E-ISSN:2456-3110

Research Article

Katigraha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

Understanding the etiopathogenesis of Katigraha - An Observational Study

Krishnan C K.1*, Markande G.2, Jain P.3
DOI: http://dx.doi.org/10.21760/jaims.7.6.12

1* Kavya Krishnan C, Final Year Post Graduate Scholar, Dept. of PG Studies in Roga Nidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

2 Geetha B Markande, Professor, Dept. of PG Studies in Roga Nidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

3 Prashanth Jain, Professor & HOD, Dept. of PG Studies in Roga Nidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.

Katigraha is one among the Vataja Nanatmaja Vyadhi which simulates with the signs and symptoms of Low Back pain. It continues to be the most common health concern for which patients seek primary care therapy. Our Acharyas explains Katigraha as a Lakshana in various Vatavyadhi and in other diseases. Here, Katigraha indicates a disease condition of the back associated with pain and stiff movements. As Gada Nigraha clearly states pain is produced due to stiffness produced by Saama or Niraama Vayu movement in to Kati hence this suggests of presence of Dhatu Kshayatmaka and Marga Avarodhaka type of Samprapti. Hence in this context Katigraha denotes a group of symptoms characterized by the restriction of movements of Kati region in which pain would be a main feature as Graha alternatively means pain as restriction is said to produce pain in the particular region. The backache or lumbago is one of conditions which results from violation of bio mechanics of spine as it results when the physical and mental strain and faulty postures alter anthropometrical precision. The 70-80% of world population suffers from backache at some point of their life. As the back pain is very subjective in nature, there are very few objectives finding in history, clinical examination and even on extensive radiological or laboratory investigation.

Keywords: Katigraha, Low back pain, Ahara, Vihara

Corresponding Author How to Cite this Article To Browse
Kavya Krishnan C, Final Year Post Graduate Scholar, Dept. of PG Studies in Roga Nidana Evam Vikriti Vigyan, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India.
Email: 		Kavya Krishnan C, Geetha B Markande, Prashanth Jain, Understanding the etiopathogenesis of Katigraha - An Observational Study. J Ayu Int Med Sci. 2022;7(6):87-98.
Available From
https://jaims.in/jaims/article/view/1949

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-25 2022-05-27 2022-06-03 2022-06-10 2022-06-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Kavya Krishnan C, Geetha B Markande, Prashanth 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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Introduction

Ayurveda is an ancient health science that focuses on overall wellness rather than curing of disease. People are fed up with the side effects and aftereffects of today’s most potent and fast acting medications, which reduce human immunity while suppressing disease. People are now turning away from synthetics and returning to nature. As a result, Ayurveda will become

the world’s future medicinal science, not only in India, but globally.

In our classics, there are 80 types of Vataja Nanatmaja Vyadhis and Katigraha is one among them.[1-3] The word Katigraha having pain and restricted movements or stiffness.[4] The vitiated Vata gets lodged in Katipradesha and produces this condition.  Hence, etiological factors of Vata Vyadhi enlisted in literature, Ativyayama, Ativicheshtita, Dukkha Shayyasana, Ati Adhwa, Sheeghrayana,[5] etc. may have a definite relation with Katigraha.

The lumbar region is a common site of a number of developmental deformities, causing symptoms ranging from simple backache to serious paralytic manifestations. The backache or lumbago is one of the conditions which results from violation of bio mechanics of spine as it results when the physical and mental strain and faulty postures alter anthropometrical precision. Low back pain is the leading cause of disability. Therefore, this condition remains a diagnostic and therapeutic challenge for the clinician as well as rheumatologist6. Low back pain affects 80% of individuals and degenerative changes of the spine is the most common cause. The aids which act as a causative factor for the low back pain in the present era are divergents of the classical explanations of Katigraha.

Majority of patients with acute low back pain have a good prognosis and most episodes resolving spontaneously in a few weeks and do not require any radiological or laboratory tests. However, while dealing with acute low back pain may require to diagnose some of the serious illnesses such as cauda equina syndrome, epidural haemorrhage, epidural abscess, etc. The psychological factors (Anxiety, stress, depression, etc.) and occupational factors (manual material handling, bending and twisting, etc.) may also play an important role in the occurence of chronic Low back pain.[7]

Musculoskeletal disorders are included one among the occupational health problems in both developed and developing countries. Most of the musculoskeletal disease causes local ache or pain and restriction of motion. The low back pain usually arises from one of the pain sensitive spinal structures but in majority of cases this pain is isolated without any localisation and without any neurologic deficits.

