|
 
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| CASE REPORT |
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| Year : 2018 | Volume
: 38
| Issue : 1 | Page : 12-19 |
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Role of śodhana śamana and bṛṃhaṇa basti in the Management of gṛdhrasī
Adil Rais1, Sangeeta R Tanwar2, Anup B Thakar3
1 Ayurveda Medical Officer, Sultanpur, Uttar Pradesh, India
2 Department of Panchakarma, SKS Ayurvedic Medical College and Hospital, Mathura, Uttar Pradesh, India
3 Director, ITRA, GAU, IPGT&RA, Jamnagar, Gujarat, India
| Date of Submission | 24-Oct-2016 |
| Date of Decision | 01-Mar-2017 |
| Date of Acceptance | 17-Jan-2022 |
| Date of Web Publication | 08-Oct-2022 |
Correspondence Address:
Dr. Adil Rais
293/28, Old Haiderganj, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/asl.ASL_213_16
gṛdhrasī is a common disorder explained in the context of vāta vyādhi in Ayurveda which greatly interferes with the quality of life. The symptoms of Gṛdhrasī simulate with sciatica. Sciatica is one of the most common causes of pain and disability. The treatment available in modern medicine for sciatica is either conservative such as rest, immobilization, analgesics, anti-inflammatory, or surgical which is not much satisfactory. Here, a case of 58-year-old female complaining of low backache radiating to the left lower limb along with numbness in the distal portion of the left leg and inability to walk without support, is reported. basti cikitsā (medicated enema) is the prime treatment modality among the pañcakarma (five main purifcation procedures) for vāta doṣa and śodhana therapy has already been established being better than śamana, a specific śodhana (purificatory), śamana (palliative) and bṛṃhaṇa (nourishing the tissues and producing anabolic effects) basti was planned in this particular case. The case under the study showed remarkable improvement in almost all the subjective and objective parameters within a span of 8 days of basti and after the follow-up of 1 month. śodhana, śamana, and bṛṃhaṇa Basti were satisfactory on subjective, objective as well as radiographic parameters and can be applied on cases of sciatica after consideration of the doṣas involved.
Keywords: bṛṃhaṇa basti, gṛdhrasī, śamana basti, Sciatica, śodhana basti
How to cite this article:
Rais A, Tanwar SR, Thakar AB. Role of śodhana śamana and bṛṃhaṇa basti in the Management of gṛdhrasī. Ancient Sci Life 2018;38:12-9 |
| Introduction | |  |
Vāta vyādhi is one of the most common disorders in current clinical practice and gṛdhrasī is one among them. There are two clinical presentations as kevalavāta and kaphavāta.[1] kevalvāta gṛdhrasī is characterized by ruk (pain), toda (pricking sensation), stambha (stiffness), muhu spandana (twitching) in the sphik (gluteal part), kaṭi (Low back), pṛṣṭha, ūru (posterior aspect of thigh), jānu (knee), jaṅghā (calf), pāda (dorsum of the foot) in order while in kaphānubandhita gṛdhrasī, associated features such as tandrā (drowsiness), gaurava (heaviness), and arocaka (no desire to eat) are usually present.[2] The condition makes raising of the leg difficult. The disease explained is strikingly similar with sciatica, caused by impingement of the L4, L5 or S1 nerve root and manifests as unilateral neuropathic pain extending from the gluteal region down the posterolateral leg to the foot.[3] All types of lumbar radiculopathies also can be interpreted in the umbrella term of sciatica syndrome. Sciatica is defined as pain along the course of the sciatic nerve or its branches and is often due to disc protrusion.[4] There is often a history of trauma as twisting of spine or lifting heavy weight, etc. Sciatica has become a major concern globally due to lifestyle alteration, due to increased prevalence, which ranges from 1.2% to 43%.[5] gṛdhrasī is an excellent example for unparallel advantage and better out come through Ayurvedic pañcakarma as well as Parasurgical treatments in comparison to various approaches including surgery in conventional medicine.
