Evaluation of the Effect of Jambira Pinda Sweda in Cervical Spondylosis w.r.t. Clinical Symptomatology

Abstract

Introduction
Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies, intervertebral discs of the neck, and the contents of the spinal canal. Spondylosis progresses with age and often develops at multiple interspaces. Though many conventional treatments are available but in view of their side effects and dependency, it is important to search for safe and effective Ayurvedic treatment.

Objective
To evaluate the effect of Jambira Pinda Sweda in cervical spondylosis w.r.t. clinical symptomatology.

Materials and methods
A single-arm, open, prospective interventional clinical study was conducted at two peripheral institutes of Central Council for Research in Ayurvedic Sciences. Total 60 patients of either sex aged between 30 years and 65 years, with clinical and radiological evidence of cervical spondylosis, were selected for the study. The treatment procedure Jambira Pinda Sweda was done daily for the period of 14 days. The patients were assessed at baseline, 7th day, 14th day, and 21st day (after 1 week without intervention) on the basis of relief in sign and symptoms of cervical spondylosis by reduction in the visual analog scale (VAS) score, Northwick Park Neck Pain Questionnaire, and SF-36 Health Survey Score for Quality of life.

Results
Mean value of VAS on baseline was 6.90, on 7th day it was 3.37, and decreased up to 2.57 on 14th day and 2.08 on 21st day showing statistically significant improvement ( p < 0.001). The mean value of Northwick Park Neck Pain Questionnaire on baseline was 45.79, on 7th day it was 23.57, which further decreased to 17.32 on 14th day showing statistically significant decrease ( p < 0.001). The significant improvement was revealed in all the parameters of the SF-36 health survey ( p < 0.001).

Conclusion
Jambira Pinda Sweda have been shown to be an effective local Ayurvedic treatment for cervical spondylosis. During the study, no adverse effect was noticed; hence, it proved to be a safe treatment.

Full text

ORIGINAL RESEARCH ARTICLE
Evaluation of the Effect of Jambira Pinda Sweda
in Cervical Spondylosis w.r.t. Clinical Symptomatology
Sakshi Sharma1, Renu Makhija2, Mridula Dua3, Valiparambil Chandran Deep4, Paravazhi Radhakrishnan5, Amit Madan6,
Bhar Gupta7, Richa Singhal8, Rakesh Rana9, Vinod Kumar Lavaniya10, Madan Mohan Sharma11, Narayanam Srikanth12,
Kartar Singh Dhiman13
AbstrAct
Introduction: Cervical spondylosis is a chronic degenerative condition of the cervical spine that aects the vertebral bodies, intervertebral
discs of the neck, and the contents of the spinal canal. Spondylosis progresses with age and often develops at multiple interspaces. Though
many conventional treatments are available but in view of their side eects and dependency, it is important to search for safe and eective
Ayurvedic treatment.
Objective: To evaluate the eect of Jambira Pinda Sweda in cervical spondylosis w.r.t. clinical symptomatology.
Materials and methods: A single-arm, open, prospective interventional clinical study was conducted at two peripheral institutes of Central
Council for Research in Ayurvedic Sciences. Total 60 patients of either sex aged between 30 years and 65 years, with clinical and radiological
evidence of cervical spondylosis, were selected for the study. The treatment procedure Jambira Pinda Sweda was done daily for the period of
14 days. The patients were assessed at baseline, 7th day, 14th day, and 21st day (after 1 week without intervention) on the basis of relief in sign
and symptoms of cervical spondylosis by reduction in the VAS score, Northwick Park Neck Pain Questionnaire, and SF-36 Health Survey Score
for Quality of life.
Results: Mean value of VAS on baseline was 6.90, on 7th day it was 3.37, and decreased up to 2.57 on 14th day and 2.08 on 21st day showing
statistically signicant improvement (p < 0.001). The mean value of Northwick Park Neck Pain Questionnaire on baseline was 45.79, on 7th day
it was 23.57, which further decreased to 17.32 on 14th day showing statistically signicant decrease (p < 0.001). The signicant improvement
was revealed in all the parameters of the SF-36 health survey (p < 0.001).
