“ Study of efficacy of simhasyadi kwatha with eranda taila in gridhrasi . ”

Now a day’s everyone is living a rush full life. Busy life schedule means due to which some of us are suffering from various vataj roga. In Gridhrasi, there is a pain in distribution of sciatic nerve from buttocks to thigh, calf and foot. Many formulae have been prescribed for gridhrasi in Ayurveda. Simhasyadi Kwatha with Eranda taila is prescribed by Bhavprakasha. The ingredients of kwatha are Vasa, Danti, and Aragwadha. These drugs possess ushna virya which acts as vatahara and kaphahara. Eranda taila is the prakshepa in this kwatha acts as potentiator. Gridhrasi affects daily routine of the patients and causes lots of difficulties in movements due to tremendous pain. Hence this study has been done to relieve the patients from their painful illness.


INTRODUCTION:
Today, busy professional and social life, improper sitting posture in offices, factories, over exertion, jerking movements during traveling and sports these entire factors create platform for the disease. In Gridhrasi, there is a pain in distribution of sciatic nerve from buttocks to thigh, calf and foot. Simhasyadi Kwatha with Eranda taila is prescribed by Bhavprakasha. The ingredients of kwatha are Vasa, Danti, and Aragwadha. These drugs possess ushna virya which acts as vata and kaphahara. Along with deepana-pachana karma, do the pachana of ama and thus relieve the symptoms of Gridhrasi. Eranda taila is the prakshepa in this kwatha acts as potentiator. It Possess the quality like snigdha, teekshna that helps it to penetrate into the minute sorts of the body and with vata anulomana property it does the shodhana karma. Gridhrasi affects daily routine of the patients and causes lots of difficulties in movements due to tremendous pain. AIMS AND OBJECTIVES: 1.
Study the efficacy of Simhasyadi kwatha with Eranda taila in Gridhrasi.

MATERIAL & METHODS:
This is the third form in the Panchavidha kashaya Kalpana where in the medicinal plant (dravya) is made into the form of Yavakuta, Water is added to it, the mixture is boiled up to certain period so as the water remains 1/2, 1/4 or 1/8 th as mentioned in texts. It is then filtered, the liquid so obtained is called as "Kwatha" i.e. decoction. Simhasyadi kwatha with Eranda taila is given to the patient in morning and evening in abhakta kala for 30 days.  SOP of the Simhasyadi kwatha and Eranda taila: Selection of ingredients and standard operational procedure for preparation of Simhasyadi kwatha for trial is as follows: Simhasyadi Kwatha is compound drug of following contents-Vasa, Danti, Aragwadha and Eranda taila. All these ingredients are purified and standardized as per ayurvedic method and taken in dry state. Collection of ingredients: All drug ingredients are selected as per Indian pharmacopeia. And there is selection of best sample from available regional market. a) Vasa (Adhatoda vasica) -Dried leave of vasa is selected for decoction from the regional market. b) Danti (Baliospermum montanum) -Dried root skin (mooltwak) & moola of danti is collected for decoction from the regional market. c) Aargwadha (Cassia fistula) -Dried bark skin (twaka) of aragwadha is collected for decoction from the regional market.  The word "Grudhra" is made from dhatu "Gridhu". The meaning of dhatu "Gridhu" is to desire, to convert, to strive after greedily. "Karan" pratyaya is added to this and then by the lopa of K and N the word Grudhra is derived. By the rule of atonupasarga, "kah" pratyaya is added to Grudhra + sho. Hence it is forming Grudhrat+ sho + ka. By the lopa of "o" and "k", "sha" is replaced by the rule "Dhatvadeh shah sah" and in female gender "angish" pratyaya is added to form the word "Gridhrasi". Nirukti: Shabdakalpadruma states that the word "Gruda" refers to a person who is crazy for eating meat. The word "Syati" in Sanskrit means to cause suffering (throwing action). Thus the word Gridhrasi applies to an illness that mostly attacks the person who is greedy of consuming meat. Grudhra means vulture. Vulture is fond of meat and has a particular fashion of eating meat. It pierces its beak deeply in the flesh and then draws it forcefully. Such a type of severe pain is experienced by the patient in Gridhrasi. Hence justifiably its name is as Gridhrasi. Also because of persisting severe pain the patient has a typical gait i.e. slightly tilted towards the affected side and affected leg in flexed position and another leg is extended. This gait resembles with that of vulture. So disease is named as Gridhrasi.

Paribhasha:
As described by Charaka, Gridhrasi is a Vatavyadhi characterized by Stambha (Stiffness), Ruk (pain), Toda (pricking pain) and Spandana (frequent twitching). These symptoms initially affect Sphik (buttock) as well as posterior aspect of Kati and then gradually radiates to posterior aspect of Uru (thigh), Janu (knee), Jangha (calf), Pada (foot). Sushruta describes that there are two Kandara in the leg that gets affected. The two Kandara include the one extending distally from the Parshni to the toes and other extending above from the parshni to the Vitapa. These two Kandara when get affected with Vata dosha limits the extension of the leg. This disease is known as Gridhrasi. Gridhrasi is mentioned under both, Samanyaja and Nanatmaja Vatavyadhi. In Nanatmaja Vatavyadhi there is involvement of a single dosha in a disease and Roopa, Karma, and Lakshnas of only that dosha is observed. In Saamanyaja Vatavyadhi along with vata there is involvement of other doshas also. Thus Gridhrasi is of Vataja and Vatakaphaja type.
According to Harit Samhita there is involvement of Rakta dhatu. Sushruta acharya, Vagbhata acharya, Bhavamishra also emphasized in their samhitas that Vata is the predominant dosha in the manifestation of Gridhrasi.

DISCUSSION:
In this era where people are immersed in the thought, how to make more money within short span of life that makes the human more vulnerable to different diseases. People don't have time for themselves for their health, so they don't follow proper dinacharya, ritucharya and pathya-apathya which act as pathway to number of diseases. As vata among the tri-doshas gets easily vitiated compared to other doshas it has to be taken special care, vata is mainly vitiated due to dhatu kshaya and margavarodha, this vitiated vata hampers the daily routine work of a person and make them dependent on others. Gridhrasi as we see is not a disease of a recent origin, it was present from the time immortal, this is because of the strenuous work done by the people in olden days or due to travelling on the horses, chariots and other mode of transports. Today the incidence is due to improper postures, the heavy load of work is specially bending and suddenly getting up, carrying heavy loads that lead to sciatica. Vyadhi synonymously stands for pain, which unless hampers the routine work of individual, is not bothered much. Gridhrasi is one of such disease. Discussion on the review of literature: Gridhrasi has been mentioned in both ayurvedic and modern text. The nirukti of gridhrasi says the person walks like or rather hops like gridra (vulture), modern context describes that a person suffering from sciatica has a limping gait which can be correlated with the gridra as told in gridhrasi. Nidanas told in ayurveda are classified under aharaja and viharaja. In the context of sciatica in western medicine more stress has been giving in relation to the occupation and work as a causative factor. Avyakta lakshnas are told as the poorvaroopa of all the vata vyadhi still it is seen that constipation and backache are the prodormal symptoms before it starts radiating. The roopas of gridhrasi are ruk (shoola), toda, stambha, spandana, gouravam, aruchi. The pain starts from the spikha and radiates towards kati, uru, jangha, pada. The similar pattern of pain has been mentioned in modern that the pain starts from lumbar region that radiates backside up to the foot. Due to the vata-prakopaka nidana sevana there will be increase of vata that will undergo sanchaya and prakopa avastha similarly with kapha there will be kapha prakopa due to kapha prakopaka nidana sevana this will lead to mandagni and there will be production of ama and it will vitiate mamsa, rakta, sira, snayu, kandara and finally sthansamshraya of both the doshas will take place in kati, sphik pradesha and cause gridhrasi. In modern certain degenerative changes happens which due to the age factor or due to trauma. It can be correlated to the dhatukhaya that occurs due to vata prakopa. Discussion on the plan of study: For the present study, 30 patients were selected from the O.P.D of the hospital attached to our college. The selection of patients based on the signs and symptoms mentioned in classics. Total 32 patients came for the treatment in the beginning, out of which 2 patients left during the follow ups. 30 patients received simhasyadi kwatha 30ml and eranda taila 10ml in morning and evening before meal for 30 days. The dose of eranda taila tapered as per requirements. All patients are between the age group 30-65 years. Patients above 65 years come under vriddha avastha and they may not tolerate the medicine. Pregnant and lactating mothers were excluded from the study as they cannot be given the teekshna aushadhi and may cause harmful effects on the baby. Patients having major illness since long time like PID, RA, DM, HTN, disc prolapse are excluded. Condition of the patient is documented in case sheet and their response to the medicine is analyzed as per the grading mentioned for various symptoms. The overall effect of the therapy assessed in terms of no change, mild-moderatemarked improvement and complete relief. Discussion on observation during the study: After focusing on the observations made and analyzing the raw data, we get the result that the drug is effective in a conducted trial. The trial was conducted on a sample size of thirty. In assessment criteria, Pain and Graha (lumber region to the sole of foot) are recorded by Coin Test. Stambha, Toda, Spandana, and Graha are recorded by Visual analogue scale. SLR angle is recorded for Sakthikshepa nigraha. Walking time (in seconds) is taken. Oxford pain chart is used for pain assessment. All tests are carried out before and after the treatment to evaluate the total effect of treatment. Discussion about the general observations: 1) According to sex: Female patients were more in number than male patients. It may be due to t h e etiological factors like exposure to Cold, Pramitashana, Diwaswapa, Abhishyandi and Paryushita bhojana etc. Hence there is vitiation of Vata dosha as well as Kapha dosha and prone to Gridhrasi. 2) According to age: Maximum patients were belonging to middle age group. It may be due to working in sitting as well as in standing position for long period of time, excessive travelling, disturbed eating habits etc. All these factors led to increase in Vata dosha and make them prone to Gridhrasi.
3) According to occupation: House maid, housewives are more prone towards excessive work, irregular diet, Diwaswapa and labors have heavy work which c a n cause vitiation of Vata dosha. So these people found most affected in this study. 4) According to prakruti: Patients having Vatakaphaja and Vatapittaja prakruti were found to more prone to Gridhrasi. 5) According to diet: Patients who have more intake of nonvegetarian diet were found to be much more prone to Gridhrasi. 6) According to disease type: Vatakaphaj Gridhrasi patients were seen more in number than Vataja Gridhrasi. Cure rate is more in Vatakaphaj type of Gridhrasi. 7) According to symptoms: All 30 patients had symptoms like pain in Sphik-kati-prishtha-uru-janu-jangha up to Pada and Sakthikshepa along with Toda and Spandana, 11 patients had Arochaka and 18 patients had symptoms like Mukha praseka, Bhaktadwesha as well as Agnimandya. There is more relief in symptoms like shoola, toda, spandana as compared to stambha and graha. Discussion on clinical observations: 1) Common etiological factors were seen, as consumption of Katu, Kashaya, Tikta rasa, Ruksha-shita-abhishyandi bhojana, heavy work, changed lifestyle, lack of exercise and many more causes. Hence most of the patients had Margavarodhjanya samprapti of Vataprakopa causing Gridhrasi. 2) Patients in primary stages of disease give good results as compared to chronic patients.
3) The aushadhi yoga is found to be more effective or shows earlier effect in Vatakaphaja prakruti. 4) Among 30 patients, 17 got mild to moderate relief from symptoms in 3 rd week of treatment. 3 patients got complete relief in 4 th week of treatment and 10 patients had no relief in symptoms. 5) As per reference in Bhavprakasha, the aushadhi yoga can cure Gridhrasi completely, but it is found that there was no relief in severe and chronic patients of gridhrasi. Also there was a recurrence of symptoms in 5 patients among 30 patients. 6) In this study the numbers of dropouts were two patients. It is due to inconvenience in drug intake, less palatability of drug, and long duration of treatment (1 month Probable mode of action of simhasyadi kwatha: The ingredients of this kwatha are Vasa, Danti and Aragwadha. These drugs also possess ushna veerya which acts as vata and kaphahara. Along with deepana and pachana karma brought by this kwatha helps in the pachana of ama and thus helps in relieving the symptoms of both types of Gridhrasi. Role of Eranda taila as Prakshepa: Eranda taila which is the prakshepa in this kwatha acts as potentiator. It Possess the quality like snigdha, teekshna that helps it to penetrate into the minute sorts of the body and as it has vata anulomana property it does the shodhana karma. It also has the vedana shamaka property. Probable mode of action of Simhasyadi kwatha with Eranda taila on subjective and objective parameters: Ruk/Shoola, Toda and Spandana-Due to teekshna and sara guna it acts as rechana thereby doing vata anulomana and helps in pacifying pain. As the formulation has vatahara karma it reduces toda. Due to teekshna guna, it acts as sookshma srotogami and reduces kapha by normalizing the gati of vata and hence reducing spandana. Gourava-Due to katu tikta rasa and katu vipaka of the formulations, it suppresses kapha and relieves gourava. Aruchi-The properties like laghu, ruksha gunas helps to promote the quality of jatharagni, helps in the shaman of ama and thus helps in reducing aruchi. Stambha and Graha-Due to katu vipaka and ushna virya it acts antagonist to kapha dosha and therefore reduces stambha and graha. SLR test and Coin test-The formulation has given positive response in the above objective parameters. Due to reduction in the severity of symptoms in the patient, gradation changed during the tests. That shows the relief in the patients.

