Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica)

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[Find the meaning and references behind the names: Man, Sunder, Main, Jaiprakash, Gaurav, Pramod]

REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 212 Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) Dr. Demendrakumar Thakre, 1 Dr. Jaiprakash Ukey, 2 Dr. Pramod Gahane 3 1 Assistant Professor, Department of Sharir Rachana, 2 Assistant Professor, Department of Agadtantra, 3 Assistant Professor, Department of Kayachikitsa, M. S. Ayurved College, Gondia, Maharashtra, INDIA. I NTRODUCTION The term ‘ Gridhrasi ’ is derived from word ‘ Gridhra’ . The word ‘ Gridhra’ is made up from ‘ Gridhu’ Dhatu . Gridhu Dhatu means to desire, to covet, strive after greedily. Various factors that have the ability of producing a disease immediately or after some period of time are termed as Nidana . The disease process starts from Hetu Sevan itself. While considering the Chikitsa part, the avoidance of Nidana forms the Address for correspondence: Dr. Demendrakumar Thakre Assistant Professor, Department of Sharir Rachana, M. S. Ayurved College, Gondia, Maharashtra, INDIA. E-mail: sunder 147@gmail.com Submission Date: 19/09/2019 Accepted Date: 24/10/2019 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA foremost line of treatment of any disease. The symptoms [1] of Gridhrasi are Ruka (pain), Toda (pricking pain), Spandana (twitching), Stabdhata (numbness), Tandra (drowsiness), Arochaka (loss of taste) etc. To be more precise about the track of pain, [2] Chakrapani says that the pain starts at hip and then radiates to lumbar region, back, thigh, knee, calf and feet in order. Also Sakthikshepanigraha (impossibility to lift the lower extremities) is added to the list of cardinal signs by Acharya Sushruta and Vagbhatta . Tandra (drowsiness), Gaurav (heaviness), Aruchi (loss of appetite), Bhaktadwesha (rejection of food), Mukhapraseka (excessive salivation) etc. are the Lakshanas of Vatakaphaja Gridhrasi . The effective treatment of Gridhrasi cannot be unified, as the pathology involves multiple varying factors. Vitiated Vata and association of Kapha Dosha stemming out from the Pakwashaya , afflicting the Asthi Dhatu vitiating Snayu and Kandara affecting in the Asthi produces the illness. Vata is the main culprit A B S T R A C T In Ayurveda, nomenclature of diseases has been done in different ways e.g. according to Dosha - Dushya involved, according to symptoms etc. Here, the word Gridhrasi is suggestive of the typical character of pain and also the gait of the patient. Gridhra means vulture. Vulture is fond of meat and has a particular fashion of eating meat. It pierces its beak deeply in the flesh and then draws it forcefully, causing severe pain. The pain in Gridhrasi is also of the same kind, hence the name of this illness. Secondly, Gridhra also means the man who is greedily striving after meat like that of vulture. Such a person is more prone to this disease ‘ Gridhrasi ’. Also, because of the persisting severe pain, the patient has a typical gait (slightly tilted towards the affected side, affected leg in flexed position and the other leg is extended). This gait resembles that of the vulture. The particular causative factors of Gridhrasi are not mentioned in the classics. The general causes of Vatavyadhi are considered as the causes of Gridhrasi since it is considered under eighty Nanatmaja Vata Vyadhies . These Vata disorders are caused by almost the same Vata Prakopaka Nidanas , but the different diseases are due to the Samprapti Vishesha of the vitiated Vayu . The Vataprakopaka Hetus found in different Samhita . Key words: Gridhrasi, Sciatica, Vataj Nidana, Vatavyadhi.

