Pre- Thesis Presentation

on
A COMPARATIVE STUDY ON EFFICACY OF AGNIKARMA AND
AJAMODADI CHURNA IN THE MANAGEMENT OF GRIDHRASI.

Presented by
DR. ABHIJIT DEY

PG Scholar

Guided by
DR. NAMITA BAISHYA
MS (Ayu), Lecturer
DEPT. OF SHALYA TANTRA
GOVT. AYURVEDIC COLLEGE, GUWWAHATI-14
INTRODUCTION
 
The modern medical science is based on analytical and reductive life

science. Ayurveda on the other hand is one of the oldest extant health
systems in the world with fundamental principles and theory based
practices.The most important objective of Ayurveda is the preservation
of health of the healthy and pacification of diseases in the patients.1
The entire science of Ayurveda has been framed upon three main
modules for the management of diseases. They are Hetu (etiological
factors), Linga (clinical features), Ausadh (treatments) (Trisutras).2 For the
prevention and cure of diseases, avoidance of aetiological factors is
essential.3
 Ayurveda the science of life if followed and practiced appropriately
helps to keep an individual maintain his healthy life and free from
diseases. But in the present era the lifestyle is gradually shifting away


from healthy living leading to sedentary lifestyle, stress, improper sitting
posture,travelling for a long time ,excessive physical exertion,etc which
leads to undue pressure on the legs,hip,joint movements resulting in
various painful musculo-skeletal and locomotory diseases like Gridhrasi.

Gridhrasi which can be equated with Sciatica syndrome in today’s

reference, carries little threat to life but it interferes greatly with the
living .Beyond suffering and discomfort associated with musculoskeletal
pain there are huge financial loss, including medical care expenses, loss
of work days and diminished quality and productivity of life.
 Gridhrasi, is one among the eighty types of Nanatmaja
Vata Vyadhis of kati Pradesh where the pain radiates from


sphika to uru jangha and paada. 4

Ancient acharyas have given the name Gridhrasi as in

this disease,the gait of the patients becomes similar to the
gait of the Gridhra(vulture). Features of Gridhrasi are ruka
(pain), toda (pricking sensation), stambha(stiffness) and
muhur spandana (involuntary movement), in the
sphika(buttock) resulting in restricted lifting of the legs. 5
 Pain is a distressing feeling often caused by intense or
damaging stimuli. According to the International Association For

the Study of Pain, pain may be defined as “an unpleasant sensory
and emotional experience associated with actual or potential
tissue damage,or described in terms of such damage”. The word
Pain comes from the old French peine, in turn from latin Poena
meaning “punishment, penalty” and that from Greek Poine
meaning “price paid, penalty, punishment”. In Ayurveda various
words like Shula, Vedana, Ruja, Toda, Pida and Dukha are found
denoting pain which is predominantly caused by abnormal Vata
dosha among Tridosha.
 Agnikarma is a therapy that has been recommended by Acharya
Susruta in different types of diseases like Bhagandara,Arsha,vrana,etc.


Also in various skin diseases like Apachi, Charmakila,Tilakalaka,Sleepad etc.
agnikarma is indicated. Agnikarma can also be applied where vitiated
vayu afflicts the twak ,mamsa ,sira, snayu, sandhi and asthi resulting in
ugra ruja( severe pain). 6

In Charak Samhita, bastikarma (niruha and anuvasan), siravedha and

agnikarma(between kandara and gulpha) has been adviced as line of
treatment .7 Acharya Chakrapani has suggested Agnikarma along with
snehan, swedan and virechan. 8
 Agnikarma seems to be an effective procedure in the
treatment of Gridhrasi because it relieves the pain quickly and
patients treated with Agnikarma therapy never suffers from pain

again, which is the main symptom of the disease.9 Acharya
Charak mentions it as Shastra Pranidhana Chikitsa 10
 Ajamodadi churna is also one such polyherbal classical formulation
mentioned in Sarangadhar samhita which is effective in diseases like
Gridhrasi and other Vata vyadhis like aamvat (rheumatoid


arthritis),sandhi pida(pain in joints),ruja in kati pristha guda janga(pain in
hip,lower back and gluteal region),tuni pratuni vishwachi(neck and back
pain associated with spondylosis) [Sarangadhar Sam. Madhyam khanda]
Gridhrasi being a Vata-Kaphaja vyadhi, Ajamodadi churna has the
ability to balance the vata and kapha dosha and their related
diseases.Ajamodadi churna reduces aggravation of vata that causes
sciatic nerve irritation resulting in inflammation,pain and numbness
along the course of sciatic nerve. 11
 The treatment of Sciatica syndrome is a challenge for the
health care system . The treatment option towards sciatica in


modern time includes conservative treatment such as rest, belts
,medications (NSAIDs and analgesics),epidural or pararadicular
injections, physiotherapy,etc. as well as different operative
techniques like Laminectomy, Fenestration surgery, Microscopic
lumbar discectomy, Chemonucleolysis ,etc.
Also advanced techniques like Laser prism (Quantum therapy),
Transcutaneous Electrical Nerve Stimulation, Interferential
Therapy,Diathermy, Ultrasonic Diathermy, Short Wave Diathermy,
Electrotherapy, Cautery, etc. may be performed.
 Researchers are now exploring the most ancient system
of medicine “Ayurveda” for a reasonable solution for one of

the most prevalent life style disorders like Gridhrasi.

In this research work 30 numbers of diagnosed cases of

Gridhrasi are taken in 3 groups to assess the efficacy of
Agnikarma in comparision with the medical management
with Ajamodadi churna. The combined efficacy of the two
therapies is also studied .
AIMS AND OBJECTIVES

AIM

A comparative study on the efficacy of Agnikarma and Ajamodadi churna in
the management of Gridhrasi.
 
 OBJECTIVES
• To study the role of Agnikarma and Ajamodadi churna in the management
of Gridhrasi.
• To evaluate the comparative efficacy of both the therapeutic procedures
and also the combined efficacy .
• To establish the probable mode of action of Agnikarma and Ajamodadi
churna in the management of Gridhrasi.
PREVIOUS RELATED STUDIES
Sl.No. AUTHOR ARTICLE SOURCE YEAR


1 Mohasin Mechanism of Action of www.ayurpub.com ISSN 2456- 2016
Kadegaon et al Agnikarma 0170
2 Devi Dr. Susheela A Clinical Study to Evaluate the http://dx.doi.org/10.7897/227 2015
et al Effect of Agnikarmain the 7-4343.06362
Management of Gridhrasi
(Sciatica)
3 Anant A comparative Study of International Journal of 2012
kumar,V.Shekhar, Agnikarma and Ajamodadi vati in Ayurvedic medicine
Kanchan M.Bolkar the Management of Gridhrasi 2012,3(3),162-169
et al w.s.r.Sciatica
4 BaishyaNamita et Effects of Agnikarma in the IJAM Vol- 4, No. 2, ISSN- 2013
al management of Gridhrasi – a 09765921
clinical study GACH, Guwahati, Assam
5 Arora Vaneet et al Review of Researches on Gridhrasi IJAMY Vol-6, No.1, IPGT 2013
(Sciatica) at IPGT&RA, Jamnagar Jamnagar
6 HS Sathish et al Review of Researches on
Agnikarma (Cauterisation)
7
Satyasmita et al A comparative clinical study on
the effect of Ajamodadi churna
IJAPC Vol.9 Issue 1 e ISSN 23500204 2018
ISSN 2456-3110 vol 4,Issue 1 2019
www.jaims.in

8 Shukla Dr.Jyoti et al
9 Raina Abhineet et al
10 M.A Stafford, P.Peng et al

and Kati vasti in the
management of Gridhrasi wsr
Sciatica
Marma therapy in Pain EJPMR , 2018,5(6) 302-305 2018
Management ISSN 2394-3211, Govt. Ayurvedic
College, Nanded, Maharashtra
Efficacy of Agnikarma in the IAMJ Vol.5 No.2 ISSN 2320-5091, 2017
management of Gridhrasi Saint Sahara Ayurvedic Medical
(Sciatica): a clinical study College, Bathinda Punjab
Sciatica: a review of History, BJA,Vol99, Issue 4, 2007
Epidemiology, Pthogenesis,
and the Role of pidural Steroid
Injection in Management
 
LITERATURE
REVIEW OF GRIDHRASI
HISTORICAL REVIEW OF GRIDHRASI:


History is an umbrella term that focusses the complete
description of any object . So, before going into the depth of the
study, an effort has been put to draw the various references
regarding Gridhrasi in particular and Vata Vyadhi in general.
The historical aspect can be completely covered by categorizing it
in the following time period as:-
• Vedic period (5000B.C to 1500 B.C)
• Upanishad and Pauranik period (4000B.C to 1000B.C)
• Samhita period
• Sangraha period
Vedic Period:-
• Ayurveda is the Upaveda of Atharvaveda . In Atharva Veda,
Vatikrita Vishanika term is mentioned, which is correlated with

Gridhrasi, which is one among the vata vyadhi.
• In Atharvaveda. 12,13. Vata is addressed not to leave the body but
bear the limbs till old age (A.V.III XI 6).
• In Rig veda and Yajur veda the word Prustha has been
mentioned. Anukam and Anukyam are the words mentioned in
vedic period which denotes spine or back.14
• Yakshma a disease condition was described in detail in the vedic
period which involves any part of the body including
Prustha,uru,sroni,asthi and majja. 15
• On the basis of above descriptions it can be said that many
varieties of vata vyadhis were prevalent during vedic period.
Upanishad and Pauranik Period:-


• In Kenopanishad, description given for Vayu, as one which
is always in motion and continuing efforts.
• Eeshopanishad also described Vata in similar manner.
• Chandogyopanishad highlighted the Chala property of
Vayu, and described its association with body movements.
• Kathopanishad named the word susumna for spinal
cord,which comes out piercing the skull.
• Prasuopanishad and Harshacharita describes the
anatomical aspects of Susumna (spinal cord) and its
functions.
 • Brahmasutra reveals the importance of Vyana vata as one
that resides in the joints and responsible for the movements


of joints. The circulation is considered as the function of
Samana Vayu. (1/5/3).

Garud purana In this treatise a separate chapter is available as

Vatavyadhi Nidana; where Gridhrasi is also an entity.
Samhita Period:
Charak Samhita (1000B.C)

In 5th Chapter of Charak Sutra Sthana, Matrashitiya Adhyay ,Pada
abhyanga is indicated in Gridhrasi. 16
In 14th Chapter of Sutra Sthan, Swedadhyay: Gridhrasi is described
as a Sweda sadhya vyadhi.17
• In 20th Chapter of Charak Sutra Sthana, Maharogadhyaya:
Gridhrasi is enumerated in the 80 nanatmaja vatavyadhis.18.
Physiological sites of Vata dosha in the body is mentioned as
Basti , Sakthi, Padau,Asthi and Pakwasaya.
• In 19th chapter of Charak sutra sthan, Ashtodariya adhyay,
description of two types of Gridhrasi - Vataj and Vatakaphaja
is mentioned. 19

• In 5th Chapter of Charak Chikitsa Sthana, Gulma Chikitsa:
Indication of lasuna ksheerapak is said for Gridhrasi. 20
• In 28th Chapter of Charak sutra sthan,Vatavyadhi chikitsa,
Lakshans along with chikitsa of Gridhrasi has been described.
21

• In 27th Chapter of Charak Chikitsa Sthana, Urustambha

Chikitsa: Asta katwara tail is mentioned for Gridhrasi. 22
Susruta Samhita (600 BC – 400 BC)

• In 1st chapter of Sushrut Nidan sthan, Vata vyadhi Nidan, Rupa and


Samprapti of Gridhrasi are described.
• In Dalhan Commentary, Sushrut Nidan sthan, the term “
Saktiutkshepa Nigraha” has been mentioned here which is similar to
the Straight Leg Rising Test in contemporary medicine.23
• In25th chapter of Sushrut Chikitsa sthan, Mahavatavyadhi Chikitsa and
8th chapter of Sharir sthan, Gridhrasi is described as indication for
Siravyeda treatment.
Site of Siravyadha in Gridhrasi is indicated.24
• The use of Guggulu in Vataj disorders was first mentioned in Susruta
Samhita. 25
 
Astanga Sangraha (6th Century AD)

• In Sutra Sthan 20th Chapter, Doshavediya Adhyaya , Gridhrasi

is included in 80 types of Vata vikara.26
• In Sutra Sthan 36th Chapter, Siravyadha Vidhirnama Adhyaya:
Siravedha Chikitsa in Gridhrasi has been mentioned.27
• In Nidan Sthan 15th Chapter, Vatavyadhi Nidan: Pathogenesis
and symptomatology of Gridhrasi has been described .28
Astanga Hriday (7th century AD)


• In the 27th chapter of Sutra sthan, site of Siraveda in
Gridhrasi is mentioned.
• In the 15th chapter of Nidan sthan, the
symptomatology and pathogenesis of Gridhrasi is
described.
• the management of snayugata kupita vayu, snehana,
dahakarma and upanaha sveda are advised. 29
Bhela Samhita (7th century AD)


• In Vatavyadhi Chikitsa Adhyaya, Basti and Raktamokshan
chikitsa are described for Gridhrasi.30
• Vata vyadhis are classified as two groups i.e. Sarbanga
roga (where total body gets involved) and Ekanga roga
(where only a part of the body gets involved)
• The diseases of pada, padatala, jangha, janu, uru, kati,
pristha are considered as Ekangarogas. 31
• Different body parts are attributed to sixteen Adhyatma devatas
and it was the belief that the functions of those body parts are

controlled by their respective Devatas. 32
Kashyap Samhita (7th century AD)

•
•

Gridhrasi included under 80 types of Vatavikaras only.
No specific chapter for Vatavyadhi chikitsa is present.
• Asthi and majja are considered as the primary sites of
Vata. 33
• Use of lasuna is widely described in Vatarogas for
prevention and cure for which a separate chapter is
allotted in Kalpasthan .34
Sangraha period:

