From, Dr.A.Jayashree Prasad 1st YEAR M.S,(AYU), DEPT OF PG STUDIES IN SHALYA TANTRA, GOVT.AYURVEDIC MEDICAL COLLEGE, BANGALORE – 09.
To, The Registrar, Rajiv Gandhi University of Health Sciences, Bangalore. Karnataka.
Through: The principal, Govt Ayurvedic Medical College Bangalore-09.
Respected Sir, Sub:-Submission of completed proforma for registration of subject for dissertation.
I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore, for the partial fulfillment of M.S (Ayu) in Shalya tantra.
Title of dissertation:
"EFFICACY OF AGNIKARMA IN THE MANAGEMENT OF MANYASTAMBHA"-A CLINICAL STUDY.
Herewith, I am enclosing completed proforma for registration of subject for dissertation.
Thanking you,
Place:Bangalore. Yours Sincerely, Date:
{Dr.A.Jayashree prasad} RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
ANNEXURE - II
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE : DR. A. JAYASHREE PRASAD AND ADDRESS 1st Year M.S.(Ayu), DEPARTMENT OF P.G. STUDIES IN SHALYA TANTRA, GOVT. AYURVEDIC MEDICAL COLLEGE, DHANVANTARI ROAD BANGALORE-5600 09.
RESIDENTIAL ADDRESS : #164-N- HIG-D- BLOCK –I 5TH CROSS 5TH PHASE NEW TOWN YELEHANKA BANGALORE-560 064.
2. NAME OF THE INSTITUTION : GOVT. AYURVEDIC MEDICAL COLLEGE, DHANVANTARI ROAD, BANGALORE - 560009
3. COURSE OF THE STUDY & : AYURVEDA DHANVANTARI SUBJECT M.S. (AYU). SHALYA TANTRA
4. DATE OF THE ADMISSION : 30-05-2008 TO THE COURSE
5. TITLE OF THE TOPIC : EFFICACY OF AGNIKARMA IN THE MANAGEMENT OF MANYASTAMBHA - A CLINICAL STUDY. -2-
6. BRIEF RESUME OF THE INTENDED WORK :
6.1 Need for the study: Manyastambha is one of the vatavyadhi, which is commonly found in today’s practice. Life style in this mechanical era is very fast. Every one has to face mental & physical stress. Nobody has time to spend for his own health care. Hence to obey dinacharya & rutucharya is far away from them . Shift duties, excessive traveling on two wheelers, irregular dietary habits, inappropriate postures are some causes, which helps in vitiation of vata. Considering all the above factors, it is very much clear that the
vatavyadhis are increasing.
Sushruta samhita gives us the earliest reference about Manyastambha during samhita kala. We will get description about Manyastambha in all Bruhatrayees.
Kashyapa has told, while explaining puerpural disorders, the woman who has undergone abnormal delivery may have 64 diseases, Manyastambha is also one of them.
Manystambha is a condition characterized by pain, stiffness of the neck and restricted movements i.e. kriyahani.
Sushruta describes that when, the Snayus of the neck are afflicted by vata along with Kapha, they restricts the movements of neck and is known as “Manyastambha”.
Keeping in view the various signs and symptoms mentioned in Ayurvedic classics, it can be correlated with neck pain. -3-
Modern view:
Statistical analysis shows neck pain is a common problem with 2/3rd of the population having neck pain at some point in their lives.
The head is supported by the lower neck and upper back, and this area commonly causes neck pain.
Neck pain, stiffness and restricted movement are a frequent consequences of trauma & degenerative changes of the cervical spine.
The top three joints in the neck allow for most movement of neck and head. The lower joints of the neck and upper part of the back, create a supportive structure for head to sit on. If this support system is affected adversely, then the muscles and ligaments in that area will tighten leading to neck pain.
Mechanical neck pain is more commonly seen in adolescents & young adults than in older patients. The exact etiology is variable and often not identified. It is commonly due to I.V.D.P.
