An open label single arm prospective clinical study on Vatagajankusharasa...

[Full title: An open label single arm prospective clinical study on Vatagajankusharasa with Pippali Churna and Manjishta Kwatha as Anupana in Gridhrasi (Sciatica)]

[Find the meaning and references behind the names: Moh, Sri, Hassan, Tota, Low, Janu, Rasa, Gopan, Gulfam, Sakthi, Vishnu]

ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 11 An open label single arm prospective clinical study on Vatagajankusharasa with Pippali Churna and Manjishta Kwatha as Anupana in Gridhrasi (Sciatica) Dr. Vishnu M L 1 , Dr. Vasantha B 2 , Dr. Totad Muttappa 3 , Dr. Yadu Gopan 4 , Dr. Moh Gulfam 5 1,4,5 Final year Post Graduate Scholar, 2,3 Associate Professor, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan, Karnataka, INDIA. I NTRODUCTION Gridhrasi , one among 80 Vataja Nanatmaja Vyadhis is characterized by Stambha, Ruk, Toda, Spandana; initially affect Sphik, Kati and then gradually radiates Address for correspondence: Dr. Vishnu M L Final year Post Graduate Scholar, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan, Karnataka, INDIA. E-mail: vishnu 2010.ml@gmail.com Submission Date: 02/09/2019 Accepted Date: 07/10/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.5.4 to posterior aspects of Uru, Janu, Jangha and Pada [2] Two types of Gridhrasi , Vataja and Vatakaphaja can be seen, in Vatajagridrasishoola , Sthamba and Thoda are prominent symptoms while in Vata- Kaphajagridrasi there will be more of Tandra, Gaurava and Arochaka [3] In Gridhrasi Lakshanas like ‘Sakthi Utkshepam Nigruhnati’ and gait similar to ‘ Gridha’ not only depicts the difficulty in walking, but also inflicts the severity of pain [4],[5] This condition is clinically very similar to sciatica, which is a condition where there is distribution of pain along the course of sciatic nerve i.e., radicular pain from low back to foot [6] In this disease, mainly Apana Vata [7] and Vyana Vata [8] vitiation are observed, but most of the times Kapha remains as associated Dosha . So for, treatment of A B S T R A C T Background - Low backache is the 2 nd most common reason for all physician visits and it is a condition that affects as many as 80-90% of people during their life time [1] Sciatica is a relatively common condition with a life time incidence varying from 13-40%. Gridhrasi in Ayurveda is a Rujapradhana Nanatmaja Vatavyadhi , which has similar presentation of sciatica intervenes with the functional ability of low back and lower limbs Vata Gajankusha Rasa is a potent medicinal preparation, which in classics have mentioned can cure severe form of Gridhrasi in a week. The present study is taken up with the hypothesis that Vata Gajankusha Rasa with Manjishta Kwatha and Pippali Churna as Anupana would be effective in the management of Gridhrasi . Objective - To evaluate the effectiveness of Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana in the management of Gridhrasi (sciatica) Method - Among 40 registered patients 36 of them completed the course of treatment. They were administered with Vatagajankusha Rasa (125 mg) twice daily with Pippali Churna (3 grams) and Manjishta Kwatha (15 ml) as Anupana before food for a period of 7 days. For stastistical analysis subjective and objective parameters were assessed by Wilcoxon signed rank and McNemar test Result - In the parameters of Gridhrasi, the medicine was found to be statistically significant in relieving the assessment parameters like Ruk, Toda , Sthambha, Aruchi, Gourava (p<0.001). In Objective parameters like SLR and Lessagues test, significant relief was observed after statistical analysis. Conclusion - Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana is effective in the management of symptoms of Gridhrasi Key words: Gridrasi, Lowback Ache, Sciatica, Vata Gajankusha Rasa, Pippali, Manjishta.