Madhava Nidana (7th century)


In Vatavyadhi Nidan, Gridhrasi is described with its symptoms.
Some symptoms like Dehasyapravakrata in Vataj and Mukhapraseka,
Bhaktadwesh in Vatakaphaj type of Gridhrasi are described first. 35

Kalyanakaraka (8th century)

8th chapter termed as Vatarogadhikar describes the pathology
and symptomatology of Gridhrasi and its treatment is given in
the 12th chapter named Vataroga chikitsa.
Chakradutta (12th century)


• For treatment of Gridhrasi some herbal remedies such as
Vaarthaka prayoga, Erandaphal payash, Rasnadi gutika are
mentioned.
• Siraveda and Agnikarma ( Shastra chikitsa) along with
vastiprayog kala are mentioned.
• Rasnaguggul vati is also indicated for the treatment of
Gridhrasi.
• In Aamvata rogadhikar, he indicated Ajamodadi vati for
the management of Ugra Gridhrasi.
Chakrapanidatta (12th century)


• Acharya Chakrapni, in his commentary on Charak
Samhita explains the specific type of pain in Gridhrasi
which starts from sphika pradesha and then radiates
downwards to kati, pristha, uru, janu, jangha and pada
in order.39
• While commenting on the functions of Vyana vata, he
states that Gati indicates Akunchana (flexion) and
Prasarana (extension) .40
Arunadutta (12th century)


• Arunadatta in his Sarvangasundari commentary on
Astanga Hridaya, clearly mentions that, the pain that
is produced at the time of raising leg straight which
restricts the movement of the limbs is due to Vata
present in Kandara.41 Now a days it is a significant
clinical test for the diagnosis of Sciatica .42
Harit Samhita (12th century)


• Gridhrasi is described as a Vyanaprakopaja Vyadhi. He
allotted separate chapters for Gridhrasi vata where
nidan, lakshana and chikitsa are explained.43
• The 22nd chapter of Tritiya Sthana deals with the
symptomatology and treatment of Gridhrasi.44
• Harit has illustrtated the classification of Vata vyadhis
according to five types of vata mentioning 16 diseases
for each type.
Gadanigraha (12 century)
• Gadanigraha describes Gridhrasi chikitsa in two khandas.The 4 th
chapter of Prayoga Khanda termed as Gutikadhikara dealswith its

treatment and the19th chapter of Kayachikitsa Khanda named as
Vatarogadhikara describes Vasti chikitsa for its treatment along with
Agnikarma and Raktamokshan.46
 
Vangasena Samhita (12 century)
• Gridhrasi is described with its two types where Vatabalasa word has
been used for Vatakaphaj Gridhrasi. The treatment part is also explained
in details with deepan, pachan, vamana, vasti, siravedha and agnikarma.47
• Rasna Guggul is mentioned in the treatment of Gridhrasi.
• Siravyadhana is given special importance in Vata disorders involving
lower limbs like Khanja, Pangu, Padadaha, Padaharsha, Vatakantaka etc.48
Dalhan (12 century)
Dalhan mentions the disease Gridhrasi as Ranghini in his
commentary on Sushrut Samhita.

Sarangadhara Samhita (13th century)
• In the 108th sloka of the 7th chapter of Purvakhanda termed as
Rogaganana, Gridhrasi is counted under 80 types of
Nanatmaja Vata vyadhi. 49
• This treatise is known for its contributions specially in the
preparation of single and compound drugs. Compounds
such as Ajamodadi Gutika was mentioned for treatment of
Gridhrasi in 2nd and 5th chapter of Madhyam Khanda.50,51
Sashilekha (13th century)
• It is written by Indu on Astanga Sangraha. There is

mention of symptoms of Gridhrasi as similar to
Viswachi. If restricted movement and pain occurs in
upper limb, it is Viswachi, and if that occurs in lower
limb is termed as Gridhrasi.53
 
Rasaratna Samucchay (13th century)
• In the 30th chapter, the treatment of Gridhrasi is
mentioned.54
Bhava Prakasha (16th century)
• Gridhrasi mentioned in Vata Vyadhi nidana.55

• Types of Gridhrasi along with its treatment is mentioned.
• He explained Dehapravakrata in Vataja Gridhrasi and in Vata-
kaphaja type of Gridhrasi, gaurava, agnimanda, mukhapraseka,
bhaktadvedwesha is mentioned.
 
Yoga Ratnakara (17th century)
• Classification along with symptomatology of Gridhrasi is
mentioned. 56
• Few preparations are mentioned for Gridhrasi in Vtavyadhi chikitsa.
Bhaishajya Ratnavali (18th century)

•

This texts follows the principle of Chakradatta for
the treatment of Gridhrasi. Various treatments for
Gridhrasi are mentioned like snehana, vasti and
Shastra karma.57
GRIDHRASI

VYUTPATTI (ETYMOLOGY) 
The word Gridhrasi is in feminine gender which is derived from the
‘Gridhu dhatu’,that means to covet, desire , strive after greedily , to be
eager for .(Students’ Sanskrit-English Dictionary)
The term Gridhrasi is derived from Gridhra + So
By adding ‘kah pratyay’ leads to Gridhra +So + Ka
By adding Kran pratyay i.e.Grid+kran the word Gridhra is derived.
 Gridhu is the dhatu which make the word Gridhra from which the


word Gridhrasi is derived. Karan pratyay is added to this by
Susudhangridhibhyaha pran (Unadi 2/24) and by the ‘lopa’ of’ ‘k and ‘n
the word Gridhra is derived.
Gridh +ra =gridhra (that means vulture)
Gridhra +sa (Antakarmani Divadi Parasamani Pada)
Anta dhatu , by using it in the form of noun adding ka pratyay by the rule
of Atoanupasarga Kah-
Gridhra+sau+ka
Gridhra+sa+a
 Replacement of “sah” by “sa” (rule of Dhatvadehsahsah)
and “lopa” of “au” and “ka” occur to give the word
“Gridhrausa”.

Finally for this word “Gridhrausa” which is in female
gender by adding “dis” pratyay the word “Gridhrasi” is
formed.
The word Gridhrasi indicates typical character of pain
and also gait of patient. The patient walks like the
Gridhra( Vulture) and leg become tensed and slightly
curved as that of vulture.So the term Gridhrasi might be
given to the disease.
NIRUKTI (DERIVATION) OF ‘GRIDHRASI:

Different text books of Sanskrit Literature shows the following
derivation of the word Gridhrasi :-
• ‘Ghridhramapisyaati.’, ‘syaati –kshepana’
• ‘Gridhramivasyaati gacchati’
• ‘urusandhavatraga’
 The Sanskrit word ‘syaati’, in Gridhrasi’ means throwing action. The
term Gridhrasi means the resemblance of the gait of the patient with

that of the vulture,patient walks with a limping gait without lifting the
legs up (Vachaspatya).

According to Amarasudha, Gridhrasi is characterised by morbidity

of vata dosha affecting the hip joint.

Gridhyatimamsam abhikanshya atisatatam iti gridh +kran

“gridhau mamsalolupo manushyaha tasyati pidayati nashyati ba”
(Sabdakalpadrum)
 The above reference from the Sabdakalpadrum states that the word
‘Gridh’ referred to a person who is crazy of eating meat. The word syaati
in Sanskrit means to cause suffering. Thus the word Gridhrasi applies to

an illness that mostly attacks the persons who are greedy of consuming
meat.
“Gridhramapi syaati sa atankakarmani atah upasargakah,
Tatcha gridhramiva syaati pidayati, gridhrasyaati bhakshyati.”
(Sabdakalpadrum)58
The pain experienced in Gridhrasi is the same as that of the pain when a
vulture pierces its beak deep onto the prey .
PARIBHASHA (DEFINITION) :

According to Charaka Samhita


Sphikapurvakatipristhorujanujanghapadangkramat,
Gridhrasi stambharukatodairgrinhaati spandate muhu..
Vatadvatakaphat tandragaurava arochakanvita..
59

 
As described by Acharya charaka, Gridhrasi is a vata vyadhi
characterized by stambha (stiffness), ruka (pain), toda (pricking pain) and
muhu spandana (frequent twitching). The symptoms initially affects the
sphika Pradesh (buttock) as well as posterior aspect of kati (waist) and
then gradually radiates to the posterior aspect of uru (thigh), janu
(knee), jangha (calf) and pada (foot).
According to Susruta Samhita
Parshnipratyangulinang tu kandarayaanilardita
Sakthnakshepa nigrahaniyad gridhrasitihisasmrita 60
  
Acharya Susruta mentions that there are two kandaras that gets
vitiated by the vata dosha limits the extension of the leg thus produces
the disease Gridhrasi. One extending distally from the parshni to the toes,
and other extending above from the parshni to the vitapa.
 
Harita
Gridhrasi originates due to the vitiation of Vyan vayu which is
responsible for all types of voluntary movements i.e. expansion,
contraction, upward, downward and oblique.
PARYAYA OF GRIDHRASI

• Rhinghini: This term was used by Vachaspati Misra the commentator of


Madhava Nidana to denote the word. Shabdakalpadrum implicates this term
to Skhalana which means displacement of Skhalana of Tarunasthi of vertebral
column. 62
• Randhrinee: Dalhan used this term while commenting on Susruta Samhita .
63
Disc is the weakest point in the lumbar spine and tends to rupture causing
sciatica as indicated by the term Randhrinee.
• Radhina: Kashiram and Adhamalla in their Gudardha Deepika and Dipika
commentary mentioned this term which means pressing,compressing and
destroying. (Sa.P.K.7.108)Compression of the nerve roots is the primary
pathology of radicular pain in sciatica as reffered by the word Radhina.
NIDANA:

Ancient Acharyas have not specifically mentioned any direct


referrences regarding the nidan of Gridhrasi but Vatavyadhi nidan are
essential factor for the manifestation of the disease ; hence the hetus of
Vatavyadhi can be considered as hetus of Gridhrasi . The causative factors
of Vatavyadhi have been clearly mentioned in Charaka Samhita 64
 Since Gridhrasi is considered as Vataja Nanatmaja Vatavyadhi, the
provocative factors of vata can also be taken as causes of Gridhrasi. In

addition to this, in Charaka Samhita69 and Astanga Hridaya 70, two specific
causes of Vatavyadhi i.e., Dhatukshaya and Avarana have been mentioned.
All the etiological factors of Vatavyadhis as well as Vata prakopa are
taken as Nidana of Gridhrasi and is classified as follows:
1. Viprakrista nidana: The person who steals the wealth of God
(V.C Vatavyadhi, sloka 2) or Bramhana and who deceives his
master or who opposes his teacher will suffer from vatavyadhi.
(Vaidya Chintamani – vatavyadhi karma vipakam)
2. Sannikrista nidana: a) Aharaja, b) Viharaja, c) Kalaja, d) Agantuja, e)
Anya hetu

• Aharaja Nidana: Rasa : The excessive intake of rasas like katu, tikta,
kashaya, Guna: like laghu, ruksha, Veerya:sheeta virya padarthas,
Karma: excessive use of vistambhi article may lead to vataprakopa.
Dravya: Food articles like masura, mudga, harenu etc. responsible
for vataprakopa.
Matra : Alpasana leads to dhatu kshaya thereby causing vataprakopa.
Adhyasana, visamasana causes ama which obstructs the srotas hence
aggravates vata.
 • Viharaja: Prajagaram – Aggravates vata by increasing ruksha guna
in the body . Langhana, plavana, vyayama – as a result of this,


excessive and continuous exertion causes dhatu kshaya and
aggravates vata. Diwaswapna 71 increases pitta and kapha, which
obstructs the channels and leads to vata prakopa.
Vegavadharana is a condition when any of the natural urges are
suppressed, and results in vata prakopa. Malavarodha is the most important
cause of vataprakopa in Gridhrasi 72. This causes pain in sacral region,
pindikodwestanam, and backache and also produces many diseases in the
lower limbs like Gridhrasi etc. Vagbhata 73 also stated that due to
obstruction of apana vayu it causes a variety of vatavyadhis.
• Kalaja: Vata sanchaya, prakopa and prasara takes place in
Grishma, varsha and Sharad ritu. During vriddhavastha 74 vata
prakopa takes place.

• Agantuja: External causes due to Abhighata are mainly
considered. Marmabhighata mainly kukundara, nitamba marmas
leads to Gridhrasi. Kunkundara75 Marma Abhighata causes loss of
power and sensation in lower extremities and may result in
pain and difficulty in walking.
PURVARUPA:
In the 4th stage of kriyakal i.e. in the sthana samsraya avastha,


purvarupa appears. For every disease certain premonitory
symptoms are noted before it is clearly established in the body.
Such symptoms are called Poorvarupa.
According to Charak, Avyakta lakshanas are purvarupa of
vatavyadhi.
RUPA: (Madhukosh on M.N. 1/7)

Rupa appears in the 5

th

stage of the vyadhi i.e. in the vyakta
avastha. Vyakta purva rupa is Rupa.( A.H/Ni/1/5).76
Depending on the lakshans, Acharya Charak (Ch/Chi.28/56)
classified Gridhrasi into two varieties..
• Vataja
• Vata kaphaja
According to Charaka, the symptoms of Vataja Gridhrasi are –
• Stambha (stiffness)
• Ruk (pain)

• Toda (pricking sensation)
• Graha (tightness)
• Muhuhspandana (frequent twitching)

In Vata-Kaphaja type of Gṛdhrasī, the symptoms are-

• Tandra (drowsiness)
• Gaurava (feeling of heaviness)
• Arochaka (anorexia)
 These are the associated symptoms which are present
along with the above (Cha.Chi/28/56-57)77.
According to
 Sushruta and Vagbhata,
Sakthikshepanigrihniyat, that means one finds restriction
in extending the leg due to severe pain. (Su/Ni/1/74;
AH/Ni/15/54).
Considering all these signs and symptoms the clinical
manifestations of Gridhrasi, may be sub divided into two
distinct categories –
A. Samanya lakshanas
B. Vishesha lakshanas
SAMANYA LAKSHANA :
Following are the Samanya lakshanas of Gridhrasi.
 
