Clinical StudA Clinical Evaluation of Agnikarma In Sandhigata Vata

W.S.R. To Cervical Spondylosis

*Dr.Mukesh Kumar Meena, ** Prof H.K.Kushwah

ABSTRACTAyurveda ,the science of life has its own methodology and hypothesis to manage all kind of diseases.

Sandhigata vata is one of the commonest joint disorder broadly coming under vata vyadhi and affects to theskeletal system in the geriatrics, because more vulnerability to dhatu kshaya at that span of life. vata doshaget provocated due to dhatu kshayatdegenerative process) or avarana prakriya and produces various typesof vatic vyadhies.

Nowadays joint disorders are one of the main cause of distress after fourth decade of age. thoughmedical science provides powerful analgesics and new surgical procedures, but due to side effects and furthercomplications, the disease is as such remains as a challenge to medical fraternity.clinical study is mostestablished method to revive all treatment hypothesis scientifically.

Agnikarma is a para-surgical procedure, advocated by Acharya Sushruta for asthi, sandhi, sira andsnayugata vata vikaras and it is highly effective without producing any further complications in comparisonto modern surgical procedures.

The drug Nirgundi and Shigru Yukt Trayodasanga Guggulu consisting Rasayana, Balya, Vatsamaka,Amapachana drugs are the best way to treat as well as control degenerative process (dhatu kshaya) inSandhigata vata.

Keeping all these facts in mind treatment modality of Sandhigata vata has been designed to equalizethe efficacy by Agnikarma and Trayodasanga Guggulu.

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* Ph.D. Scholar, deptt. of shalya tantra, NIA, Jaipur. ** H.O.D., Shalya department, NIA, Jaipur.

51

Clinical StudA Clinical Evaluation of Agnikarma In Sandhigata Vata

W.S.R. To Cervical Spondylosis

Dr.Mukesh Kumar Meena, Prof H.K.Kushwah

INTRODUCTION

Sandhigata Vat a is one of the commonestjoint disorder broadly comes under Vata Vyadhi andaffects the skeletal system in the geriatrics. This agegroup is more vulnerable to Dhatu ksaya. Vata Dosabecomes provocated due to Ksaya or Avaranaprakriya and produces various types of VatikVyadhies. To over come such type of degenerativeprocess and symptomatology various research workare going on to find out new remedy in surgical aswell as medical system.

Agnikarma is a Para surgical procedure,advocated by Acarya Susruta for Asthi, Sandhi, Sira,Snayugata Vatavikaras and it is highly effectivewithout producing any further complication. ThoughAgnikarma is one of the most important Parasurgical procedure but not in wide practice.Rasayana, Balya, Vatasamaka, Amapacana drugs arethe best way to treat as well as control degenerativeprocess (Dhatu ksaya).

Keeping all these facts in mind treatmentmodality of Sandhigata Vata has been designed toequalize the efficacy by Agnikarma and Nirgundi &Shigru Yukt Trayodasanga Guggulu with following aimand objects.

AIMS AND OBJECTS

1 To assess the efficacy of Agnikarma in SandhigataVata.

2 To assess the efficacy of Nirgundi & Shigru YuktTrayodasanga Guggulu in Sandhigata Vata.

MATERIALSAND METHODS

Patients attending the O. P.D. & 1. P. D. ofShalya dept. NIA, Jaipur were randomly selectedbased on the clinical feature and a detailed researchProforma was prepared to observe the clinicalfeature and disease pathology. The study wasexclusively based on clinical trials.

Selection of patient:-

• Sula (Pain) in cervical region

• Stambha (Stiffness) in Cervical region

• Graha (Restricted movement) of neck

Associated syrnptorns:-

• Bhrama (Giddiness)

• Sira sula (Headache)

• Cimcimayana hasta (Tingling sensation in hand)

• Suptata (Loss of sensation)

Exclusion criteria:-

• Uncontrolled Diabetes mellitus

• T. B. Spine

• Carcinoma of Cervical vertebra

Investigation: -

Routine - Blood, Urine analysis

'X' Ray of Cervical vertebrae - A. P. / Lateral view.

Grouping and Managernent:-

Patients were randomly divided into two groups

Group-A - Agnikarrna group

In this group Bindu type dahana visesa wasmade at the most painful area of neck and at otherareas also. Each patient was given four sitting ofAgnikarma at the interval of seven days. Duration ofschedule was one month.

Group - B - Nirgundi & Shigru YuktTrayodasanga Guggulu

In this group Trial drug was given rgm B. D.III divided doses with Luke warm water for onemonth.

52

Vol.II No.4 Oct-Dee 2008

Agnikarma Vidhi:-

Like other therapeutic procedure Agnikarmacikitsa divided into three phases according toTrividha upakarma.

Purvakarma: -

§ Advised to take Snigdha, Pichhila Aahara priorto this procedure

§ Preparation of Triphala Kasaya, Yastimadhuchurna, Kumari swarasa.

§ Pancha dhatu salaka was heated up to red hot

§ Preparation of local part +Local part (Neck area)was washed with Triphala Kasaya and wiped withdry sterilized gauze piece and covered this areawith a cut sheet.

Pradhana karma:-

Samyak dagdha vrana was made in vilekhadahana vishesa by red hot pancha dhatu salaka.Simultaneously kumari swarsa was applied to relieveburning sensation. Minimum space was givenbetween two points and care was taken that Samyakdagdha Vrana was produced.

Paschat karma

Application of Kumari swarasa

Immediately after doing Agnikarma Kumariswarasa applied to relieve burning sensation. ThenKumari swarasa was completely wiped out bysterilized gauze piece.

Dusting of Yastimadhu Churna

Yastimadhu churna was applied over thesamyak dagdha Vrana and Vrana was completelyfilled to prevent contamination

.:. Advised to apply paste of Haridra powder andCocoanut oil at night period.

.:. Restricted to touch water for 24 hr.

.:. Advised to avoid dietic regimen like Rice, Sigru,Brinjle, Ground nut, Potato, Beans etc.

.:. 7days gap was kept between two sittings.

Criteria for assessment:-

The improvement in the patient was assessedmainly on the basis of relief in the cardinal signs and

Journal of Ayurveda

symptoms of the disease. To assess the effect oftherapy objectively, all the signs and symptomswere given scoring depending upon their severity asbelow:

Pain:-

No Pain - (0)

- (1)Pain in Neck, mild aggravationwith movement without Radiation

Pain in Neck, severe aggravation withmovement without radiation to arm

- (2)

Pain mild or severe with radiation to arm

Pain in neck, radiation, and disturbed sleep - (4)

Restricted movement:-

Flexion-

No restriction- Able to touch theinterclavicular line

- (0)

Upto zcm difference between the chinand inter clavicular linez-acm difference between thechin and interclavicular lineMore than 4cm difference

- (1)

- (2)

Extension-

Normal i.e. able to extend the head up - (0)to the level when tip of nose andforehead becomes in horizontal planeapproximately flexion to extension= tgo degreeMoving up to 120 degree - (1)

Movement upto 110-120 degree

Movement <120- degree

Lateral rotation-

Normal i.e. able to make completerotation of neck

-(0)

Rotation with little difficulty

Rotation side to side only

Rotation one side only

Lateral Flexion-

Ear touches to shoulder tip - (0)

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Journal of Avurveda

Up to 3cm difference between the earand shoulder

3-5 em difference between the ear andshoulder tip

More than 5cm difference

Stiffness-

No Stiffness

Mild Stiffness

Stiffness, relived by external application

Stiffness, relived by medication

Stiffness, is not responded by medicine

Bhrama-

No Bhrama

Up to ihr

Up to zhr

- (1)

- (2)

- (0)

- (1)

- (2)

- (3)

- (4)

- (0)

- (1)

- (2)

Vol.II No.4 Oct-Dee 2008

Up to 3hr

More than 3hr

Chimchimayana hasta-

Absent

Occasionally

Up to thr

Up to zhr

More than 3hr

- (0)