The investigations are important to realise that the evident radiologic abnormalities may not be always responsible for back pain as it may be age related or incidental. Among patients with chronic LBP, imaging studies can be helpful to surgical or medical treatment. Radiology plays a huge role in disease prognosis by giving physicians more options, tools and techniques for the proper diagnosis and treatment. Plain radiography may detect vertebral compression fracture, degenerative changes or structural abnormalities.

The number and severity of osteophytes and back pain exist, the prevalence of degenerative changes among asymptomatic patients underlies the difficulty assigning clinical relevance to observed radiographic changes in patients with LBP.

Objectives

1. To study the etiological factors and pathogenesis of Katigraha according to classics.

2. In depth study of available classical etiological factors in causation of Low back pain in the current era.

3. To study the variants of the causative factors in relation to Low back pain under the etiological aspects of Katigraha.

Materials and Methods

A minimum of 100 patients suffering from Katigraha between age group of 16-70 years with the help of case proforma with the details of Lakshanas and Nidanas as mentioned in our classics and allied science were selected.

Patients were analyzed and selected accordingly who fulfils the diagnostic and inclusion criteria. Values obtained were assessed on the basis of percentage specially Aharaja, Vihara, Mansika and Kalaja Nidana.


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Observations and Results

On demographic data: Majority of patients, 34% belongs to the age group of 16-30 years, 52% were females, 75% were Hindu, 20% were students and housewives, 53% were graduates, 79% were married, 66% were middle class, 16% belongs to teaching field.

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On Personal Data: Among 100 patients taken for the study, 72% were habituated to Mixed diet, 34% patients were having constipated bowel, 45% were having Irregular appetite, 64% patients were having a disturbed sleep, 64% patients were not habituated to doing any exercise, 50% were having sitting nature of work, 42% were getting less Visrama, 13% addicted to Alcohol, 11% addicted to Smoking and 10% addicted to Tea.

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On Data related to Disease

On Chief complaints: Among 100 patients selected for the study, 100% patients were having pain in Low back, 98% patients were having Stiffness in Low back, 59% patients were having Aching nature of pain, 70% patients were having pain is Gradual in onset, 57% patients were having Progressive nature of pain, 55% patients were having Sub acute in chronicity, 86% were getting pain in the evening and 92% patients were getting more pain in Winter season.

On Treatment history: 50% patients underwent for Allopathic treatment.

On Dashavidha Pareeksha: Majority of the patients in the study belonged to Vata Kapha Prakriti, 85% were having Madhyama Sara, 77% were having Madhyama Samhanana, 95% were having Madhyama Satwa, 92% were having Madhyama Satmya, 83% patients were having Madhyama Pramana, 61% patients were having Madhyama Abhyavaharanashakti, 88% patients were having Madhyama Jaranashakti, 73% patients were having Madhyama 68% were coming under Madhyama Vaya Vyayamashakti and 68% patients were having Vishamagni.

On Examination and Investigations: Among 100 patients, 64% patients were having Tenderness in L3-L4 region, 32% patients were having tenderness in L4-L5 region, 92% patients were having restricted movement in Forward bending, 78% were having restriction in Rotation, 70% were having restriction in Lateral bending and 57% were having restriction in Backward bending, 22% patients were having Scoliotic changes, 71% patients were presenting with a positive Schober’s test and 57% patients were presenting with Degenerative changes in Lumbar spine.

On Aharaja Nidana: Among 100 patients selected for study, 56% consumes Katurasa daily, 57% occasionally consumes Tiktarasa, 34% consumes Rukshanna daily, 64% patients consumes Shitanna occasionally, 41% patients consumes Alpanna occasionally, 68% patients follows Laghuannasevana occasionally, 68% patients consumes Kharahara occasionally, 69% patients follows Vishamasana occasionally, 67% patients consume Shushkamamsa occasionally, 47% consumes Nivara occasionally, 81% consumes Mudga occasionally and 80% consumes Masura occasionally.


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On Viharaja Nidana: Data obtained pertaining to Ativyayama, 39% patients were following Ativyayama occasionally, 61% were doing Langhana occasionally, 60% were doing Atyadhwa daily, 45% were having the history of Abhighata, 47% have the habit of Bharavahana occasionally, 52% patients were having the habit of Dukhashayyasana daily, 75% were having the habit of Dukhasana daily, 35% have the habit of Shighrayana daily, 28% have the habit of Atiadhyayana daily, 35% patients were doing Ratrijagarana daily, 65% were doing Vegadharana occasionally and 51% were doing Divaswapna occasionally.

On Manasika Nidana: Among 100 patients, 60% patients were doing Atichintana occasionally, 36% have worries occasionally, 41% were getting short temper daily and 46% were getting fear occasionally.

On Kalaja Nidana: Among 100 patients, most of the patients getting pain, tenderness and stiffness in Varsharitu, Sisiraritu, Jirnantha and Ahoratrianta.

