Calcaneous Spur & Treatment

calcaneous spur is a common disease seen in Mid ages , here i present the management of calcaneous spur .

1. “A CLINICAL COMPARATIVE STUDY ON EFFICACY OF SALAVANA UPANAHA SWEDA WITH AND WITH OUT SIRAVYADHA IN THE MANAGEMENT OF VATAKANTAKA” Presented by : Dr Sebin Johny Guide : Dr . N.S. SHETTAR . M.D. ( Ayu .) Co Guidance: Dr Soumya S.V . M.D ( Ayu ) POST GRADUATE DEPARTMENT OF PANCHAKARMA, K.V.G. AYURVEDA MEDICAL COLLEGE AND HOSPITAL, AMBATE ADKA, SULLIA – 574327

2. Contents INTRODUCTION REVIEW ON LITRATURE OBJECTIVES MATERIALS AND METHODS OBSERVATIONS RESULTS DISCUSSION CONCLUSION

3. INTRODUCTION The primary aim of the entire human life is to attain happiness & lead a successful life. These are greatly depending upon locomotion. Vatakantaka is that disorder, which interfere with the free locomotion of the individual resulting in hindrance to his daily activities. Acharya Sushrutha was the pioneer (2500 BC) to explain it under Vatavyadhi 1 ; & in due course, other authors like Vagbhata , Yogarathnakara , Chakradatta , Vangasena and Madhavakara also narrate the same. In Vatakantaka pain in the heel develops due to walking on uneven surfaces or excessive walking. Due to the Nidanas , Vata gets vitiated and reside at Gulpha Sandhi , produces pain 1 . As the disease is affecting the Madhyama roga marga considered to be kashtasadya . Vatakantaka can be correlated to painful heel in modern parlance. It accounts for 78% of total cases of painful heel attending orthopedic clinics. It is commonly seen in strenuous workers who experience severe pain especially in the morning and during walking after sitting for long time. It is mainly due to painful heel syndrome or tender heel pad or plantar fasciitis 2 . Contemporary Science prescribes a number of analgesics, anti-inflammatory drugs & local steroidal injections & surgery in this condition. But they do not render full cure or satisfaction. More over these are costly & come along with many adverse effects. Thus an alternative Para-surgical, safe, cost effective and result oriented ayurvedic remedy was tried, expecting to fulfil the pitfalls of contemporary science.

4. Acharya Sushruta suggests Snehana , Upanaha , Agnikarma , Bandhana , Unmardana & Siravyadha as remedy for Vatakantaka in different contexts 3 Upanaha is one among Chaturvidha Swedana explained by Acharya Sushruta 4 . The pain in Vatakantaka is due to Vata Prakopa . So Upanaha Sweda can be done as it is Vatahara . Here Salvana Upanaha is considered for Upanaha Sweda . The Salvana Upanaha explained by Acharya Sushrutha in the context of Vatavyadhi Chikitsa , which is indicated in all Vata Vyadhis . The Bandhana done in Upanaha Swedha is an added advantage to this condition. So this study is taken up to clinically evaluate the efficacy of Salvana Upanaha Sweda in conditions pertaining to Vatakantaka . Acharya Vangasena gave special emphasis on the therapeutic effects of siravyadha 5 . The Para-surgical procedure of allowing the blood to bleed for therapeutic purposes is known as raktamokshana . Siravyadha is a type of raktamokshana where puncturing of the vein is done with a shastra 6 . Acharya Sushrutha , considered it as Ardha Chikitsa . Dalhana comments that it is because siravyadha cures diseases of Mamsa , Meda , Asthi & Majja . He recommends raktamokshana for Vata prakopa in Sira , Tvak , Mamsa , and Rakta which was not encountered even after the treatment of Panchakarma 7 . The clinical efficacy of Panchakarma procedures deserves appreciation and hence continues to attract the people, physicians and research workers worldwide. Hence Upanaha sweda with and without Siravyadha was decided to be studied.

