The effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management...

[Full title: The effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica]

ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 1 The effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica Dr. Bhagyashree VG 1 , Dr. Shridhar Rao SM 2 1 Post Graduate Scholar, 2 Professor & HOD, Dept. of Post Graduate Studies in Shalya Tantra, Govt Ayurvedic Medical College, Bengaluru, Karnataka, INDIA. I NTRODUCTION Gridhrasi is a condition mentioned by all Brihatrayees . The earliest reference about the details of Gridhrasi is available from Sushruta Samhita (1500 BC). [1] Address for correspondence: Dr. Bhagyashree VG Post Graduate Scholar, Dept. of Post Graduate Studies in Shalya Tantra, Govt Ayurvedic Medical College, Bengaluru, Karnataka, India. E-mail: bvgoudar 123@gmail.com Submission Date: 27/06/2019 Accepted Date: 10/08/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.4.1 Gridhrasi is included in Vataja Nanatmaja Vyadhi and also considered as Mahagada by Acharya Charaka [2] In all Ayurvedic literature, there is no direct reference regarding Nidana , but it is included in Vataja Nanatmaja Vyadhi , general Vata Prakopaka Hetus are to be considered. On the basis of symptom Gridhrasi can be correlated with the disease Sciatica in the modern parlance, [3] which occurs because of spinal nerve irritation and characterized by its distinct nature of pain in distribution of sciatic nerve and often it is associated with lumbago. The Gridhrasi is commonly seen in society as a major problem which incapacitates patient to perform his daily routine activities because of severe pain from Kati Pradesha to Padanguli . In modern medicine in reference to sciatica treatment, there is no definite curative treatment other than symptomatic management. A B S T R A C T Gridhrasi is a disease explained by Brihatrayees in the context of Vatavyadhi Adhyaya . The earliest reference about the details of Gridhrasi is available from Sushruta Samhita (1500 BC). Gridhrasi is included in Vatajna Natmaja Vyadhi and also considered as Mahagada by Acharya Charaka . In all Ayurvedic literature, there is no direct reference regarding Nidana , but it is included in Vataja Nanatmaja Vyadhi, general Vata Prakopaka Hetus are to be considered. On the basis of symptoms, Gridhrasi can be correlated with the disease Sciatica in the modern parlance, which occurs because of spinal nerve irritation and characterized by its distinct nature of pain in distribution of sciatic nerve and often it is associated with lumbago. The Gridhrasi is commonly seen in society as a major problem which incapacitates patient to perform his daily routine activities because of severe pain from Kati Pradesha to Padanguli . In modern medicine in reference to sciatica treatment, there is no definite curative treatment other than symptomatic management. Objectives of the study was to evaluate the effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica and to compare the effect of Bindu Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi . In present study 40 patients with confirmed clinical diagnosis of Gridhrasi /Sciatica were selected randomly and divided into two groups of each 20 patients. Group A patients were treated with Asthapada Panchaloha Shalaka Agnikarma and Group B patients were treated with Bindu Panchaloha Shalaka Agnikarma . After the treatment it was observed that there was statistically significant results in the main signs and symptoms i.e. pain in lumbar region, numbness, SLR test. The study shows that the treatment is statistically significant in Group A when compared to Group B. Group A overall result is 87.29% and Group B overall result is 84.64%. Key words: Gridhrasi , Sciatica , Asthapada Panchaloha Shalaka, Bindu Panchaloha Shalaka, Agnikarma.

