E-ISSN:2456-3110

Research Article

Lumbar Disc Herniation

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Effect of Shampakadi Niruha Basti in the management of Katigraha w.s.r. to Lumbar Disc Herniation - A Pilot Clinical Study

Borkar S.1*, Dash B.2
DOI: http://dx.doi.org/10.21760/jaims.8.1.5

1* Shubham Borkar, Post Graduate Scholar, Department of Panchkarma, Pt. Khushilal Sharma Govt. Autonomous Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, Department of Panchkarma, Pt. Khushilal Sharma Govt. Autonomous Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Lumbar disc herniation (LDH) is the most common lumbar spinal disorder that produces low back pain and/or leg pain. A herniated disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. LDH may be correlated with Katigraha in Ayurveda on the basis of clinical features of the disease where Vatadosha with or without Aamadosha settles in Katipradesh (lumbar region). and cause pain and stiffness. In the present study 6 patients of lumbar disc herniation were advised the treatment modalities like Shampakadi Niruha Basti along with Rasnaerandadi Kashayam and Trayodasang Guggulu orally for 16 days which was found very effective in relieving the sign and symptoms of LDH.

Keywords: LDH, Katigraha, Shampakadi Niruha Basti

Corresponding Author How to Cite this Article To Browse
Shubham Borkar, Post Graduate Scholar, Department of Panchkarma, Pt. Khushilal Sharma Govt. Autonomous Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Shubham Borkar, Babita Dash, Effect of Shampakadi Niruha Basti in the management of Katigraha w.s.r. to Lumbar Disc Herniation - A Pilot Clinical Study. J Ayu Int Med Sci. 2023;8(1):36-43.
Available From
https://jaims.in/jaims/article/view/2219

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-24 2022-11-26 2022-12-03 2022-12-10 2022-12-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes

© 2023by Shubham Borkar, Babita Dashand 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 2023;8(1)36
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation

Introduction

Lumbar disc herniation and disc protrusion are one of the most common spinal degenerative disorders, which leads to low back pain and radicular leg pain.[1] It is a pathological condition that frequently affects the spine in young and middle aged adults.[2] This condition is defined as a displacement of disc component (nucleus pulposus and annulus fibrosis) beyond the intervertebral disc space.[3] The incidence of herniated disc is about 5 to 20 cases per 1000 adults annually and is the most common in people in their third to the fifth decade of life with a male female ratio of 2:1. The estimated prevalence of symptomatic herniated disc of lumbar spine is about 1-3% of patients.[4]

Kati, Shroni and Trika are the synonymously used in Ayurvedic classics which usually refers to lumbar region. Lumbar disc herniation may be correlated with Katigraha based on clinical features of the disease. Katigraha is an independent disease entity described in Gadnigraha in Vatavyadhi chapter,[5] with the same description made available in Bhavaprakash Samhita where the Vata Dosha with or without Ama Dosha settles in Kati and causes pain and stiffness in the Katipradesh (lumbar region).[6] Aacharya Sharangdhar also mentioned Katigraha in Vataja Nanatmaja Vyadhi.[7]

In this disease pain, stiffness and numbness are found to be present at lumbar region, therefore local Abhayanga and Swedana are claimed to be very effective and provide relief. Basti Chikitsa is mainly useful in disorders related to Vata Doshas. It is highly acclaimed by Aacharya Charak and described as Ardha Chikitsha or some Aacharya accept as Sampporna Chikitsa.[8] Aasthapan Basti (Niruha Basti) is a medicated enema containing, honey, salts and medicated drugs are said to be effective in pain relief with providing Bala, Varna and Mardavta.[9] Various Vatik are formulated for alleviating Vata Dosha in different classics. Among than Shampakadi Niruh Basti is described in Sushruta Samhita (Su.Chikitsa 38/43-45) which is specially indicated in Katishool. Rasna Erandadi Kashyam is also indicated for alleviation of Vata Dosha (Sahasra Yog 1/448). Trayodasanag Guggulu is also well known for its Vata Shamak & Vrihan effect. So, in this clinical study Shampakadi Aasthapan Basti along with Rasana Erandadi Kashayam and Trayodasang Guggulu are planned as treatment regimen for managing Katigrah.

Aims and Objectives

To evaluate the effects of Shamapakadi Niruha Basti along with Rasnaerandadi Kashayam and Trayodasang Guggulu in the management of Katigraha w.s.r. to lumbar disc herniation.

Materials and Methods

In the present study, 6 patients who were attending the OPD and IPD of Pt. Khushilal Sharma Govt. Auto. Ayurvedic Hospital Bhopal with clinical sign and symptoms of Katigraha w.s.r. to LDH were selected for the study.

Diagnostic criteria

  • Pain in lower back with or without radiation.
  • Stiffness of the lumbar region.
  • Restriction of movement of lumbar region.
  • Tingling sensation or Numbness in one or both lower limbs.
  • MRI changes suggestive of lumbar disc herniation.

Inclusion criteria

  • Patients fulfilling the diagnostic criteria.
  • Patients willing to sign the consent for participation in study.
  • Patients fit for Basti Karma.

Exclusion criteria

  • Patients contraindicated for Basti Karma.
  • Patients having Spinal tumour, Tuberculosis, malignant disease of the pelvis, fracture of spine, Congenital or acquired skeletal deformity.
  • Any traumatic condition of spine leading to paralysis.
  • Recent lumbar surgery or implanted instrumentation or prosthesis.
  • Pregnant and lactating women.
  • Having Chronic pathologies e.g., Ankylosing spondylosis, Rheumatoid Arthritis, Psoriatic arthritis, Gouty Arthritis or any other chronic systemic illness.

Treatment regimen
1. Mahanarayan Taila for local

2. Kala Basti (16 days)

3. Shamapakadi Niruha Basti[10] - 625ml


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)37
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation

4. Anuvasana Basti with Sahachara Taila - 100ml

5. Shamana drugs

a. Rasnaerandadi Kashayam[11] 20 ml twice a day.

b. Trayodashanga Guggul[12] 1gm bd

Ingredients of Shamapakadi Niruha Basti

Dravya Botanical name Dose
Madhu Honey 70ml
Saindhav lavana Rock salt 5gm
Sahachara Taila   70ml
Kalka Dravya    
Pippali Piper longum 10 gm
Satpushpa               Juniperus communis
Priyangu Callicarpa macrophylla
Mulethi Glycyrrhiza glabra
Hriber Anethum sowa
Rasanjana Berberis aristate
Indrayava Holorrhena antidysenterica
Nagarmotha Cyperus rotundus
Kwatha Dravya    
Shampak (Phala Majja) Cassia fistula 450 ml
Eranda Ricinus communis
Punarnava Boerhavia diffusa
Ashwagandha Withania somnifera
Bilva Aegle marmelos
Agnimantha Premna mucronate
Shyonak Oroxylum indicum
Patala Sterospermum suaveolens
Gambhari Gemilna arborea
Bala Sida cordifolia
Rasna Pluchea lanceolata
Guduchi Tinospora cordifolia
Devadaru Cedrus deodara
Madanphala Randia spinosa

Rasna Erandadi Kashyam[11]

Drug Latin Name Family
Rasna Pluchea lanceolata Compositae
Yastimadhu Glycorriza glabra Fabaceae
Amrita Tinospora cordifolia Menispermiacea
Bala Sida cordifolia Malvaceae
Gokshura Tribulus terrestris Zygophyllaceae
Eranda Ricinus communis Euphorbiacea

Ingredients of Trayodashang Guggulu[12]

Contents Latin Name Proportion
Aabha (Babbul) Acasia arabica 1 part
Ashwagandha Withania somnifera 1 part
Hapusha Juniperus communis 1 part
Guduchi Tinospora cordifolia 1 part
Shatavari Asparagus recemosus 1 part
Gokshur Tribulus terrestris 1 part
Vriddhadaru Argyria speciosa 1 part
Rasna Pluchea lanceolata 1 part
Shatapushpa Foeniculum valgare 1 part
Karchur Curcuma zedoaria 1 part
Yavani Trachhyspermum ammi 1 part
Shunthi Zingiber officinale 1 part
Guggulu Commiphora mukul 13 parts
Ghee Clarified butter 1/2 part

Duration of study - 16 days

Follow up period - 15 days

Criteria of Assessment

Both subjective and objective parameters were employed for the assessment of the effect of the treatment.

Subjective Criteria

Pain

Parameters Gradation
No pain 0
Mild pain but no difficulty in walking 1
Moderate pain and slight difficulty in walking 2
Severe pain with severe difficulty in walking 3

Stiffness

Parameters Gradation
No stiffness 0
Sometime for 5-10 minutes 1
Daily for 10-30 minutes 2
Daily for 30-60 minutes/more than 1hrs 3

Numbness

Parameters Gradation
No numbness 0
Occasionally once in a day for 5-10 minutes 1
Daily once in a day for 10-30 minutes 2
Daily for more than 30-60 minutes 3

Tingling

Parameters Gradation
No tingling 0
Occasionally once in a day for 5-10 minutes 1
Daily once in a day for 10-30 minutes 2
Daily for more than 30-60 minutes 3

The Roland-Morris low back pain and disability questionnaire.

Please read instructions: When your back hurts, you may find it difficult to do some of the things you normally do. Mark only the sentences that describe you today.

[ ] I stay at home most of the time because of my back.

[ ] I change my position frequently to try to get my back comfortable.

[ ] I walk more slowly than usual because of my back.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)38
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation

[ ] Because of my back, I am not doing any jobs that I usually do around the house.

[ ] Because of my back, I use a handrail to get upstairs

[ ] Because of my back, I lie down to rest more often.

[ ] Because of my back, I have to hold on to something to get out of an easy chair.

[ ] Because of my back, I try to get other people to do things for me.

[ ] I get dressed more, slowly than usual because of my back.

[ ] I only stand up for short periods of time because of my back.

[ ] Because of my back, I try not to bend or knee down.

[ ] I find it difficult to get out of a chair because of my back.

[ ] My back is painful almost all of the time.

[ ] I find it to turn over in bed because of my back.

[ ] My appetite is not very good because of my back.

[ ] I can only walk short distance because of my back pain.

[ ] I have trouble putting on sock (or stocking) because of the pain in my back.

[ ] I sleep less well because of my back.

[ ] because of my back pain, I get dressed with the help of someone else.

[ ] I sit down for most of the day because of my back.

[ ] I avoid heavy jobs around the house because of my back.

[ ] Because of my back pain, I am more irritable and bad tempered with people than usual.

[ ] Because of my back, I go upstairs more slowly than usual.

[ ] I stay in bed most of the time because of my back.

Score: _______


Objective Criteria

SLR test

Angle Gradation
Equal to or greater than 90° 0
71-<90° 1
51-70° 2
31-50° 3
< 30° 4

Braggard’s sign test

Grade 0 - Negative

Grade 1 - Positive

Femoral nerve stretch test

Grade 0 - Negative

Grade 1 - Positive

Statistical analysis: The score was analysed statistically in terms of mean values of B.T. (Before Treatment), A.T. (After Treatment), S.D. (Standard Deviation) and S.E. (Standard Error). The results obtained were considered significant for p value <0.01 and insignificant for p value >0.05.

Results

On Subjective Parameters

Table 1: Showing effect of therapy in subjective parameter.

SN Symptoms Mean Difference % of changes SD W P
BT AT
1. Pain 2.667 0.1667 2.5  93.73 0.5477 21 <0.05*
2. Stiffness 2.00 0.1667 1.833  91.65 0.7528 21 <0.05 *
3. Numbness 1.167 0.3333 0.8333  71.40 0.9832 6 >0.05***
4. Tingling 1.667 0.3333 1.3333  79.98 1.033 15 >0.05***
5. Ronald and morris law 2.167 0.3333 1.833 84.58 0.4082 11 <0.005**

* - Significant, ** - High Significant, *** - Not significant

In present pilot study, the effect of therapy was analysed by computed statistically using Wilcoxon test for subjective parameter the obtained result was interpreted as follow-

  • The pain criteria before treatment mean score of “SEI was 2.667, which was reduced to 0.1667, after treatment with percentage improvement of 93.73%, which was statistically significant.

Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)39
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation
  • The stiffness criteria before treatment mean score of “SEI was 2.00, which was reduced to 0.1667, after treatment with percentage improvement of 91.65%, which was statistically significant.
  • The numbness sensation criteria before treatment mean score of “SEI was 1.167, which was reduced to 0.3333 after treatment with percentage improvement of 71.40%, which was statistically not significant.
  • The tingling sensation criteria before treatment mean score of “SEI was 1.667, which was reduced to 0.3333 after treatment with percentage improvement of 79.98%, which was statistically not significant.
  • The Ronald & morris law criteria before treatment mean score of “SEI was 2.167, which was reduced to 0.3333 after treatment with percentage improvement of 84.58%, which was statistically very significant.

On Objective criteria

Table 2: Showing effect of therapy in objective parameter

SN Objective Parameter Mean Difference % of changes SD t p
BT AT
1. SLRT 1.833 0 1.833  1 0.7528 5.966 <0.005*
2. Braggard’s sign test 5 0 0.5  0.1 0.5477 2.236 >0.05***
3. Femoral nerve stretch test  0.3333 0  0.3333  1 0.5164 1.581 >0.05***

SD: Standard Deviation, SEM: Standard Error of Mean, * - Significant, *** - Not significant

The effect of therapy was analyzed by computed statistically using Wilcoxon test for objective parameter the obtained result was interpreted as follow-

  • The SLRT Testcriteria before treatment mean score of “SEI was 1.833, which was reduced to 0, after treatment with percentage improvement of 1%, which was statistically significant.
  • The Braggard’s sign test criteria before treatment mean score of “SEI was 5, which was reduced to 0, after treatment with percentage improvement of 0.1%, which was statistically not significant.
  • The Femoral nerve stretch test criteria before treatment mean score of “SEI was 0.3333, which was reduced to 0 after treatment with percentage improvement of 1%, which was statistically not significant.

