These procedures mainly aimed at the rectification of the imbalances of Vata Dosha as well as Kapha Dosha in the treatment of Gridhrasi.

The details of these procedures are given as follows:

1. Snehan:  It can be done in two ways i.e. internally and externally. Snehan alleviates rukshata, gives laghuta and snighata to the body. As Gridhrasi is a VataVyadhi snehan helps to alleviate Vata. If Gridhrasi is due to dhatukshayajanya nidana internal snehana is beneficial along with external snehana, Padabyanga is good for Gridhrasi. Abhyanga helps to improve blood circulation and stimulates nerve endings.

2. Swedan:  Shula and Stambha in the lower extremities are the cardinal symptoms of Gridhrasi and is best treated by the Swedan Chikitsa. Swedan also helps in the liquification of the Dosha there by assisting clearing the Srotas, or else rectifying the Marga- avarana. Among the different forms of Swedan procedures Avagaha Sweda, Pizhiccil, NadiSweda, Patrapinda Sweda, Pinda Sweda and Upanaha Sweda is beneficial for Vataj disorders so it may be efficiently performed in patientsof Gridhrasi (C.Chi.28/78). But in VataKaphaja Gridhrasi, Baluka Sweda is a better option for evident reasons.

3. Vaman:  After the Snehan and Swedan, Shodhana is indicated in Gridhrasi. Shodhana in the form of Vaman is advised in patients suffering from Gridhrasi and is specially preferred in VataKaphaja Gridhrasi for evident reasons.

 4. Virechan:  Virechan has an important role in Gridhrasi. The action of Virechana is not only limited to particular site, it has effects on the whole body. In VataVyadhi most of the authors mentioned Mridu Virechana (C.Chi.28/83). Oral administration of “Eranda Sneha” along with milk is ideal for the Virechana purpose, this helps in Vata Anulomana. The Sneha Virechana clears obstruction in the Srotas and relieves Vata vitiation very quickly (A.S.Chi.23/6). Thus Sneha Virechana of Mridu nature helps in controlling Shula in Gridhrasi.

5. Basti: Pakwashaya is the primary location of Vata Dosha and Vyana Vata is vitiated in Gridhrasi. So Basti is very helpful in pacifying Vata, further it is glorified that Basti Chikitsa as ‘Ardha Chikitsa’ or ‘Purna Chikitsa’ of Vata (C.Si.1/39). By these facts, Basti is most important among the Panchakarma in the treatment of Gridhrasi. No other Chikitsa has the capacity to pacify and regulate the force of Vata apart from Basti (S.Chi.35/29-30).

· Niruha Basti: Erandamuladi Niruha and Dashamuladi Niruha are the best choices.

 · Anuvasana basti: Anuvasana basti using Vatahara Tailas like Bala Taila, Mulaka Taila, Ksheerabala Taila, Nirgundi Taila etc. are beneficial.

 6. Siravyedha:  Charaka explained Siravyedha at the site of AntaraKandara-Gulpha (C.Chi.28/101). Acharya Sushruta and Vagbhatta indicated Siravyedha four Angula above and four Angula below at the site of knee joint.

 7. Raktamokshana:

It is a general rule that when the regular treatment with Shadvidhopakrama fails to give any relief in any disease, one should consider the involvement of Rakta Dhatu in the pathogenesis and is best treated by Raktamokshana. This rule is also applicable in Gridhrasi Roga (A.H.Su.27/4-5). As the disease Gridhrasi is characterized by affliction of Rakta along with Vata, several authors have advised Raktamokshana.

8. Agnikarma:  Various Acharyas has mentioned Agnikarma in the management of Gridhrasi. According to Sushruta and Vagbhatta, in the management of Sira, Snayu, Asthi and Sandhigata Vyadhi, Agnikarma is indicated and Gridhrasi is one of the diseases with this Samprapti. 23,24,25 (S.Chi.4/8; A.H. Chi. 21/22; S.Su.12/10).