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 2 In modern medicine for the management of sciatica various modalities are available such as; Conservative treatment - Muscle relaxants, NSAID’s, opioid analgesics and corticosteroids which gives temporary relief and their long term use can lead to adverse effects such as opioid analgesics leads to develop dependence and NSAID’s affects almost all system of our body. 1 Epidural steroid injection. 2 Peri-radicular infiltration [4] On the other hand, all these management tools are not affordable for the poor, particularly in developing countries. In various Samhitas of Ayurveda, there are references regarding Gridhrasi and it is elaborated as a separate disease with specific management. Various methods of treatment in Ayurveda namely, [5] ▪ Agnikarma ▪ Siravyadha ▪ Basti karma ▪ Snehana ▪ Swedana ▪ Shamanoushadhis Stambha and Ruk are the predominant symptoms of Gridhrasi which disturbs the normal routine of the patient are effectively relieved by the Agnikarma . References show that the diseases treated with Agnikarma do not recur. By conducting the procedure of Agnikarma , there is no fear of putrification, bleeding and with minimal scarring. It also yields quick relief [6] Bindu Agnikarma to Padakanistika, Antarkandargulpha and Katipradesha has been taken in previous dissertation works [7] Here the study was planned with sincere effort to evaluate the efficacy of Asthapada Panchaloha Shalaka Agnikarma at Katipradesha comparing it with Bindu Panchaloha Shalaka Agnikarma at Katipradesha (which has been taken up in previous dissertation works) because of following reasons. According to Acharya Sushruta , in general indication of Agnikarma emphasized that Agnikarma indicated in Atyugraruja and in Gridhrasi Atyugraruja starting from the Katipradesha i.e Sphik Poorva. [8] 1 Agnikarma is effective. 2 Safe and economical. 3 Avoids drug load to the body. Strong stimulus by Agnikarma brings vascular, neurological and endocrinal adaptations. Agnikarma can be performed as an OPD procedure without any hospitalization. A IMS AND O BJECTIVES ▪ To evaluate the effect of Astha Pada Panchaloha Shalaka Agnikarma in Gridhrasi. ▪ To evaluate the effect of Bindu Panchaloha Shalaka Agnikarma in Gridhrasi. ▪ To compare the effect of both group A & B. M ATERIALS AND M ETHODS The patients suffering from classical features of Sciatica randomly selected from OPD and IPD of Sri Jayachamarajendra Institute of Indian Medicine Hospital, Bangalore Method of collection of data Patient with signs and symptoms of Gridhrasi are taken for the study like; ▪ Presence of Ruk, Toda, Stambha and Spandana in the Sphik, Kati, Uru, Janu, Jangha and Pada or pain at least in two of these sites. ▪ Positive SLR test. ▪ Positive Lasegue’s sign Inclusion Criteria ▪ Patient with features of Gridhrasi namely Ruk (continuous pain), Toda (intermittent pain), Stambha (stiffness), Spandana (twitching) over

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 3 Sphik, Kati, Prishta, Uru, Janu, Jangha extending upto Pada. ▪ Positive SLR test. ▪ Positive Lasegue’s sign ▪ Patient with chronicity upto 3 years . ▪ Patient aged between 18 years - 60 years. Exclusion Criteria ▪ Patient with uncontrolled diabetes mellitus and serious illness. ▪ Patient with traumatic paraplegia, quadriplegia, paraplegia, hemiplegia, IVDP, bowel and bladder incontinence. ▪ Agnikarma Anarha like Pitta Prakriti, Binnakosta, Garbhini, Shalya Durbala, Baala, Vriddha, Vrana Pidita, Aswedya and contraindicated in Sharadh and Greeshma Ritu . ▪ Pregnant ladies and lactating mother. Study Design After the diagnosis of Gridhrasi , based on the above criteria, the selected patients were subjected for clinical study as follows. Sample Size and Grouping A total number of 40 patients who fulfilled the above criteria were selected for the clinical study. These 40 patients were divided randomly into 2 groups. A and B consisting of 20 patients in each. Group A: Patients under group A were subjected to Agnikarma using Asthapada Panchaloha Shalaka on the affected part over the most tender area, 3 such sittings were done with an interval of 7 days. Group B: Patients under group B were subjected to Agnikarma using Bindu Panchaloha