E-ISSN:2456-3110

Case Report

Gridhrasi

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 12 DECEMBER
Publisherwww.maharshicharaka.in

An Ayurvedic management of Gridhrasi w.s.r. to Sciatica: A Case Study

Abhiranjan1*, Mishra D2, Singh AP3, Tiwari SK4
DOI:10.21760/jaims.9.12.43

1* Abhiranjan, Post Graduate Scholar, Dept of Panchakarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

2 Dipti Mishra, Post Graduate Scholar, Dept of Kayachikitsa, Government Ayurvedic College and Hospital, Patna, Bihar, India.

3 Akhilesh Prasad Singh, Associate Professor, Dept of Panchakarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

4 Satyendra Kumar Tiwari, Professor, Dept of Panchakarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.

Gridhrasi is a disease that mostly impairs a patient's ability to move around, something that is emphasized in the name. The afflicted leg of Gridhrasi illness is believed to have an unusual throwing motion as that of gait of Vulture. Acharya Charaka has described Nanatmaja and Samanayaja Vatavyadhi. Gridhrasi comes under both as it is caused by Vata (Nanatmaja) as well as Kaphanubandhi Vata (Samanayaja). Based on its sites of manifestations and the symptoms, Gridhrasi is comparable to Sciatica in contemporary medicine. The lifetime incidence of this condition is estimated to be between 13% and 40%.

Case: Present case study deals with a female patient 45 years old suffering from pain with tingling sensation in lower back region radiating to the posterior aspect of left lower limb for 6 months. On taking a detailed history and doing proper examinations patient was found to have Vata-Kaphaja Gridhrasi.

Treatment protocol: Patient was given Hingwashtak Churna, Karaskar Vati, Sahacharadi Kashaya followed by Panchakarma therapies like Shankar Sweda, Virechana, Basti, Agnikarma and Siravedha.

Results: After treatment, on symptomatic assessment and examinations, stiffness, tingling sensation and pain on pressure completely resolved with overall quality of life of patient was significantly enhanced.

Conclusion: With proper Panchakarma therapies, drug interventions and diet control Gridhrasi can be managed successfully.

Keywords: Gridhrasi, Sciatica, Shamana Chikitsa, Panchakarma, Agnikarma

Corresponding Author How to Cite this Article To Browse
Abhiranjan, Post Graduate Scholar, Dept of Panchakarma, Government Ayurvedic College and Hospital, Patna, Bihar, India.
Email: 		Abhiranjan, Mishra D, Singh AP, Tiwari SK, An Ayurvedic management of Gridhrasi w.s.r. to Sciatica: A Case Study. J Ayu Int Med Sci. 2024;9(12):321-329.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-11-14 2024-11-23 2024-12-04 2024-12-14 2024-11-25
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© 2024by Abhiranjan, Mishra D, Singh AP, Tiwari SKand 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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Abhiranjan et al. An Ayurvedic management of Gridhrasi w.s.r. to Sciatica

Introduction

In Ayurvedic classics ‘Ekadasha Indriya’ has been mentioned among these Ekadasha Indriya’ Padendriya Karmahani occurs in Gridhrasi, leading to Gridha[1] (Vulture) like gait with Vatanubandhi symptoms like ‘Stambha, Ruk, Toda, Graha and Spandana in Sphika, Kati, Prishtha, Uru, Janu, Jangha and Pada in ascending manner[2] and ‘Sakthikshepa Nigraha[3] i.e., restricted lifting of leg and in Kaphanubandhi symptoms like ‘Tandra, Gaurava and Arochaka’ are also associated. Gridhrasi is a sharp shooting pain in the lower extremity resulting from irritation of the sciatic nerve and aggravated by movement of limbs. Based on its sites of manifestations and the symptoms, Gridhrasi is comparable to sciatica in contemporary medicine. A group of symptoms known as sciatica, sometimes known as sciatic neuritis include pain that may be brought on by general compression or irritation of the sciatic nerve. And the only treatments for this illness are painkillers, surgery, physiotherapy, or bed rest, all of which can occasionally have several systemic side effects. The prevalence of sciatica varies considerably ranging from 3.8% in the working population to 7.9% in non-working population.[4] It is most prevalent in people during their 40s and 50s and men are more commonly affected than women. Low back pain has been reckoned as fifth most common cause for hospitalization and the third most repeated reason for a surgical procedure.[5]

