clinical study on sapthasaram kashayam and kottam …

“CLINICAL STUDY ON SAPTHASARAM KASHAYAM AND

KOTTAM CHUKKADI TAILA IN KATI GRAHA WITH SPECIAL

REFERENCE TO LUMBAR SPONDYLOSIS”

BY

DR. POOJA SHARADA JAGADEESH SHANBOUGH (B.A.M.S.)

Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

Bengaluru, Karnataka.

In partial fulfillment of the requirements for the degree of

“AYURVEDA VACHASPATI”

DOCTOR OF MEDICINE (AYU)

IN

KAYACHIKITSA

GUIDE

Dr. SHRIPATHI ACHARYA M.D (AYU), Ph.D. PROFESSOR & H.O.D

DEPT OF P.G STUDIES IN KAYACHIKITSA

Co-Guide

Dr. NAVEEN. K M.D (AYU)

ASSISTANT PROFESSOR

DEPT OF P.G STUDIES IN KAYACHIKITSA

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA

MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES MANIPAL

2017 - 2018

iii

LIST OF ABBREVATIONS

AP - Anteroposterior

A.T - After Treatment

A. F - After Follow-up

B.T - Before Treatment

DDD - Degenerative Disc Disease

Diff d - Difference of Mean

ES - Extremely significant

gm. - Grams

IPD - In Patient Department

LBP - Low Back Pain

LS - Lumbar Spondylosis

LSM - Lumbar Spine Mobility

ml - Milli-litre

MRI - Magnetic Resonance Imaging

N - Number of subjects

NS Non- significant

NSAIDS - Non-Steroidal Anti Inflammatory Drug

OA - Osteoarthritis

OPD - Out Patient Department

RA - Rheumatoid Arthritis

S - Significant

SD - Standard Deviation

SME - Standard Error

SI - Sacro- iliac

SLR - Straight Leg Raising Test

VAS - Visual Analogue Scale

VS - Very- significant

iv

LIST OF TABLES

TABLE

NO.

CONTENTS PAGE

NO.

1. Samprapthi in nut shell 17

2. Range of motion of lumbar spine 23

3. Drug review of Saptasaram kashayam choorna 32

4. Drug review of Kottam chukkadi taila 33

5. Drug review of Rasnasaptaka kashaya choorna 34

6. List of drugs in Saptasaram kashayam choorna 38

7. List of drug in Kottam chukkadi taila 38

8. Drava dravya used in Kottam chukkadi taila 39

9. List of drugs in Rasnasaptaka kashaya choorna 39

10. Grading of katiruja (pain) 42

11. Grading of Katigraha (stiffness) 42

12. Grading of tenderness 42

13. Grading of difficulty in walking 43

14. Grading of Schobers test 43

15. Grading of Oswestry low back disability assessment

questionnaire

43-45

16. Grading of x- ray 45

17 Statistical significance chart 47

18. Grading of results 47

19. Distribution based on Age 49

20. Distribution based on Gender 50

21. Distribution based on Marital status 51

22. Distribution based on Religion 52

23. Distribution based on Desha 53

24. Distribution based on Shareera Prakruti 54

25. Distribution based on Dietary habits 55

26. Distribution based on Socio- economic status 56

27. Distribution based on Occupation 57

28. Distribution based on Sleep 58

29. Distribution based on Agni 59

30. Distribution based on Koshta 60

31. Distribution based on Vyayama shakthi 61

32. Distribution based on Satva 62

33. Effect of treatment on Pain in Group A 63

34. Effect of treatment on Pain in Group B 64

35. Comparison of treatment on Pain between Group A and

Group B

65

36. Effect of treatment on Stiffness in Group A 66

v

37. Effect of treatment on Stiffness in Group B 67

38 Comparison of treatment on Stiffness between Group A and

Group B

68

39. Effect of treatment on Tenderness in Group A 69

40. Effect of treatment on Tenderness in Group B 70

41. Comparison of treatment on Tenderness between Group A

and Group B

71

42. Effect of treatment on Difficulty in walk in Group A 72

43. Effect of treatment on Difficulty in walk in Group B 73

44. Comparison of treatment on Difficulty in walk between

Group A and Group B

74

45. Effect of treatment on Schobers test in Group A 75

46. Effect of treatment on Schobers test in Group B 76

47. Comparison of treatment on Schobers test between Group

A and Group B

77

48. Effect of treatment on Visual analogue scale in Group A 78

49. Effect of treatment on Visual analogue scale in Group B 79

50. Comparison of treatment on Visual analogue scale between

Group A and Group B

80

51. Effect of treatment on Oswestry low back disability

assessment questionnaire in Group A

81

52. Effect of treatment on Oswestry low back disability

assessment questionnaire in Group B

82

53. Comparison of treatment on Oswestry low back disability

assessment questionnaire between Group A and Group B

83

54. Overall Comparative effect of treatment in signs and

Symptoms in Group A & Group B after treatment

84

55. Overall effect of Group A 85

56. Overall effect of Group B 86

57. Overall effect of Group A and Group B 87

vi

LIST OF FIGURES

FIGURE

NO.

CONTENTS PAGE

NO.

1. Samprapthi flow chart 18

2. Visual analogue scale 43

3. Distribution based on Age 49

4. Distribution based on Gender 50

5. Distribution based on Marital status 51

6. Distribution based on Religion 52

7. Distribution based on Desha 53

8. Distribution based on Sharira Prakruti 54

9. Distribution based on Dietary habits 55

10. Distribution based on Socio- economic status 56

11. Distribution based on Occupation 57

12. Distribution based on Sleep 58

13. Distribution based on Agni 59

14. Distribution based on Koshta 60

15. Distribution based on Vyayama shakthi 61

16. Distribution based on Satva 62

17. Effect of treatment on Pain in Group A 63

18. Effect of treatment on Pain in Group B 64

19. Comparison of treatment on Pain between

Group A and Group B

65

20. Effect of treatment on Stiffness in Group A 66

21. Effect of treatment on Stiffness in Group B 67

22. Comparison of treatment on Stiffness between

Group A and Group B

68

23. Effect of treatment on Tenderness in Group A 69

24. Effect of treatment on Tenderness in Group B 70

25. Comparison of treatment on Tenderness

between Group A and Group B

71

vii

26. Effect of treatment on Difficulty in walk in

Group A

72

27. Effect of treatment on Difficulty in walk in

Group B

73

28. Comparison of treatment on Difficulty in walk


74

29. Effect of treatment on Schobers test in Group A 75

30. Effect of treatment on Schobers test in Group B 76

31. Comparison of treatment on Schobers test


77

32. Effect of treatment on Visual analogue scale in

Group A

78

33. Effect of treatment on Visual analogue scale in

Group B

79

34. Comparison of treatment on Visual analogue

scale between Group A and Group B

80

35. Effect of treatment on Oswestry low back

disability assessment questionnaire in Group A

81

36. Effect of treatment on Oswestry low back

disability assessment questionnaire in Group B

82

37. Comparison of treatment on Oswestry low back

disability assessment questionnaire between

Group A and Group B

83

38. Overall Comparative effect of treatment in

signs and Symptoms in Group A & Group B

after treatment

84

39. Overall effect of Group A 85

40. Overall effect of Group B 86

41. Overall effect of Group A and Group B 87

viii

LIST OF PHOTO PLATES

SR. No Content Page No

1. Sapthasaram kashaya ingredients 139

2. Kottam chukkadi taila preparation 140

3. Rasnasaptaka kashaya ingredients 141

ix

ABSTRACT

“CLINICAL STUDY ON SAPTHASARAM KASHAYAM AND KOTTAM

CHUKKADI TAILA IN KATIGRAHA WITH SPECIAL REFERENCE TO

LUMBAR SPONDYLOSIS”

Objective

To study the Etiopathogenesis of Katigraha (Lumbar spondylosis) in detail.

To study the clinical effect of Sapthasaram Kashayam and Kottam Chukkadi

Taila in Katigraha.

Methods:

40 Subjects diagnosed with Katigraha who fulfil the inclusion criteria were randomly

selected from OPD and IPD of M.I.A.M.S, Manipal and also from referral sources

and special camps, conducted for the purpose. Registered patient were allotted

randomly by lottery method into two equal groups of minimum 20 subjects in each as

group A and B.

Group A: Sapthasaram kashayam given in two divided doses of 50ml each; morning

and evening 1 hour before food and Kottam chukkadi taila applied at kati region twice

daily for 30 days.

Group B: Rasnasaptaka Kashaya given in two divided doses of 50ml each morning

and evening 1 hour before food for 30 days.

Results & Interpretation:

In the group A treated with Sapthasaram Kashayam and Kottam Chukkadi Taila there

was relief in pain (27.3%), stiffness (39.9%), tenderness (44.7), difficulty in walking

x

(23.8), Schober’s test (20%), VAS (24.3%) and Oswestry test (17.2%) which was

statistically significant.(P = <0.001).

In the group B treated with Rasnasaptaka Kashayam there was relief in pain (20.2%),

stiffness (8.5%), tenderness (31.8), difficulty in walking (9.5), Schober’s test (11.5%),

VAS (18.9%) and Oswestry test (5.4%) which was statistically significant.

(P = <0.001).

Conclusion:

The patients had shown improvement in most of the criteria of assessment of

Katigraha in both the groups with a better effect in group A when compared to group

B. According to this study Sapthasaram kashaya and kottam chukkadi taila can be

opted for all the Katigraha i.e. lumbar spondylosis.

Key Words: Katigraha; Sapthasaram kashayam; Kottam chukkadi taila;

Rasnasaptaka Kashaya.

Introduction

“Clinical Study On Sapthasaram Kashayam And Kottam Chukkadi Taila In

Katigraha With Special Reference To Lumbar Spondylosis” Page 1

INTRODUCTION

Back pain, one of the major musculoskeletal pain problems, has plagued humans

since we evolved the upright bipedal position from that of the quadruped. The vast

majority of us will have at least one bout of debilitating back pain in our lives, and

many of us live with chronic symptoms.

Low back pain (LBP) affects approximately 60–85% of adults during some point in

their lives and Lumbar Spondylosis (LS) is responsible for about 10% of these. In

lumbar spondylosis low back pain, difficulty in walking, tenderness has been told as

the prominent feature1. Lumbar spondylosis is a degenerative condition affecting the

discs, vertebral bodies, and/or associated joints of the lumbar spine.

In Ayurveda, Katigraha is the term given for Low Back Ache. The term Kati means

low back region and Graha means stiffness with gripping pain. Terms like Kati, Trika,

and Shroni are used to denote the low back region in different Ayurvedic classics.

Though Kati Graha has not been described as a separate disease entity by any text

except Gada Nigraha2, it has been categorized under Vataja Nanatmaja Vyadhi in

Charaka Samhita as Prishta Graha3. As correctly said by Sushruta Acharya without

vitiation of Vata, Shoola (pain) cannot be produced4. So prime Importance should be

given to Vata dosha while considering the management of the disease. Kati Graha

which also has symptoms like low back pain and stiffness is correlated with Lumbar

spondylosis.

Kati shoola is mentioned as a symptom in different types of vataja disorders and not

as a separate disease in classical texts5. Kati ruja or shoola is also present as a

symptom of Kati graha.

Because of the lifestyle changes in diet and habits of individuals, Katigraha is

spreading as a very common disease now a day. In most of the cases, people are not

Introduction



able to manage the disease with modern medicines and also by quitting their diet and

habits or changing their lifestyle. So further studies are required to manage the

disease.

Ayurveda also recommends a wide variety of treatments and number of drugs for

Katigraha. Several research works have already been done by different institutions of

India by Research scholars and got some good results in Shamana and Shodhana

procedures. But still the problem has not been solved totally. The field of research is

widely open to get better results and solutions. So, keeping these points in view, here

an attempt has been made with Sapthasaram kashayam (internal) and Kottam

chukkadi taila (external application) mentioned in Sahasrayoga.

Sapthasaram kashayam6 consists of Varshabhu (Rakta Punarnava), Bilwa, Khalvo

(Kulatta), Ruba (Eranda), Sahachara, Sunthi, and Angimantha having Deepana,

Pachana, Srotoshodhana, Vatashamana and Brumhana will do the Samprapthi

Vighatana of Katigraha.

Kottam chukkadi taila7

containing Kottam (Kushta), Chukku (Shunti), Vayamou

(Vacha), Kardhotti (Govindhaphala), Sigru, Lasuna, Devadruma (Devadaru),

Siddhartha (Sarshapa), Suvaha (Rasna), Dadhi, Chincha rasa, Tila taila having

Vatahara properties will help in relieving the symptoms of Katigraha.

Studies on Katigraha with Rasnasaptaka kashaya have been carried out, wherein the

drug has been found to be significantly effective in reducing the morbidity hence;

Rasnasaptaka kashaya will be taken as the control in second group of patients.

Based on this statement the hypothesis has been framed for the study, which states

that Sapthasaram kashayam (internal) and Kottam chukkadi taila (external

application) is capable in controlling Katigraha.

Introduction



PREVIOUS WORKS DONE:

1. Surekha. M, management of Katigraha with Vitex nigundo, Govt. Ayurvedic

College, Trivandrum, 1986.

2. Prema.P.E, management of Katigraha due to Kati-Kaseruka-Antareeya-

Chakrika- Chyuti (lumbar disc prolapse), Govt. Ayurvedic College,

Trivandrum, 1992.

3. Bhatt Mrunalini. R, a Clinical Study on the role of Erandamoola Basti in the

management of Katigraha, IPGT & RA Gujarat Ayurveda University,

Jamnagar,1997.

4. Pattanayak. S, a Clinical Study on Katigraha (Spondilitis) with Gruthatailadi

Yoga, Gopabandhu Ayurveda Mahavidyalaya, Puri, 1999.

5. Parameshwara Namboothirik, A Clinical study on the effect of dvipanchamula

taila matra basti in the management of kati graha, N.K Jabshetty Ayurvedic

Medical College & P.G Research Centre, Bidar, 2007.

6. Najeeb T.K, A Comparative study of sringavacharana and kati basti in kati

shool w.s.r to lumbar spondylosis, Alva`s Ayurvedic Medical College,

Moodbidri, R.G.U.H.S, 2011.

7. Damayanthi Fernandes, Assessment of Clinical Efficacy of Erandamuladi

Yapana Basti and Eranda Bija Kshira Paka in the management of Kati Graha

w.s.r. to Lumbar Spondylosis., IPGT&RA, Gujarat Ayurved University,

Jamnagar, 2011.

8. Shantosh T.R, Effect of lasuna kalka with tila taila and baluka sweda in kati

graha, Shri Shivayogeshwar Rural Ayurvedic Medical College & Hospital,

Inchal, R.G.U.H.S, 2011.

Introduction



9. Vikram Balu, A Comparative clinical study to evaluate the effect of

shamanaushadi and shamanaushadi with agni karma in kati graham w.s.r. to

low back pain. SDM Ayurveda college, Udupi, R.G.U.H.S, 2012

HYPOTHESIS:

H0 - Sapthasaram kashayam (internal) and Kottam chukkadi taila

(external

application) are not effective in Katigraha.

H1- Sapthasaram kashayam (internal) and Kottam chukkadi taila (external

application) are effective in Katigraha.

H2 - Sapthasaram kashayam (internal) and Kottam chukkadi taila (external

application) are more effective than Rasnasaptaka kashaya in Katigraha.

H3 - Sapthasaram kashayam (internal) and Kottam chukkadi taila (external

application) are less effective than Rasnasaptaka kashaya in Katigraha.

Objective



OBJECTIVES OF THE STUDY

1. To study the Etiopathogenesis of Katigraha (Lumbar spondylosis) in detail.

2. To study the clinical effect of Sapthasaram Kashayam (internal) and Kottam

Chukkadi Taila (external application) in Katigraha.

3. To compare the effect of Sapthasaram Kashayam (internal) and Kottam Chukkadi

Taila (external application) as against Rasnasaptaka Kashaya in Katigraha.

Review of literature



REVIEW OF LITERATURE

HISTORIC REVIEW

Ancient Acharyas have not described Katigraha as a specific disease but the

description of its symptoms can be traced in some other conditions like Kati Shula,

Trika Shula, Prishta Shula and Vatika Shula. The disease invariably comes under Vata

Vyadhi. Here an attempt has been made to trace the disease from Vedic Period till

date.

