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A STUDY ON THE EFFECT OF SWEDANA WITH KOLAKULATHADI CHOORNA AND VALUKA IN KATIGRAHA By ANJALY. N.V. DEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA K.V.G. AYURVEDA MEDICAL COLLEGE AND HOSPITAL, …

A STUDY ON THE EFFECT OF SWEDANA WITH KOLAKULATHADI CHOORNA AND VALUKA IN KATIGRAHA By ANJALY. N.V. DEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA K.V.G. AYURVEDA MEDICAL COLLEGE AND HOSPITAL, SULLIA

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  • 1. A STUDY ON THE EFFECT OF SWEDANA WITH KOLAKULATHADI CHOORNA AND VALUKA IN KATIGRAHA By ANJALY. N.V. Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATI (M.D. AYURVEDA) In PANCHAKARMA Under the guidance of DR. SATHYAMOORTHY BHAT M D (Ayu) ProfessorDEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA K.V.G. AYURVEDA MEDICAL COLLEGE AND HOSPITAL, SULLIA – 574327 2010
  • 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATEI hereby declare that this dissertation / thesis entitled “A STUDY ON THE EFFECTOF SWEDANA WITH KOLAKULATHADI CHOORNA AND VALUKA INKATIGRAHA” is a bonafide and genuine research work carried out by me under theguidance of Dr. SATHYAMOORTHY BHAT M D (Ayu) Professor, Department of PostGraduate Studies in Panchakarma, K.V.G. Ayurveda Medical College AndHospital,Sullia.Date:Place: SULLIA ANJALY.N.V. ii
  • 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA DEPARTMENT OF POST – GRADUATE STUDIES IN PANCHAKARMA CERTIFICATE BY THE GUIDE A STUDY ON THE EFFECTOF SWEDANA WITH KOLAKULATHADI CHOORNA AND VALUKA INKATIGRAHA” ! " # $ % & &( ) * + !Date: DR. SATHYAMOORTHY BHAT.M.D(AYU)Place: Sullia Professor, Department of Post Graduate Studies in Pancha Karma K.V.G. Ayurveda Medical College and Hospital Sullia. iii
  • 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA DEPARTMENT OF POST – GRADUATE STUDIES IN PANCHAKARMA CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “A sudy on the effect ofSwedana with Kolakulathadi Choorna and Valuka in Katigraha is a bonafideresearch work done by Anjaly N.V in partial fulfillment of the requirementfor the degree of Ayurveda Vachaspathi. M.D. (Panchakarma).Date Signature of the Co –GuidePlace Dr.Sanath Kumar D.G Lecturer Dept. of Panchakarma K.V.G Ayurveda Medical College and Hospital Sullia iv
  • 5. K.V.G AYURVEDA MEDICAL COLLEGE AND HOSPITAL SULLIA (Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka) DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA ENDORSEMENT BY THE H O D; AND PRINCIPAL / HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “A STUDY ON THE EFFECT OFSWEDANA WITH KOLAKULATTHADI CHOORNA AND VALUKA INKATIGRAHA” is a bonafide research work done by Anjaly.N.V.under theguidance of DR. SATHYAMOORTHY BHAT.M.D(AYU) Professor, K.V.G.AYURVEDA MEDICAL COLLEGE, Sullia.Dr. N.S.Shettar Dr. N.S.ShettarHead of the Department PrincipalDepartment of P G Studies inPanchakarma,K.V.G. Ayurveda College and Hospital,Sullia. Date: Date: Place: Sullia Place: Sullia v
  • 6. COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation / thesis in print or electronic format for academic / researchpurpose.Date:Place: Sullia Anjaly.N.V. © Rajiv Gandhi University of Health Sciences, Karnataka. vi
  • 7. ACKNOWLEDGEMENT I pay obeisance to the lotus feet of Nelliakatu Bhagavathi with whose shower ofblessings, this task has ventured without any hindrances. I am very much happy to dedicate this work to my beloved Parents and Familywhose prayers and support made me to complete this job successfully. I whole heartedly thank Dr. Kurunji Venkatramana Gowda, Founder, K.V.G.Academy Of Liberal educations, for giving me an opportunity to study in this institution. I avail this opportunity to thank Dr. N. S. Shettar, Principal & HOD. ofPanchaKarma K.V.G.A.M.C. for evincing keen interest in my endeavors and forcontinued encouragement I express my deepest gratitude to my revered teacher and guide Dr.Sathyamoorthy Bhat, Prof, Dept. of PanchaKarma, K.V.G.A.M.C, Sullia who has guidedme throughout my research work. I offer my sincere thanks for his scholarly guidance incarrying out this research work. I express my gratitude to Dr Krishnaprakash for providing me constructiveskillful help in the study. I express my special thanks to Dr. Gururaj, whose experiencedskillful guidelines enlighted my path of research work. I also thankful to Dr. SanathKumar whose valuable suggetions made my task easier. vii
  • 8. I express my deep gratitude to my respected teachers Dr Ashok, Dr. MohanlalDr.Deeneprakash Bharadwaj, Dr Rohini Bharadwaj, Dr.Udayashankar , Dr Rajasekar,Dr. Leeladhar, Dr. Purushotham, Dr. Chetan, Dr. Hari Prasad, Dr. Harshavardhana,Dr Kavitha, and Dr Jayavani and all the teaching staff for their Support andencouragement. I am very much thankful to my classmates, juniors and friends for their helpand support. I express my sincere and deep gratitude to Mr. Midhun.N.N for hiswholehearted encouragement as well as providing all necessary facilities for thestatistical work. I would like to express the feeling of gratitude to my friend Dr.Deeksha for herencouragement and support. It is my duty to thank the para-medical and non-teaching staff of K.V.G.A.M.Cand my patients for their kind co-operation. I thank the library staff for timely help. Last but not the least, I am very thankful to all the persons who helped medirectly or indirectly in completing this research work. ANJALY .N.V. viii
  • 9. LIST OF ABBREVIATIONS USEDA.H – Ashtanga HrudayaA.S – Ashtanga SamgrahaB.P – BhavaprakashaB.S – Bhela SamhitaC.D _ Chakra dattaC.S – Charaka SamhitaG.N _ Gada NigrahaH.S _ Haritha SamhithaM.N – Madhava NidanaS.S – Sushruta SamhitaV.S – VangasenaY.R – Yogaratnakara ix
  • 10. ABSTRACT Changing of life style of modern human being has created several disharmonies inhis biological system. As the advancement of busy, professional and social life, impropersitting posture in offices, factories, continuous and overexertion, jerking movementsduring traveling and sports and other multifactoral causes create undue pressure over themusculo skeletal system. These contributes to the manifestation of diseases like low backache, sciatica etc. Description of similar conditions with same etiological factors, pathogenesis andsymptoms are available in Ayurveda classics also . Katigraha,a nanatmaja vatavyadhiconsidered by acharya Sharangadhara, is one among them. Acharya Shodala says it as acondition characterized by pain and restricted movements of the Kati. The referenceabout the disease is also available in Bhavaprakasha Amavatadhikara.In both thereference, we can see the vata as the most culprit which causes the disease, and it maymanifest with or without the association of ama. Common measures of Vatavyadhi and amavata like Svedana Virechana , Basti etccan be adopted in case of Katigraha. Among those treatments Svedana is considered forthe present study as it holds good for both vata and ama. More over Katigraha is asvedyayogya condition. Svedana is of two types knownly Rooksha and Snigdha. Rooksha sveda is amethod in which prior snehana is not done and is indicated in vataja disorders with amaassociation. Hence in Katigraha Rooksha sveda is more suitable than Snigdha sveda..ThisRookshana can be achieved through materials such as Sikata, Pashana,Kareesha,Loha,Thusha etc and also with powder of appropriate drugs. 10
  • 11. Thus in the present study an attempt is made to assess the efficacy of rookshsvedain katigraha, Kolakulatthadi Choorna and Valuka which are told in Vatavyadhi andAmavata context respectively are considered for Svedana, in the form of Pinda Sveda asit is having the properties of both Vata and Kaphashamana.Method:This study was a comparative clinical study, containing of two groups each consisting of40 patients, where 20 patients received Pinda sveda with Kolakulathadi choorna for 7days and 15 patients received the Valuka sveda for 7 days, by giving and follow up wasdone on 15th day.Assessments were done before the treatment, soon after completion of course and afterfollow up and scores were compared.Results:In KCPS group, out of 20 patients no one got complete relief, 15% patients got markedimprovement and 85% patients were improved moderately. There were no patients withmild improvement or unchanged results.In VPS group out of 20 patients, none of the patient was cured or unchanged. Onepatiens 5%got marked improvement and 75% got moderate improvement. Mildimprovent is noticed in rest 20% of patients.On comparison KCPS group showed highly significant difference in the results of painon sitting and lumbar flexion. In other parameters also it showed slight higher percentageof relief ,but it is not statistically significant. 11
  • 12. Conclusion : It is concluded that both groups showed high significance in decreasing pain,stiffness and tenderness, and improving range of movements and walking ability(P<0.001).But it is noted that the results lasted throughout the follow up period in theKCPS group and this may be due to the added effect of Vatahara choorna.Key words: Katigraha,Rooksha Sweda,PindaSweda. 12
  • 13. SL.NO CONTENTS PAGE.NO 1 INTRODUCTION 1 2 OBJECTIVES 4 3 REVIEW OF LITERATURE 6 3.1 TREATMENT REVIEW 6 3.2 DRUG REVIEW 42 3.3 DISEASE REVIEW 51 4 METHODOLOGY 98 5 RESULTS 108 6 DISCUSSION 143 7 CONCLUSION 158 8 SUMMARY 160 9 BIBLIOGRAPHIC REFERENCES 162 10 ANNEXURE 186 13
  • 14. LIST OF TABLESTable Page DescriptionNo. No. 1. Proprties, action and predominance of mahabhoothas of Swedana dravyas 7 2. Indications for Swedana Karma 8 3. Contrindications for Swedana Karma 9 4. Therapeutic effect of Rooksha guna 22 5. Samyak swinna laxanas 30 6. Atiswinna laxanas 31 7. Layers of Skin 33 8. Rasa Guna Veerya Vipaka & Dosha karma of Kolakulathadi choorna 49 9. Aharaja Nidana of Katigraha 70 10. Viharaja nidanas of katigraha 71 11. Manasika nidana of katigraha 72 12. Anyat nidana of katigraha 72 13. Pathya of Katigraha 86 14. Apathya of katigraha 87 15. Grading of total efficacy of treatment 107 16. Distribution of 40 patients of Katigraha according to Age 108 17. Distribution of 40 patients of Katigraha according to Sex 109 18. Distribution of 40 patients of Katigraha according to Religion 109 19. Distribution of 40 patients of Katigraha according to Educational status 109
  • 15. 20. Distribution of 40 patients of Katigraha according to Marital status 11021. Distribution of 40 patients of Katigraha according to Socio economic status 11022. Distribution of 40 patients of Katigraha according to occupation 11123. Distribution of 40 patients of Katigraha according to Nature of work 11224. Distribution of 40 patients of Katigraha according to mechanism of injury 11225. Distribution of 40 patients of Katigraha according to course of pain 11326. Distribution of 40 patients of Katigraha according to onset 11327. Distribution of 40 patients of Katigraha according to loss of function 11328. Distribution of 40 patients of Katigraha according to Duration of illness 11429. Distribution of 40 patients of Katigraha according to Agni 11430. Distribution of 40 patients of Katigraha according to Koshta 11531. Distribution of 40 patients of Katigraha according to Weight 11532. Distribution of 40 patients of Katigraha according to Prakruthi 11633. Distribution of 40 patients of Katigraha according to Satwa 11634. Distribution of 40 patients of Katigraha according to Diet habits 11635. Effect of Kolakulathadi Choorna Pinda Sweda on Pain of Katigraha 12336. Effect of Kolakulathadi Choorna Pinda Sweda on Tenderness of Katigraha 12437. Effect of Kolakulathadi Choorna Pinda Sweda on Lumber Movements of 125 Katigraha38. Effect of Kolakulathadi Choorna Pinda Sweda on Walking Time of Katigraha 12639. Overall Effect of Kolakulathadi Choorna Pinda Sweda on Katigraha 12740. Effect of Valuka Sweda on Pain of Katigraha 12841. Effect of Valuka Sweda on Tenderness of Katigraha 129
  • 16. 42. Effect of Valuka Sweda on Lumber Movements of Katigraha 129 43. Effect of Valuka Sweda on Walking Time of Katigraha 131 44. Overall Effect of Valuka Sweda on Katigraha 131 45. Comparison of effect of treatment on Pain on rest in two groups 138 46. Comparison of effect of treatment on Pain on sitting in two groups 138 47. Comparison of effect of treatment on Pain on walk in two groups 138 48. Comparison of effect of treatment on Tenderness in two groups 139 49. Comparison of effect of treatment on Lumbar flexion in two groups 139 50. Comparison of effect of treatment on Lumbar extension in two groups 139 51. Comparison of effect of treatment on Right lateral movement in two groups 140 52. Comparison of effect of treatment on Left lateral movement in two groups 140 53. Comparison of effect of treatment on Rotation in two groups 140 54. Comparison of effect of treatment on Walking time in two groups 141 55. Comparison of overall effect of treatment in two groups 142 LIST OF FIGURESNo. Description Page1 Layers of Skin 352 Ingredients of Kolakulathdi choorna 433 Lumbar Vertebrae 604 Lumbar disc 625 Ligaments of back 636 Muscles of back 65
  • 17. 7 Low Back Execises 968 Preparation of Pinda Potali 1059 Procedure of Pinda Sweda 106 LIST OF FLOW CHARTSNo. Description Page1 Classification of Swedana 192 Samprapti of Katigraha 27 LIST OF GRAPHSGraph Page No. Description No. 1. Distribution of 40 patients of Katigraha according to Age 117 2. Distribution of 40 patients of Katigraha according to Sex 117 3. Distribution of 40 patients of Katigraha according to Religion 117 4. Distribution of 40 patients of Katigraha according to Education 118 5. Distribution of 40 patients of Katigraha according to Marital status 118 6. Distribution of 40 patients of Katigraha according to Socio economic status 118 7. Distribution of 40 patients of Katigraha according to nature of pain 119
  • 18. 8. Distribution of 40 patients of Katigraha according to mechanism of injury 1199. Distribution of 40 patients of Katigraha according to onset 11910. Distribution of 40 patients of Katigraha according to course of pain 12011. Distribution of 40 patients of Katigraha according to loss of function 12012. Distribution of 40 patients of Katigraha according to Duration of illness 12013. Distribution of 40 patients of Katigraha according to koshta 12114. Distribution of 40 patients of Katigraha according to agni 12215. Distribution of 40 patients of Katigraha according to Prakruthi 12216. Distribution of 40 patients of Katigraha according to weight 12217. Overall Effect of Kolakulathadi Choorna Pinda Sweda on Katigraha 12718. Overall Effect of Valuka Sweda on Katigraha 13219. Comparison of effect of treatment on Pain on rest in two groups 13320. Comparison of effect of treatment on Pain on sitting in two groups 13321. Comparison of effect of treatment on Pain on walk in two groups 13422. Comparison of effect of treatment on Tenderness in two groups 13423. Comparison of effect of treatment on Lumbar flexion in two groups 13524. Comparison of effect of treatment on Lumbar extension in two groups 13525. Comparison of effect of treatment on Right lateral movement in two groups 13626. Comparison of effect of treatment on Left lateral movement in two groups 13627. Comparison of effect of treatment on Rotation in two groups 13728. Comparison of effect of treatment on Walking time in two groups 13729. Comparison of Percentage of relief in two groups 14130. Comparison of overall effect of treatment in two groups 143
  • 19. Introduction 1. INTRODUCTION Ayurveda, is a science that is widely acknowledged to be the world’s oldestsystem of health. It is not just a health care system but a complete approach to healthyliving. It offers a rich and comprehensive conception of life and health that takes intoaccount all parts of human existence, from its most abstract, transcendental value toits most concrete expressions in human physiology. In addition, it clearly upholds theintimate connection between human life and cosmic life. Panchakarma is a unique branch of Ayurveda which deals with purificationand detoxification of the body. It is unique in several senses, as this therapy is basedon eradication of the humors causing disease from the body, which no other system inthe world has addressed. This procedure of eliminating the excessively vitiated doshas are carried outin three sequential consists of three phases viz. Purva Karma, Pradhana Karma, andPaschaat Karma1. For the easy, proper, and effective administration of the ShodhanaKarma it is essential to prepare the body by specific therapeutic procedures. Thesepreliminary procedures include Deepana, Pachana, Snehana and Swedana, and arereferred by the name Poorvakarma2. Besides being the principal Purva Karma procedure, Swedana is the specifictreatment for a number of conditions especially in Vata dominant diseases whereSwedana may be a Pradhana Karma3. Charaka included Sweda Karma inShadupakrAmas shows its importance as a principal method of treatment4. In this new millennium, highly progressive and fast lifestyle has created manyproblems. Low back pain is one of mans perennial problems, a malady as widespreadas the common cold, as painful as piles and at times as crippling as a stroke. Surveysrevealed that four out of every five people around the world will be incapacitated bysevere Low back pain at some time in their lives. It has become the endemic diseaseof the age, because we lead uncongenial lives which encourage stiff joints, flabbymuscles, postural strain, tension and obesity. Katigraha is a Vataja nanatmaja vyadhi described by Sharangadhara5. None ofthe Bruhatraies have explained the Katigraha a a separate disease have considered itas a symptom in various diseases such as Arshas , Ashmari, Bhagandara etc. We findbrief description of Kati Graha as a disease with its etiological factors, symptoms,and treatment in Bhavaprakasha AmaVatadhikara6 and Gadanigraha VatavyadhiA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 1
  • 20. Introductionadhikara7. Here it is explained as a condition characterized by Shula and restrictedmovements of Kati caused by Shuddha or Sama vayu. Analyzing the samprapti reveals that the clinical manifestation of this diseaseoccures due to the morbid Vata Dosha or the combination of Vata and Kapha . As weconsidered Katigraha of Vata Kapha origin for the present study , the Snehanaprocedure by virtue of its unctuous quality is likely to worsen the imbalance ofKaphadosha. In contrast to this, sudation procedure helps in rectification ofimbalances of Kapha dosha ,and alleviation of Ama dosha. So Sweda procedurewithout prior Snehana will be beneficial in this clinical condition and thus RookshaSweda is thought for the study. Pinda Swedas is very popular among Swedana modalities. It is based on theprinciples of Sankara Sweda8 which is one among thirteen types of Sagni Swedadescribaed by Acharya Charaka. It is a process by which the whole body or aspecific part of the body is made to perspire by the application of certain heatedmedicinal puddings applied externally in the form of Pinda or boluses tied up insquare pieces of cloths . Acharya Charka has advocated the use of Pinda consisting ofTila, Masa, Kulattha, Amladravya, Ghrita, Taila, Mamsa, Cooked rice,etc.for thepurpose of Swedana but all these are having Snehana and Brumhana effect. Forachieving Rookshanatva we can use dravyas like medicated powders , excreta ofvarious animals like cow, ass, camel, pig etc. and other substances such assatushayava, pamshu, pashana loha, etc in the form of Pinda or boluses9. So in this study the efficacy of Rooksha Sweda is assessed in Vatakaphajacondition of Kati Graha . Kolakulatthadi Choorna and Valuka which are told inVatavyadhi and Amavata context respectively are considered for this, in the form of PindaSweda ,as the procedure itself is indicated in painful conditions of shleshma and medainvolvement10. The study comprises of four Sections viz –Literary review, Clinical study,Discussion and Conclusions.The first section, the review of literature is sub-classified in three chapters namely‘Sweda review’ and ‘Drug review’ and‘Disease review’The procedure Pinda Swedahas been described in detail under the heading of Sweda review’. In this chapter,historical aspect of Sweda, etymology, definition and classification of Sweda andA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 2
  • 21. Introductionalong with its indications, contra indications, action, dose, retention and SamyakYoga Lakshana and complication of Sweda are explained in detail.The details of the drugs selected for Sweda along with the description of properties ofeach ingredient in tabular form have been presented under the heading of drugreview.In ‘Disease review’ Both Ayurvedic and Modern concept of the disease have beendescribed.The second section entitled Clinical Study commences with a detailed description ofthe selection of the patients and methods adopted for this research work. Thereafter,the results obtained with statistical analysis in this study have been presented in theform of tables and graphs along with brief description of each finding.The third section entitled “Discussion” describes the logical interpretation of theresults obtained in the clinical study, based on Ayurvedic and modern principles.The last chapter summary and conclusion provides in a nutshell, the entire studyincluding conclusions derived out of it. Finally thesis has been concluded withBibliographic references and appendix.This clinical study is a sincere effort to add newer application of Sweda procedure inthe particular clinical condition. The treatment adopted here may have some edgeover the other modalities practiced in general .With this hope the present work iscarried out.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 3
  • 22. Objectives 2. OBJECTIVES OF STUDY Low back pain is the most common condition next to common cold.Epidemological studies shows that back pain is affecting nearly 60-80% of thepopulation..With the more and more automation this problem is also increasing.Eventhough it is affecting all age groups, it is the number one cause for disability inpatients younger than forty-five years of age causing more off work occasion thanmost of diseases. In Ayurvedic texts, also the Kati graha has been mentioned as a verycommon problem, charecterised by pain and restricted movement of Kati. It is amajor symptom of provoked v ta. Bruhatrayyees have not mentioned Kati graha as aseparate disease entity, but the description of the disease may be traced in some otherdisorders like Grudhrasi. Vatarakta, Ashmari etc.As vata is the causative agent,mainly Vatahara ahara, oushadha and viharas areemployed to achieve relief. Many studies are conducted on katigraha with establishedpreperations. Studies are also conducted on the effectiveness of vasti, the chieftreatment aimed in alleviating Vata dosha and thus Katigraha. Man kind has been dealing with various methods to avert pain which is themain symptom of provoked Vata , ever since its origin. Fomentation is the ancientmethod to ward off pain or at least lessen the suffering due to them. Application ofheat by various methods at a diseased site or thoughout the entire body such that itcauses perspiration is called as Sweda Vidhi in Ayurveda. Among different types of Swedana Rooksha Sweda is indicated in clinicalconditions of vitiated Vata, assossiated with Kapha and Snigdha Sveda is not thechoice of treatment11.In view of this, designed a clinical study to evaluate the therapeutic effect ofRookshasveda with Kolakulathadi choorna and valuka in Vata Kaphaja condition ofKatigraha with the following objectives. a. To study about Sweda b. Detailed study of the disease covering classical and modern literature. c. To evaluate the effect of Kolakulatthadi Choorna Pinda Sweda and Valuka Pinda Sweda in Katigraha. d. To compare the effect of Kolakulatthadi Choorna Pinda Sweda and Valuka Pinda Sweda in Katigraha.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 4
  • 23. ObjectivesPrevious researches on the same disease in various ayurvedic institutions are: 1. Pinda Sweda on Vata Vyadhies by Krishna.U.K.(1980) G.A.U. Jamnagar. 2. Keriyot S. (1995): A Study on effect of nature cure techniques in the management of Katigraha, Trivandrum university, Trivandrum 3. Bhatt M. and Singh G (1997): A clinical study on the role of Erandamoola basti in the management of Katigraha, G.A.U, Jamnagar. 4. Chavan S (2001): An observational study on the effect of Ksheera basti in Katishula,RGUHS,Mysore. 5. Sarat .K. Babu (2006) A Clinical evaluation of Kativasthi and Nirgundi Erandadi Kashaya in the management of Katigraha, RGUHS, Karnataka Banglore. 6. Vibha N R(2008): A study on yoga basti schedule In the management of Katigraha, RGUHS, Karnataka. Banglore.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 5
  • 24. Swedana Review 3. REVIEW OF LITERATURESwedana KarmaIntroduction Sweda is one of the malas described by Ayurveda. Although malas are wasteproducts in general , at times these play useful role in the body. In Ayurvedic classicsthere is a unique concept of therapeutic production or induction of sweat by a varietyof methods. This process of induction of heat in the body is termed as Swedana. In reference to Panchkarma therapy, Swedana is an important Purvakarma. Itis done to liquify the vitiated Doshas (brought about by Snehana Karma), which arespreaded throughout the body. As a result of application of Swedana, the vitiatedDoshas are made easily eradicable in the form of induction of sweating or with thehelp of Pradhana Karma such as VAmana, Virechana, Basti etc Even though, Swedana is poorva karma, it has its own entity as pradhanakarma in some diseases. The wide range of indication of the procedure shows itsimportance as principal method of treatment. Moreover Charaka included Swedakarma in Shavidhopakrmas. Thus, for samshodhana purpose, it is considered asPoorva Karma but in Sweda sadhya vyadhi it acts as the main therapy.Historical Background of Sweda Karma: It is customary, on the part of researchers belonging to various fields of knowledge, to search the Vedas, as they are the prime sources of ancient wisdom. Sweda was administered independently as one of the methods of treatment from the very ancient periods of Vedas. The most natural source of heat, for Swedana is heat rays. Imporatance of sun rays in the treatment of Hrudroga, KAmala and skin disease are described in Rig veda and Atharva veda . According to Vedas sun is the soul of all living and non-living organisms. It is the sun which gives life and heat to the whole universe. Sun bath is also recommended in the modern world also for health and prevention of diseases The works during and after the Samhitakala provide ample description on Panchakarmas and their Poorvakarmas i.e. Snehana and Swedana. Among the Samhitagranthas, Charaka samhita (1000B.C.)12 was the first to describe Swedakarma under the Shadupakramas. In this text, one can find definition, classification, indications, contra-indications and benefits of Swedana. Bhela13, considered contemporary to Charaka, had also described Swedana in detail in theA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 6
  • 25. Swedana Review Sweda adhyaya of sutrasthana. Kashyapa samhita14, written by Vriddha Jeevaka (600B.C.) did mention Swedakarma and descriptions are found with minor differences from Charaka samhita. The next book that provides equal details is Sushruta samhita15 written in 2nd century A.D. Ashtanga Samgraha16 and Ashtanga Hridaya17 had also allotted separate chapters for Sweda karma18 abcdef. . Later textbooks on Ayurveda such as Sharangadhara samhita19 and Chakradatta20 had described Swedana karma under a separate chapter, while texts such as Bhavaprakasha21, Bhaishajyaratnavali22 and Yogaratnakara23 had mentioned the utility of Swedakarma in various diseases. Derivation: • The word Swedana is derived from the root ‘Svid’ with ‘Dhy’ Pratyaya with the addition of Bhavavachaka ‘Nich’ and ‘Ach’.24 • Sweda is the Mala of Meda Dhatu and its Karma is Kleda Dharana25. Definition: • Swedana is defined as the process by which the sweat or perspiration is produced in the body by using various methods26. • Swedana is the procedure which relieves Stiffness, Heaviness and Coldness of the body and produces Sweating27. Properties of Swedana drugs28 Generally guru, teekshna and ushna dravyas induce sweating. Drugs with the Sara, Snigdha, Rooksha, Sukshma, Drava and Sthira gunas are also utilized in Sweda karma. Table No.1. Showing the properties, action and predominance of mahabhootas of Swedana dravyas:Sl. Properties Main actions Mahabhuta1 Ushna Anutsaha, moorchakrit, Swedakrit and dahakrit Agni2 Teekshna Daha-pakakara, shodhananga, sraavana Agni3 Snigdha Snehakrit, mardavakrit, bala-varnakrit Apa and Prithwi4 Rooksha Opposite to snigdha and stambhakara, khara Vayu and Agni A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 7
  • 26. Swedana Review5 Sara Anulomana, prerakata and pravrittisheela Vayu and Agni6 Sthira Chirakaritha, sthairyakara and stambhakara Prithwi7 Sookshma Sookshmachidrapraveshayogyata,vivarana Akasha, Vayu and sheelata Agni8 Guru Sada, upalepa, tarpanakrit and brimhanakrit Prithwi and Jala9 Drava Kledana, alodana, syandanakaraka JalaSwedarhas29,30,31 Table No.2, Showing conditions suitable for Sweda Karma.Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Pratishyaya + - + 30 Uru ruk / graha + - +2 Kasa + - + 31 Jangha ruk / + - + graha3 Hikka + - + 32 Kshavathu + - -4 Swasa + - + 33 Khalli + - +5 Alaghava + - - 34 AyAma + - +6 Karna shoola + - - 35 Sheeta + - -7 Manyasthamba + - - 36 Vepathu + - +8 Shira shoola + - - 37 Vatakantaka + - +9 Swara bheda + - + 38 Sankocha + - +10 Gala graha + - - 39 AyAmashoola + - +11 Ardita + - + 40 Stambha + - +12 Ekanga roga + - + 41 Gourava + - +13 Pakshaghata + - + 42 Supti + - +14 Ardita + - + 43 Nasyarha + + +15 VinAmaka + - + 44 Bastyarha + + +16 Koshtanaha + - + 45 Shodhaneeya + + +17 Vibandha + - + 46 Aahritashalya - + -18 Mutraghata + - - 47 Anupadrava - + - moodhagarbha19 Vijrimbhaka + - + 48 Samyak prajata - + -20 Parshwagraha + - + 49 Bhagandara - + -21 Prishtagraha + - + 50 Arsha - + -A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 8
  • 27. Swedana Review22 Kateegraha + - + 51 Ashmari - + -23 Kukshigraha + - + 52 Shleshma roga - - +24 Gridhrasi + - + 53 Amaroga - - +25 Mutrakrichra + - + 54 Hanugraha - - +26 Vriddhi + - + 55 Arbuda - - +27. AngAmarda + - + 56 Granthi - - +28 Pada ruk / + - + 57 Shukraghata - - + graha29 Janu ruk / + - + 58 AdhyAmaruta - - + graha (Urustambha)Sushrutha had specified that those who are fit for Nasya, Basthi and Shodhana arePoorvam Swedyas ; Ahritashalya, Moodhagarbha and Samyak prajata are PaschatSwedyas ; and Bhangandara and Arsha are Poorvam Cha Paschat cha Swedyas32. We can conclude that, in general, there are three categories of diseaseswherein Swedana is indicated – a) Vatapradhana rogas, b) Kaphapradhana rogas andc) VataKaphaja rogas33.Sweda anarhas34, 35, 36 Table No. 3. Showing unsuitable for Sweda Karma.Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Kashayanitya + - - 24 Adhyaroga + - + (Vataraktha)2 Madyanitya + + - 25 Durbala + + +3 Garbhini + + + 26 Ativisushka + - -4 Rakthapitha + + - 27 Ksheenaoja + - -5 Pithakopa + - + 28 Timira + - +6 Atisara + + - 29 Pandu - + +7 Rooksha + - - 30 Kshaya - + +8 Madhumeha + + + 31 KshAma - + +9 Vidagdhabradhna + - + 32 Ajeerna - + -10 Bhrashtabhradna + - + 33 Chardi - + -11 Visha + + - 34 Moorcha - - +A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 9
  • 28. Swedana Review12 Madyavikara + - + 35 Stambhaneeya - - +13 Shrantha + - - 36 Visarpa - - +14 Nashtasamjna + - - 37 Kushta - - +15 Sthoola + - + 38 Peeta dugdha - - +16 Pithameha + - - 39 Peeta Sneha - - +17 Trishna + + + 40 Peeta dadhi - - +18 Kshut + - + 41 Peeta madhu - - +19 Krodha + - + 42 Krita virechana - - +20 Shoka + - + 43 Glani - - +21 KAmala + - + 44 Bhaya - - +22 Udara + + + 45 Pushpitha - - +23 Kshatha + - + 46 Sootha - - + Reasons for the excemption of these diseases from Swedana have beenexplained by various acharyas. Sushrutha stated that if Swedana is performed inconditions where it is contra-indicated, either the body gets destroyed or the diseasesprogress to incurable stage. He also permits the performance of Swedana in Durbalaand Ajeernabhaktha, if their vikaras are curable only by Swedana37. Chakrapani, commenting on the verses of Charaka, says that kashayanityasbecome Rookshas and atistabdha gatras; hence, the Swedana if performed causesparvabheda. Also persons suffering from rakthapitha, pithameha, kamala etc. andpittaprakriti persons are excempted from Swedana even prior to shodhana as it maycause further pittakopa. Madhumeha persons develop shareera shaithilya and in sucha condition, Swedana is contra indicated.38Arunadatha, commenting on the verses in Ashtangahridaya, states that Swedana ifdone to an atisthoola person causes medovilayana resulting in shareera kshobha. ForRooksha, durbala, kshataksheena, kshama etc. Swedana may cause extremeemaciation. A person having good appetite if undergoes Swedana suffers fromdehaglani. In Kamala and pandu rogas, the Swedakarma causes pitta vidradhiresulting in roga vridhi. In garbhini, the Swedana induces gabrha vyapat. Forpushpitha ladies, it causes excessive bleeding. For sootha, it causes emaciation39.Vagbhata had opined if these conditions are atyayika, then mridu Sweda can beperformed40.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 10
  • 29. Swedana Review In general, we can conclude that Swedakarma is contra-indicated infour conditions: – (1) pitta, (2) raktha, (3) durbala avastha and (4) Sweda asaha.Also it is to be noted that Swedana can be performed in mridu mode if theseconditions are Sweda eka sadhya.Classification of Sweda Several types of classification of Sweda are made with different points of view. Dvividha Sweda • Based on Agni bheda41 a) Sagni (Thermal) b) Niragni (Non-thermal). In AgneyaSweda, body is exposed to heat. This is done by various methods as propogated by many eminent authors. Usually, heat is applied directly from fire or by using various types of mediators. In anagneyaSweda, sweating is effected without using external heat, by some specific physical and mental adjustments; more heat is produced which is sufficient to induce sweating. These are ten in numbers. • Based on Guna42 (A) Snigda (B) Rooksha SnigdaSweda is indicated in Vata rogas, whereas Rooksha is indicated in Kapha rogas. He also recommends snigda-Rooksha Sweda combined by adjusting medicine in Vata-Kapha rogas. • Based on the area of application43 (A) Sarvanga or general (B) Ekanga or local SarvangaSweda is done for the purpose of shodhana and in most of the Vata rogas, whereas ekanga Sweda is usually done in mild diseases affecting a small part of the body• Based on the goal of treatment44 : (A) Samshodhaneeyam (B) SamshamaneeyamSamsamana Sweda used for the purpose of Dosha Pachana (digestion of AmaDosha)A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 11
  • 30. Swedana Reviewin Sama Dosha. It improves the power of Agni, skin becomes tender and delicate andit does Srotoshodhana (cleansing effect ofmicrocirculatory channels).Samshodhana Sweda isused after Snehapana as premedication for shodhana karmalike Vamana, Virechana etc.. The main object of this Sweda is to bring unctousDoshas from Shakhas to Kostha from where the vitiated doshas are expelled out fromthe body easily. • Based on route of application.45: 1. Bahya Sweda – External fomentation 2. Abhyantara Sweda – Internal fomentationThrividha Sweda46 According to the intensity of heat, and action of Swedanakarma, it can be classified under three headings185 (A) MahanSweda (B) MadhyAmaSweda (C) MruduSwedaIf the patient is strong, doshas are excessively aggrevated and season is very cold,maximum dose of Swedana should be given. If these conditions are moderate, thenmoderate dose of Swedana and if the above said conditions are mild mrudu Swedanahas to be given. Again, the intensity of Swedana is to be adjusted when it is done at certainparts of the body. Eyes, heart, testes, etc. have to be protected from intense heat. IfSwedana is essential in these organs, only the minimum heat is to applied. In Greevaand Vamkshana, moderate heat and in all other parts of the body and when a strongelimination is needed, heat can be applied in maximum dose, if necessary.Chathurvidha Sweda47,48Sushrutha and Vagbhata has got unique opinion regarding the classification ofSwedana.The 13 varieties of Sweda prescribed by charaka and 8 varieties of Kasyapa, Bhelaand Astanga sangraha are included in this 4 varieties of Swedana karmas. Thisclassification of Swedana, is based on the method of administration and the nature ofheat produced.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 12
