Evaluation of comparative efficacy of Guda Sunthi and Manjistha Guggulu...

[Full title: Evaluation of comparative efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha (Cervical Spondylitis)]

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[Find the meaning and references behind the names: Suresh, Long, Mar, Main]

ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 1 Evaluation of comparative efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha (Cervical Spondylitis) Dr. Manjunath Akki, 1 Dr. Suresh Hakkandi, 2 Dr. Arti Panwar 3 1 Professor & Guide, 2 Professor & HOD, 3 Post Graduate Scholar, Post Graduate Dept. of Panchakarma, SJG Ayurvedic Medical College & Hospital, Koppal, Karnataka, INDIA. I NTRODUCTION Manyastambha is described under Nanatmaja Vatavyadhi [1] with Kapha involvement and it occurs in Urdwajatru Pradesh . Where, the aggravated Vata get localized in the Manyasamshrita Nadi causing Address for correspondence: Dr. Manjunath Akki Professor & Guide, Post Graduate Dept. of Panchakarma, SJG Ayurvedic Medical College & Hospital, Koppal, Karnataka, INDIA. E-mail: drmanju 78@gmail.com Submission Date: 10/02/2019 Accepted Date: 26/03/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.2.1 symptoms like Stambha and Shoola. [2] Manyastambha can be compared with earliest symptoms of cervical spondylitis. In this condition the patient complaints of neck pain. The neck is held rigidly and neck movements may exacerbate pain In Modern system of medicine, administration of muscle relaxants, NSAIDS, Analgesics, corticosteroids etc.; gives temporary relief and their long term use can produce toxic effects to the different system of the body. So, there is a need for an effective management of this condition, for the betterment of the patients suffering with the same Panchakarma therapy aims at cleansing the body from the root level of accumulated Doshas . In Manyastambha, Nasya is main line of treatment (i.e. Vatakaphahra Nasya ) [3] Acharyas state that Avapeedana Nasya is effective in the management of A B S T R A C T Manyastambha is described under Nanatmaja Vatavyadhi . It is a condition where, the aggravated Vata get localized in the Manya Pradesha causing symptoms like Stambha and Shoola . Manyastambha can be compared with earliest symptoms of cervical spondylitis. In this condition, patient complaints of neck pain. The neck is held rigidly and neck movements may exacerbate pain. Now a day, Cervical spondylitis is very common in the people who do routine activities like travelling, household work, desk job etc. It can be seen in people as early as 25 years of age. In Manyastambha , Nasya is the main line of treatment. (i.e. Vatakaphahara Nasya). Objectives: To evaluate the comparative efficacy of Guda Sunthi Avapeedana Nasya and Manjistha Guggulu Avpeedana Nasya in Manyastambha (Cervical Spondylitis). Materials and Methods: This is a comparative clinical study conducted to assess the efficacy in Manyastambha . As per the inclusion and exclusion criteria, the patients who fulfill the criteria were randomly selected and equally divided into two groups. Group A - 15 Patients received Guda-Sunthi Avapeedana Nasya . Group B - 15 Patients received Manjistha-Guggulu Avapeedana Nasya. Results and Conclusion: In Group A, 9 patients (60%) showed complete remission and 6 patients (30%) showed marked response. In Group B, 3 patients (20%) showed complete remission, 1 patient (7%) showed marked response. 6 patients (30%) showed moderate response, 4 patients (26%) showed mild response and 1 patient (7%) showed unchanged response. Key words: Manyastambha, Cervical spondylitis, Avapeedana Nasya.

