To evaluate the efficacy of Agnikarma after Siravyadhana in Pain Management of Gridhrasi w.s.r. to Sciatica: A Randomized Controlled Clinical Trial

Madhuri Suryakant Biradar; Shilpa PN

doi:10.21760/jaims.9.12.4

E-ISSN:2456-3110

Research Article

Sciatica

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 12 DECEMBER

Publisher

www.maharshicharaka.in

To evaluate the efficacy of Agnikarma after Siravyadhana in Pain Management of Gridhrasi w.s.r. to Sciatica: A Randomized Controlled Clinical Trial

Biradar MS^1*, Shilpa PN²

DOI:10.21760/jaims.9.12.4

^1* Madhuri Suryakant Biradar, Post Graduate Scholar, Dept of Pg Studies in Shalyatantra, Government Ayurvedic Medical College, Bangalore, Karnataka, India.

² Shilpa PN, Professor, Dept of Pg Studies in Shalyatantra, Government Ayurvedic Medical College, Bangalore, Karnataka, India.

Gridhrasi, a Vataj Nanatmaja Vyadhi, is characterized by pain (Ruka), pricking sensation (Toda), stiffness (Stambha), and twitching (Muhuspandana) that radiate from the Sphika up to the Pada. This condition corresponds to sciatica in modern medicine. Acharya Shodhala in Gadanigraha recommends Agnikarma as an additional therapy if Siravyadhana alone fails to relieve the pain. Although both treatments are effective individually, their combined efficacy has not been explored. A study was conducted with 40 patients randomly divided into two groups of 20 each at SJGAUH Hospital. In Group A, Siravyadhana was performed at 4 Angula above or below Janusandhi using an 18G needle. In Group B, Siravyadhana followed by Ruksha Agnikarma (Bindu Akriti) at the Padakanisthika region using a Panchadhatu Shalaka. Treatment outcomes were evaluated based on parameters recorded before and after the interventions. The results showed significant improvement in both groups, but Group B demonstrated faster recovery, fewer recurrences, and more complete relief compared to Group A. Thus, the combination of Siravyadhana and Agnikarma provides an added advantage in managing Gridhrasi, offering faster and sustained relief, and aligns with Atyayika Chikitsasutra.

Keywords: Gridhrasi, Siravyadhana, Agnikarma, Sciatica, Panchadhatu Shalaka, Bloodletting, Lower back pain, Radiating leg pain, Thermal microcautery

Corresponding Author	How to Cite this Article	To Browse
Madhuri Suryakant Biradar, Post Graduate Scholar, Dept of Pg Studies in Shalyatantra, Government Ayurvedic Medical College, Bangalore, Karnataka, India. Email:	Biradar MS, Shilpa PN, To evaluate the efficacy of Agnikarma after Siravyadhana in Pain Management of Gridhrasi w.s.r. to Sciatica: A Randomized Controlled Clinical Trial. J Ayu Int Med Sci. 2024;9(12):28-40. Available From https://jaims.in/jaims/article/view/3881

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-11-07	2024-11-18	2024-11-28	2024-12-07	2024-12-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	12.32

© 2024by Biradar MS, Shilpa PNand 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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Download PDF Back To Article Introduction Aim Objectives Materials and Methods Results Discussion Conclusion References

Madhuri SB et al. Efficacy of Agnikarma after Siravyadhana

Introduction

Gridhrasi is a condition mentioned in all Brihatrayees and is included under 80 types of Vataj Nanatmaja Vyadhi. Vatavyadhi mentioned under Astamahagada so, Grudhrasi can be included in it. Gridhrasi consist of features like Ruk, Toda, Stambha, Spandana over Sphik, Kati, Prishta, Uru, Janu, Jangha extending up to Pada in the same sequential order along with Sakti Kshepanigraha.^[1,2] On the basis of symptoms, disease can be correlated with Sciatica in the contemporary science which is caused by the impingement of L4, L5 or S1 nerve and manifests as neuropathic pain extending from the gluteal region down the posterolateral leg to the foot. Sciatica is a relatively common condition with a lifetime incidence varies from 10 to 40% while the annual incidence of an episode of sciatica ranges between 1% - 5%. Peak incidence occurs in patient from 5^th to 6^th decade.^[3]

Risk factor involves strenuous physical activity like heavy weight lifting, driving vehicle for long periods, improper sitting and sleeping postures. Conservative management of sciatica includes administration of NSAIDS, muscle relaxant and corticosteroids which gives temporary relief. In some cases, if nerve compression is more, surgical procedure like Laminectomy, discectomy is indicated but this surgical procedure which are quite expensive with their limitations.^[4]

