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EVALUATION OF THE EFFICACY OF “DWIPANCHAMULADI MAMSARASA BASTI” IN GRIDHRASI – A CLINICAL OBSERVATIONAL STUDY S JAYASANKAR , Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital ...

EVALUATION OF THE EFFICACY OF “DWIPANCHAMULADI MAMSARASA BASTI” IN GRIDHRASI – A CLINICAL OBSERVATIONAL STUDY S JAYASANKAR , Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.

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Gridrasi mamsavasti pk025_gdg Gridrasi mamsavasti pk025_gdg Document Transcript

  • EVALUATION OF THE EFFICACY OF “DWIPANCHAMULADI MAMSARASA BASTI”IN GRIDHRASI – A CLINICAL OBSERVATIONAL STUDY BY S JAYASANKARDissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of DR. P.SIVARAMUDU M.D. (AYU) M.A. (SAN) M.A (PSY), Ph.D (SAN) Professor and HOD P.G. Dept. of Panchakarma And co-guidance of Dr. YASMEEN A. PHANIBAND M.D. (Ayu)POST GRADUATE DEPARTMENT OF PANCHAKARMAD.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2007-2010
  • DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “EVALUATION OF THEEFFICACY OF DWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI –A CLINICAL OBSERVATIONAL STUDY” is a bonafide and genuine research work carried out by me under the guidance of Dr. P.Sivaramudu M.D.(Ayu), Professorand HOD and the co-guidance of Dr. Yasmeen A. Phaniband M.D.(Ayu), Lecturer,Post Graduate Department of Panchakarma, Shri D.G.M. Ayurvedic Medical College, Gadag.Date: Signature of the CandidatePlace: Gadag (Dr. S JAYASANKAR)
  • CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “EVALUATION OF THE EFFICACYOF DWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI – ACLINICAL OBSERVATIONAL STUDY” is a bonafide research work done by Dr. SJAYASANKAR in partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. P.SIVARAMUDU M.D. (Ayu) Prof. and HOD P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag.
  • CERTIFICATE BY THE CO-GUIDEThis is to certify that the dissertation entitled “EVALUATION OF THE EFFICACYOF DWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI – ACLINICAL OBSERVATIONAL STUDY” is a bonafide research work done byDr.S JAYASANKAR in partial fulfillment of the requirement for the degree ofAyurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr.YASMEEN A.PHANIBAND M.D. (Ayu)
  • J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF DWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI – A CLINICAL OBSERVATIONAL STUDY” is a bonafide research work done by Dr. S JAYASANKAR under the guidance of Dr. P.SIVARAMUDU M.D. (Ayu) Professor and HOD and the co-guidance of Dr. YASMEEN A. PHANIBAND M.D. (Ayu), Lecturer, Post Graduate Department of Panchakarma, Shri D.G.M.A.M.C., Gadag and contributed good values to the Ayurvedic research. Dr. P.Sivaramudu M.D. (Ayu) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag
  • COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation /thesis in print or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. Dr.S Jayasankar © Rajiv Gandhi University of Health Sciences, Karnataka.
  • Acknowledgement Acknowledgement On this fruitful occasion of the successful completion of this dissertation, I bowmy head to the God almighty who is always showering blessings upon me and withoutwhose blessing, I would not have been able to attain this stage in my life. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for his divine blessings. I pay homage to my late ancestor’s ways of living and achievements in the fieldAyurveda which have inspired me to take up Ayurveda as my profession. I pay myrespect to my grandfather Late Vaidyakalanidhi P.S Krishnapillai, who had been a sourceof inspiration for many. I dedicate this work to my beloved mother B.Geetha, FatherDr.P.K.Sivasankaran Nair, Brother Dr.S.Harikrishnan, Sister in law Dr.Mangalaharikrishnan and their kids (Gauri & Devi), who are the prime reasons for my allsuccess. I whole heartedly thank them for their irrational and unbreakable belief in me. I express my deep sense of gratitude to my Teacher and GuideDr.P.Sivaramudu MD.(Ayu) for the magnitude of his dynamic guidance throughout thestudy. I express my deepest sense of gratitude to my respected Guide. I would like to avail this opportunity to express my humble gratitude to myrespected co-guide Dr. Yasmeen A. Phaniband for her humble nature, good will,indulgence, dynamic supervision, scholarly suggestions during the course of this researchwork. I express my thankfulness to beloved principal Dr. G. B. Patil, for hisencouragement and support by providing all necessary facilities for this research work.
  • Acknowledgement I express my gratefulness to professor Dr. Suresh babu, M.D.(Ayu), HOD, for hisinspiration, critical suggestions, timely help rendered me through out this work. I am very much thankful to Dr. Santhosh N belavadi MD (Ayu), Dr. JairajBasarigidad MD (Ayu), for their timely help and suggestions during this study and also Iexpress my sincere thanks to Dr. Rajashekar C.V.MD (Ayu), who was former teacher inthe department, for his critical suggestions. I am sincerely thankful to professor Dr.G.Purushothamacharyulu, M.D. (Ayu) whowas former H.O.D. of the department, for his scholarly guidance. I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr. M. C. Patil, Dr.Mulugund, Dr. G. S. Hiremath, Dr. R. V. Shettar, Dr. Danappa Goudar, Dr. JagadeeshMitti, Dr. Kuber Sankh, Dr. Shashikanth Nidugundi, Dr. B. M. Mulkipatil and Dr. M D.Samudri, Dr. V. M.Sajjan, Dr. Purad, Dr. Suvarna, Dr. Shakuntala and other teachingstaff for their valuable inputs and suggestions. I express my sincere thanks to Sri. Nandakumar for his help in statistical analysis of results. I take the privilege to thank Sri. Mundinamani, Librarian. I also extend my thanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me all the necessary books and time for my literary work. I am very much thankful to Sri Tippanagowdar (Lab Technician), and Sri. Basavaraj (X-Ray Technician), for their help during the study. I extend my thanks to Sri. Kulakarni, Sri. Nabi, Smt. Sunanda and Smt. Renuka for their timely help in trail. I feel extremely thankful to seniors Dr.Rathnakumar, Dr.Udayakumar,Dr.Chandramole, Dr.Krishnakumar, Dr.Anjai, Dr.Sateesh, Dr.Subin, Dr. Febin, Dr.
  • AcknowledgementJagadeesh, Dr. Ashok M.G, Dr.Prasanna V. Joshi, Dr. Sanjeev Chaudary, Dr.Madhushree, Dr. Prasanna Kumar, Dr. Siba Prasad, Dr. Payappa Gowdar, Dr.Devandrappa Budi, Dr. Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Shailej, Dr. MuktaHiremath and others for their valuable suggestions. I pay sincere regards to my fellow colleagues Dr. Sabareesh, Dr. Rajesh, Dr.Sanath kumar, Dr. Deepak, Dr. Ishwar Patil, Dr. Praveen Nayak, Dr. Bodke, Dr. Kanti,Dr. Shakunthala, Dr. Asha, Dr. C.C Hiremath, Dr. Rotti, Dr. Bupesh, Dr. Gorpade, Dr.Deepa, Dr. Anil Jadav, Dr. Mahantesh Swami and Dr. Praveen Palled for their truly helpand co-operation. I thank my juniors Dr. Joshi Goerge, Dr. Anish, Dr. Vishwajith, Dr. Renukaraj,Dr. Sangamesh, Dr. Raghavendrachar, Dr. Jagadeesh, Dr.Maneesh, Dr. Paresh, Dr.Shilpa, Dr. Bhaghyesh, Dr Vijaya raj, Dr. Surej and Dr. Vijay Mahanthesh for theirsupport. I specially thank to my friends in UG for their help and supports (SJSAC,Chennai) and Internees, UG and PG friends in DGMAMC. I am also very much thankfulto Dr.KSR.Prasad, Smt. Lalitha who made my stay comfort throughout my P.G. carrier. I also express my obligations to Dr.Rajagopalan Nair and all the other familymembers. I also pay my respect to Late Ms.Karthyayani amma for her blessings. Lastly I pay my deepest respect for those patients who took part in the study and Ishare my success with them.Date :Place : Gadag Dr. S Jayasankar
  • LIST OF ABBREVIATIONS USED:A.S – Ashtanga Samgraha.A.H – Ashtanga Hrudaya.B.P – Bhavaprakasha.B.S – Bhela Samhita.B.R - Baishajyarathnavali.C.S – Charaka Samhita.C.D – Chakradatta.G.N – Gadanigraha.H.S – Haretha Samhita.K.S – Kashyapa Samhita.M.N – Madhava Nidana.S.S – Sushruta Samhita.S.S – Sharangadhara Samhita.V.S – Vangasena Samhita.Y.R – Yogaratnakara.
  • TABLE OF CONTENTSSI. No. Contents Page No.01 Introduction 1-402 Objectives 5-903 Review of Literature 10-8204 Materials and Methodology 83-9805 Observations and Results 99-14206 Discussion 143-15907 Conclusion 160-16208 Summary 163-16409 Bibliography 165-19410 Annexure 195-208
  • LIST OF TABLESSI. Tables PageNo No.01 Showing the Aharaja nidana of Gridhrasi. 2402 Showing the Dravya vishesha of Nidana. 2503 Showing the Viharaja nidana of Gridhrasi. 2604 Showing the Manasika nidanas of Gridhrasi. 2705 Showing the Kalaja nidanas of Gridhrasi. 2706 Showing the Anya nidanas of Gridhrasi. 2807 Showing the Samanya lakshanas of Gridhrasi. 3308 Showing the Visesha lakshanas of Vataja Gridhrasi. 3409 Showing the Visesha lakshanas of Vatakaphaja Gridhrasi. 3610 Showing the Clinical features of Sciatica. 3711 Showing the Samprapti ghatakas of Gridhrasi. 4112 Showing the Vyavachedaka nidanas of Gridhrasi. 4413 Showing the Pathyaharas of Gridhrasi. 4714 Showing the Apathyaharas of Gridhrasi. 4815 Showing the Upasaya for Gridhrasi. 4916 Showing the Anupasaya for Gridhrasi. 4917 Showing the Different Treatments of Gridhrasi. 5118 Showing the Abhyantara bheda of basti 5419 Showing the Sankhya bheda of basti. 5520 Showing the Karma bheda of basti. 5521 Showing the Anushagika bheda of basti. 5622 Showing the Rasa bheda of basti. 5623 Showing the Matra bheda of basti. 5624 Showing the Contents and Quantiy of Niruha basti dravya. 5725 Showing the Snehabasti bheda and Matra. 5826 Showing the Measurements of Bastinetra. 5927 Showing the Dosha of Bastinetra 6028 Showing the Dosha of Bastiputaka. 6129 Showing the Contraindications of Niruhabasti. 6130 Showing the indication of Niruhabasti. 6331 Showing the Contraindications of Anuvasanabasti. 6532 Showing the Dosage of Niruhabasti in different ages. 6633 Showing the Basti vyapat. 6934 Showing the Basti pranidana Doshas. 7235 Showing the Ingredients of Putoyavanyadikalka. 8036 Showing the Ingredients of Dasamula. 8137 Showing the Demographical data. 9938 Showing the Subjective Parameter grading. 10139 Showing the Subjective Parameter grading. 10240 Showing the Subjective Parameter grading. 10341 Showing the Subjective Parameter grading. 10442 Showing the Objective Parameters grading. 10543 Showing the Objective Parameters grading. 10644 Showing the Objective Parameters grading. 10745 Showing the Objective Parameters grading. 10846 Showing the Distribution of Patients by Sex. 10947 Showing the Distribution of Patients by Religion. 10948 Showing the Distribution of Patients by Occupation. 11049 Showing the Distribution of Patients by Age. 111
  • 50 Showing the Distribution of Patients by Socio economic Status. 11151 Showing the Distribution of Patients by Habits. 11252 Showing the Distribution of Patients by Involvement of Affected Limb. 11353 Showing the Distribution of Patients by Incidence of Position. 11354 Showing the Distribution of Patients by Incidence in Different Koshta. 11455 Showing the Distribution of Patients by Incidence on Agni. 11556 Showing the Distribution of Patients by Chronicity of Disease. 11557 Showing the Distribution of Patients by Incidence on Ahara. 11658 Showing the Distribution of Patients by Incidence on Aharaja nidana. 11759 Showing the Distribution of Patients by Incidence on Viharaja nidana. 11860 Showing the Incidence on Range of SLR Before treatment. 11961 Showing the Incidence on Range of SLR After treatment. 12062 Showing the Incidence on Range of SLR After follow up. 12163 Showing the Movement of Lumbar Spine Before treatment. 12264 Showing the Movement of Lumbar Spine After treatment. 12365 Showing the Movement of Lumbar Spine After follow-up. 12466 Showing the Extension of Lumbar Spine. 12567 Showing the Rotation of Lumbar Spine. 12668 Showing the Knee and Ankle jerk Before treatment. 12669 Showing the Knee and Ankle jerk After treatment. 12770 Showing the Knee and Ankle jerk After follow up. 12871 Showing the Distribution of Difference in Grade Babinski’s sign. 12972 Showing the Distribution of Patients by Walking time. 13073 Showing the Incidence based on Pain. 13174 Showing the Incidence based on Stambha. 13275 Showing the Average Retention of Niruhabasti. 13276 Showing the Average Retention of Anuvasanabasti. 13377 Showing the Distribution of Anubandha vedana Before treatment. 13478 Showing the Distribution of Anubandha vedana After treatment. 13579 Showing the Distribution of Anubandha vedana After follow up. 13580 Showing the Difference in Grade of Oswestry Disability Index. 13681 Showing the Incidence on Gait. 13782 Showing the Incidence on Visual Analogue Scale. 13783 Showing the Radiological findings. 13884 Showing the Overall Assessment. 13985 Showing the Statistical Outcome of the study Before & After Treatment. 14086 Showing the Statistical Outcome of the study Before & After Follow up. 14187 Showing the Ingredients of Dwipanchamuladi Mamsarasa Basti. 143
  • LIST OF FIGURESSI. Figures PageNo No01 Showing the Distribution of Patients by Sex 10902 Showing the Distribution of Patients by Religion. 11003 Showing the Distribution of Patients by Occupation. 11004 Showing the Distribution of Patients by Age. 11105 Showing the Distribution of Patients by Socio economic Status. 11206 Showing the Distribution of Patients by Habits. 11207 Showing the Distribution of Patients by Involvement of Limb. 11308 Showing the Distribution of Patients by Incidence of Position. 11409 Showing the Distribution of Patients by Incidence in Different 114 Koshta.10 Showing the Distribution of Patients by Incidence of Agni. 11511 Showing the Distribution of Patients by Chronicity of Disease. 11612 Showing the Distribution of Patients by Incidence on Ahara. 11613 Showing the Distribution of Patients by Incidence on Aharaja 117 nidana.14 Showing the Distribution of Patients by Incidence on Viharaja 118 nidana.15 Showing Incidence on Range of SLR Before treatment. 11916 Showing Incidence on Range of SLR After treatment. 12017 Showing Incidence on Range of SLR After follow up. 12118 Showing the Movement of Lumbar Spine Before treatment. 12219 Showing the Movement of Lumbar Spine After treatment. 12320 Showing the Movement of Lumbar Spine After follow-up. 12421 Showing the Extension of Lumbar Spine. 12522 Showing the Rotation of Lumbar Spine. 12623 Showing the Knee and Ankle jerk Before treatment. 12724 Showing the Knee and Ankle jerk After treatment. 12825 Showing the Knee and Ankle jerk After follow-up. 12826 Showing the Distribution of Patients by Walking time. 13027 Showing the Incidence based on Pain. 13128 Showing the Incidence based on Stambha. 13229 Showing the Average retention of Niruha basti. 13330 Showing the Average Retention of Anuvasana basti. 13431 Showing the Difference in Grade of Oswestry Disability Index. 13632 Showing the Incidence on Gait. 13733 Showing the Incidence on Visual analog scale. 13834 Showing the Radiological findings. 13935 Showing the Overall Assessment. 139
  • LIST OF FLOW CHARTSSI No Flow charts Page No01 Showing the causes of Sciatica. 2902 Showing the Samprapti of Vatavyadhi. 3803 Showing Samprapti of Gridhrasi. 4004 Showing Basti karmukata. 73
  • AbstractAbstract Gridhrasi is one of the commonest problem affects irrespective of sex, age andsocioeconomic status etc. The disease has the symptoms like pain (radiating), stiffness,numbness, burning sensation. It is a debilitating disease in view of its chronic andcomplications. The life time incidence of low back pain is 50%-70% with the incidenceof Sciatica being more than 40% and about 4-6% of the Sciatica is due to the lumbar discprolapse. In Gridhrasi vata and kapha doshas are involved. Bastikarma is consideredunder shodhana variety which helps in anuloma gati of vatadosha. Here an attempt ismade to evaluate the “Effect of Bastikarma in Gridhrasi”.Objective of the Study: 1. To evaluate the efficacy of Basti in the management of Gridhrasi. 2. To evaluate the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi. It was a simple randomized single clinical observational study with a pre and posttest design, 30 patients were diagnosed as Gridhrasi and fulfilling the criteria ofundergoing the process of stanika abhyanga, nadi sweda and bastikarma were selected.After examination of patients, abhyanga with Bala taila and Dasamula kashayasiddhanadisweda was administered. Alternate days Bala taila Anuvasana and DwipanchamuladiNiruhabasti performed for 6 days and finally two Anuvasanabasti was given. Theassessment criteria were noted before, during and after the treatment and follow up.Subjective parameters i.e. stambha, ruk, toda, spandana, sakthiutkshepa nigrahana are thechief complaints of Gridhrasi and objective parameters are SLR, Movement of lumbarspine, Reflexes, Walking time, Visual analogue scale, Oswetry Disability Index .Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi I
  • Abstract 100% patients manifested relief from ruk, suptata, daha after stanika abhyanga and Nadisweda. The maximum and average retention of Niruhabasti is 11 minute to 20 minute (14 patients.i.e. 46.66%). The maximum and average retention of Anuvasanabasti is 1 minute to 100 minute (17 patients.i.e.56.66%).Key Words: Gridhrasi, Sciatica, Abhyanga, Nadisweda, Bastikarma.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi II
  • Introduction Introduction "The urge to heal can only be the motive and the driving force behind our actions;the direction of these actions, the decision of where and how, is solely a matter ofunderstanding." Twenty first century is the era of life style disorders. Humans by their innate natureget along with these changes and adopt very quickly. In due course of keeping them withthe current surroundings they come across a lot of disharmonies affecting their biologicalsystem. Over exertion, improper sitting and standing postures in work place, jerkingmovements in the travel etc invariably causes jerks to the spinal column, leads to lowback ache and its related problems like Sciatica. The disease Gridhrasi or Sciatica is sucha disease which is quite commonly present in the society making the people incapable ofdoing their daily routine, due to the severity of the pain. According to the journal oforthopedics the life time incidence of low back pain is 50%-70% with the incidence ofSciatica being more than 40%. About 4-6% of the Sciatica is due to the lumbar discprolapse.1 Amongst painful diseases, sciatica occupies a foremost place by reason of itsprevalence, its production by a great variety of conditions, the great disablement it mayEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -1-
  • Introductionproduce, and its tendency to relapse; all of which have long ago led to its recognition asone of the great scourges of humanity. There are quite a lot of reference about Gridhrasi in Ayurvedic samhitas and is alsoelaborately explained with its management as an individual disease. Charaka quotedGridhrasi in vataja nanatmaja vyadhi.2 Acharyas also enumerated Gridhrasi underMahagada that indicates difficulty to cure it.3 However, occasionally Kaphanubandhamay be seen in Gridhrasi. This disease not only inflicts pain but also causes difficulty inwalking. The cardinal signs and symptoms of Gridhrasi (sciatica) are Ruk (pain), Toda(pricking sensation), Stambha (stiffness) and Muhuspandana (twitching) in the Sphik,Kati, Ooru, Janu, Jangha and Pada in order and Sakthikshepa Nigraha i.e. restrictedlifting of the leg. In Kaphanubandhata, Tandra, Gaurava, Arochaka are present.4 The Sciatic nerve is the longest nerve in our body. It runs from the back of pelvis,through buttocks, and all the way down both legs, ending at the feet.5 Anything thatcompresses or irritates the Sciatic nerve can cause a pain that radiates. Inflammation ofthe Sciatic nerve is most prevalent in the age range of 30 to 50.6 “Sciatic Syndrome” - resembles with Gridhrasi, in sciatica there is pain in thedistribution of Sciatic nerve which begins from buttock and radiates downwards to theposterior aspect of thigh, calf and to the outer boarder of foot. A Herniation orDegenerative change in inter-vertebral disc is the most common cause. There is oftenhistory of trauma, as twisting of the spine, lifting heavy objects or exposure to cold. Inreference to Sciatica treatment there is no need to state that in other medical sciences onlythe symptomatic management and also few surgical procedures with interest of adversereaction.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -2-
  • Introduction Its demo logical studies reveal that 1-10% of the total population with 12.8 per1000 for men and 6.6 per 1000 for women concordant with the earlier observation ofmale predominance.7 The disease Gridhrasi as being a vatavyadhi and vata is also controller andregulator of other two dosha, dhatu and mala and also all the body activities.8 Therefore,once vata is controlled by basti, all these factors are automatically regulated and totalbody equilibrium is achieved. Panchakarma is a very unique therapeutic procedure because of its preventive,promotive, prophylactic and rejuvinative properties as well as providing a radical cure.9Among the Panchakarma, Acharyas have given prime importance to bastikarma and eventermed this karma as Ardhachikitsa.10 Herby it’s very clear that basti is much importantprocedure among all the other treatment modalities of Ayurveda. Even Acharyas havementioned it removes the vitiated dosha, which has been spread throughout the body byquoting the word Aapadatalamastaka while explaining the spread of bastidravya in thebody.11Hypothesis: Sciatica is a term which refers to a burning, stinging, and/or numbing pain that isfelt in the buttock, thigh, leg, and/or foot; it may or may not be associated with low backpain. Not all lower extremity pain is classified as true sciatica. Sciatic pain may beclassified as radicular pain (true sciatica) - pain radiating from the low back, past theknee, and into the dermatome (L4, L5, and/or S1) of the affected lumbar nerve root; or asnon-radicular pain - pain radiating in the lower limb in a non-dermatomal pattern.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -3-
  • IntroductionBogduk defines radicular pain as a burning and/or numbing pain that presents in a band-like dermatomal pattern below the knee. Low back pain and Sciatica result in tremendous losses to our society in termsof decreased productivity and cost of treatment. Oral steroids are inexpensive andrelatively safe medications that, if effective in reducing the pain and disability associatedwith sciatica, could improve the quality of patients’ lives, and result in significant costsavings to society at large. Adequate pain assessment is critical for evaluating the efficacy of analgesictreatment in clinical practice and during the development of new therapies. It is clear tostate that ruja or vedana synonyms to the term “Pain” where the drug of choices isanalgesics. Keeping in mind the above said points and also after observing numerous clinicaltrials undergone with various procedures like snehana, swedana, virechana, basti etc inthe management of Gridhrasi, I have decided to undertake “Dwipanchamuladi mamsarasabasti yoga in Uttamamathra” for my clinical trial. By keeping hypothesis that the giventreatment procedure will help in alleviating the doshas and helps in reliving pain andstiffness. Numerous works have been undergone in the management of the Gridhrasi,though none of them included Mamsarasa in their studies..Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -4-
  • Objectives Objectives Medical science has eliminated the totality of the natural biological rules in thehuman body, mostly by dividing research and practice into many specialties. Doingintensive, masterly specialized work, it was forgotten that every part is still only a pieceof the entire body. (Max Gerson, 1958) Life without movement is impossible to think of in a healthy person’s normal life.As the advancement of busy professional and social life, improper sitting postures inoffices, factories etc. created undue pressure to the spinal cord. Continuous and overexertion, jerking movements during traveling and sports are also playing their part inproducing neuralgic pain. In this way this disease is now becoming a significant threat toworking population. Likewise, progressive disorders affecting the pelvis and nearerstructures are also precipitating this condition. In an over all assessment major number ofpatients presented to the hospital has some symptoms related with pain on low back andlegs. When we analyses the conditions which precipitate ‘Gridhrasi’ it can be learntthat any abhighata affecting the lower part of the spinal cord can produce this disease.But then even mild stresses induced in the above part can make considerable alterationsin the functions of loco motor system. This may predispose the conditions similar to‘Gridhrasi’ in due course. One of the most common diseases that affect the hip and the lower limbs isGridhrasi. As far as aetiopathology of Gridhrasi is concerned ‘Vatavaigunya’ isimportant. It essentially plays a role in the over stimulation of the nerve as experiencedby severe pain in the course of affected part.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -5-
  • Objectives Sciatica is pain in the lower back that can radiate down the buttocks and leg and occasionally in to the foot. Sciatica causes pain that may be constant and intermittent and it may include numbness, burning, or tingling sensation. Coughing, sneezing, bending over or lifting heavy objects may increase the pain. Each and every human being desires to lead a happy and comfortable life, but it is not possible owing to multifactor related with changing life style, and environmental factors etc. As per data available 80% of population in modern industrial society experience back pain at sometime during their life, fortunately in some of these its subsides within a month. But unfortunately as many as 70% of these pain recurs, out of these many of them converts into Sciatica patients as time passes. Sciatica might be revealed by a neuromuscular examination of the legs by a physician. There may be weakness of knee bending or foot movement, or difficulty in bending the foot inward or down. Reflexes may be abnormal, with weak or absent ankle-jerk reflex. Pain down the leg can be reproduced by lifting the leg straight up off the examining table. Pain is the major problem with the most of the patients with Sciatica. Many scores have been developed, including numerical and verbal rating scales, Visual analogue scale (VAS), Walking time, Gait, Range of motion, Questionnaires, and Behavioral observation methods.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -6-
  • ObjectivesPhysical/Functional Disability: Disability can be measured by several methods, based on clinical judgment, observed patient performances, or self-administered assessments. The most frequently used self reported questionnaires, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). The aims of treatment of sciatica are therefore multiple- reduction in signs and symptoms, prevention of disability in locomotor system, prevention of structural damage, and induction of remission. By considering the above aspects and treatment protocols, in the present studyan attempt is made to find suitable remedy for Gridhrasi keeping the cardinal symptomsof Gridhrasi i.e. Ruk (pain), Stambha (stiffness), Toda (pricking sensation) and Spandana(cramping sensation) the present study is intended and selected the following yogaDwipanchamuladi mamsarasa basti mentioned specially by Charaka and Vagbhata. Inthis regard the objects proposed in the study are, 1. To evaluate the efficacy of Basti in the management of Gridhrasi. 2. To evaluate the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi.To Evaluate the Efficacy of Basti in the management of Gridhrasi: Direct application of basti into pakwashaya helps for the proper regulation andco-ordination of the function of vata dosha not only in its own site but also control therelated doshas which are involved in the pathogenesis of disease. Hence it is consideredas one of the prime treatments for vata predominant diseases. The notable advantage ofbasti karma is of its quick action, which produces the desired effects like sodhana orEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -7-
  • Objectivestarpana without any side effects and also called it as Ardhachikitsa i.e. half of thetreatment for almost all diseases. Though the medicines given through niruha basti reaches pakwashaya, its veeryareaches various places through various strotheses and pacifies vitiated vata dosha in thoseplaces, nourishes the required dhatus.12 Acharya Sushrutha explains that after properadministration of basti, dravya remains in the pakwashaya, shroni, and below the nabhiand through the srotoses, the veerya of basti spread to entire body. Chakrapani states thatAgni will be in the natural state in the posture, while Gangadhara says; agni, grahani andnabhi are present in the left side. So bastidravya can reach to the large intestine andgrahani, as they are present in the sequence. In Sushruta he gives a simile like water poured at the root of tree circulates allover the tree and nourishes the body by its own specific property. In the same waybastikarma eliminates the morbid doshas and dooshyas from all the parts of the body.13To Evaluate the Efficacy of Dwipanchamuladi Mamsarasa Basti in Gridhrasi: Action of bastidravya is due to its anupravanabhava, which contains sneha alongwith other dravyas like makshika, saindhava easily moves up to grahani byanupravanabhava guna similar to that of dravya, which freely moves in the utensil.Sushruta says bastidravya reach nabhi, katipradesha and kukshi14 where the pathology issituated for Gridhrasi. Dwipanchamuladi Niruha basti and Bala taila for Anuvasana basti is selected forthe study as it having the properties of both Vatakaphashamaka, and Bala taila which isselected for the Anuvasana basti specially indicated where there is involvement of vata& also Anuvasana basti stabilizes pada, jangha, ooru, prushta, sakthi.15 Among variousEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -8-
  • Objectivesbastis Dwipanchamuladi basti is specially indicated for vataja diseases. In this bastiDasamoola kashaya acts as Vatakaphashamaka.16 Mamsarasa which nourishes the dhatus,there by promotes bala to the patient and also it helps in maintaining the equilibrium ofthridosha.17 Vasa is used along with ghrita and taila (Thrisneha) which is not commonlyused for bastikarma. It alleviates vatakaphadosha and pain arising in sandhi, asthi, marmaetc.18 Kanji also used as one of the avapadravya it alleviate vatakaphadosha and ruja.19In Dathu kshayajanya vatavyadhi there will be lose of snehamsa of dhatu so by doingmamsarasa trisnehayukta basti will replace the snehamsa of the lost dhatu, there by wecan breakdown the samprapti. As Gridhrasi is a vatavyadhi it requires the drugs which are brihmana, balakara,dhatuposhaka etc. Here in this basti combination, the mamsarasa which is used in largequantity will serve this purpose. It may help in proper dhatu poshana that intern may helpin production and nourishment of Uttarotthara dhatu’s like asti, majja etc. Muscle weakness is commonly seen in Sciatica and which may be compensatedwith the supplement of the nutrition’s in the form of mamsarasa and it may directly helpin the nourishment and strengthening of muscles as explained in classics “Mamsamamsena Vardhate”.20 In total selecting the Ajamamsarasa and Vasa in niruhakalpana is to improvise thenourishment and at the same to know the role of Dwipanchamuladi mamsarasa basti inthe management of Gridhrasi.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi -9-
  • Bastikarma Review of literature This chapter deals with historical aspects, Nidana, Poorvarupa, Rupa, Samprapti,Upasaya, Upadrava and Pathyapathya of Gridhrasi from different classics.Historical Aspect of Basti karma: The evolution of bastikarma can be traced fromVedic era i.e. Rigveda and Atharvaveda which are considered as the oldest authenticmanuscripts.Veda kala: In Kaushika Sutra of Atharvaveda, Bastikarma is indicated as a substitute forminor operation.21Purana kala: In Agnipurana, bastikarma is indicated as a principle treatment incomplaints marked by predominance of vata.22 In Ashwa Chikitsa Kathana, tailabasti isrecommended in horses to relieve their fatigue immediately. It is also stated thataccording to season different sneha should be used for Bastikarma.23Samhitha kala: Charaka Samhita being the best book for Chikitsa, Gridhrasi along withsymptomatology, management, uses, complications and advantages are described.24 Thescattered references regarding bastikarma are available in various chapters of Charakasamhita, but in Siddhisthana out of 12 chapters, 8 chapters are on the basti chikitsa. Firsttwo chapters of Siddhisthana deals with properties of bastisamyakayoga, ayogalakshanas,indications and contraindications.25 In Sushruta Samhita, Chikitsasthana four chaptershave been devoted completely for the description of the bastikarma. In these chapters,detailed information regarding bastinetra, indication, contra-indications, complications,classification of basti are available.26 In Astanga samgraha full length explanation of bastiis found in Bastividhi adhyaya.27 In this chapter, classification, indication, contra-indication, dosage, process of administration etc. have been described in detail. InEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 10 -
  • BastikarmaKalpasthana four chapters are devoted to bastikarma. In these chapters, descriptionregarding importance of bastikarma, different types of basti, snehabasti vyapath etc. aregiven. Acharya Vagbhata has explained the bastikarma in Ashtanga samgraha andAshtanga hridaya like avasthanusrutabastis, chitrabastis, prasrutikabastis, vyapath etc.28Sutrasthana of Astanga hridaya Basti Vidhi29 and Kalpasiddhi chapters named asBastikalpa and Bastivyapadasiddhi explain the every aspect of bastikarma.30 Sharangadhara samhita uttarakhanda namely Basti kalpanavidhi, Niruhabastikalpanavidhi and Uttarabasti kalpanavidhi describe various aspects of Anuvasanabasti,Niruhabasti and Uttarabasti respectively.31 Bhvaprakasha Purvakhanda has beencontributed to describe basti and also vrana basti has been explained.32 Kashyapa Samhita, Bastikarma has been explained in detail in Siddhisthana33 andKhilasthana.34 Bhela Samhita, description of basti is available in four chapters ofSiddhisthana namely Bastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhi andDoshavyapadikabastisiddhi.35 Chakradatta two chapters named Anuvasanadhikara andNiruhadhikara are dealt with Anuvasana and Niruha basti respectively.36 In MadhavaChikitsa the author has dedicated two chapters for basti karma contributing some of theimportant basti kalpas like deepana basti, ardhamatrika basti (Madhava Chikitsa 70-75).Vangasena samhita has devoted “Basti Karmadhikara” for description of bastikarma.37Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 11 -
  • Vyutpathi of Basti Vyutpathi of Basti Etymology reveals the ‘Origin and Developments’ in the meaning of a word. Theword ‘Basti’ is derived from the root word “Bas” and “Chit” pratyaya. “Vasu nivase” -To reside. “Vas-aachadane” -Which gives covering. “Vas vasane surabhikarane” -Which gives fragrance. “Vasti vaste aavrunothi moothram” -That which covers the urine. “Vasti nabhir adho bhaga sthane” -Basti is situated in the - Sub- Umbilical area.Paribhasha: The term basti in the context of Panchakarma can be used in different sense,it gives the following meaning. “oÉÎxiÉlÉÉÇ SÏrÉiÉå CÌiÉ oÉÎxiÉÈ”38 “oÉÎxiÉUÍpÉkÉÏrÉiÉå rÉxqÉÉiÉç iÉxqÉÉiÉç oÉÎxiÉËUÌiÉ xqÉ×iÉ” 39 The bag made by animal bladder is termed as “Basti”. The bladders of animals areused as the device for bastikarma in olden days. It is also said that medicinesadministered through gudamarga by a bastinetra of bastiyantra, first reaches the lowerabdominal area of the patient which contains the organ basti.40 i.e. urinary bladder. Hencethe term basti is used to designate the process in Panchakarma. Charaka defines basti as the procedure in which the properly prepared drug isadministered through rectum, reaches up to the nabhi , kati, parshva and kukshi, churnsthe accumulated dosha and purisha, spreads the unctuousness (potency of the drug) allover the body and easily comes out along with the churned purisha and doshas is calledbasti.41Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 12 -