Shalaka on the affected part over the most tender area, 3 such sittings were done with an interval of 7 days. Materials required for the study ▪ Stove - 1 ▪ Lighter - 1 ▪ Asthapada Panchaloha Shalaka - 1 ▪ Bindu Panchaloha Shalaka - 1 ▪ Bowl - 1 ▪ Marker pen - 1 ▪ Kidney tray - 1 ▪ Triphala Kashaya - Sufficient quantity ▪ Madhu and Sarpi - Sufficient quantity ▪ Cotton gauze - Sufficient quantity Table 1: Details of Panchaloha Shalaka Material used Propotion Tamra 40% Loha 30% Yashada 10% Rajatha 10% Vanga 10% ▪ Total length of Panchaloha Shalaka : 8 cms ▪ Diameter of the tip of the Bindu Shalaka : 1 mm ▪ Total length of the handle : 24.5 cms ▪ Weight of Shalaka : 225 gms Details of Asthapada Panchaloha Shalaka ▪ Total length of Asthapada Panchaloha Shalaka : 8 cms ▪ Diameter of the tip of the Asthapada Panchaloha Shalaka : 5 mm ▪ Total length of the handle : 24.5 cms ▪ Weight of Shalaka : 200 gms

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 4 Procedure Whole procedure was under three steps, Purva, Pradhana and Paschat Karma Purva Karma ▪ The patients were explained about the management procedure. ▪ Written consent was taken from every patient before hand. ▪ Advised to take Snigdha and Pichhila Aahara prior to the procedure. ▪ Patients were made to lie in prone position over the minor OT table. ▪ Lumbar region was cleaned with Triphala Kashaya and dried with sterilized gauze piece. ▪ The most tender point marked with a marker in the lumbar region. Pradhana Karma ▪ The Ashtapada Panchaloha Shalaka is heated till red hot. ▪ Ashtapada type Agnikarma is going to be made on marked point in such a way that Samyak Dagda Lakshanas (Shabda Pradurbhava, Durgandhata, Twaksankocha ) is achieved. ▪ During procedure, a swab soaked in pulp of the Kumari is applied just after making Dahana over the point. ▪ Total 3 sittings of treatment given at 7 days interval each. Pashchat Karma ▪ Immediately after Pradhana Karma , pulp of the Kumari is wiped out over the area of Agnikarma by using sterilized gauze pieces. ▪ Madhu and Sarpi was applied over the Samyak Dagdha Vrana . ▪ Patients are allowed to go home with advice not to cover the area of Agnikarma with cloth or bandage. He is advised not to use water over that part for at least 24 hours. He is advised to avoid Vatakara Ahara and Vihara . Number of sittings: Three such sittings of Agnikarma was carried out on 1 st day, 8 th day, 15 th day with a gap of 7 days each and observations were recorded in a proforma prepared before treatment (BT) 1 st day, on the 8 th day, 15 th day and 22 nd day Follow up: In cases where total relief was obtained during the study period and duration of next 30 days were fixed to observe the possibility of recurrence Assessment Criteria Subjective and objective parameters were assessed looking at the clinical response in both the groups. The patients were assessed on 1 st day (before starting the treatment), 8 th day (before 2 nd sitting), 15 th day (before 3 rd sitting) and on the 21 st day (after completion of treatment). The effect of 1 st day treatment was assessed on 8 th day before 2 nd sitting, 2 nd sitting effect was assessed on 15 th day and effect of 3 rd sitting on 21 st day. S UBJECTIVE P ARAMETERS Assessment Scale - Visual Analogue Scale Pain was graded on the basis of Visual Analogue Scale (VAS). ▪ 0 is scored as 0 = No pain ▪ 1-3 is scored as 1 = Mild Pain ▪ 4-6 is scored as 2 = Moderate Pain ▪ 7-9 is scored as 3 =Severe Pain ▪ 10 is scored as Worst Pain

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 5 Toda ▪ 0 - No intermittent pain ▪ 1 - Sometimes for 5-10 mins ▪ 2 - Daily for 10-30 mins ▪ 3 - Daily for 30-60 mins ▪ 4 - Daily more than 1 hr Stambha ▪ 0 - Absent ▪ 1 - Present Spandana in Sphik, Kati, Uru, Janu, Jangha and Pada ▪ 0 - Absent ▪ 1 - Present O BJECTIVE PARAMETERS Straight Leg Raising Test (30 - 70 Degree) ▪ 0 - Above 70 degree ▪ 1 - 60 - 70 degree ▪ 2 - 50 - 60 degree ▪ 3 - 40 - 50 degree ▪ 4 - 30 - 40 degree Lasegue’s test ▪ 0 - Absent ▪ 1 - Present Overall assessement of clinical response The overall effect of the clinical trial was assessed by considering all the parameters of assessment before and after treatment as follows; Relief Grading ▪ <25% Poor Response ▪ 25 - 49 % Moderate