5. REVIEW OF LITRATURE DISEASE REVIEW Vatakantaka – In the Ayurvedic classical texts Vatakantaka is a disease mentioned among Vatavyadhies . Susrutha and Vagbhata explain it under Vatavyadhi . There are explanations of this disease in Chakradatha , Baishajyaratnavali and Madavanidana . Nidana , Samprapthi and Lakshana are almost similarly explained in all the texts. Among Bhruhathrayees , Charakacharya didn't specifically explain this disease. History Of Vatakantaka History of Ayurveda is divided into three Vedic period Samhitha kala Sangraha Kala 1. Vedic Period: References about Vatakantaka is not visible in vedas , but the information is available regarding Vatavyadhi in general .It is mentioned in Bruhath Jaataka 23-13, Raghuvamsham9-63, Brahma Samhita 87-44, Kaashika 5-2-129 8 .

6. 2 . Samhita Kala: Susrutha Samhita Acharya Sushrutha explained Lakshanas of Vatakantaka in Nidanasthana 9. In Chikithsa Sthana specific line of treatment has been mentioned as Siravyadhana to be performed 10 Charaka Samhitha Acharya Charaka described it as Khuda Vata , Which is a synonym of Vatakantaka in the chapter Vatavyadhi Chikitsa . He explained this condition under the “ Sthana Bheda Vayu Lakshana 11 Chakrapani comments that Khuda Vata is Gulpha Vata 12 . Ashtanga Hridaya In Ashtanga Hridhaya , Vatakantaka are explained in Nidhanasthana and Chikithsa Sthana 13 3 . Sangraha Kala: Madhava Nidana 14 Vatakantaka is explained in Vatavyadhi nidana Bhavaprakasha : He explained the lakshanas and treatment of Vatakantaka in Madhyama Khanda Vatavyadhikara . From the treatment point of view he had stated Dahana , Snehana , Upanaha swedam and a combination of Indravarunimula , Pippali and Guda for internal administration 15 . Yogarathnakara : Lakshanas and treatment of Vatakantaka are explained in Vatavyadhi Adhikara of Poorvardha 16

7. Definition Of Vatakantaka Sushruth Acarya explains that by walking on uneven surfaces, Vata gets vitiated and produces pain .He says this disease is based on Khuda 23. Dalhana explained as the junction of Pada and Jangha or as Parshini 24 is Khudaka and explained that when Ruja (pain) is located in Khuddaka ( Khuddaka ashrita ) heel region called as Vatakantaka 25 . Vatakantaka – Modern Review Pain in the foot can be classified according to the region affected. Pain in the heel Pain in the mid foot Pain in the fore foot A . Pain In The Heel This can be subdivided into Pain within the heel e.g.: Fracture or disease of the calcaneum ( osteo myelitis or tumour or Paget's disease ) and arthritis of the subtaloid joint. Pain behind the heel e.g.: Tendoachillis bursitis, retrocalcaneum bursitis, apophysitisof the calcaneum ( Sever's disease) and rupture and paratendinitis of the tendoachillis . Pain beneath the heel e.g.: Infracalcaneum bursitis and plantar fasciitis (Policeman's heel) Calcaneal spur.

8. B. Pain In The Midfoot A strain on the inferior calcaneo navicular ligament (spring ligament) occurs when the foot flattens rapidly due to weakness of the short muscles of the sole or after a prolonged confinement in the bed. Kohler's disease ( osteochondritis of the navicular bone) is another cause of pain in the mid-foot. The usual victim is the child under 5 years of age. Painful limb and tenderness over the navicular bone are the diagnostic considerations; the navicular bone becomes dense with altered shape. An "over-bone" connecting the dorsal surfaces of the medial cuneiform and the base of the first metatarsal bone give rise to pain in the mid-foot. A tender and bony lump just proximal to the base of first metatarsal bone is the diagnostic feature of this condition. C . Pain In The Forefoot Or Metatarsalgia Disorders of the foot may give rise to pain in the forefoot, e.g.: splay foot associated with hallux valgus, curly toes, a claw foot with claw toes etc.

