RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
SYNOPSIS BY
Dr. KALPITHA E
FOR THE DEGREE OF AYURVEDA DHANWANTARI
M.S. (AYURVEDA) IN SHALYA TANTRA 2012
TITLE OF THE TOPIC
“A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF AGNIKARMA AND SIRAVYADHA IN GRIDHRASI(SCIATICA)”
NAME OF THE INSTITUTE
GOVERNMENT AYURVEDIC MEDICAL COLLEGE,
DHANWANTARI ROAD,
BENGALURU – 09,
KARNATAKA.
FROM,
Dr. KALPITHA E.
1st Year, P.G.Scholar, Dept.Of P.G.Studies in Shalya tantra, Government Ayurvedic Medical College, Bengaluru-560009.
TO, THE REGISTRAR, Rajiv Gandhi University of Health Sciences, Bengaluru-41
Karnataka.
Through,
THE PRINCIPAL AND H.O.D OF PG STUDIES IN SHALYATANTRA,
Government Ayurvedic Medical College,
Bengaluru- 560009.
Respected sir,
Sub: 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, Bengaluru for the partial fulfillment of M.S.(Ayu) in Shalya tantra
Title of the Dissertation
“A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF AGNIKARMA AND SIRAVYADHA IN GRIDHRASI(SCIATICA)”
Here with I am enclosing completed proforma for registration of subject for dissertation Thanking You,
Yours faithfully,
Place: Bengaluru-09
Date: Dr. KALPITHA E.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA ANNEXURE-II
PROFORMA FOR REGISTRTION OF SUBJECT FOR DISSERTATION
1) NAME AND ADDRESS OF THE CANDIDATE / DR.KALPITHA E1ST YEAR P.G.SCHOLAR, DEPT.OF P.G.STUDIES IN SHALYA TANTRA,
GOVT.AYURVEDIC MEDICAL COLLEGE,
DHANVANTARI ROAD, BENGALURU-560009.
PERMANENT ADDRESS / DR.KALPITHA E, D/O ESHWARAPPA B, H.NO 366, 2ND SECTOR, B TYPE, KUDREMUKH,CHIKKMAGALUR DIST, 577142.
2)NAME OF THE INSTITUTION / GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD,
BENGALURU-560009.
3)COURSE OF THE STUDY AND SUBJECT / AYURVEDA DHANWANTARI,
1ST YEAR MS (AYU), SHALYA TANTRA.
4)DATE OF ADMISSION TO THE COURSE / 29-10-2011
5)TITLE OF THE TOPIC / “A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF AGNIKARMA AND SIRAVYADHA IN GRIDHRASI(SCIATICA)”
6. BRIEF RESUME OF THE INTENDED WORK: 6.1 Need for the Study:
The earliest reference about the details of Gridhrasi is available from Sushruta Samhita(1500 BC). Later authors of Brihatrayees namely Charaka, Vagbhata have also described about Gridhrasi in detail.
Gridhrasi is a condition characterized by ruk, toda, stamba, spandana, in spik, kati, uru, janu, jangha, pada as per Charaka.
Keeping in view the various signs and symptoms mentioned in Ayurvedic classics, it can be correlated with Sciatica of modern science.
Sciatica is a term which refers to pain that radiates along the sciatic nerve and is typically felt in the buttock, down the leg, and possibly to foot.
Low back pain is a common condition that affects as many as 80-90% of people during their lifetime. True sciatica occurs in about 5% of cases. Sciatica is more common between 30-50years of age. Although the condition occurs in men and women about equally, some studies have shown that sciatica often is more severe in women.
In Modern system of medicine, administration of muscle relaxants, NASIDS (Non Steroidal Anti Inflammatory Drugs) opoid analgesics, corticosteroids etc; gives temporary relief and their long term use can produce toxic effects to the different system of the body. As the last resort surgical procedures are carried out, which are quite expensive and need hospitalization and also causes adverse effects like, bowel and bladder incontinence.
In Ayurveda wide treatment modalities have been explained for management of Gridhrasi, among them Agnikarma and Siravydha are taken up for this study for following reasons:
- Avoids drug load to the body
- Brings in neurological, endocrine and vascular adaptations
- Launching of revitalization(by Siravyadha)
- Strong stimulus(by Agnikarma)
This study is aimed at evaluating the Significance of Agnikarma in Gridhrasi, by comparing it with the established study Sira-Vyadha which has got 80% result as per previous dissertation.
6.2 REVIEW OF LITERATUTRE
AYURVEDIC REVIEW ON GRIDHRASI:
Nirukti:
गृध्रमपि स्यात् यो (dw.kh. p. 251)
Patients gait resembles that of vulture.
गृध्याति मांसामाभिकाङक्षाति सक्तं इति
गृध्रो मांसलोलूपो मनुष्य: तं स्याति पीडयति नाशयति वा ll1 (dw.kh. p. 251)
The bird is very fond of meat and consumes flesh of animals in such a way that it deeply pierces its beak into the flesh and then draws it out forcefully, exactly such type of pain is experienced hence the name Gridhrasi.
