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| CLINICAL TRIAL |
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| Year : 2013 | Volume
: 33
| Issue : 1 | Page : 71-75 |
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Effect of Grīvā Vasti in management of Grīvā Asthi Sandhi Gata Vāta (Cervical Spondylosis)
Yogesh Kumar Pandey, Shalini, Ajay Kumar Sharma
Department of Kayachikita, National Institute of Ayurveda, Jaipur, Rajasthan, India
| Date of Web Publication | 18-Jun-2014 |
Correspondence Address:
Yogesh Kumar Pandey
Department of Kayachikita, NIA, Jaipur, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0257-7941.134618
Introduction: Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in the neck. Keeping in view the increasing incidence of this problem in modern society a study was conducted with following.
Aims and Objectives: The aim of the following study is to assess the efficacy of Grīvā Vasti in the management of cervical spondylosis.
Materials and Methods: The study was conducted on 10 clinically, pathologically, and radiologically diagnosed patients of cervical spondylosis, selected from outpatient department/In -patient department wing of P.G. Department of Kāya Chikitsā, N.I.A., Jaipur, satisfying the inclusion criteria. Patients were treated with Grīvā Vasti with Daśamūla Tailam for 35-45 min duration, for 14 days. Assessments were performed with regard to neck disability index before and after treatment.
Statistical Analysis: Statistical analysis was done with the help of Instat GraphPad 3 using Wilcoxon matched-pairs signed ranks test.
Result: Relief in neck disability index was 65.70%, which was statistically significant (P < 0.01).
Conclusion: Result indicates that Grīvā Vasti is an effective treatment in cervical spondylosis. Keywords: Cervical spondylosis, Daśamūla Taila, Grīvā Vasti, neck disability index, Sandhi-Vāta
How to cite this article:
Pandey YK, Shalini, Sharma AK. Effect of Grīvā Vasti in management of Grīvā Asthi Sandhi Gata Vāta (Cervical Spondylosis). Ancient Sci Life 2013;33:71-5 |
| Introduction | |  |
Cervical spondylosisis a condition that is estimated to account for 2% of all hospital admissions and it is the most common cause of spinal cord dysfunction in patients older than 55 years.[1] In 1992, Rahim and Stambough[2] noted that spondylotic changes are most common in those older than 40 years. More than 70% of men and women are affected. In cervical spondylosis the degenerative changes in the intervertebral discs lead to secondary change in the adjacent vertebrae. These changes in the cervical spine may affect one or more nerve roots, the cervical cord at one or more levels or may cause simultaneous damage to the nerve roots and cord.
The symptoms and signs of cervical spondylosis fall into two main groups, those due to root compression-cervical radiculopathy, and those due to cord compression - cervical myelopathy. In radiculopathy, sensory symptoms are far more frequent than motor and the most common irritative root symptom is pain although various form of paraesthesia, hyperesthesia and hyperalgesia may occur. In cervical myelopathy, the onset is usually insidious, the patient complaining of increasing disability over a period of month. The three common initial symptoms which may occur alone or in combination are dysesthesiae in hand, weakness and clumsiness of hand and weakness in lower limbs. In addition, there may be other related symptoms which include headache, pain in the neck and symptom of vertebra-basilar insufficiency. All these may occur singly or in any combination.
Any degenerative type of pathological conditions in the body can be considered under the broad umbrella of “Vāta Vyādhi.” Sandhigata Vāta is mentioned under Vāta Vyādhi. Acharya Caraka has mentioned that Nidāna Sevana (etiological factors) aggravates Vāta and this Prakupita (vitiated) Vāta accumulates in Rikta Srotas (deficient tissues) to give rise to various generalized and localized diseases. In case, Vāta dosha is vitiated in Grīvā Sandhi (cervical joints) it leads to Grīvā Asṭhi Sandhi Gata Vāta. The symptoms of Sandhi Gata Vāta as described in Ayurvedic classics areŚūla (pain in the cervical region), Prasaraṇa Akuñcana Svedana (pain during flexion and extension), Śotha (swelling in the cervical region), Vāta pūrṇadṛtisparsha[3] (on palpation of the joints, the perception is similar to that of balloon inflated with air), Hanti Sandhigatah (loss of function), Āṭopa (crackling noise/crepitus).
