Gridhrasi kc018 hyd

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A Clinical Study on the effect of Punarnavadi churna and Tilataila Matravasti in the Management of Gridhrasi Vata, Manglakant Jha, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

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Gridhrasi kc018 hyd

  1. 1. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE DEPARTMENT OF KAYACHIKITSA Dr. B.R.K.R. GOVT. AYURVEDIC COLLEGE / GOVT. AYURVEDIC HOSPITAL ERRAGADDA, HYDERABAD CERTIFICATE This is to certify that the present dissertation embodies the outcome of originalobservations made by Dr. Manglakant Jha on ‘A Clinical Study on the effect ofPunarnavadi churna and Tilataila Matravasti in the Management ofGridhrasi Vata’ for the degree of ‘Doctor of Medicine’ (Ayurveda). This work hasbeen completed under my direct supervision after a series of scientific discussions. The scholar has put in commendable effort for designing and executing the methodsand plans for the study. Hence I recommend this dissertation to be submitted for adjudication. CO-GUIDE GUIDEDr.S.RAMALINGESWARA RAO Dr. PRAKASH CHANDER MD (Ayu) MD (Ayu) TA/ Lecturer Professor and HODPost graduate Dept. of Kayachikitsa Post graduate Dept. of KayachikitsaDr. B.R.K.R. Govt. Ayurvedic College, Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad. Hyderabad.Date : / / 2008Place : Hyderabad
  2. 2. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA POST GRADUATE DEPARTMENT OF KAYACHIKITSA Dr. B.R.K.R. GOVT. AYURVEDIC COLLEGE / GOVT. AYURVEDIC HOSPITAL ERRAGADDA, HYDERABAD CERTIFICATE This is to certify that Dr. Manglakant Jha of M.D. (Ayu) Kayachikitsa has workedfor the thesis on the topic ‘A Clinical Study on the effect of Punarnavadi churnaand Tilataila Matravasti in the Management of Gridhrasi Vata’ as per therequirements of the order laid down by the Dr.N.T.R. University of Health Sciences, for thepurpose. The hypothesis submitted by him in the first year MD (Ayu) is one and the same tothat of the dissertation submitted. I am fully satisfied with his work and hereby forward the dissertation for the evaluationof the adjudicators.Date: / / 2008 Dr.PRAKASH CHANDERPlace: Hyderabad MD (Ayu) Professor & HOD, Post graduate Dept. of Kayachikitsa Dr. B.R.K.R. Govt. Ayurvedic College, Hyderabad.
  3. 3. ACKNOWLEDGEMENT At this unforgettable moment, I prostrate my head on the feet of ouraaradhyadevi MATA JALPA for deputing me to serve the mankind. I humbly owe every successful endeavour of my life to my belovedparents. I bow my head on the feet of my grand mother, father, mother, sistersuncles, aunties, who always stand with me in each and every stressful momentsof my life. I express my greatfulness with a deep admiration to my guide Dr.PrakashChander, M.D.(Ay), Professor and H.O.D., Post graduate department ofKayachikitsa, Dr. B.R.K.R. Govt. Ayurvedic College and Hospital, Hyderabad forhis constant and valuable guidance, encouragement through out the dissertationwork. Undoubtedly the correct, affectionate and untiring guidance of my guidehas been a great asset in its completion. I express my heartful gratitude to Dr.V.Vijaya Babu, M.D.(Ay), Reader,Post Graduate Department of Kayachikitsa, Dr. B.R.K.R.Govt. Ayurvedic Collegeand Hospital, Hyderabad for his thought provoking lecturers, his constantsupport, guidance, encouragement and kind co-operation in all aspects. I am highly indebted to my co-guide Dr.S.Ramalingeswara Rao, TA /Lecturer for his valuable guidance and suggestion through out the study. I convey my whole hearted thanks and sincere respect toDr.V.L.N.Shastry, Reader, Dr.M.L.Naidu, Reader, Dr.P.Nageswara Babu, TA /Lecturer, Dr.K.Vijayalaxmi, TA / Lecturer for their kind Co-operation during thiswork.
  4. 4. I pay my sincere respect to Dr.M.Sadashiva Rao, Principal, Dr.B.R.K.R.Govt. Ayurvedic College Hyderabad for providing facilities during my study. I am highly thankful to Dr.V.Anantsayanachari, H.O.D., PG Dept. ofS.S.P. and Dr. M.Philip Anand Kumar, H.O.D., P.G.Dept. of Dravyaguna,Dr.Jeevaratnam, Reader, Dept. of Shalya and Dr.S.Sharangapani, Gaz.,Lecturer, Dept. of Shalya for his kind Co-operation during study. I cordially aknowledge my collegues Dr.K.Srinivaslu, Dr.K.Namrata,Dr.T.Sirisha, Dr.B.Arun Kumar, Dr.Nagaraj .S, Dr.D.Shivaramakrishna, Dr.K.Srinivas,Dr.V.Rajyalaxmi, Dr.D.Ushamadhuri, Dr.K.Sunitha, Dr.N.Sandhya Sandeepa,Dr.V.Jayalaxmi, Dr.B.Ravi, Dr.D.Padmaja, Dr G.Ranganath, Dr.D.NageswarRao, Dr.T.Samba Sivarao, Dr.K.Shyam Sunderam, Dr.G.Kavita, Dr.B.Poornimaand my senior Dr.K.Sireesha, Dr.G.Lavanya, Dr. Sundar Raj Perumal, andDr.J.Shivnarayana and others who have helped me a lot in one way or the otherin successful completion of this task. I acknowledge the valuable support of my friends, Dr.Dhananjaya,Mr.Sanjay singh, Dr.M.M.Jha, Dr.Y.M.Jha, Madhuri, Vedprakash and specially tomy brother Vivek Kumar Jha for their co-operation in completing this work. I am thankful to my room mates and friends Dr.Ramchandra Adhikari ‘A’,Dr.Binod Kumar Singh and Dr.Ram Adhar Yadav for their co-operation andsuggestion through out the study. I thank Mr Pratap and Mr.Mahi for typing this work. I am thankful to all my patients of trail drug and all those persons, whohave helped me directly or indirectly for this project work. Dr.Manglakant JhaDate : / / 2008Place : Hyderabad
  5. 5. LIST OF ABBREVIATIONS Ch.S. = Charaka Samhita S.S. = Susruta Samhita A.S. = Astanga Sangraha K.S. = Kashyapa Samhita B.S. = Bhela Samhita H.S. = Harita Samhita M.N. = Madhav Nidana Sh.S. = Sharangadhara Samhita V.S. = Vanga Sen Bh.P. = Bhava Prakash A.H. = Astang Hridaya Y.R. = Yogratnakar B.R. = Bhaisajya Ratnavali V.C. = Vaidya Chintamani C.D. = Chakra Dutta NPRS = Numerical Pain Rating Scale ODI = Oswetry Disability Index A.T. = After Treatment B.T. = Before Treatment H.W. = House Wife Mixed = Non Vegetarian Veg. = Vegetarian V.P. = Vata Pitta V.K. = Vata Kapha V = Vata Drvr = Driver Empl. = Employee
  6. 6. INDEXI. INTRODUCTION 1-3II. REVIEW OF LITERATURE A. Historical Review 4-9 B. Shareera 10-23 C. Disease Review  Utpatti and Definition of Gridhrasi Vata 24-26  Nidana 27-33  Poorva Roopa 34  Roopa 35-45  Sapeksha Nidana 46-47  Samprapti 48-55  Upadravas and Sadhya – Asadhyata 56-58  Chikitsa 59-65  Pathya – Apathya 66-68III. DRUG REVIEW  Description of Individual Drugs 69-84  Description of Matra Vasti 85-88IV. CLINICAL STUDY  Materials and Methods 89-93  Observations 94-107  Results 108-113  Discussion 114-119  Summary 120-121  Conclusion 122-123V. BIBLIOGRAPHY 124-126VI. ANNEXURE  Case Sheet  Questionnaire
  7. 7. Introduction INTRODUCTION Ayurveda is primordial system of medicine. The quest of the man is tolive happily. Health is the elemental factor for happiness. The task ofmedicine is to preserve and to restore the health to relieve the sufferings.Understanding Medicine is essential to both these goals. Because pain isuniversally understood as a sign of disease. It is the most common symptomthat brings a patient to physician’s attention. In evolutionary process man remains as the only animal, which standsin up right posture. The vertebral columns of quadrupeds relaxes absolutelyduring rest. Indeed the presence of curvatures in the vertebral column, mannever attains absolute rest in any posture and owing them to suffer withproblems related to vertebral column. Obviously the life style of human being has changed a lot in accordancewith the time. As the advancement of busy, professional and social life,improper sitting postures in offices and factories, continuous and over exertion,jerking movements during traveling, these factors created undue pressure onthe spine. All these factors will result in the most common disorder in mostproductive of life – Back pain. Gridhrasi1 is a shoola pradhana vataja nanatmaja vyadhi affectinglocomotor system and leaving the person disable from daily routine activity.Gridhrasi2 the name itself indicates way of gait shown by the patient due toextreme pain i.e. like gridhra or vulture. Gridhrasi3 is a condition where vata affects the gridhrasi nadicharacterized by ruk (pain), stambha (stiffness), Toda (pin pricking sensation)starting from low back region radiating down to postero lateral aspect i.e uru(thigh), Janu (knee), Jangha and Pada. Gridhrasi and sciatica can be co-related as they are having similar clinical presentation. The knowledge of thiscondition to the modern medical science is just two century old while this isknown to Ayurveda since last five thousand years. “Study on Gridhrasi vata” 1
