Madhu Sudhana Kulkarni

CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU BY DR. MADHUSUDHANA KULKARNI B.A.M.S. DISSERTATION SUBMITTED TO RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE (AYURVEDA) IN KAYACHIKITSA GUIDE DR. M.A.HULLUR M.D. (Ayu.), B.A.M.S. (Int.), Ph.D. PROFESSOR DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI. DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI 2009 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “ CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a bonafide and genuine research work carried out by me under the guidance of DR. M. A. HULLUR, M.D. (Ayu.), B.A.M.S. (Int.), Ph.D. Professor, Department of Post-Graduate studies in Kayachikitsa, AYURVEDA MAHAVIDYALAYA, HUBLI. Place: Hubli Date DR. MADHUSUDHANA KULKARNI P.G. SCHOLAR DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI KARNATAKA Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a bonafide research work done by DR. MADHUSUDHANA KULKARNI in partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE (AYURVEDA) in KAYACHIKITSA. Place: Hubli Date: GUIDE Dr. M.A.HULLUR M.D. (Ayu.), B.A.M.S. (Int.), Ph.D. PROFESSOR DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI. KARNATAKA. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA, HUBLI CERTIFICATE  This is to certify that the dissertation entitled “ CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a bonafide research work done by DR. MADHUSUDHANA KULKARNI under the guidance of DR. M.A.HULLUR, M.D. (Ayu), B.A.M.S. (Int.), Ph.D. Professor, Department of Post-Graduate studies in Kayachikitsa, AYURVEDA MAHAVIDYALAYA, HUBLI. H.O.D PRINCIPAL DR. P.G. SUBBANNAGOUDA M.D. (Ayu) DR. S.J. DESHPANDE PROFESSOR AND HEAD AYURVEDA MAHAVIDYALAYA, DEPARTMENT OF POST-GRADUATE HUBLI, (KARNATAKA) STUDIES IN KAYACHIKITSA, AYURVEDA MAHAVIDYALAYA, HUBLI (KARNATAKA). DATE: PLACE: HUBLI Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Place: Date DR. (KARNATAKA) © RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES. Karnataka shall have the rights to preserve. COPYRIGHT DECLARATION BY THE CANDIDATE I here by declare that the Rajiv Gandhi University of Health Sciences. use and disseminate this dissertation / thesis in print or electronic format for academic / research purpose. SCHOLAR DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA AYURVEDA MAHAVIDYALAYA. MADHUSUDHANA KULKARNI P. HUBLI. KARNATAKA Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .G. Sri. It is my pleasure to express gratitude to my guide Dr M. Dr Rahul.Bannigol. Dr Prabhu and Dr.A. Dr. Sri.A.J. Dr Anita Halagatti. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Dr R. for his valuable guidance throughout my career as a PG Scholar.B. Acknowledgement i ACKNOWLEDGEMENT “Skills can impress but values can inspire” By this note I bow my head to ancient Rishis who sacrificed their whole life for upliftment of mankind and my grand father Sri Venkatarao Kulkarni who inculcated skills and values in my life. Dr. And also I am very thankful to my junior collegues for their enthusiastic support in completion of this work. Dr. Dr. of Post-Graduate studies in Kayachikitsa.K.A. Dr Anita Joshi.I.Gireesh.Joshi. Prabhakar Kulkarni. I will remain ever thankful to my senior friends.A Patil and Dr Itagimath Statistician KIMS Hubli for inspiration and guidance throughout my work.Prashant.B. Sivakumar. and My colleagues Dr. Professor and Head.Sanakal. PG Library and Librarians of UG Library. Srivatsa. Dr Tyagaraja C.R. Dr Pradeep Agnihotri. for his guidance and encouragement.G. Professor. Reshma who helped me in this study. Subbanagouda. which helped me to complete this dissertation work.Joshi.S. Dr. Dr. Librarian. I am grateful to Principal. I am grateful to my teachers Dr. Hullur. It is my privilege and pleasure to express my heartfelt gratitude towards Dr P.S. Dept.S.Manjunath Naik. Dr.B R Kulkarni. Dr.Nilesh. Dr Niranjan. It is my pleasure to thank Mr Rajashekar B Alagawadi. Dr Dhanvantari. Dr S J Deshpande and former principal Dr MA Kundagol for their encouragement and help. It fills my heart with joy when I dedicate this work to my beloved parents. Ayurveda Mahavidyalaya. College and Hospital staff.MADHUSUDHANA KULKARNI Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . I am thankful to Students of third professional BAMS 2008-09. Hubli. Place: HUBLI Date: DR. Acknowledgement ii This acknowledgement would remain incomplete if I do not mention my sincere regards to all subjects included in this study and also to those who helped me directly or indirectly to complete dissertation work. Yogaratnakara • G. . Susruta Samhita • A. . Charaka Samhita • Su.S. Kalpa Sthana • Vi.S. . Chikitsa Sthana • Si. .S. Nidana Sthana • Sh. . Sutrasthana • Chi. . .H. Madhava Nidana • B. .S.D.N. Shabda Kalpa Druma • V. . . Bhela Samhita • Sha. Sharangadhara Samhita • K. Siddhi Sthana • Ni. .R. . Shareera Sthana • Ka. Bhava Prakasha • Y.S.S. . Bhaishajya Ratnavali • Sh. . Abbreviations iii ABBREVIATIONS • C. Kashyapa Samhita • C. . Ashtanga Sangraha • A. Ashtanga Hrudaya • M.S.N.S. Vangasena • Su. . . Chakra Datta • Bh.P.R. Vimana Sthana Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . . . . .K. . Harita Samhita • B. . Gadanigraha • H.D. K. Student ‘t’ test Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .S . . Significant • ‘t’ . . Poorva Khanda • M. Abbreviations iv • Ut. Madhyama Khanda • U. Highly Significant • S .K. Uttara Tantra • P. . Uttara Khanda • ‘P’ . Probability • H. .K. The present study is a clinical study. Katibasti (Astakatwara Taila) along with Trayodashanga Guggulu in the management of Gridhrasi. Shamana. Erandamooladi Nirooha basti. Sciatica. Kativasti. Astakatwara. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu  . The present study proved that remarkable result were achieved in Group B with Eranda muladi Niruha vasti in Kala Vasti schedule followed by Trayodashanga Guggulu and Rasna Saptakam Kashayam than Group A with Kati Vasti followed by Trayodashanga Guggulu and Rasna Saptakam Kashayam. Abstract     v  ABSTRACT Gridhrasi is one of the Vatavyadhi and it is the commonest disorder found in clinical practice. where one group patients received Erandamooladi nirooha Vasti in kala vasti schedule (16 days) and another group received Kativasti for duration of 14 days. Vastikarma is the best treatment in Vatavyadhi and Kativasti is a Bahya Snehana procedure which specially pacifies Vata at Kati region which is the main site of pathology. containing of two groups each group of 15 patients. Rasna Saptaka. Shamanaushadhi ie Trayodashanga Guggulu along with Rasnasaptaka Kwatha was given to all 30 patients for duration of two months. Symptoms of Gridhrasi simulate that of Sciatica. Assessment was done before and after the treatment and results obtained were statistically analyzed. The study titeled as ‘Clinical management of sciatica (Gridhrasi) through Vasti and Kativasti along with Trayodashanga Guggulu’ is focused on the evaluation of the efficacy of Erandamuladi Niruha Vasti. Key Words: Gridhrasi. Annexure a. 165-167 10. References & Bibliography………………………………. 001-003 2.xxxvi b. Discussion………………………………………………… 142-162 8.xxxix Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Methodology……………………………………………… 098-116 6.xix 11. Objectives of the Study. Conclusion………………………………………………… 163-164 9.... Introduction………………………………………………. 117-141 7. Photographs and Graphs vii ..………………………………… 004 3.iv • Abstract v • List of Tables. Observations and Results…………………………………. xii .xi 1. Previous works done……………………………………… 005 4. Table of contents vi TABLE OF CONTENTS • Acknowledgement i . Summary…………………………………………………. Case proforma xx . Review of Literature……………………………………… 006-097 5..ii • Abbreviations iii . Master charts xxxvii . GRADING 109 19. VATAKAPHAJA GRIDHRASI LAKSHANA 48 6. PROPERTIES OF ASHTA KATWARA TAILA 100 14. DISTRIBUTION ACCORDING TO SEX 117 21. DISTRIBUTION ACCORDING TO EDUCATIONAL QUALIFICATION 118 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . CLINICAL FEATURES OF HERNIATED NUCLEUS PULPOSUS 81 12. PROPERTIES OF ERANDAMULADI NIRUHA 101 15. SIGNS ASSOCIATED WITH NERVE ROOT LESIONS 80 11. DISTRIBUTION ACCORDING TO OCCUPATION 118 24. SAMANYA LAKSHANA OF GRIDHRASI 44 4. 1. PATHYA IN GRDHRASI 60 9. PROPERTIES OF RASNA SAPTHAKA KWATHA 105 18. SAMPRAPTI GHATAKA 38 3. SHAMANOUSHADHI USED IN GRIDHRASI 58 8. PROPERTIES OF TRAYODASHANGA GUGGULU 104 17. HETU OF VATA PRAKOPA AND VATA VYADHI/ GRIDHRASI 26 2. List of tables vii LIST OF TABLES TABLE. DISTRIBUTION ACCORDING TO RELIGION 117 22. TYPES OF TREATMENTS 55 7. VATAJA GRIDHRASI LAKSHANA 46 5. PAGE CONTENTS NO NO. DISTRIBUTION ACCORDING TO MARITAL STATUS 118 23. PROPERTIES OF PANCHA KOLA CHURNA 99 13. PROPERTIES OF SAHACHARADI TAILA 103 16. APATHYA IN GRDHRASI 61 10. DISTRIBUTION ACCORDING TO AGE 117 20. List of tables viii 25. DISTRIBUTION ACCORDING TO SOCIO ECONOMICAL STATUS 119 26 DISTRIBUTION ACCORDING TO HABITAT 119 27 DISTRIBUTION ACCORDING TO ADDICTION 119 28 DISTRIBUTION ACCORDING TO PRAKRUTI 120 29 DISTRIBUTION ACCORDING TO SATVA 120 30 DISTRIBUTION ACCORDING TO SATMYA 120 31 DISTRIBUTION ACCORDING TO SARA 121 32 DISTRIBUTION ACCORDING TO SAMHANANA 121 33 DISTRIBUTION ACCORDING TO VYAYAMA SHAKTHI 121 34 DISTRIBUTION ACCORDING TO AHARA SHAKTHI 122 35 DISTRIBUTION ACCORDING TO DIETARY HABITS 122 36 DISTRIBUTION ACCORDING TO AGNI 123 37 DISTRIBUTION ACCORDING TO KOSTHA 123 38 DISTRIBUTION ACCORDING TO ONSET 123 39 DISTRIBUTION ACCORDING TO CHRONICITY 124 40 DISTRIBUTION ACCORDING TO TREATMENT RECIEVED 124 41 DISTRIBUTION ACCORDING TO SIDE AFFECTED 124 42 EFFECT OF THERAPIES ON RADIATING PAIN 134 43 EFFECT OF THERAPIES ON NUMBNESS 135 44 EFFECT OF THERAPIES ON LASEGUE’S SIGN 136 45 EFFECT OF THERAPIES ON SLR TEST 137 46 COMPARATIVE EFFICACY OF THERAPY ON DIFFERENT 138 PARAMETER 47 EFFECT OF THERAPIES ON DIFFERENT PARAMETERS IN GROUP A 139 48 EFFECT OF THERAPIES ON DIFFERENT PARAMETERS IN GROUP B 139 49 OVERALL IMPROVEMENT EACH SUBJECT IN GROUP A & GROUP B 140 50 OVERALL EFFECT OF THERAPY ON 30 SUBJECTS OF GRIDHRASI 140 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . PROCEDURE OF KATI VASTI 6. List of Photographs ix LIST OF PHOTOGRAPHS SL. MIXING OF NIRUHA VASTI 8. SHAMANOUSHADHI Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . PROCEDURE OF VASTI 9. NORMAL SPINE 2. MATERIALS OF NIRUHA VASTI 7. COURSE OF SCIATIC NERVE 5. DERMATOMES 4.NO PHOTOGRAPH 1. ABNORMAL SPINE CONDITIONS NERVE ROOTS AND ITS SUPPLY TO MUSCLES AND 3. List of graphs x LIST OF GRAPHS GRAPH NO CONTENT PAGE NO 1. AGE WISE DISTRIBUTION 125 2. SEX WISE DISTRIBUTION 125 3. RELIGION WISE DISTRIBUTION 125 4. MARITAL STATUS WISE DISTRIBUTION 126 5. OCCUPATION WISE DISTRIBUTION 126 6. EDUCATION WISE DISTRIBUTION 126 7. SOCIO ECONOMIC STATUS WISE DISTRIBUTION 127 8. HABITAT WISE DISTRIBUTION 127 9. ADDICTION WISE DISTRIBUTION 127 10. SHARIRIKA PRAKRUTI WISE DISTRIBUTION 128 11. MANASIKA PRAKRUTI WISE DISTRIBUTION 128 12. SATVA WISE DISTRIBUTION 128 13. SATMYA WISE DISTRIBUTION 129 14. SARA WISE DISTRIBUTION 129 15. SAMHANANA WISE DISTRIBUTION 129 16. VYAYAMASHAKTHI WISE DISTRIBUTION 130 17. AHARASHAKTHI WISE DISTRIBUTION 130 18. JARANASHAKTHI WISE DISTRIBUTION 130 19. DIET WISE DISTRIBUTION 131 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu List of graphs xi GRAPH NO CONTENT PAGE NO 20. DIETARY HABIT WISE DISTRIBUTION 131 21. RASA WISE DISTRIBUTION 131 22. AGNI WISE DISTRIBUTION 132 23. KOSTHA WISE DISTRIBUTION 132 24. ONSET WISE DISTRIBUTION 132 25. CHRONICITY WISE DISTRIBUTION 133 26. TREATMENT WISE DISTRIBUTION 133 27. AFFECTED SIDE WISE DISTRIBUTION 133 EFFECT OF THERAPY ON CARDINAL FEATURES OF 141 28. GROUP A AND GROUP B EFFECT OF THERAPY ON TOTAL SYMPTOM SCORE IN 141 29. EACH SUBJECT UNDER GROUP A AND GROUP B OVERALL EFFECT OF THERAPY ON CARDINAL 141 30. SYMPTOMS OF BOTH GROUPS Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Introduction 1 INTRODUCTION Arohamakramanam Jivito Jivito Ayanam (Ath.4/3/7) The aim of life is to awake, be alert and move towards the humble goal (Moksha). Ayurveda the science of life if followed and practiced appropriately keeps an individual hale and healthy. Due to the professional reasons, Conditions of the roads, life style, food habbits and physical stress can motivate a condition where in the locomotor system may be involved. Amongst these clinical conditions sciatica may also be produced where in a person feels difficulty in walking and if ignored it can cripple one’s life by damaging nerves of lower limb. Sciatica is a relatively common condition with a lifetime incidence varying from 13% to 40%. The corresponding annual incidence of an episode of sciatica ranges from 1% to 5%. A number of environmental and inherent factors thought to influence the development of sciatica have been studied, including gender, body habitus, parity, age, genetic factors, occupation and environmental factors. The body mass may have been associated with low back pain. Body height may be a risk factor for sciatica, although this appears to be significant only in males in the 50–64 yr age group. The incidence of sciatica is related to age. Rarely seen before the age of 20, incidence peaks in the fifth decade and declines thereafter 1. According to our classics Gridhrasi is a condition characterised by pain starts from kati and radiates down to Pristha, Uru, Janu, Jangha and Pada respectively. The term Sciatica is applied in a some what imprecise manner of condition in which pain is experienced in buttocks, back of thigh, back side of leg and outer boarder of foot. If sciatica is not treated early it will end up in severe motor and sensory deficits of lower limb 2. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Introduction 2 Sciatica can be correlated to Gridhrasi in which a person experiences pain all along the posterior aspect of the lower limb. It is one amongst Vata Nanatmaja Vikara and has been explained elaborately in Bhruhat Trayi. Scholars have specially defined and described Nanatmaja Vata Vyadhi, because Vata is strong and potent dosha and manifest abruptly and quickly and produces major defects and serious diseases and may require emergency management. In modern medicine Sciatic pain is generally managed by using anti- inflammatory drugs, musclerelaxants and traction. Chronic cases need weight reduction, exercises to improve abdominal muscletone and strength, correction of posture and working habits. In presence of neurological symptoms or deficits or intractable pain surgical intervention is needed. But the anti-inflammatory drugs are having many side effects like gastritis, hepatotoxicity, fluid retention etc. If doesn’t get relief, surgery is advised 3. Surgery is a costly affair and having their own post operative complications.   All classical treatises of Ayurveda have emphasized the importance of Bastikarma as the most effective therapeutic measure than any other such methods, prescribed for various ailments especially in the diseases occurring due to Vatadosha. Acharya Charaka has elaborately described the Bastikarma, its uses, complications, and its advantages in Charaka Samhitha. Sushrutha has elaborately described the Bastikarma procedures, about Bastiyantra, types of Basti, complications, management, etc in different chapters of Chikitsasthana. Sarangadhara Samhitha also has given much importance to Bastikarma. Yogaratnakara, Bhavaparakasha and Vangasena dealt the Bastikarma beautifully and added newer combinations to the Ayurvedic world for a better practice. Acharya Kashyapa equated the Bastikarma as Amrutam because of its wide applications even in both infants and Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu e. One group received Katibasti and other group received Basti with Kalabasti schedule. Kati which is supposed to be the place of pathology (L. modifications of Bastiyantra. Trayodashanga guggulu has been recommended by Chakradatta in the management of Gridhrasi. recent authors in Ayurveda have also elaborately explained the Bastikarma. Later. Introduction 3 old age. Katibasti a Bahirparimarjana Chikitsa helps in alleviating the Sthanika Vata and produces the Brumhana properties in the Sthanika region i. standardised measurements and easily practicable. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .region).S. In the present study. Minium of 30 subjects diagnosed with Sciatica (Gridhrasi) are selected and categorized into two groups of 15 subjects each. ¾ To assess the role of Basti along with the Trayodashanga Guggulu in the management of Sciatica (Gridhrasi).   Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Objectives of the Study 4 OBJECTIVES OF THE STUDY ¾ To study in detail Sciatica (Gridhrasi) according to modern and Ayurveda literatures. ¾ To assess the role of Kati Basti along with Trayodashanga Guggulu in the management of Sciatica (Gridhrasi). 5. 6. 2. Tripati J. Padmavati Venkatesh – A clinical study on Gridhrasi with special reference to its management through Nirooha Basti and Trayodasanga guggulu – A.K. In 1987 Govt. and Pakshaghata. In 1984 Gujarat Ayurveda University. – Study of systematic effect of Basti with special reference to Gridhrasi. Moradiya Ganasham – A comparative study on the role of Shodhana and Shamana therapies on Gridhrasi. In 1984 at Kerala Ayurveda University. Vishwachi. 3. Jamnagar. In 1990 Gujarat Ayurveda University.V. Ayurvedic College.Varanasi. Thiruvananthapuram. Jamnagar. In 1993 at B. Pavan Kumar – Concept of Gridhrasi in Ayurveda and Modern Medical Sciences and Its management by An Ayurvedic drug Rasona (Allium sativum). 7. Hydrabad. In 1985 Govt. Raipur. Pandit Ravishankar University. Narashimhachari – A study of effect of Chaturbeeja in Gridhrasi. 4.H. Srikant U. Ayurvedic College. Hubli.    Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Jamnagar. – In 2000 at RGUHS Bengalooru. 8. P. In 1990 Gujarat Ayurveda University. Kazi Mohammed – Role of Swedana in Gridhrasi. – Gridharasi mein Basti chikitsaka prayogik Adhyayan. Nandganonkar.M.U. Previous Work Done 5 PREVIOUS WORK DONE 1. – The management of Gridhrasi with Shephalica Ghanavati (Nyctanthesarbor trists). Historical Review 6 HISTORICAL REVIEW The origin and progressive development of any disease is incomplete without considering its historical background. Here ‘Vaatakrita’ word denotes Vatavyadhi.“I have removed the distressful disease reached through your legs. For the total coverage of historical aspect. Anukyam are the words used in many occasions to denote spine or back. Many disorders leading to impairment of movements of legs are known since Vedic period. Gridhrasi is not mentioned in any form. The word Prushta has been mentioned in many places in Rig Veda and Yajur Veda 4. Vata is addressed not to leave the body but bear the limbs till the old age 5. Hence an attempt has been made to trace the references regarding Vatavyadhi in general and Gridhrasi in particular and beginning right from Vedic Period. quote from Atharva Veda says.” In addition. Anukam. pelvis and Yoni to the spine from your Ushniha Nadi 8. it has been divided in 6 parts as below: I.” Spine and dorso-lumbar spine are named separately by the words Kikasa and Anukam respectively 9. and keep the Prushta healthy for 100 years. In Atharva Veda. Vedic period The disorders which impair the movement of legs are as old as the existence of human being as walking is an inevitable function since the existence of man on the earth to search for the food. the diseases are named involving spine etc. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Another hymn says. which is having the capacity to straight and erect the foot and responsible for unimpaired organs of the entire body” is also been found in Atharva Veda 6. “Keep the thigh of the body 100 years 7. In Vedas. Prayers saying “keep Ojus in Ooru spread in Jaghana and Prushta. knees. While in Atharva Veda the word ‘Vaatikrita’ is mentioned. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . II. “Yakshma” a disease condition described in detail in Vedas said to involve 15.16. Historical Review 7 Many disorders pertaining to voluntary movement of limbs are told in Vedic Literature under the terms Vishkanda. ™ In Kenopanishad the description given for Vayu as one which is always in motion and continuing efforts 19. qualities etc. Though the term Vishkanda mainly used to 10. With the help of this Nadi the Udana Vayu moves to and fro from foot and legs to head 23. which comes out piercing the skull 22. According . ™ In Prashnopanishad the anatomy of the spinal cord and its functions are depicted. Whereas Vyamsa was mentioned in Rigveda as the disorder.17 any part of the body including Prushta. In Atharva Veda also the association of weakness of Majja and pain legs is described 18. and Majja .13 Viskanda was mentioned along with Visra which means crushing the 14 limbs and Abhishochana (burning sensation). its locations. ™ Kathopanishad named the word Sushumna for spinal cord. On the basis of above Vedic descriptions it appears that many varieties of Vata disorders were prevalent during Vedic period which impair the movement of the legs due to pain and allied conditions. Ooru. Sroni. which hamper the movement or Gati. There are elaborate descriptions of the functions and types of Vata.to it Sushumna is one of the 101 Nadi going upwards. ™ Chandokyopanishad highlighted the Chala property of Vayu and described its association with body and movements 20. ™ Eeshopanishad also described it in a similar fashion. Asthi.21. Upanishad and Purana period Upanishads used the term Anukam for spine as similar to that of Vedas.11 indicate the impairment of shoulder joint in Atharvaveda and Taittereeya Samhita12. Gridhrasi is mentioned as one among the 80 diseases exclusively caused by the morbidity of Vata Dosha 29. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 25 Agni Purana also holds identical description . • An elaborate description of symptomatology and treatment of Gridhrasi is given in the 28th chapter of Chikitsa Sthana. Panini has mentioned Vata Kopa as well as Vata Shamana. He mentioned Vishnu as Adhidaivata for Pada. Samhita period Charaka Samhita: In Charaka. • In Charaka Sutra Sthana 14th Swedadhyaya Gridhrasi is said to be treated by Swedana procedures 27. He clearly mentioned in Marma Shareera that trauma on Kukundara Marma leads to sensory and motor loss of lower limbs and leads to disability (Vaikalyata). place and method of Siravyadhana in Gridhrasi cases. Sushruta Samhita: In Shareera Sthana. • In Charaka Sutra Sthana 5th Matrashiteya Adhyaya. III. The circulation is considered as the function of Samana 24. In Siravyadha Shareera he described the position. Historical Review 8 Brahma sutra reveals the importance of Vyana Vata as the one that resides in the joints and responsible for the movements of the joints. • Two distinct clinical varieties of Gridhrasi are mentioned in 19th chapter of Sutrasthana entitled Ashtodareeya Adhyaya 28. Pada and its joints. • In 20th chapter of Sutrasthana named Maharogadhyaya. Sushruta has described the structure of Prushta. Sushumna comes out through the lower orifice of Mastishka. at different places references related to Gridhrasi are available. He has given the term Vatiki for disorders of Vata. Padabhyanga is indicated in Gridhrasi 26. He described the clinical features of Gridhrasi in the same chapter. It appears that Dhamani indicates nerves in this context and stressed the adaptation of general Vataroga therapies for Gridhrasi. Kalaayakhanja etc. In Bhagnanidana chapter he made many original observations pertaining to Sandhimukta (Dislocation or Herniation) Kandabhagna (fracture). Historical Review 9 Sushruta has given much importance by allotting the first chapter of Nidana Sthana itself for Vatavyadhi. Bhela Samhita: The description of Vata its normal and morbid states in Bhela Samhita are almost analogous to Charaka Samhita in many respects. prognosis etc. Gridhrasi is described during indication of Siravyadha for Vatavyadhi Chikitsa 31. that is Siravyadha along with general measures of Vataroga. Unlike Charaka he added the use of some oral drugs like Shaddharana yoga. • In Sushruta Shareera Sthana 8th chapter Siravyadha’s site for Gridhrasi is indicated32. But varieties of Gridhrasi are not found. • In Chikitsa Sthana 5th chapter Maha Vatavyadhi Chikitsitam. • In first chapter Nidana Sthana. clinical features. His description pertaining to classification. Swedana. Vatavyadhi Nidana symptomatology and pathology of Gridhrasi has been described 30. Pangu. Sarvanga (which involves the entire body) Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . In Sushruta Samhita Gridhrasi has been described at three places. He described identical treatment for Gridhrasi. In addition to Charaka and Sushruta he observed the following:– He classified Vata disorder into two 1. Nasya. Lavana. of Sandhimukta suits for lumbar disc prolapse which is responsible for majority of sciatica cases. external measures and suitable environment etc. He portrayed some allied conditions like Khanja. Padadaha etc in Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . However the treatment of Gridhrasi is described some what different from his previous works. Though he declared the chapter exclusively for Gridhrasi. He mentioned many disorders Vatabhanga. Janu. he added Kroshthukasheersha. The clinical features of Gridhrasi is not found in available Bhela Samhita. Kati. Jangha. Harita was the first to give importance to Gridhrasi by naming 22nd chapter of Triteeya Sthana as Gridhrasi Chikitsadhyaya. Sandhi chyuti. Padaharsha. in which many portion. He cited Prushta Stambha and Oru Stambha also as disorders of Vyana Vata which are usually associated with Gridhrasi. Harita Samhita: He has allotted separate chapters for Amavata and Gridhrasi Vata. Gridhrasi as a disorder of Vyana Vata in specific is a contribution by him. Pangu along with Gridhrasi. Prushta as Ekanga Roga. In 24th chapter of Chikitsa Sthana some general and special measures of Vata along with Vatahara Taila are discussed.) (BH-SH-7/8). It is surprising to note that Samavega dana (carrying and giving or transmission of impulse) to Vidyut (electricity. Pana etc. Ooru. The treatment of Gridhrasi immediately after describing Raktagata Vata Chikitsa indicates its association with Rakta. are lost. Kampa. He described the association of destruction or Henanga and Adhikanga with Vata Roga. Khanja. He stressed the use of Bala Taila for Vasti. Ekanga (which limit to the involvement of a particular part of the body) He mentioned the disorders of Pada. in addition to Raktamokshana. He attributed some of the functions of the body to 16 Adhyatma Devata. Probably the description of Gridhrasi might have been lost from this chapter. Historical Review 10 2. Gatrashosha. Ajamodadi Choorna etc. His description on clinical features are brief but elaborated the treatment as Raktamokshana. However the general aspects of Vata and its Etiopathogenesis are discussed in Sutrasthana in similar lines as that of Charaka. Sweda. Kashyapa observed Asthi and Majja as sites of Vata which indicate the Prushta as Vata Sthana the involvement of which leads to Gridhrasi. IV. Shatavaryadi Choorna. Guggulu and Bala in the treatment of Vata disorders. and Vasti. Sangraha period Ashtanga Sangraha and Hridaya: Vriddha Vagbhata illustrated Vata its physiological and pathological states correlating the views of both Charaka and Sushruta incorporating his original observations in his work Ashtanga Sangraha. He elaborated the use of Sneha. He described the use of Lashuna elaborately indicating the use in Vata Roga in particular both for prevention and cure allotting a separate chapter in Kalpa Sthana. Sweda. Abhyanga. oral administration of specific drugs like Rasnapanchaka Kwatha. Historical Review 11 it. considering that all this disorders are originate from Rakta and Vata and having similarity in treatment. He has allotted separate chapters for Rasona Kalpa and Guggulu Kalpa in Kalpa Sthana. He advises Dahakarma is done only in cases refractory to the above treatment during describing the site. Gridhrasi and its managements are not found in his treatise but counted under 80 types of Vata Vikara33. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . He highlighted the use of Rasona. Kashyapa Samhita: In Kashyapa Samhita there is no specific chapter for Vata Vyadhi Cikitsa. Prasara. ™ In Sutrasthana chapter 36th Siravyadha Vidhi – site for Siravyadha in Gridhrasi has been told 36.e. Gati. ™ In Sutra Sthana 20th chapter Doshabhedeya. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . In Ashtanga Hridaya Gridhrasi has been described at following places. ™ In Nidana Sthana 15th chapter Vatavyadhi Nidana symptomatology and pathogenesis of Gridhrasi is described as alike to Ashtanga Sangraha 37. Madhava Nidana: Gridhrasi finds place in the chapter of Vatavyadhi Nidana. Vruddha Vagbhata has described the functions impaired in Gridhrasi are attributed to Vyana Vata. Prakopa and Prashama. He mentioned Gridhrasi in the disorders of Vata sited at Snayu which has not been observed by any of his previous Acharya. In Ashtanga Sangraha Gridhrasi has been described at three places. ™ In Sutra Sthana 27th chapter Siravyadhavidhi – site for Siravyadha in Gridhrasi has been indicated. In Nidanasthana 15th chapter Vatavyadhi Nidana. He has made fundamental observations pertaining to the role of Sheeta and Ushna Guna in the Etiopathogenesis of Vata resulting in to Chaya. He described the varieties of Gridhrasi i. Aakunchana. Utkshepana are performed by Vyana vata. pathogenesis and symptomatology of Gridhrasi has been described 35. Historical Review 12 He has specifically mentioned that the site of Vata at the lower part of the body. Regarding the description of Gridhrasi his description is analogous to Sushruta. Vataja and Vatakaphaja more elaborately than Charaka exhibiting his specialization of Nidana which facilitate appropriate diagnosis. Apakshepana.. Gridhrasi is included under 80 types of Vata Vikara 34. However this fact has been indicated in Sushruta Samhita also. While commenting on the functions of Vyana Vata he stated that Gati indicate Akunchana and Prasarana etc. Shastra Karma. In addition to these therapies he has contributed many original yoga and measures for curing Gridhrasi and allied conditions. Ekanga.. Rukshana.e. Sarvanga. Lepa. Historical Review 13 Cakrapanidatta: While commenting on Charaka he made the following important observations pertaining to Vata in general with special reference to Gridhrasi. Arunadatta: Arunadatta in his Sarvanga Sundari commentary on Ashtanga Hridaya defines clearly that due to Vata in Kandara the pain is produced at the time of raising the leg straight and it restricts the movement of thigh. In his work called Cakradutta he presented the views of both Charaka and Sushruta in the context of general therapies of Vata and Gridhrasi. He prescribed Karshana Chikitsa. Dagdha Karma. This is an important clinical test now a days for the diagnosis of sciatica known as Straight Leg Raising Test. Deepana. Vasti preceeded by Urdhva Shodhana. 