  • 31. Swedana Review 1. Thapa Sweda: The source of heat in thapa Sweda is obtained directly from fire. The device used for heating the body are dry and rough and sometimes hard, according to the condition and availability of the things. The commonly used materials are cloth, palm of the hand, bricks, bran, sand, soil etc. Dalhana includes Jenthaka Sweda, Karshoo, Kudee, Kupa and holaka Sweda in the category of thapa Sweda. 2. Upanaha Sweda: Dalhana describes the word meaning of upanaha as bandhana or bandage. The word ‘nahu’ means to ‘bind’. The word upanaha derived from the above said dhatu. Sushrutha gives a detailed description from upanaha Sweda. Charaka acharya has not mentioned upanaha. Vatahara Dravyas are made into poultice blended with salt and Sneha and amla dravyas, suitable for the condition of the patient. Then heated into moderate heat and applied on the body with the aid of a bandage like Vatahara patras, woolen cloth or leather. Usual retension time is 12 hours and removed afterwards. Upanaha Sweda is mainly recommended for Vataja rogas having pain and stiffness . Another method of upanaha Sweda is Pradeha. Here warm poultice is applied without a bandage and has to be repeated after removing the dried poultice – preparation is the same as upanaha. Dalhana includes potala Sweda (one method of sankara Sweda) in upanaha. He accepts potala with Shastika rice, meat etc 3. Ushma Sweda: Dalhana gives the commentary on ushma as baspa ie., vapour. Sushruta acharya describes the method of Ushma Sweda as follows: o Red hot iron balls, stones and other metals are immersed in amla dravyas or Vatahara decoctions and heated and the vapour generated by this method is allowed to contact the patient’s body so as to get perspiration. o Snighda Dravyas like soup, milk, butter milk, kanjika decoction etc. are boiled and the vapour is used for Swedana by direct contact from the jar or through tubes. o Another method is by Prasthana Sweda, and the fourth method is sankara Sweda and potalas.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 13
  • 32. Swedana Review 4. Drava Sweda: In Drava Sweda, the common devices for sweating is warm liquids like hot water, decoctions amla dravyas, various types of Sneha dravyas etc. there are two types of drava Sweda. 1. Parisheka or shower method 2. Avagaha or hot bath In Parisheka moderately heated liquids are taken in convenient pots andallowed to flow continuously through the patient’s body from a moderate height.InAvagaha patient is suggested to sit in the warm liquid whether decoction or Snehas,the level of water being 5 angulas above the umbilicus. In Bhela Samhita there are 4 types of drava Sweda. Seka,droni, jalam andudakostham. Here Droni level is upto the neck. If warm water is used for jala Swedaudakoshta is same as avagaha.Sapthavidha Sweda49 Hareetha Samhitha mentions about seven types of Sweda as Loshta Sweda,Bashpa Sweda, Agnijwala Sweda, Ghatee Sweda , Jala Sweda, PhalaSweda.Ashtavidha Sweda• On the basis of applicability in children Kashyapacharya describes 8 varieties of agneyaSweda 50. 1. Hasta Sweda – Giving Swedana by applying heated palm over the body parts. 2. Pradeha - Inducing Swedana by the application of luke warm paste. 3. Nadi Sweda – Giving bashpa Sweda on the body part with the help of nadiyantra. 4. Prastara Sweda – Inducing Swedana by applying Swedana dravyas on a surface and the patient is made to lie down on that. 5. Sankara Sweda – Giving Swedana to a particular body part by using a potali filled with Vatahara dravyas. 6. Upanaha Sweda - Inducing Swedana by bandaging the paste of Vatahara dravyas on the affected part. 7. Avagaha – Immersing the affected body part in the dravadravya and inducing Swedana. 8. Parisheka – Sprinkling the lukewarm dravadravya on the affected body part.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 14
  • 33. Swedana Review According to Bhela Samhita, there are 8 types of AgneyaSweda. Sankara51 – Sudation due to a miscellaneous mixture 1. Prastara – Sudation on bed . 2. Nadi – Tube sudation . 3. Sekam – Sudation by drip. 4. Droni - patient is directed to sit in a boat like tub which can hold the luke warm dravadravya upto his neck, as expansive as to hold a person, leak- free and even-floored till he sweats profusely . 5. Jalam - pouring luke warm clean water with or without a smaller vessel on the properly uncted body 6. Udakoshtam- The person to be sudated is made to enter in a big basin filled with dravadravya up to the half and then get sudated. 7. Kutee – Sudation by entry into a special sudation hut. In Ashtanga Sangraha, Ushma Sweda is again divided into 8 varieties52 -Pinda Sweda, Samstara Sweda, Nadi Sweda, Ghanasma Sweda, Kumbhi Sweda,Kupa Sweda, Kuti Sweda, jentaka SwedaDasha vidha Sweda53Anagni Sweda is of ten types as :1. Vyayma – Exercise2. Ushna Sadana – Indwelling in a warm chamber3. Guru Pravarana – Wearing of heavy clothing4. Ksudha – Hunger5. Bahupana – Excess drinking6. Bhaya – Fear7. Upanaha – Application of poultice8. Krodha – Anger9. Aahata – Wrestling10. Atapa – Exposure to sun raysA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 15
  • 34. Swedana ReviewTrayodashavidha Sweda54 : Depending on the types of these devices, AgneyaSweda is classified into 13varieties, by Charakacharya.157Sankara Sweda: Sankara Sweda refers to application of heat by using the heated packs. Herepacks are prepared by pounded plant parts or boiled grains tied on a piece of clothpacks are then heated in boiling decoction or oil. Such warm packs are used forapplication of heat to the parts of the body diseased. This procedure is ideal forapplying heat to a portion of the body.Prastara Sweda: Application of heat by making the patient to lie down on a heated marble slabwith his body covered by a blanket is known as prastara Sweda. In this procedure firstmarble slab is heated by spreading boiled grains. size of the slab should be adequateto accommodate the patient in supine position. When the heat in the slab is tolerable,grains on the surface of the marble is covered with a silk cloth or leaves of eranda,and the patient is made to lie down on this slab with his body covered with a thickblanket. This induces sweating.Nadi Sweda: Here steam from a boiling decoction is passed on the diseased parts of thebody. And this is possible by using the unique instrument meant for this.Parisheka Sweda: Warm infusions poured on the body parts that are diseased and this procedureis known as parisheka Sweda. For this purpose dhara yantra described in shirasekamay be used.Avagaha Sweda:Warm infusions is filled into a bath-tub and the patient is made to sit in this tub for aprescribed period. This is ideal for inducing perspiration in whole body.Jenthaka Sweda: It is performed in a room specially build for this purpose. Inside this roomthere will be facility for burning the medicinal plants and space for resting for oneperson. Initially the medicinal plant is burnt to make the room. When all the smokein the smoke is cleared, patient is allowed to stay in the room for certain period withA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 16
  • 35. Swedana Reviewhis body covered with a thick blanket. In this type of Sweda whole body is exposed toheat.Ashmagna: As the name itself indicates here the Swedana in performed on a human sizemarble slab. Initially selected medicinal plants are burnt on this slab. When the slabis heated to adequate temperature the fire is extinguished by sprinkling water. Thenthe surface of slab is clean and a silk cloth is spread on the marble slab. Now thepatient is allowed to lie on this warm slab with his body wrapped by a thick blanket.Warm slab as well as steam from the slab induces sweating in the patient.Karshu Sweda: A pit in the ground specially built with a narrow mouth and wide base isrequired for this form of Swedana. First, medicinal herbs are burnt inside this pit, anda cot is placed over this pit. The cot must be such that its surface is made up of ropesand has plenty of small rents. The patient is asked to lie down on this cot covering hisbody with a thick cloth. Steam emitting from this pit passes through the cot as wellas patient and thus induces sweating.Kuti Sweda: This is another form of Swedana where a special room exclusively built forthis purpose it is utilized. It’s a small room adequate to accommodate one patient anddevoid for ventilation. Walls of the room are pasted with thick paste of medicinalplants. The patient is lie down on a cot placed on the centre of room, with his bodycovered with a thick blanket. Simultaneously red-hot coal of burnt of medicinal plantis put in an iron vessel placed near the cot. In this heated room causes perspiration inthe patient.Bhu Sweda: In a breeze fire area, human height length of the ground is selected. And thesurface of which should be leveled well. In such a surface medicinal plant are firstburnt and when ground is adequately heated the fire is extinguished by sprinklingwater. The ground is cleaned and the patient is asked to lie down on small ground.His body is wrapped with thick blanket. The heat and steam from the ground inducesperspiration in the patient.Kumbhi Sweda : Kumbhi means a pot, here a pot is used for Swedana purpose.Hence known as kumbhi Sweda. A large pot is taken and half of it is buried in theA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 17
  • 36. Swedana Reviewground. Above this a cot is placed. This cot should have surface made of rope and fullof rind. Warm decoction is filled into the pot. Patient is made to lie down on the cotwith his body draped with thick cloth. Then an iron ball is heated to red and dipped inthe decoction in the pot. This generates steam and which passes across the patientlying on the cot. Thus the heat induces perspiration in the patient.Kupa Sweda: Here a pit of the size of a cot is made on the ground in an area where there isno breeze. This pit is known as kupa. This pit is filled with medicinal plants and thenburnt. When it gets completely burnt as evident by red charcoal and no smoke iscoming out, a cot is placed over this rectangular pit. Once again the surface of the cotshould be made of ropes and should be full of rinds. The patient is made to lie on thecot and his body is draped with a thick blanket. The heat from the pit reaching thepatient on the cot induces inspiration. This is known as kupa Sweda.Holaka Sweda: In an oven medicinal plants are burnt. When the heat is still radiating, a cot isplaced over this oven. It should have plenty of rinds on its surface. Patient is asked tolie on this cot and patient’s body is draped with a thick blanket. Perspiration can beobserved in the patient’s body when he is kept in this position. Dalhana had included jentaka, karshu, kuti, kupa and holaka are tapa Swedas ; sankara, prastara, ashmaghna, nadi, kumbhi and bhu are ushma Swedas55.Charaka’s classification on Agneya Sweda is based on the method of administrationof Swedana karma whereas, Sushrutacharya and Vagbhata give stress on the nature ofheat produced.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 18
  • 37. Swedana ReviewA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 19
  • 38. Swedana ReviewAccording to different types of classifications, the PindaSweda (for the present study)may be put under following groups: I. According to Agni Bheda : it is SaagniSweda II. According to SthaanaBheda : Ekanga. III. According to GunaBheda : Rooksha Sweda IV. According to Roga And RogiBala : MadyAmaSweda V. According to Taapaadi 4 Bhedas : UshmaSweda VI. According to Sankaraadi 13 types : SankaraSweda ie Rooksha SankaraSweda VII. According to SamshAmana and Samshodhanaangabhoota Bheda :SamshAmaneeyaSwedaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 20
  • 39. Swedana Review Rooksha Sweda As we are making use of the Rookshaguna of the drugs in this present study,itis essential to know about Rookshana Karma.RookshanaCharaka encompasses the therapeutics into 6 categories popularly termed asShadvidha upakrAmas namely Langhana, Brumhana, Rookshana Snehana, Swedanaand stambhana56.This is the generic classification of all possible actions that a physician uses to treat adisease. The classical concept of Shadvidhopakrama described by Charaka, not onlyincorporates the Panchakarma measures but encompasses the entire therapeuticstrategy and philosophy. Charaka claims that by appropriate use of these Upakramas all Sadhyacategories of ailments can be cured. They should be used in consideration of theindividual and environmental factors57 An Ayurvedic physician is expected to know in depth the science and art ofthese six UpakrAmas. Charaka states that in treatment principles there is nothingbeyond these six fold methods for the treatment of a disease in the same way, as thereis nothing more important than the Tridoshas in the genesis of a disease58. 59Vagbhata classified Chikitsa into Santarpana (Bramhana) and Apatarpana(Langhana) .Santarpana includes – Bramhana, Snehana, and Stambhana.Apatarpana includes - Langhana, Rookshana, Swedana . Thus it appears that these UpakrAmas form the basic approach of medicaltreatment and all other measures described elsewhere are directly or indirectlyincorporated under this broad doctrine of treatment categories.Rookshana is an Apatarpana Chikitsa specifically used in the treatment ofSantarpanotha Vikaras. It can be achieved by Internal administration of food, drinks,medicines and external therapies like Udvartana, Lepa and different types of Swedas .Nirukti (Etymology) Rookshana means making thin, attenuation. Medical treatment for reducing fat or corpulence (Monier Williams). Rookshana word comes from Rooksha.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 21
  • 40. Swedana ReviewRooksha – • Ruh - kus, Aprema, Achikkane Nisnehe Katore cha – Amara • Parushye Katorathayam Nisnehe cha - KavikalpadrumaDefinition That which causes dryness, roughness and non-sliminess is Rookshana. Chakrapani says that Rookshana is achieved by the absence of Sneha.Drug selection criteria for Rookshana Rookshana is mainly achieved by Sneha Abhava. It is Rooksha GunaPradhana Karma and Dravya Karya is very important here. Rooksha, Laghu, Khara, Tikshna, Ushna, Sthira, Apicchila, Katina are theGunas of Rookshana. While explaining Rookshana Guna Vagbhata says VipareethaGunas of Snehana should be considered60.Table - 4 Therapeutic actions of Rookshana Guna Pradhana Pramukha Action on Guna Mahabhuta Karma Dosha Vatakara Rooksha Vayu, Agni, Prithvi Shoshana Kaphahara Vatakara Laghu Akasha, Vayu, Agni Laghuta Kaphahara Khara Vayu, Prithvi, Agni Lekhana Vatakara Pittakara Tikshna Agni Shodhana Kapha Vatahara Kshalana Vayu, Prithvi, Agni Kledachushana Apicchila Akasha Ropana Kaphahara Sthira Prithvi Dharana Kaphakara Katina Prithvi Drudeekarana Vatakara Sandra Prithvi Prasadhana KaphakaraConditions suitable for Rookshana61,62. Abhishanna – Drava Pradhana Shleshma Vikara like Prameha. Mahadosha – Kapha Vriddha state of Bahudosha like Prameha, Udara etc. Marmastha Vyadhi like Hridroga Kaphasthanagata Vikara Urusthamba, AdyaVata, PramehaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 22
  • 41. Swedana Review Ati Snigdha Krimikoshta person Sneha VyapathRookshana Karma is indicated as Purvakarma before administration of Snehapana forShodhana in conditions such as Mamsala (Upachita Mamsa), Medura (Medasvina),Bhurishleshma, and VishAmagni because they are Sneha Satmya persons. If it is notperformed then it results in Snehavyapad. In Sneha Satmya condition if Snehapanaadministered then there will be Anuthkleshana. Here Pachana is indicated i.e. nothingbut Rookshana.Unsuitable condition for Rookshana: Rooksha Nithya, Krusha persons, Vyayami, Deeptagni, Udavarta, VatajaKasa, Shosha etc63.Classification:Based on mode of administration Rookshana can be broadly classified into two:1. Bahya Rookshana 2. Abhyantara RookshanaAbhyantara Rookshana can be achieved by administering Pana – Takrapana , Anna– Yavanna , Beshaja – Triphala Kvatha, Takrarishta etc. and Beshaja UpakrAma –Rookshana / Lekhana Basti.Bahya Rookshana can be achieved by doing Udvartana, & different Sw edamodalities devoid of prior Snehana .RookshaSwedaSwedana is considered to be of two types depending upon the character of thesubstance used for the Swedana procedure. Induction of pperspiration by using theheated oily substances like oil or ghee is popularly known by the name SnigdhaSweda. Also application of heat to any part of the body following abhyang procedureis called by the name snigdha Sweda. Contrary to this,employment of Swedanaprocedure using heated dry substances like Sikata, Pashana ,Kareesha, Thusha, etc isreferred as Rooksha Sweda. Here any type of Snehana is not preferred prior to theapplication of heat.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 23
  • 42. Swedana ReviewVarious instances where Rooksa Sweda is indicated are In Kaphavihitha conditions Rooksha Sweda is beneficial64. Mruttika Sweda, is described in the management of shoola65 Valuka Sweda is advocated in Sannipatajvara66, Trikashoola67,& AmaVata.68 Swedana usingIshtika,loha,Goshakruth, Thusha,Pamshu etc after griding them with cows urine is advocated in shleshma vidradhi69 Ishtika Sweda is also advocated in Gulma70. Pinda Sweda with various combinations of drugs are advised in the management of shotha71.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 24
  • 43. Swedana Review PindaSweda Pinda Swedas is one of the most popular therapy of Panchakarma It is based on the principles of Sankara Sweda which is one of the thirteen saagni Sweda procedures described by Charka Samhita. Pinda Sweda is a process by which the whole body or a specific part of the body is made to perspire by the application of certain heated medicinal puddings applied externally in the form of Pinda or boluses tied up in square pieces of cloths. The technique is a combination of Snehana (oelation), mardana (massage) and Swedana (fomentation). Pinda Sweda will come under Sankara Sweda of Charaka and Kashyapa & Ushma Sweda of Sushruta and Vagbhata. It is of two types viz., Snigdha and Ruksha.• Sudation is done with the boluses of the seeds of tila, masha, kulatha mixed with amla dravya, ghee, taila, mamsa, odana, payasa and krishara is called as Snigdha Pinda Sweda. It is specially indicated in Vata rogas.• Sudation with the excreta of various animals like cow, ass, camel, pig etc. and other substances such as satushayava, sand, powder, stones, dry cow dung cake, iron powder etc. is called as Rooksha Pinda Sweda, which is indicated in Kapha rogas. As this study is on a major technique of Pinda Sweda, it will be relevant to describe in brief other techniques of Pinda Sweda too. The following Pinda Swedas are being practiced commonly:- 1. Shashtikashali PindaSweda72 Inducing perspiration by using heated boluses of rice is referred as Shashtikashali Pinda Sweda. This belongs to the category of AgniSweda and considered as Snigdha Sweda. Here Shashtika shali refers to the rice that grows in60 days. This rice is used in the procedure and hence the name Shashtikashali Pinda Sweda.This is also popularly known as NavaraKizhi. This is an effective procedure of Swedana and is ideal in healthy individuals ,in children and also in those suffering from illness due to morbid Vatadosha. 2. Patrapotali Sweda73 The process of sudation using a bolus of chopped leaves is called Patrapotali. Sweda. Patras of arka, eranda, shigru, nirgundi, karanja, chincha etc. are taken in equal quantity and cut into small pieces. Coconut scrapings and citrus fruit can also A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 25
  • 44. Swedana Review be mixed together with the patras. This mixture should be roasted in suitable taila (e.g. Bala taila, Masha taila, Nimba taila etc.) and bolus should be made. The drava in which the bolus is heated may be dhanyamla, gomutra, Vataharakashaya etc. The bolus of the contents should be changed daily or at least once in three days.. Indications are prasupthi, kampa, angAmarda, pakshaghata, askhepaka, gridhrasi, sandhigataVata, kateeshoola etc.2. Choorna PindaSweda74 Details of this process will be discussed in the methodology chapter as this study deals specially about Choorna PindaSweda. This is performed with boluses of medicinal powders and is also known as ‘Podikkizhi’ (common name). Powders of rasa, ashwagandha, sarala, shunti, vacha, shigru, devadaru, sarshapa, kola, kulatha, masha, godhuma, mudga, tila etc has to be taken and added saindhava lavana. Each has to be taken 10 gms and 30 gms of coconut scrapings and 2 or 3 pieces of citrus fruits can also be added. These powders and other items well mixed are to be fried in suitable oils and made into two boluses. The procedure and duration are same as the patrapottali Sweda. This procedure is the snigdha variety of choorna Pinda Sweda. The Rooksha variety of choorna Pinda Sweda is also common. Powders of kulatha, tusha etc are fried in iron pan along with saindhava lavana without oil and then made into bolus. Snigdha choornaPindaSweda is indicated in Vatarogas like apabahuka, gridhrasi etc. and Rooksha choornaPindaSweda is indicated in saAma-Kaphanubandha Vatarogas like AmaVata. 4.Valuka Sweda75 In this the bolus is prepared of sand. This is a typical Rooksha Sweda indicated in AmaVata, Vatarakta, urustambha etc. Here, the sand can be fried in dhanyamla along with saindhava lavana. Much care should be taken in testing the heat of the bolus and only moderate heat should be applied. 5.Tusha PindaSweda76 It is a process by which the bolus is prepared by the husk of the paddy. Husk of the wheat also can be used. It is a household practice in our country in swasa and kasa. 6. Jambeera PindaSweda77 Drugs used in this are jambeeraphala, saindhava lavana, and fried powders of methika, kulatha, haridra and shatapushpi. 10 citrus fruits of big size should be cutA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 26
  • 45. Swedana Review into the small pieces and 30 gms of haridra choorna and 5 gms of saindhava is added and fried in suitable oil and made into bolus. It is beneficial in pakshaghata, apabahuka, sandhi gataVata, bhagna etc. 7. Mamsa PindaSweda78 It is similar to ShashtikashaliPindaSweda. If mamsa is alone made into bolus, the drava dravya for cooking and heating is mamsa rasa. If mamsa is used along with shashtikashali, balamoola kwatha along with ksheera are the drava dravyas for cooking the mamsa and shali and also for heating the bolus. Meat of goats, hen, pig, peacock etc. are generally used. It is mainly indicated in emaciation (Shosha) prominent conditions such as atrophy, dystrophy, myopathy, pakshaghata, balaVata etc. It arrest the premature aging, promotes the growth, tonicity and strength of muscles. 8. Kukkutanda PindaSweda79 Egg yolk of hen is used for this technique. Two lemon fruits are taken and cut into pieces. It is mixed with three boiled egg yolks and fried in suitable oils and made into bolus. It is beneficial in ardita, greevagraha, hanugraha, apabahuka etc. 9. MashaPindaSweda80 Here, instead of Shashtikashali, masha (Phaseolus radiatus) is used and the procedure, duration and indications are similar to Shashtikashali PindaSwedaa. 10. GodhumaPindaSweda Here, instead of Shashtikashali, godhuma (wheat) is used and the procedure, duration and indications are similar to ShashtikashaliPindaSweda. 11. Haridradi PindaSweda81 This is specially indicated in Kshata (Trauma). Here, haridra choorna and laja choorna are taken in more quantity and sarja choorna, jeeraka choorna and manjishta choorna in less quantity. The white part of two boiled eggs is mixed thoroughly with these powders and the end product is used as a bolus. 12. DhanyaPindaSweda82 Fried powders of masha, mudga, tila, sarshapa, shashtikashali, kulatha, methika, shatapushpa and eranda beeja are made into bolus. Also, these can be cooked in milk squeezed from coconut scrapings and made into bolus and used instead of shashtikashaliPinda.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 27
  • 46. Swedana ReviewGeneral procedures of Swedana The complete process of Swedana karma can be divided into various stepsaccording to the method of administration. 1. Poorva karma 2. Pradhana karma 3. Paschat karma1.Poorvakarma :In poorva karma there are certain points to be noted carefully. a. Collection of materials(Sambhara samgraha) b. Evaluation of the condition of the patient and disease(Athura pareeksha) c. Immediate preparation for Swedana karma.a. Collection of materials: It is important to decide the type of Swedana in that particular division. Then collect materials and equipments for that particular type of Swedana. Precautions regarding any complication which may occur on the way of Swedana karma also must be taken into account and medicines are collected for the same.b. Evaluaton of the patient and disease: For a successive Swedana karma the following points are to be considered. 1. Disease : Even if the disease includes in the list of indications the stages of dosha kopa is to be noted carefully. For instance snighda Sweda is contraindicated in the Ama stage of any disease and this may adversely affect the patient. Types of Swedana varies with the diseases. Eg. Wastig diseases snighda Sweda, mootra kruchra, back pain etc avagaha and so on. 2. Ruthu or Climatic condition: For every treatment in ayurveda, the atmosphere must be clear. An extreme climate is unfit for any treatment especially for Swedana karma, because extreme cold inhibit Swedana and the extreme hot over tax Swedana which may exhaust the patient. In seethe ruthu mrudhu Sweda is indicated. In short for Sweda karma sky must be clear. 3. Patient: Before Swedana karma general condition of the patient must be checked. Only after assessing the condition of the patient the type of Swedana and its intensity duration etc are decided.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 28
  • 47. Swedana Review The patient may have ample health and vitality to withstand the effect ofSwedana. Precautions must be taken to take care of the eyes, heart, testis etc. fromexcessive haet during Swedana. Age of the children is also important, senile anddebilitated patients are unable to withstand the action of heat. So it must be adjustedaccording to the condition of the patient. After keeping in mind all these above mentioned factors the patient is takenfor the immediate preparation for Swedana. If Swedana is for shodhana, Snehana is tobe done till he attains samyak snigdhata. In all cases except in some stages of Ama,external application of Vata hara Sneha is essential. Oil is applied on head and ears.Then anoint the body with warm Vatahara taila. Before it must make sure that theprevious days food is digested completely.2.Pradhana Karma of Swedana: The patient is taken to the equipments after his remote and immediatepreparations. Heat is applied on the body with the prescribed devices according to thenature of Swedana by changing his positions if essential as to that particular type ofSwedana. • All the Swedana Karmas are to be done in a person whose last meal has been well digested and in a place which is free from wind. (except in cases of Nava Jvara etc.).83 Following points should be taken into consideration • Patient’s eyes should be protected by covering them with lotus leaves etc. • Heart region should be kept cool by the local application of cool substances84. • The heart region, testis and eyes should receive very low degree of Swedana or it should not be applied to them at all85. • Groins and lower abdomen should receive moderate Sweda86. The most important thing in Swedana is a scientific observations of the patientduring Swedana. This includes the following points: Temperature of dravyas. Change in body temperature, pulse rate of respiration. Nature of sweating Total time taken Manifestation of signs and symptoms which are favourable and unfavourable.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 29
  • 48. Swedana Review Temperature must be adjusted to the enduring capacity of the patient. Care mustbe taken to keep the temperature constant throughout the process by heatingrepeatedly. When the patient sweats profusely note for samyak lakshana. Oversweating may be manifested as burning sensation, unconsciousness, urticaria etc.3.Paschat Karma in Swedana:After attaining the signs of proper sudation on the body is cleaned by suitable devicesand allowed to rest for a time. During this time sweating is continued till his bodytemperature comes down. When sweating is subsided, fresh warm oil is applied onthe body and medicated taila on head. Then a hot water bath is given by hisattendants87. When he feels hungry he may be given some light liquid diet. All restrictionsshould be fully observed during the course of treatment with regard to diet as well asphysical and mental exertion. For washing purpose warm water alone should be used.Suppression of natural urges, physical and mental excitement etc and exposure tocold, sun, wind, smoke or dust also should be avoided. It is advisable to use pillowwhich is neither high nor very low during sleep at night. He should wear clean drycloths. Diet must be relishing, easily digestible and taken at regular intervals. Foodmaterials that are liquid in form, hot and those that do not cause vidaha should beprepared as far As possible. Food stuffs that are too spicy or the acid should also beavoided. A well balanced diet with proper amount of nutrient s is most necessary.Samyak Swinnalakshanas88a,b,c Table No.5. Showing the lakshanas observed after samyak Swedana Sl. Lakshana C.S. S.S. A.H. 1 Seetha vyuparAma + - + 2 Shoola vyuparAma + - + 3 Sthambhanigraha + - - 4 Gouravanigraha + - - 5 SanjathAmardava + + + 6 Swedasrava - + - 7 Vyadhihani - + - 8 Laghutva - + - 9 Seetharthiva - + -A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 30
  • 49. Swedana Review Among these shoola vyuparAma, sthambhanigraha, gourvanigraha, laghutva, mardava and vyadhihani are not evident immediately after Swedakarma every day, but manifest after the total course of proper Swedana. Sheeta vyuparAma, Swedasrava and seetharthitva are to be observed daily at the end of Swedakarma daily.Aswinnalakshanas If the Swedana performed is not sufficient or proper, then the lakshanas opposite to the samyak swinnalakshanas occur. Dalhana adds that heaviness of the body, ushnabhilasha and hardness of the body also occur. He has stated that mithya swinna means both alpa swinna and mithya swinna (improper sudation) and that vyadhi vridhi also occurs89.Atiswinnalakshanas90a,b,c. If the Swedana performed is in excess, it leads to many complications. Table No. 6. Showing the Atiswinna lakshanas on the patient. Sl.no Lakshana C.S S.S A.H 1 Pitta prakopa + + + 2 Murcha + + + 3 Shareerasadana + - - 4 Trishna + + + 5 Daha + + - 6 Swaradourbalya + - + 7 Angadourbalya + - + 8 Sandhipeeda - + + 9 Sphototpathi - + - 10 Rakthaprakopa - + - 11 Bhranthi - + - 12 Vidaha - + - 13 KlAma - + - 14 BhrAma - - + 15 Jwara - - + 16 Syava-raktha mandaladarshana - - + 17 Chardi - - +Management of Atiswinna Charaka advises the adoption of greeshma ritu charya along with consumptionof madhura-snigdha-seetha aharas and to follow snigdha-seetha upacharas91 . Thisincludes consumption of sasharkara mantha, jangala mriga-pakshimamsa, ghee, milkand shashtikashali. Madya should be avoided. Ahara dravyas with lavana, amla, katuA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 31
  • 50. Swedana Reviewand ushna properties and viharas such as vyayAma should be avoided. Patient shouldlive in seethagriha during the day and in the room cooled by moon rays in the night.Seethadravyas like chandana can be applied over the body. MukthAmani dharanaalso can be done. Patient can also be taken to cool forests and ponds. He/She shouldnot indulge in intercourse92. Sushruta says that all kinds of seetha upachara should beperformed immediately93. Vagbhata had advised the adoption of stambhana chikitsa in case ofatiswinna94. Drugs, which are having the properties of laghu, manda, seetha, slakshna,Rooksha, sookshma, sura and drava and having tiktha-kashaya-madhura rasas, arestambhana oushadhas. These are to be administered internally and externally toprevent further complications of the patients.Benefits of Swedana :1. Dosha DraVatam – Oleation therapy administered before Swedanakarma makesvitiated Doshas soft and removes Malasangata (Sroto- Avarodha due to stagnantMalas). Sudation therapy employed afterwards liquefies the vitiated Doshas anddirects them towards Kostha. Sudation Karma applied at this stage helps in expellingDoshas from body through Emesis or through Urination or with Sweat.952. Vata NiyAmana – If proper Sudation is administered after Oleation therapy, ithelps to facilitate the elimination of faeces, urine and semen from the body. Properregulation of Vata Dosha is important as it is the main factor responsible forcontrolling various activities of the body96.3. Gatra VinAman - With the administration of proper Oleation and Sudationtherapy, the body becomes soft and it attains elasticity. As a result, it helps in bendingof the body without any difficulty for performing various activities974. Agni Deepana – Ushna and Tikshna properties of Swedana Karma help indigestion of Ama Dosha, which results in stimulation of all the 13 types of Agni98.5. Tvaka Mardava and Prasadana – Skin contains a lot of sweat glands, whichwhen activated through Swedana therapy excrete various toxic substances of the bodyin the form of sweat. As a result the skin becomes soft and its texture improves99.6. Bhakta Shraddha – Swedanakarma improves appetite due to Ama Pachana andSrotosodhana100.7. Srotosuddhi – Sudation therapy induces Srotosodhana by opening the mouths ofA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 32
  • 51. Swedana Reviewsweat glands and by regulating Vata Dosha. As a result stagnant Malas, Sweda andVarious toxins are eliminated out of the body resulting in Srotosuddhi101.8. Nidra-Tandra Nasha - Due to induction of Sweda in the body, excessiveproduction of Nidra and Tandra is controlled largely because of fact that the bodycontents of Mala, Kapha and heaviness in the body are reduced after Sudation, whichare the key factors for inducing Sleep (Nidra) and Drowsiness (Tandra)1029. Sandhi Chesta – It is improved by inducing Sweda because joint activity isregulated by presence of Vata, Kapha and Ama at joints level. Swedana increasesDhatvagni at the level of joints, thereby improving joint functions103.10. Dosha Shodhana – Oleation therapy produces kledana of Doshas which areliquefied with the administration of Swedana. These liquified Doshas are brought intoKostha and finally removed from the body104.MODE OF ACTION OF SWEDA KARMA For proper understanding of the mode of action of Sweda Karma it is essentialto have knowledge about Twak shareera.Twak shareera Ayurveda has recognized twak as an upadhatu of mamsa105. . Sushrutadescribed the seven layers of twak and the diseases arising from the twak106. The following table shows the thickness of the seven layers of twak and thediseases arising from them.Table No. 7. Showing the different layers of twak Sl. Layer of twak Size Diseases arising from each layer 1 Avabhasini 1/18 Vrihi Sidhma, Padma, Kantaka 2 Lohitha 1/16 Vrihi Tilakalaka, Nyaccha, Vyanga 3 Swetha 1/12 Vrihi Charmadala, Ajagalli, Mashaka 4 Tamra 1/8 Vrihi Kilasa, Kushta 5 Vedinee 1/5 Vrihi Kushta, Visarpa 6 Rohinee 1 Vrihi Granthi, Apachi, Arbuda, Shlipada, Galaganda 7 Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arshas According to Sushruta, these seven layers of twak are formed, as the cream isformed layer after layer in the boiling milk. Charaka slightly differs from Sushruta and had described only six layers oftwak without naming them107. Order of these six layers is 1) udakadhara, 2)A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 33
  • 52. Swedana Reviewasrigdhara, 3) sidhma-kilasa sambhavadhishthana, 4) dadrukushtasambhavadhishthana, 5) alaji-vidradhi sambhavadhishthana and 6) arumshikaadhishthana. Among these if, the innermost layer i.e. arumshika adhishthana isinjured the patient goes into shock and develops a very serious skin disease calledarumshika, a type of boils on the phalanges and elbow joint. Bhrajakapitta, one among the panchavidha Pittas, is located in the twak. It is thisbhrajakapitta that takes up and metabolizes the drugs administered through externalapplication in the form of abhyanga, parisheka, avagaha, alepa108 etc.Modern View Most of the modern scientists recognize the possibilities of considering skinas a Large, Highly Complex Organ and as a Structuraly Integrated Organ System.The components of the integumentary system are the cutaneous membrane or skinand the associated hairs, nails and exocrine glands. The system accounts for about16% of ones body weight109. Cutaneous membrane has two components – the superficial epithelium orepidermis and the underlying connective tissues of the dermis. The associated oraccessory structures are located in the dermis and protrude through the epidermis tothe skin surface. Function of the skin is supported by an extensive network of bloodvessel branches (through the dermis) and sensory receptors that monitor touch,pressure, temperature and pain. The loose connective tissue of the subcutaneous layeror superficial fascia or the hypodermis which lies beneath the dermis separates theintegument from the deep fascia around the other organs such is muscles and bonesA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 34