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[Find the meaning and references behind the names: Bindu, Mukul]

Dr. Manjunath Akki et.al. Efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 2 Manyastambha . Avapeedana Nasya is the type of Nasya where medicated drops extracted from Aushada Kalka (paste of medicine) are instilled into the nose. Hence, With an intention to find out an effective, economical and affordable treatment modality with minimal hospitalization, the present study was undertaken to compare the efficacy of Guda Sunthi Avapeedana Nasya [4] and Manjistha Guggulu Avapeedana Nasya in Manyastambha. [5] A IMS AND O BJECTIVES To evaluate the comparative efficacy of Guda Sunthi Avapeedana Nasya and Manjistha Guggulu Avpeedana Nasya in Manyastambha (Cervical Spondylitis) M ATERIALS AND M ETHODS Comparative clinical study was conducted to assess the efficacy of two different forms of Nasya procedures in Manyastambha . Patients suffering from Manyasthambha were selected from the OPD of S.J.G.A.M. College Hospital, Koppal according to preset inclusion and exclusion criteria. Preparation of Medicine In Group A - Drugs used are SN Ingredients Botanical Name Ratio 1 Guda Jaggery 1 part 2 Sunthi Zingiber officinale 1 part In Group B - Drugs used are SN Ingredients Botanical Name Ratio 1 Manjistha Rubia cardifolia 1 part 2 Guggulu Commiphora mukul 1 part Group A : Guda and Sunthi Group B : Manjistha and Guggulu ▪ Each drug was taken in equal parts separately, i.e. 1 gm, which was soaked in water (as per requirement) 3 hours prior to the procedure. ▪ Afterwards, soaked drug was taken in Khalva Yantra and triturated well to prepare a Kalka . ▪ Kalka was kept in a clean cloth and squeezed well to get S warasa . ▪ After getting the Swarasa , required quantity should be taken in Gokarna and was used for instillation. Group A Group B Drug Guda and Sunthi Swarasa Manjistha and Guggulu Swarasa Dosage 6 Bindu in each nostril 6 Bindu in each nostril Period 7 days 7 days Duration Nasya - 7 days Follow up - 14 days Total - 21 days A. Inclusion Criteria 1 Patient with signs and symptoms of Manyastambha (Cervical spondylitis). 2 Age group between 25 - 65 yrs. 3 Patients of either sex. 4 Patients fit for Nasya Karma . B. Exclusion Criteria 1 Serious illness of spine like - Disc prolapsed, Malignancy, Myelopathies and Tuberculosis etc. 2 Trauma/Injury. 3 Other systemic conditions. Grouping Group A - 15 Patients received Guda - Sunthi Avapeedana Nasya . Group B - 15 Patients received Manjistha - Guggulu Avapeedana Nasya.

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[Find the meaning and references behind the names: Kala]

Dr. Manjunath Akki et.al. Efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 3 P ROCEDURE The whole procedure was under three steps, Purva, Pradhana and Pashchat Karma. Purvakarma Mukhabhyanga with Tila Taila and Nadi Sveda was given to Uttamanga [6] (parts of the body above the shoulders) Pradhana Karma Patients were made to lie down on the table in supine position with legs slightly raised and head slightly lowered. Eyes of the patients were covered with a band of cloth, and then the 6 Bindu Swarasa of Guda and Shunti in Group - A, and Manjishta and Guggulu in Group - B was taken in Gokarna and instilled into one nostril. The other nostril was closed while administering the medicine. The medicine was instilled slowly in “ Avicchinna Dhara ” i.e. an un interrupted stream. The same procedure is repeated in another nostril and care was taken not to shake the head during the procedure. Then, the patients were allowed to relax in same posture for 100 Matra Kala without going to sleep [7] Paschat Karma After instilling Nasya , mild fomentation should be done on forehead. Cheeks, neck, palms, soles, etc. will be rubbed mildly and then patients were asked to turn on either side and spit out the drug (phlegm) which comes in oropharynx Afterwards medicated Dhumapana, three puffs on either side of nostril was given. Lastly Kavala Graha with Sukhoshna Jala was given to the patient to expel out the residue mucous lodged in Kanta [8] A) Subjective Parameters 1) Neck pain Neck pain Grades No neck pain 0 Neck pain aggravates with movement 1 Neck pain without movement 2 Neck pain which disturbs the sleep 3 2) Stiffness Stiffness Grades No stiffness 0 Morning stiffness 1 Later hours stiffness on same day 2 Continuous stiffness 3 B) Objective Parameters Goniometric Examination- Restricted Neck Movements 1) Flexion Flexion Grades No restriction i.e. able to touch the interclavicular line, 80° 0 Movement from 70° - 80° 1 Movement from 60° - 70° 2 Movement less than 60° 3 2) Extension Extension Grades Normal i.e. able to extend the head up to the level when tip of the nose and forehead become in horizontal plane 40° 0 Movement from 40° - 50° 1 Movement from 50° - 60° 2 Movement more than 60° 3 3) Lateral flexion Lateral flexion Grades Normal i.e. ear able to touch the shoulder tip, 45° 0 Movement from 45 - 55° 1 Movement from 55° - 65° 2 Movement more than 65° 3

