Journal of Indian System of Medicine

CASE REPORT
Year
: 2019  |  Volume : 7  |  Issue : 2  |  Page : 131--138

Ayurvedic management of Gridhrasi with special respect to sciatica: a case report


Manju Mohan, Punam Sawarkar 
 Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharasthra, India

Correspondence Address:
Dr. Manju Mohan
Department of Panchakarma, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha 442001, Maharasthra.
India

Abstract

Background: Gridhrasi is one of the most common disorders of Vata, which closely resembles with sciatica, which is characterized by pain or discomfort associated with sciatic nerve. The prevalence of sciatica varies considerably ranging from 3.8% in the working population to 7.9% in the nonworking population. Contemporary medicine has limitations giving short-term relief in pain or surgical intervention with side effect. Aim and Objectives: The aim of this study was to access the efficacy of Ayurvedic management including Shodhana and Shamana Chikitsa in Gridhrasi.Materials and Methods: It is a single case study. A 43-year-old man who was already diagnosed with intervertebral disc prolapsed in L4-L5, correlated with Gridhrasi of left leg since 7 months approached to Ayurvedic hospital and was treated with Panchakarma treatment including Dashmooladi niruha vasti, Kati vasti, and Patra panda pottali sweda along with Shamana Chikitsa. The treatment was continued for consecutive one month. Results: Symptomatic assessment of patient was carried out after one month and satisfactory outcome was there and overall quality of life of patient was significantly improved. Conclusion: The aforementioned therapy gives symptomatic relief for the management of Gridhrasi.



How to cite this article:
Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to sciatica: a case report.J Indian Sys Medicine 2019;7:131-138


How to cite this URL:
Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to sciatica: a case report. J Indian Sys Medicine [serial online] 2019 [cited 2020 Aug 4 ];7:131-138
Available from: http://www.joinsysmed.com/text.asp?2019/7/2/131/271414


Full Text



 Introduction



Today’s lifestyle and nature of work are putting added tension on the usual health. The aggravating factors, such as over exertion, sedentary occupation, jerky movements during travelling, and lifting, create mental stress, which leads to low backache. One of the main causes of low backache is the intervertebral disc prolapsed (IVDP).[1] The IVDP means the protrusion from the nucleus pulposus of vertebrae through a rent within the annulus fibrosus.[2] In 95% of the lumbar disc herniation, L4-L5 and L5-S1 discs are most commonly affected.[3] In IVDP, the pain may be located in the low back only or referred to a leg, buttock, or hip, which outline the features of sciatica- syndrome. Sciatica is a strike pain, which causes difficulty in walking. It hampers the daily routine and deteriorates quality life of patient.[4]

The prevalence of sciatica varies considerably ranging from 3.8% in the working population to 7.9% in nonworking population.[5] It is most prevalent in people during their 40s and 50s and men are more commonly affected than women. Low back pain has been enumerated as fifth most common cause for hospitalization and the third most frequent reason for a surgical procedure.[6]

The signs and symptoms of “Sciatica” found in modern medicine are quietly mimic with the condition of Gṛidhrasi mentioned in Ayurveda. Gridhrasi comes under Nanatamja Vata vyadhi.[7]Gridhrasi, the name itself indicates the way of gait shown by the patient due to extreme pain, that is, Gridha or Vulture. The cardinal signs and symptoms of Gridhrasi are Ruk (pain), Toda (pricking sensation), Muhuspandan (Tingling senation), Stambha (stiffness) in the Sphik, Kati, Uru, Janu, Jangha, and Pada in order[8] and Sakthikshepanigraha (i.e., restriction in upward lifting of lower limbs).[9] In Gridhrasi, Tandra (Drowsiness), Gaurav (Heaviness), and Aruchi (Anorexia) may be present if Kapha is associated with Vata.[10]

The management provided by the contemporary medicine for this condition is either conservative or surgical in nature.[11] By taking into consideration, more prevalence rate of Gridhrasi and to overcome the above expensive therapeutics; there is great need to find out effective management of Gridhrasi. In this case study, a 43-year-old man with IVDP in lumbar region was prescribed for different Sthanik (local) and Sarvadaihik Shodhan Chikitsa (systemic putative therapy) and Shamana Chikitsa (palliative treatment), which resulted in excellent symptomatic relief.

Material and Methods

It is a single case study. Informed consent was taken from the patient in his own language.