  8. 8. Introduction According to survey low back pain is extra ordinary common andsecond ordinary to common cold with a life time prevalence of 60% - 90% andannual incidence of five percent. 80% of population will experience back painat some time in their life. Back pain4 is one of the major medical, social and economic problem inour society. The severity of back pain ranges from minor niggles toexcruciating pain; sciatica continues to be one of the most challengingproblems in primary care. Sciatica has high incidence in those who performssedentary work particularly if they spend a lot of time in motor vehicles. The treatment of sciatica in modern medicine provides a range ofanalgesics, physiotherapy, bed rest and lastly surgery which are also not thefinal answer and there is common problem of reoccurrence. An ayurvedic approach is helpful to improve quality of life in the patientof Gridhrasi and for certain extent, by administering the Ayurvedic treatment,surgical intervention can be avoided. While going through the treatments ofgridhrasi5 sequential administration of snehana, swedana, vasti, siravedha andagnikarma are lines of treatment explained in Ayurvedic classics. Apart fromthese procedures, certain shamana yogas for oral administration are alsoexplained. Among various treatments, vasti is a unique procedure, whicheliminates the aggravated doshas from the body, as such it was described ashalf of the treatment of kaya chikitsa. Matra vasti is a simplest type of vasti explained in classics. There is norestricted regimen for it. It is effective and time saving procedure whencompared to other vasti karmas. Hence I have selected mastra vasti with Tilataila for my present study. Punarnavadi churna6 having deepana, pachana, vatanulomaka,vatashamaka, vednashamaka, rasayana properties helps for the chikitsa ofGridhrasi. As per Bhavprakasha punarnavadi churn is indicated for thetreatment of Gridhrasi. Hence it is selected for the present study. “Study on Gridhrasi vata” 2
  9. 9. Introduction Different works have been carried out in different views. Still an addedeffort was made by understanding the problem with available sources ofliterature and tried to manage the condition, thinking that this may help ingiving better management for patient and helping them in relieving theirsufferings. The present study is a sincere effort to add new dimension in thetreatment of Gridhrasi. It is hoped that the humble effort in the form of thisthesis will help in understanding the effect of above mentioned measures aswell as planning the future research to find out a better cure for this diseasefrom the Ayurvedic therapeutics. REFERENCES1. Ch.S.Su.20/11.2. Sabda kalp druma Vol 2 page no 348-349.3. Ch.S.Chi. 28/56, 57.4. Back pain the facts-Pg no 19, 23.5. Ch.S.Chi. 28/99.6. Bh.P. Madhyam Khand Ch. No. 26/46 – 47 “Study on Gridhrasi vata” 3
  10. 10. Historical Review HISTORICAL REVIEWHistorical review of Gridhrasi can be classified into 4 parts as below :-I) Vedic KalaII) Pauranika KalaIII) Samhita KalaIV) Sangraha KalaI) VEDIC KALA : Vedas are the oldest recorded knowledge. Historicalaspect of Gridhrasi can be taken from Vedic period itself. Rigveda1 attributedmedical powers to Indra, who helped the lame srona in restoring his walkingpower. Some commentators consider srona as a sage, but srona alsoindicates a cripple and also a disease perhaps related to sroni. But it is notclear whether this lameness is due to a disease of sroni. There is a referencein Atharwana veda2, which requires a special mention i.e., “the piercing painfrom feet, knee, hips and hinder parts (Sroni parinama) and spine”. So thisreference denotes the pain in the same regions of Gridhrasi though the nameof the disease has not been mentioned.II) PAURANIKA KALA : In Garuda Purana a separate chapter is describedfor Vata Vyadhi. In this Chapter Gridhrasi is described as an entity. AgniPurana also holds identical description.III) SAMHITA KALA: In different samhitas description regarding Gridhrasi isavailable.CHARAKA SAMHITA: In this samhita different places refernces related toGridhrasi are availableIn Sutrasthana – Padabhyanga3 is indicated in Gridhrasi. – Gridhrasi has been described as Swedyavyadhi4 . – Gridhrasi is described in Vata nanatmaja Vyadhis5.In Chikitsasthana – Lakshana and Chikitsa 6 of Gridhrasi are described. “Study on Gridhrasi vata” 4
  11. 11. Historical ReviewSUSHRUTA SAMHITA:In Nidana Sthana – symptomatology7 and Pathology of Gridhrasi has been described.In Chikitsa Sthana – Siravedha8 is described for Gridhrasi.In Sarira Sthana – siravedha9 site for Gridhrasi is indicated.ASTANGA SANGRAH:In Sutra Sthana – Gridhrasi 10 is included under 80 types of vata vikara – Site for siravedha in Gridhrasi has been described.In Nidana Sthana – pathogenesis and symptomatology of Gridhrasi11 has been described. 12ASTANGA HRIDAYA : – Similar description as in sangraha has been described.KASHYAPA SAMHITA13 : – Gridhrasi considered as one among Aseetivatavikaras.BHELA SAMHITA : Vasti and Raktamokshana14 are indicated for Gridhrasi.HARITA SAMHITA : Harita15 was the first to give importance to gridhrasiby naming 22nd Chapter of Tritiya sthana as Gridhrasi cikitsadhyaya.IV) SANGRAHA KALA :MADHAVA NIDANA: Gridhrasi is described as an entity, description is similaras in charaka but some specific symptoms have been highlighted i.e Dehasyapravakrta16 in Vataja type,mukhapresaka and bhaktadwesha in vatakaphajatype.SHARANGADHARA SAMHITA: Gridhrasi is counted under 80 vata Nanatmajavyadhis17 in 7th Chapter of purva khanda chikitsa of gridhrasi is described in2nd and 5th Chapter of madhyamakhanda.18,19BHAVA PRAKASHA : Gridhrasi has been described according to charaka. “Study on Gridhrasi vata” 5
  12. 12. Historical ReviewCHAKRADUTTA: This deals with chikitsa part only. A detailed descriptionregarding chikitsa of Gridhrasi is available under the heading of vatavyadhichikitsa .VANGASENA SAMHITA: Vangasena20 has used the term vata balasa for vata kaphaja Gridhrasi.For the first time its vishesha chikitsa has been given. Taptataila IstikaSwedana, Upanaha, Deepana, Pachana, Vamana, Virechana, Vasti andSiravedha.In addition to these therapies, he has contributed many originalyogas and measures for the chikitsa of Gridhrasi. Sigerist has observed that sudden sharp nature of sciatica attack struckprimitive people as demon magic. Hippocrates21 believed sciatica was prevalent during Summer andAutumn months. In 4th Century B.C Caelius Aurelianus22 clearly described symptoms ofSciatica. The disease arises from observable or hidden causes eg. A suddenjerk or movement during exercise, unaccoustomed digging in the ground,exertion on lifting a weight from below; termination of haemorrhoidal bleeding. The oldest of scientific surgical text is Edwin Smith surgical papyrus,this scroll was found in a grave near Luxor, Egypt in 1862. The Papyrusdescribes Sciatica, when even than was recognized as connected withvertebral problems. Pore (1510-1590) of France observed that severe backache caused byheavy work with spine held flexed continuously. Fontane F of Florence 1797 observed root compression leads toParesis in Sciatica. Domenico cotugno, Italian anatomist 1736-1822 coined the wordSciatica in 1764. He described Sciatica as cotugno’s disease. He was the firstto describe two types of Sciatica the nervous and the arthritic recorded in1764. He described etiology, pathology and clnical manifestations of Sciatica. “Study on Gridhrasi vata” 6
  13. 13. Historical Review In his first book, Nervosa commentarious, he described that dropsy ofthe dual funnel enclosing the Sciatic nerve causes Sciatica. In his subsequent book treatise on nervous Sciatica of 1775, hedescribed cause of Sciatica as accumulation of acrid fluid in the outer vaginaeof ischiadic (Sciatic) nerve. He pointed out that Sciatica may lead to semiparalysis and muscle wasting. Richard Bright (1789-1858) described neuralgia in his book. Heconsidered Sciatica as inflammatory affection of the investing membrane of thenerve. C.E. Brown sequard (1817-1894) described root pain compression atthe inter vertebral foramen and recognized degeneration of the intervertebraldisc. Ernst charles Lasegue, French physician (1816-1883) describedwasting of muscles in the affected limbs will be seen in Sciatica. Hedemonstrated that elevation of the extended lower extremity causes pain alongSciatic nerve in Sciatica. Recorded by J.J. Forst, Lasegue’s pupil in 1881. Louis T.J. Landouzy, French physician 1845-1917, described a form ofSciatica complicated by atrophy of the muscles of the affected leg known asLandouzy’s Sciatica. Joel Ernest Goldthwait, American Physician suggested that intervertebral disc injury may be the cause of Sciatica, Lumbago, Paraplegia etc.reported in 1911. Elsberg in 1915 operated on a patient with Sciatica, finding rupturedligamentum flavum compressing fourth lumbar nerve root. Puttiv in 1927regarded that variability of angle at the lumbo sacralfacets predisposes to Sciatica. Baker in 1929 reported a root compression case from lumbo sacral discprotrusion diagnosed as neuritis affecting the Sciatic nerve. “Study on Gridhrasi vata” 7
  14. 14. Historical Review William Jason Mixter with Joseph seaton Barr, demonstrated the roleplayed by inter vertebral disc herniation in the causation of Sciatica publishedin 1934. In 1956 Jemonet W.D. observed the association of bladder dysfunctionwith bilateral sciatica. Mathews J.A. advocated the importance of rest in bed for cases ofSciatica in 1977. It occurs in all ages but more frequently among the middle aged, thereis pain in one or both hips, the latter case can be called Double Sciatica. Thus Gridhrasi or Sciatica takes origin from the vedic period inAyurvedic texts and described by modern scientist since a long time. The information given in Ayurvedic texts regarding Gridhrasi clearlyindicates that the disease was not generally prevalent in those days. Theparticular information also indicates that the activities of human are not proneto cause, pressure on the nerve roots with consequent Sciatica. In modern civilization and other related activities the prevalence ofGridhrasi has considerably increased.Now a days a lot of description is available on Gridhrasi.  “Study on Gridhrasi vata” 8