  • Vyutpathi of Gridhrasi Vyutpathi of Gridhrasi “Gridhu’ is the dhatu which makes the word ‘Gridhra’ from which the world‘Gridhrasi’ is derived. The Gridhu dhatu means to desire, to covet, strive after greedily.‘Karan’ pratyaya is added to this by ‘Susudhangridhibhyaha Kran’ & then by the lope ofK & N the word ‘Gridhra’ is derived. ‘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’, infeminine gender by adding ‘dis’ pratyaya the word ‘Gridhrasi’ is derived.Niruktti of Gridhrasi: “Urusandhau vatarogah”42 Further the author of Amarasudha opines that this disease is characterized bymorbidity of Vata dosha affecting the hip joint. “Gridhramiva sayti Gacchati” Also, because of the persisting severe pain the patient has a typical gait i.e.slightly titled towards the affected side & affected leg in flexed position & another leg isextended. This gait resembles with that of vulture. So the disease is named as Gridhrasi. Sabdakalpadruma states that, the word Gridh refers to a person who is crazy ofeating meat. The word Syaati means to cause suffering. Thus the word Gridhrasi appliesto an illness that mostly attacks the persons who are greedy of consuming meat.43 “Gridhram api syati antakarmani atonupasargakah Carva gridhra iva syati pidayathi Gridhra syati bhakshayati”Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 13 -
  • Vyutpathi of Gridhrasi According to another nirukti, Gridhrasi is characterized by severe painexperienced by the patient and is similar to the one experienced by a prey of vulturewhile being eaten up.Gridhrasi (f): In Monier Williams, Sanskrit - English dictionary it is said that, Gridhrasiis Rheumatism affecting the loins.44 Similar reference is also found in “Vaidyakashabdasindhu”Bheda of Gridhrasi: Charaka in Astodariya adhyaya mentioned two types of Gridhrasi vataja andvatakaphaja.45 Sushruta and Vagbhata have not mentioned any types. Madhava nidana,Bhavaprakasha, Yogaratnakara, Vangasena Samhita have mentioned the same above twotypes of Gridhrasi.Paryaya of Gridhrasi: The word Gridhrasi has 3 synonyms used by various authors. They are mentionedas below -1. Ringhini.46 - This term is used by Vachaspati Mishra while commenting on Gridhrasiin Madhava nidana. According to Sabdakalpadruma the meaning of this term is said as“Skhalana”i,e displacement of particularly a Picchila material. It may be a merecoincidental observation that displacement of the soft annulus is the prime pathology ofSciatica.2. Randhrini.47 - This term is used by Dalhana while commenting on Susruta, indicatesweak point or rupture. Discs are the weakest point in the lumbar spine and tend to rupturecausing Sciatica.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 14 -
  • Vyutpathi of Gridhrasi3. Radhina.48 - This term is used by Aadhamalla in Goodaarthadeepika commentary onSarangdhara Samhita. The word indicates pressing, compressing or destroying.Compression of the nerve roots is the primary pathology of radicular pain in Sciatica.Paribhasha of Gridhrasi: As described by Acharya Charaka Gridhrasi is a vatavyadhi, characterized bystambha (stiffness), ruk (pain), toda (pricking pain) and spandana (Cramping). Thesesymptoms initially affect sphik (buttock) as well as posterior aspect of kati (waist) andthen gradually radiates to posterior aspects of ooru (thigh), janu (knee), jangha (calf) andpada (foot). 49 Acharya Sushruta opines that there are two kandara in the leg that gets afflicted.The two kandara include the one extending distally from the parshni to the toes, and otherextending above from the parshni to the vitapa. These two kandara when gets afflictedwith the vata dosha limits the extension of the leg. This disease is known as Gridhrasi.50 The word Gridhrasi was the only one name used to indicate this condition inalmost all the treatises and subsequent Sangrahagrantha and occasionally with a suffixvata make it Gridhrasivata. The other terms mentioned above are used only bycommentators.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 15 -
  • Disease review Disease reviewHistorical review of Gridhrasi: The disorders that impair the movement of legs are as old as the existence ofhuman beings as walking is an inevitable function since the existence of man on earth tosearch for his food. The historical review can be classified in to Vedic period andSamhita period.Vedic period: Ayurveda is the upaveda of Atharvaveda. The references of Vatavyadhi are foundin Atharvaveda only. The word ‘Vatakrita’ is used for vatavyadhi. There are prayers inAtharvaveda to protect ojas in thighs (ooru), jangha (leg), prishta (spinal column),capacity to erect straight in padas and unimpaired organs of the body.51 There arereferences about kshiptaroga, where pipalli is mentioned as the medicine for the roga. Inthe Gridhrasi kshepana is a feature according to its derivation. Hence, we assume that inAtharvanaveda the word kshipta may be used for Gridhrasi.52 But there is no referenceabout the disease Gridhrasi as such in the Vedas. Some references are available inGarudapurana and Agnipurana about Vatavyadhi but not specified to Gridhrasi.53Samhita period: Among Bruhathrayes, Charaka has made the first description about Gridhrasi andincluded in both nanatmaja and samanyaja type of vyadhi, in Maharogadyaya54 andbheda, lakshna, chikitsa are also explained in Chikitsasthana. Sushruta has mentioned theinvolvement of kandara in the disease pathogenesis and surgical treatments are explainedEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 16 -
  • Disease reviewin detai.55 Vagbhata, in Ashtanga samgraha and Ashtanga hrudaya discussed thesymptomatology. Bhavaparakasha explained the disease Gridhrasi and its management by vamana,virechana with more importance to bastikarma.56 Madhavakara in Madhavanidanadescribed symptomatology. 57 In Kashyapa samhita Gridhrasi is considered as one among theAseetivatavikaras.58 Bhela and Hareeta had given more importance to bastikarma andrakthamokshana in their respective samhitas.59 Chakradatta along with vamana,virechanasuggested to do agnikarma in the little finger of the affected limb if the Gridhrasi is notsubsided by any treatment.60 Yogaratnakara mentioned the symptoms of Gridhrasi buthave given more importance to formulation.61 Chakrapanidatta, Dhalhana, Arunadatta, commentators of Bruhatrayes opine thatGridhrasi is a shoolapradhana vatavyadhi, kandara and snayus are affected andimpairment in lifting the lower limb is main feature.Gridhrasi in Ancient texts: Charaka samhita in Matrasheetiya adhyaya Gridhrasi is mentioned amongindications for padabhyanga.62 Swedadhyaya it is mentoned as an indication for sweda.63Ashtodariyadhyaya two types it is mentioned64 and in Maharogadhyaya it is enumeratedin the nanatmaja vatavyadhies.65 Lakshna along with Chikitsa of Gridhrasi has beendescribed in Vatavyadhi chikitsa.66 In Sushruta Samhita Vatavyadhi nidana symptomatology and pathogenesis havebeen described. Mahavatavyadhi chikitsitadhyaya Siraveda is mentioned67. The site ofsiravedha in Gridhrasi is mentioned in Siravyadhavidhi sarira.68Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 17 -
  • Disease review According to Vagbhata, In Ashtanga Samgraha Doshabhediya adhyaya Gridhrasiis included under 80 types of vatavikaras.69 The site of siravedha has been mentioned.70Vatavyadhi nidana Gridhrasi is described with its symptoms. Ashtanga hrudayaSiravyadhavidhi adhyaya site for siravedha has been mentioned.71 Vatavyadhi nidanasymptomatology, pathogenesis and in Chikitsasthana treatment of Gridhrasi is described. Vatavyadhi nidana Gridhrasi is described with its symptoms by Madhavakara. InSharangadhara Samhita Gridhrasi is counted in Nanatmaja vatavyadhies72 and inMadhyamakhanda preparations for treatment of Gridhrasi have been described.Bhavaprakasa, Gridhrasi is considered under 80 vatavyadhies and specific treatment forvatakaphaja Gridhrasi is mentioned.73 In Kasyapa samhita, Gridhrasi is considered one among 80 types of vatavikaras.74Bhela in his twentyfourth chapter basti and raktamokshana chikitsa is described forGridhrasi. Harita Samhita Gridhrasi is described as a Vyanaprakopaja vyadhi75 and dealsthe symptomatology and treatment of Gridhrasi.76 Gridhrasi has been described in theVatavyadhi chikitsa and also described bastikarma, sastrakarma, siravedha byChakradatta.77 Bhaishajya Ratnavali same description of Gridhrasi Chikitsa is found asthat in Chakradatta. In Gadanigraha Vatarogadhikara explains the symptoms78 andtreatment of Gridhrasi.79 Gridhrasi is described with its symptoms and classificationunder vatavyadhi and the treatment part is dealt by described with some preparations byYogaratnakara.80 In Vangasena Samhita, Gridhrasi is described with its two types, whereVatabalasa the word is used for vatakaphaja Gridhrasi. The treatment part is alsoexplained in detail.81Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 18 -
  • Disease review The commentators of Bruhathrayes, Chakrapani explains the specific type ofpain.82 Dhalhana on its commentary on Sushruta samhita mentions Gridhrasi as Randhiniand also describes the meaning of ‘Sakthikshepanigraha.83 Arunadatta in hisSarvangasundari commentary explained the symptom Sakthikshepanigraha.84 AcharyaIndu described Gridhrasi as having similar symptoms as that of Vishwachi.85Ayurvedic Insight of Shareera: Though there are no direct descriptions in Ayurveda about Anatomical parts,responsible in the manifestation of Gridhrasi disease. The Anatomical parts in and aroundthe Katiprishta pradesha and the Marmas (vital parts) are considered in thepathophysiology of Gridhrasi disease.1. Katiprishta pradesha (Lumbo scaral region): There are 24 asthi sandhis (joints) inprishta vamsha (vertebral column). They are movable joints which have limitedmovements (prathara sandhis). The bones of katipristha pradesha are firmly united bymamsa rajjus (ligaments). There are 60 muscles are situated in the prishtabhaga and each5 muscles are situated in the buttocks. The Sleshaka sleshma which does the function ofsandhi samsleshana is situated in these joints providing smooth movements of the joints.Trika (sacrum) the union of 5 sacral vertebras is also the seat of Avalabaka kapha.2. Katikataruna Marma: The term Kati means waist (iliac) and Taruna refers tocartilaginous or soft bones. However, Katikataruna marma lies in the shroni (Pelvis)which is an Aseeti marma lying on either side of the spine. The measure of this marma ishalf finger width (approx 1 cm). It is suitable to consider the marma near the uppermargin of pelvic bone which form the kati and few centimeters away from the lumboscraljoint. Underneath are the iliac bone, the iliac artery and sacro iliac joint ligaments.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 19 -
  • Disease review3. Kukundara Marma: The term denotes the Kukundara asthi, Kukundara literallymeans one who dwells or supports the cavity. Thus the Kukundara marma falls within thepelvic cavity. It is a sandhi marma measuring a length of approx 1 cm. This marma islying few centimeters diagonally below the Katikataruna. Just under neath this, the fibresof Sciatic nerves emerge out of the spinal chord. The structure of sacroiliac joint also fallsbeneath this marma. Sushruta says that an injury to this marma causes sensory and motordisability of lower extremities.4. Nitamba Marama: This is an Asthi marma measuring a length of approx. 1 cm.Nitamba literally refers to the region of hips. It is found upon the two pelvic bones oneither side. The Nitamba marma lies on half the distance between sacral bone and thefemoral greater trochantor. It falls just above the line diagonally drawn from sacrum tothe femoral joint. This marma almost refers to the Sciatic nerve chord before entering thefemoral region. In obese person, it may be difficult to locate this marma due to excessadiposity in this region. Many scholars opined that Nitamba marma lying above the pelvis on the back.This is apparently due to the translation of Sushruta’s sloka as ‘above’ the shroni instedof ‘upon’ the shroni palaka. Nitamba literally refers to hips and the latter is moreappropriate as on injury to this marma causes atropy of legs due to the injury to Sciaticnerves.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 20 -
  • Disease review5. Indrabasti Marma: This is a Mamsa marma found on all the four limbs located inthe forelegs and forearms. Some scholars stated the length of this marma as 2 fingerswidth and some other as half finger width. Locating Indrabasti is easier on the legs. It isexactly on the tip of the calf muscle body (Gastrocnemious) from where two of itstendons, emerge forming a ‘V’ angle. It is better palpable with patient sitting straight andsemi flexed legs. The great sciatic nerve and the tibial artery can be found below marmain lower limbs. Sciatic Nerve: The sciatic (less commonly known as the ischiatic nerve) is the largest and thickest nerve in the human body. There are bilateral branches of this nerve, which begin as spinal nerve roots in the lower back and combine to form a single nerve, before branching out again into various peripheral nerves which serve the neurological requirements of each lower limb. The Sciatic is a thick and complex nerve structure which is formed by the joining of the L4, L5, S1, S2 and S3 nerve roots. These nerve roots make up the biggest nerve in the human body.86Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 21 -
  • Disease reviewSacral Plexus: th th This plexus is formed from the ventral rami of the 4 lumbar to the 4 sacralspinal nerves. The plexus lies on the dorsal walk of the pelvis, mainly between piriformismuscle and its fascia. The nerves entering the plexus converge to form a broad triangularband. Which passes through the inferior part of the greater sciatic foramen, belowpiriformis and enters the gluteal region as the sciatic nerve. The Sciatic nerve divides intotibial and common peroneal nerves at a variable point in the thigh.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 22 -
  • Disease reviewEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 23 -
  • Nidana Nidana The particular causative factors of Gridhrasi are not mentioned in the classics.The general causes of vatavyadhi are considered as the causes of Gridhrasi since it isconsidered under Nanatmaja vatavyadhies. These vataja disorders are caused by almostthe same vataprakopaka nidanas, but the different diseases are due to the sampraptivishesha of the vitiated vayu. Vata gets vitiated by two ways viz. Dhatukshaya andMargavarana.87 The vataprakopaka hetus found in different samhitas the hetus arereorganized under the main headings of Aharaja, Viharaja, Kalaja, Manasika and Anya.Aharaja nidana: Charaka Chikitsa it is mentioned that ruksha, seeta, alpa, laghu, aharas willproduce vatavyadhies88. These are the inherent properties of vata dosha.89 All thevataprakopa ahara dravyas also produce asthivaha srotodushti.90 Ahara dravyas havingthese properties when ingested excessively cause vataprakopa by the principle of“Samanyam Vriddhikaranam”91 Rukshaguna by its soshana property is dries out the sneha in the body and itaffects the asthigata sneha. Sheeta guna which does stambhana,92 which results restrictedmovements, stiffness in the lower extremities in Gridhrasi. Laghu guna is exactlyopposite to guraguna and does lekhana karma.93 Excessive use of katurasa causes pain inlimbs, prishta etc. along with kampa, toda, bheda etc,94 which are the symptoms ofGridhrasi. Tiktarasa when used excessively, by virtue of its ruksha, khara, vishada gunaaffects rasa, rakta, mamsa, meda, asthi and majja dhatus and produces vatavyadhies.95Vagbhata has stated that tiktarasa produces vatavyadhies by dhatukshaya.96 KashayarasaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 24 -
  • Nidanaalso has khara and vishada guna and produces stambhana, sphurana and vatavyadhieswhen consumed excessively.97 Table No 1: Showing the Aharaja nidana of Gridhrasi. Aharaja Nidana CS SS AH MN BP VS Ruksha anna + + + + + + Sheeta anna + + - + + + Alpa/Parimita anna + - + + + + Laghu anna + + - + + + Tikta - + + - - - Ushna - - + - - - Kashaya - + + - + - Katu - + - - + - Table No 2: Showing the Dravya vishesha of Nidana. Dravya vishesha CS SS AH MN BP VS Vallura + + - - - - Varaka + - - - - - Shuskha Shaka - + - - - - Uddalaka - + - - - - Neevara - + - - - - Mudga + - - - - - Masura + - - - - - Harenu + + - - - - Kalaya + + - - - -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 25 -
  • NidanaViharaja nidana: Alpabojana causes bala kshaya, varna kshaya, oja kshaya etc. and affects the saraof all dhatus and may produce the vatavyadhies. Atibojana leads to the prakopa of allthree doshas. These doshas reside in the kukshi and produce various vyadhies. Amongstthem, vata produces sula, angamarda, parswagraha, pristagraha, katigraha, sirakunchanaand stambha etc.98 Ativyavaya causes Apanavata prakopa which is the main nidana in Gridhrasi.While explains the doshas of ativyavaya it is mentioned the pain in thigh, knee, calf andfeet.99 Atichankramana (Excessive walking, swimming, exercise, traveling, ridingvehicles etc.) produce, pain in pada, jangha, ooru, janu, vankshana, shroni, prusta,pricking sensation in legs, lassitude in thighs are the symptoms.100 Vishamasayya/asanaprovocates vata and produces symptoms similar to those produced by Atichankramana. Marmas which are related to Gridhrasi are Kukundara marma and Nitambamarma. Injury to Kukundara marma leads to the loss of sensation and power of lowerextremities and may result in pain and difficulty in walking. Injury to Nitamba marmaleads to atrophy of lower extremities weakness and even death may occur.101 In Astanga hrudaya it is mentioned that all the diseases are caused due tovegadharana and vegaudeerana.102 Nidra is one of the tripods of life103 and sukha, dukha,bala, abala and even life depends on timely sleep only.104 Atijagarana produces rukshataand vataprakopa and Diwaswapa produces srotorodha and kaphaprakopa. So this maylead to Gridhrasi.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 26 -
  • Nidana Table No 3: Showing the Viharaja nidana of Gridhrasi. Viharaja Nidana CS SS AH MN BP VS YR Ativyayama + + + + + + - Adyasana - + - - + - - Plavana + + - + + + + Atyadhwa + - - + - - + Pradhavana + + - + - - - Pratarana - + - - - - - Atyuchabhashana - + - - - - - Balavadvigraha - + - - - - + Vegodeerana - - + - + - - Marmaghata/Abhigata + + - + + + - Bharaharana + - - - + Dukhashayya/Asana + - - + - - - Sheegrhayana + - - + - + - Prapeedana - + - - - - - Prajagarana + + + + + + - Atiadhyayana + - - - - - - Ativyavaya + + + + + + + Vegadharana + - + + + + - Vishamopachara + - - + - + + Shrama - - - - + - - Upavasa/Langhana + + - + - + + Divasvapna + - - + - - - Kriyatiyoga/Vichestita + - + + - + - Abojana + - - + - + - Pavanatapa - - - - + + - Himatapa - - - - + - -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 27 -
  • NidanaManasika nidana: Manas control the functions of all indriyas with the help of vata.105Hence the manasavikaras may produce vataprakopa. Table No 4: Showing the Manasika nidanas of Gridhrasi. Manasika Nidana CS SS AH MN BP VS YR Chinta + - + + + + + Soka - + + + - + + Krodha - - - - - - - Bhaya - - - - - - + Athyantakarmaudayaya - - - - + - -Kalaja nidana: Besides all these reasons, seasonal variations i.e. sisira and varsha ritu,daily variations such as aparhanna, jirnannakala also cause vata prakopa. Symptoms ofGridhrasi may be aggravated during these timings.Table No 5: Showing Kalaja nidana of Gridhrasi. Kalaja Hethu CS SS AH MN BP VS Pravata - + - - - - Grishmanta - - + - - - Jeernanta - + - - - - Ahoratrianta - + + - + - Sisiraritu - + - - + - Varsharitu - + - - + - Pradosha - + - - + - Buktaanta - - + - - - Seetakala - + - - - - Abhrakala - + - - + - Prabhatakala - + - - - - Aparahna - + - - - -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 28 -
  • NidanaAnya nidana: Excessive loss of any element from the body leads to riktata of thesrotases and causes vataprakopa. The strength of body is sustained by the malas, henceexcessive loss of mala also vitiates vata. Excessive emaciation due to other diseases leadsto dhatukshaya which in turn provocates vata. Ama has inherent property of producingmargavarodha which leads to vataprakopa. If ama is produced by agnimandya and itcombines with vata, the vata samsrishta ama is capable of producing manyvatavyadhies106. Manasika hetu may also lead to production of ama.107Table No 6: Showing the Anya nidanas of Gridhrasi. Anya Nidanas CS SS AH MN BP YR VS Atiraktasravana + - - + + + + Atidoshasravana + - - + + + + Dhatukshaya + - - + + + + Rogatikarshana + - - + - + + Ama + - - + + - + Sodhanayoga - - - - + - -Etiology.108 Because of its peculiar course, length and distribution the sciatic nerve is moreexposed to internal and external trauma and inflammation than any other nerve, inmodern classics Sciatica is studied under two headings. The causes of disease in bothmedical systems are having some gross similarities. Dhatukshayajanya nidana can becorrelated to that of degenerative causes, Avaranjanya to mechanical pressure andmarmaghatakara to that of traumatic causes. The two causes of Sciatica are Compressivecauses and Non-compressive cause.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 29 -
  • NidanaFlow chart No1: Showing the causes of Sciatica.Compressive causes of sciatica - Spina bifida Congenital causes - Spondylolisthesis - Fracture of hip joint - Vertebral fractures. Traumatic cause - Lumbosacral sprain / strains. - Injuries to lumbosacral spine. - Neoplasm of spinal chord, pelvis,lumbarplexus. Mechanical pressure - Protrusions or herniation of lumbar disc - Rupture of intervertebral disc. - Degeneration of lumbar disc, lumbar vertebrae or lumbar spondylosis. Degenerative causes - Degenerative spondylolisthesis. - Rheumatoid arthritis. - Ankylosing spondylitis - Lumbar spondylitis. Inflammatory causes - Osteoarthritis of lumbar spine. - Tuberculosis of vertebral column -Leprosy. -Ischemic neurosis in diabetes mellitusNon-compressive cause - -Sciatic nerve injury due to trauma -Claudication injury to sciatic nerve.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 30 -
  • Poorvarupa Poorvarupa Poorvarupa are those signs and symptoms which appear earlier to actualmanifestation of disease, not specifically assignable to the doshas as they are mild (notclearly recognizable) and little in number.109 During the disease process the fourthkriyakala i.e. sthanasamshraya is the stage where poorvarupa are manifested “AurÉ£Çü sɤÉhÉ iÉåwÉÉÇ mÉÔuÉïÂmÉÍqÉÌiÉxqÉ×iÉqÉç ” Gridhrasi being a vatavyadhi, the samanya poorvarupa of vatavyadhi are thepoorvarupa. Charaka has mentioned that Avyakta lakshana are the poorvarupa ofvatavyadhi.110 While clarifying the word ‘Avyakta’ Chakrapani states that few mild symptomscan be considered as poorvarupa.111 Thus, the symptoms of Gridhrasi such asstambha,ruk, toda, spandana, stabdhata, tandra, arochaka etc. when manifested slightlycan be called as poorvarupa of Gridhrasi.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 31 -
  • Rupa Rupa While describing Gridhrasi, Acharya Charaka has listed ruk, toda, stambha andmuhuspandana as the cardinal symptoms. To be more precise about the track of pain,Chakrapani says that the pain starts at sphik and then radiates to kati, prishtha, ooru, janu,jangha and pada in order.112 Sakthikshepanigraha is added to the list of cardinal signs byAcharya Sushruta and Vagbhata.113 Symptoms like dehavakrata, janu, ooru sandhi spurana etc. have been defined asvataja. Vatakaphaja lakshanas of Gridhrasi are tandra, gaurava, aruchi, bhaktadwesha,mukhapraseka, staimitya. Vangasena has also added pain in payu as one of symptom.Hareeta has defined janumadhya, urumadhya and katimadhyavedana as the generalsymptom.114Samanya Lakshana of Gridhrasi:Stambha.115 “xiÉqpÉÉåoÉÉWÒûÂeɆ¡ûÉSÏlÉÉÇ xɃ¡ÓûgcÉlÉɱÉpÉÉuÉÈ” “xjÉqpÉrÉÌiÉ ÌlɶÉsÉÏMüUÉåÌiÉ” “xiÉpÉÌlÉÎw¢ürÉiuÉqÉç” Arunadatta defines stambha as inability of the limbs to flex. While Hemadriinterprets it as loss of movement. Vitiated doshas when affect snayu, sira and kandara,stambha, sphurana and supti are produced.116 This process when takes place in lowerlimb, Gridhrasi is produced.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 32 -
  • RupaRuk.117 “ÂMçü xÉiÉiÉÇ zÉÔsÉqÉç” “ÂeÉÉå uÉåSlÉÉÈ” It is included under vataprakopaka lakshanas by Vagbhata.118 Arunadattainterprets ruk as continous pain and Charaka included ruk under majjapradoshajalakshanas119 which clarifies the involvement of majjadhatu in the production of thesymptom. According to Dhalhana word ‘Ruk’ signifies pain. The track of pain explainedby Charaka exactly coincides the pathway of sciatic nerve. Hence Gridhrasi can becorrelated with Sciatica.Toda.120 “iÉÉåSÉå ÌuÉÎcNû³ÉÇ zÉÔsÉqÉç” “iÉѱiÉå CuÉ uÉåSlÉÉÈ” It means pricking sensation and is include under vataprakopaja vyadhies.121Vagbhata mentioned toda in vataprakopaja lakshanas.122 In Gridhrasi, toda is presentalong the path of Sciatic nerve.Spandana.123 “xmÉlSlÉÇ ÌMüͶÉcÉsÉlÉqÉç” “xmÉlSlÉÇ xTÑüUhÉqÉç” It is throbbing, pulsating or trembling sensation felt in the affected leg. Madhavanidana explains it is also due to vitiated vayu particularly vyana vayu.124 Bhavamishrauses the word sphurana for spandana.125Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 33 -
  • RupaSakthikshepa/utkshepa Nigraha. “¤ÉåmÉÈ mÉëxÉÉUhÉÇ iÉÇ ÌlÉaÉ×WûhÉÏrÉÉiÉç” It signifies restricted movement of the affected limb. Dhalhana explained thatbecause of the ill effect on parshni kandara, the movement of the leg is forbidden.126 “ mÉÉS E®UhÉå AzÉÌ£ü” Vagbhata modified the term kshepa as utkshepa which means upward movementor elevation or raising.127 Arunadatta clearly defined this by vyana vata is also involvedin the samprapti of Gridhrasi along with apana vata. Vyana vata carries out the functionsof all kinds of movements of the body.128 When it is involved in Gridhrasi, the movementof lower limb is restricted. If we analyze the symptoms in the light of modern medicine, it appears verysimilar to the restricted SLR (straight leg rising) test which is done to assess the degree oflimitation of the limb (hip) flexion, when knee is extended.Table No 7: Showing the Samanya lakshanas of Gridhrasi. No Lakshanas CS SS AS AH MN BP YR GN VS 1 Stambha + - - - + + + + + 2 Ruk + - - - + + + + + 3 Toda + - - - + + + + + 4 Spandana + - - - + + + + + 5 Sakthiutkshe - + + + - - - - - pa nigrahaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 34 -
  • RupaVisesha lakshana of Vataja GridhrasiDehavakrata. This sign is mentioned in Laghuthrayes but not is Bruhathrayes. Because ofextreme pain, stambha and toda etc. the patient assumes a typical limping posture.Suptata.129 “xÉÑmiÉiÉ cÉUhÉrÉÉåÈ xmÉzÉïblÉÉlÉÉqÉç» This symptom is described only by Yogaratnakara. Chakrapani explains it as lossof movement of the leg and also loss of sensation is suptata.130 Kasyapa mentionsnubness of the lower part.131Sphurana.132 “xTÑüUhÉÇ mÉÑlÉÈ mÉÑlÉÈ cÉsÉlÉqÉç” “xTÑüUhÉÇ aÉÉ§É SåzÉå xuÉsmÉcÉsÉlÉqÉç” A sense of pulsations or muscular twitching felt in kati, ooru, janu, jangha region.This symptom is similar to spandana.Stabdata. “xiÉokÉiÉÉ pÉ×zÉqÉç”The severe degree of stiffness is seen in patient suffering from vataja Gridhrasi. Table No 8: Showing the Visesha lakshanas of Vataja Gridhrasi.No Lakshanas CS SS AS AH MN BP YR GN VS1 Dehavakrata - - - - - + + - +2 sphurana - - - - - + + - +3 Suptata - - - - - - + - -4 Stabdata - - - - - + - - +Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 35 -
  • RupaViseshalakshna of Vatakaphaja Gridhrasi:Tandra.133 “iÉqÉÉå uÉÉiÉMüTüÉiÉç iÉl§ÉÉ” It is one of the twenty shleshmavikara. The inability of the sense organs to grasptheir subject, heaviness of the body, fatigue without any work etc. is the lakshanas oftandra.Gaurava.134 “AÉSìïcÉqÉÉïuÉl® uÉÉ rÉÉå aÉɧÉÇ qÉlrÉliÉå” Patient feels heaviness all over the body especially in the leg. This makes themovement of the leg further difficult.Arochaka.135 “AUÉåcÉMüxiÉÑ mÉëÉÍjÉïiÉåÅmrÉÑmÉrÉÉåaÉxÉqÉrÉåÅlÉÍpÉsÉÉwÉÉÈ” In this stage the patient has proper appetite but still patient can’t enjoy the fooddue to loss of taste.Mukhapraseka.136 “mÉëxÉåMüÈ sÉÉsÉÉxÉëÉuÉÈ” It is also known a lalapraseka. It is a symptom of kapha dushti specially bodhakakapha. But also occurs due to presence of ama in the body.Bhaktadwesha.137 “pÉ£ü²åwÉ A³É²åwÉÉ” åwÉqÉÉrÉÉÌiÉ rÉÉå eÉÉliÉÑ pÉ£ü²åwÉ xÉ EcrÉåiÉ”Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 36 -
  • Rupa When kapha is vitiated along with vata in Gridhrasi, the power of agni isdepressed. This leads to ama formation which causes feeling of heaviness in the stomach.Hence the patient develops dislike for food.Staimitya.138 “xiÉæÍqÉirÉÇ aÉɧÉÉhÉÉÇ ÌlÉÂixÉÉWûiuÉqÉç” “xiÉæÍqÉirÉÇ aÉɧÉÉhÉÉqÉmÉQÒûiuÉqÉç” In this patient feels that some wet cloth is wrapped around his leg.139 Hemadriinterprets it as alasya140Vahnimardava.141 “qÉÉSïuÉqÉ×SÒiuÉqÉç” Because of vitiated kapha as anubandhi dosha, the properties of agni especiallyjatharagni will diminish, as a result agnimandya takes place.Table No 9: Showing the Samanya lakshanas of Vatakaphaja Gridhrasi. No Lakshanas CS SS AS AH MN BP YR GN VS 1 Tandra + - - - + + + + + 2 Gaurava + - - - + + + + + 3 Arochaka + - - - + - + + - 4 Mukhapraseka - - - - - + + - + 5 Bhaktadwesha - - - - - + + - + 6 Staimitya - - - - - - + - - 7 Vahnimardava - - - - - + + - +Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 37 -
  • RupaClinical Features of Sciatica.142 The characteristic feature of sciatic syndrome is that the pain originates inlumbosacral region radiating downwards form buttock, postero lateral aspect of thigh andthe calf to the outer aspect / border of foot. Usually gradual onset but can be sudden also.So pain is felt in the back, the buttock, the thigh, the leg and the foot - together or asinvolvement of few areas. The pain may immediately follow an injury such as strain or a fall or there may belatent interval of 4 days or even weeks. After 2-3 days of pain in the lumbar spine, thepain radiates down the back of one leg form buttock to ankle and sometimes to the foot.Table No 10: Showing the Clinical Features of Sciatica.Disc Root Sensory Motor weakness Reflex Pain distributionlevel loss loss Quadriceps (kneeL3- extension), thighL4 L4 Medial calf adduction, tibialis Knee Knee medial calf anterior (foot dorsiflexion) Peroneii (foot eversion),L4- Lateral calf, Tibialis anterior (foot Lateral calf, dorsalL5 L5 dorsum of dorsiflexion), Gluteus Hamstring foot, posterolateral foot medius (hip abduction), thigh, and Toe dorsiflexion buttocks. Plantar Gastronemus / soleus surface of (foot planter flexion) Bottom foot,L5-S1 S1 foot lateral abductor hallucis (toe Ankle posterior calf, aspect of flexors), gluteus posterior thigh, foot maximus (hip extension) and buttocks.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 38 -
  • Samprapti Samprapti Samprapti is not mentioned in classics for Gridhrasi but samanyavata vyadhiSamprapti can be taken as Samprapti of Gridhrasi. Dhatukshaya and Margavarodha aretwo main reasons by which vata get vitiated.143 Because of the samprapti vishesha, thesame nidanas produce different vatavyadhies. This is because the presentation of thedisease changes according to the sthana where dosha-dushya sammurchhana takes place.Flowchart No 2 :Showing the Samprapti of Vatavyadhi.Dhatakshyakara Margavarodha Vataprakopa VatavyadhiDhatukshaya: This dhatukshaya results into the aggravation of vata and this vitiated vata fills upthe empty srotases ultimately causing vatavyadhi.144 Due to rukshadi aharas, firstly therasa dhatu kshaya takes place and it leads to further dhatus.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 39 -
  • Samprapti The agantuja factors are responsible for the ‘achaya-purvaka prakopa’ of doshas.Abhighata leads to dhatukshaya directly and vataprakopa and vitiated vata may directlyintermingle with asthi, majja dhatu to produce Gridhrasi. Asthidhatu and vatadosha haveashraya-ashrayi sambandha.145 Vataprakopaka aharasevana is the main cause of asthivaha srotodushti.146 Henceastikshaya leads to vataprakopa. Rukshadi ahara cause shoshana of majja dhatu andviruddha ahara, abhighata etc. are the causes of majjavaha srotodushti.Margavarodha: Khavaigunya plays an important role in the disease process. Atibhojana,diwaswapna etc nidanas are responsible for this kind of samprapti. Deranged jataragnileads to formation of ama. Ama produces obstruction to the normal gati of vata and thisleads to vataprakopa. Also when the amasamshrista vayu resides at kati, prishtha etc. mayproduce Gridhrasi.147 Acharya sushruta clearly mentioned the involvement of kandara in Gridhrasi.148Dhalhana explains kandara as mahasnayus and Charaka explains kandaras as theupadhatu of rakta dhatu. Chakrapani mention that kandara may also be considered assthula snayu and snayu is the upadhatu of meda and mulasthana of mamsa dhatu.149According to Vaidyaka Shabdasindhu, snayus are the nadis that conduct vayu. According to Sushruta, vayu in its normal state, while coursing through itsspecific siras helps the unobstructed performance of its specific functions viz. prasaranaand akunchana and produces clearness and non-illusiveness of buddhi and the senseorgans. When vitiated vayu enters the siras, it causes variety of diseases.150Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 40 -
  • SampraptiFlowchart No3: Showing the Samprapti of Gridhrasi. NIDANAKHAVAIGUNYAKARA AGNIMANHYA NIJA AGANTUJA AGNIDAURBALYA AMOTPTTI AVARAKA VATAPRAKOPA SROTODUSTI (Sphik,Uru,Kati,Prusta,etc.) DHATUKSHAYA & SNAYUKANDARADUSTI DOSHADOOSHYASAMOOCHANA STANASAMSRAYA GRIDHRASIVATA GRIDHRASI VATAKAPHA GRIDHRASIEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 41 -
  • SampraptiSampraptigatakas:Table No 11: Showing the Samprapti ghatakas of Gridhrasi. Dosha Vata Vyana,Apana Kapha. Dooshya Kandara,Asthi,Majja,Rasa,Rakta,Mamsa,Sira,Snayu. Srotas Mamsavaha, Medovaha, Asthivaha, Majjavaha. Agni Jataragni. Ama Jataragni Mandya Janya. Rogamarga Madhyama. Udbhavasthana Pakvashaya. Sancharasthana Gridra nadi. Vyaktasthana Sphik, Kati, Prishtha, Ooru, Janu, Jangha, Pada. Adhishtana Prishtha,Kati,Sphik. Srotodushtiprakara Sanga, Margavarodha. Vyadhiswabhava Chirakari, Asukari in some cases.Nature and Pathology of Sciatic Neuralgias: The sciatic nerve arises from L4, L5 and S1, S3 of nerve roots. Here compression orirritation is mainly due to some pathological changes in the inter-vertebral disc of lumbo-sacral region. Inter vertebral disc is the part, which sustains maximum strain and havingmore movements, annulus fibrosus is outer casing and inner softer jelly is nucleuspulposus. As disc age they fragment desiccate and collapse because of gradual diminisionin the concentration of hyaluronic acid. This starts in the nucleus pulposus resulting in thecentral annular lamellae bucking inward while the external concentric bands of annulusfibrosus bulge out wards.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 42 -
  • SampraptiVertebral and Pelvic Factors in Sciatica: As regards the pathology of Sciatica, the importance of vertebral and pelvicfactors was pointed out some years ago by an American orthopaedic surgeon. Goldthwaitwas the first to investigate the problem from its anatomical and mechanical aspects, andhis work gave inspiration to a series of researches, which have thrown great light uponthe matter. He was also the first to draw attention to the frequency of certain congenitalanomalies of the Spinal column, such as sacralisation of the fifth lumbar vertebra, andvariations in the posterior articulations. Goldthwaits views, after they had been defined and extended by other workers,became so popular that in a short time the subject of sacralisation of the fifth lumbar, andits association with sciatica, took a prominent place in medical literature.151Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 43 -
  • Vyavachedaka Nidana Vyavachedaka Nidana Gridhrasi, also presents with a clear picture of shifting pain in lower limbsradiating from sphik, kati, prishtha, ooru, janu, jangha and pada in order according toCharaka. ‘Sakthiutkshepanigraha’ is mentioned as a cardinal sign by Sushruta andVagbhata. But certain other symptoms such as stambha, toda, sphurana, ruk etc. are alsofound in some other diseases. like Oorustambha, Khalli, Kalaykhanja, Vatakantaka.These diseases can make confusion with Gridhrasi. In Oorustambha toda, sphurana, stabdhata,etc.symptoms are similar to Gridhrasi.But chardi, jwara, angamarda, dhmana etc are absent in Gridhrasi. The typical radiatingtype of pain is found in Gridhrasi only.152 In Khalli, pain is at the root of pada, jangha, ooru and karamula. Charaka hasspecified the type of pain as avamotana i.e. mardanavat.153 Vagbhata gives importance tothe severity of pain.154 But Khalli can be differentiated from Gridhrasi by the nature ofthe pain i.e. originating from sphik, kati and then radiating to the leg. Vitiated vayu while staying at kati affects the kandara of one leg, then it is calledKhanja and when it affects both the legs it is called Pangu.155 In Gridhrasi also, thekandara of leg is affected. But in Khanja there is no pain instead there is wasting in leg.Kalaykhanja is type of Khanja in this there is difficulty in walking and trembling gait.156In Gridhrasi kampana or sphurana is present but not specially related to walking. Also,sandhisaithilya is seen in Kalaykhanja but absent in Gridhrasi. Vatakantaka is a disease affecting gulfa sandhi and localised pain is the mainsymptom.157 In Gridhrasi, pain may be present at gulfasandhi but the whole leg isaffected which is not seen in vatakantaka.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 44 -
