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Role of Panchakarma Chikitsa in the Management of Katigraha (Lumbar Spondylosis): A Literature Review
Correspondence Address :
Anup Jain,
Assistant Professor, Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, GGSIPU, New Delhi-110073, India.
E-mail: dr.anupjain@gmail.com
Katigraha is a disease in which Vata gets imbalanced in its sthana (seat), causing pain to originate in the joints of sphika and prishtha-vanshasthi. According to Gadanigraha, when Vata is affected by Ama and is located in Kati Pradesh, it exhibits the symptoms of Katigraha, namely Graha (stiffness) and Ruja (pain) in Kati Pradesh (lower back). Compared with modern science, the authors can correlate this disease to lumbar spondylosis. Chronic low-back pain affects 4.2% of the population and accounts for almost 50% of total low-back pain related costs. The treatment involves various approaches, including anti-inflammatories, analgesics, muscle relaxants, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), exercises, traction, and invasive procedures like surgeries. Panchakarma, a specialised facet of Ayurveda, not only focuses on bringing the body to a state of Samadosha, thereby targeting to achieve normal health. With literary evidence supporting its efficacy, Panchakarma offers a comprehensive approach in managing such conditions, encompassing curative, preventive, and promotive aspects of health. Databases such as PubMed, Google Scholars, Shodhaganga, etc., were searched, and a total of 12 articles were shortlisted based on various Panchakarma interventions being used for the management of Katigraha. Panchakarma provides a promising avenue for the effective management of Katigraha, paving the way for enhanced well-being and improved quality of life for individuals suffering from this condition.
Shodhaganga, Svedana, Snehana, Vatavyadhi
Ayurveda is an ancient science of life that describes tridosha as the regulatory humors of the body. Amongst these tridosha, Vatadosha holds the position of dominance as it can force the other doshas, Pitta and Kapha, to move from their seats just like strong wind can displace clouds (1). Katipradesha (Lower back) is described as one of the important seats of Vata dosha (2), and one of the disorders affecting this region is Katigraha, in which Vata becomes imbalanced in its own sthana (seat), causing pain to originate in the joints of sphika and prishtha-vanshasthi. According to Gadanigraha, when Vata is affected by Ama and located in Kati Pradesh, it exhibits the symptoms of Katigraha, namely Graha (stiffness) and Ruja (pain) in Kati Pradesh (lower back) (3).
Lumbar Spondylosis is a disease diagnosed as back pain induced by spine movement and associated with stiffness (4). It is one of the most commonly found conditions in adults. Lifestyle issues and habits like bike riding, speed breakers, improper posture, heavy weight lifting, and improper rest to the spine are risk factors that aggravate this disease in working adults. Chronic low back pain is diagnosed when pain lasts more than 12 weeks and accounts for almost 50% of total back pain costs (5). Treatment in other systems of medicine commonly includes anti-inflammatory, analgesics, and muscle relaxant medications. NSAIDs and topical application of heat/ice are also found effective in relieving back pain (6).
Considering the above scenario and the needs of modern society to find an effective cure, it becomes imperative to review or search for safe and effective interventions in cases of Katigraha (Lumbar spondylosis). The rationale for conducting a review in this context stems from several factors.
Traditional knowledge vs. modern needs: Ayurveda, being an ancient science, provides insights into the understanding of health and disease that have been passed down through generations. However, in the modern context, there is a need to bridge this traditional knowledge with contemporary healthcare demands. This review seeks to explore how Ayurvedic interventions, specifically Panchakarma therapies, can address a prevalent modern health issue like Lumbar spondylosis (Katigraha).
Complexity of Ayurvedic conceptual framework: Ayurveda employs a comprehensive understanding of the human body, which involves concepts like Tridosha (the three fundamental energies), particularly Vata dosha, and their influence on health. Lumbar spondylosis is seen through the lens of Vata imbalance in Ayurveda. Therefore, exploring how Ayurvedic interventions target this specific imbalance requires a comprehensive review of existing literature.
Variability in traditional treatments: Ayurveda offers a range of interventions, including herbal remedies, dietary modifications, lifestyle changes, and Panchakarma therapies. Each of these interventions may have diverse formulations and methodologies, making it essential to review the specific interventions used in treating Katigraha to assess their efficacy and safety.
Need for evidence-based practice: In the modern healthcare landscape, there is an increasing emphasis on evidence-based practice. While Ayurveda has a rich tradition and empirical evidence, there is a growing need to subject Ayurvedic interventions to rigorous scientific scrutiny. By conducting a review of clinical research studies, this review aims to contribute to the evidence base supporting Ayurvedic interventions for the management of lumbar spondylosis.
Clinical trials, randomised or non-randomised studies with interventions of various Panchakarma modalities available on databases such as PubMed, Google Scholar, Shodhaganga, Cochrane Library, etc., from the year 1995 to August 2021, irrespective of their study centers, were searched. References of key articles were hand-searched using keywords such as ‘Katigraha’, ‘Panchakarma’, ‘Shodhana’, ‘Basti’, ‘Svedana’, ‘Katibasti’, ‘Nasya’, ‘Katidhara’, ‘Upnaha’, etc. The database of the CTRI was also searched with the same keywords to obtain a list of current and completed research on Katigraha. Screening of the title, abstract, and full text of the retrieved articles was independently conducted by two reviewers, and any differences were resolved by a third reviewer.
