From:

Dr. Divya Ravindran

Ist Year M.D., Department of Post Graduate Studies in Salyatantra

T.M.A.E Society’sAyurvedicMedicalCollege ,Sanklapur, Thanda

Hospet-583201, Karnataka

To:

The Registrar,

RajivGandhiUniversity of Health Sciences

Bangaluru, Karnataka

Through:

The Principal and the Head of the Department of Salyatantra

T.M.A.E Society’s AyurvedicMedicalCollege, Sanklapur, Thanda,

Hospet-583201, Karnataka

Respected Sir,

Sub: Regarding the submission of completed Proforma for Registration of subject for Dissertation

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangaluru, Karnataka for the partial fulfillment of M.S. (Ayurveda).

Title of the Dissertation

COMPARITIVE STUDY BETWEEN KATIVASTI AND KATIVASTI WITH AGNIKARMA IN THE MANAGEMENT OF KATIGRAHA .

Here with I am enclosing complete proforma for registration of the subject for dissertation.

Thanking you,

Yours faithfully

Place: Hospet

Date:

Dr. Divya Ravindran

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. /

Name of the candidate & Address

/ : / DR. DIVYA RAVINDRAN
DIVYADARSHANAM
VADAKKUMTHALA EAST PO
KARUNAGAPPALLY
KOLLAM- 690536
KERALA
2. / Name of the Institution / : / DEPT. OF PG STUDIES IN SALYATANTRA
T.M.A.E SOCIETY’S AYURVEDAMEDICALCOLLEGE,
SANKLAPUR, THANDA, HOSPET-583201,KARNATAKA
3. / Course of Study & Subject / : / Ayurveda Vachaspathi m.S(aYU)
SALYATANTRA
4. / Date of Admission to the Course / : / 31-10-2011
5. / Title of the Topic / : / COMPARITIVE STUDY BETWEEN KATIVASTI AND KATIVASTI WITH AGNIKARMA IN THE MANAGEMENT OF KATIGRAHA.

6. Brief resume of the intended work: -

6.1Need for the study:

Among all the mobile and immobile creations of the creator, man is gifted with the unique function of a high intellect and mobility with an erect posture to proclaim his superiority on this planet. With the advancement of busy professional and social life, improper sitting postures in offices and factories etc. create undue pressure to the spinal cord. Continuous and over exertion, jerking movements during travelling and sports are also playing their part in producing back pain. In this way the incidence of the disease is now increasing in the population irrespective of the age, sex, mode of work and area of living.

Low back ache accounts for approximately 15% of the sick leave, and is a common cause of disability in persons less than 45 years of age. Due to this low back ache the patient cannot carry out his day to day duties which leaves him being dependent on others for his basic needs. Thus it affects the patient psychologically, physically and economically by reducing his productivity.

Approximately 98% of low back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology2. Most back pain syndromes are due to inflammation, as in Lumbar Spondylitis where the inflammation of one or more vertebrae of lumbar spine occurs at the age between 20 years to 50 years3.

As the treatment the use of analgesics is on the increase which has symptomatic relief only, but is not reliable for long term medication. Surgery is usually the last resort in the treatment of back pain. It is normally recommended only if all other treatment options have been tried or if the situation is an emergency. A 2009 systematic review of back surgery studies found that, for certain diagnosis, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term2,4.

According to contemporary medical science Heat therapy is useful for back spasms and such other conditions. A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain2.Hence it is important for the physician to control the disease as early as possible so as to avoid the patient from undergoing the trauma of a surgery where the result cannot be assured.

Here comes the relevancy of the indigenous medicine and several herbal preparations and procedural based therapies. In Ayurveda “ruja” has been considered as the samanya lakshana of all vata vyadhies which hinders the person from his day to day activities. Kati- Graha which appears with the symptoms like low back ache and restricted movements is extremely prevalent in today’s world and is the second most common reason for the people to seek medical attention.

Agnikarma is capable of curing the diseases which cannot be cured by medicaments. Acharya Susrutha has mentioned that diseases do not reoccur after Agnikarma5.The importance of Agni karma is a low cost, patient friendly treatment modality which has been explained by Acharyas .Hence a treatment plan for low-back ache with Agni karma has been planned.

6.2Review of Literature:

Agnikarma is considered as boon for local vata and kapha vyadhis and disease treated by Agnikarma do not re-occur5. Due to its usna, sukshma guna patient gets relief from stiffness, pain and other associated symptoms. It is a simple modality for Asthi, Sandhi, Snayu vedana caused by Vatadosha6 and it can be performed to the Twak,Mamsa,Sira,Snayu,Sandhi and Asthi7.

According to Gada nigraha 11 vitiated Vata alone or along with kapha localizes in Katipradesa and cause the pain and stiffness at Kati pradesa. This is named as Katigraha .

Lumbar spondylitis is the inflammation of one or more vertebrae of lumbar spine. There will be pain, stiffness at low back region, usually effects the age group of 20yrs to 50yrs3.

The instrument used in this procedure is Shalaka.Acharya Susruta has mentioned 101 yantras under six groups in that he has mentioned 28 shalakas,which differ according to their shape, size and uses12.

Procedure will be done according to the classical references.

Review of literature is taken from the context of Ayurveda and contemporary books.

.

i)Disease review:

Ancient classics, contemporary texts (Ayurvedic and Modern), previous works, journal etc will be reviewed for relevant information.

Previous work done

1. Vaishnar.S.D-Studies on dagdha and agnikarma -IMS Faculty of Ayurveda,B.H.U.,1968

2.Ghate M.H.-- Agnikarma Ek Adhyayana,IPGT&RAGujaratAyurvedaUniversity, Jamnagar 1978.

3.Sabnis Kalindi.M-Role of agnikarma with different metal rods in sandhi-soola(arthragia)-a complete study -SRK Toshningal Ayurveda Mahavidyalaya,Akola,1997

4.Sajith.M-Effect of agnikarma in kadi-shoola,Shri D.M. college of Ayurveda,Udupi, 2002

5.Mahant J Vyasdev-A clinical management of sandhigatavata w.s.r.to cervical spondylosis by agnikarma, ,IPG&RAGujaratAyurvedaUniversity,Jamnagar, 2005

6.Shrinivas.K.K.-Evalution of efficacy of Agnikarma and physical exrsises in the management of kadee-shoola,National Institute of Ayurveda ,Jaipur 1999

7.Nilesh Kumar-Comparative study on the efficacy of agnikarma and electro therapy with simhanada guggulu in the management of kati-shoola, National Institute of Ayurveda ,Jaipur 2002

6.3 Objectives of the study:

.

  1. To evaluate the effect of kativasti in the management of katigraha.
  2. To evaluate the effect of agnikarma along with kativasti in the management of katigraha.
  3. The efficacy of 1 and 2 are compared.

7. Materials and Methods:-

7.1)Source of data:

Patient: The patients will be randomly selected from O.P.D & I.P.D,of the T.M.A.E Society’s AyurvedicMedicalCollege, Sanklapur, Thanda,Hospet.

Literary source: Literary aspect of the study will be collected from classical Ayurvedic, contemporary text, periodicals, paper published & journals etc.

Experimental source: It is ahuman clinical trial; no animal experimentation will be done.

7.2) Composition of trial shalaka:

a) Roupya14,15 shalaka of 12 cm in length,10 grams in weight and diameter of masuradala16 will be used.

b)Preparation of shalaka:

It is specially prepared as per the procedure

7.3)Method of Collection of data:

30 patients will be selected from O.P.D & I.P.D,of the T.M.A.E Society’s AyurvedicMedicalCollege, Sanklapur, Thanda,Hospet.

7.3.a) Sample:

The patient of katigraha will be studied under following two groups.

  • Kativasti alone Group – In this group, patients will be administered kativasti with Sahacharadi thaila. There will total one course without a gap of 7 days and no internal medicine will be given.
  • Agnikarma with kativasti Group – Agnikarma is done in the shape of bindhu, by heating one end of roupya dhatu Shalaka and keeping the other end at maximum point of tenderness of kati-graha up to the heat tolerance of the patient.
  • Patient will be educated for proper diet and life style

7.3.b) Assessment criteria:

The assessment of result of treatment had been done on the basis of clinical improvement observed in patients. Numerical score marks will be given for each sign & symptoms taken for criteria of assessment. Pain is measured through visual pain scale before and after treatment

7.3 c) Subjective parameters:

  • Katishoola(pain)
  • Inflammation
  • Numbness
  • Range of movements

7.3 d) Objective parameters:

  • Site of tenderness
  • Range of movements

7.3 e) Investigations:

  • X-Ray lumbar spine
  • CT and MRI (if needed)
  • Blood routine

7.3. f) Inclusive criteria:

  • Patient of either sex between age group of 20 to 50 yrs
  • Patient with low back pain & stiffness
  • Having the onset of 14 days is taken

7.3. g) Exclusive criteria:

  • Patient associated with systemic diseases.
  • Back ache which lasts more than 14 days is not taken
  • Pott’s spine ,Malignancy, Osteomyelitis, Osteoporosis, Sciatica , Fracture of lumbar spine,Disc prolapse of lumbar spine
  • Lactating and pregnant women,HIV

Criteria of Diagnosis

According to Gada nigraha 11 vitiated Vata alone or along with kapha localizes in Katipradesa and causes the pain and stiffness at Kati pradesa. This is named as Katigraha(Kati-shoola) .

The criteria of diagnosis will be on the basis of Ayurvedic classics i.e,Vedana, sthamba-in the Kati area and signs & symptoms of back pain which can be similor to Katigraha ,. Radiological examination will be performed to confirm the diagnosis if necessary.

7.3 h) Procedure10,11:

Kativasti alone group:-

  • Patient is made to lie in prone position . Pishta of masha is made into a paste and built like a wall around lumbo sacral area. Oil is heated and poured slowly inside the boundary with the help of cotton . when oil becomes cool it is replaced with warm oil. Continued for a period of time approx- 30 to 50 minutes for 7 days. After the duration, the oil is drained and flour is removed.

Agnikarma with Kativasti group:-

  • After following the kativasti, on the 7th day,Agnikarma is done in the shape of bindhu, by heating one end of roupya dhatu Shalaka and keeping the other end at maximum point of tenderness of kati-graha up to the heat tolerance of the patient.
  • Patient will be educated for proper diet and life style

7.3 i) Duration:

  • 30 days
  • Patient will be kept under observation period at weekly once in 30 days.

7.3 j)Comparison:

Both groups are compared-

.

7.3 k) Statistical test:

  • Chi-square test

7.4)Does the study require any investigations or interventions to be conducted on patients or other human or animal? If so, please describe briefly:

Not required

7.5) Has ethical clearance been obtained from your institution in case 7.4?

Yes, obtained.

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8. References: -

1. Low backache

2. the free encyclopedia

3. Arthritis research and therapy (web version),august2006,volume8,issue5,22

4. R.C.G.Russell,Norman S Williams and Christopher J K Bulstrode- Bailey&Love’s,ch-41,2004,24th edition,Pp568

5.Susrutha-Susruta samhita,Sutrasthana ch-12/2,English translated by Kavraj Kunjulal Bhishagranta,edited by Dr Jyotir Mitra, Chowkamba Sanskrit Series office,1998,1st edition,,vol.1., Pp84

6.Susrutha-Susruta samhita,Sutrasthana ch-12/8 ,English translated by Kavraj Kunjulal Bhishagranta,edited by Dr Jyotir Mit,ra, Chowkamba Sanskrit Series office,1998,1st edition,,vol.1. ,Pp86

7.Vagbhata-Ashtanga Sangraha,Sutrastana ch-40/3,English translation by Prof.K.R.Srikantha Murthy,Chowkamba Orientalia,Varanasi,2003,1st edition,vol.1,Pp626

8.Sabdakalpadruma,by Raja radhakantadeva bahadu and Sri Varada Prasad vasuna tadamjena sri harichandravasu,Nagapablisarsa, 2003,2nd edition,vol.2,Pp9

9.Susrutha-Susruta samhita,Uttrasthana ch-42

10.Vagbhata-Ashtanga Sangraha,Sutrastana ch-19/6,English translation by Prof.K.R.Srikantha Murthy,Chowkamba Orientalia,Varanasi,2003,1st edition,vol.1,Pp353

11.Sri vaidya sodhala and Sri indradeva tripathi, Gadanigraha with vidyotini hindi commentary, Kayachikitsa khanda,Ch-21/160, Chowkamba Sanskrit Series office,1969,1st Edition, Part-2,Pp- 508

12.Susrutha-Susruta samhita,Sutrasthana ch-7/2-5,English translated by Kavraj Kunjulal Bhishagranta,edited by Dr Jyotir Mit,ra, Chowkamba Sanskrit Series office,1998,1st edition,,vol.1. ,Pp54-55

13.Bagela

14.Rasa ratna samuchayam-5/27,Hindi commentary by Dr Indradev Tripadi,Chowkamba Sanskrit Bhavan,1998,1st edition,Pp55.

15.Susrutha-Susruta samhita,Sutrasthana ch-12/3,English translated by Kavraj Kunjulal Bhishagranta,edited by Dr Jyotir Mitra, Chowkamba Sanskrit Series office,2005,3rd edition,,vol.1., Pp85

16.Vagbhata-Ashtanga Sangraha,Sutrastana, ch-34/15,English translation by Prof.K.R.Srikantha Murthy,Chowkamba Orientalia,Varanasi,2003,1st edition,vol.1,Pp559

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