9. TREATMENT REVIEW Swedana : Chikitsa is classified into three varieties as Antahparimarjana , Bahirparimarjana and Shastrapranidhana . The presently discussed subject Swedana Karma is one among the Bahirparimarjana and Shat- Upakrama . However the concept of Abhyantara Sveda is also mentioned in the context of Jwara and Kushta . Swedana is the Upakrama which is exactly opposite to the Sthambana . A separate chapter can be seen in Ayurvedic literatures, illustrating this therapy which represents its importance in treating diseases and maintenance of health. UPANAHA SWEDA Etimology Of Upanaha : Upanahyate Asmin – Upa + Nah ( Bandhane ) “ Dhanj ” Prathyaya 139 - To tie, to cover or to wrap. Upa – is a prefix to noun/verb and denotes near by/ together. Nah – is a verb and denotes to bind/ to tie. Upanaha means - To tie or to cover or to wrap 140 Definition : Vranaalepa pinda 141 – The act of application of paste in form of Kalka is Upanaha . Pralepa iti bhasha – Upanaha is also called as Pralepa . Upanaha sweda visheshe lep 142 – Upanaha is a mode of fomentation in the form of application of medicinal drugs. Vranaadi upashamanartham lepane draye ca 143 – Upanaha means application of different drugs in a specific form for the purpose of Shamana of wound.

10. DRUG REVIEW :- Sankrit Name Botanical Name Family Rasa Guna Virya Vipaka Karma Part used Vidarika Ipomea digittata Convolvulaceae Madhura Guru, Snigdha Sheeta Madhura Vata-Pittahara Tuber Mudgaparni Phaseolus trilibus Fabaceae Madhura Laghu, Ruksha Sheeta Madhura Tridoshahara Seed Mashaparni Teramnus labialis Fabaceae Madhura Laghu, Snigdha Sheeta Madhura Vata-Pittahara Seed Shatavari Asparagus recemosus Liliaceae Madhura, Tikta Guru, Snigdha Sheeta Madhura Vata-Pitttahara Tuberous root Chinnaruha Tinospora cordifolia Menispermaceae Tikta, Kashaya Guru, Snigdha Ushna Madhura Tridoshahara Whole plant Karkatashringi Pistacia integerrima Anacardiaceae Kashaya , Tikta Laghu, Ruksha Ushna Katu Kapha-Vathahara Galls Vamshalochana Bambusa arundinacia poaceae Madhura , Kashaya Laghu , Ruksha Sheeta Madhura Kapha-Pittahara Root Nodes Leaves Padmaka Prunus puddum Rosaceae Kashaya, Tikta Laghu, Snigdha Sheeta Katu Kapha-Pittahara Stem bark Seeds Mrdvika Vitis vinifera Vitaceae Madhura Snigdha, Guru, Mrudhu Sheeta Madhura Vata-Pittahara Fruit

11. Jeevanti Leptadenia reticulate Asclepiadaceae Madhura Laghu, Snigdha Sheeta Madhura Raktha-Pittahara Root Madhuka Glycyrrhiza glabra Fabaceae Madhura Guru, Snigdha Sheeta Madhura Tridosha Hara Root Bhadradharu/ Devadaaru Cedrus deodar Pinaceae Tikta, Katu, Kashaya Laghu, Ruksha Ushna Katu Kapha-Vatahara Bark, Heart-wood Kusta Saussurea lappa Asteraceae Tikta, Katu, Madhura Laghu, Ruksha, Teekshna Ushna Katu Vata-Kaphahara Root Haridra Curcuma longa Scitaminae Tikta, Katu Ruksha, Laghu Ushna Katu Kapha-Vathahara Rhizome Varuna Cretaeva religiosa Capparidaceae Tikta, Kashaya Lagu, Ruksha Ushna Katu Kapha-Vathahara Root bark, stem bark Bala Sida cordifolia Malvaceae Madhura Laghu, Snigdha, Picchila Sheeta Madhura Vatha-Pittahara Root Atibala Sida rhombifolia Malvaceae Madhura Laghu, Snigdha Sheeta Madhura Vata-Pittahara Root Kacchura Curcuma zedoaria Zingiberacear Katu, Tikta, Kashaya Laghu, Teekshna Ushna Katu Kapha-Vatahara Tuber Leaf Shallaki Boswellia serrata Bursuraceae Kashaya, Tikta Laghu, Ruksha Sheeta Katu Kapha-Pittahara Bark Gum Lathakaranja/ Kuberaksha Caesalpinia borduc Caesalipiniaceae Tikta, Kashaya Laghu, Ruksha Ushna Katu Tridosha Hara Root bark Leaf Seed   Sahachara Barleria cristata Acanthaceae Tikta, Madhura Laghu Ushna Katu Kapha-vatahara Root Leaves

12. Agnimantha Clerodendrum phlomidis Verbinaceae Tikta, Katu, Kashaya, Madhura Ruksha, Laghu Ushna Katu Kapha-Vatahara Root-bark Leaves Eranda Ricinus communis Euphorbiaceae Madhura, Katu, Kashaya Snigdha, Teekshna, Sukshma Ushna Madhura Kapha-Vatahara Root Leaf Seed oil Asmabhedha Saxeifraceae lingulata Saxifragaceae Kashaya, Tikta Ruksha Sheeta Katu Tridosha Hara Root Leaf Flower Fruit Arka Calotropis gigantean Asclepiadaceae Katu, Tikta Laghu, Ruksha, Teekshna Ushna Katu Vatahara Root-bark Leaf Flower Latex Seed Punarnava Boerhavia diffusa Nyctaginacea Madhura, Tikta, Kashaya Laghu, Ruksha Ushna Katu Kapha-Vatahara Whole plant Dhathura Datura metal Solanaceae Tikta, Katu Laghu, Ruksha Ushna Katu Kapha-Vatahara Root Fruit Seed Flower Leaf Bharangi Clerodendrum indicum Verbinaceae Tikta, Katu Lagu, Ruksha Ushna Katu Kapha-Vatahara Root Karpasa Gossypium herbaceum Malvaceae Madhura Laghu Ushna Madhura Vatahara Seed Flower Badara Ziziphus mauritiana Rhamnaceae Madhura, Amla Guru, Snigda Sheeta Madhura, Amla Vata- Pittahara Root Leaf Fruit Yava Mordeum vulgare Graminae Kashaya, Madhura Ruksha Sheeta Katu Tridosha Hara Seed Kulatha Dolichon biflorus Fabaceae Kashaya Laghu, Ruksha Ushna Katu Kapha-Vatahara Seed

13. The some of the drugs of Kakolyadi Gana are not available, for that Acharya Bhava Mishra explains some of substitute drugs Sl .No DRUG SUBSTITUTE DRUG 1. Kakoli (Fritillaria roylei) Ashwagandha (Withania somnifera) 2. Ksheera kakoli(Lillium polyphyllum) Ashwagandha (Withania somnifera) 3. Jeevaka (Microstylis wallichil) Vidarika (Ipomea digitata) 4. Rushabhaka (Microstylis musifera) Vidarika (Ipomea digitata) 5. Meda (Polygonatumcirrhifolium) Shatavari(Asparagus racemosus) 6. Mahameda (Polygonatum verticillatum) Shatavari(Asparagus racemosus) 7. Vriddhi (Habenaria intermedia) Varahikanda (Dioscoera bulbiflora) 8. Ruddhi (Habenaria edgeworthii) Varahikanda ( Dioscoera bulbiflora )

14. Tila : Latin Name : Sesamum indicum Family : Pedaliaceae Rasa : Madhura Anurasa : Kashaya , Tikta Guna : Guru, Snigdha Veerya : Ushna Vipaka : Madhura Doshagnatha : Vatashamana Rogaghnata : Vatavyadhi , Arsha , Prameha , Saindhava : Chemical name: Sodii chloridum impura English Name: Rock Salt Rasa : Lavana , Madhura Guna : Laghu , Snigdha , Sookshma Veerya : Ushna Vipaka : Madhura Doshaghnata : Tridoshashamana Maha Snehas : 181 SARPI (ghee-butter fat), MAJJA (marrow), VASA (muscle fat) and TAILA , are ideal among all fats and ghee is best of all, because of its ability to acquire the properties of processing. (with addition of other drugs etc.)

15. Kanji: The liquor prepared with Manda (gruel) of half boiled Kulmasha ( blackgram ), Dhaanya (rice, barley etc.) is Kanjika . Mamsarasa : Preparation : If Ganamamsa Rasa is suppose to be prepared 8 Palas of Mamsa and one Prastha of water are taken. If Madhyama Mamsa Rasa suppose to be prepared 6 Palas of Mamsa and one Prastha of water are taken.

