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CLINICAL RESEARCH
Year : 2016  |  Volume : 37  |  Issue : 1  |  Page : 26-31  

Role of Raktamokshana by Ghati Yantra in treatment of Gridhrasi (sciatica): A pilot study


1 Department of Rachna Sharir, Bhausaheb Mulak Ayurved Mahavidyalaya, Nagpur, Maharashtra, India
2 Samadhan Ayurved Hospital, Nagpur, Maharashtra, India
3 Department of Conservative Dentistry, VSPM's Dental College and Hospital, Nagpur, Maharashtra, India

Date of Web Publication17-Jul-2017

Correspondence Address:
Minakshi Kumbhare-Patil
Plot No. 63, Gittikhadan Layout, Pratap Nagar, Nagpur - 440 022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ayu.AYU_212_15

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   Abstract 


Introduction: The incidence rate of Gridhrasi (sciatica) is quite significant as more than three-quarters of the world's population are affected by the disease. It is characterized by the onset of Ruja (pain), Toda (pricking), and Stambha (stiffness), initially in Sphika (gluteal region) and then radiating distally to Kati-Prishtha (low back), Janu (knee), Jangha (thigh) till Pada (feet). The patients suffering from Gridhrasi have restricted movements due to painful limb, affecting the daily routine activities. Aim: To assess the role of Raktamokshana (blood letting) done by Ghatiyantra in the patients suffering from Gridhrasi. Materials and Methods: The study was conducted on twenty patients who had reported for the treatment of Gridhrasi at an Ayurvedic hospital. Raktamokshana was done on Sphik (gluteal region) or Kati (low back) region with the help of 18 no. needle and Ghatiyantra (Kanchapatra) in four settings (0, 5th, 10th and 15th day). The sign and symptoms, namely Ruka, Toda, Stambha, and Spandana (fasiculation) were given scores depending on their severity. The patients were also assessed for straight-leg raise (SLR) test. Follow-up was done at an interval of 5 days for three times and the scores were noted down before and after treatment. The scores were analyzed by SPSS 18 software using Student's t-test. Results: Marked reduction in severity of mean scores of Ruja, Toda, Stambha, and Spandana was seen in the patients after the use of Ghatiyantra for Raktamokshana, which was statistically significant. Conclusions: Ghatiyantra is the simple and effective treatment (in adjunct to other treatment) for reducing Ruka, Toda, Stambha, and Spandana in Gridhrasi.

Keywords: Ghatiyantra, Gridhrasi, sciatica, straight-leg raise (SLR) test


How to cite this article:
Kumbhare-Patil M, Gahukar DB, Patil SN. Role of Raktamokshana by Ghati Yantra in treatment of Gridhrasi (sciatica): A pilot study. AYU 2016;37:26-31

How to cite this URL:
Kumbhare-Patil M, Gahukar DB, Patil SN. Role of Raktamokshana by Ghati Yantra in treatment of Gridhrasi (sciatica): A pilot study. AYU [serial online] 2016 [cited 2020 Aug 6];37:26-31. Available from: http://www.ayujournal.org/text.asp?2016/37/1/26/210952




   Introduction Top


The word Gridhrasi suggests the abnormal gait of patient similar to vulture. It affects the ambulatory function of the patient.[1] The people who are suffering from Gridhrasi cannot stand or sit properly due to painful limb continuously drawing his/her attention. This pain can also be compared with the pain experienced by the prey of vulture while being eaten up posing a serious threat to the quality of life, especially for those who are working. A similar condition in the modern science is sciatic syndrome or sciatica.[1] The incidence rate of this disease is significant as more than three-quarters of the world's population experiences lower back pain at some or other time during their course of life and it is the most common cause of sickness which results in the absence from work. 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.[2]

Sciatica is characterized by severe pain radiating from lower back to the leg caused by compression, irritation, or inflammation of the sciatic nerve. The main cause behind the irritation of sciatic nerve is a degenerative pathology of intervertebral disc such as bulging, desiccation, prolapse of the intervertebral disc, reduction in the intervertebral space and sacralization of vertebra and spinal canal stenosis.

