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CLINICAL RESEARCH
Year : 2010  |  Volume : 31  |  Issue : 2  |  Page : 240-244 Table of Contents     

A comparative study of Agni karma with Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (Sciatica)


1 Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, India
2 Department of Shalakya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, India

Date of Web Publication10-Nov-2010

Correspondence Address:
S K Gupta
Associate Professor, Department of Shalya Tantra, I.P.G.T.R.A., Jamnagar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.72408

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   Abstract 

Sushruta has mentioned different methods of management of diseases, such as Bheshaja karma, Kshara Karma, Agni karma, Shastrakarma and Raktamokshana. The approach of Agni karma has been mentioned in the context of diseases like Arsha, Arbuda, Bhagandar, Sira, Snayu, Asthi, Sandhigata Vata Vikaras and Gridhrasi. Gridhrasi is seen as a panic condition in the society as it is one of the burning problems, especially in the life of daily laborers. It is characterized by distinct pain starting from Sphik Pradesha (gluteal region) and goes down toward the Parshni Pratyanguli (foot region) of the affected side of leg. On the basis of symptomatology, Gridhrasi may be simulated with the disease sciatica in modern parlance. In modern medicine, the disease sciatica is managed only with potent analgesics or some sort of surgical interventions which have their own limitations and adverse effects, whereas in Ayurveda, various treatment modalities like Siravedha, Agni karma, Basti Chikitsa and palliative medicines are used successfully. Among these, Agni karma procedure seems to be more effective by providing timely relief. Shalakas for Agni karma, made up of different Dhatus like gold, silver, copper, iron, etc. for different stages of the disease conditions, have been proposed. In the present work, a comparative study of Agni karma by using iron, copper and previously studied Panchadhatu Shalaka in Gridhrashi has been conducted. A total of 22 patients were treated in three groups. Result of the entire study showed that Agni karma by Panchadhatu Shalaka provided better result in combating the symptoms, especially Ruka and Tandra, while Lauhadhatu Shalaka gave better results in combating symptoms of Spanadana and Gaurava. In the meantime, Tamradhatu Shalaka provided better effect in controlling symptoms like Toda, Stambha and Aruchi. Fifty percent patients in Panchadhatu Shalaka (Group A) were completely relieved. In Lauhadhatu Shalaka (Group B), the success rate was 00.00%, and in Tamradhatu Shalaka (Group C), the percentage of success rate was 14.28%. After analyzing the data, Tamradhatu Shalaka was found to be more effective than Lauha and Panchadhatu Shalakas.

Keywords: Agni karma , Gridhrasi, Panchadhatu Shalaka, Parshni Pratyanguli, Sciatica


How to cite this article:
Bakhashi B, Gupta S K, Rajagopala M, Bhuyan C. A comparative study of Agni karma with Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (Sciatica). AYU 2010;31:240-4

How to cite this URL:
Bakhashi B, Gupta S K, Rajagopala M, Bhuyan C. A comparative study of Agni karma with Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (Sciatica). AYU [serial online] 2010 [cited 2020 Mar 29];31:240-4. Available from: http://www.ayujournal.org/text.asp?2010/31/2/240/72408


   Introduction Top


Shalyatantra is one of the eminent branches of Ayurveda, which consists of major therapies like Bheshaja karma, Kshara Karma, Agni karma, Shastra karma and Raktamokshana. Agni karma is superior among all of them and has proved to be a boon where local involvement of Vata and Kapha doshas are observed in the disease. Agni karma is indicated in many critical diseases like Arsha, Arbuda, Bhagandara, Apachi, Antravridhi, [1] Gridhrasi, etc. and in many other disorders of Sira, Snayu, Asthi and also in Sandhigata Vata Prakopa. [2] Gridhrasi is one of the most agonizing disorders characterized by its distinct feature of severe pain starting from Sphika Pradesha (gluteal region) and radiating toward the Parshni and Pratyanguli (ankle joint and foot) of the affected side of leg. [3] The Gridhrasi may be simulated with sciatica in modern parlance on the basis of its signs and symptoms, which occurs owing to involvement of spinal nerves. Gridhrasi is an affliction, which carries greater threat to life but interferes in daily routine by its consistent pain. The person who suffers from this disease is partially handicapped, as the patient may not be able to walk, stand or sit comfortably due to his constant attention to the painful limb.

