these the entire body is nourished constantly, kept moistened to

perform actions such as flexion, extension etc, similar to a large field being nourished by small

channels of water.

Among these Mula Sra4 are forty in number

Vatavaha - 10 in number

Pittavaha - 10 in number

Kaphavaha - 10 in number

Raktavaha - 10 in number

The ten Vata carrying Sira on reaching the seat of vata, divide themselves into 175

similarly Pitta, Kapha and Rakta carrying Sira divide into the same number. Thus all these

together make up Seven Hundred.

Vata carrying Sira are 25 in one leg, same in other leg and also in the two arms.

47



Table no 10: Showing Shakhagatha Siras5.

Vatavaha Sira’s 25x4 100

Pittavaha Sira’s 25X4 100

Kaphavaha Sira’s 25X4 100

Raktavaha Sira’s 25X4 100

Total 400

In the Kostha especially there are 34 out of these 8 are in Pelvis residing in the Anus and Penis

4 each, 2 in each Flanks, 6 in the Back the same number in the Abdomen 10 in Chest.

Table no 11: Showing Koshtagata Siras.

Guda, Sisna, Sroni 08

Parswa 04

Prustha 06

Udara 06

Vaksha 10

Total 34

There are 41 in parts above the Shoulder, out of these 14 are in the Neck, 4 in the Ears 2 each,

9 in the Tongue, 6 in the Nose and 8 in the Eyes 4 each.

Table no 12: Showing Urdhvajatrugata Siras.

Karnagata 04

Jihvagata 09

Netragata 08

Nasagata 06

Greevagata 14

Total 41

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In this way 175 Vata carrying Siras are described. Similarly the classification of remaining

Siras is done. In case of Pittavaha Sira especially 10 are in the Eyes 5 each and 2 in Ears 1

each, similarly Siras of Kaphavaha and Raktavaha are distributed.

Functions of Sira6

Vata moving in its own Sira bestows non –hindrance of all activities, non-delusion in the

functions of the mind and many other activities. When the aggravated Vata reaches in its own

Sira then many diseases produced by Vata develop in the body.

Pitta moving in its own Sira does the function such as taste perception, brightness of skin

colour, keenness of digestive fire, absence of disease and even many other activities. When

aggravated Pitta accumulates in its own Sira and then many diseases of Pitta origin develop

in the body.

Kapha moving in its own Sira does lubrication of the body, augmenting strength of the body,

stability of the joints, and such other activities. When aggravated, Kapha accumulates in its

own Sira and then many diseases of Kapha origin develop in the body.

Rakta moving in its own Sira performs functions such as bestowing of colour, supplying

nutrition to the tissues, tactile sensation and many other also. When aggravated Rakta

accumulates in their own Sira then many diseased caused by blood develop in the body.

Sira do not carry either Vata, Pitta, Kapha alone, hence all Siras are said to carry all the

doshas. Aggravated doshas mix with one another and circulating in the Sira are sure to over

run their usual seats since these carry all the doshas. Vatavaha sira are light red in colour and

filled with Vata, Pittavaha sira are warm and blue in colour, Kaphavaha Sira are cold, white

and stable, Raktavaha Sira are red in colour and neither very hot nor very cold.

Avedhya Sira7

Avedhya Siras are those Siras which should not be punctured. Puncturing of these siras may

cause deformity or even death. There are 400 Siras present in the Shakhas, 136 Siras in Koshta

and 164 Siras in the parts Urdhvajatrugata. Among these 16 in the extremities, 32 in the trunk

and 50 above shoulder are to be considered as not suitable for puncturing.

49



RAKTAMOKSHANA

Letting out the impure blood from the body is known as Raktamokshana. It is one among the

Panchakarmas. A number of incurable diseases can be cured by this treatment method. It is a

unique para-surgical measure indicated in various diseases where gross vitiation of Rakta is

present. Susrutha Acharya describes about Physiology, Pathological role of Rakta and its

importance in surgical and para-surgical procedures. It is carried out either by using sharp

surgical instruments or by para-surgical measures.

TYPES OF RAKTAMOKSHANA

Raktamokshana is mainly divided into two types

1) Sashastra Visravana - Bloodletting with using cutting instruments.

2) Ashastra Visravana – Bloodletting without using any cutting instruments.

Raktamokshana using Shastra is again sub divided into two types8

1) Pracchana - Bloodletting through multiple incision in any localized area.

2) Siravyadha – It is the procedure of puncturing the vein.

Raktamokshana using Ashastras are divided into four types

1) Jaloukavacharna - Application of Leeches.

2) Sringavacharna - Application of Cow’s horn.

3) Alabu avacharna - Application of Gourd.

4) Gati Yantravacharna - Application of Gati Yantra.

Table no 13: Sites of Siravyadha in different diseases9

DISEASE NAME VEDHYA SIRA STHANA

Padadaha, Padaharsa ,

Avabhakuka,

Chippa, Visarpa, Vatarakta.

In leg 2 angula above the Kshipra Marma.

Vicharchika, Padadari,

Vatakantaka.

In leg 2 angula above the Kshipra Marma.

Kroshtukashirsha, Khanja, Pangu. In leg 4 angula above the Gulpha Sandhi.

Gridhrasi , Vishvachi, 4 angula above or below the Janu Sandhi.

Apaci. 2 angula above Indrabasti Marma in legs.

Galaganda. Sira found at Urumoola.

Pliha roga. Sira at Kurpara sandhi or the sira present

between

Little and index finger of left upper limb.

50



Yakrit roga, Kasa, Swasa. Sira at Kurpara sandhi or the sira present

between

Little and index finger of right upper limb.

Pravaahika, Udarasula. 2 angula near Sroni.

Parikartika, Upadamsa,

Suka dosha.

Medhra shitha sira.

Mutra vriddhi. Vein on posterior side of vrishana.

Jalodara. 4 angula laterally and below umbilicus.

Antra Vidradhi, Parshva shula. Vein lies between parshva, kaksha and Sthana.

Bahu shosha, Avabhakuka. Sira lies between 2 amsha.

Tritheeyaka Jwara. At the middle of trik sandhi.

Chaturthaka Jwara. Below amsa sandhi, on any lateral side.

Apasmara. At the middle of hanu sandhi.

Unmada. Between sankha and keshanta pradesha, lalata

region or apanga sira.

Jihva roga, Danta roga. Lower surface of tongue.

Talu roga. Talu sthitha sira.

Indication of Siravyadha:

- Visarpa - Vidradhi - Pliha - Gulma

- Agnisaadana - Jwara - Mukha Roga - Netra Roga

- Siro Roga - Mada - Trishna - Lavanasyata

- Kushta - Vatarakta - Raktapitta - Bhrama

- Katu and Amlodgara

51



Contraindication of Siravyadha10:

- Bala - Sthavira - Ruksha - Kshatkshina

- Bhiru - Parisranta - Madyapa -Adhvastrikarshita

- Vamita - Virikta - Aasthapita - Jagarita

- Anuvasita - Kliba - Krishna - Garbhini

- Kasa - Swasa - Pravruddha -Jwaravastha

Vyadhana Pramana11

In muscular area, puncturing should be of the size of the Yava, in other areas it shall

be half Yava or one Vrihi using a Vrihimukha Shastra. Veins on the bones should be

punctured to the size of half Yava, using a Kutharika.

Vyadhana Kala12

During Varsha puncturing should be done on days which are not cloudy, during

Grishma at time which is cool, during Hemant at midday.

Srava Pramana13

One Prastha of blood allowed to flow after venous puncture is considered as Utamma

matra by experties, in persons who are strong, who have great accumulation of doshas

and who are of suitable age,

Vyadhana vidhi14

Purva Karma

- The patient is made to undergo Snehapana either with Gritha or Taila.

- After Snehana Swedana is administered. As pitta is dominant in Raktaja disorder

Mrudu Swedana is given. It is said that doshas are diluted by the process of Snehana

and Swedana by this process they pass in to the siras.

- Patient should be advised to take Yavagu mixed with Snigdha dravyas as a drink.

- Informed consent should be taken.

- Paint the portion with spirit where Siravyadha has to be carried out.

Pradhana Karma

- The affected leg of patient is seen then it should be kept in an even place before it is

venepunctured and other leg should be slightly flexed and raised.

- Now the leg to be venepunctured should be bandaged with cloth below the knee

joint, the ankle should be pressed with hands and applying cloth four fingers above

the point the vein of leg should be punctured according to the Vyadhana pramana.

- Blood should be allowed to flow according to the Srava Pramana.

52



Paschat Karma

- After automatic cessation of bleeding tight bandage should be removed.

- The area should be bandaged properly.

- Pathya-Apathya: By the depletion of tissue due to bleeding the Agni becomes weak

and Vata becomes aggravated hence patient should be treated with food which are

not very cold, which promote blood formation and either slightly sour or devoid of

sour15.

Samayak Viddha Lakshana16

When proper instrumentation has been done blood flows out in a stream, for a period of

one Muhurtha and then stops on its own this should be understood as proper puncturing.

Just as yellow liquid flows out first from flowers of Kusumbha similarly vitiated flows out

first when veins are punctured.

Asrava Dosha17

If the vitiated blood is not let out in sufficient quantity it gives rise to swelling, burning

sensation, redness, ulceration and pain.

Atisrava Dosha18

Siravyadha if done during the time of summer, if sudation has been done in excess, if

the cutting is very much and if done by the unskilled then the blood flows out in great

quantity such excess flow produces Headache, Blindness, Loss of tissue, Burning

sensation, Hemiplegia, Monoplegia, Hiccup, Dyspnoea, Cough, Anaemia, and Death.

Srava Pravarthana19

If the blood does not flow out properly then Ela, Sitasiva, Kustha, Tagara, Patha,

Bhadradaru, Vidanga, Citraka, Trikatu, Agaradhuma, Haridra, Arkankura, Naktamaala

phala these drugs should be powered mixed with more quantity of salt and soil should

be rubbed on the mouth of the wound by this the blood flows out properly.

Atisraava Nirodha20

Powder of Lodhra, Madhuka, Priyangu, Patanga, Gairika, Sarjarasa, Rasanjana,

Salmali, Puspha, Sankha, Sukti, Masa, Yava and Godhuma sprinkled and pressed into

the wound with the tip of fingers or powder of bark of Shala, Sarja, Arjuna, Arimeda,

Meshasringi, Dhava and Dhanvana or Ash of Ksauma, powder of Samuraphena and

Laksha may be sprinkled then a bandage may be tied tightly using any bandaging

materials.

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The patient should be covered with moist cloth, put in cold room, treated with

application of poultices and pouring liquids both in cold condition.

Dusta Vyadha21-

Improper puncturing are twenty they are

Durviddha Atividdha Kunchita Piccita

Kuttita Aprasrta Atyudirna Anteviddha

Parisuska Kunita Vepita Anuthitaviddha

Satrahata Triyakviddha Aviddha Avyadhya

Vidruta Dhenuka Punahpunarviddha

Sira-Snayu-Asthi-Sandhi-Marma Viddha.

Raktasrava Nirodha Karma22

Methods of preventing bleeding are four

- Sandhana: Joining the edges of the wound.

- Skandhana: Promoting clotting.

- Pachana: Cooking.

- Dahana: Burning/ Cauterisation.

54



AGNIKARMA

AGNI

Vyuttpatti-

The word Agni is a masculine gender the word Agni has been derived from the dhatu “Agigatou”

in short the Agni denotes its upward going nature and universal presence.

Niruktti: The word Agni is having two kind of niruktties depending upon its Swarupa

and Swabhava.

According to Swarupa which spreads to various parts or organs, is called Agni.

According to Swabhava which moves in upward direction, is called Agni.

We can club this statements and define it as which spreads by moving upward is called Agni.

KARMA

Vyutpatti- The karma is derived from the dhatu ‘Du Kriya Kri Karne’ and formed as ‘Karma’.

Nirukti- Which acts that is called as Karma.

Through which the action takes place is called Karma.

AGNIKARMA

The two words Agni and Karma collectively forms a unique term or procedure i.e Agnikarma

which means “the action / karma takes place by upward spreading nature of Agni”.

Synonyms- Paryayvachi Shabdas of Agnikarma

Agnichikitsa Agnidagdha Agninotra Agnikarma

Agnikarya Dagdhakarma Dahakarma Dahankarma

Jwalankarma Paachankarma Tapanakarma Vahnidagdha

55



Types-

Dalhana, the commentator of ‘Shushrut Samhita’, has given the following description regarding

the Agnikarma-

1. “Agni krita karma”-The karma / action done / carried out by Agni.

2. ‘Agni’ Sambandhi Karma’- the Karma or action related to Agni.

In the first concept i.e“Agni krita karma”- The Agni is used directly i.e-Direct manner of

application of Agni.

In the second concept i.e ‘Agni’ Sambandhi Karma’, the Agni related things / media are used i.e

indirect manner of application of ‘Agni’. So the identical character in both the statements is the

presence of Agni, whether it is used directly or indirectly through media.

Effects-

Hence we can assess the effect of Agni karma as follows-

1. Sthanik Karma- Local action.

2. Saarvadaihik Karma- Action takes place all over the body.

3. Vishista Karma- Special kind of actions.

AGNIKARMA vs. TAU-DAM

Tau-dam is a basically traditional Himalayan therapy, practiced by the rural Himalayan people

for the disease like Liver troubles, Stomach troubles, Backache etc. This therapy was also

practiced by the ancient people and is mentioned in Ayurveda as Agnikarma.

Tau therapy is generally practiced by the older people of village and is compulsory for 6 month

to 1-year old children. The Tau is made up of a 45-60 cm long iron rod is called the Tau, which

is sharply curved at one end and has one or two holes depending upon the nature of diseases. In

this therapy, Tau device is placed directly on burning fire till it becomes red-hot and older people

of that area touches this red-hot Tau on the affected skin site of the patient for only a fraction of

a second and after burning it, the massage of the affected area with the mustard or olive oil is

done.

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In the Dam technique, fresh seeds of Terminalia chebula or Anaphalis araneosa are heated on

fire upto red hot and touched on the affected part of the body for only fraction of a second. After

this, like Tau, the affected area is massaged with the mustard or olive oil.

DAHANUPKARANA1

Dahanupakarana are the instruments to produce therapeutic burns during Agnikarma Chikitsa.

They are classified as follows according to

Table no 14: Dahanupakarana according various Acharyas.

Dahanupakarana Su. Ch. A.S. A.H.

Pippali + - + -

Aja shakrit + - + -

Godanta + - + +

Shara + + + +

Shalaka + - + -

Jambavastha + - + +

Dhatu + - - -

Madhu + + + +

Madhuchista + + + -

Guda + - + +

Vasa + - + +

Ghrita + + + +

Tailam + + + +

Yastimadhu - - + -

57



Suchi - - + -

Varti - - - +

Suryakanta - - + -

Above-mentioned Dahanupakaranas are distributed in three groups.

1st group is useful in Agnikarma Chikitsa of Twak Dhatu.

• Pippali.

• Godanta.

• Shara.

• Ajashakrita.

• Shalaka.

2nd group is useful in Agnikarma Chikitsa of Mamsa Dhatu.

-Jambaustha.

- Other Loha.

3rd group is useful in Agnikarma Chikitsa of Sira, Snayu, Sandhi, Asthi Dhatu.

- Madhu.

- Guda.

- Sneha.

DAHANA VISHESHA2:

Dahana Vishesha is the mark of figure produced on the skin after Agnikarma Chikitsa like-

1) Valaya (Circle).

2) Bindu (Dot).

3) Vilekha (Parallel line).

4) Pratisarana (Rubbed area).

58



Above mentioned four types of marks are suggested by Sushruta in the context of

Agnikarma Vidhi Adhyaya. On the other hand, Vagbhatta mentioned three more

Dahana Vishesha with addition of Sushruta Dahana Vishesha i.e.-

1) Ardhchandra (Semi Lunar).

2) Swastika (Four Tailed Mark).

3) Ashtapada (Eigh Tailed Mark).

CLASSIFICATION OF AGNIKARMA

Agnikarma is classified as follows:

1) According to Dravya

A. Snigdha Agnikarma: Madhu, Ghrita, Taila etc. are used for Sira, Snayu, Sandhi, Asthi type

of Agnikarma.

B. Ruksha Agnikarma: Pippali, Shalaka, Godanta are used for Twak and Mamsa dagdha.

2) According to Site

a. Sthanika: Kadara, Arsha, Vicharchika.

b. Sthanantariya: Apachi, Gridhrasi.

3) According to Aakriti

As described earlier in Dahana Vishesha.

4) According to Dhatu Dagdha

-Twak Dagdha.

