Upload
ayurmitra-ksrprasad
View
1.897
Download
24
Embed Size (px)
DESCRIPTION
Evaluation of Efficacy of Vaitharana Bastikarma in the management of Gridhrasi with special reference to Sciatica. Satheesh. R. Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103
Citation preview
By
Satheesh. R.
Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.
In partial fulfillment of the requirements for the degree of
AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)
In
PANCHAKARMA
Under the guidance of
Dr. G. Purushothamacharyulu,M.D. (Ayu)
And co-guidance of
Dr. Shashidhar.H. Doddamani,M.D. (Ayu)
Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,
Gadag – 582103.
2005.
Evaluation of Efficacy of Vaitharana Bastikarmain the management of
Gridhrasi with special reference to Sciatica.
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.
DECLARATION BY THE CANDIDATE
hereby declare that this dissertation / thesis entitled “Evaluation
of the Efficacy of Vaitharana Bastikarma in the management of Gridhrasi
with special reference to Sciatica.” is a bonafide and genuine research work
carried out by me under the guidance of Dr. G. Purushothamacharyulu, M.D.
(Ayu), Professor and H.O.D, Post-graduate department of Panchakarma and co-
guidance of Dr. Shashidhar. H. Doddamani, M.D.(Ayu), Assistant Professor,
Post graduate department of Panchakarma.
Date:Place: Satheesh. R.
I
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “Evaluation of
the Efficacy of Vaitharana Bastikarma in the management of Gridhrasi with
special reference to Sciatica.” is a bonafide research work done by Satheesh. R.
in partial fulfillment of the requirement for the degree of Ayurveda Vachaspathi.
M.D. (Panchakarma).
Date:
Place: Dr. G. Purushothamacharyulu, M.D. (Ayu).
Professor & H.O.D
Post graduate department of Panchakarma.
ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF
THE INSTITUTION
This is to certify that the dissertation entitled “Evaluation of
the Efficacy of Vaitharana Bastikarma in the management of Gridhrasi
with special reference to Sciatica.” is a bonafide research work done by
Satheesh. R. under the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu),
Professor and H.O.D, Postgraduate department of Panchakarma and co-guid-
ance of Dr. Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post
graduate department of Panchakarma.
Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.
Professor & H.O.D, Principal.
Post graduate department of Panchakarma.
CERTIFICATE BY THE CO- GUIDE
This is to certify that the dissertation entitled “Evaluation of
the Efficacy of Vaitharana Bastikarma in the management of Gridhrasi
with special reference to Sciatica.” is a bonafide research work done by
Satheesh. R. in partial fulfillment of the requirement for the degree of
Ayurveda Vachaspathi. M.D. (Panchakarma).
Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).
Place: Assistant Professor,
Post graduate Department of Panchakarma.
COPYRIGHT
Declaration by the candidate
I hereby declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and dissemi-
nate this dissertation / thesis in print or electronic format for academic /
research purpose.
Date: Satheesh. R.
Place:
© Rajiv Gandhi University of Health Sciences, Karnataka.
I
Acknowledgement “Many hands make light work”. I take this opportunity to mention my deep
gratitude to several personalities who have helped me in the successful completion of this
work.
I express my obligation to my honorable Guide Dr. G.
Purushothamacharyulu M.D. (Ayu), H.O.D., P.G. Department of Panchakarma,
P.G.S&R, D.G.M.A.M.C, Gadag for his critical suggestions and expert guidance for the
completion of this work.
I am extremely grateful and obliged to my co-guide Dr. Shashidhar.H.
Doddamani, Asst. Professor, P.G.S.&R, D.G.M.A.M.C, Gadag for his guidance and
encouragement at every step of this work.
I express my deep gratitude to Dr .G.B Patil, Principal, D.G.M.A.M.C,
Gadag, for his encouragement as well as providing all necessary facilities for this
research work.
I express my sincere gratitude to Dr. P. Shivaramudu M.D (Ayu),
Assistant Professor and Dr. Santhosh. N.Belavadi MD (Ayu), Lecturer for their sincere
advices and assistance.
I express my sincere gratitude to Dr. V. Varadacharyulu M.D (Ayu),
Dr.M.C.Patil M.D (Ayu), Dr. Mulgund M.D (Ayu), Dr. K. S. R. Prasad M.D (Ayu),
Dr.Dilip Kumar M.D (Ayu), Dr. R.V. Shetter M.D (Ayu), Dr. Kuber Sankh M.D (Ayu),
Dr.G.Danappa Gowda M.D (Ayu) and other PG staff for their constant encouragement.
I also express my sincere gratitude to Dr. B.G.Swamy, Dr. V.M.Sajjan,
Dr.U.V.Purad, Dr. Mallagowder, Dr. K.S.Paraddi, Dr. G.Yargeri, Dr. S.H.Radder and
other undergraduate teachers for their support in the clinical work. I thank to
Shri.Nandakumar (Statistician), Dr. Arun Baburao Biradar (East-West Computer
Services), Mr. Dipu Karuhtedath, Shri. V.M. Mundinamani (Librarian), Shri. B.S.
Tippanagoudar (lab technician), Shri. Basavaraj (X-ray technician) and other hospital and
office staff for their kind support in my study.
I express my sincere thanks to my colleagues and friends Dr. Subin
Vaidyamadham, Dr. Febin .K. Anto, Dr. Renjith.P.Gopinath, Dr. Shajil.N, Dr. Shyju
Ollakode, Dr. Sreenivasa Reddy, Dr. Hadimani, Dr. C.S.Hanumanta Gouda, Dr.Sankadal,
II
Dr. Vanitha, Dr. Naveen, Dr. Santhosh.L.Y, Dr. Varsha.S.Kulkarni, Dr. Uday Kumar,
Dr.P.Chandramouleeswaran, Dr. Ratna Kumar, Dr. K.Krishnakumar, Dr. Ashwini Dev,
Dr. Jayaraj Basarigidad, Dr. Kendadamath, Dr. V.M.Hugar, Dr. Shyla.B, Dr. Suresh
Hakkandi, Dr. Manjunath Akki, Dr. L.R.Biradar, Dr. Vijay Hiremath and other post
graduate scholars for their support.
I pay homage to my late ancestors whose lives and achievements in
Ayurveda have inspired me to take up Ayurveda as my profession. I pay my respect to
my grandfather Late Vaidyakalanidhi Dr. S.R.Warrier who has been a source of
inspiration for many.
I also express my obligations to all the family members of Perumpillichira
Warriem, Karukappilly Warriem and Mazhuvannoor Warriem. I also pay my respect to
Late Ms. Parvathy Warasiar for her support and encouragement.
I would like to mention the support and inspiration provided by Dr. P. S.
Gopi, Retd. DMO (ISM, Kerala), Dr. Mathews Vempilly, Dr. C.D.Sahadevan,
Dr.N.P.P.Namdoodiri, Dr. K.R.Suresh, Dr. Sasikumar, Dr. Beena Pradip, Dr. Anilkumar.
I also acknowledge the support and inspiration provided by my teachers Dr. K.P.
Muralidharan, Principal, S.J.S. Ayurveda College, Chennai, Dr. S.Swaminathan, H.O.D.,
Samhita & Siddhanta, S.J.S. College, Dr. Ramdas Maganti, H.O.D., Kaya chikitsa, S.J.S.
College, Dr. Vasudeva Reddy, H.O.D, Shalya, and Dr. S.Venugopal, Reader in Sanskrit.
I also thank Shri. C.S.Bhatt and family and Shri. Prasad and family for the support and
encouragement provided during my stay at Gadag.
I acknowledge my patients for their wholehearted consent to participate in
this clinical trial. I express my thanks to all the persons who have helped me directly and
indirectly with apologies for my inability to identify them individually.
I am highly thankful to Dr. Nisha Madhavan for her constant help and
encouragement throughout the work. I am also thankful to my beloved sister Mrs.
Sowmya Sathish and Mr. Sathish. P for their constant support and encouragement.
Finally I dedicate this work to my respected parents Dr. R.Ramabhadran
(Director, Dept. of ISM, Govt. of Kerala) and Mrs. R.Geetha who are the prime reasons
for all my success. Date : Satheesh. R. Place :
III
Abstract
Bastikarma is the most important among the Panchakarmas. It has already
been proved that the karma is beneficial in managing the neurological disorders.
Gridhrasi is a common disease to all class of people, now a days, and can be correlated to
Sciatica. The study ‘ Evaluation of the efficacy of Vaitharana Bastikarma in the
management of Gridhrasi with special reference to Sciatica’ is focused on this common
disease Gridhrasi. A cost effective combination of bastidravya is taken for the trial from
Vangasenasamhitha.
The objectives of the study are to evaluate the efficacy of Vaitharanabasti
in Gridhrasi and to evaluate the role of Bastikarma in Gridhrasi. The study is a
prospective clinical trial, in a single group of 30 patients, where all the patients received
Vaitharanabasti for 8 days after local abhyanga and sweda, a pariharakala for 8 days and
follow up for 1 month.
Subjective parameters are the chief and associated complaints of Gridhrasi
and the objective parameters are straight leg raising test (SLR), movements of the lumbar
spine – forward flexion, right and left lateral flexion and walking time. Assessments are
done before the treatment and after follow up.
In the study 23 patients responded moderately i.e. 50-75% relief in signs
and symptoms and 7 patients responded mildly i.e. below 50% relief in signs and
symptoms. All the parameters showed highly significant except the parameter sosha (by
using paired t test).
IV
Gridhrasi is a shoola pradhana vatavyadhi and of 2 types Vataja and
Vatakaphaja. The most common cause for the disease is IVDP with lumbar spondylosis.
The bastidravya possess amahara-shoolahara-sodhahara-sankochahara-brimhana property
at any stage of the disease. The disease Gridhrasi has all the conditions associated with it-
shoola, sthamba, sankocha, sodha (inflammation), and amatva (in vatakaphaja). The
treatment principle is brimhana too. So, here by, it is clear that Vaitaranabasti is an apt
choice in Gridhrasi.
Key Words
Vaitharanabasti ; Ghridhrasi ; SLR (Straight leg raising test) ; VAS
(Visual analogue scale) ; Movements of Lumbar spine ; Mild and moderate response ;
Probable mode of action ; Cost effective.
V
List of Abbreviations Used
⇒ AH. – Ashtanga hridaya.
⇒ AS. – Ashtanga samgraha.
⇒ BP. – Bhavaprakasha.
⇒ BR. – Bhaishajya ratnavali.
⇒ Ch. – Charaka.
⇒ CS. – Charaka samhitha.
⇒ GN. – Gada nigraha.
⇒ HS. – Hareetha samhitha.
⇒ MiR – Mild response.
⇒ MN. – Madhava nidana.
⇒ MoR – Moderate response.
⇒ No. – Number.
⇒ Pt.’s – Patients.
⇒ Sl. – Serial number.
⇒ SS. – Sushruta samhitha.
⇒ Su. – Sushruta.
⇒ Vag. – Vagbhata.
⇒ VS. – Vangasena samhitha.
⇒ YR. – Yogaratnakara.
VI
TABLE OF CONTENTS
Chapters Page No.
1. Introduction 1-3
2. Objectives 4-6
3. Review of literature 7-62
4. Methodology 63-77
5. Results 78-109
6. Discussion 110-124
7. Conclusion 125
8. Summary 126-127
9. Bibliography 128-146
10. Annexure
VII
List of tables Page Number
1. Table showing patients contraindicated for Aasthapana. 24 2. Table showing patients indicated for Aasthapana. 26 3. Table showing patients contraindicated for Anuvasana. 27 4. Table showing measurements of Bastiyantra. 29 5. Table showing Netra dosha and Putaka dosha. 30 6. Table showing dose schedule of Nirooha. 32 7. Table showing proper, insufficient & excessive signs & symptoms of Anuvasana. 35 8. Table showing proper, insufficient & excessive signs & symptoms of Nirooha. 37 9. Table showing Laxanas of Vataja Gridhrasi. 53 10. Table showing Laxanas of Vatakaphaja Gridhrasi. 53 11. Table showing clinical features of Sciatica. 54 12. Table showing Upashaya and Anupashaya. 56 13. Table showing differential diagnosis in sciatica. 58 14a. Table showing demographic data related to the study. 79 14b. Table showing demographic data related to the study. 80 15a. Table showing etiological factors and chief complaints. 81 15b. Table showing etiological factors and chief complaints. 82 16. Table showing subjective and objective parameters before and after treatment.83 17. Table showing incidence and response in sex. 84 18. Table showing incidence of religion in patients. 85 19. Table showing incidence and response in occupation. 86 20. Table showing incidence and response in socioeconomic status. 87 21. Table showing incidence of habits in patients. 88 22. Table showing nature of sleep in patients. 89 23. Table showing involvement of affected lower limb / limbs. 90 24. Table showing incidence of position at work in patients. 91 25. Table showing incidence and response in Prakriti. 92 26. Table showing incidence and response in Koshta. 93 27. Table showing incidence and response in Agni. 94 28. Table showing incidence and response in Gridhrasi types. 95 29. Table showing incidence and response to different Nidanas. 96 30. Table showing incidence and response to mode of onset. 97 31. Table showing incidence and response to variety of pain. 98 32. Table showing cause of Sciatica and response in patients. 99 33. Table showing incidence and response in age. 100 34. Table showing incidence and response in duration. 101 35. Table showing incidence of the range of SLR. 102 36. Table showing the changes in SLR after treatment. 103 37. Table showing changes in lumbar movements after treatment. 104 38. Table showing incidence and response in walking time. 105 39. Table showing incidence and response in Ruk (pain). 106 40. Table showing overall assessment. 107 41. Table showing significance effect before and after treatment. 108
VIII
List of Figures, Graphs and Photographs Page No.
1. Figure showing the anatomy of large intestine and rectum 13 2. Figure showing the anatomy of sciatic nerve 15 3. Photograph of drugs used 63 4. Photograph of basti yantra 63 5. Photograph of karma 63 6. Graph showing incidence and response in sex. 84 7. Graph showing incidence of religion in patients. 85 8. Graph showing incidence and response in occupation. 86 9. Graph showing incidence and response in socioeconomic status. 87 10. Table showing incidence of habits in patients. 88 11. Graph showing nature of sleep in patients. 89 12. Graph showing involvement of affected lower limb / limbs. 90 13. Graph showing incidence of position at work in patients. 91 14. Graph showing incidence and response in Prakriti. 92 15. Graph showing incidence and response in Koshta. 93 16. Graph showing incidence and response in Agni. 94 17. Graph showing incidence and response in Gridhrasi types. 95 18. Graph showing incidence and response to different Nidanas. 96 19. Graph showing incidence and response to mode of onset. 97 20. Graph showing incidence and response to variety of pain. 98 21. Graph showing cause of Sciatica and response in patients. 99 22. Graph showing incidence and response in age. 100 23. Graph showing incidence and response in duration. 101 24. Graph showing incidence of the range of SLR. 102 25. Graph showing the changes in SLR after treatment. 103 26. Graph showing changes in lumbar movements after treatment. 104 27. Graph showing incidence and response in walking time. 105 28. Graph showing incidence and response in Ruk (pain). 106 29. Graph showing overall assessment. 107
INTRODUCTION
Health is the supreme foundation of virtue, wealth, enjoyment and
salvation. Diseases are the destroyers of health. Ayurveda is one such system, which
prevailed 5000 years ago, which has its chief objects – preservation of health and
prevention of disease. And so this gifted science was considered the most advanced and
scientifically proven in those days and still continues it’s shining.
Whatever may be the nature of the exciting cause of the disease the actual
factors which become excited and imbalanced are the Tridoshas. So the three doshas
control the total human body and its balanced state is arogavastha i.e. the healthy status
and the imbalanced state is the rogavastha i.e. the diseased status and so the aim of the
science has got both the preventive and curative aspects.
For the better understanding of Ayurveda, the acharyas have classified the
science into 8 branches as kaya, bala, graha, shalakya, shalya, visha, rasayana and
vajeekarana. Whatever may be the branch, Panchakarma is common to all these branches
i.e. the all above branches have accepted Panchakarma chikitsa and has explained
beautifully with specifications in each branch.
Ayurveda has explained its treatment principles under two headings-
langhana and brimhana. Panchakarmas otherwise known as the elimination/purification
therapy comes under langhana, because of it Shodhana nature. It has been told in the
science that those diseases, which have been cured by Shodhana therapy i.e. by cutting
the disease from its root, will never be repeated. So the Panchakarma techniques have the
prime importance in the treatment aspects of Ayurveda. The simplicity of Panchakarma is
that it satisfies both the goals of Ayurveda by acting as swasthasya oorjaskara and
arthasya roganut as referred by the acharyas with respect to the contexts swasthavritta
and athuravritta.
Introduction 1
Vamana, Virechana, Basti, Nasya and Rakthamokshana are considered as
the Panchakarmas or the five folded therapies, in brief, but the term ‘pancha’ is ‘vistara’,
meaning elaborate. Among them acharyas have given prime importance to bastikarma
and even termed this karma as Ardhachikitsa. Herby its very clear how much important
the procedure among all the treatment modalities of Ayurveda. Even acharyas have
mentioned it removes the vitiated dosha, which has been spread throughout ht e body by
quoting the word aapadathalamasthakam while explaining the spread of bastidravya in
the body.
Bastikarma has been doing wonders in the treatments of Ayurveda.
Though it has been indicated for almost all the diseases, the prime importance of
bastikarma has been specified in the management of vatavyadhees, where the locomotor
system is affected mainly. Vata is responsible for all the functions in the body comprising
gati i.e. movement and gandhana i.e. sensation and is performed by almost all parts of the
body. All the acharyas have dealt the vata disorders, numbered 80, under a separate
chapter entitled vatavyadhi.
It would be the best way if one studies a particular subject to which it is
highly related to. As for this principle, the best way to understand or analyze bastikarma
is by checking its effect over a vatavyadhi. Gridhrasi is one among the 80 types of
vatavyadhi where even the bastikarma itself has its prime importance.
A normal daily life without moving the legs is almost impossible for any
human being, from the time immemorial to ultra modern civilized life. Though the
movements of legs are so important, these are most neglected part of the body and
vulnerable to many stresses there, by diseases. The most common disorder, which affects
Introduction 2
the movement of legs, particularly in the most productive period of life i.e. 30-50 years,
is backache problems, a third of the patient turn into Gridhrasi. The term Gridhrasi and
sciatica of modern medicine can be termed synonymous as much as they refer to the
same singular presentation – pain along the course of leg irrespective of etiological
variations.
Now the whole scientific world has high hopes in Ayurveda as capable to
provide proper and safer methods of management in disorders where the efforts with
modern medicine have failed to achieve the desired results. Already the efficacy of the
Ayurvedic drugs and techniques has gained global popularity in musculo-skeletal
disorders like rheumatoid arthritis. One such drug of choice in Gridhrasi is
Vaitharanabasti, which is told by Acharya Vangasena in his Vangasenasamhitha.
Introduction 3
OBJECTIVES
Need for the study
In Ayurveda Chikitsa, the role of Panchakarma, especially the role of
Bastikarma is important in the treatment of many diseases, mainly Vatavyadhis. Basti is
also termed as Ardhachikitsa. Acharya Vangasena has mentioned Vaitharanabasti. The
drugs used in this bastikarma are minimal in number, economic and have no proven
adverse effects. Even though it is classified under Niroohabasti, the patients are not much
restricted as in the case of Niroohabasti.
Gridhrasi is a common entity encountered in clinical practice. It is one
among the Vataja nanatmaja vyadhis as classified by Charaka. The term Gridhrasi and
Sciatica of the Modern Medicine can be considered synonymous in as much as they refer
to singular similar presentation-pain along the course of leg, irrespective of the
etiological variations i.e., pain in the sciatic nerve which is felt in the back of the thigh,
leg and foot. Low backache is the 5th most common reason for all physician visits.
Lumbar disc lesions are responsible for more continuing annoyance, frustration,
semiinvalidim, general misery and bad temper than any other impaired tissue of the body.
Even though the ailment usually has a benign course, it is responsible for direct health
care expenditures of more than $20 billion annually and as much as $50 billion per year
when indirect costs are included. Approximately 90% of adults experiences back pain at
sometime in life and 50% of persons in working populations have back pain every year.
As many as 90%of patients with acute back pain return to work with in 3 months, but
many experiences symptoms recurrence and function limitation. The treatment for
sciatica comprises analgesic drugs, NSAIDs and bed rest generally according to modern
science.
Objectives 4
Vangasena has directly indicated Gridhrasi when he explained
Vaitharanabasti in bastikarma adhikara. Considering the drugs used in the basti, it is
found that it is cheap and effective compared to other conventional method of
management of Gridhrasi. It is very particular to be mentioned at this context that only
very few studies have been conducted on the Vaitharanabasti with reference to Gridhrasi,
that too of the combination told by Vangasena, though much studies have been conducted
in Gridhrasi with shaman and shodhana measures.
So the present study “Evaluation of The Efficacy of Vaitharana
Bastikarma in the Management of Gridhrasi with Special Reference to Sciatica” is
undertaken.
The aims and objectives of the study are:
(1) To evaluate the role of Bastikarma in Gridhrasi.
(2) To evaluate the efficacy of Vaitharanabasti in Gridhrasi.
List of few studies conducted
1. A comparative study of Nirgundipatra pindasweda and bastichikitsa in the
management of Gridhrasi by Dr.U.S.Bedekar at G.A.C, Ahemmedabad (1995).
2. Studies on some systemic effects of basti with special reference to Gridhrasi,
Vishwachi and Pakshaghatha by Dr.V.Shreekanth at I.P.G.T & R.A, Jamnagar
(1984).
3. Gridhrasi mien bastikarma ka chikitsathmaka adhyayan by Dr.S.K.Pandey at
National Institute of Ayurveda, Jaipur (1988).
Objectives 5
4. Management of Gridhrasi with special reference to basti by Dr.B.S.Shridhar at
G.C.I.M, Mysore (1991).
5. Study on low backache and its management with Vaitharanabasti by
Dr.U.R.Sasikumar at G.A.C, Thiruvananthapuram.
6. A comparative study of Katibasti and Vaitharanabasti (kalabasti) in the
management of Gridhrasi by Dr. Seema Sanjore at R.T.A.M, Akola.
7. A clinical study on the management of amavata vis-à-vis seropositive rheumatoid
arthritis by Vaitharanabasti along with bhallataka siddha ksheera by Dr. Vaishali
Dhande.
Objectives 6
Historical review
Without considering the historical background the origin and progressive
development of any subject in Ayurveda is incomplete.
Basti Karma.
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, uses
complications, advantages in Charakasamhitha.1 Sushrutha has elaborately described
the Bastikarma procedures, about bastiyantra, types of bastis, complications,
management, etc in different chapters of kalpasthana.2 Acharya Vagbhata has explained
the bastikarma in Ashtangasangraha and Ashtangahridaya like avasthanusrutabastis,
chitrabastis, prasrutikabastis, vyapaths, etc. 3, 4
Sarngadharasamhitha also has given much importance to bastikarma with
the previous acharyas methods of explanations in 3 chapters, including uttarabasti.5
Yogaratnakara, Bhavaparakasha and Vangasena dealt the bastikarma beautifully and
added newer combinations to the Ayurvedic world for a better practice.6 Acharya
Kashyapa equated the bastikarma as AMRUTAM because of its wide applications even in
both infants and old age.7
Later, modern authors in Ayurveda has also elaborately explained the
Bastikarma, modifications of bastiyantra, converted the older measurements to the
present day measurements and made us things easier for the practitioners.
Historical review 7
Gridhrasi.
The disorders that impair the movement of legs are as old as the existence
of human beings as walking is an inevitable function since the existence of man on earth
to search for his food. The historical review can be classified in two divisions: -
1.Vedic period
2.Samhitha period
Vedic period.
There are prayers in Atharvanaveda to protect ojas in thighs (uru), speed
in jangha (leg), prishta (spinal column), capacity to erect straight in padas and unimpaired
organs of the body. 8 There are references about Kshiptaroga, where pipalli is mentioned
as the medicine for the roga. In the Gridhrasi kshepana is a feature according to its
derivation. Hence, we assume that in Atharvanaveda the word kshipta may be used for
Gridhrasi. 9 But there is no reference about the disease Gridhrasi as such in the Vedas.
Some references are available in Garudapurana and Agnipurana about Vatavyadhi but not
specified to Gridhrasi. 10
Samhitha period.
Charaka has made the first description about Gridhrasi and included in
both nanatmaja and samanyaja type of vyadhi, in aseetivatavyadhi adhyaya.11 Bheda,
laxana and chikitsa are also explained in chikitsasthana.12 Sushrutha, though belongs to
Dhanwantari sampradaya has mentioned the involvement of kandara in the disease
pathogenesis and surgical treatments are explained in detail.13 Vagbhata, in
Ashtangasangraha and Ashtangahridaya discussed the symptomatology and treatments.14
Historical review 8
Bhavaparakasha and Chakradatha explained the disease Gridhrasi and its
management by vamana, virechana with more importance to basti.15 Chakradatha
suggested to burn the little finger of the affected limb if the Gridhrasi is not subsided by
any treatment. 16 Yogaratnakara mentioned the symptoms of Gridhrasi but have given
more importance to formulation as of Bhaishajyaratnavali.17 Madhavakara in
Madhavanidana described symptomatology and differentiated Vataja and Vatakaphaja
Gridhrasi with additional symptoms.18
In Kashyapasamhitha Gridhrasi is considered as one among the
Aseetivatavikaras.19 Sharangadhara also mentioned the same and with treatment.20 Bhela
and Hareetha, gave more importance to Bastikarma and Rakthamokshana in their
respective samhithas.21 In Basavarajeeyam some strange symptoms like sweda, bhrama,
murcha, trishna, vidaha indicating the involvement of Pitta. He has mentioned that both
lower and upper limbs are involved. Chintamanirasa, Poornachandrodayarasa,
Drakshadigutika are his contributions.22
Chakrapanidatta, Dalhana, Arunadatta, commentators of Brihatrayees
opine that Gridhrasi is a shoola pradhana vatavyadhi, kandara and snayus are affected and
impairment in lifting the lower limb is main feature. Gridhrasi is mentioned with many
good formulations in Kalyanakaraka, Gadanigraha, Hariharasamhita, Vrindavaidyaka and
Vaidyavinodasamhita.
Vyutpatti and Nirukti.
The word Basti is derived form ‘vas + tich’ and is masculine gender.
‘Vasu nivase’23 - Means residence.
‘Vas-aachadane’ - That which gives covering.
Historical review 9
‘Vas vasane surabhikarane’ - That which gives fragrance.
‘Vasti vaste aavrunothi moothram’ - That which covers the urine.
‘Nabheradhobhage mootradhare - The position of basti is just below the
nabhi (umbilicus) and is the collecting organ of urine in the body i.e. urinary bladder.
The word Gridhrasi is of feminine gender.25
‘gridhra’ + ‘so’ – ‘Atonupasargakah’ – adding ‘kah’ pratyaya leads to ‘gridhra +
so + ka’ by lopa of ‘o’ and ‘k’, ‘sha’ is replaced by ‘sa’ by rule ‘dhatwadesh sah sah’, in
feminine gender by adding ‘dis’ pratyaya the word ‘Gridhrasi’ is derived.
‘Gridhramapi syati’, ‘sayti’ as kshepana.
‘Urusandhau vatarogah’. 26
‘Gridhramiva sayti Gacchati’.
The movement of leg resembles a throwing action (kshepana) that is
similar to the gait of vulture. According to another nirukti, in this disease the patient
experiences severe pain that is similar to the prey when vulture eats it up.
“Gridhram api syati antakarmani atonupasargakah
Carva gridhra iva syati pidayathi Gridhra syati bhakshayati”.
Gridhrasi (f) – Rheumatism affecting loins.27
Sciatica – (Si-at’î-kah) – Neuralgia along the course of sciatica nerve, most
often with pain radiating into the buttock and lower
limb, most commonly due to herniation of a lumbar
disc.28
Historical review 10
Paribhasha
In the context of Panchakarma the term basti is used in different sense.
‘Vastina deeyate iti vasti’29
‘Vastibhir deeyate yasmat tasmat vastiriti smritha’30
‘Vastina deeyate vastini va Purvamanyattavasto vasti’ 31
The term Basti means bladder. It is used as a device for Bastikarma.
Hence, the term Basti is used as a name in Panchakarma therapy to designate the process.
The medicine, which may be, medicated decoctions, milk, oil, ghee, mamsarasa of
prescribed quantities are taken in the Basti and administered through gudamarga by
means of a device Bastinetra after proper pre-treatment procedures.
The condition where pain is first felt in buttock (spik) then the posterior
aspect of waist (kati) and radiates downwards in the posterior aspect of thigh (uru), knee
(janu), calf (jangha) and foot (pada) along with stiffness (stambha), piercing sensation
(toda) associated with frequent twitching (spandana) is called Gridhrasi.32
According to Sushrutha and Vagbhata, the condition where the ligaments
(kandara) of heel and digits (parshnee) and angulees) are affected by vitiated vayu
causing difficulty in lifting the lower limb, kshepa i.e. involuntary movements or
strickings or spasmodic contractions.33, 34
Classical description of symptomatology of Gridhrasi can be very well
correlated with that of the Sciatica syndrome. Sciatica - designates a syndrome
characterized by the pain beginning in the lumbo-sacral region, spreading to the lower
limb through buttocks, thigh calf upto the foot or a disorder characterized by pain in the
distribution of Sciatic nerve. 35
Historical review 11
Paryaya & Bheda
The word Gridhrasi has 3 synonyms used by various authors. They are
mentioned as below –
1. Radhina - Pressing, compressing or destroying. 36
2. Ranghinee - Weak point / rupture. 37
3. Ringhinee - Indicates skalana i.e. displacement.38, 39
Basti is classified numerously in brief –
• On the basis of Adhisthana - Pakwashayagata, Grabhashayagata,
Vranagata, Mutrashayagata.
• On the basis of Dravya - Nirooha, Anuvasana, Sneha, Matra.
• On the basis of Karmukata - Shodhana, Lekhana, Snehana, etc.
• On the basis of Samkhya - Kala, Karma, Yoga.
• On the basis of Anushangi - Yapanabasti, Sidhabasti etc.
But Charaka has used the term Basti exclusively for nirooha as per the
commentary of Chakrapani.40 Similarly the term Basti has also been referred to the
method of shirobasti, urobasti, janubasti, etc.
Gridhrasi is one among the 80 nanatmaja vyadhis mentioned by Charaka
Chakrapani says that the pain is Gridhrasi shoola and is caused by Kevalavata.41
Gridhrasi is classified under vatavyadhi, where it can be accompanied by other doshas.
Based on dosha predominance it is classified into two types : -
1. Vataja Gridhrasi
2. Vatakaphaja Gridhrasi 42
Historical review 12
Shareera
The word shareera composes both structural and functional aspects of the
body. As basti in considered importantly in the subject certain anatomical features of
rectum and large intestine is also described.
Rectum / Guda
Sushrutha has explained elaborately on the anatomical structure of guda
while describing Arsoroga. Guda is a part, which is the extension of sthoolantra with 41/2
angula in length. It has got 3 valis (parts) named as Gudavalitrayam.43
1.Pravahini – that which does pravahana.
2.Visarjini – that which does viasrajana
3.Samvarani – that which does samvarana
There is another structure called as Gudostha, which is about a distance of
1½ yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1
angula from gudostha. The width of each vali will be 1 angula and of the colour of
elephant’s palate. 44
Charaka when described about the koshatagni has considered uttaraguda
and adharaguda. The modern commentators consider them as rectum and anus
respectively.45 All acharyas have considered guda as one among the dashajeevitha
dhamani and also one among the bahyasrotas. 46, 47, 48
The rectum forms the last 15cm of digestive tract and is an expandable organ
for the temporary storage of fecal material. Movement of fecal material into the rectum
triggers the urge to defecate.
Shareera 13
The last portion of the rectum, the ano-rectal canal, contains small
longitudinal folds, the rectal columns. The distal margins of rectal columns are joined by
transverse folds that marks the boundary between columnar epithelium of the proximal
rectum and a stratified squamous epithelium like that in the oral cavity. Very close to the
anus or anal orifice, the epidermis becomes keratinized and identical to the surface of the
skin.
There is a network of veins in the lamina propria and submucosa of the
ano-rectal canal. The circular muscle layer of the muscularis externa in the region forms
the internal sphincter and are not under voluntary control. The external anal sphincter
guards the anus and is under voluntary control. Pudental nerves carry the motor
commands. 49
Pakwashaya / Large intestine.
Pakwashaya is considered as one among the ashaya by Sushrutha,
Vagbhata.50, 51 Arunadatta comments as pakwashaya is the seat of pakwa anna i.e. that
which attains pureeshatha.52 Charaka and Vagbhata considered this as one among the
koshtangas. 53, 54 Sharangadhara has specified the location of pakwashaya (pavanasaya)
as below the Tila i.e. the liver.55
The horseshoe shaped large intestine or large bowel begins at the end of
ileum and ends at anus. Average length of about 1.5 meters and width of 7.5cms. It is
divided into 3 parts: -
1.Cecum – T portion (pouch like)
2.Colon – large portion.
3.Rectum – the last – 15 cm portion.
Shareera 14
The cecum collects and stores the chyme and begins the process of
compaction. Colon is being subdivided into ascending, transverse, descending and
sigmoid colon. The major characteristics of colon are the lack of villi. The abundance of
goblet cells, presence of distinctive intestinal glands and mucosa does not exist produces
any enzymes. The reabsorption of water is an important function of large intestine (75%)
and also absorbs number of other substances that remain in the fecal matter or that were
secreted into the digestive tract along its length like vit. K, B5, biotin, urobilinogen, bile
salts and toxins.56
As far as the Gridhrasi disease is concerned the parts affected are kati, prishta
(lumbo-sacral region) posterior aspect of uru, janu, jangha and pada region.
24 asthisandhis, slightly movable constitutes lumbo-sacral region.57 The
bones of katiprushta pradesha are firmly united by mamsarajju (ligaments).58 60 peshis
are situated in prishtabhaga and each 5 peshis are situated in buttocks.59 The union of 5
sacral vertebrae, trika, the seat of avalambaka kapha and kati is one among the vata
sthanas.60, 61 The lower limbs are considered as one karmendriya 62, 63 and the motor
functions are carried by 100 peshis, 150 snayus, 2 koorchas, 2 kandaras, 30 asthis and 17
asthisandhis situated in each limb. 64
Katikatharunamarma (asthi), kukundaramarma (sandhi) and nitamba
(asthi) are situated in the shroni (pelvis), below the pelvis and on the hip region
respectively.65
Shareera 15
Sciatica nerve or Gridhrasi nadi / snayu66
It is 2 cm broad at its origin and the largest and longest nerve in the body.
It is formed by 5 roots, which pass through lumbar 3-4th, 4-5th, 5th-1st sacral, 1st-2nd sacral
and 2nd and 3rd intervertebral joints. It leaves via the greater sciatic foramen below the
pirifromis and descends between the greater trochanter and ischial tuberosity along the
back of the thigh, dividing into the tibial and common peroneal nerve.
Apart form the sensory and motor neurons, this nerve contains some
specialized neurons. The muscles of the limbs are under the control by motor neurons and
impulses are conducted form corresponding area to the CNS by sensory neurons.
Tibial nerve
Formed by L4, L5, S1, S2, S3 roots and has muscular, cutaneous and three
genicular branches. This is the largest branch of sciatica nerve that lies superficially and
extends form the superior angle to the inferior angle of the popliteal fossa crossing the
popliteal vessel from lateral to medial side.
Common peronial nerve
Formed by L4, L5, S1, S2 and is smallest branch of the sciatic nerve. It lies
in the superficial plane. Extends form the superior angle of the fossa of the lateral angle
along the medial border of the biceps femoris. It winds around the posteriolateral aspect
of neck of fibula, pierces the peroneus nerves. In the fossa it gives rise to 2 cutaneous
branches and 3 genicular branches.
Blood supply
Vasia nervorum, which are minute vessels passes through perineurium
(branches form the blood vessel of respective area).
In Ashtangahridaya and Sushruthasamhitha which explaining about
Gridhrasi both acharyas have used the term “kandara”. Arunadatta says kandara that
emerges from the toes and passes upwards through the ankle region (parshni). But,
Dalhana on the other hand mentions kandara as ‘mahasnayu’ and can be considered as
sciatic nerve itself. 67, 68
Shareera 16
Basti Karma
Bastikarma is considered as the most important form of shodhana therapy
due to the power and advantages it confers on patients. Even though it has a resemblance
with the enema therapy, it differs in many aspects like principle, mode of application and
the advantages it renders. The term basti means bladder. It is used as a device for
bastikarma. Hence, the term basti is used as a name in Panchakarma therapy to designate
the process. It is also said that the medicine in suspension, administered through the
bastiyantra, first reaches the lower abdominal part of the patient. The lower abdominal
area or the pelvis also contains the organ basti (urinary bladder). Due to these reasons the
term basti is used in Panchakarma.
Importance of Bastikarma
Different acharyas appreciated this form of treatment considering the
efficacy it generates. No other elimination therapy is equal to basti because it expels the
vitiated doshas rapidly and easily from the body and also causes reducing as well as
nourishing the body very fastly. 69 Though emesis and purgation eliminate the vitiated
doshas form the body, the drugs used in these therapies contain katurasa, ushnaguna and
teekhsna gunas, which cannot be taken easily by children or older people. But basti can
be given in all age groups without any hesitation. 70
Bastikarma is the best method of treatment in dealing with vatavikaras and
vata dominating other vikaras as vata being the chief controller among the causative
forces of disease.71 As per the fundamental principles of Ayurveda; vata is responsible for
every movements and activities in the body whether it is of constructive or of destructive
nature. On the other hand vata is functionally required to co-ordinate with pitta and kapha
in order to accomplish various duties assigned to them in the organization of life. 72
Bastikarma 17
Pakwasaya is considered to the seat of vata. Direct application of this kind
of treatment to pakwasaya helps for the proper regulation and co-ordination of the
functions of vatadosha not only in its own site but also control the related doshas which
are involved in the pathogenesis of disease.73 Hence, it is considered as one of the apt
treatment for vata predominant disease and also called it as Ardhachikitsa by Vagbhata.74
Apart form this basti is considered as superior to the other therapeutic measures on
account of its varied actions like samshodhana, samshamana and samgrahana of doshas
on this basis of drugs used in it. 75
Basti is indicated for providing rejuvenation, happiness, increasing the
duration of life, strength, improving memory, voice, digestive power and complexion. It
removes noxious matters form the tissues, pacifies the doshas and rectifies the process of
excretion. Consequently it affords stability and thus indirectly strengthens the
reproductive capacity in man.76 Kashyapa equated the bastikarma as ‘Amrutam’, because
of its wide application even in both infants and in old age.77
Classification of Basti Since basti is an important method of therapy in Ayurveda, it can be
classified in various ways for better understanding. One cannot find any uniformity in
classification of basti among the authors of classical texts. Generally the term basti has
been used for all types of bastikarma, which includes nirooha, anuvasana, uttarabasti etc.
But Charaka has used this term basti exclusively for nirooha as per the commentary of
Chakrapani.78 Similarly the term basti has also been referred to the method of shirobasti,
urobasti, vrana basti etc. So a rational thinking on various aspects of bastikarma has
brought about the following classification.79
Bastikarma 18
1.Adhishtana bheda – The site of application.
2.Dravya bheda – The medicinal preparations used.
3.Karma bheda – The action it does.
4.Sankhya bheda – The number of bastis given.
5.Anushangika bheda – Always associated
6.Matra bheda – Based on amount used.
1. Adhishtana bheda
According to the site of application of basti it is classified into two types –
a. Internal
b. External
a. Internal
i) Pakwasayagata basti – The administration of medicine via ano-
rectal route to pakwasaya.
ii) Garbhasayagata basti – The administration of medicine via vaginal
route to garbhasaya.
iii) Mutrasayagata basti – The administration of medicine via
urethral route to mootrasaya.
iv) Vranagata basti – The medicine administered through the
vranamukha by the process of bastikarma.
b. External
In certain diseases the medicated oil is kept over the part of the body using
a cap or with flour paste for prescribed period of time and named after the site of
application of oil such as – Shirobasti, katibasti, urobasti, etc.
Bastikarma 19
2. Dravya bheda
It is based on the major ingredients of bastidravya - kwatha or sneha and
so classified into two types: -
i) Nirooha basti – The main ingredient is kwatha and it is the important type of
bastikarma having varied therapeutic effects. The basti is able to eliminate doshas form
the body and so called nirooha. Also called asthapana, as it is vayaha and aayusthapaka
the vikalpa of nirooha basti are synonyms.80 The effect of nirooha will spread all over the
body even in the cellular level and helps to eliminate the vitiated doshas adhered in
srotases and its action in the body is beyond the perception of physician.81
ii) Anuvasana basti – Sneha is the chief ingredient of anuvasana. The term
anuvasana is coined due to the unharmful effect of the bastidravya even if it is retained
inside the koshta. More over, this type of basti can be practiced daily without any serious
precautionary measure, as it is less harmful than nirooha.82
3. Karma bheda
Sushrutha and Vagbhata have made the following classification according
to their actions. 83, 84
a) Shodhana basti – Contains shodhana dravyas and removes doshas and
malas from the body.
b) Lekhana basti – Reduces medodhatu and produces lekhana in the body.
c) Sneha basti – Contains more of sneha and produces snehana in the
body.
d) Brumhana basti – Increases the rasadi dhathus and indirectly it helps in the
growth of the body.
Bastikarma 20
e) Utkleshana basti – Causes utklesha of malas and doshas by increasing its
Pramana and causes dravabhootha.
f) Doshahara basti – Purificatory or eliminating type.
g) Shamana basti – Produces shamana of doshas.
Sharangadhara added, shodhana basti to it also he has added lekhana,
brimhana, deepana and pachana types of bastis. 85 Vatakhna basti, balavarnakrita basti,
snehaneeya basti, sukrakrit basti, krimighna basti, vrushatvakrit basti has been explained
in various contexts by Charaka.86
4. Sankhya bheda
It is stated that neither snehabasti nor niroohabasti can be applied alone.87
So, Charaka has made this classification based on the number of snehabastis and
niroohabastis in a treatment.88
a) Karma basti – There are 30 numbers of bastis in this group out of which
snehabastis and niroohabastis are 18 and 12 respectively. Prescribed in chronic diseases
of prolonged nature and particularly of vata predominant.89 First 1 snehabasti then
alternate sneha and kashaya- each 12 and 5 snehabastis in the end.
b) Kala basti – There are 16 numbers of bastis. First basti is anuvasana,
then 6 nirooha and 6 anuvasana must be given alternately and in the end 3 anuvasana.
Indicated in patients of madhyamabala and vatapitta predominant conditions.90 However,
a difference of opinion regarding the number of nirooha is also prevailing.
c) Yoga basti – There are 8 numbers of bastis. 5 snehabastis and 3
niroohabastis. First basti is anuvasana, then 3 nirooha and 3 anuvasana and last 1
snehabasti. Indicated in diseases where involvement of vata dosha is found less.91
Bastikarma 21
5. Matra bheda
This classification of basti is based on the quantity of bastidravya
prescribed. The quantity may vary according to the age, strength of the patient and
severity of the disease.
a) Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of
bastidravya prescribed is dvadashaprasruta i.e. 24
palas.92
b) Prasritayogika basti – Charaka has prescribed various types of
nirooha in different doses like 4,5,6,7,8,9, and 10
prasrutas, considering the strength of the patient
and condition of the disease.93
c) Padaheena basti – In this type of basti, 3 prasrutas i.e. ¼ of
dvadashaprasruta is less form from the total
quantity of nirooha used i.e. 9 prasruthis.94
Anuvasana is also classified into 3 according to the difference in the
quantity of sneha used.
a) Sneha basti – 6 palas (¼of total quantity of nirooha) 95
b) Matra basti – The quantity of sneha that will be digested if
taken orally by 6 hours. 96
c) Anuvasana basti – ½ of the quantity of sneha basti. 97
Bastikarma 22
6. Anushangika bheda
a) Yapana basti – Enhances bala, shukra and mamsa. Mostly
employed in treating the vyapats produced by
excessive coitus. It can be given during all the
seasons of the years. It increases life span.
Charaka has explained 26 bastis of this type.
Kukkutamamsa, ksheera, eggs, kwatha, madhu,
ghrita, mamsarasa are should be added to prepare
this.98
b) Siddha basti – The basti creates bala, varna, prasanata and it
purifies more than 100 diseases. 99
c) Yuktaratha basti – Mainly indicated for travelers on horse,
different types of vehicles etc. 100
d) Vaitharana basti – It is explained by both Vangasena and
Chakradatta. It is mainly concentrating on the
elimination of doshas. It has got wide
applications.101
e) Ksheera basti – Explained for shoolam, vitsangam, anaha,
mootrakrirchha.102
f) Ardhamatrika nirooha basti – No need for sneha sweda pratikriya. Sarvaroga
nivarana in nature, mainly rajayakhsma, shoola
krimi, vatarakta. It improves sukha and ojus and
has the nature of pumsavana.103
Bastikarma 23
g) Picha basti – It is given with a drug called as Shalmaliniryasa.
It produces sthamba (stoppage) of pichasrava and
jeevashonita. It is also called as Sangrahibasti.104
h) Mutra basti – Gomutra is the main ingredient and it has the
qualities of mridu in nature, pacifies all doshas
and it is harmless.105
i) Rakta basti – When there is severe blood loss from the body,
acharya has advised to perform raktabasti that
which stops the further blood loss and initiates the
production.106
Indications and contraindications of Bastikarma As basti is one of the prime treatment of Ayurveda, one should have the
knowledge of the patients community to which it should be performed and not. All the
acharyas have been clearly explained. A brief description has been made here.
Table No: -1 Patients contraindicated/anasthapya 107, 108, 109 No. Type of patient Cha. Su. Vag. Complication 1. Ajeerna + + -
2. Atisnigdha + - + 3. Peetasneha + - -
Dooshyodara, Moorchha, Shotha.
4. Utklishtadosha + - - 5. Alpagni + + +
Teevra aruchi
6. Yanaklanta + - - 7. Atidurbala + + - 8. Kshudhaarta + - -
Shaeerashosha, pranaparodha,
Bastikarma 24
9. Trishnaarta + + - 10. Sharmaarta + - -
Kruchraswasa
11. Atikrisha + + + 12. Bhuktabhakta + - + 13. Pitodaka + - -
More karshya, utklesha of dosha happens
14. Vamita + - + 15. Virikta + - +
More rookshata happens
16. Krita nasyakarma + - + Manovibhrama, Srotonirodha 17. Krudha + - - 18. Bheeta + - -
Bastidravya moves up
19. Matha + + - 20. Moorchita + + -
Samnjanasha and Hrudayopaghata
21. Prasaktachhardi + + + 22. Prasaktanishteeva + - + 23. Swasaprasakta + + + 24. Kasaprasakta + + + 25. Hikkaprasakta + - +
Bastidravya moves up because of the existing urdhwagati of vata
26. Baddhagudodara + - + 27. Chhidrodara + - + 28. Dakodara + - + 29. Adhmana + - +
Leads to death by causing severe
distension of abdomen
30. Alasaka + - - 31. Visoochika + - - 32. Asmadosha + - - 33. Amatisara + - +
Causes teevra amavastha of the body
34. Madhumeha, Prameha
+ + + Vyadhi vardhakam
35. Kushta + + + 36. Arshas - + + 37. Pandu - + - 38. Bhrama - + - 39. Arochaka - + - 40. Unmad - + - 41. Shokagrastha - + - 42. Sthaulya - + - 43. Kandhashosha - + - 44. Kshathaksheena - + +
Bastikarma 25
45. Saptamasa garbhini - + + 46. Bala, Vruddha - + - 47. Alpavarcha - - + 48. Gudashodha - - + 49. Amaprajatha + - - 50. Shopha - - - Table No: -2 Patients indicated / asthapya110, 111, 112 No. Indication Ch. Su. Vag. No. Indication Ch. Su. Vag. 1. Sarvangaroga + + - 37. Rajakshaya + + + 2. Ekangaroga + + - 38. Vishamagni + - - 3. Kukshiroga + - - 39. Spikshoola + - - 4. Vatasanga + + + 40. Janushoola + - - 5. Mutrasanga + + + 41. Janghashoola + - - 6. Malasanga + + + 42. Urushoola + - - 7. Shukrasanga + - + 43. Gulphashoola + - - 8. Balakshaya + - - 44. Parshnishoola + - - 9. Mamsakshaya + - - 45. Prapadashoola + - - 10. Doshakshaya + - - 46. Yonishoola + + - 11. Shukrakshaya + + - 47. Bahushoola + - - 12. Aadhmana + + + 48. Angulishoola + - - 13. Angasupti + - - 49. Sthanashoola + - - 14. Krimikoshta + - - 50. Dantashoola + - - 15. Udavarta + + - 51. Nakhashoola + - - 16. Sudhatisara + + + 52. Parvasthishoola + - - 17. Parvabheda + - - 53. Shopha + - - 18. Abhitapa + - - 54. Sthmaba + - - 19. Pleehadosha + - + 55. Aantrakoojana + - - 20. Gulma + + + 56. Parikartika + - - 21. Shoola + + + 57. Maharogoktavatavyadhi + - + 22. Hridroga + - - 58. Jwara - + + 23. Bhagandara + - - 59. Timira + + - 24. Unmad + - - 60. Pratishaya - + - 25. Jwara + - + 61. Adhimantha - + - 26. Bradhna + + + 62. Ardita + + -
Bastikarma 26
27. Shirashoola + + + 63. Pakshaghata + + - 28. Karnaroga + - - 64. Ashmari - + - 29. Hritshoola + - - 65. Upadamsha - + - 30. Parshwashoola + - - 66. Vatarakta - + - 31. Prushtashoola + - - 67. Arshas - + - 32. Katishoola + - - 68. Stanyakshaya - + - 33. Vepana + - - 69. Manyagraha + + - 34. Aakshepa + + - 70. Hanugraha + + - 35. Angagaurava + - - 71. Ashmari - + + 36. Atilaghava + - - 72. Moodhagarbha - + + Amlapitta, hridroga, asrugdhara113
Amlapitta, hridroga, asrugdhara and Vishamanajwara 114
Indications for anuvasana basti 115, 116, 117 Anuvasana is indicated in patients who are already indicated for
asthapana, but special mention has been given to certain conditions like rooksha, kevala
vataroga and atyagni where anuvasana is more beneficial.
Table No: -3 Persons unfit for the anuvasana basti117, 118, 119 No. Contraindications Ch. Su. Vag. Complications 1. Anasthapya + + + 2. Abhuktabhakta + - + Sneha moves upwards 3. Navajwara + - - 4. Kamala + - + 5. Prameha + - +
Leads to udara
6. Arshas + - - Leads to aadhmana 7. Pratishyaya + - - 8. Pandu + + +
9. Arochaka + - - Leads to more annabhilasha 10. Mandagni + - - 11. Durbala + - -
Increases the condition
12. Pleehodara + + + 13. Kaphodara + + +
Leads to more dosha vardhana
Bastikarma 27
14. Oorustambha + - + 15. Garapeeta + - + 16. Kaphabhishyanda + - + 17. Gurukoshta + - + 18. Shleepada + - + 19. Galaganda + - + 20. Apachi + - + 21. Krimikoshta + - + 22. Prameha - + + 23. Kushta - + + 24. Sthaulya - + + 25. Peenasa - - + 26. Krushna - - + 27. Varchobheda + - + 28. Vishapeeta + - + Basti Yantra The instrument or device used for basti karma is called as bastiyantra. It
comprises of two parts –
1.Bastinetra
2.Bastiputaka
Bastinetra (nozzle/cannula) The general meaning of netra is eye, but here netra means nalika (tube). It
can be made of gold, silver, copper or such other higher metals or alloys, long bones of
animals, bamboo, wood etc. were used in ancient times. Generally, it must resemble the
tail of cow with a tapering end and a wider base. But, according to Charaka it is tubular
apparatus with round ends and smooth surfaces.120 The dimensions are different to suit
the patients of different age group. The following table furnishes the measurement of
bastiyantra.
Bastikarma 28
Table No: - 4 Measurements of Bastiyantra.121, 122, 123
Lumen of netra No. Age in
years
Length in
Angula Diameter of narrow
end Diameter of broad end
1. < 1 5 1 angula 2. 1 - 6 6 Size of green gram 1 angula 3. 7- 11 7 Size of black gram 1½ angula 4. 12-15 8 Size of kalayam 2 angula 5. 16- 20 9 Size of wet kalaya 2½ angula 6. > 20 12 Karkandhu 3 angula
Uttarabastiyantra 7. - 12 – 14 Sarshapa size -
Susrutha’s opinion 8. 1 6 Green gram Feather of kanku bird must pass
through. 9. 8 8 Black gram Feather of eagle must pass through. 10. 16 10 Kalayam Feather of peacock must through. 11 >25 21 Kolasthi Feather of vulture must pass
through. Pramana of vranabasti netra
It should be of 8 angulas in length and the hole should be of a mudga
pramana.124
Karnika
In order to prevent undue penetration of the bastinetra deep in to the
rectum, a karnika or rim has to be made. It is to be placed at a required point above the
distal end. Two karnikas are provided on the netra at distance of 2 angulas between one,
another at proximal end to tie the bastiputaka properly. 125
Bastikarma 29
Bastiputaka
The container or bag used to carry the bastidravya, ready for application is
known as bastiputaka. In ancient days the urinary bladder of matured animals like cow,
buffalo, dear, pig, goat etc were used. It was then processed to make soft and colorful by
removing the blood vessels and other impurities.
It should be made suitable for well fitting with the bastinetra and should
not have any foul smell. If good bladder is not available some other materials are
recommended for the purpose. They are the skin of lower limb or neck of monkeys or
other animals, thick cloth with sufficient strength and size may also be used. 126
Now a days, due to modern technological development various types of
materials are available to make up of bastiputaka and even disposable bastinetra are
available. The rubber bladder and polythene bags are best choice. Presently in most
Panchakarma theaters the disposable bastiyantras with polythene bags are in use.
Table No: -5
Netradosha and putakadosha127, 128
No. Netradosha Features Effect 1. Hraswata Too short Dravya will not reach pakwasaya 2. Deerghata Too long Dravya go beyond the pakwasaya 3. Tanuta Too thin Produces kshobha 4. Sthoolata Too big Produces lakshana 5. Jeernata Old dhatu used Injury to guda 6 Shithilabandhana Not fixed properly to the
putaka Dravya comes out
7. Parshwachhidra Hole on side Leakage of dravya happens 8. Vakrata Curved / irregular Dravyagati becomes irregular 9. Assannakarnika Karnika too near Karma becomes of no use 10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma
peedana 11. Anusrotata Small hole Cannot perform properly 12. Mahasrotrata Broad hole Cannot perform properly
Bastikarma 30
No. Putakadosha Features Effect 1. Vishama Shape not in uniform Gati vishamata happens during
pressing 2. Mamsala Muscular tissue present Produces offensive small 3. Chinnachidrayukta Presence of hole Dravya comes out 4. Sthoola Thick one Does not push dravya 5. Jalayukta Anastamosis present Produces leakage 6. Vatala Excess air space Frothy type of dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass through Preparation and procedures of bastikarma
The preparation and procedures made before, during and after
administration of nirooha, anuvasana, uttarabasti have some minor differences.
Generally, these procedures and preparations are classified into three parts: -
1.Poorvakarma (pre-treatment)
2.Pradhanakarma (treatment)
3.Paschatkarma (post-treatment)
The physician who is administering basti should have good theoretical
knowledge and sufficient practical experiences in the therapy. The classical books have
explained so many complications that are produced due to improper and in efficient
administration.
The patients selected for basti therapy has to undergo through clinical
examinations to ascertain the physical as well as the mental conditions. The following ten
factors are to be considered. 129
1.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya
6.Agni 7.Satwa 8.Vaya 9.Bala
Bastikarma 31
The critical study of the above factors will enable the physician to decide,
the type of basti, number of bastis, basti dravya, etc to be administered in the particular
patients.
