E-ISSN:2456-3110

Case Report

Katigraha

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

Effective Ayurvedic management of Katigraha - A Case Report

Kumar Prajapati G.1*, Gupta S.2, Pandey M.3, Singh R.4
DOI:

1* Govind Kumar Prajapati, Post Graduate Scholar, Department of Rog Nidan Evum Vikriti Vigyan, Pt. KLS Govt. (Auto.) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

2 Sakshi Gupta, Post Graduate Scholar, Department of Rog Nidan Evum Vikriti Vigyan, Pt. KLS Govt. (Auto.) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

3 Mahima Pandey, Post Graduate Scholar, Department of Rog Nidan Evum Vikriti Vigyan, Pt. KLS Govt. (Auto.) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

4 Rita Singh, Reader, Department of Rog Nidan Evum Vikriti Vigyan, Pt. KLS Govt. (Auto.) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

Katigraha is the commonest encountered disease. It is the condition which is characterized by stiffness, pain and impaired functioning of Lumbar spine region due to vitiation of Vata in Katipradesh. Even though this condition is not life threatening but it hampers the daily activity. Kati itself is one of the seats of Vata Dosha and the root cause of disease is aggravated by Vata. According to Ayurveda, it involves the Dushti of Asthivaha Srotas. About 80% of the industrial population and 60% of the general population suffers from low back pain due to their wrong posture. Case Report - A female pateint of 38 year old working as a tailor came to our hospital having complaint with low back pain which radiates to left lower limb, tingling sensation in bilateral lower limb, numbness in left heel region, difficulty in walking, loss of appetite, indigestion and disturbed sleep due to pain. Aim and objective - To evaluate the efficacy of Ksheerbala Tail Matra Basti and Murivennam Tail Katibasti in Katigraha for relieving pain, stiffness and impaired functioning of Lumbar spine. Result - Patient got marked relief in the pain, stiffness and tingling sensation along with improvement in walking. We will discuss the details in full paper. Conclusion - Katigraha is a common disorder of present era which is Vata Pradhan Tridoshaj Vyadhi in Ayurveda. Through this study we can conclude that Matra Basti with Ksheerbala Tail and Kati Basti with Murivennam Tail are effective in reducing the symptoms of Katigraha.

Keywords: Katigraha, Matra Basti, Kati Basti, Ayurveda, Ksheerabala Taila, Murivennam Taila

Corresponding Author How to Cite this Article To Browse
Govind Kumar Prajapati, Post Graduate Scholar, Department of Rog Nidan Evum Vikriti Vigyan, Pt. KLS Govt. (Auto.) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.
Email: 		Govind Kumar Prajapati, Sakshi Gupta, Mahima Pandey, Rita Singh, Effective Ayurvedic management of Katigraha - A Case Report. J Ayu Int Med Sci. 2023;8(2):171-174.
Available From
https://jaims.in/jaims/article/view/2291

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-12-31 2023-01-02 2023-01-09 2023-01-16 2023-01-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Govind Kumar Prajapati, Sakshi Gupta, Mahima Pandey, Rita Singhand 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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Prajapati G et al: Effective Ayurvedic management of Katigraha A Case Report

Introduction

The word ‘Katigraham’ originated from the union of two words ‘Kati’ and ‘Graham’ “Kati” is derived from the root “Kat in” meaning Sareera Avayava Vishesham. In “Amara Kosha” the word meaning of “Kati” is “Katau Vastra Varanau”, the part of the body which is covered with clothes. “Graha” means holding. It is originated from Dhatu “Graha Upadane” - one which gives support.

Thus “Katigraha” indicate a diseased condition of the back associated with pain and with stiff movements. In our classics it is mentioned under various terms like Katigraha, Trika Shula, Trika Graham, Prishthagraha and Shronibheda. “Trika” means “Trayanam Sandhayah,” union of three parts or union of three Avayava in any part of human body. As per this the shoulder and neck regions can be considered as “Trikam:. In Astanga Hridaya “Pakvashayagata Vatha” Lakshanas are explained in which the word “Trika” is mentioned. It shows that, Trika, Prishthta and Kati are three different parts of the body. In ‘Nanatmaja Vyadhis’ Katigraha, Prista Graham and Sronibheda are mentioned as separate diseases, depending on the region where pain is felt. Katigraha is one of the Vatavyadhi which is the problem of lumbar region. Even though this disease is not life threatening but it hampers the daily activity. It is described as a separate disease in the classical text Gadanigraha and Acharya Sharangdhar considered it as a Nanatmaja Vatavyadhi. Kati itself is one of the seats of Vatadosha and the root cause of disease is aggravated by Vata.[1] Katigraha is common with aging and is considered to be associated with the low back pain and disability. It is an important clinical, social and public health problem affecting the world wide population. Aging is well known risk factor of Katigraha as degenerative changes in the spine and disc are one of the major causes of Katigraha. In this disease pain and stiffness is found to be present at Katipradesh, therefore Sthanik Snehana and Swedana are very effective and provide quick result. Bahya Snehana and Swedana helps in reducing the pain, stiffness of the lumbar spine and increased the blood circulation. Basti is said to be best treatment for all Vatik disorders. It is highly acclaimed by Aacharya Charak and described as Ardhachikitsa. Hence an effort is made to evaluate the effect of Ksheerbala Matra Basti along with Murrivennam Katibasti in the management of Katigraha.

Case Report

A female patient of 38 year old working as tailor with OPD no. 56700 came to our Hospital having complaint of pain lower back which was radiating to left lower limb, tingling sensation in bilateral lower limb, numbness in left heel region, difficulty in walking, loss of appetite, indigestion and sleeplessness due to pain. According to the patient she was asymptomatic 5 months ago, and suddenly developed symptoms like pain in lumbar region radiating to left leg. Pain was intolerable in nature, associated with tingling and dragging kind of sensation and restricted left hip movements, it got aggravated by prolong standing and changing posture but subsides when the patient use to lies on bed with straight legs. Patient also noticed a change in her gait. Symptoms were aggravated by cold climate, supine posture and during night hours and got relieved by warm weather. Progressively her problems aggravated. So she approached for Ayurvedic treatment.

Table 1: O/E - Ashtavidha Pariksha

Nadi Vataj-Pittaj
Mutra Prakrut
Mala Kathin
Jivha Saam
Shabdha Spastha
Sparsha Samsheetoshna
Drik Prakrut
Aakriti Madhyam

Table 2: Samprapti Ghatak

Dosha Vata and Kapha
Dushya Asthi, Mamsa,
Srotas Asthivaha, Mamsavaha Srotas
Srotodushti Sanga
Rogamarga Madhyama
Adhisthan Katipradesh
Udhabhavasthan Pakwashaya
Vyaktasthan Kati, Sphik

Investigation: MRI scan dated 15/07/22 revealed features of lumbar spondylosis at L4-L5 level.

Assessment criteria: Criteria of Assessment was based on the signs and symptoms of Katigraha, (Table no. 6) SLR (Straight Leg Raising) test for range of movement at hip joint, FABER’S Test, FNST, lumbar movement etc. which were assessed before treatment, after treatment and after follow up. (Table no. 5) 


Journal of Ayurveda and Integrated Medical Sciences 2023;8(2)172
Prajapati G et al: Effective Ayurvedic management of Katigraha A Case Report

Table 3: Grading of subjective parameters

Symptoms Parameters Gradation
Pain 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 No stiffness 0
Some time for 5-10 minutes 1
Daily for 10-30 minutes 2
Daily for 30-60 minutes/more than 1hrs 3
Numbness 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 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

Intervention

Table 4: Medication

Procedure Drug Dose Duration
Deepan and Pachan Chitrakadi Vati 250 mg BD After meal with warm water for 3 days
Sthanik Abhyang Vata Shamak Tail - 15 days
Sthanik Sweden Dashmool Kwath - 15 days
Matra Basti Ksheer Bala Tail 60 ml After meal through anal route for 15 days
Kati Basti Murivennam Tail - 15 days

Results

We found that there was a marked improvement after the treatment. Painful and restricted movements of hip are reduced. Due to Ksheerbala Tail Matrabasti and Murivennam Tail Kati Basti Prayoga it was noticed that there was marked improvement in gait.

Table 5: Assessment before and after treatment

Parameters Before treatment After treatment
Gait  Antalgic Improved
Hip movements Right Normal Right Normal
Left Painful & Restricted Left Improved
SLR Test  45° 60°
FNST Positive Improved
FABER’S Test Positive Improved
Lumbar Flexion 30° 50°
Lumbar Extension 30° 30°
Lumbar lateral flexion Right 25° Right 25°
Left 10° Left 20°

Table 6: Assessment of Subjective parameters

SN Symptoms Grading BT Grading AT
1. Pain 2 0
2. Stiffness 2 0
3. Numbness 2 1
4. Tingling 2 1

Discussion

In Ayurvedic classics we find Vata Sthana (Kati) and Vatavyadhi which refers to the Vyadhis caused by the vitiation of Vata Dosha. Katigraha is not mentioned as a separate disease in Bruhatrayee especifically. “Katigraha is the condition in which vitiated Vata Dosha gets situated in the Katipradesh and producing Shoola (Pain) and Stambha (Stiffness). In Katigraha, there will be Stiffness throughout the lower back region, pain and restricted movement. As Acharya Sushruta says that without vitiation of Vata, Shoola cannot be arise.[2] And Gada Nigraha clearly states that Shoola take place due to Stambha which arises by Nirama and Sama Vayu Movement into Kati (Lumbar region). Katibasti was given as it is Bahya Sthanik Snehana (external local oleation) and Swedana (sudation) procedure which mainly acts against the Ruksha Guna (dryness) and Sheeta Guna (coldness) respectively of Vata.[3] Vitiated Vat is corrected in its root place i.e., Guda & Pakwashaya by Matra Basti.

Ksheerbala Tail: It is prepared from Go Ksheera (cow milk), Bala (sida cordifolia) and Tila Tail (sesame oil). This oil is widely used in various Panchakarma therapy like Kaval, Tarpan, Matra Basti, Nasya, Shiro Basti, Snehana etc. Bala has been largely used in neurological as well as heart disease. It posses analgesics and inflammatory properties. Go Dugdha contains all properties which are necessary for the nutrition and growth of overall body tissues. Tila tail as mentioned in Caraka Samhita is the best Sneha. All these three ingredients are good enough to pacify all Vata related disorders.

Murivennam Tail:The oil is used to heal the wound. It not only heals ulcers but is also effective in providing strength to the muscles, ligaments, bones and joints. It is extensively used in pain like tennis elbow, shoulder dislocation, back pain, spondylitis pain, stiffness, slip disc, acute soft tissue injury, sports injury and arthritis. According to Ayurved we can used this concoction in Aamvata,


Journal of Ayurveda and Integrated Medical Sciences 2023;8(2)173
Prajapati G et al: Effective Ayurvedic management of Katigraha A Case Report

Vrana Ropana, Abhighata, Kustha, Vedana, Sandhi Shool, Katipradesh Shool, Mamsa Gata Vata.

Conclusion

The result shows that the Ksheerbala Tail Matra Basti and Murivennam Tail Kati Basti were found very effective in relieving the sign and symptoms in Katigraha with increased functional activities. However, further work should be done on large samples to draw the final conclusion.

Reference

1. Tripathi Indradeva, Gadanigraha of Vaidya Sodhala with The Vidyotini Hindi commentary, vol-2, Kayachikitsa Khanda 19/160, 1sted Reprint, Chaukhambha Sanskrit Sansthan, Varanasi, 2011, P. 508.

2. Shastri Kaviraj. Ambikadatta Edited, Susruta Samhita Shareera 5/30 Choukhamba Sanskrut Sansthana, Varanasi. Reprint Edition 2005. Page no 46.

3. Gupta Sanjay, Sharma Radheyshyam. Comparative clinical study of Kati vasti, PatrapindaSveda and Matra Vasti in Kati Shoola (low backache). J of Ayurveda and Hol Med (JAHM), 2015; 3(6): 19–35


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