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

Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 12 Gridhrasi , drug of choice should have Vata - Kaphashamana, Dipana - Pachana and Shulaprashamana properties Vatagajankusha Rasa is a combination of Vyosha, Rasa Bhasmas, Vatsanabha, Karkatasringi, Haritaki etc. Of which Shunti, Maricha, Pippali has Deepana, Aamapachana action and improves the digestion. Vatsanabha has the property of Vikasi, Vyavayi, Yogvahi. Haritaki, Agnimantha, Karkatashringi works as Deepana, Vatanulomaka, Kaphanisaraka, Vatashamaka. Rasa-Bhasma’s improves Agni and acts as Balya, Rasayana, Vatapradhana Tridosha Shamaka . So it will be very effective in Vatavyadhis [9] Here the study was taken to find out the effectiveness of Vatagajankusha Rasa with Manjishta Kwatha and Pippali Churna as Anupana in the management of Gridhrasi (Sciatica). O BJECTIVE OF THE S TUDY To evaluate the efficacy of Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana in the management of Gridhrasi (Sciatica) M ATERIALS AND M ETHODS Source of data Patients who attended the out-patient department of Kayachikitsa at Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan Method of collection of data 49 patients (Table 1) were screened and selected based on the screening form prepared. Data was collected using specially prepared case report form. The demographic details of 40 enrolled patients of Gridrasi such as age, gender, educational status etc. are represented in table below (Table 1). Table 1: Demographic detail of 40 patients of Sciatica Geographic Observation Predominance No of Patients (%) Age 31-40 12 (30 %) Gender Male 22 (55%) Marital status Married 33 (82.5%) Educational status Middle school 18 (45%) Occupation Agriculture 12 (30%) The observations related to the disease details of the 40 patients of Sciatica are represented in table below (Table 2) Table 2: Observations related to diseaseof 40 patients of Sciatica Parameter Observation No of Patients (%) Stambha Present 37 (92.5%) Ruk Present 40 (100%) Toda Present 40 (100%) Spandana Present 36 (90%) Gaurava Present 20 (50%) Arochaka Present 9 (22.5%) Tandra Present 6 (15%) Duration Chronic 19 (47.5%) H/O trauma to LS Present 6 (15%) Diagnostic criteria Diagnosis was made on the basis of Samanya Lakshanas of Gridrasi viz. Stambha, Ruk, Toda and Spandana starting from Sphika and extend through Kati, Prishta, Uru, Janu, Jangha, Padam in an order and on the basis of symptoms of sciatica. Inclusion criteria 1 Positive Straight Leg Raising test (30 to 70 degree) 2 Patients aged between 20-70 years 3 Patients of either gender irrespective of caste, creed and religion 4 Patients who are willing to participate and sign the informed consent form

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Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 13 Exclusion criteria 1 Uncontrolled Diabetes Mellitus and Hypertension 2 Systemic disorders like Chronic Heart Disease, Chronic Renal Failure, Chronic Liver Disease 3 History of HIV, HbSAg, Carcinoma 4 Pregnant woman and lactating mother 5 History of major trauma causing fractures of pelvis and femur 6 Surgical indications such as progressive neurological deficit Ethical clearance Ethics clearance was obtained from Institutional Ethics Committee before initiation of the study (IEC No: SDM/IEC/17/2017-2018) Study design The study was open label, single arm, exploratory, prospective clinical on 30 patients of Sciatica selected using the convenience/ purposive (non-random) sampling technique with pre and post test design conducted in a tertiary Ayurveda hospital attached to quarters in southern India. Intervention Medicines - Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana. Source and authentification of drug Vatagajankusha Rasa (125 mg each) tablets were purchased from VIRGO Pharmacy, Gujarat, which is a GMP certified pharmacy. Powdered Pippali was purchased from Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital pharmacy, Udupi, which is a GMP certified pharmacy. Raw drugs for Manjishta Kwatha were procured from Kajrekar pharmacy, Belagavi and were authenticated at Dravyaguna department of Sri Dharmasthala Manjunatheswara College of Ayurveda and Hospital, Hassan. Method of preparation of Manjishta Kwatha Roots of Manjishta were cleaned and dried. They were coarsely powdered, weighed as per formula and then mixed well. 4 parts of water was added to 1 part of Manjishta coarse powder, boiled and reduced to 1/4 th part. Prepared Kwatha was packed in 210 ml bottles and labeled with name of the drug, reference, details of the manufacturer, batch number. Treatment plan Vatagajankusha Rasa tablet of 125 mg after food with 3 gm Pippali Churna and 15 ml Manjishta Kwatha as Anupana twice daily. Duration: 7 days Assessment Criteria Primary outcome measures Samanya Lakshanas of Gridrasi like Stambha, Ruk, Toda, Spandana, Tandra, Gauravata, Arochaka Symptoms of sciatica Secondary outcome measures Gait Straight leg raising Test (goniometry) Lassegues sign Table 3: Assesment criteria (self assessed scale) SN Subjective Parameter Grade Assessment 1. Sthambha 0 No stiffness 1 With up to 25% impairment in the range of movement of joint 2 With 25-50% impairment in the range of movement of joints 3 With 50-75% impairment in the range of the movement of joints 4 With more than 75% impairment in the range of movements of the joints 2. Ruk - VAS 0 No pain - Scale reading 0