Dose schedule130, 131, 132
Table No: - 6 The adult dose of nirooha basti is dvadasaprasrita i.e. 24 palas.
Dose No. Age in Years Ch. Vag. Su.
1. 1 ½ prasrita i.e. 1 pala
1 pala 2 anjalis of patients hand
2. 2 2 pala 2 pala 3. 3 3 pala 3 pala 4. 4 4 pala 4 pala 5. 5 5 pala 5 pala 6. 6 6 pala 6 pala 7. 7 7 pala 7 pala 8. 8 8 pala 8 pala 4 anjalis of patients hand 9. 9 9 pala 9 pala 10. 10 10 pala 10 pala 8 anjalis of patients hand 11. 11 11 pala 11 pala 12. 12 12 pala 12 pala 13. 13 14 pala 14 pala 14. 14 16 pala 16 pala 15. 15 18 pala 18 pala 16. 16 20 pala 20 pala 17. 17 22 pala 22 pala 18. 18 – 70 24 pala 24 pala 19. Above 70 20 pala 20 pala
To be fixed based on netra, dravya pramana, age, bala
and saralaswabhava 20. Above 25 12 prastha
The quantity of sneha basti is calculated as ¼ of nirooha with respect to age.133, 134
Bastikarma 32
Contents of niroohabasti135, 136, 137
The usual contents of nirooha basti are: -
1.Madhu (honey)
2.Lavana (rock salt)
3.Sneha (oil/ghee/taila)
4.Kalka (medicines made as paste)
5.Kwatha (decoction)
According to the condition of patient and disease other ingredients like
milk, mamsarasa, amla dravya, mutra dravyas, guda are also used. 138 Basti taila is
selected considering the disease and condition of patient. The paka of basti taila should
strictly be maintained at chikkanapaka. 139 Kalka is the paste prepared by grinding the
prescribed drugs for particular nirooha. Drugs for kalka are mentioned in
Sushruthasamhitha. If no drug is specifically mentioned shatapushpi is used as kalka. 140
Kwatha is the decoction made as per the ingredients selected rationally to suit the
condition of the patient. Madanaphala is a usual ingredient of kwatha for niroohabasti.
Contents and quantity of nirooha
Charaka has described the total quantity of nirooha as 12 prasrita. Out of
these, kwatha should be of 5 prasrita i.e. 10 palas. The sneha should be 1/6th, 1/4th and
1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and kapha respectively of nirooha.141 24 palas
of nirooha dose may be adjusted as follows on the basis of original text of Charaka and
Chakrapanidatta commentary on the same: -
1.Makshika – 4 palas.
2.Lavana – 1 karsha
3.Sneha – 4 palas.
4.Kalka – 2 palas.
5.Kwatha – 10 palas.
20 palas.
Bastikarma 33
The remaining portion should be made up by avapa dravyas (or
prakshepaka dravyas) like gomutra, mamsarasa etc. i.e. 4 palas totaling it to 24 palas.
According to Sushrutha142
1.Makshika – 4 palas.
2.Lavana – 1 karsha.
3.Sneha – 6 palas.
4.kalka – 2 palas.
5.Kwatha – 8 palas.
6.Avapadravya – 4 palas
Total quantity is 24 palas.
Bastikarma procedures
Anuvasanabasti
Pre-treatment procedure
The body of the patient should be anointed with suitable sneha and gently
fomented with hot water. Then he is advised to have his prescribed meal and made to
take a short walk. Having passed stool and urine he is laid on a coat, which is not very
high, and the head must be at lower level. No pillows are used. The patient should be on
his left side drawing up the right leg and straightening the left leg.143, 144, 145
Treatment
The oil prescribed for anuvasana may be taken in the bastiputaka and tied
well placing the bastinetra in position. The trapped air in bastiyantra is expelled by gently
pressing the bastiputaka. Then the anal region and the netra should be smeared with oil.
Gently probe the anal orifice with the index finger of the left hand and introduce the
bastinetra through it into the rectum up to first karnika. Keeping in the same position
press the bastiputaka with right hand with adequate force. Release carefully the bastinetra
when a little quantity of sneha remained inside the bastiputaka. 146
Bastikarma 34
Post-treatment procedures
The patient is kept lying on his back as long as it would take to count up to
hundred. The patient should be gently struck three times on each of the soles and over the
buttocks by patient’s own hand. The distal part of the cot should be raised thrice. Allow
him to lie for sometime in the same position. If he gets the urge for defecation he may do
it. But in the event of sneha passed immediately another anuvasanabasti should be
applied. After passing the motion with sneha in proper time the patient is allowed to take
light food if he feels hungry.147, 148 Maximum duration of the withdrawal of snehabasti is
3 yama i.e. 9 hours.
Table No: - 7 Proper, Insufficient and excessive signs and symptoms of Anuvasana basti149
Proper Insufficient Excessive Expulsion of complete oil with faeces
Low backache Palpitation
Tissues, senses become clear and functioning normal
Dry skin Fainting
Sleep becomes usual Dry stool Convulsions Body becomes light and strengthens Proper flow of natural urges
Obstruction of natural urges
Parikartika Cutting pain in guda
Complications of Snehabasti 150
Six types of complications may arise in snehabasti and are due to: -
1.Vata 2.Pitta 3.Kapha 4.Atibhukta 5.Pureesha 6.Abhukta
Specific signs and symptoms with treatments are mentioned.
Bastikarma 35
Niroohabasti Pre-treatment procedure Niroohabasti is indicated to be administered in noon, in a patient who has
an empty stomach. Abhyanga with suitable sneha and mild swedana should be done prior
to the process and the patient is advised to be on the cot as prescribed for anuvasanabasti.
Bastidravya prepared as per the direction should be taken in bastiyantra and introduced
into pakwasaya. The procedures followed for anuvasana during its applications are the
same for nirooha. 151
Post-treatment procedures
After giving the basti the patient should use pillows and lie in supine
position. Application of pressure on buttocks and other procedures followed in anuvasana
should not be done. When he gets up urges for defecation he may do the same in
squatting posture. After passing motion he may be advised to take bath in hot water and
have some solid food along with yusha, mamsarasa or milk in kapha, vata and pitta
predominant diseases respectively. It is generally seen that the adverse symptoms are
produced if any, during the therapy will subside after taking bath and their food. The
maximum time allowed for passing out the motion after the administration of the nirooha
basti is one muhurtha (48 minutes). If it did not pass out, giving basti, which consists of
sneha, kshara, mutra and amla dravyas, can bring it out. It should have snigdha, Ushna,
and teekshna properties. Phalavarti may also be used for this purpose. If the nirooha is
passed out instantly and the patient is not showing desired symptoms and signs again 2 or
3 bastis can be given. But if the patient shows excited symptoms of vata, snehabasti
should be given immediately. No particular regimen of samsarjanakarma is needed for
basti karma. 152
Bastikarma 36
Table No: - 8
Proper, Insufficient and excessive signs and symptoms of Nirooha basti153
Proper Insufficient Excessive Passing urine, stool, flatus usually
Headache Passing stool number of times
Lightness in the body Dullness in the body Feeling tasty
Pain in the heart, umbilicus, bladder, anus, penis or vagina
Body ache
Oedema Tiredness Coryza Tremors Cutting pain Sleep Anuria Weakness Dyspnoea Drowsiness Anorexia Insanity
Increased digestive power
Heaviness Hiccup
Complications of niroohabasti
Defects of physician 154
1.Sa vata bastidana – Entry of an air into rectum leads to pain in
abdomen and colic.
2.Druta praneeta – Quick administration of basti dravya leads to pain
in hip, anus, thigh, calves and retention of urine.
3.Tiryak praneeta – Horizontal introduction leads to blockage at the
tip of bastinetra. Introduction of bastidravya by
pressing basti putaka more than once leads to chat
pains, headache, and pain in thighs.
4.Ullipta – Introduction of bastidravya by pressing
bastiputaka more than once leads to chat pains,
headache, and pain in thighs.
5.Sakampa bastidana – Shivering while administration leads to erosion,
burning and swelling at anal region. Not deeply
introduced leads to burning pain in intestines.
Bastikarma 37
6.Apraneeta – Not deeply introduced leads to burning pain in
intestines.
7.Atimanda data – If done too slowly drug does not reach till
intestines.
8.Ativega data – Forceful introduction leads to the dravya reaching
up to koshta and sometimes may come out through
upper orifices.
Basti vyapats 155
1.Ayoga – Due to the administration of less quantity of basti
dravya, rock salt, add oil leads to heaviness in
abdomen, obstruction of flatus stool and urine,
burning sensation, inflammation at anal region,
itching, anorexia, dyspepsia.
2.Atiyoga – Administration of teekshna basti to mridu koshta
person leads to atiyoga and symptoms are similar to
vamana-virechana atiyoga.
3.Klama – Conduction of mridu basti in ama state, pitta and
kapha gets vitiated and block the channels, which
leads to dyspepsia. There after vata also become
vitiated and causes fatigue, syncope, burning
sensation, colic, chest pain, heaviness.
4.Adhmana – Due to administration of low potency drugs to
strong person, dry bodies and costive bowel, the
drugs not able to expel vitiated doshas and vata gets
vitiated leads to adhmana causing pain in basti and
hridaya, severe burning sensation, pain in testicles
and groin.
5.Hikka – Hiccup results in administering teekshna basti to
weak person and mridu koshta with excessive
expulsion of doshas.
Bastikarma 38
6.Hrit prapti – Bastidravya reaches the heart by entering into
deeper levels due to complete squeezing or
improper handling of bastiputaka and causes pain in
chest and the surroundings.
7.Urdhwagamana – Suppression of urges before or after bastikarma
and squeezing bastiputaka with high pressure leads
to the upward movement and may come out through
mouth.
8.Pravahika – Administration of less potent and insufficient
quantity of bastidravya to the person suffering form
intensive vitiated doshas leads to pravahika.
9.Shiroarti – Includes symptoms of headache, earache,
deafness, tinnitus and coryza, eye disorders due to
administration of less potent sheetaveerya dravyas
with insufficient quantity to weak persons.
10.Angarti – Administration of teekshna basti without
conducting pre-operative procedures like abhyanga
and sweda leads to angarti with upward movement
of vata and twisting and pricking pain in the body.
11.Parikartika – Administration of ruksha and teekshna basti in
excessive quantity to the person having mridukoshta
and in conduction of less vitiated doshas leads to
the excessive expulsion of doshas causing
parikartika.
12.Parisrava – Administration of teekshna and ushna bastis to the
person suffering from pitta roga / raktapitta leads to
parisrava and causes burning sensation, erosion and
cutting pain in anal region, severe bleeding and
fainting.
Bastikarma 39
Uttarabasti
Charaka has given the definition of uttarabasti as a means by which the
fluid or liquid or dravya is made to pass through medra (penis) or yoni (vagina) or
through the adathyapatha (external genitalia). As it is given through the uttaramarga and
it gives shreshta guna (best effect), it is called as uttarabasti.156 The bastinetra used for
uttarabasti is termed as pushpanetra. Uttarabasti should be given only after conducting 2–
3 asthapana bastis. 157 According to the age the dose may be reduced. 158
Maximum quantity of unctuous substances used in uttarabasti is half pala.
159 But Sushrutha says to use 1 anjali prasrita pramana. If kwatha is used it must be 1
prakuncha pramana. This is the dose for patients aged 25 years. For 1-year child 4/25 to
1/6th of tola pramana for uttarabasti in that of child’s hand i.e. 1 prasrithi. The pramana of
uttarabasti is 2 prasrithi in case of garbhashaya shodhana chikitsa. For mutrashayagata
basti in case of children below 12 years, girl’s prasrithi must be given. 160
Uttarabasti in males
After having bath, patient is given food containing milk and mutton juice
and is asked to defecate or micturate if necessary. Then he should be made to sit on a
stool of knee height. When penis is erected, introduce a probe into the urethral passage to
find out the route. Afterwards introduce the pushpanetra, which is connected to basti
putaka. Then squeeze well with all precautions. After the expulsion of unctuous
substance it can be repeated for 3-4 times on the same day. If the drug is not expelled
even on the next day it should be withdrawal by means of phalavarti. 161 Management of
complications are similar to that of anuvasana basti and post-operative regimen of
snehabasti is to be followed. 162
Bastikarma 40
Uttarabasti in females
Ideal time for uttarabasti in females is during ritukala. During that period
uterus and vagina will be opened. So that, the drug administered can pass easily and
mitigates vitiated vata and there by, there are chances of getting conception rapidly. It is
indicated in diseases of urinary bladder, difficulty in micturation, vaginal pain other
diseases of uterus, menorrhagia etc and it should be conducted by using medicated oils or
ghee. Pushpanetra to be introduced into uterus upto 4 inches in women. For girls it should
be introduced only up to 1-inch length in the urethral passage. Pushpanetra should not be
introduced into uterine cavity of girls before menarche. It should be introduced in the
lithotomic position. In 24 hours, it can be given 3-4 times. In this way it should be
conducted for 3 consecutive days and rest is to be given for 3 days and the process is to
be repeated. To attract the retained drug phalavarti is indicated, but of a bigger size that
of males.163
Drugs used in Basti Karma
Number of drugs belonging to animal and plant origin has been described in
the classics, which are used in bastikarma. For example, herbs, milk, mutton juice, eggs,
urine, alkalis, salts etc. The above lists suggest that almost all available drugs can be used
for bastikarma.
1. Phalini drugs - Drugs useful for emesis can be used in
asthapanabasti also.e.g: -phala, jeemutaka,
ikshwaku, dhamargava, kutaja, and
kritavedhana.164
2. Sneha drugs - Ghrita, taila, vasa, majja.165
3. Mutravarga - Aja, avi, go, mahisha, hasti, ushtra, haya, etc.166
Bastikarma 41
4. Asthapana & anuvasana gana - Dasamoola, bala, eranda, punarnava, yava, kola,
kulatha, guduchi, madanaphala, palasa etc.167
5. Adjuants for asthapanabasti - Trivrit, bilwa, pippali, kushta, sarshapa, vacha,
kutaja, satahwa, yashtimadhu, madanaphala.
6. Adjuants for anuvasanabasti - Rasna, devadaru, bilwa, madanaphala, satahwa,
swetapunarnava, raktapunarnava, gokshura,
agnimandha, syonaka.168
Basti Karmukata.
The therapeutic effect can be studied under the following headings.
The procedural effect.
By maintaining the left lateral procedure, when lying, at the time of basti
procedure, the bastidravya reaches the pakwasaya resides in the left side.169 Charaka
opines by attaining this posture, gudavalees will be relaxed. He also mentions that the
grahani is situated in the left side.170
Chakrapani states that agni will be in the natural state in the posture while
Gangadhara says; agni, grahani and nabhi are present in the left side. Jejjata comments
agni is present left side over the nabhi, guda has got a left sided relation with sthoolantra.
So bastidravya can reach to the large intestine and grahani, as they are present in the
same level.171
Action based on drug effect.
Action of basti is possible by Anupravanabhava of bastidravya, which
contains sneha along with other kalkadi dravyas. Sneha easily moves up to grahani by
anupravanabhava guna similar to that of dravya, which freely moves in the utensil.172
Charaka, says bastidravya reach nabhi, katipradesha and kukshi.173
Bastikarma 42
The Shodhana effect.
The action of basti is mainly due to the veerya. The drug used in the basti
karma will however spread in the body from pakwasaya due to their veerya, through the
appropriate channels and draws the vitiated doshas to pakwasya in the same way as sun
in the sky draws the water from earth. The veerya is drawn into the body by apanadi vatas
i.e., first by apana, then udana and throughout the body by vyana. Also as water sprinkled
at the root of tree circulates all over the tree by its own specific property.174 So
bastikarma eliminates the morbid doshas and dooshyas from the entire body (by
srotosuddhi) whether lodged in any part.
Anubhandhatva.
Basti acts mainly on asthi and majjavaha srotas. Asthi is the seat of vata
dosha.175 Dalhana says that pureeshadharakala and asthidharakala are one and the
same.176 So we can assume that if pureeshadharakala gets purified; the asthivaha srotas
will be purified. Also another factor is about the relation between pittadharakala and
majjadharakala 178 pittadharakala and grahani.179 As an opinion stays about the spread of
bastidravya till grahani and grahani is the seat of agni180, the nutrients may get absorbed
and thereby nourishes the majjadharakala, which is having a strong bond with vata and
the nervous system.
Probable Mode of Action.
It is practically seen that after appropriate administration of bastikarma the
signs and symptoms of vatavyadhi will be reduced.
Bastikarma 43
Bastidravya enters into the pakwasaya. It is the place where the water and
minerals are absorbed in proximal colon. Sodium and potassium which are essential
fundamental factors for nerve impulses and vit B12 which is essential factor for the
development and proper functioning of the nervous system are also absorbed from the
colon i.e. pakwasaya. Bastikarma helps to increase the absorbing capacity of the colon by
its actions.180
Behind the pakwasaya, there are large numbers of nerve plexuses
originating from the hypo gastric plexus and lumbosacral plexus etc. These plexus will
get nourishment and soothing effect from bastikarma because basti mainly acts on the
pakwasaya, here it nourishes, purifies and expels the unwanted toxins from the body.
Bastidravya prepared by guda, madhu, sneha etc helps in formation of
krimis (friendly bacteria) in large intestine, some bacteria synthesizes vitamins like B and
K which are essential for the maintenance and nourishment of nervous system probably
to some extend.
Another probable method is based on veerya. It is possible the veerya of
the bastidravya pass through the autonomic nervous system and expels out vitiated dosha
from the body. It is described in the modern physiology that the wall of the rectum has
pressure receptors. Whenever the stool enters the rectum, these receptors are stimulated
and the defecation reflex is initiated.
When bastinetra is introduced in the rectum the same phenomenon may
take place, which results in initiation of defecation reflex due to visceral distention and
pressure response.
Saindhava contains NaCl and others, which fulfills the requirement for
generating action potential. The release of catecholamines occurs during visceral
distention and probably this leads to the development of pressure response and ultimately
Bastikarma 44
the defecation reflex is initiated. Also, common salt forms an integral part of the body
fluids and its concentration governs the movement of fluids in various compartments
under the osmotic pressure. When hypertonic solution is given in the form of bastidravya
the introduced fluid circulates from low density to high-density solution i.e. from blood
vessels to the outer fluid in the gastro intestinal tract.181
As regard the absorption of bastidravya, it is reported that the water is
absorbed 60%-80% from the gut and normal saline is absorbed freely. Amino acids are
also reported to be absorbed. Absorption in the proximal colon is better than the distal
part.
Regulating the Gut Brain.182
In 1981,Wood described the Enteric Nervous System (ENS) as ‘The Brain
of the Gut’ that integrates information received and issues an appropriate response. ENS
integrates sensory information from mucosal receptor and organizes an appropriate motor
response from a choice of predetermined programmes. So enteric nervous system of gut
brain is an integrative system with structural and functional properties that are similar to
those in CNS and physiological and pharmacological properties of basti chikitsa are said
to be the outcome of modification of gut brain up to certain extend.
Bastikarma 45
Disease Review
Gridhrasi is a shoola pradhana vata disorder and is included under the
eighty types of vata disorders, where specific causative factors are not mentioned. But,
the nidana mentioned in the context of vatavyadhi holds good to all types of vatavyadhis.
So, nidana can be classified under following subheading.
1. Swaprakopaka Nidana
2. Margavarodhaka Nidana
3. Marmaghatakara Nidana
4. Dhatukshayakaraka Nidana
1. Swaprakopaka nidana
a) Aharaja nidana – Excess and continuous intake of rooksha, laghu, sheeta
and rasas like katu, tikta, kashaya, and irregular food
habits, insufficient diet, exclusive diet, repeated intake of
diet, intake of dried leafy vegetables, dried food articles,
cereals like varaka, kodrava, nishpava, pulses like
syamaka, mudga, kalaya, chanaka, harenu cause vata
aggravation. 183
b) Viharaja nidana – Excessive or improper activities of an individual leads to
vata vitiation e.g. exercise, walking, swimming, riding on
vehicles, ratrijagarana, ativyavaya, prapatana,
bharavahana, ativyayama, balavat vigraha.184
c) Kalaja nidana – Excessive exposure to air, cloudy atmosphere, rainy
season and part of summer, day, night and digestion and
in old age vata vitiates. 185
Gridhrasi 46
d) Psychological factors – Worry, grief, anger, fear, anxiety, and timidity are
mental factors. These causes vata prakopa as vata is said
to be controller and conductor of mind. 186
2. Margavarodhaka nidana
Vatavyadhi manifests due to vataprakopa by dhatukshaya or
margavarodha. 187 The vegadharana and udeerana bhavas causing provocation of sthanika
dosha, 188 the obstruction by amadosha due to hypo functioning of agni comes under this
aspect of nidana. Kapha vitiating factors should also be considered here as vatakaphaja
Gridhrasi, causing obstruction in the normal movement of vata.
3. Marmaghatakara nidana
Lifting of heavy weights habitual use of uncomfortable bed and seat, fall
from heights etc causes injury to katiprishtavamsha and kukundaramarma resulting in the
loss of functioning of lower limbs. 189
4. Dhatukshayakaraka nidana
The diminutions of dhatus owing to various etiological factors are also considered
as dhatukshaya increases rookshata then provoke vata.
Causes of sciatica 190
In modern classics sciatica is studied under two headings.
1. Compressive causes of sciatica.
2. Non-compressive cause for sciatica.
1. Compressive causes of sciatica
a) Congenital causes
- Spina bifida.
- Spondylolisthesis.
Gridhrasi 47
b) Traumatic cause
- Fracture of hip joint.
- Vertebral fractures.
- Lumbosacral sprain / strains.
- Injuries to lumbosacral spine.
c) Mechanical pressure on nerve due to
- Neoplasm of spinal chord, pelvis, lumbar plexus.
- Protrusions or herniation of lumbar disc.
- Rupture of intervertebral disc.
d) Degenerative causes
- Degeneration of lumbar disc, lumbar vertebrae or lumbar
spondylosis.
- Degenerative spondylolisthesis.
e) Inflammatory causes
- Rheumatoid arthritis.
- Ankylosing spondylitis.
- Lumbar spondylitis.
- Osteoarthritis of lumbar spine.
- Tuberculosis of vertebral column and spine.
2. Non-compressive cause of sciatica.
a) Leprosy.
b) Ischemic neurosis in diabetes mellitus.
c) Sciatic nerve injury due to trauma or injection.
d) Claudication injury to sciatic nerve.
Gridhrasi 48
The causes of disease in both medical systems are having some gross
similarities. Dhatukshayajanya nidana can be correlated to that of degenerative causes,
avaranjanya to mechanical pressure and marmaghatakara to that of traumatic causes.
Samprapthi
The samprapthi of Gridhrasi has not dealt separately. The samprapthi of
vatavyadhis in general also helps to explain the samprapthi of Gridhrasi. Then the
etiological factors results in the vitiation of vata which occupies in the body channels,
where degraded points are present, produces various kinds of disorders, which affects the
whole body or get localized in particular region. 191
Pressure or irritation on the sciatica nerve in the spinal area results in the
sciatica syndrome. These mechanical irritations are mainly due to pathological changes in
the intervertebral disc of lumbosacral region. Intervertebral disc is the part, which
contains maximum strains and having more movements. It has annulus fibrosus – outer
casing and nucleus pulposus – inner softer jelly. As disc age, they fragment, dissociate
and collapse of gradual diminution in the concentration of hyaluronic acid. Initially this
starts in the nucleus pulposus, resulting in the central annular lamellae buckling inward
while the external concentric bands of the annular fibrosis bulge outwards, resulting in
increased mechanical stress at cartilaginous end plates at the vertical body lip.
Degenerative changes can also affect the facet joints that lie behind and on
either side of vertebral canal and are known as oesteoarthritic changes spondylosis and
usually occur together. Extra bony growth on the vertebrae called osteophytes, may
present can press on nerve roots causing pain and irritation. As a disc degenerates it can
herniate back into the spinal canal. The weakest spot in a disc is directly under the nerve
root, and a herniation in this area puts direct pressure on the nerve which causes pain to
radiate all the ways down the patients leg to the foot.
Gridhrasi 49
Yet another pathological change will be lumbar spondylitis where
inflammation of the vertebral joint inturn leads to pain along the nerves. Mechanical
pressure over the nerve will happen in other changes the lumbar spinal stenosis, isthemic
spondylolisthesis causing sciatic syndrome. 192
So by considering the pathology of both sciences it is clear that Gridhrasi
dhamani is majorly involved in this disease pathogenesis as vata is conducting through
dhamanis. 193 These dhamanis are situated in the mamsadharakala the lotus in the
pond.194 The vata conducting structures are called as dhamanis or dhamani and Adamalla
comments as anilapuranata i.e. filled with vayu and function resembles that of nerve.
Form the description it can be assumed that motor and sensory functions of the nerves are
carries by vata through dhamani / sciatic nerve is one such pair of dhamani originates
form the lumbosacral region.
Gridhrasi nadi or snayu is another consideration. While describing the
disease condition Dalhana comments that Gridhrasi is considered as kandara and
mahasnayu, which starts form gulpha to vitapa. 195
Here, vata dosha, in particular vyanavata that is responsible for prasarana,
akunchana, utkshepana, avakshepana. In Gridhrasi these functions are impaired.196
Hareetha pointes raktadhatu as one of the dooshya in pathogenesis.197 and Dalhana’s
mahasnayu can be considered as dooshya.
In case of vatakaphaja Gridhrasi kaphadosha associated with vata to
produce this disease. Shleshmakakapha, which is situated in kati prushta bhagagata
sandhi, is vitiated to produce this type of Gridhrasi. Kapha alone cannot produce this
disease. Symptoms of vatakaphaja Gridhrasi like tandra, bhaktadwesha, arochaka is also
implies rasa vitiation. 198 So it is considered as a dooshya here.
Gridhrasi 50
Samprapthi ghatakas
1. Dosha - Vata – Vyanavata, apanavata.
Kapha – Sleshakakapha
2. Dushya - Rasa, rakta, snayu, kandara and Gridhrasi nadi,
mamsa, and asthi.
3. Srotas - Vatavahasrotases, cheshtavaha and samjnavaha.
4. Srotodushti - Sanga.
5. Ama - Jatharagnimandyajanya and dhatwagni
mandyajanya ama.
6. Agni - Jatharaagni mandya.
7. Rogamarga - Madhyama.
8. Udbhavasthana - Pakwasaya, katipradesha.
9. Adhishtanam - Gridhrasi nadi, kati prishta bhaga.
10. Vyaktasthana - Spik, kati, prishta, uru, janu and jangha and pada.
11. Vyadhiswabhava - Chirakari, ashukari in some cases.
Poorvaroopa
The vata disorders usually occurs suddenly due to the asukaritva
muhuscharitatva of vata. Hence, it is difficult to recognize the poorvaroopa prior to the
occurrence of Gridhrasi in cases of sudden onset or achayapoorvaka prakopa. References
about the prodromal symptoms of Gridhrasi are not there but Charaka’s description in
vatavyadhi ‘the indistinct laxanas and disease’ to be considered as poorvaroopa. 199
Gridhrasi 51
Recurrent attack of pain in kati, katigraha, weakness in legs may occur
intermittently for few days, weeks or even a year before manifestation of full form of the
disease. 200
Roopa
The appearance of the exact signs and symptoms commences in the
vyaktavastha i.e. the 5th kriyakala.
Vataja Gridhrasi
Sthamba (stiffness), ruk (pain), toda (piercing pain) associated with
frequent spandana (twitching), starting from spik (buttock) then kati (lumbosacral region)
and gradually in the posterior aspect of uru (thigh), janu (knee), jangha (calf) and pada
(foot). 201 According to Sushrutha and Vagbhata the kandaras (ligaments) of parshni
(heel) and angulis (digits) are affected by the vitiated vata resulting in difficulty in lifting
the lower limb.202, 203
According to Madhavakara 204 and Bhavamishra, the symptoms mentioned
by Charaka have been accepted along with dehasyapi pravakata (bending of the body),
sthamba (rigidity), sphurana in katisandhi (lumbosacral intervertebral joints) urusandhi
and janusandhi (knee joint) are observed.205 In Yogaratnakara all the signs and symptoms
are mentioned in Madhavanidana are accepted except stabdhata instead mentioned
suptatha (loss of sensation). 206
Vatakaphaja Gridhrasi
Along with the above symptoms addition of few symptoms like gaurava
(heaviness), aruchi (anorexia) and tandra (drowsiness) are mentioned.207 Madhavakara
added vahnimardava (loss of appetite) mukhapraseka (excessive salivation) along with
the symptoms of Vataja Gridhrasi.208 Yogaratnakara added staimitya and
bhaktadwesha.209
Gridhrasi 52
Table: - No 9
Showing the laxanas of Vataja Gridhrasi by different acharyas.