The incidence rate of this disease is significant as more than three quarters of the world's population experience low back pain at some or other time during their course of life and it is the most common cause of sickness which results in absence from work. In UK, approximately 10% of people are suffering from the episodes of low back pain annually and consult their family physician. It is also a major cause of illness among the working population in a developing country like India. Lack of job satisfaction, depression, obesity, smoking, alcohol and socioeconomic deprivation have also been found responsible for it. [4] This is the most common disorder which affects the movement of legs, particularly in most productive period of life, with low back pain, out of which 40% of persons have radicular pain and this comes under the umbrella of Sciatica syndrome.

Pain is the predominant symptom of Gridhrasi, which disturbs the normal routine of the patient. It is a classical fact that this pain is effectively relieved by the Agni karma. The diseases treated with Agni karma do not recur [5] and there is no fear of putrification and bleeding, and ultimately it produces balancing effect on vitiated Vata Dosha. To perform this procedure, many Dahana Upkaranas (devices) like Pippali, Ajashakrit, Godant, Shara, Shalaka, Jambavoshtha, Madhu, Guda, Sneha and different types of metals are used. [6]

In its counterpart, the management by modern medicine for this condition is by conservative treatments like rest, immobilization, and use of analgesics, anti-inflammatory drugs, physiotherapy or surgical in later course of the disease. If the pain and neurological defects do not subside on prolonged conservative treatment, finally surgery is considered, which is not a right choice as it leads to complications like limping, recurrence, permanent loss of working capabilities, etc.

As the conservative treatment with drugs has to be continued regularly for prolonged period, a need-based research for safer drugs and a procedure with better efficacy is required. Many works have been already carried out in Shamana Chikitsa which derived limited benefits, whereas Agni karma, an Ayurvedic parasurgical procedure has provided marked improvement in Gridhrasi.

In this study, the role of Agni karma has been studied with different Shalakas of Lauha, Tamra and Panchadhatu and the study has been carried out to find out the one with better efficacy among these devices.

Aims and objectives

The aim of the present study was to study the comparative effect of Agni karma by Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (sciatica).


   Materials and Methods Top


A total of 29 patients suffering from salient features of Gridhrasi, attending the OPD and IPD of I.P.G.T. & R.A., G.A.U., Jamnagar Hospital, were registered randomly, irrespective of their age, sex, religion, caste, occupation, etc. The patients were diagnosed on the basis of sign and symptoms as per specially prepared proforma.

Tamra Shalaka, Lauha Shalaka and Panchadhatu Shalaka were used for Agni karma in different groups.

Components of Panchadhatu Shalaka

Tamra (copper) → 40%

Loha (iron) → 30%

Yashada (zinc) → 10%

Rajata (silver) → 10%

Vanga (tin) → 10%

Clinical study

The patients were divided into following three groups as follows:

Group A: Agni karma done by Panchadhatu Shalaka (8 patients)

Group B: Agni karma done by Lauhadhatu (iron) Shalaka (7 patients)

Group C: Agni karma done by using Tamradhatu Shalaka (7 patients)

Inclusion criteria

Patients suffering from the cardinal features of the Gridhrasi were selected, irrespective of their sex.

Exclusion criteria


The patients associated with the following conditions were excluded from the study:

  • diabetes mellitus
  • tuberculosis (TB)
  • Ca of lumbosacral (LS) plexus
  • Ca of cauda equina
  • pregnancy
  • anemia
  • leprosy


Agni karma Vidhi

Purva karma


  • Patient was advised to take Snigdha and Pichchhila diet on the day of Agni karma.
  • Informed consent of the patient was taken.
  • The local part of the patient was painted with Triphala Kwatha.


Pradhana karma

  • At the site of Antara-Kandara-Gulpha-Madhya (popliteal fossa and at the level of sciatic notch), 15-30 Bindu (Bindu type) of Samyak Dagdha Vrana were made.
  • ½Angul (approx. 1 cm) space between two Samyak Dagdhas was maintained.