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[Find the meaning and references behind the names: Hindu, Muslim]

Dr. Manjunath Akki et.al. Efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 4 Assessment of clinical improvement Clinical improvement of the disease was based on improvement in the clinical finding and reductions in the severity of symptoms of the disease after treatment. O BSERVATION AND R ESULTS Age: Out of 30 patients, 09 patients (30%) were between the age group of 25-35 yr, 11 patients (37%) were between the age group of 36-45 yrs and 04 patients (13%) were between the age group of 46- 55 yrs and 06 patients (20%) were between the age 56-65 yrs. This indicates that as age increases, response to the treatment will be less. Sex: Among 30 patients, 12 patients (40%) were male and 18 patients (60%) were female patients Religion: Out of 30 patients, 27 patients (90%) were belongs to Hindu community and 03 patients (10%) were Muslim community. This may be due to predominance of Hindu religion in this place. Disease prevalence is not having any significance on race and religion. Occupation: Out of 30 patients, 04 patients (13%) were sedentary, 14 patients (47%) were Active, 05 patients (17%) were labour and 07 patients (23 %) were others nature of work. Agni: Out of 30, 03 patients (10%) were having Mandagni , 22 patients (73%) were having Vishamagni and 05 patients (17%) were having Tikshanagni . This shows Vishamagni persons are more prone to Vatavyadhis. Vishamagni is due to Vata , which may be one of aggravating factor. Prakruti: Out of 30 patients, 12 patients (40%) were having Vata-Pittaja Prakruti . 7 patients (20%) were having Vata-Kaphaja Prakruti, 11 patients (36.6%) were having Pitta Kaphaja Prakruti. As Vatadushti is more prominent in Manyastambha and majority of the patients were having the existence of Vata Dosha in their Prakruti constitution. This shows the person is more prone to Vataja set of diseases. Results on Subjective parameters Table 1: Effect of treatment on Stambha in both groups Patients of Manyastambha treated with Guda-Sunthi Avapeedana Nasya (Group A) got 89% relief in Stambha , while Patients treated with Manjistha- Guggulu Avapeedana Nasya (Group B) got 33% relief in Stambha . Statistical analysis of patients of Group A showed Highly Significant result (p <0.001) and patients of group B showed Moderately Significant results (p<0.05) The comparison showed that, the relief in Stambha, Group A is better than Group B. Table 2: Effect of treatment on Shula in Manya Pradesh in both groups Patients of Group A showed 92% relief in Shula in Manya Pradesh while patients of Group B showed 57% relief in Shula in Manya Pradesh . Statistically, Group A showed Moderately Significant result after the treatment and showed Significant result after the follow up period. Group Mean ± S.D. N Mean Rank Sum of Ranks U Z P Remarks Group A 0.07 0.26 15 12.43 186.5 Group B 0.67 0.90 15 18.57 278.5 Group A 0.13 0.35 15 11.87 178.0 Group B 0.80 0.86 15 19.13 287.0 Comparative difference of STAMBHA between Group A and B; Mann-Whitney U Test Qualitative Parameters Descriptive Statistics Mann-Whitney U Test Ranks Test Statistics After Treatment 66.50 2.47 IS - Insignificant; MS - Moderately Significant; S - Significant; HS - Highly significant <0.05 MS After Follow up 58.00 2.66 <0.01 S Group Mean ± S.D. N Mean Rank Sum of Ranks U Z P Remarks Group A 0.00 0.00 15 13.00 195.0 Group B 0.40 0.63 15 18.00 270.0 Group A 0.13 0.35 15 11.93 179.0 Group B 0.67 0.62 15 19.07 286.0 Comparative difference of SULA IN MANYA PRADESH between Group A and B; Mann-Whitney U Test Qualitative Parameters Descriptive Statistics Mann-Whitney U Test Ranks Test Statistics After Treatment 75.00 2.40 IS - Insignificant; MS - Moderately Significant; S - Significant; HS - Highly significant <0.05 MS After Follow up 59.00 2.63 <0.01 S