No. Laxanas CS SS AS AH HS MN GN BR BP YR VS
1. Kati, prishta, uru,
janu, jangha, pada
- Ruk
+ - - - - + + - + + +
2. -Toda + - - - - + + - + + +
3. - Sthamba + - - - - + + - + + +
4. Saktiskshepa - + - - - - - - - - -
5. Sakti utkshepana - - + + - - - - - - -
6. Dehavakrata - - - - - - + - + + +
7. Muhuspandana - - - - - + + - + + +
8. Shopha + - - - - + - + - - -
9. Karapada vidaha - - - - - - - + - - -
10. Kati-uru-janu
madhye bahuvedana
- - - - + - - - - - -
11. Suptatha - - - - - - - - - + -
12. Stabdhata - - - - - + + - + - +
13. Sphurana - - - - - + + - + + +
Table No: - 10
Showing laxanas of Vatakaphaja Gridhrasi by different acharyas.
No. Laxanas CS SS AS AH HS MN GN BP YR VS
1. Arochaka + - - - - - - - + -
2. Vahnimardava - - - - - + + + + +
3. Mukhapraseka - - - - - + + + + +
4. Bhaktadwesha - - - - - + + + + +
5. Tandra + - - - - + + + + +
6. Gaurava + - - - - - + + + +
7. Staimitya - - - - - - + - + -
Gridhrasi 53
Clinical features of sciatica 210
The characteristic feature of sciatic syndrome is that the pain originates in
lumbosacral region radiating downwards form buttock, posterolateral aspect of thigh and
the calf to the outer aspect / border of foot. Usually gradual onset but can be sudden also.
So pain is felt in the back, the buttock, the thigh, the leg and the foot - together or as
involvement of few areas.
The pain may immediately follow an injury such as strain or a fall or there
may be latent interval of 4 days or even weeks. After 2-3 days of pain in the lumbar
spine, the pain radiates down the back of one leg form buttock to ankle and sometimes to
the foot.
Table 11
Showing the clinical features of sciatica
Disc
level
Root Sensory
loss
Motor weakness Reflex
loss
Pain distribution
L3-
L4
L4
Medial calf
Quadriceps (knee
extension), thigh
adduction, tibialis
anterior (foot
dorsiflexion)
Knee
Knee medial calf
L4-
L5
L5
Lateral calf,
dorsum of
foot
Peroneii (foot eversion),
Tibialis anterior (foot
dorsiflexion), Gluteus
medius (hip abduction),
Toe dorsiflexion
Hamstring
Lateral calf, dorsal
foot, posterolateral
thigh, and
buttocks.
L5-S1
S1
Plantar
surface of
foot lateral
aspect of
foot
Gastronemus / soleus
(foot planter flexion)
abductor hallucis (toe
flexors), gluteus
maximus (hip extension)
Ankle
Bottom foot,
posterior calf,
posterior thigh,
and buttocks.
Gridhrasi 54
Specific tests for sciatica 211
1) Straight leg raising test (SLR) - It is active attempt made by the patient to raise the
entire leg with the leg in complete extension. In case of sciatica extension of the
leg is below 900, the degree of limitation being roughly proportionate to the
severity of pains.
2) Lassegues sign - Its evoked by extension of the leg on the flexed hip which causes
pain and limitation due to stretching of the sciatic nerve.
3) Bonnets phenomena - The pain increases if SLR test is carried out with thigh and
leg in a position of adduction and internal rotation.
4) Bregard’s sign - The SLR test carried out with dorsiflexion of foot increases the
pain.
5) Sicard’s sign - The pain may be elicited by carrying out the straight leg raising
test with dorsiflexion of big toe.
6) Gower’s sign - Pain is aggravated by passive dorsiflexion of the foot in SLR test.
7) Deep reflexes - Knee jerk, ankle jerk.
8) Superficial reflexes - Babniski’s reflex.
9) Movements of lumbar spine - Forward flexion, left lateral flexion, right lateral
flexion, extension and rotation.
Investigations
1. Imaging of spine
a) Plain X rays of lumbar spine - To identify the spondylitic changes and
narrowing disc space of lumbar region and to exclude other conditions such as
malignant infiltration of a vertebral body.
Gridhrasi 55
b) Myelogram - To know the disc protrusion and to exclude such lesions form
tumours.
c) Nuclear magnetic resonance imaging (NMR) - To assess any root lesion.
2. C. T. Scan (Computerized Tomography Scan)
Useful in the identification of a stenosed canal, destructive lesion of
vertebral discs, posterior elements or presence of paravertebral soft tissue masses.
To conclude the symptomatology
The symptoms sakti-kshepa and sakti-utkshepa are similar ones that of
SLR test in modern classics. The symptoms dehasya vakratha can better correlated that of
sciatica scoliosis of contemporary science and suptatha to that of parasthesia. The
kaphaja symptoms like arochaka, vahnimandya, mukhapraseka shows the ama lakshanas
in vatakaphaja Gridhrasi. The roopa or lakshana explained as samanya lakshanas, except
shophadi symptoms are taken also as pratyatma lakshanas for this disease and almost
similar symptoms are seen in the modern text for sciatica syndrome.
Upashaya and Anupashaya
Table No: - 12
Showing upashaya and anupashaya in Gridhrasi.
Upashaya Anupashaya
Medicines, diet and regimens, which bring
happiness by acting directly against cause
of disease.
Causative factor (nidana) mentioned
for Gridhrasi
Pain relieved by rest. Effect of coughing, sneezing in
sciatica patients leads to pain.
Gridhrasi 56
Sapeksha nidana
Gridhrasi can be differentiated form the following similar disease where
the anatomical structure in between kati (lumbosacral region) and lower limb are
involved.
1) Khalli – According to Arunadatta khalli is a severe painful state of both Gridhrasi
and Vishwachi. 212 Both upper and lower limbs are affected simultaneously.
Avamotana (crookedness) is not present in Gridhrasi and is a feature of khalli.213
2) Khanja – The affected anatomical region is different and the special feature
aakshepana is not present in Gridhrasi. 214
3) Pangu – Both lower limbs are affected resulting total immobilization of lower
limbs i.e. person can’t walk where as in Gridhrasi the affected person can walk.215
4) Kalayakhanja – The feature of muktasandhi bandhana resulting in cris-crossed
manner in walking with kampana is not observed in Gridhrasi. 216
5) Urustambha – Here the pathology is different form that of Gridhrasi and produces
immobilization of the thigh and calf. The movement of lower limb is completely
stopped due to severe pain, burning sensation, fever, body ache are present and
not observed all these in Gridhrasi. 217
6) Gudagata vata – Specific anatomical region is mentioned. Pain during urination
and defecation in abdomen and pain and emaciation in back, sacral region, thigh,
calf and foot.218
7) Sanyugata vata – Can be considered as a disease complex. 219
Differential diagnosis 220
Differentiation in sciatica is made on the basis of variety of
aetiopathological events, which cause compression over nerve roots or sciatic nerve.
Gridhrasi 57
Table No: - 13
Showing the differential diagnosis in sciatica No Disease /
condition AgeIn
yrs.
Location of pain
Quality of pain
Aggravating / relieving
factors
Signs
1.
Back strain
20-40
Low back, buttock posterior thigh
Ache, spasm
Increased with activity or bending
Local tenderness, limited spinal motion.
2.
Acute disc herniation
30-40
Low back to lower leg
Sharp, shooting or burning pain, parasthesia in leg.
Decreased with standing; increased with bending or sitting
Positive SLR test, weakness, asymmetric reflexes.
3.
Spondylolisthesis
Any age
Back, posterior thigh
Ache
Increased with activity a bending
Exaggeration of lumbar curve, palpable ‘step off’ tight hamstring
4.
Ankylosing spondylitis
15-40
Sacro iliac joints, lumbar spine
Ache
Morning stiffness
Decreased back motions, tenderness over sacroiliac joints.
5.
Infections
Any age
Lumbar spine, sacrum
Sharp pain, ache
Varies
Fever, percussive tenderness; may have neurologic abnormalities or decreased motion.
6.
Malignancy
>50
Affected bone(s)
Dull ache, throbbing pain, slowly progressive
Increased with recumbency or cough
May have localized tenderness neurologic signs or fever.
Gridhrasi 58
Sadhya-asadhyata
General prognosis mentioned for vatavyadhi has to be considered as
common rule because the specific prognosis of Gridhrasi has not discussed in Ayurvedic
texts. Vatavyadhi is one of the mahagada, which is cured with difficulty. 221 Patients of
vatavyadhi devoid of complications and with sufficient mamsa and bala can be cured. 222
However, when the disease is treated in the early state, with the absence of upadrava it is
curable.
Upadrava
No specific upadravas are mentioned for Gridhrasi. So, we have to
consider vatavyadhi upadravas like visarpa, daha, ruksanga, moorcha, aruchi,
agnimandya, ksheena bala mamsa, pakshavada, suptata, bhagna, kampa, adhmana, severe
pain are upadravas. 223 The symptoms like aruchi, agnimardava, suptata are the lakshanas
of Vataja and vatakaphaja Gridhrasi. So, here severe pain, kampa, shosha, daha can be
considered upadrava for Gridhrasi.
Chikitsa
Gridhrasi being a vatavyadhi the vatavyadhi chikitsa method to be
adopted. But, acharyas have specifies certain measures of treatment.
Snehana
Bhela has specifically mentioned snehapana in Gridhrasi and specified
mulakataila and sahacharataila 224 Being snayugatavikara Sushrutha and Charaka
advocated snehana. 225, 226
Gridhrasi 59
Swedana
Shoola, sthamba, features can be controlled by swedana.227 Sankara,
prastara, nadisweda can be adopted. Snigdha swedas are helpful in Vataja Gridhrasi
where as both snigdha and rooksha swedas can be adopted in Vatakaphaja Gridhrasi.
Vamana
This will be beneficial for Vatakaphaja Gridhrasi to alleviate kapha dosha.
Virechana
Mridu virechana will be helpful in vatavyadhis. 228 Snehayukta oushadha
i.e. tilvaka ghrita, eranda taila with milk .229
Basti
This is the most important Panchakarma for Gridhrasi. No other chikitsa
has the capacity to tolerate not regulate the force of vata apart form basti. 230 Any type of
basti can be adopted. 231
Siravyadha
Charaka indicated siravyadha in between kandara and gulpha .232
Sushrutha and Vagbhata advised 4 angula above or below janu sandhi. 233, 234
Agnikarma
Between kandara and gulpha .235 Good in snayu and sandhigatavata.236, 237
4 angulas below indrabastimarma in posterior side of leg little toe of the affected leg
should be burnt if the Gridhrasi is not get cured by all these treatment. 238 Lohasalaka is
specified by Hareetha for dahana. 239
Gridhrasi 60
Shamanaushadhi
⇒ Churna – Ajamodadi, abhadi, dasamooladi, krishnadi.
⇒ Kalka / lepa – Mahanimba, rasna, gunajaphala lepa, Vatahara pradeha.
⇒ Kwatha – Rasnasaptaka, sahacharadi, maharasnadi, dashamoola.
⇒ Arishta – Brihat sahachararishta, balarishta, dasamoolarishta.
⇒ Taila – Sahacharadi, eranda, mashadi, vishagarbha, narayana.
⇒ Ghrita – Chagalyadhya, gugguluthikthaka, karaskara.
⇒ Rasayoga – Vatagajankusha, swachanandabhairava, vatarakshasa.
⇒ Guggulu – Tryodashanga, yogaraja, mahayogaraja, rasnadhi, pathyadi
Treatment in modern system 240
→ Conservative treatment – Rest and analgesics, NSAIDs, lumbar traction,
antidepressive and tranquilizing drugs.
→ Surgery – Studies examining the outcome of conservative and surgical treatment
of back pain have revealed no clear advantage for surgery.
→ Sacral epidural injection
→ Lumbar extradural injection
→ Physiotherapy – Local heat and cold packs, massage gradual exercise.
→ Patient education
Gridhrasi 61
Pathya-Apathya 241 Pathya Ahara (Diet)
The food items which are madhura, amla, lavana, brimhana,
snigdha, ushna, sarpi, vasa, majja, tilapias, mamsarasa, jangala mamsa, chataka,
kukkuta, tittira, kulatha, masha, godhuma, raktashali, shashtikashali, naveena
taila, patola, shigru, tambula, varataka, dadima, parushaka, badara, lashuna,
rohitaka, drakhsa, jambira are pathya in Gridhrasi disease.
Vihara (Regimen)
Avoid all risks, weigh lifting, riding, vehicles, forward bending
while walking, sitting and standing for prolonged period. Support must be given
to feet while sitting, keep the spine in neutral position and proper posture of work
should be kept.
Apathya
Ahara (Diet)
The food items, which are katu, tikta, kashaya, and rooksha, are
apathya in Gridhrasi disease. Chanaka, kalaya, mudga, kohndra and kareera phala
are apathya in Gridhrasi.
Vihara (Regimen)
Upavasa, excessive works, vyavaya, chinta, prajagaranana,
vegadharana, chankramana, bharavahana, plavana, yana, langhana are apathya
viharas in Gridhrasi.
Gridhrasi 62
METHODOLOGY
Drug Review
Vaitharanabasti is mentioned in Vangasena samhitha and is considered as a
rare combination from a rare book. Acharya has described in a beautiful way about this
Basti. Even Chakradatta had also mentioned this basti.
Vaitharanabasti has certain specific features of its own. A Nirooha
invariably contains some ingredients that are common to all bastis. They are makshika,
lavana, sneha, kalka, and kwatha. They are mixed according to this sequence also. But in
Vaitharanabasti this planning is not maintained. The basti is constituted with following
ingredients. 242
1. Saindhava Lavana - 1 Karsha. (12gms)
2. Amleeka - 1 Pala. (48gms)
3. Guda - 1/2 Pala. (24gms)
4. Tila taila - Eeshat (little). (120ml)
5. Surabhi payas - 1 Kudava. (192ml)
The modality of mixing the ingredients is not mentioned. The main
impediment is the combination of amleeka (tamarind) and milk together. Milk will
readily copulate when combined with amleeka. Also honey and kalka are mentioned for
nirooha. A viable alternative method is adopted by mixing guda (jaggery) in water and
evaporating required quantity of water so as to make the solution dense to be used as
honey. Saindhava is an ingredient and moorchita tila taila can be used as sneha. Milk can
be used in place of kwatha.
Drug review 63
Method of preparation.
o Mix jaggery in water and evaporate the required amount of water till it
becomes dense as to be used as honey.
o Prescribed quantity of Saindhava Lavana is added and churned
thoroughly.
o After proper mixing of above constituents, the Moorchita tila taila should
be added slowly while churning in a slightly heated temperature.
o Tamarind is mixed and squeezed well in hot water and to be used as
Kalka.
o The above kalka is to be added into the vessel and continue the churning.
o Finally boiled and cooled milk of prescribed amount is added very slowly
while the churning process continues
The final product will be slightly viscous and people use to add more milk
and sometimes the tila taila is replaced by medicated taila based on the conditions.
But in the present study the proportions mentioned by the acharya has
taken with slight excess in the quantity of milk by 100ml to reduce the viscosity and to
make the total amount of bastidravya to 500ml.
Specialties of the Basti
It can be given after food in the afternoon like anuvasana. But if the
patient has adequate strength, it can be administered like a nirooha also. In the description
acharya has used the term “vinasayathyasu” indicating the fast acting nature of the
combination.
Drug review 64
Indications.
Katishotha
Amavata (khoram)
Urushotha
Chronic Urusthambha
Prishtashotha
Gridhrasi
Katishoola
Janusankhocham
Urushoola
Chronic vishamajwara.
Prishtashoola
Klaibya.
A different combination is referred in Chakradatta, named Vaitharanabasti
and is considered as ksharabasti. Instead of milk, which constitutes the liquid portion,
cow’s urine (gomutra) is told. 243
Indications : - Shoola, Anaha, Amavata.
Also another one ksharabasti with saindhava, satahwa, gomutra, amleeka,
guda and taila is told. The amount of each of these ingredients is also different from that
of Vaitharanabasti. 244
Indications : - Krimi, Udavartha, Gulma.
The properties of individual ingredients of Vaitharanabasti are discussed to
have a perfect identification and study the efficacy in repeat with that of pacifying
vitiated vata in the body, which causes Gridhrasi.
Guda (Jaggery). 245, 246
It is often called as Medicinal sugar. It contains natural goodness of minerals
and vitamins inherently present in sugarcane juice and this crowns it as one of the most
wholesome and healthy sugars in the world.
Drug review 65
Synonyms - Panek, gur, vella, sharkara.
Varieties - Puranaguda, matsyandika, khandasarkara, vimalajata,
nirmalaguda.
Components - Magnesium, potassium, iron; 2.8gm/100gm.
Medicinal use - Dry cough, cough with sputum, indigestion, constipation,
mootrashothani, raktashothani, medokara, kaphakara, vatashamaka, balya, vrushya. More
gunas are found in puranaguda.
Rasa - Madhura
Guna - Kshara, snigdha.
Veerya - Natiseeta
Vipaka - Madhura
Saindhava Lavana. (Rock salt) 247, 248
This is the best in the lavanavarga. Rock salt is the common name for the
mineral Halite.
Components - NaCl can have impurities of gypsum or transparent cubes. It has a
pure saline taste.
Rasa - lavana
Guna - laghu, snigdha, sukshma.
Veerya - ushna.
Vipaka - madhura.
Properties - chakshushya, hridya, ruchikara, promotes appetite and assists
digestion and assimilation. It posses a stronger purgative property
also.
Drug review 64
Tila Taila (Moorchita). 249, 250
By taila moorchana the unpleasant odour of the oil is changed, amadosha
is removed and good color and fragrance are obtained. It enhances the potency of the taila
also.
Composition - Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%),
oleic acid (45.4%), linoleic acid (40.4%).
Rasa - Madhura, thikta-accompanying kashaya
Guna - Sukshma, vyavai, vishada, guru, sara, vikashi, teekshna,
himasparsha.
Properties - Vatagni, aggravates pitta, does not aggravate kapha, deepana,
pachana, brimhana, balya, preenana, lekhana, promotes skin health, intellect, digestive
power, health of eyes, complexion, strength and stability of mamsadhatu, krimigna,
reduces the quantity of urine, good for hairs, cleanses the garbhasaya and yoni, helps in
overcoming aging process.
Indication - Vrana, prameha, pain in ears, yoni and head. All kinds of injuries are
relieved with tila taila. It is used for alleviation of vata, as bastidravya, nasyadravya, for
internal administration and in abhyanga and dietary articles.
Amleeka(Tamarind). 251
Latin name - Tamarindus indica Linn.
Kula - Simbi kula
Family - Leguminoseae.
Latin - Tamarindus
Sanskrit - Chincha, chukrika, chukra, amlica, amli, tittidika, suktha,
sukthika.
Drug review 65
Composition - Tartaric, citric, malic, acetic, potassium tartarate etc. In the seed
there is 63% carbohydrates.
Rasa - Amla
Guna - Guru, ruksha.
Veerya - Ushna
Dosha - When ripe kapha pitta nashaka and vata nashaka.
Uses - Tamarind and its seeds are applied externally on
inflammation. Fruit is very good in taste and is used in anorexia,
polydypsia, indigestion, and liver disorders. In heart diseases
sherbet is given. Kshara is used in urinary disorders and
abdominal pain. (Shankha Vati).
Surabhi payas (Cow’s Milk). 252, 253
Out of the 8 varieties of ksheera, goksheera is the one, which is “Hitham”.
Composition - It is made up of 87.4% water and 12.6% milk solids (3.7%fat,
8.9% milk solids-not-fat.). The milk solids-not-fat contains protein (3.4%0, lactose
(4.8%), and minerals (0.7%). Cow’s milk is heterogeneous mixture of proteins. About
80% of total protein in milk is casein and 20% is whey protein. It also contains small
amounts of various enzymes (e.g.: - lipoprotein lipase, alkaline phosphatase,
lactoperoxidase) and traces of non-protein nitrogenous compound (e.g.: - ammonia. urea,
creatinine, creatine, uric acid). This individual milk protein has got a wide range of
beneficial health and functional health.
Drug review 66
Rasa - Madhura
Guna - Snigdha
Veerya - Sheeta.
Vipaka - Madhura
Properties - Brimhana, vrishya, medhya, balya, jeevaneeya, sandhanaka,
sarvasatmya, trishnaghna, deepana, mamsakara, swasahara,
kasahara, raktapittakhna, samana, shodhana.
Indication - Swasa, kasa, pandu, sosha, gulma, udara, amlapitta, atisara,
swayadhu, jwara, daha, yoniroga, sukradosha, pradara,
mootraroga, vataroga, vataroga, pittaroga, vibandha.
Modalities - In aasthapana, vamana, nasya, lepa, avagaha, virechana, snehana.
Drug review 67
Clinical Study.
The therapeutic measures, drugs and procedures of Ayurveda have remained
in the practice since long on the basis of methodology prevalent in ancient times. This is
the time that the rationality of Ayurvedic therapeutic approach is explained on modern
scientific lines. Clinical trial is a way of research and its best method to evaluate any drug
or line of treatment. The trial is a carefully designed experiment with the aim of solving
unrewarding problems conducted on scientific line and is the only way to achieve the
objectives.
Research Approach.
Experimentation is the most powerful research approach. In the present
study, the objective is to ‘Evaluate the efficacy of Vaitarana Bastikarma in the
management of Gridhrasi with special reference to Sciatica’. The efficacy can be
determined by finding out the difference between the baseline data and after follow up
data.
Study Design.
The study design set for the present study is ‘Prospective clinical trial’. The
study was done in single group. All the patients were administered Vaitharanabasti for 8
days. Placebo capsules were given to the patients during the period of follow-up.
Selection Criteria.
Patients suffering from Gridhrasi were selected from the Post-graduation
and Research Center OPD of D.G.Melmalagi Ayurvedic Medical College Hospital,
Gadag. The criteria for inclusion and exclusion are as follows.
Drug review 68
• Inclusion Criteria.
1.Patients fit for Bastikarma.
2.Presence of clinical features of Gridhrasi both Vataja and Vatakaphaja.
3.Straight Leg Raising test being positive.
4.No discrimination of sex.
• Exclusion Criteria.
1.Age group below 18 and above 65 years of age.
2.Patients with other severe disorders.
3.Degenerative disorders with marked deformity.
4.Pregnant women and lactating mother.
5.History of major trauma causing fractures.
Sample size.
The sample size for the present study consists of 30 patients with
Gridhrasi disease.
Duration of Study.
8 days and a pariharakala of equal number of days. Follow up for 1 month.
Data Collection.
Patients selected were thoroughly examined by both subjective and
objective parameters. Detailed history and physical examination findings were noted.
Laboratory and radiological investigations such as a complete blood count, ESR, RBS,
Urine routine along with X-ray AP and Lateral views of lumbosacral regions were done,
to exclude and include in the study.
Drug review 69
Method of Examination.
On baseline data patients were thoroughly examined with complete
knowledge of nidana, ahara, vihara, occupation, duration of illness, nature of pain, site of
pain, onset of pain, severity of pain, pain relieving factors, variety of pain and associated
complaints.
The examination methods were as follows: 254
1. SLR Test – active and passive.
2. Reflexes - superficial and deep.
3. Movements of Lumbar spine.
4. Walking time. 255
Active SLR Test.
The patient who was lying supine is asked to raise one leg-keeping knee
straight. First estimated on painless side. He was asked to raise the leg till he experiences
pain as evidenced by watching his face and the angle at which the pain was experienced
was recorded
Passive SLR Test (Lassegues Sign).
The ankle was hold with one hand and the leg was gradually raised of the
patient lying supine. The angle at which pain occurred was noted and then the foot was
passively dorsiflexed. In case of sciatica the pain will be aggravated as the sciatic nerve
roots are stretched. The angle in which the sign was positive is noted before and after
treatment.
Drug review 70
Reflexes.
• Deep reflexes - 1.Knee jerk.
2.Ankle jerk.
• Superficial reflexes - Babinski’s reflex.
Knee jerk.
The patient was made to sit on the edge of a high bed, with the legs hanging
freely over the edge. Diverting the patient’s attention, the patellar tendon was struck
sharply with a hammer half way between the patella and the insertion of the tendon of
tibia. The leg will be seen to move or jerk forward with the contraction of quadriceps
muscle Diminished or absent knee jerk is likely to be in the region of L3 and L4 nerve
root lesion.
Ankle jerk.
The patient was made to lie supine, the hip was extended and the knee flexed
at right angles. The ankle was slightly dorsiflexed so as to put the tendon on moderate
tension. A sharp tap was given on Achilles’ tendon. Diminished or absent ankle jerk
suggests severe protrusion at L5-S1 disc space and S1 root damage. Bilateral absence of
ankle reflexes can be a normal finding in old age.
Babinski’s Reflex.
The patient was relaxed and side of the foot was stimulated with a blunt
object from heel towards the toes when the response to the stimulation of the sole
consists of dorsiflexion of the big toe and fanning out of other toes, it is called extensor
plantar response and is positive Babinski’s sign. The sign may be negative when the S1
nerve root is involved.
Drug review 71
Movements of Lumbar spine.
• Forward Flexion.
• Right lateral flexion.
• Left lateral flexion.
• Rotation.
• Extension.
Forward flexion.
This was examined by asking the patient to lean forward or to touch his toes
keeping the knee straight. It is important to judge what proportion of the movement
occurs at the spine and how much is contributed by hip flexion. The measurement
between tip and the middle finger and the floor was recorded before and after the
treatment.
Right lateral flexion.
Asked the patient to slide his hand down the right side of the leg to assess
this. The distance from the floor or from fixed anatomical landmarks can be then
recorded. The measurement between the tip of the middle finger and the floor was
recorded before and after the treatment.
Left lateral flexion.
Same as right lateral instead left side of the leg. The distance between the tip
of the middle finger and the floor was recorded before and after the treatment.
Extension.
Instructed the patient to arch the spine backwards, looking up at the ceiling.
The movement whether nil, limited or full was recorded before and after the treatment.
Drug review 72
Treatment Schedule.
Poorvakarma.
All the patients were asked to be in the hospital at or after 9 o clock. Every
patient was given mild abhyanga and sweda locally just prior to the introduction of basti.
The abhyanga was done with plain tila taila to the whole body and sweda was done only
on the area below the ribs to foot.
Pradhanakarma.
Vaitharanabasti was administered to all patients using disposable bastiyantra.
A quantity of 500ml was injected through the rectum in a luke warm temperature, after
the proper preparation of dravya as per the classical method discussed in drug review.
The method of administration of bastidravya was strictly followed as told by the
acharyas. After the basti, the patient was made to lie on supine posture and gentle tapping
was made on his buttocks, legs were lifted up, hips were tapped thrice with the patient’s
heel. Patient was asked to remain in the same position till the feeling of defecation. Later
after the manifestation of urges he was asked to evacuate the bastidravya. After the
limited time, 1/2hr-1hr time, patient was asked to take hot water bath and was advised
laghu bhojana
The same procedure was repeated for 8days (yoga basti krama/schedule)
and was conducted in a time between 9.30 and 10.30 am. The time of administration, the
time of retention and any complication present were noticed at the spot.
The patient was asked to follow a pariharakala of 8 days and was asked to
report on 9th, 17th and 40th days counting from the day the treatment started for follow up
and observation.
Drug review 73
Method of Assessment of treatment.
Both subjective and objective assessments were done in all the patients
after treatment. Separate grading has been given for subjective assessment parameters
that include the following.
1. Ruk 2.Toda 3. Sthamba 4.Spandana
5. Ayama 6. Tandra 7. Gourava 8.Aruchi
9. Suptatha 10.Shosha 11.Vibandha 12.Daha
And this includes both the chief and associated complaints.
