E-ISSN:2456-3110

Research Article

Sciatica

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

To evaluate the effect of Marma Chikitsa in the management of Gridhrasi (Sciatica)

Gupta R1*, Marwaha R2, Gupta P3
DOI:10.21760/jaims.9.4.4

1* Rahul Gupta, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurveda Institute, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, Professor and HOD, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurveda Institute, Bhopal, Madhya Pradesh, India.

3 Pankaj Gupta, Reader, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurveda Institute, Bhopal, Madhya Pradesh, India.

The uniqueness of Ayurveda is been scrutinized, analysed and then researched by its followers from the ancient time up to till date but it’s an endless procedure. Acc. to Ayurveda the whole human body is explained by itself but as it’s a modern era so we have to correlate each and every Ayurvedic concept with the modern science this study has been taken to correlate Ayurveda has classified the vital points in the body into 107 and named them Marma according to Acharya Sushruta Marma is constituted by confluence of Mansa (muscle), Sira (vessels), Snayu (nerves, tendons and ligaments), Asthi (bone) and Sandhi (joints). Ayurveda is an ancient health science devoted to the cure on human suffering and for the care of the health of the people. The lifetime prevalence of low back pain has been reported between 60% to 80%. By contrast, the life time prevalence of sciatica is between 2% and 4%. According to Acharya Charaka, two types of Gridhrasi have been listed Vataj and Vatakaphaja Gridhrasi is a Shula Pradhana Vata Nanatmaja Vyadhi which is characterized by the Kramat Shula in the Prushtha Bhaaga of Sphik, Kati, Uru, Jaanu Jangha and Pada Pradesha.

Keywords: Gradhrasi, Sciatica, Kshipra Marma, Gulpha Marma, Marma Chikitsa

Corresponding Author How to Cite this Article To Browse
Rahul Gupta, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurveda Institute, Bhopal, Madhya Pradesh, India.
Email: 		Gupta R, Marwaha R, Gupta P, To evaluate the effect of Marma Chikitsa in the management of Gridhrasi (Sciatica). J Ayu Int Med Sci. 2024;9(4):29-32.
Available From
https://jaims.in/jaims/article/view/3270

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-05 2024-02-15 2024-02-25 2024-02-05 2024-03-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 22.88

© 2024by Gupta R, Marwaha R, Gupta Pand 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 2024;9(4)29
Rahul Gupta et al. Evaluate the effect of Marma Chikitsa in the management of Gridhrasi

Introduction

In Ayurveda, health is not only the absence of sickness. A person has to be mentally and spiritually content in order to be healthy. 'Roga' is the name for a Doshic equilibrium imbalance Vata is the cause of all ailments and Cheshta in the Tridosha. A Marma point is, by definition, a junction on the body where two or more types of tissue, such Mamsa, Sira, Snayu, Asthi and Sandhi, converge knowledge of Marma science has been applied to both medicine and combat, in addition to being employed for therapeutic purposes through yoga and other practices. Marma Chikitsa is praised for treating a wide range of conditions, from minor illnesses to severe neuromuscular disorders. Due to its preventative, promotive, prophylactic, rejuvenating, and radical curative capabilities, Marma Chikitsa is a particularly special therapeutic technique The practice of Marma Chikitsa involves treating extremely specific critical areas. Marma Chikitsa is a therapeutic method that combines non-invasive treatment with sophisticated clinical therapy. It may be used as self-treatment. When used properly, Marma Chikitsa is drug-free, affordable, quick to accept, and nearly without adverse effects. After receiving sufficient instruction, self-practice is also advised.

Gridhrasi is classified as a Vatavyadhi in Ayurveda, and it is also held that Vata must always be present for any kind of pain to exist. Our Acharyas provided many unique therapeutical treatments for certain diseases in the Ayurvedic texts in addition to countless medications Gridhrasi is correlated with Sciatica in modern medicine. In Sciatica, there is pain in the sciatic nerve's distribution, which starts in the buttock and extends down to the back of the thigh, the calf, and the outside of the foot.

Pain is the prime symptom of Vatavyadhis, which is divided into Samanyaja and Nanatmaja, according to Charaka Samhita. Even though there are 80 different varieties of Nanatmaja Vatavyadhi, Gridhrasi occasionally appears as Kaphanubandha. The name of the condition suggests the vulture-like stance used by sufferers in response to excruciating agony, therefore it is apparent that this illness not only causes pain but also makes movement difficult, which is highly upsetting and distressing to the patient. Despite the disease's presence in the leg, it interferes with the patient's everyday activities and quality of life as a whole.

Objective of the study

1. To review the literature on concept of Marma and Marma Chikitsa.

2. To explore in brief the surrounding and underlying anatomical structures at the site of Gulpha and Kshipra Marma used in Marma Chikitsa.

3. To study the Gridhrasi in detail in Ayurveda classics and Gridhrasi (Sciatica) in modern science.

Materials and Methods

Source of data

A total 30 patients of Gridhrasi (Sciatica) were randomly selected for the present study, from the OPD and IPD Sections of different Departments of Pt. Khushilal Sharma Govt. (Autonomous) Ayurved College & Hospital, Bhopal, Madhya Pradesh. The cases were chosen at random, independent of age, gender, employment or socioeconomic status.

Method of data collection

Data of the patients who complied with the inclusion criteria was collected. Before starting the treatment their informed consent, demographic details were filled in a detailed Proforma.

Diagnostic Criteria

Special proforma incorporating classical signs and symptoms of Gridhrasi (Sciatica) will be prepared.

1. Pain starting from Sphik and radiating towards Kati (Lumber), Prasthoru (Posterior of thigh), Janu (Knee joint), Jangha (Calf), Pada (Foot) in descending order.

2. Walking time

3. SLR test.

Inclusion Criteria

1. Patients of either sex in the age group of 20 to 60 years.

2. Clinical presentation of Gridhrasi

3. Positive SLR test

4. Tenderness of the Sciatic Nerve course.

5. Severe pain on squatting.

Exclusion Criteria

1. Age group below 20 yrs. and above 60 yrs.


J Ayu Int Med Sci 2024;9(4)30
Rahul Gupta et al. Evaluate the effect of Marma Chikitsa in the management of Gridhrasi

2. Any traumatic conditions of spine and hip.

3. Fracture related to spine.

4. Previous surgical or medical history.

5. Pregnant women & lactating women.

6. Balyavastha (Very Young), Sthavir (Very Old), Ruksha (Perched Man), Kshata (Wounded), Kshina (Debilitated Person), Bhiru ( Timid), Parishrant (Tired).

Study design

Poorva Karma

  • A patient who was considered fit for procedure was prepared accordingly.
  • Patients were briefed about the Marma Chikitsa to make them aware about the process.
  • Written Consent of the patients was taken.
  • Patients were advised to relax for 5- 10 minutes.

Pradhana Karma

After proper positioning of the patient in lying posture, the specified two Marma points was located by palpation as per the protocol. The rhythm of stimulation was same as the rhythm of respiration that is approximately 18 times per minute. The digital pressure is applied as per the comfort and threshold of patients. The Marmas are located & manipulated on following locations.

Pashchat Karma

  • After Marma Chikitsa patient will be under observation for 15-20 minutes.
  • Proper instructions to the patient like to avoid unnecessary activities of the affected leg is given.

Result

This clinical study to evaluate the effect of treatment in the management of Gridhrasi (Sciatica) was a Randomized Control trial between two groups. The registered study participants were randomly divided into two groups. Group-A patients were administered Marma Chikitsa, and Group-B patients were administered with Placebo (Roasted Wheat Flour capsule) The pre-treatment and post-treatment observations are subjected into statistical

analysis to derive a conclusion regarding the effects of the Marma Chikitsa.

In group-A, 12 (80%) patients showed Moderate improvement with 50-75% change in overall score of the parameters, 01 (7%) patients showed mild improvement with 25-50% change and 02 (13%) of the patients fell in the category of marked improvement, while in group-B, majority of the patients (93%) had no improvement, one of the patients had mild improvement.

Assessment CriteriaGroup AGroup B
No Relief < 25%0014
Mild Relief 25% - 50%0101
Moderate Relief 50% - 75%1200
Marked Relief 75% - 100%0200
Cured (100% improvement in symptoms and no recurrence during follow-up period)0000

Discussion

The most important aspect of any research project is the discussion, which begins with a study of the topic and its relationship to past information and ideas.

Marma is a crucial component of Ayurvedic classics. According to Susruta Samhita, there are 107 Marma points in the human body. Low back pain (LBP) affects millions of individuals worldwide, both acutely and chronically. It is the most frequent musculoskeletal disorder worldwide.

Gridhrasi is a Shoolpradhan Vatavyadhi that pain starts from Sphik (buttock) and then radiates to Kati, Prushta (back), Uru (thigh), Janu (knee), Jangha (calf) and Paada (foot) along with Stambha (stiffness) Ruka (pain), Toda (pricking sensation) and Spandana (twitching) The study sought to determine the effect of Marma Chikitsa on Gridhrasi (Sciatica). Gridhrasi can be effectively managed by Marma Chikitsa. It is incredibly easy, inexpensive, and increases patient happiness The Marma Chikitsa was given in which following Marmas were stimulated is Gulpha and Kshipra.

ParametersGroup AGroup B
Ruka (Pain)71.4%10.6%
Stambha (Stiffness)69%9.7%
Toda (Pricking Pain)68%13.6%
Spandana (Pulsation)48%5%
Suptata (Numbness)72.5%0%
Tandra (Drowsiness)66.6%12.2%
Gaurava (Heaviness)50%11.6%
Arochaka (Anorexia)52%12.2%
SLR71.8%3.6%
Walking Test70.5%6.3%

J Ayu Int Med Sci 2024;9(4)31
Rahul Gupta et al. Evaluate the effect of Marma Chikitsa in the management of Gridhrasi

On comparing the effect of two Groups on the basis of percentage change, Group A (Marma Chikitsa) response was better than Group B (Placebo) in the relief of Gridhrasi (Sciatica). It may be due to the presence of effect of Marma Chikitsa on Vayu which is the main culprit in the disease. This data is a clear indication that Group A has best results than Group B.

Conclusion

The above clinical study was undertaken to study the effect of Marma Chikitsa on Gridhrasi it is regarded as a major Vata Vyadhi (neurological illness) correlated with sciatica. In the present study, Marma Chikitsa works better and faster on Gridhrasi signs and symptoms, causing better outcome compared to placebo. Gulpha and Kshipra Marma used in treatment of sciatica is very effective in the clinical study. Marma and its applied characteristics are detailed in Ayurveda far earlier than its value as Marma Chikitsa, which practitioners found after conducting multiple clinical studies. The approach has progressed as a result of extensive conceptual research and correlation, but the fundamental concepts remain the same.

  • Marma Chikitsa's application in Group - A was effective, inexpensive, did not require hospitalization, and was completed at the OPD level.
  • Marma Chikitsa (Group A) performs statistically much better than Group B in the therapy of Gridhrasi (sciatica).
  • As a result, at the end of this investigation, it is possible to infer that the null hypothesis (H0) is rejected and the alternate hypothesis (H1) is accepted.
  • It has been proven that Marma Chikitsa (Group A) is more successful than Placebo (Group B) in the treatment of Gridhrasi (Sciatica) in the current study

References

1. Yadav ji Trikamji, editor. Caraka samhita of Agnivesa, Sutra Sthana. Ch-18, Verse. 49. Second edition, Varanasi: Chowkhamba Subharti Prakashan; 2023. p. 109.

2. Sushruta, Sushruta Samhita,

Ayurveda-Tattva-Sandipika commentary Edited by Ambikadutta Shastri; Chaukhamba Sanskrit Sansthan Varanasi 2007; Sharira Sthana 6/4, Page no. 50-51.

3. Sushruta, Sushruta Samhita, Ayurveda-Tattva-Sandipika commentary Edited by Ambikadutta Shastri; Chaukhamba Sanskrit Sansthan Varanasi 2007; Sharira Sthana 6/4, Page no.50-51.

4. Jai Shankar Joshi. Halayudhakosha Abhidhanratnamalla. First edition, Varanasi, Uttar Pradesh, 1879.

5. Amarkosh app Nirdeshan Prof Madan Mohan Jha, Rashtiya Sanskrit sansthan, K.J.someya Sanskrit vidyapitham, Mumbai.

6. Yadav ji Trikam ji, editor. Susruta samhita of Susruta, Sharira Sthana. Ch-.06, Verse-13, First edition, Varanasi: Chowkhamba Subharti Prakashan; 2014. p. 370.

7. Shivprasad Sharma, editor. Astangasamgraha of vahata with sasilekha Sanskrit commentary by indu, Sharira Sthana. Ch-07. Verse-59, 3rd edition, Varanasi: Chowkhamba Sanskrit series office; 2012. p. 324.

8. Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

9. Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

10. Shewale AD, Karambelkar RR, Umarji BN. Study of variations in the divisions, course and termination of the sciatic nerve. J Krishna Inst Med Sci Univ. 2013 Jan 1;2(1):62-8.

11. Adibatti M, Sangeetha V. Study on variant anatomy of sciatic nerve. Journal of clinical and diagnostic research: JCDR. 2014 Aug;8(8):AC07.


J Ayu Int Med Sci 2024;9(4)32