RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA.
SYNOPSIS BY:
DR. SHASHIDHARA. R BAMS
1ST YEAR PG SCHOLAR
DEPT. OF PG STUDIES IN PANCHAKARMA
S.J.G.A.M.C, KOPPAL - 583231
Guide:
Dr. suresh n. hakkandi Md (Ayu)
READER AND H.o.d
dept. of pg studies in panchakarma
S.J.G.A.M.C, KOPPAL - 583231
CO - Guide:
Dr. S.H. JIGLUR Md (Ayu)
LECTURER
dept. of pg studies in panchakarma
S.J.G.A.M.C, KOPPAL - 583231
FOR THE DEGREE OF AYURVEDA VACHASPATHI
M.D. (AYURVEDA) IN PANCHAKARMA
2012 - 2013
TITLE OF THE TOPIC:
“A COMPARATIVE STUDY OF THE EFFECT OF KATI BASTI AND KATI PICHU WITH VISHAGARBHA TAILA IN THE MANAGEMENT OF KATIGRAHA W.S.R TO LOW BACK PAIN.”
NAME OF THE INSTITUTE:
SRI JAGADGURU GAVISIDDESHWARA AYURVEDIC MEDICAL COLLEGE AND HOSPITAL
GAVIMATH CAMPUS,
KOPPAL – 583231, KARNATAKA
From,
DR. SHASHIDHARA. R
1ST YEAR P.G. SCHOLAR
DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA
S J G AYURVEDIC MEDICAL COLLEGE AND HOSPITAL
KOPPAL - 583231.
To,
THE REGISTRAR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU.
KARNATAKA.
Through,
THE PRINCIPAL AND HOD DEPT OF PG STUDIES IN PANCHAKARMA
S J G AYURVEDIC MEDICAL COLLEGE AND HOSPITAL
KOPPAL - 583231.
Respected Sir,
SUB: Submission of Completed Proforma for Registration of Synopsis of 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, Bengaluru, for the partial fulfillment of M.D. (Ayu) in Panchakarma.
Title of the Dissertation:
“A COMPARITIVE STUDY OF THE EFFECT OF KATI BASTI AND KATI PICHU WITH VISHAGARBHA TAILA IN THE MANAGEMENT OF KATIGRAHA W.S.R TO LOW BACK PAIN.”
Here with I am enclosing completed proforma for registration of the subject for dissertation.
Thanking you
Place: Koppal Yours Faithfully, Date:
(DR. SHASHIDHARA. R)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
ANNEXURE-2
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME AND ADDRESS OF THECANDIDATE / DR. SHASHIDHARA. R
1ST YEAR P.G. SCHOLAR
DEPT OF PG STUDIES IN PANCHAKARMA
SJGAMC, KOPPAL - 583231
1.1 PERMANENT ADDRESS / #643, ADARSHA NAGAR, ARISHINAKUNTE,
NELAMANGALA – TALUK,
BENGALURU RURAL – 562123.
KARNATAKA
2. NAME OF THE INSTITUTION / SRI JAGADGURU GAVISIDDESHWARA AYURVEDIC MEDICAL COLLEGE, GAVIMATH CAMPUS,
KOPPAL – 583231.
KARNATAKA
3. COURSE OF THE STUDY AND SUBJECT / AYURVEDA VACHASPATI
M.D. PANCHAKARMA
4. DATE OF ADMISSION TO THE COURSE / 25/10/2012
5. TITLE OF THE TOPIC / “A COMPARITIVE STUDY ON THE EFFECT OF KATI BASTI AND KATI PICHU WITH VISHAGARBHA TAILA IN THE MANAGEMENT OF KATIGRAHA W.S.R TO LOW BACK PAIN.”
6. BRIFE RESUME OF THE STUDY:
6.1 NEED FOR THE STUDY:
Ayurveda the divine science of life aims not only to cure the diseased but also to maintain the Physical, Mental, Social & Spiritual well-being of an individual1.
PANCHAKARMA is one of the entity, which plays very important role in achieving above said aim of Ayurveda.
Charaka has classified Trividha Aoushadhi as Anta-Parimarjana, Bahi-Parimarjana and Shastra-Pranidhana2. Kati Basti and Kati Pichu are included in Bahi-Parimarjana Chikitsa.
Snehana and Swedana are the two Upakramas, which can be adopted for the management of Vata Vyadhi. In Kati Basti and Kati Pichu, Sukhoshna Taila is used over the Kati Pradesha. While administering on Kati Pradesha, it helps in oleation of spine and strengthens the muscles. Where the Sneha by its Snigdha, Guru and Ushna Guna counteracts the Rooksha, Laghu and Sheeta Gunas of Vata and by Ushna Guna and Sukoshnata counteracts Kapha also. By penetrating through the Sukshma Srotases of the skin to pacify the Vata and Kapha.
In Ayurvedic Samhitas Katigraha has been mentioned as a very common problem, characterised by pain and restricted movements of Kati Pradesha.The etio-pathogenesis of Katigraha is suggestive of Vata Pradhana Vyadhi14. When Shuddha or Sama Vata enters into Kati and produces the symptoms like Ruja and Stabhdata in Kati Pradesh, that condition is called as Katigraha14.
Low Back Pain, a chronic condition and most common pain disorder which is characterised by dull or sharp pain in the lower back it may also associated with burning, stiffness etc. Pain in the lower back restricts the activity, reduces work capacity, quantity of enjoyment of everyday living and turns daily life into a misery. About 40% to 80% of general population in life time in India suffer from Low Back Pain due to several stressful factors seen in their professional or social life and also due to wrong postural habits. It affects both men and women alike and common in the age group of 25 to 50 years6.
Though it is a commonest diagnosis given to the patients attending the clinics with low back pain, the current management includes NSAID'S, local anaesthesia, Steroids, sedatives etc., gives temporary relief from pain but has got severe adverse effects. In spite of recent advances in western science, the treatment is mere-symptomatic. But symptomatic management of any disease is incomplete as it cannot break up the chain of pathogenesis. So need arises to search for a safer, better and cheaper treatment. Kati Basti and Kati Pichu fulfils these criteria.
Kati Pichu is a simpler procedure than Kati Basti and fulfils the Snehana & Swedana told for management of Katigraha. Kati Pichu covers larger surface area of skin through which there may be better absorption of drugs and might give better relief from signs and symptoms. Kati Pichu being simpler than Kati Basti makes it comfortable for the patient to undergo and it can be carried out with minimal clinical set up it can perform in OPD also. If the Kati Pichu shows equal or better effect of that of Kati Basti then it can be practiced routinely as effective treatment modality for relieving the signs and symptoms of the disease.
According to Yogaratnakara Vishagarbha Taila has indicated in Katigraha taken for the study13.
Hence this study is planned to evaluate the effects of Kati Basti and Kati Pichu with Vishagarbha Taila in Katigraha.
6.2 REVIEW OF LITRETURE:
Katigraha, one of the 80 Nanatmaja Vatavyadhi mentioned by Acharya Sharangadhara3. None of Brihatrayee has explained Katigraha as a separate entity. But a brief description of Katigraha as a disease with its Lakshana and Chikitsa is available in Bhavaprakasha4, Yogaratnakara and Vrindamadhava has given about the same symptoms of Katigraha and describes its treatment in detail5.
In Charaka Samhitha, Sushrutha Samhitha and Astanga Hrudaya, in Nanatamaja Vata Vyadhi though Katigraha has not been mentioned, other symptoms of spinal diseases like Prusthagraha, Trikagraha, Manyagraha etc are found, and also mentioned as a symptom in some diseases.
Low back pain is a chronic condition characterized by a persistent dull or sharp pain in the lower back. It may also associate with burning, stiffness, numbness or tingling with the pain8. Low back pain is usually defined as pain, muscle tension or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). The most important symptoms of non-specific low back pain are pain and disability9.
Vasti is the priority treatment for Vata. “Vasu nivase” meaning to reside, as medicated oil is made to retain over the particular place. Many Vasti are termed other than the practice of Vasti Chikitsa (Enema) according to the placement viz. Hrutvasti, Shirovasti, Kativasti, Vranavasti, Januvasti, etc. Kati Basti is a procedure evolved from the principles of Shiro Basti10 a kind of Murdni Taila. A Basti is constructed with dough prepared of Masha powder, on Kati Pradesha. Warm Sneha is poured into Basti and it is allowed to stay for stipulated period of time.
Pichu is a treatment modality where a gauze or cotton swab soaked in medicaments is placed on body surface to allow slow and steady absorption of drug. In the classics there is mentioning of use of Pichu in various context like Shiro Pichu11, Yoni Pichu12, etc
6.3 Previous WORK DONE:
1. Surekha M – Mangement of Kati graha with virtex nirgundo. Govt. Ayurveda College, Thiruvananthapuram, Kerala University – 1986.
2. Dhongade S – Kati grahavar Katibasti chi Upayogita – Govt. Ayurveda College, Nagpur University, Nagpur – 1994.
3. Bhat Mrinalini R – A clinical study on the role of eranda moola basti in the mangement of Kati graha - Jamnagar Ayurveda University, Jamnagar – 1997.
4. Sarat.K. Babu - A clinical evaluation of kati basti and nirgundi erandi kashaya in the management of kati graha. ALN Roa Memorial Ayurvedic Medical College Koppa 2006 RGUHS
5. Vibha N. R – A Study on Yogabasti schedule in the management of Katigraha. SDM Collage of Ayurveda, Hassan, 2008 RGUHS.
6. Dilbag Singh Jindal – Role of Parisheka Sweda in the management of Katigraha. SDM Collage of Ayurveda, Hassan, 2008 RGUHS.
7. Anjaly N. V – A Study on the effect of Swedana with Kolakulatadi Churna and Valuka in Katigraha. KVG Ayurvedic Medical College, Sullia, 2010 RGUHS.
6.4 OBJECTIVES OF THE STUDY
v To evaluate the effect of Kati Basti with Vishagarbha Taila in Katigraha.
v To evaluate the effect of Kati Pichu with Vishagarbha Taila in Katigraha.
v To compare the efficacy of Kati Basti and Kati Pichu with Vishagarbha Taila in Katigraha.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
a) Patients: Patients suffering from Katigraha (Low back pain) will be selected randomly from the outpatient department of S.J.G. Ayurvedic Medical College and Hospital, Koppal. By pre-set inclusion and exclusion criteria.
b) Literary: Ayurveda classics and modern texts and updated with recent medical journals.
c) Preparation of Medicine:
Ingredients13:
Drug / English Name / Latin Name / QuantityTila taila / Sesame oil / Selanum indicum / 4 kg
Dattura Swarasa / Thorn apple juice / Dutura metal / 1 kg
Kanji / Fermented gruel / 4 kg
Kusta kalka / Saussurea lappa / 25 gms
Vacha kalka / Acorus calamus / 25 gms
Hriddhatri kalka / Indian gooseberry / Emblica officinalis / 25 gms
Maricha kalka / Black pepper / Piper nigrum / 25 gms
Visha / Aconitum ferox / 18 gms
Datthura bija / Thorn apple seeds / Dutura metal / 18 gms
Saindhava / Rock salt / 18 gms
All the ingredients will be well identified and collected from local areas and from market and good manufacturing will be followed for preparation and will prepare at the Dept. of RS & BK of SJGAMC & Hospital Koppal.
7.2 METHOD OF COLLECTION OF DATA:
7.2 (a) INCLUSION CRITERIA
v Patients presenting with signs & symptoms of Katigraha
v The patients, who are fit for Snehana and Svedana.
v The age group between 25 to 50 years of either sex.
7.2 (b) EXCLUSION CRITERIA
1. Patients who are having low backache due to any infection, cancerous, congenital, viscerogenic, vascular causes.
2. Patient associated with any other systemic disorder.
3. Patients with the history of trauma (Abhighata Janya Katigraha).
4. Low backache caused by any treatment for other ailments (iatrogenic).
5. Backache due to prolapse disk.
6. Post-surgical backache.
7. Contraindicated for Snehana and Svedana.
7.2 (c) DIAGNOSTIC CRITERIA
The clinical features of Katigraha (Low back pain) as mentioned in texts will be basis for diagnosis.
