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Evaluation of the efficacy of MASHABALADI TAILA IN MANYASTHAMBA (CERVICAL SPONDYLOSIS) By Shajil. N., Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
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Evaluation of the efficacy of
MASHABALADI TAILA IN MANYASTHAMBA
(CERVICAL SPONDYLOSIS)By
Shajil. N.
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D.In
KayachikitsaUnder the Guidance of
Dr. Shiva Rama Prasad KethamakkaM.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]
Department of Kayachikitsa
Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2002-2005
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “Evaluation of the efficacy of
Mashabaladi taila in Manyasthamba (CERVICAL SPONDYLOSIS)” is a bonafide
research work done by “Shajil. N.” under the guidance of Dr. SHIVA RAMA PRASAD
KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in Kayachikitsa,
DGMAMC, PGS&RC, Gadag, in partial fulfillment of the requirement for the post graduation
degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of
Health Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil)Principal,
DGM Ayurvedic Medical College,Gadag
Date:Place:
(Dr. V. Varada charyulu)Professor & HOD
Dept. of KayachikitsaPGS&RC
Date:Place: Gadag
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
This is to certify that the dissertation entitled “Evaluation of the efficacy of
Mashabaladi taila in Manyasthamba (CERVICAL SPONDYLOSIS)” is a bonafide
research work done by “Shajil. N.” in partial fulfillment of the requirement for the post
graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi
University of Health Sciences, Bangalore, Karnataka.
Dr. SHIVA RAMA PRASAD KETHAMAKKA
M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]Guide
READER IN KAYACHIKITSADGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled ““Evaluation of the efficacy
of the Mashabaladi taila in Manyasthamba (CERVICAL SPONDYLOSIS)” is a bonafide
and genuine research work carried out by me under the guidance of Dr. SHIVA RAMA
PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Reader in
Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place
(Shajil.N)
© Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date
Place
(Shajil. N)
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgement
“Many hands make light work”. This work carries some memories to express and
record about some distinguished personalities with whom I had inspired during the course of
this thesis.
I express my obligation to my guide Dr Shiva Rama Prasad Kethamakka, M.D.(Ayu)
M.A.,Ph. D (Jyotish), Reader in Kayachikitsa, for his time to time help and critical
suggestion associated with expert guidance at the completion of this dissertation.
I express my deep gratitude to Dr. V. Varadacharyulu M.D.(Ayu), Professor & H.O.D.,
for his advice and encouragement of every step of this work.
I express my obligation to beloved principal Dr. G. B. Patil, Principal for his
encouragement as well as providing all necessary facilities for this research work.
I express my profound sense of gratitude to various departments H.O.D.s, teachers
and colleagues of sister concern departments along with the ministerial, X-ray technician
and sub staff of the D.G.M. Ayurvedic Medical College, Gadag.
I express my sincere appreciation to Dr. Shashidar. H. Doddamani, Dr. R. V. Shettar,
Dr. Kuber Sankh, Dr. P. Shivaramudu, Dr. Dilipkumar, Dr. V.M.Sajjan, Dr. U.V.Purad and
Dr. Santhosh Belavadi. I express my sincere thanks to Mr. Nandakumar for his help in
statistical analysis of results.
I am grateful to the management and staff of Parassinikkadavu Ayurveda College,
Kannur, Kerala, for their inspiration and support during the postgraduate studies.
I thank the manager of the Southern Capsulation and Pharmaceuticals PVT. LTD.
Aroor, Cochin and Dr. P. S. Gopi (DMO, ISM Rtd) for the capsulation of the Mashabaladi
Thailam in gelatin form.
I acknowledge my father Vaidya Vibhooshan K. P. Raman Vaidyan and mother M.
Karthiyayini for their wholeheartedness. I am thankful to my wife Smt. Lisha Shajil and
relatives - Shri. Anil.N, Shri, Sunil.N, Leena.N, Shri. Damodaran, Smt. Leela and Shri. Liju
for their inspiration and moral support to complete this study successfully.
Last but not least all the patients those supported my dissertation with their valuable
opine needs a warm thanks giving by heart.
Place:Date:
SHAJIL.N
Abstract
Evaluation of the efficacy of
Mashabaladi taila in Manyasthamba (cervical Spondylosis)
By Shajil. N
Over time, arthritis of the neck (cervical Spondylosis) may result from bony spurs
and problems with ligaments and disks. Injuries can also cause spinal cord compression.
Manyasthamba - Cervical Spondylosis is a non-specific term describing the morphological
manifestations of progressive degeneration of the spine at the neck, creating pressure on
nerves and spinal cord at the level of the neck. Neck stiffness. Cervical Spondylosis is a
common degenerative condition of the cervical spine that most likely is caused by age-
related changes in the inter-vertebral disks. Avitaminosis, nutritional deficiencies leading
calcium deficiency were observed to lead inflammation and degeneration of cervical
vertebra resulting nerve compression causing cervical Spondylosis.
Out of few symptomatic CS, Anti inflammatory, analgesic and disease modifying
anti rheumatic drugs are the drugs of choice in contemporary system of medicine. Reduction
of sleshma Kapha, which normally align the joints, causes the vitiated Vata to settling in the
joints.
Manyasthamba, Vata Vyadhi by its nature with the symptoms such as pain and
stiffness is pacified through Vata Kapha management. Nasya with taila pacifies the Vata
Kapha mainly the Vata. Mashabaladi is the combination of drugs having the property Vata
Kapha hara. In the constituents of Mashabaladi yoga, having madhura Rasa, which pacifies
Vata and maintain Kapha Dosha. The indication of Mashabaladi thaila is Manyasthamba,
pakshagatha etc. as it has brumhana effect.
In total 41 patients were selected for the study. Both internal and external use of
Mashabaladi taila has their effects to achieve the statistical significance as P=<0.001, which
is highly significance for the all parameters, reported at the study.
It is significantly recommended that the Mashabaladi taila be used to achieve good
results in long term to pacify Vata, Kapha and combat the degenerative changes emerge in
the later ages such as 4th to 6th decades.
Table of contents
Evaluation of the efficacy of Mashabaladi taila in Manyasthamba
(CERVICAL SPONDYLOSIS)
Heading Page number
Chapter -1 Introduction 1 to 9
Chapter –2 Objectives 10 to 12
Chapter –3 Review of literature 13 to 40
Chapter –4 Methodology 41 to 73
Chapter –5 Results 74 to 116
Chapter –6 Discussion 117 to 134
Chapter –7 Conclusion 135 to 136
Chapter –8 Summary 137 to 140
Bibliographic References I to VIII
Annex – Case sheet 1 to 7
List of tables
Sno Table Heading Page
1 Comparison of manyasthamba lakshana 28
2 Level of disc herniation 33
3 Chikitsa of manyasthamba 40
4 Showing the Ayurvedic health assessment 70
5 Showing the method of final result declaration 73
6 Distribution of patients by age –Group A 75
7 Distribution of patients by age –Group B 75
8 Distribution of patients by gender – Group A 78
9 Distribution of patients by gender –Group B 78
10 Distribution of patients by religion - group-A 80
11 Distribution of patients by religion - group-B 80
12 Distribution of patients by occupation –Group A 82
13 Distribution of patients by occupation –Group B 82
14 Distribution of patients by socio economical status – Group A 84
15 Distribution of patients by socio economical status – Group B 84
16 Distribution of patients by disease duration – Group A 86
17 Distribution of patients by disease duration – Group B 86
18 Distribution of patients by pain gradation – Group A 88
19 Distribution of patients by pain gradation – Group B 89
20 Statistical variances and significance of the pain (A & B) groups 90
21 Group relationships of pain (A & B) groups 90
22 Distribution of patients by stiffness (A & B) groups 92
23 Statistical variances and significance of stiffness (A & B) groups 92
24 Group relationships of stiffness (A & B) groups 92
25 Distribution of patients by tenderness - group-A 93
26 Distribution of patients by tenderness - group-B 93
27 Distribution of patients by Agni variances – Group A 95
28 Distribution of patients by Agni variances – Group B 95
29 Distribution of patients by Ahara Nidana – Group A 97
30 Distribution of patients by Ahara Nidana – Group B 97
31 Distribution of patients by vihara Nidana –Group A 99
32 Distribution of patients by vihara Nidana –Group B 100
33 Distribution of patients by vysana Nidana –Group A 102
34 Distribution of patients by vysana Nidana –Group B 102
35 Distribution of patients by Nidra Sukham – Group A 104
36 Distribution of patients by Nidra Sukham – Group B 104
37 Distribution of patients by Manasika Lakshana - Group A 106
38 Distribution of patients by Manasika Lakshana - Group B 106
39 Distribution of patients by Associate Complaints – Group A 107
40 Distribution of patients by Associate Complaints – Group B 107
41 Overall response to the treatment Group-A 109
42 Result of Group-A 110
43 Overall response to the treatment Group-B 111
44 Result of Group-B 112
45 Overall response to the treatment in comparison with Group-A and B 113
46 Group A individual study of statistical analysis 114
47 Group B individual study of statistical analysis 114
48 Comparative study of Group-A and Group-B after treatment 115
49 Test to know the stability about the groups 116
50 Pharmacological properties of the ingredients of Mashabaladi Taila 128
51 Karma and Doshaghnata of the ingredients of Mashabaladi Taila 128
52 Overall response to the treatment in comparison with Group-A andGroup-B
132
List of figures
Sno Pictures heading Page
1 Cervical vertebrae (C1-4) Postrio-superior view 16
2 Cervical vertebrae (C2-T1) Right-Lateral view 17
3 Pathogenesis of cervical Spondylosis 37
4 Manyasthamba Samprapti 38
5 Ingredients of Mashabaladi taila 42
6 Finished Mashabaladi taila capsules 52
List of graphs
Sno Graph heading Page1 Showing the age distributions of group-A & B 77
2 Showing the distribution by Gender of group-A & B 79
3 Showing the distribution by religion of group-A & B 81
4 Showing the distribution by occupation of group-A & B 83
5 Showing the distribution by socio-economical status of group-A & B 85
6 Showing the distribution of patients by disease duration group-A & B 88
7 Showing the distribution of patients by pain gradation group-A & B 91
8 Showing the distribution of patients by tenderness group-A & B 94
9 Showing the distribution of patients by Agni variances group-A & B 96
10 Showing the distribution of patients by Ahara Nidana group-A & B 98
11 Showing the distribution of patients by vihara nidana group-A & B 101
12 Showing the distribution of patients by vyasana nidana group-A & B 103
13 Showing the distribution of patients by Nidra Sukham group-A & B 105
14 Showing Distribution of patients by Manasika Lakshana- Group A& B 106
15 Showing Distribution of patients by Associate Complaints–Group-A & B 108
16 Result of Group-A 110
17 Result of Group–B 112
18 Comparative result of Group-A and Group-B 113
19 Comparative results of Group-A and Group-B 133
1
Chapter –1
Introduction
Pain in the neck is common and may be a natural consequence of ageing in people
over 50. Like the rest of the body, bones in the neck (cervical spine) progressively
degenerate, as we grow older. Over time, arthritis of the neck (cervical Spondylosis) may
result from bony spurs and problems with ligaments and disks. The spinal canal may narrow
(stenosis) and compress the spinal cord and nerves in the arms. Injuries can also cause spinal
cord compression. The pain that results may range from mild discomfort to severe, crippling
dysfunction.
This disease is having a prevalence of 0.1-1% of the general population, with a male
to female ratio 3:1 ratio and more commonly affects population in the productive period of
life. Even though it seems to be a very small but rapidly undertaking the deep turn of the
population towards many spinal problems, such as lumbar, thoracic and cervical
Spondylosis1.
This disease is occurring in middle and later decades of life particularly above forty-
five years of age, under the influence of the Vata Dosha. During the 4th to 5th decade of the
life, according to Ayurveda, Vata influence is more in association of Dhatu ksheenata, i.e.
debility of the tissue built. Other wise this can be said as the acceleration of the degenerative
process takes place, which ultimately leads to the many more problems of spinal origin.
Cervical Spondylosis is a common degenerative condition of the cervical spine that
most likely is caused by age-related changes in the inter-vertebral disks. Clinically, several
syndromes, both overlapping and distinct, are seen: neck and shoulder pain, suboccipital
pain and headache, radicular symptoms, and cervical spondylotic myelopathy (CSM). As
2
disk degeneration occurs, mechanical stresses result in osteophytic bars, which form along
the ventral aspect of the spinal canal.
Frequently, associated degenerative changes in the facet joints, hypertrophy of the
ligamentum flavum, and ossification of the posterior longitudinal ligament occur. All can
contribute to impingement on pain-sensitive structures (nerves and spinal cord), thus
creating various clinical syndromes. Spondylotic changes often are observed in the ageing
population. However, only a small percentage of patients with radiographic evidence of
cervical Spondylosis are symptomatic.
Occupational based disorders are classified separately in the disease classifications
of contemporary medical practice. The people at their work places, forced to undergo
postures of unwanted for long period, which makes one to have the occupational based
diseases.
With the emergence of computer technology in recent years, the average income of
computer engineers ranges well above the general working class. However, this comes with
a price. Stress and long working hours in front of computers can lead to cervical pain as well
as pathological abnormalities. Many computer engineers develop something called Cervical
Spondylosis.
Cervical Spondylosis is defined by the degenerative changes of the spine at the neck,
creating pressure on nerves and spinal cord at the level of the neck. It is usually considered
by many to be a natural aging phenomenon because it usually occurs in people of age 50 or
older2.
3
Studies show that people can develop Cervical Spondylosis by sitting in front of the
computer screen for extended period of time, tilting the neck forward, head down or with a
posture leaning forward.
Symptoms may include3:
1. Pain in the neck, radiating to the shoulder blades, top of the shoulders,
upper arms, and hands or back of the head.
2. Numbness and tingling in the arms, hands and fingers; some loss of
sensation feeling in the hands; and impairment of reflexes.
3. Muscle weakness and deterioration; diminished reflexes.
4. Neck stiffness.
5. Headache
6. Dizziness; unsteady gait
7. Crunching sounds with movement of the neck or shoulder muscles.
8. With advanced disease, loss of bladder control and leg weakness
Vata disorders are dealt by Acharyas as Vata Vyadhi includes the above-discussed
spinal originate problems, especially cervical Spondylosis as “Manyasthamba”. Truly, the
Manyasthamba is one of the Vatajananatmaja Vyadhi4-5 a disease referred to the Siras in the
neck region. Even though Manyasthamba is a condition pertaining to the veins 6 of the neck
(greevagata siras) with its signs and symptoms resembles the cervical Spondylosis.
The commonest cause for cervical Spondylosis or such type of diseases is the
degenerative changes effected in the cervical region. Ayurveda though describes much of its
pathological entities with reference to that of Dosha excitations or vitiation of Vata and
Avarana, where in the root expression of the Vata vitiation is degeneration.
4
Avarana7, which is specified phenomenon of Vata interactions with the other Dosha,
causes the different pathologies in the body. The causes for such a presentation tries to
explain the underlying pathology in terms of structural and functional changes.
Why the topic chosen
Anti inflammatory, analgesic8 and disease modifying anti rheumatic drugs are the
drugs of choice in contemporary system of medicine. Fortunately all the analgesics are liable
to many side effects particularly by repeated and prolonged usage. The contemporary
medical science is depend upon Physiotherapy and rest for the regulating or retarding the
disease in association with the above said medicaments.
Ayurveda the age-old Indian system of medicine advocates a reliable management of
diseases with due consideration to protect the normal health while treating the disease with
highly efficacious and easily available drugs based on humorl theory.
Ayurvedic approach to the disease management of Manyasthamba is to retard the
degeneration or to strengthen the dhathus as the pacifying the Vata Dosha has special
importance in the management. Nasya is described as having a significant role among
Shodhana therapy as it does the important action shirah shodhana clearing the channels of
head by clearing the Dosha samghata deep rooted in the channels of indriya situated9.
In recent and past years several experimental and clinical studies have been carried
out by Ayurvedic scientists at various centers with an aim to study the disease
Manyasthamba and to evolve safer.
Cervical Spondylosis is a non-specific term describing the morphological
manifestations of progressive degeneration of the spine.
5
SPONDYLO is a Greek word meaning vertebra10. Spondylosis generally mean
changes in the vertebral joint characterised by increasing degeneration of the inter-vertebral
disc with subsequent changes in the bones and soft tissues.
From the IV to V decade, it is clear that IVD undergoes progressive desiccation,
becomes more compressible and less elastic and secondary changes ensue. Although the
majority of individuals over 40 years of age demonstrate significant radiological evidence,
but only a small percentage develop symptoms. The changes result in neural compression
resulting in radiculopathy or compression of the spinal cord resulting in myelopathy. Both
the neural and spinal cord compression will result in radiculomyelopathy.
Males predominate for myelopathy. There is no such proclivity for disc disease.
CSM is the most common cause of nontraumatic spastic paraparesis and quadriparesis. In
the 1997 Moore and Blumhardt series, 23.6% of patients presenting with nontraumatic
myelopathic symptoms had CSM.
Race: Cervical Spondylosis may affect males earlier than females, but this is not true in all
studied populations11.
Sex:
Irvine et al defined the prevalence of CSM using radiographic evidence. In males,
prevalence was 13% in the third decade, rising to nearly 100% by age 70 years. In females,
the prevalence ranged from 5% in the fourth decade to 96% in those older than 70 years.
Another study, in 1996, by Holt and Yates examined patients at autopsy. At age 60
years, one half of the men and one third of the women had a significant amount of disease.
6
In 1992, Rahim and Stambough noted that spondylotic changes are most common in
those older than 40 years. Eventually, more than 70% of men and women are affected, but
the radiographic changes are more severe in men than in women.
Role of Ayurveda and recent advances in Manyasthamba
Ayurveda the age-old Indian system of medicine advocates a reliable management
for the diseases with due consideration to protect the normal health based on Tridosha
theory, treating the disease with highly efficacious and easily available drugs.
Anti-inflammatory and disease modifying anti rheumatic drugs are the drugs of
choice in contemporary system of medicine. Fortunately all the analgesics are liable to many
side effects particularly in prolonged use.
Ayurvedic approach to the Manyasthamba is to retard the degeneration process and
strengthening the Dhatus and pacifying the Vata Dosha has special importance in the
management of any degenerative phenomenon.
Nasya is described as a significant Shodhana therapy as it has the important action
i.e. clearing the channels of head (Shirah Shodhana) by cleansing the Dosha which is deep
rooted in the channels.
In recent and past, Ayurvedic scientists at various centres with an aim to study the
Manyasthamba and to evolve safer and economical medicaments for it have carried out
several experimental and clinical studies. The works are successful to some extent to relieve
pain and stiffness, common complaints of this condition.
In 1992, S. Hebbar from G.A.M.C. Mysore, worked on Manyasthamba with special
reference to its management by Nasya.
7
In 1994, Vijaya Lakshmi from G.A.M.C. Mysore, worked on Medical management
of cervical Spondylitis.
Only few works were carried out related to the present topic .In the classics the line
of treatment was told as Rooksha Sweda and Nasya. Much of Inflammation is seen only at
the initial stage and not at the later stage .The later stages can be named as degenerative
phases. Rooksha Sweda12 is applicable only in the inflammatory stage, whereas in the
degenerative phase Brumhana Nasya and Vata pacifying drugs are more effective13.
The above works were successful to some extent. Pain and stiffness in the chronic
condition left a room to work in terms of shulahara and stambhahara modality to provide
relief during the chronic phases.
Options of Treatment in contemporary medical science14?
In broad terms, the options for the treatment of cervical Spondylosis are either
conservative or surgical. Conservative treatment encompasses immobilisation with a
cervical collar (usually a soft collar), use of analgesics or muscle relaxants, and physical
therapy. Surgery may be performed either by the anterior or the posterior approach and may
involve either single or multiple cervical segments. Anterior cervical discectomy and fusion
implies removal of the offending disk and osteophytes with fusion via either a bony graft or
instrumentation (e.g., cage or plate). The alternative is a vertebrectomy (also known as
corpectomy) in which the relevant vertebral body is removed. The posterior approach
involves either a laminectomy or some form of a laminoplasty. Although the former
involves removal of the lamina, the latter is a technique that aims to enlarge the spinal canal
by preserving and elevating the lamina roof over the dura, and it typically has less potential
than laminectomy to cause spinal instability.
8
Treatment usually is conservative, with nonsteroidal anti-inflammatory drugs,
physical modalities, and lifestyle modifications most commonly used. Surgery occasionally
is performed. Many of the treatment modalities for cervical Spondylosis have not been
subjected to rigorous, controlled trials. Surgery is advocated for cervical radiculopathy in the
patients who have intractable pain, progressive symptoms, or weakness that fails to improve
with conservative therapy. Surgical indications for CSM remain somewhat controversial15.
Natural History of Cervical Spondylosis
Cervical Spondylosis is a disorder characterised by degenerative disk disease, the
formation of spondylotic ridges and osteophytes, facet and uncovertebral joint arthritis,
ossification of the posterior longitudinal ligament, redundancy of the ligamentum flavum,
and vertebral body listhesis. Injury to nerve roots or the spinal cord may occur either directly
via mechanical trauma or compression, or indirectly via arterial insufficiency or venous
stasis.
To put into perspective the results of treatment, either conservative or surgical, it is
important to know the natural history of cervical Spondylosis. Ideally, it is necessary to
know the natural history of both cervical spondylotic radiculopathy and myelopathy. With
respect to cervical spondylotic myelopathy, there are no reliable data. The study by Lees and
Turner 16 is often cited as a description of the natural history of cervical Spondylosis.
However, it is clear that some of the patients in their study underwent various forms
of therapy, but a distinction was not made between those who were treated and those who
were not. Therefore, their conclusion that cervical spondylotic myelopathy is a disease with
a lengthy clinical course marked by long periods of non-progressive disability should be
regarded with some caution.
9
Clarke and Robinson 17 described their experience with untreated patients amongst
their larger series of patients with cervical spondylotic myelopathy. They found that
progression was common, albeit gradual, and that improvement was rare and concluded that
prognosis was generally poor. With respect to cervical spondylotic radiculopathy,
longitudinal studies suggest that symptoms may resolve with time. In the population- based
study of residents of Rochester, Minnesota, 3 90.5% of patients with cervical radiculopathy
were asymptomatic or only mildly affected after a mean follow-up period of almost 6 years.
This figure includes those patients who were treated surgically, but these were a minority
(26%) of the whole group.
The clinical manifestations of cervical spondylotic myelopathy include weakness and
spasticity due to motor long-tract dysfunction, sensory impairment due primarily to dorsal
column involvement, and bladder dysfunction. Cervical Spondylosis may also manifest only
with neck and head pain or with signs and symptoms attributable to cervical radiculopathy.
The syndrome of cervical spondylotic myelopathy must be distinguished from these
related clinical entities. With the natural history of cervical Spondylosis, can it be altered by
surgery? Are there particular circumstances that should dictate either surgical intervention or
conservative measures? Is surgery more or less indicated if symptoms are due to cervical
root or spinal cord compression? Is there any value of the natural herbal management i.e.
Ayurveda? All these questions can be answered with this clinical trail undertaken.
10
Chapter –2
Objectives of study
The present study intended to focus on the disease evaluation i.e. Manyasthamba vis-
à-vis cervical Spondylosis and the management with Mashabaladi taila internal and external
through Nasya.
