Conceptual Review on Gridhrasi (sciatica)

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REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 175 Conceptual Review on Gridhrasi (Sciatica) Priyanka K 1 , Savita Sajjan 2 1 2 nd Year Post Graduate Scholar, Department of Post Graduate Studies in Moulika Siddhanta, Ayurveda Mahavidyalaya, Hubli, Karnataka, India. 2 Professor, Department of Post Graduate Studies in Moulika Siddhanta, Ayurveda Mahavidyalaya, Hubli, Karnataka, India. I NTRODUCTION At present, the lifestyle is gradually shifting away from healthy living, and therefore people fall victim of various diseases. Sedentary lifestyle, stress, improper posture, continuous jerky movements, long traveling, etc, put maximum pressure on the spine and lower portion of the pelvis. Low back pain (LBP) is the most frequently reported musculoskeletal problem in Address for correspondence: Dr. Priyanka K 2 nd Year Post Graduate Scholar, Department of Post Graduate Studies in Moulika Siddhanta, Ayurveda Mahavidyalaya, Hubli, Karnataka, India. E-mail: koujalagipriya@gmail.com Submission Date: 09/11/2021 Accepted Date: 13/12/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA elderly adults. Sciatica is characterized by Pain radiating from the back into the buttock & into the lower extremities along its posterior or lateral aspect & most commonly caused by prolapsed Inter Vertebral Disc, the term is also used to refer, pain anywhere along the course of Sciatic Nerve. Sciatica is one such disease which is gaining Prevalence in the present scenario. The Prevalence of Sciatica symptoms reported in literature varies considerably ranging from 1.6% in general population to 43% in selected working population. Lifetime Incidence of low back pain is 50-70% with Lifetime Incidence of Sciatica more than 40%. However clinically significant Sciatica occurs in 4-6% of population [1] In modern medicine Sciatica pain is generally managed by using Anti-inflammatory drugs, Muscle-Relaxants & Tractions but the Anti-inflammatory drugs are having many side effects like Upper Gastro-Intestinal Ulcerations, Perforation, Bleeding, Liver / Kidney Problems, Allergic Reactions such as Rashes etc. If does A B S T R A C T Now a day’s most common disorder which effects the movements of leg particular in middle age is low backache pain which effects daily routine work. Gridhrasi is one among Vataja Nanatmaja Vyadhi . It is pain dominant lifestyle disorder in which the pain starts from Sphik Pradesh & radiates down to foot, here piercing type of pain which restricts the movement of the affected leg, make his walking patternlike bird vulture and put him in disgraceful condition. On the basis of the symptoms sciatica can be correlated with Gridhrasi in Ayurveda . About 80 – 90% of people get affected by low back pain and 5% of those become victims of sciatica. It is common between 30-40 yrs. of age & affects both the sex. It is a pain dominant disease and reduces human activity in terms of personal as well as social and professional life. Ayurveda categorized Gridhrasi as one of diseases caused by vitiation of Vata which is responsible for the movement and functions of the body, even Kapha vitiation along with Vata also causes Vata-Kaphaja Gridhrasi . As far as treatment of the disease sciatica is concerned, use of analgesics and physiotherapy will help to certain extent but are not the ultimate cure. Surgery is moreover expensive, and again there are chances of recurrence as well. Ayurveda gives better options in the management of this painful disorder. Key words: Gridhrasi, Sciatica, Snehana, Swedana, Basti.

