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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 4  |  Page : 293-298

Study of Trayodashanga Guggulu and Sahacharadi Kwatha with and without Greeva Basti in the management of Greevasandhigata Vata with special reference to cervical spondylosis: A randomized comparative clinical trial


1 Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India
2 Medical Officer (Ay.), Govt. Ayurvedic Hospital, Pratap Nagar, Jaipur, Rajasthan, India

Date of Submission04-Jul-2021
Date of Decision02-Feb-2022
Date of Acceptance07-Apr-2022
Date of Web Publication17-Dec-2022

Correspondence Address:
Bharatkumar Chhaganbhai Padhar
Department of Kayachikitsa, National Institute of Ayurveda, Deemed to be University (De novo), Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_198_21

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  Abstract 


Introduction: Cervical spondylosis is a common age-related condition characterized by degenerative changes in the intervertebral discs. Neck discomfort is the most prevalent symptom, and it continues to be one of the top causes of disability and growing health-care expenses. About 10 million persons per year suffer from cervical spondylosis in India. The incidence of neck pain is 25%–50% per year in the adult population. Nonsteroidal anti-inflammatory drugs are being used to provide relief in neck pain. The study was planned to assess the effect of Ayurvedic interventions in the management of cervical spondylosis. Methods: A total of 40 clinically diagnosed patients of Greeva Sandhigata Vata were randomly divided into two equal groups by computer generated randomization method. In Group A, patients were treated with Tryodashanaga Guggulu and Sahacharadi Kwath. In Group B, patients were treated with Tryodashanaga Guggulu and Sahacharadi Kwath, along with Greeva Basti (Prasarini Taila). Results: Tryodashanaga Guggulu and Sahacharadi Kwatha had provided 45.24% relief in pain (P = 0.001), 52.92% improvement in Neck Disability Index (P = 0.001), while Tryodashanaga Guggulu and Sahacharadi Kwatha along with Greeva Basti (Prasarini Taila) showed 56.47% relief in pain (P = 0.001) and 64.33% improvement in the Neck Disability Index (P = 0.001) which were statistically highly significant. On comparison, the difference in improvement in Pain (P = 0.007) Neck Disability Index (P = 0.026) was statistically significant. Conclusion: Tryodashanaga Guggulu and Sahacharadi Kwatha along with Greeva Basti (Prasarini Taila) are more effective in the management of cervical spondylosis (Greeva Sandhigata Vata) as compared to Tryodashanaga Guggulu and Sahacharadi Kwatha without Greeva Basti (Prasarini Taila).

Keywords: Cervical spondylosis, Greeva Basti, Greeva Sandhigata Vata, Prasarini Taila, Sahacharadi Kwatha, Trayodashang Guggulu


How to cite this article:
Kumar A, Padhar BC, Meena H M, Rawat S. Study of Trayodashanga Guggulu and Sahacharadi Kwatha with and without Greeva Basti in the management of Greevasandhigata Vata with special reference to cervical spondylosis: A randomized comparative clinical trial. J Ayurveda 2022;16:293-8

How to cite this URL:
Kumar A, Padhar BC, Meena H M, Rawat S. Study of Trayodashanga Guggulu and Sahacharadi Kwatha with and without Greeva Basti in the management of Greevasandhigata Vata with special reference to cervical spondylosis: A randomized comparative clinical trial. J Ayurveda [serial online] 2022 [cited 2023 Feb 6];16:293-8. Available from: http://www.journayu.in/text.asp?2022/16/4/293/364042




  Introduction Top


Sandhigata Vata is a Vata disorder in which vitiated Vata Dosha affects multiple joints throughout the body, resulting in clinical manifestations such as Sandhi Shoola (Joint pain), Shopha (Edema), painful joint movement, and joint derangement. Greeva Sandhigata Vata mainly affects Greeva Sandhi (cervical joints) and manifests in cervical symptoms similar to cervical spondylosis. Cervical spondylosis involves a number of degenerative changes affecting the whole cervical spine (i.e., intervertebral discs, facet joints, joints of Luschka, ligamenta flava, and laminae). It is more prevalent after 4th decade of life due to the inescapable process of aging.[1]

Increased social, emotional, and professional pressure at home and at work, along with excessive computer use, overexertion, and jerking motions while traveling or participating in sports, puts undue strain on the spinal cord, leading in cervical spondylosis. Average 20% to 50% of individuals suffer with neck discomfort annually with the majority of instances due to spondylosis.[2] Spondylosis of the cervical spine is rather common, accounting for around 2% of all hospital admissions. Spinal cord dysfunction is the most usually seen as a cause of the illness in people over the age of 55 years.[3]