Vedic Period:

In the Rigveda and Atharvaveda, Kikas, Anuka and Anukyat words has been used for

the back or spine8. The other words mentioned are Prishta

9, Prishthat

10, Prishtanya

11

and Prishte12

.

In Atharvaveda, where the diseases involving the name of the organs are mentioned,

there the spinal diseases have been clearly mentioned. i.e. “I have removed the

distressful disease reached through your legs, knees, pelvis and Yoni to the spine from

Ushnitha nadi13

.

In another reference it is mentioned that “remove away the disease from the Griva,

Ushniha, Kikas and Anukya”14

. Here the word Kikas is used for the spine but some

scholars opine that Kikas means cervical spine and Anukya means thoraco-lumbar

spine. Viskandha15

which is described as a Maharoga of Vata having 101 varieties16

,

etymologically it denotes a disease of the trunk which destroys or damages joints and

causes dislocation in them. It restricts the movements and hampers joint function17

.

Thus it may be correlated with degenerative disease of joints. The disease Balas18

is

referred many times in Atharvaveda where it is described as a painful disease of

spine19

and dislocation of the bone has been mentioned as a symptom20

. The

commentators Keshva and Mahidhara are of the opinion that it is a degenerative




condition. In the treatment of Balas and Viskandha respectively application of paste

of Palash splinter mixed with water etc. and affected joints are to be tied with Jangida

(Arjuna) and Aralu (Kantakari) has been mentioned21

. In Atharvaveda Samskandha

denotes a condition of body parts fusing with one another i.e. ankylosing22

. Further,

the severe acute pain in the limbs has been denoted by word Asharika23

.

Upanishad Period:

Kena Upanishad and Ish Upanishad mention about Vayu representing constant

movement, motion and continued efforts24

.

Chandogya Upanishad mentions that Vayu has Chala property and highlights its close

association with the movements of the body25

.

Taittiriya Upanishad states that Vyana Vayu stays in all the joints and performs the

movements whereas circulation is a function of Samaana Vayu26

.

Katha Upanishad describes spinal cord by the word Sushumna and states that

Sushumna comes out by piercing the skull27

.

Purana and Sutra:

Paninee (409 BC)

The words Vata prakopa and Vata Shamana have been mentioned. The disorders of

Vata have been termed as Vataki which is derived from Vata + in by Sutra 5:2:129.28

Kaushika Sutra: (400-300 BC)

Here the sharp penetrating pains have been ascribed to Lord Rudra and to fasten an

amulet of Spar on the patient while patient recites a hymn29

was the remedy been

practiced.

Purana (600BC)

Pauranic texts have used the same terminology as that of Veda. The term Kati Shula is

mentioned in the Garuda Purana30

. The properties of Vata are mentioned as Laghu,




Sheeta and Ati Ruksha in Vishnu Purana and it causes drying or emaciation in the

body31

. The treatment mentioned is to take 1part of Kushta and 2 parts of Haritaki

with warm water.

Samhita Period:

Charaka Samhita

Charaka Acharya has given detailed description of the types of Vata, properties,

locations, functions, symptoms of vitiated Vata, general and specific etiological

factors, major manifestations and their management etc.

Kati Shula which is the cardinal symptom of Kati Graha has not been directly

mentioned as a disease. Prishta Graha has been mentioned as a Nanatmaja Vyadhi32

of

Vata along with its associated symptoms like Pada Shula, Pada Suptata, Prishta Shula,

Trika Shula, etc. following context are mentioned:

• Kati Samgraha in Svedana Yogya33

• Prishta Shula, Kati Graha as a symptom of Vrikka Vidradhi.34

• Pada Shula, Pada Suptata, Prishta Graha as a Nanatmaja Vyadhi of Vata.35

• Vata Vikara of Prishta due to excess of Katu Rasa.36

• Different types of pain in Kati and Prishta in Vatika Jwara.

• Prishta Kati Graha and Shula due to excessive eating and Varchasavrita Vata.37

• Prishtaroga and Trikaroga due to Gudasthitavata and Pakvashayagata vata

respectively.38

Also Charaka Acharya has given Kati Shula as a symptom in the description of

Gridhrasi (Sciatica) the radiating pain described in the classic is one of the major

symptoms of Lumbar Spondylosis though it may present in many other diseases.




Bhela Samhita (210BC)

Acharya Bhela mentioned total 45 bones in the back and 15 in the cervical region in

sharira sthana39.

Kati Graha and Kati Shula is observed as a symptom of various

diseases like Vataja Kasa40

and Mandaagni leads to impeded movement of Vata and is

the main causes for production of Kati Shula41

. The Vata Vyadhi is classified in two

main groups i.e. Sarvanga Roga and Ekanga Roga. The pain predominant diseases

and deformities of Kati and Prishta are listed under Ekanga Roga42

. This probably

includes the intervertebral discs.

Harita Samhita (210BC)

Acharya Harita has not described Kati Graha but has mentioned Shula and mentioned

ten types of Shula giving a separate status to disease. Vata has been said to be an

inevitable factor in production of Shula43

. Obstruction to the downward movement of

Vata and impaired Agni produces Vatika Shula44

.

Kashyapa Samhita

Kati Shula has been mentioned as a disease due to mismanagement of labour

(Dushtaprajata), and eight types of Shula has been explained in Khilasthana. Swedana

is advised in Prishta and Kati Graha45

.

Sushruta Samhita (176-340AD)

Acharya Sushruta has described 30 bones and 24 Pratara types of joints in the spine46

.

In the management of dislocation of lumbar spine, Anchana (traction) followed by

Basti has been mentioned47

excessive movements of spine delay the healing of

damaged part; hence Kapatashayana is advised for these patients48

. Similarly in




Nidanasthana 15th Chapter, a detailed description of various fractures and

dislocations are given.

The cardinal symptom of Katigraha, Kati shula has been mentioned as a symptom of

Vatika Arsha, Vankshanottha Vidradhi, Bhagna, 7th stage of Sarpa Visha Akshepaka

and indirect reference can be drawn from Dalhana commentary about Pakvashaya

Gata Vata that along with Trika Vedana there will be Jangha, Trika and Prishta

Vedana.

Medieval Period:

Astanga Samgraha and Hridaya (600AD)

Both the texts have mentioned Kati Shula as a disease caused by provoked Vata

seated in Pakvashaya and Kati Toda, Kati Bheda as Purvarupa of Vata Rakta, Prishta

Ruka and Shroni Ruka in Sarvadhatvavrita Vata49

. An interesting point to note is that

what is practiced as the SLR test (straight leg raising test) as diagnostic test of

Sciatica has been mentioned as Sakti Utkshepa Nigrahnati which is a sign of

Gridhrasi.50

Madhava Nidanam (7th centuary AD)

Kati Stambha has been mentioned as a symptom of Anaha51

and Trika Graha as a

symptom of Ama vata52

. Vayu is said to be responsible for all types of pain53

. Though

the direct references are rare, sufficient references can be found on the cardinal

symptom of Kati Shula. Shula has been classified under Eka Dosha, Samsargaja,

Sannipatika and Aamaja varieties. Prishta Shula and Trika Shula have been mentioned

under Vatika Shula.




Acharya Madhava has given a detailed description of Kati Shula in 26th chapter. In

the commentary Atanka Darpana, Shri Vachaspati Vaidya said, Prishta, Trika, Kati,

Sphika Sandhi are seats of Vayu. Hence Vayu first gets lodged in these places, unites

with these parts and produce Shula. Further Shula has been described as a symptom of

Purisha Stambha, Vata Stambha, Samgraha Grahani,Vataja Arsha, Vatanubandhi

Raktarsha, Kshatakshina, Vata Rakta Purva Rupa, Gridhrasi, Vatodara

,Vankshanottha Vidradhi, Pandu Purva Rupa, Vataja Pradara, Moodha Garbha, Kati

Bhinna and Kati Sandhi Mukta.

Chakradatta (11th Cen.AD) 54&55

Acharya Chakrapani Datta has described many formulations for conditions like Kati

Graha, Kati Amaya, Kati Shula, Kati Ruja etc in vatavyadhi chapter. Also

Trayodashanga guggulu has been mentioned as the drug of choice in Katigraha. Many

of the formulations are similar to that of Vrinda Madhava.

Gada Nigraha (12th Cen .AD) 56

Katigraha as a separate disease entity has been mentioned for the first time in this text.

The chief complaint of Kati Graha is Kati Shula (Backache). Vata (Saama or

Niraama) moves in to the Kati region and produces the pain. Trayodasanga Guggulu

is mentioned as the drug of choice in Katigraha by Acharya Shodala. Few new

compounds contributed are Avagahana, Abhadi Churna, Ajamodadi Churna, Shringa

Bhasma etc.




Sharangdhara Samhita (1226AD) 57

Katigraha has been enlisted under Vataja Nanatmaja Vyadhi. Adhamalla commented

in Dipika Commentary about the disease has said that it is a specific type of pain

which occurs due to stiffness.

Rasaratna Samucchaya (13th Cen. AD) 58

Rasaratna Samucchaya has mentioned backache as an invariable symptom of

Amavata. Amavatari rasa and Eranda taila are indicated in this condition.

Bhava Prkasha (16th Cen. AD) 59

Bhava Prakasha Samhita has discussed Katigraha under the chapter of Amavata. The

description and management is similar to that of Vrinda Madhava.

Acharya Bhava Mishra has introduced Trika Shula as a separate disease and defined

Trika as the joint of 2 hip bones and spinal column. Valuka Sweda, Agni Sweda and

Trayodasanga Guggulu have been prescribed in the management of this condition60

.

Yoga Ratnakara(17th Cen AD)

Yoga ratnakara mentioned various terms like Kati Shula61

, Kati Vata, Kati Samira,

Kati Prishta Amaya, and Kati Pida etc to indicate backache. Methi Modaka with

Adrakadi Sneha, Karpasasthyadi Lepa is some of the preparations prescribed in these

conditions. Trayodashanga guggulu is mentioned as a drug of choice for Katigraha62

.




Contemporary Modern Medicine:

The Lumbar Spondylosis and the complications arising out of it were collectively

termed as the spinal degenerative disease previously. In earlier periods when the

pathology could not be differentiated it was categorized under Sciatica.

The structure of intervertebral disc was first described by Vesalius in 1543 while the

anatomist and English physician Thomas Willis described spinal nerves in 1684.

Beckett W. in 1724 described that as age advances cartilages hardens which lead to

reduction in height by 1.5- 2.4 cm in elderly people63

.

E. Harrison64

in 1821 made certain fundamental observations about anatomy,

physiology and pathology of spinal column. The strenuous position of spine lead to

compression of intervertebral disc and displacement of nucleus pulposus and ligament

laxity leads to displacement of vertebrae. Harrison was of the opinion that displaced

bone should be restored to its natural position; this became the basis of osteopathy.

Chamley in 1952 for the first time drew attention of medical circles to the problems

associated with abnormal fluid exchange in the disc. In the same year Lindbloom and

Scott suggested mental stress as a precipitating factor for occurrence of low backache.

The chemical changes associated with disc disorders have been investigated by

Mitchell and Henry in 1961 where as the enzymatic and immunological changes were

reported by Arthur Naylor in 1975. Devor M. et al (1989) has elaborated the

neurophysiologic mechanism of pain whereas Biagos et al (1990) have studied the

influence of psychological and occupational factors on low backache65

.




DISEASE REVIEW

INTRODUCTION:

The delicate yet magnificent anthropometry of human body had been a wonder to the

master minds of science as well as arts. Vertebral column (Prishta vankshna) can be

compared to a pillar which bears the whole weight of body. The backache or lumbago

is one of conditions which results from violation of bio mechanics of spine as it

results when the physical and mental strain and faulty postures alter anthropometrical

precision. Due to the increasing prevalence of life style related health problems, at

times it becomes difficult to give a specific name to a disease condition. Chakrapani

teeka mentioned, “Any symptom may manifest as a separate disease.”66

Thus each

disease can become a symptom and each symptom may manifest as a disease.

Katigraha has not been described as a separate disease entity by any text except Gada

Nigraha; it has been categorized under Vataja Nanatmaja Vyadhi in Charaka Samhita

as Prishta Graha. Sushruta Samhita clearly opines without vitiation of Vata, Shula

(pain) cannot be produced.

Here an attempt has been made to justify the usage of the word Katigraha in the

present work to explain the disease Lumbar Spondylosis by stating the etymology,

causes, pathogenesis, clinical presentations and making a scientific correlation.

VYUTPATHI:

The word Katigraha is made up of 2 words “KATI” + “GRAHA”.

KATI:

The term kati is derived from “kat + in” which is said to be the lowest part of the

trunk i.e. from the highest point of iliac crest to the lowest point of ischial tuberosity

and tip of coccyx67

.




1. Amarakosha: Kati is a synonym of Shroni (pelvis).

2. ShabdakalpaDruma68

: Kati is a body part situated near to Shroni and has

circumference of 16 Angula (finger length).

3. Vachaspatyam: “Kati Gatyam” Gatyam Dhatu means movement and when “in”

Pratyaya is added the word Kati is derived. Thus Kati is a bony structure situated

near Shroni and is of 16 Anguli circumferences.

GRAHA:

Graha is derived from “Adantchuram atman saka set” which means stiffness with

gripping pain or seizing, holding, catching or obstruction with pain.

1. Vachaspatyam: “Graha ko Grahyati Graahati, Ash aangaadi reva Manyate”,

Graha of the different parts of the body is termed Graha.

2. Monnier Williams’ Sanskrit-English Dictionary69

: Graha means seizing,

holding, catching or obstruction.

Therefore where ever there is seizing, holding, catching or obstruction with pain

at kati region it can be considered as Katigraha.

NIDANA PANCHAK

Nidana:

Katigraha as a separate disease entity is mentioned only by Gada nigrha and

Sharandhara samhita. Its roopa, samprapthi and chikitsa are mentioned but nidana of

the same is not known. It has been categorized under Vataja Nanatmaja Vyadhi in

Charaka Samhita. Since specific nidana for Katigraha is not known, the general

nidana leading to the manifestation of vata vyadhi can be taken into consideration.

Such as Intake of ruksha, sheeta, alpa and laghu ahara; excessive sexual indulgence;

remaining awake at night in excess; inappropriate therapeutic measures;

administration of therapies which causes excess elimination of doshas and blood;




fasting in excess; swimming in excess; excess walking, exercise and other physical

activities in excess; loss of dhatus; excessive emaciation because of worry, grief and

affliction by disease; sleeping over uncomfortable bed; anger, sleeping during day

time, fear and suppression of natural urges; formation of ama, suffering from trauma

and abstention from food; injuries to marma; riding over an elephant, camel, horse or

fast moving vehicles and falling down from the seat of these animals and vehicles can

be considered as the causative factors of Katigraha70

.

SAMPRAPTI:

According to Ayurveda, three Dosha are the initiators of any disease process. Vata

Dosha is predominant in the later part of middle age and old age. The Ashraya for

Vata is Asthi. The nidanas which were detailed above lead to aggravation and

vitiation of Vayu at its own Ashaya (lodging place) Pakvashaya, which would then

move out and vitiate Ashraya–Asthi71

.

Due to nidana sevana, apana vayu gets vitiated which in turn vitiates samana vayu.

Vitiated samana vayu does agnimandhya leading to production of ama. This does

strotoavarodha there by hampering the normal movements of vayu. Vitiated apana

vayu also vitiates Vyana vayu which is responsible for movements as well as

transportation of nourishments throughout the body72

.

When this series of changes takes place in a person predisposed with Kha-Vaigunya

(genetic or acquired weakness) at Kati Pradesha series of changes takes place which

leads to a disease called Katigraha.




In a nut shell the major factors involved in Samprapti are as follows:

Table no.: 1

1. Dosha Vata Apana

Vyana

Samana

Kapha Shleshaka.

