Gridhrasi (sciatica)

Gridhrasi is defined as Stambha (stiffness), Ruk (pain), Toda (pricking pain) in a radiating manner along with Spandana (tingling sensation) starting from Kati Pradesha (low back) to Prushtha (back), Janu (knee joints), Jangha (calf muscles) and Pada (dorso lateral aspect of feet) of either one side of the lower limb or may involve both lower limbs. This condition makes raising of the affected leg difficult.

1. GRIDHRASI (SCIATICA)
Dr. Rajtilak Tiwari M.D. ( Kayachikitsa)
Assistant Professor in Kayachikitsa dept. in Shivshakti
lalsharmaAyurvedic College Ratlam (M.P.)
[email protected]
Mob-9406841574/7987265922

2. INTRODUCTION
•Gridhrasiis a Vatavyadhicharacterisedby
vitiation of Vataafflicting the Kandara/ Snayu
of lower limbs. It is characterized by severe
radiating pain starting from the low back to
gluteal, posterior aspect of thigh, knee, calf
and dorsum of the foot of either one or both
sides of lower limbs. The condition makes
raising of the leg difficult. All types of lumbar
radicuolpathyalso can be interpreted in terms
of Gridhrasi.

3. Case Definition:
•Gridhrasiis defined as Stambha(stiffness),
Ruk(pain), Toda (pricking pain) in a radiating
manner along with Spandana(tingling
sensation) starting from Kati Pradesha(low
back) to Prushtha(back), Janu(knee joints),
Jangha(calf muscles) and Pada(dorsolateral
aspect of feet) of either one side of the lower
limb or may involve both lower limbs. This
condition makes raising of the affected leg
difficult.

4. Types:
•There are two clinical presentations as Kevala
Vata and Kapha Vata. Association of Kapha
produces additional symptoms like Tandra
(drowsiness), Gaurava (heaviness) and
Arochaka (loss of taste).

5. Differential Diagnosis:
•The condition should be differentiated from Katigraha
(Ankylosingspondylitis), Khanja,
•Pangu, Marmabhighataat any of the Kukundaraand
NitambaMarma.
•If the pain is localized to sacroiliac joint it may be diagnosed
as Katigrahaa condition of ankylosingshould be ruled out.
Khanjaand Panguare characterized with weakness of
lower limbs due to loss of motor power. Khanjaaffects any
one limb and Panguaffects both. These conditions may not
have any pain associated. KukundaraMarmabhighatais
characterized by motor and sensory loss. Nitamba
Maramabhighatais characterisedwith wasting of lower
limbs.

6. Line of Treatment:
•NidanaParivarjanashould be the first line of
treatment.
•• ShodhanaChikitsa–Virechana, Basti, Siravedha
•• Shamana Chikitsa-Pachana, Snehana, Swedana
including various types Pindasweda, Agnikarma, Balya
•• External applications -Abhyanga, Lepa, Katibasti,
Katipichu.
•• RasayanaChikitsafor Asthiand Vata
•• Treatment according to Doshikinvolvement
•• General line of treatment prescribed for Vatavyadhi

7. LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN’S CLINIC/PHC
•Clinical Diagnosis: On the basis of history and
clinical presentation
•Investigations: ESR (Males 0-15 mm/h,
Females –0-20 mm/h) to rule out any
inflammation

8. Treatment:
•In level 1 also some minimal Panchakarmaprocedures can
be done in OPD.
•• In Kaphaassociated conditions, RookshaLepalike
NagaradiLepaor DashangaLepaetc can be applied in the
low back region
•• Katipichuor Katibastiwith Murivenna, Dhanwataram
Tailaor NirgundyadiTailaetc can be performed later.
•• MriduSamshodhanawith ErandaTailamixed with
NirgundiSwarasacan be given in patients with
constipation.
•• Patient may be advised MatraBastiwith Dhanwantaram
Tailain or SahacharadiTailaif found to be KevalaVatika.

