A Piloting Study on Godugdha Yukta Vaitaran Basti in Vataja Gridhrasi (Sciatica) Sriram Chandra Mishra *

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1 ORIINAL RESEARCH A Piloting Study on odugdha Yukta Vaitaran Basti in Vataja ridhrasi (Sciatica) Sriram Chandra Mishra * * Vyas Ayurveda MAhavidyalaya, Khurja Received: June / Published: August reentree roup International Journal of Ayurveda and Pharmaceutical Chemistry, Mishra Vol., Issue, vdsriram@yahoo.com reentree roup

2 Abstract ridhrasi (Sciatica) is a major health problem related to locomotor system in both developed and developing countries. There is close association between low back pain and Sciatica. The prevalence data on low back pain and Sciatica shows the problematic status of the disease. As many as % of patients with acute back pain return to work within three months, but many experience symptoms of recurrence and function limitations. This hospital based observational piloting study on odugdha yukta Vaitaran basti evaluates its therapeutic efficacy on Vataja ridhrasi. For control study, Katibasti with sahacharadi tailam is taken which is a well known & proven procedure for lumbosacral disorders. The study was conducted on sixty clinically diagnosed cases of Vataja ridhrasi (Sciatica) on the basis of various subjective & objective scientific parameters. Clinically and statistically s were observed after completion of therapy which was more in Vaitaran basti group rather than Katibasti group. Both drugs were well tolerated and patients were not forced to discontinue drug treatment out of drug intolerance. However in the series of trial % recovery leading to Cure could not be achieved. This may be due to the reason that Basti chikitsa is said to be Ardhachikitsa. odugdha yukta Vaitaran basti has been found to be an effective therapeutic regimen in the management of Vataja ridhrasi. Keywords Vaitaran basti, ridhrasi (Sciatica), odugdha (Cow milk) INTRODUCTION ridhrasi (Sciatica) is enumerated under eighty types of Nanatmaja Vata vyadhis and Basti chikitsa is described as Ardhachikitsa for Vatavyadhies []. There are two groups of symptoms found in ridhrasi i.e. Vataja and Vatakaphaja. There is also indications of two types of Vaitaran basti i.e. omutra yukta (cow s urine used ref. Chakradutta [] ) and odugdha Yukta (cow s milk used ref. Vangasen [] ). Critical studies of the above two Samhitas confers that omutra yukta Vaitaran basti is used in case of Vatakaphaja ridhrasi where as odugdha yukta Vaitaran basti is used in case of Vataja ridhrasi. The present piloting study on odugdha yukta Vaitaran basti in Vataja gridhrasi (sciatica) has been planned and implemented with emphasis on easy administration, random availability, no known side effects, low cost and textual reentree roup

3 reference etc. Control studies are done using Katibasti with sahacharadi tailam which is a well known & proven procedure for lumbosacral disorders. Aims and Objectives This study aims to evaluate the therapeutic efficacy of odugdha Yukta (cow s milk used) Vaitaran basti on Vataja ridhrasi. The study was carried out at opabandhu Ayurved Mahavidyalaya, Puri. Out of the resembling cases of ridhrasi (Sciatica) having Vatik type complains, sixty cases were selected according to the selection criteria. They were divided into two groups (T I & T II ) keeping behind parity in the age, sex etc. T I were treated with odugdha yukta Vaitaran basti and T II were treated with Katibasti with sahacharadi tailam. MATERIALS AND METHODS Study Design T I (BT) vs. T I (AT) - Effectiveness of treatment group - I will be assessed T II (BT) vs. T II (AT)- Effectiveness of treatment group - II will be assessed Subjective criteria Low back pain radiating to foot (left / right / both) Stiffness (Stambha) Pain (Ruk) (Numeric pain scale) [] Pricking sensation (Toda) Fasciculation (Spandana) Objective Criteria Lumbar spine mobility (LSM) test Oswestry disability (OD) index[] The low back outcome score (LBOS) scale of reenough & Fraser[] Straight leg raising test (SLR / Sakti akshepa nigraha) The Exclusion Criteria Vatakaphaja ridhrasi (Sciatica having kapha predominance symptoms) Traumatic, infective, neoplastic conditions of spine Those who are crippled & bed bound (as per Oswestry disability index -. rade & ) Drug, Dose and Duration Vaitaran basti - 7 ml / dose, once daily, empty stomach per rectum for 8 days. [Saindhava Lavana (Rock salt) gm, uda (ur) gm, Amleeka (Tamarind) 8gm, Tila taila (Sesame oil) ml, odugdha (Cow milk) ml] Katibasti with sahacharadi tailam as per requirement locally for 8 days. RESULTS AND DISCUSSION The clinical has been ascertained on the presence of Subjective reentree roup

4 criterias as well as Objective Criterias after treatment basing on clinical assessment criteria [Table-]. The Clinical assessment of results obtained basing upon the cardinal clinical features i.e. Straight leg raising test (SLR), Lumbar spine mobility (LSM) test, Oswestry disability (OD) index, The low back outcome score (LBOS) scale of reenough & Fraser was classified in view of percentage of as follows: ridhrasi (Sciatica) can occur among various occupations that are prone to more physical works because they have to sustain higher load on their spine [Fig-]. Regarding Chronicity it is found that maximum was in > - yrs of chronicity group [Fig-]. The chronicity is due to the greatest stress and progressive degenerative changes of discs. Figure Th e i n c i d e n c e o f a g e Maximum > 7% / Cured Moderate > % to 7% Mild > % to % Unsatisfactory Negligible ( %) Observations on data - The study reveals that after the middle age, people are more prone to ridhrasi (Sciatica). The highest incidence is found in the fourth-fifth decade [Fig-]. This is Vata Prakopaka Kala (aggravation period) and according to modern science there is progressive decrease in degree of hydration of the intervertebral disc with age that leads to the cycle of degeneration resulting in disc problems and causing ridhrasi (Sciatica). About occupational status this study reveals that Table Clinical assessment criteria of the disease Figure S h o w i n g t h e i n c i d e n c e o f o c c u p a t i o n a l s t a t u s Figure S h o w i n g t h e I n c i d e n c e o f C h r o n i c i t y S t a t u s reentree roup

5 Low back pain radiating to foot (Sphik Purva Kati Pristha Uru Janu Jangha Pada Kramat Vedana) Stiffness (Stambha) Pain (Ruk) (The Numeric Pain Scale) Pricking sensation (Toda) Fasciculation /Twitching (Spandana) Straight leg rising test (SLR / Saktiakshapa nigraha) Lumbar Spine Mobility (LSM) test The Low Back Outcome Score (LBOS) Pain in lumber region not radiates to anywhere. Pain in lumber region radiates up to thigh. Pain in lumber region radiates to calf. Pain in lumber region radiates to foot. No stiffness Mild Stiffness Moderate Stiffness Severe Stiffness Pain Free Mild Pain Moderate Pain Severe Pain No Pricking Sensation Mild Pricking Sensation Moderate Pricking Sensation Severe Pricking Sensation No fasciculation Occasionally discontinued fasciculation Occasionally continued fasciculation Persistent continued fasciculation Improvement rade Severity rade > 7 (Normal) I (Unsatisfactory) - 7 (Mild form) I - (Mild) - (Moderate form) I - (Moderate) (Severe form) I > (Maximum) > cm from L.S. Junction during forward bending > - cm from L.S. Junction during forward bending > - cm from L.S. Junction during forward bending cm from L.S. Junction during forward bending Scoring (Excellent status) - Scoring (ood status) I cm (Unsatisfactory) I > - cm (Mild) I > cm (Moderate) I > cm (Maximum) I - (Unsatisfactory) I - (Mild) reentree roup

