ISSN: 2320-5407 Int. J. Adv. Res.

10(12), 964-970

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/15929
DOI URL: http://dx.doi.org/10.21474/IJAR01/15929

RESEARCH ARTICLE
DIAGNOSIS AND MANAGEMENT OF KATIGATAVATA (LOW BACK PAIN) IN AYURVEDA: A
CRITICAL REVIEW

Dr. Poona Nath Chouhan

Consultant, Department of Shalya Tantra, Nootan AyurvedicCollage and Research centre ( Proposed ), Sankalchand
Patel University, Visnagar, Mahesana.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Introduction: Low back pain has prevalence of 6.2% in general
Received: 25 October 2022 population to 92% in construction workers in India. Current health
Final Accepted: 28 November 2022 system is not so much updated to rule out this entity early which tend to
Published: December 2022 cause much more devasting medical conditions and economical
expenses. This outcome generates an opportunity for Ayurveda to
Key words:-
Katishool, Katisandhigata Vata, Lower manage it with conservative treatment.
Back Pain, Lumber Spondylosis Aims and objectives: To Compile the reference of KatisandhigataVata
(Definition, Nidana, Lakshana and Chikitsa) mentioned in various
classical texts and to evaluate the treatment modalities useful for the
management.
Discussion: Sandhi is a union of Asthi which is Ashrya of VataDosh so
as its vitiation progress, its RuksaGuna also increases which lead to
Dhatukshaya and Snehanash reduction. So Asthi and Sandhi related
Vikaras also show progression. All the classics mentioned the use of
Snehana and UpanahaKarma which will control RuksaGuna of
Vatadosha.
Result: Remedies mentioned in Ayurveda classics may boost up the
options to manage it with less efforts, maximum benefits, and least side
effects.

Copy Right, IJAR, 2022, All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Modern science considers low back ache as a burning issue which affect the people indiscriminately. It is the major
cause of disability affecting the routine life as well as work efficiency of an individual. It possesses a vast variety in
term of periodicity, severity and its presentation. In accordance with the report of World Health Organization in
2002, LBP constituted 37% of all occupational risk factors which occupies first rank among the disease
complications caused by work. Such high prevalence of complications at international levels has made the World
Health Organization to name the first decade of the third millennium as the “decade of campaign against
musculoskeletal disorders (as the silent epidemic)” (WHO, 2005)1

The prevalence of LBP in Indian population has been found to vary between 6.2% (in general population) to 92%
(in construction workers). Such large variation can be attributed to the heterogenicity of the population under study
as twenty three out of thirty-one studies reporting prevalence were conducted in different occupational groups.
Variation in obtained data may be another objective of study, various demographic characteristics of subjects in
study and definition may be used for the study. 2

Corresponding Author:- Dr. Poona Nath Chouhan 964

Address:- Consultant, Department of Shalya Tantra, Nootan Ayurvedic College and Research
Centre, Sankalchand Patel University, Visnagar, Mahesana.
ISSN: 2320-5407 Int. J. Adv. Res. 10(12), 964-970

In Ayurveda it can be correlated with KatigataVata. Some ancient texts also describe few disorders having
resemblance such as KatiGraha, TrikaGraha, PrushthaGraha, KatiVayu, TrikaShoola, PrushthaShoola,
VatajaShoola, TrikaVedana, and Gridhrasi3. Description of KatigataVata is not given separately as much as and not
included in NanatmakaBheda of Vata. In this entity Vata dosha vitiated due to various causes, as mentioned in
CharakaSamhita under the term “SandhigataAnila”, here Vata gets located in the KatiSandhi and result in
KatiSandhigataVata. MadhavNidana also describes as a Hantisandhigata: sandhinshoolatopokarotich which means
this diseases joints damaged by Vata are having symptoms like pain sensation, crepitation in joints.

This problem apparently has a favorable natural history, although it can be remarkably disabling, and has challenged
the health care providers. The medical system frequently fails to identify this complaint beforehand and therefore
leads to a disproportionate quantum of medical and economic expenses 4.

