E-ISSN:2456-3110

Case Report

Non Specific Low Back Pain

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Ayurvedic management of Katishool with special reference to Non Specific Low Back Pain: A Case Study

S. Kulkarni R.1*, G. Patrikar V.2, S. Jain S.3
DOI:

1* Renuka S. Kulkarni, Post Graduate Scholar, Department of Swasthavritta, Govt. Ayu. College, Nagpur, Maharashtra, India.

2 Vijay G. Patrikar, Professor, Department of Swasthavritta, Govt. Ayu. College, Nagpur, Maharashtra, India.

3 Sumeeta S. Jain, Professor & HOD, Department of Swasthavritta, Govt. Ayu. College, Nagpur, Maharashtra, India.

Now a day’s human are suffering from many lifestyles related disorders due to adaptation of modern lifestyle. Katishool or low back pain is one among them. Kati refers to low back region and Shool refers to pain, so called as Low back pain. It is not only clinical but also social, economic, and public health problem affecting general population indiscriminately. In this modern era it is most challenging problem. Majority of people are suffering from this palliative disease which has no complete remedy in any system till this advancement of time. Ayurvedic system of medicine is a time tested therapy and has good hold on this particular disease. Katishool is the most frequent work related musculoskeletal complaint and major health related cause in developing world. It is a price humans has to pay for their upright postures. It is not life threatening condition, but it causes great discomfort and restriction in social and other activities. According to one study, almost 80% of persons in modern industrial society will experience back pain at some time during their life. Specific etiology of most back pain is not clear. This is called as Nonspecific low back pain. Though Katishool or low back pain is the commonest diagnosis given to the subjects attending the clinics, the current management includes NSAIDs, local anesthesia, steroids, sedatives, etc. gives temporary relief from pain but has got severe adverse effects. In spite of recent advances, the treatment is mere symptomatic. So, need arises to search for a safer, better, cheaper treatment. Practically in Chandrashoor is Ahariya Dravya, so it is safe. Easily available in market. So, the adulteration is minimum and it is cost effective also, so fulfills every criterion. Panchakarma procedures like Katibasti and Matrabasti with Til Tail are also easy to do and found to be effective.

Keywords: Katishool, Non Specific Low Back Pain, Chandrashoor, Katibasti, Matrabasti

Corresponding Author How to Cite this Article To Browse
Renuka S. Kulkarni, Post Graduate Scholar, Department of Swasthavritta, Govt. Ayu. College, Nagpur, Maharashtra, India.
Email: 		Renuka S. Kulkarni, Vijay G. Patrikar, Sumeeta S. Jain, Ayurvedic management of Katishool with special reference to Non Specific Low Back Pain: A Case Study. J Ayu Int Med Sci. 2022;7(1):401-405.
Available From
https://jaims.in/jaims/article/view/1677

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-26 2022-01-28 2022-02-04 2022-02-11 2022-02-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Renuka S. Kulkarni, Vijay G. Patrikar, Sumeeta S. Jainand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kulkarni R. et al: Ayurvedic management of Katishool special Non Specific Low Back Pain

Introduction

Vata, one among the tripod of human living being is said to be superior most in all aspects; for every action or movement, strongest in its ability to produce diseases and worst mortality. Diseases related to Vata are innumerable and presentation of it is in the whole body. Even though a large number of symptoms suggest the abnormality of Vata the cardinal symptom of vitiation of this Dosha is pain which is known as Shoola in Sanskrit. This pain is universally understood as a marker of the disease and it is the most common symptom that makes a person to seek the physician’s advice. Katishoola is one such condition caused by vitiated Vata characterized by pain in the Katipradesha. Even though it is not mentioned as a separate disease in Bruhatrayees ample references are found in other texts like GadaNigraha by Acharya Shodhala and Sharangadhara Samhita. Sharangadhara has included it under the Vataja Nanatmaja Vyadhis marking its importance.[1] In Ayurveda Katishool or low back ache is considered as a Vatik disorder and mainly caused byvitiated Vat, which is due to Vat Prakopak Aahar and Vihar.[2] Katishool is not directly mentioned in Brihatrayee but references permit us to treat it as an individual pathology. In Charak Samhita though Katishool has been not enlisted in the 80 Nanatmaja Vatavyadhi, but in case of Anukta Vikara Charak stated that the Vitiated Vat reaches to which region, organ causes diseases such as Shool, Shosh, Supti, Sankocha, Stambha. These all should be considered as Vatvikara. Diseases similar to Katishool are Katiruja, Kativedana, Katitod, Katistambha, Katigraha, Trikshoola etc. When Shuddha or Sam Vat enters into Kati, it produces symptoms like Shool , Ruja, Stambha, Toda etc.[3]