Conclusion: Jambira Pinda Sweda have been shown to be an eective local Ayurvedic treatment for cervical spondylosis. During the study, no
adverse eect was noticed; hence, it proved to be a safe treatment.
Keywords: Cervical spondylosis, Jambira Pinda Sweda, Radiculopathy.
Journal of Research in Ayurvedic Sciences (2020): 10.5005/jras-10064-0103
IntroductIon
Cervical spondylosis is a chronic and progressive degenerative
condition that aects the n eck. The cervical spine refer s to the seven
small vertebrae that form th e neck in which soft discs betwee n the
vertebrae provide cushioning. During the initial phase of cervical
spondylosis, changes such as disc desiccation, reduction in disc
height and progressive reduction in the ability to bear axial loads,
is seen. Following this, laxity of soft-tissues within and around the
disc occurs resulting in disharmony of structural and mechanical
integrity of cervical spine. Eventually, a cascade of events are
set into motion that uctuates along further degeneration and
compensatory tissue adaptation. As a compensatory mechanism,
development of osteophytes also occurs. Cervical spondylosis is
also known as arthritis or degenerative osteoarthritis of the neck
and cervical oste oarthritis. This condition progresses with age and
other causative facto rs include neck injuries, work-related activ ities
that put extra strain on the cervical region, holding the neck in an
uncomfortable position for prolonged periods or repetitive stress,
genetic factor s, smoking, being overweight, and physical inac tivity.
With these factors, over a period of time, the discs get thinner, and
their ability to absorb sho ck is lost, because intervertebral disc s lose
hydration and elasticity with age and these losses lead to cracks
and ssures. Symptoms of cervical spondylosis include pain in the
neck that may radiate to arms or shoulders , headaches, weakness in
limbs, numbness in shoulders, a rms, or hands, stiness in the neck,
and trouble in keeping body balance. In later stages, spondylotic
changes may result in stenosis of the spinal canal, lateral recess, and
foramina. Spinal canal stenosis c an lead to myelopathy, where as the
stenosis of lateral recess and foramina may cause radiculopathy1
with the symptoms of sensation of “pins and needles” in the
extremities, pain in the limbs, sti neck, and headaches (mostly
on back of the head).
1–3,6,7Central Ayurveda Research Institute for Cardiovascular Diseases,
Punjabi Bagh, New Delhi, India
4Regional Ayurveda Research Institute for Urinary Disorders, Jammu,
Jammu and Kashmir, India
5National Ayurveda Research Institute for Panchakarma,
Cheruthuruthy, Kerala, India
8–13Central Council for Research in Ayurvedic Sciences, Janakpuri, New
Delhi, India
Corresponding Author: Sakshi Sharma, Central Ayurveda Research
Institute for Cardiovascular Diseases, Punjabi Bagh, New Delhi, India,
Phone: +91 9654165662, e-mail: drsakshi.sharma87@gmail.com
How to cite this article: Sharma S, Makhija R, Dua M, et al. Evaluation of
the Eect of Jambira Pinda Sweda in Cervical Spondylosis w.r.t. Clinical
Symptomatology. J Res Ayurvedic Sci. 2020;4(1):18–25.
Source of support: Nil
Conict of interest: None
© The Author(s). 2020 Open Access This article is distributed unde r the terms of the Creative Commons Attributio n 4.0 International License (https: //creativecommo ns.
org/licenses/by- nc/4.0/), which permits unrestric ted use, distribution, and non -commercial reproduc tion in any medium, provided yo u give appropriate credit to
the original author(s) and the source, prov ide a link to the Creative Commons license, and indicate if ch anges were made. The Creative Commons Pub lic Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Eect of Jambira Pinda Sweda in Cervical Spondylosis
Journal of Research in Ayurvedic Sciences, Volume 4 Issue 1 (January–March 2020) 19
In Ayurveda, cervical spondylosis can be correlated with
Sandhigata Vata. Sandhigata Vata is mentioned under Vata Vyadhi.