In Ayurveda, Gridhrasi is described as one of the Vatavyadhi. It is characterized with the onset of Ruja (pain), Toda (pricking), and Stambha (stiffness), initially in Sphika (gluteal region) and then radiating distally to Kati-Prishtha (low back), Janu (knee), Jangha (thigh) till Pada (feet).[3],[4]

The line of management includes Basti Chikitsa, Agnikarma, and Siravyadha. As Vata involvement is evident with or without Kapha due to pain and disability, Snehana (oleation) and Swedana (fomentation) Chikitsa are also advised as a treatment.[5],[6] However, in Gridhrasi, as Snayu and Rakta are involved, Agnikarma and Siravyadha (venepuncture) are also the choice of treatment.[7] The role of simple, safe, economical, and practicable Ayurvedic procedures such as Siravyadha has been studied less in the management of Vatavyadhi such as Gridhrasi. Acharya Sushruta has also mentioned that diseases those are not relieved effectively by Snehana, Lepanadi therapeutic measures, Siravyadha is a management to achieve better and earlier results.[8]Raktamokshana (blood-letting) by Siravyadha is considered to be the supreme as it drains out the vitiated Rakta and cures the disease.[9]

In the present study, patients having symptoms of Gridhrasi were treated by Raktamokshana using a specific bell-like glass instrument called Ghatiyantra.


   Materials And Methods Top


The study was conducted on the patients who reported in the outpatient department and inpatient department for the treatment of Gridhrasi (sciatica) at a private Ayurvedic hospital. For the present study, Ghatiyantra - which is a medium sized glass jar (with one end open), a kind of cupping instrument used in Unani medicine was used. It is smooth and it can be placed easily on the affected body part. Other materials used for the procedure were spirit, sterilized gauze piece pad, match box, needles and forceps [Figure 1].
Figure 1: Materials used(

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Total twenty patients of both sexes in the age group of 30-60 years were selected for the study for a period of one year. The patients were adviced not to take any pain killers during the study period and were allowed to take essential medications for diabetes and blood pressure etc., A detailed history of the selected patients was taken, along with the duly signed informed consents.

Inclusion criteria

  1. Patients with classical features of Gridhrasi, namely, pain over the Sphik (gluteal region), Kati Prushta (back), Uru (thigh), Janu (knee), Jangha (calf region), extending up to Pada (foot) which is associated with Stambha (stiffness), Toda (pricking pain), tingling and numbness of limbs, difficulty in walking, were included in the study
  2. Patients with positive straight-leg raise (SLR) test.


Exclusion criteria

  1. Cases of spondylolisthesis, sacroiliac arthritis, herpes simplex infection causing radiating pain
  2. Tuberculoma, or any cyst compressing the nerve root, diabetic neuropathies were excluded from the study.


Procedure

Purva Karma (preoperative procedure)

Before commencing the procedure, SLR test of the patients was done. For this, patients were asked to lie down in supine position on examination table and raise their legs straight and the angle was measured.

The patients were adviced to take Yavagu of rice (a rice:water in the ratio of 1:6 was cooked to form a semisolid paste) before coming to procedure. The patient was advised to lie in the prone position. Then, the patient was asked to point the highly affected area on Sphika or Kati-Prishtha by fingers. Then the site of blood-letting was selected and disinfected with povidine – iodine solution.

Pradhana Karma (main procedure)

On selected and disinfected area 3–4 pricks were given with the help of 18 number needle which leads to pinpoint bleeding [Figure 2]. Then, the Ghatiyantra was wiped from inside with spirit gauze [Figure 3] and heated with matchstick [Figure 4], which was then quickly placed on the bleeding points [Figure 5] and [Figure 6]. As the Ghatiyantra was flamed inside, it creates a vacuum because of the consumption of oxygen by the flame which raises the local area to form a bulge and oozing of the blood occurs [Figure 7]. It was kept in the same position till the blood flow stops and blood clots, after which Ghatiyantra was removed [Figure 8] and the area was cleaned with sterile gauze piece.
Figure 2: Pricking by needle

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Figure 3: Coating Ghatiyantra with spirit

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Figure 4: Agni Prajwalana (heating with matchstick)

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Figure 5: Keeping Ghatiyantra on affected area