In allopathy, this is treated by Analgesics, Anti-inflammatory agents, Corticosteroids, Muscle relaxants, Calcium
and Vitamin D supplements, Lumbar Belt, Traction, and Physiotherapy to offer. But these medicines have egregious
side goods which limit their use for a long period. Further, progressive worsening of symptoms may affect in
Lumbar conduit Stenosis, which needs surgical intervention like Hemi facetectomy, Laminectomy Slice excision,
etc. with due threat.5

This outcome generates an opportunity for Ayurveda to manage it with conservative treatment, therapies or
interventions which are cost-effective, day-care procedure, easy to perform along with its low economical expense
and having less side effects.

Aims And Objectives:-

1. To Compile the reference ofKatisandhigataVata (Definition, Nidana, Lakshana and Chikitsa) mentioned in
various classical texts and bring it under the same
2. To analyse Nidana Panchaka of theKatisandhigataVataand the etio-pathogenesis of the lumber spondylosis.
3. To evaluate the treatment modalities useful for the management of the disease.

Definition
Charakamentioned that when vitiated Vataget localized inSandhiand produce sign and symptoms like
Sandhishool(pain in joint), Vataapurnadrutisparsh, Sotha (swelling), PrasaranaakunchanyopravartischVedna(pain
on movement of joint)6

Nidana
SamanyaNidana–
Nidanafor SandhigataVata is not given individually butNidanaofVataVyadhiis considered asNidanafor
SandhigataVata

VishesaNidana7:
Special causative factors are as shown in Table 1

Table 1:- Nidana for VataVyadhi.

Aharaja Hetu Viharaja-Hetu Mansika Hetu
 Ruksha  Ativyavaya excessive indulgence of
 Sheet  Atiprjagre  Chinta
 Alpa  Vishamupacharat  Sok
 Laghu  Dosh asriksravanata  krodh
 Abhojanat  Plawana
 Ativyayama
 Atichesta
 Dukhsaiyasaishana
 Divaswapna
 Vegsandharana
 Gajo-Ustra-ashaw-
shigrayanata

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In addition to above Charaka also mentioned Nidana as Dhatukshaya, Abighatat and Marmaghata as a Nidana for
VataVyadhi
AcharyaSushruta also mentioned some VyadhijaHetu as cause of Katishool or Katigraha-
1. PurvarupaofBhagandara- “Katikapaal Vedna “
2. LakshanaofVankshan-” Vidradhi -Katiprusthgrahstivro”
3. PurvarupaofVridhi- “VastikatimushakmedresuVedna”
4. AsanprasavaLakshana – “KatiprusthamPratiSamantadvedna”

SAMPRAPTI8
Vata Prakopaka Nidana Atisevana

Vata Prokopa

Roksya,ParushayaandKharaGunaVridhiatSrotas

Dhatu khsaya

Rikta Srotas vayupuran

Vivid vat Vyadhi

Kati Sandhi Khavaigunya

Kati Sandhi Gata Vata

Samprapti-Ghataka as per shown in Table 29

Table 2:- Samprapti-Ghataka of SandhigataVata.
Samprapti Ghataka of Sandhigata Vata
Doshas  Vat-Pradhan: Inkshayajanya-sandhigatvata
 Vat-kaphpradhan: Inupstambhit-sandhigatvata According to Sushruta
Dushya Rasa, Rakta, Mansa, Sira, Asthi
Agni Jatharagni & Dhatvagni-Mandya
Srotas Ashtivaha Srotas
Srotodusti Prakara Sanga & Vimargagamana
Udbhavasthana Pakwashaya
Adhisthana Sandhi (Kati)
Vyadhi Marga Bahya Marga

Purvarupa-
No specific description is available for Kati-SandhigataVaita but Purvarupa of VataVyadhi can be considered as
Purvarupa of SandhiGata Vata which is also given as” AvyaktanamLakshana”10.

Roopa/Lakshana–
Clinical signs and symptoms as per different Ayurvedic literature is mentioned in Table 3

Table 3:- Roopa/Lakshana according to various classic.