Ayurvedic management of Gridhrasi includes treatment as:

Bheshaj, Snehana, Swedana, Siravyadhana, Basti and Agnikarma. As Aacharya Sushruta mentioned Siravyadhana and Agnikarma as Atyayika Chikitsa. Siravyadha is accepted as Ardhachikitsa in Shalyatantra like Basti in Kayachikitsa. It is one among panchakarma and one of the most commonly preferred procedure. As Gridhrasi is Aavaranajanya Vyadhi, Siravyadhana helps to remove Srotoavarodha. Also, there is involvement of Dusyakandara in the pathogenesis of Gridhrasi as Kandara is Upadhatu of Rakta. So, Siravyadhana removes Dushita Rakta. References show that the diseases treated with Agnikarma do not recur.^[5]

Aacharya Shodhalakrita Gadanigraha and Chakradatta mentioned Siravyadhana followed by Agnikarma with Panchadhatu Shalaka in the contest of Gridhrasi.

Bindu Aakriti Ruksha Agnikarma at padakanisthika, following Siravyadhana, effectively relieves pain, especially in cases of Atiugra ruja. Ruk and Stambha, the predominant symptoms of Gridhrasi which disturbs the normal routine of the patient are effectively relieved by the Agnikarma.^[6,7] As Agni possess Usna, Tikshna, Sukshma, Aashukari Guna which are opposite to Vata and Kapha. Based on this understanding, the present study investigates the combined effects of these two procedures, following the principles of Atyayika Chikitsa as described by the Acharyas.^[8,9]

Aim

To evaluate effic. of Agnikarma after Siravyadhana in pain management of Gridhrasi w.s.r. to Sciatica: A Randomized Controlled Clinical Trial.

Objectives

1. To evaluate the efficacy of Agnikarma after Siravyadhana’ in the pain management of Gridhrasis.r. to sciatica.
2. To evaluate the efficacy of Siravyadhana in the pain management of Gridhrasis.r. to sciatica.
3. To compare the results of both the groups to ascertain the efficacy of Agnikarma after Siravyadhana in comparison toSiravyadhana.

Materials and Methods

The study was conducted during the period of September 2023 to 2024.

Method of Collection of Data

Total 40 Subjects with clinical features of Ghridhrasi w.s.r. to Sciatica fulfilled the inclusion criteria approaching the Out-Patient Department and In-Patient Department of Shalyatantra at S.J.A.U.H. Bengaluru were randomly selected for the study using method of simple random sampling.

Inclusion Criteria

1. Selection of subject were done irrespective of sex, religion, occupation, economic and educational status.
2. Subject with features of Gridhrasi namely Ruk (continuous pain), Toda (intermittent pricking pain), Stambha (stiffness), Spandana (twitching sensation) over Sphik, Kati, Prishta, Uru, Janu, Jangha extending up to^[1]

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3. Positive SLR test.
4. Positive Bragard’s test.
5. Subject above 18 and below 70 years of age

Exclusion Criteria

1. Subject with any systemic disorder which may interfere with the course of treatment
2. Subject with history of fracture related to spine, Spinal tumour, tuberculosis of vertebra.
3. Pregnant, lactating woman and children.

Study Design

Group: A (20 Subjects)	Group: B (20 Subjects)
Siravyadhana	Siravyadhana followed by Agnikarma.

Intervention

Group A - Siravyadhana

Poorvakarma

Written informed consent of the patient was taken.
Required materials i.e. torniquet, measuring glass, sterile disposable gloves, needle no. 18g, kidney tray, surgical spirit, sterile gauze were collected.
Sthanika Snehana with Murchita Taila followed by Sthanika Swedana was done.
Patient was advised to take Yavagupana 1 hour prior to the procedure.

Pradhanakarma

The site of Siravyadhana was cleaned.
The tourniquet was tied 4 Angula above the Sira.
Siravyadhana was done 4 Angula above or below the ^[10]
A sterile disposable 18G needle with bevel facing upward was introduced into Sira and blood was collected in measuring glass.
The tourniquet was released.
The amount of blood was collected according to Dehabala of patient.

Paschatkarma

The site of Siravyadhana was cleaned with sterile cotton.
Haemostasis was achieved.
Sterile tight bandaging was done.

The patient was advised to elevate the limb.