Neck pain in modern science is managed conservatively with NSAID Traction Soft collar Physiotherapy Local injections of steroids Topical anesthetic creams and analgesic patches. Epidural spinal injections -4-
All these methods of modern science have one or another drawback. Prolonged administrations of NSAID may suppress the symptoms, but causes gastric irritation. Using collar belts looks awkward and interrupts routine life. Surgical techniques are quiet expensive, even for a upper middle class people.
Ayurveda is an ancient Indian Medical Science, having a great potential in the large spectrum of health with its effectivity. The parasurgical procedures like Agnikarma are being practiced in such conditions, as they have no complications and are easy to practice. -5-
6.2. Review of literature: Ayurvedic View
Nidana and Samrapthi:
ÌSuÉÉxuÉmlÉÉxÉlÉxjÉÉlÉÌuÉM×üiÉÉåÅkuÉï lÉÏËU¤ÉhÉæÈ | qÉlrÉÉxiÉqpÉÇ mÉëMÑüÂiÉå xÉ LuÉ zsÉåwqÉhÉÉuÉÚiÉÈ ||1 (ni. ch. I. sl.67. p. 267.) Sleeping during day time, improper way of sitting, standing and gazing upwards, vata aggravated and enveloped by shleshma and produces “Manyastambha”.
qÉlrÉå xÉÇÍ´ÉirÉ uÉÉiÉÉåÅliÉrÉïSÉ lÉÉŽÉæ mÉëmɱiÉå | qÉlrÉÉ xiÉqpÉÇ iÉSÉ MÑürÉÉïSÇiÉUÉrÉÉqÉ xÉÇÍ¥ÉiÉqÉç || 2 (chi. ch. 28. sl. 43 p.465) When vata gets lodged in both the carotid regions and reaches inside. It causes “Manyastambha” i.e stiffness of carotid regions.
SÒwmÉëeÉÉiÉÉqÉrÉÉÈ xÉÇÌiÉ cÉiÉÑwÉ̹ËUÌiÉ ÎxjÉÌiÉ | ...... pÉëÔ¤ÉåmÉMüÉå WûlÉÑxiÉÇpÉÉå qÉlrÉÉxiÉÇpÉÉå AmÉiÉÉlÉMüÈ || 3 (ch. 11. sl. 9 p. 577) Lakshana:
qÉlrÉÉÈ Ì¢ürÉÉWûÉÌlÉÈ AzÉÏÌiÉÌuÉMüÉUæwuÉåMüÈ | 4 (p. 602)
“ Manyastambha” is one of the eighty most predominant among the innumerable disorders of vata and causes kriyahani of Manya. Chikitsa: xlÉåWûÉåmÉlÉÉWûÉÎalÉMüqÉï oÉÇkÉlÉÉålqÉSïlÉÉÌlÉ cÉ | xlÉÉrÉÑxÉÇkrÉÉÎxrÉ xÉÇmÉëÉmiÉå MÑürÉÉï²ÉrÉuÉ iÉÎlSìiÉÈ || 1 (chi. ch. 4. sl. 8. p. 420) If vata is located in ligaments, joints and bones, then snehana, upanaha, agnikarma, bandhana, and mardana should be administered.
-6- ¤ÉÉUÉSÉÎalÉaÉïËUrÉÉlÉç Ì¢ürÉÉxÉÑ urÉÉZrÉÉiÉÈ iÉSSakÉÉlÉÉÇ UÉåaÉÉhÉÉqÉç | mÉÑlÉpÉïuÉÉ°åwÉeÉ zÉx§É ¤ÉÉUæxÉÉïkrÉÉlÉÉÇ iÉixÉÉkrÉiuÉÉ cÉ || 2 (su. ch.12. sl. 3 p. 51)
Agnikarma is more powerful than Kshara, successfully usable in diseases which are not amenable to Aushadha, Shastra, Kshara, and gives no room for the diseases to recur. It can be done to the skin, muscles, veins, tendons, joints and bones.