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Priyanka K et al. Conceptual Review on Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 176 not get relief, Surgery is advised. Surgery is very much Costly & it is having its own Post-Operative Complications. Hence our Ayurveda offers better options in the management of this painful disorder. Gridhrasi means the pain experienced by the patient is identical to the pain felt when the vulture pierces its beak deep into the prey to feed [2] Gridhrasi is a Vata Vyadhi characterized by Stambha (stiffness), Toda (pricking pain), Ruk (pain) and Spandana (frequents tingling). These above mentioned Lakshana’s initially affect Sphik (buttock) as well as posterior aspect of Kati (waist) and then gradually radiates to posterior aspects of Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot) [3] Nidana (etiology) of Gridhrasi In case of Gridhrasi specific Nidana has not been mentioned. So causative factors mentioned in producing Vata Vyadhi’s are considered as Nidana of Gridhrasi also. Since Gridhrasi is considered as Nanatmaja type of Vata Vyadhi , the provocative factors of Vata can also be taken as the causes of Gridhrasi . All the etiological factors of Vata Vyadhi as well as Vata Prakopa are taken as Nidana of Gridhrasi [4] & same is elaborated in following subtitles A) Aharaja Nidana B) Viharaja Nidana C) Manasika Nidana D) Anya Hetuja Aharaja Nidana Ruksha, Sheeta, Laghu Anna, Alpa Anna, Katu, Tikta, Kashaya Rasa, Langhana, Abhojana. Viharaja Nidana Ativyayama, Ativyavaya, Atiprajagara, Vishama Upachara, Plavana, Atiadhava, Diwaswapna, Vegadharana etc. Manasika Nidana Chinta, Shoka, Krodha & Bhaya Anya Nidana Ati Asruk Sravana, Dhatukshaya, Varshartu, Marmabhighata, Margavarana, Rogatikarshana etc. Purvarupa In classics the description regarding the Purvarupa of Gridhrasi is not available. Acharya ’s has mentioned that Avyakta Lakhana are the Poorvaroopa of Vata Vyadhi. [5] Chakrapanidatta commenting on the word Avyakta mentions that few mild symptoms are to be taken as the Poorvaroopa. [6] So, symptoms of Gridhrasi like Ruk, Toda, Stambha & Spandhana are seen in mild form. Rupa Ruk, Toda, Stambha and Muhuspandana are the cardinal symptoms. To be more precise about the track of pain, the pain starts at Sphik Pradesha and then radiates to Kati, Pristha , Uru, Janu, Jangha and Pada in order [7] In Vata-Kaphaja Gridhrasi there is Tandra, Gaurava, Arochaka. ‘ Sakthikshepanigraha ’ is also one of the predominant sign seen in Gridhrasi told by our Acharya [8,9] Samprapti of Gridhrasi Role of Vata in Gridhrasi Gridhrasi is one of 80 Nanatmaja Vata Vyadhi i.e., it is caused only because of vitiated Vata . Hence, Vataprakopaka Lakshanas like Shoola, Supti, Stambha etc. are found as the cardinal symptoms in the disease. Depending on the Karma & Sthana we can assume that Apana and Vyana Vayu Dusti can be assessed in Gridhrasi. Gati, Prasarana (extension) Akunchana (flexion), Utkshepana (lifting) etc. are the functions of Prakrut Vyana Vata. [10] The hampered Sakthikshepa Karma indicates Vyana Vayu Dusti . In Gridhrasi , the Sthanasamshraya takes place in Sphika, Kati, Pristha affecting the Kandara of leg which are the Ashraya Sthana of Apna Vayu. [11] There are two main reasons by which Vata get vitiated. They are Dhatukshaya and Margavarodha. [12] Because of the Samprapti Vishesha , the same Nidanas produce different Vata Vyadhis . This is because the presentation of the disease changes according to the

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Priyanka K et al. Conceptual Review on Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 177 Sthana where Dosha-Dushya Sammurchhana takes place. Khavaigunya plays an important role in the disease process. In Gridhrasi , because of improper posture, travelling in jerky vehicles, carrying heavy loads, etc. or sometimes spinal cord injury 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. Sadhyasadhyata of Gridhrasi It is explained that if Vata Vyadhi more than one year or chronic is difficult to cure or considered as incurable for treatment ( Asadhya ) [13] Acharya consider Vata Vyadhi as Mahagada [14] due to its tendency to be fatal or incurable. He also says that if the patient of Vatavyadhi develops the complications like Shunam (edema/inflammation), Suptatvacha (tactile senselessness), Bhagna (Fracture), Kampa (tremors), Adhmana (distention of abdomen with tenderness) and pain in internal organs, then it’s Asadhya. [15] Chikitsa of Gridhrasi Samanya Chikitsa Gridhrasi being one among the Vata Nanatamaja Vyadhi all the Vataprakopaka Hetus should be avoided, the general line of treatment of Vata Vyadhi can applied to it. Dravya having Madhura, Amla, Lavana, Snigdha, Ushna Guna Dravya & Snehana, Swedana, Asthapana & Anuvasana Basti, Nasya, Abhyanga, Utsadhana, Parisheka can be given [16] Table 1: Vishesha Chikitsa of Gridhrasi Type of treatment C.S 17 S.S 18 A.H 19 Snehana - - - Swedana - - - Vamana - - - Virecana - - - Basti + - + Siravedha + + + Agnikarma + - + Sastrakarma - - - Pathya Apathya [20] Table 2: Pathya