R.B. Patil et al / Int. J. Res. Ayurveda Pharm.

5(3), May - Jun 2014

Research Article
www.ijrap.net

EVALUATION OF THE EFFICACY OF MANYABASTI WITH NARAYANA TAILA AND

SHASHTIK SHALI PINDA SWEDA IN THE MANAGEMENT OF MANYASTAMBHA
WITH SPECIAL REFERENCE TO CERVICAL SPONDYLOSIS
R.B. Patil1*, R.R. Gayal2
1
Lecturer, Department of Panchakarma, Hon Shri A. D. A. M. C. Ashta, Maharashtra, India
2
Professor, Department of Kayachikitsa, B. S. D. T. Wagholi, Maharashtra, India

Received on: 18/04/14 Revised on: 12/05/14 Accepted on: 23/05/14

*Corresponding author
Ravikumar B. Patil M.D. (Panchakarma), Ph.D. (Scholar), Lecturer Department of panchakarma, Hon Shree Annasaheb Dange Ayurvedic medical
college, A/P Ashta, Taluka Walwa, Dist. Sangli, Maharashtra 416301 India E-mail: vaidyaravipatil@gmail.com
DOI: 10.7897/2277-4343.05361

ABSTRACT
Because of unwholesome life style, professional stress, workload people are more susceptible for various degenerative disorders. The Cervical
Spondylosis is one of the commonest degenerative condition by which the larger group of community has been affected. By considering the sign and
symptoms of cervical spondylosis it can correlate with Manyastambha. There are medicinal and surgical treatment approaches to treat this condition
which is often associated with many adverse effect. In Chakradatta it is elaborated that narayan tail is effective in manyastambha. Shashtik shali pinda
sweda is having properties like brimhana and vatashamaka which will be effective in manyastambha. Hence the present comparative study was
undertaken to assess the efficacy of manyabasti with narayana tail and shashtikshali pinda sweda in manyastambha with reference to cervical
spondylosis. The 30 patients fulfilling the inclusion and exclusion criteria were randomly divided in two groups. The assessment was done before,
after treatment and at follow up. The total duration was 21 days. Assessment were done by using subjective parameter as neck pain, stiffness and
objective parameter as measurement of various range of cervical movements with goniometry i.e. flexion, Extension, Rt. Lateral flexion and Lt.
lateral flexion. Within group comparison both procedures had shown effective results after treatment in all the parameters. The statistically significant
improvement were observed in both the groups. Both procedures had shown effective results after treatment in all the parameters. Both groups are
effective at follow up in rt. and lt. lateral flexion. Apart from this Shashtik group is effective at follow up in flexion and stiffness, this indicate that
shashtik is more effectively relieves the stiffness and spasm of muscles. The comparison between two groups showed no significant differences on
any parameter after treatment and at follow up. Thus indicates that these two procedures are effective in manyastambha. But among these two
procedures shashtik shali pinda sweda is more effectively relieves the stiffness and spasm of muscles
Keywords: Manyastambha, Cervical Spondylosis, Manyabasti, Narayan tail, Shashtik shali pinda sweda.