 History of Present Illness



Demographic detail of the patient is mentioned in [Table 1]. A 43-years-old man was apparently healthy before seven months, then he started complaints of pain in lower back region and then gradually radiates to posterior aspect of thigh, knee, calf region, and foot of left leg since six months. He also had complaints of stiffness in lower back region and left leg since six months, tingling sensation in left leg, heaviness in both legs, and difficulty while walking and bending forward since five months, these chief complaints are briefly mentioned in [Table 2].{Table 1}, {Table 2}

Simultaneously, he had pain in the cervical region for three months. Along with above complaints, he had associated symptoms of loss of appetite, gaseous distension of abdomen, constipation, sour belching, and fainting intermittently, which are briefly mentioned in [Table 3].{Table 3}

Patient had also taken contemporary medicine for low backache for one month, but didn’t get satisfactory relief and there was increase in the intensity of symptoms since last week. So he approached to Panchakarma OPD, Mahatma Gandhi Ayurved College Hospital and Research Centre, Wardha, Maharasthra, India for ayurvedic treatment, and all his previous medicines were advised to stop and Ayurvedic management with Shodhana and Shamana Chikitsa was prescribed to him. Examination of the patient including Vitals examination, Ashtavidha pariksha and specific locomotor system examination are mentioned in [Table 4], [Table 5] and [Table 6] respectively.{Table 4}, {Table 5}, {Table 6}

 Past History



Continuous jerk to low back region while driving auto for long distance, that is, around 3000 km in five or more days in a week.

No history of trauma or fall.

No history of major medical illness (e.g., HTN/DM/bronchial asthma/dengue).

No any surgical intervention.

 Medication History



Patient had taken medicine (Tab Mobizox 250mg, Tab Rantac 150mg, Tab Neurobion forte 1 tab OD, and Diclo gel for local application) for low backache for one month.

 Personal History



Food habits: mixed diet, craving for pungent food items

Sleep: disturbed sleep due to pain

Addiction: alcohol (occasionally once in a month) and tobacco (3–4 times a day)

 Family History



Not significant

Nidana Panchak

Hetu (etiology or causative factors):

Ahara: Ruksha and Katu Rasatmak ahara

Vihara: systemic Vata prakopa due to travelling, Jerky movements during auto driving, which induces Srotovaigunya.

Aggravating factor–constipation, age related degeneration (Marmabhighata)

Purvarupa (prodromal symptoms): stiffness in lower back region and left leg, vague low back pain, and mild discomfort in left leg.

Rupa (manifestation): pain in lower back region radiating to left leg, stiffness in lower back region and left leg, tingling sensation in the left leg, heaviness in both legs, difficulty while walking and bending forward.

Upashaya (relieving factors): rest in supine position and after taking analgesic medicine (Tab Mobizox 250mg).

Samprapti (patho-physiology of the disease):

Due to Vataprakopa ahara (Vata vitiating food items) and Marmabhighata at Kati pradesha (age-related degeneration) due to jerky movements while travelling and excess vitiation of Apanavayu due to constipation, which leads to vitiation of Vata and Kaphaja doshas along with vitiation of Rakta (blood), Sira (veins), and Dhamani (arteries). This ultimately causes obstruction to the neural conduction (Vatavahini Nadi) and elicited as radiating pain from Kati (lumbar region), Prushta (back), Uru (thigh), Janu (knee), Jangha (calf), and Pada (foot), and leads to generation of Gridhrasi (sciatica). In this disease, the main Dushya are Rakta, Kandara.[9]

Investigations Done

Magnetic resonance imaging (MRI) Lumbosacral spine with screening of whole spine dated on February 28, 2019 reveals S/o osteoporotic spine with diffuse circumferential disc bulge at L4-L5 disc level and early spondylodegenerative changes in L4-L5 spine shown in [Figure 1].{Figure 1}

Samprapti Ghatak

Dosha: Vata and Kapha

Dushya: Rasa, Rakta, Asthi, Majja, Sira, Kandara, and Snayu

Srotas: Rasavaha, Asthivaha, Majjavaha, and Purishavaha

Srotodushti: Sanga

Rogamarga: Madhyama

Agnimandya: Ama, Jathargnimandya, and Dhatvagnimandya

Udbhavasthana:Pakvashaya

Adhishtana: Kati and Prushthavamsha

Vyaktasthana: Sphik, Kati, Prushtha, Uru, Janu, Jangha, and Pada.[12]

Diagnosis

Vata– Kaphaja Gridhrasi (sciatica due to IVDP)

Treatment Advised

By analyzing the above pathogenesis of disease in this patient following treatment plan was prescribed, which can be subclassified under two categories, that is, Shodhana and Shamana Chikitsa shown in [Table 7] and [Table 8], respectively.{Table 7}, {Table 8}