As per classics, Nidana Sevana (etiological factors) aggravates
Vata and this Prakupita (vitiated) Vata accumulates in Rikta Strotas
(∼empty channels) to give rise to various generalize d and localized
diseases. In case Vata Dosha is vitiated in Griva Asthi Sandhi (cervical
joint), it leads to Griva Asthi Sandhigata Vata and can be diagnosed
as a Grivagraha. Some of the Lakshanas (symptoms) of Kupita
Anila (vitiated Vata) are similar to the signs and symptoms of
Grivastambha (neck stiness). These are Pani-Prishtha-Shirograha
(spasticity in leg, back, and head), Gatrasuptata (numbness),
Grivayahundanam (cervical dystonia), Bheda (breaking pain), Toda
(pricking pain), and Arti.
The pathogenesis of Sandhigata Vata as described in Ayurved ic
classics is as follows:
• Nidana (etiology): According to Acharya Charaka, Vata get
aggravated by improper food habits, untimely eating, fasting,
and undisciplined lifestyle; stress and worries , sleep disturbances;
excessive indulgence in physical exercises, wor kout, an d sexual
act; excessive emaciation because of worry, grief, and aiction
by disease; forcible suppression of or ex pulsion of natural urges;
and injuries to marmas, uncomfortable rides, and movements.2
• Purvaroopa (premonitory sign): There are no Purvaroopa for
Sandhigatavata mentioned in Samhita.
• Roopa (symptoms): Shotha (swelling), Shoola (pain), Vata Purna
Druti Sparsha (palpable as air-lled bag), Prasarane Akunchane
Vedana (pain during exion and extension),2 Hanti Sandhigata
Pravritti (abolish/restrict activities of joint)3
• Samprapti (pathoge nesis): Various etiologic al factors that vitiate
Vata cause increase in Rukshata (dryness), Kharata (hardness/
roughness) in Srotasa, and undergo Sthanasamsraya in Greeva
Sandhi Pradesha, where it gradually result in Griva Sandhigata
Vata resulting in the manifestation of symptoms as mentioned
above.4
The conventional managements for cervical spondylosis
are physical therapy/physiotherapy, ice or heat, collar, etc.
In contemporary science, muscle relaxants, narcotics (like
hydrocodone), steroid injections, and NSAIDs. If the condition is
severe and does not respond to other f orms of treatment, it may need
surgery but it is most often associated with various and sometimes
severe complications.
In Ayurveda, various modes of treatment are mentioned for
improvement in the signs and symptoms of cervical spondylosis,
specially the local treatments such as various types of Snehana
(oleation) and Swedana (sudation) are advocated for Vatavyadhis.
Jambira Pinda Sweda5 is also a modied form of Swedana, which
refers to the sudation performed by specially prepared bundles
packed with Jambira (Citrus limon (L.) Osbeck) fru it pieces. The word
Jambira Pinda is derived from two words: Jambira means lemon and
Pinda means bolus. It is a modied t ype of Sankar Sweda (one type
of sudation) having Mridu (soft) and Snigdha Guna (unctous). With
Snehana and Swedana, Vakra (cross) and Stabdha (sti) body parts
can be Namayita (exed easily). The results of Snehana and Swedana
are nourishment of Dhatus, increase in Agni-Bala, and increase in
strength of the body. In light of above, the present clinica l study has
been conducted to evaluate the role of Jambira Pinda Sweda for its
ecacy as well as safety in patients with clinical and radiological
evidence of cervical spondylosis.
objectIve
To evaluate the eect of Jambira Pinda Sweda in cervical spondylosis
(Grivagraha) with special reference to symptomatology.
MAterIAls And Methods
Study Design
It was an interventional, open-label, prospective study executed
in 2017 at two peripheral institutes of the Central Council for
Research in Ayurvedic Sciences (CCRAS), namely the Central
Ayurveda Research Institute for Cardiovascular Diseases (CARICD),
Punjabi Bagh, New Delhi, and the National Ayurveda Institute
for Panchakarma (NARIP), Cheruthuruthy, Kerala. After obtaining
necessary clearance from the institute ethical committee (IEC) (F.