  15. 15. Historical ReviewREFERENCES1. Rig veda (R. V.2-15.7).2. Adharvana Veda (9-8-21).3. Ch.S. Su. 5/90,92.4. Ch.S. Su14/20-24.5. Ch.S. Su 20/111.6. Ch.S. Chi 28/55,56.7. S.S. Ni 1/74.8. S.S. Chi5/23.9. S.S. Sa8/17.10. A.S. Su 20/13.11. A.S. Ni 15/56.12. A.H. Ni 15/54.13. K.S. Su27/21.14. B.S. Chi24/44,45.15. H.S. T Chapter 22/1-12.16. M.N. 22/55- 56.17. Sha.S. Poorva Khanda 7/108.18. Sha.S.Madhayana Khanda 2/93.19. Sha.S.Madhyama Khanda 5/6.20. V.S.Vata Vyadhi Adhikar 571,574-575.21. Medical Discoveries Who and When Pg 433,434.22. A History of Nuerological Survey Pg 393. “Study on Gridhrasi vata” 9
  16. 16. Shareera SHAREERA The initial pain in the lower part of the back is known as lumbago.Sciatica1is pain in the distribution of sciatic nerve. The initial pain in the lower partof the back is known as Lumbago. The two viz. Sciatica and lumbago are oftenassociated. Therefore there is a necessity of describing two anatomical structures. 1) Sciatic nerve 2) Lumbo-sacral region of the vertebral column.Sciatic nerve 2: Sciatic nerve is the main terminal branch of the sacral plexuswhich is formed by L 5, part of L4 & S1, S2 , S3 spinal nerves. The Sciatic nerve is the largest nerve in the body measuring about 2cm inbreadth at its commencement. It consists of two separate nerves in one sheath. 1) Common peroneal nerve 2) Tibial nerve The sciatic nerve leaves the pelvis through the greater sciatic foramen,usually below the piriformis and descends between the greater trochanter of thefemur and ischial tuberosity along the posterior surface of the thigh to the poplitealsurface, where it divides into tibial and common peroneal nerves. Branches in thethigh supply the hamstring muscles. Rami from tibial trunk pass to the semitendinosus, semi membranosus, long head of biceps, ischial head of adductormagnus. A ramus from the common peroneal trunk supplies the short head ofBiceps.TIBIAL NERVE3 : Tibial nerve is formed by lower two lumbar (L4, L5 ) and upper three sacralsegments (S1 , S2, S3 ). The tibial nerve forms the largest component of the thigh.It begins its own course in upper part of the popliteal space. It descends verticallythrough this space and the dorsum of the leg to the dorso medial aspect of theankle, from which point its terminal branches and lateral plantar nerves continueinto the foot. “Study on Gridhrasi vata” 10
  17. 17. ShareeraBranches from the Tibial proper:1) Motor branches: To the gastrocnemius; plantaris, soleus; popliteus, tibialis posterior; flexor digitorum longus, flexor hallucis longus.2) A sensory branch, the medial sural cutaneous nerve from common popliteal to form sural which supplies the skin of the dorso lateral part of leg and lateral side of the foot.3) Articular branches pass to the knee and ankle joints. Terminal branches are two. (i) The medial plantar nerve sends motor branches to: a) Flexor digitorum b) Abductor hallucis c) Flexor hallucis brevis d) First lumbrical muscles Sensory branches to the medial side of the sole, plantar surfaces of themedial three and one half phalanges of the same toes. (ii) The lateral plantar nerve sends motor branches to all the small muscles of the foot except those innervated by the medial plantar nerve and sensory branches to the lateral portions of the sole. The plantar surface of the lateral one and half toes and the phalanges of the toes.Common Peroneal nerve 4 (External popliteal): Common peroneal nerve is derived from the dorsal branches of ventralrami of the L4, L5 & S1, S2 nerves. It descends obliquely along the lateral side ofthe popliteal fossa to the head of the fibula, winds round the lateral surface of theneck of fibula deep to peroneus longus, and divides into the superficial and deepperoneal nerves. “Study on Gridhrasi vata” 11
  18. 18. Shareera Previous to its division, it gives articular and cutaneous branches.Branches given off the popliteal space are sensory and include the superior andinferior articular branches to the knee joint and lateral sural cutaneous nerve,which joins the medial sural cutaneous nerve, supplies external malleolus and thelateral side of the foot and fifth toe. The 3 terminal branches are the recurrent articular and the superficial anddeep peroneal nerves, the articular nerve accompanies the anterior tibialrecurrent artery, supplying the tibio fibular and knee joints and a twig to the tibialisanterior muscle.Superficial peroneal nerve5 (Musculo cutaneous): It passes between peronei and extensor digitorum longus, pierces deepfascia in the distal third of the leg, and divides into medial and lateral branches. Inits course it supplies muscular branches to peroneus longus and peroneus brevisand filaments to the skin of the lower part of the leg. Medial branch supplies the medial side of great toe, adjacent sides of thesecond and third toes. Lateral branch supply the contiguous sides of third and fourth and of fourthand fifth toes. It also supplies skin of lateral side of the ankle. “Study on Gridhrasi vata” 12
  19. 19. ShareeraSCIATIC NERVES DISC HERNIATION MEDIAL VIEW OF RIGHT VERTEBRAL COLUMN SACRAL & COCCYGEAL PLEXI “Study on Gridhrasi vata” 13
  20. 20. ShareeraDeep Peroneal nerve 6:Muscular branches: Tibialis anterior, extensor hallucis longus extensor digitorumlongus and peroneus tertuis; articular branches supply the ankle joint. Lateral terminal branches supply extensor digitorum brevis, Interosseousbranches to tarsal and metatarso phalangeal joints of second; third and fourthtoes.Lumbo Sacral region: Vertebral column is divided into 1) Cervical spine, consisting of 7 vertebrae. 2) Thoracic spine with 12 vertebrae. 3) Lumbar spine with 5 vertebrae. 4) Sacrum: Even though it consists of five sacral vertebrae, in adult they are fused in one known as sacrum. 5) Coccyx: It is fused structures of four coccygeal vertebrae in an adult. Sometimes both sacrum and coccyx may even fuse with each other in lateradulthood.CURVATURE OF THE SPINE: During evolution7 the transition from quadrupedal to the bipedal state ledfirst to the straightening and then to the inversion of the lumbar curvature. Theerection of trunk has been obtained partly by backward tilting of pelvis and partlyby bending of Lumbar column.On the first day of life:1. The lumbar column is concave anteriorly at 5 months.2. The lumbar curve is still slightly concave interiorly but the concavity disappears at 13months.3. From 3 years onwards lumbar lordosis begins to appear.4. Becoming obvious by 8 years.5. And assuming the definitive adult state at 10 years. “Study on Gridhrasi vata” 14
  21. 21. Shareera Elongation takes place rapidly as a child learns to walk. In the averageadult lumbar region comes to form about 32% of the total length of the spine. Aswell as the lumbar lordosis there are cervical, thoracic and sacral curvatures,which increase its resistance to axial compression forces 10 times that of astraight column. Thoracic kyphosis is a feature common to all mammals, whereas lumbar lordosis is especially human kind is connected with the erect postureon straight legs.The features of the lumbar lordosis and the vertebral column are at rest. 1) The angle of the sacrum formed between the horizontal and the plane containing the superior aspect of S1 , averages 30 . 2) The lumbo sacral angle lying between the axis of L5 and the sacral axis averages 140 . 3) The angle of pelvic tilt formed by the horizontal and the line joining the promontory to the superior border of the pubic symphysis averages 60 . 4) The index of lumbar lordosis can be determined by joining the supero posterior border of L 1 to the posterior inferior border of L5 . The perpendicular to this line is usually maximal at L3 and represents the index of lordosis. It is greater as Lordosis is more marked and almost disappears when the column is straight. 8Lumbar Vertebrae : In man each typical presacral vertebra is composed of four parts.1) The body, which is primarily for transmission of forces.2) The lamina and pedicles, which enclose the spinal canal.3) The spinous and transverse processes for muscle and ligament attachment.4) The posterior facets, which guide and limit motion between vertebrae. The vertebral body lies anteriorly and is the largest part of the vertebra.The Vertebral arch is shaped like a Horse shoe and behind the vertebral body. Itbears on each side an articular process which divides the arch into an anteriorpedicle and a posterior lamina the spinous process is attached to the midlineposteriorly. The vertebral arch therefore is attached to the vertebral body by the “Study on Gridhrasi vata” 15
