Gridhrasi or sciatica is a severely painful situation in which pain radiates to the lower legs (one side or both). It may start from the lower back down or from down to the upper lower back. The course generally occupies from origin to supply or distribution area of the sciatica nerve due to its compressive or irritative factor. In Ayurveda pain is explained with the terms Toda, Spandana, Graha, Stambha, and Vedana from Kati-Pradesh to Padanguli (foot). Gridhra term stands for vulture that pierces its beak withdraw it forcibly and results in a severe jerk-like action similarly action occurs with the nerve so named as Gridhrasi in Ayurveda or another possible reason is gait appearance like vulture due to tilting of the body towards affected part
Causative factor/Nidana –
- Ruksha/dryness Guna by its Shoshana/dry up property is reducing the lubricative property in the body which manifests as stiffness in Kandra/tendons and joints of legs.
- Excessive intake of Sheeta/Cold Ahara leads to Stambhan in Srotas, Snayu, Kandara, etc. which results in restricted movements of joints in lower extremities.
- Intake Laghu/light Guna is done Lekhana karma leads to Osteoporosis in bony tissues.
- Excessive ingestion of Katu, Tikta, and Kashaya rasa provokes Vata dosha. Atialpa, Atilaghu Ahara, and Abhojana can lead to loss of Bala, varna, upachaya, Oja, etc. It causes harm to Sharir, mana, buddhi, indriya and affects the Sara of all dhatus.
- Atijagarana/ night awakening
- Diwaswapa/ day
- Ativayavaya/ excessive indulgence in sexual activity
- Excessive walking, swimming, exercise, etc.
- Atyasana/ excessive food intake.
- Suppression of natural urges
- Riding or falling off from fast-moving object
- Excessive stress
- Over anxiety
- Excessive depression
- unstable mentality or desires.
Kala: Often seasonal variation may also act as a causative factor.
- Pain starts at sphika and then radiates to Kati, prishtha, Uru, janu, jangha, and pada in order.
- Toda/ pricking pain
- Stambha / feeling of tightness in legs- restricted joint movements
- Spandana/Pulsating, trembling sensation
- Sakthikshepa Nigraha/ restricted movement of the joints affected limb
- Kati-Uru Jaanu Madhye Bahuvedana
- Tandra (drowsiness)
- Gaurav (Heaviness)
- Aruchi, (Anorexia)
- Dehasyapravakrata, (Gaitdisturbance)
Types of Gridhrasi:
Based on signs and symptoms it is majorly of two types of Gridhrasi:
- Vataja- Dehasyapravakrata (gait disturbance) and Suptata(numbness)
- VataKaphaja Gridhrasi: Tandra, Gaurav, Arochaka, Mukhapraseka and Bhaktadwesha.
UPASHAYA – ANUPSHAYA:
Upashaya is the suitable use of drugs, diet, and behavior, which are contrary to etiology or disease or produce effects contrary to them, while Anupshaya aggravates the disease. Satmya, Pathya, and Upshaya have the same meaning.
|Ahara:||Godhuma, Masha, Purashaali, Vartak, Patol, Rasona, Taila, Ghrita, Kshira, Tila, Draksha, Dadima, etc.||Mudga, Kalaya, Brihatshaali, Yava, Rajmasha, Kodrava, Kshara, bitter, astringent taste, etc|
|Vihara:||Abhyanga, Swedana, Tarpana, NirVata sthana, Atapa sevana, Nasya, Ushnapravarana, Basti etc||Chinta, Bhaya, Shoka, Krodha, Vagavidharana, Chankramana, Annasana, Ativyavaya, Jagrana.|
Ayurveda Samprapti Ghataks/ elements of pathogenesis
|Nidana :||Vataprakopaka nidana|
|Dosha||Vata – Apana and Vyana vayu, Kapha|
|Agni||Jatharagni and Dhatvagni|
|Ama||Jatharagnimandyajanita & Dhatvagnijanita|
|Samcharasthana||Rasayani of Apanakshetras|
|Adhisthana||Kandaras of Parshni, Pratyanguli and Sphika, Kati, Uru,Janu, Jangha, Pada|
|Srotas||Rasa, rakta, mamsa, meda, asthi, majja|
|Srotodushti||Sanga and Margavarodha|
|Vyakti||Sphika, kati, prishtha, uru, janu, jangha, pada|
|Bheda||Vataj and VataKaphaj|
SADHYA-ASADHYATA/ Prognosis: Generally, as per Ayurved its prognosis is similar to Vata Vyadhies, very difficult to cure. However, it also depends on many factors like Bala of Nidana & Rogi Bala, the strength of dosha Prokopa, the sthana of the disease, severity of signs and symptoms, duration of the disease, Rogamarga, Dhatudushti, etc.
