|Year : 2021 | Volume
| Issue : 3 | Page : 196-200
Management of spondylosis-induced sciatica (Gridhrasi) with variation of Basti Dravya as per the Avastha of the disease: a case study
Neelam Kaalia, Chanchal Aggarwal, Santosh K Bhatted
Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||01-Oct-2020|
|Date of Decision||09-Jul-2021|
|Date of Acceptance||24-Jun-2021|
|Date of Web Publication||28-Sep-2021|
Dr. Neelam Kaalia
Department of Panchakarma, All India Institute of Ayurveda, New Delhi.
Source of Support: None, Conflict of Interest: None
Background: Improper sitting posture in office or continuous work in one posture and overexertion, lifting heavy weights, and jerking movements during traveling—all these factors create undue pressure and stress injury to the spine and play an important role in producing low back pain (LBP). Several low back conditions can cause sciatica, and lumbar disk degeneration is one of them. Based on the clinical symptoms, it can be correlated with Gridhrasi described in Ayurveda. Aim: The aim of this study was to treat a patient of Vata Kaphaja Gridhrasi on the basis of Avastha of Doshas with the help of Panchakarma treatment. Materials and Methods: This is a single case study of a 42-year-old female patient with complaints of severe acute pain in the lower back radiating to B/L lower limbs associated with a tingling sensation, a burning sensation in the upper and lower phalanges, and stiffness in joints for one month, causing difficulty in sitting and standing. She was treated by using Snehana, Svedana, and Basti Chikitsa along with Shamana Aushadha for three months in total. Assessment was done on BT (0th day), AT (31st day), and two follow-ups (61st day and 90th day) on the basis of VAS pain (Ruk), VAS stiffness (Stambha), fingertip to floor test, fasciculation (Spandana), straight leg raising (SLR) test by goniometer, femoral stretch, LBOS scale, and Maine Seattle Back Questionnaire for QoL. Result: The patient showed significant relief in VAS score for pain and stiffness, fingertip to floor distance was reduced significantly. Improvement was noticed in fasciculation and SLR test after treatment of one month.
Keywords: Avastha of Dosha, Basti, Gridhrasi, low back pain, lumbar disc degeneration, sciatica
|How to cite this article:|
Kaalia N, Aggarwal C, Bhatted SK. Management of spondylosis-induced sciatica (Gridhrasi) with variation of Basti Dravya as per the Avastha of the disease: a case study. J Indian Sys Medicine 2021;9:196-200
|How to cite this URL:|
Kaalia N, Aggarwal C, Bhatted SK. Management of spondylosis-induced sciatica (Gridhrasi) with variation of Basti Dravya as per the Avastha of the disease: a case study. J Indian Sys Medicine [serial online] 2021 [cited 2021 Dec 2];9:196-200. Available from: https://www.joinsysmed.com/text.asp?2021/9/3/196/326843
| Key Messages:|| |
In Gridhrasi (sciatica), the cumulative effect of Basti Chikitsa predominant treatment protocol shows significant improvement in various signs and symptoms according to the Avastha of Doshas. Otherwise, it will lead to aggravation of the disease if Avastha of Dosha and disease are not kept in mind.
| Introduction|| |
Improper sitting posture in office or continuous work in one posture and overexertion, lifting heavy weights, and jerking movements during traveling—all these factors create undue pressure and stress injury to the spine and play an important role in producing LBP. Several low back conditions can cause sciatica, and lumbar disk degeneration is one of them. An estimated 80% of the population experiences LBP during their lifetime. Sciatica refers to weakness, numbness, or tingling in the leg with low backache. In Ayurveda, sciatica can be correlated with Gridhrasi because of similarity in their clinical presentation. Gridhrasi (sciatica) is considered as Vata Vyadhi (diseases caused by vitiation of Vata). The common symptoms of Gridhrasi are pain that starts from Sphik (Buttock) and then radiates to Kati (Lumbar region), Prushta (Back), Uru (Thigh), Janu (Knee), Jangha (Calf), and Paada (Foot) along with Stambha (Stiffness), Toda (Pricking pain), and Spandana (Twitching); if the ailment is caused by aggravated Vata and Kapha, then the patient suffers from Tandra (Drowsiness), Gaurava (Heaviness), and Aruchi (Anorexia) also. In contemporary science, the disease is treated with NSAIDs, analgesics, muscle relaxants, calcium, Vitamin D supplements, and finally surgery. However, all these medical treatments are not long-lasting and cause side effects, limiting their use for a long period. Here, the need arises to search for effective Ayurveda treatment according to the Dosha Avastha (Stage of Dosha vitiation) of the disease. In this article, a case study of Gridhrasi and the variation of Basti Dravya (Enema Ingredients) as per the Avastha of Dosha in the patient is presented and successfully treated through a radical approach with the help of Panchakarma treatment. In Gridhrasi (sciatica due to lumbar disk degeneration) being a Vatavyadhi, Basti Chikitsa seems to be a preferred treatment. Further, variation of Basti Dravya as per the Avastha of Dosha such as Sama, Nirama, Dhatukshayajanya Vata Prakopa, and Avaranottha Vata Prakopa plays a significant role in providing immediate relief without any adverse effects.
| Case History|| |
A 42-year-old Hindu married female patient came to Panchakarma OPD of the All India Institute of Ayurveda, Sarita Vihar, New Delhi with the complaints of severe acute pain in the lower back radiating to B/L lower limbs associated with a tingling sensation, a burning sensation in the feet, and stiffness in joints since one month. The pain was so severe that she had difficulty in standing for even 10 min. and she had difficulty in lying straight on the bed. She was only comfortable in the prompt lateral position with continuous pain in her back. She had complaints of pain in the heels, white discharge per vaginum, flatulence, constipation, fatigue with a feverish feeling, and frequent cold and cough since one year. This condition had developed gradually. First, the patient felt pain in the lower back, which developed with stiffness in the joints followed by a tingling sensation in B/L legs, causing difficulty in sitting and standing. She took analgesics to relieve pain whenever it was aggravated.
The patient had Vata Kapha Prakriti with a sedentary lifestyle [Table 1].
| Clinical Examination|| |
Vital signs: Pulse, 80/min; respiratory rate, 17/min
BP: 110/80 mm Hg; Temperature: Afebrile
SLR: Positive, Left 30°, Right 20°
Spine movements: Pain increases on flexion and extension, difficulty in bending forward
Braggard’s sign: Positive
Faber test: Negative
No evidence of trauma, systemic disorder, rheumatoid arthritis, and gout
Sama Lakshana: Present
| Investigations|| |
- Hb: 13.2 g/dL
- TLC: 9.3 × 103 cu mm
- ESR: 12 mm during first hour
- FBS: 78.8mg/dL
- PPBS: 86.5mg/dL
- Urine: WBC (0–2), calcium oxalate present
- MRI findings: Lumbosacral spine was suggestive of lumbar spondylosis with disk degenerative changes at L3–L4, L4–L5, and L5–S1 levels indenting the right existing nerve root.
As per treatment principles, Panchakarma procedures were planned for a total duration of one month [Table 2] with internal medicines for three months [Table 3].
|Table 2: Panchakarma procedures adopted (December 7, 2019 to January 5, 2020)|
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| Result|| |
The results of the interventions are detailed in [Table 4][Table 5][Table 6].
| Discussion|| |
Gridhrasi is considered as Vata Vyadhi and has been mentioned under Vata Nanatamaja Vikara. Involvement of the pathology of the lumbar disc (Asthi and Tarunasthi) along with Vata Dosha leads to the causation of sciatica (Gridhrasi). Hence, the line of treatment of Vata Vyadhi such as Sarvanga Abhyanga with Karpasthyadi and Dhanwantara Taila, Jambeera Pinda Svedana with Karpasthyadi Taila as Purvakarma of Basti Chikitsa and Panchatikta Ksheera Basti was administered while keeping in mind the degenerative changes in the MRI of the lumbar spine of the patient, which could be correlated with Dhatukshayaj Asthi Ashrita Vikara. Tikta Dravya Siddha Ksheera, Ghrita Basti is specially advised in Asthi Vikaara. Due to the presence of Aama lakshanas, the Valuka Swedana was chosen until the Nirama avastha was attained. As the patient complained of pain and a tingling sensation in the upper and lower phalanges, Jambeera Pinda Svedana was chosen as a Svedana Karma, which is indicated in Vata Kapha predominant conditions. Karpasthyadi Taila was chosen for the neurological involvement in pain, as the patient had a positive SLR test. The MRI of the lumbosacral spine was not performed to find out any radiological improvement in the lumbosacral spine due to the patient’s financial condition.