  • Vyavachedaka Nidana In the poorvarupa of Vatarakta toda, sphurana, supti at janu, jangha, ooru, kati arementioned158 but these symptoms may be found in hands and are accompanied by othersymptoms such as excessive sweating or complete loss of sweating, itching, discolorationetc. which are not found in Gridhrasi. In severe stages of Amavata, pain at gulfa, trika, janu, ooru is found159 but again,it can be in hands and other joints of the body. It is associated with shotha and otheramajanita symptoms which are absent in Gridhrasi.Table No 12: Showing the Vyavachedaka nidana of Gridhrasi. Kalayakhanja Oorustambha Vata kantaka Vatarakta Gridhrasi Amavata No Lakshanas Khalli 1 Vedana + - - - - - - 2 Stambha + + - - - - - 3 Ruk + + - + + - + 4 Toda + + - + - + - 5 Muhu spandana + - - - - + - 6 Sakthiutkshepa nigraha + - - - - - - 7 sphurana + + + - - + - 8 Dehavakrata + - + - - - - 9 Stabdhata + + - - - - - 10 Staimitya + + - - - - - 11 Suptata + - - - - + - 12 Tandra + + - - - - - 13 Arochaka + + - - - - - 14 Difficulty in walking + - - + - - -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 45 -
  • Vyavachedaka NidanaDifferential diagnosis of conditions causing sciaticaDisc herniation: There is usually a history of acute lumbago, of sudden onset, eitherimmediately preceding the sciatica or at a more remote data.Cauda equina: Backward protrusion of the lower intervertebral lumbar discs or of thelumbo-sacral disc may compress the cauda equina, with unilateral or bilateral sciaticadistribution.Spondylolisthesis: The presence of this deformity does not prove that it is of sciatic pain.Since it can be present without discomfort, when sciatica is so caused, however, it isusually bilateral and neurological signs motor, sensory and reflex are usually severe.Spondylosis: There is usually a history of chronic, intermittent pains in the lower back,recurrent attacks of sciatica, and evidence of osteoarthritis else where in the spine and inthe largest joints of the limbs.Pott’s disease: Occasionally involves the lower lumbar vertebrae, with local pain andstiffness and sciatic radiation. Pain extending to the buttock and back of thigh, withoutneurological signs, may be in the nature of a referred pain from the diseased vertebraeitself, without implication of the nerve roots. Radiographs of the spine will ultimatelyshow rarefaction and collapse.Ankylosing spondylitis: Pain usually centered in the low back often radiates to the backof the thighs and groin. ‘Morning stiffness’ or an increase in stiffness after periods ofinactivity.Sacro-iliac arthritis: Alteration of pain is significant i.e., pain comes in on buttock andposterior thigh and then it transfers itself to the other side. Sings of first and second sacralsegments involvements and no lumbar signs.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 46 -
  • Sadhya-Asadhya Sadhya - Asadhya While mentioning the importance of sadhyasadhyata Charaka mentions, ‘Thephysician who knows the differential diagnosis between the curable and the incurableamong diseases and begins treatment in time with full knowledge of the case obtainssuccess in his effort with certainty. But if he fails in the same he will suffer loss of moneyand will tarnish his learning and fame.160 The separate prognosis of Gridhrasi is not mentioned in the classics. Hence thegeneral principles of Sadhyasadhyata can be applied to Gridhrasi. Gridhrasi, being avatavyadhi, sadhyasadhyata of vatavyadhi is applicable to it. Sushruta and Vagbhata haveincluded vatavyadhi in the Mahagada which itself signifies that they are difficult to cure.All the vatavyadhies if neglected or after a certain period of time become asadhya ordurupakrama.161 Charaka had mentioned some Vatavyadhi’s, which are either not curable due tosthana gambheerata or curable with effort in case they are of recent origin and mentionedthe symptoms like Sandhichuti, Hanustambha, Kunchana, Kubjata, Ardita, Pakshaghata,Khuddavata, Angasosha etc. may or may not be cured even after careful treatment.162 Sushruta warns that if vatavyadhi complicated by Sotha, Suptatwacha, Bhagna,Kampa, Aadhmana, and deep seated pain then it ends as fatal.163 Charaka further statedthat when the patient has sufficient strength and without any complications and if thedisease is treated in earlier stage, then it can be cured. Generally it is seen that Gridhrasiif given proper treatment and if proper diet is mentioned together with nidana parivarjanais though not completely incurable. It is usually kashtasadhya.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 47 -
  • Pathya-Apathya Pathya-Apathya That which is not against the srotas and priya to manas.164 Srotas is always animportant integral part of samprapti of a disease. In person who indulges in pathyakaraahara and vihara, the dosha sanchaya doesn’t occur, to such an extent we can avoid causedreadful diseases.165 Acharya Lolimbaraja who was known as the best poet physician was the first toexplain the significance of pathya in his work Vaidhya Chintamani. He feels that if aperson knows all about pathya then there is no necessity of taking the aushadha for thedisease. There is no specific Pathya-Apathya is not mentioned for Gridhrasi, But thegeneral Pathya-Apathya mentioned for Vatavyadhis is holds good for Gridhrasi.Bhaishajya ratnavali have the detail description of pathyapathya.Pathya Ahara and Viharas of Gridhrasi:166Table No 13: Showing the Pathyaharas of Gridhrasi. Pathya Ahara 1 Rasa Madhura,Amla,Lavana 2 Shukadhanya Nava godhuma, Nava shali, Rakta shali, Shashtika shali. 3 Shimbi varga Nava tila, Masha, Kulatha. 4 Shaka varga Patola, Shigru, Vartaka, Lashuna,Dadima 5 Mamsa varga Ushtra,Go,Varaha,Mahisha,Magura,Bheka,Nakula, Chataka,Kukkuta, Tittira, Kurma. 6 Jala varga Ushnajala, Shritasheetajala, Narikelajala. 7 Dugdhavarga Dadhi, Gritha, Kilata, Kurchika. 8 Mutravaga Go,Aja 9 Madyavarga Dhanyamla, Sura. 10 Snehavarga Ghrita, Tila, Vasa, Majja.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 48 -
  • Pathya-ApathyaPathya Viharas of Gridhrasi: Snigdhaswedana, Abhyanga, Basti, Snaihikadhuma,Snehagandusha, Sukhoshnaparisheka, Samvahana, Avagahana are the upakramas to befollowed. Also patient should reside at a place where direct wind is avoided and sunlightis present.Apathya Aharas and Viharas of Gridhrasi:167Table No 14: Showing the Apathyaharas of Gridhrasi. Apathya Ahara 1 Rasa Katu, Tikta, Kashaya. 2 Shukadhanya Truna, Kangu, Koradusha, Neevara, Syamaka. 3 Shimbi varga Rajamasha, Nishpava, Mudga, Kalaya 4 Phalavarga Jambu,Udumbura,Kramuka,Tinduka. 5 Mamsa varga Sushka mamsa, Kapota, Paravata Gramya, Anupa, Audaka mamsa, Chataka, Kukkuta, Barhi, Tittira. 6 Jala varga Seetajala. 7 Dugdhavarga Gardabha.Apathya Vihara of Gridhrasi: Vyavaya, Hastiaswanam atichankramana, Prajagarana,Chinta, Vegavidharana, Srama, Chardi and Upavasa will lead to vataprakopa..Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 49 -
  • Upasaya and Anupasaya Upasaya and Anupasaya Upasaya are the medicines, diets and regimens which bring about happiness eitherby acting directly against the cause of the disease or it may produce such effect on thedisease indirectly. When identical symptoms having two or more disease are meethostilely (or encountered) in such conditions, disease could be best differentiated byadopting Upasaya. Upasaya for Gridhrasi has not been mentioned particularly. But, if there isuncertainty as whether the disease is Oorusthambha or Gridhrasi, to differentiate thesetwo we can adopt Upasaya. If symptoms aggravate on the application of oil, then we canconsider it to be Oorusthambha and if the symptoms alleviate we can consider it asGridhrasi. Table No 15: Showing the Upasaya for Gridhrasi. Upasaya Ahara Vihara Godhuma, Masha, Puranashali,Patola, Abhyanga, Tarpana, Swedana, Nasya, Vartaka, Kilata, Rasona, Taila,Ghrita, Nirvata Sthana, Atapa Sevana, Vasti, Kshira, Tila, Draksha, Dadima etc. Ushnapravarana, etc. The nidana mentioned for vatavyadhi, Gridhrasi are considered as Anupasaya. Table No 16: Showing the Anupasaya for Gridhrasi. Anupasaya Ahara Vihara Mudga, Kalaya, Brihatshali, Yava, Chinta, Bhaya, Shoka, Krodha, Rajmasha, Kodrava, Sharma, Tikta Vegavidharana, Chankramana, & kashaya rasa etc Annasana, Ativyavaya, Jagarana etcEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 50 -
  • Chikitsa Chikitsa The treatment of a disease varies according to the morbid state of doshas in thebody, bala, prakruti etc. of the patient. If the doshaprakopa is minimum langhana chikitsa,moderate dosha prakopa langhana and pachana chikitsa and if dosha prakopa ismaximum, shodhana therapy should be adopted.168 While treating any disease, the first and foremost pinciple to be followed is toavoid nidanas.169 For Gridhrasi, all the vataprakopaka hetus including external factorssuch as excessive walking, riding etc. should be avoided. Gridhrasi is a vataja disorder, so general treatment of vatavyadhi can be adopted,keeping an eye on the same “DWIPANCHAMULADI MAMSARASA BASTI” istaken for the study, it is useful for all vataja disorders (Sreshta). Charaka has advised upakramas like snehana, swedana, asthapana and anuvasanabasti, nasya, abhyanga, utsadana, parisheka etc. Among these he has praised asthapanaand anuvasana basti are the best treatment for vata.170 Sushruta has advised sirobasti, sirosneha, snaihika dhumapana, sukhoshnagandusha for the treatment of vatavyadhies.171 Vagbhata has stated that sneha, sweda, mruda samshodhana, deepana andpachana.172Bruhathrayes: Siravedha between the kandara & gulfa, bastikarma and agnikarma is theline of treatment for Gridhrasi mentioned by Charaka.173 Sushruta, has advised onlysiravedha at janu after flexion.174 Siravedha four angula above or below janu ismentioned by both Ashtanga Samgraha and Ashtanga Hrudaya.175Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 51 -
  • ChikitsaLaghuthrayes: Bhavaprakasa also states that basti should be given to patients ofGridhrasi only after doing vamana and virechana karma and in deeptagni andniramavastha.176 Sharangadhara has not specified any treatment.Anyasamhitas: Chakradatta has described the importance of deepana, pachana &urdhvashodhana, basti, and also siravedha. If not relieved by this treatment then agikarmaat kanishthika anguli of pada has been suggested.177 Yogaratnakara advises siravedhaand suggests if the treatment fails agnikarma in the little finger of the leg is advised.178Harita while describing the treatment of Gridhrasi states that blood letting should beperformed followed by sweda. He also suggests if the disease does not respond to thistreatment agnikarma must be done.179 Bhela mentioned snehapana, snehabasti and snehaunmardana, raktamokshana also advised.180 Vangasena has repeated the necessity ofurdhvashodhana before basti and snehana, deepana, pachana also mentioned.181 InGadanigraha has been given the same as by Bhavaprakasa.182 Bhaishajya ratnavali hasgiven the same treatment for Gridhrasi as decribed by Chakradatta. Table No 17: Showing the Different Treatments of Gridhrasi. Chikitsa prakara CS SS AS BP YR HS BS CD Snehana - - - - - + + + Swedana - - - - - + - + Vamana - - - + - - - + Virechana - - - + - - - + Basti + - + + + - + + Siravedha + + + - + - - + Raktamokshana - - - - - + + - Agnikarma + - + - + + - + Sastrakarma - - - - - - - +Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 52 -
  • ChikitsaSnehana: Snehana should be done only in nirupastambha vata.183 Sneha pacifies vata,brings out softness in the body and removes malasanga.184 External snehana includesabhyanga, parisheka, avagaha etc. It acts on sparshanendriya which is the seat of vayu.While mentioning the action of abhyanga. Sushruta has stated that after 900 matras thesneha can reach majjadhatu.185 It signifies the action of sneha on asthi, majja dhatuswhich are involved in Gridhrasi.Swedana: Snehanapurvaka swedana is indicated in nirama vatavyadhies while onlyswedana is indicated in samavatavyadhies.186 Swedana liquifies the doshas and expandsthe srotases, helping the doshas to travel towards their own sthana. Swedana activatesagni, creates komalata, ruchi, clears srotasas, diminishes tandra. It produces mruduta tothe body. Charaka says that proper snehana and swedana can make even dry woodflexible.187 In Gridhrasi stambha, ruk, toda etc. are the main symptoms. Snehana andswedana by virtue of their vatasamaka and dhatuposhaka properties are useful inrelieving the symptoms.Mriudu Samsodhana: The doshas which are not pacified by snehana and swedanashould be removed from the body. Hence mrudu virechana and vamana is advised for thispurpose.188Basti: Basti is the best treatment for vata because it has systemic effect in eliminatingdoshas from the body gradually by pakwashaya shodhana.189 Charaka further says thatthere is no therapeutic procedure comparable to that of basti, in as much as it possessesrapid and useful properties of cleansing.190 Thus, basti is considered as chikitsardha.191Asthapana basti is srotovishodhana and malapahara, while anuvasana performs thefunction of malashodhana and vatashamana. Basti increases bala, agni, medha, varna etc.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 53 -
  • ChikitsaIt strengthens the body, prolongs life, removes doshas from all over the body and thuspacifies all the ailments. It is praised as ‘Sarvarthakari’192Sahasrayoga: It is compilation of yogas by an unknown author. Sahacharadi kashaya,Ashtavargam kashaya, Rasonadi kashaya, Rasnaerandadi kashaya, Dhanvantaram taila,Ksheerabala taila, Prabhanjanavimardanam taila, Karpasasthyadi taila, Panchasneham,Narasimha choornam etc are mentioned for Gridhrasi and Vataja disorders.Shamanaushadhi:Churna – Ajamodadi, Abhadi, Dasamooladi, Krishnadi.Kalka / lepa – Mahanimba, Rasna, Gunajaphala, Vatahara pradeha.Kwatha – Rasnasaptaka, Sahacharadi, Maharasnadi, Dashamoola.Arishta – Brihat sahachararishta, Balarishta, Dasamoolarishta.Taila – Sahacharadi, Eranda, Mashadi, Vishagarbha, Narayana.Ghrita – Chagalyadhya, Gugguluthikthaka, Karaskara.Rasayoga – Vatagajankusha, Swachanandabhairava.Guggulu – Tryodashanga, Yogaraja, Mahayogaraja, Rasnadhi. Bastikarma “xÉuÉïÇÍcÉÌMüixÉÉqÉÌmÉ oÉÎxiÉqÉåMåü”193 All classical treatises of Ayurveda have emphasized the importance of bastikarmaas the most effective therapeutic measure than any other such methods prescribed forvarious ailments especially in the diseases occurring due to vatadosha. Acharya Kashyapaequated the bastikarma as AMRUTAM because of its wide applications even in bothinfants and old age.194Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 54 -
  • ChikitsaClassification of Basti: Knowledge of the classification is very essential for the better understanding ofbasti therapy. In classics different types of bastis are explained based on the quantity ofthe drug, the quality of the substance and the expected action of the basti, etc. there isalso difference of opinion in classification. Generally the term basti has been used for alltypes of bastikarma, which includes niruha, anuvasana, and uttarabasti. But Charaka hasused this term basti exclusively for niruha as per the commentary of Chakrapani.195Fnally bastikarma has been brought into the following classifications broadly.1. Adhishtana bheda: According to the site of application of basti it is of two types a. Abhyantara (Internal) b. Bahya (External)Abhyantara (Internal).Table No 18: Showing the Abhyantara bheda of basti. SI Type of Basti Administration of medicine through 01 Pakwasayagata basti Ano-rectal route to pakwasaya 02 Garbhasayagata basti Vaginal route to garbhasaya 03 Mutrasayagata basti Urethral route to mutrasaya 04 Vranagata basti Vranamukha by the process of bastikarmab. Bahya (External). In certain diseases the medicated oil is kept over the part of the body using a capor with flour paste for prescribed period of time and named after the site of application ofoil such as,Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 55 -
  • Chikitsa -Shiro basti, Kati basti.Bahya -Greeva basti, Netra basti. - Janu basti, Uro basti.2. Dravya bheda: Based on the drugs which are used in basti preparation it is of twotypes.196 Anuvasana bastiDravya bheda Niruha basti3. Sankhyabheda:197 Table No 19: Showing the Sankhyabheda of basti. SI Basti Sankya AnuvasanaSankya NiruhaSankya 01. Yoga basti 8 5 3 02. Kala basti 16 10 6 03. Karma basti 30 18 124. Karma bheda.198 Table No 20: Showing the Karmabheda of basti. SI Basti Action 01. Shodhana basti Removes doshas and malas from the Shareera 02. Lekhana basti Reduces Medodhatu and produces Lekhana karma 03. Sneha basti Sneha pradhana produces snehana to the Shareera 04. Brumhana basti Nourishes the Rasadi dhatu’s 05. Utkleshana basti Produces Utkleshatha of dosha’s and mala’s 06. Doshahara basti It is a shodhana type of Niruha basti.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 56 -
  • Chikitsa5. Anushangika bheda. Table No 21: Showing the Anushagikabheda of basti. SI Basti SI Basti 01. Yapana basti.199 09. Rakta basti.207 02. Siddha basti.200 10. Piccha basti.208 03. Yuktaratha basti.201 11. Kshara basti.209 04. Vaitharana basti.202 12. Samgrahi basti.210 05. Ksheera basti.203 13. Varnaprasadana basti.211 06. Ardhamatrika basti.204 14. Choorna basti.212 07. Teekshna basti. 15. Kaphavatahara basti. Mridu basti. Pittaraktahara basti. Sadharana basti.205 Kaphapittahara basti. 08. Mutra basti.2066. Rasa bheda.213 Table No 22: Showing the Rasabheda of basti. SI Basti SI Basti 01. Madhurarasa skandha 04. Katurasa skandha 02. Amlarasa skandha 05. Tiktarasa skandha 03. Lavanarasa skandha 06. Kashayarasa skandha7. Matra bheda.214 Table No 23: Showing the Matrabheda of basti. Sl Basti Quantity of Basti Dravya 01. Dvadashaprasrutabasti 12Prasrutha(1 Prasrutha 2Pala 96ml) 02. Prasritayogika basti 4,5,6,7,8,9&10Prasrutha(Acc.Strength of the patient) 03. Padaheena basti 1/4thDvadashaprasruta basti i.e. 9 Prasrutha Sharangadhara added, deepanaand pachana types of bastis.215Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 57 -
  • ChikitsaNiruha basti. The basti which eliminates the vitiated dosha thus provides strength to the body,is called niruha basti.216 It restores the dridata, bala, varna, shukra and it prevents theaging process; it is named as asthapana basti, as it acts like a vaya and ayusthapaka.217Contents of Niruhabasti.218 Makshika (honey), Lavana (rock salt), Sneha (ghritha/taila), Kalka (paste ofselected drugs), Kwatha (decoction) and Avapadravyas are the contents of Niruhabasti.According to the condition of patient and disease other ingredients like ksheera,mamsarasa, amla dravya, mutra and guda are also used as avapa dravyas.219 Taila isselected keeping in view the disease and condition of patient. If no drug is specificallymentioned for kalka Putoyavanyadi can be used.220 Kwatha is the decoction made as perthe ingredients selected rationally to suit the disease.Quantity of Niruha basti.221 The quantity of niruha is 12 prasruta, out of this 5 prasrita kwatha i.e. 10 palas.The sneha should be 1/6th, 1/4th and 1/8th i.e. 4 pala, 6 pala, 8 pala in pitta, vata and kaphadosha respectively in niruha 24 palas of niruha dose may be adjusted as followsTable No 24: Showing the Contents and Quantiy of Niruha basti dravya. Sl Niruha basti Dravya CS SS 1 Makshika 4 palas. 4 palas. 2 Lavana 1 karsha 1 karsha 3 Sneha 4 palas. 6 palas. 4 kalka 2 palas. 2 palas. 5 Kwatha 10 palas. 8 palas. 6 Avapadravya 4palas 4 palas. Total quantity 24 palas 24palasEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 58 -
  • ChikitsaAnuvasana basti. The peculiarity of this basti is that it has no adverse effects, it is safe, can be useddaily.222 It is one of the type of snehabasti.Table No 25: Showing the Snehabastibheda and Matra.223 SI Basti bheda Quantity 01 Sneha basti 6 Pala (298ml)i.e.1/4th of the quantity of Niruha. 02 Anuvasana basti 3 Pala (144ml) i.e. 1/2 of the Sneha Basti. 03 Matra basti 1½ Pala (72ml) i.e. minimum quantity of Sneha BastiDrugs used for Basti karma: Number of drugs belonging to animal and plant origin has been described in theclassics, which are used in bastikarma. For example, Sasya,Ksheera, Mamsarasa Swarasa,Mutra, Kshara,Lavana etc. The above lists suggest that almost all available drugs can beused for bastikarma.Phalini drugs - Drugs useful for emesis can be used in Asthapanabasti. e.g: Phala, Jeemutaka, Ikshwau, Dhamargava, Kutaja & Kritavedhana.Sneha dravyas - Ghrita, Taila, Vasa, Majja.Mutravarga dravyas - Aja, Avi, Go, Mahisha, Hasti, Ushtra, Haya, etc.Asthapana&Anuvasana gana - Dasamula, Bala, Punarnava, Eranda, Kola, Kulatha,Guduchi, Yava, Madanaphala, Palasa.Kalka for Asthapanabasti -Trivrit, Bilwa, Pippali, Kushta, Sarshapa, Vacha, Kutaja,Satahva, Yashtimadhu, Madanaphala.Kalkadravya anuvasana basti - Rasna, Devadaru, Bilwa, Madanaphala, Gokshura,Satahwa, Swetapunarnava, Raktapunarnava,Yvani, Kusta.etcEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 59 -
  • ChikitsaBasti Yantra: The device used for basti karma is called as bastiyantra. It comprises of two parts: A. Bastinetra. B. Bastiputaka.A. Bastinetra. The netra should be made of gold, silver, and copper or with other higher metals,alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail of cowwith a tapering end and a wider base, or like pyramid shape with round ends and smoothsurfaces.224Table No 26: Showing the Measurements of Bastinetra.225 Sl Age in years Length in Lumen of netra Angula Diameter of Diameter of broad end narrow end 1 <1 5 1 angula 2 1-6 6 Green gram 1 angula 3 7- 11 7 Black gram 1½ angula 4 12-15 8 Kalaya 2 angula 5 16- 20 9 Kalaya(Wet) 2½ angula 6 > 20 12 Karkandhu 3 angula Uttara bastiyantra 7 - 12 – 14 Sarshapa - Susrutha’s opinion 8 1 6 Mudga Feather of kanku bird must pass through. 9 8 8 Masha Feather of eagle must pass through. 10 16 10 Kalaya Feather of peacock must through. 11 >25 21 Kolasthi Feather of vulture must pass through.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 60 -
  • ChikitsaPramana of vranabasti netra. The hole should be of a mudga pramana, with 8 angulas of length.226Karnika. Two karnikas are provided on the netra at distance of 2 angulas between one,another at proximal end to tie the bastiputaka properly. In order to prevent unduepenetration of the bastinetra deep in to the rectum, a karnika or rim has to be made. It isto be placed at a required point above the distal end.Bastiputaka. The container of the bastidravya is known as bastiputaka. And it should be madefrom bladder of animals to fit the bastinetra and should be soft, strong and not have badsmell. The bladder of Go, Mahisha, Varaha, Aja, Aurabhra, Avi, Harini can be used asbasti putaka. If good bladder is not available other materials like skin of lower limb orneck of monkeys or other animals, thick cloth with sufficient strength and size arerecommended for the purpose.227 As the technology advances the development varioustypes of materials are available to make bastiputaka and even disposable bastinetra areavailable. The rubber bladder and polythene bags are best choice as these materials aredisposable, safe and easy to perform.Table No 27: Showing the Dosha of Bastinetra.228No. Netradosha Features Effect 1. Hraswata Too short Dravya will not reach pakwasaya 2. Deerghata Too long Dravya go beyond the pakwasaya 3. Tanuta Too thin Produces kshobha 4. Sthoolata Too big Produces KarshanaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 61 -
  • Chikitsa5. Jeernata Old dhatu used Injury to guda 6 Shithilabandhana Improperly fixed to putaka Dravya comes out7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / Irregular Dravyagati becomes irregularTable No 28: Showing Dosha of Bastiputaka.229 No. Putakadosha Features Effect 1. Vishama Shape not in uniform Gati vishamata happens 2. Mamsala Muscular tissue present Produces offensive small 3. Chinnachidrayukta Presence of hole Dravya comes out 4. Sthoola Thick one Does not push dravya 5. Jalayukta Anastamosis present Produces leakage 6. Vatala Excess air space Frothy type of dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass throughIndications and Contra-indications of Bastikarma. As basti is one of the prime treatment modality of Ayurveda, the knowledge ofthe indication and contraindication will make the success in the treatment. A briefdescription has been made here.Niruha ayogya/ Anasthpya.230Table No 29: Showing the Contraindications of Niruhabasti. No Type of Patient CS SS AH Complication 1 Ajeerna + + - Dooshyodhara, 2 Atisnigdha + - + Moorcha, 3 Peetasneha + - - ShothaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 62 -
  • Chikitsa 4 Utklistadosha + - - Teevra 5 Alpagni + + + Aruchi 6 Yanaklanta + - - Shareerashosha 7 Atidurbala + + - Pranaparodha 8 Kshudaarta + - - Kruchraswasa 9 Trishnaarta + + - 10 sharmaarta + - - 11 Atikrisha + + + More karshya, 12 Bhuktabhakta + - + utklesha of dosha 13 Pitodaka + - - 14 Vamita + - + More rookshata happens 15 Virikta + - + 16 Krita nasyakarma + - + Manovibhrama,Srotonirodha 17 Krudha + - - Basti dravya moves up 18 Bheeta + - - 19 Matha + + - Samnjanasha,Hrudayopaghata 20 Moorchita + + - 21 Prasktachardi + + + Basti dravya moves up because of the existing 22 Prasaktanisteeva + - + urdhwagati of vata 23 Swasapraskta + + + 24 Kasapraskta + + + 25 Hikka praskta + - + 26 Baddhagudhodara + - + Leads to death by causing severe distension of abdomen 27 Chhidrodhara + - + 28 Dakodara + - + 29 Adhmana + - + 30 Alasaka + - - 31 Visoochika + - - 32 Asmadosha + - - Causes teerva amavastha of the body 33 Amatisara + - + 34 Madhumeha + + + Vyadhi vardhakamEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 63 -
  • Chikitsa 35 Kushta + + + 36 Arshas - + + 37 Pandu - + - 38 Bhrama - + - 39 Arochaka - + - 40 Unmada - + - 41 Shokagrastha - + - 42 Sthoulya - + - 43 Kandhasosha - + - 44 Kshataksheena - + + 45 Saptamasa garbini - + + 46 Bala,Vruddha - + _ 47 Alpavarcha - - + 48 Gudashosha - - + 49 Amaprajatha + - - 50 Shopha - - -NiruhaYogya/Asthapya.231Table No 30: Showing the Indication of Niruhabasti. No. Indication CS SS AH No Indication CS SS AH 1. Sarvangaroga + + - 37. Rajakshaya + + + 2. Ekangaroga + + - 38. Vishamagni + - - 3. Kukshiroga + - - 39. Spikshoola + - - 4. Vatasanga + + + 40. Janushoola + - - 5. Mutrasanga + + + 41. Janghashoola + - - 6. Malasanga + + + 42. Urushoola + - - 7. Shukrasanga + - + 43. Gulphashoola + - - 8. Balakshaya + - - 44. Parshnishoola + - - 9. Mamsakshaya + - - 45. Prapadashoola + - - 10. Doshakshaya + - - 46. Yonishoola + + - 11. Shukrakshaya + + - 47. Bahushoola + - -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 64 -
  • Chikitsa 12. Aadhmana + + + 48. Angulishoola + - - 13. Angasupti + - - 49. Sthanashoola + - - 14. Krimikoshta + - - 50. Dantashoola + - - 15. Udavarta + + - 51. Nakhashoola + - - 16. Sudhatisara + + + 52. Parvasthishooa + - - 17. Parvabheda + - - 53. Shopha + - - 18. Abhitapa + - - 54. Sthmaba + - - 19. Pleehadosha + - + 55. Aantrakoojana + - - 20. Gulma + + + 56. Parikartika + - - 21. Shoola + + + 57. Maharogoktava + - + tavyadhi 22. Hridroga + - - 58. Jwara - + + 23. Bhagandara + - - 59. Timira + + - 24. Unmad + - - 60. Pratishaya - + - 25. Jwara + - + 61. Adhimantha - + - 26. Bradhna + + + 62. Ardita + + - 27. Shirashoola + + + 63. Pakshaghata + + - 28. Karnaroga + - - 64. Ashmari - + - 29. Hritshoola + - - 65. Upadamsha - + - 30. Parshwashooa + - - 66. Vatarakta - + - 31. Prushtashoola + - - 67. Arshas - + - 32. Katishoola + - - 68. Stanyakshaya - + - 33. Vepana + - - 69. Manyagraha + + - 34. Aakshepa + + - 70. Hanugraha + + - 35. Angagaurava + - - 71. Ashmari - + + 36. Atilaghava + - - 72. Moodhagarbha - + +Anuvasana yogya.232 Anuvasana is indicated in patients who are already indicated for asthapana, butspecial mention has been given to certain conditions like rooksha, kevala vataroga andatyagni where anuvasana is more beneficial.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 65 -
  • ChikitsaAnuvasana ayogya.233Table No 31: Showing the Contraindications of Anuvasana basti. No. Contraindications CS SS AH Complication 1. Anasthapya + + + 2. Abhuktabhakta + - + Sneha moves upwards 3. Navajwara + - - Leads to udara 4. Kamala + - + 5. Prameha + - + 6. Arshas + - - Leads to adhmana 7. Pratishyaya + - - 8. Pandu + + + 9. Arochaka + - - Causes annabhilasha 10. Mandagni + - - Increases the condition 11. Durbala + - - 12. Pleehodara + + + causes more dosha vardhana 13. Kaphodara + + + 14. Oorustambha + - + 15. Garapeeta + - + 16. Kaphabhishyanda + - + 17. Gurukoshta + - + 18. Shleepada + - + 19. Galaganda + - + 20. Apachi + - + 21 Krimikoshta + - + 22 Prameha - + + 23 Kushta - + + 24 Sthaulya - + + 25 Peenasa - - + 26 Krushna - - + 27 Varchobheda + - +Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 66 -
  • ChikitsaPreparation and Procedures of Bastikarma: The preparation and procedures made before, during and after administration ofNiruha, Anuvasana, Matra, and Uttarabasti with little differences. Generally, theseprocedures are classified into three parts: - 1.Poorvakarma 2.Pradhanakarma 3.Paschatkarma Selected patients for basti therapy have to undergo thoroughly clinicalexaminations to ascertain the physical as well as the mental conditions. Following tenfactors are to be considered for clinical examination.234 1.Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya 6.Agni 7.Satwa 8.Vaya 9.BalaThis will enable the physician to decide, the type of basti, number of bastis, basti dravya,etc to be administered in the particular patient.Mathra of Niruha basti.235Table No 32: Showing the Dosage of Niruhabasti in Different ages. No Age in Dose Years CS AH SS 01. 1 ½ prasrita 1Prakuncha 2 anjalis of patients hand i.e. 1 pala 02. 2 2 pala 2Prakuncha 03. 3 3 pala 3Prakuncha 04. 4 4 pala 4Prakuncha 05. 5 5 pala 5Prakuncha 06. 6 6 pala 6Prakuncha 07. 7 7 pala 7Prakuncha 08. 8 8 pala 8 prakuncha 4 anjalis of patients hand 09. 9 9 pala 9Prakuncha 10. 10 10 pala 10Prakuncha 8 anjalis of patients handEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 67 -
  • Chikitsa 11. 11 11 pala 11Prakuncha 12. 12 12 pala 12Prakuncha 13. 13 14 pala 14Prakuncha 14. 14 16 pala 16Prakuncha 15. 15 18 pala 18Prakuncha 16. 16 20 pala 20Prakuncha To be fixed based on netra, dravya pramana, age, bala and saralaswabhava 17. 17 22 pala 22Prakuncha 18. 18 – 70 24 pala 24Prakuncha 19. Above 70 20 pala 20Prakuncha 20. Above 25 12 prasthaProcedure of bastikarma:Anuvasanabasti.Poorvakarma. The patient should pass his/her natural urges then body of the patient should beanointed with suitable sneha and mrudu sweda. He should not have excessive appetite,then is advised to have his prescribed meal in madyamamatra and made to take a shortwalk. Patient is asked to lie over basti droni which is not very high, and the head must beat lower level. The patient should be lie on the droni on his left lateral position withstraight left leg and semi flexed right knee.236Pradhanakarma. The prescribed amount of sneha should be taken in the bastiputaka and tied wellplacing the bastinetra in position. Air is trapped from bastiyantra by gently pressing thebastiputaka. Then the anal region and the netra should be smeared with oil to minimizethe pain and irritation.237 Gently probe the anal orifice with the index finger of the leftEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 68 -
  • Chikitsahand and introduce the bastinetra through it into the rectum up to the mark of firstkarnika. Keeping in the same position press the bastiputaka by putting the adequate forcethen withdraw from the site.Paschatkarma. The patient is asked to sleep in same position as long as it would take to count upto hundred. The patient should be gently struck three times on each of the soles and overthe buttocks and where ever pain is there. The distal part of the cot should be raisedthrice. Allow patient to lie for sometime in the same position, if given sneha passedimmediately; another anuvasanabasti should be adopted.261 After passing the motion withsneha in proper time the patient is allowed to take light food in the evening if he feelshungry. Three yama is the maximum time for basti pratyagamana.239Niruhabasti:Poorvakarma. Abhyanga and swedana should be done over waist region and over abdomen priorto the procedure. Suitable time to administer niruha basti is Madhyahne kinchidavrute. Inempty stomach240 patient should lie comfortably on left lateral position, he should keephis body straight and, and use his folded left hand as pillow. He should then flex his rightleg, keeping left leg straight.Pradhanakarma. After the the anal examination the anus should be lubricated and then lubricatedbasti netra should be inserted into it up to the first ring (1/4th part from the top) slowlyand straightly parallel to the vertebral column once we have to wait for a few seconds forthe body to accommodate the nozzle before squeeze the nirooha dravya. Vagbhata inEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 69 -
  • ChikitsaAstanga Samgraha says that (pidana kala) time taken for squeezing is 30 matras.Practically it takes half to one minute.241Paschatkarma. After the pradhana karma patient is advised lie in supine position, pillow shouldbe placed below the vankshana pradesha. According to Chakradatta the patient has to liein supine position for about 100 matras.242 The other procedures followed in anuvasana should not be done in this condition.After passing motion he may be advised to take bath with hot water and have normalfood along with yusha, mamsarasa or ksheera in kapha, vata and pitta predominantdiseases respectively.243 The maximum time for basti pratyagamana is one muhurtha(48 minutes).244 If itdid not pass out, giving basti, which consists of sneha, kshara, mutra, amla dravyas andphalavarti, can bring it out. It should have the properties like snigdha, ushna, andteekshna if the niruha is passed out instantly again two or three bastis can be given.245Parihara kala. As jataragni is not much hampered; so specific regimen is not necessary duringthe pariharakala. During the period patient should avoid vata vardhaka nidanas.Table No 33: Showing the Basti vyapat (vaidya kruta and bastikrut).246 No Vyapat CS SS AH 01 Netra dosha 8 11 8 02 Basti putaka dosha 8 5 8 03 Dravya dosha - 11 - 04 Shaya dosha - 7 7 05 Pranidhana dosha 8 6 7 06 Peedana dosha - 4 -Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 70 -
  • Chikitsa 07 Niruha vyapat 12 9 6 08 Sneha vyapat 6 8 8 09 Atura vyapat - 15 - Total 42 76 44Complications of Sneha basti.247 Six types of complications may occur due to the following factors. Specific signsand symptoms with treatments are not mentioned 1. Vata, 2.Pitta, 3.Kapha, 4.Atibhukta, 5.Pureesha, 6.AbhuktaBasti Vyapats.248Twelve bastikruta vyapats are explained in classics those are as follows:-1).Ayoga: If administred less quantity of basti dravya, saindhava, add oil leads toheaviness in abdomen, obstruction of flatus stool and urine, local burning sensation,inflammation, itching, anorexia and dyspepsia.2).Atiyoga: Administration of teekshna basti in mridu koshta person leads to atiyoga andsymptoms are similar as in vamana-virechana atiyoga.3).Klama: Conduction of mridu basti in ama avastha, pitta and kapha gets vitiated andsrotorodha; leads to dyspepsia. There after vata also become vitiated and causes fatigue,syncope, burning sensation, colic, chest pain, heaviness.4).Adhmana: Due to administration of alpa veerya drugs to strong person, and rookshaPerson the drugs not able to expel vitiated doshas and vata gets vitiated leads to adhmanacausing pain in basti and hridaya, severe burning sensation, pain in testicles and groin.5).Hikka: it results in administering teekshna basti to weak person and mridu koshta withexcessive expulsion of doshas.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 71 -