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Figure 6: Ghatiyantra in place

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Figure 7: Oozing of the blood

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Figure 8: Removal of Ghatiyantra

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Paschata Karma (postoperative procedure)

The removed Ghatiyantra left a ring shaped mark on the affected area [Figure 9] which was massaged by soft hand [Figure 10] and the patient was asked to take rest.
Figure 9: Ring mark on the area of application of Ghatiyantra

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Figure 10: Massage with soft hand

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The patient was recalled for follow-up for three times at an interval of 5 days. Patients were also observed for any improvement in SLR test after the use of Ghatiyantra, during the follow-up visits.

Assessment criteria

Subjective symptoms presented by the patients were given score and were assessed before and after performing of Raktamokshana by Ghatiyantra. In objective parameters SLR test was done and angle with the help of protractor was noted for comparison.



Gradation for Subjective parameters

Ruja (pain)

0: No pain

1: Painful, walks without limping

2: Painful walks with limping but without support

3: Painful can walk only with support

4: Painful unable to walk.



Stambha (stiffness)

0: No stiffness

1: Mild stiffness

2: Moderate stiffness

3: Severe stiffness

4: Very severe stiffness.



Toda (pricking type of pain)

0: No pricking sensation

1: Mild pricking sensation

2: Moderate pricking sensation

3: Severe pricking sensation.



Spandana (fasciculation)

0: No fasciculation

1: Mild fasciculation

2: Moderate fasciculation

3: Severe fasciculation.



Statistical analysis

The statistical analysis was done by applying paired t-test using SPSS version 18 software (IBM Corporation, Armonk, New York, U.S.).


   Results Top


In case of the symptom Ruja, it was observed that after the use of Ghatiyantra, eight patients out of 20 (40%) got 100% relief with reduction of intensity from score 4 to 0, and in remaining patients, 50–90% reduction in pain was seen. The mean score before treatment was 2.55, while after treatment, the mean score was 0.75 which was statistically significant with p < 0.001 [Table 1].
Table 1: Effect of Raktamokshana by Ghatiyantra on sign and symptoms of Gridhrasi (sciatica)

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In case of Toda, 14 patients out of 20 patients (70%) the score reduced from 3 to 0 (100%), and in remaining patients, 70–90% reduction was seen. The mean score before and after treatment was found to be 2.35 and 0.35 respectively which was statistically significant [Table 1].

In case of Stambha, 6 patients out of 20 (30%) have got reduction in score from 4 to 0 (100%), and in remaining patients, 60–80% improvement was seen. The mean score of Stambha was 2.35 before treatment and 0.75 after treatment which was statistically significant [Table 1].

Similarly, in case of the symptom Spandana, it was seen that after the use of Ghatiyantra, 14 patients out of 20 (70%) got 100% relief with score reducing from 3 to 0, and in remaining patients, 60–90% relief was seen. The mean score before treatment was 1.55 which was observed to decline to 0.30 with p < 0.001 which was statistically highly significant [Table 1].

After the use of Ghatiyantra, the SLR test shows improvement up to 25% in first 5 days, 40% in 10 days, and 80–90% at the end of 15 days. The mean value for SLR test was found to be 36.25° before treatment which has increased to 80° with statistically high significance [Table 1].


   Discussion Top


Referring to previous study [9], in Gridhrasi, the main affected area was Sphik, i.e., gluteal region and Kati, i.e., lumbar spine and there is often a history of trauma as twisting of the spine, lifting heavy objects, or exposure to cold; similar findings were also seen in the present study.

Acharya Charaka has described Siravyadha, Basti Karma and Agnikarma in the management of Gridhrasi. Acharya Sushruta has mentioned that diseases, which are not relieved by Snehana, Lepanadi therapeutic measures can be treated with Siravyadha as an emergency management. Siravyadha is also accepted as half of the therapeutic measure in Shalya Tantra like Basti in Kayachikitsa. In Panchakarma Chikitsa, the vitiated. Doshas are purified whereas in Siravyadha vitiated Rakta Dhatu is removed.