INTRODUCTION position of individual and family but also draining of

In present era human being is prone for numerous national resource due to work hour lost. Manyabasti is
degenerative problems, because of unwholesome life one of the panchakarma procedures which are effective in
styles, food habits and professional strain, in association manyastambha. Narayana tail is effective in
with road and traffic situation. The Cervical Spondylosis manyastambha.9 Shashtik shali pindasweda is unique
is one of the commonest degenerative, neurological procedure which may improve the strength of fibrous
condition by which the major population has been tissue increase movement and flexibility of the joints and
affected1,2. Most of the person above 40 years of age relives the pain.10 Hence after consideration of all these
shows significant radiological changes and a major aspects manyabasti and shashtikshali pinda sweda were
percentage among them develop symptoms. It is found selected for present study.
that half of the population develop cervical spondylosis at
the age of 50 years. By age 60, 70 % of women and 85 % Objectives of Study
of men show changes consistent with cervical spondylosis • To evaluate the efficacy of Manyabasti with Narayana
on x-ray. 3-5 By considering the sign and symptoms of Taila in the management of Manyasthambha w.s.r. to
cervical spondylosis it can correlate with Manyastambha. Cervical Spondylosis.
The Manyastambha is a vataja nanatmaja Vyadhi. The • To evaluate the efficacy of shashtikshali pinda sweda
symptoms are Ruk (pain) and Stambha (stiffness and in the management of Manyasthambha w.s.r. to
restricted movement) in manya Pradesh (cervical region). Cervical Spondylosis.
The Vata Dosha gets vitiated and takes ashraya at manya • To evaluate the comparative efficacy of Manyastambh
pradesha affecting the manya siras causing stambha and and shashtikshali pinda sweda in the management of
ruja of neck. Hence pain at manya Pradesh and stambha Manyasthambha w.s.r. to Cervical Spondylosis.
of manya. The stambha is the resultant spasticity of neck
muscles, which stretches and makes neck stiff.6-8 Because Research Methodology
of its prevalence and unavailability of satisfactory Source of Collection of Data
management the particular alignment has become a For the present clinical study, the patients were randomly
challenge for health care providers. The modern treatment selected from the outpatient and inpatient department of
includes analgesics surgical procedures which is often Hon. Shree Annasaheb Dange Ayurvedic medical college,
associated with many adverse effects. Because of such Shree Dhanvantri hospital and research centre, Ashta.
problems it not only affects the social and economic This study conducted under the ethical clearance number

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ADAMC/RW/362-B/2013 dated 5/3/2013. 30 patients The oil were heated up to warmness over the water bath
who fulfil the inclusion criteria irrespective of sex, and poured slowly inside the ring
religion, economic and literary status were selected for Its uniform temperature was maintained throughout the
the study. process by replacing warm oil.

Study Design Pashchat Karma

Diagnostic Criteria Oil is removed by dipping cotton and squeezing in a
Patients with classical sign and symptoms of container, Dough were removed. The area is wiped off
manyastambha with that of cervical spondylosis i.e., Pain and cleans properly.
at nape of neck. Restricted range of neck movements and
stiffness were selected for the clinical study. X-RAY Procedure for Shashtika Shali Pinda Sweda
cervical spine both AP and Lateral view showing changes Purva Karma
of cervical spondylosis. Preparation of Pottali: 150 g of shashtik shali was cooked
with 750 ml of milk and decoction of balamool. Two
Inclusion Criteria boluses were prepared out of it. Another 750 ml of milk
• Well diagnosed patients of Manyastambha (Cervical and decoction heated in low temperature to dip the
Spondylosis) boluses for warming the pottali.
• Patients between the age group of 25 to 70 years.
• Patients fit for Manyabasti and shashtikshali pinda Preparation of the Patient
sweda were selected. Patient was allowed to lie down in prone position
comfortably. Abhyanga was done with tila tail to
Exclusion Criteria Manyapradesh.
• Cervical vertebra fracture, cervical rib, Cervical canal
stenosis Pradhana Karma
• Ankylosing spondylitis, The warm pottalis (boluses) were applied in synchronized
• Brachial Neuralgia, manner over manyapradesha.
• Congenital torticollis. Precaution were taken that the heat of boluses should be
• Rheumatoid Arthritis bearable
The temperature of bolus was maintained throughout
Investigations procedure by alternate exchange of heated pottali.
· All the patients were subjected to X-RAY cervical
spine both AP and Lateral view. Pashchat Karma
· Blood: BSL(R), Total leukocytes count, Differential The paste remained over the body were scrapped off. The
leukocytes count, ESR, Hb area wiped off and cleans properly.
· Urine: Bile salt, Bile pigment, Albumin, Sugar
Subjective parameters
Intervention • Neck pain
This study was a comparative clinical study in between • Stiffness
two procedures Manyabasti and shashtikshali pinda
sweda. 30 patients were divided randomly in 2 groups Objective parameters
based on inclusion and exclusion criteria. Measurement of various ranges of cervical movements
Group A: In this group 15 patients were given with goniometry
manyabasti. • Flexion
Group B: In this group 15 patients were given • Extension
shashtikshali pinda sweda. • Rt. Lateral flexion
Follow up period: Follow up study was done for 14 days. • Lt. lateral flexion
Total duration: 21 days.
Grading
Procedure for Manyabasti Subjective parameters
Purva Karma
Table 1: Grading for the parameter neck pain
Preparation of Mashapishti
Black gram powder was mixed with sufficient quantity of Grade 1 No pain
water to make thick paste (dough). It is then rolled into Grade 2 Mild pain occasional / intermittent, relived on rest
flat slab like structure. Grade 3 Moderate pain frequent, pain relived after taking
pain killers
Grade 4 Severe pain, not tolerable, not relived fully even
Preparation of the Patient after taking pain killers.
Patient was allowed to lie down in prone position
comfortably. Table 2: Grading for the parameter neck stiffness

