Rajiv Gandhi University of Health Sciences

Bengaluru, Karnataka

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A CRITICAL STUDY ON THE CONCEPT OF UTTARABHAKTIKA SNEHA AND ITS EFFICACY IN THE MANAGEMENT OF MANYASTAMBHA”

BY,

DR. TRUPTI C BALULMATH

PG SCHOLAR

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA, HUBBALLI- 580 024

GUIDE,

DR. J. R. JOSHI

                       M.D (Ayu)

PROFESSOR AND H.O.D

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA

AYURVEDA MAHAVIDYALAYA, HUBBALLI- 580 024

CO-GUIDE,

DR. SOURABHA KOKATNUR

M.D.(Ayu), PGDPCAP, PhD

ASSOCIATE PROFESSOR

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA

                            AYURVEDA MAHAVIDYALAYA, HUBBALLI- 580 024

2023-2024

AYURVEDA MAHAVIDYALAYA

HUBBALLI- 580024

From,

DR. TRUPTI C BALULMATH

             P.G Scholar,

             Department of Post Graduate Studies Ayurveda Samhita and Siddhanta

             Ayurveda Mahavidyalaya

             Hubballi – 580024

TO, 

THE REGISTRAR,

             Rajiv Gandhi University of Health sciences

             Bengaluru, Karnataka.

Through,

The Principal and

The Head of the Department of Post Graduate Studies in Ayurveda Samhita and Siddhanta.

            Ayurveda Mahavidyalaya,

            Hubballi- 580024.

 Respected sir,                 

Sub:  Submission of Completed Proforma for Registration of subject for Dissertation.

  I request you to kindly Register the below mentioned subjects against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bengaluru for partial fulfilment of   M. D (Ayu) in Ayurveda Samhita and Siddhanta.

TITLE OF DISSERTATION:

“A CRITICAL STUDY ON THE CONCEPT OF UTTARABHAKTIKA SNEHA AND ITS EFFICACY IN THE MANAGEMENT OF MANYASTAMBHA”

 Here, I am enclosing a completed proforma for registration of subject for dissertation.

Thanking you,

Place: Hubballi                                                                                    Yours faithfully

Date:                                                                              (DR.TRUPTI C BALULMATH)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.   NAME OF THE CANDIDATE :          DR. TRUPTI C BALULMATH

      AND ADDRESS                                     1^st Year P.G. Scholar             

DEPARTMENT OF POSTGRADUATE

STUDIES IN AYURVEDA SAMHITA AND SIDDHANTA,

AYURVEDA MAHAVIDYALAYA,

HUBBALLI- 580 024.

       PERMANENT ADDRESS :                 DR. TRUPTI C BALULMATH                     

                                                                        C/O CHANNAYYA

                                                                        PLOT NO. 3, 23^RD CROSS,

                                                                        MANAGULI  LAYOUT, VIDYAGIRI 

                                                                        BAGALKOT

                                                                        PIN - 587102

2.   NAME OF THE INSTITUTION:        AYURVEDA MAHAVIDYALAYA,

                                                                       HUBBALLI - 580024

3.   COURSE OF STUDY AND:                DOCTOR OF MEDICINE(AYURVEDA)   

                        SUBJECT                            AYURVEDA SAMHITA AND SIDDHANTA

4.   DATE OF ADMISSION:                     04/12/2023

TO THE COURSE         

5. TITLE OF TOPIC: “A CRITICAL STUDY ON THE CONCEPT OF UTTARABHAKTIKA SNEHA AND ITS EFFICACY IN THE MANAGEMENT OF MANYASTAMBHA”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

The word ‘Sneha’ is derived from the Sanskrit root ‘Snih’(Visheshana). It means ‘to render affection’, or ‘to render lubrication’¹. Adding suffix ‘lyut’ with this root makes the word ‘snehana’². Snehana is one among the shadvidhopakramas mentioned by Acharya Charaka³. The procedure which brings about snigdhata, vishyandata, mruduta and klinnata in the body is called as Snehana⁴. The gunas of snehana dravya are guru, sheeta, sara, snigdha, manda,  sookshma, mrudu and drava⁵.

        Acharya Sushruta describes that sneha is the saara of purusha.The prana of purusha is supported as well as protected by the Sneha⁶. Acharya also explains the benefits of Snehapana as-the person will have deeptagni, parishuddha koshta, pratyagra dhatu, bala and varna. He will have dhridendriya, his aging process will be delayed and he lives for hundred years⁷.