No. 6-21/2012-ACRI/ Tech./IEC/217; dt. 23.05.15 and F. No. 3/1/2014-
NRIP/Tech.; dt. 08.06.15) of both participating centers, the study
was registered prospectively under Clinical Trials Registry—India
(CTRI/2015/10/006300).
Study Participants
In present study, total 60 particip ants (30 at each center) of either sex
aged betwee n 30 years and 65 years were recruited after obtaining
the informed written consent. Total study period was of 6 months
with recruitment period of 5 months.
Inclusion Criteria
Participants of either sex aged between 30 years and 65 years,
diagnosed as cervical spondylosis with clinical and radiological
evidence with or without cervical radiculopathy.
Exclusion Criteria
• Age below 30 years and above 65 years.
• Cases of cervical spo ndylosis with intractable pain, neurologic al
decit, severe deltoid, or wrist extensor weakness.
• Patients with acute cervical pathology apart from cervical
spondylosis excluding any clinical evidence of cervical
spondylotic myelopathy.
• Patients with poorly controlled hypertension (>140/90 mm
Hg), patients with poorly controlled diabetes mellitus having
HBA1c >7.0%.
• Patients who have a past history of any type of cardiovascular
disease, patients with any hepatic or renal disorder, with liver
enzymes twice the normal or serum creatinine >1.4 mg.
Study Interventions
Study intervention is the procedure, Jambira Pinda Sweda for 14
days daily in the morning time. Procedure compliance was assesse d
on 7th and 14th days and one follow-up without treatment was
done on 21st day.
Preparations for Jambira Pinda Sweda
Ingredients for preparing the Potali (poultice) for Jambira Pinda
Sweda are Jambira (C. limon chopped into pieces) 750 g along
with Shatapushpa Choorna (powder of Anethum sowa Kurz fruits)
250 g, Saindhava (rock salt) 30 g, and Haridra Choorna (powder of
Curcuma longa L. rhizome) 60 g fried in 100 mL of Mahanarayana
Taila6 for making Potali and it was also used fo r reheating the Potali
in sucient quantity.

Eect of Jambira Pinda Sweda in Cervical Spondylosis
Journal of Research in Ayurvedic Sciences, Volume 4 Issue 1 (January–March 2020)
20
Preparation of Potali
Sliced lemon and other ingre dients are fried in 100 mL Mahanarayana
Taila till brown color appears , and then divided into four equal parts
and made into Potalis accordingly.
Preoperative Procedure
The participants selected for the study were seated with legs
extended in a Droni (a specific table) and Abhyanga (external
oleation) was performe d with Mahanarayana Taila all over the body
for about 10 minutes and then Talam is applied on center of the
head with 10 mL Ksheerabala Taila.7 Talam is a procedure of retaining
medicines over the center of the head, which is done before doing
almost all Ayurvedic procedure s to protect body from temperature
variations during the main treatment.
Procedure
Out of the four prepared Potalis, two Potalis were heated up to
40–45°C by keeping on the hot pan containing Mahanarayana
Taila. These Potalis are applied to the patients as per the general
procedure for about 30 –45 minutes. Care was taken to maintain the
temperature throughout the procedure by reheating the Potalis.
Postoperative Procedure
After the procedure, the body was wiped with clean towel,
Talam was removed, and Rasnadi Choorna8 (5 g) was applied. The
participants were advised to take complete rest for half an hour
to one hour.
Study Procedure
On the baseline day (0 day), general information—(personal
identication and demographic prole); physical and systemic
examination; Visual Analogue Scale (VAS); Northwick Park Neck
Pain Questionnaire; and SF36 Questionnaire were recorded into the
predesigned case rep ort forms (CRFs). During th e treatment on the
7th day, progress of the treatment was assessed and similarly at the
end of the treatment, i.e., 14th day. A follow-up without treatment
was done on the 21st day where physical examination and clinical
assessment, VAS, Northwick Park Neck Pain Q uestionnaire, and SF36
Questionnaire were assessed (Flowchart 1).
