Article Type: Research Article Article Citation: Dr Prashant Amrutkar, and Dr Amruta Amrutkar.
(2021). AN AYURVEDIC APPROACH TO A CASE OF LOW BACK PAIN (KATIGRAHA) WITH
SPECIAL REFERENCE TO LUMBAR SPONDYLOSIS. International Journal of Research
-GRANTHAALAYAH, 9(1), 158-163. https://doi.org/10.29121/granthaalayah.v9.i1.2021.3093 Received Date: 01 January 2021 Accepted Date: 31 January 2021 Keywords: Katigraha Lumbar
Spondylosis Vata Vyadhi Katigraha is a condition where the lower back region is afflicted with Vitiated Vata and present with symptoms such as pain with stiffness. Katigraha mentioned in Ayurveda can be correlated with Lumbar spondylosis due to similarity of clinical manifestations. About 60% to 80% of the population in India suffer from this condition. The current case study was carried out at the Department of Panchakarma, B.S.D. Trust’s Ayurved Hospital and Research Centre,Wagholi,Pune. A 44 year male patient suffering with lumbar spondylosis was treated with samanya chikitsa of vata vyadhi i.e.Abhyanga, Swedana, Basti and Kati Basti treatment. Patient was treated for a period of 8 days. The response to the treatment was recorded and therapeutic effect was evaluated through symptomatic relief. Clinically, cardinal symptoms were significantly reduced and degree of anterior flexion increased from 40 degree to 90 degree. Radiographically, X Ray L.S. Spine showed an improvement in loss of lumbar lordosis. However, it still shows that the patient is suffering from lumbar spondylosis.
1. INTRODUCTIONVata dosha or Sama Vata Dosha (Ama associated Vata Dosha) afflicts Kati Pradesha
(low back) and produces symptoms such as pain with stiffness, then the
condition is known as Katigraha.[1] This can be correlated with lumbar spondylosis. Back pain with stiffness is the
main cardinal symptom in lumbar spondylosis. This cardinal symptom is
comparable with the ‘Graha’ condition mentioned in
Ayurveda classics. Lumbosacral part of the spine is comparable with ‘Kati’
mentioned in ayurvedic texts. Hence, Lumbar spondylosis in contemporary
medical science can be correlated with the Kati graha
(one of the eighty Nanatmaja Vata
Vikar) mentioned in Charak
Samhita. [2] In lumbar spondylosis, back pain is usually felt in
the lumbosacral area and the back of thighs. The commonest site of pain in the
spine is the intervertebral disc. Patients often complain of spinal stiffness,
paraspinal muscle spasm, radiating pain to the extremities, difficulties in the
activities of daily living such as sitting, walking, picking up things and so
on. In chronic cases, back pain is often associated with neurological symptoms
like altered sensation and weakness in the muscle innervated by the compressed
nerve roots. Lumbar Spondylosis is a common term used to describe this
degenerative condition of lumbar spine. Between 70 to 90 percent of individuals
will experience back pain at some point in their lives. [3] In this condition, both the intervertebral disc and
adjacent vertebrae get involved. The intervertebral disc ages owing to
proteoglycan within the disc, which becomes dehydrated as a result. Therefore,
the disc becomes narrower and this in turn narrows the nerve root canal.
Secondary changes also occur in the facet joints with loss of joint space,
sclerosis and osteophyte formation. [4] In modern medicine, the disease is in early stage,
it is managed by medications such as analgesics and anti-inflammatory drugs,
Muscle relaxants, corticosteroids, epidural steroid injections etc. but these
drugs have lots of side effects and cannot be used for a long time; When
symptoms are moderately severe or more, especially if it hampers the activity
of patient, surgical intervention is advised. [5] So, it
is the need of time to seek other treatment options mentioned in ayurveda classics. In Ayurveda classics, low back pain-Katigraha is explained in a broad aspect under Vatavyadhi & based on symptoms it may be correlated to
Dhatu Gatawa. According to samprapti
of Vatavyadhi, Katigraha is
primarily caused by vitiation of Vata dosha and Asthi, Mansa, Majja dhatu kshaya. Acharya Sushruta, describes that, when vitiated Vata
Dosha invades the Asthi
Dhatu symtpoms like Asthi shosha, Asthi Prabheda
& Asthi Shoola are
produced. (6) He also describes that, when vitiated Vata
Dosha invades the Sandhi, it leads to Hanthi of Sandhi (Restriction of joint movements) & Shopha (Muscle Spasm. [6]
Therefore, Vatavyadhi Samanya
chikitsa i.e., Abhyanga (Snehana),
Swedana, Basti etc
mentioned in ayurveda classics, was selected for the
present case.[7] So,
this case report is planned to evaluate the collective effect of samanya chikitsa indicated for Vata Vyadhi. 2.