7.2 (d) RESEARCH DESIGN
30 Patients of Katigraha will be randomly divided in to the following two groups, each comprise of 15 patients.
1) Kati Basti with Vishagarbha Tail Group (KBG)
Each patient will be subjected to Kati Basti on Kati Pradesh with Vishgarbha Taila.
Duration: 7 consecutive days, daily 30 minutes.
Procedure: A Basti is constructed with dough of Masha powder on Kati Pradesha. Warm Vishagarbha Taila is poured into it and constant temperature will be maintained.
2) Kati Pichu with Vishagarbha Taila Group (KPG)
Each patient will be subjected to Kati Pichu on Kati Pradesh with Vishagarbha Taia.
Duration: 7 consecutive days, daily 30 minutes.
Procedure: Two Pichu (cotton swab) as required size are taken and are soaked in hot Vishagarbha Taila one of them is taken out and placed over Kati Pradesha. When the temperature comes down it is exchanged with the hot Pichu.
7.2 (e) ASSESSMENT CRITERIA
· Subjective and objective parameters of baseline data to post medication data comparison are used for assessment.
7.2 (f) SUBJECTIVE PARAMETERS:
· Katigraha
· Katishula
· Reduced walking capacity due to pain
7.2 (g) OBJECTIVE PARAMETERS:
· Tenderness
· Range of movements.
7.2 (h) Study duration: Total 21 days.
7.2 (i) Procedure: 7 days.
7.2 (j) Follow up: 14 days.
7.2 (k) Readings will be taking on: 0, 7th, 14th and 21st day.
7.3 LABORATORY INVESTIGATION:
Diagnostic and Exclusion.
1. Blood routine (Hb%, TC, DC, ESR, Fasting Blood Sugar)
2. X-Ray (If necessary).
7.4 Has Ethical Clearance Been Obtained From Your Institution?
Ethical clearance shall be obtained from ethical committee, SJG Ayurvedic Medical College & Hospital, Koppal.
8. LIST OF REFERENCES:
1. SUSHRUTHA SAMHITHA; Hindi translation by, Dr.Ananat Ram Sharma, Published by, Chaukhambha Subharathi Prakashan, Varanasi; Reprint-2006; Vol. I; Sutra Sthana; P.357; 15:
2. AGNIVESHA; CHARAKA SAMHITHA; Hindi translation by, Brahmananda Tripathi; Published by, Chaukhambha Subharti Prakashan, Varanasi; Reprint-2004; Part I; Sutra Sthana; P.295; 14:39-40
3. SHARANGADHARA SAMHITHA: By Prof K.R Srikanta Murthy, Chowkamba orientalia Varanasi, 3rd edition 1997, Prathama Khanda 7/105-106. P 40
4. BHAVA PRAKASHA; with Vidyotini Hindi Commentary, By, Pt. Sri Brahmashankara Mishra, Published by, Chaukhambha Sanskrita Sanasthan, Varanasi; Part-II; P.286; 29:53
5. VRNDAMADAVA or Siddha Yoga; Translated by Dr.P.V.Tewari and Dr. Asha Kumari; Published by, Chowkhambha Vishva Bharati, Varanasi; Edition 2006; Part-I; P.318; 22:85-86
6. http://ayurmahc.com/topic.html
7. SUSHRUTHA SAMHITHA; Hindi translation by, Dr.Ananat Ram Sharma, Published by, Chaukhambha Subharathi Prakashan, Varanasi; Reprint-2006; Vol. I; Nidana Sthana; P. 459; 1:23-24; Vol. II; Nidana Sthana; P. 489; 4:5
8. http://ayurmahc.com/topic.html
9. BMJ; Clinical review- Diagnosis and treatment of low back pain; 2006:332; 1430-1434
10. ASHTANGA HRIDAYA: Ashtanga Hridaya of Vaghbata with hindi commentary By Dr.Brahmanand Tripathi. Published by Choukhamba Sanskrit Partishtan Delhi. reprint 2007 Sutrasthana 22/26-31 p 260-261