Group B - Siravyadhana followed by Agnikarma

Assessment criteria

Subjective Parameter

Table 1: Grading for subjective parameters

Description	Grade
1. Ruk (Continuous pain)
No Pain	0
Trivial pain	1
Mild pain	2
Moderate pain	3
Severe pain	4
2. Toda (Pricking Pain)
No intermittent pricking pain	0
Sometimes for 5-10 minutes	1
Daily for 10-30 minutes	2
Daily for 30-60 minutes	3
Daily more than 1 hour	4
3. Stambha (Stiffness)
No Stiffness	0
Stiffness for less than 15 min after sitting for long duration but relived by mild movement.	1
Stiffness more than 1 hour or more than once in a day but routine works are not disturbed.	2
Stiffness lasting for more than 1 hour many times a day mildly affecting the daily routine.	3
Episode of stiffness lasting 2-6 hour or daily routine hampered.	4
4. Spandana (Twitching sensation)
No throbbing at all	0
For few minutes occasionally.	1
Daily once in a day for 10-15 minutes.	2
Many times in a day for few minutes.	3
Daily for many times Severely hampering daily routine.	4

Poorvakarma

The written informed consent was taken.
Siravyadhana was performed on the patient as mentioned, Once the patient was stable after Siravyadhana, Agnikarma was carried.
Required materials: Sterile gauze, sterile disposable gloves, surgical spirit, sponge holding forceps, Panchadhatu Shalaka, Ghrita, Madhu.
Patient was advised to lie down in prone position.

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Pradhanakarma

The Panchadhatu Shalaka was heated to red hot.
Bindu Akriti Agnikarma was performed with the red-hot Shalaka at Padakanishtika (lateral and ventral aspect of little toe) of the affected limb till appearance of Samyaka Dagdha Lakshana.

Paschatkarma

Immediately after Agnikarma, Madhu and Ghrita were applied over the area.

Duration of Treatment

Duration of treatment was 1 day.

Subjective and Objective parameters were assessed before and after the treatment upto 5 days.

Objective Parameter

Table 2: Grading for Objective parameters

Description	Grade
Straight Leg Raising Test - (between 30° to 70°)
Above 70°	0
60 - 70°	1
50 - 60°	2
40 - 50°	3
30 - 40°	4
Bragard’s Test
Negative	0
Positive	1

Results

(Within Group)

1. Ruka

Ranks
Groups				N		Mean Rank			Sum of Ranks
BT	Group A			20		18.50			370.00
	Group B			20		22.50			450.00
	Total			40
H0	Group A			20		21.50			430.00
	Group B			20		19.50			390.00
	Total			40
H6	Group A			20		20.85			417.00
	Group B			20		20.15			403.00
	Total			40
H12	Group A			20		22.45			371.00
	Group B			20		18.55			449.00
	Total			40
H24	Group A			20		21.05			421.00
	Group B			20		19.95			399.00
	Total			40
D3	Group A			20		22.60			452.00
	Group B			20		18.40			368.00
	Total			40
D5	Group A			20		22.00			440.00
	Group B			20		19.00			380.00
	Total			40
Test Statisticsa
		BT	H0		H6		H12	H24		D3	D5
Mann-Whitney U		160.000	180.000		193.000		161.000	189.000		158.000	170.000
Wilcoxon W		370.000	390.000		403.000		371.000	399.000		368.000	380.000
Z		-1.255	-.624		-.220		-1.168	-.336		-1.424	-1.778
P value (2-tailed)		.209	.532		.826		.243	.737		.154	.075
a. Grouping Variable: Groups
b. Not corrected for ties.

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2. Toda

Ranks
Groups			N		Mean Rank		Sum of Ranks
BT	Group A		20		18.45		369.00
	Group B		20		22.55		451.00
	Total		40
H0	Group A		20		20.95		419.00
	Group B		20		20.05		401.00
	Total		40
H6	Group A		20		19.50		390.00
	Group B		20		21.50		430.00
	Total		40
H12	Group A		20		21.50		430.00
	Group B		20		19.50		390.00
	Total		40
H24	Group A		20		21.50		430.00
	Group B		20		19.50		390.00
	Total		40
D3	Group A		20		22.00		420.00
	Group B		20		20.00		400.00
	Total		40
D5	Group A		20		20.50		410.00
	Group B		20		20.50		410.00
	Total		40
Test Statisticsa
		BT		H0	H6	H12	H24	D3	D5
Mann-Whitney U		159.000		191.000	180.000	180.000	180.000	190.000	200.000
Wilcoxon W		369.000		401.000	390.000	390.000	390.000	400.000	410.000
Z		-1.208		-.295	-.628	-.781	-1.041	-1.000	0.000
P value (2-tailed)		.227		.768	.530	.435	.298	.317	1.000
a. Grouping Variable: Groups
b. Not corrected for ties.

3. Stambha

Ranks
Groups		N	Mean Rank	Sum of Ranks
BT	Group A	20	20.15	403.00
	Group B	20	20.85	417.00
	Total	40
H0	Group A	20	22.13	442.50
	Group B	20	18.88	377.50
	Total	40
H6	Group A	20	21.28	425.50
	Group B	20	19.73	394.50
	Total	40
H12	Group A	20	22.88	457.50
	Group B	20	18.13	362.50
	Total	40

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H24	Group A			20		21.88			437.50
	Group B			20		19.13			382.50
	Total			40
D3	Group A			20		21.50			430.00
	Group B			20		19.50			390.00
	Total			40
D5	Group A			20		22.00			440.00
	Group B			20		19.00			380.00
	Total			40
Test Statisticsa
		BT	H0		H6		H12	H24		D3	D5
Mann-Whitney U		193.000	167.500		184.500		152.500	172.500		180.000	170.000
Wilcoxon W		403.000	377.500		394.500		362.500	382.500		390.000	380.000
Z		-.212	-.955		-.469		-1.512	-1.127		-1.433	-1.778
P value (2-tailed)		.832	.339		.639		.130	.260		.152	.075
a. Grouping Variable: Groups
b. Not corrected for ties.

4. Spandana

Ranks
Groups				N		Mean Rank			Sum of Ranks
BT	Group A			20		20.50			410.00
	Group B			20		20.50			410.00
	Total			40
H0	Group A			20		21.25			425.00
	Group B			20		19.75			395.00
	Total			40
H6	Group A			20		20.50			410.00
	Group B			20		20.50			410.00
	Total			40
H12	Group A			20		20.00			400.00
	Group B			20		21.00			420.00
	Total			40
H24	Group A			20		19.50			390.00
	Group B			20		21.50			430.00
	Total			40
D3	Group A			20		20.50			410.00
	Group B			20		20.50			410.00
	Total			40
D5	Group A			20		20.50			410.00
	Group B			20		20.50			410.00
	Total			40
Test Statisticsa
		BT	H0		H6		H12	H24		D3	D5
Mann-Whitney U		200.000	185.000		200.000		190.000	180.000		200.000	200.000
Wilcoxon W		410.000	395.000		410.000		400.000	390.000		410.000	410.000
Z		0.000	-.466		0.000		-.593	-1.433		0.000	0.000
P value (2-tailed)		1.000	.641		1.000		.553	.152		1.000	1.000
a. Grouping Variable: Groups
b. Not corrected for ties.

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5. SLR Test

Ranks
Groups				N		Mean Rank		Sum of Ranks
BT	Group A			20		19.00		380.00
	Group B			20		22.00		440.00
	Total			40
H0	Group A			20		19.00		380.00
	Group B			20		22.00		440.00
	Total			40
H6	Group A			20		22.10		442.00
	Group B			20		18.90		378.00
	Total			40
H12	Group A			20		20.83		416.50
	Group B			20		20.18		403.50
	Total			40
H24	Group A			20		22.25		445.00
	Group B			20		18.75		375.00
	Total			40
D3	Group A			20		22.10		442.00
	Group B			20		18.90		378.00
	Total			40
D5	Group A			20		23.00		460.00
	Group B			20		18.00		360.00
	Total			40
Test Statisticsa
		BT	H0		H6	H12	H24		D3	D5
Mann-Whitney U		170.000	170.000		168.000	193.500	165.000		168.000	150.000
Wilcoxon W		380.000	380.000		378.000	403.500	375.000		378.000	360.000
Z		-.938	-.938		-1.075	-.215	-1.249		-1.114	-2.360
P value (2-tailed)		.348	.348		.282	.829	.212		.265	.018
a. Grouping Variable: Groups
b. Not corrected for ties.

6. Bragards Test

Ranks
Groups		N	Mean Rank	Sum of Ranks
BT	Group A	20	20.50	410.00
	Group B	20	20.50	410.00
	Total	40
H0	Group A	20	20.50	410.00
	Group B	20	20.50	410.00
	Total	40
H6	Group A	20	20.50	410.00
	Group B	20	20.50	410.00
	Total	40
H12	Group A	20	20.50	410.00
	Group B	20	20.50	410.00
	Total	40
H24	Group A	20	20.50	410.00
	Group B	20	20.50	410.00
	Total	40

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D3		Group A		20		23.50			470.00
		Group B		20		17.50			350.00
		Total		40
D5		Group A		20		23.00			460.00
		Group B		20		18.00			360.00
		Total		40
Test Statisticsa
	BT		H0		H6		H12	H24		D3	D5
Mann-Whitney U	200.000		200.000		200.000		200.000	200.000		140.000	150.000
Wilcoxon W	410.000		410.000		410.000		410.000	410.000		350.000	360.000
Z	0.000		0.000		0.000		0.000	0.000		-1.964	-2.360
P value (2-tailed)	1.000		1.000		1.000		1.000	1.000		.050	.018
a. Grouping Variable: Groups
b. Not corrected for ties.

Overall response

The parameters of assessment i.e., Ruka (Group A: 85% and Group B: 100%), Toda (Group A: 100% and Group B: 100%), Stambha (Group A: 85% and Group B: 100%:), Spandana (Group A: 100% and Group B: 100%), SLR test (Group A: 75% and Group B: 100%), Bragard’s test (Group A: 75% and Group B: 100%).
There is no statistically significant difference between Group A (Siravyadhana) and Group B (Siravyadhana followed by Agnikarma) in most tests at various time points (BT, H0, H6, H12, H24, and D3). However, at D5, significant differences were observed in the SLR and BRAGARD'S tests, with Group B showing better results than Group A. But within the group statistically Significant difference was observed.
In most of the evaluated parameters (Ruka, Toda, Stambha, Spandana, SLR, and Bragard's test), Group B demonstrated clear edge over Group A by providing faster and more effective symptomatic relief based on mean rank.

Material required for Siravyadhan and Procedure of Siravyadhan

Materials required and procedure of Siravyadhan followed by Agnikarma

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Discussion

Discussion on Demographic data

Age: Out of total 40 subjects in group A and Group B, maximum subjects were in age group of 31-40 years. They were 37.5% (15 Subjects), Suggesting its highest prevalence in the 3^rd and 4^th decade.

Gender: Out of 40 Subjects in group A and group B, maximum Subjects were male. They were 52.5% (21Subjects). And female was 45% (18 Subjects), which indicate that Gridhrasi affects both sexes almost equally.

Occupation: Out of 40 Subjects in Group A and Group B, maximum Subjects occupation was Housewife 27.5 % (11 Subjects). The prevalence suggests that poor posture during work, irregular food habits, excessive exercise, less water intake are the predisposing factors for developing Gridhrasi.

Socioeconomic status: Out of 40 Subjects in Group A and Group B, maximum Subjects belong from middle class were 72.5% (29 Subjects) who work as labour, drivers, table work, housewives where h/o improper posture, excess work without rest, lifting heavy weight being the cause for Gridhrasi.

Diet: In this study, maximum patients having mixed diet 62.5% (25 Subjects), showing that use of Katu, Tikta, Kashaya Rasa Sevan, Guru Ahara Sevan, causing Vata Prakopa.

Religion: Out of 40 Subjects in Group A and Group B, maximum Subjects were Hindu 90% (36 Subjects). Maximum or almost all patients in this study were observed from Hindu community.

But religion does not seem to have any significant relationship with disease Gridhrasi. The reason could be the high proportion of Hindu population residing in the study place.

Discussion on Procedure

Siravyadhana

The Raktamokshana focuses on Dushta Raktadosha Nirharana and is often used to treat blood vitiation-related ailments. In Raktasamudbhava Vyadhi Rakta should be treated first. Siravyadha, considered in this study, is one of the chikitsa sutras in Gridhrasi and is considered the best remedy for Shodhana in the Raktaja Vikaras. Siravyadha is known as Sarvanga Sodhini. while the rest of the Panchakarmas like Vamana, Virechana & Vasti are specific to each of the Doshas and Sthanas, but this Karma produces Sodhana in the entire body. In this study, the therapeutic effect of Siravyadha by reducing pain on Gridhrasi and whole-body effect shown by Samyaka Siravyada Lakshanas.

Poorvakarma: Raktautkleshana is crucial before Siravyadha (bloodletting therapy). Tila Yavagu reduces blood viscosity and improves the process of preparing blood for Raktanirharana by serving as Sadhyosnehana. Tila Yavagu is crucial for Vicharana and Sadya Sneha in Siravyadha because the emphasis is on Rakta (blood) rather than Koshta

Abhyanga and Swedana: Abhyanga was done using Murchita Tila Taila, which has Ushna, Teekshna Guna and by Abhyanga vasodilation occurs, and prior to Swedana, Abhyanga was done. Swedana by Ushna Guna decreases the viscosity of blood, hence enhances blood flow. After Sthanika Abhyanga and Swedana, vein becomes prominent thus making easy to perform the procedure.

Pradhanakarma: For Siravyadha therapy, the site of vein to be selected is 4 Angula above and below the Janusandhi or a significant nearby vein is chosen as the location. The vein is then tapped to make it more visible, making the procedure easier. A carefully adjusted tourniquet is tied. Finally, the site is cleaned with surgical spirit and 18 G needle introduced in the vein and blood collected in measuring jar. Haemostasis achieved.

Paschatkarma: After stopping the blood flow, the Vyadhana site and foot were cleaned with spirit, and the site was then bandaged.

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The measurement of the blood was accurately done using ameasuringjar. Maximum up to 150ml of blood should be collected (As per Avara Matra mentioned by Aacharya Dalhana). If excessive amount of blood collected it produces Rukshata in the body and may develop complications like Murcha, Pipasa, Angamarda, Glani, Pandu, Shosha.

Agnikarma

Agnikarma is one among the Anushastrakarma. There is a direct reference for Agnikarma in Ayurvedic classics which can be roughly correlated to cauterization of modern science. However, Agnikarma has added benefit of pain management especially in acute or highly painful condition as told by Acharya Susrutha as Athugrarujee. The site of Agnikarma adopted was- 5 most tender points at Padakanisthika (ventral and lateral aspect of 5th toe) of affected leg. Gridhrasi is of 2 types, Vataja and Vatakaphaja, and Agnikarma is beneficial as Vata and Kaphahara. As the symptoms of Gridhrasi states Spikhpoorva Kati Prista Uru Janu Jangha Padam - Kramat, the disease is seen in entire leg, Agnikarma at sciatic nerve endings (Padakanisthika) was planned for the study. In Chikitsa of Gridhrasi, Agnikarma has been said. And also there is reference that if any treatment modality fails ultimately Agnikarma helps.

Poorvakarma: Picchilaannapana was advised prior to Agnikarma as this helps to increase Snighdata in the body.

Pradhanakarma: Procedure was explained to the patient and consent was taken. The Bindu Akriti Ruksh Agnikarma done with the Red Hot Panchadhatu Shalakha over the Padakanisthika (ventral and lateral aspect of little toe) of affected limb till appearance of Samyak Dagdha lakshana.

Paschatakarma: Mixture of Madhu and Grutha was applied over the Dagdhavrana as quoted by Sushrutacharya. The procedure accepted generally because of its proximity to the idea of Agnikarma in the Samhitas.

Discussion on Results

The study assessed the comparative efficacy of Siravyadhana alone (Group A) and Siravyadhana followed by Agnikarma (Group B) in managing Gridhrasi symptoms, using parameters like Ruka, Toda, Stambha, Spandana, SLR test, and Bragard's test.

Ruka (Pain): Group B showed faster recovery, with 80% recovery by Day 3 and 100% by Day 5, compared to 60% and 85% in Group A. The p-value of 0.075 on Day 5 indicated a trend toward faster recovery in Group B due to the combined effect of Agnikarma's Ushna and Ruksha properties along with Siravyadhana.

Toda (Pricking Sensation): Group B demonstrated quicker relief, achieving 85% improvement by 12 hours and 95% by 24 hours, compared to 75% and 85% in Group A. Both groups reached 100% recovery by Day 5.

Stambha (Stiffness): Group B showed faster improvement, with 90% recovery by 24 hours and complete recovery by Day 3, while Group A achieved 75% and 90% recovery, respectively. Agnikarma's Ushna Guna addressed the Sheeta nature of Vata and Kapha.

Spandana (Twitching): Both groups showed significant improvement, achieving 100% recovery by Day 3. The early recovery was slightly faster in Group B.

SLR Test: Group B demonstrated quicker symptom relief, with 80% reaching Grade 0 by Day 3 and 100% by Day 5, compared to 65% and 75% in Group A. Agnikarma’s Tikshna and Sukshma properties enhanced Vata pacification.

Bragard's Test: Both groups showed no improvement by 12 hours. However, Group B reached 80% recovery by Day 3 and 100% by Day 5, compared to 50% and 75% in Group A.

Overall results

While both groups showed significant improvement within their parameters, Group B exhibited faster and more complete recovery across all symptoms. Though most p-values exceeded 0.05, indicating no statistically significant difference, a trend favouring Group B's outcomes was evident, especially by Day 5. The combined action of Siravyadhana (removal of Avarana) and Agnikarma (neutralization of vitiated Doshas) proved more effective.

Probable mode of action of Siravyadhana

Siravyadha has direct action on Raktha Dhaatu and it does the Dushitaraktanirharana. There is involvement of Dusyakandara in the pathogenesis of Gridhrasi as Kandara is Upadhatu of Rakta. So, Siravyadhana removes Dushita Rakta.

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Acharya Sushruta mentioned that in the condition of Gridhrasi, there is Shonitaavarana and Siravyadhana could help in removing this Avarana. Gridhrasi is having Ashukari Swabhava, Raktamokshana Karma provides ‘Ashu Vedana Shanti’.

The Lakshanas like Sarva Sandhi-Sharira Shula, Sphutana, Supti, Gatra Spurana are explained as indications for Siravyadha in classics. These Lakshanas can be correlated with the symptoms like numbness, weakness, tingling sensation and heaviness of the affected part. In the Samprapti of Gridhrasi the Prakupita Vata, Vaata Kaphadosha cause Avarana of Vaata and Rakta. and Sthaanasamshraya of Dosha in Dhamani, Sira and Naadi thereby causing Rasa, Rakta and Mamsa Dushti resulting in radiating pain starting from Sphik towards Kati, Prishta, Uru, Jaanu, Jangha. As there is Rakta and Sira involvement and Siravyadha may correct the Samprapti.

As Dalhana states when there is involvement of Dosha and Dhooshya in the Disease manifestation Dhooshya should be treated and in turn Dosha can be brought to normalcy. Hence Siravyadha which has direct action on Raktha Dhatu may help in Gridhrasi in relieving pain.

Gridhrasi is a Snaayugatavyadhi and Snaayu is an upadhaatu of Mamsa Dhaatu whose quality is in turn dependent on Shuddha Rakta. So Siravyadha may improve the quality of Rakta and there by act on Mamsa and Snaayu. The mechanism behind the action of Siravyadha can be understand as, the removal of congested blood from the Avarana site will reduce the pressure around the nerves may relieves the pain.

After Siravyadha there will be improvement in local circulation and reduction of concentration of pain producing substances in blood due to the expulsion of impurified blood. This will help in repairing the damaged tissue and also to block the pain pathway.

Probable mode of action of Siravyadhana followed by Agnikarma

Aacharya Shodhalakrita Gadanigraha and Chakradatta mentioned Siravyadhana followed by Agnikarma in the contest of Gridhrasi. Agnikarma following Siravyadhana, effectively relieves pain, especially in cases of Atiugra ruja.

As Agni possess Usna, Tikshna, Sukshma, Aashukari Guna which are opposite to Vata and Kapha so, helped in management of pain. Acharya Susruta has mentioned that Agnikarma is a clear indication for “Atyagre Ruje” which may generate from different sites i.e., Asthi, Sandhi, Snayu, Sira, Mamsa and Twak and the disease which cannot be treated with Yantra, Shastra, Kshara can be cured by Agnikarma and it is Apunarbhava chikitsa. So, it might showed add on effect of it with less chance of reoccurrence.

In Gridhrasi, there will be Vatavriddhi and sometimes Kaphavriddhi and in turn there will be increase in Sheeta Guna, which causes Stambha. When Agnikarma is done, it increases Ushnata and subside Sheetaguna and thus may help in relieving symptoms of Gridhrasi.

When direct heat is transferred in to tissue, it causes Dhatuutkleshana and improves Dhatwagni causing Amapachana leading to Niramata. Due to Niramata of Vata and Kapha, Dushya Samurchana Vighatana takes place. Thus, may bring back normalcy in affected part.

When Agnikarma is done, it probably increases the Sthanikaagni, by this the waste products(metabolites) which are produced gets excreted, which normalizes the blood circulation thus resulting in reduction in intensity of pain.

In classics there are different materials were used for transferring the therapeutic heat in Agnikarma procedures.

Heat produced by the Agnikarma, helps to achieve muscle relaxation and relieve muscle spasm with inflammation. Raising the temperature of damaged tissue through Red Hot Shalaka may speed up the metabolic process, improve circulation by vasodilatation, reduce oedema, accelerate repair, which can reduce painful stiffness in joints like arthritis. Thus, Agnikarma may help in reducing the Ruka and Stambha.

Counter irritation theory: A counter irritant stimulates sensory nerve endings and thus relieves pain. Effect on muscle tissue: Heat induces muscle relaxation.

TENS Effect: Trans Electric Nerve Stimulation relieves pain by burning superficial nerve endings tends close the gate and prevent the sensory transmission of pain.

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Madhuri SB et al. Efficacy of Agnikarma after Siravyadhana

Theory of thermodynamics: Theory of thermodynamics on biological system suggests that when thermal energy is transferred from instrument to the tissue, then the thermostatic centre of the body is activated immediately and get activated to distribute this localised rise in temperature throughout the body. So, vasodilatation increases and blood flow increases which result in pain relief.

Conclusion

Based on the conceptual study, observation and statistical analysis made in the clinical study, the following conclusions were drawn: There is no statistically significant difference between Group A (Siravyadhana) and Group B (Siravyadhana followed by Agnikarma) in most tests at various time points (BT, H0, H6, H12, H24, and D3). However, at D5, significant differences were observed in the SLR and BRAGARD'S tests, with Group B showing better results than Group A. But within the group statistically Significant difference was observed. In most of the evaluated parameters (Ruka, Toda, Stambha, Spandana, SLR, and Bragard's test), Group B demonstrated clear edge over Group A by providing faster and more effective symptomatic relief based on mean rank. Based on observation and result, following Null hypothesis can be accepted. During the follow-up period, 40% of subjects in Group A experienced a recurrence of pain, compared to 30% in Group B. But the intensity of pain was mild. Comparative analysis of overall effect of the treatments in both the groups show that both the groups imparted symptomatic relief from pain in less duration of time, hence adopted as Atyayika Chikitsa.

References

1. Agnivesh, Charaka, Drudabala, Chakrapanidatta. Chikitsa Sthana, Chapter Vatavyadhi Chikitsa, Verse 56-57. In: Acharya YT, editor. Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition: 2019. Varanasi: Chaukhamba Orientalia; 2019. p. 620.

2. Sushruta, Dalhana, Gayadasa. Nidana Sthana, Chapter Vatavyadhi Nidana, Verse 74. In: Acharya YT, Narayana Ram, editors. Sushruta Samhita with Nibandha Sangraha and Nyayachandrika Commentary. Reprint Edition: 2017. Varanasi: Chaukhamba Sanskrit Sansthan; 2019. p. 268.

3. Davis D, Maini K, Vasudevan A. Sciatica [Internet]. Available from: https://www.ncbi.nlm.nih.gov

4. Textbook of Orthopaedics. New Delhi: Jaypee Brothers Medical Publishers; 2006. p. 636.

5. Sushruta, Dalhana, Gayadasa. Sutra Sthana, Chapter Agnikarmavidhiadhyaya, Verse 3. In: Acharya YT, Narayana Ram, editors. Sushruta Samhita with Nibandha Sangraha and Nyayachandrika Commentary. Reprint Edition: 2017. Varanasi: Chaukhamba Sanskrit Sansthan; 2019. p. 51.

6. Tripathi SI. Gadanigraha of Sri Vaidya Sodhala with the Vidyotini Hindi commentary. Volume 2, Kayacikitsa Khanda, 19th chapter, sl no. 148-154. Varanasi: Chaukhamba Sanskrit Sansthan; 1994. p. 507.

7. Virachita SS. Chakradatta with Hindi Commentary, Chikitsasngrahagrantha, Vatavyadhi Chikitsa Adhyaya, Sl.No. 56. Varanasi: Chaukhamba publication; p. 273.

8. Sushruta, Dalhana, Gayadasa. Sutra Sthana, Chapter Agnikarmavidhiadhyaya, Verse 5. In: Acharya YT, Narayana Ram, editors. Sushruta Samhita with Nibandha Sangraha and Nyayachandrika Commentary. Reprint Edition: 2017. Varanasi: Chaukhamba Sanskrit Sansthan; 2019. p. 51.

9. Sushruta, Dalhana, Gayadasa. Sharir Sthana, Chapter Siravyadhavidhiadhyaya, Verse 5. In: Acharya YT, Narayana Ram, editors. Sushruta Samhita with Nibandha Sangraha and Nyayachandrika Commentary. Reprint Edition: 2017. Varanasi: Chaukhamba Sanskrit Sansthan; 2019. p. 379.

10. Sharma AP. Sushruta Samhita with Nibandha Samgraha, Hindi commentary of Dalhanaacharya, Sharirasthana, 8th chapter, sl. no. 8. Varanasi: Chaukhamba Orientalia; p. 380.

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J Ayu Int Med Sci 2024;9(12)39

Research Article

Sciatica

Journal of Ayurveda and Integrated Medical Sciences

To evaluate the efficacy of Agnikarma after Siravyadhana in Pain Management of Gridhrasi w.s.r. to Sciatica: A Randomized Controlled Clinical Trial

Biradar MS1*, Shilpa PN2

Introduction

Aim

Objectives

Materials and Methods

Results

Discussion

Conclusion

References

Biradar MS^1*, Shilpa PN²