Mashabaladi yoga is mentioned at Chakradatta with reference to the management of
Manyasthamba is prepared in taila form as avartita to fortify the efficacy and also to
administer per Nase, and capsulated in 300 mg gelatine capsule. The compound of
Mashabaladi Yoga reduces pain, and swelling in association with anti degenerative
properties as it pacifies the Vata. So the combination is assumed as most suitable in the
management of Manyasthamba.
In this regard the objectives proposed in the study are discussed one after another as
under -
1) To evaluate the vedana samakatawa (analgesic effect) of Mashabaladi Taila in
Manyasthamba (Cervical Spondylosis)
The condition Manyasthamba is effecting the neck region with the symptoms such as
pain and stiffness. Manyasthamba and its management through various methods are possible
viz, Vatahara dravya, vedana stapaka dravya, Mardana, etc. One out of them is Mashabaladi
thailam, which is administered as Pratimarsha Nasya in both Nase and/, or internally in the
form of capsule at present study.
The specificity of the shoolaghna and Vatahara effect is studied as the analgesic
effect of contemporary. Pain relief is to offer for the patient by al means. Shoola hara
(vedansthapana) nervine tonics Vatahara these said properties are effective over Dosha
11
predominance and Dushya Dhatus to regulate normally by fragmenting the underneath
pathologies.
As the patient experiences at the most pain and inconvenience due to the stiffness at
neck region. The analgesic effect of Mashabaladi taila in Manyasthamba can be evaluated
by the means of studying the pain and stiffness with specified parameters. Understanding
the cumulative effect of the Mashabaladi yoga is possible through the above said methods.
The Mashabaladi yoga comprises of Kapha Vata hara in nature, which reduces pain
and stiffness and there by regulate the concern organ pathology. This can be understood that
the study of base line data to the final data differences after the drug administration to the
patient’s those who are included by the present parameters of exclusion and inclusion
criteria.
2) To evaluate the vyathiharthwa (disease regression) of Mashabaladi taila in
Manyasthamba (cervical Spondylosis)
The Vyadhi, Manyasthamba is a Vata Vyadhi by its nature. Traditionally, it is
believed that the degeneration of joints and related structures is inevitable and progressive in
nature as the Vata ages are achieved, i.e. the progressive age from 5th decade onwards. But
the degeneration is witnessed now a day at the early age groups, which is alarming for the
health associates.
In the present study the specifically the regression of degeneration is estimated
through the Kapha vruddhi kara bhavas accumulation in the body by offering the Vata
antagonistic management. The antagonistic management of the Vata activates the bone
integrity to re-establish and there by the normal bony component with its functions re-
establishes.
12
Such improvement on functional or structural components in the cervical joints
where the disease regression study is made through noticing the effect of Mashabaladi taila
in Manyasthamba i.e. cervical Spondylosis. It can be evaluated by either understanding the
cumulative effect of the above said yoga at hypothetical level or directly estimating the
disease regression through parameters.
3) To evaluate the cumulative effect of Pratimarsha Nasya and internal administration
of the Mashabaladi taila in Manyasthamba (cervical Spondylosis)
Pratimarsha Nasya (Brumhana Nasya) is per Nase administration of medicine gives
snehana – unctuousness and rechana – elimination effect in the head and surroundings.
Nasya karma when it is done properly and regularly, keeps the person’s eye, nose, and ear
unimpaired it is also prevent premature graying of hair, head ache etc. It alleviates the
disease of urdwajathru like Manyasthamba, Ardhita etc.
The cumulative effect of the Avartita Mashabaladi taila internally and as Pratimarsha
Nasya is studied to establish the relation to the management.
13
Chapter –3
Review of literature
The disease references are much available in Vedas and Samhita as only Vata vikara.
It is evidential that there is no direct reference of the disease as Manyasthamba is available
from vedic literature, but can definitely find indirect references here and there. In the
Rigveda and Atharvana Veda we can see the details of Vata bheda, Sleshmaka Kapha18.
Sandhi Vyadhi and medicines used in Vata Vyadhi.
The references are found from Bhruhatrayes and Laghu trayees many more about the
disease Manyasthamba. Manyasthamba is highlighted in early 20th century and even they
have mentioned the Shodhana and Shamana line of managements.
Charaka Thrimarmeeya chapter of Siddhi Sthana19, he explained Manyasthamba is
because of head injury i.e. shiro abigatham and considered “Antharayama” as
Manyasthamba. Similarly Vagbhata 20 also refer Manyasthamba is a symptom of
“Antharayama”. In further while explaining the Nasya vidhi, he has indicated Nasya
especially Brumhana Nasya for Manyasthamba21.
Susruta Samhita dealt Manyasthamba as the prodromal symptom of Apathanaka, a
Vata Vyadhi. But Gayadasa, commentator of Susruta, considers Manyasthamba as
individual disease entities because of its causative factors are discussed separately as a
disease22-23.
Later texts of Ayurveda Madhava Nidana24, Bhavaprakasha25 and Sharangadhara
Samhita26 dealt Manyasthamba as individual disease by discussing its detailed pathology
along with its specific line of treatment. Chakradutta27, Vangasena28 and Bhaishajaya
14
Ratnavali29 also discussed Nidana and treatment for Manyasthamba as an individual entity
of disease.
At the present day of context, the contemporary science explains elaborated
description of cervical Spondylosis, which is degenerative disease, has been studied under a
separate branch named as Rheumatology linked with the bonny lesions30.
Etymology of Manyasthamba
The Manyasthamba comprised of two meaningful words, Manya and sthamba, which
makes the meaning of stiffness of the neck muscles. It clearly states the pathogenesis of the
neck and its contents. The derivation of the Manyasthamba is as follows31.
“Manya” means the back of the neck or the part below the head, manya and
Greeva are synonyms.
“Sthamba” relays the meaning of stopping or retarding the functions of the
neck i.e. inability of neck movements
With the above stated definitions and derivations we can draw a conclusion as such
the disease Manyasthamba is a disease of the neck where the movements are restricted or
disturbed because of the underlying pathology. The pathology is either degeneration or of
local pathological entities, either because of the internal humoral vitiation or exogenic
factors32.
Paribasha33
Vata is vitiated either because of Avarana or Dhatu kshaya. When Vata covered by
Kapha or Dosha accumulation makes Manyasthamba. Even though Manyasthamba is told as
a vataja nanatmaja Vata Vyadhi Kapha Dosha associations are also inscribed in the
Samprapti.
15
This is because the Vata is vitiated and lodging in the Kapha sthana so the Kapha
involvement can occur. When any disease is not treated properly at the initial stage it may
lead to further deterioration. Such activity is happening even in Manyasthamba too. At the
initial stage of the disease the Kapha Anubandhatwam is acknowledged. When it becomes
chronic, it becomes as a total Vata disorder, which is degenerative condition in nature.
Surface Anatomy of the disease concern
Vertebral column34-35-36
The total numbers of bone present in the body are together called as skeleton. The
main division of skeleton is into axial and appendicular. The axial skeleton includes
vertebral column, sternum, ribs, and skull. The appendicular skeleton includes these bones
of the upper and lower limbs and girdle bones. The vertebral column extends from the base
of the skull through the whole length of the neck and trunk. It consists of thirty-three
separate irregular bones called vertebra placed in series and connected together by ligaments
and discs of fibro-cartilage to form a flexible curved support for the trunk.
The vertebral column varies length but it is about 70cm in man and 60cm in women.
Th vertebra is named according to region in which they lie. They are 7 cervical, 12 thoracic,
5 lumbar, 5 sacral, 5 coccygeal.
With the exception of the first two cervical vertebrae all other vertebra consists of a
large anterior weight bearing body and a posterior placed vertebral arch. The arch springs
from the postero-lateral aspects of the body and with its surrounds large hole, vertebral
foramina. When the vertebra are placed in series these foramina together with the ligamenta
flava, that unite the adjacent laminae form the vertebral canal which lodges the spinal chord
with its meaning and blood vessels.
16
Atlas (first cervical) vertebra
The first cervical vertebra is called the atlas it looks very different from a typical
cervical vertebra as it has no body and no spine. It consists of two lateral masses joint
anteriorly by a short anterior arch, and posteriorly by a much longer posterior arch. The
arches give the atlas a ring like appearance. The large transverse process pierced by a
foramen transversarium, projects latterly from the lateral mass. The superior aspects of each
lateral mass shows an elongated concave facet, which articulates with the corresponding
condyle of the occipital bone.
Figure –1
Cervical vertebrae (C1-4) Postrio-superior view
The axis (second cervical) vertebra
The most conspicuous feature of the axis, which distinguishes it from all other
vertebra, is the presence of a thick finger like projection arising from the upper part of the
17
body. This projection is called the densor odontoid process. The anterior aspect of the dens
bears a convex oval facet for articulation with the anterior arch. Its posterior aspect shows a
transverse grove for the transverse ligament. The pedicles, laminae and spine are the thick
and strong, the inferior articular facets are placed below the junction of the pedicles and the
laminae.
Figure –2 Cervical vertebrae (C2-T1) Right-Lateral view
The seventh cervical vertebra
The seventh cervical vertebra differs from a typical vertebra in having a long thick
spinus process, which ends in a single tubercle. The tip of the process forms a prominent
surface landmark. Because of this fact this vertebra is referred to as the vertebra prominence.
18
The transverse processes are also large and have prominent posterior tubercles. In this
vertebra the vertebral artery and vein do not transverse the foramen transversarium of this
vertebrae an accessory vertebral vein passes through the foramen.
Anatomy of inter vertebral joints
All vertebrae from 2nd cervical to 7th cervical vertebrae articulate by cartilaginous
joints between their bodies, synovial joints between their articular process (Zygapophysical)
and fibrous joints between their laminae and also between their transverse and spinous
process.
Inter-vertebral disc
It is a fibro-cartilagenous disc, which bends the two adjacent vertebral bodies, except
the axis. Morphologically it is a segmental structure as opposed to the vertebral body, which
is inter-segmental.
Inter-vertebral discs Shape: The shape of the inter-vertebral disc corresponds to that of the
vertebral bodies between which it is placed.
Inter-vertebral discs Thickness: It varies in different region of the column and in different
parts of the same disc. In cervical region the disc are thicker in front than behind.
Structure of inter-vertebral disc: Each disc is made up of three parts, viz., Nucleus
pulposes, annulus fibrosus and cartilaginous plate. The individual component description is
as follows.
Nucleus pulposus: It is the central part of the disc, which is soft and gelatinous at birth. Its
water content is 90% in newborn and 70% in old age. It is kept under tension and acts as a
hydraulic shock absorber. It represents the remains of the notochord and contains few multi
nucleated notochordal cells during the first decade of life. After which there is a gradual
19
replacement of the mucord material by fibro cartilage derived mainly from the cells of
annulus fibrosus and partly from the cartilaginous plates covering the upper and lower
surfaces of the vertebrae. Thus with advancing age the disc becomes amorphous and
difficult to differentiate from the annulus. Its water binding capacity and the elasticity are
reduced.
Annulus fibrousus: It is the peripheral part of the disc made up of a narrower outer zone of
collagenous fibres and a wider inner zone of fibro cartilage. The laminae form incomplete
collars, which are convex downwards and re corrected by strong fibrous bands. They
overlap into one another at obtuse angles. The outer collagenous fibers bend with anterior
and posterior longitudinal ligaments.
Cartilaginous plate: Two cartilaginous plates lie one above the other below the nucleus
pulposes. Disc gains its nourishment from the vertebrae by diffusion through these plates.
Function of inter-vertebral discs: Inter-vertebral discs give shape to the vertebral column.
They act as a vertebral series of shock absorbers or buffers. Each disc may be linked to a
coiled up spring.
Movements of the cervical column: Range of movements between vertebrae is restricted
by the limited deformities of inter-vertebral discs. Whose greater thickness at cervical
column increases individual range. It is also limited by the topography of the zygophysial
joints and by concomitant changes in tension of the ligamentous syndesmoses. Thus the total
range of vertebral movement includes flexion, extension, lateral flexion rotation.
Flexion: In flexion the anterior longitudinal ligaments become relaxed and the anterior part
of inter-vertebral discs are composed. While at its limit the posterior longitudinal ligament
20
ligamentum flora, inter-spinous and supra-spinous ligaments and posterior fibres of inter-
vertebral discs are tensed.
Extension: In extension the opposite event of flexion occurs. Tension of the anterior
longitudinal ligament, Anterior disc fibres and approximation of spines, zygopophyses and
compression of posterior disc fibres, limits extension.
Lateral flexion: Here the inter-vertebral discs are laterally compressed and contra-laterally
tensed and lengthened motion being limited by tension of antagonist muscles and ligaments.
It is always combined with rotation, lateral movements occur in any part of the column but
are greatest in cervical and lumbar region.
Rotation: Rotation involves twisting of vertebrae relative to each other, with torsional
deformation of intervening discs. Movement is slight at cervical level.
Neuro anatomy
Cervical plexus37-38
The cervical plexus is formed by the vertebral rami of the upper four cervical
nervous. The rami emerge between the anterior and posterior tubercles of the cervical
transverse processes, grooving the costo transverse bars. The four roots are with one another
to form three loops.
The plexus is related posteriorly to the muscles, which arise from the posterior
tubercles of the transverse process i.e., the Levator scapulae and the scanlenus medius.
Anteriorly to the pre-vertebral facia, the interior jugular vein and sterno mastoid.
21
Branches
A) Superficial cutaneous branches
1. Lesser occipital (c2)
2. Greater auricular(c2,c3)
3. Transverse (anterior) cutaneous nerve of the neck (c2,c3)
4. Supra clavicular (c3,c4)
B) Deep branches
1. Communicating branches
2. Muscular branches
(a) rectus capitis anterior from c1
(b) rectus captis lateratus from c1,c2
(c) longus capitis from c1,c2,c3
(d) lower root of anasa cervicalis c2c3
Muscles supplied by cervical branches
1. Stermomastoid – c2 and accessory nerve
2. Trapezius – c3-c4
3. Lavetor scapularis – c3c4c5
4. Phrenic nerve c3c4c5
5. Longus colli c3-8
6. Scalenus medius c3-8
7. Scalenus anterior c4-6
8. Scalenus posterior c6-8
Phrenic nerve
This is a mixed nerve and carrying motor fibres to the diaphragm and sensory fibres
from the diaphragm, the pleura, the pericardium, and part of the peritoneum.
22
Origin: It arises chiefly from the 4th cervical nerve but receives contributions from c5 may
come directly from the root or indirectly through the nerve to the subclavius.
Ayurvedic in sight of Shareera
There are four asthi sandhis in neck (kandda). They are movable joints, which have
limited movements (prasthara sandhis). The ligaments (snayu) present in manya are two39-40.
Marma41
Vagbhata defines that marma is the meeting of mamsa, asti, sira, snayu, dhamani and
sandhi and is the place where the prana is felt. Manya is a sira marma.
Based on the vulnerability, the marmas are classified in to five types. In that manya
is vaikalya kara marma, the name of the marma is derived from the word ‘vikala’, which
means deform or cripples. Thus it is understandable here that these marma on receiving
injury or insults shall result in the deformity of the related body parts in diseased condition
of the pathology happens to proliferate in to these marma sites. Then it is likely that the
body parts are crippled or deformed even after the control of disease.
Bony component development factors42
According to the Ayurvedic literature, the body is, made up of seven dhatus. Out of
then asthi is the gambhir, 5th dhatu by chronological order. It is hard, stable and gives shape
to body. It is formed from pruthvi, teja, vayu and akasa.
Susruta explains the pitrja bhavas (inherited from father) which support the evolution
of the asthi Dhatu, in the foetal stage. The influence of the factor is not confirmed to the life
of the foetus in the uterus. But they play a very significant role in the development of asthi
Dhatu43.
23
According to modern observation the hard, soft and hollow parts of the body are
developed from ectoderm, mesoderm, and endoderm44. But according to Ayurveda the
organs and other structure of the body are evolved from the sapta Dhatu.
According to the law of successive production of Dhatu “krama parinama Nyaya45”
asthi is produced from its previous one that is from meda. Pruthvi Guna is much more
present in bones. Meda creates a compact mass of Pruthvi, Agni, anila etc by its own heat
and forms the bones. Vata creates sponginess of the interior of bones, which is filled with
sneha obtained from meda. This is also called the majja (the marrow) vayu and akasa and
others from the spongy substance as well.
Development46-47
Ossification of bones begins in the third month of intra- uterine life and advances
with age. Initially they are cartilaginous, and complete their ossification at the age of 25, but
even there some remain in a cartilaginous stage till the end of life. In a person with a Kapha
Prakruti the bones are firm and tough48.
Bony components degenerative factors49
Degenerative diseases in Ayurveda view, many a times appear to be the vitiation of
Vata as well as the deterioration of the body tissues that are termed as Dhatu.
We know that the ageing process is also understood as a degenerative process, which
comes as an on slat of time Ayurveda has mentioned that ageing process is a disease that
occurs naturally that no body can avoid hence, grouped under the classification
Swabhavabala pravritta Vyadhi In Susruta Samhita50. Old age is considered to be a period of
Vata predominance. Where in body gets dry, light and becomes depleted of essence.
24
Degeneration is not only as an in balance of Dosha, but also to know it in terms of
lack of good quality Rasa Dhatu in other words, when we see degeneration. Process in the
body importance should be laid on to provide the body with pure nutrients essence i.e., Rasa
Dhatu, for which it is essential to maintain a good state of metabolism.
Ayurveda says that all the ailments are due to a low digestive and metabolic
capacity, which is termed as mandagni51. It is not enough to load the system with required
amount of foodstuff. The power of digestion and metabolism is termed as Agni in Ayurveda.
The concept of Agni in Ayurveda is vital when we want to deal with health or disease. A
weak Agni will turn the so-called balanced diet in to a disease. Generating toxins in the body
is called as Ama. An inefficient state of digestion and nutritional essence, Rasa Dhatu,
which in turn will badly effect the production of the subsequent body tissues and ultimately
pave for disease of degenerative in origin.
Digestion and metabolism relations to degenerative disorders52
An efficient power of digestion in the gastrointestinal track includes proper
functioning of the main and accessory organs of the Maha Srotas. Many other chemicals that
we come in to contact with our daily life have been found to be endocrine disruption, which
interfere in the endocrine functioning of the organism there by posing a threat to the health
and harming the very process of procreation and degeneration.
Patho-physiology of cervical Spondylosis53-54
The age related changes in cartilage include alterations in proteoglycas and collagen,
which decrease tensile strength and shorten fatigue life. Despite this relationship, it is an
over simplification to consider osteo-arthritis as merely a disease of cartilage wear and tear.
Chondrocytes play a primarily role in the nervous function. Process and constitute the
25
cellular basis of the disease. The chondrocytes in osteo-arthritic cartilage produce IL-1 and
TNF-alpha, which are known to stimulate the procedure of catabolic metalloproteinase and
inhibit the synthesis of both type 2 collagen and proteoglycans. The effects of these
cytokines potentates because their receptors show increased sensitivity. Other mediators,
such a prostaglandin derivatives and IL-6, also have a role in this cascade of matrix
degradation. Most of these cytokines also have pro-inflammatory cells are present in many
osteo-arthritic joints. These precise events lead to the secretion of cytokines.
Nidana – the aetiology of Manyasthamba
It is also essential to determine the exact nature of the disease with special reference
to the Dosha, Dhatu, Malas, Srotas, and Agni involved in this manifestation of disease.
Causes in general55:
v In addition to age and possibly gender, several risk factors have been
proposed for cervical Spondylosis.
v Repeated occupational trauma (e.g., carrying axial loads, professional
dancing, and gymnastics) may contribute.
v Familial cases have been reported; a genetic cause is possible.
v Smoking also may be a risk factor.
v Conditions that contribute to segmental instability and excessive segmental
motion (e.g., congenitally fused spine, and cerebral palsy, Down syndrome)
may be risk factors for spondylotic disease.
As the Manyasthamba is a Vata Vyadhi, the Vata Vyadhi Nidana has to be
considered here. Manyasthamba is one among the eighty types of Vata disorders. There is
no much difference in the causative factors of Vata diseases. Only due to Samprapti
26
Vishesha of vitiated Vata will leads to variety of Vata disorder like Ardhita, Pakshagata,
Manyasthamba etc., the factors which causes vitiation of Vata are classified under the
following sub headings.
1. Swaprakopaka Nidana
2. Margavarodhaka Nidana
3. Marmaghatakara Nidana
4. Dhatukshayakaraka Nidana
The etiological factors having some properties of Vata causes increase of Vata.
According to Samanya Vishesha Siddhanta, the principle of the doctrine is the combination
of similar brings about vrudhi and the dissimilar to kshaya56. Further excessive and constant
consumption of the same etiological factors results in to provocation of Vata. Apart from
these the factors which favours the provocation of Vata are also to be considered here. These
etiological factors are classified as follows.
Swaprakopaka Nidana
Ahara (dietetic factors)
Excessive and continuos in take of diet possessing the properties of ruksha, Sheeta
Laghu, and rasas like Katu, Tikta, Kashaya, irregular food habits, in sufficient diet, intake of
dried leafy vegetables, dried food articles, cereals like varaka, kodrava, pulses like syamaka,
mudga, kalaya, chanaka, harenu.
Vihara57
Ratri jagarana, excessive walking, excessive swimming, excessive riding on horses
and vehicles, ativyavaya, prapatane (talking) adhyasana, bharavahana (weight lifting)
ativyayama (excessive exercise) balavat vigraha, (fighting with persons of superior strength).
27
Seasonal factors and Vayah
Rainy season and part of the summer season. End part of the day, night, digestion are
the seasonal which makes Vata prokopa in the old age Vata Dosha is dominant makes Dhatu
kshaya (degenerative changes)
Mithyo pachara of Pancha karma58
Improper doing of Vamana, Virechana, Vasti etc., the term denotes has atiyoga as
well as heena yoga. The wrongly carried out methods cause vitiation of Vata Dosha.
Psychological factors59
Due to worry, grief, anger, fear, anxiety, the body becomes emaciation causes Vata
vitiation.
Margavarodhaka Nidana
The etiological factors which causes obstruction in the normal movement of Vata
results in the prakopa of Vata.
Vegha dharana and udheerane60
Suppression of natural urges and inducing the urges forcefully causes Vata prokopa.
In Manyasthamba these factors causes prakopa of Vyanavata, a sthanika Dosha may
aggravate the condition.
Ama
Due to hypo functioning of Agni, the food that is not completely digested, yields
immature Rasa in Amashaya, obstructs the Vatavaha Srotas, causes the vitiation of Vata and
moves around in different directions to produce a Vata Vyadhi.
28
Other Doshas
Manyasthamba is told as Vata kaphaja even though it is included in Vataja
nanatmaka Vyadhi. Here Kapha Dosha involvement is present. The Kapha prokopa ahara
nidanas causes the obstruction of Vata makes sthanika disease.
Kapha prokopa factors
Ahara: Excessive and continuous usage of sweet, acidic, salty, cold and heavy food
articles like yavaka, black gram, curd, milk, nava danyas. Anupa mamsa etc.,
Vihara: Day sleep, excessive sleep, suppression of vomiting
Marmabhigata: Injury to neck causes Vata prakopa resulting kshata of the manya
siras and asthi bramsa, hence it results in to the loss or restriction of neck movements. The
etiological factors such as carrying heavy weight over head, sleeping in irregular surface,
etc, can cause the marmagata in the neck region61-62.