Follow-Up Result: After completion of the treatment period the patients were followed up for another 15 days to assess further any complain of lower back ache.

Adverse Effects: There were no any adverse effects or adverse drug reaction was noted during and after the study duration.

Discussion

Discussion on Diseases

LDH is a common lower back disorder in the present era. Disturbed lifestyle and postural defects leads to this disorder. A herniated disc is a displacement of disc material beyond the intervertebral disc. A variety of therapeutic intervention has been proposed for the treatment of symptomatic LDH, including conservative treatment with NSAIDs, analgesics, steroids and physical therapy and surgical treatment with Discectomy, epidural steroid injections but in modern medicine most probably used intervention is surgical process which is not much effective. LDH may be correlated with Katigraha in Ayurveda classics, Gadanigraha considers Katigraha to be one among the Vatavyadhis. It clearly projects Vata Dosha as the major factor behind the whole pathogenesis.it explains that the vitiated Vayu takes its Ashraya in the Kati Pradesha causing pain and stiffness.

Discussion on Therapy

A convincing treatment approach is available in Ayurveda for this disease. Ayurveda advocates Panchakarma therapies like local Abhyanga, Swedan, Kati Basti and Basti procedure along with Shamana therapy in the management of Katigraha.

Sthanik Abhyanga (massage) acts on the root of Mamsavahasrotas i.e., Snayu, Twak and Raktavahini. The medicated oil used for massage remain in the skin for 300 seconds (Matras) and gradually and consecutively permits through different tissues elements like Rakta, Mamsa, Meda, Asthi, Majja, the medicated oil takes about 100 Matras each, to persuade and permeate through these different categories of tissue elements.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)40
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation

It may thus nourish the superficial and deep muscles and make the joints stable.

Swedan removes stiffness (Stambhagna) and excess Vata and Kaphadosha (Kapha-Vata Nirodhana). Thus, by its action, the breakdown the pathogenesis by removing obstruction in the micro channels (Sroto Sanga Vighatana) may take place and stiffness of the joints relieved.[13]

Mode of action of Basti

Acharyas’s told the importance of Vayu in the production of diseases and there is none other than Basti is the best treatment for aggravated Vata. So, Acharya Charaka praised Basti as half of the treatment and some scholars called it complete treatment.

Chakrapani quotes Parashara’s opinion “Mulam Gudam Shareerasya, Sirah Tatra Pratistitah: Sarvam Shareeram Pushnati Murdhanam Yavadashritah” the Guda is the root of the body & also it is the Pratishtana of Siras. Basti produce Tarpan of the Moordagata Siras & also increases the strength, potency.

According to Goyal & Hirano (1996) the Enteric Nervous System (ENS) is a collection of neurons in the G.I.T. that constitutes the “Brain of Gut” & can function independent of C.N.S. The ancient wisdom of Ayurveda considering the Pakvasaya as the seat of Vata. Basti drug reaches first to the Pakvasaya and then to the Grahani. Pakvasaya is the site of Purishadhara Kala and Grahani is the site of Pittadhara Kala. So, Basti directly acts on Purishdhara Kala and Pittadhara Kala. Commentator Dalhana has commented that Purishdhara and Asthidhara Kala are same and Pittadhara Kala and Majjadhara Kala are one and same. So, from these evidences it is clear that Basti has directed action on Asthi and Majja Dhatu.

Shamapakadi Niruha Basti contains Aragwadha, Eranda, Punarnava, Ashwagandha which mainly pacifies the Pristha-Trik-Uru Shula and reduces symptoms like stiffness and numbness by its Vaatkaphhar property indicated in pain and stiffness located lumbar region.[14]

Sahachara Tail (Anuvasana) is indicated in Daruna Vatavyadhi by Acharya Charaka so, it is helpful in pain and nourish the root place of Vayu (Pakwashaya).


Discussion on Shaman Drug

Rasnaerandadi Kashayam contains Rasna, Eranda, Sahachara, Devadaru, Musta, Ativisha having Rasa Tikta-Katu, Veerya Usna and Vatakaphahara effect and slightly Mutrala, Sophagna, Sula Hara effects.