Pradhana Karma Grade 1 0 to 25 % restriction of movements.

Grade 2 25 % to 50 % restriction of movements.
Ring of black gram paste attached around the cervical Grade 3 50 % to 75 % restriction of movements.
region. Grade 4 75 % to 100 % restriction of movements.

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Objective parameters Table 10: Distributions of the patients as per Satva

The ranges of movements of the cervical spine were the
Satva Group A Group B Total
objective parameters selected for the present study. This No % No % No %
range of movement of the neck was measured with the Pravara 3 20.0 3 20.0 6 20.0
help of a goniometry as before, after and at follow-up. Madhyama 7 46.66 9 60.0 16 53.33
The readings were taken in degrees directly and Avara 5 33.33 3 20.0 8 26.66
observations were noted.
Table 11: Distributions of the patients as per Satmya

RESULTS Satmya Group A Group B Total

No % No % No %
Table 3: Age wise distribution of the patients Ekarasa 2 13.3 1 6.7 3 10.0
Sarvarasa 5 33.3 7 46.7 12 40.0
Age in Group A Group B Total Snigdhasatmya 3 20 4 26.7 7 23.3
Years No % No % No % Rukshasatmya 5 33.3 3 20.0 8 26.7
20-30 2 13.3 3 20 5 16.7
31-40 3 20 2 13.3 5 16.7 Table 12: Distributions of the patients as per Pramana
41-50 2 13.3 5 33.3 7 23.3
51-60 3 20 2 13.3 5 16.7 Pramana Group A Group B Total
61-70 5 33.3 3 20 8 26.7 No % No % No %
Pravara 2 13.3 1 6.7 3 10.0
Table 4: Distributions of the patients as per sex Madhyama 7 46.3 13 86.7 20 66.7
Avara 6 40 1 6.7 7 23.3
Sex Group A Group B Total
No % No % No % Table 13: Distributions of the patients as per Ahara Shakti
Male 8 53.33 9 60.0 17 56.66
Female 7 46.66 6 40.0 13 43.33 Ahara Group A Group B Total
shakti No % No % No %
Table 5: Distributions of the patients as per Occupational status Pravara 3 20 % 1 6.7 % 4 13.3 %
Madhyama 4 26.7 % 11 73.3 % 15 50.0 %
Occupation Group A Group B Total Madhyama 8 53.3 % 3 20.0 % 11 36.7 %
No % No % No %
Sedentary 3 20 5 33.33 8 26.66 Table 14: Distributions of the patients as per Vyayama Shakti
Active 5 33.33 6 40 11 36.66
Labour 7 46.66 4 26.66 11 36.66 Vyayama Group A Group B Total
shakti No % No % No %
Table 6: Distributions of the patients as per Economical status Pravara 1 6.7 3 20.0 4 13.3
Madhyama 8 53.3 6 40.0 14 46.7
Economic Group A Group B Total Avara 6 40.0 6 40.0 12 40.0
status No % No % No %
Poor 4 26.66 3 20 7 23.34 Table 15: Distribution of patients as per duration of illness
Middle 8 53.33 7 46.66 15 50
Rich 3 20 5 33.33 8 26.66 Duration in Group A Group B Total
Months No % No % No %
Table 7: Prakrutiwise distributions of the patients <6 5 33.3 2 13.3 7 23.3
6-12 5 33.3 6 40.0 11 36.7
Prakruti Group A Group B Total 12-24 4 26.7 5 33.3 9 30.0
No % No % No % >24 1 6.7 2 13.3 3 10.0
Kaphaja 3 20.0 2 13.3 5 16.7
Pittaja 4 26.7 5 33.3 9 30.0 Table 16: Distributions of the patients as per Mode of onset
Vataja 8 53.3 8 53.3 16 53.3
Mode of Group A Group B Total
Table 8: Distributions of the patients as per Sara Onset No % No % No %
Chronic 7 46.7 10 66.7 17 56.7
Sara Group A Group B Total Insidious 7 46.7 4 26.7 11 36.7
No % No % No % Acute 1 6.7 1 6.7 2 6.7
Pravara 3 20 1 6.7 4 13.3
Madhyama 7 46.7 9 60.0 16 53.3 Statistical Analysis
Avara 5 33.3 5 33.3 10 33.3
The analysis was done with a non parametric Kruskall
Table 9: Distributions of the patients as per samhanana Wallis test for between group and Wilcoxons signed rank
test for within group.
Samahnana Group A Group B Total
No % No % No %
Pravara 3 20 1 6.66 4 13.33
Madhyama 8 53.33 9 60 17 56.66
Avara 4 26.66 5 33.33 9 30