While in modern science, the low back pain without any specific etiology is considered as nonspecific low back pain. Both specific and Non Specific low back pain have more or less common treatment programme. Treatment given to these patients is mostly conservative. But the patient is reviewed at regular intervals to additional signs suggesting organic illness. The diagnosis of back pain is essentially clinical. There is no use getting X-rays done in acute pain less than 3 weeks duration as it does not affect treatment. X-rays are usually normal in Non-specific low back pain, these provide only baseline. For specific pathologies treatment

of the cause should be done accordingly. But now a days most of back pains falling in Nonspecific category have a set programme of treatment, mostly conservative.[4]

There are many Ayurvedic herbs which are useful in Katishool, externally and internally, out of these Chandrashoor is one of the Ahariya Dravya described by Bhavprakash in Bhavprakash Nighantu in Mishrak Gana. Vat Prakop is the main factor for Katishool and Chandrashoor pacifies Vat (Vatshamak), Mridu Shodhana (do purification softly), Shoolhara (relives pain) due to its Guna and Ushna Virya with Vatkaphahara Dosha Karma.[5]

Aim and Objective

To estimate the efficacy of Ahariya Dravya (Chandrashoor) and Katibasti with Matrabasti in management of Katishool with special reference to nonspecific low back pain.

Materials and Methods

Type of study: Single case study.

Study centre: Government Ayurved hospital, Nagpur.

Case Report

A Hindu married 32yr old female patient visited on 18/12/2020, OPD of department of Swasthyarakshan with OPD no. 7368 for chief complaint of pain in lower back region, mild stiffness in lower back, Painful movements since 15 days and constipation from 8-10 days. She already has done C.B.C., Urine examination (Routine and Microscopic) which were all appeared within normal limit. X ray imaging (lower back) showed no significant changes. She has regular and normal menstrual cycle with no any significant history and uncomplicated obstetric history (P1L1, M-3yr, FTND).

Past history: There is no any significant past history.

Family history: There is no any significant family history.

General examination

BP - 120/70mm of Hg

P - 80/min


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Kulkarni R. et al: Ayurvedic management of Katishool special Non Specific Low Back Pain

Height - 160cm

Weight - 56kg

BMI - 21.9

Systemic examination - normal

Personal history

Bowel habits - one time/day (not satisfactory, sometimes hard stool)

Exercise - never

Day sleeping - Sometimes

Food - Mixed diet

Water intake - 2-3 lit.

Tea - 2-3 times/ day

Junk food - 2-3 times/ week

Occupation - desk work (Prolonged sitting)

Restrictions advised

  1. Refrigerated, salty, spicy and deep fried oily food items and junk food.
  2. Daytime sleep
  3. Continuous sitting in same position.
  4. Tea

Intervention

Appropriate changes were made in the dietary habit of patient. After obtaining written informed consent, she was put on Chandrashoor Beej Churna 3gm twice a day, one in empty stomach early in the morning and other at night with luke warm water. Firstly, it was given for 5 days. Then after seeing the positive effect on symptoms, it was continued for 1 month. Along with above treatment Katibasti and Matra Basti (60ml) with Til Tail was given for 15 days.

Kati Basti: The procedure of applying heat to the lumber region by retaining warm oil within a specially formed frame on this area is known as Katibasti. It is indicated in painful conditions of lower back region. The procedure was done with Til Tail for 15-20 minutes for duration of 15 days.

Matra Basti: Administration of medicated or non-medicated oil or any Sneha Dravya through rectal route in prescribe dose (60ml) is called as Matra Basti. In this case study Til Tail was used for Matra Basti for 15 days.

Subjective criteria

1. Katishool (Pain): visual analogue scale

VAS Grade Severity Index
0-1 0 No pain
2-4 1 Mild pain
5-7 2 Moderate pain
8-10 3 Severe pain

2. Katistambha (Stiffness)

Absent 0
Mild 2
Moderate 4
Severe 6

3. Functional disability (Modified Owestry Low Back Pain Disability Grading)

Score 0 Pain free full activity
Score 1 Perform independently with pain
Score 2 Perform with minimal assistance
Score 3 Perform with maximum assistance
Score 4 Unable to perform

Objective criteria

SLR

Ask the patient to lie down flat on supine position, ask him to raise one leg while watching the patient’s face and stop when the patient complains of pain and confirm that he is complaining of back or leg pain.

  • Above 60° - Grade 0
  • 45-60° - Grade 1
  • 30-45° - Grade 2
  • 0-30° - Grade 3

Walking time: Walking time of the patient for distance of 10 m will be recorded.

Distance from finger to ground in centimeters (Forward Bending): Ask the patient to bend down and measure the distance between tips of fingers of hand to the floor with the help of measuring tape.

Observations

Following observations were found before and after the intervention

Table 1: Before Treatment

SN Subjective criteria Gradation
1. Katishool 5
2. Katistambha 2
3. Functinal Disability 1

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Table 2: After treatment

SN Subjective criteria Gradation
1. Katishool 1
2. Katistambha 1
3. Functional Disability 0

Table 3: Objective criteria before and after the treatment.

SN Objective criteria Before treatment After treatment
1. SLR 60° 80°
2. Walking time 21sec 18sec
3. Distance from finger to ground in centimeters 10cm 4cm

Results

Significant improvement was observed in the subjective as well as objective parameters of the patient [table 1,2,3].

Discussion

Acharya Charak described each and every pain is just because of aggravated or vitiated Vat Dosha. To treat this condition Vatshaman Dravya and Panchakarma procedures are choice of treatment. Here in this case Ahariya Dravya is used for Shaman as well as Panchakarma procedures are also used to treat disease.

  • Ahariya Dravya: Mainly Aampachak, Shothhara, Vathara Dravyas are mainly important to treat Katishoola. Chnadrashoor is Katu in Rasa and Vipak and it is of Ushna Veerya.[7] Also it is Laghu, Ruksha, Teekshna in Guna. It balances Vat and Kapha Dosha. So, it is Ampachak, Vathara in properties. It might have helped to overcome pain and stiffness.
  • Katibasti: It is the combination of Snehan and Swedan procedure which help to subside the aggrevated Vat Dosha. Til Tail is have Vat Kaphashamak properties and by nature Snehan Dravyas help to overcome the accumulation of Vata at the site of Lumber region and may nourish the underlying tissue.
  • Matrabasti: As per Acharya Charak ‘Bastivatharanam’ it means Basti is best treatment for Vat Dosha.[8] In this study Til Tail is used for Matra Basti. In Charak Samhita Chikitsasthan it is described that, there is no medication which excels Til Tail
  • in curing Vatik disorders because of its Vyavayi property i.e., which pervades the body before going through the process of digestion, hot heavy and unctuous properties.[9]

Conclusion

On the basis of this single case study it can be concluded that use of Ahariya Dravya like Chandrashoor and simple Panchakarma procedures like Katibasti and Matrabasti are effective in the management of Katishool (Non Specific Low Back Pain).

Reference

  1. Medegar R., Effect Of Gandharva Hastadi Taila Virechan And Trivrut Lehya Virechana In Trika Shoola w.s.r.t. Low Back Pain – Comparative Study, 2011,pg 2
  2. Bandil V., Sharma R., A clinical evaluation of Rasnadi Guggul and Katibasti in Katishool w.s.r. to Lumbo-Sacral disorders, Journal of Ayurveda, vol2, No.2, Apr-Jun 2008, Pg50-58.
  3. Sampat D., Chandaliya S., Comparative clinical trial between Dhanyamla Sahit and Rahit Erandamoola (Ricinus communis Linn) Basti in Katigat Vata, International Ayurvedic Medical Journal, ISSN:2320 5091, vol 3, issue 5, may 2015,pg 1441-1448.
  4. Maheshwari J, Essential orthopedics, edition 3, chapter 30, pg 261
  5. Kale S., Pawar P. Therapeutic action of Chaturbeej Churna in Katishool, Journal of Sanskrit Samhita Siddhanta, 2017, volume 2, Apr-Jun, ISSN:2454-3926,Pg32-35.
  6. Trikamji Y, Charaka Samhita with the Ayurveda Dipika commentary by Chakrapanidatta, Chaukhamba Surbharati Prakashan, Varanasi, edition 2008, Sutrasthana, Chapter 25, Verse 40, p.n.131.
  7. Billore K, Yelne M., et al. Database on Medicinal Plants used in Ayurveda: Volume 7, CCRAS, New Delhi, 2005, Chandrashoor - Lepidium sativum, p.54
  8. https://www.easyayurveda.com/2011/02/24/sesame-and-sesame-oil-benefits-total-ayurveda-details/

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