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  Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 34  |  Issue : 1  |  Page : 86-89  

Efficacy of traditional treatment regimen on Kati Shoola with special reference to lumbar spondylolisthesis


1 Professor, Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Rajagiriya, Sri Lanka
2 Medical Officer, Ayurvedic Teaching Hospital, Borella, Sri Lanka
3 Probationary Lecturer, Institute of Indigenous Medicine, University of Colombo, Rajagiriya, Sri Lanka

Date of Web Publication23-Jul-2013

Correspondence Address:
E. R. H. S. S. Ediriweera
Department of Nidana Chikitsa, Institute of Indigenous Medicine, University of Colombo, Rajagiriya
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.115435

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   Abstract 

According to Ayurveda, Kati Shoola is a disease with pain in lumbar region. Lumbar spondylolisthesis, anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below, is one of the common causes. Current case study was carried out at Ayurveda Teaching hospital, Borella, to evaluate the efficacy of a treatment regimen used by Sri Lankan traditional physician family "Weerasinghe." A 59-year-old female with a 9-month history of lumbar spondylolisthesis was treated with this regimen. The patient had progressive pain in left lower back, right and left buttocks, and difficulty in bending forward over 5°. X-ray of lumbo sacral region indicated that patient was suffering from Grade 3 lumbar spondylolisthesis. She was treated for 65 days with four treatment packages consisting of 13 prepared medicines. The response to the treatment was recorded and therapeutic effects were evaluated through symptomatic relief. Clinical symptoms were significantly reduced and degree of anterior flexion increased from 5° to 90°. However, X-rays indicated that the patient was still suffering from Grade 3 lumbar spondylolisthesis. This regimen is effective in successfully treating Kati Shoola (lumbar spondylolisthesis) by helping to reduce the symptoms and improving the degree of anterior flexion.

Keywords: Kati Shoola , lumbar spondylolisthesis, traditional medicine


How to cite this article:
Ediriweera E, Gunathilka H, Weerasinghe K, Kalawana O. Efficacy of traditional treatment regimen on Kati Shoola with special reference to lumbar spondylolisthesis. AYU 2013;34:86-9

How to cite this URL:
Ediriweera E, Gunathilka H, Weerasinghe K, Kalawana O. Efficacy of traditional treatment regimen on Kati Shoola with special reference to lumbar spondylolisthesis. AYU [serial online] 2013 [cited 2019 May 21];34:86-9. Available from: http://www.ayujournal.org/text.asp?2013/34/1/86/115435


   Introduction Top


Kati Shoola is a disease which is mainly caused by vitiation of Vata Dosha. Some ancient texts also describe Kati Shoola as a symptom of some disorders such as Kati Graha, Trika Graha, Prushta Graha, Kati Vayu, Trika Shoola, Prushta Shoola, Vataja Shoola, Trika Vedana, and Grudrasi Vata.[1],[2],[3] The word "spondylolisthesis" comes from the Greek words "spondylos" meaning spine or vertebra and "listhesis" meaning to slip or slide. Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. It occurs most often in the lumbar spine. Most patients are asymptomatic. Sometimes pain in the low back, thighs, and/or legs, which radiates into the buttocks, muscle spasms, leg pain, or weakness, tight hamstring muscles, and irregular gait can be seen. [4] This condition can be correlated with Kati Shoola.

The treatment regimen, which is described here, is used by the eminent Sri Lankan traditional physician family "Weerasinghe" to treat patients suffering from Kati Shoola successfully. The duration of the treatment is 65 days, using 13 different Ayurvedic and Sri Lankan traditional medicines. So far, no scientific evaluation has been carried out on the efficacy of this treatment regimen. Hence, this clinical study was undertaken.


   Case Report Top


A 59-year-old woman, who attended the Outdoor Patients Department of Ayurvedic Teaching Hospital, Borella, for treatment of her lower back pain, was selected and admitted to the ward. She had a 9-month history of progressively increasing pain in left lower back and both buttocks, but no pain in both legs. She was an otherwise healthy farmer, capable of doing heavy work. She had no history of trauma and her symptoms have increased gradually.

On physical examination, prominence of the upper posterior border of the sacrum was observed on the lower back. Patient had little discomfort in buttocks on turning to the lateral side. Straight leg raising test was negative in both legs. She could flex the body forward up to 5°. Motor and sensory functions were normal in right and left legs and both deep and superficial reflexes were also normal.

All details of the patient including present history, past history, treatment history, dietary habits, lifestyle, and addictions were recorded before the treatment. Necessary examinations and X-rays in lumbo sacral region were done and findings were recorded. Patient was kept on a normal diet without any specific restrictions and was advised not to lift any weights. The patient was treated with four treatment regimens for 65 days. Details are as below.

First treatment regimen (day 1-10)

The patient was treated for 10 days with 120 ml of decoction of Eranda Saptaka with Rasona Methi Abhaya and 30 ml of Punarnawasawaya twice a day before meals. She was also given two pills of Chandraprabha each weighing 250 mg with lukewarm water and 5 g of powder of Safufe Surinjan with honey twice a day after meals. Thirty milliliters of Nirgundi oil was applied on Kati Pradesha (lumbar region).