  • Chikitsa6).Hritprapti: Bastidravya reaches the heart by entering into deeper levels due tocomplete squeezing or improper handling of bastiputaka and causes pain in chest andthe surroundings.7).Urdhwagamana: Suppression of urges before or after bastikarma and squeezingbastiputaka with high pressure leads to the upward movement and may come out throughmouth.8).Pravahika: Administration of less potent and insufficient quantity of bastidravya tothe person suffering form intensive vitiated doshas leads to pravahika.9).Shiroarti: Includes symptoms of headache, earache, deafness, tinnitus and coryza, eyeDisorders due to administration of less potent sheetaveerya dravyas with insufficientquantity to weak persons.10).Angarti:Administration of teekshna basti without conducting pre-operativeprocedures like abhyanga and sweda leads to angarti with upward movement of vata andtwisting and pricking pain in the body.11).Parikartika: Administration of ruksha and teekshna basti in excessive quantity to theperson having mridu koshta and in conduction of less vitiated doshas leads to theexcessive expulsion of doshas causing parikartika.12).Parisrava: Administration of teekshna and ushna basti to the person suffering frompitta roga / raktapitta leads to parisrava and causes burning sensation, erosion and Cuttingpain in anal region, severe bleeding and fainting.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 72 -
  • ChikitsaTable No 34: Showing the Basti pranidana Doshas. Sl Dosha Causes and Signs and symptoms 01 Savata bastidana Entry of air into rectum leads to pain in abdomen and colic 02 Atidruta praneeta Quick administration of basti dravya leads to pain in hip, anus, thigh, calves and retention of urine. 03 Tiryak praneeta Horizontal introduction leads to blockage at the tip of bastinetra.Introduction of bastidravya by pressing basti putaka more than once leads to chest pain,headache,and pain in thighs. 04 Ullipta Introduction of bastidravya by pressing bastiputaka more than once leads to chest pain, headache, and pain in thighs. 05 Sakampa Shivering while administration leads to erosion, burning and swelling at anal region. Not deeply introduced leads to burning bastidana pain in intestines. 06 Apraneeta Not deeply introduced leads to burning pain in intestines. 07 Atipraneeta Over penetration of netra leads abhigata 08 Atimanda data If done too slowly drug does not reach till intestines. 09 Bahyaga Not fully introducing the netra up to first karnika. 10 Ativega data Forceful introduction leads to the dravya reaching up to kosta and sometimes may come out through upper orifices.BastiKarmukata.249Bastikarma is having multidimensional therapeutic effects as earlier mentioned for betterunderstanding it can be studied under the following headings.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 73 -
  • ChikitsaFlow chart No 4: Showing the Basti karmukata. Basti karmukata Procedural effect Medicinal effect Left lateral position Veerya of the drugPakvasaya and Agni resides Spreads Apadatalamastakam Gravity of the anatomical slope facilitates passing of Brings doshas from dravya across the rectum srotases and other areas. Reaches pakvasaya (main Brings doshas from whole seat of vata and basti is body prime treatment for vata) Doshas eliminates with the help of BastiEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 74 -
  • ChikitsaSciatica Treatment Measures:250In addition to resuming usual activities, try the following measures:Cold packs. Initially, using cold packs may be able to reduce inflammation and relievediscomfort. Wrap an ice pack or a package of frozen peas in a clean towel and apply tothe painful areas for 15 to 20 minutes at least several times a day.Hot packs. After 48 hours, apply heat to the areas that hurt. Use warm packs, a heat lampor a heating pad on the lowest setting. If you continue to have pain, try alternating warmand cold packs.Stretching. Stretching exercises for your low back may help relieve nerve rootcompression. Avoid jerking, bouncing or twisting during the stretch and try to hold thestretch at least 30 seconds.Over-the-counter medications. Pain relievers (analgesics) fall into two categories, thosethat reduce pain and inflammation and those that only treat pain. No steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and acetaminophen(Tylenol, others) can both be helpful for sciatica.Although they can provide real relief, both types of medication have a "ceiling effect"that is, theres a limit to how much pain they can control. If you have moderate to severepain, exceeding the recommended dosage wont provide additional benefits. Whats more,NSAIDs can cause side effects such as nausea, stomach bleeding or ulcers, andacetaminophen can cause liver problems if taken in excess.Exercise, stretching, massage and other nondrug treatments can often provide the samebenefits without side effects.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 75 -
  • ChikitsaRegular exercise. It may seem counterintuitive to exercise when youre in pain, butregular exercise is one of the best ways to combat chronic discomfort. Exercise promptspatient’s body to release endorphins, chemicals that prevent pain signals from reachingyour brain.Early in the course of sciatica, water exercise or other low-impact exercise such as astationary bicycle will help you stay active without worsening symptoms. Later, as youimprove and the pain lessens, combining aerobic activity with strength training and corestability exercises that improve the strength of your back muscles can help limit theeffects of age-related degenerative changes in your back.Outlook (Prognosis) 251 If the cause of the sciatic nerve dysfunction can be identified and successfullytreated, full recovery is possible. The extent of disability varies from no disability topartial or complete loss of movement or sensation. Nerve pain may be severe and persistfor a prolonged period of time.Possible Complications Partial or complete loss of leg movement Partial or complete loss of sensation in the leg Recurrent or unnoticed injury to the leg Side effects of medicationsEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 76 -
  • Drug Review Drug Review As individuals, we have the power and the responsibility to keep our organism inbalance by observing a number of simple rules of behavior relating to sleep, food,exercise and drugs. The role of therapists and health professionals will be merely to assistus in doing so. (Fritj of Capra, 1983) Historically, the practice of medicine has been bound to traditional ways andtransmitted wisdom. Prior to the development of scientific method, medical knowledgerepresented a treasure that was pains takingly gained through familiarity with the worksof ancient physicians and through constant reflection on the experiences of life. In its efforts to secure control over disease processes through the tested andproven methods of drug-based treatments during the twentieth century, the Westernmedical community seemingly lost sight of the broader dimensions of healing. This wasperhaps an understandable response in view of the immense difficulties of the task. A formulation must contain the ingredients of potential effects for which it isused. In other words, the action of a medicine depends upon the sum total effect of theingredients in it. To have an idea about the qualities of the ingredients of“DWIPANCHAMULADI MAMSARASA BASTI” the description of those are givenhere below.252Madhu.253 Madhu due to its prabhava & yogavahi assumes magnifies gunas of whateverdravya is used along with it.254 Hence madhu is used along with most of the aharas &aushadhas which are kaphamedo and mehahara.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 77 -
  • Drug Review Rasa - Madhura, Kashaya Guna - Ruksha, Guru Veerya - Sheeta Vipaka - Madhura.Proparties : Agnideepana,varnya, lekhana, hrdya, vajeekarana, sandhana, sodhana,ropana, chakshusya, prasadana, kustaghna, krimighna, chardighna, swasaghna, kasaghna,atisarasamana, vranasodhana, pramehaghna, trishnaghna, vishaghna.Components: Sugers like fructose, glucose, sucrose, maltose, proteins, fats, vitamins,minerals, enzymes, amino acid, volatile aromatic substances, ashes and water.Saindhava Lavana.255This is the best in the lavanavarga. Guna - Laghu, Snigdha, Sukshma. Veerya - Ushna. Vipaka - Madhura.Properties: Chakshushya, hridya, ruchikara, agnideepana, vrishya, tridoshaghna.Uses: Alepana, sneha, sweda, vamana, virechana, niruha, anuvasana, nasya, sastrakarma.Components: NaCl can have impurities of gypsum or transparent cubes. It has a puresaline taste.Ghrita. Ghrita is one among mahasneha.256 According to Bhavaprakasa use of ghrita indiet leads to rasayana effect.257 It improves smriti, medha, budhhi,258 varna, svara,saukumaryata, increases rasa, sukra, ojas259 strengthens sensory organs and softens thebody.260 Addition of Ghrita or any sneha makes basti a homogenous mixture. This snehaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 78 -
  • Drug Reviewbrings uniformity in the mixture and due to this, kalka of basti mingles quickly. Inaddition to above all qualities, ghrita possesses a yogavahi property. “Esu caivottamam Sarpihi Samskarasyanuvartanat”261 Ghrita is recommended as pathya in vatavyadhis. In vata disorders snehainstantaneously provides nourishment to dhatus, it promotes bala, agni and longevity tolife.262Components: Triglycerides: 97.98%, diglycerides: 0.25-0.4%, monoglycerides 0.16-0.38%, keto-acid glyceride 0.015-0.018,free fatty acid 0.1-0.44%, phospholipids 0.2-1.0,Sterol 0.22-0.41%, vitamin-E 24 x10-3gm/100gm, vitamin-K 01 x10-4 gm/100gm.Tila Taila.263 264 The word “taila” is derived from tila (sesamum) but in general ‘taila’ isconsidered for all oils. Susruta mentioned that tilataila is best among the taila vargas265and it alleviates vata but at the same time does not aggravate kapha.Proparties: Bhrihmana, vrishya, twakprasadana, medhomardava,balakara,varnya,lekhana, pachana, vataghna, karnasulaprasamana.Uses: Parisheka, abhyanga, avagaha, basti, snehapana, karnapurana, akshipurana.266Components: Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%), oleic acid(45.4%), linoleic acid (40.4%).Vasa. Vasa is the upadhatu of mamsa.267 It is the essence or extract of suddhamamsa.268Vasa is not commonly used for basti karma, while mentioning Dwipanchamuladi basti,Arunadatta mentioned vasa can be used for basti karma, but majja cannot be used forEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 79 -
  • Drug Reviewbastikarma.269 Chakrapani also says that except majja all the snehas can be used forbastikarma270 and is also used for snehapana.271 Susruta says that the persons who is having increased appetite, and diseases ofvata are suitable to use vasa, sneha in internal and external form as well, is advised inasthi-majjagata vata.272 Mahasneha is indicated in asthi and majjavrita vata.273Proparties: Bhagna, bhristayoni, sandhi, asthi, marma, kosta, sira, karnarujanasaka.274Balataila.275 In Balataila, bala, ksheera and taila are the inredients. Among these bala is themain ingredient and ksheera is also having rasayana and brihmana properties. Bala taila isindicated in all the vatavyadhis.Proparties of bala: Rasa-Madhura Guna-Laghu, Snigdha, Picchila Veerya- Sheeta Vipaka- Madhura Prabhavam- Balya Dosha karma- Vata pitta hara, balya, brumhana, vrishya Karma- Balya, brumhana, vrishya Rogaghnata- Raktapitta, vatavyadhi, prameha, kshayaKalka.277 This kalka yoga is mentioned in Balaguduchyadi basti in Astanga hrudaya andCharaka samhita.276 and this kalka yoga is used as a common kalka dravya whereverkalka is not mentioned.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 80 -
  • Drug Review Table No 35: Showing the Ingredients of Putoyavanyadikalka.Name Rasa Guna Veerya Vipaka Doshagnata Karmukata Yavani Katu Laghu Ushna Katu Vatakapha- Pachana (Hyocyam- Tikta Ruksha samana Ruchyausniger.Linn) GrahiMadanaphala Madhura Laghu Ushna Katu Kaphavata- Pachana (Randia- Tikta Ruksha samana RuchyaDumetoram) Kashaya Katu Bilwa Kashaya Laghu Ushna Katu Vatakapha- Balya (Aegle Tikta Ruksha samana Deepana marmelos) Madhura Pachana Kusta Tikta Laghu, Ushna Katu Vatakapha- Vrshya (Saussurea- Madhura Ruksha samana Kasaghna lappa) Vacha Tikta Laghu Ushna Katu Kaphavata- Vibanda, (Acorus Katu Ruksha samana Soolaghna calamus) Satahva Katu Laghu Ushna Katu Kaphavata- DeepanaAnethumsowa Tikta Ruksha samana Pachana Teekshna Sulaghna Ghana Tikta Laghu Seeta Katu Kaphavata- Balya (Cyperus- Kashaya Ruksha samana Jwarghna Rotundus) Katu Pippali Katu Laghu Anush- Madh- Kaphavata- Deepana(Piperlongam) Teeks- naseeta ura samana Vrishya hna KustaghnaKwatha.277 Kashaya helps in maintaining the volume of the fluid; it helps in spreading andcleaning. Dasamula having the proparty of alleviate all the doshas, especially Brihat-panchamula pacifies vata and kapha doshas.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 81 -
  • Drug Review Table No: 36 Showing the Ingredients of Dasamulakashaya. Name Rasa Veerya Vipaka Guna Doshagnata KarmukataBilwa Kashaya Ushna Katu Laghu Vatakapha- BalyaAegle- Tikta Ruksha hara Pachana.marmelosGambhari Tikta Ushna Madhura Guru Tridosha- Deepana,Pach-Gmelinaar- Kashaya hara ana,Medhya.boreaPatala Tikta Ushna Katu Laghu Tridosha- Sothahara,Stereosper- Kashaya Ruksha hara Aruchi,Hikka,Mumsuave- SwasaolensAgnimantha Tikta Ushna Katu Laghu Kaphavata- DeepanaPremna- Katu Ruksha hara Sothaharaintegrifolia Kashya AnulomanaShyonaka Tikta Sheeta Katu Laghu Tridosha- Deepana,Oroxylum- Kashaya Ruksha hara Grahi,Kasa,indicum Atisara,Aruchi.Shalaparni Madhura Ushna Madhura Guru Tridosha- Vrushya,Briha-Desmodium- Tikta Snigdha hara na,Rasayana,gangeticum Sotha,Jwarahara.Prishniparni Madhura Ushna Madhura Laghu Tridosha- Deepana,Vrush-Uraria picta Tikta Snigdha hara ya,DahaghnaBrihati Katu Ushna Katu Laghu Kaphavata- Grahi, Pachana,Solanumindi- Tikta Ruksha hara Soola,Swasa,cumKantakari Tikta Ushna Katu Laghu Kaphavata- Deepana,Solanumxa- Katu Ruksha hara Kasa,nthocarpum ParshwasoolaGokshura Madhura Sheeta Madhura Guru Vatapitta- Balya,Ashmari,Tribulusterr- Snigdha hara Prameha,Swasaestris Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 82 -
  • Drug ReviewAvapadravyas. Avapadravyas are added in asthapana and anuvasana if the disease is chronic. Thequantity mentioned in classic for avapadravyas are three phala. These three phalas has tobe filled with avapadravyas like ksheera, amladravya, mamsarasa, mutra etc. In thisparticular yoga Acharyas have mentioned Ajamamsarasa and Kanjika.Mamsarasa (Aja). Mamsarasa will produce the effect of rasayana.278 Usage of Ajamamsa will yieldthe nourishment of all the dhatus.279 Rasa - Madhura Guna - Laghu,Snigdha Vipaka - Madhura Veerya - AnushnasheetaProparties: Tridoshahara, ruchya, bhrihmana, peenasanasana.280Kanjika. It is taken internally it cures ajeerna, sula, dhaha and jwara. It alleviate vata andkaphadoshas also.281 Rasa - Amla. Guna - Laghu,Teekshna. Vipaka - Amla. Veerya - Ushna. Karma- Rochana, Pachana, Deepana, Bastisodhaka,Malabhedaka.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 83 -
  • Drug ReviewEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi i
  • Materials and Methods Materials and Methods If we are interested in obtaining the highest quality of information, we are welladvised to engage scientific ways of knowing. An understanding of research methodsallows us to become critical consumers of information. Understanding research methodsallows us to assess the wealth of information we receive each day in light of some verydiscerning standards. Science is distinctive in that it employs set methodical proceduresthat aim to reduce or control the amount of error that creeps into the process of knowing. Ayurveda is an established medical system, which has been developed by variousancient Acharyas after rigorous experiments and examinations. But today it’s necessaryto prove the Ayurvedic facts on the modern parameters, without altering its basicstructure as Methodical approach is the backbone of research. Research is a scientific study through which one can establish new facts,discarding the old facts or modifying the present facts. Utmost care is taken in designingthe methodology for conducting this study. Clinical research involves theexperimentation of a drug/therapy on a population and recording the feedback based onwhich postulations are made regarding the usefulness of the drug/therapy in the disease.Research Approach: In the present study, the main objective is to “EVALUATE THE EFFICACY OFDWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI’’. The efficacy wasdetermined by finding out the difference between the baseline data of the parameters tothe after pariharakala data.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 83 -
  • Materials and MethodsStudy Design: The study design set for the present study is Prospective clinical trial (anobservational clinical study). The study was done in single group. The treatment modalityused in this clinical study is basti karma, which included sthanika abhyanga and swedanaas poorvakarma. All the patients were administered Dwipanchamuladi mamsarasa bastifor 8 days (Yogavasti) and 16days of pariharakala was given and 8 days of follow upperiod was set.Reasons for Selection of the Study Design: The results and conclusions of a clinical trial depend on the study design. Theaim of this study was to find out the“ EVALUATE THE EFFICACY OFDWIPANCHAMULADI MAMSARASA BASTI IN GRIDHRASI ’’.Source of Data: Patient suffering from Gridhrasi were selected from O.P.D and I.P.D. ofD.G.M.A.M.C & H., Gadag after fulfilling the Inclusion and Exclusion criteria.Sample Size: The sample size for the present study was 30 patients suffering from Gridhrasi asper the selection criteria selected.Selection Criteria: The cases were selected strictly as per the pre-set inclusion and exclusion criteria.Inclusion Criteria: 1. Patient above 20 and below 70 years of age. 2. Presence of clinical features of Gridhrasi like sthambha, ruja etc. 3. Patient fit for basti karma.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 84 -
  • Materials and MethodsExclusion Criteria: 1. Patient below 20 and above 70 years. 2. Pregnant women and lactating mothers. 3. Patient with other systemic disorders. 4. History of major trauma causing fractures. 5. Degenerative disorders with marked deformity. 6. Patients unfit for basti karma.Study Duration: Dwipanchamuladi Yoga Basti: 8 days Pariharakala: 16 days Total study duration: 24 daysCriteria for Diagnosis: The signs and symptoms of Gridhrasi mentioned in Ayurveda were the main basis ofdiagnosis. Diagnosis will be established by clinical examination of signs and symptoms ofGridhrasi as follows: 1. Ruja in Sphik, Kati, Prushta, Ooru, Janu, Jangha and Pada. 2. Sthambha of affected Sakthi 3. Prasupthi in Sphik, Kati, Prushta, Ooru, Janu, Jangha and Pada. 4. Burning sensation in Sphik,Kati, Prushta, Ooru, Janu, Jangha and Pada. 5. Straight leg raising test being positive.Data Collection: Patients were thoroughly examined both subjectively and objectively. Detailedhistory pertaining to the mode of onset, previous ailment, previous treatment history,Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 85 -
  • Materials and Methodsfamily history, habits, ashtavidhapareeksha. Routine investigations and Radiologicalfeatures are also investigated to exclude other pathologies.Method of Examination.282 The physical examination is not as important as the history in identifyingsecondary causes of acute low back pain. Nevertheless, certain aspects of the physicalexamination are considered important.Gait and Posture: Observation of the patients walk and overall posture is suggested for all patientswith low back pain. Scoliosis may be functional and may indicate underlying musclespasm or neurogenic involvement.Range of Motion: The examiner should record the patients forward flexion, extension, lateralflexion and lateral rotation. Pain with forward flexion is the most common response andusually reflects mechanical causes. If pain is induced by back extension, spinal stenosisshould be considered. Point tenderness over the spine with palpation or percussion may indicatefracture or an infection involving the spine. Tenderness over the sciatic notch withradiation to the leg often indicates irritation of the sciatic nerve or nerve roots. Palpatingthe paraspinous region may help delineate tender areas or muscle spasm.Straight Leg Raising Test (SLR):283 The patient who was lying supine is asked to raise one leg by keeping the kneestraight. Each leg is raised separately until pain occurs. The angle between the bed andthe leg should be recorded. Pain occurring when the angle is between 30 and 60 degreesEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 86 -
  • Materials and Methodsis a provocative sign of nerve root irritation. The angle in which the sign was positive isnoted. Placing the knee back in full extension during straight leg raising and the foot ispassively dorsiflexed also increase the pain The angle at which pain occurred wasrecorded. (Lasègues sign)Reflexes and Motor and Sensory Testing:284 Testing knee and ankle reflexes in patients with radicular symptoms often helpsdetermine the level of spinal cord compromise. Weakness with dorsiflexion of the greattoes and ankle may indicate L5 and some L4 root dysfunction. Sensory testing of themedial (L4), dorsal (L5) and lateral (S1) aspects of the foot may also detect nerve rootdysfunction.Knee jerk. The patient was made to sit on the edge of a high bed, with the legs hanging freelyover the edge. Diverting the patient’s attention, the patellar tendon was struck sharplywith a hammer half way between the patella and the insertion of the tendon of tibia. Theleg will be seen to move or jerk forward with the contraction of quadriceps muscle.Diminished or absent knee jerk is likely to be in the region of L3 and L4 nerve rootlesion.Ankle jerk. The patient was made to lie supine, the hip was extended and the knee flexed atright angles. The ankle was slightly dorsiflexed so as to put the tendon on moderatetension. A sharp tap was given on Achilles’ tendon. Diminished or absent ankle jerkEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 87 -
  • Materials and Methodssuggests severe protrusion at L5-S1 disc space and S1 root damage. Bilateral absence ofankle reflexes can be a normal finding in old age.Babinski’s reflex. The patient was relaxed and side of the foot was stimulated with a blunt objectfrom heel towards the toes when the response to the stimulation of the sole consists ofdorsiflexion of the big toe and fanning out of other toes, it is called extensor plantarresponse and is positive Babinski’s sign. The sign may be negative when the S1 nerveroot is involve.Movements of Lumbar Spine: 285Forward Flexion. This was examined by asking the patient to lean forward or to touch his toeskeeping the knee straight. It is important to judge what proportion of the movementoccurs at the spine and how much is contributed by hip flexion. The measurementbetween tip and the middle finger and the floor was recorded.Right lateral flexion. Instructed the patient to slide his hand down the right side of the leg to assess this.The distance from the floor or from fixed anatomical landmarks can be then recorded.The measurement between the tip of the middle finger and the floor was recorded.Left lateral flexion. Same as right lateral instead left side of the leg, the distance between the tip of themiddle finger and the floor was recorded.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 88 -
  • Materials and MethodsExtension and Rotation. For extension instructed the patient to arch the spine backwards, looking up atthe ceiling. For rotation asked the patient to rotate the lumbar region and the movementwhether nil, limited or full was recorded.Spinal Root Examination:286(A)Inspection : Examine the patient both in the standing and sitting in the erect posture.If there is any abnormality noted, which vertebrae is involved and at what level anyvertebral projection is most prominent, noted the presence of any local projection orangular deformity of the spine. Curvature of the spinal column, abnormal curvature maybe in anterior (lordosis), posterior (kyphosis), or lateral direction (scoliosis) wererecorded.(B) Palpation: This is carried out in standing and prone posture.Tenderness: Thumb may be pressed along the spinous processes from the abovedownwards along its whole extent. Note the level of maximum tenderness. Tendernessmay be elicited by pressing upon the side of the spinous process in an attempt to rotatethe vertebra. Tenderness also be elicited by applying the gentle blows on either side ofthe spine.Swelling: Arising from the spinal column and may be seen in lumbar region (Coldabscess).C) Percussion: Percussion over the spine is sometimes performed to elicit the tendernessin addition to the method already described.Movement of lumbar spine, SLR are also comes under the spinal root examination.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 89 -
  • Materials and MethodsOswestry Disability Index:287 Oswestry disability index is an extremely important tool to measure patient’spermanent functional disability. By choosing best answer for the questions that describesthe pain and limitation. Adding up the points for each section and calculated the level ofdisability according the formula. Point total/50 X 100 = % of disabilityVisual Analogue Scale:288 Visual analog scales are used to get a move reliable longitudinal measure of pain.The patients are asked to mark against the number corresponding to how he or she feelsat that moment the simplest form is a 10 cm long line, to assess severity of pain verbal. 0 1 2 3 4 5 6 7 8 9 10Description is taken from the patient as trivial, mild, moderate and severe. Then they areasked to mark their pain levels.Walking time:289The patient was asked to walk a distance of 21 meters and time taken for walking wasrecorded.The Materials Used for the Study: Makshiksa - 100ml Lavana - 10gm Sneha a) Murchita Ghrita -100 ml b) Murchita Taila -100 mlEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 90 -
  • Materials and Methods c) Vasa -100ml Yavanayadi kalka -30gm Dasamula kashya -340ml Ajamasarasa -340 ml Kanjika -100mlPreparation of Medicines: A total 25 liter of Murchita tila taila, 10 liter of Murchita Go-ghritha, 10 literVasa, 18 liters of Bala taila, 10 liters of Kanjika were prepared in the department ofRasashastra and Bhaishajya kalpana, D.G.M.A.M.C.and H. Gadag. And taila paka wasdone according to Sharngadhara Samhita.Kashaya. 200gms of Dasamula kashaya choorna was added to 1600ml water and boiled upto its 1/4 i.e. 400ml. The drugs were checked with the criteria mentioned in the classicalAyurvedic texts and modern botanical parameters with experts before using them in thestudy.Taila Murchana.290 For the taila Murchana1/16th part of Manjistha, 1/64th part of Haritaki ,Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera, Nalika, Ketakipushpa,1 part of Tila taila, and 4 parts of jala was taken and reduced for tailaavasesha.Ghrita Murchana.291 Triphala-1phala, Haridra-1phala, Mustha-1phala, Matulunga swarasa -1phala,Ghrita-2 prastha, water-8 prastha were added and heated on mandagni for making pakaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 91 -
  • Materials and Methodstill attaining the ghrita siddha lakshana. Then the vessel was taken out from the fire andghrita was filtered.Vasa. Vasa is scrapped from the meat and omentum of goat, then it is boild with water,after boiling the Vasa separates and floats on the water surface like oil. Then it isdecanted to another vessel and it is heated to remove the water particles and stored in airtight container.Mamsarasa.292 800 gms of Ajamamsa was added with 1600 ml of water and cooked in a vessel,until the contents are reduced to its ¼ th quantity, i.e. 400ml. It is filtered and used it asavapa dravya.Kanjika. One part of rice and 15 part of water boiled in a vessel till the rice gets boiled andfiltered and kept for fomentation for 20 days. After fermentation again it was filtered andkept it in the air tight container and used for bastikarma.Bala Taila. Bala, Ksheera and Taila are the three ingredients in this yoga.100 palas ofbalamula kashaya and one adhakaka of ksheera was added in to two palas of taila andreduced according to tailapaka vidhi.Poorvakarma. All the patients were asked to be in the hospital with in 9.A.M. Every patient wasgiven stanika abhyanga and swedana just prior to the introduction of bastidravya. Theabhyanga was done with Bala taila to the udarapradesha direction and kati, prushta, ooru,Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 92 -
  • Materials and Methodsjanu, jangha and pada. Swedana was done only on to the area where the abhyanga wasdone.Pradhanakarma. Dwipanchamuladi niruha basti was administered to all patients by using plasticenema pot fit with soft rubber tubes at the terminal end was used. For Niruha a quantityof 1150 ml luke warm bastidravya and for Anuvasana 100 ml of Balataila was taken inthe bastiputaka, tied well and air is trapped from bastiyantra. Then the anal region and thenetra is smeared with oil. Gently probed the anal orifice with the index finger of the lefthand and was introduced the bastinetra through the rectum up to the mark of first karnika. The method of administration of bastidravya was strictly followed as told by theAcharyas. After the basti, the patient was made to lie on supine posture and gentletapping was made on his buttocks, legs were lifted up, hips were tapped thrice with thepatient’s heel. Patient was asked to remain in the same position till the feeling of defecation.Later after the manifestation of urges he was asked to evacuate the bastidravya. After thelimited time, 1/2hr-1hr time, patient was asked to take hot water bath and was advisedwith laghu bhojana. The same procedure was repeated for 8days. The time of administration, the time ofretention, complication was noticed if any.Paschatkarma.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 93 -
  • Materials and Methods Basti pratyagamana kala was recorded and then thorough examination of thepatient was repeated by noting all the vital data again. Patient was advised with all thepathyapathya to be maintained in the basti pariharakala. The patient was asked to follow a pariharakala of 16 days and was asked to reporton 24th day from the treatment schedule started, for follow up and observation.Methods of Assessment of Clinical Response: Subjective parameters and objective parameters were made out to assess theClinical response.Assessment of Response to Treatment: For subjective analysis gradation of lumber pain and pain in leg are theParameters. For objective analysis SLR test and movements of lumber spine are theparameters. Every patient was observed before treatment and after the treatment forclinical response. The result is analyzed as below.1. Best responded. SLR test being negative, total absence of clinical symptoms and maximumincrease in the movement of lumber spine and Oswestry Disability Index grading 1 (0-20%).2. Responded. SLR test being negative or maximum improvement, minimum increase in themovements of lumber spine and presence of clinical symptoms and Oswestry DisabilityIndex grading 2 (20-40%).3. Not responded.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 94 -
  • Materials and Methods SLR test being negative or same or minimum improvement, with the presence ofclinical symptoms and the increase in the movements of lumber spine are very minimaland Oswestry Disability Index grading not improved.Certain gradations and declarations are made about the data, which are as follows,Gradings of Subjective parameter:Ruk (pain) : Grade 0 - No pain. Grade 1 - Trivial pain. Grade 2 - Mild pain. Grade 3 - Moderate pain. Grade 4 - Severe pain.Sthamba (Stiffness): Grade 0 - No stiffness. Grade 1- Up to 25% impairment of movements. Grade 2 - 25-50% impairment of movements. Grade 3 - 50-75% impairment of movements. Grade 4 - More than 75% impairment movements.Toda: Shooting pain -Grade 0 – Absent. Grade 1 – Present. Tingling sensation -Grade 0 – Absent. Grade 1 – Present. Burning sensation -Grade 0 – Absent. Grade 1 –Present.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 95 -
  • Materials and MethodsSpandana: Cramping - Grade 0 – Absent. Grade 1 – Present.Tandra: Grade 0 – Absent. Grade 1 – Present.Gaurava: Grade 0 – Absent. Grade 1 – Present.Aruchi: Grade 0 – Absent. Grade 1 – Present.Dehavakrata: Grade 0 – Absent. Grade 1 – Present.Vahnimandhya: Grade 0 – Absent. Grade 1 – Present.Mukhapraseka: Grade 0 – Absent. Grade 1 – Present.Bhakthadwesha: Grade 0 – Absent. Grade 1 – Present.Suptata: Grade 0 – Absent. Grade 1 – Present.Staimitya: Grade 0 – Absent. Grade 1 – Present.Stabdata: Grade 0 – Absent. Grade 1 – Present.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 96 -
  • Materials and Methods Sphurana: Grade 0 – Absent. Grade 1 – Present. Gradings of Objective parametere. Straight Leg Raising Test: Grade 0 - More than 90° Grade 1 - 71°-90° Grade 2 - 51°-70° Grade 3 - 31°-50° Grade 4 - up to 30° Movements of Lumbar Spine. Flexion, Right Lateral bending, Left Lateral bending - Grade 0 - 0 -10cms. Grade 1 - 11 - 20cms. Grade 2 - 21 - 30cms. Grade 3 - 31 - 40cms. Grade 4 - 41 - 50cms. Grade 5 - 51 - 60cms.Extension, Rotation - Grade 0 – Full. Grade 1 – Limited. Grade 2 – Nil. Walking time: Grade 1 - up to 20 seconds. Grade 2 - up to 21-30seconds. Grade 3 - up to 31-40seconds. Grade 4 - up to 41-50seconds. Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 97 -
  • Materials and Methods Grade 5 - up to 51-60seconds.Visual Analogue Scale(VAS): Grade 0 - 0 cms. Grade 1 - 1-3 cms. Grade 2 - 4-6 cms. Grade 3 - 7-10 cms.Knee & Ankle jerk- Grade 0 – Brisk. Grade 1 – Diminished. Grade 2 – Absent.Babinski’s sign- Grade 0 – Negative. Grade 1 – Positive.Oswestry Disability Index (ODI): Grade 1 - 0% to20 %(Minimal disability). Grade 2 - 21% to 40 %(Moderate disability). Grade 3 - 41% to 60 %(Severe disability). Grade 4 - 1% to 80 %(Crippled disability). Grade 5 - 81% to 100 %(Exaggerating symptoms).Gait: Grade 0 – Normal. Grade 1 – Abnormal.Overall Assessment of Results: Grade 1 - Best responded. Grade 2 - Responded. Grade 3 - Not responded.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 98 -
  • Materials and MethodsEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi II
  • Observations and results Table No. 37. Showing the Demographical data Sex Religion Occupation Eso-status Position Duration Vyasana Leg Ahara Agni Kosta affectedSi.No Age Teekshna Sedentar Standing Stooping Smoking Vishama Bilateral Christen Vegetari Squattin Tobacco Madhya Above 6 Alcohol Muslim Labour Kroora Up to 1 Female Middle Manda Higher Sitting Mridu Mixed Active Hindu Right Sama 1 to 2 2 to 4 4 to 6 None Male Poor Left1 32 + - + - - - - + - - + + + - + + - - - - - + - - + - - + - - - - + + - -2 35 - + + - - - + - - + - + - - - - - - + - - - - + - + - + - - - - + + - -3 40 - + + - - + - - - + - + + - - + - - - - - - - + + - - + - - - - + - + -4 60 + - + - - + - - - - + + + - - + - - - - - - - + + - - + - + - - - + - -5 37 - + + - - - - + - - + + + + - + - - - - - - - + - + - + - + - - - + - -6 51 + - + - - + - - - + - + - - - - - - - + - + - - - + - + - - - - + + - -7 40 - + + - - + - - - + - + + + + - + - - - - - - + + - - + - + - - - + - -8 40 - + + - + - - - + - + + - - - + - - - - - - + + - - - + - - - + + - -9 60 + - + - - + - - - + - - + - - + - - - - - - - + - + - + - - - - + + - -10 40 + - - + - - + - - - + + + + + + - - - - - + + - - + - - + - - - + + - -11 40 + - + - - - - + - - + + + + + + - - - - - + - - - - + + - + - - - + - -12 45 + - + - - - - + - + - + + + + + - - - - - + - - - - + + - + - - - + - -13 25 + - + - - - + - - - + + + + + - - + - - - + - - - + - + - - - - + - + -14 34 + - + - - - + - - + - - + - - + - - - - - - - + - - + - + - - - + - + -15 62 - + + - - - - + - - + + - + - - - + - - - - + - - + - - + - - - + + - - Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 99
  • Observations and results Table No. 37. Showing the Demographical data Sex Religion Occupation Eso-status Position Duration Vyasana Leg Ahara Agni Kosta affectedSi.No Age Sedentar Standing Stooping Smoking Vishama Bilateral Christen Vegetari Squattin Tobacco Teekshn Madhya Above 6 Alcohol Muslim Labour Kroora Up to 1 Female Middle Manda Higher Sitting Mridu Mixed Active Hindu Right Sama 1 to 2 2 to 4 4 to 6 None Male Poor Left16 39 + - + - - - + - - + - + + - - + - - - - - - - + - + - + - - - + - - - +17 65 + - + - - - - + - - + + + - + + - - - - - - + - - - + - + - - - + - + -18 40 - + + - - + - - - - + - + - + - - - - + - - - + - + - + - - - - + - + -19 59 + - + - - + - - - + - - + - + + - - - - - + - - - - + + - + - - - + - -20 45 - + + - - + - - - - + + + - - - - + - - - - - + - - + - + - - - + + - -21 55 - + + - - - - + - - + + + - + + - - - - - + - - - + - + - - - + - - - +22 25 + - + - - - + - - + - + + - - - - - - + - - - + + - - - + - - - + + - -23 32 + - + - - - - + - - + + + + - - - + - - - + - - - - + + - - - - + + - -24 45 - + + - - - - + - - + + + - - + - - - - - - - + + - - + - + - - - + - -25 34 + - + - - - + - - - + + + + - - - + - - - + - - - - + + - + - - - + - -26 44 - + + - - - + - - - + + - - - + - - - - - - - + + - - + - + - - - + - -27 36 + - + - - - + - - + - + + + - - - + - - - - - + - - + + - - - - + + - -28 44 + - - + - - - + - + - + + - + + - - - - - + + - - + - - + - - - + + - -29 38 + - + - - - + - - - + + - - + + - - - - - + - - - + - + - - - - + + - -30 30 - + + - - - + - - + - + - - - - + - - - - - - + - - + + - - - - + + - - Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 100