Dhatu kshaya kara Nidana
The Dhatu kshya can arise due to various etiological factors. The Dhatu kshya causes
increase of rukshata thus prakopa of Vata. In old age due to the degeneration of the discs
increases pressure on nerve roots by which nerve roots of the vertebra is compressed and the
compression of vertebra is causing Manyasthamba. Excessive indulgence in exercise or sex
causing Dhatu kshaya is also a cause of Vata prakaopa leads to Manyasthamba.
Table –1
Comparison of Manyasthamba Lakshana
SusrutaMadhavaNidana
BhavaPrakasha
YogaRatnakara
Diwaswapna + + + +
Asanasthana vikruthi + + + +
Urdwanireekshana + + + +
29
Divaswapnam
As we all known Divaswapnam causes Kapha prakopa, which is involved in early
stages of the disease to be more specific. It can be interpreted in terms of sleeping in bad
postures. Which causes minor trauma to the cervical spine and leads Manyasthamba.
Asanasthana Vikruthi63-64-65-66
Here Asana as upaveshanam and sthana as urddwa vibhavanam, which means the
postural disturbances specifically with reference to sitting. Persons sitting or even lying
down in bad postures, which in turn leads to improper positioning of cervical vertebrae, this
puts uneven pressure over the spinal nerve roots producing different signs and symptoms.
We know that when a person sits or sleeps in improper head positions, if that person is of
middle age or old aged as he has already developed degenerative changes in the cervical
vertebrae. Which is due to ageing process, hence a wrong posture cause minor trauma
accelerates the pathology of degeneration leading to set of clinical features.
Urdwa Nireekshana67-68-69-70
Dalhana clarifies that by looking upwards continuously is vakra position of manya
leads to minor trauma and precipitates the symptoms. In Charaka Samhita abigathwam of
siras has told one of the reason for Manyasthamba. In the modern science they described
severe trauma such as suddenly turning the head, continuously looking upwards, repeated
movements of cervical vertebrae, desk work, clinical work, weight lifting etc., causes for
cervical Spondylosis. Apart from the above age is obviously the most important
predisposing factor.
30
Etiological factors according to modern 71
1) Postural causes
v Drooping shoulder
v Condition in the muscles fascia, ligaments and glands
v Trauma
v Occupational strain
2) Condition of the cervical spine
v Inter vertebral disc prolapse
v Lesions in the vertebral bodies
v Trauma: old fractures, dislocation, subluxations
v Tuberculosis
v Tumour deposits
v Ankylosing Spondylitis
3) Intra-spinal conditions
v Cord tumours
v Syringomyelia
v Extradural tumours
v Shoulder lesions
v Peri-arthritis
v Supra spinatus tendnitas
v Sub deltoid bursitis
4) Reffered pain
v Cardiac ischemia can cause left sided brachial neuralgea
v Sub-diaphragmatic lesions like gall bladder lesions cause right
sided pain
31
5) Systematic cause
v Diabetic neuropathy
Purvaroopa 72
Poorva rupa are the premonitory symptoms, which occur before the complete
manifestation of a disease. Commonly all disease will show some premonitory symptoms
before the disease develops but there are no such premonitory symptoms of Manyasthamba
are mentioned in the classics but In general before manifestation of Manyasthamba vitiated
Vata will show its symptoms in the body. This includes mild pain in the neck and also
stiffness of neck.
Roopa73
The term roopa implies both signs and symptoms, which plays a very important role
in the diagnosis and management of the disease. The lakshana develops after the
poorvaroopa as the Samprapti (pathology) advances from sthana samshraya avastha to
vyaktha vastha. At this stage, the Dosha- dushya sammurchana becomes continuous and the
total signs and symptoms are observed. In this stage of Sammurchita Dosha ruk (pain) and
Stambha (stiffness) becomes the only signs and symptoms told in the classics as Lakshana
pertaining to the Manyasthamba is visualized. These can be classified in association with the
other symptoms as under with different headings, which we don’t find in the classics. They
are -
1 Asymptomatic
2 symptomatic
Symptomatic stage can be classified in to -
1. Pain restricted to only manya pradesha
2. Pain radiating down to the arm, fore arm, hand and fingers
32
Asymptomatic stage
In the classics, Asymptomatic stage is described as the vrudhvastha. The dhatus will
becomes ksheena, which is a quite natural process in which the Dhatus becomes degenerated
as age progresses.
Occasionally, few people in spite of appearing these changes will not show any
significant signs and symptoms related to the stage of Asymptomatic, as there is no
involvement of the nerve root.
In modern science they explained as follows the vertebra of most people past 50
years of age shows some evidence of a degenerate changes. It is important to realise that
such finding may be Asymptomatic and of no clinical significance.
Symptomatic stage
It can be classified as a localised pain in manyapradesha and radiating pain down the
arm, fore arm, hand, and fingertip according to the site of the pain.
This classification is made on the basis of Manyasthamba pathology involved with
the signs and symptoms. Pain is the symptom produced due to involvement of different
anatomical structures in the disease process.
Hence minimal involvement reflects with pain restricted only to manya pradesha and
in the advanced cases, it even involves special nerves, which causes the radiation of pain
down to the arms depending upon the involvement of nerve root segments.
Here the presenting symptom will be stiffness of neck i.e., sthamba of manya. The
sthamba is the resultant of spasticity of neck muscles, which stretches and make neck stiff.
Vedana in manya pradesha are manya shoola, this is outstanding clinical symptoms in all
most of all patients.
33
Symptoms74
The typical symptoms of the cervical Spondylosis consists of radiating pain and
stiffness of the neck or arms, restricted head movements head aches, spastic paralysis, and
weakness in the arms and legs. Because of the combination of neurological symptoms and
bone degeneration and the common incidence of arthritis in the elderly, cervical Spondylosis
may be difficult to distinguish from primary neurological disease with unrelated arthritis.
The degenerative process may begin in any of the joints in the cervical spine, and
over time it also cause secondary changes in the other joints. Inter vertebral disc may be
primarily affected. As the disc narrows the normal movement of that segment is altered and
the adjacent joints are subjected to abnormal forces and pressures leading to degenerative
arthritis. Dysphagia can results from large anterior osteophytes that are bony growths at the
front of the spine, all though this is rare.
Clinical aspects75
The signs and symptoms produced are the results of nerve root compression, spinal
cord compression, or both. The most common complaint is neck pain, which limits its
motion and is aggravated by neck extension. Pain also may radiate in one arm in a pattern
Characteristic of the particular root involved.
Table –2: Level of disc herniation
Manifestation C4-C5 C5-C6 C6-C7 C7-T1Rootcompressed
C4 C5 C6 C7
Weakness Deltoid Biceps Triceps, wrist,extension
Hand intrinsicwrist flexion
Sensory loss Lateralshoulder
Lateral arm forearm,thumb, lateral aspectof finger
Middle finger Ring and littlefinger
Reflexinvolvement
Deltoidpectoralis
Biceps Triceps Finger flexion
34
Lhermitter’s sign76-77
Refer to sudden electrical sensation down the neck and back triggered by neck
flexion. It is also is seen in cervical Spondylosis, cervical spine cord tumour, radiation
mylopathy.
Spurling’s sign78-79
Refers to the reproduction or exacerbation of pain upon pushing down on the head
and bending towards the involved side the reduction of the pain when axial traction is
applied to the head is also suggestive of a disc. Finally, in the shoulder abduction test raising
the affected arm above the head reduces the pain.
Huck step tender triad80-81
Classically in cervical Spondylosis has three tender areas, representing the huck step
tender triad should be felt for. These are -
1. At the base of the neck anterior to the trapezes
2. Over the insertion of the deltoid
3. In the extensor mass of the fore arm
Manyasthamba Samprapti
Samprapti is a series of pathological changes takes place in the body from day of
development of the disease till to complete manifestation and establishment of the disease
with its complications. The knowledge of Samprapti is very much essential from Chikitsa
point of view and it also helps to understand complete pathogenesis of a disease, as it has
told by our Acharyas. “Samprapti vightanameva Chikitsa”, which means systemic breaking
of Samprapti is called Chikitsa hence a proper knowledge of Samprapti along with its
35
ghatakas is very much essential. An elaborate description of Samprapti of Manyasthamba is
not available in the classics.
The Vata Dosha along with Kapha Dosha get vitiated and take asraya at manya
pradesha affecting the manya siras causing sthambana and ruja of neck. Bhavamishra
explained the pathogenesis of Manyasthamba elaborately but he did not describe the
pathological structural changes in the articular cartilage disc and vertebrae.
Vata prakopa Nidanas mentioned like datukshya, which mainly occur during the mid
and later decades of life time can be interpreted in terms of degenerative changes found in
the cervical spine and disc which is the resultant of ageing process mentioned in the ailed
science.
Second one is due to margavarodha. The Nidanas like adhyaashana, vishamasana
(oordha Nireekshana, asmasthama sayanam) and other Ama kara Nidanas vitiated first Agni
leading to manda Agni and production of Ama causing margkavarodha in this way all the
above Nidanas will causes Vataprakopa either by datukshya or margavarodha.
While describing Samprapti of Manyasthamba (cervical Spondylosis) it should be
under stood in this manner. When we go though the pathological changes found at cervical
spine, the change in the ligamentum flavum, which is indicative of early stages of disease.
Here at this initial stage we can expect the involvement of Kapha.
In the latter stage it involves nerves roots and even spinal cord, which is attributed
solely to Vata vitiation. In some patients we can find shotha localised part and in the allied
science they claim that swelling is found in early stages i.e., cervical Spondylitis, which is
suggestive of vitiation of Kapha. When the due course all diseases are not treated properly it
leads to Vatic in nature. In the initial stage we can accept the involvement of Kapha in
36
Manyasthamba (Cervical Spondylosis) but the latter stage, we find the compression of nerve
root due to ostyophytes changes producing different signs and symptoms which are
collectively termed as Manyasthamba (Cervical Spondylosis). It can be attribute the role of
Vata Dosha and there is minimal or no involvement of Kapha.
Samprapti Ghatakas
The knowledge of Samprapti gataka is very much essential while treating a disease
because systematic breaking of pathogenesis as Samprapti is known as treatment of a
particular disease
Dosha Vata- Vyanavata
Kapha sleshma Kapha
Dushya asthi, majja, sanyu, mamsa,
Agni jatara Agni mandya janya Ama,
asthi dhatuagni mandya janya Ama
Srotas asthi vaha Srotas
Sroto dusthti sanga
Udhbhara sthama pakwasaya
Sanchar sthana rasayani
Roga marga madhayama rogamarga
Adhishtanam manya pradesha
Vyaktha sthana manya pradesha
37
Figure –3Pathogenesis of cervical Spondylosis82
Aging
Decreased in water content
of nucleus pulposes the central portion of disc
Disc dehydrates.
Cartilaginous disc becomes softening roughening, fibrillation
lateral clefts and pits appear followed by erosion
Trauma Decreases the height of disc and becomes less
ability to resist loading and stress.
Collagen fibers fragment and the annulus the out run of the disc,
bulges in to spinal and nerve root canals
Due to lower height and increased mobility resulting
the stress in the vertebral end plates and worn out of cartilage,
Cause the development of spurs and the facet joint Hyper trophy and further
narrow with nerve root canals.
Spinal ligaments thickness looses their elasticity and
herniated in to the spinal canal.
Cervical Spondylosis
38
Figure –4Manyasthamba Samprapti
Vaya and Nidanas
Diwaswapna, Asanasthana sayanam Vata prakaopa
Urdhwanireekshana
Sleshmavarana
Stana samshraya in manya siras
Kupitha Vata
Manyasthamba
Description of Manyasthamba according to shad Kriyakala
Sanchaya and prokopa83:
Accumulation of Dosha is chaya and vilayana is prokopa. In these stages Jatharagni
mandya, Ama formation, vitiation of doshas, stabdha Purna koshta, Anga gaurava
dhatukshaya and dhatwagni mandya take place.
Prasara:
Virulent Ama circulates in the whole body due to chala and sheeda Guna of vitiated
Vata. There is appearance of atopa, Angasada, archer, avipaka, daurbalya, and amgamardha
etc.,
39
Sthana samsraya:
The vitiated Ama and Vata lodges in the manya pradesha in this stage the purva rupa
are presented like stabdhata (stiffness) ruja, . Etc.,
Vyakthi:
The clinical features of Manyastambha like stabthata, ruja, and graha to manya
pradasha are the symptoms of its complete manifestation.
Bheda: Bhedavastha suggests the chronicity of the disease Manyastambha.
Management of cervical Spondylosis in contemporary science
Strong medical reassurance coupled with advice from a physiotherapist about
posture and improving physical fitness can sometimes be helpful .A small evening dose of a
tricylic antidepressant may improve sleep but the condition tends to have a chronic and
protracted course in most patients. The surgical procedure proposed for removing the bone
spur and possible fusion of two or more cervical vertebrae.
Ayurvedic line of management
Susruta84 says Nidana parivarjana is Chikitsa. But Charaka85 has further amplified
the scope of Chikitsa by saying, Chikitsa aims not only the less exposure to the causative
factors of the disease, but also at the restoration of Doshic equilibrium. Manyasthamba being
Vataja Vyadhi, treatment of Vata Vyadhi can be adopted. But, specific line of treatment is
described for Manyasthamba.
Chikitsa sutra of Manyasthamba 86-87-88-89-90
The steps and procedures to be adopted in the management of the Manyasthamba are
as follows.
1. Rooksha Sweda2. Panchamoolakwatha or dasamoolakwatha sevana3. Nasya karma
40
Table - 3Chikitsa of Manyasthamba according to different Acharyas are depicted as under.
CHIKITSA BhavaPrakasha
YogaRatnakara
SusrutaSamhita
BhaishajyaRatnavali
Chakradutta
Sneham + _ _ _ _
Swedam + + _ _ _
Nasyakarma + + + + -
Nasapanam - + _ + +
Bhava Mishra91 mentions that the Abhyanga with thaila or grutha should be done in
Manyasthamba. Bhavaparakasha and Yogaratnakara indicate Rooksha Sweda and Nasya.
Bhaishajyaratnavali and also Chakradutta indicate Mashabaladi yoga Taila Nasapanam92
(Nasya) in Manyasthamba. Mashabaladi Taila even can be used as pana i.e. internal
medication, which is the present dissertation topic. Apart from the above mentioned specific
management, as the disease is a Vata Vyadhi Vata Chikitsa sutra and methodologies of the
pacifying measures of Vata are also adaptable.
Upashaya and Anupashaya93
In the process of investigating the disease Upashaya methods that is therapeutic trails
with certain diet, drug activities are also considered as a tool in some cases. As there is no
Upashaya and Anupashaya for Manyasthamba mentioned in the classics. But we can select
the Vata Vyadhi Upashaya because Manyasthamba comes under the Vata Vyadhi some of
the observations done during clinical trials are listed as cold breezes, continuos work
morning hours, weight lifting as Anupashaya for Manyasthamba.
Abhyanga, swedha, rest, avoiding pillows are considered as Upashaya. Even in the
contemporary science they have described the hot massage relieves the pain which is as
Upashaya.
41
Chapter –4
Methodology
The materials and methods of the present study consists of following headings
1. Selection of patients
2. Grouping of patients
3. Drug review
4. Criteria of assessment
1) Selection of patient
Patients of Manyasthamba (cervical Spondylosis) fulfilling the criteria of diagnosis
were selected in the present study. Patients were distributed in group A and group B
randomly for the study, based on preset inclusion and exclusion criteria. Patients were
excluded, as they are discontinuous at the treatment or unable to fulfil the study design.
Inclusion criteria
1. People complaining of pain and stiffness with the cervical region
2. Without any discrimination of chronic and severity of the disease
3. All the other condition explained apart from the exclusion criteria are included
Exclusion criteria
1. Patients below 15 and above 65 years of the age
2. Pregnant women and lactating mother
3. Any other systemic disorders other than that of Manyasthamba (CS)
4. Any other degenerative diseases associated
42
Criteria of diagnosis
The signs and symptoms of Manyasthamba mentioned in Ayurveda and modern
science were the main basis of diagnosis. The selected patients were subjected to following
investigations.
1. Radiography of cervical region (radiologist report)
2. Random blood sugar.
2) Grouping of patients
After the diagnosis, the patients were randomly distributed in two groups as -
Group A = Patients will receive Mashabaladi taila capsules internally and
Group B = Patients will receive Mashabaladi taila capsules internally in association
with the Pratimarsha Nasya of Avruta Mashabaladi taila.
This study was conducted on total patients who could continue the treatment for full
duration and come for follow up till to the last. The patients were selected from O.P.D &
P.G.S & R.DGMAMC Hospital
3) Drug review
The main objective of present study is to evaluate the effect of Mashabaladi yoga
screening of the drugs mentioned in Chakradatha94, Yogaratnakara95 etc. The details of the
herbs included in Mashabaladi yoga are in equal quantity and their identification and
pharmacological properties are described here under.
1. Masha (Phascolus mungo)
2. Bala (Sida cordifolia)
3. Kapi kachu (Mucuna purita)
4. Truna (Desmostachya bipinnate)
43
5. Rasna (Pluchea lanceolata)
6. Aswagandha (Withania somnifera)
7. Eranda (Ricinus communis)
8. Ramada (Ferula foetida)
9. Lavana (Rock salt)
10.Tila taila (Seasum indicum)
Individual drug description:
1) Rasna (Pluchea lanceolata) 96-97-98-99
Family; Zingiberaceae
Synonyms: sugandha mula, yuktha rasa, surasa
Gana; anuvasanopaga, vaysthanpana (Charaka) arkadigana, sleshma samshamna (Susruta)
v Rasa - Tikta,
v Guna - Guru,
v Vipaka - Katu,
v Veerya - Ushna,
v Prabhava - Vishagna
Identification: A perenniate, aromatic, rhizomatus herb, 1.8 - 2.1 metre in height, leaves
oblong, lanceolate, glabraus, accuminate, very short petioled, ligule short, rounded, ciliated,
flowers, fragrant greenish white with red veined lips, in dense
Panicles, fruit capsules orange red when rip.
Chemical combination100: tylophorime, tylöphorimine, mineral matter, pluchin
Parts used: Rhizomes
44
Properties and uses: The rhizomes are bitter, thermo-genic Nervine tonic, stimulant, anti
inflammatory and tonic they are useful in vitiated conditions of Vata and kapha, rheumatoid
arthritis, inflammations, asthma
Visishta yoga: Rasna sapthakam kasayam and maha rasnadhi kasayam.
Dose: choorna 3-6 gm, kwatha 50-100ml
2) Bala (Sida cordifolia) 101-102-103
Family - Malvacea
Synonyms: peetha pushpa, sahadevi, vatyalika
v Rasa- Amla, Madhura, Kashaya
v Vipaka- Madhura
v Guna – guru, Snigdha, Pichchila
v Veerya – Sheeta
v Doshagnadha - Vata pittaghna
v Karma- daha Prashamana, Vedana Stapana, sukrala
Identification: A small, erect, grey, pubescent, branched under shrub, with a slender erect
stem, the young shoots being covered over with soft grey stellate down, leaves with two to
three small stiff, minute spiny projections at the nodes flowers pale yellow to cream white,
axillary and solitary on slender peduncles, fruits 5-6 or 3 chambered with one seed in each
chamber.
Chemical composition: The ash contains phytosterol, calcium carbonate, phosphate,
potassium nitrate, ephedrine, leaves contain mucilage, tannin, organic and asparagine, root
also contains aspargin.
Parts used: Whole plant
45
Properties and uses: The roots are diaphoretic, aphrodisiac and tonic. They are used in
vitiated conditions of Vata, swellings104, and fever.
Uses- daha, swasa, Vata vihadi
Dose- juice ½ once to one once, power-20 gm
Gana Balya, brimhaneeya, praja sthapan
Dose; Juice 20 ml
Visishta yoga; Balarishtam
3) Kapi kachu (Mucuna purita) 105-106-107
Family: Papilonacieae
Synonyms: Atma guptha, vrushya, markati, kandura, adhyanda, dushparsha
v Rasa- Madhura, Tikta
v Vipaka – Madhura
v Veerya – Ushna.
v Guna – guru, Snigdha,
v Doshaghnata - Tridosha hara,
v Karma – vrishya, brimhaneeya Balya, vajeekara
Identification: It is found all over India. This is a semi woody annual or more often a
perennial thinner, annual shoots with slender ternate, branches that when young are usually
clothed with short and pressed whitish hairs but become glabrescent orally slightly hairy
when mature bearing alternate pinnately trifotate fairly large leaves that are densely gray
Chemical composition: It contains Ral, tannin, protein, and manganese,
Parts used: seed and root
46
Uses: sukla vardhak, uthajaka, Vata shamak Balya, nervine tonic, diuretic Vata nadi
dourbalya, ardhita, apabuke pakshagatha
Gana –Balya, madhuraskandha (Charaka) vidhargandhadhi
Yoga – vanevee gutika, mashabaladi Kwata
Dose – choorna 5-10 grams root powder 5-10 Gms
Kwatha ¼ once
4) Truna: (Desmostachya bipinnate) 108-109-110
Family: Graminceae
Synonyms: kusha
v Rasa: Madhura Kashaya,
v Guna- Laghu, Snigdha,
v Veerya- Sheeta,
v Vipaka- Madhura.
v Dosha karma- Tridosha shamana.
Identification: It grows 1-3 feet length biennial shrub, roots are strong deep-rooted leaves
are elongated and arrow shaped light hairy structure seen on the leaves. Petiole 6-14inch
length, and straight. Seed ¼ inch long and round in shape.
Chemical composition: containing Indian Melissa oil, citrol, lonone, and vitamin A
Properties and Uses: Ushna, Sweda janana, mootrajanana, jwaragna, vatanulomana,
uthajaka, kapavatahara, deepana, Pachana, shoola, akshapaka.
Parts used: whole plant
Properties and uses: Ushna, sedajanana, mootrajanana, jwaragna, Vatanulomana, uthajaka,
kapha vata hara, deepana, and Pachana .
47
It is used in pratishya, jawara, atisara, adhmana, soola, akshapa, kateeshoola, amavata,
Gana: Truna panchamoola
Visishta yoga : Truna panchamoola kasaya
Dose: kasaya 20- 100 ml
5) Masha (Phascolus mungo) 111-112-113
Family; Fabaceae
Synonyms; uddulu
v Rasa: Madhura
v Guna: Guru, Snigdha,
v Veerya: Ushna ,
v Vipaka: Madhura.
v Dosha karma: Vata shamana.
Identification an erect hairy annual with long twining branches, leaves trifoliate, leaflet
ovate, entire, flower small, yellow on elongating peduncles fruits cylindrical pods, hairy
with a short, hooked beak, seeds 1-4 per pod generally black with a white hilum protruding
from the seed.
Chemical composition: contain Melissa oil, citrol, ionone, and vit. A
Parts used: roots and seeds
Properties: The seeds are sweat, emollient, thermo genetic, diuretic aphrodisiac, tannic,
nutrition’s, appetiser, laxative, and nervine tonic they are useful in vitiated conditions in
Vata neuropathy dyspepsia, anorexia, constipation.