The procedure which takes out the doṣa (morbid matter/toxins) from the nearest route of its vitiation is considered as śodhana. vamana, virecana, śiro virecana, nirūha basti, and raktamokṣaṇa are among the five types of śodhana mentioned in classics.[6] The therapy which pacifies the remaining doṣa in the body is considered as śamana while that nourishes the body tissues is known as bṛṃhaṇa therapy. basti is the most important among pañcakarma due to its multiple effects and is considered to be half or even sometimes the complete treatment. gṛdhrasī is a vāta predominant condition, having pain as the most prominent symptom. All types of pain occur because of vāta kopa[7] and basti is the best to pacify vāta doṣa.[8] As basti is not only best for vāta disorders but also equally effective in correcting the morbid pitta, kapha, rakta, saṃsargaja (condition due to vitiation of two doṣas), and sannipātika (condition due to the involvement of all three doṣas) conditions[9] and śodhana therapy has been established being better than Ŝamana,[10] a specific śodhana, śamana and bṛṃhaṇa basti has been planned in this pitta-kapha anubandhita vāta disorder. A case of sciatica, in an active lady, due to sciatic nerve pressure by compressive disc bulge and its management through pañcakarma with different basti modalities is reported.
| Patient Information | | |
A 58-year-old female, Hindu by faith, belonging to Jamnagar, visited pañcakarma OPD of I. P. G. T and R. A, Jamnagar, complaining of persistent low back ache, radiating to left lower limb, difficulty in walking due to pain for 20 days. Onset of pain was sudden; there was a history of jerk while attempting to stand from the sitting position. After about 15 min of injury, pain radiated in the left lower limb along the posterolateral aspect of thigh and leg up to the foot and toes. Numbness in the distal portion of left lower limb was also reported by the patient.
Gradually, the condition of the patient worsened and had difficulty in sitting and carrying out normal routine activities due to increased severity of pain. Pain and numbness worsened after prolonged sitting and on attempting to stand or making an effort to walk. Pain was not relieved on lying in supine or any other position. Mild relief was observed on taking analgesics.
The patient had no past history of any significant complaints or any long-term illness or drug history was reported by the patient. No addiction history was present.
agni (digestive capacity): Patient was having mild agnimāndya (decreased digestion and reduced appetite), history of irregular bowel habits was present with usually hard stools and a frequency of 1 in one or 2 days.
- Koṣṭha: krūra koṣṭha (incomplete bowel evacuation and hard stools with straining)
- Bala: madhyama bala (moderate physical strength)
- Prakṛti: kapha vātaja
- doṣa dūṣya lakṣaṇa: Predominant doṣa in the disease was vāta associated with pitta and kapha. Since there was a history of sudden jerk or āghāta which may be responsible for local inflammation, thus vitiating pitta doṣa. Besides, āvaraṇa of kapha may also be considered to play an important role in the manifestation of āvaraṇa janya symptoms such as stiffness, gaurava (heaviness),[11] and letharginess in the patient.
| Clinical Findings on Examination | | |
On further examination, straight leg raising test and Lassegue's sign were positive in both lower limbs, but severity was more on the left side. There was mild sensory deficit on the dorsal surface of the left foot, to the first interdigital space. Motor weakness or reflex disturbances were not observed.
On investigations, a normal lumbar spine was revealed by plain anteroposterior and lateral radiographs of the lumbar and pelvic areas while magnetic resonance imaging (MRI) lumbar spine revealed posterior disc bulge at L3-L4 level with narrowing of lower lumbar dural sac and loss of lumbar lordosis was noted [Figure 1].
| Diagnostic Assessment | | |
Assessment criteria followed for subjective and objective parameters was as:
Subjective parameters:
The patient was assessed for pain, stiffness, Numbness, difficulty in walking and Sensory deficit [Table 1], [Table 2], [Table 3], [Table 4], [Table 5].
Pain during Leg raising was assessed by Straight Leg Raising test and Lassegue's sign [Table 6].
Severity of pain was also assessed by VAS scale [Table 7].