Ruk (Pain).
The grading for the pain was given on the basis of Visual Analogue Scale
(VAS)256. It is used to get a more reliable longitudinal measure of pain. The patients were
asked to mark against the number corresponding to how he or she feels at that moment.
The simplest form is a 10cm long line the ends of which indicate no pain on one side and
a pain as bad as it can be on the other side.
No pain_______________________________pain as bad it can be.
20cm.
They were asked to mark their pain levels on the visual analogue scale. As
the patients did not seem to be satisfied with the small 10cm VAS. Therefore scale of
length 20cm was taken. They were drawn on the case sheet and given to the patient.
So the scorings made,
Grade 0 – No pain – Scale reading 0.
Grade 1 – Trival pain – Scale reading 0-5cm.
Grade 2 – Mild pain – Scale reading 6-10cm.
Grade 3 – Moderate pain – Scale reading 11-16cm.
Grade 4 – Severe pain – Scale reading 16-20cm.
Drug review 74
Sthamba (Stiffness).
1. Grade 0 - No stiffness.
2. Grade 1 - With up to 25% impairment in the range of movements of joints.
Patient can perform daily routine work without any difficulty
3. Grade 2 - With up to 25-50% impairment in the range of movements of
joints. Patient can perform daily routine work with mild or
moderate difficulty.
4. Grade 3 - With up to 50-75% impairment in the range of movements of
joints. Patient can perform daily routine work with moderate or
severe difficulty.
5. Grade 4 - With more than 75% impairment in the range of movements of
joints. Patient totally unable to perform daily routine work.
Toda (Piercing pain)
Grade 0 - Absent
Grade 1 - Mild, occasionally in a day.
Grade 2 - Moderate, after movement, daily, frequent not persistent.
Grade 3 - Severe, persistent.
Spandana (Twitching)
Ayama (Dragging)
Gowrava (Heaviness) Grade 0 – Absent.
Aruchi (Tastelessness) Grade 1 - Present.
Shosha (Wasting)
Vibandha (Constipation)
Drug review 75
Daha (Burning sensation)
1) Grade 0 – Absent.
2) Grade 1 – Occasionally in a day.
3) Grade 2 – Frequent and persistent
Suptatha (Numbness)
1) Grade 0 – Absent.
2) Grade 1 – Occasionally in a day.
3) Grade 2 – Frequent and persistent.
Objective Parameters.
Straight leg raising test (SLR)
This is assessed positive at 0- 900 (with pain) negative 900 (without pain).
Movements of lumbar spine.
1) Forward flexion – Assessed by measuring the distance between the tip of the
middle finger and floor in cms.
2) Right lateral flexion – Assessed by measuring the distance between the tip of the
right middle finger and floor in cms.
3) Left lateral flexion – Assessed by measuring the distance between the tip of the
left middle finger and floor in cms.
Walking time.
1) To cover 21 meters.
2) Grade 0 – up to 20 seconds.
3) Grade 1 – up to 21-30 seconds.
4) Grade 2 – up to 31-40 seconds.
5) Grade 3 – up to 41-50 seconds.
6) Grade 4 – up to 51-60 seconds.
Drug review 76
Overall Assessment.
1) Complete relief - 100% relief.
2) Marked response - More than 75% relief in signs and symptoms.
3) Moderate response - 50-75% relief in signs and symptoms.
4) Mild response - Below 50% relief in signs and symptoms.
5) Unchanged - No relief.
Drug review 77
RESULTS
In the present clinical study subjective and objective changes were
considered for the assessment of Ayurvedic management of Gridhrasi (Sciatica) with
Vaitharanabasti. Thirty patients were selected and were administered with
Vaitharanabasti. All the patients were assessed before and after the treatment. Both
subjective and objective changes were recorded according to the guidelines of proforma
of case sheet.
The data were collected as follows: -
1. Demographic data
2. Data related to etiological factors, type and duration of chief complaints.
3. Data related to subjective and objective parameters before and after treatment.
4. Data related to incidence of disease and response to treatment.
5. Statistical analysis and assessment for response.
Results 73
Table. No: -17
Showing the incidence and overall response in sex.
Sl. Sex No. of Pt.’s % MoR % MiR %
1 Male 23 76.6 18 78.3 5 21.7
2 Female 07 23.4 5 71.4 2 28.6
Among 30 patients, 23 patients i.e. 76.6% were males and 18 males
responded moderately i.e. 78.3% and 5 males responded mildly i.e. 21.7%. 7 females
were i.e. 23.4% and 5 responded moderately i.e. 71.4% and 2 responded mildly i.e.
28.6%.
Incidence & overall response in sex
23
7
18
552
05
10152025
Male Female
Sex
No.
of P
t.'s
No. of Pt.’s MoR MiR
Results 74
Table No: -18
Showing the incidence of religion in the Gridhrasi patients.
Sl. Religion No. of Pt.’s %
1 Hindu 27 90
2 Muslim 3 10
3 Christian 0 0
4 Others 0 0
Among 30 patients, 90% i.e. 27 patients were Hindus and 10% i.e. 3
patients were Muslims. There were no Christian or other religion patients reported.
Incidence of religion
Hindu90%
Muslim10%
HinduMuslim
Results 75
Table No: - 19
Showing the incidence and overall response in occupation.
Sl. Occupation No. of Pt.’s % MoR % MiR %
1 Sedentary 4 13.3 2 50 2 50
2 Active 19 63.4 15 78.9 4 21.1
3 Labour 7 23.3 6 85.7 1 14.3
Among 30 patients, 4 patients i.e. 13.3% were sedentary and 2 patients
responded moderately i.e. 50% and 2 patients responded mildly i.e. 50%. 19 patients
were active i.e. 63.4% and 15 patients i.e. 78.9% responded moderately and 4 patients i.e.
21.1% responded mildly. 7 patients, i.e. 23.3% were labour,6 responded moderately i.e.
85.7% and 1 responded mildly i.e. 14.3%.
4 2 2
1915
47 6
10
5
10
15
20
No. of
pt.'sSed Act Labour
Occupation
Incidence & overall assessment in occupation
No. of Pt.’s MoR MiR
Results 76
Table No: - 20.
Showing the incidence and response to treatment in different
socioeconomic status.
Sl. Socioeconomic status No. of Pt.’s % MoR % MiR %
1 Poor 2 6.7 2 100 - -
2 Middle class 21 70 15 71.4 6 28.6
3 High class 7 23.3 6 85.7 1 14.3
Among 30 patients, 21 (70%) patients were middle class and 15 patients
responded moderately i.e. 71.4% and 6 responded mildly i.e. 28.6%. 7 patients were of
high-class i.e. 23.3% and 6 responded moderately i.e. 85.7% and 1 mildly i.e. 14.3%.
Poor were 2, i.e. 6.7% and both responded moderately i.e. 100%.
2 2 0
2115
6 7 61
05
10152025
No. of
Pt.'s
Poor Middle class High class
Economical status
Incidence & response in economical status
No. of Pt.’s MoR MiR
Results 77
Table No: - 21.
Showing the incidence of habits in patients.
Sl. Type of habit No. of Pt.’s %
1 Smoking 8 26.6
2 Tobacco 24 80
3 Alcohol 12 40
4 None 6 20
Among the 30 patients, 80% of the patients i.e. 24 had the habit of using
tobacco, 40% of the patients were in the habit of consuming alcohol i.e. 12 patients,
26.6% of them had the habit of smoking i.e. 8 patients and 20% of patients were devoid
of any habits i.e. 6 patients.
26.6
80
40
20
0
10
20
30
40
50
60
70
80
%
Smoking Tobacco Alcohol None
Habits
Incidence in the habits of patients
%
Results 78
Table No: - 22.
Showing the nature of sleep in patients.
Sl. Nature of Sleep No. of Pt.’s %
1 Sukha 3 10
2 Alpa 26 86.7
3 Vishama 1 3.3
Among the 30 patients, 3 patients i.e. 10% had sukha nidra, 26 patients i.e.
86.7% had alpa nidra and 1 patient had vishama nidra i.e. 3.3%.
Incidence of Nature of sleep
3
26
105
1015202530
Sukha Alpa Vishama
Type of nidra
No.
of P
t.'s
No. of Pt.’s
Results 79
Table No: -23.
Showing involvement of affected lower limb or limbs.
Sl. Leg affected No. of Pt.’s %
1 Right leg 12 40
2 Left leg 13 43.3
3 Both legs 5 16.7
Among 30 patients, 43.3% i.e. in 13 patients the radiating pain was
towards the left lower limb, 40% of the patients i.e. in 12 patients radiating pain was
towards the right lower limb and bilaterally affected were 5 patients i.e. 16.7%.
Incidence of affected limb
Rt leg
40%
Lt. leg
43%
Both legs
17%
Rt leg Lt. leg Both legs
Results 80
Table No: - 24.
Showing incidence of position at work in patients.
Sl Position of work No. of Pt.’s %
1 Sitting 25 83.3
2 Standing 26 86.7
3 Stooping 29 96.7
4 Squatting 15 50
25 patients had the position at sitting while work i.e. 83.3%, 26 patients
stand while work i.e. 86.7%, 96.7% i.e. 29 patients stoop while work and 50% i.e. 15
patients squat and work.
83.3 86.796.7
50
020406080
100
%
Sitting Standing Stooping Squatting
Position at work
Incidence in the position at work
%
Results 81
Table No: -25.
Showing the incidence and overall response in prakriti.
Sl. Prakriti No. of Pt.’s % MoR % MiR %
1 Vata pitta 8 26.7 5 62.5 3 37.5
2 Vata kapha 21 70 18 85.7 3 14.3
3 Kapha pitta 1 3.3 - - 1 100
Among 30 patients, 8 patients i.e. 26.7% were of vata pitta and 5 patients
62.5% and 3 patients i.e. 37.5% responded moderately and mildly. 21 patients i.e. 70%
were vata kapha prakriti and 18 (85.7%) patients responded moderately and 3 patients i.e.
14.3% responded mildly and in kapha pitta prakriti only 1 patient and responded mildly.
85 3
2118
3 1 0 105
10152025
No. of
Pt.'s
VP VK KP
Prakriti
Incidence & response in prakriti
No. of Pt.’s MoR MiR
Results 82
Table No: - 26
Showing the incidence and response in different koshta of patients.
Sl. Type of Koshta No. of Pt.’s % MoR % MiR %
1 Mridu 1 3.3 1 100 - -
2 Madhya 16 53.3 12 75 4 25
3 Kroora 13 43.3 10 76.9 3 23.1
4 Sama - - - - - -
Among 30 patients, 16 patients i.e. 53.3% were madhya koshta and 12
patients responded moderately i.e.75% and 4 patients responded mildly i.e. 25%. 13
patients i.e. 43.3% were of kroora koshta and responded moderately were 10 patients i.e.
76.9% and 3 patients responded mildly i.e. 23.1%. One patient was mridu and responded
moderately.
1 1 0
16
12
4
1310
302468
10121416
No. of
Pt.'s
Mridu Madhya Kroora
Nature of koshta
Incidence & response in different koshta
No. of Pt.’s MoR MiR
Results 83
Table No: - 27
Showing the incidence and response to treatment in different agni.
Sl. Type of agni No. of Pt.’s % MoR % MiR %
1 Manda 6 20 4 66.7 2 33.3
2 Vishama 4 13.3 3 75 1 25
3 Teekshna 1 3.3 - - 1 100
4 Sama 19 63.4 16 84.2 3 15.8
Among 30 patients, 19 patients were of samagni i.e. 63.4% and 16 patients
responded moderately i.e. 84.2% and 3 patients mild i.e. 15.8%, 6 patients were
mandagni i.e. 20% and 4 responded moderately, 66.7%, 2 responded mildly 33.3%. 4
were vishamagni 13.3% and 3 responded moderately i.e. 75% and 1 mildly i.e. 25% and
only 1 patient was teekshna agni and responded mildly.
642431
10 119163
0 5 10 15 20No. of Pt.'s
Mridu
Vishama
Teekshna
Sama
Nat
ure
of a
gni
Incidence & response in terms of agni
No. of Pt.’s MoR MiR
Results 84
Table No: -28.
Showing the incidence and response in all types of Gridhrasi
Sl. Type of Gridhrasi No. of Pt.’s % MoR % MiR %
1 Vataja 24 80 19 79.2 5 20.8
2 Vatakaphaja 6 20 4 66.7 2 33.3
Among 30 patients, vataja were 24 i.e. 80% and 19 (79.2%) responded
moderately while 5 responded mildly i.e. 20.8%. Vatakaphaja were 6 i.e. 20% and 4
responded i.e. 66.7%, moderately while 2 responded mildly i.e. 33.3%.
Incidence & response in types of Gridhrasi
24
6
19
45 20
10
20
30
Vataja Vata KaphajaType of Gradrasi
No. of
Pt.'s
No. of Pt.’s MoR MiR
Results 85
Table No: - 29.
Showing the nidana and response to different nidana bhavas
Sl. Type of nidana No. of Pt.’s % MoR % MiR %
1 Swaprakopaka 12 40 11 91.7 1 8.3
2 Marmaghataka 12 40 8 66.7 4 33.3
3 Margavarodha 6 20 4 66.7 2 33.3
Among 30 patients, 12 patients showed swaprakopaka nidana bhavas and
12 patients showed Marmaghatakara bhavas i.e. 40% each and 6 patients showed
margavarodha nidana bhavas i.e. 20%. In the swaprakopaka, 11 patients showed
moderate response i.e. 91.7% and 1 mild response i.e. 8.3%. In marmaghataka 18 patients
showed moderate response i.e. 66.7% and 4 patients showed mild response i.e. 33.3%. In
margavarodha 4 patients showed moderate i.e. 66% and 2 patients showed mild i.e.
33.3%.
12 11
1
12
8
46
42
02468
1012
No. of
Pt.'s
Swa Marm a Marga
Nidana
Incidence & response interms of nidanas
No. of Pt.’s MoR MiR
Results 86
Table No: -30.
Showing the incidence and response to different mode of onset.
Sl. Mode of onset No. of Pt.’s % MoR % MiR %
1 Gradual 21 70 15 71.4 6 28.6
2 Sudden 9 30 8 88.9 1 11.1
Among 30 patients, 21 patients had gradual onset i.e. 70% and 15 patients
responded moderately i.e. 71.4% and 6 patients responded mildly i.e. 28.%. 9 patients
had sudden onset and 8 responded moderately i.e. 88.9% and 11.1% i.e. 1 patient
responded mildly.
2115
6
98
1
0 5 10 15 20 25
No. of Pt.'s
Gradual
Sudden
Mod
e of
ons
et
Incidence & responce in mode of onset
No. of Pt.’s MoR MiR
Results 87
Table No: - 31.
Showing the incidence and response to different variety of pain.
Sl. Variety of pain No. of Pt.’s % MoR % MiR %
1 Chronic 21 70 15 71.4 6 28.6
2 Acute 9 30 8 88.9 1 11.1
Among 30 patients, 21 patients had chronic pain i.e. 70% and 15 patients
responded moderately i.e. 71.4% and 6 patients responded mildly i.e. 28.6%. 9 patients
had acute pain and 8 responded moderately i.e. 88.9% and 11.1% i.e. 1 patient responded
mild.
21
15
69 8
10
5
10
15
20
25
No. of
Pt.'s
Chronic Acute
Variety
Incidence & response to variety of pain
No. of Pt.’s MoR MiR
Results 88
Table No: - 32.
Showing cause of sciatica and response in patients.
Sl. Cause of sciatica No. of Pt.’s % MoR % MiR %
1 L.S. with IVDP 15 50 9 60 6 40
2 Spondylolisthesis 1 3.3 - - 1 100
3 IVDP 14 46.7 14 100 - -
Among 30 patients, 15 patients i.e. 50% had lumbar spondylosis with
IVDP and out of that 9 responded moderately i.e. 60% and 6 responded mildly i.e. 40%.
Only IVDP cases were 14 i.e. 46.7% and responded moderately 100%. 1 case (3.3%) of
spondylolisthesis responded mildly.
15
96
1 0 1
14 14
00
2
4
6
8
10
12
14
16
No. of
Pt.'s
L.S. with IVDP SL IVDP
Cause of sciatica
Cause of sciatica & response
No. of Pt.’s MoR MiR
Results 89
Table No: - 33.
Showing the incidence and overall response in age.
Sl. Age in years No. of Pt.’s % MoR % MiR %
1 21-30 6 20 6 100 - -
2 31-40 3 10 2 66.7 1 33.3
3 41-50 11 36.6 9 81.8 2 18.2
4 51-60 9 30 6 66.7 3 33.3
5 61-70 1 3.3 - - 1 100
Among 30 patients, 6 patients were of 21-30 age group and all the 6 patients
responded moderately. 3 patients i.e. 10% were of 31-40 age group and 2 patients i.e.
66.7% responded moderately and 33.3% i.e. 1patient responded mildly. 11 patients i.e.
36.6% were of 41-50 age group and 9 patients i.e. 81.8% responded moderately and 2
patients responded mildly i.e. 18.2%. 51-60 age group had 9 patients i.e. 30% and 66.7%
i.e. 6 patients responded moderately and 3 patients i.e. 33.3% responded mildly. In age
group of 61-70. 1 patient was there and responded mildly.
660
3211192
96310 1
0 2 4 6 8 10 12No. o f Pt.'s
21 -30
31 -40
41 -50
51 -60
61 -70
Age
gro
up
In c id en ce & resp on se in a g e g ro u p s
N o. o f P t.’s M oR M iR
Results 90
Table No: - 34.
Showing the incidence and overall assessment in duration.
Sl. Duration in years No. of Pt.’s % MoR % MiR %
1 Below 1 year 8 26.7 8 100 - -
2 1-2 16 53.3 14 87.5 2 12.5
3 3-4 4 13.3 1 25 3 75
4 5-6 1 3.3 - - 1 100
5 Above 6 1 3.3 - - 1 100
Among 30 patients, 8 patients i.e. 26.7% were below one year duration and all the
8 patients responded moderately i.e. 100%, 16 patients were under 1-2 year duration i.e.
53.3% and 14 responded moderately i.e. 87.5% and 2 responded mildly i.e. 12.5% 4
patients i.e.13.3% were under 3-4 years duration and 3 responded mildly i.e. 75% and 1
responded moderately i.e. 25%. 1 patient each i.e. 3.3% were there in 5-6 and above 6
year duration i.e. 3.3% each and both the patients responded mildly i.e. 100%.
8 8
0
1614
24
13
1 0 1 1 0 10
5
10
15
20
No. of
Pt.'s
Below 1 year 1 to 2 3 to 4 5 to 6 Above 6
Duration
Incidence & response in duration
N o. o f P t.’s M oR M iR
Results 91
Table No: -35.
Showing the incidence of range of SLR in the patients. (Of most affected leg).
Sl. SLR range in degrees No. of Pt.’s %
1 80-89 - -
2 70-79 - -
3 60-69 3 10
4 50-59 13 43.3
5 40-49 14 46.7
6 30-39 - -
Among 30 patients, 14 patients i.e. 46.7% were shown positive at 40-490
degree, 13 patients i.e. 43.3% were shown positive at 50-590 and 10% i.e. 3 patients were
positive at 60-690.
Incidence of Range of SLR
0 0
3
13 14
00
5
10
15
80-89 70-79 60-69 50-59 40-49 30-39
Degrees of SLR
No.
of P
t.'s
No. of P t.’s
Results 92
Table No: - 36.
Showing the changes in SLR after treatment.
Right leg Left leg Sl. Difference in degree
No. of Pt.’s % No. of Pt.’s %
1 1-10 1 3.3 2 6.6
2 11-20 10 33.3 9 30
3 21-30 6 20 5 16.6
4 31-40 1 3.3 3 10
5 41-50
Not considering the particular leg or bilateral, among 30 patients, 19
patients shown 11-20 degree difference, 11 patients shown 21-30 degree difference, 4
patients shown difference in 31-40 degree an 3 patients shown difference in 1-10 degrees.
Changes in SLR after treatment
1
10
6
12
9
53
02468
1012
1 to 10 11 to 20 21 to 30 31 to 40 41 to 50Difference in degrees
No.
of P
t.'s
Right leg No. of Pt.’s Left leg No. of Pt.’s
Results 93
Table No: - 37.
Showing the changes in lumbar movement after treatment.
Forward flexion Right lateral flexion Left lateral flexionSl. Difference in cm.
No. of Pt.’s % No. of Pt.’s % No. of Pt.’s %
1 1-5 - - 1 3.3 1 3.3
2 6-10 6 20 12 40 6 20
3 11-15 18 60 13 43.3 19 63.3
4 16-20 6 20 4 13.3 4 13.3
Among 30 patients, 60% patients i.e. 18 showed 11-15 cms difference in forward
flexion, 6 patients each i.e. 20% showed 6-10 cms and 16-20cms difference in forward
flexion i.e.40% combined
Regarding lateral flexion-right, 43.3% showed, i.e. 13 patients, difference in11-15
cms, 40% i.e. 12 patients showed 6-10 cms difference, 13.3% i.e.4 patients showed 16-20
cms difference and 1 patient showed (3.3%), 1-5 cm difference.
In left lateral flexion 63.3% i.e. 19 patients showed difference in 11-15cms, 20%
i.e. 6 patients showed 6-10 cms difference 4 patients showed i.e. 13.3%, 16-20 cms
difference and 1 patient showed 1-5 cms difference i.e. 3.3%.
0 1 1
6
1 2
6
1 8
1 3
1 9
64 4
0
5
1 0
1 5
2 0
N o . o f
P t.'s
1 to 5 6 to 10 11 to 15 16 to 20
D iffe re n c e in c m s
C h a n g e s in lu m b a r m o ve m e n ts
F orw ard flexion N o . o f P t.’sR igh t la te ra l flexion N o . o f P t.’sLe ft la te ra l flexion N o . o f P t.’s
Results 94
Table No: -38.
Showing the assessment of walking the before and after treatment.
Before treatment After treatment Sl. Walking grade
No. of Pt.’s % No. of Pt.’s %
1 Grade 0 - - 16 53.3
2 Grade 1 1 3.3 13 43.3
3 Grade 2 12 40 - -
4 Grade 3 14 46.7 1 3.3
5 Grade 4 3 10 - -
Among 30 patients, before treatment, 46.7% i.e. 14 patients were under
grade 3, 40% i.e. 12 patients under grade 2, 10% i.e. 3 patients were under grade 4 and 1
patient i.e. 3.3% under grade 1. After treatment 53.3% responded to grade 0 i.e. 16
patients, 43.3% i.e. 13 patients responded to grade 1 and 3.3% i.e. 1 patient to grade 3.
Changes in walking time
0 1
12 14
3
1613
0 1 005
101520
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4
Grades
No.
of P
t.'s
Before treatment After treatment
Results 95
Table No: -39.
Showing the assessment of Ruk (pain) before and after treatment.
Before treatment After treatment Sl. Walking grade
No. of Pt.’s % No. of Pt.’s %
1 Grade 0 - - - -
2 Grade 1 - - 14 46.7
3 Grade 2 1 3.3 15 50
4 Grade 3 19 63.3 1 3.3
5 Grade 4 10 33.3 - -
Among 30 patients, before treatment, 19 patients (63.3%) were presented
grade 3 pain, 10 patients (33.3%) presented grade 4 pain and 1 patient (3.3%) presented
grade 2 pain. After treatment 15 patients (50%) presented in grade 2 pain, 14 patients
(46.7%) presented grade 1 pain and 1 patient (3.3%) presented grade 3 pain.
0 0 0
14
1
1519
1
10
00
5
10
15
20
No. of
Pt.'s
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4
Grades
Assessment of pain
Before treatment After treatment
Results 96
Table No: - 40.
Showing the overall assessment.
Sl. Response No. of Pt.’s %
1 Complete relief - -
2 Marked response - -
3 Moderate response 23 76.7
4 Mild response 7 23.3
5 Unchanged - -
Among 30 patients, 76.7% i.e. 23 patients showed moderate response
23.3% i.e. 7 patients showed mild response.
0 0
23
7
005
10152025
No. of
Pt.'s
CR Mar Mod Mild No
Response
Overall assessment
No. of Pt.’s
Results 97
Table No. 41. Individual study of the parameters to show significance effect before and
after the treatment.
Sl. Parameter Mean S.D. S.E. t-value p-value Remarks
1. Ruk 1.733 0.521 0.095 18.242 <0.001 H.S.
2. Stamba 1.7 0.534 0.097 17.52 <0.001 H.S.
3. Toda 1.0 0.525 0.095 10.526 <0.001 H.S.
4. Spandana 0.333 0.479 0.087 3.827 <0.001 H.S.
5. Ayama 0.233 0.43 0.078 2.987 <0.01 H.S.
6. Tandra 0.666 0.379 0.069 2.405 <0.05 H.S.
7. Gaurava 0.166 0.379 0.069 2.405 <0.05 H.S.
8. Aruchi 0.166 0.379 0.069 2.405 <0.05 H.S.
9. Suptata 0.966 0.182 0.033 29.00 <0.001 H.S.
10. Shosha - - - - - -
11. Vibandha 0.566 0.504 0.092 6.152 <0.001 H.S.
12. Daha 0.933 0.639 0.116 8.04 <0.001 H.S.
13. Forward flexion 13.633 3.899 0.711 19.174 <0.001 H.S.
14. Rt. Lateral flexion 11.366 3.253 0.593 19.156 <0.001 H.S.
15. Lt. Lateral flexion 11.733 2.97 0.542 21.64 <0.001 H.S.
16. Walking time 2.1 0.547 0.1 21.0 <0.001 H.S.
17. SLR Rt. 12.666 11.943 2.18 5.81 <0.001 H.S.
18. SLR Lt. 13.666 13.06 2.384 5.732 <0.001 H.S.
Conclusion of the statistical analysis.
All the parameters show highly significant except he parameter shosha.
There is a constant change in the group before and after the treatment (as p value <0.001).
Assume that the treatment is not response for increment or decrement of the readings
before and after the treatment. To know among the groups which parameter is having
more effect of the treatment we used paired t test. The parameter suptata is most
Results 98
significant than the other (by comparing t value). The parameter tandra gaurava and
aruchi are showing same significance in the group (as t value is same). The parameter
suptata is having uniform effect on the patient in the group (by comparing coefficient
variation). There is more variation in the parameter SLR left (by compairing standard
deviation). The parameters ruk, sthamba and toda show highly significance, among these
three ruk and sthambha is more significant than the toda (by comparing t value). The
parameter ayama is not having uniform effect on the patient in the group. The mean and
S.D. of tandra, gaurava and aruchi shows the same effect.
Among the parameters forward flexion, right and left lateral flexion and
walking time approximately having same effect even though the mean effect of these two
are different. Among the left lateral flexion and walking time, the left lateral flexion
shows little highly significance than the walking time. But there is a much difference in
the mean effect and there is more variation in the left lateral flexion.
Results 99
Table No. 42. Individual study of the parameters to show significance effect before and after the
treatment.
Sl. Parameter Mean S.D. S.E. t-value p-value Remarks
1. Ruk 1.733 0.521 0.095 18.242 <0.001 H.S.
2. Stamba 1.7 0.534 0.097 17.52 <0.001 H.S.
3. Toda 1.0 0.525 0.095 10.526 <0.001 H.S.
4. Spandana 0.333 0.479 0.087 3.827 <0.001 H.S.
5. Ayama 0.233 0.43 0.078 2.987 <0.01 H.S.
6. Tandra 0.666 0.379 0.069 2.405 <0.05 H.S.
7. Gaurava 0.166 0.379 0.069 2.405 <0.05 H.S.
8. Aruchi 0.166 0.379 0.069 2.405 <0.05 H.S.
9. Suptata 0.966 0.182 0.033 29.00 <0.001 H.S.
10. Shosha - - - - - -
11. Vibandha 0.566 0.504 0.092 6.152 <0.001 H.S.
12. Daha 0.933 0.639 0.116 8.04 <0.001 H.S.
13. Forward flexion 13.633 3.899 0.711 19.174 <0.001 H.S.
14. Rt. Lateral flexion 11.366 3.253 0.593 19.156 <0.001 H.S.
15. Lt. Lateral flexion 11.733 2.97 0.542 21.64 <0.001 H.S.
16. Walking time 2.1 0.547 0.1 21.0 <0.001 H.S.
17. SLR Rt. 12.666 11.943 2.18 5.81 <0.001 H.S.
18. SLR Lt. 13.666 13.06 2.384 5.732 <0.001 H.S.
Results 100
Conclusion of the statistical analysis.