2. and Raktamokshana etc. Shodhana. Vangasena Samhita: Vangasena followed Madhavakara in description Nidana and Cakradutta in describing Chikitsa. Pachana drugs for Gridhrasi at the beginning and then Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . He was first to describe the line of treatment of Gridhrasi in very detailed manner i. He had indicted the classification of Vata Roga into two 1. Shodhana.e. In this text treatment part of Gridhrasi has been explained at two places (1) 4th chapter Prayoga Khanda (2) 19th chapter of Kayachikitsa Khanda Dalhana: Dalhana Acharya made some observations pertaining to Gridhrasi while commenting on Sushruta Samhita as follows:- It appears that he considered Gridhrasi Nadi as Kandara stated by Sushruta. He mentioned that Gridhrasi is termed as “Randhrini” by lay people. While commenting on Gridhrasi Chikitsa he indicated Shonita Mokshana is to be performed only after adopting general therapies of Vata disorders. Lepa. Sharangdhara Samhita: Sharangdhara mentioned Gridhrasi among 80 Vata disorders. He termed it as Maha Snayu which runs from lumbar region to Gulpha. Gadanigraha: Author has described the line of treatment of Gridhrasi in very detailed manner i. Raktamokshana etc. Historical Review 14 Ishtikasweda. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Shastrakarma. If pain and restriction of movement occurs in the upper limb the disease is called Vishvachi and similar presentation in lower limb termed as Gridhrasi. Upanaha and Shodhana.e. Indu: Indu mentioned in his Sashilekha Vyakhya on Ashtanga Sangraha that in Gridhrasi the symptoms are alike to Vishvachi. Dagdhakarma.. He stated that Siravyadhana is to be adopted in two or three places followed by Gunja Kalka Lepa for immediate relief. legs are forty two like Vataraktaja etc. Vasti preceded by Urdhva Shodhana. He mentioned that the disorder of Charana i. which suits to Gridhrasi also. Dhanyamla Avagaha Sweda. Sahasrayogam: It is compiled by an unknown author or authors containing description of numerous preparations particularly used traditionally in Kerala. Visvachi. Panchasneha. Narasimha Choorna etc. Khanja and Ooru Stambha in the list of Balavattara Vata disorders. Abundant Yoga for Vata disorders. Dhanvantara Taila. Historical Review 15 Adhamalla. Rasonadi Kashaya. Some people call it as “Radhi” also. Rasnaerandadi Kashaya. Karpasasthyadi Taila. Gridhrasi and allied conditions can be found in this text. Yogaratnakara: The author elaborated stage wise therapeutic measures for Vata disorders in general. Prominent among them are: Sahacharadi Kashaya. the commentator on Sharangdhara Samhita stated that the Gridhrasi is popularly known. Ashtavargam Kashaya. Gridhrasi. He observed that Visvachi also similar to Gridhrasi situated in arm. Rasaratna Samucchaya: It deals treatment of Gridhrasi in its 30th chapter. He described many preparations though are similar to previous works. Pangu. Khalli. Avartita Ksheerabala Taila. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Basavaraajeeyam: He included Kalaya Khanja. Prabhanjanavimardana Taila. Bhavaprakasha: Bhavamishra told the symptoms and treatment of Gridhrasi including the disease in eighty types of Vata Vikara. V. He classified them into two: (1) Sadyobhavita and (2) Kalantarabhavita. Gananathsen in his outstanding work Siddhanta Nidana described Gridhrasi in 6th chapter along with Shula.S. Vaidya C. Varrier in his works Ashtanga Shareera and Brihat Shareera coined many words in Sanskrit to describe Anatomy absorbing the results of observation made by modern anatomists. Dr. Vaidyaratnam P. Prominent among them are Bhaishajya Ratnavali. He has recommented Shirovasti and Agnikarma in Gridhrasi chikitsa. “Antara Kandaraangulyo Shirovastyagnikarma Ca”. Mahamahopadhyaaya Pandit Gananath Sen.e. In subsequent Sangraha Grantha and treatises many more effective yoga have been described for Vata disorders and Gridhrasi. He considered the Gridhrasi is of Vranashotha involving Gridhrasi Nadi. He described Gridhrasi Nadi and associated structures in his works similarly Gananathsen in his Pratyaksha Shareera also described anatomy in the same manner. Varier.S. Historical Review 16 Gangadhara: Gangadhara made some important observations particularly in Gridhrasi Chikitsa. Vaidya Hariprapanna. Prominent among them are. The Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . He has taken into consideration a Pathaantara of Charaka in the particular context i. In Abhighataja Shula he mentioned Asthi Bhagna which is caused due to trauma. He described it under Vranashothaja Shula. Pandit Taranath.. Recent Ayurvedic Authors Views: In the beginning of last century influenced by the developments in modern medicine some Ayurvedic experts attempted to enrich Ayurveda without loosing its basic concepts. Vaidyaratnam P. Dwarakanath etc. There may be many pain management physicians who would agree with those sentiments today. early frustrations with difficulties in identifying a cause of and treating sciatica were expressed by Fuller in his book Rheumatism. Rheumatic Gout and Sciatica (1852). to describe pains or ‘ischias’ felt around the hip or thigh. He also noted that pain radiating to the foot was a good prognostic sign. Pindikodweshtana are mentioned in Kriya Vaishmya Shula. sciatica was thought to be due to a variety of rheumatic conditions causing inflammation of the sciatic nerve. Hippocrates himself referred to ‘ischiatic’ pain affecting men between 40 and 60 yr. He observed that young men described pain that lasted about 40 days before resolving spontaneously. Nadi Dourbalyaja Shula is described by him in the same chapter which indicates root pains. He stated ‘the history of sciatica is. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . By the 19th century. it must be confessed. The gradual onset is stated to be due to Vranashotha (abscess) Peshi Sankochana. VI. but not vice versa. Review of Sciatica The ancient Greeks were familiar with sciatic neuralgia and used the term ‘sciatica’. He observed that sciatica could be continuous or intermittent and noted that continuous pain could become intermittent. The Italian anatomist Domenico Cotugno (1736–1822) wrote the first book on sciatica in 1764 and for many years it was known as Cotugno's disease. He was the first to distinguish sciatica due to nervous disease from the aching pain associated with low back pain. Historical Review 17 Sadyobhavita are due to direct involvement of Sanjnavaha nadi by Urdwejana indicating irritation or compression. However. whereas localized hip pain was less likely to resolve. the record of pathological ignorance and therapeutic failure’. He considered the possibility that these ‘tumours’ could in fact be prolapsed disc material. The concept of prolapsed disc material causing pain was later revisited by Mixter and Barr who reviewed the pathology of all excised chondromas of the spine held in the Harvard Medical School pathology museum. who felt that pressure on a nerve would lead to loss of function rather than pain. however. Of 16 specimens reviewed. the neurosurgeon Eslberg (1931) described removal of cartilaginous ‘tumours’ from the spinal canal. Historical Review 18 The intervertebral disc was first implicated as a causative factor in sciatica in the early 20th century. the first patient with a preoperative diagnosis of ‘ruptured intervertebral disc’ was operated on in the Massachusetts General Hospital. This idea was challenged by Kelly. It led to an active research programme that is still ongoing38. Schmorl and Andrae (1929) described posterior disc protrusions seen at post-mortem studies. They concluded that sciatica and neurological sequelae were due to protrusion of normal disc material. causing sciatic type pain. with subsequent improvement of symptoms. comparing them with normal disc material. Six months later. The presence of pain was initially ascribed to pressure on nerve roots. Around the same time. Lindahl and Rexed found evidence of an inflammatory response on lumbar nerve roots at laminectomy leading to the theory that prolapse of an intervertebral disc may provoke an inflammatory reaction in lumbar nerve roots. was initially rejected. therefore. pain must arise by a different mechanism. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 10 were judged to contain normal disc material. In an early surgical management of sciatica. the prolapsed intervertebral disc has been irreversibly linked with the pathogenesis of sciatica. This idea. This led to the landmark paper published in the New England Journal of Medicine and since then. but did not link these with sciatic pain and concluded they were probably asymptomatic in life. 1 Gridhramapisyati.e. Following derivations are taken from the different text books in Sanskrit literature substantiates the same. and strive after greedily on eager for. 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.e. hence the name Gridhrasi to this pain dominant malady. This word is also formed in another grammatical method as “Grudhr+ So Atonupasargah” – Adding “Kah” Pratyaya leads to Gridhra + So + Ka. It is opined that. By this Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . ‘Syati’-as-‘Kshepana’. further by Lopa of ‘O’ and ‘K’ and ‘Sha’ is replaced by ‘S’a’ by the rule ‘Dhaatvaadeshu S’ah Sah’ to get the word Gridhraus. Etymological Derivation 19 ETYMOLOGICAL DERIVATION OF GRIDHRASI Vyutpatti: 39 The word Gridhrasi is in feminine gender which is derived from the Dhatu “Gridhu” that means to covet. By the 40 rule of “Susudhadhri Dhibhyah Krammam ” as well as by adding “Run” Pratyaya i. “Grudhr” is derived. Grudh + Krun followed by Lopa of “K” and “N” the word Grudh + Ru i. 2 “Orusandhau Vatarogah 41” 3 “Gridhramiva Syati Gacchati”. Finally for this word Gridhraus which is in female gender by adding ‘Dis’ Pratyaya the word ‘Gridhrasi’ is derived. desire. in this disease the patients gait becomes altered as his legs becomes tense and slightly curved due to pain resembling walk of the vulture. The disease Gridhrasi is said to cause an abnormal throwing action in the affected leg... Gridhra refers to the bird Vulture. The Sanskrit word Syaati in Gridhrasi means throwing action. Gridhrasi is Rheumatism affecting the loins. Further the author of Amarasudha opines that this disease is characterized by morbidity of Vata Dosha affecting the hip joint. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Sanskrit . According to another Nirukti. Paryaya: Following are the synonyms of Gridhrasi. These symptoms initially affect Sphik (buttock) as well as posterior aspect of Kati (waist) and then gradually radiates to posterior aspects of Ooru (thigh).45. Acharya Sushruta opines that there are two Kandara in the leg that gets afflicted. the word grudhra refers to desiring. eager for. In Monier Williams. Ruk (pain). Janu (knee). greedily.English dictionary it is said that. Gridhrasi is characterized by severe pain experienced by the patient and is similar to the one experienced by a prey of vulture while being eaten up. These two Kandara when gets afflicted with the Vata Dosha limits the extension of the leg. The two Kandara include the one extending distally from the Parshni to the toes. The reference from Shabda Kalpa Druma states that. Similar reference is also found in “Vaidyaka Shabda Sindhu” Paribhasha: As described by Acharya Charaka Gridhrasi is a Vatavyadhi characterized by Stambha (stiffness). Toda (pricking pain) and Spandana (frequents switching). Jangha (calf) and Pada (foot) 42. and other extending above from the Parshni to the Vitapa.44. This disease is known as Gridhrasi 43. great desire for. Etymological Derivation 20 abnormality the gait of the patients is said to resemble the gait of bird vulture and hence the name Gridhrasi to this unique illness. Compression of the nerve roots is the primary pathology of radicular pain in sciatica as referred by the word Radhina. More over according to the Shabdakalpadruma this term refers to Skhalana meaning displacement. Etymological Derivation 21 1. Ischalgia composed from the Attic Greek words. It indicates pressing. 3. (That means pain + buttock or hip). Derivation of Sciatica: The term Sciatica is derived from the neo-latin word Ischalgia. The word Gridhrasi was the only one name used to indicate this condition in almost all the treatises and subsequent Sangraha Grantha and occasionally with a suffix Vata make it Gridhrasi Vata. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Disc is the weakest point in the lumbar spine which tends to rupture causing sciatica as indicated by the word Randhrinee. indicates weak point or rupture. The other terms mentioned above are used only by commentators. Randhrinee (Dalhana) 47 This term is used by Dalhana while commenting on Shusruta. 2. It may be a mere coincidental observation that displacement of the soft annulus is the prime pathology of sciatica as referred by the word Ringhinee. compressing or destroying. Sciatica literally means pain in the lower buttock and upper part of the thigh. Radhina (Adamalla & Kaashirama) 48 This term is used by Adhamalla and Kaashirama in their Deepika and Goodhaartha Deepika commentary on Sharangdhara Samhita. Ringhinee (Vacaspatimishra) 46 The word Ringhinee means the disease that cause to creep or crawling or that makes a person to go slowly. thigh. spreading to the lower limb through buttock. pertaining to ischium i.e. the inferior dorsal part of the hip ..e. The term is used for the disease as well as the nerve. Afterwards as soon as the pathology came to light many words indicating the disease came into use i. calf till the foot or a disorder characterized by pain in the distribution of the Sciatic nerve.e.. Due to the observations made by Cutugno (1764) this was termed as Cutugno’s Disease. The word sciatica derived from Greek word Ischiadikas i. Etymological Derivation 22 Definition of Sciatica: The term Sciatica designates a syndrome characterized by the pain beginning in the lumbo-sacral region. Dissyndrome Pinched nerve sciatica Ruptured disc Herniated disc Disc protrusion Herniated disc pulposis Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The synonyms used for sciatica are numerous as follows: According to Greek & modern medicine in the 15th century the term Cyetica and Scyetyka were used to indicate this condition. In another point of view Nidana may be classified into two types as Samanya Nidana and Vishesha Nidana. Charaka 50 and Bhavaprakasha 51 have clearly mentioned the causative factors of Vatavyadhi. Prajnaparadha and Parainama. the factors that precipitate Prakopa of Vata can also be taken as the Nidana of Gridhrasi. This word either refers to etiopathogenesis of the disease in general or the etiology of the illness in particular. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The description of Nidana for all the disorders is not uniform in Ayurvedic literature.55. However.54. Astanga Sangraha and Astanga Hridaya etc. The Nidana factors of Vatavyadhi in general are also the Nidana of the Gridhrasi. but in Sushruta Samhita. This is followed by the specific treatment as per the etiopathogenesis of the disease. the causes of Vatavyadhi have not been clearly described. the Samprapti and clinical presentation is unique for each Vatavyadhi.53. Disease review 23 NIDANA The word ‘Nidana’ is used in Ayurvedic classics in a broad sense. This word is derived from the Sanskrit Dhatu ‘Ni’ which carries the meaning to determine. in these texts the causative factors of provoked Vata Dosha are available 52.56. From the perspective of treatment. as the exclusive Nidana of Gridhrasi is not elaborated. Since Gridhrasi is regarded as Vatavyadhi of Nanatmaja type. Nidana has utmost importance as the avoidance of etiological factor forms the first and foremost line of treatment. (Ni – Nishchaya Deeyate Jnanam). distinguishing them from one another. Description of Nidana is restricted to Samanya Nidana in regards to many other diseases 49. All the Nidana may be categorized into three groups as Asatmeindriyartha Samyoga. In relation to some of the diseases both Samanya and Vishesha Nidana are enumerated. Though the etiologies of all the Vatavyadhi are similar. Astanga Sangraha and Astanga Hridaya. in Charaka Samhita. the S’eeta Veerya articles cause the Prakopa of Vata. i. Rasatah: The various tastes of the dietetic articles. Eating before digestion of the previous meal also leads to Vata Prakopa. Matratah: Less eating or fasting comes under this heading. which lead to the prakopa of Vata iii. vii. v. the excessive use of which lead to the Prakopa of Vata have been included in this group. iv. Dravyatah: In this group all the dietetic articles responsible for Vata prakopa have been included. Mithyopayogatah: The violation of the rules like. the root cause of Vatavyadhi is mentioned as either Dhatu Kshaya or Margavarana 57. not to drink water when thirsty or not to eat when hungry also lead to Vata Prakopa Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . vi. Veeryatah: For instance. All the etiological factors of Vatavyadhi as well as Vata Prakopa are taken as Nidana of Gridhrasi and the same is elaborated in the following subtitles. Karmatah: Excessive use of Vishthambi article may lead to the Prakopa of Vata and it has been included under this heading. Disease review 24 In addition to this. Seeta etc. Gunatah: This group includes the quality of dietetic articles like Rooksha.58.59. Kalatah: The Vata Prakopa occurs at the end of digestion. ii. A) Aharaja (dietetic factors) B) Viharaja (behavior factors) C) Agantuja (external factors) and D) Anya Hetuja (miscellaneous factors) A) Aharaja: The causative dietetic factors included under this group have been again subdivided into the following 8 groups. viii. I. II. (1) Mithyaprayogatah: The faulty habits of the body or improper use of body which may lead to the Prakopa of Vayu have been included under this heading.1. (2) Atiyogata: The excessive usage of the Karmendriya or the parts of the body which cause Prakopa of the Vayu have been included under this heading. The details of the causative factors are enlisted in table no. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Kalatah: The periodic factors responsible for Vata Prakopa have been included under this heading. Karmatah. Kalatah. II. Disease review 25 B) Viharaja: The causative factors related to the habit and regimen of the patient have also been subdivided into two groups viz. b) Manasika: The psychic factors responsible for Vata Prakopa have been included under this heading. C) Agantuja: External factors like trauma leading to Vata Prakopa have been included under this heading. D) Anya Hetuja: 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. a) Kayatah: The etiological factors of Vata related with the body have been further subdivided into the following sub-groups. I. Karmatah: Such habits of (a) Kayatah (somatic) and (b) Manasika (psychic) which lead to the Prakopa of Vayu have been included under this heading. . . + . - Shaluka (Nelumbium speciosum) . + . + . - Mudga (Phaseolus mungo) .H. .S. Disease review 26 Table No. B. - Nishpava (Dolichos lablab) .P AHARAJA (Dietetic causes) I. - Chanaka (Cicer arietinum) . . + . . . Su. - Shyamaka (Setaria italica) . - Tumba (Lagenaria valgaris) . - Harenu (Pisum sativum) . - Uddalaka (A variety of Paspalum Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . + . - Kalaya (Lathyrus sativus) . - Kariya (Capparis decidua) . . + . + . - Shushka shaka (Dry vegetable) + . + . + . . + . + . . . - Trunadhanya (Grassy grain) . . - Bisa (Nelumbuo nucifera) . - Chirbhata (Cuccumus melo) . . . 1: Hetu of Vata Prakopa and Vata Vyadhi / Gridhrasi: Causes Ca. - Neevara (Hygroryza aristata) . + . A. . + . - Koradusha (Paspalum scrobiculatum) . - Jambava (Eugenia jambolena) . + . + . . . - Masoora (Lens culinaris) . + + . . + . - Kalinga (Holarrhena antidysenterica) . - Tinduka (Diospyros tomentosa) . + . + + . A. . Dravyatah (Substantial) Adhaki (Cajanus cajan) . Matratah Abhojana (fasting) + + . + + + + Katvanna (acrid taste) . + . + + - Sheetanna (cold diet) + . . + . + . Karmatah Vishthambhi (constipative diet) . - Varaka (Carthamus tinctorius) . Rasatah Kashayanna (astringent taste) . + + + + Pramitashana (Taking food in improper time) . . + + + Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . + . - V. . - Jeermanta (After digestion) . . . + + + + Tiktanna (Bitter taste) . + . + Alpashana (dieting) + . + + . Veeryatah Sheeta . - III. + . - VI. + Gurvanna (heavy diet) . . + . . Disease review 27 scrobiculatum) . . - Viroodhaka (Germinated Seed) . . . - II. + + - Vishmashana (Taking unequal food) . Gunatah Rukshanna (ununctous diet) + + + + + Laghvanna (light diet) . + + + + IV. Kalatah Adhyashana (eating before digestion of Previous meal) . . - VII. . + . + . - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . . + . + . . . . . . + + . + . - Lohachalana (Shaking of metal) . + . . - Ashmavikshepa (Throwing of stone) . . . . Karmatah 1. + . Mithyayogatah Ashmabhramana (Whirling stone) . - Dukhasana (uncomfortable sitting) + . . + . . . . - Dukhashayya (uncomfortable sleeping) + . - Shilabhramana (Whirling of rock) . - Lohotkshepa (Pulling down metal) . - Ghadhotsadana (strong rubbing) . + . . - Lohabhramana (whirling of metal) . - Ashmachalana (Shaking of stone) . + . - Damyagaja nigraha (subduing untameable elephant) cow and horse . - Kashtachalana (shaking of wood) . . - Paragatana (Strike with others) . - Divaswapna (day sleep) + + . - Balavat vigraha (wrestling with superior healthy one) . + . + . . . - Lohavikshepa (Throwing of metal) . + . - Ashmotkshepa (pulling down stone) . + . . . - Kashtabhramana (whirling of wood) . - Kashtotkshepa (pulling down wood) . + . Disease review 28 (B) VIHARAJA (Behaviour) I. + . - Kashta vikshepa (throwing of wood) . . . - Vegadharana (Voluntary suppression of natural urges) + + + + + Vegodeerana (Forceful drive of natural urges) . . + + - Atipradhavana (Excessive running) + + . . + . - Atiraktamokshana (Excessive Blood letting) . + Atisthana (standing for a long period) . - Atiprabhashana (Continuous talking) . - 2. . . + . . . Atiyogatah Atigamana (excessive walking) + . . - Shilotkshepa (Pulling down rock) . + Atisrama (over exertion) . - Atipratarana (Excessive swimming) . . + + - Atilanghana (Leaping over ditch) + + + . . - AtipLavana (Excessive bounding) + + . . + . + + - Vishamopachara (Abnormal gestures) + . - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . + + . - Atihasya (Loud laughing) . . - Shilavikshepa (Throwing of rock) . . - Atiprapeedana (Violent pressing blow) . + . + . + . . . + + . . + + + - Atijrumbha (Loud yawning) . - Atikharacapakarshana (Violent stretching of the bow) . + . + . . . - Atiprajagarana (Excessive awakening) + + + + + Atiprapatana (Leaping from height) . - Bharaharana (Head loading) . Disease review 29 Shilachalana (Shaking of rock) . . . . Kalatah Abhra (cloudy season) . + + + Chinta (worry) + . + + - Kriyatiyoga (excessive purification therapy) . . . - Rathaticarya (excessive riding on chariot) . + Sheetakala (early winter) . + - Gajaticarya (excessive riding on elephant) . . . + Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . - Adyasana (sitting for a long period) . . + + + Padaticarya (walking long distances) . + . + . + Shoka (Grief) + . . + . + + - Greeshma (summer season) . + . - (B) Manasika Bhaya (fear) + . + + + + Apararatra (the end of the night) . - Turangaticarya (excessive riding on horse) . - Mada (Intoxication) . . . Disease review 30 Ativyayama (Violent exercise) + + + + + Ativyavaya (excessive sexual intercourse) + + + + + Atiadhyayana (excessive study) . - Shishira (winter) . + + + II. . . - Atyucchabhashana (speaking loudly) . + . . . . . + + . + + - Pravata (windy day) . . . - Aparahnna (evening) . - Krodha (Anger) + . + Varsha (rainy season) . + . + + . . + + . . + . . . - (D) ANYA HETUJA Ama (undigested article) + . . - Gaja. Disease review 31 (C) AGANTUJA Abhighata (trauma) + . . . . . . - Doshakshaya (depletion of Dosha) + . Ashvasrnghrayanapatamsana (Falling from speedy. + Margavarana + . running elephant. - Gadakrta mamskshaya (wasting due to disease) . . Ushtra. . . . . . - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . - Dhatukshaya (loss of body elements) + . - Rogatikarshana (emaciation due to disease) + . + Asrukshaya (loss of blood) + + + . . . . . camel and horse) + . the complete knowledge of its pathogenesis is a must. carrying heavy loads. They may not be able to produce the Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . According to Acharya Sushrut ‘Dosha-dushya sammurchhana janitovyadhi. Prishta etc. The disease process starts right from hetuSevanaa. There are two main reasons by which vata get vitiated. The word ‘Samprapti’ means ‘Samyak Prapti of Roga’ that is the proper understanding of the disease process. Disease review 32 SAMPRAPTI To treat a disease. Sphik. travelling in jerky vehicles. The actual manifestation of the disase occurs when the circulating vitiated Dosha get accumulated where khavaigunya is already present. exposure to mild but continuous trauma to Kati. Since Gridhrasi is a vatavyadhi. The process of manifestation of the disease by the morbid Dosha which are 60 circulating all over the body is known as Samprapti. the detailed samprapti has not been mentioned in Ayurvedic classics. Khavaigunya plays an important role in the disease process. improperly treated pelvic diseases are responsible for producing Sthanavaigunya at Kati. In Gridhrasi.’. the same nidana produce different vatavyadhi. For the disease Gridhrasi. This is because the presentation of the disease changes 62 according to the sthana where Dosha-dushya sammurchhana takes place . sphik region because of improper posture. Jati or Agati . The whole disease process is explained as ‘Shatkriyakalas’ by Acharya Sushrut. vitiating Dosha. They are Dhatukshaya 61 and margavarodha . digging etc or sometimes spinal cord injury. Because of the samprapti vishesh. the general samprapti of vatavyadhi along with specific description available are considered here for the explanation of samprapti. Here the intermediate steps of samprapti i. Rukshadi ahara cause shoshan of Majjaa Dhatu. Abhighata etc. In severe vataprakopa. Asthi Dhatu and vata Dosha have ashraya-ashreyi sambandha. Prasara etc. the disease may be produced. Sandhi are responsible for the movement of the limbs. upward lifting of the lower limb is affected. Among the five types of vata. In Gridhrasi. Also sometimes kapha is the anubandhi Dosha producing vatakaphaj Gridhrasi. Majjaa Dhatu to produce Gridhrasi. Also vataprakopaka ahara Sevana is the main cause of Asthivaha srotodushti 63. Abhighata leads to Dhatukshaya directly and vata provocation is liable to occur. Asthikshaya deals with vataprakopa. Majjaa is the deep seated sheha in the AsthiDhatu. Viharatmaka hetus like ativyayam etc. Also Abhighata may lead to Khavaigunya at the site. Basti etc. Obviously. Pakwashaya is the Udbhavasthana of the disease. Because of various hetus Apana is vitiated. Sakthiutkshepanigraha is the main sign i.e. Viruddha ahara. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . but after acquiring some vyanjaka hetu (exciting cause).e. are absent. Chaya. The vitiated vata may directly intermingle with Asthi. This clearly explains the involvement of Vyana vayu in the samprapti as these movements are governed by Vyana vayu. Disease review 33 disease at the instance. are the causes of Majjaavaha srotodushti which are commonly observed in the patients of Gridhrasi. Apana and Vyana vayu are mainly involved. Apana resides in the lower part of the body especially Kati. The agantuja factors chiefly Abhighata etc are responsible for the ‘achaya- purvak prakopa of Dosha. may cause Asthivaha srotodushti. Vata is the main culprit in Gridhrasi. Prakopa. Dalhana explain kandara as mahasnayu. vayu in its normal state. According to Vaidyak Shabdasindhu. which are the symptoms of Gridhrasi under the diseases produced due to dushti of snayu. It is also well known that the Prakopa of Vata may occur in two ways viz. supti. Probable samprapti ghataka are as follows - Dosha: Similar to any other Nanatmaja type of Vata Vyadhi. Samprapti Ghataka: Acharya have mentioned “Samprapti vighatanameva chikitsa” ie breaking of samprapti is chikitsa. Here we are trying to ascertain the factors involved in the samprapti of disease so that treatment will be successful.e. Also Charak has mentioned stambha. This can be correlated to the prolapse of interverteBral disc. Snayu are the nadis that conduct vayu. definite involvement of Vata Dosha in the pathogenesis is characteristic of Gridhrasi. it causes variety of diseases 65 Sushrut has quoted special variety of Sira called as vatavaha Sira. Acharya sushruta clearly mentioned the involvement of kandara in Gridhrasi64. 66 Charaka explains kandara as the upaDhatu of rakta Dhatu . due to Dhatukshaya and Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Snayu is the 68 upaDhatu of meda and mulasthana of mansa Dhatu . while coursing through its specific Sira helps the unobstructed performance of its specific functions viz. Chakrapani 67 mentions that kandara may also be considered as sthula snayu . sira and kandara 69. Bramsha of sandhi specifically in the vertebral column may be seen. sphurana etc. When vitiated vayu enters the Sira. According to Sushrut. in the senses. Disease review 34 sandhichuti i. which are the channels of movement of vata. Prasarana and Akunchana and produces clearness and non-illusiveness of Buddhi and the sense organs. . Gridhrasi Sakthiutkshepanam Nigrahneeyat is one of the cardinal symptoms to be found in Gridhrasi patients. this is afflicted in Gridhrasi. To be more precise. This Kshepana and Utkshepana etc. particularly in producing Vatakaphaja type of Gridhrasi. Acharya Sushruta opines that Kandara is affected by vitiated Dosha causing the Gridhrasi. As Gridhrasi is a disease. even Udana Vayu may involve in the pathogenesis as it is initiator for any work and Prayatna. accumulation of Kapha Dosha plays an important role. Though Prana situated in Moordha its functions extended to whole body including lower extremities which is one of the Karmedriya. which hamper the movement and Sakthi Utshepa Grahana. morbid Vyana Vayu is the primary cause of the illness. In the first instance. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Abhighata etc. Snayu is Moolasthana of Mamsa as well as Updhatu of Meda. Kandara is considered as Updhatu of Rakta. Pramitasana. Cakrapani says that Kandara may also be taken as Sthoola Snayu. Vyayama. Dooshya: The symptoms like pain at the Kati and Prshtha is suggestive of involvement of Asthi Sandhi. By this observation it is evident that out of five types of Vata. In the case of Margavarodha. In rare cases of Gridhrasi. Rooksha. The role of other Vata can not be ruled out as these types of Vata are mostly interrelated in their physiological functioning. there may be burning sensation along with pain. Oorja and Bala are its attributes. Disease review 35 Margavarodha. Pain in the leg radiating from the buttock to heal is suggestive of affection of Snayu Upadhatu. the Apana having its site in Kati and Sakthi. As described in SushutaSamhita. Laghu. activities are being attributed to Vyana Vayu. Nidana leads to direct Sanchaya and later Prakopa of Vayu. Seeta. which indicates even the involvement of the Pitta Dosha. legs and heal indicates the lower half of the body as the Sancara Sthana of the Dosha. Asthi is the site of Vata and there is an inverse relation between each other. Asthivaha Srotas Sroto Dushti: Free movement of the lower extremities leading to smooth ambulation is the Pravrutti of the legs. Agni and Ama:- Praseka. Sancarasthana:. Srotas: Vatavaha. For instance. increasing Vayu causes Asthikshaya which lead to the further Prakopa of Vata.Rasayanies and gridhrasi nadi. Inability to extend the legs affecting the gait is one of the predominant symptoms of Gridhrasi. The lack of these symptoms in Vataja Gridhrasi indicates that Agni is unaffected in this type of disease. Udbhavasthana: The invariable involvement of Vata Dosha in the pathogenesis of Gridhrasi reveals that the disease stems out from the Pakvashaya. Inability to move the limbs to its fuller extent is suggestive of Apravrutti. Arocaka. Here involvement of Asthi sandhi is evident by the symptom of Sakthiutkshepanam Nigrahneeyat. Distribution of symptoms like pain in the low back region extending up to the thigh. In addition to this the Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Bhaktadwesha are some of the distinguishing clinical manifestation of Vatakaphaja Gridhrasi and is indicative of JatharAgni Mandya. Disease review 36 On the other hand. These citations justify the contention that Sanga type of Srotodushti is characteristic of Gridhrasi. Similar to any other Nanatmaja type of Vatavyadhi Gridhrasi is also considered as Pakvashayodbhava Vyadhi. Kati Ooru.madhyama 12. Vitiated Vyana Vayu getting localized in these areas produces the symptoms. Khandara of Parshni. Janu and Pada region. Pada and Anguli are the Adhishtana of Gridhrasi. Needless to say these sites of pain is the Adhishthana of the disease. Roga marga . Gaurava and Tandra point towards the ubiquitous distribution of vitiated Dosha. Jangha.adaha shakha 11. Arocaka. To be more precise Sphik. Abnormal Vyana Vayu stemming out from the Pakvas’aya circulates in the lower part of the body and gets localized in the Kati Prshtha. Asthi and Rakta Dhatu involving the respective Srotas produces the severe pain originating in the Kati Prushta region radiating to Jangha. Disease review 37 typical symptoms of Vatakaphaja Gridhrasi like. Aruchi.chirakari Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 10. the specific etiological factors leads to the vitiation of Vyana Vayu. To sum up. Agnimandya etc. In addition to this in Vatakaphaja Gridhrasi there will be involvement of Rasa Dhatu as well as Annavaha Srotas causing the symptoms like Tandra. Here the Vyana Vayu afflicts the Snayu. Janu and Pada. Vyadhi swabhava . Jangha Prushta. Vyakta sthana . Prushta. Adhishthana:- Pain originating from the Kati Prishtha region radiating to Janu Jangha and Pada is the cardinal symptom of the disease. Mamsa. Disease review 38 Table No. uru. • Swabhava : Chirkari Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . jangha. Kapha. pada. Nadi • Agni : JatharAgni • Ama : JatharAgnimandyajanita • Udbhavasthana : Pakwashaya / Kati • Samcharasthana : Rasayani / vata vaha nadi • Adhisthana : Prishtha. sphik • Srotas : Asthi. vatavaha nadi • Srotodushti : Sanga • Rogamarga : Madhyam • Vyakta sthana : Sphik.Kati.2: Samprapti ghatak: • Dosha : Vata – Apana and Vyana vayu. Kati. janu. • Dushya : Asthi. prishtha. Toda etc.. Stambha. Disease review 39 Schematic Representation of Samprapti of Gridhrasi Nidana Excessive vatakara Dhatukshaya Marmaghata ahara vihara sevana karaka nidana Agantuja nidana Mandagni / Vishamagni Ama Vata Sanchaya Sthanasamshraya at kati. Jangha and pada thus producing shithilatha Sthanika vikruti of Asthi Dhatu Derangement of anatomy and physiology of Gridhrasi Nadi Gridhrasi Produces Ruk. prista. janu. along the distribution of Gridhrasi Nadi Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . uru. Acharya Charaka is of the opinion that. Vague low back pain. as the effective treatment at this stage definitely reduces the possible organic damage as well as degree of morbidity. This nature of the Poorvaroopa is described as Avyakta Lakshana. By the consideration of above cited general rule of Poorvaroopa in regards to Vatavyadhi. Gridhrasi being a Vatavyadhi. The development of these symptoms following excessive exercise straining the back. They occur prior to complete manifestation of disease and may suggest the forthcoming illness. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . the description regarding the Poorvaroopa of Gridhrasi is not available. in general the vague symptoms. or else direct trauma to the back are always corroboratory of Gridhrasi. In classics. mild discomfort in the lower extremities. or else any few symptoms of the respective Vatavyadhi in its minimal severity. that too in their initial stage are the Poorvaroopa. Poorvaroopa of this disease may be assumed. author of the Madhukosha commentary emphasize the vague nature of the Poorvaroopa. altered sensation in the legs and similar other symptoms of Gridhrasi in its minimal severity may be considered as Poorvaroopa. Diagnosis at this stage of the illness gains paramount importance. Even then few of the general citations in the classics pertaining to the occurrence of the Poorvaroopa in Vatavyadhi is worth mentioning. During the course of the Samprapti of an illness. Disease review 40 POORVAROOPA Poorvaroopa are indications of impending diseases. the morbid Dosha circulating ubiquitously in the body tend to localize in an area and produces some of the unique symptoms and is referred by the name Poorvaroopa. Whereas Acharya Sushruta and Acharya Vagbhata have added Sakthyutkshepanigraha to 71. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Pain starting from Sphik and radiating towards Kati. Janghaprushtha and Pada in successive order. it may be sub divided into two distinct categories (i) Samanya Lakshana (ii) Vishesha Lakshana i) Samanya Lakshana: These clinical manifestations are seen in both Kevala Vataja and Vatakaphaja type of Gridhrasi. have been stated as symptoms of Vatakaphaja Gridhrasi by Acharya Charaka. are specially categorized as Vatika Lakshanas in Bhavaprakasha. Considering all the clinical manifestations of Gridhrasi. where in it is clearly recognizable as all its characteristic signs and symptoms manifest. Mukhapraseka. Madhava Nidana and Yogaratnakara 74.. Other lakshanas like Tandra. Gaurava.77. Following are the Samanaya Lakshana of Gridhrasi. Similar references are available in textbooks like Madhava Nidana.75. Ruk and Toda are the two main words used to describe the character of pain in this disease. Disease review 41 ROOPA Roopa appears in the Vyaktavastha i. is the cardinal symptom of Gridhrasi. Ooruprushtha. Januprushtha. Bhavaprakasha and Yogaratnakara.e. fifth Kriyakala of the disease. Janu Ooru Sandhi Spurana etc.76. Some signs and symptoms like Dehasyapi Pravakrata. Arocaka. This is the unique stage of the illness. In addition to this Acharya Charaka has described 70 Stambha and Muhuspandana as the cardinal signs of Gridhrasi. Bhaktadwesha etc.72.73 the cardinal signs . e. As the movement of the legs worsen the pain. from buttock to heal. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Toda: ‘Todah Soocivyadhanavat Vyadha’ 82 ‘Toda Vicchinna Shoolam’ 83 Intermittent pain similar to the feeling of pin prick is known as Toda. Jangha and Pada 81 region is also considered as the symptom of Gridhrasi .. Stambha: ‘Stambha Nishchalakaram’ 84 85 ‘Stambha Bahu Ooru Jangha Deenam Sankochanadhya Bhavah’ ‘Stambha Nishkriyatvam’ 86 Stambha refers to the stiffness or rigidity felt at the thigh and legs and is another symptom of Gridhrasi. Kati. The restriction to move the legs also affects the gait of the patient.e. Non radiating pain felt at sites like. stiff muscles prevent this and there by manifesting as the symptom Stambha. Disease review 42 Ruk: ‘Ruk Satatam Shoolam’ 78 ‘Ruk Shoolam’ 79 ‘Ruja Vedana’ 80 In Gridhrasi Ruk or Shuoola i.. the site of Toda is similar to the site of Shoolam i. as his steps are short. pain starts from Sphik region and radiates till the Pada. pain is one of the prime symptoms and is felt throughout the lower limb. Ooru. Janu. cautious and slow. This typical radiating pain involving the legs is suggestive of sciatica syndrome modern parlance where pain is felt along the course of the sciatic nerve. Fasciculation may be present in lower extremities in patients of Gridhrasi. Some of these symptoms are indicative of vitiation of Pitta Dosha in Gridhrasi 92. Disease review 43 Sakthiutkshepanam Nigrahneeyat: ‘Kshepam Prasaranam Tam Nigrahanyat Avarudhyat Ityarthah’ 87 The movement Kshepana refers to extension. These symptoms include Shopha. Static or non-radiating pain is also characteristic of Gridhrasi. Ooru (thigh) and Janu (knee) region 89. Bhrama and Trishna.e. Kara Pada Vidaha Krit. Further the commentator Arunadutta very clearly defines this symptom as ‘Pada Udharane 88 Ashakti’ expressing the inability of the patient to elevate the legs. lifting is legs is affected in Gridhrasi. As the extension of the legs worsens the pain patient prefers to assume the flexed position of the legs. Patient of Gridhrasi is unable to extend his legs as extending the legs worsens the pain. To be more precise this symptom is seen in the muscle supplied by the sciatic nerve. Acharya Vagbhata opines that it is the Utksepana i. Katyooru Janu Madhye Bahuvedana: It is a distinct feature of Gridhrasi mentioned by Acharya Hareeta. this refers to the severe pain experienced at Kati (low back). Moorcha. Few of the symptoms of Gridhrasi are exclusively mentioned In Basavarajeeyam.. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Muhu Spandana: ‘Spandana Spuranam’ 90 ‘Spandanam Hi Kincit Calanam’ 91 Sphurana refers to the fasciculation. Sveda. Disease review 44 Table No. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .3: Samanya Lakshana of Gridhrasi: Lakshanas CS SS AS AH HS MN GN BR BP YR Sphik Poorva Kati Pristhooru Janu Jangha Padam Kramat Ruk + + + + + Sphik Poorva Kati Prushthooru Janu Jangha Padam Kramat Toda + + + + + Sphik Poorva Kati Prushthooru Janu Jangha Padam Kramat Stambha + + + + + Pashni Pratyanguleenam Tu Kandara Yanilardita + + + Sakthnaha Ksepana Nigrahneeyat + + + Kati Ooru Janu Madhye Bahu Vedana + Muhu Spandana + ii) Visesha Lakshanas: The unique symptoms of Gridhrasi that indicate either Vataja or Vatakaphaja Gridhrasi are described as Vishesha Lakshana. It is evident that the predominance of Vata Dosha or Vatakapha Dosha in the Sampraptti of Gridhrasi leads to the manifestation of Vishesha Lakshana. 96. Disease review 45 Vataja Gridhrasi: Here the Sampraptti of the Gridhrasi is characterized by the sole involvement of Vata Dosha.94. This gait is also typical in Gridhrasi. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . It may be lateral and forward bending of body. Hence the whole body is tilted on the normal side and he assumes the bending posture or limping. Suptata: The patient experiences varied degree of parasthesia or sensory loss in the affected limb. The patient of Gridhrasi keeps the leg in flexed position and tries to walk without much extension in the affected side. Dehasya Vakrata: Madhava described this symptom which means that patient of Gridhrasi acquires a particular posture due to pain.95. Following are the Vishesha Lakshana of Vataja Gridhrasi 93. Ooru. Sphuranam: ‘Sphuranam Gatra Deshe Swalpa Calanam’ 97 ‘Sphuranam Punah Punah Calanam’ 98 The symptom of fasciculation in Kati. Evidently there will not be association of Kapha Dosha in the Samprapti. Stabdata Bhrisham: The severe degree of stiffness is seen in patient suffering from Vataja Gridhrasi. Janu and Jangha are similar to the Spandana or Muhuspandana is characteristic of Vataja Gridhrasi. + Ooru Sandhi Spurana + + + + Jangha Sandhi Sphurana . + - Janu Sandhi Sphurana + + + + Stabdata Brisham + + + Suptata Brisham Vatakaphaja Gridhrasi: Involvement of Kapha Dosha in the Samprapti of Gridhrasi cause the below mentioned unique features 99.100. Disease review 46 Table No.101. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . manifests as a feeling of drowsiness or inability of sense organs to grasp their respective objects followed with yawning or even fatigue without doing any labour 104. Vahni Mardava: Sluggishness of the JatharAgni resulting in impairment of both Abhyavaharana as well as Jarana Shakti Tandra: “Tandrayantu Prabhodhito Api Klamayati Nidrabheda” 103 This occurs due to Kapha and Tama Dosha.102. .4: Vataja Gridhrasi Lakshanas: Lakshanas CS SS AS AH HS MN GN BP YR Dehasya Vakrata + + + + Toda + + + + Kati Sandhi Sphurana + + .105. Mukha Praseka: Mukhapraseka means excessive salivation in mouth is due to Kapha in associated with Ama. Arochaka: ‘Arocakastu Prarthite Apyupayogasamaye Anannabhilasha’ 107 ‘Aruci Prarthita Anna Bhakshana Asamarthyamucchyte’ 108 It is a subjective symptom where patient fails to appreciate the taste in the mouth irrespective of state of appetite. Due to Kapha vitiation patient feels as if his lower extremities are covered with wet cloth. Gaurava is the feeling of heaviness of the body in general or lower extremities particular. Staimityam: ‘Staimityam Gatranam Nirutsahatvam’ 110 Inertness of the body. Association of Ama is also contended in the causation of this aversion towards food. because the seat of Bodhaka Kapha is Jiwha which does Rasa Bodhana. Staimitya means timidness or frozen sensation. Needless to say this symptom is due to the morbid Kapha Dosha. feeling of freezing sensation in the affected lower limb. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . In comparison to the role of Vata Dosha involvement of Kapha Dosha has much to with the manifestation of Arocaka. Disease review 47 Bhaktadvesha: ‘Dveshamayati Yo Jantu Bhaktadvesha Sa Ucchate’ 106 Secondary to the sluggishness of JatharAgni and Kaphadusti patient of Gridhrasi develops aversion towards food. Gaurava: ‘Ardra Charmavanaddham Mivetyartha’ 109 Patient feels heaviness particularly in the lower limb or limbs. 5: Vatakaphaja Gridhrasi Lakshanas: Lakshanas CS SS AS AH HS MN GN BP YR Arocaka + + Vahnimardava + + + + Mukha Praseka + + + + Bhakta Dvesha + + + + Tandra + + + + + Gaurava + + + + Staimitya + + Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Disease review 48 Table No. diets and regimens which bring about happiness either by acting directly against the cause of the disease or it may produce such effect on the disease indirectly. Charaka says. Most of the Acharya has told that Vatavyadhi. if develops the complications like Shoona (oedema/inflammation) Suptatvaca (Tactile senselessness).anupashaya Sushruta considers the Vatavyadhi as Mahagada due to its tendency to be fatal or incurable. It is essential to know the Sadhyasadhyata of a disease before the treatment. Kampa (tremors) Adhmana (distension of abdomen with tenderness) and pain in internal organs. “A physician who can distinguish between curable and incurable diseases and initiate treatment in time with the full knowledge about the various aspects of the therapeutics can certainly accomplish his object of curing the disease. generally are difficult to cure. disease could be best differentiated by adopting Upashaya . Disease review 49 UPASHAYA. Sushruta mentions that a patient of Vatavyadhi. Upashaya is rightly called as exploratory therapy. Bhagna (fracture). When two or more diseases having identical symptoms are met (or encountered) in such conditions. ANUPASHAYA AND SADHYASADHYATA Upashaya are the medicines. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Vagbhata calls it as Maharoga. then he does not survive. Their description in various classics is as follows – Sushruta has elaborately described Upadrava of eight Maharogas including Vatavyadhi in general as well as that of Vata-vyadhi independently 111. Specific Upadrava of Vatavyadhi:- • Shotha • Suptata • Bhagna • Kampa • Adhmana If Vata Vyadhi co-exist with any of the above mentioned Upadrava then in such patient disease come under the heading of Asadhya (incurable) category. Disease review 50 UPADRAVA Upadrava are produced as a sequel of the disease proper. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Their emergence increases the graveness and complexity of treatment. Upadrava of Eight Mahavyadhi: • Bala Kshaya • Shvasa • Trishna • Mamsa Shosa • Vamana • Jwara • Murchha • atisara • Hikka If these are present then it is wise not to start any treatment procedure. But vata is an exception as vata vridhhi is to be treated by Tarpana and Kshaya by Langhana 114. Gridhrasi. Disease review 51 CHIKITSA Chikitsa is the counteraction of Ruja. Parisheka. riding etc should be avoided. • Shastra pranidana (Surgical intervention). Mardana etc. The process which establishes equilibrium in these body elements is Chikitsa 112. While treating any disease. Samshamna. For Gridhrasi. (Amarkosha). There is a general principle that Vridhhi of Dosha should be treated by Langhana and their kshaya with tarpana. being a vatavyadhi. Agnikarma etc. It is the process of breaking down the pathogenesis of a disease. the first and foremost principle to be followed is 115 to avoid nidana . Basti. Virechana. The therapeutic approach of Ayurvda can be broadly classified into two types. Samshodhana. Prakruti etc.Shastrakarma.Ksharakarma. If the Doshaprakopa is minimum langhana chikitsa. Shodhana therapy should be adopted . Bala. all the vataprakopaka hetus including external factors such as excessive walking. Nasya. the general line of treatment of vatavyadhy can applied to it. moderate Doshaprakopa Langhana and Pachana Chikitsa and if 113 Doshaprakopa is maximum. of the patient. Swedana. The treatment of a disease varies according to the morbid state of Dosha in the body. The samshodhana is an eleminative process of vitiated Dosha and includes: • Antah parimarjana (Internal purification) – Vamana. • Bahirparimarjana (External purification) – Abhyanga. Diseases are caused due to vitiated Dosha involving Dhatu etc. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . It signifies the action of Sneha on Asthi – Majjaa Dhatus which are involved in Gridhrasi. Swedana. But Taila is praised in vatavyadhi as it is having exactly 121 opposite properties as that of vata . Utsadana. External Snehana is done by Abhyanga. Sukhoshna Gandusha for the treatment of vatavyadhi 119. In Ashtang 118 Samgraha Hemant rutucharya is indicated in Vatavyadi . While mentioning the kala of Abhyanga. Vagbhata has stated that Sneha. Snehana Snehana should be done only in Nirupastambhita vata 120 by the word Snehana both external and internal Snehana is included. Snigdha. All the above Upakramas have their own qualities. Lavana. Sweda. Sneha pacifies vata. Avagaha etc. Mamsarasa and Anuvasana Basti pacify the vata . Ushna properties and upakrama like Snehana. Abhyanga. Parisheka. Amla. For internal Snehapana chaturvidha Maha Sneha are indicated. brings out softness in the body and removes Malasanga 122. Also when they are done in a proper sequence. Trasana. Lavana dravya. It acts on sparshanendriya which is the seat of vayu. Parisheka etc. Amla. Here is a quick look on these karma specifically in relation to vatavyadhi – Gridhrasi. Nasya. the therapy as a whole also has its benefits.   Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Mruda Samshodhana along with Madur. 123 Sushrut has stated that after 900 matras the Sneha can reach MajjaaDhatu . Among these he has praised asthapana and Anuvasana Basti as the best treatment for vata 116. AsthApana and Anuvasana Basti. Sneha siddha with Deepan 117 and Pachan drugs. Similarly Sushruta has advised shiroBasti. Disease review 52 Charaka has advised Dravya having Madur. Madya. SnaihikA dhumapana. Veshtana. Then drugs like Trivrut. helping the Dosha to travel towards their own Sthana. Virechana drugs have adhobhagaharana prabhava. Toda. diminishes Tandra . Nadi. Toda etc. Amla. are the main symptoms. Swedana liquifies the Dosha and expands the Srotas. Mrudu Samshodhana The Dosha which are not pacified by Snehana and Swedana should be 127 removed from the body. 125 clears Srotas. Ruk. Vatanulomana is necessary for the vayu obstructed by Mala lodged in srotas. are the various types of Swedanakarma 124. Snehana and Swedana bring the vitiated Dosha to koshtha. creates KoMalata. Charak says that it brings out the Mala from the body. eliminates the disease and adds years to ones life by improving the quality of life 129. Lavana. Hence Mrudu Virechana is advised for this purpose . Graha etc. increases the strength. In Gridhrasi Stambha. Stambha. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Ruk. Disease review 53 Swedana Snehanapurvaka Swedana is indicated in Nirama Vatavyadhi while only Swedana is indicated in Samavata vyadhie. It is to be done by Snigdha. Snehana and Swedana by virtue of their vatashamak and Dhatuposhak properties are useful in relieving the symptoms. Snehanapurvak Swedana relieves the symptoms such as Harsha. Shotha. It produces Mruduta in the body. It removes Dosha from Amashaya and Pakwashaya. Ushna drugs 130. Prastara. Charak says that proper Snehan and Swedana can make even dry wood flexible126. Snigdha Virechana is advised for vatavyadhi. Sankara etc. Aragvadha and Erand Taila should be used for virechana 128. Swedana activates Agni. Ruchi. removes Dosha from all over the body and thus pacifies all the ailments. Asthapana Basti is Srotovishodhana and Malapahara. It strengthens the body. in addition to its being a quick agent of impletion and depletion and is unattended with danger 135. prolongs life. Disease review 54 Basti Basti is the best treatment for vata. because it makes the vata to move in its natural paths and channels. The following table shows as to which karma are advocated by which classics. SPECIFIC TREATMENT OF GRIDHRASI While describing the specific treatment for Gridhrasi. in as much as it possesses rapid and useful properties of cleansing. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Niruha Basti is advised for removal of Dosha 131. Acharya have given importance to karma but at the same time different shamana yoga are also mentioned in the texts. It is praised as ‘Sarvarthakari’ 134. Thus. Agni. While explaining the importance of Basti. Basti is considered as parama vatahara. Medha. Charak says that there is no therapeutic procedure comparable to that of Basti. Varna etc. while Anuvasana performs the function of Brihmana Balya and vatashamana 133. Also it has systemic effect in eliminating Dosha from 132 the body gradually by Pakwashaya shodhana . Basti is rightly considered as Chikitsardha 136. Basti increases Bala. In patients who are weak or Avirechya. . trivrit ghrita. Other formulations include decoction of shephalika. Disease review 55 Table No. - Niruha Basti + . . .6: Types of Treatments:  Type of treatment CH SU AS CD BP YR HS BS Snehana . pippali churna along with Erandataila Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . + + Agnikarma + . . . . + + Swedana . . + + . He has said that administration of Basti before Urdhvashodhana is useless. . Siravedha four angula above or below janu is mentioned for Gridhrasi in both Ashtanga Samgraha and Ashtanga Hridaya 139. rasna guggulu. Pachan & Urdhvashodhan before administration of Basti to a patient having Gridhrasi. . . decoction of panchmoola. Chakradatta has described the treatment of Gridhrasi more precisely. + + . + Siravedha + + + + . . Also recipies like erand phala payas and vartaku prayoga are advised. + . + + . . Basti (Anuvasana & Niruha) and Agnikarma as the line of treatment for Gridhrasi 137. A number of combinations are described in the text for the shaman chikitsa of Gridhrasi. . . . - Charaka mentions Siravedha between the kandara & gulfa. One of such combinations i. + + - Shastrakarma . Sushruta. . . + . - Raktamokshana . being the master of Shalyatantra has advised only Siravedha at janu after flexion 138. . saindhavadya taila. . + . . . . + + + + . . - Virechana . + . - Anuvasana Basti + . chhagaladya ghrita. . . .e Trayodashanga Guggulu. . While treating kaphavataja Gridhrasi. + - Vamana . He has described the importance of Agnideepan. etc. Erand taila along with Gomutra when administered for one month specially in the morning hours relieves Gridhrasi. Gridhrasi is also included under the various indications for Maharasnadi kwath. Yogaratnakara has advocated the use of lashuna along with hingu. Bhavaprakasha also states that Basti should be given to patients of Gridhrasi only after doing vamana and virechana karma and in Diptagni and Niramavastha. The sara of brihatnimba (bakana) is also useful is asadhya Gridhrasi. jiraka. Disease review 56 and Gomutra is advocated. matulunga and ardraka swarasa taken with chukra and guda are useful in shoola of Kati. He has advised decoction of erandmoola. Sharangadhara has described decoction of dashmoola or nirgundi with pushkarmoola and hingu. prishtha. Also rasna guggulu. Gridhrasi. udavarta. dwastrinshak guggulu. Also use of panchmooli kashaya. trika and gulma. If not relieved by this treatment then Agikarma at kanishthika anguli of pada has been suggested. Trayodashanga guggulu. brihati & kantakari for chronic Gridhrasi. mahanimba and rasna kalka and prasarani. Chakradatta has mentioned a small operation with prior Snehana & Swedana to remove granthi in Gridhrasi and also siravedha four angula below Indra Basti marma. pathyadi guggulu are advised in Gridhrasi. If this fails Agnikarma in the little finger of the leg is advised. krutamalak along with erandtaila is advised for the Gridhrasi patients who cannot walk. Also taila. in the morning for the patients of Gridhrasi. mashadi and narayana taila. Abhadi churna. The decoction of sinhasya. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . uru. decoction of rasna saptak. bilwa. mahavishagarbha taila etc. ghrita. danti. Yogaratnakar advises siravedha in the area of four angula around Basti and Mutrendriya. vajigandhadi oil for Basti or oral use & saindhavadya taila is described. Yogaraja Guggulu. bala. Narsimha Coorna. Vatavidhvamsa Rasa. Most of them are herbal preparations rather than Rasaushadhis. Several oral medicinal preparation have mentioned in the classics for the treatment of Gridhrasi. some of the examples include Maharasnadi Kvatha. Kvatha. 3 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Amrita Guggulu. Abhyanga should be done with vatanashaka oil. Shamanaushadhi: Several medicinal formulations have been mentioned in the treatment of Gridhrasi Roga. Balarishta. Lepa. Bala Taila. Bhela mentioned raktamokshana as the best treatment for Gridhrasi. Also bala taila. Arishtha. Agnikarma must be done four fingers above the gulfa on any nadi. Shephalika Kvatha. pippali and pushkarmoola if taken with erada tail cures Gridhrasi. Besides whatever is pathya in vata vikara is pathya in this disease also 140. Dhanvantari Taila. Disease review 57 Harita while describing the treatment of Gridhrasi states that in this disease blood letting should be performed followed by Sweda. Taila. However if the disease does not respond to this treatment Agnikarma with an iron rod is advised. There are different type of preparations like Coorna. BrihatVatacintamani Rasa few are listed in the table. Rasna Saptaka Kvatha. Guggulutikta Ghrita. Bhaishajya ratnavali has given the same treatment for Gridhrasi as decribed by Chakradatta. Sahacaradi Kvatha. Lasunapaka. atibala. 141 Vangasena has repeated the necessity of Urdhvashodhana before Basti . Phanta of drugs like shatavari. Gritha. Sneha Basti and Sneha unmardana are also advised. mulaka taila & sahacharadi taila are advised for external application. Vati and Guggulu Kalpas. - Rasona Kalka . - Dashamoola Kashaya + + .N Choornas Ajamodadi Coorna . + . . - Krishnadi Coorna . . . . . . . - Swalpa Rasona Pinda . . + + - Taila and Ghrita: Chagalyadhya Ghrita . Disease review 58 Table no. . .7: Shamanaushadhis used in Gridhrasi: KALPANAS Y. - Vatahara Pradeha .D G. - Balarishta . . . - Kalka and Lepa: Maha Nimba Kalka + + . + . . . . + + + Erandadi Kashaya . + + + Maha Rasnadi Kashaya + + + . + - Gun`ja Phala Lepa + + . . .S B. - Shefalikapatra Kashaya . + . - Rasnasaptaka Kwatha + + .R S. - Dashamooladi Coorna . . . . + . + . . . + . . . . + + - Bala Taila . - Abhayadi Coorna + . . - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . + + . - Rasnadi Coorna + . - Qwatha/Kashaya and Arishta: Panchamoola Kashaya + . + .R C. . .P B. + + . . . . . . . . . - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . . + . . . + + + + Trayodashanga Guggulu + . + + - Yogaraja Guggulu . Disease review 59 Eranda Taila + . + - Mashadi Taila . . . . . + . . - Vati. . - Vajeegandhadi Taila + . . + - Vishagarbha Taila + . . + Saindhavadya Taila + . . . . . - Saptaprastamsha Taila . - Vatagajankusha Rasa . . + - Eladi Taila . + . . + - Vijaya Bhairava Taila . + - Rasnapooteeka Taila + . . - Vatari Rasa . . . - Swacchanda Bhairava Rasa . + . . + . - Shatavari Taila + + . . + . . - Pathyadi Guggulu + . . - Narayana Taila . - Vatarakshasa Rasa + . . + - Datturadi Taila . + . + . . . . . + + . . . + . . . + . . Guggulu and Rasayogas: Rasna Guggulu + . . - Mahabaladi Taila + + . . - Prasarani Taila + + . . - Mahayogaraja Guggulu . . - Vishnu Taila and Ghrita . . . + . . . Tamboola Matsyandika. Bahri Mamsa Varga (Peacock). Draksha --- Ghrita. Patola. Jeeraka. Gorasa Varga Dadhi. Anya Dravya Punarnava. --- Vartaka. Parvata. Vatsaka. Khudisha. Vastuka. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Raktashali Godhooma. Phala Varga Badara. Matsya Varga Nakra. Mishi. Dugdha.8: Pathya in Gridhrasi: I.mTittiri.R) and in Basavarajeeyam. Shakha Varga Moolaka. Table No. Gagrara. Kilata. --- Jangalamamsa Shileendhra. Soorana.Cataka. Puranadhanya Shami Dhanya Varga Masha. Kataka Ramatha. Prishnakali.R. Tarkkari Dadima. Tikta. Rasa Lavana - Shooka Dhanya Varga Godhooma. Dunduka. Kasamarda.R B. Quite opposite to this the food and regimen that are otherwise is named as Apathya. Krishna. Kooshmanda. Ahara Y. Karavellaka. Parooshaka. Mundi. Disease review 60 PATHYA – APATHYA The diet and regimen that is congenial to the health both in healthy and diseased are referred by the name Pathya. Pathya and Apathya in regards to the Vatavyadhi in general is also considered as Pathya and Apathya of Gridhrasi as elaborated in Yogaratnakara (Y. Shigru. koorcika Sneha Varga Taila Lashuna. Br’hati. Kulattha Kukkuta. Kulattha Masha. --- Jhasha Patola. Nivara. Tikta. Shameedhanya (Kangani). Kanda. Ervaru. Disease review 61 II.9: Apathya in Gridhrasi: I. Katu Anna Guru & Abhishayandi Tataka and Tatinijala. Tikta. Bimba. Jala Varga Sheetambu Pradushta (jala) salila Shukadhanya Varga Navadhanya Mudga. Sharasinimba II. Nimba Mrinali.) Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .R. Langhana (Y.R.R B.R.R B. Trapu. Kuruvinda. Ahara Y. Shakha Varga Koshataki . B. Shakala. Rasa Kashaya. Sarshapa.R Cinta Prajagara Vegavidharana Shrama Sheeta pavana Sevana Vyavaya Hariyana Chankramana III.R Abhyanga --- Table No. Kareera Kareera Anya Dravyas Kshaudra. Chanaka Alabu. Shyamakacoorna Mudgaka. Karma Chardi. Karma Y. Vihara Y. Nishapava Kalaya. the importance of SLR sign in sciatica was described by Lasegue. ISHI) which means • Affecting the hip or the sciatic nerve • Of or belonging to the ischium or hip (The Oxford English Dictionary) The term sciatica was known since centuries. The term seems to have come into use about the beginning of the 19th century. Sciatica is no longer considered as a single disease but it is considered as a syndrome. sciatica was considered only due to sciatic neuritis. Disease review 62 MODERN REVIEW 142 The disease ‘Sciatica’ is named because of the involvement of sciatic nerve. having been abbreviated from ‘ischiatic’ to ‘sciatic’ Sciatic – (Si-at’ik) (Mediv L – Sciaticus. a Paris neurologist (1816). the hip joint. Hence the disease was also known as Cotugno disease (1736). a Neapolitan anatomist. Previously. Later it became clear that it is due to stretching of sciatic nerve Charcot (1825) described scoliosis.Ischiodicus from – ischion. entering English from French (Henary Alana Skinner. a corrupt form of Gr. Now-a-days. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . But four decades back Mixer and Barr illustrated the role of intervertebral disc lesions in the causation of sciatica. The sciatic nerve derives its name from its relationship to ischium. Though the association of low backache or lumbago with sciatica was known. the characteristic posture of the patient with sciatica. 1949) The disease Sciatica was described as neuralgia of sciatic nerve firstly by Cotunnius. ‘THOU COLD DCIATICA’ were words put into the mouth of Timen of Athens by Williom Shakespeare. Hence. which form the sciatic nerve. (Harrison’s Principles of Internal Medicine). Anatomy and physiology of sciatic nerve The sciatic nerve is the largest nerve of the body. causes pain that extends mainly down the postero and anterolateral aspects of leg and into the foot termed sciatica. • Pain radiating from a lumbosacral nerve root into the leg is sciatica (French’s index of differential diagnosis). The whole pathology of sciatica revolves around sciatic nerve. S1. S2 and S3. Disease review 63 Definition of sciatica: • The terms Sciatica has come to be applied to a benign syndrome characterized especially by pain beginning in the lumber region and spreading down the back of one lower limb to the ankle (Brain and Banister’s clinical neurology) . L5. Here the nerve runs vertically downwards under cover of Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The nerve is really composed of two loosely bound portions. It derives its fibers from all the roots of the sacral plexus. • Irritation of the fourth and fifth lumbar and first sacral roots. The nerve originates in the pelvis and passes through the greater sciatic notch usually below the piriformis into the buttock. namely L4. to understand the disease thoroughly anatomy and physiology of sciatic nerve should be studied first. measuring about three quarters of an inch in breadth. the tibial and the common peroneal nerves bound together by connective tissue. semitendinosus and semimembranosus and a branch to the ischial part of the adductor magnus all arising from the medial side of the nerve trunk and fibres are derived from the tibial division of the sciatic nerve. it divides into its two terminal branches. The tibial nerve supplies gastrocnemius. Muscular branches: They are distributed to the flexors of the leg viz. which arises from its lateral side and contains fibres from the common peroneal division of the sciatic nerve. The medial and lateral plantar Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . sometimes they emerge from the pelvis separately and remain so. S2 and S3. really separate adherent structures. The point midway between the ischial tuberosity and greater trochanter indicates the site of the nerve on the body surface. above this it passes in a gentle curve medially. lying on the short muscles of the gluteal region midway between the greater trochanter and the ischial tuberosity. The sciatic nerve also supplies the short head of the biceps femoris. popliteus. the bicep femoris (long head). perforating posterior part of its fibrous capsule posteriorly. Disease review 64 gluteus maximus. At about the junction of the middle and lower thirds of the thigh. The branches of the sciatic nerve are as follows: Articular: These branches arise from the upper part of the nerve and supply the hip joint. it is soon crossed by the long head of biceps as this muscle passes laterally. L5. The tibial nerve has its roots from L4. S1. Terminal branches: Tibial and common peroneal nerves are the terminal branches of the sciatic nerve. in fact. the tibial and the common peroneal nerves. These two nerves are. It is important for injections not be given into near the nerve. Emerging from the covering gluteus maximus. for this reason most injections are given in the upper and outer quadrant of the gluteal region. flexor digitorum longus and flexor hallucis longus. plantaris and soleus as well as tibialis posterior. Also it supplies the muscles of the calf and sole of the foot. It descends along the lateral margin of the popliteal fossa and passes into peroneus longus where it divides into superficial and deep peroneal nerves. peroneus tertius and extensor digitorum brevis and the ankle joint. The superficial peroneal supplies the peroneus longus and brevis and most of the dorsum of the foot. which is carried out by the hamstrings and of all the muscles below the knee. After complete division of the nerve. S1 and S2. The sciatic nerve supplies nearly the whole of the integument of the leg. extensor hallucis longus. the tibial nerve is rarely inured although wounds in the popliteal fossa or post dislocation of the knee joint may damage it. the heel and the plantar aspect of the foot and toes. Disease review 65 nerves supply the small muscles of feet. the joints of the ankle and foot. extensor digitorum longus. producing foot drop. and the skin of the distal half of the back of the calf. L5. The deep peroneal branch also supplies tibialis anterior. Foot drop occurs as a result of paralysis of the anterior tibial group of muscles and the peronei. After complete interruption of the sciatic nerve there is paralysis of flexion of the knee. Injury here paralyses all the dorsiflexors and evertor muscles of the foot. but drags the toes of the affected foot and is unable to stand on his toes or heel on the paralysed side. The patient can stand and walk. The common peroneal nerve is formed by the divisions of L4. Applied Anatomy The sciatic nerve may be injured in posterior dislocations or fracture dislocations of the hip. Owing to its deep position. The common peroneal is the most commonly injured nerve in the lower limb because of its exposed position at the fibular neck. It supplies the lateral aspect of the thigh. light touch is the form of Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . especially below the knee. There is variable cutaneous loss on the anterolateral aspect of the leg and dorsum of the foot. Articular processes face inward and outward and dislocation without fracture is impossible. extending about 5 cm distal to the internal malleouls. the new bone laid down in osteoarthritis narrows the foramina even further and causes shooting pains down the leg. but the ankle jerk is lost and so too is the plantar reflex. These large number vertebrae enlarge as we descend the column. the fifth vertebra is huge and carries the weight of the whole vertebral column.L5 nerves increase for various reasons e.Appreciation of the pressure and of vibration is lost over the whole of the foot. with the exception of a zone about 4 cm wide along its inner aspect. roughly from midline in front to midline behind upto about 5 cm below the upper end of the fibula. from above downward. and position and joint sense are lost in the toes. The knee jerk is unaffected. also without overlap. This is supplied by the sephanous nerve. The intervertebral foramina in the lumber region decrease in size. Disease review 66 sensation which is lost most extensively. The laminae do not overlap and the spines are massive and point directly backward. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . while the lumber nerves increase in size. On the leg the area of anaesthesia to light touch includes the outer aspect. except for the proximal two thirds of its inner aspect. Analgesia to pin-prick is less extensive than anaesthesia to light touch .g. Lumber Vertebrae For the causation of sciatica. Anaesthesia to cotton wool extends over the whole of the foot. the specific anatomy of lumber vertebrae should be considered. This particular arrangement explains the commonness of sciatica. in which the tight fit of L4. ligament sprain ™ Post surgical back pain e. Disease review 67 AETIOLOGY Predisposing Causes • Age: Sciatica is most common in the 3rd to 6th decade. Causes • True sciatic neuritis • Mechanical - ™ Trauma ™ Degenerative Diseases ⇒ Spondylosis ⇒ Spondylolisthesis ⇒ Disc Herniation ⇒ Spinal Stenosis ™ Muscle strain. But some authors say that it is a disease of early and midlife. • Sex: It occurs 3 times more frequently in males than in females. The maximum incidence is found in 3rd and 4th decade. ankylosing spondylitis.g. sacroilitis • Malignant - ™ Metastastic Disease Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Arachnoiditis • Inflammatory (non-infectious) - ™ Spondyloarthropathy e. • Exposure to cold and damp weather is also one of the factors. Continued pressure on the nerve such as in motor driving may predispose to sciatica. osteoarthritis. • Occupational Factors: History of trauma or repeated stress such as lifting heavy objects is obtained in many cases.g. Pregnancy ™ Vascular causes e. Trauma The trauma may be sudden such as fall from heights. continued pressure in long distance lorry drivers. lifting heavy weight etc. Also repeated trauma like digging. travelling in jerky vehicles are some of the factors. It is a disease of early and middle life and occupational causes may be evident such as exposure to damp. Also it may be due to injections.g. The causes are discussed in details here under. bending. penetrating injuries etc. Genitourinary and Gynaecological disorders. True Sciatic neuritis It may follow an attack of lumbago. popliteal fossa haematomas and myofascial bands secondary to trauma. Disease review 68 ™ Multiple Myeloma ™ Primary Tumour of Bone. Severe sciatica may be due to diabetes mellitus. lifting heavy loads when lumbar spine is flexed. spinal cord or nerve root • Infection - ™ Osteomyelitis ™ Paravertebral abscess ™ Discitis • Bone disorders - ™ Osteoporotic Vertebral Collapse ™ Paget’s disease • Pain arising from outwith the spine - ™ Referred pain e. Postural factors such as Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .g. Rare causes of sciatic pain have been gluteal tumours. Abdominal aortic aneurysm ™ Psychogenic pain. Disc Herniation It is the major cause of severe. lying flat on the hard surface under the influence of narcotics or coma plays the role. Occasionally spondylosis may occur at multiple levels. Spondylosis Spondylosis is a fatigue fracture at the pars interarticularis or isthmus of the lumber spine Spondylolisthesis The fatigue fractures heal by fibrous union. which weakens the motion segment and sets the stage for the occasional slip of one vertebra on another. It is due to either a single injury or repeated minor injures. Spondylosis and spondylolisthesis most frequently occur at L5. It is most likely to occur between the fifth lumber and first sacral vertebrae with lessening frequency between the fourth and fifth lumber. Disease review 69 sitting for long time in an overstuffed chair. the third and fourth lumber. termed spondylolisthesis.S1 level (90 percent) with L4-L5 level. sleeping with back hyperextended. the second and third lumber and rarely between the first and second lumber vertebrae. badly designed car or scooter seat. chronic or recurrent low back pain and sciatica. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . the next most common site (5 percent). The cause may be degenerative changes. Spinal Stenosis In this condition. A sneeze. Sprains and Strains A strain is an injury to muscle. pushing the frayed and weakened annulus posteriorly. tendon or fascia beyond the elastic limit while sprain is an injury to the ligaments of a joint. repetitive microtrauma. the root is usually affected by bony and soft tissue encroachment in the root canal and occasionally in the central canal. recurrent lumber ache. Degeneration of posterior longitudinal ligaments and the annulus fibrosus which occurs in most adults of middle and advanced years may have taken place silently or may have been manifested by mild. Some of the important are congenital or developmental. Occasionally discal and arthritic factors may play a role. The pain is usually confined to lower back and may involve the sciatic nerve. Patients suffer from chronic low back pain and sciatica. lurch or other trivial movement may then cause the nucleus pulpous to prolapse. The L4 and L3 toots are occasionally affected in their root canals. Fifth lumber root is most commonly involved. Segmental Instability A spinal segment is probably unstable if it moves beyond its normal bounds of restraint and returns again to its preformed position. Paget’s disease or a congenital abnormality of the shape or size of the canal. Both of these are the result of injury. In more severe cases of disc diseases. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . accumulated macrotrauma etc. the nucleus may protrude through the annulus to become extruded to lie as a free fragment in the vertebral canal. Disease review 70 Many factors are responsible for the herniation. Associated bony or soft tissue encroachment into the root canal produces root symptoms. Piriformis Syndrome Sciatic pain is said to result from entrapment of the nerve deep and inferior to the piriformis muscle. steroid therapy etc. In this condition spinal roots are compressed against the floor or roof of the intervertebral canal by an enlarged superior or inferior facet. Arachnoiditis It is an inflammatory subdural process leading to fibrosis. Disease review 71 Facet Syndrome This commonly occurring condition usually arises in the dysfunctional or unstable phase of spondylosis causing an ill-defined type of pain. Sacroilitis : Sacroilitis may follow acute salpingitis or prostatitis and may be responsible for sacroiliac pain and tenderness and morning stiffness. which binds together the roots of the cauda equina. The causes of arachnoiditis are surgical trauma. Osteoarthritis Osteoarthritic changes are the results of degenerative changes in the disc. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Also osteoarthritis of the hip joint produces pain in the groin which may radiate down the outer side of the thing. intrathecal haemorrhage etc. hypertrophy or contracture of the piriformis muscle. Ankylosing Spondylitis It is an inflammatory disorder of unknown aetiology. foreign material. vertebral bodies and apophyseal joints. infection. It may occur secondary to trauma. neuropathic disorders. Ostearthritis of lumber spine produces sciatic pain. with resultant spasm. It affects the intervertebral and costovertebral joints and especially the sacroiliac joints. There is often a history of trauma in the area. angiosarcoma. Multiple Myeloma Multiple myeloma is the most common malignant primary bone tumour Early in its course can easily be overlooked as the cause of back pain. osteoid osteoma. The pain is widely distributed in extremities. Primary tumour of bone. The disease may appear alone or as a part of syndrome associated with another disease such as rheumatoid arthritis. Extramedullary tumours such as neurofibromas. Osteoid osteoma and benign osteoblastoma of the vertebrae can present with back pain and a fixed scoliosis Tumours within the vertebral canal can cause pain with or without neurological signs. Fibrositis Syndrome Fibrositis is an entity noted to cause sciatica and low back pain especially L4 through S1 interspinous ligament region. Metastatic Disease Secondaries from breast. spinal cord or nerve root Primary bone tumours are unusual in the spine though Paget’s sarcoma. malignant lymphoma and reticulum cell sarcoma can occur. kidney and prostate can present as back pain and sciatica. Neurofibromas can enlarge the intervertebral formen from bone erosion and cause root pain. chordoma. lung. Also non-Hodgkin’s and Hodgkin’s lymphoma may involve the spine. thyroid. angiomas. although a wide range of other bacteria have been isolated including Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . solitary myeloma. Vertebral Osteomyelitis It is most commonly caused by haematogenous spread of staphylococcus aureus. Disease review 72 It develops in about one third of patients with psoriatic arthritis. meningiomas and lipomas may cause compressive lesions of cauda equina. Spinal tuberculosis is now becoming a rare condition but may lead to progressive destruction of the cancellous bone and vertebral collapse. in which the bone mass is reduced with decreased mineralization of the osteoid. tibia. pelvic infection or a retroverted uterus may produce back pain. Infection can be introduced during spinal surgery. Osteomalacia. Epidural Abscess Spinal epidural abscess is encountered rarely. brucella and Mycobacterium tuberculosis. The bones most affected are the pelvis. and femur. but it should be considered when compressive symptoms are associated with severe pain. Discitis It is an infective inflammatory process involving the paediatric intervertebral disc and adjacent end plates. Similarly prostatic disease may cause pain to the back and along the sciatic Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . epidural injections and myelography or it can spread from adjacent lesions. Osteoporosis Osteoporosis can result in compression fractures. Disease review 73 coliforms. It is probably frequently unrecognized. often in absence of a history of trauma may be the presenting symptom. lower vertebrae. Referred Pain Uterine prolapse. Acute pain superimposed on chronic discomfort. may coexist with osteoporosis and needs to be excluded. fibroids. fungi and anaerobes. pseudomonas. Paget’s Disease There is very chronic enlargement of the diameter of the bones accompanied by a rarefying osteitis with enlargement of the Haversian spaces. Staph. streptococci. aureus is the most common organism cultured. Sciatic claudication is an insufficiency of the inferior gluteal artery producing ischaemia of the sciatic nerve and claudication in a sciatic distribution. which results in the widening of the sacroiliac joint with structural changes with increased in the lumber lordosis and tension on the sciatic nerve. Vascular Causes Vascular lesions within the distribution of the femoral artery such as atheroma or thromboangitis obliterans are occasional causes of pain in the leg in middle age and later in life. Psychogenic Pain Back pain is seldom if ever purely psychogenic in origin. These conditions usually persist throughout pregnancy and a few weeks after delivery. It is unwise to assume that the complaint of low back pain is made solely to gain attention or receive compensation. the level of relaxin rises. If the head of the foetus comes to lie up against the sacral trunk. usually with loss of dorsiflexion. At about 10-12 weeks of gestation. particularly when there is root involvement. Its function is to absorb loads and permit movement while protecting the spinal cord and emerging Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . PATHOGENESIS In its totality the behaviour of the spine is that of a flexible rod. Out right malingering is rarely seen. Pregnancy The back and leg pain that occurs during pregnancy is considered mechanical for the most part. Disease review 74 distribution. Pelvic tumours such as chondrosarcoma or chordoma or retroperitoneal secondary deposits may imitate mechanical back pain. sciatic nerve may be affected. though this does happen occasionally. Intermittent claudication is not always present in these cases. thigh alignment facilitating absorption of impact loads during walking and running. Due to mechanical pressure a loose fragment of nucleus pulposus. is composed of upto 90 sheets of collagen fibres. But if more peripheral fibres of the annulus are also torn or separated. is composed of two morphologically separate parts. which is avascular. can either extrude through a fissure in the annulus or as a Schmorl’s node through the vertebral end plate. Disease review 75 nerve roots. The central part of the disc is called nucleus pulposus. called the annulus fibrosus. the protrusion will increase in size and finally rupture through the outer Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Herniated disc is the common source of acute and chronic disability. This provides a good shock absorbing mechanism which becomes less efficient with age as the nucleus becomes more fibrotic. The fibres in adjacent sheets run at 30o angles to each other This lamination of the annular layers strengthens the annulus and prepares it to accept high stresses. Also when responsible for symptoms it is only one factor amongst many. even when loaded. The normal spine posture is vertical with cervical and lumber lordoses and a mild thoracic kyphosis. The intervertebral disc. The outer part. Disruption of the inner fibres of the posterior annulus alone will not cause the nucleus to bulge. then the L4-L5 disc are by far the most commonly affected. may result in cord or more usually cauda equina compression. The force distribution throughout the spine is such that the L5-S1. Root pressure at these sites gives rise to pain and neurological signs in ipsilateral leg. although the prolapse can occur at only level. usually referred to as sciatica. The second commonest site of prolapse is at the posterior margin of the disc where the extruded nucleus presses on the highly bound posterior spinal ligament. More chronic disc protrusion associated with degeneration can lead to the condition of spinal stenosis. This causes the symptoms of cord claudication with pain in the legs on exertion. prolapse takes place preferentially at this site. Disease review 76 fibres as a nuclear hernia. This causes pain without lateralizing signs and if large. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . leading to interference with bladder function and anal sphincter competence. Prolapse of the intervertebral disc occurs when the nucleus pulposus is no longer contained within the annulus but bulges through it. which is adjacent to the emerging spinal nerve roots. Because of the increased curvature of the posterolateral border of the vertebra. The integrity of the bony spinal canal may be interrupted at the pars interarticularis either because of a congenital defect or trauma. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The classical spinal infection was tuberculosis. especially when loading is abnormal as a result of degeneration and narrowing of adjacent disc or in a more wide spread fashion from alignment abnormalities such as scoliosis. Myeloma may present with back pain. The spine may be the sit of infection or tumour. The resultant forward slippage of the vertebra is called spondylolisthesis. Disease review 77 Diagram showing a disc protrusion where there is a loose frgment and a fissure. which started from haematogenous spread to a disc and spread through the vertebral end plates into the two adjacent vertebrae. Primary malignancy may occur but is less common than secondaries. particularly from breast. The infection is now most commonly with staphylococci with streptococci becoming increasingly important and more exotic infections occurring in the iatrogenically immunocompromised and those with AIDS. There is a bulge of the annulus but some of the outer annular fibres remain intact. Spondylosis is the association of the degeneration and narrowing of the disc space with the development of osteophytic lipping at the adjacent vertebral margin. The loose fragment is sequestrated when it is outside the annulus. now seen almost exclusively in the elderly. A complete annular fissure results in an extrusion when a loose fragment is partly within and partly outside the annulus. bowel and prostrate. There is often secondary osteoarthritis in the associated apophyseal joints. This led to vertebral body collapse with preservation of the posterior spinal elements leading to severe angulation.the gibbus. The apophyseal joints are particularly prone to osteoarthritis. • Pain deep in the buttock and thigh. In some cases. the nerve is either directly injured or indirectly compressed by haematoma or protrusion. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . aching in character and intensified by spinal movements. the nerve and its roots can be irritated by various reasons. • Pain in the back. Symptoms and Signs Pain The onset is subacute and sciatica is frequently preceded by lumber pain which may have occurred intermittently for years. pain along the sciatic nerve is the cardinal symptom. The pathological changes which develop in the damaged nerve depend upon the severity of the injury and the amount of toxic agents irritating the nerve. In some cases it consists of a feeling of discomfort in the lower back and down the posterior surface of the leg. however. • Pain radiating to the leg and foot and momentarily increased by coughing and sneezing. Subsequently degeneration of the nerve occurs but when the injury is minor in nature the degeneration will not take place usually and complete recovery takes place in a few days or weeks in such cases the prognosis will be good. When the nerve is subjected to moderate degree of pressure or when it is slightly damaged temporary interruption of functions of the nerve may occur. The severity of pain varies greatly. Disease review 78 In traumatic lesions. it is so intense in nature that it totally incapacitate the affected individual. It is possible to distinguish three elements in the pain. Thus. or swelling or surrounding organs leads to pain in the course of nerve. also aching or gnowing in character and influenced by the posture of the limb. Thus. When there is severe injury to the nerve at any point. the sheath at the point of injury is destroyed. Tenderness There is tenderness on pressure along the course of the sciatic nerve i. the sciatic notch. Numbness and sensory impairment There is often a feeling of numbness. Tendon Reflexes Ankle jerk may be diminished or lost when the first sacral root is involved. not only of the muscles supplied by the sciatic nerve.When the first sacral root is compressed the pain radites to the outer border of the foot. There is rarely much sensory loss. the knee jerk may be diminished. In general the pain is intensified by stooping. heaviness or deadness in the leg. especially along the outer border of the foot. If the fourth lumber root is involved. When the pressure is upon the fifth lumber root. popliteal space behind the head of the fibula and external malleolus and in the sole of the foot. it spreads from the outer aspect of the leg to the inner border of the foot. but also of the gluteal and sometimes of all the muscles of the lower limb. The plantar reflex is flexor. Weakness and atrophy of muscles There are muscular hypotonia and slight wasting. 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. Compression of the first sacral root may cause weakness of the small muscles of the foot and the calf muscles of the foot or great toe or even foot drop. Occasionally muscular twitchings may be observed. while it is preserved in case of fifth lumber root. sitting and walking. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . middle of the back of the thigh.e. Disease review 79 The distribution of pain depends upon the nerve root involved. Disease review 80 Scoliosis: Scoliosis is a term used to describe a lateral curvature of the spine. Sciatic List Table No. aspect of leg. The trunk is often tilted well over to one side. Quadriceps Knee L4 knee and inner aspect of shin And tibialis ant. Abnormal posture occurs quiet involuntarily as the body attempts to minimize painful pressure upon a nerve root. By for the most common primary cause is the protrusion of an intervertebral disc. lat. Sciatic scoliosis lasts only as long as some primary painful condition of the spine produces a spasm of muscles to protect the area that hurts.10: Signs associated with common nerve root lesions affecting the leg: Reflex Root Parasthesiae / Numbness Muscle Weakness Changes L1 Groin . - L2 Front of mid thigh Quadriceps - L3 Front of lower thigh Quadriceps Knee Front of lower thigh. The trunk is often titled well over to one side root. Back of leg. Back of thigh. aspect of foot and Calf wasting and weakness Ankle S1 sole of plantar flexors Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . lat. Ankle L5 Extensor hallucis longus dorsum of foot to big toe. 11: The Clinical Features of Herniated Nucleus Pulposus: Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Disease review 81 Table No. aggravating factors etc. character of pain. should be taken. Posture: The shape of the lumber spine is altered and the mobility is restricted. The spinal mobility is checked by the ability to bend forwards. The following signs are helpful to confirm the diagnosis of sciatica. They help for differential diagnosis as well as treatment decisions.g. personal history. infectious diseases. Straight leg raising test (SLR) There is no universal agreement about the correct way to perform the straight leg raising test. One method is Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Examination General examination Any clues for systemic diseases should be looked for e. Tenderness: Local tenderness and presence of trigger points in the back and limb should be identified. obstetric history and occupational history should be inquired. its distribution. Disease review 82 CLINICAL DIAGNOSIS History A detailed history regarding the nature. Te muscular spasm produces list to one or other side on standing. fever etc. past medical history. mode of onset. Musculoskeletal Examination Gait: The patient of sciatica has a very typical limping gait while walking. any associated diseases and also family history. Also history of trauma. chronicity. known as sciatic scoliosis. There may be loss of normal lordosis. on a counch or on the floor. the ‘bow string test All the above mentioned tension signs are generally present when a lower lumber or sacral root is involved in the pathological process of pain. the knee is first flexed and then extended and the tibial nerve compressed at the popliteal fossa with the examining fingers of one hand. Normally the leg can be raised upto 80o . when at the limit of straight leg raising the knee is slightly flexed. However. In the same position. Another method is to support the heel in the cupped hand of the examiner and having explained the method to the patient.90o without any pain. • Bow-string test: At the limit of straight leg raising. the limb is extremely rotated. the experience of pain is recorded. ask him to do straight leg raising. the foot is dorsiflexed to see if tension on the posterior tibial nerve increases the sensation of pain. They are marked Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . gently lift the heel from the counch with the knee still extended. although a little uncomfortable for the patient. relaxing the sacral plexus and then internally rotated. increasing root tension. Disease review 83 that when the patient is in the horizontal position. Crossed leg pain is pathognomic of a disc herniation and suggests a poor prognosis. • Bragaad’s test: At maximum straight leg raising. • Lasegue test: It elicits pain in the leg or back. The opposite hand rests on the pelvis to limit pelvic rotation. This test is most useful diagnostically to assess the severity of the pain and prognostically to assess the results of treatment. better repeatability is obtained by lifting the leg to the maximum permitted level. the hip further flexed and the knee then extended. The patient is asked about the site of that pain. The elevation is stopped when the patient complains of pain which is due to stretching of the affected root and the angle is assessed using goniometer. extensor hallucis longus (L5 or S1). tibial arteries should be palpated because claudication pain can be confused with the redicular pain. • Palpation of the abdomen is also mandatory. Others • The dorsalis pedis and ant.e. All the above signs have got some clinical value but it is not always that one or more of them may be present and the diagnosis has to be confirmed by other measures. hypoasthesias should be marked. Areas of numbness. Also pelvic rotation and testing of sacroiliac joints by pressure on two anterior superior iliac spines should be done. • Rectal examination should be carried out and in women vaginal examination also. quadriceps (L4 and 5) should be recorded. Investigations Laboratory investigations • Urine examination for sugar etc. as an abdominal mass may explain the cause of pain. but mild or absent with nerve root irritation from long standing degenerative change. peronei (S1). Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . • The motor power of selected muscles i. • Wasting of muscles of the leg especially quadriceps should be measured. • The sensation should be recorded by using a sharp pin. ankle and plantar reflexes should be examined and they should be symmetrical on both the sides. Disease review 84 with acute root involvement from a disc protrusion. Neurological Examination • The knee. S1) in anteroposterior.C.R.).) These are especially helpful in screeing for infection or myeloma.S. It is obviously contraindicated if lumber puncture is contraindicated Epidurography can be done for the diagnosis of intraspinal lesions not visualized by conventional myelography. • Rheumatoid factor for rheumatoid arthritis. malignancy. lymphomas and connective tissue disorders.L5. carrying risk of damage and infection. The purpose is to outline the spinal cord and nerve root in order to demonstrate pathological lesions such as lesions or fissuring of annulus. sclerosis of vertebral bodies. • Myelography: Myelography is radiography after injection of an opaque substance into the lumber spinal subarachnoid space. Erythrocyte sedimentation rate (E. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . cyst on sacral nerve roots etc. alkaline phosphatase in suspected hyperparathyroidism. spondylolisthesis. Discography may be done by injecting contrast medium directly into the intervertebral disc but it is pain-provocating. • Immunoglobulin electrophoresis is useful in diagnosis of multiple myeloma. Many causes of sciatic pain are associated with bony changes visible in radiographs Roentgenograms of lumber spine (L4. disc herniations. serum calcium. Disease review 85 • Complete blood count (C.B. usually at the L2-L3 level. uric acid. phosphorus. Other Diagnostic Techniques • Plain Radiographs: No assessment of spine is complete without radiographs. osteoporosis. Also it is difficult to interprete. prolapse etc. lateral and oblique planes gives differential diagnosis of narrowing of disc space. • Cerebrospinal fluid examination for the diagnosis of disease of the central nervous system and spinal cord. Paget’s disease and acid phosphate in suspected case of metastatic carcinoma of prostate. No ionising radiations involved and intradural soft tissue lesions can be visualized without the need for intrathecal contrast. It is a highly sensitive method for demonstrating bone disease. has been the combination of CT scan with myelography using a non-ionic water soluble medium such as iohexol. • Procaine Injection Test: Disappearance of the pain following local injection of procaine or lidocaine into the tender spot is both diagnostic and therapeutic of fibrositic pain. • EMG: Electromyographic studies help to confirm the presence of impaired nerve functions. both benign and malignant. intravenous pyelography and barium enema may be necessary to find out aortic aneurysm or pelvic or rectal pathology. Selective muscle degeneration can be identified and can suggest the nerve root responsible. • MRI: MRI has several advantages over CT scanning in the assessment of cervical and lumbosacral spines. Disease review 86 • C. Reconstruction techniques can be used to outline the spinal cord and nerve roots with a precision hitherto impossible. • Aortic arteriography.T. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . • Nerve conduction tests support a diagnosis of peripheral nerve entrapment of the common peroneal nerve at the neck of the fibula and of the post tibial nerve in tarsal tunnel syndrome. from syringomyelia to lesions of the lumbosacral nerve roots and cauda equina. often providing an earlier diagnosis and demonstrating more lesions than are found on X-ray. Scan: An important advance in radiological investigation of post fossa and spinal lesions. • Radionuclide Bone Scanning: Bone scanning is currently used to investigate a wide range of spinal disorders. Spinal radiographs show variable disc space narrowing with osteophytic lipping and irregularity of the facet joints. Combining the information obtained from a careful clinical history and physical examination with the additional knowledge gleaned from certain special radiographic investigations confirms the anatomical source of pain and makes possible a specific diagnosis. More than one root may be involved but objective neurological signs are usually less prominent than in acute disc prolapse. MRI. recurrent sciatica with osteoarthritis elsewhere in the spine. One can feel a step on deep palpation of the posterior elements of the segment above the spondylolisthetic joint. Disc Herniation: Disc trouble often begins with a popping or snapping sensation in the back followed by low back pain. True sciatic neuritis It is certainly very rare and the diagnosis should be accepted with reserve even when investigations appear to exclude all other causes. Disease review 87 Differential diagnosis A precise diagnosis is the foundation for a rational plan of therapy for low back pain and sciatica. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Spondylolisthesis Often tenderness is elicited near the segment which ‘slipped’ forward. It is however important to remember that such changes will be found in the majority of aged spines so that the appearance seen may not account for symptoms. The defect is best visualized on oblique projections or with CT scan. Degenerative and isthmic spondylolisthesis are easily recognized by conventional radiography. Spondylosis There is often a history of chronic or intermittent spinal pain. Disease review 88 Although. A muscle. Contrast myelography may outline the herniation unless the lesion involves the lateral recess when appearance may be normal. reflex and sensory changes may be present. Radiographs of the lumber spine may show significant narrowing of the affected disc space. laughing or sneezing. Spinal Stenosis Though the pain from root entrapment is in the same distribution as the sciatica from disc lesion its character is different. reflex and sensory impairment may be found. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Sprains and Strains The history of onset of pain is important. After acute disc prolapse the spinal fluid is often normal though there may be slight rise in protein content. this pain is severe specially at night. the initial episode may subside. Criteria for disc protrusion. Marked limitation of straight leg raising is found with positive popliteal compression. CT scan will show bony and/or ligamentous encroachment into the lateral recess of the central canal or into the root canal. It is described as a severe pain often unremitting day and night whilst the pain from a disc is frequently relieved by lying down. Such pain is found in middle aged and older patients. On examination there is difficulty in standing and walking . The lumber lordosis may be lost and there may be scoliosis which becomes more marked with forward flexion.Lumber spine is stiff with tenderness at the level of the lesion. Motor. Localization of such herniation by CT or MRI scanning offers an improved diagnostic method. incapacitating and aggravated by coughing. During the attack the pain is severe. there is tendency for recurrence. Neurological signs vary according to the site of the lesion motor. ligament or fascial injury will be most painful immediately and gradually improve. Facet Syndrome It mimics all aspects of nerve root compression including muscle weakness and neurological abnormalities. the diagnosis of soft tissue injury is a process of elimination. Thus. Segmental instability The instability results in backache with or without referred pain round the pelvis or into the posterior thighs. The pain. The contrast medium during myelography does not fill the root sheaths and tends to be irregularly loculated. A reliable symptom is the history of a ‘catch’ in the back when moving from forward flexion to the erect standing position. Electromyography and nerve conduction studies confirm the site of entrapment. Piriformis Syndrome History of twisting injury is often present. On surgical exploration. Relief of pain by injection of local anaesthetic into the piriformis is said to be diagnostic. some reduction of SLR. often deep seated in rectum and vagina. recurrent episodes of pain – would be unusual with soft tissue injury. Disease review 89 even without leg pain-a list. Internal rotation and resisted abduction of the flexed hip are painful. Arachnoiditis Often there is history of multiple lumber operations and myelograms and are left with backache and sciatica in combination with mild to moderate motor. But it tends to be unilateral and coexisting back pain may also be present. pain aggravated by coughing. the arachnoidal Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . It is aggravated by excessive unnatural or erratic movements of the lumber vertebral segment. sensory and reflex changes. may be severe and incapacitating. The severity of the symptoms often bears little relation to the radiological findings. Inflammatory changes start in the sacroiliac joints and if progressive. radioscintigraphy and CT imaging are helpful. The lack of nerve root Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Ankylosing Spondylitis Night pain and morning stiffness may be the major complaints. X-ray. 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. Raised ESR and prevalence of HLA B-27 antigen confirm the diagnosis. Pain may be present when there are minimal findings on an X-ray and conversely. adherent to dura and tightly bound to pia and roots. malaise and fever and the pain usually can be relieved by rest. ridging and bridging of vertebrae can be seen in asymptomatic patients in middle and lateral life. too often in the kyphotic position. Sacroilitis Referred pain from the sacroiliac joint may radiate to the buttocks. There is notable absence of systemic symptoms such as fatigue. will gradually spread cranially up the spine involving the apophyseal joints. the vertebral end plates and ligamentous attachments until the ligaments are ossified. posterior thigh. Disease review 90 membrane is thickened and opaque. but asymmetric sacro-iliac involvement with radiation into the buttock and thigh is not unusual. Radiograph of pelvis is diagnostic. marked osteophytic overgrowth with spur formation. with sclerosed sacroiliac joints and a ‘bamboo spine’. hip movements are restricted and pain provoked by passive movements. The spine is stiff. Involvement of costovertebral joints restricts chest expansion. In arthritis of hip joint. groin and occasionally to the lateral calf and ankle. Disappearance of pain following local injection of procaine or lidocaine into tender spots is both diagnostic and therapeutic. constant pain unrelieved by recumbency. sternal puncture to obtain bone marrow for histology may be necessary. Patient looks anxious. unremitting progressive course. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The syndrome affects women more often than men. Disease review 91 tension signs and absence of motor. Primary Tumours Insidious onset of pain without history of trauma. Studies point to disturbance in non-REM sleep as a possible cause. intense and progressive nature of pain. Fibrositis Syndrome Pain is widely distributed in the extremities and trunk and is associated with stiffness and exhaustion. fatigued and often desperate for relief. If the typical picture of multiple ‘punched out’ lesions is absent in radiographs. the diagnosis is confirmed. Movement of the joint is usually restricted. reflex or sensory deficits helps to distinguish sacroiliac joint syndrome from nerve root compression lesions. Scintigraphy will be more helpful than radiography in early diagnosis. Abnormalities on serum protein electrophoresis studies and presence of Bence Jones proteinuria usually clinch the diagnosis. Metastatic Disease The distinguishing feature is the unrelenting. Multiple Myeloma The complaints of the patient may he nonspecific but there may be general lack of well being of the patient. Often a needle biopsy of the spine under fluoroscopic control is most direct route for diagnosis. One or more trigger points may be found on palpation. preventing sleep at night. Skinfold tenderness and reactive hyperaemia may be noted. When manipulation or injection to the sacroiliac joint effectively breaks the cycle of pain. Disease review 92 Neurological signs may be relatively late in appearing but lumber puncture will usually reveal a raised cerebrospinal fluid protein level and there may be a partial or complete intrathecal block. The most useful and reliable investigations are a Technetium bone scan to determine the level of lesion and a computerized axial tomographic (CAT) scan to identify the precise location of the nidus. Primary tumours of the lumber canal are best assessed with MRI. Vertebral Osteomyelitis Vertebral osteomyelitis is not easily differentiated from mechanical causes of back pain on clinical grounds alone. Pain is aggravated by activity and relieved by rest. There is frequently a great deal of muscle spasm, more than is usually encountered with an acute disc lesion. Pyrexia, loss of weight and loss of appetite accompany spinal infection. The radiological features of vertebral osteomyelitis are characteristic, with destruction of the end plate. The disc is soon involved and rapidly destroyed by proteolytic enzymes of the pyogenic organisms with spread to adjacent vertebrae. ESR is invariably elevated. Discitis Commonly found in children. There is low grade fever, back pain or abdominal or hip pain and a refusal to walk or stand. ESR and white cell count are raised. Radiological features of disc space narrowing and irregularities of the end plate lag behind the clinical symptoms. Epidural Abscess There is often a coexisting debilitating disease like diabetes or cirrhosis and a source of infection from spinal surgery, needle investigation or retroperitoneal surgery. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Disease review 93 Osteoporosis: Age, sex and especially the menopause are important in development of osteoporosis. Also factors such as hyperparathyroidism, corticosteroid drugs etc should be considered. Low bone mineral density is the most important determinant in osteoporosis compression fractures, with a deficiency in bone mass per unit volume. Sudden failure of vertebral body results in spontaneous severe back pain. Gradual failure of several vertebrae is often associated with chronic back pain, sometimes with episodic increase in the pain with development of kyphosis and loss of height. The clinical diagnosis is confirmed radiologically. One or more vertebrae are collapsed, with a loss of mineral content appearing as decreased density. Paget ’s disease The disease may lead to compression of the spinal cord or roots because of encroachment on the canal or foramen by pagetoid bone. Enlargement of vertebral body may cause stenosis. Laboratory investigations show increased serum alkaline phosphatase, but serum calcium is usually normal. Refered pain A thorough history taking and abdominal examination may direct attention away from the spine to the source of viscerogenic pain, an elevated ESR to an infection. Vascular Causes Abdominal aortic aneurysm can produce nagging chronic backache. Careful examination of abdomen, including auscultation may reveal the source of the symptoms. Radiographs of lumber spine may show erosion of the anterior aspect of the vertebral bodies or calcification of enlarged aorta. Peripheral vascular disease with claudication can be confused with spinal stenosis. The vascular pain is induced by exercise such as walking. The diagnosis is readily Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Disease review 94 established by diminution in the volume of the femoral, dorsalis pedis or posterior tibial pulses. In sciatic claudication, the claudication is in a root distribution but spinal examination and myelography are normal. Psychogenic Causes The appropriate diagnosis is usually evident after a thorough history and a careful physical 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 from time to time experience 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 number of 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 operation a relapse may occur. Management: Most patients with lower back pain and sciatica are managed conservatively (non- surgically). Treatment will depend on the diagnosis, but for patients with mechanical pain (the vast majority) the mainstays of treatment are reassurance, patient education, analgesia and physiotherapy. However, a minority of patients will require surgery, depending upon the nature of the underlying problem and patients with specific underlying conditions will require treatment of these. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Disease review 95 GENERAL Patient Education The patient with mechanical back pain can usually be reassured that this is not a progressive condition and that the pain is likely to settle or at least become less severe. 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 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. Bed Rest For a patient with severe acute back pain, ‘controlled physical activity’ is now preferred to prolonged bed rest. Recumbency has adverse effects on many systems including the spine. Whilst in the bed, it is immaterial whether the patient lies supine or on the side A pillow beneath the knees can be helpful. If a patient does rest in bed, then the duration of this rest should be limited to 2-3 days. Manipulation Techniques A wide variety of manipulation techniques are advocated, although there is some controversy as to how effective these are as there have been few clinical trials addressing their efficacy. Spinal Orthroses Lumber supports have been widely used for relief of back pain. A support within the corset gives better relief. Besides limiting lumber motility, an orthrosis can decrease Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu If this is not helpful. Back School Back school is a structured intervention programme for a group of individuals and provides patients with information about back pain of mechanical origin. Muscle relaxants are often helpful adjunct. but the painful spasm that can accompany injection and the complications of the occasional anaphylactic shock. SURGERY Surgical management should be reserved for those whose symptoms do not respond after strict bed rest or after traction or manipulation and become chronic. Tricyclic antidepressants. perhaps by local warmth and by stimulation of mechanoreceptors. Injection Therapy A proportion of clinicians give epidural corticosteroids to patients with nerve root compression.g. Chemonucleolysis Chemonucleolysis is the treatment of disc herniation by a lysing agent. Chymopapain enjoyed a decade of popularity. However. Disease review 96 intradiscal pressure and provides relief. amitryptiline 10-25 mg. those who Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . DRUG TREATMENT Back pain is usually non inflammatory and so a simple analgesic should be tried in the first instance. may relieve chronic pain and improve the patient’s sleep pattern. then an NSAID may be added in. how this knowledge can be applied in day to day activities and how the spine can be strengthened by improving fitness. compliance is poor. the value of this form of therapy has been much debated. commenced in low dosage e. about types of stress that can injure the spine. cerebral haemorrhage and paraplegia have directed many of its original advocates towards small doses and other percutaneous techniques. but it may be several weeks before they take effect. However. wide exposure and combined fusion are in use. Sporting activity and supervised weight training are good for the spine. Arthrodesis of the involved segments is indicated only in cases in which there is extra ordinary instability usually related to anatomic abnormality such as spondylolysis. The surgical procedure most often indicated is a hemilaminectomy with excision of the disc involved. standing and sleeping postures lessen the intradiscal pressure. • One should avoid sudden strenuous activity such as lifting heavy objects etc. various surgical procedures from percutaneous techniques. • Diet and nutrition also play an important role. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . swimming running are also helpful. sufficiently severe to cause disability. Regular exercises such as brisk walking. microdiscectomy to traditional fenestration. • Spinal strength and spinal fitness should be looked for. To reduce the disc pressure on the nerve root. Prevention can be done by following: • Posture is important. without conditioning. Central disc prolapse producing a saddle sensory loss and bladder paralysis is an indication for immediate referral for surgery. Disease review 97 relapse and those with gross and persistent symptoms of root compression. Correct sitting. PREVENTION Preventive aspect plays a major role in diseases like sciatica. 1 Part • Chavya . Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . MATERIALS: The following materials were used in the Clinical Trial. Pancha Kola Churna 143 2. Eranda Mooladi Niruha 145 4.1 Part • Chitraka . Trayodashanga Guggulu 147 6.1 Part • Nagara .1 Part • Pippali Moola . 1. Ashtakatvara Taila 144 3. Methodology 98 METHODOLOGY The present study “Clinical Management of Sciatica (Gridhrasi) Through Vasti. Kativasti along with Trayodashanga Guggulu” includes following materials and methods. Rasna Saptaka Kwatha 148 Ingredients: 1) Pancha Kola Churnam: Used For Amapachana • Pippali .1 Part The above mentioned five ingredients of Panchakola Churna were powdered seperatly mixed and used. Sahacharadi Taila 146 5. Methodology 99 Table No. Vata Zingiber 5 Nagara Katu Ruksha Ushna Madhura Kaphahara officinale Tikshna Deepana 2) Ashtakatvara Taila : Used for Kati vasti Ingredients: Kalka Dravya : • Pippali mula – 1 part • Shunti – 1 part Sneha : • Sarshapa Taila – 16 parts Drava dravya : • Katvara – 16 parts • Dadhi – 16 parts Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .N Drug Rasa Guna Virya Vipaka Name Karma Laghu Vata Piper 1 Pippali Katu Snigdha Ushna Madhura Kaphahara longum Tikshna Deepana Kapha Pippali Piper Laghu Vatahara 2 Katu Ushna Katu Moola longum Ruksha Deepana Pachana Kapha Piper Laghu Vatahara 3 Chavya Katu Ushna Katu chaba Ruksha Deepana Pachana Vata Laghu Plumbago Kaphahara 4 Chitraka Katu Ruksh Ushna Katu zeylanica Deepana Tikshna Pachana Guru.12: Properties of Pancha Kola Churnam: Botanical Dosha S. 1 part • Palasha . Murchita Tila Taila . 30 gram 5.N Drug Rasa Guna Virya Vipaka Name and Karma Kapha Vatahara Pippali Piper Laghu 1 Katu Ushna Katu Deepana mula longum Ruksha Pachana Laghu Kaphavataghna Zingeber Katu 2 Shunti Snigha Ushna Madhura Pachana Vrushya officinale Madhura Ushna Hrudya Snigdha Brassica Katu Kaphavataghna 3 Sarshapa Ushna Ushna Katu jancea Tikta Deepana Lekhana Tikshna Amla 4 Katvara .1 part • Shaliparni – 1 part • Prushna parni – 1 part • Goksura – 1 part • Bala – 1 part • Rasna – 1 part Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Kalka . Gomutra . Saindhava . Snigdha Ushna Amla Hrudyam Madhura Vatahara Table No. 75 ml Ingredients of the kwatha Dravya(Yavakutachurna form) • Erandamula . Kashaya Snigdha Ushna Amla Deepana Snigdha Deepanam Amla 5 Dadhi . 400 ml (Erandamuladi) 6. 200 ml 4. Madhu . 10 gram 3.1 part • Bruhati .13: Properties of Pancha Kola Churnam: 3 Eranda Mooladi Niruha : (Used for Niruha Vasti) Contents of Niruha Vasti 1. 100 ml 2. Kwatha .1 part • Kantakari . Methodology 100 Botanical Doshaghnata S. 1 part • Daruharidra.1 part • Musta.1 part • Shatapushpa.1 part Table No.1 part • Vatsaka. vasti communis peedahara Butea Katu Snigdha Vata 2 Palasha Ushna Katu monosperma Tikta Ushna kaphahara Kaphavatahara Solanum Katu 3 Bruhati Ushna Ushna Katu Grahi Pachana Anguivi Tikta Deepana Kaphavatahara Solanum Katu Laghu Pachana 4 Kantakari Ushna Katu Xantocarpum Tikta Ruksha Shukra rechana Tridoshaghna Pseudarthria Tikta 5 Shaliparni Guru Ushna Madhura Brumhana Viscida Madhura Rasayana Desmodium Tridoshaghna 6 Prushnaparni Madhura Ushna Ushna Madhura gangeticum Vrushya Tridoshgna Tribules Vasti 7 Goksura Madhura Sheeta Sheeta Madhura terrestris shodhana Deepana Vatapittahara 9 Bala Sida cordifolia Madhura Sheeta Sheeta Madhura Balakara Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .1 part • Nirgundi .1 part • Hapusha.N Drug Rasa Guna Virya Vipaka Name and karma Kaphavatahara Ricinus 1 Eranda mula Madhura Ushna Ushna Madhura Kati.1 part • Yashti Madhu. Methodology 101 • Guduchi – 1 part • Ashvagandha – 1 part • Devadaru – 1 part • Madana phala – 1part Ingredients of Kalka Dravya: • Vacha .1 part • Pippali.14: Properties of Eranda Mooladi Niruha Vasti: Botanical Doshaghnata S. Methodology 102 Alpinia Guru Kaphavahara 10 Rasna Tikta Ushna Katu galangal Ushna Pachana Vataraktahara Tinospora Tikta 11 Guduchi Ushna Ushna Madhura Rasayani cordifolia Katu Deepana Vatakaphahara Withania Kashaya 12 Ashvagandha Ushna Ushna Katu Atishukrala somnifera Tikta Rasayani Boerhavia Kashaya Kaphavatagna 13 Punarnava Ushna Ushna Katu diffusa Madhura Shophagna Cassia Kashaya 14 Argvadha Ushna Ushna Katu Vatakaphahara fistula Tikta Kaphavatahara Cedrus Laghu 15 Devadaru Tikta Ushna Katu Dushtavruna deodara snigdha Shodhana Kaphahara Randia Madhura 16 Madanaphala Laghu Ushna Katu Vamaka dematorum Tikta Lekhana Deepana Acorus Katu Shakrut 17 Vacha Ushna Ushna Katu calamus Tikta Mootra shodhani Anethum Deepana 18 Shatapushpa Katu Laghu Ushna Katu graveolens Vatakaphahara Sphaeranthus Tikta Ushna Medhya 19 Hapusha Ushna Katu indicus Madhura Laghu Krimihara Vatahara Callicarpa Tikta 20 Priyangu Sheeta Sheeta Madhura Keshya macrophylla kashaya Vrushya Yashti Glycyrrhiza Sheeta Pittanilahara 21 Madhura Sheeta Madhura madhu glabra Guru Balavarnakara Laghu Vata Piper Katu 22 Pippali Snigdha ushna madhura Kaphahara longum Tikta Tikshna Deepana Kaphahara Holarhena Katu 23 Vatsaka Ruksha Sheeta Katu Shoshana antidysenterica Kashaya Grahi Kapha Katu Cyperus pittahara 24 Musta Kashaya Sheeta Sheeta Katu rotundus Grahi Tikta Deepana Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Deepana.N Drug Rasa Guna Virya Vipaka Name and Karma Nilgirianthus Tikta. Sahacharadi Taila : Used for Anuvasana Contents of Anuvasana– Sacharadi taila 100 ml Saindhava 3. 1 Sahachara ushna katu ciliates katu snigdha tridosha hara Madhura Guru 2 Tila Taila Sesamum Vatakaphahara Kashaya snigdha Ushna Madhura indicum Twachya Tikta Picchila 3 Ksheera Snigdha Raktapittahara Milk Madhura Sheeta Madhura Guru Rasayana Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Ushna.Sahachara kwatha 10 parts b.15: Properties of Sahacharadi Taila: Botanical Doshagnata S. Methodology 103 Kaphahara Berbaris Ruksha 25 Daruharidra Katu Sheeta Katu Twak aristata Ushna doshahara Ropaka Laghu Madhura Shodhana 26 Madhu Honey ruksha Ushna Madhura Kashaya Sandhana Sukshma Tridoshahara Laghu Tridoshahara Lavana 27 Saindhava Salt Snigsha Sheeta Madhura Deepana Madhura Sukshma Pachana Madhura Guru Murcchita Sesamum Vatakaphahara 28 Kashaya snigdha Ushna Madhura Tila taila indicum Twachya Tikta Picchila Kapha Katu Ushna 29 Gomutra Cows urine Ushna Katu vatahara shula Lavana Tikshna hara 4).Ksheera 04 parts Table No.5 grams Ingredients of Sahacharadi Taila Kalka – Sahacharamula kalka 01 part Sneha. Tila Taila 06 parts Drava dravya a. Sheet Madhur Medhya. 7 Ushna Katu u ervora Pitta. Deepana. Gokshur Madhrua Sheeta terrestris a a Tridoshagna Vrudhadar Argyrcian Kashaya.N Drug Rasa Guna Name a a Karma 1 Acacia Guru Sheet 1 Abha Kashaya Katu Kaphahara grahi Arabica ruksha a Ashawa Withania Tikta. Rasayani. Cordifolia tikta a a Deepani Asparagus Guru. Tinispora Kashaya. Trayodashanga Guggulu: Used as Shamana Ingredients- Abha 1 part Ashwagandha 1 part Hapusha 1 part Guduchi 1 part Shatawari 1 part Gokshura 1 part Vruddhadaru 1 part Rasna 1 part Shatapushpa 1 part Shati 1 part Yawani 1 part Shunthi 1 part Guggulu 13 parts Goughrita 6. a Rasayana Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Bal 2 Ushna Katu gandha somnifera Kasaya a ya. Balya. Ushn Medhya. Ushn Madhur 4. Ushna. Ushn Vatakaphahara. Methodology 104 5). 