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Introduction

Manyasthambha is a vataja nanatmaja due vata prakopaka nidana sevana vyadhi can be correlated to cervical spondylosis., The vitiated Vata get lodged in neck region resulting muscular pain in neck area. [1] Incidence of Cervical spondylosis is increasing every year. This hampers the most active phase of life. Cervical spondylosis is a degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disc of the neck. Spondylosis progresses with age and often develops at multiple interspaces.[1]  The prevalence of cervical spondylosis is 13.76%, although it differs significantly among the urban 13.07%, suburban15.97%, and rural 12.25% of populations.[2]

Nasya karma is the best chikitsa for the Urdhwajatrugata roga (Disorders of Supraclavicular region). In Shiro- Rogas Nasya is a unique treatment in ayurveda. Nose is considered as a gateway for head. Medicine administrated through nose goes into head and not only expel vitiated doshas but also gives bala to Urdhwajatrugata organ.[3] Nasyakarma is most effective on vitiated doshas and cures the diseases which are situated in the nasa, sira, manya. Bruhat Vishnu taila[4,5] is known as best vata and kapha hara taila and so it acts well on Ruk, Stambha, Shotha and Gaurav. Hence here an attempt is made to study efficacy of Bruhat Vishnu taila Nasya in management of Manyasthambha.

Objectives:

To study the efficacy of Bruhat Vishnu taila Nasya in management of Manyasthambha.

Materials & methods:

               It was a single armed open, clinical study wherein 30 patients suffering from Manyasthambha were selected as per the inclusion exclusion and diagnostic criteria from teaching hospital attached to Ayurvedic Medical College Terdal. Bruhat Vishnu taila - 8 Bindu in each nostril for 7 days., follow up were taken on 14 and 21 days.

Diagnostic Criteria:

               For diagnosis detail medical history were taken based on the sign and symptoms of Manyasthambha.

Signs:

1. Poorly localized tenderness.

2. Restricted neck movement: -Flexion, Lateral flexion, Extension, Rotation.

3. Cervical compression test.

4. Shotha (swelling)

Symptoms:

1. Ruk (Cervical pain) aggravated by movement.
2. Stambha (Cervical stiffness.)
3. Referred pain (occiput between the shoulder blade upper limb)
4. Vertigo.
5. Tingling sensation in upper limb.

Inclusion Criteria:

1. Patient were selected irrespective of gender, occupation and habitat having age between 20-60 years
2. Patient presenting classical sign and symptoms of Manyasthambha, are fit for Nasya and willing to sign the consent form.

Exclusion Criteria:

1. Patient suffering from major systemic disease like carcinoma, Tuberculosis of cervical  spine and stenosis of spinal cord.
2. Pregnant women and lactating mother. Patient who are regular on NSAIDS and steroid dependent.

Age: As per inclusion criteria of patients were selected having age between 20 years to 60 yrs. and distributed it in four-sub age groups. Out of 30 patients’ number of patients found in age group 20-29 were 04[13.3%], in age group 30 to 39 yrs. were 09 [30%], in 40 to 49 yrs. age group were 06[20%], and 11[36.7%] patients from age group 50-60 yrs. of Manyastambha was observed.

Prakruti: Out of 30 patients in 10[33.3%]were of Kapha-Pittaj prakruti, 15[50.0%] were of Pitta-kaphaj prakruti followed by 05[16.7%] patients were Vata-Kaphaj Prakruti.

Clinical Observations:

1. Ruk (Neck pain):

The effect was not seen significant on Day 7, Day 14 as compare to Day 0. Similarly, there is no significant difference observed on day 14 and day 21.However, it  is significant on Day 7 and day 14 compare to Day 0 and also found highly significant on Day 21 as compare to Day 0.

1. Sthambha (Neck stiffness):

The effect was not seen significantly on Day 7 as compare to Day 0. Similarly, there is also no significant difference observed on Day 14 compare to day 7 compare to day 14. However, it is highly significant on Day 14 and Day 21 compare to Day 0, it is also significant on Day 21 compare Day 7. So, it can be concluded that there was highly significant difference in Sthambha (Neck stiffness) of Manyastambha  on Day 14 and 21 as compare to Day 0.

1. Pain in arms:

The effect was not seen significantly on Day 7 and Day 14 as compare to Day. However, it is highly significant on Day 14 and Day 21 compare to Day 0, it is also significant on Day 14 compare Day 7 and Day 21 compare to day 14. So, it can be concluded that there was highly significant difference in Pain in arms of Manyastambha on Day 14 and 21 as compare to Day 0.