STAMBHA :

“स्तम्भः-निष्क्रियत्वम्” (Hemadri on AH.Su.12:51/1 )
“स्तम्भःबाहूरूजङ्घादीनांसंकु ञ्चनाद्यभाव” (Arundatta on AH.Su.12:51/1)
Rigidity felt at uru and jangha region resulting in pain
and restricted movement of the muscles and joints of lower
limb.
RŪKA:


“रूक् - सततं शूलम्” (Arundatta on AH.Su.12:49/2)
“रूक् – शूलम्” (Hemādri on AH.Su:12:49/2)
“रुजो वेदनाः” (Dalhana on Su.Ni.5:13)

In Gridhrasi, Ruka is one of the main symptoms of

Gridhrasi wherein the pain starts from sphika pradesh
radiating to the pada and non-radiating pain is felt at
kati,uru,janu,janga.
TODA:
• “तोदः - सूचिब्याधनवत्व्यथा” (Yogendranath Sen on Ca.Ci.7:14/2)

• “तोदो - विच्छिन्नंशूलम्” (Arundatta on AH.Su.12:49/2)
• “तोदः - तोत्रेणेवव्यथा” (Hemadri on AH.Su.12:49/2)
Pricking type of pain similar to the prick of a pin.

GRAHA:
“ग्रह–ग्रहनम्” (Sabdakalpadrum)
Graha is the restriction in the movement of the leg
manifested in the form of difficulty in walking.
MUHU SPANDANA :


• “स्पन्दनं स्फु रणम्” (Hemadri on AH.Su.12:50/2)
• “स्पन्दनं हि –किञ्चिच्चलनम्” (Arundatta on AH.Su12:50/2)

Sphurana refers to the fasciculation present in the lower

extremity which is experienced in the muscle supplied by
the Sciatic nerve.
SAKTHNAHUT KSEPAM NIGRAHINYAT :

“क्षेपः प्रसारणं, तं निगॄह्णीयादवरुन्ध्यादित्यर्थः”


(Dalhana on Su.Ni.1:74)

Dalhan mentioned the word Kshepa which denotes prasarana

i.e. patient experiences pain on extending the leg.
VISESHA LAKSHANAS:
Vataja Gridhrasi:
DEHASYA VAKRATA

Madhavakara and Bhavprakash mentioned this symptom,
which means the patient of Gridhrasi adopts a particular posture
either by lateral and forward bending due to pain(M.Ni/22/56). 80
The patient tries to put his body weight on the unaffected leg
causing a limping posture.

SPHURANA:
“स्फु रणंपुनःपुनःचलनम्” (Dalhana on Su.Ci.1:7)
A type of muscle twitching in kati, uru, janu, jangha is similar to that of
spandana or muhuspandana.
SUPTATA:
The patient experiences varied degree of paraesthesis or sensory loss
in the affected limb.

Vata Kaphaja Gridhrasi:


In Gridhrasi when kapha dosha involves along with vata, following
lakshanas are manifested as-
 
GAURAVA:
“आर्द्रचर्मावनद्धं वा यो गात्रं मन्यते नरः” (Su.Sa.4:55)
Gaurava is the condition where the patient feels heaviness of the
body and lower extremities in particular. Here kapha dosha is mainly
involved.
TANDRA:


“इन्द्रियार्थेष्वसम्प्राप्ति गौरवं जॄम्भणं क्लमः I
निद्रार्तस्येव यस्येहा तस्य तन्द्रा विनिर्दिशेत् II” (Su.Sa.4:49)

Tandra occurs as a result of tama, vata and kapha dosha

due to which there is a feeling of drowsiness or inability of
sense organs to grip followed by yawning and fatigue
caused without any labour.
AROCAKA:

“अरोचकस्तु प्रार्थितेऽप्युपयोगसमयेऽनभिलाष I”
 (Chakrapāni on Ca.Ci.9:20).

“अरुचिमानित्यनेनप्रार्थितान्नभक्षणासामर्थ्यमुच्यते I
(Chakrapāni on Ca.Ci.16:14).

It is a subjective feature where patient fails to appreciate the taste in

the mouth irrespective of state of appetite. In comparison to the role of
Vāta dosha, involvement of Kapha dosha has much to do with the
manifestation of arochaka, because the seat of Bodhaka Kapha is jihvā
which does rasa bodhana (perception of taste).
MUKHA PRASEKA: Mukhapraseka means excessive salivation
caused due to vitiation of Kapha in association with Āma.
 
BHAKTA DVESA:

“Dveshamayati yojantu bhaktadvesha cha ucchate”

Secondary to the sluggishness of jatharagni and Kapha

dusti, patient of Gridhrasi develops aversion towards food.
Association of ama is also contended in the causation of this
aversion towards food. (Madhukosha on MN.14:4)
STAIMITYAM:

“स्तैमित्यं गात्राणामपटुत्वम्” (Arundatta on AH.Su.12:53/2)
“स्तैमित्यं – आलस्यम्” (Hemadri on AH.Su.12:53/2)

Inertness of the body, feeling of frozen sensation in the

affected lower limb wherein the patient feels as if his lower
extremities are covered with wet cloth .
UPASAYA:
Upasaya deals with the medicines, diets and regimens
which brings comfort either by acting against the cause of

the disease directly or it may generate such effect on the
disease indirectly. Upasaya for Gridhrasi has not been
mentioned specifically in any classical texts but, it is said
that to differentiate two diseases whether the disease is
Urusthambha or Gridhrasi, upasaya can be adopted.
SAMPRAPTI:


To treat a disease, the complete knowledge of its pathogenesis
is important. The process of manifestation of the disease by the
vitiated dosha which are circulating all over the body is known as
Samprapti. Samprapti means samyak prapti of roga i.e. proper
understanding of the disease process.81A proper understanding of
samprapti is crucial in the treatment of any disease, as chikitsa in
Ayurvedic texts mainly deals with samprapti vighatana i.e.
dissolution of the process of pathogenesis (AS/Ni/1/13).
On the basis of symptoms mentioned in texts, the probable
Samprapti-ghataka of Gridhrasi can be traced as –
Dosha :
Pradhana: 
Vata (mainly Vyana & Apana Vayu )
Anuvandha: Kapha (in Vata-Kaphaja Gridhrasi)
Dushya: Mamsa, Asthi, Sandhi, Snayu, Kandara
Srotas : Mamsavaha, Asthivaha &Vatavaha
Srotodushti : Sanga
Agni: Jatharagni
Ama: Jatharagnimandya janita
Udbhava sthana: Pakvasaya
Sanchara sthana: Apana kshetra
Adhisthana: Sphik, Kati, Pristha, Uru, Janu, Jangha, Pada
 The different factors involved in the pathogenesis of Gridhrasi can
be described independently as follows-
 

Dosha: Similar to any other nanatmaja type of Vatavyadhi, distinct
involvement of Vata dosha in the pathogenesis is characteristic of
Gridhrasi. Vāta prakopa may take place in two ways i.e. due to dhatukshaya
and margavarodha. In dhatukshaya, ruksha, laghu, sheeta, pramitasana,
vyayama, abhighata etc. are the hetus which leads to direct sanchaya and
results in prakopa of Vayu. In the case of margavarodha, accumulation of
Kapha plays a significant role in producing Vata-Kaphaja type of
Gridhrasi.
Dushya:
The symptoms like pain in the kati and pristha suggests involvement
of asthi sandhi. Pain in the leg which radiates from the buttock to heel is

suggestive of affection of snayu . Acharya Sushruta opines that kandara is
affected by vitiated Vata dosha in Gridhrasi. Chakrapani says that kandara
may also be taken as sthula snayu (Cha/Su/11/48)82. Snayu is the moola
of mamsa dhatu, so mamsa dhatu can be considered as dushya. On the
other hand, asthi is the site of Vata and there is an inverse relation
between each other. For instance, increasing Vayu causes asthi kshaya
resulting further Vata prakopa.
So from this it can be said that mamsa, asthi, sandhi, snayu, kandara
may be considered as dushya in the disease Gridhrasi.
Srotas: Mamsavaha, asthivaha and vatavaha are the srotas which are mainly
involved in this disease.
 

Srotodushti: Sanga type of srotodusti is found in Gridhrasi.
 
Udbhavasthana: The main udbhavasthana of Gridhrasi is pakvasaya
,similar to other nanatmaja type of Vatavyadhi,it is considered as
pakwasayudbhava vyadhi.
 
Adhisthana:

According to Chakradatta, kati and sphika are the initial sites, from

where the disease begins. According to Sushruta, kandara of parsni, pada
and anguli are affected by vitiated dosha. Thus sphika, kati, uru, janu,
jangha, kandara of parshni, pada and anguli may be considered as the
adhisthana of the disease Gridhrasi.
Sadhyasadhyata 83 Knowledge about Sadhyasadhyata is much
needed for the treatment of any disease . Acharya Susruta considered
Vata Vyadhi as one of the Astamahagadas which means diseases which are
fatal or incurable. Acharya Vagbhat considers it as Maharoga. Most of
the Acharyas are having same opinion about the difficulty in treating
Vata Vyadhis generally.
CHIKITSA:


Chikitsa is the process of breaking down the pathogenesis of a
disease ( Samprapti vighatanam) . Diseases are caused due to
vitiated doshas involving the dushyas (dhatus, upadhatus, malas etc.).
The process which establishes balance in the body elements is
called Chikitsa.
While treating any disease,the first line of treatment is Nidan
parivarjan i.e. to avoid all etiological factors. In Gridhrasi all the
causative factors of Vata vyadhi should be avoided.
Charaka (Cha/Chi/28/101) 88 and Susruta (Su/Chi/5/23) 89
recommended siravedha as the first line of treatment in Gridhrasi.
 Charaka mentions Siravyadhana in between kandara and

gulpha, Vastikarma and Agnikarma as the specific Chikitsa
sutra of Gridhrasi.

Sushruta has advised Siravyadhana, four angulas above

or below the janu sandhi 90 and also other measures for the
treatment of Vatavyadhi that can also be adopted in Gridhrasi
depending upon the condition.
 Vagbhata mentioned that Gridhrasi may be caused due to Vata
prakopa in snayu (AH/Ni/15/14/1). For the management of


Snayugata kupita Vayu, snehana, Dahakarma and Upanaha sveda is
advised (AH/Chi/21/22/2). Siravyadhana - four angulas above or
below the janu sandhi is suggested in case of Gridhrasi
(AH/Su/27/15/1).

Chakradutta 91 has given the detail description in the treatment

of Gridhrasi. He opined that vasti should be administered after
proper Agni deepana, Ama pachana and Urdhva sodhana. Chakradatta
mentioned Agnikarma in the management of Gridhrasi.
 Bhava Prakasha92, advised vamana and virechana before
administration of vasti. 
Bhela mentioned Raktamokshana as the best treatment of
Gridhrasi.93
Snehana: Snehapana should be adviced at first in all cases of
Gridhrasi, except in cases related to Ama & kapha. In cases of


Ama & Kapha, deepana and pachana should be given before
snehapana to facilitate niramavastha and deeptagni. 94
 
Swedana: After proper snehana, swedana karma should be
adviced. The swedana must be used preceded by sneha
abhyanga or Snigdha sweda. Sankara, prastara & Nadi 95 are
mainly given . However 13 types of sweda may be used
according to the requirement. Shoola and Stamba can be
controlled by swedana.
Shodhana:

The following karmas are included under the sodhana karma.

a) Vamana
b) Virechana 
c) Vasti

• Vamana: After snehana swedana, vamana should be adopted if

required . Chakrapani mentioned urdhwa sodhana followed by vasti.
This will be useful for vatakaphaja Gridhrasi to pacify kapha dosha.
• Virechana: Virecana chikitsa plays an important role in the treatment
of Gridhrasi. Acharya Charak mentioned mridu Virecana in Vātavyādhi
chikitsa96. The Sneha-Virechana clears obstruction in the srotas and
relieves Vāta vitiation very quickly.
Vasti karma (Ch/Si/10/6): The Vasti karma is considered as pradhana
chikitsa for vata vyadhi because it directly enters into pakwasaya, strikes


at the root of the vitiated vata result in alleviation of vata dosha. 97
 
After sodhana chikitsa, shaman chikitsa is to be performed. Different
shaman yogas are also mentioned in the classical texts as shown in the
table as -
Table:- Shamanoushadis used in Gridhrasi according to different
Ayurvedic texts .
ŚAMANA AUSHADHA

Ajamodādi Curna
YR

-
 Sa
CHURNA
+
BP

-
BR

-
CD

-
GN

-
Abhayādi Curna + - - - - -
Krisnādi Curna - - + + - -
Rāsnādi Curna + - - - - -
Daśamūlādi Curṇa - + - - - -
KALKA AND LEPA
Mahā Nimba Kalka + + - - - -
Rasona Kalka - + - - - -
Svalpa Rasona Pinda - - - - + -
Guñjā Phala Lepa + + - - - -
Vātahara Pradeha - - - + - -
 KAŚĀYA / KVĀTHA YR SA BP BR CD GN
Pañcamūla kaśāya + - - + + +
Mahārāsnādi kaśāya
Śefālikā patra kaśāya
+
-
 +
+
+
+
-
+
-
+
-
+
Erandādi kaśāya - - - + - -
Dashamūla kaśāya + + - - - -
ARISHTA
Balārishta - - - + - -
Daśamūlārishta - + - - - -
TAILA AND GHRITA YR SA BP BR CD GN
Chāgalyādya ghrita - - - + + -
Balā taila - + + - - -
Eranda taila + - + + - -
Vājīgandhādi taila
Saindhavādya taila
+
+  -
-
-
-
-
-
-
+
+
-
Māshādi taila - + - - + -
Visagarbha taila + - - + - -
Prasārani taila + + - - - -
Mahābalādi taila + + - - - -
Śatāvari taila + + - - - -
Nārāyana taila - + - - - -
Vishnu taila and ghrita - - - - + -
Vijaya bhairava taila - - - - + -
Rāsnāputika taila + - - - - -
Saptaprastamsa taila - - - - + -
Elādi taila - - - - + -
GUGGULU KALPA AND RASAUSHADHIS, YR SA BP BR CD GN