Derangement of cervical joints and vertebrae, intervertebral disc degeneration, and reduced lubrication produce irritation, compression, or inflammation of nerves, resulting in severe pain and muscle spasm. In modern medicine, the disease is treated with analgesics, corticosteroids, surgical decompression, and traction, which only provide short relief and have several side effects in addition to the financial and physical costs. As a result, there is an urgent need for a long-term, cost-effective, and side-effect-free treatment. Hence, Trayodashang Guggulu, Sahacharadi Kwatha, and GreevaBasti were selected to assess their efficacy in the management of Greeva Sandhigatavata.

Greeva Basti with Prasarini Taila having oiliness, and hot properties, expected to improve derangement of cervical joints, lubrication of joints, and muscle relaxation resulting in improvement of neck pain and muscle spasm. The contents of Trayodashang Guggulu, and Sahacharadi Kwatha having Vatahara, Shulahara (analgesic), Shothahara (Anti-inflammatory), and Rasayana (Rejuvenating) are expected to breakdown the pathogenesis of Greeva Sandhigata Vata (cervical spondylosis) and relief in symptoms of the disease.

Objectives

The objective is to compare the efficacy of “Trayodashang Guggulu and Sahacharadi Kwatha” with and without Greeva Basti in the management of “Greevasandhigata Vata” (cervical spondylosis)


  Materials and Methods Top


Methods

It was open-label, randomized clinical trial. A total of 40 patients (20 patients in each group) were randomly divided into two groups by computer-generated randomization. The study was approved by the Institutional Ethical Committee (IEC) vide letter No. IEC/ACA/2019/1-20; on May 28, 2019, before starting the study. The trial has been registered with CTRI. (CTRI/2020/03/024226).

Inclusion criteria

Patients of either gender, having age between 18 and 70 years, willing to participate in the trial, with clinical signs and symptoms of Greevasandhigata Vata w. s. r. to cervical spondylosis, having chronicity of disease <5 years, and radiological finding of cervical spondylosis were included in the study.

Exclusion criteria

Patients having a history of recent cervical, spinal, or shoulder surgery or implanted instrumentation or surgery for cervical spondylotic myelopathy, long-term intake of steroid and cytotoxic treatment, comorbidities like uncontrollable hypertension, diabetes mellitus, etc., evidence of malignancy, participation in any clinical trial within the last 6 months, and pregnant or lactating women were excluded from the study.


  Materials Top


Grouping

Group A: TryodashanagaGuggulu, two tablets (500 mg. each) twice a day after lunch and dinner with lukewarm water with Sahacharadi Kwatha (40 ml) orally, empty stomach once a day in the morning for 30 days.

Group B: Tryodashanaga Guggulu, two tablets (500 mg. each) twice a day after lunch and dinner with lukewarm water with Sahacharadi Kwatha (40 ml) orally, empty stomach once a day in the morning for 30 days along with Greeva Basti with Prasarini Taila was done daily for 45 min once a day for 15 days.

Trial drugs

  1. Trayodashang Guggulu[4]
  2. Sahacharadi Kwatha[5]
  3. Prasarini Taila.[6]


Method of administration of Greeva Basti

With the help of the paste of black gram powder, two inches height and four inches diameter wall was prepared on the cervical area and filled with lukewarm Prasarini Taila and allowed to remain there till cold, after that oil is replaced with lukewarm water.

Criteria of assessment

The assessment was done based on changes in parametric and nonparametric variables.

Nonparametric variables

All registered patients of “Greevasandhigata Vata” (Cervical Spondylosis) were assessed on the basis of certain symptoms such as pain,[7] stiffness, flexion, extension, rotation of the neck, right lateral flexion, left lateral flexion, oss of sensation, headache, vertigo, weakness in muscles, swelling, and NDI.[8]

Objective parameter

The following investigations were performed on all the patients before and after the treatment: hemoglobin (Hb), total leukocyte count (TLC), erythrocyte sedimentation rate (ESR), Serum Creatinine, C-reactive protein (CRP), Serum Glutamic Oxaloacetic Transaminase (SGOT), Serum Glutamic Pyruvic Transaminase (SGPT), Antero-Posterior and lateral X-ray view of the cervical spine.

Scoring pattern for CRP: (positive 1 and negative 0).