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

Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 14 1 Mild pain - Scale reading >0-3 (Mild pain complained by patient when asked) 2 Moderate pain - Scale reading >3-6 (Patient frequently complained of pain and has painful look) 3 Severe pain - Scale reading >6-10 (Excruciating pain associated with painful cries and agonizing look) 3. Toda 0 No pricking sensation 1 Mild pricking sensation sometimes 2 Frequent pricking sensation 3 Severe pricking sensation all the time 4. Spandana 0 Absent 1 Present 5. Gowrava 0 No heaviness 1 Occasionally 2 Daily and high in frequency but not persistent 3 persistent 6. Arochaka 0 No complains 1 1-2 times weekly complains of no desire to eat anything 2 3-4 times weekly complains of no desire to eat anything 3 Always complains of no desire to eat anything 7. Tandra 0 Absent 1 Present 8. SLR (Straight Leg Rising) 0 SLR 90 degrees 1 SLR 70-90 degrees 2 SLR 50-70 degrees 3 SLR 30-50 degrees 4 SLR 0-30 degrees 9. Lasegue’s Sign 0 absent 1 present 10. Tenderness 0 No tenderness 1 Subjective experience of tenderness 2 Wincing of face on expression 3 Wincing of face and withdrawal 4 Do not allow to touch 1 Abnormal O BSERVATIONS AND R ESULTS Total 40 patients of Gridhrasi were registered for the study; out of which 4 were dropout and rest 36 patients completed the study. The effectiveness of the therapy in those 36 patients are being shown here under the separate headings. Statistical analysis was done using SPSS VER. 23 using Wilcoxon signed rank test and McNemar test Table 4: Results of Wilcoxon signed rank test showing the effect of therapy. Param eter Negative ranks Positive ranks Ti e s To tal Z valu e P valu e N M R SR N M R SR Stamb ha Rt BT-AT 1 7 9 00 15 3.0 0 0 0 0 0 0.0 0 1 9 36 - 3.8 27 .000 * Stamb ha Lt BT-AT 1 9 10 .5 0 19 9.5 0 1 1 0 5 0 10 50 1 6 36 - 4.0 25 .000 * Ruk Rt 1 9 10 .0 19 0.0 0 0 0 0.0 0 1 7 36 - 4.3 .000 *

