Gridhrasi W . S . R To Sciatica-A Literature Review

To keep up with ever changing ever growing field of research in modern medical science. The Ayurvedic concepts need to be analyzed and updated in relevance with developments in the contemporary sciences. Numerous therapeutic modalities have been advocated by our Acharyas in the management of each disease. However, their efficacy needs reestablishment by means of thorough and intensive researches. Gridhrasi is such an entity enumerated fewer than eighty types of nanatmaja Vataj Vyadies. It is characterized by its distinct pain emerging from buttock and goes towards the heal of afflicted side. Based on the symptom complex, it can be broadly correlate with disease Sciatica in Modern Science. As per the data available, the lifetime prevalence of low back pain is estimated to be 60-70%. Although most patient is self-treat back, pain and only 25-30% seek medical care. As far as treatment of the disease is concerned, use analgesics and physiotherapy will help to certain extent but are not the ultimate cure. The management of Sciatica in Modern Science is not complication less and having a lot of side effects and even surgical intervention is of the same status. However, these miracle therapies come at the coast affecting the other part of body and thus viscous circle is started curing one part and afflicting other. To break this, one needs wisdom and guide. This is the place where Ayurveda comes to rescue the world from the pain of disease by providing nectar from the result-oriented modalities.


INTRODUCTION:
Low back pain is one of the common conditions of loco motor system disorder, affects people during their productive life. Sciatica prevalence from different studies ranged from 1.2% to 43% [1] .as per Davidson, low back pain,'Lumbago',is the commonest medical cause of inability to work, but in the great majority of patients due to abnormalities of joints and ligaments in the lumbar spine rather than herniation of an inter-vertebral disc. [2]  About 40% cases of low back pain are of radicular in origin and considered under the sciatic syndrome. It is a pain dominant disease and reduces human activity considerably in terms of personal as well as social and professional life. The condition resembles disease Gridhrasi mentioned in Ayurveda under the context of Vatavyadhi, and here piercing type of pain, which restricts the movement of the affected leg, make his walking pattern-like bird vulture and put him in disgraceful condition. [3] Gridhrasi is one among 80 types of Nanatmaja Vata vyadhi. The name itself indicates the change of gait shown by the patients due to extreme pain just like Gridhra (Vulture), this disease not only inflicts pain but also causes difficulty in walking, which is very much frustrating to the patient. The cardinal signs and symptoms are Ruk, Toda, Sthamba, Spandana in the Sphik, Kati, Uru, Janu, Janga and Pada, Tandra, Gaurava, Arochaka.

AIMS AND OBJECTIVES:
To study in detail about LITERATURE RIEVIEW of Gridhrasi.

MATERIALS AND METHODS:
Classical Ayurvedic texts, Commentaries, Various Article, Previously conducted research studies thoroughly reviewed and analysed.

REVIEW ON GRIDHRASI: VYUTPATTI:
The word Gridhrasi is in feminine gender, which is derived from the Dhatu "Gridhu" that means to covet, desire, and strive after greedily on eager for. By the rule of "Susudhadhri Dhibhyah Krammam " as well as by adding "Run" Pratyaya i.e., Grudh + Krun followed by Lopa of "K" and "N" the word Grudh + Ru i.e., "Grudhr" is derived. This word is also formed in another grammatical method as "Grudhr+ So Atonupasargah" -Adding "Kah" Pratyaya leads to Gridhra + So + Ka, further by Lopa of 'O' and 'K' and 'Sha' is replaced by 'S'a' by the rule 'Dhaatvaadeshu S'ah Sah' to get the word Gridhraus. Finally for this word Gridhraus which is in female gender by adding 'Dis' Pratyaya the word 'Gridhrasi' is derived. Gridhra refers to the bird Vulture. It is opined that, in this disease the patients gait becomes altered as his legs becomes tense and slightly curved due to pain resembling walk of the vulture, hence the name Gridhrasi to this pain dominant malady.

NIRUKTI:
Gridhrasi is an illness predominantly affecting the ambulatory function of the patient and the same is stressed in the derivation of the word Gridhrasi. Following derivations are taken from the different textbooks in Sanskrit literature substantiates the same.

PARYAYA:
Following are the synonyms of Gridhrasi.

Ringhinee (Vacaspatimishra)
The word Ringhinee means the disease that cause to creep or crawling or that makes a person to go slowly. More over according to the Shabdakalpadruma this term refers to Skhalana meaning displacement.