2. Dushya Dhatu Rasa

Rakta

Mamsa

Meda

Asthi (MAINLY)

Majja

Upadhatu Snayu

Sandhi

Mala Pureesha

3. Agni Jataragni

4. Udbhava Sthana Pakvashhaya

5. Vyakti Sthana Kati

6. Sanchara Sthana Adhah Sharira

7. Marga Madhyama roga marga

8. Srotas Rasavaha

Raktavaha

Mamsavaha

Medavaha

Asthivaha

Majjavaha

Pureeshavaha




FLOW CHART:

NIDANA SEVAN (DHATUKSHAYAJANYA)

Apana vayu dushti Kha vaigunya

Samana vayu dushti Vyana vayu dusti

Jataragni mandya

Amotpathi

Srotorodha

Dries up shleshaka kapha

Sthana samshraya at kati pradesha due to presence of kha vaigunya

Pain and stiffness at kati pradesha

Katigraha

Figure no: 1

POORVAROOPA

Poorvaroopa of Katigraha has not been described by classics. Chakrapani comments

poorvaroopa means “Avyaktam” which means laghuta of disease73

. Thus mild

recurrent backache, slight stiffness, sudden pain on lifting weight or bending down

etc. may come under premonitory symptoms.

ROOPA

Gada nigraha explains Kati ruja and Kati graha as the prime symptom of Katigraha.

1. KATI GRAHA

Movements in the body as well as distribution of nourishment are carried out by

vyana vayu. When vyana vayu is aggrevated by apana vayu and ama by nidana

sevana, there is reduction of chala guna and ruksha guna of Vyana Vayu due to

Anyonya Avarana either by Apana (due to severe Vata Prakopa) or due to Ama74

.

This results in graha.




2. KATI RUJA

Ruja that is localised at kati pradesh (lumbo-sacro iliac region) is a feature seen in

katigraha. This happens because vitiated vyana vayu dries up shleshaka kapha and

causes pain75

. Abhighata or external trauma is another cause of pain in the kati

pradesh.

UPASHAYA, ANUPASHAYA

Upashaya anupashaya for Katigraha has not been mentioned. So in general what is

mentioned for vata can be considered here.

In Charaka Samhita in the context of Asthi –Majjagata Vata it is mentioned that the

diet should be predominantly consisting of Madhura, Amla and Lavana Rasa, one

should ingest mamsa rasa specially Goat meat soup which is cooked with Snigdha,

Dadhi, Amla and Vyosha, milk and milk products (Payasa) etc76

.

In the case of Kapha Avrita Vata, Yava, Jangala Mriga Pakshi Mamsa Rasa, Jirna

Sarpi, Sarshapa Taila or Tila Taila has been said to be beneficial. Along with these a

regimen of residing in a Nivata Sthana (no direct strong wind), Pravarana (covering

body with clothes) and doing massage and fomentation and Avagaha (tub Bath) etc

have been mentioned classically77

. Exercise, sexual intercourse, liquor, salty spicy

diet, suppression of natural urges, anger and pulses have been mentioned as Apathya

(non- beneficial) for the patients78

.

SADHYAASADHYATA

Most Vata Vyadhi is either Krichra Sadhya or Yapya or Asadhya. In Vangasena

Samhita, during Amavata description it is mentioned that afflictions of deeper tissues

like Asthi and Majja are regarded as curable only at the initial stages that too with

hard efforts. Katigraha is Vata Nanatmaja Vyadhi affecting the Ashraya Sthana of

Vata, where the disease is of Madhyama Roga Marga. Therefore, even at the initial

stage it is Kricchra Sadhya and at later stage it may be Yapya or Asadhya79

.




SAPEKSHA NIDANA

1) Kati shula is seen in Purva Rupa of Vata Rakta along with pain in Janu, Jangha,

Uru, Hasta, and Pada and associated with Kandu and Sphurana in those regions80

.

2) Pakvashayagata Vata81 where Antrakujana, Shula, Atopa, difficulty in defecation

and urination are the symptoms whereas Antra Kujana etc abdominal symptoms

will be absent in case of Lumbar Spondylosis.

3) In Prushta graha there is pain and stiffness at prushta pradesha.

4) Other case where kati shula is seen includes some sthaulya patients and garbhini.

5) Kati shula is present in Gridhrasi along with radiating pain from kati towards one

or both the legs.

UPADRAVA

Sushruta Acharya has described the complications of Vata Vyadhi as Visarpa, Daha,

Vedana, Angasanga, Murcha and Agnimandya82

. The person suffering from Vata

Vyadhi along with above mentioned Upadrava is considered incurable.

CHIKITSA

Katigraha in most of the classics has been mentioned as a symptom under Nanatmaja

Vata Vyadhi, but for the first time Gada Nigraha has mentioned it as a separate

disease. The pain in the lumbar region is one of the cardinal symptoms thus Kati

Graha is given the synonym of Kati Shula. The treatment aspects for Kati Graha can

be broadly classified under 3 main headings: Antah Parimarjana (which can be

reclassified under Shamana and Shodhana), Bahih Parimarjana and Satvavajaya

Chikitsa.

1. Antah Parimarjana 2. Bahih Parimarjana

3. Satvavajaya Chikitsa




1. Antah Parimarjana

Though both Virechana and Basti are indicated as Shodhana measures considering the

pathogenesis, classics have indicated Basti and specifically Yapana Basti as the

treatment of choice. Under the Shamana therapy many formulations containing

Shamana as well as Rasayana properties have been indicated. Some of the

formulations are Ardraka Swarasa with Matulunga Swarasa, Chukra with Jaggery, oil

or Ghee, Shunti Phanta, Trayodashanga Gugglu, Masha Gokshura Kvatha, Sunthi-

Guduchi with pippali, Ajamodadi Vataka, Shunthi Gritha, Kanjika Shatpal, Shandaki,

Abhadi Churna, Ajamodadi Churna, Shringa Bhasma, ErandaTaila (Castor oil) and

Nirgundi Swarasa (juice), Mritotthapana Rasa and Udayabhaskar Rasa etc.

Chakradatta mentions internal use of ErandaTaila whereas Vrinda Madhava and

Bhavaprakasha mention Eranda Payas (Eranda Bija Kshira Paka) for Kati Shula.

2. Bahih Parimarjana

I. ABHAYNGA

Ayurvedic Dinacharya advocates daily Sarvanga Abhyanga or minimum head, arms,

soles and ears massage. By this advice one may comprehend that the Acharya were

well aware of the invariable Vata vitiation due to daily activities and that an abnormal

increase in Vata will diminish rejuvenative capacity of body. Abhyanga being a

modality of snehana is able to control the irregularities of Vata.

II. SWEDANA

Drava (Avagahana etc) as well as Ruksha Swedana (Baluka) has been indicated in the

classics considering the pure Vataja and Saama Vataja pathogeneses.




III. ANCHANA –TRACTION

Acharya Sushruta in the context of management of fractures and dislocations has

mentioned traction as one of the treatment modalities for lumbar pain due to

Subluxation or dislocation83

.

3. Satvavajaya Chikitsa

Ayurvedic Satvavajaya Chikitsa involves practice of Achara Rasayana and

understanding and removing the causative factor that can disturb mental health. It also

involves following basic precautions to avoid aggravation of disorders.

MODERN DISEASE REVIEW- LUMBAR SPONDYLOSIS

ETYMOLOGY

The word SPONDYLOSIS is made up of 2 words “Spondylos” (Greek) and “Lysis”.

Spondylos means Spine and Lysis means to disintegrate. Thus it may be defined as

follows84

:

1. Lumbar Spondylosis is a degenerative disorder of the lumbosacral spine giving rise

to disc degeneration and osteophyte formation leading to spinal deformity, low back

pain radiating down one or both lower extremities and features of lumbar

radiculopathy.

2. Outgrowth of immature bony processes from the vertebrae reflecting the presence

of degenerative disease and calcification.

3. Spondylosis generally means change in the vertebral joint characterized by

increasing degeneration of the intervertebral disc with subsequent changes in the

bones and soft tissues. Spondylolisthesis, spinal canal stenosis are resultant

pathological changes.




CAUSES:

Spondylosis is caused from years of constant abnormal pressure from joints

subluxation, sports, poor posture, being placed on vertebrae and the discs between

them. Spondylosis can affect a person at any age; however older people are more

susceptible.

RANGE OF MOTION AT LUMBAR VERTEBRAE:

Table no.: 2

Range

Flexion 50 degrees

Schober’s test:

To perform this test, two marks

are made, one 10 cm above S1

and another 5 cm below. The

patient then bends forward.

Normally, the points distract at

least 5 cm. Less indicates

reduced lumbar motion.

Involves straightening of the lumbar

lordosis or possibly even slight

forward movement. Movement

occurs at the upper lumbar levels and

is limited by the zygophaseal joint

capsule, ligaments of intervertebral

joint, tension in muscles and lumbar

fascia.

Extension 30 degree It is primarily limited by impact of

spinous process or inferior articular

process on the underlying lamina.

Lateral

Flexion

20-30 in each direction Complex and variable combination of

lateral bending and rotator movement

of the interbody joints.

Rotation 15 degree rotation is available in

each direction from neutral.

It is very limited in lumbar spine as

there are no primary rotators of LS;

rotation is achieved by the oblique

abdominal muscles acting on the

thorax, the movements of which

impose a screwing effect on the LS.

It is limited by the zygopophaseal

joint in the side opposite to that of the

direction of rotation.




PHYSICAL EXAMINATION

To diagnose a case of Lumbar Spondylosis, following examinations were carried out:

I. Lumbar curvature: any deformity in lumbar curvature was assessed for any

compensatory lordosis, kyphosis or scoliosis or any other abnormal posture.

II. Schober’s test is used to evaluate degree of restriction of spinal movements.

Schober’s test can be performed in flexion with patient standing or in

extension from a prone position. A line is drawn between PSIS and a distance

of 10 cms is measured above and a distance of 5 cms below the line to give a

15 cms space. Normally, on flexion, a normal elongation of 6 cms or more is

noted. For lateral flexion, patient is asked to bend on right and left side one

by one without bending knees and distance between shoulders and ankles is

noted.

III. Straight Leg Raising test:

Active straight Leg Raising test, make the patient lie supine with both legs extended,

raise the leg on unaffected side by lifting the heel with one hand while preventing

knee flexion with other hand. This causes pain at the sacro-iliac joint owing to the

rotational strain produced by the tension of hamstring muscles. Normally, leg can be

raised up to 75 degree. If pain appears under 40 degrees, it indicates impingement of a

protruding intervertebral disc on a nerve root. If pain appears only above 40 degree, it

suggests tension on a nerve root from any cause.

IV. Lassegue’s sign or passive Straight Leg Raising test:

It is important to differentiate sacro-iliac lesion from sciatica. The patient is asked to

lie completely relaxed. Now, the straight leg is gradually raised by holding the ankle

with one hand. When the leg is raised to maximum limit without pain, dorsiflexion of




the foot is attempted. It may cause pain or muscle spasm in the posterior thigh if there

is lumbar root or sciatic nerve irritation.

V. Femoral nerve stretch test:

Compression of the upper lumbar nerve roots produce a positive femoral stretch test

and a negative S.L.R and vice versa is true for lower lumbar roots. In this, keeping the

patient in prone position, the ankle is grasped and flexed at knee. This causes pain in

the appropriate distributions by stretching the femoral roots in L2-L4. The test is

positive if this sudden limitation of movement due to pain felt at the anterior part of

the thigh causing reflex contraction of the quadriceps.

Neurological signs:

Reflexes:

The knee and ankle jerks and the plantar response are elicited. They are compared

with the other leg, which may be reduced or absent depending upon nerve root

involvement.

Sensory impairment :

Each dermatome should be tested with cotton wool and pin, comparing the sensation

with opposite leg. Joint positive sense should be tested in the big toe, if S1 root is

involved, sensory impairment is the form of sensory loss or hyperesthesia,

hypoesthesia may be present.

Appearance and tone :

Muscle wasting should be noted particularly of the buttocks, which is positive only in

chronic case. The tone of the muscles groups can be assessed by palpation.




DIFFERENTIAL DIAGNOSIS85

:

Ankylosing spondylosis

Progressive ossification of the joints of the spine occurs. Patients with Ankylosing

spondylosis are usually young men who complain of mild to moderate pain which

early in course of the back of the thighs. In early course there are symptoms like

morning stiffness or chest expansion, tenderness over the sternum and decreased

motion and flexion contractures of the hips may also be present.

Rheumatoid arthritis

Spinal rheumatoid arthritis tends to be localized to the cervical apophyseal joints and

atlanto-axial articulation. The pain, stiffness and limitation of motion are there in the

neck and back of the head. RA is rarely confined to the spinal segments but affect

multiple joints and it do not lead to significant degree of intervertebral bridging.

Neoplastic conditions of the spine

There may be benign or metastatic tumours. Malignancy may involve vertebrae,

pelvis or retro peritoneum.

Metabolic conditions of the spine

Osteomalacia is described as a group of disease denoted by a decrease in the primary

mineralization of newly formed bone matrix or osteoid. Paget’s disease is

characterized by excessive and abnormal remodelling of bone. Osteoporosis is the

decrease in bone mass with the remaining bone being histologically and chemically

normal.




Myofascial pain or fibromyalgia syndrome

Myofascial pain syndrome is characterized by regional musculoskeletal pain (usually

chronic) and localized areas of tenderness (tender points) on digital palpation.

Fibromyalgia syndrome is defined as a chronic, painful condition with widespread

musculoskeletal aching accompanied by multiple tender points.

Spinal Osteoarthritis (OA)

A degenerative process defined radiologically by joint space narrowing,

osteophytosis, subchondral sclerosis, and cyst formation. The term “osteoarthritis”

suggests pathology limited to bone.

COMPLICATIONS86

:

Lumbar Spondylosis, if not treated in proper stage may progress and give rise to

following conditions.

Lumbar Spondylolisthesis

This is anterior slippage of one vertebra over the next lower vertebrae due to

degenerative changes in the facet joint and/or intervertebral disc at the same level.

Spinal canal stenosis

It is generally defined as less than 100mm3 of area within the Dura available in the

neural canal. The spinal canal can be narrowed by degenerative changes and/or

developmentally either centrally or laterally damaging nervous tissue directory disc or

osteophyte. Cardinal symptom is pseudo claudication or neurogenic claudication

provoked by standing or walking. Description of pain, numbness, weakness, and

symptoms in bilateral leg, accompanied by backache, ankle reflexes reduced or

absent, knee reflexes reduced or absent, knee reflexes reduced or absent. EMG is




abnormal. Canal stenosis may manifest as a disorder of micturition. The bladder

dysfunction may be intermittent or continuous and may take the form of incontinence,

retention or recurrent urinary infection.

Cauda Equinea syndrome

This is the most serious condition amongst three. Sometime, massive derangement of

disc or the extrusion of a large free fragment into the spinal canal causes compression

of cauda Equinea, usually at the level of L4-L5 or L5-S1. Pain may be mild or severe.

Usually bilateral sciatica, weakness and numbness of lower limbs are the main

features. Involvement of all the nerves may be occurring with profound motor and

sensory changes in the legs. Saddle anaesthesia and absence of buttock muscle tone

are signs of S2-S5 root damage. Further, involvement of sacral nerves will produce

additional sensory changes but more importantly sphincter disturbances with retention

of urine and faeces.

MANAGEMENT OF LUMBAR SPONDYLOSIS:

I. NSAIDS

NSAIDS are widely regarded as an appropriate first step in management, providing

analgesic and anti-inflammatory effects. There is adequate data demonstrating

efficacy in pain reduction in the context of chronic low back pain with use most

commonly limited by gastrointestinal complaints.

II. Opioid medications

Opioid medications may be considered as an alternative or augmentive therapy for

patients suffering from gastrointestinal effects or poor pain control on NSAID

management. The practice of prescribing narcotics for chronic low back pain sufferers




is extremely variable within practitioners, with a range of 3–66% of chronic taking

some form of opioid in various literature studies. These patients tend to report greater

distress/suffering and higher functional disability scores.

III. Antidepressants

The use of antidepressants for treatment of LBP symptoms has also been explored

considerably given their proposed analgesic value at low doses, and dual role in

treatment of commonly co-morbid depression that accompanies LBP and may

negatively impact both sleep and pain tolerance.

IV. Muscle relaxants

Muscle relaxants, taking the form of either antispasmodic or antispasticity

medications, may provide benefit in chronic low back pain attributed to degenerative

conditions.