Second treatment regimen (day 11-20)

During the next 10 days, the patient was treated internally with 120 ml of decoction of Madhu Yashtee Nisha Yugma, and 5 g each of paste of Nawarathna and Thripala Churna twice a day before meals.

Siddhartha Taila Pichu was also carried out by soaking 20 g of cotton in 60 ml of Siddhartha Taila and keeping over Kati Pradesha for 60 minutes in the morning at 10.00 a.m. Then, in the afternoon at 2.00 p.m., 30 g of paste of Ankenda paste was applied on the lumbar region and kept on for 120 minutes.

Third treatment regimen (day 21-40)

For the third regimen of the treatment, patient was treated internally and externally as mentioned in the second treatment regimen. Additionally, 120 ml of decoction of Dashamula Wenivelgeta was given twice a day before meals from day 21 to day 40.

Fourth treatment regimen (day 41-65)

From day 41 to 65, the patient was treated internally with 120 ml each of decoction of Dashamula Wenivelgeta and decoction of Punarnawashtaka twice a day before meals. Siddhartha Taila Pichu was performed as described in the second treatment regimen. Thirty grams of paste of Wellangiriya was applied on lumbar region in the afternoon at 2.00 p.m. and kept on for 120 minutes.

Preparation of drugs

All medicines were prepared at the Pharmacy, Ayurveda Teaching Hospital, Borella, Sri Lanka, according to the Ayurvedic Pharmacopoeia, Department of Ayurveda, Sri Lanka. Decoction of Punarnawashtaka, Punarnawasawaya, pills of Chandraprabha, Thripala Churna, and Nirgundi oil were prepared according to the methods given in the classical text. [5] Bhaishayja Ratnavali.

Preparation of decoction of Dashamula Wenivelgeta

Five grams each of roots of Dashamula, seeds of Coriandrum sativum (Dhanyaka) and stem of Coscinum fenestratum are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.

Preparation of decoction of Eranda Saptaka with Rasona Methi Abhaya

Six grams of each of the ingredients of decoction of Eranda Sapthaka, pericarp of Terminalia chebula (Abhaya), seeds of Trigonella foenum (Methika), and bulb of Allium sativum (Rasona) are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.

Preparation of decoction of Madhu Yashtee Nisha Yugma

8.5 g each of roots of Glycyrrhiza glabra (Madhuyashti) and Stereospermum suaveolens (Patala), stem of Coscinum fenestratum, rhizomes of Curcuma longa (Haridra), tubers of Cyperus rotandus (Mustaka), stem bark of Azadirachta indica (Nimba), and Cassia fistula (Vyadighata) are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.

Preparation of paste of Nawaratna

Five grams of each of finely powdered seeds of Cumminum cyminum (Jeeraka), Nigella sativa (Krishna Jeeraka), Carum copticum (Ajamoda), Vernonia anthelmintica (Atavi jeeraka), Myristica fragrance (Jatiphala), fruits of Piper longum (Pippali), mace of the fruits of M. fragrance, calyx of Eugenia caryophyllus (Lavanga), stem of the G. glabra, roots of Piccorrhiza curroa (Tikta), rhizomes of Zingiber officinalis (Shunti), resins of Ferula foetida (Hingu), 130 g of finely powdered pericarp of T. chebula (Abhaya), and 65 g of finely powdered pericarp of Terminalia bellirica (Bibhitaka) are ground well, adding honey, till it becomes a fine paste. [6]

Preparation of powder of Safufe Surinjan

Forty-eight grams of roots of Colchicum luteum (Surinjan), 12 g each of seeds of C. cumminum, leaves of Cassia angustifolia (Swarnapatrika), Mentha viridis (Pudina), 36 g of pericarp of T. chebula, and 144 g of sugar candy are powdered together.

Preparation of Safufe Surinjan

Five hundred grams of each of the roots of Aegle marmelos (Bilva), Premna intergrifolia (Agnimantha), Oroxylum indicum (Shyonaka), Stereospermum suaveolens (Patala), Gmelina aborea (Kashmarya), Solonum melongena (Vruhathi), and Ricinus communis (Eranda), and entire plant of Alysicarpus Vaginalis (Bhumi Shalaparni), Aerava Lanata (Astmabayda), Solanum Xanthocarpum (Kantakari), Tribulus terrestris (Gokshura), and Sida cordifolia (Bala) are boiled in 92.16 l of water until the volume is reduced to 23.04 l and then filtered. 23.04 l each of extract of rhizomes of Asparagus racemosus (Shatawari), fresh cow's milk, and 5.76 l sesame oil are mixed with the above decoction and heated. Sixty grams of each of finely powdered seeds of Peucedanum graveolens (Shatapushpa), Eletteria cardamomum (Ela) and Carum copticum (Ajamoda); rock salt, stems of Santalum album (Shwetha Chandana), Pterocarpus santalinus (Rakta Chandana), and Coscinum fenestratum, roots of Withania somnifera (Vaji Gandha) and Nardostachys jatamansi (Jatamansi), rhizomes of Acorus calamus (Vacha), Alpinia galanga (Rasna), and Zingiber officinalis, entire plant of Rubia cordifolia (Manjishta), fruits of P. longum (Pippali) and Saussurea lappa (Kushta), purified Shilajatu, and rock alum (Sinhala name: Galmada) are added to the above solution. The whole mixture is heated while stirring continuously, and when it reaches "Samapaka" stage, the medicated oil is taken out from the fire, allowed to cool down, and filtered. [6]