- (1)

- (2)

- (3)

- (4)

OBSERVATION

Demographics and Patient characteristic

Group Nos. of patient registered

Total Regd. Completed LAMA

A 18 11 7

B 15 10 5

Effect of Agnikarma cikitsa

Cardinal Symptom n Mean score SD SE 't' p %

B .T. A.T. ± ±

Sula 11 3 0·72 0·46 0-46 16.25· <0.001 76Stambha 10 1.9 0·7 0.42 0·42 9.23 <0.001 63

Graha 4 2 0·75 0·5 0·5 5 <0.02 62·5Bhrama 4 1.25 0·5 0·5 0·5 3 >0.05 60

SiraSula 10 1.3 0·5 0.42 0.42 6.15 <0.001 61

Chichimayana Hasta 3 1.33 0.66 0·57 0·57 2 >0.10 50

Suptata 2 1.5 1 0·71 0.71 1 >0.10 33

Effect of Nirgundi and Shigru Yukt Trayodasanga Guggulu

Cardinal Symptom N Mean score S.D. S.E. 't' P %

B.T. A.T. ± ±

Sula 10 1.1 1.1 0·56 0.18 10·55 <0.001 63

Stambha 5 1.8 0.8 0·71 0.31 3.22 <0.05 55

Graha 9 1.9 0·77 0·33 0.11 10 <0.001 59

Bhrama 3 1.33 0·5 0·57 0·33 2 >0.10 62

Sirasula 6 1.66 0·5 0·41 0.16 7·52 <0.001 69

Cimcimayana Hasta 7 1.28 0.42 0·37 0.14 6.07 <0.001 67

Suptata 3 1.33 0.66 0·57 0·33 2 >0.10 50

54

VoUI No.4 Oct-Dee ZOOS

Comparative study of Results of both group

Cardinal Group A Group BSymptoms

Sula 76% 63%

Stambha 63% 55%

Graha 62.5% 59%

Associated Group A Group BSymptom

Bhrama 60% 62%

SiraSula 61% 69%

Cicimayana Hasta 50% 67%

Suptata 33% 50 %

Effect of Agnikarma was more observed oncardinal symptoms and effect of TrayodasangaGuggulu was significant on associated symptoms

DISCUSSION

o Discussion on Panchdhatu shalaka-

Panchdhatu shalaka got red hot at atemperature of 820°C ,it is measured by putting theshalaka in the electric furnace. that means once it gotred hot,it takes a lot of time in cooling whichprovides sufficient time for making samyak dagdhavrana morefzo-ag) in numbers at a time.

o Probable mode of action of Agnikarma

According to ayurveda-

Sandhigata vata is caused by vitiated vat adosha with anubandha of kapha, agnikarma isconsidered as best therapy to pacify these vata andkapha dosha,because agni possesses usna, tikshna,sukshma, asukari guna which are opposite to vataand kapha.due to usna, tikshna, sukshma, asukariguna it removes the srotavarodha and helps toincrease the rasa-rakt samvahana to the affectedjoints.

Therapeutic heat transferred by agnikarmaincreases the dhatwagni, so metabolism at dhatu(tissue)level increases which helps to digest the amadosha or metabolites.

Journal of Avurveda

According to modern science-

§ Gate control theory-

Pain sensations are transferred by two typesof fibers "A" fibers (stimulated by heat, cold, andtouch) "C" fibers (stimulated by pain),here the gatemechanism is blocked by stimuli from "A" fibers sothe pain will not be felt.

§ Action on pain receptors-

Pain receptors are located in skin, thepathway for transmission of thermal and pain signalsare parallel and terminates at same area. So out ofthese two sensations the strong one is felt i.e.thermal/heat sensation.

§ Counter irritation theory-

Counter irritants stimulates sensory nerveendings and relieves pain.

§ Blocking mechanism-

Agnikarma probably blocks the pathway ofpain which makes the person to not feel the pain.