INJECTION THERAPY87

• Epidural steroid injections

Epidural steroid injections have become a common interventional strategy in the

management of chronic axial and radicular pain due to degeneration of the lumbar

spine. These injections may be performed through interlaminar, transforaminal, or

caudal approaches.

Facet injections

Facet joints, also termed zygapophysial joints, are paired diarthrodial articulations

between adjacent vertebrae. Diagnostic blocks of the joint inject anaesthesia directly

into the joint space or associated medial branch.




SI joint injections

The sacroiliac joint space is a diarthrodial synovial joint with debated innervation

patterns that involve both myelinated and unmyelinated axons. There is moderate

evidence to support the use of both diagnostic and therapeutic blocks of the SI joint.

At this point, there is limited evidence to support radiofrequency neurotomy (ablation

procedure) of the SI joint.

Surgical Options

Surgical interventions are generally reserved for patients who have failed conservative

options. Many surgical approaches have been developed to achieve one of the two

primary goals: spinal fusion or spine decompression (or both). Spinal fusion is

considered in patients with misalignment or excessive motion of the spine, as seen

with DDD and Spondylolisthesis. Decompression surgery is indicated for patients

with clear evidence of neural impingement, correcting the intrusion of bone or disc as

might be seen in spinal or foraminal stenosis, disc herniation, osteophytosis, or

degenerative Spondylolisthesis.




DRUG REVIEW

Drug profile:

40 patients of Katigraha will be randomly selected from OPD and IPD of Muniyal

institute of Ayurveda medical sciences and divided into two groups, as Group-A

containing 20 patients and Group-B containing 20 patients.

Group-A will be given Sapthasaram kashayam (internally) and Kottam

chukkadi taila (external application).

Group-B will be given Rasnasaptaka kashaya.

Dose and Duration for both the groups

Group A :

Sapthasaram kashayam (internally) will be given in two divided doses of 50ml each;

morning and evening 1 hour before food and Kottam chukkadi taila (external

application) 10-15 ml twice daily for 30 days.

Group B :

Rasnasaptaka Kashaya will be given in two divided doses of 50ml each morning and

evening 1 hour before food for 30 days.

Duration: 30 days




SAPTHASARAM KASHAYAM

Table no.:3

Sr.

no

Drug name Botanical

name88

Rasa Guna Virya Vipaka Krama

1. Varshabhu

(rakta

punarnava

Boerhaavia

diffusa

Madhura,

tikta, kashaya

Ruksha Ushna Madhura Anulomana,

shothahara,

mutrala,

vatakaphahara

2. Bilwa Aegle

marmelosa

Madhura Laghu Sheeta Madhura Mutrala,

tridoshaghna

3. Kulattha

(khalvo)

Dolichos

biflorus

Kashaya Laghu,

sara

Ushna Katu Vidahi,

svedasangraha

ka, krumihara,

kaphavatahara

4. RUBA

(eranda)

Ricinus

communis

Madhura Guru,

snigdha

Ushna Madhura Vatahara,

vrushya,

amapachana

5. Sahachara Barleria

prionitis

Madhura,

tikta

Snigdha Ushna Katu Kaphahara,

keshya, kasa,

ranjana,

visahara

6. Shunti Zingiber

officinale

Katu Laghu,

snigdha

Ushna Madhura Anulomana,

dipana, hrudya,

pacana,

vatakaphahara

7. Agnimantha Clerodendr

um

phlomidis

Katu, tikta,

kashaya

Laghu,

ruksha

Ushna Katu Vatakaphahara,

svayathuhara




KOTTAM CHUKKADI TAILA

Table no.: 4

Sr.

no

Drug

name

Botanical

name

Rasa Guna Virya Vipak Karma

1. Kottam

(kushta)

Saussuria

lappa

Katu,

tikta

Laghu Ushna Katu Kaphavatahara,

raktashodaka, varnya,

shukrala

2. Chukka

(shunti)

Zingiber

officinale

Katu Laghu,

snigdha

Ushna Madhura Anulomana, dipana,

hrudya, pacana,

vatakaphahara

3. Vayampu

(vacha)

Acarus

calamus

Katu,

tikta

Laghu,

teekshna

Ushna Katu Dipana, vatahara,

krumihara, malamutra

vishodhana etc

4. Shigru Moringa

oleifera

Madhur

a, katu,

tikta

Laghu,

picchila,

ruksha,

sara,

teekshna

Ushna Katu Vataghna, dipana,

recana, samgrahi,

hrudya, visaghna,

sukrala etc

5. Lasuna Allium

sativum

Madhur

a, katu

Guru,

picchila,

sara,

snigdha,

teekshna

Ushna Katu Balya, dipana, hrudya,

medhya,

vatakaphahara,

varnya,

raktadoshahara etc

6. Devadaru Cedrus

deodara

Tikta Laghu,

snigdha

Ushna Katu Kaphavatahara,

drushtavrana shodhaka

7. Kardhotti

(Govindap

hala)

Capparis

sepiaria

Katu,

tikta

Laghu,

ruksha

Ushna Katu Dipana,

kaphavatahara, ruchya

8. Siddhardh

a

(sarshapa)

Brassica

campestris

Katu,

tikta

Snigdha,

teekshna

Ushna Katu Dipana,

kaphavatahara, hrudya

9. Suvaha

(rasna)

Alpinia

officinarum

Tikta Guru Ushna Katu Amapacana,

kaphavatahara

10. Tila taila Sesamus

indicum

Madhur

a, tikta,

kashaya

Sara,

snigdha,

guru,

suksma,

vyavayi,

visada,

vikasi

Ushna Madhura Balya, dipana,

garbhashaya

shodhana, medhya,

snehana, vatahara etc

11. Chincha

rasa

Tamarindus

indica

Madhur

a, amla,

kashaya

Guru,

ruksha,

sara

Ushna Amla Kaphavatahara,

bastishudhikara,

bhedi, hrudya,

vishtambhi

12. Dadhi Curd Amla Grahi,

guru

Ushna Amla Vatajit, ruchya




RASANASAPTAKA KASHAYA89&90

Table no.:5

Sr.

no

Drug

name

Botanical

name

Rasa Guna Virya Vipak Karma

1. Rasna Alpinia

officinarum

Tikta Guru Ushna Katu Amapacana,

kaphavatahara

2. Amruta Tinospora

cordifolia

Tikta,

kashaya

Laghu Ushna Madhura Balya, depana,

rasayana, sangrahi,

tridoshashamaka,

raktashodaka,

jvaragna

3. Aragvadha Cassia fistula Tikta Guru Sheeta Katu Pittahara, vatahara,

koshtashuddhikara

4. Devadaru Cedrus

deodara

Tikta Laghu,

snigdha

Ushna Katu Kaphavatahara,

drushtavrana

shodhaka

5. Trikantaka Tribulus

terrestris

Madhura Guru,

snigdha

Sheeta Madhura Bruhana, vatahara,

vrushya,

ashmarihara,

vastishodaka

6. Eranda Ricinus

communis

Madhura Guru,

snigdha

Ushna Madhura Vatahara, vrushya,

amapachana

7. Punarnava Boerhaavia

diffusa

Madhura,

tikta

Laghu,

ruksha

Ushna Madhura Kaphavatahara,

vishaghna,

pittashamaka,

jvarahara,

agnidipaka

Methodology



MATERIALS AND METHODS

The study entitled “Clinical study of Sapthasaram Kashayam and Kottam Chukkadi

taila in Katigraha with special reference to Lumbar Spondylosis” was carried out in

40 subjects suffering from Katigraha, selected from the OPD and IPD of Muniyal

institute of Ayurveda Medical Sciences, Manipal.

Aims and Objectives:

1. To study the Etiopathogenesis of Katigraha (Lumbar spondylosis) in detail.

2. To study the clinical effect of Sapthasaram kashayam (internal) and Kottam

chukkadi taila (external application) in Katigraha.

3. To compare the effect of Sapthasaram kashayam (internal) and Kottam

chukkadi taila (external application) as against Rasnasaptaka kashaya in

Katigraha.

Source of data:

Literary source:

All Ayurveda, modern literature and contemporary texts including the journals,

websites etc will be reviewed pertaining to the drug and diseases in the intended

study.

Pharmaceutical source:

The formulations selected for research work, Sapthasaram kashayam and Kottam

chukkadi taila will be prepared in the Muniyal Ayurveda pharmacy, Manipal as per

Standard Operative procedure.

Methodology



Clinical Source:

Subjects diagnosed with “Katigraha” who fulfill the inclusion criteria were randomly

selected from OPD and IPD of Muniyal Institute of Ayurveda Medical Sciences and

Hospital, Manipal and also from referral sources and special camps conducted for the

purpose.

Subject Selection:

1. Diagnostic criteria

The subjects will be diagnosed based on:

1. Stiffness (Kati graha)

2. Pain (Kati ruja)

3. Tenderness

4. Difficulty in walking

5. Lumbar spine mobility91

6. X-ray (LS spine AP & LAT)

2. Inclusion Criteria:

Clinically diagnosed cases of Katigraha (lumbar spondylosis) were taken for the

study.

A. Subjects of age group- 30 to 60 years (Irrespective of gender).

B. L.S.M (Lumbar spine mobility) tests:

If flexion of the spine is less than 6cm

If lateral flexion of the spine is less than 35o

If extension of the spine is less than 30o

If spinal rotation from the waist on either side is less than 45o (per side).

Methodology



3. Exclusion Criteria:

1) Subjects having complicated diseases like spinal tumor, fracture of vertebrae,

Malignancy and Tuberculosis of spine etc.

2) Subjects with known case of diabetes mellitus and hypertension.

3) Subjects with history of trauma to the spine and with marked deformities of

spinal cord and disc prolapse.

4) Ankylosing spondylosis, Rheumatoid Arthritis, Psoriatic Arthritis, Gouty

Arthritis, Pregnancy, Epilepsy or any other serious systemic illness.

5) Subjects aged below 30 yrs. and above 60 yrs.

Laboratory Investigations:

1. Complete blood test

2. Fasting blood sugar

3. Plain X-ray of lumbar spine (AP and LAT)

4. RA factor (To rule out Rheumatoid arthritis)

5. Serum uric acid (To rule out Gout)

6. Mantoux test (Only if necessary- to rule out TB of spine)

7. HLAB27 (if necessary)

8. MRI (if necessary)

Methodology



DRUG COMPOSITION:

SAPTHASARAM KASHAYAM

Table no: 6

SR

NO.

SANSKRIT

NAME

BOTANICAL NAME

PART

USED

PROPORTION

1. VARSHABHU

(Rakta Punarnava)

Boerhavia diffusa Root 1 part

2. BILWA Aegel marmelos Root 1 part

3. KHALVO

(Kulattha)

Dolichos biflorus Seed 1 part

4. RUBA (Eranda) Ricinus communis Root 1 part

5. SAHACHARA Barleria prionitis Root 1 part

6. SHUNTI Zingiber officinale Rhizome 1 part

7. AGNIMANTHA Clerodendrum

phlomidis

Root 1 part

KOTTAM CHUKKADI TAILA

Table no: 7

SR

NO.

SANSKRIT NAME BOTANICAL

NAME

PART

USED

PROPORTION

1. KOTTAM (Kushta) Saussuria lappa Root 1 part

2. CHUKKA (Sunthi) Zingiber officinale Rhizome 1 part

3. VAYAMPU (Vacha) Acorus calamus Rhizome 1 part

4. SIGRU Moringa oleifera Bark 1 part

5. LASUNA Allium sativum Root 1 part

6. KARDHOTTI

(Govindhaphala)

Capparis sepiaria Root 1 part

7. DEVADRUMA

(Devadaru)

Cedrus deodara Heartwood 1 part

8. SIDDHARTHA

(Sarshapa)

Brassica campestris Seed 1 part

9. SUVAHA (Rasna) Alpinia officinarum Rhizome 1 part

Methodology



Remaining ingredients-

Table no: 8

Serial no. Sanskrit names English names Proportions

1. Tila taila Sesame oil 1part

2. Dadhi Curd 4 parts

3. Chincha rasa Tamarind juice 16 parts

RASNASAPTHAKA KASHAYA

Table no. 9

SR

NO.

SANSKRIT

NAME

BOTANICAL

NAME

PART USED

PROPORTION

1. RASNA Alpinia officinarum Rhizome 1 part

2. AMRUTA Tinospora cordifolia Stem 1 part

3. ARAGVADHA Cassia fistula Bark 1 part

4. DEVDARU Cedrus deodara Heartwood 1 part

5. TRIKANTAKA Tribulus terrestris Fruit 1 part

6. ERANDA Ricinus communis Root 1 part

7. PUNARNAVA Boerhavia repens Root 1 part

Preparation of medicine:

All the ingredients are collected from Authentic vendor and Approved by Dravyaguna

experts from M.IA.M.S Manipal.

The useful parts and the ratio of the individual ingredients are as per classical

reference.

After the preparation the product were standardised.

Preparation of SAPTHASARAM kashayam choorna by using ingredients:

Varshabhu, Bilwa, Khalvo, Ruba, Sahachara, Sunthi, Angimantha as per Sahasrayoga

at Muniyal Ayurveda pharmacy, Manipal as per the Standard Operative procedure.

Methodology



Method of preparation :

10 grams Sapthasaram Kashayam choorna is taken and added with 16 parts (800 ml)

of water and reduced to 1/8th

part (100 ml) and taken at morning and evening before

food.

Preparation of KOTTAM CHUKKADI TAILA by using ingredients:

KALKA DRAVYA: Kottam, Chukku, Vayampu, Sigru, Lasuna, Devadaru,

Kardhotti, Siddhardha, Suvaha.

DRAVA DRAVYA: Dadhi, Chincha rasa

SNEHA DRAVYA: Tila taila

As per Sahasrayoga and Sharangadhara Samhita it was prepared at Muniyal Ayurveda

pharmacy, Manipal as per the Standard Operative procedure.

Method of preparation92

:

1 part of kalka (all the kalka dravya mixed together), 4 parts of oil (tila taila), and 16

parts of Drava dravya are added together boiled and reduced to the quantity of oil.

This oil is made warm and 10-15 ml is applied at kati pradesha twice daily.

Preparation of RASNASAPTAKA kashaya choorna93

by using ingredients:

Rasna, Amruta, Araghwada, Devdaru, Gokshura, Eranda & Punarnava as per

Bhaishajya Ratnavali at Muniyal Ayurveda pharmacy, Manipal as per the Standard

Operative procedure.

Method of preparation :

10 grams Rasnasaptaka Kashaya choorna is taken and added with 16 parts (800 ml) of

water and reduced to 1/8th

part (100 ml) and taken at morning and evening before

food.

Design of Study

A single blind randomized comparative clinical study.

Methodology



Interventions:

A minimum of 40 subjects fulfilling the diagnostic and inclusion criteria irrespective

of their gender, caste, religion, education status and socio-economic status were taken

for the study. Registered patient were allotted randomly by lottery method into two

equal groups of minimum 20 subjects in each as group A and B.

Group-A

Drug – Sapthasaram kashayam (internally) and Kottam chukkadi taila (external

application)

Dosage – 50ml (Kashaya) & 10-15 ml (Taila)

Time of administration – Morning and evening minimum 1 hour prior to food.

Duration of treatment – 30 days

Follow up – 31st and 45

th day of treatment

Group-B

Drug – Rasnasaptaka kashaya

Dosage – 50ml

Time of administration - Morning and evening minimum 1 hour prior to food.



th day of treatment

Assessment Criteria:

Subjects were assessed based on the assessment criteria and were observed for the

symptomatic changes on 31st day. Follow up were taken on 45

th day. The results

obtained were analyzed statistically.

Methodology



Subjective parameters:

1. Kati ruja (Pain)

Table: 10

0

No pain

1

Localized, recurrent, mild pain in back, not radiating to legs, exaggerated by

Walking & lifting weight, completely relieved by rest.

2

Recurrent, Mild but uncomfortable pain in back, radiating to one/ both leg,

Exaggerated by movements, subsided by rest.

3

Moderate but dreadful pain in the back, with/ without radiation, exaggerated

by bending, not relieved by rest, relieved by fomentation & massage, not

Disturbing sleep.