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

Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 15 BT-AT 0 0 0 59 Ruk Lt BT-AT 1 2 6 50 78 00 0 0 0 0 0.0 0 2 4 36 - 3.4 64 .001 * Toda Rt BT-AT 1 6 9 03 14 4.5 0 1 8 5 0 8.5 0 1 9 36 - 3.5 78 .000 * Toda Lt BT-AT 8 4 50 36 00 0 0 0 0 0.0 0 2 8 36 - 2.7 14 .000 * Gaura va Rt BT-AT 6 3 50 21 00 0 0 0 0 0.0 0 3 0 36 - 2.4 49 .014 * Gaura va Lt BT-AT 6 3 50 21 00 0 0 0 0 0.0 0 3 0 36 - 2.4 49 .014 * Arocha ka AT- BT 6 3 50 21 00 0 0 0 0 0.0 0 3 0 36 - 2.3 33 .020 * ASLR Rt BT- AT 2 2 12 .0 2 26 4.5 0 1 1 1 5 0 11 50 1 3 36 - 4.3 15 .000 * ASLR Lt BT-AT 1 8 9 50 17 1.0 0 0 0 0 0 0.0 0 1 8 36 - 4.2 43 .000 * PSLR Rt BT- AT 1 9 10 .0 0 19 0.0 0 0 0 0 0 0.0 0 1 7 36 - 4.2 64 .000 * PSLR Lt BT- AT 1 7 9 59 16 3.0 0 1 8 0 0 8.0 0 1 8 36 - 3.6 26 .000 * Tender ness Rt BT- AT 2 0 10 .5 0 21 0.0 0 0 0 0 0 0.0 0 1 6 36 - 4.4 72 .000 * Tender ness Lt BT-AT 1 7 9 50 16 1.5 0 1 9 5 0 9.5 0 1 8 36 - 3.7 71 .000 * * - Significant Table 5: Results of McNemar test showing the effect of therapy. Parame ter BT AT N P valu e Remar ks Prese nt Abse nt Prese nt Abse nt Spanda na Rt BT-AT 25 11 11 25 3 6 .000 S Spanda na Lt BT-AT 10 26 5 31 3 6 .063 NS Tandra 5 31 0 36 3 6 .063 NS Lassegu e test Rt BT-AT 26 10 17 19 3 6 .004 S Lassegu e test Lt BT-AT 18 18 7 29 3 6 .001 S DISCUSSION Statistically significant improvements were observed in the primary and secondary outcome measures with administration of Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana . Assessment of these parameters was done after 7 days of treatment. Stambha was manifested as a result of Vataprakopa and Sheetaguna . Vata due to its Ruksha and Kharaguna produce dryness and decreases Snigdhata and Shlakshnata ( Shleshaka Kapha ) in Mamsa Dhatu , which is essential for proper contraction and relaxation of muscles. Ingredients of Vatagajankusha Rasa like Rasasindhura, Lohabhasma, Swarnamakshika, Gandhaka, Vatsanabha, Tankana, Trikatu etc. with the Bhavana of Nirgundi and Mundi Swarasa makes the drug more potent against Vata and Kapha disorders. Shudha Haratala, Shunti, Pippali act as Vatashamaka , due to its Ushnavirya and Snigdha Guna , which might have reduced the Stambha .

