E-ISSN:2456-3110

Case Report

Katishoola

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 4 May
Publisherwww.maharshicharaka.in

Effect of Dashmoola Siddha Ksheera Paka Kati Basti in Katishoola - A Single Case Study

Venkatesh P.1, Ashivini.2*
DOI:

1 Padmavati Venkatesh, Professor, Department of Panchakarma, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

2* Ashivini, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.

According to Ayurveda, Katishoola is a disease with pain in lumbar region. In modern it is nearly correlated with Lumbar spondylolisthesis, in which anterior displacement of a vertebra or the vertebral column in a relation to the below vertebral is one of the common causes. Katishoola is a disease which is mainly caused by the vitiation of Vata Dosha. Some ancient texts also describe Katishoola as a symptom of some disorders such as Kati Graha, Trika Graha, Prushta Graha, Grudrasi etc. The present article deals with a case of diagnosed Grade 1 lumbar spondylolisthesis of L4 over L5 and got advised for surgery. The Ayurvedic diagnosis of Katishoola was made. Management included Kshira Kativasti with Sadhyo Virechana to evaluate the efficacy of a treatment regimen Dashamoola Siddha Ksheera Paka Basti with Katibasti. A 65 years old female with a 10 years history of lumbar spondylolisthesis was treated with Katibasti. The response to the treatment was recorded and therapeutic effect were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and this katibasti is effective in successfully treating Katishoola by helping to reduce the symptoms and improving the degree of anterior flexion.

Keywords: Katishoola, Ayurveda, lumbar spondylolisthesis, Katibasti, Dashmoola Siddha Kshir Paka

Corresponding Author How to Cite this Article To Browse
Ashivini, Final Year Post Graduate Scholar, Department of Panchakarma, Ayurveda Mahavidhyalaya, Hubli, Karnataka, India.
Email: 		Padmavati Venkatesh, Ashivini, Effect of Dashmoola Siddha Ksheera Paka Kati Basti in Katishoola - A Single Case Study. J Ayu Int Med Sci. 2022;7(4):127-132.
Available From
https://jaims.in/jaims/article/view/1810

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-05 2022-04-07 2022-04-14 2022-04-21 2022-04-28
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Padmavati Venkatesh, Ashiviniand 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].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)127
Venkatesh P et al: Effect of Dashmoola Siddha Ksheera Paka Kati Basti in Katishoola

Introduction

Ayurveda refers this condition as ‘Kati Shoola’ Kati refers to low back and Shoola refers to Pain. Kati Shoola is a disease which is mainly caused by vitiation of Vata Dosha, due to various causative factors Vata gets vitiated and accumulates in the Kati region causing Katishoola. Katishoola has not been described as a separate disease in Brihattrayis, rather it has been mentioned as a symptom of the diseases. It has been mentioned as Trika Graham, Prishta Graham in the context of Vataja Nanatmaja Vikaras by Acharya Charaka. Even though Acharya Charaka has not mentioned the condition directly, but by his quotation "Hetu Sthaana Visheshat Ca Bhavet Roga Vishesha Krit"[1] he has indirectly mentioned all those-condition which can arise due to localization of Vata in specific part of the body.

Madhavakara of Madhava Nidana mentions Kati Shoola as Trika Vedana which is caused due to accumulated Vata in Pakvashaya.

Bhela has mentiond Katishoola is one of the Vatavyadhi and included under Ekanga Roga in sutrasthana he has described Kati Prusthagata Vata and Katishoola is one of the Lakshana in bhagandara. Sharangadhara included Katishoola in Vataja Nanatmaja Vikara.

A clear description regarding the Samprapti, Lakshana of Kati Graha is explained by the Shodhala in the Kayachikitsa Khanda, Vataroga Adhikara. He has described various formulations for Kati Shoola and has specifically indicated Trayodashanga Guggulu for Kati Graha.[2]

Bhava Prakash has explained Katigraha and Trika Shoola as a separate disease. He has defined Trika as the joint between two hip bones and spinal column, has explained Trika Shoola Lakshana, and its management in Madhyamakhanda in Vatavyadhi chapter.[3]

In Yogaratnakar under the heading of Vata Vyadhi, it has been mentioned as Kati Sandhigata Vata, Kati Vata, Trika Shoola. Hence, these can be considered as the synonyms of Kati Shoola.[4]

The estimated worldwide lifetime prevalence of low back pain varies from 50% to 84%. The occurrence of low back pain in India is also alarming with nearly 60% of the people in India have suffered

from low back pain at some time during their lifespan. Low back pain also restricts mobility, interferes with normal functioning and results in lifelong pain and permanent disability. In India, most of the low-income group people are engaged in physically demanding jobs which may increase the risk of low back pain and disability.[5]