Patient was also assessed for the same parameters after the treatment regimen.
| Investigations | | |
Radiograph
Plain anteroposterior and lateral radiographs of the lumbar and pelvic areas revealed a normal lumbar spine.
MRI lumbar spine showed posterior disc bulge at L3-L4 region causing indentation on thecal sac and nerve roots (Report details are in table number 16.)
As shown in [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6].
| Therapeutic Intervention | | |
Taking into account the kapha vātaja prakṛti of the patient and the nature of the complaints, dīpana pācana with medicated water by śuṇṭhi (Zingiber officinale) and dhānyaka (Coriandrum sativum) was planned before commencing with the planned treatment [Table 8]. This was also continued during 8 days of yoga basti wherein anuvāsana basti is administered on the 1st day followed by three alternate anuvāsana and nirūha and one anuvāsana at last.
After reassessment of agni, mṛdu saṃśodhana in the form of koṣṭha śuddhi with gandharvahastādi eraṇḍa taila[13] was given on the daily basis for 3 days at night just before sleep.
This was followed by basti regimen of 8 days comprising of śodhana śamana, and bṛṃhaṇa basti [Table 9] along with sarvāṅga abhyaṅga (External Application of Oil) with balā taila and bāṣpa svedana (Steam fomentation) as pūrva karma of basti (pre-operative procedure). Basti comprised of anuvāsana by muriveṇṇa taila[14] and nirūha basti was given with three different drugs with differently desired effects [Table 10].
| Results | | |
Significant improvement was reported in symptoms by the patient which was also present when assessed on subjective and objective grounds:
Symptomatically, the patient reported significant relief in pain at the lower back region and noteworthy reduction in numbness and stiffness in the low back region after the completion of yoga basti was also seen [Table 11].
| Discussion | | |
This case was approached in this particular manner owing to the involvement of other doṣas like kapha and pitta in the pathogenesis of the disease as compared to other forms of gṛdhrasī where predominantly only vāyu is the chief player. Thus, śodhana was planned ahead of śamana, followed by bṛṃhaṇa with an aim to render nourishment to the local tissues involved and restore normalcy in the functioning of lumbosacral region.
The case under the study showed remarkable improvement in almost all the subjective and objective parameters within a span of 8 days of basti and after the follow-up of 1 month. After assessing the prakṛti (physiological characters specific to an individual based on doṣas), agni (digestive capacity) and Koṣṭha (nature of bowel), Dīpana (Appetizers) pācana (digestive stimulant drugs) was planned with medicated water by śuṇṭhi (Zingiber officinale Rosc.) and dhānyaka (coriandrum sativum linn.) Powder to improve the digestive capacity of the patient to ensure better agni during the planned ŝodhana regimen.
Mild saṃśodhana in the form of koṣṭha śuddhi was planned with gandharvahastādi eraṇḍa taila considering the krūra koṣṭha of the patient to ensure better absorption and efficacy of basti as ācārya caraka has also quoted the administration of mṛdu recaka drug to manage vāta vyādhi.[15]
Basti has been considered as the mainstay of treatment for vāta predominant conditions.[16] Pain is the most prominent symptom of gṛdhrasī which is produced by vāta prakopa and basti is the best treatment to pacify vāta doṣa. ācārya caraka has considered basti as half of the treatment of all the diseases[17] and also described in the management of gṛdhrasī.[18] Basti does vātānulomana and relaxes the spinal muscles controlling apāna vāyu. Considering gṛdhrasī as a vāta predominant condition, with involvement of kapha and pitta respectively in this particular case, specific basti was planned for 8 days. Anuvāsana was administered with muriveṇṇa oil due to features such as stiffness, letharginess, and heaviness characterizing vāta-kapha predominance.
