Review article on the Gridharasi (Sciatica)

Nirukti of Gridharasi

Gridharasi is derived from root word “Gridhra” which means to covert, to be eager for. Gridhasi is feminine words. The word Gridhraus is formed from adding Kah prataya in root along with sho by the rule of “atonupasarge kah” forming grdhrat + sho +Ka and by diminish of “O” and “K” replaced by “S” by the rule of “Dhatvadeh shah sah” and again feimine gender “Anngis” pratayaha is added in Gridhraus giving the word Gridharasi [2].

Definition: When kandara (Ligaments) from the heel up to toes are afflicted by the vitiated vayu, movement of lower extremity get restricted which is known as Gridharasi Roga [3]. There are two kandara in legs that get affected i.e, one is extending distally from paarshni to toes and another extending above from parsini to vitapa and these two kandara getting afflicted with vata dosha and causes limitation on the extension of legs and these is known as Gridharasi. Ghridhrasi is one among 80 vatavyadhiu which is characterized by Ruk (pain), toda (pricking type of pain), stiffness (stambha) and frequent twictching. These signand symptoms initially start from sphik (buttock) as well as posterior aspect of kati(waist) and then gradually radiates to pristha(posterior aspects) of uru(thigh), janu(knee) and jangha(calf) and pada(foot) in the corresponding order[4].

Etiology of Ghridhrasi: In the Ayurveda classical texts, there is no mentioned of specific Nidana (causes) for Gridharasi mentioned. As this is a Vatavyadhi, a common Vatavyadhi Nidana can be taken for its causes. Common causes of vata outbreak (aggravation of vata) are dhatakshaya (weakness of body tissue) and cloudiness, poor diet (less quantity of food items), cold diet (cold in nature), over consumption of micro diet (light grains) are Aaharaj nidana (a dietary diagnosis) of Gridharasi. Similarly, ativyayam (excessive exercise), prajagarana (night waking), atyadhva (excessive walking), ativyavaya (excessive sexual intercourse), aticheshta (excessive work), dukhashayya (resting in improper position), dukhaasana (sitting in improper posture), vegadharana (suppression of natural velocity), abhigata (injury), marmaghata (injury to a vital body part), spadya yana (traveling at a fast pace) can be specific Viharaja Nidana for Gridharasi [5, 6].

Purvaroopa of Gridharasi: According to charaka Samhit, has stated poorvarupa of vatavyadhi as avyatalakshan. As gridhrashi being one of vatavyadhi poorvarupa of gridharsi is also avyakta lakshana. Cakrapani states that few /little symptoms can be considered as purvaroopa [7].

Rupa of Gridharasi: Ruk(pain), Toda (pricking pain), Stambha (stiffness), Muhu spandana are rupa of Gridharasi states by acharya charaka.

Again, acharya chakrapani states that pain starts from sphik (buttock) which radiates to kati (waist), uru (thigh), janu (knee), jangaha (calf) and pada (foot) in the corresponding order. sankhanah kshepam, nigrahaniyat, janumadhye vedana,uru Madhya vedana, kati Madhya vedana are rupa of Gridharasi etc.

Samprati: Due to vata prakopa or vata vridhi, vataja Gridharasi is produced having the symptoms of stambha, ruka, toda as well as muhu spandana. Vata prakopa Aahara, vihara etc leads to the aggravation of vata and at the mean time ruksha, khara, laghu, sheeta, daruna, vishada, chala guna of vata suppresses the snigdha, guru, mridu, pichilla guna of kapha which directs to decreases the sleshma. Decreasing the sleshma in prustha region, kati, sakthu and also in the kandara and replaced by the prakupit vata. By this way, Vata located in the kandara (ligaments) and gives rise to the symptoms like stambha, ruka, toda, spandana in kati, prustha, janu, jangha and pada in the corresponding order. During the explanation of vata -kaphaja Gridharasi. Acharya charaka explained the symptoms like aruchi, tendra and gaurava in addition to the symptoms of vataj Gridharasi. Together with vata prakopaka nidana as well as nidana which prakopa kapha give rise to the agnimandya which causes the collection of Ama frequently. This condition also affects Rasa dhatu’s agni, leading to the production of kapha abundantly as the mala of rasa Dhatu. During this samprapti, vitiated vata does not suppress kapha as mentioned in the vataja type of Gridharasi. Here vitiated vata also bound agnimandya and finally help in the accumulation of kapha. On the opposite hand, kha-vaigunya also occurs because of the various nidana sevana, in kati, pristha, Sakthi and kandara. Thus, both prakupita vata and kapha by spreading get localized at the area of the khavaigunya. Within the stage of kha- vaigungya along with the shanasamshraya that vitiated vata get cloaked by kapha and give rise to the symptoms of vata-kaphaja Gridharasi [8, 9].

