6. Brief Review of Intended Study

6. BRIEF REVIEW OF INTENDED STUDY

6.1. Need for study:

Walking without any difficulties is one of the major requirements of human life. There are so many conditions that limits our ability to move, among these Gridhrasi is the most common disorder. It has a prevalence of 1-10% of the population and occurs mostly in the age group of 25-45 without any sexual predilection.1

Gridhrasi can be compared with Sciatica in the contemporary system of medicine which occurs due to the compression or irritation of the sciatic nerve,2 which is considered to be the largest3 and thickest4 nerve in the human body. Any pathology that occurs in the nerve leads to aching pain in lumbar region and may radiate the buttocks thigh, calf and foot5. Non-steroidal anti-inflammatory drugs (NSAIDS) are mainly used in the treatments of this condition, if this pathology gets worstend sometimes it needs surgical procedures6.

Vatavyadhis are generally Kashtasadhya vyadhis7 and requires proper management. Acharya Charaka has mentioned Gridhrasi under Vataja nanatmaja Vyadhis8. The condition derived its name due to similarity of affected persons gait to that of Gridhra. Many Acharyas have mentioned symptoms like Sthamba, Toda9 etc and several treatment modalities of this condition like Vamana, Virechana, Vasti etc, Among them Vasti is considered to be the main therapy for vatavyadhis10, by administering the vasti the oushadha dravya reaches the pakwashaya and dislodge prakupitha vata from its moola stana11.

About 60 – 80% of the world population suffers from Low back ache and associated problems at some stage of their life time. In the present scenario the condition is likely to increase due to the sophisticated life style, and hence finding a solution of this problem is much important. Considerable work has been done on gridhrasi, among them dwipanchamuladi mamsarasa vasti mentioned in Ashtanga hrudaya / Kalpasthana has been taken for clinical trial, so the present study “EVALUATION OF THE EFFICACY OF DWIPANCHAMULADI MAMSARASA VASTI IN GRIDHRASI” is undertaken.

6.2. Review of Literature:

Acharyas have mentioned both symptoms12, 13 and treatments of Gridhrasi in the Vatavyadhi adhyaya. Among them Charaka has mentioned Siravyadhana, Vasti and Agnikarma as the treatment principle for Gridhrasi14, where as Susrutha (the father of surgery) has given much importance to siravyadhana15. Bhavaprakasha has described Vamana, Virechana along with Vasti karma16. By considering the above treatment principles acharyas has given much importance to the Vastikarma.

Vasti is considered to be the Ardha chikitsa17. It is mainly indicated for Vatika disorders and even it can be helpful in Pitta, Kapha and Raktaja disorders also18. Different types of Vasti has been mentioned in our classics, among them Dwipanchamuladi mamsarasa Vasti is specially indicated for vatika diseases19. In this vasti Dasamoola, Sneha, and Kanjika acts as vata samaka, Mamsarasa is Brihmana and Tridoshaghna. In Vatavyadhi there will be loss of sneha, this loss of sneha may be replaced by doing Dwipanchamuladi mamsarasa vasti, So that samprapthi of this disease may be reversed. By keeping this view the above topic is taken for the purpose of Clinical study.

Some recent works of different research centers in Gridhrasi are as follows,

1. Satheesh.R- Evaluation of the efficacy of Vaitharana Vastikarma in the management of Gridhrasi w.s.r.t Sciatica,Panchakarma,D.G.M.A.M.C, Gadag-2005.
2. Rao Kameswara – A clinical study of the role of Vajigandhadi tailam for both internal administration and Vastikarma in the management of Gridhrasi, Kayachikitsa, Dr.B.K.R.R.GovtAyurvedaCollege, Hyderabad-2004.
3. Khagram Rita V- Comparative study of kativasti and matravasti in the management of Gridhrasi, Panchakarma, Institute for post graduate teaching and research in Ayurveda, Jamnagar-2004.
4. Sridhar. B.S. – Management of Gridhrasi w.s.r.t. Vasti, Kayachikitsa, Govt.AyurvedaMedicalCollege, Mysore-1991.