Response ▪ 50 - 74% Good Response ▪ 75 - 100 % Excellent response O BSERVATIONS AND R ESULTS Age: Out of total 40 patients in group A and group B, maximum patients were in age Group 50-59 (32.50%). Group wise division: They were 30% and 35% respectively in A and B Group. Sex: Out of 40 patients in group A and Group B, 20 patients were made. They were 65% and 35% respectively in A and B group. Religion: Out of total 40 patients in group A and Group B, maximum patients were of Hindu religion (92.50%). Group wise division: In Group A they were 95% of Hindus, while in group B they were 90% of Hindus. Occupation: Out of total 40 patients in Group A and Group B, maximum patients were found housewife. They were 22 (55%). Group wise division: In, Group A, they were 65% and Group B they were 45%. Economic status: Out of total 40 patients in group A and Group B, maximum patients were Middle class (67.50%). Group wise division: In, Group A, Middle class are 65% and Lower are 25%. In, Group B, Middle class are 70% and Lower are 30%. Affected side: In the study as a total 40 patients, 23 patients Affected Side were Right (57.50%) Among the 12 patients in group A is 60% and 11 patients in group B is 55%. Results on subjective parameters Table 2: Effect of Group - A and B on Ruk of ( Gridhrasi ) Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Day AT BT- AT 2.8 5 8 th 1.5 5 1.3 0 45.6 1 0.57 1 0.12 8 4.38 <0.0 5 20 t h 0.6 5 2.2 0 77.1 9 0.76 8 0.17 2 7.95 <0.0 5 AT 0.3 0 2.5 5 89.4 7 0.82 6 0.18 5 9.99 <0.0 5

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 6 Group B 2.7 5 8 th 1.9 5 0.8 0 29.0 9 0.52 3 0.11 7 4.77 <0.0 5 20 t h 1.0 5 1.7 0 61.8 2 0.57 1 0.12 8 11.2 4 <0.0 5 AT 0.4 5 2.3 0 83.6 4 0.57 1 0.12 8 15.2 0 <0.0 5 Effect on Ruk In this work of 20 patients studied in Gridhrasi with Group - A, Ruk revealed are given in detail in Table No. 2. Statistical analysis showed that the mean score which was 2.85 before the treatment was reduced to 0.30 after the treatment with 89.47% improvement and there is a statistically significant. (P<0.05). In this work of 20 patients studied in ( Gridhrasi ) with Group-B, Ruk revealed are given in detail in Table No. 2. Statistical analysis showed that the mean score which was 2.75 before the treatment was reduced to 0.45 after the treatment with 83.64% improvement and there is a statistically significant. (P<0.05). Table 3: Effect of Group - A and B on Toda of ( Gridhrasi ) Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Da y AT BT- AT 3.5 0 8 th 2.1 0 1.4 0 40.0 0 0.68 1 0.15 2 6.66 <0.0 5 20 th 1.4 0 2.1 0 60.0 0 1.11 9 0.25 0 8.39 <0.0 5 AT 1.1 0 2.4 0 68.5 7 1.39 2 0.31 1 8.17 <0.0 5 Group B 3.2 5 8 th 2.3 0 0.9 5 29.2 3 0.39 4 0.08 8 3.64 <0.0 5 20 th 1.2 5 2.0 0 61.5 4 0.64 9 0.14 5 7.72 <0.0 5 AT 0.5 0 2.7 5 84.6 2 0.78 6 0.17 6 11.7 7 <0.0 5 Effect on Toda In this work of 20 patients studied in Gridhrasi with Group-A, Toda revealed are given in detail in Table No.3. Statistical analysis showed that the mean score which was 3.50 before the treatment was reduced to 1.10 after the treatment with 68.57% improvement and there is a statistically significant. (P<0.05) In this work of 20 patients studied in Gridhrasi with Group-B, Toda revealed are given in detail in Table No.3. Statistical analysis showed that the mean score which was 3.25 before the treatment was reduced to 0.50 after the treatment with 84.62% improvement and there is a statistically significant. (P<0.05) Table 4: Effect of Group - A and B on Sthamba of Gridhrasi Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Da y AT BT- AT 1.0 0 8 th 0.5 5 0.4 5 45.0 0 0.51 0 0.11 4 3.94 <0.0 5 20 t h 0.0 5 0.9 5 95.0 0 0.22 4 0.05 0 19.0 0 <0.0 5 AT 0.0 5 0.9 5 95.0 0 0.22 4 0.05 0 19.0 0 <0.0 5 Group B 1.0 0 8 th 1.0 0 0.0 0 0.00 0.00 0 0.00 0 0.00 >0.0 5 20 t h 0.7 0 0.3 0 30.0 0 0.47 0 0.10 5 2.85 <0.0 5 AT 0.3 0 0.7 0 70.0 0 0.47 0 0.10 5 6.66 <0.0 5 Effect on Sthamba In this work of 20 patients studied in Gridhrasi with Group-A, Sthamba revealed are given in detail in Table No.4. Statistical analysis showed that the mean score which was 1.00 before the treatment was not reduced to 0.05 after the treatment with 95% improvement and there is a statistically significant (P<0.05).