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[Find the meaning and references behind the names: Anna, Han, Rasa, Anas]

Dr. Demendrakumar Thakre et al. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 213 in Gridhrasi . Obviously, Pakwashaya is the Udbhavasthana of the disease. Among the five types of Vata , Apana and Vyana Vayu are mainly involved. In Gridhrasi , Sakthiutkshepanigraha (impossibility to lift the lower limbs) is the main sign i.e. upward lifting of the lower limb is affected. This clearly explains the involvement of Vyana Vayu in the Samprapti as these movements are governed by Vyana Vayu . Also sometimes Kapha is the Anubandhi Dosha producing Vatakaphaja Gridhrasi . Therefore, the procedures mainly aimed at the rectification of the imbalances of Vata Dosha as well as Kapha Dosha, if associated, forms the sheet anchor of treatment of Gridhrasi . Thus, the unique pathogenesis eases the planning of the treatment in case of Vataja Gridhrasi . But in case of Vatakaphaja Gridhrasi , the final treatment planned should pacify the Vata as well as Kapha Dosha effectively [3] A IMS AND O BJECTIVES 1 To study the Nidana and Samprapti of Gridhrasi (sciatica) 2 To study the specific Vataj and Vatakaphaj Nidana of Gridhrasi (sciatica). Nidana [4,5] The general causes of Vatavyadhi are considered as the causes of Gridhrasi since it is considered under eighty Nanatmaja Vata Vyadhies . These Vata disorders are caused by almost the same Vata Prakopaka Nidanas . Table 1: Vata Prakopa Samanaya Nidana . Ahartah Nidana (causative factor related to diet) The Factors Ch Su A. H M. N S.S B. P H.S C.D Dhatukshayakaraka (substances causing dhatu depletion) : Ruksha Anna (dry food) + + + + + + - + Sheeta Anna (cold food) + + - + + + - - Alpa/Parimit Anna (diet below the requirement) + - + + + + - - Laghu Anna (light diet) + + - + + + - - Langhana (fasting) + - - + - - - - Abhojana/Anas han (complete fasting) + + - + - + - - Katu, Kashaya, Tikta Rasa (diet with pungent, astringent, bitter tastes) - + + + - + - + Shushkashaka (dry vegetables) - + - - - - - - Mudga, Nishpav, Masura (lentils) - + - - - + - - Shushkamansa (drymeat) - + - - - - - - Margavaranjanaka (substances causing obstructioin of Dhatu ) Vishamashana (untimely diet) - + - - - - - - Adhyashana (overeating) - + - - - + - + Bhuktamjeerna taram (eating immediately after meals) - - - - - + - - Viruddhabhoja n (incompatible food) - - - - - + + - Kalaya, Chana, Masura (some type of lentils) - + - - - + - -

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

Dr. Demendrakumar Thakre et al. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 214 Kashaya Rasa (astringenttast e) - + + - - + - + Table 2: Vihartah Nidana (lifestyle habits) Factors C h S u A. H M. N S. S B. P H. S C. D Dhatukshayakarak (factors leading to depletion of Dhatu ) Ativyavaya (excess in sexual activity) + + + + - + - + Atiprajagara (staying awake at night) + + + + + + + + Vishamupachara (contradictory treatment) + - - + - - - - Ati Plavana / Bahubhyam Taranam (excess off swimming) - + - - - - - - AtiPradhaavan (excessive running) + + - + - + + - AtiVyayam (excessive excercise) + + + + - - + + AtiVicheshta (hyperactivity) + - + - - - - - Dukkha Shayya / Asana (uncomfortable posture while sleeping) + - - - - - - - Abhighata (trauma) + + - + + - - - Bharaharan (carrying weight) - + - - + + - - Vega udirana (excess of natural urges) - - + - - - - - Ucchayebhashyan am (loud talking) - - + - - - - + Padaticharya (excessive walking) - - + - - - - - Margavaranjanak (factors leading to obstruction of dhatu) Vegavarodha (suppression of natural urges) + + + + - + - + Sheetajaltaran / Atisevan (excessive intake of cold water) - + - - + - - - Table 3: Manasika Nidana (mental causative factors) Factors C h S u A. H M. N S. S B. P H. S C. D Chinta (stress) + - + + + + + + Shoka (grief) + - + + + + - + Krodha (anger) + - - - - - - - Bhaya (fear) + - + - + + - + Atyantakamauda ya (excessive desire for sex) - - - - + + - - Atyantatamoguna (excess of tama) - - - - - - + - Bhutabhishanga - - - - - - + - Table 4: Miscellaneous Factors C h S u A. H M. N S. S B. P H. S C. D Dhatukshayakarak Atidoshasravana (excessive flow of doshas) + - - + - - - - Vamanvirechanaati yoga - - + - - - - -

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[Find the meaning and references behind the names: Guru, Deep, Ama, Sneha]

Dr. Demendrakumar Thakre et al. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 215 Atiasriksravana (excessive blood letting) + - - + - + + - Rogatikarshana (overtreatment) + - - + - + - - Margavarodhajanak Ama + - - - - - - - Vata gets vitiated by two ways viz. Dhatukshaya and Margavarana . So, the various Vataprakopaka Hetus are divided like wise. The Hetus are reorganized under the main headings as Aharatah , Viharatah , Kalatah , Manasika and Miscellaneous [6] DISCUSSION Samprapti (Pathogenesis) The process of manifestation of the disease by the morbid Doshas which are circulating all over the body is known as Samprapti , Jati or Agati [7] The whole disease process is explained as ‘ Shatkriyakalas’ by Acharya Sushruta . They are Sanchaya, Prakopa, Prasara, Sthanasamshraya, Vyakta and Bheda . For the disease Gridhrasi , the detailed Samprapti has not been mentioned in Ayurvedic classics. Since Gridhrasi is a Vatavyadhi , the general Samprapti of Vatavyadhi along with specific description available are considered here for the explanation of Samprapti . There are two main reasons by which Vata get vitiated. They are Dhatukshaya and Margavarodha [8] Because of the Samprapti Vishesh , the same Nidanas produce different Vatavyadhies . This is because the presentation of the disease changes according to the Sthana where Dosha-Dushya Sammurchhana takes place [9] Khavaigunya plays an important role in the disease process. In Gridhrasi , exposure to mild but continuous trauma to Kati , Sphika region because of improper posture, travelling in jerky vehicles, carrying heavy loads, digging etc. or sometimes spinal cord injury, improperly treated pelvic diseases are responsible for producing Sthanavaigunya at Kati , Sphika , Prishta etc. They may not be able to produce the disease at the instance, but after acquiring some Vyanjaka Hetu (exciting cause), the disease may be produced. Here, the Samprapti takes place either by Apatarpana or Santarpana or Agantuja . In the state of Apatarpana , all the Dhatus viz. Rasa, Rakta, Mansa etc. are subjected to Kshaya . This Dhatukshaya results into the aggravation of Vata and this vitiated Vata fills up the empty Srotasas ultimately causing Vatavyadhi [10] The second type of Samprapti takes place by Santarpana causing Margavarodha . Here Kapha is found as Anubandhi Dosha along with Vata . Atibhojan , Diwaswapa etc. are the factors responsible for this kind of Samprapti . Deranged Jatharagni leads to formation of Ama . Ama produces obstruction to the normal Gati of Vata . To overcome the resistance Vata attempts to function hyperdyanamically. This leads to Vataprakopa . Also when Ama Samshrista Vayu resides at Kati , Prishtha etc. Gridhrasi may be produced [11] Lakshanas like Tandra , Gaurav , Agnimandya etc. are observed due to involvement of Kapha and Ama . Impaired Dhatwagni may lead to the production of Adhyasthi , Arbuda , Granthi etc. i.e. Apachita Dhatus . If they cause Avarodha in the Vatavahanadi of the lower limb, Gridhrasi may be produced. The Agantuja factors chiefly Abhighata (trauma) etc. are responsible for the ‘ Achayapurvaka Prakopa’ of Doshas . Abhighata leads to Dhatukshaya directly and Vata provocation is liable to occur. The vitiated Vata may directly intermingle with Asthi , Majja Dhatu to produce Gridhrasi . Here the intermediate steps of Samprapti i.e. Chaya, Prakopa, Prasara etc. are absent. Also Abhighata may lead to Khavaigunya at the site. Asthidhatu and Vata Dosha have Ashraya - Ashreyi Sambandha. Asthikshaya deals with Vata Prakopa . Also Vata Prakopaka Ahara Sevan is the main cause of Asthivaha Srotodushti [12] Viharatmaka Hetus like Ativyayam etc. may cause Asthivaha Srotodushti . Majja is the deep seated Sneha in the Asthidhatu . Rukshadi Ahara cause Shoshan of Majja Dhatu. Viruddha Ahara, Abhighata etc. are the causes of Majjavaha Srotodushti which are commonly observed in the patients of Gridhrasi . Mansa and Meda Dhatu are Snigdha , Guru Dhatu. Rukshadi Ahar hampers the process of their Poshan (nourishment) leading to Mansa and Meda Kshaya . Also Sphika is Mansa Pradhan Avayava . Sphika Shushkata is mentioned in Mansakshaya Lakshana . Rukshata at