iuÉYqÉÉÇxÉÍxÉUÉxlÉÉrÉÑ xÉlkrÉÎxjÉÎxjÉiÉåÅirÉÑaÉëÂÎeÉ uÉÉrÉÉuÉÑÎcNíûiÉ MüÌPûhÉ xÉÑmiÉqÉÉÇxÉå uÉ×hÉåaÉëljrÉzÉÉæïÅoÉÑïS pÉaÉlSUÉmÉÍcÉÎzsÉmÉS cÉqÉïMüÐsÉ ÌiÉsÉMüÉsÉMüÉl§ÉuÉ×ή xÉÎlkÉÍxÉUÉcNåûSlÉÉÌSwÉÑ lÉÉÌQûzÉÉåÍhÉiÉÉÌiÉ mÉëuÉ×̨ÉwÉÑ cÉÉÎalÉMüqÉï MÑürÉÉïiÉç | 1 (su.ch. 40 sl. 2 p. 626) in presence of very severe pain in the skin, muscles, veins, ligaments, bony joints, and bones caused by aggravated vata extra growths of muscles which are grown upward, hard & without sensation, ulcer, tumor, hemorrhoids, malignant tumor, fistula in ano, glands in neck, filariasis, warts, hernia, tearing of the joints & veins, sinus ulcer & profuse bleeding Agnikarma should be done.
Yogaraja Guggulu: ÍcɧÉMÇü ÌmÉmmÉÍsÉqÉÔsÉÇ...... CÌiÉ rÉÉåaÉUÉeÉ aÉÑaaÉÑsÉÑÈ |5 (sl. 216-224. p. 421)
Ingredients: Chitraka, Pippalimoolam, Krishnajeeraka, Vayuvidanga, Ajamoda, Jeeraka, Devadaru, Chavya, Ela, Saindhavalavana, Kushta, Rasna, Goukshura, Dhanyaka, Triphala, Musta, Vyosha, Twak, Khas, Yavakshara, Talisapatra, Lavanga, Sarjikshara, Kachura, Danti, Guduchi, Hapusha, Ashwagandha, Shatavari, Lohabhasma and Guggulu.
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Indications: Amavata, krimiroga, vrana, pleeha, gulma, udara, anaha, arsha, useful in sandhimajjagata vata, padagraha, kroshtuka shirsha, manyastambha, hanugraha, karnagraha, karnashoola, shirashoola, and vatajashoola.
Abbreviations chi – chikitsa sthana Ni – Nidan sthana su – sutra sthana sl – shloka ch.-chapter
Previous work done:
1. Pandya Pragnesh. Role of Agnikarma in the management of Sandhigata Vata, (Unpublished P.G. studies Dissertation, Gujarath University, 1990). 2. Mahanth J. Vyasadev. A clinical management of sandhigata vata w.s.r. to cervical spondylosis by Agnikarma. (Unpublished P.G. Studies dissertation, Gujarath University, 2005). 3. Ajithakumari P.A. A study with management of sandhigata vata due to greevakasheruka Kshata. (Quadriplegia due to cervical spine injury). Unpublished P.G. Studies dissertation, Trivendram, 1994. 6.3. Objectives of Study: 1. To evaluate the efficacy of Agnikarma in Manyastambha
2. To evaluate the efficacy of yogaraj guggula in Manyastambha.
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7. MATERIALS AND METHODS:
7.1 Source of Data: Patients with lakshanas of Manyastambha will be selected from the OPD & IPD of SJIIM Hospital Bangalore. 7.2 Method of collection of data. 40 Patients who fulfill the inclusive criteria will be selected. A. Diagnostic Criteria: Patients with signs and symptoms of Manyastambha supplemented with that of Acute and Chronic neck pain would be the main criteria for diagnosis namely, i. Radiological evidence of O.A ii. Pain and restricted movements of neck iii. Radiating pain to the upper limb iv. Tenderness
B. Inclusion Criteria: Patients in the age group of 18-65 years irrespective of sex, who fulfill the diagnostic criteria. Patients without bony deformities.
C. Exclusion criteria: 1. Patients with systemic diseases 2. Congenital deformities 3. Infections of bones 4. Rheumatoid Arthritis 5. Presence of cervical rib, springels shoulder 6. Benign or malignant tumours of cervical spine. 7. Meningitis 8. Head injuries
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D. Study Design: 40 patients who fulfill the inclusive criteria will be selected and divided in to two groups Group A, Group B, and each consisting of 20 patients. Group A, Patients of this group will be treated with Agnikarma by using shalaka over the site of pain for 2 sittings with an interval of 1 week. Group B, Patients of this group will be given Yogaraja guggulu 500 mg. thrice daily after food for 14 days.
Assessment criteria:- Assessment will be made with following parameters. (a) Subjective parameters.: - Pain - Stiffness - Restricted movement (b) Objective parameters - Tenderness - Range of movements of neck
Total effect of the therapy will be assessed as, i) Complete remission ii) Marked improvement iii) Moderate improvement iv) Unchanged A period of ninety days will be fixed for observing possible recurrence after the completion of the treatment.
7.3 Investigations: Plain x-ray of the neck Anterio posterior Lateral Range of motion will be recorded by using Goniometer. 7.4 Ethical Clearance: Ethical clearance will be obtained by the ethical committee. -10-
8. Bibliography: 1. Susruta. Susruta Samhita – with the commentaries, Nibandha Sangraha of Dalhanacharya and Nyaya Chandrika Panjika of Gayadasacharya. Edited by Yadavji Trikamji Acharya and Narayan Ramacharya Kavaytritaha. Varanasi : Chaukambha Orientalia ; 2005. pp. 824. 2. Charaka. Charaka Samhita – Text with English translation Agnivesha’s treatise refined, annotated and redacted by Dhridabala. 7th ed. Varanasi : Chaukamba Orientalia ; 2003. Vol. 2. pp. 879 3. Kasyapa. Kasyapa Samhita - Text with English translation by Prof. P.V. Tiwari. 1st ed. Varanasi : Chaukambha Vishwabharati Orientalia ; 1996. pp. 792. 4. Yoga Ratnakara. With the commentary Vaidyaprabha of Dr. Indradev Tripathi and Dr. Dayashankar Tripathi, 1st ed. Varanasi : Krishnadas Academy ; 1998. pp. 894. 5. Ayurvediya shabda kosha - Edited by Veni Madhava Shasthri, Narayna Hari Joshi. Mumbai ; Maharashtra Rajya Sahitya and Sanskriti Mandali,; pp. 975. 6. John Crawford Adams. Outline of orthopaedics – 10th ed. 1986 Churchil livingstone ; 1986. pp. 506. 9 SIGNATURE OF THE CANDIDATE 10 REMARKS OF THE GUIDE 11 NAME AND DESIGNATION DR. B.A. VENKATESH, B.S.A.M., B.A.M.S., M.D. (AYU) OF THE GUIDE PROFESSOR AND HOD, DEPT OF P.G. STUDIES IN SHALYATANTRA, GAMC, BANGALORE.
11.1 SIGNATURE
11.2 NAME AND
DESIGNATION OF THE CO-
GUIDE
11.3 SIGNATURE 11.4 HEAD OF THE DR. B.A. VENKATESH, B.S.A.M., B.A.M.S., M.D. (AYU) DEPARTMENT PROFESSOR AND HOD, DEPT OF P.G. STUDIES IN SHALYATANTRA, GAMC, BANGALORE. 11.5 SIGNATURE 11.6 REMARKS OF THE
PRINCIPAL
12 SIGNATURE