E-ISSN:2456-3110

Review Article

Lumbar Spondylosis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha w.s.r. of Lumbar Spondylosis - A Case Study

Shivani P1*, Manisha P2, Kamini S3
DOI:10.21760/jaims.8.12.36

1* Paliwal Shivani, Post Graduate Scholar, Pg Department of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

2 Pandey Manisha, Post Graduate Scholar, PG Department of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

3 Soni Kamini, Reader, PG Department of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Low back pain has become a major health problem now days, about 60-80% of world population experience lower back pain at some time in their lives. Katigraha is one among the Vata Nanatmaj Vyadhi described in Gadanigraha and Sharangadhar classical text. Acharya Shodhalya described that it is condition characterized by pain and restricted movement of Kati which can be correlated with the Lumbar Spondylosis. Lumbar Spondylosis is degenerative condition affecting the Disc, Vertebras, and associated Joints of Lumbar Spine. In Modern Science there are no effective treatments are available for this condition but in Ayurveda there is safe and effective regimen described by our Acharyas. In our case study diagnosed case of Lumbar Spondylosis with the complaints of lower back pain, stiffness and difficulty in walking and standing, tingling sensation since 2 month. In our treatment regimen externally Kati Pizhichil, Shashtikshali Swedan, and internally Panchtikta Ghrita Guggulu, Panchtikta Ksheera Basti and Matra Basti with Ksheera Bala Tail were given. During this procedure different parameters are assessed before and after treatment there is significant relief in previous complaints.

Keywords: Katigraha, Lumbar Spondylosis, Kati Pizhichil, Shashtikshali Swedan, Panchtikta Ksheera Basti, Matra Basti.

Corresponding Author How to Cite this Article To Browse
Paliwal Shivani, Post Graduate Scholar, Pg Department of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.
Email: 		Shivani P, Manisha P, Kamini S, Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha w.s.r. of Lumbar Spondylosis - A Case Study. J Ayu Int Med Sci. 2023;8(12):241-245.
Available From
https://jaims.in/jaims/article/view/2967

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-11 2023-10-21 2023-11-01 2023-11-09 2023-11-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. nil. yes 14.32 none

© 2023by Shivani P, Manisha P, Kamini Sand 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].

J Ayu Int Med Sci 2023;8(12)241
Shivani Paliwal et al. Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha

Introduction

Katigraha is an independent disease described by Aacharya Shodhlya in Gadanigraha Vatavyadhi chapter Where Vata Dosha with or without Ama Dosha settles in Kati and causes pain and stiffness in the Kati Pradesh (lumber region)[1] and Aacharya Sharngdhar included in types of Vata Roga. Kati, Shroni, and Trika are synonymously used in Ayurvedic classics which usually refers to Lumbar region.[2]

Katigraha may be correlated with Lumbar Spondylosis on the basis of clinical features of the disease. In Present era of Modernization in people follow many unwanted practices like improper sitting, posture for long time in offices, lack of physical exercise, load bearing movement during travelling and sports. All these factors create pressure and cause compressive injury to the spine, that play an important role in producing Lumbar Spondylosis.

Patient with the Lumbar Spondylosis have pain in axial spine. The location of these degenerative changes is identified within the facet joints, intervertebral discs, sacroiliac joints, nerve root, dura and myofascial structures. These changes may peak in different clinical presentations such as spinal stenosis, disc herniation, bulging of ligamentum flavum, spondylolisthesis, lumbar radiculopathy. It may include lower back pain, leg pain as well as numbness and motor weakness to lower extremities that worsen with upright stance and walking, and improve with sitting and supine positioning. It affect 60-85% of adult during some point in their lives.[3] Fortunately, For the large majority of individual, symptoms are mild and transient with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 month, affect an estimated 15-45% of the population.

In Modern Science treatment of Lumber Spondylosis involves limited conservative and surgical procedures. Medicine like analgesics, NSAIDS, steroids, anticonvulsant, antidepressant drugs used for reducing pain which provide only symptomatic relief with many side effects. For permanent cure surgery is the last option. After surgery many patients do not get relief and also causes adverse effect.

Ayurveda plays an important role in such type of situations.

Panchakarma therapy involve like Kati Pizhichil and Shashtik Shali are type of local Swedan which increases the blood flow of affected area and relax muscles as well as reduce the pain.

SSPS is a type of Brimhaniya Snehika Swedan providing nutrition to the muscular tissues. Panchtikta Ghrita Guggulu is indicated in Sandhi-Asthi-Majjagat Vata in classical text of Ayurveda.

It pacify mainly Vata and Kaph Doshas.[4]

Kheera Basti is described as the main line of treatment in Asthi Gata Vikaras by Aacharya Charaka.[5] It pacify Vata, improves the general condition of the body, and act as rejuvenator of the body. Matra Basti is type of Anuvasana Basti.

It promotes strength, without calling for any strict regimen of diet, and also cause easy elimination of Mala and Mutra. It performs the function of Brimhana and cures Vata Vyadh.[6]

Case Report

NameXYZ
Age46 Years
SexFemale
AddressBhopal
OccupationHouse wife

Chief complains

1. Lower back pain and stiffness since 2 month

2. Swelling on left lower limb with tingling sensation

3. Difficulty in walking and longtime sitting & standing

History of present illness

According to patient she was suffering from mild lower back pain before 2 month after that lower back pain was progressively increases with stiffness, tingling sensation in left leg, difficulty in walking and unable to perform his daily living activity.

For these complaints she was taking modern medicine for many years but had no relief after that she came in Pt. Khushilal Sharma Govt Ayurvedic Hospital for better management.

History of past illness

No any significant illness was found (i.e., HTN, DM)


J Ayu Int Med Sci 2023;8(12)242
Shivani Paliwal et al. Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha

Personal History

AddictionNo
Diet2 time/day
AppetiteNormal
Micturition1 time in night
Bowel1 time/ day
Sleep6-8 hrs in night
Height5’4”
Weight86 kg

On examination

General conditionModerate, Afebrile
Pulse rate76/min
Respiratory rate16/min
Blood pressure130/80 mmHg

Assessment Criteria

Following criteria was adopted-

Pain

ParametersGradation  
No pain0
Mild pain but no difficulty in walking1
Moderate pain and slight difficulty in walking2
Severe pain with severe difficulty in walking3

Stiffness

ParametersGradation
No stiffness0
Stiffness for 5-10 minutes1
Daily for 10-30 minutes2
Daily for 30-60 minutes/ more than 1 hrs3

Numbness

ParametersGradation
No numbness0
Occasionally once in a day for 5-10 minutes1
Daily once in a day for 10-30 minutes2
Daily for more than 30-60 minutes3

Tingling

ParametersGradation
No tingling0
Occasionally once in a day for 5-10 minutes1
Daily once in a day for 10-30 minutes2
Daily for more than 30-60 minutes3

Treatment protocol

Total treatment duration - 1 month

TreatmentDurationDrug
ExternalKati Pizhichil 15 daysKottamchukadi Taila
Shastik Shali Pinda Sweda15 days-
InternalPanchtikta Ghrita Guggulu30 days-
Panchtikta Ksheer Basti21 days-
Matra Basti9 daysKsheera Bala oil

Investigation

  • HB - 11.6 gm%
  • ESR - 30mm/1hr
  • MRI Report - LS spine

At L5-S1 level disc desiccation with reduced intervertebral disc space is seen with symmetrical diffuse posterior disc bulge causing narrowing of bilateral neural foramina with impingement over bilateral exiting nerve roots at this level. Bilateral facet joint arthrosis is noted. Mild fatty infiltration of the paraspinal muscles noted.

At L4-L5 levels disc desiccation with reduced intervertebral disc space and symmetrical diffuse posterior disc bulge is seen causing indentation over left traversing nerve roots and narrowing of bilateral neural foramina with impingement over bilateral exiting nerve roots at this level. Bilateral facet joint arthrosis noted.

At L3-L4 level disc desiccation with reduced intervertebral disc space and diffuse asymmetrical posterior disc bulge is seen causing indentation over anterior subarachnoid space with narrowing of bilateral neural foramina with likely abutment of bilateral exiting nerve roots. Mild bilateral facet joint effusion noted at this level.

Discussion

In this case line of treatment was Kati Pizhichil with Kottamchukkadi Tailam, Shastikshali Pinda Swedan, Panchatikta Ksheer Basti, Matra Basti with Ksheera Bala oil and Panchtikta Ghrita Guggulu. Kottamchukkadi Tailam is an Ayurvedic oil which is prepared by drugs like - Kushta (Saussurea lappa), Sunthi (Zingibar officinale), Shigru (Moringa oleifera), Adraka Moola, Chincha Phala (Tamarindus indica), Rashon (Allium sativum), Rasna (Pluchea lanceolata), Tila Taila (Sisamum indicum), Sarshap (Brassica campesstris), Vacha (Acorus calamus), Devdaru (Cedrus deodar). Sheeta Guna of Vata is responsible for stiffness and pain in body which is neutralized by Ushna Guna of Kottamchukkadi Tailam.[7]

.


J Ayu Int Med Sci 2023;8(12)243
Shivani Paliwal et al. Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha

SSPS content is Balamoola (Sida cordifolia), Ashwagandha (Withania somnifera), Shatawari (Asparagus racemosus), Ksheera (milk), Sathi Chawal. The heat provided by bolus of SSPS dipped in Bala Moola Kwath with Godugdha which increased blood flow locally, relieve pain, muscle spasm, increase tendon extensibility. Bala absorbed locally and provided Nourishment to Muscular tissues and prevent from emaciation, atrophy and detrimental changes.[8]

Most of the ingredients of Panchtikta Ghrita Guggulu have Tikta Rasa, Ushna Virya, Madhura and Katu Vipaka. Tikta Rasa increase Dhatwagni (metabolic stage), as Dhatwa Agni increase nutrition of Asthi and Majja Dhatu will be increased. So degeneration in Asthi Dhatu not occur rapidly as a result they may get stable.[9]

Basti is said in Ayurveda as half of the whole treatment schedule. It is said to control almost all the diseases and Doshas. It is very acute on its onset of action, through it is typically scheduled to eliminate and pacify Vayu. Internally in the form of Basti Panchtikta Ksheera was given. It contain Guduchi (Tinospora cordifolia), Nimba (Azadirakta indica), Vasa (Aghathoda vasica), Kantakari (Solanum surrattense), Patola (Trichosanthes diocia), Ksheera (milk), Goghrita (ghee), Madhu (honey) and Saindhav (salt). As per the quantity of this Basti and use of Ksheera as a main ingredient, Ksheera Basti serves dual function, i.e., Niruha and Anuvasana, hence, it act as Shodhan as well as Snehana. It relieve Margavarodha and produces Brimhana effect.[10] Matra Basti is given with Ksheera Bala oil, it contain Bala (Sida cordifolia), Tila Tail (Sesamum indicum) and milk, used as Pana, Abhyanga and Basti in Vata Vyadhi. Godugdha contain all the elements necessary for the growth and nutrition of bones, nerves, muscles and other tissues of human body. Bala abundantly mentioned in Ayurveda and has been largely used in neurological as well as in musculoskeletal disease and reported to have analgesic and anti-inflammatory activity. Tila Taila nourishes and strengthens all Dhatu, checks Dhatukshaya and thus alleviates Vata.[11]

Result

As per objective assessment criteria, the patient sign were analyzed before & after treatment during the followed period.

SNSymptomsBTAT
1.Pain31
2.Stiffness30
3.Numbness31
4.Tingling sensation20

Percentage relief

The following tables show the effect of treatment-

SNSymptoms% Relief
1.Pain66.6 %
2.Stiffness100 %
3.Numbness66.6 %
4.Tingling Sensation100 %

Conclusion

Katigraha or Lumbar Spondyloisis has a similar etiology and clinical presentation. Katigraha is a common disorder of present era. It is Vata Pradhan Vyadhi which is treated by Vata Shaman therapy like Kati Pizhichil with Kottamchukadu Taila, Shashatik Shali Pinda Sweda, Panchatikta Ksheer Basti, Matra Basti with Ksheera Bala Taila. These all treatment which proved to be very effective in this condition. Treatment has higher significance in pacifying the symptoms of Katigraha and marked reduction in clinical symptoms like Katishoola and stiffness. All the subjective parameters showed a remarkable response to the treatment. There were no tropical and systemic adverse drug effects at the end of the study and the preparation in definitely have the potential effect of treat Katigraha. To know the conclusion of this treatment regimen we should perform it on large sample.

References

1. Gadanigraha by Indradev Tripathi and Ganga sahay Pandey in Vata roga adhikar (19/160), Chaukhamba sanskrita sansthan, Varanasi, page no. 508

2. Sharngadhar samhita hindi commentary by shree mati Shelja shrivastava purva khanda (7/106), Chaukhamba sanskrita sansthan, Varanasi, p.n.100

3. Laxmaiah Manchikanti, Epidemiology of Low Back Pain, Pain Physician, Volume 3, Number 2, 2000[last cited 15 apr 2019]; pp 167-192. Available from; https://www.physio-pedia.com/Lumbar_spondylosis

4. Kviraj atridev gupta in Ashtang sangraha, Vata vyadhi chikitsitam, chapter (23/35), Chaukhamba sanskrita sansthan, Varanasi, 2019, p.n. 129


J Ayu Int Med Sci 2023;8(12)244
Shivani Paliwal et al. Effect of Panchkarma and Panchtikta Ghrita Guggulu in Katigraha

5. Charak samhita composed by Agnivesh and revised by Charak and Dradhabala edited by Prof. Banwari Lal Gaur, pratham khanda, Sutra sthan, chapter (28/27), Rashtriya Ayurveda vidhyapeeth, Delhi p.n 947

6. Vasant Patil. Principles and Practice of Panchakarma. 3rd ed. Bangalore; Atreya Ayurveda Publications. 2016.465

7. Sahastra Yoga. Taila Yoga Adhikar, CCRAS, 1990;p283

8. Vasant Patil. Principles and Practice of Panchakarma. 3rd ed. Bangalore; Atreya Ayurveda Publications. 2016.p206

9. Akhtar B, Mahto RR, Dave AR, Shukla VD. Clinical study on Sandhigata Vata w.s.r. to Osteoarthritis and its management by Panchatikta Ghrita Guggulu. Ayu. 2010 Jan;31(1):53-7.

10. Kaalia N, Bhatted SK, Acharya SH. Effect of Panchatikta Ksheera basti with Kati basti in Katishoola w. s. r lumbar disc degeneration – A clinical study. Indian J Health Sci Biomed Res 2021;14:108-12.

11. Jatinder Verma, Gopesh Mangal. New Perspectives of Ksheerabala Taila (oil): A Critical Review. IJATM.2019;1(1):24-30.


J Ayu Int Med Sci 2023;8(12)245