A comparative clinical study to evaluate the efficacy of Eranda Beeja Payasa...

[Full title: A comparative clinical study to evaluate the efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matrabasti in the management of Gridhrasi w.s.r to Sciatica Syndrome]

ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 72 A comparative clinical study to evaluate the efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matrabasti in the management of Gridhrasi w.s.r to Sciatica Syndrome Dr. Laxmi Lingaraddy Post Graduate Scholar, Department of Kayachikitsa, BLDEA’s AVS Ayurved Mahavidyalaya, Vijayapur, Karnataka, INDIA. I NTRODUCTION Our Ancient Acharyas had identified this problem long back and named it ‘ Gridhrasi ’. The word ‘ Gridhrasi ’ itself suggests the gait of the patient which is similar to Gridhra (vulture) due to pain. All the Ayurvedic classics including those written in medieval period have described the aetiopathogenesis and symptomatology of Gridhrasi in concise form. Best part is the description narrated in these classics exactly coincides to the description of ‘Sciatica’ Address for correspondence: Dr. Laxmi Lingaraddy Post Graduate Scholar, Department of Kayachikitsa, BLDEA’s AVS Ayurved Mahavidyalaya, Vijayapur, Karnataka, INDIA. E-mail: laxmireddy 008@gmail.com Submission Date: 12/09/2019 Accepted Date: 21/10/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.5.14 including the important diagnostic test SLR which is described as ‘Sakthinikshepanigraha ’ [1] by our Acharyas . The prime cause of Gridhrasi is the vitiated Vata. Hence it is included in Vata Nanatmaja Vyadhi Sometimes Kapha may be associated with vitiated Vata localization of the vitiated Doshas in Gridhrasi is described in a particular order in which pain starts from Sphik a nd then radiates to Pada along with Stambha, Toda etc. Despite of the technological and pharmacological advancement in modern system of medicine, the management of Sciatica is still a medical problem where no permanent medical treatment is available except some palliative measures. Chances of recurrence are high even after surgery which are expensive with their limitations. To fulfill the expectations from the Ayurvedic field and to find out more effective and safe therapy for Gridhrasi we have selected Gridhrasi for the research work. Ayurveda has description of various therapies for treatment of Gridrasi, Chakradatta has explained Eranda Beeja Payasa [2] for Gridhrasi Chikitsa in Vatavyadi Chikitsa Adhyaya and Charaka Samhita has special formulation A B S T R A C T Gridhrasi is a Rujapradhana Nanatmaja Vata Vyadhi, intervening with the functional ability of low back and lower limbs. The aim of the study is to evaluate the efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matra Basti in the management of Gridhrasi with special reference to Sciatica Syndrome. 60 patients of Gridhrasi were selected and randomly divided into two groups as Group A- 30 patients and Group B-30 patients. Group A were subjected to Matra Basti with 60 ml Sahacharadi Tail a for 7 days followed by Eranda Payasa 40 ml orally BD for 30 days. Group B were subjected to Matra Basti with 60 ml Sahacharadi taila for 7 days followed by Lashuna Ksheera 40 ml orally BD for 30 days. Overall effect of treatment was assessed on the basis of statistical analysis is observed that efficacy of Eranda Beeja Payasa is comparatively more than Lashuna Ksheera in the management of sciatica The patients have shown improvement in all the criteria of assessment of Gridhrasi in both the groups. Marked reduction is observed in the total severity of the illness in both the group with better effect in group A when compared to group B. Key words: Gridrasi, Sciatica, Vatavyadhi, Eranda Beeja Payasa, Lashuna Ksheera, Matrabasti.