16. SIRAVYADHA REVIEW Saranath sira – that which conveys is called sira Poorva karma Selection of Sira The Sira which are invisible and which are not prominent should not be selected. Out of 700 Siras , 16 Siras in Shaka , 32 in Madhya Shareera , 50 in Urdvajatru are regarded as contraindicated for Siravyadha . Pradhana karma of siravyadha 193 The patient should be duly anointed ( Sneha ) and fomented ( Sweda ) before the procedure. Drava Anna and Yavagu should be given (liquid food is recommended for the purposeof liquefying the blood so as to bleed easily.). Then at proper season the patient should be brought near the physician and made to sit or lie down and the part to be punctured upon should be tied ( Yantrana ), neither too loosely (e.g., in the Shakha ) nor too tightly (e.g., in the Uttamanga ) with any of the accessories, such as Patta Vastra , Charma , Antarvalkala , Lata etc , so as not to create any pain or agitation in patients mind. Then the Sira should be duly opened with proper instrument with a care regarding the local Marma . The physician should raise the vein by tapping on it with his middle finger. On finding that the vein has risen up and felt by touch, he should hold the Kutarika with his left hand keeping its handle up, place it on the vein in its centre , tap it with his middle finger triggered by the thumb or press it with the middle of the thumb. At places where the vein is hidden or the skin is thick, pressing with the thumb to cut the vein should be done carefully.

17. Amount of bloodletting: The maximum amount of blood to be let out is one Prastha according to Acharya Sushruta (one prastha is 13 ½ pala ) 193 . According to Dalhanacharya the amount has to be fixed according to the strength of the patient, strength of the Doshas and strength of the disease 196 . An intelligent surgeon should allow a part of the vitiated blood to remain rather than drain it excessively. Palliative measures should be followed to pacify the remaining Dosha in the blood 197 . In the first stage of the disease ( Vatashonita ), blood should be let out in small quantity only. Excess blood let may cause aggravation of Vata. 198 Paschat karma After bloodletting is done the food or diet, which is neither hot nor cold and is light, which can be easily digested and that which stimulates the digestion are recommended. The power of digestion as well as the power of metabolism is to be carefully maintained. If the food and drinks are extremely cold then it impairs digestion and metabolism and if the food is too hot it creats vitiation of the blood. The food which consists of buttermilk with yoosha , yavagu , peya must be given to the patient. With this intake of diet which promotes the formation of blood, grutha and sheeta jala parisheka must be advised.

18. Objectives of the Study Evaluate the efficacy of Upanaha Sweda in Vatakantaka . Evaluate the efficacy of Upanaha Sweda done after Siravyadha in Vatakantaka . Compare the efficacy of Upanaha Sweda with and without Siravyadha in Vatakantaka .

19. Hypothesis H - There is no effect of Siravyadha and Upanaha sweda In Vata Kantaka H - There is significant effect of Upanaha Sweda in Vatakantaka H - There is significant effect of Siravyadha with Upanaha Sweda in Vatakantaka

20. SOURCE OF DATA Patients who attended the O.P.D and I.P.D, Department of Panchakarma of K.V.G Ayurveda Medical College and Hospital, Sullia , during the period from May 2015 to February 2017 having the complaints of Vatakantaka were screened. Among them 30 patients fulfilling the inclusion criteria of the present study were taken. Detailed history taking and physical examinations were carried out in these patients. Relevant data along with the elaborate assessment of Pain, Functional Ability & Functional Disability were registered in the designed case pro forma.

21. Inclusion Criteria : 1. Age group between 20 and 60 years, Irrespective of religion, sex and occupation. 2. Patients with symptoms of Vatakantaka . 3. Patient fit for Swedana Karma. 4. Patient fit for Siravyadha Exclusion Criteria: 1. Persons contra-indicated for Swedana and Siravyadha 7 according to classics. 2. Open wounds, fractures. 3. Allergic skin condition. 4. Impaired skin sensation condition. 5. Known case of hypertension, hypotension, diabetes mellitus, malignancy, bleeding disorders and anemic patients Laboratory investigations: 1. Hb %, CT, BT, RBS. 2. X-Ray- if necessary

22. Assessment criteria Assessment of the condition will be done based on a detailed proforma and will be analyzed statistically before treatment, after treatment and follow up period. Subjective Parameters: Heel pain. Objective Parameters: Tenderness.

23. GRADING OF PARAMETERS PAIN GRADE No pain Tolerable (And does not prevent any activities) 1 Tolerable (But does prevent some activities) 2 Intolerable (But can do Walking , jogging, Running,Play activicties , Daily work etc ) 3 Intolerable (Cannot do Walking, Jogging, Running, Play Activicties , Daily work etc ) 4 Intolerable ( Unable to verbally communicate because of pain) 5

24. PAIN ASSESSEMENT SCALE (VAS) 0-10 NUMERIC PAIN RATING SCALE 0 1 2 3 4 5 6 7 8 9 10 No Moderate Worst Pain Pain Possible Pain

25. Tenderness Grading Grade 1 The patient says the joint is tender Grade 2 The patient winces Grade 3 The patient winces and withdraw the affect part Grade 4 The patient will not allow the joints to be touched Table Number-20:

26. Materials & Methods Materials required for Upanaha Sweda : Drugs of Kakolyadi Gana , Bhadradarvadi Gana , Kanji, Mamsarasa , Mahasneha and Saindava Lavana .

27. MAHASNEHA(Except Majja) P rocedure for U panaha S I No Sneha Quantity 1 Sarpi 10ml 2 Taila/Tila taila 10ml 3 Vasa 10ml 4. MAMSARASA - 20ml 5. KANJI -20 ml 6. SAINDHAVA LAVANA - 10 Grams 7. Cotton cloth for Bandana 8. Steel bowl 9. Gas Stove 10. Steel Vessels 11. Eranda Patras 12. Steel Spoon.

28. Materials Used for Siravyadha Tila taila- Sufficient quantity Gas stove-one Towel-one Hot water Tourniquet-one 18. no. Needle –one Sterile glove Measuring jar-one Sterile Gauze & pad- Sufficient quantity Roller bandage

29. Material used for both procedure

30. OBSERVATIONS AND RESULTS based on sex – 50% male & 50% Female Based on Marital Status- 80% Married & 20% Unmarried Based on Age- Middle age is more effected Based on Occupation : 26% O f h ouse wife Based on Religion :76.6% Hindu’s Based on Socio Economic Status: 40% of Both Poor & High Based on Education: 30% 0f Both Primary and Graduates Based on Prakrithi : 56.7% of Vata Kapha Based on Duration of Illness :86.7% up to one year Based on Weight :43.3% between 61-70 Kg

31. Results Effects of Upanaha Sweda Effect of Group-B on Pain of Vatakantaka SYMPTOM Mean score % S.D (±) S.E (±) t value p value BT     BT-AT PAIN 2.87 AT 1.73 1.13 39.53 0.352 0.091 3.80 <0.001 FU 1.40 1.47 51.16 0.516 0.133 5.82 <0.001 Statistical analysis showed that the mean score which was 2.87 before the treatment was reduced to 1.73 after the treatment and after follow up it became 1.40 with 51.16% improvement and there is a statistically highly significant. (P<0.001 ) SYMPTOM Mean score % S.D (±) S.E (±) t value p value BT     BT-AT PAIN 3.73 AT 1.87 1.87 50 0.743 0.192 6.63 <0.001 FU 0.93 2.80 75 0.862 0.223 10.19 <0.001 Statistical analysis showed that the mean score which was 3.73 before the treatment was reduced to 1.87 after the treatment and after follow up it became 0.93 with 75% improvement and there is a statistically significant change. (P<0.001

32. Effect of Group - A and B on Pain of Vatakantaka Effect of Group-A and B Tenderness of Vatakantaka Effect of Group-A Tenderness of Vatakantaka In patients registered in GROUP-A group showed highly significant improvement (P<0.001). The mean score which was 2.47 before treatment reduced to 1.60 after the treatment and after follow up it become 1.27 with 48.65% improvement Effect of Group-B on Tenderness of Vatakantaka In patients registered in GROUP-B group showed statistically significant improvement (P<0.001). The mean score which was 3.07 before treatment reduced to 1.40 after the treatment andafter follow up it become 0.93 with 70% improvement

33. Result on group A EFFECT OF TREATMENT IN GROUP - A Class Grading No of patients 0-25% No Improvement 26% -50% Mild Improvement 3 51% - 75% Moderate Improvement 12 76% - 100% Marked Improvement Result on group B EFFECT OF TREATMENT IN GROUP - B Class Grading No of patients 0-25% No Improvement 26% -50% Mild Improvement 51% - 75% Moderate Improvement 5 76% - 100% Marked Improvement 10

34. Comparative results of Group-A and Group-B Characteristics Group-A Group-B Signs and Symptoms Mean score Percentage of relief Mean score Percentage of relief BT FU BT FU PAIN 2.87 1.40 51 3.73 0.93 75 VAS 6.60 2.53 62 7.33 0.80 89 TENDERNESS 2.47 1.27 49 3.07 0.93 70 Group A Group B Mean Difference SE (±) T value P value 56.62 81.49 24.87 3.75 6.22 <0.001 Comparative analysis of the overall effect of the treatments in both the groups was done by statistically with paired t test. The test shows that the treatment is statistically significant in Group B when compared to Group A. Group A overall result is 56.62% and Group B overall result is 81.49%.