  • Observations and results Table No. 38. Showing the Subjective Parameter gradings STAMBHA RUK TODA SPANDANA DEHAVAKRATA SUPTATA Shooting Pain Tingling BurningSi.No Sensation sensation B A A B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F T T F 1 2 1 1 4 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 3 2 2 2 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 2 2 2 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4 2 1 1 3 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 3 3 2 3 3 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 2 1 1 3 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 7 3 2 1 3 2 2 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 8 2 1 1 4 4 3 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 9 3 2 1 2 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 010 2 1 1 4 2 1 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 011 3 2 2 4 2 2 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 012 2 0 0 3 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 013 3 2 1 4 3 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 014 4 3 2 2 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 015 2 1 1 3 2 2 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 Stambha : Grade0-No stiffness,Grade1- up to 25% impairment,Grade2 - 25-50% impairment,Grade3 -50-75% impairment,Grade4 -More than 75% impairment. Ruk : Grade0-No pain,Grade1-Trivial pain, Grade2- Mild pain,Grade3- Moderate pain,Grade4-Severe pain. Toda,Spandana,Dehavakrata,Suptata : Grade0- Absent, Grade1-Present. *BT-Before treatment,AT-After treatment,AF-After follow up.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 101
  • Observations and results Table No. 39. Showing Subjective Parameter gradings STAMBHA RUK TODA SPANDANA DEHAVAKRATA SUPTATA Shooting Pain Tingling BurningSi.No Sensation sensation B A A B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F T T F16 2 1 0 3 2 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 017 3 1 0 2 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 018 2 1 1 4 3 2 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 019 2 2 1 3 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 020 3 2 1 4 3 2 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 021 2 1 1 3 2 3 1 0 1 1 0 0 1 1 1 0 0 0 0 0 0 1 0 022 2 0 0 3 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 023 1 1 1 4 2 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 024 3 2 2 4 3 3 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 025 3 2 1 3 2 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 026 2 1 1 4 3 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 027 2 1 1 3 2 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 028 2 1 1 3 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 129 2 1 1 3 3 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 030 2 2 1 3 2 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 Stambha : Grade0-No stiffness, Grade1- up to 25% impairment, Grade2 - 25-50% impairment, Grade3 -50-75% impairment, Grade4 - More than 75% impairment. Ruk : Grade0-No pain, Grade1-Trivial pain, Grade2-Mild pain, Grade3-Moderate pain, Grade4-Severe pain. Toda,Spandana,Dehavakrata,Suptata : Grade0-Absent, Grade1-Present. *BT-Before treatment,AT-After treatment,AF-After follow up.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 102
  • Observations and results Table No. 40 Showing the Subjective Parameter gradings GAURAVA AROCHAKA MUKHA BAKTHA STAIMITYA VAHNI PRASEKA DWESHA MANDHYA TANDRASi.No B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 12 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Gaurava,Arochaka,Mukhapraseka,Baktadwesha,Staimitya,Vahnimandhya,Tandra :Grade0-Absent, Grade1-Present *BT-Before treatment,AT-After treatment,AF-After follow up.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 103
  • Observations and results Table No. 41. Showing Showing the Subjective Parameter gradings GAURAVA AROCHAKA MUKHA BAKTHA STAIMITYA VAHNI PRASEKA DWESHA MANDHYA TANDRASi.No B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F 16 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 20 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 21 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 25 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 26 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 27 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Gaurava,Arochaka,Mukhapraseka,Baktadwesha,Staimitya,Vahnimandhya,Tandra : Grade0-Absent, Grade1-Present *BT-Before treatment,AT-After treatment,AF-After follow up.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 104
  • Observations and results Table No. 42 Showing Objective Parameters gradings STRAIGHT LEG RAISING TEST MOVEMENT OF LUMBAR SPINE ACTIVE PASSIVE Si.No Right Leg Left Leg Right Leg Left Leg FF RLF LLF EXT ROT B A A B A A B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F T T F T T F 1 3 2 1 1 0 0 2 2 1 0 0 0 5 4 5 4 3 3 3 3 3 1 1 0 1 0 0 2 2 1 1 2 2 2 2 1 1 2 2 2 1 1 1 3 3 3 4 4 3 1 1 1 1 1 1 3 2 2 2 1 1 1 2 2 1 1 1 1 5 5 5 4 5 5 3 3 3 1 1 0 1 0 0 4 1 1 1 2 2 2 1 1 1 2 1 1 3 3 3 4 3 3 3 3 2 1 0 0 1 0 1 5 1 1 1 3 3 3 0 0 0 3 3 3 5 4 5 3 2 2 5 4 5 1 1 1 1 1 1 6 1 1 1 2 2 1 1 1 1 2 2 2 4 3 2 5 3 3 4 3 2 1 1 1 1 1 1 7 3 3 2 1 0 0 3 2 1 1 1 1 3 2 2 4 4 4 5 4 4 1 1 1 1 0 0 8 3 3 3 3 2 2 3 3 2 3 2 2 1 1 0 3 3 3 3 3 3 1 1 1 1 1 1 9 1 1 1 2 2 2 1 1 1 2 1 1 0 0 0 4 3 3 3 4 4 1 1 1 1 1 1 10 1 1 1 3 2 1 1 1 1 2 1 1 2 1 1 3 2 2 4 3 3 1 0 0 1 0 0 11 4 3 3 3 3 3 4 3 3 3 2 2 5 5 5 5 5 5 5 5 4 1 1 0 1 1 1 12 2 1 1 2 1 1 2 1 1 2 1 1 3 0 0 2 0 0 1 0 0 1 0 0 1 0 0 13 2 1 1 3 2 1 1 1 1 2 1 1 5 4 5 5 4 3 5 5 4 1 1 1 1 1 1 14 2 2 1 2 2 1 2 1 1 2 2 1 1 1 0 4 4 3 4 4 3 1 1 1 1 1 1 15 2 2 2 3 2 2 2 1 1 3 2 3 5 5 4 5 5 5 4 4 5 1 1 1 1 1 1 Straight leg raising test : Grade0-More than 90°, Grade1-71°-90°, Grade2-51°-70°, Grade3-31°-50°,Grade4 -up to 30°. Movement of lumbar spine (FF,RLF,LLF) : Grade0-0–10cms, Grade1-11 – 20cms, Grade2-21 – 30cms, Grade3-31– 40cms, Grade4-41 – 50cms, Grade5-51 – 60cms. (EXT,ROT) : Grade0-Full, Grade1-Limited , Grade2-Nil. *BT-Before treatment, AT-After treatment, AF-After follow upEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 105
  • Observations and results Table No. 43. Showing Objective Parameters gradings STRAIGHT LEG RAISING TEST MOVEMENT OF LUMBAR SPINE ACTIVE PASSIVE Si.No Right Leg Left Leg Right Leg Left Leg FF RLF LLF EXT ROT B A A B A A B A A B A A B A A B A A B A A B A A B A A T T F T T F T T F T T F T T F T T F T T F T T F T T F 16 1 1 1 2 1 1 1 1 1 1 1 1 2 1 0 3 2 2 3 3 3 1 0 0 1 1 1 17 2 2 1 3 2 2 2 1 1 2 1 1 2 2 1 4 3 2 5 4 4 1 0 0 1 0 0 18 2 1 1 1 1 1 2 1 1 1 1 1 5 5 5 4 4 3 3 2 2 1 1 1 1 1 1 19 2 2 2 2 2 2 2 2 2 2 2 2 5 5 4 5 4 4 5 5 5 1 1 1 1 1 1 20 3 2 2 4 2 2 3 2 1 3 2 2 3 2 2 5 4 4 4 4 3 0 0 0 1 0 0 21 2 2 2 2 1 2 2 2 1 1 1 1 5 4 4 5 4 4 4 4 4 1 1 1 1 1 1 22 2 1 1 1 1 1 1 1 1 1 1 1 3 3 2 2 2 2 3 3 2 1 0 0 0 0 0 23 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 0 0 1 1 1 0 0 0 24 4 3 3 2 1 1 3 3 3 1 1 1 3 2 2 2 2 2 3 2 2 1 1 0 1 0 0 25 4 2 1 2 2 1 3 1 1 1 1 1 5 4 4 5 5 4 5 5 4 1 0 0 1 0 0 26 4 3 2 2 1 1 4 3 2 2 1 1 1 1 1 5 4 4 4 4 4 1 1 1 1 1 1 27 2 1 1 2 1 1 2 1 1 1 1 1 2 1 1 3 2 2 2 2 2 2 1 1 1 0 0 28 1 1 1 2 2 1 1 1 1 1 1 1 2 1 1 1 1 1 1 0 0 1 1 0 1 1 1 29 1 1 1 2 1 1 1 1 1 2 1 1 3 2 2 4 4 4 2 2 2 1 1 1 1 1 1 30 2 2 2 2 2 2 1 1 1 1 1 1 3 3 2 4 3 3 4 3 3 1 1 1 1 1 1 Straight leg raising test : Grade0-More than 90°, Grade1-71°-90°, Grade2-51°-70°, Grade3-31°-50°,Grade4 -up to 30°. Movement of lumbar spine (FF,RLF,LLF) : Grade0-0–10cms, Grade1-11 – 20cms, Grade2-21 – 30cms, Grade3-31– 40cms, Grade4-41 – 50cms, Grade5-51 – 60cms. (EXT,ROT) : Grade0-Full, Grade1-Limited , Grade2-Nil. *BT-Before treatment, AT-After treatment, AF-After follow upEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 106
  • Observations and results Table No. 44. Showing Objective Parameters gradings KNEE JERK ANKLE JERK BABINSKI SIGN OWI VAS GAIT WTSi.No Right Leg Left Leg Right Leg Left Leg Right Leg Left Leg B A A B A A B A A B A A B A A B A A B A B A A B A A B A A T T F T T F T T F T T F T T F T T F T F T T F T T F T T F 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 4 2 3 2 1 0 0 0 3 2 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 1 0 0 0 1 1 1 3 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 4 2 3 3 2 0 0 0 2 2 2 4 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 3 2 3 2 1 0 0 0 2 2 1 5 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 5 3 2 2 2 0 0 0 2 2 2 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 1 0 0 0 1 1 1 7 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 5 3 3 2 2 0 0 0 3 2 2 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 3 2 0 0 0 2 2 2 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 3 2 2 0 0 0 2 1 1 10 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 4 2 3 2 1 0 0 0 2 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 5 3 3 2 2 1 1 1 4 3 3 12 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 1 1 0 0 0 3 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 4 2 3 3 2 0 0 0 2 2 1 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 2 0 0 0 2 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 3 2 3 2 2 1 1 1 5 4 4 Knee jerk, Ankle jerk : Grade0-Brisk, Grade1-Diminished, Grade2 –Absent, Babinski sign : Grade0-Negative, Grade1-PositiveOswestry Disability Index : Grade1-0% to20 %, Grade2-21% to 40 %, Grade3-41% to 60 %, Grade 4-61% to 80 %, Grade 5-81% to 100 %.Visual Analogue Scale : Grade0 -0 cms, Grade1-1-3cms, Grade2 -4-6 cms, Grade3 -7-10 cms, Gait : Grade0-Normal, Grade1-Abnormal.Walking time : Grade1-up to 20 seconds, Grade2-up to 21-30seconds, Grade3-up to 31-40seconds, Grade4-up to 41-50seconds, Grade5-up to 51-60seconds.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 107
  • Observations and results Table No. 45 Showing Objective Parameters gradings KNEE JERK ANKLE JERK BABINSKI SIGN OWI VAS GAIT WTSi.No Right Leg Left Leg Right Leg Left Leg Right Leg Left Leg B A A B A A B A A B A A B A A B A A B A B A A B A A B A A T T F T T F T T F T T F T T F T T F T F T T F T T F T T F 16 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 3 2 3 2 1 0 0 0 2 1 1 17 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 3 2 3 2 1 0 0 0 2 2 1 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 3 3 3 2 0 0 0 2 1 1 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 1 0 0 0 3 2 2 20 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 4 3 2 1 0 0 0 3 2 2 21 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 5 3 3 3 2 0 0 0 4 4 4 22 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 3 2 3 1 1 0 0 0 2 1 1 23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 2 0 0 0 2 1 1 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 3 3 0 0 0 3 3 3 25 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 4 2 3 2 1 0 0 0 3 2 1 26 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 3 2 2 0 0 0 3 2 1 27 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 2 0 0 0 2 1 0 28 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 4 2 3 1 1 0 0 0 2 2 1 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 2 3 2 2 0 0 0 2 2 1 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 3 2 2 1 0 0 0 2 2 2 Knee jerk, Ankle jerk : Grade0-Brisk, Grade1-Diminished, Grade2 –Absent, Babinski sign : Grade0-Negative, Grade1-Positive, Oswestry Disability Index : Grade1-0% to20 %, Grade2-21% to 40 %, Grade3-41% to 60 %, Grade 4-61% to 80 %, Grade 5-81% to 100 %. Visual Analogue Scale : Grade0 -0 cms, Grade1-1-3cms, Grade2 -4-6 cms, Grade3 -7-10 cms. Gait : Grade0-Normal, Grade1-Abnormal. Walking time : Grade1-up to 20 seconds, Grade2-up to 21-30seconds, Grade3-up to 31-40seconds, Grade4-up to 41-50seconds, Grade5-up to 51- 60seconds Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi 108
  • Observations and Results Observations and Results 33 patients were registered for this study; out of this 3 patients were excluded, sotheir data has not been included here. The remaining 30 patients of Gridhrasi fulfillingthe criteria for diagnosis were treated in single group.Demographic Data:1. Distribution of Patients by Sex.Table No 46: Showing the Distribution of Patients by Sex. Si.No Sex No of Patients Percentage 1. Male 18 60% 2. Female 12 40%Among 30 patients 18 patients i.e. 60% were males and females were 12 patients i.e.40%.Fig No 1: Showing the Distribution of Patients by Sex. 20 15 Male Fe male 10 5 02. Distribution of Patients by Religion.Table No 47: Showing Distribution of Patients by Religion. Si.No Religion No of Patients Percentage 1. Hindu 28 93.33% 2. Muslim 02 06.66%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 109 -
  • Observations and Results Among 30 patients 93.33% patients i.e. 28 patients were Hindus and 06.66%patients i.e. 2 patients were Muslims.Fig No 2: Showing the Distribution of Patients by Religion.3025 Hindu2015 Muslim10 5 03. Distribution of Patients by Occupation. Table No 48: Showing the Distribution of Patients by Occupation. Si.No Occupation No of Patients Percentage 1. Sedentary 09 30.00% 2. Active 10 33.33% 3. Labour 11 36.66% Among 30 patients 9 patients i.e. 30% were Sedentary, 10 patients i.e. 33.33%were Active and 11 patients i.e. 36.66% were Labour.Fig No 3: Showing the Distribution of Patients by Occupation. 12 10 Sedentary 8 Active 6 4 L abour 2 0 Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 110 -
  • Observations and Results4. Distribution of Patients by Age.Table No 49: Showing the Distribution of Patients by Age. Si.No Age No of Patients Percentage 1. 21-30 03 10.00% 2. 31-40 15 50.00% 3. 41-50 05 16.66% 4. 51-60 05 16.66% 5. 61-70 02 06.66% Among 30 patients, 3 patients i.e. 10% were of 21-30 age group, 15 patients i.e.50% were of 31-40 age group, 05 patients i.e. 16.66% were of 41-50 age group, 05patients i.e. 16.66% were of 51-60 age group, 02 patients i.e. 06.66% were of 61-70 agegroup.Fig No 4: Showing the Distribution of Patients by Age. 16 14 21-30 12 31-40 10 41-50 8 51-60 6 61-70 4 2 05. Distribution of Patients by Socio-economic Status. Table No 50: Showing the Distribution of Patients by Socio economic Status. Si.No Socio-status No of Patients Percentage 1. Poor 16 53.33% 2. Middle 14 46.66%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 111 -
  • Observations and ResultsAmong 30 patients 16 patients i.e. 53.33% were poor, 14 patients i.e. 46.66% weremiddle class.Fig No 5: Showing the Distribution of Patients by Socio economic Status. 16 15.5 Poor 15 14.5 Middle 14 13.5 136. Distribution of Patients by Habits.Table No 51: Showing the Distribution of Patients by Habits. Si.No Habits No of Patients Percentage 1. Tobacco 12 40.00% 2. Alcohol 04 13.33% 3. None 16 53.33% Among 30 patients 40% i.e. 12 patients had the habit of using Tobaco, 13.33% i.e.04 patients had the habit of Alcohol and 16 patients i.e. 53.33% patients were devoid ofany habits.Fig No 6: Showing the Distribution of Patients by Habits. 16 14 12 Tobac o 10 Alcohol 8 None 6 4 2 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 112 -
  • Observations and Results7. Distribution of Patients by Involvement of Limb.Table No 52: Showing the Distribution of Patients by Involvement of Affected Limb. Si.No Leg affected No of Patients Percentage 1. Right Leg 08 26.66% 2. Left Leg 12 40.00% 3. Both Leg 10 33.33% Among 30 patients, 26.66% (8patients) had the radiating pain towards the Rightlower limb, 40% patients (12 patients) had radiating pain towards the left lower limb andbilaterally affected by 33.33%(10 patients).Fig No 7: Showing the Distribution of Patients by Involvement of Affected Limb. 12 Right leg 10 8 Left leg 6 4 Bilateral 2 08. Distribution of Patients by Incidence of Position. Table No 53: Showing the Distribution of Patients by Incidence of Position. Si.No Position No of Patients Percentage 1. Sitting 24 80.00% 2. Standing 26 86.66% 3. Stooping 10 33.33% 4. Squatting 12 40.00% 24 patients had the position at sitting while work i.e. 80%, 26 patients stand whilework i.e. 86.66%, 10 patients stoop while work i.e. and 33.33% and 12 patients squat atwork.i.e.40%.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 113 -
  • Observations and ResultsFig No 8: Showing the Distribution of Patients by Incidence of Position. 30 25 Sitting 20 Standing 15 Stooping 10 Squatting 5 09. Distribution of Patients by Incidence in Different Koshta.Table No 54: Showing the Distribution of Patients by Incidence in Different Koshta. Si.No Koshta No of Patients Percentage 1. Mridu 05 16.66% 2. Madhya 23 76.66% 3. Kroora 02 06.66% Among 30 patients, 05 patients (16.66%) were Mridu Koshta, 23 patients(76.66%) were Madhyama koshta, 02 patients were Kroora koshta (06.66%).Fig No 9: Showing the Distribution of Patients by Incidence in Different Koshta. 25 20 Mridu 15 Madhya 10 Kroora 5 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 114 -
  • Observations and Results10. Distribution of Patients by Incidence of Agni. Table No 55: Showing the Distribution of Patients by Incidence on Agni. Si.No Agni No of Patients Percentage 1. Mandagni 09 30.00% 2. Vishmagni 02 06.66% 3. Samagni 19 63.33% Among 30 patients, 09 patients had Mandagni i.e. 30%, 02 patients hadVishamagni i.e. 06.66%, 19 patients were having Samagni, i.e. 63.33%.Fig No 10: Showing the Distribution of Patients by Incidence of Agni. 20 Manda 15 Vishama 10 Sama 5 011. Distribution of Patients by Chronicity of Disease. Table No 56: Showing the Distribution of Patients by Chronicity of Disease. Si.No Duration in years No of Patients Percentage 1. Below one year 17 56.66% 2. 1-2 years 03 10.00% 3. 2-4 years 06 20.00% 4. 4-6 years 01 03.33% 5. Above 6 years 03 10.00% Among 30 patients, 17 patients i.e. 56.66% were below one year chronicity, 03patients i.e.10.00% were under 1-2 year chronicity, 06 patients i.e.20.00% were under 2-4Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 115 -
  • Observations and Resultsyear chronicity, 01 patient i.e.03.33% were under 4-6 year chronicity, 03 patientsi.e.10.00% were above 6 year chronicity .Fig No 11: Showing the Distribution of Patients by Chronicity of Disease. 18 Below 1 Year 16 1-2 Year 14 12 2-4 Year 10 8 4-6 Year 6 4 Above 6 Year 2 012. Distribution of Patients by Incidence of Ahara. Table No 57: Showing the Distribution of Patients by Incidence on Ahara. Si.No Diet No of Patients Percentage 1. Vegetarian 22 73.33% 2. Mixed 08 26.66% Among 30 patients, 22 patients i.e. 73.33% were Vegetarian, 08 patients i.e.26.66% were Non-Vegetarian.Fig No12: Showing the Distribution of Patients by Incidence on Ahara. 25 20 Vege tarien 15 Mixed 10 5 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 116 -
  • Observations and Results13. Distribution of Patients by Incidence of Nidana.Table No 58: Showing the Distribution of Patients by Incidence on Aharaja nidana. Si.No Ahara No of Patients Percentage 1. Ruksha 27 90.00% 2. Sheetha 11 36.66% 3. Laghu 21 70.00% 4 Alpha 07 23.33% 5 Kashaya 02 06.66% 6 Katu 22 73.33% 7 Tiktha 03 10.00% 90% of patients had the habit of taking Ruksha ahara (27 patients), 11 patientshad the habit of taking Sheeta ahara (36.66%), 21 patients had the habit of taking Laghuahara (70%), 07 patients had the habit of taking Alpa ahara (23.33%), Kashaya rasa 2patients (06.66%), Katu rasa 22 patients (73.33%), 03 patients (10%) had the habit oftaking Tikta rasa.Fig No 13: Showing the Distribution of Patients by Incidence on Aharaja nidana. 30 Ruksha 25 Sheeta 20 Laghu 15 Alpha K ashaya 10 K atu 5 Tikta 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 117 -
  • Observations and Results14. Distribution of Patients by Incidence of Nidana.Table No 59: Showing the Distribution of Patients by Incidence on Viharaja nidana. Si.No Vihara No of Patients Percentage 1. Yana 28 93.33% 2. Vishama upachara 30 100% 3. Vyayama 22 73.33% 4 Divaswapna 14 46.66% 5 Marmaghata 11 36.66% 93.33% of patients (28) had the experience in traveling in bike, cycle and othervehicles, 100% (30) patients had the experience in difficult activities, 22patients(73.33%) had the experience of excessive exercise, 14 patients (46.66%) werehaving the habit of day sleep, 11 patients (36.66%) had experience of marmagatha.Fig No 14: Showing the Distribution of Patients by Incidence on Viharajanidana. 30 Yana 25 Vishama upachara 20 Vyayama 15 Divaswapna 10 Marmagata 5 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 118 -
  • Observations and Results15. Distribution of Patients by Incidence on Range of SLR. Table No 60: Showing Incidence on Range of SLR Before treatment. Si.No Grade Right Leg Left Leg No of Patients % No of Patients % 1. Grade 1 08 26.66% 06 20.00% 2. Grade 2 14 46.66% 16 53.33% 3. Grade 3 04 13.33% 07 23.33% 4. Grade 4 04 13.33% 01 03.33% Among 30 patients, 08 patients i.e. 26.66% were shown positive at Grade 1 atright and 06 patients i.e.20% at left leg, 14 patients (46.66%) were shown positive atGrade 2 on right and 16 patients i.e.53.33% at left leg, 04 patients (13.33%) were shownpositive at Grade 3 on right leg and 07 patients i.e.23.33% at Left leg, 04 patients(13.33%) were shown positive at Grade 4 on right and 01 patient i.e.03.33% at left leg.Fig No 15: Showing Incidence on Range of SLR Before treatment. 16 14 12 10 Right le g 8 Left leg 6 4 2 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 0-More than 90°,Grade 1-71°-90°,Grade 2-51°-70°,Grade 3-31°-50°, Grade 4-up to 30°Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 119 -
  • Observations and Results16. Distribution of Patients by Incidence on Range of SLR. Table No 61: Showing Incidence on Range of SLR After treatment. Si.No Grade Right Leg Left Leg No of % No of % Patients Patients 1. Grade 0 00 00.00% 02 06.66% 2. Grade 1 15 50.00% 11 36.66% 3. Grade 2 10 33.33% 15 50.00% 4. Grade 3 05 16.66% 02 06.66% Among 30 patients, 02 patients i.e. 06.66% were shown positive at Grade 0 at leftleg, 15 patients i.e. 50% were shown positive at Grade 1 on right and 11 patientsi.e.36.66% at left leg, 10 patients (33.33%) were shown positive at Grade 2 on right and15 patients i.e.50% at left leg, 05 patients (13.33%) were shown positive at Grade 3 onright and 02 patient’s i.e.06.66% at left leg.Fig No 16: Showing Incidence on Range of SLR After treatment. 16 14 12 10 Right leg 8 6 Left leg 4 2 0 Grade 0 Grade 1 Grade 2 Grade 3 Grade 0-More than 90°,Grade 1-71°-90°,Grade 2-51°-70°,Grade 3-31°-50°, Grade 4-up to 30°Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 120 -
  • Observations and Results17. Distribution of Patients by Incidence on Range of SLR. Table No 62: Showing Incidence on Range of SLR After follow up. Si.No Grade Right Leg Left Leg No of Patients % No of Patients % 1. Grade 0 00 00.00% 02 06.66% 2. Grade 1 19 63.33% 16 53.33% 3. Grade 2 08 26.66% 10 33.33% 4. Grade 3 03 10.00% 02 06.66% Among 30 patients, 02 patients i.e. 06.66% were shown positive at Grade 0 on leftleg, 19 patients i.e. 63.33% were shown positive at Grade 1 on right and 16 patientsi.e.53.33% at left leg, 08 patients (26.66%) were shown positive at Grade 2 on right and10 patients i.e.33.33% at left leg, 03 patients (10.00%) were shown positive at Grade 3 onright and 02 patients i.e.06.66% at left leg. Fig No 17: Showing Incidence on Range of SLR After follow up. 20 18 16 14 Right leg 12 10 Left le g 8 6 4 2 0 Grade Gr ade Grade Grade 0 1 2 3 Grade 0-More than 90°,Grade 1-71°-90°,Grade 2-51°-70°,Grade 3-31°-50°, Grade 4-up to 30°Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 121 -
  • Observations and Results18. Distribution of Difference in Grade of Lumbar Spine Movement. Table No 63: Showing the Movement of Lumbar Spine Before treatment.Si.No Difference Forward flexion Right lateral Left lateral in grade flexion flexion No of % No of % No of % Patients Patients Patients 1. Grade 0 01 03.33% 00 00.00% 00 00.00% 2. Grade 1 05 16.66% 02 06.66% 03 10.00% 3. Grade 2 05 16.66% 03 10.00% 02 06.66% 4. Grade 3 08 26.66% 06 20.00% 09 30.00% 5. Grade 4 01 03.33% 10 33.33% 09 30.00% 6. Grade 5 10 33.33% 09 30.00% 07 23.33% Among 30 patients, 01 patient(03.33%) each showed Grade 0 and Grade 4 inforward flexion, 05 patients(16.66%) each in Grade 1 and Grade 2, 08 patients wereshown Grade 3(26.66%), 10 patients showed Grade 5(33.33%). Regarding right lateralflexion, 02 patients i.e.06.66% showed Grade 1, 03 patients i.e.10.00% in Grade 2, 06patients were shown Grade 3(20%), 10 patients showed Grade 4(33.33%), 09 patientswere shown Grade 5(30%).In left lateral flexion, 09 patients i.e.30% each showed Grade3 and Grade 4, 03 patients i.e.10% in Grade 1, 02 patients were shown Grade 2(06.66%),07patients showed Grade 5(23.33%).Fig No 18: Showing the Movement of Lumbar Spine Before treatment. 10 9 8 7 Forward fle xion 6 5 Rt Lat flexion 4 3 2 Lt Lat flexion 1 0 Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 122 -
  • Observations and Results19. Distribution of Difference in Grade Lumbar Spine Movement. Table No 64: Showing the Movement of Lumbar Spine After treatment. Si.No Difference Forward flexion Right lateral Left lateral in grade flexion flexion No of % No of % No of % Patients Patients Patients 1. Grade 0 02 06.66% 02 06.66% 03 10.00% 2. Grade 1 09 30.00% 01 03.33% 00 00.00% 3. Grade 2 05 16.66% 06 20.00% 07 23.33% 4. Grade 3 04 13.33% 08 26.66% 09 30.00% 5. Grade 4 05 16.66% 09 30.00% 08 26.66% 6. Grade 5 05 16.66% 04 13.33% 03 10.00% 05 patients i.e.16.66% each showed Grade 4, Grade 5, Grade 2, 09 patientsi.e.30% showed Grade 1, 02 patients were shown Grade 0(06.66%), 04 patients showedGrade 3(13.33%) in forward flexion. Regarding right lateral flexion, 02 patientsi.e.06.66% showed Grade 0, 01 patient i.e.03.33 % in Grade 1, 06 patients were shownGrade 2 (20%), 08 patients showed Grade 3(26.66%), 09 patients were shown Grade4(30%), 04 patients i.e.13.33% showed Grade 5. In left lateral flexion, 03 patients eachi.e.10% each showed Grade 0 and Grade 5, 07 patients i.e.23.33% in Grade 2, 09 patientswere shown Grade 4(30%), 08 patients showed Grade 4(26.66%).Fig No 19: Showing the Movement of Lumbar Spine After treatment. 9 8 7 6 Forward flexion 5 Rt Lat flexion 4 3 Lt Lat flexion 2 1 0 Grad e 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 123 -
  • Observations and Results20 .Distribution of Difference in Grade of Lumbar Spine Movement. Table No 65: Showing the Movement of Lumbar Spine After follow-up. Si.No Difference Forward flexion Right lateral Left lateral in grade flexion flexion No of % No of % No of % Patients Patients Patients 1. Grade 0 05 16.66% 02 06.66% 03 10.00% 2. Grade 1 07 23.33% 00 00.00% 00 00.00% 3. Grade 2 07 23.33% 07 23.33% 07 23.33% 4. Grade 3 01 03.33% 10 33.33% 09 30.00% 5. Grade 4 04 13.33% 08 26.66% 08 26.66% 6. Grade 5 06 20.00% 03 10.00% 03 10.00% In forward flexion, 07 patient i.e.23.33% each showed Grade 1 and Grade 2, 05patients i.e.16.66% showed Grade 0, 04 patients were shown Grade 4 (13.33%), 01patient showed Grade 3(03.33%), 06 patients were shown Grade 5 i.e.20%. Regardingright lateral flexion, 02 patients i.e.06.66% showed Grade 0, 07 patients i.e.23.33 %showed Grade 2, 10 patients were shown Grade 3 (33.33%), 08 patients showed Grade4(26.66%), 03 patients were shown Grade 5(10%). In left lateral flexion, 03 patients wereshown Grade 0(10%), 07 patients i.e.23.33 % showed Grade 2, 09 patients were shownGrade 3 (30%), 08 patients showed Grade 4(26.66%), 03 patients were shown Grade5(10%).Fig No 20: Showing the Movement of Lumbar Spine After the follow-up. 10 9 8 Forward flexion 7 6 Rt Lat flexion 5 4 Lt Lat flexion 3 2 1 0 Gra de 0 Gr ade 1 Gr ade 2 Grade 3 Grade 4 Gra de 5Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 124 -
  • Observations and Results Grade 0-0 – 10cms,Grade 1 -11 – 20cms,Grade 2 -21 – 30cms, Grade 3-31 – 40cms,Grade 4 -41 – 50cms,Grade 5 -51 – 60cms21. Distribution of Difference in Grade of Lumbar Spine Movements.Table No 66: Showing the Extension of Lumbar Spine. SI Grade Before Treatment After Treatment After follow-up No of % No of % No of % Pt Pt Pt 1. Grade 0 01 03.33% 08 26.66% 13 43.33% 2. Grade 1 28 93.33% 22 73.33% 17 56.66% 3. Grade 2 01 03.33% 00 00.00% 00 00.00% Among 30 patients, before treatment 01 patient each shown Grade 0 and Grade2(03.33%) and remaining 28 patients shown Grade 1(93.33%). After the treatment 08patients were shown Grade 0, remaining 22 patient’s i.e.73.33% were shown Grade 1.After the follow-up, 13 patients were shown Grade 0 and 17 patients were shown Grade1(56.66%)Fig No 21: Showing the Extension of Lumbar Spine. 30 25 Before treatment 20 After treatment 15 10 After follow-up 5 0 Grade 0 Gr ade 1 Grade 2Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 125 -
  • Observations and Results22. Distribution of Difference in Grade of Lumbar Spine Movements.Table No 67: Showing the Rotation of Lumbar Spine. SI Grade Before Treatment After After follow-up Treatment No of % No of % No of Pt % Pt Pt 1. Grade 0 02 06.66 13 43.33 12 40 2. Grade 1 28 93.33 17 56.66 18 60 Among 30 patients, before treatment 02 patients shown Grade 0 (06.66%) and 28patients shown Grade 1(93.33%). After the treatment, 13 patients were shown Grade0(43.33%), remaining 17 patients i.e.56.66% were shown Grade1. After the follow-up, 12patients were shown Grade 0 (40.00%) and 18 patients were shown Grade 1(60.00%).Fig No 22: Showing the Rotation of Lumbar Spine. 30 25 Before tre atment 20 After treatme nt 15 10 After follow-up 5 0 Grade 0 Grade 1 Grade 0-Full, Grade 1-Limited, Grade 2-Nil23. Distribution of Difference in Grade of Reflexes. Table No 68: Showing the Knee and Ankle jerk Before treatment. SI Grade Knee Jerk Ankle Jerk No of Patients No of Patients Rt % Lt % Rt % Lt % 1. Grade 0 20 66.66% 19 63.33% 20 66.66% 20 66.66% 2. Grade 1 10 33.33% 11 36.66% 10 33.33% 10 33.33%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 126 -
  • Observations and Results Among 30 patients, 20 patients were shown Grade 0 in right leg i.e.66.66% and inleft leg 19 patients, i.e.63.33%, 10 patients were shown Grade 1 in right leg i.e.33.33%and in left leg 11 patients i.e.36.66%. Ankle jerk of the right leg and left leg were 66.66%( 20 patients), 10 patients were each shown Grade 1 in right leg and in left leg (33.33%)Fig No 23: Showing the Knee and Ankle jerk Before treatment. 20 18 16 14 Knee jerk Right 12 Ankle jerk Right 10 Knee jerk Left 8 6 Ankle jerk Left 4 2 0 Grad e 0 Grade 124. Distribution of Difference in Grade of Reflexes. Table No 69: Showing the Knee and Ankle jerk After treatment. SI Grade Knee Jerk Ankle Jerk No of Patients No of Patients Rt % Lt % Rt % Lt % 1. Grade 0 21 70.00% 21 70.00% 21 70.00% 21 70.00% 2. Grade 1 09 30.00% 09 30.00% 09 30.00% 09 30.00% Among 30 patients, Knee jerk of the right leg and left leg were shown Grade 0 in70.00 %( 21 patients), 09 patients each were shown Grade 1 in right leg and left legi.e.30.00%. Ankle jerk of the right leg and left leg were shown Grade 0 in 70.00 % i.e.(21 patients) and 09 patients each were shown Grade 1 in right leg and left legi.e.30.00%.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 127 -
  • Observations and ResultsFig No 24: Showing the Knee and Ankle jerk After treatment. 25 20 Knee jerk Right 15 Ankle je rk Right Knee jerk L eft 10 Ankle je rk L eft 5 0 Grade 0 Grade 125. Distribution of Difference in Grade of Reflexes. Table No 70: Showing the Knee and Ankle jerk After follow-up.SI Grade Knee Jerk Ankle Jerk No of Patients No of Patients Rt % Lt % Rt % Lt %1. Grade 0 22 73.33% 21 70.00% 22 73.33% 21 70.00%2. Grade 1 08 26.66% 09 30.00% 08 26.66% 09 30.00% Among 30 patients, Knee jerk, 22 patients were shown Grade 0 in right legi.e.73.33% and in left leg 21 patients’ i.e.70.00%, 08 patients were shown Grade 1 inright leg i.e.26.66% and in left leg 09 patients, i.e.30.00%. 22 patients were shown Grade0 in right leg i.e.73.33% and in left leg 21 patients’ i.e.70.00%, 08 patients were shownGrade 1 in right leg i.e.26.66% and in left leg 09 patients i.e.30.00%. Fig No 25: Showing the Knee and Ankle jerk After follow-up. 25 20 Knee je rk Right 15 Ankle je rk Right Knee je rk L eft 10 Ankle je rk Left 5 0 Grade 0 Grade 1Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 128 -
  • Observations and Results Grade 0-Brisk, Grade 1-Diminished, Grade 2-Absent 26. Distribution of Difference in Grade of Reflexes. Table No 71: Showing the Distribution of Difference in Grade Babinski’s sign.S Grade Before treatment After treatment After follow-upI No of Patients No of Patients No of Patients Rt % Lt % Rt % Lt % Rt % Lt %1 Grade 0 23 76.6 24 80 23 76.6 24 80 22 73.3 23 76.62 Grade 1 07 23.3 06 20 07 23.3 06 20 08 26.6 07 23.3 Among 30 patients, Babinski’s sign before treatment, 23 patients were shown Grade 0 in right leg i.e.76.66% and in left leg 24 patients i.e.80.00%, 07 patients were shown Grade 1 in right leg i.e.23.33% and in left leg 06 patients i.e.20.00% .After treatment, 23 patients were shown Grade 0 in right leg i.e.76.66% and in left leg 24 patients i.e.80.00%, 07 patients were shown Grade 1 in right leg i.e.23.33% and in left leg 06 patients i.e.20.00%. After follow-up, 22 patients were shown Grade 0 in right leg i.e.73.33% and in left leg 23 patients, i.e.76.66%, 08 patients were shown Grade 1 in right leg i.e.26.66% and in left leg 07 patients i.e.23.33%. Grade 0-Negative, Grade 1-Positive Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 129 -
  • Observations and Results27. Distribution of Patients by Walking time. Table No 72: Showing the Distribution of Patients by Walking time. Si.N Walking Before treatment After treatment After follow-up o Grade No of % No of % No of % Patients Patients Patients 1. Grade 0 00 00.00% 00 00.00% 02 06.66% 2. Grade 1 02 06.66% 11 36.66% 17 56.66% 3. Grade 2 17 56.66% 15 50.00% 07 23.33% 4. Grade 3 08 26.66% 02 06.66% 02 06.66% 5. Grade 4 02 06.66% 02 06.66% 02 06.66% 6. Grade 5 01 03.33% 00 00.00% 00 00.00% Among 30 patients, before treatment, 06.66% i.e. 02 patients were each underGrade 1 and Grade 4, 56.66% i.e. 17 patients under Grade 2, 26.66% i.e. 08 patients wereunder Grade 3 and 1 patient i.e. 03.33% under Grade 5. After treatment, 36.66% patientsresponded to Grade 1 i.e. 11 patients, 50% i.e. 15 patients responded to Grade 2 and06.66% i.e. 02 patients each were under Grade 3 and Grade 4. After follow-up, 06.66%i.e. 02 patients were each under Grade 0, Grade 3 and Grade 4, 56.66% i.e. 17 patients(56.66%) were under Grade 1, 07 patients (23.33%) under Grade 2. Fig No26: Showing the Distribution of Patients by Walking time. 18 16 14 Bef Treatment 12 10 Aft Treatment 8 6 4 Aft Follow-up 2 0 Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 1-up to 20 seconds, Grade 2-up to 21-30seconds, Grade 3-up to 31-Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 130 -
  • Observations and Results 40seconds, Grade 4-up to 41-50seconds, Grade 5- up to 51-60seconds.28. Distribution of Patients by Incidence of Pain.Table No 73: Showing Incidence based on Pain (Ruk). Si.No Grade Before treatment After treatment After follow-up of pain No of % No of % No of % Patients Patients Patients 1. Grade 0 00 00.00% 00 00.00% 00 00.00% 2. Grade 1 00 00.00% 07 23.33% 19 63.33% 3. Grade 2 05 16.66% 15 50.00% 07 23.33% 4. Grade 3 15 50.00% 07 23.33% 04 13.33% 5. Grade 4 10 33.33% 01 03.33% 00 00.00% Among 30 patients, before treatment, 16.66% i.e. 05 patients were under Grade 2,50% i.e. 15 patients under Grade 3, 33.33% i.e. 10 patients were under grade 4. Aftertreatment, 23.33% responded to Grade 1 i.e. 07 patients, 50% i.e. 15 patients respondedto Grade 2, 23.33% i.e. 07 patients were under Grade 3, 01 patient i.e.03.33% respondedto Grade 4. After follow-up, 63.33% i.e. 19 patients were under Grade 1, 23.33% i.e. 07patients were under Grade 2, 13.33% i.e. 04 patients were under Grade 3.Fig No 27: Showing Incidence based on Pain (Ruk). 20 18 16 B ef Treatment 14 12 Aft Tre atment 10 8 Aft Follow-up 6 4 2 0 Grade 0 Grade 1 Grad e 2 Grade 3 Grad e 4Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 131 -
  • Observations and Results Grade 0 - No pain, Grade 1 - Trivial pain, Grade 2 - Mild pain, Grade 3 - Moderate pain, Grade 4 - Severe pain29. Distribution of Patients by Incidence of Stambha. Table No74: Showing Incidence based on Stambha. Si.No Grade of No of Patients Percentage Stambha 1. Grade 1 03 10.00% 2. Grade 2 23 76.66% 3. Grade 3 04 13.33% Among 30 patients, 10.00% i.e. 03 patients were under grade 1, 76.66% i.e. 23patients were under grade 2, 13.33% i.e. 04 patients were under grade 4. Fig No 28: Showing Incidence based on Stambha. 25 20 Grade 1 15 Grade 2 10 Grade 3 5 0 Grade 0 - No stiffness, Grade 1- With up to 25% impairment ,Grade 2 - With 25-50% impairment , Grade 3 - With 50-75% impairment, Grade 4 - With more than 75% impairment30. Distribution of Patients by Average Retention of Niruha basti. Table No 75: Showing Average retention of Niruha basti. Si.No Duration in No of Patient % minutes 1. 01 min – 10 min 11 36.66% 2. 11 min – 20 min 14 46.66% 3. 21min – 30min 04 13.33%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 132 -