In modern medical sciences the condition is managed by use of analgesic, corticosteroid, surgical decompression, traction which provides temporary relief and has a number of side-effects besides being costly. Hence, it is an urgent need of time for a permanent, cost-effective and safe treatment devoid of side effects.
Aims and objectives
To assess the efficacy of Grīvā Vasti with Daśamūla Tailam in the management of cervical spondylosis.
| Materials and methods | | |
The study was conducted on 10 clinically, pathologically, and radiologically diagnosed patients of Grīvā Asthi Sandhi Gata Vāta (cervical spondylosis). The selection of patients was made from outpatient department/in patient department wing of P.G. Department of Kaya Cikitsā, N.I.A., Jaipur.
- Study design
Single center and open label - Inclusion criteria
- Patients of either sex with presenting classical symptoms of cervical spondylosis[4] and X-ray suggesting cervical spondylopsis,[5] confirmed by qualified radiologist
- Patients above 18 years and <70 years
- Exclusion criteria
- Pregnant and lactating mothers
- Contraindication and previously treated with Grīvā vasti
- Recent cervical, spinal, or shoulder surgery or implanted instrumentation or previous surgery for cervical spondylotic myelopathy
- Stenosis of the spinal canal
- Patients suffering from any infectious disease (like tuberculosis), metabolic disease (like diabetes mellitus and hypothyroidism), orchronic diseases (such as rheumatoid arthritis, systematic lupus erythromatous, and ankylosing spondylitis)
Administration of drugs
A total of 10 registered patients of cervical spondylosis were advised for Grīvā Vasti with Daśamūla Tailam for 35-45 min duration, for14 days.
Trial drugs: Dayamūla Tailam - (Bhaiśajya Ratnāvali, Śiro Roga)
Ingredients
- Method of preparation Daśamūla taila was prepared using the Snehapāka Vidhi (classical method of preparation of medicated oils) as per Bhaiśajya Ratnāvalī
All the components of Daśamūla Tailam, except Tila Tailam were taken to form Kvātha and Kalka. This Kalka and Kvātha was mixed with Tila Tailam and boiled continuously until the sign of Samyak Pāka appeared - Method of administration of Grīvā Vasti
Materials required: - Flour of black gram (Māśa powder): 250-300 g/day
- Daśmūla Tailam: 200-250 ml/day
Duration - 35-45 min for 14 days.
Procedure
Pūrva Karma I (preparation for procedure)
Patient was let to lie down on the table in prone position after having confirmed that he/she has passed stools and voided properly. Then the patient was asked to drape clothes so that cervical area could be exposed properly.
Pradhāna Karma (procedure)
Taking ample quantity of water, the dough of black gram powder was prepared. This dough was used to form a wall which was two inches height and four inches diameter on the cervical area. This wall was filled with Daśamūla Tailam using a cotton piece and was let to be there for 35-45 min. To ensure the constancy of temperature, a little portion of oil was taken out and the remaining oil within the wall was mixed with warm oil.
Pashchāt Karma (postprocedure care)
To remove the oil, a spoon was used and the oil was collected in a separate vessel. After this, the dough wall was removed. The patient was allowed to relax and take rest. i.e. they lay in the supine position inside the room.
Precautions
- During the course of treatment, patients were advised to take rest on uniformly plain wooden table surrounded and cover themselves using blanket
- Patients were advised to avoid lifting heavy objects on head. They were also advised to avoid exposure to cold air immediately after the procedure.
Criteria of assessment
Neck disability index
It is a questionnaire used to find out the level of disability of neck before and after treatment. It consists 10 questions such as pain intensity, personal care (like washing dressing), lifting, reading, headache, concentration, work, driving, sleeping, recreation, etc., each having 6 questions (0-5 points).
Statistical methods used
Obtained observations were analyzed statistically with the help of Instat GraphPad 3 and Wilcoxon matched-pairs signed ranks test was used.
