Madhu Sudhana Kulkarni

CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI)
THROUGH VASTI AND KATI VASTI ALONG WITH

TRAYODASHANGA GUGGULU
BY
DR. MADHUSUDHANA KULKARNI

B.A.M.S.
DISSERTATION SUBMITTED TO
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE.
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

DEGREE OF
DOCTOR OF MEDICINE (AYURVEDA)

IN
KAYACHIKITSA
GUIDE
DR. M.A.HULLUR
M.D. (Ayu.), B.A.M.S. (Int.), Ph.D.
PROFESSOR
DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA

AYURVEDA MAHAVIDYALAYA, HUBLI.
DEPARTMENT OF POST GRADUATE STUDIES IN

KAYACHIKITSA
AYURVEDA MAHAVIDYALAYA, HUBLI
2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “ CLINICAL
MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND
KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a
bonafide and genuine research work carried out by me under the
guidance of DR. M. A. HULLUR, M.D. (Ayu.), B.A.M.S. (Int.), Ph.D. Professor,
Department of Post-Graduate studies in Kayachikitsa, AYURVEDA
MAHAVIDYALAYA, HUBLI.
Place: Hubli
Date DR. MADHUSUDHANA KULKARNI
P.G. SCHOLAR
DEPARTMENT OF POST-GRADUATE STUDIES IN
KAYACHIKITSA
KARNATAKA
Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with
Trayodashanga Guggulu
KAYACHIKITSA
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “CLINICAL
bonafide research work done by DR. MADHUSUDHANA KULKARNI in
partial fulfillment of the requirement for the degree of DOCTOR OF
MEDICINE (AYURVEDA) in KAYACHIKITSA.
Place: Hubli
Date: GUIDE
Dr. M.A.HULLUR
M.D. (Ayu.), B.A.M.S. (Int.), Ph.D.
PROFESSOR
DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA
KARNATAKA.
KAYACHIKITSA
CERTIFICATE
This is to certify that the dissertation entitled “ CLINICAL

bonafide research work done by DR. MADHUSUDHANA KULKARNI

under the guidance of DR. M.A.HULLUR, M.D. (Ayu), B.A.M.S. (Int.),
Ph.D. Professor, Department of Post-Graduate studies in Kayachikitsa,
H.O.D PRINCIPAL
DR. P.G. SUBBANNAGOUDA
M.D. (Ayu) DR. S.J. DESHPANDE
PROFESSOR AND HEAD
AYURVEDA MAHAVIDYALAYA,
DEPARTMENT OF POST-GRADUATE
HUBLI, (KARNATAKA)
STUDIES IN KAYACHIKITSA,
(KARNATAKA).
DATE:
PLACE: HUBLI
COPYRIGHT
DECLARATION BY THE CANDIDATE

I here by declare that the Rajiv Gandhi University of Health
Sciences, Karnataka shall have the rights to preserve, use and
disseminate this dissertation / thesis in print or electronic format for
academic / research purpose.
Place:
Date DR. MADHUSUDHANA KULKARNI

P.G. SCHOLAR
DEPARTMENT OF POST-GRADUATE
STUDIES IN KAYACHIKITSA
AYURVEDA MAHAVIDYALAYA, HUBLI,
(KARNATAKA)
© RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
Acknowledgement i
ACKNOWLEDGEMENT
“Skills can impress but values can inspire”
By this note I bow my head to ancient Rishis who sacrificed their whole life
for upliftment of mankind and my grand father Sri Venkatarao Kulkarni who
inculcated skills and values in my life. It fills my heart with joy when I dedicate this
work to my beloved parents.
It is my pleasure to express gratitude to my guide Dr M.A. Hullur, Professor,
for his guidance and encouragement, which helped me to complete this dissertation
work.
It is my privilege and pleasure to express my heartfelt gratitude towards
Dr P.G. Subbanagouda, Professor and Head, Dept. of Post-Graduate studies in
Kayachikitsa, for his valuable guidance throughout my career as a PG Scholar.
I am grateful to Principal; Dr S J Deshpande and former principal Dr MA
Kundagol for their encouragement and help.
I am grateful to my teachers Dr.Prashant.A.S, Dr.A.I.Sanakal,
Dr.S.K.Bannigol, Dr.B.B.Joshi, Dr.J.R.Joshi, Dr Pradeep Agnihotri, Dr Anita Joshi,
Dr Anita Halagatti, Dr.Manjunath Naik, Dr Tyagaraja C, Dr.S.A Patil and Dr
Itagimath Statistician KIMS Hubli for inspiration and guidance throughout my work.
I will remain ever thankful to my senior friends; Dr. Srivatsa, Dr.Nilesh, Dr
Niranjan, and My colleagues Dr.Gireesh, Dr Dhanvantari, Dr R. Sivakumar, Dr
Rahul, Dr Prabhu and Dr. Reshma who helped me in this study. And also I am very
thankful to my junior collegues for their enthusiastic support in completion of this
work.
It is my pleasure to thank Mr Rajashekar B Alagawadi, Librarian, PG Library
and Librarians of UG Library, Sri.B R Kulkarni, Sri. Prabhakar Kulkarni.
Acknowledgement ii
This acknowledgement would remain incomplete if I do not mention my
sincere regards to all subjects included in this study and also to those who helped me
directly or indirectly to complete dissertation work.
I am thankful to Students of third professional BAMS 2008-09, College and
Hospital staff, Ayurveda Mahavidyalaya, Hubli.
Place: HUBLI
Date: DR.MADHUSUDHANA KULKARNI
Abbreviations iii
ABBREVIATIONS
• C.S. - Charaka Samhita
• Su.S. - Susruta Samhita
• A.S. - Ashtanga Sangraha
• A.H. - Ashtanga Hrudaya
• M.N. - Madhava Nidana
• B.P. - Bhava Prakasha
• Y.R. - Yogaratnakara
• G.N. - Gadanigraha
• H.S. - Harita Samhita
• B.S. - Bhela Samhita
• Sha.S. - Sharangadhara Samhita
• K.S. - Kashyapa Samhita
• C.D. - Chakra Datta
• Bh.R. - Bhaishajya Ratnavali
• Sh.K.D. - Shabda Kalpa Druma
• V.S. - Vangasena
• Su. - Sutrasthana
• Chi. - Chikitsa Sthana
• Si. - Siddhi Sthana
• Ni. - Nidana Sthana
• Sh. - Shareera Sthana
• Ka. - Kalpa Sthana
• Vi. - Vimana Sthana
Abbreviations iv
• Ut. - Uttara Tantra
• P.K. - Poorva Khanda
• M.K. - Madhyama Khanda
• U.K. - Uttara Khanda
• ‘P’ - Probability
• H.S - Highly Significant

• S - Significant
• ‘t’ - Student ‘t’ test
Abstract v
ABSTRACT
Gridhrasi is one of the Vatavyadhi and it is the commonest disorder found in
clinical practice. Symptoms of Gridhrasi simulate that of Sciatica. Vastikarma is the
best treatment in Vatavyadhi and Kativasti is a Bahya Snehana procedure which
specially pacifies Vata at Kati region which is the main site of pathology.
The study titeled as ‘Clinical management of sciatica (Gridhrasi) through
Vasti and Kativasti along with Trayodashanga Guggulu’ is focused on the
evaluation of the efficacy of Erandamuladi Niruha Vasti, Katibasti (Astakatwara
Taila) along with Trayodashanga Guggulu in the management of Gridhrasi.
The present study is a clinical study, containing of two groups each group of
15 patients, where one group patients received Erandamooladi nirooha Vasti in kala
vasti schedule (16 days) and another group received Kativasti for duration of 14 days.
Shamanaushadhi ie Trayodashanga Guggulu along with Rasnasaptaka Kwatha was
given to all 30 patients for duration of two months. Assessment was done before and
after the treatment and results obtained were statistically analyzed.
The present study proved that remarkable result were achieved in Group B
with Eranda muladi Niruha vasti in Kala Vasti schedule followed by Trayodashanga
Guggulu and Rasna Saptakam Kashayam than Group A with Kati Vasti followed by
Trayodashanga Guggulu and Rasna Saptakam Kashayam.
Key Words: Gridhrasi, Sciatica, Kativasti, Erandamooladi Nirooha basti,
Astakatwara, Rasna Saptaka, Shamana.
Table of contents vi
TABLE OF CONTENTS
• Acknowledgement i - ii
• Abbreviations iii - iv
• Abstract v
• List of Tables, Photographs and Graphs vii - xi
1. Introduction………………………………………………. 001-003
2. Objectives of the Study...………………………………… 004
3. Previous works done……………………………………… 005
4. Review of Literature……………………………………… 006-097
5. Methodology……………………………………………… 098-116
6. Observations and Results…………………………………. 117-141
7. Discussion………………………………………………… 142-162
8. Conclusion………………………………………………… 163-164
9. Summary…………………………………………………... 165-167
10. References & Bibliography……………………………….. xii - xix
11. Annexure
a. Case proforma xx - xxxvi
b. Master charts xxxvii - xxxix
List of tables vii
LIST OF TABLES
TABLE. PAGE
CONTENTS
NO NO.
1. HETU OF VATA PRAKOPA AND VATA VYADHI/ GRIDHRASI 26
2. SAMPRAPTI GHATAKA 38
3. SAMANYA LAKSHANA OF GRIDHRASI 44
4. VATAJA GRIDHRASI LAKSHANA 46
5. VATAKAPHAJA GRIDHRASI LAKSHANA 48
6. TYPES OF TREATMENTS 55
7. SHAMANOUSHADHI USED IN GRIDHRASI 58
8. PATHYA IN GRDHRASI 60
9. APATHYA IN GRDHRASI 61
10. SIGNS ASSOCIATED WITH NERVE ROOT LESIONS 80
11. CLINICAL FEATURES OF HERNIATED NUCLEUS PULPOSUS 81
12. PROPERTIES OF PANCHA KOLA CHURNA 99
13. PROPERTIES OF ASHTA KATWARA TAILA 100
14. PROPERTIES OF ERANDAMULADI NIRUHA 101
15. PROPERTIES OF SAHACHARADI TAILA 103
16. PROPERTIES OF TRAYODASHANGA GUGGULU 104
17. PROPERTIES OF RASNA SAPTHAKA KWATHA 105
18. GRADING 109
19. DISTRIBUTION ACCORDING TO AGE 117
20. DISTRIBUTION ACCORDING TO SEX 117
21. DISTRIBUTION ACCORDING TO RELIGION 117
22. DISTRIBUTION ACCORDING TO MARITAL STATUS 118
23. DISTRIBUTION ACCORDING TO OCCUPATION 118
24. DISTRIBUTION ACCORDING TO EDUCATIONAL QUALIFICATION 118
List of tables viii
25. DISTRIBUTION ACCORDING TO SOCIO ECONOMICAL STATUS 119
26 DISTRIBUTION ACCORDING TO HABITAT 119
27 DISTRIBUTION ACCORDING TO ADDICTION 119
28 DISTRIBUTION ACCORDING TO PRAKRUTI 120
29 DISTRIBUTION ACCORDING TO SATVA 120
30 DISTRIBUTION ACCORDING TO SATMYA 120
31 DISTRIBUTION ACCORDING TO SARA 121
32 DISTRIBUTION ACCORDING TO SAMHANANA 121
33 DISTRIBUTION ACCORDING TO VYAYAMA SHAKTHI 121
34 DISTRIBUTION ACCORDING TO AHARA SHAKTHI 122
35 DISTRIBUTION ACCORDING TO DIETARY HABITS 122
36 DISTRIBUTION ACCORDING TO AGNI 123
37 DISTRIBUTION ACCORDING TO KOSTHA 123
38 DISTRIBUTION ACCORDING TO ONSET 123
39 DISTRIBUTION ACCORDING TO CHRONICITY 124
40 DISTRIBUTION ACCORDING TO TREATMENT RECIEVED 124
41 DISTRIBUTION ACCORDING TO SIDE AFFECTED 124
42 EFFECT OF THERAPIES ON RADIATING PAIN 134
43 EFFECT OF THERAPIES ON NUMBNESS 135
44 EFFECT OF THERAPIES ON LASEGUE’S SIGN 136
45 EFFECT OF THERAPIES ON SLR TEST 137
46 COMPARATIVE EFFICACY OF THERAPY ON DIFFERENT 138

PARAMETER
47 EFFECT OF THERAPIES ON DIFFERENT PARAMETERS IN GROUP A 139
48 EFFECT OF THERAPIES ON DIFFERENT PARAMETERS IN GROUP B 139
49 OVERALL IMPROVEMENT EACH SUBJECT IN GROUP A & GROUP B 140
50 OVERALL EFFECT OF THERAPY ON 30 SUBJECTS OF GRIDHRASI 140
List of Photographs ix
LIST OF PHOTOGRAPHS
SL.NO PHOTOGRAPH
1. NORMAL SPINE
2. ABNORMAL SPINE CONDITIONS
NERVE ROOTS AND ITS SUPPLY TO MUSCLES AND

3.
DERMATOMES
4. COURSE OF SCIATIC NERVE
5. PROCEDURE OF KATI VASTI
6. MATERIALS OF NIRUHA VASTI
7. MIXING OF NIRUHA VASTI
8. PROCEDURE OF VASTI
9. SHAMANOUSHADHI
List of graphs x
LIST OF GRAPHS
GRAPH
NO CONTENT PAGE NO
1. AGE WISE DISTRIBUTION 125
2. SEX WISE DISTRIBUTION 125
3. RELIGION WISE DISTRIBUTION 125
4. MARITAL STATUS WISE DISTRIBUTION 126
5. OCCUPATION WISE DISTRIBUTION 126
6. EDUCATION WISE DISTRIBUTION 126
7. SOCIO ECONOMIC STATUS WISE DISTRIBUTION 127
8. HABITAT WISE DISTRIBUTION 127
9. ADDICTION WISE DISTRIBUTION 127
10. SHARIRIKA PRAKRUTI WISE DISTRIBUTION 128
11. MANASIKA PRAKRUTI WISE DISTRIBUTION 128
12. SATVA WISE DISTRIBUTION 128
13. SATMYA WISE DISTRIBUTION 129
14. SARA WISE DISTRIBUTION 129
15. SAMHANANA WISE DISTRIBUTION 129
16. VYAYAMASHAKTHI WISE DISTRIBUTION 130
17. AHARASHAKTHI WISE DISTRIBUTION 130
18. JARANASHAKTHI WISE DISTRIBUTION 130
19. DIET WISE DISTRIBUTION 131
List of graphs xi
GRAPH
NO CONTENT PAGE NO
20. DIETARY HABIT WISE DISTRIBUTION 131
21. RASA WISE DISTRIBUTION 131
22. AGNI WISE DISTRIBUTION 132
23. KOSTHA WISE DISTRIBUTION 132
24. ONSET WISE DISTRIBUTION 132
25. CHRONICITY WISE DISTRIBUTION 133
26. TREATMENT WISE DISTRIBUTION 133
27. AFFECTED SIDE WISE DISTRIBUTION 133
EFFECT OF THERAPY ON CARDINAL FEATURES OF 141

28.
GROUP A AND GROUP B
EFFECT OF THERAPY ON TOTAL SYMPTOM SCORE IN 141

29.
EACH SUBJECT UNDER GROUP A AND GROUP B
OVERALL EFFECT OF THERAPY ON CARDINAL 141

30.
SYMPTOMS OF BOTH GROUPS
Introduction 1
INTRODUCTION
Arohamakramanam Jivito Jivito Ayanam (Ath.4/3/7)
The aim of life is to awake, be alert and move towards the humble goal (Moksha).
Ayurveda the science of life if followed and practiced appropriately keeps an
individual hale and healthy. Due to the professional reasons, Conditions of the roads,
life style, food habbits and physical stress can motivate a condition where in the
locomotor system may be involved. Amongst these clinical conditions sciatica may
also be produced where in a person feels difficulty in walking and if ignored it can
cripple one’s life by damaging nerves of lower limb.
Sciatica is a relatively common condition with a lifetime incidence varying
from 13% to 40%. The corresponding annual incidence of an episode of sciatica
ranges from 1% to 5%.
A number of environmental and inherent factors thought to influence the
development of sciatica have been studied, including gender, body habitus, parity,
age, genetic factors, occupation and environmental factors.
The body mass may have been associated with low back pain. Body height
may be a risk factor for sciatica, although this appears to be significant only in males
in the 50–64 yr age group. The incidence of sciatica is related to age. Rarely seen
before the age of 20, incidence peaks in the fifth decade and declines thereafter 1.
According to our classics Gridhrasi is a condition characterised by pain starts
from kati and radiates down to Pristha, Uru, Janu, Jangha and Pada respectively.
The term Sciatica is applied in a some what imprecise manner of condition in
which pain is experienced in buttocks, back of thigh, back side of leg and outer
boarder of foot. If sciatica is not treated early it will end up in severe motor and
sensory deficits of lower limb 2.
Introduction 2
Sciatica can be correlated to Gridhrasi in which a person experiences pain all
along the posterior aspect of the lower limb. It is one amongst Vata Nanatmaja Vikara
and has been explained elaborately in Bhruhat Trayi. Scholars have specially defined
and described Nanatmaja Vata Vyadhi, because Vata is strong and potent dosha and
manifest abruptly and quickly and produces major defects and serious diseases and
may require emergency management.
In modern medicine Sciatic pain is generally managed by using anti-
inflammatory drugs, musclerelaxants and traction. Chronic cases need weight
reduction, exercises to improve abdominal muscletone and strength, correction of
posture and working habits. In presence of neurological symptoms or deficits or
intractable pain surgical intervention is needed. But the anti-inflammatory drugs are
having many side effects like gastritis, hepatotoxicity, fluid retention etc. If doesn’t
get relief, surgery is advised 3. Surgery is a costly affair and having their own post
operative complications.
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, its uses,
complications, and its advantages in Charaka Samhitha. Sushrutha has elaborately
described the Bastikarma procedures, about Bastiyantra, types of Basti,
complications, management, etc in different chapters of Chikitsasthana. Sarangadhara
Samhitha also has given much importance to Bastikarma. Yogaratnakara,
Bhavaparakasha and Vangasena dealt the Bastikarma beautifully and added newer
combinations to the Ayurvedic world for a better practice. Acharya Kashyapa equated
the Bastikarma as Amrutam because of its wide applications even in both infants and
Introduction 3
old age. Later, recent authors in Ayurveda have also elaborately explained the
Bastikarma, modifications of Bastiyantra, standardised measurements and easily
practicable.
Katibasti a Bahirparimarjana Chikitsa helps in alleviating the Sthanika Vata
and produces the Brumhana properties in the Sthanika region i.e. Kati which is
supposed to be the place of pathology (L.S.region). Trayodashanga guggulu has been
recommended by Chakradatta in the management of Gridhrasi.
In the present study, Minium of 30 subjects diagnosed with Sciatica
(Gridhrasi) are selected and categorized into two groups of 15 subjects each.
One group received Katibasti and other group received Basti with Kalabasti
schedule.
Objectives of the Study 4
OBJECTIVES OF THE STUDY
¾ To study in detail Sciatica (Gridhrasi) according to modern and
Ayurveda literatures.
¾ To assess the role of Kati Basti along with Trayodashanga Guggulu in the
management of Sciatica (Gridhrasi).
¾ To assess the role of Basti along with the Trayodashanga Guggulu in
the management of Sciatica (Gridhrasi).
Previous Work Done 5
PREVIOUS WORK DONE
1. Srikant U. – Study of systematic effect of Basti with special reference to
Gridhrasi, Vishwachi, and Pakshaghata. In 1984 Gujarat Ayurveda University,
Jamnagar.
2. Kazi Mohammed – Role of Swedana in Gridhrasi. In 1984 at Kerala Ayurveda
University, Thiruvananthapuram.
3. Tripati J.K. – Gridharasi mein Basti chikitsaka prayogik Adhyayan. In 1985
Govt. Ayurvedic College, Pandit Ravishankar University, Raipur.
4. Narashimhachari – A study of effect of Chaturbeeja in Gridhrasi. In 1987 Govt.
Ayurvedic College. Hydrabad.
5. Moradiya Ganasham – A comparative study on the role of Shodhana and
Shamana therapies on Gridhrasi. In 1990 Gujarat Ayurveda University,
Jamnagar.
6. Nandganonkar. P. – The management of Gridhrasi with Shephalica Ghanavati
(Nyctanthesarbor trists). In 1990 Gujarat Ayurveda University, Jamnagar.
7. Pavan Kumar – Concept of Gridhrasi in Ayurveda and Modern Medical
Sciences and Its management by An Ayurvedic drug Rasona (Allium sativum).
In 1993 at B.H.U.Varanasi.
8. Padmavati Venkatesh – A clinical study on Gridhrasi with special reference to
its management through Nirooha Basti and Trayodasanga guggulu – A.M.V.
Hubli. – In 2000 at RGUHS Bengalooru.
Historical Review 6
HISTORICAL REVIEW
The origin and progressive development of any disease is incomplete without
considering its historical background. Hence an attempt has been made to trace the
references regarding Vatavyadhi in general and Gridhrasi in particular and beginning
right from Vedic Period. For the total coverage of historical aspect, it has been
divided in 6 parts as below:
I. Vedic period
The disorders which impair the movement of legs are as old as the existence of
human being as walking is an inevitable function since the existence of man on the
earth to search for the food. Many disorders leading to impairment of movements of
legs are known since Vedic period.
In Vedas, Gridhrasi is not mentioned in any form. While in Atharva Veda the
word ‘Vaatikrita’ is mentioned. Here ‘Vaatakrita’ word denotes Vatavyadhi.
Anukam, Anukyam are the words used in many occasions to denote spine or
back. The word Prushta has been mentioned in many places in Rig Veda and Yajur
Veda 4. In Atharva Veda, Vata is addressed not to leave the body but bear the limbs
till the old age 5. Prayers saying “keep Ojus in Ooru spread in Jaghana and Prushta,
which is having the capacity to straight and erect the foot and responsible for
unimpaired organs of the entire body” is also been found in Atharva Veda 6.
Another hymn says, “Keep the thigh of the body 100 years 7, and keep the
Prushta healthy for 100 years.” In addition, the diseases are named involving spine
etc. quote from Atharva Veda says- “I have removed the distressful disease reached
through your legs, knees, pelvis and Yoni to the spine from your Ushniha Nadi 8.”
Spine and dorso-lumbar spine are named separately by the words Kikasa and Anukam
respectively 9.
Historical Review 7
Many disorders pertaining to voluntary movement of limbs are told in Vedic
Literature under the terms Vishkanda. Though the term Vishkanda mainly used to
10,11
indicate the impairment of shoulder joint in Atharvaveda and Taittereeya
Samhita12,13 Viskanda was mentioned along with Visra which means crushing the
14
limbs and Abhishochana (burning sensation). Whereas Vyamsa was mentioned in
Rigveda as the disorder, which hamper the movement or Gati.
“Yakshma” a disease condition described in detail in Vedas said to involve

15,16,17
any part of the body including Prushta, Ooru, Sroni, Asthi, and Majja . In
Atharva Veda also the association of weakness of Majja and pain legs is described 18.
On the basis of above Vedic descriptions it appears that many varieties of Vata
disorders were prevalent during Vedic period which impair the movement of the legs
due to pain and allied conditions.
II. Upanishad and Purana period
Upanishads used the term Anukam for spine as similar to that of Vedas. There are
elaborate descriptions of the functions and types of Vata, its locations, qualities etc.
In Kenopanishad the description given for Vayu as one which is always in motion
and continuing efforts 19.
Eeshopanishad also described it in a similar fashion.
Chandokyopanishad highlighted the Chala property of Vayu and described its
association with body and movements 20,21.
Kathopanishad named the word Sushumna for spinal cord, which comes out
piercing the skull 22.
In Prashnopanishad the anatomy of the spinal cord and its functions are depicted.
According ,to it Sushumna is one of the 101 Nadi going upwards. With the help of
this Nadi the Udana Vayu moves to and fro from foot and legs to head 23.
Historical Review 8
Brahma sutra reveals the importance of Vyana Vata as the one that resides in
the joints and responsible for the movements of the joints. The circulation is
considered as the function of Samana 24.

25
Agni Purana also holds identical description . Panini has mentioned Vata
Kopa as well as Vata Shamana. He has given the term Vatiki for disorders of Vata.
Sushumna comes out through the lower orifice of Mastishka.
III. Samhita period
Charaka Samhita:
In Charaka, at different places references related to Gridhrasi are available.
• In Charaka Sutra Sthana 5th Matrashiteya Adhyaya, Padabhyanga is indicated in
Gridhrasi 26.
• In Charaka Sutra Sthana 14th Swedadhyaya Gridhrasi is said to be treated by
Swedana procedures 27.
• Two distinct clinical varieties of Gridhrasi are mentioned in 19th chapter of
Sutrasthana entitled Ashtodareeya Adhyaya 28.
• In 20th chapter of Sutrasthana named Maharogadhyaya, Gridhrasi is mentioned as
one among the 80 diseases exclusively caused by the morbidity of Vata Dosha 29.
• An elaborate description of symptomatology and treatment of Gridhrasi is given in
the 28th chapter of Chikitsa Sthana.
Sushruta Samhita:
In Shareera Sthana, Sushruta has described the structure of Prushta, Pada and
its joints. He mentioned Vishnu as Adhidaivata for Pada. He clearly mentioned in
Marma Shareera that trauma on Kukundara Marma leads to sensory and motor loss of
lower limbs and leads to disability (Vaikalyata). In Siravyadha Shareera he described
the position, place and method of Siravyadhana in Gridhrasi cases.
Historical Review 9
Sushruta has given much importance by allotting the first chapter of Nidana
Sthana itself for Vatavyadhi. He described the clinical features of Gridhrasi in the
same chapter. He portrayed some allied conditions like Khanja, Pangu, Kalaayakhanja
etc. But varieties of Gridhrasi are not found. In Bhagnanidana chapter he made many
original observations pertaining to Sandhimukta (Dislocation or Herniation)
Kandabhagna (fracture). His description pertaining to classification, clinical features,
prognosis etc, of Sandhimukta suits for lumbar disc prolapse which is responsible for
majority of sciatica cases.
He described identical treatment for Gridhrasi, that is Siravyadha along with
general measures of Vataroga. It appears that Dhamani indicates nerves in this context
and stressed the adaptation of general Vataroga therapies for Gridhrasi. Unlike
Charaka he added the use of some oral drugs like Shaddharana yoga, Lavana,
Swedana, Nasya, external measures and suitable environment etc.
In Sushruta Samhita Gridhrasi has been described at three places.
• In first chapter Nidana Sthana, Vatavyadhi Nidana symptomatology and pathology
of Gridhrasi has been described 30.
• In Chikitsa Sthana 5th chapter Maha Vatavyadhi Chikitsitam, Gridhrasi is described
during indication of Siravyadha for Vatavyadhi Chikitsa 31.
• In Sushruta Shareera Sthana 8th chapter Siravyadha’s site for Gridhrasi is
indicated32.
Bhela Samhita:
The description of Vata its normal and morbid states in Bhela Samhita are
almost analogous to Charaka Samhita in many respects. In addition to Charaka and
Sushruta he observed the following:– He classified Vata disorder into two
1. Sarvanga (which involves the entire body)
Historical Review 10
2. Ekanga (which limit to the involvement of a particular part of the body)
He mentioned the disorders of Pada, Jangha, Janu, Ooru, Kati, Prushta as
Ekanga Roga. He attributed some of the functions of the body to 16 Adhyatma
Devata. It is surprising to note that Samavega dana (carrying and giving or
transmission of impulse) to Vidyut (electricity.) (BH-SH-7/8).
He mentioned many disorders Vatabhanga, Kampa, Gatrashosha, Sandhi
chyuti, Khanja, Pangu along with Gridhrasi. He described the association of
destruction or Henanga and Adhikanga with Vata Roga. The clinical features of
Gridhrasi is not found in available Bhela Samhita, in which many portion, are lost.
In 24th chapter of Chikitsa Sthana some general and special measures of Vata
along with Vatahara Taila are discussed. Probably the description of Gridhrasi might
have been lost from this chapter. However the treatment of Gridhrasi is described
some what different from his previous works. He stressed the use of Bala Taila for
Vasti, Pana etc, in addition to Raktamokshana. The treatment of Gridhrasi
immediately after describing Raktagata Vata Chikitsa indicates its association with
Rakta.
Harita Samhita:
He has allotted separate chapters for Amavata and Gridhrasi Vata. Gridhrasi as
a disorder of Vyana Vata in specific is a contribution by him. He cited Prushta
Stambha and Oru Stambha also as disorders of Vyana Vata which are usually
associated with Gridhrasi.
Harita was the first to give importance to Gridhrasi by naming 22nd chapter of
Triteeya Sthana as Gridhrasi Chikitsadhyaya. Though he declared the chapter
exclusively for Gridhrasi, he added Kroshthukasheersha, Padaharsha, Padadaha etc in
it, considering that all this disorders are originate from Rakta and Vata and having
similarity in treatment.
His description on clinical features are brief but elaborated the treatment as
Raktamokshana, Sweda, Abhyanga, oral administration of specific drugs like
Rasnapanchaka Kwatha, Shatavaryadi Choorna, Ajamodadi Choorna etc.
He advises Dahakarma is done only in cases refractory to the above treatment
during describing the site. He highlighted the use of Rasona, Guggulu and Bala in the
treatment of Vata disorders. He has allotted separate chapters for Rasona Kalpa and
Guggulu Kalpa in Kalpa Sthana.
Kashyapa Samhita:
In Kashyapa Samhita there is no specific chapter for Vata Vyadhi Cikitsa.
However the general aspects of Vata and its Etiopathogenesis are discussed in
Sutrasthana in similar lines as that of Charaka. Kashyapa observed Asthi and Majja as
sites of Vata which indicate the Prushta as Vata Sthana the involvement of which
leads to Gridhrasi. He elaborated the use of Sneha, Sweda, and Vasti. He described
the use of Lashuna elaborately indicating the use in Vata Roga in particular both for
prevention and cure allotting a separate chapter in Kalpa Sthana. Gridhrasi and its
managements are not found in his treatise but counted under 80 types of Vata
Vikara33.
IV. Sangraha period
Ashtanga Sangraha and Hridaya:
Vriddha Vagbhata illustrated Vata its physiological and pathological states
correlating the views of both Charaka and Sushruta incorporating his original
observations in his work Ashtanga Sangraha.
He has specifically mentioned that the site of Vata at the lower part of the
body. He has made fundamental observations pertaining to the role of Sheeta and
Ushna Guna in the Etiopathogenesis of Vata resulting in to Chaya, Prakopa and
Prashama.
Vruddha Vagbhata has described the functions impaired in Gridhrasi are
attributed to Vyana Vata. Gati, Prasara, Aakunchana, Apakshepana, Utkshepana are
performed by Vyana vata. Regarding the description of Gridhrasi his description is
analogous to Sushruta. He mentioned Gridhrasi in the disorders of Vata sited at Snayu
which has not been observed by any of his previous Acharya.
In Ashtanga Sangraha Gridhrasi has been described at three places.
In Sutra Sthana 20th chapter Doshabhedeya. Gridhrasi is included under 80 types
of Vata Vikara 34. In Nidanasthana 15th chapter Vatavyadhi Nidana, pathogenesis
and symptomatology of Gridhrasi has been described 35.
In Sutrasthana chapter 36th Siravyadha Vidhi – site for Siravyadha in Gridhrasi
has been told 36.
In Ashtanga Hridaya Gridhrasi has been described at following places.
In Nidana Sthana 15th chapter Vatavyadhi Nidana symptomatology and
pathogenesis of Gridhrasi is described as alike to Ashtanga Sangraha 37.
In Sutra Sthana 27th chapter Siravyadhavidhi – site for Siravyadha in Gridhrasi
has been indicated.
Madhava Nidana:
Gridhrasi finds place in the chapter of Vatavyadhi Nidana. He described the
varieties of Gridhrasi i.e., Vataja and Vatakaphaja more elaborately than Charaka
exhibiting his specialization of Nidana which facilitate appropriate diagnosis.
Cakrapanidatta:
While commenting on Charaka he made the following important
observations pertaining to Vata in general with special reference to Gridhrasi. He
had indicted the classification of Vata Roga into two
1. Sarvanga,
2. Ekanga.
While commenting on the functions of Vyana Vata he stated that Gati
indicate Akunchana and Prasarana etc.
In his work called Cakradutta he presented the views of both Charaka and
Sushruta in the context of general therapies of Vata and Gridhrasi. He was first to
describe the line of treatment of Gridhrasi in very detailed manner i.e., Shodhana,
Vasti preceeded by Urdhva Shodhana, Shastra Karma, Dagdha Karma, Lepa, and
Raktamokshana etc.
Arunadatta:
Arunadatta in his Sarvanga Sundari commentary on Ashtanga Hridaya defines
clearly that due to Vata in Kandara the pain is produced at the time of raising the leg
straight and it restricts the movement of thigh. This is an important clinical test now a
days for the diagnosis of sciatica known as Straight Leg Raising Test. However this
fact has been indicated in Sushruta Samhita also.
Vangasena Samhita:
Vangasena followed Madhavakara in description Nidana and Cakradutta in
describing Chikitsa. In addition to these therapies he has contributed many original
yoga and measures for curing Gridhrasi and allied conditions. He prescribed Karshana
Chikitsa, Rukshana, Deepana, Pachana drugs for Gridhrasi at the beginning and then
Ishtikasweda, Upanaha and Shodhana. He stated that Siravyadhana is to be adopted in
two or three places followed by Gunja Kalka Lepa for immediate relief.
Gadanigraha:
Author has described the line of treatment of Gridhrasi in very detailed
manner i.e., Shodhana, Vasti preceded by Urdhva Shodhana, Shastrakarma,
Dagdhakarma, Lepa, Raktamokshana etc. In this text treatment part of Gridhrasi has
been explained at two places
(1) 4th chapter Prayoga Khanda
(2) 19th chapter of Kayachikitsa Khanda
Dalhana:
Dalhana Acharya made some observations pertaining to Gridhrasi while
commenting on Sushruta Samhita as follows:-
It appears that he considered Gridhrasi Nadi as Kandara stated by Sushruta.
He termed it as Maha Snayu which runs from lumbar region to Gulpha. He mentioned
that Gridhrasi is termed as “Randhrini” by lay people. While commenting on
Gridhrasi Chikitsa he indicated Shonita Mokshana is to be performed only after
adopting general therapies of Vata disorders.
Indu:
Indu mentioned in his Sashilekha Vyakhya on Ashtanga Sangraha that in
Gridhrasi the symptoms are alike to Vishvachi. If pain and restriction of movement
occurs in the upper limb the disease is called Vishvachi and similar presentation in
lower limb termed as Gridhrasi.
Sharangdhara Samhita:
Sharangdhara mentioned Gridhrasi among 80 Vata disorders. He mentioned
that the disorder of Charana i.e, legs are forty two like Vataraktaja etc.
Adhamalla, the commentator on Sharangdhara Samhita stated that the Gridhrasi is
popularly known. Some people call it as “Radhi” also. He observed that Visvachi also
similar to Gridhrasi situated in arm.
Rasaratna Samucchaya:
It deals treatment of Gridhrasi in its 30th chapter.
Basavaraajeeyam:
He included Kalaya Khanja, Gridhrasi, Visvachi, Khalli, Pangu, Khanja and
Ooru Stambha in the list of Balavattara Vata disorders.
Bhavaprakasha:
Bhavamishra told the symptoms and treatment of Gridhrasi including the
disease in eighty types of Vata Vikara.
Yogaratnakara:
The author elaborated stage wise therapeutic measures for Vata disorders in general,
which suits to Gridhrasi also.
He described many preparations though are similar to previous works.
Sahasrayogam:
It is compiled by an unknown author or authors containing description of
numerous preparations particularly used traditionally in Kerala. Abundant Yoga for
Vata disorders, Gridhrasi and allied conditions can be found in this text. Prominent
among them are: Sahacharadi Kashaya, Ashtavargam Kashaya, Rasonadi Kashaya,
Rasnaerandadi Kashaya, Dhanvantara Taila, Avartita Ksheerabala Taila, Dhanyamla
Avagaha Sweda, Prabhanjanavimardana Taila, Karpasasthyadi Taila, Panchasneha,
Narasimha Choorna etc.
Gangadhara:
Gangadhara made some important observations particularly in Gridhrasi
Chikitsa. He has taken into consideration a Pathaantara of Charaka in the particular
context i.e., “Antara Kandaraangulyo Shirovastyagnikarma Ca”. He has
recommented Shirovasti and Agnikarma in Gridhrasi chikitsa.
In subsequent Sangraha Grantha and treatises many more effective yoga have
been described for Vata disorders and Gridhrasi. Prominent among them are
Bhaishajya Ratnavali.
V. Recent Ayurvedic Authors Views:
In the beginning of last century influenced by the developments in modern
medicine some Ayurvedic experts attempted to enrich Ayurveda without loosing its
basic concepts.
Prominent among them are, Mahamahopadhyaaya Pandit Gananath Sen,
Vaidya Hariprapanna, Vaidyaratnam P.S. Varier, Pandit Taranath, Vaidya C.
Dwarakanath etc.
Vaidyaratnam P.S. Varrier in his works Ashtanga Shareera and Brihat
Shareera coined many words in Sanskrit to describe Anatomy absorbing the results of
observation made by modern anatomists. He described Gridhrasi Nadi and associated
structures in his works similarly Gananathsen in his Pratyaksha Shareera also
described anatomy in the same manner.
Dr. Gananathsen in his outstanding work Siddhanta Nidana described
Gridhrasi in 6th chapter along with Shula. He described it under Vranashothaja Shula.
He considered the Gridhrasi is of Vranashotha involving Gridhrasi Nadi. In
Abhighataja Shula he mentioned Asthi Bhagna which is caused due to trauma. He
classified them into two: (1) Sadyobhavita and (2) Kalantarabhavita. The
Sadyobhavita are due to direct involvement of Sanjnavaha nadi by Urdwejana
indicating irritation or compression.
The gradual onset is stated to be due to Vranashotha (abscess) Peshi
Sankochana, Pindikodweshtana are mentioned in Kriya Vaishmya Shula. Nadi
Dourbalyaja Shula is described by him in the same chapter which indicates root pains.
VI. Review of Sciatica
The ancient Greeks were familiar with sciatic neuralgia and used the
term ‘sciatica’, to describe pains or ‘ischias’ felt around the hip or thigh. Hippocrates
himself referred to ‘ischiatic’ pain affecting men between 40 and 60 yr. He observed
that young men described pain that lasted about 40 days before resolving
spontaneously. He also noted that pain radiating to the foot was a good prognostic
sign, whereas localized hip pain was less likely to resolve.
The Italian anatomist Domenico Cotugno (1736–1822) wrote the first book on
sciatica in 1764 and for many years it was known as Cotugno's disease. He was the
first to distinguish sciatica due to nervous disease from the aching pain associated with
low back pain. He observed that sciatica could be continuous or intermittent and noted
that continuous pain could become intermittent, but not vice versa.
By the 19th century, sciatica was thought to be due to a variety of rheumatic
conditions causing inflammation of the sciatic nerve. However, early frustrations with
difficulties in identifying a cause of and treating sciatica were expressed by Fuller in
his book Rheumatism, Rheumatic Gout and Sciatica (1852). He stated ‘the history of
sciatica is, it must be confessed, the record of pathological ignorance and therapeutic
failure’. There may be many pain management physicians who would agree with those
sentiments today.
The intervertebral disc was first implicated as a causative factor in sciatica in
the early 20th century. Schmorl and Andrae (1929) described posterior disc
protrusions seen at post-mortem studies, but did not link these with sciatic pain and
concluded they were probably asymptomatic in life. In an early surgical management
of sciatica, the neurosurgeon Eslberg (1931) described removal of cartilaginous
‘tumours’ from the spinal canal, with subsequent improvement of symptoms. He
considered the possibility that these ‘tumours’ could in fact be prolapsed disc material.
This idea, however, was initially rejected.
The concept of prolapsed disc material causing pain was later revisited by
Mixter and Barr who reviewed the pathology of all excised chondromas of the spine
held in the Harvard Medical School pathology museum, comparing them with normal
disc material. Of 16 specimens reviewed, 10 were judged to contain normal disc
material. They concluded that sciatica and neurological sequelae were due to
protrusion of normal disc material. Six months later, the first patient with a
preoperative diagnosis of ‘ruptured intervertebral disc’ was operated on in the
Massachusetts General Hospital. This led to the landmark paper published in the New
England Journal of Medicine and since then, the prolapsed intervertebral disc has been
irreversibly linked with the pathogenesis of sciatica.
The presence of pain was initially ascribed to pressure on nerve roots. This
idea was challenged by Kelly, who felt that pressure on a nerve would lead to loss of
function rather than pain; therefore, pain must arise by a different mechanism. Around
the same time, Lindahl and Rexed found evidence of an inflammatory response on
lumbar nerve roots at laminectomy leading to the theory that prolapse of an
intervertebral disc may provoke an inflammatory reaction in lumbar nerve roots,
causing sciatic type pain. It led to an active research programme that is still ongoing38.
Etymological Derivation 19
ETYMOLOGICAL DERIVATION OF GRIDHRASI
Vyutpatti:
39
The word Gridhrasi is in feminine gender which is derived from the Dhatu
“Gridhu” that means to covet, desire, and strive after greedily on eager for. By the
40
rule of “Susudhadhri Dhibhyah Krammam ” as well as by adding “Run” Pratyaya
i.e., Grudh + Krun followed by Lopa of “K” and “N” the word Grudh + Ru i.e.,
“Grudhr” is derived. This word is also formed in another grammatical method as
“Grudhr+ So Atonupasargah” – Adding “Kah” Pratyaya leads to Gridhra + So + Ka,
further by Lopa of ‘O’ and ‘K’ and ‘Sha’ is replaced by ‘S’a’ by the rule
‘Dhaatvaadeshu S’ah Sah’ to get the word Gridhraus. Finally for this word Gridhraus
which is in female gender by adding ‘Dis’ Pratyaya the word ‘Gridhrasi’ is derived.
Gridhra refers to the bird Vulture.
It is opined that, in this disease the patients gait becomes altered as his legs
becomes tense and slightly curved due to pain resembling walk of the vulture, hence
the name Gridhrasi to this pain dominant malady.
Nirukti:
Gridhrasi is an illness predominantly affecting the ambulatory function of the
patient and the same is stressed in the derivation of the word Gridhrasi. Following
derivations are taken from the different text books in Sanskrit literature substantiates
the same.
1 Gridhramapisyati, ‘Syati’-as-‘Kshepana’.
2 “Orusandhau Vatarogah 41”
3 “Gridhramiva Syati Gacchati”.
The disease Gridhrasi is said to cause an abnormal throwing action in the
affected leg. The Sanskrit word Syaati in Gridhrasi means throwing action. By this
abnormality the gait of the patients is said to resemble the gait of bird vulture and
hence the name Gridhrasi to this unique illness. Further the author of Amarasudha
opines that this disease is characterized by morbidity of Vata Dosha affecting the hip
joint. The reference from Shabda Kalpa Druma states that, the word grudhra refers to
desiring, greedily, eager for, great desire for.
According to another Nirukti, Gridhrasi is characterized by severe pain
experienced by the patient and is similar to the one experienced by a prey of vulture
while being eaten up.
In Monier Williams, Sanskrit - English dictionary it is said that, Gridhrasi is
Rheumatism affecting the loins. Similar reference is also found in “Vaidyaka Shabda
Sindhu”
Paribhasha:
As described by Acharya Charaka Gridhrasi is a Vatavyadhi characterized by
Stambha (stiffness), Ruk (pain), Toda (pricking pain) and Spandana (frequents
switching). These symptoms initially affect Sphik (buttock) as well as posterior aspect
of Kati (waist) and then gradually radiates to posterior aspects of Ooru (thigh), Janu
(knee), Jangha (calf) and Pada (foot) 42.
Acharya Sushruta opines that there are two Kandara in the leg that gets
afflicted. The two Kandara include the one extending distally from the Parshni to the
toes, and other extending above from the Parshni to the Vitapa. These two Kandara
when gets afflicted with the Vata Dosha limits the extension of the leg. This disease is
known as Gridhrasi 43,44,45.
Paryaya:
Following are the synonyms of Gridhrasi.
1. Ringhinee (Vacaspatimishra) 46
The word Ringhinee means the disease that cause to creep or crawling or that
makes a person to go slowly. More over according to the Shabdakalpadruma this term
refers to Skhalana meaning displacement.
2. Randhrinee (Dalhana) 47
This term is used by Dalhana while commenting on Shusruta, indicates weak
point or rupture.
3. Radhina (Adamalla & Kaashirama) 48
This term is used by Adhamalla and Kaashirama in their Deepika and
Goodhaartha Deepika commentary on Sharangdhara Samhita. It indicates pressing,
compressing or destroying.
It may be a mere coincidental observation that displacement of the soft
annulus is the prime pathology of sciatica as referred by the word Ringhinee. Disc is
the weakest point in the lumbar spine which tends to rupture causing sciatica as
indicated by the word Randhrinee. Compression of the nerve roots is the primary
pathology of radicular pain in sciatica as referred by the word Radhina.
The word Gridhrasi was the only one name used to indicate this condition in
almost all the treatises and subsequent Sangraha Grantha and occasionally with a
suffix Vata make it Gridhrasi Vata. The other terms mentioned above are used only
by commentators.
Derivation of Sciatica:
The term Sciatica is derived from the neo-latin word Ischalgia. Ischalgia
composed from the Attic Greek words. (That means pain + buttock or hip). Sciatica
literally means pain in the lower buttock and upper part of the thigh.
Definition of Sciatica:
The term Sciatica designates a syndrome characterized by the pain beginning
in the lumbo-sacral region, spreading to the lower limb through buttock, thigh, calf till
the foot or a disorder characterized by pain in the distribution of the Sciatic nerve.
The synonyms used for sciatica are numerous as follows:
According to Greek & modern medicine in the 15th century the term Cyetica
and Scyetyka were used to indicate this condition. The word sciatica derived from
Greek word Ischiadikas i.e., pertaining to ischium i.e., the inferior dorsal part of the
hip . The term is used for the disease as well as the nerve.
Due to the observations made by Cutugno (1764) this was termed as
Cutugno’s Disease.
Afterwards as soon as the pathology came to light many words indicating the
disease came into use i.e.
Dissyndrome
Pinched nerve sciatica
Ruptured disc
Herniated disc
Disc protrusion
Herniated disc pulposis
Disease review 23
NIDANA
The word ‘Nidana’ is used in Ayurvedic classics in a broad sense. This word
is derived from the Sanskrit Dhatu ‘Ni’ which carries the meaning to determine. (Ni –
Nishchaya Deeyate Jnanam). This word either refers to etiopathogenesis of the
disease in general or the etiology of the illness in particular. From the perspective of
treatment, Nidana has utmost importance as the avoidance of etiological factor forms
the first and foremost line of treatment. This is followed by the specific treatment as
per the etiopathogenesis of the disease. All the Nidana may be categorized into three
groups as Asatmeindriyartha Samyoga, Prajnaparadha and Parainama. In another
point of view Nidana may be classified into two types as Samanya Nidana and
Vishesha Nidana. The description of Nidana for all the disorders is not uniform in
Ayurvedic literature. In relation to some of the diseases both Samanya and Vishesha
Nidana are enumerated. Description of Nidana is restricted to Samanya Nidana in
regards to many other diseases 49.
The Nidana factors of Vatavyadhi in general are also the Nidana of the
Gridhrasi, as the exclusive Nidana of Gridhrasi is not elaborated. Though the
etiologies of all the Vatavyadhi are similar, the Samprapti and clinical presentation is
unique for each Vatavyadhi, distinguishing them from one another.
Charaka 50 and Bhavaprakasha 51 have clearly mentioned the causative factors
of Vatavyadhi, but in Sushruta Samhita, Astanga Sangraha and Astanga Hridaya etc.
the causes of Vatavyadhi have not been clearly described. However, in these texts the
causative factors of provoked Vata Dosha are available 52,53,54,55,56.
Since Gridhrasi is regarded as Vatavyadhi of Nanatmaja type, the factors that
precipitate Prakopa of Vata can also be taken as the Nidana of Gridhrasi.
Disease review 24
In addition to this, in Charaka Samhita, Astanga Sangraha and Astanga
Hridaya, the root cause of Vatavyadhi is mentioned as either Dhatu Kshaya or
Margavarana 57,58,59.
All the etiological factors of Vatavyadhi as well as Vata Prakopa are taken as
Nidana of Gridhrasi and the same is elaborated in the following subtitles.
A) Aharaja (dietetic factors)
B) Viharaja (behavior factors)
C) Agantuja (external factors) and
D) Anya Hetuja (miscellaneous factors)
A) Aharaja: The causative dietetic factors included under this group have been again
subdivided into the following 8 groups.
i. Dravyatah: In this group all the dietetic articles responsible for Vata prakopa
have been included.
ii. Gunatah: This group includes the quality of dietetic articles like Rooksha,
Seeta etc. which lead to the prakopa of Vata
iii. Rasatah: The various tastes of the dietetic articles, the excessive use of which
lead to the Prakopa of Vata have been included in this group.
iv. Karmatah: Excessive use of Vishthambi article may lead to the Prakopa of
Vata and it has been included under this heading.
v. Veeryatah: For instance, the S’eeta Veerya articles cause the Prakopa of Vata.
vi. Matratah: Less eating or fasting comes under this heading.
vii. Kalatah: The Vata Prakopa occurs at the end of digestion. Eating before
digestion of the previous meal also leads to Vata Prakopa.
viii. Mithyopayogatah: The violation of the rules like, not to drink water
when thirsty or not to eat when hungry also lead to Vata Prakopa
Disease review 25
B) Viharaja: The causative factors related to the habit and regimen of the patient
have also been subdivided into two groups viz. I. Karmatah, II. Kalatah.
I. Karmatah: Such habits of (a) Kayatah (somatic) and (b) Manasika (psychic) which
lead to the Prakopa of Vayu have been included under this heading.
a) Kayatah: The etiological factors of Vata related with the body have been further
subdivided into the following sub-groups.
(1) Mithyaprayogatah: The faulty habits of the body or improper use of body
which may lead to the Prakopa of Vayu have been included under this
heading.
(2) Atiyogata: The excessive usage of the Karmendriya or the parts of the
body which cause Prakopa of the Vayu have been included under this heading.
b) Manasika: The psychic factors responsible for Vata Prakopa have been included
under this heading.
II. Kalatah: The periodic factors responsible for Vata Prakopa have been included
under this heading.
C) Agantuja:
External factors like trauma leading to Vata Prakopa have been included under
this heading.
D) Anya Hetuja:
All other causatives factors of the Prakopa of Vata which could not be
included in any of above classification have been presented under this heading. The
details of the causative factors are enlisted in table no.1.
Disease review 26
Table No. 1: Hetu of Vata Prakopa and Vata Vyadhi / Gridhrasi:
Causes Ca. Su. A.S. A.H. B.P
AHARAJA (Dietetic causes)
I. Dravyatah (Substantial)
Adhaki (Cajanus cajan) - + - - -
Bisa (Nelumbuo nucifera) - + + - -
Chanaka (Cicer arietinum) - - + - -
Chirbhata (Cuccumus melo) - - + - -
Harenu (Pisum sativum) - + - - -
Jambava (Eugenia jambolena) - - + - -
Kalaya (Lathyrus sativus) - + + - -
Kalinga (Holarrhena antidysenterica) - - + - -
Kariya (Capparis decidua) - - + - -
Koradusha (Paspalum scrobiculatum) - + - - -
Masoora (Lens culinaris) - + - - -
Mudga (Phaseolus mungo) - + - - -
Nishpava (Dolichos lablab) - + - - -
Neevara (Hygroryza aristata) - + - - -
Shaluka (Nelumbium speciosum) - - + - -
Shushka shaka (Dry vegetable) + - - -
Shyamaka (Setaria italica) - + - - -
Tinduka (Diospyros tomentosa) - - + - -
Trunadhanya (Grassy grain) - - + - -
Tumba (Lagenaria valgaris) - - + - -
Uddalaka (A variety of Paspalum
Disease review 27
scrobiculatum) - + - - -
Varaka (Carthamus tinctorius) - + - - -
Viroodhaka (Germinated Seed) - - + - -
II. Gunatah
Rukshanna (ununctous diet) + + + + +
Laghvanna (light diet) - + + - +
Gurvanna (heavy diet) - - + + -
Sheetanna (cold diet) + - + - -
III. Rasatah
Kashayanna (astringent taste) - + + + +
Katvanna (acrid taste) - + + + +
Tiktanna (Bitter taste) - + + + +
IV. Karmatah
Vishthambhi (constipative diet) - - + - -
V. Veeryatah
Sheeta - - - - -
VI. Matratah
Abhojana (fasting) + + - - +
Alpashana (dieting) + - + + -
Vishmashana (Taking unequal food) - + - - -
VII. Kalatah
Adhyashana (eating before digestion of
Previous meal) - + - - -
Jeermanta (After digestion) - + + + +
Pramitashana (Taking food in improper time) - - + + +
Disease review 28
(B) VIHARAJA (Behaviour)
I. Karmatah
1. Mithyayogatah
Ashmabhramana (Whirling stone) - - + - -
Ashmachalana (Shaking of stone) - - + - -
Ashmavikshepa (Throwing of stone) - - + - -
Ashmotkshepa (pulling down stone) - - + - -
Balavat vigraha (wrestling with superior
healthy one) - + + - -
Damyagaja nigraha (subduing untameable
elephant) cow and horse - - + - -
Divaswapna (day sleep) + + - - -
Dukhasana (uncomfortable sitting) + - - - -
Dukhashayya (uncomfortable sleeping) + - - - -
Ghadhotsadana (strong rubbing) - - + - -
Kashtabhramana (whirling of wood) - - + - -
Kashtachalana (shaking of wood) - - + - -
Kashta vikshepa (throwing of wood) - - + - -
Kashtotkshepa (pulling down wood) - - + - -
Lohabhramana (whirling of metal) - - + - -
Lohachalana (Shaking of metal) - - + - -
Lohavikshepa (Throwing of metal) - - + - -
Lohotkshepa (Pulling down metal) - - + - -
Paragatana (Strike with others) - - + - -
Shilabhramana (Whirling of rock) - - + - -
Disease review 29
Shilachalana (Shaking of rock) - - + - -
Shilavikshepa (Throwing of rock) - - + - -
Shilotkshepa (Pulling down rock) - - + - -
Bharaharana (Head loading) - + + - -
Vegadharana (Voluntary suppression of
natural urges) + + + + +
Vegodeerana (Forceful drive of natural urges) - - + + -
Vishamopachara (Abnormal gestures) + - - - -
2. Atiyogatah
Atigamana (excessive walking) + - + - -
Atihasya (Loud laughing) - + + + -
Atijrumbha (Loud yawning) - + - - -
Atikharacapakarshana (Violent stretching
of the bow) - - + + -
Atilanghana (Leaping over ditch) + + + - -
AtipLavana (Excessive bounding) + + - - -
Atiprabhashana (Continuous talking) - - + + -
Atipradhavana (Excessive running) + + - - -
Atiprajagarana (Excessive awakening) + + + + +
Atiprapatana (Leaping from height) - + - - -
Atiprapeedana (Violent pressing blow) - + - - -
Atipratarana (Excessive swimming) - + + - -
Atiraktamokshana (Excessive Blood letting) - - - - +
Atisrama (over exertion) - - - - +
Atisthana (standing for a long period) - + - - -
Disease review 30
Ativyayama (Violent exercise) + + + + +
Ativyavaya (excessive sexual intercourse) + + + + +
Atiadhyayana (excessive study) - + + - -
Adyasana (sitting for a long period) - + - - -
Atyucchabhashana (speaking loudly) - - - + -
Gajaticarya (excessive riding on elephant) - - + + -
Kriyatiyoga (excessive purification therapy) - - + + +
Padaticarya (walking long distances) - + - - -
Rathaticarya (excessive riding on chariot) - + - - -
Turangaticarya (excessive riding on horse) - + - - -
(B) Manasika
Bhaya (fear) + - + + +
Chinta (worry) + - + - -
Krodha (Anger) + - - - -
Mada (Intoxication) - - - - +
Shoka (Grief) + - + + +
II. Kalatah
Abhra (cloudy season) - + - - -
Aparahnna (evening) - + + + +
Apararatra (the end of the night) - - + + -
Greeshma (summer season) - - + + -
Pravata (windy day) - + + - -
Shishira (winter) - - - - +
Sheetakala (early winter) - + - - +
Varsha (rainy season) - + + - +
Disease review 31
(C) AGANTUJA
Abhighata (trauma) + - - - -
Gaja, Ushtra, Ashvasrnghrayanapatamsana
(Falling from speedy, running elephant,
camel and horse) + - - - -
(D) ANYA HETUJA
Ama (undigested article) + - - - +
Asrukshaya (loss of blood) + + + - -
Dhatukshaya (loss of body elements) + - - - -
Doshakshaya (depletion of Dosha) + - - - -
Rogatikarshana (emaciation due to disease) + - - - -
Gadakrta mamskshaya (wasting due to
disease) - - - - +
Margavarana + - - - -
Disease review 32
SAMPRAPTI
To treat a disease, the complete knowledge of its pathogenesis is a must. The
word ‘Samprapti’ means ‘Samyak Prapti of Roga’ that is the proper understanding of
the disease process.
The process of manifestation of the disease by the morbid Dosha which are
60
circulating all over the body is known as Samprapti, Jati or Agati . According to
Acharya Sushrut ‘Dosha-dushya sammurchhana janitovyadhi.’. The disease process
starts right from hetuSevanaa, vitiating Dosha. The actual manifestation of the disase
occurs when the circulating vitiated Dosha get accumulated where khavaigunya is
already present. The whole disease process is explained as ‘Shatkriyakalas’ by
Acharya Sushrut.
For the disease Gridhrasi, the detailed samprapti has not been mentioned in
Ayurvedic classics. Since Gridhrasi is a vatavyadhi, the general samprapti of
vatavyadhi along with specific description available are considered here for the
explanation of samprapti.
There are two main reasons by which vata get vitiated. They are Dhatukshaya
61
and margavarodha . Because of the samprapti vishesh, the same nidana produce
different vatavyadhi. This is because the presentation of the disease changes

62
according to the sthana where Dosha-dushya sammurchhana takes place .
Khavaigunya plays an important role in the disease process. In Gridhrasi, exposure to
mild but continuous trauma to Kati, sphik region because of improper posture,
travelling in jerky vehicles, carrying heavy loads, digging etc or sometimes spinal
cord injury, improperly treated pelvic diseases are responsible for producing
Sthanavaigunya at Kati, Sphik, Prishta etc. They may not be able to produce the
Disease review 33
disease at the instance, but after acquiring some vyanjaka hetu (exciting cause), the
disease may be produced.
The agantuja factors chiefly Abhighata etc are responsible for the ‘achaya-
purvak prakopa of Dosha. Abhighata leads to Dhatukshaya directly and vata
provocation is liable to occur. The vitiated vata may directly intermingle with Asthi,
Majjaa Dhatu to produce Gridhrasi. Here the intermediate steps of samprapti i.e.
Chaya, Prakopa, Prasara etc. are absent. Also Abhighata may lead to Khavaigunya at
the site.
Vata is the main culprit in Gridhrasi. Obviously, Pakwashaya is the
Udbhavasthana of the disease. Among the five types of vata, Apana and Vyana vayu
are mainly involved. Apana resides in the lower part of the body especially Kati, Basti
etc. Because of various hetus Apana is vitiated. In Gridhrasi, Sakthiutkshepanigraha is
the main sign i.e. upward lifting of the lower limb is affected. This clearly explains
the involvement of Vyana vayu in the samprapti as these movements are governed by
Vyana vayu. Also sometimes kapha is the anubandhi Dosha producing vatakaphaj
Gridhrasi.
Asthi Dhatu and vata Dosha have ashraya-ashreyi sambandha. Asthikshaya
deals with vataprakopa. Also vataprakopaka ahara Sevana is the main cause of
Asthivaha srotodushti 63. Viharatmaka hetus like ativyayam etc. may cause Asthivaha
srotodushti.
Majjaa is the deep seated sheha in the AsthiDhatu. Rukshadi ahara cause
shoshan of Majjaa Dhatu. Viruddha ahara, Abhighata etc. are the causes of
Majjaavaha srotodushti which are commonly observed in the patients of Gridhrasi.
Sandhi are responsible for the movement of the limbs. In severe vataprakopa,
Disease review 34
sandhichuti i.e. Bramsha of sandhi specifically in the vertebral column may be seen.
This can be correlated to the prolapse of interverteBral disc.
Acharya sushruta clearly mentioned the involvement of kandara in Gridhrasi64.
Dalhana explain kandara as mahasnayu. According to Vaidyak Shabdasindhu, Snayu
are the nadis that conduct vayu. According to Sushrut, vayu in its normal state, while
coursing through its specific Sira helps the unobstructed performance of its specific
functions viz. Prasarana and Akunchana and produces clearness and non-illusiveness
of Buddhi and the sense organs. When vitiated vayu enters the Sira, it causes variety
of diseases 65 Sushrut has quoted special variety of Sira called as vatavaha Sira, which
are the channels of movement of vata, in the senses.

66
Charaka explains kandara as the upaDhatu of rakta Dhatu . Chakrapani
67
mentions that kandara may also be considered as sthula snayu . Snayu is the
68
upaDhatu of meda and mulasthana of mansa Dhatu . Also Charak has mentioned
stambha, supti, sphurana etc. which are the symptoms of Gridhrasi under the diseases
produced due to dushti of snayu, sira and kandara 69.
Samprapti Ghataka:
Acharya have mentioned “Samprapti vighatanameva chikitsa” ie breaking of
samprapti is chikitsa. Here we are trying to ascertain the factors involved in the
samprapti of disease so that treatment will be successful.
Probable samprapti ghataka are as follows -
Dosha:
Similar to any other Nanatmaja type of Vata Vyadhi, definite involvement of
Vata Dosha in the pathogenesis is characteristic of Gridhrasi. It is also well known
that the Prakopa of Vata may occur in two ways viz. due to Dhatukshaya and
Disease review 35
Margavarodha. In the first instance, Rooksha, Laghu, Seeta, Pramitasana, Vyayama,
Abhighata etc., Nidana leads to direct Sanchaya and later Prakopa of Vayu.
In the case of Margavarodha, accumulation of Kapha Dosha plays an
important role, particularly in producing Vatakaphaja type of Gridhrasi. In rare cases
of Gridhrasi, there may be burning sensation along with pain, which indicates even
the involvement of the Pitta Dosha.
As described in SushutaSamhita, Gridhrasi Sakthiutkshepanam Nigrahneeyat
is one of the cardinal symptoms to be found in Gridhrasi patients. This Kshepana and
Utkshepana etc. activities are being attributed to Vyana Vayu. By this observation it is
evident that out of five types of Vata, morbid Vyana Vayu is the primary cause of the
illness. The role of other Vata can not be ruled out as these types of Vata are mostly
interrelated in their physiological functioning. To be more precise, the Apana having
its site in Kati and Sakthi, this is afflicted in Gridhrasi. Though Prana situated in
Moordha its functions extended to whole body including lower extremities which is
one of the Karmedriya. As Gridhrasi is a disease, which hamper the movement and
Sakthi Utshepa Grahana, even Udana Vayu may involve in the pathogenesis as it is
initiator for any work and Prayatna, Oorja and Bala are its attributes.
Dooshya:
The symptoms like pain at the Kati and Prshtha is suggestive of involvement
of Asthi Sandhi. Pain in the leg radiating from the buttock to heal is suggestive of
affection of Snayu Upadhatu.
Acharya Sushruta opines that Kandara is affected by vitiated Dosha causing
the Gridhrasi. Kandara is considered as Updhatu of Rakta. Cakrapani says that
Kandara may also be taken as Sthoola Snayu. Snayu is Moolasthana of Mamsa as well
as Updhatu of Meda.
Disease review 36
On the other hand, Asthi is the site of Vata and there is an inverse relation
between each other. For instance, increasing Vayu causes Asthikshaya which lead to
the further Prakopa of Vata. Here involvement of Asthi sandhi is evident by the
symptom of Sakthiutkshepanam Nigrahneeyat.
Srotas: Vatavaha, Asthivaha Srotas
Sroto Dushti:
Free movement of the lower extremities leading to smooth ambulation is the
Pravrutti of the legs. Inability to move the limbs to its fuller extent is suggestive of
Apravrutti. Inability to extend the legs affecting the gait is one of the predominant
symptoms of Gridhrasi. These citations justify the contention that Sanga type of
Srotodushti is characteristic of Gridhrasi.
Agni and Ama:-
Praseka, Arocaka, Bhaktadwesha are some of the distinguishing clinical
manifestation of Vatakaphaja Gridhrasi and is indicative of JatharAgni Mandya. The
lack of these symptoms in Vataja Gridhrasi indicates that Agni is unaffected in this
type of disease.
Udbhavasthana:
The invariable involvement of Vata Dosha in the pathogenesis of Gridhrasi
reveals that the disease stems out from the Pakvashaya. Similar to any other
Nanatmaja type of Vatavyadhi Gridhrasi is also considered as Pakvashayodbhava
Vyadhi.
Sancarasthana:- Rasayanies and gridhrasi nadi. Distribution of symptoms like
pain in the low back region extending up to the thigh, legs and heal indicates the
lower half of the body as the Sancara Sthana of the Dosha. In addition to this the
Disease review 37
typical symptoms of Vatakaphaja Gridhrasi like, Aruchi, Gaurava and Tandra point
towards the ubiquitous distribution of vitiated Dosha.
Adhishthana:-
Pain originating from the Kati Prishtha region radiating to Janu Jangha and
Pada is the cardinal symptom of the disease. Vitiated Vyana Vayu getting localized in
these areas produces the symptoms. Needless to say these sites of pain is the
Adhishthana of the disease. To be more precise Sphik, Kati Ooru, Prushta, Jangha
Prushta, Khandara of Parshni, Pada and Anguli are the Adhishtana of Gridhrasi.
To sum up, the specific etiological factors leads to the vitiation of Vyana Vayu.
Abnormal Vyana Vayu stemming out from the Pakvas’aya circulates in the lower part of
the body and gets localized in the Kati Prshtha, Jangha, Janu and Pada. Here the Vyana
Vayu afflicts the Snayu, Mamsa, Asthi and Rakta Dhatu involving the respective Srotas
produces the severe pain originating in the Kati Prushta region radiating to Jangha, Janu
and Pada region. In addition to this in Vatakaphaja Gridhrasi there will be involvement of
Rasa Dhatu as well as Annavaha Srotas causing the symptoms like Tandra, Arocaka,
Agnimandya etc.
10. Vyakta sthana - adaha shakha
11. Roga marga - madhyama
12. Vyadhi swabhava - chirakari
Disease review 38
Table No.2: Samprapti ghatak:
• Dosha : Vata – Apana and Vyana vayu, Kapha.
• Dushya : Asthi, Nadi
• Agni : JatharAgni
• Ama : JatharAgnimandyajanita
• Udbhavasthana : Pakwashaya / Kati
• Samcharasthana : Rasayani / vata vaha nadi
• Adhisthana : Prishtha,Kati, sphik
• Srotas : Asthi, vatavaha nadi
• Srotodushti : Sanga
• Rogamarga : Madhyam
• Vyakta sthana : Sphik, Kati, prishtha, uru, janu, jangha, pada.
• Swabhava : Chirkari
Disease review 39
Schematic Representation of Samprapti of Gridhrasi
Nidana
Excessive vatakara Dhatukshaya Marmaghata

ahara vihara sevana karaka nidana Agantuja nidana
Mandagni / Vishamagni
Ama
Vata Sanchaya
Sthanasamshraya at kati, prista, uru, janu, Jangha and pada thus producing shithilatha
Sthanika vikruti of Asthi Dhatu
Derangement of anatomy and physiology of Gridhrasi Nadi
Gridhrasi
Produces Ruk, Stambha, Toda etc., along the distribution

of Gridhrasi Nadi
Disease review 40
POORVAROOPA
Poorvaroopa are indications of impending diseases. They occur prior to
complete manifestation of disease and may suggest the forthcoming illness. During
the course of the Samprapti of an illness, the morbid Dosha circulating ubiquitously in
the body tend to localize in an area and produces some of the unique symptoms and
is referred by the name Poorvaroopa. Diagnosis at this stage of the illness gains
paramount importance, as the effective treatment at this stage definitely reduces the
possible organic damage as well as degree of morbidity.
In classics, the description regarding the Poorvaroopa of Gridhrasi is not
available. Even then few of the general citations in the classics pertaining to the
occurrence of the Poorvaroopa in Vatavyadhi is worth mentioning. Acharya Charaka
is of the opinion that, in general the vague symptoms, or else any few symptoms of
the respective Vatavyadhi in its minimal severity, that too in their initial stage are the
Poorvaroopa. This nature of the Poorvaroopa is described as Avyakta Lakshana.
author of the Madhukosha commentary emphasize the vague nature of the
Poorvaroopa.
By the consideration of above cited general rule of Poorvaroopa in regards to
Vatavyadhi, Gridhrasi being a Vatavyadhi, Poorvaroopa of this disease may be
assumed. Vague low back pain, mild discomfort in the lower extremities, altered
sensation in the legs and similar other symptoms of Gridhrasi in its minimal severity
may be considered as Poorvaroopa. The development of these symptoms following
excessive exercise straining the back, or else direct trauma to the back are always
corroboratory of Gridhrasi.
Disease review 41
ROOPA
Roopa appears in the Vyaktavastha i.e., fifth Kriyakala of the disease. This
is the unique stage of the illness, where in it is clearly recognizable as all its
characteristic signs and symptoms manifest.
Pain starting from Sphik and radiating towards Kati, Ooruprushtha,
Januprushtha, Janghaprushtha and Pada in successive order, is the cardinal
symptom of Gridhrasi. Ruk and Toda are the two main words used to describe the
character of pain in this disease. In addition to this Acharya Charaka has described
70
Stambha and Muhuspandana as the cardinal signs of Gridhrasi. Whereas
Acharya Sushruta and Acharya Vagbhata have added Sakthyutkshepanigraha to

71,72,73
the cardinal signs . Some signs and symptoms like Dehasyapi Pravakrata,
Janu Ooru Sandhi Spurana etc, are specially categorized as Vatika Lakshanas in
Bhavaprakasha, Madhava Nidana and Yogaratnakara 74,75,76,77.
Other lakshanas like Tandra, Gaurava, Arocaka, Mukhapraseka,
Bhaktadwesha etc, have been stated as symptoms of Vatakaphaja Gridhrasi by
Acharya Charaka. Similar references are available in textbooks like Madhava
Nidana, Bhavaprakasha and Yogaratnakara.
Considering all the clinical manifestations of Gridhrasi, it may be sub
divided into two distinct categories
(i) Samanya Lakshana
(ii) Vishesha Lakshana
i) Samanya Lakshana:
These clinical manifestations are seen in both Kevala Vataja and
Vatakaphaja type of Gridhrasi. Following are the Samanaya Lakshana of
Gridhrasi.
Disease review 42
Ruk:
‘Ruk Satatam Shoolam’ 78
‘Ruk Shoolam’ 79
‘Ruja Vedana’ 80
In Gridhrasi Ruk or Shuoola i.e., pain is one of the prime symptoms and is
felt throughout the lower limb, pain starts from Sphik region and radiates till the
Pada. Non radiating pain felt at sites like, Kati, Ooru, Janu, Jangha and Pada
81
region is also considered as the symptom of Gridhrasi . This typical radiating
pain involving the legs is suggestive of sciatica syndrome modern parlance where
pain is felt along the course of the sciatic nerve.
Toda:
‘Todah Soocivyadhanavat Vyadha’ 82
‘Toda Vicchinna Shoolam’ 83
Intermittent pain similar to the feeling of pin prick is known as Toda, the
site of Toda is similar to the site of Shoolam i.e., from buttock to heal.
Stambha:
‘Stambha Nishchalakaram’ 84
85
‘Stambha Bahu Ooru Jangha Deenam Sankochanadhya Bhavah’
‘Stambha Nishkriyatvam’ 86
Stambha refers to the stiffness or rigidity felt at the thigh and legs and is
another symptom of Gridhrasi. As the movement of the legs worsen the pain, stiff
muscles prevent this and there by manifesting as the symptom Stambha. The
restriction to move the legs also affects the gait of the patient, as his steps are
short, cautious and slow.
Disease review 43
Sakthiutkshepanam Nigrahneeyat:
‘Kshepam Prasaranam Tam Nigrahanyat Avarudhyat Ityarthah’ 87
The movement Kshepana refers to extension. Patient of Gridhrasi is unable
to extend his legs as extending the legs worsens the pain. Acharya Vagbhata
opines that it is the Utksepana i.e., lifting is legs is affected in Gridhrasi. Further
the commentator Arunadutta very clearly defines this symptom as ‘Pada Udharane
88
Ashakti’ expressing the inability of the patient to elevate the legs. As the
extension of the legs worsens the pain patient prefers to assume the flexed position
of the legs.
Katyooru Janu Madhye Bahuvedana:
It is a distinct feature of Gridhrasi mentioned by Acharya Hareeta. this
refers to the severe pain experienced at Kati (low back), Ooru (thigh) and Janu
(knee) region 89. Static or non-radiating pain is also characteristic of Gridhrasi.
Muhu Spandana:
‘Spandana Spuranam’ 90
‘Spandanam Hi Kincit Calanam’ 91
Sphurana refers to the fasciculation. Fasciculation may be present in lower
extremities in patients of Gridhrasi. To be more precise this symptom is seen in
the muscle supplied by the sciatic nerve.
Few of the symptoms of Gridhrasi are exclusively mentioned In
Basavarajeeyam. These symptoms include Shopha, Kara Pada Vidaha Krit, Sveda,
Moorcha, Bhrama and Trishna. Some of these symptoms are indicative of vitiation
of Pitta Dosha in Gridhrasi 92.
Disease review 44
Table No.3: Samanya Lakshana of Gridhrasi:
Lakshanas CS SS AS AH HS MN GN BR BP YR
Sphik Poorva Kati Pristhooru
Janu Jangha Padam Kramat
Ruk + + + + +
Sphik Poorva Kati Prushthooru
Toda + + + + +
Sphik Poorva Kati Prushthooru
Stambha + + + + +
Pashni Pratyanguleenam Tu
Kandara Yanilardita + + +
Sakthnaha Ksepana
Nigrahneeyat + + +
Kati Ooru Janu Madhye Bahu
Vedana +
Muhu Spandana +
ii) Visesha Lakshanas:
The unique symptoms of Gridhrasi that indicate either Vataja or
Vatakaphaja Gridhrasi are described as Vishesha Lakshana. It is evident that the
predominance of Vata Dosha or Vatakapha Dosha in the Sampraptti of Gridhrasi
leads to the manifestation of Vishesha Lakshana.
Disease review 45
Vataja Gridhrasi:
Here the Sampraptti of the Gridhrasi is characterized by the sole involvement
of Vata Dosha. Evidently there will not be association of Kapha Dosha in the
Samprapti. Following are the Vishesha Lakshana of Vataja Gridhrasi 93,94,95,96.
Dehasya Vakrata:
Madhava described this symptom which means that patient of Gridhrasi
acquires a particular posture due to pain. It may be lateral and forward bending of
body. The patient of Gridhrasi keeps the leg in flexed position and tries to walk
without much extension in the affected side. Hence the whole body is tilted on the
normal side and he assumes the bending posture or limping. This gait is also typical in
Gridhrasi.
Stabdata Bhrisham:
The severe degree of stiffness is seen in patient suffering from Vataja
Gridhrasi.
Sphuranam:
‘Sphuranam Gatra Deshe Swalpa Calanam’ 97
‘Sphuranam Punah Punah Calanam’ 98
The symptom of fasciculation in Kati, Ooru, Janu and Jangha are similar to the
Spandana or Muhuspandana is characteristic of Vataja Gridhrasi.
Suptata:
The patient experiences varied degree of parasthesia or sensory loss in the
affected limb.
Disease review 46
Table No.4: Vataja Gridhrasi Lakshanas:
Lakshanas CS SS AS AH HS MN GN BP YR
Dehasya Vakrata + + + +
Toda + + + +
Kati Sandhi Sphurana + + - +
Ooru Sandhi Spurana + + + +
Jangha Sandhi Sphurana - - + -
Janu Sandhi Sphurana + + + +
Stabdata Brisham + + +
Suptata Brisham
Vatakaphaja Gridhrasi:
Involvement of Kapha Dosha in the Samprapti of Gridhrasi cause the below
mentioned unique features 99,100,101,102.
Vahni Mardava:
Sluggishness of the JatharAgni resulting in impairment of both
Abhyavaharana as well as Jarana Shakti
Tandra:
“Tandrayantu Prabhodhito Api Klamayati Nidrabheda” 103
This occurs due to Kapha and Tama Dosha, manifests as a feeling of
drowsiness or inability of sense organs to grasp their respective objects followed with
yawning or even fatigue without doing any labour 104,105.
Mukha Praseka:
Mukhapraseka means excessive salivation in mouth is due to Kapha in
associated with Ama.
Disease review 47
Bhaktadvesha:
‘Dveshamayati Yo Jantu Bhaktadvesha Sa Ucchate’ 106
Secondary to the sluggishness of JatharAgni and Kaphadusti patient of
Gridhrasi develops aversion towards food. Association of Ama is also contended in
the causation of this aversion towards food.
Arochaka:
‘Arocakastu Prarthite Apyupayogasamaye Anannabhilasha’ 107
‘Aruci Prarthita Anna Bhakshana Asamarthyamucchyte’ 108
It is a subjective symptom where patient fails to appreciate the taste in the
mouth irrespective of state of appetite. In comparison to the role of Vata Dosha
involvement of Kapha Dosha has much to with the manifestation of Arocaka, because
the seat of Bodhaka Kapha is Jiwha which does Rasa Bodhana.
Gaurava:
‘Ardra Charmavanaddham Mivetyartha’ 109
Patient feels heaviness particularly in the lower limb or limbs.
Gaurava is the feeling of heaviness of the body in general or lower extremities
particular. Needless to say this symptom is due to the morbid Kapha Dosha.
Staimityam:
‘Staimityam Gatranam Nirutsahatvam’ 110
Inertness of the body, feeling of freezing sensation in the affected lower limb.
Staimitya means timidness or frozen sensation. Due to Kapha vitiation patient feels as
if his lower extremities are covered with wet cloth.
Disease review 48
Table No.5: Vatakaphaja Gridhrasi Lakshanas:
Lakshanas CS SS AS AH HS MN GN BP YR
Arocaka + +
Vahnimardava + + + +
Mukha Praseka + + + +
Bhakta Dvesha + + + +
Tandra + + + + +
Gaurava + + + +
Staimitya + +
Disease review 49
UPASHAYA, ANUPASHAYA AND SADHYASADHYATA
Upashaya are the medicines, diets and regimens which bring about happiness
either by acting directly against the cause of the disease or it may produce such effect
on the disease indirectly. Upashaya is rightly called as exploratory therapy. It is
essential to know the Sadhyasadhyata of a disease before the treatment. Charaka says,
“A physician who can distinguish between curable and incurable diseases and initiate
treatment in time with the full knowledge about the various aspects of the therapeutics
can certainly accomplish his object of curing the disease.
When two or more diseases having identical symptoms are met (or
encountered) in such conditions, disease could be best differentiated by adopting
Upashaya - anupashaya
Sushruta considers the Vatavyadhi as Mahagada due to its tendency to be fatal
or incurable. Vagbhata calls it as Maharoga. Most of the Acharya has told that
Vatavyadhi, generally are difficult to cure.
Sushruta mentions that a patient of Vatavyadhi, if develops the complications
like Shoona (oedema/inflammation) Suptatvaca (Tactile senselessness), Bhagna
(fracture), Kampa (tremors) Adhmana (distension of abdomen with tenderness) and
pain in internal organs, then he does not survive.
Disease review 50
UPADRAVA
Upadrava are produced as a sequel of the disease proper. Their emergence
increases the graveness and complexity of treatment. Their description in various
classics is as follows –
Sushruta has elaborately described Upadrava of eight Maharogas including
Vatavyadhi in general as well as that of Vata-vyadhi independently 111.
Upadrava of Eight Mahavyadhi:
• Bala Kshaya
• Shvasa
• Trishna
• Mamsa Shosa
• Vamana
• Jwara
• Murchha
• atisara
• Hikka
If these are present then it is wise not to start any treatment procedure.
Specific Upadrava of Vatavyadhi:-
• Shotha
• Suptata
• Bhagna
• Kampa
• Adhmana
If Vata Vyadhi co-exist with any of the above mentioned Upadrava then in
such patient disease come under the heading of Asadhya (incurable) category.
Disease review 51
CHIKITSA
Chikitsa is the counteraction of Ruja. (Amarkosha). It is the process of
breaking down the pathogenesis of a disease. Diseases are caused due to vitiated
Dosha involving Dhatu etc. The process which establishes equilibrium in these body
elements is Chikitsa 112.
The therapeutic approach of Ayurvda can be broadly classified into two types.
Samshodhana, Samshamna. The samshodhana is an eleminative process of vitiated
Dosha and includes:
• Antah parimarjana (Internal purification) – Vamana, Virechana, Nasya, Basti.
• Bahirparimarjana (External purification) – Abhyanga, Swedana, Parisheka,
Mardana etc.
• Shastra pranidana (Surgical intervention)- Shastrakarma,Ksharakarma, Agnikarma
etc.
The treatment of a disease varies according to the morbid state of Dosha in the
body, Bala, Prakruti etc. of the patient. If the Doshaprakopa is minimum langhana
chikitsa, moderate Doshaprakopa Langhana and Pachana Chikitsa and if

113
Doshaprakopa is maximum, Shodhana therapy should be adopted . There is a
general principle that Vridhhi of Dosha should be treated by Langhana and their
kshaya with tarpana. But vata is an exception as vata vridhhi is to be treated by
Tarpana and Kshaya by Langhana 114.
While treating any disease, the first and foremost principle to be followed is
115
to avoid nidana . For Gridhrasi, all the vataprakopaka hetus including external
factors such as excessive walking, riding etc should be avoided. Gridhrasi, being a
vatavyadhi, the general line of treatment of vatavyadhy can applied to it.
Disease review 52
Charaka has advised Dravya having Madur, Amla, Lavana, Snigdha, Ushna
properties and upakrama like Snehana, Swedana, AsthApana and Anuvasana Basti,
Nasya, Abhyanga, Utsadana, Parisheka etc. Among these he has praised asthapana
and Anuvasana Basti as the best treatment for vata 116.
Vagbhata has stated that Sneha, Sweda, Mruda Samshodhana along with
Madur, Amla, Lavana dravya. Veshtana, Trasana, Madya, Sneha siddha with Deepan
117
and Pachan drugs, Mamsarasa and Anuvasana Basti pacify the vata . In Ashtang
118
Samgraha Hemant rutucharya is indicated in Vatavyadi . Similarly Sushruta has
advised shiroBasti, SnaihikA dhumapana, Sukhoshna Gandusha for the treatment of
vatavyadhi 119.
All the above Upakramas have their own qualities. Also when they are done in
a proper sequence, the therapy as a whole also has its benefits. Here is a quick look on
these karma specifically in relation to vatavyadhi – Gridhrasi.
Snehana
Snehana should be done only in Nirupastambhita vata 120 by the word Snehana
both external and internal Snehana is included. For internal Snehapana chaturvidha
Maha Sneha are indicated. But Taila is praised in vatavyadhi as it is having exactly
121
opposite properties as that of vata . Sneha pacifies vata, brings out softness in the
body and removes Malasanga 122.
External Snehana is done by Abhyanga, Parisheka, Avagaha etc. It acts on
sparshanendriya which is the seat of vayu. While mentioning the kala of Abhyanga,
123
Sushrut has stated that after 900 matras the Sneha can reach MajjaaDhatu . It
signifies the action of Sneha on Asthi – Majjaa Dhatus which are involved in
Gridhrasi.
Disease review 53
Swedana
Snehanapurvaka Swedana is indicated in Nirama Vatavyadhi while only
Swedana is indicated in Samavata vyadhie. Nadi, Prastara, Sankara etc. are the
various types of Swedanakarma 124.
Swedana liquifies the Dosha and expands the Srotas, helping the Dosha to
travel towards their own Sthana. Swedana activates Agni, creates KoMalata, Ruchi,
125
clears Srotas, diminishes Tandra . Snehanapurvak Swedana relieves the symptoms
such as Harsha, Toda, Ruk, Shotha, Stambha, Graha etc. It produces Mruduta in the
body. Charak says that proper Snehan and Swedana can make even dry wood
flexible126.
In Gridhrasi Stambha, Ruk, Toda etc. are the main symptoms. Snehana and
Swedana by virtue of their vatashamak and Dhatuposhak properties are useful in
relieving the symptoms.
Mrudu Samshodhana
The Dosha which are not pacified by Snehana and Swedana should be
127
removed from the body. Hence Mrudu Virechana is advised for this purpose .
Snigdha Virechana is advised for vatavyadhi.
Snehana and Swedana bring the vitiated Dosha to koshtha. Then drugs like
Trivrut, Aragvadha and Erand Taila should be used for virechana 128. Virechana drugs
have adhobhagaharana prabhava. It removes Dosha from Amashaya and Pakwashaya.
Charak says that it brings out the Mala from the body, increases the strength,
eliminates the disease and adds years to ones life by improving the quality of life 129.
Vatanulomana is necessary for the vayu obstructed by Mala lodged in srotas.
It is to be done by Snigdha, Amla, Lavana, Ushna drugs 130.
Disease review 54
Basti
Basti is the best treatment for vata. In patients who are weak or Avirechya,
Niruha Basti is advised for removal of Dosha 131.
Basti is considered as parama vatahara, because it makes the vata to move in
its natural paths and channels. Also it has systemic effect in eliminating Dosha from
132
the body gradually by Pakwashaya shodhana . Asthapana Basti is Srotovishodhana
and Malapahara, while Anuvasana performs the function of Brihmana Balya and
vatashamana 133.
Basti increases Bala, Agni, Medha, Varna etc. It strengthens the body,
prolongs life, removes Dosha from all over the body and thus pacifies all the ailments.
It is praised as ‘Sarvarthakari’ 134.
While explaining the importance of Basti, Charak says that there is no
therapeutic procedure comparable to that of Basti, in as much as it possesses rapid and
useful properties of cleansing, in addition to its being a quick agent of impletion and
depletion and is unattended with danger 135.
Thus, Basti is rightly considered as Chikitsardha 136.
SPECIFIC TREATMENT OF GRIDHRASI
While describing the specific treatment for Gridhrasi, Acharya have given
importance to karma but at the same time different shamana yoga are also mentioned
in the texts. The following table shows as to which karma are advocated by which
classics.
Disease review 55
Table No.6: Types of Treatments:
Type of treatment CH SU AS CD BP YR HS BS
Snehana - - - + - - + +
Swedana - - - + - - + -
Vamana - - - + + - - -
Virechana - - - + + - - -
Niruha Basti + - - - - - - -
Anuvasana Basti + - + + + + - +
Siravedha + + + + - + - -
Raktamokshana - - - - - - + +
Agnikarma + - + + - + + -
Shastrakarma - - - + - - - -
Charaka mentions Siravedha between the kandara & gulfa, Basti (Anuvasana
& Niruha) and Agnikarma as the line of treatment for Gridhrasi 137.
Sushruta, being the master of Shalyatantra has advised only Siravedha at janu
after flexion 138.
Siravedha four angula above or below janu is mentioned for Gridhrasi in both
Ashtanga Samgraha and Ashtanga Hridaya 139.
Chakradatta has described the treatment of Gridhrasi more precisely. He has
described the importance of Agnideepan, Pachan & Urdhvashodhan before
administration of Basti to a patient having Gridhrasi. He has said that administration
of Basti before Urdhvashodhana is useless. A number of combinations are described
in the text for the shaman chikitsa of Gridhrasi. One of such combinations i.e
Trayodashanga Guggulu. Other formulations include decoction of shephalika,
decoction of panchmoola, trivrit ghrita, rasna guggulu, , chhagaladya ghrita,
saindhavadya taila. Also recipies like erand phala payas and vartaku prayoga are
advised. While treating kaphavataja Gridhrasi, pippali churna along with Erandataila
Disease review 56
and Gomutra is advocated. Chakradatta has mentioned a small operation with prior
Snehana & Swedana to remove granthi in Gridhrasi and also siravedha four angula
below Indra Basti marma. If not relieved by this treatment then Agikarma at
kanishthika anguli of pada has been suggested.
Bhavaprakasha also states that Basti should be given to patients of Gridhrasi
only after doing vamana and virechana karma and in Diptagni and Niramavastha.
Erand taila along with Gomutra when administered for one month specially in the
morning hours relieves Gridhrasi. Also taila, ghrita, matulunga and ardraka swarasa
taken with chukra and guda are useful in shoola of Kati, uru, prishtha, trika and
gulma, Gridhrasi, udavarta. He has advised decoction of erandmoola, bilwa, brihati &
kantakari for chronic Gridhrasi. The decoction of sinhasya, danti, krutamalak along
with erandtaila is advised for the Gridhrasi patients who cannot walk. The sara of
brihatnimba (bakana) is also useful is asadhya Gridhrasi. Also rasna guggulu,
pathyadi guggulu are advised in Gridhrasi.
Yogaratnakara has advocated the use of lashuna along with hingu, jiraka, etc.
in the morning for the patients of Gridhrasi. Also use of panchmooli kashaya,
vajigandhadi oil for Basti or oral use & saindhavadya taila is described. Yogaratnakar
advises siravedha in the area of four angula around Basti and Mutrendriya. If this fails
Agnikarma in the little finger of the leg is advised. Gridhrasi is also included under
the various indications for Maharasnadi kwath, Abhadi churna, Trayodashanga
guggulu, dwastrinshak guggulu, mahavishagarbha taila etc.
Sharangadhara has described decoction of dashmoola or nirgundi with
pushkarmoola and hingu, decoction of rasna saptak, mahanimba and rasna kalka and
prasarani, mashadi and narayana taila.
Disease review 57
Harita while describing the treatment of Gridhrasi states that in this disease
blood letting should be performed followed by Sweda. Abhyanga should be done with
vatanashaka oil. Phanta of drugs like shatavari, bala, atibala, pippali and
pushkarmoola if taken with erada tail cures Gridhrasi. However if the disease does not
respond to this treatment Agnikarma with an iron rod is advised. Agnikarma must be
done four fingers above the gulfa on any nadi. Besides whatever is pathya in vata
vikara is pathya in this disease also 140.
Bhela mentioned raktamokshana as the best treatment for Gridhrasi. Also bala
taila, mulaka taila & sahacharadi taila are advised for external application. Sneha
Basti and Sneha unmardana are also advised.

141
Vangasena has repeated the necessity of Urdhvashodhana before Basti .
Bhaishajya ratnavali has given the same treatment for Gridhrasi as decribed by
Chakradatta.
Shamanaushadhi:
Several medicinal formulations have been mentioned in the treatment of
Gridhrasi Roga. Most of them are herbal preparations rather than Rasaushadhis. There
are different type of preparations like Coorna, Kvatha, Arishtha, Gritha, Taila, Lepa,
Vati and Guggulu Kalpas. Several oral medicinal preparation have mentioned in the
classics for the treatment of Gridhrasi, some of the examples include Maharasnadi
Kvatha, Rasna Saptaka Kvatha, Sahacaradi Kvatha, Shephalika Kvatha, Narsimha
Coorna, Guggulutikta Ghrita, Bala Taila, Dhanvantari Taila, Yogaraja Guggulu,
Amrita Guggulu, Lasunapaka, Balarishta, Vatavidhvamsa Rasa, BrihatVatacintamani
Rasa few are listed in the table. 3
Disease review 58
Table no.7: Shamanaushadhis used in Gridhrasi:
KALPANAS Y.R S.S B.P B.R C.D G.N
Choornas
Ajamodadi Coorna - + - - - -
Abhayadi Coorna + - - - - -
Krishnadi Coorna - - + + - -
Rasnadi Coorna + - - - - -
Dashamooladi Coorna - + - - - -
Kalka and Lepa:
Maha Nimba Kalka + + - - - -
Rasona Kalka - + - - - -
Swalpa Rasona Pinda - - - - + -
Gun`ja Phala Lepa + + - - - -
Vatahara Pradeha - - - + - -
Qwatha/Kashaya and Arishta:
Panchamoola Kashaya + - - + + +
Maha Rasnadi Kashaya + + + - - -
Shefalikapatra Kashaya - + - + + +
Erandadi Kashaya - - - + - -
Dashamoola Kashaya + + - - - -
Balarishta - - - + - -
Rasnasaptaka Kwatha + + - + + -
Taila and Ghrita:
Chagalyadhya Ghrita - - - + + -
Bala Taila - + + - - -
Disease review 59
Eranda Taila + - + + - -
Vajeegandhadi Taila + - - - - +
Saindhavadya Taila + - - - + -
Mashadi Taila - + - - + -
Vishagarbha Taila + - - + - -
Prasarani Taila + + - - - -
Mahabaladi Taila + + - - - -
Shatavari Taila + + - - - -
Narayana Taila - + - - - -
Vishnu Taila and Ghrita - - - - + -
Vijaya Bhairava Taila - - - - + -
Rasnapooteeka Taila + - - - - -
Saptaprastamsha Taila - - - - + -
Eladi Taila - - - - + -
Datturadi Taila - + - - - -
Vati, Guggulu and Rasayogas:
Rasna Guggulu + - + + + +
Trayodashanga Guggulu + - - + + -
Yogaraja Guggulu - + - + - -
Mahayogaraja Guggulu - - + - - -
Pathyadi Guggulu + - + - - -
Vatari Rasa - - - + - -
Vatagajankusha Rasa - - - + - -
Vatarakshasa Rasa + - - - - -
Swacchanda Bhairava Rasa - + - - - -
Disease review 60
PATHYA – APATHYA
The diet and regimen that is congenial to the health both in healthy and
diseased are referred by the name Pathya. Quite opposite to this the food and regimen
that are otherwise is named as Apathya. Pathya and Apathya in regards to the
Vatavyadhi in general is also considered as Pathya and Apathya of Gridhrasi as
elaborated in Yogaratnakara (Y.R) and in Basavarajeeyam.
Table No.8: Pathya in Gridhrasi:
I. Ahara
Y.R B.R.
Rasa Lavana -
Shooka Dhanya Varga Godhooma, Raktashali Godhooma, Puranadhanya
Shami Dhanya Varga Masha, Kulattha Masha, Kulattha
Kukkuta,mTittiri, Bahri
Mamsa Varga (Peacock),Cataka,
---
Jangalamamsa
Shileendhra, Parvata,
Matsya Varga Nakra, Gagrara, Khudisha,
---
Jhasha
Patola, Kooshmanda,
Karavellaka, Shigru,
Shakha Varga
Moolaka, Tikta, Patola,
---
Vartaka, Soorana, Tarkkari
Dadima, Parooshaka,
Phala Varga
Badara, Draksha ---
Ghrita, Dugdha, Kilata,
Gorasa Varga
Dadhi, koorcika
Sneha Varga Taila
Lashuna, Tamboola
Matsyandika, Prishnakali, Br’hati, Vastuka,
Anya Dravya Punarnava, Krishna, Kasamarda, Dunduka,
Vatsaka, Mundi, Jeeraka, Mishi, Kataka
Ramatha.
Disease review 61
II. Karma
Y.R. B.R
Abhyanga ---
Table No.9: Apathya in Gridhrasi:
I. Ahara
Y.R B.R.
Rasa Kashaya, Tikta, Katu
Anna Guru & Abhishayandi
Tataka and Tatinijala,
Jala Varga Sheetambu
Pradushta (jala) salila
Shukadhanya Varga Navadhanya
Mudga, Nivara,
Shyamakacoorna Mudgaka, Sarshapa,
Shameedhanya
(Kangani), Kuruvinda, Nishapava
Kalaya, Chanaka
Alabu, Ervaru, Bimba, Shakala, Kanda, Trapu,
Shakha Varga
Koshataki , Kareera Kareera
Anya Dravyas Kshaudra, Tikta, Nimba Mrinali, Sharasinimba
II. Vihara
Y.R B.R
Cinta
Prajagara
Vegavidharana
Shrama Sheeta pavana Sevana
Vyavaya
Hariyana
Chankramana
III. Karma
Chardi, Langhana (Y.R.)
Disease review 62
MODERN REVIEW 142
The disease ‘Sciatica’ is named because of the involvement of sciatic nerve.
The sciatic nerve derives its name from its relationship to ischium, having been
abbreviated from ‘ischiatic’ to ‘sciatic’
Sciatic – (Si-at’ik) (Mediv L – Sciaticus, a corrupt form of Gr- Ischiodicus
from – ischion, the hip joint, ISHI) which means
• Affecting the hip or the sciatic nerve
• Of or belonging to the ischium or hip
(The Oxford English Dictionary)
The term sciatica was known since centuries. ‘THOU COLD DCIATICA’
were words put into the mouth of Timen of Athens by Williom Shakespeare. The term
seems to have come into use about the beginning of the 19th century, entering English
from French (Henary Alana Skinner, 1949)
The disease Sciatica was described as neuralgia of sciatic nerve firstly by
Cotunnius, a Neapolitan anatomist. Hence the disease was also known as Cotugno
disease (1736).
Though the association of low backache or lumbago with sciatica was known,
the importance of SLR sign in sciatica was described by Lasegue, a Paris neurologist
(1816). Later it became clear that it is due to stretching of sciatic nerve Charcot
(1825) described scoliosis, the characteristic posture of the patient with sciatica.
Previously, sciatica was considered only due to sciatic neuritis. But four decades back
Mixer and Barr illustrated the role of intervertebral disc lesions in the causation of
sciatica.
Now-a-days, Sciatica is no longer considered as a single disease but it is
considered as a syndrome.
Disease review 63
Definition of sciatica:
• The terms Sciatica has come to be applied to a benign syndrome characterized
especially by pain beginning in the lumber region and spreading down the back of one
lower limb to the ankle (Brain and Banister’s clinical neurology) .
• Pain radiating from a lumbosacral nerve root into the leg is sciatica (French’s index of
differential diagnosis).
• Irritation of the fourth and fifth lumbar and first sacral roots, which form the sciatic
nerve, causes pain that extends mainly down the postero and anterolateral aspects of leg
and into the foot termed sciatica. (Harrison’s Principles of Internal Medicine). The
whole pathology of sciatica revolves around sciatic nerve. Hence, to understand the
disease thoroughly anatomy and physiology of sciatic nerve should be studied first.
Anatomy and physiology of sciatic nerve
The sciatic nerve is the largest nerve of the body, measuring about three quarters
of an inch in breadth. It derives its fibers from all the roots of the sacral plexus, namely
L4, L5, S1, S2 and S3. The nerve
is really composed of two loosely
bound portions, the tibial and the
common peroneal nerves bound
together by connective tissue.
The nerve originates in the pelvis
and passes through the greater
sciatic notch usually below the
piriformis into the buttock. Here
the nerve runs vertically
downwards under cover of
Disease review 64
gluteus maximus, lying on the short muscles of the gluteal region midway between
the greater trochanter and the ischial tuberosity. Emerging from the covering gluteus
maximus, it is soon crossed by the long head of biceps as this muscle passes laterally.
At about the junction of the middle and lower thirds of the thigh, it divides into its two
terminal branches, the tibial and the common peroneal nerves. These two nerves are,
in fact, really separate adherent structures, sometimes they emerge from the pelvis
separately and remain so. The point midway between the ischial tuberosity and
greater trochanter indicates the site of the nerve on the body surface, above this it
passes in a gentle curve medially. It is important for injections not be given into near
the nerve, for this reason most injections are given in the upper and outer quadrant of
the gluteal region.
The branches of the sciatic nerve are as follows:
Articular: These branches arise from the upper part of the nerve and supply the hip
joint, perforating posterior part of its fibrous capsule posteriorly.
Muscular branches: They are distributed to the flexors of the leg viz. the bicep
femoris (long head), semitendinosus and semimembranosus and a branch to the
ischial part of the adductor magnus all arising from the medial side of the nerve trunk
and fibres are derived from the tibial division of the sciatic nerve. The sciatic nerve
also supplies the short head of the biceps femoris, which arises from its lateral side
and contains fibres from the common peroneal division of the sciatic nerve.
Terminal branches: Tibial and common peroneal nerves are the terminal branches of
the sciatic nerve.
The tibial nerve has its roots from L4, L5, S1, S2 and S3. The tibial nerve
supplies gastrocnemius, popliteus, plantaris and soleus as well as tibialis posterior,
flexor digitorum longus and flexor hallucis longus. The medial and lateral plantar
Disease review 65
nerves supply the small muscles of feet. Also it supplies the muscles of the calf and
sole of the foot, the joints of the ankle and foot, and the skin of the distal half of the
back of the calf, the heel and the plantar aspect of the foot and toes. Owing to its deep
position, the tibial nerve is rarely inured although wounds in the popliteal fossa or
post dislocation of the knee joint may damage it.
The common peroneal nerve is formed by the divisions of L4, L5, S1 and S2. It
descends along the lateral margin of the popliteal fossa and passes into peroneus
longus where it divides into superficial and deep peroneal nerves. It supplies the
lateral aspect of the thigh. The superficial peroneal supplies the peroneus longus and
brevis and most of the dorsum of the foot. The deep peroneal branch also supplies
tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius
and extensor digitorum brevis and the ankle joint. The common peroneal is the most
commonly injured nerve in the lower limb because of its exposed position at the
fibular neck. Injury here paralyses all the dorsiflexors and evertor muscles of the foot,
producing foot drop. There is variable cutaneous loss on the anterolateral aspect of the
leg and dorsum of the foot.
Applied Anatomy
The sciatic nerve may be injured in posterior dislocations or fracture
dislocations of the hip. After complete interruption of the sciatic nerve there is
paralysis of flexion of the knee, which is carried out by the hamstrings and of all the
muscles below the knee. Foot drop occurs as a result of paralysis of the anterior tibial
group of muscles and the peronei. The patient can stand and walk, but drags the toes
of the affected foot and is unable to stand on his toes or heel on the paralysed side.
The sciatic nerve supplies nearly the whole of the integument of the leg, especially
below the knee. After complete division of the nerve, light touch is the form of
Disease review 66
sensation which is lost most extensively. Anaesthesia to cotton wool extends over the
whole of the foot, with the exception of a zone about 4 cm wide along its inner aspect,
extending about 5 cm distal to the internal malleouls. This is supplied by the
sephanous nerve. On the leg the area of anaesthesia to light touch includes the outer
aspect, roughly from midline in front to midline behind upto about 5 cm below the
upper end of the fibula. Analgesia to pin-prick is less extensive than anaesthesia to
light touch .Appreciation of the pressure and of vibration is lost over the whole of the
foot, except for the proximal two thirds of its inner aspect, and position and joint
sense are lost in the toes. The knee jerk is unaffected, but the ankle jerk is lost and so
too is the plantar reflex.
Lumber Vertebrae
For the causation of sciatica, the specific anatomy of lumber vertebrae should
be considered. These large number vertebrae enlarge as we descend the column, the
fifth vertebra is huge and carries the weight of the whole vertebral column. The
laminae do not overlap and the spines are massive and point directly backward, also
without overlap. Articular processes face inward and outward and dislocation without
fracture is impossible. The intervertebral foramina in the lumber region decrease in
size, while the lumber nerves increase in size, from above downward. This particular
arrangement explains the commonness of sciatica, in which the tight fit of L4,L5
nerves increase for various reasons e.g. the new bone laid down in osteoarthritis
narrows the foramina even further and causes shooting pains down the leg.
Disease review 67
AETIOLOGY
Predisposing Causes
• Age: Sciatica is most common in the 3rd to 6th decade. But some authors say that it
is a disease of early and midlife. The maximum incidence is found in 3rd and 4th
decade.
• Sex: It occurs 3 times more frequently in males than in females.
• Occupational Factors: History of trauma or repeated stress such as lifting heavy
objects is obtained in many cases. Continued pressure on the nerve such as in
motor driving may predispose to sciatica.
• Exposure to cold and damp weather is also one of the factors.
Causes
• True sciatic neuritis
• Mechanical -
Trauma
Degenerative Diseases
⇒ Spondylosis
⇒ Spondylolisthesis
⇒ Disc Herniation
⇒ Spinal Stenosis
Muscle strain, ligament sprain
Post surgical back pain e.g. Arachnoiditis
• Inflammatory (non-infectious) -
Spondyloarthropathy e.g. ankylosing spondylitis, osteoarthritis, sacroilitis
• Malignant -
Metastastic Disease
Disease review 68
Multiple Myeloma
Primary Tumour of Bone, spinal cord or nerve root
• Infection -
Osteomyelitis
Paravertebral abscess
Discitis
• Bone disorders -
Osteoporotic Vertebral Collapse
Paget’s disease
• Pain arising from outwith the spine -
Referred pain e.g. Genitourinary and Gynaecological disorders, Pregnancy
Vascular causes e.g. Abdominal aortic aneurysm
Psychogenic pain.
The causes are discussed in details here under.
True Sciatic neuritis
It may follow an attack of lumbago. It is a disease of early and middle life and
occupational causes may be evident such as exposure to damp, continued pressure in
long distance lorry drivers. Also it may be due to injections, penetrating injuries etc.
Rare causes of sciatic pain have been gluteal tumours, popliteal fossa haematomas
and myofascial bands secondary to trauma. Severe sciatica may be due to diabetes
mellitus.
Trauma
The trauma may be sudden such as fall from heights, lifting heavy weight etc.
Also repeated trauma like digging, bending, lifting heavy loads when lumbar spine is
flexed, travelling in jerky vehicles are some of the factors. Postural factors such as
Disease review 69
sitting for long time in an overstuffed chair, badly designed car or scooter seat,
sleeping with back hyperextended, lying flat on the hard surface under the influence
of narcotics or coma plays the role.
Spondylosis
Spondylosis is a fatigue fracture at the pars interarticularis or isthmus of the
lumber spine
Spondylolisthesis
The fatigue fractures heal by fibrous union, which weakens the motion
segment and sets the stage for the occasional slip of one vertebra on another, termed
spondylolisthesis. It is due to either a single injury or repeated minor injures.
Spondylosis and spondylolisthesis most frequently occur at L5,S1 level (90 percent)
with L4-L5 level, the next most common site (5 percent). Occasionally spondylosis
may occur at multiple levels.
Disc Herniation
It is the major cause of severe, chronic or recurrent low back pain and sciatica.
It is most likely to occur between the fifth lumber and first sacral vertebrae with
lessening frequency between the fourth and fifth lumber, the third and fourth lumber,
the second and third lumber and rarely between the first and second lumber vertebrae.
Disease review 70
Many factors are responsible for the herniation. Some of the important are congenital
or developmental, repetitive microtrauma, accumulated macrotrauma etc.
Degeneration of posterior longitudinal ligaments and the annulus fibrosus which
occurs in most adults of middle and advanced years may have taken place silently or
may have been manifested by mild, recurrent lumber ache. A sneeze, lurch or other
trivial movement may then cause the nucleus pulpous to prolapse, pushing the frayed
and weakened annulus posteriorly. In more severe cases of disc diseases, the nucleus
may protrude through the annulus to become extruded to lie as a free fragment in the
vertebral canal.
Spinal Stenosis
In this condition, the root is usually affected by bony and soft tissue
encroachment in the root canal and occasionally in the central canal. The cause may
be degenerative changes, Paget’s disease or a congenital abnormality of the shape or
size of the canal. Fifth lumber root is most commonly involved. The L4 and L3 toots
are occasionally affected in their root canals.
Sprains and Strains
A strain is an injury to muscle, tendon or fascia beyond the elastic limit while
sprain is an injury to the ligaments of a joint. Both of these are the result of injury.
Occasionally discal and arthritic factors may play a role. The pain is usually confined
to lower back and may involve the sciatic nerve.
Segmental Instability
A spinal segment is probably unstable if it moves beyond its normal bounds of
restraint and returns again to its preformed position. Patients suffer from chronic low
back pain and sciatica.
Disease review 71
Facet Syndrome
This commonly occurring condition usually arises in the dysfunctional or unstable
phase of spondylosis causing an ill-defined type of pain. In this condition spinal roots are
compressed against the floor or roof of the intervertebral canal by an enlarged superior or
inferior facet.
Piriformis Syndrome
Sciatic pain is said to result from entrapment of the nerve deep and inferior to the
piriformis muscle. There is often a history of trauma in the area, with resultant spasm,
hypertrophy or contracture of the piriformis muscle.
Arachnoiditis
It is an inflammatory subdural process leading to fibrosis, which binds together
the roots of the cauda equina. Associated bony or soft tissue encroachment into the root
canal produces root symptoms. The causes of arachnoiditis are surgical trauma, infection,
foreign material, intrathecal haemorrhage etc.
Ankylosing Spondylitis
It is an inflammatory disorder of unknown aetiology. It affects the intervertebral
and costovertebral joints and especially the sacroiliac joints.
Osteoarthritis
Osteoarthritic changes are the results of degenerative changes in the disc,
vertebral bodies and apophyseal joints. Ostearthritis of lumber spine produces sciatic
pain. Also osteoarthritis of the hip joint produces pain in the groin which may radiate
down the outer side of the thing. It may occur secondary to trauma, neuropathic
disorders, steroid therapy etc.
Sacroilitis : Sacroilitis may follow acute salpingitis or prostatitis and may be responsible
for sacroiliac pain and tenderness and morning stiffness.
Disease review 72
It develops in about one third of patients with psoriatic arthritis.
Fibrositis Syndrome
Fibrositis is an entity noted to cause sciatica and low back pain especially L4
through S1 interspinous ligament region. The pain is widely distributed in extremities.
The disease may appear alone or as a part of syndrome associated with another
disease such as rheumatoid arthritis.
Metastatic Disease
Secondaries from breast, thyroid, lung, kidney and prostate can present as
back pain and sciatica. Also non-Hodgkin’s and Hodgkin’s lymphoma may involve
the spine.
Multiple Myeloma
Multiple myeloma is the most common malignant primary bone tumour Early
in its course can easily be overlooked as the cause of back pain.
Primary tumour of bone, spinal cord or nerve root
Primary bone tumours are unusual in the spine though Paget’s sarcoma,
chordoma, osteoid osteoma, angiosarcoma, solitary myeloma, malignant lymphoma
and reticulum cell sarcoma can occur. Osteoid osteoma and benign osteoblastoma of
the vertebrae can present with back pain and a fixed scoliosis Tumours within the
vertebral canal can cause pain with or without neurological signs. Extramedullary
tumours such as neurofibromas, angiomas, meningiomas and lipomas may cause
compressive lesions of cauda equina. Neurofibromas can enlarge the intervertebral
formen from bone erosion and cause root pain.
Vertebral Osteomyelitis
It is most commonly caused by haematogenous spread of staphylococcus
aureus, although a wide range of other bacteria have been isolated including
Disease review 73
coliforms, pseudomonas, streptococci, brucella and Mycobacterium tuberculosis,
fungi and anaerobes. Infection can be introduced during spinal surgery, epidural
injections and myelography or it can spread from adjacent lesions. Spinal tuberculosis
is now becoming a rare condition but may lead to progressive destruction of the
cancellous bone and vertebral collapse.
Discitis
It is an infective inflammatory process involving the paediatric intervertebral
disc and adjacent end plates. Staph. aureus is the most common organism cultured.
Epidural Abscess
Spinal epidural abscess is encountered rarely, but it should be considered
when compressive symptoms are associated with severe pain.
Osteoporosis
Osteoporosis can result in compression fractures. Acute pain superimposed on
chronic discomfort, often in absence of a history of trauma may be the presenting
symptom.
Osteomalacia, in which the bone mass is reduced with decreased
mineralization of the osteoid, may coexist with osteoporosis and needs to be excluded.
It is probably frequently unrecognized.
Paget’s Disease
There is very chronic enlargement of the diameter of the bones accompanied
by a rarefying osteitis with enlargement of the Haversian spaces. The bones most
affected are the pelvis, lower vertebrae, tibia, and femur.
Referred Pain
Uterine prolapse, fibroids, pelvic infection or a retroverted uterus may produce
back pain. Similarly prostatic disease may cause pain to the back and along the sciatic
Disease review 74
distribution. Pelvic tumours such as chondrosarcoma or chordoma or retroperitoneal
secondary deposits may imitate mechanical back pain, particularly when there is root
involvement.
Pregnancy
The back and leg pain that occurs during pregnancy is considered mechanical
for the most part. At about 10-12 weeks of gestation, the level of relaxin rises, which
results in the widening of the sacroiliac joint with structural changes with increased in
the lumber lordosis and tension on the sciatic nerve. If the head of the foetus comes to
lie up against the sacral trunk, sciatic nerve may be affected, usually with loss of
dorsiflexion. These conditions usually persist throughout pregnancy and a few weeks
after delivery.
Vascular Causes
Vascular lesions within the distribution of the femoral artery such as atheroma
or thromboangitis obliterans are occasional causes of pain in the leg in middle age and
later in life. Intermittent claudication is not always present in these cases. Sciatic
claudication is an insufficiency of the inferior gluteal artery producing ischaemia of
the sciatic nerve and claudication in a sciatic distribution.
Psychogenic Pain
Back pain is seldom if ever purely psychogenic in origin. It is unwise to
assume that the complaint of low back pain is made solely to gain attention or receive
compensation, though this does happen occasionally. Out right malingering is rarely
seen.
PATHOGENESIS
In its totality the behaviour of the spine is that of a flexible rod. Its function is
to absorb loads and permit movement while protecting the spinal cord and emerging
Disease review 75
nerve roots. The normal spine posture is vertical with cervical and lumber lordoses
and a mild thoracic kyphosis, thigh alignment facilitating absorption of impact loads
during walking and running.
The intervertebral disc, which is avascular, is composed of two
morphologically separate parts. The outer part, called the annulus fibrosus, is
composed of upto 90 sheets of collagen fibres. The fibres in adjacent sheets run at 30o
angles to each other This lamination of the annular layers strengthens the annulus and
prepares it to accept high stresses. The central part of the disc is called nucleus
pulposus. This provides a good shock absorbing mechanism which becomes less
efficient with age as the nucleus becomes more fibrotic.
Herniated disc is the common source of acute and chronic disability. Also
when responsible for symptoms it is only one factor amongst many. Disruption of the
inner fibres of the posterior annulus alone will not cause the nucleus to bulge, even
when loaded. Due to mechanical pressure a loose fragment of nucleus pulposus, can
either extrude through a fissure in the annulus or as a Schmorl’s node through the
vertebral end plate. But if more peripheral fibres of the annulus are also torn or
separated, the protrusion will increase in size and finally rupture through the outer
Disease review 76
fibres as a nuclear hernia. Prolapse of the intervertebral disc occurs when the nucleus
pulposus is no longer contained within the annulus but bulges through it. Because of
the increased curvature of the posterolateral border of the vertebra, prolapse takes
place preferentially at this site, which is adjacent to the emerging spinal nerve roots.
The force distribution throughout the spine is such that the L5-S1, then the L4-L5 disc
are by far the most commonly affected, although the prolapse can occur at only level.
Root pressure at these sites gives rise to pain and neurological signs in ipsilateral leg,
usually referred to as sciatica. The second commonest site of prolapse is at the
posterior margin of the disc where the extruded nucleus presses on the highly bound
posterior spinal ligament. This causes pain without lateralizing signs and if large, may
result in cord or more usually cauda equina compression, leading to interference with
bladder function and anal sphincter competence. More chronic disc protrusion
associated with degeneration can lead to the condition of spinal stenosis. This causes
the symptoms of cord claudication with pain in the legs on exertion.
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Diagram showing a disc protrusion where there is a loose frgment and a
fissure. There is a bulge of the annulus but some of the outer annular fibres
remain intact. A complete annular fissure results in an extrusion when a loose
fragment is partly within and partly outside the annulus. The loose fragment is
sequestrated when it is outside the annulus.
Spondylosis is the association of the degeneration and narrowing of the disc
space with the development of osteophytic lipping at the adjacent vertebral margin.
There is often secondary osteoarthritis in the associated apophyseal joints.
The integrity of the bony spinal canal may be interrupted at the pars interarticularis
either because of a congenital defect or trauma. The resultant forward slippage of the
vertebra is called spondylolisthesis.
The apophyseal joints are particularly prone to osteoarthritis, especially when
loading is abnormal as a result of degeneration and narrowing of adjacent disc or in a
more wide spread fashion from alignment abnormalities such as scoliosis.
The spine may be the sit of infection or tumour. The classical spinal infection was
tuberculosis, which started from haematogenous spread to a disc and spread through
the vertebral end plates into the two adjacent vertebrae. This led to vertebral body
collapse with preservation of the posterior spinal elements leading to severe
angulation- the gibbus, now seen almost exclusively in the elderly. The infection is
now most commonly with staphylococci with streptococci becoming increasingly
important and more exotic infections occurring in the iatrogenically
immunocompromised and those with AIDS.
Primary malignancy may occur but is less common than secondaries,
particularly from breast, bowel and prostrate. Myeloma may present with back pain.
Disease review 78
In traumatic lesions, the nerve is either directly injured or indirectly compressed by
haematoma or protrusion, or swelling or surrounding organs leads to pain in the
course of nerve.
Thus, the nerve and its roots can be irritated by various reasons. The pathological
changes which develop in the damaged nerve depend upon the severity of the injury
and the amount of toxic agents irritating the nerve. When the nerve is subjected to
moderate degree of pressure or when it is slightly damaged temporary interruption of
functions of the nerve may occur. When there is severe injury to the nerve at any
point, the sheath at the point of injury is destroyed. Subsequently degeneration of the
nerve occurs but when the injury is minor in nature the degeneration will not take
place usually and complete recovery takes place in a few days or weeks in such cases
the prognosis will be good.
Symptoms and Signs
Pain
The onset is subacute and sciatica is frequently preceded by lumber pain which may
have occurred intermittently for years. Thus, pain along the sciatic nerve is the
cardinal symptom. The severity of pain varies greatly. In some cases it consists of a
feeling of discomfort in the lower back and down the posterior surface of the leg. In
some cases, however, it is so intense in nature that it totally incapacitate the affected
individual. It is possible to distinguish three elements in the pain.
• Pain in the back, aching in character and intensified by spinal movements.
• Pain deep in the buttock and thigh, also aching or gnowing in character and
influenced by the posture of the limb.
• Pain radiating to the leg and foot and momentarily increased by coughing and
sneezing.
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The distribution of pain depends upon the nerve root involved.When the first sacral
root is compressed the pain radites to the outer border of the foot. When the pressure
is upon the fifth lumber root, it spreads from the outer aspect of the leg to the inner
border of the foot. In general the pain is intensified by stooping, sitting and walking.
Tenderness
There is tenderness on pressure along the course of the sciatic nerve i.e. the sciatic
notch, middle of the back of the thigh, popliteal space behind the head of the fibula
and external malleolus and in the sole of the foot.
Numbness and sensory impairment
There is often a feeling of numbness, heaviness or deadness in the leg, especially
along the outer border of the foot. There is rarely much sensory loss, though there is
often blunting of light touch and pinprick over the outer half of the foot and the three
toes and lower part of the outer aspect of the leg when the first sacral root is involved.
Weakness and atrophy of muscles
There are muscular hypotonia and slight wasting, not only of the muscles supplied by
the sciatic nerve, but also of the gluteal and sometimes of all the muscles of the lower
limb. Compression of the first sacral root may cause weakness of the small muscles of
the foot and the calf muscles of the foot or great toe or even foot drop. Occasionally
muscular twitchings may be observed.
Tendon Reflexes
Ankle jerk may be diminished or lost when the first sacral root is involved, while it is
preserved in case of fifth lumber root. If the fourth lumber root is involved, the knee
jerk may be diminished. The plantar reflex is flexor.
Disease review 80
Scoliosis:
Scoliosis is a term used to describe a lateral curvature of the spine.
Sciatic scoliosis lasts only as long as some primary painful condition of
the spine produces a spasm of muscles to protect the area that hurts. By
for the most common primary cause is the protrusion of an
intervertebral disc. Abnormal posture occurs quiet involuntarily as the
body attempts to minimize painful pressure upon a nerve root. The trunk is often titled
well over to one side root. The trunk is often tilted well over to one side.
Sciatic List
Table No.10: Signs associated with common nerve root lesions affecting the leg:
Reflex
Root Parasthesiae / Numbness Muscle Weakness
Changes
L1 Groin - -
L2 Front of mid thigh Quadriceps -
L3 Front of lower thigh Quadriceps Knee
Front of lower thigh, Quadriceps Knee

L4
knee and inner aspect of shin And tibialis ant.
Back of thigh, lat. aspect of leg, Ankle

L5 Extensor hallucis longus
dorsum of foot to big toe.
Back of leg, lat. aspect of foot and Calf wasting and weakness Ankle
S1
sole of plantar flexors
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Table No.11: The Clinical Features of Herniated Nucleus Pulposus:
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CLINICAL DIAGNOSIS
History
A detailed history regarding the nature, character of pain, its distribution,
mode of onset, chronicity, aggravating factors etc. should be taken. Also history of
trauma, infectious diseases, personal history, past medical history, any associated
diseases and also family history, obstetric history and occupational history should be
inquired.
Examination
General examination
Any clues for systemic diseases should be looked for e.g. fever etc. They help
for differential diagnosis as well as treatment decisions.
Musculoskeletal Examination
Gait: The patient of sciatica has a very typical limping gait while walking.
Posture: The shape of the lumber spine is altered and the mobility is restricted. The
spinal mobility is checked by the ability to bend forwards. There may be loss of
normal lordosis. Te muscular spasm produces list to one or other side on standing,
known as sciatic scoliosis.
Tenderness: Local tenderness and presence of trigger points in the back and limb
should be identified.
The following signs are helpful to confirm
the diagnosis of sciatica.
Straight leg raising test (SLR)
There is no universal agreement
about the correct way to perform the
straight leg raising test. One method is
Disease review 83
that when the patient is in the horizontal position, on a counch or on the floor, ask him
to do straight leg raising. Another method is to support the heel in the cupped hand
of the examiner and having explained the method to the patient, gently lift the heel
from the counch with the knee still extended. Normally the leg can be raised upto 80o
- 90o without any pain.
The opposite hand rests on the pelvis to limit pelvic rotation. The elevation is
stopped when the patient complains of pain which is due to stretching of the affected
root and the angle is assessed using goniometer. The patient is asked about the site of
that pain. However, although a little uncomfortable for the patient, better repeatability
is obtained by lifting the leg to the maximum permitted level.
This test is most useful diagnostically to assess the severity of the pain and
prognostically to assess the results of treatment. Crossed leg pain is pathognomic of a
disc herniation and suggests a poor prognosis.
• Lasegue test: It elicits pain in the leg or back, when at the limit of straight leg
raising the knee is slightly flexed, the hip further flexed and the knee then
extended.
• Bragaad’s test: At maximum straight leg raising, the foot is dorsiflexed to see if
tension on the posterior tibial nerve increases the sensation of pain. In the same
position, the limb is extremely rotated, relaxing the sacral plexus and then
internally rotated; increasing root tension, the experience of pain is recorded.
• Bow-string test: At the limit of straight leg raising, the knee is first flexed and
then extended and the tibial nerve compressed at the popliteal fossa with the
examining fingers of one hand, the ‘bow string test
All the above mentioned tension signs are generally present when a lower
lumber or sacral root is involved in the pathological process of pain. They are marked
Disease review 84
with acute root involvement from a disc protrusion, but mild or absent with nerve root
irritation from long standing degenerative change.
Also pelvic rotation and testing of sacroiliac joints by pressure on two anterior
superior iliac spines should be done.
Neurological Examination
• The knee, ankle and plantar reflexes should be examined and they should be
symmetrical on both the sides.
• The motor power of selected muscles i.e. extensor hallucis longus (L5 or S1),
peronei (S1), quadriceps (L4 and 5) should be recorded.
• Wasting of muscles of the leg especially quadriceps should be measured.
• The sensation should be recorded by using a sharp pin. Areas of numbness,
hypoasthesias should be marked.
Others
• The dorsalis pedis and ant. tibial arteries should be palpated because claudication
pain can be confused with the redicular pain.
• Palpation of the abdomen is also mandatory, as an abdominal mass may explain
the cause of pain.
• Rectal examination should be carried out and in women vaginal examination also.
All the above signs have got some clinical value but it is not always that one or
more of them may be present and the diagnosis has to be confirmed by other
measures.
Investigations
Laboratory investigations
• Urine examination for sugar etc.
Disease review 85
• Complete blood count (C.B.C.), Erythrocyte sedimentation rate (E.S.R.) These are
especially helpful in screeing for infection or myeloma.
• Rheumatoid factor for rheumatoid arthritis, serum calcium, phosphorus, uric acid,
alkaline phosphatase in suspected hyperparathyroidism, malignancy, osteoporosis,
Paget’s disease and acid phosphate in suspected case of metastatic carcinoma of
prostate.
• Immunoglobulin electrophoresis is useful in diagnosis of multiple myeloma,
lymphomas and connective tissue disorders.
• Cerebrospinal fluid examination for the diagnosis of disease of the central nervous
system and spinal cord.
Other Diagnostic Techniques
• Plain Radiographs: No assessment of spine is complete without radiographs.
Many causes of sciatic pain are associated with bony changes visible in
radiographs Roentgenograms of lumber spine (L4,L5,S1) in anteroposterior,
lateral and oblique planes gives differential diagnosis of narrowing of disc space,
spondylolisthesis, sclerosis of vertebral bodies, disc herniations, prolapse etc.
• Myelography: Myelography is radiography after injection of an opaque substance
into the lumber spinal subarachnoid space, usually at the L2-L3 level. The purpose
is to outline the spinal cord and nerve root in order to demonstrate pathological
lesions such as lesions or fissuring of annulus, cyst on sacral nerve roots etc. It is
obviously contraindicated if lumber puncture is contraindicated Epidurography
can be done for the diagnosis of intraspinal lesions not visualized by conventional
myelography. Discography may be done by injecting contrast medium directly
into the intervertebral disc but it is pain-provocating, carrying risk of damage and
infection. Also it is difficult to interprete.
Disease review 86
• C.T. Scan: An important advance in radiological investigation of post fossa and
spinal lesions, from syringomyelia to lesions of the lumbosacral nerve roots and
cauda equina, has been the combination of CT scan with myelography using a
non-ionic water soluble medium such as iohexol. Reconstruction techniques can
be used to outline the spinal cord and nerve roots with a precision hitherto
impossible.
• MRI: MRI has several advantages over CT scanning in the assessment of cervical
and lumbosacral spines. No ionising radiations involved and intradural soft tissue
lesions can be visualized without the need for intrathecal contrast.
• Procaine Injection Test: Disappearance of the pain following local injection of
procaine or lidocaine into the tender spot is both diagnostic and therapeutic of
fibrositic pain.
• EMG: Electromyographic studies help to confirm the presence of impaired nerve
functions. Selective muscle degeneration can be identified and can suggest the
nerve root responsible.
• Nerve conduction tests support a diagnosis of peripheral nerve entrapment of the
common peroneal nerve at the neck of the fibula and of the post tibial nerve in
tarsal tunnel syndrome.
• Radionuclide Bone Scanning: Bone scanning is currently used to investigate a
wide range of spinal disorders, both benign and malignant. It is a highly sensitive
method for demonstrating bone disease, often providing an earlier diagnosis and
demonstrating more lesions than are found on X-ray.
• Aortic arteriography, intravenous pyelography and barium enema may be
necessary to find out aortic aneurysm or pelvic or rectal pathology.
Disease review 87
Differential diagnosis
A precise diagnosis is the foundation for a rational plan of therapy for low
back pain and sciatica. Combining the information obtained from a careful clinical
history and physical examination with the additional knowledge gleaned from certain
special radiographic investigations confirms the anatomical source of pain and makes
possible a specific diagnosis.
True sciatic neuritis
It is certainly very rare and the diagnosis should be accepted with reserve even
when investigations appear to exclude all other causes.
Spondylosis
There is often a history of chronic or intermittent spinal pain, recurrent sciatica
with osteoarthritis elsewhere in the spine. More than one root may be involved but
objective neurological signs are usually less prominent than in acute disc prolapse.
Spinal radiographs show variable disc space narrowing with osteophytic lipping and
irregularity of the facet joints. It is however important to remember that such changes
will be found in the majority of aged spines so that the appearance seen may not
account for symptoms.
Spondylolisthesis
Often tenderness is elicited near the segment which ‘slipped’ forward. One can
feel a step on deep palpation of the posterior elements of the segment above the
spondylolisthetic joint. Degenerative and isthmic spondylolisthesis are easily
recognized by conventional radiography. The defect is best visualized on oblique
projections or with CT scan, MRI.
Disc Herniation: Disc trouble often begins with a popping or snapping sensation in
the back followed by low back pain.
Disease review 88
Although, the initial episode may subside, there is tendency for recurrence.
During the attack the pain is severe, incapacitating and aggravated by coughing,
laughing or sneezing. On examination there is difficulty in standing and walking
.Lumber spine is stiff with tenderness at the level of the lesion. The lumber lordosis
may be lost and there may be scoliosis which becomes more marked with forward
flexion. Marked limitation of straight leg raising is found with positive popliteal
compression. Neurological signs vary according to the site of the lesion motor, reflex
and sensory impairment may be found.
After acute disc prolapse the spinal fluid is often normal though there may be
slight rise in protein content. Radiographs of the lumber spine may show significant
narrowing of the affected disc space. Contrast myelography may outline the
herniation unless the lesion involves the lateral recess when appearance may be
normal. Localization of such herniation by CT or MRI scanning offers an improved
diagnostic method.
Spinal Stenosis
Though the pain from root entrapment is in the same distribution as the
sciatica from disc lesion its character is different. It is described as a severe pain often
unremitting day and night whilst the pain from a disc is frequently relieved by lying
down; this pain is severe specially at night. Such pain is found in middle aged and
older patients. Motor, reflex and sensory changes may be present. CT scan will show
bony and/or ligamentous encroachment into the lateral recess of the central canal or
into the root canal.
Sprains and Strains
The history of onset of pain is important. A muscle, ligament or fascial injury
will be most painful immediately and gradually improve. Criteria for disc protrusion,
Disease review 89
even without leg pain-a list, pain aggravated by coughing, some reduction of SLR,
recurrent episodes of pain – would be unusual with soft tissue injury. Thus, the
diagnosis of soft tissue injury is a process of elimination.
Segmental instability
The instability results in backache with or without referred pain round the
pelvis or into the posterior thighs. A reliable symptom is the history of a ‘catch’ in the
back when moving from forward flexion to the erect standing position. It is
aggravated by excessive unnatural or erratic movements of the lumber vertebral
segment.
Facet Syndrome
It mimics all aspects of nerve root compression including muscle weakness
and neurological abnormalities. But it tends to be unilateral and coexisting back pain
may also be present.
Piriformis Syndrome
History of twisting injury is often present. The pain, often deep seated in
rectum and vagina, may be severe and incapacitating. Internal rotation and resisted
abduction of the flexed hip are painful. Electromyography and nerve conduction
studies confirm the site of entrapment. Relief of pain by injection of local anaesthetic
into the piriformis is said to be diagnostic.
Arachnoiditis
Often there is history of multiple lumber operations and myelograms and are
left with backache and sciatica in combination with mild to moderate motor, sensory
and reflex changes. The contrast medium during myelography does not fill the root
sheaths and tends to be irregularly loculated. On surgical exploration, the arachnoidal
Disease review 90
membrane is thickened and opaque, adherent to dura and tightly bound to pia and
roots.
Ankylosing Spondylitis
Night pain and morning stiffness may be the major complaints, but
asymmetric sacro-iliac involvement with radiation into the buttock and thigh is not
unusual. Inflammatory changes start in the sacroiliac joints and if progressive, will
gradually spread cranially up the spine involving the apophyseal joints, the vertebral
end plates and ligamentous attachments until the ligaments are ossified. The spine is
stiff, too often in the kyphotic position, with sclerosed sacroiliac joints and a ‘bamboo
spine’. Involvement of costovertebral joints restricts chest expansion. Raised ESR and
prevalence of HLA B-27 antigen confirm the diagnosis. X-ray, radioscintigraphy and
CT imaging are helpful.
Osteoarthritis
Patient often complains of pain centered in the spine that is increased by
motion and is almost invariably associated with stiffness and limitation of motion.
There is notable absence of systemic symptoms such as fatigue, malaise and fever and
the pain usually can be relieved by rest. The severity of the symptoms often bears
little relation to the radiological findings. Pain may be present when there are minimal
findings on an X-ray and conversely, marked osteophytic overgrowth with spur
formation, ridging and bridging of vertebrae can be seen in asymptomatic patients in
middle and lateral life. In arthritis of hip joint, hip movements are restricted and pain
provoked by passive movements. Radiograph of pelvis is diagnostic.
Sacroilitis
Referred pain from the sacroiliac joint may radiate to the buttocks, posterior
thigh, groin and occasionally to the lateral calf and ankle. The lack of nerve root
Disease review 91
tension signs and absence of motor, reflex or sensory deficits helps to distinguish
sacroiliac joint syndrome from nerve root compression lesions. Movement of the joint
is usually restricted. Scintigraphy will be more helpful than radiography in early
diagnosis. When manipulation or injection to the sacroiliac joint effectively breaks the
cycle of pain, the diagnosis is confirmed.
Fibrositis Syndrome
Pain is widely distributed in the extremities and trunk and is associated with
stiffness and exhaustion. One or more trigger points may be found on palpation.
Skinfold tenderness and reactive hyperaemia may be noted. The syndrome affects
women more often than men. Studies point to disturbance in non-REM sleep as a
possible cause. Disappearance of pain following local injection of procaine or
lidocaine into tender spots is both diagnostic and therapeutic.
Metastatic Disease
The distinguishing feature is the unrelenting, intense and progressive nature of
pain. Patient looks anxious, fatigued and often desperate for relief. Often a needle
biopsy of the spine under fluoroscopic control is most direct route for diagnosis.
Multiple Myeloma
The complaints of the patient may he nonspecific but there may be general
lack of well being of the patient. Abnormalities on serum protein electrophoresis
studies and presence of Bence Jones proteinuria usually clinch the diagnosis. If the
typical picture of multiple ‘punched out’ lesions is absent in radiographs, sternal
puncture to obtain bone marrow for histology may be necessary.
Primary Tumours
Insidious onset of pain without history of trauma, unremitting progressive
course, constant pain unrelieved by recumbency, preventing sleep at night.
Disease review 92
Neurological signs may be relatively late in appearing but lumber puncture will
usually reveal a raised cerebrospinal fluid protein level and there may be a partial or
complete intrathecal block. The most useful and reliable investigations are a
Technetium bone scan to determine the level of lesion and a computerized axial
tomographic (CAT) scan to identify the precise location of the nidus. Primary
tumours of the lumber canal are best assessed with MRI.
Vertebral Osteomyelitis
Vertebral osteomyelitis is not easily differentiated from mechanical causes of
back pain on clinical grounds alone. Pain is aggravated by activity and relieved by
rest. There is frequently a great deal of muscle spasm, more than is usually
encountered with an acute disc lesion. Pyrexia, loss of weight and loss of appetite
accompany spinal infection. The radiological features of vertebral osteomyelitis are
characteristic, with destruction of the end plate. The disc is soon involved and rapidly
destroyed by proteolytic enzymes of the pyogenic organisms with spread to adjacent
vertebrae. ESR is invariably elevated.
Discitis
Commonly found in children. There is low grade fever, back pain or
abdominal or hip pain and a refusal to walk or stand. ESR and white cell count are
raised. Radiological features of disc space narrowing and irregularities of the end
plate lag behind the clinical symptoms.
Epidural Abscess
There is often a coexisting debilitating disease like diabetes or cirrhosis and a
source of infection from spinal surgery, needle investigation or retroperitoneal
surgery.
Disease review 93
Osteoporosis: Age, sex and especially the menopause are important in development
of osteoporosis. Also factors such as hyperparathyroidism, corticosteroid drugs etc
should be considered. Low bone mineral density is the most important determinant in
osteoporosis compression fractures, with a deficiency in bone mass per unit volume.
Sudden failure of vertebral body results in spontaneous severe back pain. Gradual
failure of several vertebrae is often associated with chronic back pain, sometimes with
episodic increase in the pain with development of kyphosis and loss of height. The
clinical diagnosis is confirmed radiologically. One or more vertebrae are collapsed,
with a loss of mineral content appearing as decreased density.
Paget ’s disease
The disease may lead to compression of the spinal cord or roots because of
encroachment on the canal or foramen by pagetoid bone. Enlargement of vertebral
body may cause stenosis. Laboratory investigations show increased serum alkaline
phosphatase, but serum calcium is usually normal.
Refered pain
A thorough history taking and abdominal examination may direct attention
away from the spine to the source of viscerogenic pain, an elevated ESR to an
infection.
Vascular Causes
Abdominal aortic aneurysm can produce nagging chronic backache. Careful
examination of abdomen, including auscultation may reveal the source of the
symptoms. Radiographs of lumber spine may show erosion of the anterior aspect of
the vertebral bodies or calcification of enlarged aorta.
Peripheral vascular disease with claudication can be confused with spinal stenosis.
The vascular pain is induced by exercise such as walking. The diagnosis is readily
Disease review 94
established by diminution in the volume of the femoral, dorsalis pedis or posterior
tibial pulses. In sciatic claudication, the claudication is in a root distribution but spinal
examination and myelography are normal.
Psychogenic Causes
The appropriate diagnosis is usually evident after a thorough history and a
careful physical examination.
Prognosis
In mild cases of sciatica the stage of severe pain lasts for 2 to 3 weeks and the
patient recovers in a month or two, except that he may from time to time experience
aching in the course of the leg and stooping may still excite some pain. In more severe
cases there may be slight improvement after several weeks, but the condition then
becomes stationary and the patient continues to suffer from considerable pain for a
number of months. Relapses are common. In some cases they occur at frequent
intervals, in others the second attack may be delayed until 10 or more years after the
first. Operation gives good results in 90 percent of cases operated upon, but even after
operation a relapse may occur.
Management:
Most patients with lower back pain and sciatica are managed conservatively (non-
surgically). Treatment will depend on the diagnosis, but for patients with mechanical
pain (the vast majority) the mainstays of treatment are reassurance, patient education,
analgesia and physiotherapy. However, a minority of patients will require surgery,
depending upon the nature of the underlying problem and patients with specific
underlying conditions will require treatment of these.
Disease review 95
GENERAL
Patient Education
The patient with mechanical back pain can usually be reassured that this is not a
progressive condition and that the pain is likely to settle or at least become less
severe.
Occupational Therapy and Physiotherapy
The occupational therapist and physiotherapist both play an important educative role
advising on issues such as seating, desk/table height and sleeping on a firm mattress
as appropriate. Physiotherapist will teach the patient with low back pain, back
protection measures e.g. the correct way in which to lift and a range of exercise to
strengthen the supporting musculature of the back. There are a variety of other
treatment modalities used by physiotherapists e.g. heat or cold packs etc.
Bed Rest
For a patient with severe acute back pain, ‘controlled physical activity’ is now
preferred to prolonged bed rest. Recumbency has adverse effects on many systems
including the spine. Whilst in the bed, it is immaterial whether the patient lies supine
or on the side A pillow beneath the knees can be helpful. If a patient does rest in bed,
then the duration of this rest should be limited to 2-3 days.
Manipulation Techniques
A wide variety of manipulation techniques are advocated, although there is some
controversy as to how effective these are as there have been few clinical trials
addressing their efficacy.
Spinal Orthroses
Lumber supports have been widely used for relief of back pain. A support within the
corset gives better relief. Besides limiting lumber motility, an orthrosis can decrease
Disease review 96
intradiscal pressure and provides relief, perhaps by local warmth and by stimulation
of mechanoreceptors. However, compliance is poor.
Back School
Back school is a structured intervention programme for a group of individuals and
provides patients with information about back pain of mechanical origin, about types
of stress that can injure the spine, how this knowledge can be applied in day to day
activities and how the spine can be strengthened by improving fitness.
DRUG TREATMENT
Back pain is usually non inflammatory and so a simple analgesic should be tried in
the first instance. If this is not helpful, then an NSAID may be added in. Tricyclic
antidepressants, commenced in low dosage e.g. amitryptiline 10-25 mg, may relieve
chronic pain and improve the patient’s sleep pattern, but it may be several weeks
before they take effect. Muscle relaxants are often helpful adjunct.
Injection Therapy
A proportion of clinicians give epidural corticosteroids to patients with nerve root
compression. However, the value of this form of therapy has been much debated.
Chemonucleolysis
Chemonucleolysis is the treatment of disc herniation by a lysing agent. Chymopapain
enjoyed a decade of popularity, but the painful spasm that can accompany injection
and the complications of the occasional anaphylactic shock, cerebral haemorrhage and
paraplegia have directed many of its original advocates towards small doses and other
percutaneous techniques.
SURGERY
Surgical management should be reserved for those whose symptoms do not respond
after strict bed rest or after traction or manipulation and become chronic, those who
Disease review 97
relapse and those with gross and persistent symptoms of root compression,
sufficiently severe to cause disability. Central disc prolapse producing a saddle
sensory loss and bladder paralysis is an indication for immediate referral for surgery.
The surgical procedure most often indicated is a hemilaminectomy with excision of
the disc involved. Arthrodesis of the involved segments is indicated only in cases in
which there is extra ordinary instability usually related to anatomic abnormality such
as spondylolysis. To reduce the disc pressure on the nerve root, various surgical
procedures from percutaneous techniques, microdiscectomy to traditional
fenestration, wide exposure and combined fusion are in use.
PREVENTION
Preventive aspect plays a major role in diseases like sciatica. Prevention can be done
by following:
• Posture is important. Correct sitting, standing and sleeping postures lessen the
intradiscal pressure.
• One should avoid sudden strenuous activity such as lifting heavy objects etc.
without conditioning.
• Spinal strength and spinal fitness should be looked for. Sporting activity and
supervised weight training are good for the spine. Regular exercises such as brisk
walking, swimming running are also helpful.
• Diet and nutrition also play an important role.
Methodology 98
METHODOLOGY
The present study “Clinical Management of Sciatica (Gridhrasi) Through
Vasti, Kativasti along with Trayodashanga Guggulu” includes following materials and
methods.
MATERIALS:
The following materials were used in the Clinical Trial.
1. Pancha Kola Churna 143
2. Ashtakatvara Taila 144
3. Eranda Mooladi Niruha 145
4. Sahacharadi Taila 146
5. Trayodashanga Guggulu 147
6. Rasna Saptaka Kwatha 148

Ingredients:
1) Pancha Kola Churnam: Used For Amapachana
• Pippali - 1 Part
• Pippali Moola - 1 Part
• Chavya - 1 Part
• Chitraka - 1 Part
• Nagara - 1 Part
The above mentioned five ingredients of Panchakola Churna were powdered seperatly
mixed and used.
Methodology 99
Table No.12: Properties of Pancha Kola Churnam:
Botanical Dosha
S.N Drug Rasa Guna Virya Vipaka
Name Karma
Laghu Vata
Piper
1 Pippali Katu Snigdha Ushna Madhura Kaphahara
longum
Tikshna Deepana
Kapha
Pippali Piper Laghu Vatahara
2 Katu Ushna Katu
Moola longum Ruksha Deepana
Pachana
Kapha
Piper Laghu Vatahara
3 Chavya Katu Ushna Katu
chaba Ruksha Deepana
Pachana
Vata
Laghu
Plumbago Kaphahara
4 Chitraka Katu Ruksh Ushna Katu
zeylanica Deepana
Tikshna
Pachana
Guru, Vata
Zingiber
5 Nagara Katu Ruksha Ushna Madhura Kaphahara
officinale
Tikshna Deepana
2) Ashtakatvara Taila : Used for Kati vasti
Ingredients:
Kalka Dravya :
• Pippali mula – 1 part
• Shunti – 1 part
Sneha :
• Sarshapa Taila – 16 parts
Drava dravya :
• Katvara – 16 parts
• Dadhi – 16 parts
Methodology 100
Botanical Doshaghnata
Name and Karma
Kapha Vatahara
Pippali Piper Laghu
1 Katu Ushna Katu Deepana
mula longum Ruksha
Pachana
Laghu Kaphavataghna
Zingeber Katu
2 Shunti Snigha Ushna Madhura Pachana Vrushya
officinale Madhura
Ushna Hrudya
Snigdha
Brassica Katu Kaphavataghna
3 Sarshapa Ushna Ushna Katu
jancea Tikta Deepana Lekhana
Tikshna
Amla
4 Katvara - Kashaya Snigdha Ushna Amla Deepana
Snigdha
Deepanam
Amla
5 Dadhi - Snigdha Ushna Amla Hrudyam
Madhura
Vatahara
Table No.13: Properties of Pancha Kola Churnam:
3 Eranda Mooladi Niruha : (Used for Niruha Vasti)
Contents of Niruha Vasti
1. Madhu - 100 ml
2. Saindhava - 10 gram
3. Murchita Tila Taila - 200 ml
4. Kalka - 30 gram
5. Kwatha - 400 ml (Erandamuladi)
6. Gomutra - 75 ml
Ingredients of the kwatha Dravya(Yavakutachurna form)

• Erandamula - 1 part
• Palasha - 1 part
• Bruhati - 1 part
• Kantakari - 1 part
• Shaliparni – 1 part
• Prushna parni – 1 part
• Goksura – 1 part
• Bala – 1 part
• Rasna – 1 part
Methodology 101
• Guduchi – 1 part
• Ashvagandha – 1 part
• Devadaru – 1 part
• Madana phala – 1part
Ingredients of Kalka Dravya:
• Vacha - 1 part
• Shatapushpa- 1 part
• Hapusha- 1 part
• Nirgundi - 1 part
• Yashti Madhu- 1 part
• Pippali- 1 part
• Vatsaka- 1 part
• Musta- 1 part
• Daruharidra- 1 part
Table No.14: Properties of Eranda Mooladi Niruha Vasti:
Botanical Doshaghnata
Name and karma
Kaphavatahara
Ricinus
1 Eranda mula Madhura Ushna Ushna Madhura Kati, vasti
communis
peedahara
Butea Katu Snigdha Vata
2 Palasha Ushna Katu
monosperma Tikta Ushna kaphahara
Kaphavatahara
Solanum Katu
3 Bruhati Ushna Ushna Katu Grahi Pachana
Anguivi Tikta
Deepana
Kaphavatahara
Solanum Katu Laghu Pachana
4 Kantakari Ushna Katu
Xantocarpum Tikta Ruksha Shukra
rechana
Tridoshaghna
Pseudarthria Tikta
5 Shaliparni Guru Ushna Madhura Brumhana
Viscida Madhura
Rasayana
Desmodium Tridoshaghna
6 Prushnaparni Madhura Ushna Ushna Madhura
gangeticum Vrushya
Tridoshgna
Tribules Vasti
7 Goksura Madhura Sheeta Sheeta Madhura
terrestris shodhana
Deepana
Vatapittahara
9 Bala Sida cordifolia Madhura Sheeta Sheeta Madhura
Balakara
Methodology 102
Alpinia Guru Kaphavahara

10 Rasna Tikta Ushna Katu
galangal Ushna Pachana
Vataraktahara
Tinospora Tikta
11 Guduchi Ushna Ushna Madhura Rasayani
cordifolia Katu
Deepana
Vatakaphahara
Withania Kashaya
12 Ashvagandha Ushna Ushna Katu Atishukrala
somnifera Tikta
Rasayani
Boerhavia Kashaya Kaphavatagna

13 Punarnava Ushna Ushna Katu
diffusa Madhura Shophagna
Cassia Kashaya
14 Argvadha Ushna Ushna Katu Vatakaphahara
fistula Tikta
Kaphavatahara
Cedrus Laghu
15 Devadaru Tikta Ushna Katu Dushtavruna
deodara snigdha
Shodhana
Kaphahara
Randia Madhura
16 Madanaphala Laghu Ushna Katu Vamaka
dematorum Tikta
Lekhana
Deepana
Acorus Katu Shakrut
17 Vacha Ushna Ushna Katu
calamus Tikta Mootra
shodhani
Anethum Deepana
18 Shatapushpa Katu Laghu Ushna Katu
graveolens Vatakaphahara
Sphaeranthus Tikta Ushna Medhya

19 Hapusha Ushna Katu
indicus Madhura Laghu Krimihara
Vatahara
Callicarpa Tikta
20 Priyangu Sheeta Sheeta Madhura Keshya
macrophylla kashaya
Vrushya
Yashti Glycyrrhiza Sheeta Pittanilahara

21 Madhura Sheeta Madhura
madhu glabra Guru Balavarnakara
Laghu Vata
Piper Katu
22 Pippali Snigdha ushna madhura Kaphahara
longum Tikta
Tikshna Deepana
Kaphahara
Holarhena Katu
23 Vatsaka Ruksha Sheeta Katu Shoshana
antidysenterica Kashaya
Grahi
Kapha
Katu
Cyperus pittahara
24 Musta Kashaya Sheeta Sheeta Katu
rotundus Grahi
Tikta
Deepana
Methodology 103
Kaphahara
Berbaris Ruksha
25 Daruharidra Katu Sheeta Katu Twak
aristata Ushna
doshahara
Ropaka
Laghu
Madhura Shodhana
26 Madhu Honey ruksha Ushna Madhura
Kashaya Sandhana
Sukshma
Tridoshahara
Laghu Tridoshahara
Lavana
27 Saindhava Salt Snigsha Sheeta Madhura Deepana
Madhura
Sukshma Pachana
Madhura Guru
Murcchita Sesamum Vatakaphahara
28 Kashaya snigdha Ushna Madhura
Tila taila indicum Twachya
Tikta Picchila
Kapha
Katu Ushna
29 Gomutra Cows urine Ushna Katu vatahara shula
Lavana Tikshna
hara
4). Sahacharadi Taila : Used for Anuvasana
Contents of Anuvasana–
Sacharadi taila 100 ml
Saindhava 3- 5 grams
Ingredients of Sahacharadi Taila
Kalka – Sahacharamula kalka 01 part
Sneha- Tila Taila 06 parts
Drava dravya a- Sahachara kwatha 10 parts
b- Ksheera 04 parts
Table No.15: Properties of Sahacharadi Taila:
Botanical Doshagnata
Name and Karma
Nilgirianthus Tikta, Ushna, Deepana,
1 Sahachara ushna katu
ciliates katu snigdha tridosha hara
Madhura Guru
2 Tila Taila Sesamum Vatakaphahara
Kashaya snigdha Ushna Madhura
indicum Twachya
Tikta Picchila
3 Ksheera Snigdha Raktapittahara
Milk Madhura Sheeta Madhura
Guru Rasayana
Methodology 104
5). Trayodashanga Guggulu: Used as Shamana
Ingredients-
Abha 1 part
Ashwagandha 1 part
Hapusha 1 part
Guduchi 1 part
Shatawari 1 part
Gokshura 1 part
Vruddhadaru 1 part
Rasna 1 part
Shatapushpa 1 part
Shati 1 part
Yawani 1 part
Shunthi 1 part
Guggulu 13 parts
Goughrita 6.5 parts
Table No.16: Properties of Trayodashanga Guggulu:
Botanical Viry Vipak Doshagnata and

S.N Drug Rasa Guna
Name a a Karma
1
Acacia Guru Sheet
1 Abha Kashaya Katu Kaphahara grahi
Arabica ruksha a
Ashawa Withania Tikta, Ushn Vatakaphahara,Bal
2 Ushna Katu
gandha somnifera Kasaya a ya, Rasayani,
Sphaeranthus Tikta, Ushna, Ushn Medhya,
3 Happusha Katu
indicus Madhura Laghu a Vatakaphahara
Vataraktahara,
Tinispora Kashaya, Ushn Madhur
4. Guduchi Ushna Rasayani, Balya,
Cordifolia tikta a a
Deepani
Asparagus Guru, Sheet Madhur Medhya, Deepana,
5. Shatavari Madhura
racemosus Sheeta a a Vatapittahara
Tribulus Sheet Madhur Balakrut,
6. Gokshur Madhrua Sheeta
terrestris a a Tridoshagna
Vrudhadar Argyrcian Kashaya, Ushn Kaphaahara,
7 Ushna Katu
u ervora Pitta, a Rasayana
Methodology 105
Alpinia Guru, Ushn Kaphavatahara,

8 Rasna Tikta, Katu
galanga Ushna a Pachana
Shatapushp Anethum Ushn Deepana,
9 Katu Laghu Katu
a graveolens a Anulomana
Kaempferia Katu,Tikt Ushn Kaphavatahara,
10 Shati Ushna Katu
galanga a a Deepana
Trachysprmu
m Ushn Deepan,
11 Ajamoda Katu Tikshna Katu
roxberghianu a Kaphavatahara
m
Zingiber Katu, Laghu, Ushn Madhur Amavatagna,
12 Shunthi
officinale Madhura Ushna a a Pachani
Vishada
Tikta, Rasayana, Deepana,
Commiphora Ruksha, Ushn
13 Guggulu Kashaya, Katu Rasayana,
mukul Sukshm a
Katu Tridoshagna
a
6). Rasnasaptaka Kwatha : Used as Anupana for Trayodashanga gugulu
Rasna 1 part
Gokshura 1 part
Eranda 1 part
Devadaru 1 part
Punarnava 1 part
Guduchi 1 part
Ashwagandha 1 part
Table No.17: Properties of Rasnasaptaka Kwatha:
Botanical Doshagnata
Name and Karma
Guru, Kaphavatahara,
1 Rasna Alpinia galanga Tikta, Ushna Katu
Ushna Pachana
Tribulus Balakrut,
2. Gokshur Madhrua Sheeta Sheeta Madhura
terrestris Tridoshagna
Ricinus Kaphavatahara,
3 Eranda Madhura Ushna Ushan Madhura
communis Kati, Vasti,
Methodology 106
Peedahara
Laghu, Kaphavatahara,
4 Devadaru Cedrus deodara Tikta Ushna Katu,
Snigdha Amadoshahara
Boerhavia Kashaya, Kaphavatahara,

5 Purnarnava Ushna Ushna Katu
diffusa Tikta Shotagna
Vataraktahara,
Tinispora Kashaya,
6. Guduchi Ushna Ushna Madhura Rasayani, Balya,
cordifolia tikta
Deepani
Kashaya, Kaphavatahara,
7 Aragwadha Cassia fistula Ushna Ushna Madhura
Madhura Sramsana
Methodology 107
METHODS
Study design: Prospective randomized Clinical study
Source of Data:
Patients attending the OPD of the Post Graduate Department of Kayachikitsa,
Ayurveda Mahavidyalaya Hospital, Hubli were selected.
Methods of collection of Data :
a. A clinical survey of patients attending the OPD of Post Graduate
Department of Kayachikitsa, Ayurveda Mahavidyalaya Hospital Hubli
wesre selected as per the criteria of diagnosis.
b. Literatures were collected from the Post Graduate Department Library,
Ayurveda Mahavidyalaya, Hubli, Internet and medical journals.
c. The data obtained by the clinical trials were statistically analyzed by
applying the student‘t’ test.
Sample size:
Minimum of 30 patients diagnosed as Sciatica (Gridhrasi) were selected and
randomly categorized into two groups consisting 15 patients in each group.
Inclusion Criteria:
1. Subjects with classical features of Sciatica (Gridhrasi) such as pain
starting from Hip and radiating down to back of the thigh, knee, leg
and foot.
2. Subjects of either sex between 20-60 years were taken for clinical trial.
3. Normal L. S. spine X-ray.
4. Subjects Yogya for adopted therapies.
Methodology 108
Exclusion Criteria:
1. Subjects who were below 20 years and above 60 years were excluded.
2. Subjects with disc lesions, spinal tuberculosis, HIV-infection or any
other chronic illness and pregnant women.
3. Subjects Ayogya for adopted therapies.
Investigations:
i. Blood examination - Hb%
TC
DC
ESR
RBC
ii. Urine - Albumin / Sugar / Microscopy
iii. VDRL
iv. RA Test
v. X-ray of lumbar spine AP and Lateral view
Parameters of study
Subjective Parameters: - Such as;
1. Pain starting from Hip and radiating down to back of the thigh, knee,
leg, foot and numbness in the affected lower limb.
Objective parameters: - such as
1. SLR test
2. Lasegue’s sign.
Methodology 109
Table No.18: Grading:
Assessment Criteria B.T A.T
Radiating Pain
Numbness
SLR test
Lasegue’s sign.
Assessment Based on Scoring:

Radiating Pain
0 No Radiating Pain
1 Pain Radiating to hip and back of thigh
2 Pain Radiating to Popleteal fossa
3 Pain Radiating upto foot
Numbness
0 No Numbness
1 Mild (Once/day)
2 Moderate (2-3/day)
3 Continuous
SLR
0 Negative
1 60 Degree and Above
2 In between 30 Degree to 60 Degree
3 Less than 30 Degree
Lasegue’s Sign
0 Absent
1 Present
Methodology 110
Assessment criteria:
1. Changes in subjective parameters.
2. Changes in objective parameters which were recorded in the following pattern.
• Marked relief – above 75% improvement
• Moderate relief – 50-75% improvement
• Mild relief – 25-50% improvement
• No relief – below 25% improvement
INTERVENTIONS:
GROUP –A
1) Amapachana with Panchakola Choornam
5gm twice daily with warm water before food for 3-5 days.
2) Kati Vasti with Ashtakatvara Taila.
Details about kati vasti procedure are as follows,
Schedule of Kati Vasti :
Day Duration
1 30 minutes
2 35 minutes
3 40 minutes
4 45 minutes
5 50 minutes
6 55 minutes
7 60 minutes
8 60 minutes
9 55 minutes
10 50 minutes
Methodology 111
11 45 minutes
12 40 minutes
13 35 minutes
14 30 minutes
Here the time duration of stay of oil on 1st day was 30 minutes and 5 minutes per day
was increased upto 7th day and 8th day the same time was maintained
and after 8th day 5 minutes per day was reduced upto 14th day.
Procedure of Kati Vasti
• Requirements
• Administration of Vasti
• Pathya Palana
Requirements
• Black gram Powder
• Ashta Katwara Taila
• Water Bath
• Cotton
• Steel bowels
• Towel
Administration of Kati Vasti
1. After proper Evacuation of bowel the subject was properly examined,
in between 8-9 a.m. the subject was asked to lie down on his/her
abdomen. The low back region was exposed.
2. Then circular frame prepared out of black gram paste measuring 5” in
dia meter and 1 ½” in depth was properly sealed on Lumbosacral
region.
Methodology 112
3. Oil was heated on a water bath up to 50 C and poured into the frame,
the upper level of the oil was 1” above the skin.(care was taken about
burns)
4. The temperature of oil was well maintained by changing cooled oil
with warm oil.
5. After completion of duration, frame was removed and gentle abhyanga
was done and mild Nadi Sweda was applied on lumbo Sacral region.
Pathya Palana
1. Rest for 15 minutes
2. Hot water bath
3. Light diet (Yavagu)
4. Avoid from cold wind and travelling.
3. Shamanoushadhi
Medicine – Tryodashanga Guggulu
Dosage – 1 tab thrice a day (1 tab = 325 mg)
Anupana – Rasnasptaka Kwatha
Kala – Half an hour before food
Duration – 2 months
Follow up 3 months
GROUP - B
1) Amapachana with Panchakola Choornam
5gm twice daily with warm water before food for 3-5 days.
2) Vasti procedure was done in kalavasti schedule which includes 10 anuvasana
and 6 Niruha Vasti. The procedure which was adopted includes the following steps.
Schedule of the kalavasti.
Methodology 113
Contents of the vasti.
Requirements
Administration of Vasti
Pathya Palana
Schedule of the Vasti
Day Administered Vasti day Administered
Vasti
1st Anuvasana 9th Anuvasana
2nd Niruha 10th Niruha
3rd Anuvasana 11th Anuvasana
4th Niruha 12th Niruha
5th Anuvasana 13th Anuvasana
6th Niruha 14th Anuvasana
7th Anuvasana 15th Anuvasana
8th Niruha 16th Anuvasana
Here on first day Anuvasana was given full stomach and 2nd day Niruha was
given with Empty stomach. This alternative administration of vasti was followed
upto 13th day and schedule was completed by giving 3 consecutive anuvasana
vasti on 14th, 15th and 16th day.
Contents of the vasti
a) Niruha vasti
1. Madhu - 100 ml
2. Saindhava - 10 gram
3. Murchita Tila Taila - 200 ml
4. Kalka - 30 gram
Methodology 114
5. Kwatha - 400 ml (Erandamuladi)
6. Gomutra - 75 ml
b) Anuvasana Vasti
1. Sahacharadi Taila - 100 ml
2. Saindhava - 3-5 gm.
Requirements
i. Enema can
ii. Prescribed Medicine
iii. Rubber Catheter (No. 10)
iv. Water bath
v. 100 ml Syringe
vi. Cotton
vii. Gloves
Administration of Vasti
a) Administration of Anuvasana
1) After getting proper amapachana lakshana the subject was examined
properly.
2) Next day after proper evacuation of bowel, bath was given with luke
warm water, Ransadi Churna was applied over head.
3) Food was given in sufficient quantity when the patient got hungry.
4) Just after intake of food local Abhyanga and Swedana was done and
anuvasana Vasti was given with syringe attached with catheter in left
lateral position.
Methodology 115
5) Immediately after administration of Vasti gentle strokes were done on
buttocks, then the patients palm were briskly rubbed against each
other.
6) Then observed for Evacuation, after proper evacuation the patient was
asked to drink one cup of hot water processed with Dhanyaka.
b) Administration of Niruha
1) After proper evacuation of anuvasana Vasti next day morning the subject
was properly examined and Niruha Vasti was administered in between 8 –
9 a.m. after doing proper Sarvanga Abhyanga and Swedana.
2) Observed for samyak Vasti lakshana .
3) After proper evacuation, bath was given then light diet was given when
he/she got appetite. Then warm water processed with dhanyaka was given
for drinking.
Pathya Palana
Specific diet and proper regimens were advised followed after Vasti karma.
Diet - Diet regimen includes Yavagu with milk twice in a day and luke warm
water processed with Dhanyaka for drinking.
Behavior - Activities which were to be avoided as follows.
1) Atyasana - Assuming sitting posture for long
duration
2) Athishtana - Standing for longer time.
3 Yana - Travelling
4 Vachamsi - Excessive talking
5 Divaswapna - Day sleep
6 Vegavarodha - Supperession of urges
Methodology 116
7 Shitopacharana - Exposure to cold
8 Athapa - Exposure to sun light
9 Shoka - Grief
10 Rosha - Anger
11 Akala Bhojana - Untimely intake of food
12 Ahita Bhojana - In compatible food
The subject was advised to avoid these activities for about 30 days.
3. Shamanoushadhi
Medicine – Tryodashanga Guggulu
Dosage – 1 tab thrice a day (1 tab = 325 mg)
Anupana – Rasna Saptaka Kwatha
Kala – Half an hour before food
Duration – 2 months
Follow up - 3 months
Observations 117
OBSERVATIONS
The data obtained by this clinical study was analyzed on different parameters.
The observations made in this regard are comprehended here with.
Table No.19: Distribution according to age:
Age (Yrs.) A B Total Percentage

21-30 4 7 11 36.67 %
31-40 5 4 9 30 %
41-50 1 1 2 6.66 %
51-60 5 3 8 26.67 %
The first observation table notifies that the sample was split up into Four classes of 10
years age group. The least age of the patient was 23 years and maximum age was 60
years. Maximum patients were recorded in age group of 21-30 years i.e. 11 (36.67%)
followed by 31-40 years, 9 (30%), 51-60 years, 8 (26.67 %) and Minimum patients
were in the age group 41- 50 years, 2 (6.66%).
Table No.20: Distribution According to sex:
Sex A B Total Percentage

Male 7 4 11 36.67 %
Female 8 11 19 63.33 %
Distribution according to sex shows that in this sample19 (63.33 %) patients were
female while 11 (36.67%) patients were male.
Table No.21: Distribution according to religion:
Religion A B Total Percentage

Hindu 4 6 10 33.33 %
Muslim 10 9 19 63.33 %
Christian 1 - 1 3.33 %
In this present study shows that 19 (63.33%) were Muslim while 10 (33.33%) belong
to Hindu community and 1(3.33 %) belonged to Christian community.
Observations 118
Table No.22: Distribution according to marital status:
Marital Status A B Total Percentage

Married 12 13 25 83.33 %
Unmarried 2 2 04 13.33 %
Widow /Widower 1 - 1 3.33 %
Above table shows that 25 (83.33%) patients were married, 4 (13.33%) were un
married and 1(3.33%) patient was a widow.
Table No.23: Distribution according to occupation:
Occupation A B Total Percentage

House hold 6 10 16 53.33%
Service 3 2 5 16.67%
Laborer 4 1 5 16.67%
Business 1 - 1 3.33%
Retired 1 - 1 3.33%
Tailor - - - -
Others - 02 2 6.67%
Above table shows about, the occupation wise distribution of patients. It shows that
16 (53.33%) patients were doing household work, 5 (16.67%) were in service, 5
(16.67%) were laborers, 2 (6.67%) belonged to others category, 1 (3.33%) patient was
businessman and 1 (3.33%) patient was a retired person.
Table No.24: Distribution according to educational qualification:
Education A B Total Percentage

Illiterate 5 1 6 20.00 %
Literate -Primary 5 9 14 46.66%
Secondary - - - -
Higher Secondary 1 1 2 6.67 %
Graduate 4 04 8 26.67 %
Observations 119
Above table shows that 6(20%) patients were illiterate, amongst the literates
14(46.66%) were of Primary level, 8 (26.67%) patients were graduates and 2 (6.67%)
patients were Higher secondary.
Table No.25: Distribution according to socioeconomic status:
Socioeconomic
A B Total Percentage
Status
Poor 4 1 5 16.66 %
Lower middle 1 4 5 16.67 %
Middle 7 8 15 50.00 %
Upper middle 3 2 5 16.67 %
Above table shows that 15 (50%) were middle class, 5 (16.67%) each patient, were of
poor class, lower middle and upper class.
Table No.26: Distribution according to Habitat:
Distribution
Habitat
Rural 3 2 5 16.67 %
Urban 12 13 25 83.33 %
The above table shows that there were 25 (83.33%) patients residing in Urban area
and 5(16.67 %) in rural area.
Table No.27: Distribution according to addiction:
Addiction A B Total Percentage

Tea 1 1 2 6.67 %
Smoking 2 - 2 6.67 %
Tobacco 2 1 3 10.00 %
Pan 2 2 4 13.33 %
Panmasala - 2 2 6.66 %
Alcohol - - - -
No addictions 10 7 17 56.67%
Observations 120
Above table shows 4(13.33%) were addicted to Pan, 3(10%) were addicted to tobacco
chewing and 2 (6.67%) each patient were addicted to tea, smoking and Pan masala
and 17 (56.67%) didn’t have any addictions.
Table No.28: Distribution according to Prakruti:
Prakruti A B Total Percentage

Sharirika
Vatapitta 11 7 18 60.00 %
Vatakapha 4 8 12 40.00 %
Pittakapha - - - -
Manasika
Rajasika 10 9 19 63.33 %
Tamasika 5 6 11 36.67 %
Above table shows 18 (60%) belonged to Vata pitta Prakruti, 12 (40%) belonged to
vata kapha prakruti. In manas bhavas 19 (63.33%) patients showed dominance of raja
guna and 11(36.67%) showed dominance of Tamo guna.
Table No.29: Distribution according to Satva:
Satva A B Total Percentage

Pravara - - - -
Madhyam 8 12 20 66.67 %
Avara 7 3 10 33.33 %
Maximum patients were observed to be in possession of madhyam satva 20 (66.67%)
and 10 (33.33%) were of Avara Satva.
Table No.30: Distribution according to Satmya:
Satmya A B Total Percentage

Pravara - - - -
Madhyam 12 11 23 76.67 %
Avara 3 4 7 23.33 %
Observations 121
Maximum patients 23 (76.67%) were of Madhyama Satmya and 7 (23.33%) were
Avara satmya.
Table No.31: Distribution according to Sara:
Sara A B Total Percentage

Pravara - - - -
Madhyam 10 12 22 73.33 %
Avara 5 3 8 24.67 %
Above data depicts that the sara of 22 (73.33%) patients was Madhyama and 8
(24.67%) were Avara.
Table No.32: Distribution according to Samhanana:
Samhanana A B Total Percentage

Pravara - - - -
Madhyam 12 12 24 80.00 %
Avara 3 3 6 20.00 %
Samhanana wise distribution is shown in the above table. 24(80%) patients had
Madhyam Samhanana and 6 (20%) had Avara Samhanana.
Table No.33: Distribution according to Vyayam shakti:
Vyayam Shakti A B Total Percentage

Pravara - - - -
Madhyama 6 4 10 33.33 %
Avara 9 11 20 66.67%
Majority of the patients i.e. 20 (66.67%) were having avara vyayam shakti, 10
(33.33%) had madhyama vyayama shakti.
Observations 122
Table No.34: Distribution according to Aharashakti:
Abhyavaharana A B Total Percentage

Shakti
Pravara - - - -
Madhyama 11 10 21 70.00 %
Avara 4 5 9 30.00 %
Jarana Shakti
Pravara - - - -
Madhyama 10 10 20 76.67 %
Avara 5 5 10 33.33 %
Ahara shakti of patients suffering from Gridhrasi is shown in the table 21 (70%)
patients had madhyama abhyavaharana and 9 (30%) had Avara Shakti. 20 (76.67%)
were of Madhyama Jarana shakti and 10 (33.33%) were of Avara Jarana Shakti.
Table No.35: Distribution according to dietary Habits:
A)
Dietary Habits A B Total Percentage
Vegetarian 3 4 7 23.33 %
Mixed 12 11 23 76.67 %
B)
Dietary Habits A B Total Percentage
Regular 3 2 5 16.67 %
Irregular 12 13 25 83.33 %
C)
Dominant Rasa
Consumed
Madhur 1 - 1 3.33 %
Amla 6 6 12 40.00 %
Lavana 3 - 3 10.00 %
Katu 5 9 14 46.67 %
Tikta - - - -
Kashaya - - - -
Observations 123
Dietary Patterns of the study sample depicts from this table that mixed were
23(76.67%) where as remaining 7 (23.33%) were of vegetarian diet. 25(83.33%)
patients were of irregular food habits and 5 (16.67 %) had regular food habits.
Analysis on the basis of dominant rasa consumed showed that maximum patients
were using Katu rasa i.e. 14 (46.67%) followed by Amla rasa 12 (40%). Affinity for
Lavana was 3 (10%) and only one patient was using Madhura rasa.
Table No.36: Distribution according to Agni:
Jatharagni A B Total Percentage

Sama - - - -
Manda 11 12 23 76.67 %
Vishama 4 3 7 23.33 %
Tikshna 0 0 0 00%
Above given table approaches the patient in terms of their Agni Status. There is
presence of Mandagni in 23 (76.67%) patients, Vishamagni in 7 (23.33%)
Table No.37: Distribution according to Koshtha:
Koshtha A B Total Percentage

Mridu 2 1 3 10.00 %
Madhyama - 2 2 6.67 %
Krura 13 12 25 83.33 %
Among 30 patients Krura Koshtha was found in 25 (83.33 %) Mridu in 3 (10%) and
Madhyama Koshta in 2 (6.67%).
Table No.38: Distribution according to type of onset:
Onset A B Total Percentage

Sudden 3 3 6 20.00 %
Gradual 12 12 24 80.00%
Table shows the type of onset of the symptoms. Sudden onset was found in 6 (20%)
patients while 24 (80%) showed gradual onset.
Observations 124
Table No.39: Distribution according to chronicity:
Chronicity A B Total Percentage

Upto 12 months 6 7 13 43.33 %
1 to 3 years 7 7 14 46.67 %
4 to 6 years 1 1 2 6.67 %
7 to 9 years - - - -
Above 9 years 1 - 1 3.33 %
It was found that 14 (46.67 %) patients were in the range of 1 to 3 years duration. 13
(43.33%) patients were of 12 months duration, 2 (6.67 %) showed duration of 4 to 6
years, and 1(3.33 %) patient showed duration above 9 years.
Table No.40: Distribution according to treatment received:
Treatment received A B Total Percentage

Ayurvedic 3 1 4 13.33 %
Allopathic 12 13 25 83.33 %
Homeopathic - - - -
Others - 1 1 3.33 %
Not taken - - - -
Majority of the patients i.e. 25 (83.33 %) had received Allopathic treatment, 4
(13.33%) had received Ayurvedic treatment, 1 (3.33%) patient had received other
treatment such as acupuncture etc.
Table No.41: Distribution of patients according to their side affected:
Leg A B Total Percentage

Right 6 10 16 53.33 %
Left 9 5 14 46.67 %
Both - - - -
Radiation of pain was seen in 16 (53.33%) patients in right lower limb and 14 (46.67
%) had radiation in left lower limb. No patients reported with bilateral involvement.
Observations 125
Graph No. 1 Age Wise Distribution
Graph No. 2 Sex Wise Distribution
Graph No. 3 Religion Wise Distribution
Observations 126
Graph No. 4 Marrital status Wise Distribution
Graph No. 5 occupation Wise Distribution
Graph No. 6 Education Wise Distribution
Observations 127
Graph No. 7 Socio economic status Wise Distribution
Graph No. 8 Habitat Wise Distribution
Graph No. 9 Addiction wise Distribution
Observations 128
Graph No. 10 Shareerika Prakriti wise Distribution
Graph No. 11 Manasika Prakriti wise Distribution
Graph No. 12 Satva wise Distribution
Observations 129
Graph No. 13 Satmya wise Distribution
Graph No. 14 Sara wise Distribution
Graph No. 15 Samhanana wise Distribution
Observations 130
Graph No. 16 Vyayama shakti wise Distribution
Graph No. 17 Ahara shakti wise Distribution
Graph No. 18 Jarana shakti wise Distribution
Observations 131
Graph No. 19 Diet wise Distribution
Graph No. 20 Dietary habits wise Distribution
Graph No. 21 Rasa wise Distribution
Observations 132
Graph No. 22 Agni wise Distribution
Graph No. 23 Koshta wise Distribution
Graph No. 24 Onset wise Distribution
Observations 133
Graph No. 25 Chronicity wise Distribution
Graph No. 26 Treatment wise Distribution
Graph No. 27 Affected side wise Distribution
Results 134
RESULTS
Effect of therapy on different parameters such as Radiating pain, Numbness,
SLR test, Lasegue’s sign and associated symptoms are shown below.
Totally 30 subjects were registered for clinical trial. The inclusion criteria was
clinical features of Sciatica (Gridhrasi) Age group between 20 – 60 of either sex and
duration was more than 2 months.
Table No.42: Effect of therapies on Radiating Pain:
Group A Group B
BT AT BT AT
Mean 2.2 0.73 2.53 0.60
Difference Mean 1.46 1.93
SD (+) 0.86 0.88 0.51 0.73
Difference SD 0.02 0.22
SE (+) 0.22 0.22 0.13 0.19
Difference SE 0.00 0.05
t value 11 10.64
p value <0.001 <0.001
Remarks Highly Significant Highly Significant
Effect of Kati Basti on Radiating pain in Group A: The mean before
treatment was 2.2 which were reduced to 0.73 after the treatment. The total effect of
therapy provided statistically highly significant (p<0.001) result with‘t’ value of 11.
Effect of Basti on Radiating pain in Group B: The mean before treatment
was 2.53 which was reduced to 0.6 after the treatment. The total effect of therapy
provided statistically Highly significant (p<0.001) result with‘t’ value of 10.64
Results 135
Table No.43: Effect of therapies on Numbness:
Group A Group B
BT AT BT AT
Mean 2.2 0.73 2.26 0.40
SD (+) 0.86 0.88 0.70 0.63
SE (+) 0.22 0.22 0.18 0.16
t value 11 8.67
p value <0.001 <0.001
Effect of Kati Basti on Numbness in Group A: The mean before treatment was 2.2
which were reduced to 0.73 after the treatment. The total effect of therapy provided
statistically highly significant (p<0.001) result with‘t’ value of 11.
Effect of Basti on Numbness in Group B: The mean before treatment was 2.66
which was reduced to 0.4 after the treatment. The total effect of therapy provided
statistically Highly significant (p<0.001) result with‘t’ value of 8.67
Results 136
Table No.44: Effect of therapies on Lasegue’s Sign:
Group A Group B
BT AT BT AT
Mean 1 0.66 1.00 0.46
SD (+) 0.00 0.48 0.00 0.51
SE (+) 0.00 0.12 0.00 0.13
t value 2.64 4
p value <0.02 <0.01
Remarks Significant Significant
Effect of Kati Basti on Lasegue’s sign in Group A: The mean before treatment was
1.00 which was reduced to 0.66 after the treatment. The total effect of therapy
provided statistically significant (p<0.02) result with‘t’ value of 2.64.
Effect of Basti on Lasegue’s sign in Group B: The mean before treatment was 1.00
which was reduced to 0.46 after the treatment. The total effect of therapy provided
statistically significant (p<0.01) result with‘t’ value of 4.
Results 137
Table No.45: Effect of therapies on SLR test:
Group A Group B
BT AT BT AT
Mean 1.73 0.40 1.80 0.20
SD (+) 0.70 0.57 0.67 0.41
SE (+) 0.18 0.14 0.17 0.10
0.10Difference SE 0.04 0.07
t value 10.58 9.79
p value <0.001 <0.001
Effect of Kati Basti on SLR test in Group A: The mean SLR before treatment was
provided statistically highly significant (p<0.001) result with‘t’ value of 10.58.
Effect of Basti on SLR test in Group B: The mean before treatment was 1.8 which
was reduced to 0.2 after the treatment. The total effect of therapy provided
statistically Highly significant (p<0.001) result with‘t’ value of 9.79.
Results 138
Table No.46: Comparative efficacy of Therapies on different parameters:

Table No. . Showing the Comparative efficacy of the therapies in Group A and
Group B by using unpaired ‘t’ test
No. Group A Group B

Sl. Parameters of
of S.D. S.E. S.D. S.E. ‘t' p Remarks
No. assessment Mean Mean
Pts (±) (±) (±) (±)
1 Radiating pain 30 1.46 0.51 0.13 1.93 0.70 0.18 2.07 >0.05 S
2 Numbness 30 1.46 0.51 0.13 1.86 0.83 0.21 1.57 >0.10 NS
3 SLR test 30 1.33 0.48 0.12 1.60 0.63 0.16 1.29 >0.10 NS
4 Lasegue’s sign 30 0.33 0.48 0.12 0.53 0.51 0.13 1.09 >0.10 NS
Comparative efficacy of the therapies in Group A and Group B:
The mean of radiating pain in Group A was 1.46, SD is 0.51 and SE is 0.13. In
Group B, the mean of radiating pain was 1.93, SD is 0.70 and SE is 0.18. The
comparative efficacy of Group A with Group B showed statistically significant
(p>0.05) result with‘t’ value of 2.07.
The mean of Numbness in Group A was 1.46, SD is 0.51 and SE is 0.13. In
Group B, the mean of Numbness was 1.86, SD is 0.83 and SE is 0.21. The
comparative efficacy of Group A with Group B showed statistically not significant
The mean of SLR test in Group A was 1.33, SD is 0.48 and SE is 0.12. In
Group B, the mean of SLR test was 1.60, SD is 0.63 and SE is 0.16. The comparative
efficacy of Group A with Group B showed statistically not significant (p>0.10) result
with‘t’ value of 1.29.
Results 139
The mean of Lasegue’s sign in Group A was 0.33, SD is 0.48 and SE is 0.12.
In Group B, the mean of Lasegue’s sign was 0.53, SD is 0.51 and SE is 0.13. The
comparative efficacy of Group A with Group B showed statistically not significant
Table No.47: Effect of Therapy on different parameter in Group A:
General Symptoms B.T. A.T. %

Radiating pain 2.2 0.73 66.66
Numbness 2.2 0.73 66.66
SLR test 1.73 0.40 76.92
Lasegue’s sign 1.00 0.66 33.33
Effect of therapy on different parameters in group A:
A maximum percentage i.e. 76.92% relief was observed in SLR test and
66.66% relief was observed in Radiating pain and Numbness 33.33% relief was
observed in the Lasegue’s sign.
Table No.48: Effect of Therapy on different parameter in Group B:
General Symptoms B.T. A.T. %

Radiating pain 2.53 0.60 76.31
Numbness 2.26 0.40 82.35
SLR test 1.80 0.20 88.88
Lasegue’s sign 1.00 0.46 53.33
Effect of therapy on different parameters in group B:
A maximum percentage i.e. 88.88% relief was observed in Parameter SLR test
and 82.35% relief was observed in Numbness. 76.31% relief was observed in the
Radiating Pain. 53.33% relief was observed in Lasegue’s sign.
Results 140
Table No.49: Overall improvement in each subject in Group A and Group B:
Total Improvement in each Total Improvement in each

Patient No.
Patient in Group A Patient in Group B
1 62.50 90.00
2 55.56 40.00
3 100.0 66.67
4 85.71 85.71
5 33.33 100.0
6 44.44 100.0
7 100.0 100.0
8 44.44 100.0
9 83.33 55.56
10 100.0 83.33
11 50.00 57.14
12 30.00 37.50
13 100.0 88.89
14 85.71 100.0
15 100.0 85.71
The therapy under Group A provided relief ranging from 30% to 100%, with
an average of 71.67%. Whereas the therapy under Group B provided relief ranging
from 37.50 % to 100 % with an average of 79.37%.
Table No 50: The Overall effect of therapy on 30 subjects of Gridhrasi(Sciatica):

Remarks Group A Group B Total
Marked relief
08 53.33% 10 66.67% 18 60.00%
Above 75 %
Moderate relief
03 20.00% 03 20.00% 06 20.00%
50-75%
Mild relief
04 26.67% 02 13.33% 06 20.00%
25%-50%
No relief
00 00.00% 00 00.00% 00 00.00%
Below 25%
In this study 18 (60%) subjects got Marked relief, 06 (20%) subjects got
Moderate relief, 06 subjects (20%) got Mild relief.
Results 141
Graph No.28: Effect of Therapy on Cardinal features in Group A & B (In %):
90
80
70
60
50
% of Improvement in Group A
40
% of Improvement in Group B
30
20
10
0
Radiating Numbness SLR test Lasegue’s
pain sign
Graph No.29: Effect of therapy on Total symptom score in each subject under Group A
and Group B:
120
Patient No.
100
80
Total
60 Improvement in
each Patient in
40 Group A
Total
20 Improvement in
each Patient in
0 Group B
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Graph No. 30: The Overall effect of study on Cardinal Symptoms in both Groups
80.00%
70.00%
60.00%
50.00%
40.00% Group A
30.00% Group B
20.00% Total
10.00%
0.00%
Marked Relief Moderate Mild Relief No Relief
Above 75 % Relief 50‐75% 25%‐50% Below 25%
Discussion 142
DISCUSSION
Main intention of any research is to re-examine the established facts and
clarify the doubts and fill the lacunas. The process starts with forming of hypothesis,
detailed planning of research, which is followed by meticulous and ardous execution
of strategy, at prefinal stage clubbing the observation and results on which certain
conclusion can be drawn. This section titled ‘Discussion’ analyses and contemplates
the observations made during the project and results obtained post therapeutically on
the selected problems i.e. Gridhrasi. The discussion part is done as follows under 4
headings.
1. Discussion on Historical Review
2. Discussion on Vyadhi.
3. Discussion on therapies.
4. Discussion on observations and results.
Discussion on Historical Review:
The disorders which impair the movement of legs are as old as the existence of
human being. As walking is an inevitable function since the existence of the man on
the earth to search for the food. Many disorders leading to impairment of legs were
known since vedic period in Veda. Gridhrasi is not mentioned in any form, while
Atharvaveda the word Vaatikrita was mentioned which denotes Vata Vyadhi.
Many disorders pertaining to voluntary movements of limbs as told in Vedic
literature under the term Vishkanda. Though the term Vishkanda mainly used to
indicate the impairment of shoulder joint in Atharva Veda, and Taittereeya Samhita,
Viskanda was mentioned along with Visha which means crushing the limbs and
Abhishochana (burning sensation), where as Vyamsa was mentioned the Rigveda as
the disorder which hamper the Gati.
Discussion 143
‘Yakshma’ a disease condition described in detail in Vedas said to involve any
part of body including Prishta, uru, Sroni, Asthi and Majja. So it can be inferred that
many varieties of Vata disorders were prevalent during Vedic period.
As the science advanced in Samhita Kala, Charaka Samhita was the first and
foremost treatise which elaborates Vata, Vatavyadhi and Gridhrasi in full length,
further he describes Pancha Vata and aetiology of its morbidity along with its clinical
features, the unique patho geneses of Vata vitiation due to the obstruction to its
passage or functioning was elucidated in full detail.
Sushruta being well versed with Shareeram describes structure of Prushta,
Pada and joints. He mentions clearly in Marma Shareera that trauma of Kukundara
Marma leads to sensory and motor loss of lower limbs and leads to disability.
Sushruta has given much importance by allotting first chapter of Nidana
Sthana it self for Vatavyadhi, even though he describes the clinical features of
Gridhrasi in the same chapter, but varieties of Gridhrasi were not found, he had made
many original observation pertaining to Sandhimukta, his description pertaining to
classification, clinical features, prognosis of Sandhimukta suits for lumbar disc
prolapse which is responsible for majority of Sciatica cases. In Chikitsa aspect the
therapies described in Bhagna Chikitsa are also use full in Gridhrasi cases especially
of Abhighataja origin. He describes traction, manipulation etc. briefly to restore the
dislocation which suits for Gridhrasi cases also.
The descriptions of Vata in its normal and morbid state in Bhela Samhita were
almost analogous to Charaka. The treatment pertaining to gridhrasi described sum
what different from his previous works. He stresses the use of Bala Tila for Vasti,
Pana, etc., in addition to Raktamokshana. The treatment of Gridhrasi is explained
Discussion 144
immediately after describing Rakta Gata Vata Chikitsa which indicates its association
with Pitta.
Harita who mentions Gridhrasi is a disorder due to impaired function of Vyana
Vayu, he had high lightened use of Rasona, Guggulu and Bala in the treatment of
Vata Vyadhi. He has allotted separate chapter for Rasona Kalpa, Guggulu Kalpa in
Kalpa Sthana.
Vriddha Vagbhata has given place for Vata Vyadhi in both Nidana and
Chikitsa Sthana Similar to Sushruta. He mentioned Gridhrasi in the disorders of Vata
seated at Snayu.
Madhavakara describes the varieties of Gridhrasi i.e. Vataja and Vata Kaphaja
more elaborately than Charaka, Exhibiting his specialisation of Nidana which
facilitates appropriate diagnosis.
It was an interesting comment made by Arunadatta in his Sarvanga Sundari
Commentary on Ashtanga Hridaya defines clearly that due to Vata in Kandara the
pain is produced at the time of raising the leg straight and it restricts the movement of
thigh. This is an important clinical test now days for the diagnosis of sciatica known
as SLR test. Sodhala the author of Gadanigraha was the first person to point at the
necessity of Rakta Dushtihara therapies in Vata Roga, when usual measures failed to
achieve desired result.
Dalhana gives a clear idea about the anatomical location of Gridhrasi that is he
considered Gridhrasi Nadi as Kandara stated by Sushruta. He has mentioned it as
Maha Snayu which runs from Lumbar region to the foot, he terms Gridhrasi as
Randhani which means weak point or Rapture.
Adhamalla the commentator on Sarangadhara samhita stated that the Gridhrasi
is popularly known Radhi indicates pressuring, Compressing & Destroying.
Discussion 145
During modern ages especially Greeks who were familiar with terminologies
like sciatic neuralgia and Sciatica, to describe pain felt around hip or thigh.
Hippocrates had noted that pain radiating to foot was good prognostic sign, where as
localized hip pain was less likely to resolve.
1764 Italian anatomist Domenco Cotungo was the first person to distinguish
sciatica due to nerve as a disease from the aching pain associated low back pain.
1929 schmorl and Andrae brought the concept of disc protrusions, which were
observed during post mortem studies but did not link these with sciatic pain and
concluded they were probably asymptomatic life.
Initially presence of pain was ascribed to presume on nerve roots, this was
challenged by Kelly who felt that pressure on a nerve would lead to loss of function
rather than pain. Lindal & Rexed found evidence of inflammatory response on
Lumbar nerve roots at laminicotmy leading to the theory that prolapse of an
intervertebral disc may provoke an inflammatory reaction in Lumbar nerve roots
causing the sciatic type pain.
Discussion on Vyadhi :
Gridhrasi is a pain dominant disorder affecting the Kandara. It is caused by the
imbalance of Vata Dosha. Other Dosha can also modify the clinical presentation in
which Kapha is major one than the rest. This vitiated Dosha afflict the Rakta, Asthi
and Snayu involving related Srotas produce the alarming symptoms in Sphik initially
followed with progressive radiation to distal part of the leg. The involvement of
Kapha Dosha in its pathogenesis results in the occurrence of typical symptoms like
Aruchi, Tandra, and Gaurava etc and is named as Vatakaphaja Gridhrasi. Description
of Gridhrasi in Brihatrayi and Laghutrayi are concise but ample enough to understand
the condition in excel.
Discussion 146
The word Gridhrasi refers to a disease with awful pain experienced by the
patient and is similar to the pain experienced by a prey of vulture while being
eaten up. This similarity itself suggests its gravity of distress. Onset of Ruk, Toda
and Stambha initially in Sphik and establishing distally to Kati, Prushta, Janu,
Jangha till Pada is the unique feature of this illness. For the same reason elevation
of thigh will be restricted in patients suffering from Gridhrasi. It may be worth
mentioning here that Acharya Charaka listed the symptamatology of the illness
and Acharya Sushruta was particular about the signs of disease there by
completing the total clinical presentation of Gridhrasi. Along with the cardinal
symptoms, the presence of symptoms indicative of involvement of other morbid
Dosha may also add to the clinical manifestations.
A similar condition in modern parlance is sciatica syndrome. It is the
distribution of pain along the course of the sciatic nerve or its component nerve
roots is characteristic. This illness is named so because of its complexity in
symptoms as well as etiological factors. Pain starting from lumbo-sacral region
radiating downwards from buttocks, posterior-lateral aspect of the thigh and the
calf to the outer aspect (or border) of the foot is the cardinal symptom of sciatica
syndrome. Radiating deep seated cramping pain in buttocks followed with
numbness and parasthesia in lower extremities favours the diagnosis. Restricted
SLR Test and Lasegue’s sign consolidates the diagnosis clinically and even the
illness can be confirmed by imaging techniques. Prolapse of intervertebral disc,
external mechanical pressure and degenerative changes of the lumbar spine are the
commonest causes for sciatica. History of trauma may add up in the process of
diagnosis.
Discussion 147
Discussion on therapies :
The treatment of a disease varies accordingly to the morbid state of dosha in
the body, Bala, Prakriti etc., of the patient. If the Dosha Prokopa is minimum,
Langhana Chikitsa and if Dosha Prokopa is maximum Shodhana therapy should be
adopted. There is a general principle that Vriddhi of Dosha should be treated by
Langhana and their Kshaya with Tarpana. But Vata is an exception as Vata Vriddhi is
to be treated by Tarpana and Kshaya by Langhana.
While treating any disease, the first and foremost principle to be followed is to
avoid Nidana. For Gridhrasi, all the Vata Prakopa Hetu including external factors
such as excessive walking, riding etc should be avoided. Gridhrasi being a Vatavyadhi
the general line of treatment of Vatavyadhi can applied to it.
When we review the classics about the therapeutic aspect of Gridhrasi, it
revolves around effects like Amapachana, Vedana Sthapana, Deepana, Vata Shamana,
Balya and Rasayana.
These effects can be achieved by applying following therapies which are
considered to be the superior most in alleviating Prakupita Vata like,
Snehana Swedana
Niruha basti Anuvasana basti
Mridu Shodhana Shamanoushadhi
Snehana:
Snehana should be done in Nirupastambhita Vata. By the word Snehana both
external and internal Snehana is included. Especially Taila is praised in Vata Vyadhi
as it is having exactly opposite properties of Vata. Sneha pacifies Vata brings out
softness in body and removes Mala Sanga. It also does the Poshana Dhatu and thus
maintains the Prana.
Discussion 148
The external Snehana is done by Abhyanga, Parisheka, and Avagaha etc. It
acts on sparshanendriya which is the seat of Vayu. While mentioning the Kala of
Abhyanga, Sushruta has stated that after 900 Matra the Sneha can reach Majja Dhatu.
It signifies the action of Sneha on Asthi-Majja Dhatu which are involved in Gridhrasi.
Swedana:
Snehapoorvaka Swedana is indicated in Nirama Vata Vyadhi, while only
Swedana is indicated in Sama Vata Vyadhi. Nadi, Prastara, Sankara etc. are various
types of Sweda.
Swedana Liquefies the Dosha and expands the Srotas, helping Dosha to travel
towards their own Sthana. Swedana increases Agni, creates Komalatha, Ruchi, clears
Srotas, and diminishes tandra. Sneha Poorva Swedana relieves the complaints such as
Harsha, Toda, Ruk, Shotha, Stambha, Graha etc. Charaka says that proper Snehana
and Swedana can make even dry wood flexible.
In Gridhrasi Stambha, Ruk, Toda etc. are main symptoms. Snehana and
Swedana by virtue of their Vatashamaka and Dhatu Poshana properties are useful in
relieving the above said complaints.
Mridu Shodhana:
When we go to Samprapti of Gridhrasi, Vata which has been obstructed by
Ama and getting Sthana Samsraya initially at Kati then to Prishta, Janu, Jangha &
Pada.
So to relieve the obstruction caused by Ama at the same time Shodhana
shouldn’t vitiate Vata, so Mridu Virechana / Snigdha Virechana had been advised.
This cleansing process gently removes the mala which has been lodged in Amashaya
and Pakwashaya without causing Vata Prakopa.
Discussion 149
Vasti:
All the texts in Ayurveda accept and talks very much about the Vasti and its
significance. Large intestine is the main site of Vata; Vata is a catalyst which controls
all neurological activities. It controls dormant Pitta and Kapha and makes them active.
Anabolism and Catabolism depend upon the normal physiological activities of Vata;
Agni the central factor for health and ill health is also regulated and maintained by
rhythm of Vata. Vasti is the treatment which is applied directly to the main seat of
Vata.
Vasti is mainly indicated in Vata predominant diseases. The two types of
abnormalities of Vata namely, Avarana and Dhatu Kshaya can be treated by Vasti
karma. Direct application of this kind of treatment to Pakvashaya helps not only in
regulating and co-ordinating Vata Dosha in its site but also controls the other diseases
involved in the pathogenesis of diseases.
Among all the therapeutic procedures Vasti is superior because Vamana and
Virechana have many complications and person becomes debilitated. Vasti along with
Shodhana does the other functions like Shamana, Rasayana, Vajikarana and any
desired therapeutic effects.
Apart from this Vasti is considered as superior to all other therapeutic
measures on account of its various actions like Samshodhana, Samshamana and
Samgrahana (Retaining and absorbing).
It is evident that oral administration of medicine for Virechana therapy may
produce the symptoms like abdominal distress, nausea and anorexia due to Katu,
Tikta and hot properties of drugs commonly used for this purpose. More ever
Virechana cannot be used as a method of Shodhana in children and very elder
Discussion 150
persons. It might be the reason why Kashyapa equated Vasti Karma as Amruta due to
its wide applications even infants and aged.
Also while explaining the importance of Vasti Charaka says that there is no
therapeutic procedure comparable to that of Vasti, in as much as it possesses rapid
useful properties of cleansing, in addition to its being a quick agent of impletion and
depletion. Thus Vasti is rightly considered as Chikitsardha.
Probable mode of action of Basti:
Basti is a purificatory process by which all vitiated Dosha are expelled from
the anal canal and thus Vata is pacified. As a result of excretion of vitiated Dosha the
physiological equilibrium in three Dosha is maintained and lasting results are
produced after the therapy in the form of sound health. Basti therapy is a complex
process in which several factors take active part for completing the action of Vasti.
Instead of pinpointing to one type of mechanism it is presumed that various
factors work in collaboration with each other to produce the beneficial effect of Basti
therapy. Here an attempt has been made to explain the probable mode of action of
Basti in the Samprapti Vighatana of Gridhrasi.
In Gridhrasi, Vata specifically Apana and Vyana Vayu Dushti is found. Basti
stays at Pakwashaya and starts its action from there. Pakwashaya is the natural abode
of Vayu. Basti conquers the vitiated Vata is its Prakruta Sthana by which Vata
dwelling in other parts of the body is automatically conquered. Basti removes
Malasamghata and thus maintains the Anuloma gati of Apana Vayu. This further
helps in regulation of Samana & Vyana Vayu. Vata is vitiated by Laghu, Ruksha, and
Sheeta etc Guna. Basti with its Snigdha Guna destroys Rukshata, with Guru Guna
Laghuta and with Ushna Guna Sheetatva of Vata.
Discussion 151
Basti administered with proper methodology spreads in the organs of the
lower abdomen viz. Pakwashaya, Nabhi etc. but effects brought out by its vivid
potentials can be visualized throughout the body. It removes Dosha from toe to top of
the body. Specifically Dosha clinging at Kati, Prushta and Koshta, where Sthana
Samsraya takes place in Gridhrasi, are scrapped off and diverted to the exterior. Thus
the effect of Basti is not restricted to Apana Kshetra but by its strength, its virtues
traverse throughout the body aided by Apana, Udana & Vyana Vayu.
The Adhisthana of Basti is Pureesha Dhara Kala. Dalhana states that Pureesha
Dhara Kala is Asthi Dhara Kala. Also Asthi and Vata have Ashraya Ashreyi
Sambandha. Hence Basti Dravya with their Madhura, Tikta rasa, Ushna Veerya,
Snigdha Guna pacifies Vayu and act on Asthivaha Srotas. Majja is the habitat of Vata
according to Kashyapa. Also Pitta Dhara Kala is Majja Dhara Kala. Vasti Dravya
comes in direct contact with Grahani where Pitta Dhara Kala lies. So they directly act
on Majja Dhara Kala, nourishing Majja Dhatu. Also it has been documented that
Majja Dhatu Snehana, Tarpana is brought about by the ninth Basti given succession.
Sneha given at Guda which is considered the Moola of the body reaches the whole
body and nourishes all Dhatu upto Shukra. Also, Anuvasana Basti gives strength to
Kati, Prushta, Pada etc. Thus, Basti nourishes and replenishes all the Dhatu, thereby
combating Dhatukshaya.
It is proven fact that serum protein and fatty acid levels increase after basti
karma. These are necessary for nourishment of the nervous tissue. Also basti acts on
the natural bacterial flora of the intestines which is important for the synthesis of Vit.
B6, B12. Basti Chikitsa decreases the ketoacid and pyruvic acid levels, due to which
Vit. B. synthesis increases. This Vit.B restricts the demyelination process of the
nerves and helps in regeneration. One theory proposes that the virya of basti dravyas
Discussion 152
spreads through A.N.S. and expels out vitiated Dosha from the body. This signifies its
action on the nervous system.
Basti is known to potentiate Agni. Basti checks Agnimandya and hence the
production of Ama. Basti also aids in accomplishing the task of srotoshodhana. It
scavenges the Dosha and Mala from the body and purifies the cannels. Ushna,
Tikshna, Ruksha properties of Basti help in Amapachana and Kapha Shoshana and
Sroto Vishodhana. Madhu added in Basti scrapes out the Dosha which are producing
upalepa in the Srotas as by Lekhana karma. Saindhava lavana with its Sukshma Guna
carries the drug to minute parts and destroys Avarodha. Kalka helps in Dosha
Sravana. Thus, the whole therapy removes the srotorodha and Vata Kapha Shamana
also occurs.
Basti is also seen to act upon the Roopa like Ruk, Toda, the cardinal
symptoms of Gridhrasi, which are produced by Vayu. Basti by mitigating Vata
relieves the symptoms. Also, it acts on other symptoms like Stambha, Sankocha etc.
and is specially indicated in persons having Stabdhata, Sankocha and Vatakrut
Shoola. The Deepana, Pachana and Kapha Nashaka karma of Basti reduces the
Vatakaphaja symptoms like Tandra, Gaurava, and Arochaka etc. Thus, Basti acts on
the Dosha, Dushya, Srotas involved in Gridhrasi and also on its Roopa. It hits both the
types of Samprapti i.e. Santarpanajanya and Apatarpanajanya. This undoubtedly
proves the efficacy of Basti therapy in the treatment of Gridhrasi.
Erandamuladi Niruha Basti which contains many drugs among them Ushna
veerya are 22 & Sheeta veerya are 7, Katu Vipaka – 9 & Madhura – 20 Vipaka
Kaphavatashamaka are of 9 in number, Maximum are having Laghu, Ruksha Guans
and Katu Tiktha and Kashaya Rasa and also as a Avapa Dravya Gomutra is
mentioned.
Discussion 153
Indications: As it is having the Gomutra, maximum number of Ushna veerya having
the Laghu Ruksha Guans it mainly does Deepana and Lekhana. The diseases
indicated for this Basti like, Shula in Janga, Uru, Pada, and Prusta. In case of Kapha-
avrutha conditions, it does Marutha-nigrahana, in case of Mala-mutra sanga, Arsha
Anaha and Admana Grahani dosha.
Probable Mode of Action of Kati Basti:
The materials used are Ashtakatvara Taila. Acharya Charaka has mentioned in sutra
sthana 4/22, Masha is swedopaga, Ushna in Veerya, Vata shamaka and Kapha
vardhaka, Guru and Snigdha in Guna. Instead of Masha – Godhooma, Valmika
Mruttika and metal rings are also can used. The taila poses guna like Ushna, Teekshana,
Vyavayi, Vikasi, Sukshma, Sara and vata shamaka by virtue of which it penetrates the
transdermal route.
The mode of action Kati Vasti is influenced by means of following factors.
• Medicated oil
• Temperature is well maintained
• Oil retention
Medicated oil acts by its veerya and as well through its gunas by getting absorbed
through the transdermal route. Thus acts as Shoola prashamana, Pustikara,
Shramahara, Bala vardhaka. It Brings about Snigdhata and also Mardawata.
Temperature:
In response to pain or in case of muscle spasm, there is compression of blood
vessels, blood flow is reduced. The temperature together releases the compress of the
blood vessels.
The retention time – that acts dually i.e. nourish and increases blood supply.
Discussion 154
Warm oils are made to stay for particular period in the Kati region in the circle
created by masha pishti.
Here the warm oil increases the local circulation and due to the local rise of
temperature (Sthanika Swedana) the pores in the skin open up and the microfined oil
particle (due to heating of kati basti oil) infiltrate into the skin and the local effect is
wonderfully achieved. The oil reduces the Rookshata by its property, removes the
pain, and reduces the grahatva by vata shamana, along with local tissue nourishment
by brumhaneeya guna. Kati basti for 14 regular days can give a wonderful and
sustained relief from the complaints.
Shamana Therapy
The Shamana like therapy generally Employed after Shodhana to restore Agni,
to digest the residual Ama and to pacify the excited Dosha. When we consider the
Samprapti of Gridhrasi, it takes place in two different ways.
a) Santarpana Janya (Ama/Avarana Janya)
b) Apatarpana Janya
So to make proper Samprapti Vighatana the drugs should have following properties
like.
1) Deepana – Pachana
2) Vedana Sthapana (acting at centre & local)
3) Shothahara
4) Balya (acts on Manas & Shareera)
5) Rasayana
If Shamanoushadhi is taken with proper dose, Kala, Anupana leads to
1) Complete Eradication of Vyadhi with sustained effects.
2) Checks the reoccurrence.
Discussion 155
3) Repairs the damaged structures.
4) Maintains the optimal supply of nutrition to the tissue.
Probable mode of action of Trayodashanga Guggulu
The drugs which comprises Trayodashanga Guggulu can be categorised
according to their karma, as follows.
Drug Property
1) Abha Balya, Bruhmana
2) Ashwagandha Balya, Vrushya, Vatashamaka
3) Vriddhadaru, Hapusha, Rasna Amapachana
4) Shunti Deepana, Shothahara
5) Shatapuspa, Shati, Yavani Vatanulomana, Vedhanastapaka
6) Guggulu Sukshma, Rasayana
7) Ghrita Jeevaniya, Rasayana, Deepana
Probable Acting
Samprapti Vighatana
Drug
Ama Amapachana – Deepana Shunti, Hapusha,
Vataprakopa Vatanulomana Shatapuspa, Shati, Yavani
Sthanasamshraya in kati Katibalya Abha, Guggulu,
Advances upto padha Vatashamana Ashwagandha, Rasna
Shoshana of Sira, Brihmana, Rasayana Guduchi, Shatavari,

Khandara, snayu Gokshura, Guggulu, Ghrita.
When we consider Samprapti of Gridhrasi due to Apatarpana or Abhighata
where Vata Prakopa takes place due to Riktata of Srotas or damage to vital points
leading to sandhichyuta and Vata Prakopa. Here along with Deepana Pachana
properties, the drugs like Guggulu, Abha resins having Rasayana and Balya property.
Discussion 156
That replaces the damaged nerve tissue and Rasna, Yavani, acts as Vedana Sthapana
and Vata Shamaka. Shunti, Daruharidra acts as Shothahara.
Ghrita which fills the Rikta Srotas and brings Mardavata thus leads to proper
canalisation of Vata and disintegrating the Samprapti.
Even though drugs acts according to there Rasa, Guna, Vipaka, Veerya, but
other factors also play a vital role which has been rightly coated by Ashtanga
Sangrahakara in 17 chapters as follows:
“The process of life both in animal and vegetables are governed by
chemical and physical phenomena controlled by nerve force, which is well developed
in former but is rudimentary in latter. Ayurvedists have how ever tried to explain that
the selective action of the Drug is not quite so arbitry as it appears, but that it
subserves panchamahabhuta influence or other forces of nature which control all
physiological and chemico physical activities in animal and vegetables.
Discussion on Observations:
Discussion on Age: In the present study the sample was split up into four
classes of 10 years age group. The least age of the patient was 23 years and maximum
age was 60 years. Maximum patients were recorded in age group of 21-30 years i.e 11
(36.67%) followed by 31-40 years, 9 (30%), 51-60 years, 8 (26.67 %) and Minimum
patients were in the age group 41- 50 years, 2 (6.66%). The above said statistics does
indicate that Ghridhrasi disease can be seen in any age.
Sex: Distribution according to sex shows that in this sample 19 (63.33 %) patients
were female while11 (36.67%) patients were male. The maximum number of female
patients are suggestive that women are more affected by Gridhrasi which may be due
to age related degenerative changes, menopause induced osteoporotic changes and as
well as physical stress as aggravating factor.
Discussion 157
Religion: Present study shows that 19 (63.33%) were Muslim while 10 (33.33%)
belonged to Hindu community and 1(3.33 %) belonged to Christian community. The
above said fact does not throw any light on vulnerability of Gridhrasi amongst any
religion, but however special researches are required to substantiate the role of
religion in the causation of Gridhrasi.
Marital status: Present study shows that 25 (83.33%) patients were married, 4
(13.33%) were unmarried and 1(3.33%) patient was a widow. The above fact proves
beyond doubt that physical stress is more common in married people which may play
a vital role in the Samprapti of Ghridhrasi.
Occupation: Present study shows that 16 (53.33%) patients were doing household
work. 5(16.67%) were in service, 5 (16.67%) were labourers, 2(6.67%) belonged to
others category, 1(3.33%) patient was businessman and 1(3.33%) patient was a retired
person. Almost 30 patients who belonged to different occupations support the claim
of Ghridhrasi as an occupational hazard.
Education: Present study shows that 6 (20%) patients were illiterate, amongst the
literates 14(46.66%) were of Primary level, 8 (26.67%) patients were graduates and 2
(6.67%) patients were Higher secondary. Education does not highlight the claim or
support the claim of education being the cause of Ghridhrasi.
Socio Economic Status: Present study shows that 15 (50%) were middle class, 5
(16.67%) each patient, were of poor class, lower middle and upper class. The above
said statistics of about 25 patients who belonged to Middle class, Lower middle class
and poor class is suggestive of the fact that Nutrition does have a major role in the
Samprapti of Ghridhrasi.
Habitat: Present study shows that there were 25 (83.33%) patients residing in Urban
area and 5(16.67 %) in rural area. As the research was carried out at the hospital
Discussion 158
located in the urban area, the maximum numbers of patients were from urban area.
Hence nothing can be said here.
Addiction: Present study shows that 4 (13.33%) were addicted to Pan, 3(10%) were
addicted to tobacco chewing and 2 (6.67%) each patient were addicted to tea,
smoking and Pan masala and 17 (56.67%) didn’t have any addictions. Lot of
elaborative research is required to substantiate the role of tobacco, Alcohol etc
addictions.
Prakruti: Present study shows 18 (60%) belonged to Vata pitta Prakruti, 12 (40%)
belonged to vata kapha prakruti. In manas bhavas 19 (63.33%) patients showed
dominance of raja guna and 11(36.67%) showed dominance of Tamo guna. The
above fact shows that the incidence of Vata Roga in the Vata predominant Prakriti.
Satva: Maximum patients were observed to be of madhyama satva 20 (66.67%) and
10 (33.33%) were of Avara Satva.
Satmya: Maximum patients 23 (76.67%) were of Madhyama Satmya and 7 (23.33%)
were Avara satmya.
Sara: Above data depicts that the sara of 22 (73.33%) patients was Madhyama and 8
(24.67%) was Avara.
Samhanana: Samhanana wise distribution in the present study 24(80%) patients had
Madhyam Samhanana and 6 (20%) had Avara Samhanana
Vyayam shakti: Majority of the patients i.e. 20 (66.67%) were having avara vyayam
shakti, 10 (33.33%) had madhyama vyayama shakti.
Aharashakti: Present study show that 21 (70%) patients had madhyama
abhyavaharana and 9 (30%) had Avara Shakti. 20 (76.67%) were of Madhyama
Jarana shakti and 10 (33.33%) were of Avara Jarana Shakti. The role of Satwa,
Discussion 159
Satmya, Sara, Samhanana, Vyayama Shakti and Ahara Shakti needs to be researched
in elaborative way.
Dietary Habits: Dietary Patterns of the study sample depicts that mixed were
23(76.67%) where as remaining 7 (23.33%) were of vegetarian diet. 25(83.33%)
patients were of irregular food habits and 5 (16.67) % had regular food habits.
Analysis on the basis of dominant rasa consumed showed that maximum patients
were using katu rasa i.e. 14 (46.67%) followed by Amla rasa 12 (40%). Affinity for
Lavana was 3 (10%) and only one patient was using Madhura rasa. The mixed diet
and Katu, Amla Rasa pradhana diet may definitely play role in the Samprapti of
Ghridhrasi. But however further work is needed.
Agni: There is presence of Mandagni in 23 (76.67%) patients, Vishamagni in 7
(23.33%). The above fact shows the role of Agni (directly or indirectly) in the
Samprapti of Ghridhrasi.
Koshtha : Among 30 patients Krura Koshtha was found in 25 (83.33 %) , Mridu in 3
(10%) and Madhyama koshtha in 2 (6.67%). The above said fact is suggestive that
Vata Dosha related problems are more seen in Krura Koshti.
According to type of Onset: Sudden onset was found in 6 (20%) patients while 24(
80%) showed gradual onset. It is a proven fact that Ghridhrasi presentations are
always gradual in onset due to many reasons behind.
According to Chronicity : It was found that 14 (46.67 %) patients were in the range
of 1 to 3 years duration. 13 (43.33%) patients were of 12 months duration, 2 (6.67 %)
showed duration of 4 to 6 years, and 1(3.33 %) patient showed duration above 9
years. The above said facts do not show anything other than Ignorance and negligence
amongst the population.
Discussion 160
According to treatment received: Majority of the patients i.e. 25 (83.33 %) had
received Allopathic treatment, 4 (13.33%) had received Ayurvedic treatment, 1 (3.33%)
patient had received other treatment such as acupuncture etc. The above said values are
suggestive of the fact that allopathic treatments are symptomatic in nature and Ayurvedic
treatments are undoubtedly safe and long lasting.
According to their side affected: Radiation of pain was seen in 16 (53.33%) patients in
right lower limb and 14 (46.67 %) had radiation in left lower limb. No patients reported
with bilateral involvement. The above said facts support the claim of pain of radiating
nature has diagnostic importance and the same is the inclusion criteria of our study.
Discussion on Results
Effect of therapy on Radiating pain:
In Group A, the mean before treatment was 2.2 which were reduced to 0.73
after the treatment. The total effect of therapy provided statistically highly significant
(p<0.001) result with‘t’ value of 11. The percentage of relief in Group A was 66.66%
In Group B, The mean before treatment was 2.53 which were reduced to 0.6
(p<0.001) result with‘t’ value of 10.64 and percentage of relief was 76.31%.
This denotes, the Erandamuladi Niruha Vasti is more effective in controlling
the radiating pain due to its quick absorption in the gut and also relieving the Apana
Vata dushti. Once again it proves that Vasti is the best therapy for Vata Vyadhi.
Effect of therapies on Numbness:
In Group A, The mean before treatment was 2.2 which were reduced to 0.73
(p<0.001) result with‘t’ value of 11. The percentage of relief in Group A was 66.66%.
Discussion 161
In Group B, The mean before treatment was 2.66 which were reduced to 0.4
after the treatment. The total effect of therapy provided statistically Highly significant
(p<0.001) result with‘t’ value of 8.67 and percentage of relief in Group B was 82.35%
Vasti given in Kala Vasti schedule improved the function of sciatic nerve and
reduced numbness by alleviating sthanika Vata dosha and nourishing sthanika dhatu
and upadhatu.
Effect of therapies on Lasegue’s sign: In Group A, The mean before treatment was
provided statistically significant (p<0.02) result with‘t’ value of 2.64. The percentage
of relief in Group A was 33.33%.
In Group B, The mean before treatment was 1.00 which was reduced to 0.46
after the treatment. The total effect of therapy provided statistically significant
(p<0.01) result with‘t’ value of 4 and the percentage of relief in group B was 53.33%.
Group B showed better result in Lasegue`s sign also due to the action of Vasti
in the nervous system. The combined effect of Vata Kaphahara Vasti dravya
significantly acts upon Lumbo-Sacral Vertebrae along with nerve roots.
Effect of therapies on SLR test:
In Group A, the mean before treatment was 1.73 which was reduced to 0.40
(p<0.001) result with‘t’ value of 10.58 and the percentage of relief in Group A was
76.92%
In Group B, The mean before treatment was 1.8 which was reduced to 0.2
after the treatment. The total effect of therapy provided statistically Highly significant
(p<0.001) result with‘t’ value of 9.79 and percentage of releif in Group B was
88.88%.
Discussion 162
This also shows the high significance of Kashaya Vasti, particularly
Erandamuladi Niruha in the management of sciatica (Gridhrasi). Kativasti, even
though acts as Bahirparimarjana Karma showed good result in SLR test.
Conclusion 163
CONCLUSION
The present study, Clinical Management of Sciatica (Gridhrasi) through Vasti and
Kativasti along with Trayodashanga Guggulu was carried out in 30 patients with 2
groups, each consisting of 15 subjects for duration of 2 months and follow up for 3
months. The following conclusions were drawn based on observations and results
which were achieved after systematic and appropriate clinical research.
Sciatica which is well explained in modern medicine can be well equated with
Gridhrasi told in Ayurvedic classics in the aspects of etiology, etio-pathogenesis,
clinical manifestation and treatment.
• Gridhrasi affects invariably patients of any age with higher incidences in
females than in males.
• Married people were more reported with sciatica (Gridhrasi) due to their
excessive physical strain.
• Irregular dietary habits and mixed diet have significance in gradual onset of
Gridhrasi.
• Most of the sciatic patients had gradual onset of the symptoms. Chronicity
showed 1- 3 years of duration in maximum patients.
• Gridhrasi is a Vata pradhana Vyadhi with the involvement of Pitta and Kapha
Dosha.
• Vata Pitta Prakriti persons are more affected than Vata Kaphaja persons.
• Vatakara Ahara Vihara has a major role in the causation of Gridhrasi.
• Mandagni and Krura Koshta were observed in most of the patients of
Gridhrasi.
Conclusion 164
• Management of Gridhrasi (Sciatica) with Kati Vasti and Niruha Vasti along
with Trayodasanga Guggulu showed good result in the subjective and
objective parameters of the present study.
• Amapachana followed by Shamana along with Trayodashanga Guggulu and
Rasna Saptakam Kashayam played excellent role in relieving the major
symptoms of Gridhrasi.
• The present study proved remarkable result in Group B with Eranda muladi
Niruha vasti in Kala Vasti schedule followed by Trayodashanga Guggulu and
Rasna Saptakam Kashayam than Group A with Kati Vasti followed by
Trayodashanga Guggulu and Rasna Saptakam Kashayam.
Recommendations:
Gridhrasi if not detected early and treated properly can cripple one’s life hence
further research with a larger sample supported by modern investigative procedures is
need of the hour.
Proper education to the people who are involved in stress oriented professions
should be done so as to achieve effective prevention of Gridhrasi (Sciatica).
Summary 165
SUMMARY
In spite of the spine’s excellent form and function, Sciatica (Gridhrasi) is a
major clinical problem involving the locomotor system. Sciatica is one of the many
conditions causing back pain and pain in the lower limb. This condition causes great
discomfort to the patient and affects his daily routine as it is directly related to the
locomotor system.
It would be a great achievement, if we are able to treat such an agonizing
condition with principles laid by our ancient Acharya. Keeping this view in mind, the
project titled “Clinical Management of Sciatica (Gridhrasi) through Vasti and
Kativasti along with Trayodashanga Guggulu” was undertaken. The two therapeutic
modalities i.e. Vasti and Kativasti were applied for the treatment of Gridhrasi. The
study was persued with the following Aims and objectives.
• To study aetiopathogenesis, symptomatology and progress of Gridhrasi with
special reference to ‘Sciatica.’
• To assess the efficacy of both Vasti and Kativasti along with Shamana Aushadhi
(Trayodashanga Guggulu)
• To find out quick, cheap and effective remedy.
The research methodology was derived from the Ayurvedic literature along
with modern literature, proper planning was done and no attempt was made to shift
from the principles laid in the texts while conducting the study.
The study was planned in two parts - Conceptual and clinical. The conceptual
part deals with the important fundamentals to understand Gridhrasi from Ayurvedic as
well as modern point of view. Firstly, the Historical aspect of Gridhrasi is presented
extending from Vedic era to present era. Previous research work carried out by
various scholars on Gridhrasi has been incorporated. Concept of vata : physiological
Summary 166
as well as pathological aspect along with brief description of the anatomical parts is
mentioned. Nidan panchak, Sadhya – asadhyata, and Chikitsa are explained. It is
followed by Modern review. Here History of Sciatica, Definition, Anatomy and
Physiology of sciatic nerve, Aetiology, Pathogenesis, Differential diagnosis and
Management have been studied.
The evidences have been collected from authentic texts in favour of the
potential of the drugs used. It has been attempted to propose the probable samprapti
vightana by the components of the formulation used and their mode of action.
The subsequent portion deals with clinical part of the study. For this, 30
patients presenting with the clinical picture of Gridhrasi were selected from the OPD
and IPD of Ayurveda Mahavidayalaya College and Hospital, Hubli. These patients
were randomly divided into two groups of fifteen each and were subjected to planned
treatment regimen.
In one group, patients underwent Vasti Chikitsa along with Shamana
Aushadhi and in another group Kativasi along with shamanaushadhi. The total
duration of treatment in both groups was 2 months.
Prior to advent of treatment, a detailed proforma was duly filled for each
patient and necessary laboratory investigations were carried out to assess the general
condition of the patient as well as to rule out any underlying pathology. Throughout
the therapy, patients were advised to avoid the hetu such as bharaharana etc. and to
stick to the dietary regimen. In case of IPD patients daily follow up was done and in
OPD patient’s assessment was done fortnightly. Laboratory investigations were
repeated after completion of the therapy.
The results thus obtained were subjected to analytical statistical techniques to
assess the efficacy of both types of treatments. The final results thus obtained were
Summary 167
interpreted and graded as Cured, Marked improvement, Moderate improvement, Mild
improvement and No improvement and presented in the form of tables, graphs and
comments. Critical assessment of the total effect of therapies on individual patient
reflects that Vasti therapy along with shamana was more effective in pacifying the
symptoms of Gridhrasi as compared to Kativasti along with shamana therapy.
References xii
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58) A.S.Ni.15/7,8
59) A.H.Ni.15/5,6
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67) C.D.11/48
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70) C.S.Chi.28/4
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72) A.H.Ni.15/54
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76) B.P.U.K.24
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78) A.H.Su.Arunadatta vyakya.12/49
79) A.H.Su.Hemadri vyakya.12/49
80) Su.S.Ni.Dalhana vyakya.5/13
81) M.N.Madhukosha vyakya.24/54-55
82) C.S.Chi.Yogendranathsen vyakya.7/14
87) SU.S.Ni.Dalhana vyakya.1/74
88) A.H.Ni.Arunadatta vyakya.15/4
89) H.S.22/1-2
92) Bh.R.6th Chapter
93) M.N.22/55
94) G.N.Vol.2.19/63
95) Y.R. Moola.Vatavyadhi.Page.398/3-4
96) B.P.M.K.31st Chapter
97) A.S.Su.Indu vyakya.19/5
98) Su.S.Chi.Dalhana vyakya.1/7
99) M.N.22/56
References xvi
100) G.N.Vol.2.19/64
101) Y.R. Moola.Vatavyadhi.Page.398/3
102) B.P.M.K.31st Chapter
103) Su.S.Su.Dalhana vyakya.45/3
104) Su.S.Sh.4/35
105) A.H.Su.9/7
106) M.N.Madhukosha vyakya.14/4
107) C.S.Chi.Chakrapani vyakya.9/20
108) C.S.Chi.Chakrapani vyakya.16/4
109) Su.S.Sh.Dalhana vyakya.4/55
110) A.H.Su.Indu vyakya.9/39
111) Su.S.Su.33/66-67
112) C.S.Su.16/35
113) C.S.Vi.3/43
114) A.H.Su.11/26
115) Su.S.Ut.1/25
116) C.S.Su.20/13
117) A.H.Su.13/1-3
118) A.S.Su.21/3
119) Su.S.Chi.4/22-26
120) C.S.Chi.28/75
121) A.H.Su.1/26
122) C.S.Si.1/7
123) Su.S.Chi.24/30
124) C.S.Chi.28/78
References xvii
125) Su.S.Chi.33/22
126) C.S.Chi.28/79-81
127) C.S.Chi.28/83
128) C.S.Chi.28/84
129) C.S.Su.15/22
130) C.S.Chi.28/85
131) C.S.Chi.28/86
132) C.S.Si.11/18
133) C.D.Su.2/15
134) C.S.Si.1/27-28
135) C.S.Si.10/5
136) C.S.Si.1/40-41
137) C.S.Chi.28/101
138) Su.S.Chi.5/23
139) A.H.Su.27/15
140) H.S.22/1-11
141) V.S.Vatavyadhi.595-591
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144) C.S.Chi.27/47
145) A.H.Ka.4/7-10
146) A.H.Chi.21/70
147) C.D.Vatavyadhi.22/72-75
148) Sha.S.M.K.2/89
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Annexure xx
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA,

Ayurveda Mahavidyalaya, Hubli
TITLE OF DISSERTATION:
" CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH
VASTI AND KATI VASTI ALONG WITH TRAYODASHANGA
GUGGULU"
Guide: Dr. M.A. Hullur Candidate: Dr.Madhusudan Kulkarni

M.D. (Ayu),PhD,B.A.M.S.(Int) M.D.Scholar
Sl. No OPD No.
IPD No Bed No
GROUP ALLOCATION
1. Name of the patient :
2. Father’s/Husband’s Name :
3. Age : yrs .
4. Sex : Male/Female
5. Religion : Hindu Muslim Christian Others
6. Occupation : Sedentary Active Labour Others
7. Educational status : Illit Primary H.S Degree P.G.
8. Marital status : Married Unmarried Widow Divorced
9. Economical Status : Poor Middle class Higher class
10. Habitat : Urban Rural
11. Address : …………………………. Phone No. :

………………………….
………………………….
12. Date of Schedule Initiation
13. Date of Schedule Completion:

Annexure xxi
14-Pradhana vedana:
Complaint duration
1-
2-
3-
4-
5-
6-
15.Anubandha vedana
Complaint duration
1-
2-
3-
4-
5-
6-
16 .Vedana vrittanta
Annexure xxii
17. Poorva vyadhi vruttanta
1. Childhood disease
2. Adulthood disease
3. Geriatric disease
18. Poorva chikitsa vruttanta
Surgical Non Surgical

YES
Modern
NO
Shodhana Shamana
YES
Ayurveda
NO
Others Relief from previous treatment
19. kautumbika vruttanta
Relation Dead/Alive Health status Treatment history
1-
2-
3-
4-
5-
6-
7-
8-
Annexure xxiii
19. Vayaktika vruttanta
1. Aharasambandi vruttanta: veg / mixed
Quantity
Quality
appetite
2. Vihara sambhandhi vruttanta
A- Nidra: Sound / Good / Disturbed

Day ___ hours / Night ___ hours
If disturbed reason: Mental strain: Y/N

If yes - since ___
Diwaswapna: Y/N RatriJagarana: Y/N
B- Vyayama: Type of excersise: no / mild / moderate / heavy

for ___ mins/hrs.
C- Chintana:
D- Type of profession: Occupation: ___
Sedentary / Involves physical strain / Involves mental

strain
Since_______day/years
Work in standing posture _____ hrs
Work in bending posture ______ hrs
Traveling _____ hrs
Vehicle used- 2 wheeler / 4 wheeler / bullock cart
E- Hours of work: _______ /day
F- vyasana: Beedi / Cigarettes / Alcohol l / Tobacco chewing /

Tobacco snuff / tea / coffee/ pan / panmasala
Since___ ___time/day
Annexure xxiv
4. Rajo sambandhi vruttanta
Menarche _______ years
M.C. _________ days
Character. Regular / Irregular / Painfull / Painless
Menopause _______ years
4. Prasuti vrittanta - P__G__L__D__A
5. marital history –
6 - Sexual history –
5. History of contraception
Temporary: Mechanical / Chemical / Oral / Local / I.U.C.D
Permanent: Tubectomy / Vasectomy / Hysterectomy

Annexure xxv
ATURA SAMANYA PARIKSHA ( GENERAL EXAMINATION):
1) Ashtasthana Pariksha
Nadee : ___ /min
Mutra : usual / Dysuria / polyuria / Oligoria
frequency_______ time / day-night
Colour ____
Mala : Regular / Irregular

Formed / Unformed / constipated
Frequency ____ time/day
Consistency ______
Colour _____
Jihwa : Prakruta Vaikruta Cracks
Sabda :
Sparsha :
Druk :
Aakruthi:
Annexure xxvi
2). Dashavidha Pariksha
Prakriti: Sharira – V/P/K/VP/VK/PK/S - Predominance

Manasa – SR/RT/ST - Predominance
Sara Pravara / Madhyama / Avara
Samhanana Pravara / Madhyama / Avara
Pramana Pravara / Madhyama / Avara
Satmya Pravara / Madhyama / Avara
Satva Pravara / Madhyama / Avara
Ahara Shakti Abhyavaharanashakti Pravara / Madhyama / Avara
Jaranashakti Pravara / Madhyama / Avara
Vyayamashakti Pravara / Madhyama / Avara
Vaya Youvana (16 – 34) / Madhyama (34 - 70) / Vriddha (>70)
3 - ASSESMENT OF DOSHA
Vatavriddhi karshya karshnya gatrakampa sphurana

ushnakamita Samgnanasa Nidra nasa Balaupaghata
Indriyaghata asthishula Majja shosha malasanga
adhmana atopa moha dainya
shoka pralapa
Pittavriddhi/kopa Peeta twag glani indriyadourbalya ojovisramsa
sheetaabhilasa daha tiktasyata trt
murcha alpanidra krodha paka
sveda kleda srava raga
Kapha vriddhi shwaitya shaitya sthoula alasya
gourava angasada murcha tandra
nidra swasa kasa praseka
hrullasa agnisada sandhivishlesha kandu
upadeha chirakari sthairya
Vata kshaya praseka hrullasa alpavak Alpacheshta

apraharsha angasada agnivaishamya
Pitta kshaya aniyatatoda arochaka avipaka Gourava
angaparushya nakhaNayana shukla Shaitya
Kapha kshaya bhrama udveshtana anidra Angamarda
pariplosha toda dava Daha
sphotana vapana dhumayana Snadhishaitilya
hrudayadrava shleshmashyashoonyata
Annexure xxvii
4- ASSESMENT OF DHATU
Rasa Vridhi Praseka Arochaka Asyavairasya Hrillasa

Swadudwesha Angamarda Kapha linga
Kshaya
Sabdasahatva Hridayadrava Kampa Sosha
Soola Sunyata Spandana Ghattana
Alpacheshtaya srama Tarsha
Rakta Vridhi Kushta Visarpa Pitaka Asrigdhara
Akshidaha Mukhadaha Medradaha Gudadaha
Gulma Vidradhi Pleeha Vyanga
Kamala Agninasa Tamapravesa Raktaangata
Raktanetrata Vatarakta Raktapitha Pitha linga
Kshaya Tvagroukshya Amlabhilasha Seetabhilasha Sirasaithilya
Mamsa Vridhi Galaganda Gandamala Arbuda Granthi
Taluroga Jihwaroga Kantharoga Sphig udara
gouravavrdhi
Gala Oshta gouravavrdhi Bahu Uru Jangha gouravavrdhi
Kapha linga Rakta linga
Kshaya Sphigadi Toda Roukshya Akshaglani
sushkata
Sandhi sphotana Dhamani saithilya
Medas Vridhi Swedagandha Angagandha Angasidhilata Sayyasukha
Asanasukha Swapnasukha Hrdayopalepa Khanangata
Netropadeha Jihwopadeha Sravanopadeha Galasosha
Kesa ativridhi Nakhavridhi Seetapriyatwa Padadaha
Talusosha Madhurasyata Karadaha Dourbalya
Javoparodha Krichravyavaya Atisweda Pipasa
Atikshut Kapha linga Rakta linga Mamsa linga
Kshaya Pleeha vridhi Katiswapa Sndhisunyata Angaroukshya
Karsya Srama Sosha Mamsa linga
Medura Mamsa preeti
Asthi Vridhi Adhyasthi Adhidanta
Kshaya Danta sata Romasata Nakhasata Kesasata
Roukshya Parushya Asthitoda
Asthi badha mamsa abhilasha Sandhi saidhilya
Majja Vridhi Netra gourava Anga gourava Rakta gourava Arumsha
Kshaya Asthi soushirya Nistoda Dourbalya
Bhrama Tamo darsana
Sukra Vridhi Atistree kamata Sukra asmari
Kshaya Srama Dourbalya Asya sosha Timira
Angamarda Panduta Sadana Klaibya
Mushka toda Medra Chirat nisheka Sarakta
dhumayana nisheka
Annexure xxviii
5-ASSESSMENT OF SROTAS:
Prana Atisrishtam Atibadham Kupitam Alpalpam

Sasabdam Sasoolam
Anna Anannabhilasha Arochaka Avipaka Chardi
Udaka Jihwasosha Talusosha Oshtasosha Klomasosha
Kandhasosha Atipipasa
Rasa Asradha Aruchi Asyavairasya Arasajnata
Hrillasa Gowrava Tandra Angamarda
Jwara Tama Pandutwa Srotorodha
Klaibya Sada Krisangata Agninasa
Akalavali Akalapalita
Rakta Kushta Visarpa Pitaka Raktapitha
Asrgdhara Gudapaka Medrapaka Asyapaka
Pleeehavriddhi Gulma Vidradhi Neelika
Kamala Vyanga Viplava Tilakalaka
Dadru Charmadala Switra Pama
Kota Asramandala
Mamsa Adhimamsa Arbuda Keela Galasaluka
Sundika Putimamsa Alaji Galaganda
Gandamala Upajihwika
Medas Swedagandha Angagandha Angasidhilata Sayyasukha
Asanasukha Swapnasukha Seetapriyatwa Hrdayopalepa
Netropadeha Jihwopadeha Sravanopadeha Khanangata
Kesa ativridhi Nakhavridhi Galasosha Talusosha
Madhurasyata Karadaha Padadaha Ayuhrasa
Javoparodha Dourbalya Atisweda Atikshut
Pipasa Krichra vyavaya
Asthi Adhyasthi Adhidanta Dantabheda Dantasula
Asthibheda Asthisula Dantavivarnata Kesadosha
Nakhadosha Lomadosha Smashrudosha
Majja Parvaruk Bhrama Murcha Tamodarsana
Arumsha
Sukra Klaibya Aharshana Apatyadosha
Mutra Atisrishtam Atibadham Prakupitam Alpa alpam
Abheekshnam Bahalam Sasoolam
Mala Krichrena Alpa alpam Sasabda Sasoolam
Atidrava Atigradhita Atibahu
Sweda Aswedanam Atiswedanam Parushyam Atislakshnata
Anga paridaha Romaharsha
Annexure xxix
6 - Vital signs
1. Pulse: per min

2. B.P: mm of Hg
3. Temperature: f
4. Heart rate: /min
5. Respiratory rate: /min
7- General Physical examination.
1. Built and nourishment: well/ moderate/ poor.

2. Height _____ meter
3. Weight: _____ kg
4. Pallor: P/A
5. Edema: P/A
6. Cyanosis: P/A
7. Ictrus P/A
8. Lymphadenopathy P/A
9. Neck: Thyroid: Normal/abnormal.
XII. SYSTEMIC EXAMINATION
Inspection Palpation Percussion Ascultation
Respiratory
Cardiovascular
G . I . T.
Annexure xxx
SPECIAL EXAMINATION:
Examination of L.S. Spine -
1- Flexion - normal / painful / restricted
2- Extension - normal / painful / restricted
3- lateral bending - normal / painful / restricted
Curvarure of spine
cervical -
thoracic -
lumbar -
Spinal root examination –
Root Pain Sensory loss Motar weakness Reflex

involved changes
2nd Front of mid Front of mid Quadriceps Knee jerk
lumbar thigh thigh
3rd Front of lower Front of Quadriceps Knee jerk
lumbar thigh lower thigh
4th Side of thigh/ Side of thigh/ Anterior tibialis, Knee jerk
lumbar font of inner font of inner weak dorsiflexion
thigh thigh of foot
th
5 Back of thigh, Back of Anterior tibialis, ankle jerk
lumbar lateral leg, thigh, lateral weak plantar
dorsum of foot leg, dorsum flexion of big toe
to big toe of foot to big
toe
1st Base of leg, Base of leg, Gastronimeus, ankle jerk
sacral sole and side o sole and side weak plantar
foot o foot flexion of big toe
and foot
Annexure xxxi
GAIT -
normal / abnormal
If abnormal - ____________ type of gait
S.L.R. TEST –
ACTIVE -
right lower limb - + ve / -ve at ____ degrees
left lower limb - + ve / -ve at ____ degrees
PASSIVE –
right lower limb - + ve / -ve at ____ degrees
left lower limb - + ve / -ve at ____ degrees
Investigations :
i. Blood examination - Hb%
TC
DC
ESR
RBC
ii. Urine - Albumin / Sugar / Microscopy
iii. VDRL
iv. RA Test
v. X-ray of lumbar spine AP and Lateral view

Annexure xxxii
i. NIDANA
Aharatmaka :
Viharatmaka :
Manasa:
ii. PURVARUPA
iii. ROOPA -
iv. SAMPRAPTI
• Dosha : K/P/V
• Dushya: R/RK/Ma/Md/AS/Mj/SK/Swedha/Muthra/purisha
• Agni: Jatharagni/Dhatvagni
• Ama: Jatharagni mandya janita/Dhatvagnimandya janita
• Srotas Iinvolved: Ra/Meda/Mamsa/Sweda/Others.
• Srotodusti Prakara: AP/S/V/SG
• Udbhava sthana: Amasaya/ Pakvashaya
• Sanchara sthana: Sarvashareera
• Vyakta sthana: Sarvanga/Udara/Sphik/Gala/Stana/others
• Roga marga
• Adhisthana
• Vyadhi Swabhava
Annexure xxxiii
Group A
CHIKITSA
1- Amapachana
Panchakola choorna 3- 5 gms with hot water twice a day before

food
From ________ to ________
2- Kati Basti
By – Asta Katvara Taila
Days Æ 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Matra of taila
Kala
Retansion time
3- Shamana chikitsa
Trayodashanga Guggulu 1 tab thrice a day before
food
Rasna saptaka kwatha 20 ml thrice a day before food
From ________ to ________
4-Follow up
From _______ to ________
Annexure xxxiv
Group B
CHIKITSA
1- Amapachana - with Panchakola Choorna 5 gms twice a day with hot

water
From_______ to ________
2 – Basti – Erandamooladi nirooha ( kala basti schedule ) from

_______ to _________
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Days Æ
Basi Prakara
Matra
Kala
Pratyagamana
kala
Retansion
time
No. of
evacuations
Any other
features
Basti parihara kala 32 day _______ TO ________

3- Shamana chikitsa
Trayodashanga Guggulu 1 tab tid
Rasna saptaka kwatha 20 ml bid
From ________ to ________
4-Follow up From _______ to ________
Annexure xxxv
Assessment Based on Scoring :
Radiating Pain
0 No Radiating Pain
1 Pain Radiating to hip and back of thigh
2 Pain Radiating to Popleteal fossa
3 Pain Radiating upto foot
Numbness
0 No Numbness
1 Mild (Once/day)
2 Moderate (2-3/day)
3 Continuous
SLR
0 Negetive
1 60 Degree and Above
2 In between 30 Degree to 60 Degree
3 Less than 30 Degree
Lasegue’s Sign
0 Absent
1 Present
Annexure xxxvi
SCORES OF PARAMETERS BEFORE AND AFTER TREATMENT –
Assessment Criteria B.T A.T
Radiating Pain
Numbness
SLR test
Lasegue’s sign.
RESULT -
CURED / RESPONDED / NOT RESPONDED
SIGNATURE OF THE GUIDE SIGNATURE OF THE SCHOLAR
DR. M.A.HULLUR M.D(Ayu), Ph.D DR. MADHUSUDAN KULKARNI

MASTER CHART - OBSERVATIONS - GROUP A
Vyayama Shakti
Dietary Habits Prakruti
Jarana Shakti
Marital Status
Abhyavarana
Leg Affected
Samhanana
Occupation
Shareerika
Chronicity
Education
Economic
Veg/Mixed
Dom.Rasa
Addiction
Manasika
Reg/Irreg
Name
OPD/IPD
Religion
Satmya
Habitat
Koshta
Status
Shakti
Onset
Socio
Satva
Sl.No
Agni
Sara
Age
Sex
AVAR
2322 48 M M M Teacher Upper Grad Urban M Irreg Amla M VK R V KR - 6YRS M M M M M Grad Rt
1 N.M.KALASAGI A
JUBEDA AVA AVAR
4007 60 F M M H.Wife Poor Illt Rural M Irreg Katu M VP T V KR - 1 YR A M M M Grad Rt
2 BYAHATTI RA A
RUKSARA R AVAR Suddn
4667 30 F M M H.Wife Middle H.S Urban M Irreg Amla M VP R M M SUPARI 15 Dys M M M M M Lt
3 BURBURI A e
SHAHEEN S
5135 30 F M M H.Wife Poor Illt Urban M Reg Amla A VP R M M - 1 year A M M M M M Grad Rt
4 DANDEVALE
AVA
6816 65 M M M Lawyer Upper Grad Urban M Reg Katu A VK T V KR - 3 mnth M M M M M Grad Rt
5 A.M.KAGADGAR RA
ERAMMA AVA AVAR AVA
6810 40 F H M H.Wife Middle Primary Urban M Irreg Katu A VP R V KR SUPARI 1 yr M M M Grad Rt
6 NIDGUNDI RA A RA
AVAR
324 21 F H UM Student Middle Grad Urban M Irreg Amla M VK R M KR - 1yr M M M M M Grad Rt
7 ANURAG A
AVA AVA
7224 55 F M M H.Wife Poor Primary Urban M Irreg Katu M VK T M KR - 2 mnth M M M M Grad Rt
8 NAJAMUNNISA RA RA
ANNAPOORNA AVAR
9286 38 F H M H.Wife Middle Primary Urban M Irreg Amla M VK R M KR - 2 mnth M M M M M Grad Rt
9 HANGI A
BASAVARAJ VE
10016 22 M H UM Farmer Poor Primary Rural Irreg Katu M VK R M KR GUTKA 1.5 yr M M M M M M Grad Lt
10 ITAGATTI G
LAV CIGARE AVA Suddn
10813 26 M H UM Student Middle Grad Urban M Irreg A VK R M KR 2 mnth M M M M M Lt
11 ANIL ATHANI ANA TTE RA e
KASHAVVA VE AVA Suddn
11144 28 F H M H.Wife Middle Primary Rural Irreg Katu A VP R M KR SUPARI 7 mnth M M M M M Lt
12 DUNDARI G RA e
TAHEERA
11310 35 F M M H.Wife Middle Primary Urban M Irreg Amla M VK R M KR - 1 yr M M M M M M Grad Rt
13 MULLA
SHAMEENA AVA
11129 38 F M M H.Wife Middle Primary Urban M Irreg Katu A VP T M KR - 1 yr M M A M M Grad Rt
14 BHANU RA
CHANDRASHEKA Suddn
863 30 M H UM Driver Middle Primary Urban M Irreg Katu M VP T M KR PAN 1yr M M M M M M Rt
15 R SIDDHAPUR e
Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu xxxvii
Master Chart of Assessment Symptoms of Group A and B
Master Chart of Major Symptoms - Group A Master Chart of Major Symptoms - Group B
SUBJECTIVE OBJECTIVE SUBJECTIVE OBJECTIVE
RADIATING LASEAGUE'S RADIATING LASEAGUE'S

NUMB NESS SLR Test NUMB NESS SLR Test
Patient PAIN SIGN PAIN SIGN
Patient No.
No.
BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT
1 3 1 3 1 1 0 1 1 1 3 0 3 0 3 0 1 1
2 3 1 3 1 2 1 1 1 2 3 2 3 2 3 1 1 1
3 2 0 2 0 2 0 1 0 3 2 0 2 1 1 0 1 1
4 2 0 2 0 2 0 1 1 4 3 1 2 0 1 0 1 0
5 3 2 3 2 2 1 1 1 5 2 0 3 0 1 0 1 0
6 3 2 3 2 2 0 1 1 6 2 0 1 0 2 0 1 0
7 1 0 1 0 1 0 1 0 7 2 0 2 0 1 0 1 0
8 3 2 3 2 2 0 1 1 8 2 0 2 0 2 0 1 0
9 2 0 2 0 1 0 1 1 9 3 1 3 1 2 1 1 1
10 1 0 1 0 1 0 1 0 10 2 1 1 0 2 0 1 0
11 3 1 3 1 3 2 1 1 11 3 1 2 1 1 0 1 1
12 3 2 3 2 3 2 1 1 12 3 2 2 1 2 1 1 1
13 1 0 1 0 1 0 1 0 13 3 0 3 0 2 0 1 1
14 2 0 2 0 2 0 1 1 14 3 0 3 0 2 0 1 0
15 1 0 1 0 1 0 1 0 15 2 1 2 0 2 0 1 0
Clinical Management of Sciatica (Gridhrasi) through Vasti and Kati Vasti along with Trayodashanga Guggulu xxxix

Madhu Sudhana Kulkarni

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CLINICAL MANAGEMENT OF SCIATICA (GRIDHRASI)

THROUGH VASTI AND KATI VASTI ALONG WITH

DR. MADHUSUDHANA KULKARNI

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

DOCTOR OF MEDICINE (AYURVEDA)

DEPARTMENT OF POST-GRADUATE STUDIES IN KAYACHIKITSA

DEPARTMENT OF POST GRADUATE STUDIES IN

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “ CLINICAL

MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND

KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a

bonafide and genuine research work carried out by me under the

guidance of DR. M. A. HULLUR, M.D. (Ayu.), B.A.M.S. (Int.), Ph.D. Professor,

Department of Post-Graduate studies in Kayachikitsa, AYURVEDA

AYURVEDA MAHAVIDYALAYA, HUBLI

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “CLINICAL

MANAGEMENT OF SCIATICA (GRIDHRASI) THROUGH VASTI AND

KATI VASTI ALONG WITH TRAYODASHANGA GUGGULU” is a

bonafide research work done by DR. MADHUSUDHANA KULKARNI in

partial fulfillment of the requirement for the degree of DOCTOR OF

MEDICINE (AYURVEDA) in KAYACHIKITSA.

This is to certify that the dissertation entitled “ CLINICAL

bonafide research work done by DR. MADHUSUDHANA KULKARNI

DECLARATION BY THE CANDIDATE

Sciences, Karnataka shall have the rights to preserve, use and

disseminate this dissertation / thesis in print or electronic format for

academic / research purpose.

Date DR. MADHUSUDHANA KULKARNI

© RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

“Skills can impress but values can inspire”

work to my beloved parents.

It is my pleasure to express gratitude to my guide Dr M.A. Hullur, Professor,

It is my privilege and pleasure to express my heartfelt gratitude towards

Dr P.G. Subbanagouda, Professor and Head, Dept. of Post-Graduate studies in

Kayachikitsa, for his valuable guidance throughout my career as a PG Scholar.

I am grateful to Principal; Dr S J Deshpande and former principal Dr MA

Kundagol for their encouragement and help.

I am grateful to my teachers Dr.Prashant.A.S, Dr.A.I.Sanakal,

Dr.S.K.Bannigol, Dr.B.B.Joshi, Dr.J.R.Joshi, Dr Pradeep Agnihotri, Dr Anita Joshi,

Dr Anita Halagatti, Dr.Manjunath Naik, Dr Tyagaraja C, Dr.S.A Patil and Dr

I will remain ever thankful to my senior friends; Dr. Srivatsa, Dr.Nilesh, Dr

Niranjan, and My colleagues Dr.Gireesh, Dr Dhanvantari, Dr R. Sivakumar, Dr

thankful to my junior collegues for their enthusiastic support in completion of this

It is my pleasure to thank Mr Rajashekar B Alagawadi, Librarian, PG Library

and Librarians of UG Library, Sri.B R Kulkarni, Sri. Prabhakar Kulkarni.

This acknowledgement would remain incomplete if I do not mention my

directly or indirectly to complete dissertation work.

I am thankful to Students of third professional BAMS 2008-09, College and

Hospital staff, Ayurveda Mahavidyalaya, Hubli.

Date: DR.MADHUSUDHANA KULKARNI

• C.S. - Charaka Samhita

• Su.S. - Susruta Samhita

• A.S. - Ashtanga Sangraha

• A.H. - Ashtanga Hrudaya

• M.N. - Madhava Nidana

• B.P. - Bhava Prakasha

• H.S. - Harita Samhita

• B.S. - Bhela Samhita

• Sha.S. - Sharangadhara Samhita

• K.S. - Kashyapa Samhita

• C.D. - Chakra Datta

• Bh.R. - Bhaishajya Ratnavali

• Sh.K.D. - Shabda Kalpa Druma