For treatment of Gridhrasi, different site for Agnikarma are as mentioned below;

a. Charak: Antara Kandara Gulpha

b. Charkradatta: Pada Kanistika Anguli (little toe of the affected leg).

 c. Harita: Four Angula above the Gulpha in Tiryak Gati.

Mostly in practice where pain is more prominent primarily, Agnikarma Chikitsa can be done.

 9. Shastra Karma:  Chakradatta has given the treatment of Gridhrasi in details. He has mentioned a small operation with prior Snehana and Swedana to remove Granthi in Gridhrasi and also Siravedha four Angula below Indrabasti Marma (C.D.22/51-54).

PATHYA – APATHYA

 Specific Pathya and Apathya for Gridhrasi have not been mentioned, but as this disease is a Vata Vyadhi, pathya apathya of Vata Vyadhi can be followed.

Pathya Ahara Godhuma,Masha, Kulattha, Raktashali, Godugdha, Ajadugdha, Ghrita, Taila, Vasa, Majja, Go Mutra, Draksha, Amra, Badara, Madhuka, Ushna Jala, Sura, Madira, Surasava, Amlakanjika, Mamsa (Kukkuta, MAyura, Chataka, Tittir, Nakra, Matsya, Varah, Jalachara Mamsa), Patola, Shigru, Rasona, Jivanti, Madhura, Amla, Lavana Rasa Pradhana Ahara are Pathya.

Pathya Vihara Atapa Sevana, Mridu Shayya, Ushnodaka Snana etc.

Apathya Ahara Yava, Kodrava, Shyamaka, Nirava, Chanaka, Kalaya, Gadarbha dugdha, Madhu, Sheeta Jala, Navamadya, Ati Madhya Pana, Sushka Mamsa (Kapota, Paravat, Kulinga, Shuka, Shushka Mamsa), Jambu, Kramuka, Kasheruka, Lavali, Parpataki Phala, Kumuda, Kamalanala, Palakya, Udumbara, Katu, Tikta, Kashaya Rasa Pradhana Ahara are Apathya.

Apathya Vihara: Chinta, Ratri Jagarana, Vega Vidharana, Shrama, Anashana, Vyavaya, Vyayama, Chankramana, Kathina Shayya, Yana gamana are Apathya.

DISCUSSION:

Gridhrasi is shoola pradhan vyadhi so it disturbs daily routine and whole life of patients. Gridhrasi is observed due to vitiation of vata, causes by more intake of vata prakopak ahara, vihara. So singdha pradhan majja, medadi dhatues are not nourished well and show result Rasa, Rakta, Asthi, Majja dhatus are affected. Asthipuran karma is disturbed and Asthi dhatu become shushra, durbala especial at sandhies of Kati, Sphik and janu . Vitiated vata accumulated in Kati Pradesh due to this gridhrasi Nadi, Snayu, kandara is vitiated hence symptoms like ruk, toda , stambha etc. are produce. Agni mandhya which leads to formation of Ama, which causes margavarodha of strotasa and further leads to obstruction of Vatagati. In ayurveda has description of various therapies for the treatment of Gridhrasi was explained by various Acharya in ancient period. Sequential administration of snehan,swedan,vaman,virechana, basti, siravedha and agnikarma are line of treatment of Gridhrasi described in Ayurvedic literature.Hence shodhan along with shaman chikitsa helps to treat the patient as mentioned by Acharyas.

CONCLUSION:

Gridhrasi is more common in present era due to today’s life style and increasing habit of vata prakopak ahara vihar. Gridhrasi  aetiopathology is mainly due to vata vaigunaya. In management of the disease, in removing the vatavaigunya pertaining the disorder shodhana and shaman therapy should be indicated. Shodhana removes out the vitiated dosha by the nearest channel that leads to root out the disease. In the treatment of Gridhrasi Shodhan and Shaman chikitsa place a very important role.

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