The susceptibility of Rakta towards impurity is so versatile that the classics were compelled to agree upon Rakta as fourth Dosha. Dushita (vitiated) Rakta from the related Siras (veins) should be let out to protect the health or to remove the disease. The symptoms and Samyaka Siravedha are Laghavam (body and painful area) and Vedanashanti (pain reduction), bleeding stop itself, it means the pain arising from a disease condition get subsided followed by decrease in the symptoms of the disease so Siravedha can be used in pain predominant diseases.[10],[11],[12]

In previous studies,[4],[7] researchers used Siravyadha to let out Rakta Dhatu along with vitiated Doshas and reported that Siravyadha gives spontaneous relief in the cardinal symptoms of Gridhrasi due to release of impurities or Doshas from the affected area. Similarly in the present study vitiated Doshas along with Rakta Dhatu was let out by pricking with needle on affected area, The vacuum created by the Ghatiyantra helps the vitiated blood to ooze out. which gives spontaneous relief from symptoms of Gridhrasi due to release of Doshas with the blood from the body.


   Conclusions Top


After using Ghatiyantra as a treatment modality in patients with Gridhrasi, it can be concluded that the use of Ghatiyantra imparts measurable reduction in the intensity of Ruja, Toda, Spandana, and Stambha which are the major symptoms of Gridhrasi. Ghatiyantra is the simple and effective treatment (in adjunct to other treatment) for Gridhrasi.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Singh MS, Kotangale YT, Burley AK. A comparative clinical study on the effect of Matra Basti and Rasna Gugglu in the management of Gridhrasi. Ayurlog Natl J Res Ayu Sci 2013;1:16-20.  Back to cited text no. 1
    
2.
Bakhashi B, Gupta SK, Rajagopala M, Bhuyan C. A comparative study of Agni Karma with Lauha, Tamra and Panchadhatu Shalakas in Gridhrasi (Sciatica). Ayu 2010;31:240-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Pandey RK, Bhatted S. Effect of Eranda Mooladi Basti along with other Ayurvedic formulation in gridhrasi (sciatica): A case report. Ann Ayurvedic Med 2013;2:109-13.  Back to cited text no. 3
    
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Fulzele A, Ingle N, Kadu A, Singh JP. Clinical evaluation of Agnikarma in management of Gridhrasi. Am J PharmTech Res 2013;3:440-6.  Back to cited text no. 4
    
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Padmakiran C, Ramachandra R, Prasad UN, Niranjan R. Role of Katibasti in Gridhrasi. International Ayurvedic Medical Journal 2013;1:1-5.  Back to cited text no. 5
    
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Lohith BA, Girish KJ. Clinical study to assess the effect of yoga in gridhrasi. IJRAP 2013;4:50-3.  Back to cited text no. 6
    
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Ali M, Shukla VD, Dave AR, Bhatt NN. A clinical study of Nirgundi Ghana Vati and Matra Basti in the management of Gridhrasi with special reference to sciatica. Ayu 2010;31:456-60.  Back to cited text no. 7
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8.
Chaturvedi S, Katara P. Role of Agnikarma and Rakta Mokshana Karma in Gidhrasi WSR to Sciatica. International Journal Science and Reasearch 2014;3:359-62.  Back to cited text no. 8
    
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Umale NP, Shylaja RK. Efficacy of Siravedha in the management of pain in Gridhrasi. International Ayurvedic Medical Journal 2013;1:50-5.  Back to cited text no. 9
    
10.
Shastri RD, editor. Charak Samhita of Agnivesha, Chikitsa Sthana, Ch. 5, Ver. 137-139. Reprint ed. Varanasi: Chaukhamba Bharti Academy; 2006. p. 216.  Back to cited text no. 10
    
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Shastri AD, editor. Sushruta Samhita of Sushruta, Sutra Sthana, Ch. 8, Ver. 23. Reprint ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2007. p. 67.  Back to cited text no. 11
    
12.
Gupta AD, commentator. Upadhyay Y, editor. Astanga Hridayam of Vagbhata, SutraSthana, Ch.17, Ver.18-22. Reprint ed. Varanasi: Chaukhamba Sanskrit Sansthan, 2005. p. 148-152.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
 
 
    Tables

  [Table 1]



 

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