A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF KSHEERA VAITARANA AND DASHAMOOLA KSHEERA VASTHI IN THE MANAGEMENT OF KATIGRAHA W.S.R. TO LUMBAR

Dr. Sushma. P 1 , Dr. S. Mahendra Kumar 2 and Dr. Manorama Singh 3 . 1. MD-Panchakarma, Consultant Panchakarma Specialist, Kapil Ayurveda Chikitsalayam, Champapet, Hyderabad 2. MD-Ayurveda, Consultant Physician, Kapil Ayurveda Chikitsalayam, Champapet, Hyderabad 3. MD-Panchakarma, Panchakarma Practitioner, Pune, Maharashtra. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Each and every human desires to live happy and comfortable life, but it is impossible owing to multiple factors related with changing lifestyle, environmental factors etc.lifestyle of modern human being has created several disharmonies in his biological system.The advancement of busy professional and social life,improper sitting posture in office, factories, continuous and over exertion, jerking movements during travelling and sports etc factors create undue pressure on the spinal cord and play an important role in producing katigraha.Likewise,progressive disorders affecting the pelvis and nearer structures are also precipitating this condition.In this way, this disease is now becoming a significant threat to the working population. The severity of pain makes an individual wretched.In this study lumbar spondylosis is correlated to katigraha. Even surgical intervention is not friutfull in the management of lumbar spondylosis. Such forlorn patients after taking allopathic treatement for sufficiently long period come to Ayurveda with great credence. So it is the need of the hour to direct the effort to re-establish the measures indicated for katigraha in the classic texts of Ayurveda by proving its efficacy on the parameters established by recent medical science. In current study, assessment of ksheera vaitarana vasthi, Dashamoola ksheera vasthi in yogavasthi pattern for a period of 8 days is attempted in management of katigraha. It provided highly significant results in improving range of movements and pain intensity.

ISSN: 2320-5407
Int. J. Adv. Res. 6(1), 269-275 270 Sama (with Ama) or Nirama (without Ama) Vayu movement into Kati (lumbar region) hence this suggests of presence of Dhatu Kshayatmaka (degenerative) and Marga Avarodhaka (obstructive) type of Samprapti (pathology). Katigraha is one such condition in which the vitiated vata is localizing in the katipradesha and producing stiffness and pain there.Vasthi karma is one among the best treatment for vata disorders.Chakrapani on commenting explains that when we nourish the root whole plant will be nourished.In this regard the process of degeneration can be successfully treated by vasthi karma 4 .

Plan of Study:-
The present study has been carried out on 10 patients treated in two groups. The criteria of diagnosis was based upon the classical signs & symptoms of the disease and investigations like X-ray, MRI etc. 5 patients out of the total 10 patients of Katigraha underwent Yoga vasthi in which anuvasana with Sahacharadi tailam and niruha with ksheera vaitarana. 5 patients of Group B out of the total 10 patients of Katigraha underwent Yoga vasthi in which anuvasana with Sahacharadi tailam and niruha with Dashmoola ksheera kashayam.
Follow up was given for 16 days from next day after the treatment for both groups.
The improvement in the symptoms of the disease and the changes in the clinical tests before & after the treatment were the main criteria of assessment. The total effects of the therapies were also assessed in terms of Good relief, moderate relief, mild relief and no relief.

Diagnostic Criteria And Assessment Criteria:-
The main symptoms like pain, stiffness and piercing pain were considered as subjective parameters. The objective parameters included NPRS grading for tenderness.

Preparation of the vasthi:-Preparation of Niruha Vasthi involves following steps:-
The ingredients should be mixed by triturating in the order of Madhu, Saindhava, Sneha, Kalka, Kwatha and then Avapa dravya one by one gradually until it becomes a homogeneous mixture. 8 Then it should be churned further to make it more fine and homogeneous. It is to be heated in water bath to make it Sukhoshna i.e. near to the normal body temperature. Advise to The Patient:-Patient is to be asked to pass his natural urges before Vasthi Pranidhana and not to laugh, cough, sneeze and take the yawning while administering Vasthi.

Basti Pranidhana:-Niruha vasthi:-
Vasthi is to be administered when the patient is having the symptoms of Jirna Ahara and is not very much hunger. The patient is asked to keep his left hand below the head as a pillow, to extend the left leg completely and to flex the right leg at the knee joint, keeping on the left leg by flexing the hip joint. Then Sukhoshna vasthi Dravya is to be applied in the anal region and on the vasthinetra, remove the cotton piece and the air bubble if any and keep the thumb on the netra while introducing it. Then introduce the vasthinetra gradually in the parallel direction to that of the vertebral column up to part of the netra until the nearer karnika fixes over the anus. Then hold the vasthiputaka in the left hand and keep the right hand on the putaka. After this press it gradually with the constant pressure, neither too fast nor to slow without tremoring the hand. By asking the patient to breath in, push the vasthidravya into the rectum till a little quantity remains in the putaka otherwise Vayu enters into the Pakvashaya, and then withdraw the netra gradually. Then patient is asked to lie down in the supine position gradually and sphiktadhana is to be done slowly and softly 3-4 times. After this, the patient is asked to lie in a comfortable position with a pillow below the hips till he gets the urge for defecation and when he/she gets the urge ask him/her to sit in Utkatasana and pass the urge.

