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Gridhrasi (sciatica)
Gridhrasi, or sciatica, is a condition characterized by severe, radiating pain from the lower back to the legs, making leg movement difficult. The document provides a comprehensive overview of its definition, types, differential diagnosis, treatment protocols, and dietary recommendations, emphasizing the importance of determining underlying causes and tailoring treatments accordingly. It outlines a tiered approach to management ranging from basic treatment at outpatient facilities to advanced therapies in specialized centers.
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Gridhrasi (sciatica)
- 1. GRIDHRASI (SCIATICA) Dr. RajtilakTiwari M.D. ( Kayachikitsa) Assistant Professor in Kayachikitsa dept. in Shivshakti lal sharma Ayurvedic College Ratlam (M.P.) [email protected] Mob-9406841574/7987265922
- 2. INTRODUCTION • Gridhrasi isa Vatavyadhi characterised by vitiation of Vata afflicting the Kandara / Snayu of lower limbs. It is characterized by severe radiating pain starting from the low back to gluteal, posterior aspect of thigh, knee, calf and dorsum of the foot of either one or both sides of lower limbs. The condition makes raising of the leg difficult. All types of lumbar radicuolpathy also can be interpreted in terms of Gridhrasi.
- 3. Case Definition: • Gridhrasiis defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.
- 4. Types: • There aretwo clinical presentations as Kevala Vata and Kapha Vata. Association of Kapha produces additional symptoms like Tandra (drowsiness), Gaurava (heaviness) and Arochaka (loss of taste).
- 5. Differential Diagnosis: • Thecondition should be differentiated from Katigraha (Ankylosing spondylitis), Khanja, • Pangu, Marmabhighata at any of the Kukundara and Nitamba Marma. • If the pain is localized to sacroiliac joint it may be diagnosed as Katigraha a condition of ankylosing should be ruled out. Khanja and Pangu are characterized with weakness of lower limbs due to loss of motor power. Khanja affects any one limb and Pangu affects both. These conditions may not have any pain associated. Kukundara Marmabhighata is characterized by motor and sensory loss. Nitamba Maramabhighata is characterised with wasting of lower limbs.
- 6. Line of Treatment: •Nidana Parivarjana should be the first line of treatment. • • Shodhana Chikitsa – Virechana, Basti, Siravedha • • Shamana Chikitsa- Pachana, Snehana, Swedana including various types Pindasweda, Agnikarma, Balya • • External applications - Abhyanga, Lepa, Katibasti, Katipichu. • • Rasayana Chikitsa for Asthi and Vata • • Treatment according to Doshik involvement • • General line of treatment prescribed for Vatavyadhi
- 7. LEVEL 1: ATSOLO AYURVEDA PHYSICIAN’S CLINIC/PHC • Clinical Diagnosis: On the basis of history and clinical presentation • Investigations: ESR (Males 0-15 mm/h, Females – 0-20 mm/h) to rule out any inflammation
- 8. Treatment: • In level1 also some minimal Panchakarma procedures can be done in OPD. • • In Kapha associated conditions, Rooksha Lepa like Nagaradi Lepa or Dashanga Lepa etc can be applied in the low back region • • Katipichu or Katibasti with Murivenna, Dhanwataram Taila or Nirgundyadi Taila etc can be performed later. • • Mridu Samshodhana with Eranda Taila mixed with Nirgundi Swarasa can be given in patients with constipation. • • Patient may be advised Matra Basti with Dhanwantaram Taila in or Sahacharadi Taila if found to be Kevala Vatika.
- 9. Medicines at level1 for Gridhrasi Drug Dose form Dose Time of administratio n Duration Anupana Aswagandha powder 3-6 gm After meal /Twice of day 1-2 week Luke warm water Rasna Churna 3-5 gm Twice a day 1-2 week Luke warm watrer Shunthi Churana 3-5 gm Twice a day 1-2 week Luke warm water Chopchini churana 0.5-2 gm Twice a day 1-2 week Sugar – 3 gm
- 10. Ksheerapaka Ksheera PakaUse 5 seeds for preparation Once a day 1-2 weeks Paarijaat Patra Swarasa1 Swarasa 15 ml Empty stomach / twice a day 1-2 weeks Rasnasaptakam Kashaya2 Kwatha 12 – 24 ml Empty stomach / 6 am & 6pm 1-2 weeks Luke wate Sahacharadi Kashaya Kwatha 12 – 24 ml Empty stomach / 6 am & 6 pm 1-2 weeks Luke wate Maharasnadi Kashaya3 kwatha 12-24 ml Empty stomach /6am-6pm 1-2 weeks Luke wate Yogaraja Guggulu4 vati 1-2 vati Twice a day 1-2 weeks Luke wate
- 11. Trayodashan ga Guggulu4 Vati 1-2 tabTwice daily 1-2 weeks Warm water Plain & various types of processed Eranda Taila Taila 15-50 ml Empty stomach - early morning or at bed time As per need Hot water or milk Bala Taila, Mahanarayana Taila, Nirgundyadi Taila, Sahachardi Taila, Vishagarbha Taila, Prasaranyadi Taila, Murivenna / Kuzhampu, Karpasasthydi Taila / Kuzhampu, Dhanwntaram Taila / Kuzhampu, etc. for Abhyanga and Sweda
- 12. Pathya - Apathya(Diet and life style education): • Do’s - • • Ahara: Advice light Vatanuloman diet like Shigru Shaka (drumstick), brinjal, Methi, Jeerak, Hingu, Saindhava, Yoosha, Mamsarasa etc. may be given. • • Vihara: Correct postures while sitting or lifting the weight, regular suitable Yogasana and Abhyanga, hot water bath, fomentation, comfortable seats and bed should be used. Bowel and bladder urges should be attended timely. • Dont’s - • • Ahara: Vata aggravating diet like pulses, peas, wafers, biscuits etc, cold food and cold drinks, stale food, excessive use of chilly. • • Vihara: Exposure to cold, heavy physical work, spongy mattresses and easy chairs.