9. Medicines at level 1 for Gridhrasi
Drug Dose form Dose Time of
administratio
n
Duration Anupana
Aswagandha
powder 3-6 gm After meal
/Twice of day
1-2 week Lukewarm
water
Rasna Churna 3-5 gm Twice a day
1-2 week Luke warm
watrer
Shunthi
Churana 3-5 gm Twicea day1-2 week Luke warm
water
Chopchini churana
0.5-2 gm
Twice a day1-2 week
Sugar –3 gm

10. Ksheerapaka KsheeraPakaUse 5 seeds for
preparation
Once a day 1-2 weeks
PaarijaatPatra
Swarasa1
Swarasa 15 ml Empty stomach
/ twice a day
1-2 weeks
Rasnasaptakam
Kashaya2
Kwatha
12 –24 ml Empty stomach
/ 6 am & 6pm
1-2 weeks
Luke warm
water
Sahacharadi
Kashaya Kwatha 12 –24 ml Empty stomach
/ 6 am & 6 pm
1-2 weeks Luke warm
water
Maharasnadi
Kashaya3
kwatha 12-24 ml Empty stomach
/6am-6pm
1-2 weeks Luke warm
water
Yogaraja
Guggulu4
vati 1-2 vati Twice a day 1-2 weeks Luke warm
water

11. Trayodashan
gaGuggulu4
Vati
1-2 tab Twice daily 1-2 weeks Warm water
Plain &
various types
of processed
ErandaTaila
Taila 15-50 ml Empty
stomach -
early
morning or
at bed time
As per need Hot water or
milk
Bala Taila, Mahanarayana Taila, Nirgundyadi Taila, Sahachardi Taila, Vishagarbha Taila,
Prasaranyadi Taila, Murivenna / Kuzhampu, Karpasasthydi Taila / Kuzhampu,
Dhanwntaram Taila / Kuzhampu, etc. for Abhyanga and Sweda

12. Pathya-Apathya(Diet and life style
education):
•Do’s -
•• Ahara: Advice light Vatanulomandiet like ShigruShaka
(drumstick), brinjal, Methi, Jeerak, Hingu, Saindhava, Yoosha,
Mamsarasaetc. may be given.
•• Vihara: Correct postures while sitting or lifting the weight,
regular suitable Yogasanaand Abhyanga, hot water bath,
fomentation, comfortable seats and bed should be used. Bowel
and bladder urges should be attended timely.
•Dont’s-
•• Ahara: Vataaggravating diet like pulses, peas, wafers, biscuits
etc, cold food and cold drinks, stale food, excessive use of chilly.
•• Vihara: Exposure to cold, heavy physical work, spongy
mattresses and easy chairs.

13. Referral Criteria:
•Cases not responding to above line of Shamana
management.
•Chronic cases of Gridhrasiwith full-fledged
symptoms or associated morbidities like foot
drop, muscle wasting etc which require well
planned In -Patient Panchakarmatreatment.
•3. Acute cases of Gridhrasiwith severe pain which
require strict bed rest and traction massages etc.

14. LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES
Clinical Diagnosis: Same as level
•Clinical Diagnosis: Same as level 1 for a fresh case
reporting directly.
•Investigations: Same as level 1, in addition
•• X ray of the lumbosacral spine
•Treatment: In addition to the Shamanamanagement
mentioned in Level 1, some of the following drugs
may be added as per the requirement and status of
the patient. Intensive combination therapies of
Rasaushadhiand Kashthoushadhi(herbo-mineral
drugs) can also be used.

15. Medicines at level 2 for Gridhrasi
drog Dose form dose Time of
administretion
Anupana
Dashamoola
Kwatha
kwath 12-24 ml Empty stomach /
twice daily
-
Guggulutiktakam
Kashaya
kwath 12-24ml Empty stomach /
twice daily
Dhanwantaram
Kwatha
kwath 12-24ml
Empty stomach /
twice daily
Dhanwantaram
Vati
Guggulutiktaka
Ghrita5 Ghrita 15-30 ml Before food on
appetite / once-
twice a day