Visishta yoga: masha baladi kwatha, masha baladi thaila
Dose: Choorna 5-10 Gms
48
6) Ashwa gandha (Withania somnifera) 114-115-116
Family: Solanaceae
Synonyms: Varaha karna, vajee gandha, varada, balada, gokarna, gandhata
v Rasa-Madhura, Kashaya, Tikta,
v Vipaka- Madhura
v Veerya-Ushna,
v Guna-guru, Snigdha,
v Doshaghnata- Kapha, vatagna karma, shukrla vrishya, Rasayana,
Balya,
Identification: An erect branching under shrub reaching about 150 cm in height, usually
clothed with minutely satellite tomentum, leaves ovate up to 10 cm long, flowers greenish or
lurid yellow in axillary’s fascicles, fruits globase Berrces which are orange coloured when
mature enclosed in a persistent calyx. The fleshy roots when dry are cylindrical, gradually
tapering down with a brownish white surface and pure white inside when broken
Chemical composition: It contains with aniol, hentria contane, different alkaloids,
somnifera;
Parts used; Rhizomes
Properties and uses: The tuberous roots are astringent, bitter, acrid, somniferous,
thermogenic, stimulant aphrodisiac and tone. They are useful in vitiated conditions of Vata,
tissue-building nervous breakdown, and insomnia. The leaves are bitter and are
recommended in painful swellings and fever.
Gana; Balya, brimhaneeya, madhurakandha (Charaka)
Visishta yoga: Aswagandharishta, ashwagandhavaleha, aswagandhadi Choorna.
49
Dose
Choorna – 5grams
Leha – 1-2 teaspoon (20gm)
Asava; 20-30 ml
7) Eranda (Ricinus communes) 117-118-119
Family- Euphorbiaceae
Synonyms – grandhva hasthe, pancharguta, vardhaman, chitra
Gana; Gudoochaytadi Gana, bhadaneeya, swedopaga, angamardha prashamana madhura
skandha (Charaka) vidarigandhadi Vata shamshamana (Susruta)
v Rasa -Madhura, Katu, Kashaya
v Vipaka – Madhura.
v Veerya- Ushna,
v Guna- guru, Snigdha, pichila- Teekshna sookshma,
v Doshagnata – Kapha vatagna
Identification – it grows throughout India, this is a tall branched shrub or almost a small tree
2-4 meters or more high the stem and branches are green when young but turns gray leaves
alternate, long petiole, stipulate pelt ate, palmate compound viewed broad.
Flowers are fairy large, monoceious petals the staminate flowers are usually
located in the distal or upper half of the inflorescence in a crowded manner and the petals
are at the base part. Fruits are glabose or globular, oblong explosively dehiscent three sided
capsule. Seeds oblong 1cm – 15cn long with smooth hard crustaceous test and oily or fleshy
endosperm.
50
Chemical composition: It contains recinine, glycerides, and ricinoleie acid linoleum, stearic,
hydroxyl steam
Parts used; whole plant
Properties and uses: Shoola, shotha, katu, Basthi, shirashoola, udara, jwara, bradhna, anaha,
kasa, kushta
Vishishtayoga- Erandapaka, Eranda mooladi kwatha, rasnadhi kwatha
Dose; Moola quatha; ½-1ounce
Beeja kalka – 1gm
Oil – ½ - ounce
Patra kalka – 10gms
8) Hingu (Ferula foetida) 120
Family – Umbelliferae
Synonyms; Sahasravedhi, Ramada balheeka, bhedhana, bhootari, deepta grihani, jantughna,
jathauka shooladvita
v Rasa – Katu
v Guna – Laghu, Snigdha,
v Veerya – Ushna,
v Vipaka – Katu
Identification: It is present Punjab, Afghanistan plant grows up to 2m high leaves are
pubescent at least when young. Lower leaves orate cauline sheaths large from which spring
simple or scarcely compound umbels, leafless gray glabrous fruit.
Chemical composition: It contains asaresinotannot, disulphide and allyl- per-sulphide due to
which it contains characteristic small. It also contains resin, alkaline, fernic, and valerianic.
51
Parts used- niriyasa
Properties and use -Vata Kapha hara property, pain-relieving property
Gana--Sanya sthapani deepanaeeya, pippalyadi, ushakadi, ooshakadi (susrutha)
Visishta yoga - Hinguvadi choorna, Hingashtaka gutika,Raja pravartana vati
Dose- 2-5 grams
9) Thila (Seasum indicum) 121-122
Family – Pedaliaceae
Synonyms: homadhanya, pavitra, papaghna,
v Rasa – Madhura,
v Guna-guru, Snigdha, Anurasa -Kashaya, Tikta
v Vipaka – Madhura
v Veerya – Ushna
Identification: Annual herb of 1-meter height, stalk bears soft tender hairs, leaves 7-12 cm
long flowers tender, ciliated, bluish, whitish, brown, or yellowish. Seeds small white,
brownish, or black.
Chemical composition: It contains protein carbohydrate, minerals, phosphorous; oil contains
70p.c of liquid fats consisting of the glycerides of oleic and linoleic acid
Parts used – seeds
Properties and used
It is having vatahara, Madhya, pain-relieving property (soola prasaman) Balya
10) Saindhava (rock salt) 123-124
Synonyms: Induppu
Sanskrit: saindhava
52
English: rock salt
Source: Found in nature in extensive beds mostly associated with clay and calcium sulphate.
To obtain it holes are dug into these rocks, which soon become filled up with salt water. The
water evaporated and the salt is left ready for use
Characters: It is found in small white crystalline grains or transparent cubes. It is brownish
white externally and white internally. It has a pure saline taste and burns with yellowish
flame.
Action: In small doses it is highly carminative stomachic and digestive it promotes the
appetite and assists digestion and assimilation125
Uses: It is given in dyspepsia and other abdominal disorders to use digestion weakened by
diarrhea
Yoga- nalikera Lavana, Vadavanal Choorna
Dose 5-15gms (3-4times)
Preparation of medicine
Mashabaladi avarthi thaila is prepared from different drugs. The yoga mentioned in
Chakradatha is selected in the study and it is made as 11 Avarti taila. The combination and
position of yoga is followed sharangadhara snehavidhi126.
v Each one part of Masha, Bala, Rasna, Eranda, Kapi kachu, Truna,
Aswagandha, Lavana and Ramada
v 6 parts of Tilatailam.
v 24 parts of kasaya
v One part of kalka Dravya to be added at the time of preparation.
53
On an auspicious day at a time and when the astral combinations are favorable, the
equal quantities of above said drugs are chopped and added with 96 parts of water to 6 parts
of the raw drug. The liquid is boiled on mandhagni (slow fire) and reduced to 1/4 of its
quantity. This Kashaya is added with 1/6 part kalka and 6 parts of tila thaila for the
preparation of Mashabaladi Taila. The paka indicated is Mrudu paka for the internal
administration. At the completion of the procedure, after ascertaining the Taila paka
swangasheetala taila is filtered. On the next day again to this1/6 part kalka with 6parts of
tila thaila and 24 parts of Kashaya is added and the same procedure as previous is repeated
for eleven times. The drug prepared is the Ekadasha Avartita Mashabaladi taila, which is in
Mrudupaka accepted for the Nasya and also internal administration.
Avarthita thailam127
The literal meaning of avarthi thaila is to rotate, or repeat. As in Rasasastra there is
concept of “mardhana guna vardhanam” being there particularly more efficacious, the same
is true for avarthi in take in thaila kalpana.
In general the entire procedure of sneha Kapha involves three components viz oil,
decoction and paste of herbs. The basic aim of the procedure being to acquire the liquid
soluble essence in to the oil while preparing the decoction most of the volatile oil gets
evaporates and only water soluble active principles comes into the final product. The
decoction inters acts with the oil and emulsion like stage is reached when the complex
alkaloids get enlarged with the glycoside Easters of the fatty acids. The paste comes directly
in contact with the oil. The fat-soluble components of herbs and even some volatile oils
mixed in to oils.
54
The essential components coming in contact of per unit oil is more and the oil is thus
formed is more concentrated in case of reprocessing
Nasya
Nasya karma a therapeutic procedure of intra nasal drug administration is one of the
well-known pancha karma. According to the dose of medicine, it is divided as Marsha
Nasya and Pratimarsha Nasya. Prati Marsha Nasya128 is daily 2-3 drops in each nostril with
out any Poorva karma and pathyas. The finest specification of this therapy is made in the
Ayurvedic books, as acting on the body parts above the shoulder, that is the parts lying upon
inside the skull and the neck. Ancient authors of Samhita proclaim that the drug
administration in Nasya shall enter the head
The point of interest here is the marma is called shringata has been mentioned as a
via media during the transportation of drugs administered in the Nasya karma secondly the
procedure of Nasya itself involves massaging over marma existing on the face and head.
Administration of drug
Mashabaladi taila capsules were given through oral route. 4 capsules were given in
two-divided dose half an hour before to food. Pratimarsha Nasya was carried out every day
up to 30 days. 2-3 drops in each nostrils at morning 6 Am to 7Am. External rubrificients and
internal pain relieving medicaments were strictly avoided even in the follow up period.
Pathya and Apathya 129
All the patients were advised to take comfortable light diet and to avoid non-
vegetarian food and fried foods and in further advised to undergo daily a small time of neck
physical exercise. All the patients were advised not to take cold drinks, cold food, day sleep
and other apathya ahara-vihara mentioned in Vata Vyadhi.
55
Criteria of assessment
Results were assessed according to the improvement in the clinical signs and
symptoms, and overall improvement etc.
Methods of examination 130
Complete medical history of the patient has to be taken, which helps to rule out other
conditions that cause symptoms similar to cervical Spondylosis. Also examine the patient
physically and take X-rays or use other diagnostic imaging tests to see inside the body.
History of any illnesses or chronic conditions, exact location of neck pain and when
the problem began, how the pain felt, whether the patient have ever injured previously
treated for neck pain, has to be thoroughly inquired.
Physical exam:
One should identify tender spots along the back of the neck and evaluate patients’
ability to move the neck in various directions. In further reflexes and the function of nerves
and muscles in the arms and legs also to be examined by watching the patients walk.
Imaging:
X-rays and/or MRI (magnetic resonance imaging) studies may show bone spurs and
other abnormalities and reveal the extent of damage to the cervical spine. In certain cases, it
may need additional tests before to doctor makes a diagnosis. Sometimes it may want ones
to see a neurologist for evaluation.
Scoring system
Many varieties of the scoring systems are globally available. Some are utilised in this
study. Few more are –
56
v Developed by Tanaka et al Japan. Normal score = 20. Has 4 categories,
subjective symptoms, ability to work, finger function, objective signs
History of Manyasthamba (cervical Spondylosis) 131
v Clinical syndromes associated with cervical Spondylosis vary.
♦ Intermittent neck and shoulder pain (cervicalgia) is the most common
syndrome in clinical practice. This is a frustrating problem for physicians and
patients, as often no associated neurologic signs are present.
Ø When neurologic deficits are present, diagnostic imaging often
can define the cause. When they are not present, imaging usually
is not helpful, as the incidence of radiologic abnormalities is high
in older patients, even in asymptomatic patients. A main problem
is that the source of pain in this situation is poorly understood.
This syndrome may be related to compression of the sino-
vertebral nerves and the medial branches of the dorsal rami in the
cervical region.
Ø Neck pain experienced with cervical Spondylosis often is
accompanied by stiffness, with radiation into the shoulders or
occipital. It may be chronic or episodic, with long periods of
remission. One third of patients with cervicalgia from cervical
Spondylosis present with headache, and over two-thirds present
with unilateral or bilateral shoulder pain. A significant amount of
these patients also present with arm, forearm, and/or hand pain.
57
v Another poorly understood associated clinical syndrome is chronic sub-occipital
headache.
♦ Although the dermatomes corresponding to cervical nerve roots 1-3 (C1-
C3) are located on the head, occipitoatlantal and atlantoaxial degeneration
seems unlikely to be the cause of pain in these areas, because there are no
contributions to these joints from the dorsal rami of C1-C3.
♦ The greater occipital nerve usually cannot be compressed by bony
structures, yet headaches can be the dominant symptom in a patient with
degenerative cervical disease. Headaches usually are sub-occipital and
may radiate to the base of the neck and the vertex of the skull.
v Radiculopathy is understood more thoroughly than the previously outlined syndromes.
♦ The most commonly involved nerve roots are the sixth and seventh
cervical nerve roots, caused by C5-6 or C6-7 Spondylosis, respectively.
Patients usually present with pain, paresthesias, weakness, or a
combination of these symptoms. Most present without a history of trauma
or a precipitated cause. The pain usually is in the cervical region, upper
limb, shoulder, and/or interscapular region.
♦ Occasionally, the pain may be atypical and present as chest pain
(pseudoangina) or breast pain. Usually the pain is more frequent in the
upper limb than in the neck, although it frequently is present in both
areas. Cervical radiculopathy usually is not associated with myelopathy.
v CSM is the most common cause of nontraumatic paraparesis and tetraparesis. The
process usually develops insidiously.
58
♦ In the early stages, patients often present with a stiff neck. They also may present
with stabbing pain in the preaxial or postaxial border of the arms.
♦ Patients with a high compressive myelopathy (C3-C5) can present with a
syndrome of "numb, clumsy hands." The patient describes a loss of manual
dexterity; difficulty with writing; nonspecific, diffuse weakness; and abnormal
sensations.
♦ Patients with a lower cervical myelopathy typically present with a syndrome of
weakness, stiffness, and proprioceptive loss in the legs. These patients often
exhibit signs of spasticity. Weakness or clumsiness of the hands may be observed
in conjunction with weakness in the legs. Motor loss in the hands with relative
sparing of the legs is a relatively rare syndrome.
♦ Symptoms commonly are asymmetric in the legs.
♦ Loss of sphincter control and urinary incontinence are rare, but some patients
complain of urgency, frequency, and urinary hesitancy.
v An important cause of acute myelopathy that may be related to cervical spondylosis is
central cord syndrome.
♦ This syndrome typically occurs when an elderly patient experiences an acute
hyperextension injury with preexisting, acquired stenosis due to ventral
osteophytes and infolding of redundant ligamentum flavum, resulting in acute
cord compression.
♦ Patients usually present with a history of a blow to the forehead.
59
♦ The syndrome consists of upper extremity weakness greater than lower extremity
weakness, varying degrees of sensory disturbances below the lesion, and
myelopathic findings (eg, spasticity, urinary retention).
Physical History of Manyasthamba (CS):
q Examination findings include neck pain, radicular signs, and myelopathic signs.
Patients with neck pain from spondylosis often present with neck stiffness. This
is a nonspecific sign, and other causes of neck pain and stiffness (eg, myofascial
pain, intrinsic shoulder pathology) must be considered and excluded.
q If the history is compatible with cervical radiculopathy, carefully search for signs
of muscle atrophy in the following muscles: supraspinatus, infraspinatus, deltoid,
triceps, and the first dorsal interosseus muscle.
q Winging of the scapula also may occur, since it may occur with C6 or C7
radiculopathy. Palpate all muscles, since this may allow earlier detection of
wasting than visualization. Detecting weakness in either one myotomal
distribution or 2-3 peripheral nerves likely excludes peripheral nerve injury as the
cause. Muscle testing is important because muscle findings have more specificity
than sensory or reflex findings.
q Perform a detailed sensory and reflex examination in every patient who presents
with a history that is suggestive of cervical spondylosis. Note that radicular
findings often do not adhere strictly to textbook dermatomal charts. Patients
often experience more pain proximally in their limbs, while paresthesias
dominate distally.
60
q Look for physical evidence of other causes of radiculopathy-type symptoms (eg,
tenderness lateral to the neck in the supraclavicular fossa, Tinel sign).
q The neck compression test (Spurling test or sign), if positive, is useful when
assessing a patient for cervical radiculopathy.
q This test is best performed by having the patient actively extend his or her neck,
laterally flex, and rotate to the side of the pain while sitting. Next, use careful
compression by slight axial loading. This maneuver works by narrowing the
ipsilateral neural foramina during flexion and rotation, while the initial extension
causes posterior disk bulging.
q While this maneuver has a low sensitivity for cervical radiculopathy, it has a
specificity of nearly 100%. Other useful tests are the axial manual traction test
and the shoulder abduction test.
v In CSM, the most typical examination findings are suggestive of upper motor
dysfunction, including hyperactive deep tendon reflexes, ankle and/or patellar clonus,
spasticity (especially of the lower extremities), Babinski sign, and Hoffman sign.
♦ The Hoffman sign 132 is a reflex contraction of the thumb and index
finger after nipping the middle finger. Although this sign usually is
present with corticospinal tract dysfunction, unlike the Babinski sign, it
also can be present in generalized hyperreflexic states and in neurosis. It
also may be found (usually bilaterally and incomplete) in persons without
CSM.
♦ Thus this sign is only valuable if it is associated with other upper motor
neuron–related findings. The Hoffman sign is best elicited by positioning
61
the patient’s hand at rest, then stabilizing the proximal phalanx between
the examiner's index and middle finger; with the examiner's thumb, the
patient’s distal middle finger is flicked downward.
♦ Dynamic Hoffman sign: The sensitivity of this examination maneuver
may be increased by examining the patient during multiple full flexion or
extension of the neck.
v Another occasionally useful test is the pectoralis muscle reflex.
♦ This is elicited by tapping the pectoralis tendon in the deltopectoral groove,
which causes adduction and internal rotation of the shoulder if hyperactivity is
present. It suggests compression in the upper cervical spine (C2-C4).
♦ If the patient exhibits diffuse hyperreflexia, then the jaw jerk may distinguish an
upper cervical cord compression from lesions that are above the foramen
magnum.
♦ Examine gait in any neurologic examination whenever possible. Patients with
CSM typically exhibit a stiff or spastic gait, especially later in the course of their
disease.
♦ Another helpful sign is Lhermitte sign. This consists of electric shocklike
sensations that run down the center of the patient’s back and shoot into the limbs
during flexion of the neck.
Ø This sign is not specific for CSM and classically is attributed to
the posterior column's dysfunction. Other causes of Lhermitte sign
include multiple sclerosis, tumors, and other compressive
pathology.
62
♦ Sensory abnormalities in CSM have a variable pattern on examination.
Ø Loss of vibratory sense or proprioception in the extremities can occur,
particularly in the feet. Spinothalamic sensory loss may be asymmetric.
Ø Diabetes mellitus or other metabolic causes of peripheral neuropathy can
confound the sensory examination. Perform a complete motor
examination. Wasting of the intrinsic hand musculature is a classic
finding in CSM.
Symptoms
1. Unilateral neck pain, nape pain and pain at suprascapular,
scapular or interscapular, usually precedes other symptoms
2. Radiating arm pain
3. Finger parasthesia
4. Weakness
Signs
1. Motor weakness
2. Diminished deep tendon reflexes
3. Sensory disturbance
Investigations:
The mainstay of imaging is plain X-Rays and MRI. Plain X-Rays reveal narrowed
disc space, and anterior and posterior marginal lipping of the vertebral bodies. Loss of
cervical lordosis is an early finding. Spinal cord narrowing correlates with myelopathy.
Neurophysiologhical studies (EMG and nerve conduction studies) can be used when the
diagnosis is in doubt. Carpal tunnel syndrome, thoracic inlet syndrome, amyotrophic lateral
63
sclerosis may be accurately diagnosed by neurophysiological studies. MRI is the preferred
modality. Apart from clearly delineating the soft tissue and disc compression it may show
signal intensity changes in the cord itself and helps to assess the degree of cord damage.
Investigations of Manyasthamba may include the following.
Ø In contrast to the spinal cord in myelopathy, the compressed root can
rarely be depicted even with MRI
Ø Detection of either spondylosis or laterally herniated disc at the involved
root level leads to diagnosis
Ø Plain Xrays- Only spurs at the involved nerve root can be assumed to
cause the symptoms. Spurs of the superior articular process more likely to
be a compressive factor than spurs of the Luschka joint. Disc joint spaces
at levels of herniation are usually preserved. Therefore a disc space of
normal height at the affected level suggests a disc herniation as the cause
of compression
Ø CT scanning- most useful for detecting bony Spondylitis spurs. The slice
just cranial to the to the disc space is the most informative slice
Ø MR scanning- the most useful for herniated disc.
Ø However disc protrusions are seen in 20% of asymptomatic patients 45-
54yrs old. 57% in those over 64.
Ø CT myelogram with low dose water soluble contrast media
Investigations has to follow the signs and symptoms described with the
Manyasthamba and cervical Spondylosis simultaneously. Thus the clinical features come
64
across with are discussed here under. Neural compression syndromes are - radiculopathy,
myelopathy or radiculomyelopathy.
They can be acute, sub-acute, or chronic and occasionally acute exacerbation of
chronic symptoms can occur. Radiculopathy refers to symptoms and signs of nerve root
compression such as shooting pain down the arm, “pins and needles” to frank sensory and
motor deficits and absence of reflex corresponding to the nerve root involved. There is also
frequently referred pain and tenderness along the medial border of the scapula and in about
60% of patients there is occipital headache due to muscle spasm.
The commonest roots affected are C5 and C6. Myelopathy has been classified in
various ways and depends on the involvement of the lateral or medial cord or vascular
involvement. The signs may be a mixture of upper motor neuron signs in the lower limbs
and lower motor neuron signs in the upper limbs and may simulate MND or syringomyelia.
Occasionally the presentation may be that of Brown-Sequard syndrome. Bladder
involvement is unusual. Combination of radicular and cord symptoms are found in
radiculomyelopathy. Various autonomic symptoms can be produced, such as vertigo,
flushing, tinnitus and visual blurring. These may be mediated by the sympathetic
contribution to the sinveretebral nerves from the stellate ganglion.
Vertebro basilar insufficiency due to Spondylitis compression of the vertebral artery
is uncommon, though popularly diagnosed.
Lab Studies:
Cyanocobalamin (vitamin B-12) 133 levels and a serum rapid plasma reagin may
help distinguish metabolic and infectious causes of myelopathy from CSM. Metabolic and
65
infectious conditions may co-exist with cervical Spondylosis, and thus an abnormal
laboratory profile does not exclude CSM.
Imaging Studies:
Although plain films of the cervical spine are the least costly and most widely
available imaging modality, the imaging study of choice is MRI. Although a narrow spinal
canal with a sagittal diameter of 10-13 mm (as visualised on plain radiograph) has been
associated with a higher incidence of neurologic deficit and CSM, this measurement has
become less important with the widespread availability of MRI. MRI allows direct
visualisation of neural structures and allows a more accurate estimation of the cord space.
Plain radiographs can help assess the contribution of spinal alignment and
degenerative spondylolisthesis to canal stenosis. MRI is a noninvasive and radiation-free
procedure that provides excellent imaging of the spinal cord and subarachnoid space and is a
sensitive method for determining involvement of these by extradural pathology.
MRI allows multiplanar imaging, excellent imaging of the neural elements, and
increased accuracy in diagnosing intrinsic cord disease. It may detect pathology in the
asymptomatic patient, or the pathology may be unrelated to the symptoms. Teresi et al, in
1987, noted that 57% of patients who were older than 64 years had disk bulging; 26% of
patients in this age group had evidence of cord compression on MRI.
MRI may overlook some spondylotic changes (e.g., small lateral osteophytes, mid
body calcific densities). Overall, MRI’s advantages significantly outweigh its deficiencies,
and thus it has become the standard diagnostic study for spondylotic disease. It has been
demonstrated to be an accurate imaging modality in several studies.