Rāsnā guggulu + - + + + +
Trayodaśānga guggulu + - - + + -
Yogarāja guggulu - + - + - -
Mahāyogarāja guggulu - - + - - -
Pathyādi guggulu + - + - - -
Vātāri rasa - - - + - -
Vātagajankusha rasa - - - + - -
Vātarākshasa rasa + - - - - -
Svacchanda bhairava rasa - + - - - -
PATHYA – APATHYA

Pathya 
The diet and regimen that is congenital to the health
both in healthy and disease person and which have no
adverse effect on body and mind are termed as Pathya 98.
Specific Pathya and Apathya of Gridhrasī are not described.
Hence Pathya and Apathya of Vātavyādhi in general can be
applied for patients of Gridhrasī.
Āhāra:

• Anna varga :
• Phala varga :

Kulattha, Māsha, Godhūma, Raktaśāli, Navina tila.
Āmalaki, Rasayukta Phala, Dādima, Drāksā,
Jāmbīra, Badara.
• Śāka varga : Patola, Śigru, Rasona.
• Dugdha varga : Kshīra, Ghrita, Navanīta.
• Dravya varga : Māmsa rasa, Mudga yūsa, Dhānyāmla.
• Taila varga : Tila taila, Sarsapa taila, Eranda taila.
• Anya varga : Tāmbula, Elā, Kustha.
Vihara: Sukhosna Pariseka, Nirvāta sthāna, Samvāhana, Avagāhana,
Abhyanga, Brahmacarya, Ūshna Prāvarana, Agni, Āatapa sevana, Snigdha-
usha Lepa.
  
Apathya: Those āhāra and vihāra which have adverse effects on body are
called Apathya.
 
Āhāra: Kalāya, Canaka, Kanguni, Kodrava, Śyāmāka, Nivāra, Nispāva bīja,
Rājamāsa, Karīra, Jāmbu, Trinaka, Tinduka, Śuska māmsa, Dūsita Jala.
 
Vihāra: Vegadhārana, Ati vyavāya, Ati vyayāma, Vamana, Ati Raktamoksana,
Prajāgarana, Divāsvapna, Adhva, Ati-Gaja-Aśva-Ūstra-Yāna sevana
 
REVIEW OF LITERATURE ON
AGNIKARMA
Introduction
The word Agnikarma is made up of two words i.e. Agni and Karma.No
object in nature can be concieved,if it has not inherited with agni. The agni in the


form of bhutagni,jatharagni and dhatwagni is the life for creatures.
With the application of Agni when various heated materials are used to cure the
diseases ,that process is known as Agnikarma.
 
Derivation of “AGNI”:
Agni the male gender word is derived from the root “Agigatau agyati
agnayamna prapyanti” i.e it gives the rebirth.
Derivation on the basis of appearance :
“Agni vyaptau angati vyapnoti iti agni”
This indicates the omnipresence of Agni in the Universe.
Derivation on the basis of nature:
“angati urdhwa gacchati iti agni”
That which moves on the upward direction is Agni.
Derivation of the term “KARMA”:
The term “karma” is derived from the Sanskrit root word “kri”
by adding “manin”pratyay.

The way through which an action takes place or action taken to do
a work is called Karma.
Some examples of Karma found in various contexts like
Spandana, gamana, unaman, virechan, etc. The above words indicates
some works.
In Dalhan commentary on Susruta Samhita , Agnikarma is
mentioned as:
Agninaa krita karma- The karma carried out by Agni.
Agni sambandhi karma - The karma related to Agni.
HISTORICAL REVIEW OF AGNIKARMA
Regarding Agnikarma, various texts are available till now since the
Vedic period .
• Vedic period
• Samhita period 
• Samgraha period
 
VEDIC PERIOD:

Rig Veda:
Application of Agni has been mentioned in the context of
gynaecological and obstretical diseases. (10/162/1-4).
• Yayur Veda: Yayur veda has symbolized agni and its purpose in
sheeta related disorders.(23/10/01)


• Samveda: It enumerates a separate chapter bearing detail description
about Agni called “Agneya Kanda”. Special names have been given to
Agni as Parameshwara, Aatma, Vaishwanara etc.
 
• Atharva Veda: Atharva Veda identified and worshipped Agni as God
and the disinfectant purpose of Agni is clear from the verses itself. The
verses give an idea of Agni being used to protect the body from
invading microorganisms. (Ath.5/23/2, 1/28/1,12/3/24,12/1/19).
Agni is considered as Rakshoghna in Atharva Veda.
Samhita Period:

Susruta Samhita:

• Acharya Sushrut mentioned Agnikarma as a parasurgical
procedure and its superiority amongst all other
parasurgical procedures.99
• In Kalpasthan, Uttaratantra and also in Sutra sthan
Agropaharaniya adhyay, Agnikarma mentioned as
Upayantra, Anushastra and one of the 60 Upakramas of Vrana
• Indication of Agnikarma in various diseases are there in the
following references.
List of references of application of Agnikarma in Susruta Samhita
Shiro roga Su.Su.12/9


Netra roga Su.Su.12/9
pakshma kopa Su.Su.16/3
Adhimantha Su.Su.12/9
Lagana Su.U.14/5
Medaja ostha Su.Chi.22/9
Adhidanta Su.Su.22/23
Krimidanta Su.Su.22/40
Arsha roga Su.Su.6/3
Bhagandara Su.Su.8/23-27
Nadi vrana Su.Su.12/10
Upadansha Su.Su.19/50
Antra vriddhi Su.Su.12/10
Indication of Agnikarma in various Kshudra Rogas are as follows:
Chippa Su.Chi. 20/10
Kunakha
Valmika
Jatumani
 Su.Chi. 20/11
Su.Chi.20/48
Su.Chi. 20/32
Visha Su.K.5/5
Vata vyadhi Su.Chi.12/10
Medaja granthi Su.Chi. 18/17/18
Medajagalagand Su.Chi.18/54
Kaphaj arbuda Su.Chi. 18/31-39
Sleepada Su.Su. 12/10
Pleeha Su.Chi.14/16
Rakatatipravitti Su.Su.12/10,14/39-40
Vrana Su.Chi.1/89,7/35,2/37,Su.Su.12/10
Charak Samhita:
• Explains Agnikarma chikitsa as Shastra Pradhan in 11th chapter of
Sutrasthan.
• Mentions Agnikarma as a treatment of Vrana in Dwivraniya Adhyay.


List of referrences of application of Agnikarma in various diseases are as:-
Granthi visarpa (Ch.Chi. 21/132)
Sanyasi (Ch.Chi.24/46)
Kaphaj gulma (Ch.Chi.5/61)
Ardhavabhedak (Ch.Chi.9/79)
Bhagandara (Ch.Chi. 12/97),
Visha chikitsa (Ch.Su 28/26)
Gridhrasi (Ch. Chi.28/100)
Granthi visarpa (Ch.Chi. 21/132)
Manas Roga (Ch.Chi 28/26)
SANGRAHA KAAL:

In Sangraha kaal, Astanga Sangraha and Astanga Hridaya are the texts


mentioning Agnikarma as a therapeutic procedure for various diseases.
• Astanga Sangraha: The Sutrasthan 40th chapter deals with
Agnikarma Vidhi and there are many other references where
Agnikarma is used in different diseases.
• Astanga Hridaya: Sutrasthan 30th chapter deals with Agnikarma.
• Chakradatta: Chakradatta has explained Agnikarma for Gridhrasi
in the perspective of Vata vyadhi.100
• Yogaratnakar : mentioned Agnikarma for Gridhrasi.101
Agnikarma chikitsa is also mentioned in Sarangadhara Samhita,
Gadanigraha, Vangasena, Bhavaprakasha, Chakrapani, Dalhan as a
therapy in various diseases.
Dahanaupakarana: 102

Different

Dahanaupakaranas are mentioned in the
classics during the description of diseases which are treated
by Agnikarma. These are the instruments having their own
peculiarity which produce samyak dagdha (therapeutic
burns) during Agnikarma chikitsa.
List of referrences of using Dahanaupakaran in different
texts :-
Dahanaupakaran S.S C.S A.S A.H
Pippali + - + -
Aja shakrit + - + -


Godanta + - + +
Shara + + + -
Shalaka + - + +
Jambavostha + - + -
Dhatu + - - +
Madhu + + + -
Madhucchista + + + -
Guda + - + +
Vasa + - + +
Ghrita + + + +
Tailam + + + +
Yastimadhu - - + -
Suchi - - + -
Varti - - - +
Suryakanta - - + -
Majja - + - -
Ardhenduvaktra shalaka + - + +
Nadi yantra - - - +
Kolasthidal shalaka + - + +
According to the site of application, Dahanaupakarana:

Site of application
Twakgata vikara (skin)  Dahanopakaran
Pippali, ajashakrit, godanta,shara, shalaka
Mamsagata vikara (muscle) Jambavaustha, Panchadhatu Shalaaka,
Kshaudra
Sira (artery and vein), Snayu Kshaudra (honey), Guda(jaggery), Sneha
(ligaments),Asthi (bones), Sandhi
(joints)

Marma (vital points) Kshaudra , Guda, Sneha.

According to the origin, Dahanopakarana may be classified as: 103

Origin
Vanaspatija

Dahanopakarana
Pippali (Piper longum), Yastimadhu (Glycerrhiza glabra),
Haridra (Curcuma longa) ,Guda, Sneha Taila, Sarjarasa

Pranija Ajashakrit , Godanta , Madhoochista

Dhatuja Panchadhatu (Tamra40%, Louha30%, Yasad10%,
Rajat10%,Vanga 10%), Shara Shalaka, Jambavostha,
Suryakanta, Suchi,Stone.
Classification of Agnikarma:

According to Dravya:104

• Snigdha Agnikarma: madhu, ghrita, taila, etc are used for
sira snayu, sandhi, asthi dahana.
• Ruksha Agnikarma: pippali, shalaka, godanta etc are used
for twak and mamsa dahana.
According to Site:105

• Sthanik (local): kadara, arsha, bhagandara

• Sthanantariya (systemic): Apachi, Gridhrasi, Antravriddhi,
Vishuchika.
According to disease:106


• In the diseases like Arsha, Kadara etc, Agnikarma should
be done after surgical excision (chedan)
• In the diseases like Bhagandara,Nadi vranaetc,
Agnikarma should be done after surgical incision
(bhedan)
According to Akriti:107

Acharya Sushrut have mentioned four types of Agnikarma-


• Valaya: Agnikarma done in the site of the diseases in circular way.
• Bindu: Agnikarma done in the site of the affected part in dot shape
projection with the tip of the Shalaka .
• Vilekha: In this type, Agnikarma done in the affected part by making
different shapes like tiryak (oblique),riju (vertical) and vakra(angular) by
the heated shalaka.
• Pratisarana: In this type, Agnikarma is done by the heated Shalaka in a
scrapping manner.
• Acharya Vagbhata has added three more types of Agnikarma-
• Ardha Chandra: Agnikarma is applied over the affected area with the help
of Shalaka in semi-circular or crescent shape.
• Swastika: Specific shape of Swastik yantra.
• Astapada:. Specific shape containing eight limbs in different directions.
According to Dhatu:108
According to Acharya Sushrut and Vagbhat, Agnikarma
should be done as per involvement of the dhatus such as-
• Twak dagdha 
• Sira and Snayu dagdha
• Mamsa dagdha
• Asthi and Sandhi dagdha

Signs of Agnikarma in Twak dagdha:109

When applied to the skin it produces “cher cher” sound,
Durgandhata and Twak sankocha
 Signs of Mamsa Dagdha: Kapota varnata, Alpaswayathuvedana
(minimal pain and swelling), Sushkasankuchita vranata (ulcer becomes
dry and contracted).
  
Signs of Sira Snayu dagdha: Krishnonnatha vranatha (ulcer appears
elevated and black ), Sravasannirodhascha (blockage of secretions).
 
Signs of Asthi Sandhi Dagdha:
• Karkkashvranatha (wound appears rough), Asthirvranatha
(firmness is lost).
• All these signs represent the features of Samyak Dagdha.
According to four types of dagdha:110
• Plustha dagdha
• Durdagdha

 
• Samyak dagdha
• Atidagdha 
Plusta Dagdha :
This type of dagdha occurs by the improper heating of the Shalaka.
The affected area becomes hyperpigmented along with severe burning
sensation. It is mentioned as “Tuttha Dagdha” by Vagbhat.
Durdagdha:

This type of dagdha appears in the form of vescicles or blisters , with


sucking and burning pain, redness, suppuration i.e exudation or ulceration and
the symptoms remains for a long time.
Samyak Dagdha

This type of Dagdha is neither too deep ( anavagarha vrana) nor too
elevated (susamsthitam vranam), colour of the affected part resembles like the
fruit of palm i.e, talaphalavarna .
Atidagdha

In Atidagdha, there occurs Mamsavalambana i.e loose muscle hanging due

to excessive heat being applied to the skin.
Agnikarma kala :111
Acharyas have mentioned Agnikarma to perform in all ritus except
Sharad (autumn) and Grishma(summer).
 

