CONCLUSION

The present study demonstrates that both Ethnic Marma Therapy and Wet Cupping Therapy are effective in the management of Griva Sandhigata Vata with special reference to cervical spondylosis. Each therapy produced a highly significant reduction in Griva sandhi shoola and Griva sandhi stambha, a highly significant gain in all six directions of cervical movement, and a highly significant fall in the Neck Disability Index, every one of these changes carrying a p value of 0.001. Both groups moved from the range of moderate disability before treatment to the range of no or minimal disability after treatment, which indicates that the functional recovery obtained was not merely statistical but of a magnitude that patients would recognise in daily life.

On comparison between the two groups, not one of the fifteen outcome comparisons reached the conventional threshold of significance. The mean change in pain gave p = 0.374, stiffness gave p = 0.124, the Neck Disability Index gave p = 0.740, the associated complaints gave p values from 0.394 to 0.577 and the six cervical movements gave p values from 0.210 to 1.000. The null hypothesis, that Ethnic Marma Therapy and Wet Cupping Therapy are equally effective in the management of cervical spondylosis, is therefore accepted, and both alternative hypotheses are rejected. This acceptance should be read as an absence of demonstrated difference rather than as positive proof of equivalence, since fifteen patients in each group provide limited power to detect a modest difference. The consistent numerical advantage of Group A in the two subjective parameters, 68.24% against 57.54% in pain and 65.97% against 56.15% in stiffness, together with the p value of 0.124 for stiffness, represents a trend in favour of Ethnic Marma Therapy that a larger trial might resolve.

Since the two procedures deliver comparable benefit, the choice between them may reasonably rest on considerations other than efficacy, and here the difference in invasiveness becomes decisive. Ethnic Marma Therapy requires no instrument, breaks no skin and carries no risk of haemorrhage or infection, whereas wet cupping involves scarification with the attendant possibility of bleeding, skin discoloration, rash, transient increase in pain and local infection. Where two treatments are equally effective, the less invasive is ordinarily to be preferred, and this consideration weighs particularly in elderly patients, in those receiving anticoagulant therapy and in those with impaired glycaemic control. Neither therapy required any internal medication, which is a further advantage in patients for whom the prolonged use of non-steroidal anti-inflammatory drugs is hazardous.

It is concluded that Ethnic Marma Therapy deserves a wider place in the conservative management of Griva Sandhigata Vata than it presently occupies, and that Wet Cupping Therapy remains a reasonable alternative where local evacuation is specifically indicated and the contraindications to scarification have been excluded. The findings are limited by the small sample, the open-label design, the absence of a sham-controlled arm and the lack of long-term follow-up, and they should therefore be confirmed by an adequately powered multicentric trial incorporating a placebo arm and a follow-up period of not less than six months, so that the durability of the response and the rate of recurrence can also be established.