At the study site, data of all the patients were recorded in
predesigned CRFs and were also entered in electronic formats
(e-formats) designed in MS -Excel with many data validation checks
to ensure correct data entry. The e-formats and xerox of the CRFs
along with the laboratory investigations reports of the patients
were sent by the participating center s to the council’s headquarters
timely for the purpose of clinical trial monitoring.
Outcomes
The primary outcome measures were analyzed as mean change in
VAS and Northwick Park Neck Pain Questionnaire.9 The secondary
outcome measure was change in quality of life (QoL) that was
assessed by the SF-36 Health Survey Questionnaire.10
Statistical Analysis
Primary outcome and secondary outcome measures, i.e., VAS Score,
Northwick Park Neck Pain Questionnaire, and SF-36 health survey,
were analyzed as mean change in the response from baseline to
14th day and follow-up at the end of 21st day by using paire d t-test.
A p value of less than 0.05 was considered signicant. Symptomatic
relief was assessed as percentage change in terms of presence of
any symptom from baseline to en d of the treatment. The statistical
analysis was done using SPSS version 15.0.
Flowchart 1: Study schedule

Eect of Jambira Pinda Sweda in Cervical Spondylosis
Journal of Research in Ayurvedic Sciences, Volume 4 Issue 1 (January–March 2020) 21
observAt I o n s
Out of the total 60 patients enrolled in the study, one dropped out
during the course of the study. Hence, data of a total 59 patients
were used for statistical analysis (Flowchart 2).
It was observed that majority of the patients were in the age
group of 41–50 years (44.1%) followed by age group 30–40 years
(30.5%). Maximum patients were female (69.5%) and 30.5% were
male. About 94.9% of the patients were married. About 93.2%
of the patients were literate and 6.8% were illiterate. Present
occupationwise, 18.6% were engaged in desk work followed by
23.7% eld work with physical labor, 11.9% eld work, and 45.8%
housewives. Socioeconomically, 61.0% patients were above
poverty line followed by 39% below poverty line. About 54.2% of
the patients were living in urban area followed by 40.7% in rural
area. Hindu religion dominated the sample size 84.7% followed by
Muslim (11.9%) and 1.7% each of Sikh and Christian . About 66.1% of
the patients were nonvegetarian an d 33.9% veget arian. About 6.8%
of the patients were addic ted to smoking, 5.1% to alcohol, and 88.1%
had no such addiction. About 57.6% of the patients had normal
sleep pattern while 42.4% had abnormal. About 81.4% patients
had regular bowel habits and 18.6% had irregular. About 69.5%
patients were doing moder ate labor followed by 10.2% of oce job
and 5.1% patients doing h eavy labor. About 74.6% patient s showed
average emotional stress while 25.4% moderate (Table 1). By general
physical examination at the baseline, it was observed that 59.3%
patients were average built, 37.3% were well-built, and 3.4% were
emaciated and 54.2% patients were moderately nourished, 44.1%
were well nourished, and 1.7% were malnourished (Table 2). The
average weight of the patient was 65.32 kg where maximum we ight
being 111 kg. The mean body mass index (BMI) was 26.17 kg/m,2
mean respiratory rate was 18.27, and mean pulse rate was 74.83.
The mean systolic blood pressure was recorded as 121.08 mm Hg
and mean diastolic blood pressure was 80.78 mm Hg (Table 3). On
examination, 69.50% patients wer e not having any problem in other
joints than vertebral column while 30.50% patients were having
problem in other joints also.
results
Mean value of VAS on baseline was 6.90, on 7th day it was 3.37 and
decreased up to 2.57 on 14th day and 2.08 on 21st day showing
signicant improvement while paired dierence was 3.525, 4.373,
and 4.814 on 7th, 14th, and 21st day, respectively, which is also
statistically signicant (p < 0.001) (Table 4).