-Mamsa Dagdha.

-Sira-Snayu Dagdha.

-Asthi Dagdha.

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DAGDHA BHEDA3

According to Sushruta, all Dagdha are included under four types of Dagdha Vrana.

1) Plushtha Dagdha: Plushtha is that in which a pigmented area of the skin has affected with

severe burning pain sensation.

2) Dur Dagdha: In which Sphota appear which accompanied with severe pain of sucking and

burning in nature along with redness and Paka which are subsided after a long time.

3) Samyaka Dagdha: Acharya Sushruta mentioned Samanya Lakshana produced in any type

of Dhatu and special symptoms are only related to the Dhatu concerned.

Samanya Lakshana of Samyaka Dagdha Vrana4:

- Ana-awagadha Vranata (Wound which is not deep).

- Talphala Varnata (Fruit of Tala tree-blue-black in colour).

- Susamshita Vrana (Without elevation or depression).

Special Symptoms of Samyaka Dagdha Vrana Related to Skin5.

- Shabdapradurbhao (Production of sound).

- Durgandhata (Bad odour).

- Twak Sankocha (Contraction of the skin).

Special symptoms of Samyaka Dagdha Vrana Related to Mamsa Dhatu.

- Kapotvarnata (Colour like that of pigeon i.e. ashy, dark grey).

- Alpa Swayathu (Mild swelling).

- Alpa Vedana (Less pain).

- Shuska Sankuchit Vranata (Dry, Contracted wound).

Special symptoms and signs of Samyaka Dagdha Vrana Related to Sira, Snayu.

-Krishna Vranata (Black coloration).

- Unnata Vranata (Elevated).

- Srava – Sannirodha (Stoppage of discharge).

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Special symptoms and signs of Samyaka Dagdha Vrana Related to Sandhi, Asthi.

-Rukshata (Dryness).

-Arunata (Dark red coloration).

-Karkashata (Roughness).

-Sthirata (Stability).

4) Ati Dagdha 6:

- Mamsa-avalambana (Hanging of burnt tissue).

- Gatra-vishlesha (Parts become loose and useless).

- Destruction of Sira, Snayu, Sandhi (Tendons in joints).

- Jwara (Fever).

- Daha (Burning).

- Pipasa (Thirst).

- Murchha (Unconsciousness).

AGNI KARMA KALA7:

Agnikarma can be done in all seasons, except Sharad and Grishma because, in Sharad there is

a Prakopa of Pitta and Agnikarma also aggravates Pitta which may lead to be Pitta Prakopa

Avastha, due to this reason Agnikarma is contraindicated in Sharad and Grishma Ritu. Even in

these seasons it can be done in diseases of emergency condition, after adopting proper counter

methods.

Dalhana has advised to cover the body or the site of Agnikarma with moist cloth, uses of cold

foods and drinks, applying pastes which have cooling effect etc. as counter methods to pacify

the effect of burning.

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AGNIKARMA

A Procedure:

It should be done under following manner.

- Purva Karma:

- Indication of Agnikarma8:

-Shiroroga –Pakshmakopa -Shlista Vartma

-Visavartma -Alaji -Arbuda

-Puyalasa -Abhisyanda -Adhimantha

-Lagana -Medoj -Ostharoga --

Danta Nadi -Krimidanta -Adhidanta -

Shitadanta - Dantavriddhi -Jalarbuda

-Arsha -Bhagandara -Chipa

-Kadara -Valmika - Jatumani

-Mashaka -Tilakalaka -Charmakila

-Prasupti -VisaChikitsa -Sarpadansha

-Gridhrasi -Vatajashula -Vishwachi

-Galaganda -GandAmala -Apachi

-Granthi -Antravriddhi -Shlipada

-Nadivrana -Upadansha -Gulm

-Visuchika -Alsaka -Vilambika

-Sanyasa -Unmada -Yakruta & Pleehodara

-Shonita Atipravritti -Sira Sandhi Chheda -Visarpa, Shotha.

Contraindications of Agnikarma9:

-Pitta Prakriti. - Bhinna Kostha. - Daurbalya.

-Vriddha. -Antah Shonita. -Anuddhrata Shalya.

-Baal. -Bhiru. -Multiple Vrana.

-Balaka.

62



The person contraindicated for Swedana (sudation) therapy is also contraindicated for

Agnikarma.

Swedana is contraindicated for the person and suffering from10:

-Pandu, -Atisara -Kshaya - Guda Bhramsha

-Udara Roga -Nasa Sangya -Chhardi - Shochita,

-Oja Kshaya -Vidagdha - Rakta Pitta -Sthula Ajirna

-Kruddha -Trishna -Daurbalya -Kshuda,

-Visha -Pidita -Kshata -Timira.

According to Charaka, Agnikarma should not be done in the Vrana of Snayu, Marma, Netra,

Kustha and Vrana with Visha and Shalya11.

Agropaharaniyani

-The Agnikarma room should be well prepared with all required Agropaharaniyani

described by Acharya Sushruta12.

- Prepare Triphala Kashaya for Prakshalana of the local part of patient.

- Yashtimadhu Churna, small pieces of Kumari Patra, swab holding forceps, Plota, Pichu, and

gas stove, Shalakas etc. are kept ready for use.

-The Shalaka is heated upto becomes red hot on fire.

Pre-operative assessment.

-Agnikarma is contraindicated in the people who have Pitta predominant Prakriti.

- There is involvement of Snayu, Kandara, Asthi or Sandhi, hence radiological investigations,

M.R.I., C.T. Scan etc are done to find out the pathology as per requirement.

- Patient is advised to take Pichchhila and Snigdha light diet before treatment.

Take informed consent

-It is advisable to take written informed consent of the patient before going to Agnikarma as it

gives information regarding the procedure to the patient and relatives. It is also useful in

medico-legal cases in favour of the physician.

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Pradhana Karma:

Aasana for Agnikarma: In Gridhrasi, Prone position is best to do Agnikarma as it is good

and comfortable to the patient.

Consideration of the site for Agnikarma:

Agnikarma for Gridhrasi at Antara-Kandara-Gulpha Pradesh as mentioned by Acharya

Charaka13.

Painting & Drapping:

- The patient is asked to lie down on the table in prone position. Then the diseased area is

exposed and painted with Triphala Kashaya.

- Drap the local part of the patient with sterilized cut sheets.

-To make Samyaka Dagdha Vrana: After carefully considering the symptoms of the disease,

vitals and the strength of the patient as well as disease and seasons, physician should

undertake the patient for Agnikarma.

- The Samyak Dagdha Vrana should be produced by red hot Shalaka on the diseased skin of

the patient. The number of the Samyak Dagdha Vrana should be made according to the

extent of the diseased area.

- Apply immediate cooling agents: After making Samyak Dagdha Vrana apply cooling agent

immediately to subside burning pain. Here, we used small pieces of Kumari Patra after

crushing with swab holding forceps.

- Dusting and Bandaging:

- Here we have used Yashtimadhu Churna for dusting and Samyak Dagdha Vrana were covered

with Plota and proper Patta Bandhana was applied.

- Inspection of defective Agnikarma and management:

1) Plushtha Dagdha: If the Shalaka is not properly heated then it will produce this type of

Dagdha.

MANAGMENT

- For Plushtha Dagdha, warming of the body and administration of drugs / medicines of hot

properties should be given; when the temperature of the body increases, blood liquefies;Due to

its cold potency water makes the blood thick and coagulate, so that, only heat gives comfort.

64



- Warming the body again which has been burnt by fire is advocated with the intention of

maintaining the fluidity of blood and its normal circulation. This would ensure quick relief of

symptoms. On the other hand application of cold water, making the blood thick and makes

difficult to circulate – is the opinion of Dalhana.

2) Durdagdha: Durdagdha can occur when the physicians are unskilled and hand of patient is

shaking his body parts due to fear of burn.

MANAGEMENT

- In Durdagdha the physician should resort to both warm and cold therapies, application of

Ghee, poultices and bathing the body should be done in cold state only.

3) Ati-Dagdha: This complication is produced due to more heat which is transferred from the

red hot Shalaka to the diseased part.

MANAGEMENT

-In Ati Dagdha the torn muscles should be removed followed by cold therapies, then the

physician should apply the paste of rice, bark of Tinduki mixed with ghee or cover the wound

with leaves of Guduchi or aquatic plant (like lotus etc.). All the treatments which are similar to

that of Visarpa of Pitta origin should be done.

- Madhuchhisthadi Ghrita contains Madhuchhistha, Madhuka, Lodhra, Sarjarasa,

Manjishtha, Chandana and Murva, these should be macerated together and then cooked with

Ghee, is considered to be best for healing of wound in all kinds of burns.

4) Daha: More or less burning pain is experienced by each and every patient who uses to take

Agnikarma Chikitsa.

- This may be treated by Ghrutakumari Patra Swarasa.

5) Dushtha Vranata: After Agnikarma, it should be observed for any complications. If there is

any sign of Sepsis, treat the patient accordingly.

Pashchat Karma:

- Pathya Apathya & Follow Up: In Agnikarma procedure, we make Samyak Dagdha

Vrana. It is necessary that it should be healed without any complications. So all the

Pathya-Apathyas which have been described by Acharya Sushruta are advised here. It

is utmost advisable to the patient that “Do not allow water to touch the Samyak Dagdha

Vrana site for one Ahoratra (24 hours)”. Observe the complete Ropana of the Vrana.

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Agnikarma Shreshthata:

Agni is better than alkali in action of burning it is said so because disease treated by burning

will not recur again and also because, those diseases which are incurable by the use of

medicines, sharp instruments and alkalis may be cured by Agnikarma.

Dalhana has mentioned Agnitapta Shastras that prevent sepsis in surgical procedure.

Agnikarma is also useful after Shastra Karma to avoid reccurence for eg. Kadara Sastrakarma.

“Agnitaptena sastrena chindyat, Anytha

Atapta sastra chedena paka bhaya syat”14.

Due to these properties Agnikarma is accepted as superior than other procedures.

AGNIKARMA Vs ELECTROSURGERY or DIATHERMY

In Modern medicine, there is no use of therapeutical burn i.e. Samyak Dagdha Chikitsa. But

on the other form, uses of Agnikarma as for coagulation and tissue destruction are being used.

Cauterization15

Cauterization is a medical term describing the burning of the body to remove or close a part of

it.Electrocautery and chemical cautery are the main forms of cauterization used today.

Accidental burns can be considered cauterization as well. Cautery can also mean the branding

of a human, either recreational or forced.

History

Hot cautery were applied to tissues or arteries to stop them from bleeding.To stop heavy

bleeding, especially during amputations Cauterization was used. This is a simple procedure: A

piece of metal is heated over fire and applied over the wound causing tissues and blood to heat

rapidly to extreme temperatures and in turn causing coagulation of the blood. This stops

bleeding, at the cost of extensive tissue damage.

Cautery is described in the Hippocratic Corpus. The cautery was used for almost every possible

purpose in ancient times: as a ‘counter-irritant’, as a means of destroying tumours, as a

bloodless knife, as a haemostatic etc. Later special medical instruments called Cautery were

used to cauterize arteries. These were first mentioned by Abu al-Qasim al-Zahrawi (Abulcasis)

in his Kitab al-Tasrif. Abu al-Qasim al-Zahrawi also introduced the technique of ligature of the

arteries as an alternative to cauterization. This method was later improved and used more

effectively by Ambroise Paré.

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Electrocautery

Electro cauterization is the process of destroying tissue using metal probe heated by electric

current (much like a soldering iron). This procedure is used to stop bleeding from small

vessels (larger vessels being ligated) or for cutting through soft tissue. Unlike electrocautery,

Electro surgery is based on generation of heat inside tissue, using electric current passing

through the tissue itself. Electro cauterization is preferable to chemical cauterization because

chemicals can leach into neighbouring flesh and cauterize outside of the intended boundaries.

Use of this electric cautery to cut the tissue or to coagulate the bleeding points, so this

application of electro cautery is ideal for removing Small Skin Tags, Papiloma and also to

control the bleeding during surgical procedures.

Chemical cautery

Many chemical reactions can destroy tissue and some are used routinely in medicine, most

commonly for the removal of small skin lesions (i.e. warts or necrotized tissue) or for

Haemostasis. The disadvantages are that chemicals can leach into areas where cauterization

was not intended. For this reason, laser and electrical methods are preferable, where practical.

Some cauterizing agents are mentioned as below-

• Silver nitrate: Active ingredient of the lunar caustic, a stick that traditionally looks like a

large match-stick. It is dipped into lunar caustic solution and pressed onto the lesion to be

cauterized for a few moments.

• Trichloroacetic Acid.

• Cantharidin: An extract of the blister beetle that causes epidermal necrosis and blistering

used to treat warts.

Diathermy:

The basic principle is to deliver high frequency current to the human body by means of active

electrode and this after passing through the tissue to be diathermized returns via a return

electrode. The intense heat produced by the passage of current destroys it in different ways

depending on the type of current used. Cutting current is undamped and produce cutting effect

secondary to intense heat generation within the tissue. It is haemostatic also and no bleeding

can occur. Coagulating current is highly damped and coagulates by tissue dehydration and its

effect is mainly haemostatic. Blended current is a combination of two types of waves

introducing both cutting and coagulating effects. Most new surgical units deliver low voltage

cutting or blended current from a solid state generating unit through an isolated bipolar system

which is considered the safest.

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BASTIKARMA

Ayurvedic approach to the treatment of disease comprises of mainly two procedures

1) Shodhana.

2) Shamana.

In classics it has been said that there is no possibility of reoccurrence of the disease cured by

Shodhana Chikitsa while the disease cured by Shamana may reoccur1.

Basti is the principal treatment for Vataja vyadhis. According to Acharya Charaka

there is no cause greater than Vata in the manifestion of the disease and there is no better

remedy, other than Basti. Hence he has mentioned in Agrya Sangraha that “Bastistantranam”2.

Basti destroys completely the root of vitiated Vata by entering the Mulasthana of Vata

Dosha i.e. Pakvasaya. Hence, it is the principal treatment for an important factor Vata, which

is supposed to be responsible for all diseases. Thus, Basti is said to be the ardha chikitsa and

sometimes, the complete treatment3.

No either therapeutic measures other than Basti cleanses the body quickly and easily,

cauases depletion and nourishment instantaneously and is free from any adverse effect4.

Though emesis and purgation eliminate the vitiated Doshas from the body, the drugs used in

these therapies contain Katu rasa, Ushna and Tikshna Gunas, which cannot be taken easily by

children or elder people5. But Basti can be given in all age groups without any hesitation.

Kashyapa equated Basti Karma to ‘Amrutam’ and indicated it in both infants and old age6.

Basti Karma is superlative in the management of disorders produced by vitiated Vata.

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DERIVATION:

The word Basti derived from root “Vas” which when suffixed by “Tich” i.e. ‘Vas+tich’

gives rise to the word BASTI and is a masculine gender.

Table no.15 – Showing the derivations of Basti.

Sl no. Nirukti Meaning

1 Vasu nivase To reside, to stay, to do well

2 Vasu achhadane To cover, to coat

3 Vasu snehachhadane praharshenu Covering of Sneha for the elimination

4 Vasa vaasane surabhikarane To produce the effect of pleasant smell

5 Vaste aavranoti mutram It denotes an organ, which covers the

urine

6 Nabhisth adhobhago mutradhare

sthane

It denotes an organ situated below the

umbilicus, which retain the urine

DEFINATION:

Basti is desirable for the increase of doshas having predominance of Vata or for the

Vata alone it is the foremost among all treatments. Basti is the procedure that which is

administered with the help of Basti (bladder) or the drugs administered first reaches to the

Basti7.

The Karma in which, the medicine administered through anal canal reaches up to the

Nabhi Pradesh, Kati, Parshwa, Kukshi churns the accumulated Dosha and Purisha, spreads the

unctuousness all over the body and easily comes out along with the Purisha and Dosha is called

Basti8.

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CLASSIFICATION OF BASTI:

I] On the basis of Adhisthana9:

Table no.16 – Showing the types of Basti on the basis of Adhisthana.

1 Pakvashayagata Basti Basti Dravya administered through anal canal into

the colon

2 Garbhashayagata Basti Basti Dravya administered through the vagina

into the uterus

3 Mutrashayagata Basti Basti Dravya administered through the urethra

into the urinary bladder

4 Vrina Basti Basti Dravya administered into the Vrina for its

Shodana and Ropana purpose.