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 73 Lashuna Ksheera [3] for treatment of Gridrasi in context of Gulma Chikitsa Adhyaya and Basti Ardhda Chikitsa [4] according to Charaka. So here an effort is made to compare the efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matra Basti with Sahacharadi Taila. [5] M ATERIALS AND M ETHODS It is a comparative study done at BLDE’S AVS Ayurveda Mahavidyalaya Hospital and Research Centre, Vijayapur. In which 60 patients of Gridhrasi were selected and randomly divided into two groups as Group A - 30 patients and Group B - 30 patients. Group A was subjected to Matra Basti with 60 ml Sahacharadi Tail a for 7 days and Eranda Payasa 40 ml orally BD for 30 days. Group B was subjected to Matra Basti with 60 ml Sahacharadi Taila for 7 days and Lashuna Ksheera 40 ml orally BD for 30 days. Total study duration was 37 days. The signs and symptoms were scored on basis of standard parameters and analysed statistically by using student ‘t’ test for subjective criteria. Patients were reviewed on 38 th day of treatment in both group. A detailed proforma was prepared for assessment of subjective and objective parameters by grading them. The data obtained was recorded statistically. Subjective criteria were 1. Ruk, 2 Toda, 3. Stamba and 4. Sputatha in Sphik, Kati, Uru, Janu, Jangha and Pada. Objective parameters were 1. SLR test, 2. Muscle power and 3. walking time Considering the relief of major symptoms, the subjects were divided into the following poor response <24%, moderate response 25%-49% Good response 50%-74% and excellent response 75%- 100%. Preparation of Eranda Beeja Payas: Remove the seeds of Eranda fruits and compound them, boil 25 gms of this powder with 250 ml of milk till it reduces to 40 ml. Preparation of Lashuna Ksheera: 4 Palas of dehusked Lashuna is boiled by adding 8 times of milk and water and reduced to the quantity of milk. Inclusion Criteria 1 Either sex and Age 20 -60 years 2 Patients with Pratyatma Lakshanas of Gridrasi and cardinal symptoms of sciatica. 3 Patient with IVDP, spondylosis, spondylolisthesis, lumbar canal stenosis. Exclusion Criteria 1 Patients with DM, CA-spine, caries -spine, pott’s disease and pregnancy 2 Patients with history of RTA following direct injuries to spine, emergency surgical intervention. 3 Patients with bladder and bowel incontinence. Assesment Criteria A detailed proforma was prepared for assessment of subjective and objective parameters by grading them. The data obtained was recorded statistically. Subjective Criteria Ruk in Sphik, Kati,Uru, Janu, Jangha and Pada. Toda in Sphik, Kati,Uru, Janu, Jangha and Pada. Stamba in Sphik, Kati,Uru, Janu, Jangha and Pada. Suptata, Spandana in Sphik, Kati,Uru, Janu, Jangha and Pada. Objective Parameters SLR test Muscle power Walking time The improvement in the patients was assessed mainly on the basis of relief in the cardinal symptoms of the disease. To assess the effect of therapy objectively, all the sign and symptoms were given scoring pattern depending upon their severity as below: Ruka (Pain) No pain – 0 Occasional pain – 1

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 74 Mild pain but no difficulty in walking – 2 Moderate pain and slight difficulty in walking – 3 Severe pain with sever difficulty in walking – 4 Toda (Pricking Sensation) No pricking sensation – 0 Occasional pricking sensation – 1 Mild pricking sensation – 2 Moderate pricking sensation – 3 Severe pricking sensation - 4 Stambha (Stiffness) No stiffness – 0 Sometimes for 5 – 10 minutes – 1 Daily for 10 – 30 minutes – 2 Daily for 30 – 60 minutes – 3 Daily more than 1 hour – 4 Suptata (Numbness score) No numbness – 0 Occassional – 1 Mild but continuous – 2 Moderate – 3 Severe – 4 Spandana (Twitching) No Twitching – 0 Sometimes for 5-10 minutes – 1 Daily for 10-30 minutes – 2 Daily for 30-60 minutes – 3 Daily more than 1 hour – 4 Muscle power System of grading recommended for the patient of peripheral nerve injuries by committee of medical research council has given following valuation. No contractions present – 0 Flicker of movement which can be seen and felt – 1 Muscle contraction with gravity eliminated -2 Muscle contraction against gravity -3 Muscle contraction against gravity and resistance -4 Normal muscle contraction -5 Walking time For this purpose patient was asked to walk 20 feet distance in a Straight way in full speed and time taken was recorded by the help of a stopwatch in seconds. Able to walk 20 ft within 15 sec – 0 Able to walk 20 ft within 15 -25 sec - 1 Able to walk 20 ft within 25 -35 sec- 2 Able to walk 20 ft within 35 -45 sec - 3 Able to walk 20 ft in >40 sec - 4 S.L.R. Test More than 90 degree – 0 71 – 90 degrees – 1 51 – 70 degrees - 2 31 – 50 degrees – 3 Up to 30 degree – 4 Total effect of therapy Considering the relief of major symptoms, the subjects were divided into the following the total efficacy of each therapy. Class Grading <24% Poor Response 25-49% Moderate Response 50-74% Good Response 75-100% Excellent Response