 Observations and Result



After completion of one month of total Ayurvedic therapy (Shodhana and Shamana Chikitsa), the patient had found significantly relief in the lumbar pain, tingling sensation, and heaviness with increased range of movement of spine. Gait was also improved. The patient got complete symptomatic relief. Assessment of patient was carried out by specific subjective [13],[14],[15],[16],[17],[18],[19],[20] and objective criteria including Oswestry low back pain disability questionnaire [21] on 0, 15th day, and 30th day, which are shown in [Table 9]. No radiological investigation was carried out after completion of therapy.{Table 9}

 Discussion



Chikitsa Sutra (treatment principle) of Gridhrasi involves Vasti karma, Siravyedha, and Agnikarma Chikitsa.[22] The treatment protocol, which was planned for this patient can be divided into Shodhana Chikitsa with Vasti karma along with Shamana Chikitsa. The treatment principles applied for the management of this disease condition are Vedanasthapana Chikitsa (analgesic), Shothahara (anti-inflammatory), and Vata dosha pacifying treatment along with strengthening and nutritive therapy for the various musculatures and structures in lumbar region and lower extremities. The probable mode of action of these aforementioned Shodhana and Shamana Chikitsa can be explored as follows:

Shodhana Chikitsa

Sarwanga Abhyanga with Karpooradi taila: Abhyanga (local massage) is one of the Purvakarma, which acts on the roots of mamsavahasrotas (channels carrying muscle nutrients and waste), that is, Snayu, twak and raktavahini. It may thus nourish the superficial and deep muscles and make the joint stable. It acts on Sparshnendriya, which is the seat of Vayu.[23]Abhyanaga with Karpooradi taila[24] is having analgesic, anti-neuralgic, and anti-inflammatory properties. It is indicated in muscle spasm, joint stiffness, backache, and arthritis.[25]

Nadisweda: Swedana (sudation) is Sthambhaghna (removes stiffness), Sandhicheshtakar (increases joint mobility), Srotoshuddhikar (clearing the micro channels), and Kapha-vata nirodhana (removing excess vata and kapha dosha).[26] Thus, it liquefies the Doshas and expand the srotas, helping the doshas to travel toward their own sthana leading to the Srotosanga vighatana (breakdown the pathogenesis by removing obstruction in the micro channels) and stiffness of the joint relieved.[23]

Sarwanga Patrapindapottali Sweda with Nirgundi, Arka, Eranda, Shigru, Karpooradi taila: Patrapinda pottali sweda consisting of medicated leaves with oil pacifies Vata without increasing kapha due to its snigdha and ruksha gunas.[27] It induces the Swedan effect without increasing the Aam (toxic waste product) condition. It provide soothing effect to the affected region, that is, nerve and muscle relaxation may result in reduction of compression of nerve root that also reduce radiating pain and numbness. Patrapinda sweda is mainly used to provide relief from pain, inflammation, swelling, and stiffness associated with bone, joint, or musculoskeletal pain.[28] In Gridhrasi, Snehana, and Swedana by virtue of their Vata shamak and Dhatuposhaka properties are useful in relieving the symptoms of Gridhrasi such as Stambha and Ruja.

Kati Vasti with Karpooradi taila: Kati Vasti is a type of Snigdha Swedana. Application of Kati Vasti (L4-L5 region) was carried out to provide good nourishment and strengthen the affected part due to protrusion and alleviated Vatavyadhi. In this, there is degeneration of intervertebral disc and lubrication function of Shleshak kapha is affected, which result in compression and irritation. Kati vasti with karpooradi taila is a unique combination in which, properties of both snehana and swedana are incorporated, which helps to lubricate local musculature as well as tissue of nearby affected region and also increases local blood flow that help to drain out the inflamed exudates.[29]