- Principle of treatment/ Chikitsa Siddhanta–The first and the foremost principle to be adopted in the treatment of every disease is Nidana Parivarjana (to avoid the nidana of the disease).
- Vishishta Chikitsa for Gridhrasi:-The effective and specific treatment of Gridhrasi cannot be single-lined as it is a multifactorial disease, as the pathology involves multiple varying factors. Vitiated Vata and association of Kapha dosha stemming out from the pakwashaya, afflicting the asthi dhatu vitiating snayu and Kandara affecting in the asthi produces the illness. Therefore, the procedures are mainly aimed at the rectification of the imbalances of Vata dosha as well as Kapha dosha if associated forms the sheet anchor of treatment of Gridhrasi.
- Treatment therapies-
- Snehana: Snehana or oleation therapy- Used externally (abhyanga, avagaha,parisheka, etc. and internally.
- Swedana: In the forms of swedana procedures, avagaha sweda, pizhiccil, nadisweda, Patra pinda sweda, pinda sweda, and upanaha sweda may be used which reduces the stiffness.
- Vamana: Medicine-induced vomiting to cure the internals of the body to break the chain of pathogenesis.
- Virechana: Sneha Virechana of Mridu nature is another Medicine induced purgation therapy to cure the internals of the body to break the chain of pathogenesis. helps in controlling Shula in Gridhrasi.
- Basti: Best treatment modality of Vyana Vata-induced disorder is Basti Chikitsa.
- Niruha Basti: Best choice for Niruha basti is Erandamuladi Niruha and Dashamuladi
- Anuvasana basti: Use of vatahara tailas like bala taila, mulaka taila, ksheerabala taila, prasarani taila are considerd as Anuvasana basti
- Raktamokshana: – Siravyedha: Siravyedha four angula above and four angula below at the site of the knee joint.
- Agnikarma: Agnikarma at Antara Kandara Gulpha or Pada Kanishka anguli (little toe of the affected leg).
- Shamana Chikitsa/ conservative treatment: Following Chikitsa can be included under shaman chikitsa–
- Vedanashamaka chikitsa – To pacify the severity of pain.
- Vatahara chikitsa – Elimination of vitiated Vata Dosha.
- Kaphahara chikitsa – Pacification of vitiated Kapha Dosha.
- Deepana & pachana chikitsa – To balance the Agni
Shamana aushadhi (Conservative medicine ) used in Gridhrasi:
|S.N.||Churna||Kalka and Lepa||Kwatha, Kashaya and Arishta||Taila and Ghrita||Vati, Guggulu and Rasyoga|
|1||Ajamodadi Churna||Maha Nimba Kalka||Panchamula Kashaya||Chagalyadhya Ghrita||Rasna Guggulu|
|2||Abhayadi Churna||Rasona Kalka||Maha Rasnadi Kashaya||Bala Taila||Trayodashanga Guggulu|
|3||Krishnadi Churna||Swalpa Rasona Pinda||Shefalikapatra Kashaya||Eranda Taila||Yogaraja Guggulu|
|4||Rasnadi Churna||Gunja Phala Lepa||Erandadi Kashaya||Vajeegandhadi Taila||Mahayogaraja Guggulu|
|5||Dashmuladi Churna||Vatahara Pradeha||Dashmula Kashaya||Saindhavadhya Taila||Pathyadi Guggulu|
|6||Balarishta||Maashadi Taila||Vatari Rasa|
|7||Dashmularishta||Vishagarbha Taila||Vatagajankusha Rasa|