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 7 In this work of 20 patients studied in Gridhrasi with Group-B, Sthamba revealed are given in detail in Table No.4. Statistical analysis showed that the mean score which was 1.00 before the treatment was not reduced to 0.30 after the treatment with 70% improvement and there is a statistically significant (P<0.05). Table 5: Effect of Group - A and B on Spandana of Gridhrasi Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Da y AT BT- AT 1.1 5 8 th 0.5 5 0.6 0 52.17 0.59 8 0.13 4 3.79 <0.0 5 20 t h 0.1 0 1.0 5 91.30 0.60 5 0.13 5 8.12 <0.0 5 AT 0.0 0 1.1 5 100.0 0 0.48 9 0.10 9 10.5 1 <0.0 5 Group B 1.0 0 8 th 1.0 0 0.0 0 0.00 0.00 0 0.00 0 0.00 <0.0 5 20 t h 0.7 0 0.3 0 30.00 0.47 0 0.10 5 2.85 <0.0 5 AT 0.2 5 0.7 5 75.00 0.44 4 0.09 9 7.55 <0.0 5 Effect on Spandana In this work of 20 patients studied in Gridhrasi with Group-A, Spandana revealed are given in detail in Table No.5. Statistical analysis showed that the mean score which was 1.15 before the treatment was reduced to 0.00 after the treatment with 100% improvement and there is a statistically significant. In this work of 20 patients studied in Gridhrasi with Group-B, Spandana revealed are given in detail in Table No.5. Statistical analysis showed that the mean score which was 1.00 before the treatment was reduced to 0.25 after the treatment with 75% improvement and there is a statistically significant. Results on Objective parameters Table 6: Effect of Group-A and B on SLR of Gridhrasi. Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Da y AT BT- AT 3.1 5 8 th 1.4 0 1.7 5 55.5 6 0.63 9 0.14 3 7.76 <0.0 5 20 t h 0.7 0 2.4 5 77.7 8 0.75 9 0.17 0 11.6 7 <0.0 5 AT 0.2 0 2.9 5 93.6 5 0.94 5 0.21 1 14.4 9 <0.0 5 Group B 3.0 5 8 th 2.0 5 1.0 0 32.7 9 0.32 4 0.07 3 4.61 <0.0 5 20 t h 1.0 5 2.0 0 65.5 7 0.32 4 0.07 3 9.21 <0.0 5 AT 0.5 0 2.5 5 83.6 1 0.60 5 0.13 5 12.4 5 <0.0 5 Effect on SLR In this work of 20 patients studied in Gridhrasi with Group-A, SLR revealed are given in detail in Table No.6. Statistical analysis showed that the mean score which was 3.15 before the treatment was reduced to 0.20 after the treatment with 93.65% changes and there is a statistically significant. In this work of 20 patients studied in Gridhrasi with Group-B, SLR revealed are given in detail in Table No.6. Statistical analysis showed that the mean score which was 3.05 before the treatment was reduced to 0.50 after the treatment with 83.61% changes and there is a statistically significant Table 7: Effect of Group - A and B on Lasegue’s Sign of Gridhrasi Group A Mean score % S.D (±) S.E (±) t valu e p valu e BT Day AT BT- AT 1.0 0 8 th 0.4 0 0.6 0 60.00 0.50 3 0.11 2 5.34 <0.0 5 20 t h 0.1 0 0.9 0 90.00 0.30 8 0.06 9 13.0 8 <0.0 5

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 8 AT 0.0 0 1.0 0 100.0 0 0.00 0 0.00 0 19.0 0 <0.0 5 Group B 1.0 0 8 th 1.0 0 0.0 0 0.00 0.00 0 0.00 0 0.00 >0.0 5 20 t h 0.8 0 0.2 0 20.00 0.41 0 0.09 2 2.18 <0.0 5 AT 0.4 5 0.5 5 55.00 0.51 0 0.11 4 4.82 <0.0 5 Effect on Lasegue’s Sign In this work of 20 patients studied in Gridhrasi with Group- A, Lasegue’s Sign revealed are given in detail in Table No.7. Statistical analysis showed that the mean score which was 1.00 before the treatment was reduced to 0.00 after the treatment with 100% changes and there is a statistically significant. In this work of 20 patients studied in Gridhrasi with Group- B, Lasegue’s Sign revealed