II] On the basis of type of Dravya10:

1] Nirooha Basti

The Basti in which Kashaya is the dominant ingridient. Kashaya, Madhu, Saindhava, Sneha

and Kalka are the ingredients commonly used in Nirooha Basti. Mamsa Rasa, Kshira, Mutra,

Amlakanji, Dadhimastu, Rakta etc. also used as Aavaapa Dravya to alter the quantity, quality

and action of Basti.

2] Sneha Basti:

In this type mainly four types of Sneha in the form of medicated Ghrita, Taila, Vasa and

Majja are administered through the anal canal into the colon.

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This Sneha Basti classified into three types according to the Dose.

Table no.17 - Showing the type of Sneha Basti according to the Dose:

Sl no. Type of Basti Quantity of Basti

1 Sneha Basti 6 Pala (288ml) 1/4th of Nirooha Basti

2 Anuvasana Basti 3 Pala (144ml) 1/2 of Sneha Basti

3 Matra Basti 1½ Pala (72ml) 1/2 of Anuvasana Basti

III] Classification according to number of Basti11:

Table no.18 – Showing the types of Basti according to number of Basti.

Sl

no.

Basti Total no.

of Basti

Acc to Sequence of Basti Indications

1 Karma

Basti

3 0 Charaka 18Anuvasana + 12 Nirooha Vata Pradhana Roga,

Uttama Shareera &

Satva Bala. Kashyapa 24Anuvasana + 6 Nirooha

2 Kala

Basti

16 Charaka &

Chakrapani

10Anuvasana + 6 Nirooha Pitta Samsarga,

Madhyama Bala,

Madhyama Dosha 15 Vagbhata 9Anuvasana + 6Nirooha

3 Yoga

Basti

8 Charaka &

Vagbhata

5Anuvasana + 3Nirooha Kaphanubandhi Vata

Prakopa, Alpa Bala

IV] On the Basis of Special Purpose:

Madhutailika Basti, Siddha Basti, Yuktaratha Basti,

Yapana Basti, Picchha Basti, Vaitarana Basti.

V] On the Basis of Chief Action:

Snehana Basti, Brimhana Basti, Shamana Basti, Lekhana Basti, Shodana Basti,

Sangrahika Basti, Rasayana Basti, Vajikarana Basti, Balavarnakara Basti, Chakshushya Basti.

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VI] On the basis of Nature of Basti Dravya:

Mridu Basti

Madhyama Basti

Tikshna Basti

VII] On the basis of Main Drug:

Kshira Basti, Mamsa Rasa Basti, Gomutra Basti,

Rakta Basti, Kshara Basti, Dadhimastu Basti.

BASTI DRAVYA:

According to Vagbhata12:

Madana, Kutaja, Kushtha, Devadali, Madhuka, Vacha, Dashamoola, Rasna, Yava,

Mishi, Kritavedana, Kulattha, Madhu, Lavana, Trivritt.

According to Charaka13:

Asthapanopaga Gana: Trivrutt, Bilva, Pippali, Kushtha, Sarshapa, Vacha,

Vatsakaphala, Shatapushpha, Madhuka, Madanaphala.

Anuvasanopaga Gana: Rasna, Devadaru, Bilva, Madana, Shatapushpa, Vriscira,

Punarnava, Gokshura, Agnimantha, Shyonaka.

BASTI YANTRA:

The instrument used for the administration of the Basti Dravyas is known as Basti

Yantra.

It comprises at two parts:

1) Basti Putaka.

2) Basti Netra.

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1) BASTI PUTAKA14:

It is bag like container used to hold the Basti Dravya. The urinary bladder of the animals

such as sheep, cow, buffalo, goat etc. which is tough, soft, odourless, clean and made reddish

by processing with Kashaya Bhavana. If the animal bladder unavailable then the skin from the

neck region of the bird Plavaja or Ankapada or thick cloth can be used.

Basti Putaka Dosha and their Vyapad15:

Table no.19 - Showing the Basti Putaka Dosha and their Vyapad.

Name of Putaka Dosha Vyapad

Vishama(irregular shape) Gativaishamya(change of direction)

Mamsala(containing muscle) Visratva(odour)

Chidra(hole) Srava(leakage)

Sthula(thick) Dourgrahya(difficulty to handle)

Jalika(network of veins) Nisrava(froth)

Vatala(containing air) Phenila(froth)

Snigdha(oily) Cyuta(slipping/falling)

Klinna(moist) Adharyatva(not possible to handle)

2) BASTI NETRA16:

Here Netra is a tubular structure which is attached to the Basti Putaka through which

the Basti Dravya is introduced. Further details are given in the table below.

Table no. 20 – Showing the description of Basti Netra.

Material used Gold, Silver, Copper, Bronze, Cow’s horn, Long bones of animals,

bamboo, wood etc.

Shape Gopuccha Samana (cow’s tail)

Thickness Mulabhaga(base)-Angushtha Samana(equal to thumb)

Agrabhaga(tip)- Kanishtika Samana(equal to little finger)

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Size according to the age as told by Charaka17:

Table no.21 - Showing the size of Basti Netra as per Charaka.

Age Size in Angula Increment per year Diameter of the

Agrabhaga(tip)

1-6 yrs 6 - Size of Mudga

7-12 yrs 8 1/3 Size of Karkandu

13-20 yrs 12 ½ Size of Sateena

Size according to the age as told by Sushruta18:

Table no.22 - Showing the size of Basti Netra as per Sushruta.

Age Size in

Angula

Diameter of

Mulabhaga

Diameter of

Mulabhaga

Chidra

Diameter of

Agrabhaga

Chidra

Diameter

of

Karnika

from tip

1 yr 6 Kanishtika

Samana (little

finger)

Kanka Pakshi

Nadi Samana

Size of

Mudga

1/2 Angula

8 yrs 8 Anamika

Samana (ring

finger)

Syena

Pakshi(eagle)

Nadi Samana

Size of

Masha

2 Angula

16

yrs

10 Madhyama

Anguli Samana

(middle finger)

Mayur

Pakshi(peacock)

Nadi Samana

Size of

Kalaya

2 ½ Angula

25

yrs

12 Angushta

Samana (thumb)

Grudhra Pakshi

Samana

Size of

Kolasthi

3 Angula

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Basti Netra Dosha and their Vyapad19:

Table no. 23 - Showing Basti Netra Dosha and their Vyapad.

Sl no. Basti Netra Dosha Vyapad

1 Hrisva Aprapti (Basti Dravya not reaches inside)

2 Deergha Ati Gati (movement of Basti Dravya)

3 Tanu Kshobha (irritation)

4 Sthula Karshana (pressure)

5 Jeerna Kshanana (injury)

6 Sithila Bandhana Srava (leak)

7 Parshwa Chhidra Guda pida (pain in rectum)

8 Vakra Gati jihmaa (wrong movement)

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MATRABASTI

Matra Basti is a type of Anuvasana Basti i.e. Sneha Basti, described in the classics. It is termed

so, because the dose of Sneha used in this is very less as compared to the dose of in Sneha

Basti20.

According to Acharya Vagbhata, the Matra Basti is the type of Basti in which the dose of Sneha

is equal to Hrasva Matra of Snehapana. It can be given all the time without any complications

and no restrictions during the course of MatraBasti21.

Indications:

According to Charaka, Matra Basti is recommended for daily use in persons emaciated by over

work, load lifting, over exertion, way-faring, and riding or indulgence in women, in debilitated

persons as well as in those afflicted with Vata disorders.

Table No.24: Indications of Matrabasti22.

Sl.No Indications Ch.S A.S. A.H.

1 Karma Karshita + - -

2 Bhara Karshita + + +

3 Adhva Karshita + + +

4 Vyayama Karshita + + +

5 Yana Karshita + + -

6 Stri Karshita + + +

7 Durbala + + +

8 Vata Rogi + + +

9 Bala - + +

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10 Vriddha - + +

11 Chintatur - + +

12 Stri - + -

13 Nripa - + +

14 Sukumara - + -

15 Alpagni - + +

16 Sukhatma - - +

Contra-Indications:

In classics, regarding the Matra Basti there is no major contraindications mentioned. But

according to Acharya Vagbhata, Matra Basti should not be administered in person having

Ajirna23.

Qualities of Matra Basti:

It is promotive of strength.

Demands no strict regimen of diet.

Causes easy elimination of Mala and Mutra.

It performs Brimhana Karma in the body.

Curative of Vata disorder.

It can be administered at all times, in all seasons and is harmless24.

Dose of Matra Basti:

According to Vagbhata, the dose of Hrasva Snehapana is considered to be the dose of Matra

Basti. The Matra which gets digested in two Yama i.e. 6 hours, is called as Hrasva Matra but

the dose required to get digested in two Yama is not mentioned25.

According to Acharya Sushruta, the dose of Matra Basti is ¼ of the dose of Anuvasana Basti

and the dose of Anuvasana Basti is ¼ of Niruha Basti i.e. 24 Pala.

Hence, the dose of Anuvasana Basti is 6 Pala and dose of Matra Basti is 1½ Pal i.e. 6 Tola26.

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According to Chakrapani, commentary on Charaka the dose of Sneha Basti is 6 Pala, dose

of Anuvasana Basti is 3 Pala and of Matra Basti is 1½ Pala27.

On the basis of above reference it can be said that the dose of Matra Basti is1½ Pala of Sneha

i.e. 6 Tola equal to 60-72 ml.

Food before Basti Procedure:

After consumption of excessive Snigdha Ahara, Matra Basti should not be given because

Sneha taken in double quantity gives rise to Mada and Murchha. Before Matra Basti, intake of

excessive Ruksha Ahara should be avoided because it causes depletion of Bala and Varna. So

any diet which is suitable to the patient should be given but in less quantity28.

Pathya -Apathya for Matra Basti:

There is no specific demand of diet and behaviour during use of Matra Basti. But according

to Acharya Vagbhata, it is to be restricted for the day sleep after administration of Matra Basti29.

Retention of Matra Basti:

The Pratyagama kala of Sneha Basti is 3 yama i.e. 9 hours. Matra Basti being type of Sneha

Basti; its Pratyagama Kala is also 3 Yama i.e. 9 Hours. There is no harm if Matra Basti is

retained in the body, because while describing Anuvasana Basti, it has been said that it is not

harmful to body even in the event of its being retained in the body for a whole day. Also the

dose of Matra Basti is very small which can get easily absorbed in the body without coming

out. It is believed that Sneha Basti should be retained in the body. If Basti material returns

much earlier, it cannot produce the desired effect in the body30.

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Table No-25: Samyak Yoga, Ayoga and Atiyoga Lakshana of Anuvasana Basti (Matra

Basti) 31.

Samyak Yoga Lakshana Ayoga Lakshana Atiyoga Lakshana

Sa Anila Sa Purisha Sneha

Pratyagamana

Adha Sharira Ruja Hrillasa

Raktadi Buddi-Indriya

Prasada

Udara Ruja Moha

Svapnanuvrutti Prushta Ruja Klama

Laghuta Parsva Ruja Sada

Bala Ruksha Gatrata Murcha

Srustasca Vega Ruksha Svara Vikartika

Absence of Daha Purisha Sanga

Absence of Ruja Mutra Sanga

Vata Sanga

Complications of Sneha Basti:

Though, it has been said that there is no major complication by the use of Matra Basti, but

minor complications may be produced due to obstruction of Sneha by Vata, Pitta, Kapha or by

excess of Mala or food and when given to a person on empty stomach. These six conditions of

complications are likely to arise during the use of Sneha Basti32.

1) Vata Avrita Sneha.

2) Pitta Avrita Sneha.

3) Kapha Avrita Sneha.

4) Anna Avrita Sneha.

5) Purisha Avrita Sneha.

6) Abhukta Pranita Basti.

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Probable mode of action of Basti

Basti - Acharya Charaka qouted Basti is the best treatment for Vata“Vasti hi

Vataharanam”. Basti drug first reaches to the Pakvashaya (large intestine). Pakvashaya is the

chief site of Vatadosha33. Vagbhata says the veerya of Basti is conveyed to Apana and then to

Samanavata, which may regulate the function of Agni.It then goes to Udana, Vyana and Prana,

thus providing its efficacy all over the body34. At the same time Basti by pacifying Vata,

restores the disturbed Kapha and Pitta at their original seats and thus helps in breaking the

pathogenesis. Pakvashaya is the site of Purishadharakala. Commentator Dalhana has said

Purishadhara and Asthidhara kala are one and same. Basti drugs directly acts on

Purishadharakala so we can take its direct action on Asthidharakala also. Sushruta has

mentioned 6th Basti nourishes Mamsa Dhatu, 7th Basti nourishes Meda Dhatu, 8th Basti

nourishes Asthi Dhatu and 9th Basti nourishes Majja Dhatu. Thus, through Basti, we achieve

Vata Dosha Shamana and Snehana of Asthi Dhatu35. So we achieve the Shamana of

Sandhigatavata by breaking the Samprapti.

According to modern medical science, as per Basti /Enema concerned, in Transrectal

route, the rectum has a rich blood and lymph supply and drug can cross the rectal mucosa like

other lipid membrane. Thus unionized and lipid soluble substances are readily absorbed from

the upper rectal mucosa is carried by the portal circulation via the middle and inferior

hemorrhoidal veins.Thus administration of drugs in the basti form has faster absorption and

provides quicker results.

The rectal wall contains neurorecepters and pressure receptors which are stimulated by

various Basti dravyas. Stimulation results in increase in conduction of sodium ions. The inward

rush of sodium ions through the membrane of the unmyelinated terminal is responsible for

generating the action potential, influx of ion there by generating action potential. Generally the

action potential is initiated by increase in permeability to sodium ions, Saindhav Lavana

present n Basti probably generates the action potential and absorption of Basti dravyas Thus

by entering in general circulation, Basti drugs acts on whole the body.

Vasti may act through the nervous system or through the enteric receptors. It may increase the

secretion of local enzyme or neurotransmitters. By virtue of their permeability the drugs may

increase the normal bacterial flora of endogenious synthesis of vitamin B1 and B12 as well as

80



vit K, which are normally manufactured by bacterial flora.VitB12 may have a role to play in

the regeneration and maintenance of nerve cells. Basti karma also reverses the effects of

degeneration by enhancing immunity.

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DRUG REVIEW

Aushadha has been given the second place only to Physician amongst the four fold

factor of treatment with the remaining places occupied by the Upasthata and Rogi respectively.

Ayurvedic literature speaks about the importance of the drug as “nothing in the world

exist which does not have therapeutic utility.” Taking this fact into consideration Ayurvedic

Physicians have formulated single as well as compound drugs for the cure as well as prevention

of various elements.

For the purpose of Matra Basti, Pancha Tikta Guggulu Ghrita has been taken as it is

indicated in Vatavyadhi especially in Asthi, Snayu, and Majja as mentioned in Sahasrayoga.

The drugs used in this study are as follows.

1) Murcchita Tila Taila for Abhyanga.

2) Panchatiktha Guggulu Ghrita for Basti.

The raw drugs are identified and collected with the help of Dravya Guna department

and medicines are prepared in our college pharmacy with the guidance of Rasashastra and

Bhaishajya Kalpana department.

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1. Murcchita Tila Taila Ingredients1:

Triphala, Mushta, Rajani, Hrivera, Lodra, Suchipushpa, Vatankura, Nalika (all in equal

quantity. Total quantity must be 1/4th to that of Tila Taila.)

Taila – 1 part

Jalam – 4 part

Table no.26 - Showing Contents of Murcchita Tila Taila:

Dravya Rasa Guna Virya Vipaka Karma

Haritaki2 Pancharasa

(Lavana varjita),

Kashaya Pradhana

Laghu,

Ruksha

Ushna Madhura Tridoshahara,

Shotahara,Balya,

Medhya

Vibhitaki3 Kashaya Ruksha,

Laghu

Ushna Madhura Tridoshahara,

Raktastambhana,

Amalaki4 Pancharasa

(lavanarahit),

Amla Pradhana

Guru,

Ruksha,

Shita

Shita Madhura Tridoshahara,

Dahaprashamana,

Deepana, Medhya

Mushta5 Katu,Tikta,

Kashaya

Laghu,

Ruksha

Sheeta Katu Shotahara,Deepan,

Pachan

Rajani6 Tikta Laghu,

Ruksha

Ushna Katu Vataghna,

Vedanasthapana

Hrivera7

(Tagar)

Katu,Tikta,

Kashaya

Laghu,

Snigdha

Ushna Katu Kaphavata Shamaka,

Vedanasthapana,

Deepan, Hridhya

Ladra8 Kashaya Laghu,

Ruksha

Sheeta Katu Kapha-pitta

Shamaka,

Kushtaghna,

Stambhana

Suchipushpa9 Madhura,Tikta,

Katu

Laghu,

Snigdha

Ushna Katu TridoshaShamaka,

Varnya,Dipana,

Pachana

Vatankura10 Kashaya,

Madhura

Guru,

Ruksha

Sheeta Madhura Varnya,Kapha-pitta

Shamaka, Grahi

Nalika11 Madhura,Tikta,

Katu

Laghu,

Ruksha,

Tikshna

Ushna Katu Chedana,

Sleshmahara,

Kasaghna, Swasahara

Tila12 Madhura Guru,

Snigdha

Ushna Madhura Medya,Snehana,

Vedanasthapana

83



2. Ingredients of Panchatiktaguggulu ghrita 13:-

Kwatha Dravya: Nimba, Amrita, Vasa, Patola, Kantakari, 10 Pala each. Jala 16 Prastha.