All the parameters show highly significant except he parameter
shosha. There is a constant change in the group before and after the treatment (as
p value <0.001). Assume that the treatment is not response for increment or
decrement of the readings before and after the treatment. To know among the
groups which parameter is having more effect of the treatment we used paired t
test. The parameter suptata is most significant than the other (by comparing t
value). The parameter tandra gaurava and aruchi are showing same significance in
the group (as t value is same). The parameter suptata is having uniform effect on
the patient in the group (by comparing coefficient variation). There is more
variation in the parameter SLR left (by compairing standard deviation). The
parameters ruk, sthamba and toda show highly significance, among these three
ruk and sthambha is more significant than the toda (by comparing t value). The
parameter ayama is not having uniform effect on the patient in the group. The
mean and S.D. of tandra, gaurava and aruchi shows the same effect.
Among the parameters forward flexion, right and left lateral flexion and
walking time approximately having same effect even though the mean effect of these two
are different. Among the left lateral flexion and walking time, the left lateral flexion
shows little highly significance than the walking time. But there is a much difference in
the mean effect and there is more variation in the left lateral flexion.
Results 101
Table No. 14a.
Demographic data related to the evaluation of efficacy of Vaitharanabasti in Gridhrasi.
Sex Religion Occupation Eco. status Diet Vyasana Prakriti ResponseSl. OPD Age M F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1. 3779 26 + - + - - - - + - + - - + - + - - + - - + - 2. 3474 35 + - + - - - - + + - - - + - + + - + - - + - 3. 3117 22 + - + - - - + - - + - + - - + - - - + - + - 4. 3121 55 + - + - - + - - - + - - + - + + - + - - - + 5. 3803 45 - + + - - - + - - + - + - - - - + - + - + - 6. 2687 48 + - + - - - + - - + - - + - + - - - + - + - 7. 3816 55 + - + - - - + - - + - - + + + - - - + - + - 8. 3815 52 + - + - - - + - - - + - + - + - - - + - + - 9. 3761 26 + - + - - + - - - + - - + - + + - - + - + - 10. 3948 25 + - - + - + - - - - + - + - - - - - + - + - 11. 4014 56 + - + - - - - + - + - - + + + + + - + - + - 12. 4035 46 - + + - - - + - - - + - + - - - - - + - + - 13. 4038 30 + - + - - - - + + + - - + - + + + - + - + - 14. 4078 44 + - + - - - + - - - + - + + + + - - + - + - 15. 4131 45 - + + - - - + - - - - + - + + - - - + - + -
Table No. 14b. Demographic data related to the evaluation of efficacy of Vaitharanabasti in Gridhrasi.
Sex Religion Occupation Eco. status Diet Vyasana Prakriti Resp. Sl. OPD Age M F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
16. 4461 44 + - - + - - + - - - - - + + + - - - + - - + 17. 4532 40 + - + - - - + - - - + - + - + + - - + - + - 18. 4247 38 + - + - - - - + - + - - + - + + - + - - + - 19. 161 48 + - - + - - - + - + - - + - + - - - + - - + 20. 182 41 - + + - - - - + - + - + - + + - - - + - + - 21. 1550 57 + - + - - - + - - - - - + + + - - + - - + - 22. 1551 54 + - + - - - + - - - - - + - + + - - + - + - 23. 3544 45 - + + - - - + - - - - - + - + - - + - - - + 24. 3541 49 + - + - - - + - - - - - + - + + - - + - - + 25. 1655 54 - + + - - - + - - - - + - - - - + - + - - + 26. 1666 23 + - + - - - + - - - + - + + + + - + - - - + 27. 1711 54 + - + - - - + - - - - + - - + + - - - + - + 28. 1869 45 - + + - - - + - - - - + - - - - + - + - - + 29. 2092 60 + - + - - + - - - - + + - - - - + - + - - + 30. 2132 65 + - + - - - + - - - - - + + + - - + - - - + Total 23 7 27 3 0 4 1
9 7 2 2
1 7 8 22 8 24 12 6 8 21 1 23 7
1 – Hindu, 2 – Muslim, 3 – Christian, 4 – Sedentary, 5 – Active, 6 – Labour, 7 – Poor, 8 – Middle class, 9 – Highclass, 10 – Vegetarian, 11 – Mixed, 12 – Smoking, 13 – Tobacco, 14 – Alcohol, 15 – None, 16 – Vatapitta, 17 – Vatakapha, 18 – Kaphapitta, 19 – Moderate response, 20 – Mild response.
Table No. 15a.
Showing the etiological factors and chief complications of patients in the study. Type Leg affected Onset Variety Scol. Position. at work Nidana Sciatica cau. Duration Sl.
V VK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1. + - - + - - + + - + - - + - - + - - - - + + - - - - 2. + - + - - + - - + + - - + + - - - + - - + - - + - - 3. + - - + - + - + - - + + - + - + - - - - + + - - - - 4. + - - - + - + - + + - + - + - - - + + - - - - + - - 5. + - - + - - + - + + - + + + + + - - + - - + - - - - 6. + - - - + - + - + + - - + + - + - - + - - - + - - - 7. + - - + - + - + - - + + + + - + - - - - + + - - - - 8. + - + - - - + - + + - - + + - + - - - - + - + - - - 9. + - + - - + - + - + - + - + + - - - - - + + - - - - 10. + - + - - + - + - + - + - + - - - + - - + + - - - - 11. - + - + - - + - + + - + + + + - + + + - - - + - - - 12. - + - - + - + - + + - + + + + - + - + - - - + - - - 13. - + - + - - + - + + - + + + + - + - - - + - + - - - 14. + - + - - - + - + + - + + + + + - + - - + - + - - - 15. - + - - + - + - + + - + + + + - + - + - - - + - - -
Table No. 15b.
Showing the etiological factors and chief complications of patients in the study. Type Leg affected Onset Variety Scol. Position. at work Nidana Sciatica cau. Duration Sl.
V VK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 16. + - - + - + - + - + - + + + - - - + - - + + - - - - 17. - + - - + - + - + + - + + + - - + - + - - - + - - - 18. + - + - - + - + - + - + + + + - - + - + - - + - - - 19. + - + - - - + - + + - + + + + - - + + - - - + - - - 20. + - + - - - + - + + - + + + + + - - - - + - + - - - 21. + - - + - - + - + + - + + + - + - - +- - - - + - - - 22. + - - + - - + - + + - + + + - - - + + - - - + - - - 23. + - + - - + - + - + - + + + + + - - + - + - + - - - 24. + - - + - - + - + + - - + + + - - + - - - - + - - - 25. + - - + - - + - + + - + + + + + - - - - - - + - - - 26. + - + - - + - + - - + + + + - - - + + - + - - - - - 27. + - - + - - + - + + - + + + + - - + + - + + - + - - 28. - + + - - - + - + + - + + + + - + - - - - - - + - - 29. + - + - - - + - + + - + + + - + - - - - - - - - + - 30. + - - + - - + - + + - + + + - - - - + - - - - - - + T. 24 6 12 13 5 9 21 9 21 27 3 25 26 29 15 12 6 12 15 1 14 8 16 4 1 1
1 – Right leg,2 – Left leg, 3 – Bilateral, 4 – Sudden, 5 – Gradual, 6 – Acute, 7 – Chronic, 8 – Present, 9 – Absent, 10 – Sitting, 11 – Standing, 12 – Stooping, 13 – Squatting, 14 – Swaprakopaka, 15 – Margavarodhaka, 16 – Marmaghatakara, 17 – Lumbar spondylosis with IVDP, 18 – Spondylolisthesis, 19 – IVDP, 20 – Below 1 year, 21 – 1-2 year, 22 – 3-4 years, 23 – 5-6 years, 24 – Above 6 years, Scol. – Scoliosis, Sciatica cau. – Causes of sciatica, T. – Total.
Table No. 16. Showing data related to subjective and objective parameters before and after treatment.
Ruk Stambha Toda Spandana Ayama Tandra Gaurava Aruchi Suptata Shosha Vibandha Daha Fwd. FL Rt.La.Fl Lt.La.Fl. W.T. SLR Rt. SLR Lt. Sl. No. B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A
Res
01. 3 2 3 1 2 1 0 0 0 0 0 0 0 0 0 0 2 0 1 1 1 0 0 0 39 19 41 30 43 31 2 0 90 90 40 80 MoR 02. 4 1 4 2 3 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 0 47 20 53 42 51 42 3 0 45 85 90 90 MoR 03. 3 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0 0 1 0 0 0 30 18 53 40 54 40 2 0 90 90 60 80 MoR 04. 4 3 4 3 3 2 1 1 1 1 0 0 0 0 0 0 2 2 1 1 1 0 2 1 53 45 56 48 55 47 4 3 60 65 40 45 MiR 05. 4 2 3 1 3 1 1 0 1 0 0 0 0 0 0 0 2 1 1 1 1 0 2 0 36 21 54 40 52 39 3 0 60 85 45 75 MoR 06. 3 1 2 0 2 1 0 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 0 41 22 59 41 57 41 2 0 90 90 55 80 MoR 07. 3 1 2 1 2 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 36 19 59 39 57 40 3 0 90 90 45 80 MoR 08. 3 2 3 2 2 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 0 40 25 59 42 58 40 3 1 45 70 90 90 MoR 09. 3 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 0 0 26 16 50 40 49 39 2 0 55 80 90 90 MoR 10. 3 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 0 0 29 17 49 40 51 42 2 0 60 80 90 90 MoR 11. 4 2 3 2 3 2 0 0 1 0 1 0 1 0 1 0 2 1 1 0 1 0 2 1 32 22 57 44 56 45 4 1 90 90 50 70 MoR 12. 4 2 3 1 2 1 1 1 0 0 1 0 1 0 1 0 2 1 1 1 1 0 2 0 40 27 56 46 56 45 3 1 65 80 40 75 MoR 13. 3 1 2 1 2 1 0 0 0 0 1 0 1 0 1 0 2 1 1 1 1 0 0 0 32 20 57 41 58 40 3 0 90 90 55 80 MoR 14. 4 2 3 2 2 1 1 0 1 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 40 23 54 44 54 42 3 1 45 75 90 90 MoR 15. 4 2 4 1 2 1 1 1 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 32 23 59 46 58 45 4 1 55 75 70 85 MiR 16. 3 1 2 1 1 0 0 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 0 0 30 18 51 42 52 40 2 0 90 90 55 80 MoR 17. 4 2 3 1 2 1 0 0 1 0 1 0 1 0 1 0 2 1 1 1 0 0 2 1 40 27 58 46 57 45 3 1 40 65 65 80 MoR 18. 3 2 3 2 2 1 0 0 1 1 0 0 0 0 0 0 2 1 1 1 0 0 2 1 35 25 52 44 53 45 2 1 50 70 90 90 MiR 19. 3 1 3 1 2 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 29 20 51 41 53 40 3 1 65 80 90 90 MoR 20. 3 1 3 1 1 0 0 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 42 27 59 47 58 46 2 0 55 75 90 90 MoR 21. 4 2 4 2 3 2 1 0 1 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 43 30 59 49 57 48 3 1 70 85 40 60 MoR 22. 3 1 3 1 2 1 1 0 1 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 35 20 54 44 55 43 2 0 90 90 55 75 MoR 23. 3 1 3 1 2 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 32 17 49 39 51 40 2 0 55 75 90 90 MoR 24. 3 2 3 1 2 1 0 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 30 19 51 40 52 41 2 0 90 90 45 65 MoR 25. 3 1 3 1 2 1 0 0 1 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 38 24 59 47 58 46 2 0 90 90 55 75 MoR 26. 2 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 1 0 0 0 0 0 35 13 40 36 40 36 1 0 65 80 90 90 MoR 27. 3 2 3 1 3 1 0 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 40 26 53 42 54 41 3 1 90 90 55 70 MiR 28. 4 2 3 1 3 1 1 1 1 1 1 0 1 0 1 0 2 1 1 1 0 0 2 1 51 36 56 45 57 46 3 1 40 60 90 90 MiR 29. 3 2 3 1 2 1 1 0 0 0 0 0 0 0 0 0 2 1 1 1 0 0 2 1 41 24 53 44 54 43 3 1 50 70 90 90 MiR 30. 3 2 3 1 2 1 0 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 2 1 36 23 54 46 55 45 3 1 90 90 40 65 MiR
DISCUSSION
Discussion part is divided into five sections.
1. Discussion on Gridhrasi and Sciatica.
2. Discussion on importance of bastikarma in Gridhrasi.
3. Discussion on clinical study.
4. Discussion on importance of Vaitharanabasti in Gridhrasi
5. Discussion on probable mode of action of Vaitharanabasti and the probable
mechanism of action of Vaitharanabasti.
Gridhrasi and Sciatica
The disease Gridhrasi is a vatavyadhi, counted one among the
vatavyadhis. It is a classical condition characterized by radiating pain down the leg. This
type of pain having a peculiar course is termed Gridhrasi shoola. The peculiarity is, it
starts in the kati and takes a course on the posterior aspect of the lower extremity and
reaches the toes.
Sciatica, a clinical entity that is described in modern medical science, has
a striking resemblance to the symptomatology of Gridhrasi. It can be better compared
through a discussion made from the shareera (anatomy) to the roopa (clinical
presentation) of the disease.
On a closer look into the shareera, the parts, which are affected in the
Gridhrasi disease, are kati prishta pradesa, kandaras of parshni and angulis, kukundara
marma, katikatharunamarma and the Gridhrasi snayu / nadi. While discussing the modern
aspect, the anatomical structures, which are affected in Gridhrasi disease, are lumbar
vertebrae, intervertebral joints, lumbo-sacral plexus and sciatic nerve.
Summary 102
In the samprapthi review, two opinions were put forward as- Gridhrasi
dhamani and Gridhrasi snayu / nadi. Commenting on to the context Dalhana has
considered it as kandara and termed as Mahasnayu. He has also used the term
kandaradwayam indicating the sciatic nerve of both legs. The mahasnayu starts from
gulpha to vitapa. Vriddha Vagbhata Gridhrasi occurs due to vata sited at snayu. So basing
on these commentaries, the concept of Gridhrasi dhamani can be rejected and the
Gridhrasi snayu / nadi is the apt term for the sciatic nerve that also starts from the gulpha
to vitapa on both legs.
Dhamanis are having the property of dhmana (pulse vibrations) as each
spurt of fluid impinges on the wall of arteries and so dhamani is considered as a part of
the circulatory system. Snayus are the nadis that conduct vayu as per vaidyasabdasindhu.
It is also noted that snayu binds the dehamamsa (muscles), asthi (bones), medas (fat
tissue) and strengthens the joint. So by conducting the vayu through out the body, snayu
helps in prasarana, akunchana etc. So here by we can assume that the snayu is more
connected to the musculo-skeletal system and so the sciatic nerve can be considered as
Gridhrasi nadi / snayu.
A better comparison can be made from the nidana. The nidanas were
considered under 4 headings.
1. Swaprakopakara nidana – Includes ahara, vihara and manasika.
2. Margavarodhaka nidana – Causing obstruction to vata.
3. Marmaghatakara nidana – Injury / trauma.
4. Dhatukshayaja nidana – Depletion of dhatu.
Summary 103
Though these are considered different, the nidana bhavas ultimately are
inter related. But as to know the exact cause for the onset of disease such a classification
has been made. The swaprakopakara nidanas, marmaghatakara nidans and
margavarodhaka nidanas eventually leads to dhatukshaya and there by producing vataja
type of Gridhrasi in the body. Another type is the vatakaphaja Gridhrasi where the
margavarodha janya nidana bhavas can be considered because the presenting complaints
include tandra, gourava, and aruchi along with Gridhrasi shoola. Taking the kaphavrita
vata symptoms into considerations, both the condition go in parallel confirming the
margavarodha.
Considering the etiological factors for the sciatica we can find the similar
types of factors responsible for the condition. Avitaminosis, nutritional deficiencies
leading to calcium deficiency were observed to lead inflammation of sciatic nerve
resulting to sciatica by modern scientists. Intake of excessive and heavy fatty meals was
observed to lead to accelerate degenerative process and can be considered as kapha
provocation diet. The posture at work of sitting, stooping, squatting, standing etc are
considered as the cause for sciatica. The psychological factors anxiety, tension, fear etc
leads to prolonged contraction of back muscles. So all these factors can be considered as
the swprakopakara nidana factors of Ayurveda.
Trauma is observed to be the single most important causative factor for
disc prolapse. Trauma / abhighata to the marmas are to be interpreted here. Almost all the
patients of Gridhrasi have a history of trauma. Here the term to be considered much is the
abhighata i.e. the acute injuries, fall from the height, heavy manual works, heavy blow on
the low back etc further leads to degenerative changes in the particular area. Even this
can also trigger the condition in degenerated vertebrae also.
Summary 104
The degenerative changes can be correlated with the dhatukshaya features.
For this degeneration to happen all other causative factors are the reason. The lumbar
spondylosis, where marked degeneration of the vertebrae happen, can be considered,
which inturn leads to the disc prolapse causing sciatica.
Based on the samprapthi the correlation can be established. The vata
provoked excessively by the factors analyzed above settles in kati pradesha (lumbar
region), and prishtavamsathara tharunasthi (intervertebral disc), when further precipitated
by trauma or stress initiates the displacement of sleshmika sleshma (nucleous pulposus)
and get obstructed by vitiating Gridhrasi nadi (sciatic nerve) thereby involving kandaras
of pada causing stabdhata (stiffness), ruk (pain), toda (pinning sensations), spandana
(spasms), in the region beginning from spik (gluteal region), kati (lumbar region), prishta
(back), uru (thigh), janu (knee), jangha (foot) and its angulees (toes). This is going on par
with the pathogenesis of sciatica in the modern medicine.
Considering the poorvaroopa and roopa, the similarities in both Gridhrasi
and sciatica can be found. Both have the same singular presentations - pain along the
course of leg. The poorvaroopas of the Gridhrasi can be considered as the mild form of
the roopas, as lack of contextual explanations. This includes the pain over the spik, kati,
prishta etc and can be considered as low backache. When the pain extends to uru, janu,
jangha pada and angulees the roopavastha happens. The same way the typical sciatic
nerve pain is radiating type, where the low backache turns to a radiating one through the
course of sciatic nerve as the prolapsed disc compresses the nerve root.
Summary 105
On the later stages the dehavakratha (scoliosis) and the abnormal
sensations like toda, spandana, ayama etc happens. Further it leads to the impairment in
uplifting of the leg and loss of sensations, which can be termed as sakthi utkshepana
nigrahana and suptatha in turn leads to neurological deficit. Regarding the gait of the
patient it will be of limping nature in sciatica, which can be considered as gridhramaiva
syati.
Role of Bastikarma in Gridhrasi.
Gridhrasi being a vatavyadhi, the treatments explained for vatavyadhis
have to be administered here. Vaghbata, after the aakshepaka and pakshaghata chikitsa,
has told that the snehadi vatavyadhi chikitsa have to be followed in other disorders of
vatavyadhi after considering the sthana, dooshya etc. Even basti is the prime treatment
for vatavyadhis as the shodhana for vata is basti.
Pakwasaya is considered as the main seat of vata. Basti is being
administered to the pakwasaya and the action of the drug is on to the site of the vitiated
dosha. Also the pakwasaya sameepya of the rogadhishtana is also a considerable factor
here.
Basthi causes shodhana of malas from all parts of the body including
srotas and sushumna. This measure is supposed to facilitate the restoration of the
prolapsed disc material to normality on one hand and increases strength and resistance of
the Gridhrasi nadi, vertebrae ligament, joints and muscles on the other.
Summary 106
The role can be better explained by the relationship between
pureeshadharakala – asthidharakala and pittadharakala – majjadharakala – grahani. As
the involvement of asthi is there in the disease, it is to be assumed that the drug acting
upon pureeshadharakala will certainly have its action over asthi, as both the kalas are the
same. Acharyas have told that the dravya reaches upto the grahani. Pittadharakala is
grahani and is the majjadharakala also. So it has to be assumed that the nutrients will
certainly get absorbed and there by pacifies vata as majjadhatu poshana ultimately results
in vata shamana.
In Gridhrasi of swaprakopaka origin, nirooha by vatahara dravyas
evacuates the vitiated vata and helps in the production of normal vata and nourishes the
dhatus according to the samanya vishesha siddhanta.
In Gridhrasi of dhatukshaya janya, nirooha by vatahara drugs along with
anuvasana by balya, brimhana, snehana are to be given, as anuvasana helps in the
nourishment of dhatus and nirooha in pacifying the vata.
The patient should be treated with deepana, pachana, snehana, swedana
and shodhana in margavarana janya Gridhrasi. By these measures avarana is removed.
Later basti is given for the production of normal vata as well as to pacify the vitiated vata.
Vata is vitiated in the Gridhrasi of marmaghataka origin. Basti is
considered as the main treatment in marmaghata.
It is emphasized that the basti administered stays in the pakwasaya, shroni
and below the nabhi and spreads the veerya throughout the body including prishta, which
is considered as one among the parts involved in Gridhrasi.
Summary 107
Clinical study
The patients were selected incidentally from exclusively conducted
medical camps in the premise of Shri .D. G. Melamalagi Ayurvedic Medical College and
Hospital Gadag. Both the types of Gridhrasi were taken. Patients of both sexes were
selected for the clinical study between the age group 18 to 65 years for the purpose of
administration of shodhana chikitsa.
In total, 30 patients were selected for the study. All the patients were
subjected to thorough clinical, laboratory and radiological examinations. There is no drop
out in the study and all the 30 patients were appeared for the assessment of results. The
laboratory tests like total blood count, differential count and ESR were carried out to
exclude infections, disorders like tuberculosis of spine, the RBS was carried out to rule
out diabetes. The radiology of LS spine is also a diagnostic criteria to exclude the
conditions like severe osteoporosis, fractures, osteophytes etc. But in the present study,
among all the 30 patients, not a single patient has shown the above exclusion conditions.
The straight leg raising test is a good objective parameter to diagnose the
Gridhrasi disease in western medicine. Some of the authorities of Ayurveda mentioned
that kshepana and utkshepana are the salient features of Gridhrasi disease. These
kshepana and utkshepana symptoms can be attributed to straight leg raising test of
modern medicine. The other objective parameters taken were movements of lumbar spine
and walking time.
Most of the patients belonged to active (63.4%) followed by labour
(23.3%) and sedentary (13.3%). Considering the nidana aspect it could find that most of
the patients had a history of marmaghata (40%), fall from height or an accident or a blow
on back. Later it triggered with the exposure to the prakopaka nidana bhavas which
include vehicle riding, heavy manual work, weight lifting, walking etc. 6 patients showed
the margavarodha nidana factors (20%).
Summary 108
Considering the socioeconomic status of the patients in the clinical study,
most of the patients were middle class (70%) and male and female ratios were 76.6% and
23.4% respectively. The study records suggested larger number of Hindus (90%). But it
does not mean that Hindus are more prone to this disease because this data is only a
reflection of geographical predominance of the community.
73.3% of the patients were of mixed diet while 26.7% were vegetarians.
This only reflects the predominance of diet in this region. 80% of the patients had the
habit of using tobacco, as it is a very common habit in local population. Hence it would
not be wise to conclude that Gridhrasi is prevalent in persons having the habit of tobacco
chewing.
Maximum number of patients were having Vatakapha prakriti (70%) as
the most age group were in between 41-50 (36.6%) supported by 51-60 (30%), 21-30
(20%). So it can be assumed that majority of the Gridhrasi disease happens in between 4th
and 5th decade of life.
Regarding the type of Gridhrasi mot of the patients were vataja type (80%)
while vatakaphaja were of 20%. Hence vataja is more common than vatakaphaja
Gridhrasi. The predominance of vata is found in both the varieties. The radiological
examinations of LS spine reveals that the cause of sciatic nerve compression is mainly
due to lumbar spondylosis (50%), without degenerative changes (46.7%) and
spondylolisthesis (3.3%). The spondylosis and spondylolisthesis are due to the
degenerative changes in the lumbar vertebrae. Thus here asthidhatu kshaya (degenerative
changes) is one of the causes for provocation of vata. According to the modern medicine
lumbar spondylosis is the common causes for sciatica. So it supports that the cause of
Gridhrasi is vataprakopa, mainly due to degenerative changes in LS spine both in
Ayurveda and modern medicine.
Summary 109
Among 30 patients the most affected limb was left lower limb (43.3%)
followed by right lower limb (40%) and both lower limbs (16.7%). Mode of onset was
gradual (70%) and showed chronic pain (70%). Patients with sudden onset and acute pain
were 30%. The position at work of almost all the patients were either sitting (83.3%) or
standing (86.7%) or stooping (96.7%) or squatting (50%). But most of the patients were
doing the work in first three positions continuously, which inturn triggers the cause of
disc prolapse. All the patients (100%) showed the nature of radiating pain towards the
affected limb. Scoliosis was present in 90% of the patients and sosha (muscle waisting)
were present in 86.6%.
63.4% patients were of samagni and 20% patients with mandagni, which
is characteristic feature of vatakaphaja Gridhrasi. It may be because of the majority of
patients were of 21-50 i.e. madhyavayaha i.e. pittavayaha.
Response to the treatment.
Assessments of response were done both subjectively and objectively.
After recording the baseline data and post treatment data of the factors, ruk, sthamba,
spandana, toda, ayama, aruchi, gourava, tandra, suptatha, sosha, daha, vibandha in
gradings as the subjective parameters and the factors such as straight leg raising test in
degrees, the movements of the spine viz, forward flexion, right and left lateral flexions in
centimeters and walking time as the objective parameters, the assessments were done.
The statistical analyses of the subjective and objective parameters were made on these
assessments.
As Gridhrasi is a shoola pradhana vatavyadhi, eventhough the other
subjective parameters are taken for assessment, the effect was more concentrated on ruk
Summary 110
(pain). Among 30 patients, 63.3% of the patients were at grade 3, 33.3% were of grade 4
and 3.3% at grade 1. After treatment 50% were at grade 2, 46.7% at grade 1 and 3.3% at
grade 3. This shows that there was marked variation in the grades of pain in the patients.
So in the statistical analysis the parameters pain showed highly significant with t value-
18.24 the corresponding p value <0.001.
The parameters sthamba and toda shows highly significant with t value
17.52 and 10.526 respectively and the corresponding p values <0.001, <0.001. Among
ruk, sthamba and toda, ruk and stambha are more significant than toda by comparing the
t- value.
The parameters suptatha having most significance than others with a t
value 29.00 the corresponding p value <0.001. The parameters tandra, gaurava and aruchi
are showing same significance in the group with t value 2.405 the corresponding p value
<0.05. The parameter ayama is not having uniform effect on the patients in the group.
The parameters vibandha and daha also showed highly significant with t
value 6.152 and 8.04 respectively corresponding p-values <0.001 and <0.001. All the
subjective parameter showed highly significant except the parameter sosha.
Considering the response in some of the individual categories, in the
duration, 53.3% were under the category 1-2 years, 26.7% were below 1 year, 13.3% in
3-4 years and 3.3% each in 5-6 and above 6 years. Below I year case 100% responded
moderately and 75% showed mild response. The patients with the duration above 5 years
showed mild response only. So, the more chronic cases showed only very mild response
and the patients with less duration, i.e. below 2 years, showed moderate relief. It may be
because of the less number of days of treatment.
Summary 111
In the vataja and vatakaphaja types, 79.2% showed moderate response and
20.8% showed mild response in vataja Gridhrasi while 66.7% showed moderate response
and 33.3% showed mild response. In the cause of sciatica, 60% showed moderate
response and 40% responded mildly. Where as in IVDP all the patients showed moderate
response. A single case of spondylolisthesis showed only a mild response. So it can be
assumed here that the treatment is more effective in vataja Gridhrasi and in the inter
vertebral disc prolapse without the lumbar spondylosis. 60% of the spondylosis patients
responded moderately and continuation of the treatment for more days would have
brought a better result.