Due to excessive hot climate in Sharad ritu there is an increase in
pitta dosha and Agnikarma being an ushna chikitsa further aggravates
Pitta leading to various diseases of pitta prakopa.
Acharya Susruta mentioned in case of emergency conditions
Agnikarma can be performed even in any season including sharad and
grishma, but with appropriate precautions and certain measures like
covering the site with moist cloth ,use of cold foods and applying
soothing paste over the site of Agnikarma so that pitta vitiation can be
countered by cold application.
AGNIKARMA VIDHI112
Agnikarma should be performed after the patient is served with


Picchilya anna (slimy diet) and in empty stomach in case of obstructed
foetus, urinary calculus, fistula in ano, enlargement of the abdomen,
haemorrhoids and diseases of mouth and oral cavity.
 
Pre-Procedure Assessment:
• To consider the sign and symptoms of the disease carefully.
• Assessment of the vital points, tolerance of the patient, season ,
for the procedure.
Procedure according to Vaghbhat113
After Agnikarma is done in proper manner, the area of burning should be
applied with a mixture of ghrita and madhu.

Contraindications for Agnikarma:114


The contraindications regarding Agnikarma can be categorized on the basis
of the following:
• Pitta prakriti
• Bhinna kostha
• Durbala
• Briddha
• Antahsonita
• Anudhrita shalya
• Bala
• Bhiru
• Aneka vrana
Also patients who are contraindicated for Swedana:

• Pandu • Atisara


• Kshaya • Guda bhramsa
• Udara roga • Nasta sangya
• Chhardi • Shosita
• Alcoholic • Oja kshaya
• Vidagdha • Raktapitta
• Sthula • Ajirna
• Kruddha • Trishna
• Adhya rogi • Garbhini
• Prameha • Ruksha
• Daurbalya • Shranta
• Visha • Ksudha
• Timira • Kshata
Importance of Agnikarma :113
According to Acharya Sushruta,Agnikarma therapy was considered superior


among other Dahankriyas like Ksharakarma ,etc due to some qualities.These are :-
• Apunarnavaat : it means that the diseases which are treated by Agnikarma
will not occur.That means chances of recurrence is very less.
• Nirjantukarana (sterilization action): Agnikarma has a sterilization or
aseptic effect.
• Curative property: With the help of Agnikarma, diseases are eradicated
from its root.
• Haemostatic action: Agnikarma causes coagulation and closure of bleeding
vessels. Furthermore in Susruta Samhita, four methods of haemostasis are
mentioned i.e. Sandhana, Skandana, Dahana, Pachana among them Dahana
can be considered as Agnikarma.
• Shamana affect on Doshas: Agnikarma shows shaman affect on both Vata
and Kapha doshas.
 
MODERN REVIEW
HISTORY:

The use of cautery has been practiced since primitive period, when

heated stones were used to attain hemostasis. The use of electricity in
medicine began in the 18th century161
Cautery is described in the Hippocratic Corpus . The cautery was
used for almost every possible purpose in ancient times; as a counter
irritant, as a haemostatic, as a bloodless knife, as a means of destroying
tumors etc.
Franz Nagelschmidt in 1897, discovered that patients with
circulatory and articular diseases are treated by applying electric
currents. He then coined the term “diathermy” to describe the heating
effect162
 MODERN PERSPECTIVE

In modern system of medicine,most of the heating methods comes
under the process of Cauterisation. Electrocautery and diathermy are
such types of procedures more commonly being used . Examples are:
• Surgeons and obstreticians uses cautery for haemostasis
frequently.
• Obstretics use cautery in cervical erosion.
• ENT specialists utilizes cautery to treat nasal polyps.
In modern medicine, application of cautery is used in coagulation and
tissue destruction which mimics the Agnikarma therapy.
Diathermy:
Diathermy is a bipolar therapeutic apparatus commonly practiced in
muscle and joint conditions and in most of surgical procedures. It uses a


high frequency electric current to stimulate generation of heat within
body tissues.
Effects:
a)Helps in increasing blood supply in the deeper structures like
muscle.
b)Helps in relieving pain.
c)Improves the mobility of tissues as they heal.
Types of Diathermy
There are mainly three types of Diathermy :-

 Ultrasound or Ultrasonic
 Shortwave and
 Microwave Diathermy
Ultrasonic Diathermy:


• Ultrasonic diathermy produces sound waves for treating
deep tissues , which penetrates a depth of 1-5 cm,
depending on the frequency of electric current used.
• The technique of ultrasound diathermy is passage of
electric current through crystals to cause vibration and
sound waves,and the phenomenon is called Piezo-electric
Effect.
• It is used in musculoskeletal sprains,strains and muscle
spasms.
 Short Wave Diathermy: Shortwave diathermy uses high
frequency electromagnetic energy to generate heat.

• It has a frequency of 107 to 108 Hz .
• The frequency used for therapeutic purpose is of 27, 120,
1000 Hz (27.12MHz) and wavelength of 11.06 m .
 
Microwave Diathermy:
• It is an irradiation of tissue with energy of electromagnetic
waves i.e microwaves (wavelength of 1 -100cm).
• Therapeutically the radiation with wavelength of 12.25 cm
and a frequency of 2450 MHz is frequently used.
Electro Therapy or Electro Cautery
This therapy uses electric current or electric stimulation for
therapeutic purposes.
  
Types : on the basis of frequency used
• High frequency current, used for diathermic or heating
effects.
• Low frequency current used for stimulation of nerve or
muscle.
This electric current produces rise in the temperature in the tissues
which generates heat.
Cauterization


• It is a technique of burning or scarring of the skin or
tissues with a heated instrument or caustic substance
used for therapeutic purposes in order to stop
bleeding or to prevent infection.
• The electric cautery often consists of a short loop of
platinum wire at the end of an insulated handle which
is made red hot by the passage of an electric current.
• This is then applied to the area to cause coagulation
Types:

Galvano cautery

Paquelin’s thermos cautery
Thermo cautery Button cautery
Chemical cautery Potential cautery
Diathermy Cold cautery
Steam cautery Actual cautery
Bipolar cautery/ Surgical cautery Monopolar cautery etc.
 
MODERN REVIEW ON SCIATICA
Definition:

• Sciatica is a health condition characterized by pain  starts from the 


lower back down to the leg and foot . It is caused by impaction of
lumbo-sacral nerve root L4, L5, S1 forming the sciatic nerve and
manifests as unilateral neuropathic pain extending from the gluteal
region down the posterolareral leg to the foot.114.
• Sciatica is a pain emanating from the lower back that is felt along
the distribution of the sciatic nerve in the lower extremity. It
typically occurs as a result of lumbar disc disease and is felt in the
back of the thigh and sometimes the rest of the lower extremity.
(Taber’s Cyclopaedic Medical Dictionary)
Derivation:


The disease “Sciatica” is named because of the
involvement of the sciatic nerve. The Sciatic nerve derives its
name from its relationship to Ischium having been
abbreviated from Ischiatic to Sciatic which means
• Affecting the hip or the sciatic nerve
• Belonging to the ischium or hip115
Borrowed from middle French Sciatique, via late latin
Sciaticus,variant of Ischiadicus from ancient Greek. 116
Synonyms:
Sciatic neuralgia, sciatic neuritis, lumbar radiculopathy, Disc


syndrome, Herniated Disc pulposis.
 
Epidemiology:
A recent review showed that the prevalence of the sciatic
symptoms is rather variable, with the values ranging from 1.6% to
43% in study conducted using Medline, EMBASE and CINAHL
for the years 1980-2006. . If stricter definitions of sciatica were
used, in terms of pain distribution and or pain duration, lower
prevalence rates were reported.117
 Studies in working populations with physically
demanding jobs consistently report higher rates of sciatica

compared to studies in the general population.
The prevalence of Sciatica estimation varies widely
between studies. This may be due to differences in
definitions, methods of data collections and perhaps
population studied.118
A number of factors including gender, body habits like
smoking, parity, age, genetic factors, occupation, and
environmental factors thought to influence the development
of sciatica have been studied.
History of the disease

History reveals that Sciatica and Low back pain are
considered as one of the common anomalies of the
mankind . Authentic findings about the etiology and its
probable better treatments can be found after reviewing
various ancient theories.
History of Evolution of the Concept of Sciatica :
Time period Texts Remark on Sciatica
1000 BC Susruta Samhita Association of vata, vata kapha in the

3000 BC Charak Samhita

 disease.Mentioned the term “ gridhrasi”as like as
the gait of a vulture.
Mentioned different treatment modalities
depending upon Doshas and Dhatus.
2nd Century Adab-al-tabib Considered it as a chronic and poor prognosis
disease.
9 century
th
Ferdos-al-Hekmah by Ali ibn He was the first to believe that sciatica is a
Sahl Rabban al -Tabari condition of pain in the nerve which descends from
hip to digits .
Until 19 Century Al-harooniah treatiseTaqwin
th
Comprehensive explanations about definitions,
al-abdan, Kaholasa al-Hikmah, etiologies, treatments of sciatica .
Exir Azam etc
1736-1822 Domenico Cotugno Associated pain of Sciatica with the irritation of the nerve by
“acrid humors” derived from blood, which was an 1000 year old
concept and was dominant till 19th AD, also differentiated
arthritic pain.


1864 Lasegue Disc diseases including prolapse were recognized but not related
to sciatic nerve until Lasegue’s sign indicate stretching of Sciatic
nerve.
1901 Krause and Herman First successful removal of ruptured disc via laminectomy ,
Oppenheim surgeons thought they had removed an enchondroma.
1927 Vittorio Putti Recognized degenerative changes of intervertebral foramen as a
cause of Sciatic nerve compression.
1929 Dandy Operated for low back and leg pain , finding cartilegenous
fragments lying loose in the spinal canal
1934 Mixter and Barr Found nuclear disc herniation and degenerative changes in disc
of patients suffering from Sciatica
Late 90’s Mixter and Barr, M.A Emergence of concept of non-compressive radiculopathy.
Stafford.etc Role of inflammatory mediators.
Acute application of the nucleus pulposus to dorsal root ganglia
without mechanical compression rapidly increases neuronal
activity in the thalamus.
Anatomy of Sciatic nerve :120
The sciatic nerve is 2cm broad at its origin and is the thickest nerve

in the body, formed from the anterior and posterior division of the
nerve root L4 to S3 and is the major branch of the lumbosacral plexus i.e
from the ventral rami of the fourth lumbar to third sacral spinal nerves.
Distally it branches medially to the Tibial Nerve and laterally to the
Common Peroneal Nerve .
It leaves the pelvic cavity and enters the gluteal region via the
greater sciatic foramen, deep to the lower border of Piriformis muscle,
and descends between the greater trochanter of the Femur and the
ischial tuberosity along the back of the thigh, dividing into the Tibial
and Common Peroneal nerve proximal to the knee.

 Superiorly it goes deep to the Gluteus maximus muscle,resting on the
posterior ischial surface with the nerve to Quadratus femoris between
them;it then crosses posterior to the Obturator externus and the Gemelli,


then on to the Quadratus femoris,separated by it from Obturator internus
and the hip joint ; and accompanied medially by the Posterior Cutaneous
Nerve of Thigh and the Inferior Gluteal Artery .More distally it is behind
the Adductor magnus muscle and is crossed posteriorly by the long head
of the Biceps femoris. It corresponds to a line from just medial to the
midpoint between the Ischial tuberosity and the Greater trochanter to the
apex of the popliteal fossa.
It supplies articular branches to the hip joint, with muscular branches
to biceps femoris, Semitendinosus and Semimembranosus and the ischial
part of the adductor magnus.
Root: L4,L5, S1,S2, S3
Branches:
Tibial nerve- After crossing popliteal fossa, it descends with the
posterior tibial vessels to lie between the heel and the medial malleolus,

planter nerves. 
ending under the flexor retinaculum by dividing into medial and lateral

It corresponds to a line in the midline of the limb, vertical from the

apex of the popliteal fossa, to the level of the fibular neck and thence to a
point midway between the medial malleolus and calcanean tendon.
Common peroneal nerve- After crossing the popliteal fossa, it
descends obliquely along the lateral side of popliteal fossa to the fibular
head. Now it curves lateral to the fibular neck deep into the peroneus
longus and divides into superficial and deep peroneal nerves.It then
supplies medial sides of first toe , second and third toes ,some parts of
fourth and fifth toes, lateral ankle with dorsum . It gives off articular and
cutaneous branches before division.
Functions of Sciatic nerve121

Motor

The motor branch of sciatic nerve stimulates the muscles of the thigh
which include semitendinosus muscle,semimembranosus muscle,short head
and long head of the bicep femoris, adductor magnus.
Tibial branch of the sciatic nerve stimulates the muscles in the lower leg
which include lateral and medial gastrocnemius, soleus, popliteus,etc.

Sensory
The sensory branch of the sciatic nerve control sensation of the entire foot
and most of the leg. The sensory branches includes sural nerve,deep fibular
nerve,superficial fibular nerve and medial calcaneal branches.
ANATOMY OF SPINE:122


The anterior segment of the spine consists of cylindrical vertebral
bodies separated and cushioned by intervertebral discs and held
together by the anterior and posterior longitudinal ligaments.
The intervertebral discs are composed of a gel filled centre called
nucleus pulposus bounded by a tough cartilaginous ring, the annulus
fibrosus. Discs surrounded are accountable for the 25% of the spinal
column length and permit the bony vertebrae to move easily upon each
other.