Kalka Dravya: Patha, Vidanga, Devadaru, Gajapippali, Yavakshara, Sarjikshara, Shunti,

Haridra, Shatapushpa, Chavya, Kushta, Tejovati, Maricha, Kutaja, Ajamoda, Chitraka,

Katurohini, Bhallataka, Vacha, Pippali, Rasna, Manjishta, Ativisha, Vatsanabha, Yavani, 1 part

each and Guggulu 5 part.

Sneha Dravya: Goghrita 1 Prastha.

Method of Preparation: Kashaya is prepared by adding Yavakuta churna of all the kwatha

dravya each 10 pala in 16 prastha water by reducing 1/8th part. Then kalka is prepared by adding

fine powder of all kalkadravya except guggulu.1 prastha ghrita, kalka and kwatha is added into

it and ghrita is prepared in mandagni till appearance of Snehasiddhi laxanas and add guggulu

and filter it, after that keep it in air tight container.

Indications: Vatavyadhi, Kushta, Gulma etc

84



Table No 27: Showing Guna and Karma of Drugs used in PTGG.

Dravya Rasa Guna Virya Vipaka Karma

Nimba14 Tikta Laghu Sheeta Katu Kandugna

Guduchi15 Tikta Guru, Snigdha Ushna Madhura Rasayana

Vasa16 Tikta Laghu,Ruksha Sheeta Katu Chedana

Patola17 Tikta Laghu,Ruksha Ushna Katu Jwaragna

Kantakari18 Tikta Laghu,Tikshna Ushna Katu Kasahara

Patha19 Tikta Laghu,Tikshna Ushna Katu Stanyashodhana

Vidanga20 Katu Laghu,Ruksha Ushna Katu Krimighna

Devadaru21 Tikta Laghu,Snigdha Ushna Katu Vedanasthapana

Gajpippali22 Katu Laghu,Snigdha Anushna Katu Kasahara

Yavaksara23 --- Tikshna,Ushna --- --- Pachana,Chedana

Sarjikshara24 Katu,

Lavana

Tikshna,Ushna --- --- Gulmanashan,

Kasahara,Krimihar

Shunti25 Katu Laghu,Snigdha Ushna Madhura Truptighna

Haridra26 Tikta Ruksha,Laghu Ushna Katu Kushtagna

Mishi27 Madura Laghu,Snigdha Sheeta Madhura Vatanulomana

Chavya28 Katu Laghu,Ruksha Ushna Katu Truptighna

Kushta29 Tikta Laghu,Ruksha Ushna Katu Shukrashodhana

Tejovati30 Katu Laghu,Ruksha Ushna Katu Dantashodhana

Maricha31 Katu Laghu,Tikshna Ushna Katu Deepana

Vatsaka32 Tikta Laghu,Ruksha Sheeta Katu Amahara

Ajamoda33 Katu Laghu,Ruksha Ushna Katu Shulaprashaman

Chitraka34 Katu Laghu,Tikshna Ushna Katu Deepana

Katurohini35 Tikta Ruksha,Laghu Sheeta Katu Pittavirechana

85



Bhallataka36 Katu Laghu,Snigdha Ushna Madhura Kushtagna

Vacha37 Katu Laghu,Tikshna Ushna Katu Sanjnasthapana

Pippali38 Katu Laghu,Snigdha Anushna Katu Kasahara

Rasna39 Tikta Guru Ushna Katu Vedanasthapana

Manjista40 Tikta Guru,Ruksha Ushna Katu Raktaprasadana

Ativisha41 Tikta Laghu,Ruksha Ushna Katu Deepana

Visha42 Madura Ruksha,Laghu Ushna Madhura Swedajanana

Yavani43 Katu Laghu,Ruksha Ushna Katu Shulaprashaman

Guggulu44 Tikta Suksma,Laghu Ushna Katu Vedanasthapana

Goghrita45 Madura Snigdha Sheeta Madhura Deepan,Snehana

86



MATERIALS AND METHODS

Source of Data:

Clinical data: Patient suffering from Gridhrasi will be selected from OPD and IPD

department of Shalya Tantra, Shree Shivayogeeshwar Rural Ayurvedic Medical

College and Hospital, Inchal and from other camps and referrals.

Literary data: Required literary information for intended study shall be procured from

Ayurvedic Classical texts, Medical Journals, Modern books, Retrospective studies and

Internet sources.

Drug source: The mentioned drug will be selected from local areas and Market after

proper identification and the required quantity of Medicines will be prepared in Shree

Shivayogeeshwar Rural Ayurvedic Medical College Pharmacy Inchal.

Diagnostic criteria:

Diagnosis will be established by clinical examination and sign and symptoms of

Gridhrasi as follows-

1. Ruja in Sphik, Kati, Uru, Prushta, Jangha, Janu, and Pada.

2. Toda in Kati, Uru, Prushta, Jangha, Janu, and Pada.

3. Stambha of affected Sakthi.

4. Spandana.

5. Straight Leg Raising [SLR] test being positive.

Inclusion criteria:

1. Both sexes between the age group of 20 to 60 years.

2. Observation of clinical features of Gridhrasi i.e Ruk, Toda, Spandana, and

Stambha.

3. Pain along the course of Sciatica nerve.

4. Patient fit for Siravyadha, Agnikarma and Basti Karma.

5. Straight Leg Raising (SLR) test being positive.

87



Exclusion criteria:

1. Patient of age below 20 years and above 60 years.

2. Pregnant women and lactating mother.

3. Patient with other Severe Systemic Metabolic disorders such as Diabetes

mellitus, Hyperthyroidism, Cardiac diseases etc.

4. Patients having any Hematological and Bleeding disorder.

5. Patients who are unfit for Siravyadha, Agnikarma and Basti Karma.

Research Design:

Sample size and grouping:

In the present study, the sample size of 60 patients suffering from Gridhrasi were

selected as per the inclusion criteria. Patients were randomly distributed into two groups, 30

patients in each group.

Group A: 30 patients were subjected to Siravyadha followed by Agnikarma and

Matra Basti with Panchatiktha Guggulu Gritha.

Group B: 30 patients were subjected to Agnikarma and Matra Basti with

Panchatiktha Guggulu Gritha without Siravyadha.

Study Design:

The study design of the present study is ‘Comparative clinical trial’. In this the patients

of Group-A were compared with Group-B patients. The data relate to the study was collected

and recorded in case record proforma of Gridhrasi.

Study duration:

Total study duration 30 days

GROUP A

1st Day --- Siravyadha.

2nd Day --- Agnikarma.

3rd-11th Day --- Matra Basti with Pancha Tikta Guggulu Ghritha.

20th Day --- First Follow Up.

30th Day --- Second Follow Up.

88



GROUP B

1st Day --- Agnikarma.

2nd- 10th Day --- Matra Basti with Pancha Tikta Guggulu Ghritha.

20th Day --- First Follow Up.

30th Day --- Second Follow UP.

Collection of Data:

The patients were thoroughly evaluated both subjectively and objectively. The patients

who fulfilled the inclusion criteria were subjected for routine investigations and radiological

examination. Before subjecting to the clinical trial, an informed consent was taken from the

patient.

History taking: Detail history was collected regarding the demographic data and data related

to the disease and recorded as per case record proforma.

Treatment schedule:

After the diagnosis the patients were randomly categorised into two groups.

GROUP A – In this group patients will be treated with Siravyadha followed by

Agnikarma and Matra Basti with Pancha Tikta Guggulu Ghritha.

GROUP B – In this group patients will be treated with Agnikarma and Matra Basti with

Pancha Tikta Guggulu Ghritha without Siravyadha.

PROCEDURE REVIEW

The procedure entirely consists of:

1) Purva Karma.

2) Pradhana Karma.

3) Pashchat Karma.

89



SIRAVYADHA VIDHI

Purva Karma

- The Siravyadha room should be well equipped with all the Agropaharaniyani required

for the procedure.

- Inform consent of the Patient was taken.

- Patients were advised for Yavagu or Light liquid diet before Siravyadha procedure.

- Local Snehana and Swedana should be carried out on the affected leg.

- Paint the portion with spirit where Siravyadha has to be carried out.

Pradhana Karma

- The affected leg of patient is seen then it should be kept in an even place before it is

venepunctured and other leg should be slightly flexed and raised.

- Now the leg to be venepunctured should be bandaged with tourniquet below the knee

joint and applying tourniquet four fingers above the point the vein of leg should be

punctured.

- Try to visualize the superficial vein below four Angulas of the Janu Sandhi.

- Siravyadha should be done with the help of needle no 20.

- The vitiated blood let out and on an average about 30-40ml of blood has been collected

in a kidney tray.

- The tourniquet has been taken out and gradually the blood flow would be stopped.

- Then tight dressing should be applied.

Paschat Karma

- The patient is advised to be relaxed in Supine position.

- After bloodletting the patient should be fed with Milk or Shastik Rice.

- Pathyapathya were advised.

90



AGNIKARMA VIDHI

Purva Karma:

- The Agnikarma room was well prepared with all the Agropaharaniyani.

- Triphala Kwatha for Prakshalana of the local part of the patient was prepared freshly.

- Yashti Madhu Churna, small pieces of Kumari patra, swab holding forceps, Plota

(gauze), Pichu (cotton), and Gas stove, Shalakas were kept ready for use.

- Patient was advised for Snigdha and Pichchhila light diet before Agnikarma Chikitsa.

- Inform consent of the Patient was taken.

- The Shalaka was heated on fire till red hot.

- The patient was put on the Agnikarma table in prone postion and the diseased part

was prepared with Triphala Kashaya and local part was drapped with sterilized cut

sheet.

Pradhana Karma:

- The affected leg of the patient was seen and at the site of 4 angula above the Gulpha

Sandhi on posterior side of affected leg Bindu type of Samyak Twak Dagdha Vrana

were produced with the help of red hot heated Pancha Loha Shalaka.

- Occasionally we made Samyak Dagdha Vrana on the way of Sciatic Nerve where

maximum pain has felt.

Pashchat Karma:

- After producing Samyak Dagdha Vrana, the pulp of Kumara patra was applied on

Samyak Dagdha Vrana to get relief from burning sensation instantly.

- After wiping of Kumari Patra Swarasa, Avachurna (dusting) of Yashtimadhu Churna

was done.

- Pathyapathya were advised as per Sushrutachary’s Vrana Rogadhikara till the

healing of Samyak Dagdha Vrana was achieved.

91



MATRA BASTI VIDHI

Purva Karma

- The patient was adviced to take light food neither too Ruksha nor too Singdha and

not more than three fourth of routine quantity.

- Before instillation of Matra Basti Abhyanga with Murcchita Tila Taila and Bhaspa

Sweda was performed on the region of Kati and Udara.

- Chankramanadi karma- Patient was adviced to walk for 100 steps and excreting the

urine, stool and other vega’s.

Pradhana Karma

- After preparing the enema syringe ready with appropriate sized rubber catheter and

luke warm Panchatiktha Guggulu Ghrita ready.

- The patient was advised to sleep in left lateral position with the left lower extremity

straight and right lower extremity flexed on knee and hip joint .The patient was made

to keep his left hand below the head.

- The luke warm Panchatiktha Guggulu Ghrita weighing about 70ml was taken in

Enema syringe, Rubber catheter oleated with Panchatiktha Guggulu Ghritha was

attached to it.

- Rubber catheter was inserted into the anus of the patient gently up to the length of

around 10cms.

- The patients were asked to take deep breath while introducing the catheter and drug.

- The total Taila was administered to avoid air entrance in Pakvashaya.

Paschat Karma

- After instillation of Matra Basti, patient was advised to lie in supine postion keeping

head low postion and patient’s buttocks were gently tapped.

- After some time patient was adviced to get up from the table and take rest.

- Proper Pathya should be followed.

92



Procedure Review

Group A

- Siravyadha is done on the day one.

- Agnikarma is done on the day two.

- Matra Basti with Pancha Tiktha Guggulu Ghritha is carried out from

Day 3rd-11th.

Group B

- Agnikarma is done on the day one.

- Matra Basti with Pancha Tiktha Guggulu Ghritha is carried out from

Day 2nd-10th.

Assessment was done on 1st day (before starting the treatment )

And 11th day of the treatment.

Follow up was done on 20th and 30th day.

Treatment duration-11 days for Group A and 10 days for Group B.

Total study duration-30 days

Assessment of the results:

In both the group Subjective and Objective parameters were made out to assess the clinical

response.

The patient were assessed on 1st day (before starting the treatment), 11th day (after completion

of treatment), 20th and 30th day (i.e. on total two follow up period)

Laboratory investigations:

-Hb

-RBS

-BT, CT.

93



Interventions:

1. The patients were assessed before during and after the treatment as per assessment

criteria.

2. The nature of the study was explained to the patients in detail and pre-treatment

consent was taken.

3. The patients had full right to withdraw from the study at any time.

4. The data of patients were maintained confidently.

Assessment Criteria:

Disease features scoring pattern

1) Ruk/Ruja (pain)

Absent(no pain) 0

Mild(pain but no difficulty in walking) 1

Moderate(pain & slight difficulty in walking) 2

Severe(severe difficulty in walking) 3

2) Toda (pricking sensation)

Absent (no pricking sensation) 0

Mild(pricking sensation but no difficulty in walking) 1

Moderate((pricking sensation & slight difficulty in

walking)

2

Severe (severe difficulty in walking) 3

3) Stambha (stiffness)

Absent(no stiffness) 0

Mild(some times for 5-10mins) 1

Moderate(daily for 10-30mins) 2

Severe(daily for > 1hour) 3

94



4) Spandana (tingling sensation)

Absent(no twitching) 0

Mild(sometimes for 5-10 mins) 1

Moderate(daily for 10-30mins) 2

Severe(daily for >1 hour) 3

5) Straight Leg Raise (SLR) test:

Negative (-) 0

Positive (+) 1

Overall assessment of clinical response:

The overall effect of the clinical trial was assessed by considering all the parameters of

assessment before and after treatment as follows:

Good response: > 75% improvement

Moderate response: 50 – 75% improvement

Mild response: 25 – 50% improvement

Poor response: up to 25% improvement

No response: 0% or No improvement

95



Sample size and grouping:

In the present study, the sample size of 60 patients suffering from Gridhrasi were

selected as per the inclusion criteria. Patients were randomly distributed into two groups, 30

patients in each group.

Group A: 30 patients were subjected to Siravyadha followed by Agnikarma and

Matra Basti with Panchatiktha Guggulu Gritha.

Group B: 30 patients were subjected to Agnikarma and Matra Basti with

Panchatiktha Guggulu Gritha without Siravyadha.

SAMPLE SIZE OF ESTIMATION

96



Table of Patients Information

GROUP – A

Sl

no

Name of the

Patients

Age

(in

years)

Sex Religion Marital

Status

Occupation S-E

Status

1 Sachin Patil. 28 Male Hindu Married Others Middle

Class

2 Ramesh Wali. 25 Male Hindu Unmarried Others Middle

Class

3 Shoaib Nadaf. 29 Male Muslim Unmarried Employee Middle

Class

4 Renukha Kittur. 41 Female Hindu Married Others Poor

5 Shreedhar Naik. 32 Male Hindu Married Employee Middle

Class

6 Imran Sutagati. 44 Male Muslim Married Employee Rich

7 Basappa

Hiregoudar.

34 Male Hindu Married Others Middle

Class

8 Rudravva Yardal. 48 Female Hindu Married Others Middle

Class

9 Sanjay

Murkibhavi.

33 Male Hindu Married Employee Middle

Class

10 Shivanand

Kabbur.

47 Male Hindu Married Others Poor

11 Mahesh Chabbi. 35 Male Hindu Married Others Poor

12 Arif Pasha. 45 Male Muslim Married Others Poor

13 Laxmi Pujeri. 31 Female Hindu Married Employee Middle

Class

14 Vijay Angadi. 41 Male Hindu Married Others Rich

15 Deepa Ganiger. 38 Female Hindu Married Others Middle

Class

16 Rajshekar

Vakkund.

42 Male Hindu Married Employee Rich

17 Shivanand

Nesargi.


Class

18 Prakash Hugar. 43 Male Hindu Married Employee Middle

Class

19 Heena Gadag. 37 Female Muslim Married Others Middle

Class

20 Mahadev Harigen. 46 Male Hindu Married Others Poor

21 Girish Patil. 36 Male Hindu Married Employee Rich

22 Mahadev

Yaragatti.


Class

97



23 Sheela Deshnoor. 39 Female Hindu Married Others Poor

24 Naveen Madnur. 47 Male Hindu Married Employee Middle

Class

25 Shankar

Hanchinmanni.


26 Abdul Nadaf. 49 Male Muslim Married Employee Middle

Class

27 Mallavva

Hiremath.

52 Female Hindu Married Others Rich

28 Sagar Hosur. 43 Male Hindu Married Others Poor

29 Mallikarjun

Sampagav.


Class

30 Sadhashiv Mallur. 44 Male Hindu Married Employee Middle

Class

98




GROUP B

Sl

no

Name of the

Patients

Age

(in

years)


Status

Occupation S-E

Status

1 Channappa

Sampagav.

24 Male Hindu Unmarried Others Middle

Class

2 Ajay Bolagoudar. 26 Male Hindu Unmarried Others Middle

Class

3 Akash Moogi. 28 Male Hindu Married Employee Rich

4 Sangmesh Patil. 42 Male Hindu Married Others Middle

Class

5 Shivappa

Pattanshetti.


Class

6 Sunita Sankal. 32 Female Hindu Married Employee Middle

Class

7 Subani Inamdhar. 44 Male Muslim Married Others Poor

8 Raju Gadad. 43 Male Hindu Married Employee Rich

9 Nagraj Bailwad. 34 Male Hindu Married Others Middle

Class

10 Sumayya Attar. 43 Female Muslim Married Others Poor

11 Lokesh Kallur. 46 Male Hindu Married Others Middle

Class

12 Rudrappa Metri. 36 Male Hindu Married Others Poor

13 Mallavva

Madanalli.


14 Malesh Nandi. 44 Male Hindu Married Others Middle

Class

15 Manjunath

Neginal.


16 Gangavva

Melavanki.

48 Female Hindu Married Others Middle

Class

17 Govind Savalgi. 45 Male Hindu Married Employee Poor

18 Kavita Hosur. 38 Female Hindu Married Others Middle

Class

19 Shivraj Hadpad. 42 Male Hindu Married Others Poor

20 Pradeep Arlikatti. 41 Male Hindu Married Others Poor

21 Sangeeta Patil. 37 Female Hindu Married Others Middle

Class

22 Mohseen Malik. 41 Male Muslim Married Employee Rich

23 Muttann

Khodanpur.


Class

99



Discussion on Observation of clinical study:

Age: The patients between age group 20 to 60 years were taken for the study. Among 60

patients those are between 41-50 years were 52%, between 31-40 years were about 28%

and between 21-30 years were 10% and between 51-60 years were 10% are affected.

Sex: Male patients were affected more than the female. But the incidence is equal in both

men and women, due to random selection of patients and small sample size exact incidence

was not got.

Religion: Hindu patients were more affected than the Muslims. It may be due to

geographically surrounding of this study, people of Hindu religion were more.

Marital status: Married patients were more affected than the single. This may be due to

chronicity in the pathogenesis of the disease and random selection of the patients. As we

have selected patients above 20 years and below 60 years for the study, by the age above

20 years usually marriages occurs, this may be the reason.

Occupation: The employees less affected compared to other groups which includes

Farmers, Housewives etc. which may be due to lack of Hygiene, Stressful work,

Unwholesome diet etc. reasons.

Socio-economic status: Patients from Middle class family were more affected than Poor

and Rich patients. But this is not a big difference as 53% in Middle class and 28% in Poor

and 18% in Rich. Socio-economic status is not having direct relation with aetiology.

24 Roopa Hongal. 45 Female Hindu Married Others Poor

25 Nagesh

Devalapur.

41 Male Hindu Married Others Rich

26 Prabhakar Patil. 49 Male Hindu Married Employee Middle

Class

27 Asad Siddiqui. 33 Male Muslim Married Others Poor

28 Shrishail

Gireppagoudar.


Class

29 Shantavva

Salimath.


Class

30 Shobha Ronad. 31 Female Hindu Married Others Poor

100



OBSERVATION AND RESULTS

Statistical Analysis

Statistical results of Siravyadha followed by Agnikarma and Matrabasti in Group-A patients

and Agnikarma and Matrabasti without Siravyadha in Group-B patients before and after

treatment.

Total 60 patients were registered in this study. Out of that all 60 patients were studied in this

project. 30 patients were in Group A while 30 were in Group B. Each patient was observed

thoroughly and noted neatly. The observations are recorded and necessary charts and graphs

were made.

101



DISTRIBUTION OF PATIENTS BASED ON SEX

Table No. 28: Distribution of Patients Based on Sex.

Sex

No. of Patients and Percentage

Group A Group B Total

MALE 23 76.7% 21 70.0% 44 73%

FEMALE 7 23.3% 9 30.0% 16 27%

Sex wise: Out of 60 patients in group A and Group B, 44 patients were Male and 16 patients

were Female.

Figure no 1: Incidence of Sex.

102



DISTRIBUTION OF PATIENTS BASED ON AGE:

Table No. – 29: Distribution of Patients Based on Age.

Age in years No. of Patients and Percentage


21-30 3 10% 3 10% 6 10%

31-40 10 33% 7 23% 17 28%

41-50 13 43% 18 60% 31 52%

51-60 4 13% 2 7% 6 10%

Age wise: Out of total 60 patients in group A and group B, maximum patients were in age

Group 41-50 years. They were 52%. Group wise division: They were 43% and 60%

respectively in A and B Group.

Figure no 2: Incidence of Age.

103



DISTRIBUTION OF PATIENTS BASED ON OCCUPATION: Table No. – 30: Distribution of Patients Based on Occupation.

Occupation



Employee 12 40% 8 27% 20 33%

Others 18 60% 22 73% 40 67%

Occupation wise: Out of total 60 patients in Group A and Group B, maximum patients were

found others. They were 40 (67%).

Group wise division: In Group A, they were 60% and Group B they were 73%.

Figure no 3: Incidence of Occupation.

104



DISTRIBUTION OF PATIENTS BASED ON RELIGION:

Table No. – 31: Distribution of Patients Based on Religion.

RELIGION



HINDU 25 83.3% 26 86.7% 51 85.0%

MUSLIM 5 16.7% 4 13.3% 9 15.0%

Religion wise: Out of total 60 patients in group A and Group B, maximum patients were of

Hindu religion (85%).

Group wise division: In Group A they were 83.3% of Hindus, while in Group B they were

86.7% of Hindus.

Figure no 4: Incidence of Religion.

105



DISTRIBUTION OF PATIENTS BASED ON SOCIO ECONOMIC STATUS

INVOLVED: Table No. –32: Distribution of Patients Based on Socio Economic Status.

Socio Economic Status



Rich 5 16.7% 6 20.0% 11 18%

Middle Class 17 56.7% 15 50.0% 32 53%

Poor 8 26.7% 9 30.0% 17 28%

Socio Economic Status wise: Out of total 60 patients in group A and Group B, maximum

patients are Middle Class (53%).

Group wise division:

In Group A, Rich are 16.7%, Middle class are 56.7% and Poor’s are 26.7%.

In, Group B, Rich are 20%, Middle class are 50% and Poor’s are 30%.

Figure no 5: Incidence of Socio Economic Status.

106



DISTRIBUTION OF PATIENTS BASED ON MARITAL STATUS:

Table No. 33: Distribution of Patients Based on Marital Status.

Marital Status No. of Patients and Percentage


Married 28 93.3% 28 93.3% 56 93%

Unmarried 2 6.7% 2 6.7% 4 7%

Marital Status: Out of total 60 patients in Group A and Group B, maximum patients Marital

Status were married ie: 56 (93%).

Group wise:

In Group A, maximum patients Marital Status were married (93.3%).

In Group B, maximum patients Marital Status were married (93.3%).

Figure no 6: Incidence of Marital Status.

107



RESULTS

Table no 34: Effect of Group - A on Ruk.

SYMPTOM Mean score

% S.D (±) S.E (±) t value p value BT BT-AT

Ruk 2.67

AT 1.43 1.23 46.25 0.430 0.079 9.711 <0.05

F1 1.30 1.37 51.25 0.490 0.089 11.19 <0.05

F2 0.20 2.47 92.50 0.507 0.093 21.49 <0.05

Effect on Ruk

In this work of 30 patients were studied with Group-A Ruk revealed are given in detail.

Statistical analysis showed that the mean score which was 2.67 before the treatment was

reduced to 1.43 after the treatment and after follow up it became 0.20 with 92.50%

improvement and there is a statistically significant. (P<0.05) results are graphically represented

in figure.

Table no 35: Effect of Group-B on Ruk.

SYMPTOM Mean score


2.60

AT 1.47 1.13 43.59 0.346 0.063 8.729 <0.05

F1 1.40 1.20 46.15 0.407 0.074 9.327 <0.05

F2 0.33 2.27 87.18 0.450 0.082 17.95 <0.05

108



Effect on Ruk

In this work of 30 patients were studied with Group-B on Ruk revealed are given in detail.

Statistical analysis showed that the mean score which was 2.60 before the treatment was

reduced to 1.47 after the treatment and after follow up it became 0.33 with 87.18%

improvement and there is a statistically significant change. (P<0.05) results are graphically

represented in figure.

Figure no 7: Showing effect on Ruk.

Table no 36: Effect of Group-A Toda.

SYMPTOM Mean score

% S.D

(±) S.E (±) T value

p

value BT BT-AT

Toda 2.73

AT 1.53 1.20 43.90 0.407 0.074 8.50 <0.05

F1 0.63 2.10 76.83 0.481 0.088 17.29 <0.05

F2 0.23 2.50 91.46 0.509 0.093 16.34 <0.05

109



Effect on Toda

An assessment of Toda in patients before and after the treatment with Group-A showed

reduction in the mean score from 2.73 to 1.53 after the treatment and after follow up it became

0.23 with 91.46% improvement. It is found to be statistically significant (P<0.05). The details

are shown with statistical data and graphically represented in figure.

Table no 37: Effect of Group-B on Toda.

SYMPTOM Mean score

% S.D (±) S.E (±) T value p value BT BT-AT

Toda 2.50

AT 1.37 1.13 45.33 0.571 0.104 6.76

<0.05

F1 0.73 1.77 70.67 0.568 0.104 11.27

<0.05

F2 0.33 2.17 86.67 0.699 0.128 17.14 <0.05

Effect on Toda

An assessment of Toda in patients before and after the treatment with Group-B showed

reduction in the mean score from 2.50 to 1.37 after the treatment and after follow up it became

0.33 with 86.67% improvement. It is found statistically significant (P<0.05). The details are

shown with statistical data and graphically represented in figure.

110



Figure no 8: Showing effect on Toda.

Table no 38: Effect of Group-A Stambha.

SYMPTOM Mean score

% S.D (±) S.E(±) t value p value BT BT-AT

STAMBHA 2.57

AT 1.47 1.10 42.86 0.481 0.088 7.48 <0.05

F1 0.57 2.00 77.92 0.587 0.107 11.86 <0.05

F2 0.27 2.30 89.61 0.596 0.109 16.34 <0.05

Effect on Stambha

Magnitude of Stambha in patients before and after the treatment was assessed and analysed

statistically. In patients registered in GROUP-A showed significant improvement (P<0.05).

The mean score which was 2.57 before treatment reduced to 1.47 after the treatment and after

follow up it become 0.27 with 89.61%improvement. Further the particulars are shown in

statistical data and graphically represented in figure.

111



Table no 39: Effect of Group-B on Stambha.

SYMPTOM Mean score

% S.D (±) S.E(±) t value p value BT BT-AT

STAMBHA 2.57

AT 1.44 1.13 44.16 0.346 0.063 8.71 <0.05

F1 0.74 1.83 71.43 0.592 0.108 11.22 <0.05

F2 0.37 2.20 85.71 0.484 0.088 17.14

<0.05

Effect on Stambha

Magnitude of Stambha in patients before and after the treatment was assessed and analysed

statistically. In patients registered in GROUP-B showed statistically significant improvement

(P<0.05). The mean score which was 2.57 before treatment reduced to 1.44 after the treatment

and after follow up it become 0.37 with 85.71% improvement. Further the particulars are shown

in statistical data and graphically represented in figure.

Figure no 9: Showing effect on Stambha.

112



Table no 40: Effect of Group A on Spandana.

SYMPTOM Mean score


SPANDANA 2.60

AT 1.37 1.23 47.44 0.430 0.079 8.10 <0.05

F1 0.57 2.03 78.21 0.490 0.089 13.22 <0.05

F2 0.23 2.37 91.03 0.556 0.102 18.29 <0.05

Effect on Spandana

By the treatment, in GROUP-A Spandana was observed with a mean reduction of score from

2.60 to 1.37 after treatment and after follow up it again reduced to 0.23 with 91.03%

improvement. Analysis of this data shows statistically significant improvement (P<0.05).

Further details are given in statistical data and graphically represented in figure.

Table no 41: Effect of Group-B on Spandana.

SYMPTOM Mean score


SPANDANA 2.73

AT 1.50 1.23 45.12 0.430 0.079 8.73 <0.05

F1 0.70 2.03 74.39 0.556 0.102 13.36 <0.05

F2 0.27 2.47 90.24 0.507 0.093 21.24 <0.05

Effect on Spandana

By the treatment, in GROUP-B Spandana was observed with a mean reduction of score from

2.73 to 1.50 after treatment and after follow up it again reduced to 0.27 with 90.24%



113



Figure no 10: Showing effect on Spandana.

Table no 42: Effect of SLR Test on Group-A.

SYMPTOM Mean score


SLR TEST 1.00

AT 0.17 0.83 83.33 0.379 0.069 12.04 <0.05

F1 0.13 0.87 86.67 0.346 0.063 13.73

<0.05

F2 0.07 0.93 93.33 0.254 0.046 20.15 <0.05

By the treatment, in GROUP-A SLR Test was observed with a mean reduction of score

from 1.00 to 0.17 after treatment and after follow up it again reduced to 0.07 with 93.33%



114



Table no 43: Effect of SLR Test on Group-B.

SYMPTOM Mean score


SLR TEST 1.00

AT 0.30 0.70 70.00 0.466 0.085 8.23 <0.05

F1 0.23 0.77 76.67 0.430 0.079 9.76

<0.05

F2 0.17 0.83 83.33 0.379 0.069 12.04

<0.05

By the treatment, in GROUP-B SLR Test was observed with a mean reduction of score

from 1.00 to 0.30 after treatment and after follow up it again reduced to 0.17 with 83.33%



Figure no 11: Showing effect on SLR Test.

115



ASSESSMENT OF TOTAL EFFECT OF THERAPY

Table No 44: Overall effect on Group-A.

EFFECT OF TREATMENT IN GROUP - A

Class Grading No of patients

0-25% No Improvement 0

26% -50% Mild Improvement 0

51% - 75% Moderate Improvement 22

76% - 100% Marked Improvement 8

Figure no 12: Result on Group A.

116



ASSESSMENT OF TOTAL EFFECT OF THERAPY

Table No 45: Overall effect on Group-B.

EFFECT OF TREATMENT IN GROUP – B

Class Grading No of patients

0-25% No Improvement 0

26% -50% Mild Improvement 2

51% - 75% Moderate Improvement 24

76% - 100% Marked Improvement 4

Figure no 13: Result on Group B.

117



Table No 46 A: Comparative results of Group-A and Group-B.

Characteristics Group-A Group-B

Signs and

Symptoms

Mean score Percentage

of relief

Mean score Percentage

of

relief

Overall relief of

Symptoms (%) BT FU BT FU

RUK 2.67 0.20 92.50 2.60 0.33 87.18 89.84

TODA 2.73 0.23 91.46 2.50 0.33 86.67 89.07

STAMBHA 2.57 0.27 89.61 2.57 0.37 85.71 87.66

SPANDANA 2.60 0.23 91.03 2.73 0.27 90.24 90.63

SLR TEST 1.00 0.07 93.33 1.00 0.17 83.33 88.33

Table No 46 B: Comparative results of Group-A and Group-B.