  • 53. Swedana Review Figure No:1 Structure of SkinGeneral functions of the skin • Protection of underlying tissues and organs. • Excretion of salts, water and organic wastes. • Maintenance of normal body temperature. • Synthesis of a steroid, vitamin D3 that is subsequently converted to the hormone calcitriol, important to normal calcium metabolism. • Storage of nutrients. • Detection of touch, pressure, pain and temperature stimuli and the relay of that information to the nervous system.Sweda and Swedavahasrotas Sweda is produced from medodhathu as a mala duringdhathuparinAma116. When the body becomes hot, the udaka that comes out from theromakupas is called Sweda110. Sweda is an apyadravya111. Sweda is brought to thesurface of the skin through the Swedavaha srotases by the action of vyanaVata112.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 35
  • 54. Swedana ReviewThe excretion of the Sweda bestows moisture and delicate nature to the skin.According to Hemadri, the hair on the skin is supported by the Sweda. Medas and romakupa are the moolas of Swedavaha srotas. They get vitiated due to ativyayAma, atisantapa, indiscriminate indulgence in cold and heat, krodha, shoka and bhaya. Their vitiation produces the following lakshanas- aSwedana (anhydrosis), atiSwedana (hyperhydrosis), parushya (roughness of the body), atislakshnata (excessive smoothness of the body), paridaha (general burning sensation) and lomaharsha (horripulations).Mode of Action of Swedana We can understand the mode of action of Swedana by theproperties ofSwedana drugs as follow.1. Ushnata – This is originated from Agneya guna and is opposite to Shita guna. Itinduces unethusiasm, relieves stiffness and promotes unconsciousness, thirst, burningsensation, sweat and digestion in the body. It is Agni Mahabhuta dominant property.Ushna guna of Swedana does Srotosuddhi and Amapachana and so it relievesstiffness2. Tikshnata – It is also Agni Mahabhuta dominant property. It produces Burningsensation, Paka (ripening) and Srava (Secretions). Tikshna guna is responsible forripening of Vitiated Doshas and Malas and their discharges from theirrespective places. It alleiviates Vata and Kapha Dosha and stimulates PittaDosha. It decreases the Mamsa and Meda Dhatu and acts as Lekhanadravya.3. Rukshta – It is the opposite property of Snigdha guna. It is the property of non –unctuous substance. Ruksha Guna induces firmness in the body and wards offsoftness. It is dominant in Vayavya and Agneya Mahabhutas. Rukshata causesdryness, vitiates Vata Dosha and alleiviates Kapha Dosha in the body. It is beneficialin Samavastha.4. Sthirata – This property is opposite to Sara guna. It represents immobility. Itinduces firmness and stability in the body.5. Sarata– It has dominance of Jala Mahabhuta and has the property ofadvancingwhich is termed as “Preranashila.” It initiates the movement of Vata Dosha, Mala andother things in the body, which is termed as ‘Chala’A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 36
  • 55. Swedana Reviewguna by Acharya Vagbhatta .‘Chala’ guna is chiefly composed of VayuMahabhuta.6. Snigdhata – It is dominated with Jala and Prithivi Mahabhuta. It inducesunctousness, softness, strength, and texture to the body.7. DraVata – These substances are dominant in Jala Mahabhuta which promotestickiness, moistness, Softness and happiness. A drava substance possessesliquifaction of the Doshas and helps in the movement of fluid from one part of thebody to another.8. Sukshmata – It is composed of predominantly with Agni Mahabhuta. It is theproperty by which it can pass through the Srotas (Microchannels). Normallysubstances which are hot, sharp, Subtle, non-unctuous and non-slimy havepredominance of Agni Mahabhuta. They produce metabolism, lusture,radiance and colour.9. Guruta – Guru Substances are dominat in Prithivi and Jala Mahabhuta. It performsactions like Sadakruta, Uplepakruta, Balakruta and Bruhanakruta. Here, someopposite properties are mentioned in Swedana durgs. Like Sthira and Sara, Snigdhaand Ruksha. We can understand this as where local Swedana is required, dravyahaving Sthira property should be selected and where generalized Swedana is requireddravya having Sara property should be selected. Likewise Snigdha dravya is selectedfor Snigdha Swedana and Ruksha dravya is selected for Ruksha Swedana. Swedana has its main actions like Stambhaghna, Gauravaghna, Shitaghnaand Sweda Karakatva. How Swedana performs there actions, we can understand itas below. Swedakarma has four major actions over the body – (a) Stambhaghnata, (b) Gouravaghnata, (c) Sheethaghnata and (d) Swedakarakata.a. Stambhaghnata Stambha means stiffness. This attribute is a resultant of excess seetha gunaand also influence of factors such as samanavata which promotes Agni, sleshakaKapha which lives in Sandhi,, Amarasa mamsa, vasa and medas is contributory to theproduction of stambha. SAmanavayu, by Ruksha guna absorbs Snigdhata and thereby produces contractures and stiffness. SleshakaKapha is snigdha and pichila andhence if decreased (kshaya) results in less lubrication of joints causing stiffness.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 37
  • 56. Swedana ReviewSwedakarma being snigdha and ushna corrects both these deranged dosha ghatakasand relieves stiffness. Chakrapani had stated that stambha also means obstruction orblock. Therefore, Swedana not only relieves stiffness, but also clears blocking ofpassages (srotorodha). Srotas as a structural entity is Kaphapradhana. Ayana ortransport is the most important function of srotas. This is under the control of Vata.There by it is evident that there is a predominant influence of Vata and Kapha overthe srotas. Vitiation of these two hampers the structural and functional aspects of thesrotas. We know that Swedana has the opposite qualities to that of Vata and Kapha,thereby producing a palliative effect on them and the srotas is becoming normal. It iswell known that unless there is a srotodushti there is no disease. Thus, it is evidentthat Swedana clears the srotodushti or sanga. In other words, by contact of bearable warmth, the area in contact gets morecirculation. The lumina of the contracted body architecture get smoother and wider.This rendering a stiff entity smooth relieves variety of obstructions.Widening of the core and simultaneous liquefaction of the solid or semi-solidmaterial makes the flow easier. Widening of the tract and fluid character of thematerial inside makes the obstructions released slowly. –2. Gauravaghna – Swedana relieves heaviness in the body. Apya ghataka(liquidsubstances )of the body comes out through Sweda. Apya tatva is Guru. Due to theirexpulsion, lightness is achieved. Swedana stimulates muscles andnerves and so lightness is gained. Heaviness of the body is being relieved by Swedana. By means of Swedana,the fluids in the body are being excreted through the Sweda (sweat) and hence thefeeling of lightness in the body. Swedana stimulates the nerve endings and promotesmuscle strength.3. Shitaghna – Swedana is mainly Ushna so it relieves Shita by opposite property. It has to be understood as the patient is relieved of the coldness existing prior(the ushna guna pradhana Sweda karma is performed). In fact, by the excretion ofsweat, the heat in the body is being transferred out.4. Sweda Karakatva – Swedana promotes Sweating. Sweda is a type of Mala.Sweda is related to Dhatvagniand Bhutagni (Metabolism).Swedana relieves heaviness in the body. Apya ghatakaliquidA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 38
  • 57. Swedana Reviewsubstances of the body comes out through Sweda. Apya tatva is Guru.Due to their expulsion, lightness is achieved. Swedana stimulates muscles andnerves and so lightness is gained. Swedana drugs by Ushna and Tikshna gunas are capable of penetrating themicrocirculatory channels (Srotas) where they activate the sweat glands to producemore sweat. After dilatation of microchannels, Laghu and Sara guna of these drugsenable them to act on the Snigdha Dosha in the channels and direct them to movetowards kostha or excrete them through micropores of the skin in the form of sweat,resulting in Srotosodhana. The Doshas brought in Kostha are expelled out of the bodywith the help of VAmana or Virechana therapy.Sweda is the by product of Meda Dhatu which dominates in Jala Mahabhuta. TheSweda produces kleda in the body which is also Apa Mahabhuta pradhana. TheUdakDhatu is present in the body in various forms like faeces, urine, Sweda, skin, lymphand blood etc. It performs important functions like Jivana, Tarpana, Malashodhanaetc. when Swedavaha Srotas is vitiated,it leads to presentation of various symptomslike irregular production of sweating, roughness of the skin, burning sensation allover the body etc. Sweat consists of sodium chloride, water, urea, lactic acid, potassium,calciumetc. These all substances are present in extra cellular fluid also, whichprovidenutrition to cells. Excessive sweating in the body leads to depletion ofcontents of extra cellular fluid. Sodium chloride is one of the major substances whichis lost during sweating. Due to its loss feeling of exhaustion or weakness in the bodyoccurs. Swedana by its qualities like Ushna, Tikshna etc,. Does stimulation in thebody. It increases the metabolic rate in the body. Ushna guna of Sweda dilates thecapillaries thus it increases circulation. Increased circulation leads more eliminationof waste products and more absorption of Sneha or drugs through the skin. Also itstimulates muscles and nerves which promotes its renovation. Heat administration bySwedana may produce hypno- analgesic effect by diverted stimuli. Sweating controls the heat production, water and electrolyte balance in thebody. Sweat glands are controlled by central nervous system. Hypothalamus is thecenter of heat regulation in our body. Though the signals generated by thetemperatureA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 39
  • 58. Swedana Reviewreceptors of the hypothalamus are extremely powerful in controlling bodytemperature. Receptors in other parts of the body also play an important role in thetemperature regulation. The temperature control system employs two important mechanisms to reduceheat when the body temperature is too hot during Swedana Karma.1. Vaso dilation – In almost all areas of the body, the skin blood vessels becomeintensely dilated. This is caused by inhibition of the sympathetic centres in theposterior hypothalamus that causes vaso constriction. Full vasodilation can increasethe rate of heat transfer to the skin as much as eight folds. The core heat brought tothe skin get dissipated to the surrounding by –Conduction Convection Radiation andEvaporation. So it can be inferred that the Ushna guna of Swedana karma leads tostimulation of Sympathetic Nervous System and there is vasodilation (Srotovispharana). Ushna guna also increases the circulation of Rasa and Rakta in the body.2. Induction of Sweating – An Additional one degree increase in body temperaturecauses enough sweating to remove ten times of the basal rate of body heatproduction.During Swedana karma the body temperature rises to more than 2-3oC. It results inincreased Sweating by the above said mechanism. Due to the effect of ‘Sara’ and‘Sukshma’ guna of Swedana dravya, the ‘Lina Doshas’ are liquified in our body andthey come out through micropores which are present over the skin as pores of sweatglands. Since there is extreme vasodilation due to production of heat, it results inmore of excretion of liquified vitiated Doshas from the body resulting in SrotaSodhana. Thus, Swedana drugs induce cleansing effect in the body.PHYSIOLOGICAL EFFECTS OF HEAT113 Heating the tissues results in increased metabolic activity, increased bloodflow and stimulation of neural receptors in the skin or tissues and have many otherindirect effects. • Increased metabolism The increase in metabolism is greatest in the region where most heat is produced,which is in the superficial tissues. As a result of the increased metabolism there is anincreased demand for oxygen and foodstuffs, and an increased output of wasteproducts, including metabolites.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 40
  • 59. Swedana Review • Increased blood supply As a result of increased metabolism, the output of waste products from the cells isincreased. These include metabolites, which act on the walls of the capillaries andarterioles causing dilatation of these vessels. In addition, the heat has a direct effecton the blood vessels, causing vasodilatation, particularly in the superficial tissueswhere the heating is greatest. Stimulation of superficial nerve endings can also causea reflex dilatation of the arterioles. As a result of vasodilatation there is an increasedflow of blood through the area so that the necessary oxygen and nutritive materialsare supplied and waste products are removed. • Effects of heating on nervesHeat appears to produce definite sedative effects. The effect of heat on nerveconduction has still to be thoroughly investigated. Heat has been applied as a counterirritant, which is the thermal stimulus, may effect the pain sensation as explained bythe gate theory of Melzack and Wall.Indirect effects of heatingo Muscle tissue – Rise in temperature induces muscle relaxation and increases the efficiency of muscle action, as the increased blood supply ensures the optimum conditions for muscle contraction.o General Rise in temperature – As blood passes through the tissues in which the rise of the temperature has occurred, it becomes heated and carries the heat to other parts of the body, so that if heating is extensive and prolonged a general rise in temperature occur.o Fall in blood pressure – If there is generalized vasodilatation the peripheral resistance is reduced, and this causes a fall in blood pressure. Heat reduces the viscosity of the blood, and this also tends to reduce the blood pressure.o Increased activity of sweat glands – There is reflex stimulation of the sweat glands in the area exposed to the heat, resulting from the effect of the heat on the sensory nerve endings. As the heated blood circulates throughout the body it affects the centers concerned with regulation of temperature, and there is increased activity of the sweat glands throughout the body.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 41
  • 60. Drug Review DRUG REVIEWINTRODUCTION The drugs are the tools of a Physician. The rational use of drug means that thehalf of the treatment is over. In Ayurvedic classics there are a lot of single andcompound drugs which mentioned in several contexts. Most of them are not re-testedaccording to the current research methodology. Unless the drug is tested through thismethodology the drug will not get proper recognition in the scientific world. Thelogical application of these spectra according to the different stages and conditions ofthe patient and disease is the prime key for the suitability of that drug in a givendisease. Hence, considering the importance of drug in the disease management c rya Caraka mentioned drug as second important factor in Cikits Catusp dThe Drugs Utilized In The Present Study Are: • Kolakulathadi choorna • Valuka1. KOLAKULATHADI CHOORNA It is one of the commonest materiall used for Pinsa Sweda especially of Rooksha variety. While explaining the about different pradeha yogya dravyas Charaka describes about this particular combination114. Chakrapani, commenting on Charaka samhita, stated that upanaha is of two types – Sagni and Niragni. The Sagni upanaha is nothing but Sankara Sweda itself. So these pradeha dravyas can be used in Utkarika or Pinda form and it is it is in generally practiseed too.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 42
  • 61. Drug Review Figure No:2 Ingredients of Kolakulathadi Choorna:A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 43
  • 62. Drug ReviewKola115:Botonical Name : Zizyphus sativus.Family Name : Rhamnus.Sanskrit Name : Karkandhu, Badari, Kola, Kuval, Visham.Rasa : Amla, Madhura, Kashyaya.Veerya : Seetha.Vipaka : Madhura.Guna : Guru, Snigdha, Pichila.Doshaghnata : Vata pitta shyAmak.Botanical Description There are three main verities namely Rajbadar, Badar, Kshudrabadar. It is amedium sized tree with spikes. Bark-grey and thorn, Rajbadar variety is used inmedicine,Kulatha116Botonical Name : Dolichos biflorus Linn.Family Name : LeguminoseaeSanskrit Name : Kulatha, Tamrabeeja, Shweta beejaRasa : KashayaVeerya : UshnaVipaka : AmalaGuna : Laghu, Rooksha, TikshnaDoshaghnata : Kapha, Vata, ShyAmak.Parts used : SeedsExternal usesPowder of kulatha if applied whole body reduce excessive perspiration.Devadaru117Botonical Name : Cedrus Deodara.Family Name : Conifereae.Rasa : Tiktha.Veerya : Ushna.Vipaka : Katu.Guna : Laghu Snigdha.Pradhana karma : Vedana Stapana gana.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 44
  • 63. Drug Review It contains dark coloured oil and resin, internally usefull in all rukpradanavyadhis in Aruchi and Krimi, in Raktadushya and Kaphajakasa. External uses –inflammation is relieved by its local application, its local application and oil is usedin arthritis.Masha118 a,bBotonical Name : Phascolus mungoFamily Name : Fabaceae.Sanskrit Name : Uddulu, Masha.Rasa : Madhura.Veerya : Ushna.Vipaka : Madhura.Guna : Guru Snigdha.Dosha Karma : VatashAmak.Chemical CompositionContains Melissa oil, citrol, ionone, and vit. A.Parts usedRoots and seeds.Atasi119Botonical Name : Linum Usitaissimum Linn.Family Name : Linaceae.Sanskrit Name : Pichila, Medaganda, Hemavati, Rudraneela.Rasa : Madhura, Tiktha.Veerya : Ushna.Vipaka : Katu.Guna : Guru Snigdha.Dosha Karma : VatashAmak, Kaphapitta vardhak.Chemical Composition Seeds have 37 to 44% oil, white seeds have more oil, fresh oil is more viscousand colourless but in fresh air gets solidified.External uses The poulitice of the flour of Atasi is used to assimilate inflammation, thisexternal application of its oil i.e., abhyanga in VatashyAmak.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 45
  • 64. Drug ReviewTila120Botonical Name : Sesamum indicum Linn.Family Name : Pedalianeae.Sanskrit Name : Tila, Homadhanya, Pavitra, Pitrutarpan.Rasa : Madhura.Veerya : Sheeta.Vipaka : Madhura.Guna : Guru Snigdha.Dosha Karma : VatashAmak, Kaphapitta vardhak.Chemical CompositionIt contains oil 50-60%, Proteins 22%. It is an excellent Snehan and analegesic and isvery useful for wound healing. It is very useful in dry skin and body ache by acting aVatashAmak. Among all the varieties of taila, tila taila is considered to be the best fornourishing all the seven dhatus of the body.Kushtam121Botonical Name : Saussurea luppaFamily Name : CompositaeSanskrit Name : Padmatertha, Punyasagar, BrahnaterthaRasa : Tikta katu madhura.Veerya : Ushna.Vipaka : Katu.Guna : Laghu Rooksha, Tikshna.Dosha Karma : Kapha Vata haram.Chemical CompositionRoots contain 1.5% aromatic oil, Glucoside, Saussurinsalt, Resin, Tannin, Insulin18% stable oil, Nitrate, Glucose etc,. Leaves do not contain aromatic oil onincinerating, roots yield 3.5% Ash. It contains large quantity of manganese.Vacha122Botonical Name : Acorus calamus LinnFamily Name : AraceaeSanskrit Name : Ugroganda, Shadgrantha, ShataparvikaRasa : Tikta katu.Veerya : Ushna.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 46
  • 65. Drug ReviewVipaka : Katu.Guna : Laghu, Tikshna, Sara.Dosha Karma : Kapha Vata haram.Chemical CompositionRhizome bark has 1.5 to 3.5% volatile oil which contains an asaryaldehyde. Besides,it contains Acorine, Engenal, Asarone, Caffeine and little Astrigent.External usesBeing analegesic and Anti inflammatory its paste is useful in Rhematoid Artharitis,Osteoartharitis and hemiplegia.Satahwa123Botonical Name : Anethum sawa.Family Name : Umbeliferae.Sanskrit Name : Shatapatrika, Shata pushpikaRasa : Katu Tikhta.Veerya : Ushna.Vipaka : Katu.Guna : Laghu, Rooksha, Tikshna.Dosha Karma : Kapha Vata haram.Chemical CompositionDried ripe fruit contains a volatile oil 3-4% which is composed of anethine,Phellanndriene, and di-limonene, Apiol, also contain carvotie and Hydrocarbone.Yava124Botonical Name : Trachi spermum LiniFamily Name : Umbeliferae.Sanskrit Name : YavaRasa : Katu Tikhta.Veerya : Ushna.Vipaka : Katu.Guna : Laghu, Rooksha.Dosha Karma : Kapha Vata haram by tikshna and ushna, pitta vardaka, used in Kapha Vata disease.Parts used : SeedsA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 47
  • 66. Drug ReviewChemical composition Aromatic oil is present in the seeds which solidifies on cooling and is calledthymol cyst.External uses Being analgesis, anti-inflammatory, laxative, antibacterial, complexionenhancer and antidote its external application reduces oedema and pain, skin diseases,scorpion bite.Rasna125Botonical Name : PluchealanceolataFamily Name : CompositeaeSanskrit Name : Atirasa, Elaparni, GandhanakuliRasa : Tikhta.Veerya : Ushna.Vipaka : Katu.Guna : Guru.Dosha Karma : Kapha Vata haram.Parts used : BarkUses:Rheumatoid Arthitis, Vata disorders, tuberculosis. It is and antipyrectic and is usefulin skin diseases like itching, ringworms, ecezema. Rasana has a specific action inRheumatoid arthritis.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 48
  • 67. Drug ReviewTable No. 8. Showing the Rasa, guna, veerya, vipaka, and dosha karma of kolakulathadi choorna. Botanical Name Family Synonyms Rasa Veerya Vipaka Guna Dosha karma Zizyphus sativus Rhamnus Badari, visham, kola Amla madhura Sheetha Madhura Guru Vata pitta shyAmak kashaya snigdha pichila Dolichos biflorus Leguminoseae Kulatha Tamrabeeja Kashaya Ushna Amala Laghu Kapha Vata Linn Shweta beeja Rooksha ShyAmak Tikshna Cedrus deodara Conifereae Devadaru Tiktha Ushna Katu Laghu Vedhana stapana Roxb. Suradaru snigdha gana Pluchea Compositae Rasna Tiktha Ushna Katu Guru Vata haram lanceolata vishagnam Phaseolous Mungo Fabaceae Uddulu Madhura Ushna Madhura Guru Vata shAman Masha snigdha Linum usitassimum Linaceae Medagnda Madhura Ushna Katu Guru Vata shAmak Kapha Linn. Hemavati Tiktha snigdha pitta vardak Atasi Sesamum indicum Pedalianeae Tila Homadhanya Madhura Sheetha Madhura Guru Vata shAmak Kapha Linn. Pavitra snigdha pitta vardak Saussurea luppa Compositae Padmatertha Tiktha Ushna Katu Laghu Vata Kapha haram Punyasagar Katu Rooksha Brahnatertha Madhura Tikshna Acorus calamus Araceae Ugroganda Tiktha Ushna Katu Laghu Kapha Linn Shadgrantha Katu Tikshna Vata Shataparvika Sara Haram Anethum sawa Umbeliferae Shatapatrika Katu Ushna Katu Laghu Kapha Shata pushpika Tiktha Rooksha Vata Tikshna Haram Trachi spermum Umbellifere Yava Katu Tikta Ushna Katu Rooksha Kapha Lini Laghu Vata shAmakaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 49
  • 68. Drug Review2,VALUKAIt is told that’ Jagatyevam anoushadham’.There is nothing in this world which is nothaving any medicinal property. Utilizing valuka for inducing Swedana is a bestexample for this.It is famous for its Amahara,shothahara,and kaphahara properties. The procedure of Swedana by using valuka is also a variety of ushmasveda. In theearly texts the Valukasveda is indicated for vatakaphaja jvara . And in the later texts it isextended to other conditions like amavatha. The indication of Valuka Sweda are seen evenunder trikasula The purpose of its indication is mainly to eradicate the Kapha and Amadosha, bywhich Pitta and Vata can be easily pacified. By the depletion of kapha the channels getclarified resulting in lightness of body. It is beneficial in all vata kaphaja conditions,. Itsoftens the channels and restores the agni. It and relieves shirashoola, angabhanga stambhaetc of Vata Kapha origin126 .A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 50
  • 69. Disease ReviewKATIGRAHAHistorical review Medical history is most fascinating as it records man’s conflict with man’signorance, disease and history of his survival from time to time to give a picture ofculture and civilization. Hence an attempt is being made to review the historicalbackground of Kati Graha which is essential for tracking the origin and progressivedevelopment of the disease. I. Veda Upanishad and Purana Kala : In Vedas the word Vatakrit is mentioned which denotes Vatavyadhi.The terms Anukam, Anukyam are used in many occasions to denote spine or back.But there is no mention of disease Kati Graha as such in this period. II. Samhita Period This is the period when Ayurvedic system of medicine was methodically arranged in a rational way with scientific terminology.Caraka Samhita:In Maharogadhyaaya, the 20th chapter in Sootrasthana, where he enlists nanatmajaVata vyadhi, though Kati graha has not been mentioned, other symptoms of spinaldisease like Prushtha graha, Trikagraha, supti, , etc. are found.In addition, the elaborate description of treatment of imbalance of Vata in general,and at specific sites and when the passage is obstructed in particular is also made inthe same context.Different references related to Katigraha in charaka samhita : • Prushtha graha, Trika graha is explained as nanatmaja Vata vyaadhi127 • Kati sangraha as one of the swedya vyaadhi 128 • Prushtha, Kati graha as symptom of vrukkaja vidhradhi129 • Kati shula as a symptom in Gridhrasi130 • Vata vikara of Prushtha due to excess use of Katu rasa131 • Different types of pain in Kati and Prushtha in Vataja jwara132 • Trika, Prushtha rogas as a lakshana of Gudagatha Vata133 • TrikaVedana as a lakshana of Pakvashayagata Vata134 • Kati Shula, Trika & Prushtha Shula lakshanas of Vataja Arshas135 Sushruta Samhita:A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 51
  • 70. Disease ReviewThe therapies described in Bhagna Chikitsa also useful in Katigraha cases especiallyof Abhighataja origin. He described traction, manipulation etc, briefly to restore thedislocations which suits to Katigraha also.Different references related to Katigraha in Sushruta samhita:• In Pakwashaya gata Vata Acharya has included Trika Vedana as a symptom136• Kati Shula is observed as a symptom in Vataja arshas137, vankshanotha vidhradhi138, bhagna, and in seventh stage of Sarpavisha akshepa139 Bhela Samhita: He has classified Vata vyaadhi into two groups- Sarvanga and Ekanga Vata, all the pain dominating diseases of Kati and Prushtha being enlisted in Ekanga Vata roga140.Kati shula is observed as a complication of many diseases like Vataja kasa. Mandagni and impeded movement of Vata are the main cause of Kati shula. While describing the Yapana basti he has mentioned it will relieve the pain at Kati. Hareeta Samhita: Hareeta described the etiological factors of Vata Prakopa very elaborately. He has illustrated the Vata disorders classifying according to five varieties of Vata with mentioning about 16 diseases for each type. He cited Prushthastambha and Oorusthambha also as disorders of Vyana Vata. He mentioned Katishoola as a symptom of Grudhrasi and AmaVata.He mentioned some yogas together for Grudhrasi AmaVata and Katishoola 141 Kashyapa Samhita: He observed Asthi and Majja as sites of Vata which indicate the Prushtha as Vata Sthana the involvement of which may lead to Katigraha. According to him, Kati shula is one of the complication occuring due to dushprajata. He has advised Swedana as a treatment for it.142 III. Sangraha period and others This is considered as the golden period of Indian medicine in which the eight branches of Ayurveda were fully developed.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 52
  • 71. Disease ReviewAshtanga Sangraha and Hridaya: Vruddha Vagbhata has given place for Vata Vyadhis in both Nidana Sthanaand Chikitsa Sthana similar to Sushruta. In Nidana Sthana he detailed individualetiological factors for vitiation and their clinical features for all the five varieties ofVata in Vatarakta Nidana chapter.Even though it is not mentioned specifically, the impaired functions in Katigraha likeGati, Prasarana, Aakunchana, can be attributed to those by Vyana Vata as per thecitations of Vruddha Vagbhata. Apana Vata also moves in Shroni and Ooru asconnoted by him.Both these texts have mentioned about Kati shula in the disease of provoked Vata,seated in pakwaasaya. 143In Astanga Samgraha and Hridaya Kati Graha is explained as a symptom in VataJwara and MadhyAma144 margashrita Vyadhi. 145 Kati toda and Kati bheda arementioned as a poorva roopa of Vata rakta.146 Sarvadhatu avruta Vata produces painin Prushtha and shroni.Madhava Nidana: He had described Vatavyadhis more elaborately incorporating all thesymptoms described by Charaka, Sushruta and Vagbhata.He has given detailed description of shula. Vayu is said to be responsible for alltypes of pain. Prushtha shula and trika shula are mentioned in the symptoms of Vatajashula. . Prushtha shula has been mentioned as the disease of Vata Kaphajapredominance.The symptom Kati shula manifests in the following diseases-Sangrahagrahani147Vataja arsa148 Vatanubandhi raktaarsa149 AAmaVata150Aanaha.151Gadanigraha: Vaidya Shodhala had mentioned at the introduction of Vata Rogadhikara thatVatavyadhis leads to all other disorders. This is the only work where Katigraha isexplained as a separate disease condition along with the Vatavyadhis.How ever, it isto be noted that he has mentioned details of the disease only in the chikitsa adhyayaof Vatarogadhikara152 along with the treatment of all other Vatavyadhis, details ofwhich he has not mentioned in the nidana adhyaya.In this text treatment part of Katigraha or Katisthambha has been explained at twoplacesA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 53
  • 72. Disease Review a) 2nd chapter Prayoga Khanda b) 19th chapter of Kayachikitsa KhandaHe has described various formulations for Katishula and has specifically indicatedTrayodashanga guggulu for Katigraha.In the Prayoga Khanda Tailadhikara he has mentioned:• Chathurtha prasarani tailam and Molaka Tailam for Katisthambha153• Trutheeya maha masha tailam for various ailments of Kati, Jangha and Janu.154In addition, he has pointed out the necessity of Raktadushtihara therapies inVatarogas when the usual measures have failed to achieve the desired results.Sharangdhara Samhita:The author has mentioned Kati graha among the Nanatmaja Vata Vyadhis in itsPradhAma khanda 7th chapter.155 AdhAmalla in his commentary says that it is aVedana vishesha (specific type of pain) due to Sthambha (stiffness).In addition, the author has mentioned various treatments for katigraha and Katishulain detail. He has indicated Rasna Sapthakam Kashayam especially for Katigrahaand Eranda Sapthakam kashayam for various ailments of katipradesha.He has also indicated Ajamodadyam choornam for Ruja in katipradesha.Bhava Prakasha Bhava Prakash explains Kati Graha as a separate disease in AmaVata Chikitsa Adhikara and has specified few, treatments like valukaSweda, agniSweda and formulations like trayodashanga guggulu in this156.Yogaratnakara: In Yogaratnakara various references of Katishula and Katigraha are availablein the context of Vataja Arshas157, Gudasthita Vata158, Pakwashayagata VataLaxana159. The author has introduced various terms to denote backache like Kati shula,Kati Vata and Kati pida in the asheeti Vataroga chikitsa. In addition, he has advisedErandataila prayoga, and preparations like eranda beeja payasa, Modaka with Taila,ghruta, ardraka rasa etc. for such conditions.Rasa Ratna Samuchaya In this treatise of Vagbhata, Kati shula has been mentioned as an invariablesymptom in the context of AAmaVata160.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 54
  • 73. Disease ReviewIn Brihat Nighantu Ratnakara161& Dhanwantari Nighantu162 it is explained in thecontext of Bhagandara and its management.Bhaishajya Ratnavali contains the treatment aspects and in particular the use ofGuggulu Kalpanas in Kati Graha163.Sahasrayogam: It is compiled by an unknown author or authors containing description ofnumerous preparations particularly used traditionally in Kerala. Abundant yogas forVata disorders and allied conditions can be found in this text. Important among themare Sahacaradi Kashayam, Nirgundierandadi kashayam, Ashtavargam Kashayam,Rasonadi Kashayam, Rasnairandadi Kashayam, Dhanvantaram Tailam, AvartitaKsheerabala Tailam, Dhanyaamla Avagaha Swedam, PrabhanjanavimardanamTailam, Karpasasthyadi Tailam, PanchaSneham, Narasimha Choornam etc From the above paragraphs it is understood that a great deal of emphasis is available on the Nidana and Chikitsa of Kati Graha.VYUTPATHIThe word katigraha as it indicates is constituted by two words ‘kati’ and ‘graha’.Kati : The word ‘kati’ is derived from the dhatu “kat + in” and it is considered as a ‘sharira avayava vishesha’, a bodily part where the dress is tightened.164 According to Amarakosha Shroniphalaka themselves are called as Kati165. Vaidyaka Shabda Sindhu also considers Shroni as Kati166. According to Monier Monier Williams – Kati is the hollow space above the hip or the loins167Graha:The term ‘graha’ is derived from the dhatus ‘Adant-Churam-Atmam-Saka-Set’. Theterm is explained as ‘Graho Grahanam’, by Durga das, which means to collect orcatch168. Nirukti of Graha is that which has Sanga as a prominent feature. According to Monier Williams’s the meaning of Graha is to sieze, catch and catch hold169.So from these two references it can be derived that the term Katigraha collectivelyindicates a condition charecterised by a catch or stiffness in Katipradesha.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 55
  • 74. Disease ReviewPARIBHASHA • Katigraha being most common disease in the clinical practice is not explained in any Brihattrayis. But explained as a laxana in ajeerna, kshataksheena, Vatajwara and some other diseases. • The term katigraha is explained by acharya shodhala as a condition characterised by the vitiated vayu either shuddha or with Ama, taking ashraya in the katipradesha causing ruja and graham in the area. • Sharangadhara has explained it as ‘katisthambhena vedana vishesha’ a condition marked by pain and stiffness in the kati pradesha.PARYAAYA • In Raja Nighantu many synonyms of Kati are mentioned. They are Kati, kukudmati, shroni, nitamba, kateerakam, aaroha, shroniphalakam, kalatram, rasanaapadam170 etc.Among all the synonyms mentioned above, the word Shroni has been extensivelyused by various acharyas and commentators.RACHANA SHAREERAIn Katigraham the vitiated Vata get lodges at Katipradesha. Therefore, before goingto the disease aspects, the location, lmitations ,anatomy and physiology of Kati are tobe under stood properly. In classics we have scattered reference of anatomical andphysiological consideration of Kati. Here an attempt is made to enumerate thosestructures, which are helpful in maintaining the stability of the joints. LocationIn Shadanga shaareera Kati is a cylindrical region present in the Antharadhi orMadhyashareera.171.Limitations of Kati Though, clear limitations are not mentioned for the demarcation of the region Kati, with the help of the surrounding structures the limitations could be inferred.1. Upper limitation - It could be taken as the Naabhi172.2. Lower limitation -It could be taken as the Medhra and Mushka173. PrAmana For Kati, Acharya Charaka mentions that it is of 16 angulas in diameter174.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 56
  • 75. Disease Review Acharya Sushruta mentions that the prAmana of kati in males is 18 angulas invistara which is equal to the vistara of urah pradesha of females. Here, Dalhanaquotes the opinion of other authorities that 24 angula is the vistaara of urah in maleswhich is equal to the prAmana of shroni in females175. Acharya Vagbhata has mentioned both the vistara (diameter) and parinaaha(circumference) for kati. He mentions, the vistara is 16 angulas and 50 angulas as theparinaaha176.Other factors, which are to be highlighted in understanding the Sandhi are-Shleshaka Kapha Among five variety of Kapha, Shleshaka Kapha resides in joints. It keeps thejoints firmly united, protects their articulation opposes their separation anddisunion177.Shleshmadhara Kala It is the fourth Kala, which is situated in all joints of living beings. As wheelmoves on well by lubricating the axis, joints also function properly if supported withKapha. This helps in lubrication of joints178.Vyana Vata Vata governs every movement in the body. Vyana Vata is one among the fivevarieties of Vata, which resides at Hridaya and controls most of the motor functions.The Gati or physical movement is also one of its functions. Gayadasa commenting on Sushruta has quoted the wordings of an unknownauthor as though the Vyana Vata is functioning all over the body it resides in theSandhi179.Structures present in Kati Chief structures that come in the kati pradesha are,1. AsthiMainly 5 asthis are said to be present in the kati pradesha. They are 1 Gudaasthi, 1Bhagaasthi, 2 Nitambaasthis, and 1 in Trika region (Trikaasthi)180.Acharya Charaka mentions that 2 Shroniphalakas and a Bhagaasthi is present inShroni pradesha181.2. SandhiAcharya Sushruta tells that among the 2 types of sandhis mentioned, i.e.Cheshtaavanta and Sthira, sandhi present in kati pradesha belong to CheshtaavantaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 57