        Sneha can be used as both Abhyantara and Bahya. Acharya Vagbhata says that the sneha given before, in the middle and after the meals cures the diseases of adhobhaga, madhyabhaga and urdhwabhaga respectively and also gives strength to those parts of the body⁸.

        Uttarabhaktika sneha refers to the sneha which is given after food. It is a brumhana type of vicharana sneha. It is also called as Urdhwabhaktika sneha, Auttarabhaktika sneha, Bhaktopari sneha etc. There are references of using this type of sneha in diseases like Avabahuka, Vata-Pittaja Kasa, Vataja Swarabheda, Bahushosha, Bahu-sheershagata vyadhi, Karnashoola, Vataja Abhishyanda, Kshavathu vegavarodhajanya vikaras etc⁹.

        A healthy life has been a cherished wish of man since ages. But in present era, human life has become more stressful and is suffering with various degenerative disorders due to change in lifestyle, food habits, travelling, lack of exercise, sitting for long time in one position etc.

         Manyastambha is one of the Vataja Nanatmaja Vikara which manifests in the Manya Pradesha. ‘Manya’ refers to ‘Greevayaha paschat shira’¹⁰ which means ‘back or nape of the neck’. ‘Stambha’ refers to ‘Nischalikarana’¹¹ which means ‘rigidity, stiffness or immovable’. Thus Manyastambha is a clinical presentation in which there is pain and restricted movements of the neck.

        Acharya Charaka and Acharya Vagbhata have explained that when the Vata gets localized in the Manya and gets spread into the Antarnaadi, it causes Manyastambha^12,13. Acharya Sushruta has described specific Nidanas for manifestation of Manyastambha as-Divaswapna, Vishama Sthana Shayana and Adhika Urdhwa Nirikshana. Due to these reasons, the Kupita Vata will get Avrita by the Kapha leading to Manyastambha Roga¹⁴. This can be compared with Paraspinal muscular spasm of cervical region.

         Paraspinal muscles run along the length of spinal column. They enable the spine to extend, rotate and bend. These muscles remain attached to the spine and coordinate the movements of the spine and stabilize it. Paraspinal muscle spasm of cervical region can be defined as persistent, involuntary muscle contraction which can range from minor discomfort with accompanying stiffness to a sudden, tight and intense neck pain. In the general population, the point prevalence of neck pain ranges from 0.4% to 41.5%, the 1-year incidence ranges from 4.8% to 79.5%, and lifetime prevalence may be as high as 86.8%¹⁵.

          In Manyastambha, there will be Vyana Vata Dushti. Acharya Vagbhata has mentioned that in Vyana Vata Dushti, after the pratah bhojana, the aushadha should be given¹⁶. The medicine is to be administered in the morning because the site of vyaana vayu is considered to be hridaya. Acharyas have stated that as every flower blooms in the morning everyday, similarly every morning heart also blooms, activating vyaana vayu in it. Thus the medicine administered in the morning will reach hridaya and will act properly on vyaana vaayu. The medicine should be administered after meal, as the vyaana vaayu gets activated after the digestion of food and formation of ahara rasa. Thus the administered medicine is carried along with the vyaana vaayu and helps to cure the diseases related with vyaana vaayu¹⁷.

          The mode of Uttarabhaktika Sneha is through the Nasa Marga, i.e., by the procedure of Nasapana. Nasapana is a special procedure which can be considered as a modification of Nasya where the Aushadhi instilled into the nostril is to be swallowed and is mainly practiced in Vatavyadhi, specifically Urdhwajatrugata Vyadhi¹⁸. In this study, Palasha Kshara Ghrita¹⁹ is used for Nasapana. 

           Movement is an important characteristic feature of human body. Ayurveda explains that Vata is responsible for all the activities and movements, and its derangement leads to loss of body movement.  Manyastambha is one of the Vatavyadhi in which there is pain and restricted movements of the neck, which hampers easy neck movements.

           So this study, “A CRITICAL STUDY ON THE CONCEPT OF UTTARABHAKTIKA SNEHA AND ITS EFFICACY IN THE MANAGEMENT OF MANYASTAMBHA” is an attempt to understand and analyze the action of Uttarabhaktika Sneha in Manyasthamba.

6.2 REVIEW OF THE LITERATURE:

1. Review on the concept of Uttarabhaktika Sneha .

2. Review on Manyastambha as per Ayurvedic classics.

3. Review on paraspinal muscle spasm of cervical region.

4. Review on efficacy of Uttarabhaktika Sneha in Manyastambha.

PREVIOUS WORK DONE:

1.Dr. Vishnu P.R. – A clinical study of effect of Karpasasthyadi Taila Nasya in the management of Manyastambha. Bhagwan Mahaveer Jain AMC Gajendragad. 2010

2.Dr. Unnikrishnan V.S. – A comparative clinical study to evaluate the efficacy of Nasya and     Nasapana along with Shamanoushadhi in the management of Manyastambha w.s.r to Cervical Spondylosis. Ayurveda Mahavidyalaya Hubli.  2016

3.Dr. Palak Rathod - A comparative clinical study to evaluate the effect of Trayodashanga  Guggulu with Nasya Karma and Rasnadi Guggulu with Nasya Karma in the management of Manyastambha w.s.r to Cervical Spondylosis. Sri Kalabyreshwara Swamy Ayurvedic Medical College Hospital & Research Centre, Bangalore. 2017

4.Dr. Harsha Hamza P – A clinical study on the efficacy of Nagara Taila Snehapana in Manyastambha. KVG Ayurveda Medical College & Hospital, Sullia. 2019

6.3 AIM OF STUDY:

       To critically analyse the concept of Uttarabhaktika Sneha and its efficacy in the       management of Manyastambha.

6.4 OBJECTIVES OF STUDY:

      1. To study the concept of Uttarabhaktika Sneha from Ayurvedic classics

      2. To study the concept of Manyastambha from Ayurvedic classics

      3. To evaluate the effect of Uttarabhaktika Sneha in Manyastambha.

6.5 HYPOTHESIS:

       H0- Uttarabhaktika Sneha is not effective in the management of Manyastmabha.

       H1- Uttarabhaktika Sneha is effective in the management of Manyastambha.

7. MATERIALS AND METHODS:

     The present study entitled “A CRITICAL STUDY ON THE CONCEPT OF       UTTARABHAKTIKA SNEHA AND ITS EFFICACY IN THE MANAGEMENT OF MANYASTAMBHA” will be done with following materials.

7.1 SOURCE OF DATA:

1)      Literary study will be on the data compilations from the Bruhatrayees, and other classical books, including peer Reviewed journals, UGC approved articles and journals, presented papers, previous work done which are available in the central and departmental library of Ayurveda Mahavidyalaya, Hubli.

2)      In the present study the research scholar proposes to take the subjects attending the OPD and IPD of HASS’s Ayurveda Mahavidyalaya Hospital, Hubli.

7.2METHOD OF COLLECTION OF DATA:

Ø Literary Data-will be collected from Post Graduate Library Department of Ayurveda Samhita and Siddhanta, Ayurveda Mahavidyalaya & Hospital Hubli, Authentic Research Journals, Websites and Digital Publications.

Ø Clinical Data- will be collected from the Subjects suffering with Manyastambha attending the OPD and IPD of Ayurveda Mahavidyalaya & Hospital, Hubli fulfilling the inclusion criteria as per the proforma will be selected for the study.

Ø A clinical evaluation of Subjects will be done by collection of data through information obtained by history, physical examination.

Ø  Statistical test: The data which are obtained by the clinical trial will be statistically analysed by applying Wilcoxon signed-rank test.

Ø  The drug required for the clinical study will be procured and prepared in the Post Graduate Department of Rasa Shastra and Bhaishajya Kalpana, Ayurveda Mahavidyalaya, Hubli.

DIAGNOSTIC CRITERIA: Subjects presenting with classical lakshanas of Manystambha

A.Stambha (restricted movements) in Manya Pradesha

B.Shoola (pain) in Manya Pradesha

INCLUSION CRITERIA:

1.Subjects of age group- 30 to 60 years of either sex

2.Subjects presenting the classical symptoms of Manyastambha

3.Subjects fit for Nasapana

EXCLUSION CRITERIA:

1.Subjects with history of trauma with deformity.

2.Subjects with obstructive nasal pathologies like nasal polyp, DNS etc.