are given in detail in Table No.7. Statistical analysis showed that the mean score which was 1.00 before the treatment was reduced to 0.45 after the treatment with 55% changes and there is a statistically significant Assessment of total effect of therapy Table 8: Overall effect of Group-A Effect of treatment in Group - A Class Grading No of patients 0-25% No improvement 0 26 – 50 % Mild improvement 1 51 – 75% Moderate improvement 2 76 – 100 % Marked improvement 17 Table 9: Overall effect of Group-B Effect of treatment in Group - B Class Grading No of patients 0-25% No improvement 0 26 – 50 % Mild improvement 2 51 – 75% Moderate improvement 5 DISCUSSION Agnikarma is an important therapeutic measure in Ayurvedic system of medicine, which has got worldwide popularity because of its simple administration and its efficacy in variety of disorders. It is unique form of therapy performed using Agni which has been described to be superior than Ksharakarma , as disease treated by it will not relapse and moreover those incurable by Bheshaja, Shastra and Kshara Karma yield to it. This is subtype of Anushastra Karma . In Chikitsa of Gridhrasi role of Agnikarma is been emphasized. While describing the general indications of Agnikarma Aacharya Sushruta has explained that, Agnikarma can be adopted in managing Ugraruja . And also, there is reference that, the disease which are not amneable to drugs, surgical instruments and caustic alkali, can be successfully treated by Agnikarma and there will be no recurrence. Another explanation is Ushna Guna of Agni improves Dhatvagni that pacifies Amadosha and reduces the pain by these means as Vataprashamana occurs, pain subsides spontaneously. It is hypothetically stated that after Samyak Dagdha , some local antibodies or non-specific immune-globins may act as a disease modifying agents. It is also hypothetically stated that when Agnikarma is done it stimulates piezo electricity there by releasing electrical signals and then cause oriental deposits in lesions, this resists deformity and prevents further damage, thus may help to bring back normalcy. CONCLUSION On comparing over all effect of the therapy, Group A was better than Group B. Asthapada Panchaloha Shalaka Agnikarma was more effective in managing the pain than Bindu Panchaloha Shalaka Agnikarma. As comparing to Bindu Shalaka , the number of Agnikarma required per sitting is considerably less in Asthapada Panchaloha Shalaka. Statistically both groups showed significant changes making SLR and Lasegue’s sign negative better in Group A. In Group A out of 20 patients after the completion of treatment 8 patients were completely improved, 5 patients were markedly improved and 6 patients were moderately

Dr. Bhagyashree VG et.al. The effect of Asthapada Panchaloha Shalaka Agnikarma. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 9 improved 1 patient was mildly improved. None of the patients were found unchanged. In Group B out of 20 patients after the completion of 5 patients were completely improved, 4 patients were markedly improved, 10 patients were markedly improved 1 patient was mildly improved. None of the patients were unchanged. The patients who had got complete relief had a follow up period of 30 days and was observed that 2 patients from Group A and 3 patients of Group B had recurrence. The test shows that the treatment is statistically not significant in Group B when compared to Group A. Group A overall result is 86.87% and Group B overall result is 80.86%. REFERENCES 1 Sushruta, Sushruta Samhita, with Nibandha Samgraha commentary by Dalhana and Nyayachandrika panjika by Gayadasa Edited by ‘Vaidya Yadavji Trikamji Acharya’ and ‘Narayan Ram Acharya’ Nidanasthana, Chaukambha Sankrit Sansthan, Varansi,UP, Edition- 2008, Sutrasthana. Chapter 1/74 pp 268. 