Qualitative and Quantitative Assessment of Vata Dosha in a Case of Gridhrasi (Sciatica) by Nadi Tarangini Device – A Case Study

Aims: To evaluate the qualitative and quantitative assessment of vata doshain a case of gridhrasi by nadi tarangini device. Introduction: Ayurveda has an unique method of patient examination by ashtavidha pareeksha. i.e. nadi, mutra, mala, jivha, shabda, sparsha, drik and akruti. Amongst which examination of nadi becomes prominent examination which helps in better diagnosis of a disease/vyadhi. Gridhrasi is shoola pradhana vataja nanatmaja vatavyadhi, affecting the back involving lower limb which hampers patient’s daily routine activity. Line of Management of gridhrasi includes siravyadha, bastikarma and agnikarma. Siravyadha and agnikarma are considered as instant pain relieving Case Study Desai and Dhule; JPRI, 33(32A): 188-197, 2021; Article no.JPRI.70070 189 methods. Raktamokshana by siravyadha is considered to be ardha chikitsa according to Sushruta. Siravyadha is specially indicated in case of gridhrasi. It is a simple OPD level procedure affordable/economical to all categories of patients and time saving. As siravyadha gives instant relief and gridhrasi is vataja nanatmaja vyadhi, it is easy for the assessment and understanding of reduction in symptoms by nadi tarangini device. Hence, in this case study an attempt is made to assess the quantitative and qualitative analysis of vata dosha before and after the procedure of siravyadha. Case Study: A patient, 45 years old; he showed the main clinical signs and symptoms of gridhrasi came to our OPD, had a history of 2 years, and had worsened in the past two days. He underwent a careful examination and we recorded a detailed medical history. With all purva, pradhana and paschat karma, siravyadha procedure was done and nadi tarangini readings were taken before, after and on 10th day of siravyadha procedure. Place and Duration of the Study: Study was conducted in ‘Sri Jain AGM Ayurved Medical College & Hospital, Varur-Hubballi (Karnatak). Study duration was 10 days. Results: Patient got marked relief in subjective criteria i.e. stambha, toda, ruk, toda, spandana, gaurava and also in objective parameters i.e. straight leg raise test, lassegue’s test and Oswestry low back pain score. It was seen that, there was visible difference in the analysis of nadi tarangini report. Conclusion: It can be concluded that, siravyadha gives better relief in gridhrasi. And it was found that nadi tarangini can be used to assess the dosha dushti and many other parameters.

It is said that, nadi should be examined in left hand in females and right hand in male patients. Nadi gives us specific information or knowledge about sadhyaasadhya roga, predominance of dosha or avastha.
While examination, the use of tip of index finger denotes vata nadi, middle finger denotes pitta nadi and ring finger denotes kapha nadi [1].
Nadi tarangini is a modern scientific instrument which records nadi / Pulse on basis of heart rate variability. This is Invented and Patented by Dr. Aniruddha Joshi. The nadi tarangini contains a diaphragm element with strain gauge, a transmitter and an amplifier, a digitizer for quantifying analogue signal. The system acquires 16-bit accuracy data with practically no external electronic or interfering noise. Prior systems for obtaining the nadi pulses have been few and far between, when compared to systems such as ECG. The pulse waveform is also shown to have the desirable variations with respect to age of patients, and the pressure applied at the sensing element [2].
The system of the present invention is intended to eliminate all the human errors in the nadi diagnosis performed manually by different practitioner and the diagnostics could be performed based on accurate and quantitative information.
Nadi tarangini is a tool to detect and analyze information about your inner health. Nadi tarangini is a perfect combination of hardware and artificial intelligence-based, intuitive software that makes the first move in the new age nadi pariksha system. Nadi tarangini is one of its kinds of invention which can accurately diagnose physical, mental and emotional imbalances in the body. It is based on the non-invasive science of traditional alternative medicine that helps reach the root cause of disease and not just the symptoms. Using three pressure sensors to record the pulse on wrist at vata, pitta and kapha locations, it mimics the way a vaidya takes nadi manually [3].
Among the many disorders described in the Samhita, gridhrasi (sciatica) is one of nanatmaja vyadhi. gridhrasi is a well known vata vikara with pain as a predominant symptom which starts from sphik (Hip), kati, prushta and radiates to uru (Thigh), janu (Knee), jangha (Calf) and padatala (Foot) predesh (Region) posterior side. Gridhrasi is said to be of 2 types namely, Vataja and vatakaphaja [4]. As per modern science, the pain of sciatica radiates from lumbar region to down the toes of affected side. Hence, it is co-related to sciatica [5]. Sushruta has described the treatment by raktamokshana in general for all vatavyadhi including gridhrasi.
The raktamokshana is the half treatment as for as the surgical diseases are concerned.
Raktamokshana by siravyadha is the choice of treatment for gridhrasi as per the Sushruta.
Here is an attempt made to assess Quantitative and Qualitative analysis of vata dosha before and after the procedure of siravyadha in cases of gridhrasi (Sciatica) as a case study.