Mean value of the Northwick Park Neck Pain Questionnaire on
baseline was 45.79; on 7th day it was 23.57, which fur ther decreased
to 17.32 on 14th day and 15.42 on 21st day showing improvement
while paired dierence was 22.22 on 7th day, 28.47 on 14th day
of the treatment, and 30.37 on 21st day, which was statistically
signicant (p < 0.001) (Table 5).
Flowchart 2: Outow of the patients in the study Table 1: Demographic prole (n = 59)
Age group
30–40 18 (30.5)
41–50 26 (44.1)
51–60 12 (20.3)
61–65 3 (5.1)
Sex
Male 18 (30.5)
Female 41 (69.5)
Marital status
Married 56 (94.9)
Unmarried 2 (3.4)
Widow(er) 1 (1.7)
Educational status
Illiterate 4 (6.8)
Read and write 55 (93.2)
Present occupation
Desk work 11 (18.6)
Field work with physical work 14 (23.7)
Field work 7 (11.9)
Housewife 27 (45.8)
Nature of occupation
Heavy labor 3 (5.1)
Moderate labor 41 (69.5)
Oce job 6 (10.2)
Sedentary 9 (15.3)
Socioeconomic status
Above poverty line 36 (61)
Below poverty line 23 (39)
Habitat
Urban 32 (54.2)
Semiurban 3 (5.1)
Rural 24 (40.7)
Religion
Hindu 50 (84.7)
Muslim 7 (11.9)
Sikh 1 (1.7)
Christian 1 (1.7)
History of present illness
No 49 (83.1)
Yes 10 (16.9)
Dietary habits
Vegetarian 20 (33.9)
Nonvegetarian 39 (66.1)
Addiction
Smoking 4 (6.8)
Alcohol 3 (5.1)
None 52 (88.1)
Sleep pattern
Normal 34 (57.6)
Abnormal 25 (42.4)
Bowel habits
Regular 48 (81.4)
Irregular 11 (18.6)
Status of emotional stress
Average 44 (74.6)
Moderate 15 (25.4)
Values as expressed as n (%)

Eect of Jambira Pinda Sweda in Cervical Spondylosis
Journal of Research in Ayurvedic Sciences, Volume 4 Issue 1 (January–March 2020)
22
The quality of life was assessed by the SF-36 Health Survey
Questionnaire, which showed signi cant improvement in its every
domain, i.e., physical functioning (18.559), role limitation due to
physical health (55.93), limitations due to em otion problem (46.890),
energy fatigue (14.746), emotional well-being (11.729), social
functioning (16.73), pain (22.54), and general health (20.59). The
improvement in each domain of SF36 was statistically signicant
(p < 0.0001) (Table 6).
Safety Prole
The procedure has proven to be harmless, safe, and eective. No
adverse eects or allergic outbursts were observed during the
treatment.
dIscussIon
Cervical spondylosis is a chronic progressive degenerative
condition; its symptoms increase with advancing age. Analgesics,
Table 2: Physical examination (n = 59)
Parameter Mean (SD)
Status of built
Average 35 (59.3)
Emaciated 2 (3.4)
Well-built 22 (37.3)
Status of nutrition
Moderately nourished 32 (54.2)
Malnourished 1 (1.7)
Well nourished 26 (44.1)
Table 3: General examination (n = 59)
Parameter Mean (SD)
Weight (kg) 65.32 (12.883)
BMI (kg/m2) 26.171 (4.9556)
Respiratory rate (per minute) 18.27 (0.762)
Pulse rate (per minute) 74.83 (10.277)
Systolic blood pressure (mm Hg) 121.08 (16.992)
Diastolic blood pressure (mm Hg) 80.78 (5.079)
Table 4: Eect of treatment on VAS (n = 59)
VAS Mean value Paired dierence t value p value
Baseline 6.90 (1.517) – – –
7th day 3.37 (1.541) 3.525 (2.062) 13.13 <0.001
14th day 2.53 (1.356) 4.373 (1.77) 18.972 <0.001
21st day 2.08 (1.725) 4.814 (2.004) 18.449 <0.001
Values as expressed as mean (SD)
Table 5: Eect of treatment on northwick park neck pain
questionnaire (n = 59)
Northwick
park neck pain
questionnaire Mean value Paired
dierence t value p value
Baseline 45.7972
(15.44889) – – –
7th day 23.5719
(14.63754) 22.22525
(13.10678) 13.025 <0.001
14th day 17.3208
(10.93011) 28.47644
(12.66831) 17.266 <0.001
21st day 15.4252
(12.34109) 30.37203
(17.11513) 13.631 <0.001
Values as expressed as mean (SD)
Table 6: Eect of treatment on SF36 questionnaire (n = 59)
Domain Mean value Paired
dierence t value p value