S.N. Lakshana C.S. S.S. A.H. A.S. M.N. B.P. Shodala Y.R*.
1 Vatapurnadritisparsh + - + + - - -

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2 Shotha + + + + - + +
3 Prasarana Akunchanyo + - + + - - -
Pravartisch Vedna
4 Hantisandhi - + - - + + +
5 Shoola - + - - + + +
6 Atopa - - - - + - -
*C.S.- Charaka Samhita, S.S- Sushruta Samhita, A.H. Ashtanga Hridayam, A.S.- Ashtanga Samgraha, M.N.-
Madanapala Nighantu, B.P.- Bhavaprakasha, Y.R.- Yogaratnakara
Sadhyata-Asadhyata-
If SandhigataVata is occurs newly, having strong immunity not making any complication than it is Sadhya.
Otherwise, it is KrichhaSadhya. More over if there is dominance of the VataDosha& patients develop complication
of VataVyadhi then it is Yapya11

SandhigataVatais one of the VataVyadhi, therefore it is Kasthasadhyabecause it occurs in aged people and is
situated in Marmasthana, it is MadhyamaRogaMarga, and it is Asthi, and Majja Dhatu Ashrita12

Chikitsa –
Aim of all the treatment modalities described in Ayurveda is to control the Vatadosha and increase the
ShleshakaKaph in Kati Sandhi to its proper functioning with suppression of other associated symptoms. Various
aspects of treatment are mentioned for SandhigataVata according to various classics which are listed below

AcharyaSushruta had given a variety of modalities such as when VataDosh situated in Snayu and Sandhi can be
managed by Snehana, Upanaha, Agnikarma, Bandhan and Mardanakarma13 and aggravated Vatalocalized in whole
body then Siravedha should be done and if it is localized in one place then ShringaYantra can be used to manage
it 14.Use of Kshaum, Karpas, or Karnika made bandage is used tie at various part of body where there is Shoola and
Stambha15.

In CharakaSamhita it is stated that it can be cured as “BahyabhyantaraSneheastimajjagatjaye” which indicate the

application of BahayaSnehana (external massage by oil) and AbhyantaraSnehapana (taking of ghee, oil by orally)16
As SandhigataVata is MadhyamaMargagata disorder in which Vata gets localized in Sandhi. Hence to manage it
drugs acting on both VataDushti and AsthiDhatu should be chosen. Considering this point, Basti medicated with
TiktaDravya, Ghrita and Ksheera is specially recommended in treatment of AshtivahaSrotodusti. 17

According to AcharyaVagbhataVata situated in Katisandhi can be treated by Snehana, Chhedan and

UpanahaKarma18

Yogaratnakara also supported the protocol of Shusruta to some extent, in which treatment is given as, Agnikarma,
Snehana, SwedanforSandhigataVata.

Bhavaprakash mentioned Dahana, Snehana, Upanaha as a therapeutic modality along with this he also mentioned
use of Indervarunimool and Pippali in KarshaMatra with honey. 19Other various treatment modalities by different
classics of Ayurveda are mentioned in Table 4.

Table 4:- Treatment modalities by various classics.

S.N. Treatment modality C.S. S. S A.H. Y.R. B.P.
1 Snehana + + + + +
2 Upanaha - + + + +
3 Agnikarma - + + + +
4 Shringa yantra - + - - -
5 Bandhan karma - + - - -
6 Mardana karma - + - - -
7 Basti karma + - - - -
8 Aushadha karma - - - - +

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Pathya-Apathya
Use of Sarpi, Tail, Vasa, Majja, Abhyanga, Basti, Snehana, Swedana, useofNivatasthan, Pravarana, Mansa Rasa,
Kshira, Madhur -Amala- Lavana Rasa, Bhojana and Bhranhana Dravya intake.20

Modern Review of Low Back Pain

Low back pain is a common clinical presentation of musculoskeletal disorders due to spinal pathology and lumbar
spondylosis is responsible for about 10% of all back pain. It is characterized by progressive loss of function and
painful lumbar joint movements21

Etio-Pathogenesis
The high prevalence of contemporaneous degenerative changes to the intervertebral disk, vertebral body,
and associated joints suggestsa progressive anddynamic medium, with
interdependent changes being secondary to disk space narrowing. Intervertebral disks are believed to undergo First”
Degenerative cascade” of three overlapping phases that may occur over the course of decades.