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Discussion

In the present era, human society is dominated by mechanical life, frequent changes in lifestyle, environmental factors and climate. The major somatic disorders include a regular work schedule in improper posture, continuous and over exertion, a lengthy travelling in various vehicles in faster and lack of exercises can lead to undue more pressure on spinal cord to create Low back pain. In the present era, unwholesome

food, a sedentary lifestyle, a lack of relaxation and excessive activity create a variety of problems, among them most of the diseases belongs to Vatavyadhi. Katigraha is one among the Vata Vyadhi and it is produced by the Prakupita Vata which is moved out from the Pakwashaya and get localized in the Katipradesha, thereby vitiates Snayu and Kandara in the Katipradesha. Due to various Aharaja and Viharaja Nidanas, Samprapti of Katigraha occurs in three ways. They are Dhatukshayajanya, Margavaranajanya and Abhighatajanya Katigraha. In this study, most of the patients are having Dhatukshayajanya Katigraha which happened after prolonged period.

Discussions on Observations

Discussion on demographic data

Major part of the population involved in the study belonged to 16-30 years followed by 31-45 years of age group (23%). this may be due to the reason that most of the patients were youngsters and middle aged and others belonged to the working class. The degenerative changes develop over time; increased prevalence of degenerative spine pathology with age. Majority of patients were Females. this may be due to the middle aged and older women are more susceptible to osteoporosis than men and younger women because of a perimenopausal increase in the rate of bone resorption. The sex difference could be related to gonadal steroid hormones such as estradiol and testosterone modulate sensitivity to pain and analgesia. Other variables such as lifestyle habits of females, diet, parity and use of contraceptive may be relevant. Data obtained pertaining to Religion of the patients shows highest incidence of Low back pain in Hindu Community and the selected area has a projection of Hindu community. Most of the patients were married in the obtained data. The marriage increases the responsibilities, increased household works, taking care of children and increased emotional stress causes the higher risk of Low back pain. In the present study, 82% patients were having normal delivery and 11% were having caesarean section. In women, the postpartum back pain may occur and it lasts up to 6 months or might continue up to a decade. This type of back pain mostly occurs by performing activities such as bodily movements, such as walking, lifting, bending or carrying new born babies continuously. Pregnancy related changes


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happen in the musculoskeletal system that persist after delivery. During childbirth, the women may undergo bodily trauma that directly involves the low back, pelvic bone, joints and soft tissues causing pain and discomfort in the low back area. The type of delivery such as vaginal, instrumental or caesarean section may also have a role in the pathogenesis of Low back pain. 53% patients were graduates and most of the patients belongs to Middle class family. Well educated people more likely to be affected by disabling back pain due to their nature of work. The graduation and LBA may not have direct relation. But, well graduation make the people to do a good job, where the physical and mental stress will be more. In present study, majority of patients were working in teaching field and software engineers. In which the mental and physical stress were there and the graduated people are more aware about their health and there is a faster approach to the doctors which is not observed in lower educated people. This may be due to their work related or life style modifications. The common causes are irregular food habits, lack of exercise, etc. Most of the study areas were Rural locality, so data showed highest incidence in Rural habitat. Most of the patients were students and housewives followed by Teachers, Business, Labourers, Office work and Drivers. The Housewives who work a lot at home are more likely to suffer from mechanical strain. Both recent and yearly prevalence of Low back pain is more in rural Housewives. The vulnerability of students due to stress and numerous hours of studying and training makes them at risk of Low back pain. In the teaching field the risk of low back pain is due to continuous standing and walking during sessions, bending over students at their desks, sitting in improper posture and physical inactivity. In Business and Office workers the prevalence of Low back pain may be due to defective sitting postures and travelling may be the reason. The works related Low back pain is associated with exposure to ergonomic stressors at work, environmental(physical), psychosocial and personal risk factors. Among these lifting and carrying heavy objects, awkward posture, psychosocial job demands and job dissatisfaction, repetitive movement, static workload, bed making were reported as a major risk factor for Low back pain. In drivers, due to overuse of ligaments and muscles, the soft tissues become strained and inflamed, potentially leading to muscle spasms and pain.

Discussion on Personal History

Most of the patients were following a mixed diet especially red meat, burger and processed meats are associated with high inflammation. The red meat may be a great source of protein, because it increases the pain in low back. Red meat contains a substance in it called as neu5gc. This substance promotes inflammation. Dominant part of the patients having Constipated bowel habit. Often, constipation swells the intestines with the faecal matter and leads to discomfort in both the abdomen and back. This type of back pain is typically having the nature of dull and aching. The constipated bowel may lead to Vilomagati of Apana Vayu and it causes pain in the Lower back. Most of the patients were having aa Irregular appetite. Irregular appetite is linked to the gastrointestinal symptoms like gas, bloating, etc. which are having a relation with the back pain. The irregular nature of appetite is mainly due to the Vata Dosha Prakopa. This will cause Dushti of Kapha and thereby Sanga or Vilomagati of Vayu. So, it will get aggravated in the later stages of Sroto Avarodha. Due to pain in the lower back, majority of the patients were having a disturbed sleep. The pain caused due to Dukkhashayyasana i.e., improper sleeping posture and Ratrijagarana or delayed sleeping habit are the observed causative factors for the occurrence of disease in this study. Proper rest and sound sleep needed for maintaining nourishment especially for lower lumbar spine, because these spines are always under pressure while sitting, standing, heavy lifting, etc. The stiffening of spine and muscles in the low back occurs due to lack of exercise by majority of patients. Most of the patients engaged their work in sitting position. Sitting down for long periods or in improper manner causes the discs in the vertebrae to lose their cushioning, which cause back pain. Long sitting cause extensive pressure on the back, so the nerves get pinched due to continuous rubbing of intervertebral discs. It can also lead to muscular atrophy due to weight gain. Some of the patients were not getting proper Visrama after their heavy workload. Proper Visrama helps to get rid of low back pain. These patients were pre occupied with their work and their personal lives. As a result, no one was getting time to take proper rest even though they are having back pain. Excessive alcohol use has been found to worsen back pain and contribute to additional complications. Alcohol decreases circulation


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which may lead to pain and inflammation. Higher rate of alcohol abuse seen in people living with pain to get relax from pain. In several studies, smoking has been associated with the occurrence of spinal pain, mostly low back pain. Exposure to second hand smoke during childhood may increase the risk of developing back and neck problems in later life. The tea act as diuretics and there will be excess water elimination, so there is a reduced transportation of nutrients to the nucleus pulposus of the vertebrae. This may the reason to increase pain in people who are addicted to tea.

Discussion on data related to disease

In Katigraha, pain is the cardinal feature. So, in the present study, all patients were having pain in Low back and majority of patients were having Stiffness (Stambha) in the Low back as it is the cardinal feature of Katigraha due to movement of Saama and Niraama Vayu in the Kati. The Sthabdhtata is due to Ruksha, Khara and Shita Guna of Vata in case of Niramaja Katishoola. In Samaja Katishoola, vitiation of Vyana Vayu may occur by the aggravation of Apana and Ama due to Nidanasevana. Thus, the Graha occur due to reduction of Chala and Ruksha Guna of Vyana Vayu due to Anyonya Avarana either by Apana or due to Ama. When the vitiated Vata takes Ashraya in the Katipradesha, it leads to Shoshana of Shleshaka Kapha present in the Sandhis. So, there will be a hampered functioning of joints and thus, leading to prevention in the movements at the Katipradesha. The movements in the Lumbosacral region get restricted either completely or partially. Majority of patients were having Aching nature of pain is present. Most of the patients had gradual in onset. The degenerative changes associated with disturbance of water content and actual sequestration starts in the nucleus pulposus, spreads to the posterior annulus and ends with annulus rupture. The changes in the structure of spinal vertebrae will happen gradually except in case of Abhighataja and sudden heavy lifting. The progressive nature of pain is mainly due to the unawareness about their illness. Most patients unaware that, their illness is progressing until they begin treatment, at which point avoiding causative factors, a modified diet and an altered lifestyle play a significant impact. Most of the patients were having Katigraha which was subacute in nature. The main reasons for chronicity lack of awareness towards gravity and unwillingness

to avoid causative factors. Majority of patients were more back pain in the evening time and in Winter season. This may be due to the heavy workload in the daytime. Due to the cold nature, the Shitatwa will increase Vata Prakopa in our body and produces Various Vataja disorders.

Discussion on Dashavidha Pareeksha

Dwandwaja prakriti is more prevalent in society, so majority of patients presents with Vata Kapha Prakriti. As the disease is mainly caused due to the involvement of Vata Dosha, there will be more chances of getting Katigraha. As the disease itself is produced due to Vata Vriddhi and Kapha Aavarana, Vata and Kapha related Prakriti are more prone to get early degenerative changes. Dominant was showed with Madhyama Sara, which has apparently no effect on this study. Madhyama Samhanana predominancy may due to ageing, the compactness of bone decreases mainly in case of osteoporosis by the reduced bone mineral density. Also, due to Dhatukshaya, Vataprakopa happens. Dominant was showed with Madhyama Satwa. The psychological disturbances lead to contraction of skeletal muscles due to release of certain neurotransmitters like adrenalin. Due to recurrent emotional disturbances, the muscles and soft tissues present in the back will get continuous contraction, as these muscles which helps for the maintenance of body postures. Then there will be a decreased nutrition to these structures and thus leading to early degeneration. Most of the patients were having Madhyama Satmya and which has no effect on this study. Dominant were showed with Madhyama pramana. Most of the women have increased height as compared to the normal. Some of the recent studies shows that, there is a relation between height and back pain in females. The BMI and height are linked to the pathogenesis of low back pain. The taller people are more likely to suffer with Low back ache. This is because taller people have a greater tendency to slouch. Unfortunately, when they slouch, the back ligaments are overstretched which leads aches and pains. Predominancy of Madhyama Abhyavaharana Shakti and Madhyama Jarana Shakti. Majority of patients consumes rich in protein and starches together results into absorption of one being delayed by the other. Similarly, eating sugars and acid fruits hinder the action of ptyalin and pepsin, reducing the secretion of saliva and delaying digestion. Intake of Viruddha Ahara like bakery items usually fermented foods, artificial flavourings,


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etc consumers are more in the present study and it creates Ama. Consuming aerated drinks or soft drinks are having carbon dioxide which creates a vacuum inside the body and it can be correlated with direct explanation for aggravation of Vata and a reduced appetite. Most of the patients were having Madhyama Vyayamashakti. Due to pain and stiffness, the patients are unable to do the normal movements of the low back, such as forward bending, backward bending, lateral flexion and rotation. Regular joint movements, such as aerobic or yogic asanas will promote blood supply to the disc, surrounding muscles and the vertebra itself. Most of the patients in the present study were belongs to Madhyama Vaya. This may be due to the working age is mainly in Madhyama Vaya people. Dominant patients showed Vishamagni due to the predominance of Vata Prakriti. If there is any impairment in the Vata, it will produce disturbances in the Agni. Vishamagni is influenced by Vata Dosha. The impaired Vishamagni causes Vilomagati of Vayu. This Vayu gets lodged in Katipradesha and lead to Katigraha.

Discussion on examinations

Most of the patients were having tenderness in their low back. Maximum patients were having tenderness in L3-L4 region (64%) and followed by tenderness in L2-L3 (47%) region. And in some patients, the tenderness present in two intervertebral discs. The aggravated Vata Dosha might have provoked, there is a disturbed function of Katisandhi at the onset and started process of Asthikshaya. This may be reason to cause tenderness in Katipradesha. Majority of patients were having restricted movements during Forward bending, Backward bending, lateral bending and rotation. This may be due to, in chronic stages of Katishoola, aggravation of Vatadosha due to Dhatukshaya leads to improper joint nourishment to joints, compression of nerve roots and due to stretching of muscles. Some patients showed Scoliotic changes in their Spine. Typically, the pain that experience with adult onset, scoliosis is the result of pressure on spinal discs, facet joints and muscle pain. But scoliosis can cause pain for other reasons. The curvature of the spine can stretch or irritate nerves and also strain joints, causing them to become inflamed. In present study, only few patients got other deformities like Lordosis, Disc prolapse and Disc compression. In the present study, Schober’s test is used as a diagnostic

tool. Maximum number of patients were having moderate range of flexion. Schober’s test is the simple and noninvasive screening method for lumbar mobility. It is classically used to determine, if there is a decrease in lumbar spine range of motion especially in flexion. It helps to understand the severity in the restriction of lumbar spine mobility. In chronic low back pain, due to stiffness there is a difficulty in bending. For example; those who are showing negligence of pain in the lower back or due to the increased use of analgesics while getting pain. Analgesics give immediate relief but, the condition get worsen in the lumbar spine due to the Prakupita Vata which is located in the low back. Majority of patients showed with degenerative changes, that is observed through the radiological examination. The prevalence of degeneration increases with age. It is an age-related wear and tear on spinal disc causes low back pain. Many studies have been undergone about disc degeneration, where ageing remains the identifying risk factor for this condition. Factors such as smoking, obesity, diabetes mellitus, hypertension and physical activity such as driving and lifting weight might enhance disc degeneration. Present study showing changes in the X-ray, formation of osteophytes, sclerotic changes and reduced disc space were more found in L2-L3, L3-L4 and L4-L5 segments. Along with Degenerative changes, patients showed with Osteophytic changes, Sclerotic changes and reduction in intervertebral disc space. Osteophytic changes observed in patients having Lumbar spondylosis, Scoliosis, and compression. The osteophytes or bone spurs usually developing after a long period along with the process of disc degeneration. The disc or the cartilage in between the bones of spine breaks down and rub against other bones or tissues. It also put pressure on nearby nerves. Thereby produces more friction and inflammation. The inflammation can lead to pain and stiffness in the lumbar spine. Patients suffering from Severe degeneration and disc compression showed sclerotic changes. These sclerotic changes caused either by primary or secondary to arthritis, trauma or degenerative changes. The narrowing of intervertebral disc space due to severe disc degeneration, disc compression and due to disc prolapse.

