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Gridhrasi - A Case presentation
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Gradhrasi

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Gradhrasi

  1. 1. THE ROLE OF PANCHKARMA IN THE MANAGEMENT OF GRIDHRASI W.S.R. TO SCIATICA Dr. Harish Kumar M.D
  2. 2. Introduction <ul><li>One of the Nantamaja Vikaras </li></ul><ul><li>Characterised by piercing pain/stiffness/cramps beginning from sphika region and gradually radiates down to Kati, Janu, Jangha and Foot region. Leading disability in walking. </li></ul><ul><li>Systemic symptoms – Heaviness, Drowsiness and Anorexia (due to Kapha) </li></ul>
  3. 3. DEFINITION <ul><li>fLQd~ iwokZ dfVi`&quot;Bks:tkuqt³~xkinaØekr~A x`/kzlh LrEHk:d~rksnSx`Zg~.kkfr LiUnrs eqgq%A okrk}krdQkÙkUækxkSjokjkspdkfUorkAA </li></ul><ul><li> ¼p-fp- 28@56½ </li></ul><ul><li>ikÆ&quot;.kÁR;³~xqyhuka rq d.Mjk ;k·fuykÆnrkA lDFku% {ksia fux`g~.kh;kn~ x`/kzlhfr fg lk Le`rkAA </li></ul><ul><li>¼lq-fu- 1@74½ </li></ul><ul><li>ikf&quot;.kZ çR;³~xqyhuka ;kd.Mjk ek#rkfnZrkA lDF;qR{ksia fux`g~.kkfr x`/kzlha rka çp{krsAA </li></ul><ul><li>¼v-â-fu- 15@54½ </li></ul>
  4. 4. Sciatica <ul><li>Pain in the leg generally unilaterally caused by irritation of Sciatica Nerve </li></ul><ul><li>There may be numbness, difficulty in moving or controlling the leg. </li></ul><ul><li>Pain, generally travel from back of thigh to back of calf and may also extend upwards to the hips and downwards to the foot. </li></ul>So comparatively Sciatica resembles with the Gridhrasi described in Ayurvedic text.
  5. 5. HETU (CAUSES) <ul><li>Ruksha, Sita, Alpa, Laghu, Tikata, Katu, Kashaya - Anna sevana (food intake) </li></ul><ul><li>Atimaithuna (excess of sexual intercourse) </li></ul><ul><li>Ativyayam </li></ul><ul><li>Excessive sitting on a chair for longer time </li></ul><ul><li>Excessive standing for longer time. </li></ul><ul><li>Amotpatti </li></ul><ul><li>Dhatukshaya etc. </li></ul>
  6. 6. HETU (CAUSES) <ul><li>All causes of Sciatic according to modern science – </li></ul><ul><li>Trauma </li></ul><ul><li>Compression of Sciatic Nerve </li></ul><ul><ul><li>Degenerative disease like tuberculosis, Osteoarthritis, Ankylosing spondylitis. </li></ul></ul><ul><ul><li>Hypertrophy and spasm of Pyriformis muscles </li></ul></ul><ul><ul><li>Tumour or Malignancy </li></ul></ul><ul><ul><li>Slipped Disc </li></ul></ul><ul><ul><li>Spinal stenosis </li></ul></ul><ul><ul><li>Compression by uterus in late pregnancy. </li></ul></ul>
  7. 7. For Vataja Gridhrasi <ul><li>Nidana Sevana </li></ul>Vitiation of Vata Dhatukshaya Rukshata, Kharata & Parushata (Hardness) Kha-Vaigunya (emptiness) in srotas in Kati region and along Sciatic nerve innervation Sciatica (Gridhrasi) Accumulation of Vata In chronic Stage or without treatment
  8. 8. For Vatakaphaja Gridhrasi <ul><li>Nidana Sevana </li></ul>Formation of Ama Abnormal formation of Mala of Dhatu and Dosha Obstruct normal pathway of Vayu Gridhrasi Excessive secretion or vitiation of Kapha
  9. 9. Samprapti Ghataka (Pathological Factors) <ul><li>Dosha - Vata </li></ul><ul><li>Type of Vata affected - Vyan Vata, Apan Vata, Samana Vata </li></ul><ul><li>Dushya - Rasa, Rakta, Mansa, Majja, Asthi. </li></ul><ul><li>Udabhava Sthana - Pakvashaya </li></ul><ul><li>Adhisthana - Kati, Adho ( v/k% ) Shakha Kandara - By Sushruta Snayu - By Vagbhatta (A.H.N. 15/14) </li></ul><ul><li>Srotas - Rasavaha, Raktavaha, Asthivaha (in Avarana Samprapti) </li></ul><ul><li>Marmasthisandhyanusari </li></ul>
  10. 10. Role of Panchakarma in Gridhrasi <ul><li>Treatment stated by Acharya Charaka in Gridhrasi are – </li></ul><ul><li>Siravedha </li></ul><ul><li>Bastikarma </li></ul><ul><li>Agnikarma </li></ul><ul><li>Treatment stated by Acharya Sushruta in Gridhrasi is – </li></ul><ul><li>Siravedha </li></ul><ul><li>Treatment stated by Acharya Bhel – </li></ul><ul><li>Snehana (oleation) </li></ul><ul><ul><li>Internal </li></ul></ul><ul><ul><li>External </li></ul></ul><ul><li>Massage </li></ul><ul><li>Basti </li></ul><ul><li>Raktamokshana </li></ul>
  11. 11. Advisable Panchakarma Procedure for Vataja Gridhrasi <ul><li>Snehana, Swedana, Anuvasana Basti </li></ul>Advisable Panchakarma Procedure for Vatakaphaja Gridhrasi Deepana, Pachana, Ruksha Swedana, Asthapana Basti, Raktamokshana. Panchakarma Procedure adopted are A)    Snehana (Oleation treatment ) – Snehana corrects Rukshata, Kharata, parushtwa. Snigdhatwa, Slaksnatwa and Mriduta decreases accumulated Vata. It gets Anuloma (Usual) Gati (direction) again and thereby disease/Symptoms decreased / Cured. Snehana can be given in all forms - Snehapana (Oil intake), Abhyanga (Oil massage), Anuvasana basti (oil enema). B)   Swedana - Bahya Swdana at the site of Vata Prakopa - It is with nadi, Prastara, Ruksha sweda according to condition.