§ Increased metabolic activity-

Consequent heating increases cell metabolismand due to increased supply of oxygen and nutrientsprocess of cell repair increases.

§ Increased blood supply-

Heat causes vasodilatation so the increasedblood flow to the superficial tissues prompts oxygenand nutrients supply and removal of waste products.

§ Effects on muscle tissue-

Heat induces muscle relaxation.

o Probable mode of action of trial drug-

Nirgundi and Shigru Yukt TrayodashangaGuggulu is having contents which can be divided into four categories according to their action-

r.Rasayana, Balya, Vayasthapan, Vrihana-

Aswagandha, Guduchi, Satavari, Rasnahaving these properties.

2.Vedanasthapana,Vatashamaka, Sulaprashamana,Sothahara-

Guggulu, Nirgundi, Shigru, Sunthi, Yavani,55

Journal of Ayurveda

Karchura, Rasna, Vriddhadaruka and Gokshru havingthese properties.

3. Amapachana, Rochana, Deepana, Vatanulomana-

Sunthi, Rasna, Satpuspha, Yavani.

4·Vishagna -

Shigru is having this property, it helps todetoxify the body by assimilating the toxicmetabolites deposited in the body which areconsidered as a precursor for disease.

CONCLUSION

[J Majority of drugs in the trial drug havingvatashamaka, rasayana, balya, amapachanaproperties so it is a drug of choice for geriatics.

[J Significant relief In Grivasula (76%),Gr ivasthambhafog ss), Grivagraha(62.5%) andSirahsularo rss) were found in agnikarma group.Results in Bhrama,Cimcimayan hasta and suptatawas statistically insignificant.

[J Nirgundi and Shigru Yukt Trayodashanga gugguluprovided good results in Grivasula(63%),Grivagraha (59%), Grivasthambha (55%),Sirahsula (69%), Cimcimayan hasta (67%).Results in Suptata and Bhrama was statisticallyinsignificant.

[J Agnikarma provides good relief in sandhigatavat a (cervical spondylosis) so it can be adopt asa standard procedure for the management alongwith other drugs.

Need for further research-

[J Well designed experimental studies are needed toevaluate the effect of agnikarma on pain.

[J Further research studies are needed to focus onthe exact mechanism of action of heat / agni onpathophysiology of pain.

[J Further research studies are needed to designdifferent types of shalakas along withtemperature recording,temperature maintainingand temperature modulation facility.

VaLlI No.4 Oct-Dee 2008

REFERENCE-

Hridaya with Sarvangasundar Tika andRasayana Tika, Chaukhambha

Varanasi, 1982.

AstangaAyurvedaOrientalia,

2 Charak Samhita by Agnivesha of Chakrapanidatta- edited by Vaidya Jadavaji Trikamji Acharya -Chaukhambha Sanskrit Sansthan, Varanasi, 1998.

3 Sushruta Samhita - edited with Ayurveda -Tattva- Sandi pika by Kaviraja Ambikadutta Shastri, 12thedition,2001.

4 VacaspatyamChaukhambha

SritaranathSanskrita Series

Tarkavacaspati,Varanasi.rce a.

5 Yogaratnakar - Vaidyaraja Datto Borkar, GajananBook Depot. Prakasana, Pune, Reprint 1984.

6 Davidson's Principles and practice of Medicine, 19th

Ed it io n.c o o g .

7 Harrison's Principle of Internal Medicine, 13th

Edition- Edited by Kasper, Hauser, Braunwald,Longo, Fauci, Jameson, 2005.

8 Hutchinson's Clinical Methods, 21" Edition Edited byMichael Swash,2002.

9 PharmacologySatoskar, S.D.Edition, 2004.

R.S.14th

and PharmacotherapeuticsBhandarkar, S.S. Ainapure

1 0 Principles of Anatomy and Physiology - TortoraGrabowski - 10th Edition.

1 1 Taber's Cyclopedic Medical Dictionary _18th Edition byJaypee Brother, New Delhi.

1 2 Text book of Medical Physiology - Guyton and Hall-9th Edition.

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