Dashmooladi Niruha Vasti followed by Sahachara taila Anuvasana Vasti: Vasti is the best treatment for Vata dosha as per Acharya Charaka.[30]Vasti has systemic action as the active principles (Virya) of Vasti preparation are absorbed through Pakwashaya (intestine) and spread to various channels of the body. It reaches at the site of lesion and induces systemic effects and relieves the disease.[31]Vasti helps to remove Kapha Avarana over Vata due to protrusion as well as it acts on Vata dosha, that is, Pakwashaya, which is the prime site of Vata dosha. It relieves constipation as well as helps to relieve edema, inflammation, necrosis due to its Srotoshodhana effect by Vata kaphahara properties of Kwatha drugs. Dashmoola is Tridoshahara. Guduchi is having Vedanasthapana, Vataghna action due to Snigdha and Ushna gunas, cause stimulation of dhatvagni by its tikta rasa and provide nutrition to the dhatus by Madhura vipaka.[32]Punarnava is having Kapha vataghna action due to Ushna virya and also having Shothahara, Rasayana properties.[33]Ashwagandha has property to pacify Vata by Madhura and Ushna gunas. They are Balya, Vedanasthapana, and Shothahara.[34]Anuvasana Vasti with Sahachara taila get absorbed and spread throughout the body up to subtle channels.[35]Sahachara taila is having specific property of Gati viseshatvam (helps to move) due to its Madhura and tikta rasa and having Vatahara, Bruhana (nourishing), and Pachana properties.[36]

Shamana Chikitsa

Agnitundi Vati: As the name suggest Agni means digestive fire, hence the one which improves digestive fire. Agnitundi Vati induces Pachana at gastrointestinal as well as Dhatauata level (cellular and tissue level) and corrects Jatharagni as well as Dhatvagni. It is indicated in Adhmana, Shula, pain related to Vata imbalance.[37]

Trayodashanga Guggulu: Vatanulomana and Aampachana properties of the ingredients of Trayodashanga Guggulu[38] help in relieving Malabaddhata (Constipation). Due to Deepana and Pachana properties Tandra, Gauravta, and Aruchi are also reduced. Along with this, it has anti-inflammatory, anti-arthritis, anti-gout, analgesic, muscle relaxant, and antioxidant properties by energize the growth of bone forming cells by producing more osteoclasts and osteoblasts. It prevent the pro-inflammatory cytokines, activity of xanthine oxidase, hydrogen peroxide, and renal microsomal lipid peroxidation process and also blocks the action of histamine and enhances the level of dopamine.[39]

Rasnasaptak Kwatha: Rasnasaptak kwatha[40] is having an excellent Vata Shamaka property. Along with Aampachana, all these herbs are known for their anti-inflammatory activity, analgesic, and anti-arthritic activity viz. Rasna, Gokshura, and Eranda. Some of them even known for their immunomodulatory activity like Guduchi, Aragvadha is having Vata-Kapha Shamaka properties and is Mridu Virechaka, so helps to remove constipation and also does antioxidant activity.[41]

Tablet Shallaki with combination of Erandamula and Guduchi was used which is mainly indicated in treatment of inflammatory arthropathies, spondylitis, and gout. It contains the extract of Salai Guggulu (Boswellia serrata), Erandamula (Ricinus communis), and Guduchi (Tinospora cordifolia). Guggulu is used to relief joint pain, stiffness, and inflammation. Erandamula is best ayurvedic herb used to relieve inflammation, swelling, eases bowel movement, and Guduchi, which is a well known immune modulator corrects auto immune disorders.[42]

Gandharva Haritaki Churna: Gandharva Haritaki Churna is polyherbal classical ayurvedic medicine. The ailment reside in the Kati Pradesh, which is the seat of Vata dosha, Mridu virechana is line of treatment of Vatavyadhi[43] and this formulation has Vatahara, Vrishya and Snigdha Virechaka properties. It is indicated in the management of pain in Vatavyadhi, Sandhivata, Gridhrasi, and Ardita. This formulation is used for Anulomana, Ajeerna, and Aruchi induced diseases.[44]

By taking all the aforementioned discussion into consideration that the overall effect of all treatment regime planned in this patient induces Vatashamana, Srotoshodhana, and Shothahara effects, that is, it can be used as an excellent analgesic, anti-inflammatory, and nutritive therapy for such degenerative entity.[45]

 Conclusion



As per the Ayurvedic treatment principle, Shodhana with Snigdha mridu virechana followed by Vasti is the line of treatment of Vata situated in Adhobhaga.[46] The overall effect of the aforementioned therapy reveals that sciatica can be cured effectively with collaborative approach of various Panchakarma procedures including Dashmooladi Niruha Vasti, Patrapinda Pottali Sweda, Kati Vasti along with Shamana Chikitsa without causing any adverse event and it may be an alternative therapy for sciatica in current era. Now till date there is no need to patient to undergo any surgical intervention as well as there is no recurrence in symptoms. This study is about the presentation of the single case only. An attempt must be made for further exploration of effect of these Panchakarma therapies in large population for establishing standard treatment protocol. To combat the disease in minimum duration, we have used multi treatment approach to get synergistic effect.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

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