A clinico comparative study on the role of Panchakarma and Physiotherapy in...

[Full title: A clinico comparative study on the role of Panchakarma and Physiotherapy in the management of Pristhgraha w.s.r. to cervical spondylosis]

ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 1 A clinico comparative study on the role of Panchakarma and Physiotherapy in the management of Pristhgraha w.s.r. to cervical spondylosis Mandloi Balwant 1 , Chaturvedi Preeti 2 1 MD Panchkarma, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. 2 Reader PG Department of Panchkarma, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. I NTRODUCTION Pristhagraha comes under the eighty types of Nanatmaja Vata Vyadhies. [1] Detailed description regarding the Pristhagraha is not available as a separate disease entity in any of the classical Ayurvedic Address for correspondence: Dr. Mandloi Balwant MD Panchkarma, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. E-mail: balwantmandloi 43@gmail.com Submission Date: 17/01/2022 Accepted Date: 25/02/2022 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.7.2.1 texts. The disease Pristhgraha is characterized by Graha in Pristha Pradesh , which is similar to that of cervical spondylosis, characterized by neck pain, radiating to the shoulders, arms or head, so that person is unable to perform normal routine work. Ageing is the major risk factor that contributes to the onset of cervical spondylosis, but now days it is also encountered in young and middle age population. The most common evidence of degeneration is found at C 5- C 6 followed by C 6-C 7 and C 4-C 5 Respectively, [2] 25% of adults under the age of 40, 50% of adults over the age of 40 and 85% of adults over the age of 60 showing some evidence of disc degeneration [3] Pristha Basti is an adopted procedure of Snigdha Swedana in which both the properties of Snehana and Swedana are incorporated which comes in direct contact of painful region. Vata Dosha has Sheeta, Ruksha properties and A B S T R A C T Background: Cervical Spondylosis is the term given to the occurrence of osteoarthritis in the cervical spine. It is characterized by degeneration of the intervertebral discs and osteophyte formation. This is extremely common and radiological changes of cervical spondylosis are very frequently in apparently healthy individuals above the age of 50 years. In Ayurveda it has a high resemblance with Pristhagraha , which comes under Nanatmaja Vatavikara . Objectives: To study the effect of Pristh Basti, Nasya Karma and Rasnasaptak Kwath in the management of Pristhgraha (cervical spondylosis), to study the effect of Rasnasaptak Kwath and Physiotherapy in the management of Pristhgraha (cervical spondylosis) and to compare the effect of group-A & group-B in the management of Pristhgraha (cervical spondylosis). Material and Methods: In this study total 47 patients of Pristhagraha were selected from OPD and admitted in IPD of Pt. Khushilal Sharma Govt. (Auto.) Ayurvedic Hospital, Bhopal, and divided into two groups. Group A with 30 patients and group B with 17 patients. Group A patients were treated with Pristha Basti and Nasya Karma with Prasarini Taila along with oral administration of Rasnasaptaka Kwath whereas in group B 17 patients were treated with physiotherapy along with oral administration of Rasnasaptaka Kwath . Observation: The analysis of result showed that the group A regimen was comparatively more effective than the regimen of group B. Pristha Basti and Nasya Karma along with Rasnasaptaka Kwath provided marked improvement in 73.33% of patients and moderate improvement in 26.66% of patients whereas Physiotherapy along with Rasnasaptaka Kwath alone provided marked improvement in 23.52% of patients, moderate improvement in 47.05% patients and mild improvement in 29.41% of patients in this study. Conclusion: In Group-A 79.98% relief was noted whereas 66.75% relief was noted in Group-B; which indicates that Group-A showed better results than Group-B Key words: Ayurveda, Cervical spondylosis, Prishthagraha, Rasnasaptak Kwatha, Nasya, Physiotherapy