  22. 22. Shareerapedicles. Transverse processes are attached to the arch near the articularprocesses. In the vertical plane these various constituents like in anatomicalcorrespondence making three pillars an anterior major pillar comprising thestacked vertebral bodies and two posterior minor pillars made up to the articularprocesses. The vertebral body has a dense bony cortex surrounding a spongymedulla. The cortex of the superior and inferior aspects is called the vertebralplateau. The sagittal section comprises two fans like sheaves of oblique fibres.The first arising from the superior surface fans out at the level of the two pediclesto reach the corresponding superior articular processes and spinous process.The second, arising from the inferior surface, fans out at the level of the twopedicles to reach the corresponding inferior articular processes and spinousprocess. The criss-crossing of these three trabecular systems constitutes zonesof maximum resistance as well as a triangular area of minimum resistance. Thistriangle is made up only of vertical trabeculae and explains the wedge-shapedcompression fractures that occur. Each vertebra can be compared to a lever system where the articularprocesses constitute the fulcrum. This lever system allows the absorption of axialcompression forces applied to the vertebral bodies and indirect absorption in theposterior ligaments and muscles. In the lower lumbar vertebrae the diameter ofspinal canal is comparatively greater. The center of this cylinder does notcoincide with the center of the vertebral plateaux so when upper vertebra rotateson the lower one the upper vertebras body must slide over that of the lowervertebra. The shearing forces the ensue limit the rotation so that it is minimalboth segmentally and over the whole lumbar spine. The stacked vertebral bodies of the spinal column acts as a pillar and dueto the secondary curves make the backbone some sixteen times stronger than if itwere straight. They permit spine to transmit the weight of the body to the pelvisand reduces the muscular effort otherwise needed to keep a person upright. “Study on Gridhrasi vata” 16
  23. 23. ShareeraIntervertebral Disc: The intervertebral disc accounts for about 1/3 rd of total height of thelumbar spine. The vertebrae in mammals articulate with another adjacentvertebrae by means of inter vertebral discs. The mobility, and the need forsimultaneous load bearing, necessitates some form of hydrostatic structure toconvert unidirectional forces into stresses acting in all directions. The disc have two components. 1. Anulus fibrosis 2. Nucleus pulposus.Annulus fibrosis: Annulus forms a fibro cartilaginous ring, more fibrous andelastic peripherally, more cartilaginous in the inner part. The Annular fibers aregathered in concentric lamellae, successive layers overlapping in alternativelyoblique directions. Thus nucleus is enclosed in an inextensible casing formed bythe vertebral plateaux and the annulus, whose woven fibers in the young preventany prolapse of the nucleus. The many elastic fibers of the young, healthy annulus gradually disappearsduring the aging process.Nucleus Pulposus: Nucleus pulposus comprises 40% of the disc and is asemifluid gel readily deformable but incompressible. It is the central core of the IVDisc. Collagen fibers form a three dimensional honey comb network, enmeshingthe muco protein gel with its rich content of muco poly saccharides orproteoglycans, chondroitin 6-sulfate. Nucleus pulposus acts as a perfecthydrostatic medium. It distributes axial load radially to be absorbed by the fibersof the surrounding annulus fibrosus. The hydrostatic action is predicted becauseof its high water content. When a vertebral plateau presses on the IVD thenucleus bears 75% of force and the annulus 25%. The nucleus transmits some ofthe force to the annulus in the horizontal plane and the tangential tensile strain is4-5 times the applied external load. “Study on Gridhrasi vata” 17
  24. 24. Shareera With age the nucleus looses its water absorbing capacity and the pre-loaded state tends to be lost. Hence the lack of flexibility of the vertebral columnin aged. During standing the water in the gelatinous matrix of the nucleus escapesinto the vertebral body through microscopic pores and during course of the daydisc becomes thinner. At night the water absorbing capacity of the nucleus drawswater back into the nucleus from vertebral bodies and disc regains its originalthickness. Therefore flexibility of the vertebral column greatest in the morning andat this time the spine is longer than in evening. Nucleus is a noto chordalremmant.Functions of the Annulus:1. Forms the chief structural unit between vertebral bodies and provides a mobile segment.2. Encloses and retains the nucleus pulposus.3. Restricts and regulates movement. Eg. Sagittal lumbar movement is restricted almost entirely by tough annulus. In full flexion when the articular process are more separated, some half of the diagonal lamellae restrict rotation to a degree and are thus under stress during this movement.4. By virtue of an inherent elasticity, the annulus fibrosus helps to absorb the shock of compression forces, which are sustained as a circumferential tensile stress in the annulus. The diagonal strapping effect of the fibrous lamellae is important here. The posterior post especially the postero lateral part of the annulus is a siteof potential weakness because  Thinning and bifurcation of Annular fibers posteriorly.  Fibrous tissue is adopted to withstand tension rather than pressure and in the lordotic lumbarspine; gravitational compression falls most heavily on the posterior aspects of the vertebral body joints. “Study on Gridhrasi vata” 18
  25. 25. Shareera  Posterior longitudinal ligament is attenuated, thin and expanded at the level of the disc.  The eccentric position of the nucleus pulposus, which lies closer to posterior aspect of the disc.  The susceptibility of this locality to succumb to under the stress of rotation strains.Functions of pulposus1. Its fluid permits the formation of a mobile segment and allows an even distribution of compression forces over the opposed surfaces of vertebral disks.2. The viscid gel acts like a dynamic hydraulic suspension system. This gel spreads the pressure uniformly over the entire surfaces of the vertebral bodies and so behaves like a shock absorber. In a young adult the normal intervertebral disc will yield and deform only atpressure over 1400 pounds, but in an older individual this occurs with only about350 pounds. The normal disc is actually more resistant to trauma than bone and is notwhat gives under extreme pressure or the vertebrae will fracture before the disc.The spinal disc serve two functions. 1. To provide mobility to the spine. 2. To act as a shock absorber.Movements of the discs 9: During extension the upper vertebra moves posteriorly reducing theinterspace posteriorly and driving the nucleus anteriorly. The nucleus presses onthe anterior fibers of the annulus increasing their tension and this tends to restorethe upper vertebra to its normal position. “Study on Gridhrasi vata” 19
  26. 26. Shareera During flexion the upper vertebra moves anteriorly reducing the interspaceanteriorly and driving the nucleus posteriorly. The nucleus now presses on theposterior fibers of the annulus increasing their tension. During axial rotation the central fibers of the annulus are stretched,compressing the nucleus and causing the internal pressure to rise. Flexion and axial rotation tend to tear the annulus and drive the nucleusposteriorly through tears in the annulus. Whatever force is applied to the disc, theinternal pressure is increased and the fibers of the annulus are stretched. Owingto the relative movement of the nucleus, the stretching of the annulus tends tooppose this movement. The hydrostatic properties of the nucleus and the relatively high pressurethat is exhibits relieves the annulus fibrosus from vertical stress, thus makingtilting movements of loaded lumbar spine easier.Nutrition of the Disc: The adult disc is virtually avascular. Nutrition appears to depend uponimbibition of fluid into it from the vertebral bodies and from spare vessels of theannulus during the first years of life. This process must obviously be assisted bythe rhythmic movements and compression of daily activities and it is of interestthat there is a diurnal variation in body height. There is a reason that active movements assists normal fluid imbibitionprocesses between spongiosa and pulposa, this may be a factor in delaying theslow inevitable drying up of the discs with ageing. The lack of directly penetrating vessels makes the intervertebral disc, thelargest avascular structures in the body. Diffusion of solutes can take placethrough the central portion of the hyaline cartilaginous end plates as well asthrough the annulus fibrosus. Posteriorly the areas available for diffusion aresmaller. The central part of the disc, and particularly the boundary zone betweenthe nucleus pulposus and annulus fibrosus is exposed to possible deficiency ofnutrition. “Study on Gridhrasi vata” 20
  27. 27. Shareera The disc appears to live and thrive on movement change and die slowlythrough lack of it. There is now a shift of emphasis from the idea that discdisorders result from purely mechanical derangement, to the view that nutritionand metabolism of the disc and the biochemistry of degenerative change, are ofequal importance.LIGAMENTS: The ligaments of the lumbar region are more stronger and denser than elsewhere. The anterior longitudinal, posterior longitudinal ligaments are linked at eachvertebral level by the Intervertebral disc. Other ligaments connect arches of adjacent vertebrae - ligamentumflavum, inerspinous, supraspinous ligament, anterior and posterior ligament ofarticular processes, inter transverse ligament.Action of ligaments : The dense anterior longitudinal ligament is stronger thanthe posterior ligament and limits extension of the vertebral column. The ligamentaflava help to restore the vertebral column to its original position after bendingmovements and is important in resisting rotation. The spinous processes areconnected by the supra spinous and infraspinous ligaments which particularlylimit, flexion.Movements of the Vertebral column: The mechanical stability of the column is assured by reason of the axis ofrotation passing through the bodies and not through the neural arches, so that thebodies are not displaced from each other during movement. The spinal column has 3 degrees of freedom; it is allowed flexion andextension, lateral flexion and rotation. The range of these elementary movementsat each individual joint is very small but the movements are cumulative over thewhole column. Moll and wright found an initial increase in mean spinal mobilityform the 15-24 decade to the 25-34 decade followed by a progressive decreasewith advancing age of as much as 50 percent of mobility. “Study on Gridhrasi vata” 21
