E-ISSN:2456-3110

Case Report

Sciatica

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Ayurvedic management of Gridhrasi (sciatica): A Case Report

Vishwakarma N1*, Singh R2, Srivastava S3, Shrivas S4
DOI:10.21760/jaims.9.4.48

1* Nidhi Vishwakarma, Post Graduate Scholar, Dept of Rog Nidan Evum Vikriti Vigyan, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

2 Rita Singh, Professor and Head, Dept of Rog Nidan evum Vikriti Vigyan, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

3 Sanjay Srivastava, Reader, Dept of Rog Nidan evum Vikriti Vigyan, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

4 Sapna Shrivas, Post Graduate Scholar, Dept of Panchakarma, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.

Sciatica is one of the most common emerging diseases in India which is affecting peoples physically as well as mentally. It can be defined as low back pain radiating to unilateral lower limb or bilateral lower limb along with paraesthesis. Treatment includes internal medication for pain and inflammation, Physical therapy and spinal injections. And lastly surgery is advised for those who do not respond to conservative treatment. But the success rate for this surgery is not so high. A 60 year male patient presenting with complain of back pain radiating to b/l lower limbs since 3 years treated with Ardhang Snehan Swedan along with Erandamoolaadi Basti (Kaal Yoga) and oral Ayurveda medication. Total duration of the treatment was 16 days however significant pain relief observed from the day three. This case is an evidence to demonstrate the effectiveness of Ayurveda treatment in case of Gridhrasi (Sciatica) and as a proposition for further research on more number of patients.

Keywords: Gridhrasi, Sciatica, Niruha Basti, Anuvasan Basti, Sarvanga Abhyanga Swedana, Case Report

Corresponding Author How to Cite this Article To Browse
Nidhi Vishwakarma, Post Graduate Scholar, Dept of Rog Nidan Evum Vikriti Vigyan, Pt Khushilal Sharma Government Ayurveda College, Bhopal, Madhya Pradesh, India.
Email: 		Vishwakarma N, Singh R, Srivastava S, Shrivas S, Ayurvedic management of Gridhrasi (sciatica): A Case Report. J Ayu Int Med Sci. 2024;9(4):291-295.
Available From
https://jaims.in/jaims/article/view/3260

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-14 2024-02-24 2024-03-04 2024-03-14 2024-03-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.22

© 2024by Vishwakarma N, Singh R, Srivastava S, Shrivas 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].

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Nidhi Vishwakarma et al. Ayurvedic management of Gridhrasi (sciatica)

Introduction

Sciatica is a disease of musculoskeletal system in which pain goes down the leg from the lower back. This pain goes down the back, outside, or front of leg. Most of the times symptoms are only on one side of the body. Weakness or numbness may occur in various parts of the affected leg and foot. It is caused due to irritation, inflammation and compression of the sciatic nerve,[1] which branches from your lower back through your buttocks and reaches down each leg. Most of the cases of sciatica are due to spinal disc herniation on pressing one of the lumbar or sacral nerve roots. Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors and pregnancy are other possible causes of sciatica. Sciatica are most common during peoples 30s and 50s and men are more frequently affected than women.[2] The disorder seems to apparently non serious but it cripples the patient. Science of Ayurveda had identified this long back, categorized it among Nanatmaja Vata Vyadhi[3] (disease caused by aggravation of Vata) and named it Gridhrasi. The word itself suggests the gait of the patient which is similar to Gridha (vulture) due to pain. Gridhrasi is characterized by Stambha (stiffness) Ruka (pain) Toda (pricking pain) and Spandana (tingling sensation).

These symptoms initially effects Sphika (buttocks) and lower back and then gradually radiates to posterior aspects of Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot)[4] Interestingly the diagnostic criteria i.e. SLR test is similar to that of Sakthiutkshepa Nigrah (unable to lift leg).[5] The disease might appear as non-serious but it cripples the person completely, this shows the importance of effective treatment from the symptoms of Sciatica.

Case Report

A 60 years-old male patient (O.P.D.No.20230047030 ) was apparently normal before 7 years. Gradually he started to suffer severe lumber pain which was radiating from lumber to left leg along with difficulty and pain while walking and sitting, heaviness in both legs, stiffness in lumber region. Patient took allopathic treatment but the patient got only temporary relief. One month ago due to the heavy weight lift, the symptoms aggravated and the pain started to radiate to b/l lower limbs with paraesthesia.

After seeking advice to orthopaedic surgeon, he was advised for surgery. But patient was not willing for the surgery. So, the patient came to Kayachikitsa OPD of Pt. Khushilal Sharma Ayurveda Hospital on date 27/07/2023.Then patient got admitted on 03/08/2023 for further Ayurvedic management.

Physical Examination

  • General condition - Moderate, Afebrile
  • Pulse rate - 76/min
  • P. - 120/80 mmHg
  • Respiration rate - 18/min
  • Straight Leg Raise Test - Right leg - 60 +ve, Left leg - 30 +ve

Investigation

MRI Lumbosacral

  • Reduced lordosis
  • Changes of spondylosis and desiccation of lumbar disc.
  • Soft tissue lumbar canal stenosis from L1 to L5 levels contributed by posterior osteophytes posteriorly protruding lumbar disc, hypertrophied ligaments and facets, this is more prominent at L3 and L4 levels. Encroachment of both L2-3, L3-4 and L4-5 foramina is noted. Compression of descending and exiting nerve roots at multiple levels is likely.

Diagnosis : Gridhrasi (Sciatica)

Table 1: Grading of the symptoms

SNSubjective symptomsParametersGradation
1.Pricking painAbsent
Mild
Moderate
Severe		0
1
2
3
2.Pulling painAbsent
Mild
Moderate
Severe		0
1
2
3
3.StiffnessAbsent
Mid
Moderate
Severe		0
1
2
3
4.Tenderness of sciatica nerveAbsent
Mild
Moderate
Severe		0
1
2
3

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Nidhi Vishwakarma et al. Ayurvedic management of Gridhrasi (sciatica)
SNSubjective symptomsParametersGradation
5.SLR Scoring0
10
20
30
40
50
60
70
80
90		9
8
7
6
5
4
3
2
1
0
6.Pressing powerUpto 10 kg
10-20 kg
20-25kg
>25kg		3
2
1
0
7.Walking speed time taken to cover 60 stepsUpto 20 sec
21-40 sec
41-60 sec
>60 sec		0
1
2
3
8.Sensory ImpairmentAbsent
Mild
Moderate
Severe		0
1
2
3
9.Posture§ No complaints
§ Patient walk without difficulty but experienced difficulty from getting up from squatting posture
§ Difficulty to squat
§ Difficulty in climbing up stairs
§ Limping gait
§ Can stand on both limbs but with pain
§ Can stand without touching the effected limb on floor
§ Can sit on bed without support but with pain and difficulty
§ Lying on bed with pain affected limb flexed by supportive pillows		0
2
3
4
5
6
7
8
9

The Rolland Morris Low Back Ache and Disability questionnaire[6]

Treatment Module

Patient was given following Panchakarma treatment for 16 days

1. Kaal Basti : Erandmooladi Niruha Basti - 400ml

2. Sahchar Tail Anuvasan Basti - 100ml

3. Adhrang Abhyang with Vatshaamak oil and Adhrang Swedana with Dashmool Along with the following oral medication:

a) Cap Lumbagest - 2 bd

b) Rheumat - 90 liquid - 10ml bid

c) Tab Rasrajeshwara Rasa - 1 bd along with the physiotherapy.

Result

Patient got marked improvement from the disease after 16 days of complete treatment. Following are the BT, AT recordings of the patient.

Table 2: Showing percentage of relief in symptoms

SNSymptomsScore BTScore ATPercentage of Relief
1.Pricking pain3166.67%
2.Pulling pain30100%
3.Stiffness pain30100%
4.Tenderness of sciatic nerve30100%
5.SLR - Rt. Leg
Lt. leg		3
6		0
0		100%
100%
6.Pressing power3166.67%
7.Walking speed3166.67%
8.Sensory impairment30100%
9.Posture9444%

Table 3: Showing percentage of relief

SNScaleScore BTScore ATPercentage of Relief
1.Rolland and Morris low back pain and disability questionnaire (RMQ)39782.1%

Discussion

In this patient from history and clinical examination it was clear that there is severe aggravation of Vata, hence Vata Hara treatment with Vata Hara drugs is used.

Sarvanga Abhyanga with Vatshamak Taila - Abhyanga has been praised as Vata Shamaka by Acharya Shushrut. Also, according to Charaka, Vayu dominates Sparshaendriya, and Abhyanga is extremely beneficial for Vata Vyadhi as per Charaka.[7] According to Dalhana, Sneha reaches to Majja Dhatu, when Abhyanga is done for 900 Matra. In Gridhrasi, Asthi Majja Vaha Strotas Asthi get disturbed, Sneha strengthens Srotas and pacify increased Vata Dosha at the site of affliction.

Sarvanga Nadi Swedana with Dashmool Kwatha - Swedana is Vatahara, cures stiffness, heaviness and is best treatment considered to relieve pain. Swedana with Dashmool Kwath[8]


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which is Ushna Virya, Guru and Snigdha helped in relieving symptoms of Vata like pain and stiffness in the patient.

Effect from Anuvasana Basti: Anuvasana Basti will retain the oil for a specific period without causing any adverse effect. It protects Pureeshadhara Kala by giving Snehana effect. Tila Taila having Ushna Veerya and Guru, Snigdha Guna[7] combats Ruksha and Laghu Guna of Vata[8] which in turn does Vata Shamana.

Effect from Niruha Basti - Madhu having Yogavahi and Sukshma Marga Anusarita[9] property acts as catalyst and penetrates into the Sukshma Srotas. Saindhava Lavana having Laghu and Tridosha Shamaka Guna[10] was added to it. Sneha Dravya, Taila having Ushna Veerya, Snigdha Guna[11] combats Ruksha and Laghu Guna of Vata,[12] which in turn causes Vata Shamana. Kalka is the main drug, which gives potency to the whole combination. It helps to disintegrate the Malas. Kwatha does Anulomana and Nirharana of Doshas. Erandamula Niruha Basti is Vataghna and is indicated in Jangha, Uru Pada, Prushta Shula Hara.[13] Eranda being main ingredient, has Snigdha, Sukhsma and Teekshna properties does Srotoshodhana and thus acts as Vatahara, Balya and Vedhanasthapana.[14] Hence considering the properties of all the ingredients, Erandamooladi Basti is effective in treating Gridhrasi.

Conclusion

The present study with Erandmoolaadi Basti (Kaal Yoga) along with some supportive oral medication and physiotherapy proved to be effective in reducing Lakshanas of Gridhrasi and has shown good results in assessment parameters taken into consideration. The study suggests that the above-described treatment can be taken as better choice of treatment in the management of Gridhrasi vis-à-vis Sciatica. The study can be taken up for further study on large scale.

References

1. Kavita, Santosh Kumar Bhatted. Management of Gridhrasi w.s.r to Acute Sciatica through Panchakarma treatment. International Journal of Ayurveda and Pharma Research. 2019;7(5):60-63

2. Stanley J. Swierzewski, Remedy health media. sciatica overview; available at

www.healthcommunities.com

3. Brahmanand Tripathy. Agnivesh Charaka Samhita, Sutra sthana, Chaukhamba Prakashan Varanasi, 2016.20/11 p. 390.

4. Brahmanand Tripathy. Agnivesh Charaka Samhita, sutra sthana, Chaukhamba Prakashan Varanasi, 2016.20/11 p.390.

5. Bhrahmanand Tripathy. Vagbhatta Ashtang Hriday. Nidana Sthana Chaukhamaba Sanskrit Sansthan, Varanasi. 2003.15/54, p.544.

6. Roland Morris Disability Questionnaire website www.rmdq.org accessed on June 2019.

7. Kashinath Pandey, Gorakhnath Chaturvedi, Agnivesh Charaka Samhita, Sutra Stahana, Chaukhamba Prakashana, Varanasi, 2003. 5/85, 86, 87, p.169.

8. Yadav ji Trikam ji, Ayurved Deepika Commentary of Chakrapani, Charak Samhita, Chikitsa Sthana, Chaukhamba Prakshan Varanasi, 2000.28/144, p623

9. Agnivesha, Charaka, Drudabala, Chakrapanidatta. Sutra Sthana, Chapter 27, Verse. 286. In: Acharya Y T(Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition, 2011. Varanasi: Chowkhamba Surabharati Prakashan: 2011.p.169.

10. Vagbhata, Astanga sangraha with the sanskrit commentary Sasilekha by Indhu, edited by; Dr. Shivprasad Sharma, chaukhambha Sanskrit series office, Varanasi, Sutra sthana, 6th chapter, shloka 92.

11. Astanga Sangraha with the commentaries of Sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri, edited by; Pandit. Bhishgacharya Harishastri Paradkar Vaidya, Chaukhambha Orientalla, Varanasi, Reprint 2015, Sutra sthana, 6thchapter, Shloka 92.

12. Agnivesha, Charaka, Drudabala, Chakrapanidatta.Sutra Sthana, Chapter 27, Verse.300. In: Acharya Y T(Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition, 2011. Varanasi: Chowkhamba Surabharati Prakashan: 2011.p.170.

13. Agnivesha, Charaka, Drudabala, Chakrapanidatta. Sutra Sthana, Chapter 27, Verse. 286. In: Acharya Y T(Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition,


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2011. Varanasi: Chowkhamba Surabharati Prakashan: 2011.p.169.

14. Vagbhata, Astanga Sangraha with the commentaries of sarvangasundara of Arunadatta and Ayurvedarasayana of Hemadri, edited by; Pandit. Bhishgacharya Harishastri Paradkar Vaidya chaukhambha orientalla, Varanasi, Reprint 2015, Sutra sthana, 1st chapter, shloka 10.

15. Agnivesha, Charaka, Drudabala, Chakrapanidatta. Siddhi Sthana, Chapter 1, Verse.40. In: AcharyaY T(Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition, 2011. Varanasi: Chowkhamba Surabharati Prakashan: 2011.p.684.

16. Agnivesha, Charaka, Drudabala, Chakrapanidatta. Sutra Sthana, Chapter 27, Verse. 297. In: Acharya Y T(Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition, 2011. Varanasi: Chowkhamba Surabharati Prakashan: 2011.p.170


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