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ISSUE 3 (2016) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Bhingardive K. B. et.al., Pain Management by Panchakarma Therapy w.s.r. to chronic Low Backache – A Case Study, Int. J. Ayu. Alt. Med., 2016; 4(3):156-159

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CASE REPORT Scientific Journal Impact Factor 5.733 (2015) by InnoSpace Sci. Res., Morocco

PAIN MANAGEMENT BY PANCHAKARMA THERAPY W.S.R. TO CHRONIC LOW BACKACHE – A CASE STUDY

Bhingardive Kamini B.1*, Sarvade Dattatray 2, Santoshkumar Bhatted 3

1. PG Scholar, Dept. of Panchakarma, National institute of Ayurveda, Jaipur, India, Contact No. +917877736643, E-mail - drkamini111@gmail.com

2. PG scholar, Dept. of Dravyaguna, National institute of Ayurveda, Jaipur, India, Contact No. +919024937238, E-mail- dr.sarvade@gmail.com

3. H.O.D & Asso. Prof. Dept. of Panchakarma, National institute of Ayurveda, Jaipur, India, Contact

No. +919414048459, E-mail- drsantoshbhatted@rediffmail.com

Article Received on - 28th May 2016 Article Revised on - 18th July 2016 Article Accepted on - 25th July 2016

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Bhingardive K. B. et.al., Pain Management by Panchakarma Therapy w.s.r. to chronic Low Backache – A Case Study, Int. J. Ayu. Alt. Med., 2016; 4(3):156-159

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CASE REPORT *Corresponding Author Bhingardive Kamini B. PG Scholar, Dept. of Panchakarma, National institute of Ayurveda, Jaipur, India, Contact No. +917877736643, E-mail - drkamini111@gmail.com

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ABSTRACT: Current study is carried out to find out the combined effect of certain classical

Panchakarma treatment like Kati Basti, Dashamoola Basti in a case of chronic low back pain. A female patient aged 52years was admitted in the I.P.D. of Panchakarma dept. of NIA Jaipur, presented with the complaints of low back pain with difficulty in sitting and standing since 2 years associated with anorexia, B/L knee joint pain since 2-3 months. This condition can be correlated to the symptom of Katishoola described in Ayurveda which is one of the VataVyadhi. Ayurveda provide range of treatment especially Panchakarma, so patient was treated with Kati Basti and Dashamoola Basti in Yoga Basti schedule (total 8 basti) accompanied by certain conventional oral medication. Low backache reduced, back stiffness reduced, mild relief was found in B/L knee joint pain, range of movement of spine increased. It can be concluded that Panchakarma treatment is effective in pain management of low backache patients.

Key Words: Kati Basti, DashmoolaBasti, Katishoola, Low backache

INTRODUCTION Low back pain (LBP) is pain, muscle tension, or stiffness, localized below the costal margin and above the inferior gluteal folds, with or without referred or radicular leg pain (sciatica). [1] The most important symptoms of LBP are pain and disability (activity limitation). Aging is a well-known risk factor of LBP as degenerative changes in the spine and disc are one of the major causes of LBP. [2] Low back pain is one of the major causes of activity limitation and work absence throughout much of the world. [3] It is the second most common reason for visits to physicians. [4] The point prevalence of LBP is 28.5% found in an Asian country. [5] About 70% people have the chance of developing LBP at least once in life. [6] In Ayurveda this condition can be correlated with Katishoola which is one of the Vatavyadhi. It is classical fact that this pain is effectively relieved by Basti, swedana etc. In it`s counterpart, the management by modern medicine for this condition is by conservative treatment like rest, immobilization, use of analgesics, anti-inflammatory drugs, physiotherapy or surgical in later course of the disease. If the pain and neurological defect may not subside on prolonged conservative treatment finally surgery is considered which not a right choice. So we have used Ayurvedic modality to treat the disease. CASE REPORT A female patient aged 52 years was admitted in the I.P.D. of Panchakarma dept. NIA Jaipur, presented with the complaint of low backache with difficulty

in sitting and standing since 2 years associated with anorexia, B/L knee joint pain since 2-3 months. By taking detailed clinical history patient was having accidental trauma on back region and after that gradually above symptoms appears. She took Allopathic regimen for symptomatic relief. Now again she was suffering with same complains since 2 month. This history of the patient revealed the chronicity of the disease. OBSERVATIONS Signs: -Tenderness in lumbo-sacral area, S.L.R test negative, femoral stretch test was positive. Symptoms: - Localised shooting type of pain in lower back region without radiating to lower limb, associated with anorexia, B/L knee joint pain.

Prakriti: - Kapha- Vata. Vaya: - Madhyavastha Bala: - Madhyama Agni: - Manda Koshtha: - Madhyama

Lab investigation positive findings:- ESR-32 mm/hr CRP- positive Treatment given: Kati Basti: - The procedure of applying heat to the sacral or lumbar region by retaining warm medicated oil within a specially formed frame on this area is known as Kati Basti. It is indicated in painful condition of low back region. [7]

PAIN MANAGEMENT BY PANCHAKARMA THERAPY W.S.R. TO CHRONIC LOW BACKACHE – A CASE STUDY

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Bhingardive K. B. et.al., Pain Management by Panchakarma Therapy w.s.r. to chronic Low Backache – A Case Study, Int. J. Ayu. Alt. Med., 2016; 4(3):156-159

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The procedure was done with DashamoolaTailam, 30 minutes per setting for duration of 15 days. Basti Karma:- NiruhaBasti: - The composition of the medicine administered in the form of Basti contains Dashamoola Kwath (herbal decoction), Sneha (medicated Oil/Ghee), Madhu (Honey), Saindhava Lavana (rock salt) and Kalka (herbal paste). [8]