Mandloi Balwant et al. Role of Panchakarma and Physiotherapy in the management of Pristhgraha ISSN: 2456-3110 ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 2 Pristha Basti being Snigdha and Ushna in nature alleviate the Vata dosha. Among Panchakarma therapies Nasya is the most important and effective treatment of Urdhvajatrugata Roga . In Charaka Samhita Sutra Sthan , it has been given first place in the sequence of Panchakarma. [4] The systematic performance of Nasya Karma helps in relieving almost all the diseases of the head and neck. “Navanerdhumpanescha Sarvanevopapadayet” Navana and Dhumapaan is indicated in all types of Vata Vyadhi by Acharya Charaka [5] Rasnasaptak Kwath is mentioned in Chakradutta as a remedy for “ Prishta Trika Parshva Shooli ” [6] Thus, the combination of Pristha Basti, Nasya Karma and Rasnasaptak Kwath has been planned to validate the effect of this regimen in the management of Pristhagraha (cervical spondylosis). Physiotherapy is a discipline of medicine where physical methods such as exercise, manipulation or other electrical modalities are used to improve physical ailments. It provides several benefits for relieving pain and spasm also help to maintain the strength of the back muscles and improve the flexibility. Ultrasound therapy is a deep heating modality that use for high frequency acoustic vibrations [7] The treatment time is 5 minutes, according to the patient tolerance and comfort. In this period of modernization and fast life, people undergo many unwanted practices like improper sitting posture for long time in offices, continuous work in one posture, over exertion, lack of physical exercise, excessive loads to bearing movements during travelling and sports all these factors create undue pressure and compressive injury to the spine, that play an important role in producing disease like Cervical spondylosis. Erroneous dietary habits and irregular life style is responsible for early degenerative changes and play a vital role in the manifestation of such degenerative disorder. In the management of such condition, modern medicine has limited conservative and surgical procedures. The use of analgesic for subsiding the pain, anti-convulsant drugs, antidepressant drugs for radicular pain, steroid to reduce inflammation and muscle relaxants which provide only temporary symptomatic relief and many times have hazardous side effects. However, Ayurveda treatment offers holistic approach, needs further scientific validation, it is therefore being considered synergistic effects of all the present regimen may produce therapeutically better results, with an intention to find out an effective, economical and affordable treatment modality with minimal hospitalization, the present study was planned A IM AND O BJECTIVES 1 To study the effect of Pristh Basti, Nasya Karma and Rasnasaptak Kwath in the management of Pristhgraha (cervical spondylosis). 2 To study the effect of Rasnasaptak Kwath and Physiotherapy in the management of Pristhgraha (cervical spondylosis) . 3 To compare the effect of group-A & group-B in the management of Pristhgraha (cervical spondylosis). M ATERIAL AND M ETHODS The study was simple randomized clinical trial on 47 patients of Cervical spondylosis selected from OPD and IPD of Pt. Khushilal Sharma Govt. Autonomous Ayurveda College and Institute, Bhopal (M.P.), and divided into two groups viz. Group A and Group B The drugs required for the clinical study had been procured and prepared in the department of Rasa Shastra and Bhaishajya Kalpana , Pt. Khushilal Sharma Govt. Ayurveda hospital, Bhopal These patients were allotted in both the group as below: Grouping In this study total 47 patients of Cervical spondylosis were registered. Patient were randomly divided into two groups, i.e., Group A and Group B. Group A - In this group, 30 patients of Cervical spondylosis were registered and treated with Pristh Basti and Nasya Karma with Prasarani Taila along with Rasnasaptak Kwath in the dose of 40 ml twice a day for 21 days Group B - In this group, 17 patients of Cervical spondylosis were registered and treated with