Regarding the objective parameters: - 46.7% of patients were positive in
SLR test and angle in between 40-49 degrees, 43.3% in between 50-59 degrees and 10%
in between 60-69 degrees. In this differentiation was made in both right and left lower
limb. In the right lower limb 33.3% showed a difference in 11-20 degrees after treatment,
20% showed a difference in 21-30 degrees, 3.3% each in 1-10 degrees and 31-40 degrees.
While of the left leg 30% showed a difference in 11-20 degrees, 16.6 in 21-30 degrees,
10% showed 31-40 degrees and 6.6% in 1-10 degrees. So here it is visible that most of
the patients responded in a difference in degrees between 11-30. The t value of SLR for
right leg is 5.81 corresponding p-value <0.001, t value of SLR of left leg is 5.73
corresponding p-value <0.001 and both showing highly significant.
In the forward flexion 60% of the patients showed the difference in 11-15
cms, 20% each in 6-10cms and 16-20cms after the treatment. In the right lateral flexion
43.3% of the patients showed 11-15cms difference, 40% showed 6-10cms difference,
13.3% showed 16-20cms difference and 3.3% showed 1-5cms difference after treatment.
Summary 112
In the left lateral flexion, 63.3% showed 11-15cm difference 20% showed 6-10cms
difference, 13.3% showed 16-20cms difference and 3.3% showed 1-5cms difference after
treatment. So, the response in this parameter is 11-20cms after the treatment.
Of the walking time 53.3% of patients responded to grade 0, 43.3% of
patients responded to grade 1 and 3.3% to grade 3. So among the parameters forward
flexion, right lateral flexion, left lateral flexion and walking time, the forward and right
lateral flexion approximately having same effect even though the mean effect of these
two are different. Between the left lateral and walking time, the left lateral shows little
highly significance than the walking time. But there is a much difference in the mean
effect and there is more variation in the left lateral flexion.
In the overall assessment, among 30 patients, 23 patients showed moderate
response (76.7%) i.e. 50-75% relief in signs and symptoms and 7 patients showed mild
response i.e. below 50% relief in signs and symptoms. The statistical evaluation showed
all parameters, both subjective and objective has shown highly significance except the
parameter sosha.
Here by, from the above mentioned results it is obvious that Vaitaranabasti
is efficient in the management of Gridhrasi.
Vaitaranabasti and Gridhrasi
This yoga has been selected for the study because of the direct indication
of the yoga towards Gridhrasi in Vangasena samhitha. He has considered this under
niroohabasti. The management given to all 30 patients includes abhyanga with plain tila
taila, swedana locally and Vaitaranabasti consecutively for 8 days. In this particular
context pain is considered as the most important symptom and the aim of management of
Summary 113
is to contain it, as Gridhrasi is a shoola pradhana vatavyadhi. Even the association of
kapha and pitta, however, may be present to a minimum level, but this is not taken into
active consideration since ruk (pain) is exclusively due to vitiation of vata.
The pre-operative procedures like vamana, virechana were not performed
because of the lack of the contextual propriety. Snehabasti is also not administered in
between because of the following reasons: - firstly, Vaitaranabasti is constituted with
saindhava, guda, amleeka, taila and dugdha. All of these are snigdha pharmacologically
and do not create any rookshata in the body, which is considered to be one of the
complication of administering nirooha alone. Secondly, administration of anuvasana may
adversely affect the assessment in that it may become biased or the result of the treatment
may be attributed to the effect of snehabasti. For obvious reasons medicated oil were not
used for abhyanga.
Probable mode of action of Vaitaranabasti
Not only by virtue of its own properties Vaitaranabasti can be considered
as a mridu ksharabasti. The basti itself act as shodhana also. The adding of milk in the
combination makes it mridu. Guda, saindhava and amleeka posses a ksharaguna and with
the moorchita tila taila it has a lekhana property also.
From the diseases mentioned as the indications of Vaitaranabasti, khora
amavata, chronic urusthamba, chronic vishamajwara, it is understood that the dravya has
got its amadoshahara property. Shoola pradhana vyadhis like Gridhrasi, kati shoola,
prishta shoola are indicated. The sodha conditions i.e. inflammatory conditions like kati
sodha, uru sodha, prishta sodha; stiffness condition like janusankocha; klaibya, where
brimhana is needed, are indications for Vaitaranabasti. From these all indications, we can
come into a conclusion that Vaitaranabasti possess an amahara-shoolahara-sodhahara-
sankochahara-brimhana property at any stage of the disease.
Summary 114
The disease Gridhrasi has all the conditions associated with it- shoola,
sthamba, sankocha, sodha (inflammation), and amatva (in vatakaphaja). The treatment
principle is brimhana too. So, here by, it is clear that Vaitaranabasti is an apt choice in
Gridhrasi.
Vyanavata impairment is obvious in this disease and for that the treatment
line is oordhva – adha shodhana and shamana. In the kevala vatavyadhi the main line of
treatment is brimhana with sneha. The amla- lavana-snehayukta bastis are advocated. So
it is very clear that this particular basti acts as vatashamaka and thereby reduces the
symptoms in Gridhrasi.
In the assessment of clinical recovery in terms of pain and other
symptoms, movements of lumbar spine, SLR and walking time 76.6% showed moderate
response. In the vatakaphaja Gridhrasi 66.7% moderate response even with the symptoms
including tandra, gourava, aruchi and the amaharatva property is thus established.
Probable mechanism of action of Vaitaranabasti
The vataja disorders are originating in pakwasaya, so it is the nearest way
to expel the vatadosha. The Vaitaranabasti administered is retained for about 7-10
minutes. Though the bastidravya is not absorbed entirely, some of the minute elements
are absorbed, which travels from pakwasaya to the whole body. The chemical reaction
sequence originated in pakwasaya passes fro cell-to-cell, ultimately in the entire body.
The milk constitutes high quality proteins. In addition, the whey proteins
have been demonstrated to increase the bone strength in experimental animals. The
lactose that enters the colon favors calcium and possibly phosphorus absorption in human
and is able to strengthen the nervous system. The anti inflammatory action of amleeka
and tila taila has already been proved.
Summary 115
The mucosa of the large intestine does not produce any enzyme. Any
digestion that occurs results due to the enzymes introduced from the small intestine or
from bacterial action. These mucous secretion occurs as local stimuli, such as friction or
exposure to harsh chemicals, trigger short reflexes involving local nerve plexuses. So,
here we can assume that the administered bastidravya, slightly alkaline in nature,
stimulates the bacterial action in colon and as a result vit K, vit B12, thiamine, riboflavin
etc are formed. They are essential for maintaining structural and functional integrity of
nervous system understood as normal functions of vata. The bacterial flora flourishes
abundantly on administration of niroohabasti dravya produces a favorable environment
for their growth, thus helps in maintaining the body strength.
The Vaitaranabasti has got the more lipid contents in it. The rectum has a
rich blood and lymph supply and drugs can cross the rectal mucosa like other lipid
membranes. The unionized and lipid soluble substances are rapidly absorbed from the
rectum. In the rectum, in the upper portion, the absorption is via the upper rectal mucosa
and is carried to the superior hemorrhoidal vein into portal circulation where as that
absorbed in the lower rectum enter directly into the systemic circulation via middle and
inferior hemorrhoidal vein.
These factors- the probable mode of action and probable mechanism of
action may be responsible for the relief in the signs and symptoms of the disease. So
these observations suggests that this therapy not only produces symptomatic relief but
also control the disease process and may cause long lasting effect.
Summary 116
CONCLUSION
A close perusal of the observation and inference that can be drawn leads to the
following conclusions.
• Vaitharanabasti is an effective treatment in the management of Gridhrasi and it
shows long lasting result.
• On both vataja and vatakaphaja Gridhrasi, Vaitharanabasti found effective in
managing the chief and associated complaints except shosha.
• Vaitharanabasti can be administered without prior snehapana, swedana or
virechana.
• Complications are seldom occurring during and after the course of bastikarma.
• Vaitharanabasti can be prescribed without going into the intricacies of mutations
and permutations of doshas.
• It is easy to constitute, less time consuming and gives least discomfort to both
patient and physician.
• It is cheap compared to other conventional methods of management of Gridhrasi.
• Gridhrasi can be undoubtedly compared with that of Sciatica on its
etiopathogenesis and symptomatologies etc.
• Sciatic nerve can be named as Gridhrasi nadi / snayu.
• The study reveals that the disease is more prevalent in active class and
degeneration / dhatukshaya is the main cause i.e. lumbar spondylosis.
Suggestions for future study
1. Study is better to be conducted on a large sample.
Study has been conducted in yoga basti Sankhya and facts revealed in the study suggest
that the results will be more encouraging if the Vaitharanabasti is administered in the
Sankhya of kalabasti or karmabasti.
117
SUMMARY
The present study entitled ‘ evaluation of the efficacy of Vaitharanabasti in the
management of Gridhrasi (Sciatica)’ consists of 7 parts.
1. Introduction
2. Objectives
3. Review of literature
4. Methodology
5. Results
6. Discussion
7. Conclusion
The introduction consists of the general description of Ayurveda,
importance of Panchakarma, importance of bastikarma in Panchakarma and in vatavyadhi
and importance of basti in Gridhrasi.
The objectives consist of the need for the study and objectives of the study
and studies conducted on the related topic in the past and recent times.
Review of literature consists of the historical review, vyutpatti and
nirukthi of both bastikarma and Gridhrasi. The shareera part deals with both anatomy and
physiology related to the bastikarma and Gridhrasi. In the karma review, the procedure,
indications and contraindications etc of nirooha, anuvasana and uttarabasti, the drugs
used and the probable mode of action of basti are discussed. In the disease review,
nidana, samprapthi, poorvaroopa, roopa, vyavachedaka nidana etc are elaborated.
Summary 118
Methodology part deals with the preparation of Vaitharanabasti, drugs
used in Vaitharanabasti and its properties. The study design, subjective and objective
parameters with their gradings and tests to assess the parameters are explained.
The observations and results are dealt in the result section. The
demographic data, response to treatment and overall response are also dealt. Results are
given in the form of tables along with a short description. The improvements in selected
parameters are statistically analyzed and presented in the form of tables and graphs.
Discussion part is divided into five sections. First section entitled –
discussion on Gridhrasi and Sciatica – deals with the correlation between Gridhrasi and
Sciatica through the anatomical aspect to the roopavastha. The second section discuss
about the importance of bastikarma in Gridhrasi. Discussion on clinical study – the third
section deals with the analysis of clinical response to the treatment with logical
interpretation. The fourth section deals with the importance of Vaitharanabasti in
Gridhrasi and lastly the fifth section deals the probable mode of action of Vaitharanabasti
and the probable mechanism of action of Vaitharanabasti.
Summary 119
BIBLIOGRAPHIC REFERENCES 1. Agnivesa, Charakasamhitha Siddhisthana chapter 1-5, 7, 8, 10-12. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 680-703,709-715, 734-738. (Kasi Sanskrit series 228).
2. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35, 36, 37, 38. Varanasi:
Krishnadas Academy; 1980. p. 525-548. (Krishnadas Ayurveda series 51).
3. Ashtangasangraha Suthrasthana chapter 28 - Kalpasthana chapters 4, 5, 6, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485, 579-606. (Jaikrishnadas Ayurvedic series 79).
4. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 – Kalpasiddhi chapter 4, 5.
Varanasi: Krishnadas Academy; 1982. p. 270, 753, 763. (Krishnadas Academic series 4).
5. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, 6, 7. 3rd ed.
Varanasi: Chaukhambha Orientalia; 1983. p. 318-338. (Jaikrishnadas Ayurveda Granthamala 53).
6. Vangasena, Vangasenasamhitha Bastikarmaadhikara. Jain Sankarlalji Vaidya,
editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 952. 7. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 54. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 289. (Kasi Sanskrit series 154).
8. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions).
Kottakkal: Aryavaidyasala Seminar publications; 1988. p. 7. 9. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions).
Kottakkal: Aryavaidyasala Seminar publications; 1988. p. 7. 10. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions).
Kottakkal: Aryavaidyasala Seminar publications; 1988. p. 8. 11. Agnivesa, Charakasamhitha Suthrasthana chapter 20 sloka 11. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 113. (Kasi Sanskrit Series 228).
12. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 56, 101. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 619, 621. (Kasi Sanskrit Series 228).
13. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi:
Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51).
Bibliography 119
Sushrutha, Sushruthasamhitha Shareerasthana chapter 8 sloka 17. Varanasi: Krishnadas Academy; 1980. p. 381. (Krishnadas Ayurveda series 51).
14. Ashtangasangraha Nidanasthana chapter 15 sloka 56. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 248. (Jaikrishnadas Ayurvedic series 79). Ashtangasangraha Chikitsasthana chapter 23 sloka 13. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 523. (Jaikrishnadas Ayurvedic series 79). Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 54. Varanasi: Krishnadas Academy; 1982. p. 535. (Krishnadas Academic series 4). Vagbhata, Ashtangahridaya Chikitsasthana chapter 21 sloka 1. Varanasi: Krishnadas Academy; 1982. p. 722. (Krishnadas Academic series 4).
15. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 133-140. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 243-244. (Chaukhambha Sanskrit series 130). Chakrapanidatta, Chakradatta chapter 22. P.V.Sharma, editor. Varanasi: Chaukhambha Publishers; 1998. p. 183-214. (Kasi Ayurveda series 17).
16. Chakrapanidatta, Chakradatta chapter 22 sloka 53. P.V.Sharma, editor. Varanasi: Chaukhambha Publishers; 1998. p. 189. (Kasi Ayurveda series 17).
17. Yogaratnakara Vatavyadhinidana – Vatavyadhichikitsa. Vaidya
Lakshmipatisastry, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 511, 512. (Kasi Sanskrit series 160).
18. Madhavakara, Madhavanidana chapter 22 sloka 54. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 538. (Chaukhambha Ayurvijnana Granthamala 46).
19. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 27 sloka 20-21. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 41. (Kasi Sanskrit series 154).
20. Sharangadhara, Sarngadharasamhitha Poorvakhanda chapter 7. 3rd ed. Varanasi:
Chaukhambha Orientalia; 1983. p. 77. (Jaikrishnadas Ayu. Granthamala 53).
21. Bhelacharya, Bhelasamhitha Chikitsasthana chapter 26. Girijadayal Shukla, editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p. 210, 215, 219. Hareetamuni, Hareethasamhitha chapter 22 sloka 1-2, 6-12. Vaidya Ravidatta Shastry, editor. Varanasi: Khemaraja Srikrishnadas; 1927. p. 346, 348.
22. Vaidyavara Basavaraja, Basvarajeeyam Prakarana 6. Shri Govardhana Sharma, editor. Varanasi: Chaukhambha Vidyabhavan; 1987. p. 93.
Bibliography 120
23. Amarasimha, Amarakosha Manushyavarga 6 sloka 73. Pundit Vishwanath Jha, editor. Delhi: Motilal Banarasi Das; 1976. p. 139.
24. Kasture VG, Ayurvediyapanchakarmavigyan chapter 6. 6th ed. Nagpur: Shree
Baidyanath Ayurved Bhavan Ltd.; 1998. p. 371.
25. Amarasimha, Amarakosha sloka 2015. Pundit Vishwanath Jha, editor. Delhi: Motilal Banarasi Das; 1976.
26. Amarasimha, Amarakosha. Pundit Vishwanath Jha, editor. Delhi: Motilal
Banarasi Das; 1976. p. 452.
27. Williams Monier Monier Sir, Sanskrit English Dictionary cognate Indo-European languages. New Delhi: Motilal Banarasi Das; 1970. p. 361.
28. Dorland’s pocket Medical Dictionary. 26th Ed. Novak D.P, editor. Noida: W. B.
Saunders Co; 2001. p. 743.
29. Arunadatta, Ashtangahridaya Suthrasthana chapter 19 sloka 1. Varanasi: Krishnadas Academy; 1982. p. 270. (Krishnadas academic series 4).
30. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5 sloka 1. 3rd ed.
Varanasi: Chaukhambha Orientalia; 1983. p. 319. (Jaikrishnadas Ayu. Granthamala 53).
31. Ashtangasangraha Suthrasthana chapter 28 sloka 2. Prof.K.R.Shrikhantamurthy,
editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485. (Jaikrishnadas Ayurvedic series 79).
32. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 56. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228).
33. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi: Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51).
34. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 54. Varanasi:
Krishnadas Academy; 1982. p. 535. (Krishnadas academic series 4).
35. Helfet.A.J, Disorders of lumbar spine chapter 4. 2nd ed. Toronto: J.B.Lippincott Company; 1972. p. 28.
36. Adamalla, Goodarthadeepika Sarngadharasamhitha Poorvakhanda chapter 7 sloka
108. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 103. (Jaikrishnadas Ayu. Granthamala 53).
Bibliography 121
37. Dalhana, Nibandhasangraha Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi: Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51).
38. Raja Radhakantha Deva Bahadur, Shabdakalpadruma vol 4, 3rd ed.
Varanasi:Chaukambha Sanskrit Series; p. 255.(Chaukambha Samskrita Granthamala-93).
39. Madhavakara, Madhavanidana chapter 22 sloka 54. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 538. (Chaukhambha Ayurvijnana Granthamala 46).
40. Agnivesa, Charakasamhitha Siddhisthana chapter 7 sloka 1. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 709. (Kasi Sanskrit series 228).
41. Agnivesa, Charakasamhitha Suthrasthana chapter 20 sloka 11. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 113. (Kasi Sanskrit series 228).
42. Agnivesa, Charakasamhitha Suthrasthana chapter 19 sloka 4-7. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 110. (Kasi Sanskrit series 228).
43. Sushrutha, Sushruthasamhitha Nidanasthana chapter 2 sloka 5. Varanasi: Krishnadas Academy; 1980. p. 272. (Krishnadas Ayurveda series 51).
44. Sushrutha, Sushruthasamhitha Nidanasthana chapter 2 sloka 6-7. Varanasi:
Krishnadas Academy; 1980. p. 272. (Krishnadas Ayurveda series 51).
45. Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 10. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 338. (Kasi Sanskrit series 228).
46. Vagbhata, Ashtangahridaya Shareerasthana chapter 3 sloka 13. Varanasi:
Krishnadas Academy; 1982. p. 388. (Krishnadas academic series 4).
47. Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 338. (Kasi Sanskrit series 228).
48. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5 sloka 10. Varanasi:
Krishnadas Academy; 1980. p. 364. (Krishnadas Ayurveda series 51).
49. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 899.
50. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5 sloka 8. Varanasi:
Krishnadas Academy; 1980. p. 364. (Krishnadas Ayurveda series 51).
51. Vagbhata, Ashtangahridaya Shareerasthana chapter 3 sloka 10-11. Varanasi: Krishnadas Academy; 1982. p. 387. (Krishnadas academic series 4).
Bibliography 122
52. Vagbhata, Ashtangahridaya Shareerasthana chapter 3 sloka 10-11. Varanasi:
Krishnadas Academy; 1982. p. 387. (Krishnadas academic series 4).
53. Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 10. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 338. (Kasi Sanskrit series 228).
54. Vagbhata, Ashtangahridaya Shareerasthana chapter 3 sloka 12. Varanasi:
Krishnadas Academy; 1982. p. 387. (Krishnadas academic series 4).
55. Sharangadhara, Sarngadharasamhitha Poorvakhanda chapter 5 sloka 9. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 44. (Jaikrishnadas Ayu. Granthamala 53).
56. Martini.F.H, Fundamentals of Anatomy and Physiology chapter 24. 4th ed. New
Jersey: Prentice Hall Inc. Simon & Schuster; 1998. p. 900.
57. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5 sloka 27. Varanasi: Krishnadas Academy; 1980. p. 367. (Krishnadas Ayurveda series 51).
58. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5 sloka 14. Varanasi:
Krishnadas Academy; 1980. p. 365. (Krishnadas Ayurveda series 51).
59. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5 sloka 37. Varanasi: Krishnadas Academy; 1980. p. 367. (Krishnadas Ayurveda series 51).
60. Vagbhata, Ashtangahridaya Suthrasthana chapter 10 sloka 1. Varanasi:
Krishnadas Academy; 1982. p. 174. (Krishnadas academic series 4).
61. Vagbhata, Ashtangahridaya Suthrasthana chapter 12 sloka 14. Varanasi: Krishnadas Academy; 1982. p. 194. (Krishnadas academic series 4).
62. Sushrutha, Sushruthasamhitha Shareerasthana chapter 1 sloka 4. Varanasi:
Krishnadas Academy; 1980. p. 338. (Krishnadas Ayurveda series 51).
63. Agnivesa, Charakasamhitha Shareerasthana chapter 7 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 337. (Kasi Sanskrit series 228).
64. Sushrutha, Sushruthasamhitha Shareerasthana chapter 5. Varanasi: Krishnadas
Academy; 1980. p. 363. (Krishnadas Ayurveda series 51). 65. Sushrutha, Sushruthasamhitha Shareerasthana chapter 6 sloka 27. Varanasi:
Krishnadas Academy; 1980. p. 374. (Krishnadas Ayurveda series 51).
66. Chaurasia.B.D, Human Anatomy (vol 2) section 1 chapter 7. 3rd ed. New Delhi: CBS Publishers and Distributors; 1995. p. 75-77.
Bibliography 123
67. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 54. Varanasi: Krishnadas Academy; 1982. p. 535. (Krishnadas academic series 4).
68. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi:
Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51).
69. Agnivesa, Charakasamhitha Siddhisthana chapter 10 sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 724. (Kasi Sanskrit series 228).
70. Agnivesa, Charakasamhitha Siddhisthana chapter 10 sloka 5-6. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 724. (Kasi Sanskrit series 228).
71. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 1. Varanasi: Krishnadas Academy; 1982. p. 270. (Krishnadas academic series 4).
72. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 86. Varanasi:
Krishnadas Academy; 1982. p. 285. (Krishnadas academic series 4).
73. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 36 sloka 6. Varanasi: Krishnadas Academy; 1980. p. 529. (Krishnadas Ayurveda series 51).
74. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 87. Varanasi:
Krishnadas Academy; 1982. p. 286. (Krishnadas academic series 4).
75. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 525. (Krishnadas Ayurveda series 51).
76. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 27-28. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 682. (Kasi Sanskrit series 228).
77. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 289. (Kasi Sanskrit series 154).
78. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 18. Varanasi:
Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).
79. Kasture VG, Ayurvediyapanchakarmavigyan chapter 6. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 373.
80. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 18. Varanasi: Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).
81. Ashtangasangraha Suthrasthana chapter 28 sloka 4. Prof.K.R.Shrikhantamurthy,
editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485. (Jaikrishnadas Ayurvedic series 79).
Bibliography 124
82. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 17. Varanasi: Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).
83. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 19. Varanasi:
Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).
84. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 61. Varanasi: Krishnadas Academy; 1982. p. 282. (Krishnadas academic series 4).
85. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5 sloka 19-22. 3rd ed.
Varanasi: Chaukhambha Orientalia; 1983. p. 323. (Jaikrishnadas Ayu. Granthamala 53).
86. Agnivesa, Charakasamhitha Siddhisthana chapter 8. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 713-715. (Kasi Sanskrit series 228).
87. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 37 sloka 77. Varanasi: Krishnadas Academy; 1980. p. 536. (Krishnadas Ayurveda series 51).
88. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 47-48. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 684. (Kasi Sanskrit series 228).
89. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 7. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).
90. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 8. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).
91. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).
92. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 37 sloka 39. Varanasi:
Krishnadas Academy; 1980. p. 533. (Krishnadas Ayurveda series 51).
93. Agnivesa, Charakasamhitha Siddhisthana chapter 8 sloka 2-14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 713. (Kasi Sanskrit series 228).
94. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 118. Varanasi:
Krishnadas Academy; 1980. p. 548. (Krishnadas Ayurveda series 51). 95. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 36 sloka 3. Varanasi:
Krishnadas Academy; 1980. p. 528. (Krishnadas Ayurveda series 51).
96. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 53. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).
Bibliography 125
97. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).
98. Agnivesa, Charakasamhitha Siddhisthana chapter 12 sloka 15. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 731. (Kasi Sanskrit series 228).
99. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 116. Varanasi: Krishnadas Academy; 1980. p. 548. (Krishnadas Ayurveda series 51).
100.Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 170. Jain Sankarlalji
Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 999.
101.Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 186-190. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 1000.
102. Chakrapanidatta, Chakradatta chapter 73 sloka 29-31. 2nd ed. P.V.Sharma
editor. Varanasi: Chaukhambha Publishers; 1998. p. 628. (Kasi Ayurveda series 17).
103. Chakrapanidatta, Chakradatta chapter 73 sloka 23-26. 2nd ed. P.V.Sharma
editor. Varanasi: Chaukhambha Publishers; 1998. p. 627-628. (Kasi Ayurveda series 17).
104. Vagbhata, Ashtangahridaya Chikitsasthana chapter 9 sloka 72-76. Varanasi:
Krishnadas Academy; 1982. p. 661. (Krishnadas Academic series 4). 105. Agnivesa, Charakasamhitha Siddhisthana chapter 6 sloka 83. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 708. (Kasi Sanskrit series 228).
106. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 182-185. Jain Sankarlalji Vaidya editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 999.
107. Vagbhata, Ashtangahridaya Chikitsasthana chapter 19 sloka 4, 5, 6. Varanasi:
Krishnadas Academy; 1982. p. 271-272. (Krishnadas Academic series 4). 108. Agnivesa, Charakasamhitha Siddhisthana chapter 2 sloka 14-15. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 688-689. (Kasi Sanskrit series 228).
109. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 21. Varanasi: Krishnadas Academy; 1980. p. 527. (Krishnadas Ayurveda series 51).
110. Agnivesa, Charakasamhitha Siddhisthana chapter 6 sloka 83. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 708. (Kasi Sanskrit series 228).
Bibliography 126
111. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 5. Varanasi: Krishnadas Academy; 1980. p. 525. (Krishnadas Ayurveda series 51).
112. Vagbhata, Ashtangahridaya Chikitsasthana chapter 19 sloka 2-3. Varanasi:
Krishnadas Academy; 1982. p. 271. (Krishnadas Academic series 4).
113. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 6 sloka 6-7. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 331. (Jaikrishnadas Ayu. Granthamala 53).
114. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 102. Jain
Sankarlalji Vaidya, editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 992.
115. Agnivesa, Charakasamhitha Siddhisthana chapter 2 sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 689. (Kasi Sanskrit series 228).
116. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 6. Varanasi:
Krishnadas Academy; 1982. p. 272. (Krishnadas Academic series 4). 117. Agnivesa, Charakasamhitha Siddhisthana chapter 2 sloka 18-19. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 689. (Kasi Sanskrit series 228).
118. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 8. Varanasi:
Krishnadas Academy; 1982. p. 272. (Krishnadas Academic series 4). 119. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 22. Varanasi:
Krishnadas Academy; 1980. p. 527. (Krishnadas Ayurveda series 51). 120. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 7. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 691. (Kasi Sanskrit series 228). 121. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 10-14. Varanasi:
Krishnadas Academy; 1982. p. 273-274. (Krishnadas Academic series 4). 122. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 8-9. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 691. (Kasi Sanskrit series 228). 123. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 7-9. Varanasi:
Krishnadas Academy; 1980. p. 525-526. (Krishnadas Ayurveda series 51). 124. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 11. Varanasi:
Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51).
Bibliography 127
125. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 14. Varanasi: Krishnadas Academy; 1982. p. 274. (Krishnadas Academic series 4).
126. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 10-12. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 692. (Kasi Sanskrit series 228).