4

Severe (Horrible) pain in the back with / without radiation to legs, unchanged

by rest, disturbing the sleep, relieved by fomentation, lotions or lower

analgesics

5

Severe(Agonizing) continuous pain in the back, radiation to both legs, disturbs

sleep, requires higher analgesics or major injections for spinal block

6

Intense degree of continuous pain not relieved by any measures

2. Kati graha (Stiffness)

Table: 11

0 no restriction of movements

1 restriction in any one movement of above

2 restriction in any 2 movements

3 restriction in any 3 movements

4 restriction in all 4 movements

3. Tenderness

Table: 12

0 no tenderness

1 mild tenderness without any sudden response on pressure

2 Wincing of face on pressure due to tenderness

3 Wincing of face withdrawal of affected part on pressure

4 Resists touch due to tenderness

Methodology




Table: 13

0 No difficulty in walking

1 Pain restrict walking more than 1 mile

2 Pain restrict walking more than ½ mile

3 Pain restrict walking more than ¼ mile

4 Unable to walk at all

5. Schobers test94

Table: 14

0 No restrictions > 5 cm

1 Mild restriction upto 4cm

2 Moderate restriction upto 3cm

3 Severe restriction < 2cm

6. Visual analogue scale (for pain assessment)

Figure no: 2

7. Oswestry low back disability assessment questionnaire95

.

Table: 15

Section 1 – Pain intensity

I have no pain at the moment

The pain is very mild at the moment

The pain is moderate at the moment

The pain is fairly severe at the moment

The pain is very severe at the moment

Section 2 – Personal care (washing,

dressing etc)

I can look after myself normally

without causing extra pain

I can look after myself normally but it

causes extra pain

It is painful to look after myself and I

Methodology



The pain is the worst imaginable at the

moment

am slow and careful

I need some help but manage most of

my personal care

I need help every day in most aspects

of self-care

I do not get dressed, I wash with

difficulty and stay in bed

Section 3 – Lifting

I can lift heavy weights without extra

pain

I can lift heavy weights but it gives

extra pain

Pain prevents me from lifting heavy

weights off the floor, but I can manage

if they are conveniently placed eg. on

a table

Pain prevents me from lifting heavy

weights, but I can manage light to

medium weights if they are

conveniently positioned

I can lift very light weights

I cannot lift or carry anything at all

Section 4 – Walking*

Pain does not prevent me walking any

distance

Pain prevents me from walking more

than 1 mile


than ½ mile


than 100 yard

I can only walk using a stick or

crutches

I am in bed most of the time

Section 5 – Sitting

I can sit in any chair as long as I like

I can only sit in my favourite chair as

long as I like

Pain prevents me sitting more than one

hour

Pain prevents me from sitting more

than 30 minutes

Pain prevents me from sitting more

than 10 minutes

Pain prevents me from sitting at all

Section 6 – Standing

I can stand as long as I want without

extra pain

I can stand as long as I want but it

gives me extra pain

Pain prevents me from standing for

more than 1 hour


more than 30 minutes


more than 10 minutes

Pain prevents me from standing at all

Section 7 – Sleeping

My sleep is never disturbed by pain

My sleep is occasionally disturbed by

pain

Because of pain I have less than 6

hours sleep


hours sleep

Section 8 – Sex life (if applicable)

My sex life is normal and causes no

extra pain

My sex life is normal but causes some

extra pain

My sex life is nearly normal but is

very painful

My sex life is severely restricted by

Methodology




hours sleep

Pain prevents me from sleeping at all

pain

My sex life is nearly absent because of

pain

Pain prevents any sex life at all

Section 9 – Social life

My social life is normal and gives me

no extra pain

My social life is normal but increases

the degree of pain

Pain has no significant effect on my

social life apart from limiting my more

energetic interests eg, sport

Pain has restricted my social life and I

do not go out as often

Pain has restricted my social life to my

home

I have no social life because of pain

Section 10 – Travelling

I can travel anywhere without pain

I can travel anywhere but it gives me

extra pain

Pain is bad but I manage journeys over

two hours

Pain restricts me to journeys of less

than one hour

Pain restricts me to short necessary

journeys under 30 minutes

Pain prevents me from travelling

except to receive treatment

Laboratory parameters:

1) Radiological evidences (X-ray lumbar spine)

X-rays were assessed as per Kellegren and Lawrance scale for degenerative changes.

Table: 16

Grade 1 Doubtful narrowing of joint space and possible osteophytic lipping.

Grade 2 Definite osteophytes, definite narrowing of joint space.

Grade 3 Moderate multiple osteophytes, definite narrowing of joints space,

some sclerosis and possible deformity of bone contour.

Grade 4 Large osteophytes marked narrowing of joint space, severe sclerosis

and definite deformity of bone contour.

2) Hemoglobin percentage

3) ESR

Methodology



Concomitant Diet and Regimen:

Avoid Potatoes, Brinjals, Chanaka, Beans, Green peas, Shushka ahara, Viruddha

ahara, Fast food, Aerated drinks, and Bakery items. Mainly laghu, ruksha and

sheeta guna ahara.

Avoid Ati vyayama; mild to moderate exercises can be done.

Avoid Ati maithuna.

Drop-out criteria:

During the course of treatment, no serious condition or serious adverse effects was

noted and also none of the subject himself or herself wanted to withdraw from the

study. Thus there was no drop- out subjects.

Adverse effects and compliance:

Any adverse effect as such about the drug is not been noted in the study.

Statistical analysis:

The information gathered regarding demographic data was shown in percentage. The

scores of assessment criteria were analyzed statistically in the form of mean score B.T

(Before Treatment), A.T. (after Treatment), Difference of mean (B.T. - A.T), S.D.

(Standard Deviation), S.E (Standard Error). Students paired „t‟ test and Mann

Whitney U test was carried out for within the groups and Unpaired “t” test for

between the groups. The results were considered Significant or Insignificant

depending upon P value.

Methodology



Significance chart

Table: 17

Extremely significant p<0.0001

Highly (Very) significant p<0.001

Significant p<0.05

Not significant P>0.05

Overall Effect of Therapy:

The total effect of therapy was calculated by calculating overall percentage of

improvement of individual subjects. All the Before Treatment (BT) score of every

symptom of subjects were added. Total After Treatment (AT) score of every

symptoms of the patient were also added. Overall percentage of improvement of each

patient was calculated by the following formula:

Total BT – Total AT

x 100

Total BT

The results thus obtained were categorized according to the Grades given below:

Table: 18

Complete remission 100% relief in complaints

Marked Improvement 75 – 99% relief in complaints

Moderate improvement 50 – 74% relief in complaints

Mild Improvement 25 – 49% relief in complaints.

No improvement / Condition Unchanged < 25% relief in complaints

Sample size of estimation



SAMPLE SIZE OF ESTIMATION

A minimum of 40 patients fulfilling the diagnostic and inclusion criteria irrespective

of their gender, caste, religion, education status and socio-economic status were taken

for the study. Registered patient were allotted randomly by lottery method into two

equal groups of minimum 20 patients in each as group A and B.

Sample size: 40 patients

Number of groups: 2 groups (Group A & Group B)

Level of study: OPD and IPD

Type of study: Single blind randomized comparative clinical study.

Source of data: Patients who fulfill the inclusion criteria were randomly selected

from OPD and IPD of Muniyal Institute of Ayurveda Medical Sciences and

Hospital, Manipal and also from referral sources and special camps conducted for

the purpose.

Group-A

Drug – Sapthasaram kashayam (internally) and Kottam chukkadi taila (external

application)

Dosage – 50ml (Kashaya) & 10-15 ml (Taila)

Time of administration – Morning and evening minimum 1 hour prior to food; and

10-15 ml oil is applied at kati region.

Group-B

Drug – Rasnasaptaka kashaya

Dosage – 50ml

Time of administration - Morning and evening minimum 1 hour prior to food.



th day of treatment.

Results



RESULTS

OBSERVATIONS AND ANALYSIS

All the 40 subjects who were suffering from Katigraha, their demographic details and

other observations were recorded and the data obtained is presented below:

1. Distribution based on Age:

Among 40 subjects of Katigraha, 40 % belonged to age group 51-60 years, 27.5%

belonged to age group 41-50 years and 32.5% belonged to age group 30-40 years.

Detail of the subjects in Group A and Group B according to the age is shown in Table

No: 19 and Figure No: 3

Table no.: 19

Age group

(years)

Group A

N=20

Group B

N=20

Total

N=40

Percentage %

30-40 6 7 13 32.5

41-50 5 6 11 27.5

51-60 9 7 16 40

Figure no: 3

32.5

27.5

40

Distribution based on Age

30-40

41-50

51-60

Results



2. Distribution based on Gender:

Among 40 subjects of Katigraha, 57.5 % were male and 42.5% subjects were female.

Detail of the subjects in Group A and Group B according to the gender is shown in

Table No: 20 and Figure No: 4

Table no.: 20

Gender Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Male 10 13 23 57.5

Female 10 7 17 42.5

Figure no: 4

57.5

42.5

Distribution based on Gender

Male

Female

Results



3. Distribution based on Marital status:

Among 40 subjects of Katigraha, 65% subjects were married, 27.6% were unmarried

and 7.5% were divorcee. Detail of the subjects in Group A and Group B according to

the marital status is shown in Table No: 21 and Figure No: 5

Table no.: 21

Marital status Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Married 13 13 26 65

Unmarried 7 4 11 27.6

Divorcee 0 3 3 7.5

Figure no: 5

65

27.6

7.5

Distribution based on Marital status

Married

Unmarried

Divorcee

Results



4. Distribution based on Religion:

Among 40 subjects of Katigraha, 77.5% subjects were Hindu, 10% were Christians

and 12.5% were Muslims. Detail of the subjects in Group A and Group B according

to the Religion is shown in Table No: 22 and Figure No: 6

Table no.: 22

Religion Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Hindu 16 15 31 77.5

Christian 2 2 4 10

Muslim 2 3 5 12.5

Figure no: 6

77.5

10

12.5

Distribution based on Religion

Hindu

Christian

Muslim

Results



5. Distribution based on Desha:

Among 40 subjects of Katigraha, 87.5% subjects belonged to anupa desha and 12.5%

belonged to sadharana desha. Detail of the subjects in Group A and Group B

according to the desha is shown in Table No: 23 and Figure No: 7

Table no.: 23

Desha Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Anupa 18 17 35 87.5

Sadharana

2 3 5 12.5

Figure no: 7

87.5

12.5

Distribution based on Desha

Anupa

Sadharana

Results



6. Distribution based on Sharira Prakruti:

Among 40 subjects of Katigraha, 55% subjects were Vatakapha prakruti, 20% were

Vatapitta prakruti and 25% were Kaphapitta prakruti. Detail of the subjects in Group

A and Group B according to the sharira prakruti is shown in Table No: 24 and Figure

No: 8

Table no.: 24

Prakruti Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Vatakapha 10 12 22 55

Vata pitta 3 5 8 20

Kaphapitta 7 3 10 25

Figure no: 8

55

20

25

Distribution based on Sharira Prakruti

Vatakapha

vatapitta

Kaphapitta

Results



7. Distribution based on Dietary habits:

Among 40 subjects of Katigraha, 27.5% subjects were vegetarians and 72.5% were

having mixed diet. Detail of the subjects in Group A and Group B according to the

dietary habits is shown in Table No: 25 and Figure No: 9

Table no.: 25

Dietary habits Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Vegetarian 7 4 11 27.5

Mixed 13 16 29 72.5

Figure no: 9

27.5

72.5

Distribution based on Dietary habits

Vegetarian

mixed

Results



8. Distribution based on Socio- economic status:

Among 40 subjects of Katigraha, 17.5% subjects belong to lower class, 62.5% belong

to middle class and 20% belong to upper middle class. None of them belong to rich

category. Detail of the subjects in Group A and Group B according to the socio –

economic status is shown in Table No: 26 and Figure No: 10

Table no.: 26

Socio-

economic

status

Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Lower class 4 3 7 17.5

Middle class 14 11 25 62.5

Upper middle

class

2 6 8 20

Rich 0 0 0 0

Figure no: 10

17.5

62.5

20

1.2

Distribution based on Socio- economic status

Lower class

Middle class

Upper middle class

Rich

Results



9. Distribution based on Occupation:

Among 40 subjects of Katigraha, 27.5% subjects were house wife, 5% were farmers,

10% were businessman, 32.5% were doing desk work and 25% were field workers.

Detail of the subjects in Group A and Group B according to the occupation is shown

in Table No: 27 and Figure No: 11

Table no.: 27

Occupation Group A

N=20

Group B

N=20

Total

N=40

Percentage %

House wife 8 3 11 27.5

Farmers 1 1 2 5

Businessman 2 2 4 10

Desk work 8 5 13 32.5

Field work 1 9 10 25

Figure no: 11

27.5

5 10

32.5

Distribution based on Occupation

House wife

Farmers

Businessman

Desk work

Field work

Results



10. Distribution based on Sleep:

Among 40 subjects of Katigraha, 77.5% subjects had normal sleep and 22.5% had

disturbed sleep. None of them had insomnia. Detail of the subjects in Group A and

Group B according to the sleep is shown in Table No: 28 and Figure No: 12

Table no.: 28

Sleep Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Normal 14 17 31 77.5

Disturbed 6 3 9 22.5

Insomnia 0 0 0 0

Figure no: 12

77.5

22.5

0

Distribution based on Sleep

Normal

Disturbed

insomnia

Results



11. Distribution based on Agni:

Among 40 subjects of Katigraha, 70% subjects had sama agni, 27.5% had vishama

agni and 2.5% had manda agni. None of them had teekshna agni. Detail of the

subjects in Group A and Group B according to the Agni is shown in Table No: 29 and

Figure No: 13

Table no.: 29

Agni Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Sama 13 15 28 70

Vishama 6 5 11 27.5

Manda 1 0 1 2.5

Teekshna 0 0 0 0

Figure no: 13

70

27.5

2.5 0

Distribution based on Agni

SAMA

VISHAMA

MANDA

TEEKSHNA

Results



12. Distribution based on Koshtha:

Among 40 subjects of Katigraha, 75% subjects had madhyama koshtha and 25% had

krura koshtha. None of them had mrudu koshtha. Detail of the subjects in Group A

and Group B according to the koshtha is shown in Table No: 30 and Figure No: 14

Table no.: 30

Koshtha Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Krura 5 5 10 25

Madhyama 15 15 30 75

Mrudu 0 0 0 0

Figure no: 14

25

75

0

Distribution based on Koshtha

KRURA

MADHYAMA

MRUDU

Results



13. Distribution based on Vyayama shakthi:

Among 40 subjects of Katigraha, 15% subjects had pravara vyayama shakthi, 47.5%

had madhyama vyayama shakthi and 37.5% had avara vyayama shakthi. Detail of the

subjects in Group A and Group B according to the vyayama shakthi is shown in Table

No: 31 and Figure No: 15

Table no.: 31

Vyayama

shakthi

Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Pravara 2 4 6 15

Madhyama 10 9 19 47.5

Avara 8 7 15 37.5

Figure no: 15

15

47.5

37.5

Distribution based on Vyayama shakthi

PRAVARA

MADHYAMA

AVARA

Results



14. Distribution based on Satva:

Among 40 subjects of Katigraha, 5% subjects had pravara satva, 80% had madhyama

satva and 15% had avara satva. Detail of the subjects in Group A and Group B

according to the satva is shown in Table No: 32 and Figure No: 16.

Table no.: 32

Satva Group A

N=20

Group B

N=20

Total

N=40

Percentage %

Pravara 1 1 2 5

Madhyama 15 17 32 80

Avara 4 2 6 15

Figure no: 16

5

80

15

Distribution based on Satva

PRAVARA

MADHYAMA

AVARA

Results



RESULT AND INTERPRETATION

1a) Effect of treatment on Pain in Group A:

Table No: 33

SYMPTOM N BT

Mean

MEAN Diff

d

% Paired t test Significant

SD SEM t P

PAIN 20 2.58 AT 1.9 0.705 27.3 0.78 0.18 4.951 0.0001 ES

AF 1.76 0.823 31.8 0.66 0.16 4.667 0.0003 ES

Figure no: 17

Interpretation: In Group A mean score observed before the treatment was 2.58.

After Treatment value reduced to 1.88, the effect of treatment showed 27.3 %

improvement in pain score which is statistically extremely- significant (P=0.0001).

After Follow-up value reduced to 1.76, the effect of treatment showed 31.8 %

improvement in pain score which is statistically extremely- significant (P=0.0003).

0

0.5

1

1.5

2

2.5

3

BT AT AF

Effect of treatment on Pain in Group A

PAIN

Results



1b) Effect of treatment on Pain in Group B:

Table No: 34

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t P

PAIN 20 2.95 AT 2.35 0.600 20.3 1.04 0.23 5.339 <0.0001 ES

AF 1.85 1.100 37.2 0.87 0.19 11.00 <0.0001 ES

Figure no: 18

Interpretation: In Group B mean score observed before the treatment was 2.95.


improvement in pain score which is statistically extremely- significant (P<0.0001).


improvement in pain score, which is statistically extremely- significant. (P<0.0001)

0

0.5

1

1.5

2

2.5

3

3.5

BT AT AF

Effect of treatment on Pain in Group B

PAIN

Results



1c) Comparison of effect of treatment on Pain between Group A and Group B:

Table No: 35

MEAN GROUP

A

GROUP

B

SD Mean

diff

T Unpaired t test Significant

Group

A

Group

B

F P

AT 1.90 2.35 0.91 1.04 0.45 1.455 1.301 0.1539 NS

AF 1.75 1.85 0.91 0.87 0.10 0.3541 1.082 0.7252 NS

Figure no: 19

Interpretation: Mean score of Group A was 1.90 and mean score of Group B was

2.35 and the value is statistically non- significant (P=0.1539) between the groups after

treatment in Pain.

Mean score of Group A was 1.75 and mean score of Group B was 1.85 and the value

is statistically non- significant (P=0.7252) between the groups after Follow-up in

Pain.

2.58

1.9 1.75

2.95

2.35

1.85

0

0.5

1

1.5

2

2.5

3

3.5

BT AT AF

Group A

Group B

Results



2a) Effect of treatment on Stiffness in Group A:

Table No: 36

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM T P

STIFFNESS 20 2.75 AT 1.90 0.850 30.9 0.96 0.21 5.667 <0.0001 ES

AF 1.65 1.100 40 0.87 0.19 6.242 <0.0001 ES

Figure no: 20



improvement in stiffness score which is statistically extremely- significant

(P<0.0001).

After Follow-up value reduced to 1.65, the effect of treatment showed 40 %

improvement in stiffness score which is statistically extremely- significant.

(P<0.0001)

0

0.5

1

1.5

2

2.5

3

BT AT AF

Effect of treatment on Stiffness in Group A

STIFFNESS

Results



2b) Effect of treatment on Stiffness in Group B:

Table No: 37

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM T P

STIFFNESS 20 2.35 AT 2.15 0.200 8.5 1.30 0.29 2.179 0.0421 S

AF 1.70 0.650 27.6 1.03 0.23 3.901 0.0010 ES

Figure no: 21



improvement in stiffness score which is statistically significant (P=0.0421).


improvement in stiffness score which is statistically extremely- significant

(P=0.0010).

0

0.5

1

1.5

2

2.5

BT AT AF

Effect of treatment on Stiffness in Group B

STIFFNESS

Results



2c) Comparison of effect of treatment on Stiffness between Group A and Group

B:

Table No: 38

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 1.90 2.15 0.96 1.30 0.250 0.6868 1.829 0.4964 NS

AF 1.65 1.70 0.87 1.03 0.05 0.1653 1.388 0.8696 NS

Figure no: 22


2.15 and the value is statistically non- significant (P= 0.4964) between the groups

after treatment in Stiffness.

Mean score of Group A was 1.65 and mean score of Group B was 1.70 and the value

is statistically non- significant (P= 0.8696) between the groups after Follow-up in

Stiffness.

2.75

1.9

1.65

2.35 2.15

1.7

0

0.5

1

1.5

2

2.5

3

BT AT AF

Group A

Group B

Results



3a) Effect of treatment on Tenderness in Group A:

Table No: 39

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t/r p

TENDERNESS 20 1.05 AT 0.60 0.470 44.7 0.68 0.15 0.815 0.0039 VS

AF 0.45 0.647 61.6 0.60 0.13 0.839 0.0005 ES

Figure no: 23



improvement in tenderness score which is statistically very- significant (P=0.0039).

After Follow- up value reduced to 0.45 , the effect of treatment showed 61.6 %

improvement in tenderness score which is statistically extremely- significant

(P=0.0005).

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Effect of treatment on Tenderness in Group A

TENDERNESS

Results



3b) Effect of treatment on Tenderness in Group B:

Table No: 40

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM T p

TENDERNESS 20 1.10 AT 0.75 0.350 31.8 0.71 0.16 3.199 0.0047 VS

AF 0.50 0.600 54.5 0.51 0.11 5.339 <0.0001 ES

Figure no: 24



improvement in tenderness score which is statistically Very- significant (P=0.0047).


improvement in tenderness score which is statistically extremely- significant.

(P<0.0001)

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Effect of treatment on Tenderness in Group B

TENDERNESS

Results



3c) Comparison of effect of treatment on Tenderness between Group A and

Group B:

Table No: 41

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 0.60 0.75 0.68 0.71 0.150 0.6789 1.108 0.5013 NS

AF 0.45 0.50 0.60 0.51 0.05 0.2820 1.390 0.7795 NS

Figure no: 25


0.75 and was statistically non- significant (P=5013) between the groups after

treatment in Tenderness.

Mean score of Group A was 0.45 and mean score of Group B was 0.50 and was

statistically non- significant (P=7795) between the groups after Follow-up in

Tenderness.

1.05

0.6

0.45

1.1

0.75

0.5

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Group A

Group B

Results



4a) Effect of treatment on Difficulty in walk in Group A:

Table No: 42

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t/r P

DIFFICULTY

IN WALKING

20 1.05 AT 0.80 0.250 23.8 0.89 0.20 2.517 0.0210 S

AF 0.70 0.350 33.3 0.80 0.17 0.946 0.0156 S

Figure no: 26



improvement in difficulty in walking score which is statistically significant

(P=0.0210).



(P=0.0156).

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Effect of treatment on Difficulty in walk in Group A

DIFFICULTY IN WALKING

Results



4b) Effect of treatment on Difficulty in walk in Group B:

Table No: 43

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t P

DIFFICULTY

IN WALKING

20 1.05 AT 0.95 0.100 9.5 0.88 0.19 1.453 0.1625 NS

AF 0.75 0.300 28.5 0.63 0.14 2.854 0.0102 S

Figure no: 27



improvement in difficulty in walking score which is statistically Non- significant

(P=0.1625).



(P=0.0102).

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Effect of treatment on Difficulty in walk in Group B

DIFFICULTY IN WALKING

Results



4c) Comparison of effect of treatment on Difficulty in walk between Group A

and Group B:

Table No: 44

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 0.80 0.95 0.89 0.88 0.150 0.5325 1.017 0.5975 NS

AF 0.70 0.75 0.80 0.63 0.05 0.2182 1.574 0.8284 NS

Figure no: 28


0.95 and was statistically non- significant (P=0.5975) between the groups after

treatment in difficulty in walking.


statistically non- significant (P=0.8284) between the groups after Follow –up in

difficulty in walking.

1.05

0.8

0.7

1.05

0.95

0.75

0

0.2

0.4

0.6

0.8

1

1.2

BT AT AF

Group A

Group B

Results



5a) Effect of treatment on Schobers test in Group A:

Table No: 45

SYMPTOM N BT

Mean

MEAN Diff

d

% Paired t test significant

SD SEM t P

SCHOBERS

TEST

20 1.25 AT 1.00 0.250 20 0.72 0.16 2.517 0.0210 S

AF 0.95 0.300 24 0.68 0.15 2.854 0.0102 S

Figure no: 29


After Treatment value reduced to 1.00, the effect of treatment showed 20 %

improvement in schober’s test score which is statistically significant (P=0.0210).

After Follow-up value reduced to 0.95, the effect of treatment showed 24 %

improvement in schober’s test score which is statistically significant (P=0.0102).

0

0.2

0.4

0.6

0.8

1

1.2

1.4

BT AT AF

Effect of treatment on Schobers test in Group A

SCHOBER'S TEST

Results



5b) Effect of treatment on Schobers test in Group B:

Table No: 46

SYMPTOM N BT

Mean

MEAN Diff

d


SD SE

M

t P

SCHOBER

TEST

20 1.30 AT 1.15 0.150 11.5 0.81 0.18 1.831 0.0828 NS

AF 0.95 0.350 26.9 0.60 0.13 3.199 0.0047 VS

Figure no: 30



improvement in stiffness score which is statistically non- significant (P=0.0828).


improvement in stiffness score which is statistically very- significant (P=0.0047).

0

0.2

0.4

0.6

0.8

1

1.2

1.4

BT AT AF

Effect of treatment on Schobers test in Group B

SCHOBER'S TEST

Results



5c) Comparison of effect of treatment on Schobers test between Group A and

Group B:

Table No: 47

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 1.00 1.15 0.72 0.81 0.150 0.6158 1.255 0.5417 NS

AF 0.95 0.95 0.68 0.60 0.00 0.000 1.288 0.999 NS

Figure no: 31



treatment in Schober’s test.


statistically non- significant (P=0.999) between the groups after Follow -up in

Schober’s test.

1.25

1 0.95

1.3

1.15

0.95

0

0.2

0.4

0.6

0.8

1

1.2

1.4

BT AT AF

Group A

Group B

Results



6a) Effect of treatment on Visual analogue scale in Group A:

Table No: 48

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t p

VAS 20 3.70 AT 2.80 0.900 24.3 1.19 0.26 7.285 <0.0001 ES

AF 2.40 1.353 36.6 0.94 0.21 7.255 <0.0001 ES

Figure no: 32



improvement in VAS score which is statistically extremely- significant (P<0.0001).


improvement in VAS score which is statistically extremely- significant. (P<0.0001)

0

0.5

1

1.5

2

2.5

3

3.5

4

BT AT AF

Effect of treatment on VAS in Group A

VAS

Results



6b) Effect of treatment on Visual analogue scale in Group B:

Table No: 49

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t p

VAS 20 3.70 AT 3.00 0.700 18.9 1.48 0.33 5.480 <0.0001 ES

AF 2.40 1.300 35.1 1.23 0.27 7.935 <0.0001 ES

Figure no: 33



improvement in VAS score which is statistically extremely- significant (P<0.0001).


improvement in VAS score which is statistically extremely- significant. (P<0.0001)

0

0.5

1

1.5

2

2.5

3

3.5

4

BT AT AF

Effect of treatment on VAS in Group B

VAS

Results



6c) Comparison of effect of treatment on Visual analogue scale between Group A

and Group B:

Table No: 50

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 2.80 3.00 1.19 1.48 0.200 0.4687 1.544 0.6420 NS

AF 2.40 2.40 0.94 1.23 0.00 0.000 1.794 0.999 NS

Figure no: 34



treatment in VAS.


statistically non- significant (P=0.999) between the groups after Follow – up in VAS.

3.7

2.8

2.4

3.7

3

2.4

0

0.5

1

1.5

2

2.5

3

3.5

4

BT AT AF

Group A

Group B

Results



7a) Effect of treatment on Oswestry low back disability assessment questionnaire

in Group A:

Table No: 51

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM T p

OSWESTRY 20 28.44 AT 23.54 4.895 17.2 16.02 3.58 5.505 <0.0001 ES

AF 20.65 7.790 27.3 16.31 3.64 7.362 <0.0001 ES

Figure no: 35



improvement in Oswestry low back disability assessment questionnaire score which is

statistically extremely- significant (P<0.0001).

After Follow-up value reduced to 20.65 , the effect of treatment showed 27.3 %



0

5

10

15

20

25

30

BT AT AF

Effect of treatment on Oswestryin Group A

OSWESTRY

Results



7b) Effect of treatment on Oswestry low back disability assessment questionnaire

in Group B:

Table No: 52

SYMPTOM N BT

Mean

MEAN Diff

d


SD SEM t p

OSWESTRY 20 29.46 AT 27.85 1.610 5.4 12.75 2.85 4.679 0.0002 ES

AF 23.96 5.550 18.8 12.41 2.77 8.248 <0.0001 ES

Figure no: 36




statistically extremely- significant (P=0.0002).

After Follow-up value reduced to 23.96 , the effect of treatment showed 18.8 %



0

5

10

15

20

25

30

35

BT AT AF

Effect of treatment on Oswestryin Group B

OSWESTRY

Results



7c) Comparison of effect of treatment on Oswestry low back disability

assessment questionnaire between Group A and Group B:

Table No: 53

MEAN GROUP

A

GROUP

B

SD Mean

diff


Group

A

Group

B

F P

AT 23.54 27.85 16.02 12.75 4.305 0.9401 1.578 0.3531 NS

AF 20.65 23.96 16.31 12.41 3.31 0.7220 1.727 0.4747 NS

Figure no: 37

Interpretation: Mean score of Group A was 23.54 and mean score of Group B value

increased to 27.85 and was statistically non- significant (P=0.3531) between the

groups after treatment in Oswestry low back disability assessment questionnaire.

Mean score of Group A was 20.65 and mean score of Group B value increased to


Follow- up in Oswestry low back disability assessment questionnaire.

28.44

23.54

20.65

29.46 27.85

23.96

0

5

10

15

20

25

30

35

BT AT AF

Group A

Group B

Results



Overall Comparative effect of treatment in signs and Symptoms in Group A &

Group B after treatment

Table No: 54

SIGNS &

SYMPTOMS

MEAN DIFF. A.T STANDARD

DEVIATION “t”

value

“p”

value GROUP

A

GROUP

B

GROUP

A

GROUP

B

PAIN 0.823 1.10 0.91 1.04 1.455 0.1539

STIFFNESS 1.1 0.650 0.96 1.30 0.6868 0.4964

TENDERNESS 0.647 0.600 0.68 0.71 0.6789 0.5013

DIFFICULTY IN

WALKING 0.350 0.300 0.89 0.88 0.5325 0.5975

SCHOBER’S

TEST 0.300 0.350 0.72 0.81 0.5417 0.6158

VAS 1.353 1.300 1.19 1.48 0.4687 0.6420

OSWESTRY

QUESTIONAIRE 7.790 5.550 16.02 12.75 0.9401 0.3531

Figure no: 38

Interpretation: Group A is showing better effect in reducing stiffness, tenderness,

difficulty in walking, visual analogue scale and Oswestry low back disability

questionnaire whereas Group B was effective in relieving pain and Schobers test.

0.823 1.1 0.647

0.35 0.3

1.353

7.79

1.1 0.65 0.6

0.3 0.35

1.3

5.55

0

1

2

3

4

5

6

7

8

9

PAIN STIFFNESS TENDERNESS DIFFICULTY

IN WALKING

SCHOBER'S

TEST

VAS OSWESTRY

Group A

Group B

Results



Overall effect of Group A on 20 patients of Katigraha

Table No: 55

Total effect Percentage No of patients % of relief

Cured 100% 0 0

Marked

improvement

76-99% 5 25

Moderate

improvement

51-75% 10 50

Mild

improvement

25-50% 2 10

No improvement <25% 3 15

Figure no: 39

0

25

50

15

10

Group A

CURED

MARKED IMPROVEMENT

MODERATE IMPROVEMENT

NO IMPROVEMENT

MILD IMPROVEMENT

Results



Overall effect of Group B on 20 patients of Katigraha

Table No: 56

Total effect Percentage No of patients % of relief

Cured 100% 0 0

Marked improvement 76-99% 6

30

Moderate improvement 51-75% 8 40

Mild improvement 25-50% 5 25


Figure no: 40

0

30

40

25 5

Group B

CURED

MARKED IMPROVEMENT

MODERATE IMPROVEMENT

MILD IMPROVEMENT

NO IMPROVEMENT

Results



Overall comparative effect of Group A and Group B on 40 patients of Katigraha

Table No: 57

Total effect Percentage Group A Group B

Cured 100% 0 0

Marked

improvement

76-99% 5

6

Moderate

improvement

51-75% 10 8

Mild improvement 25-50% 2 5


Figure no: 41

0

5

10

2 3

0

6

8

5

1

0

2

4

6

8

10

12

Group A

Group B

Discussion



DISCUSSION

In any kind of research, discussion is considered as a vital entity. With proper

discussion, the idea of the researcher can be conveyed properly by logical reasoning

of observations. Further it helps proper drawing of conclusions and also predicting

future scopes and paves the way for futuristic research.

