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