EVALUATION OF EFFICACY OF KUKKUTANDA POTTALI SWEDA AND KUKKUTANDA UPANAHA SWEDA IN MANYASTHAMBHA- A COMPARATIVE STUDY

Vibha Tadas 1 , Dr. Shweta D. Parwe 2 . 1. PG Scholar, Dept of Panchakarma, MGACH &RC, Salod (H), Wardha. 2. Associate Professor, Dept of Panchakarma, MGACH &RC, Salod (H), Wardha. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The incidence of neck pain in adult is approximately 20-50% per year; the prevalence's of cervical spondylosis is similar for both sexes although the degree of severity is greater for males. Approximately 95% of population of people by age 65 have cervical spondylosis to some degree, it's the most common spine dysfunction in elderly people. The discs between the 3 rd and 7 th cervical vertebre are most commonly affected. Repeated occupational trauma may contribute to development of cervical spondylosis [2]. Cervical spondylosis is the term given to the occurrence of osteoarthritis in the cervical spine. It is characterized by degeneration of intervertebral discs and osteophyte formation this is extremely common and radiological changes of cervical spondylosis are very frequently in 50. It leads to pain in the neck that may be radiate and neck is held rigidly. Paraesthesia and sensory loss may be found in the affected segment and there may be lower motor neuron sign [3]. It disturbed the daily routine and overall life of the patient. Person can't perform day to day work properly due to severity of pain and stiffness.
Looking into sign and symptoms of cervical spondylosis one can correlate it with manyasthambha. It is a vatajananatmajavyadhi [4].The symptoms of which includes ruk and sthambha in manyapradesh and associated asthi and sandhis.AcharyaSushruta have mentioned 2 types of manyasthambha i.e. vataja and vatakaphaja [5]. In initial stages of manyasthambha there is vataavarana by kapha which later turns out to kevelavatavyadhi.
Because of its prevalence and unavailability of satisfactory management the particular alignment has become a challenge for health provider.

ISSN: 2320-5407
Int. J. Adv. Res. 5 (11), 919-926 920 Swedanakarma is important purva karma next to snehana. Besides being the principle poorvakarma procedure, swedana is the specific treatment for a number of disorders of vatapradhana and vatakapha diseases [6]. Acharya Charaka has included swedanakarma under shadupakrama [7] and thus respect swedana as a principle method of treatment. The development of neuropathic pain is a complex mechanism, which clinicians and researchers are continually working to better understand. Kukkutandaswedana mentioned by Bhavaprakasha for the treatment of manyasthambha [8], the ushna, tikshnaguna of kukkutanda along with saindhavalavana applied in the method of swedanakarma causes kaphavilayana and snigdhaguna of ghritha and ushnaguna of swedana pacifies the vata. So the purpose of this study is to observe the efficacy of kukkutandapottaliSwedaand kukkutandaupanahasweda in manyasthambha.

Preparation of the Pottali:-
The contents of all the eggs (except the shell) are emptied into a bowl. To this 10ml ghritha &10gms saindhavalavana is added. The entire mixture is stirred well and made to reach a semi-solid consistency over a induction. The scrambled and processed eggs are poured on a cloth and tied into a pottali and kept ready for use.

Pradhanakarma:-
After abhyanga, the pottali is dipped in ghrita being heated on a water bath and gently rubbed in a circular manner over manyaregion with intermittent dipping in warm ghrita until samyak swinna lakshanas occurs.

Paschaat Karma:-
After swedana the part is wiped with a towel dipped in warm water and the wetness is gently wiped off with dry clean towel. Then the patient is to be advised to take complete rest for half hour.

Preparation of Upanaha:-
The contents of all the eggs (except the shell) are emptied into a bowl. This 10ml ghrita & 10gms saindhava is added. The entire mixture is stirred well, this mixtureis poured over a heated frying pan and it should be in a low flame, when it becomes like flake (omelet) kept over erandapatra& ready for use. The thickness is around 1-1.5 cm for Swasthikabandhana 2 and ½ meter and1meter width nagamani cloth folded & kept rolled.
Pradhana karma:-After abhyanga, the prepared warm upanaha applied over manya region considering tolerable heat capacity of the patient then covered with erandapatra and tied swastikabandana using nagamani cloth.
Paschat Karma:-Advice the patient to remove the upanaha after 12 hour. That body area was to be washed well with lukewarm water.