SUMMARY:
The present study entitled 'Study of efficacy of Simhasyadi Kwatha with Eranda Taila in Gridhrasi.' This comprises of five sections: SECTION 1:-This section is sub classified by two chapters namely 'Ayurvedic review' and 'Modern review'. The first chapter deals with the Ayurvedic review of Gridhrasi. In this chapter first of all a detail description regarding Gridhrasi according to Ayurvedic point of view has been given which contains historical review, Vyutpatti, Nirukti, Paribhasha, Nidana panchaka, Vyavacchedaka Nidana, Sadhya-asadhyatva and Pathya-Apathya. Then chikitsa sutra of Vatavyadhi with special reference to Gridhrasi has been elaborated. The second chapter deals with the description of Sciatica from modern point of view presented with the definition, anatomy and physiology of sciatic nerve, etiology, pathology, sign and symptoms and the diagnosis of sciatica. The management and the preventive measures of sciatica have been discussed. Also it shows previous research work done on Gridhrasi. SECTION 2:-This section termed as 'Drug review' commences with a description and properties of drug selected for the study. As well as it shows the pictures of whole drug and its collected parts. SECTION 3:-This section entitled as 'Clinical study' presents with the detailed description of the selection of patients, methods adopted for the research work, study design, criteria for assessment. Thereafter the results obtained with statistical analysis in this study have been given in the form of Graphs and Tables. SECTION 4:-This section contains 'Discussion' which describes the logical interpretation of results obtained in the clinical study, the mode of action of drug based on Ayurvedic and modern principles. SECTION 5:-After analyzing the data and the observations carefully, Conclusion drawn from the present study and it is discussed in the last chapter. CONCLUSION: