E-ISSN:2456-3110

Research Article

Lumbar Spine

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

An observational study of anatomical changes in Lumbar Spine produced due to Atibharvahan in farmers using MRI

Moharana D.1*, Kar S.2, Das K.3
DOI: http://dx.doi.org/10.21760/jaims.8.3.5

1* Dibyajyoti Moharana, Assistant Professor, Department of Panchakarma, Shri Krishna Ayurvedic Medical College, Varanasi, Uttar Pradesh, India.

2 Sarbeswar Kar, Professor, Department of Shalakya Tantra, Principal, JSS Ayurvedic Medical College, Mysore, Karnataka, India.

3 K. C. Das, Professor, Department of Kayachikitsa, Principal, SVM Ayurvedic Medical College, Ilkal, Karnataka, India.

For diagnosis and treatment of various diseases anatomical study i.e., Rachana Sharir is necessary. Rachana Sharir - human anatomy is explained in detailed by various Acharyas in their Samhitas. For locomotory movements of human body, bones and joints are essential aspect of anatomical learning. Detail explanation of Asthi (bones) is described in Ayurvedic classics and modern science which will be studied and utilized for the observational study of lumbar spine in farmers due to Atibharvahan. India is agriculture predominant country. As numbers of farmers are more which deals with heavy weight lifting leading to physical stress and strain in Lumbar spine, which was not studied earlier.

Keywords: Lumbar Spine, Atibharvahan, MRI

Corresponding Author How to Cite this Article To Browse
Dibyajyoti Moharana, Assistant Professor, Department of Panchakarma, Shri Krishna Ayurvedic Medical College, Varanasi, Uttar Pradesh, India.
Email: 		Dibyajyoti Moharana, Sarbeswar Kar, K. C. Das, An observational study of anatomical changes in Lumbar Spine produced due to Atibharvahan in farmers using MRI. J Ayu Int Med Sci. 2023;8(3):31-36.
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https://jaims.in/jaims/article/view/2332

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-02-01 2023-02-03 2023-02-10 2023-02-17 2023-02-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Dibyajyoti Moharana, Sarbeswar Kar, K. C. Dasand 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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Moharana D et al: Anatomical Changes in Lumbar Spine produced due to Atibharvahan

Introduction

The description of anatomy in Ayurveda is peculiar. Marma, Srotas, Kala etc. are described only in Ayurveda. One should have a thorough knowledge of basic principles in Ayurveda, for the successful use of Ayurvedic way of treatment. The modern science of medicine has developed anatomy by continuous research in this subject. Hence an Ayurvedic physician must know modern anatomy and its applied aspects. He must study how the anatomical structure has been involved and modified in a particular disease. Considering involvement and changes of structures he should decide the line of treatment to get the complete success in the treatment.

The success of treatment depends on the knowledge of human body. While considering the pathology/ etiology of any disease by Ayurvedic method, Ayurvediya Racană Sârira must be considered first but beyond that; knowledge of modern anatomy must be applied for the thorough understanding of the disease because it is said that,

The physician who studies only one science will not be able to arrive at a correct decision. Therefore, the physician should study many sciences.

In brief modern anatomy must be studied in details by a physician and structural involved must be examined. Now days advanced diagnostic imaging techniques help us in this regard.[1,2]

Vayu develops hollowness within the bone which is filled up by the essence of Meda called Majjā (marrow). Asthi is an important place of Vayu. It produces Saushirya porosity in bones, Bhrama and Timira Darsana (Blackout). Majja Kshaya causes Alpa Šukrata, pain in joints and bones and feeling of hollowness in the bone. Joints of bones are those where bones articulate together with the ligaments and tendons.Ati Sopha, Ruja, Balaksaya, Parva Bheda Sopha, Sandhikarmoparati (inoperativeness of joint) mark the injury of the movable or immovable joint.

Caraka Samhita is the first and foremost treatise that elaborates Vata, Vatavyadhi at full length. The role of Vata Dosha in health and disease is described in the first chapter itself. He allotted major part of 12th chapter entitled Vatakalakaleeya for the description of Vata, its normal functions and both intrinsic and extrinsic factors for

its aggravation. In 17th chapter Kiyantashiraseeya, the two modes of morbidity of Vata i.e., Chaya and Prakopa as well as different courses of Doshas in the pathogenesis of disease are described. He has mentioned Shula as a symptom of provoked Vata.

In Maharogadhyaaya, the 20th chapter in Sutrasthana, where he enlists Nanatmaja Vatavyadhi, though Kati Graha has not been mentioned, other symptoms of spinal disease like Prushtha Graha, Trikagraha, Pada Shula, Supti, etc. is found.

As he has not given place for Vatavyadhi in Nidana Sthana, he stressed the importance of Vata in 28th chapter of Chikitsa Sthana. He further described five varieties of Vata and etiology of its morbidity along with its clinical features. The description of morbidity of Vata included the different clinical manifestation according to the site of involvement. The unique pathogenesis of Vata vitiation due to the obstruction to its passage or functioning is elucidated in full detail. In addition, the elaborate description of treatment of imbalance of Vata in general, and at specific sites and when the passage is obstructed in particular is also made in the same context. This chapter also includes the complete description of certain common Vatavyadhi is in regards its etiology, pathogenesis, general principles of treatment as well as treatment in particular.

Different references related to Katishoola in Charaka Samhita:

  • Prishthashoola as Nanatmaja Vatavikara
  • Katiprishthashoola or Graha as a symptom of Vrikkajavidradhi
  • Jengha-Uru-Trika Shoola occurs in Apatarpana disorders
  • Excessive use of Katu Tikta and Kashaya Rasa leads to Vatavyadhi
  • Different types of pain In Kati and Parshva in Vataja Jwara
  • Different types of pain in Kati and Prishtha in Vatika of Taitarika Jwara and Udara Roga
  • Kati-Prishtha Shoola in Vatika Arshas
  • Kati-Uru-Trika Shoola in Vatika Atisara have been mentioned
  • Trika -Vedana due to Pakwashayagata Vata
  • Trika Roga is Told in Gudagata Vata have been mentioned

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  • Prishthashoola as Nanatmaja Vatavikara
  • Katigraha as one of the Swedya
  • Katiprishthashoola or Graha as a symptom of Vrikkajavidradhi
  • Jengha-Uru-Trika Shoola occurs in Apatarpana disorders
  • Excessive use of Katu Tikta and Kashaya Rasa leads to Vatavyadhi
  • Different types of pain in Kati and Parshva in Vataja Jwara
  • Different types of pain in Kati and Prishtha in Vatika of Taitarika Jwara and Udara Roga
  • Kati-Prishtha Shoola in Vatika Arshas
  • Kati-Uru-Trika Shoola in Vatika Atisara have been mentioned
  • Trika -Vedana Due to Pakwashayagata Vata
  • Trika Roga is told in Gudagata Vata have been mentioned

Anatomy was much advanced during Sushrut’s period. He has counted 300 bones and 24 Prakaaras of joints in relation to the spine. In Sharira Sthana, Sushruta has described the structure of Prushtha, Pada and its joints. He clearly mentioned in Marma Sharira that trauma on Kukundara Marma leads to sensory and motor loss of lower limbs and leads to disability (Vaikalyata). In Siravyadha Sharira he described the position, place and method of Siravyadhana in Vatavyadhi cases.[3]

Sushruta has given much importance by allotting the first chapter of Nidana Sthana itself for Vatavyadhis. He portrayed some allied conditions like Gridhrasi, Khanja, Pangu, Kalayakhanja etc. but references for Katigraha are not found. In Bhagna Nidana chapter he made many original observations pertaining to Sandhimukta (dislocation or herniation) Kandabhagna (fracture). His description pertaining to classification, clinical features, prognosis etc., of Sandhimukta suits for lumbar disc prolapse which is responsible for majority of Low back ache and sciatica cases.[4]

Hareeta described the etiological factors of Vata Prakopa very elaborately. He has illustrated the Vata disorders classifying according to five varieties of Vata with mentioning about 16 diseases for each type.


In Kashyapa Samhita there is no specific chapter for VataVyadhi Chikitsa. However, the general aspects of Vata and its aetiopathogenesis are discussed in Sutrasthana in similar lines as that of Charaka.[5]

Methods

1. Total number of 30 patients were selected in OPD basis irrespective of their gender.

2. Informed written and valid consent of the patient taken prior to commencement of clinical trials.

Total 32 Patients completed the study successfully.

Observations were carried out before and after completion of treatment and during each follow up.

Method of selection of Study subjects

  • Patient suffering from lower back pain, restricted lower back movements, numbness & weakness of both legs studied.
  • A case record form will be designed for the study.
  • Based on clinical observations farmers selected after giving an idea of the project and informed consent taken prior to study.
  • Patient clinically examined in detail.
  • The structural involvements and changes noted with the help of X-ray (radiology).

A] Inclusion criteria

1. The patients were professionally Farmers.

2. Patient between 35-70 years of age were selected.

3. Professional Farmers who have had complaint of persistent lower back pain and restricted lower back movements were selected.

4. Patient who has been in the profession for more than 10 years.

5. Patients were selected irrespective of gender, region and religion etc.

B] Exclusion criteria

1. All patients with congenital, traumatic, functional, infective, inflammatory, neoplastic pathology were excluded.

2. Non-co-operative patients were excluded.



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Operational definition of Atibharvahan

Patient (Farmer) who does daily weight lifting (more than 27kg, even small weight for long time) since more than 10 years, daily work of farmers is laddering, ploughing, water/seeds/soil lifting in bucket, hoeing dry soil, bund trimming etc. wet/dry soil, spade work, disk harrowing, cutting crops, grain cutting, grain threshing by beating, pounding grain etc.

Ayurveda is a science of life, which is framed on a many concepts. All these concepts are proved & established facts. The methodology adopted to establish these facts was holds good for that perspective era. In the present era, due to globalization of Ayurveda & too easily convince the common people, these olden techniques are not sufficient, so these old principles should be reestablished with the help of modern advanced technology. As Asthi & Majja is among Sapta Dhatu & it does the function of Dharana & Purana. The normalcy & abnormality of Asthi & Majja can be easily visualized with the help of so many techniques. One among them is MRI. By these deformities of IV foramina, Muscles, Ligaments, IV space, etc. can be ruled out & this is one amongst best technology to rule out deformities of Asthi & Majja Dhatu.

For diagnosis and treatment of various diseases anatomical study i.e., Rachana Sharir is necessary. Rachana Sharir - human anatomy is explained in detailed by various Acharyas in their Samhitas, test and in classics. For locomotory movements of human body, bones and joints are essential aspect of anatomical learning. Detail explanation of Asthi (bones) is described in ayurvedic classics and modern science which will be studied and utilized for the observational study of lumbar spine in farmers due to Atibharvahan.[6-8]

Discussion on demographic data

1. Atibharvahan for long time causes more symptoms in patient: In this preset study 30 subjects showed Katishool (pain), 28 subjects showed Katistabdhata, 26 subjects showed Chankraman Kashtata (Difficult in walking)

2. Age: In this Present Clinical trial group of 5 patients belongs to Age Group 35 to 40 years, 6 patients belongs to Age Group 41 to 50 years, 12 patients belongs to Age Group 51 to 60 years, 7 patients belongs to Age Group 61to 70 years

3. Gender: In these present study 11 subjects was female and 19 subjects were male. Male are prone for this, because working phenomena.

4. Atibharvahan duration: In this Present Clinical trial group of 9 patients belongs to Atibharvahan duration 15 to 25 years – 8 patients belongs to Atibharvahan duration 26 to 35 years, 9 patients belongs to Atibharvahan duration 36 to 45 years, 4 patients belongs to Atibharvahan duration 46 to 55 years.

5. Intervertebral disc changes: In this preset study 5 subjects showed Intervertebral disc bulge L1-L2, 10 subjects showed Intervertebral disc bulge L2-L3, 18 subjects showed Intervertebral disc bulge L3-L4, 26 subjects showed Intervertebral disc. Bulge L4-L5, 23 subjects showed posterior disc bulge L5-S1.

6. Intervertebral Foramina Changes: In this preset study 2 subjects showed Intervertebral foramen narrowing L1-L2. 7 subjects showed Intervertebral foramen narrowing L2-L3, 17 subjects showed Intervertebral foramen narrowing L3-L4, 21 subjects showed Intervertebral foramen narrowing L4-L5, 16 subjects showed Intervertebral foramen narrowing L5-S1,

7. Ligaments changes: In this Present Clinical trial 12 patients showed Thickening of Ligaments, 18 patients showed Unremarkable Thickening of Ligaments.

8. Lumbar Muscle Changes: In this preset study 8 subjects showed Muscles Spasm, 20 subjects showed Mild Muscles Spasm, 2 subjects showed Unremarkable Muscles Spasm.

Results

Assessment Criteria

1. Vertebral Body: All subjects showed degenerative & osteophytic changes in vertebral body.

2. IV Disc: 2 subjects showed posterior disc bulge at L1-L2 & L4-L5, 3 subjects showed posterior disc bulge at L1-L2, L2-L3, L3-L4 & L5-S1, 5 subjects showed at posterior disc bulge L2-L3 & L4-L5, 1 subjects showed posterior disc bulge at L2-L3 & L4-L5, 3 subjects showed posterior disc bulge L2-L3, L4 L5 & L5-S1, 1 subjects showed posterior disc bulge L3-L4, 14 subjects showed posterior disc bulge L3-L4 & L5-S1.


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Moharana D et al: Anatomical Changes in Lumbar Spine produced due to Atibharvahan

3. IV Space: In this present Study, all subjects showed reduced IV space.

4. Muscles: All subjects showed Unremarkable mild Spasm in muscles.

5. Ligaments: All subjects showed Unremarkable mild thickening in Ligaments.

6. IV foramina: 1 subject showed L1-L2 & L4-L5 narrowing IV foramina, 1 subject showed L1-L2 L5- S1 narrowing IV foramina, 3 subject showed L1-L2, L2-L3, L3-L4 & L5-S1 narrowing, 5 subject showed L23-L3, L4 L5 & L5-S1 narrowing, 3 subject showed L2-L3 & L5-S1 narrowing, 1 subject showed L2-L3, L4 L5 & L5-S1 L5 narrowing, 1 subject showed L2-L3, L4 L5 L5 narrowing, 1 subject showed L3 L4, L4-L5 L5 narrowing, 12 subject showed L3-L4 & L5 S1 narrowing, 1 subject showed L3-L4 L5 narrowing.

Mechanism of Action: Ati Bhar Vahan means excessive Shareera Ayas Janana Karma that is more than Ardha Shakti Vyayam. When person performs the Ati Bhar Vahan continuously it leads to increase in Laghu, Ruksha, Sukshma, Teekshna Guna, in Shareera. Later it invariably leads to Vata Vitiation. Because Vata have some Guna, Like Laghu, Ruksha, Sukshma, etc on the basis of Samanya Siddhanta, as per contemporary science, excessive exercise causes the injury to the body like changes in bone & bone marrow.

Discussion

  • Asthi & Majja is among Sapta Dhatu, & it does the function of Dharana & Purana.
  • The normal & abnormality of Asthi & Majja can be easily visualised with the help of so many techniques.
  • One among them is MRI.
  • By these deformities of IV foramina, Muscles, Ligaments, IV space, etc. can be ruled out & this is one amongst best technology to rule out deformities of Asthi & Majja Dhatu

MRI for evaluation of various acute traumatic spinal injuries

  • Ligamentous injury
  • Disc damages and herniations
  • Extra medullary haemorrhage.
  • Vascular injuries
  • Cord injuries
  • Acute vs old vertebral fracture
  • Benign vs malignant fracture

Mechanism of Action

  • Ati Bhar Vahan means excessive Sharira Ayas Janana Karma
  • That is more than Ardha Shakti Vyayam.
  • When person performs the Atibharvahan continuously it leads to increase in Laghu, Ruksha, Sukshma, Teekshna Guna, In Shareera.
  • Later it invariably leads to Vata Because Vata have some Guna, like Laghu, Ruksha, Sukshma, etc on the basis of Samanya Siddhanta
  • Excessive exercise causes the injury to the body like changes in bone & bone marrow.
  • Farmers having a work like pulling, pushing the heavy things. Heavy work load effects on the lumbar region.
  • Asthi Majjagata Vata is the Vata situating condition deep in Asthi & Majja Dhatu, in which patient is suffering from severe pain, insomnia, tenderness.

Role of MRI

With advances in computer graphics technology, a complete 3D computer graphics-based geometrical model of the locomotor system

Conclusion

Degenerative & osteophytic changes of vertebral body, Intervertebral space reduces. Intervertebral posterior disc bulge specifically L-4 & L-5. Intervertebral foramina narrowing specifically L-4 L-5 is found.

Straightening of lumbar spine is noted due lumbar muscle spasm. This structural modification accompanied by thickening of ligamentum flavum.

References

1. Golwala A.F. & Golwala S.A. (1988): Medicine for Students, 24th edition, India

2. Guyton & Hall (1996) : Textbook of medical physiology, 9th edition, A PRISM Indian edition, Bangalore



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3. Harrison: Principles of Internal Medicines, 15th International Edition, edited by Eugene Braunwald, Anthony S. Fanci, Stephen L. Hauser, Dennis L. Kasper, Dan L. Longo, J. Larry Jameson and McGraw-Hill – Medical Publishing Division, Vol.- I.

4. Sushruta, Sushruta Samhita, Ayurveda Tatvasandipika Hindi Commentary, by Kaviraja Ambika Datta Shastri. Varanasi: Chaukhambha Sanskrita Sansthana, 2003 17 th ed., Su. Sharira. 5/20, page and 5/21, no, 320-321

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6. Chaurasia B.D. Human Anatomy CBS Publishers and distributors 2019; Volume 2: 219,220,221

7. Sarpotdar S. Reasearch Methodology and Medical Statistics. Manikarnika Publication; 2018: 270.

8. Pt. Sarangdhar, Sharangdhar Samhita, Dipika Hindi Commentary, by Dr. Brahmanand Tripathi, Revised ed., Varanasi: Chaukhambha Subharti Prakashan, 2013 Sharangdhar poorva khand 7,105, 106.


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