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 75 O BSERVATION AND R ESULTS Table 1: Comparisons between Groups A and B in Ruk Observati ons Recorded Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 2.07 (2.0) 0.6 4 333.0 0 0.0 38 HS Grou p B 3 0 2.4 (2.0) 0.4 98 Follow up Grou p A 3 0 1.37 (1.0) 0.7 2 420.0 0 0.6 23 NS Grou p B 3 0 1.47 (1.0) 0.6 3 NS: Non significant Table 2: Comparisons between Groups A and B in Toda Observat ions Recorded Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 1.758 (2.0) 0.5 77 351.0 0 0.1 10 NS Grou p B 3 0 1.97 (2.0) 0.8 5 Follow up Grou p A 3 0 1.137 (1.0) 0.5 16 405.0 0 0.5 86 NS Grou p B 3 0 1.233 (1.0) 0.6 78 IS: Insignificant Table 3: Comparisons between Groups A and B in Stambha Observat ions Recorded Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen Grou p A 3 0 1.83 (2.0) 0.5 92 420.0 0 0.5 90 NS t Grou p B 3 0 1.63 (2.0) 0.9 27 Follow up Grou p A 3 0 1.037 (1.0) 0.6 68 375.0 0 0.2 14 NS Grou p B 3 0 0.833 (1.0) 0.7 91 NS: Non significant Table 4: Comparisons between Groups A and B in Suptatha Observat ions Recorded Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 1.483 (1.0) 0.7 85 379.0 0 0.3 58 NS Grou p B 3 0 1.6 (2.0) 0.8 14 Follow up Grou p A 3 0 0.896 (1.0) 0.6 18 364.5 00 0.2 21 NS Grou p B 3 0 0.7 (1.0) 0.5 96 NS: Non significant Table 5: Comparisons between Groups A and B in Active SLR Left Leg Observat ions Recorded Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 0.967 (.5) 1.0 33 400.5 00 0.4 20 NS Grou p B 3 0 1.275 (2.0) 1.2 51 Follow up Grou p A 3 0 0.7 (0.0) 0.8 37 409.5 00 0.5 15 NS Grou p B 3 0 0.931 (1.0) 1.0 33 NS: Non significant

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 76 Table 6: Comparisons between Groups A and B in Active SLR Right Leg Assessm ent Observat ions Recorded on Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 1.967 (2.0) 0.8 09 445.5 0 0.9 43 NS Grou p B 3 0 1.965 (2.0) 0.9 44 Follow up Grou p A 3 0 1.433 (1.5) 0.7 28 422.5 0 0.6 62 NS Grou p B 3 0 1.41 (1.0) 0.9 46 IS: Insignificant Table 7: Comparisons between Groups A and B in Muscle Power Assessm ent Observat ions Recorded on Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen t Grou p A 3 0 4.53 (5.0) 0.68 1 331.0 0 0.0 17 HS Grou p B 3 0 4.87 (5.0) 0.43 42 Follow up Grou p A 3 0 4.57 (5.0) 0.62 6 332.5 00 0.0 18 HS Grou p B 3 0 4.87 (5.0) 0.43 42 HS: Highly significant Table 8: Comparisons between Groups A and B in Walking Time Assessme nt Observati ons Recorded on Descriptive statistics Test Statistics Grou p N Mean ± S.D. Mann whitn ey U test P val ue Rema rks After treatmen Grou p A 3 0 1.5 (0.0) 1.7 76 362.0 0.1 NS t Grou p B 3 0 0.8 (0) 1.5 4 0 38 Follow up Grou p A 3 0 1.47 (5.0) 1.7 56 363.5 00 0.1 43 NS Grou p B 3 0 0.8 (0) 51 54 NS: Not significant. Overall effect of treatment Respons e Relief of Symptom s Group A Group B Tota l Total percentag e N % N % N % Excellent 75-100% 0 0 0 0 0 0 Good 50-74% 1 9 63 4 1 8 60 37 61.7 Moderat e 25-49% 1 0 33 3 1 1 36 . 7 21 35 Poor <24% 1 3.3 1 3 3 2 3.3 The overall effect of Erandabeeja Payasa in Group A had good response in 19 (63.4%) patients, moderate response in 10(33.3%) patients and poor response in 1 (3.3%) patient. The overall effect of Lashuna Ksheera in Group B had good response in 18 (60%) patients, moderate response in 11 (36.7%) patients and poor response in 1 (3.3%) patients. DISCUSSION Eranda Beeja Payasa : This Eranda Beeja Payasa cures Gridrasi. Madhura, Katu, Kashaya Rasa, Snigda and Teekshna Guna , Usna Veerya , Shothahara like properties of Eranda collectively helps to mitigate Vata and Kapha Doshas . According to Charaka Samhita it is Bhedaniya, Angamarda Prashamana, Svedopaga . As Bhedaniya it acts by the property of purgation i.e. Nitya Virechana, Vatanulomana does Vikrutavata get relieved from Katipradesha thus helps to get rid of Gridrasi Vata. By Angamarda Prashamana Guna Eranda relieves radiating pain in the limbs.