35. DISCUSSION Discussion on Vatakantaka Acharya Sushrutha gives the description of Vatakantaka under Vatavyadhi chapter. The features of Vatakantaka are severe pain in the pada and ankle joint caused by the improper placement of the feet on the ground , by walking on an uneven ground frequently, placing the feet improperly while walking, running etc., causes exertion there by vata that is localized in Gulpha gets aggravated and produces severe pain in Pada . Discussion on Upanaha Sweada : Upanaha is one among Chaturvidha Swedana explained by Acharya Sushruta . Keeping these views of Acharyas in mind we have selected to treat the condition with Upanaha Sweda . The Yoga for Upanaha Sweda was selected from Sushruta Sutrastana , 38 th and 39 th Chapter. Dharanakala of this Salvana Upanaha was between10- 12 hours. Duration of treatment was 07days. MODE OF ACTION OF UPANAHA SWEDA Swedana drugs by ushna and teekshna guna are capable of penetrating the micro circulatory channels( srothas ), where they activate the sweat glands to produce more sweat. After dilatation of srothas , laghu and sara guna of these drugs enable them to act on dosha sangatha in channels, remove the stagnation, making the sticky contents mobile & direct them towards koshta or excrete them through micro pores of the skin in the form of sweat, resulting in srotho shodhana . During fomentation, heating the tissues results in rise of temperature , leading to increased metabolism. This in turn increases vasodilatation , increased blood flow ,supply of more oxygen & nutrients with simultaneous removal of accumulated metabolic wastes .

36. DISCUSSION ON SIRAVYADHANA: Siravyadha is considered to be the ardha chikitsa . The procedure of siravyadha as explained in classics is difficult to put in vogue practice. Hence its technique is modified in this study. The procedure is carried out with the help of 18.no needle where the tip of the needle is yavakara / vreehimukha akara . Based on the shape at its tip it can be called as vreehi mukha shastra . This needle would be better substitute for classical vreehimukha shastra , the advantages being free availability, well sterilized condition, seldom occurrence of complications, possibility of accurate measurement of extracted blood and over to all these it causes minimum discomfort. Probable mode of action of siravyadha : Prakupita vata circulating through the rakta present in siras of pada .According to the concept of shodhana , always deranged dosha should be removed from nearest routes. Siravyadha is also one of the shodhana therapy, so according to roga adhisthana , different sites of siravyadha are selected in different diseases. In vatakantaka , padadaha , padadari …. And others, the site of siravyadha mentioned is -‘Two angulas above kshipra marma ’ was taken . In Ayurvedic references particularly in Sharangadhara samhitha it has been described that when blood is vitiated, there will be pain and odema . Also both Sushrutha & Sharangadhara quotes that by siravyadhana there will be vedanashanthi ie relief of pain. By this it can be understood that siravyadha has the efficacy of relieving the pain in vatakantaka . Dalhana tells shonithavasechana helps in curing diseases of mamsa , meda , asthi majjagata .It will clean dhamani,dusta raktha & twak .

37. Discussion on patients of Vatakantaka who underwent the trial Sex: Out of 30 patients in group A and Group B, 15 patients were female and 15 patients were male.The sample is too small to convey definite conclusion. Marital Status : Out of 30 patients in group A and Group B, 24 patients were married and 6 patients were Unmarried. The sample is too small to convey definite conclusion.   Age : Out of total 30 patients in group A and group B, maximum patients were in age Group 30-49, 40-59 and 50-69 years. They were 26.7%, 26.67 and 26.7% respectively. Group wise division: They were 20%, 13.3% and 33.3%, 40% respectively in A and B Group . May be in this age group of 30-49, 40-59 and 50-69 this disease is common because of their strenuous long standing work and due to their Ahara Swabhava .   Occupation : Out of total 30 patients in Group A and Group B, maximum patients were found housewife. They were 8 (26.7 %).Group wise division: In, Group A, they were 26.7% and Group B they were 26.7%.Due to their long standing and walking through uneven surface may be the reason for that. Religion: Out of total 30 patients in group A and Group B, maximum patients were of Hindu religion (76.7%). Group wise division: In, Group A they were 86.7% of Hindus, while in g roup B they were 66.7% of Hindus and 33.33% Christians. The sample is too small to convey definite conclusion.