 The posterior spine consists of the vertebral arches and


processes. Each arch consists of a paired cylindrical pedicles
anteriorly and paired laminae posteriorly. The vertebral arch
also gives rise to two transverse processes laterally, and one
spinous process posteriorly with two superior and two inferior
articular facets. The apposition of the anterior and posterior
facet constitute a facet joint.
Functions: 123


Anterior spine acts as shock absorber in different body
activities, such as walking, running etc and protects contents
of spinal canal.
• Posterior spine protects the spinal cord and nerves
within the spinal canal and provide an anchor for the
attachment of the muscles and ligaments.
• The contraction of the muscles attached to the spinous
and transverse processes and laminae works like a
system of pulleys and lever and leads to flexion,
extension, and lateral bending of the spine.
Etiology: 124

Sciatica is a symptom rather than a specific diagnosis. The


evidences which are available from basic science and clinical
research indicates that both inflammation and compression are
significant for the nerve root to be symptomatic.
Sciatica is mainly diagnosed by history taking and physical
examination.
The two most common etiologies are :


• Compression from degenerative joint disease
• Disc Herniation
In addition to these there are other etiologies of lumbar
radiculopathy which can be classified as below:
• Congenital / developmental
• Intervertebral disc herniation
• Minor trauma
• Fractures
• True sciatic neuritis
Classification of the etiologies of Lumbar Radiculopathy125

Category Conditions
Congenital /
Developmental 
 Spondylolysis and spondylolisthesis
 Kyphoscoliosis
 Spina bifida occulta
Minor trauma  Strain or Sprain
Fractures Traumatic
 History of fall from the height
 Motor vehicle accidents
 Compression fracture
 Ischial or iliac bone fracture
Atraumatic
 Osteoporosis
 Neoplastic infiltration
 Osteomyelitis
 Degenerative
 Narrowing of Intervertebral foramina
 Disc-osteophyte complex
 Internal disc distraction
 Lumbo sacral spine with neurogenic claudication


 Arthritis
 Spondylosis
 Facet or sacroiliac arthropathy
 Neoplasm – metastatic, hematologic, primary bone tumors,
Infection / Inflammation
 Spinal epidural abscess
 Discitis or septic disc
Intervertebral disc herniation
 Gluteal bursitis
 Ischiorectal abscess
 Meningitis
 Pott’s spine
 PID
 Lumbar arachnoiditis
 Autoimmune eg. Ankylosing spondylitis, reactive arthritis
Metabolic
 Osteoporosis – hyperparathyroidism, immobility
 Osteosclerosis eg. Paget’s disease
Vascular
 Abdominal aortic aneuryms
True sciatic neuritis  Post herpetic neuralgia
 Leprosy
 Polyarthritis Nodosa




Injection neuritis
Radiation neuritis
Diabetic neuritis
 Vitamin deficiencies
CLINICAL FEATURES:126

Pain:

Pain is the cardinal symptom. Clinically three types of pain can be
noted as -
• Pain in the back , aching, and escalating on spinal movements.
• Pain deep in the buttock and thigh, aching in character and
inclined by posture.
• Pain radiating to the leg and foot and increased by coughing and
sneezing.
 Tenderness: It is best elicited on applying pressure over the
course of the sciatic nerve i.e. the sciatic notch, middle of the back


of the thigh, popliteal space behind the head of fibula and
external malleolus and in the sole of the foot.
• Numbness and sensory impairment:
Patient experiences numbness , heaviness in the leg mainly
along the outer border of the foot.
• Weakness and atrophy of muscles:
o Muscular hypotonia and slight wasting of all the muscles of
the lower limb.
o Compression of the S1 nerve root may cause weakness of
the small muscles of the foot and the calf muscles or the
great toe.
Table: 19-Common Nerve Root Lesions of the Leg:127
Area Nerve Altered sensation Muscle Reflex Loss of function

L2-L3
Root

L3 Front of lower thigh.


weakness
involvement
Quadriceps Diminished Paraesthesia infront of
midthigh
L3-L4 L4 Front of lower thigh, Quadriceps and Diminished Foot upward (heel walk)
knee and inner aspect tibialis anterior knee jerk
of shin.
L4-L5 L5 Back of thigh, lateral Extensor Diminished Pain and numbness in the
aspect of leg, dorsum Hallucis ankle jerk top of the foot, particularly
of foot and big toe. longus. in the web between the
great toe and the 2nd toe.
L5-S1 S1 Back of leg, lateral Wasting of calf Diminished Difficulty in walking on
aspect of the foot and muscle and ankle jerk tip toes.
sole. plantar flexors
weakness.
CLINICAL DIAGNOSIS:128

Sciatica syndrome or sciatic radiculopathy is mainly diagnosed on the


basis of history and physical examination.
The onset, duration, extent, chronicity and severity of pain, aggravating
and risk factors of sciatica should be considered.
In addition to that a clear history of trauma, infectious disease, personal
history, medical history, and associated illness, family and obstetrics history
also should be noted.

Gait: Typically a limping type of gait while walking can be seen .

Posture:
• The shape of the lumbar spine is altered and the mobility is restricted.
• Spinal mobility is inspected by the ability of forward bending.
• There may be asymmetry in the prominence of the paraspinal muscles,
suggestive of spasm .
Tenderness:
The tender pain triggering points are to be recognized in the back

and limb. There are some clinical tests which can confirm the diagnosis.
These are:-
• Straight Leg Raising Test(SLR) : This test is done with the patient
asked to lie in supine condition and both the legs extended, one leg
is passively flexed at the hip, keeping the knee extended. Normally it
can be lifted upto 90degree. It is restricted in sciatica and also in
meningitis.
• Lasegue’s test: This test is performed once the leg is raised at a
particular level for the SLR test, and the patient gets pain at the level,
the foot is dorsiflexed. If the pain worsens, it is due to sciatica.
LABORATORY INVESTIGATIONS:129

• Complete blood count, ESR, CRP, RA factor to differentiate

insufficiency diseases.

inflammatory or infective origin, autoimmune, renal

• Serum uric acid, serum calcium, alkaline phosphatase

abnormalcy suspected in hyperparathyroidism, malignancy,
osteoporosis, Paget’s disease or metastatic diseases.
• Urine for sugar, albumin and microscopic examination.
• Immunoglobulin electrophoresis is useful in diagnosis of
multiple myeloma, lymphoma and connective tissue disorders.
RADIOLOGICAL INVESTIGATIONS:

•
• 
Plain radiographs
C.T scan
• MRI
• Myelography
• EMG
Differential Diagnosis of Sciatica130
Diseases Features


  It is a spinal condition that affects the lower vertebrae to slip
  forward or anteriorly onto the vertebral body, pedicles and
Spondylolisthesis superior articular facets, leaving the posterior elements behind.
 Persistant low back pain and sometimes pain in the thigh.
 The defect is best visualized in oblique projections by
conventional radiographs, CT scan or MRI.
   Injury or weakness causes the inner part of disc to protrude
  through the outer ring leads to herniation of disc.
   Pain and numbness,commonly on one side of the body.
Disc herniation  .Pain worsens at night or with certain movements like
standing,sitting and walking short distances.
 Significant loss of disc space is seen in radiographs. Contrast
myelograph may outline herniation.
 Diseases Features
   Arthritic spine disease usually presents with the insidious onset
Ankylosing of pain in low back and buttock.
Spondylitis  Pain during night, morning stiffness in the back, pain not

 
subsided by rest, raised ESR and HLA-B27 compatibility.
Sclerosed sacroiliac joints and a ‘bamboo spine’appearance ,
too often kyphotic position.
   Spine shows varying degrees of degenerative changes
   Involvement of one or more roots, neurological signs are less
Spondylosis prominent than that in Disc Prolapse.
 Chronic intermittent spinal pain , recurrent sciatica with
osteoarthritis elsewhere is found.
 Radiograph shows narrowing of disc space with osteophytic
lipping and facet joints irregularity.
 Diseases Features
   Pain is severe and often deep seated , and intolerable in rectum and
  vagina along within the buttocks.
Pyriformis Syndrome 

Electromyography and conduction studies confirm the site of
entrapment.
 Pain relief by injecting local anaesthesia into the piriformis muscle is
said to be diagnostic.
   Abnormal spinal canal narrowing causes restriction to the spinal canal,
  leads to neurological deficit.
Spinal canal stenosis  Severe constant pain persists throughout the day.
 CTscan reveals bony , ligamentous encroachment into the lateral recess
of the central canal or into the root canal.
 Diseases Features

   After multiple lumbar operations and myelograms, backache and sciatica may
Arachnoiditis

  

persists in combination with mild and moderate motor , sensory and reflex
changes .
Patient give history of pain centred in the spine which is increased by
Osteoarthritis movements and is invariably associated with stiffness and restriction of
  movements.
   Pain may be present when there are minimal radiological findings
   conversely, marked overgrowth in osteophytes with spur formation, bridging
Osteoarthritis and ridging of vertebrae can be noted in asymptomatic patients in middle and
lateral life.
 In hip joint arthritis, hip movements are restricted and pain gets aggravated by
passive movements, radiographs are diagnostic.
 Diseases Features
   Pain gets aggravated by activities and subsided by rest.
   There will be frequently muscle spasm and is usually
 
 
Vertebral
 
encountered with acute disc lesion .
There will be Pyrexia,weight loss and anorexia along with
spinal infection.
Osteomyelitis  Radiological findings shows destruction of disc end plate by
proteolytic enzymes of the pyogenic bacteria which spreads to
adjoining vertebra.
 There will be invariably raised ESR.
   It may be due to encroachment on the canal or foramen leads
  to compression of the spinal cord or roots.
   Enlargement of vertebral body may cause stenosis.
Paget’s disease  Laboratory findings shows increased level of serum alkaline
phosphatase , but serum calcium is usually normal.
 Diseases Features
  There will be referred pain from the sacroiliac joint which may radiate to
  the buttocks, posterior thigh and groin and occasionally to the lateral calf

 
 
Sacroilitis and ankle.

 Usually found in children with low grade fever, back ache or
abdominal pain, hip joint pain and the child refuses to walk or stand.
 Discitis  Increased WBC and elevated ESR.
 Radiological features shows disc space narrowing and irregularities of
the end plate lag behind the clinical symptoms.
   A detail history taking and abdominal examination may direct attention
Referred pain away from spine to the source of pain anywhere in viscera.
 Raised ESR may be found.
   Unrelenting, intense, progressive nature of pain is the distinguishing
  feature.
Metastatic cause  Person looks anxious, fatigued and often desperate for relief.
 Needle biopsy of spine under fluoroscopic control is the most direct
route for diagnosis.
TREATMENT131


In each and every disease it is necessary to treat quickly.
Generally patient hopes that pain will go away and get better
by itself. In caseof Sciatica also people bear pain till it becomes
worst.There will be long term nerve damage for this delay.
The line of treatment of sciatica is included under two
categories :-
• Conservative
• Surgical
Conservative treatment includes following :-
Bed rest
The first line of conservative treatment is bed rest and avoidance of active
movements.
Use of Analgesics

Patients are adviced to use different types of analgesics and NSAIDs such as
Aspirin,Ibuprofen,Piroxicam,etc in the initial phase of treatment.Muscle
relaxants and anti-depressants may be required for pain relief.

Intramuscular steroid injection

Intramuscular corticosteroid steroid injections are used which reduces
inflammation of the nerve root .

Physiotherapy
Active and passive physiotherapy are generally adviced,which includes flexion
and extension exercises depending upon the increase or decrease of pain.
Epidural steroids
A long-acting steroid is injected into the epidural space in the
treatment of lumbar nerve root pain, on the basis of reducing nerve root
inflammation.

SURGICAL TREATMENT:132


Absolute indications of surgery :
• Cauda equina syndrome
• Progressive neurological deficit
Relative indications of surgery:
• Failure of conservative surgery
• Recurrent neurological deficit
• Significant neurological deficit with significant SLR
reduction.
DIFFERENT SURGICAL MODALITIES:

• Laminectomy 
• Hemilaminectomy
• Fenestration surgery
• Chemonucleolylis
• Microscopic lumbar discectomy

Recent new techniques like Radiofrequency Discal procedures

like Nucleoplasty,Intradiscal Biacuplasty(IDB),etc. are
practiced.
 
DRUG REVIEW
 The term drug is thought to originate from the old French
word “Drogue” i.e medicinal plants preserved as dry matter in


barrel (Harper,Douglas etymology dictionary)
A drug is defined as any substance intended for use in the
diagnosis,cure,mitigation,treatment or prevention of disease in
human or other animals (By federal law)
According to the Amarkosha, synonyms of drug are
Ausadham, Bhesajam, Bhaisajyam etc
Drug rightly occupies the second position in the chikitsa
chatuspada since it plays a pivotal role in achieving success against
diseases. Acharya Charaka has stressed upon the knowledge of
therapeutic drug by considering it among the “trisutra” i.e Hetu,
Linga, Aushadh in Ayurveda. (Ch.Su.1/24)
Acc. to Acharya Vagbhat ,


“bahukalpam bahugunam sampannam yogyam ausadham”
(A.H .Su. 1/28)

The drug should be suitable for many preparations, should

possess many useful properties, endowed with virtues and
suitable to be used in varied conditions in different diseases and
in different types of patients.  
AJAMODADI CHURNA170


This is a polyherbal classical formulation which consists of 12
dravyas (drugs) as ingredients used in the management of
Gridhrasi and other Vata vyadhis like Aamvat,sadhivata, etc.. The
ingredients are as follows :-
• Ajamoda or Carum roxburghianum
• Vidanga or Embelia ribes
• Pippali or Piper longum
• Devdaru or Cedrus deodara
• Chitraka or Plumbago zeylanica
•
• 
Pipalimula or Piper longum root
Haritaki or Terminalia chebula
• Saindhava Lavana or Rock salt
• Maricha or Piper nigrum
• Satapushpa or Anethum graveolens
• Vriddhadaruka or Argyreia nervosa
• Sunthi or Zingiber officinale
 AJAMODA171
“Ajam modayati harshayati va Ajamoda Iva Ajamodika.”