6 The Oswestry Disability (OD) Assessment scale (Oswestry disability index -.) - Scoring (Fair status) I (Moderate) - Scoring(Poor status) I (Maximum) No disability (%) I > % - % (Minimal disability) % - % (Moderate disability) % (Severe disability) - 8 % (Crippled) 8 - (Bed bound) > % (Unsatisfactory) I - % (Mild) I > - % (Moderate) I No disability (%) (maximum improve) N.B.,,, are respective rades of Severity of symptoms and I, I, I, I are respective rades of Improvement in symptoms Response of treatment - odugdha yukta Vaitaran basti exhibits good clinical in terms of relieving individual symptoms as well as reducing the severity of disease. As regards subjective and objective parameters all patients belonging to T I & T II were got relief, which has been critically assessed in the language of percentage. So far the of cardinal sign symptoms in the present study, the percentage being 8. % &. % in Radiation of pain,. % &. % in Stambha (Stiffness), 8. % &. % in Ruk (Pain),.77 % &. % in Toda (Pricking sensation),. % &. % in Spandana (Fasciculation) among Trial group-i (T I ) & Trial roup-ii (T II ) reentree roup respectively. Considering the vital objective parameters, the percentage of being 7. % & 8.8 % in S.L.R test,. % &. % in L.S.M. test, 8.88 % &. % in L.B.O.S. scale,. % &. % in O.D. index among T I & T II, respectively [Table,, ]. The clinical assessment of results proves the efficacy of odugdha yukta Vaitaran basti which shows that maximum cases are got moderate [Table ]. The statistical adjudication with suitable parameters for different sign and symptoms shows highly significant at. % level [Table ]. Discussion on acceptability of trial drug The trial drug was selected from ayurvedic text Vangasen samhita. It mainly comprising of Saindhava Lavana (Rock salt), uda

7 (ur), Amleeka (Tamarind), Tila taila (Sesame oil) and odugdha (Cow milk). Table Showing the presence of Cardinal features, Degree of severity in T I T I Radiation of pain Stambha (Stiffness) Ruk (Pain - Numeric scale) Toda (Pricking sensation) Spandana (Fascicula tion) S.L.R test L.S.M. test L.B.O.S. scale O.D. index Presenc e of cardina l feature s BT Before Treatment BT (Severity grade) AT (Severity grade) f % f % f % f % f % f % f % f % AT After Treatment f - Frequency % - Percentage ,,, Respective radations Table Showing the presence of Cardinal features, Degree of severity in T II T I Presen ce of cardin al featur es BT (Severity grad) AT (Severity grade) f % f % f % f % f % f % f % f % Radiation of pain Stambha (Stiffness) Ruk (Pain Numeric scale) Toda reentree roup 7

8 (Pricking sensation) Spandana (Fascicula tion) S.L.R test L.S.M. test L.B.O.S. scale O.D. index BT Before Treatment AT After Treatment f - Frequency % - Percentage ,,, Respective radations Table Percentage average in T I & T II Average % of T I T II Radiation of pain 8.. Stambha (Stiffness).. Ruk (Pain - Numeric scale) 8.. Toda (Pricking sensation).77. Spandana (Fasciculation).. S.L.R test L.S.M. test.. L.B.O.S. scale O.D. index.. T I Treatment roup, T II Treatment roup There were no unpleasant incidents or side effects due to Vaitaran basti therapy. Another advantage of Vaitaran basti is that it is easy to constitute, less time consuming and gives least discomfort to both patient and physician. It is cheap as compared to other conventional methods of management reentree roup 8 of ridhrasi (Sciatica). While returning through rectum, it decreases the intra abdominal pressure by cleansing the bowel through evacuation of fecal matter during the course of basti. TABLE Clinical Results S. No. Clinical assessment Maximum / Cured Moderate Mild After treatment (8 Days) T (n = ) T (n = ) f % ƒ % Unsatisfactory T I Treatment roup, T II Treatment roup n No of patients The composition of Vaitaran basti is such that it strongly reduces the pain and prevents the degenerative processes. Modern researches also appreciate individual action on bone and bone marrow to promote strong