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

Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 16 Ruk and Toda Lakshanas were manifested as a result of Prakopa of Vyanavata and Apana Vata and Sleshaka Kapha due to Nidanas like Atibharavahana , Vishama Cheshta and Divaswapna . Bhasmas , Hareetaki, Karkatasringi in Vatagajankusha Rasa are Vatashamaka Dravayas. Pippali, Maricha and Shunti are Shoola Prashamana Dravyas. Vatsanabha is Kaphavatahara and Rujapaha . Manjistha Kashaya helps in pacifying the Prakupitavata due to its Ushnavirya and Madhura Rasa. Pippali Manjishta Vatsanabha have analgesic activity due to glycosides, alkanoids and other bio active compounds present in them and helps in reducing the pain [10],[11] Sanga of Vata and its increased Chalaguna can be held responsible for localised pulsations ( Spandana ). Vatagajankusha Rasa containing Vatahara drugs like Hareetaki and Vatsanabha having Ushnalaghu Guna might have removed Sanga by Vata Anulomana. Manjishta and Shunti acts as Srotoshodhaka and Raktaprasadaka. Tandra is a Kaphaja Lakshana seen in Gridhrasi . Vatagajankusha Rasa containing Lohabhasma , Tankana, Pippali, Shunti, Karkatasringi on administration does Kaphaharana and reduces Tandra. Gourava was manifested due to the Guru Guna predominantly found in Kapha Dosha . Aruchi is a Kaphajananathmaja Vyadhi . Vatagajankusha Rasa contains Shunthi and Pippali having Laghuguna and Ushnaveerya, helps in Kaphahara property. Haritaki, Agnimantha, Karkatshrangi works as Deepana, Vatanulomaka, Kaphanissaraka and Vatashamaka . Rasa Bhasmas increases the Agni . Manjisthakashaya having Rukshaguna, Ushnavirya, Katuvipaka reduced Gourava and Arochaka . Pippali Churna having Katu Rasa and Usnavirya did Kaphaharana and reduced above symptoms . Reduction in the degree of SLR was manifested as a result of Vyana Vata vitiation, due to Prakupita Kapha Dosa . The Prakopa of Kapha Dosha was caused due to Guru Guna. The combination of Rasa Oushadhis in Vatagajankusha Rasa acts as Vatapradhana Tridoshahara. Karkatasringi, Haritaki, Agnimantha works as Agnideepaka, Vatanulomaka, Kaphanisaraka and Vatashamaka. Another cause for reduction in SLR is the Shoshana of Sira and Snayu. These are the Upadhatus of Raktadosha. Manjishta is Raktaprasadaka which nourishes the Rakta and its Upadhatus and improves the blood circulation. Manjishta being Pitta-Kapha Shamaka, can counteract the Pitta or Kaphaanubandha with Vata. Movements of the lower limbs are improved by Bhasmas and drugs like Pippali, Haritaki, Vatsanabha having Balya, Rasayana property by promoting Dhathu Poshana . Tenderness was manifested as a result of Raktadusti and Vataprakopa . Manjistha Kashaya having Madhuratikta Rasa and Ushna Virya did Sroto Shodhana and Rakta Prasadana . Drugs Like Hareetaki, Vatsanabha, Shunti, Pippali in Vataganjankusha Rasa are having Vatahara , Vedanasthapana properties, which might have acted on tenderness. Discussion on mode of action of drug Vatagajankusha Rasa is a combination of Rasa Aushadhis like Rasa Sindhura, Lohabhasma, Swarnamakshika Bhasma, Gandhaka, Haratala, Tankana and Dravyas like Haritaki, Karkatasringi, Vatsanabha, Shunti, Pippali, Agnimantha with Bhavana in Nirgundi Swarasa and Mundi Swarasa. This combination of Rasa Oushadhis acts as Vatapradhana Tridoshahara . They increase the Jataragni and works as Balya and Rasayana . After Marana , Rasa Bhasmas become microfine particles. They get easily absorbed into the body along with Rasa Dhatu and provides nourishment to the body. After Marana the particle size of Bhasma reduces into the size of “platelets” (1.5 чm) and it can be absorbed through the gap junctions and epithelial tissues in middle gut. Particles penetrate the intestinal barrier either by endocytosis, phagocytosis or persorption and transit to the blood stream [12] Pippali, Maricha, Shunti are Shoolaprashamana Dravyas . They improve digestion by Deepanapachana Karma and thereby improves the overall nourishment of the body. Vatsnabha is Kaphavatahara and Rujapaha. It has Vikasi, Vyavayi, Yogvahi Guna makes it easy to reach the cellular level. Karkatasringi,

[Find the meaning and references behind the names: Dennis, June, Singh, Main, Anthony, Gopa, Verma, Nil, Med, April, Eugene]

Dr. Vishnu M L. et al. An open label single arm prospective clinical study on Gridhrasi (Sciatica) ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 17 Haritaki, Agnimantha work as Agnideepaka, Vatanulomaka, Kaphanisaraka and Vatashamaka. Nirgundi, Agnimantha, Lauha Bhasma, Shudha Gandhaka and Tankana Bhasma act as Shothahara. Shunti acts as Srotoshodhaka and Raktaprasadaka. Pippali, Manjishta, Vatsanabha have analgesic activity due to glycosides, alkanoids and other bio active compounds present in them and helps in reducing the pain. Pippali Choorna due to its Katu Rasa, Laghu Snigdha Guna and Madhura Vipaka acts as Deepaka, Vatanulomaka, Balya, Rasayana ; improves the Jataragni and nourishes the body. Manjishta Kwatha is having Tikta Rasa, Ushna Guna and Katu Vipaka. It’s Raktaprasadaka action improves the blood circulation and it is Srotoshodhaka . Thus Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha Anupana acts as Vata Pradhana Tridosha Shamaka, Deepaka, Pachaka, Shothahara, Srotovishodhaka, Raktaprasadaka, Balya and Rasayana. CONCLUSION Vatagajankusha Rasa contains the main ingredients like Rasa Sindhura, Loha bhasma, Swarnamakshika Bhasma , Shunthi , Pippali , Vatsanabha etc. and hence acts on Vata and Kapha Dosha which shows its action on both variants of Gridhrasi . Vatagajankusha Rasa with Pippali Churna and Manjishta Kwatha as Anupana showed marked effect on the signs and symptoms of Gridhrasi - Ruk, Toda, Stambha, Gourava and Aruchi. Medicines showed marked effect on objective parameters of Gridhrasi like - Straight leg raising test and lassegues test. Range of movements of lumbar spine showed significant improvement after treatment. Vatagajankusha Rasa orally in the dose of 125 mg twice daily with Pippali Churna (3 gm) and Manjishta Kwatha (15 ml) as Anupana for 7 days is effective in Gridhrasi. REFERENCES 1 Dennis L Kasper, Eugene Braunwald, Anthony S Fauci et al : Harrison’s principal of Internal Medicine, 14 th chapter 19 th edition – 2016 published by McGraw-Hill Medical Publishing Division, Page no. 1002-7 2 Acharya JT, editor. Charaka Samhita of Agnivesha, Sutrasthana, Ch. 20, Ver. 11. 4 th ed. Varanasi: Chaukhambha Surbharati Prakashana; 1994. p. 113. 3 Acharya JT, editor. Charaka Samhita of Agnivesha, Chikitasthana, Ch. 28, Ver. 56-57. 4 th ed. Varanasi: Chaukhambha Surbharati Prakashana; 1994. p. 619. 4 Paradakara HSS, Ashtanga Hrudayam with Sarvanga Sundaram commentary of Arunadutta and Ayurveda Rasayana of Hemadri. Nidana Sthana 15/54. 10 thed. Varanasi (India): Chaukambha Orientalia; 2014. P.535 5 Acharya JT, editor. Sushruta Samhita of Sushruta, Nidansthana, Ch. 1, Ver. 74. 4 th ed. Varanasi: Chaukhambha Prakashana;1980. p. 268. 6 www.wikipedia.org/wiki/Sciatica browsed on 10/12/2015,2.30 pm.- Valat JP;Genevay, S; Marty, M; Rozenberg, S; Koes,B(April 2010). Sciatica best practice and research.Clinical rheumatology. 7 Paradakara HSS, Ashtanga Hrudayam with Sarvanga Sundaram commentary of Arunadutta and Ayurveda Rasayana of Hemadri. Sutra Sthana 12/9. 10 thed. Varanasi (India): Chaukambha Orientalia; 2014. P.193. 8 Paradakara HSS, Ashtanga Hrudayam with Sarvanga Sundaram commentary of Arunadutta and Ayurveda Rasayana of Hemadri. Sutra Sthana 12/7. 10 thed. Varanasi (India): Chaukambha Orientalia; 2014. P.193. 9 Verma A, A.K. Singh - A clinical & comparative study of vatgajankushras and sallaki tablet in the management of Gridhrasi with special reference to sciatica - International ayurvedic medical journal, (issn:2320 5091) (february, 2107) 5 (2). 10 G Vedhanayakai, Indian journal of experimental biology, vol 41, june 2003, pp 649-651 11 Anarpatel, Journal of pharmaceutical science and research, vol 2 (12), 2010, 809-813 12 C.B. Jha, B.Bhattacharya, K.K.Narang, Bhasmas as natural nanaorobots: the bio relevant metal complex. J. Tradt Nat Med; 1(1): 2-9 ******************************* How to cite this article: Dr. Vishnu M L, Dr. Vasantha B, Dr. Totad Muttappa, Dr. Yadu Gopan, Dr. Moh Gulfam. An open label single arm prospective clinical study on Vatagajankusharasa with Pippali Churna and Manjishta Kwatha as Anupana in Gridhrasi (Sciatica). J Ayurveda Integr Med Sci 2019;5:11-17. http://dx.doi.org/10.21760/jaims.4.5.4 Source of Support: Nil, Conflict of Interest: None declared.

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