  28. 28. Shareera Flexion and extension in the anterior posterior plane occur in all regions ofthe column and these movements are particularly free at the specialized atlanto-occipital joint, free in the lumbar and cervical region and very restricted in thethoracic region. Rotation is free in the specialized altanto – axial joints but elsewhere it is determined by the shape of the apophyseal joints. Kapandji- Lumbar spine contributes 60flexion and 35extension to spinalmobility. For thoraco lumbar region taken as a whole, flexion is maximally 105and extension 60 to range of lateral flexion to each side is 20in the lumbar ,column. Axial rotation from side to side during standing is 20 lumbar column inand 90 the thoraco lumbar region taken as a whole. for The thoracic movement are most limited because these vertebra are tied tothe ribs. All the mobility depends to a considerable extent on the muscles andligaments of both the spine and the back. Morris (1973) – Intrinsic spinal stability is provided by intervertebral discsand ligaments, and extrinsic stability imparted to vertebral column by the action ofmuscles. The intrinsic stability is the result of pressure within the disc which tendsto push the vertebral bodies a part and the tension provided by the ligamentswhich tends to pull the bodies together. Thus the vertebral segments and discsare firmly bound together by ligaments under tension: 1. A longitudinal system, which binds all the vertebrae together into a mechanical unit. 2. A longitudinal system, which secures one segment to another. This arrangement accounts for relative stability of the spine dissected free ofmusculature. Morris, Lucas, and Bresler (1961) showed that flexibility between twovertebrae varies directly with the square of the vertical height of the disc andindirectly with the square of the horizontal diameter of the body. Thus for a givenload and cross-section an increase in the height of the disc and the length of theligaments tends to increase the apparent flexibility, while an increase in the cross-sectional size of the disc tends to reduce apparent flexibility. Because of the “Study on Gridhrasi vata” 22
  29. 29. Shareeraproportionally greater height of the lumbar disc, the range of intervertebral motionis some what greater in the lumbar region; but because of the greater horizontaldiameter, the flexibility is less than in thoracic region. REFERENCES1. Gray’s Anatomy pg no. – 11822. Sciatic nerve – Gray’s Anatomy pg no. – 1182 – 11843. Tibial nerve – Gray’s Anatomy pg no. 1184 – 11854. Common perineal nerve – Gray’s Anatomy pg no. – 11885. Superficial perineal nerve – Gray’ Anatomy pg no. 1188 – 11906. Deep perineal nerve – Gray’s Anatomy – pg no. 11887. Backache & its evolution&conservative trt. Pg no.– 53 – 578. Lumbar vertebra – Bbackache & its evolution& conservative trt.pg no. – 54-559. Movement of Disc –Backache & its evolution& conservative trt. Pg no. – 56&57. “Study on Gridhrasi vata” 23
  30. 30. Utapatti & Definition UTPATTI & DEFINITION OF GRIDHRASI VATA 1 UTPATTI: The word Gridhrasi is of feminine gender, Gridhra’ +So’“Atonupasargakah”- adding’kah” pratyaya leads to Gridhra + So+ Ka by lopa of‘O’ and ‘k’ ,”Sha” is replaced by “Sa” by rule “ Dhatwadesh sah sah”In femalegender by adding “Dis” pratyaya the word Gridhrasi is derived. The word ‘Gridhrasi’ is derived from Dhatu “Grudhu”means – to covet,desire and strive after greedily on eager for. Gridhra refers to bird (Eagle) that desires to eat flesh always. Gait of the patients is said to resemble the gait of Eagle hence the nameGridhrasi. “Gridhyati2 maamsamabhi kankshati satatam iti” “Grudhro mamsa lolupa manushyatam syati peedyati nashyati vaa” Gridhrasi is a peculiar vata roga, which affects a person who is greedy offlesh. Gridhrasi is a nerve of the lower extremity, which is resemble to Eaglebeak in shape.Definition: Charaka3 has given the following definition. A condition where the painstarts initially from kati, then the waist, back, thigh, knee and calf muscle aregradually affected with stiffness, pain and pricking sensation and associated withfrequent twitching is called “GRIDHRASI”. 4 Susruta and his commentators define, Gridhrasi limiting the affected part. Dalhana defined Gridhrasi limiting the affected part. The condition is saidto be Gridhrasi where the movements of Sakthi are restricted due to vata vitiatingthe kandaras of heel and the related toes.All the other authors followed Charaka. “Study on Gridhrasi vata” 24
  31. 31. Utapatti & DefinitionSynonyms of Gridhrasi: According to Ayurveda vagmayam, 1. Gridhrasi : The patient who suffers with Gridhrasi walks like Eagle. The Gridhrasi nadi is curved similar to the nose of Gridhra i.e. Eagle. 2. Rhinghini 5 : Vachaspati Misra who has written commentary on Madhava Nidana explained the word Rhinghini. This term indicates skhalana of Tarunasthi of vertebral column. 3. Rhandrini : Dalhana used this term while commenting on Susrutha. (Su.Ni.1/75). It means degeneration of Tarunasthis of verterbral column. 4. Radhana 6 : This term is used by Kashiram in Gudardha deepika commentary on Sarangadhara Samhita. It indicates pressure. In this context it indicates compression of Sciatic nerve. According to Greek and Modern medicine in 15th Century the term Cyeticaand scyetyka were used to indicate this condition. Sciatica is derived from Greek word Ischiadikas i.e., pertaining to ischium,the term is used for the disease as well as the nerve.Definition: 7 SCIATICA is a type of neuritis characterized by severe pain along the pathof Sciatic nerve or its tributaries. Inflammation/injury of the nerve causes pain thatpasses from the back or thigh down its length into entire lower limbs. (Principlesof Anatomy and Physiology). It is also termed as contugno’s disease.  “Study on Gridhrasi vata” 25
  32. 32. Utapatti & DefinitionREFERENCES1. Amara Kosha Sloka no 2015.2. Sabda Kalpa Druma Vol II pg no 348,349.3. Ch.S.Chi.28/56.4. S.S.Ni. 1/74.5. M.N. 22/54.6. Sha.S.Poorva Kandha 7/108.7. Principles of Anatomy and Physiology-Tortora Pg. no 381. “Study on Gridhrasi vata” 26
  33. 33. Nidana NIDANA Gridhrasi is included under vatavyadhis, where specific etiological factorsare not mentioned; hence Nidana of vatavyadhi can be considered as nidana ofGridhrasi. Charaka Samhita 1 and Bhava Prakasha2 clearly mentioned thecausative factors of vatavyadhi, but in Sushruta samhita3,4, Astanga Sangraha5 6,7and Astanga Hridaya the causes of vatavyadhi have not been clearly described.However, in these texts the causative factors of provoked vata dosha areavailable. Since Gridhrasi is considered as Nanatmaja vatavyadhi, the provocativefactors of vata can also be taken as causes of Gridhrasi. In addition to this, in Charaka samhita 8, Ashtanga Sangraha9 andAshtanga Hrudaya10, two specific causes of vatavyadhi i.e., Dhatukshaya andAvarana have been mentioned. All the etiological factors of vatavyadhis as well as vata prakopa are takenas Nidana of Gridhrasi and is classified as follows: 111. Viprakrista nidana: The person who steals the wealth of God or Bramhanaand who deceives his master or who opposes his teacher will suffer fromvatavyadhi. (Vaidya chintamani – vatavyadhi karma vipakam)2. Sannikrista nidana: a)Aharaja, b)Viharaja, c)Kalaja, d)Agantuja e) Anyahetua) Aharaja Nidana: The excessive intake of rasas like katu, tikta, kashaya,laghu, rooksha gunas and sheeta veerya padarthas lead to vataprakopa. 12 “Sarvada sarva bhavanam samanyam vriddhi karanam” The dravya, which possess similar properties, increases the other dravya,which is resumblant to it in properties.Dhanya - Mudga, Masoora, Adhaki, Kalaya, Nishpava etc.Phalas - Jambu, Bilwa, Kapitha etc.Sakas - Kareera, Karavellaka, Patola, Rakta punarnava. “Study on Gridhrasi vata” 27