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[Find the meaning and references behind the names: Anna, Deepika, Kumar, Krishna, Rajeev, Rai, Prakashan]

Dr. Manjunath Akki et.al. Efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 5 Results on Objective parameters (Range of Movement) Table 3: Effect of treatment on flexion in both groups Patients of Group A showed 95% reduction while patients of Group B showed 44% reduction in Flexion. Statistical analysis of patients of both groups showed significant results (p<0.01). Table 4: Effect of treatment on Extension in both groups Patients of Group A showed 95% reduction while patients of Group B showed 42% reduction in extension. Statistical analysis of patients of both groups showed significant results (p<0.01) Table 5: Effect of treatment on Lateral Flexion in both groups Patients of Group A showed 91% reduction while patients of Group B showed 38% reduction in lateral flexiont. Statistical analysis of patients of group A showed highly significant results (p<0.001) and groups B showed significant results (p>.0.01). CONCLUSION On comparing the overall effect of the therapies, Group A ( Guda-Sunthi Avapeedana Nasya ) was better than Group B ( Manjistha-Guggulu Avapeeadna Nasya) , comparatively both the groups have almost same significance in the parameters. But both the Groups shows more net mean effect and results lasted throughout follow-up period. The parameter Stambha statistically showed Highly Significant results (p <0.001) in patients of Group A and showed Moderately significant results (p<0.05) in patients of group B. Statistical analysis of patients of group A showed Highly significant results in lateral flexion (p<0.001) and groups B showed Significant results (p> 0.01). REFERENCES 1 Kashinath Shastri, Commentary: Ayurveda Deepika of Chakrapaniadatta on Charaka Samhitha of Charaka, Sutrasthana, chapter 20, verse no. 11, 5 th edition, Varanasi: Chaukambha Sanskrit Sansthan; 2012; 269 2 Kashinath Shastri and Gorakhanath Chaturvedi. Charaka Samhitha of Charaka, Chikitsasthana, chapter 28, verse no. 43, Reprint, Varanasi: Chaukambha Bharati Academy: 2001; 784 3 Ambikadutta Shastri. Sushrutasamhita of Sushruta, Chikitsasthana, chapter 5, verse no. 20, 12 th edition, Varanasi: Chaukhamba Sanskrit Sansthana: 2001; 32 4 Shrikantha Murthy K R. Sharangadhara Samhita of Sharanghadhara, Uttara Khanda, chapter 8, verse no.2 nd edition, Varanasi: Chaukambha Orientalia; 2006, 225. 5 Rajeev Kumar Rai, Vangasen Samhita of Vangasena, Vatavyadhinidanam, verse no.119, Reprint, Prachya Prakashan; 2010, 26 6 Anna Moreshwar Kunte and Krishna Ramachandra Shastri Navre. Commentary: Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri on Asthangahridaya of Vagbhata, Sutrasthana, verse no. Group Mean ± S.D. N Mean Rank Sum of Ranks U Z P Remarks Group A 0.07 0.26 15 12.93 194.0 Group B 0.60 0.91 15 18.07 271.0 Group A 0.07 0.26 15 12.43 186.5 Group B 0.67 0.90 15 18.57 278.5 <0.05 MS After Follow up 66.50 2.47 <0.05 MS Comparative difference of FLEXION between Group A and B; Mann-Whitney U Test Qualitative Parameters Descriptive Statistics Mann-Whitney U Test Ranks Test Statistics After Treatment 74.00 2.16 IS - Insignificant; MS - Moderately Significant; S - Significant; HS - Highly significant Group Mean ± S.D. N Mean Rank Sum of Ranks U Z P Remarks Group A 0.07 0.26 15 12.90 193.5 Group B 0.67 0.98 15 18.10 271.5 Group A 0.07 0.26 15 12.40 186.0 Group B 0.73 0.96 15 18.60 279.0 <0.05 MS After Follow up 66.00 2.49 <0.05 MS Comparative difference of EXTENSION between Group A and B; Mann-Whitney U Test Qualitative Parameters Descriptive Statistics Mann-Whitney U Test Ranks Test Statistics After Treatment 73.50 2.19 IS - Insignificant; MS - Moderately Significant; S - Significant; HS - Highly significant Group Mean ± S.D. N Mean Rank Sum of Ranks U Z P Remarks Group A 0.07 0.26 15 10.90 163.5 Group B 0.93 0.88 15 20.10 301.5 Group A 0.13 0.35 15 11.23 168.5 Group B 1.00 0.93 15 19.77 296.5 <0.01 S After Follow up 48.50 3.04 <0.01 S Comparative difference of LATERAL FLEXION between Group A and B; Mann-Whitney U Test Qualitative Parameters Descriptive Statistics Mann-Whitney U Test Ranks Test Statistics After Treatment 43.50 3.36 IS - Insignificant; MS - Moderately Significant; S - Significant; HS - Highly significant.