66
Plain films of the cervical spine are an inexpensive way of assessing spondylotic
disease in symptomatic patients. Cervical spine films can demonstrate disk space narrowing,
osteophytosis, loss of cervical lordosis, unco-vertebral joint hypertrophy, apophyseal joint
osteo-arthritis, and vertebral canal diameter. The nearly universal presence of spondylotic
radiographic changes in elderly patients (and the similar appearance of a cervical spine film
in a symptomatic patient and an asymptomatic patient) allows the classification of an
individual patient as having mild, moderate, or severe spondylotic changes.
CT is another important imaging modality. Superior to MRI in its definition of bony
anatomy, CT better defines the neural foramina. CT often is used to complement MRI and
provide additional bony detail to characterise a lesion responsible for neural encroachment.
Myelography also is useful for demonstrating nerve root lesions. It is particularly
useful in-patients who are considered for re-operation. Although some authors advocate CT
myelography as having a lower rate of false-positive results than conventional myelography,
Penning et al concluded in 1986 that CT myelography provides additional data only when a
myelogram is positive. A negative myelogram followed by CT study in a patient with
suspected Spondylosis is unlikely to demonstrate any clinically useful findings.
Electro-diagnostic studies 134
Electro-diagnostic studies are useful in many patients. Electromyography (EMG)
may help diagnose cervical radiculopathy and occasionally identify CSM. EMG is useful in
the study of radiculopathy, as it demonstrates a close correlation with neuroimaging and
operative findings.
It also provides anatomic distribution of abnormalities, thus facilitating the
differential of cervical radiculopathy from other similar causes of radicular symptoms. EMG
67
can help determine how long a lesion has been present. When using modern imaging
techniques such as magnetic resonance imaging (MRI), EMG can help clarify whether a
lesion observed on imaging is the cause of nerve root pathology.
In a patient with CSM, EMG can exclude specific syndromes of peripheral
neuropathy rather than confirm CSM.
Somatosensory-evoked potentials (SSEPs) and cortical motor-evoked potentials
(MEPs) also may help evaluate spinal cord dysfunction, especially in timing intervention for
the asymptomatic or minimally symptomatic patient with early CSM.
Histologic Findings:
Histologic findings associated with CSM are greatest at the site of maximal
compression. Changes in the gray matter range from consistent motor neuron loss and
ischemic changes in surviving neurons to necrosis and cavitation. Frequently, involvement
of white matter is minimal, although it can be variable.
White matter changes, when they occur, generally are seen in the ventral inner
portion of the dorsal column or in the lateral columns that border the Gray matter. The
anterior columns are affected only mildly. Nongliotic necrosis frequently is described.
Wallerian degeneration of posterior columns cephalad to the site of compression and of
corticospinal tracts caudal to the site of compression frequently occurs.
Widespread proliferation of small, thickened, hyalinized, intermedullary blood
vessels frequently is reported. Many of these findings are similar to the pathologic model of
vascular occlusion. Extensive infarction of Gary and white matter is associated with
anterior/posterior compression ratios of less than 20%.
68
Parameters and methods used in the study
One base line data patients were thoroughly examined with complete knowledge
Nidana, Ahara, Vihara, occupation, duration of illness, nature of pain site of pain, onset of
pain, severity of pain relieving factors, gradation of pain and associated complaints.
The examination methods are as slump test, upper limb tension test, passive neck
flexion, Ayurvedic health assessment, muscle strength, and mobility grade of cervical spine.
Ø Slump test 135-136
Described Mait land in 1985, as a test for assessing the mobility of pain sensitive of
structures in the column. It is a test combining cervical, trunk, flexion, SLR, and ankle
dorsiflexion finally, when all the compartments are in place, with the nerves system at full
stretch, the cervical flexion is released. Response is decreased positive or negative based on
this release.
Monitor changes in pain as sequential changes in posture
1. Cervical spine flexion
2. Knee extension
3. Ankle dorsiflexion
4. Neck dorsiflexion
5. Both legs extended
This gives the assessment of neural tension in the evaluation of Manyasthamba.
Mobility grading of cervical 137
Flexion is examined by asking the patient to touch the chin to chest full forward
flexion is present. When the chin touches the chest. It is graded as 4. If the flexion is 75%of
69
total movement then it graded as 3. 50% of the movement is graded as 2, 25% of total
movement is graded as 1 and no movement is as graded 0.
v Full extension of at least 30 degree beyond the horizontal is only possible.
It is graded as 4 if the extension is75 degree of total movement then it is graded as 3.
50 degree of the movement is graded, as 2.25 degree of movement is 1 and 0 as no
movement.
Lateral flexion
Lateral flexion should be at least 40degree to each side. Starting from the neutral
position of the head is tilted first to one side and then the other. Grading is done as above.
Treatment schedule of groups
Group A: The patients were selected in this group were given Mashabaladi
capsules 2Bid for 15 days. Patients reviewed every 15 days. Total medication
time is one month and follows up 15 days.
Group B: In this group patients will receive Mashabaladi taila as Pratimarsha
Nasya and oral medicines.
Pratimarsha Nasya: When a patient is in lying position on a bed,
with his hand and legs kept straight and free, at a head lower position
by keeping the pillow support under the neck, the Nasya is
administered. This position with facilitates the direct entry of the
drug. The medicine 2 drops of Mashabaladi taila (11avarthi) is
instilled into each nostril. The Pratimarsha Nasya is undertaken for 30
days of treatment period and also at the follow up period of 15 days.
70
Methods of assessment of treatment
For the assessment of treatment following grading were taken
1) Ayurvedic health assessment 138
Acharya Kashyapa does Ayurvedic health assessment according to the swasthya
Lakshanas are mentioned here under.
Table – 4
Showing the Ayurvedic health assessment
Symptoms
Annabilasha Sukha swapnam
Bhuktasya paripakam Sukha prabothanam
Srishta vit Balam
Srishta mutra Varnam
Sarira laghavam Soumanasyam
Suprasenedriyam Samagnita
All the above symptoms are assessed individually in grades mentioned is as follows.
Ayurvedic health
assessment
Grade 1=very satisfied
Grade 2=some what satisfied
Grade 3=neither satisfied nor dissatisfied
Grade 4=some what unsatisfied
Grade 5=very dissatisfied
Pain Grade 0: no pain
Grade 1: mild pain
Grade 2: more than mild but tolerable pain
Grade 3: moderately severe pain
Grade 4: severe pain
Grade 5: intolerable perhaps suicidal pain
71
Stiffness Grade 0: no movement
Grade 1: up to 25% of the total movement
Grade 2: up to 50% of the total movement
Grade 3: up to 75% of the total movement
Grade 4: full range
Mobility Grade 0: no movement
Grade 1: up to 25% of the total movement
Grade 2: up to 50% of the total movement
Grade 3: up to 75% of the total movement
Grade 4: full range
Passive neck flexion Grade 0: with any difficulty
Grade 1: with some difficulty
Grade 2: with much difficulty
Grade 3: unable to do
Upper limb tension test Grade 0: negative
Grade 1: tightness (rigidity)
Grade 2: pain
Slump and Full slump: Grade 4: pain (ache)
Grade 3: tight ness (rigidity)
Sympathetic slump: Grade 2: pain (ache)
Grade 1: tight ness (rigidity)
Muscle strength 139
v Grade 0: Complete paralysis
v Grade 1: A flicker of contraction only
v Grade 2:Power detectable only when gravity is excluded by appropriate postural
adjustment
v Grade 3: The limp can be held in the force of gravity but not the examiner’s
resistances.
72
v Grade 4:There is some degree of weakness, usually described as poor, fear or
moderate strength
v Grade 5:Normal power is present
VAS method of assessment 140
A VAS (Visual Analogue Scale) can be interpreted as a ratio scale and is more
sensitive to change. The VAS is a 100mm horizontal scale; with no pain at one end and
worst pain at the other end with out inter viewing the categories.
0__________________________________________100mm.
Patients was asked to mark “x” in the scale for how much pain they had in the past weak.
Overall assessment of the Treatment [Improvement criteria]
The results were classified in to three groups as listed below.
1. Much responded
2. Responded
3. Not responded
Criteria for over all assessment
The difference in the regression of the disease is measured in grading. For the better
response it is offered 2 points and for the response 1 point. Baseline to the final results data
are assessed through the stipulated parameters is calculated to declare the result. The result
declaration parameters are –
1. Pain
2. Stiffness
3. Flexion
4. Extension
73
5. Right lateral bending
6. Left lateral bending
7. Passive neck flexion
8. Upper limb torsion test
9. SLUMP full
10. Sympathetic SLUMP
11. Muscle strength
12. Ayurvedic Health Assessment
Achieved points for the individual patient is considered to declare the final result.
The final result declaration is based upon the points and declaration is as follows.
Table –5
Showing the method of final result declaration
Points Result
0 – 6 Not responded
7-15 Responded
16 -24 Much responded
74
Chapter –5
Results
47 patients were registered for the present study. Out this, 6 patients were excluded
(2 discontinued and 4 not fulfilling the criteria for diagnosis), hence their data has not been
included here. The remaining 41 patients of Manyasthamba, fulfilling the criteria for
diagnosis, were treated in the following groups.
Group. A - Mashabaladi thaila (11 Avarthi) capsule internally - 22patients
Group. B- Mashabaladi thaila (11Avarthi) capsule internally and as Pratimarsha
Nasya also. – 19 patients.
All the patients were examined before and after the treatment, according to the case
sheet format given in the annex. Both the subjective and objective changes were recorded.
The data recorded are presented under the following headings.
A. Demographic data
B. Data related to the disease.
C. Data related to the overall response to the treatment
D. Statistical analysis of the clinical and functional parameters and inter group comparison.
75
A) Demographic data:
The details of age, sex, religion, and occupation etc. of the 41 patients is as follows.
A1) Distribution of patients by Age
Table-6
DISTRIBUTION OF PATIENTS BY AGE -GROUP A
Age
Tot
al n
o of
pati
ents
% Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
15-25 2 9.09 1 50 1 50 0 0
25-35 1 4.54 0 0 1 100 0 0
35-45 8 36.36 4 50 3 37.50 1 12.50
45-55 5 22.73 0 0 4 80 1 20
55-65 6 27.28 0 0 6 100 0 0
Total 22 5 15 2
Table-7
DISTRIBUTION OF PATIENTS BY AGE - GROUP B
AgeTotal no
ofpatients
%Much
Responded % Responded %Not
Responded %
15-25 0 0 0 0 0 0
25-35 4 2 50 2 50 0 0
35-45 5 3 60 2 40 0 0
45-55 6 2 33.3 4 66.66 0
55-65 4 0 0 4 100 0
Total 19 7 12
76
Age distributions:
Observation:
As we observe in the study, the age factors are discussed under the class intervals of
10 each from 15 to that of 65 years of ages. The patients observed from the group-A are of
22 and in the Group-B are of 19. The distributions are observed as maximum from that of
the degenerative age groups such as 45- 65 age groups (Both groups). But still the age
interval of 35-45 show remarkably increased number, i.e. 13 patients inclusive of both
groups. The distributions as observed at the intervals of are 15-25 as 2 patients, 25-35 as 5
patients, 35-45 as 13 patients, 45-55 as 11 patients and 55-65 as 10 patients. The individual
group vise patients are depicted at the above charts.
The Group-A distributions are as follows. Observations at the intervals of are 15-25
as 2 (9.09%) patients, 25-35 as 1(4.54%) patients, 35-45 as 8 (36.36%) patients, 45-55 as
5(22.72%) patients and 55-65 as 6 (27.27%) patients.
The Group-B distributions are as follows. Observations at the intervals of are 15-25
as 0 (0%) patients, 25-35 as 4(21.05%) patients, 35-55 as 5 (26.31%) patients, 45-55 as
6(31.57%) patients and 55-65 as 4 (21.05%) patients.
Result:
The individual results based upon the age distributions along with percentages are as
follows.
In the group-A it is observed as – the 15-25-age intervals show the significant results
and 2 out of 1 (50%) patient responded much and the second (50%) patient responded. In
25-35 age group, 1 patient reported and responded (100%). In 35-45 interval, 8 patients
reported and out of 1 (12.5%) patient not responded, 3 (37.5%) responded and 4 (50%)
77
much responded. In 45-55-age interval, 5 patients reported out 1 (20%) patient not
responded and 4 (80%) patients responded. The last interval, which is prone for
degeneration, out of reported 6 patients, all 6 (100%) responded to the treatment, i.e.
Mashabaladi taila capsules as internal medication.
In the group-B it is observed as – the 15-25-age intervals are not reported. In 25-35
age group, 4 patients reported and in that 2 (50%) responded and 2 (50%) much responded.
In 35-45 interval, 5 patients reported and out of 3 (60%) patients much responded, 2 (40%)
responded. In 45-55-age interval, 6 patients reported out 2 (33.33%) patients much
responded and 4 (66.66%) patients responded. The last interval, which is prone for
degeneration, out of reported 4 patients, all 4 (100%) responded to the treatment, i.e.
Mashabaladi taila capsules as internal medication along with the Mashabaladi taila
Pratimarsha Nasya.
Graph – 1
Showing the Age distributions of Group-A and Group-B
2
1
8
5
6
0
4
5
6
4
0
1
2
3
4
5
6
7
8
9
15-25 25-35 35-45 45-55 55-65
Age intervals
Patients
Group_A
Group_B
78
A2) Distribution of patients by Gender
Table- 8
DISTRIBUTION OF PATIENTS BY GENDER - GROUP AG
EN
DE
R
Tot
al n
o of
pati
ents %
Muc
hR
espo
nded %
Res
pond
ed %
Not
Res
pond
ed %
Male 12 54.54 2 16.66 10 83.33 0 0
Female 10 45.45 3 30 5 50 2 20
Total 22 5 15 2
Table-9
DISTRIBUTION OF PATIENTS BY GENDER - GROUP B
GE
ND
ER
Tot
al n
o of
pati
ents %
Muc
hR
espo
nded %
Res
pond
ed %
Not
Res
pond
ed %
Male 9 47.36 3 33.33 6 66.66 0 0
Female 10 52.63 4 40 6 60 0 0
Total 19 7 12
Distribution by Gender:
Observation:
The male female ratio in the Group-A is 5:6 (10:12 patients) and in the Group-B it is
9:10. The percentage of the distribution does not show any gender differentiation to get this
degenerative disease. The observations are 12 Patients i.e. (54.54%) in Group A were male
79
and 10 patients i.e. (45.45%) were female .In the Group B, 10 patients i.e. (52.63%) were
female and 9 patients are i.e. (47.36%) were male.
Result:
In Group A and Group B together total 21 (51.21%) male patients and 20 (48.78%)
female patients were reported.
In which, the Group-A Males of 12 patients show the results as under. 2 patients
(16.66%) are much responded and 10 (83.33%) patients are responded out of the 12 males.
Out of the females reported (10 patients) 3 (30%) are much responded and 5 (50%)
responded. The 2 (20%) of Group-A females are not responded.
In which, the Group-B Males of 9 patients reported and out of 3 patients (33.33%)
are much responded and 6 (66.66%) patients are responded. Out of the females reported (10
patients) 4 (40%) are much responded and 6 (60%) responded. There was no patient who
doesn’t respond to the treatment in this group.
Graph –2
Showing the Distribution by Gender of Group-A and Group -B
Gr-A,10 FEMALE, 45.45% ,
Gr-A, 12MALE 54.54%
Gr-B, 10 FEMALE,
52.63%
Gr-B, 9 MALE, 47.36%
MALE
FEMALE
80
A3) Distribution of patients by religion
Table – 10DISTRIBUTION OF PATIENTS BY RELIGION - Group-A
ReligionT
otal
no
ofpa
tien
ts
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Hindu 20 90.9 5 25 14 70 1 5
Muslim 2 9.09 0 0 1 50 1 50
Christian 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0
Total 22 5 15 2
Table – 11DISTRIBUTION OF PATIENTS BY RELIGION - Group-B
Religion
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Hindu 17 89.47 6 35.29 11 58.82 0 0
Muslim 2 10.52 1 50 1 50 0 0
Christian 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0
Total 19 7 12 0
Distribution by religion:
Observation:
For the convenience of the study, the religion communities are grouped as 1) Hindu,
2) Muslim, 3) Christian and 4) Others. The Group-A has 22 patients and Group-B 19
patients. Out of the 22 patients in group-A 20 patients belongs to Hindu and only 2 patients
81
are of Muslim community. In the Group-B, out of 19 patients reported 17 are of Hindu and 2
Muslims. No other community patients were reported, as this locality is a Hindu dominated
area.
Result:
Out of the 20 patients of Group-A Hindus, 5 (25%) patients much responded and 14
(70%) patients responded and 1 (5%) patient not responded. Out of reported 2 Muslims
1(50%) patient responded and the second (50%) not responded.
Out of the 17 patients of Group-A Hindus, 6 (35.29%) patients much responded and
11 (58.82%) patients responded. Out of reported 2 Muslims 1(50%) patient much responded
and the second (50%) has responded.
Graph -3
Showing the Distribution by Religion of Group-A and Group –B
20
2
0 0
17
2
0 00
5
10
15
20
25
Hindu Muslim Christian Others
Religion
Patients
Group-A
Group-B
82
A4) Distribution of patients by Occupation
Table - 12
DISTRIBUTION OF PATIENTS BY OCCUPATION -GROUP A
Occupation
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Sedentary 9 40.9 2 22.22 6 66.66 1 11.11
Active 9 40.9 2 22.22 6 66.66 1 11.11
Labour 4 18.18 1 25 3 75 0 0
Total 22 5 15 2
Table - 13
DISTRIBUTION OF PATIENTS BY OCCUPATION -GROUP B
Occupation
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Sedentary 8 42.10 5 62.5 3 37.5 0 0
Active 9 47.36 2 33.33 7 77.7 0 0
Labour 2 10.52 0 0 2 100 0 0
Total 19 7 12 0
Distribution by occupation:
Observation:
For the convenience of the study common occupational listing are grouped. They are
based on the work mode as, sedentary, active and labour. Out of the 22patients in Group-A,
9 (40.97%) patients in each of sedentary and active groups were reported and 4 (18.18%)
patients reported from labour class. From the Group-B, out of 19 patients, 8 (42.1%) patients
as sedentary and 9 (47.36%) patients of active class were reported. The rest of 2 (10.52%)
patients in the Group-B are of Labour group.
83
Result:
In Group-A, out of 9 patients of sedentary, 2 (22.22%) much responded, 6 (66.66%)
patients responded and 1 (11.11%) patient is not responded. 9 patients of active class in
Group-A, 2 (22.22%) patients much responded and 6 (66.66%) patients responded. 1
(11.11%) patient not responded. Out of the 4 patients of labour class, 1 (25%) patient much
responded and 3 (75%) patients were responded.
In Group-B, out of 8 patients of sedentary, 5 (62.5%) much responded, 3 (37.5%)
patients responded. 9 patients of active class in Group-B, 2 (33.33%) patients much
responded and 7 (77.77%) patients responded. All the 2 patients of labour class patients
responded (100%) to the treatment.
Graph –4
Showing the Distribution by occupation of Group-A and Group –B
9 9
4
8
9
2
0
1
2
3
4
5
6
7
8
9
10
Sedentary Active Labor
Occupation
Patients
Group-A
Group-B
84
A5) Distribution of patients by Socio-economical status
Table -14
DISTRIBUTION OF PATIENTS BY SOCIO ECONOMICAL STATUS - GROUP A
Socio-Economical
StatusT
otal
no
ofpa
tien
ts
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Poor 5 22.73 0 0 5 100 0 0
Middle 13 59.09 430.7
6 7 53.84 215.3
8
High 4 18.18 1 25 3 75 0 0
Aristocrat 0 0 0 0 0 0 0 0
Total 22 5 15 2Table -15
DISTRIBUTION OF PATIENTS BY SOCIO ECONOMICAL STATUS - GROUP B
Socio-Economical
Status
Totalno of
patients% Much
Responded%
Responded%
NotResponded
%
Poor 4 21.05 1 25 3 75 0 0
Middle 10 52.63 4 40 6 60 0 0
High 5 26.32 2 40 3 60 0 0
Aristocrat 0 0 0 0 0 0 0 0
Total 19 7 12 0
Distribution by socio-economic status:
Observation:
In this study the common four groups of economical statues are considered. They are
1) Poor class, 2) Middle class, 3) High class and 4) Aristocrat classes.
85
Out of 22 patients reported in the Group-A, maximum numbers of 13 (59.09%)
patients are from middle class. 5 (22.73%) patients reported from the poor class and 4
(18.18%) patients are from high class. Out of 19 patients reported in the Group-B, maximum
numbers of 10 (52.63%) patients are from middle class. 4 (21.05%) patients reported from
the poor class and 5 (26.31%) patients are from high class. No patients from Aristocrat class
reported here in the Ayurvedic hospital.
Result:
Out of the 13 patients of Group-A middle class, 4 (30.76%) patients much
responded, 7 (53.84%) patients responded and 2 (15.38%) were not responded. From the
poor class all 5 (100%) responded to the management. 3 (75%) patients out of 4 reported
Group-A high classes are responded and 1 (25%) patient is much responded.
Out of the 10 patients of Group-B middle class, 4 (40%) patients much responded, 6
(60%) patients responded. From the poor class patients 3 (75%) out of 4 patients responded
to the management and 1 (25%) patient is much responded. 3 (60%) patients out of 5
reported Group-B high classes are responded and 2 (40%) patients are much responded.
Graph – 5Showing the Distribution by socio-economical status of Group-A and Group –B
54
13
10
45
0 00
2
4
6
8
10
12
14
Group-A Group-B
by socio-economical status
Patients
Poor
Middle
High
Aristocrat
86
B) Data related to the disease.
B1) Distribution of patients by disease duration
Table –16Distribution of patients by disease duration - GROUP A
Duration Total no ofpatients %
MuchResponded % Responded %
NotResponded %
Below 1
year 7 31.81 3 42.85 4 57.14 0 0
1--2 5 22.72 2 40 3 60 0 0
2--3 1 4.54 0 0 1 100 0 0
3--4 2 9 0 0 2 100 0 0
4--5 3 13.63 0 0 3 100 0 0
5--6 2 9 0 0 2 100 0 0
6--7 2 9 0 0 0 0 2 100
Total 22 5 15 2
Table -17Distribution of patients by disease duration - GROUP B
Duration Total no ofpatients %
MuchResponded % Responded %
NotResponded %
Below 1year
9 47.36 5 55.55 4 44.45 0 0
1--2 2 10.52 1 50 1 50 0 0
2--3 3 15.78 1 33.33 2 60.66 0 0
3--42 10.52 0 0 2 100 0 0
4--5 1 5.26 0 0 1 100 0 0
5--6 1 5.26 0 0 1 100 0 0
6--71 5.26 0 0 1 100 0
0
Total 19 7 12 0
87
Distribution of patients by disease duration:
Observation:
The chronicity is distinguished here in 1-year interval, up to 7 years. As we observe
out of 22 patients of Group-A, maximum 7 (31.81%) falls under below one year category. 5
(22.72%) patients appear under 1-2 year group and 3 patients are covered under 4-5 year
group. 2 (9%) patients in each group of 3-4, 5-6 and 6-7 years of chronicity are observed.
Only one (4.54%) patient is observed in the group of 2-3 years chronicity.
At the Group-B, out of 19 patients maximum 9 (47.36%) is below one year category.
3 (15.78%) patients appear in 2-3 year group and 2 patients each are covered under 1-2 and
3-4 year groups. One (5.26%) patient in each group of 4-5, 5-6 and 6-7 years of chronicity
are observed.
Result:
Out of 7 patients reported in Group-A below one-year category, 3 (42.85%) patients
much responded. And 4 (57.14%) patients were responded to treatment. Out of 5 patients of
1-2 years chronicity category, 2 (40%) patients were much responded and 3 (60%) were at
responded category. Out of the other groups all are responded for the treatment.
Out of 9 patients reported in Group-B below one-year category, 5 (55.55%) patients
much responded. And 4 (44.45%) patients were responded to treatment. Out of 2 patients of
1-2 year’s chronicity category, one each much responded and responded for the treatment.
Out of 3 patients of 2-3 years chronicity, 1 (33.33%) much responded and 2 (66.66%) were
at responded category. Out of the other groups all are responded for the treatment.
88
Graph -6
Showing the Distribution of patients by disease duration Group-A and Group –B
B2) Distribution of patients by Pain Gradation
Table –18Distribution of patients by Pain Gradation - GROUP A
PainGrade
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
1 2 9.09 2 100 - - - -
2 7 31.81 2 28.57 5 71.42 - -
3 6 27.27 1 16.66 5 83.33 - -
4 7 31.81 0 - 5 71.42 2 28.57
5 0 - - - - - - -
Total 22 5 15 2
7
5
1
2
3
2 2
9
2
3
2
1 1 1
0
1
2
3
4
5
6
7
8
9
10
Below 1year
1--2 2--3 3--4 4--5 5--6 6--7
Disease duration in Years
Patients
Group-A
Group-B
89
Table –19Distribution of patients by Pain Gradation - GROUP B
PainGrade
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
1 3 15.78 2 66.66 1 - -
2 7 36.84 5 71.42 2 - -
3 6 31.57 1 16.66 5 - -
4 3 15.78 - - 3 - -
5 0 - - - - - -
Total 19 8 11 0
Distribution of patients by Pain gradation:
Observation:
Distribution of patients by Pain severity gradation was made as under.
Grade 0: no pain
Grade 1: mild pain
Grade 2: more than mild but tolerable pain
Grade 3: moderately severe pain
Grade 4: severe pain
Grade 5: intolerable perhaps suicidal pain
Out of 22 patients in Group-A, 7 (31.81%) in each grade of 4 and 2 are witnessed. 6
(27.27%) patients observed under the grade 3 and 2 (9.09%) were in grade 1. Out of 19
patients of Group-B, 7 (36.84%) are of grade 2, 6 (31.57%) are of grade 3 and 3 (15.78%)
each in the grade 1 and 4. There were no patients reported either in Group A or B with the
Grade 5 pain symptoms.
90
Result:
In the group-A, 2 (100%) patients of grade 1 are much responded. From the Grade-
2, two (28.57%) patients are much responded and 5 (71.42%) patients are responded. At the
Grade-3 patients one (16.66%) is much responded and 5 (83.33%) patients are responded.
Under grade-4, 5 (71.42%) patients are responded and 2 (28.57%) patients are not
responded.
In the group-B, 2 (66.66%) patients of grade-1 are much responded and 1 (33.33%)
patient is responded. From the Grade-2 five (71.42%) patients are much responded and 2
(28.57%) patients are responded. At the Grade-3 patients, one (16.66%) is much responded
and 5 (83.33%) patients are responded. Under grade-4, 3 (100%) patients are responded.
The statistical variances and significance of the pain is as follows.
Table –20
Statistical variances and significance of the pain
Pain Mean S.D S.E T-value P-value Remarks
Group-A 1.227 0.428 0.091 13.483 <0.001 Highly
Significant
Group-B 1.421 0.507 0.116 12.25 <0.001 Highly
Significant
Table –21
Group relationships of Pain (A & B) show the following values.
Group Mean SD SE PSE Z-Value P Value Remarks
Group-A 1.818 0.795 0.169
Group-B 1.789 0.787 0.18
0.246 0.117 >0.05 Not
Significant
91
Graph – 7
Showing the Distribution of patients by Pain Gradation Group-A and Group –B
B3) Distribution of patients by Stiffness
Stiffness is one of the parameter and the symptom observed in the Manyasthamba.
The observation is made under the gradations as declared below.
Grade 0: no movement
Grade 1: up to 25% of the total movement
Grade 2: up to 50% of the total movement
Grade 3: up to 75% of the total movement
Grade 4: full range
2
7
6
7
0
3
7
6
3
00
1
2
3
4
5
6
7
8
1 2 3 4 5by Pain gradation
PatientsGroup-A
Group-B
92
Table - 22
Distribution of patients by Stiffness
Num
ber
ofpa
tient
s
Perc
enta
ge
Muc
hre
spon
ded
Perc
enta
ge
Res
pond
ed
Perc
enta
ge
Not
resp
onde
d
Perc
enta
ge
Group-A 21 95.45 5 23.80 14 66.66 2 9.52
Group-B 19 100 7 36.84 12 63.15 0 0
The distributions of stiffness patients in the Group-A are 21 (95.45%) out of 22 and
in the Group-B it is 19 (100%) out of 19 patients reported. Thus the significance of the
symptom is elicited. The Group-A patients responded to the treatment are 14 (66.66%) out
of 21 patients and in the Group-B it is 12 (63.15%). The much-responded category in the
group-A is 5 (23.80%) and of Group-B is 7 (36.84%). Only 2 (9.52%) of Group-A show no
response. The statistical evaluation of the stiffness is as follows.
Table - 23
Statistical variances and significance of Stiffness
Group Mean S.D S.E T-value P-value Remarks
Group-A 0.409 0.503 0.107 3.822 <0.001 Highly
Significant
Group-B 0.684 0.477 0.109 6.275 <0.001 Highly
Significant
Table – 24
Group relationships of Stiffness (A & B) show the following values.
Group Mean SD SE PSE Z-Value P Value Remarks
Group-A 0.727 0.55 0.117
Group-B 0.526 0.512 0.1170.165 1.218 >0.05
Not
Sign
ific
ant
93
B4) Distribution of patients by Tenderness
For measuring the tenderness Huck step tender Triad is followed. It is as follows.
T1 = tenderness present at the base of the neck anterior to the
Trapezieus muscle.
T2 = over the insertion of the Deltoid muscle
T3 = the extensor mass of the fore arm
Table – 25
Distribution of patients by Tenderness - Group-A
Areas
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
T1 22 100 5 22.72 15 68.18 2 9.09
T2 16 72.72 1 6.25 13 81.25 2 12.5
T3 5 22.72 0 0 3 60 2 40
Table – 26
Distribution of patients by Tenderness - Group-B
Areas
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
T1 19 100 7 36.84 12 63.15 0 0
T2 12 63.15 4 33.33 8 66.66 0 0
T3 6 31.57 0 0 6 100 0 0
94
In the group-A, out of 22 patients all has shown the T1 area tenderness and out of 15
(68.18%) responded and 5 (22.72%) patients were much responded. Only 2 (9.09%) patients
were not responded. In the T2 area, 16 (72.72%) patients reported tenderness. Out of these
13 (81.25%) show the response and 1 (6.25%) patient show much response. Only 2 (12.5%)
patients those who have not responded with T1 area are not responded here even. At the T3
area of tenderness, 5 (22.72%) patients reported and out of them 3 (60%) responded and the
same 2 (40%) patients of the above groups are not responded.
In the Group-B out of 19 patients T1, T2 and T3 areas of tenderness show 19 (100%),
12 (63.15%) and 6 (31.57%) patients respectively. Out of the T1 area of tenderness 12
(63.15%) were responded and 7 (36.84%) patients are much responded. At the T2 area of
tenderness 8 (66.66%) patients were responded and 4 (33.33%) patients were much
responded. At the T3 area of tenderness all 6 (100%) patients responded to the management.
There was no patient who doesn’t respond for the treatment in this category.
Graph –8
Showing the Distribution of patients by Tenderness Group-A and Group –B
22
16
5
19
12
6
0
5
10
15
20
25
T1 T2 T3Huck step tender Triad
PatientsGroup-A
Group-B
95
B5) Distribution of patients by Agni variances
Observations:
Agni variances are classified as four groups, viz. Sama, Manda, Teekshna and
Vishama. In the group-A out of the 22 patients 9 (40.9%) patients felt Samagni, 7 (33.81%)
with Mandagni, 5 (22.72%) patients with Vishamagni and 1 (4.54%) patient had
Teekshnagni. In the Group-B, out of the 19 patients 8 (42.10%) patients felt Samagni, 7
(36.82%) with Mandagni, 2 (10.52%) patients with Vishamagni and 2 (10.52%) patients had
Teekshnagni. The tabulation is depicted as under.
Table –27Distribution of patients by Agni variances - GROUP A
Agni
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Sama 9 40.90 4 44.44 5 55.55 0 0
Manda 7 31.81 0 0 5 71.42 2 68.19
Teekshna 1 4.54 0 0 1 100 0 0
Vishma 5 22.72 1 20 4 80 0 0
Table –28Distribution of patients by Agni variances - GROUP B
Agni
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Sama 8 42.10 5 62.50 3 37.50 0 0
Manda 7 36.82 1 14.28 6 85.71 0 0
Teekshna 2 10.52 1 50 1 50 0 0
Vishma 2 10.52 0 0 2 100 0 0
96
Result:
Out of 9 patients who reported with samagni in Group-A, 5 (55.55%) patients are
responded and 4 (44.44%) are much responded. 7 patients of mandagni show response with
5 (71.42%) and the rest of 2 (28.58%) show no response. The reported one patient of
Teekshangni has responded (100%) to the treatment. Out of the Vishamagni Category 4
(80%) patients are responded and 1 (20%) patient has much responded.
Out of 8 patients who reported with samagni in Group-B, 3 (37.5%) patients are
responded and 5 (62.5%) are much responded. 7 patients of mandagni show response with 6
(85.71%) and the rest of 1 (14.28%) patient show no response. Out of the reported 2 patients
of Teekshangni 1 (50%) has responded and another (50%) much responded to the treatment.
Out of the Vishamagni Category 2 (100%) patients are responded.
Graph – 9
Showing the Distribution of patients by Agni variances Group-A and Group –B
9
7
1
5
8
7
2 2
0
1
2
3
4
5
6
7
8
9
10
Sama Manda Teekshna VishmaAgni variances
Patients Group-A
Group-B
97
B6) Distribution of patients by Ahara Nidana
Table –29Distribution of patients by Ahara Nidana - GROUP A
Rasa Totalno of
patients%
MuchResponded % Responded %
NotResponded %
Katu rasa 15 - 3 20 10 66.66 2 13.33
Tiktarasa
5 - - - 3 60 2 40
Kasayarasa
5 - 1 20 3 60 1 20
Atisheeta
4 - 1 25 3 75 - -
Atirooksha
8 - 2 25 5 62.50 1 12.50
Alpaaahara
7 - 4 57.14 2 28.57 1 14.28
Laguaahara
6 - 2 33.33 3 50 1 16.66
Table –30Distribution of patients by Ahara Nidana - GROUP B
Aahara Total noof
patients%
MuchResponded % Responded %
NotResponded %
Katu rasa 16 - 7 43.75 9 56.25 -
Tikta rasa 7 - 2 28.57 5 71.42 -
Kasayarasa
3 - 1 33.33 2 66.66 -
Ati sheeta 4 - 3 75 1 25 -
Atirooksha
4 - 1 25 3 75 -
Alpaaahara
11 - 4 36.36 7 63.63 -
Laguaahara
3 - 1 33.33 2 66.66 -
98
Observations:
Here in this part of the study, Katu Rasa, Tikta Rasa, Kasaya Rasa, Ati sheeta Ahara,
Ati rooksha Ahara, Alpa Ahara and Lagu Ahara categories are made. Their distributions in
the Group-A are as follows. 15 patients use Katu Rasa (58.18%), 5 patients use (22.72%)
Tikta Rasa, 5 patients use (22.72%) Kasaya Rasa, 4 patients use (18.18%) Ati sheeta Ahara,
8 patients use (36.36%) Ati rooksha Ahara, 7 patients use (31.81%) Alpa Ahara and 6
patients use (27.27%) Lagu Ahara in the Group-A.
16 patients use Katu Rasa (84.21%), 7 patients use (36.84%) Tikta Rasa, 3 patients
use (15.78%) Kasaya Rasa, 4 patients use (21.05%) Ati sheeta Ahara, 4 patients use
(21.05%) Ati rooksha Ahara, 11 patients use (57.89%) Alpa Ahara and 3 patients use
(15.78%) Lagu Ahara in the Group-B.
Graph –10
Showing the Distribution of patients by Ahara Nidana Group-A and Group –B
15
5 54
87
6
16
7
34 4
11
3
0
2
4
6
8
10
12
14
16
18
Katu rasa Tiktarasa
Kasayarasa
Ati sheeta Atirooksha
Alpaaahara
Laguaahara
Ahara Nidana
Patients Group-A
Group-B
99
Results:
All most all patients responded to the treatment except people using the Katu Rasa in
the Group-A, and there was no patient who doesn’t respond for the treatment in the Group-
B. The rest of percentages are shown in the tabulation.
B7) Distribution of patients by Vihara Nidana
Table -31
Distribution of patients by Vihara Nidana -GROUP A
Vihara
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Asamasthanasayanam
4 18.18 0 0 4 100 0 0
Urdwanireekshnam
10 45.45 2 25 6 50 2 25
Diva swapnam 0 0 0 0 0 0 0 0
Vyayama 11 50 2 18318 8 72.72 1 9.09
Langhana 0 0 0 0 0 0 0 0
Plavana 0 0 0 0 0 0 0 0
Adwagamana 6 27.27 2 33.33 3 50 1 16.66
Yaana 4 18.18 2 50 2 50 0 0
100
Table- 32
Distribution of patients by Vihara Nidana -GROUP B
Vihara
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Asamasthanasayanam
4 21.05 1 25 3 75 0 0
Urdwanireekshnam
8 42.10 3 37.50 5 62.50 0 0
Diva swapnam 2 10.52 1 50 1 50 0 0
Vyayama 11 57.89 3 27.27 8 72.72 0 0
Langhana 0 0 0 0 0 0 0 0
Plavana 0 0 0 0 0 0 0 0
Adwagamana 10 52.63 2 20 8 80 0 0
Yaana 2 10.52 0 0 2 100 0 0
Observations:
In the Group-A, out of 22 patients, it was observed those patients with Adhika
Vyayama were found (11 patients) more (50%) exposed to the Manyasthamba. Next to it the
cause was elicited as Urdwa nireekshnam (10 patients – 45.45%), subsequent to it is
Adwagamana (6 patients – 27.27%), Asamasthana sayanam (4 patients – 18.18%), and
Yaana (4 patients – 18.18%) are placed. Patients with Diwaswapna (Day sleep), Langhana
(jumping) and Plavana (swimming) were not reported in the study.
In the Group-B, out of 19 patients, it was observed those patients with Adhika
Vyayama were found (11 patients –57.89%) more exposed to the Manyasthamba. Next to it
the cause was elicited as Adwagamana (10 patients – 52.63%), subsequent to it is Urdwa
nireekshnam (8 patients – 42.10%), Asamasthana sayanam (4 patients – 21.05%),
101
Diwaswapna (Day sleep) (2 patients– 10.52%) and Yaana (2 patients– 10.52%) are placed.
Patients with Langhana (jumping) and Plavana (swimming) were not reported in the study.
Results:
Over all much responded patients of the major category of Group-A adhika
Vyayama have 2 (18.18%) patients with much responded and 8 (72.72%) patients with
responded results. 1 patient (9.09%) is not responded. The second largest number category
of Group-A Urdhwa Nereekshanam show 2 (20%) patients in much responded, 6 (60%)
patients in responded and 2 (20%) patients in not responded criteria. The rest of the items
mentioned in the vihara of Group-A are less significant and show smaller deviations.
Graph –11
Showing the Distribution of patients by Vihara Nidana Group-A and Group –B
4
10
0 0 0
6
44
8
2
0 0
10
2
11 11
0
2
4
6
8
10
12
Asam
asth
ana s
ayan
am
Urdwa n
ireek
shnam
Diva sw
apnam
Vyaya
ma
Langh
ana
Plavan
a
Adwagam
ana
Yaana
Vihara Nidana
Patients
Group-A
Group-B
102
Over all much responded patients of the major category of Group-B adhika Vyayama
have 3 (27.27%) patients with much responded and 8 (72.72%) patients with responded
results. The second largest number category of Group-B Adhwagaman show 2 (20%)
patients in much responded, 8 (80%) patients in responded criteria. The third largest number
category of Group-B Urdhwa Nereekshanam show 3 (37.5%) patients in much responded, 5
(62.5%) patients in responded criteria. The rest of the items mentioned in the vihara of
Group-A are less significant and show smaller deviations.
B8) Distribution of patients by Vysana Nidana
Table – 33Distribution of patients by Vysana Nidana -GROUP A
Vysana
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Madhayapana
3 13.63 1 33.33 2 66.66 0 0
Dhoomapana
6 27.27 1 16.66 5 83.33 0 0
TobaccoChewing
10 45.45 4 40 6 60 0 0
No habits 3 13.63 0 0 1 33.33 2 66.66
Table – 34Distribution of patients by Vysana Nidana -GROUP B
Vysana
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Madhayapana
0 0 0 0 0 0 0 0
Dhoomapana
3 15.78 1 33.33 2 66.66 0 0
TobaccoChewing
12 63.15 4 33.33 8 66.66 - -
No habits 4 21.05 2 50 2 50 0 0
103
Observations and Results:
It is a very common observation that the addictions may play major role in causing
the disease. Here an emphasis is made to understand the role of addictions in Manyasthamba
etiology. Three categories are observed viz., madyapana, dhoomapana and chewing the
tobacco. Out of these even though some patients are recorded no significance is observed
with reference to the disease. The not responded patients in the Group-A fall under the no
habit category. This data clearly states the prevalence of addictions in the modern society.
The graphical representation is as under.
Graph – 12
Showing the Distribution of patients by Vyasana Nidana Group-A and Group –B
3
6
10
0
3
12
3 4
0
2
4
6
8
10
12
14
Madhaya pana Dhooma pana Tobacco chewing No habitsVyasana Nidana
PatientsGroup-A
Group-B
104
B9) Distribution of patients by Nidra Sukham
Table – 35
Distribution of patients by Nidra Sukham -GROUP A
NidraSukham
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Normal 6 27.27 3 50 3 50 0 0
Less 8 36.36 1 12.50 5 62.50 2 25
Disturbed 8 36.36 2 25 4 50 2 25
Table – 36
Distribution of patients by Nidra Sukham -GROUP B
NidraSukham
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Normal 3 15.78 1 33.33 2 66.66 0 0
Less 7 36.84 2 28.57 5 71.42 0 0
Disturbed 9 47.36 4 44.44 5 55.55 0 0
Observation and Results:
The sleep has much impact over the Manya and to get the inconvenient condition
Manyasthamba. Thus Nidra sukham is evaluated from the effected patients. Patients those
have disturbed sleep is more in the Group-A (8 patients – 36.36%) and in the Group-B (9
patients – 47.36%). Sleeplessness is witnessed in the Group-A (8 patients – 36.36%) and in
the Group-B (7 patients – 36.84%). This is not an etiological factor of elicitation but
certainly a factor involving and the inconvenience of the Manyasthamba as Lakshana is
presented through the sleep.
105
GRAPH –13
Showing the distribution of patients by Nidra Sukham group-A and group –B
B10) Distribution of patients by Manasika Lakshana
Observations and Results:
The involvement of the Manasika Lakshana in Manyasthamba is enumerated under
Chinta, Shoka and Bhaya categories. Much of the patients in the Group-A show, 6 (27.27%)
Chinta and 3 (13.63%) each in Shoka and Bhaya categories. The patients not responded fall
one each in the Shoka and Bhaya categories. Like the same as Group-A in the Group-B also
much of the patients show, 6 (31.57%) Chinta and 4 (21.05%) of Shoka and 1 (5.26%)
patient in Bhaya categories. There were no patients who were not responded for the
treatment in the Group-B. The tabulations and pictogram is followed as under.
63
87
89
0 2 4 6 8 10
Patients
Normal
Less
Disturbed
Nidra Sukham
Group-B
Group-A
106
Table –37
Distribution of patients by Manasika Lakshana - GROUP A
Manasika
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Chinta 6 50 2 33.33 4 66.66 - -
Shoke 3 33.33 1 33.33 1 33.33 1 33.33
Baya 3 33.33 - 2 66.66 1 33.33
Table –38Distribution of patients by Manasika Lakshana - GROUP B
Manasika
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Chinta 6 54.54 2 33.33 4 66.66 -
Shoke 4 36.36 - - 4 100 -
Baya 1 9.09 - - 1 100 -
Graph – 14Showing Distribution of patients by Manasika Lakshana - Group A and B
6
4
1
6
3 3
0
2
4
6
Patients
Chinta Shoke Baya Group-A
Group-B
Manasika Lakshana
Group-A
Group-B
107
B11) Distribution of patients by Associate Complaints
Table –39
Distribution of patients by Associate Complaints – GROUP A
AssociateComplaints
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Numbnessandtingling
12 54.54 2 16.66 6 50 2 16.66
Muscleweakness
5 22.72 0 0 4 80 1 20
Head ache 11 50 2 18.18 7 63.63 2 18.18
crunchingsound
12 54.54 2 16.66 8 16.66 2 16.66
Dizziness 4 18.18 1 25 2 50 1 25
Table –40
Distribution of patients by Associate Complaints – GROUP B
AssociateComplaints
Tot
al n
o of
pati
ents
%
Muc
hR
espo
nded
%
Res
pond
ed
% Not
Res
pond
ed
%
Numbnessandtingling
13 68.42 3 23.07 10 76.92 0 0
Muscleweakness
4 21.05 1 25 3 75 0 0
Head ache 5 26.31 1 20 4 80 0 0
crunchingsound
4 21.05 2 50 2 50 0 0
Dizziness 3 15.78 1 33.33 2 66.66 0 0
Observations:
The associated complaints recorded in the evaluation of the Manyasthamba are
tabulated as under in the Groups. Out of them the maximum number of patients reported
108
with the Numbness and tingling sensation in both groups, i.e. Group-A, 12 patients
(54.54%) and Group-B, 13 patients (68.42%). The Muscle weakness was found in Group-A,
5 patients (22.74%) and Group-B, 4 patients (21.05%). Headache is common among many
and found that in Group-A, 11 patients (50%) and Group-B, 5 patients (26.31%). The next
symptom associated is crunching sound is observed as in the Group-A 12 (54.54%) patients
and in the Group-B 4 (21.05%) patients. The last symptom evaluated is Dizziness and it is
observed as 4 (18.18%) and 3 (15.78%) in the Group A and B respectively.
Results:
Patients with the one or more associated symptoms together are not responded in the
Group-A and all the patients of the Group-B are responded to the treatment. The graphical
expression of the associated complaints is as follows.
Graph – 15Showing Distribution of patients by Associate Complaints – Group A and B
43
1211
5
12
45
13
4
0
2
4
6
8
10
12
14
Numbnessand tingling
Muscleweakness
Head ache Crushingsound
Dizziness
Associate Complaints
Patients
Group-A
Group-B
109
C) Data related to the overall response to the treatment
The over all response is based upon the different parameters involved in the study.
They are pain, stiffness, flexion, extension, right lateral movement, left lateral movement,
passive neck flexion, upper limb torsion test, SLUMP full, SLUMP sympathetic, muscle
strength and Ayurvedic Health assessments are made under specified gradations. The
detailed tabulations are as follows.