Pathya Yogaratnakar Rasa Lavana Shuka Dhanya Godhuma, Raktha Shali Simbi Dhanya Masha, Kulattha Mamsa Varga Kukkuta, Chataka, Jangala Mamsa Shaka Varga Patola, Kushamanda, Shigru, Mulaka Phala Varga Dadima, Badara, Draksha Anya Dravya Lashuna, Punarnava, Jeeraka Karma Abhyanga Table 3: Apathya Apathya Yogaratnakar Rasa Kashaya, Tikta, Katu Simbi Dhanya Mudga, Kalaya, Chanaka Shaka Varga Bimba, Kareera Vihara Chinta, Prajagara, Vegadharana, Shrama Karma Chardi, Langhana DISCUSSION About 80-90% of people get affected by low back pain and 5% of those become victims of sciatica. It is common between 30-40 yrs of age & affects both the sex. Because at present, the lifestyle is gradually shifting away from healthy living, and therefore people fall victim of various diseases. Sedentary lifestyle, stress, improper posture, continuous jerky

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Priyanka K et al. Conceptual Review on Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 178 movements, long traveling, etc., put maximum pressure on the spine and lower portion of the pelvis which are the main causative factor for sciatica. In modern medicine Sciatica pain is generally managed by using Anti-inflammatory drugs, Muscle-Relaxants & Tractions but the Anti-inflammatory drugs are having many side effects like Upper Gastro-Intestinal Ulcerations, Perforation, Bleeding, Liver / Kidney Problems, Allergic Reactions such as Rashes etc. If does not get relief, Surgery is advised. Surgery is very much Costly & it is having its own Post Operative Complications. The Samprapti of Gridhrasi takes place either by Dhatukshaya or Margavarana . In Dhatukshayaja Samprapti , due to Nidana Sevana there is Prakopa of Vata Dosha leading to improper nourishment of Rasadi Dhatu , & there is Uttarotara Dhatu Kshaya Avastha causing Sroto Rikatata & there is Vata Prokopa causing Gridhrasi . When Vayu is obstructed by Kapha, Ama due to Mandagni leading to Amarasa Utpatti & there is no proper nourishment of other dhatus leading to Margavaranajanya Samprapti of Gridhrasi . In Gridhrasi Saktikshepanigraha is the main sign i.e., lifting of the lower limb is affected. In today’s er a it can be compared to Straight Leg Rising test which is one of the diagnostic tool in Gridhrasi . Ayurveda takes unique approach to the management of above symptoms with Panchakarma like Snehana, Swedhana, Basti . Snehana (oleation) - Taila is supposed to be the best for Vata as Vata is Ruksha, Sheeta, Laghu, Khara and Taila has just opposite qualities like Snigdha, Usna, Guru, Pichila . Thus, Taila alleviates Vata and at the same time does not increase Kapha as it is Ushna . By Snehana Karma it brings Mruduta in the Shareera, Agni Dipana & removes Mala Sanghata. [21] Swedana (Sudation) - Even dry wood can be made soft and flexible with Snehana and Swedana . Swedana also helps in the liquefication of the Dosha there by clearing the Srotas , removes Margavarana , removes stiffness, heaviness & coldness from the body [22] Bastikarma and concept of selection of the Basti Karma. Basti is the important Karma in the treatment of Vata Vyadhi’s . It is indicated in almost all Vata Vyadhi’s . Further it is described that Basti Chikitsa as ‘ Ardha Chikitsa’ or ‘ Purna Chikitsa’ of Vata . No other Chikitsa has the capacity to pacify and regulate the force of Vata apart from Basti . Any type of Basti can be adopted but, initially one should purify the body by Shodhana Karma to get the desired effect. It does Vaya Sthapana , brings Dhrudata in Dhatus , increases Ayu, Agni & Medha , brings Swara & Varna Prasadhana , increases Shukra & Bala , removes vitiated Dosha from the body [23] The Basti Dravya when enters the Pakvashaya by its Virya removes the vitiated Doshas present in the entire body from foot to the head just as the sun situated in the sky dries of the moisture from the earth [24] CONCLUSION Sciatica is a major clinical problem involving the locomotor system. This condition causes great discomfort to the patient & affects his daily routine as it is directly related to the locomotor system. Prevalence of Sciatica is on the rise and it demands different approach while treating. Pain, disability, dissatisfaction with existing treatment modalities. It would be great achievement if we are able to treat such an agonizing condition with principles laid by our ancient Acharyas . A detailed explanation about Gridhrasi is found in Ayurvedic classical texts, viz. Nidan a (causative factors), Samprapti (pathogenesis), Lakshana (clinical features) and Chikitsa (conservative management , Agnikarma, Siraveda and Panchakrama ). Ayurveda management seems to promising and a ray of hope in patients of Gridhrasi (Sciatica). Quality research in the field may provide global acceptance of Ayurveda management in Sciatica. REFERENCES 1 Patil N. J, Patil D, Sciatica (Gridhrasi)- An Ayurvedic Perspective Review article Submission-14/7/2017, Accepted- 25/9/2017, Journal of Ayurveda & Integrated Medical Science https://www.jaims.in

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Priyanka K et al. Conceptual Review on Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 179 2 The Sabdakalpadruma of Shri Haricharanavasu & Ashesha Shastra Visharada Kovida Vrunda Chaukhamba Surbharati Prakashan, Varanasi, Edition: 2015. 3 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-56. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -619. 4 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-15-18. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -617. 5 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-19. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -617. 6 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 11 th chapter, verse-12. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -478. 7 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-56. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -619. 8 Sushrut, Sushruta Samhita, with Nibandhasangraha of Dalhanachrya & Nayachandrika Panjika of Gayadasachrya edited by Vaidya Yadavji Trikamji Acharya. Nidana sthana , 1 st chapter, Verse - 74 Chaukhamba Surbharati Prakashan, Varanasi, Page Number – 268 9 Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata,with the commentaries: Sarvangasundara of Arunadatta & Ayurvedarasyana of Hemadri ,Nidana sthana, 15 th chapter, verse – 54, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2016, Page Number.-535. 10 Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata,with the commentaries: Sarvangasundara of Arunadatta & Ayurvedarasyana of Hemadri ,sutra sthana, 12 th chapter, verse – 6-7, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2016, Page Number.-193. 11 Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata, with the commentaries: Sarvangasundara of Arunadatta & Ayurvedarasyana of Hemadri ,sutra sthana, 12 th chapter, verse – 9, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2016, Page Number.-193. 12 Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata, with the commentaries: Sarvangasundara of Arunadatta & Ayurvedarasyana of Hemadri ,Nidana sthana, 15 th chapter, verse – 5-6, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2016, Page Number.-530. 13 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-72-74. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -620. 14 Sushrut, Sushruta Samhita, with Nibandhasangraha of Dalhanachrya & Nayachandrika Panjika of Gayadasachrya edited by Vaidya Yadavji Trikamji Acharya. Sutra sthana, 33 rd chapter, Verse - 4 Chaukhamba Surbharati Prakashan, Varanasi, Page Number – 144 15 Sushrut, Sushruta Samhita, with Nibandhasangraha of Dalhanachrya & Nayachandrika Panjika of Gayadasachrya edited by Vaidya Yadavji Trikamji Acharya. Sutra sthana, 33 rd chapter, Verse - 7 Chaukhamba Surbharati Prakashan, Varanasi, Page Number – 144 16 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Sutra sthana, 20 th chapter, verse-13. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -114. 17 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 28 th chapter, verse-101. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -621. 18 Sushrut, Sushruta Samhita, with Nibandhasangraha of Dalhanachrya & Nayachandrika Panjika of Gayadasachrya edited by Vaidya Yadavji Trikamji Acharya. Chikitsa sthana, 5 th chapter, Verse -23 Chaukhamba Surbharati Prakashan, Varanasi, Page Number – 428

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Priyanka K et al. Conceptual Review on Gridhrasi (Sciatica) ISSN: 2456-3110 REVIEW ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 180 19 Dr. Anna Moreshwar Kunte & Krsna Ramachandra Sastri Navre, edited by Pt. Hari Sastri, Astangahrdaya of Vagbhata,with the commentaries: Sarvangasundara of Arunadatta & Ayurvedarasyana of Hemadri ,Sutra sthana, 27 th chapter, verse – 15, Chaukhambha Sanskrit Sansthan, Varanasi, Reprint 2016, Page Number.-328. 20 Bhisagratna Brahmasankar Sastri. Yoga Ratnakara by Vaidya Lakshmipati Sastri with Vidyotini Hindi Commentary. Chaukhambha Prakashan Varanasi. Edition: 2010. Purvardha. Vatavyadhi Chikitsa Adhyaya, 1 st -4 th Shloka. Page No: 548. 21 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Siddhi sthana, 1 st chapter, verse-7. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -678. 22 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Sutra sthana, 22 nd chapter, verse-11. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -120. 23 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Chikitsa sthana, 1 st chapter, verse-27-28. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -682. 24 Vd Yadavji Trikamaji Acharya, Agnivesha, Charaka Samhita, with Ayurveda Dipika Commentary by Chakrapani, Siddhi sthana, 7 th chapter, verse-64. Chaukhamba Publication, New Delhi. Reprint 2018, Page Number -712. ******************************* How to cite this article: Priyanka K, Savita Sajjan. Conceptual Review on Gridhrasi (Sciatica). J Ayurveda Integr Med Sci 2021;6:175-180. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 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 (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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