Nidana, Samprapti & Lakshana:
पार्ष्णि प्रत्यङ्गुलीना तु कण्डरा यानिलार्दिता
सक्थ्नः क्षेपं निग्रहणीयादगृध्रसीति ही सा स्मृता
When the ligament of heel and toes are afflicted with vata, they obstruct the movements of leg. This is known as Gridhrasi. 2 (Ni.ch.1 sl. 74)
स्फिक्पूर्व कटी पृष्ठोरूजानुजङ्गापदं क्रमात्
गृध्रसी स्तम्भरूतोदगृंहाति स्पन्द्ते मुहुः
वाताद्वातकफाद्तन्द्रागौरवोचकान्विता
Gridhrasi (Sciatica) starts from hip and gradually comes down to waist, back, thigh, knee, shank and foot and affects these parts with stiffness, distress and piercing pain and also frequent quivering. These symptoms of vata but when the disorder is caused by vata and kapha it is associated with drowsiness, heaviness and anorexia .3
(chi.ch.28 sl.56-57)
Chikitsa:
स्नेहोपनाहाग्निकर्मबन्धनोन्मर्दनानि च l
स्नायुसन्ध्यास्थिसंप्राप्ते कुर्याद्वायवतान्द्रिता ll
In case of vata located in ligaments, joints and bones, one should employ carefully unction, poultice, cauterization, binding and pressing. 2 (chi.ch. 14 sl.8)
अन्तराकन्डरागुल्फं सिरा बस्त्याग्निकर्म च l
गृध्रसीषु प्रयुन्जीत खल्ल्यां तूष्ण्णॊपानाहनाम् ll
Venesection in tentocalcaneum and ankle and cauterization are applied in sciatica.3 (chi.ch. 28 sl.101)
गृध्रस्यार्तस्य जङ्गायाः स्नेहस्वेदे कृते भृशम् l
पद्भ्यां निर्मार्दितायाश्च सूक्ष्ममार्गेण गृध्रसीम् ll
अवतार्य्याङ्गुलौ सम्यक् कनिष्ठायां शनैः शनै: l
‘जात्वा समुन्न तं ग्रन्थिं कण्डरायां व्यवस्थितम् ll
तं शस्त्रेण विदार्य्याशु प्रवालाङ्करसन्निभम् l
समुद् धृत्याग्निना दग्ध्वा लिम्पेद् यष्टचाह्रचन्दनैः ll
विध्येच्छिरामिन्द्रवस्तेरधस्ताच्चतुरङ्गुले l
यदि नोपशम्ं गच्छेद् दहेत् पादकनिष्ठिकाम् ll
At first, the leg of the patient of Sciatica should be massaged, fomented and pressed with feet so as to make the nerve prominent. Then it should be put on the little finger gradually and prominently elevated pointed should be incised, the sprout like portion should be removed and finally be cauterized and pasted with Madhuyeshti and chandana. The vein four fingers below Indrabasti(calf)should be punctured. If it does not give relief the little finger of the foot is cauterized. 4 (chi.ch. 22 sl. 189-190)
Abbrevations:
chi. : Chikitsa sthana
Ni. : Nidana sthana
sl. : Sloka
ch. : chapter
dw. : dwitiya
kh. : khanda
p. : inclusive page no
MODERN REVIEW ON SCIATICA:
A syndrome characterized by pain radiating from back into the buttock and into the lower extremities along its posterior or lateral aspect and most commonly caused by prolapse of the intervertebral disc. The lower turn is also used to refer to pain anywhere along the course of Sciatic nerve.5 (p. 273)
Sciatica is the pain in the distribution of sciatic nerve. Most commonly it is due to the protrusion of the degenerated L5 to S1 disc that impinges upon S1 nerve root. The pain is most prominent during active movements, stooping, coughing, sneezing or lifting heavy weight with restricted SLR sign, weakness of the extensor halleus muscle, evidenced by: weak dorsiflexion of the great toe. 6 (p. 1148)
Irritation of the 4th and 5th Lumber and 1st sacral roots, which form the sciatic nerve causes pain that extends mainly down the postero and antero lateral aspect of the leg and into the foot is termed as Sciatica. 7 (p. 2155)
PREVIOUS WORK DONE
· Yogithabali MR- Efficacy of Agnikarma over Padakanistikam(little toe) and Kati basti in Gridhrasi-a comparative study(dissertation) RGUHS. Karnataka Bengaluru; 2006
· Shekokar Anant- A comparative study of Agnikarma and Ajamodadi vati in management of Gridhrasi w.s.r to Sciatica(dissertation) Gujrat Ayurcedic university. Jamnagar ; 2004
· Dhananjaya Alva- Role of Agnikarma in management of Gridhrasi w.s.r to Sciatica(dissertation)RGUHS. Karnataka. Bidar; 2008
6.3 OBJECTIVES OF THE SYUDY
· To evaluate the efficacy of Agnikarma in Gridhrasi.
· To evaluate the efficacy of Siravyadha in Gridhrasi.