Statistical methods used in the study

Sigma state (4.0 version), manufactured by Informer Technologies, Inc. software was used for the analysis of data. Data were represented by mean, median, and standard deviation of mean or median, standard error of mean or median, and 95% confidence interval of mean or median, as per the types of data.

For nonparametric variables, Wilcoxon signed-rank test was used. For parametric variables, students paired t-test was used. For intergroup comparison of nonparametric variables, Mann–Whitney U-test was used. For intergroup comparison of parametric variables, Student's unpaired t-test was used.

Observations and results

Demographic observation

By analysis of data, it was observed that the maximum number of patients were between 41 and 50 years of age group (37.5% patients), 72.5% patients were male, 95% patients belonged to Hindu community, 80% patients were married, 47.5% patients were educated up to secondary school, 37.5% of the total patients were doing office work, 52.5% patients were from a middle class, 62.5% patients belonged to urban aria, 75% patients had the habit of taking a purely vegetarian diet, and 41.67% patients were found to be addicted to tea.

Demographic observations related to Nidana – maximum 57.5% of the total patients were suffering from the disease for 1–2 years. All patients (100%) presented with the symptom of pain and 24 patients (60%) presented with restricted head movements, followed by 20 patients (50%) suffering from a headache. Sixteen (40%) presented with stiffness and restricted extension. Fourteen patients (35%) were suffering from restricted right lateral flexion and 17 patients (42.5%) with restricted left lateral flexion. Fifteen patients (37.5%) were suffering from loss of sensation and 8 patients (20%) with weakness in muscles. Twelve (30%) were suffering from vertigo and 9 (22.5%) from swelling.

Observations related to X-ray findings

We saw that reduction of space between C4 and C5 was found in 10 patients (25%), whereas space between C5 and C6 was diminished in 15 patients (37.5%). Reduction of space between C6 and C7 was found in 10 patients (25%). The presence of osteophytes was found in 19 (47.5%) patients. Osteoporosis was found in 9 (22.5%) patients, straightening of the cervical spine was found in 9 (22.5%) patients, and decreased cervical lordosis of the cervical spine was seen in 16 (40%) patients.


  Results Top


Tryodashanaga Guggulu and Sahacharadi Kwatha had provided 45.24% relief in pain (P = 0.001), 47.37% improvement in extension of neck (P = 0.008), 52.92% improvement in Neck Disability Index (P = 0.001), while Tryodashanaga Guggulu and Sahacharadi Kwatha along with Greeva Basti (Prasarini Taila) showed 56.47% relief in pain (P = 0.001), 52.94% improvement in rotation of neck (P = 0.008), and 64.33% improvement in Neck Disability Index (P = 0.001) which were statistically highly significant [Table 1]. On comparison, the difference in improvement in pain (P = 0.007), extension of neck (P = 0.015), and Neck Disability Index (P = 0.026) was statistically significant. Improvement in stiffness, left lateral flexion, loss of sensation, vertigo, weakness in muscles, and swelling was statistically insignificant (P > 0.05) [Table 2].
Table 1: Effect of therapy in subjective parameters (Wilcoxon Matched-Pair Singed-Rank Test)

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Table 2: Intergroup comparison of Group A and Group B for subjective parameters: (Mann–Whitney test)

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Decrease in SGPT was statistically highly significant (P < 0.001), decrease in SGOT was statistically significant (P < 0.05), and changes in other objective parameters were statistically insignificant [Table 3].
Table 3: The effect of therapy on laboratory investigations (objectives parameters): (Paired t-test)

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Patients in Group B showed highly significant results (P < 0.001) in subjective parameters such as pain, stiffness, extension, rotation of neck, left lateral flexion, headache, and NDI, whereas improvement in the right lateral flexion, loss of sensation, and vertigo was statistically significant (P < 0.05). Improvement in muscles weakness and swelling was statistically insignificant (P > 0.05) [Table 1].

In the case of objective parameters, i.e., decrease in ESR was statistically significant (P < 0.05), while changes in other objective parameters were statistically nonsignificant [Table 3].


  Discussion Top


Discussion on the probable mode of action of trial drugs

The ingredients of Trodashanaga Guggulu (TG) like Asvagandha, Hapusha, Guduchi, Rasana, Sunthi, and Ajavayan alleviate Vata Dosha and provide relief in painful movement of joints due to their Usna Virya, Vata Kapha Shamaka property. TG also improves the function of Agni due to its Deepana and Pachana activities. Improved functions of Agni with these drugs help to nourish the body tissues properly. Proper nutrition helps to delay the degeneration process of Sandhi and thus cervical spondylosis too.