The study taken up here was “Clinical study on Sapthasaram kashayam and Kottam

chukkadi taila in Katigraha with special reference to lumbar spondylosis”

DISCUSSION ON CLINICAL STUDY

In this study, Sapthasaram kashayam with Kottam chukkadi taila and Rasnasaptaka

kashaya were selected for the management of Katigraha. 40 subjects were randomly

selected from O.P.D and I.P.D of MIAMS, Manipal. They were divided into 2 groups

of 20 subjects each as Group A and Group B.

In, Group A – Sapthasaram kashayam with Kottam chukkadi taila was given to 20

subjects

Group B – Rasnasaptaka Kashaya was given to 20 subjects.

The final result was drawn based on assessment of individual subjects on various

parameters and then finally inferences were drawn considering relevant statistical

methods and are presented here.

DISCUSSION ON OBSERVATIONS

DEMOGRAPHIC DATA:

In the present study a total number of 40 subjects were registered, out of which, all the

40 subjects have completed the treatment.

Discussion



AGE:

Among 40 subjects of Katigraha, maximum of 40 % belongs to age group 51-60

years, 27.5% belongs to age group 41-50 years and 32.5% belongs to age group 30-40

years. The higher incidence in 51- 60 years shows that maximum amount of physical

as well as mental weakness is felt at this age. It is a part of late madhyama Vaya and

going into Vardhakya. Hence, there is chance of vata dosha vriddhi leading to

increased disease occurrence.

GENDER:

The maximum number of subjects which was 57.5 % volunteered for the study were

males and 42.5% were females. The general data suggests that men appear to have

more significant degenerative changes than women, both with regard to number and

severity of osteophyte formation.

MARITAL STATUS:

In this study, maximum number of subjects i.e. 65% was married, where as 27.6%

were unmarried and 7.5% were divorcee. The higher number of patients in middle age

group ensures that maximum subjects are married. Further, marriage increases the

familial and social responsibilities and profound psychological and emotional stress.

This may predispose to Katigraha as the disease is psycho somatic.

RELIGION:

In the present study, 77.5% subjects were Hindu by religion, 12.5% were Muslims

and 10% were Christians. This should be attributed to the fact that particular

demographic area is populated maximally by Hindus.

Discussion



DESHA:

From the total subjects who volunteered for the present study, 87.5% subjects belong

to anupa desha and 12.5% belong to sadharana desha. This might be as Manipal,

Udupi and nearer areas have properties like humidity, moisture and heat, which

aggravate Vata and kapha in all those who live in these areas. This might be a

precipitating factor for early degeneration.

SHARIRA PRAKRUTI:

In the present study, on examination it was found that 55% subjects were Vatakapha

prakruti, 20% were Vatapitta prakruti and 25% were Kaphapitta prakruti. As the

disease is produced due to Vata Vriddhi and Kapha Aavarana, Vata and Kapha related

Prakruti are more prone to get early degenerative changes.

DIETARY HABITS:

In the present study, 27.5% subjects were vegetarians and 72.5% were having mixed

diet. This should be attributed to the fact that particular demographic area was non

vegetarians.

SOCIO- ECONOMIC STATUS:

Maximum number of subjects that is, 62.5% belong to middle class, 17.5% belong to

lower class and 20% belong to upper middle class. None of them belong to rich

category. Middle class people have stressful job, family security issues, physical and

mental tensions. Lower class and upper middle class also have similar problems. All

this leads to lack of rest, poor nutrition and psychological disorders which lead to

Discussion



early degeneration of lumbar spine. Higher economic status people have better living

conditions; travelling facilities and nutrition which help them have a healthy life.

OCCUPATION:

Maximum number of subjects that is, 32.5% were doing desk work, 27.5% subjects

were house wife, 5% were farmers, 10% were businessman and 25% were field

workers. Due to partly sedentary lifestyle the joints tend to be improperly supported

and further faulty sitting postures (desk work) predispose to backache. House wife’s

have double role of managing occupation as well as completing family duties which

leads to early degeneration of lumbar spine.

SLEEP:

In the present study, 77.5% subjects had normal sleep and 22.5% had disturbed sleep.

None of them had insomnia. Proper rest to the body is required. Excess of physical

work and improper sleep leads to speed up the degeneration process of the body. In

this study maximum subjects have normal sleep so it can be said that sleep dint have

much significance in study.

AGNI:

In the present study, 70% subjects had sama agni, 27.5% had vishama agni and 2.5%

had manda agni. None of them had teekshna Agni. The role of Agni in the

pathogenesis cannot be ruled out. Nevertheless the state of Agni through the

pathogenesis of Katigraha may vary and hence maximum subjects having samaagni

may not be against the samprapti of the disease.

Discussion



KOSHTHA:

Maximum number of subjects that is, 75% subjects had madhyama koshtha and 25%

had krura koshtha. None of them had mrudu koshtha. The predominant form of

Koshtha is in accordance with the state of Agni.

VYAYAMA SHAKTI:

Maximum number of subjects that is, 47.5% had madhyama vyayama shakti,

followed by 37.5% had avara vyayama shakti and 15% subjects had pravara vyayama

shakti. Regular exercise and movement of the joint is required for proper nutrition

flow to the vertebral disc and the surrounding muscles. Thus madhyama and avara

vyayama shakti is a predisposing factor for the manifestation of the disease. Further

the changed lifestyles and occupation also attribute to the Vyayama shakti

SATVA:

In the present study, 80% had madhyama satva 15% had avara satva and 5% subjects

had pravara satva. When a person is psychological weak, series of changes will take

place in the body wherein the muscles and soft tissue structures go in to a stage of

continuous contracture which is more evident at back as the muscles which help

maintaining the posture of the body are situated there. Then the nutrition to these

structures decrease leading to early degeneration. Thus madhyama and avara satva is

a predisposing factor for the manifestation of the disease.

NIDANA:

Chanaka, Shushka Shaka-Mamsa etc have been mentioned classically as foods which

lead to Vata Prakopa. Also Ruksha, Laghu, Shita Guna, Katu Rasa which are

Discussion



mentioned in the classic are found to be present as etiological factor even in present

era. Potatoes, Beans are believed to be increase Vata Dosha in the body. The vihara’s

such as sedentary habits with vishamasthana, shigrayana, divaswapna, abhighata etc

are also applicable today.

However, in the present study more of kaphakara nidanas were found amongst

the subjects than that for vata. The occurrence of the disease Katigraha hence

highlights predominant etiology in terms of viharaja bhavas and a possible pathology

of avarana.

DISCUSSION ON RESULTS

I. Effect of treatment on Pain:

Pain was 27.3% in Group A, while 20.3% in Group B. The statistical result shows that

Group A (Sapthasaram kashaya and Kottam chukkadi taila) (p value = 0.0001) and

Group B (Rasnasaptaka kashaya) (p value <0.0001) both were having Extremely

significant results.

Comparison between the groups showed, mean score of Group A was 1.90 and mean

score of Group B was 2.35 and the value is statistically non- significant (P=0.1539)

after treatment in Pain.

Comparison between the groups showed ,mean score of Group A was 1.75 and mean

score of Group B was 1.85 and the value is statistically non- significant (P=0.7252)

after Follow-up in Pain.

II. Effect of treatment on Stiffness:

Stiffness was 30.9% in Group A, while 8.5% in Group B. The statistical result shows

that Group A (Sapthasaram kashaya and Kottam chukkadi taila) was having

Discussion



Extremely significant result (p value <0.0001) in the symptom than Group B

(Rasnasaptaka kashaya) (p value =0.0421) which is significant.


score of Group B was 2.15 and the value is statistically non- significant (P= 0.4964)

after treatment in Stiffness.


score of Group B was 1.70 and the value is statistically non- significant (P= 0.8696)

after Follow-up in Stiffness.

III. Effect of treatment on Tenderness:

Tenderness was 44.7% in Group A, while 31.8% in Group B. The statistical result

shows that Group A (Sapthasaram kashaya and Kottam chukkadi taila) (p value

=0.0039) and Group B (Rasnasaptaka kashaya) (p value <0.0047) both were having

Very significant results.


score of Group B was 0.75 and was statistically non- significant (P=5013) after

treatment in Tenderness.


score of Group B was 0.50 and was statistically non- significant (P=7795) after

Follow-up in Tenderness.

IV. Effect of treatment on Difficulty in walking:

Difficulty in walking was 23.8% in Group A, while 9.5% in Group B. The statistical

result shows that Group A (Sapthasaram kashaya and Kottam chukkadi taila) was

Discussion



having significant result (p value =0.0210) in the symptom than Group B

(Rasnasaptaka kashaya) (p value =0.1625) which is Non- significant.


score of Group B was 0.95 and was statistically non- significant (P=0.5975) after

treatment in difficulty in walking.



Follow –up in difficulty in walking.

V. Effect of treatment on Schober’s test:

Schober’s test was 20% in Group A, while 11.5% in Group B. The statistical result

shows that Group A (Sapthasaram kashaya and Kottam chukkadi taila) was having

Significant result (p value =0.0210) in the symptom than Group B (Rasnasaptaka

kashaya) (p value =0.0828) which is Non- significant.



treatment in Schober’s test.



Follow -up in Schober’s test.

VI. Effect of treatment on Visual analogue scale:

Visual analogue scale was 24.3% in Group A, while 18.9% in Group B. The statistical

result shows that Group A (Sapthasaram kashaya and Kottam chukkadi taila) (p value

Discussion



<0.0001) and Group B (Rasnasaptaka kashaya) (p value <0.0001) both were having

Extremely significant results.


score of Group B was 3.00 and was statistically non- significant decrease (P=0.6420)

after treatment in VAS.



Follow – up in VAS.

VII. Effect of treatment on Oswestry low back disability assessment

questionnaire:

Oswestry low back disability assessment questionnaire was 17.2% in Group A, while

5.4% in Group B. The statistical result shows that Group A (Sapthasaram kashaya and

Kottam chukkadi taila) (p value <0.0001) and Group B (Rasnasaptaka kashaya) (p

value =0.0002) both were having Extremely significant results.


score of Group B value increased to 27.85 and was statistically non- significant

(P=0.3531) after treatment in Oswestry low back disability assessment questionnaire.

Comparison between the groups showed, Mean score of Group A was 20.65 and

mean score of Group B value increased to 23.96 and was statistically non- significant

(P=0.4747) after Follow- up in Oswestry low back disability assessment

questionnaire.

Discussion



PROBABLE MODE OF ACTION OF DRUGS:

SAPTHASARAM KASHAYAM is mentioned in Sahasrayoga. Its ingredients are

Varshabhu (Rakta Punarnava), Bilwa, Khalvo (Kulatha), Ruba (Eranda), Sahachara,

Sunthi and Angimantha. When considering the Dosha karma of the drug majority of

the drugs in the yoga are having Vatakaphahara properties. Punarnava. Kulatha,

Sahachara, Shunti and Agnimantha have vatakaphahara karma. Bilwa has

tridoshahara property and Sahachara has kaphahara property. Shunti also has deepana

and pachana properties whereas Eranda has amapachana and anulomana property. In

Katigraha there is dominance of vata and kapha dosha and there is pain and stiffness

due to vata avaruta kapha (specifically shleshaka kapha). All these drugs have the

property of Vatakaphahara which does samprathi vighatana of the disease and helps to

bring back the normal conditions of the vitiated doshas.

KOTTAM CHUKKADI TAILA is mentioned in Sahasrayoga. Its ingredients are

KALKA DRAVYA: Kottam (Kushta), Chukku (Shunti), Vayampu (Vacha), Sigru,

Lasuna, Devadaru, Kardhotti (Govindhaphala), Siddhardha (Sarshapa), Suvaha.

DRAVA DRAVYA: Dadhi, Chincha rasa. SNEHA DRAVYA: Tila taila. All the

drugs in mentioned in the yoga have Vatakaphahara properties. Shunti, Vacha,

Shigru, Lashuna, Kardhotti, Sarshapa, Rasna, Chinch rasa and Tila taila have deepana

karma. Shunti and Rasna have amapachana property. Lasuna has asthi- mamsa

sandhanakara property all this will help in the breaking of the pathogenesis of the

disease Katigraha.

RASNASAPTAKA KASHAYA is mentioned in Bhaisajya Ratnavali. Its ingredients

are Rasna, Amruta, Araghwada, Devdaru, Gokshura, Eranda & Punarnava. All the

drugs in mentioned in the yoga have Vatakaphahara properties. Rasna, Devadaru and

Punarnava have kaphavatahara karma. Amruta is tridoshashamaka and raktashodhaka

Discussion



and has rasayana effect on the body. Aragvadha is vatapittahara and

koshtashuddhikara. Trikantaka and Eranda are vatahara and have madhura rasa.

Amruta and punarnava also has deepana karma. Rasna , Eranda and Devadaru are

having vedanahara action which helps to alleviate pain.

In short, when considering the yoga’s it is observed that the drugs were arranged in a

Systematic and Logical manner that it is having the properties of Vatakaphahara,

Deepana, Pachana, Anulomana, Rasayana and Vedanahara effects which helps in

effective management of Katigraha.

LIMITATIONS:

Preparing kashaya daily by the subjects was found to be troublesome for some,

due to which there was irregularity in consumption of kashaya.

Small sample size couldn’t let us draw a generalized conclusion.

SUGGESTIONS FOR FUTURE RESEARCH:

The study is advised in large samples.

Assessment of efficacy of similar drugs for a longer duration in Lumbar

Spondylosis.

Incorporation of higher diagnostic tools like newly developed advances in MRI

imaging, which can quantitatively assess tissue hydration in the disc (such as

T1ρ), spectroscopic (HR-MAS) methods as non-invasive biomarkers of early disc

degeneration and digital X-rays of lumbar spine in flexion etc as assessment of

objective criteria.

Work can be also be done using the kashaya along with external modalities like

abhyanga – sweda and kati basti.

Conclusion



CONCLUSION

After a detailed conceptual compilation, clinical observations, result analysis and

discussion, the following conclusions were made.

Lumbar Spondylosis due to its clinical manifestation, pathogenesis and complication

can be positively correlated with Katigraha mentioned in Gada Nigraha. The Samanya

Nidanas mentioned for Vata Prakopa stand true even for Lumbar Spondylosis.

In the present study, though the aharaja nidanas in terms of rasa or gunas were

not in favour of direct vata Prakopa, the vihara’s such as sedentary habits with

vishama Sthana, shigrayana may predispose to kha-vaigunya in kati. Further the

aharaja nidanas could have influenced an avaranaja samprapthi in Katigraha.

Group A which had Sapthasaram kashaya and Kottam chukkadi taila showed

extremely significant result in both subjective and objective parameters such as

stiffness, tenderness, difficulty in walking, visual analogue scale and Oswestry low

back disability assessment questionnaire whereas Group B with Rasnasaptaka

kashaya as the intervention showed significant results in pain and Schobers test.

When compared, the difference in effect was Non- significant.

Sapthasaram kashayam (internal) and Kottam chukkadi taila (external

application) for 30 days gave better result in relieving the symptoms of

Katigraha.

Rasnasaptaka kashaya was also found effective in relieving the symptoms of

Katigraha when given for 30 days.

Comparison between the groups showed that the former has better effect than the

latter in all the clinical parameters.

Conclusion



A review of the Rasnasaptaka of the therapeutics in two groups revealed that most of

the drugs were Vata Kapha Shamaka, Agnideepaka, Aamahara, Vaataanulomaka,

Vedanasthapana. Some even are proven to have a rasayana effect.

The former group had Bahya Snehana as well, which adds to the Vatashamaka or

Vatahara action and hence helped to obtain a better Improvement. This also proves

the role of additional modalities with internal medications in the management of

Katigraha and hence Vatavyadhi or any other disease.

Even though the drugs were given for a period of 30 days, improvement was

observed. Hence, considering the improvement obtained in this period, it is logical to

infer that if continued for a longer duration, better results could be obtained. Also, it is

hoped that this study will encourage further more clinical trials with a prolonged

duration.