Sadhyasadhyata of Gridharasi: Vata vyadhi having duration of more than one year is considered as the asadhya vyadhi. Acharya has put vatavyadhi as the mahagada due ti its fatal nature. It is also mentioned that vatavyadhi with oedema, suptavacha, bhgana, kamoa, adhmana is considered as asdhaya [10, 11].

Chikista

Nidana Parivajana: First line of treatment of diseases is Nidana parivarjana. Acharya Sushrutha has mentioned that before the administration of any treatment firstly nidana should be stop. In the previous page we have describe the classical references of nidana of Gridharasi should be avoided.

Principle of treatment of Gridharasi: Chikista sidhanta of Gridharasi, being a Vata Pradhan Vyadhi (diseases caused by Vata), treatment to stabilize Vata Dosha is prescribed in Gidrhasi. The purpose of which is to restore the state of health by balancing the increased vata or vata kapha doshas. The principle of treatment of Gridharasika is Shiravedha (Venesection), Basti Karma (Enema Procedure) and Agni Karma (cauterization) [12].

Snehana (Oleation Therapy): The first and most important medical treatment for Vata-Vyadhi diseases is lubrication (oleation). In this process, the patient is treated by oiling with various medicated ghee, oil, muscle fat, bone marrow, etc. It reduces the ruksha guna of the body. Oils nourish weak tissues, increase strength and also improve digestion and metabolism. In case of kaphaj Gridharasi, Rukshana can be used to calm the kapha and then only lubrication should be done.

Swedana (Sudation Therapy): After oleation, sudation therapy should be given to the patient. This can be done through various fomentation therapies like Nadisveda, tub bath, steam bath, etc. Repeated sweating is the most important treatment for rheumatism. Sweating reduces pain, stiffness, heaviness which are symptoms of Gridharasi [13].

Shiravedha (vein puncture): There is contamination of tendon in the sciatica because kandara is upadhatu of rakta. So that in sciatica also rakta dhatu being contaminated so that sciatica with rakta krita vata and pittakrita vata symptoms should have treatment of shiravedha but in the dhatu kshaya janya ghridhrasi, shiravedha should be contraindicated [14]. According to Charak, siravedha should be done in between kandara and gulfa [15].

Basti Therapy: In Ayurveda, the Pakwashaya (large intestine) is considered the main seat of vata. It is considered an ideal treatment for vata disorder (As.S.Su.1.49) [16]. According to Charaka, Anuvasana basti and niruha basti should be given for the patient of the sciatica.

Agni karma: Agni Karma is performed in the region of kati to reduce nerve irritation and pain. Agni Karma is performed on the nerve that goes down from the little toe. Agnikarma is prohibited if there is a daha, toda etc [17].

Kati Basti: In the process, the specially prepared oil is placed on the surface of the body in the kati region for a certain period of time. By doing this, the muscles and nerves in that area become stronger and the joints become flexible. Rasayana Therapy According to different acharya rasayana, brimahaniya drugs mainly consisting of the madhura rasa should be given.

Shastik Shali Pinda Sweda: A procedure in which a special type of rice called Shastik Shali (60 days ripe rice) is treated with medicine in milk, made into a paste and applied to the affected body part. It gives nourishment and strength to the affected area.

Pathya