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Flexion Table 24: Statistical analysis of within group changes in Shashtik

Within group changes shali pinda sweda

RT. Lateral Flexion Z Asymp.sig.(2

Table 17: Statistical analysis of within group changes in Manyabasti tailed) P value
After-Before treatment -3.409 0.001
Flexion Z Asymp.sig.(2 Follow up- Before treatment -3.417 0.001
tailed) P value Follow up- After treatment -2.615 0.009
After-Before treatment -3.42 0.001
Follow up- Before treatment -3.41 0.001
Follow up- After treatment -1.7 0.09 Between Groups

Table 18: Statistical analysis of within group changes in Shashtik Table 25: Statistical analysis between two groups for Rt. lateral
shali pinda sweda flexion

Flexion Z Asymp.sig.(2 RT. Lateral Chi- Df Asymp.sig. .(2

tailed) P value Flexion Square tailed) P
After-Before treatment -3.417 0.001 Before treatment 6.612 1 .010
Follow up- Before treatment -3.41 0.001 After treatment 0.016 1 .899
Follow up- After treatment -2.716 0.007 Follow up 2.009 1 .156

Between Groups Lt. Lateral Flexion

Within group changes
Table 19: Statistical analysis between two groups for flexion
Table 26: Statistical analysis of within group changes in Manyabasti
Flexion Chi- Square Df Asymp.sig.
Before treatment .210 1 .646 LT. Lateral Flexion Z Asymp.sig.(2
After treatment .191 1 .662 tailed) P value
Follow up .270 1 .603 After-Before treatment -3.415 0.001
Follow up- Before treatment -3.411 0.001
Extension Follow up- After treatment -2.032 0.042
Within group changes
Table 27: Statistical analysis of within group changes in Shashtik
shali pinda sweda
Table 20: Statistical analysis of within group changes in Manyabasti
LT. Lateral Flexion Z Asymp.sig.(2
Extension Z Asymp.sig.(2 tailed) P value
tailed) P value After-Before treatment -3.182 0.001
After-Before treatment -3.297 0.001 Follow up- Before treatment -3.413 0.001
Follow up- Before treatment -3.411 0.001 Follow up- After treatment -3.115 0.002
Follow up- After treatment -1.64 0.101