The contents such as Shatavari, Ashwagandha, and Guduchi due to their rejuvenating property prevent further degeneration of body tissues aound cervical joint. Shunthi, Shatapushpa, and Yavani improve digestion and metabolism. Ghee facilitate the absorption and penetration of the drug.[9]

Anti-inflammatory and antioxidant activities of TrayodashangGuggulu have been established through various in vitro studies.[10] A study noted that the oleo-resin fraction of Guggulu possesses significant anti-arthritic and anti-inflammatory activities at the minimal effective dose of 12.5 mg/100 g body weight.[11]

Probable modes of action of Sahacharadi Kwatha

Sahacharadi Kwatha contains Sahachara (Barleria prionitis), Suradaru (Devadaru) (Cedrus deodara), and Sunthi (Zingiber Officinale). The decoction prepared with these herbs is used for the treatment of sciatica, low back pain, and disc prolapse. Sahacharadikashayam also possesses anti-inflammatory and analgesics activities.[12] Sahachara reduces Kapha and Vata due to its Ushana Virya, Snigdha Guna, and Katu Vipaka.[13] Sahachara also possesses antioxidant, anti-inflammatory, anti-arthritic, and cytoprotective activities.[14],[15],[16] Devadaru possesses immune-modulating, anti-inflammatory, anti-arthritic, analgesic, and antioxidant activities.[12] Sunthi has Anulomana, Deepana, Pachana, and Vatakaphahara properties.[17] Z. officinale has reported analgesic, anti-inflammatory, and antioxidant properties.[18]

Probable modes of action of Eranda Taila

Eranda Sneha due to its Sukshma Guna[19] penetrates microchannels and removes the obstruction, due to Katu Rasa and Ushna Virya, it potentiates digestive fire, and acts as Vata Shamaka due to its Snigdha Guna. It exerts its action in two ways: first, systemic effect on inflammation due to its anti-inflammatory properties, and second, emergency effect on pain and inflammation after purgation.[20] A study reported a similar analgesic effect of castor oil to diclofenac sodium with lesser side effects.[21]

Probable modes of action of Prasarini Taila

Gada Nigraha has mentioned the indication of Prasarini Taila in eighty types of Vata Roga for external and internal uses.[22] Prasarini Taila improves microcirculation and helps to provide nutrients to nerves and thus improves the functions of nerves and their associated structures.[23]

Mode of action of Greeva Basti

Local application of Greeva Basti with lukewarm Prasarini oil helps to alleviate Vata due to its Snigdh, Ushna, and Sukshma qualities. Greeva Basti with lukewarm oil also acts as sudation therapy and increases local circulation and perspiration and thus provides relief in Gaurava (heaviness) and Stambha (stiffness). Due to the Swedana effect of Greeva Basti, Romancha (sizzling sensation), Toda (pricking pain), Vedana (pain), Shotha (edema), Angagraha (stiffness in organs), and Ayama (feeling of expansion) get reduced and the organs become soft and elastic.[24] Acharya Charak opines that the body becomes soft and elastic through applying Snehana and Svedana as the dry wood becomes soft and elastic after applying the oil.[25] Greeva Sandhigata Vata is one among Vatavyadhi, and Snehana and Svedana are advocated for the best treatment modalities for Vatavyadhi.[26]

Sandhivata is a pain-dominant disease and relief from pain is the sign of proper Swedana.[27]

Thermal effect of warm oil

Prasarini Tail is used for Greeva Basti. The use of oil to prepare Prasarini Taila makes the lipoidal bond with drugs used to prepare this oil, which helps for penetration of oil at a deeper level. The oil used as media to prepare the Prasarini Taila also increases the rate of transdermal drug delivery. The use of lukewarm oil for Greeva Basti produces hyperthermia and improves blood and lymphatic circulation on the applied part. Greeva Basti modifies various inflammatory molecules and reduces inflammation. It reduces pain through muscle relaxation due to Ushana and Snigdha Guna of warm Prasarini oil.[28]


  Conclusion Top


Tryodashanaga Guggulu and Sahacharadi Kwatha along with Greeva Basti of Prasarini Taila are more effective in the management of Greeva Sandhigata Vata (cervical spondylosis) as compared to Tryodashanaga Guggulu and Sahacharadi Kwatha without Greeva Basti.

Financial support and sponsorship

This study was supported by the National Institute of Ayurveda, Jaipur.

Conflicts of interest

There are no conflicts of interest.





 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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