Preparation of paste of Ankenda

Sixty milliliters of juice is extracted from leaves of Acronychia pedunculata (Ankota). Ten grams of finely powdered alum sulfate (Sphaticari) is added to it and heated until a semi-solid paste is obtained.

Preparation of paste of Wellangiriya

Forty grams of leaves of Paramignya monophylla is ground with 5 g of rhizomes of Curcuma longa and 5 g of common salt (Samudra Lawana), till it becomes a fine paste.


   Results and Discussion Top


Response to the treatment was recorded, and therapeutic effects were evaluated by symptomatic relief of the patient. It was observed that the patient's clinical symptoms were reduced gradually during the treatment period [Table 1]. Although these symptoms were reduced completely or partially at the end of the treatment, the X-ray of lumbar sacral region showed that there was no change in the condition of lumbar spondylolisthesis and the patient was still having Grade 3 lumbar spondylolisthesis.
Table 1: Evaluation of clinical symptoms

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According to the Ayurveda, Shoola (pain) occurs due to vitiation of Vata Dosha. Vata Dosha is vitiated by Srotas Awarodata (obstructions of channels) and Dhathu Kshaya (depletion of tissues/malnutrition). In Kati Shoola Apana Vata is mainly involved. So, the aim of the treatment is to pacify vitiated Vata Dosha, especially Apana Vata.

Ingredients of decoctions of Dashamula Wenivelgeta, Eranda Sapthaka with Rasona Methi Abhaya, Madhu Yashtee Nisha Yugma and Punarnawashtaka, Punarnawasawaya, pills of Chandraprabha, powders of Safufe Surinjan and Thripala, paste of Nawarathna, oil of Nirgundi and Siddhartha, and pastes of Ankenda and Wellangiriya have the properties of Vata Shamaka (pacify the vitiated Vata Dosha), Vedana Sthapana (sedative), and Shoola Prashamana (analgesic), Tarpana (enhance the nutrition), Balya (promote strength), Rasayana (rejuvenation), and Srotha Shodana (purifying channels). As the drugs used in the present study have the above properties, they are beneficial for diseases originating by vitiation of Vata Dosha. These drugs also have the properties of Tarpana (enhancing nutrition), Balya (promoting strength), and Rasayana (rejuvenation), and help in improving the qualities of Asthi Dhatu (bones) and reformation of wasting tissues. Patient suffering from Kati Shoola showed a significant symptomatic relief with this treatment regimen.


   Conclusion Top


It is concluded that this treatment regimen completely or partially relieves the symptoms in Kati Shoola (lumbar spondylolisthesis). These medicines can be utilized in treating patients who are suffering from Kati Shoola, to reduce both signs and symptoms successfully and with greater effectiveness. It is proposed that the therapy may be accepted as a treatment method of Kati Shoola (lumbar spondylolisthesis).

 
   References Top

1.Sharma PV, editor, Charaka Samhita, Chikitsa Sthana, Vata Vyadhi Chikithsa Adhyaya, 28/28, 2 nd ed. Varanasi: Chaukhamba Sanskrit Sansthan; 1990. p. 225.  Back to cited text no. 1
    
2.Murthy KR, editor and translator. Susruta Samhita, Nidanasthana, Vata Vyadhi Nidana 1/20. Varanasi, India: Chaukhambha Orientalia; 2000. p. 102-10.  Back to cited text no. 2
    
3.Murthy KR, editor and Translator. Madhava Nidana, Vatavyadhi Nidana 22/14, 57. Varanasi, India: Chaukhambha Orientalia; 1986. p. 65-90.  Back to cited text no. 3
    
4.Hasiett C, Chilvers ER, Boon NA, Colledge NR, Hunter JA, editors. Davidson's Principles and Practice of Medicine. Edinburgh, London, New York, Sydney, Toronto: Churchill Livingstone; 2002. p. 325-30.  Back to cited text no. 4
    
5.Sri Govindadasa. Baishajyaratnavali with Vidyothini Hindi Vyakhya. Varanasi, India: Chaukhambha Orientalia; 1991.  Back to cited text no. 5
    
6.Anonymous, Department of Ayurveda, Ayurveda Pharmacopoeia, Volume 2. Colombo, Srilanka: Department of Ayurveda; 1994. p. 228-303.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1]


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