Phase I (Dysfunction Phase)

initially effects of repetitive microtrauma with the development of circumferential painful tears of the outer,
innervated anulus, and associated endplate separation that may compromise disk nutritional supply and waste
removal. Similar tears may coalesce to come radial tears, further prone to protrusion, and impact the disk
capacity to maintain water, performing in desiccation and reduced disk height. Crevices or tears may come ingrown
by vascular tissues and nerve endings, adding innervation and the disk‟s capacity for pain signal transmission.

Phase II (Instability Phase)

is characterized by the loss of mechanical integrity, with progressive disk changes of resorption, internal disruption,
and additional annular tears, combined with further facet degeneration that may induce subluxation and instability.

Phase III (Stabilization Phase),

continued disk space narrowing and fibrosis occurs along with the formation of osteophytes and trans discal lead to
further mechanical progression, building upon this degenerative cascade of the intervertebral disk, and result into
several implications of disk space narrowing.

Narrowed Intervertebral canal‟s dimensions get approximated by adjacent pedicles. Due to rebounding of
longitudinal ligaments, laxity allows bulging of ligamentum flavum and spine instability potential. Increased spine
movement permits subluxation of the superior articular process (SAP), causing a narrowed anteroposterior
dimension of the intervertebral and upper nerve root canals. Laxity may also translate into altered weight
mechanisms and pressure relationships on vertebral bone and joint spaces believed to influence osteophyte
formation and facet hypertrophy to both inferior and superior articular processes with risks for projection into the
intervertebral canal and central canal, respectively. Oblique orientations of the articular processes may further cause
retro-spondylolisthesis, with resulting anterior encroachment of the spinal canal, nerve root canal,and intervertebral
canal22

Clinical Features
Symptoms begin as low backache, initially worst during activity, but later present almost all the time. There may be
a feeling of „a catch‟ while getting up from a sitting position, which improves as one walks a few steps. Pain may
radiate down the limb up to the calf (sciatica) because of irritation of one of the nerve roots. There may be
complaints of transient numbness and paraesthesia in the dermatome of a nerve root, commonly on thelateral side of
leg or foot (L5, S1roots) respectively23

Treatment
It is a degenerative condition so it cannot be prevented to further progression but there are several majors to pain
relief and stiffness reduction to some extent.

Conservative
1. NSAIDs like ibuprofen, diclofenac, ketorolac etc.
2. Opiates intake- Codeine, oxymorphone etc.
3. Muscle relaxants – Serretopeptidase and tranquilizers like Tricyclic antidepressants

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4. Epidural steroidal injection

5. Surgical management like Laminectomy, spinal decompression surgery etc.

Discussion:-
KatisandhigataVata is not described in detail but Panchnidana of VataVyadhi is well explained in ayurvedaclassics
in which Nidana include the VataProkopaAharaja, Viharaja, MansikaHetu. Its disease of Vriddhaavastha in which
there is pre-dominance of Vatadosha which further increase its prevalence. And Sandhi is a union of Asthi which is
Ashrya of Vata dosh so as its vitiation progress, its RukshaGuna also increases which lead to Dhatukshaya and
Snehansh reduction So Asthi and Sandhi related Vikaras also show progression.

SampraptiChakra and sign and symptoms also suggest that Shotha, Shoola,
PrasaranaAkunchanyoPravartischVedna and Stambha of KatiSandhi which are very similar to degenerative
disorders of modern science.

To treat SandhigataVata all the classics aims to manage the VataDosh and to again increase the Snehans in Asthi-
Sandhi. and as a favor to this from above we can say that all the classics mentioned the use of Snehana and
UpanahaKarma which will control RukshaGuna of Vatadosha. Agnikarma also has a UshanaGuna property which
will control Vatadosha and KaphaDosha both. Rest of modalities like Bandhankarma, Shringayantra based
Raktamokshana and AushadhaKarma also aim for the same.

Conclusion:-
KatisandhigataVata is a very peculiar entity to manage with modern treatments available but remedies mentioned in
Ayurveda classics may boost up the options to manage it with less efforts, maximum benefits, and least side effects.

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