Methods of Assessment of clinical response:-
Clinical parameters and functional parameters were made out to assess the clinical response in both the groups. Grade 0 -Normal movement Grade 1 -0 to 25% restricted Grade 2 -25% to 50% restricted Grade 3 -50% to 75% restricted Grade 4 -75% to 100% restricted.  Group B: The overall effect of treatment on subjective parameters for manyashool shows t=4.48, p value is equals to 0.0001 which shows statistical significant difference before and after treatment. Sthambha shows t=3.75, p value is equals to 0.002 which shows significant difference before and after treatment in sthambha. 924

Graph no 2:-Overall improvement of therapy in group A &B
The statistical analysis was done by using descriptive and inferential statistics using Chisquare test, student's paired and unpaired t test and software used in the analysis were SPSS 17.0 version, GraphPad 6.0 version and EPI-INFO 6.0 version and p<0.05 is considered as level of significance.
The overall improvement of the objective parameters shows statistically significance difference before treatment and after treatment.

Discussion:-
The statistical analysis was done on pottali & upanaha method of kukutandaswedana. Both pottali & upanaha showed significant results in all the parameters. There was no significant difference observed in the efficacy of the treatments in between two groups statistically. Clinically Kukkutandapottali showed better improvement compared to upanaha in all parameters.
For the parameter Pain, In group-A the mean BT 3.73 was reduced to 1.93 after treatment the t value is 6.44, p <0.0001and Relief 48.25% and in group B the mean was BT 3.66 was reduced 2.26 after treatment t value is4.83 p <0.0001value, and Relief 38.25% Hence clinically, Group A patients showed better improvement in reduction of pain. There was no significant difference observed in the efficacy of the treatments in between two groups.
For the parameter Stiffness In group-A the mean was BT 2.80 was reduced to1.06 after treatment the t value is 5.77, p <0.0001, and Relief 62.14% and in group B the mean BT2.86 was reduces 1.80 after treatment the t value is 3.75, p <0.002 and Relief 37.06% Hence clinically, Group A patients showed better improvement in reduction Stiffness. There was no significant difference observed in the efficacy of the treatments in between two groups.
For the objective parameter Neck disability Index In group-A the mean was BT 65 was reduced to37.33 after treatment the t value is 7.490, p <0.0001, and Relief 42.56% and in group B the mean BT 74.46 was reduces 57.80 after treatment the t value is 4.628, p <0.0001 and Relief 22.37% Hence clinically, Group A patients showed better improvement. There was no significant difference observed in the efficacy of the treatments in between two groups.

Discussion on probable mode of action of swedana:-
The sedative effect produced relieves the pain in the area. This may be because of the increased blood supply which produces removal of waste products hence getting good nourishment [12].Heat is also a counter-irritant i.e. the thermal stimulus may affect the pain sensation as ex-plained in pain gate theory of Melzack and Wall [13]. This explains the effect of heat applied on the nerves. Vāta is the responsible factor for inducing pain [14] in the body and the properties of Vāta and Swedana are exactly the opposite. Hence, the heat can cause reduction in pain by reducing the swelling, removing the coldness at the site and causing perspiration [15]. Swedana by its snigdha and uśhna property relieves sthambha [16]. Uśhnaguna of swedana does srotośhuddhi and amapāchana and relieves stiffness. The rise in temperature induces muscle relaxation and in-creases the efficiency of muscle action, as the increased blood supply ensure the optimum conditions for muscle contraction [17].
Relieves Coldness :-This is mainly due to uśhnagunaof Sweda. As a result of the increased metabolism, the output of waste products from the cells is increased. These include metabolites, which act on the walls of capillaries and arterioles causing dilation of these vessels. In addition, the heat has a direct effect on the blood vessels, causing vasodilatation, particularly in the superficial tissues where the heat is more. Stimulation of superficial nerve endings can also cause a reflex dilatation of the arterioles. As a result of the vasodilatation, there is an increased flow of blood through the area so that the coldness of body gets re-moved [18].
Relieves heaviness:-By means of swedana, the fluids sustained in the body are being excreted through the swedana and hence the feeling of lightness occurs in the body [19].