MATERIALS
AND METHODS
A Case Report: Name of
patient-XYZ; Age-44 Yrs/Male; Occupation-Designer
(Computer Work) Long time Seating type of job; OPD Reg No 2020/2064; IPD Reg
No- 2020/889; DOA-10/06/2020; DOD-17/06/2020 Brief history of a
case: A 44 years old male patient,
presented with the chief complaints of severe pain at low back (Katishool) and stiffness at low back (Katigraha)
and other symptoms are difficult during walking and while seated (Asane- Gamane Kashtata)
for 15 days. Patient had a history of frequently constipating. Complaints were
worsened 3 days before the admission. He underwent allopathic treatment for the
past 15 days but did get only mild and temporary relief. So, for further
management he came to Panchakarma OPD, at B.S.D.Trust’s
Ayurved Hospital and Research Centre,Wagholi,Pune. 2.1. DIAGNOSIS AND ASSESSMENT CRITERIA
Lumbar spondylosis was diagnosed on the basis of
following parameters. Also, these parameters were assessed before and after the
treatment. 1) Pain at
low back (Katishoola)- was assessed by grading of
pain by using Visual Analog Scale (VAS). 0|________________________________________| 09 Table 1: Assessment and grading of pain
On the day of admission, the patient was in
distressing, miserable pain with a VAS Score of 5. 2) Stiffness
at low back (Katigraha)- was assessed by grading of
Range of Motion (ROM) by using the Oswestry
Disability Index (ODI) Table 2: Assessment and grading of
stiffness
On the day of admission, the range of movements
were restricted, the patient was with upto 50%-75%
impairment in Range of motion of joint and patient can perform daily work with
moderate or severe difficulty i.e., Grade 3; on the day of admission oswestry disability index was 25 points/50 percent. 3) Investigation:
X-ray of Lumbosacral Spine (AP/ LAT Views) was assessed during and after
treatment. X-ray of Lumbosacral Spine (12/06/2020) revealed lumbar spondylosis.
Muscle spasm with loss of lumbar lordosis seen. Also, minimally reduced L5-S1
Disc space seen. Tiny anterio-lateral osteophytes at
L4-L5 Vertebral levels-degenerative changes were noted. 4) Clinical
examination: Difficulty in Straight Leg Rising (SLR) i.e., anterior flexion was
assessed before and after treatment. At the time of admission, clinical
examination revealed tenderness in the lumbar region. The SLR test was positive
40 degrees at left and 45 degrees at right. The range of movements Treatment
given-Following treatment was given for 8 days 1) Kati basti- Kati basti with Mahanarayana Thailam for 20 min
was given daily for 8 days. 2) Sarvanga Abhyanga with Mahanarayana
Thailam for 30 minutes daily for 8 days followed by 3) Bashpa Sweda with decoction of
Ashwagandha. 4) Matra Basti- Matra basti of 60 ml each was given for 6 days out of the total 8
days of treatment. Each 60 ml of matra basti was consists of Mahanarayana
Tail 30 ml + Chinchalavan Tail 30 ml; Matrabasti was given after lunch at 12:30 pm 5) Niruha Basti- The preparation of niruha
basti was done in the usual manner of Niruha Basti. Madhu 30 ml added together with saidhav 5 gms, mixed well; then
50 ml of Tila Tailam was
added with the previous mixture. Lastly, decoction of 400 ml of Panchatikta Kashay was added to
it. The mixture is then filtered through a sieve. Niruha
basti was given on empty stomach at morning 07:30 am Matra basti and Niruha basti were administered as
follows.
M: Matrabasti; N: Niruha Basti Out of 8 days of treatment- total 6 Matra basti and 2 Niruha basti were administered. 3.