Pashchat karma

  • Gel of Ghritakumari on Samyak Dagdha Vrana was applied to get rid of instant burning sensation.
  • Dusting of Yashtimadhu Churna was done on Samyak Dagdha Vrana and it was covered with a sterilized gauze piece.


Frequency of Agni karma

A total of six sittings ofAgni karma were done with a gap of 7 days between two subsequent sittings.

Follow-up

Follow up was done up to 1 month period.

Criteria for assessment of pain

The assessment was done chiefly on the basis of relief found in the cardinal signs and symptoms of the disease. To assess the effect of therapy on objective parameters, all the signs and symptoms were given a number for scoring, depending upon their severity, ranging from 0 to 3.

Criteria for assessing the total effect

  • Cured: More than 75% relief in the complaints of patient
  • Marked improvement: 50-75% relief in the complaints of patient
  • Improvement: 25-50% relief in the complaints of patient
  • Unchanged: Up to 25% relief in the complaints of the patients



   Results and Observations Top


It was observed that maximum number of patients (51.72%) belonged to the age group of 40-60 years and 58.62% patients were females. In this study, it was noted that 96.55% patients were married and 86.20% patients were from middle economic class, 48.27% patients were housewives and 86.2% patients were from urban areas. Maximum 79.31% had reported sound sleep and 37.93% were having more than 2 years history of the disease. Maximum patients (96.55%) were of Vata Kaphaja Prakriti, and 51.16% patients were having Krura Koshtha. Also, 55.17% patients were of Madhyama Satva, and 58.62% patients were of Madhyama Vyayama Shakti. Maximum patients were of Aanoopa Desha, i.e., 86.20%. On evaluation of Nidana factors, it was revealed that 82.75% patients were having Katu Dravya atisevana. Diwaswapna was found in 100% of patients. Maximum patients, i.e., 51.72% were suffering from Chinta. History of Abhighata (trauma) was found in 10.34% of the patients only. Ruka (pain in sciatica nerve distribution), SLR (Straight Leg Raising) test positive and tenderness at sciatic notch were found in all the patients.

Effect of Agni karma in Group A (Panchadhatu Shalaka)

A relief of 71.42% from Ruka symptom was seen, and 56.25% relief was observed in SLR test which was statistically highly significant. In Gaurava, 71.42% relief was found which was significant statistically. Also, 60% relief in Toda, 50% relief in Stambha, 66.66% in Spandana and 33.33% relief in Aruchi were observed, which was statistically insignificant [Table 1].
Table 1 :Effect of Panchadhatu Shalaka (Group A; n = 8)


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Effect of Agni karma in Group B (Lauhadhatu Shalaka)

A relief of 68.75% from Ruka symptom, 100% relief in Spandana and 100% relief in Aruchi was found. In Toda, 50% relief was found; in Stambha and Tandra, no relief was found. In SLR (Straight Leg Raising) test, 31.25% relief was found which was statistically significant. In Gaurava, 80% relief was observed which is considered statistically insignificant [Table 2].
Table 2 :Effect of Lauhadhatu Shalaka (Group B; n = 7)


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Effect of Agni karma in Group C (Tamradhatu Shalaka)

A relief of 66.66% in Ruka symptom and 31.25% in SLR test were found and were highly significant statistically. In Toda, 100% relief was found. Also, 66.66% relief in Stambha symptom, 50% relief in Aruchi and 28.57% relief in Gaurava symptom were found, which were statistically insignificant [Table 3].
Table 3 :Effect of Tamradhatu Shalaka (Group C; n = 7)


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The comparison statement of the study showed in [Table 4] and [Table 5] that Tamradhatu Shalaka provided better result in all aspects of signs and symptomatology of Gridhrasi in constrast to the other two Shalakas.
Table 4 :Comparative result of three Shalakas (Groups A, B, C)


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Table 5 :Overall effect of the therapy


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Post-Agni karma Vrana

The mild wound scar formed by Agni karma Shalaka completely healed within a week and the scar disappeared within 2 weeks of post-Agni karma period.