  34. 34. Nidana Alpasana leads to dhatu kshaya thereby causing vataprakopa.Adhyasana, visamasana causes ama which obstructs the srotas henceaggravates vata. As per “Vayordhatu kshayat kopo margasyavaranenacha”13b) Viharaja : Prajagaram – increases ruksha guna in body and aggravatesvata. Langhana, plavana, athyadwa sevana, vyayama – as a result of thisexcessive and continuous exertion results in dhatu kshaya and aggravates vata.Diwaswapna14 increases pitta and kapha, which obstructs the channels and leadsto vata prakopa. Vegavadharana is a condition when any of the natural urges aresuppressed, then vata prakopa takes place. So far Gridhrasi is concerned 15malavarodha is most important to cause vataprakopa . This causes pain insacral region, pindikodwestanam, and backache and also produce many diseasesin the lower limbs like Gridhrasi etc. Vagbhata16 also stated that avarodha ofapanavata causes a variety of vatavyadhis.c) Kalaja : Vata vitiation takes place in varsha, Grishma and Sharad ritu. It also aggravates in Aparahnakala, Jeernannakala, Apararatra and in sheeta kala. During vriddhavastha 17 vata prakopa takes place.d) Agantuja: Abhighata due to external causes are considered specially while carrying heavy loads, wrestling with a person of superior strength, leaping and jumping etc. Marmabhighata particularly to kukundara, nitamba marmas leads toGridhrasi. 18 Kunkundara (Marma abhighata) loss of power and sensation in lowerextremities and may result in pain and difficulty in walking. Nitamba: Injury, causes swelling, weakness, pain paresis in lower limbsand even death in due course of time. Falling off from back of animals and higher places also causemarmabhighata. “Study on Gridhrasi vata” 28
  35. 35. Nidana The pathological19 changes in the vertebral column are mainly occurred byphysical strain. In physical activity, standing alone increases load on the disc fourfold compared to supine strengthening exercises almost double the load in thedisc over the standing posture. It illustrates the impact of physical activity on thevertebral column. Most of the activities we are observing in society are already described inAyurveda as Nidana in Vatavyadhi. The prolonged stooped posture imposes loads on the posterior ligamentsof the spine and the fibers of inter vertebral disc, stretched ligaments increasejoint laxity, which can lead to hyper flexion injury. Ligament damage seems tooccur during traumatic sporting activity with the spine at its end range of motion.In above conditions the tensile forces works on ligaments, which are capable ofonly withstanding tensile forces, if it is excessive it ruptures ligaments. Attempting to lift and twist with awkward loads so that extension androtatory movements are involved together produces Interverbetral disc rupture inlumbar region. The excessive compressional load acting on the nucleus pulposusis the basis for disc degeneration, vertical compression of spinal segments thevertebral end plates are the first to fracture leads to osteo arthritic changes in theinter vertebral joints Segmental instability occurs when the normal movement betweenvertebrae is lost because of degenerative changes involving any one of thecomponents of disc followed by Sub luxation. Fractures, Dislocations and disc prolapse when compress the spinal cordresults in paralysis of limbs which can be attributed to injury of marmas. HenceAgantuja nidana is a prime factor in the disorders of the vertebral column.Anya hetu: Dosha Asrik sravanadapi - Excessive elimination of mala, rakta duringvamana, virechana, vasti karmas leads to vata prakopa. This can be consideredas Iatrogenic cause. “Study on Gridhrasi vata” 29
  36. 36. Nidana Etiological factors of vata prakopa &vata vyadhi with reference to Gridhrasi. NIDANA CS SS AS AH MN BPAharajaRasa Katu, Tikta, Kashaya + + + +Guna Laghu + + + + Ruksha + + + + + Seeta + + + +Karma Vistambi +Veerya Sheeta +Dravya Adhaki + + Bisa + Harenu + Chanaka + Kalaya + Koradusha + Masura + + Mudga + + Nivara + Nishpava + + Saluka + Suskashaka + Syamaka +Krama Abhojana + + + + Alpasana + + + Visamasana + + + + Adhyasana + + Pramitasana + +Kayika Atigamana + + + +(atiyoga) Atihasya + + Atilanghana + + + Atiplavana + + Atipradharana + Atiprajagarana + + + + + + Ati prapatana + Ati prapidana + Ati pratarana + + Ati raktamokshana + + Ati Sharma + Ati vichestitam + + + Ati vyayam + + + + + Ati Adhyayana + + Kriyati yoga + + + + + Padati charya + “Study on Gridhrasi vata” 30
  37. 37. NidanaMithyayoga Asama bhramana, chalana, + vikshepa, asamotkshepa Balavat vigraha + + Bhara harana + + + Diwa Swapna + + Dukhasana sayya + + Kastabhramanachalana + vikshepa Vegadharana + + + + + + Vishamapochara +Manasika Bhaya, Chinta, Soka + + + + + Krodha + + Mada +Kalaja Aparahna + + + + Apararatra + + Grishma + + Pravata + + Shisira + Seeta kala + + Varsha + + +Agantuja Abhighataja + + Gaja, Ustra, Ashwa, + + Shighrayana patana Marmaghata + +Anyahetuja Dosa Asrik sravana + + + + Dhatu kshaya + + + Ama + + + Rogati karshana + + + Margavarana +Causes of Sciatica 20: Sciatica is neuralgia in the distribution of Sciatic nerve or its componentnerve roots.I. Compressive causes: a) Congenital – Spina bifida, Spondylolisthesis. b) Traumatic – Fracture of hip joint Vertebral fractures Lumbo sacral sprain and strain. “Study on Gridhrasi vata” 31
  38. 38. Nidana c) Mechanical pressure on the nerves- In the spinal cord - Tumors of cauda equina. Arachnoiditis, haemorrhage/ infection irritating meninges of the cord. In the cord space – Protruded inter verterbal disc, extra medullary tumors. In vertebral column – Spondylolisthesis, spondylosis, Bone tumor, stenosis of intervertebral canal and lateral recess hypertrophy of apophyseal facets. In the back - Fibrositis of posterior longitudinal ligament. In the thigh and buttock - Neurofibroma, Hermorrhage within or adjacent to nerve sheath. In the pelvis - Sacro iliac arthritis, Tumors of lumbo sacral plexus.Other destructive disease: Neoplastic: Metastatic carcinoma, multiple myeloma, Hodgkins and NonHodgkins lymphoma. Infections: Infection in vertebral column due to pyogenic organisms –staphylococci, Tubercular bacilli, Spinal epidural abscess. Several metabolic diseases of bone such as hyper parathyroidism,osteoporosis precipitates bone dysfunction. This in turn leads to vertebral bodyweakness, leading to vertebral fractures, protrusion, herniation etc. Inflammatory causes : - Rheumatoid arthritis - Ankylosing spondylitis - Lumbar spondylitis - Osteo arthritis of lumbar spine. - Tuberculosis of vertebral column and spine. “Study on Gridhrasi vata” 32
  39. 39. NidanaII. Non-compressive causes: Ischaemic necrosis in Diabetes Mellitus, leprosy, direct injury due topenetrating wounds. Eg. Gunshot or misplaced injections, claudication of sciaticnerve, compression injury to Sciatic nerve by foetal head during delivery. Some times over exposure to cold or sitting on chatted grass may inducethe pain.Catamenial sciatica: The unusual developmental anamoly of implantation ofendometriosis in the Sciatic nerve at the sciatic notch may cause sensorimotorSciatic nerve palsies. These may be associated with peri menstrual pain in thebuttock or posterior aspect of the thigh. REFERENCE1. Ch.S.Chi.28/15,17.2. Bh.P. Utt. Kha .24/1,2.3. S..S.Su..21/19,20.4. S.S.Ni 1/67,68,79.5. A.S.Ni.15/31,34,41.6. A.H. Ni 1/14,15.7. A.H. Ni 15/29,32,33,478. Ch.S.Chi 28/599. A.S.Ni 15/7,8.10. A.H.Ni15/5,6.11. V.C.Vata Vyadhi.Sloka:212. Ch.S.Su.1/44.13. Ch.S.Chi.28/58.14. Ch.S.Su.21/24.15. Ch.Chi.28/18.16. A.H.Su.4/2.17. S.S.Su.21/19.18. S.S.Sa.6/48.19. Back Ache Its Evolution & Conservative Treatment20. Medicine for Students –Golwalla-pg 621,622 “Study on Gridhrasi vata” 33
  40. 40. Poorva Roopa POORVA RUPA 1 “Poorva rupam pragutpathi lakshanam vyadhehi” For every disease certain premonitory symptoms are noted before it isclearly established in the body. Such symptoms are called Poorva roopa. “Avyakta lakshanam tesham poorva roopamiti smritam Atma rupam tu yad vyaktam apayo laghuta punaha ” 2 According to Charaka Avyakta lakshanas are purvaropa of vatavyadhi.According to Chakrapani 3commentary on Avyakta, few mild early symptoms areto be taken as purva rupa. The very specific symptoms if manifest insignificantlycan be considered as poorvarupa of Gridhrasi. Stambha, Ruk, Toda,Muhuspandana, Grihnati. Diagnosis at this stage of illness gains paramount importance. Theeffective treatment at this stage reduces the degree of morbidity. REFERENCE1. Ch.S.Ni.1/7.2. Ch.S.Chi.28/19.3. Chakrapani on Ch.S.Chi.11/12. “Study on Gridhrasi vata” 34
  41. 41. Roopa ROOPA “Utpanna vyadhi bhodaka meva lingam rupam” 1 Lakshanas, which occur after the manifestation of vyadhi, known as Rupa.Vyakta purva rupa is Rupa.2 Charaka 3classified Gridhrasi into two varieties. 1. Vataja 2. Vata shleshmaja. Considering all the clinical manifestations of Gridhrasi, it may besubdivided into samanya lakshnas and vishesha lakshanas.Samanya Lakshanas: These lakshanas are seen in both vataja and vata kaphaja type ofgridhrasi.RUK: “Ruk satatam shoolam” 4 5 “Ruk shoolam” 6 “Ruja vedana” In Gridhrasi, Ruk-pain is starting from sphik and radiating towards kati,prista, uru, janu, jangha and pada. Non-radiating pain felt at sites like kati, uru,janu, jangha, pada is also considered as symptom of Gridhrasi.7 This typical radiating pain involving legs is suggestive of Sciatica wherepain is felt along the course of Sciatic nerve.Toda: “Todah sooci vyadhanavat vyadha”8 9 “Toda vicchinna shoolam” Intermittent pain similar to feeling of pinprick.Stambha: “Stambha nischalakaram”9 “Stambha bahu uru janghadeevam sankuchanadhya bhava10 “Stambha nishkriyatvam”11 “Study on Gridhrasi vata” 35