Inclusion criteria: Data analysis focused entirely on Ayurvedic controlled clinical trials (randomised and non-randomised controlled trials) conducted in patients suffering from Katigraha between 1995 and August 2021. Only articles published in the English language were eligible for inclusion.
Exclusion criteria: Ayurvedic review articles on Katigraha, Ayurvedic clinical studies on complications of Katigraha, related animal studies, case studies or case series, observational studies, and modern studies were excluded from the study.
A total of 138 articles were retrieved after searching the selected databases. Upon an extensive review of literature from the above sources, 48 articles were removed due to duplicity (in the form of articles and listings appearing as citations in Google Scholar). Among the remaining 90 articles, 46 were removed as they were not clinical trials but only case studies and observational studies. From the remaining 44 articles, 15 were removed as they were reviews. Full texts of 29 articles were identified, but among them, 17 were excluded as they contained only Shamana chikitsa, Snehana chikitsa, or therapies like Marma therapy, Yoga, etc., in the treatment groups. Hence, a total of 12 articles were included (Table/Fig 1).
Comparative review of included 12 articles, Features of study participants and types of intervention with exact outcomes are mentioned in (Table/Fig 2) (7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18).
Katigraha is a disease in which Vata gets vitiated and is situated in Katipradesh, producing symptoms like shool and stambh. As it is Krichrsadhya, shamana aushadhi alone is not enough to treat the disease, so Panchakarma chikitsa is of prime importance, as evident from the success of all the above-reviewed studies.
Role of snehana and svedana in vatavyadhi: For vata vyadhi, Snehan and Svedana are the best line of treatment. Sneha dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mridu, Guru (19), which are opposite to Vata, thus alleviating it. When administered, Snehan provides nourishment to emaciated tissue. As Katigraha is a Vata vyadhi, Snehan softens the muscles, ligaments, and tendons, correcting stiffness, rigidity in the body, and lubricating the Srotas. Following Snehan, Svedana should be given, alleviating pain, stiffness, oedema, and making the body soft (20). Repeated administration of Snehan and Svedana ensures that the koshta becomes soft, preventing vayu diseases from permanently lodging there.
Role of virechan in katigraha: Acharya Charak mentioned Mridu Virechan in Vata Vyadhi (21). If the disease does not subside with Snehan and Svedana, the patient should be given Virechan with mild drugs added with unctuous ingredients. This process cleanses the body of morbidities, stimulates Agni, and is followed by the administration of Snehan and Svedana once again.
Role of basti in vatavyadhi: In Charak Siddhisthan, Acharya Charak described Basti as Ardh Chikitsa (22), the best therapy to subdue aggravated Vata. The primary sign of Vata aggravation is pain, making Basti an effective treatment for the disease. Since Katigraha is a Vata vyadhi, basti is considered the best treatment for this condition.
Role of bahi parimarjan chikitsa: Katibasti (23) is a Snigdha, Saagni type of Sveda often recommended for conditions like back pain and arthritis. Medicated oils with analgesic and anti-inflammatory properties should be used. These oils help in the formation of lipoidal bonds, aid in the penetration of drug molecules, increase blood circulation to the affected area, balance Doshas, strengthen muscles, release toxins, and reduce inflammation.
Patra pinda sveda (24) is a form of Svedana that falls under Pinda Sveda. It involves using leaves of medicinal plants with analgesic, anti-degenerative, and anti-inflammatory properties. This treatment reduces symptoms like Shula and Stambha in Katigraha. The Ushna Guna stimulates the sympathetic nervous system and promotes vasodilation. The Sara and Sukshama Guna of Svedana Dravya liquefy Doshas, facilitating their excretion through micropores on the skin, resulting in the elimination of vitiated Doshas from the body. Both Patrapinda Sveda and Kati basti combine Snehana and Svedana, forming the first line of treatment for Vata Dosha.
Limitation(s)
In this review, the quality of individual studies was not assessed, and findings were synthesised quantitatively. The present review applied a limited search strategy. Due to the broad nature of this review, the synthesis and interpretation of findings are limited. The article, being exploratory in nature, does not provide exact decision-making but rather aids in reaching a conclusions about various types of therapies that may be useful in managing Katigraha.
The comprehensive exploration of the management of Katigraha, a Vata-dominant disorder, highlights the significance of a holistic approach in Ayurveda. The review has emphasised the intrinsic role of Panchakarma therapies, particularly Snehan, Svedana, Virechan, Basti, and Bahi Parimarjan Chikitsa, in effectively addressing the complexities of this ailment. Snehana, with its unique qualities opposite to Vata, stands out as a pivotal therapy, softening muscles and lubricating the Srotasa, thereby correcting stiffness and rigidity in the body. The integration of Snehan, Svedana, Virechan, Basti, and Bahi Parimarjan Chikitsa forms a comprehensive treatment protocol that not only addresses the symptoms but also targets the root cause of the Vata vitiation. This approach, based on the ancient wisdom of Ayurveda, provides a promising avenue for the effective management of Katigraha, paving the way for enhanced well-being and improved quality of life for individuals suffering from this condition.
DOI: 10.7860/JCDR/2024/62954.19250
Date of Submission: Dec 18, 2023
Date of Peer Review: Jan 24, 2024
Date of Acceptance: Feb 26, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 19, 2023
• Manual Googling: Feb 02, 2024
• iThenticate Software: Feb 24, 2024 (5%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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