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[Find the meaning and references behind the names: Nil, Med]

Dr. Manjunath Akki et.al. Efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha ISSN: 2456-3110 ORIGINAL ARTICLE Mar-Apr 2019 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2019 | Vol. 4 | Issue 2 6 17, Reprint, Varanasi: Chaukhamba Surabharati Prakashan; 2002, 290. 7 Anna Moreshwar Kunte and Krishna Ramachandra Shastri Navre. Commentary: Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri on Asthangahridaya of Vagbhata, Sutrasthana, verse no. 18,19, Reprint, Varanasi: Chaukhamba Surabharati Prakashan; 2002, 290. 8 Anna Moreshwar Kunte and Krishna Ramachandra Shastri Navre. Commentary: Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri on Asthangahridaya of Vagbhata, Sutrasthana, verse no. 20-22, Reprint, Varanasi: Chaukhamba Surabharati Prakashan; 2002, 290-291. ******************************* How to cite this article: Dr. Manjunath Akki, Dr. Suresh Hakkandi, Dr. Arti Panwar. Evaluation of comparative efficacy of Guda Sunthi and Manjistha Guggulu Avapeedana Nasya in Manyastambha (Cervical Spondylitis). J Ayurveda Integr Med Sci 2019;2:1-6. http://dx.doi.org/10.21760/jaims.4.2.1 Source of Support: Nil, Conflict of Interest: None declared.

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Gokarna, Uttamanga, Kanta, Shula, Stambha, Pradhana-karma, Paschat-karma, Kalka, Vishamagni, Mandagni, Purvakarma, Manyastambha, Dhumapana, Nasyakarman, Kavalagraha, Labour, Active, Hindu community, Extension, Group A, Follow-up, Muslim community, Cervical spondylitis, Inclusion criteria, Exclusion criteria, Clinical study, Neck pain, Swarasa, Complete remission, Shoola, Tikshanagni, Subjective parameter, Objective parameter, Avapeedana nasya, Pashchat Karma, Flexion, Lateral Flexion, Moderate response, Mild response, Mann-Whitney U-test, Group B, Pitta Kaphaja Prakruti.