Effectiveness of Varmam in the management of Cervical Spondylosis - Literature Review

P. Mangaiarkarasi¹, M. Mohamed Musthafa² , T. R. Siddique Ali³

¹ PG Scholar, ²Head of the Department, ³Lecturer - Department of Varmam Maruthuvam, Government Siddha Medical College, Arumbakkam, Chennai, Tamil Nadu, India.

ABSTRACT

Cervical spondylosis is the most common type of spinal pathology which is more common in middle-aged or senile populations with a high potential to affect physical and mental health. Prevalence of Cervical Spondylosis in the world ranges from 16.7% to 75.1%^(1). This review brings elaborate idea about the effectiveness of Varmam in the management of cervical spondylosis. Contemporary western treatments offer temporary relief in acute phase associated with high cost and many adverse reactions, when taken for long period. So, there is a need to search an effective therapy to treat Cervical Spondylosis with less or no adverse effects. Siddha system of medicine is traditional system of medicine followed in southern India. Varmam is one of the special branch in Siddha System of Medicine⁽²⁾. Varmam is a traditional non-invasive approach and is very affordable and immediate pain relief is feasible by manipulation of Varmam points. it's a highly effective traditional treatment methodology for cervical spondylosis and other painful musculoskeletal conditions. Hence there's a requirement for a treatment procedure which compensates of these lacunae.

Key words: Siddha , Varmam, Cervical spondylosis, Saganavatham, NSAID, Traditional treatment.

INTRODUCTION

In the world Prevalence of cervical spondylosis is ranges from 16.7% to 75.1%⁽¹⁾. 10 million of cases per year are affected by Cervical Spondylosis in India. The prevalence of Cervical Spondylosis is similar for both sexes. Cervical spondylosis is defined as “arthrosis” of the posterior intervertebral joints in the Cervical vertebrae ⁽³⁾. In general, the currently available Analgesic, antiarthritic drugs, steroid injection, NSAIDs, muscle relaxants, physiotherapy and surgery for cervical spondylosis causes high cost, many adverse reactions when taken for long period. So, there is a need to search an effective therapy to treat Cervical Spondylosis with less or no adverse effects. Many countries have their own traditional system of medicine. AYUSH (an acronym for Ayurveda, Yoga, and Naturopathy, Unani, Siddha, Sowga Rigpa) is traditional system of medicine which has been followed in India.Siddha system has its own principles which are based on 96 thathuvaas⁽⁴⁾ Vital channels (naadis), three humours (vali, azhal, iyam), derangement of three humours leads to diseases. Siddha system helps to revitalize and rejuvenate the deranged organ. The treatment methodologies of Siddha system include Agamarunthugal (internal medicines), Puramarunthugal (external medicines) and Pura Maruthuvam (external therapies)Varmam therapy is the one of the special therapies of the Siddha system of medicine

VARMAM THERAPY

Varmam means energy which is the basis of whole universe and whole existence in human body the energy is called as Vaasi that is life energy like qi in Acupuncture. In human life energy is concentrated in certain vital points they are called Varmam points ⁽²⁾. The life energy is constantly flowing in particular pathway i.e naadi ⁽⁵⁾ in human body like meridian in Acupuncture .when the flow is obstructed (or damaged) partially or completely which leads to disease. Varmam points located in insertion of bones, muscles, nerves, blood vessels, joints ⁽⁶⁾. We would like to give idea about the therapeutic benefits of Varmam techniques in reducing pain and discomfort in Cervical spondylosis patients. 9 Varmam points are predominantly used for Cervical Spondylosis persistent problem.

Therapeutic effect of Varmam therapy:

Varmam energy plays an important role in maintaining the physiology of the human body. Varma Kannadi exemplifies that the Varmam energy helps to protect the physical body.

According to the below verse from Varma kannaadi,Varmam energy protects the human body from disease. ⁽⁷⁾

omethuvae varmamuthal karuviellam

Oppanamai thulamathaik kathu nirkum - Varma Kannadi.

Varmam Manipulation Techniques

Before manipulating the points, the therapist should know the dimension of the points. Because depending on these dimensions the usage of finger and manipulation techniques are determined. Varmam points can be located using finger measurements. While measuring only the palmar aspect of the finger should be considered. Also fingers of the patients should be used to measure.⁽⁸⁾

One finger measurement = breadth of index finger

Two fingers measurement = breadth of index and middle fingers

Three fingers measurement = breadth of index, middle and ring fingers

Four fingers measurement = breadth of index, middle, ring and little fingers

Five fingers measurement = breadth of index, middle, ring, little fingers and index finger of the other hand.

Erai = breath of Thumb .

Varmam and its pressure value

During therapeutic application Varmam points are manipulated gently using the physician’s fingers. In order to attain this some basic measures have been handled by our ancestors. This is being termed as ‘Mathirai”. The magnitude of this Mathirai varies from ¼ unit, ½ unit, ¾ unit and 1 unit ^(6,7).

