E-ISSN:2584-0002

Case Report

Kayachikitsa

International Journal of Ayurveda and Herbal Research

2023 Volume 1 Number 1 April
Publisherwww.a2zjournals.com

A Critical Analysis On The Ayurvedic Aspect Of Katigraha (Low Back Pain): A Successful Case Study

Gupta A.1*, Nagpal S.2
DOI: 10.54060/ijahr.v1i1.5

1* Arpana Gupta, Scholar, Department of Kayachikitsa, Pt. Khushilal Sharma Government (Autonomus) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

2 Swati Nagpal, Reader, Department of Kayachikitsa, Pt. Khushilal Sharma Government (Autonomus) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.

Abstract: A frequent condition affecting the back's muscles, nerves, and bones is low back discomfort. Pain might range from a continual dull sensation to a sudden acute sensation. Low back pain affects approximately 60 to 85% of adults during some point of their life. Katigraha indicates a disease condition of the lower back associated with pain, stiffness, and restricted movements. A condition when pure saam vayu reaches kati Pradesh and produces pain is known as katigraha. In Ayurveda samhitas, katigraha has been mentioned as both anubandha and anubandhya vyadhi. It can be correlated with Lumbar Spondylosis due to similarity of clinical manifestations. Lumbar spondylosis is a degenerative condition that develops gradually over time, being more common in older individuals. Contemporary medicine has its own limitations giving only short-term relief in pain or surgical intervention with side effects. So this single case was taken to demonstrate the effects of ayurvedic treatment modality. After a month, the patient's symptoms were assessed, and the results were satisfactory. The patient's general quality of life had also greatly improved.

Keywords: Katigraha, panchakarma, katibasti, kala basti, low back pain, lumbar spondylosis

Corresponding Author How to Cite this Article To Browse
Arpana Gupta, Scholar, Department of Kayachikitsa, Pt. Khushilal Sharma Government (Autonomus) Ayurveda College & Institute, Bhopal, Madhya Pradesh, India.
Email: 		Arpana Gupta, Swati Nagpal, A Critical Analysis On The Ayurvedic Aspect Of Katigraha (Low Back Pain): A Successful Case Study. IJAHR. 2023;1(1):23-29.
Available From
https://ahr.a2zjournals.com/index.php/ahr/article/view/5/version/5

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-01 2023-04-04 2023-04-08 2023-04-13 2023-04-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18 18

© 2023by Arpana Gupta, Swati Nagpaland Published by A2Z Journals. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

International Journal of Ayurveda and Herbal Research 2023;1(1)23
Gupta A et al.

Introduction

According to Gadanigraha

वाय कटुःयाश्रितुः श द्धुःसामोवा जनयेद्रजम्।कश्रटग्रहुः सश्रवज्ञेयुःपन सक्थिद्वयाश्रितुः ॥१६० ॥

A condition when pure saam vayu reaches kati Pradesh and produces pain is known as katigraha. Katigraha indicates a disease condition of the lower back associated with pain, stiffness, and restricted movements. Lower back discomfort caused by spondylosis is a significant clinical, social, economic, and public health issue that affects the whole world's population. Long periods of sitting, a poor diet, a lack of exercise, and stress are the primary causes of low back pain in today's society. With the changes in lifestyle, low back ache is a very common complaint now-a-days in every age group. One of the main causes of low back ache is the intervertebral disc prolapse. In 95% of the lumbar disc herniation, L4-L5 and L5-S1 discs are most affected. It can happen suddenly or gradually over time from repetitive movements. Low back pain caused by spinal degeneration and injury. Conditions linked to back pain include:

  • Muscle or ligament strain
  • Bulging or ruptured discs
  • Arthritis
  • Osteoporosis

The pathophysiology of Katigraha is mostly influenced by Vata and Kapha. In this case, the disease's pain and stiffness are two symptoms that are caused by the Vata and Kapha Doshas. Katigraha is one of the Vatavyadhis, according to Gadanigrahakara. It blatantly implies that Vata Dosha is the primary cause of the whole pathophysiology associated with Katigraha. He says that the Kati Pradesha is where the ashraya of the vitiated shudha or samavayu, which causes pain and stiffness, takes place.