•

Botanical Name :- Carum roxburghianum
• Family :- Umbelliferae
• English name :- Celery, Ajowan
• Hindi name :- Ajamoda, Ajamotha
• Bengali name :- Randhuni
• Local name :- Ajowan
• Sanskrit synonym:- Vastamoda, Kharaswa, Lochakarkata,
Vallimoda, Agni, Jimutaka, Agniskha
Medicinal qualities :-
• Guna - Laghu, Ruksha, Teekshna
• Rasa - Katu, Tikta
• Vipak – Katu
• Veerya – Ushna 
• Effect on Tridosha - Kapha –Vatahara

Classification on categories :-
• A/ Charak Samhita – Shulaprasamana, Dipaniya
• A/ Sushrut & Vagbhat – Pippalyadi group of dravyas
• A/ Bhavprakash Nighantu – Haritakyadi varga
• A/ Kayadev Nighantu – Ausadhi varga
• A/ Dhanwantari Nighantu – Satapushpadi varga
• A/ Raj Nighantu – Pippalyadi varga
Medicinal Properties :-


• Ajamoda is Vasti roga ruja paha (cleanses urinary
bladder and relieves bladder pain).
• Dipani ( Improves digestion strength )
• Vidahini (may cause burning sensation)
• Hridya ( good for heart,cardiac tonic)
• Vrishya ( Natural aphrodisiac)
• Balakari ( Improves strength)
Therapeutic Uses:


Netramaya (Eyedisorder), Krimi (worm infestation),
Chardi (vomiting), Hikka (Hiccough), Adhman (Blotting),
Aruchi (Anorexia).

Part used:- Fruits

Dose:- 1-3 gms per day
Contraindication;- Pregnancy as it causes uterine
contraction.
Morphology:
Ajamoda is an erect, annual herb growing upto 2-3 feet tall.
Leaves are pinnate to bipinnate. Flowers are small,creamy-white

occur in dense compound umbels. Seeds are broad,ovoid to
globose.

Distribution: Cultivated in Europe, America and Asian countries.

Phytochemical constituents: Ajamoda contains Glycosides,

Steroids and different types of phenolic including Furano
coumarins, Flavones and trace elements such as sodium,
potassium, calcium and Iron.
2) HARITAKI172
“Haritaki pathyanam”;

“Harate sarva roganam cha tatah prokta haritaki”

• Botanical name:- Terminalia Chebula

• Family :- Combretaceae
• Hindi name :- Harad, Harra
• English name :- Chebulic myrobalan
• Bengali name :- Haritaki
• Assamese name :- Xilikha
Medicinal properties :-
• Rasa- Lavan varjita Pancha Rasa


• Guna- Laghu, Ruksha
• Vipak- Madhur
• Veerya- Ushna

• Effect on Tridosha:- Haritaki balances tridoshas (vata,pitta

and kapha); Madhu,Tikta,Kashaya- balances pitta; Katu,Tikta ,
Kashaya-balances kapha; Amla-balances vata

• Action:- Varnya, Medhya, Lekhan, Sothanuth, Deepan,

Pachan, Chakshusya, Rasayan, Ayushya.
Part used :- Fruit
Dose :- 1-3 gms of Fruit powder.

Medicinal uses:- used in Kustha, Gulma, Udavarta, Sotha, Pandu,
Arsha, Shiroroga, Atisar, Arochaka, Prameha, Anaha.
Morphology:- Medium size deciduous tree growing upto 30 m in
height. Leaves are alternate, sub-opposite, oblong-ovate with an
acute tip, cordate at the base. Fruits are drupe like, Glabrous,
smooth, yellow to orange-brown in colour with five longitudinal
ridges. Flowers are monoecious, dull, whitish yellow in colour
with strong, unpleasant odour. Seeds are globose, pale yellow in
colour.
Distribution :- Found throughout south and south-east Asia


including India, Bhutan, Nepal, Srilanka,etc.

Chemical constituents :-It contains Chebulagic acid,

chebulic acid, tannic acid,galic acid, ethylgalate, ellagic acid,
chebulinic acid, chebulinin, 2,4-chebulyl Beta-D-glucose and
glucose esterified with galic acid to various degrees.
3) PIPPALI173


“Piparti palayati purusham purayati cha kshinan dhatuniti”

• Botanical name :- Piper longum (Lin)

• Family :- Piperaceae
• Hindi name :- Pipli
• English name :- Long pepper
• Bengali name :- Pipal,Pipul
• Assamese name :- Pipali, Paan-Pipali
• Sanskrit synonym :- Kana, Vaidehi, Magadhi, Krishna
Medicinal Properties :-
• Rasa – Katu
• Guna – Laghu,Tikshna
• Vipak - Madhur 
• Veerya – Ushna
• Effect on Tridosha ;- Balances Vata and Kapha
dosha
Parts used ;- Fruit ,Root
Dose :- 0.5 to 1 gm in single or multiple dose/day
Medicinal uses :-
Used in Pleeha roga,Obesity, Asthma, Anaemia,
Tuberculosis, Rheumatoid arthritis .
Morphology: Slender climber , Leaves are ovate, acute at apex,


chordate and strongly oblique at base, 7-nerved, membranous,
shining, darkgreen above, pale and dull beneath. Male and female
flowers are distinct, densely arranged and thickly cylindrical,
pubiscent rachis. Fruit is long and fleshy, red in colour when ripe
and turns black when dried.

Chemical constituents:- Essential oil, Mono and sesquiterpenes,

Caryophyllene, Piperine, Piper longumine, Piper nolanine,etc.
4) VIDARA / VRIDDHADARUKA174


“Vriddhadaruka mulani slakshna churnanai karayet”

• Botanical name :- Argyreia nervosa

• Family :- Convolvulaceae
• English name :- Elephant creeper
• Hindi name :- Ghaavpattaa
• Bengali name :- Bijataadaka
• Sanskrit synonym :- Vriddhadaru, Antahakotarapushpi
• Assamese name :- Vriddhi lata
Medicinal properties :-
• Rasa – Kashaya , katu, tikta

• Guna – Laghu,snigdha
• Veerya – Ushna
• Vipak – Madhur

Effect on Tridosha :- It pacifies Kapha and vata dosha in

the body.

Parts used :- Root, Seeds, Leaves

Dose :- 3-6 gms
Action:

Balya, Agnikara, Kanthya, Medhya, Rasayana, Svarya,
Vrishya, Vishaghna, Aamvatahara, Arshohara, Sothahara,
Ayushkara, Krantikara

Therapeutic Uses :
Shula, Shopha, Apasmara, Aruchi, Aamvata, Gulma,
Vataruja, Anaha, Udavarta, Udara, Vatarakta.
5) PIPPALIMULA

•
•

Botanical name :- Piper longum root
Family :- Piperaceae
• Hindi name :- Pipala, Pippalki mool
• English name :- Root of Long pepper
• Bengali name :- Pipalmool,Pipulmool
• Sanskrit name :- Chavikashira, Kanamula ,
Katugranthi , Sarvagranthika
Medicinal Properties:-
Rasa- Katu; Guna- Laghu, Ruksha; Vipaka – Katu;
Veerya- Ushna 
Effect on Tridosha :-Balances Kapha and Vata dosha
Part used:- Root
Dose:- 0.5 to 1 gm in divided dose per day.
Benefits:-
Sleshma sanghata nashana, Krumihara, Deepana,
Pachana, Udarahara, Anahahara , Gulmahara, Shwasahara,
Vatahara, Rochana
Morphology:-


Glabrous perennial under-shrub with erect or sub-
scandent nodose stem and slender branches.Leaves are
simple, alternate, stipulate and petiolate or nearly sessile.
Lower ones broadly ovate, cordate, upper ones oblong,
ovate, all entire, smooth, thin with reticulate venation; veins
raised beneath.It flowers nearly throughout the year.
Inflorescence is spike with unisexual small achlamydous
densely packed flowers and form very close clusters of small
grayish green or darker grey berries.
Distribution:-

A number of geographical varities are available in
different agroclimatic regions of India, the most popular
being Assam, West Bengal and Nepal varieties.

Chemical Constituents: Essential oil, Piperine, B-

sitosterol, Cepharadiones, etc.
6) CHITRAKA175

“Chitrakah chitravyagrah”

• Botanical name :- Plumbago Zeylanica
• Family :- Plumbaginaceae
• Hindi name :- Chitra, Chitavur
• English name :- Leadwort
• Bengali name :- Chitachitu
• Sankrit synonym :- Anala, Dahana , Pithi, Vahanisajnaka,
Agni
Medicinal properties:-
• Rasa – katu; Guna- Laghu, Tikshna, Ruksha; Veerya- Ushna; Vipak
– Katu


• Effect on Tridosha: Because of its hotness, it balances vata and
kapha dosha.
• Part used:- Root, Bark
• Dose;- Powder 1-2 gm in divided dose per day

Benefits:-
• Vahanikrut, Pachana, Laghu, Grahanihara, Kusthahara, Sothahara

Uses :-
• Used in the treatment of Amenorrhoea, Hepatomegaly,
Splenomegaly.
• Red variety of Chitraka improves appetite, it helps to gain weight.
Morphology:
Perennial herb with glabrous, climbing , erect stem. The leaves

are petiolate or sessile.Leaves are thin, ovate ,entire glabrous with
length upto 4 cm. Petiole is narrow.Flowers have white corollas
17-33 mm in diameter, have elongated spikes.

Distribution :- Found throughout India.

Chemical constituents: Chitranone, Plumbagin, 3-

chloroplumbagin.
7) SHATAPUSHPA176


“Shatapushpa laghustikshna pittakridipani katu”

• Botanical name :- Anethum Graveolans

• Family :- Apiaceae
• Hindi name :- Soyo
• English name :- Dill
• Bengali name :- Saluka
• Sanskrit synonym :- Shatahva, Shatapuspa, Chatra
Medicinal properties :-
• Rasa – Katu, Tikta


• Guna – Laghu , Tikshna
• Veerya – Ushna
• Vipak- Katu
Effect on Tridosha:- It balances vata and kapha dosha and
increases pitta dosha.
Parts used:- Fruits, Essential oil
Dose :-
• Powder 2-4 gm/day with plain water after meal.
• Dill seed oil 1-3 drops.
Benefits :-
Dipani, Jwar, Vrana, Shula, Akshiroga, Vastikarma.


• Morphology:- This herb grows annually upto 40-60 cm, the
stems are clad with lacy , delicate,aromatic leavesof blue-green
colour. These leaves are floosy type divided into fine pinnate
structure. Seeds are flat, small and very light. Fruits are oval
shape. Stalk carries heavy flower cluster.
• Distribution :- It is the native of Asia and Mediterranean. Also
found in parts of Europe and America.
• Chemical constituents :- Fruit contains essential oil having
major compounds like Carvone, Limonene, a-phellandrene.
8) DEVDARU177


“Devanam daru iti darunam va deva iti”

• Botanical name :- Cedrus deodara

• Family :- Pinaceae
• English name :- Himalayan cedar
• Hindi name :- Devadara, Devdara
• Bengali name:-Beyar
• Sanskrit synonym :- Indradaru , Devakashta, Bhadradaru
Medicinal properties :-
• Rasa – Tikta, Kashaya
• Guna – Ruksha,Laghu
• Vipaka – Katu
• Veerya – Ushna

Effect on Tridosha :- Balances Kapha and Vata dosha.
Part used :- Deodar Bark,Himalayan cedar oil,Leaves, Resin
Dose :-
• Bark powder 1-5 gm
• Kashaya – Decoction 50-100 ml in divided doses per
day
• Oil – 30 to 40 drops.
Benefits :-
Dushtavrana shodhana ; Krumihara ; Kusthahara ; Anilahara ;
Kasahara ; Amahara ; Shwasahara


Morphology :-
Large evergreen, dioecious tree; bark grayish brown , dark, almost
black,with vertical and diagnonal cracks dividing into irregular oblong
scales; leaves solitary, acicular, stiff, sharp pointed, 25-37 mm long. Male
flowers solitary and erect, pale green to yellowish green with purplish
tinge, oblong, ovoid. Female flowers are solitary and erect at the end of
arrested branchlets ; flowers, at the time of pollination are oblong, ovoid,
pale glaucous green .
Distribution:- Found in North-west Himalayas from Kashmir to
Mussorie .
Chemical constituents:- Essential oil from wood; P–
methylacetophenon ,atlantone, Toxifilin.
9) MARICH178


“Mriyante jantavoaneneti jantughna ityartha”

• Botanical name :- Piper nigrum Linn

• Family name :- Piperaceae
• Hindi name :- Kalimirch
• English name :- Black Pepper , Common pepper
• Bengali name :- Golmarich
• Assamese name :- Jaluk
Medicinal properties :-
• Rasa – Katu 
• Guna- Laghu , Tikshna , Sukshma
• Virya - Ushna
• Vipaka – Katu

Effect on Tridosha :- Balances Kapha and Vata

Morphology:- Black pepper is tropical climbing perennial,
flowering vive. The stem is cylindrical , dichotomously

branched much thickened at nodes. Leaves are simple ,
alternate, ovate-oval , nearly orbicular, rounded or more or
less cordate at base and oblique, acuminate, acute ,
coriaceous , glabrous , petioles long and stout. Flowers are
bisexual, sessile in axils of fleshybracts with 2 lateral
bracelets arranged in leaf opposed spikes 5 cm long , slender
, bracts oblong , very obtuse , perianth absent ; stamens 2,
anther 2-celled .
Distribution: It is cultivated in humid tropical parts i.e. hills of
South-western India and also in Assam, Karnataka, Maharashtra and

Kerala. It is also cultivated in Srilanka, Malaysia and Indonesia .

Uses :-
• Used in flatulence , gas , bloating and indigestion.
• Used as good stimulator of appetite.
• It provides relief from pain.
• It also has a good hypotensive agent that lowers the blood
pressure .
• Having antiparasitic property which provides protection to
body.
10) SAINDHAV LAVAN

•
•

English name :- Rock salt or Himalayan rock salt
Hindi name :- Saindha namak
• Bengali name :- Saindhav lavan
• Assamese name :- Kala nimak
• Sanskrit synonym:- Sheetashiva, Sinhuja, Naadeya, Manimantha.
• It is available in the mines of Punjab. It is of two varieties- Shweta
saindhav and Rakta saindhav.
Medicinal properties :-
• Rasa – Lavan,slightly madhur
• Guna – Laghu , Snigdha
• Veerya – Sheeta
Effect on Tridosha :-

• Balances pitta due to its sheeta veerya .
• Balances Vata due to the lavan rasa.
• Helps to relieve chest congestion due to sputum accumulation
because it also relieves kapha .