Summary



SUMMARY

The present work entitled “CLINICAL STUDY ON SAPTHASARAM

KASHAYAM AND KOTTAM CHUKKADI TAILA IN KATIGRAHA WITH

SPECIAL REFERENCE TO LUMBAR SPONDYLOSIS” comprises of following:

Introduction

Objective


Historic Review

Disease Review

Drug Review

Methodology


Results

Discussion

Conclusion

Summary

Introduction

It deals with introduction to the disease Katigraha in present era, need of Ayurvedic

management, objectives of the study & Hypothesis. It also includes plan of study in

brief.

Objective

The objective of the study is mentioned here. .

Review of Literature

The Review of literature comprises of the following fragments:

Summary



A. Historical Review: Here brief description of the historical aspect of the disease

from Vedic era to the present time is dealt. The descriptions of the disease related

subjects mentioned in Purana, Veda, Samhitha, Sangraha etc revealed here.

B. Disease review: It elaborates the general description of Katigraha and modern

disease Lumbar spondylosis which includes the Nirukti, Nidana, Samprapthi,

Rupa, Poorvarupa, Upashaya anupashaya, Sadhya asadhyatha, Sapeksha nidana,

Upadrava and Chikitsa are mentioned in Ayurveda part. Etymology, Etiology,

Physical examinations, Differential diagnosis, Complications, and Treatment are

mentioned in modern part.

C. Drug Review: Deals with detailed description of each of the ingredients in the

medicinal preparations used for the study. The Rasa panchaka, Botanical

descriptions, Dosha karma, Chemical constituents etc are mentioned here.

Methodology

Materials and Methods: The materials and methods of the present work deals with

the protocol of the study, details of the selection of patients, methods followed and

criteria of assessment are discussed. 40 patients were selected and divided into 2

groups with 20 each in Group A & Group B.


The basic idea of the study in which 40 patients were selected and divided into 2

groups with 20 each in Group A & Group B is mentioned.

Result

A. Observations: The observations made during the clinical study representations of

patients according to Age, Gender, Occupation etc are presented in order with

tables and graphs.

Summary



B. Statistical analysis of the findings and the results obtained are methodically

presented in this section with suitable tables and graphs.

Discussion

In this section, the observations and results obtained are critically analysed and

interpreted on the basis of facts established in various literatures to unravel the truth

of efficacy of the treatment taken for the study. The comparative results were

discussed in detail, based on clinical data. Observations are also discussed with

relevant opinions and arguments.

Conclusion

The final conclusions drawn from the present clinical research work are presented in

this fragment.

Summary

Includes a brief summation of the whole thesis.

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chronic spinal pain: a systematic review. Pain Physician. 2007;10:185–212.

[PubMed]

88. Shastry J.L.N, Chunekar K.C. Dravyaguna vijnana. Vol- 2. Reprint. Varanasi:

Chaukhambha Orientalia; 2010. Pp- 1134.

89. Govinda Das, Brahmashankar Mishra editor, Ambikadatta Shastri, Rajeshwardatta

Shastri. Bhaisajya Ratnavali with Hindi translation. 20th

ed. Varanasi:

Chaukambha Prakashan; 2010. Pp- 1312. P - 536.

90. Sharma Priya Vrat. Chakradatta (Sanskrit text with English translation). 2nd ed.

Varanasi: Choukambha Publication; 2007. Pp - 731. P - 228.

References



91. Watson Jones. J.N. Wilson Editor. Fractures and Joint injuries. 7th

ed. Elsevier

publications; 2011. Pp- 1164. P - 721.

92. Sharangadhara. Translated by Himasagara Chandra Murthy. Sharangadhara

Samhita. Varanasi: Chaukambha Sanskrit Series Office; 2010. Pp- 454. P - 199.


Hindi commentary. Reprint. Varanasi: Chaukhambha Prakashan; 2010. Pp- 573. P

- 522.

94. Michael Swash. Hutchinson’s Clinical Methods. Section- 3. 21st Ed. China:

Elsevier publications & U.K: Harcourt publishers; 2002. Pp- 501. P - 204.

95. http://www.rehab.msu.edu/files/docs/Oswestry low back disability.pdf dated 18th

march 2016, 11:45am.

Consent form

“Clinical Study On Sapthasaram Kashayam And Kottam Chukkadi Taila In Katigraha With

Special Reference To Lumbar Spondylosis” Page 116

gÉÆÃVAiÀÄ ¸ÀªÀÄäw ¥ÀvÀæ/ PATIENTS CONSENT FORM

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§gÀÄªÀ C¢üPÁgÀªÀ£ÀÄß ºÉÆA¢gÀÄªÀ §UÉÎ w½¢zÉÝÃ£É.

I…………………………Aged………….Yrs. R/o………………….is exercising my free

power of choice, hereby give my consent to be included as a trial subject in the clinical

research “CLINICAL STUDY ON SAPTHASARAM KASHAYAM AND KOTTAM

CHUKKADI TAILA IN KATI GRAHA W.S.R TO LUMBAR SPONDYLOSIS”

I understand that I may be treated with drug for the disease with which I am suffering. I have

been informed to my satisfaction the aim and objective of the clinical trial, Ingredients of the

trial drug, treatment and follow up. I am also aware of the right to opt out of the trial at any

time during the course of my treatment. I will not make any compensatory claim for any

hazardous effects on me during the treatment.

Patients Signature/gÉÆÃVAiÀÄ ºÀ¸ÁÛPÀëgÀ ……………………………

Patient has signed the declaration and has given consent.

Signature of the Research scholar ………………………..

¸ÀÜ¼À/ Place:

¢£ÁAPÀ/Date:

Ethical committee clearance letter



Case proforma



PG DEPARTMENT OF KAYACHIKITSA

MUNIYAL INSTITUTE OF AYURVEDA MEDICAL SCIENCES

MANIPAL

CASE PROFORMA

“CLINICAL STUDY ON SAPTHASARAM KASHAYAM AND

KOTTAM CHUKKADI TAILA IN KATI GRAHA WITH SPECIAL

REFERENCE TO LUMBAR SPONDYLOSIS”

GUIDE: PROF: DR. SHRIPATHI ACHARYA; M.D. (AYU) Ph.D.

CO-GUIDE: PROF: DR. NAVEEN .K; M.D. (AYU)

RESEARCHER: DR. POOJA SHARADA JAGADEESH

SHANBOUGH

NAME: Group: A/B

AGE: DATE:

SEX: OPD/IPD NO:

ADDRESS: RELIGION:

PLACE: PHONE NO:

CONSENT: I hereby agree that I have fully educated with the disease,

treatment. I hereby satisfied whole heartedly accept the medical trail over

me.

Investigator’s signature Patient’s signature

Case proforma



Details of patient:

1. Name of the patient : Age : Sex :

2. Address :

3. Centre :

4. Patient No. :

5. Group No. :

6. O.P.D. : I.P.D.:

Date of Admission: Date of Discharge:

7. Marital status:

Married Unmarried Widow

Divorcee

8. Educational status

Illiterate Read and write Primary

Middle School High School College

Others

9. Occupation :

Desk work Field work

Field work with physical labour

Field work with intellectual

Indicate nature of work:

10. Economical status :

Poor Middle Higher middle

Higher class

11. Religion :

Chief Complaints with Duration:

Present Absent Duration

1. Kati shoola

2. Kati graha

Case proforma



Associate Complaints:

1. Toda (Pricking pain)

2. Spandana (Twitching)

3. Tenderness

4. Walking difficulty

5. Stambha (Stiffness)

6. Supti (Numbness)

7. Nindranasa (Disturbed sleep)

History of Present Illness

1. Onset of disease : Sudden Gradual Insidious

2. Course : Progressive Intermittent Continuous

3. Duration :

4. Radiation : Rt.leg Lt.leg

From To

5. Nature of pain :

Dull aching Pricking Stabbing

Pulling Shooting

6. Factors aggravating the disease/Chief complaints :

Diurnal: Morning Afternoon Evening Night

Seasonal: Seeta Varsha Ushna

Movements: Walking Climbing stairs Squatting

Forward bending Backward bending Sneezing/ Coughing

Positive factors may be spell out:

7. Factors relieving the disease/Chief complaints :

Diurnal: Morning Afternoon Evening Night

Seasonal: Seeta Varsha Ushna

Movements: Standing Sitting Lying Bending

Positive factors may be spell out:

Past History: YES NO

1. Past illness, having relation with present illness :

If yes, specify

2. Hypertension

3. Diabetes Mellitus

Case proforma



Others (specify)

Treatment History

1. Treatment given so far : Ayurvedic medicine Modern medicine

Unani Homoeopathy

Any other, specify:

Spell out the medicine given and results obtained:

Family History

Personal History

1. Diet :

Type of Diet: Vegetarian Mixed

Dominance of Rasa in diet:

Madhura Amla Lavana

Katu Tikta Kashaya

Dominance of Guna in diet:

Guru Laghu Sheeta

Ushna snighdha Ruksha

Dietary Habit:

Samashana Adhyashana Vishamashana

Supplementary Diet: Tea/Coffee/Cold Drinks/Milk/Butter milk/others

2. Appetite:

Poor Moderate Good

3. Sleep: hours / day hours / night

Disturbed Insomnia

4. Exercise: Yes No

If yes, Type:Regular Irregular Less Proper Excess

5. Emotional Stress : Yes No

6. Bowel Habit : Regular Constipation Hard stool

Loose stool

7. Dependency : Yes No

If yes, specify :

Case proforma



Menstrual History:

1. Age of menarche: Age of menopause:

2. Nature: Regular Irregular Painful

Painless

3. Quantity: Heavy Scanty Moderate

Obstetric History:

1. No. of deliveries:

2. Type of delivery : Normal Caesarean

3. Abortion: Yes No

4. Last delivery:

History of Contraception:

1. Type : Temporary Permanent

Duration year

Physical Examination :

General Examination:

1. Built : Lean Medium Heavy

2. Gait : Normal Abnormal

If abnormal, specify abnormality:

3. Body Weight (in kgs) :

4. Blood Pressure :

5. Body temperature :

6. Pulse :

7. Respiration :

Present Absent

8. Cyanosis

9. Anaemia

10. Jaundice

11. Pigmentation

12. Clubbing

13. Deformities

14. Lymphadenopathy

Case proforma



If any, specify

Systemic Examination:

Normal Abnormal

1. C.V.S with chest

If any, specify

2. C.N.S

If any, specify

3. Respiratory System

If any, specify

4. Digestive System

If any, specify

5. Uro-Genital System

If any, specify

6. Locomotor System

Examination of Spine:

Inspection:

Posture: Normal Abnormal

Gait: Normal Abnormal

If abnormal, specify abnormality:

Swelling: Present Absent

Redness: Present Absent

Deformity: Present Absent

If any, specify:

Muscle wasting:

Present Absent

Palpation:

Tenderness: Present Absent

If present, specify Area:

Temperature: Normal Abnormal

Swelling: Present Absent

If present, specify:

Case proforma



Movement :

Normal Painful Restricted Absent

Flexion:

(Schober's test)

Extension:

Lateral Flexion:

Rotation

Neurological Examination of spine:

Sensory impairment:

Present Absent

Motor Function:

Full Active Active No active

Motion Motion Motion

Reflexes:

(Flip Test)

Normal Reduced Absent

Exaggerated

Other Tests:

Straight Leg Raising Test

Positive Negative

Lasegue’s sign

Positive Negative

Bowstring test

Positive Negative

Femoral stretch test:

Positive Negative

Astavidha Pariksha :

1. Nadi :

Vata Pitta Kapha

Regular Irregular

Case proforma



2. Mala : 0-1 / 2-3 / >3 / day

Mala Pravrutti:

Regular Irregular Satis.Evacuated

Unsatis. Evacuated

Consistency:

Solid Semisolid Drava

Picchila Grathita

Odour :

Durgandha Normal

Sama Nirama

3. Mutra :

Frequency: times/day

times/night

4. Jihwa :

Upalipta Anulipta Sputita

Ruksha

5. Shabda :

Vishesha Avishesha

6. Sparsha:

Ushna Sheeta Samashitoshna

7. Drika:

Prakrit Vaikrit

8. Akriti :

Sthula Madhyama Krusha

Dashavidha Pareeksha:

1. Prakrititaha :

2. Vaya :

Bala Madhyama Vriddha

Pravara Madhyama Avara

3. Vikrititah :

Case proforma



4. Samhanana:

5. Satva :

6. Pramana :

7. Satmya :

8. Aharashakti :

Abhyavarana

Jarana

9. Sara:

10. Vyayama Shakti :

Rogabalapareeksha:

Dosha :

Dushya :

Prakriti :

Desa :

Kala :

Hetu :

Linga :

Deha bala :

Agni bala :

Chetasa bala :

Nidana :

Aharatmaka: Atibhojana/Guru ahara/ Katu/ Tikta/ Ushna/ Sheeta/ Laghu ahara/ Chanaka/

Masura/ Masha/ Aadaki/ Others

Viharatmaka: Ativyayama/ Atichankramana/ Bharaharana/ Ativyavaiya/ Ratrijagarana/

Others

Case proforma



Manasa: Chinta/ Udvega/ Kama/ Krodha/ Others

Purvarupa: Katishool/ Others

Pathogenesis of Disease according to Ayurveda concept

Dosha :

Anubandhadosha :

Anubandhyadosha :

Avarakadosha :

Ksheenadosha :

Sroto Pariksha

Pranavaha srotas :

Udakavaha srotas :

Annavaha srotas :

Rasavaha srotas :

Raktavaha srotas :

Mamsavaha srotas :

Medhavaha srotas :

Asthivaha srotas :

Majjavaha srotas :

Shukravaha srotas :

Mootravaha srotas :

Swedhovaha srotas :

Purishavaha srotas :

Investigation:

Complete blood test like Hb% , TC, DC , ESR

Fasting blood sugar

Plain X-ray of lumbar spine (AP and LAT)

Case proforma



RA factor (To rule out Rheumatoid arthritis)

Serum uric acid (To rule out Gout)

Mantoux test (Only if necessary- to rule out TB of spine)

HLAB27 (if necessary)

MRI scan - if necessary

Provisional Diagnosis:

Final Diagnosis:

Modern:

Ayurvedic:

Complications:

Prognosis:

Treatment given:

1. Spathasaram kashayam: 100ml/ day in 2 divided doses of 50ml each; 1 hour

before food and kottam chukkadi taila : application at kati Pradesh twice daily.

2. Rasanasapthaka kashayam: 100ml/ day in 2 divided doses of 50ml each; 1

hour before food.

ASSESSMENT CRITERIA:

Subjective:

No. Symptoms B.T. A.T.

(31st

day)

45th

day

1. Kati ruja (Pain)

2. Kati Sthambha (stiffness)

3. Tenderness


Case proforma



Objective:

No. Parameters B.T A.T

(31st

day)

45th

day

1. Schober’s test

2. Visual analogue scale

3. Functional disability

Laboratory:

No. Parameters B.T. A.T.

(31st

day)

45th

day

1. X- ray lumbar spine

2. Haemoglobin percentage

3. ESR

Assessment of Functional Disability (Oswestry Disability assessment Questionnaire):

No. Parameters B.T. A.T.

(31st

day)

45th

day

1. Pain intensity

2. Personal care

3. Lifting

4. Walking

5. Sitting

6. Standing

7. Sleeping

8. Sex life

9. Social life

10. Travelling

Case proforma



Condition of the patient after treatment:

Cured Worse

Marked Improvement No Improvement

Moderate Improvement Mild Improvements

Signature of researcher Signature of Co-Guide

Signature of Guide

Annexure-images



ANNEXURE

SAPTASARAM KASHAYAM INGREDIENTS:

BILVA AGNIMANTHA ERANDA

FIGURE NO: 42 FIGURE NO:43 FIGURE NO:44

SHUNTHI KULATHA PUNARNAVA

FIGURE NO:45 FIGURE NO:46 FIGURE NO:47

SAHACHARA

FIGURE NO: 48

Annexure-images



KOTTAM CHUKKADI TAILA PREPARATION:

FIGURE NO: 49 FIGURE NO: 50 FIGURE NO: 51



Annexure-images



RASNASAPTAKA KASHAYAM INGREDIENTS:

RASNA GOKSHURA ARAGVADHA


PUNARNAVA DEVADARU AMRUTA


ERANDA

FIGURE NO: 64

clinical study on sapthasaram kashayam and kottam …

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