  • 76. Disease Reviewsandhi. Three sandhis are present in kati which belong to Tunnasevani variety amongthe 8 variety of sandhis mentioned182.3. SiraAmong 700 siraas present in the body, 32 siraas are present in the Shroni whichconsists of Vaatavaha, Pittavaha, Kaphavaha and Raktavaha siraas each 8 innumber183.4. DhAmaniAcharya Sushruta says, among 24 dhAmanis, 10 adhoga dhAmanis supply thePakwashaya, Kati, Mutra, Pureesha etc184.5. SnaayuSnaayus are structures resembling the shape of a hemp. Among the 900 snaayuspresent in the body, 230 snaayus are present in the Madhyashareera, among which 60are present in kati185.6. kandaraa16 kandaraas are present in the body which helps in performing the actions likeextension and flexion. Among them 4 kandaraas present in the Prishtha which tightlybinds the Shroni with Prishtha and the Nitamba and other parts of the lowerregions186.7. MarmaKatikataruna , Kukundara , Nitamba , Paarshvasandhi are related with Shroni inPrishthabhaaga.187Pratyangaas present in KatiJaghana, Guda, Medhra, Bhaga and Basti are some chief pratyangaas that lie in thekatipradesha 188Dheerghayu lakshanas of KatiAcharya Charaka, mentions that, the ideal kati should be 1/3rd of the Urah (chest)pradesha. It should be equally proportionate, well built and well covered byMaamsa192.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 58
  • 77. Disease ReviewANATOMY OF LOW BACK 192,193 It is necessary to have understanding of anatomy to appreciate which elementlumbar spine can be injured and thus become painful to prescribe treatment onrational basis.1) LUMBAR VERTEBRAEEach lumbar vertebra is divided in to three sets of functional elements.1) Anterior element - consisting vertebral body2) The middle elements - consisting of pedicles3) Posterior elements - laminae, articular process, spinous process, accessory process, transverse process, mamillary process.a) ANTERIOR ELEMENTThese are the essential components of vertebral column endowing it with bulk andheight. They sustain compression loads applied to the vertebral column, including notonly body weight, but also the compression loads imparted by contraction of backmuscles.b). THE MIDDLE ELEMENTS/ PEDICLESThey are the only connection between the posterior and anterior elements. It transfersthe controlling forces in the posterior to anterior elements.c). POSTERIOR ELEMENTRegulates the passive and active forces applied to the vertebral column and there bycontrol its movements. i) Articular process provides a locking mechanism that resists forward sliding, and twisting of the vertebral bodies. The spinous processes, transverse processes, mamillary processes, and accessory processes provides areas for muscle attachments and constitute lever that enhances the action of the attached muscles. ii) The lamina transmits the forces from spinous process and the inferior articular processes to the pedicles. Thus they are susceptible to injuries such as pars intra articular fractures.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 59
  • 78. Disease Review Figure No: 32) JOINTSWhen any two lumbar vertebrae are articulated they form a three joint complex calledthe motion segment. An intra vertebral disc forms the principle between two vertebralbodies. The other 2 joints are formed by the articulation of superior articularprocesses of the vertebra and inferior articular process of the vertebra above. Theseare known as zygophyseal/ Apophyseal/ Facet joints.ZYGOPHYSEAL JOINTSThese are the typical synovial joints endowed with cartilage, capsule and synovialmembrane. The articular facets exhibit variations in both the shape of their articularsurface and general direction in which they face. Such variations determine the extentto which joints can prevent forward sheer translations between vertebral bodies andaxial rotations of the inter-body joint. These movements are resulted by the impactionof interior articular process of the vertebra below. The only movement permitted bythe lumbar zygophyseal joints sliding movement in a vertical direction, which isexecuted during flexion and extension of the vertebral column.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 60
  • 79. Disease Review3) INTRA VERTEBRAL DISCSEach intra vertebral disc consists of three components.i) Central gelatinous nucleus pulposusii) Surrounding annulus fibrosisiii) Pair of vertebral end platesi) CENTRAL GELATINOUS NUCLEUS PULPOSUSNucleus consists of a matrix of proteoglycans that bind considerable amount water.ii) SURROUNDING ANNULUS FIBROSISIt consists concentric laminae of collagen fibers. In each laminae the fibers areparallel and oriented 65 degree from the vertical, but the direction of inclinationalternates in successive laminae. The inner fibers of the annular fibrosus envelop thenucleus pulposus and are attached to the margins of the vertebral end plates. Theouter fibers are attached to the margins of the vertebral bodies and constitute theligamentous portion of the annulus fibrosus.iii) VERTEBRAL END PLATESThese are the cartilaginous substance which covers the superior and inferior surfaceof each vertebral body within the area encircled by the ring apophysis. The two endplates of each disc cover the nucleus pulposus as well as the inner 2/3rd of theannular fibrosus.The foremost function of disc is to separate the vertebral bodies so that movementsmay occur between the vertebral bodies. The disc must be sufficiently compliant toallow movement but sufficiently strong to with stand compression. Compressionbetween vertebral bodies is fundamentally resisted passively by the sheer bulk of theannulus fibrosus. The role of nucleus pulposus is to brace the annulus pulposus andthere by braced it is able to with stand the compression loads, and an impairment ofnucleus function compromises the ability of annulus to withstand compression loadscausing it to fail by buckling.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 61
  • 80. Disease Review Figure No: 4 Lumbar disc5. LIGAMENTSThe role of ligaments of the lumbar spine has been over emphasized. In effect, noligaments can stabilize the lumbar spine.Major ligaments are:1) Anterior longitudinal ligamentThese are broad, strong fibrous band attached to the anterior surface of all vertebrae.It decreases in width at the level of disc. It consists of tendons from crus ofdiaphragm.2) Posterior longitudinal ligamentIt runs posterior to the body of vertebrae separating it from dural sac. It is looselyattached and has inter- woven connection with disc. It has only a nominal role inresisting separation of posterior ends of vertebral bodies during flexion.3) Ligamentum flavumIt connects laminae and extends laterally to the articular facet. It is thickest in lumbarregion. It assists in restoring the column to correct attitude after flexion position andmay protect disc from injury.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 62
  • 81. Disease Review4) Supraspinatum ligamentIt joins the tips of the spinous processes of the vertebrae with aid of intra spinousligament.5) Inter spinous ligamentIt connects the adjoining spinous processes from their tips to roots.6) Inter transverse ligamentThese are essentially membranes that extend between adjacent transverse processes.They constitute part of facial system that separates the muscles of the ventralcompartment from the posterior compartment.7) Ilio lumbar ligamentBinds Transverse process of L5 to the Ileum. It resists forward sliding, lateralbending and axial rotation of L5 on sacrum. Figure No: 4 Ligaments of BackA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 63
  • 82. Disease Review 6. MUSCLES Muscles directly control the movement of vertebral column. In relaxed standing posture almost all muscles are relaxed except slight activity in psoas and abdominus. On anatomic and functional grounds, the paravertebral musculature can be divided into three groups:1. Psoas major and minor: arises from the anterolateral aspect of the lumbar spine and inserts into the lesser trochanter of the femur. It is a flexor of the hip. Upon contraction, as in sit ups, the psoas exerts immense compression on the intervertebral discs.2. Quadratus lumborum and intertransversarii lateralis: Quadratus lumborum is a wide and somewhat rectangular muscle that consists of a complex aggregation of various oblique and longitudinal running fibers that connect the lumbar transverse processes, the ilium, and the 12th rib. Its principal action is fixation of the 12th It is wide rectangular muscle that consist a complex aggregation of various oblique and longitudinally running fibers that connects the lumbar transverse process; the ileum and the 12th rib. Its main action is fixation of 12th rib during respiration. It has a weak action to flex the lumbar spine laterally. While bending forward first 60 degree of movement occurs at lumbar spine and followed by additional movement, 25 degree at hips and pelvis. Glutei and hamstrings lock the initial flexion of the pelvis. At the end of flexion, all spinal muscles are relaxed and the humans are at maximum strain at the movement. Extension of the back with loads shows increased activity in back muscles. Intertransversarii lateralis connect consecutive transverse processes but are too small to exert significant forces on the lumbar spine. They act as proprioceptors.3. Lumbar back muscles: lie behind and cover the posterior elements of the lumbar vertebrae. A. Intertransversarii medialis- are small muscles that connect the accessory process and mamillary process of consecutive vertebra and works as large proprioceptive transducers. B. Interspinales: are short muscles that connect the spinous processes of adjacent lumbar vertebrae. They have proprioceptive function. C. Multifidus: is a Para median muscle connects lumbar spinous process, mamillary process, ilium and sacrum. It is the only muscle covering lumbosacral A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 64
  • 83. Disease Review region. The main action is to extend the lumbar spine or control its flexion, also opposes the flexion effect of abdominal muscles to produce rotation of lumbar spine. D. Longissimmus thoracis: it has thoracic and lumbar fibers. Lumbar fibers stem from the accessory processes and transverse processes of L1-L5 vertebrae and are anchored to the ilium. The thoracic fibers contribute to erector spinae aponeurosis. The lumbar fibers produce lateral flexion by unilateral contraction and posterior sagittal rotation and posterior translation by bilateral contraction. E. Iliocostalis lumborum: consists of lumbar and thoracic components. Lumbar component connects transverse processes of L1-L4 to the iliac crest. Thoracic fibers contribute to the erector spinae aponeurosis. F. Erector spinae aponeurosis: is a wide tendinous sheath attached to the tips of the lumbar and sacral spinous processes and to the sacrum and ilium. It can exert tension across the lumbar spine and the energy for this tension is provided by muscle bellies distributed in thoracic region. Figure No: 5A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 65
  • 84. Disease ReviewThe principal role of back muscles is to control sagittal rotation of the vertebra that is,forward bending. The back muscles have no power for other movement. Theirorientation is essentially vertical; they lack a substantial horizontal component toachieve or withstand axial rotation or to resist forward shear.Thoracolumbar fasciaIt consists of three layers – anterior, middle, and posterior. Anterior layer is thin andis the fascia of quadratus lumborum. Middle layer lies behind the quadratuslumborum, is attached to the tips of the lumbar transverse processes and directlycontinuous with the intertransverse ligaments. The posterior layer is formed byaponeurosis of the latissimus dorsi and may assist the back muscles during lifting.NERVE SUPPLYThe structures receiving innervation is in principle a potential source of pain, if it isaffected or afflicted by an appropriate pain- producing pathology.Vertebral bodies receive the supply from Gray rami communicantes and ventral ramiin the form of anterior and posterior longitudinal (sinu vertebral nerves) plexuses.The I.V. Disc innervation is provided by rami communicantes anterolaterally andsinu vertebral nerves posteriorly. The structures posterior to the intervertebralforamen are supplied by branches of dorsal rami.BLOOD SUPPLYArteries – at various vertebral levels is derived from pairs of lumbar arteries, theupper four of which arise from the descending aorta, whereas the fifth arises from themedian sacral artery.Vein – the venous drainage of vertebral bodies starts as a subchondral post capillaryplexus beneath each vertebral end plate. tributaries from back muscles drain into theascending lumbar veins, other parts are drained by anterior internal, anterior external,posterior internal venous plexuses.BIOMECHANICS OF LUMBAR SPINEThe cardinal movements of the lumbar spine are Flexion, Extension, Axial rotationand lateral Flexion.Flexion and ExtensionFlexion and Extension involve the combination of sagittal rotation and translation.During flexion of the lumbar spine, each vertebra rotates and translates anteriorly; aA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 66
  • 85. Disease Reviewreciprocal combination occurs in extension. The range of rotation is about 6- 100 persegment, and the range of translation is about 2mm. Translation is resisted primarilyby zygapophyseal joints and secondarily by annulus fibrosis of vertebral joints.Rotation is resisted annulus fibrosis, capsules of zygapophyseal joints, ligaments ofIV joints, and most importantly by active or passive tension of back musclessupplemented by passive tension in the thoracolumbar fascia.Extension is limited primarily by bony impaction. Either the spinous process impactagainst each other or the inferior articular process impacts against the laminae below.Axial rotationBecause there are no primary rotators of the lumbar spine, axial rotation is amovement imposed secondarily on the lumbar vertebrae and their joints.Rotation is achieved by the oblique abdominal muscles acting on the thorax, themovements of which impose a screwing effect on the lumbar spine from L1 to thesacrum.The motion is resisted by impaction of zygapophyseal joints and by tensiondeveloped in the annulus fibrosus; resistance limits the range of rotation at eachlumbar segment to <30.Lateral flexion- Little is known about the lateral flexion of the lumbar spine, whichinvolves a complex and variable combination of lateral bending and rotatorymovements of the inter body movements and diverse movements of thezygapophyseal joints.NIDANA The word Nidana is used in Ayurvedic classics in a broad sense. This word isderived from the Sanskrit Dhaatu ‘Ni’ that carries the meaning—to determine. (Ni—Niscaya deeyate jnaanam). This word refers to etiopathogenesis of the disease eitherin general or to the etiology of illness in particular. From the perspective of treatment,Nidana has utmost importance as the avoidance of etiological factor forms the firstand foremost line of treatment. This is followed by specific treatment as peretiopathogenesis of the disease.Nidana in general may be categorized into three groups: •Asatmendriyaartha samyoga •PrajnaparadhaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 67
  • 86. Disease Review •ParinAma In addition, to obtain a vague picture of the factors involved Nidana can bedivided into SAmanya & Vishesha Nidana. The description of Nidana for all the disorders is not uniform in Ayurvedicliterature. In certain diseases, we can find description of both SaAmaanya as well asVishesha Nidana, but it is restricted to SaAmanya Nidana with regard to many otherdiseases. Though the etiologies of all the Vatavyadhis are similar, the samprapti &clinical presentation is unique for each Vatavyadhi, distinguishing them from oneanother.196 Charaka197 & Bhavaprakasha198 clearly mentions the causative factors ofVatavyadhi; but in Sushruta samhita, Ashtanga Sangraha & Ashtanga Hrudaya etc.the causes of Vatavyadhi have not been clearly described. However, in these texts thecausative factors of provoked Vatadosha are available.199a,b,c,d,e. In Gadanigraha written by Shodhala we can get a clear reference of Katigrahaas a disease along with other Vatavyadhis. Even though Katigraha is not projected as a separate disease in Bruhatrayees,from a reference by Cakrapani while commenting on Caraka Nidana 8/40, it may bediagnosed as a separate disease. He says that ‘any symptom may manifest as aseparate disease also’. However, in these references also an exclusive Nidana for Katigraha cannotbe found. From the Adhishtana and lakshana of Katigraha we can make out that thecondition is precipitated by Vatadosha. So the Nidana factors for Vatavyaadhi ingeneral can be considered as the Nidana of Katigraha. Moreover, Asthi being thedhaatu involved in the pathogenesis, Nidana for Asthivaha and Purishavahasrotodushti may act as Nidanas for Katigraha. In addition to these Caraka and Vagbhata has mentioned Dhatukshaya andMargavarodha to be the root cause of all the Vatavyadhis.200a,b,c. Therefore, all the etiological factors of Vatavyadhi as well as Vata Prakopaare taken as Nidana of Katigraha and the same is elaborated in the following subtitles. A) Aaharaja (dietetic factors) B) Viharaja (behavior factors)A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 68
  • 87. Disease Review C) Aagantuja (external factors) and D) Anya Hetuja (miscellaneous factors)A) Aaharaja: The causative dietetic factors included under this group have beenagain subdivided into the following 8 groups. i. Dravyatah: In this group, all the dietetic articles responsible for Vata Prakopa have been included. ii. Gunatah: This group include the quality of dietetic articles like Rooksha, Sheeta etc. which lead to the Prakopa of Vata iii. Rasatah: The various tastes of the dietetic articles, the excessive use of which lead to the Prakopa of Vata have been included in this group. iv. Karmatah: Excessive use of Visht’hambhi article may lead to the Prakopa of Vata and it has been included under this heading. v. Veeryatah: For instance, the Sheeta Veerya articles cause the Prakopa of Vata. vi. Matratah: Less eating or fasting comes under this heading. vii. Kalatah: The Vata Prakopa occurs at the end of digestion. Eating before digestion of the previous meal also leads to Vata Prakopa. In addition, it has been observed that the backache is precipitated by cold exposure. vii. Mithyopayogatah : The violation of the rules like not to drink water when hungry or not to eat when thirsty also lead to Vata Prakopa. viii. Desha swaroopa: Jangala desha is also an etiological factor for backache. Most of theetiological factors said above are the etiological factors of Vataja shula. Pakwashayais the main seat of Vata. The purisadhara kala also serves the function of asthidharakala. Hence, the factors of purisa vaha sroto du ti are worth mentioning here. Thepurisha vegarodha, ati bhojana, ajirna and durbala agni are the causes for purisa vahasroto du ti.B) Viharaja: The causative factors related to the habit and regimen of the patient has been subdivided into two groups’ viz. I. Karmatah, II. Kalatah.I. Karmatah: Such habits of (a) Kayatah (somatic) and (b) Manah (psychic) whichlead to the Prakopa of Vayu have been included under this heading.a) Kayatah: The etiological factors of Vata related with the body have been further subdivided into the following sub-groups.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 69
  • 88. Disease Review 1) Mithyaprayogatah: The faulty habits of the body or improper use of body which may lead to the Prakopa of Vaayu have been included under this heading. 2) Atiyogatah: The excessive uses of the Karmendriyas or the parts of the body, which cause Prakopa of the Vayu, have been included under this heading.b) Manah: The psychic factors responsible for Vata Prakopa have been included under this heading.II. Kalatah: The periodic factors responsible for Vata Prakopa have been included under this heading.C) Aagantuja: External factors like trauma leading to Vata Prakopa have been under thisheading.D) Anya Hetuja: All other causatives factors of the Prakopa of Vata, which could not beincluded in any of above classification, have been presented under this heading. Thedetails of the causative factors are enlisted in table no.1.In general, by the activity of the etiological factors the addition of the qualitiessimilar to the one present in the Vata Dosha causes its morbidity. As per this principleit is clear that the factors mentioned in the above list cause imbalance of Vata Dosha.So also these factors may cause the illness Katigraha, as this diseases is regarded asone of the Vatavyadhi.Aharaja Nidana:Table No. 9: Showing the Aharaja nidana of Kati graha explained in different treatises: Nidana C.S201 S. S202 A.H203 M.N204 Y.R205 B.P206Kashaya - + + - - +Katu - + + - - +Tikta - + + - - +Rooksha + + + + + +Laghu + - + + + -Sheeta + - + + - -Alpabhojana + + + - + +A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 70
  • 89. Disease ReviewAbhojana + + - + + +Pramitabhojana - - + - - - Dravya visheshaNidana C.S S. S A.H M.N Y.R B.PVallura + - - - - -Varaka + - - - - -Shuskha Shaka - + - - - -Uddalaka - + - - - -Neevara - + - - - -Mudga + - - - - -Masura + - - - - -Harenu + - - - - -Kalaya + - - - - -Viharaja Nidana:Table No. 10: Showing the Viharaja nidana of Kati graha explained in differenttreatises: Viharaja C.S S. S A.H M.N Y.R B.PAti VyayAma + + + + - -Langhana + + - + + -Plavana + + - + + -Atyadhwa + - - + + -Pradhavana - + - - - -Pratarana - + - - - -Atyuchabhashana - + - - - -Balavadvigraha - + - - + -Abhighata + + - + - +Marmaghata - - + + - -Bharaharana + - - - + -Dukhashayya - - + + - -Dukhasana + - - - - -Sheegrhayana + - + + - -Prapeedana - + - - - -Atiadhyayana + - - - - -Ati vyavaya + + + + + +Atijagarana + + + + + +Vegadharana + + + + + -Vishamopachara + - - + + -ShrAma - - - - - +Upavasa + + + + + +PuraVata sevana - - - - - +Divasvapna + - - - - -A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 71
  • 90. Disease ReviewManasika karana:Table No.11: Showing the Manasika nidana of Kati graha explained in differenttreatises: Nidana C.S S. S A.H M.N Y.R B.PChinta + - + + + +Shoka - + + + + -Krodha - - - - - -Bhaya - - - - + -Anyat (other nidanas):Table No. 12: Showing the Anyata nidana of Kati graha explained in differenttreatises: Nidana C.S S. S A.H M.N Y.R B.PAtiraktasravana + - - + + -Atidoshasravana + - - + + +Dhatukshaya + - - + + +Rogatikarshana + - - + + +Divasvapna + - - - - - As Mentioned above, Vata can get vitiated by Panchakarma apacharas likeAtidoshasravana, Atirakthasravana, Atiyoga of langhana, Apatarpana etc anddhatukshayakarabhavas like rogakarshana, gadakrita Atimamsakshaya. Both DhatuKshya and Stholya are considered as casautative factor for Vatavyadhi. In Sthoulya, themeda-avarana is the mechanism, which in turn leads to improper nourishment of Dhatuscausing Kshya in Dhatus except Meda231.Sannikrishta Hetu: AtivyayAma, Abhighata, Marmaghata, Bharaharana, Sheeghrayana, Pradhavana,Atisankshobha.SAMPRAPTI The study of samprapthi is the most important aspect of understanding thedisease. It explains the complete disease process which starts immediately afternidana sevana. It includes the explanation about the dearrangement of Doshas and thepathological changes that takes place in a person leading to the formation of thediseases and also the mode of manifestation of clinical features.207 The knowledge ofSamprapti is very much essential from Chikitsa point of view as it hastold by ourAcharyas. “Samprapti vightanameva Chikitsa”, which means systemic breaking ofA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 72
  • 91. Disease ReviewSamprapti is called Chikitsa hence a proper analysis of Samprapti along with itsghatakas is very much essential Gadanigrahakara considers katigraha to be one among the Vata vyadhis. Itclearly projects Vata dosha as the major factor behind the whole pathogenesisinvolved in Katigraha. He explains that the vitiated shudha or sAma vayu takes itsashraya in the katipradesha causing pain and stiffness. In the dominance of Vatadosha, Shula is the main presenting symptom. It is already mentioned that all theNidanas of Vatavyadhi & Vata prakopa can be regarded as Nidana of Katigraha. Specific samprapti of Katigraha is not descried in the classics butbeing a Vata vyadhi its samprapti vyapara is on the similar lines ofVatavyadhies. The two types of samprapti have been discussed before as dhatukshayaand margavarodhaDhatuKshaya as a reason for KatigrahaContinuous ingestions of food materials which are ruksha, sheeta, laghu, suska innature, ratri jagarana, vegavidharana, pramitasana, and all such causes lead to dhatukshaya208 (Ch.su. 17/76,77). And Vataprakopa. And in terms ,due to predominance ofVata with its Ruksha, Khara, etc. Guna and. Leads to loss of Kapha in quality andquantity This will lead to Kapha, Degeneration of body elements takes place bywhich Dhatus formed will not be of good quality. It occurs specially in Asthi, majja,meda, mamsa dhatu kshaya.. Reduction of Kapha in Sandhis makes Sandhi Bandhana Shithilata.Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi being the mainparticipant of the joint its Kshaya leads Khavaigunya in the joints. In this condition if Nidana Sevana done further produces Vata Prakopa. IfVata Prakopa is not corrected by appropriate means and simultaneously if the personindulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vataspreads all over the body through these Srotas. In the meantime, Sthanasamshraya ofPrakupita Vata take place in the Khavaigunyayukta Sandhi in Katipradesha. Thislocalized Vayu due to its Ruksha, Laghu, Kharadi Guna over power and undo allproperties of Sleshaka Kapha producing stiffness and pain in the katipradeshaultimately resulting in the disease Katigraha.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 73
  • 92. Disease ReviewMargavarodha as a reason for Katigraha The disease Katigraha can be manifested due to kevala Vata or by sAma Vata.The sAma Vata indicates the margavarodhajanya type of vikruthi. The Nidanas likeadhyaashana, vishAmasana and other Ama kara Nidanas first vitiates Agni leading tomanda Agni. Both JatharAgni and DhatwAgni are deranged giving rise to Ama ofboth origins cause Srotavarodha in the Adhishtana. Due to such srotavarodha in thegati of Vata produces lakshanas like, ‘ruk’, stumbha etc.. Many times when khavaigunya is present at kati, sphik sandhi, snayu, kandaraand nadi and some kind of trauma , exposure to cold etc. act as a vyanjaka hetu.Sometimes without any previous khavaigunya severe trauma or injury to lambosacralregion leads to sudden contraction of mansapeshi of katisandhi which inturn leads tosransa or bhramsa of kasherukasthi of katisandhi (Prolapse intervertebraldisc) andVataprakopa. This can be said as agantuja nidanajanya katigraha The knowledge of Samprapti ghataka is very much essential while treating adisease because systematic breaking of pathogenesis as Samprapti is known astreatment of a particular disease1. Samcaya Avastha:Excessive use of Dosa Prakopaka Nidanas cause accumulation of Dosa in its ownplace, which is known as Cayavastha (Su.S. Su. 21/18). This is the first chance toprevent the disease process if one can able to judge the symptoms of accumulatedDosa. The various Nidanas of Vata Prakopa have been mentioned in previouschapter, the indulgence to which lead to the accumulation of Vata Dosa. This is calledthe first stage of Kriya kala. Along with vathakara activities,if the person indulgeswith adhyaashana, vishAmasana and other Ama kara Nidanas first vitiates Agnileading to formation of mandagni2. Prakopa Avastha:Vilayana roopa vrudhi or increased quantity of excited or aggravated dosha, which isconfined to its own location, constitutes the prakopa avastha. If the person continuescontact with particular Nidanas even after chaya lakhanas are seen it ultimatelyresults in this stage.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 74
  • 93. Disease ReviewIn the present context the Vatakara Nidanas like balavadvigraha, ativyayaAma etc.leads to further aggravation and excitation of Vata dosha providing perfect base formanifestation of a Vata vyadhi.The dearrangemant in Both JatharAgni and DhatwAgni leads to the formationofAma of both origins .Neglecting this stage results in the third stage of prasara.3. Prasara Avastha: The third of Kriyakala is called as Prasara Avastha. In this stage morbidDosas propagate all over the body. The provocated and diffused Dosas circulatethrough the channels other than their normal ways of circulation. It is to be noted that vayu which possess the power of locomotion or extrememobility is responsible for this expansion. The prakupita dosha sometimes singly orin two or all three of them together, with rakta, expand and swarms the body in alldirections.As they move in different directions it causes various disorders and dysfunctions, thenature and location of which depends on the direction the doshas move. In the present context when the excited Vata spreads to the marga ofshleshaka Kapha present in the joints of katipradesha it causes anga saada. In thisstage the Amadosha also moves towards its favorite place,the kati which is also athrikasandhi. So we can conclude the first three stages of kriya kala that a vague and variedpresentation of symptoms are manifested which does not give enough ground todiagnose it as katigraha. If the disease is detected in this stage, it becomes easy toarrest the progression of the disease with timely interventions like adoption of properahara and vihara.4. Sthanasamsraya Avastha:During sthanasamsraya avastha the vitiated doshas are said to have reached toparticular sthana and get obstructed there and intimately mix with and vitiate one, twoor more dushyas in that particular portion of body. This, what is generally called of’Dosha Dushya Samurchhana’ It is due to srotovaigunya or the pathologicalinvolvement of related srotas.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 75
  • 94. Disease Review In this context, various Vatakara Nidanas especially those giving undue strainto the katipradesha produces srotovigunata in the channels present there. The vitiateddosha (vyana, apana) undergoes localization at the site of khavaigunya. Here thedosha vitiates the dushya (asthi, snayu, peshi, majja) by confining itself to thekatipradesha Ama of both origins cause Srotavarodha in the Adhishtana. Thus thegati of Vata get obstructed resulting in katigraha. The resultant symptoms of painand stiffness are found in a mild form distinctive of poorvaroopa of Vata vyadhis.5. Vyakti Avastha:This stage is called the Vyakti Avastha because disease manifests clearly in thisstage. This stage is marked by the presence of pain due to the vitiated Vata andstiffness due to shoshana of the shleshaka Kapha in the joints of katipradesha. Thenormal movements at the katipradesha are hampered due to the stiff joints.6. Bheda Avastha:This is the 6th stage of Kriyakala. If the disease process has not been stopped here orneglected it causes the various complications related with the disease and it becomeschronic. The avoidance of the treatment in this stage leads the disease in incurablestage. This is called the Bheda Avastha It finally attains asadhyata in this stage.The disease when neglected in vyakthavastha it attains bhedavastha. This stage canmake the condition worse by manifestation of degenerative changes in the dooshyaas(asthi) which are irreversible. The disease proceeds into more severe forms due toextensive dhatukshaya.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 76
  • 95. Disease Review Flow Chart No:2A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 77
  • 96. Disease ReviewNo: 7Samprapti Ghatakas of Katigraha •Dosha V ta Vyana Apana(Vrudhi) Kapha leshaka (Kshaya) •Dushya Dhaatu Asthi Upadhaatu Kandara,Snayu •Udbhava sthaana Pakwaashaya •Vyakta sthaana Kati •Sancharasthana Ardha sharira •M rga MadhyAma roga marga •Srotas Asthivaha Mamsavaha,Purishavaha •Srotodushti Sanga •Agni Jataragni , Dhatvagni •Ama Jataragni & Dhatvagnimandya Janya AmaPOORVAROOPA These Purvarupa usually are exhibited during the stage of ‘Sthana Samshraya’of the ‘Shadkriyakala’209. At that time when Dosha-Dushya-Sammurcchana takesplace, some specific sign and symptoms are observed in particular disease which maybe clear or not, they are termed as Purvarupa. It is important to diagnose and treat thedisease at this stage so that patient may be saved from the functional or organicdAmage as well as degree of morbidity. which may be created during completemanifestation of the disease.In classics, the description regarding the Poorvaroopa of Katigraha is not available.Even then, few of the general citations in the classics pertaining to the occurrence ofthe Poorvaroopa in Vatavyadhi is worth mentioning. Charaka has mentioned that Avyakta Lakshana are the Purvarupa of theVatavyadhi. Chakrapanidatta commenting on the word Avyakta mentions that fewmild symptoms are to be taken as the Purvarupa210. But Vijayarakshita, thecommentator of Madhava Nidana has given the clear meaning of the term Avyakta,according to which symptoms not exhibited clearly are Purvarupa and they are dueto- 1) Weak causative factors. 2) Very less or mild symptoms. 3) Less Avarana of DoshasA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 78
  • 97. Disease Review It is obvious from the above reference that Avyakta is Alpa Vyakta or lessmanifested. So, in Kati Graha also Purvarupa can be taken as minor symptomsproduced before the actual manifestation of the disease.Vague pain, mild discomfort in the low back and limitation in the spinal movementsin its minimal severity may be considered as Poorvaroopa of katigraha. Thedevelopment of these symptoms following excessive exercise straining the back, orelse direct trauma to the back are always corroboratory of Katigraha.ROOPARoopa appears in the Vyaktaavastha i.e., fifth Kriyaakaala of the disease. This is theunique stage of the illness, where in it is clearly recognizable as all its characteristicsigns and symptoms manifest211. Here in this stage, the dosha-dushya sammoorchanais completed with the manifestation of all the lakshanas of vyadhi including thepratyatma linga, which are essential for the diagnosis of the disease. Katigraha being a Vatavyadhi is characterized by pain and stiffness atthe katipradesha. These symptoms manifest in a clear and distinguishable form fromits vague and mild form in poorvaroopavastha. The term katigraha itself is self-explanatory pointing out the characteristic feature of graham or stiffness. Thecondition is such that almost all the movements at the katipradesha or the lower backregion are hampered preventing the person from performing his day-to-day activities.Acharya Charaka has hinted regarding various Vatavyadhis, which can occuraccording to the Hetu and Sthana vishesha, other than those he has explained indetail78. Based on this excerpt various disorders can be considered due to vitiatedVata taking ashraya in katipradesha, including katigraha. This progression occurs dueto various Nidanas mentioned earlier including direct injury to the Katipradesha.Ruja: Acharya Shodhala while explaining katigraha has mentioned pain as one of the prime symptom. Ruja is the term used by him to describe the character of pain in this disease. ‘Ruja Vedana.’212 ‘Ruk Satatam Shulam’213 ‘Ruk Shulam’214A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 79
  • 98. Disease Review In a typical case, pain is confined to the katipradesha or the Lumbo sacral andsacroiliac region only. Pain can arise due to the vitiated vyaana Vata, which dries upthe shleshaka Kapha in the joints creating friction. If the vitiation is due to anyabhighaata pain can manifest because of injury to the sandhi as well as thesurrounding structures. Radiation of pain towards the lower limb is not seen in atypical case, but can be found in few low back disorders where there is a defect in theInter vertebral discs, which is giving tension to a nerve root passing out.Graham :The characteristic feature of katigraha is graha or stiffness at the katipradesha. Thevitiated Vata when it takes ashraya in katipradesha it leads to the shoshana of theshleshaka Kapha present in the sandhis there. The shoshana of shleshaka Kapha leadsto the hampered functioning of the joints preventing all the movements at thekatipradesha. Thus, the movements at the Lumbo-sacral region like flexion,extension, lateral flexion and rotation are hampered either completely or partially.The degree of affection varies depending on the presentation of etiological factors,such as the site of the structures injured and the extent of injury and duration.VYAVACHCHEDHAKA NIDANA OF KATI GRAHA Diagnosis is successfully made by thoroughly observing the patient toexplore the clinical manifestations and analyzing the symptoms to determine thevitiation of Dosha, involvement of Dhaatu, affliction of Srotas, as well as other eventsof Sampraapti. Vyavachchedhaka Nidana or comparison of diseases presentingsimilar clinical features helps us for proper diagnosis.Acharya charaka has described that one symptom may be common to manydiseases,one symptom may be related to only one disease, many symptom may berelated to only one disease, and many symptoms may be common to many diseases.So for better understanding of the disease we have to look it through different anglesHere comes the Chathurvidha pareeksha,ie knowing the disease as a separate disease,as a symptom of other disease, as a poorvaroopa,and as an upadrava.Katigraha as a separate diseaseGada nigraha and Bhaaprakasha described katigraha as a separate disease, which isthe stratum of the present study.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 80
  • 99. Disease ReviewKatigraha as an assossiated symptom Stambha Ruk & thoda of Kati is mentioned in Gridhrasi sAmanya lakshana216. • In Vataja grudhrasi sphurana and stabhata of kati is mentioned217. • Kati graha is mentioned inVatajvara218. • AmaVata219 • Ashmari220 • Kati graha is mentioned Vankshanotha & vrikkaja vidradhi221. • Stambha of kati is told in Pureeshaja anaha222. • Kati graha is mentioned in Kshataja kasa223. • Ruk & sadana of kati is mentioned in Pandu sAmanya lakshana224. • Sangraha Grahani225 • Kati shoola is mentioned in Vataja pakvatisara226 • Vedana in kati pradesha is mentioned in Asanjatha jalodara227 • In Vathodara ruja of kati prushta is mentioned228. • In Vatholbanarshas & Vathanubandha raktharshas Vedana in kati pradesha is told229. • Vedana in kati pradesha is told as an upasthitha prasava lakshana and it is seen in gyenic disorders such as Vatika Asrugdara, Upavishtaka Nagodara, and Prakcharana230. • Svapna of kati is mentioned in medakshaya231 • Kati, ooru vamkshana bhanjana is mentioned in bahyayAma232. • Kati bhanga is seen in seventh vega of Sthavara visha233. • In Sahajarsha Thrutheeyaka jvara and Madatyaya, trikagraha is 234 mentioned as a symptomKatigraha as poorva roopa • Katigraha is seen as a poorvaroopa for Ksheena roga along with raktamootratha235. • Nistoda,sphurana,bheda,supti and guruta of kati,janu jangha ooru amsa are mentioned in Vatarakta236. • Kati kapala vedana is told in Bhagandara poorvaroopa237. • Basti,kati mushka,medra vedana is mentioned as poorva roopa for Vrudhi238.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 81
  • 100. Disease ReviewKatigraha as upadrava • Stambha arthi and bhedana of kati,guda jangha, ooru and basti are mentioned in Athidrutha basti datha doshas239. • In Snehabastivyapat kati shoola is explained240. • Langhana atiyoga may lead to Vedana in kati pradesha241 • Kati prushta vedana will be occurred due to Rathaksobha in pariharakala242. • Parshva prushta katigraha may manifest due toAthimatraahara. 243 • Overusage of katurasa may lead to vyadha of kati and prushta region244.Katigraha as a part of samprapti • In Pakvashaya Vata kopa245 kati graha is mentioned along with shoola anaha antrakoojana, etc. • Jangha ooru, trika prushta rogas may manifest when the Vata prakopa occurs in the gudapradesha246. • Trika sandhi pravesha is explained in the disease AmaVata247.Apart from this the Katigraha disease itself is of two types shudha /Vataja&SAma/VataKaphaja . So while diagnosing Katigraha, conditions like dhatukshayaand avarana should be differentiated apart and this will help in successful treatment.SADHYATA – ASADHYATAThe Sadhyata-asadhyata or prognosis of a disease depends on many factors such asthe Bala of Nidana or Hetu, the strength of Dosha Prakopa, the Sthana of the disease,severity of signs and symptoms, duration of the disease etc. It also depends upon theage, sex, RogAmarga, Dhatudushti etc. These common rules are applicable in thecase of Kati Graha. In addition, Kati Graha is a Vatavyadhi and the Svabhava ornatural trend of Vayu is also an important factor. Acharya Sushruta has explainedVatavyadhi as Mahavyadhi which is cured with difficulty. He also says that if thepatient of Vatavyadhi develops the complication like Sunam, Suptatvacham , Bhagna, Kampa , AdhAmana and pain in internal organs, then he doesn’t survive249.According to Acharya Charaka, if Vatavyadhi is connected with Sandhichuti,Kunjanam, Kubjata, Ardita, Pakshaghata, Anshashosha, Panguta and those which areMajja and Asthigata are usually cured with difficulty or even incurable.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 82
  • 101. Disease ReviewKati Graha is a Vatavyadhi if it is associated with Kapha the chances of cure are morethan in Kevala Vataja variety. Still however if the patient comes earlier for thetreatment and if given prompt proper treatment in sufficient dose and duration, thenthe patient is likely to be cured or less likely to suffer from a subsequent attack ofpain. In case the changes in the spinal joints are in advanced nature of the diseasethen with even the best treatment it is not likely to be cured.UPASHAYA AND ANUPASHAYA Upashaya are the medicines, diets and regimens, which bring about happinesseither by acting directly against the cause of the disease or it may produce such effecton the disease indirectly. Upashaya is rightly called as exploratory therapy250. When identical symptoms having two or more disease are meeting hostilely(or encountered) in such conditions, disease could be best differentiated by adoptingUpashaya.Upashaya for katigraha has not been mentioned particularly. How ever theNidana mentioned for Vatavyadhi, can be considered as Anupashaya.Upashaya: Upashaya is much important; especially during the treatment usually alldrugs, diet and regimen which give long lasting relief in Kati graha may be taken asUpashaya, having snigdha & ushna gunas are prescribed to pacify the Vata kopa. Forexample Abhyanga, Swedana, Ushna ahara, Ushna ritu etc. This should be adoptedin the nirAma avastha of Vatavyadhi (Kati graha) only. When the same drugs areprescribed in the saAma avastha of Vatavyadhi the disease aggravates.Anupashaya: All the drugs, diet and regimen which exaggerate the disease are taken forAnupashaya for Kati graha. Also hetus of Vatavyadhi can also be taken asAnupashaya. When upashaya method applied during sAmaavastha can also beincluded under Anupashaya. The diet having laghu, ruksha, sheeta gunas, anashana,alpashana, sheeta rithu can be considered as Anupashaya.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 83
  • 102. Disease ReviewCHIKITSA Katigraha one of the Vatavyadhi is produced by the vitiated Vata stemmingout from the pakvashaya, localizing in the Kati pradesha, may afflict the AsthiDhaatu, and vitiates the Snayu and Kandara of the Kati pradesha. The resultantcondition is characterized by pain and stiffness of the Katipradesha. It is difficult tounify an effective treatment for this, as the disease may or may not be assossiatedwith Ama. Therefore, the procedures aiming at the rectification of the imbalances inVata Dosha as well as Kapha Dosha forms the sheet anchor of treatment ofKatigraha. The general principles of treatment of Vata Dosha should be adopted in casesof Katigraha after the assessment of Dooshya, Prakruti, Vaya, Linga, Bala, Satwa,Satmya. The treatment of Katigraha includes various measures to suit its variedclinical entities, stages and associated complaints. The treatment also constitutes theAahara, Vihara, Shodhana, SAmana and surgical measures. The specific Nidanas ofthe diseases must be identified and efforts must be made for its Parivarjana. Theetiological factors mentioned previously pertaining to Aahara Vihara etc are to beavoided with special reference to the identification of the actual cause of the patient’spresent condition. After reviewing the classics, it is ideal to manage Katigraha withfollowing principles of treatment.SNEHANA: Snehapana can be adopted in Katigraha except in conditions of Ama,AvritaVata, Ajeerna, Aruchi etc. In case of associated Ama or Kapha Dosha,Langhana and Pachana are the first line of treatment preceding Snehapana to facilitatethe NirAmaavasta. Both Ghruta paana and Taila paana can be effectively adoptedaccording to the conditions after attaining NiraAmavastha. Bahya Snehana can beperformed in the form of Snehadhara, Abhyanga, Avagaha, Parisheka, Kativasthi etc.SWEDANA: Katigraha is a Swedasadhya vyadhi. Among the different forms of Swedaprocedures, Avagaha Sweda, Pizhichil, Naadi Sweda, PatraPinda Sweda, PindaSweda, and Upanaaha Sweda may be performed efficiently in Katigraha. Swedana isA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 84
  • 103. Disease Reviewalso useful in relieving stiffness in Prushta and Kati pradesha. It can be done in entirebody or in affected part of the body like kati, Prushta etc alone.MRIDU SAMSHODHANAVIRECANA:Virecana has an important role in Katigraha. The action of Virecana is not onlylimited to particular site but has effects on the whole body. In Vatavyadhi most of theauthors mentioned Mridu Virecana.251 VriddhaVagbhata specifies that Virecana must be employed in Vata disordersthat are not subsided by Snehana and Swedana. Oral administration of ‘ErandaSneha’ along with milk is ideal for the Virecana purpose252. This will help in bothVata Anulomana as well as smooth excretion of Mala. Thus Sneha Virecana of Mridunature clears obstruction in the srotas and helps in controlling Shoola of katigraha.BASTI: Basti is said to be the Pradhana Chikitsa for Vata Rogas because it immediatelyenters into Pakwashaya and corrects the root of vitiated Vata Dosha dwelling in otherparts of the body. Further Basti Chikitsa has been glorified as ‘Ardha Chikitsa’ orPoorna Chikitsa of Vata.253Sushruta stressed that the disorders of Vata either Sarvanga or Ekanga can becorrected by Basti alone. Basti has various effects on body like increase of strength,complexion, restoration and equilibrium of Dosha Dhatu and Malas. It is useful inalmost all Vata Rogas and relieves stiffness and contractures. Vangasena advised 254sodhana and administration of basti in Katigraha . Vangasena inBastikarmaadhikara has quoted Vaitarana Basti, is useful in KatiShula, Uru Shula,Prushta Shula, Shotha, and other Vataja disorders.SAMANA CIKITSA: Several preparations which are having VedanashAmaka effect are enlisted inclassical texts for Katigraha.Churna:Ajamodaadi Coorna, Abhayaadi Coorna, KrishnadiCoorna, Rasnaadi CoornaKalka and Lepa:Maha Nimba Kalka, Rasona Kalka, Swalpa Rasona, Vaatahara PradehaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 85
  • 104. Disease ReviewKashaaya and Arishta:Panchamoola Kashaaya, Maha Rasnaadi Kashaaya, Erandaadi Kashaaya DashamoolaKashaaya, , Rasna Saptaka Kwatha, Sahacharaadi Kwatha, Shephalika Kwatha,Balarishta and Dashamoolarishta.Ghrita and Taila:Chagaalyadhya Ghrita, Bala Taila, Eranda Taila, Vajeegandhaadi Taila,Saindhavaadya Taila, Maashaadi Taila, VishagarbhaTaila, PrasaaraniTaila,Mahaabalaadi Taila, Naraayana Taila, VishnuTaila and GhritaVijaya BhairaVataila,RasnapooteekaTaila, SaptaprastamsaTaila, Datturaadi Taila.Guggulu and Rasayogas:Rasna Guggulu Trayodashanga Guggulu, Yogaraaja Guggulu, MahayogaraajaGuggulu, Pathyaadi Guggulu, Vataari Rasa, Vatagajankusha Rasa, VatarakshasaRasa.YOGAASANA: - The yoga exercises are the most effective and acclaimed as the best suitable for both prevention and management of low backache. Yogic asanas which are beneficial in the treatment of backache are Bhujangasana, Shalabhasana, Halasana, Uttanpadasana and Shavasana.PATHYA – APATHYA Those Aharadi Dravyas, which are beneficial to Srotas and have no adverseeffect on body and mind, are termed as Pathya255. Pathya is a major pillar supportingthe line of treatment of any disease. Quite opposite to this the food and regimen thatare otherwise is named as Apathya. Pathya and Apathya of Katigraha are notdescribed separately. Hence Pathya and Apathya of Vata Vyadhi in general isconsidered for Katigraha also.Pathya256:Table No. 13: Showing the Pathyas of Kati graha: Ahara 1 Rasas 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.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 86
  • 105. Disease Review 5 Mamsa varga Ushtra, Go, Varaha, Mahisha, Magura, Bheka, Nakula,Chataka,Kukkuta, Tittira, Kurma. 6 Jala varga Ushnajala, Shrithasheetajala, Narikelajala. 7 Dugdhavarga Go, Aja, Dadhi, Gritha, Kilata, Kurchika. 8 Mutravaga Gomutra. 9 Madyavarga Dhanyamla, Sura. 10 Snehavarga Ghrita, Tila, Vasa, Majja. 11 Present day Orange juice, carrot, all fibrous fruits and Vegetables. food stuffs Vihara 1 Veshtana, Trasana, Mardana, Snana, Bhushayya, 2 Present day & activities: Physiotherapy exercise, Yoga asana’s, Steam bathApathya257:Table No. 14: Showing the Apathyas of Kati graha: Ahara 1 Rasas 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 6 Jala varga Sheetajala. 7 Dugdhavarga Gardabha. 8 Present day food Fast food, cold beverages, liquor. stuffs Vihara 1 Manasika: Chinta, Shoka, Bhaya. 2 Present day Long standing sitting, driving, staying in AC etc activities:A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 87
  • 106. Disease ReviewLOW BACK ACHE 258,259,260 All structures in the spinal column,other than cartilage is pain sensitive,but theexact mechanism of pain production within individual structure is unknown.Amongst patients presenting with back pain,the main role of history and examinationis to identify the small number who have serious orspecefic spinal disorder. The low back ache can be manifested due to 1. Intra spinaous cause 2. Extrspinous causes.A) Reasons In the back • Congenital abnormalities – Spina Bifida, Spondylolisthesis, Hemivertebra, Split vertebra, Abnormality in the articular process, Sacralisation of the transverse process of the 5th lumbar vertebra. • Functional defects – Anteroposterior imbalance (pregnancy, potbelly, fixed flexion deformity of the hip joints) and lateral imbalance due to leg length discrepancy etc. • Deformities: Scoliosis, Kyphosis, Lordosis. • Mechanical derangements: Prolapsed lumbar disc, acute lumbago, Spondylolisthesis, Spinal canal stenosis • Soft tissue disorder: Lower lumbar ligamentous Sprain, Strain, Muscle spasm. • Trauma –Injuries to intervertebral joints, spondylolisthesis, compression fracture, vertebral process fracture and ruptured disc • Infectious conditions: Tuberculosis of spine, pyogenic infections of spine. • Inflammatory conditions : Rheumatoid arthritis, Brucellosis, Osteo arthritis Ankylosing spondylitis, Myositis, fibrositis. • Degenerative causes – Spondylosis, Senile osteoporosis, Degenerative disc disease. • Neoplastic conditions -Primary tumours e.g. multiple myeloma, eosinophilic granuloma, haemangioma, Osteoid osteoma. Metastatic tumours from breast, bronchus, kidney, supra renal, prostate, thyroid, gastro intestinal tract.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 88
  • 107. Disease Review Reasons other than Back • Abdominal Disorders e.g. pancreatitis, cholecystitis, biliary calculus, peptic ulcer, hiatus hernia. • Pelvic Disorders e.g. inflammatory condition of the ovaries and tubes, any intra pelvic tumour. • Genito urinary causes e.g. renal infection, renal or ureteric calculus, prostatitis, prostatic carcinoma, seminal vesiculitis. • Vascular disorders e.g. ischemic pain from occlusion of the aorta or iliac arteries and aneurismal dilatation of the aorta may cause backache.Some conditions like Spina bifida, Hemi vertebra are not frequently come across.Spondylolisthesis, Spinal canal stenosis may require surgical management.Rheumatoid arthritis involves all the joints it is not considered.So for the presentstudy Patients with other systemic disorders and conditions like Spondylolisthesis,Spina bifida, Tuberculosis of spine, Ankylosing Spondylitis, Spinal canal stenosisand Malignancies are excluded.Pain and stiffness is particularly found in conditionssuch as Spondylosis, intervertebral disc prolapse, osteo arthritis Ankylosing spondylitis and soft tissuedisorders.Out of these pain which is mechanical in origin or soft tissue disorders inotherwords only is considered for the present study.Mechanical painThe lower back supports most of the weight of the body and is subject to the mostmechanical stress. As a result, the lower back is commonly injured. Lower back paincaused by strained muscles(lumbar strain) or ligaments( lumbar sprain) is the mostcommon type of mechanical back pain . Differentiating a strain from a sprain can bedifficult, as both injuries will show similar symptoms. Many doctors refer to bothinjuries as a category called "musculoligamentous injuries" of the lumbar spine.Onset is often acute assossiated with lifting and bending. Mechanical pain is relatedto activity and is generally relieved by rest. It is usually confined to the lumbao sacralregion, buttuck or thigh,is asymmetrical,and does not radiate beyond the knee.Risk: Lower back sprains and strains occur in every culture and country in theworld. They correlate with few risk factors other than increasing age. Twisting whileA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 89
  • 108. Disease Reviewholding or lifting heavy objects or persons is frequently an inciting event for backsprain and strain, as are vigorous sports, falls, and motor vehicle accidents. Anecdotalinformation does link certain occupations with increased risk for back sprain andstrain, including construction, mining,agriculture and nursing .Psychological factorslike job dissatisfaction, depression, anxiety, are important risk factors for both acutepain and transition to chronic pain and disabilityIncidence and Prevalence: Lower back pain is the second most common complaint seen by physicians.Back pain is a human condition with 60-80% of the world’s population experiencingpain at at some time in their lives. Among this mechanical pain accounts for morethan 90% of the back pain episodes, usually affecting patients aged 22-55 years. Although there is no evidence that back pain prevalence has increased,reported disability due to back pain, particularly work absence, has increasedsignifically in the last 30 yearsSome well known factors that contribute to low back pain include: • Poor conditioning • Obesity • Smoking • Improper use/lifting technique Signs and Symptoms of Lumbar Muscle Spasms a. Pain around the low back and upper buttocks b. Pain associated with activities, and generally relieved with rest c. Muscle spasm d. Palpable tension in the muscles of the lower back. Diagnosis is based upon the clinical history, physical exam and x-rays.History: The individual may report sharp pain and tenderness. If bleeding in themuscle has occurred, swelling (edema) beneath the skin may be present. As a resultof the injury and accompanying pain, the individuals movement may be limited, evento the point of requiring temporary immobilization. The pain may be persistent orassociated with a specific movement or activity. Turning, sitting, and bendingforward usually worsen pain.Physical exam: The exam may reveal tenderness to the touch or upon pressure,localized swelling, and areas of discoloration along the back and gluteal area. RangeA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 90
  • 109. Disease Reviewof motion will be limited due to pain and muscle spasm, and the involved musclesmay be tense. The physician may try to identify the particular movements or positionsthat aggravate the pain and determine whether the pain is relieved by lying down orrest.Tests: Most cases of back strains and sprains do not require any diagnostic tests.Occasionally x-rays or MRI may be necessary to rule out other potential causes ofback pain.Lumbar strainBack strain is also referred to as pulled back muscles. It is an injury to either amuscle or a tendon, that connects muscles to bones, and caused due to overusage oroverloading of the muscle. When a muscle is stressed beyond its limits, injuryoccurs. With injury comes inflammation, which is part of the healing process.Inflammation causes pain and can also trigger muscle spasms and they are usually notas severe as a back sprain. In fact, strains involving the back may not even causesymptoms until the following day. Back strains are most often seen in persons whose occupation or leisure activitiesinvolve excessive lifting or torso rotation. Many strains are the result of inadequatewarm-up, excessive training, or inadequate healing of a previous muscular injury • Poor lifting techniques as well as lifting objects that are too heavy can overload the back and cause strained back muscles. Weak muscles are more easily overloaded and injured than strong muscles, but any muscle can be overloaded. • Falling down or an unexpected twisting of the back can also cause pulled back muscles. • Though the pain is usually caused by overstretching or tearing of back muscles, sometimes an irritated spinal joint triggers muscle spasms around the joint. • Back Muscle Strain may also be by Overuse.When one position is held too long, the back muscles get fatigued and strained. Byproducts of muscular activity (such as lactic acid) build up in the back muscles. High levels of these acidic waste products in the muscles cause muscle irritation and pain.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 91
  • 110. Disease Review • Back exercises with too many repetitive quick movements can also cause back pain • Poor posture also cause the muscles to have to work harder to support the spine, which leads to fatigue, strain, and back pain. • A strain is an injury to either a muscle or a tendon, the tissue that connects muscles to bonesSigns and Symptoms of Strains.Symptoms of pulled back muscles include back pain and muscle weakness andsometimes back muscle spasms. The back pain may be sudden, but usually comes ongradually.They can also have localized swelling, cramping, or inflammation and, witha more severe strain, some loss of muscle function. Patients typically have pain in theinjured area and general weakness of the muscle when they attempt to move it.Severe strains that partially or completely tear the muscle or tendon are often verypainful and disabling. Strain Severity &Prognosis Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear. • Grade I Strain: This is a mild strain and only some muscles or tendons become stretched, with few torn fibers and no loss of muscle strength. Healing occurs within two to three weeks. • Grade II Strain: This is a moderate strain with more extensive dAmage to muscle fibers and involves a greater number of injured muscle or tendon fibers with noticeable loss of strength. Healing occurs within three to six weeks. • Grade III Strain: This is a severe injury with a complete rupture of a muscle, resulting in complete functional loss of the affected muscle or tendon. This typically requires a surgical repair of the muscle; the healing period can be up to three months.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 92
  • 111. Disease ReviewLumbar sprainA sprain is an injury to a ligament, the tough, fibrous tissue that connects bones toother bone. Injury to other nonmuscular structures, disc, facet, capsule, etc. of theback, also discussed under this heading. Back sprains usually result from overstretching a ligament, most often due to twisting, heavy lifting, or sustained postural loading. Sudden movements can cause injury to the ligaments because the muscles dont have time to react - e.g. in a fall or car accident. The muscles dont contract enough to keep the spine within its normal range of motion, causing ligaments to stretch or tear.Acute pain can result from a back sprain. The pain may also gradually get worse over a couple of days as inflammation developsSigns and Symptoms of SprainsThe usual signs and symptoms of a muscle sprain include pain, swelling, bruising,and the loss of functional ability (the ability to move and use the joint). However,these signs and symptoms can vary in intensity, depending on the severity of thesprain.Sprain Severity• Grade I Sprain: A grade I (mild) sprain causes overstretching or slight tearing of the ligaments with no joint instability. A person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Bruising is absent or slight, and the person is usually able to put weight on the affected joint.• Grade II Sprain: A grade II (moderate) sprain causes partial tearing of the ligament and is characterized by bruising, moderate pain, and swelling. A person with a moderate sprain usually has some difficulty putting weight on the affected joint and experiences some loss of function. An x-ray or MRI may be needed.• Grade III Sprain: A grade III (severe) sprain results in a complete tear or rupture a ligament. Pain, swelling, and bruising are usually severe, and the patient is unable to put weight on the joint. An x-ray is usually taken to rule out a broken bone. This type of a muscle sprain often requires immobilization and possibly surgery.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 93
  • 112. Disease ReviewSymptoms of Back SprainSevere back sprains cause severe back pain, swelling and bruising and make it almostimpossible to move. Like back strain, back sprains may trigger back muscle spasms.Back Sprain PrognosisHealing time depends on the severity of the sprain. Most back sprains heal in six toeight weeks but it can take several months for complete recovery from a severe backsprain.MANAGEMENT OF LOW BACK ACHE Most back pain is caused by simple strains and the main focus of this site is how to prevent recurring back pain by strengthening the muscles that support the spine with back exercises, along with correcting posture, using proper lifting techniques, and understanding the physical limitations of the back. There is also information on a wide range of back pain treatments, including complementary treatments, for the relief of both acute and chronic back pain. Radical treatment of the Low back ache is planned with the due consideration of the etiology of the illness. Relieving the pain and other discomfort by different measures should not be the sole purpose of the treatment. Key principles include:1) Prevention"Prevention is better than cure," it is told in classics, in this study preventivemeasures are very essential things, some different posture are mentioned here.In sitting posture:- To maintain the good sitting posture.- To Avoid a long time sitting posture.- Change in position for every 15 minutes.- A seat placed at a height from the ground that is slightly less than the lengthof the leg from knee to foot.-The lumbar spine can be kept in contact with the squab support at the back of the chair.In standing posture:- To avoid asymmetrical standing- Keep knees relaxed on comfortably straight position.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 94
  • 113. Disease ReviewIn lying posture:- The side lying position is generally a safe and comfortable posture forsleeping - To maintain the proper position to getting out of bed- Keep the spine in a neutral positionDuring work:- Avoid forward bending while working.- Do not wear the high heel shoes.- Use of better techniques while lifting.Other major points in prevention are weight reduction and avoidance of any unusualactivity that can hurt the back. Keep trunk muscles in optimal condition by regularexercise such as brisk walking, swimming etc.2) Non-operative treatment Heat and Cold - In the acute patient, the application of therapeutic heat andcold usually precedes traction or exercise. Modalities include the use of hydrocollator packs, whirlpool, diathermy, ultrasound and phonophoresis.Bracing: Braces provide pain relief by stimulating some of your nerve fibers whichmake you feel that your back is more stable and secure.Traction- The mechanical benefit of traction is to decrease the lordosis of the lumbarspine. It can be applied in a sustained manner or intermittent manner.Bed rest and manipulation –An adequate period of bed rest is of at least 2 weeks areadvised. A firm resting surface is important. Any comfortable position can beassumed but resting in prone, because of the associated hyperextension, isdiscouraged. After the proposed period the patient is gradually mobilized but shouldreturn to bed if the pain reappears.3) Drug therapy Activity and walking as tolerated combined with the nonsteroidal anti-inflammatory drugs (NSAIDS) are also frequently prescribed. Muscle relaxants can also be used. • Acetaminophen (TylenolTM) can provide optimal pain relief with limited side effects. Anti-inflammatories such as MotrinTM (ibuprofen) and AleveTM (naproxen), may also be beneficial However, their use should be limited to only a short period of time.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 95
  • 114. Disease Review Figure No:6A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 96
  • 115. Disease ReviewPatients who have persistent back pain beyond 1-2 weeks should consult with theirphysician. Physical therapy and in some cases counseling on how to cope with thepain can be helpful. Continuing to exercise and trying to be as functional as possibleat home and work may also be helpful. Spinal manipulation is not thought to behelpful. Massage can help in the short term. More frequently used medicationsinclude non steroidal anti inflammatory drugs and acetaminophen. Muscle relaxantsare another class of drugs that are frequently used.4) Surgical interventions - If not relieved by conservative treatment. - Quick recurrence of symptom. - Evidence of large prolapse causing pressure on cauda equina. Selective injection treatment for backache They are based on principles of regional anesthesia. Cortico steroids areinjected locally to relieve inflammation and pain. It can be injected to epidural spaceor into the desired foramen under fluoroscopy.Lidocaine is the most widely used agent in the concentration of 0.5 – 2%. Onset ofaction is 1-5 minutes and duration is 1-2 hrs. Bupivacaine has slower onset of action5- 20 min but provides longer pain relief.ComplicationsComplications of severe lower back injuries include fractures, dislocations, andavulsion injuries (tearing away of a part or structure). An avulsion fracture involvesthe tearing away of a piece of bone with a ligament at the point of attachment and canresult in spinal instability or nerve root or spinal cord injury. Bleeding into a musclecan result in severe pain.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 97
  • 116. Methodology 4 .METHODOLOGYMATERIALS AND METHODSResearch is defined as scientific and diligent study, investigation or experimentationin order to establish facts and analyze their significance. Research is done forestablishing new facts, discarding the old or modifying them. Many times research isdone to validate old principles with fresh proofs. Always research need not end withpositive results. In research one problem is constructed with suitable experimentalmethods and honest observations are made to arrive at a logic conclusion.Research Approach:In the present study, the main objective is to “ Study on The Effect of Swedana WithKolakulatthadi Choorna And Valuka In Katigraha”. The efficacy was determined byfinding out the difference between the base line data of the parameters to the afterfollow-up data.Source of Data: Patients of either sex who attended the outpatient and in patient deparments ofin K.V.G. Ayurveda Medical College and Hospital, Sullia. in the period fromDecember 2004 to August 2005 complaining of low backache and stiffness werescreened. Out of these 40 patients suffering from Katigraha fulfilling the belowmentioned inclusion criteria were taken for the study. Demographic data and disease-specific data are collected according to the case-record form given in the appendix. .Study design-:The study design set for the present study is ‘comparative clinical study’. Selected patients of Katigraha are randomly and equally divided into 2 groupsirrespective of sex, occupation and Socio economic status. • Group A:- The patients of this group was subjected to Kolakulatthadi Choorna Pinda Sweda for thirty minutes daily. • Group B:- The patients of this group was subjected to Valuka Pinda Sweda for thirty minutes daily. Both the groups will be treated for a period of seven days. The efficacy was determined by finding out the difference between the baseline data of the parameters to the follow-up data and the results obtained in both theindividual groups were compared.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 98
  • 117. MethodologySelection Criteria:Diagnostic criteria • Kati Shoola. • Stiffness of the Kati. • Reduced range of movement of Kati. • Tenderness in Kati.The cases were selected strictly as per the pre-set inclusion and exclusion criteria.Inclusion criteria: 1) Patients having the classical Lakshanas of Katigraha will be selected. 2) Patients of the age group between 20 and 70 years irrespective of sex, occupation, Socio economic status. 3) Patient fit for Rooksha SwedaExclusion criteria: 1) Age group below 20yrs and beyond 70yrs. 2) Patients with other systemic disorders. 3) Conditions like Spondylolysthesis, Spinabifida, Tuberculosis of spine, Ankylosing spondylitis, Spinal canal stenosis, Vertebral fracture, and MalignanciesData Collection: Patients were thoroughly examined both subjectively and objectively.Detailed history pertaining to the mode of onset, previous ailment, previous treatmenthistory, family history, habits, Ashtavidha pareeksha and Dashavidhapareeksha andphysical examination findings were noted. Routine investigations were done toexclude other pathologies. Radiological features were also investigated.Examination of lumbar region:History: The common symptoms with which a patient generally presents are pain,swelling, stiffness, mechanical disorders (e.g. Locking, giving way, click etc.) andlimp.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 99
  • 118. MethodologyInspection: • The lumbar region was fully exposed • Patient was first examined in the standing position, secondly in the seated position, thirdly in the supine position and lastly in the prone position • The limits of the swelling were clearly made out. • Any discolouration were examined • The gradings were allotted on the basis of criteria explained in the end of this section. • Any deformities like scoliosis kyphosis,lordosis were examined. • Any abnormalities in the gait were examined. • Walking time was recorded (the time taken to cover 50 meters). • Any presence of muscular spasm was examined. • Muscular wasting above and below the joint was examined.Palpation: • Local tenderness was examined. • Local temperature was examined with the back of the hand • SwellingTenderness - Apart from these two classical symptoms, tenderness can be elicited inconditions when there is severe pain. It can be elicited by pressing the thumb alongthe whole length of the spinal column. Tenderness may be elicited by pressing uponthe side of spinous process in an attempt to rotate the vertebra. This can also beelicited by giving gentle blows on either side of the spine. It must be remembered thatat times the patient may flinch with pain as soon as the skin is being touched. In suchcases pinch up the skin to differentiate whether the pain is in the skin or in the spine.Movements: The cardinal movements of the lumbar spine are flexion, extension,compression, axial rotation and lateral flexion Both active and passive movementswere examined.Flexion & Extension: Flexion and extension are clinically the most obvious;compression is the most overlooked and underrated movement yet clinically the mostrelevant.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 100
  • 119. MethodologyLateral movements: Lateral flexion is a complex movement with variablecombinations of lateral bending, rotator movement and movements ofzygoapophyseal joints.Rotation: There are no primary rotators of the lumbar spine, so axial rotation is asecondary movement achieved by the oblique abdominal musclesMethods of Assessment of Clinical Response: Subjective parameters and objective parameters were made out to assess theClinical response.Subjective Parameters: Pain on rest(Lying),Pain on sitting ,Pain on movementObjective parameters: Tenderness, Lumbar flexion, Lumbar extension, Right lateralmovement, Left lateral movement, Rotation.Assessement Parameters With Grading:Pain on rest(On lying): Grade 0 - No complaint Grade 1 - Reveals on enquiry (mild) Grade 2 - Complaints frequently when moves joints (moderate) Grade 3 - continues pain (Severe)Pain on rest(On sitting): Grade 0 - No complaint Grade 1 - Reveals on enquiry (mild) Grade 2 - Complaints frequently when moves joints (moderate) Grade 3 - continues pain (Severe)Pain on movement(on walk): Grade 0 - No complaint Grade 1 – Can able to walk more than 10 mtrs Grade 2 - Can able to walk only Up to 5 mtrs Grade 3 - Cannot walk due to painTenderness: Grade 0 - No tendernessA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 101
  • 120. Methodology Grade 1 - Pain on touch Grade 2 - Pain on touch and winces Grade 3 - Withdraws the part Grade 4 - Not allow to touch the partLumbar flexion: Grade 0 - Able to touch the ground Grade 1 –.able to go upto ankle Grade 2 – able to go just below knee Grade 3 – Not upto kneeLumbar extension: Grade 0 – Able to do dowithout difficulty Grade 1 - Able to do with pain Grade 2 – Cannot able to doRight lateral movement: Grade 0 – Able to go below knee without difficulty Grade 1 - Able to go below knee with pain Grade 2 – Cannot go below knee Grade 3 – No movementLeft lateral movement: Grade 0 – Able to go below knee without difficulty Grade 1 - Able to go below knee with pain Grade 2 – Cannot go below knee Grade 3 – No movementRotation: Grade 0 – Can rotate easily Grade 1 – Rotation with difficulty Grade 2 – Cannot rotate.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 102
  • 121. MethodologyWalking time to cover 21meters of distance: Grade 0 - up to 20sec. Grade 1 - 21-30 sec. Grade 2 - 31-40 sec. Grade 3 - 41-50 sec. Grade 4 - 51-60 sec.Therapeutic interventionMaterials required for therapeutic intervention: Fine powder - 500gms Valuka -1500 Cotton cloth(45 cm x 45cm) -2 Tags -2 Iron vessel -I Towel -1Method of therapeutic intervention: In both group of patients, the procedure of Pinda Sweda is conducted in boththe groups .They differs only in the drug used for the procedure. The procedure ofadministration in general is devided into three stages in both group and is identical. Treatment Schedule Group A – RookshaSwedam with Kolakulathadi choorna Pinda. Group B-Valuka Sweda Poorva karma Preparation of the medicine Medicine Kolakulathadi choorna, the above said ingredients were taken in raw form after removing the impurities. There then individually were pulverized to get fine powder after obtaining the fine powder they were mixed to get uniform mixture. Preperation of Pottali The powder fried in the vessel till it attains a goldenbrown colour’ 2 Pottali were prepared each containing 200 gms of Kolakulathadi choorna they were tied properly and kept for ready for the treatment .A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 103
  • 122. Methodology Preperation of Patient Patient were selected after fulfilling the criterias. The procedure was explained in brief to the patient. The patient was made to lie on the table and lower limbs and Kati Pradesa exposed .Pradhanakarma: The potali is heated by keeping in the valuka placed over fire. Two pottalis were heated up to a sustainable heat . It should be genly applied over the lumbar region and on other related affected parts the after confirming the temp. of the potalis on the dorsum of hand of therapists. This procedure is done by pressing, rubbing & keeping over the said body parts. The whole procedure was repeated for about 20-30 min depending on the response of the individual patient Both potalis are used alternatively after reheating to maintain uniform temp. through out the procedure. Same potali is used for 3 days Paschat karma Patient is asked to rest for 15-20 minutes in the comfortable position. Advise to take bath with hot water Pathya during treatment period & pariharakala The pathyacharana is an important factor which was followed for 28days including the treatment period & pathyacharana. Patients were advised to take katu-tiktha-kashaya-Rooksha varjitha aharadravyas in light quantity. Rice gruel with little milk was advised as the ideal food. Patient was advised to drink hot water only. Patient was advised to avoid sexual intercourse, blocking of natural urges, traveling, exercise, over-speech, uneven sitting & lying postures, exposure to wind, cold, heat and dust, anger and grief.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 104
  • 123. Methodology Figure No:7 Method of preparation of PotaliA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 105
  • 124. Methodology Figure No:8 Procedure of Pinda SwedaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 106
  • 125. Methodology Follow up study: The patient was asked to follow a pariharakala of 14days and was asked to report on 21st day counting from the day the treatment schedule started. On the 21st day the final assessment readings were taken for the Statistical study. Statistical Analysis: For assessing the improvement of symptomatic relief and to analyze statistically the observations were recorded before, after the treatment and after follow- up. The mean, percentage, S.D, S.E, and t-value (paired t-test) were calculated from the observation recorded. The comparison of efficacy of both the groups are done by unpaired t test.The total result including the overall effect of therapy is given in tables for the two groups. ASSESSMENT OF TOTAL EFFECT OF THERAPY Table no.15Complete remission 100% relief in signs and symptoms and walking without any pain were considered as complete remissionMarked improvement 75-99% relief in signs and symptomsModerate improvement 50-74% relief in signs and symptomsMild Improvement 25 – 49% relief in signs and symptomsUnchanged No change in signs and symptoms A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 107
  • 126. Results 5. RESULTS In the present study, 40 patients suffering from Katigraha fulfilling the inclusioncriteria were studied and were randomly categorised into Kolakulathadi choorna panda svedagroup and Valuka panda sveda group.Incidence ObservationsTable No.16Distribution of 40 patients of Katigraha according to age. KCPS VPS AGE GROUP N=20 % N=20 % TOTAL % 20-29 7 35% 5 25% 12 30% 30-39 5 25% 4 20% 9 22% 40-49 3 15% 3 15% 6 15% 50-59 4 20% 2 10% 6 15% 60-70 1 5% 6 30% 7 18% Analysis of age incidence of 40 patients suffering from Katigraha showed morenumber of patients between the age group of 20 to 39 years. Further, in group A out of 20patients, a maximum of 60% patients were between the age group of 20 to 39 years. Detailsof the age incidence are given Table no.16 and graphically represented in Graph No.1.Table No.17Distribution of 40 patients of Katigraha according to Sex KCPS VPS SEX N=20 % N=20 % TOTAL % Male 8 40% 7 35% 15 38% Female 12 60% 13 65% 25 62% In the sample taken for the study, 62% of females were registered in comparison to38% of males. Details of the sex incidence are given table no.17 and graphically representedin Graph No.2.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 108
  • 127. ResultsTable No.18Distribution of 40 patients of Katigraha according to Religion KCPS VPS RELIGION N=20 % N=20 % TOTAL % HINDU 16 80% 16 80% 32 80% MUSLIM 2 10% 3 15% 5 12% CHRISTIAN 2 10% 1 5% 3 8% 80% of the patients were Hindus in the sample, 12% of patients were Muslims andthe rest 8% were Christians. Distribution of patients according to the religion in both thegroups are given in Table No.18and graphically represented in Graph No.3.Table No.19Distribution of 40 patients of Katigraha according to their Educational qualification: KCPS VPS TOTAL EDUCATION N=20 % N=20 % % ILLITERATE 1 5% 0 0% 1 3% PRIMARY 4 20% 6 30% 10 25% SECONDARY 3 15% 6 30% 9 23% HIGHER SECONDARY 5 25% 4 20% 9 23% GRADUATION 7 35% 4 20% 11 28% In the sample taken for the study 28% were gratuates ,23%were educated till highschool and 23% had metriculation i.e., 25% had completed Primary school, 3% wereilliterate.. Details of educational qualifications in each group are given in table no.19 andgraphically represented in Graph No.4.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 109
  • 128. ResultsTable No.20Distribution of 40 patients of Katigraha according to Marital status: KCPS VPS MARITAL STATUS N=20 % N=20 % TOTAL % MARRIED 11 55% 9 45% 20 50% UNMARRIED 8 40% 12 60% 20 50% The Marital status. of the present sample distributed equally as married andunmarried ie. 50% each. Details on each group are given in table no.20 and graphicallyrepresented in Graph No.5.Table No.21Distribution of 40 patients of Katigraha according to socio-economical status: SOCIO ECNOMIC KCPS % VPS STATUS N=20 N=20 % TOTAL % HIGHER 3 15% 3 15% 7 18% UPPER MIDDLE 6 37% 4 20% 10 25% MIDDLE 6 37% 9 45% 15 38% POOR 4 20% 4 20% 9 23% Maximum number of patients belonged to middle class i.e., 38% while 25%belonged to upper middle class .23% were belongs to very poor socio-economical status. Andthe least 18% were belonged to higher status. Detailed description of socio-economical statusof the patients are given Table no.21 and graphically represented in Graph No.6.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 110
  • 129. ResultsTable No. 22Distribution of 40 patients of Katigraha according to their occupation: OCCUPATION KCPS % VPS % TOTAL % N=20 N=20BUSINESS 2 10% 2 10% 4 10%STUDENT 5 25% 1 5% 6 15%COOLIE 1 5% 0 0% 1 3%HOUSE WIFE 6 30% 7 35% 13 33%ATTENDER 1 5% 1 5% 2 5%TAILORING 1 5% 0 0% 1 3%NURSE 1 5% 0 0% 1 3%AGRICULTURIST 1 5% 1 5% 2 5%OFFICE STAFF 1 5% 3 15% 4 10%PAINTER 0 0% 1 5% 1 3%TEACHER 1 5% 2 10% 3 8%BEAUTICIAN 0 0% 1 5% 1 3%DRIVER 0 0% 1 5% 1 3% In the study, maximum patients were manual house wives i.e., 33% where as15%were students, 10% the patients were involved in business & 10% were office staff.8% teachers, 5% attender, 5% agriculturists, 3% were in different categories such as driver,beautician, painter, nurse, tailoring & coolie Detailed description of type of work of thepatients are given Table no.22 and graphically represented in Graph No.7.Table No.23Distribution of 40 patients of Katigraha according to their Nature of work: KCPS VPS NATURE OF WORK N=20 % N=20 % TOTAL % BENDING 6 30% 8 40% 14 35% SITTING 4 20% 3 15% 7 18% STANDING 3 15% 2 10% 5 13% TRAVELLING 5 25% 4 20% 9 23% WALKING 2 10% 3 15% 5 13%A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 111
  • 130. ResultsOccupation which involved bending predisposed the patients to strain of the back. In thepresent study 35% of the patients had similar occupation. 23% had to travel in two wheelersetc .as a part of their occupation leading to strain at low back. 18% of patients had to sit forlong duration. 13% had to walk more and 13% had to stand erect for long duration as a partof their work.Details of incidence of Nature of work are given Table no.23 and graphically represented inGraph No.8.Table No.24Distribution of 40 patients of Katigraha according to their mechanism of injury: MECHANISM OF KCPS VPS INJURY N=20 % N=20 % TOTAL % BENDING FORWARD 4 20% 5 25% 9 23% FALL 2 10% 2 10% 4 10% HIT 2 10% 1 5% 3 8% JERKY MOVEMENTS 3 15% 2 10% 5 13% LIFTING WEIGHT 3 15% 5 25% 8 20% NO CAUSE 6 30% 5 25% 11 28%In majority of patients 28% have developed the disease without any cause. Bending forwardwas a cause for 23%, Lifting heavy weight was the main cause for 20%, 13% followed byjerky movements, 10% had history of fall patients and 8% had history of hit at lumbar areaDetails of incidence of mechanism of injury are given Table no.24 and graphicallyrepresented in Graph No.9A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 112
  • 131. ResultsTable No.25Distribution of 40 patients of Katigraha according to course of pain: KCPS VPS COURSE OF PAIN N=20 % N=20 % TOTAL % CONTINOUS 4 20% 6 30% 10 25% INTERMITTENT 5 25% 4 20% 9 23% PROGRESSIVE 11 55% 10 50% 21 53%53% of the patients reported the course of pain as progressive, 25% patients werecomplaining continuous course of pain and 23% patients were having intermittent pain(Table-36). Details of incidence of course of pain are given Table no.25and graphicallyrepresented in Graph No.10.Table No.26Distribution of 40 patients of Katigraha according to onset: KCPS VPS ONSET N=20 % N=20 % TOTAL % GRADUAL 12 60% 11 55% 23 58% INCIDIOUS 5 25% 3 15% 8 20% SUDDEN 3 15% 6 30% 9 23%In 58% disease manifested gradually , 23% had sudden onset , 20% followed by someincident Details of incidence of onset are given Table no.26 and graphically represented inGraph No.11.Table No.27Distribution of 40 patients of Katigraha according to loss of function: KCPS VPS LOSS OF FUNCTION N=20 % N=20 % TOTAL % MILD 5 25% 4 20% 9 23% MODERATE 13 65% 14 70% 27 68% SEVERE 2 10% 2 10% 4 10%A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 113
  • 132. ResultsIn most of the patients 68% moderate loss of function was observed while 23% patients hadmild loss of function and 10% had severe loss of function. (Table-33).Details of incidence of loss of function are given Table no.27 and graphically represented inGraph No.12Table No.28Distribution of 40 patients of Katigraha according to duration of illness: KCPS VPS DURATION OF ILLNESS N=20 % N=20 % TOTAL % < 1 MONTH 8 40% 10 50% 18 45% 2-6 MONTHS 4 20% 3 15% 7 18% 6 MONTHS - 1 YEAR 2 10% 3 15% 5 13% 1 -2 YEAR 2 10% 2 10% 4 10% ABOVE 2 YEARS 1 5% 2 10% 3 8%45% patients had developed the disease with in 1 month followed by 18% had 2-6 months13% had 6 months to 1year duration, 10% had 1-2 year and 8% had above 2years (Table-34).Details of incidence of duration of illness are given Table no.28and graphically representedin Graph No.13Table No.29Distribution of 40 patients of Katigraha according to Agni: KCPS VPS AGNI N=20 % N=20 % TOTAL % MANDAGNI 5 25% 4 20% 9 23% SAMAGNI 8 40% 11 55% 19 48% TEEKSHNAGNI 3 15% 2 10% 5 13% VISHAMAGNI 4 20% 3 15% 7 18%Type of Agni observed in 40 patients of the present study is shown in the following table,48% of the patients were having Samagni, followed by Mandagni in 23%. Vishamagni isfound to be in 18% and teekshnagni in 13% of the patients.Details of incidence of Agni are given Table no.29 and graphically represented in GraphNo.14A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 114
  • 133. ResultsTable No.30Distribution of 40 patients of Katigraha according to Koshta: KCPS VPS KOSHTA N=20 % N=20 % TOTAL % KRURA 6 30% 7 35% 13 32% MADHYAMA 11 55% 9 45% 20 50% MRUDU 3 15% 4 20% 7 18%Madhyama Koshta was found in majority of the individuals 50%, followed by Krura Koshtain 32% and mrudu Koshta was found only in 18 % patients (Table-39).Details of incidence of koshta are given Table no.30 and graphically represented in GraphNo.15Table No.31Distribution of 40 patients of Katigraha according to Weight: KCPS VPS WEIGHT N=20 % N=20 % TOTAL % 31-40 0 0% 3 15% 3 8% 41-50 3 15% 5 25% 8 20% 51-60 3 15% 5 25% 8 20% 61-70 7 35% 4 20% 11 26% 71-80 5 25% 2 10% 7 18% 81-90 1 5% 1 5% 2 5% 91-100 1 5% 0 0% 1 3%The incidence was more 40% seen in patients having weight in the range of 41 – 60 kg. 26%of patients were from the weight category of 61 – 70 kg and 18% from the 71 – 80 kg range,8% is found to be in each 31-40kg and 81-100kg range. Details of incidence of katigraha aregiven Table no.31 and graphically represented in Graph No.16A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 115
  • 134. ResultsTable No.32Distribution of patients according to Prakruti: KCPS VPS PRAKRUTI N=20 % N=20 % TOTAL % VAATA-PITTA 3 10% 3 10% 6 10% PITTA-KAPHA 2 7% 2 7% 4 7% VAATA-KAPHA 7 23% 7 23% 14 23% PITTA-VAATA 1 3% 1 3% 2 3% KAPHA-VAATA 5 17% 4 13% 9 15% KAPHA-PITTA 2 7% 3 10% 5 8% A predominance of Vaata-kapha constitution was observed in the patients with 23%incidence followed by Kapha-Vaata with 15%, Vaata-pitta with 10%, Kapha-pitta with 8% ,Pitta-kapha with 7%, Pitta-vaata with 3%.Table No.33Distribution of patients according to Satva: KCPS VPS SATWA N=20 % N=20 % TOTAL % PRAVARA 6 20% 5 17% 11 18% MADHYAMA 13 43% 14 47% 27 45% AVARA 1 3% 1 3% 2 3% Analysis of Satva revealed 45% Madhyama Satva, 18% of Pravara and 3% of AvaraSatva. Incidence of Satva of the patients is given in the table above.Table No.34Distribution of patients according to Diet habits: KCPS VPS DIET HABITS N=20 % N=20 % TOTAL % VEG 6 30% 8 40% 14 35% MIXED 14 70% 12 60% 26 65%Maximum number of patients ie.65% were taking mixed diet and rest 35% wereVegetarians. Details of incidence of diet habits are given Table no.34 and graphicallyrepresented in Graph No.19A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 116
  • 135. Results GRAPHICAL PRESENTATION Graph No:1 Distribution of 40 patients of Katigraha according to age Graph No:2 Distribution of 40 patients of Katigraha according to sex Graph No:3 Distribution of 40 patients of Katigraha according to ReligionA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 117
  • 136. Results Graph No:4 Distribution of 40 patients of Katigraha according to Education Graph No:5 Distribution of 40 patients of Katigraha according to Marrital status Graph No:6 Distribution of 40 patients of Katigraha according to Socio economic statusA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 118
  • 137. Results Graph No:7 Distribution of 40 patients of Katigraha according to occupation Graph No:8 Distribution of 40 patients of Katigraha according to Mechanism of injury Graph No:9 Distribution of 40 patients of Katigraha according to onsetA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 119
  • 138. Results Graph No:10 Distribution of 40 patients of Katigraha according to course Graph No:11 Distribution of 40 patients of Katigraha according to loss of function Graph No:12 Distribution of 40 patients of Katigraha according to duration of illnessA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 120
  • 139. Results Graph No:13 Distribution of 40 patients of Katigraha according to koshta Graph No:14 Distribution of 40 patients of Katigraha according to agniA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 121
  • 140. Results Graph No:15 Distribution of 40 patients of Katigraha according to Prakruthi Graph No:16 Distribution of 40 patients of Katigraha according to WeightA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 122
  • 141. Results RESULTS Effects of Kolakulathadi Choorna Pinda Sweda As mentioned earlier 20 patients of Kati Graha were treated with Kolakulathadi Choorna Pinda where the Swedana was given for 30 minutes every day . The effects of this type of Swedana on each parameter were as follow: Table-35 Effect of Kolakulathadi Choorna Pinda Sweda on Pain of Katigraha Measures S.D S.E t p SYMPTOM BT- % Remarks BT (+-) (+-) value value AT PAIN ON AT 0.600 0.700 54.000 0.497 0.278 2.522 <.001 H.S 1.300 REST(LYING) FU 0.500 0.800 62.000 0.551 0.308 2.597 <.001 H.S PAIN ON AT 0.700 0.950 58.000 0.490 0.274 3.466 <.001 H.S 1.650 REST(SITTING) FU 0.550 1.100 67.000 0.611 0.342 3.218 <.001 H.S PAIN ON AT 0.500 1.250 71.000 0.678 0.379 3.300 <.001 H.S 1.750MOVEMENT(WALK) FU 0.450 1.300 74.000 0.707 0.395 3.290 <.001 H.S Effect on Pain on rest (Lying): In group KCPS, statistical analysis revealed that the mean on Pain on rest (Lying) score of Katigraha which was 1.3 before the treatment was reduced to 0.6 after the treatment and 0.5 after follow up with 62% improvement. This change is statistically highly significant (P 0.001). Effect on Pain on rest (Sitting): As revealed by the statistical analysis, the improvement in symptom Pain on Sitting before and after the treatment with KCPS in patients of Katigraha are given below. The mean score observed before the treatment was 1.65 which reduced to 0.70 after the treatment, and after follow up it became 0.550 with 67% improvement. This remission of the symptom after the treatment, is statistically highly significant (P 0.001). A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 123
  • 142. Results Effect on Pain on movement (Walk): With regard to the symptom Pain on walk in patients of katigraha treated with KCPS showed definite improvement. A reduction was seen in the mean Pain on walk score from 1.750 before the treatment to 0.500 after the treatment and after follow up it again reduced to 0.450 with 74% improvement. On statistical analysis the data is found to be significant. (P 0.001). Table-36 Effect of Kolakulathadi Choorna Pinda Sweda on Tenderness of Katigraha Measures S.D S.E t p SYMPTOM BT- % Remarks BT (+-) (+-) value value AT AT 0.550 1.400 72.000 0.760 0.425 3.294 <.001 H.STENDERNESS 1.950 FU 0.500 1.450 74.000 0.810 0.453 3.201 <.001 H.S Effect on Tenderness: Effect of KCPS on tenderness before and after the treatment in 20 patients of Katigraha are given below. In group KCPS, statistical analysis revealed that the mean tenderness score of Katigraha which was 1.950 before the treatment was reduced to 0.550 after the treatment and after follow up it became 0.500 with 74% improvement. This change is statistically highly significant (P 0.001). Further details with Standard Deviation, A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 124
  • 143. Results Effect on Lumbar Movements: Table-37 Effect of Kolakulathadi Choorna Pinda Sweda on Lumber Movements of Katigraha S.D S.E Measures % (+-) (+-) t pSYMPTOM BT- value value BT AT LUMBAR 1.900 AT 0.700 1.200 63.000 0.646 0.361 3.320 <.001 FLEXION FU 0.600 1.300 68.000 0.735 0.411 3.163 <.001 LUMBAR 1.200 AT 0.400 0.800 67.000 0.551 0.308 2.597 <.001EXTENSION FU 0.350 0.850 71.000 0.593 0.331 2.565 <.001 RIGHT 1.200 AT 0.550 0.650 54.000 0.443 0.248 2.624 <.001LATERALMOVEMENT FU 0.450 0.750 63.000 0.544 0.304 2.466 <.001 LEFT 1.600 AT 0.800 0.800 50.000 0.471 0.263 3.037 <.001LATERALMOVEMENT FU 0.750 0.850 53.000 0.519 0.290 2.927 <.001ROTATION 1.250 AT 0.550 0.700 56.000 0.454 0.254 2.761 <.001 FU 0.500 0.750 60.000 0.463 0.259 2.898 <.001 Effect on lumbar flexion By the treatment, in KCPS group significant reduction of Lumbar Flexion was observed with a mean reduction of score from 1.900 to 0.700 after treatment and after follow up it again reduced to 0.600 with 68% improvement. . Analysis of this data shows statistically significant improvement (P 0.001) A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 125
  • 144. ResultsEffect on lumbar extensionIn this work of 20 patients studied in Katigraha with KCPS on lumbar extensionrevealed are given in detail in Table No.06a. Statistical analysis showed that themean score which was 1.200 before the treatment was reduced to 0.400 after thetreatment. and after follow up it became 0.350 with 71% improvement. And there is astatistically significant change. (P 0.001). Results are graphically represented inGraph No:23Effect on right lateral movement An assessment of right lateral movement in patients of Katigraha before andafter the treatment with KCPS showed reduction in the mean right lateral movementscore from 1.200 to 0.550 after the treatment, and after follow up it became 0.450with 63% improvement. It is found to be statistically significant. (P 0.001) .Effect on left lateral movement : In group KCPS, statistical analysis revealed that the mean on left lateralmovement Pain score of Katigraha which was 1.600 before the treatment wasreduced to 0.8 after the treatment and after follow up it become 0.75 with 53%improvement. This change is statistically highly significant (P 0.001).Effect on Rotation : Magnitude of restriction of axial rotation in patients of Katigraha before and afterthe treatment was assessed and analyzed statistically. In patients registered in KCPS groupshowed highly significant improvement in mean score(P 0.001). The mean score which was1.25 before treatment reduced to 0.55 after the treatment. and after follow up it become 0.5with 60% improvement.Table-38 Effect of Kolakulathadi Choorna Pinda Sweda on Walking Time of Katigraha Measures S.D S.E t p SYMPTOM BT- % BT (+-) (+-) value value AT TIME AT 1.150 0.750 39.000 0.505 0.282 2.656 <.001 TAKEN TO 1.900 COVER 21 FU 1.050 0.850 45.000 0.519 0.290 2.927 <.001 MTRSA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 126
  • 145. ResultsWalking Time: Walking ability is another important area of assessment, done by recording the timetaken to cover a fixed distance. Patients were asked to walk 21mtrs as fast as possible. Inpatients registered in KCPS group showed highly significant improvement in meanscore(P 0.001). The mean score which was 1.9 before treatment reduced to 1.15 after thetreatment. and after follow up it become 1.05 with 45% improvement. Further the particularsare tabled below in Table No.29a and graphically represented in Graph No:27 Table-39 Overall Effect of Kolakulathadi Choorna Pinda Sweda on Katigraha No. of Category % patients Complete remission 0 0 Marked improvement 3 15% Moderate improvement 17 85% Mild Improvement 0 0 Unchanged 0 0Overall Effect:Consideration of over all effects provided KCPS showed that 5% of patient got completeremission, marked improved was found in 50% of cases and 45% got moderateimprovement. There was no patient with mild improvement or unchanged result. (Table-48).The overall result of Kolakulathadi Choorna Pinda Sweda on 20 patients of Katigraha isgraphically represented in Graph No:17 Graph No:17 Overall Effect of Kolakulathadi Choorna Pinda Sweda on KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 127
  • 146. Results Effects of Valuka Pinda SwedaAs mentioned earlier 20 patients of Kati Graha were treated with Valuka Pinda Sweda wasgiven for 30 minutes every day . The effects of this type of Swedana on each parameter wereas follow:Table-40Effect of Valuka Pinda Sweda on Pain of Katigraha Measures S.D S.E t p SYMPTOM BT- % BT (+-) (+-) value value AT PAIN ON AT 0.600 0.800 57.000 0.471 0.263 3.037 <.001 1.400 REST(LYING) FU 0.600 0.800 57.000 0.471 0.263 3.037 <.001 PAIN ON AT 0.850 1.000 54.000 0.571 0.319 3.130 <.001 1.850 REST(SITTING) FU 0.950 0.900 49.000 0.485 0.271 3.320 <.001 PAIN ON AT 0.650 1.150 64.000 0.613 0.343 3.355 <.001 1.800MOVEMENT(WALK) FU 0.700 1.100 61.000 0.577 0.323 3.410 <.001Effect on Pain on rest (Lying): In group VPS, statistical analysis revealed that the mean on Pain on rest (Lying)score of Katigraha which was 1.4 before the treatment was reduced to 0.6 after thetreatment and after follow up it remains the same with 57% improvement. Thischange is statistically highly significant (P 0.001).Effect on Pain on rest (Sitting): As revealed by the statistical analysis, the improvement in symptom Pain onSitting before and after the treatment with VPS in patients of Katigraha are given below. Themean score observed before the treatment was 1.85 which reduced to 0.85 after the treatment.and after follow up it became 0.95 with 49% improvement. This remission of the symptomafter the treatment, is statistically highly significant (P 0.001)Further details are given in Table No.27a. and graphically represented in Graph No:Effect on Pain on movement (Walk): With regard to the symptom Pain on walk in patients of katigraha treated withVPS showed definite improvement. a reduction was seen in the mean Pain on walkscore from 1.8 before the treatment to 0.650 after the treatment and after follow up itA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 128
  • 147. Results again reduced to 0.7 with 61% improvement. On statistical analysis the data is found to be significant. (P 0.001). Table-41 Effect of Valuka Pinda Sweda on Tenderness of Katigraha Measures S.D S.E t p SYMPTOM BT- % BT (+-) (+-) value value AT AT 0.650 1.350 68.000 0.762 0.426 3.171 <.001 TENDERNESS 2.000 FU 0.700 1.300 65.000 0.735 0.411 3.163 <.001 Effect on Tenderness: Magnitude of tenderness before and after the treatment in 20 patients of Katigraha are given below. In VPS group, statistical analysis revealed that the mean tenderness score of Katigraha which was 2.00 before the treatment was reduced to 0.65 after the treatment and after follow up it became 0.7 with 65% improvement. This change is statistically highly significant (P 0.001 Table-42 Effect of Valuka Pinda Sweda on Lumber Movements of Katigraha Measures % S.D (+- S.E t pSYMPTOM BT- ) (+-) BT value value AT LUMBAR 2.000 AT 0.800 1.200 60% 0.707 0.395 3.037 <.001 FLEXION FU 0.900 1.100 55% 0.644 0.360 3.056 <.001 LUMBAR 1.400 AT 0.500 0.900 64.000 0.525 0.294 3.065 <.001EXTENSION FU 0.550 0.850 61.000 0.519 0.290 2.927 <.001 RIGHT 1.750 AT 0.850 0.900 51.000 0.563 0.315 2.861 <.001 LATERALMOVEMENT FU 0.900 0.850 49.000 0.557 0.312 2.728 <.001 LEFT 1.550 AT 0.700 0.850 55.000 0.519 0.290 0.297 <.001 LATERALMOVEMENT FU 0.700 0.850 55.000 0.519 0.290 0.297 <.001ROTATION 1.700 AT 0.800 0.900 53.000 0.563 0.315 2.861 <.001 FU 0.800 0.900 53.000 0.563 0.315 2.861 <.001 A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 129
  • 148. ResultsEffect on lumbar flexion By the treatment, in VPS group significant reduction of Lumbar Flexion wasobserved with a mean reduction of score from 2.00 to 0.800 after treatment and after followup it again reduced to 0.9 with 55% improvement. . Analysis of this data shows statisticallysignificant improvement (P 0.001)Effect on lumbar extensionIn this work of 20 patients studied in Katigraha with VPS on lumbar extension revealed aregiven in detail in Table No.06a. Statistical analysis showed that the mean score which was1.4 before the treatment was reduced to 0.500 after the treatment. and after follow up itbecame 0.55 with 61% improvement. and there is a statistically significant change. (P 0.001)Effect on right lateral movement An assessment of right lateral movement in patients of Katigraha before and after thetreatment with VPS showed reduction in the mean right lateral movement score from 1.75 to0.850 after the treatment. and after follow up it became 0.900 with 49% improvement. it isfound to be statistically significant. (P 0.001) .Effect on left lateral movement : In group VPS, statistical analysis revealed that the mean on left lateralmovement Pain score of Katigraha which was 1.55 before the treatment was reducedto 0.7 after the treatment and after follow up it become .7 with 55% improvement.This change is statistically highly significant (P 0.001).Further details are given in Table No.27a. and graphically represented in Graph No:Effect on Rotation : Magnitude of restriction of axial rotation in patients of Katigraha before andafter the treatment was assessed and analyzed statistically. In patients registered inKCPS group showed highly significant improvement in mean score(P 0.001). Themean score which was 1.700 before treatment reduced to 0.800 after the treatment.and after follow up it become 0.800 with 53% improvement. Further the particularsare tabled below in Table No.29a and graphically represented in Graph No:A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 130
  • 149. Results Table-43, Effect of Valuka Pinda Sweda on Walking Time of Katigraha Patients Measures S.D S.E t p SYMPTOM BT- % BT (+-) (+-) value value AT TIME AT 1.300 0.650 33.000 0.443 0.248 2.624 <.001 TAKEN TO 1.950 COVER 21 FU 1.250 0.700 36.000 0.497 0.278 2.522 <.001 MTRS Effect on Walking Time: Walking ability is another important area of assessment, done by recording the timetaken to cover a fixed distance. Patients were asked to walk 21mtrs as fast as possible. Inpatients registered in VPS group showed highly significant improvement in meanscore(P 0.001). The mean score which was 1.95 before treatment reduced to 1.3 after thetreatment. and after follow up it become 1.25 with 36% improvement. Table-44 Overall Effect of Valuka Pinda Sweda on the Patients of Katigraha No. of Category % patients Complete remission 0 0 Marked improvement 1 5% Moderate improvement 15 75% Mild Improvement 4 20% Unchanged 0 0Overall Effect:Consideration of over all effects provided VPS showed that 5% of patient got markedimprovement, 30% of cases had mild improvement and 65% got moderate improvement.There was no patient with complete remission or unchanged result. (Table-48). The overallresult of valuka Pinda Sweda on 20 patients of Katigraha is graphically represented in GraphNo:18A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 131
  • 150. Results Graph No:18 Overall Effect of Valuka Pinda Sweda on the Patients of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 132
  • 151. ResultsGRAPHICAL REPRESENTATION OF RESULTS Graph No:19 Effect of Therapy on Pain On Rest(Lying) of Katigraha Graph No:20 Effect of Therapy on Pain On Rest(Sitting) of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 133
  • 152. Results Graph No:21 Effect of Therapy on Pain On movement(walk)of Katigraha Graph No:22 Effect of Therapy on Tenderness of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 134
  • 153. Results Graph No:23 Effect of Therapy on Lumbar flexion of Katigraha Graph No:24 Effect of Therapy on Lumbar Extension of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 135
  • 154. Results Graph No:25 Effect of Therapy on Right Lateral Movement of Katigraha Graph No:26 Effect of Therapy on Left Lateral Movement of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 136
  • 155. Results Graph No:27 Effect of Therapy on Rotation of Katigraha Graph No:28 Effect of Therapy on Time Taken To Cover 21 Mtrs of KatigrahaA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 137
  • 156. Results Comparative results of Kolakulathadi Choorna Pinda Sweda and Valuka Sweda in Katigraha Table no.45 Comparison of effectof treatment on Pain on rest in two grups: Mean Mean S.E (+-) t value p value RemarksKCPS VPS Difference65.556 62.500 3.056 9.302 0.328 0.74490093 NS In the present study, the effect on Pain on rest in patients of Katigraha was significantly reduced in both KCPS group as well as VPS group after the treatment. The reduction of Pain on rest in KCPS Group is better than the VPS Group. The mean percentage of relief in Group KCPS is 65.56% against the mean score 62.5 % in Group VPS. This variation seen in these two Groups are statistically not significant as it indicated by the unpaired t test Table no.46 Comparison of effectof treatment on Pain on sittingin two grups: Mean Mean S.E (+-) t value p value KCPS VPS Difference Remarks 73.684 52.778 20.906 7.478 2.796 0.00835357 Significant Reduction in severity of Pain on sitting was observed in both the Groups in this work. The difference in percentage of relief in Group KCPS is 73.68 and this mean score is comparatively more than the difference in percentage of relief in Group VPS which was 52.78 This difference in mean Ruk score is statistically significant Table no.47 Comparison of effect of treatment on Pain on walk in two grups: Mean Mean S.E (+-) t value p valueKCPS VPS Difference Remarks80.000 68.333 11.667 8.333 1.400 0.16962519 NS A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 138
  • 157. Results Definite Reduction in Pain on walk was observed in both KCPS group and VPS group. The difference in percentage of relief in Group KCPS is 80.0 and this mean score is comparatively more than that of Group VPS which was 68.33. Table no.48 Comparison of effect of treatment on Tenderness in two grups: Mean Mean S.E (+-) t value p value KCPS VPS Difference Remarks 78.750 65.833 12.917 8.579 1.506 0.14044128 NS Group KCPSshowed 78.75%of relief a Whereas VPS group revealed only 65.83% .Hence, though both the medications are effective in relieving tenderness in patients of Katigraha, Group KCPS is better than Group VPS. Table no.49 Comparison of effectof treatment on Lumbar Flexion in two grups: Mean Mean S.E (+-) t value p value Difference RemarksKCPS VPS 71.667 53.333 18.333 7.993 2.294 0.02743110 Significant Improvement in Lumbar Flexion was seen in both the groups. The mean percentage of relief in Group KCPS is 71.667 and this mean score is more than that Group VPS which was 53.33. Table no. 50 Comparison of effectof treatment on Lumbar extension in two grups: Mean Mean S.E (+-) t value p value RemarksKCPS VPS Difference75.556 64.706 10.850 10.644 1.019 0.31618475 NS In this work, the effect on Lumbar extension in patients of Katigraha was significantly reduced in both KCPSgroup as well as VPS group after the treatment. The reduction in KCPSGroup was better than the VPS Group. Group KCPS showed 75.56% of relief where as A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 139
  • 158. Results VPS group revealed only 64.71%. The variation seen in these two Groups are statistically insignificant as it indicated by the unpaired’ ‘t test. Table no.51 Comparison of effect of treatment on Right lateral movement in two grups: Mean Mean Remarks S.E (+-) t value p valueKCPS VPS Difference64.444 47.222 17.222 11.379 1.513 0.14028783 NS Improvement in Right lateral movement was observed in both KCPSgroup and VPS group. Group KCPS showed 64.44% of relief where as VPS group revealed only 47.22%. which is statistically insignificant. Table no.52 Comparison of effectof treatment on Left lateral movementin two grups: Mean Mean Remarks S.E (+-) t value p valueKCPS VPS Difference 60.417 57.843 2.574 9.089 0.283 0.77894050 NS Group KCPSshowed a mean 60.417% mean percentage of relief. Whereas VPS group revealed only 57.84%. Hence, though both the medications are effective in improving left lateral movement in patients of Katigraha, Group KCPS is superior than Group VPS. But difference in mean is statistically insignificant. Table no. 53 Comparison of effectof treatment on Rotation in two grups: Mean Mean REMARKS S.E (+-) t value p valueKCPS VPS Difference 66.667 52.778 13.889 10.771 1.289 0.20620196 NS Improvement in Rotational movement was observed in both the groups. The mean percentage of relief of rotation in Group KCPS is 66.667 and this mean score is higher than that of Group VPS which was 52.78 This difference is statistically insignificant. A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 140
  • 159. ResultsTable no. 54Comparison of effectof treatment on time taken to cover 21 mtrs in two grups: Mean Mean REMARKS S.E (+-) t value p valueKCPS VPS Difference46.667 35.833 10.833 9.814 1.104 0.27657790 NSReduction in time taken to cover 21 mtrs was observed in both the Groups after treatment.The mean percentage of relief of in Group KCPS is 46.667 and this score is higher than thatof Group VPS which was 35.833 This difference in mean score is statistically insignificant. Graph No29Comparison of effect of Kolakulathadi Choorna Pinda Sweda and Valuka Pinda Sweda On comparison KCPS group showed highly significant difference in the results ofpain on sitting and lumbar flexion. In other parameters also it showed slight higherpercentage of relief ,but it is not statistically significant. It is concluded that both groups showed high significance in decreasing pain,stiffness and tenderness, and improving range of movements and walking ability (P<0.001).It is observed that KCPS group shows a sustained effect even after followup ,but in valukagroup complaints are slightly reoccurring..A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 141
  • 160. Results In the present study, all Signs and Symptoms in patients of Katigraha was significantlyreduced in both KCPS group as well as VPS group after the treatment. On Comparison KCPSgroup showed higherFrom the above data, it is seen that the KCPS group got better results after treatment in allparameters. The same data after the proposed period of follow up showed an increased reliefand better results in the KCPS group due to the long-standing effect of the therapy. Comparison of over all effect of therapiesTable no.55Table showing Comparison of over all effect of therapies: Category KCPS % VPS % Complete remission 0 0 0 0 Marked improvement 3 15 1 5 Moderate improvement 17 85 15 75 Mild Improvement 0 0 4 20 Unchanged 0 0 0 0From the above data, it is clear that in KCPS group 5% got complete relief & 0 in VPSgroup. In the marked improvement category, 50% in KCPS group and 5% in VPS group,moderate improvement category 45% in KCPS group and 65% in VPS group,there was nomild improvement category in KCPS group and 30% in VPS group , there was no patientwith unchanged results in both groups.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 142
  • 161. Results Graph No :30 Comparative overall efficacy of both groupsA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 143
  • 162. Discussion 6. DISCUSSION Any hypothesis or principle, if to be proved must be discussed thoroughly from all angles, which has been clearly stated by Charaka long back. After the formation of a hypothesis, it has to be tested and observed by various methods and eventually the results are obtained. All these should be well supported by proper reasoning or logic and finally concluded. A hypothesis gets established as a principle if the reasoning given is satisfactory, otherwise it remains as it is. Discussion improves the knowledge and it is the most essential phase of anyresearch work. Keeping this in view, the facts which have emerged from the studycan be studied in 4 main headings. 1) Discussion on Katigraha 2) Discussion on Pinda Sweda 3) Discussion on clinical study. 4) Discussion on results.1. Discussion on KatigrahaVata is a force, which has got two functions; one is to recognize and other is tostimulate all the activities in the body. Due to its Chala Guna it moves all over thebody. The movement or Gati of the motive force Vata, has to be analyzed properly.By virtue of this property Vata has the nature of moving to different parts of thebody, localize there and produce disease pertaining to that structure. Katigraha is notmentioned as a separate disease condition in any of the Bruhatrayees directly. Eventhough Acarya caraka has not mentioned the condition directly, but by his quotation“Hetu sthaana visheshat ca bhavet roga vishesh krit” he has indirectly mentioned allthose conditions which can arise due to localization of vaata in specific parts of thebody. Katigraha is one such condition in which the vitiated Vata is localizing in thekatipradesha and producing stiffness and pain there. This is a condition in which the gatatva of Vata can be considered. In case ofGatatva the aggravated Vata finds a suitable place for its lodgment. The suitable placemay be such as Dhatu, Upadhatu, Ashaya, and Avayava. Due to consumption of VataVardhaka Ahara and Vihara the aggravated Vata while moving throughout the bodyA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 144
  • 163. Discussionlodges in Khavaigunya Yukta Srotas. After getting lodged at those parts it impairs thefunctions of particular structure and produces disease. Kati is an area where there is a conglomeration of various sandhis, snaayu,and peshis. Sandhi is a place where two or more structure unites. In the context ofAsthi Sandhi means a junction between two bones. Sandhi is not a single structurerather it is considered as an organ. There are different structures, which helps inmaintaining the stability of the joint. Snayu or ligament, are those structures whichhelps in proper binding of the joint. They unite the bones and help to direct the bonemovement and prevent the excessive and undesirable motion. Muscle tone helps tomaintain the alignment of the joint. Shleshmadharakala situated in the jointssupported by Shleshaka Kapha helps in lubrication, provides nutrients and helps inkeeping the joint firmly united. Therefore the vitiation of Vata can cause pathologiesof these structures in the kati pradesha leading to there hampered functioning. Ayurveda explains the pathology of Katigraha in two settings. Dhatukshayaand avarana. In Dhatukshya Janya Katigraham due to old age and Vatakara AharaVihara there will be qualitative change in the joint material gradually leading todisease manifestation. The other set of Samprapti where in due to continuous pressuredue to various factors like accumulated mala the joint may get affected (Due toAvarana) leading to disease manifestation. But here the characteristic symptom ofstiffness may or may not be seen but the referred pain can be obtained. Thisdemarcation in Samprapti helps in planning the treatment. The Cikitsa Sootra of Kati graha is Snehana, Swedana. Since it is aVataKapha Vikara and Avarana is the resultant, Swedana would be an ideal line oftreatment. In the contemporary science treatment is mainly aimed at Non–pharmacological methods and analgesics. Among Non–pharmacological treatmentphysical heat therapy is given importance. Katigraham is characterized by joint pain,and stiffness. The heat applied to the affected area helps in combating many of thesymptoms. In this disease, Vata is the most culprit but Kapha is also having significantrole in the manifestation of disease. So a Swedana procedure which is aiming atKapha as well as Ama is the better choice. Here comes the role of Rooksha Sweda.As per classics, Katigraha is not only mentioned in Vatavyadhyadhikara but isA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 145
  • 164. Discussion narrated in AmaVatadhikara also. Thus the management of both holds good for Katigraha. Therefore Kolakulatthadi Choorna and Valuka which are told in Vatavyadhi and AmaVata context respectively are thought for Swedana, in the form of Pinda Sweda. as it is having the properties of both Vata and KaphashAmana On Nidana- Specific Nidana for Kati Graha is not mentioned so SAmanya Vatavyadhi Nidana is considered here. By Ahara and Manasika Nidana, Vata Prakopa takes place and lodges in place where there is Khavaigunya. In Avarana janya condition, of Kati Graha Vyana Vata is affected with Ama which restricts the Prasarana, Akunchana of Adhoshaka. The Sheeta Guna of Vata and Kapha is increased which leads to Shula and Stambha.On Purvarupa- Symptoms not exhibited clearly are Purvarupa and they are due to- 1) Weak causative factors. 2) Very less or mild symptoms. 3) Less Avarana of Doshas Symptoms like mild back ache causing restrictions in the movements of the spine . On Rupa- Ruja – Pain located at the lumbar region & buttocks. Graha – Difficulty in the movements of spine like flexion, extension and rotation. On Samprapti- The term Samprapti is applied to express the course of the appearance of disease right from Nidanasevana to Vyadhi Utpatti. The knowledge of Samprapti helps in the comprehension of the specific features of a disease like Dosha, Dushya, Srotodushti, Ama and Agni etc. The study of Samprapti Vighatana is said to be done by treatment. Kati Graha Samprapti can be understood as when there is Agantuja Nidana like Abhigata it causes direct Khavaigunya thereby leading to Sthanasamshraya of vitiated Dosha leading to Shitilata and manifestation of disease Kati Graha. 2) Discussion on Procedure-Rooksha Sweda Katigraha is a Vatavyadhi by its nature. The condition katigraha is affecting the low back region with the symptoms such as pain and stiffness. Vata is vitiated either because of Avarana or Dhathukshya when Vata covered by Kapha or Dosha accumilation makes Katigraha. In initial stage of the disease the Kapha anubandam is A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 146
  • 165. Discussionacknowledge. Ayurveda advocates a reliable management of this condition throughhighly efficiencies and easily available drugs based on doshic theory. In the classic, the treatment is told as Rooksha Sweda where we considerKatigraha in the doshic level as Vata and Kapha are the two main factors involved inthe pathogenesis of Katigraha. Here the pain and stiffness are two symptoms presentin the disease which can be attributed the Vata and Kapha dosha lakshna RookshaSweda is told for srotoshodhana there by subside the vitiated Kapha which is in thekatipredesha and for this purpose, Kolakulathadi choorna & valuka are used whichrelieves the pain and stambatwa. By Swedana we can get the effects like twakmruduta, twakprasada, srotoshodhana, stabdhatwa in the sandhis are relieved andbecomes easy for chesta. Charaka while explaining the effects of Swedana he says it is best insankocha, ayAma, shoola, sthambha etc. all the vikaras of sarvanga and ekanga.Kolakulathadi Choorna Most of the ingredients of kola kulatthadi churna are having Laghu ushnasnigdha gunas and Kapha Vata hara properties. Katigraha being a Vataja vyadhi withKapha avarana gets regressed by the usage of this choorna as Rooksha Sweda.Valuka SwedaThe procedure of Swedana by using valuka is also a variety of ushmaSweda.Valukais having the property of lekhana and pacifies the Kapha,by which Vata can beeasily pacified.By the depletion of Kapha the channels get clarified resulting inlightness of body.It is observed that the Valuka is having the ability to sustain the heat for moreduration and this helpsto avoid repeated heatinf of potaly,when compared to choorna.Discussion about Pinda SwedaThe present study deals with the evaluation of Pinda Sweda shows followinganalyzed factors.1. Prakruti:In the present study, the patients who are having Vaata and Kapha predominanceshowed tolerance to temperature more than other Prakruti. Such persons were able totolerate maximum temperatures. This owes to the quality of Vaata and Kaphawherein Seeta predominance is observed. These recordings were done with the helpof pyrometer. The persons who were having Pitta predominant Prakruti i,e Pitta VaataA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 147
  • 166. Discussionand Pitta Kapha showed minimum tolerance to temperature . This owes to the PittaDosha where in tolerance to Uhsna Guna is minimal. Hence it may be viewed that thepersons who are having predominance of Vaata and Kapha Prakruti may toleratemore temperature when compared to Pitta predominant Prakruti.2 Temperature:In the present study the maximum temperature recorded was 460 C. Minimum of 410C was observed as the temperature tolerance. When we viewed the Prakruti it wasrelated with Kapha Vata and Pitta respectively. Hence it may be viewed that a fixedtemperature cannot be taken as norm.3. Duration:During this series, minimum of 30 minutes, maximum of 50 minutes time wasobserved. This observation pertaining to minimum duration observed in Pittapredominant Prakruti whereas maximum duration seen in Vaata Kaphapredominance. This observation again stress on individual Dosha/ Prakruti which isholding key in the decision of Samyak Swinna Lakshanas. Hence it is not possible toput a maximum or minimum time barrier for all the patients. A range of minimum of30 minutes and maximum of 50 minutes may be considered as standard.No complications of Sweda (atiyoga, ayoga and mitya yoga) were observed in thisstudy3) Discussion on Clinical studyThis clinical study is a sincere effort to add newer combinations of shamanatreatment with proved efficacy to the list already present. The present work is carriedout with the hope that the treatment adopted here may have some edge over the othercombinations prescribed in routine practice. The materials and methods of the present work with complete description ofthe assessment criteria are given here. The descriptive statistical analysis of thesample taken for the study is methodically elaborated. The observations, results andtheir statistical analysis are presented in order with tables and graphs.In the chapter entitled discussion, the results obtained are critically analyzed to revealthe truth of efficacy of the combination taken for the study. The final conclusionsdrawn from the present clinical research work are detailed in the chapter summaryand conclusion.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 148
  • 167. DiscussionPLAN OF STUDYThe present study has been carried out on 40 patients treated in two groups. Thecriteria of diagnosis was based upon the signs and symptoms of the disease . Thepatients with deformities of spinal column and those with associated systemicdisorders were excluded from the study.20 patients out of the total 40 patients of Katigraha studied, underwentKolakulathadhi choorna Pinda Sweda 30 minutes daily for 7 days.20 patients of the second group were given valuka panda Sweda 30 minutes daily for7 days.Follow up was done after 15 days from the completion of treatment for both groups.The improvement in the signs & symptoms of the disease were the main criteria ofassessment. The total effects of the therapies were also assessed in terms of completeremission, marked improvement, moderate improvement mild improvement andunchanged.Diagnostic criteria and assessment criteria: To diagnose katigraha the main symptoms pain and stiffness was considered.Both main symptoms of pain and stiffness were present in all patients but theintensity of pain may defer from patient to patient. Various movements of the spine were elicited by various objective and subjective criteria included assessment of pain, stiffness, range of movement of Kati and tenderness in Kati.Subjective parameters: Pain on rest , Pain on movement, Stiffness in KatiObjective parameters: Tenderness, Lumbar flexion , Lumbar extension, Right lateral movementLeft lateral movement, RotationInvestigation:Routine hematological investigations like Hb%, TC, DC, ESR and Routine Urineinvestigations were done in all cases. RBS and serum Cholesterol were done in somecases to rule out systemic diseases. Routine radiological examination of the Lumbosacral spine in Antero posterior and lateral position was done in selected cases to ruleout various abnormalities.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 149
  • 168. DiscussionNIDANATMAKA ASPECTSAge:Maximum numbers of patients were obtained in the age group of 31 – 50 years, i.e.68%. In the age group of 21 – 30 years 14% of patients were obtained, and in the agegroup of 51 – 60 years 12% of patients were recorded. Minimum numbers of patientswere seen from the age group 11 – 20, i.e. 6%.This finding clearly shows that the age group of 31- 50 years are mostly affected.Sex:Male patients i.e. 62% exceeded the female patients who were 38%.This may be dueto demographic facts.Religion:Among the patients selected for the study 38% were Hindus, 30% were Muslims and32% were Christians. This may be due to demographic facts.Marital status:The Marital status. of the present sample distributed equally as married andunmarried ie. 50% eachSocio-economic Status:The study showed more incidences (63%) of the condition in patients hailing from alower socio economic conditions owing to the nature of work, condition of living etc.About 23% of patients were belongs to very poor socio-economical status. and only18% from higher status suffered from the conditionOccupation:In the study, maximum patients were manual house wives i.e., 33% where as15%were students, 10% the patients were involved in business & 10% were office staff.8% teachers, 5% attender, 5% agriculturists, 3% were in different categories such asdriver, beautician, painter, nurse, tailoring & coolie.Maximum number of patients belonged to the categories of hardworking life style.Nature of workOccupation which involved bending predisposed the patients to strain of the back. Inthe present study 35% of the patients had similar occupation. 23% had to travel intwo wheelers etc .as a part of their occupation leading to strain at low back. 18% ofpatients had to sit for long duration. 13% had to walk more and 13% had to standerect for long duration as a part of their work.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 150
  • 169. DiscussionMechanism of injuryIn majority of patients 28% have developed the disease without any cause. Bendingforward was a cause for 23%, Lifting heavy weight was the main cause for 20%,13% followed by jerky movements, 10% had history of fall patients and 8% hadhistory of hit at lumbar areaCourse of pain53% of the patients reported the course of pain as progressive, 25% patients werecomplaining continuous course of pain and 23% patients were having intermittentpainOnsetIn 58% disease manifested gradually , 23% had sudden onset , 20% followed bysome incidentLoss of functionIn most of the patients 68% moderate loss of function was observed while 23%patients had mild loss of function and 10% had severe loss of functionChronicity Here in this study, the maximum number of patients were having chronicity within 1 month (45% ). Next highest number of patients were found having the chronicityhad 2-6 months( 18%). 13% had 6 months to 1year duration, 10% had 1-2 year and8% had above 2years This observation is due to the radomised clinical study.Deha prakruthiIn the present study the majority of the patients were of Vata Kapha prakruthi 9patients (23%) and next dominent prakruthi is Kapha Vata which are 9 innumber(15%) Vaata-pitta with 10%, Kapha-pitta with 8% , Pitta-Kapha with 7%,least are pitta Vata patients with 5 in numbers (3%) the significance of increasednumber of Vata Kapha prakruthi is may be due to the geographical area were thestudy is conducted.Agni In the present study the majority of the patients were of sAmagni 19 patients(48%) and next dominent mandagni which are 9 (23%) in numbers, VishAmagni isfound to be in7 patients (18% ) , least are teeksnagni patients with 5 in numbersA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 151
  • 170. Discussion(13%). The significance of increased number of SAmagni is may be due to thegeographical area were the study is conducted.Koshta In the present study the majority of the patients were of madyAma 19 patients(50%) and next dominent Koshta is Krura which are 13 in numbers(32%) least areMrudu koshta patients with 7 in numbers (18%). Tthe significance of increasednumber of madyAma koshta is may be due to the geographical area were the study isconducted. SatvaAnalysis of Satva revealed 45% MadhyAma Satva, 18% of Pravara and 3% of AvaraSatva. Incidence of Satva of the patients is given in the table aboveWieghtThe incidence was more 40% seen in patients having weight in the range of 41 – 60kg. 26% of patients were from the weight category of 61 – 70 kg and 18% from the71 – 80 kg range, 8% is found to be in each 31-40kg and 81-100kg rangeDiet habitsMaximum number of patients ie.65% were taking mixed diet and rest 35% wereVegetariansMain symptoms:The two main symptoms of pain and stiffness were seen in all the patients.Associated symptom:About 64% of the patients had tenderness associated with the main complaints.4) Discussion on ResultsAll the cases were reported to K.V.G. Ayurvedic medical college hospital, postgraduation department. Special medical camps were also conducted in the college forselecting the patient. 43 cases were registered and from that 40 cases were selectedfor the study. Observed features in the patients during the study were recorded in thecase sheets and these observations were analyzed and tabulated after completion ofclinical study. These observations findings are discussed below.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 152
  • 171. DiscussionEFFECT OF THERAPIES : This study was conducted on 40 patients of Kati Graha by randomlydividing them into two groups viz KCPS group and VPS group. Both the groupswere given Swedana 30 minutes daily for 7 days.After completion of the courses of the treatment as mentioned above neither any drugwas given nor any procedure was repeated, but the patients were asked to report forfollow up study after 15 days from completion of the therapy. The effects of bothtypes of Swedana were assessed as follow:Effect on Pain on rest (Lying):: Patients of Kati Graha treated with KCPS hadhighly significant relief in pain on rest by 54% which became 62% after 15 days offollow up.Patients of Kati Graha treated with VPS got highly significant relief of 57.% in painon rest which continued in follow up also.The comparison showed that the relief in VPS group is better in comparison to KCPSEffect of Therapies on Pain on rest (Sitting):KCPS provided highly significant relief in Pain on rest Sitting of 58.% to the patientsof Kati Graha. It further increased to 67% during follow up.Patients of Kati Graha treated with VPS showed that this therapy provided relief of54% in Pain on rest Sitting and after follow up it got slightly increased..The comparison showed that the relief in KCPS group is better in comparison to VPSwhich is statistically significant.Effect of Therapies on Pain on movement (Walk): The improvement noticed inPain on Walk soon after completion of the KCPS group was 71.% which was furtherimproved to 74.% on follow up.In VPS group 64% improvement was noticed at the end of the therapy the signs andsymptoms got slightly aggravated to 61% during follow up period.On comparison it can be said that the effect of KCPS schedule was slightly better incomparison to VPS schedule in providing the relief in Pain on Walk. But thisdifference is not statistically significantA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 153
  • 172. DiscussionEffect of Therapies on Tenderness : Patients of Kati Graha treated with KCPS got72% relief in tenderness which was statistically highly significant. After stopping thetreatment this relief continued and became 74% at the follow up of 15days.Patients of Kati Graha treated with VPS got highly significant relief of 68% in thetenderness. After stopping the treatment the signs and symptoms got slightlyaggravated and became 65% at 15 days follow up periodThe comparison showed that the reduction in pain was better in KCPS group, whichis enhanced in the follow up period indicating the long term benefit rendered bySwedana Chikitsa.Effect of Therapies on Lumbar Flexion:The improvement noticed in right lateral flexion criteria soon after completion of thecourse in KCPS group was 63% which was improved to 68% on follow up.Patients of Kati Graha treated with VPS showed that this therapy provided relief of60% in lumbar flexion which increased to 55% during follow up.Obviously the effect of KCPS was better in comparison to VPS in providing theimprovement in lumbar flexion. and is statistically significantEffect of Therapies on Lumbar extension:67% improvement was observed in KCPS group soon after treatment course whichwas improved to 71% after the follow up period.64.% improvement was observed in VPS group after treatment which get slightlyworsen to 61% in the follow up period.Though there is a difference in the percentage of relief it is not statisticallysignificantEffect of Therapies on right lateral movementKCPS provided highly significant imrovement in right lateral movement of 54.% tothe patients of Kati Graha. It further increased to 63% during follow up.Patients of Kati Graha treated with VPS showed that this therapy providedimprovement of 51% and it worsen slightly to49% after follow up.on comparison it isfound that the difference in the percentage of relief it is statistically insignificantA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 154
  • 173. DiscussionEffect of Therapies on left lateral movement :Patients of Kati Graha treated with KCPS got 50% improvement in left lateralmovement which was statistically highly significant. After stopping the treatment thisrelief continued and became 53% at the follow up of 15days.Patients of Kati Graha treated with VPS got highly significant relief of 55.83% in thetenderness. After stopping the treatment and rest, at the time of follow up ,the resultremained the same.Effect of Therapies on Rotation :The improvement noticed in lumbar rotation soon after completion of treatment inthe KCPS group was 56% which was further improved to 60% on follow up.In VPS group 53% improvement was noticed at the end of the therapy and the signsand symptoms and remained same during follow up period.On comparison it can be said that the effect of KCPS schedule was slightly betterpercentage of relief in comparison to VPS schedule in providing the relief in Pain onWalkEffect of Therapies on Walking Time:The results of this study showed that KCPS therapy provided highly significant reliefof 39.%in the walking capacity just after the course. This relief was further improvedup to 45% at the follow up of two month.VPS provided highly significant relief in the walking capacity of 33% after thecourse, which get slightly worsen to 36% on follow up for two monthsThe comparison showed that the improvement provided in walking capacity wasbetter in KCPS group. difference in the percentage of relief it is not statisticallysignificantOverall Effect of the Therapy: In assessing overall effect of therapy it was seen that In KCPS group, out of 20 patients no one got complete relief, 15% patients got marked improvement and 85% patients were improved moderately. There were no patients with mild improvement or unchanged results.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 155
  • 174. Discussion In VPS group out of 20 patients, none of the patient was cured or unchanged. One patiens 5%got marked improvement and 75% got moderate improvement. Mild improvent is noticed in rest 20% of patients.Comparison of the Effects of Both the Therapies:It is obvious from the foregoing that KCPS provided better relief in the criteria likepain on sitting and lumbar flexion with highly significant when compare to VPSgroup.. It also provided comparatively better relief in other criteria such as lumbarextension, lumbar rotation, and has enhanced effect in the follow up..VPS groupprovided improvement in all the parameters with statistically significant values butthe percentage of relief is slight lesser when compared to the KCPS group.It is obvious from the foregoing that both types of Rooksha Sweda adopted for thisstudy provided significant relief in the signs and symptoms of the patients of KatiGraha. Taking into consideration the comparison of effects in both the groups, it isobserved that KCPS group provided better relief in parameters and is found to behaving sustained effect. The other group also gave significant relief in all theparameters but tends to remains as it is or aggrevate slightly during follow up.Probable Mode of Action:.Swedana karma is also a very useful panchkarma modality used as a purvakarma(preparatory procedures) and main therapeutic measure. Swedana is speciallyindicated in symptoms like sankocha(stiffness) ,ayama (pain) shoola(tenderness),stambha(restrictedmovement), gaurav(heaviness), supti(numbness) Virtually allthese indications are cardinal symptoms of Katigraha. In this way Swedana mightplay crucial role in relief of such symptomatology of Katigraha.Application of medicaments, heat and massage definitely helps in eliminating thenumber of noxious elements through skin. The application of heat in different formsof Swedana promotes local circulation and metabolic activities and also opens thepores of the skin to permit transfer of medicaments and nutrients towards to neededsites. It also initiates elimination of vitiated Doshas and Malas through skin andperspiration.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 156
  • 175. DiscussionPHYSIOLOGICAL EFFECT OF HEATThe therapeutic effects of the locally applied heat are as follows: 1. Pain relief 2. Muscle relaxation 3. Increased blood flow 4. Increased rate of tissue healing 5. Increases the extensibility of tissue 6. Reduction in joint stiffness1. Pain relief: Application of local heat to reduce pain is a common therapeutic technique. When heat is applied to the painful muscle spasm, it reduces the excitability of the muscle spindle. Heat has been applied as a counter irritant, which is the thermal stimulus, may effect the pain sensation as explained by the gate theory of Melzack and Wall.2. Muscle relaxation: Muscle spasm is a protective mechanism of body, which occurs due to injury of that part, which is generally associated with lower motor neuron activity. So when we apply the heat it reduces the muscle spasm or we can say relaxes the muscles and reduce the pain also, by leaving sedative effect.3. Increased blood flow: As we saw that heat reduces viscosity of fluid as a physical effect, due to this there is vasodilatation which occurs in response to heat and this increased vasodilatation of the hot surface appears as a redness of skin of that area.4. Increased rate of tissue healing: When heat is applied to the tissue it results in increase in chemical reaction rate of blood and increase in blood flow. In this response there is increase in oxygen intake and increase in the number of W.B.Cs and nutrition. Which will increase the healing rate5. Increases the extensibility of collagen fibres: By application of heat the collagen fibres becomes soft and at the same time it will follow a passive or active stretching. There is increase in the extensibility of the collagen fibres like in periarthrities of shoulder. When ultrasound is applied with exercise it increases the healing and movement at that joint.6. Reduction in joint stiffnessRise in temperature induces muscle relaxation and increases the efficiency of muscleaction, as the increased blood supply ensures the optimum conditions for musclecontraction.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 157
  • 176. DiscussionHeat appears to produce definite sedative effects. The effect of heat on nerveconduction has still to be thoroughly investigated. Heat has been applied as a counterirritant, which is the thermal stimulus, may effect the pain sensation as explained bythe gate theory of Melzack and Wall.Mode of Action on Symptoms:Pain: It is the cardinal symptom of Vata.in this disease the Vata is find to get blockedby the Kapha or Ama.Sweda by its ushna guna trespasses the sheeta guna of bothVata and Kapha.and the choorna used in the first group is having Vatahara propertyStambha: stambha is the resultant of Kapha or Ama dosha and Rooksha Sweda isaimed at the same. More over in this study the drugs used is having Ushna, Sukshmaand Teekshana gunas which helps to reduce the Kapha hence produced better relief inStambha.Lumbar movements: Swedana may help in relieving muscle spasm and contribute ineasing the lumbar movements along with the Sweda Chikitsa which is having VataKaphahara property.Walking distance:The Sweda procedure relieves cold, pain stiffness heaviness of the body, bringssoftness and smoothness to the body produce sadequate sweating and remission ofdisease occurs by virtue of which improve the quality of life.On the basis of above finding it can be concluded that both types of RookshaSwedabe adopted in the management of Katigraha.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 158
  • 177. Conclusion 7. CONCLUSIONThe following conclusions are drawn on the basis of the conceptual analysis andobservations made in the clinical study ,with two different RookshaSwedamodalities at K.V.G. Ayurvedic medical college and Hospital, Sullia Kati Graha/ Low Back Ache is commonly seen in society as a prominent problem. The disease Katigraha is a sthana vishesha Vatavyadhi.. It is explained as a separate disease in Gada Nigraha and Bhava Prakasha. Strenuous physical work, old age and direct abhigata are the predisposing factors in the manifestation of the disease. Vyana Vayu is an essential factor for manifestation of the disease Kati Graha. Maximum incidence of this disease was seen in the age group of 21-39 years. There is no direct reference regarding Nidana and Samprapti of Kati Graha Kati Graha is a painful condition and so far there is no established therapy. Mainly Vatavyadhi Chikitsa has bee advocated in Kati Graha. Rooksha Sweda karma is a modification of the sankara Sweda (or sagni upanaha) that comes under ushma type of Swedana. No complications of Sweda (atiyoga, ayoga and mitya yoga) were absorbed in this study. Kolakulathadi choorna Pinda Sweda group showed high significance in decreasing pain, stiffness and tenderness, and improving range of movements and walking ability which was noted completely after follow up(P<0.001). Valuka Sweda group also showed significant result in reducing pain and tenderness soon after the treatment but recurrence of the condition was seen after the follow up period During the follow up period (15 day) the results attained seemed to wear out in both Rooksha Swedas, but results lasted throughout the follow up period in the KCPS group and this may be due to the added effect of Vatahara choorna.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 159
  • 178. Conclusion LIMITATIONS The sizes of sample and time period were small to draw a generalized conclusion. Therefore, the therapy can be tried in a large sample for appropriate duration to observe its proper efficacy. The procedure of Pinda Sweda was a long-standing procedure, which needed admission in hospital and specialized care. RECOMMENDATION FOR FURTHER STUDY The study is advised on large samples. Various other Vatahara Choornas and other Rooksha Sweda modalities told in classics like ishtika pashana ,loha etc which is cost effective and easily available should be tried.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 160
  • 179. Summary 8. SUMMARY The present dissertation entitled ““A comparative study on the effect ofKolakulathadi choorna Pinda Sweda and Valuka in Kati Graha” has been carried outto find out the efficacy of the therapeutic effect Rooksha Sweda in Katigraha. Thestudy is carried out by using two different materials such as one is medicated powderand other with sand. This study contains Introduction, Objectives, and Review ofliterature, Methodology, Results, Discussion and Conclusion.Chapter 1 - Abstract Introduction &Objectives of the study is explained.Chapter 2 - The first section is sub-classified in three chapters namely ‘Swedanareview’ and Drug review and Disease review’.. Swedana procedure has been dealtwith in detail under the heading of Swedana review. In this chapter, historical aspectof Sweda, etymology, definition and classification of Sweda and along with itsindications, contra indications, action, Duration, are explained in detail. The details ofthe drugs selected for Sweda along with the description of properties of each drug intabular form have been presented under the heading of drug review. Thereafter BothAyurvedic and Modern concept of Katigraha and low back pain have been describedin the third chapter.Chapter 3 – Methodology- Material and methods includes criteria for selection andgrouping of patients, treatment schedule and grading of the disease etc. are explained.Observation of patients includes distribution of patients according to age, sex;economical status, diet etc. are represented along with the tables and charts.The second section entitled Clinical Study commences with a detailed description ofthe selection of the patients and methods adopted for this research work. Thereafter,Chapter 4 – Results – The results of the therapies after the treatment and afterfollow-up along with the statistical analysis have been presented in the form of tablesand graphs along with brief description of each finding.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 161
  • 180. SummaryChapter 5 – Discussion – Includes elaborate discussion about disease, the treatmentmodality, the logical interpretation of the results obtained in the clinical study andprobable mode of action of drugs.Chapter 6 - Conclusion – It is concluded that both groups showed high significancein decreasing pain, stiffness and tenderness, and improving range of movements andwalking ability (P<0.001).But it is noted that the results lasted throughout the followup period in the KCPS group and this may be due to the added effect of Vataharachoorna.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 162
  • 181. Bibliography 9. BIBLIOGRAPHIC REFERENCES 1. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter 5, Shloka No.3, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 19. 2. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibhandhasangraha commentory by Dalhana on Sutra Sthana, Chapter 5, Shloka no.3, Edition: Reprint: 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 19. 3. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.8, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 88. 4. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 22, Shloka no.4, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 120. 5. Pandit Parashurama Shastri Vidyasagar edited Sharangadhara Samhita, Deepika Commentory by Adamalla on Prathama Khanda, Chapter 7, Shloka No.105, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.103. 6. Prof. K.R. Srikantha Murthy edited Bhavaprakasha, Dwithitya khanda, 26nd Chapter, Shloka no. 53, Edition First 1998, Pub: Krishnadas Academy, Varanasi (UP), Page no. . 7. Sri Ganga Sahaya Pandeya Edited Gadanigraha,Chapter 19, Shloka 160 Chaukhamba Sanskrit Samsthan K.37/117, Gopal Mandir lane, Post box No.1139, Varanasi (UP), Edition:Reprint 2005, Page No 508A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 163
  • 182. Bibliography 8. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.41, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 90 9. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.25, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 89 10. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.26, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 89 11. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Dwithya Khanda, Chapter 1, shloka No. 546, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No.114 . 12. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.41, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 90 13. Acharya Bhela, Bhela Samhita, Sutra Sthana, Chapter 23, Edited by Prof. Priyavrat Sharma, Pub: Chaukambha Visvabharati, Varanasi (UP), Edition:Reprint 2005, Page No.38-40. 14. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Sutra Sthana, Chapter 23, Shlokha No. 20-21, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 24-29.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 164
  • 183. Bibliography 15. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 513-515. 16. Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 26, Shloka No.56, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.192- 199 17. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.253-259. 18. a) Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.25-27, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 89. b) Acharya Bhela, Bhela Samhita, Sutra Sthana, Chapter 23, Edited by Prof. Priyavrat Sharma, Pub: Chaukambha Visvabharati, Varanasi (UP), Edition:Reprint 2005, Page No.38-40 c) Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Sutra Sthana, Chapter 23, Shlokha No. 20-21, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 24-29. d)Vaidya Jadavaji Trikamji Acharya edited Acharya edited Sushruta Samhita, Nibhandhasangraha commentory by Dalhana and Nyaya Chandrika Panjika of Gayadasa on Sutra Sthana, Chapter 32, Shloka no.12, Edition: Reprint: 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 513A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 165
  • 184. Bibliography e) Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 26, Shloka No.5, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.193 f) Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, shloka no 6-7 Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.254. 19. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 2, , 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.294.20. Priyavrat Sharma edited Chakradatta of Chakrapanidutta, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K-37/109, Gopal Mandir lane, Varanasi (UP), Page No. 183-214.21. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madyama Khanda, Chapter 24, shloka No. 546, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 227.22. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 27, Shloka No. 14, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 373-417.23. Dr. Indradev Tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara, Vatavyadhi Chikitsa, Shloka No. 117 and Vatavyadhi Chikitsa, Shloka No. 119, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 517.24. Raja Radha Kanta Deva edited Shabda Kalpadruma, vth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.495.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 166
  • 185. Bibliography25. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka No.5, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.120.26. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 22, Shloka No.11, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 12027. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 8828. Vaidya Haridasa Shridhara Kasture, Ayuvediya PanchakarmaVignan Chapter 3, Edition: Reprint 2009, : Shree Baidyanath Ayurved Bhavan Ltd.; Naine Allahabad, Ragi Karyalaya 1, gupta lane, Calcutta-6 p. 159.29. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.20- 24, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 8930. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.17-19, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 514.31. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.25-27, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.25932. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.17-19, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 514.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 167
  • 186. Bibliography33. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.8, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 8834. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.16- 19, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 8835. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.25, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 515.36. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.21-24, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.25837. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.25, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 515.38. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.16- 19, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 8839. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.21-24, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.25840. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.21-24, Reprint, 2007, Pub:Chaukhamba SurbharatiA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 168
  • 187. Bibliography Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.25841. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.65, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 9242. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.66, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 9243. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.66, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 9244. Vaidya Jadavaji Trikamji Acharya edited edited Sushruta Samhita, Nibhandhasangraha commentory by Dalhana and Nyaya Chandrika Panjika of Gayadasa on Chikitsa Sthana, Chapter 32, Shloka no.22, Edition: Reprint: 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 51445. Vaidya Haridasa Shridhara Kasture, Ayuvediya PanchakarmaVignan, Edition: Reprint 2009, : Shree Baidyanath Ayurved Bhavan Ltd.; Naine Allahabad, Ragi Karyalaya 1, gupta lane, Calcutta-6 p. 16446. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 14, Shloka no.7, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 88A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 169
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  • 192. Bibliography 79. Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 9. 80. Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 10. 81. Namboodiri VMC, Notes on Panchakarma. Mezhathur: Vaidyamadham Vaidyasala; 1960. p. 41. 82. Keraleeya Chikitsakrama (Malayalam) Chapter 2. Trivandrum: Vasudevavalasam Publications; 1982. p. 7. 83. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.15, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.257 84. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.27, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 515. 85. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter14, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701. 86. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.15, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.257 87. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 515.A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 174
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  • 201. Bibliographyc) . Vagbhata, Ashtangahridaya nidanasthana chapter 15 sloka 5,6. Varanasi: KrishnadasAcademy; 1982. p.530-531 (Krishnadas Academic series 4).201. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 15-19. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P 617. (Kasi Sanskrit series 228).202. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 1-2. Varanasi: KrishnadasAcademy; 1980. p. 255. (Krishnadas Ayurveda series 51).203.Vagbhata, Ashtangahridaya nidanasthana chapter 15 sloka 5. Varanasi: KrishnadasAcademy; 1982. p.531. (Krishnadas Academic series 4).204. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter 22, Shloka No. 1-4, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi,Page No. 232.205. Yogaratnakara: Vidyotini Hindi commentary by Vaidya Laksmipathi Sastri, 7th edtn1999, Chaukambha Sanskrit Sansthan, Varanasi.pg 400206. Acharya Bhavamishra, Bhavaprakash; Vidyotini Hindi Commentry by Brahmasankaramisra & Rupalalji Vaisya, Chaukmbha Sanskrit Sansthan, Varanasi pg 450207. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter 1, Shloka No. 10,Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi,Page No. 58208. Agnivesa, Charakasamhitha sutrasthana chapter 17 sloka 76-77. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P103. (Kasi Sanskrit series 228).209 Sushrutha, Sushruthasamhitha Sutrasthana chapter 21 sloka Varanasi: KrishnadasAcademy; 1980. p. 237,239. (Krishnadas Ayurveda series 51).210. Agnivesa, Charakasamhitha chikitsasthana chapter 11 sloka 12. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.478 (Kasi Sanskrit series 228).211. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter 1, Shloka No. 7,Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi,Page No. 39212. . Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 23. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P 617. (Kasi Sanskrit series 228).213. Vagbhata, Ashtangahridaya sutraasthana chapter 12 sloka 49. Varanasi: KrishnadasAcademy; 1982. p.530-531 (Krishnadas Academic series 4).214. Hemadri commentary on Vagbhata, Ashtangahridaya sutraasthana chapter 12 sloka 49.Varanasi: Krishnadas Academy; 1982. p.200-201 (Krishnadas Academic series 4).215.Dalhana commentary on Sushrutha, Sushruthasamhitha Nidanasthana chapter 5 sloka13. Varanasi: Krishnadas Academy; 1980. p.200-201. (Krishnadas Ayurveda series 51).A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 183
  • 202. Bibliography216. Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 56. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.619 (Kasi Sanskrit series 228).217. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter 22, Shloka No.55-56, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160,Varanasi, Page No. 39218. a) Vagbhata, Ashtangasangraha Nidanasthana chapter 2 sloka 5. Varanasi: KrishnadasAcademy; 1982. p.358 (Krishnadas Academic series 4).b) Vagbhata, Ashtangahridaya nidanasthana chapter 2 sloka 12. Varanasi: KrishnadasAcademy; 1982. p.449 (Krishnadas Academic series 4).219. Acharya Bhavamishra, Bhavaprakash; Vidyotini Hindi Commentry by Brahmasankaramisra & Rupalalji Vaisya, Chaukmbha Sanskrit Sansthan, Varanasi220. Yoga Ratnakara edited by Indradev Tripati and Daya Shankar Tripati, Published byKrishnadas academy, edition- 1(1998), pg 70221.a) Prof. Yadunadana Upadhyaya edited Madava Nidana, Part II, Chapter 40, ShlokaNo,15, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160,Varanasi, Page No. 39b) . Agnivesa, Charakasamhitha sutrasthana chapter 17 sloka 101. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.104 (Kasi Sanskrit series 228).222. Sushrutha, Sushruthasamhitha Uttaratantra chapter 56 sloka 22 Varanasi: KrishnadasAcademy; 1980. p. 237,239. (Krishnadas Ayurveda series 51).223. Vagbhata, Ashtangahridaya nidanasthana chapter 3 sloka 19. Varanasi: KrishnadasAcademy; 1982. p.530-531 (Krishnadas Academic series 4).224. Agnivesa, Charakasamhitha chikitsasthana chapter 16 sloka 16. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. (Kasi Sanskrit series 228).225. Acharya Madhavakara, Vijayarakshita and Shrikantadatta Shastri MadhukoshaCommentary, Madhava Nidana with Vidyotini Hindi commentary edited by BrahmanandTripati, Vol. I, Edition, 1998, Published by Chowkambha Surabharati Prakashana226. Agnivesa, Charakasamhitha chikitsasthana chapter 19 sloka 5. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.548 (Kasi Sanskrit series 228).227. Vagbhata, Ashtangasangraha nidanasthana chapter 12 sloka 8. Varanasi: KrishnadasAcademy; 1982. p.530-400 (Krishnadas Academic series 4).228. Vagbhata, Ashtangasangraha nidanasthana chapter 12 sloka 8. Varanasi: KrishnadasAcademy; 1982. p.400 (Krishnadas Academic series 4).229.a) Agnivesa, Charakasamhitha chikitsasthana chapter 14 sloka 11. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.502 (Kasi Sanskrit series 228).A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 184
  • 203. Bibliographyb) Agnivesa, Charakasamhitha chikitsasthana chapter 14 sloka 172. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.508 (Kasi Sanskrit series 228).230. Vagbhata, Ashtangasangraha Shareerasthana chapter 4 sloka 16. Varanasi: KrishnadasAcademy; 1982. p.293 (Krishnadas Adcademic series 4).231. Vagbhata, Ashtangasangraha Sutrasthana chapter 19 sloka 6. Varanasi: KrishnadasAcademy; 1982. P 149 (Krishnadas Academic series 4).232. Sushrutha, Sushruthasamhitha Nidanasthana chapter 1 sloka 57. Varanasi: KrishnadasAcademy; 1980. p. 265 (Krishnadas Ayurveda series 51).233. Sushrutha, Sushruthasamhitha Kalpasthana chapter 2 sloka 39. Varanasi: KrishnadasAcademy; 1980. p. 237,239. (Krishnadas Ayurveda series 51).234. a)Agnivesa, Charakasamhitha chikitsasthana chapter 3 sloka 71. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 404 (Kasi Sanskrit series 228).b) Vagbhata, Ashtangasangraha nidanasthana chapter 6 sloka 160. Varanasi: KrishnadasAcademy; 1982. p.492 (Krishnadas Academic series 4).235.a) Agnivesa, Charakasamhitha chikitsasthana chapter 11 sloka 12-13. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P 478. (Kasi Sanskrit series 228).b) ) Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter 10, Shloka No,15,Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi,Page No 355236. Agnivesa, Charakasamhitha chikitsasthana chapter 29 sloka 16. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P 628. (Kasi Sanskrit series 228).237. Sushrutha, Sushruthasamhitha Nidanasthana chapter 4 sloka 4. Varanasi: KrishnadasAcademy; 1980. p. 280. (Krishnadas Ayurveda series 51).238. Sushrutha, Sushruthasamhitha Nidanasthana chapter 12 sloka 5. Varanasi: KrishnadasAcademy; 1980. p. 315. (Krishnadas Ayurveda series 51).239. Vagbhata, Ashtangahridaya kalpasthana chapter 5 sloka 47. Varanasi: KrishnadasAcademy; 1982. p. 738(Krishnadas Academic series 4).240.Sushrutha, Sushruthasamhitha Chikitsasthana chapter 36 sloka 36. Varanasi: KrishnadasAcademy; 1980. p. 530. (Krishnadas Ayurveda series 51).241. Vagbhata, Ashtangahridaya sutrasthana chapter 14 sloka 29. Varanasi: KrishnadasAcademy; 1982. p.227 (Krishnadas Academic series 4).242. Agnivesa, Charakasamhitha chikitsasthana chapter 12 sloka 13. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. (Kasi Sanskrit series 228).243. Agnivesa, Charakasamhitha vimanasasthana chapter 1 sloka 7. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.231 (Kasi Sanskrit series 228).A Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 185
  • 204. Bibliography244. Vagbhata, Ashtangahridaya sutrasthana chapter 10 sloka 19. Varanasi: KrishnadasAcademy; 1982. p.173 (Krishnadas Academic series 4).245. Vagbhata, Ashtangahridaya NIdanasthana chapter 15 sloka 17. Varanasi: KrishnadasAcademy; 1982. p.532 (Krishnadas Academic series 4).246. Agnivesa, Charakasamhitha chikitsasthana chapter 15 sloka 45. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.517 (Kasi Sanskrit series 228).247. Acharya Bhavamishra, Bhavaprakash; Vidyotini Hindi Commentry by Brahmasankaramisra & Rupalalji Vaisya, Chaukmbha Sanskrit Sansthan, Varanasi251. Agnivesa, Charakasamhitha chikitsasthana chapter 28 sloka 83. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 620 (Kasi Sanskrit series 228).252.Vagbhata, Ashtangasangraha chikitsasthana chapter 23 sloka 160. Varanasi: KrishnadasAcademy; 1982. p.530-531 (Krishnadas Academic series 4).253. Agnivesa, Charakasamhitha sutrasthana chapter 1 sloka 40. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p.8 (Kasi Sanskrit series 228).254. Vangasena by by Kavivar shree shaligramaji Vayshya ,edited by vydya Sakarlal jain pgno. 574-576255. Agnivesa, Charakasamhitha sutrasthana chapter 25 sloka 45. 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. P133. (Kasi Sanskrit series 228).256 Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 611-625, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan,varanasi, Page No. 586.257.Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 626-630, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan,varanasi, Page No. 587.258.Harrison Harissons Principles of Internal Medicine, 14th Edition, 1998.pgno.113International Edition, Ed - Anthony Fauci S. et al., 1998.259 www.about.com/health/rewiew.htm260. www.article click.comA Study on The Effect of Swedana with Kolakulathadi Choorna and Valuka in Katigraha 186
  • 205. DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA K.V.G. AYURVEDA COLLEGE AND HOSPITAL, SULLIATitle: A STUDY ON THE EFFECT OF SVEDANA WITH KOLAKULATTHADI CHOORNA AND VALUKA IN KATIGRAHAGUIDE : DR. SATHYAMOORTHY BHAT M.D. (AYU.)SCHOLAR : DR. ANJALY .N. V.====================================================== CLINICAL CASE PROFORMA1. Name of the patient : Sl. No :2. Sex : OPD No :3. Religion :4. Occupation : IPD No :5. Economical Status :6. Educational status :7. Marital status :8. Address :_____________________________ Phone /Mobile No : ____________________________ Email ID : _____________________________9. Type of treatment : Group A Group B10.Date of Schedule Initiation :Date of Schedule Completion :11. Result : Complete / Marked/ Moderate/ Mild/ Unchanged12. Consent: I here by agree that, I have been fully educated with the disease andtreatment, here by satisfied whole heartedly, and accept the medical trial over me. Patient’s Signature 186
  • 206. CHIEF COMPLAINTSPain in lumbar Region - Days/Months/YrsStiffness of lumbar Region - Days/Months/YrsASSOSSIATED COMPLAINTS :HISTORY OF PRESENT ILLNESS : • Onset : Insidious / Sudden / Gradual • Course : Progressive / Intermittent / Continuous • Mechanism of injury : Bending Forward / Fall/ Hit / Jerky Movements / Lifting Weight / No cause • Nature of pain : Radiating/ local/ refered/ Dull aching / Deep pain / Pricking / Shooting / Excruciating • Loss of function : Mild / Moderate /severe. • Aggravating factor : -Diurnal ; M / A / E / N -Cold / Hot / Sunlight / Wind / Temperature change / other (Specify) -Movement : Squatting / Walking / Climbing stairs • Relieving factor : - Diurnal : M / A / E / N - Natural / Cold / Hot / Medicine - Rest: Yes / NoH/O past Illness : History of Trauma of lumbosacral region / Degenerative diseases of pelvis / T.B. of spine / Any othersFamily History : H/O similar complaints 187
  • 207. Treatment history:Using systemic/Topical medications/ Surgical historyOthers if any:Occupational history:Nature of work:-Sedentary / Traveling / Labour /Bending / Sitting /Standing / WalkingWorking hours :- Day / NightObstetric history :-Personal HistoryAh ra : Samashana/Adhyashana/Vishamashana Quantity:Alpa/Madhyama/Avara Nature of diet: Veg/MixedVih ra : Sedentary / Traveling / Labour / Agriculture Day / Night- :Agni : Sam gni / Mand gni / Teeksh gni / Visham gniKoshta : Mrudu / Madhyama / KruraNidra : Sound/Disturbed , Divaswapna/Ratrijagarana , Hours of sleep-:Vyasana : None/Tobacco/Alcohol/Cigeretts/OthersMala : Prakrutha / Malabadhatha / Athisaranatha ; Sama / NiramaMootra : Prakrutha / Alpa / Athi : Pravruthi Sankya :Dashavidha PareekshaPrakruthi : VP/ P K/KP /PV/KV / PK /VK/ VPKVikruthi :P/M/AVaya :P/M/ASatmya : Ekarasa. / Sarva rasa / Vyamishra Rooksha satmya /Snigda satmyaSara :P/M/A(T/R/M/M/A/M/S/S)Satwa :P/M/ASamhanana :P/M/APramana : P / M / A - Height : Weight :Aharashakthi : Abhyaharana shakthi Jarana shakthi 188
  • 208. Vyayamashakthi :Vaya : Bala/ Yuva/ VruddaVital signsPulse rate :Blood pressure :Respiratory Rate :Temperature :Srotopareeksha a) Asthivaha srotas : Asthibedha / Sandhi shaithilya b) Mamsavaha srotas : Parvabheda / Asthinistoda / Asthishunyata c) Ithara : EXAMINATION OF LUMBOSACRAL REGIONInspection : Swelling over spine Deformity: Kyphosis/ Lordosis/Scoliosis Wasting Redness Any otherPalpation : Tenderness Nature of swellingRange of movementsMovements : Normal Restricted AbsentFlexionExtensionLeft lateralRight lateralRotation 189
  • 209. Tests : Right Left S.L.R.InvestigationsHematological :Hb% E.S.R. T.L.C. D.C. :N___%, L__%,B__%,eBiochemical : F.B.S.R A Factor :Urine analysis : Sugar, Albumin, Microscopic.X-Ray Lumbar spine : AP & Lateral ViewsNidaanaAhara :- Katu / Tikta/ Kashaya /Ati Sheeta/ Ati Rooksha Alpa Bhojana / Pramitha BhojanaVihara :- Vega Dharana / Athivyavaya / Nishajaagarana / Ativyaayama/ Yanam/ Plavana /AdhvagamanaManasika :- Athibhaya / Athishoka / AthichinthaOccupational :- Bending Forward / Fall/ Hit / Jerky Movements / Lifting Weight / Traveling / Labour / Sitting /Standing / WalkingPoorvarupa :Roopa : Pain in lumbar Region - Stiffness of lumbar Region 190
  • 210. Upashaya/Anupashaya : Ushna / Seetha Rooksha / SnigdhaDignosisAssessment Criteria: A.T FOLLOW UPPARAMETERS B.T (7th day) (21st day) Tenderness Pain on rest(On lying) Pain on rest(On Sitting) Pain on movement (on walk) Lumbar flexion Lumbar extension Right lateral movement Left lateral movement Rotation Time taken to cover 21 mtrsResult : Complete / Marked/ Moderate/ Mild/ UnchangedSignature of the Candidate Signature of the Guide (Dr. Anjaly.N.V) (Dr. Sathyamoorthy Bhat) Signature of the Professor and HOD (Dr. N.S. Shetter.) 191
  • 211. ANNEXURE INCIDENCE CHART OF KCPS GROUPSL AG MARRITAL SOCIO- NATURE OFNO NAME E SEX RELIGION STATUS EDUCATION ECNOMIC OCCUPATION WORK HIGHER 1 UMESH 42 MALE HINDU UNMARRIED SECONDARY MIDDLE BUSINESS TRAVELLING FEMAL 2 HARSHITHA 20 E HINDU UNMARRIED GRADUATION UPPER MIDDLE STUDENT SITTING 3 DINESH 21 MALE HINDU UNMARRIED ILLITERATE POOR COOLIE BENDING FEMAL HIGHER 4 PRABHA 38 E HINDU MARRIED SECONDARY UPPER MIDDLE HOUSE WIFE WALKING 5 LOKAYYA 48 MALE HINDU MARRIED SECONDARY POOR ATTENDER STANDING 6 KIRAN 22 MALE HINDU UNMARRIED GRADUATION UPPER MIDDLE STUDENT TRAVELLING FEMAL 7 SUMALATHA 35 E HINDU MARRIED SECONDARY MIDDLE TAILORING SITTIING FEMAL 8 DHANYA 31 E HINDU MARRIED GRADUATION MIDDLE NURSE STANDING FEMAL HIGHER 9 SHASHIKALA 28 E HINDU MARRIED SECONDARY HIGHER HOUSE WIFE WALKING FEMAL HIGHER 10 ABDUL SAMEER 21 E MUSLIM UNMARRIED SECONDARY MIDDLE STUDENT TRAVELLING 11 ROHITH 24 MALE HINDU UNMARRIED GRADUATION HIGHIER STUDENT TRAVELLING FEMAL 12 MADHAVI 62 E HINDU MARRIED PRIMARY POOR HOUSE WIFE BENDING FEMAL 13 SUSHEELA 59 E HINDU MARRIED PRIMARY HIGHER HOUSE WIFE BENDING AGRICULTURIS 14 BALAKRISHNA 56 MALE HINDU UNMARRIED PRIMARY POOR T BENDING ANNAMMA FEMAL CHRISTIA 15 CHERIYA 55 E N MARRIED GRADUATION UPPER MIDDLE OFFICE WORK SITTIING HIGHER 16 SURESH BHAT 35 MALE HINDU MARRIED SECONDARY MIDDLE BUSINESS TRAVELLING FEMAL 17 SUMINA 22 E HINDU UNMARRIED GRADUATION UPPER MIDDLE STUDENT SITTING 18 VISHVANATH 47 MALE HINDU MARRIED GRADUATION UPPER MIDDLE TEACHER STANDING FEMAL CHRISTIA 19 MARIYAMMA 56 E N MARRIED PRIMARY POOR HOUSE WIFE BENDING FEMAL 20 FATHIMA 39 E MUSLIM MARRIED SECONDARY MIDDLE HOUSE WIFE BENDING 192
  • 212. INCIDENCE CHART OF KCPS GROUPSL NO NAME DURATION MECHANISM OF INJURY ONSET COURSE LOSS OF FUNCTION PRAKRUTHI SATVA AGNI KOSHTA DIET HABITS WEIGHT 1 UMESH 2 MONTHS JERKY MOVEMENTS GRADUAL INTERMITTENT MODERATE VAATA-KAPHA MADHYAMA THEEKSHNAGNI MADHYAMA MIXED 68 2 HARSHITHA 6 M0NTHS HIT INCIDIOUS PROGRESSIVE MODERATE KAPHA-VAATA MADHYAMA SAMAGNI MADHYAMAM VEGETARIAN 45 3 DINESH 1 DAY LIFTING WEIGHT SUDDEN CONTINOUS SEVERE PITTA-KAPHA MADHYAMA MANDAGNI KRURAM MIXED 56 4 PRABHA 4 MONTHS FALL GRADUAL INTERMITTENT MODERATE VAATA-KAPHA MADHYAMA VISHAMAGNI MADHYAMA MIXED 91 5 LOKAYYA 2 YEARS NO CAUSE GRADUAL PROGRESSIVE SEVERE PITTA-KAPHA PRAVARA MANDAGNI MADHYAMA MIXED 62 6 KIRAN 1 YEAR JERKY MOVEMENTS INCIDIOUS PROGRESSIVE MODERATE KAPHA-VAATA MADHYAMA VISHAMAGNI KRURAM MIXED 69 7 SUMALATHA 4 MONTHS BENDING FORWARD INCIDIOUS INTERMITTENT MILD VAATA-KAPHA PRAVARA MANDAGNI MADHYAMA VEGETARIAN 60 8 DHANYA 2 YEAR LIFTING WEIGHT GRADUAL PROGRESSIVE MILD PITTA-VAATA MADHYAMA MANDAGNI MADHYAMA MIXED 71 9 SHASHIKALA 1YEAR BENDING FORWARD GRADUAL PROGRESSIVE MODERATE VAATA-PITTA PRAVARA SAMAGNI MRUDU VEGETARIAN 59 10 ABDUL SAMEER 6 MONTHS NO CAUSE GRADUAL PROGRESSIVE MODERATE KAPHA-VAATA MADHYAMA SAMAGNI MADHYAMA MIXED 64 11 ROHITH 1 WEEK JERKY MOVEMENTS SUDDEN CONTINOUS MODERATE KAPHA-PITTA MADHYAMA MANDAGNI MADHYAMA MIXED 51 12 MADHAVI 3 MONTHS LIFTING WEIGHT INCIDIOUS PROGRESSIVE MILD VAATA-KAPHA AVARA VISHAMAGNI KRURAM MIXED 75 13 SUSHEELA 3 WEEKS NO CAUSE GRADUAL CONTINOUS MODERATE KAPHA-VAATA PRAVARA VISHAMAGNI KRURAM VEGETARIAN 78 14 BALAKRISHNA 2 DAYS BENDING FORWARD GRADUAL PROGRESSIVE MODERATE VAATA-PITTA PRAVARA THEEKSHNAGNI MADHYAMA MIXED 68 15 ANNAMMA CHERIYA 2 WEEKS NO CAUSE GRADUAL PROGRESSIVE MODERATE VAATA-KAPHA MADHYAMA SAMAGNI MADHYAMA MIXED 70 16 SURESH BHAT 2 MONTHS BENDING FORWARD GRADUAL INTERMITTENT MODERATE VAATA-PITTA MADHYAMA SAMAGNI MRUDU VEGETARIAN 78 17 SUMINA 3 YEAR NO CAUSE GRADUAL PROGRESSIVE MILD VAATA-KAPHA PRAVARA SAMAGNI MADHYAMA MIXED 46 18 VISHVANATH 1 WEEK HIT SUDDEN CONTINOUS MODERATE VAATA-KAPHA MADHYAMA SAMAGNI KRURAM VEGETARIAN 66 19 MARIYAMMA 10 DAYS NO CAUSE GRADUAL INTERMITTENT MODERATE KAPHA-VAATA MADHYAMA SAMAGNI KRURAM MIXED 76 20 FATHIMA 1 MONTH FALL INCIDIOUS PROGRESSIVE MILD KAPHA-PITTA MADHYAMA THEEKSHNAGNI MRUDU MIXED 45 193
  • 213. INCIDENCE CHART OF VPS GROUPSL NO NAME AGE SEX RELIGION MARRITAL STATUS EDUCATION SOCIO-ECNOMIC OCCUPATION NATURE OF WORK 1 RENUKA 38 FEMALE HINDU MARRIED SECONDARY MIDDLE HOUSE WIFE BENDING 2 MARYKKUTTY 61 FEMALE CHRISTIAN UNMARRIED PRIMARY POOR HOUSE WIFE BENDING 3 RAVISHANKAR 24 MALE HINDU UNMARRIED SECONDARY POOR PAINTER BENDING 4 KHADEEJUMMA 65 FEMALE MUSLIM UNMARRIED PRIMARY MIDDLE HOUSE WIFE BENDING 5 KAVITHA 32 FEMALE HINDU UNMARRIED GRADUATION UPPER MIDDLE TEACHER STANDING 6 VENKETESH 40 MALE HINDU UNMARRIED GRADUATION MIDDLE CLERK SITTING 7 SHIHAS AHMD 21 MALE MUSLIM UNMARRIED HIGHER SECONDARY UPPER MIDDLE STUDENT TRAVELLING 8 MONAPPA GOWDA 68 MALE HINDU MARRIED PRIMARY MIDDLE AGRICULTURIST BENDING 9 LATHIKA 37 FEMALE HINDU MARRIED HIGHER SECONDARY MIDDLE BEAUTICIAN STANDING 10 JAYALAKSHMI 63 FEMALE HINDU MARRIED GRADUATION HIGHER RETIRED TEACHER SITTING 11 SHIVAMMA 64 FEMALE HINDU MARRIED PRIMARY MIDDLE HOUSE WIFE WALKING 12 NALINAKSHI 39 FEMALE HINDU UNMARRIED HIGHER SECONDARY MIDDLE BUSINESS TRAVELLING 13 RAMACHANDRAPPA 64 MALE HINDU UNMARRIED SECONDARY UPPER MIDDLE BUSINESS TRAVELLING 14 PRATHIBHA 42 FEMALE HINDU MARRIED GRADUATION HIGHER BANK EMPLOY SITTING 15 JAYAMMA 53 FEMALE HINDU UNMARRIED PRIMARY MIDDLE HOUSE WIFE BENDING 16 SHEHNAZ 29 FEMALE MUSLIM UNMARRIED PRIMARY POOR HOUSE WIFE WALKING 17 RAGHAVENDRA 29 MALE HINDU MARRIED SECONDARY MIDDLE DRIVER TRAVELLING 18 SHEELAVATHI 55 FEMALE HINDU MARRIED SECONDARY HIGHER HOUSE WIFE BENDING 19 CHANDRASHEKHAR 42 MALE HINDU MARRIED HIGHER SECONDARY UPPER MIDDLE CLERK BENDING 20 GAYATRY 25 FEMALE HINDU UNMARRIED SECONDARY POOR ATTENDER WALKING 194
  • 214. INCIDENCE CHART OF VPS GROUPSL DURATI MECHANISM OF LOSS OF PRAKRUTH DIET WEIGNO NAME ON INJURY ONSET COURSE FUNCTION I SATVA AGNI KOSHTA HABITS HT BENDING GRADU PROGRESSI VAATA- MADHYA VEGITERI 1 RENUKA I MONTH FORWARD AL VE MILD PITTA MA MANDAGNI MRUDU AN 44 BENDING GRADU INTERMITT VAATA- MADHYA MADHYAM 2 MARYKKUTTY 3 WEEKS FORWARD AL ENT MODERATE PITTA MA SAMAGNI AM MIXED 43 KAPHA- MADHYA MADHYAM VEGITERI 3 RAVISHANKAR 1 WEEK LIFTING WEIGHT SUDDEN CONTINOUS SEVERE VAATA MA SAMAGNI AM AN 69 2 JERKY GRADU PROGRESSI VAATA- 4 KHADEEJUMMA MONTHS MOVEMENTS AL VE MILD KAPHA PRAVARA SAMAGNI KRURAM MIXED 80 7 GRADU PROGRESSI KAPHA- MADHYAM VEGITERI 5 KAVITHA MONTHS LIFTING WEIGHT AL VE MODERATE PITTA PRAVARA MANDAGNI AM AN 56 VAATA- THEEKSHNA VEGITERI 6 VENKETESH 1 YEAR LIFTING WEIGHT SUDDEN CONTINOUS MODERATE PITTA PRAVARA GNI MRUDU AN 78 INCIDIO KAPHA- MADHYA 7 SHIHAS AHMD 2 YEAR FALL US CONTINOUS MODERATE PITTA MA SAMAGNI KRURAM MIXED 50 MONAPPA 3 KAPHA- VISHAMAGN 8 GOWDA MONTHS NO CAUSE SUDDEN CONTINOUS SEVERE VAATA AVARA I MRUDU MIXED 81 GRADU INTERMITT VAATA- MADHYA VISHAMAGN VEGITERI 9 LATHIKA 3 YERS NO CAUSE AL ENT MODERATE KAPHA MA I KRURAM AN 55 INCIDIO PROGRESSI VAATA- MADHYA MADHYAM VEGITERI 10 JAYALAKSHMI 5 DAYS FALL US VE MODERATE KAPHA MA SAMAGNI AM AN 70 BENDING GRADU PROGRESSI KAPHA- MADHYA 11 SHIVAMMA 5 YEARS FORWARD AL VE MODERATE VAATA MA MANDAGNI KRURAM MIXED 52 VAATA- MADHYA MADHYAM 12 NALINAKSHI IO DAYS LIFTING WEIGHT SUDDEN CONTINOUS MODERATE PITTA MA SAMAGNI AM MIXED 71 RAMACHANDR BENDING GRADU PROGRESSI KAPHA- MADHYA 13 APPA 1 YEAR FORWARD AL VE MILD PITTA MA MANDAGNI KRURAM MIXED 54 3 INCIDIO PROGRESSI PITTA- THEEKSHNA MADHYAM VEGITERI 14 PRATHIBHA MONTHS HIT US VE MODERATE KAPHA PRAVARA GNI AM AN 62 8MONTH GRADU INTERMITT VAATA- MADHYA VISHAMAGN 15 JAYAMMA S NO CAUSE AL ENT MODERATE KAPHA MA I KRURAM MIXED 67 PITTA- MADHYA 16 SHEHNAZ 15 DAYS NO CAUSE SUDDEN CONTINOUS MODERATE KAPHA MA SAMAGNI MRUDU MIXED 87 BENDING GRADU PROGRESSI PITTA- MADHYAM VEGITERI 17 RAGHAVENDRA I MONTH FORWARD AL VE MODERATE VAATA PRAVARA SAMAGNI AM AN 65 VAATA- 18 SHEELAVATHI 5 DAYS LIFTING WEIGHT SUDDEN CONTINOUS MODERATE KAPHA AVARA SAMAGNI KRURAM MIXED 73 CHANDRASHEK GRADU INTERMITT VAATA- MADHYA MADHYAM 19 HAR 3 WEEKS NO CAUSE AL ENT MILD KAPHA MA SAMAGNI AM MIXED 91 JERKY GRADU PROGRESSI KAPHA- MADHYA MADHYAM 20 GAYATRY 3 WEEKS MOVEMENTS AL VE MODERATE VAATA MA SAMAGNI AM MIXED 59 195
  • 215. OBSERVATION OF GRADING POINT ON CLINICALFEATURE OF KATIGRAHA IN KCPS GROUP RIGHT LATER PAIN ON ALSL PAIN ON PAIN ON MOVEMENT(WAL TENDERNES LUMBAR LUMBAR MOVE LEFT LATERAL TIME TAKEN TONO REST(LYING) REST(SITTING) K) S FLEXION EXTENSION MENT MOVEMENT ROTATION COVER 21 MTRS A A A A B A AF B A AF B A F B A F B A AF F B A F NAME T T U T T U BT AT AFU T T U T T U T T U BT AT U BT AT AFU T T U BT AT AFU 1 UMESH 0 0 0 1 0 0 2 0 0 2 1 1 2 1 1 0 0 0 1 0 0 1 0 0 0 0 0 2 1 1 HARSHIT 2 HA 1 0 0 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 1 0 0 1 0 0 2 1 1 3 DINESH 3 2 1 3 2 2 3 2 1 4 2 1 3 2 1 3 1 1 3 2 1 2 1 1 2 1 0 4 2 1 4 PRABHA 0 0 0 1 0 0 1 0 0 2 1 1 2 1 1 1 0 0 0 0 0 3 2 1 1 0 0 2 1 1 LOKAYY 5 A 3 1 0 3 2 1 3 2 1 3 2 1 3 1 0 3 2 1 1 0 0 2 1 1 3 2 1 3 2 1 6 KIRAN 2 1 0 2 1 1 2 1 1 2 1 1 2 1 1 1 0 0 2 1 1 1 0 0 0 0 0 2 1 1 SUMALA 7 THA 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 2 1 1 1 0 0 1 1 1 8 DHANYA 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 1 1 1 0 0 0 0 0 1 0 0 1 0 0 SHASHIK 9 ALA 2 1 1 2 1 1 2 0 0 2 1 1 2 1 1 2 1 1 0 0 0 3 2 2 2 1 1 2 2 1 ABDUL10 SAMEER 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 1 1 2 1 1 1 1 1 2 1 111 ROHITH 2 1 0 2 1 1 2 1 1 2 1 1 2 1 0 2 0 0 2 1 0 1 0 0 2 1 0 2 2 1 MADHAV12 I 0 0 0 1 0 0 1 0 0 2 1 0 1 0 0 0 0 0 1 0 0 2 1 1 1 0 0 2 2 2 SUSHEEL13 A 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 1 0 0 1 1 1 2 1 1 2 1 1 2 1 1 BALAKRI14 SHNA 1 1 1 2 1 0 2 0 0 2 1 0 2 2 1 2 1 0 2 1 0 0 0 0 1 0 0 2 1 0 ANNAM MA15 CHERIYA 2 1 1 2 1 1 2 0 0 2 1 1 2 1 1 1 0 0 2 1 1 2 1 1 1 0 0 2 1 1 SURESH16 BHAT 2 1 1 2 1 1 2 1 1 2 1 1 2 0 0 0 0 0 0 0 0 3 2 1 2 1 1 2 1 117 SUMINA 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 2 1 1 0 0 0 1 0 0 1 0 0 VISHVAN18 ATH 1 1 0 2 1 0 2 1 1 2 1 1 2 1 0 2 1 1 0 0 0 2 1 0 0 0 0 2 2 1 MARIYA19 MMA 2 1 0 2 1 0 2 0 0 3 1 1 3 1 0 1 0 0 1 0 0 3 2 2 1 0 0 1 1 020 FATHIMA 0 0 0 1 0 0 1 0 0 1 0 0 2 1 1 0 0 0 2 1 1 0 0 0 2 1 1 1 0 0 196
  • 216. OBSERVATION OF GRADING POINT ON CLINICALFEATURE OF KATIGRAHA IN VPS GROUPSL PAIN ON RIGHT LATERALN PAIN ON PAIN ON MOVEMENT(WAL TENDERNE LUMBAR LUMBAR MOVEMENT LEFT LATERAL TIME TAKEN TOO REST(LYING) REST(SITTING) K) SS FLEXION EXTENSION MOVEMENT ROTATION COVER 21 MTRS A A A B A AF B A AF B A F B A F B A AF B A F NAME T T U T T U BT AT AFU T T U T T U T T U BT AT AFU BT AT AFU T T U BT AT AFU 1 RENUKA 1 0 0 1 0 1 2 0 1 2 0 1 2 0 1 1 0 0 1 0 1 0 0 0 1 0 0 1 1 1 MARYKK 2 UTTY 2 1 1 2 1 1 1 0 0 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 RAVISHA 3 NKAR 2 1 1 3 2 2 3 2 2 3 2 2 3 2 2 2 1 1 3 2 2 2 1 1 3 2 2 4 3 3 KHADEEJ 4 UMMA 0 0 0 2 1 1 1 0 0 1 1 1 1 1 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 KAVITH 5 A 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 VENKET 6 ESH 0 0 0 0 0 0 1 0 0 2 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 0 0 1 0 0 SHIHAS 7 AHMD 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 1 0 0 3 2 1 0 0 0 2 1 1 2 1 1 MONAPP A 8 GOWDA 2 1 1 3 1 2 3 1 2 3 1 2 3 1 2 2 1 1 2 1 1 2 1 1 3 1 2 3 2 2 9 LATHIKA 2 1 1 2 1 1 2 1 1 2 0 0 2 0 0 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 JAYALA10 KSHMI 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 0 0 2 1 1 2 1 1 SHIVAM11 MA 2 1 1 2 1 1 2 1 1 2 0 0 2 0 0 2 1 1 2 0 0 2 1 1 2 1 1 3 2 2 NALINA12 KSHI 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 0 0 0 3 2 2 2 1 1 2 1 1 RAMACH ANDRAP13 PA 1 0 0 0 0 0 1 0 1 2 0 1 2 0 1 1 0 1 1 1 0 1 1 1 1 0 0 1 0 1 PRATHIB14 HA 2 1 1 2 1 1 2 0 0 2 0 0 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 JAYAMM15 A 0 0 0 2 1 1 1 0 0 3 1 1 3 1 1 1 0 0 2 1 1 2 1 1 2 1 1 3 3 3 SHEHNA16 Z 1 0 0 2 1 1 2 1 1 1 0 0 2 1 1 0 0 0 2 0 0 1 0 0 2 1 1 1 1 1 RAGHAV17 ENDRA 2 1 1 3 2 2 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 2 1 0 2 0 0 2 1 1 SHEELA18 VATHI 2 1 1 2 0 1 2 1 1 2 1 1 2 1 1 2 0 0 0 0 0 2 1 1 1 1 0 2 1 1 CHANDR ASHEKH19 AR 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 3 2 2 0 0 0 1 1 1 1 1 120 GAYATRI 1 0 0 2 1 1 2 1 1 2 1 1 2 1 1 0 0 0 2 1 1 2 1 1 0 0 0 2 1 1 197
  • 217. 198