The need of the century is a medication that reduces pain, enhances functional capacity, recovers from functional handicap, and regulates the condition effectively without much economic burden since medical science has realized how serious the situation is. The likelihood of Gridhrasi is rising year by year as a result of sedentary lifestyles, increased computer use, increasing body weight, mental stress, demanding work schedules, and transportation practices. In the current context, all of these exacerbate bad posture, which is one of the primary causes of illnesses involving the spine and nerve compression. It is a fact that current technology, despite its recent advancements, is unable to provide efficient treatment for sciatica. Ayurvedic treatment principles has been found to be very much effective in the management of Gridhrasi, based on which a patient case study has been discussed here.

Aim and Objective

To evaluate the effect of Panchakarma and Shaman Chikitsa in the management of Gridhrasi.

Case Report

It is a single case study. Informed consent was taken from the patient in her own language.

Patient Details: A 35 years old female patient reported at Panchakarma OPD of Government Ayurvedic Hospital, Patna in May 2024 the case details of which has been discussed here:

Marital Status - Married, Religion - Hindu, Occupation - Nursing Staff, Address: Patna Bihar, Registration No.- A21711/4712, D.O.A.- 01/05/2024, D.O.D.- 03/06/2024

Pradhana Vedana (Chief Complaints)

  • Pain with stiffness and tingling sensation in lower back region radiating to the posterior aspect of left lower limb up to toe from last 6 months.
  • The intensity of pain has increased from last 15 days.

Associated Complaints

  • Unable to walk properly due to pain from 15 days.
  • Pulling and piercing type of pain in lower back and left posterior thigh and calf region.
  • Decreased appetite with feeling of heaviness from last 1 month.

Vedana Vruttanta (History of Present Illness)

Patient was apparently normal 6 months back. Gradually she started feeling piercing pain in lower back region which started radiating to posterior aspect of left lower limb within 7 days and due to severity, she was not able to do her daily works properly. She consulted an allopathic doctor who prescribed her with medication and rest. The treatment gave her temporary relief, but pain recurred which was continuous in nature and used to aggravate after strenuous work later she also developed heaviness and anorexia. From last 15 days before she consulted Panchakarma OPD of our hospital pain and stiffness got much severe that she came to a stage where she was unable to do her household work also.


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Then she consulted the Panchakarma OPD of GACH, Patna where she was diagnosed as a patient of Gridhrasi and after one week of oral medication she got overall relief and for further improvement she got admitted in the Panchakarma IPD.

Purva Vyadhi Vruttanta (Past History):No H/O T2DM/HTN/Thyroid disorders/Kochs etc.

Kula Vyadhi Vruttanta (Family History): Nothing significant

Shalyakarma Vruttanta (Surgical History): Tubectomy - 5 years earlier

Prasava Vruttanta (Obstetrical History): G3 P3 A0 L3 D0.

Menarche: 15 years

Vyaktika Vruttanta (Personal History)

  • Ahara - Mixed Diet, Katu-Lavan rasa, Ruksha Ahara, Viruddha Ahara, Adhyasana, Vishamsana
  • Vihara - Nursing job leads to work stress, irregular working hours and sleep and being a housewife prolong standing, improper sitting posture
  • Appetite - Decreased appetite but takes food regularly.
  • Bowel - From 1 months hard with straining
  • Micturition - Normal
  • Addiction - Tea
  • Sleep - Disturbed from 6 months due to pain
  • Mansik -

General examination

  • P. - 136/80 mm Hg
  • PR - 78/Min
  • R. - 20/Min
  • Height - 5 feet 2 inches
  • Weight - 64 kg
  • Temperature - Afebrile
  • Edema / lymphadenopathy / pallor / icterus / clubbing / cyanosis - absent

Systemic examination

  • S.- Centrally placed trachea, Normal breathing sounds and airway entry
  • CVS - S1 S2 normal, no murmur
  • P/A - Soft, non-tender, no organomegaly
  • CNS - Fully conscious and well oriented to time, place and person, all cranial nerves are intact.

Musculo-skeletal system

  • Gait - Limping
  • Upper limbs - Normal
  • Lower limbs - Stiffness in the left calf and thigh region with restricted range of motion with positive SLR test 45 and Bragard’s Sign.
  • Redness and warmth / Weakness / Swelling / Deformity - Absent

Examination of spine

  • Inspection - No visible deformity or sign of trauma
  • Palpation - Tenderness over L5, S1, S2 level
  • Movements - Cervical/Thoracic- NAD

Lumbosacral - Flexion Restricted, Extension - Restricted, Left lateral flexion - Not possible, right lateral flexion - Restricted.

  • SLR test (active) ▪ Positive at 45° on the left leg ▪ Negative on the right leg.
  • Bragard’s test ▪ Positive at the left leg. ▪ Negative on the right leg.

MRI of LS spine: Left paracentral disc bulge at L5-S1 level causing mild foraminal stenosis and left exiting nerve root compression.

Assessments

Ashta Asthana Pariksha

  • Nadi - 78 / min
  • Mutra - 4-5 Times / day
  • Mala - Saam, once daily, Krura Kostha
  • Jihva - Nirlipta
  • Shabda - Prakrita
  • Sparsha - Sama Sheetoshna
  • Drik - Prakrit
  • Akriti - Madhyam

Dasha Vidha Pariksha

  • Prakriti - Vata-Kaphaj
  • Vikriti - Hetu- long hours of sitting and working, irregular duty hours and sleep, Ruksha and Viruddha Ahara, weight gain, Vegadharana

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  • Dosha - Vata-Kaphaj
  • Dooshya - Rasa, Rakta (Kandara), Asthi, Majja
  • Desha - Bhumi-Sadharana

  Atur - Kati, Vama Pada

  • Kala - Ritu - Grishma, Kriyakala - Vyakta Avastha
  • Bala - Rogi - Madhyam, Roga - Madhyam
  • Sara - Madhyam
  • Samhanana - Madhyam
  • Pramana - Madhyam
  • Satmya - Madhyam
  • Satva - Madhyam
  • Aharashakti - Jarana Shakti - Avara, Abhyavaharana Shakti - Madhyama
  • Vyayama Shakti - Avara
  • Vaya - Madhyama

Investigations

Hb - 12.5 gm%
E.S.R. - 30 mm/hr
Platelets - 2.20 lakhs/cmm
FBS - 92 mg/dl
X-ray LS Spine - WNL

Vyadhi Vyavachedan (Provisional Diagnosis)

  • Vataja Gridhrasi - Stambha (+), Ruk (+), Toda (+), Spandate Muhuhu (+), Deha Vakrata (+) in Sphika, Kati, Prishtha, Uru, Janu, Jangha and
  • Vata-Kaphaj Gridhrasi: Vataja symptoms associated with Gaurava (+), Arochaka (+), Tandra (-).

Vyadhi Vinischaya (Final Diagnosis): Vata-Kaphaj Gridhrasi

Chikitsa (Treatment plan)

OPD Basis Treatment: for first seven days to treat the Aamavastha first along with Vedanahara and Vatanulomana.

1. Hingwastak Churna - 3 gm BD with first bolus of meal
2. Arthrum Capsule - 500 mg BD (Ingredients: Parijata, Nirgundi, Rasna, Shallaki Niryasa, Ashwagandha, Surinjana, Trikatu)
3. Karaskar Vati - 125 mg BD

4. Ruksha Pind Sweda with Kottamchukadi Churna folowed by Nagaradi Lepa over LS Spine.
5. Dhanyak - Shunthi medicated water.

IPD Basis Treatment: After 7 days of OPD Treatment there was relief in pain, appetite and bowel improved, feeling of heaviness reduced and then patient was admitted for IPD treatment.

Along with above 1,2,3 and 5 no. oral medication Sahacharadi Kashaya was added - 20 ml BD before meal with Dhanyak-Shunthi medicated water.

  • Therapy advised

A) Ruksha Pind Sweda with Kottamchukadi Churna followed by Nagaradi Lepa over LS Spine for first 7 days.

B) Patrapinda Pottali Sweda followed by Bashpa Sweda with Dashmool Kwath and Kati Basti with Mahanarayana + Vishtinduk Tail for next 7 days.

C) Virechana - 5 Days Shodhana Snehapana with Guggulu Tiktakam Ghrita - 30ml-60ml-90ml-120ml-150ml, on 6 and 7th day Saranga Bahya Snehana, Swedana was done and on 8th day Virechana with Trivrit Avaleha - 40g with Triphla Kwath 50ml mixed with Gandharvahastadi Erand Taila - 20 ml was given at 10 AM. After attaining Madhyam Shuddhi 5 Days of Sansarjana Krama was followed and Yoga Basti was done

D) Yoga Basti - Anuvasana Basti with Sahacharadi Taila - 60 ml

Niruha Basti - Erandamooladi Niruha Basti - 550 ml

Schedule of Yoga Basti

Day12345678
BastiAANANANA

Content of Eranda Mooladi Niruha Basti:[6]

Kwatha Dravya: 1. Eranda Moola (Riccinus communis root) 2. Laghu Panchamool (Root of 5 drug) i.e., Salaparni (Desmodium gangeticum), Prisnaparni (Uraria picta), Kantakari Badi (Solanum indicum), Kantakari Chhoti (Solanum xanthocarpum), Gokshur (Tribulus terrestris) 3. Rashna (Pluchea lanceolata) 4. Ashvagandha (Withania somnifera) 5. Atibala (Abutilon indicom) 6. Guduchi (Tinospora ccardifolia) 7. Punarnava (Boerhavia diffusa) 8. Aragvadha (Cassia fistula) 9. Devadaru (Cedrus deodara) 10. Madana Phala (Randia dumetorum).


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Kalka Dravya: 1. Shatahva (Anethum sowa) 2. Hapusha (Juniperus communis) 3. Priyangu (Callicarpa macrophylla) 4. Pippali (Piper longum) 5. Madhuka (Glycyrrhiza glabra) 6. Bala (Sida cordifolia) 7. Vatsaka (Holarrhena antidysentrica) 8. Musta (Cyperus rotandus).

Preparation of Eranda Mooladi Niruha Basti: The following ingredients were triturated thoroughly as per classics to get a homogeneous preparation.

1. Kwatha (Decoction of above mention Kwatha Dravya) 350 ml
2. Kalka (Paste of above mention Kalka Dravya) 15 gm
3. Sneha (Guggulu Tiktaka Ghrita) 80 ml
4. Madhu (Honey) 60 ml
5. Saindhava (Rock salt) 5 gm
6. Gomutra Ark 60 ml

After these IPD treatments patient had mild tingling sensation and pain only on brisk walking after 5 mins and then Siravedha was done from prominent vein of Gulpha Sandhi and conductive Agnikarma with Suvarna Shalaka at never roots of Sciatic Nerve. Post these therapies stiffness, tingling sensation and pain on pressure completely resolved and intensity of pain on brisk walking has reduced.

Discharge advises for 15 days

Trayodasang Guggulu - 500mg BD
Karaskar Vati - 125mg BD
Maharajprasarani Tail Capsule - 2 Cap BD
Sahacharadi Kashaya - 20ml BD
Nasya with Ksheerbala Tail

Vishtinduk Tail - E/A

Pathya

Sarpi, Swadu, Amla, Lavana Rasa Ahara, Godhuma, Masha, Shali, Kulattha, Mamsa Rasa, Dadim, Jambir, Draksha, etc., daily Asthanik and Pada Abhyanga, Nirvata Asthana Vaas.

Apathya

Tikta, Katu, Kashaya Rasa Ahara Atisevana, Late night food, Chinta, Vegadharan, Shrama especially Bharavahana, strenous activity, jerk to low back region, Anashana etc.

Follow Up: 2 follow-up was done at gap of 15 days and 1 month.

Observation and Results

The patient was able to do her daily activities comfortably and no relapse of any symptoms was there. Her gait has become normal and range of motion has become painless and comfortable. The Oswestry Disability Index,[7] subjective and objective criteria were evaluated before and after treatment. Disability Index of Patient has improved from crippled state to state of minimal disability.

Assessment Criteria

The improvement will be assessed on basis of relief in sign and symptoms of Gridhrasi. All sign and symptoms will be assigned score depending upon their severity to assess effect of treatment objectively and subjectively, details of which are given below

Subjective Parameters

SNSign & SymptomsCriteriaScoreBTAT
1.Ruka (Pain)No pain030
Painful movement without limping1
Painful movement with limping gait but without support2
Painful, can walk only with support3
Painful, unable to walk4
Severe pain needs medications5
2.Stambha (Stiffness)No stiffness040
Mild stiffness for 5-10 minutes1
Moderate stiffness for 10- 60 minutes2
Severe stiffness more than 1 hour many times a day mildly affecting the daily routine3
Stiffness lasting for 2-6 hours, daily routines are hampered severely4
3.Toda (Pricking sensation)No pricking sensation031
Mild pricking sensation occasionally in a day1
Moderate pricking sensation, frequent not persistent2
Moderate pricking sensation, persistent3
Severe pricking sensation4

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4.Aruchi (Anorexia)Normal taste, feeling to eat food on time010
Feeling to take food but no proper digestion1
Anannabhilasha - not feeling to take food even if hungry2
Bhaktadvesha - irritability to touch, smell, seeing and listening about food3
Abhaktachchanda - aversion to food because of anger, stress etc.4
5.TandraNo Drowsiness000
Mild with no interference in daily activities1
Moderate with manageable interference in daily activities2
Severe with unmanageable interference in daily activities3
6.Gaurava (Heaviness)No feeling of heaviness020
Mild with no interference in daily activities1
Moderate with manageable interference in daily activities2
Severe with unmanageable interference in daily activities3

Objective Parameters

SNSign & SymptomsCriteriaScoreBTAT
1.SLREqual to or greater than 90⁰031
71⁰ - <90⁰1
51⁰ - <70⁰2
31⁰ - <50⁰3
<30⁰4
2.Walking Time (To cover 20 meter)Up to 20 Sec.020
21-40 Sec.1
41-60 Sec.2
More than 60 Sec.3
3Bragard’s SignNegative010
Positive1
4GaitNormal010
Antalgic1

Percentage Relief Formula = Finding Score ÷Total Score ×100
18 ÷ 20 ×100 = 90% relief

Discussion

This case of Gridhrasi (Sciatica) was treated first by Amapachana, Langhan and Vatanulomaka Samana Aushadi along with Ruksha Pinda Sweda and Kati Lepana to combat the condition of Saamavastha first. After attaining the Niramavastha, Snehana and Panchakarma Procedures like Patrapinda Sweda, Kati Basti, Virechana, Basti Karma, Siravedha and Agnikarma was used along with Shaman Chikitsa protocols asper the treatment guidelines of Gridhrasi.[8]

Sarvanga Abhyanga (Oleation therapy) with Mahanarayana Tail and Vishtinduk Tail acts as Vata Shamaka and Shoolahara. It corrects Rukshata, Kharata, Parushata and it brings about Snigdhatwa, Slaksnatwa and Mriduta in body which decreases accumulated Vata. Vata gets Anuloma (Usual) Gati again and thereby alleviates the symptoms.

Patrapinda Pottali Sweda (PPS) which is a form of Shankara Sweda and is Snigdha Sweda. It treats the painful conditions mainly caused by Vata and Vatakaphaja Dosha owing to the properties of ingredients used. It promotes the release of toxins, reduces the inflammation, and strengthens the joints, muscles, and nerves (by releasing the stiffness and hence compression over the nerve roots) of the affected area, the Vedanasthapana, Vata Shamaka (analgesic), Shothahara (anti-inflammatory), and Dhatuposhaka properties (strengthening and nutritive therapy) of Patra Pinda Swedana can help improve muscle tone and tissues function & may alleviate symptoms of Sciatica.

Kati Basti with Mahanarayana Tail and Vishtinduk Tail is a form of external Snigdha Sweda applied over the local lesion site of lumbosacral region in Niramavastha which gives immediate results because it acts at the site of lesion and pacify the Vata Dosha.


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It is done in Vata (+++) condition. The warm herbal oil allows absorption into muscles, ligaments, and tendons, thereby relaxing back and healing any underlying conditions, calming pain and stiffness. It improves local circulation, nourishes and bolsters muscles and nerves, and helps heal degeneration, releases spasms and brings back adaptability.

Urdhva Shodhana prior to Basti has been mentioned in Gridhrasi for the proper action and gaining the benefits of Basti. Without Urdhva Shodhana, Basti is of no use. Hence, Virechana was adopted for Kostha Shodhana and then Yoga Basti was used. For Shodhana Snehapan Guggulu Tiktakam Ghrita was used which acts over the Rakta, Asthi and Majja Dhatu which is the afflicted Dushya in Gridhrasi. The Sneha Virechana clears obstruction in the Srotas and relieves Vata vitiation very quickly. Thus, Sneha Virechana of Mridu nature helps in controlling Shula in Gridhrasi.

Erandmooladi Niruha Basti is explained as Srotoshodhak and used in Saam Avastha thus helpful in relieving the Sanga (compression or narrowing of foramen) doing complete Samprapti Vighatana and thus serving the purpose of Basti as Shodhanaupakrama by avoiding the recurrence. Basti corrects local as well as systemic pathology and the best treatment for the correction of Vata and the diseases of Asthi, Sandhi and Marma. Erandamooladi Niruha Basti is specially indicated in pain in Janga (lower leg), Uru (thigh region), Pada (foot) and Prusta (low back region and in Kapha-Avrutha conditions. Which makes it very suitable for Vata-Kaphaj Gridhrasi. The Guggulu Tiktaka Ghrita used as Sneha in Basti preparation is specifically indicated for Asthi Majja Gata Vyadhi.

Raktamokshana gives immediate relief in pain of Gridhrasi. It is helpful to eliminate Doshas from Shakha. Kandra is Updhatu of Rakta and Kandra is Dushya in Gridhrasi. Gridhrasi Vata is Rakta Vata and is due to Vyana Vayu Prakopa as stated by Acharya Harita. Vyana Vayu is related to blood circulation. Through Siravedha there is elimination of Ama which obstructs the Srotas or channels and normalizes the Gati of Vayu. In superficial nerve involvement, Siravedha was found effective to relieve Suptata.

In Agnikarma, Agni possesses Ushna, Tikshna, Sukshma and Aashukari properties, which are opposite to Vata and anti Kapha properties.

Physical heat through Shalaka is transferred as therapeutic heat to Twak Dhatu. From Twakdhatu this therapeutic heat acts in three ways. First, due to Ushna, Tikshna, Sukshma, Ashukari Guna it removes Srotavarodha, pacifies vitiated Vata and Kapha Dosha and maintains their equilibrium. Secondly, it increases Rasa Rakta Samvahana (blood circulation) to affected site. The excess blood circulation to affected part flushes away pain producing substances and patient gets relief from symptoms. Third, therapeutic heat increases Dhatwagni, so metabolism of Dhatu becomes proper and digests Amadosha from affected site and promotes proper nutrition from Purva Dhatu. In this way Asthi and Majja Dhatu become more stable.

Hingwashtak Churn[9] contains Sunthi, Pippali, Marica, Ajmoda or Yavani, Svetajiraka, Krishna Jiraka, Suddha Hingu and Saindhava Lavana. It is indicated in Agnimandya (Digestive impairment), Shula (Colicky Pain), Gulma (Abdominal lump) and Vataroga (Disease due to Vata Dosha) and hence was used in Aamavastha of disease.

Karaskar Vati an ayurvedic medicine that acts on Nerves & Muscles. It acts as Nervine tonic & Cardiac stimulant. Shudda Kupilu acts as a stimulant to nerves & is useful in conditions of dysfunction of motor nerves. Maricha protects against oxidative damage by free radicals, & reactive oxygen species thus protecting nerve functions.

Sahacharadi Kashayam are having ingredients which are Vata-Kapha Shamaka, Vedanasthapana Shulahara, Shothahara and Nadiuttejaka (Nerve stimulant) properties along with strengthening and nutritive therapy for various musculature and structure in lumbosacral region and lower extremities which is very much effective in treatment of Sciatica.[10]

Trayodashanga Guggulu is a combination of 13 herbs including Guggulu processed in ghee. It acts with its properties of Vedanastapana, Shoolhara and Rasayana, Madhur Vipaka, Ushna Virya. Being Ushna Virya and through Snigdha Guna of Madhur Vipaka it suppresses symptoms of Stambha, Toda and reduces pain. It has its action on Asthi, Majja and Snayu Gata Vata. Intervertebral disc regeneration requires Glycosaminoglycan (GAGs), collagen and protein which is possible by Madhur Vipaka and Rasayana property of Trayodashanga Guggulu.[11]


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Maharaja Prasarini Tailam Capsule is specific formulation form Bhaisajya Ratnavali Vatarogadhikara indicated for Stambha, Vishwachi, Sarva Vata Rogas, Neurological and rheumatic complaints, Cervical and Lumbar spondylosis. It is vastly used in Vata Anubandha with Kapha conditions.

Conclusion

Gridhrasi described in Ayurvedic texts is very much similar to Lumbo-Sciatic Syndrome described in modern science. It is also believed that any type of pain can’t be without presence of Vata. Gridhrasi is a severely painful condition so, Vata predominance in its pathogenesis is clear but due to sedentary life style and Agnimandhya the Anubandha of Kapha or Ama is so often. Gridhrasi by nature is Kashtasadhya. Still however if the patient comes earlier for the treatment and if given prompt proper treatment in sufficient dose and duration, then the patient is likely to be cured or less likely to suffer from a subsequent attack of pain. From this study we can demonstrate the superior management of Gridhrasi through Panchakarma therapies and Shamana Chikitsa. As of right now, the patient is doing well with her regular routines. The considerable results of this one case study have given rise to a lot of optimism and options regarding Gridhrasi management. However, for further studies a randomized clinical studies of big sample size will help to verify standard outcomes.

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2. Agnivesha M. Chikitsasthana Vatvyadhichikitsa (28/56-57). In: Shastri SN, editor. Charaka Samhita, Vidyotini Hindi Commentary. Reprint ed. Varanasi: Chaukhambha Bharati Academy; 2016. p. 787. (Vol.2).

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4. Kaila-Kangas L, Leino-Arjas P, Karppinen J, Viikari-Juntura E, Nykyri E, Heliovaara M. History of physical work exposures and clinically diagnosed sciatica among working and nonworking Finns aged 30-64. Spine (Phila Pa 1976). 2009;34:964-9.

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