Mandloi Balwant et al. Role of Panchakarma and Physiotherapy in the management of Pristhgraha ISSN: 2456-3110 ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 3 Physiotherapy - (UST & exercise therapy) along with oral administration of Rasnasaptak Kwath in the dose of 40 ml twice a day for 21 days. Table 1: Procedure, Duration, Drug and Dose Procedure Duration Drug Dose Time Pristha Basti 1-21 days Prasarani Tail 250- 300 ml 35 minute s Nasya Karma 1-21 days (7 days Nasya +1 da y Rest+7 days Nasya +1 da y Rest+5 days Nasya ) Prasarani Tail 8 Bindu each nostri l Physiotherap y 1-21 days Shaman drug 1-21 days Rasnasapta k Kwath 40 ml two time a day Before meal Study duration - 21 days Follow up - 7 th , 14 th , 21 th day for clinical observation. Follow up period - 21 days. Inclusion Criteria ▪ Patients of either sex with presenting symptoms of Pristhagraha (cervical spondylosis) ▪ Patient above 20 years & less than 60 years age. ▪ Patients fit for Nasya Karma . ▪ Patients with written consent to participate in the study. Exclusion Criteria ▪ Patients who are not given the written consent form. ▪ Patient having history of chronic systemic illness. ▪ Pregnant women and lactating mother. ▪ Patient who needs surgical care or having undergone any surgical intervention for spine. Laboratory Investigations ▪ X-RAY cervical spine (for diagnostic and exclusion) ▪ CBP with ESR Criteria for Assessment In present study subjective criteria for assessment as follows - (Vyasdev Mahanta et al. 2005, IPGT&RA where in the following clinical signs and symptoms have graded by scoring system). ▪ Pain ( Shula ) ▪ Stiffness ( Graha ) ▪ Giddiness ( Bhrama ) ▪ Tingling sensation ( Chimchimayana Hasta ) ▪ Restricted movement o Flexion o Extension o Lateral rotation o Lateral Flexion O BSERVATIONS Table 2: Distribution of the patients Status of Treatment Group A Group B Total Registered 30 17 47 Discontinued 00 00 00 Completed 30 17 47 Overall Assessment Table 3: Showing the overall effect of therapy in Group A and Group B Assessment Group A % Group B % No. of pts. No. of pts. Complete remission (100% relief) 0 0 0 0

Mandloi Balwant et al. Role of Panchakarma and Physiotherapy in the management of Pristhgraha ISSN: 2456-3110 ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 4 Marked improvement (75% to < 100% relief) 22 73.33% 4 23.52% Moderate Improvement (50% to <75% relief) 8 26.66% 8 47.05% Mild Improvement (25% to <50% relief) 0 0 5 29.41% No Improvement (< 25 % relief) 0 0 0 0 ▪ In this study marked improvement was found in 73.33% patients in group A and 23.52% patients in group B. ▪ Moderate improvement was found in 26.66% patients in group A and 47.05% patients in group B. ▪ Mild improvement was not found in any of the patients in the group A and 29.41% patients were found in group B. R ESULT All available sign & symptoms were analyzed on the basis of scoring pattern. Routine hematological investigations were carried out to exclude any other systemic illness. Final outcome of the treatment was assessed by statistical analysis. In Group A – Results were statistically extremely significant in Pain, Stiffness, Bhrama, Chimchimayana Hasta , Range of movement. Marked improvement was found in 73.33% and 26.66% of the patients had moderate improvement. None of the patients had mild improvement and no improvement at all In Group B – Results were statistically extremely significant in Pain, Stiffness, Bhrama, Chimchimayana Hasta , Range of movement. 23.52% patients got Mark improvement, 47.05% patients had Moderate improvement, 29.41% got mild improvement, none of the patient had found no improvement. Overall effect of therapy: In Group A 79.98% relief was noted whereas 66.75% relief was noted in Group B; which indicates that Group A ( Pristha Basti, Nasya Karma along with Rasnasaptak Kwath ) showed better results than Group B (Ultrasound, Exercise along with Rasnasaptak Kwath . DISCUSSION This study is comprising of five chapters, viz. Conceptual study, Drug review, Clinical study, Discussion, Summary and Conclusion. It covers the review of Ayurveda, modern review and other Therapeutic Procedures, recommended to manage the Vatavyadhi (Cervical Spondylosis). In Ayurvedic review, Nidana Panchaka, Sadhya-Asadhyata of the disease has been described. As Pristhagraha is not mentioned as a separate disease so the Nidanas mentioned for Vata-Vyadhi and Vata Prakopa are incorporated as causative factors of Pristhagraha (Cervical Spondylosis), though separate Nidanas are not mentioned. In Modern review, Cervical Spondylosis with Epidemiology, Definition, anatomy and physiology, Etiological factors, Explanation of the pathogenesis and Symptomatology , Differential Diagnosis, Diagnostic tests, Prevention, and Management of the cervical spondylosis has been described. In the Procedure review detailed description of Pristha Basti, Nasya Karma, Physiotherapy has been described. It includes etymology, definition, indication, contraindication, Poorva Karma, Pradhana Karma and Paschata Karma along with probable mode of action. Drug review deals with, complete description of major contents of Prasarini Taila used in Pristha Basti and Nasya Karma procedure and Rasnasaptak Kwath . In this section Rasa, Guna, Veerya, Vipaka, Karma, Doshaghnata, Rogaghnata, chemical composition, Pharmacological actions and therapeutic evaluations of drugs have been discussed. The Clinical study contains; Aims and Objectives, Plan of study, Material and method, Criteria for selection of the patients, In this study total 47 patients completed the treatment (Group-A 30 Patients and Group-B 17 Patients). Some of the observations obtained through this study are as follows:

Mandloi Balwant et al. Role of Panchakarma and Physiotherapy in the management of Pristhgraha ISSN: 2456-3110 ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 5 Maximum number of patients i.e., 40.4% in between the age group of 31-40 years, 53.2% were females, 83% were Married, 83% were urban, maximum number of patients 89.4% Hindu community. The maximum patients of this study i.e., 48.9% were graduate, 36.2% patients field work with physical intellect, 36.2% were house wife, 48.9% patients belonged to lower middle class. The maximum patients of this study i.e., 51.1% were founded to be vegetarian, 36.2% had poor appetite, 36.2% had moderate appetite, 44.6% of the patients had poor digestion, 78.7% of the patients had irregular bowel habits. Maximum number of patients i.e., 55.31% had emotional stress, 85.1% patients were nonsmokers, 78.7% of the patients do not have any addiction with, 61.7% were Krur Kostha. The maximum patients of this study i.e., 61.7% patients had Vata Kapha Prakriti. The maximum patients of this study i.e., 63.8% were Madhyama Samhanana, 76.6% were Madhyam Pramana, 51.1% patients were Sarva Rasa Satmya, 36.2% patients were Pravara Satva, 46.8% had Madhyama Abhyavarana Shakti, 63.9% had Avara Jarana Shakti, 57.5% had Avara Vyayam Shakti . CONCLUSION On the basis of clinical manifestation, pathogenesis and complication cervical spondylosis can be correlated with Pristha Graha . Pristhgraha comes under the eighty types of Nanatmaja Vata Vyadhies . Vata provocating factors are accepted as Nidana . Vyana Vayu and Shleshaka Kapha are essential component for pathogenesis of Pristhagraha (Cervical Spondylosis). In this clinical study majority of the patients had Dvandaja Prakriti i.e., Vata-Kaphaja, Vata-Pittaja and Krura Koshtha and Vishamagni; these finding support of the Vitiated Vata Dosha. Patient