Improper sitting postures, traveling, change in form of transport, use of two-wheeler and sports activities etc. create a pressure on the spine which plays an important role in producing low backache or sciatica. The pain affects the lower lumbar spine, lumbo-sacral area and sacro-iliac joints. The most common level for degenerative anterolisthesis is L4-L5. Female are 5 times more likely to suffer from anterolisthesis than males.[6]

Low back pain is common. The main cause for low back pain is a strain of the muscles, or other soft structures (e.g., ligaments and tendons) connected to the back bones (vertebrae). Sometimes it is the cushion between the bones (intervertebral disc) which is strained, and which bulges out (herniates) and presses on the nearby nerves (as in sciatica). Low back pain is pain affecting the lower part of the back. It is described as: Acute if it has lasted less than 6 weeks, Sub-acute if it has lasted 6-12 weeks, Chronic if it has lasted more than 12 weeks.[7]

Case Report

A 65-year-old woman, who attended the Outdoor Patients Department of Ayurvedic Mahavidhyalaya and Hospital, Hubballi, for treatment of lower back pain, was selected and admitted to the ward.

Pradhana Vedana: She had a 10 years history of progressively increasing pain in left lower back and both buttocks, pain in both thighs.

Anubandha Vedana: Pain in right thigh and calf muscles aggravates on walking. pain while walking and difficulty in forward bending. disturbed sleep.

Vedana Vritthanta: Patient was apparently normal 10 years before gradually she started develop pain in the back region along with pain in right thigh and calf muscles, patient neglected the above symptoms which was gradually developed, as she was a professionally farmer, capable of doing heavy work. She had no history of trauma and her symptoms have increased gradually hence she visited our hospital for treatment purpose.



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Purva Vyadhi Vruttanta: N/H/O - Diabetes Mellitus, N/H/O -Hypertension, N/H/O - Trauma

On physical examination

Inspection: Prominence of the upper posterior border of the sacrum was observed on the lower back.

Palpation: Motor and sensory functions were normal in right and left legs and both deep and superficial reflexes were also normal.

SLR test: Straight leg raising test was negative in both legs. She could flex the body forward up to 5°.

Local examination of lumbo sacral region

Spine curvature Normal
Swelling Absent
Discoloration Absent
Warmth Absent
Tenderness Present ++
Stiffness Absent

Special examination

Coin test positive Positive
Schober's test Positive
SLR test negative Negative

Investigation: X-ray of lumbo-sacral - lateral x-ray showing lumbar spondylolisthesis of L4 over L5

Treatment protocol

Koshta Shuddhi Kati Basti
Medicine – 75 ml of Eranda Taila Medicine – Dashamoola Siddha Ksheera Paka
Duration – 1 day Duration – 7 days
Vegas – 6 Parihara Kala – 1 month

Methods of Dashamoola Siddha Kseera Paka Basti preparation[8]

Procedure Drug Dose Duration
Dashamoola Siddha Ksheera Paka Kati Basti Dashmoola 50 gm 7 days
Water 400ml
Ksheera 1600ml
Masha flour 350 gm

Method

The patient is thoroughly examined, patient is given Erandataila for Mala Vata Anulomana. Drug –Dashmoola, milk (400 ml) and water (1600 ml) are considered in the ratio of 1:8:32. All these are taken in a clean stainless-steel vessel and boiled over mild fire until Ksheera Avashesha (only milk part remains.)

Kati Basti[9]

Kati Basti is procedure in which retaining of warm medicated Dashamoola Siddha Ksheera Paka with in a specially formed frame in the lumbo-sacral region. It performs the combined action of Snehana and Svedana.

Purva Karma

Preparation of the patient

  • The Prakruti and Vikriti of the patient are documented in detail. The disease related examinations are also performed.
  • Pateint is given a Sadhyo-Virechana for detoxification. This will also evacuate the bowel and reduce the pressure over the back and thus enhance the effect of Kati Basti
  • Sambhara Sangraha - Materials needed for the treatment are collected. those are
Materials Required Quantity
Black gram flour 350 gms
Vessel 3
Spoon 1
Cotton Q.S

Make thick dough with black gram powder by mixing with adequate quantity of water

Pradhana Karma

Bastiyantra Dharana and Basti Dravya Dharana

Using the thick dough make a rim and fix it firmly on the low back (lumbo-sacral) region where the highest pain is present. Take the specified Dashmoola Siddha Ksheer Paka, warm it and pour on the inner wall of rim taking care not to spill out. When oil becomes cool, remove it with cotton & again refill with warm oil. Uniform temperature should be maintained throughout the procedure. Time and duration of the procedure varies according to the disease condition. Usually, Kati Basti is done for 30-45 minutes for 7 days.