  • Observations and Results 4. 31min – 40min 00 00.00% 5. 41min – 50min 01 03.33% Among 30 patients, 11 patients were retained the medicine up to 01 to 10 minutesi.e.36.66%, 14 patients were retained the medicine up to 11 to 20 minutes i.e.46.66%, 04patients were retained up to 21 to 30 minutes i.e.13.33%, 01 patient retained up to 41 to50 minutes i.e.03.33%.Fig No 29: Showing Average retention of Niruha basti. 14 12 01-10 min 10 11-20 min 8 21-30 min 6 31-40 min 41-50 min 4 2 031. Distribution of Patients by Average Retention of Anuvasana basti. Table No76: Showing the Average Retention of Anuvasana basti. Si.No Duration in minutes No of Patients % 1. 01 min – 100 min 17 56.66% 2. 101 min – 200 min 01 03.33% 3. 201min – 300min 07 23.33% 4. 301min – 400min 02 06.66% 5. 401min – 500min 01 03.33% 6. 501 min – 600 min 01 03.33% 7. 601 min – 700 min 01 03.33%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 133 -
  • Observations and Results 17 patients were retained the medicine up to 01 to 100 minutes (56.66%), 01 patient (03.33%) retained each 101 to 200 minutes, 401 to 500 minutes, 501 to 600 minutes, 601 to 700 minutes, 07(23.33%) patients retained the medicine up to 201 to 300 minutes, 02 patients (06.66%)were retained up to 301 to 400 minutes. Fig No 30: Showing Average Retention of Anuvasana basti.1816 01-100 min14 101-200 min12 201-300 min10 301-400 min 8 401-500 min 6 4 501-600 min 2 601-700 min 0 32. Distribution of Patients by Anubandha vedana. Table No 77: Showing Distribution of Anubandha vedana Before treatment. Si.No Anubandha vedana Before Treatment Male % Female % 1. Shooting pain 18 60.00% 11 36.66% 2. Tinkling sensation 08 26.66% 05 16.66% 3. Burning sensation 05 16.66% 03 10.00% 4. Cramping sensation 03 10.00% 03 10.00% 5. Dehavakrata 01 03.33% 01 03.33% 6. Suptata 08 26.66% 06 20.00% 7. Tandra 05 16.66% 03 10.00% 8. Gaurava 04 13.33% 01 03.33% 9. Arochaka 05 16.66% 04 13.33% 10. Mukhapraseka 02 06.66% 00 00.00% 11. Bakthadwesha 02 06.66% 01 03.33% 12. Staimithya 00 00.00% 00 00.00% 13. Vahnimandhya 04 13.33% 02 06.66% Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 134 -
  • Observations and Results Table No 78: Showing Distribution of Anubandha vedana After treatment. Si.No Anubandha vedana After Treatment Male % Female % 1. Shooting pain 03 10.00% 03 10.00% 2. Tinkling sensation 01 03.33% 01 03.33% 3. Burning sensation 00 00.00% 01 03.33% 4. Cramping sensation 01 03.33% 01 03.33% 5. Dehavakrata 01 03.33% 01 03.33% 6. Suptata 00 00.00% 00 00.00% 7. Tandra 02 06.66% 04 13.33% 8. Gaurava 01 03.33% 01 03.33% 9. Arochaka 00 00.00% 02 06.66% 10. Mukhapraseka 00 00.00% 00 00.00% 11. Bakthadwesha 00 00.00% 00 00.00% 12. Staimithya 00 00.00% 00 00.00% 13. Vahnimandhya 00 00.00% 02 06.66%Table No79: Showing Distribution of Anubandha vedana After follow up. Si.No Anubandha vedana After the follow up Male % Female % 1. Shooting pain 01 03.33% 01 03.33% 2. Tinkling sensation 00 00.00% 01 03.33% 3. Burning sensation 00 00.00% 01 03.33% 4. Cramping sensation 00 00.00% 00 00.00% 5. Dehavakrata 01 03.33% 01 03.33% 6. Suptata 01 03.33% 00 00.00% 7. Tandra 00 00.00% 03 10.00% 8. Gaurava 00 00.00% 01 03.33% 9. Arochaka 00 00.00% 02 06.66%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 135 -
  • Observations and Results 10. Mukhapraseka 00 00.00% 00 00.00% 11. Bakthadwesha 00 00.00% 00 00.00% 12. Staimithya 00 00.00% 00 00.00% 13. Vahnimandhya 00 00.00% 02 06.66%33. Distribution of Difference in Grade of Oswestry Disability Index. Table No 80: Showing Difference in Grade of Oswestry disability index. Si.No Grading Before Treatment After Treatment No of % No of % Patients Patients 1. Grade 1 00 00.00% 00 00.00% 2. Grade 2 00 00.00% 23 76.66% 3. Grade 3 07 23.33% 06 20.00% 4. Grade 4 18 60.00% 01 03.33% 5. Grade 5 05 16.66% 00 00.00% Among 30 patients, before treatment, 07bpatients had shown Grade 3 i.e.23.33%,18 patients had shown Grade 4 i.e.60%, 05 patients shown Grade 5 i.e.16.66%. Afterfollow up, 23 patients had shown Grade 2 i.e.76.66%, 06 patients had shown Grade 3i.e.20%, 01 patient showed Grade 4 i.e.03.33%.Fig No 31: Showing Difference in Grade of Oswestry Disability Index. 25 20 Before treatment 15 After follow up 10 5 0 Grade Gr ade 2 4Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 136 -
  • Observations and Results Grade 1-0% to20 %( Minimal disability), Grade 2 -21% to 40 %( Moderate disability), Grade 3-41% to 60 %( Severe disability),Grade 4-61% to 80 % ( Crippled disability)Grade 5 -81% to 100 %( Exaggerating symptoms)34. Distribution of Patients by Incidence of Gait. Table No 81: Showing Incidence on Gait. Si.No Grading Before After Treatment After follow-up Treatment No of % No of % No of % Patients Patients Patients 1. Grade 0 28 93.33% 28 93.33% 28 93.33% 2. Grade 1 02 06.66% 02 06.66% 02 06.66%Among 30 patients, 02 patients were observed Grade 1 i.e.06.66%, remaining patients areGrade 0 only i.e.93.33%.Fig No 32: Showing Incidence on Gait. 30 25 20 Grade 0 15 10 Grade 1 5 0 Grade 0 - Normal,Grade1 - Abnormal35. Distribution of Difference in Grading of Visual Analogue Scale.Table No 82: Showing Incidence on Visual analog scale. Si.No Grading Before Treatment After Treatment After follow-up No of % No of % No of % Patients Patients Patients 1. Grade 0 00 00.00% 00 00.00% 00 00.00% 2. Grade 1 00 00.00% 03 10.00% 14 46.66% 3. Grade 2 02 06.66% 21 70.00% 15 50.00%Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 137 -
  • Observations and Results 4. Grade 3 28 93.33% 06 20.00% 01 03.33% Among 30 patients, before treatment, 02 patients were recorded Grade 2i.e.06.66%, 28 patients i.e.93.33% were recorded Grade 3. After treatment, 03 patientswere recorded Grade 1 i.e.10%, 21 patients i.e.70.00% were recorded Grade 2, 06patients had recorded Grade 3 i.e.20%. After follow-up, 14 patients were recorded Grade1 i.e.46.66%, 15 patients i.e.50.00% were recorded Grade 2, 01 patient recorded Grade 3i.e.03.33%.Fig No33: Showing Incidence on Visual analogue scale.3025 Before treatment20 After treatment15 After follow-up1050 Grade 1 Gr ade 2 Grade 3 Grade 0 (No pain)-0cms,Grade 1 (Mild pain)-1-3cms,Grade 2 (Moderate pain)-4-6cms,Grade 3 (Severe pain) -7-10cms36. Distribution of Patients According to Radiological Findings.Table No 83: Distribution of Patients According to Radiological Findings. Si.No Radiological findings No of % Patients 1. Lumbar spondylosis 19 63.33% 2. Osteoporosis 04 13.33% 3. Ankylosingspondylitis 01 03.33% 4. No abnormalities 00 00.00% Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 138 -
  • Observations and Results Amog 30 patients, 19 (63.33%) patients were diagnosd Lumbar spondylosis, 04(13.33%) patients were diagnosed Osteoporosis, 01(03.33%) patient was diagnosedAnkylosing- spondylitiesFigure No 34: Showing Distribution of Patients According to Radiological Findings. 20 15 Spondylosis Osteoporosis 10 Ankylosingspon dylitis 5 037. Distribution of Patients by Overall Effect of Treatment in 30 Patients. Table No 84: Showing Overall Assessment. Treatment effect No. of Patients Percentage Best Responded 03 10% Respondent 27 90% Not Responded 00 00% Among 30 patients, 90 %( 27 patients) showed moderate response and 10% (03Patients) showed best respondence. Fig No 35: Showing Overall Assessment. 30 Best responded 25 20 Responded 15 Not responded 10 5 0Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 139 -
  • Observations and Results Table No 85: Showing Statistical Outcome of the study Before & After Treatment. Mean Net SD SE T- P-value Rem- Parameter BT AT Mean value arksSthambha 2.366 1.433 0.933 0.520 0.095 <0.001* 9.82 HSRuk 3.166 2.033 1.133 0681 0.124 <0.001* 9.13 HSShooting pain 0.966 0.2 0.766 0.430 0.078 12.38 <0.001* HSTingling sensation 0.4 1.433 0.933 0.520 0.095 9.82 <0.001* HSBurning sensation 0.266 0.033 0.233 0.430 0.078 2.98 <0.01 HSSpandana 0.2 0.066 0.133 0.345 0.063 2.11 <0.05 HSDehavakrata 0.033 0.033 0.00 0.00 0.00 - - -Suptata 0.466 0.00 0.466 0.507 0.092 5.06 <0.001* HSGaurava 0.233 0.066 0.166 0.379 0.069 2.40 <0.05 HSArochaka 0.3 0.066 0.233 0.430 0.078 2.98 <0.05 HSMukhapraseka 0.066 0.00 0.068 0.257 0.047 1.44 >0.05 NSBaktadwesha 0.1 0.00 0.1 0.305 0.055 1.18 <0.001* HSStaimitha 0.00 0.00 0.00 0.00 0.00 - - -Vahanimandhya 0.2 0.066 0.133 0.345 0.063 2.11 <0.05 HSTandra 0.266 0.2 0.066 0.253 0.046 1.43 >0.05 NSSLR Active Right 2.133 1.666 0.466 0.571 0.104 4.48 <0.001* HSSLR Active Left 2.1 1.566 0.533 0.571 0.104 5.12 <0.001* HSSLR Passive Right 1.866 1.433 0.433 0.568 0.103 4.20 <0.001* HSSLR Passive Left 1.7 1.3 0.4 0.498 0.090 4.44 <0.001* HSForward Flexion 3.1 2.533 0.566 0.678 0.123 4.60 <0.001* HSRight Lateral 3.7 3.1 0.666 0.606 0.110 6.05 <0.001* HSLeft Lateral 3.5 3.166 0.4 0.498 0.090 4.44 <0.001* HSExtension 1.00 0.733 0.266 0.499 0.082 2.24 <0.05 HSRotation 0.933 0.566 0.366 0.490 0.089 4.11 <0.001* HSKnee jerk Right 0.333 0.3 0.033 0.182 0.033 1.00 >0.05 NSKnee Jerk Left 0.366 0.3 0.066 0.253 0.046 10.86 <0.001* HSAnkle Jerk Right 0.3 0.3 0.00 0.00 0.00 - - -Ankle Jerk Left 0.333 0.3 0.033 0.182 0.033 1.00 >0.05 NSBabinski signRight 0.233 0.233 0.00 0.00 0.00 - - -Babinski sign Left 0.2 0.2 0.00 0.00 0.00 - - -VAS 2.933 2.1 0.833 0.592 0.108 7.71 <0.001* HSGAIT 0.066 0.066 0.00 0.00 0.00 - - -WT 2.433 1.833 0.6 0.563 0.102 5.88 <0.001* HSEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 140 -
  • Observations and Results Table No 86: Showing Statistical Outcome of the study Before Treat & Follow up. Parameter Mean Net SD SE T- P-value Rem- BT AF Mean value arksSthambha 2.366 1.066 0.366 0.490 0.089 4.11 <0.001* HSRuk 3.166 1.5 1.666 0.802 0.146 11.41 <0.001* HSShooting pain 0.966 0.066 0.9 0.305 0.055 16.36 <0.001* HSTinglingsensation 0.4 0.033 0.366 0.490 0.089 4.11 <0.001* HSBurningsensation 0.266 0.033 0.233 0.430 0.078 2.98 <0.05 HSSpandana 0.2 0.00 0.2 0.406 0.074 2.70 <0.01 HSDehavakrata 0.033 0.033 0.00 0.00 0.00 - - -Suptata 0.466 0.033 0.433 0.504 0.092 4.70 <0.01 HSGaurava 0.233 0.033 0.2 0.406 0.074 2.70 <0.01 HSArochaka 0.3 0.066 0.233 0.430 0.078 2.98 <0.01 HSMukhapraseka 0.066 0.00 0.066 0.253 0.046 1.43 >0.05 NSBaktadwesha 0.1 0.00 0.1 0.305 0.055 1.81 >0.05 NSStaimitha 0.00 0.00 0.00 0.00 0.00 - - -Vahanimandhya 0.2 0.066 0.133 0.345 0.063 2.11 <0.01 HSTandra 0.266 0.1 0.166 0.379 0.069 2.40 <0.01 HSSLR Active Right 2.133 1.466 0.2 0.406 0.074 2.70 <0.01 HSSLR Active Left 2.1 1.4 0.166 0.461 0.084 1.97 >0.05 NSSLRPassiveRight 1.866 1.2 0.233 0.430 0.078 2.98 <0.01 HSSLR PassiveLeft 1.7 1.3 0.40 0.262 0.047 8.51 <0.001* HSForwardFlexion 3.1 2.333 0.766 0.727 0.132 5.80 <0.001* HSRight Lateral 3.7 2.933 0.766 0.727 0.132 5.80 <0.001* HSLeft Lateral 3.5 2.933 0.7 0.534 0.097 7.21 <0.001* HSExtension 1.00 0.566 0.433 0.504 0.092 4.70 <0.001* HSRotation 0.933 0.6 0.333 0.479 0.087 3.82 <0.001* HSKnee jerk Right 0.333 0.266 0.066 0.253 0.046 1.43 >0.05 NSKnee Jerk Left 0.366 0.3 0.066 0.253 0.046 1.43 >0.05 NSAnkle Jerk Right 0.3 0.266 0.033 0.182 0.033 1.00 >0.05 NSAnkle Jerk Left 0.333 0.3 0.033 0.182 0.033 1.00 >0.05 NSBabinskisign Rt 0.233 0.266 0.033 0.182 0.033 1.00 >0.05 NSBabinski signLt 0.2 0.233 0.033 0.182 0.033 1.00 >0.05 NSOWI 3.933 2.266 1.666 0.479 0.087 19.14 <0.001* HSVAS 2.933 1.566 1.366 0.614 0.112 11.19 <0.001* HSGAIT 0.066 0.066 0.0 0.0 0.0 - - -WT 2.433 1.5 0.933 0.739 0.135 6.91 <0.001* HSEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 141 -
  • Observations and Results To know on which parameters the efficacy of treatment procedure is moreeffective, the statistical analyses is done by using paired t-test, by assuming that thetreatment procedure is same all the parameters.From the analyses Mukhapraseka, Tandra, Knee jerk right, Ankle jerk left shows nonsignificant before treatment and Afterfollowup, but in all other parameters shows highlysignificant BRx and ATx as P<0.05.The treatment is more effective in during follow up in Ruk and Shooting pain(By comparing t-value).Conclusion: The study shows treatment is more effective in shooting Pain, Ruk,Sthambha, Tingling sensation and Suptata. The further study can be conducted byconsidering chronicity of the disease and profession.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 142 -
  • Discussion Discussion This chapter deals with the analysis of probable cause of the conceptual study,clinical, observations, findings and the results of the study on Gridhrasi disease.Conceptual study:Discussion on Basti Karma - Probable mode of action: Gridhrasi is a common entity encountered in clinical practice. It is one of thevataja nanatmaja vyadhi classified by Charaka. The term Gridhrasi and Sciatica of themodern science can be considered synonymous in as much as they refer to singularsimilar presentation. Basti is mainly indicated in vata prominent diseases. The two kindsof abnormalities (Dhatukshaya and Margavarodha) of vata can be treated by bastikarma.Direct application of this kind of treatment to Pakwasaya helps not only regulating andco-ordinating the vatadosha in its site, but controls other doshas involved in pathogenisisof the disease. Hence it is considered as Ardha chikitsa.293 In the clinical trial, selecting the basti procedure and its role in Ghridrasi chikitsais stated and discussed in objective chapter.Discussion on Preparation of Dwipanchamuladi Mamsarasa Basti:Table No 87: Showing the Ingredients of Dwipanchamuladi Mamsarasa Basti. SI No Material Quantity 01 Makshika 96 ml 02 Lavana 12 gms 03 Sneha Murchita Taila 96 ml Murchita Ghrita 96 ml Vasa 96 ml 04 Kalka 30 gms 05 Dashamuladi Kwata 336 ml 06 Avapa Dravya Mamsarasa 336 ml Kanjika 96 mlEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 143 -
  • Discussion The mixing of the basti dravya was carried out according to the classics. The finepower of 12 gms saindava lavana was mixed with 96 ml of makshika in a khalvayantratill got a clear mixture. Later 96 ml of each murchita taila, murchita ghrita and vasa weremixed slowly one by one after making it slightly heating. After getting a homogeneousmixture of these, 360ml of sukoshna kashaya was added and mixed properly. The 336 mlof prepared mamsarasa and 96 ml of kanjika were added slowly. These are then mixedproperly till homogeneous mixture was formed. The makshika, snehadravyas and kanjika were taken in the quantity of oneprasrutha (96ml) each. The dashamula kashaya and mamsarasa were taken in equalquantity i.e. 336ml each as explained by Acharya Cakrapani.294Discussion on Using Ajamamsa Rasa in Niruha basti in Gridhrasi: The fresh Ajamamsa was used to prepare the msarasa. The preparation was doneas explained in Ayurveda shabdha kosha. The Ajamamsa is having the quality equal toshareera dhatu,295 bhrimana, balakara, pushtikara296 and also tridoshahara especiallyVatahara.297 Goats store their fat under their skin and around their organs. They do not storetheir fat in their muscle, therefore there is far less fat than other red meats. Even the fatthey do have is mostly polyunsaturated (the healthier type of fat compared to saturatedfat). Goat meat is high in Protein and Iron. In 3oz cooked goat meat contains Calories122, Fat 2.58 (g), Saturated Fat 0.79(g), Protein 23 (g) and Iron3.2 (mg). This supportsthe Ayurvedic view of nourishment and which may help in the degeneration ofdegenerated tissues.298Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 144 -
  • Discussion As Gridhrasi is a vatavyadhi it requires the drugs which are brumhana, balakara,dhatu poshaka etc. Here in this basti combination, the mamsa rasa which is used in largequantity will serve this purpose. It may help in proper dhatuposhana that intern may helpin production and nourishment of Uttarottara dhatu’s like asti, majja etc. In Gridrasi main dushya involved are sira and snayu, where snayu is upadhatu ofmeda. This may get nourished with mamsarasa which is used in the form of avapadravya. The vatahara property of mamsarasa may helps in the samprapti vighatana ofGradhrasi. Muscle weakness is commonly seen in Sciatica and which may be compensatedwith the supplement of the nutrition’s in the form of mamsarasa and it may directly helpin the nourishment and strengthening of muscles as explained in classics “Mamsamamsena Vardhate” The degeneration of the lumbar disk is the common cause for the Sciatica. Theproper nourishment for the regeneration may help in ceasing of disease pathology andfurther detoriation of the condition. This may be expected from the administration ofmamsarasa.Discussion on Poorva Karma:A. Abhyanga: Balataila is mentioned by Gadanigraha used for Anuvasana basti andAbhyanga. Gridhrasi vatadosha is main cause for samprapti, for samprapti vighatanavatasamaka drugs are necessary, In this combination Bala is the main drug, it willincrease strength and mitigates vatadosha.299 Ksheera also act as rasayana, jeevaneeyaand balya.300 Taila is having the properties like brihmana, preenana, sodhana and tila tailais considered as best among tailas.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 145 -
  • DiscussionMode of action Abhyanga: The Abhyanga is acting over the skin, which is a seat ofvata. The skin is not only a seat of vata but also for lasika (lymph). Thus the lymphaticdrainage will be the prime effect of Abhyanga. Lymph possesses a relatively largeamount of the amino acid tryptophan, especially when compared with the dietary intake.It likewise has a large amount of albumin (protein), glucose and histaminase (breaksdown histamine). Hypothetically, blood aminoacids like tryptophan increase aftermassage. An increase in plasma tryptophan subsequently causes a parallel increase in theneurotransmitter (chemical between nerve endings) at motor end plates, and serotonin,which is made from tryptophan. Serotonin has been implicated in several phychiatricdiseases with low levels of metabolite found by researchers in depression andschizophrenia. Giving albumin bound protein tryptophan to the brain with proper diet andmassage should theoretically increase brain serotonin. In practice the abhyanga relievessystems like those caused by serotonin depletion, anxiety, irritability, etc. The main objective of Abhyanga is creating softness in the external skin andsmoothing of internal viscera and tissues. When softness is induced in skin, the skinbecomes lustrous, attains complexion and colour. More over an oily or unctuous skin isgoing to prevent the body from exposure of heat and dust. Ayurveda explains the actionof Abhyanga as Brimhana, Sodhana and Shamana.301B.Swedana: Charaka included swedana karma in shadupakramas.302 Sweda relivesstambha, gaurava, seeta, and induce sweda.303 Swedana karma represents the therapy bywhich a person is made to sweat. It is not recommended in excitement of pitta dosha andit removes vata and kaphadosha.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 146 -
  • Discussion Nadisweda is the unique form of swedana procedure, where the perspiration isinduced by passing stream over the body parts by using special instrument. Herbs(Dasamula) added with water are boiled in this instrument to generate the stream.Mode of action Swedana: Thermal therapy increases the circulation and local metabolicprocess with relaxation of the musculature. Application of heat causes relaxation ofmuscles and tendons improves the blood supply and activates the local metabolicprocesses which are responsible for the relief of pain and stiffness.Discussion on Basti Procedure:Anuvasanabasti: Balataila is used for Anuvasana basti, ingredients are vatasamaka andhaving Rasayana properties. Gridhrasi is mainly dhatukshaya janya vatavyadhi, by usingbalataila it may over come the symptoms which are present in Gridhrasi.Niruhabasti: Basti dravya enters into the Pakwasaya, where the water and minerals areabsorbed in proximal colon. Sodium and potassium which are essential fundamentalfactors of the body, it is prove that bio availability of a drug is more in rectal rout. Honeyas an ingredient in basti dravya which contains Sucrose and lot of enzymes.Saindhava contains Sodium Chloride and other ions which help in generating the actionpotential. Honey has also got ambiphillic (Lipophilic and Hydrophillic) action. Salt(saindhava) helps in electrolyte exchange. The emulsifying nature of the solution has gota cleansing healing effect. Kalka which has got irritant properties along with other ingredients may inducecolonic distension. This distension stimulates pressure which produces evacuatory reflex.The bastidravya gets absorbed by intestinal microflora their by it maintains the electrolyteEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 147 -
  • Discussionbalance in the body. It enhances the biodegradability of the drugs and it increases theabsorption of colon. Basti is having two actions, expelling the doshas and nourishing the body. First,potency of the bastidravya gets absorbed to have its systemic action. Second major actionis related with the facilitation of excretion of morbid doshas responsible for the vyadhisprocess into the colon from where they are evacuated.Discussion on Disease Gridhrasi vis-À-vis Sciatica: Clinical condition entity which isdescribed in modern medical science, has a striking resumbalance to the symptomatologyof Gridhrasi. Sciatica has varied origin, but the commonest cause is the degenerativechanges in the lumbar vetebrae. When we look into the shareera, the parts which areaffected in Gridhrasi disease are kati, prishta pradesha, kandaras of parshini, angulis,kukundara marma, katikatarana marma and nitamba marma. While discussing on modernaspect, the Anatomical structures which are affected in Gridhrasi disease are Lumbarvertebrae, Intervertebral joints, Lumbo-scral pexus and Sciatic nerves. The swaprakopaka nidana, Margavarodhaka nidana, Marmabhighata nidana andDhatukshaya janya nidana are responsible for Gridhrasi disease. The Dhatukshaya meansAstidhatukshaya i.e. degenerative changes in Lumbar vertebrae. The degenerative changeof the lumber vertebrae causes spondylolistuesis, Lumbar spondylosis, etc. These leads tocompression of Sciatic nerve, there by producing the pain along the course of sciaticnerve. In Sciatica the pain in leg is always associated with lumbar pain, hence it has beentermed as Lumbago Sciatica Syndrome. The Straight Let Raising (SLR) test is a good objective parameter to diagnose theGridhrasi disease in Western medicine. Some of the authorities of Ayurveda mentionedEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 148 -
  • Discussionthat Kshepana and Utkshepana are for salient features of Gridhrasi disease. TheseKshepana and Utkshepana symptoms can be attributed to Straight Leg Raising test ofmodern medicine.Discussion on X-ray studies: By considering the common pathological conditions ofsciatica like Lumbar disc herniation, Degenerative disc disease, Lumbar spinal stenosis,Isthmic spondylolisthesis, Lumbar spondylosis, Osteoporosis, Sacralization, Ankylosingspondylitis, Spinal infections, Spinal tuberculosis, Spinal injuries, Referred pain fromvisceral disease, Gynecologic and urologic disease and tumors of vertebral column- MRIstudies and X-ray studies helps for the differential diagnosis of the sciatica. In my clinicaltrial, for differential diagnosis purpose and for the diagnosis purpose only, X-ray study istaken for the selected patients. It reveals that among 30 patients, 19(63.33%) patientsradiological reports shows degenerative changes (Lumbar Spondylosis), 0(03.33%)patients findings shows Ankylosing spondylosis, 04(13.33%) patients showedOsteo Porosis, 06(20%) Showed no abnormalities. Due to limitations of present clinicalstudy and study duration, X-ray study is not done after the treatment and follows up inthe sense that smaller sample and shortest study duration may not reveal actual changesof degenerative changes.Discussion on Clinical Study: A total 30 patients suffering from Gridhrasi fulfilling theinclusion criteria were studied. The observations and the results as well as statisticalanalysis of these are mentioned below.• Number of patients registered in study - 33• Number of patients completed the study - 30• Number of dropout - 03Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 149 -
  • DiscussionDiscussion on Observations (Demographic Data): Age- Out of 30 patients of Gridhrasi, maximum of 15 patients (50.00%) were belonged to the age group of 31-40 years, and this is the age group supporting the high incidence because of their increased stressful and strained work schedules. Sex- Among the 30 patients of this study 18patients (60%) were males may be because of their involvement in works which are more prone to pathogenesis of the Gridhrasi. Religion- Among 30 patients of this study, maximum 28 patients (93.33%) of patients were belonged to Hindus, 2 Patients (06.66%) from Muslim community. This shows geographical predominance of Hindus in and around GADAG area. Socio-economic status- Maximum of 16 patients (53.33%) belongs to poor class, 14 patients (46.66%) from middle class. During my clinical study, due to randomized selection of patients got more poor class patients. Occupation- Maximum of 11 patients (36.66%) was labour, 10 patients (33.33%) having active lifestyle, 9 patients (30%) were sedentary. Because of the hard work, lifting heavy things and working for long hours in fields, labour class is more affected. Chronicity of the disease- Maximum of 17 patients (56.66%) having chronicity of disease below 1year, followed by 6 patients (20.00%) were 2 to 4 years, 3 patients (10.00%) were each in 1 to 2 year and above 6 years, 1patient (03.33%) had disease chronicity between 4 to 5 years. The variation in percentage of diseased patients selected may be due to random selection of patients for clinicalEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 150 -
  • Discussion trial and may the health awareness of patients who had the disease with crippling pain made them to come under trial below one year of history. Addiction- Maximum of 16 patients (53.33%) had no addiction, 12 patients (40.00%) had addiction to tobacco, and 4 patients (13.33%) had addiction to alcohol. In my clinical study, no significant influence of this factor of addiction attributed to cause Gridhrasi is found. Diet- In this study 22 patients (73.33%) were of vegetarian diet. Remaining 8 patients (26.66%) were mixed. Consumption of ruksha, katu, sheeta etc.food materials like dried Jowar rotis; Mandaki preparations in the vegetarian group may be prone to the disease Gridhrasi. Koshta- Maximum of 23 patients (76.66 %) were belongs to Madhyama koshta, 2 patients (06.66%) were belongs to Krura koshta, and 5 patients (16.66%) were belonging to Mrudu koshta. Agni - Maximum of 19 patients (63.33 %) had Samagni, 9 patients (30.00%) had Mandagni and remaining 2 patients (06.66%) were of Vishamagni. The level of agni plays a major role in samprapti of the disease as the mandagni causes the improper digestion of food ingested leads to Vatakaphaja Gridhrasi. Vihara - 28 patients (93.33%) had the experience in traveling in bike, cycle and other vehicles. 30patients (100%)had the experience in difficult activities. 22 patients had the experience of excessive exercise (73.33%), 14 (46.66%) were having the habit of day sleep. 11 patients(36.66) had experience of Marmagatha nidana. This revels that the traveling in two-wheeler and other activities whichEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 151 -
  • Discussion will give more strain may lead to intervertebral space narrowing in lumbar region will lead to Sciatica.Effect of the Therapy: Observation of Abhyanga and Nadisweda: The patients were carefully observed and examined before administering the abhyanaga and nadisweda. Abhyanga was done on each patient with Bala taila(Lumbar region ,Abdomen, Lower limbs). Nadisweda also done where the massage was given. After completion of Abhyanga, Nadisweda, patients got good relief from cardinal symptoms. In some of the cases it reappeared after the treatment. During the rest day patients were advised to take vatahara aharas and advised to maintain the viharas which will not increase vatadosha. Observation of Basti Karma: On the day of basti, in the morning between 8 to 8.30 AM Bastikarma was performed. For Anuvasana Bala taila 100 ml used and Niruha basti around 1150 ml of Dwipanchamuladi mamsarasa basti preparation were used. Vital data like B.P, Pulse, and Respiratory rate was noted before the treatment and after the treatment. Retention of Niruha Basti Dravya: In the present study, after administration of Bastikarma the maximum 14 patients (46.66 %) were retained up to11 to 20 minute and minimum 1 patient (03.33%) was retained up to 41 to 50 minute. In this factor, calculation of retention of niruha basti dravya after administration makes a vital role in deciding the samyak basti lakshanas. In my clinical study, observation made that retention time of niruha basti dravya varies from 11 to 20 minutes in 14 patients and pratyagmana of the niruha basti dravya along withEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 152 -
  • Discussion morbid doshas in fecal matter suggesting that procedure and effect of the basti karma is having influence over the response of treatment. Retention of Anuvasana basti dravya: After administration of Anuvasana basti, the maximum 17 patients (56.66%) were retained up to1 to 100 minute and minimum 1 patient (03.33%) was retained up to 601 to 700 minute. In my clinical study, observation made that 17 patients retained the anuvasana basti dravya upto 100 minutes without complications suggesting that observed samyak anuvasita lakshanas, procedural effect of basti over the response of the treatment indicates Vatasamana in Yoga basti karma.Discussion on Effect of Treatment on Clinical Symptoms: Cardinal symptoms Stambha-In my clinical study observation made that Grade 1 of 01 patient (3.33%), Grade 2 of 18 patients (60%), Grade 3 of 10 patients (33.33%), and Grade 4 of 01 patient (3.33%) has got the response of the treatment and after follow up shows Grade 01 of 20 patients (66.66%) and Grade 2 of 06 patients (20%) and Grade 0 of 04 patients(13.33%) indicate the response of treatment over the symptom. Ruk-Pain is one of the cardinal symptom in Gridhrasi. After follow up 19 patients were shown Grade 1(63.33%), 07 patients were shown Grade 2(23.33%), and 04 patients were shown Grade 3(13.33%).Before the treatment it was, 05 patient were in the position of Grade 2(16.66%), 15 patients had Grade 3(50.00%) and 10 patients were on Grade 4(33.33%). Before the treatment the intencity of the pain was Grade 2, Grade3, Grade 4, intencity of the pain wasEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 153 -
  • Discussion reduced up to Grade 1(19 patients) , Grade 2(1 patent), 11 patients shifted to lower Grade from Grade 3 and no one showed Grade 4 after the follow up(10 patients has got relief and shifted to lower grades). Anubandha vedana Shooting pain- Before the treatment 29 patients (96.66%) were having the symptom and after follow up only 02 patients reported the symptom (06.89%). After the follow up 27 patients (93.10%) got complete relief from shooting pain. The results show the effect of the study in Gridhrasi. Tingling sensation- Before the treatment 12 patients (40%) were having the symptom and after follow up only 01(08.33%) patient reported the symptom.11 patents(91.66%) not showed tingling sensation after the follow up. Hence the treatment is having effect over tiling sensation. Burning sensation- Before the treatment 08 patients (26.66%) were having the symptom and after follow up only 01 patient (12.5%) reported burning sensation in leg, 07 patients (87.5%) got relief completely from burning sensation. Spandana- Before the treatment 06 patients (20.00%) were having the symptom and after follow up no one reported pulsating pain. Dehavakrata- 02 patients were shown same grade (Grade1) in before and after the follow up (06.66%). The treatment having not much effect over the symptom Dehavakrata but slight improvement is observed after the follow up. Suptata- Noticed 14 patients (46.66%) before the treatment, 01 patient (07.14%) was recorded after the follow up.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 154 -
  • Discussion Tandra- The symptom was found in 08 patients (26.66%) patients before the treatment, 05 patients (62.5%) were reduced after the follow up. Gaurava- 05 patients (16.66%) were suffered from Gaurava before the treatment, after the follow-up it was 01 patient (20%). Arochaka- 09 patients (30%) had the symptom before the treatment, 07 patients (77.17%) of the symptom was reduced after the follow up. Mukhapraseka- 02 patients (06.66%) patients were suffered from Mukhapraseka, the symptom was not recorded after the treatment. Bhaktadwesha- Among 30 patients 03 patients (10%) showed the symptom, and then it came down after the treatment (00.00%). Vahnimandhya: Before treatment 06 patients (20%) of the suffered from Vahnimandhya, after the follow-up it was 02 patients (33.33%). By observing the above factors and associated symptoms after follow up, the effect ofthe given therapy shows complete relief in Mukhapraseka, Spandana and Bhaktadwesha.Good response observed in Shooting pain, Tingling sensation, Burning sensation in legs,Suptata and Gaurava. Moderate response seen in Tandra, Arochaka and Vahnimandya.No Response of treatment seen in Dehavakrata factor.Discussion on Effect of Treatment on Clinical Parameters:Straight leg raising test : Right Leg - There is no negative sign of SLR in right leg, but the Grade of movement is increased. Before the treatment Grade 02 was more i.e.14 patients (46.66%) and after follow up 08 patients (26.66%), 08 patients in Grade 1 (26.66%), Grade 3 and Grade 4 showed the same i.e. 04 patients (13.33%) in eachEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 155 -
  • Discussion Grade. After the follow up 19 patients were under Grade 1(63.33%), 08 patients were under Grade 2(26.66%), 03 patients in Grade 3 (10.00%). From the observed data, 4 patients of grade 4 improved to grade 0, 4 patients of grade 3 improved to 3, 14 patients of grade 2 improved to 08, 8 patients of rade1 improved to 19. The mean percentage improvement in this parameter is 22.17 % and statistically significant at level of P= <0.001. Left Leg - In left leg, before the treatment, 16 patients were in Grade 2(53.33%), 07 patients in Grade 3(23.33%), 06 patients showed Grade 1(20%) and 01 patient in Grade 4(03.33%). After the follow up 16 patients were shifted to Grade 1(53.33%), 10 patients were in Grade 2(33.33%), 02 patients were each in Grade 0 and Grade 2(06.66%). 02 patients shown Grade 0(Negative sign), 28 patients improved the range of movements and Grade 4 is completely absent after the follow up. Mean percentage improvement in left leg is 25.71% corresponding p- value <0.001 is highly significant.Movement of Lumbar Spine : Forward flexion - Out of 30 patients, before treatment, 10 patients (33.33%) were fall under Grade 5, 5 patients were each showed Grade 1 and Grade 2(16.66%), 08 patients were showed the Grade 3(26.66%), 01 patient each on Grade 0 and Grade 4(03.33%). After follow up, 07 patients were each showed Grade 1 and Grade 2 (23.33%), 06 patients were fall under Grade 5 (20%), 04 patients were in Grade 4(13.33%) and 05 patients were in Grade 0 (16.66%). After the follow up 05 patients (16.66%) showed maximum relief (Grade 0) andEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 156 -
  • Discussion other patients are shifted lower Grades. Mean percentage improvement of flexion is 18.38 % corresponding P-value <0.001 and statistically significant. Right lateral flexion - Among 30 patients, before treatment, 10 patients were fall under Grade 4 (33.33%), 09 patients were fall under Grade 5 (30%), 06 patients were in Grade 3 (20%), 03 patients were fall under Grade 2 (10%) and 02 patients were in Grade 1(06.66%). After follow up, 10 patients were showed Grade 3 (33.33%), 08 patients were fall under Grade 4(26.66%), 07 patients were in Grade 2 (23.33%), 03 patients were in Grade 5 (10%) and 02 patients were on Grade 0 (06.66%). After the follow up 02 patients showed maximum relief (Grade 0), before it was 0 and other patients increased the movement. The mean percentage of right lateral flexion is17.14% corresponding P-value <0.001 and it is highly significant. Left lateral flexion - Among 30 patients, before treatment, 09 patients were each showed Grade 3 and Grade 4 (30%), 07 patients were fall under Grade 5 (23.33%), 03 patients were fall under Grade 1 (10%) and 02 patients were under Grade 2 (06.66%). After the follow up, 09 patients were fall under Grade 03 (30%), 08 patients were in Grade 4 (26.66%), 07 patients were showed Grade 2 (23.33%), 03 patients were each fall under Grade 0 and Grade 5 (10%). After the follow up 03 patients showed maximum relief (Grade 0), before nobody was recorded Grade 0. Left lateral flexion is 09.54% and it is statistically highly significant at level of P-value<0.001 Extension - Before the treatment complete extension was observed in only 01 patient (03.33%) and after the follow up 13 more patients they are able to extentEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 157 -