In Ayurveda, samanya vatavyadhi nidana for Katigraha are :

  • Consumption of light, dry, cold, and insufficient food.
  • Excessive sex and insomnia.
  • Ineffective therapies such as prolonged fasting, swimming, or walking.
  • Excessive physical activity and exercise.
  • Anxiety, sadness, and crippling illnesses.
  • Using uncomfortable mattresses or chairs
  • Anger, daytime sleep, repressing desires that come naturally, indigestion, trauma, and not eating.
  • Vital organ damage, collisions with moving objects, riding horses or camels, etc.

This whole situation aggravates vata. This fills up the body's empty channels and causes a variety of generalized or specific illnesses.

Samprapti

Vata and Kapha are the two main factors involved in the pathogenesis of Katigraha.


Table 1. Factors in the pathogenesis of Katigraha

 1 Dosha Vata Kapha Apana, vyana
(vriddhi) Sleshaka,
avalambaka (kshaya)
 2 Dushya Dhaatu Updhaatu Rasa, Asthi Kandara, Snayu
 3 Udbhavasthaana Pakwashaya
 4 Vyaktasthaana Kati
 5 Marga Madhyama roga marga
 6 Strotas Rasavaha, Asthivaha, Purishavaha
 7 Strotodushti Sanga
 8  Agni Mandya

The following are the main signs of katigraha:

  • Shoola, a type of pain that can be intense, searing, or dull.
  • The sama vayu movement in Kati (the lumbar region) causes muscular spasms that result in stambha (stiffness) in this area as well.

The overall deterioration of the spine, which can affect the joints, discs, and bones of the spine, is referred to as spondylosis. It is a deteriorating disorder that can get worse as people age and can affect any part of the spine, including:

  • Cervical — neck
  • Lumbosacral — low back/sacrum
  • Lumbar — low back
  • Thoracic — upper, mid-back

Degeneration of the lumbar vertebrae is one way to characterize lumbar spondylosis. The discs and vertebrae of the lower back are deteriorating due to ageing. Osteoarthritis and degenerative disc disease are common names for these alterations.


International Journal of Ayurveda and Herbal Research 2023;1(1)24
Gupta A et al.

Aim and Objectives

This study's objective was to evaluate the effectiveness of Ayurvedic treatment, including Shodhana and Shamana Chikitsa, in katigraha.

Material and Methods

For this study, patient of katigraha was registered from OPD of Kayachikitsa Department and admitted in female IPD of PKLS Govt. Ayurveda Hospital, Bhopal. The allopathic medicines were stopped during the study period. The registered patient was informed regarding the procedures that she would undergo and was admitted in the hospital.

The drugs required for Panchakarma procedures were procured and prepared in Panchakarma in PKLS Govt. Ayurvedic Hospital, Bhopal. The duration of the study was one month.

Case Study

A 35-year-old female patient presented with the complaints of pain in lumbar region and stiffness in left leg. She took modern medicines too, but did not get any relief. So, for further treatment she came to PTKLS Govt. Ayu. Hospital & Institute Bhopal.

The pt. was admitted in PTKLS Govt. auto Ayurveda college and institute Bhopal.

H/o Present Illness

According to the pt. she was alright 7 months back, then she started feeling pain in lower back and stiffness in left leg. She presented the symptoms of lower back ache, stiffness, and difficulty in walking due to pain.

Past History

There was no any h/o of DM, HTN or any other major illness or surgery in the past.

Table 2. Personal history

Occupation housewife
Appetite normal
Bowel clear
Sleep disturbed due to pain
Micturition normal
Allergy none
Addiction none

General Examination

The observations in the general examination are as follows:

  • Pallor, icterus, cyanosis, clubbing $ oedema – Absent
  • BP= 124/80 mmHg
  • Pulse – 70/min
  • Spo2 and all vitals were stable.

The observations in the systemic examination are shown in table 3 and the lab examination are in table 4.


Table 3. Systemic examination

R. S Bilateral lungs sound clear
CVS Normal
P/A Normal
CNS Pt. was conscious and well oriented.

Table 4. Lab investigations

Hb % 12.9 gm %
Serum uric acid 5.4 mg/dl
Random blood sugar 101.2 mg/dl

Assessment Criteria

The assessment criteria for the study of the selected patient are as follows:

  • Ruka (Pain)
  • Stambha (Stiffness)
  • Suptta (Numbness)
  • ODI ( Oswestry disability Index )

Table 5. Ruka (pain)

Grade Pain
0 No pain
1 Mild pain but no difficulty in walking
2 Moderate pain and slight difficulty in walking
3 Severe pain with severe difficulty in walking

Table 6. Stambha (Stiffness)

Grade Stiffness
0 No stiffness
1 Sometimes for 5-10 min
2 Daily for 10-30 min
3 Daily for 30-60 min / more than 1 hr

Table 7. Suptta (Numbness)

Grade Numbness
0 No numbness
1 Paresthesis
2 Severe paresthesis

International Journal of Ayurveda and Herbal Research 2023;1(1)25
Gupta A et al.
3 Intolerable paresthesis
4 Paralysis

Table 8(a). ODI (Oswestry disability Index)

IJAHR V001 Iss001 SN005 - 8a.jpg

Table 8(b). ODI (Oswestry disability Index)

IJAHR V001 Iss001 SN005 - 8b.jpg

MRI scan of Lumbosacral Spine

The observation of the MRI scan are as follows:

  • Diffuse posterior bulge with posterior protrusion of L4-5 disc, indenting thecal sac.
  • Bilateral facetal arthropathy at L4-5 level.

The MRI scan report of a patient and the film is shown in figure 1 a and b.


International Journal of Ayurveda and Herbal Research 2023;1(1)26
Gupta A et al.

IJAHR V001 Iss001 SN005 - fig - 1 a.jpg

Figure 1(a). MRI L-S SPINE report of a patient

IJAHR V001 Iss001 SN005 - fig - 1 b.jpg

Figure 1(b). MRI L-S SPINE film of patient

 

Table 9. Treatment Regimen

Punarnavadi guggal 2 BD
Rasna saptak kwath 20 ml BD
Shivakshara pachan churna 5 gm HS
Kati basti Narayan taila
Kala basti -Niruh basti- dashmooladi kwathAnuwasana basti - Narayan taila
Physiotherapy  

Results

The results of the study on the selected registered patient are as follows:

  • After treatment there was marked relief in LBA and STIFFNESS. 
  • was able to walk more freely.
  • Walking time increased.

Table 10. Basti retention time of Kala Basti Plan

Day  Date  Basti Aadana kala Pratyaga
mana kala 		Retention
time
1 17/09/2021 Anuvasana 11:00 a.m. 11:20 p.m. 20 min
2 18/09/2021 Anuvasana 11:15 a.m. 01:00 p.m. 1 hr 45 min
3 19/09/2021 Niruha 09:40 a.m. 10:00 a.m. 20 min
4 20/09/2021 Anuvasana 11:00 a.m. 12:40 p.m. 1 hr 40 min
5 21/09/2021 Niruha 10:00 a.m. 10:15 a.m. 15 min
6 22/09/2021 Anuvasana 10:30 a.m. 12:15 p.m. 1 hr 45 min
7 23/09/2021 Niruha 09:20 a.m. 09:45 p.m. 25 min
8 24/09/2021 Anuvasana 11:00 a.m. 01:20 p.m. 2 hr 20 min
9 25/09/2021 Niruha 09:00 a.m. 09:15 a.m. 15 min
10 26/09/2021 Anuvasana 10:00 a.m. 11:00 a.m. 1 hr
11 27/09/2021 Niruha 09:10 a.m. 09:30 a.m. 20 min
12 28/09/2021 Anuvasana 10:00 a.m. 12:10 p.m. 2 hr 10 min
13 29/09/2021 Niruha 10:00 a.m. 10:20 a.m. 20 min
14 30/09/2021 Anuvasana 10:15 a.m. 01:45 p.m. 3 hr 30 min
15 1/10/2021 Anuvasana 10:00 a.m. 02:00 p.m. 4 hr
16 2/10/2021 Anuvasana 11:00 a.m. 01:45 p.m. 2 hr 45 min

Table 11. Change of reading in pain, stiffness and numbness

Sign of symptoms Before treatment After treatment
Pain 3 1
Stiffness 3 1
Numbness 0 0

Table 12. Change of reading in different activity symptoms

Sign of symptoms Before treatment After treatment Result in %
Walking 3 1 80
Personal care 3 1 80
Social life 3 1 80

International Journal of Ayurveda and Herbal Research 2023;1(1)27
Gupta A et al.
Sex life - - -
Pain intensity 5 1 80
Lifting 4 2 70
Sitting 3 1 80
Standing 4 0 100
  Travelling  4  1 80
Sleeping 2 0 100
Total 31 8 83.33 %

Discussion

Punarnavadi Guggulu – Punarnavadi guggulu contains mainly punarnava, erandamoola, shunthi, guggulu, eranda taila etc. which possess vata-kaphahara, shoolahara and anulomaka properties along with anti-inflammatory, analgesic, muscle relaxant properties and even regenerative properties which gives relief from the disease.

Rasnasaptaka Kwatha – Rasnasaptaka kwatha possess an excellent vata shamaka property. It has the following contents rasana, amrita, aaraghwadh, devdaru, trikantaka, punarnava, etc. having the property anti-inflammatory, analgesic, anti-arthritic.

Shivakshara Pachan Churna – Vata and Pitta's digestive processes are normalized. The food that has been consumed is properly absorbed and assimilated. Rich in carminative and anti-spasmodic herbs, it quickly relieves gassiness and biliousness.

Kati basti with Narayana Taila – Kati basti is a type of snigdha swedana. Application of kati basti was carried out in order to provide nourishment and strength to the affected area. Here due to degeneration of inter-vertebral disc and affected function of Shleshaka kapha, results in irritation and compression. The combination of kati basti and Narayana taila, which combines the benefits of both snehana and swedana, helps lubricate the local muscle and tissues of the adjacent afflicted area and also enhances local blood flow, which aids in draining the inflamed exudates.

Dashmooladi Niruha basti followed by Narayana tail Anuvasana basti – According to Acharya Charaka, basti is the best treatment for vata dosha. Since the active ingredients in basti preparation are absorbed by the Pakwashaya (intestine) and subsequently distributed to numerous bodily channels. It gets to the diseased area, causes affect throughout the body, and provides alleviation. Basti acts on the primary location of vata dosha, pakwashaya

, and aids in the removal of the avarana of kapha over vata caused by protrusion.  It helps in relieving constipation, odema, inflammation and necrosis due to its strotoshodhana effect. Dashmool is a tridoshahara drug. Guduchi possesses vedanasthapana, vataghna action due to snigdha and ushna gunas. Due to its ushna virya and shothahara characteristics, Punarnava possesses kapha-vataghna activity. The effects of anuvasana vasti with narayana taila permeate the body and reach subtle pathways.

Conclusion

Katigraha is considered as one of the Vata Nanatmaj vikara. The principal symptom of katigraha, low back pain, is relatively common nowadays owing to a mechanical lifestyle, despite the fact that it is not extensively mentioned in Ayurvedic writings. It is a relatively typical ailment. It may occur instantly or gradually over time as a result of repeated motion. Long periods of sitting, a poor diet, a lack of exercise, and stress are the primary causes of low back pain in today's society. As a result, one should be aware of the causes and symptoms before treating.

References

  1. Mangal G, Garg G, Shyam S. OA03.18. “A comparative study of kati basti with sahacharadi taila and maha narayana taila in the management of gridhrasi (Sciatica).” Anc Sci Life [Internet]. 2013;32(5):41. Available from: http://dx.doi.org/10.4103/0257-7941.123856
  2. Vangasena, Vangasena Samhita, edited by Kaviraj Shri Shalligramji Vaishya, Vatavyadhiadhikara Adhyaya Shloka 326-332, Kamaraj Shri Krishnadasa Prakashsena Mumbai, p.351.
  3. Mishra S, editor. Govinddas, Bhaisajyaratnavali; Vatavyadhi Chikitsa Prakarana: Chapter 26, Verse 69. Varanasi, India: Chaukhamba Surbharati Prakashan; 2007. p. 142-143.
  4. Agnivesha, Charaka Samhita, Vatavyadichikitsaadhyaya, Vidyotini. Shastri K, editors. Sutra sthana. Varanasi: Chaukhamba Sanskrit Sansthan. 
  5. Tripathi I. editor Sodhal. Gadanigrah. Vol. 2. First edition Varanasi Chaukhamba Sanskrit Sansthan, Vatavyadi; 2011. p. 488. 

International Journal of Ayurveda and Herbal Research 2023;1(1)28
Gupta A et al.
  1. Sharma PV, editor. Sutrasthana; Yagyapurushiyadhyaya. Charaka Samhita of Agnivesha. 8th ed. Chapter 25, Verse 40. Varanasi, India: Chaukhamba Orientalia; 2007. p. 168. 
  2. Sharma PV, editor. Siddhisthana; Bastivyapadasiddhi Adhyaya. Charaka Samhita of Agnivesha. 8th ed. Chapter 7, Verse 64. Varanasi, India: Chaukhamba Orientalia; 2007. p. 638.
  3. Deshpande AP, Subhash R, editors. Textbook of Dravayguna Vigyan (English), Part-2, A.R. Nandurkar. Shaniwar Peth, India: Proficient Publishing House; 2007. p. 271.
  4. Deshpande AP, Subhash R, editors. Textbook of Dravayguna Vigyan (English), Part-2, A.R. Nandurkar. Shaniwar Peth, India: Proficient Publishing House; 2007. p. 551.
  5. Venkatesh V Goudar, Supriya Y. Testing the Validity of Charakokta Chikitsa Sutra for Gridhrasi: A Case Study. Published in International Journal of Trend in Scientific Research and Development (ijtsrd). 2022;(7):1240–4.
  6. Barcelo P, Dalmases Gosse R. Lumbar spondylosis. Rev Esp Reum Enferm Osteoartic [Internet]. 1959 [cited 2023 Jan 27]; 15:320–8. Available from: https://www.physio-pedia.com/Lumbar_Spondylosis
  7. Lunardo E. Lumbar spondylosis: Causes, symptoms, and treatment [Internet]. Bel Marra Health - Breaking Health News and Health Information. 2017 [cited 2023 Feb 27]. Available from: https://www.belmarrahealth.com/lumbar-spondylosis-causes-symptoms-treatment/
  8. Hellinger S, Telfeian AE, Lewandrowski K-U. Magnetic resonance imaging documentation of approach trauma with lumbar endoscopic interlaminar, translaminar, compared to open microsurgical discectomy. Int J Spine Surg [Internet]. 2022;16(2):343–52. Available from: http://dx.doi.org/10.14444/8226
  9. Aaos.org. [cited 2023 Feb 27]. Available from: https://www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2

  1. Jenks A, Hoekstra T, Tulder MV, Ostelo RW, Rubinstein SM, Chiarotto A. Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which has superior measurement properties in older adults with low back pain? J Orthop Sports Phys Ther [Internet]. 2022;52(7):457–69. Available from: http://dx.doi.org/10.2519/jospt.2022.10802

International Journal of Ayurveda and Herbal Research 2023;1(1)29