The magnitude of Mathirai

The magnitude of the Mathirai to be given to the patient depends on the body condition and severity of the disease. Pressure can be given continuously for a specific time or intermittently according to necessity. If given intermittently a gap of 10 seconds in between two successive manipulations are to be maintained.

CERVICAL SPONDYLOSIS

Cervical Spondylosis is defined as arthrosis of the intervertebral joints in the cervical vertebrae with subsequent changes in the bones and soft tissues. Spondylosis is usually asymptomatic. Symptoms are usually manifested of encroachment of local neural elements such as cervical nerve roots, spinal cord, vertebral artery (or) sympathetic nerves. Symptoms of the cervical spondylosis is pain in the nap of the neck, Radiating pain to the upper limbs, Numbness and weakness in arms, hands and fingers, Giddiness, Chronic sub occipital headache. InSiddha system of medicine, the disease “Saganavatham ^” is discussed under the types of Vatha diseases and it is correlated with “Cervical spondylosis” ⁽²⁾

Fig 1. X- ray of cervical spine (lateral view) showing features of cervical spondylosis

Kaelumey kaluthinki larikku mealung

Kediyana karamirandu mekavae nonthu

Vaalumey sareramellang kanath thirukkum

Valiparukku manangkannu mayakka maakum

Yaelumey erandukannu mericha lunda

Metramaai salanthanu mirugik kaanunth

Theylumey kotinathu porka dukkum

Saganava thathinida therkkang thaney

- Yugi Vaidya Chinthamani 800 ⁽⁹⁾

Table 1. Comparison of symptoms between Siddha and modern aspect.

Methodology of review

Classical text books, various published scholarly articles on Varmam and Cervical spondylosis were studied and used as a material to highlight the subject.

The following search terms were used: Varmam, Saganavatham, Cervical spondylosis.

Varmam points for Saganavadam

Nine Varmam points was selected for this study in Saganavadam mentioned below ⁽¹⁰⁾

1. Mudichu Varmam

2. Kaakattai Kaalam

3. Kaisulukki Varmam

4. Sippi Varmam

5. Savvu Varmam

6. Kaimootu Varmam

7. Manipanthaga Varmam

8. Koli Kaluthu Varmam

9. Kavuli Varmam

Table 2. Varmam points and its scientific correlations ­ Name of the Varmam	Anatomical location	Technique	Pressure type	Time and frequency
­­­Mudichu Varmam­­­	over the spinous process of C7	The middle three fingers will be placed over the point, pressed and clock wise rotation given 3 times and fingers are moved towards the right shoulder joint with gentle pressure and front support given to the patient. ii. The middle three fingers will be placed over the point, anti-clockwise rotation given 3 times and fingers are moved towards the left shoulder joint with gentle pressure and front support to the patient. iii. Place middle three finger over the point rotation given clock wise 3 times and anti-clockwise rotation given 3 times then the fingers are moved down the dorsum with gentle pressure along the spine.	¼ Mathirai	10 seconds and 3 times
Kaakattai kalam	In the supra clavicular fossa.	Press and release three times with middle three fingers in that location.	¼ Mathirai	10 seconds and 3 times
Kaisulukki Varmam	4 inches below C7 & 3 fingers lateral to vertebral column near the medial border of scapula.	Fix the middle of the thumb opposing bilaterally, applying gentle pressure move medial and lateral.	¼ Mathirai	10 seconds and 3 times
Sippi Varmam	One inch below the Kaisulukki Varmam Place the pulp of thumb and give ¼ Mathirai press towards the scapula.	Fix the center portion of the thumb and apply deep pressure and move upward.	¼ Mathirai	10 seconds and 3 times
Savvu Varmam	4 inches below the anterior axillary fold along the medial border of arm.	Press and release using thumb.	¼ Mathirai	10seconds and 3 times
Kaimootu Var mam	Center of the Cubital fossa	Fix both thumbs in this point, with 1/4 Mathirai pressure. Move towards the side of the elbow joint, fix the finger there and ask the patient to flex the elbow.	¼ Mathirai	10 seconds and 3 times
Kavuli Varmam	Web area between thumb and index finger.	Press with thumb and move upward.	¼ Mathirai	10 seconds and 3 times
Manipanthaga Varmam	Centre point of ventral aspect wrist joint	Press and release three times with thumb	¼ Mathirai	10 seconds and 3 times
Koli Kaluthu Varmam	Medial and lateral point of wrist.	Ask patient to extend the upper limb completely, hold the point firmly by thumb and index finger with ¼ Mathirai pressure. Ask the patient to rotate the hand clockwise and anti-clockwise three times. Then with ¼ Mathirai pressure, move thumb from the radial side to ulnar side along dorsal aspect.	¼ Mathirai	10 seconds and 3 times