6.3 Aims and Objectives of the study:

1. To evaluate the efficacy of Vasti in Gridhrasi.

2. To evaluate the efficacy of Dwipanchamuladi Mamsarasa Vasti in Gridhrasi

7. MATERIALS AND METHODS

7.1 Source of Data:

a) Patients: Patients suffering from symptoms of Gridhrasi will be selected from O.P.D and I.P.D, Dept of Panchakarma, P.G.S. & R.C, Shri D.G.M.A.M.C. & H, Gadag.

b) Literary: Literary aspect of study will be collected from classical Ayurvedic texts,

Modern texts, recent medical journals and Internet.

c) Therapy : Vastikarma:

Anuvasana vasti: Bala tailam20.

Asthapana vasti : Dwipanchamuladi mamsarasa.

d) Selection of drug: The trial drugs will be collected from the surrounding areas and local market after being properly identified.

e) Preparation of Medicine:

Ingredients:

a) Bala Tailam

Bala

Ksheera

Tailam

b) Dwipanchamuladi mamsarasa vasti

Makshikam

Lavanam

Sneham

a)Murchita Ghritam21

b)Murchita Tailam22

c)Vasa

Pooto Yavanayadi kalkam

Dasamula kashayam

Ajamamsarasam

Kanjikam

Vasti dravya kalpana based on the above drugs will be prepared as per classics23

7.2 Methods of collection of data:

a) Study design:A single Randomized observational clinical study

b) Sample size:A minimum of 30 patients suffering from Gridhrasi will be

selected in a single group.

c) Inclusion criteria:

1. Patient above 20 and below 70 years of age.

2. Presence of clinical features of Gridhrasi like sthambha, ruja etc.

3. Patient fit for Vasti karma.

d) Exclusion criteria:

1. Patient below 20 and above 70 years.

2. Pregnant women and lactating mothers.

3. Patient with other serious systemic disorders.

4. History of major trauma causing fractures.

5. Degenerative disorders with marked deformity.

6. Secondary malignancies.

f) Criteria for diagnosis

Diagnosis will be established by clinical examination of signs and symptoms of Gridhrasi as follows:

1. Ruja in Sphik, Kati, Prushta, Uru, Janu, Jangha and Pada.
2. Sthamba of affected sakthi.
3. Burning sensation in the thigh.
4. Numbness and muscle weakness.
5. Straight leg raising test being positive.

g) Posology:A total quantity of 864ml (approximately) Dwipanchamuladi Mamsarasa Vasti will be given in Yogavasti24 pattern.

h) Study duration:

Dwipanchamuladi yoga vasti: 8 days

Follow up: 16 days

Total study duration: 24 days

7.3 Assessment of results:

The subjective and objective parameters of the base line data to pre and post medication will be compared for assessment of the results.

a) Subjective parameters:

1)Ruja in Sphik, Kati, Prushta, Uru, Janu, Jangha and Pada.

2)Sthamba of affected sakthi.

3)Burning sensation in the thigh.

4)Numbness and muscle weakness.

b) Objective parameters:

1) Straight leg raising (SLR) test.

2) Movements of lumbar spine.

3) Walking time.

7.4 Investigations

1)Hb%, TC, DC, ESR, RBS. (IF NECESSARY)

2)X-ray of lumbar spine (AP & LAT view)

7.5 Ethical Clearance: Yes, obtained and enclosed.

8. LIST OF REFERENCES :

1) 8/11/2007.

2) 31/10/2007.

3)

4)B.D.Chaurasia edited Human Anatomy,Second volume,Chapter-7,Third edition-reprint 2000,Pub:C.B.S.Publishers and distributers,New Delhi.Page no:75.

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Varanasi,Page no:114.

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Varanasi,Page no:268.

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Nidanastana,Chapter 15th,Sloka-54, Ninth edition(2002),Pub: Chaukhambha

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Page no: 243.

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Page.no:525.

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1286&1287, Edition-18,Pub: Chaukhambha sanskrit sansthan ,Varanasi,

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