1. Bhrama (Vertigo):

The effect was seen significantly on Day 14 and Day 21 as compare to Day 0. Similarly, there is also significant difference seen on day 7 and day 14, 21 However, it is not significant on Day 14 and Day 21. So, it can be concluded that there was highly significant difference in symptom Bhrama (vertigo) on Day 14, 21 as compare to Day 0.

1. Tingling sensation

The effect was not seen significantly on Day 7 as compare to Day 0.Similarly, there is also no significant difference observed on Day 14 compare to day 7 and day compare to 21.

However, it  is highly significant on Day 14 and Day 21 compare to Day 0, it is also significant on Day 21 compare Day 7. So, it can be concluded that there was highly significant difference in Tingling sensation of Manyastambha  on Day 14 and 21 as compare to Day 0.

1. Tenderness

The effect was seen significant on Day 7 as compare to Day 0. Similarly, there is also significant difference observed on Day 14 & Day 21 compare to day 0. However, it  is not significant on Day 7 verses Day 14, and day 14 and day 21. So, it can be concluded that there was highly significant difference in Tenderness of Manyastambha  on Day 14 and 21 as compare to Day 0.

1. Shotha(swelling)

The effect was seen significantly on Day 7 , 21 as compare to Day 0. However, it is not significant on Day 7 and Day 14, 21 compare to Day 0. So, it can be concluded that there was significant difference in Shotha(swelling) of Manyastambha  on Day 7 & 21 and only.

Neck Disability Index :

In Neck Disability Index criteria, it was observed that the Mean ± SD before treatment was 50.33±9.15 and after treatment was 29.06±8.35 , and t  value was 14.15 and  p value obtained was <0.0001 which is considered as highly significant.

Objective criteria:

Effect of Therapy on Symptoms of Manyastambha in Study Group Statistically:                                       

In Objective criteria, for the parameter of Flexion, Extension, Lateral flexion, rotation, it was observed that p value obtained was <0.001 which is considered as highly significant.

Percentage of Relief:

               In Group A, the percentage of relief noted in Ruk (Neck pain) on Day 7 was 5.9%, on day 14 it was 43.1% and 64.7% relief on Day 21. The percentage of relief noted in Pain in arms on Day 7 was 20.3%, on day 14 it was 37.3% and 37.5% relief on Day 21. In symptom, Bhrama (vertigo) relief was  23.9%,56.7% and 67.2% on day 7,14 and day 21 respectively. The percentage of relief noted in Tingling sensation on Day 7 was 19.5%, on day 14 it was 53.7% and 80.5% relief on Day 21. In symptom, Tenderness  relief was  42.9%, 67.3% and 81.6% on day 7,14 and day 21 respectively. The percentage of relief noted in Shirashool (Headache) on Day 7 was 57.6%, on day 14 it was 66.7% and 84.8% relief on Day 21. The percentage of relief noted in Shotha(Swelling) on Day 7 was 75%, on day 14 it was 60% and 75% relief on Day 21.The percentage of relief noted in Flexion on Day 7 was 36 and 80% relief on Day 21. The percentage of relief noted in Extension on Day 7 was 57.1%, and 75% relief on Day 21. The percentage of relief noted in Lateral flexion  on Day 7 was 46.9%, and 68.8% relief on Day 21. The percentage of relief noted in Rotation on Day 7 was 56.3%, and 71.9% relief on Day 21.

In study 12[40%] patients got marked relief, while 16[53.3%] patient got Moderate Relief and 02[6.67%] patient was in Mild Relief category.

Discussion

In Manyastambha, Asthigata vata is produced by vyana vayu and slesmaka kapha. greeva pradesh becomes the location of vitiated vayu, which result pain and stiffness in manya pradesh.[6] Nasya balances Vata and Kapha relives symptoms of pain and stiffness The condition of Manyastambha, is the clinical condition in which the back of the neck becomes rigid or stiff and the movements of the neck are impaired. The stiffness of neck is consequence of aggravated vata lodging in the cervical region. Along with Vata, Kapha dosha is also associated in this disease. Vata is vitiated either because of kaphavarana or Dhatu kshaya. Vata is vitiated and lodged in the Kapha sthana so the Kapha involvement can occur.[7]

Conclusion

In this study, 30 patients of ‘Manyastambha’ were taken attending Panchakarma O.P.D of the Hospital. Patients were administered Bruhat Vishnu Taila Nasya  8 Bindu in each nostril for 7 days daily in the morning for the period of 7 days. There were significant results obtained among signs and symptoms like Ruka, Sthambha, Bhrama, Shotha (swelling), Chimchimayan, Restricted neck movement Flexion, Extension, Lateral flexion, Rotation.  In the parameters, Neck Disability Index criteria, it was as highly significant. Bruhat Vishnu Taila is cost effective and easily available and can be recommended for the management the of Manyatsmabha.