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Introduction

Ayurveda is considered as one of the oldest and traditional system of medicine .The current lifestyle is slowly moving away from healthy living , which cause numerous disease to affect people. Sedentary way of life, inappropriate posture, due to constant jerky movement , stress, long time travelling, heavy weight lifting, prolonged walking and standing and sometimes trauma  puts maximum pressure on the lumbar region with lower limb. Gridhrasi is a Vatavyadhi, Specific samprapti of Ghridrasi is not explained in Ayurveda but it is one of the 80 type of Nanatmaja vatavyadhi[1]. i.e. only brought on by vitiated Vata, hence the majority of lakshanas are Vataprakopaka lakshanas, characterised by stambha (stiffness), toda (pricking pain), ruka (pain), and spandana (tingling sensation)mostly[2]. Kapha may be associated with vitiated vata and due to these Tandra, Gaurava, Arochaka, may be occur[3]. Above mentioned lakshana initially affect Sphika(buttock), also extend to posterior aspect of Uru (thigh), Janu (knee), Jangha(calf) , Pada(foot). In modern science it  corresponds  with sciatica pain. The typical sciatica pain is start along with sciatica nerve , it can be unilateral or bilateral. Based on the severity of the condition it causes difficulty in walking, where the gait is described as one slightly tilted to the affected side with the affected lower limb in flexed position. And the other lower limb extended which resembles to that of vulture( Ghridh). About 80–90% of people gets affected by lowback pain and prevalence is 5% of those who experience sciatica [4]. According to modern medicine, treatment of sciatica includes analgesics ,steroids and surgical intervention ,which is not sufficient for overall relief. Ayurvedic chikitsa will help to cure Gridhrisi mostly without any adverse effect, Acharya Charaka describes Bastikarma, Siravedh and Agnikarma[5]. Acharya Sushruta adviced siravedha above and below four angula of janusandhi[6]. Whereas Acharya Vaghbhata adviced siravedha four angula above and below the janusandhi, also they mentioned Agnikarma and anuvasana basti[7]. where as Acharya charaka stated in sutrasthana, whenever there is prakopitdosha which should eliminated with shodhana chikitsa from which the recurrence of same doshaprakopa will not happen again and again, as in shaman chikitsa may show recurrence [8].  

At GACH Nanded, various research were conducted to find the importance of Ghridhrasi management. These articles present the results of a systematic review that was conducted on 4 research projects (at GACH and completed between 2000 and 2020). All these works were conducted on Ayurvedic management or shodhana and shaman chikitsa. 

Material and methods

Thesis work completed by post graduate students at Government Ayurved College, Nanded, Maharashtra, India

Study NO. 1 : Vd. Tukaram Sambhaji Dudhmal (2000)                                                                                            

There were 60 patients in total who were randomly divided into two groups for this study.

Group A :Trial group

No. of patient : 30

Treatment given : Siravedha was done after snehana and swedana till 100 ml blood was let out above and below four anguli of janusandhi (knee joint) of affected side.

Group B : Control group

No. of patient : 30

Conclusion : Study result shows trial group have statistically remarkable relief in symptoms

Study NO. 2 : Dr. Priyanka Ramakanta Hambarde (2015)

There were total 60 no. of patient who were divided into 2 groups.

Treatment given :Group A : Siravedha was done form four angula above knee joint where four angula distance taken from upper border of knee joint . Great saphenous vein was selected for both Siravedha .

Group B : Siravedha was done four angula below knee joint where four angula distance taken from lower border of knee joint .

Conclusion : combined study of overall effect of therapy in both group shows that there was very minute difference in both group. 

Study NO. 3 : Dr. Gayatri shashikant kalamkara (2015)

In this study ,total 60 patient were selected and randomly divided into 2 groups, here 30 patient in each group

Treatment given :

Group A : Sunthisiddha Erandataila ( 5 ml ) with ksheera ( 20 ml) HS along with Rasna guggul 500 mg BD  for 7 day

Group B : Rasna guggul 500 mg BD before meal with lukewarm water for 7 day

Conclusion : looking at the parameter ,Reduction in pain ( ruka ),toda, and SLRT is greater in Group A Than Group B

Study NO. 4 :Dr. Dipali uttamrao suke (2016)

Single group of 30 patient

Treatment given : Panchamuli kashaya (40 ml) with Erandataila(20ml) orally BD before meal for 7 days

Conclusion :It was observed that Panchamuli kashaya with eranda taila was more effective in treating Vatakaphaja Gridhrasi.

Discussion

As the sciatica is painful condition according to modern treatment , analgesics were used to treat it. Which was often associated with adverse effect hence as a substitute of these Ayurveda has cheaper redily available , effective formulation or management for Gridhrasi. In the first study , Siravedha followed by snehana and  swedana , due to  anubandha of raktadosha ,siravedha act as removing congested blood in area of shonita avruttavata. It reduces the symptoms like Ruka, Chimachimayan, Sadnyanasha, Prushtavankshana shoola. This study shows significant relief in Siravedha followed by Snehana, swedana in Gridhrasi patient [9].The 2ndstudy, statistically proves that study result obtained in both the group are approximately same i.e. Siravedha shows approximately same effect in patient of Gridhrasi done above knee joint and below knee joint. Principle of siravedha is to let out raktadhaatu along with vitiated vatadosha where raktadhatu is prominent [10]. In 3rd study ,Sunthisiddha erandataila with ksheera and rasnaguggula combination is effective in treating the chief complaints. Vatakaphaja gridhrasi can be considerd as upstambhit vatavyadhi . Erandtaila is virechaka and sunthi is amapachaka leads to strotoshodhana.avarana of ama and khapha gets removed and leads to vatamulomana, so with these vatalunomana , pain in patient get relieved.[11]  In 4th study, Agnimandya is important event in samprapti of vatakaphaja gridhrasi, which leads to accumulation of ama which further lead to strotorodha , hence it is treated with  amapachaka, strotoshodhaka , vatanulomaka , vatakaphaja shamakaaushadhi like panchamulikashaya .Erandataila is virechaka, ushnatikshna , strotoshodhaka .

It was observed that formulation of panchamulikashaya with ErandaTaila was more effective in treating Vatakaphaja Gridhrasi because of virechaka and deepanapachana properties of this drug .[12]

Conclusion

There are four research studies on Gridhrasi management in this article. Combiation of Shaman chikitsa with panchakarma had been used in all of the work.

Review shows improvement in result of chief complaints and neurological finding in both the groups but effect of  siravedha chikitsa  was slightly better than internal medications of erandataila with kwatha formulations.