RESULTS
Results of the treatment were observed on the basis of following parameters as follows. Table 3: Results of the treatment
BT-Before treatment; AT-After treatment; ODI-Oswestry Disability index Table 3 shows that the patient found significant
relief in symptoms after the treatment. Lower back Pain was reduced by 80%
(from VAS Score 5 to 1); Stiffness was reduced by 66% (from ROM Grade 3 to 1)
With upto 25% impairment in ROM of joint and patient
can perform daily work without any difficulty. SLR Test in B/L legs was
increased to 80 degrees from 40 degrees.Oswestry
Disability Index was improved by 76% from 25 Points to 6 Points. 4.
DISCUSSION
In the present case of lumbar spondylosis, the
patient was affected more with Katigraha might be
because he has to do more prolonged seating type of work (Occupation-Computer
work designer). Prolonged sitting posture exerts pressure over low back and
provides favourable condition for lodging (Sthana Samsharaya) of already
vitiated Vata Dosha.
Patient’s age showed that, above 40 years of age, degenerative changes start
that leads to Vitiated Vata Dosha
disorders. In Ayurveda classics, most of the joint pain
related conditions have been explained under the heading of Vatavyadhi.
Katigraha is comparable with the clinical
manifestation of Lumbar Spondylosis. Katigraha is one
of the eighty Nanatmaja Vata
Vikara mentioned in Ayurveda classics. So, this
present case of lumbar spondylosis was treated with Samanya
Chikitsa of Vatavyadhi
including Sarvanga Abhyanga, Bashpasweda,
Katibasti and Basti. Probable mode of
action of Samanya Chikitsa
of Vatavyadhi Sarvanga Abhyanga is a
type of Bahya Snehana.
Acharya Dalhana explains that the drugs and oil used
in Abhyanga gets absorbed by the skin, reaching to particular Dhatu when
applied for sufficient time. Hence it is clear that drugs used in the abhanga get absorbed by the skin; it prevents and corrects
disorders caused by affliction of vata. Bashpa Sweda is Sagni prakara of Sweda. Acharya
chakrapani has stated that stambha also means
obstruction or block. Therefore, Swedana not only
relieves stiffness, but also clears blockage of passages. Snigdha
Sweda pacifies vata dosha and relieves stiffness. Katibasti was the procedure
selected for local application as Kati is the most probable region afflicted in
this condition.Kati Basti is a snigdha,
saagni type of swedana
which by its local effect helps in relieving Stambha,
Shaityata and helps in relieving intensity of pain
and stiffness. It may help in immediate relief of symptoms causing an analgesic
effect. The lipoidal bond is suitable for penetration of drug molecules through
stratum corneum[8]. On
this basis, it can be assumed that, in Katibasti oil
helps in the formation of lipoidal bonds thus helps in penetration of drug
molecules. Katibasti is a type of Swedana,
so it induces hyperthermia which improves local blood and lymphatic circulation
and thereby improving local tissue metabolism[9]. It
reduces inflammation by modifying secretions of various inflammatory mediators,
relaxes local musculature by physical effect of heat, increases the rate of
transdermal drug delivery and thereby reduces pain [10] Basti Chikitsa is
considered as an Ardha Chikitsa
(half line of treatment)[11] and
Shrestha Chikitsa for pacifying aggravated Vata. So, it is highly recommended and useful treatment in
Vitiated Vata disorders. Acharya Sushruta
explains the mode of action of Basti saying that, Basti given through rectal
route gets absorbed and shows its effects all over the body just like the water
gets absorbed through the roots and nourishes the whole plant. Considering overall effects of Samanya
Chikitsa of Vatavyadhi
including Sarvanga Abhyanga, Bashpasweda,
Katibasti and Basti was highly effective in this
present case of Lumbar Spondylosis. 5.
CONCLUSION
Patient of low back pain (Katigraha)
diagnosed as Lumbar Spondylosis was treated with Samanya
Chikitsa of Vatavyadhi
including Sarvanga Abhyanga, Bashpasweda,
Katibasti and Basti. Overall, collective effects of Samanya Chikitsa of Vatavyadhi showed highly effective results in this present
case. Patient had better effect in relieving pain, stiffness and Oswestry Disability Index (ODI) change with Panchakarma
therapy. Thus it can be concluded that Ayurvedic
approach is better, safe and effective treatment as compared with contemporary
approach in treating painful spinal conditions. This study needs further
evaluation on large numbers of patients. SOURCES OF FUNDING
This
research received no specific grant from any funding agency in the public,
commercial, or not-for-profit sectors. CONFLICT OF INTEREST
The
author have declared that no competing interests exist. ACKNOWLEDGMENT
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