Clinical Evaluation of Agnitundi Vati in the management of Gridhrasi With special reference to Sciatica

In the present era, Gridhrasi is the commonly occurring disease in both geriatric and middle age. It causes due to irritation of sciatic nerve. According to Ayurveda,vataprakopak nidanas i.e. depletion of dhatu and obstruction of channels are the causes of Gridhrasi. Vata plays a major role in pathogenesis of the disease but sometimes associated with kapha. Agnitundi Vati described in Sharangadharsamhita has the properties acting on both vata and kapha. To assess the efficacy of Agnitundi vati in the management of Gridhrasi, present study was undertaken in 30 patients of both types of Gridhrasi. 125250 mg of Agnitundi Vati was given orally, two times daily after meal with lukewarm water for total 21 days. It showed hopeful results in subjective and objective parameters of Gridhrasi. The study shows that Agnitundi vati is effective in management of both types of Gridhrasi, but more effective in vatakaphaj Gridhrasi. 76 * Corresponding Author: Gabhane S M, Professor, Department of Rognidan-Vikritivigyan, Datta Meghe Ayurvedic Medical College Hospital and Research Center, Wanadongri, Nagpur. Email id mungle.shilpa@gmail.com Gabhane S M et.al., Role of Agnitundi Vati in the management of Gridhrasi (Sciatica) Published online in http://ijam.co.in ISSN No: 0976-5921 Diagnostic criteria Patients were diagnosed on the basis of following clinical features 1.Patients having cardinal symptoms of Gridhrasilike Ruk, Toda,Stambha andSpandana in Sphik, Kati radiating to Prishthabhaga of Uru, Janu, Jangha and Pada. 2.Positive straight leg raises (SLR) test in affected leg. Inclusion Criteria 1.Patients fulfilling the diagnostic criteria. 2.Patients of both sex between age group 2065 years. Exclusion Criteria 1.Benign or Malignant tumour of spine, traumatic injury, Tuberculosis of vertebral column. 2.Developmental anomalies. 3.Uncontrolled diabetes mellitus,cardiovascular diseases. 4.Pregnant and Lactating women. Laboratory Investigation (Objective Parameter) •Routine haematological investigationHb%, TLC, DLC, ESR •Urine for routine and microscopic examination •X-ray of Lumbosacral spine – AP and Lateral view. Plan of Treatment 125250 mg of Agnitundi Vati wasgiven orally, two times daily after meal with lukewarm water for total 21 days. A gap of 1 day was given in between two weeks. Weekly follow up was taken. Agnitundi Vati was prepared in Universal Pharmacy, Nagpur.


Introduction
Sciatica is characterised by constant aching painin the lumber region radiating to the buttock, calf and foot caused by irritation of the sciatic nerve. (1) It is quite a common condition with a lifetime incidence varying from 13% to 40%. The consequent annual incidence of an episode of sciatica ranges from 1% to 5 %. (2) It can be compared to Gridhrasi described in ayurvedic text having pricking pain, twitching along the route of sciatic nerve. It occurs both in old and middle age. It is one of the 80 types of Nanatmaja vyadhi of vata. (3) The generalvata prakopa nidanas are nidanas of Gridhrasisuch as improper sitting posture, over exertion, over loading, trauma to lumbosacral spine, production of ama, jerky movements during travelling etc. (4) The samprapti of Gridhrasi is a complex mechanism. The vata provoked by the above-mentioned factors, either by depletion of dhatu or by the occlusion of channels, enters the emptymajjavaha srotas and leads to Gridhrasi. (5) The cardinal features of Gridhrasi are ruk(pain), toda(pricking sensation),stabdhata(stiffness), spandana(twitching) in the buttocks, low back region radiating to thigh, knee, calf region and foot,whereas arochak (aversion to food), tandra(drowsiness),and gaurava(feeling of heaviness) come across additionally when kapha is associated with vata. (6) Due to severe pain, it creates little threat to life. Treatment of the disease includes analgesics, traction therapy and physical therapy. Surgery i.e. removal of disc herniation also recommends according to stage. This treatment reduces only leg pain and corresponding symptoms, not the back pain and the chances of recurrence are more.
Vata plays major role in the pathogenesis of the disease but most of the times associated with kapha. Alsobeing a nervine disorder, can be treated by a drug having deepana, pachana, vatashamakaand shoolaghna properties along with having action on nerves. Agnitundi vati mentioned in Sharangadhara samhita is having all the properties. (7) This drug is using being successfully to cure vatarogas. But it is need to study on scientific measures to make more use of it.

Objective of the study
To evaluate the efficacy of Agnitundi Vati in the management of Gridhrasi.

Source of Data
Patients attending the OPD and IPD of the Department of Rognidan-Vikritivigyan and Dept of Kayachikitsa, Pakwasa Samanvay Rugnalaya and Dept of Rognidan-Vikritivigyan of Akhil Bhartiya Ayurved Anusandhan, Nagpur.

Method of Collection
30 participants fulfilling the diagnostic and inclusion criteria, belonging to either sex irrespective of socio-economic status and caste were selected and registered for the clinical study. Prakriti, addiction, gender, occupation of the patients was also studied.