  • Discussion (43.33%) i.e. 12 patients from Grade 1and 2 shifted to Grade 0 and Grade 2 was absent after the follow up. The mean percentage is 26.7%, this is significant at the level of P-value <0.005. Rotation - Before the treatment complete rotation observed in only 02 patients (06.66%)and after the follow up 10 more patients they are able to rotate the lumbar region (12 Patients, i.e. 40.00%) i.e10 patients from Grade 1 shifted to Grade 0 .Grade 2 was absent before the treatment and after the follow up. Mean percentage is 39.33%, this is statistically highly significant at the level of P-value <0.001. Reflexes: Knee jerk (Right leg) the mean percentage is 30%, this is not significant at the level of P-value >0.05. The mean percentage of left leg is 18.03 %, it is highly significant at the level of P-value <0.001. The mean percentage of Ankle jerk left leg is 09.09 %, this is not significant at the level of P-value >0.05. There is no statistical response in Right ankle jerk, Babinski’s sign.Visual Analogue Scale: Before the treatment the intensity of pain marked by 28 patients (93.33%) were in Grade 03 and 02 patients (06.66%) were in Grade 02. After the follow up, it is observed that 01 patient (03.33%) marked to Grade 3, Grade 2 marked 15 patients (50%) and Grade 01 reported 14 patients (46.66%). The mean percentage of improvement in 30 patients is 28.40%, which indicates that the given treatment bastikarma showed considerable effect on reducing the pain in all theEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 158 -
  • Discussion patients of Gridhrasi in this study and statistically significant at level of P-value <0.001.Walking time: Before treatment, 17 patients were under Grade 2 (56.66%), 08 patients were under Grade 3 (26.66%), 02 patients were each under Grade 4 and Grade 1 (06.66%). After the follow up, it is reported that 17 patients under Grade 1(56.66%), 07 patients under Grade 2 (23.33%), 02 patients were each under Grade 3 and Grade 4 and Grade 0. 02 patients showed the maximum time reduction in walking time. Thus a reduction of walking time indicates the improvement. The parameter shows 24.66% mean improvement and it is statistically significant at level of P -value<0.001.Oswestry Disability Index : Before the treatment there were 07 patients (23.33%) in Grade 3, 18 patients(60%) in Grade 4, 05 patients(16.66%) were in Grade 5. Before the treatment Grade 1 and Grade 2 was absent and after the follow up 23 patients (76.66%) were in Grade 02, remaining 07 patients (23.33%) in Grade 3 and Grade 4 and Grade 5 was absent after the follow up. It is statistically highly significant P -value<0.001.Discussion on Over All Assessment of Treatment: After observing the above clinical parameters, the effect of the therapy has beengraded in to three, they are Best responded, Responded and Not responded. From theclinical data, total 03 (10%) patients were best responded and 27 (90%) patients wereresponded to the given treatment.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 159 -
  • Conclusion Conclusion At the end of the study, following conclusions can be drawn on the basis ofobservations made, results achieved and thorough discussions in the present context. Gridhrasi occurs due to provoked vata and seated in the kandaras of the lower extremities. Impairment of Utkshepanadi karma is the main features along with ruk, sthabdatha, and toda etc. The symptamatology of Gridhrasi explained in the classics are having the resemblance to the symptomatology of Sciatica explained in contemporary science. The main cause of Sciatica, degenerative changes in the lumbar vertebrae can be compared with the Dhatukshayaja nidana of Gridhrasi. Observation: Maximum of 11 (36.66%) patients are belongs to Labor Group Maximum of 15 (50%) patients are belongs to age group 31-40 years. Maximum of 12 (40%) patients showed the involvement of Left leg. Maximum of 26 (86.66%) patients were had standing position at work. Maximum of 17 (56.66%) patients had chronicity below 1 year. Results: In this study 01 patient (3.33%), in average retained Niruha basti for maximum time of 41-50. Maximum of 14 (46.66%) patients were retained bastidravya for 11-20 minutes.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 160 -
  • Conclusion In Anuvasana basti, 1 patient (03.33%) was retained up to 601 to 700 minute, where as maximum of 17 patients (56.66%) were retained up to1 to 100 minutes. There is a significant reduction in Stambha (55.55%) and in Ruk (52.63%) were observed. Associated symptoms of Gridhrasi reduced significantly. In overall assessment of the study, 3 patients (10%) shown Best response and 27 patients (90%) shown response to the treatment. Dwipanchamuladi mamsarasa basti is an effective treatment in the management of Gridhrasi and it shows long lasting result. In the classics it is mentioned that this is the ideal basti for vata. This basti gives good result in vataja Gridhrasi, and it is found effective in managing the chief and associated complaints except shosha and gait. Complications seldom occurr during and after the course of bastikarma. Limitations of the study: The sample size was small. The period of study was limited. Longer follow up was not done. Clinical parameters were not considered up to date. Study has been conducted in Yogabasti sankhya and facts revealed in the studysuggest that, the results will be more encouraging if the Dwipanchamuladi mamsarasabasti is administered in the of Kalabasti or Karmabasti patern.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 161 -
  • Conclusion Scope for the Further Study:The following recommendations are made on the basis of observation and conclusion forthe further studies as well as overcome limitations of the study. Same study can be repeated by taking larger samples. The effect of the Dwipanchamuladi mamsarasa basti can be studied in the patern of Kalabasti or Karmabasti. Same study can be taken with the help of Radiologist to know the effect of treatment over degenerated changes in sciatica with particular intra vertebral narrowing and compression of sciatic nerve.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 162 -
  • Summary Summary The thesis entitled “Effect of Dwipanchamuladi mamsarasa basti inGridhrast” consists of seven parts.• Introduction• Objectives• Review of Literature• Methodology• Observation and Results• Discussion• Conclusion and summaryIntroduction: This part consists of the general description of health and prelavance ofSciatica. In this part, discussion on Gridhrasi is covered briefly and selection ofbastikarma for this study is discussed. This part is also consists of discussion aboutlacuna in current knowledge and proposed or formulated Hypothesis of this study isdiscussed briefly.Objectives: This part consists of brief description of types of life style which causesGridhrasi, before the put frothing the objectives. After considering the clinicalparameters, two objectives were discussed.Review of Literature: Conceptual study of Gridhrasi deals with the the historical aspectsrelated to bastikarma and bheda, matra, yogya, ayogya, vyapath etc are mentioned.Explaind about nidana, paribasha, vyutpatti, of Gridhrasi and also rupa, poorvarupa,samprapti, upasaya, pathya, apathya, sadhya, asadhya, vyavachedaka nidana andhighlighted drugs which are used for my clinical trial. Basti karma was studied asEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 163 -
  • Summaryprocedure, observation during procedure and briefly discussed about a review on currentphysiology.Methodology: The materials and methods adapted for the study are described here.This chapter deals with the• Protocol of the study Vs objective of the study.• Inclusion and exclusion criteria for the patients.• Method of administration of Bastikarma.• Intervention and criteria of assessment.Observations and Results:The observation made on demographic incidence of age, sex, habits etc are presented inthe form of tables and graphs. The results of the clinical study are presented with mastercharts and statistical analysis in the form of tables with brief narrations.Discussion: The conceptual part of bastikarma and its effect on Gridhrasi are explained.Clinical data is discussed in detail. The result obtained in clinical study, as well asobservations in it are discussed with relevant arguments.Conclusion and Summary: The conclusion of whole clinical study and bastikarma areexplained in this chapter. Limitation of study and further scope for studyis also discussedbriefly. In summary, summarized the whole thesis.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 164 -
  • Bibliography Bibilography 1. Journal of Orthopaedics-www.jortho.org. 25/09/09 2. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter20th, shloka no.11, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.113. 3. (a) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sutrasthana, chapter33rd, Shloka no 4, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.144. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadhatta) chapter8th, shloka no.30, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.497. 4. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.56, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. (b) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter1st, Shloka no 74, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.268. 5. B.D.Chaurasia edited, Human Anatomy, Chapter-7th, Third edition-reprint 2000, Pub: Sathish Kumar Jain for CBS Publishers and Distributors, New Delhi, Page no.75. 6. www.bakersfieldtrackclub.com.17/08/09 7. http://herkules.oulu.fi/isbn9514264800/, 18/10/2007. 8. Prof P.V.Tewari edited, Kasyapa Samhita, Khilastana, Chapter 8 th, Shloka no. 4 & 5, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no .524. 9. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter16th, shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.97. (b) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrhrasthana, chapter15th, shloka no.22, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.96. 10. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter19th, shloka no.86, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.285 . (b)Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Sutrasthana, Chapter36th, shloka no.3, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.245 .Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 165 -
  • Bibliography 11. (a) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no.27, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.527 (b) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter7th, shloka no.64, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.712 12. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter20th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.114. 13. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no.24 & 25, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.527. 14. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no.24 to 27, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.527. 15. Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Siddhisthana, chapter 4th, shloka no.24, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.699. 16. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter 6th, shloka no.167, Ninnth edition and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.120. 17. Sri Brahma sankara Misra edited, Bhavaprakasha Nighandu, 1st part, Mamsa varga, shloka no. 73-75, 11th edition 2004, Pub: Chukamba publications, Varanasi, Page no.715. 18. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter 16th, shloka no.11, Ninnth editio and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no. 245. 19. Pandit Sri Brahma sankara Misra edited, Bhava Prakasha, Madyama Khanda, Part 2 , Sandhana varga, chapter 21st, shloka no.2 , Fifth edition 1988,Pub: Chukamba Sanskrit sansthan,Varanasi, Page no. 683. 20. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited Astanga Hrudaya, sutrasthana, (Arunadhatta) chapter1st, shloka no.14, Ninth edition and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.10.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 166 -
  • Bibliography 21. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 229, shloka 63. Second edition, Pub:Varanasi Sanskrita University, Varanasi, Page no. 335. 22. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 279, shloka 63, Second edition, Pub: Varanasi Sanskrita University, Varanasi , Page no. 412. 23. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 289, shloka 14, Second edition, Pub:Varanasi Sanskrita University, Varanasi Page no. 428. 24. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.56 &101, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619 & 621. 25. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 8th to 10th, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.678 to 726. 26. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter 35 to 38th, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.525 to 548. 27. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Sutrasthana, Chapter28th, First edition and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.212 to 222. 28. Dr.Shivaprasad Sharma edited, Astanga Samgraha, Kalpasthana, Chapter 4 to 7th, First edition and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.596 to 616. 29. Pt.Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Sutrasthana, chapter 19th, Ninth edition and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.270 to 286. 30. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Kalpasthana, chapter 4th&5 th,Ninth edition, and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.753 to 769. 31. Prof.K.R.Srikanta Murthy edited, Sarangadhara Samhita, Uttara kandha, chapter 5 to 7th, Fourth edition, Print 2001, Pub: Choukambha Orientalia, Page no.209 to 222. 32. Pandit Sri Brahma Sankara Mishra edited, Bhava prakasha, Poorva Khanda, Sandhana varga, chapter 5th , shloka no.2, Fifth edition 1988, Pub:Chukamba Sanskrit Sansthan Page no.683Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 167 -
  • Bibliography 33. Prof P.V.Tewari edited, Kasyapa Samhita, Siddhisthana, Chapter 1 & 2, 5 to 8 th, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no .257 to 273, 295 to 316. 34. Prof P.V.Tewari, edited, Kasyapa Samhita, Khilastana, Chapter 7 & 8th, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no .510 to 541. 35. Prof. Priya Vart Sharma edited, Bhela Samhita, Siddhisthana, Chapter 5 to 8th , Reprint 2005, Pub : Chaukambha Viswabharati, Varanasi, Page no.542 to 576. 36. Prof.Priya Vart Sharma, edited, Chakradatta, chapter 72 & 73rd, Second edition 1998, Pub:Chaukhamba Orientalia, Varanasi, Page no.619 to 620. 37. Dr.Nirmal Saxena edited, Vangasena Samhita, chapter no 83rd, First.edition 2004, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.1145-1170. 38. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter 19th, shloka no.11, Ninnth edition and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.273. 39. Prof.K.R.Srikanta Murthy edited, Sarangadhara Samhita, Uttara Kandha, chapter 5th, shloka no1, Fourth edition, Print 2001, Pub: Choukambha Orientalia, Page no.209. 40. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Sutrasthana,(Indu) Chapter28th, shloka no.2, First edition and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.212. 41. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 1st, shloka no.40, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.684. 42. Amarasimha, Amarakosha , Pt. Viswanatha Jha edited, pub: Motilal banarasi das, Delhi 1976, Page no.452. 43. Raja Radha Kantha Deva Bahadur edited, Shabda Kalpa Druma, Vol.2, 3rd edition, Pub : Choukambha Sanskrit Series, Page no.348 -349. 44. Williams Monier Sir ,Sanskrit English Dictionary ,cognate Indo-Europian Languages, New delhi, Pub:Mothilal Banarasi Das 1970. Page no.361 45. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, (Chakrapani), chapter19th, shloka no.7, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.110.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 168 -
  • Bibliography 46. Raja Radha Kantha Deva Bahadur edited, Shabda Kalpa Druma, Vol.4, 3rd edition, Pub: Choukambha Sanskrit Series, Page no.255. 47. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, (Dhalhana) Nidanasthana, chapter 1st, Shloka no.74, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.268. 48. Adhamalla, Goodartha deepika, Sarangadhara Samhita, Purva khanda, Chapter 7th shloka no.108, 3rd edition 1983, Pub: Choukambha Oriantalia, Varanasi, Page no.103. 49. Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Chikitsasthana, chapter 28th, shloka no.56, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 50. (a) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter1st, Shloka no 74, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.268. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadhatta) chapter 15th, shloka no.54, Ninenth edition, and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.535. 51. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions). Kottakkal: Aryavaidyasala Seminar publications; 1988. Page no.7. 52. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions). Kottakkal: Aryavaidyasala Seminar publications; 1988. Page no. 7. 53. Purushothamacharyulu G Dr, Gridhrasi (Sciatica and associated conditions). Kottakkal: Aryavaidyasala Seminar publications; 1988. Page no. 8. 54. Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Sutrasthana, chapter 20th, shloka no.11, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.113. 55. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter 5th, Shloka no.23, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.428. 56. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha Madhyama Khanda, chapter 24th, Shloka no 129-134, Fifth edition 1988, Part 2, Pub: Chaukambha Sanskrit Sanstan,Varanasi, Page no:241.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 169 -
  • Bibliography 57. Prof. Yadunandana Upadhyaya edited, Madhva nidana, part 1,32nd edition 2002, 22nd chapter, shloka no 54th , Pub: Chaukambha Sanskrit Sanstan,Varanasi, Page no 483. 58. Prof P.V.Tewari, edited, Kasyapa Samhita, Sutrasthana, Chapter 27 th, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no.20 & 21, Page no.68. 59. (a) Ramavalamba Shastri edited, Harita samhita,Triteeya Sthana, chapter 22nd, shloka no.6 to 11, First edition 1985, Pub:Prachya Prakashan,Varanasi, Page no 326. (b) Prof.Priya Vart Sharma, edited, Bhela Samhita , Chikitsathana, Chapter 24th , Shloka no 44& 45, Reprint -2005, Pub : Chaukambha Viswabharati, Varanasi, Page no.454. 60. Prof.Priya Vart Sharma edited, Chakradatta, chapter 22nd, shloka no.51 & 55, Second edition 1998, Pub: Chaukhamba Orientalia, Varanasi, Page no.189. 61. Dr.Indradev Tripathi & Dr. Daya Shankar Tripathi edited, Yogaratnakara, Vatavyadhi nidanam, shloka no.67th, First edition 1998, Pub: Chaukambha Sanskrit Series Office, Varanasi, Page no.407. 62. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter5th, shloka no.91 & 92, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.43. 63. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter14th, shloka no.21, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.89. 64. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter19th, shloka no.3, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.110. 65. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Sutrasthana, chapter20th, shloka no.11, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.113. 66. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter 28th, shloka no.56, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. (b) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.101, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.621.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 170 -
  • Bibliography 67. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter 5th, Shloka no.23, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.428. 68. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sareerasthana, chapter 8th, Shloka no.17, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.381. 69. Dr.Shivaprasad Sharma edited, Astanga Samgraha, Suthrasthana, Chapter 20th, shloka no.15, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.158. 70. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, Chapter 36th, shloka no.9, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.246. 71. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter27th, shloka no.14, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.328. 72. Prof.K.R.Srikanta Murthy edited, Sarangadhara Samhita, Purva kandha, chapter 7th, shloka no.108, Fourth edition Print 2001, Pub: Choukambha Orientalia, Page no. 40. 73. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha madhyama khanda, chapter 24th,shloka 129-134, Fifth edition 1988, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi.P:241. 74. Prof P.V.Tewari, edited, Kasyapa Samhita, Sutrasthana, Chapter 27 th, shloka no. 21, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no.68. 75. Ramavalamba Shastri edited, Harita samhita ,Triteeya Sthana, chapter20th , shloka no.31, first edition ,1985, Pub:Prachya Prakashan ,varanasi, Page no 311. 76. Ramavalamba Shastri edited, Harita samhita ,Triteeya Sthana, chapter22nd, shloka no.1,first edition 1985, Pub:Prachya Prakashan ,varanasi, Page no 325. 77. Prof.Priya Vart Sharma edited, Chakradatta, chapter 22nd, shloka no. 51 & 55, Second edition 1998, Pub: Chaukhamba Orientalia, Varanasi, Page no.189. 78. Sri Ganga Sahaya Pandeya edited, Gadanigraha, Kayachikitsa Khanda, chapter no.19 th, shloka no.62, First edition 1969, Pub : The Chowkhamba Vidhyabhavan, Varanasi, Page no.486.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 171 -
  • Bibliography 79. Sri Ganga Sahaya Pandeya edited, Gadanigraha, Kayachikitsa Khanda, chapter no.19th, shloka no.148 to 154, First edition 1969, Pub: The Chowkhamba Vidhyabhavan, Varanasi, Page no.506. 80. Dr.Indradeva Tripathi &Dr. Daya Shankar Tripathi edited, th Yogaratnakara,Vatavyadhi Chikitsa, shloka no.157 , first edition 1998, pub: Chaukambha Sanskrit Sanstan, Varanasi, Page no 415& 416. 81. Dr.Nirmal Saxena edited, Vangasena Samhita, chapter no 28th, shloka no113 to 115, First.edition 2004, Pub: Choukambha Sanskrit Series Office, Varanasi, Page no.574 to 575,404. 82. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana,(Chakrapani) chapter28th, shloka no.56, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 83. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana,(Dalhana) chapter 1st, Shloka no.74, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.268. 84. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadatta)chapter15th, shloka no.54, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.535. 85. Dr.Shivaprasad Sharma edited, Astanga Samgraha, Nidanasthana, (Indu)Chapter 15th, shloka no.56, First edition and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.416. 86. http://www.sciatica-pain.org/nerve-roots.html 87. Vaidya Jadavji Trikamji Acharya edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.59, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 88. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.15, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.617. 89. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter12th, shloka no.4, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.79. 90. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter5th, shloka no.17, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.251.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 172 -
  • Bibliography 91. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.56, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 92. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sutrasthana, chapter46th, Shloka no 515, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.252. 93. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sutrasthana, chapter46th, Shloka no 519, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.252. 94. Vaidya Jadavji Trikamji Acharya, edited Charaka Samhitha, Suthrasthana, chapter 26th, shloka no.42, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.144. 95. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 26th, shloka no.42, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.145. 96. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter10th, shloka no.16, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.176. 97. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 26th, shloka no.43, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.145 (b) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sutrasthana, chapter42th, Shloka no 10, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.186 98. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter 2nd, shloka no.7, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.238. 99. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 12th, shloka no.13, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.631. 100. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 12th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.631Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 173 -
  • Bibliography 101. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareerasthana, chapter 6th, Shloka no 26, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.366. 102. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, sutrasthana, chapter4th, shloka no.21, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.56. 103. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter11th, shloka no.35, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.74. 104. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter21st, shloka no.36, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.118. 105. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareerasthana, chapter 1th, Shloka no 5, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.339. (b)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter8th, shloka no.4 & 7, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.55. 106. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter15th, shloka no.48, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.517. 107. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter2nd, shloka no.8, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.238. 108. Joshi.V.R, Low backache- API Textbook of Medicine section XVII Rheumatology. 6th ed. Sainani.G.S, editor. Mumbai: Association of Physician s of India. Page no. 1077. 109. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthanasthana, chapter1st, shloka no.3-4 , Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.441 110. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.19, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.617. 111. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, (Chakrapani)chapter11th, shloka no.12, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.478.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 174 -
  • Bibliography 112. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.56, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 113. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter1rd, Shloka no 74, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.268. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter 15th, shloka no.54, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.535. 114. (a)Ramavalamba Shastri edited Harita samhita ,Triteeya Sthana,22nd chapter shloka no.1 ,first edition ,1985 pub:Prachya Prakashan ,varanasi, Page no 321. (b) Prof. Yadunandana Upadhyaya edited, Madhva nidana, 22nd chapter, shloka number 54th, 32nd edition 2002, Pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 483. (c) Dr.Shivaprasad Sharma, edited, Astanga Samgraha, nidanasthana, Chapter 15th, shloka no56 , First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.416. (d)Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha madhyama khanda, chapter 24,shloka 129-132, Fifth edition 1988, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi.P:241. (e) Dr.Nirmal Saxena edited, Vangasena Samhita, chapter no 28rd,shloka no. 113- 115 First.edition, 2004 pub: Choukambha Sanskrit Series Office,Varanasi, Page no.404 115. (a) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadhatta) chapter12th, shloka no.49, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201. (b) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter 1st, Shloka no 27, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.262. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter12th, shloka no.50, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201. 116. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter28th, shloka no.21, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.179. 117. (a)Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter12th, shloka no.49, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201. (b)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana(dalhana), chapter 5th, Shloka no 13,Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 175 -
  • Bibliography edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.285. 118. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter12th, shloka no.49, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201. 119. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter28th, shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.179 . 120. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, (Arunadhatta) chapter12th, shloka no.50, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201. 121. Prof. Yadunandana Upadhyaya edited, Madhva nidana, Part 1,32nd edition - 2002, 22nd chapter, shloka number 6-8th, Pub: Chaukambha Sanskrit Sanstan, Varanasi. Page no 456. 122. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, sutrasthana, chapter12th, shloka no.49, Ninth edition and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201 123. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, sutrasthana, (Arunadatta)chapter12th, shloka no.50, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201 124. Prof. Yadunandana Upadhyaya edited,Madhva nidana,Part 1,32nd edition - 2002, 22nd chapter, shloka number 6-8th,pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 456. 125. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha madhyama khanda, , chapter 24,shloka 129, Fifth edition 1988, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi.P:241. 126. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana (Dalhana) chapter1st, Shloka no 74, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.268. 127. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadhatta) chapter 15th, shloka no.54, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.535Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 176 -
  • Bibliography 128. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter 12th, shloka no.6-7, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.193. 129. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, st Nidanasthana,(Chakrapani) chapter1 , shloka no.21, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.200. 130. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana,(Chakrapani) chapter20th, shloka no.11, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.113. 131. Prof P.V.Tewari, edited, Kasyapa Samhita, Siddhisthana, Chapter 5th,shloka no 9, Reprint 2002, Pub: Chaukambha Viswabharati, Varanasi, Page no.20 & 21, Page no.296 132. (a) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter1st, Shloka no 7, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.397. (b) Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana,(Indu) Chapter 19th, shloka no.5, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.153 133. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareerasthana, chapter4st, Shloka no56, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.360. 134. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareerasthana, chapter 4th, Shloka no55, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.360. 135. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, (Chakrapani) chapter 9th, shloka no.20, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.469. 136. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Nidanasthana,(Chakrapani) chapter1st, shloka no.29, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.199. 137. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareerasthana, chapter 4th, Shloka no 32, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.327 (b) Prof. Yadunandana Upadhyaya edited, Madhva nidana,(Madhu kosha) 32nd edition -2002, 14 th chapter, shloka number 4th ,pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 345Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 177 -
  • Bibliography 138. (a) Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, (Indu) Chapter 9th, shloka no.39, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.92. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, (Arunadhatta) chapter15th, shloka no.54, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.535. 139. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha,(Chakrapani) chikitsasthana, chapter3rd, shloka no.86, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.406 140. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthanasthana, chapter12th, shloka no.53, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.201 141. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, (Chakrapani) chapter26th, shloka no.43, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.145 142. Adams. J.C.Dr, Outline of Orthopedics chapter 10. 13th ed. London: Churchill Livingston; 2001. p. 200-205. 143. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 28th, shloka no.58, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.613. . 144. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.617. (b) Bhisagacharya Harishasthri Par adkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15st, shloka no.5 , Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.431. 145. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter11th, shloka no26 , Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.186 146. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter5th, shloka no.7, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.250. 147. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter15th, shloka no.48, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.517.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 178 -
  • Bibliography 148. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter 1st, Shloka no 74, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.268. 149. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, th Suthrasthana,(Chakrapani) chapter15 , shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.515 150. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Shareeraasthana, chapter 7th, Shloka no 9, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.377. 151. NEW CONCEPTIONS IN THE PATHOGENESISOF SCIATIC PAIN- Delivered at the University of Liverpool on March 10th, 1927By Prof. V. PUTTI, Instituto ortopedico Rizzoli,BOLOGNA 152. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter27th, shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.613. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15th, shloka no.49, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.534 153. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.51, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.619. 154. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15th, shloka no.55, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.535 155. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter1st, Shloka no 77, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.268. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15th, shloka no.45, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.434 156. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15th, shloka no.46, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.438 157. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Nidanasthana, chapter1st, Shloka no 79, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan,Varanasi, Page no.269.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 179 -