Randhrinee (Dalhana)
This term is used by Dalhana while commenting on Shusruta, indicates weak point or rupture.

DERIVATION OF SCIATICA:
The term Sciatica is derived from the neolatin word Ischalgia. Ischalgia composed from the Attic Greek words. (That means pain + buttock or hip). Sciatica literally means pain in the lower buttock and upper part of the thigh.

DEFINATION OF SCIATICA:
The term Sciatica designates a syndrome characterized by the pain beginning in the lumbo sacral region, spreading to the lower limb through buttock, thigh, and calf until the foot or a disorder characterized by pain in the distribution of the Sciatic nerve. Gridhrasi According to Acharya Charaka, in Gridhrasi there is Ruka (Pain), Toda (Pricking Pain), Stambha (Stiffness), and Muhuspandanam (Twitching pain), in waist and hip and back of the thigh, knee, calf and foot respectively, found in Vataja type and Tandra [4] According to Sushruta, When the Kandara i.e. ligaments from the heel upto all the toes are afflicted by vitiated Vata, movements of the lower extremity get restricted, that is known as Gridhrasi. Parshani Pratyangulinamtu Kandara Yanilardita Sakthanh Kshepam Nigraharniyat Gridhrasi Hi Sa Smrita (Su. Nid. 1/74) [5] According to Dalhana, Kandara is Mahasnayu. (Dalhana commentary on Sushruta Nidana / 1-74) [6] Here, it is noticeable that, in Ayurvedic texts Kandara, Snayu, Srotas, Dhamni, Sira, Nadi, are abundantly described but anatomically these are not clear. There are many controversies in these structures at present. According to Harita, Gridhrasi is a condition originates due to vitiation of Vyana Vata. In regard of action of Vyana Vata in texts, it has been told that Vyana Vata is responsible for five type of voluntary movements i.e. Expansion, Contraction, Upward, Downward and Oblique, and vitiation of Vyanavata, chiefly a condition, due to masking of Vyana Vata by Kapha lead to cessation of movement, heavyness, of body, stiffness in bones and joints -(Su. Nid. 1/39, Ch. Chi. 28/228) [7] [8] NIDANA OF GRIDHRASI: [9] [10] [11] (I) The causative factors explained in the classics may be divided into many groups, but for the sake of convenience this can be grouped into two types viz.

UPADRAVA:
Upadrava are produced as a sequel of the disease proper. Their emergence increases the graveness and complexity of treatment. Their description in various classics is as follows: Sushruta has elaborately described Upadrava of eight Maharogas including Vatavyadhi in general as well as that of Vata-vyadhi independently [20] .

Upadrava of Eight
If these are present then it is wise not to start any treatment procedure.
If Vata Vyadhi co-exist with any of the above-mentioned Upadrava then in such patient disease come under the heading of Asadhya (incurable) category.

CHIKITSA:
Chikitsa is the counteraction of Ruja. (Amarkosha). It is the process of breaking down the pathogenesis of a disease. Diseases are caused due to vitiated Dosha involving Dhatu etc. The process, which establishes equilibrium in these body elements, is Chikitsa [21] . The therapeutic approach of Ayurveda can be broadly classified into two types.  .-28). It is clearly stated that when Vyana Vayu get masked by Kapha, produces restricted movements and Achraya Sushruta has same opinion. Here, Kapha also plays an important role in manifestation of Gridhrasi. As Gridhasi, is a Nanatmaja Vata Vyadhi so in classics, general Vata Vyadhi Chikista has been mentioned for it where as some Acharyas have given some specific line of management. The Samprapti of Gridhrasi takes place either by Dhatukshaya or due to Margavarana. Here the Sira, Kandara of the affected limb will get Sankocha. In all Ayurvedic literature, the treatment of 'Gridhrasi' is given in two forms.i.e. Shodhana and Shamana .As far as treatment of the disease is concerned, use analgesics and physiotherapy will help to certain extent but are not the ultimate cure. The management of Sciatica in Modern Science is not complication less and having a lot of side effects and even surgical intervention is of the same status. Surgeries are moreover expensive, and again there are chances of recurrence as well. Ayurveda offers ample of better options in the management of this painful disorder. In this disease, mainly Apana and Vyana Vayu vitiation are observed, but most of the times Kapha remains as associated Dosha.