Observation
Maximum number of patients i.e. 31.42% were found in age group 41-50 year 62.85% were female. Cervical spondylosis was found maximum i.e. 31.43% in laborers whose job was carrying heavy weights on their heads. Maximum patient (60%) had mixed type of dietary habit. Maximum patients (45.72%) had Vāta-pittaja prakriti. Maximum patient i.e. 34.28% had chronicity of 1-2 year, followed by 28.59% patient had <1 year onset of disease was insidious in maximum patient i.e. 94.28%. all patient i.e. 100% had shula (pain in the cervical region), 85.71% patients had prasāran ākuñcana vedana (painful flexion and extension), 71.42% patients had headache, numbness and tingling sensation in arm, 57.14% patients had dizziness/vertigo and weakness in arms and only 25.71% patients had śhoth (swelling) in the cervical region [Table 1].
| Results | | |
Mean score of neck disability index, was 24.2 before treatment which lowered down to 8.3 after treatment with a standard deviation ± 3.348 giving a relief of 65.70% which is statistically very significant (P < 0.01) [Table 2].
| Discussion | | |
Earlier cervical spondylosis was considered a medical condition in which the degeneration of the inter-vertebral disks occurred due to old-age. This condition is commonly caused due to regularly ignoring ergonomics of our bodies, e.g. working for long hours with computers, wrong postures while performing day-to-day life functions, sports/repetitive injuries such as long hours of playing video games, texting etc., In cervical spondylosis, the degenerative changes in the intervertebral discs lead to secondary change in the adjacent vertebrae. These changes in the cervical spine may affect one or more nerve roots, the cervical cord at one or more levels or may cause simultaneous damage to the nerve roots and cord.
Any degenerative type of pathological conditions in the body can be classified under the broad umbrella of “Vāta vyādhi.” Sandhigata Vāta is mentioned under Vāta vyādhi. The term Gata is derived from the root “Gam” which means gone to, arrived at, situated in, directed to, so it can be understood that the word Gata is related with site (i.e. Grīvā Asṭhi and sandhi) in which vitiated Vāta doṣa get situated and develop the symptom of Asthi and sandhigata Vāta.
Acharya Caraka emphasises, use of Snehana (oleation), Svedana (fomentation), Upanāha (poultice), etc., for management of Vāta Vyādhis. In addition, Svedana is an effective remedy for hyperaesthesia, pain, swelling, stiffness and restriction to movement. In present study Grīvā Vastiis employed as the method of external oleation and fomentation.
Probable modes of action of Daśmūla Taila
Among the 10 drugs of Daśamūla, 5 drugs have Vāta - Kaphaśāmaka (Vāta-Kapha pacifying) property, 4 drugs have Tridoṣaghna property and 1 drug has Vāta-Pitta śamak property. It means, in Daśamūla all drugs have Vāta shāmak property and 9 drugs have Vāta - Kapha śāmak property. Therefore, it stands to reason that the tailam is Vāta śāmaka, Vāta-Kapha Shamak and Tridosaghna. In Ayurvedic texts, we find the mention, “Daśamūlam Tridoshaghnam Kaphmarut Nāśnam” (Daśamūlam destroys the vitiations of the three doṣas as well as the vitiation of Kapha and Vāta).
Since, the sandhigata Vāta may be of two types viz. Kṣyajanya (primary degenerative changes) and Āvaraṇajanya (degenerative changes secondary to inflammation). Daśmūla has Kapha-Vāta hara action; therefore it effectively pacifies vitiation of Kaph-Vāta. Tila taila pacifies Vāta by its Guru, Snigdha Guṇa and Uṣṇa Veerya So Daśmūla Taila is expected to be effective in all forms of Grīvā sandhigata Vāta.
In the view of knowledge of modern science, the various components present in drugs Daśamūla possess anti-inflammatory[6],[7] and analgesic action. Therefore, by the action of these constituents it breaks the basic pathology and helps in relieving its clinical features.
Tila Tailam properties as per Ayurveda:
- Rasa-Madhura, Kaṣāya, Tikta, Guṇa-Guru, Snigdha
- Vīrya-Uṣṇa Vipaka-Madhura
- Doshaghnta: Vāta śāmaka. Therefore, it should be effective in Sandhi Vāta.
Probable modes of action of Grīvā Vasti
Grīvā Vasti is a procedure in which both the properties of Snehana and Svedana are incorporated. It is included under Ṣaḍvidha Upakrama (six unique procedures), Bahiḥparimārjana Cikitsā (external modalities of treatment), SthanikaŚamana Cikitsā (local physical therapy) and retaining type of procedure. The reason behind the selection of Grīvā Vasti is that it comes under direct contact with painful region. In this disease pathogenesis is at cervical-region and is mostly associated with structural changes of the vertebral column. There is derangement in cervical joints and vertebrae, degeneration of intervertebral disc and lubrication function of Śleṣmaka Kapha is affected, which results in compression, irritation or inflammation of Nāḍi i.e. nerve, resulting in severe pain and muscle spasm. Therefore, local oleation and fomentation is very effective and gives quick results because they act at the site of pathogenesis.
As Vāta Dosha is śīta (cold), Rūkṣha (dry) in nature and fomentation being Uṣṇa and with prior oleation, unctuous in nature, alleviates Vāta. Fomentation increases sweat and throws out waste products along with sweat. Thus it decreases kleda in the body resulting in the reduction of Gaurava (heaviness) and Stambha (stiffness) which are common symptoms of Vāta vyādhis. After fomentation, Romānca (sizzling sensation), Toda (pricking pain), Vedanā (pain), Śotha (oedema), Angagraha (stiffness in organs), Ayama (feeling of stretching) vanishes and the organs become soft and elastic.[8]
Ācarya Caraka has pointed that when even dry wood can be made to become soft and flexible with Snehana and Swedana then why not the living organs?[9],[10] Sandhi Vāta is clearly mentioned in the list of Swedanārha vyadhis and also the cardinal and associated features of sandhi Vāta like Śūla (pain), Vāta pūrnadṛtisparśa (swelling), prasāraṇaakuñcanavedanā (painful flexion and extension), śotha, have been mentioned. Sandhi Vāta is a Vāta vyādhiand sometimes āvaraṇajanya. Svedanais also indicated in Vāta vyadhis as well as Vāta kaphaja Vyadhis.[11]
SandhiVāta is a śūlapradhana Vāta vyādhi (painful condition) and śūlavyuparama (destruction of pain) is the sign of proper fomentation.[12] In Grīvā Vasti the warm oil is retained for a long time (Approx. 45 min) at the site of pathology. The resultant effect of the procedure produced according to the physiology is stated below:
Skin is very sensitive to oleation therapy. Vāyu, located in the skin dominates in the Sparśendriya i.e. tactile sensory organ. Through skin only Vīryas (active principles) of Abhyaṅga (oleation), Pariśeka (fomentation), Avagāha (bath), Ālepa (locally applied pastes), enter into the body after undergoing paka (metabolism) with Bhrājaka Pitta in tvacha (skin).
So, oil used in Grīvā Vasti reaches the different dhātus if it is applied for sufficient time. Hence it is clear that the drug used in the Grīvā Vasti gets absorbed by the skin. When snehana drug reaches to the particular dhātu it subsides or cures the disease of that particular dhatu.
The drugs used in Grīvā Vasti have properties which are opposite to that of Vāta doṣa. These drugs are Vāta hara, kapha hara, properties. Hence, this regimen provides nutrition for the body strengthens the muscle and reduces the stiffness.
Thermal effect of warm oil
Heat has been defined as increase in the mean molecular velocity of particles. In general, this has catalytic effect on all chemical process. Thus, application of heat results in an increase in the local metabolism of the cell and increased transport through the cell membranes. For every increase of 1°C within the physiological limits, the metabolic activity increases by about 10%. The local metabolic increase leads to an increase in the oxygen partial pressure (po2), the carbon di-oxide partial pressure (pco2) and acidity pH. These three factor po2, pco2 and pH determine the local perfusion by their effect on pre-capillary sphincter and meta arterioles. The pre-capillary sphincter and the meta-arterioles in the tissue control the local homeostasis by alternate contractions and relaxations. This alternate activity controls the perfusion of the capillary bed. At the same time, the contraction forces the blood in the capillaries forward. This process of auto-regulation is referred to as “vasomotion,” which is principally determined by the oxygen concentration.
An increase in the temperature of connective tissue, in particular the collagenous tissue such as skin, muscle, tendon, ligament or articular capsule will be accompanied by an increase in the elasticity The amplitude of all the three components i.e. viscous, viscoelastic and elastic components of resting intact muscle fibers is reduced to varying degrees as the temperature is raised from 10°C to 35°C.[13] Simultaneously, the viscosity of the matrix decreases. Consequently, connective tissue such as tendon tissue and ligament will also become more elastic.
| Conclusions | | |
Grīvā Asṭhi sandhi gata Vātahas a peak in the 4th decade of life, i.e. Vāta prakopaka Kāla and spondylosis degenerative changes in the intervertebral joints starts after 40 years of age. It is clear that during the course of natural ageing, dhātukṣaya in terms of degeneration is the prime cause of the origin of Grīvā Asṭhi sandhi gata Vāta (~cervical spondylosis). Cervical spondylosis is adhātukṣayajanya roga. In this study, majority of patients had neck pain, pain during flexion and extension of neck, headache numbness and tingling sensation in arms.
Patient's neck disability was improved significantly which indicates the efficacy of Grīvā Vasti with Daśamūla Tailam over chief complaints. All the patients tolerated Grīvā Vasti very well. No side/toxic effects were reported in any of the patients registered for the trial.
In view of the above, it can be concluded that Grīvā Vasti with Daśamūla Tailam is effective in management of Grīvāsthi Sandhi Gata Vāta (cervical spondylosis).
A study involving a larger number of patients may be conducted to confirm the results of the present study. Longer follow up can also be considered. Internal bṛmhana therapies can prevent relapse of the condition.
| References | | |
| 1. | Young WF. Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons. Am Fam Physician 2000;62:1064-70, 1073. 
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| 2. | Rahim KA, Stambough JL, Colorado University, Rheumatology Department, 1992. Available from: http://www.physio-pedia.com. Last accessed on 18.03.2014 at 10:26 PM
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| 3. | Charak Samhita: Chikitsa Sthan, Adhyaya 28, Sloka-37, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2006. p. 783.
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| 4. | Marica W. Cervical sspondylosis, its early diagnosis and treatment. 2 nd ed. London: William Meinemann Medical Book Limited; 1971. p. 59-67.
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| 5. | Marica W. Cervical sspondylosis, its early diagnosis and treatment. 2 nd ed. London: William Meinemann Medical Book Limited; 1971. p. 68.
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| 6. | Balasubramanian T, Chatterjee TK, Sarkar M, Meena SL. Anti-inflammatory effect of Stereospermum suaveolens ethanol extract in rats. Pharm Biol 2010;48:318-23.
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| 7. | Singh RS, Ahmad M, Wafai ZA, Seth V, Moghe VV, Upadhyaya P, Anti-inflammatory effects of Dashmula, an Ayurvedic preparation, versus Diclofenac in animal models J. Chem. Pharm. Res., 2011, 3 (6):882-888
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| 8. | Charak Samhita: Chikitsa Sthan, Adhyaya 28, Sloka-80, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2006. p. 791.
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| 9. | Charak Samhita: Chikitsa Sthan, Adhyaya 28, Sloka-79, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2006. p. 791.
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| 10. | Charak Samhita: Sutra Sthan, Adhyaya 14, Sloka-5, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2003. p. 281.
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| 11. | Charak Samhita: Sutra Sthan, Adhyaya 14, Sloka-3, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2003. p. 281.
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| 12. | Charak Samhita: Sutra Sthan, Adhyaya 14, Sloka-13, Hindi Commentary By Sastri and Chaturvedi. Varanasi: Chaukhambha Bharati Academy; 2003. p. 283.
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| 13. | Mutungi G, Rantunga KW. Temperature-dependent changes in the viscoelasticity of intact resting mammalian (rat) fast- and slow-twitch muscle fibre J Physiol 1998;508.1:253-65.
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[Table 1], [Table 2]
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