16. Ashwagandh
arishta
Arishta 10-20 ml After food /
twice daily
Balarishta6 Arishta 10-20 ml After food /
twice daily
Sahachardi
Taila/ Bala
Taila,
Karpasasthya
di Taila,
Dhanwntaram
Taila7
Taila Can be used
for Basti
Vatagajankus
ha Rasa
Gutika
Twice a dailyWith madhu

17. Vatavidhwams
aRasa9

18. LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT
HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS
•Clinical Diagnosis: Same as level 1for a fresh case reporting
directly
•Investigations:
•• USG abdomen & pelvis–to rule out any visceral pathology or
gynecological issues related to uterus and adnexaand PID, leading
•to low back pain and pain in lower limbs
•• USG –KUB –To rule out renal calculi and obstructive lower
urinary tract symptoms.
•• CT Scan–For better assessment of bony canal
•• MRI Lumbosacralwith whole spine screening.

19. Treatment:
•In addition to the management of Level 1 and
Level -2, if needed Panchakarma procedures
can be performed. Full course Basti Karma like
Yogabasti, Kalabasti and Karmabasti can be
done in selected cases.

20. PanchakarmaProcedures at level 3 for
Gridhrasi
Karma Choice of drugs Indications Remarks
Udwartana
KolakulathadiChurna;
Yava, Kola, Kulattha;
Triphala Churna;
KaphaVataGhridhrasi
-associated with
heaviness in affected
limb, severe
numbness, spinal
canal stenosisand
sciatica in obesity
More effective in
Samaconditions
Swedana Tapa, Ushma–
Various herbal
Churnas, steam
generated with herbal
leaves
In persistent pain
without Pitta
symptoms
Reduces associated
muscle spasm
immediately

21. Churnapinda
Sweda
KolakulathadiYoga,
Various Vata/ Kapha
haraChurnas
Early stages of
GridhrasiSaama,
Kaphsamsrishta
Kevala Vata,
Pittanubandha contra
indicated
Patrapinda
Sweda
Various leaves of Vata
alleviating property
Usually after
ChurnapindaSweda,
directly on Nirama
stage
Pittanubandhacontra
indicated
Pittanubandhacontra
indicated
Pittanubandhacontra
indicated
JambeeraPinda
Sweda
Citrus fruit, turmeric
and Vataalleviating
Churnas
Same as above +
localisedoedema
Pittanubandhacontra
indicated

22. ShashtikaPinda
Sweda/ Shashtika
Lepana
Shashtikarice, Bala
decoction and milk
Later stages of
Gridhrasi, disuse
atrophy, wasting,
weakness,
Pittanubandha
Kaphanubandha,
Sama, Sheeta
Anupashayacontra
indicated
Katibasti MurivennaTaila
Dhanwantaharametc
In severe pain, when
pain aggravates on
manipulation.
Virechana Plain or processed
various ErandaTail,
TrivritaLehya,
AbhayadiModaka,
IchabhediRasa etc
Directly in all
constipated cases.
Also done after
Shodhanaga
Snehapana.
Always done as Mridu
Samshodhanaafter
various Swedana
procedures for 7 days.
NirgundiSwarasais
added in ErandaTaila
for better results.

23. AnuvasanaBasti DhanwantaraTaila,
SahacharadiTaila
etc.
In all Gridhrasiin
VataPradhanastage.
Care for contra-
indications of Nasya
and oral Snehapana
NiroohaBasti Erandamooladi,
Madhutailika,
VaitaranaBasti,
KsharaBastietc and
various Yoga
explained in classics
Niramastages of
Gridhrasi, Vata
Pradhanastage.
VaitaranaBasti
should be done even
in Amastages
RaktaMokshana-
Siravedha
Scalp set, intra-
venouscanula, tray,
tourniquet etc
Non responding cases
to SnigdhaRooksa,
Sheetaor Ushna
approaches, in acute
and severe pains
Agnikarma Shalaka, Ghrita, Taila
etc
Non responding cases
to any approaches.,
severe pain,
KandaragataShoola

24. Pathya-Apathya(Diet and life style
education):
•Same as level 1
•Rasayana:
•1. RasonaKalka
•2. Bhallataka
•3. Aswagandha
•4. Guduchi
•5. Bala