9 bones. On the whole, keeping in consideration the composition and there multidimensional effect, it can be inferred that the nutrient property of uda (ur), Tila taila (Sesame oil) and odugdha (Cow milk) work against vitiated Vata due to loss of dhatus (Dhatukshaya). The obstruction of reentree roup passage of Vata (Margavarodha) can be eliminated due to anti-inflammatory benefit attributed to Amleeka (Tamarind) and Saindhava Lavana (Rock salt). TABLE Statistical analysis showing the effectiveness of trial-i & trial-ii with respect to different sign & symptoms Sign & Symptoms Radiation of pain Stambha (Stiffness) Ruk (Pain - numeric scale) Toda (Pricking sensation) Spandana (Fasciculation) S.L.R test Treatment roup T I T II T I T II T I T II T I T II T I T II T I T II Duration Mean ± S.D. Mean diff. ± S.E B.T..8 ±. A.T.. ±. B.T..77 ±. A.T..87 ±.8 B.T.. ±.8 A.T.. ±. B.T..7 ±.8 A.T.. ±.8 B.T..8 ±. A.T.. ±. B.T..8 ±. A.T.. ±.7 B.T.. ±.7 A.T..7 ±. B.T..7 ±. A.T.. ±. B.T.. ±. A.T.. ±. B.T.. ±. A.T.. ±.7 B.T.. ±. A.T.. ±.7 B.T..7 ±. A.T.. ±. d. f. (n- ) t Value. ±...±...±...±...±...±...±..8.±...±..8.7±..8.±. 7..7±.7.7 p - Value Remarks

10 T I L.S.M. test T II T I L.B.O.S. scale T II T I O.D. index T II B.T..7 ±..±.. A.T.. ±.7. B.T..7 ±.7.±.. A.T.. ±.7. B.T.. ±..±.. A.T.. ±.. B.T.. ±..±.. A.T.. ±.8. B.T..7 ±..±.. A.T.. ±.. B.T..7 ±..±..78 A.T.. ±.. T - Trial roup P-Value Probability at. % level t - Value Test of Significance d. f. Degree of freedom n = No. Of Patients Highly significance at.% lvl CONCLUSION The nature of incurability and abandancy of ridhrasi (Sciatica) has inspired to undertake such a problem. The clinical assessment of results proves the efficacy of Vaitaran basti (odugdha yukta) with moderate in symptoms. However, in the series of trial % recovery leading to cure could not be achieved. This may be due to the reason that Basti chikitsa is said to be Ardhachikitsa. One may try Basti chikitsa along with other chikitsa to get % results. Hence Vaitaran basti (odugdha yukta) is acceptable for the management of Vataja ridhrasi (Sciatica) which is proved by the response of the above clinical trial. reentree roup

11 REFERENCES [] Brahmananda Tripathy, Charakasamhitha Sidhisthana chapter sloka -, Chaukhambha Surabharati Prakashana () p.. [] P.V.Sharma, Chakradatta chapter 7 sloka, Varanasi: Chaukhambha Publishers (8) p. 8 [] Jain Sankarlalji Vaidya, Vangasenasamhitha Bastikarmaadhikara, Khemnath Srikrishnadas publishers () p.. [] McCaffery, M., & Beebe, A. Pain: Clinical Manual for Nursing Practice. Baltimore: V.V. Mosby Company. () [] reenough C Fraser RD. Assessment of outcome in patients with low-back pain. Spine. ; 7: - (Table page 7). [] Fairbank JC, Pynsent PB, The Oswestry Disability Index. Spine ; ():- Mishra Vol., Issue, vdsriram@yahoo.com reentree roup