E-ISSN:2456-3110

Case Report

Lumbar Spondylosis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Evaluation of the effect of Marma Chikitsa in the Pain Management of Katigraha (Lumbar Spondylosis) - A Single Case Study

Raypure S1*, Marwaha R2, Bhalerao N3
DOI:10.21760/jaims.9.7.53

1* Sneha Raypure, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurved College and Institute, Bhopal, Madhya Pradesh, India.

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

3 Nisha Bhalerao, Associate Professor, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurved College and Institute, Bhopal, Madhya Pradesh, India.

Lumbar Spondylosis (LS) is defined as degenerative condition affecting the discs, vertebral bodies and associated joints of the Lumbar spine. Low back pain affects approximately 60 - 85% of adults and LS is responsible for about 10% of all the back pain conditions.[1] In Lumbar Spondylosis patient often complaint of back pain that increases with movement, is associated with stiffness, and is better with inactivity. A 39 years aged female patient residing at Bhopal, India came to Pt. Khushilal Sharma Ayurvedic Hospital and Institute, Bhopal with the complaint of lower back ache i.e. pain and stiffness in Lumbar region and restricted movement of Lumbar spine for 6 months. In this case study effect of Marma Chikitsa in pain management of Lumbar spondylosis is evaluated. This case study shows that pain in Lumbar spondylosis may be successfully managed by Marma Chikitsa.

Keywords: Lumbar spondylosis, Katigraha, Marma Chikitsa, Vital Points, Lumbar Pain, Back Ache, Orthopaedics

Corresponding Author How to Cite this Article To Browse
Sneha Raypure, Post Graduate Scholar, Dept of Rachna Sharir, Pt Khushilal Sharma Govt Ayurved College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Raypure S, Marwaha R, Bhalerao N, Evaluation of the effect of Marma Chikitsa in the Pain Management of Katigraha (Lumbar Spondylosis) - A Single Case Study. J Ayu Int Med Sci. 2024;9(7):335-338.
Available From
https://jaims.in/jaims/article/view/3296

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-14 2024-05-27 2024-06-07 2024-06-17 2024-06-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.38

© 2024by Raypure S, Marwaha R, Bhalerao Nand 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(7)335
Sneha R et al. Evaluation of the effect of Marma Chikitsa

Introduction

Ayurveda is one of the oldest extant heath system in the world. Among the hidden sciences of India, Marma science is the most important. Marma Sthana is the juncture of Mansa, Sira, Asthi & Sandhi. Marma has described in all three great treatise i.e., Charak Samhita, Sushrut Samhita, and Ashtanga Hridaya. Marma represents the sciences & specific vital points in the body (Marmas), that are the seats of life (Prana) here, Prana is nothing but the source of Urja (energy).[2]

Spondylosis is very commonly found health problem among both rural and urban population. Spondylosis or Osteoarthritic spine disease, typically occurs in later life and primarily involves the Cervical and Lumbosacral spine. In Lumbar Spondylosis patients of Lumbar Spondylosis Often complaint of back pain that increases with movement, is associated with stiffness, and is better with inactivity.

Spondylosis is a form of lower back pain and is an important clinical, social, economic and public health problem affecting world wide popullation. Lower back pain affect all age groups and is very frequent reason for medical consultation. There is no exact clinical entity mentioned in classics like Lumbar Spondylosis but it can be correlated with Katigraha, a disorder of Vata. Vata Dosha or Sama Vata Dosha (Vata Dosha associated with Aama [the toxins released due to altered digestion and metabolism] when afflicts Kati Pradesha (low back) and produce symptoms such as pain with stiffness, then condition is known as Katigraha.[3]

Katigraha has been described as a separate disease by Gadanigraha. It has been categorized under Vataj Nanatmaja Vyadhi in Charaka Samhita as Prishtagraha. Katigraha is Shosha, Stambha and Shula predominant Vyadhi. As correctly said by Acharya Sushruta without vitiation of Vata, Shula (pain) cannot be produced.

Gadanigraha clearly states that pain is produced due to stiffness produced by Saama or Niraama Vayu movement in to Kati hence this suggests of presence of Dhatu Kshayatmaka & Marga Avarodhaka type of Samprapti. Katigraha denotes a group of symptoms characterized by the restriction of movement of Kati (Lumbar) region, which are completely correlated with that of Lumbar Spondylosis.

Case Report

A 39 years aged female patient residing at Bhopal (MP), India came to Pt. Khushilal Sharma Ayurvedic Hospital and Institute, Bhopal (MP), India with complaint of lower back ache i.e., pain and stiffness in Lumbar region and restricted movement of Lumbar spine for last 8 months. Nature of pain is increases with movements and decreases with rest or in supine position. During this period patient took analgesics and anti-inflammatory medicine for pain management but didn’t get relief. She is advised for surgery (spinal fusion) but she doesn’t want to proceed with surgical intervention. To avoid surgical intervention and for pain relief she opted Ayurvedic treatment.

History of Past Illness

No history of hypertension, diabetes mellitus or any other serious illness.

Surgical history: NAD

Personal history

Patient was non smoker, non alcoholic and not having allergy to any drug or food item. No family member had similar problem.

  • Bowel: Constipated
  • Appetite: Normal
  • Micturation: Normal
  • Sleep: Disturbed due to pain.

Clinical findings

At time of examination, patient was found anxious and came by wheel chair. Palpation revealed tenderness at Lumbar region and Muscle spasms were noted at back of thighs during movements of hips. Range of movements was restricted (flexion, extension, lateral bending, rotation etc.) at hip and both of Knee joints. General health of patient was good her pulse was 76/min, BP was 130/90 mm of Hg, and patient was afebrile. There was no tingling, numbness or weakness of muscles in lower extremities. There was no significant finding on lab investigation.

Diagnosis and Assessment

Lumbar spondylosis was diagnosed by presence of pain, stiffness, restricted movements at Lumbar region and by CT scan findings like,


J Ayu Int Med Sci 2024;9(7)336
Sneha R et al. Evaluation of the effect of Marma Chikitsa

disc degeneration in between L5 - S1, spondylolisthesis of L5 over S1 and osteophytes formation at lumbar spine. A criterion of assessment was based on both subjective and objective criteria scoring of Oswestry low back pain disability questionnaire and VAS (visual analogue scale). The Oswestry low back pain disability questionnaire also known as ‘the Oswestry Disability Index’ is an extremely important tool to measure patient’s functional disability and it is considered as the ‘gold standard’ of low back functional outcome tools. This is composed of 10 sections (Questions). Each question is rated on 6 point (0-5) scale measuring activities like, personal care, sleep, social life etc.[4] The visual analogue scale (VAS ) consist of a straight line with the end points defining extreme limits such as - no pain at all and pain as bad as it could be. Patient was asked to mark his pain level on the line between the two end points.

Treatment

The treatment involved administration of Marma Chikitsa. The details of administration are as follows.

Marma Chikitsa

Following Marmas are taken for evaluation of Marma Chikitsa in pain management of Katigraha - i.e., Bruhati Marma, Parshvasandhi Marma, Katiktarun Marma,Kukundar Marma.[5]

Table 1: Marma points stimulated in Katigraha

SNName of the MarmaStimulation timeSittings of Marma chikitsaTotal time period
1.Bruhati Marma0.8secTwo times a day30 days
2.Parshvasandhi Marma0.8secTwo times a day30 days
3.Katiktarun Marama0.8secTwo times a day30 days
4.Kukundar Marma 0.8secTwo times a day30 days

A steady and moderate pressure will be applied slowly and gently. Pressure will be increased gradually depending upon patient strength. During the therapy, therapist was supposed to continuously watch the facial expression of the patients.

Shoola (Pain)

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

Graha (Stiffness)

ParametersGrade
No stiffness0
Some time for 5-10 minutes1
Daily for 10-30 minutes2
Daily for 30-60 minutes/more than 1hrs3

Suptata (Numbness)

ParametersGrade
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

ParametersGrade
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

Observations

ParameterBefore TreatmentAfter treatment
Back pain
Back stiffness
Numbness
Tingling sensation		2
1
2
2		0
0
1
0

Discussion

Spondylosis, also known as spinal osteoarthritis, can affect millions of people globally, leading to chronic pain, stiffness, and reduced mobility. This can have a significant impact on our quality of life. According to Ayurveda, the main etiological factor for Katigraha is vitiated Vata. Marma is related to the Prana which associated with Vata Dosha therefore Marma mainly deals with Vata Dosha and Marma Chikitsa can be especially useful in treating the Vata disorders. Marma Sthana may be regarded as special Pranic switches in the body, which when properly stimulated, can lead to the proper flow of Prana in different body parts, resulting in the desired therapeutic benefits. Prana can be guided to clear obstructions, enhance energy flow, access latent energy stores, and establish links with the higher forces of nature and life by manipulating Marmas.[6] Out of the five forms of Vata Dosha, Vyana Vayu, that is associated with the skin, as well as the movement and circulation of the Prana, can be most closely linked to the Marmas.


J Ayu Int Med Sci 2024;9(7)337
Sneha R et al. Evaluation of the effect of Marma Chikitsa

Thus, stimulation of the Marmas can balance Vyana Vayu and Vata Dosha, resulting in the corresponding healing effect in diseases like Katigraha.[7] Marma therapy not only helps in Vata Vyadhi but also helps to clear channels and improve circulation of body. Lumbar Spondylosis can be treated with nonsteroidal anti-inflammatory drugs or pain relievers, heat or ice applications, and physical therapy. Usually, surgery is considered a last resort for severe cases that do not responds to other treatment options. Use of such treatment doesn’t necessarily show effective results and also have adverse effects. Instant pain relief is motive of Marma Chikitsa, and it is done by relaxing the back muscles, releasing the spasm[8] which ultimately help in decreasing pain of Lumbar Spondylosis.

Conclusion

The case report shows significant improvement. Stimulation of Marma can produce analgesia by secreting a number of prostaglandin inhibitors, endorphins, interferon and other opioid like substances which are hundreds of times more potent than opium.[9] So, if Marma Chikitsa practiced well, can be used as an alternative, nonmedical and non- invasive therapy for pain management of Lumbar spondylosis, and thereby avoiding the side effects of analgesics and surgery.

References

1. Damayanthie Fernando KP, Thakar AB, Shukla VD. Clinical efficacy of Erandamuladi Yapana Vasti in the management of kati graham (Lumbar spondylosis). AYU (An International Quarterly Journal of Research in Ayurveda) 2013; 34: 36. http://dx.doi.org/10.4103/0974-8520.115444.

2. Alka Mishra, Vandana Shrivastava. Exploring the science of Marma – An Ancient Healing Technique – Part 4: Marma Therapy; Department of Ayurveda and Holistic Health, Haridwar, Uttarakhand, India.

3. Tarun Kumar, Rajashekhar V. Sanapeti, B.S.Prasad. Evaluation of effect of Poulties (Upanaha Sweda) in low Back pain (katigraha): A randomized comparative clinical trial Ayu 2019;40;159-63.

4. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000;25: 2940-52. http://dx.doi.org/10.1097/00007632-200011150-00017

5. Sunil Kumar Joshi. Marma Science and Principles of Marma Therapy, New Delhi, Vani Publications, 2019 page- 27.

6. Frawley D, Ranade S, Lele A (2008), Ayurveda and Marma Therapy (1st edition), Chaukhamba Sanskrit Pratishthan, ISBN no. 81-7084-282-4, 96-111(5).

7. Frawley D, Ranade S, Lele A. Ayurveda and Marma therapy. Delhi: Chaukhambha Sanskrit Pratishthan; 2015.

8. Phull G, R. Clinical Approach to Marma Chikitsa. 2nd IP Innovative Publication Pvt. Ltd.; 2019. ISBN: 978-93- 5300-962-5. Р. 188.

9. Sunil Kumar Joshi, Marma science and Principles of Marma Therapy, Edition -2019, Vani Publication page 55.


J Ayu Int Med Sci 2024;9(7)338