Physical functioning
Baseline 58.05 (22.457) – – –
14th day 76.61 (18.252) −18.559
(13.584) 10.494 <0.001
21st day 80.71 (17.979) −22.119
(18.223) 9.323 <0.001
Role limitations due to physical health
Baseline 8.47 (22.257) – – –
14th day 64.41 (39.720) −55.932
(39.485) 10.881 <0.001
21st day 72.88 (37.797) −64.407
(39.99) 12.371 <0.001
Limitations due to emotional problems
Baseline 31.64 (45.242) – – –
14th day 78.53 (37.533) −46.89
(47.594) 7.568 <0.001
21st day 83.04 (34.677) −51.402
(46.86) 8.426 <0.001
Energy/fatigue
Baseline 48.47 (16.822) – – –
14th day 63.22 (17.139) −14.746
(15.85) 7.146 <0.001
21st day 68.22 (17.733) −19.746
(18.157) 8.353 <0.001
Emotional well-being
Baseline 58.24 (15.970) – – –
14th day 69.97 (14.600) −11.729
(12.448) 7.237 <0.001
21st day 63.83 (16.109) −15.593
(15.891) 7.537 <0.001
Social functioning
Baseline 59.75 (22.513) – – –
14th day 76.48 (16.752) −16.7373
(16.995) 7.564 <0.001
21st day 81.14 (16.144) −21.398
(19.975) 8.229 <0.001
Pain
Baseline 51.36 (15.045) – – –
14th day 73.90 (14.2211) −22.5458
(17.9348) 9.656 <0.001
21st day 77.80 (14.3450) −26.5254
(19.4981)
−10.5 <0.001
General health
Baseline 40.08 (15.100) – – –
14th day 60.68 (15.438) −20.593
(15.117) 10.464 <0.001
21st day 65.93 (15.770) −25.847
(16.378) 12.122 <0.001
Values as expressed as mean (SD)

Eect of Jambira Pinda Sweda in Cervical Spondylosis
Journal of Research in Ayurvedic Sciences, Volume 4 Issue 1 (January–March 2020) 23
anti-inammatory agents, antidepressants, strategies to improve
posture, and stress management are widely used conventional
methods of providing symptomatic relief. The Cochrane review
group advocates that a combination of exercise, mobilization
physiotherapy, and manipulation are more eective treatment
modalities. Other modalities like acupuncture, traction,
electrotherapy, and psychotherapy are also conventionally used
but are of uncertain value.11
In Ayurveda, various indigenous drugs and procedure
are used including Snehapana, Upanaha, Agnikarma, Tai la
Abhyanga, Virechana Karma (therapeutic purgation), Basti Karma
(therapeutic enema), and classical drugs like Simhanada Guggulu,
Mahavatavidhwamsa Rasa, Ashwagandha Choorna (powder of
Withania somnifera (L.) Dunal roots), Shunthi Choorna (powder
of Zingiber officinale Roscoe rhizome), etc., for management
of Sandhigata Vata. The effect of Ayurvedic local treatment
procedures like Snehana, Swedana, Griva Basti, Patra Potali Sweda,
Pinda Swedana, etc., has shown signicant results in reducing
symptomatology of Sandhigata Vata, which has been proved by
various clinical researches.12
A clinical study to assess eec t of Grivabasti with Karpasasthyadi
Taila in cervical spondylosis revealed statistically significant
results.13 Conclusive results from a study of year 2013 shows that the
combined eect of Griva Basti, Patra Potali Sweda, and Nasya (nasal
instillation) can oer benets to reducing symptoms of cervical
spondylosis.14 Another clinical study states that Tikta Kshira Basti
can oer good benet in neurological manifestations of cervical
spondylosis like tingling sensation, numbness, diminished muscle
power, and diminished reexes whereas Patrapinda Sweda can do
better to relieve pain, tenderness, stiness, vertigo, and restricted
movements.15
Jambira Pinda Swedana was used in a clinical study with oral
medication, i.e., Yogaraja Guggulu, Mahavatavidhwansa Rasa,
Ashwagandha Choorna, Shunthi Choorna, Maharasnadi Kwatha,
in females suering from Sandhigata Vata (osteoarthritis), which
showed signicant improvement in clinical symptoms.16
In the present study, Jambira Pinda Sweda was exclusively
used in management of symptomatology of cervical spondylosis.