  • Observation of Samyak Yoga Lakshana - Like Sheetaghnata, Shoolaghnata, Sthambhaghnata, Gauravaghnata, Mardavata, Svedakarakata.
  • Removal of Basti Dravya and Basti Yantra

Paschat Karma

  • Mridu Abhyanga is done over the Kati Pradesha.

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Venkatesh P et al: Effect of Dashmoola Siddha Ksheera Paka Kati Basti in Katishoola
  • Patient is advised to follow Pathya-Apathya as per instructed

Pathya[10]

Aharaja

1. Rasa Madhura-Amla-Lavana
2. Shukadhanya Nava Godhuma, Nava Shali, Rakta Shali, Shashtika Shali
3. Shimbi Varga  Nava Tila, Masha, Kulatha
4. Shaka Varga Patola, Shigru, Vartaka, Lashuna
5. Mamsa Varga Ushtra, Go, Varaha, Mahisha, Magura, Bheka, Nakula, Chataka, Kukkuta, Tittira, Kurma
6. 6 Jala Varga Ushnajala, Shrithasheetajala, Narikelajala
7. Dugdhavarga Go, Aja, Dadhi, Ghritha,
8. Mutravaga Gomutra
9. Madyavarga Dhanyamla, Sura
10. Snehavarga Ghritha, Tila, Vasa, Majja
11. Present day food stuffs Orange juice, carrot, all fibrous fruits and Vegetables

Viharaja

1.  Veshtana, Trasana, Mardana, Snana, Bhushayya
2. Present day & activities: Physiotherapy exercise, Yoga Asana, Steam bath

Apathya[11]

Aharaja

1. Rasas Katu, Tikta, Kashaya
2. Shukadhanya Truna, Kangu, Koradusha, Neevara, Shyamaka
3. Shimbivarga 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 stuffs Fast food, cold beverages, liquor

Viharaja

1. Manasika Chinta, Shoka, Bhaya

Vyayama

  • Ustrasana
  • Bhujanga Asana
  • Shallabh Asana
  • Nauka Asana

Observation and Results

Symptoms Before Treatment After Treatment
Pain in low back Grade 4 Grade 0
Pain in left buttock Grade 3 Grade 1
Pain in right buttock Grade 3 Grade 1
Degree of anterior flexion 15 90

Grade 0: no pain

Grade 1: Occasional pain

Grade2: Intermitted pain

Grade 3: Frequent pain

Grade4: Continuous pain.

Indications of Kati Basti - Lumbar spondylosis, disc prolapse (IVDP), Lumbar canal.

Discussion

Spondylolisthesis is described as a translation of a vertebra with respect to the vertebra below without any modification or notable lesion to the pars interarticularis. The present article deals with a case of diagnosed Grade 1 lumbar spondylolisthesis of L4 over L5 and got advised for surgery. It can be considered as various conditions like Kati Shoola, Kati Graha, Trika Graha, Prushta Graha, Trika Shoola, Prushta Shoola, Grudrasi in Ayurveda.

Katishoola simply means pain in low back area. It is a condition due to deranged Vata Dosha. Management included Vatahara procedures described in Ayurveda like Abhyanga, Kativasti, Kshira Vasti, Virechana, Vaitarana Vasti and Dashmoola Siddha Ksheera Basti as Katibasti along with internal medications.

Dashmoola Siddha Kshir Paka Kati Basti is a very simple and effective Snehayukta Swedana procedure. This procedure cures pain in low back, especially due to Spondylolisthesis. But it is not widely used.

As per Ayurveda, Shoola (pain) occurs due to vitiation of Vata Dosha. Vata Dosha is vitiated by Srotorodha (obstructions of channels) and Dhathu Kshaya (depletion of tissues). In Kati Shoola, Apana Vata (Vata located in the low back region) is mainly involved. So, the aim of the treatment is to pacify vitiated Vata Dosha, especially Apana Vata.

Eranda Taila by the virtue of its laxatives action flushes metabolites out of the body and highly effective in alleviating inflammation and pain when given in medicinal forms. which is very useful in normalising Tridoshas and specifically have Vatahara Gunas. Sadhyo Virechana was followed by Dashmoola Sidda Kshir Paka Kati Vasti for 7 days was planned for present case study.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)130
Venkatesh P et al: Effect of Dashmoola Siddha Ksheera Paka Kati Basti in Katishoola

Panchakarma interventions started with Katibasti for 7 days. Katibasti is a Snehayukta Sweda Basti procedure which helps to decrease low back ache, alleviates numbness due to nerve compression & strengthens back muscles which maintain normal curvature of the spine the bone tissues.

Mode of action[12]

Dashamoola Ksheerapaka contains Bilva, Agnimantha, Shyonaka, Patala, Gambhari, Bruhati Kantakari, Shaliparni, Prisniparni, Gokshura - 1 part each, Ksheera - 8 parts, water - 32 parts. Dashamoola Ksheera Paka Basti has been indicated in treatment of Shoolahara.

Most of the drugs in Dashamoola are having Madhura & Kashaya Rasa, Laghu Ruksha Guna, Ushna Veerya, Madhura Vipaka, which mainly act on Vata Vikriti. Madhura Rasa and Madhura Vipaka helps to pacify vitiated Vata, Kashaya Rasa and Ushna Veerya does Amapachana & cleanses the Srotasa.

Collectively the actions of Dashamoola are Vatahara, Parshvashulahara, Shothahar, Balya, Amapachaka.

Ksheera is having Madhura Rasa, Snigdha Guna, Madhura Vipaka and it is Jeevaniya, Balya, Rasayana, Medhya, Sara, Anulomaka in nature.

Thus, when Dashamoola is processed with Ksheera, it provides Dhatu Poshana, in turn alleviates Vata gives strength to the muscles, joints help in normal Prasarana and Akunchana.

By the above properties Dashamoola Ksheerapaka is Vatanulomaka, Balya, Shothahara, Shoolahara. The patient reported relief for most of the complaints after 7 days of Dashmoola Siddha Kshir Paka Kati Basti procedure

Conclusion

It is concluded that this treatment regimen completely relieves the symptoms in Kati Shoola (lumbar spondylolisthesis). These medicines can be utilized in treating patients who are suffering from Kati Shoola, to reduce both signs and symptoms successfully and with greater effectiveness.

It is proposed that the therapy may be accepted as a treatment method of Kati Shoola (lumbar spondylolisthesis).

Reference

1. R.K Sharma & Bhagavan das, editor. Charaka Samhita, Varanasi: Chaukhamba Sanskrit Sansthan 2019; Chikitsa Sthana, Vata Vyadhi Chikithsa Adhyaya, 28/23. Volume 5 . Varanasi: p.g no. 25.

2. Ganga Sahaya Pandeya, Gada Nigraha, Part 2, Chapter 19, Verse 160, Varanasi; Chaukhambha Sanskrit Sansthan; 2006.

3. Dr.Bulusu sitaram Bhavaprakashaof bhavamisra ,Madhyama Khandaa, Chapter 24, Verse 115-116, Delhi; Chaukhambha Orientalia, Varanasi; 2017 pg no. 277

4. Yogaratnakara. Hindi Commentary by Shri Laxmipati Shastri, Purvardha, Vata Vyadhi Adhyaya, Varanasi; Chaukhambha: 2003.p.504.

5. https://www.google.com/url?sa=t&source=web&rct=j&url=https://indianjpain.org/article

6. https://www.researchgate.net/publication/333385465_International_Journal_of_Ayurveda_and_Pharma_Research_Case_Study_ayurvedic_management_of_lumbar_spondylolisthesis_kati_shoola_with_special_reference_to_chincha_lavana_sweda-a_case_report

7. https://www.researchgate.net/publication/314095062_diagnosis_and_management_of_katishoola_low_back_pain_in_ayurveda_a_critical_review

8. Dr.P.Himasagara Chandra murti,Sarangdharacharya Sarangadhara Samhita Varanasi: Chaukhamba Sanskrit Sansthan; Madhyama khanda Kvathakalpana adhyaya 2/161 pg no.139

9. Dr.Vasant C. Patil. Panchakarma Chaukhamba Publication new delhi Snehana chapter pg no.168

10. Govinda Das Sena. Bhaishajya Ratnavali. Chapter 26, Varanasi; Chaukhambha Sanskrit Series: 2002. p.611.

11. Govinda Das Sena. Bhaishajya Ratnavali. Chapter 26, Varanasi; Chaukhambha Sanskrit Series: 2002. p.626.

12. http://www.iamj.in/posts/2020/images/upload/5232_5241_1.pdf


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