CASE REPORT
A Case study was done to assess the qualitative and quantitative analysis of vata dosha in a 45 (forty five) Years male patient.

Chief Complaints
He was complaining of pain in lower back region which is radiating to right leg since 2 years. Got worsen since 2 days. He was complaining of twitching type of pain, difficulty in sitting, standing since 1 month. Stiffness (stambha), aruchi (Tastelessness) and gouravata (Heaviness) since 1 month.

History of Present Illness
A male patient aged 45 years presented with above said complaints one month. The patient consulted a physician in Hubli and was being treated with NSAIDs and other supplements for more than 15 days and patient felt little relief; but since last two days there is regression of symptoms severe than previous episode. Now the patient came to our hospital "Sri Jain AGM Ayurved Medical College and Hsopital, Varur -Hubballi (Karnataka)" for further treatment. With prior informed consent obtained by the patient, following procedure was conducted.

2.
A reading was taking with the help of nadi tarangini before the procedure.

Pradhana karma:
Patient was made to sit in a jaanu sama aasana (on a chair of his knee height), facing east in a warm room, devoid of breeze and dust. The area round right ankle joint (antara khandara gulpha sandhi) was slowly tapped with fingers to find the veins; a 18 no. needle was inserted into vein. Blood flowing out was collected in kidney tray till it stops by itself. There was total 120ml blood was collected in 13 minutes.
Paschat karma: Interpretation of scores: 0% to 20%: minimal disability: The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting sitting and exercise.

21%-40%: moderate disability:
The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means. 41%-60%: severe disability: Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation.

61%-80%: crippled:
Back pain impinges on all aspects of the patient's life. Positive intervention is required.

OBSERVATIONS AND RESULTS
The observations were tabulated as below: There was significant reduction in subjective and objective parameters. There was 67% relief in stambha, 50% relief in toda, 67% relief in spandana, there was no relief in ruk and 50% relief in gaurava immediately after siravyadha procedure.
In objective criteria, 100% relief was found in Oswestry low back pain score, 67% relief in SLR test, 100% relief in Lassegue's test and There was reduction from 11033 to 1443 in pressure amplitude in vata nadi immediately after siravyadha procedure.
There was 100% relief in Oswestry low back pain score, SLR test, Lassegue's test. 1792 was found as pressure amplitude in vata nadi on 10 th day of siravyadha procedure.  low back pain score  3  0  100  0  100  2  SLR test  3  1  67  0  100  3  Lassegue's test  1  0  100  0  100  4 Device interpretation (Quantitative observation) 11033 Fig. 1 1443 Fig. 2 1792 Fig. 3 With the help of nadi tarangini, changes in vata dosha guna were found and they are tabulated as below; It was seen that, there was reduction in vata dosha values in nadi tarangini report even on 10 th day of follow up. That means, siravyadha gives relief in cases of gridhrasi for a minimum period of 10 days.

DISCUSSION
Gridhrasi is included under the 80 types of nanatmaja vata vyadhi. Acharya Charaka has described siravyadha, basti karma and agnikarma in the management of gridhrasi. acharya sushruta has mentioned diseases; those are not relieved so quickly by snehana, lepanadi therapeutic measures in these situation siravyadha is an emergency management to achieve better results.
The symptoms of samyak siravyadha are laghavam (Body and painful area) and vedanashanti (pain reduction). Siravyadha reduces pain of gridhrasi diseases immediately and also reduces other symptoms of gridhrasi like pricking sensation, stiffness, tingling sensation, heaviness and increases the SLR angle in a single sitting procedure. This procedure Siravyadha may help in this disease gridhrasi by correcting the dosha-vyana vata and dushya kandara which is upadhatu of rakta. Siravyadha expels out vitiated rakata and vyana vata and facilitates normalcy of vayu. The entire treatment as accepted easily by the patients. There were no side effects noticed in the patients. There is no need to be hospitalization of the patient in the procedure.

CONCLUSION
This case study of effect of "Qualitative and quantitative analysis of Vata Dosha by nadi tarangini in case of gridhrasi -A Case Study, it was found that Nadi tarangini device gives best reports based on Heart Rate Variability. It was found that there is reduction in values recorded by device after the siravyadha procedure when compared to before procedure reports. Siravyadha in the pain management of gridhrasi gave promising result. Siravyadha shows immediate pain relief in gridhrasi. It can be concluded that, Nadi tarangini Device can be used to assess various parameters in various diseases and it helps clinicians to decide on treatment modalities and also easy explanation to beneficiaries.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).