Anuvasana vasthi:-
The Sneha prescribed for Anuvasana may be taken in the Vasthi-putaka and tied well placing the Vasthi-netra in position. The trapped air in Vasthi-yantra is expelled by gently pressing the Vasthi-putaka. Procedure of administration same as Niruha vasthi.

Overall Effect Of Therapies:-
The assessment of the results was made by adopting the standard methods of scoring the signs and symptoms of katigraha. It included assessment for objective and subjective criteria by means of various tests and all signs and symptoms as per Ayurvedic classics with grading of parameters.

Effect of Yoga vasti-A therapy on objective criteria after treatment:-
On examination, the effects of Yoga vasti therapy on objective parameter before and after the treatment in 5 patients of katigraha are documented. The statistical analysis of NPRS in group A is extremely significant by 73.91%.

Effect of Yoga vasti-B therapy on objective criteria after treatment:-
The effects of Yoga vasti therapy on objective parameter before and after the treatment in 5 patients of katigraha are documented. The statistical analysis of NPRS is extremely significant by 82.3%.
Overall assessment of therapies, yogavasthi in Group-B is more significant than Group -A. Saindhava: Due to its sukshma and Tikshna properties, it helps to pass the drug molecule in systemic circulation through mucosa. Thus, it helps the vasthi dravya to reach up to molecular level.It also helpful for the elimination of waste due to irritant property.It is capable of liquefying the viscid matter and breaking into minute particles.

Guda:-
In this vasthi instead of madhu jaggery is used. It along with saindhava makes homogenous mixture, to form a solution having properties to permeable the water easily. The retention of the irritative substances may be favoured by making its solution as nearly isotonic as possible by using colloidal fluids. Here, Purana guda should be taken as it is Laghu, pathya, anabhishyandi, agnivardaka and vatapittaghna. It also helps in carrying the drug up to microcellular level. Ghrita is Vata-pittashamaka, balya, agnivardhaka, madhura, saumya, sheeta Virya, shula, jwarahara, vrishya and vayasthapaka also. Thus, it pacifies Vata, improve the general condition of the body and acts as a rejuvenator of the body. Thus, helps in the samprapti vighatana of the Katigraha. Ghrita is having property like Yogavahi which is helpful in increasing bio-availability of other drugs without loosing its own property. Ghrita also contains vitamin D which plays an important role to utilize calcium and phosphorous in blood and bone building.
Chincha:-Chincha is having Vata-Kaphashamaka, Ruksha and Ushna properties. These properties of the chincha make it useful for the disease Katigraha.
Ksheeram:-In Ksheera Vaitarana vasthi, GO Ksheeram is chief content, which is owing to its Madhura rasa, madhura vipaka, sheeta virya, snigdha guna. Milk contains all the elements necessary for the growth and nutrition of bones, nerves muscles and other tissues. It is rich in proteins, fats, carbohydrates, vitamins, and minerals.
The aggravated vata when localised in kati brings stiffness this is Katigraha.Due to vata vitiation and pain aggravation here brmhanam type of vasthi has to be adopted i.e., Ksheera vaitarana vasthi.Snigdha,guru property of goksheeram mitigates vata dosha and inturn decreases the signs and symptoms of the disease condition.The Amlalavana-snehayukta vaitarana vasthi acts as vatashamaka & there by reduces the symptoms in Katigraha. The Goksheera Vaitarana vasthi has got the more lipid contents in it.The rectum has a rich blood and lymph supply and drugs can cross the rectal mucosa like other lipid membranes.The unionized and lipid soluable substances are rapidly absorbed from the rectum.In the rectum, in the upper portion the absorption is via the upper rectal mucosa and is carried to the superior haemorrhoidal vein into portal circulation.Where as that absorbed in the lower rectum enter directly into systemic circulation via middle and inferior haemorrhoidal vein. These factorsthe probable mode of action and probable mechanism of action may be responsible for the relief in the signs and symptoms of the disease.
Thus, vasthi dravya when administered reaches up to the micro and macro level due to its virya (potency) helps first to disrupt the pathogenic process and carries out the morbid matter toward Pakwashaya for the elimination. Thus it works as curative as well as purificative measure. Milk contains all the elements necessary for the growth and nutrition of bones, nerves muscles and other tissues. It is rich in proteins, fats, carbohydrates, vitamins and minerals.