Table 21: Statistical analysis of within group changes in Shashtik Between Groups
shali pinda sweda
Table 28: Statistical analysis between two groups for Lt. Lateral
Extension Z Asymp.sig.(2 flexion
tailed) P value
After-Before treatment -3.413 0.001 LT. Lateral Flexion Chi- Square Df Asymp.sig.
Follow up- Before treatment -3.418 0.001 Before treatment 1.443 1 .230
Follow up- After treatment -0.955 0.339 After treatment 10.212 1 .001
Follow up 10.480 1 .001
Between Groups
Pain scores
Table 22: Statistical analysis between two groups for extension Within group changes
Extension Chi- Df Asymp.sig. Table 29: Statistical analysis of within group changes in Manyabasti
Square
Before treatment .004 1 .948 Pain Z Asymp.sig.(2
After treatment 9.895 1 .002 tailed) P value
Follow up 11.551 1 .001 After-Before treatment -3.477 0.001
Follow up- Before treatment -3.482 0.001
RT. Lateral Flexion Follow up- After treatment -1.414 0.157
Within group changes
Table 30: Statistical analysis of within group changes in Shashtik
shali pinda sweda
Table 23: Statistical analysis of within group changes in Manyabasti
Pain Z Asymp.sig.(2
RT. Lateral Flexion Z Asymp.sig.(2 tailed) P value
tailed) P value After-Before treatment -3.453 0.001
After-Before treatment -3.42 0.001 Follow up- Before treatment -3.453 0.001
Follow up- Before treatment -3.417 0.001 Follow up- After treatment -1.414 0.157
Follow up- After treatment -3.195 0.001

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Between Group Lt. Lateral Flexion

The significant improvement noted in lt. lateral flexion
Table 31: Statistical analysis between two groups for pain score among both the groups after treatment (p = 0.001) and at
follow up (p = 0.001), in comparison with before
Pain Chi- Square Df Asymp.sig.
Before treatment 0.067 1 .796
treatment. Both the groups shown significant
After treatment 0.000 1 .983 improvement in lt. lateral flexion at follow up in
Follow up 0.002 1 .996 comparison with after treatment (M, p = 0.042 and. SSP p
= 0.002)
Stiffness
Within group changes Pain scores
The significant decrease noted in pain score among both
Table 32: Statistical analysis of within group changes in Manyabasti the groups after treatment (p = 0.001) and at follow up (p
= 0.001), in comparison with before treatment. Both the
Stiffness Z Asymp.sig.(2
tailed) P value groups shown no significant decrease in pain score at
After-Before treatment -3.0 0.003 follow up in comparison with after treatment (M, p =
Follow up- Before treatment -3.16 0.002 0.157 and. SSP p = 0.157).
Follow up- After treatment -1.0 0.32
Stiffness
Table 33: Statistical analysis of within group changes in Shashtik
shali pinda sweda The significant improvement noted in stiffness among
both the groups after treatment (M, p = 0.003, SSP, p =
Stiffness Z Asymp.sig.(2 0.004) and at follow up (M p = 0.002, SSP p = 0.001), in
tailed) P value comparison with before treatment. Also the shashtik
After-Before treatment -2.887 0.004
group shown significant improvement in stiffness at
Follow up- Before treatment -3.176 0.001
Follow up- After treatment -2.45 0.014 follow up in comparison with after treatment (p = 0.014).

Between Group In Between Group Comparisons

Kruskal Wallis test showed no significant differences
Table 34: Statistical analysis between two groups for stiffness between groups on any parameter after treatment and at
follow up. Thus indicating that the both procedures are
Stiffness Chi- Df Asymp.sig. .(2
Square tailed) P value
effective.
Before treatment 1.445 1 .229
After treatment 0.701 1 .402 DISCUSSION
Follow up 0.337 1 .562 Manyastambha w.s.r. to cervical spondylosis, is a
degenerative disorder by which a larger population get
Within group comparison affected in present era. This disorder influences the socio-
Flexion economic condition of person and family. It also damage
The significant improvement noted in flexion among both the national resource due to work hour lost. Manyabasti is
the groups after treatment (p = 0.001) and at follow up (p a procedure in which the warmed oil poured over
= 0.001), in comparison with before treatment. Also the manyapradesh (nape of neck). Its uniform temperature
shashtik group shown significant improvement in flexion was maintained throughout the process by replacing warm
at follow up in comparison with after treatment (p = oil. Shashtika shali pinda sweda is a procedure in which
0.007). pottali (bolus) is prepared out of shahtika shali, milk and
balamoola decoction. The bolus is made warm in heated
Extension milk and decoction then applied over the manyapradesha.
The significant improvement noted in extension among Due to unwholesome lifestyle and food habits this
both the groups after treatment (p = 0.001) and at follow disorder is affecting almost all the age groups. Even
up (p = 0.001), in comparison with before treatment. Both though this is degenerative disorder, not only labours
the groups shown no significant improvement in group but also the people who are having sedentary
extension at follow up in comparison with after treatment occupation also get affected. In consideration with
(M, p = 0.101 and. SSP p = 0.339). prakruti the vataja prakruti person are more prone to this
(53.3 %). In accordance with Sara, samhanan, satva,
Rt. Lateral Flexion satmya, pramana, ahara shakti and vyayama shakti
The significant improvement noted in right lateral flexion madhyama (medium) group shown majority. Among the
among both the groups after treatment (p = 0.001) and at 30 patients selected, 7 were having symptoms since
follow up (p = 0.001), in comparison with before within 6 months (23.3 %), 11 since 6-12 months (36.7 %),
treatment. Both the groups shown significant 9 since 12-24 months (30 %) and 3 since more than 24
improvement in right lateral flexion at follow up in months (10 %). Among the 30 patients selected, mode of
comparison with after treatment (M, p = 0.001 and. SSP p onset seen was in 17 patients chronic (56.7 %), 11
= 0.009) patients insidious (36.7 %) and in 2 patients it was acute
(6.7 %). Within group comparison both procedures had
shown effective results after treatment in all the
parameters. Both groups were significant in flexion after

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treatment and at follow up, in comparison with before get strengthen. So pressure gradient on cervical spine get
treatment. Only the shashtik group had shown significant reduced. Thermal and pain signals are located in skin
improvement in flexion at follow up in comparison with parallel to each other. Among these two sensations the
after treatment. The significant improvement was noted in stronger one is received, which is thermal (heat) sensation
extension among both the groups after treatment and at and pain sensation ceases.
follow up, in comparison with before treatment. There
was no significant improvement in extension at follow up CONCLUSION
in comparison with after treatment among both the Manyastambha (cervical spondylosis) is affected to larger
groups. In rt. lateral flexion and lt. lateral flexion the population. Manyabasti and Shashtik shali pinda sweda
significant improvement noted in both the groups after are effective treatment procedures for manyastambha i.e.
treatment and at follow up, in comparison with before cervical spondylosis. Among these two procedures
treatment. Both the groups had shown significant shashtik shali pinda sweda is more effectively relieves the
improvement in rt. lateral flexion and lt. lateral flexion at stiffness and spasm of muscles.
follow up in comparison with after treatment. Both groups
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Cite this article as:
because of which the blood circulation improves, results R.B. Patil, R.R. Gayal. Evaluation of the efficacy of Manyabasti with
in removal of catabolic waste such as lactic acid. As the Narayana taila and Shashtik shali pinda sweda in the management of
blood circulation improves the anabolism increases as Manyastambha with special reference to Cervical spondylosis. Int. J.
tissues receives the nutrients and oxygen promptly. Res. Ayurveda Pharm. 2014;5(3):299-304 http://dx.doi.org/10.7897/
2277-4343.05361
Because of this the muscles supporting the cervical spine

Source of support: Nil, Conflict of interest: None Declared

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