   Discussion Top


Highest incidence of the disease was reported in age group of 40-60 years, which is Vata Prakopaka Kala. According to modern science there is a progressive decrease in the degree of hydration of the intervertebral disk with age, which leads to the cycle of degeneration process, resulting in disk problems and causing Gridhrasi (sciatica). Higher incidence was observed in females, probably because of the fact that they do not take proper care of the spine while doing more strenuous works like lifting weights, bending, sitting and sustained non-neutral postures which predisposed them to sciatica. Geographic proportion of Hindus in the city might be a reason for its higher incidence in Hindu community. Majority of the patients reported sound sleep which might be due to the relief in lying position. Maximum percentage of more than 2 years of chronicity showed inadequate attention toward their health. Maximum patients were having Krura Koshtha which reflects the role of Agnimandya and constipation in the pathogenesis of Gridhrasi. Shushkashaka, Adhyashana, Alpashana and Kathina Bhojana types of Aharaja Nidanas were responsible for Vata Prakopa and degenerative changes in the body. Diwaswapna, Vega Sandharana, Aticheshta and Bharavahan like Viharaja Nidanas may be the precipitative factors as they cause Vata Kapha-Prakopa and strain on spine directly. Chinta was one of the causative factors of Vata in Manasika Nidana. Under Agantuja Nidanas, Abhighata was one of the direct causes producing this disease. Apart from these factors, multiple pregnancy, neuritis, chronic constipation, and history of trauma support the hypothesis that the presence of prior Kha-Vaigunya increased the incidence of acquiring disease of that Srotas. After evaluation of cardinal signs and symptoms, presence of maximum Vataja symptoms followed by Vata-Kaphaja type of symptoms was found. As per the classics, Gridhrasi is of two types, i.e., Vataja and Vata-Kaphaja. But in this study, only Vata-Kaphaja type of Gridhrasi had been found. SLR test was used as an objective parameter for the diagnosis, assessment of severity of disease and also as a parameter for estimation to know the effect of therapy.


   Conclusion Top


Agni karma therapy is result oriented for sthanika involvement of Vata in Vatakaphaja disorders. It is an ambulatory treatment modality and affordable to the common man. No significant changes have been seen in routine investigations of blood, urine, as well as plain X-ray of LS spine after the treatment. Thickness of Shalaka plays an important role to maintain constant and optimum temperature. To maintain the constant temperature, all Shalakas were bearing equal weights of 100 g. Tip of the Shalaka was sufficiently pointed enough to create Bindu Dahana Vishesa. The patients were given six sittings of Agni karma in this study with an interval of 7 days between two sittings. It is further suggested that more number of sittings may be required depending upon chronicity and severity of the disease. The comparison statement of the study showed that the Tamra Dhatu Shalaka provided better result in many aspects of signs and symptomatology of Gridhrasi in contrast to other two Shalakas, i.e., Lauha and Panchadhatu Shalakas.

 
   References Top

1.Sushruta , Sushruta Samhita, Ayurveda Tatvasandipika Hindi commentary, by Kaviraj Dr. Ambika dutta Shashtri. 17 th ed. Su.su.12/10, Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 39.  Back to cited text no. 1
    
2.Sushruta, Sushruta Samhita, Ayurveda Tatvasandipika Hindi commentary, by Kaviraj Dr. Ambika dutta Shashtri. 17 th ed. Su.Ch.4/8, Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 26.  Back to cited text no. 2
    
3.Charaka Samhita: By Chakrapani with Ayurveda Dipika Commentary. Bombay: Nirnaya Sagar Press; Ch. Ch.28/101. 1941.  Back to cited text no. 3
    
4.Haslett C, Chilvers ER, Hunter JA, Boon NA. Davidson's principles and practice of Medicine. 18 th ed. In: Britton R, editor. Toronto: Churchill Living Stone; 1999..   Back to cited text no. 4
    
5.Sushruta, Sushruta Samhita, Ayurveda Tatvasandipika Hindi commentary, by Kaviraj Dr. Ambika dutta Shashtri. 17 th ed. Su.su.12/3, Varanasi: Chaukhambha Sanskrita Sansthana; 2003. p. 38.  Back to cited text no. 5
    
6.Sushruta, Sushruta Samhita, Ayurveda Tatvasandipika Hindi commentary, by Kaviraj Dr. Ambika dutta Shashtri. 17 th ed. Su.su.12/4, Varanasi: Chaukhambha Sanskrita Sansthana; 2003, p. 38.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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