  • Bibliography (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter15th, shloka no.53, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.534 158. Prof. Yadunandana Upadhyaya edited,Madhva nidana,part 1,32nd edition - 2002, 23nd chapter, shloka number 6th ,pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 501 159. Prof. Yadunandana Upadhyaya edited,Madhva nidana,part 1,32nd edition - 2002, chapter25th, shloka no 78th ,pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 511 160. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter10th, shloka no.8, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.66. 161. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.235, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.626. 162. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.72 & 74, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620. 163. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Sutraasthana, chapter33rd, Shloka no 7, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.144. 164. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter25th, shloka no.45, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.133. 165. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter30th, shloka no.330, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.649. 166. Kaviraj Shri Ambika Dutta Shastri edited,Bhaishajya Ratnavali chapter26th, shloka no.574-576, Eighteen th Revised edition 2005 pub: Chaukambha Sanskrit Bhavan ,Varanasi Page no586 167. Kaviraj Shri Ambika Dutta Shastri edited,Bhaishajya Ratnavali chapter26th, shloka no.578-579,Eighteen Revised edition 2005 pub: Chaukambha Sanskrit Bhavan ,Varanasi Page no587Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 180 -
  • Bibliography 168. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter3rd, shloka no.43 & 44, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.246. 169. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Uttaratantra, chapter1st, Shloka no 25, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.597. 170. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter20th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.114. . 171. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter 4th, Shloka no 22, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.422. 172. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter13th, shloka no.1-3, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.211 173. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.101, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.621 174. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter 5th, Shloka no 23, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.428 175. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter27th, shloka no.15, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.328 176. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, Fifth edition, chapter 24,shloka 133-134, 1988, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi.P:243. 177. Prof.Priya Vart Sharma edited, Chakradatta, chapter 22nd, shloka no. 51 & 55, Second edition, 1998, Pub: Chaukhamba Orientalia, Varanasi, Page no.189-190. 178. Dr.Indradeva Tripathi &Dr. Daya Shankar Tripathi Edited ,Yogaratnakara, Chikitsasthana, Vatavyadichikitsa, shloka no.157th, first edition ,1998, pub: Chaukambha Sanskrit Sanstan,Varanasi. Page no 416 179. Ramavalamba Shastri edited, Haritasamhita, Triteeya Sthana,22nd chapter shloka no.1-11,first edition ,1985 pub:Prachya Prakashan ,varanasi, Page no 325.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 181 -
  • Bibliography 180. Prof.Priya Vart Sharma, edited, Bhela Samhita, Chikitsa sthana, Chapter 24th , Shloka no 45,Reprint -2005 ,Pub : Chaukambha Viswabharati , Varanasi , Page no 454. 181. Dr.Nirmal Saxena edited, Vangasena Samhita, chapter 28th, shloka no 574-575, First.edition, 2004 pub: Choukambha Sanskrit Series Office,Varanasi, Page no.447 . 182. Sri Ganga Sahaya Pandeya edited Gadanigraha, Kayachikitsa Khanda, Vatavyadi chikitsa, shloka no.148-149, and First edition 1969, Pub: The Chowkhamba Vidhyabhavan, Varanasi, Page no.243. 183. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.75, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620. 184. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.7, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.678. 185. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana,(Dalhana) chapter24 th, Shloka no.30 , edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no 488. 186. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.78, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620. 187. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter28th, shloka no.79 to 81, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620. 188. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, chikitsasthana, chapter28th, shloka no.53, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620 189. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter11th, shloka no.18, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.728. 190. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter10th, shloka no.5, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.724.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 182 -
  • Bibliography 191. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.39, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.683. 192. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.27 & 28, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.682 193. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.39, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.683. 194. Prof P.V.Tewari edited Kasyapa Samhita,Khilasthana, Varanasi,Chapter no8,Shloka no 54 Reprint 2002, Pub: Chaukambha Viswabharati, Page no .533 195. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana,(Chakrapani) chapter7th, shloka no.1, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.709. 196. (a) Prof.K.R.Srikanta Murthy edited, Sarangadhara Samhita, Uttarakandha, chapter 5th, shloka no1, Fourth edition, Print 2001, Pub: Choukambha Orientalia, Page no.209. (b)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35rd, Shloka no 18, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.526 197. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.47 to 48, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.684. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter19th, shloka no.63-64, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.282. 198. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 19, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.527. 199. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter12th, shloka no.15, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.731. 200. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter10th, shloka no.3, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.724.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 183 -
  • Bibliography 201. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter38rd, Shloka no 102, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.547. 202. Dr.Nirmal Saxena edited, Vangasena Samhita, Vastikarmadhikara, First.edition, 2004 pub: Choukambha Sanskrit Series Office,Varanasi, Page no.1164. 203. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter8th, shloka no.4, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.713. 204. Prof.Priya Vart Sharma edited, Chakradatta, chapter 73nd, shloka no. 23-26 & 55, Second edition, 1998, Pub: Chaukhamba Orientalia, Varanasi, Page no.628. 205. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitassthana, chapter35th, Shloka no 10, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.526. 206. Dr.Nirmal Saxena edited, Vangasena Samhita, Vastikarmadhikara, sloka no.182-185, First.edition, 2004 pub: Choukambha Sanskrit Series Office,Varanasi, Page no.1164. 207. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter8th, shloka no.25, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.714. 208. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter19th, shloka no.64, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.55. 209. Dr.Nirmal Saxena edited, Vangasena Samhita, Vastikarmadhikara, shloka 171, First edition, 2004 pub: Choukambha Sanskrit Series Office,Varanasi, Page no.1164 210. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter38rd, Shloka no 84, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.544. 211. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter8th, shloka no.4, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.713. 212. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, th Siddhisthana,(Chakrapani) chapter10 , shloka no.13 & 14, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.725.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 184 -
  • Bibliography 213. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Vimanasthana, chapter8th, shloka no.139 to 144, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.284. 214. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter8th, shloka no.2 to 46, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.687 to 690. (b)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter38rd, Shloka no 118, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.548. 215. Prof.K.R.Srikanta Murthy edited, Sarangadhara Samhita, uttara kandha, chapter 6 to 31th, Fourth edition, Print 2001, Pub: Choukambha Orientalia, Page no.209 to 219 216. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 18, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.526. 217. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 1-2, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.525. 218. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.23, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.687 to 693. (b)Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, sutrasthana, chapter19th, shloka no.45, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.279 219. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter38th, Shloka no 30, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.542. 220. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Kalpasthana, chapter4th, shloka no.2, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.754 221. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter38th, Shloka no 36-41, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.543 (b)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.31 to 33, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.615.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 185 -
  • Bibliography 222. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 18, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.526 223. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, th Siddhisthana,(Chakrapani) chapter 4 , shloka no.53 to 54, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.701. 224. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 12, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.526 (b)Dr.Shivaprasad Sharma edited, Astanga Samgraha, Suthrasthana, Chapter 28th, shloka no.17, First edition and print 2006, Pub: Choukambha Sanskrit Series Office, Varanasi, Page no.215. 225. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.7 to 9, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.691. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter19th, shloka no.13 & 14, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.273 226. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 11, edition and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.526. 227. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, Chapter 28th, shloka no.18, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.216. 228. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 5th, shloka no.4 to 5, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.702. 229. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter 5th, shloka no.6 to 7, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no 702 230. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 21, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.527 (b)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter2nd, shloka no.14 & 15, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.688.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 186 -
  • Bibliography (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter19th, shloka no.4-5, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.271. 231. (a)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 5, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.525 (b) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter2nd, shloka no.16, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.689. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter19th, shloka no.23, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.271 232. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter2nd, shloka no.19, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.689. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, sutrasthana, chapter19h, shloka no.6, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.272 233. (a) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 21-22, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.527 (b)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter2nd, shloka no.17 & 18, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.689. (c) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter19th, shloka no.78, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.272 234. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.6, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.691. 235. (a). Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.31 & 32, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.695. (b) Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Suthrasthana, chapter19th, shloka no.18&19, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.274 (c) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha Edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 7, edition, and Reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.525Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 187 -
  • Bibliography 236. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.17, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.692. 237. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.19, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.692. 238. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.25 to 30, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.693. 239. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Nidanasthana, chapter19th, shloka no.27, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.276 240. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, Chapter 28th, shloka no.37, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.219 241. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, Chapter 28th, shloka no.27,-30 First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.217 242. Prof.Priya Vart Sharma, edited, Chakradatta, chapter72nd, shloka no.20-23, 2nd edition, 1998, Pub: Chaukhamba Orientalia, Varanasi, Page no.621. 243. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter19th, shloka no.50-52, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no. 280. 244. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter19th, shloka no.47, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.280 . 245. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter19th, shloka no.47-49, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.280. 246. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 33, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.529. 247. .Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter4th, shloka no.26 & 28, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.699Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 188 -
  • Bibliography 248. .Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter7th, shloka no.7 to 62, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.709 to 712. 249. (a) Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.24, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.693 (b)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter20th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.114. (c) Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Chikitsasthana, chapter35th, Shloka no 24 to 27, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.527. (d)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter1st, shloka no.40, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.678. 250. Mayo Foundation for Medical Education and Research (MFMER). Ref: April 22, 2008 © 1998-2009 251. Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.) 7/10/2009 252. (a)Vaidya Jadavji Trikamji Acharya, edited, CharakaSamhitha, Siddhisthana, chapter3rd, shloka no.35, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.695. (b)Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Kalpasthana, chapter4th, shloka no.4, Ninth edition and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.754. (c)Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Kalpasthana, Chapter4th, shloka no.5, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.596. 253. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter27th, shloka no.243 to 246, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no167. (b)Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Suthrasthana, chapter 45th, Shloka no 132, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan ,Varanasi, Page no.207.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 189 -
  • Bibliography 254. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Suthrasthana, Chapter6th, shloka no.63, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.43. 255. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana,chapter 1st, shloka no.88 to 89, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.21. (b)Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter 6th, shloka no.143 to 144, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.115 256. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 13th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no 82. 257. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, Fifth edition 1988, Ghritavarga, shloka 1 to 3, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi, Page no.775. 258. Pt. Bhisagacharya Harishasthri Paradkara Vaidya, edited, Astanga Hrudaya, Sutrasthana, chapter 16th, shloka no.8, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.244. 259. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter13th, shloka no.14, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.82. 260. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 13th, shloka no.43, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.74. 261. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 13th, shloka no.13, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.82. 262. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter 28th, shloka no.81, edition, and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.620. 263. Vaidya Jadavji Trikamji Acharya, & Narayan Ram Acharya, Kavyatheertha edited, Susruta Samhita, Suthrasthana, chapter 45th, Shloka no 112 to 113, edition, and reprint 2004, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.205.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 190 -
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  • Bibliography 273. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Chikitsasthana, chapter 28th, shloka no.195, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.625. 274. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 13th, shloka no.16, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.82 275. Sri Ganga Sahaya Pandeya edited Gadanigraha, Kayachikitsa Khanda, chapter no.19th, shloka no.166, First edition 1969, Pub: The Chowkhamba Vidhyabhavan, Varanasi, Page no507. 276. (a)Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana, chapter3rd, shloka no.14, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.692. (b)Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Kalpasthana, chapter 4th, shloka no.2, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.754. 277. (a)Vaidya Vishnu MahadevGogtaeedited, Ayurvedic Pharmacology and Therapeutic Uses of Medicinal Plants, First edition,Oct2004, Pub: Bharatiya Vidya Bhavan, Mumbai. (b)Dr.K.MNadkarnis, Indian Meteria Medica, Vol 1, Revised and Enlarged by A.K.Nadkarni, Third Revised and Enlarged Editon,1982, Pub:Popular Prakashan Private LTD, Mumbai. 278. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Suthrasthana, chapter 27th, shloka no.312 to 315, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.171. 279. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Suthrasthana, chapter 6th, shloka no.63, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia, Varanasi, Page no.98. 280. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, Mamsavarga, shloka 73 to 75, Fifth edition 1988, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi, Page no.715 281. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, chapter.21, shloka 1 to 2, Fifth edition 1988,Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi, Page no.784. 282. Physical Examination(Bigos SJ, Bowyer OR, Braen GR, Brown K, Deyo R, Haldeman S, et al. Acute low back problems in adults. Clinical practice guideline no. 14 (AHCPR publication no. 95-0642). Rockville, Md.: U.S. Department ofEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 192 -
  • Bibliography Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, December 1994 283. A manual on clinical surgery, edited by S.Das, 6Th edition, Page no.224 and 225-226. 284. A manual on clinical surgery, edited by S.Das, 6Th edition, Page no209. 285. A manual on clinical surgery, edited by S.Das, 6Th edition, Page no 224-225 286. a)A manual on clinical surgery, edited by S.Das, 6Th edition, Page no 220-223 b)Hutchison’s Clinical Methods 22 nd Edition, Edited by Michael Swash and Michael Glynn 157-159 287. FairbankJC,Pynsent PB,”The Oswestry Disability Indx”Spine 200025(22) Page2940-2952. 288. http://www.sprigfeild.com 289. The management of Khanja and Pangu with Panchakarma, Published by the director, Central council for research in Ayurveda and Sidda, Published in 1999, Page no-40 290. Kaviraj Shri Ambika Dutta Shastri edited, Bhaishajya Ratnavali, chapter 5th, shloka no.1286- 1287,Eighteenth Revised edition 2005, pub: Chaukambha Sanskrit Bhavan ,Varanasi, Page no .185. 291. Kaviraj Shri Ambika Dutta Shastri edited, Bhaishajya Ratnavali, chapter 5th, shloka no.1285,Eighteenth Revised edition 2005, pub :Chaukambha Sanskrit Bhavan ,Varanasi, Page no 185. 292. Veni Madhava Joshi and Narayana Hari Joshi edited, Ayurvedeeya Sabdakosha, Print 1968, Pub:Maharashtra Rajya Sahithya Ani Samskriti Mandala, Mumbai, Page no.617. 293. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Suthrasthana, chapter 19th, shloka no.26, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.98. 294. Vaidya Jadavji Trikamji Acharya, edited, Charaka Samhitha, Siddhisthana,(Chakrapani) chapter 3rd, shloka no.35, edition and reprint 2005, Pub: Choukambha Surbharati Prakashan, Varanasi, Page no.692. 295. Pt. Bhisagacharya Harishasthri Paradkara Vaidya edited, Astanga Hrudaya, Suthrasthana, chapter 6th, shloka no.63, Ninth edition, and reprint 2002, Pub: Choukambha Orientalia,Varanasi, Page no.18.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 193 -
  • Bibliography 296. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, Fifth edition 1988, Mamsavarga, shloka no 28, Part 2, Pub:Chaukambha Sanskrit Sanstan,Varanasi, Page no.709. 297. Pandit Sri Brahma Sankara Misra edited, Bhavaprakasha, madhyama khanda, Fifth edition 1988, Mamsavarga, shloka no 1, Part 2, Pub: Chaukambha Sanskrit Sanstan,Varanasi, Page no.705. 298. Ref: Sources: (1) USDA Handbook #8, 1989; (2) Nutritive value of foods, Home and Garden Bulletin Number 72, USDA, Washington DC, US Government Printing Office, 1981. 299. Dr.Shivaprasad Sharma, edited, Astanga Samgraha, Sutrasthana, Chapter13th, shloka no.3, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.124 300. Shivaprasad Sharma, edited, Astanga Samgraha, Sutrasthana, Chapter 6th, shloka no.27, First edition, and print 2006, Pub: Choukambha Sanskrit Series Office,Varanasi, Page no.27. 301. Dr.K.S.R.Prasad, Dynamics of Ayurveda, http://technoayurveda.wordpress.com, 27/9/09Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 194 -
  • Annexure SPECIAL CASESHEET FOR GRIDHRASI Post Graduate Studies and Research Centre (Panchakarma) Shri. D.G.M. Ayurvedic Medical College, GadagGuide : Dr. P. Sivaramudu. M.D.(Ayu)P.G. Scholar : S. Jayasankara. Name of the patient : Sl. No.b. Father’s/ Husband’s Name : OPD. No.c. Age : Years IPD No.d. Sex M F Bed No.e. Religion : Hindu Muslim Christian Othersf. Occupation : Sedentary Active Labour Othersg. Economical Status : Poor Middle class Higher classh. Address :………………………………………….Phone No. ………………………………………… ………………………………………… E-mail: Pin:i. Date of Schedule Initiation :j. Date of Schedule Completion :k. Result:l. Consent: I hereby agree that, I have been fully educated with the disease and treatment. Hereby satisfied whole heartedly, and accept the medical trial over me. Investigator’s Signature. Patient’s Signature.Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 195 -
  • AnnexurePradana Vedana: (Chief Complaints)(a) RUK (Pain) Onset : Sudden Gradual Duration Variety : Acute Chronic Nature : Local General Radiated At Postural Change : Yes No Aggravating Factors : Physical Exercise Emotion Exposure to cold Exposure to heat Any other causes Relieving factors : Rest Pain relievers Pressure Severity of pain : Gr. 0 Gr. 1 Gr. 2 Gr. 3 Gr. 4 Lumbar region : Lumbodorsal Lumbar Lumbosacral Leg : Right Left Both Duration Thigh Calf Foot Types of Pain : Toda Spandana Ghrinadi(b) STHAMBHA (Stiffness) : Present Absent Grade Site : ………………………………………………… Sequential General Duration Relieving factors : Rest Walking Pain relievers Time : Early morning Morning Afternoon Evening NightEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 196 -
  • Annexure Anubandha Vedana P A Anubandha Vedana P A (j) TANDRA (Drowsiness)(a) DEHAVAKRATHA (k) GOURAVA (Heaviness(b) SPHURANA (l)ARUCHI (Tastelessness(c) STABTADA (m)BAKTHA DWESHA(d) SUPTATA (Aversion to food) (n) MUKHA PRASEKA(e) STAIMITYA (Salivation)(f) MUSCLE CRAMPS (o) VAHNIMANDHYA (p) SLEEPLESSNESS(g) SHOOTING PAIN(h) TINGLING SENSATION (q) BURNING SENSATION (r) CONSTIPATION(i) MUSCLE WEAKNESSHistory of present illness:Mode of onset : Sudden Gradual Trauma Lifting up weightPart first affected: Spik Kati Uru Janu Jangha PadaDirection of spread: Back and outer side of thigh, leg and foot Sacroiliac jointsLimb affected: R. Lower limb L. Lower limb BilateralRoutine activities affected: Yes NoEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 197 -
  • AnnexureHistory of past illness:Treatment History:Family history Present Absent :Personal History :Ahara : Vegetarian MixedAgni : Manda Teekshna Vishama SamaKoshta : Madhya Mrudu KrooraNidra : Sukha Alpha Ati VishamaVyasana : Smoking Tobacco Alcohol NoneMutra Pravurti- Frequency : Day NightMalapravurthi - Frequency : 1 time 2 times more constipatedAarthavapravurthi : Alpa Ati Vishama RajonivruttiNo. Of issues if any : ………………………………History of previous pregnancy and labour: ………………………………………………Position during daily working hours Standing Sitting Stooping SquattingNature of work: Hard manual Moderate manual Sedentary House work Office work OthersPsychological status: Anxious Depressed Irritable Angry Grief Broody NormalEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 198 -
  • AnnexureGeneral Examinations:Pulse / min Blood Pressure /mm HgTemperature 0 Respiration F /minWeight Kg Height cms.Ashtasthana Pareeksha:Nadi MutraMala JihwaShabda SparshaDrik AkrutiSroto Pareeksha:Astivaha -Mamsavaha -Rasavaha -Raktha -Nidana: (a) Ahara:Ruksha Sheeta Laghu Alpa Kashaya Katu TiktaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 199 -
  • Annexure(b) Vihara: Car Sitting(1) Yana Motorcycle (2) Vishama Standing Upachara Bullock Cart Labour Bicycle Rathrijagarana(3) Pradhavana (4) Vyayama(5) Plavana (6) Divaswapna(7) Marmaagata Nidana (8) Dhatukshaya Nidana(c) Manasika:Investigations: Hb% G/dl T.C. Cells/cumm BLOOD D.C. P L E M B E.S.R. mm/hr R.B.S Mg/dlRadiological Findings: X raySignature of Guide Signature of Scholar(DR.P.SIVARAMUDU) (S.JAYASANKAR)Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 200 -
  • Annexure SPECIAL WORK SHEET FOR GRIDHRASIName of the patient : Sl. No. :Age : OPD. No. :Sex : M F IPD No. : Bed No. :Date of Schedule Initiation :Date of Schedule completion : Blood Pressure Pulse Respiratory Rate Vital Examination Before After Before After Before After 1st Day 2nd Day 3rd Day 4th Day 5th Day 6th Day 7th Day 8th DayChikitsa:Vasti Karma Nireekshana : Dwipanchamuladi Yogavasti Date of Basti initiation Date of Basti completionEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 201 -
  • Yoga Vasti Time Vasti dravya Time of Vasti dravya Mala Nireekshana pramana Retention pratyagamana Vega kala Observations I Day (Anuvasana) am ml min II Day (Niruha) am ml min III Day (Anuvasana) am ml min IV Day (Niruha) am ml min V Day (Anuvasana) am ml min VI Day (Niruha) am ml min VII Day (Anuvasana) am ml min VIII Day (Anuvasana) am ml minEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 202 - Annexure
  • Annexure Samyak Anuvasana Vasti P ASamyak Niruha Vasti P A LakshanasLakshanas Sa sakruth tailamPrasrushta vit-mutra-vayu Indriya PrasadaRuchi Vardhanam Sukha swapnaAgnivardhanam LaghutaPakvasaya Laghutha BalaRoga santhi Normal VegasBala Criteria’s for Assessment:Cardinal Symptoms Before After After Treatment Treatment Follow up1. Sthamba2. Ruk General BT AT AF General Symptoms BT AT AF Symptoms 7. Deha vakrata1. Toda a. Shooting Pain 8. Vahnimandhya b. Tinkling sensation 9. Mukha praseka c.Burning sensation 10. Bakthadvesha2. Spandana Cramping 11.Suptata3. Tandra 12.Sphurana4. Gaurava5. Aruchi 13. Stabtada6. StaimityaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 203 -
  • Annexure SLR Before Treatment After Treatment After Follow upActive - Right leg At…………Degrees At…………Degrees At…………Degrees - Left leg At…………Degrees At…………Degrees At…………DegreesPassive - Right leg At…………Degrees At…………Degrees At…………Degrees - Left leg At…………Degrees At…………Degrees At…………Degrees Movement of BT AT AF Reflexes BT AT AF Leg lumbar spine RightForward flexion Knee jerk LeftRight lateral Rightflexion Ankle jerkLeft lateral flexion Left Babinski’s RightExtension signRotation LeftOswestry Disability Index (ODI)(a) Intensity BT AF 1. I can tolerate the pain I have with out having to use pain killers ( )( ) 2. The pain is bad but I manage with out taking pain killers. ( )( ) 3. Pain killers give complete relief from pain ( )( ) 4. Pain killers give moderate relief from pain. ( )( ) 5. Pain killers give very little relief from pain. ( )( ) 6. Pain killers have no effect on the pain and I do not use them. ( )( )(b) Care BT AF 1. I can look after myself normally without causing extra pain. ( )( ) 2. I can look after myself normally but it causes extra pain. ( )( ) 3. It is painful to look after myself and Iam slow and careful. ( )( ) 4. I need some help but manage most of my personal care. ( )( ) 5. I need help every day in most aspect of self care. ( )( ) 6. I do not get dressed wash with difficulty and stay in bed. ( )( )Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 204 -
  • Annexure(c) Lifting BT AF 1. I can lift heavy weights with out extra pain. ( )( ) 2. I can lift heavy weights but it gives extra pain. ( )( ) 3. Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned for example on a table. ( )( ) 4. Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned. ( )( ) 5. I can lift only very light weights. ( )( ) 6. I cannot lift or carry anything at all. ( )( )(d)Walking BT AF 1. Pain does not prevent me walking any distance. ( )( ) 2. Pain prevents me walking more than one mile. ( )( ) 3. Pain prevents me walking more than 0.5 miles. ( )( ) 4. Pain prevents me walking more than 0.25 miles. ( )( ) 5. I can only walk using a stick or crutches. ( )( ) 6. I am in bed most of the time and have to crawl to the toilet. ( )( )(e) Sitting BT AF 1. I can sit any chair as long as I like. ( )( ) 2. I can only sit in my favorite chair as long as I like. ( )( ) 3. Pain prevents me sitting more than one hour. ( )( ) 4. Pain prevents me from sitting more than 0.5 hours. ( )( ) 5. Pain prevents me from sitting more than 10 minutes. ( )( ) 6. Pain prevents me from sitting at all. ( )( )(f) Standing BT AF 1. I can stand as long as I want with out extra pain. ( )( ) 2. I can stand as long as I want but it gives me extra pain. ( )( ) 3. Pain prevents me from standing for more than one hour. ( )( ) 4. Pain prevents me from standing for more than 30 minutes. ( )( ) 5. Pain prevents me from standing for more than 10 minutes. ( )( ) 6. Pain prevents me from standing at all. ( )( )(G) Sleeping BT AF 1. Pain does not prevent me from sleeping well. ( )( ) 2. I can sleep only by using tablets. ( )( ) 3. Even when I take tablets I have less than 6 hours sleep. ( )( ) 4. Even when I take tablets I have less than 4 hours sleep. ( )( ) 5. Even when I take tablets I have less than 2 hours sleep. ( )( ) 6. Pain prevents me from sleeping at all. ( )( )(h) Sex Life BT AF 1. My sex life is normal and causes no extra pain. ( )( ) 2. My sex life is normal but causes some extra pain. ( )( ) 3. My sex life is nearly normal but is very painful. ( )( ) 4. My sex life is severely restricted by pain. ( )( ) 5. My sex life is nearly absent because of pain. ( )( ) 6. Pain prevents any sex life at all. ( )( )Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 205 -
  • Annexure(I) Social Life BT AF 1. My social life is normal and gives me no extra pain. ( )( ) 2. My social life is normal but increases the degree of pain. ( )( ) 3. Pain has no significant effect on my social life apart from limiting energetic interests such as dancing. ( )( ) 4. Pain has restricted my social life and I do not go out as often. ( )( ) 5. Pain has restricted my social life to my home. ( )( ) 6. I have no social life because of pain. ( )( )(J) Traveling BT AF 1. I can travel anywhere without extra pain. ( )( ) 2. I can travel anywhere but it gives me extra pain. ( )( ) 3. Pain is bad but I manage journeys over 2 hours. ( )( ) 4. Pain restricts me to journeys of less than 1 hour. ( )( ) 5. Pain restricts me to short necessary journeys under 30 minutes. ( )( ) 6. Pain prevents me from traveling except to the doctor or hospital ( )( )Visual Analogue Scale (VAS)BT 0 1 2 3 4 5 6 7 8 9 10AT 0 1 2 3 4 5 6 7 8 9 10AF 0 1 2 3 4 5 6 7 8 9 10 Walking time Gr.0 Gr.1 Gr.2 Gr.3 Gr.4 Gr.5 Before After Treatment After follow upGait : Normal Abnormal If abnormal ……………………….. type of GaEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 206 -
  • Annexure Spinal Root Examinations Root Pain Sensory loss Motor weakness Reflex changeinvolved2 nd Front of mid thigh Front of mid Quadriceps Diminis-Lumbar thigh hed knee jerk3 rd Front of lower Front of Quadriceps Diminis-Lumber thigh lower thigh hed knee jerk4 th Side of thigh Side of Quadriceps Diminis-Lumbar thigh hed knee jerk Front of inner leg Front of Anterior inner leg tibialis Weak dorsiflexion of foot5 th Back of thigh Back of AnteriorLumbar thigh tibialis Absent Lateral leg Lateral leg Weak plantar /Diminishe flexion of big d ankle Dorsum of foot to Dorsum of toe jerk big toe foot to big toeI st Base of leg sole Base of leg Gastro-Sacral and side of foot sole and nomies weak side of foot plantar flexion Absent of big toe and ankle jerk foot INVESTIGATOR’S NOTE: Signature of Guide Signature of Scholar (DR.P.SIVARAMUDU) (S.JAYASNKAR) Evaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 207 -
  • Annexure Scores assessed at different stages of the treatmentSubjective BT AT AF Objective BT AT AFparameter parameter1. Sthamba 1.SLR2. Ruk Active SLR RL3. Toda LL a. Shooting Pain Passive SLR RL b. Tingling LL sensation 2.Movement of c. Burning lumbar spine sensation Forward flexion4. Spandana Cramping Right lateral flexion5. Tandra Left lateral flexion6. Gaurava Extension7. Aruchi Rotation8. Dehavakrata 3.Refexes9. Vahnimandhya Knee jerk RL LL10. Mukhapraseka Ankle jerk RL11. Bakthadvesha LL12.Staimitya Babinski’s RL13.Spuhrana sign LL14.Suptata 4.OWI15.Stabtada 5.VAS 6.Walking time 7.GaitEvaluation of the efficacy of Dwipanchamuladi mamsarasa basti in Gridhrasi - 208 -