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 77 By Swedopaga property and Sukshma Sara Guna relieves Srotoavaroda of Vatavaha Srotas. According to Sushruta Samhita it is Adhobagahara, Vata Sanshamana By Adhobagahara property Eranda does Virechana and Vatanulomana thus reliveing symptoms of Gridrasi Vata. Major chemical constituents of Eranda ( ricinus communis ) [6] called ricinine, glyseroids, rcinolic acids have purgative actions. Researches have been already conducted to evaluate the anti inflammatory potential of ricinus communis and results showed the anti inflammatory activity in wistar rats. Combined effect of Eranda and Ksheera as Eranda Payasa gives better results in sciatica. Mrudu Virechana is mentioned in the line of treatment of Vata Vyadhi in general. Pain is produced mainly by Vata Prakopa which can be pacified by Nitya Virechana. So Nitya Virechana acts as Vatanulomana and relaxes the spinal muscles controlling Apana Vayu. Asthi and Sandhi is being site of Vata and Nitya Virechana purifies the Purishdara Kala . As Pakwashaya is the main site of Vata and Virechana helps for Vatashamana, if we consider constipation as attributing factor for Gridrasi Eranda helps to relieve the Vikrut Vayu by Nitya Virechana which is obstructed by Apana Vayu. Eranda Beeja Payasa has Vata Kaphari, Amashodhana, Srotovishodana, Shothahara, Angamarda Prashamana, so recommended in Gridrasi. Lashuna Ksheera: Garlic improves circulation and cardiovascular health to get more blood flow where it needs to go. It strengthens the immune system and reduces the inflammation. The potent properties of calcium, protein and vitamin B-12 [7] from milk gives relief from sciatica pain researches have proved. Madhura and Lavana Rasa, Snigda and Guru Guna, Ushnavirya, Katu Vipaka, Vatakaphaha and Rasayana Karma collectively mitigate Vikruta Apana Vayu in the Pakvashaya which is Mula Sthana of Vata and helps to relieve Gridrasi Vata. Lashuna by its qualities and processing techniques has been proved to be best Naimittika Rasayana. It depends on Yukti of Bhishak t o administer in different forms especially Lashuna Ksheera form and ultimately bring out its rejuvenation action. Lashuna has been rightly mentioned as Amrita by Acharya Kashyapa as it has got multi-dimensional positive therapeutic effects over the health. Basically Lashuna is known for its Ushna and Teekshna qualities which combats Ama a nd enhances Agni. It does Srotoshodana by removing deep seated Ama ensuring the anti oxidant properties and anti auto immune properties. It is the drug with typical Pancha Mahabhuta constitution which opens many therapeutic avenues in the treatment. It contains Snigdha and Guru Guna in combination with Teekshna and Ushna Guna which is very typical. This help to provide Vatahara action. Madhura Rasa and Madhura Vipaka helps in inducing strength and promotive effects and contribute to nutritive and promoting activity by yielding Rasayana property. As we know in Rasayana there will be subsequent nourishment of all Dhatus. Garlic extracts have been shown to exert anti inflammatory effects, one study indicated that thiacre monone, a sulphur compound isolated from garlic inhibits neuro-inflammation. CONCLUSION A marked reduction is observed in the total severity of the illness in both the groups with better effect in group A when compared to group B. Observing the clinical efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matra Basti. None of the patients developed any untoward symptoms during the course which indicates the safety of both the procedures. Only 4 patients with Pitta Prakruti had the gastritis complaints in summer for Lashuna Ksheera after 10 days of Pana . Only 2 patients had loose stools and abdomen pain after 3 days of Eranda Beeja Payasa Pana. Elderly patients with Vataja Gridrasi symptoms and Dhatu Kshayajanya Gridrasi responded very well for Eranda Beeja Payasa and showed relief of

