Jour. Res. Ay. Sid. Vol. VI No.J. 3 & 4 pp. 36-43

The Role of Hingutriguna Taila in theTreatment of Gridhrasi Sciatica

Prem Kishore* and M.M. Padbi"'*

Received on June 29th, 1984

The clinical trial of Hingutrib-guna Taila along with Abhyangaand Sveda has been conducted inthirty patients of Gridhrasi. It hasbeen noted that the disease affectsmostly the adult males, particularlyin the age 'group of forty one tofifty years. The treatment providedprompt improvement in most of thepatients within a short period anddefinite relief has been observed inthe patients who completed three tofour weeks of treatment completerelief has been noted in about 60%of the patients who completed the fullcourse of treatment. A ttempt has alsobeen made to explain the possiblemechanism of action of the formula-tion.

* Assistant Director Incharge,

•• Research Assistant (Ayurveda)Central Research Institute AyurvedaUnit: I, Bhubaneswar 751009

Characterstic pain in the distribu-tion of sciatic nerve has been ter-med as Sciatica. It may be due toinflammation or pressure on sciaticnerve or its roots. The disease isquite painful and causes disabilityto the patients. It finds place inAyurveda under the title Gridhrasi,and is considered as one of the Vata-vyadhis. The treatment of this disea-se in Ayurveda is based on Vatasamaka drugs and Vasti Cikitsa,Thought the preparations of Gugg-ulu are quite common in practice,the trial-practice of other herbalslike Nirgundi (Jain et a11976, Nairet a11978, 1980) Bhallataka (Tripa-thi et al-1965) have also showngood results. The use of Rasonaand Eranda, specially its oil, hasbeen extensively recommended forthe treatment of Vatavyadhis ingeneral and Gridhrasi in particular.As such in order to clinically assesstheir efficacy in the treatment ofGridhrasi, trial of HingutrigunaTaila which is prepared mainly

36

Prem Kishore et al

from these drugs has been takenup. The formulation though men-tioned for the treatment of Gulmahas immense potential for utili-sation in the treatment of Vatavyadhis, specially Gridhrasi (Padhi, etaI1981).

Method of Study

The patients for study havebeen selected from the out-pa-tients, deparment on the basis oftypical clinical manifestation of thedisease.

1. Typical pain originating frombuttock and radiating uptofoot from the posterior portionof the affected lower limb.

2. Tingling and numbness.

3. Positive straight leg raisingtest.

4. Tenderness at buttock.

The specific scale/criteriaadopted for gradation of pain andtenderness have been as under.

Pain: Mild (+) - Complainedby patients when asked.

Moderate- Patient frequently com-plaints of pain and has

(+ +) a painful look.

Severe-Exer uciating pain associatedwith painful cries and

(+ + +) ago nising look.

Tenderness (to be tested bydigital pressure)

Grade-l Patients say the partis tender

Grade-2 patients winces

Grade-S Patient winces andwithdrawns theaffectedparts.

Grade-a Patient does not allowthe part to be touched.

The trial has been taken up atthe in-patients, department levelfor a duration of three to fourweeks and the following treatmenthas been provided.

1. Hingutriguna Taila 5 m\. twoor three times a day withwarm water, internally

2. Taila Abhyanga and Sveda

The periodical observations oncardinal clinical manifestations andobjective findings have been madeto assess the effect of treatment.The results have been classifiedaccording to the degree ofimprove ments into the followingfor groups.

1. Completerelief:

2. Partialrelief:

37

Complete relief ofcardinal clinicalmanifestations andresumption of fullfunction of thea ffected part.

Relief of mani-festations andtheir intensity by50% and more.

The Role of Hlngutriguna Talla in G,ldh,al;

3. No relief: No relief or onlymarginal improve-ment.

Obsenations and Results

The disease has been found toaffect the persons of twenty oneyears and above and the frequencyhas been at itl maximum in theage range of forty-one to fiftyyears. The males are more proneto suffer from the disease thanfemales (Table-I. Fig. 1).

Table 1Showing the age and sex distribution

4. Drop out: Discontinuationof treatmentbefore trial periodended.

S.No. TotalSex Age in years

21-30 31-40 41-50 51-60 61 and above

1. Male 2 5 8 4 1 20 (66.6~)2. Female 1 1 3 2 3 10 (33.3%>

Total: 3(10%) 6(20%) 11(36.6%) 6(20~) 4(13.3%) 30(100%)

10, #

ani-:zw•....h 5<Ca,t....0.0;;z

15 '.· •• 1 MALE fEMALE

0 ,..q::~

0 C> 0 C>n ..:r U') \0 If'I , 1 ,.- .- .- c- or-N n -q If) 10

AGE IN YEARSFig 1

38

Prem Kishore t t al

Most of the patients underobservation have been sufferingfrom the disease for less thanone year though patients withchronic history of nine years havealso been observed. Both thesides have been equally affected inthe' patients under observation.The intensity of pain in the patients

t under observation has been mod-erate in most cases and a few of

i them were having severe pain.The tenderness of Grade-2 wasobserved in most patients and onlya few patients were having Grade-ltenderness. The straight leg rai-sing test was positive in all Cases

Table 2

at an angle of 300 or less. X-raywas done in one case who didnot Show improvement after thefull course. It showed deminitionof inter-vertebral space, deformityof number-S and scoliosis.

The effect of treatment was obvi-ous within a short period. All,but one, patients who completedthree to [four weeks of treatmentshowed definite efficacy of treat-

: ment. Most of the patients sho-wed improvement and completerelief within the stipulated neriodof three to four weeks of treatment.while further treatment was need-ed in some cases (Table-2)

Showing the effect of treatment in relation to the duration of treatment

S.No.

Duration oftreatment(in days)

Completerelief

Dropout

Results TotalPartialrelief

Norelief

3 3I. 1-10 days

2. 11-20 days 3

3. 21-30 days 54. 31-40 days 3

5. 41-50 days 2

6. 51 days andabove

Total :- 13

1 5 9

3

2

I

8

S

4

1

8 8 30

39

The Role of Hingutrlguna Tatla in Gridhras!

The analysis of data in relationto age, sex and chronicity doesnot show a y significant relation-ship. However, effect has beenbetter in persons where the rightside was affected. The overalleffect of the treatment has heengood, since 43.3% of the patientshave been completely relieved and26 66% patients have shown signi-ficant improvement and have been

VIt-2W 20....••...<0-

L...0•0z 10

4.0

30

oC.R.

grouped as partial relief. Onlyone patient who completed thestipulated course did not showany relief. The remaining eightpatients discontinued the treat-ment and have been grouped asdrop outs. Most of the dropout had left the treatment dueto personal inconvenience or prob-lem, though they were showingsigns of improvement. (Fig-z),

-TOTALRES U L T S

P. R • N.R. 0.0.

Fig 2

40

Prern kishore et a/

Discussion

The treatment of this diseasein Ayurveda has been based onherbal and herbo- m ineral prepar-ations as well as in certain Panca-karma proceedures. The prepara-tion Hingutriguna Taila has beentaken up for trial with a view toevolve a simple and effective treat-ment to this disease. The obser-vations on thirty patients indicatethat the disease generally affects thepersons above the age of twenty-one years, through the maximumincidence has been found 1D

the age group of forty oneto fifty years. The diseaseaffects males more fr .quentlythan females. The efficacy of thetreatment has been quite obvioussince almost all the patients whocompleted the full course of treat-ment showed definite improvement,out of which about 60% werecompletely relieved. It may alsobe seen that the results are inconfirmity with the observationsreported earl ier (Padh i et al 198 J ).

The efficacy also compares wellwith other clinical trials citedearlier. The possible mechanismof action of this formulation inthis disease may be explained onthe basis of Ayurvedic pharmaco-dynamic principles (Dravyaguna)since the ingredients of this for-mulation are Usna and Snigdhawhich are opposite to the proper-ties of Vatadosa (Table-S).