38. Socio Economic StatuS: Out of total 30 patients in group A and Group B, maximum patients are high and Poor (40%). Group wise division: In, Group A, High class are 33.3% and poor are 46.7%.In , Group B , High class are 46.7% and poor are 33.3%. Due to their strenuous and long working hours may be the reason for that . Education: Out of total 30 patients in Group A and Group B, maximum patients’ Education were primary and Graduate ie : 9 (30 %).Group wise: In, g roup A, maximum patients Education were primary 40% and graduate were 40 %.In , Group B, maximum patients Education were primary 20% and Graduate were 40 %.Due to their long working hours may be the reason for that Prakruthi: Out of total 30 patients in Group A and Group B, maximum patients were found vata kapha prakruthi followed by Vata Pitta prakruthi . They were 17 (56.7%) and 9 (30%) Respectively. Group wise division: In, Group A, they were 66.7% and 33.3% respectively. In, Group B. Thus the observation of prakrithi shows that Vata Kapha Pradanatha may be important in Vatakantaka . Duration: In the study as a whole (30 patients) 26 patients fall under upto 1 years (86.7 %).Among 15 patients in group A, 14 patients fall under upto 1 years (93.3%) Among 15 patients in group B, 12 patients fall under upto 1 years (80 %). Weight: Out of total 30 patients in Group A and Group B, maximum patients’ weight were 61-70 kg ie: 13 (43.3 %). Group wise: In, g roup A, , maximum patients’ weight were 51-60 kg ie : 7 (46.7 %).In , Group B, , maximum patients’ weight were 61-70 kg ie : 9 (60 %).Over weight may be the cause for the vatakantaka .

39. Over All Assessment Of Result: The percentage of improvement in Group A on Pain is 51%, VAS is 62%. And Tenderness is 49% and the percentage of improvement in Group B on Pain is 75%, VAS is 89%. And Tenderness is 70%. The comparison of two groups denotes that Group B is superior than Group A. Comparative results of Group A and Group B Comparative analysis of the overall effect of the treatments in both the groups was done by statistically with paired t test. The test shows that the treatment is statistically significant in Group B when compared to Group A. Group A overall result is 56.62% and Group B overall result is 81.49%.  

40. CONCLUSION To conclude Vatakantaka is a disease commonly found . Vatakantaka is common in both sex. It mainly effect lower and higher class due to their strenuous work. It causes severe pain especially in the morning and during walking after long hours of rest. Vatakantaka causes difficulty in walking and effects daily activities. Increased body weight is also one of precipitating factor. There was not much relief noticed with other modalities of medicine. It took a long time to cure and patient’s satisfaction was less. Vatakantaka was more common in middle age and maximum number of the case had chronicity was within One year. For desparate patients Upanaha Sweda with and without Siravyadha are therapies to give results. Both the procedures were very simple, safe, economical and effective procedure. They don’t need much preparation and can be done in OPD as well as IPD. Both showed better improvement in symptomology .Out of this Upanaha Sweda With Siravyadha (Group B) showed better improvement in symptomology than Upanahs Sweda (Group A) There was a marked improvement in pain and tenderness. Main Conclusions are Drawn : Both the procedures ( Upanaha Sweda with and without Siravyadha ) are effective in treating Vatakantaka . Over all the Group B is more effective clinically and statistically than Group A in almost all the parameters. Both are beneficial in Vatakantaka It is having instant effect and can be accepted as a suitable treatment modality for current era

41. REFERENCES Sushruta Samhita Charaka Samhita Vangasena Bhavapraksha Madhvanidana Astangasangraha Bharata Bhaisjiya Ratanakara Bhavprakash Nighantu Chakradata Harita Samhita Astangahridayam