  42. 42. Roopa It is stiffness at uru and jangha region in Gridhrasi, due to pain the movement i.e., restricted in the muscles and joints of lower limb. This stiffness affects gait of the patient.Sakthna kshepa nigrahanyat: 12 “Kshepam prasaranam tam nigrahanyat avarudhyat ityarthah” Hence, word kshepam means prasarana or extension. According toDalhana it is the sign of restriction during extension of leg. This is more clear by 12commentary of Arunadutta on Astanga Hridaya explained as urdhwa preranaavarundhati i.e., restriction in raising the leg. As the extension of the legsworsens the pain patient prefers to assume the flexed position of the legs.Kati Uru Janu madhya Bahu vedana: A distinct feature in Gridhrasi mentioned by Harita13, severe pain at kati,uru and Janu region.Muhu spandana: 14 “Spandana Spuranam” 15 “Spandanam hi Kinchit chalanam” Spurana refers to the fasciculation. This symptom is seen in the musclesupplied by the Sciatic nerve.Pain in Payu: Described by Vangasena16 only. This may be due to derangement ofApanavayu. Payu is one of main sthanas of Apana vayu and Apana Vayugoverns functions of defecation. Therefore, when apana vayu is vitiatedconstipation results and pain in peri anal region occurs.VISESHA LAKSHANAS:Vataja Gridhrasi:Dehasya vakrata: Madhava described this symptom, which means the patient ofGridhrasi acquires a particular posture because of pain. The patient of Gridhrasikeeps the leg in flexed position and tries to walk without much extension in the “Study on Gridhrasi vata” 36
  43. 43. Roopaaffected side. Because of extreme pain, stambha, toda etc., the patient assumesa typical limping posture. It can be considered as Sciatic scoliosis – maintained by reflex contractionof the para spinal muscles.Stabdata Brisham: The severe degree of stiffness is seen in the patient suffering from VatajaGridhrasi.Spuranam: “Spuranam Gatra deshe swalpa chalanam”17 “Spuranam punah punah chalanam” 18 A type of muscle twitching in kati, uru, Janu, Jangha is similar to that of spandana or muhuspandana.Suptata: The patient experiences varied degree of parasthesis or sensory loss in theaffected limb.Vata Kaphaja Gridhrasi: In Gridhrasi when anubanda of kapha dosha is present following lakshanasare seen.Vahni mardava: Decreased abhyavaharana and jarana shakti causes loss of appetite.Tandra: 19 “Tandrayantu prabhodito api klamayati nidrabheda ” Due to tama, vata and kapha, there will be a feeling of drowsiness orinability of sense organs to grasp followed with yawning and fatigue without anywork. “Study on Gridhrasi vata” 37
  44. 44. RoopaMukha praseka: Excessive salivation in the mouth occurs due to kapha in association withama.Baktadwesha: “Dveshamayati yo jantu bhaktadvesha sa ucchate” 20Because of loss of appetite and kapha dusti, patient feels aversion towards food.Arochaka: “Arochakastu prarthite apyupayoga samaye anabhilasha”21 “Aruchi prarthita Anna Bhakshana Asamarthya mucchyate” 22 Dislike of consuming food. The patient fails to appreciate the taste in themouth irrespective of state of appetite. Vata and kapha are involved because theseat of bodhaka kapha is jihwa, which does raso bodhana.Gaurava: Heaviness particularly occurs in the lower limb.Staimityam: “Staimityam gatranaam nirutsaahatvam” 23 Inertness of body, feeling of freezing sensation in the affected lower limb,due to kapha vitiation patient feels as if his lower extremities are covered with wetcloth. “Study on Gridhrasi vata” 38
  45. 45. Roopa Rupa of Gridhrasi according to different Acharyas Samanya Lakshanas CS SS AH AS HS BP MN YR VS BRKati prista uru janu jangha + + + + +pada –RukKati prista uru janu jangha + + + + +pada –TodaKati prista uru janu jangha + + + + +pada – StambhaKati prista uru janu jangha + + + + +pada –MuhuspandanaSakthnaha kshepam + + + +nigrahaniyatKati uru janu madhye bahu +vedanaParshni pratyanguleenam tu + + +kandara yanilarditaPain in payu +Sopha, karapada vidaha +Specific VatajaDeha vakrata, Toda + + +Stabdata + + +Janu jangha uru sandhi + + + +spuranaSuptata +Specific Vata kaphajaTandra + + + + +Gaurava + + + +Arochaka + + + +Vahni mardava + + + + +Mukha praseka + + + + +Bhakta dwesha + + + + +Staimitya +Clinical features of Sciatica: The clinical course of Sciatica depends on the nature of the underlyingpathology. In most of the patients pains are caused by a ruptured intervertebral disc.In some patients the symptoms are produced by Arthitis in the Sacroiliac joint orspine, spondylolisthesis, lumbar canal stenosis that are commonly seen. “Study on Gridhrasi vata” 39
  46. 46. RoopaA fully developed prolapsed inter vertebral disc24 consists of(1) Pain in the sacroiliac region, radiating into the buttock, thigh, calf and foot.(2) A stiff or unnatural spinal posture.(3) Some combination of paraesthesias, weakness and reflex impairment. The most common history is that of severe low back pain after an injury.The acute attack subsides within a few days sciatic pain eventually develops afterthe appearance of low back pain. As the Sciatic pain increases in intensity andextent, the backache become less and occasionally may be entirely absent. Intermittency of symptoms is characteristic, and each succeeding attack isusually more severe.Pain: The pain of herniated intervertebral disc varies from severe to mild forms.With most severe pain, patient is forced to stay in bed. The patient is usuallymost comfortable lying on his back with legs flexed at the knees and hips. Thepain is frequently made worse by an activity that increases intra spinal and intradiscal pressures such as coughing, sneezing and bearing down duringdefecation. When the condition is less severe walking is possible, though fatigue setsin quickly, with a feeling of heaviness and drawing pain. Sitting and standing up from a sitting position are particularly painful. Painis characteristically provoked by pressure over the course of the Sciatic nerve atthe classic points of valliex (Sciatic notch, retro trochanteric gutter, and posteriorsurface of thigh, head of fibula. Pressure at one point may cause radiation of painand tingling down the leg pain is referred to the involved dermatome.Reduced mobility: 25 Forward bending in particular is restricted . In acute stage with markedmuscle spasm all mobility is restricted. “Study on Gridhrasi vata” 40
  47. 47. RoopaList of trunk: The lumbar spine most often deviates away from the affected side. The 26disk is usually lateral to the nerve root , and the tilt of the spine away from theaffected side. Protrusion medial to the nerve root causes a list to the painful side.The disk is often accentuated when bending forward. A list or tilt will elevate one iliac crest. This asymmetry is responsible forthe commonly diagnosed “longer leg on one side” and the erroneous assignmentof the back pain to asymmetry of leg length. The patient stands with affected leg slightly flexed at the knee and hip, sothat only the ball of the foot sets on the floor. In walking, the knee is flexedslightly, and weight bearing on the painful leg is brief and cautious, giving a limp.It is particularly painful for the patient to go up and down stairs.Neurological signs: Motor signs are present in about 96% of cases and include atrophy of legmuscles, determined by measuring leg circumferences and muscle weakness. Weakness of dorsi flexion of large toe and inability to walk on heelsindicate fifth lumbar root involvement by fourth lumbar disk. Inability to walk on toes because of calf muscle paresis points to first sacralroot involvement by the fifth lumbar disk. Sensory signs found in 80% of patients.Nerve tension signs:  Straight leg – Raising Sign (S.L.R.): It is the active attempt made by patient to raise the entire leg with the leg incomplete extension. In case of sciatica extension of the leg is below 90 The .degree of limitation is roughly proportional to the severity of pain. Elongation of nerve root by straight leg raising or by flexing the leg at thehip and extending it at the knee (lasegue maneuver) is most consistent amongpain provoking signs. Crossed leg pain is pathognomic of severe disc prolapse. “Study on Gridhrasi vata” 41
  48. 48. RoopaVariations of the lasegue maneuver – Bragard sign: Accentuation of the pain by dorsi flexion of foot. Neris sign: With patient standing, forward bending of the trunk will cause flexion of the knee on the affected side. Naffziger sign: Sciatica may be provoked by forced flexion of the head and neck, coughing, or pressure on both jugular veins, all of which increase the intra spinal pressure. Sicard sign: The pain may be elicited by carrying out test with dorsiflexion of big toe. There are typical patterns of symptoms for each level of root involvement.Lumbar root lesionsDisc Root Sensory Motor weakness Reflex Painlevel loss loss distributionL 3-L4 L4 Antero Quadriceps (knee Knee Lateral medial calf extension) thigh thigh. and shin. adduction, Tibialis anterior (foot dorsiflexion)L 4-L5 L5 Antero Peroneii (foot eversion), None or Buttock, lateralleg, tibialis anterior (foot rarely back and Dorsum of dorsiflexion) gluteus reduced side thigh, foot, great medius (Hip abduction) ankle lateral lower toe. Toe dorsiflexion. reflex. leg.L 5-S1 S1 Lateral Gastrocnemius, soleus Ankle Buttock, malleolus, (foot plantor flexion) Back of lateral foot, Abductor hallucis (toe thigh and heel and flexors), gluteus calf to heel. web of fourth maximus (Hip & fifth toes. extension)Cauda equina syndrome: A large midline disc herniation may compress several roots of caudaequina. Patients have bilateral leg pain. Peri anal numbness, saddle dysesthesiaand loss of anal reflex are seen or diminished rectal tone characterizes anadvanced cauda equina syndrome. Sensory deficit involves lower sacral roots.Difficulty with urination including either frequency or overflow incontinence maydevelop relatively early. “Study on Gridhrasi vata” 42