It is clear that all the threeingredients are Usna Virya andsnigdha which are mainly contradic-tory to the Sita and Ruksa propertiesof Vatadosa; hence appropriate forits alleviation. The drugs havealso been indicated in a number ofpainful conditions as well asVatavyodhis and supposed to provideanodyne action in the treatmentof Gridhrasi, In addition to theeffect of internal medication, theAbhyanga (Massage) and Sveda(fomentation) also play an impor-tant role in the relief of thisdisease.

Table -3Showing the properties of the ingredients of Hingutriguna Taila

and Vatadosa.

SHARIRAGUNA---~--------------------

Hingu Eranda Taila Rasona Vatadosa--~.-----

Usnavirya Usnavirya Usnavirya Sita

Snigdha Snigdha Snigdha Ruksa

Picchila Visada

Guru Laghu

41

The Role of Hingutriguna Tallo in Grldhrast

tf mcfT ~ f:qf<R~rT if ~~f~1lT ~hr <fiT srmcr fcrfg

'"~11 f~T"<: !Jef ~11. (1,11.tfT~1

~ (1,ef~~~ il; mi!f f~~f~TITff(:f If,T 'TeAm il; a[~ umZil q-~ m~-

c

-"<:Tllq-U&l1IT fq;lH lTl1T~ I ~ ~mlTlI'T fq; o!frfcr 5tTZi: ~lil!f "<:Tmll'l ~TI

fcr~qq;~ 41-50 eN q;T ~ q

srmfcffi q;~T ~ I ~fcRm ~ ~

9;lCifcrif ~T ~m"<: ~TaT ~ t:tcrf;;r;rUflTZiT it aT;:r ~ '<iT"{ ~T~ C"q;'fiTf~ 9;lCifcr '!.~T 'fiT ~ Af~a(:fT~ fl1(:fTI ~ ~crfcr aq; f<rf.f>rnr ~itcr~ "<:Tf~) if ~ 5tTl1: 60% 'fiT~~ (:fT~ fl1(:fTI ~Ttrcr il; sr~rqfcffcr ~T ~~rcr;:rT 'fiT ~lSc 'fi~ 'fiTsrll"Hf~ij' ~)cr ~~ if f'fiZiTlTZiT ~ I

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Jain P.K. et al 1976

Madhava 1976

Mason S. & Swash M. 1980

Nadakarni K.M. 1976

Nair P.R.C. et al 1978

Ramachandran Nair, P.et al

1980

Role of Nirgundi (Vitex negundo)in Gridhrasi, JRIMY & H. XI,No.2 P-97-102.

Madhava Nidanam Commentaryby Sudarsan Shastri ChowkhambaSanskrit Sansthan, Varanasi.

Hutchson'sELBS andLondon.

ClinicalBailliere

MethodsTindall,

Indian Materia Medica-3rd Edi-tion, Vol.-I and II.

The effect of Nirgundi Panchangaand Guggulu in Sodhan-cum-Samana and Samana treatment ofGridhrasi JRIMY & H. XIII,No.3, Sept. P.14-19.

The role of Sodhana Therapy inGridhrasi, JRAS, Vol. I No.4.P. 529-549.

42

Prem kishore et al

SharmaP. V.

Tripathy, S. N. Ojha D.and Kishore P.

Vagbhata

Warner E. C.

1975

1965

1975

1980

Dravyaguna Vinjana-I1nd EditionPart-II & III.

Chowkhamba Sanskrit Sansthan,Varanasi.

Role of Semicarpus anacardiumin the management of Sciatica.Antiseptic, September, 1965.

Astanga Hr idaya-Commentery byAtridev Gupta, Sth Edition,Chowkhamba Sanskrit Sansthan,Varanasi.

Savil's system of Clinical Medi-cine CBS Publishers and Distri-butors, Delhi.

43