Discussion on Aharaja Nidana

Speaking about the Gunas of Ahara that is commonly seen as a habit; Excessive


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consumption of chilly, pepper and spicy foods increases the Katu rasa and finally Vataprakopa due to Ruksha and Laghu Guna. Frequent consumption of spicy foods could trigger upper GIT and may end up in indigestion, thereby produce Ama and it can lead to Katigraha. Very spicy foods can cause heartburn, making pain worse. The heartburn is another digestive disorder, if it is not treated properly causes pain in chest, throat and can radiate to lower back. The consumption of coffee, cocoa, beer, bitter melon, broccoli, leafy spinach, etc increases Tikta rasa in the body. Excess bitter taste may produce toxicity leading to loss of appetite, lowers blood sugar, etc. This may be due to the Ruksha, Laghu and Shita Guna of Tikta Rasa will cause Prakopa of Vata Dosha. The continuous usage of Tikta Rasa causes Sarva Dhatu Shoshana and finally Vata Dosha Prakopa. More patients were habituated to consume Yava, Laja,etc. that increases Ruksha Guna and Shitatwa in the body and causes fainting, depletion and destruction of tissues and also produce Vatavyadhis. The Ruksha Guna produces Rukshata, Katinya, Stambhana and Shoshana of Dhatus, thereby leading to Vatavriddhi. It produces dehydration in our body. Mainly it includes degenerative changes, musculoskeletal and neuromuscular diseases. Most of the patients were using refrigerated food items in their home. Because refrigerating food items helps to prevent them from getting damaged and it preserves things for a long period. In the present era, refrigerator is one thing that they cannot live without. Cold food items cause various gut related problems like bloating, puffiness, cramps and also lowers boy temperature. Thereby, reducing the flow and circulation of blood all over the body. The Shitanna produces Stambhata in the body and it is Vata Vardhaka by consuming ice creams, refrigerated food items such as vegetables, fruits, soft drinks, instant products, etc. This may have an impact on muscles and bones in the low back. The patients consume less food leads to weight loss and a significant loss of water and minerals in the body which in turn decreases bone density. Weaker bones produce spinal misalignments. Some patients were having a reduced appetite also consume less Ahara, thereby produces Vataprakopa. The less intake of food is not capable of promoting Bala and Upachaya to the person, thereby produces Vatapradhana Vyadhis due to its vitiation. Patients were having light meals, juices in night time, and as a part of Upavasa, they were not consuming proper amount

of food as they need. Daily consumption of light food might be not enough for the bodily activities. The Laghuanna will also provide Ropana and gives Laghutwa in the body. Intake of light food indicates quantity wise consumption of Ahara. It may lead to mental, physical and emotional health problems. The symptoms like reduced nourishments, sleep disturbances, constantly feeling cold, constipation, anxiety and weight loss. All these may have direct or indirect impact on low back pain. Majority of patients were habituated with excessive consumption of food items such as Pasta, Pizza, instant noodles, spicy chicken tenders, beverages, coffee produces Kharatwa in the body. The Khara Guna produces Parushya, Karkashata, Rukshana, Apatarpana and Lekhana of Dhatus, thereby Dhatus getting Kshaya. Due to Dhatukshaya, the Prakopa of Vata Dosha happens. Roughness quality is also increased in the body through administration of certain medicines, food or activities having roughness quality predominantly. Similarly, it causes dryness in excreta, thereby produces constipation and difficulty to pass the stools. The patients were habituated to have food in improper timings. The Apraptakala Bhojana produces Ama which aggravates all the Tridoshas. The aggravated Doshas produce Agnivaishamya followed by Ajirna. Atitakala Bhojana were also seen in some patients as they do the suppression of hunger resulting into Karshya, Vaivarnya, body ache, etc. The Karshya and body ache are caused due to the improper nourishment to all body parts and this may lead to pain in low back. Patients were habituated to take Chipped beef (partially dried beef), Idiyirachi (traditional Kerala style), Kawaab (air dried, spiced meat), dried boneless salted mutton, etc and unhygienic meat. This increases dryness in the body. The dried meats are keeping after processing and preserved by curing, salting, smoking, drying or canning. People who are following unhealthy lifestyle are more prone to consume this type of meat. By the consumption of Nivara which belongs to Shukadhanya aggravates Vata due to its Shitavirya, Laghutwa. It is a wild variety of rice that produces dryness and lightness to the body. Mudga is having the properties of Kashaya, Rukshta, Shitavirya and Laghutwa, thereby causes Vataprakopa. It helps to reduce the food intake, thereby lowers the weight. The oxalates which are present in the green gram accumulate in the body fluids and they may worsen the kidney and gall bladder disorder. So, this hampers the calcium


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absorption. The reduced calcium causes osteopenia, a reduction in the bone density. Over a period of time, osteoporosis develops and the bones become thin and more prone for fractures. The excess consumption of Masura increases tannins, phytosterols, phenolics and phytic acid. Thereby, causes constipation, stomach upset, heart burn, flatulence, muscle aches and pain, weight loss and impairment in the mineral absorption by the presence of these chemical constituents. It is having the property of Laghu, Shitavirya, Kashaya and Rukshata.