127. Agnivesa, Charakasamhitha Siddhisthana chapter 5 sloka 4-6. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 702. (Kasi Sanskrit series 228). 128. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 36 sloka 8-11. Varanasi:
Krishnadas Academy; 1980. p. 529. (Krishnadas Ayurveda series 51). 129. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 6. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 691. (Kasi Sanskrit series 228). 130. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 17-19. Varanasi:
Krishnadas Academy; 1982. p. 274. (Krishnadas Academic series 4). 131. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 9. Varanasi:
Krishnadas Academy; 1980. p. 526. (Krishnadas Ayurveda series 51). 132. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 31. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 695. (Kasi Sanskrit series 228). 133. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 19. Varanasi:
Krishnadas Academy; 1982. p. 274. (Krishnadas Academic series 4). 134. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 27. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228). 135. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 45. Varanasi:
Krishnadas Academy; 1982. p. 279. (Krishnadas Academic series 4). 136. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 23. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 693. (Kasi Sanskrit series 228). 137. Ashtangasangraha Suthrasthana chapter 28 sloka 28. Prof.K.R.Shrikhantamurthy
editor. Varanasi: Chaukhambha Orientalia; 1996. p. 492. (Jaikrishnadas Ayurvedic series 79).
138. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 30. Varanasi: Krishnadas Academy; 1980. p. 542. (Krishnadas Ayurveda series 51).
139. Vagbhata, Ashtangahridaya Kalpasthana chapter 6 sloka 21. Varanasi:
Krishnadas Academy; 1982. p. 775. (Krishnadas Academic series 4).
Bibliography 128
140. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 26-28. Varanasi: Krishnadas Academy; 1980. p. 541. (Krishnadas Ayurveda series 51).
141. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 30. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228). 142. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 29-30. Varanasi:
Krishnadas Academy; 1980. p. 542. (Krishnadas Ayurveda series 51). 143. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 22-23. Varanasi:
Krishnadas Academy; 1982. p. 275. (Krishnadas Academic series 4). 144. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 27. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228). 145. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 38 sloka 1-6. Varanasi:
Krishnadas Academy; 1980. p. 539-540. (Krishnadas Ayurveda series 51). 146. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 24-26. Varanasi:
Krishnadas Academy; 1982. p. 276. (Krishnadas Academic series 4). 147. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 26-30. Varanasi:
Krishnadas Academy; 1982. p. 276-277. (Krishnadas Academic series 4). 148. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 28-29. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228). 149. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 43-45. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 685. (Kasi Sanskrit series 228). 150. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 26-30. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 699-700. (Kasi Sanskrit series 228). 151. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 13-17. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 692. (Kasi Sanskrit series 228). 152. Ashtangasangraha Suthrasthana chapter 28 sloka 19. Prof.K.R.Shrikhantamurthy
editor. Varanasi: Chaukhambha Orientalia; 1996. p. 491. (Jaikrishnadas Ayurvedic series 79).
153. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 41-43. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 685. (Kasi Sanskrit series 228).
154. Agnivesa, Charakasamhitha Siddhisthana chapter 5 sloka 16. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 702. (Kasi Sanskrit series 228).
Bibliography 129
155. Agnivesa, Charakasamhitha Siddhisthana chapter 7 sloka 4-62. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 709-712. (Kasi Sanskrit series 228).
156. Agnivesa, Charakasamhitha Siddhisthana chapter 9 sloka 40. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 719. (Kasi Sanskrit series 228). 157. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 70. Varanasi:
Krishnadas Academy; 1982. p. 283. (Krishnadas Academic series 4). 158. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 37 sloka 102. Varanasi:
Krishnadas Academy; 1980. p. 537. (Krishnadas Ayurveda series 51). 159. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 72. Varanasi:
Krishnadas Academy; 1982. p. 283. (Krishnadas Academic series 4). 160. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 37 sloka 102, 106, 107.
Varanasi: Krishnadas Academy; 1980. p. 537-538. (Krishnadas Ayurveda series 51).
161. Agnivesa, Charakasamhitha Siddhisthana chapter 9 sloka 56-59. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 719. (Kasi Sanskrit series 228). 162. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 75-76. Varanasi:
Krishnadas Academy; 1982. p. 283-284. (Krishnadas Academic series 4). 163. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 77-78, 81-82.
Varanasi: Krishnadas Academy; 1982. p. 285. (Krishnadas Academic series 4). 164. Agnivesa, Charakasamhitha Suthrasthana chapter 1 sloka 83-84. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 21. (Kasi Sanskrit series 228). 165. Agnivesa, Charakasamhitha Suthrasthana chapter 1 sloka 87. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 21. (Kasi Sanskrit series 228). 166. Agnivesa, Charakasamhitha Suthrasthana chapter 1 sloka 94-95. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 21. (Kasi Sanskrit series 228). 167. Agnivesa, Charakasamhitha Suthrasthana chapter 2 sloka 11-14. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 25. (Kasi Sanskrit series 228). 168. Agnivesa, Charakasamhitha Suthrasthana chapter 4 sloka 25-26. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 26. (Kasi Sanskrit series 228). 169. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 37 sloka 29-30. Varanasi:
Krishnadas Academy; 1980. p. 533. (Krishnadas Ayurveda series 51).
Bibliography 130
170. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 24. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 693. (Kasi Sanskrit series 228).
171. Jejjata, Charakasamhitha Siddhisthana chapter 3 sloka 24. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 693. (Kasi Sanskrit series 228). 172. Jejjata, Charakasamhitha Siddhisthana chapter 3 sloka 24. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 693. (Kasi Sanskrit series 228). 173. Agnivesa, Charakasamhitha Siddhisthana chapter 1 sloka 140. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 684. (Kasi Sanskrit series 228). 174. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 23-25. Varanasi:
Krishnadas Academy; 1980. p. 527. (Krishnadas Ayurveda series 51). 175. Vagbhata, Ashtangahridaya Suthrasthana chapter 11 sloka 26. Varanasi:
Krishnadas Academy; 1982. p. 186. (Krishnadas Academic series 4). 176. Dalhana, Nibandhasangraha Sushruthasamhitha Kalpasthana chapter 5 sloka 40.
Varanasi: Krishnadas Academy; 1980. p. 574. (Krishnadas Ayurveda series 51). 177. Dalhana, Nibandhasangraha Sushruthasamhitha Kalpasthana chapter 5 sloka 40.
Varanasi: Krishnadas Academy; 1980. p. 574. (Krishnadas Ayurveda series 51). 178. Dalhana, Nibandhasangraha Sushruthasamhitha Kalpasthana chapter 5 sloka 40.
Varanasi: Krishnadas Academy; 1980. p. 574. (Krishnadas Ayurveda series 51). 179. Vagbhata, Ashtangahridaya Shareerasthana chapter 3 sloka 50. Varanasi:
Krishnadas Academy; 1982. p. 394. (Krishnadas Academic series 4). 180. Guptha.S.J.Dr, Panchakarma therapy. Calcutta: Ayurveda Vikas; 2000. p. 50-51.
181. Sharma.A.K.Prof, Role of Bastikarma in the management of Vatavyadhi. Jaipur: Ayurveda Mahasammelan Pathrika; 2004. p. 74-75.
182. Singh.R.H. Prof, Panchakarma therapy Chapter 12. 2nd ed. Varanasi:
Chaukhambha Sanskrit Series Office; 2002. p. 362. (Chaukhambha Sanskrit series CIV)
183. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 15-16. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 617. (Kasi Sanskrit series 228).
183. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 15-18. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228).
Bibliography 131
185. Vagbhata, Ashtangahridaya Nidanasthana chapter 1 sloka 14-15. Varanasi: Krishnadas Academy; 1982. p. 444. (Krishnadas Academic series 4).
186. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 16. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 617. (Kasi Sanskrit series 228). 187. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 59. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228). 188. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 17. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 617. (Kasi Sanskrit series 228). 189. Dalhana, Nibandhasangraha Sushruthasamhitha Shareerasthana chapter 6 sloka
26. Varanasi: Krishnadas Academy; 1980. p. 374. (Krishnadas Ayurveda series 51).
190. Joshi.V.R, Low backache- API Textbook of Medicine section XVII
Rheumatology. 6th ed. Sainani.G.S, editor. Mumbai: Association of Physicians of India. p. 1077.
191. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 60. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228). 192. Natarajan.M.Dr, Textbook of Orthopedics and Traumatology chapter 12. 4th ed.
Chennai: M.N.Orthopedic Hospital; 2000. p. 147-150. 193. Dalhana, Nibandhasangraha Sushruthasamhitha Shareerasthana chapter 9 sloka
11. Varanasi: Krishnadas Academy; 1980. p. 385. (Krishnadas Ayurveda series 51).
194. Sushrutha, Sushruthasamhitha Shareerasthana chapter 4 sloka 8-9. Varanasi:
Krishnadas Academy; 1980. p. 355-356. (Krishnadas Ayurveda series 51). 195. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi:
Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51). 196. Ashtangasangraha Suthrasthana chapter 20 sloka 2. Prof.K.R.Shrikhantamurthy,
editor. Varanasi: Chaukhambha Orientalia; 1996. p. 368. (Jaikrishnadas Ayurvedic series 79).
197. Hareetamuni, Hareethasamhitha chapter 20 sloka 31-32. Vaidya Ravidatta
Shastry, editor. Varanasi: Khemaraja Srikrishnadas; 1927. p. 323. 198. Agnivesa, Charakasamhitha Suthrasthana chapter 28 sloka 10. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 179. (Kasi Sanskrit series 228).
Bibliography 132
199. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 56-57. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228).
200. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions).
Kottakkal: Aryavaidyasala Seminar publications; 1988. p. 70. 201. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 56-57. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228).
202. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 74. Varanasi:
Krishnadas Academy; 1980. p. 268. (Krishnadas Ayurveda series 51). 203. Vagbhata, Ashtangahridaya Nidanasthana chapter 16 sloka 54. Varanasi:
Krishnadas Academy; 1982. p. 535. (Krishnadas Academic series 4). 204. Madhavakara, Madhavanidana chapter 22 sloka 55. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 538. (Chaukhambha Ayurvijnana Granthamala 46).
205. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 124-132. 5th
ed. Varanasi: Chaukhambha Orientalia; 1988. p. 241-243. (Chaukhambha Sanskrit series 130).
206. Yogaratnakara Vatavyadhinidana sloka 4. Vaidya Lakshmipatisastry editor.
Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 511 (Kasi Sanskrit series 160).
207. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 57. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228). 208. Madhavakara, Madhavanidana chapter 22 sloka 56. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 538. (Chaukhambha Ayurvijnana Granthamala 46).
209. Yogaratnakara Vatavyadhinidana sloka 3-4. Vaidya Lakshmipatisastry, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 511 (Kasi Sanskrit series 160).
210. Adams. J.C.Dr, Outline of Orthopedics chapter 10. 13th ed. London: Churchill
Livingston; 2001. p. 200-205. 211. Adams. J.C.Dr, Outline of Orthopedics chapter 10. 13th ed. London: Churchill
Livingston; 2001. p. 172-177.
Bibliography 133
212. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 55. Varanasi: Krishnadas Academy; 1982. p. 535. (Krishnadas Academic series 4).
213. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 57. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 619. (Kasi Sanskrit series 228). 214.Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 45. Varanasi:
Krishnadas Academy; 1982. p. 534. (Krishnadas Academic series 4). 215. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 45. Varanasi:
Krishnadas Academy; 1982. p. 534. (Krishnadas Academic series 4). 216. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 46. Varanasi:
Krishnadas Academy; 1982. p. 534. (Krishnadas Academic series 4). 217. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 47-51. Varanasi:
Krishnadas Academy; 1982. p. 534. (Krishnadas Academic series 4). 218. Subrahmanian Shridevi Dr, Gridhrasi- Oru Padhanam. Kottakkal:
Aryavaidyasala Seminar publications; 1988. p. 31. 219. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 44. Varanasi:
Krishnadas Academy; 1982. p. 531. (Krishnadas Academic series 4). 220. Patel T.A, Ogle A.A, Diagnosis and Management of Acute Low back pain.
University of Kansas Medical Center.2002. Available from: www.spine-health.com. Accessed on 6th December 2002.
221. Sushrutha, Sushruthasamhitha Suthrasthana chapter 33 sloka 4. Varanasi:
Krishnadas Academy; 1980. p. 144. (Krishnadas Ayurveda series 51). 222. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 74. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228). Madhavakara, Madhavanidana chapter 22 sloka 77. Varanasi: Chaukhambha
Surbharathi Prakashan; 1998. p. 552. (Chaukhambha Ayurvijnana Granthamala 46).
223. Sushrutha, Sushruthasamhitha Suthrasthana chapter 33 sloka 7. Varanasi: Krishnadas Academy; 1980. p. 144. (Krishnadas Ayurveda series 51).
224. Bhelacharya, Bhelasamhitha Chikitsasthana chapter 26. Girijadayal Shukla
editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p. 210, 215, 219. 225. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi:
Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).
Bibliography 134
226. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 75-76. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228).
227. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 80. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228). 228. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 83. 4th ed. Varanasi:
Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228). 229. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 84-85. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228).
230. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 35 sloka 29-30. Varanasi:
Krishnadas Academy; 1980. p. 528. (Krishnadas Ayurveda series 51). 231. Shukla Vidyadhar, Kayachikitsa (vol 3) chapter 1. Varanasi: Chaukhambha
Surbharathi Prakashan; 2002. p. 26 (Chaukhambha Ayurvijnana Granthamala 30).
232. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 101. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 621. (Kasi Sanskrit series 228).
233. Sushrutha, Sushruthasamhitha Chikitsasthana chapter 8 sloka 17. Varanasi:
Krishnadas Academy; 1980. p. 439. (Krishnadas Ayurveda series 51). 234. Vagbhata, Ashtangahridaya Suthrasthana chapter 27 sloka 15. Varanasi:
Krishnadas Academy; 1982. p. 328. (Krishnadas Academic series 4). 235. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 101. 4th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 621. (Kasi Sanskrit series 228).
236. Sushrutha, Sushruthasamhitha Suthrasthana chapter 12 sloka 10. Varanasi:
Krishnadas Academy; 1980. p. 52. (Krishnadas Ayurveda series 51). 237. Vagbhata, Ashtangahridaya Chikitsasthana chapter 28 sloka 101. Varanasi:
Krishnadas Academy; 1982. p. 621. (Krishnadas Academic series 4).
238. Chakrapanidatta, Chakradatta chapter 22 sloka 53-55. P.V.Sharma, editor. Varanasi: Chaukhambha Publishers; 1998. p. 189-190. (Kasi Ayurveda series 17).
239. Hareetamuni, Hareethasamhitha chapter 22 sloka 6-12. Vaidya Ravidatta
Shastry, editor. Varanasi: Khemaraja Srikrishnadas; 1927. p. 348.
Bibliography 135
240. Patel T.A, Ogle A.A, Diagnosis and Management of Acute Low back pain. University of Kansas Medical Center.2002. Available from: www.spine-health.com. Accessed on 6th December 2002.
241. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions).
Kottakkal: Aryavaidyasala Seminar publications; 1988. p. 106-109. 242. Vangasena, Vangasenasamhitha Bastikarmaadhikara sloka 186-190. Jain
Sankarlalji Vaidya, editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 1000.
243. Chakrapanidatta, Chakradatta chapter 73 sloka 32. P.V.Sharma editor. Varanasi: Chaukhambha Publishers; 1998. p. 628. (Kasi Ayurveda series 107).
244. Chakrapanidatta, Chakradatta chapter 73 sloka 29-31. P.V.Sharma editor.
Varanasi: Chaukhambha Publishers; 1976. p. 628. (Kasi Ayurveda series 17).
245. Sushrutha, Sushruthasamhitha Suthrasthana chapter 45 sloka 160-167. Varanasi: Krishnadas Academy; 1980. p. 209. (Krishnadas Ayurveda series 51).
246. Chemical components of Jaggery- Environ Health Perspect. 1994. Available
from: www.sugarindia.com. Accessed on 4th November 2004. 247. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal
plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 540. 248. Rubin.K.Dr, Chemical components of Rock salt. University of Hawaii.2003.
Available from: www.geophysics.com/hawaii/HI96822. Accessed on 4th November 2004.
249. Govindadasa, Bhaishajyaratnavali Jwarachikitsa prakarana. 7th ed. Kaviraj
Ambikadatta Shastri, editor. Varanasi: Chaukhambha Orientalia; 1983. p. 130. (Kasi Sanskrit series 152).
250. Sushrutha, Sushruthasamhitha Suthrasthana chapter 45 sloka 113. Varanasi:
Krishnadas Academy; 1980. p. 205. (Krishnadas Ayurveda series 51). 251. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal
plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 530. 252. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal
plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 542. 253. Jensen.R.G, Handbook of milk composition. New York: Academic press; 1995.
Available from: www.dairyhealth.com. Accessed on 4th November 2004.
Bibliography 136
254. Adams. J.C.Dr, Outline of Orthopedics chapter 10. 13th ed. London: Churchill Livingston; 2001. p. 173-177.
255. Nair.P.R, Management of Khanja and Pangu with Panchakarma. New Delhi:
CCRAS; 1999. p. 40. 256. Laurence.D.R, Clinical Pharmacology chapter 17. 8th ed. Singapore: Churchill
Livingstone; 1997. p. 289.
Bibliography 137
SPECIAL CASE SHEET FOR GRIDHRASI Post Graduate Research and Studies Centre (Panchakarma)
Shri. D.G.M. Ayurvedic Medical College, Gadag Guide : Dr. Purushothamacharyulu M.D. (Ayu) Co- Guide : Dr. Shashidar H. Doddamani M.D. (Ayu) P.G. Scholar : Satheesh R. 1. Name of the patient : Sl. No. 2. Father’s/ Husband’s Name : OPD. No. 3. Age : Years IPD No. 4. Sex Bed No. M F 5. Religion : Hindu Muslim Christian Others 6. Occupation : Sedentary Active Labour Others 7. Economical Status : Poor Middle class Higher class 8. Address :………………………………………….Phone No. ………………………………………… ………………………………………… E-mail : Pin : 9. Date of Schedule Initiation : 10. Date of Schedule Completion : 11. Result :
CompletelyRelieved
Marked Response
Moderate response
Mild response
Un changed
12. Consent : I hereby agree that, I have been fully educated with the disease and treatment. Hereby satisfied whole heartedly, and accept the medical trial
over me.
Investigator’s Signature. Patient’s Signature.
1
Chief Complaints with duration. a) RUK (Pain)
Onset : Sudden Gradual Variety : Acute Chronic Nature : Local General Radiated
Yes No At Postural Change :
Physical Exercise Emotion Exposure to cold Exposure to heat Any other causes
Aggravating Factors :
Rest Pain relievers Pressure Relieving factors : Severity of pain : Gr. 0 Gr. 1 Gr. 2 Gr. 3 Gr. 4 Lumbar region : Lumbodorsal
Lumbar Lumbosacral
Duration
Leg : Right Left Both Duration Thigh Calf Foot
b) STHAMBHA (Stiffness) : Present Absent Grade Site : …………………………………………………
Sequential General Duration
Rest Walking Pain relievers Relieving factors : Time : Early morning Morning Afternoon Evening Night
Toda Spandana Ayama c) Abnormal Sensations :
Present Absent Duration d) TANDRA (Drowsiness) :
Present Absent Duration e) GOWRAVA (Heaviness) :
Present Absent Duration f) ARUCHI (Tastelessness) :
2
Present Absent g) DEHAVAKRATHA (Scoliosis) : 2. Associated Complaints
Present Absent a) Numbness : : R. Lower limb L. Lower limb Bilateral
b) Wasting : Present Absent R. Lower limb L. Lower limb Bilateral c) Constipation : Present Absent Recent Long Standing
Present Absent d) Burning Sensation :
R. Lower limb L. Lower limb Bilateral
Present Absent e) Sleeplessness : Duration –daily …………………hrs. 3. History of present illness
Sudden Gradual Mode of onset :
Trauma Lifting up weight Part first affected :
Spik Kati Prushta Uru Janu Jangha Pada Direction of spread
Back and outer side of thigh, leg and foot Sacroilliac joints
R. Lower limb L. Lower limb Bilateral Routine activities affected : Yes No
3
4. History of past illness Episodes of same illness Yes No Obesity Yes No Tuberculosis Yes No Other Vata Vyadhees Yes No Diabetes Mellitus Yes No Trauma/Fracture involved of lumbar region Yes No Others Yes No
5. Treatment History
Modern Medicine Ayurvedic Medicine Others Relief with previous treatment
Cured Partially cured No relief at all 6. Family history – relevant : Yes No 7. Personal History Ahara : Veg Mixed Agni : Manda Theekshna Vishama Sama Koshta : Madhya Mrudu Kroora Mutra Pravurti- Frequency : Day Night Nidra : Sukha Alpha Ati Vishama Vyasana : Smoking Tobacco chewing Alcohol None
1 time 2 times more constipated Malapravurthi : Frequency :
Alpa Ati Vishama Rajonivrutti Aarthavapravurthi : No. of issues if any : ……………………………… History of previous pregnancy and labor : ……………………………………………… Abortions : Miscarriages : Yes No Yes No
4
Position during daily working hours Nature of work
Hard manual Moderate manual Sedentary House work Office work Others
Psychological status Anxious Depressed Irritable Angry Grief Broody Normal 8. Vital Examinations Pulse Blood Pressure
Standing Sitting Stooping Squatting
/mm Hg/ m Temperature Respiration 0C /m Weight Height Kg Cms. Nadee pareeksha
Dosha
Gati
Poornata
Spanda
Khatinya
9. Dasa Vidha Pareeksha
a) Prakuthi V P K VP VK PK Sannipata
b) Vikruthi
Hethu Prakruthi Dosha Desa Dushya Kala Bala Linga
Pravara Madhyama Avara c) Sara
Susamhata Madhyasamhata Asamhata d) Samhanana
5
Sama Adhilka Heena e) Pramana
Ekarasa Sarvarasa Vyamishra f) Satmya
Pravara Madhyama Avara g) Satva
Abhyavahara P M A Jaranasakti P M A
h) Aharasakthi i) Vyayama Sakti Pravara Madhyama Avara j) Vayaha Bala Madhyama Vrudha 10. Srotopareeksha
SROTAS OBSERVED LAKSHANA
Pranavaha
Annavaha
Udakavaha
Rasavaha
Raktavaha
Mamsavaha
Medovaha
Asthivaha
Majjavaha
Sukravaha
Pureeshavaha
Muthravaha
Aarthavavaha
6
11. Nidana
I. Swaprakopakara Nidana a) Ahara b) Vihara c) Manasika Guna Seeta Ratrijagarana Chinta
(Worry)
Rooksha Yanam (Riding) Laghu Bharavahana
(Weight lifting)
Rasa Katu Vyayama
Shoka (grief)
Tikta Pradhavana (Running)
Kashaya Jumping
Bhaya (Fear)
Shushkanna Pratarana (Swimming)
Upavasa Walking
Krodha (Anger)
II Marmaghatakara nidana III. Dhatukshayakaraka nidana
12. Special Examination a) VISUAL ANALOGUE SCALE (VAS) Before 9th day 17th day 40th day b) Spinal root examination
Root involved Pain Sensory loss Motor weakness Reflex change 2 nd Lumbar Front of mid
thigh Front of mid
thigh Quadriceps Diminished
knee jerk
3 rd Lumber Front of lower thigh
Front of lower thigh
Quadriceps Diminished knee jerk
4 th Lumbar Side of thigh Side of thigh Quadriceps Diminished knee jerk
Front of inner leg
Front of inner leg
Anterior tibialis
Weak dorsiflexion of foot
7
Back of thigh Back of thigh Anterior tibialis
Lateral leg Lateral leg
5 th Lumbar
Dorsum of foot to big toe
Dorsum of foot to big toe
Weak plantar flexion of big toe
Absent /Diminished ankle jerk
I st Sacral Base of leg sole and side of foot
Base of leg sole and side of foot
Gastronimus weak plantar flexion of big toe and foot
Absent ankle jerk
b) Gait : Normal Abnormal
If abnormal, ……………………… type of gait
c) Straight Leg Raising test (SLR) Active Right-Negative / Positive At………………Degrees
Left- Negative /Positive At………………Degrees
Passive Right-Negative / Positive At………………Degrees
Left- Negative /Positive At………………Degrees
d) Reflexes
Leg Absent Diminished Brisk
Right
Knee jerk
Left
Right Ankle jerk
Left
Leg Positive Negative
Right
Babinski’s sign
Left
8
e) Movement of lumbar spine Type of movements Nil Limited Full
Forward flexion
Right lateral flexion
Left lateral flexion
Extension
Rotation
f) Walking time Time taken to cover 21 meters Gr.0 Gr. I Gr. II Gr. III Gr. IV g) Other Investigations
TC
DC P L E M B
ESR
RBS
Hb%
Blood
Serum Alkaline phosphatase
Sugar
Albumin
Urine
Microscopic
X-ray
(Lumbosacral)
AP &Lat view
13. Basti Karma Nireekshana : Date of Basti initiation Date of Basti completion
9
Observations Time Amount
Introduced Time of
Retention No. of times
Motion passed
Upadrava if any
I Day am ml min
II Day am ml min
III Day am ml min
IV Day am ml min
V Day am ml min
VI Day am ml min
VII Day am ml min
VIII Day am ml min
14. Assessment of Results
Chief and Associated Complaints Before 9th Day 17th Day 40th Day
Ruk
Sthambha
Toda
Spandana
Ayama
Tandra
Gourava
Aruchi
Suptata
Shosha
Vibandha
Daha
10
Objective Assessment
a) SLR passive Before 9th Day 17th Day 40th Day
Right
Left
b) Movements of lumbar spine
i) Forward flexion in cms
ii) Right lateral flexion in cms
iii) Left lateral flexion in cms
Nil Limi ted
Full Nil Limi ted
Full Nil Limi ted
Full Nil Limi ted
Full
iv) Extension
v) Rotation
c) Walking time
Before 9th Day 17th Day 40th Day
Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 Gr.0 Gr.1 Gr.2 Gr.3 Gr.4
Signature of Scholar Signature of Supervisor.
11
SCORE SHEET A) Ruk (Pain) Grade 0 - No pain - Scale reading 0
Grade 1 - Trival pain - Scale reading 0-5
Grade 2 - Mild pain - Scale reading 6-10
Grade 3 - Moderate pain - Scale reading 11-16
Grade 4 - Severe pain - Scale reading 16-20
B) Sthambha (Stiffness) Grade 0 – No stiffness Grade 1- With up to 25% impairment in the range of movement of joints. Patient can perform daily routine work with out any difficulty. Grade 2- with 25-50% impairment in the range of movement of joints. Pt. has moderate to severe difficulty in performing daily routine. Grade 3- With 50-75% impairment in the range of movement of joints. Pt. has moderate to severe difficulty in performing daily routine. Grade 4 - With more than 75% impairment in the range of movements of the joints. Patient totally unable to perform daily routine C) Toda Grade 0- Absent (Piercing pain) Grade 1- Mild, occasionally in a day
Grade 2- Moderate, after movement, daily,
frequent not persistant.
Grade 3- Severe, persistant. D) Spandana Grade 0 - Absent (Twitching) Grade 1 - Present E) Ayama Grade 0 - Absent Grade 1 - Present F) Tandra Grade 0 - Absent (Drowsiness) Grade 1 - Present G) Gowrava Grade 0 - Absent (Heaviness) Grade 1 - Present
12
H) Aruchi Grade 0 - Absent (Tastelessness) Grade 1 - Present I ) Suptata Grade 0 - Absent (Numbness) Grade 1 - Present
J) Shosha Grade 0 - Absent (Wasting) Grade 1 - Present K) Vibandha Grade 0 - Absent (Constipation) Grade 1 - Present L) Daha Grade 0 - Absent (Burning sensation) Grade 1 - Present
II. SLR Test is assessed as positive at 00 to 900 with pain, negative at 900 (without pain) III. Movements of lumbar spine : 1 Forward flexion : Assessed by measuring the distance between the tip of
middle finger and floor in cms. 2. Rt. Lat. Flexion : Assessed by measuring the distance between the tip of right
middle finger and floor in cms. 3. Left Lat flexion : Assessed by measuring the distance between the tip of left
middle finger and floor in cms. IV. Walking time - to cover 21 meters Grade 0 - upto 20 sec. Grade 1 - upto 21-30 Sec Grade 2 - upto 31-40 Sec Grade 3 - upto 41-50 Sec Grade 4 - upto 51-60 Sec. V. Overall assessment Complete relief - 100% relief Marked response - more than 75% relief in signs and symptoms. Moderate response - 50-75% relief in signs and symptoms. Mild response - Below 50% relief in signs and symptoms Unchanged - No relief
13