- 13. Referral Criteria: • Casesnot responding to above line of Shamana management. • Chronic cases of Gridhrasi with full-fledged symptoms or associated morbidities like foot drop, muscle wasting etc which require well planned In - Patient Panchakarma treatment. • 3. Acute cases of Gridhrasi with severe pain which require strict bed rest and traction massages etc.
- 14. LEVEL 2: CHC’SOR SMALL HOSPITALS WITH BASIC FACILITIES Clinical Diagnosis: Same as level • Clinical Diagnosis: Same as level 1 for a fresh case reporting directly. • Investigations: Same as level 1, in addition • • X ray of the lumbo sacral spine • Treatment: In addition to the Shamana management mentioned in Level 1, some of the following drugs may be added as per the requirement and status of the patient. Intensive combination therapies of Rasaushadhi and Kashthoushadhi (herbo-mineral drugs) can also be used.
- 15. Medicines at level2 for Gridhrasi drog Dose form dose Time of administretion Anupana Dashamoola Kwatha kwath 12-24 ml Empty stomach / twice daily - Guggulutiktakam Kashaya kwath 12-24ml Empty stomach / twice daily Dhanwantaram Kwatha kwath 12-24ml Empty stomach / twice daily Dhanwantaram Vati Guggulutiktaka Ghrita5 Ghrita 15-30 ml Before food on appetite / once-
- 16. Ashwagandh arishta Arishta 10-20 mlAfter food / twice daily Balarishta6 Arishta 10-20 ml After food / twice daily Sahachardi Taila / Bala Taila, Karpasasthya di Taila, Dhanwntaram Taila 7 Taila Can be used for Basti Vatagajankus ha Rasa Gutika Twice a daily With madhu
- 17.
- 18. LEVEL 3: AYURVEDAHOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS • Clinical Diagnosis: Same as level 1for a fresh case reporting directly • Investigations: • • USG abdomen & pelvis– to rule out any visceral pathology or gynecological issues related to uterus and adnexa and PID, leading • to low back pain and pain in lower limbs • • USG – KUB – To rule out renal calculi and obstructive lower urinary tract symptoms. • • CT Scan– For better assessment of bony canal • • MRI Lumbosacral with whole spine screening.
- 19. Treatment: • In additionto the management of Level 1 and Level -2, if needed Panchakarma procedures can be performed. Full course Basti Karma like Yogabasti, Kalabasti and Karmabasti can be done in selected cases.
- 20. Panchakarma Procedures atlevel 3 for Gridhrasi Karma Choice of drugs Indications Remarks Udwartana Kolakulathadi Churna; Yava, Kola, Kulattha; Triphala Churna; Kapha Vata Ghridhrasi - associated with heaviness in affected limb, severe numbness, spinal canal stenosis and sciatica in obesity More effective in Sama conditions Swedana Tapa, Ushma – Various herbal Churnas, steam generated with herbal leaves In persistent pain without Pitta symptoms Reduces associated muscle spasm immediately
- 21. Churnapinda Sweda Kolakulathadi Yoga, Various Vata/ Kapha hara Churnas Early stages of Gridhrasi Saama, Kaphsamsrishta Kevala Vata, Pittanubandha contra indicated Patrapinda Sweda Various leaves of Vata alleviating property Usually after Churnapinda Sweda, directly on Nirama stage Pittanubandha contra indicated Pittanubandha contra indicated Pittanubandha contra indicated Jambeera Pinda Sweda Citrus fruit, turmeric and Vata alleviating Same as above + localised oedema Pittanubandha contra indicated
- 22. Shashtika Pinda Sweda /Shashtika Lepana Shashtika rice, Bala decoction and milk Later stages of Gridhrasi, disuse atrophy, wasting, weakness, Pittanubandha Kaphanubandha, Sama, Sheeta Anupashaya contra indicated Katibasti Murivenna Taila Dhanwantaharam etc In severe pain, when pain aggravates on manipulation. Virechana Plain or processed various Eranda Tail, Trivrita Lehya, Abhayadi Modaka, Ichabhedi Rasa etc Directly in all constipated cases. Also done after Shodhanaga Snehapana. Always done as Mridu Samshodhana after various Swedana Nirgundi Swarasa is added in Eranda Taila for better results.
- 23. Anuvasana Basti DhanwantaraTaila, Sahacharadi Taila etc. In all Gridhrasi in Vata Pradhana stage. Care for contra- indications of Nasya and oral Snehapana Nirooha Basti Erandamooladi, Madhutailika, Vaitarana Basti, Kshara Basti etc and various Yoga explained in classics Nirama stages of Gridhrasi, Vata Pradhana stage. Vaitarana Basti should be done even in Ama stages Rakta Mokshana - Siravedha Scalp set, intra- venous canula, tray, tourniquet etc Non responding cases to Snigdha Rooksa, Sheeta or Ushna approaches, in acute and severe pains Agnikarma Shalaka, Ghrita, Taila etc Non responding cases to any approaches., severe pain, Kandaragata Shoola
- 24. Pathya-Apathya (Diet andlife style education): • Same as level 1 • Rasayana: • 1. Rasona Kalka • 2. Bhallataka • 3. Aswagandha • 4. Guduchi • 5. Bala