3.Subjects unfit for Nasapana

4.Subjects of Diabetes and Hypertension

PARAMETERS OF STUDY:

7.2 A) SUBJECTIVE PARAMETERS:

        1.Shoola (pain)

        2.Stambha (stiffness)

7.2 B) OBJECTIVE PARAMETERS :

       Range of movements – flexion, extension, lateral bending, rotation

GRADATION OF PARAMETERS:

Subjective parameters

a.Muscular spasm

Modified Ashworth Scale

b.Pain

Numeric Rating Scale

Objective Parameters

Range of movements

a.Flexion

b.Extension

Rotation

Lateral flexion

STUDY DESIGN:

         It is clinical study with 30 subjects of Manyastambha fulfilling the inclusion criteria will be taken from the O.P.D, I.P.D and Medical camps conducted by A.M.V & H Hubli. The parameters of signs and symptoms will be graded on the basis of the standard method of Statistical analysis.

SAMPLE SIZE:

A minimum of 30 subjects will be selected.

ASSESSMENT CRITERIA:

The data which are obtained by the clinical trial will be statistically analysed by applying Student’s One sample Wilcoxon signed-rank test. Reduction in subjective and objective parameters before and after the treatment will be assessed and the result will be recorded as:

Results                                                         Response of the patient

Marked reduced in parameters              - 76%- 100% reduce of signs and symptoms

Moderately reduced in parameters       - 51%- 75% reduce of signs and symptoms

Mild reduce in parameters                     - 26%- 50% reduce of signs and symptoms

No reduction in parameter                     - 0% - 25% reduce of signs and symptoms

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly. – YES

a.RBS

b.X-Ray PNS

c.MRI Screening – Cervical Spine (if necessary)

INTERVENTION:

A minimum of 30 cases diagnosed as Manyastambha will be selected and analysed.

Intervention – Uttarabhaktika Sneha (by Nasapana)

·         Dravya – Palasha Kshara Ghrita

·         Matra – 1 Pala (48 ml)

·         Aushadha Sevana Kala – Adhobhakta (after Pratah Bhojana) ; excluding Varsha Rutu

·         Duration – 5 days

·         Follow up – Every 15^th day

·         Total duration of Study – 45 days

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

‘YES’.

Ethical clearance has been obtained by the ETHICAL COMMITTEE constituted by   AYURVEDA MAHAVIDYALAYA AND HOSPITAL, HUBBALLI and written consent will be taken by each individual patient or by an attendant if the patient is illiterate, in a printed consent form.

8. LIST OF REFERENCES:

1.      Vasant C. Patil. Further clinical study on Standardization of Shodhanartha Snehapana [MD Dissertation]. Jamnagar : IPGT & RA Jamnagar; 2006.

2.      Mukundilal Dwivedi. Ayurvediya Panchakarma Chikitsa. Delhi:Chaukhamba Sanskrit Pratishthan; 2012. Chapter 2, Purvakarma Parichaya; p.66

3.      VdYadavjiTrikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 13^th chapter, Verse No.3-4, Chaukhambha Surbharati Prakashan, Varanasi, 2023: Page No. 120.

4.      VdYadavjiTrikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Sutra Sthana 13^th chapter, Verse No. 11, Chaukhambha Surbharati Prakashan, Varanasi, 2023: Page No. 120.

5.      Acharya Vagbhata, Ashtanga Hridayam with the commentaries: Sarvangasundari of Arunadatta and Ayurveda Rasayana of Hemadri, Sutrasthana 16^th chapter, Verse no. 1; Chaukhamba Orientalia, Reprint 2022, Page no. 243.

6.      Acharya Sushruta, Sushruta Samhita, Nibandhasangraha commentary by Dalhana, Chikitsa Sthana 31^st chapter, Verse no. 3; Chaukhamba Surbharati Prakashan, Reprint 2023, Page no. 507.

7.      Acharya Sushruta, Sushruta Samhita, Nibandhasangraha commentary by Dalhana, Chikitsa Sthana 31^st chapter, Verse no. 56; Chaukhamba Surbharati Prakashan, Reprint 2023, Page no. 512.

8.      Acharya Vagbhata, Ashtanga Hridayam with the commentaries: Sarvangasundari of Arunadatta and Ayurveda Rasayana of Hemadri, Sutrasthana 16^th chapter, Verse no. 22; Chaukhamba Orientalia, Reprint 2022, Page no. 248.

9.      Aswani P.S, Amritha M.S, Rohit K.S, G.K.Swamy, A Review on Snehapana with special reference to Autharabhaktika Snehapana, IAMJ:Vol.8, Isuue 3, March-2020, ISSN:2320 5091.

10.  Deva R.R., Shabdakalpadruma, Reprinted 3^rd ed, Delhi, Naga Publishers,2003:630.

11.  Acharya Sushruta, Sushruta Samhita, Nibandhasangraha commentary by Dalhana, Chikitsa Sthana 1^st chapter, Verse no. 27; Chaukhamba Surbharati Prakashan, Reprint 2023, Page no. 262.

12.  VdYadavjiTrikamaji Acharya, Agnivesha, Charaka Samhita with Ayurveda Dipika commentary by Chakrapani, Chikitsa Sthana 28^th chapter, Verse No. 43, Chaukhambha Surbharati Prakashan, Varanasi, 2023: Page No. 618.

13.  Acharya Vagbhata, Ashtanga Hridayam with the commentaries: Sarvangasundari of Arunadatta and Ayurveda Rasayana of Hemadri, Nidana Sthana 15^th chapter, Verse no. 22; Chaukhamba Orientalia, Reprint 2022, Page no. 532.

14.  Acharya Sushruta, Sushruta Samhita, Nibandhasangraha commentary by Dalhana, Chikitsa Sthana 1^st chapter, Verse no. 67; Chaukhamba Surbharati Prakashan, Reprint 2023, Page no. 262.

15.  Daniel T.Kuo; Prasanna Tadi, Cervical Spondylosis, StatPearls Publishing, National Library of Medicine, May 1 2023.

16.  Acharya Vagbhata, Ashtanga Sangraha, Sutra Sthana 23^rd chapter, Verse no. 13, Chaukhamba Sanskrit Series, Varanasi, 2006, Page no. 179.

17.  Dr. Nistha Nema and Dr. Praveen Kumar Mishra, A conceptual review of aushadha sevana kala in Ayurveda Siddhanta, 2018, 4(6), 56-61.

18.  Manasa Shetty, Vijaymahantesh Hugar, Varsha Kulkarni. Critical review on the concept of Nasapana. Journal of Ayurveda and Holistic Medicine, Vol-9, Issue-5 (May 2023).

19.  Sri Sadananda Sharma, Rasa Tarangini, 14^th chapter, Verse no. 102.

09. SIGNATURE OF CANDIDATE:

10. REMARKS OF GUIDE: Trial will be conducted under my direct Supervision.

The synopsis of the dissertation is forwarded for needful action.

11. NAME AND DESIGNATION OF:

11.1 Guide:                                            DR. J R JOSHI, M.D (Ayu)

     PROFESSOR AND HEAD OF THE DEPARTMENT

                                                  DEPT. OF POST GRADUATE STUDIES IN

                                                   AYURVEDA SAMHITA AND SIDDHANTA

                                                               AYURVEDA MAHAVIDYALAYA, HUBLI.

11.2 Signature:

11.3 Co-guide:                                      DR. SOURABHA KOKATNUR

                                                                                                 M.D (Ayu), PGDPCAP, PhD

                                                               ASSOCIATE PROFESSOR

                                                               DEPT. OF POST GRADUATE STUDIES IN    

                                                               AYURVEDA SAMHITA AND SIDDHANTA                                                   

                                                               AYURVEDA MAHAVIDYALAYA,

                                                               HUBLI.

11.4 Signature:

11.4 Head of the Department:             DR. J R JOSHI, M.D (Ayu)

   PROFESSOR AND HEAD OF THE DEPARTMENT

                                                  DEPT. OF POST GRADUATE STUDIES IN

                                                   AYURVEDA SAMHITA AND SIDDHANTA

                                                               AYURVEDA MAHAVIDYALAYA,

                                                               HUBLI.

11.5 Signature:

12. REMARKS OF THE PRINCIPAL: Forwarded for needful action

12.1 Principal:                                           DR. PRASHANTH A S

                                                                                 M.D (Ayu) Ph.D.

                                                                    PRINCIPAL

                                                                    AYURVEDA MAHAVIDYALAYA,

                                                                    HUBLI-580024

12.2 Signature: