sciatica
•A CLINICAL STUDY ON THE EFFECT OF ADITYA PAKA GUGGULU WITH YOGAVASTI IN THE MANAGEMENT OF GRIDHRASI VATA
BY
Dr.D.ALI BASHA
GUIDE:
Dr.V.VIJAYA BABU. M.D(AYU)
READER
CO-GUIDE:
Dr.S.RAMALINGESWARA RAO.M.D(AYU)
LECTURER/T.A
POST GRADUATE DEPARTMENT OF KAYACHIKITSA
Dr.B.R.K.R. GOVT. AYURVEDIC COLLEGE, HYDERABAD.
Dr.N.T.R UNIVERSITY OF HEALTH SCIENCES, VIJAYAWADA,
ANDHRA PRADESH.
•INTRODUTION
•Life started from a single cell organism and extends to more complex state during evolution.
•Vertebrates have axial skeleton system the other groups.
•Human beings possess discs instead of cartilages as in
four legged animals.
•Man is the only animal who stands in upright posture .
•Man never attains absolute rest in any posture due to presence of curvatures owing them to suffer with problems related to vertebral column.
•Sciatica is also one among them resulted from underlying pathology in the vertebral column.
•Gridhrasi is a shoola pradhana Vataja Nanatmaja vyadhi affecting lower limbs.
•Gridhrasi the name itself indicates way of gait shown by the patient due to extreme pain i.e., like Gridhrasi of Eagle.
•PREVALENCE OF SCIATICA
•Back pain is experienced by 80% of population at some time in their life.
•Out of which 40% of persons have radicular pain and this comes under the umbrella of sciatica.
•In earlier days man performed 50 lifts per day,but the 20th century man perform 10 times that figure.
•Sciatica is one of the major medical,social and economic problems in our society.
•Incidence of sciatica in those employed in heavy industry is 5times than in light industry.
•There is high incidence in those who perform sedentary work.
UTPATTI
•Gridhra+so+ka =Gridhrasi.
•Word gridhrasi derived from dhatu-grudhu”.
•Grudhra refers to bird eagle.
•Gridhrasi is a nerve of lower extremity, which resemble to eagle beak in shape.
•HISTORICAL ASPECT
•Historical review can be classified into:
1. Vedic kala 2. Pauranika kala 3.Samhitha kala 4.Sangraha kala.
•Rigveda attributes medical powers to Indra who helped the lame srona in restoring his walking power.
•Atharwana veda – The piercing pain from feet, knee, hips, and hinder parts and spine.
•Garuda purana – Separate chapters is described for vata vyadhi.
•Samhitha kala – Charaka, Susrutha, Astanga Sangraha, Astanga Hridaya, Kashyapa, Madava nidana, Sharangadhara,Vangasena and so many Acharyas are explained in detail under Vata vyadhi prakarana.
•Hippocrates believed Sciatica was prevalent during summer and autumn months.
•Domestic Cotugno, Italian anatomist(1736-1822) coined the word Sciatica in 1764.
•Elsberg in 1915 operated on a patient with Sciatica, finding ruptured ligamentum flavum compressing fourth lumbar nerve root.
•In 1956 Jemonet W.D observed the association of bladder dysfunction with bilateral Sciatica.
•C.E Brown sequard(1817-1894) dscribed root pain compression at the inter vertebral foramen and recognized degeneration of the intervertebral disc.
•SAREERAM
Definition of VATA:-
•Susrutha defined as Va gathigandhanayo.
•The meaning of the word gati is movement, moving, going etc… and of gandhana is intimation, information, hint etc.
Importance of VATA:- “Yavanthi tistathi vathohi dehe thavanthu jivathi”
•So long as vata lasts in the body, as long does life exists.It is indicated of the continuity of life.
Seat of vata:-
“pakvashaya katisakthi srotrasthi sparshanendriyam
Sthanam vathasya tatrapi pakvadhanam visheshataha”
Vata in relation with Gridhrasi vata:-
•Gridhrasi is the Vataja Nanatmaja vyadhi.
“Spikurva kati pristourujanu jangha padam kramath”
•The course of Gridhrasi vata is spik, kati, Prista, uru, janu, jangha & pada, these all palces are stanas of vata and all these are Asthi predominant parts. In Asrayaasrayee Bhava sambhanda Vata & Asthi relation is entirely opposite, i.e., when vata decreases asthi vriddhi occurs, when vata increases asthji kshaya occurs.
•Due to vata prakopaka nidana, vata got vitiated, when ever vata vitiates asthi kshaya takes place i.e., degeneration of bone, which is one of the main cause of Gridhrasi vata.
•
Modern aspect:-
•Sciatica is pain in the distribution of sciatic nerve. The initial pain in the lower part of the back is known as Lumbago. The two viz. Sciatica and lumbago are often associated.
•Sciatic nerve is the main terminal branch of the sacral plexus which is formed by L5, part of L4 & S1, S2, S3 spinal nerves.
•The sciatic nerve is the largest nerve in the body measuring about 2cm in breadth at its commencement. It consists of two separate nerves in one sheath.
1) Common peroneal nerve 2) Tibial nerve
Tibial Nerve:-
•Tibial nerve is formed by lower two lumbar (L4, L5) and upper three sacral segments (S1, S2, S3). The tibial nerve forms the largest component of the thigh.
Common Peroneal Nerve (External Popliteal):-
•Common peroneal nerve is derived from the dorsal branches of ventral rami of the L4, L5 & S1, and S2 nerves. It descends obliquely along the lateral side of the popliteal fossa to the head of the fibula.
Curvature of the Spine:-
•During evolution the transition from quadrepedal to the bipedal state led first to the straightening and then to the inversion of the lumbar curvature. The erection of trunk has been obtained partly by backward tilting of pelvis and partly by bending of lumbar column.
•
Inter vertebral Disk:-
•The inter vertebral disk accounts for about 1/3 rd of total height of the lumber spine.
The disc has two components
1)Annulus fibrosis 2)Nucleus pulposus.
Annulus fibrosis:-
•Annulus forms a fibro cartilaginous ring, more fibrous and elastic peripherally, more cartilaginous in the inner part.
Nucleus pulposus:-
•Nucleus pulposus comprises 40% of the disc and is a semi fluid gel readily deformable but incompressible.
Functions of the Annulus:-
•Forms the chief structural unit between vertebral bodies and provides a mobile segment.
•Encloses and retains the nucleus pulposus.
•Restrict and regulates movement.
Function of pulposus:-
•1. Its fluid permits the formation of a mobile segment and allows an even distribution of compression forces over the entire surfaces of the vertebral disks.
•2. The viscid gel acts like a dynamic hydraulic suspension system.
•
NIDANA
•Gridhrasi is included under vatavyadhis, where specific etiological factors are not mentioned; hence Nidana of vatavydhi can be considered as nidana of Gridhrasi.
•Since Gridhrasi is considered as Nanatmaja vata vyadhi, the provocative factors of vata can also be taken as cause of Gridhrasi.
•In addition to this, in Charaka Samhitha, Astanga sangraha and Astanga Hridaya, two specific causes of vata vyadhi i.e., Dhatukshya and Margaavarodha have been mentioned.
1) Viprakrista Nidana 2) Sannikrista Nidana
Sannikrista Nidana:- Can be classified into
1) Aharaja, 2) Viharaja, 3) Kalaja, 4) Agantuja, 5)Anyahetu
Causes of Sciatica: -
1. Compressive causes
a) Congenital-Spina bifida, Spondylolisthesis.
b) Traumatic- Fracture of hip joint, Vertebral fractures, Lumbo sacral sprain and strain.
c) Mechanical pressure on the nerves
2. Non-compressive causes:- Ischemic necrosis in Diabetes Mellitus, leprosy, direct injury due to penetrating wounds.
3.Inflammatory causes:- R.A, A.S, L.S, Osteo arthritis of lumbar spine.
Catamenial sciatica:-
•The unusual developmental anomaly of implantation of endometriosis in the sciatic nerve at the sciatic notch may cause sensor motor sciatic nerve palsies.
•
• POORVA RUPA
•“Poorva rupam pragutpathi lakshanam vyadhehi”
•For every disease certain premonitory symptoms are noted before it is clearly established in the body. Such symptoms are called poorva rupa.
•Avyakta lakshanam tesham poorva rupamiti smritam
•Atma rupam tu yad vyaktam apayo laghuta punaha”
•According to Charaka avyakta lakshanas are poorva rupa of vata vyadhi. According to chakrapani commentary on avyakta, few mild early symptoms are to be taken as poorva rupa.
•
ROOPA
•Charaka has given the following definition. A condition where the pain starts initially from kati, then the waist, back, thigh, knee and calf muscle are gradually affected with stiffness pain and pricking sensation and associated with frequent twitching is called “GRIDHRASI”.
•Susrutha define, Gridhrasi limiting the affected part.
•Synonyms of Gridhrasi:-
• Rhinghini, Rhandrini, Radhana.
Definition:
Sciatica is a type of neuritis characterized by severe pain along the path of sciatic nerve or its tributaries.
•Charaka classified Gridhrasi into two verities.
1) Vataja 2) Vata kaphaja
Samanya lakshana:
•Kati prista Uru Janu Jangha pada-Stamba Ruk, Toda,Muhuspandana, Kati Uru madhye bahu vedana, Pain in payu.
•
Specific Vataja:
•Dehavakrata,toda, Stabdata, Janu Jangha uru sandhi spurana, Suptata
Specific Vata Kaphaja:
•Tandra, Gaurava, Arochaka, Vahnimardava, Mukhapraseka, Bhaktadwesa, Staimitya
Clinical features of sciatica:
•Pain, Reduced mobility, Neurological Signs, S.L.R.(straight leg raising test), Lasegue maneuver: flexing at hip &extending at knee.Crossed S.L.R. indicates severe disc prolapse.
•Symptom sakthnaha kaseshepam nigrahaneeyat is identical to S.L.R.
•Deha vakrata is nothing but sciatic scoliosis.
•Suptata refers to parasthesia.
•
SAMPRAPTHI GHATAKAAS
•Dosha : Vata : Vyana vayu, Apana vayu
Kapha : Sleshmaka kapha
•Dushya : Rasa, Rakta, Mamsa, Asthi, Kandara, Snayu
•Srotas : Chestavaha, Sangnavaha
•Sroto dusti prakara : Sangam
•Agni : Jataragni, Dhatwagni
•Udbhavasthana : Pakwasaya
•Sanchara stana : Prista vamsha
•Adhistana : Spik, Kati, Prista and Adhosakha
•Rogamarga : Madhyama
•
UPADRAVA AND SADHYASADHYATA
UPADRAVA:
“Roga arambaka dosha Prakopa janya anya vikara”
•Upadhrava is the complication produced in a disease, which develops after the formation of main disease.
•In practice the following things may be considered as upadravas
•Khanja vata
•Sosha
SADHYASADHYATA:
•Susrutha considered vata vyadhi as mahagada due to its tendency to be incurable of fatal. Vagbhata calls it as maharoga. Most of the acharyas have told that vata vyadhi, generally are very difficult to cure.
SAPEKSHA VYADHI VINICHAYAM
•Many of the diseases have resemblance with one another as the symptoms are concerned. But their line of treatment differs basically. Chikitsa should be started after confirmation of disease by differential diagnosis.
•Gridhrasi has to be differentiated from the following to arrive at a diagnosis.
1) Urusthamba 2) Kanjha 3) Pangu
4) Kalaya kanja 5) Gudagata vata 6) Khalli
•
CHIKITSA
•Samprapthi vigatanam is termed as Chikitsa.
•Susrutha recommended siravyadha as the first line of treatment in Gridhrasi.
•Chakradatta has given the treatment of Gridhrasi in detail. He stressed that vasti should be administered after proper Agni deepana, ama pachana and urdhva sodhana.
“Gridhrasyartham param samyagrekene vamanene vaa
gnatva viramam deeptagnim vastibhisamupachereth”{Bha.Pra}
•Bhava Prakasha advised vamana and virechana before administration of vasti.
•
•
MANAGEMENT OF SCIATICA
A) Conservative treatment:
1) Rest: Complete rest in bed supine position for 3-6 weeks.
2)Medication: Analgesic, anti-inflammatory and occasionally muscle relaxant medication.
3) Heat and cold:
4) Traction: Traction has also been used over the centuries to treat low back pain on the theory that stretching the muscles and separating the vertebra will have positive effects on the disc.
5) Exercise:
6) Miscellaneous forms: 1) Trans cutaneous electrical nerve stimulation (TENS)
2) Epidural steroid.
B) Surgical treatment: Before considering surgical intervention C.T. scan, M.R.I., Myelogram or other useful investigation must be done to localize the lesion.
•
DRUG ASPECT
•Gridhrasi is mainly caused due to asthi dhatu kshaya(degenerative changes)
SELECTION OF THE DRUG: In the present clinical trail, the drug selected is orally ADITYA PAKA GUGGULU Dashamula kashya as Anupanam along with YOGA VASTI (Earanda Niruha vasti and Balaaswaganda taila Anuvasana vasti).
•“Adityapaka guggulu”{Vangasena Vata vyadhi Prakaranam}-guggulu is considered as best vatahara drug. Moreover the ingredients pose Rasayana, Deepana, Pachana properties. Indeed Rasayana dravya enhance the assimilation of all dhatus including Asthi dhatus.
•The Deepana Pachana properties of dravya increase Jataragni perhaps Asthi Dhatwagni and also pacifies kapha.
•“Vasti vataharanam srestam” Anuvasana vasti with Balaaswaganda tailam{Sah. Yog} and Earanda Niruha vasti {Charaka Siddhi 3} with Earanda tailam has been taken for trail.
ADITYAPAKA GUGGULU
•Reference : Vangasena vata vyadhi adhikaranam
•Ingredients : Amalaki, Haritaki, Vibithaki, Pippali each1 pala, Twak and Ela each 1/2 pala, Guggulu 5 pala and Dasha mula kwath 2 times to all drugs.
•Dose : 2 tab t.i.d for 40 days
•Anupana : Dashamula kashaya 30 ml.
•Indications : All vata rogas.
•
BALA ASWAGANDHA TAILAM
Reference : Sahasra Yogam Taila Prakaranam.
For Anuvasana vasti Balaswaganda tailam : 120ml
•EARANDA NIRUHA VASTI
•Reference : Charaka siddhi stana 3rd chapter.
•Preparation of kashaya
Take kashaya dravyas and 2 Adakas water placed in a bowel and kept on flame till the water reduces to 1/8 part, there by the kashaya is prepared.
Kalka dravyas eacch 1 karsha.
•Saindava lavanam : 5-10gms
•Madhu : 30ml
•Tailam : 60ml
•Kashayam : 300-500ml
•Gomutram : 150-200ml
•Total Quantity : 600-800ml
•Indications :
All vata vyadhi, Shoola, Ashmari, Arshas Grahani etc.,
•ADMIINIISTRATION OF VASTI
•
AMALAKI HAREETAKI VIBHEETAKI PIPPALI TWAK
GUGGULU ASWAGANDHA BALA SAINDAVA EARANDA
LAVANAM
KUTAJA
BEEJA CHANDANA MANJISTA DURVA YASTI MADHU
•
SARIBHA USHEERA MUSTA KUSTA AGARU
HARIDRA GOMUTRAM SATAHWA KUMUDA GUDUCHI
PUNARNAVA ARAGVADHA MADHANAPHALA HAPUSHA VACHA
•
RASANJANA BILWA AGNIMANDHA SYONAKA PATALA
KASHMARI GOKSHURA VIDHARI GANDHA RARANDA MULA
ADHITYA PAKA GUGGULUY
•
MATERIALS AND METHODS
Aim of the study:
•The present clinical study to know the effect of Adityapaka Guggulu and Yoga vasti in the Gridhrasi vata.
Location of study:
•The cases for the study and clinical trails were selected from in patients and out patients department of P.G unit, Kayachikitsa, Government Ayurvedic Hospital, Erragadda, Hyderabad.
•30 cases were selected and studied.
Inclusion criteria:
•Gridhrasi diagnosed according to classical signs and symptoms, and also Radiological investigations.
•Patients of age above 20 and below 60.
•SLR test positive.
Exclusion criteria:
•Proven cases of Malignancy.
•Congenital abnormalities in lumbar spine.
•Known cases of tuberculosis.
•Pregnants
•History of trauma causing fractures.
•Surgical indications such as progressive neurological deficit, bilateral signs and symptoms of bowel and bladder involvement.
•
Subjective Parameters:
•Separate grading has been given for subjective assessment parameters that include the following.
•1) Sthamba, 2) Ruk, 3) Toda, 4) Spandana, 5) Daha, 6) Pain in payu, 7) Deha vakrata, 
Sosha, 9) Vibandha, 10) Aruchi, 11) Gourava, 12)Agnimandya,
13) Tandra, 14) Suptata.
Objective parameters:
•Numerical Rating Scale (NRS)
•S.L.R. Test
•Oswestry Disability index (ODI)
Diagnostic criteria:
•The parameters for diagnosis are completely based on classical symptoms.
•The test for sciatica like Straight Leg Raising Test (SLRT) was considered.
•X-ray lumbo sacral spine AP-view was done to exclude and include in the study.
Investigations:
–CBP, ESR, Routine Urine examination for sugar and albumin.
•
Research Design: