Following derivations taken from the different text books in Sanskrit literature substantiates same.^[1,2]

• Gridhramapisyati, ‘Syati’- as - ‘Kshepana’.
• Urusandhau Vatarogah” (Ch.Chi.28/101)
• Gridhraamiva Syaati Gachhati.

Here the word Gridhrasi is suggestive of the typical character of pain and also the gait of the patient. Further as in this disease the patient walks like the bird Gridhra and his legs become tense and slightly curved so due to the resemblance with the gait of a vulture, Gridhrasi term might have been given to this disease. Gridhram Api Syati So Antakarmani Atonupasargakah, Chanchva Gridhra Iva Syati Peedayati, Gridhra Syati Bhakshati Gridhra is a bird called as vulture in English.

This bird is fond of meat and it eats flesh of an animal in such a fashion that it deeply pierce its beak in the flesh then draws it out forcefully, exactly such type of pain occurs in Gridhrasi and hence the name “Gridhramapisyati”, ‘Syati’-as-“Kshepana”.

Table 1: Vata Prakopa Samanaya Nidana.

Aharaja Nidana (causative factor related to diet)

3. Manasika Nidana (mental causative factors):

4. Anya Hetu:

Poorvarupa

Gridhrasi being a Vata Vyadhi, the Samanya Poorvarupa of Vata Vyadhi are the Poorvarupa of Gridhrasi. Charaka has mentioned that Avyakta Lakshana are the Poorvarupa of Vata Vyadhi. While clarifying the word, ''Avyakta'’ Chakrapani states that few mild symptoms can be considered as Poorvarupa.^[6]

Thus, the symptoms of Gridhrasi such as Ruka (pain), Toda (pricking pain), Spandana (twitching), Stabdhata (numbness), Tandra (drowsiness), Arochaka (loss of taste) etc. when manifested slightly can be called as Poorvarupa of Gridhrasi.

Roopa

Complete manifestation of the disease is called as Roopa. In the fifth Kriyakala i.e., Vyakti Avastha, the characteristic symptoms and signs of a disease appear clearly and the disease can be recognized without any doubt. While describing Gridhrasi, Acharya Charaka has listed Ruka, Toda, Stambha and Muhuspandana (mild twitching) as the cardinal symptoms.^[7] To be more precise about the track of pain, Chakrapani says that the pain starts at hip and then radiates to lumbar region, back, thigh, knee, calf and feet in order. Also, Sakthikshepanigraha (impossibility to lift the lower extremities) is added to the list of cardinal signs by Acharya Sushruta^[8] and Vagbhatta.^[9]

But, if there is uncertainty as whether the disease is Urusthambha or Gridhrasi, to differentiate these two we can adopt Upashaya. If symptoms aggravate on the application of oil, then we can consider it to be Urusthambha and if the symptoms alleviate, we can consider it as Gridhrasi. The Nidana mentioned for Vatavyadhi are considered as Anupashaya for Gridhrasi.

Sapeksha Nidana

Diagnosis is successfully made by thoroughly observing the patient to explore the clinical manifestations and analyzing the symptoms to determine the vitiation of Dosha, involvement of Dhatu, affliction of Srotas, as well as other events of Samprapti. Diagnosis of Gridhrasi can be made easily by typical clinical presentation of radicular pain with restricted leg raising reveals the vitiation of Vata and occasionally in association with Kapha Dosha, afflicting the Asthi as Dhatu and Snayu and Kandara as Upadhatu involving the Asthivaha Srotas. Though Gridhrasi is characterized by a distinct course of radiating pain but sometimes it may be a difficult task to differentiate the similar conditions like Urusthambha, Khalli, Khanjta and Panguta. Even then the differentiation may be made easy by analyzing the course of pain, character of pain, severity, associated phenomena and functional disability in patients of Gridhrasi. Sapeksha Nidana of Gridhrasi, in this context with other diseases having alike symptoms is described as below –

1. In Gridhrasi, a distinct radiating pain which emerging from buttock and goes towards the feet along the course of sciatic nerve is found which is absent in other disease like Urustambha, Khalli etc.
2. In Gridhrasi, Sakthikshepa is being restricted, whereas in Urustambha patients feel heaviness in their thigh and difficulty in walking.
3. Urustambha is associated with Jwara, Chhardi, Aruchi, Agnimandya which are not usually found in Gridhrasi.
4. In Khalli, the severity of pain is more than that of Gridhrasi and is generally proximal in nature.
5. In Khanja and Pangu, first and foremost symptom is paralysis which may be present in Sciatica only as a late complication, and no history of pain may be present in Khanja and Pangu.
6. In Gudagata Vata, in addition to pain in foot, symptoms like Shosha, retention of faeces, urine and flatus, colic flatulence and formation of stone may also be present (Ch. Chi. 20/25).

Lakshanas like Tandra, Gaurav, Agnimandya etc. are observed due to involvement of Kapha and Ama. Impaired Dhatwagni may lead to the production of Adhyasthi, Arbuda, Granthi etc. i.e., Apachita Dhatus. If they cause Avarodha in the Vatavahanadi of the lower limb, Gridhrasi may be produced.

Samprapti Ghataka

Dosha - Vata - Especially Vyana and Kapha
Dushya - Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Sira, Kandara, Snayu
Srotasa - Rasavaha, Raktavaha, Mamsavaha, Medovaha, Asthivaha, Majjavaha
Srotodushti Prakara - Sanga, Margavarodha
Agni - Jatharagni and Dhatwagni
Ama - Jatharagnijanya and Dhatwagnijanya
Udbhavasthana - Pakwashaya
Sanchara Sthana - Rasayanis of Apanakshetra
Adhisthana - Kandaras of Parsani and Pratyanguli and Sphika, Kati, Uru, Janu, Jangham, Pada
Vyakta Rupa - Ruka, Toda, Stambha in Adhosakthi, Uru, Janu, Jangha and Pada, Arochaka, Tandra, Gaurava.
Vishishta Chikitsa for Gridhrasi

The effective treatment of Gridhrasi cannot be unified, as the pathology involves multiple varying factors. Vitiated Vata and association of Kapha Dosha stemming out from the Pakwashaya, afflicting the Asthi Dhatu vitiating Snayu and Kandara affecting in the Asthi produces the illness. Therefore, the procedures mainly aimed at the rectification of the imbalances of Vata Dosha as well as Kapha Dosha if associated forms the sheet anchor of treatment of Gridhrasi. Thus, the unique pathogenesis eases the planning of the treatment in case of Vataja Gridhrasi. But in case of Vatakaphaja Gridhrasi, the final treatment planned should pacify the Vata as well as Kapha Dosha effectively. With the due consideration of this, following principles of treatment are advocated in the Ayurvedic classics-

So, Basti is very helpful in pacifying Vata, further it is glorified that Basti Chikitsa as ‘Ardha Chikitsa’ or ‘Purna Chikitsa’ of Vata. By these facts, Basti is most important among the Panchakarma in the treatment of Gridhrasi.

No other Chikitsa has the capacity to pacify and regulate the force of Vata apart from Basti. Any type of Basti can be adopted but, initially one should purify the body by Shodhana Karma to get the desired effect.^[20,21]

Niruha Basti: Niruha Basti like Erandamuladi Niruha and Dashamuladi Niruha are the best choices. Anuvasana Basti: Anuvasana Basti using Vatahara Tailas like Bala Taila, Mulaka Taila, Ksheerabala Taila, Prasarani Taila etc. are beneficial.

6. Siravyedha: Charaka explained Siravyedha at the site of Antara-Kandara Gulpha (Ch. Chi. 28/101). Acharya Sushruta and Vagbhatta indicated Siravyedha four Angula above and four Angula below at the site of knee joint.^[22]

7. Raktamokshana: It is a general rule that, when the regular treatment with Shadvidhopakrama fails to give any relief in any disease, one should consider the involvement of Rakta Dhatu in the pathogenesis and is best treated by Raktamokshana. This rule is also applicable in Gridhrasi Roga (A.H.Su.27/4-5). As the disease Gridhrasi is characterized by affliction of Rakta along with Vata, several authors have advised Raktamokshana.^[23]

8. Agnikarma: Various Acharya mentioned Agnikarma in the management of Gridhrasi. According to Sushruta and Vagbhatta, in the management of Sira, Snayu, Asthi and Sandhigata Vyadhi, Agnikarma is indicated and Gridhrasi is one of the diseases of these Samprapti.^[24,25,26]

For treatment of Gridhrasi, different site for Agnikarma are as mentioned below:

Charaka: Antara Kandara Gulpha

Charkradatta: Pada Kanistika Anguli (little toe of the affected leg).

Harita: Four Angula above the Gulpha in Tiryak Gati.

9. Shastra-Karma: Chakradatta has given the treatment of Gridhrasi in details.

• Phala Varga : Amla, Rasayukta Phala, Dadima, Draksha, Jambira, Badara.
• Shaka Varga : Patola, Shigru, Rasona.
• Dugdha Varga : Kshira, Ghrita, Navneeta.
• Dravya Varga : Mamsa Rasa, Mudga Yusha, Dhanyamla.
• Taila Varga : Tila Taila, Sasharpa Taila, Eranda Taila.
• Anya Varga : Tambula, Ela, Kustha.

Pathya Vihara : Sukhoshna Pariseka, Nirvata Sthana, Samvahana, Avagahana, Abhyanga, Brahmacharya, Ushna Pravarana, Agni Aatapa Sevana, Snigdha- Ushna Lepa.

Apathya Ahara: Kalaya, Chanaka, Kanguni, Kodrava, Shyamaka, Nivara, Nishpava Beeja, Rajmasha, Karira, Jambu, Trinaka, Tinduka, Shushka Mamsa, Dushita Jala.

Apathya Vihara: Vegadharana, Vyavaya, Vyayama, Vamana, Raktamokshana, Prajagarana, Diwaswapna, Adhava, Ati-Gaja-Ashwa-Ushtra-Yana Sevana.

Discussion

Due to modernization, the life style of the people has become more sedentary and younger and older populations are falling prey to many Vatika disorder affecting the loco motor system. “Gridhrasi” which is enumerated among the “Nanatmaja Vyadhi of Vata” in the classics, it is high on list. This disorder as such is not life threatening or dreadful, but the excruciating pain that the patient goes through is very agonizing.

Moreover, it also afflicts the most productive groups of the society. The word Gridhrasi refers to a disease with awful pain experienced by the patient and is similar to the pain experienced by a prey of vulture while being eaten up.

These similarities itself suggest its gravity of distress. Onset of Ruk, Toda and Stambha initially in Sphika and establishing distally to Kati-Prishtha, Janu, and Jangha till Pada is the unique feature of this illness. The word ‘Sphika Purva’ is suggestive of the lumbo-sacral involvement initially and eventually causing pain in the course of sciatic nerve or at the sites mentioned above. For the same reason elevation of thigh will be restricted in patients suffering from Gridhrasi.

History of trauma may add up in the process of diagnosis. Modern medical treatment has its own limitation in managing this type of disease. It can provide either conservative or surgical treatment and is highly symptomatic and with troublesome side effects, whereas such type of conditions can be better treated by the management and procedures mentioned in Ayurvedic classics. Therefore, Ayurveda holds greater responsibility and role in the treatment and prophylactic care for such type of conditions.

Snehana, Swedana and Mrudu Shodhana are the line of treatment in all Vatavyadhis. Even though, Snayu and Rakta are involved as Dushya, Agnikarma and Siravyadha are also the chief lines of treatment. The chief purpose of treatment is to disintegrate the union of Dosha and Dushya. These therapeutic measures disintegrate the union of Dosha and Dushya. Basti therapy is therefore preferred as line of treatment as it eradicates the root cause of the disease. Any medication which soothes the magnitude of pain, improves the functional ability along with Samprapti Vighatana is the best in patients of Gridhrasi.

Conclusion

Gridhrasi is a prevalent condition in society, presenting as a significant health concern. The manifestation of this disease is closely linked to Vyana Vayu, a fundamental factor in its pathogenesis. Characterized by intense pain, Gridhrasi lacks a universally established treatment protocol. Ayurvedic texts primarily recommend Vatavyadhi Chikitsa for managing this disorder. However, direct references regarding its Nidana (etiology) and Samprapti (pathogenesis) remain scarce. In modern medical science, Gridhrasi is often correlated with Sciatica. Among the various Panchakarma therapies, Basti Chikitsa is considered the foremost treatment modality, offering not only curative benefits but also preventive and promotive effects. Recognized as the most effective remedy for morbid Vata, Basti is also beneficial in conditions involving Kaphaja and Pittaja imbalances.

References