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[Find the meaning and references behind the names: Buddhi, Guna, Janu, Sakthi, Sandra]

Dr. Demendrakumar Thakre et al. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 216 Mansa Dhatu produces Stambha in the muscles of lower limb restricting its movement. Katisandhi may be involved in Gridhrasi . Sandhis are responsible for the movement of the limbs. In severe Vataprakopa , Sandhichuti i.e. Bramsha of Sandhi specifically in the vertebral column may be seen. This can be correlated to prolapse of intervertebral disc. In the Lakshanas of Asthi, Meda and Mansa Kshaya, Sandhi Shunyata, Sandhi Shaithilya and in Asthi and Majja Kshaya, Asthi Saushirya, Asthi Daurbalya and Laghuta are described [13] All these Dhatukshaya Lakshanas can be correlated to degenerative changes specifically in bone e.g. osteomalacia, osteoporosis, spondylosis, tuberculosis etc. Acharya Sushruta has mentioned the involvement of Kandara in Gridhrasi . Dalhana explain Kandara as Mahasnayus . According to Vaidyaka Shabdasindhu, Snayus are the Nadis that conduct Vayu . According to Sushruta , Vayu in its normal state, while coursing through its specific Siras helps the unobstructed performance of its specific functions viz. Prasarana and Akunchana and produces clearness and non illusiveness of Buddhi and the sense organs. When vitiated Vayu enters the Siras , it causes variety of diseases. Sushruta has quoted special variety of Siras called as Vatavaha Siras , which are the channels of movement of Vata , in the senses. Charaka explains Kandaras as the Upadhatu of Rakta Dhatu [14] Chakrapani mentioned that Kandara may also be considered as Sthula Snayu. Snayu is the Upadhatu of Meda and Mulasthana of Mansa Dhatu . Also Charaka has mentioned Stambha , Supti, Sphurana etc. which are the symptoms of Gridhrasi under the diseases produced due to Dushti of Snayu, Sira and Kandara [15] Thus, from the above description involvement of Rasa, Rakta, Mansa, Meda and mainly Asthi, Majja Dhatus, Kandaras, Siras and Snayus is obvious in Gridhrasi . Table 5: Samprapti Ghataka Nidana Vataprakopakanidana Dosha Vata – Apana and Vyanavayu, Kapha Dushya Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Sira, Kandara, Snayu Agni Jatharagni and Dhatvagni Ama Jatharagnimandyajanita and Dhatvagnijanita Udbhavasthana Pakwashaya Samcharasthana Rasayani of Apanakshetras Adhisthana Kandaras of Parshni , Pratyanguli and Sphik Sphikaa, Kati, Uru, Janu, Jangha, Pada. Srotas Rasa, Rakta, Mamsa, Meda, Asthi, Majja Srotodushti Sanga and Margavarodha Rogamarga Madhyam Vyakti Sphika, Kati, Prishtha, Uru, Janu, Jangha, Pada. Bheda Vataj and Vata Kaphaj Swabhav Chirkari CONCLUSION Gridhrasi is produced by Vata Prakopaka or Vata Vriddhi having symptom of Stambha, Ruka, Toda and Muhuspandanam . Vata Prakopa Ahara Vihara gives rise to aggravation of Vata and at the same time, Ruksha, Khara, Laghu, Sheeta, Daruna, Vishada, Chala Guna of Vata suppresses the Snigdha , Guru, Mridu, Pichchhila and Sandra Guna of Kapha which leads to decrease of Sleshma . Decreased Sleshma in Kati- Pristha, Sakthi and in Kandara in turn result into aggravation of Vata . This way, Vata located in Kandara and produces the symptoms viz. Stambha, Ruka, Toda and Spandana in Kati, Pristha, Uru, Janu, Jangha and Pada in respective order. REFERENCES 1 Shukla V, editor, (1 st ed.). Charaka Samhita of Charak, Nidansthana: Chapter 1, Verse 9. Varanasi: Chowkhambha Sanskrit Series, 2002; p 195 2 Shukla V, editor, (2 nd ed.). Charaka Samhita of Charak, chikitsa: Chapter 28, Verse 56. Varanasi: Chowkhambha Sanskrit Series, 2002; p 741

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

Dr. Demendrakumar Thakre et al. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Sept-Oct 2019 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2019 | Vol. 4 | Issue 5 217 3 Srikantha Murthya. K. R, Sushruta Samhita of Sushruta, Vol 1, 1 st Edition, Chaukhamba Orientalia, Varanasi, 2000: pp 108 4 Yadavji Trikamji, editor, Charaka. Charaka Samhita (Ayurveda Deepika commentary of Chakrapanidatta revised by Charaka and Dridhabala).. 4 th ed. Varanasi: Chaukamba Publishers; 2013. Chikitsa sthanam, 28/59. p.619. 5 Haridasasiva Paradakara, Vagbhata. Ashtanga Hridaya (Commentaries of Ayurveda Rasayana by Hemadri and Sarvanga Sundari by Arunadatta,). 4 th ed. Varanasi: Chaukamba Publications; 2010. Nidana Sthanam, 15/6. p.533. 6 Shukla V, editor, (2 nd ed.). Charaka Samhita of charak, chikitsa: Chapter 28, Verse 59. Varanasi: Chowkhambha Sanskrit Series, 2002; p 619 7 Tripathi B, editor, (1 st ed.). Ashtanga hridaya of Vagbhata, SootraSthana; Chapter 12, Verse 51. Varanasi: Chowkhambha Sanskrit Series, 2009; p 178. 8 Sharma U, editor, (1 st.). Madhav Nidan of Madhavkara, ArshaRognidan: Chapter 1, Verse 10. Benares: Chowkhambha Sanskrit Series, 1943; p 43 9 Shukla V, editor, (2 nd ed.). Charaka Samhita of charak, chikitsa: Chapter 28, Verse 50. Varanasi: Chowkhambha Sanskrit Series, 2002; chakrapani p 619. 10 Yadavji Trikamji Sushruta Sutra Sthana 21/33 Sushruta Samhita, NibandhaSangraha, Reprint edition 2010 Varanasi, Chaukhamba surbharti Prakashana p 106. 11 Shukla V, editor, (2 nd ed.).Charaka Samhita of charak, chikitsa: Chapter 28, Verse 17. Varanasi: Chowkhambha Sanskrit Series, 2002; p 617 12 Shukla V, editor, (2 nd ed.).Charaka Samhita of charak, chikitsa: Chapter 15, Verse 48. Varanasi: Chowkhambha Sanskrit Series, 2002; p 517 13 Shukla V, editor, (1 nd ed.).Charaka Samhita of charak, Vimansthan: Chapter 5, Verse 7. Varanasi: Chowkhambha Sanskrit Series, 2002; p 250. 14 Aathavale PG, editor, (2 nd ed.). Sushrut Samhita of Sushruta; SharirSthana, Chapter 7, Verse 9, Nagpur, Godavari publishers and book promoters,2008; p 377 15 Shukla V, editor, (2 nd ed.).Charaka Samhita of charak, chikitsa: Chapter 15, Verse 77. Varanasi: Chowkhambha Sanskrit Series, 2002; p 518. ******************************* How to cite this article: Dr. Demendrakumar Thakre, Dr. Jaiprakash Ukey, Dr. Pramod Gahane. Critical review on pathogenesis of Vataj and Vatakaphaj Gridhrasi (Sciatica). J Ayurveda Integr Med Sci 2019;5:212-217. 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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