C1) Overall response to the treatment Group-A
Table – 41
Overall response to the treatment Group-A
OPD.NO. Pa
in
Stif
fnes
s
Flex
ion
Ext
ensi
on
Rt.l
at
Lt.l
at
Pass
ive
UL
TT
SLU
MP-
Full
SLU
MP-
Sym
p
Mus
cle
stre
ngth
AH
A
Tot
al
Rem
arks
295 1 0 2 2 2 2 1 1 2 2 0 1 16 MR4430 2 2 2 0 0 0 1 1 2 0 0 1 11 R3865 2 1 2 0 1 1 1 0 2 0 1 1 12 R3875 1 2 0 2 0 2 1 2 2 0 2 1 15 R357 1 0 2 2 2 2 1 1 2 2 0 1 16 MR10 2 2 2 2 2 1 1 1 2 2 2 1 20 MR269 1 0 2 0 0 0 0 0 2 0 0 1 6 NR4388 1 0 0 2 0 1 0 1 0 0 0 1 6 NR4198 2 2 2 0 2 2 0 1 0 2 0 2 15 R4045 2 2 0 0 2 2 0 2 2 2 0 2 16 MR625 2 0 0 0 0 0 2 2 2 2 0 2 12 R651 1 2 2 0 0 1 2 2 0 2 0 1 13 R4473 1 0 1 2 0 2 1 1 0 0 0 1 9 R3931 1 0 2 1 1 1 1 1 2 2 0 1 13 R695 2 0 1 2 0 1 2 1 2 2 0 2 15 R4427 2 1 2 2 0 0 2 2 0 2 0 1 15 R4245 1 0 0 0 0 2 2 1 2 2 1 1 11 R455 1 0 2 2 2 2 1 1 2 2 0 0 15 R634 1 1 2 2 2 2 1 0 2 2 0 1 16 MR4439 1 0 2 2 2 2 2 1 0 0 0 0 12 R708 1 0 1 0 1 2 1 1 2 0 0 1 10 R745 1 0 2 2 2 1 1 1 2 2 0 1 15 R
MR = MUCH RESPONDED, R = RESPONDED and NR = NOT RESPONDED-2
110
In the Group-A it is found that much responded patients are 5 (22.72%) and the
Responded patients are 15 (68.18%) and the last category of Not responded is 2 (9.09%) of
the results when compared with the parameters of subjective and objective together. The
graphical representation of the Group-A is as follows.
Table –42
Result of Group-A
Result Patients Percentage
Much Responded 5 22.72
Responded 15 68.18
Not Responded 2 9.09
Total 22 100
Graph – 16
Result of Group –A
Much Responded,
5, 22.73%
Responded,
15, 68.18%
Not Responded,
2, 9.09%
111
C2) Overall response to the treatment Group-B
In the Group-B it is found that much responded patients are 7 (36.84%) and the
Responded patients are 12 (63.15%) and the no patients in the last category of Not
responded of the results when compared with the parameters of subjective and objective
together. The graphical representation of the Group-B is as follows.
Table – 43
Overall response to the treatment Group-B
OPDNO
Pain
Stif
fnes
s
Flex
ion
Ext
ensi
on
Rt.l
at
Lt.l
at
Pass
ive
UL
TT
SLU
MP-
Full
SLU
MP-
Sym
p
Mus
cle
stre
ngth
AH
A
Tot
al
Rem
arks
3776 2 2 1 0 0 0 2 2 0 0 0 1 10 R4060 2 2 2 1 0 1 2 2 0 0 0 1 13 R4357 2 0 2 2 2 2 1 0 2 2 2 1 18 R4547 1 1 1 1 0 1 1 1 2 2 0 1 12 R4551 2 2 2 1 1 0 1 1 2 2 0 1 15 R4578 1 1 0 2 2 0 0 0 2 2 0 1 11 R4083 2 2 2 2 2 2 1 1 2 2 0 1 19 MR4618 2 0 2 0 2 2 1 1 2 2 2 2 18 MR4448 2 2 1 0 1 0 1 1 2 2 2 2 16 MR3969 2 2 1 0 0 1 2 0 0 0 2 2 12 R4084 2 2 1 2 2 1 1 1 2 2 2 2 20 MR485 1 0 2 2 2 2 1 0 2 2 0 1 15 R633 1 0 2 0 0 2 1 0 2 2 0 1 11 R3999 1 1 1 2 2 2 1 1 2 2 0 1 16 MR4234 2 2 1 0 1 1 1 1 2 2 2 1 16 MR4142 1 0 2 2 0 2 2 2 2 0 0 2 15 R3971 1 1 0 2 1 1 1 1 0 2 2 1 13 R4816 1 0 1 1 1 1 1 1 2 2 0 0 11 R3970 1 2 2 2 0 2 2 1 0 2 0 2 16 MR
MR = MUCH RESPONDED, R = RESPONDED and NR = NOT RESPONDED-2
112
Table – 44
Overall response to the treatment Group-B
Result Patients Percentage
Much Responded 7 36.84
Responded 12 63.15
Not Responded 0 0
Total 19 100
Graph – 17
Result of Group –A
Responded,
12, 63.16%
Not
Responded,
0, 0.00%
Much
Responded,
7, 36.84%
113
C3) Overall response to the treatment in comparison with Group-A and Group-B
Table – 45
Overall response to the treatment in comparison with Group-A and Group-B
Group-A Group-B
Result Patients Percentage Patients Percentage
Much Responded 5 22.72 7 36.84
Responded 15 68.18 12 63.15
Not Responded 2 9.09 0 0
Total 22 100 19 100
Graph – 18
Comparative result of Group-A and Group-B
57
15
12
2
0
0
2
4
6
8
10
12
14
16
Group-AGroup-B
Group-A 5 15 2
Group-B 7 12 0
Much Responded
RespondedNot
Responded
114
D) Statistical analysis of the clinical and functional parameters
Table – 46
D1) Group A individual study of statistical analysis
Parameter Mean S.D S.E T-value P-value Remarks
Pain 1.227 0.428 0.091 13.483 <0.001 H.S
Stiffness 0.409 0.503 0.107 3.822 <0.001 H.S
Flexion 0.772 0.428 0.091 8.483 <0.001 H.S
Extension 0.636 0.492 0.104 6.115 <0.001 H.S
RT lateral 0.545 0.509 0.108 5.046 <0.001 H.S
LT lateral 0.636 0.581 0.123 5.1 <0.001 H.S
Passive neck flexion 0.818 0.394 0.0841 9.726 <0.001 H.S
ULTT 0.909 0.294 0.062 14.661 <0.001 H.S
Slump full 0.727 0.455 0.097 7.494 <0.001 H.S
Symptoms 0.772 0.428 0.0914 8.446 <0.001 H.S
AYU health 3.045 2.572 0.548 5.556 <0.001 H.S
Muscle strength 0.181 0.394 0.084 2.154 <0.005 H.S
Table – 47
D2) Group B individual study of statistical analysis
Parameter Mean S.D S.E T-value P-value Remarks
Pain 1.421 0.507 0.116 12.25 <0.001 H.S
Stiffness 0.684 0.477 0.109 6.275 <0.001 H.S
Flexion 0.947 0.404 0.092 10.29 <0.001 H.S
Extension 0.684 0.477 0.109 6.275 <0.001 H.S
RT lateral 0.631 0.495 0.113 5.584 <0.001 H.S
LT lateral 0.684 0.582 0.1336 5.1 <0.001 H.S
Passive neck flexion 0.947 0.229 0.052 18.211 <0.001 H.S
ULTT 0.789 0.418 0.096 8.218 <0.001 H.S
Slump full 0.736 0.452 0.103 7.145 <0.001 H.S
Symptoms 0.789 0.418 0.096 8.218 <0.001 H.S
AYU health 3.105 2.726 0.625 4.968 <0.001 H.S
Muscle strength 0.368 0.495 0.113 3.256 <0.001 H.S
HS = Highly significant, NS = Not Significant, S = Significant
115
D3) Comparative study of Group-A and Group-B after treatmentTable -48
Parameter Group Mean SD SE PSE Z-Value P Value Remarks
A 1.818 0.795 0.169Pain
B 1.789 0.787 0.180.246 0.117 >0.05 N.S
A 0.727 0.55 0.117Stiffness
B 0.526 0.512 0.1170.165 1.218 >0.05 N.S
A 3.6818 0.567 0.12Flexion
B 3.368 0.683 0.1560.196 1.59 >0.05 N.S
A 3.545 0.67 0.142Extension
B 3.315 0.82 0.1880.235 0.978 >0.05 N.S
A 3.272 0.702 0.149Right lateral
B 3.21 0.713 0.1630.22 0.281 >0.05 N.S
A 3.227 0.972 0.207Left lateral
B 3.105 1.1 0.2520.326 0.374 >0.05 N.S
A 0.772 0.685 0.146Passive neckflexion B 1.157 0.958 0.219
0.263 1.463 >0.05 N.S
A 0.863 0.56 0.119ULTT
B 0.947 0.524 0.120.169 0.497 >0.05 N.S
A 3.045 0.213 0.045SLUMP full
B 3 00.045 1 >0.05 N.S
A 1.81 0.394 0.084SLUMPSympathetic B 1.105 0.315 0.072
0.11 0.69 >0.05 N.S
A 27.318 5.065 1.079Ayurvedichealthassessment B 25.315 5.099 1.169
1.591 1.258 >0.05 N.S
A 4.636 0.492 0.104Musclestrength B 4.736 0.452 0.103
0.146 0.684 >0.05 N.S
116
D4) Test to know the stability about the groupsTable -49
Group-A Group-B
Parameters Mean S.D C.V Mean S.D C.V Remarks
Pain 1.818 6.776 42.68 1.789 0.766 * *
Passive neck 0.772 0.669 86.65 1.157 0.932 80.55 B group is stable
ULTT 0.863 0.547 63.38 0.947 0.51 53.85 *
SLUMP full 3.045 0.208 6.83 3 0 * *
SLUMPSympathetic
1.181 0.385 32.59 1.105 0.306 27.69 B group is stable
Muscle strength 4.636 0.481 10.375 4.736 0.44 9.29 B group is stable
If we compare both the groups all the parameters shows not significant (p>0.05) by
using large sample test. Overall the group B is highly significant in stiffness, flexion
extension, RT lateral, left lateral, passive neck flexion, muscle strength. (p<0.05) by using
paired ‘t’ test.
The stiffness is highly significant in the group B as compared with the group A (t
value). The parameter passive neck movement, upper limb tension test, slump sympathetic,
and muscle strength having uniform effect in the group B by comparing coefficient of
variation. There is much variation in Ayurvedic health assessment in both groups. The pain
is having same variation in both the groups. (By comparing variance).
There is no variation in the group B after the treatment of parameter the slump full.
The group-A, the parameter flexion slump full, slump sympathetic is having highly
significant (by comparing t value).
117
Chapter –6
Discussion
Over time, arthritis of the neck (cervical Spondylosis) may result from bony spurs
and problems with ligaments and disks. Injuries can also cause spinal cord compression.
Manyasthamba - Cervical Spondylosis is a non-specific term describing the
morphological manifestations of progressive degeneration of the spine. Cervical
Spondylosis is a common degenerative condition of the cervical spine that most likely is
caused by age-related changes in the inter-vertebral disks. Clinically, several syndromes,
both overlapping and distinct, are seen: neck and shoulder pain, suboccipital pain and
headache, radicular symptoms, and cervical spondylotic myelopathy (CSM).
Manyasthamba - Cervical Spondylosis is defined by the degenerative changes of the
spine at the neck, creating pressure on nerves and spinal cord at the level of the neck. Neck
stiffness. The changes in Manyasthamba result in neural compression resulting in
radiculopathy or compression of the spinal cord resulting in myelopathy.
Manyasthamba - Cervical Spondylosis may also manifest only with neck and head
pain or with signs and symptoms attributable to cervical radiculopathy. The syndrome of
cervical spondylotic myelopathy must be distinguished from these related clinical entities.
Considering the etiological factors for the cervical Spondylosis we can find the
similar type of factors responsible for the condition. Avitaminosis, nutritional deficiencies
leading calcium deficiency were observed to lead inflammation and degeneration of cervical
vertebra resulting nerve compression causing cervical Spondylosis.
118
Causes of Manyasthamba
Considering the reference of Manyasthamba to cervical Spondylosis the better
comparison can be made from the Nidana. The main Nidana can be considered fewer than 4
headings.
1. Swaprakopa Nidana – including Ahara Nidana
2. Margavarodhaka Nidana – causing obstruction to Vata
3. Marmaghata kara Nidana – injury/trauma
4. Dhatukshayaka Nidana – depletion of Dhatu
Though these are considered different the Nidana bhaves ultimately they are inter
related. But to know the exact cause for the onset of disease such a classification has been
made. The swaprakopa nidanas, marmabigata and margavarodhaka nidanas eventually leads
to Dhatukshaya and there by producing the vatika symptoms.
Spondylotic changes often are observed in the ageing population. However, only a
small percentage of patients with radiographic evidence of cervical Spondylosis are
symptomatic.
Stress and long working hours in front of computers can lead to cervical pain as well
as pathological abnormalities. The commonest cause for cervical Spondylosis or such type
of diseases is the degenerative changes effected in the cervical region. Anti inflammatory,
analgesic and disease modifying anti rheumatic drugs are the drugs of choice in
contemporary system of medicine.
In take of excessive and heavy fatty meals were observed to leads to accelerate
degenerative process and can be considered as Kapha provocative diet. The posture of work
i.e., looking upward direction lying on irregular surface etc. are considered as the cause for
119
cervical Spondylosis. The physiological factors Shoka, Bhaya, chinta etc. lead to prolonged
contraction of neck muscles. So all these factors can be considered as the swaprokopa
Nidana factors in Ayurveda.
Trauma is observed to be the next causative factor for the disc prolapse. Trauma or
abigatha to the marmas are considered here. Almost all the patients of cervical Spondylosis
have a history of trauma or bad postures which in turn leads to improper positioning of
cervical vertebrae, this puts uneven pressure over the spinal nerve roots producing different
signs and symptoms.
It is observed that when a person is sleeps improper head position, especially of
middle aged or old aged, with developed degenerative processes in the cervical vertebrae,
may have Manyasthamba. Spondylosis is due to ageing process or with wrong postures
causing minor trauma, can accelerate the pathology of Manyasthamba and further
degeneration leading to set a clinical feature.
The Ahara and vidhara as elucidated in the Nidana induces reduction of sneha
bhavas and simultaneously Vata prokopha i.e., Vyanavata that normally controls all the
movements of the body due to Dhatu kshya. Reduction of slashma Kapha, which normally
align the joints, causes the vitiated Vata to settling in the joints.
Pathology in Manyasthamba
Based on the Samprapti the correlation can be established. The Vata prakopa
excessively by the factors analysed above settles in manya pradesha (cervical region) when
further precipitated by trauma or stress it initiates displacement of the sleshmika Kapha and
gets obstructed by vitiating. Manya sira (cervical nerve) they’re by causing pain and
120
sthamba. The pathogenesis of Manyasthamba is also the same as that of the contemporary
medicine is concerned.
Manyasthamba is a Vata Vyadhi by its nature. The condition Manyasthamba is
effecting the neck region with the symptoms such as pain and stiffness. The analgesic effect
of Mashabaladi taila in Manyasthamba can be evaluated by the means of studying the pain
and stiffness with specified parameters. The Pratimarsha Nasya alleviates the disease above
to shoulder level like Manyasthamba, Ardhita etc.
Vata is vitiated either because of Avarana or Dhatu kshaya. When Vata covered by
Kapha or Dosha accumulation makes Manyasthamba. At the initial stage of the disease the
Kapha Anubandhatwam is acknowledged.
On the other hand, the Cervical Spondylosis is a degenerative disorder that may
cause loss of normal spinal structure and function although ageing is the primary cause, the
location and rate of degeneration is individualised. The degenerative process may impact the
cervical regions of the spine effecting the inter-vertebral discs and facet joints. Spondylosis
generally mean changes in the vertebral joint characterised by increasing degeneration of the
inter-vertebral disc with subsequent changes in the bones and soft tissues.
As people age goes certain biochemical changes occur affecting tissue found through
out the body in the spine. Each vertebral body has four facet joints that work like hinges.
Management in Manyasthamba
Ayurveda advocates a reliable management of this condition through highly
efficacious and easily available drugs based on humorl theory.
121
Ayurvedic approach to the disease management of Manyasthamba is to retard the
degeneration or to strengthen the dhathus as the pacifying the Vata Dosha has special
importance in the management.
Options from contemporary medical science
In broad terms, the options for the treatment of cervical Spondylosis are either
conservative or surgical. Surgery is advocated for cervical radiculopathy in the patients who
have intractable pain, progressive symptoms, or weakness that fails to improve with
conservative therapy.
The present study intended to focus on the disease evaluation i.e. Manyasthamba vis-
à-vis cervical Spondylosis and the management with Mashabaladi taila internal and external
through Pratimarsha Nasya.
The discussion is to be made on the following headings
1. Manyasthamba as a diseases of importance
2. Present management modality
3. Action of Mashabaladi taila on demographic data
4. Action on signs and symptoms
5. Statistical significance of Mashabaladi taila on Manyasthamba
Manyasthamba is a disease pertaining to the neck. It’s characterised by shoola and
sthamba it is a disorder caused by Vata prokopa. Basic underneath pathology is Dhatu kshya
(degeneration), which mainly occurs during mid and later decades of life time we can be
interrupted in terms of degenerative changes found in the manya pradesha (cervical spine
and disc), which is resultant of ageing process mentioned in the allied science.
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This above said pathological changes are very basic for the manifestation of
Manyasthamba, in spite of this changes in same persons they remain a-symptomatic when
persons does the activities like (asanasthana sayanam, urdwa nireekshana) Nidana which
causes trauma to the neck. (Cervical vertebra) exhibiting pain and stiffens here Vata is
getting avarana by Kapha.
Bhavamishra was the first to refer the disease pathogenesis with the seven pairs of
manya siras involved in the disease pathology. Apart from these the Vyanavata is
controlling all the movements in the body, is obstructed to its gati occurs due to the
sleshmaka Kapha prakopa, present in manyapradesha by vihara nidanas lika asana sthana
sayana etc.
Bony component degenerative factor in Ayurveda
Sleshaka Kapha is located in the joints of the body. It keeps the joints firmly united
and helps in their function joints may also be made up of muscles, tendons and blood
vessels. Even the meeting point of two-opposing surface of cell can also be designated as a
joint. When Sleshaka Kapha getting vrudhi or kashya produces particular symptoms due to
the ageing process the Vata gets prokopa by its own Nidana.
Marma and cervical Spondylosis
Manya marma is vaikalya karamarma,the name of the marma is itself denotes its
important i.e., deforms or cripples. Thus it is understandable here that these marma on
receiving injury or insults shall result in the deformity of the related body parts in diseased
condition.
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In Manyasthamba the injury by sudden movements of the neck, bad postures, and
sleeping on the irregular surface will cause minor injuries to the manya marma, can not
perform the normal functions of the neck.
Agni and Manyasthamba
Manyasthamba is experienced in the middle age at this stage usually people feels lass
Agni bala. Ahara which enters in to the body is not properly digesting in the Amashaya
because of the hypo functioning the Agni that leads to improper nourishment to dathus
leading Dhatu kshaya (degeneration)
Present management modality
In the classics the treatment is told as rooksha sweda, and Nasya where we consider
Manyasthamba in the doshic level Vata and Kapha are the two main factors involved in the
pathogenesis of Manyasthamba. Here the pain and stiffness are two symptoms present in
this disease. Which can be attributed the Vata and Kapha Dosha Lakshana.
Rooksha sweda is told for srothosodhana there by subside the vitiated Kapha is the
manya pradesha and after the Nasya is told. Here the Nasya with thaila strengthen the Vata.
Mashabaladi is the combination of drugs having the property Vata Kapha hara. In the
constituents of Mashabaladi yoga, most of the drugs having madhura Rasa, which pacifies
Vata and maintain Kapha Dosha (Vata Kapha hara effect)
Probable mode of action of Mashabaladi taila
Manyasthamba is seen in the middle age or after the stage. It is the degenerative
stage. Because of the kshaya of the body Vata is getting prakopa, prakopita Vata is getting
Avarana by Kapha locally. Avarana in the sleshmasthana especially in neck contributes
towards the symptoms. So srotho sodhana, brumhana and Kaphahara is the line of treatment.
124
Mashabaladi thaila yoga is rich in madhura rasa and snigha Guna and because of the
taila preparation it will work as brumhana and Kapha hara.
Probable mode of action of Mashabaladi taila Nasya
The absorption of the drugs is carried out in three media they are by general blood
circulation, after absorption through mucous membrane. The direct pooling into Venus sinus
of brain via inferior ophthalmic veins and next one absorption directly in to the cerebra
spinal fluid.
Apart from the small emissary veins entering cavernous sinuses of the brain, a pair of
venous branch emerging from alliance will drain into facial vein. Just almost in the opposite
direction inferior ophthalmic in other hand also drain into cavernous sinus of the menages.
And in addition neither the facial vein nor the ophthalmic veins have any venial values so
there are more chances of blood draining from facial vein into the cavernous sinus in the
lowered head position.
The nasal cavity directly opens with the frontal maxillary and sphenoidal air sinus
epithelial layer is also continuous through out then the momentary retention of drug in naso
pharynx. Medicine causes oozing as drug material enters into air sinus, which are rich with
blood vessels entering the brain and remaining through the existing foramens in the bones
there are better chances of drug transportation in this path.
Recent authors as middle cephalic fosse of the skull consisting para-nasal sinus and
meningial vessels and nerves one can see in to the truth of narration made have explained
the shringataka marma by Vagbhata here.
The drug administered enters the para nasal sinus especially frontal and sphenoid
sinus i.e., shringataka where the ophthalmic veins and the other veins spread the sphenoid
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sinus are in close relation with intra-cranial structures. Thus there may be a so far undetected
route between air sinuses and cavernous sinuses enabling the transudation of fluids. As a
whole, the mentioning of the shringataka in this context seems to be more reasonable.
Hypothesis of Avartha taila
In general the entire procedure of sneha paka involves three components viz. Oil,
decoction and paste of herbs. The basic aim of the procedure is being to acquire the liquid
soluble essence in to the oil. While preparing the decoction most of the volatile oil get
evaporated and water-soluble active principles come in to the final product.
The decoction interacts with the oil and emulsion like stage is reached when the
complex alkaloids get entangled with the glycoside Easters of the fatty acids. The paste
comes directly into contact with the oil as it is prevented from burning by continues stirring
and the entire process being operated over mild heat, it is possible to get fat soluble
components of herbs and even some volatile oils mixed into oil. The essential components
coming into contact of per unit oil is more and the oil thus formed is more concentrated in
case of reprocessing.
Discussion on observations
The patients were selected incidentally from the OPD of Shri DGM Melmalagi
Ayurvedic medical college and hospitals, gadag. Patients of both sexes were selected for this
prospective clinical study between the age group 15-65 years, for the purpose of
administration of Mashabaladi thaila.
In total 41 patients were selected for the study. All the patients where subjected to
through clinical, laboratory and radiological examinations. All the 41 patients were appeared
for the assessment of result. The laboratory tests like ESR, RBS, were carried out to exclude
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infections disorders like tuberculosis of spine, RBS was carried out to rule out diabetes. The
radiology of cervical spine is also diagnostic-criteria, to exclude the conditions like severe
osteoporosis, fractures etc.