  49. 49. RoopaLumbar canal stenosis and spondylotic caudal radiculopathy: Osteo Arthritic or spondylotic changes may lead to compression of one ormore caudal roots. The problem is exaggerated if there is a congenital narrowlumbar canal. The roots are caught between the posterior surface of the vertebralbody and the ligamentum flavum posteriorly. Lateral recess stenosis, alluded toabove, may also contribute to root compression. Symptoms are of neurogenic claudication. Nonspecific low back pain androot pains followed by paraesthesias in the lower limbs, which come on withwalking down hill, and relieved by rest. In acute condition patient gains relief bysquatting or lying down with the legs flexed at the hips and knees. Standing, andparticularly standing with the lumbar spine in extension, aggravates the condition.Osteo Arthritis: Pain is centered in the affected part of spine, is increased by movement,and is associated with stiffness and limitation of motion. A slightly flexed postureis preferred. Discomfort is accentuated when the erect posture is resumed.Spondylolisthesis: Anterior displacement of a vertebral body in relation to inferior adjacentvertebra can cause root compression with resultant leg pain and weakness. Painoften aggravated by walking or standing.InvestigationsImaging of spine: Plain x-rays of lumbar spines: To identify the spondylotic changes andnarrowing in the lumbar spine or sacro-iliac lesion or hip joints.Myelogram: To know the disc protrusion and to differentiate such lesions fromtumors. Nuclear magnetic resonance imaging (NMR): To assess any root lesion. “Study on Gridhrasi vata” 43
  50. 50. Roopa Computed Tomography scan (C.T.Scan): Useful in the identification of astenosed canal, destructive lesion of vertebral bodies and posterior elements orpresence of paravertebral soft tissue mass.Magnetic Resonance Imaging (M.R.I): Which virtually replaces C.T.Scan. studyof degenerative disc. The symptom “Sakthnaha Kshepam Nigrahaneeyaat” is identical to S.L.R.test described in modern classics. The symptom “Dehasya vakrata” is nothing butthe Sciatica Scoliosis” and suptata refers to the parasthesia.  “Study on Gridhrasi vata” 44
  51. 51. RoopaREFERENCES1. Madhu Kosha on M.N.1/7.2. A.H.Ni.1/5.3. Ch.S.Chi.28/56.4. Aruna Datta on A.H.Su.12/49.5. Hemadri on A.H.Su.12/49.6. Dalhana on S.S.Ni.5/13.7. Madhukosha on M.N.22/54,55.8. Yogendranath Sen on Ch.S.Chi. 7/14.9. Arunadatta on A.H.Su.12/49.10. Arunadatta on A.H.Su 12/50.11. Hemadri on A.H.Su.12/50.12. Dalhana on S.S.Su.Ni 1/74.,Arunadatta on A.H.Ni.15/4.13. H.S.Tri.22/1,2.14. Hemadri on A.H.Su.12/50.15. Arunadatta on A.H.Su.12/49.16. V.S.Vatavyadhi adhikar-Sloka 571.17. Indu on A.S.Su.19/5.18. Dalhana on S.S. Chi.1/7.19. Dalhana S.S.Su.45/3.20. Madhukosha on M.N.14/4.21. Chakrapani on Ch.S.Chi.9/20.22. Chakrapani on Ch.S.Chi 16/41.23. Indu on A.S.Su 9/89.24. Principles of Neurology Adams and Victor Pg 213,14.25. Arthopadic Principles and their application pg no 1489.26. Merits Text book of Neurology pg 439. “Study on Gridhrasi vata” 45
  52. 52. Sapeksha Nidana SAPEKSHA NIDANA Chikitsa of vyadhi should be started after confirmation of disease bydifferential diagnosis. Many of the diseases have resemblance with one anotheras the symptoms are concerned. But their line of treatment differs basically. Cardinal symptoms of Gridhrasi are: - Pain starting in the sphik, kati, prista radiating down the lower limb. - Saktyukshepa nigrahanyat - Restriction in raising the leg. Other symptoms like stamba, toda, spurana etc., may be present.Gridhrasi has to be differentiated from the following to arrive at a diagnosis. 11) Urustambha : - The vitiated kapha along with medha obstructs the vata and pitta in uru pradesha producing immobilization of thigh and calf. - The patient experiences strange feeling that leg does not belong to himself. He is unable to perceive the cold sensation in the affected limb. - The movement of the lower limb is completely stopped due to severe pain. - Urusthamaba is associated with jwara, chardi, angamarda etc., which are not found in Gridhrasi. In Gridhrasi the posterior aspects of thigh, calf along with kati, janu, pada, are involved. Movement is possible.2) Khanja2: Difficulty in walking with involvement of one lower limb. Akshepana is present.3) Pangu: Both limbs are affected resulting in total immobilization of lower limb.4) Kalaya khanja: The feature of muktasandhi bandhana resulting in criss crossed manner in walking with kampana.5) Gudagata vata3: In addition to pain symptoms like emaciation in back, sacral region, thigh, calf, foot, retention of faeces, urine and flatus, colic, flatulence and formation of stone may also be present. “Study on Gridhrasi vata” 46
  53. 53. Sapeksha Nidana6) Khalli: According to Gayadasa, Khalli is a severe painful state of both Gridhrasi4 and Vishwachi. Both upper and lower limbs are affected simultaneously. Avamotana (Mardana like shoola) of pada, jangha, uru, karamoola is seen. Avamotana is not present in Gridhrasi. REFERENCES1. Ch.S.Chi.27/13,14,17,18.2. M.N.22/59-60.3. Ch.S.Chi.28/25.4. M.N.22/74. “Study on Gridhrasi vata” 47
  54. 54. Samprapti SAMPRAPTI “Vyadhi janaka dosha vyapara vishesha yuktam vyadhi 1 Jameha samprapti shabdena vachyam” The process of pathological changes in the body commencing from nidanato complete manifestation of the disease is called Samprapti. The Samprapti of Gridhrasi depends on Age, Sex, occupation and dietaryhabits of the people. Estimation of Samprapti is essential to treat diseasesuccessfully. Chikitsa is nothing but “Samprapti Vighatanam”. The pathogenesis of vata vyadhi takes place in two ways. When a personis exposed to vata prakopakara nidana his dhatus will not be nourished by virtueof soshana. Rasa dhatu kshaya takes place and further dhatus are not nourishedproperly. As a result of Dhatu kshaya 2, srotas become khara, ruksha, parushaand results into sroto riktata (devoid of Snehamsa). These rikta srotas gets filledwith vata dosha and results many vata vyadhis either in the whole body or targetorgans. Vitiated kapha, Ama obstructs vata dosha. It causes srotorodha andgenerates vatavyadhi at avarodha sthana. Vatavyadhi Samanya Samprapti Nidana Dhatukshaya Margavarodha Vataprakopa Vatavyadhi “Study on Gridhrasi vata” 48
  55. 55. Samprapti Gridhrasi Visesha Samprapti NidanaAgantuja Avarana AgnimandyaAbhigatajaMarmagathaja Vatavikriti Vatavriddhi Ama Margavarodha Sroto avarodha Dhatu kshaya Sroto Rikta DOSHA DUSHYA SAMMURCHANA AT THE SITE OF KHAVAIGUNYA STHANA SAMSRAYA AT KATI, PRISTA, URU, JANU, JANGHA, PADA Gridhrasi “Study on Gridhrasi vata” 49
  56. 56. Samprapti SAMPRAPTI GHATAKASDosha : Vata : Vyana vayu, Apana vayu Kapha : Sleshmaka kaphaDushya : Rasa, Rakta, Mamsa, Asthi, Kandara, SnayuSrotas : Chestavaha, SangnavahaSroto dusti prakara : SangamAgni Jatharagni, DhatwagniUdbhavasthana : PakwasayaSanchara sthana : Prista vamshaAdhistana : Spik, Kati Prista and AdhosakhaRogamarga : MadhyamaDosha: According to Susruta, Shakthnah kshepam nigrahaneeyat is one of thecardinal symptoms of Gridhrasi. The kshepana and utshepana etc., activities areattributed to vyanavata. Morbid vyana vayu is the primary cause of illness.Apana vayu having its site in kati & sakthi is also involved. Sleshmaka kaphagets involved as it resides in sandhi.Dushya: Susruta 3 clearly indicated the involvement of Kandara, which areupadhatu of mamsa. Dalhana considered kandara as mahasnayu, which starts from Gulpha tovitapa. One of the causes of this disease is mamsa lolupatwa (according toderivation of Gridhrasi). So mamsa dhatu is considered as one of the dushyas. 4 Hareeta points Rakta dhatu as one of the dushya in pathogenesis. Symptoms like pain at Kati and Prista is suggestive of involvement of Asthi.Since there is emaciation of dhatus due to lack of nourishment, rasadhatu is alsoinvolved. “Study on Gridhrasi vata” 50
  57. 57. SampraptiSrotas: Chestavaha and sangnavaha srotas The movements are performed by chestavaha srotas. The sensations areperceived by Sagnavaha srotas. Sciatic nerve composes both Sangnavaha and chestavaha srotases. In Gridhrasi vata the leg movements are impaired along with sensoryimpairment i.e., Parasthesia etc.Agni: Praseka, Arochaka, Bhaktadwesha are some of the distinguishing clinicalmanifestation of Vatakaphaja Gridhrasi and is indicative of Jatharagni Mandya.Udbhavasthana: The involvement of Vata Dosha in the pathogenesis of Gridhrasi revealsthat the disease stems out from the Pakwasaya. Similar to any other Nanatmajatype of Vatavyadhi Gridhrasi is also considered as Pakwashayodbhava vyadhi.Sancharasthana: Distribution of symptoms like pain in the low back region extending up tothe thigh legs and heal indicates the lower half of the body as the Sancharasthana.Adhishthana: Spik, Kati, Uru, Prushta, Jangha, Pada are the adhishtana of Gridhrasi. To sum up, the specific etiological factors leads to the vitiation of VyanaVayu. Abnormal vyana vayu stemming out from the Pakwashaya circulates in thelower part of the body and gets localized in the kati, prishta, uru, janu, jangha,pada. Vyana vayu afflicts the mamsa, asthi etc. dhatu involving cheshtavaha,sagnavaha srotas producing the severe pain originating in the Kati prushtaradiating to Jangha, Janu and Pada region. “Study on Gridhrasi vata” 51

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