It is a modied type of Sankara Sweda having Mridu and Snigdha
Guna. Swedana is one of the important treatment modalities for
number of disorders especially of Vata-Kapha origin mentioned
in Panchakarma. Acharya Charaka has included Swedana Karma
under Shadupakarma, where it is described as a principal method
of treatment. It improves blood circulation, increases muscle
strength, and relieves body pain and stiness. The ingredients of
Jambira Pinda Sweda Potali are Vata-Kaphashamaka, Shoolaghana
(analgesic), and Shothahara (anti-in ammatory)17 and Jambira being
the main ingredient of the Potali is Amla Rasatmaka (sour in taste)
hence possesses Vatashamaka (pacifying Vata) properties. Before
performing Jambira Pinda Potali Swedana, local Abhyanga with
Mahanaryana Taila was done. Mahanaryana Taila also possesses
good Vatahara property—as it contains essential ingredients
that are demulcent, anodyne, and have strengthening eect on
muscles. It also enhances cutaneous and capillary bl ood circulation.
Abhyangya Karma is Snehakara, Kledkaraka, Vatashamaka because
Sneha reaches to Mamsa, Meda, Asthi, and Majjadhatu18 and
provides nourishment to them, which further strengthens the
muscles and relieves the stiness. After Abhyanga, Jambira Pinda
Potali Sweda was applied to aected part of the body which is
Vata-Kaphashamaka and also provide Strotoshuddhi. This procedure
also decreases the Stambha and releases the pain. Saindhava
Lavana is Tridoshaghana and well known for Sadhyasnehana
due to its Sukshma and Snigdha Guna.19 It helps to dissolve and
expel the Doshas and relieve joint stiness. Rasandi Choorna is
also a Vata-kaphahara drug. Throughout, the procedure Talam
with Ksheerabala Taila was done as maintains the normal body
temperature during the procedure.
During the procedure, the heat produced by the medicated
bolus increases the temperature by 2–3° in specic areas of the
body, which signicantly helps in vasod ilatation and improves local
blood supply. Thereby signicantly reducing the inammation,
pain, and stiness in the neck region and associated symptoms,
which are evident by VAS and Northwick Park Neck Pain
Questionnaire (Tables 3 and 4). The improvement was also seen in
each domain of SF36 Questionnaire, such as physical functioning,
pain, energy fatigue, general health, etc. (Table 5), which overall
proves that Jambira Pinda Sweda is an eective local remedy in the
management of clinical symptoms of cervical spondylosis.
conclu s I o n
The present study was inten ded to explore the role of Ayurvedic l ocal
treatment Jambira Pinda Sweda in relieving the s ymptomatology in
cervical spondylosis. It has been obser ved that the local treatment
in the form of Jambira Pinda Sweda has shown considerable
improvement in the scoring of VAS, Northwick Park Neck Pain
Questionnaire, and SF36 Questionnaire after treatment. It has
proven that Jambira Pinda Sweda considerably reduces pain,
stiness, and associated s ymptoms of cervical spondylosis. H ence,
this study concludes that Jambira Pinda Sweda can be considered as
a safe and eective lin e of treatment for management of the disease.
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