Trayodashanga Guggul is a combination of 13 herbs including Guggulu processed in ghee. The ingredients like Shatavari, Ashwagandha, and Guduchi are known as rejuvenators and provides strength to Dhatus. Shunthi and Ajamoda improve Jatharagni whereas Babbul is especially acts on Asthidhatwagni. Ghee with its Yogavahi property helps in better absorption and penetration of the drug. Thus, Trayodashang Guggulu directly impacts on the etiology of Katigata Vata and helps in the disintegration of the Samprapti and settles down the vitiated Vata Dosha.

Discussion on Result

Shamapakadi Niruha Basti shown better effect on subjective criteria i.e., pain with percentage of improvement 93.73%. In stiffness the percentage of improvement was 91.65% which was statistically significant.

The pilot study (Effect of Erandamooladi Niruha Basti with Rasnaerandadi Kashayam in the Management of Katigraha w.s.r. to Lumbar Disc Herniation - A Pilot Clinical Study by Dr. Neetu Dixit in Journal WJPR Article Received on 09 June 2020) with Erandamooladi Niruha Basti shown better effect on subjective criteria i.e., pain with percentage of improvement 81.25%. In stiffness the percentage of improvement was 90.94% which was statistically significant.

Therefore, it can be discussed that Shamapakadi Niruha Basti shown better result than Erandamooladi Niruha Basti on comparing result.

Thus, this treatment regimen shows significant improvement in the Katigraha (LDH).

Conclusion

The result shows that Shamapakadi Niruha Basti and Rasnaerandadi Kashayam with Trayodashanga Guggul were found very effective in relieving the sign and symptoms in LDH (Katigraha) with increased functional activities. However, further work should be done on large samples to draw the final conclusion.


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)41
Borkar S et al: Shampakadi Niruha Basti in Katigraha w.s.r. to Lumbar Disc Herniation

Reference

1. Yang H, Liu H, Li Z, et al. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. Int J Clin Exp Med 2015;8:1634–44.

2. Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: evidence-based practice. Int J Gen Med 2010;3:209–14.

3. Anderson PA, McCormick PC, Angevine PD. Randomized controlled trials of the treatment of lumbar disk herniation: 1983–2007. J Am Acad Orthop Surg 2008;16:566–73.

4. Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. https://www.ncbi.nih.gov/books.

5. Sri Vaidya Sodhala. Gadanigraha. Ch.19, vers 160 part 2. Varanasi: Chaukhambha Sanskrit Sansthan; 3th Edition 1999. P.508

6. Sri Bhavamisra. Bhavaprakasa. Ch.26, vers 53 part 2. Varanasi: Chaukhambha Sanskrit Sansthan; 7th Edition 2000. P.286.

7. Sri Adamalla. Sharangdhara Samhita Prathama khanda, Ch.7, vers 105: Chaukhambha orientalalia 3rd Edition 1983.P.103.

8. Agnivesha. Charak Samhita. Ch.1, vers 40 part 2. Varanasi: Chaukhambha Sanskrit Sansthan; Edition 2013.P.971.

9. Charaka Samhita Ch, Siddhi Sthan Part 2 Chaukhambha Sanskrit Sansthan Edition 2020 P.987

10. Shushruta Samhita, Part 1 Varanasi: Chaukhambha Sanskrit Sansthan; Edition 2018 P..212

11. Sahastrayog, Kendriya Ayurveda Vigyan Anusandham Parishad Kashayam Adhyay Prakaran, Rasna Erandadi Kashayam, verse 448, Reprint 2011.

12. Bhatta Gopal Krishna. Rasendra Sar Sangraha. Rasavidyotini Hindi Commentary, Tripathi Indradev. Editor, Chaukhambha Orientalia Publications, 17th Edition; 1991. Varanasi. chapter 1 verse 402, p. 98


13. Kurubar A Deepti, B. T. Munnoli, D. Vijay kumar, Arbar Aziz, Patil Amol. Role Of Matra Vasti (Enema) Over Abhyanga (Massage) And Sweda (Sudation) In Reducing Spasticity In Cerebral Palsy With Suddha Bala Taila - A Randomized Comparative Clinical Study. Int. J. Ayur. Pharma Research, 2014; 2(2): 47-52.

14. Santoshkumar Bhatted et.al: Management of Spondylosis Induced Sciatica through Panchkarma w.s.r. to Vata Kaphaja Gridhrasi – A case study JAIMS, July-Aug, 2019; 4(4)


Journal of Ayurveda and Integrated Medical Sciences 2023;8(1)42