Clinical Evaluation of Agnitundi Vati in the management of Gridhrasi
With special reference to Sciatica

Abstract
In the present era, Gridhrasi is the commonly occurring disease in both geriatric and middle age. It causes due to irritation of sciatic nerve. According to Ayurveda,vataprakopak nidanas i.e. depletion of dhatu and obstruction of channels are the causes of Gridhrasi. Vata plays a major role in pathogenesis of the disease but sometimes associated with kapha. Agnitundi Vati described in Sharangadharsamhita has the properties acting on both vata and kapha. To assess the efficacy of Agnitundi vati in the management of Gridhrasi, present study was undertaken in 30 patients of both types of Gridhrasi. 125-250 mg of Agnitundi Vati was given orally, two times daily after meal with lukewarm water for total 21 days. It showed hopeful results in subjective and objective parameters of Gridhrasi. The study shows that Agnitundi vati is effective in management of both types of Gridhrasi, but more effective in vatakaphaj Gridhrasi.

Diagnostic criteria
Patients were diagnosed on the basis of following clinical features •Urine for routine and microscopic examination •X-ray of Lumbosacral spine -AP and Lateral view.

Plan of Treatment
125-250 mg of Agnitundi Vati wasgiven orally, two times daily after meal with lukewarm water for total 21 days. A gap of 1 day was given in between two weeks.
Weekly follow up was taken.
Agnitundi Vati was prepared in Universal Pharmacy, Nagpur.

Assessment Criteria
Subjective and objective parameters presented by the patients were given score and were assessed before and after every week for 3 weeks.

Observations and Result
Total 30 patients of Gridhrasi were registered. Important features were as follows:

Graph 1. Showing the distribution of gender in 30 patients of Gridhrasi
Maximum, 63.3% were females.

Graph 2. Showing the relation of age in 30 patients of Gridhrasi
Maximum, 36.66% were in age group 31 -40 and 86.65% were in the age group of 31 -60 years.

Graph 3. Showing the relation of occupation in 30 patients of Gridhrasi
Maximum, 36.66%were homemakers,

Graph 4. Showing the relation of Addiction in 30 patients of Gridhrasi
Maximum, 46.67% were having addiction of tobacco chewing and gutkha and 33.33% having addiction of beetle nut.

Graph 5. Showing the Prakriti wise distribution in 30 patients of Gridhrasi
According to prakriti, 36.67% patients were of vata-kaphaj and 36.67% were of vata-pittaj prakriti.

Graph 6. Showing the relation of Agni in 30 patients of Gridhrasi
According to agni, majority of patients i.e. 60% were having mandagni.
Cardinal symptom of ruk, toda and positive SLR test were found in all patients.
76.67% patients were having symptoms in right leg.
The drug is found highly effective in SLR test 73.80%.

Criteria for assessing the effect of therapy
The effect of therapy was evaluated on the basis of improvement in sign and symptoms. Statistical analysis, means, standard deviations and standard errors and percentages were calculated. Kruskal Wallis Test with Dunn's Multiple Comparison Test was applied for assessing sign and symptoms. Mann Whitney's Test was applied for assessing laboratory investigations.

Discussion
The maximum number of patients was present between 31-40 age groups. In vataprakriti individuals vatavriddii starts at this age. As age increases, the form and composition of the individual structure may increase the risk of injury due to decrease in hydration of inter vertebral disc. (8) This decrease in hydration may be due to rukshata which increases as a result of vatavriddhi. Prevalence commonly found in this age group.
Sex-the higher incidence of disease occurred in females. (9) There was higher incidence of sciatica in homemakers. Working constantly with improper posture for long duration during household work, lack of exercise; irregular food habits and cold exposure are the contributing factors. Labourer also show comparatively high incidence because of heavy work they do. (10) A high proportion of patients were having vatapittaj and vatakaphaj prakriti suggesting that vata has major role in the manifestation of sciatica Maximum patients were having addiction of beetle nut, tobacco chewing and gutkha. These factors lower the bone mineral density causing osteoporosis. It causes osteoporotic vertebral fractures compressing the sciatica nerve thereby responsible for nervine damage. (11) As beetle nut is kashaya in rasa, it vitiates vata. (12)

Effect of therapy
Kupeelu (Strychnos nux-vomica Linn.) is the major content of drug which is more effective in nervine disorders. It improves stimulatory function of vata, when function of vata decreases due to association with kapha.
All contents of Agnitundi vati are deepana, pachana, vatashamaka and shoolaghna in properties. Due to its ushna virya it normalises the function of apana and vyanavayu. (13)

Conclusion
The drug Agnitundi vati showed good results in both types of Gridhrasi, but better relief seen in vatakaphaj Gridhrasi. Ingredients of this vati having deepana, Amapachana, vatashamaka and shoolaghna properties. it improves agni by digesting ama which is the main factor in vatakaphaj Gridhrasi. In this way relieves generalised symptoms such as aruchi, gaurava and tandra. This drug works at the root level of samprapti and minimizes chances of recurrence.