Discussion on Viharaja Nidana

Most of the patients were dominant with Ativyayama. Excessive exercise leads to Shosha and Vataprakopa leading to Shoola. Ativyayama gradually leads to Krishata, Sarvadhatukshaya and Ojokshaya, thereby Vataprakopa occurs. Excess physical activity causes muscles and ligaments in the low back to stretch too much and tear. This results into pain, stiffness and even muscle spasms in the back. Majority of patients were belonging to Hindu religion as they are following the rituals of Upavasa. Due to that, the Langhana brings Laghutwa to the body and thereby Vataprakopa happens.

The Langhana mainly done by Upavasa by Anasana and Alpabhojana. Among these Alpabhojana in Upavasa is more seen in patients and this leads to starvation. Thereby the person will get less nutrition to the body and reduce the body weight. Excessive walking causes Vatavriddhi. Prolonged walking gives tear and strain to the muscles in the lower back, which leads to aches and pain. People who are having over weight are having high risk of muscle strain after prolonged walking. Dominant patients were having the history of Abhighata. It results into the affliction of Asthi, Snayu, Mamsa and Sandhi causes Vataprakopa. Acute low back pain is often caused by sudden injury to the muscles and ligaments supporting to back. The pain caused by the muscle spasms or strain or tear in the muscles and ligaments. In osteoporosis, compression fracture of the spine also may occur. Bharavahana gives more pressure on Sandhi and Mamsa of lumbar spine and it leads to structural deformities in the vertebra causes Vataprakopa. Attempting to lift and twist with heavy loads cause intervertebral rupture in lumbar region. It gives compression on nucleus pulposus and leads to disc degeneration.

Majority of patients were getting pain in low back due to Dukhashayyasana and Dukhasana. This may be due to the improper posture during sitting and sleeping causes discomfort in the Katipradesha and leads to Katigraha. Prolonged sitting makes the muscles in the back to become strained and painful, reducing the blood supply, slowly developing stiffness and weakness in the back and trunk. Improper sleeping posture give more pressure on the spine and produce various disorders of spine. The patients were doing Shighrayana for reaching their destination causes pain in Sphik, Prishta, Kati, Vamkshana, etc. Overusing of muscles and ligaments in the back can cause low back pain. After a long period, he lumbar spine and soft tissues become strained and inflamed, potentially leading to muscle spasms and pain. Most of the patients were students and they were doing Atiadhyayana. While Adhyayana, the person does the strain their lower back for a longer duration by continuous sitting or in irregular sitting posture. This leads to Vataprakopa. The patients belong to students, software engineers and old age were doing Ratrijagarana produces Rukshata in the body. Due to Ruksha Guna predominance, Vata get aggravated. Recent studies showing that, inadequate or interrupted sleep may worsen back pain. The lack of sleep shuts down the release of growth hormone. The night time release of growth hormone is necessary for relieving pain and healing the body. A lack of sleep prevents this process. Most of the patients do the Dharana mainly Mootra and Purisha during their work. Suppression of forceful expulsion of urges mainly Mootra and Purisha leads to Prakopa of Vatadosha especially Apanavata. And some patients do the Vegadharanas like Adhovegadharana, Kshudhavega, Nidravega, and Shukravega Dharana leads to Angabhanga due to Vataprakopa. Majority of volunteers were found in housewives and office workers.

In case of housewives, the Divaswapna is in the home itself in the form of lying position. Due to that, there is formation of Ama, and it obstruct the channels of Vata. In case of officeworkers, they were doing Divaswapna in sitting position and during travelling in vehicle due to their workload and stress. The sleeping during travelling and in sitting position give some discomforts in Katipradesha. Sleeping during daytime is Abhishyandikara which leads to Margavarodha in Asthimajjavaha Srotas in the Katipradesha.



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Discussion on Manasika Nidanas

Majority of patients were having a stressful life due to their work related and family related problems. It affects their mental health either in the form of Chinta, Krodha or Bhaya. Katigraha occurs in these patients by Vataprakopa. The Manasika Nidanas make the person’s body to lower the capacity to with strain the physical strain. Majority of volunteers were worried about their future during because of busy life schedule. That affects their mental health and it gives more pressure on their neck and back mainly, thereby getting low back pain. And Vataprokopa also occurs due to its Rajoguana. Due to heavy stressful life, patients were getting anger very easily. Majority of patients had a disturbed sleep during night due to pain in low back. The sleeplessness might be also having a relation to get anger easily. Excessive Krodha gives Shoshana of Dhatus and thereby Vata get aggravated. Dominant patients were having fear in their life due to various reasons and thinking about their future life. Thereby releasing of hormones such as cortisol and adrenaline that typically causes an involuntary tightening of muscles especially in neck, shoulders and down to the spine. Prolonged tension in these areas leads to back pain especially low back pain. Excessive Bhaya produces Dhatukshaya gradually and thereby Vatavriddhi occurs.

Discussion on Kalaja Nidana

The Kalaja Nidanas or diurnal changes aggravate the severity of Katigraha. The muscles, tendons and ligaments that supports spine makes them tighten and contract when the cold season starts. In cold weather, the people were not doing the activities as compared to other seasons. This lack of activity leads to muscles in the back to weaken and results into back pain due to stiffness. The barometric pressure or the weight of air decreases during rainy days and increases during sunny days causing fluid in joints get thickened, making them stiffened and affects the spine and worsen pain in low back. In Varsharitu, Prakopa of Vatadosha occurs as diurnal changes. In cold winter, there is less blood flow to the muscles, tendons and ligaments that supports the spine. The decreased blood flow can cause tightening of surrounding tissues which gives more strain on spinal nerves and the pain aggravates. Majority of patients were having pain at the end of digestion. This might be due to the type of

food they had. Patients habituated with food items like potato, refrigerated food, ice creams, spicy foods, meat produce pain in low back by the formation of gas, bloating after their digestion. Ahoratriantha means the end of the day and night. The end of the day these patients were having more physical and mental stress after the day work. Due to this the patients getting back pain worsen. At the end of night, the patients have a history of back pain were getting a disturbed sleep due to pain and restricted movements. Due to pain, the patients unable to sleep continuously.

Conclusion

The Katigraha is a Shoola Pradhana Vyadhi due to aggravated Vata Dosha in the Katipradesha. The pain in the Katipardesha mainly starts when the Asthikshaya process occurs. Due the predominance of Vataprakopa and Kaphaprakopa Nidanas, Vyana Vayu get obstructed in the Katipardesha, thereby Shoshana of Shleshaka Kapha happens and it leads to occurence of Katigraha. In the chronic stage of Katigraha, the vitiated Vata hampers the normal circulation of Rasa and Rakta Samvahana in the Katipradesha. This will result into improper nourishment of the spine and Akunchana Prasarana Pravritti Sa Vedana due to Sthambhana. The works related Low back pain is associated with exposure to ergonomic stressors at work, physical, psychological and personal risk factors. The changed lifestyle, addictions, improper postures during their work, heavy lifting, reduced relaxation and food habits are also having an important role in the prevalence of Low back pain. The Viharaja Nidanas like Langhana, Atyadhwa, Bharavahana, Dukhashayyasana, Dukhasana, Shighrayana, Atijagarana and Vegadhrana plays a major role in the occurrence of Katigraha. The Aharaja Nidanas like Katu Rasahara, Rukshanna, Shitanna, Laghuanna and Kharahara were major supportive factors for the occurrence of low back pain, whereas Tikta Rasahara, Vishamasana, Shushkamamsa, Mudga and Masura were minor supportive factors. Mainly the Manasika Nidanas like Chinta, Bhaya and Krodha make the person’s body to lower the capacity to with stand the physical stress to decrease the body healing capacity. The Kalaja Nidanas, mostly they help in the aggravation of the condition in the form of pain and restricted movements due to diurnal changes. In the present era changed food habits


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which includes less nutritious and more harmful foods like fast food, fermented foods, instant food preparation, cold items and junk foods are also giving support for the occurrence of the Low back pain. The changed busy life includes improper postures while sitting and lying position, prolonged standing, heavy lifting, works related travelling gives more stress on the lumbar spine. This leads to reduced blood supply and nutrition to the vertebrae are more prone for the degeneration, disc herniation, fractures and stenosis. These causative factors can be considered under the Nidanas of Katigraha as explained in the Samhitas. Thus, the present study showed a relation of these causative factors towards Dhatukshayajanya Katigraha. Along with study of etiological factors, radiological examinations will also helpful for the proper diagnosis through changes in the structures of lumbar vertebrae and it helps to give a quality treatment. Most of the patients are having degenerative changes in the radiological examination. Thus, it supports the Dhatukshayajanya Katigraha as per Ayurveda.

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