2 Sharma RK, Bhagwan Das, Charaka Samhita, Text with English Translation and Critical Exposition, Varanasi, Choukhambha Sanskrit Series office. 2009 sutrasthana. Chapter 20/11 pp 113. 3 www.en.wikipedia.org/wik/Enteric-nervous-system. 4 https://insights.ovid.com/pubmed?pmid=11337625 5 Sushruta, Sushruta Samhita, with Nibandha Samgraha commentary by Dalhana and Nyayachandrika panjika by Gayadasa Edited by ‘Vaidya Yadavji Trikamji Acharya’ and ‘Narayan Ram Acharya’ Nidanasthana, Chaukambha Sankrit Sansthan, Varansi,UP, Edition- 2008 chikitsasthana. Chapter 5/23 pp 428. 6 Sushruta, Sushruta Samhita, with Nibandha Samgraha commentary by Dalhana and Nyayachandrika panjikaby Gayadasa Edited by ‘Vaidya Yadavji Trikamji Acharya’ and ‘Narayan Ram Acharya’ Nidanasthana, Chaukambha Sankrit Sansthan, Varansi,UP, Edition- 2008 sutrasthana. Chapter 12/3 pp 51. 7 Vagbhata. Ashtanga Hridaya- (Text, English Translation, Notes, appendix Indices) Translated by KR Srikanthamurthy. 4 th ed. Varanasi: Chowkhambha Krishnadas Academy; Reprint 2013. Vol. I 8 Sharma RK, Bhagwan Das, Charaka Samhita, Text with English Translation and Critical Exposition, Varanasi, Choukhambha Sanskrit Series office. 2009 chikitsasthana.Chapter 28/56 pp 618. ******************************* How to cite this article: Dr. Bhagyashree VG, Dr. Shridhar Rao SM. The effect of Asthapada Panchaloha Shalaka Agnikarma in the pain management of Gridhrasi w.s.r. to Sciatica. J Ayurveda Integr Med Sci 2019;4:1-9. http://dx.doi.org/10.21760/jaims.4.4.1 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Vihara, Nidana, Ayurveda, Sushruta-samhita, Gridhrasi, Toda, Stambha, Snehana, Shalyatantra, Pradhana-karma, Paschat-karma, Garbhini, Vriddha, Doi, Pittaprakriti, At, Ruj, Spandana, Mahagada, Siravyadha, Bastikarman, Agnikarma, Samhitas of Ayurveda, Diabetes mellitus, Sciatica, Modern medicine, Lumbago, Journal of Ayurveda, Hemiplegia, Pain management, Statistical analysis, Group A, Economic status, Original article, In this work, Inclusion criteria, Exclusion criteria, Sample size, Overall effect of therapy, Statistically Significant, Swedana, Effect of therapy, Acharya Sushruta, Acharya Charaka, Brihatrayee, Vataja Nanatmaja Vyadhi, Visual analogue scale, Effect of treatment, Subjective parameter, Triphala Kashaya, Shamanoushadhi, Objective parameter, Muscle relaxant, SLR test, Overall effect, Ruk, Toda, Stambha, Conservative treatment, Mean score, Greeshma Ritu, Symptomatic management, Kati pradesha, Pashchat Karma, Spinal nerve irritation, Samyak Dagdha Vrana, Lasegue's Sign, Intermittent pain, Post Graduate Scholar, Quadriplegia, Opioid Analgesic, Paraplegia, ISSN, Positive SLR test, No recurrence, Epidural steroid injection, Quick Response Code, OPD, Vatakara Ahara, Corticosteroid, Statistically not significant, Straight Leg Raising, Group B, Accepted Date, SLR, BT, Treatment was, Katipradesha, Madhu and Sarpi, S.D, S.E, Aswedya, NSAID's, Govt Ayurvedic Medical College, Affected side, After the treatment, Before the treatment, Treatment with, Lasegue's test, Bowel incontinence, Vata Prakopaka Hetu.