Uses of Saindhav Lavan :-

Rochan, Deepan, Vrishya ,Chaksushya , Avidahi , Hriddya ,
Hikkanash.
11) VIDANGA178
“Vidati bhinnati kriminiti”

• 
Botanical name :- Embelia ribes
• Family :- Myrsinaceae
• English name :- False black pepper
• Hindi name :- Vaividang
• Bengali name :- Vidang, Biranga
• Sanskrit synonym :- Jantuhantri , Chitratandula ,
Amogha
Medicinal properties :-
• Rasa – Kashaya, Katu
• Guna – Laghu , Ruksha, Tikshna
•
•
Veerya – Ushna
Vipaka- Katu

Effect on Tridosha :- Balances Vata and Kapha dosha.
Part used :- Fruits , Root
Dose :- Powder 3-5 gms; Decoction 3-15 ml
Benefits:- Krumihara, Krumikustha ( useful in infective skin
diseases), Pramehahara, Shirorogahara, Vahnikara, Shulahara
(relieves abdominal coliky pain)
Uses :-
• Vidanga is used in all types of worm infestations.
•
•
Rasayan
Rakta sodhak

• Arshohara
• Used to treat Unmad
• Used for various dental ailments
• Used to treat snake bite poisoning
• Used to cure chronic cough.
Morphology:- Embelia ribes is woody creeper shrub with brittle
and flexible stem. Leaves are simple, alternate , ovoid and sharp at


both the ends. Length of Leaves is 3 inch long and 1.5 inch broad.
Flowers are small, white in colour and have small petioles 3 to 4
inch in length. Fruits are small just like black pepper, reddish
brown to black in colour. Fruits are found in bunches. Outer
covering of fruit is fragile and from inside seeds are spotted.
Distribution :- It is found in the hilly areas of India like Lower and
central Himalayas down to Konkan, Deccan, Western Ghats and
South India.
Chemical constituents:- Embelin, Christembine, Vilangine,
Quercitol .
12) SUNTHI179
“Shunthati hanta kapham vatascheti shunthati soshayeti”

• 
Botanical name :- Zingiber Officinale
• Family :- Zingiberaceae / Scitamineae
• English name :- Dry Ginger
• Hindi name :- Saunth , Sunth
• Bengali name :- Shunti
• Assamese name :- Ada
• Sanskrit synonym: Shunti, Mahausadha, Vishwa Bhesaja,
Nagara
Medicinal properties :-
• Rasa – Katu
• Guna – Guru, Ruksha , Tikshna
• Veerya - Ushna
• Vipak – Madhur 
Effect on Tridosha :- It balances Kapha dosha
Part used :- Rhizome
Dose:- Fresh juice – 5-10 ml; powder – 1-2 gm; syp – 2-5 ml in divided
doses.
Benefits:- Dry Ginger is unctuous , promotes digestion, Vrushya ,
Rochana , Hrudya, Deepana, Shophana, Shwasahara, Sleepada.
Chemical constituents :- a- curumene , D- camphene , a- &b-
Zingiberenes, Zingiberol, Ginner glycolipids A, Gingerdiol,etc.
METHOD OF PREPARATION OF AJAMODADI CHURNA
The churna was prepared according to the method given in
Ayurvedic texts.
INGREDIENT
Ajamoda Fruit

PART USED QUANTITY
1 part or 12 gm
Vidanga Fruit 1 part or 12 gm
Saindhav Lavan Salt 1 part or 12 gm
Devdaru Wood 1 part or 12 gm
Chitraka Bark 1 part or 12 gm
Pippali Fruit 1 part or 12 gm
Shatapushpa Fruit 1 part or 12 gm
Pippalimoola Stem 1 part or 12 gm
Maricha Fruit 1 part or 12 gm
Haritaki Fruit 5 parts or 60 gm
Vrddhadaruka Root 10 parts or 120 gm
Sunthi Rhizome 10 parts or 120 gm
PROCEDURE

• All the ingredients were purchased and collected from a local shop at Fancy
Bazar,Guwahati .

• All the ingredients of the Ajamodadi churna were clearly understood and
identified.
• The ingredients were authenticated in the State Ayurveda Pharmacy,
Guwahati,Assam.
• All the above 12 ingredients were thoroughly washed and cleaned.
• After drying in proper sunlight for few days, all the ingredients were cut into
proper size as required.
• After cutting, ingredients were taken in fixed quantity separately in a Grinding
machine and grind till a fine powder was formed .
• The ingredients in powdered form were then passed through a 80 – mesh sieve and
each one of them was powdered and weighed separately and then mixed together
in a suitable quantity or proportion to yield a uniformly blended churna.
• The churna should be stored in airtight container in a dry place ,but for this
research work, it was packed in small packets.

Dose:
For Adults the dose of Ajamodadi churna is 1-3 gms along with
lukewarm water twice daily after food and for children it is 500 mg – 1gm.
Adverse effects:-

• In very higher doses, Ajamodadi churna may cause gastric
irritation.
• People with high blood pressure need to exercise caution while
taking Ajamodadi churna.

Contraindication:-
• Ajamodadi churna is best avoided during Pregnancy due to the
presence of Chitraka which has very high potency and results in
uterine contraction and bleeding also.
• Can be used during Lactation period.
Indications of Ajamodadi churna


Other than Gridhrasi, Ajamodadi churna is indicated in
various diseases as mentioned in Ancient texts.
According to Sarangadhar samhita180, Ajamodadi churna is
useful in the treatment of -
• Aamvata (Rhematoid Arthritis)
• Sandhi pida ( pain & inflammation of joints )
• Pain in Kati pristha Guda Jangha
• Tuni Pratuni Viswachi (neck and back pain associated
with spondylosis) .
According to Chakradatta , Ajamodadi churna is indicated in the treatment
of-
• Swara bheda181 (Hoarseness of voice)
• Viswachi
• Pratuni 
• Hridhroga (cardiac diseases)
• Severe pain in Kati,vasti,Guda,Asthi,Jangha
• Pain and inflammation of Joints182
According to Yogaratnakara183, Ajamodadi churna is mentioned in the
treatment of Sandhivata (Osteoarthritis) and Aamvata.
According to Bhisajya Ratnavali, Ajamodadi churna is beneficial in the
treatment of Swara bheda184 (Hoarseness of voice) and different types of
Prameha roga like Pistameha and Ojomeha185.
According to Harit Samhita185, Ajamodadi churna is useful in the
treatment of Aamvata.
TRIPHALA KWATH

Since thousands of years, Triphala has been used as an Ayurvedic


medicine for a number of chronic diseases. This is a formulation
having three fruits mixed in equal parts. They are:
• Amalakhi or Emblica officinalis.
• Haritaki or Terminalia chebula
• Vibhitaki or Terminalia bellerica

Active Constituents of Triphala:

Bioflavonoids, high vitamin C, chebulinic acid, gallic
acid,sitosterol, linoleic oil and phospholipids.
Medicinal properties of Triphala186
As a natural colon cleanser:


Helps in elimination of waste and toxic materials from the body.
Helps in absorbtion of sodium and water thereby
maintaining the electrolyte imbalance.
Used as a laxative which helps in alleviating various
diseases like constipation, digestive problems and stress.
 
As a natural bulk laxative:
A suitable laxative which has no irritating and other
undesirable affect.
It causes no dependency.
Beneficial for eyesight:
• Improves eyesight.
• Prevents cataract.
Beneficial in Hypertension:

• It normalizes blood circulation.
• Reduces cholesterol and helps to prevent atherosclerosis in
arteries.
Anti-inflammatory and pain relieving:
• Due to both the properties it helps reducing oedema.
Improves digestion, increases appetite.
Increases number of RBCs in blood
Helps to maintain blood sugar level.
Helps in improving skin tone and clearing complexion.
 YASTIMADHU (Glycyrrhiza glabra)187

“Yastimadhukasya medhyani chaitani rasayanani”

Family :- Fabaceae 
Sanskrit: Yashtimadhu, Madhuka.
English: Liquorice root
Bengali: Jastimadhu
Hindi name: Mulethi, mulathi .
Assamese name:jastimadhu
Medicinal Qualities :-
Rasa – Madhura ; Guna- Guru, Snigdha ;Vipaka – Madhura;
Veerya- Sheeta
Action on Tridosha :- Vata- Pittahara
MADHUSARPI
While considering management of Samyak dagdha vrana in


Ayurvedic Texts we find that Acharya Sushruta has described
application of a mixture prepared by Madhu and Sarpi (Ghrita)187 over
the twaka vrana ( burn wound ) to get relief from burning sensation .
 
Ghrita: Acharya Sushruta has mentioned Ghrita as Kantivardhak (i.e
improving skin lustre), and Rakshoghna i.e. having anti-microbial
activity. It is also Madhur in vipak, vata and pitta shamak in nature. (Su.
Su.25/96-97).
Vagbhata has also described Ghrita as Vrana Shodana and Ropana.188
Madhu:
The varnya property of Madhu helps in Savarnikaranam(Improves
skin Lustre) . Madhu acts as, Lekhana (Debridement), Shodhan (Purifying),

and Ropan (Healing). Madhu is Kaphagna, Picchila (Sticky), and Madhura
and kashaya in taste . All these properties help in vrana sodhana.
(Su.Su.25/132)
Vagbhat has described madhu as Vranashodhana, Sandhan and Ropana
.189.
 ALOE VERA / GHRITAKUMARI
Chemical composition and properties of Aloe vera193


Constituents Number and Identification Properties and activity
Amino acids Provides 20 of the 22 required amino acids and 7 of the 8 Basic building blocks of proteins in the
essential ones. body and tissue muscles.
Anthraquinones Provides Aloe emodin, Aloetic acid,alovin,anthracine Analgesic, antibacterial
Enzymes Anthranol, barbaloin, smodin, ester of cinnamonic Antifungal and antiviral activity
acid,resistannol
Hormones Auxins and Gibberllins Wound healing and anti-inflammatory
Minerals Calcium,chromium,copper,iron,manganese, Essential for good health
potassium,sodium and zinc
Salicylic acid Aspirin like compounds Analgesic
Saponins Glycosides Cleansing and antiseptic
Steroids Cholesterol, campesterol,sistosterol, lupeol Antiseptic and anti-inflammatory
  properties
Sugars Monosaccharides, Glucose and Fructose polysaccharides: Antiviral,immune modulating activity
Glucomannans/polymannose
Vitamins A,B,C,E,choline,B12,Folic acid Antioxidant(A,C,E),neutalises free radicals.
Therapeutic Uses of Aloevera194
Wound Healing: Researchers have found that the wound healing
property of Aloe vera gel has been attributed to Mannose-6-

phosphate.Glucomannan and Gibberllin a plant growth hormone
interacts with growth factor receptors of fibroblast and stimulates its
activity and proliferation which increases collagen synthesis after topical
and oral administration of Aloe vera and further increases wound
contraction and improving breaking strength.
Moisturizing effect: The moisturizing effects have been observed in
the treatment of dry skin. Muco-polysaccharides helps in binding
moisture into the skin. Aloe vera gives soothing effect and acts as
moisturizing agent which helps in keeping the skin moist in harsh and
dry weather. Aloe vera is used in cosmetic industry as a good skin tonic.
Anti-inflammatory Action: Aloe vera inhibits the cyclooxygenase
pathway and reduces prostaglandin E2 production from

arachidonic acid. A novel anti-inflammatory compound called C-
glucosyl chromone was isolated from the extracts of aloevera gel.
The aloe sterol includes campesterol, lupeol and cholesterol which
helps in reducing the inflammation and pain.
 
Antiseptic Effects: The antiseptic property of Aloe vera is due to
presence of six antiseptic agents namely lupeol, salicylic acid, urea
nitrogen, cinnamonic acid, phenols and sulphur. These
compounds have inhibitory action on fungi, bacteria and viruses.
PANCHADHATU SHALAKA 195

It is composed of :


• Tamra (Copper) – 40 %
• Loha (Iron)– 30 %
• Yashada (Zinc) – 10 %
• Rajata (Silver) - 10 %
• Vanga (Tin) – 10 %
Panchaloha Shalaka is not mentioned in the classics; but it has been
developed over time by considering various experimental results until
the above mentioned constitution was arrived upon.
The Panchaloha Shalaka retains heat for a longer period and is easy to
handle. Also, it is an effective tool for carrying out moderate degree of
tissue destruction as compared to other Dahanaupkarnas.
Analytical Study of Ajamodadi churna
The Phyto-chemical analysis and TLC reports were studied in the
Drug Testing Laboratory (DTL). The following results are shown below
as :-
1.
SL NO. NAME OF TEST

OBSERVATION

Physical Evaluation
Net weight
 
270 gm
 
Type of sample Dried powder
PHARMACOGNOSTIC EVALUATION
2. Organoleptic Evaluation Colour Brown
Odor Acromatic
3. Microscopic Evaluation Powdered Microscopy shows presence of xylem
vessel,spiral vessel,vascular bundle,etc.
4. Thin Layer Chromatography TLC of ethanolic extract was carried out as per
references. Four major spots were identified(UV
short wave)& Rf value determined.
5. Phyto-chemical Screening Test for Alkaloids Present
  Test for steroids Absent
Test for Glycosides Present
    Test for Flavanoids Present
Test for fats & oils Present
Test for Tannins Present
 CHEMICAL EVALUATION


6. Physico-Chemical Evaluation Moisture content 6.56%
Total Ash 7.67%
Acid Insoluble Ash 0.68%
Alcohol Soluble Extractive 9.22%

Water Soluble Extractive 16.23%

PH(10%w/v) 5.5
 
Thank You