E-ISSN:2456-3110

Review Article

Gridhrasi

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Conceptual study of Gridhrasi with special reference to Sciatica

Chauhan S1*, Ram M2, Jaiswal RT3, Dubey R4
DOI:10.21760/jaims.9.7.25

1* Simran Chauhan, Post Graduate Scholar, Department of Samhita and Siddhanta, Government Pg Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India.

2 Manohar Ram, Reader and HOD, Department of Samhita and Siddhanta, Government Pg Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India.

3 Ramnihor Tapsi Jaiswal, Reader, Department of Samhita and Siddhanta, Government Pg Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India.

4 Rameshkant Dubey, Reader, Department of Swasthavritta, Government Pg Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India.

It has been observed that Katishoola or Lower backache has become a common problem in middle and old age people. The causes of lower backache may be neurological, metabolic, degenerative, traumatic, bad posture, or restless lifestyle. Gridhrasi or Sciatica is one of the reasons for backache so a person cannot sit and walk properly. In this disease person walks like Gridhra and his legs become curved and tense. It is mentioned in Vataj Nanatmaja Vyadhi in various Ayurvedic Samhitas where the course of the Sciatic nerve corresponds to Pratyatma Lakshana of Gridhrasi.

Keywords: Gridhrasi, Sciatica, Lumbar spondylosis, Vataj Nanatmaja Vyadhi, Katishool, Marma

Corresponding Author How to Cite this Article To Browse
Simran Chauhan, Post Graduate Scholar, Department of Samhita and Siddhanta, Government Pg Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India.
Email: 		Chauhan S, Ram M, Jaiswal RT, Dubey R, Conceptual study of Gridhrasi with special reference to Sciatica. J Ayu Int Med Sci. 2024;9(7):166-170.
Available From
https://jaims.in/jaims/article/view/3512

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-17 2024-05-27 2024-06-14 2024-06-20 2024-06-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.33

© 2024by Chauhan S, Ram M, Jaiswal RT, Dubey Rand 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)166
Simran C et al. Conceptual study of Gridhrasi with special reference to Sciatica

Introduction

The term Gridhra means Eagle, a bird and the term Gridhrasi means that the patient has the gait of Gridhra or Eagle. i.e., the eagle which walks with a limp, without lifting a leg. There is also another reason, where the Gridhrasi Nadi is curved similar to the nose of Gridhra i.e., eagle, since the disease involves the Nadi, it is also named Gridhrasi. Ringhini This term is used by Vachaspati Misra while commenting on Gridhrasi in Madhava Nidana. This term indicates the prolapse of the lumbar intervertebral disc material. Radhina, this term is used by Kashiram in his Gudarthadhadeepika commentary on Sarangadhara Samhita. It indicates pressing, compressing or destroying; hence the use of these synonyms indicates the pathophysiology of Gridhrasi.

Gridhrasi is a Vata Vyadhi characterized by Stambha (stiffness), Toda (pricking pain), Ruk (pain) and Spandana (frequent tingling). These above-mentioned Lakshana initially affect Sphik (buttock) as well as the posterior aspect of Kati (waist) and then gradually radiate to posterior aspects of Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot).

It has been observed that lower backache is more common in the second decade, and disc disease and disc herniation is more common in the third and fourth decade. According to the modern view. The usual history of lumbar disc herniation is of repetitive low back pain, radiating to the buttocks and decreased by rest. Radiculopathy refers to pain in the distribution of the Sciatic nerve and is caused due to disc herniation, called Sciatica.

Sciatica is one such disease that is gaining Prevalence in the present scenario. The Prevalence of Sciatica symptoms reported in the literature varies considerably ranging from 1.6% in the general population to 43% in selected working population. Lifetime Incidence of low back pain is 50-70% with Lifetime Incidence of Sciatica more than 40%. However, clinically significant Sciatica occurs in 4-6% of the population.

Aim and Objectives

To collect various references from the Ayurvedic classical text on Gridhrasi and modern textbooks on Sciatica. To compile the pathophysiology of Gridhrasi concerning Sciatica.

Materials and Methods

Ayurvedic classical texts of Brihatrayi, Laghutrayi and modern textbooks are referred to and gathered about the pathophysiology of Gridhrasi concerning Sciatica.

Review of Literature

Disease review on Gridhrasi

Charak Samhita

Charaka in Chikitsa Sthanam, mentioned Gridhrasi where initially pain arises from Sphik and radiates along with Kati, Prista, Uru, Janu, Jangha, and Padam. He mentioned two types of Gridhrasi -

Vataja Gridhrasi is characterized by Ruk, Toda, Stambha, Muhuspandanam

Vata-Kaphaja, characterized by Tandra, Gaurava, Arochaka

Acharya Sushruta

In Gridhrasi when the ligaments of heels and toes are afflicted with Vata, causes difficulty in lifting the leg.

Acharya Vagbhata

Vagbhata has mentioned that tendons in the heel and greater toe are afflicted with vitiated Vata, thereby making it difficult to lift the leg is known as Gridhrasi.

Vriddha Vagbhata also opines the same as above.

Bhavaprakasha

Bhavamishra has explained Gridhrasi as, the pain initially starts in Sphik and gradually radiates to Kati, Uru, Prishta, Janu, Jangha and Padam. He also mentioned rigidity or stiffness of the lower limb, throbbing pain, dragging pain and repeated twitches are the symptoms of Gridhrasi. The two types mentioned by him are Vataja and Vata-Kaphaja.

Yogaratnakara

Yogaratnakara explained that initially, it affects the Sphik and then radiates to Kati, Prista, Janu, Jangha and Padam causing stiffness, pricking pain and repeated twitching in the affected parts in Vatavyadhi Addhyaya 5. It is of two types Vata and Vata-Kapha.


J Ayu Int Med Sci 2024;9(7)167
Simran C et al. Conceptual study of Gridhrasi with special reference to Sciatica

In the case of the Vataja type, there is pricking pain, bending of the body, severe twitching, and numbness of the knee, waist and thigh joints. In the case of the Vata-Kapha type, there is a feeling of being covered with a wet cloth, depletion of digestive fire, drowsiness, excessive salivation and aversion to food.

Basavarajeeyam

The author Basavaraju had mentioned Gridhravata Lakshana as Shopha, Karapada Vidaha, Sweda, Murcha, Bhrama, Trshna. The author had specifically described an exclusive feature known as “Skalanam”.

Nidana (etiology) of Gridhrasi

In the case of Gridhrasi specific Nidana has not been mentioned. So causative factors mentioned in producing Vata Vyadhi’s are considered as Nidana of Gridhrasi also. Since Gridhrasi is considered a Nanatmaja type of Vata Vyadhi, provocative factors of Vata can also be taken as causes of Gridhrasi. All etiological factors of Vata Vyadhi as well as Vata Prakopa are taken as Nidana of Gridhrasi & same is elaborated in following subtitles

1. Aharaja Nidana
2. Viharaja Nidana
3. Manasika Nidana
4. Anya Hetuja

Aharaja Nidana

Ruksha, Sheeta, Laghu Anna, Alpa Anna, Katu, Tikta, Kashaya Rasa, Langhana, Abhojana.

Viharaja Nidana

Ativyayama, Ativyavaya, Atiprajagara, Vishama Upachara, Plavana, Atiadhava, Diwaswapna, Vegadharana etc.

Manasika Nidana

Chinta, Shoka, Krodha & Bhaya

Anya Nidana

Ati Asruk Sravana, Dhatukshaya, Varshartu, Marmabhighata, Margavarana, Rogatikarshana etc.

Purvarupa

Purvarupa of Gridhrasi In classics, the description of theis not available. Acharya’s has mentioned that Avyakta Lakhana is the Poorvaroopa of Vata Vyadhi.

Chakrapanidatta commenting on word Avyakta mentions that few mild symptoms are to be taken as Poorvaroopa. So, symptoms of Gridhrasi like Ruk, Toda, Stambha & Spandhana are seen in mild form.

Rupa

Ruk, Toda, Stambha and Muhuspandana are cardinal symptoms. To be more precise about track of pain, pain starts at Sphik Pradesh and then radiates to Kati, Pristha, Uru, Janu, Jangha and Pada in order. In Vata-Kaphaja Gridhrasi there is Tandra, Gaurava, and Arochaka. ‘Sakthikshepanigraha’ is also one of the predominant signs seen in Gridhrasi told by our Acharya.

In relation to Dosha

Gridhrasi is considered to be one of the 80 Nanatmaja Vata Vyadhis. Among all Tridosha Vata possesses quality of movement. Sushruta describes word Vata as derived from ‘VA' which signifies Gati (motion or movement). The word Praspandana i.e., movements of body is governed by function of Vata, here this function specifically implies Vyana Vata. The Vyana Vata is responsible for Prasarana (extension) and Akunchana (flexion). Sushruta made fundamental observation that in the process of disease in Kriya Kala had observed that Vata plays a major role in the Prasarana stage of Kriya Kala. In the pathogenesis of Gridhrasi, there is derangement of Vata leading to difficulty in lifting legs which are mentioned by Sushruta and Vagbhata as Sakti Utshepa.

In relation to Samprapti

The disease in view of Shatkriyakala, there are stages of Vyadhi which are Sanchaya, Prapkopa, Prasara, Sthanasamshraya, Vyakta and Bheda. When we see Gridhrasi mentioned under Vata Vyadhi the predominant Dosha involved here is Vata and Anubandha is Kapha. There are two main reasons by which Vata gets vitiated which are Dhatukshaya and Margavarodha. In Gridhrasi. Depending on the Nidana whether it is Dhatukshayajanya Nidana like Ativyavaya (excess sexual activity), Atiprajagara (staying awake at night), Ativyayama (excessive exercise), Ativicheshta (working excessively), Dukkha Shayya or Asana (uncomfortable posture while sleeping) would lead to Dhathukshaya and Margavarodhajanya Vikara like Vishamashana (untimely diet), Adhyashana (overeating),


J Ayu Int Med Sci 2024;9(7)168
Simran C et al. Conceptual study of Gridhrasi with special reference to Sciatica

Viruddhabhojana (incompatible food), Bhuktam-jeerna (eating immediately after meals ) would lead to obstruction of movement of Vata by Kapha producing symptoms of Vata Kapha Gridhrasi as Tandra, Aruchi and Gaurava.

In relation to Rogamarga

The Vyadhi occurs and progresses in a certain pathway which is called to be as Rogamarga. Depending upon the organ involved, based on anatomical and physiological aspects it is classified as Bahya, Madyama and Abhyantara. These signify the origin of the Vyadhi. The Madyama Rogamarga involves anatomical structures like Marma, Asthi, Sandhi, Snayu, and Kandara which are involved in the Vyadhi of Gridhrasi.

In relation to Marma

Sushruta mentions that trauma on the Kukundara Marma (lumbar area of the vertebral column) leads to sensory and motor loss of lower limbs and leads to Vaikalyata (disability) which is observed as numbness and difficulty in lifting the leg.

Kukundara Marma is located on either side of Prushta Vamsha (lower back of the spine) positioned over the outer part of the Jaghana Parshwa (lateral part of ilium bone or gluteal muscle). Kukundra Marma is classified into one Prushta Gata Marma and second as Sandhi Marma which is predominantly made of Sandhi i.e., bony joints. The Snayu, Sira, Ashti, and Mamsa are also present but in lesser proportion. It is a Vaikalyakara Marma, therefore injury to this Marma leads to Kaya Chesta Upaghata (dysfunction in the movement of the body) and Sparsha Ajanam (loss of sensation) which is observed in the disease of Gridhrasi.

In Relation with Upadhathu

Asthi Samyogah Tatra Upanibaddha Ca Snayuh, due to the support of Snayu all the joints sustain the body weight. In Gridhrasi the Kandaras are vitiated by the Doshas. Charaka explains that Kandaras are Updhatu of Raktha Dhathu. Chakrapani mentions that Kandara may also be taken as Sthula Snayu. Snayu is Mula Sthana of Mamsa and Updhathu of Meda.

Pathogenesis of Sciatica

In the pathogenesis of Sciatica acute lumbar disc herniation is often precipitated by trauma, usually by lifting heavy weight or a fall.

The nucleus pulposus may bulge or rupture the annulus fibrosa, giving rise to pressure on the nerve exiting from the lower vertebral column and in spinal ligaments. The altered mechanic of the lumbar spine results in loss of lumbar lordosis and spasm of the paraspinal musculatures. The root pressure on the nerve limits the flexion of the thigh on the affected side where the straight Leg raised test is positive which is mentioned as a feature of Sakthi Utkshepa.

Acharya Charaka mentions the Pratyatmika Lakshana of Gridhrasi where pain arises from Sphik and travels along with Kati, Prista, Uru, Janu, Jangha, Padam which is clinically noticed along the course of sciatic nerve where it takes its root from L4 to S3, leaving the pelvis and enters the gluteal region via greater sciatic foramen. It emerges inferiorly to the piriformis muscle and descends in an inferolateral direction innervating the muscles of the posterior thigh, and hamstring portion and indirectly innervating its terminal branches to all muscles of the leg and foot. Thus, mentioned in classical texts.

Gridhrasi is mentioned under the Vata Vyadhi in Brihatrayi and Laghutrayi. It may be compared best with sciatica in modern terms. In Ayurveda, the pathophysiology of this disease involves Vata as Pradhana Dosha. The development of the spine starts from the third week of intrauterine life and continues till the third decade of life. The area between the Lumbar vertebral bodies and sacral vertebral bodies is a transitional zone at increased risk of injury due to the bio-mechanics that occur between these regions. Separating each vertebral body of the spine are pads of fibro cartilage-based structures that provide support, flexibility and minor load. A healthy intervertebral disc maintains a certain level of pressure which is called intra- discal pressure above this the nucleus pulposus prolapse and compresses exiting nerves from adjacent sides causing features of sciatica which can be compared with Pratyatmika Lakshana of Gridhrasi.

Conclusion

All the Ayurvedic classics have mentioned describing the Vyadhi Gridhrasi. The description of this Vyadhi is missing in Bhela Samhita and Kashyapa Samhita. There has always been a struggle in comparing the pathophysiology in view of modern books and with Ayurvedic classical text.


J Ayu Int Med Sci 2024;9(7)169
Simran C et al. Conceptual study of Gridhrasi with special reference to Sciatica

Gridhrasi being Nanatmaja Vikara of Vata Dosha which responsible for Gati is hampered. In Sciatica, functional movement of Lumbar is restricted & clinical features & pathogenesis of Gridhrasi can correlated with modern view of Sciatica.

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