· To compare the efficacies of Agnikarma and Siravydha in management of Gridhrasi, thereby study the Significance of Agnikarma .
7. METHODOLOGY
7.1 Source of Data:
The patients suffering from classical features of Sciatica will be selected from OPD and IPD of Sri Jayachamarajendra Institute of Indian Medicine Hospital, Bangalore- 09.
7.2 Method of Collection of Data
A total of 40 cases who fulfill the diagnostic criteria will be randomly selected irrespective of sex, religion, economic status, and marital status.
A) Diagnostic Criteria
Patient with signs and symptoms of Gridhrasi are taken for the study like –
· Presence of Ruk, Toda, Stambha and Spandana in the Sphik, Kati, Uru, Janu, Jangha, and Pada or pain atleast in two of these sites.
· Tenderness along the course of sciatica nerve.
· Positive SLR test .
· Positive Bragards sign.
· Positive Lassegue’s sign.
B) Inclusion Criteria
· Patient with features of Gridhrasi namely ruk (continous pain), toda (intermitent pain), stambha (stiffness), spandana (twitching) over sphik, kati, prishta, uru, janu, jangha extending upto pada.
· Positive SLR test .
· Positive Bragards sign.
· Positive Lassegue’s sign.
· Patient with chronicity upto 1 years.
C) Exclusion Criteria
· Patient with other systemic disorder and serious illness.
· Patient with traumatic paraplegia, paraplegia, hemiplegia, bowel & bladder incontinence.
· Patient with history of Compression fracture, Lumbar canal stenosis, 3rd & 4th degree disc prolapse, diagnosed by X ray
· Patient aged below 16years and above 60years.
· Agnikarma anarha.
· Siravyadha anarha.
D) Plan For The Treatment 40 Patient fulfilling the inclusion criteria will be randomly divided in to two group as Group A and Group B consisting 20 patients each.
STUDY DESIGN:
GROUP A / Agnikarma with panchaloha shalaka / Will be executed in 2 sittings at the interval of 15daysGroup B / Siravyadha – antarakandaragulpha / Will be executed in 2 sittings at the interval of 15days
NOTE: The changes in the signs and symptoms with the treatment shall be observed before treatment, on 1st day and on the 15th day of treatment and these observations shall be recorded in the proforma of case sheet prepared for the study. A duration of 30 days shall be fixed to observe the possibility of recurrence in cases whose total relief would be obtained and the same shall be recorded in the proforma of case sheets.
The result obtained shall be statistically analyzed and the conclusion shall be drawn.
E) Assessment Criteria
Subjective parameters
· Ruk,
· Toda
· Stambha
· Spandana in sphik, kati, uru, janu, jangha and pada
Objective parameters
· Straight Leg Raising Test
· Bragards Sign
· Lassegue’s test
Subjective and Objective parameter before & after treatment are analyzed by using appropriate statistical method & final conclusion shall be drawn.
7.3 INVESTIGATIONS – X-ray &
MRI if necessary
7.4 ETHICAL CLEARANCE
Ethical clearance shall be obtained from ethical committee, Government
Ayurvedic Medical College, Bangalore.
8) BIBLIOGRAPHY :
1) Raja Radhakantadev Bahaddur. Shabdakalpadruma. 2nd ed. 2003. Delhi: Naga publishers; Dwithiya khanda. pp .315
2) Sushruta. Sushruta samhita. edited and translated by Prof. Priyavrata Sharma. 2005. Varanasi: Chaukambha Vishwabharati oriental publishers and distributers; vol . pp.696
3) Charaka. Charaka samhita. translated by Prof. Priyavrat Sharma, 2005, Varanasi: Chaukambha Orientalia; vol 2. pp.879
4) Cakrapani, Cakradatta : Sanskrit text with English translation treatise on principle & practice of ayurvedic medicine by Priyavrat Sharma. 3rd ed. 2002. Varanasi: chaukambha publications; pp.731
5) Dorland’s pocket medical dictionary: 26th ed. 2004. pp 931
6) API text book of medicine editor in chief- Siddharth N. Shah.7th ed.2003. Mumbai: The association of Phisicians of India; pp1511
7) Harrison’s principles of internal medicine. Anthony S.Fauci editors.$ Mc Graw hill Publication. 15th ed. Vol 1, 2001: pp 143,97
9 / Signature of Candidate:10 / Remark of the Guide:
11 / Name and Designation of (In block letters):
11.1 / Guide: / Dr. AHALYA SHARMA
BAMS , MD(AYU)
PROFESSOR,
DEPT OF P.G STUDIES IN
SHALYA TANTRA,G.A.M.C,
BANGALORE.
11.2 / Signature:
11.3 / Head Of The Department: / Dr. R.VIJAYASARATHI.
BSAM.BAMS.MD (AYU)
PROFESSOR & H.O.D
DEPARTMENT OF P.G. STUDIES IN SHALYA TANTRA,
G.A.M.C, BANGALORE-560 009.
11.4 / Signature:
12.1 / Remark of the chairman and Principal:
12.2 / Signature:
10