of different age and occupation who have more exposure to stressful working environment, continuous work in one posture, over exertion, lack of physical exercise, excessive loads to bearing movements during travelling and sports are more susceptible for Cervical Spondylosis . Therapeutically, treatment protocols in both the Group A (Pristha Basti with Nasya Karma followed by Rasnasaptak Kwath) and Group B (US&Exercise followed by Rasnasaptak Kwath) are effective in reducing symptoms of Cervical Spondylosis but Pristha Basti with Nasya Karma followed by Rasnasaptak Kwath is more effective in comparison of Physiotherapy (US&Exercise) followed by Rasnasaptak Kwath . Group A found better relief in most of the parameters like pain, stiffness, Bharama, Chimchimayana Hasta and range of movement. This may be because of Vata and Kapha pacifying effects of Pristha Basti and Nasya Karma. Majority of drugs of Rashnasaptak Kwath contains Vata Kapha Shamaka, Rasayana and Amapchana property. While Ultrasound therapy and Exercise helps to strengthens and restore the normal functions of muscles and joints. No adverse drug reaction was observed during the study or in the duration of follow up period. REFERENCES 1 Shastri Kashinath, Chaturvedi Gorakhnath. Charak Samhita of Agnivesha, revised by Charaka and Dridhbala, part I. Chaukhambha Bharati Academy, Varanasi. Reprint, 2015; Sutra Sthana 20, verse 11; page no;399. 2 Colledge NR, Walker BR, Ralston SH (Editors), Allen CMC (author). Davidson ’s Principles & practices of medicine, Chapter 26 th ; Neurological Disease. Churchill Livingstone Elsevier Publication. 21 st edition, 2010; p 1221. 3 https://www.physio-pedia.com/Cervical_Spondylosis (Last cited at 19/09/ 2020 time 2 PM) 4 Shastri Kashinath, Chaturvedi Gorakhnath. Charak Samhita of Agnivesha, revised by Charaka and Dridhbala, part I. Chaukhambha Bharati Academy, Varanasi. Reprint, 2015; Sutra Sthana 2, verse 3-6; page no;51. 5 Agnivesha, Charaka, Dridhabala, Aacharya Vidyadhar Shukla (ed). Charaka Samhita, Chikitsa Sthana 28/88. Chaukhamba Sanskrit Pratishthana, Varanasi. second edition, 2013; pg-703. 6 Tripathi Indradev. Chakradatta, Chakrapanidatta with Vaidayaprabha hindi commentary. Chaukhambha Sanskrit Sansthan, Varanasi. 2008,p 238.

Mandloi Balwant et al. Role of Panchakarma and Physiotherapy in the management of Pristhgraha ISSN: 2456-3110 ORIGINAL ARTICLE March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 6 7 Borghouts J A, Koes BW, Bouter LM, The clinical course - and prognostic factors of non-specific neck pain: a systematic review. Pain. (1998) 77:1-13. ******************************* How to cite this article: Mandloi Balwant, Chaturvedi Preeti. A clinico comparative study on the role of Panchakarma and Physiotherapy in the management of Pristhgraha w.s.r. to cervical spondylosis. J Ayurveda Integr Med Sci 2022;2:1-6. http://dx.doi.org/10.21760/jaims.7.2.1 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 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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Ayurveda, Shula, Graha, Nasya, Bhrama, Vatavyadhi, Panchakarma, Pain, Nasyakarman, Prasarinitaila, Vatadosha, Physical exercise, Stiffness, Modern medicine, Extension, Statistical analysis, Group A, Quality of life, Ayurveda treatment, Symptomatic relief, Oral administration, Clinical study, Clinical trial, Neck pain, Adverse drug reaction, Acharya Charaka, Vata-Kapha, Vata Kaphaja, Subjective Criteria, Vata Pittaja, Range of Movement, Muscle relaxant, Surgical Procedure, Physiotherapy, Cervical Spondylosis, Drug review, Ayurvedic hospital, Radicular pain, Systemic illness, Written consent, Urdhvajatrugata Roga, Exercise therapy, Intervertebral disc, Lifestyle, Disc degeneration, Snigdha Swedana, Flexion, Lateral Flexion, Diagnostic test, Rasnasaptak Kwath, Ultrasound therapy, Osteophyte formation, Rasnasaptak Kwatha, Spinal injury, Group B, Lateral rotation.