Dashamoola Basti was given in Yoga Basti schedule (8 days) with the following contents. Madhu -60gms Saindhava lavana -05 gms Dashamoola tailam-90ml Shatapushpa Kalka -30gms Dashamoola kwatha -240 ml The contents of Dashamoola Kwatha are Bilva (Aegle marmelos(L.) Correa ex Roxb.), Agnimantha (Premna mucronata Linn.), Shyonaka (Oroxylum indicum(Linn) Vent.), Patala (Stereospermum suaveolens (Roxb.) DC.), Gambhari (Gmelina arborea Roxb.), Shaliparni (Desmodium gangeticum (L.) DC.), Prishnaparni (Urariapicta Desv.), Brihati (Solanum indicum Linn.), Kantakari (Solanum nigrum Linn.), Gokshura (Tribulus terrestris Linn. ) Anuvasana Basti:- Administration of medicated oil or other fat through the rectal route in a prescribed dose is called as Anuvasana Basti. In this case study Dashmoola taila was used for Anuvasana Basti. Shamana Aushadhi: - Palliative treatment with

1) Simhanada Guggulu - 2 pills (500 mgm) thrice in a day

2) Rasnasaptaka Kwath – 5gm thrice a day

3) Ashwagandha Churna 2gms +Gokshura 2gm+ Chopchini - 500mg thrice in a day

4) Tarunikusumakar Churna5 gm.at bed time with Luke warm water.

RESULT Relief was found in Low back pain and stiffness with increased range of movement of spine. Mild relief was found in B/L knee joint pain. DISCUSSION Basti Karma is said to be the Ardha Chikitsa or even Poorna Chikitsa among all the Snehadi Karma, as Vata Dosha is the sole responsible entity for pathology pertaining to Shakha, Koshtha, Marma, Urdhvanga and Sarvaanga Avayava and as it does Vikshepa as well as Sanghata of Dosha, Dooshya

and Mala.Ayurveda has the privilege of offering the best remedies for low back pain and related painful conditions. Katishoola is one Among Vata Vikara. Basti Chikitsa is the best treatment for correcting Vata Dosha, further Dashamoola Basti was selected as it possesses properties like tridosha shamaka, Shothahara, Shoola prashamana which help in reduction of inflammation and pain. Especially Dashamoola taila used as Sneha in Basti corrects the degeneration that took place at the level of disc by virtue of Snigdha guna and Balya and Brimhana action. Kati Basti: Keeping warm medicated oil on lumbar region for specific time period is known as Kati Basti. It is a combination of Snehana and Svedana which is the first line of treatment for Vata Dosha. The hot medicated oil increases the circulation in the localized region and helps in deep absorption into the skin which nourishes and strengthens the muscles and nerves. It also pacifies one of the primary sites of Vata by relieving pain, tension and restoring flexibility of spine. The Dashamoola Taila used in Kati Basti is shothaghna and Snehana in nature helps to overcome the accumulation of Vata at the site of pathology and may nourish the underlying tissue. Shamana drugs: - Mainly Aamapachana, Shothahara, Brimhana properties reduces the Shotha and helps in prevention of further degeneration of Asthi and Majja Dhatu. Vatahara property might have helped to overcome degeneration of disc and prevent further Vata Prakopa. CONCLUSION On the basis of this single case study, it can be concluded that Panchakarma treatments like Kati Basti, Dashamoola Yoga Basti has been effective in the pain management of low backache patients thereby improving quality of life. REFERENCES

1. Van der Heijden GJMG, Bouter LM, Terpstra-Lindeman E. The efficacy of traction for low back pain: results of a randomized blinded pilot study. Ned T Fysiotherapie1991; 101: 37-43.

2. Lawrence A, Rafael HL, Simeon M. Back pain and osteoporosis. In: John Hopkins White Papers, 1-37, Rebus, 2003. New York:

3. Lidgren L. The bone and joint decade 2000-2010. Bull WorldHealth Organ 2003; 81:629.

4. Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in work age adults in rural North India. Indian J Med Sci2003; 57: 145-7

5. Tomita S, Arphorn S, Muto T, et al. Prevalence and risk factors of low back pain among Thai and Myanmar migrant sea food processing factory workers in Samut Sakorn Province, Thailand. Ind Health 2010; 48: 283-91.

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ISSUE 3 (2016) INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE eISSN-2348-0173 pISSN-2395-3985

Bhingardive K. B. et.al., Pain Management by Panchakarma Therapy w.s.r. to chronic Low Backache – A Case Study, Int. J. Ayu. Alt. Med., 2016; 4(3):156-159

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6. Van Tulder M, Becker A, Bekkering T, et al. European guidelinesfor the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15: 169-91.

7. Dr. G. Shrinivasa Acharya, Panchakarma Illustrated, first edition 2006, Choukhambha Sanskrit Pratishthan, Delhi, ISBN-81,7084-3079,p.254.

8. Dr. Shukla V., Dr. Tripathi R.D., Charaka Samhita Siddhisthana, Chapter 03/23; Varanasi: Chaukhamba Surbharati Prakashan; Reprint 2010; p.901

CITE THIS ARTICLE AS – Bhingardive K. B. et.al., Pain Management by Panchakarma Therapy w.s.r. to chronic Low Backache – A Case Study, Int. J. Ayu. Alt. Med., 2016; 4(3):156-159 Source of Support – Nil Conflict of Interest – None Declared

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