3 Happusha Katu indicus Madhura Laghu a Vatakaphahara Vataraktahara.5 parts Table No. 5. 6.16: Properties of Trayodashanga Guggulu: Botanical Viry Vipak Doshagnata and S. Shatavari Madhura racemosus Sheeta a a Vatapittahara Tribulus Sheet Madhur Balakrut. Ushn Kaphaahara. Sphaeranthus Tikta. Guduchi Ushna Rasayani. 9 Katu Laghu Katu a graveolens a Anulomana Kaempferia Katu.Tikt Ushn Kaphavatahara. Katu galanga Ushna a Pachana Shatapushp Anethum Ushn Deepana. 3 Eranda Madhura Ushna Ushan Madhura communis Kati. 2. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Laghu. 11 Ajamoda Katu Tikshna Katu roxberghianu a Kaphavatahara m Zingiber Katu.17: Properties of Rasnasaptaka Kwatha: Botanical Doshagnata S. 12 Shunthi officinale Madhura Ushna a a Pachani Vishada Tikta. 1 Rasna Alpinia galanga Tikta. 8 Rasna Tikta. Deepana. Ushna Katu Ushna Pachana Tribulus Balakrut. Rasayana. Vasti. Ushn Kaphavatahara. mukul Sukshm a Katu Tridoshagna a 6). Methodology 105 Alpinia Guru. 10 Shati Ushna Katu galanga a a Deepana Trachysprmu m Ushn Deepan. Kaphavatahara. Ushn 13 Guggulu Kashaya. Rasnasaptaka Kwatha : Used as Anupana for Trayodashanga gugulu Rasna 1 part Gokshura 1 part Eranda 1 part Devadaru 1 part Punarnava 1 part Guduchi 1 part Ashwagandha 1 part Table No. Ushn Madhur Amavatagna. Katu Rasayana.N Drug Rasa Guna Virya Vipaka Name and Karma Guru. Gokshur Madhrua Sheeta Sheeta Madhura terrestris Tridoshagna Ricinus Kaphavatahara. Commiphora Ruksha. 4 Devadaru Cedrus deodara Tikta Ushna Katu. Methodology 106 Peedahara Laghu. Snigdha Amadoshahara Boerhavia Kashaya. 6. 5 Purnarnava Ushna Ushna Katu diffusa Tikta Shotagna Vataraktahara. cordifolia tikta Deepani Kashaya. 7 Aragwadha Cassia fistula Ushna Ushna Madhura Madhura Sramsana Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Balya. Kaphavatahara. Kaphavatahara. Guduchi Ushna Ushna Madhura Rasayani. Kaphavatahara. Tinispora Kashaya. Ayurveda Mahavidyalaya Hospital. b. Hubli were selected. Internet and medical journals. Hubli. knee. spine X-ray. Methods of collection of Data : a. Methodology 107 METHODS Study design: Prospective randomized Clinical study Source of Data: Patients attending the OPD of the Post Graduate Department of Kayachikitsa. Literatures were collected from the Post Graduate Department Library. Subjects of either sex between 20-60 years were taken for clinical trial. 3. c. leg and foot. Subjects Yogya for adopted therapies. The data obtained by the clinical trials were statistically analyzed by applying the student‘t’ test. Normal L. Subjects with classical features of Sciatica (Gridhrasi) such as pain starting from Hip and radiating down to back of the thigh. Sample size: Minimum of 30 patients diagnosed as Sciatica (Gridhrasi) were selected and randomly categorized into two groups consisting 15 patients in each group. 2. Ayurveda Mahavidyalaya. S. Ayurveda Mahavidyalaya Hospital Hubli wesre selected as per the criteria of diagnosis. 4. A clinical survey of patients attending the OPD of Post Graduate Department of Kayachikitsa. Inclusion Criteria: 1. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Subjects who were below 20 years and above 60 years were excluded. spinal tuberculosis. 2. Subjects Ayogya for adopted therapies. 1. Methodology 108 Exclusion Criteria: 1. Objective parameters: . leg. RA Test v. SLR test 2. Subjects with disc lesions.such as 1.Such as. Blood examination . Investigations: i. X-ray of lumbar spine AP and Lateral view Parameters of study Subjective Parameters: . HIV-infection or any other chronic illness and pregnant women. foot and numbness in the affected lower limb. Urine . knee. Lasegue’s sign. Albumin / Sugar / Microscopy iii. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . VDRL iv. 3. Pain starting from Hip and radiating down to back of the thigh. Hb% TC DC ESR RBC ii. 18: Grading: Assessment Criteria B.T Radiating Pain Numbness SLR test Lasegue’s sign.T A. Methodology 109 Table No. Assessment Based on Scoring: Radiating Pain 0 No Radiating Pain 1 Pain Radiating to hip and back of thigh 2 Pain Radiating to Popleteal fossa 3 Pain Radiating upto foot Numbness 0 No Numbness 1 Mild (Once/day) 2 Moderate (2-3/day) 3 Continuous SLR 0 Negative 1 60 Degree and Above 2 In between 30 Degree to 60 Degree 3 Less than 30 Degree Lasegue’s Sign 0 Absent 1 Present Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Schedule of Kati Vasti : Day Duration 1 30 minutes 2 35 minutes 3 40 minutes 4 45 minutes 5 50 minutes 6 55 minutes 7 60 minutes 8 60 minutes 9 55 minutes 10 50 minutes Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Methodology 110 Assessment criteria: 1. 2. Changes in objective parameters which were recorded in the following pattern. Details about kati vasti procedure are as follows. 2) Kati Vasti with Ashtakatvara Taila. Changes in subjective parameters. • Marked relief – above 75% improvement • Moderate relief – 50-75% improvement • Mild relief – 25-50% improvement • No relief – below 25% improvement INTERVENTIONS: GROUP –A 1) Amapachana with Panchakola Choornam 5gm twice daily with warm water before food for 3-5 days. 2. the subject was asked to lie down on his/her abdomen. in between 8-9 a. After proper Evacuation of bowel the subject was properly examined. Methodology 111 11 45 minutes 12 40 minutes 13 35 minutes 14 30 minutes Here the time duration of stay of oil on 1st day was 30 minutes and 5 minutes per day was increased upto 7th day and 8th day the same time was maintained and after 8th day 5 minutes per day was reduced upto 14th day. Then circular frame prepared out of black gram paste measuring 5” in dia meter and 1 ½” in depth was properly sealed on Lumbosacral region. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .m. Procedure of Kati Vasti • Requirements • Administration of Vasti • Pathya Palana Requirements • Black gram Powder • Ashta Katwara Taila • Water Bath • Cotton • Steel bowels • Towel Administration of Kati Vasti 1. The low back region was exposed. The procedure which was adopted includes the following steps. Hot water bath 3. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Methodology 112 3. Light diet (Yavagu) 4. Rest for 15 minutes 2. 3. Shamanoushadhi Medicine – Tryodashanga Guggulu Dosage – 1 tab thrice a day (1 tab = 325 mg) Anupana – Rasnasptaka Kwatha Kala – Half an hour before food Duration – 2 months Follow up 3 months GROUP . 5. Oil was heated on a water bath up to 50 C and poured into the frame. Avoid from cold wind and travelling.(care was taken about burns) 4. frame was removed and gentle abhyanga was done and mild Nadi Sweda was applied on lumbo Sacral region.B 1) Amapachana with Panchakola Choornam 5gm twice daily with warm water before food for 3-5 days. the upper level of the oil was 1” above the skin. ƒ Schedule of the kalavasti. The temperature of oil was well maintained by changing cooled oil with warm oil. After completion of duration. 2) Vasti procedure was done in kalavasti schedule which includes 10 anuvasana and 6 Niruha Vasti. Pathya Palana 1. Murchita Tila Taila . Contents of the vasti a) Niruha vasti 1. 30 gram Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Methodology 113 ƒ Contents of the vasti. 15th and 16th day. 100 ml 2. Kalka . Saindhava . 200 ml 4. This alternative administration of vasti was followed upto 13th day and schedule was completed by giving 3 consecutive anuvasana vasti on 14th. 10 gram 3. ƒ Requirements ƒ Administration of Vasti ƒ Pathya Palana Schedule of the Vasti Day Administered Vasti day Administered Vasti 1st Anuvasana 9th Anuvasana 2nd Niruha 10th Niruha 3rd Anuvasana 11th Anuvasana 4th Niruha 12th Niruha 5th Anuvasana 13th Anuvasana 6th Niruha 14th Anuvasana 7th Anuvasana 15th Anuvasana 8th Niruha 16th Anuvasana Here on first day Anuvasana was given full stomach and 2nd day Niruha was given with Empty stomach. Madhu . 2) Next day after proper evacuation of bowel. Cotton vii. Sahacharadi Taila . 75 ml b) Anuvasana Vasti 1. Methodology 114 5. Kwatha . Ransadi Churna was applied over head. Requirements i. Rubber Catheter (No. Enema can ii. Prescribed Medicine iii. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . bath was given with luke warm water. Water bath v. Gomutra . 10) iv. 4) Just after intake of food local Abhyanga and Swedana was done and anuvasana Vasti was given with syringe attached with catheter in left lateral position. 100 ml 2. 3) Food was given in sufficient quantity when the patient got hungry. 3-5 gm. Gloves Administration of Vasti a) Administration of Anuvasana 1) After getting proper amapachana lakshana the subject was examined properly. 400 ml (Erandamuladi) 6. Saindhava . 100 ml Syringe vi. Diet .Excessive talking 5 Divaswapna . Pathya Palana Specific diet and proper regimens were advised followed after Vasti karma. 6) Then observed for Evacuation. bath was given then light diet was given when he/she got appetite.Assuming sitting posture for long duration 2) Athishtana . then the patients palm were briskly rubbed against each other.Travelling 4 Vachamsi .Activities which were to be avoided as follows. after doing proper Sarvanga Abhyanga and Swedana.Standing for longer time. 3 Yana . 3) After proper evacuation. 1) Atyasana . Behavior . b) Administration of Niruha 1) After proper evacuation of anuvasana Vasti next day morning the subject was properly examined and Niruha Vasti was administered in between 8 – 9 a.Supperession of urges Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Then warm water processed with dhanyaka was given for drinking. 2) Observed for samyak Vasti lakshana . after proper evacuation the patient was asked to drink one cup of hot water processed with Dhanyaka.Day sleep 6 Vegavarodha .m. Methodology 115 5) Immediately after administration of Vasti gentle strokes were done on buttocks. Diet regimen includes Yavagu with milk twice in a day and luke warm water processed with Dhanyaka for drinking. 3 months Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Untimely intake of food 12 Ahita Bhojana .Anger 11 Akala Bhojana . Shamanoushadhi Medicine – Tryodashanga Guggulu Dosage – 1 tab thrice a day (1 tab = 325 mg) Anupana – Rasna Saptaka Kwatha Kala – Half an hour before food Duration – 2 months Follow up .Exposure to sun light 9 Shoka .Grief 10 Rosha . Methodology 116 7 Shitopacharana .In compatible food The subject was advised to avoid these activities for about 30 days. 3.Exposure to cold 8 Athapa . 20: Distribution According to sex: Sex A B Total Percentage Male 7 4 11 36.e.33 % Christian 1 .67%) followed by 31-40 years. 51-60 years. Table No.67%) patients were male. 1 3.33%) belong to Hindu community and 1(3.33 % Muslim 10 9 19 63. 11 (36.50 years. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .33%) were Muslim while 10 (33.19: Distribution according to age: Age (Yrs.33 % Distribution according to sex shows that in this sample19 (63. Table No.66%).21: Distribution according to religion: Religion A B Total Percentage Hindu 4 6 10 33. The least age of the patient was 23 years and maximum age was 60 years.33 %) belonged to Christian community.) A B Total Percentage 21-30 4 7 11 36. Observations 117 OBSERVATIONS The data obtained by this clinical study was analyzed on different parameters. 8 (26.66 % 51-60 5 3 8 26.67 % 31-40 5 4 9 30 % 41-50 1 1 2 6. 9 (30%). Table No.67 % The first observation table notifies that the sample was split up into Four classes of 10 years age group.33 % In this present study shows that 19 (63.67 %) and Minimum patients were in the age group 41.67 % Female 8 11 19 63. 2 (6. The observations made in this regard are comprehended here with. Maximum patients were recorded in age group of 21-30 years i.33 %) patients were female while 11 (36. . It shows that 16 (53.33 % Widow /Widower 1 .22: Distribution according to marital status: Marital Status A B Total Percentage Married 12 13 25 83.67% Above table shows about. .67 % Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .33%) patients were doing household work. - Others .67%) belonged to others category. Table No. 2 (6.33%) patient was a retired person.00 % Literate -Primary 5 9 14 46.33%) patient was businessman and 1 (3.24: Distribution according to educational qualification: Education A B Total Percentage Illiterate 5 1 6 20.67%) were in service.33% Retired 1 .66% Secondary .67 % Graduate 4 04 8 26. . Observations 118 Table No.33 % Above table shows that 25 (83.23: Distribution according to occupation: Occupation A B Total Percentage House hold 6 10 16 53.33%) patient was a widow. 1 3. - Higher Secondary 1 1 2 6.67% Laborer 4 1 5 16.33%) were un married and 1(3. the occupation wise distribution of patients. 5 (16.67%) were laborers.33% Service 3 2 5 16.33%) patients were married. 4 (13. Table No.33 % Unmarried 2 2 04 13. . 02 2 6. 5 (16.67% Business 1 .33% Tailor . 1 (3. 1 3. 1 3. 66 % Lower middle 1 4 5 16. amongst the literates 14(46. Observations 119 Above table shows that 6(20%) patients were illiterate.00 % Upper middle 3 2 5 16.67% Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .26: Distribution according to Habitat: Distribution A B Total Percentage Habitat Rural 3 2 5 16.67 % Tobacco 2 1 3 10. 2 6.33 % The above table shows that there were 25 (83. lower middle and upper class.67%) patients were Higher secondary.33%) patients residing in Urban area and 5(16. Table No.66%) were of Primary level.67 % Smoking 2 . 2 2 6. Table No. - No addictions 10 7 17 56. 8 (26.67%) patients were graduates and 2 (6. Table No.33 % Panmasala .67 %) in rural area. . 5 (16.67 % Urban 12 13 25 83. were of poor class.67 % Above table shows that 15 (50%) were middle class.67%) each patient.67 % Middle 7 8 15 50.25: Distribution according to socioeconomic status: Socioeconomic A B Total Percentage Status Poor 4 1 5 16.27: Distribution according to addiction: Addiction A B Total Percentage Tea 1 1 2 6.00 % Pan 2 2 4 13.66 % Alcohol . . . .29: Distribution according to Satva: Satva A B Total Percentage Pravara . - Madhyam 8 12 20 66.67%) each patient were addicted to tea. 12 (40%) belonged to vata kapha prakruti.33%) were addicted to Pan. Table No.67 % Avara 7 3 10 33. .30: Distribution according to Satmya: Satmya A B Total Percentage Pravara .67%) didn’t have any addictions. Observations 120 Above table shows 4(13. . 3(10%) were addicted to tobacco chewing and 2 (6. - Manasika Rajasika 10 9 19 63.67%) showed dominance of Tamo guna. . In manas bhavas 19 (63.33 % Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .67 % Above table shows 18 (60%) belonged to Vata pitta Prakruti.00 % Pittakapha . .33 % Tamasika 5 6 11 36.33%) patients showed dominance of raja guna and 11(36.67 % Avara 3 4 7 23.67%) and 10 (33. smoking and Pan masala and 17 (56. - Madhyam 12 11 23 76.00 % Vatakapha 4 8 12 40.28: Distribution according to Prakruti: Prakruti A B Total Percentage Sharirika Vatapitta 11 7 18 60.33 % Maximum patients were observed to be in possession of madhyam satva 20 (66. Table No.33%) were of Avara Satva. Table No. 31: Distribution according to Sara: Sara A B Total Percentage Pravara .33: Distribution according to Vyayam shakti: Vyayam Shakti A B Total Percentage Pravara .67%) were of Madhyama Satmya and 7 (23.00 % Avara 3 3 6 20. - Madhyam 12 12 24 80. . Observations 121 Maximum patients 23 (76. - Madhyam 10 12 22 73. 20 (66.67 % Above data depicts that the sara of 22 (73.33%) patients was Madhyama and 8 (24. 24(80%) patients had Madhyam Samhanana and 6 (20%) had Avara Samhanana. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 10 (33. . Table No. Table No.00 % Samhanana wise distribution is shown in the above table.33 % Avara 5 3 8 24.33%) were Avara satmya.e.67%) were Avara.67% Majority of the patients i.33 % Avara 9 11 20 66. . .67%) were having avara vyayam shakti.32: Distribution according to Samhanana: Samhanana A B Total Percentage Pravara . - Madhyama 6 4 10 33.33%) had madhyama vyayama shakti. Table No. . . Observations 122 Table No.34: Distribution according to Aharashakti: Abhyavaharana A B Total Percentage Shakti Pravara - - - - Madhyama 11 10 21 70.00 % Avara 4 5 9 30.00 % Jarana Shakti Pravara - - - - Madhyama 10 10 20 76.67 % Avara 5 5 10 33.33 % Ahara shakti of patients suffering from Gridhrasi is shown in the table 21 (70%) patients had madhyama abhyavaharana and 9 (30%) had Avara Shakti. 20 (76.67%) were of Madhyama Jarana shakti and 10 (33.33%) were of Avara Jarana Shakti. Table No.35: Distribution according to dietary Habits: A) Dietary Habits A B Total Percentage Vegetarian 3 4 7 23.33 % Mixed 12 11 23 76.67 % B) Dietary Habits A B Total Percentage Regular 3 2 5 16.67 % Irregular 12 13 25 83.33 % C) Dominant Rasa A B Total Percentage Consumed Madhur 1 - 1 3.33 % Amla 6 6 12 40.00 % Lavana 3 - 3 10.00 % Katu 5 9 14 46.67 % Tikta - - - - Kashaya - - - - Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Observations 123 Dietary Patterns of the study sample depicts from this table that mixed were 23(76.67%) where as remaining 7 (23.33%) were of vegetarian diet. 25(83.33%) patients were of irregular food habits and 5 (16.67 %) had regular food habits. Analysis on the basis of dominant rasa consumed showed that maximum patients were using Katu rasa i.e. 14 (46.67%) followed by Amla rasa 12 (40%). Affinity for Lavana was 3 (10%) and only one patient was using Madhura rasa. Table No.36: Distribution according to Agni: Jatharagni A B Total Percentage Sama - - - - Manda 11 12 23 76.67 % Vishama 4 3 7 23.33 % Tikshna 0 0 0 00% Above given table approaches the patient in terms of their Agni Status. There is presence of Mandagni in 23 (76.67%) patients, Vishamagni in 7 (23.33%) Table No.37: Distribution according to Koshtha: Koshtha A B Total Percentage Mridu 2 1 3 10.00 % Madhyama - 2 2 6.67 % Krura 13 12 25 83.33 % Among 30 patients Krura Koshtha was found in 25 (83.33 %) Mridu in 3 (10%) and Madhyama Koshta in 2 (6.67%). Table No.38: Distribution according to type of onset: Onset A B Total Percentage Sudden 3 3 6 20.00 % Gradual 12 12 24 80.00% Table shows the type of onset of the symptoms. Sudden onset was found in 6 (20%) patients while 24 (80%) showed gradual onset. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Observations 124 Table No.39: Distribution according to chronicity: Chronicity A B Total Percentage Upto 12 months 6 7 13 43.33 % 1 to 3 years 7 7 14 46.67 % 4 to 6 years 1 1 2 6.67 % 7 to 9 years - - - - Above 9 years 1 - 1 3.33 % It was found that 14 (46.67 %) patients were in the range of 1 to 3 years duration. 13 (43.33%) patients were of 12 months duration, 2 (6.67 %) showed duration of 4 to 6 years, and 1(3.33 %) patient showed duration above 9 years. Table No.40: Distribution according to treatment received: Treatment received A B Total Percentage Ayurvedic 3 1 4 13.33 % Allopathic 12 13 25 83.33 % Homeopathic - - - - Others - 1 1 3.33 % Not taken - - - - Majority of the patients i.e. 25 (83.33 %) had received Allopathic treatment, 4 (13.33%) had received Ayurvedic treatment, 1 (3.33%) patient had received other treatment such as acupuncture etc. Table No.41: Distribution of patients according to their side affected: Leg A B Total Percentage Right 6 10 16 53.33 % Left 9 5 14 46.67 % Both - - - - Radiation of pain was seen in 16 (53.33%) patients in right lower limb and 14 (46.67 %) had radiation in left lower limb. No patients reported with bilateral involvement. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Observations 125 Graph No. 1 Age Wise Distribution Graph No. 2 Sex Wise Distribution Graph No. 3 Religion Wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Observations 126 Graph No. 4 Marrital status Wise Distribution Graph No. 5 occupation Wise Distribution Graph No. 6 Education Wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu Observations 127 Graph No. 8 Habitat Wise Distribution Graph No. 9 Addiction wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 7 Socio economic status Wise Distribution Graph No. 10 Shareerika Prakriti wise Distribution Graph No. 11 Manasika Prakriti wise Distribution Graph No. 12 Satva wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Observations 128 Graph No. 14 Sara wise Distribution Graph No. 13 Satmya wise Distribution Graph No. Observations 129 Graph No. 15 Samhanana wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Observations 130 Graph No. 16 Vyayama shakti wise Distribution Graph No. 17 Ahara shakti wise Distribution Graph No. 18 Jarana shakti wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Observations 131 Graph No. 19 Diet wise Distribution Graph No. 20 Dietary habits wise Distribution Graph No. 21 Rasa wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 24 Onset wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 22 Agni wise Distribution Graph No. 23 Koshta wise Distribution Graph No. Observations 132 Graph No. 27 Affected side wise Distribution Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Observations 133 Graph No. 26 Treatment wise Distribution Graph No. 25 Chronicity wise Distribution Graph No. 51 0. Totally 30 subjects were registered for clinical trial.22 SE (+) 0.001) result with‘t’ value of 11.53 0. Effect of Basti on Radiating pain in Group B: The mean before treatment was 2. The total effect of therapy provided statistically Highly significant (p<0. Numbness.22 0.60 Difference Mean 1. SLR test.001) result with‘t’ value of 10.05 t value 11 10. The total effect of therapy provided statistically highly significant (p<0.02 0.53 which was reduced to 0.001 Remarks Highly Significant Highly Significant Effect of Kati Basti on Radiating pain in Group A: The mean before treatment was 2.86 0.88 0. Results 134 RESULTS Effect of therapy on different parameters such as Radiating pain.73 2.6 after the treatment.2 0.001 <0.13 0.00 0.64 p value <0. Lasegue’s sign and associated symptoms are shown below.73 Difference SD 0.73 after the treatment.93 SD (+) 0.19 Difference SE 0. The inclusion criteria was clinical features of Sciatica (Gridhrasi) Age group between 20 – 60 of either sex and duration was more than 2 months.46 1.42: Effect of therapies on Radiating Pain: Group A Group B BT AT BT AT Mean 2. Table No.2 which were reduced to 0.64 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .22 0. 67 p value <0.22 0. Results 135 Table No.4 after the treatment.26 0.2 0.63 Difference SD 0.43: Effect of therapies on Numbness: Group A Group B BT AT BT AT Mean 2. The total effect of therapy provided statistically Highly significant (p<0.02 0.02 t value 11 8.001) result with‘t’ value of 8. Effect of Basti on Numbness in Group B: The mean before treatment was 2.88 0.66 which was reduced to 0.73 after the treatment. The total effect of therapy provided statistically highly significant (p<0.70 0.40 Difference Mean 1.22 0.18 0.2 which were reduced to 0.86 0.001 Remarks Highly Significant Highly Significant Effect of Kati Basti on Numbness in Group A: The mean before treatment was 2.00 0.001 <0.73 2.86 SD (+) 0.46 1.67 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .16 Difference SE 0.001) result with‘t’ value of 11.07 SE (+) 0. 02) result with‘t’ value of 2. Results 136 Table No.02 <0.12 0.00 which was reduced to 0.00 0.01) result with‘t’ value of 4.00 0.48 0.64. The total effect of therapy provided statistically significant (p<0.66 1.01 Remarks Significant Significant Effect of Kati Basti on Lasegue’s sign in Group A: The mean before treatment was 1.51 Difference SD 0.00 0.51 SE (+) 0.46 after the treatment.00 0. The total effect of therapy provided statistically significant (p<0. Effect of Basti on Lasegue’s sign in Group B: The mean before treatment was 1.13 t value 2.54 SD (+) 0. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .48 0.66 after the treatment.13 Difference SE 0.64 4 p value <0.46 Difference Mean 0.44: Effect of therapies on Lasegue’s Sign: Group A Group B BT AT BT AT Mean 1 0.00 which was reduced to 0.00 0.12 0.33 0. The total effect of therapy provided statistically highly significant (p<0.57 0.60 SD (+) 0.41 Difference SD 0.40 after the treatment.10Difference SE 0.07 t value 10.13 0.17 0.18 0.20 Difference Mean 1.10 0. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .80 0. Results 137 Table No.79 p value <0. The total effect of therapy provided statistically Highly significant (p<0.73 0.001) result with‘t’ value of 9. Effect of Basti on SLR test in Group B: The mean before treatment was 1.73 which was reduced to 0.8 which was reduced to 0.40 1.26 SE (+) 0.001) result with‘t’ value of 10.001 <0.58.70 0.001 Remarks Highly Significant Highly Significant Effect of Kati Basti on SLR test in Group A: The mean SLR before treatment was 1.79.14 0.04 0.33 1.2 after the treatment.45: Effect of therapies on SLR test: Group A Group B BT AT BT AT Mean 1.58 9.67 0. the mean of Numbness was 1.48 0.51 and SE is 0.70 and SE is 0. Group A Group B Sl.13 1. SD is 0.05) result with‘t’ value of 2.48 0.13 1.63 0.93 0.18 2.12 0. In Group B.10) result with‘t’ value of 1.46. SD is 0.53 0.10) result with‘t’ value of 1.18. the mean of SLR test was 1.D.51 0.46.83 0. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .93.07. the mean of radiating pain was 1.E.51 and SE is 0.13. The comparative efficacy of Group A with Group B showed statistically not significant (p>0.29 >0.46 0.63 and SE is 0. The comparative efficacy of Group A with Group B showed statistically not significant (p>0.07 >0. Showing the Comparative efficacy of the therapies in Group A and Group B by using unpaired ‘t’ test No. S.12.10 NS Comparative efficacy of the therapies in Group A and Group B: The mean of radiating pain in Group A was 1.13.60. The comparative efficacy of Group A with Group B showed statistically significant (p>0. S.46: Comparative efficacy of Therapies on different parameters: Table No.10 NS 4 Lasegue’s sign 30 0.86.70 0.60 0. Parameters of of S.83 and SE is 0.51 0. SD is 0.16.46 0.05 S 2 Numbness 30 1. assessment Mean Mean Pts (±) (±) (±) (±) 1 Radiating pain 30 1. S. Results 138 Table No.86 0.13 1.33 0.10 NS 3 SLR test 30 1.33 0.33. In Group B. SD is 0. .48 and SE is 0.57.12 1.21.E.51 0.09 >0.21 1. SD is 0.16 1.29.57 >0. The mean of SLR test in Group A was 1. ‘t' p Remarks No. The mean of Numbness in Group A was 1.D. In Group B. SD is 0. 76.73 66. A. the mean of Lasegue’s sign was 0.88% relief was observed in Parameter SLR test and 82. SD is 0.13.20 88. A. 53.31% relief was observed in the Radiating Pain.00 0.12.46 53.09.47: Effect of Therapy on different parameter in Group A: General Symptoms B.T.e.26 0.33 Effect of therapy on different parameters in group A: A maximum percentage i.48: Effect of Therapy on different parameter in Group B: General Symptoms B.66 33.92 Lasegue’s sign 1.48 and SE is 0.T.33.53.00 0.e.92% relief was observed in SLR test and 66.31 Numbness 2.88 Lasegue’s sign 1. The comparative efficacy of Group A with Group B showed statistically not significant (p>0.53 0.T.33% relief was observed in Lasegue’s sign. 76. % Radiating pain 2. Results 139 The mean of Lasegue’s sign in Group A was 0.2 0. Table No.66 Numbness 2.51 and SE is 0.2 0. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . % Radiating pain 2.10) result with‘t’ value of 1.T.35 SLR test 1.33% relief was observed in the Lasegue’s sign.66 SLR test 1.40 76. In Group B. Table No. 88.73 66.73 0.80 0.60 76.33 Effect of therapy on different parameters in group B: A maximum percentage i. SD is 0.35% relief was observed in Numbness.40 82.66% relief was observed in Radiating pain and Numbness 33. 00 2 55.00 57.50 90.0 7 100.00% 00 00.0 100.00% Above 75 % Moderate relief 03 20.44 100.33 11 50. Whereas the therapy under Group B provided relief ranging from 37.0 9 83.00% 03 20.67% 18 60.00% 00 00.50 13 100.00 37.67 4 85.33 55.00% 25%-50% No relief 00 00.49: Overall improvement in each subject in Group A and Group B: Total Improvement in each Total Improvement in each Patient No.56 40.0 6 44.00% 50-75% Mild relief 04 26.33% 06 20.67%.33 100.56 10 100.89 14 85.0 66.14 12 30.0 83.50 % to 100 % with an average of 79. Patient in Group A Patient in Group B 1 62. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .71 The therapy under Group A provided relief ranging from 30% to 100%.37%.0 88.0 85.71 85.00 3 100. Results 140 Table No.33% 10 66.0 15 100.44 100.67% 02 13.00% Below 25% In this study 18 (60%) subjects got Marked relief. 06 subjects (20%) got Mild relief.71 5 33.71 100. Table No 50: The Overall effect of therapy on 30 subjects of Gridhrasi(Sciatica): Remarks Group A Group B Total Marked relief 08 53. 06 (20%) subjects got Moderate relief.0 8 44.00% 06 20. with an average of 71. 00% 70. 100 80 Total  60 Improvement in  each Patient in  40 Group A Total  20 Improvement in  each Patient in  0 Group B 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Graph No. 30: The Overall effect of study on Cardinal Symptoms in both Groups 80.00% Group B 20.00% Group A 30.00% 60.29: Effect of therapy on Total symptom score in each subject under Group A and Group B: 120 Patient No.00% 0.00% Total 10.00% Marked Relief  Moderate  Mild Relief  No Relief  Above 75 % Relief 50‐75% 25%‐50% Below 25% Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Results 141 Graph No.00% 40.28: Effect of Therapy on Cardinal features in Group A & B (In %): 90 80 70 60 50 % of Improvement in Group A 40 % of Improvement in Group B 30 20 10 0 Radiating Numbness SLR test Lasegue’s pain sign Graph No.00% 50. Discussion on therapies. 1. at prefinal stage clubbing the observation and results on which certain conclusion can be drawn. while Atharvaveda the word Vaatikrita was mentioned which denotes Vata Vyadhi. Viskanda was mentioned along with Visha which means crushing the limbs and Abhishochana (burning sensation). and Taittereeya Samhita. This section titled ‘Discussion’ analyses and contemplates the observations made during the project and results obtained post therapeutically on the selected problems i.e. Many disorders leading to impairment of legs were known since vedic period in Veda. Many disorders pertaining to voluntary movements of limbs as told in Vedic literature under the term Vishkanda. Gridhrasi. which is followed by meticulous and ardous execution of strategy. Discussion on Historical Review 2. Discussion on Vyadhi. detailed planning of research. Though the term Vishkanda mainly used to indicate the impairment of shoulder joint in Atharva Veda. Discussion 142 DISCUSSION Main intention of any research is to re-examine the established facts and clarify the doubts and fill the lacunas. where as Vyamsa was mentioned the Rigveda as the disorder which hamper the Gati. Discussion on Historical Review: The disorders which impair the movement of legs are as old as the existence of human being. Gridhrasi is not mentioned in any form. As walking is an inevitable function since the existence of the man on the earth to search for the food. 3. The process starts with forming of hypothesis. The discussion part is done as follows under 4 headings. Discussion on observations and results. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 4. Vatavyadhi and Gridhrasi in full length. he had made many original observation pertaining to Sandhimukta. manipulation etc. Sroni. briefly to restore the dislocation which suits for Gridhrasi cases also. So it can be inferred that many varieties of Vata disorders were prevalent during Vedic period. As the science advanced in Samhita Kala. clinical features. his description pertaining to classification. He describes traction. Pana. The descriptions of Vata in its normal and morbid state in Bhela Samhita were almost analogous to Charaka. in addition to Raktamokshana. He mentions clearly in Marma Shareera that trauma of Kukundara Marma leads to sensory and motor loss of lower limbs and leads to disability. uru. Sushruta has given much importance by allotting first chapter of Nidana Sthana it self for Vatavyadhi. further he describes Pancha Vata and aetiology of its morbidity along with its clinical features. He stresses the use of Bala Tila for Vasti. Charaka Samhita was the first and foremost treatise which elaborates Vata. The treatment pertaining to gridhrasi described sum what different from his previous works. Asthi and Majja. Pada and joints. Sushruta being well versed with Shareeram describes structure of Prushta. In Chikitsa aspect the therapies described in Bhagna Chikitsa are also use full in Gridhrasi cases especially of Abhighataja origin. even though he describes the clinical features of Gridhrasi in the same chapter. Discussion 143 ‘Yakshma’ a disease condition described in detail in Vedas said to involve any part of body including Prishta. etc. The treatment of Gridhrasi is explained Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . prognosis of Sandhimukta suits for lumbar disc prolapse which is responsible for majority of Sciatica cases. but varieties of Gridhrasi were not found. the unique patho geneses of Vata vitiation due to the obstruction to its passage or functioning was elucidated in full detail.. This is an important clinical test now days for the diagnosis of sciatica known as SLR test. Adhamalla the commentator on Sarangadhara samhita stated that the Gridhrasi is popularly known Radhi indicates pressuring. Vataja and Vata Kaphaja more elaborately than Charaka. Exhibiting his specialisation of Nidana which facilitates appropriate diagnosis. Compressing & Destroying. Harita who mentions Gridhrasi is a disorder due to impaired function of Vyana Vayu. he terms Gridhrasi as Randhani which means weak point or Rapture. Discussion 144 immediately after describing Rakta Gata Vata Chikitsa which indicates its association with Pitta. Guggulu and Bala in the treatment of Vata Vyadhi. He has allotted separate chapter for Rasona Kalpa. Sodhala the author of Gadanigraha was the first person to point at the necessity of Rakta Dushtihara therapies in Vata Roga. he had high lightened use of Rasona. Guggulu Kalpa in Kalpa Sthana. It was an interesting comment made by Arunadatta in his Sarvanga Sundari Commentary on Ashtanga Hridaya defines clearly that due to Vata in Kandara the pain is produced at the time of raising the leg straight and it restricts the movement of thigh. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Madhavakara describes the varieties of Gridhrasi i. Vriddha Vagbhata has given place for Vata Vyadhi in both Nidana and Chikitsa Sthana Similar to Sushruta. He has mentioned it as Maha Snayu which runs from Lumbar region to the foot. He mentioned Gridhrasi in the disorders of Vata seated at Snayu.e. Dalhana gives a clear idea about the anatomical location of Gridhrasi that is he considered Gridhrasi Nadi as Kandara stated by Sushruta. when usual measures failed to achieve desired result. to describe pain felt around hip or thigh. which were observed during post mortem studies but did not link these with sciatic pain and concluded they were probably asymptomatic life. Other Dosha can also modify the clinical presentation in which Kapha is major one than the rest. Discussion 145 During modern ages especially Greeks who were familiar with terminologies like sciatic neuralgia and Sciatica. Hippocrates had noted that pain radiating to foot was good prognostic sign. this was challenged by Kelly who felt that pressure on a nerve would lead to loss of function rather than pain. and Gaurava etc and is named as Vatakaphaja Gridhrasi. Description of Gridhrasi in Brihatrayi and Laghutrayi are concise but ample enough to understand the condition in excel. Discussion on Vyadhi : Gridhrasi is a pain dominant disorder affecting the Kandara. Asthi and Snayu involving related Srotas produce the alarming symptoms in Sphik initially followed with progressive radiation to distal part of the leg. Initially presence of pain was ascribed to presume on nerve roots. The involvement of Kapha Dosha in its pathogenesis results in the occurrence of typical symptoms like Aruchi. This vitiated Dosha afflict the Rakta. Tandra. Lindal & Rexed found evidence of inflammatory response on Lumbar nerve roots at laminicotmy leading to the theory that prolapse of an intervertebral disc may provoke an inflammatory reaction in Lumbar nerve roots causing the sciatic type pain. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . It is caused by the imbalance of Vata Dosha. 1929 schmorl and Andrae brought the concept of disc protrusions. 1764 Italian anatomist Domenco Cotungo was the first person to distinguish sciatica due to nerve as a disease from the aching pain associated low back pain. where as localized hip pain was less likely to resolve. It is the distribution of pain along the course of the sciatic nerve or its component nerve roots is characteristic. A similar condition in modern parlance is sciatica syndrome. external mechanical pressure and degenerative changes of the lumbar spine are the commonest causes for sciatica. This similarity itself suggests its gravity of distress. Prolapse of intervertebral disc. Janu. Toda and Stambha initially in Sphik and establishing distally to Kati. Prushta. Along with the cardinal symptoms. Pain starting from lumbo-sacral region radiating downwards from buttocks. This illness is named so because of its complexity in symptoms as well as etiological factors. Onset of Ruk. For the same reason elevation of thigh will be restricted in patients suffering from Gridhrasi. History of trauma may add up in the process of diagnosis. Restricted SLR Test and Lasegue’s sign consolidates the diagnosis clinically and even the illness can be confirmed by imaging techniques. Discussion 146 The word Gridhrasi refers to a disease with awful pain experienced by the patient and is similar to the pain experienced by a prey of vulture while being eaten up. posterior-lateral aspect of the thigh and the calf to the outer aspect (or border) of the foot is the cardinal symptom of sciatica syndrome. the presence of symptoms indicative of involvement of other morbid Dosha may also add to the clinical manifestations. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Jangha till Pada is the unique feature of this illness. It may be worth mentioning here that Acharya Charaka listed the symptamatology of the illness and Acharya Sushruta was particular about the signs of disease there by completing the total clinical presentation of Gridhrasi. Radiating deep seated cramping pain in buttocks followed with numbness and parasthesia in lower extremities favours the diagnosis. Discussion 147 Discussion on therapies : The treatment of a disease varies accordingly to the morbid state of dosha in the body. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Deepana. While treating any disease. Vata Shamana. all the Vata Prakopa Hetu including external factors such as excessive walking. Balya and Rasayana. riding etc should be avoided. There is a general principle that Vriddhi of Dosha should be treated by Langhana and their Kshaya with Tarpana. By the word Snehana both external and internal Snehana is included. It also does the Poshana Dhatu and thus maintains the Prana. For Gridhrasi.. When we review the classics about the therapeutic aspect of Gridhrasi. Prakriti etc. it revolves around effects like Amapachana. These effects can be achieved by applying following therapies which are considered to be the superior most in alleviating Prakupita Vata like. Sneha pacifies Vata brings out softness in body and removes Mala Sanga. Especially Taila is praised in Vata Vyadhi as it is having exactly opposite properties of Vata. Gridhrasi being a Vatavyadhi the general line of treatment of Vatavyadhi can applied to it. Vedana Sthapana. But Vata is an exception as Vata Vriddhi is to be treated by Tarpana and Kshaya by Langhana. of the patient. If the Dosha Prokopa is minimum. Snehana Swedana Niruha basti Anuvasana basti Mridu Shodhana Shamanoushadhi Snehana: Snehana should be done in Nirupastambhita Vata. the first and foremost principle to be followed is to avoid Nidana. Langhana Chikitsa and if Dosha Prokopa is maximum Shodhana therapy should be adopted. Bala. Janu. are various types of Sweda. Shotha. Vata which has been obstructed by Ama and getting Sthana Samsraya initially at Kati then to Prishta. Swedana Liquefies the Dosha and expands the Srotas. Mridu Shodhana: When we go to Samprapti of Gridhrasi. Stambha. While mentioning the Kala of Abhyanga. Discussion 148 The external Snehana is done by Abhyanga. while only Swedana is indicated in Sama Vata Vyadhi. Ruk. Sneha Poorva Swedana relieves the complaints such as Harsha. helping Dosha to travel towards their own Sthana. Sankara etc. Sushruta has stated that after 900 Matra the Sneha can reach Majja Dhatu. Ruchi. Toda. Nadi. It acts on sparshanendriya which is the seat of Vayu. Charaka says that proper Snehana and Swedana can make even dry wood flexible. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . and diminishes tandra. Parisheka. It signifies the action of Sneha on Asthi-Majja Dhatu which are involved in Gridhrasi. This cleansing process gently removes the mala which has been lodged in Amashaya and Pakwashaya without causing Vata Prakopa. Prastara. Swedana: Snehapoorvaka Swedana is indicated in Nirama Vata Vyadhi. clears Srotas. Snehana and Swedana by virtue of their Vatashamaka and Dhatu Poshana properties are useful in relieving the above said complaints. are main symptoms. Jangha & Pada. Graha etc. So to relieve the obstruction caused by Ama at the same time Shodhana shouldn’t vitiate Vata. and Avagaha etc. Toda etc. Ruk. creates Komalatha. Swedana increases Agni. so Mridu Virechana / Snigdha Virechana had been advised. In Gridhrasi Stambha. Discussion 149 Vasti: All the texts in Ayurveda accept and talks very much about the Vasti and its significance. Vajikarana and any desired therapeutic effects. Vasti along with Shodhana does the other functions like Shamana. Tikta and hot properties of drugs commonly used for this purpose. More ever Virechana cannot be used as a method of Shodhana in children and very elder Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Rasayana. Among all the therapeutic procedures Vasti is superior because Vamana and Virechana have many complications and person becomes debilitated. It is evident that oral administration of medicine for Virechana therapy may produce the symptoms like abdominal distress. The two types of abnormalities of Vata namely. Vata is a catalyst which controls all neurological activities. Avarana and Dhatu Kshaya can be treated by Vasti karma. nausea and anorexia due to Katu. Samshamana and Samgrahana (Retaining and absorbing). Vasti is mainly indicated in Vata predominant diseases. Anabolism and Catabolism depend upon the normal physiological activities of Vata. Apart from this Vasti is considered as superior to all other therapeutic measures on account of its various actions like Samshodhana. It controls dormant Pitta and Kapha and makes them active. Direct application of this kind of treatment to Pakvashaya helps not only in regulating and co-ordinating Vata Dosha in its site but also controls the other diseases involved in the pathogenesis of diseases. Agni the central factor for health and ill health is also regulated and maintained by rhythm of Vata. Vasti is the treatment which is applied directly to the main seat of Vata. Large intestine is the main site of Vata. This further helps in regulation of Samana & Vyana Vayu. Basti conquers the vitiated Vata is its Prakruta Sthana by which Vata dwelling in other parts of the body is automatically conquered. and Sheeta etc Guna. Probable mode of action of Basti: Basti is a purificatory process by which all vitiated Dosha are expelled from the anal canal and thus Vata is pacified. Discussion 150 persons. Thus Vasti is rightly considered as Chikitsardha. Pakwashaya is the natural abode of Vayu. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Here an attempt has been made to explain the probable mode of action of Basti in the Samprapti Vighatana of Gridhrasi. Vata specifically Apana and Vyana Vayu Dushti is found. Basti stays at Pakwashaya and starts its action from there. Basti therapy is a complex process in which several factors take active part for completing the action of Vasti. Basti removes Malasamghata and thus maintains the Anuloma gati of Apana Vayu. Also while explaining the importance of Vasti Charaka says that there is no therapeutic procedure comparable to that of Vasti. with Guru Guna Laghuta and with Ushna Guna Sheetatva of Vata. Vata is vitiated by Laghu. Ruksha. As a result of excretion of vitiated Dosha the physiological equilibrium in three Dosha is maintained and lasting results are produced after the therapy in the form of sound health. It might be the reason why Kashyapa equated Vasti Karma as Amruta due to its wide applications even infants and aged. in as much as it possesses rapid useful properties of cleansing. Instead of pinpointing to one type of mechanism it is presumed that various factors work in collaboration with each other to produce the beneficial effect of Basti therapy. in addition to its being a quick agent of impletion and depletion. Basti with its Snigdha Guna destroys Rukshata. In Gridhrasi. Hence Basti Dravya with their Madhura. This Vit. Also Asthi and Vata have Ashraya Ashreyi Sambandha. thereby combating Dhatukshaya. Majja is the habitat of Vata according to Kashyapa. Also it has been documented that Majja Dhatu Snehana. The Adhisthana of Basti is Pureesha Dhara Kala. Thus the effect of Basti is not restricted to Apana Kshetra but by its strength. Udana & Vyana Vayu. Vasti Dravya comes in direct contact with Grahani where Pitta Dhara Kala lies. It removes Dosha from toe to top of the body. Basti nourishes and replenishes all the Dhatu. Prushta. nourishing Majja Dhatu. where Sthana Samsraya takes place in Gridhrasi. Tarpana is brought about by the ninth Basti given succession. due to which Vit. Discussion 151 Basti administered with proper methodology spreads in the organs of the lower abdomen viz. Sneha given at Guda which is considered the Moola of the body reaches the whole body and nourishes all Dhatu upto Shukra. are scrapped off and diverted to the exterior. B. Basti Chikitsa decreases the ketoacid and pyruvic acid levels. Pada etc. Prushta and Koshta. Pakwashaya. Specifically Dosha clinging at Kati. Dalhana states that Pureesha Dhara Kala is Asthi Dhara Kala.B restricts the demyelination process of the nerves and helps in regeneration. Also basti acts on the natural bacterial flora of the intestines which is important for the synthesis of Vit. Anuvasana Basti gives strength to Kati. Also. These are necessary for nourishment of the nervous tissue. its virtues traverse throughout the body aided by Apana. So they directly act on Majja Dhara Kala. One theory proposes that the virya of basti dravyas Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Thus. Snigdha Guna pacifies Vayu and act on Asthivaha Srotas. It is proven fact that serum protein and fatty acid levels increase after basti karma. synthesis increases. Tikta rasa. B6. Nabhi etc. Ushna Veerya. Also Pitta Dhara Kala is Majja Dhara Kala. but effects brought out by its vivid potentials can be visualized throughout the body. B12. Basti by mitigating Vata relieves the symptoms. Kalka helps in Dosha Sravana. the whole therapy removes the srotorodha and Vata Kapha Shamana also occurs. Saindhava lavana with its Sukshma Guna carries the drug to minute parts and destroys Avarodha. Maximum are having Laghu. Srotas involved in Gridhrasi and also on its Roopa. Basti is also seen to act upon the Roopa like Ruk. Dushya. Madhu added in Basti scrapes out the Dosha which are producing upalepa in the Srotas as by Lekhana karma. Erandamuladi Niruha Basti which contains many drugs among them Ushna veerya are 22 & Sheeta veerya are 7. Basti checks Agnimandya and hence the production of Ama. Ruksha properties of Basti help in Amapachana and Kapha Shoshana and Sroto Vishodhana. which are produced by Vayu. It scavenges the Dosha and Mala from the body and purifies the cannels. Katu Vipaka – 9 & Madhura – 20 Vipaka Kaphavatashamaka are of 9 in number.N. Sankocha and Vatakrut Shoola. Ruksha Guans and Katu Tiktha and Kashaya Rasa and also as a Avapa Dravya Gomutra is mentioned.S. and Arochaka etc. Basti is known to potentiate Agni. the cardinal symptoms of Gridhrasi. Basti also aids in accomplishing the task of srotoshodhana. Ushna. and expels out vitiated Dosha from the body. It hits both the types of Samprapti i.e. This undoubtedly proves the efficacy of Basti therapy in the treatment of Gridhrasi. Also. Sankocha etc. The Deepana. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Pachana and Kapha Nashaka karma of Basti reduces the Vatakaphaja symptoms like Tandra. Thus. Basti acts on the Dosha. Santarpanajanya and Apatarpanajanya. Tikshna. Thus. it acts on other symptoms like Stambha. Toda. This signifies its action on the nervous system. and is specially indicated in persons having Stabdhata. Gaurava. Discussion 152 spreads through A. The diseases indicated for this Basti like.e. Vyavayi. Uru. Pustikara. it does Marutha-nigrahana. In case of Kapha- avrutha conditions. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The mode of action Kati Vasti is influenced by means of following factors. Sara and vata shamaka by virtue of which it penetrates the transdermal route. It Brings about Snigdhata and also Mardawata. Instead of Masha – Godhooma. Vata shamaka and Kapha vardhaka. Ushna in Veerya. Teekshana. Discussion 153 Indications: As it is having the Gomutra. Vikasi. blood flow is reduced. maximum number of Ushna veerya having the Laghu Ruksha Guans it mainly does Deepana and Lekhana. Sukshma. Shramahara. Probable Mode of Action of Kati Basti: The materials used are Ashtakatvara Taila. Shula in Janga. The temperature together releases the compress of the blood vessels. in case of Mala-mutra sanga. Bala vardhaka. • Medicated oil • Temperature is well maintained • Oil retention Medicated oil acts by its veerya and as well through its gunas by getting absorbed through the transdermal route. The retention time – that acts dually i. nourish and increases blood supply. Pada. Valmika Mruttika and metal rings are also can used. Temperature: In response to pain or in case of muscle spasm. and Prusta. Arsha Anaha and Admana Grahani dosha. Guru and Snigdha in Guna. there is compression of blood vessels. The taila poses guna like Ushna. Thus acts as Shoola prashamana. Masha is swedopaga. Acharya Charaka has mentioned in sutra sthana 4/22. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . The oil reduces the Rookshata by its property. When we consider the Samprapti of Gridhrasi. Here the warm oil increases the local circulation and due to the local rise of temperature (Sthanika Swedana) the pores in the skin open up and the microfined oil particle (due to heating of kati basti oil) infiltrate into the skin and the local effect is wonderfully achieved. Discussion 154 Warm oils are made to stay for particular period in the Kati region in the circle created by masha pishti. to digest the residual Ama and to pacify the excited Dosha. Anupana leads to 1) Complete Eradication of Vyadhi with sustained effects. along with local tissue nourishment by brumhaneeya guna. Shamana Therapy The Shamana like therapy generally Employed after Shodhana to restore Agni. Kala. Kati basti for 14 regular days can give a wonderful and sustained relief from the complaints. a) Santarpana Janya (Ama/Avarana Janya) b) Apatarpana Janya So to make proper Samprapti Vighatana the drugs should have following properties like. and reduces the grahatva by vata shamana. removes the pain. 1) Deepana – Pachana 2) Vedana Sthapana (acting at centre & local) 3) Shothahara 4) Balya (acts on Manas & Shareera) 5) Rasayana If Shamanoushadhi is taken with proper dose. it takes place in two different ways. 2) Checks the reoccurrence. Yavani Vatanulomana. Vatashamaka 3) Vriddhadaru. 4) Maintains the optimal supply of nutrition to the tissue. Here along with Deepana Pachana properties. Brihmana. Vedhanastapaka 6) Guggulu Sukshma. Rasayana Guduchi. Guggulu. Bruhmana 2) Ashwagandha Balya. Shatavari. Deepana Probable Acting Samprapti Vighatana Drug Ama Amapachana – Deepana Shunti. snayu Gokshura. Yavani Sthanasamshraya in kati Katibalya Abha. Shothahara 5) Shatapuspa. Abha resins having Rasayana and Balya property. Ghrita. Hapusha. Shati. Rasna Amapachana 4) Shunti Deepana. as follows. Vataprakopa Vatanulomana Shatapuspa. Rasna Shoshana of Sira. When we consider Samprapti of Gridhrasi due to Apatarpana or Abhighata where Vata Prakopa takes place due to Riktata of Srotas or damage to vital points leading to sandhichyuta and Vata Prakopa. Vrushya. Guggulu. Shati. Khandara. Discussion 155 3) Repairs the damaged structures. Rasayana. Hapusha. Advances upto padha Vatashamana Ashwagandha. Rasayana 7) Ghrita Jeevaniya. Probable mode of action of Trayodashanga Guggulu The drugs which comprises Trayodashanga Guggulu can be categorised according to their karma. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . the drugs like Guggulu. Drug Property 1) Abha Balya. which is well developed in former but is rudimentary in latter. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . but other factors also play a vital role which has been rightly coated by Ashtanga Sangrahakara in 17 chapters as follows: “The process of life both in animal and vegetables are governed by chemical and physical phenomena controlled by nerve force.66%).67 %) and Minimum patients were in the age group 41. Discussion 156 That replaces the damaged nerve tissue and Rasna. Shunti.50 years. The maximum number of female patients are suggestive that women are more affected by Gridhrasi which may be due to age related degenerative changes.67%) patients were male. 51-60 years. Vipaka. Even though drugs acts according to there Rasa. 8 (26. The least age of the patient was 23 years and maximum age was 60 years. Maximum patients were recorded in age group of 21-30 years i.67%) followed by 31-40 years. 9 (30%).33 %) patients were female while11 (36. menopause induced osteoporotic changes and as well as physical stress as aggravating factor.e 11 (36. Discussion on Observations: Discussion on Age: In the present study the sample was split up into four classes of 10 years age group. Guna. Ghrita which fills the Rikta Srotas and brings Mardavata thus leads to proper canalisation of Vata and disintegrating the Samprapti. Ayurvedists have how ever tried to explain that the selective action of the Drug is not quite so arbitry as it appears. Sex: Distribution according to sex shows that in this sample 19 (63. Yavani. but that it subserves panchamahabhuta influence or other forces of nature which control all physiological and chemico physical activities in animal and vegetables. Daruharidra acts as Shothahara. The above said statistics does indicate that Ghridhrasi disease can be seen in any age. Veerya. acts as Vedana Sthapana and Vata Shamaka. 2 (6. 5 (16.67%) each patient. Education does not highlight the claim or support the claim of education being the cause of Ghridhrasi.67%) patients were graduates and 2 (6. Lower middle class and poor class is suggestive of the fact that Nutrition does have a major role in the Samprapti of Ghridhrasi. Discussion 157 Religion: Present study shows that 19 (63. but however special researches are required to substantiate the role of religion in the causation of Gridhrasi.33%) patient was a retired person.33%) were unmarried and 1(3. The above said fact does not throw any light on vulnerability of Gridhrasi amongst any religion.66%) were of Primary level.67%) were labourers. were of poor class.33%) patient was a widow. Marital status: Present study shows that 25 (83. lower middle and upper class.67 %) in rural area. 5 (16. Almost 30 patients who belonged to different occupations support the claim of Ghridhrasi as an occupational hazard.67%) patients were Higher secondary.67%) belonged to others category.33%) patients residing in Urban area and 5(16.33%) patient was businessman and 1(3. The above said statistics of about 25 patients who belonged to Middle class. As the research was carried out at the hospital Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . 8 (26.33 %) belonged to Christian community.33%) patients were married.67%) were in service.33%) belonged to Hindu community and 1(3. Education: Present study shows that 6 (20%) patients were illiterate.33%) were Muslim while 10 (33. Socio Economic Status: Present study shows that 15 (50%) were middle class. 1(3. Habitat: Present study shows that there were 25 (83. 4 (13. The above fact proves beyond doubt that physical stress is more common in married people which may play a vital role in the Samprapti of Ghridhrasi.33%) patients were doing household work. amongst the literates 14(46. 2(6. Occupation: Present study shows that 16 (53. 5(16. 12 (40%) belonged to vata kapha prakruti. Hence nothing can be said here. Aharashakti: Present study show that 21 (70%) patients had madhyama abhyavaharana and 9 (30%) had Avara Shakti.33%) patients was Madhyama and 8 (24.67%) didn’t have any addictions.67%) and 10 (33. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .33%) were of Avara Jarana Shakti. Satmya: Maximum patients 23 (76. Samhanana: Samhanana wise distribution in the present study 24(80%) patients had Madhyam Samhanana and 6 (20%) had Avara Samhanana Vyayam shakti: Majority of the patients i.e. Prakruti: Present study shows 18 (60%) belonged to Vata pitta Prakruti.33%) were of Avara Satva.67%) each patient were addicted to tea. Satva: Maximum patients were observed to be of madhyama satva 20 (66. Sara: Above data depicts that the sara of 22 (73.67%) were having avara vyayam shakti. 20 (66.33%) were addicted to Pan.67%) was Avara. Alcohol etc addictions. 20 (76.33%) patients showed dominance of raja guna and 11(36.67%) were of Madhyama Jarana shakti and 10 (33. The above fact shows that the incidence of Vata Roga in the Vata predominant Prakriti. 10 (33. Lot of elaborative research is required to substantiate the role of tobacco. Addiction: Present study shows that 4 (13. the maximum numbers of patients were from urban area.33%) had madhyama vyayama shakti.33%) were Avara satmya.67%) were of Madhyama Satmya and 7 (23.67%) showed dominance of Tamo guna. In manas bhavas 19 (63. Discussion 158 located in the urban area. The role of Satwa. smoking and Pan masala and 17 (56. 3(10%) were addicted to tobacco chewing and 2 (6. 67 %) patients were in the range of 1 to 3 years duration. Sara. 14 (46.33%) patients were of irregular food habits and 5 (16.67%). The above fact shows the role of Agni (directly or indirectly) in the Samprapti of Ghridhrasi. Discussion 159 Satmya. Agni: There is presence of Mandagni in 23 (76.67 %) showed duration of 4 to 6 years.33%) were of vegetarian diet. But however further work is needed.e. Analysis on the basis of dominant rasa consumed showed that maximum patients were using katu rasa i. According to Chronicity : It was found that 14 (46.67%) where as remaining 7 (23. 25(83.67%) followed by Amla rasa 12 (40%). Amla Rasa pradhana diet may definitely play role in the Samprapti of Ghridhrasi. Affinity for Lavana was 3 (10%) and only one patient was using Madhura rasa. 2 (6. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .33%) patients were of 12 months duration.67) % had regular food habits. Samhanana. Dietary Habits: Dietary Patterns of the study sample depicts that mixed were 23(76. It is a proven fact that Ghridhrasi presentations are always gradual in onset due to many reasons behind. Vishamagni in 7 (23. 13 (43.67%) patients. Vyayama Shakti and Ahara Shakti needs to be researched in elaborative way. The above said fact is suggestive that Vata Dosha related problems are more seen in Krura Koshti.33%).33 %) . The above said facts do not show anything other than Ignorance and negligence amongst the population. Koshtha : Among 30 patients Krura Koshtha was found in 25 (83.33 %) patient showed duration above 9 years. and 1(3. The mixed diet and Katu. Mridu in 3 (10%) and Madhyama koshtha in 2 (6. According to type of Onset: Sudden onset was found in 6 (20%) patients while 24( 80%) showed gradual onset. 66% In Group B.64 and percentage of relief was 76. 1 (3. Discussion 160 According to treatment received: Majority of the patients i. the mean before treatment was 2.33%) patients in right lower limb and 14 (46. The above said values are suggestive of the fact that allopathic treatments are symptomatic in nature and Ayurvedic treatments are undoubtedly safe and long lasting. According to their side affected: Radiation of pain was seen in 16 (53.33 %) had received Allopathic treatment.53 which were reduced to 0.33%) had received Ayurvedic treatment.6 after the treatment. The mean before treatment was 2.001) result with‘t’ value of 11. Effect of therapies on Numbness: In Group A. Once again it proves that Vasti is the best therapy for Vata Vyadhi. the Erandamuladi Niruha Vasti is more effective in controlling the radiating pain due to its quick absorption in the gut and also relieving the Apana Vata dushti. The total effect of therapy provided statistically highly significant (p<0.001) result with‘t’ value of 11. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .2 which were reduced to 0. 25 (83. The total effect of therapy provided statistically highly significant (p<0.66%.001) result with‘t’ value of 10.e. This denotes. The above said facts support the claim of pain of radiating nature has diagnostic importance and the same is the inclusion criteria of our study. The percentage of relief in Group A was 66.67 %) had radiation in left lower limb.2 which were reduced to 0. The mean before treatment was 2. No patients reported with bilateral involvement.73 after the treatment.33%) patient had received other treatment such as acupuncture etc. 4 (13. The percentage of relief in Group A was 66.31%. The total effect of therapy provided statistically highly significant (p<0. Discussion on Results Effect of therapy on Radiating pain: In Group A.73 after the treatment. 66 which were reduced to 0. Group B showed better result in Lasegue`s sign also due to the action of Vasti in the nervous system.35% Vasti given in Kala Vasti schedule improved the function of sciatic nerve and reduced numbness by alleviating sthanika Vata dosha and nourishing sthanika dhatu and upadhatu. The mean before treatment was 1.58 and the percentage of relief in Group A was 76.2 after the treatment. The mean before treatment was 2.88%. Effect of therapies on Lasegue’s sign: In Group A.001) result with‘t’ value of 9.33%.4 after the treatment.66 after the treatment.33%.001) result with‘t’ value of 8.67 and percentage of relief in Group B was 82. the mean before treatment was 1.40 after the treatment. Discussion 161 In Group B.00 which was reduced to 0. The total effect of therapy provided statistically Highly significant (p<0. The total effect of therapy provided statistically significant (p<0.02) result with‘t’ value of 2. The total effect of therapy provided statistically highly significant (p<0.46 after the treatment. The total effect of therapy provided statistically Highly significant (p<0.8 which was reduced to 0.00 which was reduced to 0. The percentage of relief in Group A was 33. The mean before treatment was 1.001) result with‘t’ value of 10. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .01) result with‘t’ value of 4 and the percentage of relief in group B was 53.64.73 which was reduced to 0. The total effect of therapy provided statistically significant (p<0. The combined effect of Vata Kaphahara Vasti dravya significantly acts upon Lumbo-Sacral Vertebrae along with nerve roots. In Group B.79 and percentage of releif in Group B was 88. Effect of therapies on SLR test: In Group A. The mean before treatment was 1.92% In Group B. particularly Erandamuladi Niruha in the management of sciatica (Gridhrasi). even though acts as Bahirparimarjana Karma showed good result in SLR test. Discussion 162 This also shows the high significance of Kashaya Vasti. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Kativasti. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . clinical manifestation and treatment. etio-pathogenesis. • Irregular dietary habits and mixed diet have significance in gradual onset of Gridhrasi. each consisting of 15 subjects for duration of 2 months and follow up for 3 months. • Gridhrasi affects invariably patients of any age with higher incidences in females than in males.3 years of duration in maximum patients. • Vatakara Ahara Vihara has a major role in the causation of Gridhrasi. Conclusion 163 CONCLUSION The present study. Sciatica which is well explained in modern medicine can be well equated with Gridhrasi told in Ayurvedic classics in the aspects of etiology. • Most of the sciatic patients had gradual onset of the symptoms. • Vata Pitta Prakriti persons are more affected than Vata Kaphaja persons. Chronicity showed 1. • Gridhrasi is a Vata pradhana Vyadhi with the involvement of Pitta and Kapha Dosha. • Married people were more reported with sciatica (Gridhrasi) due to their excessive physical strain. • Mandagni and Krura Koshta were observed in most of the patients of Gridhrasi. The following conclusions were drawn based on observations and results which were achieved after systematic and appropriate clinical research. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kativasti along with Trayodashanga Guggulu was carried out in 30 patients with 2 groups. Conclusion 164 • Management of Gridhrasi (Sciatica) with Kati Vasti and Niruha Vasti along with Trayodasanga Guggulu showed good result in the subjective and objective parameters of the present study. Recommendations: Gridhrasi if not detected early and treated properly can cripple one’s life hence further research with a larger sample supported by modern investigative procedures is need of the hour. • Amapachana followed by Shamana along with Trayodashanga Guggulu and Rasna Saptakam Kashayam played excellent role in relieving the major symptoms of Gridhrasi. • The present study proved remarkable result in Group B with Eranda muladi Niruha vasti in Kala Vasti schedule followed by Trayodashanga Guggulu and Rasna Saptakam Kashayam than Group A with Kati Vasti followed by Trayodashanga Guggulu and Rasna Saptakam Kashayam. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Proper education to the people who are involved in stress oriented professions should be done so as to achieve effective prevention of Gridhrasi (Sciatica). ’ • To assess the efficacy of both Vasti and Kativasti along with Shamana Aushadhi (Trayodashanga Guggulu) • To find out quick. The research methodology was derived from the Ayurvedic literature along with modern literature.e. Summary 165 SUMMARY In spite of the spine’s excellent form and function. the Historical aspect of Gridhrasi is presented extending from Vedic era to present era. if we are able to treat such an agonizing condition with principles laid by our ancient Acharya. • To study aetiopathogenesis. This condition causes great discomfort to the patient and affects his daily routine as it is directly related to the locomotor system. cheap and effective remedy. Previous research work carried out by various scholars on Gridhrasi has been incorporated. The conceptual part deals with the important fundamentals to understand Gridhrasi from Ayurvedic as well as modern point of view. The study was persued with the following Aims and objectives. the project titled “Clinical Management of Sciatica (Gridhrasi) through Vasti and Kativasti along with Trayodashanga Guggulu” was undertaken.Conceptual and clinical. Firstly. The two therapeutic modalities i. The study was planned in two parts . proper planning was done and no attempt was made to shift from the principles laid in the texts while conducting the study. symptomatology and progress of Gridhrasi with special reference to ‘Sciatica. Sciatica (Gridhrasi) is a major clinical problem involving the locomotor system. Vasti and Kativasti were applied for the treatment of Gridhrasi. Sciatica is one of the many conditions causing back pain and pain in the lower limb. Concept of vata : physiological Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Keeping this view in mind. It would be a great achievement. patients underwent Vasti Chikitsa along with Shamana Aushadhi and in another group Kativasi along with shamanaushadhi. For this. In case of IPD patients daily follow up was done and in OPD patient’s assessment was done fortnightly. and to stick to the dietary regimen. It has been attempted to propose the probable samprapti vightana by the components of the formulation used and their mode of action. It is followed by Modern review. a detailed proforma was duly filled for each patient and necessary laboratory investigations were carried out to assess the general condition of the patient as well as to rule out any underlying pathology. Aetiology. In one group. The results thus obtained were subjected to analytical statistical techniques to assess the efficacy of both types of treatments. patients were advised to avoid the hetu such as bharaharana etc. These patients were randomly divided into two groups of fifteen each and were subjected to planned treatment regimen. Throughout the therapy. Nidan panchak. The final results thus obtained were Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . and Chikitsa are explained. The total duration of treatment in both groups was 2 months. 30 patients presenting with the clinical picture of Gridhrasi were selected from the OPD and IPD of Ayurveda Mahavidayalaya College and Hospital. Hubli. Here History of Sciatica. Definition. Differential diagnosis and Management have been studied. Summary 166 as well as pathological aspect along with brief description of the anatomical parts is mentioned. Prior to advent of treatment. Laboratory investigations were repeated after completion of the therapy. The subsequent portion deals with clinical part of the study. The evidences have been collected from authentic texts in favour of the potential of the drugs used. Pathogenesis. Anatomy and Physiology of sciatic nerve. Sadhya – asadhyata. Mild improvement and No improvement and presented in the form of tables. graphs and comments. Moderate improvement. Critical assessment of the total effect of therapies on individual patient reflects that Vasti therapy along with shamana was more effective in pacifying the symptoms of Gridhrasi as compared to Kativasti along with shamana therapy. Marked improvement. Summary 167 interpreted and graded as Cured. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . References xii REFERENCES 1) Maheshwari. Page no.6 16) Atharvaveda 9/37.18 19) Kenopanishad 3/10 20) Chandogyopanishad 4/16/1 21) Chandogyopanishad 4/3/1 22) Katopanishad 2/3/16 23) Prashnopanishad 3/7 24) Brahma Sutra 1/5/3 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .4 18) Atharvaveda 9/7/7.230 2) Price’s Text Book of Medicine 3) Maheshwari.J – Essential Orthopedics. Page no.J – Essential Orthopedics.21 17) Rigveda 10/163/2.230 4) Yajurveda 9/21 5) Atharvaveda 3/11/6 6) Atharvaveda 19/60/2 7) Atharvaveda 19/67/45 8) Atharvaveda 9/8/21 9) Atharvaveda 9/33/2 10) Atharvaveda 2/4 11) Atharvaveda 3/9 12) Taitireeya Samhita 7/3 13) Taitireeya Samhita 2/1 14) Atharvaveda 2/4/2 15) Atharvaveda 2/33/2.5. 36/9 37) A.S.15/54 38) http://bja.Deepika& Goodarthadeepika vyakya.S.Sh.Ni. 7/108 49) A.H. References xiii 25) Agni Purana 192 Chapter 26) C.S.16/56 45) A.S.1/74 44) A.org 39) Amarakosha.H.14/20-24 28) C.20/13 35) A.Ni.8/17 33) K.15/56 36) A.Chi.27/21 34) A.S.Su.H.S.2015 40) Amarakosha Unaadi 2/24 41) Amarasudha.N.P.S.Ni.Ni.Ni.Nibhandha sangraha vyakya 1/74 48) Sha.19/7 29) C.1/74 31) Su.S.Su.20/11 30) Su.S.Atankadarpana Commentary 22/54 47) Su.1/10 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Su. Page no.Ni.K.Su.Su.452 42) C.S.S.S.S.15/54 46) M.S.S.Chi.5/23 32) Su.Ni. Shloka No.5/90-92 27) C.Ni.Su.28/56 43) Su.S.Su.oxfordjournals. S.24/1-2 52) Su.S. References xiv 50) C.18/45.15/17 67) C.Chi.S.8 59) A.S.15/77 69) C.15/29.1/10 61) C.28/59 58) A.H.Ni. Su.7/9 66) C.Sh.15/16 74) C.15 56) A.1/74 65) Su.Su.28/15-17 51) B.H.15/7.33.Ni.6 60) M.S.H.Ni.28/29 70) C.Chi.S.H.S.S.S.Ni.28/56 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Chi.47 57) C.D.11/48 68) C.41 55) A.S.34.S.1/67.Su.68.U.21/33 63) C.Vi.Ni.15/31.S.28/50 62) C.Ni.1/74 72) A.Ni.S.1/14.S.Su.Chi.K.Ni.32.Chi.21/19-20 53) Su.S.Ni.79 54) A.N.S.28/4 71) Su.15/54 73) A.Ni.Su.S.S.15/5.Chi.Chi.5/7 64) Su.P.S. Arunadatta vyakya.Vatavyadhi.Vol.N.Yogendranathsen vyakya.H.Su. Moola.22/55 94) G.12/50 91) A.S.1/7 99) M. Moola.H.Chi.Su.12/50 85) A.Vatavyadhi.Chi.22/56 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Hemadri vyakya.22/1-2 90) A.Su.Arunadatta vyakya.Su.P.H.Su. References xv 75) M.25/56 76) B.H.R.H.24/54-55 82) C.R.19/5 98) Su.398/1-2 78) A.S.398/3-4 96) B.S.Page.1/74 88) A.Arunadatta vyakya.S.5/13 81) M.12/49 84) A.R.N.Arunadatta vyakya.24 77) Y.12/49 80) Su.N.K.N.19/63 95) Y.12/50 86) A.S.Ni.P.Hemadri vyakya.H.Dalhana vyakya.Su.Indu vyakya.Hemadri vyakya.6th Chapter 93) M.Page.Arunadatta vyakya.12/49 79) A.15/4 89) H.Dalhana vyakya.S.12/50 87) SU.Su.Su.7/14 83) A.U.Madhukosha vyakya.Su.H.H.12/50 92) Bh.2.Hemadri vyakya.H.Ni.M.Ni.Dalhana vyakya.31st Chapter 97) A.N.K. 1/7 123) Su.Chi.Su.16/4 109) Su.4/22-26 120) C.R.Su.S.Su.H.H.N.3/43 114) A.9/39 111) Su.S.Chi.9/20 108) C.24/30 124) C.Madhukosha vyakya.33/66-67 112) C.Dalhana vyakya.H.Su.S.Su.20/13 117) A.19/64 101) Y.16/35 113) C.Indu vyakya.S.Vol.Chi.Chi.S.Chi.1/26 122) C.Su.N.S.4/35 105) A.S. References xvi 100) G.Ut.Su.Sh.Si.13/1-3 118) A.Vi.H.398/3 102) B.S.31st Chapter 103) Su.45/3 104) Su.Chakrapani vyakya.4/55 110) A.M.S.P.S.Su. Moola.14/4 107) C.S.S.28/75 121) A.Dalhana vyakya.Vatavyadhi.S.Su.21/3 119) Su.S.9/7 106) M.1/25 116) C.Sh.28/78 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Chakrapani vyakya.11/26 115) Su.Page.Chi.2.S.Su.S.H.K. Page no.4/7-10 146) A.Vatavyadhi. Hutchinson’s Clinical methods.27/47 145) A.S.R.Chi.H.S.252 143) Y.Chi.28/79-81 127) C.Chi.28/85 131) C.1242.S.D.com.S.S.1/40-41 137) C.M.S.22/1-11 141) V.S. Davidson’s principles and practice of medicine.S.28/101 138) Su.2/89 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu .Moola.Chi.Ka.Su.Chi.27/15 140) H.22/72-75 148) Sha. www.Si.595-591 142) www.S.D.Vatavyadhi.K. References xvii 125) Su.Si.33/22 126) C.28/86 132) C.H.2/15 134) C.S.Chi.Chi.28/84 129) C.oxfordjournals.org.11/18 133) C.S.S.Su.S.S. Page no.10/5 136) C.Su.5/23 139) A.82.Si. 144) C.S. Page No.S.Chi.21/70 147) C.Chi.Si.S.1/27-28 135) C.15/22 130) C.28/83 128) C.Chi.wikipedia.H. Boon D.published by Chaukhambha Sanskrit Samsthan.1985.Colledge.Brain.Walker R. 6.Dhanvantari Nighantu. 7th Edition. Varanasi. 1st edition.Umapati mishra Chaukambha Publication. Anonymous.5th edition.1951. 9.1997.’Charaka Samhita’ redacted by Charaka.Nicolas. 1999. 1999.K.1996. 11.Dridabala with Ayurveda Deepika commentary by Chakrapannidatta with English translation by Dr. edited by Prof. Ramaswamy Sastrulu and Sons. Institute of Franceeis D.edited by Jharkhand Ojha. Varanasi.Roopalal Vaishya.with Vidyothini Hinditika by Bhishakratna Shri.Indologoc. published by Chaukhambha Vishwabharathi. Priyavat Sharma. Bhela Samhita. Agnivesha. Krishnamurthy. Varanasi. NighantuAdarsha vol 2Chaukambha Publication.edited by VaidyaYadavjiTrikamjiAcharya. Davidsons Principle and Practice of Medicine. Bapalal. Bhaishajya Ratnavali. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . Chaukambha Publication.’Charaka Samhita’ redacted by Charaka.2001. Bhavaprakasha. 2. Yogaratnakara. Published by Chaukhambha Sanskrit Bhavan.20th edition. K.Sharma and Vaidya Bhagawandash. Published by Chaukhambha Sanskrit Samsthan.Dridabala with Ayurveda Deepika commentary by Chakrapannidatta.R. 1997. 10. with Vidyotini Hindi Commentary by Vaidya Lakshmipathi Sahstri. Haareeta Samhita. Bhela. redacted by Bhishakratna Shri Brahma Shankara Mishra with Vidyotini tika by Kaviraj Sri.Churchill Livingston. Chaukambha Publication. 7. Bhramhashankara Shastri and Sri. Dhanvantari. Haareeta. Basavaraju. 8.Nicki. with English translation Dr. Pondicherry. Bibliography xviii BIBLIOGRAPHY 1.Vaidya. 5. Bhavamishra.2nd edition.R. 4. 2000. Ambikadutta Shastri edited by Sri Rajashwara Dutta Shastri. 13th Edition.R. Varanasi. 8th Edition. Madras. Published by V. 3. Dasa Govinda.1st edition. Agnivesha. 2006.G. Bavasavarajeeyam. 16. Delhi: Vagmaya Anusandaha1st edition. Published by Chaukhambha Orientalia. Vaidya Sodhala.V. Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu . edited by Vaidya Yadavji Trikamji Acharya and Narayan Ram Acharya. 1990.I. Astanga Hridaya with commentaries Sarvangasundara of Arunadutta and Ayurveda Rasayana of Hemadri. Astanga Sangraha with Hindi Vyakhya by Kaviraj Atridev Gupta. R. Vaghbatacharya.. 18. edited by P. 1998. Tivari. Varanasi. vol. Srikanta Murthy. Pub: Publications and Information Directorate. 14. K. Sharangadara. 1. 29th Edition. Varanasi. 8th edition. Reprinted edition.MadhavaNidanam Uttardha with Madhukosha Vyakhya by Vijayarakshita and Srikantadutta and Vidyotini tika by Ayurvedacharya Sri Sudarshana Shastri. New Delhi. Kashyapa. 13.. Ed: Vaidya Mahendrapala Simha Arya. Madhavakara. published by Chaukhambha Orientalia. Hillside road. Sahasra Yoga. published by Krishnadas academy Varanasi. Kashayapa Samhita.S. Varanasi. C. Bibliography xix 12.Essential Orthopaedics. Chaukhambha Samskita Samsthan. Maharshi Sushruta. Reprinted edition.1997.Chaukhambha Sanskrit Samsthan. 1999.3rd edition. Varanasi. .11th edition. 22. edited by pandit Bhishak Acharya. 17. 19. Sushruta Samhita with Nibandhasarasangraha Commentary of Sri Dalhana Acharya and Nyana Chandrika Panjika of Sri Gayadasacharya.1998. Hari Shastri paradkar Akola. Chaukambha Publication. published by Krishnadas Academy Varanasi. 15. 21.2003. 4th edition. 3rd edition. The Wealth of India. Haragovind Shastry.Mehta publication.Namalinganushasana of Amarakosha. Varanasi. Vaghbatacharya. 20.1997.1997. Gadanigraha.R. Maheshwari J. Sharangadara samhita English translated edition by Ayurveda Vidwan Prof. 1993. published by Chaukhambha Orientalia. 8.S.A.Madhusudan Kulkarni M. Hullur Candidate: Dr. (Ayu).M. Date of Schedule Initiation 13. Annexure xx DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA.S Degree P. Address : ………………………….D. …………………………. Ayurveda Mahavidyalaya. Father’s/Husband’s Name : 3. No OPD No. Economical Status : Poor Middle class Higher class 10. Occupation : Sedentary Active Labour Others 7.D. Hubli TITLE OF DISSERTATION: " CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU" Guide: Dr. Date of Schedule Completion: .B. Habitat : Urban Rural 11.A. Educational status : Illit Primary H.(Int) M. Phone No. Marital status : Married Unmarried Widow Divorced 9.G.PhD. Religion : Hindu Muslim Christian Others 6. : …………………………. M. Name of the patient : 2. 12. 4. IPD No Bed No GROUP ALLOCATION 1.Scholar Sl. Age : yrs . Sex : Male/Female 5. Vedana vrittanta .Anubandha vedana Complaint duration 1- 2- 3- 4- 5- 6- 16 . Annexure xxi 14-Pradhana vedana: Complaint duration 1- 2- 3- 4- 5- 6- 15. Poorva chikitsa vruttanta Surgical Non Surgical YES Modern NO Shodhana Shamana YES Ayurveda NO Others Relief from previous treatment 19. Poorva vyadhi vruttanta 1. kautumbika vruttanta Relation Dead/Alive Health status Treatment history 1- 2- 3- 4- 5- 6- 7- 8- . Childhood disease 2. Adulthood disease 3. Annexure xxii 17. Geriatric disease 18. C. Annexure xxiii 19.Vyayama: Type of excersise: no / mild / moderate / heavy for ___ mins/hrs.Chintana: D.Nidra: Sound / Good / Disturbed Day ___ hours / Night ___ hours If disturbed reason: Mental strain: Y/N If yes . Aharasambandi vruttanta: veg / mixed Quantity Quality appetite 2. Vayaktika vruttanta 1.Hours of work: _______ /day F.Type of profession: Occupation: ___ Sedentary / Involves physical strain / Involves mental strain Since_______day/years Work in standing posture _____ hrs Work in bending posture ______ hrs Traveling _____ hrs Vehicle used. Vihara sambhandhi vruttanta A.2 wheeler / 4 wheeler / bullock cart E.vyasana: Beedi / Cigarettes / Alcohol l / Tobacco chewing / Tobacco snuff / tea / coffee/ pan / panmasala Since___ ___time/day .since ___ Diwaswapna: Y/N RatriJagarana: Y/N B. Sexual history – 5.C. Prasuti vrittanta . P__G__L__D__A 5.U. marital history – 6 . _________ days Character.D Permanent: Tubectomy / Vasectomy / Hysterectomy . Rajo sambandhi vruttanta Menarche _______ years M.C. Regular / Irregular / Painfull / Painless Menopause _______ years 4. History of contraception Temporary: Mechanical / Chemical / Oral / Local / I. Annexure xxiv 4. Annexure xxv ATURA SAMANYA PARIKSHA ( GENERAL EXAMINATION): 1) Ashtasthana Pariksha Nadee : ___ /min Mutra : usual / Dysuria / polyuria / Oligoria frequency_______ time / day-night Colour ____ Mala : Regular / Irregular Formed / Unformed / constipated Frequency ____ time/day Consistency ______ Colour _____ Jihwa : Prakruta Vaikruta Cracks Sabda : Sparsha : Druk : Aakruthi: . 70) / Vriddha (>70) 3 .Predominance Sara Pravara / Madhyama / Avara Samhanana Pravara / Madhyama / Avara Pramana Pravara / Madhyama / Avara Satmya Pravara / Madhyama / Avara Satva Pravara / Madhyama / Avara Ahara Shakti Abhyavaharanashakti Pravara / Madhyama / Avara Jaranashakti Pravara / Madhyama / Avara Vyayamashakti Pravara / Madhyama / Avara Vaya Youvana (16 – 34) / Madhyama (34 .ASSESMENT OF DOSHA Vatavriddhi karshya karshnya gatrakampa sphurana ushnakamita Samgnanasa Nidra nasa Balaupaghata Indriyaghata asthishula Majja shosha malasanga adhmana atopa moha dainya shoka pralapa Pittavriddhi/kopa Peeta twag glani indriyadourbalya ojovisramsa sheetaabhilasa daha tiktasyata trt murcha alpanidra krodha paka sveda kleda srava raga Kapha vriddhi shwaitya shaitya sthoula alasya gourava angasada murcha tandra nidra swasa kasa praseka hrullasa agnisada sandhivishlesha kandu upadeha chirakari sthairya Vata kshaya praseka hrullasa alpavak Alpacheshta apraharsha angasada agnivaishamya Pitta kshaya aniyatatoda arochaka avipaka Gourava angaparushya nakhaNayana shukla Shaitya Kapha kshaya bhrama udveshtana anidra Angamarda pariplosha toda dava Daha sphotana vapana dhumayana Snadhishaitilya hrudayadrava shleshmashyashoonyata . Dashavidha Pariksha Prakriti: Sharira – V/P/K/VP/VK/PK/S .Predominance Manasa – SR/RT/ST . Annexure xxvi 2). ASSESMENT OF DHATU Rasa Vridhi Praseka Arochaka Asyavairasya Hrillasa Swadudwesha Angamarda Kapha linga Kshaya Sabdasahatva Hridayadrava Kampa Sosha Soola Sunyata Spandana Ghattana Alpacheshtaya srama Tarsha Rakta Vridhi Kushta Visarpa Pitaka Asrigdhara Akshidaha Mukhadaha Medradaha Gudadaha Gulma Vidradhi Pleeha Vyanga Kamala Agninasa Tamapravesa Raktaangata Raktanetrata Vatarakta Raktapitha Pitha linga Kshaya Tvagroukshya Amlabhilasha Seetabhilasha Sirasaithilya Mamsa Vridhi Galaganda Gandamala Arbuda Granthi Taluroga Jihwaroga Kantharoga Sphig udara gouravavrdhi Gala Oshta gouravavrdhi Bahu Uru Jangha gouravavrdhi Kapha linga Rakta linga Kshaya Sphigadi Toda Roukshya Akshaglani sushkata Sandhi sphotana Dhamani saithilya Medas Vridhi Swedagandha Angagandha Angasidhilata Sayyasukha Asanasukha Swapnasukha Hrdayopalepa Khanangata Netropadeha Jihwopadeha Sravanopadeha Galasosha Kesa ativridhi Nakhavridhi Seetapriyatwa Padadaha Talusosha Madhurasyata Karadaha Dourbalya Javoparodha Krichravyavaya Atisweda Pipasa Atikshut Kapha linga Rakta linga Mamsa linga Kshaya Pleeha vridhi Katiswapa Sndhisunyata Angaroukshya Karsya Srama Sosha Mamsa linga Medura Mamsa preeti Asthi Vridhi Adhyasthi Adhidanta Kshaya Danta sata Romasata Nakhasata Kesasata Roukshya Parushya Asthitoda Asthi badha mamsa abhilasha Sandhi saidhilya Majja Vridhi Netra gourava Anga gourava Rakta gourava Arumsha Kshaya Asthi soushirya Nistoda Dourbalya Bhrama Tamo darsana Sukra Vridhi Atistree kamata Sukra asmari Kshaya Srama Dourbalya Asya sosha Timira Angamarda Panduta Sadana Klaibya Mushka toda Medra Chirat nisheka Sarakta dhumayana nisheka . Annexure xxvii 4. Annexure xxviii 5-ASSESSMENT OF SROTAS: Prana Atisrishtam Atibadham Kupitam Alpalpam Sasabdam Sasoolam Anna Anannabhilasha Arochaka Avipaka Chardi Udaka Jihwasosha Talusosha Oshtasosha Klomasosha Kandhasosha Atipipasa Rasa Asradha Aruchi Asyavairasya Arasajnata Hrillasa Gowrava Tandra Angamarda Jwara Tama Pandutwa Srotorodha Klaibya Sada Krisangata Agninasa Akalavali Akalapalita Rakta Kushta Visarpa Pitaka Raktapitha Asrgdhara Gudapaka Medrapaka Asyapaka Pleeehavriddhi Gulma Vidradhi Neelika Kamala Vyanga Viplava Tilakalaka Dadru Charmadala Switra Pama Kota Asramandala Mamsa Adhimamsa Arbuda Keela Galasaluka Sundika Putimamsa Alaji Galaganda Gandamala Upajihwika Medas Swedagandha Angagandha Angasidhilata Sayyasukha Asanasukha Swapnasukha Seetapriyatwa Hrdayopalepa Netropadeha Jihwopadeha Sravanopadeha Khanangata Kesa ativridhi Nakhavridhi Galasosha Talusosha Madhurasyata Karadaha Padadaha Ayuhrasa Javoparodha Dourbalya Atisweda Atikshut Pipasa Krichra vyavaya Asthi Adhyasthi Adhidanta Dantabheda Dantasula Asthibheda Asthisula Dantavivarnata Kesadosha Nakhadosha Lomadosha Smashrudosha Majja Parvaruk Bhrama Murcha Tamodarsana Arumsha Sukra Klaibya Aharshana Apatyadosha Mutra Atisrishtam Atibadham Prakupitam Alpa alpam Abheekshnam Bahalam Sasoolam Mala Krichrena Alpa alpam Sasabda Sasoolam Atidrava Atigradhita Atibahu Sweda Aswedanam Atiswedanam Parushyam Atislakshnata Anga paridaha Romaharsha . P: mm of Hg 3. Weight: _____ kg 4. Edema: P/A 6. SYSTEMIC EXAMINATION Inspection Palpation Percussion Ascultation Respiratory Cardiovascular G . I . Cyanosis: P/A 7. XII. . Respiratory rate: /min 7. Height _____ meter 3. Neck: Thyroid: Normal/abnormal. T. Heart rate: /min 5. 2. 1. Pallor: P/A 5. Ictrus P/A 8. B. Built and nourishment: well/ moderate/ poor. Temperature: f 4. Annexure xxix 6 . Pulse: per min 2.General Physical examination. Lymphadenopathy P/A 9.Vital signs 1. lateral bending .S. ankle jerk sacral sole and side o sole and side weak plantar foot o foot flexion of big toe and foot . ankle jerk lumbar lateral leg. Back of Anterior tibialis. Knee jerk lumbar font of inner font of inner weak dorsiflexion thigh thigh of foot th 5 Back of thigh.Flexion . Annexure xxx SPECIAL EXAMINATION: Examination of L. Spine - 1.normal / painful / restricted 3.normal / painful / restricted 2. dorsum flexion of big toe to big toe of foot to big toe 1st Base of leg. Gastronimeus.normal / painful / restricted Curvarure of spine cervical - thoracic - lumbar - Spinal root examination – Root Pain Sensory loss Motar weakness Reflex involved changes 2nd Front of mid Front of mid Quadriceps Knee jerk lumbar thigh thigh 3rd Front of lower Front of Quadriceps Knee jerk lumbar thigh lower thigh 4th Side of thigh/ Side of thigh/ Anterior tibialis.Extension . Base of leg. lateral weak plantar dorsum of foot leg. thigh. Urine . TEST – ACTIVE - right lower limb . X-ray of lumbar spine AP and Lateral view . Albumin / Sugar / Microscopy iii.R. RA Test v. + ve / -ve at ____ degrees Investigations : i. Blood examination . ____________ type of gait S. + ve / -ve at ____ degrees left lower limb . + ve / -ve at ____ degrees left lower limb . VDRL iv.L. Hb% TC DC ESR RBC ii. + ve / -ve at ____ degrees PASSIVE – right lower limb . Annexure xxxi GAIT - normal / abnormal If abnormal . Annexure xxxii i. SAMPRAPTI • Dosha : K/P/V • Dushya: R/RK/Ma/Md/AS/Mj/SK/Swedha/Muthra/purisha • Agni: Jatharagni/Dhatvagni • Ama: Jatharagni mandya janita/Dhatvagnimandya janita • Srotas Iinvolved: Ra/Meda/Mamsa/Sweda/Others. NIDANA Aharatmaka : Viharatmaka : Manasa: ii. ROOPA - iv. • Srotodusti Prakara: AP/S/V/SG • Udbhava sthana: Amasaya/ Pakvashaya • Sanchara sthana: Sarvashareera • Vyakta sthana: Sarvanga/Udara/Sphik/Gala/Stana/others • Roga marga • Adhisthana • Vyadhi Swabhava . PURVARUPA iii. Shamana chikitsa Trayodashanga Guggulu 1 tab thrice a day before food Rasna saptaka kwatha 20 ml thrice a day before food From ________ to ________ 4-Follow up From _______ to ________ .5 gms with hot water twice a day before food From ________ to ________ 2.Amapachana Panchakola choorna 3. Annexure xxxiii Group A CHIKITSA 1.Kati Basti By – Asta Katvara Taila Days Æ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Matra of taila Kala Retansion time 3. Shamana chikitsa Trayodashanga Guggulu 1 tab tid Rasna saptaka kwatha 20 ml bid From ________ to ________ 4-Follow up From _______ to ________ .Amapachana . of evacuations Any other features Basti parihara kala 32 day _______ TO ________ 3.with Panchakola Choorna 5 gms twice a day with hot water From_______ to ________ 2 – Basti – Erandamooladi nirooha ( kala basti schedule ) from _______ to _________ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Days Æ Basi Prakara Matra Kala Pratyagamana kala Retansion time No. Annexure xxxiv Group B CHIKITSA 1. Annexure xxxv Assessment Based on Scoring : Radiating Pain 0 No Radiating Pain 1 Pain Radiating to hip and back of thigh 2 Pain Radiating to Popleteal fossa 3 Pain Radiating upto foot Numbness 0 No Numbness 1 Mild (Once/day) 2 Moderate (2-3/day) 3 Continuous SLR 0 Negetive 1 60 Degree and Above 2 In between 30 Degree to 60 Degree 3 Less than 30 Degree Lasegue’s Sign 0 Absent 1 Present . T Radiating Pain Numbness SLR test Lasegue’s sign.A.D DR. RESULT - CURED / RESPONDED / NOT RESPONDED SIGNATURE OF THE GUIDE SIGNATURE OF THE SCHOLAR DR.HULLUR M.D(Ayu). MADHUSUDAN KULKARNI . M.T A. Annexure xxxvi SCORES OF PARAMETERS BEFORE AND AFTER TREATMENT – Assessment Criteria B. Ph. 1 yr M M M M M M Grad Rt 13 MULLA SHAMEENA AVA 11129 38 F M M H.Wife Poor Illt Urban M Reg Amla A VP R M M .Wife Middle Primary Rural Irreg Katu A VP R M KR SUPARI 7 mnth M M M M M Lt 12 DUNDARI G RA e TAHEERA 11310 35 F M M H. 2 mnth M M M M Grad Rt 8 NAJAMUNNISA RA RA ANNAPOORNA AVAR 9286 38 F H M H.OBSERVATIONS . 3 mnth M M M M M Grad Rt 5 A.S Urban M Irreg Amla M VP R M M SUPARI 15 Dys M M M M M Lt 3 BURBURI A e SHAHEEN S 5135 30 F M M H. 2 mnth M M M M M Grad Rt 9 HANGI A BASAVARAJ VE 10016 22 M H UM Farmer Poor Primary Rural Irreg Katu M VK R M KR GUTKA 1.5 yr M M M M M M Grad Lt 10 ITAGATTI G LAV CIGARE AVA Suddn 10813 26 M H UM Student Middle Grad Urban M Irreg A VK R M KR 2 mnth M M M M M Lt 11 ANIL ATHANI ANA TTE RA e KASHAVVA VE AVA Suddn 11144 28 F H M H.Rasa Addiction Manasika Reg/Irreg Name OPD/IPD Religion Satmya Habitat Koshta Status Shakti Onset Socio Satva Sl.Wife Middle Primary Urban M Irreg Katu A VP T M KR .No Agni Sara Age Sex AVAR 2322 48 M M M Teacher Upper Grad Urban M Irreg Amla M VK R V KR .Wife Middle Primary Urban M Irreg Amla M VK R M KR . 1yr M M M M M Grad Rt 7 ANURAG A AVA AVA 7224 55 F M M H.Wife Middle H.M.Wife Poor Primary Urban M Irreg Katu M VK T M KR .Wife Middle Primary Urban M Irreg Katu A VP R V KR SUPARI 1 yr M M M Grad Rt 6 NIDGUNDI RA A RA AVAR 324 21 F H UM Student Middle Grad Urban M Irreg Amla M VK R M KR . MASTER CHART .Wife Middle Primary Urban M Irreg Amla M VK R M KR . 1 YR A M M M Grad Rt 2 BYAHATTI RA A RUKSARA R AVAR Suddn 4667 30 F M M H. 1 yr M M A M M Grad Rt 14 BHANU RA CHANDRASHEKA Suddn 863 30 M H UM Driver Middle Primary Urban M Irreg Katu M VP T M KR PAN 1yr M M M M M M Rt 15 R SIDDHAPUR e Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu xxxvii .KAGADGAR RA ERAMMA AVA AVAR AVA 6810 40 F H M H.M.GROUP A Vyayama Shakti Dietary Habits Prakruti Jarana Shakti Marital Status Abhyavarana Leg Affected Samhanana Occupation Shareerika Chronicity Education Economic Veg/Mixed Dom. 1 year A M M M M M Grad Rt 4 DANDEVALE AVA 6816 65 M M M Lawyer Upper Grad Urban M Reg Katu A VK T V KR . 6YRS M M M M M Grad Rt 1 N.Wife Poor Illt Rural M Irreg Katu M VP T V KR .KALASAGI A JUBEDA AVA AVAR 4007 60 F M M H. Group B SUBJECTIVE OBJECTIVE SUBJECTIVE OBJECTIVE RADIATING LASEAGUE'S RADIATING LASEAGUE'S NUMB NESS SLR Test NUMB NESS SLR Test Patient PAIN SIGN PAIN SIGN Patient No.Group A Master Chart of Major Symptoms . BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 3 1 3 1 1 0 1 1 1 3 0 3 0 3 0 1 1 2 3 1 3 1 2 1 1 1 2 3 2 3 2 3 1 1 1 3 2 0 2 0 2 0 1 0 3 2 0 2 1 1 0 1 1 4 2 0 2 0 2 0 1 1 4 3 1 2 0 1 0 1 0 5 3 2 3 2 2 1 1 1 5 2 0 3 0 1 0 1 0 6 3 2 3 2 2 0 1 1 6 2 0 1 0 2 0 1 0 7 1 0 1 0 1 0 1 0 7 2 0 2 0 1 0 1 0 8 3 2 3 2 2 0 1 1 8 2 0 2 0 2 0 1 0 9 2 0 2 0 1 0 1 1 9 3 1 3 1 2 1 1 1 10 1 0 1 0 1 0 1 0 10 2 1 1 0 2 0 1 0 11 3 1 3 1 3 2 1 1 11 3 1 2 1 1 0 1 1 12 3 2 3 2 3 2 1 1 12 3 2 2 1 2 1 1 1 13 1 0 1 0 1 0 1 0 13 3 0 3 0 2 0 1 1 14 2 0 2 0 2 0 1 1 14 3 0 3 0 2 0 1 0 15 1 0 1 0 1 0 1 0 15 2 1 2 0 2 0 1 0 Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu xxxix . Master Chart of Assessment Symptoms of Group A and B Master Chart of Major Symptoms . No.