  12. 12. Different specialized Panchakarma procedure which provides simultaneous Snehana and Swedana <ul><li>Kayaseka (Pizhichil) - A part of Kerliya Panchkarma. Good for external snehana and swedana. </li></ul><ul><li>Patra Pinda Swedana - Good for external senahana in Gradhrasi - It also provides muscles strength and relief in muscles spasm . </li></ul><ul><li>Kati Basti - One of the varieties of Bahya Snehana, gives immediate results because it acts at the site of lesion and pacify the Vata Dosha. </li></ul><ul><li>Basti - Anuvasan Basti/ Matra Basti - By Bala taila, Mahanarayana Taila, Dashmoola Taila. </li></ul><ul><li>Niruha Basti - By Erandamooladi Kwatha, Dashmoola kwatha, Vaitarana Vasti. </li></ul>
  13. 13. Mridu Virechana <ul><li>For removing constipation in Vataja Prakrati or Vata predominant disease by Erand Oil, hingu Triguna Taila </li></ul><ul><li>For removing Ama and constipation in Kaphaja prakriti or Kapha predominant disease by Nishotha Churna + Sunthi Churna + Madhu </li></ul>Raktmokshana <ul><li>Raktamokshana can cure the disease when other treatment do not have effect on disease / when other treatment fails. </li></ul><ul><li>It gives immediate relief in pain of Gridhrasi. It is helful to eliminate doshas from Shakha and in this therapy there is no need to bring the Doshas in Koshtha. </li></ul>
  14. 14. Various sites of Raktmokshana <ul><li>4 Angula lower from Medhra ( es<ª ) and Basti (Vrinda) </li></ul><ul><li>4 Angula up or low from janu Sandhi (Sushruta) </li></ul><ul><li>4 Angula up from Gulf (Harita) </li></ul><ul><li>In between the Kandara and Gulf (Charaka) </li></ul>Back side Back side Femoral triangle Inner side
  15. 15. Probable Mode of Action of Raktmokshana <ul><li>Kandra is updhatu of Rakta and Kandra is Dushya in Gridhrasi. </li></ul><ul><li>Gridhrasi Vata is Rakta Vata as stated by Harita </li></ul><ul><li>Gridhrasi is due to Vyana vayu Prakopa as stated by Harita and Vyana Vayu is related to blood circulation. </li></ul><ul><li>Elimination of Ama by Siravedha which obstructs the srotas or channels and Vayu gets anuloma. </li></ul>
  16. 16. Vamana <ul><li>Yet Vagbhatta and Sushruta contraindicated Vamana in Vata Vyadhi. Although Chakrapani indicated Urdhwa Shodhana (Vamana) in Gridhrasi as - </li></ul><ul><li>x`/kL;kÙkZ uja lE;d~ ikpuk|SfoZ'kksf/kre~A KkRoka uja çnhIrkfXua ofLrfHk% leqikpjsr~AA uknkS ofLrfof/ka dq;kZn~ ;kon~/oZ u 'kq/;frAA Lusgks fujFkZdLrL; HkLeU;sokgqfr;ZFkkAA </li></ul><ul><li>¼pØnÙk 22@49&50½ </li></ul>
  17. 17. Conclusion <ul><li>Gridhrashi described in Ayurvedic texts is very much similar to Sciatic syndrome described in modern medicine and advisable Panchakarma treatment are </li></ul><ul><li>Snehana </li></ul><ul><li>Swedana </li></ul><ul><li>Mridu Vamana </li></ul><ul><li>Mridu Virechana </li></ul><ul><li>Basti - Niruha / Anuvashana/ Matra </li></ul><ul><li>Kati basti </li></ul><ul><li>Pizhichil </li></ul><ul><li>Patra Pinda </li></ul><ul><li>Raktmokshana </li></ul>
  18. 18. Thank You
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