Dr. Laxmi Lingaraddy. A comparative clinical study on Gridhrasi w.s.r to Sciatica Syndrome ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 78 symptoms Ruk, Toda and Suptata where as young and middle aged patients with Vatakaphaja Gridasi symptoms responded very well for Lashuna Ksheera and showed relief of symptoms like Stambha and Ruk REFERENCES 1 Acharya Sushruta, Sushruta Samhita, Nibandh Sangraha by Dalhanacharya and Nyayachandrika Pangika on Nidana Sthana edited by Yadhavji Trikamji Acharya, published by Chaukambha Surabhirati Prakashan, Varanasi, 2003 edition, 1 st chapter Vata Vyadhinidana, shloka 73, Pp no 268. 2 Chakradatta, Varanasi, Chaukhambha Surbharati Prakashan, chapter 27 th , Pp.46-54. 3 Acharya Agnivesha, Charak Samhita with Ayurveda Pradipika commentary by Chakrapani edited by Yadhavji Trikamji Acharya, published by Chaukambha Surabhirati Prakashan,Varanasi, 2003 edition, Gulmachikitsa Adhyaya 5 th chapter\95 th shloka \Pp no 275. 4 Acharya Agnivesha, Charak Samhita with Ayurveda Pradipika commentary by Chakrapani edited by Yadhavji Trikamji Acharya, published by Chaukambha Surabhirati Prakashan, Varanasi, 2003 edition, Vatavyadhi Chikitsa Adhyaya\28 th chapter 5 Acharya Vaghbata, Astanga Hridaya, Vidyothani Teeka, edited by Kaviraj Gupta, Chaukambha Surabhirati Prakashan, Varanasi, 2007 edition, 21 chapter\Vatavyadi Chikitsaadhyaya\ 42 shloka. 6 Dravyaguna Vignana, J.L.N.Shastry, Varanasi, Chaukhambha Surbharati Prakashan, Vol 2, Edition 2005, Drug no-115, Pp-531 7 Dravyaguna Vignana, J.L.N.Shastry, Varanasi, Chaukhambha Surbharati Prakashan, Vol 2, Edition 2005, Drug no-105,Pp-473 ******************************* How to cite this article: Dr. Laxmi Lingaraddy. A comparative clinical study to evaluate the efficacy of Eranda Beeja Payasa and Lashuna Ksheera along with Matrabasti in the management of Gridhrasi w.s.r to Sciatica Syndrome. J Ayurveda Integr Med Sci 2019;5:72-78. http://dx.doi.org/10.21760/jaims.4.5.14 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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Ayurveda, Vata, Kapha, Gridhrasi, Toda, Stambha, Apanavayu, Matra-basti, Shothahara, Stamba, Ushnavirya, Vatavyadhi, Acharya, Panchamahabhuta, Ruj, Spandana, Katuvipaka, Kayachikitsa, Madhuravipaka, Madhurarasa, Suptata, Ricinus communis, Katurasa, Comparative study, Sciatica, Kashaya Rasa, Statistical analysis, Group A, Astanga-Hridaya, Inclusion criteria, Exclusion criteria, Clinical study, Assessment criteria, Comparative clinical study, Anti-inflammatory, Nitya Virechana, Subjective Criteria, Naimittika Rasayana, Anti-inflammatory effect, Muscle power, Vata Nanatmaja Vyadhi, Matrabasti, Objective parameter, Guru guna, SLR test, Walking time, Sciatica syndrome, Sahacharadi Taila, Vatashamana, Ayurvedic classic, Rasayana Karma, Medical problem, Palliative measure, Good response, Moderate response, Poor response, Teekshna Guna, Peripheral nerve injuries, Group B, Creative Commons Attribution License, Dravyaguna Vignana, Excellent Response, Student 't' test, Standard parameter.