Nirūha basti was used in a specifically designed regimen, i.e., śodhana śamana, and bṛṃhaṇa basti. śodhana therapy has already been established in which eraṇḍamūla nirūha was administered first to ensure saṃśodhana. eraṇḍa mūla is quoted as “vṛṣya vātaharaṇam” in classical texts.[8] It is also indicated in the management of gṛdhrasī.[19] eraṇḍamūla does śodhana due to its virecaka guṇa which is because of Ricinoleic acid present in it.[20] madhu (Honey), having rūkṣa (Dry), kaṣāya (astringent) and chedana (scrapping) property, was used in higher dose (100 ml) while preparation of this śodhana basti to ensure the elimination of kapha doṣa.[21]
This was followed by nirūha basti with rāsnā saptaka kvātha[22] for its vāta śamaka as well as śodhana effects.
Last nirūha basti was administered with guḍūcī kṣīra pāka to provide nourishing and bṛṃhaṇa effects on asthi-majjā dhātu owing to its tikta rasa and madhura vipāka and also to pacify pitta doṣa since history of trauma was present as a precipitating factor leading to local inflammation.
The presenting features of gṛdhrasī arise basically due to compression of the sciatic nerve at its root, causing pain and numbness along the path of the nerve. Considering direct involvement of lumbar spine in gṛdhrasī and compression of spinal cord and exiting nerves, it can be considered as a vāta vyādhi wherein the dhātūs involved are essentially asthi and majjā. Basti is said to be the treatment modality of choice for vāta vyādhi. Other important characteristic of basti is that it reaches pakvāśaya and then to grahaṇi[23] which are considered to be analogous to purīṣa dharakalā̄ and pitta dharakalā Kalā, respectively. As per ḍalhaṇa, pitta dharakalā̄ and asthi dharakalā are similar while purīṣa dhara and majjā dharakalā̄ also bear resemblance.[24] Hence, basti is believed to act directly on asthi and majjadhātu.
In a study of basti therapy, it is revealed that the pyruvic acid gets decreased in the blood which indicates the increase in the Vitamin B1.[25] This vitamin is beneficial for nervous system, circulatory system as well as digestive system. In thiamine deficiency, the nerve tissue cannot utilize glucose upon whom the central nervous system frequently show chromatolysis and swelling in deficiency. Thiamine deficiency causes degeneration of myelin sheaths of the nerve fibers of both central and peripheral nervous system resulting in polyneuritis and occasionally paralysis.[26]
In this particular case, there was significant relief in the symptoms such as pain, stiffness, and inability to walk [Table 12] in the patient. The patient reported considerable improvement in walking without any support after treatment. However, significant changes were observed in the objective parameters such as VA scale, straight leg raising, and Lassegue's sign [Table 13], [Table 14], [Table 15].
These changes were not only limited to objective parameters but were also present in the MRI of lumbar spine. There was an increase in the diameter of spinal canal after basti at the L4-L5 and L5-S1 [Table 16] and [Table 17]. As basti is a decompression therapy, it tends to relieve pressure at lumbosacral spinal region which is the region of spine wherein maximum movement is present. Since basti depressurizes this particular region, thereby improving movement and releasing pain. The specifically planned basti not only pacifies vitiated vāta doṣa but also considerably reduces the aggravated pitta and kapha doṣa and thereby the cumulative effects produced by all the three doṣas. Thus, the effect produced is not only on features of vāta like pain but also on other features such as stiffness, letharginess, and local inflammation which represent involvement of aggravated kapha and pitta. | Table 17: Diameter of spinal canal before and after treatment as per magnetic resonance imaging
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| Conclusion | | |
This was a case of gṛdhrasī in which classical symptoms due to vāta like pain, numbness were present, besides due to involvement of kapha and pitta doṣa, features such as stiffness, letharginess, and local inflammation were present. Basti is practiced routinely for conditions such as gṛdhrasī, but here mainstay of treatment was not only pacification of vāta but also providing local healing and nourishment to restore the normal function at the lumbosacral region where maximum movement and flexibility is present. Thus, specific śodhana śamana, and bṛṃhaṇa basti were designed and the effects produced were encouraging on subjective, objective as well as radiographic parameters.
This was a single case study to evaluate efficacy of śodhana śamana and bṛṃhaṇa basti in cases where engrossment of several factors are present simultaneously in disease pathology. More such trials need to be conducted on a larger scale to draw more concrete conclusions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17]
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