During the thorough examination of the patient, it was found that the patient had symptoms similar to grade-3 Asthikshaya. Therefore, Panchatikta Ksheera Basti as Yoga Basti was administered. The patient got relief in tingling sensation and stiffness in the back. However, there was no improvement in the complaint of pain in the back due to Dhatukshayajanya Vataprakopa, particularly Asthi and Tarunasthi Kshaya. Further assessment revealed the shift of the disease to the symptoms of grade-2 Asthikshaya. Due to the shift in the Avastha of the disease and Kaphavrita Vata Lakshana, Erandamooladi Yoga Basti and Saindhavadi Taila Anuvasana was administered for another eight days, which is Deepana and Lekhana in nature along with Nirgundi Patra Pinda Svedana with Dhanwantar and Murivenna Taila. The patient showed significant and more relief in complaints of pain, stiffness, and fasciculation along with improvement in Klama, Gaurava, Alasya, and Suptata. A significant improvement was noticed in assessment parameters such as finger to floor distance, SLR, LBOS scale, and MSBQ grading.
Gandharvahastadi Kashaya was given as it has Vatashamana, Agnivardhana, Ruchyam, and Malasodhana properties. Ajamodadi Churna and Shankha Vati was given for the purpose of Aamapachana and Vatanulomana. MahasudarshanaGhana Vati has Tikta-Kashaya Rasa Pradhana, which helps in Aamapachana. Pushyanuga Churna was given for the complaint of white discharge. Triphala Churna causes Malashodhana and Vatanulomana, so it was given at night with lukewarm water. These internal medications were continued for three months for the prevention of Aama formation during follow-up and Parihara kala after panchakarma to maintain the balance in the body.
| Conclusion|| |
It can be concluded that although there are conservative treatments such as NSAIDS, analgesics, and surgical intervention for LBP, the patients do not want to opt for them due to their side effects and costly management. That is why it is the need of the hour to find out a treatment modality that not merely relieves pain but also restores the functional and structural stability and treats sciatica in a better way by adopting the principles and practices of Ayurveda, especially the Avasthik Chikitsa based on Dhatukshaya or Avarana of Dosha. Hence, Ayurveda can provide a cost-effective and sustainable treatment modality with its different formulations as per the Avastha of disease, which could be highly effective in the treatment of sciatica.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Charaka - The Speciality Ayurveda. Sciatica and Ayurveda. Available from:http://www.charaka.org/sciatica-ayurveda/ [Last accessed on 25 Sep 2020].
Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24:769-81.
Kumar M, Garg G, Singh LR, Singh T, Tyagi LK. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. Int J Pharm Biol Sci Arch 2011;2:1050-61.
Agnivesha . Maharoga Adhyaya, 20/11, Acharya YT, editor. Shri Chakrapanidatta, commentator, Charaka Samhita, Sutrasthana. Varanasi: Chaukhamba Surbharati Prakashan; 2016. p. 113.
Agnivesha , Vatavyadhichikitsa Adhyaya, 28/55–56, Acharya YT, editor. Shri Chakrapanidatta, commentator, Charaka Samhita, Chikitsasthana. Varanasi: Chaukhamba Surbharati Prakashan; 2016. p. 619.
Sharma S, Hakkandi S, Akki M. A comparative clinical study on patra pinda sweda and nadi sweda in the pain management of gridhrasi w.s.r. to sciatica. Int J Ayurveda Pharm Res 2019;6:9-16.
Vidyanath R, Nishteshwar K. Sahastrayogam, kashaya prakarana. Varanasi: Vatahara Kwatha, Chaukhamba Sanskrit Series Office; 2008: p. 46.
Dundukanath. Rasendra Cintamani, 9/Shularogadhikara 17. Hindi commentary by Mishra SN (Reprint). Varanasi: Chowkhambha Orientalia; 2006. p. 262.
Agnivesha , Yonivyapadchikitsa Adhyaya, 30/90–95. Acharya YT, editor. Shri Chakrapanidatta, commentator. Charaka Samhita, Chikitsasthana. Varanasi: Chaukhamba Surbharati Prakashan; 2016. p. 638.
Agnivesha , Vividhashitapitiya Adhyaya, 28/27. Acharya YT, editor. Shri Chakrapanidatta, commentator. Charka Samhita, Sutrasthana. Varanasi: Chaukhamba Surbharati Prakashan; 2016. p. 180.
Vaidyan KVK, Pillai SG. Sahasrayogam. Mullackal, Alappuzha: Vidyarambam Publication; 2011. p. 78.
Sarngadhara . Prathamkhanda 6/52 Sarngadhara Samhita, Commentary by Adhamalla A, and Kasirama, editor. Varanasi, Chaukhamba Surbharti Prakashan; 2013. p. 184.
Babu MSS. Grahani Chikitsadhikar, Shankavati/1, Yoga Ratnakara, English translation. Vol 1, 2nd ed. Varanasi, India: Chaukhamba Sanskrit Series Office; 2011. p. 363.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]