The patients observed from the graph-A are of 22 and in the group-B are of 19. The
distributions are observed as maximum from that of the degenerative age group such as 45-
65 age groups.
But the still the age groups of 35-45 show a remarkably increased number. The study
reveals that the incidence is more common between 3rd to 6th decade of life, in with the
degenerative changes occurs in the cervical vertebrae, ligaments and inter-vertebral joints.
The male and female ratio in the group-A is 5; 6 and in the group B it is 9; 10. The
percentage of the distribution does not show any gender differentiation to get this
degenerative disease. But in group A and group B together total 21 male patients and 20
female patients were reported.
The observation shows that the incidence is more in male usually the male patients
are more prone to get trauma due to nature of work. Their consciousness about their health
and freedom to approach the physician supports the reason for the dominance of male in the
sample.
As for as religion is concerned almost all the patients were Hindus. It doesn’t mean
that Hindus are more prone to get this disease, this may be due to the locality is a Hindu
dominated area.
Out of the 22 patients reported in the group A maximum number of patients (13) are
from middle class, 5 patients from the poor class and 4 patients from the high class.
127
The economical status in the present study shows that, more number of patients from
middle class. Compared to higher and poor class. Usually the only middle class people visit
for Ayurvedic treatment. This may be the reason for finding more middle class patients
compared to lower class and the middle class.
Out of the 22 patients reported in the group A of disease duration, maximum number
(2) not responded patients fall under the 6-7 years chronicity. The observation shows that
when the chronicity is high the percentage of relief is less.
In the present study, it was observed that maximum number of patients much
responded were in 1 and 2 grade in group A and B.
Drug action
The mode of action of drugs is based on the theory of Pancha mahaboota. The body
is composed of five mahabootas and similar is the composition of drugs. Drugs when used
combined with the selective mahaboota and by altering the quantity and quality produce
their action by further influencing the respective doshas, dhathus and malas.
In the constituents of Mashabaladi yoga, most of the drugs having Madhura Rasa,
which pacifies the Vata and maintains the dhatus like Rasa, Mamsa, Medas, Asti, Majja and
Sukra.
The madhura Rasa in the final form circulates through Rasa Dhatu all over the body
and influences (pacifying Vata) by its Snigdha Guna through metabolic process. When the
Rasa comes in contact the similar quality increased the doshas that are adhered in dhatus,
which maintains the body. Masha, rasna, kapikashu and tila thaila is having guru Guna and
Madhura Rasa. It has anabolic effect on metabolic process. So it maintains Vata and delays
the degenerative process.
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Table-50Pharmacological properties of the ingredients of Mashabaladi Taila
Name Rasa Guna Veerya VipakaMasha Madhura Guru Sheeta MadhuraBala Madhura Laghu, pichila,
SnigdhaSheeta Madhura
Kapikachu Madhura Tikta Guru Snigdha Ushna MadhuraTruna Madhura
KashayaLaghu Snigdha Sheeta Madhura
Rasna Tikta Guru Ushna KatuAswagandha Madhura Tikta
KatuLaghu Snigdha Ushna Madhura
Eranda Madhura KatuKashaya
Snigdha tekshnasookshma
Ushna Madhura
Ramada Katu Snigdha, Laghuteekshna
Ushna Katu
SaindhavaLavana
Lavana Laghu Snigdhasuskshma
Ushna Madhura
Tila thaila Madhura tikthakasaya
Vyavayisookshma
Ushna Madhura
Table-51Karma and Doshaghnata of the ingredients of Mashabaladi Taila
Name Dosha gnata KarmaMasha Vata shamaka,Pitta Kapha
vardhakaVata shamaka, vedhanasthapaka, shoola presana
Bala Vata Pitta shamaka Vedana sthapanaKapikachu Tridoshagna Vata vyadhihara nadi
dourbalya kshenaTruna Tridoshagna Kapha Vata hara shoola haraRasna Kaphagna vatagna Veedana shamaka shota hara
sandhi shoolaharaAswagandha Kaphagna vatagna Vedana sthapana shoola
prasamana deepanashootahara
Eranda Kaphagna vatagna Vedana sthapana shota harabalya angamardha hara nadidourblya
Ramada Kaphagna vatagna Nedanasthapana deepanaLavana vatagna Chekshushya hridya
ruchikara deevanaTila thaila Kaphagna Vata hara Srotha Shodhana Agni
deepana
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Drug effect on symptoms
The symptoms are graded, deference in before and after treatment is compared in the
symptoms. In Manyasthamba pain and stiffness are the main Lakshana i.e. symptoms.
Effect on pain (vedana)
According to Ayurveda pain is caused because of Vata vitiation. So
the drugs should have Vata hara property. Here the Mashabaladi yoga, almost
all the drugs having Vata hara, shoolahara property.
Effect on stiffness (sthambta)
According to Ayurveda the movements are controlled by Vyanavata
and the sleshmaka Kapha which is present in the joints have the lubricating
action and nourishing the joints.
Ingredients in the Mashabaladi yoga having brumhana Dravyas and is made in to
taila form so the Mashabaladi taila is having Vata Kapha hara property.
Individual drug action
Masha
Masha seeds have the nutritional diuretic and nervine tonic action,
hence it pacifies Vata and maintains sleshmaka Kapha thus it nourishes the
joints.
Bala
Bala is the drug of choice for vatika disease, it contains ephedrine and
it has diaphoretic, aphrodisiac, tonic property. They are used in vitiated
conditions of Vata and shopha. The methonolic extract of the Sida cordifolia
showed significant oedema suppressant activity. Probable mechanism of
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action may due to its inhibitory effect on release of mediators of
inflammation such as histamine hydroxy tryptamine brady kinin etc.
Rasna
It is also the drugs of choices for vatika disease. It is having Kapha
vata hara property. It contain tylophorine and pluchin, are found possess
significant anti-inflammatory action.
Aswagandha
Aswagandha have Vata Kapha hara property. It is balya and
Rasayana. It is used in vatika shoola, balya, nervine tonic. Due to its
Rasayana property it nourishes the Dhatus.
Kapikachu
Kapikachu is having Madhura Rasa, Guru, Snigdha Gunas, and
Tridosha hara. They are useful in vitiated conditions of Vata and tissue build
up process.
Eranda
Eranda contains riunolic acid glycerides it is used in shoola and
shotha.
Hingu
Hingu is having katurasa, legu snigha Gunas it act as deepana, vadana
sthapana.
Truna
It is having Madhura Kashaya Rasa, Sheeta Veerya and Madhura
Vipaka. It acts like Kapha Vata hara and shoola hara.
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Thila thailam
It is having deepana pachana, brumhana, balya, preenana. It is used
for alleviation of Vata and all kinds of injuries and srotho sodhana. It contain
palmitic acid, steariacid
Cumulative effect of Mashabaladi taila
The indication of Mashabaladi thaila is Manyasthamba, pakshagatha etc. because of
the drug combination having brumhana swabava.
The Mashabaladi yoga is prepared as thaila form. Thaila is the drug of choice for
Vata and Kapha.
The Mashabaladi is made as 11 avarthi thaila it increases its potency and acquire the
liquid soluble essence in to the oil while preparing the decoction most of the volatile oil gets
evaporated and only water soluble active principles comes in to the final product. The
decoction inters act with the oil and emulsion like stage is reached when the complex
alkaloids get enlarged with the glycoside Easters of the fatty acids. The paste comes directly
in contact with the oil. The fat-soluble component of herbs and even some volatile oils
mixed in to oils.
Statistical viability of Mashabaladi Taila in Manyasthamba
If we compare both the groups all the parameters shows not significant (p>0.05) by
using large sample test. Overall the group B is highly significant in stiffness, flexion
extension, RT lateral, left lateral, passive neck flexion, muscle strength. (p<0.05) by using
paired ‘t’ test.
The stiffness is highly significant in the group B as compared with the group A (t
value). The parameter passive neck movement, upper limb tension test, slump sympathetic,
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and muscle strength having uniform effect in the group B by comparing coefficient of
variation. There is much variation in Ayurvedic health assessment in both groups. The pain
is having same variation in both the groups. (By comparing variance).
There is no variation in the group B after the treatment of parameter the slump full.
The group A, the parameter flexion slump full, slump sympathetic is having highly
significant (by comparing t value).
Result of Mashabaladi Taila in Manyasthamba
The over all response is based upon the different parameters involved in the study.
They are pain, stiffness, flexion, extension, right lateral movement, left lateral movement,
passive neck flexion, upper limb torsion test, SLUMP full, SLUMP sympathetic, muscle
strength and Ayurvedic Health assessments are made under specified gradations. The
detailed tabulations are as follows.
Overall response to the treatment in comparison with Group-A and Group-B
Table - 52
Group-A Group-B
Result Patients Percentage Patients Percentage
Much Responded 5 22.72 7 36.84
Responded 15 68.18 12 63.15
Not Responded 2 9.09 0 0
Total 22 100 19 100
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Graph –19
Comparative results of Group-A and Group-B
In the Group-A it is found that much responded patients are 5 (22.72%) and the
Responded patients are 15 (68.18%) and the last category of Not responded is 2 (9.09%) of
the results when compared with the parameters of subjective and objective together.
In the Group-B it is found that much responded patients are 7 (36.84%) and the
Responded patients are 12 (63.15%) and the no patients in the last category of Not
responded of the results when compared with the parameters of subjective and objective
together.
57
1512
2
0
0
5
10
15
Group-A
Group-B
Group-A 5 15 2
Group-B 7 12 0
Much Responded
RespondedNot
Responded
134
Limitation of the study
1. the sample size was small
2. the period of study was limited
3. longer follow up was not done
4. lab test like Cyanocobalamine and EMG is not economical so it is
excluded from the test
Future Scope for the further study
The following recommendations are made on the basis of
observations and conclusions made in the study, as guidelines for the further
studies, which are made in future to over come the limitations listed.
1. Same study can be repeated by taking a large number of
samples and longer duration.
2. The effect of Marsha Nasya can be studied.
135
Chapter –7Conclusion
The following conclusions are drawn on the basis of the research undertaken with the
Mashabaladi taila capsules internally and used as Pratimarsha Nasya at the D.G.M.
Ayurvedic medical college and Hospital, Gadag.
1. Manyasthamba is well known disease from Bhavanishra period and it was well
discussed including 7 pairs of the Siras emerging from the sides of neck.
2. The disease Manyasthamba and cervical Spondylosis are similar in their etiology, sign
and symptoms.
3. The Dosha entities included in this disease are Vyanavata and Sleshmaka Kapha.
4. The statements of researchers, as it is prevalent in 4th to 6th decade of life to non-
discrimination of occupational groups is conformed in the study.
5. Manyasthamba is common in the groups those working with the pressure over the
cervical vertebrae i.e. manya.
6. The contemporary medical tools of investigations rule out the pathology of cervical
Spondylosis vis-à-vis Manyasthamba.
7. The study with the Mashabaladi taila reveals that it is a good analgesic i.e. vedana
shamaka.
8. The Mashabaladi taila is a srotoshodhaka.
9. The Mashabaladi taila is a Vatahara.
10. The Mashabaladi taila Pratimarsha Nasya doesn’t show any exclusive effect over the
disease. But it can not be stated even such, because all patients in the group, received the
136
Pratimarsha Nasya reported relieved. It is recommended that the Nasya as a purification
procedure as Marsha Nasya if made may produce requisite results.
11. Both internal and external use of Mashabaladi taila has their effects to achieve the
statistical significance as P=<0.001, which is highly significance for the all parameters,
reported at the study.
12. If we compare both the groups all the parameters shows not significant (p>0.05) by
using large sample test.
13. Overall the group B is highly significant in stiffness, flexion extension, RT lateral, left
lateral, passive neck flexion, muscle strength. (p<0.05) by using paired ‘t’ test.
14. The stiffness is highly significant in the group B as compared with the group A (t value).
15. The parameter passive neck movement, upper limb tension test, slump sympathetic, and
muscle strength having uniform effect in the group B by comparing coefficient of
variation. There is much variation in Ayurvedic health assessment in both groups. The
pain is having same variation in both the groups. (By comparing variance).
16. There is no variation in the group B after the treatment of parameter the slump full. The
group A, the parameter flexion slump full, slump sympathetic is having highly
significant (by comparing t value).
17. The result is 5 patients of Much Responded, 15 patients of Responded and 2 patients of
Not Responded in the group-A. The result is 7 patients of Much Responded, 12 patients
of Responded and no patients in the not-Responded class in the group-B.
18. So, it is significantly recommended that the Mashabaladi taila be used to achieve good
results in long term to pacify Vata, Kapha and combat the degenerative changes emerge
in the later ages such as 4th to 6th decades.
137
Chapter –8Summary
Over time, arthritis of the neck (cervical Spondylosis) may result from bony spurs
and problems with ligaments and disks. Injuries can also cause spinal cord compression.
Manyasthamba - Cervical Spondylosis is a non-specific term describing the
morphological manifestations of progressive degeneration of the spine. Cervical
Spondylosis is a common degenerative condition of the cervical spine that most likely is
caused by age-related changes in the inter-vertebral disks.
Manyasthamba - Cervical Spondylosis is defined by the degenerative changes of the
spine at the neck, creating pressure on nerves and spinal cord at the level of the neck. Neck
stiffness. The changes in Manyasthamba result in neural compression resulting in
radiculopathy or compression of the spinal cord resulting in myelopathy.
Manyasthamba - Cervical Spondylosis may also manifest only with neck and head
pain or with signs and symptoms attributable to cervical radiculopathy. Avitaminosis,
nutritional deficiencies leading calcium deficiency were observed to lead inflammation and
degeneration of cervical vertebra resulting nerve compression causing cervical Spondylosis.
Spondylotic changes often are observed in the ageing population. However, only a
small percentage of patients with radiographic evidence of cervical Spondylosis are
symptomatic. .
The commonest cause for cervical Spondylosis or such type of diseases is the
degenerative changes effected in the cervical region. Anti inflammatory, analgesic and
disease modifying anti rheumatic drugs are the drugs of choice in contemporary system of
138
medicine. Reduction of sleshma Kapha, which normally align the joints, causes the vitiated
Vata to settling in the joints.
Manyasthamba is a Vata Vyadhi by its nature. The condition Manyasthamba is
effecting the neck region with the symptoms such as pain and stiffness.
When Vata covered by Kapha or Dosha accumulation makes Manyasthamba. The
degenerative process may impact the cervical regions of the spine effecting the inter-
vertebral discs and facet joints.
Here the pain and stiffness are two symptoms present in this disease. Which can be
attributed the Vata and Kapha Dosha Lakshana. Nasya with thaila pacifies the Vata Kapha
mainly the Vata.
Mashabaladi is the combination of drugs having the property Vata Kapha hara. In the
constituents of Mashabaladi yoga, most of the drugs having madhura Rasa, which pacifies
Vata and maintain Kapha Dosha (Vata Kapha hara effect)
Manyasthamba is seen in the middle age or after the stage. Because of the kshaya of
the body Vata is getting prakopa, prakopita Vata is getting Avarana by Kapha locally.
Patients of both sexes were selected for this prospective clinical study between the
age group 15-65 years, for the purpose of administration of Mashabaladi thaila.
In total 41 patients were selected for the study. The distributions are observed as
maximum from that of the degenerative age group such as 45-65 age groups. But the still the
age groups of 35-45 show a remarkably increased number. Out of the 22 patients reported in
the group A maximum number of patients (13) are from middle class, 5 patients from the
poor class and 4 patients from the high class.
139
The economical status in the present study shows that, more number of patients from
middle class. Out of the 22 patients reported in the group A of disease duration, maximum
number (2) not responded patients fall under the 6-7 years chronicity.
When drug action is emphasised with the constituents of Mashabaladi yoga, most of
the drugs having Madhura Rasa, which pacifies the Vata and maintains the Kapha Dosha,
dhatus like Rasa mamsa medas majja and Sukra.
The Madhura Rasa in the final form circulates through Rasa Dhatu all over the body
and influences (pacifying Vata) by increasing Kapha property through metabolic process.
According to Ayurveda pain is caused because of Vata vitiation. So the drugs should
have Vata hara property. Here the Mashabaladi yoga, almost all the drugs having Vata hara,
shoolahara property.
The indication of Mashabaladi thaila is Manyasthamba, pakshagatha etc. because of
the drug combination having brumhana swabava. Thaila is the drug of choice for Vata and
Kapha. The fat-soluble component of herbs and even some volatile oils mixed in to oils.
Overall the group B is highly significant in stiffness, flexion extension, RT lateral,
left lateral, passive neck flexion, muscle strength. The stiffness is highly significant in the
group B as compared with the group A (t value). The parameter passive neck movement,
upper limb tension test, slump sympathetic, and muscle strength having uniform effect in the
group B by comparing coefficient of variation. (By comparing variance).
Thus the conclusions are drawn as -
1. The Mashabaladi taila Pratimarsha Nasya doesn’t show any exclusive effect over the
disease. But it can not be stated even such, because all patients in the group, received the
140
Pratimarsha Nasya reported relieved. It is recommended that the Nasya as a purification
procedure as Marsha Nasya if made may produce requisite results.
2. Both internal and external use of Mashabaladi taila has their effects to achieve the
statistical significance as P=<0.001, which is highly significance for the all parameters,
reported at the study.
3. If we compare both the groups all the parameters shows not significant (p>0.05) by
using large sample test.
4. Overall the group B is highly significant in stiffness, flexion extension, RT lateral, left
lateral, passive neck flexion, muscle strength. (p<0.05) by using paired ‘t’ test.
5. The stiffness is highly significant in the group B as compared with the group A (t value).
6. The parameter passive neck movement, upper limb tension test, slump sympathetic, and
muscle strength having uniform effect in the group B by comparing coefficient of
variation. There is much variation in Ayurvedic health assessment in both groups. The
pain is having same variation in both the groups. (By comparing variance).
7. There is no variation in the group B after the treatment of parameter the slump full. The
group A, the parameter flexion slump full, slump sympathetic is having highly
significant (by comparing t value).
8. The result is 5 patients of Much Responded, 15 patients of Responded and 2 patients of
Not Responded in the group-A. The result is 7 patients of Much Responded, 12 patients
of Responded and no patients in the not-Responded class in the group-B.
So, it is significantly recommended that the Mashabaladi taila be used to achieve good
results in long term to pacify Vata, Kapha and combat the degenerative changes emerge in
the later ages such as 4th to 6th decades.
141
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SPECIAL CASE SHEET FOR MANYSTAMBADEPARTMENT OF KAYACHIKITSA
POST GRADUATE STUDIES AND RESEARCH (KAYACHIKTSA)SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG.
GUIDE: Dr. K. SIVARAMA PRASAD. SCHOLAR : SHAJIL. N MD (Ayu), MA (Astra).
Sl.No:OPD.No:IPD.No:
1. Name of the patient:
2. Father’s Name/Husband’s Name:
3. Age Dt.Schedule Initiation :
Dt.Schedule Completion :
4. Sex
5. Religion
6. Occupation
7. Economical Status
8. AddressPin:PH:
9. Group
10. Selection
11. Result
ConsentI Son/Daughter/Wife of
Exercise my free will to participate in the said study. The attending physicianthe purpose of clinical evaluation and native of drug treatment has informedme to my satisfaction. I am also aware of my right to quit at any time during the schedule.
Signature of the Patient
M F
Hindu Muslim Christian Others
Sedentary Active Labour
Poor Middle High Aristocrat
Group A Group B
Included Excluded
Responded Not Responded Discontinued
Case sheet
2
Chief Complaints
I. Pain
a). Onset
b). Site
c). Nature of pain
d). Duration
e). Severity
Grade(Grade 0: No pain, Grade 1: Mild pain, Grade 2: More than mild pain
but tolerable, Grade 3: Moderately severe pain , Grade 4: Severe pain, Grade5: Intolerable, perhaps suicidal pain)
f). Aggravating factor
g). Relieving factor
II). Stiffness of neck
III) Tenderness (Huckstep tender triad)
1 2 3
Sudden Gradual
Cervical Cervico thoracic Shoulder
Localised Vague Radiated
Intermittent Continues
Since
1 2 3 4 5
Movement Rest
Rest Pain relievers Tranquilises Pressure
0 1 2 3
Case sheet
3
Associated complaintsI). Numbness and tinglingSensation
II) Muscle weakness and
deterioration
III. Headache
IV. Crunching sounds
V. Dizziness; while
OTHER ASSOCIATED COMPLAINTS
Arms Hands Fingers
Shoulder Arms Hands Fingers
1-2 times per month
1-2 times per week
Daily but intermittent pain
Continuous pain
Movement of the neck
Movement of the Shoulder muscles
Bending
Flexion Extension Rt. Lateral Lt. Lateral
1 Amavata
2 Disc Prolapse
3 Spinal Stenosis
4 Cervical Thoracic Joint Disease
Case sheet
4
General Examination
1.PULSE /Min 2.B.P mm of Hg
3.TEMP 0F 4. RESPIRATION /Min
5.HEIGHT /Cm 6.WEIGHT /Kg
NIDANA
AAHARA VIHARA MANASIKA
Katu Rasa Asamasthana sayanam Chinta
Tikta Rasa Urdhwa Nireekshanam Shoka
Kashaya Rasa Diva swapnam Bhaya
Ati Sheeta Vyayama VYASANA
Ati Rooksha Langhana Madhya Pana
Alph Ahara Plavana Dhooma Pana
Laghu Ahara Adhvagamana Tobacco Chewing
NIDRA Yanam
Vishama Upachara
Prajagara
SPECIAL EXAMINATION
a) DARSANA Before After
Swelling
Redness
Muscle waisting
b) SPARSANA
Warmth over joint (t0)
Tenderness
Bony component palpable
7.AGNI MANDA TEEKSHNA SAMA VISHAMA
c) MOBILITY OF CERVICAL JOINT
Before After
Flexion
Extension
Rt. Lateral
BendingLt. Lateral
Rotation
Case sheet
5
INVESTIGATIONS
RBS
X-RAY
E.S.R.
ASSESMENT OF RESULTS
PARAMETER B. T. A. T.
Pain Grade
Stiffness
Flexion
Extension
Rt. Lateral
Mobility
Lt Lateral
Passive neck flexion
Upper limb tension test
Slump Full
Slump Sympathetic
Ayurvedic health assessment
Muscle strength
Case sheet
6
Pain on VAS
B.T. 0 100mm
A.T. 0 100mm
TREATMENT PROTOCOL
Distribution of MBLT Cap. &Nasya
DATE NOTES
Initial-Day 1
2ND -DAY 15
3RD -DAY 30
4TH -DAY 45
INVESTIGATOR’S NOTE:
SIGNATURE OF GUIDE SIGNATURE OF THE SCHOLAR
Case sheet
7
Ayurvedic Health Assessment: - (AHA Criteria)
SL.No Symptoms Before After
1 Annabhilasha
2 Bhuktasya paripakam
Srishta vit3
Srishta mutra
4 Shareera laghava
5 Suprassana indriya
Sukha swapnam6
Sukha prabodhanam
7 Bala
8 Varna
9 Somanasyam
10 Samagnita
Total Score
Very satisfied=1; somewhat satisfied=2; neither satisfied nor dissatisfied=3; somewhat
dissatisfied-4; very dissatisfied=5.