Assessmen

t

parameters

Group A Group B

Unpaired T Test

(Group A vs Group

B) Re

ma

rks Mea

n SD SE

Mea

n SD SE SD SE

T

valu

e

P

Value

Ruk 0.20 0.41 0.07 0.33 0.48 0.09 0.44 0.08 1.16 >0.05 N

S

Toda 0.23 0.43 0.08 0.33 0.48 0.09 0.45 0.08 0.85 >0.05 N

S

Stambha 0.27 0.45 0.08 0.37 0.49 0.09 0.47 0.09 0.82 >0.05 N

S

Spandana 0.23 0.43 0.08 0.27 0.45 0.08 0.44 0.08 0.29 >0.05 N

S

SLR Test 0.07 0.25 0.05 0.17 0.38 0.07 0.32 0.06 1.2 >0.05 N

S

118



Table no 46 C: Comparative results of Group A and Group B.

Group A Group B Mean Difference SE (±) T value P value

72.49 66.68 5.81 2.36 2.50 <0.05

Comparative analysis of the overall effect of the treatments in both the groups was done

by statistically with Un paired t- test. The test shows that the treatment is statistically significant

in Group A when compared to Group B. Group A overall result is 72.49% and Group B overall

result is 66.68%.

Figure no 14: Comparative results of Group-A and Group-B.

119



DISCUSSION

In human body, the Lumbar spine is the site of most expensive orthopaedic problem in

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

dependent upon the spine. So the disease affecting lumbar spine are handled very carefully.

Gridhrasi is a disease which originates in Pakvashaya and Sphika and Kati i.e. lumbar spine

are the seat.

In classics, Gridhrasi is included under the 80 types of Nanatmaja Vata Vikara under

the heading of Vatavyadhi as a separate clinical entity. Acharya Sushruta has emphasized the

involvement of Antara-Kandara-Gulpha producing the disease Gridhrasi. He also added an

important sign of Gridhrasi i.e. Sakthanaha-Kshepam-Nigrahaniyat i.e. restriction in lifting the

affected leg. Nowadays, this sign is known as S.L.R. test. It plays a major role in diagnosis of

the disease and assessment of effect of therapy as an objective parameter. Sciatica is a condition

in modern medicine which can be correlated with Gridhrasi in ayurveda. In this condition, there

will be pain in distribution of sciatic nerve which begins in the lower back and radiates through

the posterior aspect of the thigh and calf and to the outer boarder of foot. Herniation and

degenerative changes in the disk are the most common causes. There is often history of trauma

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

The disability caused by this disease hampers day to day activity of the patients and

makes the patients crippled. There is no need to state that modern medical treatment has its

own limitation in managing this type of disease. 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.

In Ayurvedic texts, there are various methods used as a line of treatment, some of which are

effective, simple, safe and cheap for the patients. Following are the few references in the

management of Gridhrasi. Acharya Charaka has described Basti Karma and Agnikarma in the

management of Gridhrasi. Acharya Sushruta has described treatment of it in Vata Vyadhi

Chikitsa Adhyaya. For both Sarvanga Vata and Ekanga Vata, he has advised Raktmokshana.

Acharya Sushruta has explained diseases, which do not get relieved quickly by Snehana,

Lepanadi therapeutic measures, in such condition Siravyadha is considered to be an emergency

management to achieve better results. Siravyadha is also accepted as half of the therapeutic

measure in Shalya Tantra like Basti in Kayachikitsa. Agnikarma chikitsa is mentioned in

management of Sira, Snayu, Sandhi and Asthi Samprapti. Basti is the prime and most beneficial

therapy for Vata Vyadhi. Matrabasti is safe and easy for admission even at OPD levels. In

Sahasrayoga Pancha Tikta Guggulu Ghrita is indicated in Vata Vyadhi.

With the above concept a clinical study was undertaken in two Groups

Group A- Siravyadha followed by Agnikarma and Matrabasti.

Group B- Agnikarma and Matrabasti without Siravyadha.

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MODE OF ACTION OF SIRAVYADHA

In Panchakarma Chikitsa, the vitiated Doshas are purified whereas in Siravyadha to let

out Rakta Dhatu along with vitiated Doshas where Rakta Dhatu is predominant. The

susceptibility of Rakta dhatu towards getting impured is so versatile that the acharyas were

forced to agree upon Rakta as fourth Dosha. Therefore Dushita Rakta from the related Siras

should be let out to protect the health or to remove the disease. Since, Pitta is depend on Rakta,

therefore Raktamokshana decreases the quantum of enhancement of Pitta, henceforth Doshas

and Pittaja Vyadhi are too relieved or cured by the therapy.

Siravyadha does raktaprasadana. This occurs by stimulation of Yakrit and Pliha which are the

moola of Raktavaha srotas. Whole of the Raktavaha srotas gets correceted when these organs

are corrected. Raktamokshana decreases the workload on Raktavaha srotas.

The Dusta Rakta which is Shaakhashrita are expelled by Siravyadha as it is the nearest

route for Dosha niharana. Amlata in Rakta is responsible for Ruk. Hence Raktamokshana by

Siravyadha is instrumental in relieving symptoms like Ruk by reducing Amlata in Rakta.

Siravyadha comprises of Apatarpana Rupa Chikitsa which enhances the migration of Dusta

Doshas from Asthi and Sandhi to Rakta. It produces Langhana, Swedana, Pittahara,

Raktadoshaharana. Hence Siravyadha invariably results in immediate cure when compared to

other therapeutic procedure that take longer periods for the relief of symptoms.

121



MODE OF ACTION OF AGNIKARMA

The Pharmacodynamics of a therapy depends on its property like Rasa, Guna, Virya Vipaka

etc. in term of Ayurveda. It is primarily the Dosha Shamaka activity, which is used to correct

the vitiated Dosha to reinstate the Tri-Doshik equilibrium i.e. the main aim of therapy. Agni

Karma is stated as the ultimate therapy for those disorders which are not curable with any other

measures.

Analysis of General Samprapti of Gridhrasi reveals that mainly Vyana Vata plays a major role

in manifestation of disease and this is also supported by Harita’s statement that Gridhrasi is

result of vitiation of Vyana Vata mainly. Here one thing is again noteworthy that Acharya

Charaka and Acharya Sushruta have stated that when Kapha does avarana of Vyana Vata, it

gives rise to frequent restricted movement, that’s why Kapha plays a role as Anubandha in

manifestation of disease Gridhrasi. Kandra of Parsani and Pratyanguli have been stated as

adhisthana of disease Gridhrasi.

Hence, when Agni Karma is done then by virtue of its Ushna, Tikshna, Sukshma guna it breaks

the Avarana of Vyana Vata by Kapha and release the Vata to perform its normal functions,

thus symtoms like Stambha, Ruka and Toda get subsided. Agni karma increases the Dhatwagni,

so metabolism of Dhatu becomes proper and digest the Ama Dosa from the affected site and

promotes proper nutrition from Purva Dhatu and in this way, Asthi and Majja Dhatu become

more stable.Thus result precipitated in the form of relief from all symptom. Further it can be

endorsed that the therapeutic heat goes to the deeper tissue like Mamsa Dhatu and neutralizes

the Sheeta Guna of Vata and Kapha Dosa. Hence, Vitiated Dosas come to the phase of

equilibrium and patients get relief from the symptoms.

Here, disease Gridhrasi should be considered as a Prakriti Samvet Samavata Vyadhi that means

clinical features as just similar to Vyadhi Utpattikaraka Bhava. Hence, to break that Dosh-

Dushya Samurchhana, Agni Karma is an ideal modality of treatment for Gridhrasi.

122



MODE OF ACTION OF BASTI

In Gridhrasi vitiated Vata is the main causative factor along with Kapha as Anubandha. Basti

is said to be main treatment of Vata Dosha. According to Sushruta with change in ingredients

Basti may pacify other Doshas also. Acharya Sushruta has explained that as the water poured

at the root of the plant reaches up to the leaves in same way the Veerya of the drugs given in

the Basti reaches all over the body through the Srotas in the same way. Again he has said that

by the action of Apana and the other Vata even though Basti drugs quickly come out alone or

with Mala, their Veerya acts all over the body. This action is just similar to the absorption of

moisture buy the Sun from the Earth. The same action of Basti has also advocated by Acharya

Charaka, Basti while lying in the Pakvashaya, draws morbrid Dosha lodged in the entire body

by its Veerya just as the Sun situated in the sky sucks up the moisture from the Earth.

Acharya Vagbhatta elaborated this thing a little further in the sequential manner that firstly

Veerya of Basti drugs reaches the Apana Vata, then reaches the Samana, Vyana, Udana and

Pran Vata respectively, nourishes, rearranging them and thereby promoting the health. After

nourishing the Vata, Veerya of Basti drugs acts on Pitta and Kapha to bring them in normal

state. According to Kashayapa, Vata Vaha Nadi is made up of Majja Dhatu and Majja is the

seat of Vata Dosha. For nourishment of Majja and pacification of Vata, Sneha plays a major

role. According to Jejjata commentary on Sushruta, Basti drugs enter up to Laghu Antra and

enhance the functions of Agni and thereby wins over vitiated Vata Dosha. Dalhana consideres

Purishadhara Kala and Asthidhara Kala are one and the same, Asthi being the site of Vata.

Basti Materials purify the Purishadhara Kala. Hence, with purification of Purishadhara Kala

Asthi Vaha Srotas will be purified and subsides vitiated Vata. Pakvasaya, is the main site for

Vata and Basti dravyas i.e. mainly Sneha, possesses Vata Shamaka property. Hence, by virtue

of Vata Shamaka property of Basti, Vata gets subsided. Here, it is noteworthy that the Pancha

Tikta Guggulu Ghrita, which was used for Matra Basti, possesses Vata Kapha Shamaka guna

to subsiding the disease.

Panchatiktha guggulu ghrita is used for matrabasti and it is indicated in Raktapradoshaja vikara

having Vata and Kapha predominant Tridoshaja vyadhi. The majority of Drugs in Panchatiktha

guggulu ghrita are having Tikta rasa, Ushnavirya, Pitta shamaka, Raktaprasadana and

Kushtagna properties. The Tiktarasa does Pittashamana, Ushnavirya does Kapha Vata shamana

and Ghrita does Tridosh Shaman due to Sanskarasya Anuvartana guna. Guggulu will become

more potent when combined with Ghrita and acts as Tridosha shamaka. So this is the best

formulation for Vata roga such as Asthigata vata, Sandivata, and Majjagata vata.

123



Discussion on Observation of clinical study:

Age: The patients between age group 20 to 60 years were taken for the study. Among 60

patients those are between 41-50 years were 52%, between 31-40 years were about 28%

and between 21-30 years were 10% and between 51-60 years were 10% are affected.

Sex: Male patients were affected more than the female. But the incidence is equal in both

men and women, due to random selection of patients and small sample size exact incidence

was not got.

Religion: Hindu patients were more affected than the Muslims. It may be due to

geographically surrounding of this study, people of Hindu religion were more.

Marital status: Married patients were more affected than the single. This may be due to

chronicity in the pathogenesis of the disease and random selection of the patients. As we

have selected patients above 20 years and below 60 years for the study, by the age above

20 years usually marriages occurs, this may be the reason.

Occupation: The employees less affected compared to other groups which includes

Farmers, Housewives etc. which may be due to lack of Hygiene, Stressful work,

Unwholesome diet etc. reasons.

Socio-economic status: Patients from Middle class family were more affected than Poor

and Rich patients. But this is not a big difference as 53% in Middle class and 28% in Poor

and 18% in Rich. Socio-economic status is not having direct relation with aetiology.

Discussion on Roopa:

Ruk (pain):

Group A: Among 30 patients, 20 were having severe and 10 were has moderate Ruk.

Group B: Among 30 patients 18 were having severe and 12 were has moderate Ruk.

Toda (pricking sensation):

Group A: Among 30 patients, 22 having severe and 8 were having moderate Toda.

Group B: Among 30 patients, 17 having sever, 11 were having moderate and 2

were having mild Toda.

124



Stambha (stiffness):

Group A: Among 30 patients, 19 having severe, 9 were having moderate and 2 having mild

Stambha.

Group B: Among 30 patients, 17 having severe and 13 were having moderate Stambha.

Spandana (tingling sensation):

Group A: Among 30 patients, 19 having severe, 10 were having moderate and 1 having

mild Spandana.

Group B: Among 30 patients, 22 having severe and 8 were having moderate Spandana.

Straight Leg Raising (SLR) Test:

Group A: All 30 patients are having SLR Test Positive.

Group B: All 30 patients are having SLR Test Positive.

Discussion on results of individual symptoms:

To assess the effectiveness of the procedure, the statistical analysis is done by using

Unpaired T-test.

Ruk: Strongly significant result was seen with P value <0.05. 92.50% improvement was

observed in Group A, 87.18% improvement was observed in Group B during follow up.

Toda: Strongly significant result was seen with P value <0.05. 91.46% improvement was


Stambha: Strongly significant result was seen with P value <0.05. 89.61% improvement was


Spandana: Strongly significant result was seen with P value <0.05. 91.03% improvement was


SLR Test: Strongly significant result was seen with P value <0.05. 93.33% improvement was


125



Discussion on overall results of the treatment:

In Group A: Out of 30 patients, 8 patients showed Good response and 22 patients showed

moderate response.

In Group B: Out of 30 patients, 4 patients showed Good response, 24 patients showed

moderate response and 2 showed mild response.

Inference: Comparative analysis of the overall effect of the treatments in both the groups was

done by statistically with Unpaired t-test. The test shows that the treatment is statistically

significant in Group A when compared to Group B. Group A overall result is 72.49% and

Group B overall result is 66.68%.

After seeing the above readings we may conclude that, the overall response of treatment is

better in Group A compared to Group B. Hence Siravyadha followed by Agnikarma and Matra

Basti is better compared to Agnikarma, Matra Basti without Siravyadha in the management of

Gridhrasi.

126



CONCLUSION

On the basis of present study following conclusion can be drawn-

Gridhrasi is the Vata Vyadhi having predominance of Vata and Vata-Kapha.

Exact modern correlation is not possible, to some extent Gridhrasi can be corelated with

Sciatica.

The results were encouraging during the study.

Siravyadha is the half of the Shalyatantra Chikitsa as Basti in Kayachikitsa.

Raktamokshana by Siravyadha is considered to be supreme as it drains out the vitiated

Rakta and cures the disease.

Agnikarma Chikitsa is mentioned in the management of Sira, Snayu, Asthi and Sandhi

Samprapti and Gridhrasi is formed by involving all these structures.

Basti Karma is the one of the prime treatment modality in Vata Rogas. It eradicates

Vata from the root along with other vitiated Doshas.

Siravyadha followed by Agnikarma and Matrabasti was very effective in reduction of

symptoms of Gridhrasi.

Agnikarma and Matrabasti without Siravyadha was also effective in reduction of

symptoms of Gridhrasi.

Even though both line of treatment are effective in Gridhrasi. Compared to Agnikarma

and Matrabasti without Siravyadha, Siravyadha followed by Agnikarma and Matrabasti

was more effective statistically as well as clinically.

Hence finally it is concluded that Siravyadha followed by Agnikarma and Matra Basti

is more effective than Agnikarma and Matrabasti without Siravyadha.

After follow up some symptoms reappears which have fully reduced during the

treatment.

Sample size in the present study was less hence result may change in the large

sample study.

127



SUMMARY

Summary provides a whole theme of the study and anything in research needs to be

summarized and put in a nutshell, so that a further progress in the subject or any part of the

work can be considered in future for the benefit of the humanity as well as the science.

The present study entitled as “A Comparative study on the effect of

Agnikarma, Matra Basti with and without Siravyadha in the management

of Gridhrasi’’ – A COMPARATIVE CLINICAL STUDY. Comprises following

sections:

1. Introduction

2. Objectives of the study

3. Review of literature

4. Materials & Methods

5. Observations and Results

6. Discussion

7. Conclusion

1. Introduction:

In the first section – Introduction, the importance of selection of Gridhrasi in modern

era, need of Ayurvedic management is mentioned. It includes plan of study and mainly the

protocol of the present research work.

2. Objectives of the study:

Objectives of the study are evaluation of efficacy of Siravyadha, Agnikarma and Matra

Basti in the management of Gridhrasi and evaluation of efficacy of Agnikarma and Matra Basti

in the management of Gridhrasi and to compare the efficacy of Agnikarma, Matra Basti with

and without Siravyadha in management of Gridhrasi.

128



3. Review of Literature:

This includes mainly historical review of Gridhrasi, Review of detail description

regarding Gridhrasi with accordance to Ayurvedic point of view has been mentioned which

deals with Vyutpatti, Nirukti, Paribhasaha, Nidana Panchaka, Sapeksha Nidana, Sadya-

Asadhyata and Upadrava of Gridhrasi. At last Chikitsa Sutra of Vata Vyadhi w.s.r to Gridhrasi,

Siravyadha, Agnikarma and Matra Basti has been discussed.

The detail description of Siravyadha, Agnikarma and Matra Basti have been discussed.

In drug review, description about Rasa, Guna, Virya, Vipaka and Karma of all the drugs which

are used for the study were explained. Method of preparation of medicines which were used

during the study are also been explained.

The Ayurvedic knowledge has been supplemented with the Modern Medical Literature,

available regarding the disease Sciatica. The detailed description of the disease with various

aspects like Causative factors, Symptomatology, Pathology, Differential Diagnosis, Prognosis

and Management has been discussed.

4. Materials and Methods:

Here all the materials required for the study were mentioned and method of collection

of literary data, sample data and drug data are been explained. Then inclusion and exclusion

criteria, diagnostic criteria, study duration, procedure of Siravyadha, Agnikarma and Matra

Basti with Pancha Tikta Guggulu Ghrita and assessment criteria were mentioned.

5. Observations and Results:

It includes observation of all demographic data with their percentage and graphical

presentation of age, sex, occupation etc. And results of individual symptoms followed by

overall response of the treatment.

6. Discussion:

This includes discussion on disease, treatment, observation, results, individual

symptoms, over all response of treatment and probable mode of action of Agnikarma, Matra

Basti with and without Siravyadha on Gridhrasi was explained.

7. Conclusion:

This is the last part of the study, which shows final result of the study.

129



REFERENCES

INTRODUCTION:

1. Nicholas A Boon and other edited Davidson’s principle and practice of Medicine.

2. Cha.Chi 28/56.

3. Su.Ni 1/74.

4. A.H.Ni 15/54.

5. Su.Sha 8/20-23.

6. Su.Su 12/10.

7. A.S.Chi 28/3.

8. Sahasra Yogam- Ghrita Prakarana.

HISTORICAL REVIEW:

1. Atharvaveda 6/109/3.

2. Atharvaveda 6/44/3.

3. Cha.Su 20/11.

4. Cha.Su 19/7.

5. Cha.Su 5/90-92.

6. Cha.Chi 28/56-57, 101.

7. Su.Ni 1/74.

8. Su.Chi 5/23.

9. Su.Sha 8/17.

10. A.S.Su 20/13.

11. A.S.Ni 15/56.

12. A.S.Su 36/9.

13. A.H.Ni 15/54.

14. A.H.Su 27/14.

15. K.S.Su 27/21.

16. B.S.Chi 26/44-45.

17. M.N 22/55-56.

18. K.K 8th / Vatarogadhikara.

19. K.K 12th / Vatarogadhikara.

130



20. C.D 22/40-54.

21. A.D on A.H Ni 15/54.

22. G.N. Prayoga Khanda 4.

23. G.N.Kayachikitsa Khanda 19.

24. Dal commentary on Su.S.Ni 1/74.

25. V.S Vatavyadhi Adhikara.

26. Indu commentary.

27. Sha.S.Pu.Kha 7.

28. Sha.S.Ma.Kha 2 and 5.

29. R.R.S 30.

30. B.P.Ma.Kha 24.

31. Y.R.Vatavyadhi Nidana.

32. B.R 26/37-47.

DISEASE REVIEW:

1. A.K.Pranishya Varga 5/21-24.

2. Shabdha.Kalpa.Druma page no.361.

3. Cha.Chi 28/56.

4. Su.Ni 1/74.

5. Cha.Ni 1/3.

6. Cha.Chi 28/59.

7. Cha.Chi 28/15-18, Su.Su 21/19-20, A.H.Ni 1/14, 15/29, 32, 33, 47, M.N 22/1-3,

B.P.Ut.Kha 24/102.

8. Cha.Chi 28/19.

9. A.H.Ni 1/5.

10. Cha.Chi 28/56.

11. Su.Ni 1/74, A.H.Ni 16/54.

12. Cha.Chi 28/56-57, A.H.Ni 16/54, Su.Ni 1/74, M.N.22/25, B.P.Ma.Kha 24/124-132,

Y.R.Vatavyadhi Nidana/4.

13. M.N 22/55.

14. Cha.Chi 28/56-57, Su.Ni 1/74.

131



15. Ch.Su 28/17, Cha.Chi 28/56-57, M.N 22/54-55, A.H.Su 12/49, Cha.Su 20/11, A.H.Su

12/51, B.P.Ma.Kha 24/129, Su.Ni 1/74, A.D on A.H.Ni 15/54.

16. M.N 22/56, Cha.Su 20/11.

17. Su.Sha 4/56, Cha.Su 28/9, Cha.Chi 28/56-57, Su.Chi 5/23, M.N 22/56.

18. Cha.Chi 28/59.

19. Cha.Chi 28/17.

20. Cha.Chi 27/3, A.H.Ni 15/49-51, Cha.Chi 28/26-27.

21. A.H.Ni 15/55.

22. M.N 22/59-60, A.H.Ni 15/43.

23. Cha.Chi 28/25.

24. Su.Ni 1/79, A.H.Ni 15/53.

25. Cha.Chi 28/26.

26. M.N 23/6.

27. Cha.Chi 28/72-74.

28. Su.Su 33/7.

29. Cha.Chi 28/101.

30. Su.Chi 5/23.

31. A.H.Su 27/15.

32. C.D.Vatavyadhikara/73.

33. B.P.Ma.Kha 24/134-148.

34. Y.R.Vatavyadhikara.

35. Sha.S.Ma.Kha 2/95-96.

36. H.S.T.S 22/1-11.

37. B.S.Chi 24/44-45.

38. V.S.Vatavyadhi/591-595.

39. B.R 26/4, 37, 40-47.

40. Cha.Chi 28/104, B.R 26/611-625.

41. B.R 26/626-630.

132



SIRAVYADHA REVIEW:

1. Su.Sha 8/23.

2. Su.Sha 7/4-5.

3. Su.Sha 7/3.

4. Su.Sha 7/6.

5. Su.Sha 7/7.

6. Su.Sha 7/8-15.

7. Su.Sha 7/19-21.

8. Su.Su 14/25.

9. Su.Sha 8/17.

10. Su.Sha 8/3.

11. Su.Sha 8/9.

12. Su.Sha 8/10.

13. Su.Sha 8/16.

14. Su.Sha 8/6-8.

15. Su.Su 14/37-38.

16. Su.Sha 8/11-12.

17. Su.Su 14/29.

18. Su.Su 14/30.

19. Su.Su 14/35.

20. Su.Su 14/36.

21. Su.Sha 8/18-19.

22. Su.Su 14/39-40.

AGNIKARMA REVIEW:

1. Su.Su 12/4, A.S.Su 40/2, A.H.30/41-43, Cha.Chi 25/104.

2. Su.Su 12/11, A.S.Su 40/5.

3. Su.Su 12/16.

4. Su.Su 12/16.

5. Su.Su 12/8.

6. Su.Su 12/16.

7. Su.Su 12/5.

133



8. A.H.Su. 30/41-43.

9. Su.Su 12/14, A.H.Su 30/44.

10. Cha.Su 14/15-18, Su.Chi 32/25-26, A.H.Su 17/21-24.

11. Cha.Chi 25/105.

12. Su.Su 5/6, Su.Su. 12/4.

13. Cha.Chi. 28/101.

14. Dal Commentary on Su.Chi 2/46.

15. Cauterization- Wikipedia, the free Encyclopedia.

BASTI REVIEW:

1. Cha.Su 16/20.

2. Cha.Su 25/40.

3. Cha.Si 1/38-39.

4. Cha.Si 10/4-5.

5. Cha.Si 10/6-7.

6. K.S.Si 1/9.

7. A.D on A.H.Su 19/1.

8. Cha.Si 1/40.

9. Su.Chi 35/11.

10. Su.Chi 35/18.

11. Cha.Si 1/47-48.

12. A.H.Su 15/3.

13. Cha.Su 4/13.

14. Cha.Si 3/10-12.

15. Cha.Si 3/7-9.

16. Cha.Si 3/5-7.

17. Cha.Si 3/8.

18. Su.Chi 35/7-8.

19. Cha.Si 5/4-5.

20. Cha.Si 4/52-57, A. H. Su 19/67, Su.Chi 38/18.

21. A. H. Su 19/68-69, A.S.Su 28/9.

22. Cha.Si 4/52-54, A.H.Su 19/68-69.

134



23. A.S.Su 28/9.

24. Cha.Si 4/52-54.

25. A.S.Su 28/9.

26. Su.Chi 38/18.

27. Cha.Chi 4/54.

28. Su.Chi 37/55-56.

29. A.S.Su 28/9.

30. A.H.Su 19/29-30.

31. Cha.Si 1/44, 46.

32. Cha.Si 4/25.

33. Cha.Si 1/31.

34. A.S.Kal 5/68-72.

35. Su.Su 32/12.

DRUG REVIEW:

1. B.R.Jwaradhikara 269-270.

2. Acharya P.V.Sharma, Dravyaguna Vignana, Vol II, Varanasi; Choukambha Bharati

Academy; Reprint 2001. Page No.753.













135











13. Dr. K. Nistheshwar and Dr. R. Vidyanath edited Sahasra Yogam Published by

choukambha Sanskrit series Varanasi, First edition-2006, Ghrita Prakarana Page No-

60.

14 Acharya P.V.Sharma, Dravyaguna Vignana, Vol II, Varanasi; Choukambha Bharati

Academy; Reprint 2001 .Page. No-149.


Academy; Reprint 2001, Page No-761.















23 Acharya Vagbhata, Astanga Sangraha, Saroj Hindi commentary, Sutrasthana, 12th

Chapter. Shloka-36, Edited by Dr.Ravi Dutt Tripathi, Delhi; Choukambha Sanskrit

Pratishtana; 1992, Page No-255.

136




Chapter. Shloka-37, 38, Edited by Dr.Ravi Dutt Tripathi, Delhi; Choukambha Sanskrit

Pratishtana; 1992. Page no-256.










Academy; Reprint 2001. Page No-572.



















137
















Chapter, Shloka-73-77, Edited by Dr.Ravi Dutt Tripathi, Delhi, Choukambha Sanskrit

Pratishtana, 1992, Page No-102.

138



BIBLIOGRAPHY

1. Nicholas A Boon and others edited Davidson’s principles and practice of medicine 20th

edition 2006, published by Charchill Livingstone, page no-1082.

2. Dr. Tarachand Sharma, Introductory History of Ayurveda, Hindi version, Pub; Nath

Pusthak Bhandar, rohatak, new edition, 1995.

3. Acharya Agnivesha – Charaka Samhita, elaborated by Charaka and Drudhabala with

the Ayurveda Dipika, commentary by Chakrapanidatta, Edited by Vaidya Yadhavaji

Trikamji Acharya, Pub; Choukambha Surabharati Prakashana, Varanasi, Reprint 2005.

4. Acharya Agnivesha – Charaka Samhita, revised by Charaka and Drudhabala with

elaborated Vidyotini Hindi commentary by Pt.Kashinath Shastri, Dr.gorakhnath

Chaturvedi, Part I, Pub; Choukambha Bharati Academy, Varanasi, Reprint; 2003.

5. Acharya Agnivesha – Charaka Samhita, revised by Charaka and Drudhabala with

elaborated Vidyotini Hindi commentary by Pt.Kashinath Shastri, Dr.gorakhnath

Chaturvedi, Part II, Pub; Choukambha Bharati Academy, Varanasi, Reprint; 2003.

6. Maharshi Sushruta – Sushruta Samhita, edited with Ayurveda tattva Sandipika hindi

commentary by Kaviraja Ambikadutta Shastri, Part I, Pub; Choukambha Sanskrit

Samsthan, Varanasi, reprint edition; 2005.

7. Maharshi Sushruta – Sushruta Samhita, edited with Ayurveda tattva Sandipika hindi

commentary by Kaviraja Ambikadutta Shastri, Part II, Pub; Choukambha Sanskrit

Samsthan, Varanasi, reprint edition; 2005.

8. Acharya Vagbhata – Astanga Hridaya, Edited with the Vidyotini Hindi commentary by

Kaviraj Atridev Gupta, Edited by Vaidya adunandana Upadhyaya, Pub; Choukambha

Sanskrit Samsthan, Varanasi, Reprint edition; 2005.

9. Acharya Vrddha Vagbhata – Astanga Sangraha, Edited with Saroj Hindi commentary

by Dr.Ravidatta Tripathi, Pub;Choukambha Sanskrit Pratishtan, Delhi, Reprint edition;

2003.

10. Madhavakara – Madhava Nidana with Madhukosha Sanskrit commentary by Shri

Vijayarakshita and Shrikantadatta with Vidyotini Hindi commentary by Shri

Sudarshana Shastri, Part I, Pub; Choukambha Sanskrit Bhavana, Varanasi, Reprint

edition; 2004.

139



11. Madhavakara – Madhava Nidana with Madhukosha Sanskrit commentary by Shri

Vijayarakshita and Shrikantadatta with Vidyotini Hindi commentary by Shri

Sudarshana Shastri, Part II, Pub; Choukambha Sanskrit Bhavana, Varanasi, Reprint

edition; 2004.

12. Sharangadhara – Sharangadhara Samhita, Krishna Hindi commentary by Acharya Shri

Radhakrishna Parashara, Pub; Vaidyanath Ayurved Bhavan Pvt.Ltd. New edition;

2012.

13. Dr. Ramnivas Sharma and Dr. Surendra Sharma, Sahasrayogam with Sanskrit

Malayalam and Hindi translation, Pub; Choukambha Sanskrit Pratisthan, Delhi, Reprint

edition; 2007.

14. Yogaratnakara with Vidyotini Hindi commentary by Vaidya Shree Lakshmipati

Shastri, Pub; Choukambha Sanskrit Samsthan, Varanasi, Reprint edition; 2005.

15. Kaviraj Govind Das Sen – Bhaisajya Ratnavali, edited with Siddhiprada Hindi

commentary by Prof.Siddhinandana Mishra, Pub; Choukambha Surabharati

Prakashana, Varanasi, 1st edition 2005.

16. Prof. P.V.Sharma – Dravyaguna Vignana, Vol-I, Pub; Choukambha Bharati Academy,

Varanasi, Reprint; 2004.

17. Prof. P.V.Sharma – Dravyaguna Vignana, Vol-I, Pub; Choukambha Bharati Academy,

Varanasi, Reprint; 2004.

18. Dr. Siddhinandan Mishra – Ayurvediya Rasashashtra, Pub; Choukambha Orientalia,

Varanasi, 4th edition; 2004.

19. Dr. Shobha G. Hiremath – Bhaisajya Kalpana, Pub; IBH Prakashana, Bangalore,

Reprint edition; 2011.

20. Dr. Vidyadhara Shukla – Kayachikitsa, Pub; Choukambha Surabharati Prakashana,

Varanasi, Reprint edition; 2004.

21. Dr. Vidyadhara Shukla – Ayurveda Vikruti Vignana, Pub; Choukambha Sanskrit

Pratisthana, Delhi, Reprint edition; 2002.

22. Vaidhya. Haridas Shridhar Kasture – Ayurvediya Panchakarma Vignana, Pub; Shree

Baidyanath Ayurved Bhavan Ltd. Culcutta, 9th edition; 2006.

23. Dr Vijay and Dr Swapnil, Text book of Shalya Tantra, first edition Nov 2009.

24. Dr Anantkumar and Dr Kanchan, Text book of Shalya Tantra, edition 1- Jan 2009,

Edition 2- April 2012.

140



25. Dr. Vasant C Patil – Principles and practice of Panchakarma, 3rd edition, Reprinted;

2005.

26. K. Sembulingam & Prema Sembulingam – Essentials of Medical Physiology, Pub;

Jaypee Brothers Medical Publishers Pvt.Ltd. New Delhi, 2nd edition, Reprint 2003.

27. API Text Book of Medicine – Siddharth N Shah, Editor in Chief, M. Paul Anand,

Executive editor, Pub; The association of physicians of India, Mumbai, 7th edition;

2003.

28. Ayurvedic Pharmacopoeia of India, National Institute of Science communication, Pub;

Controller of Publications, Civil lines, Delhi. C.S.I.R. 1st edition; 2008.

29. Harrison’s Principles of Internal Medicine – Edited by Dr.Kasper, Dr.Hauser,

Dr.Braunwald, Dr.Longo, Dr.Fauci, Dr.Jameson, McGraw-Hill Medical Publishing

Division, New York, 18th edition.

30. Davidson’s Principles and Practice of Medicine, Christopher Haslett, Edvin R.

Chilvers, John A, A.Hunter, Nicholas A Boon, Churchills Livingstone – U.K. 18th

edition; 1999.

31. B.D.Chaurasia’s - Human Anatomy, Vol-II, Pub; CBS Publishers & Distributors, New

Delhi, 4rd edition, 2004.

32. www.sciaticaclinic.com-Wikipedia, the free Encyclopedia.

33. www.oxford reference/concise medical dictionary/sciatica.

34. Dr. K. Nistheshwar and Dr. R. Vidyanath edited Sahasra Yogam Published by

choukambha Sanskrit series Varanasi, First edition-2006, Ghrita Prakarana Page No-

60.

35. Vranda Madhav, Dr. Premavati Tewari, edited by Sidda Yoga, Published by

Choukambha Publication, Visvabharati Varanasi, First Edition-2006,

http://www.sciaticaclinic.com-wikipedia/

http://www.oxford/

141




COLLEGE & HOSPITAL INCHAL

POST GRADUATE STUDIES IN SHALYA TANTRA

“A COMPARATIVE STUDY ON THE EFFECT OF AGNIKARMA, MATRA BASTI

WITH AND WITHOUT SIRAVYADHA IN THE MANAGEMENT

OF GRIDHRASI” – A COMPARATIVE CLINICAL STUDY.

PATIENT CONSENT FORM

I _____________________________ hereby agree that I have been

fully educated with the disease and treatment. I have been explained the investigation,

treatment, complications of the disease.

I hereby accept the medical trial over me.

ನಾನು............................................................................................ ಈ ಮೆಲ್ಕ ಂಡ ಆಸ್ಪ ತೆ್ರಯಲಿ್ಲ

ಚಿಕಿತೆ್ರ ಪಡೆಯಲು ಒಪ್ಪಪ ಗೆ ನೀಡಿರುತ್ರತ ೀನೆ. ರೀಗದ ಸಂಪೂರ್ಣ ಮಾಹಿತಿ, ಚಿಕಿತೆ್ರ ಹಾಗು

ಅದರ ತಿೀವೆ್ತ್ರ ಮತ್ತತ ಆಗುಹೀಗುಗಳ ಬಗೆೆ ವಿವ್ರವಾಗಿ ನನಗೆ ಅರ್ಥಣಸಿರುತ್ತತ ರೆ. ಚಿಕಿತೆ್ರಯ

ಅವ್ಧಿಯಲಿ್ಲ ಯಾವುದೇ ತರಹದ ಅನಾನುಕುಲ್ವೆನಸಿದರೆ ನನನ ದೇ ತಿೀಮಾಣನವ್ನುನ

ತಗೆದುಕೊಳಳ ಲು ಸ್ವ ತಂತೆನಾಗಿರುತ್ರತ ೀನೆ.

ವೈದಯ ರ ರುಜು ರೀಗಿಯ ರುಜು

142



143




COLLEGE & HOSPITAL, INCHAL.

CASE SHEET FOR GRIDHRASI

DEPARTMENT OF SHALYA TANTRA

Group -A / B

1. Name of the patient: Sl. No.:

2. Father’s/Husband’s Name: OPD No:

3. Age: years IPD No:

4. Sex: Male/ Female Bed No:

5. Religion: Hindu/ Muslim/ Christian/ Others

6. Occupation:

7. Economic status: Poor/ Middle/ Rich.

8. Marital Status: Married/ Unmarried.

9. Educational Status: Literate/ Illiterate.

10. Address: Phone No:

11. Date of admission:

12. Date of Completion of treatment:

13. Follow up on: / /

14. Result:

Good response / Marked Response / Moderate Response / Mild Response / No Response

PROFORMA PROTOTYPE

144



I] Pradhana Vedana:

II] Anubandhi Vedana:

III] Adyatana Vyadhi Vrittanta: [H/O Present illness]

Mode of onset: Sudden / Gradual.

Radiation To: Right lower limb / Left lower limb / Bilateral.

Aggravation Factor: Physical Exercise /Walking /Sitting /Any other.

Relieving Factor: Rest /Pain killers / Any other.

IV] Vedana Vrittanta:

V] Poorva Vyadhi Vrittanta:

VI] Chikitsa Vrittanta:

a) Ayurvedic medicine:

b) Modern medicine:

c) Other systems of medicine:

VII] Kula Vrittanta:

145



VIII] Vayaktika Vrittanta:

Ahara: Veg / Non-veg.

Matra: Alpa /Sama /Adhika.

Vihara: Regular/Occasional/Routine activities only/No activity.

Agni: Manda /Teekshana /Vishama /Sama.

Kosta: Mrudu / Madhyama / Krura.

Nidra: Alpa /Ati /Sama/ Divaswapna /Ratri Jagarana.

Vyasana: Tea /Coffee /Smoking /Tobacco /Alcohol /None.

Aarthava Pravritti: Regular /Irregular /Menopause.

Mala Pravritti: Regular /Constipated.

Mootra Pravritti:

Position during work: Standing /Sitting /Walking /Stooping.

IX) i. Samanya Pareeksha

1 Temperature: /˚ F.

2 Resp rate: /minute.

3 Pulse rate: /minute.

4 Blood pressure (mm of Hg).

5 Height in cms.

6 Weight in kgs.

146



ii. Astasthana Pareeksha:

1 Nadi: minute/Regular/Irregular. 5 Shabda: Prakruta/ Vikruta.

2 Mutra: Prakruta/ Vikruta. 6 Sparsa: Mrudu/ Khara.

3 Mala: Baddha/ Abaddha times/day. 7 Drik: Prakruta/ Vikruta.

4 Jiwha: Alipta/ Ishat lipta/ Lipta. 8 Akriti: Sthula/ Madhyama/ Heena.

iii. Vishesha Pareeksha: 1) C.N.S:

2) C.V.S:

3) R.S:

X) Dashavidha Pareeksha:

Prakriti: V /P /K /VP /VK /KP /S

Vikruti:

Saara: Pravara/ Madhyama/ Avara.

Samhanana: Susamhana/ Madhyama/ Asamhata.

Satwa:

Satmya: Eka / Madhyama/ Sarva rasa.

Pramana: Heena/ Sama/ Adhika.

Ahara Shakti:

Vyayama Shakti: Pravara/Madhyama/ Avara.

Vaya: Baala/ Madhyam/ Vruddha.

147



XI) Sroto Pareeksha

1) Annavaha srotas.

2) Rasavaha srotas.

3) Udakavaha srotas.

4) Majjavaha srotas.

Others

XII) Vishesha Pareeksha:

i) Straight Leg Raising Test (SLR): Right: +ve / -ve

Left: +ve / -ve

ii) Laboratory Investigations:

Investigations Before treatment During follow up

Hb % in gm/dl.

RBS in mg/dl,

CT,BT.

iii) Radiological Investigation:

X-ray Lumbo Sacral spine.

148



XIII) Chikitsa Vidhi:

Siravyadha Karma Neerikshana:

Agnikarma Neerikshana:

Basti Karma Neerikshana:

No. of

days

Type

of

Basti

Bastidana

Kala

Basti

Pratyagamana

Kala

Time of

retention

Samyak

Lakshanas

Upadravas

if any

1st day

2nd day

3rd day

4th day

5th day

6th day

7th day

8th day

9th day

149



XIV) ASSESSMENT CRITERIA:

Subjective Assessment:

Symptoms BT AT AF

Ruk/Ruja

Toda

Stamba

Spandana

Objective Assessment:

SLR Test BT AT AF

Right leg

Left leg

Signature of Scholar Signature of Guide

(Dr.Akshay Ganachari.) (Dr. R C Yakkundi.)

150




GROUP – A

Sl

no

Name of the

Patients

Age

(in

years)


Status

Occupation S-E

Status

1 Sachin Patil. 28 Male Hindu Married Others Middle

Class

2 Ramesh Wali. 25 Male Hindu Unmarried Others Middle

Class

3 Shoaib Nadaf. 29 Male Muslim Unmarried Employee Middle

Class

4 Renukha Kittur. 41 Female Hindu Married Others Poor

5 Shreedhar Naik. 32 Male Hindu Married Employee Middle

Class

6 Imran Sutagati. 44 Male Muslim Married Employee Rich

7 Basappa

Hiregoudar.


Class

8 Rudravva Yardal. 48 Female Hindu Married Others Middle

Class

9 Sanjay

Murkibhavi.


Class

10 Shivanand

Kabbur.


11 Mahesh Chabbi. 35 Male Hindu Married Others Poor

12 Arif Pasha. 45 Male Muslim Married Others Poor

13 Laxmi Pujeri. 31 Female Hindu Married Employee Middle

Class

14 Vijay Angadi. 41 Male Hindu Married Others Rich

15 Deepa Ganiger. 38 Female Hindu Married Others Middle

Class

16 Rajshekar

Vakkund.


17 Shivanand

Nesargi.


Class

18 Prakash Hugar. 43 Male Hindu Married Employee Middle

Class

19 Heena Gadag. 37 Female Muslim Married Others Middle

Class

20 Mahadev Harigen. 46 Male Hindu Married Others Poor

21 Girish Patil. 36 Male Hindu Married Employee Rich

22 Mahadev

Yaragatti.


Class

151



23 Sheela Deshnoor. 39 Female Hindu Married Others Poor

24 Naveen Madnur. 47 Male Hindu Married Employee Middle

Class

25 Shankar

Hanchinmanni.


26 Abdul Nadaf. 49 Male Muslim Married Employee Middle

Class

27 Mallavva

Hiremath.


28 Sagar Hosur. 43 Male Hindu Married Others Poor

29 Mallikarjun

Sampagav.


Class

30 Sadhashiv Mallur. 44 Male Hindu Married Employee Middle

Class

152




GROUP B

Sl

no

Name of the

Patients

Age

(in

years)


Status

Occupation S-E

Status

1 Channappa

Sampagav.

24 Male Hindu Unmarried Others Middle

Class

2 Ajay Bolagoudar. 26 Male Hindu Unmarried Others Middle

Class

3 Akash Moogi. 28 Male Hindu Married Employee Rich

4 Sangmesh Patil. 42 Male Hindu Married Others Middle

Class

5 Shivappa

Pattanshetti.


Class

6 Sunita Sankal. 32 Female Hindu Married Employee Middle

Class

7 Subani Inamdhar. 44 Male Muslim Married Others Poor

8 Raju Gadad. 43 Male Hindu Married Employee Rich

9 Nagraj Bailwad. 34 Male Hindu Married Others Middle

Class

10 Sumayya Attar. 43 Female Muslim Married Others Poor

11 Lokesh Kallur. 46 Male Hindu Married Others Middle

Class

12 Rudrappa Metri. 36 Male Hindu Married Others Poor

13 Mallavva

Madanalli.


14 Malesh Nandi. 44 Male Hindu Married Others Middle

Class

15 Manjunath

Neginal.


16 Gangavva

Melavanki.


Class

17 Govind Savalgi. 45 Male Hindu Married Employee Poor

18 Kavita Hosur. 38 Female Hindu Married Others Middle

Class

19 Shivraj Hadpad. 42 Male Hindu Married Others Poor

20 Pradeep Arlikatti. 41 Male Hindu Married Others Poor

21 Sangeeta Patil. 37 Female Hindu Married Others Middle

Class

22 Mohseen Malik. 41 Male Muslim Married Employee Rich

23 Muttann

Khodanpur.


Class

153



24 Roopa Hongal. 45 Female Hindu Married Others Poor

25 Nagesh

Devalapur.

41 Male Hindu Married Others Rich

26 Prabhakar Patil. 49 Male Hindu Married Employee Middle

Class

27 Asad Siddiqui. 33 Male Muslim Married Others Poor

28 Shrishail

Gireppagoudar.


Class

29 Shantavva

Salimath.


Class

30 Shobha Ronad. 31 Female Hindu Married Others Poor

154



GROUP A

Sl

no.

RUK TODA STAMBHA SPANDANA SLR TEST

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

1 3 2 2 0 3 1 0 0 2 1 0 0 2 1 0

0

+ - - -

2 2 1 1 0 3 2 1 1 3 2 1 1 3 2 1 0 + - - -

3 3 2 2 1 3 2 1 0 3 1 0 0 2 1 0 0 + + + -

4 3 1 1 0 2 0 0 0 3 2 2 1 3 2 1 1 + - - -

5 3 1 1 0 3 2 1 0 1 1 0 0 2 1 0 0 + - - -

6 2 1 1 0 3 2 0 0 3 2 1 0 3 2 1 1 + - - -

7 3 2 2 1 2 1 1 0 3 1 0 0 3 2 1 0 + +

+

+

8 2 1 1 0 3 2 1 1 3 2 2 1 3 1 0 0 + - - -

9 3 1 1 0 3 1 0 0 2 1 0 0 2 0 0

0

+ - - -

10 2 1 1 0 2 0 0 0 3 2 1 0 3

1

0 0 + - - -

11 3 2 1 0 3 2 1 0 1 1 0 0 2 1 0

0

+ - - -

12 3 1 1 0 3 1 1 0 3 2

1

1 3

2

1 1 + - - -

13 3 2 2 1 3 2 1 1 2 1 0 0 3 1 1 0 + - - -

14 2 1 1 0 3 2 0 0 3 2 1 0 3

2

1 1 + - - -

15 3 2 1 0 2 1 1 0 3 1 0 0 3 1 1 0 + - - -

16 3 2 2 0 3 2 1 0 2 1 0 0 3 2 1 1 + + - -

MASTER CHART

155



17 3 2 1 0 3 2 1 1 3 2 1 1 2 1 0 0

+

+ + +

18 2 1 1 0 3 1 1 0 2 1 0 0 3 2 2 1 + - - -

19 3 1 1 0 3 2 1 0 3 2 1 0 2 1 0 0 + - - -

20 2 1 1 0 2 1 0 0 3 1 0 0 3 2 1 0 + - - -

21 3 2 2 1 3 2 1 0 3 2 1 0 2 1 0 0 + - - -

22 3 2 1 0 2 1 0 0 2 1 0 0 3 2 2 1 + - - -

23 2 1 1 0 3 2 1 1 3 2 2 1 1 0 0 0 + - - -

24 3 2 2 1 3 2 1 0 2 1 0 0 3 1 0 0 + - - -

25 2 1 1 0 2 1 0 0 3 2 1 0 3 2 1 0 + - - -

26 3 2 2 0 3 2 1 1 2 1 0 0 3 2 1 0 + + + -

27 3 1 1 0 3 2 1 0 3 2 1 1 2 1 0 0 + - - -

28 2 1 1 0 3 2 1 1 3 1 0 0 3 2 1 0 + - - -

29 3 2 2 1 2 1 0 0 2 1 0 0 3 1 0 0 + - - -

30 3 1 1 0 3 2 0 0 3 2 1 1 2 1 0 0 + - - -

156



GROUP B

Sl

no

RUK TODA STAMBHA SPANDANA S L R TEST

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

B

T

A

T

F

1

F

2

1 3 2 2 1 2 1 0 0

2

1 1 1 3 2 1 1 + - - -

2

2

1 1 0 2 2 1 1 3 2 1 1 2 1 0 0 + - - -

3 3 2 2 1 3 2 1 0 2 1 0 0 3 2 1 0 + - - -

4 2 1 1 0 3 2 2 0 3 2 2 1 3 1 0 0 + - - -

5 3 2 2 1 1 1 0 0 2 1 1 0 3 1 0 0 + - - -

6 2 1 1

0

2 1 1 1 3 2 1 1 3 2 2 1 + - - -

7 3 2 2 1 3 2 2 0 2 1 0 0 2 1 0 0 + - - -

8

2

1 1 0 3 2 1 1 3 2 1 0 3 2 1 0 + + + +

9 3 2 2 1 2 0 0 0 3 1 0 0 3 2 1 1 + - - -

10 2 1 1 0 2

1

1 0 3 2 2 1 3 2 1 0 + - - -

11 3 2 2 1 3

2

1 1 2 1 0 0 2 1 0 0 + + + +

12 2 1 1 0 2 1 0 0 3 2 2 1 3 2 1 0 + - - -

13 3 1 1 0 3 2 1 1 2 1 0 0 3 2 1 0 + + - -

MASTER CHART

157



158



SIRAVYADHA PROCEDURE

PHOTOS

159



AGNIKARMA PROCEDURE

160



BASTI KARMA

MATERIALS RECQUIRED

PANCHA TIKTA GUGGULU GHRITA

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