Asthivikara ss-mys

I

“CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.R TO

MANAGEMENT OF SANDHIGATAVATA”

By

DR. RANJITH KUMAR SHETTY, B.A.M.S.

Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore.

In the partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (AYURVEDA)

in

AYURVEDA SIDDHANTA

Under The Guidance of

Dr. N.ANJANEYA MURTHY M.D. (Ayu)

Professor, Department of Post-Graduate Studies in Ayurveda Siddhanta,

G.A.M.C., Mysore.

Co-Guide DR.VASUDEV A. CHATE, M.D. (Ayu)

Lecturer, Department of Post-Graduate Studies in Ayurveda Siddhanta

GAMC Mysore – 570021 &

DR.KIRAN KALAIH, M.S. (Ortho)

Professor and Orthopedic surgeon, Mysore Medical College and Research center,

Mysore – 570021

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,

GOVERNMENT AYURVEDA MEDICAL COLLEGE,

MYSORE.

2010

Ayurmitra

TAyComprehended

VIII

ACKNOWLEDGEMENT

I bow to the sacred feet of Almighty, without the blessings of whom this study would

not have been completed.

I sincerely express my indebtedness and profound gratitude to my Guide

Dr. N. Anjaneya Murthy, Professor, Department of PG Studies in Ayurveda

Siddhanta, Government Ayurveda Medical College, Mysore for his valuable guidance

& encouragement throughout my study.

I sincerely acknowledge my reverend teacher and Co- guide Dr.Vasudev A Chate,

Lecturer, Department of PG Studies in Ayurveda Siddhanta, Government Ayurveda

Medical College, Mysore and another Co-guide Dr.Kiran Kalaih, Professor &

Orthopedic surgeon, Mysore Medical College and Research center, Mysore for his

valuable guidance and support throughout my study.

I am highly thankful to Dr. K.Naseema Akhtar, Professor and HOD, Department of

PG Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore,

for her constant support and encouragement at every stage of this study.

I am highly thankful to Late. Dr.G.N.Shakuntala, Former HOD, Department of PG

Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, for

her constant guidance, continuous supervision and help at every stage of this study.

I am grateful to Principal Dr.Ashok D.Satpute, Principal, Government Ayurveda

Medical College, and Mysore for his support and encouragement.

I owe my deep sense of gratitude to all my teachers Dr.T.D.Ksheera Sagar,

Dr.H.M.Chandramouli, Dr.G.Gopinath, Dr.Shantaram, Dr.Rajendra, Dr.T.R.Shantala

Priyadarshini, Dr.Shrivathsa, Dr.Mythrey, Dr. Anand Katti, Dr.Ananth Desai, Dr.

Nalini, Dr.Adarsh and all other teachers for their support in this study.

I am thankful to physician Dr.Anuradha Nadakarni and all other hospital staffs for

their help during the course of study.

IX

I owe my special thanks to my classmates and friends Dr.Kalyani, Dr.Geetha,

Dr.Ramesh and Dr.Kavitha for their comments, cooperation and timely advises, they

stood beside and inspired me through out the completion of this study.

I thank my younger colleagues Dr. Athika Jan, Dr. Aravind B.S, Dr.Pallavi G,

Dr.Rekha A.R Dr.Preetha and Dr.Arhanth for their help and support throughout my

work.

I am thankful to my senior colleagues Dr.Savitha Shenoy, Dr.Soubhagya, Dr.Kedar

Sharma, Dr. Vijayalakshmi, Dr.Yogesh, Dr.Aparna, Dr.Annapoorani, Dr.Pankaj

Pathak and Dr.Rajesh Bhat for their help.

I acknowledge my special thanks to my friend Dr.Kiran Kumar Agadi, for his support

and encouragement throughout my study.

I am thankful to my colleagues Dr.Vyasaraj Tantry, Dr.Parveen, Dr.Pallavi,

Dr.Ranjani, Dr.Ananthshayan, Dr.Sameena and to my younger colleagues Dr.Mahesh,

Dr.Adhitya, Dr.Sowmya, Dr.Shubharani, Dr.Geetha and Dr.Sridharmurthy,

Department of P.G.studies in Kayachikitsa, for their help.

I wish to place my sincere gratitude to my friends Dr.Rajaram, Dr.Ravi, Dr.Sowmya

M.D and Dr.Sharif for their support.

I also owe my heart felt gratitude to my teacher Dr.Hariprasad Shetty and all other

teachers of under graduation who initiated and instilled in me the knowledge of this

holy science.

This acknowledgement would not be complete without paying obeisance to my

parents Mr. Ramayya Shetty and Late. Jyothi R Shetty. Their constant

encouragement and guidance propelled me to achieve my goal.

I convey my special thanks enveloped with affection to my beloved younger sisters

Ms.Rajani Kumari and Ms.Nisha Shetty and younger brother Mr. Vignesh Shetty

for their valuable timely help and support.

I wish to convey my thanks to U.G. and PG Librarian Mrs Varalakshmi and Mr

Somasundar for providing library facilities.

X

I thank Dr.Lancy D’souza for his valuable help and guidance in the statistical

analysis and interpretations.

I convey my heartfelt thanks to Manager, M/s SDM Ayurveda Pharmacy , Kuthpady

Udupi who helped me in procuring drugs for my dissertation.

I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in a

documented form.

Last but not the least, I express my thanks to all my patients , without whom I

wouldn’t have completed this dissertation and I thank all those who helped me

directly or indirectly in my studies with apologies for my inability to identify and

thank them individually.

Date:

Place: Mysore Dr. Ranjith Kumar Shetty

XI

LIST OF ABBREVATIONS

A.H: Ashtanga Hrudaya

A.K: Amara Kosha

A.S: Ashtanga Sangraha

B.P:Bhava Prakasha

B.S: Bhela Samhita

C.D: Chakradatta

C.S: Charaka Samhita

H.S: Harita Samhita

M.N: Madhava Nidana

S.K.D: Shabda kalpa Druma

S.S: Sushruta Samhita

Sha.Sa: Sharangdhara Samhita

Y.R: Yoga Ratnakara

XII

ABSTRACT

Background of the Study

Asthi pradoshaja vikara is a condition in which Asthi gets vitiated extremely

by the doshas and changes its natural form and leads to many disorders like adhyasthi

adhidanta etc. Classical texts mention that tikta ksheera sarpi is the best line of

treatment for Asthi pradoshaja vikaras. Sandhi mainly constitutes Asthi. Hence this

research is undertaken to study the concept of Asthi pradoshaja vikaras and to

evaluate the efficacy of tikta ksheera sarpi in Janusandhigatavata.

Objectives of the study

To review in detail about Asthi and Asthi pradoshaja vikaras.

To assess the involvement of Asthi with the help of radiology (x-ray).

To assess the role of Asthi in manifestation of sandhigatavata.

To study the role of tiktaka dravyas in the management of sandhigatavata.

Method

A Comparative Single Blind Clinical Study was conducted with pre and post

design. Patients of janusandhigatavata were categorised into two groups namely

Group A and Group B, consisting of 15 patients each.

Intervention

The intervention of clinical study was carried according to the individual group as

mentioned below.

Group-A

Trikatu churna was administered for ama pachana.

After attaining niramavastha patients were subjected to abhyanga with

ksheerabala taila followed by nadi sweda.

XIII

The sequence of 15 bastis in the form of kala basti was administered starting from

anuvasana with panchatikta ghrita (total 9 anuvasana bastis) and niruha basti with

panchatikta ksheera sarpi (total 6 niruha bastis) .

Group-B

Trikatu churna was administered for ama pachana.

After attaining niramavastha patients were subjected to abhyanga with

ksheerabala taila followed by nadi sweda.


anuvasana with bala ghrita (total 9 anuvasana bastis) and niruha basti with bala

sadhita ksheera sarpi (total 6 niruha bastis) .

Results

All the patients considered for the study showed improvement in both the

groups, which is statistically significant. But comparatively Group A showed good

result clinically when compared to Group B.

Interpretation and Conclusion

Based on both the literary and clinical aspects of the study, Janusandhigatavata

was considered under Asthi pradoshaja vikaras.

Group A showed good result with statistical significance ( p value 0.042 )

compared to Group B with no statistical significance ( p value 0.819).

Keywords Asthi pradoshaja vikaras

Janusandhigatavata

Kala basti

Panchatikta ghrita

Bala ghrita

XIV

CONTENTS

Sl. No Particular Page No.

1. Introduction 1-2

2. Objectives 3

3. Review of literature

4. Review on Asthi Pradoshaja vikaras 4-42

5. Review on Sandhigatavata 43-64

6. Review on Basti 65-72

7. Drug review 73-79

8. Materials and methods 80-94

9. Observation and results 95-130

10. Discussion 131-162

11. Conclusion

Recommendations for further study

163-164

12. Summary 165-166

13. Bibliographic reference 167-184

14 Annexure I-XI

XV

List of Tables

Table No

Particular Page No.

1 Showing the Paryayas of Asthi 6

2 Showing the Panchabhoutika sanghatana of Asthi 7

3 Showing the Sroto mulas of Asthi 8

4 Showing the Numbers of Asthi 8

5 Showing the Types of Asthi 9

6 Showing the Malas of Asthi 10

7 Showing the Vruddhi lakshanas of Asthi 11

8 Showing the Kshaya lakshanas of Asthi 12

9 Showing the different Asthi pradoshaja vikaras 14

10 Showing the Nidanas for Janusandhigatavata 45

11 Showing the Lakshanas of Janusandhigatavata 49

12 Showing the Saapeksha nidanas for Janusandhigatavata 51

13 Showing the Chikitsa for Janusandhigatavata 53

14 Showing Differential diagnosis of Knee osteoarthritis 61

15 Showing Differential diagnosis of Knee osteoarthritis 62

16 Showing the Properties of Trikatu 73

17 Showing the Properties of Panchatikta & Bala 74

18 Showing distribution of patients according to Age 95

19 Showing distribution of patients according to Sex 96

20 Showing distribution of patients according to Marital status 96

21 Showing distribution of patients according to Education 96

22 Showing distribution of patients according to Religion 97

23 Showing distribution of patients according to Socio-economic status

97

XVI

24 Showing distribution of patients according to Occupation 98

25 Showing distribution of patients according to Habitat 98

26 Shows distribution of patients according to Diet 99

27 Showing distribution of patients according to Prakruti 99

28 Showing distribution of patients according to Samhanana 100

29 Showing distribution of patients according to Pramana 100

30 Showing distribution of patients according to Sattva 100

31 Showing distribution of patients according to Koshtha 101

32 Showing distribution of patients according to Agni 101

33 Showing distribution of patients according to Bala 102

34 Showing distribution of patients according to Vyayama 102

35 Showing distribution of patients according to Joint involvement 103

36 Showing results of Joint pain ( Rt Knee ) 112

37 Showing Systemic measures in Joint pain (Rt Knee)

113

38 Showing results of Joint pain ( Lt knee ) 114

39 Showing Systemic measures in Joint pain (Lt Knee) 114

40 Showing results of Joint stiffness ( Rt knee ) 115

41 Showing Systemic measures in Joint stiffness (Rt Knee) 116

42 Showing results of Joint stiffness ( Lt knee ) 117

43 Showing Systemic measures in Joint stiffness ( Lt knee ) 117

44 Showing results of Joint swelling ( Rt knee ) 118

45 Showing Systemic measures in Joint swelling ( Rt knee ) 119

46 Showing results of Joint swelling ( Lt knee ) 120

47 Showing Systemic measures in Joint swelling ( Lt knee ) 120

48 Showing results of Joint crepitus ( Rt knee ) 121

49 Showing Systemic measures in Joint crepitus ( Rt knee ) 121

50 Showing results of Joint crepitus (Lt Knee) 122

XVII

51 Showing Systemic measures in Joint crepitus (Lt Knee) 123

52 Showing the Overall results within the groups 124

53 Showing the Overall results of the groups 125

54 Showing the significance of overall results 125

55 Showing sadhyaasadhyata of Asthi pradoshaja vikaras 139

56 Showing the chikitsa of Asthi Pradoshaja Vikaras 141

List of Illustrations

Sl.No Particulars Page No.

1 Showing Age wise distribution of 30 patients 104

2 Showing Sex wise distribution of 30 patients 104

3 Showing Marital status wise distribution of 30 patients 104

4 Showing Education wise distribution of 30 patients 105

5 Showing Religion wise distribution of 30 patients 105

6 Showing Occupation wise distribution of 30 patients 105

7 Showing Habitat wise distribution of 30 patients 106

8 Showing Diet wise distribution of 30 patients 106

9 Showing Prakruti wise distribution of 30 patients 106

10 Showing Samhanana wise distribution of 30 patients 107

11 Showing Pramana wise distribution of 30 patients 107

12 Showing Sattva wise distribution of 30 patients 107

13 Showing Koshtha wise distribution of 30 patients 108

14 Showing Agni wise distribution of 30 patients 108

15 Showing Bala wise distribution of 30 patients 108

XVIII

16 Showing Vyayamashakti wise distribution of 30 patients 109

17 Showing joint involvement wise distribution of 30 patients 109

18 Showing results of Joint pain (Rt Knee) 126

19 Showing results of Joint pain (Lt Knee) 126

20 Showing results of Joint stiffness (Rt Knee) 127

21 Showing results of Joint stiffness (Lt Knee) 127

22 Showing results of Joint swelling (Rt Knee) 128

23 Showing results of Joint swelling (Lt Knee) 128

24 Showing results of Joint crepitus (Rt Knee) 129

25 Showing results of Joint crepitus (Lt Knee) 129

26 Showing overall results within the groups 130

27 Showing overall results in 30 patients 130

List of flow charts

Chart No.

Particular Page No.

1 Showing Samanya Samprapti of Asthi Pradoshaja Vikaras 23

2 Showing the Vishesha Samprapti of Asthi pradoshaja vikaras

138

3 Showing the probable Samprapti of Janusandhigatavata 146

Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata

Dr.Ranjith Kumar Shetty 1

INTRODUCTION

Being an eternal science, 'Ayurveda', the 'science of human life', deals with

physical, psychological as well as spiritual well being of an individual. It covers all

the spheres of human life. It is not merely a materialistic science, but a philosophical

and factful truth, which our great ancestral sages, through their experience, logic and

power of wisdom, had found true and proved it to the truth of time. To keep it in pace

with advancing or so called modern age or scientific age is the present day task. To

proceed with such an incredibly rewarding task, is not more a challenge but an

exhaustive endeavour.

Human creatures have emerged as specialized species in the process of

evolution. The study of human being includes both physiological & pathological

entities. Ancient seers of Ayurveda have classified the elements of the body under

three fundamental components- Dosha, Dhatu and Mala. These three entities are

responsible for the maintenance of structural and functional integrity of the body.

Among these basic elements Dhatus are especially meant for dharana & poshana of

shareera. The equilibrium state of these dhatus results in arogya, where as any

imbalance in it produces vikara.

Dhatu pradoshaja vikara is a condition in which the dhatus are in vitiated state.

Among the dhatu pradoshaja vikaras, Asthi pradoshaja vikaras include adhyasthi,

asthibheda, asthishula etc. Acharya Charaka mentions that Panchakarma ,ksheera,

sarpi & tikta dravya basti are the treatment modalities for Asthi pradoshaja vikaras.

Sandhigatavata is a vata vyadhi, with characteristic features of Vatapurna

dhruti sparsha, shotha, vedana, sandhi shaithilyata & atopa. Here sandhi means asthi



melana, so in pathological condition, Asthi is also found to be vitiated & it can be

correlated to osteoarthritis as per the contemporary science.

According to World Health Organization, OA is the second commonest

musculoskeletal problem in the world (30%). The reported prevalence of OA from a

study in rural India is 5.78%. The major risk factors associated with knee OA seen in

population study were; age, females, obesity, smoking, occupational knee bending,

physical labor and chondrocalcinosis. Symptomatic and radiographic OA increases

with age.

Osteoarthritis is defined as degenerative condition of the articular surfaces of

the joint, particularly weight bearing joints. The clinical features are joint stiffness,

diminished mobility, discomfort & pain. The pathological changes occur in articular

cartilages, adjacent bones & synovium.

Evidence based medicine is the mantra of the modern era. So revalidation &

revitalization is essential through research in both fundamental & applied aspect of

Ayurveda. Asthi is one entity which can be visualized easily by radiology. The

revalidation of Asthi pradoshaja vikaras is possible with the help of radiological

investigations.

Hence, this work is undertaken to study the Asthi pradoshaja vikaras w.s.r.to

role of Asthi in manifestation of sandhigatavata & its management with tikta ksheera

sneha basti.



OBJECTIVES OF THE STUDY

To review in detail about Asthi and Asthi pradoshaja vikaras.

To assess the involvement of Asthi with the help of radiology (X-ray).

To assess the role of Asthi in manifestation of sandhigatavata.




ASTHI PRADOSHAJA VIKARAS

The shareera is made up of dosha, dhatu and mala. Among them dhatu is

meant for deha dharana. When this dhatu gets vitiated by doshas it leads to a specific

condition known as dhatu pradoshaja vikara. Among the dhatu pradushaja vikaras,

Asthi pradoshaja vikara is one.

Derivation

The term ‘Asthi pradoshaja vikaras’ consists of three terms. They are Asthi,

Pradoshaja and Vikara.

1. AÎxjÉ

The term ‘asthi’ is a napumsaka linga pada. The vyutpatti of which is as follows:

AxÉç + YÍjÉlÉç AÎxjÉ 1

It is derived from the mula dhatu ‘AxÉç’ and ‘YÍjÉlÉç’suffix.

AÎxjÉ: MüÐMüxÉ, MÑüsrÉqÉç, MümÉÉsÉ.2

Dictionary meanings: hard or firm, a bone, skull bones.3

2. mÉëSÉåwÉeÉ: mÉë+SÉåwÉ+eÉ 4

The term ‘mÉëSÉåwÉeÉ’ is a pullinga pada. The vyutpatti of which is as follows.

mÉë: mÉëM×ü¹ålÉ, EiMüwÉåï, AÉUqpÉ.5

Dictionary meanings: excessively, commencement, beginning.6

SÉåwÉ: SÉåwÉhÉqÉç, SÒ¹qÉç, mÉÉmÉqÉç.7,8

Dictionary meanings: a fault, defect, sinfulness. 9

eÉ: eÉlrÉiuÉÉiÉç, eÉlqÉÌlÉ,eÉlÉÉ¬ïlÉå.10,11



Dictionary meanings: born from, produced, caused by.

3. ÌuÉMüÉU

The term ‘ÌuÉMüÉU’ is a pullinga pada .The vyutpatti of which is as follows.

ÌuÉ+M×ü+bÉgÉç ÌuÉMüÉU.12

The term ÌuÉMüÉU is derived from moola dhatu ‘M×ü’ with ‘ÌuÉ’ upasarga and ‘bÉgÉç’

pratyaya.

ÌuÉMüÉU: mÉËUhÉÉqÉ, ÌuÉM×üÌiÉ, ÌuÉÌ¢ürÉÉ.13

Dictionary meanings: change of form or nature, an alteration, transformation.14

Collectively Asthi pradoshaja vikaras means the excessively vitiated doshas

takes shelter in the asthi and changes its natural form and produces different disorders.

Asthi Pradoshaja Vikaras have been selected for the applied study of this

work. These diseases occur due to vitiation of Asthi Dhatu, so it is important to know

the Asthi Dhatu, before describing Pradoshaja Vikara. Therefore now in the sequence

of concepts, concept of Asthi has been described here.

Asthi dhatu

Definition

zÉUÏUxjÉxÉmiÉkÉÉiuÉliÉaÉïiÉ kÉÉiÉÑÌuÉzÉåwÉ |15

It is one among the sapta dhatus which are present in the shareera.

qÉÉÇxÉÉprÉliÉUxjÉå (WûÉQèû) CÌiÉ ZrÉÉiÉå kÉÉiÉÑpÉåSå |16

Form of dhatu which is present inside the mamsa dhatu is known as Asthi.



Synonyms

Following synonyms are used for Asthi; 17,18,19

Keekasa = hard, firm.

Kulyam = a bone.

Kapala = the skull, cranium, skull bone.

Astri = not feminine, masculine.

Medojam = which is produced from meda.

Table No.1: Showing the Paryayas of Asthi

Sl.no Paryaya S.K.D A.K

1. Keekasa + +

2. Kulyam + +

3. Medojam + -

4. Kapala - +

5. Astri - +

Asthi Utpatti and Poshana

The formation of dhatu takes place in the following order- from annarasa rasa

will form, then rasa to rakta, rakta to mamsa, mamsa to meda, meda to asthi, asthi to

majja, from majja shukra will form, in this way uttarottara dhatu will be formed by

the previous dhatu. During this process heat produced by the combination of pruthvi,

agni and vayu acts on medas giving rise to kharatva (hardness) and thus produces the

asthi. This is in the form of krama parinama paksha or theory of transformation. The

uttarottara dhatu is nourished by the previous dhatu. 20

Food composed of Panchabhutas which is predominantly composed of Pruthvi, Tejas

and Vayu does poshana of the asthi dhatu. 21



Time taken for asthi formation

There are two opinions regarding formation of Asthi depending upon the time factor.

Asthi is formed on the 6th day. 22

Asthi is formed on 20th day. 23

Asthi swarupa (nature)

‘Kathina’ and ‘sthira’ are the swarupa of Asthi. 24

Asthi Panchabhoutika sanghatana

The panchabhoutika sanghatana of asthi which are mentioned in different samhitas

are tabulated below. 25,26

Table No.2: Showing the Panchabhoutika sanghatana of Asthi

Sl.no Panchabhutas C.S S.S

1. Pruthvi + +

2. Agni/ tejas + +

3. Anila + +

Asthidhara kala

Purishadhara kala is considered as asthidhara kala. 27

Asthivaha sroto mula28, 29, 30

The asthivaha sroto mulas which are mentioned in different samhitas are listed below.



Table No.3: Showing the Sroto mulas of Asthi

Sl.no Sroto mula C.S A.H A.S

1. Medo dhatu + + +

2. Jaghana + + +

3. Asthi sandhi + - -

Asthi Sankhya31, 32, 33, 34,35,36,37

The numbers of asthis in the shareera according to different samhitas are as follows.

Table No.4: Showing the Numbers of Asthi

Sl.no Text books Numbers

1. Charaka Samhita 360

2. Sushruta Samhita 300

3. Astanga Hrudaya 360

4. Astanga Sangraha 360

5. Bhavaprakasha 300

6. Kashyapa Samhita 360

7. Bhela Samhita 360

The distributions of asthis in the shadanga of shareera are as follows.

According to Sushruta samhita38

Shaakha : 140

Shroni, parshva, prushtha, uras: 117

Greevordhva : 63



According to Ashtanga sangraha39

Shaakha :140

Madhya shareera:120

Urdhva shareera: 100

Asthi Bhedas40,41,42

Depending upon size, shape, position of asthis in the body totally asthis are divided

into five types. These are tabulated below.

Table No.5: Showing the Types of Asthi

Sl.no Types S.S A.S B.P

1. Kapala + + +

2. Ruchaka + + +

3. Taruna + + +

4. Valaya + + +

5. Nalaka + + +

Asthi’s present in the janu, nitamba, amsa, ganda, talu, shankha, vankshana and

madhyashira are known as kapalasthi.

The dashanas are known as ruchakasthi.

Asthi’s present in the ghrana, karna, greeva and akshikuta are called as

tarunasthi.

Asthi’s in pani, pada, parshva and prustha are valayasthi.



The remaining asthi’s are nalakasthi.

Asthi Karmas

The asthi karmas are as follows

Deha dharana. 43

Majja pushti. 44

Asthi supports the mamsa, sira and snayu. 45

Asthi Upadhatu

The upadhatu of Asthi is danta 46.

Asthi Malas

During the formation of any dhatu it will produce their own malas. Similarly Asthi

also has malas, as per different texts. 47,48,49

Table No.6: Showing the Malas of Asthi

Sl.no Asthi mala C.S S.S B.P

1. Kesha + - -

2. Loma + - +

3. Nakha - + +

4. Roma - + -

Sara lakshanas

According to Charaka samhita, the asthi sara lakshanas are prominent parshni

(heel),gulpha (ankles), janu (knee), aratni (elbows), jatru (collar bones), chibuka



(chin), shira (head) and parva (joints) and also asthi (bone), nakha (nails) and danta

(teeth). Such individuals are endowed with qualities such as mahotsaha (enthusiastic),

kriyavanta (active), kleshasaha (enduring), sarasthi and shareera (having strong &

firm body) as well as ayushmanta (longivity). 50

As per Sushruta samhita, asthisara purusha lakshanas are mahashira (big

head), mahaskandha (big shoulders) and drudha danta (strong teeth), drudha hanu

(strong jaws), drudha asthi (strong bones) and drudha nakha (strong nails). 51

Asthi Vruddhi and kshaya lakshanas

Lakshanas of Asthi Kshaya and Vruddhi have been explained by almost all the

samhitas. Charaka samhita has not mentioned the Vruddhi Lakshanas of the Dhatus

but in Susruta samhita, Ashtanga sangraha and Ashtanga hrudaya vruddhi lakshanas

have been mentioned. The Lakshanas of the asthi vruddhi and Kshaya are as follows.

Asthi Vruddhi lakshanas 52,53,54

Table No.7: Showing the Vruddhi lakshanas of Asthi

Sl.no Vruddhi lakshanas S.S A.H A.S

1. Adhyasthi + + +

2. Adhidanta + + +

3. Kesha vruddhi + - -

4. Nakha vruddhi + - -



Asthi Kshaya lakshanas 55,56,57,58,59

Table No.8: Showing the Kshaya lakshanas of Asthi

Sl.no Kshaya lakshanas C.S S.S A.H A.S H.S

1. Prapatana of kesha, loma,

nakha, smashru and dwija

+ - - - -

2. Shrama + - - - -

3. Sandhi shaithilyata + - - - -

4. Asthi shoola - + - - -

5. Danta and nakha bhanga - + - - -

6. Roukshyata of danta and

nakha

- + - - -

7. Deha roukhsyata - + - - -

8. Asthi toda - - + + -

9. Sadana of danta, kesha,

nakha, loma.

- - + - -

10. Shaatana of danta, nakha,

roma, kesha.

- - - + -

11. Roukshyata of danta, nakha,

roma, kesha.

- - - + -

12. Parushyata of danta, nakha,

roma, kesha.

- - - + -

13. Asthi baddha mamsa

abhilasha

- - - + -

14. Atimanda chesta - - - - +

15. Veerya maandya - - - - +

16. Medasa kshaya - - - - +

17. Visamnyata - - - - +

18. Kampana - - - - +



Asthi vyapathija rogas 60

According to Bhela Samhita, asthi vyapattija rogas are danta roga, ativruddhi of asthi

and abhipatana of nakha, smashru, kesa, roma.

ASTHI PRADOSHAJA VIKARAS

Definition of Asthi pradoshaja vikaras

“SÉåwÉSÕÌwÉiÉåwuÉirÉjÉïÇ kÉÉiÉÑwÉÑ xÉÇ¥ÉÉ– UxÉeÉÉåÅrÉÇ, zÉÉåÍhÉiÉeÉÉåÅrÉÇ, qÉÉÇxÉeÉÉåÅrÉÇ, qÉåSÉåeÉÉåÅrÉÇ, AÎxjÉeÉÉåÅrÉÇ....|”61

When the Dhatus are vitiated extremely by the Doshas then it causes

respective "Dhatu Pradosaja Vikaras” it may be rasa pradoshaja vikaras, rakta

pradoshaja vikaras or asthi pradoshaja vikaras etc.

Importance of Dhatu pradoshaja vikaras

Dalhana mentioned the reason behind explaining the Dhatu Pradosaja Vikara

separately, these are, 62

19. Kaarshyata - - - - +

20. Angabhanga - - - - +

21. Vamana - - - - +

22. Kathorata - - - - +

23. Vatadi dosha shaithilyata - - - - +

24. Shopha - - - - +

25. Vikampana - - - - +

26. Shosha - - - - +

27. Ruja - - - - +



1. Chikitsa Vishesa Vijnanartha

2. Sukhasadhyatvadi Karma Bodhartham

Knowledge of these two is very much essential for a Vaidya, to avoid failure

in practice. Chakrapani distinctly revealed that in some cases only dosha viparita

chikitsa will not bring complete relief to the patient. One should treat dhatu also

because of ashraya prabhava.

“ mÉëuÉ×®zÉÉåÍhÉiÉÉ´ÉrÉÉxiÉÑ uÉÉiÉÉSrÉ AÉ´ÉrÉmÉëpÉÉuÉÉ³É xuÉÍcÉÌMüixÉÉqÉÉ§ÉåhÉ mÉëzÉÉqrÉÌiÉ||” 63

Chakrapani has used the term "Ashraya Prabhava" to indicate the significance of

Dhatu in the treatment.

Asthi pradoshaja vikaras 64,65

The Asthi pradoshaja vikaras which are mentioned in different classics are tabulated

below.

Table No.9: Showing the different Asthi pradoshaja vikaras

Sl.no Vyadhi C.S S.S

1. Adhyasthi + +

2. Adhidanta + +

3. Dantabheda + -

4. Dantashoola + -

5. Asthibheda + -

6. Asthishoola + +

7. Vivarnata + -



8. Kesa, Loma, Nakha, Smashru

Dosha

+ -

9. Kunakha - +

10. Asthi Toda - +

Yogendranath sen in commentary of Charaka samhita mentioned that kesha,

loma and smashru are malas of the asthi dhatu. This is the reason to consider keshadi

doshas as one among the asthi pradoshaja vikaras. 66

Nidanas for Asthi pradoshaja vikaras

The nidanas of asthi pradoshaja vikaras can be classified into samanya and vishesa

nidana. These are as follows.

Samanya nidana 67,68

In Charaka samhita and Astanga hrudaya, samanya nidanas are mentioned for all the

dhatu pradoshaja vikaras. These are;

A. Dosha guna sama ahara and vihara

B. Dhatu viguna ahara and vihara

C. Rutu viguna ahara and vihara

Dosha guna sama ahara and vihara: The intake of nidanas in the form of ahara and

vihara which are having similar gunas to that of particular dosha gunas leads to

dosha vruddhi by samanyam vruddhikaranam siddhanta. E.g: if person consumes

rukshadi guna yukta ahara and vihara then there will be vata vruddhi.



Dhatu viguna ahara and vihara: The intake of nidanas in the form of ahara and

vihara which are having dissimilar gunas to that of particular dhatu gunas i.e dhatu

virodhaka swabhava by vishesa siddhanta.

Rutu viguna ahara and vihara: The particular ahara and vihara which are dealt for

each rutu if not followed leads to dosha vitiation i.e. vipareeta to rutucharya

palana.

Vishesa nidana 69,70,71

In Charaka samhita some specific nidanas are mentioned for Asthi pradoshaja vikaras.

These are;

A. Ativyayama

B. Ati sankshobha

C. Ati vighattana

D. Vatala ahara and vihara

Ativyayama: ativyayama means excessive shareera ayasa janaka karma.

Atisankshobha: Atisankshobha means abhighata (Yogindranath sen). It means

injury or excessive jerk or violence or commotion.

Ativigattana: Ativighattana means atichaalana (Yogindranath sen). It means

excessive movements or separated or loosened or shaking.

Vatala ahara and vihara sevana: Vata guna samana ahara and vihara sevana. For

e.g,

Vatala ahara: ruksha – sheeta- laghu guna pradhana ahara sevana, alpa matra

ahara sevana, mudga, masoora, vaartaaka, kalinga, harenuka etc.



Vatala vihara: ativyavaya, ati jagarana, krodha, bhaya, vegadharana, abhighata,

upavasa, shoka, plavana etc.

Poorvarupa 72

None of the Ayurvedic classics have mentioned poorvarupa of Asthi

pradoshaja vikaras. Avyakta lakshanas or alpa vyakta lakshanas are considered as

poorvarupa.

Rupa

Each Asthi pradoshaja vikara is having its own lakshana. These are as follows.

Adhyasthi 73

Adyasthi means adhika asthi i.e, additional bone or extra bone.

Adhidanta 74

Adhidanta means adhika danta i.e, additional tooth or extra tooth.

Dosha: Vata

Characteristic features: There will be an extra tooth eruption over the tooth and during

the eruption pain associates and after the eruption pain subsides. This condition is

called adhidanta.

Dantabheda 75,76

It is a condition were cutting type of pain in danta is seen and is called as dantabheda.

It is also called as ‘bhanjanaka’.



Dosha: Vata (Vagbhata)

Vata + Kapha (Sushruta)

Characteristic features: It is a vataja vyadhi and there will be toda, bheda, ruk and

sphutana in the danta. This is known as dantabheda.

It is a kaphavataja vyadhi in which teeth falls down due to mukha vaktrata and

associated with teevra ruja. This is known as bhanjanaka.

Dantashoola 77,78

There will be a severe or acute pain in the tooth is called as dantashoola.

Other names: Dalhana (Sushruta)

Sheetadanta (Vagbhata)

Dosha: Vata

Characteristic features: The vitiated vata dosha causes untolerable cutting type of pain

in the teeth and is called dalana.

Ashtanga hrudaya also opines same, but called it as sheeta danta because the patient is

not able to eat or drink sheeta padarthas.

Asthibheda 79

It is a condition in which bhidhyamanasya vyatha (cutting type or splitting type of

pain) will be present in asthi. This is known as asthibheda.

Asthishoola 80

It is a condition in which severe or acute pain in asthi like shanka sphutanavat. This is

known as asthishoola.



Asthitoda 81

It is a condition in which vicchinna shoola (pricking or breaking type of pain) will be

present in asthi. This is known as asthitoda.

Vivarnata

These disorders are two in number. They are shyavadanta and krimidanta.

Shyavadanta 82,83

The blackish discoloration of tooth is called as shyavadanta.

Dosha: Rakta + Pitta (Sushruta)

Rakta + Pitta + Vata (Vagbhata)

Characteristic features: The vitiated rakta along with pitta, burns the danta twacha and

causes the shyavata (blackish) or neela (blue) varnata of danta. This is known as

shyavadanta.

The danta becomes shyava varna due to the vitiation of rakta, pitta and vata is known

as shyavadanta.

Krimidanta 84,85

The condition in which decaying of tooth takes place is called as krimidanta.

Dosha: Vata

Characteristic features: Due to the vitiation of vata dosha, danta becomes krishna

varna, chidra yukta, chalayukta, sravayukta, teevra rujayukta or sometime intermittent

shoola. This is known as krimi danta.

Ashtanga hrudaya explained krimidanta in a more ellaborate manner, which is as

follows.



Vata vitiation danta moola shotha

Danta kshata sushira

Danta majja shosha production of krimi

Danta shoola, srava chala danta

Puya rakta srava danta vidradi

Kesha, loma and smashru vikaras

The kesha, loma and smasru vikaras are indralupta, ruhya, khalitya and palitya.

Indralupta 86,87,88

The partial or complete loss of hair from all over the body is called as indralupta.

Synonyms: Ruhya, Chacha

Dosha: Tridosha + Rakta

Characteristic features: The vitiated vata and pitta affects the roma kupas and causes

roma patana, then the vitiated kapha and rakta obstructs the roma kupas. So there is

no chance for regrowth of hairs. This condition is called as indralupta.

Ashtanga hrudaya also opines same.

Karteeka opines that if hair loss is from all over the body is called as Ruhya and fall

of smashru is known as indralupta.

Khalitya 89,90,91

The condition in which gradual loss of hair takes place in the scalp is called as

khalitya.

Dosha: Tridosha (Charaka)

Tridosha + Rakta (Sushruta & Vagbhata)



Characteristic features: The vitiated vatadi doshas along with increased shareera

ushnata removes the snigdata in kesha moolas leading to gradual hair loss is called as

khalitya.

The vitiated vata and pitta affects the roma kupas and causes roma patana, then the

vitiated kapha and rakta obstructs the roma kupas. So there is no chance for regrowth

of hairs. The complete loss of scalp hair is called khalitya.

The pathology of khalitya is like indralupta i.e, vata and pitta causes kesha shatana,

kapha and rakta obstructs the kesha moolas so there is no chance of re growth of hair

but in khalitya kesha shatan is g radual or slow, not sudden as in indralupta.

Palitya 92,93,94

The condition in which discoloration of hair takes place is called as palitya.

Dosha: Tridosha (Charaka)

Pitta (Sushruta & Vagbhata)

Characteristic features: The vitiated vatadi doshas and increased shareera ushnata

removes the snigdhata in kesha moolas causing discoloration of hair, it becomes

kapila varna.

Due to krodha, shoka and shrama the increased shaeera ushnata and vitiated pitta

causes pachana or discoloration of keshas in the shiras which is called as palitya.

Ashtanga hrudaya also opines same as Sushruta samhita and mentions some other

lakshanas depending upon predominance of doshas.

In vata predominance, hair becomes shyava varna, ruksha, khara and jalaprabha.

In pitta predominance, hair becomes peetabha with daha.

In kapha predominance, hair becomes snigdayukta, shukla varna and sthula.



In tridosha vitiation all the above symptoms together present.

Kunakha 95,96

A disease of the nails which is ugly in appearance. This condition is called as

kunakha.

Syonyms: Kuleena (Sushruta)

Dosha: Pitta +Vata

Characteristic features: The vitiated pitta and vata localizes at the sides of the nail

beds producing daha, paka and vedana and is called as chippa. When this condition is

in mild form, it is known as kunkha and nakha attains rukshatva, kharatva and asita

varna. Other causes for kunakha include abhighata.

Ashtanga hrudaya also opines same and added one more lakshana i.e, jwara.

Samprapti 97

The nidanas of the asthi pradoshaja vikara are ativyayama, atisankshobha,

ativighattana and vatala ahara- vihara which leads to agni dushti and is the cause of

production of abnormal asthi. In such conditions if the patient continues the intake of

causative factors (Nidana Sevana), there will be excessive vitiation of doshas as they

have been already vitiated earlier. These excessive vitiated doshas when lodges in

asthi dhatu, the manifestation of asthi pradosaja vikara takes place at various sites in

the body according to sthana dusti or Khavaigunya.



Flow chart No.1: Showing Samanya Samprapti of AsthiPradoshaja Vikara

Sadhyasadhyata 98,99

Among the Asthi pradoshaja vikaras, some are considered as asadhya vyadhis

and some are considered as yapya vyadhis and some are kashta sadhya vyadhis.

Dalana, bhanjanaka, shyavadanta, tridoshaja khalitya, tridoshaja palitya and

dantashoola are considered as asadhya vyadhis. Indralupta, ekadoshaja khalitya and

Nidana sevana

Dosha gunasama

ahara‐vihara

Dhatu viguna ahara‐

vihara

Rutu vigunaa ahara‐vihara

Dhatu dushti

Dosha dushti Dosha dushti

Asthi dhatu dushti

Khavaigunya

Dosha‐dushya sammurchana

Particular Asthi pradoshaja vikaras



ekadoshaja palitya are considered as yapya vyadhis. The remaining diseases are

considered as kashtasadhya vyadhis i.e adhyasthi, adhidanta, dantabheda, asthibheda,

asthi toda, asthishoola and kunakha.

Upadrava

None of the Ayurvedic classics have mentioned upadravas of Asthi pradoshaja

vikaras.

Arishta lakshanas

Regarding arishta lakshanas, there is no direct reference in the context of Asthi

prradoshaja vikaras.

Chikitsa

According to Charaka Samhita, Asthyashrita vyadhis are treated by

Panchakarma, especially by Basti, which is prepared out of Ksheera, Sarpi, and Tikta

Dravyas. While commenting on chikitsa sutra Chakrapani opines that tikta ksheera

sarpi basti is ‘hita’ for asthi pradoshaja vikaras. 100

Other treatment modalities which are expalined in different classical texts can be

adopted to treat Asthi pradoshaja vikaras. These are as follows.

According to Sushruta Samhita, snayu and sandhyasthi gata rogas are treated by

sneha, upanaha, agnikarma, bandhana and unmardana. 101



According to Ashtanga hrudaya, diseases due to vitiation of Asthidhatu are treated

by basti, which is prepared by Ksheera, Sarpi, and Tikta Dravyas. Ashtanga

sangrahakara also opines same treatment. 102,103

According to Yogaratnakara, bahya and abhyantara snehana karma are adopted to

treat asthimajjagata rogas. 104

According to Harita Samhita, asthi kshaya is treated by processed ghrita, usage of

different types of ksheeras, chandana, drakshadi churna, all types of jangala desha

praani mamsa sevana and all types of Madura pradhana annas. 105

Chikitsa for Adhidanta 106,107

Kshara karma

When danta is jarjarita, then krimidantavat chikitsa is to be adopted i.e. swedana,

rakta visravana, gandusha, nasya, agnikarma.

Danta nirharana, then vranavat chikitsa.

Chikitsa for Danta bheda108

All the vata-kapha nashaka kriya.

Arditavat chikitsa

Abhyanga with narayana taila.

Swedana and vasti.

Kavala with aakara karabhadi yoga.

Eranda taila pana.

Gandusha dharana: ksheera prepared out of tila + yashtimadhu.



Chikitsa for Danta shoola109

According to Sushruta samhita, it is an asadhya vyadhi.

Gandusha with hingvadi taila or eranda + dvivyaghri + bhukadamba siddha taila

or yastimadhu taila.

Danta nirharana with danta nirgatana yantra.

Danta pali lekhana, then agni karma with ushna taila.

Danta pali gharshana or pratisarana with fine powders of musta, saindhava,

dadima tvacha, triphala, rasanjana, shunti + madhu.

Kavala with ksheeri vruksha kashaya

Nasya with anu taila or ksheera prepared out of yashtimadhu + vidari +

shrungataka + kasheru.

Chikitsa for Krimidanta110,111

Immovable teeth: swedana, rakta mokshana, vataghna avapeeda nasya, sneha

gandusha, bhadradarvadi lepa, snigdha bhojana.

Movable teeth: danta nirharana and agni karma.

If tooth is perforated: filling the gap with guda or madhuchista and agnikarma,

filling the gap with the milk of saptacchada or arka.

Chikitsa for Indralupta112,113

First siravyadhana is done at the nearer site of lesion, then application of the paste

which is prepared by kaseesa, manashila, tuttha and maricha or pippali to the

head.



Application of bhrungaraja taila or bruhati taila + gunja moola or bhrungaraja

swarasa + taila (pakwa) or gomutra + japa pushpa or root and fruit of gunja or

langali moola + ksheera or karaveera patra swarasa or kantakari swarasa + madhu

or dhattura patra swarasa with madhu or ghrita, bhallataka rasa with madhu or

ghrita, tila pushpa + gokshura with madhu or ghrita, hastidanta masi with tila taila.

Upto completion of treatment snana is not adviced.

Chikitsa for Khalitya and Palitya114,115,116

Shareera shodana : vamana and virechana

Nasya karma with vidarigandhadi taila or sahacharadi taila or bhrungaraja taila or

prapoundarikadi taila or mahaneela taila or laghupanchamooladi taila or nimba

taila or bhruhatyadi taila or jeevaniya gana taila.

Shiroabhyanga with mahaneela taila or bhrungaraja taila

Lepa with priyaladi yoga or tiladi yoga.

Palitanashaka loha yoga for oral administration.

Application of jatamamsi + kushta + tila + Krishna sariva + neelotpala + gomutra

+ madhu.

Oral intake of ksheera daily.

Bramhacharya palana.

Chikitsa for Kunakha117

Shastra karma: swedana with the part being immersed in ushna jala and nail has

to be removed.



Agni karma

Chakra taila for application.

Sarja churna for application

Madhuroushadha siddha taila for application.

Application of haridra + agaru and kalimaka kalka.



BONE AND BONE DISORDERS

Bone is essentially a highly vascular, living, constantly changing mineralized

connective tissue. It is remarkable for its hardness, resilience and regenerative

capacity, as well as its characteristic growth mechanisms. 118

Synonyms of bones: bone, off-white, os, pearl, ivory, osseous tissue. 119

Number of bones120

The human skeleton consists of 206 bones.

Upper limbs- 64

Lower limbs- 62

Vertebrae- 26(33)

Skull- 29

Ribs- 24

Sternum- 1

Classification of bones121

(A). According to position

1. Axial: bones forming the axis of the body. e.g, skull, ribs, sternum and vertebrae.

2. Appendicular: bones forming the skeleton of limbs.

(B). According to size and shape

1. Long bones: present in upper and lower limbs.



2. Short long bones: same as above but are miniature in size. e.g, metacarpals,

metatarsals and phalanges.

3. Short bones: small, polyhedral and generally cuboidal in shape.e.g, carpel and

tarsal bones.

4. Flat bones: expanded and plate like. e.g, scapula, sternum, ribs, parietal and

frontal bones.

5. Irregular bones: irregular in general outline and do not fit in any of the categaries.

e.g, vertebrae and some skull bones.

6. Pneumatic bones: flat or irregular bones possessing a hollow space within their

body which contains air. e.g, ethmoid, maxilla, mastoid part of temporal bone.

7. Sesamoid bones: sesamoid means ‘seed- like’. They are nodules of bones. e.g,

pisiform, patella.

(C). According to gross structure

1. Compact bone: the outer cortical part of long bones, which is hard and has a

homogenous appearance.

2. Spongy bone: the inner part of bone which is less hard and presents a spongy

appearance. E.g, flat, short and irregular bones and ends of long bones.

3. Diploic bone: consists of inner and outer tables of compact bone with an

intervening porous layer which is occupied by a spongy substance consisting of

bone marrow and diploic veins. Eg, most of cranial bones.

(D). According to development

1. Membranous bones: which develop in membrane.

2. Cartilaginous bones: which develop in cartilage.



Development of bones122

Both cartilages and bones are mesodermal in origin. They develop from the

embryonic mesenchyme which is the loose cellular connective tissue with a fluid

matrix.

Structure of cartilage and bone123

1. Cartilage: Cartilage is a variety of hard connective tissue.

Characteristic feature: translucent, firm (less hard than bone) and elastic. It is

compressible and can withstand considerable pressure, pull and torsion.

Histological structure: Cartilage consists of two basic structures

i. Chondrocytes: usually large, rounded and encapsulated. They are embedded in

the matrix.

ii. Matrix: it depends upon the character and properties of the cartilage of a gel

like ground substance which makes the cartilage solid. It contains cartilage

cells and fibres.

Types of cartilage: Depending upon the type of fibers in the matrix and number of

cells cartilages are divided into 3 types. (a) Hyaline cartilage

(b) White fibro cartilage

(c) Elastic cartilage

(2) Bone: Bone is a type of hard connective tissue and is the hardest structure in the

body



Composition of bone124

i. Organic matter: Forms1/3 weight of bone; consists of fibrous material and

cells; responsible for the toughness and resilience of bone.

ii. Inorganic matter: Forms 2/3 weight of bone; consists of the following minerals

salts-calcium phosphate, calcium carbonate, calcium fluoride and magnesium

phosphate; responsible for the rigidity and hardness of bone.

Bone cells: These are (i) Osteoblasts (ii) Osteocytes (iii) Osteoclasts. 125

Osteoblasts: These are ovoid cells with basophilic cytoplasm and an oval nucleus.

They lie against the surface of bone in the inner layer of periosteum and the

endosteum i.e. at the sites where active bone formation is in progress. They form

protein elements of the matrix and control deposition of mineral salts in relation to

collagen fibres. They produce alkaline phosphatase which helps in precipitation of

calcium phosphate and other salts.

Osteocytes: Osteoblasts becomes Osteocytes by forming matrix around itself and

becoming dormant when active bone formation is not required. They occupy the

lacunae.

Osteoclasts: These are large multi nucleated giant cells with acidophilic cytoplasm,

which contains many vacuoles. They arise by fusion of Osteoblasts and Osteocytes

and are concerned with resorption of bone during growth and remodeling of skeleton.

They produce acid phosphatase which dissolves inorganic constituents of bone.



Periosteum: It is a thick layer of fibrous tissue which covers bone surfaces except

over its articular surfaces where it is replaced by articular cartilage. Through its blood

vessels it nourishes the bone and if torn, the underlying bone dies. Periosteum has

bone forming activity in times of need.

Endosteum: It is highly vascular membrane which lines the medullary cavity on the

inner surface of a compact bone.

Bone minerals, Calcitropic hormones and bone mineral homeostasis126

Three major ions, calcium, phosphorous and magnesium; three major Calcitropic

hormones, parathyroid hormone (PTH), 1,25dihydro vitamin D3 and calcitonin; and

three major target organs, bone, kidney and gut are involved in the metabolism of

bone, bone mineral and bone growth.

Minerals

Calcium: The total body content of calcium is about 1000gms. More than 99% of this

is in the bone. Normally, 90% of the filtered calcium is reabsorbed in the proximal

tubule and loop of henley and 8% in the distal tubule and collecting duct.

Reabsorption at the latter site is increased by PTH and decreased by metabolic

acidosisand phosphate depletion. Tubular intestinal absorption of calcium adjusts so

that the plasma level set by the prevailing secretion rate of PTH can be maintained

without the loss of calcium from bone.



Phosphate: The total body content of phosphate is about 700gms, of which 85% is in

bone and most of the remainder is inside cells. Inorganic phosphate is an integral part

of bone mineral. The concentrations of inorganic phosphate in glomerular filtrate are

similar to that in plasma. Normally, about 85% of the filtered load is reabsorbed, 75%

in the proximal tubules and 10% in the distal tubules. Both proximal and distal

reabsorption of phosphate is decreased by PTH and calcium.

Magnesium: The total body content of magnesium is about 20gm, of which 65% in

bone and most of the remainder is intracellular. Net gastrointestinal absorption of

magnesium is about 40% intake. Normally, about 96% of filtered magnesium is

reabsorbed. Magnesium is an important component of the adenylate cyclase system

and is required in the process of vitamin-D activation. Severe and prolonged

hypomagnesaemia inhibits PTH release and induces resistance to the action of PTH

on bone.

Calcitropic hormones

Vitamin-D: Intestinal absorption of dietary vitamin-D occurs mainly in jejunum.

Both viaminD2 and vitamin D3 are prohormonal forms and are inert until activated in

the liver and kidney through sequential hydroxylations. The production of

1,25(OH)2D3 is directly related to body needs; its formation is enhanced by vitamin D

depletion,PTH, hypocalcaemia and hypophosphataemia. The effect 1,25(OH)2D3 on

the intestineis to increase the absorption of calcium and phosphorus. In the skeleton

1,25(OH)2D3 has two actions; mobilization of calcium and phosphorus from



previously formed bone and probably promotion of maturation and mineralization of

the organic matrix.

Parathyroid hormone: The function of PTH is to maintain ionized calcium

concemtration in the ECF. PTH secretion increases with a fall and decreases with a

rise in plasma ionized calcium. The extracellular concentration of ionized calcium is

the most important physiological regulator minute to minute secretion of PTH. PTH

has a dual action on bone, of calcium release and bone remodeling. PTH increases

osteoclastic bone resorption by first acting on Osteoblasts or stromal fibroblasts,

which release osteoclast activating cytokines.

Calcitonin: Calcitonin is the only hormone in humans capable of actively lowering

serum calcium. The hypocalcimic action of CT results from the inhibition of bone

resorption and decreased in the absolute number of Osteoclasts and increased bone

mineral deposition. It also affects Osteocytes causing decreased calcium ion flux

across the cell membranes. These effects are opposite of PTH. Calcitonin secretion is

stimulated by hypercalcaemia and inhibited by hypocalcaemia. Calcitonin protects

against hypercalcaemia. Calcitonin levels are lowered by oestrogen deficiency.

Oestrogen: The limited number of estrogen binding sites is on Osteoblasts as well as

Osteoclasts. Its decline at menopause results in a rapid bone loss, associated with

increased osteoclastic bone resorption, particularly trabecular.



Other systemic hormones: Other hormones, which regulate bone growth and

metabolism, include growth hormone, somatomedins, insulin, glucocorticoids, thyroid

hormones, prolactin and gonadotropins.

Local factors: Most of the local regulators of bone remodeling are synthesized by

skeletal cells and include growth factors, cytokines and prostaglandins.

Functions of bones: 127

Constitute framework of the body and hence gives shape and form to the body.

Forms central axis of the body.

Supports and transmits weight of the body.

Provides the levers essential for locomotion by forming articulations and giving

attachment to muscles and ligaments.

Provide mechanical protection to vital organs such as brain, heart and lungs.

Stores calcium.

Forms blood in their marrow.

Blood supply of bones: Derived from 4 sources. They are; 128

i. Nutrient artery

ii. Periosteal artery

iii. Metaphyseal artery

iv. Epiphysial artery



Lymphatic drainage of bones: The lymphatics of the haversian systems drain into

the periosteal lymph vessels. 129

Nerve supply of bones: They apparently consist of both sensory and motor

(autonomic) fibres. 130

Bone disorders131,132

Some of the bone disorders are as follows.

Bone Spur

A bone spur (osteophyte) is a bony growth formed on normal bone. Bone spur is just

extra bone. It’s usually smooth, but it can cause wear and tear or pain if it presses or

rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body.

Common places for bone spurs include the spine, shoulders, hands, hips, knees, and

feet.

Bone pain

Chronic bone pain: Subacute or chronic bone pain usually has the following

characteristics.

Localized to the affected bone, rather than the joint

Present at rest and worse at night-time

Not clearly worsened by movement or usage (unlike joint or periarticular pain)

Not readily reproduced by joint movement

Focal tenderness on local pressure.

Other features in the enquiry usually points to the most likely cause. For example;



Slowly but relentlessly progressive pain suggests a destructive disease like

malignancy or chronic infection. Malignancy is usually associated with weight

loss, fatigue and symptoms relating to the primary site.

Pain that is experienced over a wider area of a bone and accompanied by

deformity strongly suggests Paget's disease.

Osteomalacia is associated with bone tenderness and limb girdle weakness.

Pain from osteonecrosis is initially bony and progressive but then may develop

superadded features of joint pain (worse on usage or weight-bearing, with or

without radiation, reproduced by examination) as the adjacent joint cartilage

collapses and the joint is involved (mainly hips, shoulders or elbows).

Severe arthropathy with subchondral bone attrition and collapse most commonly

osteoarthritis, may also cause bone pain, though this inevitably superimposed

upon a chronic history of usage –related joint pain.

Acute bone pain: Fracture

Sudden onset pain that is very well localized, severe and worsened by even slight

movement should always suggest a fracture. This is the major clinical manifestation

of metabolic bone disease.

Fragility fractures occur spontaneously or as the result of relatively minor trauma;

they are typical of osteoporosis.

Pathological fractures occur in bone that is structurally abnormal, such as in

Paget's disease, osteomalacia, bone metastasis and parathyroid bone disease. Like

fragility fractures, they can occur spontaneously or follow minor trauma.

High-energy fractures result from major trauma (e.g. car crash, falls from a



height) and can affect normal bones. The same is true of stress (fatigue) fractures

in healthy individuals, such as athletes and military recruits, who are exposed to

repetitive trauma.

Toothache

A toothache, also known as odontalgia or, less frequently, as odontalgy, is an aching

pain in or around a tooth. In most cases toothaches are caused by problems in the

tooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, a

marginally cracked tooth, infected dental pulp (necessitating root canal treatment or

extraction of the tooth), jaw disease, or exposed tooth root. Causes of a toothache may

also be a symptom of diseases of the heart, such as angina or a myocardial infarction,

due to referred pain.

Dental caries

Dental caries, also known as tooth decay or a cavity, is a disease where bacterial

processes damage hard tooth structure (enamel, dentin, and cementum). These tissues

progressively break down, producing dental caries (cavities, holes in the teeth). Two

groups of bacteria are responsible for initiating caries: Streptococcus mutans and

Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and,

in severe cases, death.

Hyperdontia

Hyperdontia is the condition of having supernumerary teeth, or teeth which appear in

addition to the regular number of teeth. The most common supernumerary tooth is a

mesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary



central incisors. Fourth and fifth molars that form behind the third molars are another

kind of supernumerary teeth.

Fissure or cracked teeth

The deep pits and fissures in teeth are where some 80% of cavities begin. In reference

to the teeth, fissures are thin grooves in the biting surfaces (frequently extending onto

the sides). They are significant because of their tendency to accumulate food and

bacterial plaque. It may not be possible to remove plaque from deep pits and fissures

in teeth, and some 80% of cavities are believed to originate there.

Tooth discoloration

Tooth discoloration is caused by multiple local and systemic conditions. Extrinsic

dental stains are caused by predisposing factors(poor oral hygiene) and other factors

such as dental plaque and calculus, foods and beverages, tobacco, chromogenic

bacteria, metallic compounds, and topical medications. Intrinsic dental stains are

caused by dental materials (eg, tooth restorations), dental conditions and caries,

trauma, infections, medications, nutritional deficiencies and other disorders (eg,

complications of pregnancy, anemia and bleeding disorders, bile duct problems), and

genetic defects and hereditary diseases. (eg, those affecting enamel and dentin

development or maturation).

Onychogryphosis

Onychogryphosis is a thickening and distortion of the toenails usually due to tight or



ill fitting shoes. These types of nails are caused by damage to the cells that grow the

nail. This can be sudden acute damage such as dropping a heavy object onto the toe or

can be due to a gradual damage over the years with the toes impacting into the toe box

of the shoes or with various sporting activities.

Alopecia areata

Alopecia areata is a condition affecting humans, in which hair is lost from some or all

areas of the body, usually from the scalp. Because it causes bald spots on the scalp,

especially in the primary stages, it is sometimes called spot baldness. In 1%–2% of

cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire

epidermis (Alopecia universalis).

Hair may also be lost more diffusely over the whole scalp, in which case the

condition is called diffuse alopecia areata.

Alopecia areata monolocularis describes baldness in only one spot. It may occur

anywhere on the head.

Alopecia areata multilocularis refers to multiple areas of hair loss.

The disease may be limited only to the beard, in which case it is called Alopecia

areata barbae.

If the patient loses all the hair on his/her scalp, the disease is then called Alopecia

areata totalis.

If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia

areata universalis.



Grey Hair

Grey hair is usually associated with ageing, but this is not always the case. Early

greying of the hair is basically hereditary, and can inherit it from one of our parents or

grandparents. Grey hair can also be influenced by stress. A person experiencing a

prolonged period of stress and anxiety may notice, over a period of time, white hairs

gradually appearing. Malnutrition, worry, shock, deep sorrow, tension and other

similar conditions may also slow down the production of melanin resulting in grey

hair.

Investigations 133

The following investigations are usually done in bone disorders.

Bone mineral profile

Calcitropic hormone assay

Imaging technique

Plain radiography

Bone scan or Scintigraphy

Bone densitometry

Quantitative ultrasound

Quantitative computed tomography

Magnetic resonance imaging

Bone biopsy and Histomorphometry



SANDHIGATAVATA

Sandhigatavata is mentioned under Vatavyadhi by all the samhitas.

Janusandhigatavata represents the variety of sandhigatavata. The knowledge of

disease is obtained by the study of Nidana, Purvarupa, Rupa, Upashaya and Samprapti

which are termed as Nidana Panchaka.

Derivation

JanuSandhigata vata is a compound word with 4 words combined. Janu, Sandhi, Gata

and Vata.

Janu

Vyutpatti: eÉlÉç +gÉÑhÉç 134

The term ‘janu’ is derived from the mula dhatu ‘eÉlÉç’ and ‘lÉÑhÉç’ suffix.

Nirukti: EÂ eÉÇbÉrÉÉåUç qÉkrÉ pÉÉaÉ:| 135

The region between the uru and jangha is called janu.

Sandhi

Vyutpatti: xÉÇ+ kÉÉ+ ÌMü: 136

The term is derived from ‘sam’ upasarga and ‘dhaa’ dhatu. It means that which does

the sandhaana is nothing but sandhi.

Nirukti: AxjlÉÉÇ iÉÑ xÉlkÉrÉÉå ¾ûÉåiÉå MåüuÉsÉ: mÉËUMüÐÌiÉïiÉÉ:| 137

Place where the joining of bone takes place is known as sandhi.



Gata

Vyutpatti: aÉÇ + £ü: 138

The term gata is derived from ‘gam’ dhatu and ‘kta’ upasarga.

Nirukti: aÉqÉç- aÉqÉlÉå|139

This is approached or situated.

Vata

Vyutpatti : uÉÉ + iÉlÉç 140

The term vata is derived from mula dhatu ‘vaa’ and ‘tan’ suffix.

Nirukti: uÉÉ aÉÌiÉ aÉlkÉlÉrÉÉå: CÌiÉ| 141

Which is having mobility or movement is called vata.

The vitiated vata when gets lodged in janu sandhi leads to the manifestation of

janusandhigatavata.

Paryaya of Sandhigata vata. 142

Sandhivata

Sandhigatavata

Khudavata

Jeerna vata

Nidana

There are no special set of nidanas mentioned in classics for sandhigatavata or

janusandhigatavata. The set of nidanas mentioned for vatavyadhi can be considered



for janusandhigatavata. These are listed below. 143,144,145,146,147,148,149

Table No.10: Showing the Nidanas for Janusandhigatavata

Nidana C.S S.S A.H A.S M.N Y.R B.P

Aharaja Nidana

a) Rasavishesha

Katu - + + + - - +

Tikta - + + + - - -

Kashaya - + + + - - -

b) Guna Vishesha

Rooksha + + + + + + +

Laghu + + - + + + +

Sheeta + + - + + + +

c) Dravya Vishesha

- + - - - - -

Varaka - + - - - - -

Shushka shakha - + - - - - -

Uddalaka - + - - - - -

Neevaara - + - - - - -

Mudga - + - - - - -

Masoora - + - - - - -



Harenu - + - - - - -

Kalaaya - + - + - - -

Nishpaava - + - - - - -

Virudhaka dhanya - - - + - - -

Vistambhi dhanya - - - + - - -

Trina dhanya - - - + - - -

Chanaka - - - + - - -

Kareera - - - + - - -

Thumba - - - + - - -

Kalinga - - - + - - -

Chirbhata - - - + - - -

Bisa - - - + - - -

Shabooka - - - + - - -

Jambava - - - + - - -

Tinduka - - - + - - -

Vihara

Ativyayama + + + + + + +

Langhana + + - + + + -

Plavana + + - + + + -

Atyadhwa + + - + + + -



Pradhavana - + - + - - -

Pratarana - + - + - - +

Atyuccha bhashana - - + + - - -

Balavadnigraha - + - + - - -

Abhighata + + - + + + +

Marmaghata + - - - + + -

Bharaharana - + - + - - -

Dukhasana + - - - - - -

Gaja, ushtra ashwa

sheeghrayana patina

+ + - + + + -

Prapeedana - + - - - - -

Atiadhyayana - + - + - - -

Ativyavaya + + + + + + +

Ati jagarana + + + + + + +

Vegadharana + + + + + + +

Vegodeerana - - - + - - -

Vishamopachara + - - + + + -

Shrama - - - - - - +

Upavasa + + + + + + +

Prakvatasevana - - - + - - +

Ama + - - - + + +



Divaswapna + - - - - - -

Ashma, shila, loha

kastha Utkshepana,

vikshepa, bhramana

chalana

- - - + - - -

Manasika Karana

Chinta + - + - + + +

Shoka + - + + + + +

Krodha + - - - + + +

Bhaya + - - + - - -

Anya Nidana

Atiraktasravana + - + + + - -

Atidosha sravana + - + + + - -

Dhatukshaya + - + + + - -

Rogatikarshana + - + + + - -

Purvarupa150

Classical text book of Ayurveda do not ennumarate any of the purvarupa for

janusandhigatavata. The lakshanas of janusandhigatavata in subtle form can be

considered as purva roopa.



Roopa

The four cardinal features of sandhigatavata or janusandhigatavata explained

by various samhitas are tabulated below.151,152,153,154,155,156

Table No.11: Showing the Lakshanas of Janusandhigatavata

1) Prasarana akunchana vedana: Shula is a main symptom in Sandhigatavata.

Shula usually increases by movements like Akunchana, Prasarana because of vata

prakopa.

2) Vatapurna druti shotha: Shotha which is similar toVatapurna druti sparsha has

been described. Srotorodha occurs due to vata Sanga which is responsible for shotha.

Being a variety of vata, on palpation the swelling is felt like a bag filled with air.

3) Sandhihanti: First sushruta samhita explained this symptom followed by

Madhavakara. This word is explained by Dalhana and Gayadaha as inability to

perform actions like prasarana and akunchana.

Sl.no Lakshanas C.S S.S A.H A.S M.N B.P

1. Vatapurna druti sparshvat

shotha/shopha

+ + + + - +

2. Prasarana akunchanayo

pravritischa vedana/shoola

+ + + + + +

3. Sandhi hanti - + - - + +

4. Atopa - - - - + -



4) Atopa: Atopa means gud-gudaya shabda. That means there will be peculiar type

of sound in the sandhi during movemensts. This is mentioned in madhava nidana.

Samprapti 157,158

Sandhigatavata has not been explained in classics of ayurveda. It is explained

under the heading of the Vata Vyadhi. So samanya samprapti of vatavyadhi can be

considered the samprapti of sandhigatavata or janusandhigatavata.

The aggravated vata pervades into the rikta srotus in the body and produces various

disorders either generalized (pertaining to entire body) or localized (single part of

body). Here the term rikta srotus refers to snehadiguna shunya.

According to Ashtanga hrudaya, dhatukshaya aggravates vata and also

responsible for to produce rikta srotus. Vitiated vata travels throughout the body and

settles in the rikta srotus and further vitiates the srotus leading to the manifestation of

vatavyadhi. When this type of process occurs in the janu sandhi it leads to the

manifestation of janusandhigatavata.

Upashaya

All drugs, diet and regimen which give long lasting relief in Sandhigatavata

may be taken as Upashaya. For example; Abhyanga, Swedana, Ushna Ahara, Ushna

Ritu etc.

Anupashaya

All drugs, diet and regimen which exaggerate the disease are taken as



Anupashaya for that disease. Also Hetus of that disease can also be taken as

Anupashaya. The diet having Laghu, Ruksha, Sheeta Gunas, Anashana, Alpashana,

Sheeta Ritu, can be considered as Anupashaya.

Sadhyasadhyata159

Sandhigata Vata is a kashta sadhya vyadhi.

Sapeksha Nidana160

To get a clear idea regarding the disease Sandhigatavata, a comparative study of

cardinal symptoms of similar disease entities are given below.

Amavata

Vatarakta

Kroshtuka Sheersha

Sandhigatavata

Table No.12: Showing the Sapeksha nidanas for Janusandhigatavata

Factors

Sandhigata vata Amavata Vatarakta Kroshtuka sheersha

Amapradhanya

Absent Present Absent Absent

Jvara


Hridgaurava


Vedana

During Prasarana Akunchana Pravritti

Vrischika Damshavat and Sanchari

Mushika Damshavat Vedana

Teevra

Shotha

Vatapurna Driti sparsha

Sarvanga and Sandhigata

Mandala yukta

Kroshtuka Sheershavat



Sandhi

Weight bearing joints

Big and Small joints,

Big joints

Only knee joint

Upashaya

Abyanga Ruksha Svedana

Rakta Shodhana

Rakta Shodhana

Chikitsa

Charaka samhita does not mention any specific line of treatment for

sandhigatavata but the general measures mentioned for vatavyadhi are to be

considered i.e, usage of sarpi, taila, vasa and majja in the form of seka, abhyanjana

and basti, snigdha sveda, nivata sthana, pravarana, mamsa rasa sevana, payas sevana,

bhojana prepared out of madhura, amla and lavana and other brumhana measures. 161

Sushruta samhita, collectively mentions the treatment for snayu, sandhi and asthigata

vata which includes;

Snehana

Upanaha

Agnikarma

Bandhana

Mardana

In commentary Acharya Dalhana enumerates that these treatments have to be

continued for a long time i.e., chirakala. The chikitsa which is mentioned in Sushruta

samhita is followed by other samhitas and are tabulated below. 162,163,164,165,166,167,168



Table No.13: Showing the Chikitsa for Janusandhigatavata

Different shamanoushadhis suggested in janusandhigatavata 169,170,171

Kalka

Tagaramula kalka with takra

Indravaruni mula + pippali + guda

Churna

Alambushadya churna

Aabhadi churna

Kwatha

Maharasnadi kwatha

Rasna panchaka kwata

Vati

Ajamodadi vati

Chikitsa S.S A.S A.H C.D Y.R B.R B.P

Snehana + - + + + + -

Abhyanga - + - - - - -

Mardana + + - + + + -

Swedana - + - - + - +

Bhandana + + - + - + -

Agnikarma + + + + - + +



Guggulu

Adityapaka guggulu

Trayodashanga guggulu

Yogaraja guggulu

Yogaraja guggulu brihat

Shodasheeti guggulu

Simhanada guggulu

Rasaushadi

Panchananarasa lauha

Vatarakshasa rasa

Sneha

Phalatrikadi sneha

Dashamula siddamajja sneha

Majja sneha

Panchatikta guggulu ghrita

Prasarani taila

Vishnu taila

Siddartha taila

Pathyapathya172,173

According to this general rule of Pathyapathya, the nidanas, which cause the diseases,



are to be considered as apathya. Hence in this study the nidanas, which have been

described earlier, are apathya for the patients of janusandhigatavata.

Pathya Ahara – Internal and external use of Sneha, viz. ghrita, taila, vasa and

majja, mamsarasa, ksheera, mamsa, snehanvita bhojana, fruits having amla rasa

like dadima, recipes having madhura, amla and lavana Rasa.

Pathya Vihara – Nirvatasthana, atapa Sevana, garbhagriha, agnisantapa,

gurupravarana, mrudu shayya, brahmacharya .

Pathya Ausadha – Sukhoshna parisheka, abhyanga, snigdha sveda, basti, sneha

virechana, shiro basti, shirah sneha, snaihika dhumapana, snaihika nasya,

sukhoshna sneha gandusha, samvahana . Drugs like kumkum, agaru, tejapatra,

kustha, ela, tagara.



OSTEOARTHRITIS

Osteoarthritis is one among the common musculoskeletal diseases affecting

the human being making an important cause of disability. There is no simple

definition of osteoarthritis as it requires consideration of 3 overlapping areas-

pathological changes, radiological changes & clinical consequences. Pathologically

there is an alteration in cartilage structure; radiologically there are osteophytes & joint

space narrowing and clinically pain, disability.

Knee osteoarthritis is the most common form of osteoarthritis. It is usually

unilateral in the beginning but becomes bilateral over a period of time. Obesity,

female gender and knee bending are predominant risk factors. .It may involve

predominantly medial femorotibial, lateral femorotibial or patellofemoral

compartment.174,175

Etymology176

The term osteoarthritis is composed of two terms i.e, osteo and arthritis.

Osteo-The world Osteo comes from the Greek word ‘Osteon’.

The word osteo means bone.

Arthritis-The prefix ‘Arth’ means joint. The suffix ‘itis’ is defined as inflammation.

Hence, Arthritis means inflammation of joint.

So, Osteoarthritis can be defined as inflammation of the bony part of the joint.



Synonyms177,178

The osteoarthritis has following synonyms.

Osteoarthritis

Arthrosis

Degenerative Joint Disease

Wear and Tear Arthritis

Hypertrophic Osteoarthritis.

Classification 179

1. Primary OA - is the most common form of the disease, no predisposing factor is

apparent.

2. Secondary OA- is pathologically indistinguishable from idiopathic OA. but is

attributable to an underlying cause.

Causes of osteoarthritis180

Primary OA:

No known cause.

Secondary OA

Pre-existing joint damage;

Rheumatoid arthritis

Gout

Seronegative spondyloarthropathy

Septic arthritis



Paget’s disease

Avascular necrosis e.g; corticosteroid therapy

Metabolic disease;

Chondrocalcinosis

Hereditary haem0chromatosis

Acromegaly

Systemic diseases;

Haemophilia- recurrent haemoarthrosis

Haemoglobinopathies e.g; sickle cell disease

Neuropathies

Factors predisposing to osteoarthritis181

Obesity: predicts later risk of radiological and symptomatic OA.

Hereditary: familial tendency to develop nodal and generalized OA.

Gender: polyarticular OA is more common in women; a higher prevalence after

the menopause suggests a role of sex hormones.

Hypermobility: increased range of joint movements and reduced stability leads to

OA.

Osteoporosis: commonest risk factor for OA.

Trauma: a fracture through any joint. Meniscal and cruciate ligament tears cause

OA of the knee.



Congenital joint dysplasia: alters joint biomechanics and leads to OA.

Joint congruity: congenital dislocation of the hip or a slipped femoral epiphysis or

osteonecrosis causes early onset of OA.

Occupation: miners develop OA of the hip, knee and shoulder.

Sports: repetitive use and injury in some sports causes a high incidence of lower

limb OA.e.g; football.

Pathogenesis 182

Normal hyaline cartilage consists of chondrocytes embedded in extracelluar

matrix composed of water, type II collagen and proteoglycon. The cartilage remains

stable with active degeneration and regeneration occurring in equilibrium. OA results

from excessive degeneration compared to regeneration.

Earliest identifiable changes are loss of proteoglycons and decreased

metachromasia in cartilage. There is focal loss of cartilage, associated with reactive

proliferation of chondrocytes to form clusters. Progression of these changes leads to

breach of surface integrity, fissures, pitting, flaking of cartilage and development of

vertical clefts. This fissure deepens and may expose to subchondral bone, which

becomes ivory like, due to thickening and vascularisation. Associated bone growth in

subchondral region leads to sclerosis, while growth in the margin leads to the

formation of osteophytes which alters the contour of the joint and may restrict

movement.



Clinical features183

Symptoms

Joint pain

Joint gelling (stiffening & pain after immobility)

Crepitus

Joint instability

Loss of function

Signs

Joint tenderness

Crepitus on movement

Limitation of range of movement

Joint instability

Joint effusion

Wasting of muscles

Differential diagnosis184

Osteoarthritis of the knee has to be differentiated from following conditions.

Acute suppurative arthritis

Gonococcal arthritis

Tubercular arthritis

Rheumatoid arthritis

Gout

Rheumatic fever



Table No.14: Showing Differential diagnosis of Knee osteoarthritis

Knee

Osteoarthritis

Rheumatoid

arthritis

Gouty

arthritis

Causes Primary unknown,

secondary

degenerative

changes due to local

or systemic

involvement.

unknown unknown

Pattern of

joint

involvement

Mono or poly

articular arthritis

large or sometimes

small joints, Knee

joint most

frequently, may or

may not be

symmetrical

arthritis.

Poly articular, large

joint, both upper and

lower joints,

symmetrical

arthritis.

Mono or

polyarticular small

MTP joints, great

toe and knee

affected in

decreasing

percentage.

Symptoms

related to

joints

Initially intermittent

aching provoked by

use and relieved by

rest. Swelling,

stiffness, muscular

spasm, Osteophyte

formation.

Continuous pain

provoked by joint

use, swelling,

morning stiffness

more than 1 hour,

anorexia, fever, pain

all over body.

Acute agonizing

pain especially at

night, swelling,

severe functional

impairment,

anorexia, nausea,

change in mood.

Lab

investigation

Not specific RA test positive,

ESR is raised.

Serum uric acid is

raised.



Table No.15: Showing Differential diagnosis of Knee osteoarthritis

Acute

Suppurative

arthritis

Gonococcal

arthritis

Tubercular

arthritis

Rheumatic

fever

Cause Primary

infection,

secondary

infection to

acute

Osteomyelitis.

Infection by

Gonococci

Usually

secondary to

established

focus in lungs

or other area.

Joint

involvement

pattern

Large joints

and Knee

asymmetrical

arthritis.

Large joints,

asymmetrical

arthritis.

Large joints,

asymmetrical

arthritis

Joint

involvement

in the form of

fleeting and

transient

polyarthritis.

Systemic

features

Fluctuating

fever.

Maculo

pustular or

vesicular

rashes.

Anorexia,

weight loss,

night sweats,

evening rise of

temperature.

Chorea,

carditis fever,

subcutaneous

nodules.

Lab

investigation

ESR raised Demonstratio

n of

gonococci in

urethral

discharge.

ESR raised. ESR raised,

ASLO titer

above

200,Leucocyt

osis common.



Investigations 185

Primary investigations

X-rays are abnormal only when the damage is advanced; joint space narrowing

and osteophytes.

MRI demonstrates early cartilage & subchondral bone damages.

Arthroscopy reveals early fissuring & surface erosion of the cartilage.

Secondary investigations

Blood tests: there is specific tests; the ESR, rheumatoid factor & nuclear

antibodies are negative.

Management186

The treatment of OA is aimed at minimizing pain, optimizing function and reducing

disability. Management of OA requires a comprehensive approach involving non

pharmacological, pharmacological and surgical therapies.

Non – pharmocolgical therapy

Education: e.g; avoidance of poor posture.

Weight reduction

Exercises

Application of hot pack, ice pack, hydrotherapy, massage.

Uses of devices like knee brace.

Pharmacological therapy

Non steroidal anti inflammatory drugs like aceclofenac, acetaminophen celecixib.

Intra-articular steroid injections.



Chondroitin and glucosamine were used as nutritional agents.

Surgical therapy

Arthroplasty; total or unicompartmental knee replacement.

Arthrodesis

Osteotomy



BASTI

Basti is the one among the major procedures in panchakarma. The classical

literatures attaches a great significance to this form of treatment and points out the

vivid scope of its applicability. Depending upon the uses of different drugs, basti act

as a dosha shodhaka, dosha shamaka, restoration of shukra, brumhana in krusha

individuals, karshana in obese individuals, improvement in vision, prevention of

aging, improvement in lusture, strength and longevity. 187

Derivation188

“ uÉxÉÑ – ÌlÉuÉxÉå oÉxÉç-AÉcNûÉSlÉå uÉxÉç –uÉÉxÉlÉå xÉÑUÍpÉMüUhÉå,

oÉÎxiÉ-uÉxiÉå: AÉuÉ×hÉÉãÌiÉ qÉÔ§ÉÇ| uÉxÉç-ÌiÉcÉç|

lÉÉpÉåUkÉÉåpÉÉaÉå qÉÔ§ÉÉkÉÉUå xjÉÉlÉ å(mÉÑ.)||

AÉæwÉkÉ SÉlÉÉjÉåï SìurÉpÉåSå|” (uÉÉcÉxmÉirÉqÉç)

The word Basti is derived from the root 'Vas' by adding 'Tich' Pratyaya and it belongs

to pullinga pada.

Means to reside, to stay or to dwell.

Means to cover/to coat.

Coating of Sneha for the elimination.

Gandha denotes bad smell hence it refers to Mala and verb 'Ardane'is derived

from Ardagatau "Yachane Cha" denotes the movement (in the colon) and to beg

(drawing of waste material in the colon from all over the body).

To produce the effect of pleasant smell.



It denotes an organ, which covers the urine.

It denotes an organ situated below the umbilicus, which hold the urine.

It denotes an instrument used for the administration of the medicine.

Definition:

1. oÉÎxiÉlÉÉ SÏrÉiÉå CÌiÉ oÉÎxiÉ:| 189

2. oÉÎxiÉÍpÉ: SÏrÉiÉå rÉxqÉÉiÉç iÉxqÉÉiÉç oÉÎxiÉËUÌiÉ xqÉ×iÉ:| 190

Basti means urinary bladder of animal which were being used to introduce medication

through different routes.

Classification191

A. Depending upon Adhishthana bheda

a. Pakvashayagata

b. Garbhashyagata

c. Mutrashayagata

d. Vranagata

B. Depending upon Dravya bheda

a. Niruha basti

b. Anuvasana basti

i. Sneha basti

ii. Anuvasana basti

iii.Matra basti



C. Depending upon kaarmukata

According to Charaka samhita

a. Vataghna basti

b. Balavarnakrut basti

c. Snehaneeya basti

d. Shukrakrut basti

e. Krimighna basti

f. Vrushyatvakrut basti

According to Sushruta samhita

a. Shodhana basti

b. Lekhana basti

c. Snehana basti

d. Brhumana basti

According to Ashtanga sangraha

a. Uthkleshana basti

b. Doshahara basti

c. Shaman basti

D. Depending upon sankhya bheda

a. Karma basti

b. Kala basti

c. Yoga basti



E. Depending upon anushangika bheda

a. Yaapana basti

b. Siddha basti

c. Prasruta yogika basti

d. Dvadasha prasrutika basti

e. Paada heena basti

Kala basti

This is is a form of basti which is classified depending upon the number of

bastis, which includes both anuvasana and niruha basti.

Charaka samhita opines that Kala Basti includes half the number of Basti to that of

Karma Basti. Here, Chakrapani opines that it includes 16 Basti. On the first day 1

anuvasana is to be given then afterwards 6 anuvasana and 6 niruha can be given

alternatively. Lastly, 3 anuvasana are to be given. 192 Ashtanga hrudaya opines that

Kala Basti includes the group of 15 Basti. i.e, a group of 15 bastis, with one

anuvasana basti at the beginning and 3at the end, with 6 niruha bastis and 5 anuvasana

bastis alternatively in the middle. 193

Niruha basti

xÉ SÉåwÉ ÌlÉWïûUåiÉç zÉUÏUå SÉåwÉ WûUhÉÉSè lÉÏUÉåWû uÉÉxjÉmÉlÉqÉç AÉrÉÑ xjÉÉmÉlÉÉiÉç AxjÉÉmÉlÉqÉç|194

That which expels the doshas from the body is called as niruha, due to its

vayasthapana karma it is called as asthapana.



Anuvasana basti

AlÉÑuÉÉxÉlÉ iÉ§É rÉjÉÉ mÉëqÉÉhÉqÉç aÉÑhÉ ÌuÉÌWûiÉ: xlÉåWû oÉÎxiÉÌWû ÌuÉMüsmÉÉå AlÉÑuÉÉxÉlÉ: mÉÉSuÉM×ü¹:|195

This is the vikalpa of niruha basti but it contains more quantity of sneha hence it is

called as a sneha basti and basti dravya is quarter of niruha basti.

Yogyayogya for basti 196,197,198

Indications of niruha basti

Vataja roga, sarvanga roga, kukshi roga, bala mamsa kshaya, mutra-vata-mala sanga,

janu shoola, hrudroga, parva asthi shoola etc.

Contraindications of niruha basti

Ajeerna, athisnigdha, kshudhartha, vamita, virikta, pandu, arochaka, amadosha, kshata

ksheena, alpavarcha etc.

Indications of anuvasana basti

Which are already mentioned under the indications of niruha basti.

Contraindications of anuvasana basti

Anasthapya, navajwara, pandu, pleehodara, vishapeeta, shleepada, sthoulya, kushta,

prameha etc.

Basti yantra199

Basti yantra contains two parts. They are;

i.Basti netra

ii.Basti putaka



Basti netra

This is nalika which is connected to the basti putaka, is measures about 12 angulis (for

more than 20 years aged patients and for bellow 20 years different size is mentioned)

and it is having 2-3 karnikas.

Basti putaka

It is made up of bladder of animals or plastic bags or thick cloth or rubber bag.

Yoga-ayoga-atiyoga lakshanas of basti200,201

Niruha basti

Samyak niruha lakshanas

Prasrushta vit-mutra-vata, ruchi vriddhi, agni vriddhi, ashaya laghuta, roga upashanti,

prakruti sthapanashareera laghuta, upachaya.

Ayoga niruha lakshanas

Ruja in shira-hrudaya-nabhi-basti-guda-medhra or yoni, shotha, pratishyaya, guda

kartika, hrullasa, vata-mutra sanga, aruchi, shareera jadyata.

Atiyoga niruha lakshanas

Angasupti, angamarda, klama, kampa, nidra, dourbalya, tama pravesha, unmada,

hikka.

Anuvasana basti

Samyak anuvasana lakshanas

Snehayukta shakrut pravritti, raktadi dhatu vruddhi, indriya prasada, samyak swapna,

shareera laghuta, bala vrudhi, vega swapravruti, na osha and chosha.



Ayoga anuvasana lakshanas

Ruja in adhoshareera- udara- baahu-prushta, rukshata and kharatva of shareera,

avarodha of mutra and vata, vishtabdhata of anila-vata-mutra.

Atiyoga anuvasana lakshanas

Hrullasa, moha, klama, sada, murcha, vikartika, daha, pravahana, arti, pipasa.

Basti karmukata

The basti karmukata which is explained in different classics are as follows.

When Basti is administered, the basti dravyas enters the pakwashaya which is the

main Sthana of Vata Dosha, there by sub siding the vitiated vata and destroys vikaras,

since vata dosha is responsible for all the vikaras. By sub siding the Vata, all Vikaras

located in the other parts of the body are also destroyed. This is better understood with

the help of a simile that when the root of a plant is destroyed then naturally the stem,

branches, sprouts, fruits, leaves are destroyed.

Commentator Chakrapani has quoted that Guda is the Mula of the body where all

Siras are located. So the basti dravyaas reaches siras and performs its functions. 202

The action of basti dravyas are illustrated with a simile, just as a tree fed with water at

its roots, puts forth green leaves and delicate sprouts, and in due course of time grows

into a big tree, full of blossom and fruits, similarly the basti dravyas reaches all parts

of the body and does its functions.This is further elaborated in sushruta samhita and

states that The veerya of basti dravya reachs all over the body through the srotas in the

same way as the water poured at the root of the plant reaches upto leaves. Even

though basti dravyas quickly comes out alone or with mala, their veerya acts over the

whole body by the action of Apana and the other Vayu. This action takes place just



like sun draws moisture from the earth. The method of administration of anuvasana

basti is as follows. The administration of 1st basti does the snehana of basti and

vankshana. The properly administered 2nd basti tends to restore the vayu in the

murdha bhaga to its normalcy. The 3rd basti increases the bala and varna. The 4th and

5th anuvasana basti does the snehana of rasa and rakta. The 6th and 7th basti then

nourishes the mamsa and meda. The 8th and 9th bastis nourishes the asthi and majja.

During the intervals the niruha basti should be given. 203

Basti dravyas in Pakvashaya acts on whole body in the same way as that of sun, though

placed in the sky, causes evaporation of water on the earth.The Virya (potency) of

collective Basti drug is first taken up by Apana Vayu, i.e. it acts or influences the Gunas

of Apana Vayu with which it comes in contact first.Consequently the Samana Vayu isalso

affected followed by Vyana, Prana and Udana. By the Gunas of Basti Dravya, thevitiated

Vayu regains their normal state and supports the body. They also bring vitiatedPitta and

Kapha in their normal state, and the five types of Vayu nourishs their respective Sharira-

Bhuta Guna.The Virya (potency) of Dravya (substance) is propogated by the Vyana in

Tiryak or lateral direction, by the Apana in downward direction and in upward direction

by Prana, just as water pipes carry water to the different parts of the field similarly

the“Harini” (Channels) carry the Gunas of the Basti Dravya to every part the body, hence

Basti which is appropriate will with the help of Vata, Pitta and Kapha through the Siras

will spread all over the body and cures even the most difficult disease. 204



DRUG REVIEW

The drugs which are used in this study are Trikatu churna, Panchatikta ghrita and Bala

ghrita.

1. Trikatu churna has been used for amapachana. The ingrediants of which are

explained below. 205,206

Table No.16: Showing the Properties of Trikatu Drug

Sl.no

Name Latin name

Rasa

panchaka

Karmas Parts used

Chemical composition

1. Shunti Zingiber officinale

Rasa: Katu Guna: Laghu, snigdha Veerya: Ushna Vipaka:

Madhura Doshaghnata: Kapha-vata shamaka

Shothahara,vedanasthapana, rochana, shulaprashamana

Kanda Zingiberin, zingiberol, gingerin

2. Pippali Piper longum

Rasa: Katu Guna: Laghu, snigdha, teekshna Veerya: Anushna sheeta Vipaka: Madhura Doshaghnata:Kapha-vata shamaka

Deepana, vatanulomana,shula prashamana

Phala, mula

Piperin, piplasterol



3. Maricha Piper nigrum

Rasa: Katu Guna: Laghu, teekshna Veerya: Ushna Vipaka: Katu Doshaghnata: Vata-kapha shamaka

Lekhana, deepana, pachana,vatanulomana

Phala Piperin, piperdine

2. Panchatikta (Guduchi, Nimba, Vaasa, Kantakari, Patola), Bala, Godugda, Goghrita,

Shatapushpa, Madhu and Saindhava are used for basti . The explanations of these

drugs are given below. 207.208

Table No.17: Showing the Properties of Panchatikta & Bala

Sl.no

Name Latin name

Rasa panchaka

Karmas Parts used

Chemical composition

1. Guduchi

Tinospora cordifolia

Rasa: Tikta, kashaya Guna: Guru,snigdha Veerya: Ushna Vipaka: Madhura Doshaghnata: Tridosha shamaka

Vedanasthapana, deepana, pachana,rasayana

Kanda Berberin,giloin, tinosporin

2. Nimba

Azadirecta indica

Rasa: Tikta, kashaya Guna: Laghu Veerya:

Jantughna, dahaprashamana, vedasthapana,grahi

Tvak ,patra, pushpa, beeja

Nimbin, nimbidin, nimbosterol



Sheeta Vipaka: Katu Doshaghnata Kapha-pitta shamana

3. Vaasa

Adhatoda vesica

Rasa: Tikta, kashaya Guna: Ruksha, laghu Veerya: Sheeta Vipaka: Katu Doshaghnata: Kapha-pitta shamana

Shothahara, vedasthapana, stambhana

Mula , patra, pushpa

Vasicine, adhatodic acid

4. Kantakari

Solanum xanthocarpum

Rasa: Katu, tikta Guna: Laghu, ruksha, teekshna Veerya: Ushna Vipaka: Katu Doshaghnata: Kapha-vata shamana

Deepana, pachana, shothahara

Panchanga

Solasinine, carpesterol, solasodine

5. Patola

Trichosanthes dioica

Rasa: Tikta Guna: Laghu, ruksha Veerya:

Deepana, pachana, anulomana, shotahara

Phala, patra, mula

Trichisanthin, cucurbita



Ushna Vipaka: Katu Doshaghnata: Kapha-pitta shamaka

6. Bala Sida

cardifolia

Rasa: Madhura Guna: Laghu, picchila snigdha, Veerya: Sheeta Vipaka: madhura Doshaghnata: Vata-pitta shamaka

Balya, vedasthapana, bruhmana

Mula Ephidrin, hypaphorine

Godugda 209,210

Properties and action

Rasa: Madhura

Guna: Mridu, snigdha, slakshana, picchila, guru, manda, prasanna

Veerya: Sheeta

Vipaka: Madhura

Doshagnata: Vata-pitta shamaka

Karmas: Jivaneeyam, Preenanam, Rasayanam, Brimhanam, Vrishyam, Medhya,

Balya, Deepaniya.

Chemical composition: 87.3% water,3.9% milk fat,8.8% solids- not fat, Protein –



3.25%, Lactose – 4.6%, Minerals – 0.65% - Ca, P, Mg, K, Na, Zn, CO, Fe, Cu,

sulphates, bicarbonates, Acid – 0.18% - citrates, formates, acetate, lactate, oxalate.,

Enzymes – peroxidase, catalase, phosphatase, lipase., Gases – oxygen, nitrogen.,

Vitamins – A, C, D, thiamine, riboflavin, others.

Goghrita211,212

Biological name: Bos taurus


Rasa: Madhura

Guna: ,Guru, Snigdha, Mrudu, Yoghavahi,

Veerya: Sheeta

Vipaka: Madhura

Doshagnata: Vata-pitta shamaka

Karmas: Jeevaniyam, Rasayanam, Medhya, Vishanashaka, Chakshushya,

Arogyakara,Vrushya,

Chemical composition: Triglyceride (1) Saturated: Short chain (%) 37.6 Butyric 8.8,

Long chain (%) 62.4 Caproic 3.5Trisaturated (%) 39.0 Caprylic 2.2, High Melting 4.9

Capric 3.0, Partial glyceride : Lauric 8.8Diglycerides (%) 4.3 Myristic 9.9,

Monoglycerides (%) 0.7Palmitic 26.1, Phospholipids : Stearic 9.1Total cholesterol

(mg%) 330.0 High Sat 1.0, Lanosterol (mg%) 9.32 (2) Unsaturated, Lutein

(microg/g 4.2 Lower unsaturated 1.8, Squalene (microg/g 59.2 Hexadecenoic 2.8,

Carotene 7.2 Oleic 24.7,Vit. A 9.2 Unsat. Polyethenoid 3.5, Vit. E 30.5.



Shatapushpa 213,214

Botanical name: Anethum sowa


Rasa: Katu

Guna: Laghu, Teekshna,

Veerya: Ushna

Vipaka: Katu

Doshaghnata: Vata-kapha shamaka

Karmas: Deepana, vedanasthapana, shothahara, anulomana

Parts used:Phala

Chemical composition: Carvone, limonene, cugenol.

Madhu215,216

Bilological name: Apis


Rasa: Madhura, kashaya

Guna: Sheeta, Laghu, ruksha,

Veerya: Ushna

Vipaka: Katu

Doshaghnata: Tridosha shamaka

Karmas: Chakshushya, vishahara

Chemical composition: glucose, sucrose, alkaloids, iron, wax volatile oil, water.



Saindhava 217,218

Biological name: Rock salt


Rasa: Lavana

Guna: Laghu, snigdha

Veerya: Sheeta

Vipaka: Madhura

Doshagnata: Tridosha shamaka

Karmas: Deepana, pachana, rochaka, chakshushya, hrudya.

Chemical composition: Potassium, Chlorides.



MATERIALS AND METHODS

It is essential to mention the materials and methods used for the study based on

which the literary and clinical work has been carried out. The materials used for the

study were categorized in to following three headings.

Materials

1. Literary

2. Drugs

a. Deepana- Pachana: Trikatu churna

b. Abhyangartha : Ksheerabala taila

c. Avuvasanartha :i. Panchtikta ghrita (Group-A)

ii.Bala ghrita (Group-B)

d. Niruhartha: Group-A: Madhu

Saindhava

Panchatikta ghrita

Shatapushpa kalka

Panchatikta ksheera paka

Group -B: Madhu

Saindhava

Bala ghrita

Shatapushpa kalka

Balamula ksheera paka



3. Instruments : i. Douche set

ii.Enema Syringe

iii.Rubber catheter

Collection of materials

A) Literary: The literary source for the present study was obtained from vedic

scriptures, classical texts of Ayurveda, western medical text books, published articles

in reputed journals and also from the various media like internet followed by

retrospective study of related research works.

B) Drugs

Panchatikta ghrita, bala ghrita, panchatikta kwatha churna, balamula kwatha

churna and shatapushpa kalka was purchased from Sri Dharmasthala

Manjunatheshwara Ayurveda Pharmacy, Kuthpady, Udupi – 574 118.

Trikatu churna and ksheerabala taila was taken from Government Ayurveda

Medical College & Hospital, Mysore.

Honey was purchased from B.R. hills, Chamarajanagar district.

Saindhava lavana was purchased from Govindraj setty & sons, D.D.Urs. Road

Mysore.

Fresh Ksheera was purchased from Nandini dairy Mysore.

C) Instruments

Douche set (Basti pranidhanartha)

Douche set contents:

1. Douche can- with 1000ml capacity



2. Douche tube with 2 openings and length about 41/2 inches long and 6mm diameter.

3. Douche F set containing two units 1st unit which is attached to the douche tube, it

has a valve at proximal end to maintain the flow.

4. Second unit which is attached to the 1st unit at proximal end and distal end is blunt

and is has got two lateral and one distal openings, both will measure about four

inches long and one and half mm diameter.

5. Assembly and calibrations of douche set.

i. All the units of douche set were properly sterilized and dried.

ii. Douche tube is connected firmly to the exit nozzle at the bottom of the douche can.

iii. The distal end of the tube was properly conncted to the 1st unit of ‘F’ set which

connects the wall.

iv. Nozzle part of the douche ‘F’ set was connected with 1st unit of the ‘F’ set.

Collabartion of the Douche set

1. The prepared basti dravya was carefully poured into the douche can and held it

vertically.

2. The valve was opened and the drawn basti dravya was allowed to flow through the

tube and ‘F’ set easily.

3. Precaution was taken to remove all the air present in tube and ‘F’ set.

4. Keeping it vertical the basti dravya was made to flow till it reaches the required

level marked on douche can.

5. Then the valve was closed.



Methodology

Basti dana vidhi- Basti dana vidhi includes purva karma, pradhana karma and paschat

karma.

Purva karma

1. Examination of patients: Dosha, oushadha, desha, kala, satmya, agni, sattva, oka,

vaya and bala, are examined before administration of basti.

2. Preparation of the medicine.

3. Matra nirnaya: Matra of anuvasana and niruha basti was fixed to 80ml and 600ml

respectively. The ingredients are as follow.

Anuvasanartha dravya

i.For Group A: Panchatikta ghrita - 80ml

ii. For Group B: Balaghrita -80ml.

Niruhartha dravya

i.For Group-A

Madhu- 50ml

Saindhava- 5gm

Panchatikta ghrita- 80ml

Shatapushpa kalka- 5gm

Panchatikta ksheera paka- 450ml

Total -600ml



ii. For Group-B

Madhu- 50ml

Saindhava- 5gm

Bala ghrita- 80ml

Shatapushpa kalka- 5gm

Balamula ksheera paka- 450ml

Total – 600ml

Mixing of basti dravya

Mixing of basti dravya is done according to the quotation

‘makshikam lavanam sneham kalkam kwatham’.

Deepana – Pachana

The amapachana is essential before administration of basti. Trikatu churna was

administered for ama pachana to all the patients.

Pradhana karma

This includes basti pranidhana vidhi.

Anuvasana bastipranidana vidhi

Snehana & swedana

Patient was subjected for abhyanga by ksheerabala taila for 15 mins and swedana for

10 mins.

Basti poorva bhojana

Specially cooked rice was administered in precise quantity before administration of

anuvasana basti.



Procedures of basti pranidhana

Anuvasana basti procedure

Position

Patient was made to lie on the table in left lateral position with left lower

extremity straight and right lower extremity flexed on knee and hip joint and

asked the patient was asked to keep head on his flexed left hand.

Oleation of anus was done by applying the ghrita.

Patient was asked to take deep breath while administration of basti.

Assembled and clabbered douche set was taken and the douche can was kept 4ft

height from the patient.

Ghrita was applied to the 2nd unit of douche F set and was slowly introduced in to

the anus and valve was opened.

Valve was closed when can becomes empty and some quantity of medicine was in

tube.

Precautions were taken to avoid shivering of hands, quicker insertion and too slow

insertion.

The douche F set 2nd unit was removed slowly and asked the patient was asked to

remain in the same posture for 1min.

After that, patient was asked to lie down in supine position and mardana was done

over the udara, paada and hasta.

Then patients were advised to take rest and eliminate mala when there is an urge

and time was recorded.



Paschat karma

Basti pratyagamana and nireekshana

a. Duration of elimination of basti is known as basti pratyagamana kala

(Su.chi.38/5). The kala is one muhurtha (48 mins) for niruha basti and for

anuvasana upto 24 hours and patient was kept under observation for any

complication.

b. Patients were advised to take prescribed food on feeling hungry.

c. Patients were asked to avoid the following.

i.Aharaja: apathya, adhika matrayukta, guru, sheeta and ati snigdha etc.

ii.Vihara: maithuna, apathya vihara.

Niruha basti procedure

On next day morning patients were asked to eliminate mala and mootra.

The patients were examined for complications if any.

Ksheerabala taila abhyanga was done properly for 15mins and swedana by nadi

sweda for 10 mins.

Niruha basti medicines were properly prepared mixed in the manner of

makshikam lavanam sneha kalka & kwatha.

Procedure of administration of basti- the anuvasana basti procedure was followed

by the niruha basti, only basti poorva ahara was not administered.

Like above procedure on 3rd, 5th, 7th, 9th, 11th, 13th, 14th, 15th day anuvasana basti

was administered and on 2nd, 4th, 6th, 8th,10th and 12th day niruha basti was

administered.



Samsarjana karma

For basti karma there is no such reference of samsarjana karma as advised in vamana

and virechana, but patients were advised to take restricted ahara and vihara and avoid

the pariharya vishayas for 30 days. Advised ahara are only laghu and ushna ahara,

mainly dugda yukta yavagu or dugda yukta anna. Vihara – bed rest and pariharya

vishayas- to avoid astamaha doshakara vishayas i.e;

i.Avoid sitting, standing posture for long time.

ii.Avoid excessive talking, travelling, day sleep, vega dharana, sheetopachara, atapa

sevana.

iii. Avoid shoka, krodha.

iv.Avoid akala and ahita ahara.

v.Avoid astanga maithuna.



METHODS

Aim

The present work was under taken for the analytical study of asthi pradoshaja vikaras

supported by the study on the effect of panchatikta ksheera sarpi and bala sadhita

ksheera sarpi in sandhigatavata.

Objectives of the study

To review in detail about asthi and asthi pradoshaja vikaras.

To assess the involvement of asthi with the help of radiology (x-ray).

To assess the role of asthi in manifestation of sandhigatavata.


Research Design

A comparative literary study of Ayurvedic literature on asthipradoshaja vikaras

with current updated view (western medicine).

A comparative clinical study where the incidentally selected patients were

systematically allotted to Group A and B respectively.

Source of the patients

Patients of either sex diagnosed as janusandhigatavata were selected from the O.P.D

and I.P.D of GAMC Hospital Mysore. A special free camp was conducted for

janusandhigatavata in the campus of GAMC Hospital Mysore.



Selection criteria

Patients were diagnosed as janusandhigatavata after preliminary examination.

Patients were selected with respect to age and irrespective of sex, caste,

occupation and socioeconomic status.

Patients fulfilling inclusion criteria.

Patients willing to participate in the study were selected by explaining them the

intervention in detail.

Inclusion criteria

The individuals having janusandhigatavata lakshanas will be selected.

The individuals yogya for basti will be selected.

The individuals of either sex between the age group 30-60 years will be selected.

Exclusion criteria

Any other systemic disorders which interferes the course of treatment will be

excluded.

Pregnant women will be excluded.

Diagnostic criteria

Subjective parameters

Vedana

Shotha

Atopa

Stabdhata



Objective parameters

Antalogic gait

Osteophytes

Bony swelling around the joint

Sampling Method

Systemic method was adopted for group A and B, patients No.1 and 2 respectively

were fixed as a starting number and uniform difference of the two patients were

maintained for each group till the required size of 15 patients for each group was

attained.

Investigation

Following investigation was performed before treatment, after treatment and at the

end of the follow up to assess the severity and clinical improvement respectively.

X-ray of knee joint.

Intervention

The intervention of clinical study was carried according to the individual group as

mentioned below.

Group-A

The patients of group A were administered with trikatu churna in appropriate

doses for deepana and pachana till niramavastha was attained.

After attaining niramavastha patient was aubjected to abhyanga (udara, kati and

janusandhi) with ksheerabala taila followed by nadi sweda.




anuvasana with panchatikta ghrita (total 9 anuvasana basti) and niruha basti with

panchatikta ksheera sarpi (total 6 niruha basti) by maintaining the proper duration

between them and performing abhyanga and swedana before each basti. After

pratyagamana of each basti patients were advised to take cooked rice and maintain

the pariharya vishayas.

Group-B

The patients of group B were administered with trikatu churna in appropriate

doses for deepana and pachana till niramavastha was attained.

After attaining niramavastha patients were subjected to abhyanga (udara, kati and

janusandhi) with ksheerabala taila followed by nadi sweda.

The sequence of 15 bastis in the form of kala basti were administered starting

from anuvasana with bala ghrita (total 9 anuvasana basti) and niruha basti with

bala sadhita ksheera sarpi (total 6 niruha basti) by maintaining the proper duration

between them and performing abhyanga and swedana before each basti. After

pratyagamana of each basti patients were advised to take cooked rice and maintain

the pariharya vishayas.

Assessment criteria

The results were evaluated by subjective and objective criteria mainly based on

clinical observation by grading method.

Shoola /pain

Grade0: No pain.



Grade1: Mild pain (working for 8hrs pain starts & reduces after 1/2hr rest)

Grade2: Moderate pain (working for 4hrs pain starts & reduces after 1hr rest)

Grade3: Severe pain (working for an 1hr pain starts &does not subside even after

taking rest)

Shotha/swelling

Grade0: No swelling.

Grade1: Mild swelling (working for 8hrs swelling starts & reduces after 1/2hr rest)

Grade2: Moderate swelling (working for 4hr swelling starts & reduces after 1hr rest)

Grade3: Severe swelling (working for an 1hrs swelling starts &does not subsides even

after taking rest)

Stabdatha/stiffness

Grade0: No stiffness.

Grade1: Mild stiffness (knee flexion upto 100-120 degree & no difficulty in walking)

Grade2: Moderate stiffness (knee flexion upto 80-100 degree & slight difficulty in

walking)

Grade3: Severe stiffness ((knee flexion upto 60-80 degree & difficulty in walking)

Atopa/crepitus

Grade0: No crepitation.

Grade1: Palpable crepitus

Grade2: Palpable + Audible crepitus

Grade3: Crepitus always audible



X-ray changes

Grade0: Normal knee joint (no loss of cartilage & no deformation).

Grade1: Mild changes (some loss of articular cartilage, minute osteophytes, joint

space narrowing <3mm)

Grade2: Moderate changes (rough edges, definite osteophytes, moderate bone

attrition <5mm)

Grade3: Severe changes (definite deformity of bone ends, definite osteophytes with

severe joint space >5mm)

Overall assessment

Based on the grading given in the assessment criteria the improvement will be

assessed as below.

Complete remission, all signs and symptoms relieved.

Marked improvement, all signs and symptoms brought to the lower grading than

before.

Moderate improvement, at least three signs and symptoms brought to the lower

grade than before.

Minor improvement, at least two signs and symptoms brought to the lower grade

than before.

No improvement, all signs and symptoms persisting.

Statistical Analysis to assess Individual and comparative effects of the groups was

done using Chi- Square test, Contingency Co-efficient Test and Descriptive statistics.

All the statistical methods were carried out through the SPSS (Statistical presentation



system software) for Windows (version 16.0).

Data Collection

Data was collected before treatment, after treatment and at the end of follow up.



OBSERVATIONS

Total 30 patients coming under the inclusion criteria were randomly taken for the

clinical study and made into group A and B. Observations in the present study were

done in three stages.

i) General Observations for all the patients

ii) Observations during intervention

iii) Observation on results

General observations

In the present study total 32 patients were registered, out of which 2 patients

discontinued the treatment during various stages of the clinical study and with 30

patients the clinical study was completed.

Age

Table No.18: Showing distribution of patients according to Age

Age No. of patients Percentage (%)

30-40yrs 5 16.7%

41-50yrs 15 50.0%

51-60yrs 10 33.3%

In present study there was limitation for age. The patients of the age between 30-60

years were selected. It was found that the patients of age group between 30-40 years

were 5 (16.77%) 41-50 years were 15 (50.0%) and 51-60years were 10(33.3%).



Sex

Table No.19: Showing distribution of patients according to Sex

Sex No. of patients Percentage (%)

Males 9 30.0%

Females 21 70.0%

In the present study it was observed that more number of patients were females i.e.21,

(70.0%) and male patients were 9 (30.0%).

Marital status

Table No.20: Showing distribution of patients according to Marital status

Marital status No. of patients Percentage (%)

Married 29 96.66%

Unmarried 1 3.33%

In the present study it was observed that majority of patients were married .i.e. 29

(96.66%) and unmarried were only 1 (3.33%).

Education

Table No.21: Showing distribution of patients according to Education

Education No of patients Percentage (%)

Illiterate 8 26.66%

Primary school 7 23.33%



Middle school 3 10.0%

Higher school 6 20.0%

Graduate 4 13.33%

Postgraduate 2 6.66%

In the present study it was found that the majority of patients were illiterate i.e., 8

(26.66%) , 7(23.33%) had completed primary education ,3 (10.0%) had completed

middle school education, 6(20.0%) had completed higher school education ,

4(13.33%) were graduates and 2 (6.66%) were post graduates.

Religion Table No.22: Showing distribution of patients according to Religion

Religion No. of patients Percentage (%)

Hindu 29 96.660%

Muslim 1 3.33%

In the present study it was observed that majority of patients were from Hindu

community i.e., 29 (97.0%) and from Muslim community were only 1(3.0%).

Socio-economic status

Table no.23: Showing distribution of patients according to Socio-economic status

Socio-economic status No. of patients Percentage (%)

Poor class 5 16.66%

Middle class 23 76.66%



Rich class 2 6.66%

In the present study it was found that majority of the patients belonged to middle class

i.e., 23 (76.66%), 5 (16.66 %) patients belonged to poor class and 2 (6.66%) patients

belonged to rich class.

Occupation

Table No.24: Showing distribution of patients according to Occupation

Occupation No.of patients Percentage (%)

Farmer 6 20.0%

Housewife 15 50.0%

Professional 9 30.0%

In this study it was observed that majority of the patients were housewives i.e 15

(50.0%) professionals were 9 (30.9%) and farmers were 6 (10.0%).

Habitat

Table No.25: Showing distribution of patients according to Habitat

Habitat No. of patients Percentage (%)

Urban 18 60.0%

Rural 12 40.0%

In the present study it was found that the patients from urban residency were more

i.e., 18 (60.0%) and patients belonging to Rural were 12 (40.0%).



Diet Table No.26: Showing distribution of patients according to Diet

Diet No. of patients Percentage (%)

Vegetarian 13 43.33%

Mixed 17 56.66%

In the present study it was found that the patients with vegetarian diet were 13

(43.33%) and mixed diet were 17 (56.66%) both were equally present.

Prakruti

Table No.27: Showing distribution of patients according to Prakruti

Prakruti No. of patients Percentage (%)

Vatapittaja 13 43.33%

Pittakaphaja 13 43.33%

Kaphavataja 4 13.33%

In the present study among 30 patents 13 patients (43.33%) were of Vata pitta

prakruthi, 13 patients (43.33%) were of pittakaphaja prakruthi and 4 patients

(13.33%) were of kapha vataja prakruthi.

Sara In the present study all the 30 patients (100%) were having madhyama sara.

Samhanana



Table No.28: Showing distribution of patients according to Samhanana

Samhanana No.of patients Percentage(%)

Pravara 2 6.66%

Madhyama 21 70.0%

Avara 2 6.66%

Among 30 patients 21 patients (70.0%) were of madhyama samhanana, 2 patients

(6.66%) were of avara samhanana and 2 patients (6.66%) were of pravara

samhanana.

Pramana Table No.29: Showing distribution of patients according to Pramana

Pramana No. of patients Percentage (%)

Madhyama 26 86.66%

Avara 4 13.33%

In the present study among the 30 patients 26 patients (86.66%) were having

madhyama pramana and 4 patients (13.33%) were having avara pramana.

Satva

Table No.30: Showing distribution of patients according to Satva

Satva No. of patients Percentage (%)

Pravara 1 3.33%

Madhyama 23 76.66%

Avara 6 20.0%



Among 30 patients 22 patients (76.66%) were of madhyama sattva, 7 patients (20.0%)

were of avara sattva and 1 patient (3.33%) had pravara sattva.

Satmya

In the present study all the 30 patients (100%) were having madhyama satmya.

Koshta Table No.31: Showing distribution of patients according to Koshta

In the present study most of the patients i.e., 24(80.0%) of them had madhyama

koshtha, while only 3(10.0%) of them had krura koshtha and 3(10.0%) had mrudu

koshtha.

Agni

Table No.32: Showing distribution of patients according to Agni

Agni No.of patients Percentage (%)

Manda 9 30.0%

Teeksha 4 13.33%

Sama 2 6.66%

Vishama 15 50.0%

Koshtha No. of patients Percentage (%)

Krura 3 10.0%

Madhyama 24 80.0%

Mrudu 3 10.0%



Among 30 patients 15 patients (50.0%) had Vishamagni, 9 patients (30.0%) had

mandagni and 4 patients (13.33%) had teekshna agni and 2 patients (6.66%) had

samagni.

Bala Table No.33: Showing distribution of patients according to Bala

Bala No.of patients Percentage (%)

Pravara 1 3.33%

Madhyama 28 93.33%

Avara 1 3.33%

In the present study most of the patients i.e., 28(93.33%) of them had madhyama bala,

while only 1 patient (3.33%) of them had pravara bala and 1patient (3.33%) had avara

bala.

Vyayama shakti

Table No.34: Showing distribution of patients according to Vyayama Vyayama shakti No.of patients Percentage (%)

Pravara 1 3.33%

Madhyama 28 93.33%

Avara 1 3.33%

Among 30 patients, 28 patients (93.33%) had madhyama vyayama shakti, 1 patient

(3.33%) had avara vyayama shakti and 1 patient (3.33%) had pravara vyayama

shakti.



Joint involvement Table No.35: Showing distribution of patients according to Joint involvement

Side involvement No. of patients Percentage (%)

Unilateral 2 13.33%

Bilateral 28 86.66%

Among 30 patients, 28 patients (86.6%) had bilateral joint involvement and only 2

patients (13.3%) had unilateral involvement of joint.



Observations

Illustration No.1: Showing age wise distribution of 30 patients

Illustration No.2: Showing sex wise distribution of 30 patients

Illustration No.3: Showing marital status wise distribution of 30 patients



Illustration No.4: Showing education wise distribution of 30 patients

Illustration No.5: Showing religion wise distribution of 30 patients

Illustration No.6: Showing occupation wise distribution of 30 patients



Illustration No.7: Showing habitat wise distribution of 30 patients

Illustration No.8: Showing diet wise distribution of 30 patients

Illustration No.9: Showing prakruti wise distribution of 30 patients



Illustration No.10: Showing samhanana wise distribution of 30 patients

Illustration No.11: Showing pramana wise distribution of 30 patients

Illustration No.12: Showing satva wise distribution of 30 patients



Illustration No.13: Showing koshta wise distribution of 30 patients

Illustration No.14: Showing agni wise distribution of 30 patients

Illustration No.15: Showing bala wise distribution of 30 patients



Illustration No.16: Showing vyayamashakti wise distribution of 30 patients

Illustration No.17: Showing joint involvement wise distribution of 30 patients



Observations during intervention

Group-A

All the patients were presenting with varied degree of sama lakshanas.

Patients received trikatu churna; thrice daily in a dose of 4gm till niramavastha was

attained.

It was observed that the duration taken to attain niramavastha was 2-3 days.

All the patients received Kalabasti regularly for 15 days.

All the patients received panchatiktaka ghrita for anuvasana basti and pancatikta

ksheera sarpi for niruha basti.

The dose was adjusted to 80ml for anuvasana and 600ml for niruha basti.

It was observed that pratyagamana kala was 30mins to 24 hrs for anuvasana basti

and 5mins to 40 mins for niruha basti.

Patients were comfortable at the end of the treatment.

There were no complications observed.

Patients received samsarjana karma (pathyapathya) for 30 days.

Group-B

All the patients were presenting with varied degree of sama lakshanas.

Patients received trikatu churna; thrice daily in a dose of 4gm till niramavastha was

attained.

It was observed that the duration taken to attain niramavastha was 2-3 days.

All the patients received Kalabasti regularly for 15 days.



All the patients received bala ghrita for anuvasana basti and bala sadhita ksheera

sarpi for niruha basti.

The dose was adjusted to 80ml for anuvasana and 600ml for niruha basti.

It was observed that pratyagamana kala was 30mins to 24 hrs for anuvasana basti and

5mins to 40 mins for niruha basti.

Patients were comfortable at the end of the treatment.

There were no complications observed.

Patients received samsarjana karma (pathyapathya) for 30 days.



RESULTS

Results based on observations

The results on lakshanas of Janusandhigatavata before treatment, after treatment and

after follow up based on the subjective and objective parameters are explained below.

Results based on subjective parameters

Joint Pain

Table No.36: Showing results of Joint pain ( Rt Knee )

Session

Groups Pain R Before After Follow up

No 0 (0%) 2(13.3%) 2(13.3%)

Mild 2(13.3%) 13(86.7%) 12(80.0%)

Moderate 8(53.3%) 0(0%) 1(6.7%)

Group A

Severe 5(33.3%) 0(0%) 0(0%)

No 1(6.7%) 5(33.3%) 3(20.0%)

Mild 3(20.0%) 10(66.7%) 11(73.3%)

Moderate 10(66.7%) 0(0%) 1(6.7%)

Group B

Severe 1(6.7%) 0(0%) 0(0%)

Total 30 (100 %) 30 (100%) 30 (100%)



Table No.37: Showing Systemic measures in Joint pain (Rt Knee)

Groups Value Approx sig

Group A Nominal by Nominal Contingency Coefficient

N of Valid cases

650

45

.000

Group B Nominal by Nominal Contingency Coefficient

N of Valid cases

605

45

.000

In Group A before treatment 5 patients had severe pain, 8 patients had moderate pain

and 2 patients had mild pain. After treatment 13 patients attained mild pain and 2

patients attained no pain. After the follow up, 12 patients’ attained mild pain, 1patient

attained moderate pain and 2 patients attained no pain.

In Group B before treatment 1 patient had severe pain, 10 patients had moderate pain,

3 patients had mild pain and 1 patient had no pain. After treatment 10 patients attained

mild pain and 5 patients attained no pain. After follow up, 1 patient attained moderate

pain, 11 patients had mild pain and 3 patients attained no pain.

By observing the results, it has been noted that there was improvement seen in both

the groups and statistically highly significant with P value 0.000 in the both groups.

But comparatively Group A shows high significance than Group B.



Table No.38: Showing results of Joint pain ( Lt knee ) Session

Groups Pain L Before After Follow up

No 0 (0%) 9 (60 %) 10 (66.7%)

Mild 9 (60%) 6 (40%) 5 (33.3%)

Moderate 5 (33.3%) 0 (0%) 0 (0%)

Group A

Severe 1 (6.7%) 0 (0%) 0(0%)

No 1 (6.7%) 9 (60%) 8 (53.3%)

Mild 7 (46.7%) 6 (40%) 6 (40.0%)

Moderate 6 (40%) 0 (0%) 1 (6.7%)

Group B

Severe 1 (6.7%) 0 (0%) 0 (0% )

Total 30 (100 %) 30 (100%) 30 (100%)

Table No.39: Showing Systemic measures in Joint pain (Lt Knee)



N of Valid cases

581

45

.001


N of Valid cases

527

45

.008

In Group A before treatment 1 patient had severe pain, 5 patients had moderate pain

and 9 patients had mild pain. After treatment 6 patients attained mild pain and 9

patients attained no pain. After the follow up, 5 patients attained mild pain and 10

patients attained no pain.

In Group B before treatment 1 patient had severe pain, 6 patients had moderate pain, 7



patients had mild pain and 1 patient had no pain. After treatment 6 patients attained

mild pain and 9 patients attained no pain. After follow up, 1 patient attained moderate

pain, 6 patients had mild pain and 8 patients attained no pain.


the groups and statistically highly significant with P value 0.001 in Group A and

Group B is statistically significant at P value 0.008. But Group A shows better result

han Group B.

Joint stiffness Table No.40: Showing results of Joint stiffness ( Rt knee )

Session

Groups Stiffness R Before After Follow up

No 3 (20%) 11 (73.3%) 11 (73.3%)

Mild 6 (40%) 4 (26.7%) 3 (20%)

Group A

Moderate 6 (40%) 0 (0%) 1 (6.7%)

No 3 (20%) 9 (60 %) 9 (60%)

Mild 6 (40%) 6 (40%) 6 (40%)

Group B

Moderate 6 (40%) 0 (0%) 0 (0%)

Total 30 (100%) 30 (100%) 30 (100%)



Table No.41: Showing Systemic measures in Joint stiffness (Rt Knee)



N of Valid cases

501

45

.005


N of Valid cases

505

45

.004

In Group A before treatment 6 patients had moderate stiffness, 6 patients had mild

stiffness and 3 patients had no stiffness. After treatment 4 patients attained mild

stiffness and 11patients attained no stiffness. After the follow up, 1 patient attained

moderate stiffness, 3 patients’s attained mild stiffness and 11 patients attained no

stiffness.

In Group B before treatment, 6 patients had moderate stiffness, 6 patients had mild


stiffness and 9 patients attained no stiffness. After follow up, 6 patients had mild

stiffness and 9 patients attained no stiffness.



Group B is statistically significant at P value 0.004. But Group B shows more

significance than Group A.



Table No.42: Showing results of Joint stiffness ( Lt knee )

Session

Groups Stiffness L Before After Follow up

No 5 (33.3%) 13 (86.7 %) 12 (80%)

Mild 9 (60%) 2 (13.3 %) 3 (20%)

Group A

Moderate 1 (6.7%) 0 (0%) 0 (0%)

No 3 (20%) 12 (80%) 14 (93.3%)

Mild 10 (66.7 %) 3 (20%) 1(6.7%)

Moderate 1 (6.7 %) 0 (0%) 0 (0%)

Group B

Severe 1 (6.7 %) 0 (0%) 0 (0%)

Total 30 (100%) 30 (100%) 30 (100%)

Table No.43: Showing Systemic measures in Joint stiffness ( Lt knee )



N of Valid cases

458

45

.018


N of Valid cases

561

45

.002

In Group A before treatment 1 patient had moderate stiffness, 9 patients had mild


stiffness and 13 patients attained no stiffness. After the follow up, 3 patients attained

mild stiffness and 12 patients attained no stiffness.

In Group B before treatment 1 patient had severe stiffness, 1 patient had moderate

stiffness, 10 patients had mild stiffness and 3 patients had no stiffness. After treatment



3 patients attained mild stiffness and 12 patients attained no stiffness. After follow up,

1 patient had mild stiffness and 14 patients attained no stiffness.


the groups and statistically highly significant with P value 0.002 in Group B and

Group A is statistically significant with P value 0.018. But Group B shows significant

value than Group A.

Joint Swelling Table No.44: Showing results of Joint swelling ( Rt knee )

Session

Groups Swelling R Before After Follow up

No 8 (53.3%) 13 (86.7%) 15 (100%)

Mild 5 (33.3%) 2 (13.3%) 0 (0%)

Group A

Moderate 2 (13.3%) 0 (0%) 0 (0%)

No 9 (60%) 14 (93.3%) 15 (100%)

Mild 5 (33.3%) 1 (6.7%) 0 (0%)

Group B

Moderate 1 (6.7%) 0 (0%) 0 (0%)

Total 30 (100%) 30 (100%) 30 (100%)



Table No.45: Showing Systemic measures in Joint swelling ( Rt knee )



N of Valid cases

453

45

.021


N of Valid cases

437

45

.031

In Group A before treatment 2 patients had moderate swelling, 5 patients had mild

swelling, and 8 patients had no swelling. After treatment 2 patients attained mild

swelling and 13 patients attained no swelling. After the follow up all the 15 patients

attained no swelling.

In Group B before treatment 1 patient had moderate swelling, 5 patients had mild

swelling and 9 patients had no swelling. After treatment 1 patients attained mild

swelling and 9 patients attained no swelling. After follow up all the 15 patients




Group B is statistically significant with P value 0.031. But Group A shows

significance than Group B.



Table No.46: Showing results of Joint swelling ( Lt knee )

Session

Groups Swelling L Before After Follow up

No 9 (60%) 13 (86.7%) 15 (100%)

Mild 4 (26.7%) 2 (13.3%) 0 (0%)

Group A

Moderate 2 (13.3%) 0 (0%) 0 (0%)

No 9 (60%) 15 (100%) 14 (93.3%) Group B

Mild 6 (40%) 0 (0%) 1 (6.7%)

Total 30 (100%) 30 (100%) 30 (100%)

Table No.47: Showing Systemic measures in Joint swelling ( Lt knee )



N of Valid cases

418

45

.049


N of Valid cases

435

45

.005

In Group A before treatment 2 patients had moderate swelling, 4 patients had mild

swelling and 9 patients had no swelling. After treatment 2 patients attained mild

swelling and 13 patients attained no swelling. After the follow up all the 15 patients


In Group B before 6 patients had mild swelling and 9 patients had no swelling. After

treatment all the 15 patients attained no swelling. After follow up, 1 patient attained

mild swelling and 14 patients attained no swelling.




the groups and statistically highly significant with P value 0.005 in Group B and

Group A is statistically significant with P value 0.049. But Group B shows

significance than Group A.

Joint Crepitus Table No.48: Showing results of Joint crepitus ( Rt knee )

Session

Groups Crepitus R Before After Follow up

No 5 (33.3%) 10 (66.7%) 7 (46.7%)

Palpable 4 (26.7%) 5 (33.3%) 8 (53.3%)

Group A

Audible 6 (40%) 0(0%) 0(0%)

No 4 (26.7%0 12 (80%) 8(53.3%)

Palpable 7 (46.7%) 3 (20%) 7 (46.7%)

Group B

Audible 4 (26.7 %) 0 (0%) 0 (0%)

Total 30 (100%) 30 (100%) 30 (100%)

Table NO.49: Showing Systemic measures in Joint crepitus ( Rt knee )



N of Valid cases

503

45

.004


N of Valid cases

486

45

.008

In Group A before treatment 6 patients had audible crepitus, 4 patients had palpable

crepitus and 5 patients had no crepitus. After treatment 5 patients’ attained palpable

crepitus and 10 patients attained no crepitus. After the follow up, 8 patients attained



audible crepitus and 7 patients attained no crepitus.

In Group B before 4 patients had audible crepitus, 7 patients had palpable crepitus and

4 patients had no crepitus. After treatment, 3 patients attained palpable crepitus and

12 patients attained no crepitus. After follow up, 7 patient attained palpable crepitus

and 8 patients attained no crepitus.



Group B is statistically significant with P value 0.008. But Group A shows high

significance than Group B.

Table No.50: Showing results of Joint crepitus (Lt Knee)

Session

Groups Crepitus L Before After Follow up

No 5 (33.3%) 14 (93.3%) 13 (86.7%)

Palpable 9 (60%) 1 (6.7%) 2 (13.3%)

Group A

Audible 1 (6.7%) 0 (0%) 0 (0%)

No 5 (33.3%) 13 (86.7%) 13 (86.7%)

Palpable 9 (60%) 2 (13.3%) 2 (13.3%)

Group B

Audible 1 (6.7%) 0 (0%0 0 (0%)

Total 30 (100%) 30 (100%) 30 (100%)



Table No.51: Showing Systemic measures in Joint crepitus (Lt Knee)



N of Valid cases

513

45

.003


N of Valid cases

483

45

.008

In Group A before treatment 1 patient had audible crepitus, 9 patients had palpable

crepitus and 5 patients had no crepitus. After treatment 1 patient attained palpable

crepitus and 14 patients attained no crepitus. After the follow up, 2 patients attained

audible crepitus and 13 patients attained no crepitus.

In Group B before 1 patient had audible crepitus, 9 patients had palpable crepitus and

5 patients had no crepitus. After treatment, 2 patients attained palpable crepitus and

13 patients attained no crepitus. After follow up, 2 patient attained palpable crepitus

and 13 patients attained no crepitus.



Group B is statistically significant at P value 0.008. But Group A shows significance

than Group B.

Result based on the Objective parameter

Radiological findings

X-ray was done before treatment, after treatment and after the end of follow up in

Group A and Group B. But no changes were observed radiologically in both the

groups after the treatment and after the end of follow up.



Overall assessment

Observation was done for 45 days with 15 days treatment and 30 days without

treatment. The results were evaluated by the parameters mainly based on clinical

observations that are janusandhi shula, shotha, stabdhata and atopa by grading

method.For each follow up the scores were compared with the pre-test scores and the

statistical analysis was done.

Table No.52: Showing the Overall results within the groups

Groups

Result Group A Group B

Marked improvement 6(40.0%) 4(26.7%)

Moderate improvement 7(46.7%) 6(40.0%)

Mild improvement 1(6.7%) 5(33.3%)

No improvement 1(6.7%) 0(0%)

Total 15(100.0%) 15(100.0%)

In the present study among the 30 patients, in Group A 6patients (40.0%) attained

marked improvement, 7 patients (46.7%) attained moderate improvement, 1 patient

(6.7%) attained mild improvement and only 1 patient (6.7%) attained no

improvement. In Group B, 4 patients (26.7%) attained marked improvement, 6

patients (40.0%) attained moderate improvement and 5 patients (33.3%) attained mild

improvement.



Table No.53: Showing the Overall results of the groups

Result No. of patients Percentage (%)

Marked improvement 10 33.3%

Moderate improvement 13 43.3%

Mild improvement 6 20.0%

No improvement 1 3.3%

Total 30 100.0%

Table No.54: Showing the significance of overall results

Group A Group B

Chi-square test .042 .819

In the present study among 30 patients, 10 patients (33.3%) attained marked

improvement, 13 patients (43.3%) attained moderate improvement, 6 patients (20.0%)

attained mild improvement and only 1 patient (3.3%) attained no improvement.

By observing the overall results, it has been noted that there was improvement seen

in both the groups and statistically highly significant with P value P value 0.042 in

Group A and Group B is statistically non significant with P value 0.819. By this, it

can be concluded that Group A has got significant result than Group B.



Results

Illustration No.18: Showing results of Joint pain (Rt Knee)

Illustration No.19: Showing results of Joint pain (Lt Knee)



Illustration No.20: Showing results of Joint stiffness (Rt Knee)

Illustration No.21: Showing results of Joint stiffness (Lt Knee)



Illustration No.22: Showing results of Joint swelling (Rt Knee)

Illustration No.23: Showing results of Joint swelling (Lt Knee)



Illustration No.24: Showing results of Joint crepitus (Rt Knee)

Illustration No.25: Showing results of Joint crepitus (Lt Knee)



Illustration No.26: Showing overall results within the groups

Illustration No.27: Showing overall results in 30 patients



DISCUSSION

Discussion is the interpretation of observations and results obtained from the

clinical study along with the review. So the relevant points are discussed here.

Discussion on the title

“Concept of Asthi Pradoshaja vikaras w.s.r to Management of Sandhigatavata.”

Ayurveda is a science of life, which is framed on many concepts. All these concepts

are proved and established facts. The methodology adopted to establish these facts was

holds good for that respective era. In the present era due to globalization of Ayurveda

and to easily convince the common people, these olden techniques are not sufficient.so

these old principles should be restablished with the help of modern advanced technology.

As Asthi is one among the sapta dhatu and it does the function of dharana. The normalcy

and abnormalcy of Asthi can easily be visualized with the help of so many techniques,

one among them is X-ray. By this extra growth, fracture, increase of porocity,

calcification etc deformities which can be ruled out and this is one among best technology

to rule out sandhigatavata. Sandhigatavata is a common joint disorder occurs due to the

deformity mainly in the Asthi. As per the World Health Organization OA is the second

commonest musculoskeletal problem in the world. The reported prevalence of OA from a

study in rural India is 5.78%. Hence the present study is undertaken to restablish the

concept of Asthi pradoshaja vikaras with the help of radiology and supported by

considering sandhigatavata as an Asthi pradoshaja vikara treating as per the chikitsa sutra

explained in the Asthi pradoshaja vikaras.



Discussion on Asthi pradoshaja vikaras

Discussion on definition

When the Asthi gets vitiated extremely by the vata dosha along with other doshas

and changes its natural form and leads to a specific condition which is known as Asthi

pradoshaja vikaras.

Classification of Asthi pradoshaja vikaras

Depending upon involvement of different parts, the Asthi pradoshaja vikaras can be

classified into four types. They are;

Asthi pradoshaja vikaras due to involvement of Asthi

E.g; Adhyasthi, Asthi shoola.

Asthi pradoshaja vikaras due to involvement of Danta

E.g; Danta shoola, Danta bheda.

Asthi pradoshaja vikaras due to involvement of Kesha, smashru and loma

E.g; Indralupta, Khalitya, Palitya

Asthi pradoshaja vikaras due to involvement of Nakha

E.g; Kunakha

Discussion on nidana

The nidanas which are mentioned for Asthi pradoshaja vikaras can be classified as

follows.

1. Aharaja nidana: vatala ahara.



2. Viharaja nidana: ativyayama, ati vighattana.

3. Manasika nidana: ati sankshobha

Aharaja nidana

Vatala ahara and vihara sevana: Over indulgence in ruksha, laghu and alpa matra

ahara aggravates vata in the shareera. The chief qualities of vata are ruksha, laghu,

sukshma etc. these are similar to each other. So it will lead to vata vitiation. Viharas

like ati chesta, abhigata, etc cause the vata vitiation. When the vitiated vata gets

lodges in Asthi, it leads to different disorders.

Viharaja nidana

Ati vyayama: Ativyayama means excessive shareera ayasa janaka karma i.e more

than ardha shakti vyayama. When person performs the ati vyayama continuously it

leads to the increase in laghu, ruksha, sukshma, teekshna guna in the shareera. Later it

invariably leads to vata vitiation. Because vata havs the same gunas like laghu,

ruksha, sukshma etc on the basis of samanya siddhanta. As per the contemporary

science, excessive exercise causes the injury to the body like bone fracture, bone pain

etc.

Ati vighattana: ati vighattana means excessive movements or separation or injury. It

directly affects the particular part of the body. It is considered as the abhighataja

nidana. Here it directly affects the Asthi dhatu initially later vitiation of vata dosha

takes place due to ashraya ashrayee bhava. Then it leads to different disorders like

Asthi bheda, Asthi shoola etc. even in the contemporary science, it is mentioned that

external injury is one of the main causative factor for the manifestation of bone



disorders like osteoarthritis etc.

Manasika nidana

Ati sankshobha: ati sankshobha means excessive manasika kshobha (mental stress or

disturbance). When the person is under mental stress, then it will leads to increase in

rajo guna in the shareera. As per the classics, rajo guna is one among the vata guna.

So it invariably increases the vata dosha in the shareera. As per the contemporary

science mental disturbance is the cause for all most all the disorders.

Discussion on poorvarupa

All the Asthi pradoshaja vikaras have avyakta or alpa vyakta lakshanas as

poorvarupa. So it is difficult to consider particular poorvarupa for all Asthi pradoshaja

vikaras.

e.g, Danta shoola: mild tooth ache can be considered has a poorva rupa for danta

shoola.

Kunakha: mild discoloration can be considered has a poorva rupa for kunaka.

Discussion on rupa

Adhyasthi (Bone spur): It refers to additional bone or extra bone. It generally forms

in response to pressure, rubbing, or stress that continues over a long period of time. It

is usually smooth, but it can cause wear and tear or pain if it presses on the other

bones or soft tissues. Bone spurs usually limit joint movement and typically cause

pain. Has such bone spur may originate anywhere in the body like ankle, knee,

shoulder etc. e.g; calcaneal spur.



Adhidanta (Hyperdontia): It refers to additional or extra teeth. Which appear in

addition to the regular number of teeth and is mal-formed. There is evidence of

hereditary factors along with some evidence of environmental factors leading to this

condition. Many supernumerary teeth never erupt, but they may delay eruption of

nearby teeth or cause other dental problems.

Danta bheda and Danta shoola (Odontalgia): As per Ayurvedic classics these are

two different disorders. Here patient suffers from different form of pain like cutting;

pricking etc. This pain can often be aggravated somewhat by chewing or by hot or

cold temperature. Causes of tooth ache may also be a symptom of the heart, such as

angina or myocardial infarction due to referred pain.

Asthi bheda, Asthi shoola and Asthi toda (Bone pain): As per Ayurvedic classics

these are the different Asthi pradoshaja vikaras. Details regarding each disorder are

not available in any of the classics. The individual feels different forms of pain in the

bone due to different disorders. In the contemporary science there are conditions

characterized by bony pain which includes both acute and chronic. Chronic pain will

be present in some disorders like Osteoarthritis; Paget’s disease etc. Acute pain will

be present in the fractures.

Shyavadanta (Tooth discoloration): The blackish or kapila varnata of the tooth is

called as shyavadanta. Tooth discoloration is caused by multiple local and systemic

conditions. Extrinsic dental strains are caused by poor oral hygiene etc. Intrinsic

dental strains are caused by dental materials (eg, tooth restorations), dental conditions

and caries, trauma, infections, medications, nutritional deficiencies and other

disorders (eg, complications of pregnancy, anemia and bleeding disorders, bile duct



problems), and genetic defects and hereditary diseases (eg, those affecting enamel and

dentin development or maturation).

Krimidanta (Dental caries): In this condition danta becomes Krishna varnata, chidra

yukta, sravayukta or sometimes with shoola. When it is neglected then it leads to

complications like danta vidradi. Dental caries is a disease where bacterial processes

damage hard tooth structure, if left untreated, the disease can lead to pain, infection

and in severe cases death may occur. When the pH at the surface of the tooth drops

below 5.5, demineralization proceeds faster than remineralization (meaning that there

is a net loss of mineral structure on the tooth's surface). This results in the ensuing

decay.

Indralupta (Alopecia areata): The partial or complete loss of hair from all over the

body is called as indralupta. It can be correlated to alopecia areata or some times it is

called as spot baldness, in which hair is lost from the localized area or all areas of the

body, usually from the scalp. This disease may be limited only to the beard, in which

case it is called alopecia areata barbae. The area of hair loss may tingle or be very

slightly painful. It occurs more frequently in individuals who have affected family

members, suggesting that heredity may be a factor.

Khalitya (Alopecia areata universalis): The condition in which partial loss of hair

takes place in the scalp and there is no chance for regrowth of hair. This condition can

be correlated to alopecia universalis. If all body hair, including pubic hair is lost then

it called s alopecia areata universalis. Alopecia universalis can occur at any age, and is

currently believed to be an autoimmune disorder. Alopecia Universalis may be acute

and short-lived or remain permanently.



Palitya (Grey hair): When the hair becomes kapila varna in the early age then it is

called as palitya. This condition can be correlated to the premature grey hair. Early or

premature greying of hair is basically hereditary and other causes are stress, anxiety

and malnutrition. An individual who is under a prolonged period of stress and anxiety

may notice, over a period of time, white hairs gradually appearing. Malnutrition,

worry, shock, deep sorrow, tension and other similar conditions may also slow down

the production of melanin resulting in grey hair.

Kunakha (Onychogyphosis): This is a condition in which daha, paka, vedana and

asita varnata will be present in the nakha. This can be correlated to the

onychogryphosis. These types of nails are caused due to damage to the cells that grow

the nail. Discomfort can result when footwear or even bed sheets press on thickened

nails, because the surface beneath the nails (the nail plate) is also thickened and

tender. The thickening of a nail, which is common in older people, may be caused by

several factors including injury (such as that caused by ill-fitting shoes), infection,

poor blood supply, diabetes, or inadequate intake of nutrients.

Discussion on samprapti

Probabal pathogenesis which is involved in the manifestation of Asthi pradoshaja

vikaras can be understood by this flow chart.



Flow chart No.2: Showing the vishesha samprapti of Asthi pradoshaja vikaras

Nidana

Ati vyayama Ati sankshobha Ati vighattana Vatala ahara & vihara

Vata dushti Vata dushti Asthi dushti Vata dushti

Asthi dhatu dusti

Dosha dushya sammurchana

Sthaana samshraya in particular angaavayava (Asthi, Danta, Kesha, Nakha)

Particular Asthi pradoshaja vikaras (Adhyasthi, Danta shoola, Khalitya, Kunakha)



Discussion on upashaya and anupashaya

On careful observation of Asthi pradoshaja vikaras, we find that eall are mainly

related to vitiation of vata dosha only. So the upashaya and anupashaya which are

mentioned for vatavyadhis can also be considred for Asthi pradoshaja vikaras. For

example; abhyanaga, swedana, ushna ahara, ushna rutu etc are the upashaya.

Anashana, alpashana, sheeta rutu, vyayama etc are the anupashaya.

Discussion on sadhyaasadhyata

Table No.55:- Showing sadhyaasadhyata of Asthi pradoshaja vikaras

Vyadhis Asadhya Yapya Kashta

Dhaalana + - -

Bhanjanaka + - -

Shyavadanta + - -

Tridoshaja khalitya + - -

Tridoshaja palitya + - -

Danta shoola + - -

Indralupta - + -

Ekadoshaja khalitya - + -

Ekadoshaja palitya - + -

Adhyasthi - - +

Adhidanta - - +

Dantabheda - - +

Asthi shoola - - +

Asthi toda - - +

Kunakha - - +



Among the Asthi pradoshaja vikaras dhaalana, bhanjanaka, shyavadanta, tridoshaja

khalitya, tridoshaja palitya and dantashoola are considered as asadhya vyadhis

because these are tridoshaja vyadhis and treatment modality in such cases are not

satisfactory and prognosis is very poor. The diseases like indralupta, ekadoshaja

khalitya and ekadoshaja palitya are considered as yapya vyadhis because it requires

long duration of treatment and some times it gets may cured but chances of

reccurrence are more. Other diseases like adhyasthi, adhidanta, dantabheda, Asthi

shoola, Asthi toda and kunaka are considered as kashta sadhya vyadhis because it

requires both shamana aoushadhis and shastra karma.

Discussion on treatment

In Charaka samhita the treatment principles are explained for Asthi pradoshaja

vikaras. But in other samhitas like sushruta samhita, Ashtanga hrudaya, Ashtanga

sangraha the direct reference for the treatment of Asthi pradoshaja vikaras is not

available, but treatment principles explained for Asthi kshaya and vruddi looks similar

as explained in Charaka samhita. The treatment modalities are panchakarama (tikta

ksheera sarpi basti) and vatahara ahara-vihara.

Panchakarma: This is the major treatment modality, which is always used to

eradicate the diseases which are located in shaakha, marma, asthisandhi and this is is

the best treatment for chronic disorders. By adopting panchakarma one can subside

the doshas which are located all over the body and by this diseases can be eradicated

completely. Ability of evacuation, superiority and enormity of the procedures ,target

of dosha eradication and multitude of action are characterstics of pachakarma. Bones

are present all over the body and are the hardest structures in the body. Due to these



reasons panchakarma is the major procedure for Asthi pradoshaja vikaras.

Basti: Basti is the best treatment modality for vata and the vitiated doshas located

below the nabhi pradesha. The administered basti reaches the pakvashaya which is the

place of purushadhara kala. Pakvashaya and Asthi are the main seats of vata dosha,

therefore increased or decreased formation of vata affects all the sites of vata

especially Asthi. Hence purishadhara kala is also considered Asthidhara kala. So it

invariably nourishes the Asthi also.

Especially tikta sadhita ksheera sarpi basti is indicated in Asthi pradoshaja vikaras.

Tikta rasa has predomonently vayu and akasha mahabhuta and as per arunadatta tikta

rasa has a unique property to maintain the kharatva of Asthi dhatu. Asthi also has

preodominently pruthvi, vayu and teja mahabhuta.so tikta invariably increases the

kharatva in the Asthi. Ksheera and sarpi has predominantly pruthvi, jala mahabhuta

and madhura rasa yukta. These properties will check the vitiated vata dosha. The

provocation of Vata will result into Asthi Dhatu dushti Basti is the best treatment

explained for Vata Dosha so the Tikta Rasa in combination with Sneha Dravyas in the

form of Basti have a bifold nature i.e it provides sufficient nourishment to the Asthi

Dhatu as well as check the Vata Dosha also.

Table No.56:- Showing the chikitsa of Asthi Pradoshaja Vikaras

Chikitsa

Asthi pradoshaja

vikaras

Panchakarma Shastra karma Shamana karma

Adhidanta Rakta mokshana,

Nasya

Kshara karma,

Agni karma,

Danta nirharana

Gandusha



Danta bheda Vasti - Kavala

Gandusha

Abhyanga

Swedana

Danta shoola Nasya Danta nirharana

Dantapali lekhana

Gandusha

Pratisarana

Kavala

Krimidanta Rakta mokshana

Avapeeda nasya

Danta nirharana

Agni karma

Gandusha

Lepa

Indralupta Rakta mokshana Siravyadha Lepa

Shiroabhyanga

Khalitya & Palitya Nasya - Shiroabhyanga

Lepa

Adhyasthi,

Asthi shoola

Asthi bheda

Asthi toda

Basti - Abhyanga

Swedana

Among the Asthi pradoshaja vikaras adhidanta, danta bheda, danta shoola,

krimidanta, indralupta, khalitya and palitya occurs in the jatru urdhva pradesha. So

nasya, kavala, gandusha, shiroabhyanga are considered to be the main treatment

modalities. Asthi shoola, Asthi bheda, Asthi toda and adhyasthi are may manifest any

where in the body, so basti is considered as main treatment principle.

Discussion on Janusandhigatavata

Sandhigata Vata is described in all Samhitas and Sangraha Granthas as a

separate clinical entity under the heading of Vata Vyadhi. While commenting on the

word “Khudavata” Chakrapani explains the meaning of Khudavata as “Gulpha Vata”



or Sandhigata Vata. Hence, it can be said that according to Chakarapani, Sandhigata

Vata (janusandhigatavata) is the Nanatmaja Vata Vikara.

Discussion on definition

The disease Janusandhigatavata can be defined as a disease of Janu Sandhi

(Joint) with symptoms of Sandhishula, Sandhishotha and pain during akunchana and

prasarana and in the later stage affects the joint (Hanti Sandhi). In contemporary

science a similar condition is explained and is called as Osteoarthritis which is a

degenerative joint disorder with the symptoms of Joint Pain, Joint Swelling,

Restricted and Painful Movements of the Joints and Joint Instability.

Discussion on nidana

The nidanas of janusandhigatavata are vatakara and kapha-majjahara.

Shleshaka kapha is the major component of sandhi and performs the normal function

of sandhi. Due to the above said nidana sevana, the rukshatva and achalatva guna

increases. Simultaneously these properties also influences the kapha ashraya sthana

and majja dhatu which is present within the Asthi. Due to majja kshaya Asthi

soushiryata occurs. In another way as Asthi and vata are ashraya ashrayee, whenever

Asthi increases vata decreases and vice versa. Due to above said nidana sevana the

vata dosha increases which is present in the Asthi. By this vitiation occurs in the

Asthi. In this way these nidanas will lead to the manifestation of janusandhigatavata.

Discussion on purvarupa

Jansandhigatavata is one among the vatavyadhi, so avyakta or alpavyakta

lakshanas are considered as poorvrupa. Mild sandhi shula or shotha prior to the



manifestation of disease janusandhigatavata may be taken as its Purvarupa.

Discussion on rupa

The janusandhigatvata lakshanas can be classified as follows.

Sandhishula: Shula is the main symptom of prakupita vata. Shula usally increases by

movements like akunchana, prasarana because of vata prakopa. It is worst during

evening because of the tendency of vata which naturally aggravates at evening period,

hence the shula. It can be correlated te joint pain, which occurs due to bone attrition

and pressure of osteophytes over the soft tissues.

Sandhishotha: Due to nidana sevana vata gets prakupita and affects the srotus by

decreasing kapha, creates the shotha in the sandhi pradesha so it senses like a

vatapoorna druti. It means on palpation the swelling is felt like a bag filed with air.

Contemporary science mentions that joint swelling occurs due to inflammation.

Sandhiatopa: Janusandhigatavata is a localized vatavyadhi in which prakupita vayu

affects janusandhi which means akasha mahabhuta is increased at the site of

janusandhi and shabda is a guna of akasha. Hence shabda is heard or palpated.

Contemporary science, mentions clearly regarding crepitations due to the rubbing of

adjacent bony surface against each other during movement.

Sandhihanti: This occurs in the chronic stage of janusandhigatavata. In the

preliminary stage of janusandhigatavata due to above said symptoms there is

restriction of movements. Due to this reason the sanga in the srotus increases the vata



dosha, by that the sandhi loses movement . This condition is called as sandhihanti.

This can be correlated to the knock knee deformity.

Discussion on samprapti

The Vata Dosha is aggravated due to different factors and Vata moves out of

its Ashaya to circulate in the entire body and its constituents. During circulation it

gets localized in the roots of Asthivaha and Majjavaha Srotas. i.e. Asthi Sandhi. In the

Asthi and Majjavaha Srotas. The chief qualities of Vata are Khara, Ruksha, Vishada,

and Laghu. Sandhi gives Ashraya to Shleshaka Kapha which has Guru, Snigdha and

Mrudu guna. When aggravated Vata gets localized in Sandhi, it over powers all the

qualities of Kapha. The chief task of Kapha is dharana or to sustain. This chief aim of

kapha is destroyed by the influence of aggravated Vata. When aggravated Vata is

localized into a single joint, the disease will be reflected in only one Joint but if Vata

is localised in many joints, the disease may be presented by multiple joint

involvements.

Samprapti Ghataka

Dosha - Vata -Vyana vata vruddhi

Kapha - Sleshaka kapha kshaya

Dushya - Asthi, Majja, Snayu, Peshi.

Srotas - Asthivaha, majjavaha

Rogamarga - Madhyama

Udbhava sthana - Pakwashaya

Sanchara sthana - Rasayani



Roga Marga - Madhyama

Adhisthana - Janu Sandhi

Vyaktasthana - Janu Sandhi

Flow chart No.3: Showing the probable samprapti of Janusandhigatavata

Discussion on sadhyasadhyata

Janusandhigatavata is one of the Vatavyadhi and is considerd as Mahagada.

This diseaseis situated in Marma pradesha and Madhyamarogamarga. The Asthi and

vata are ashraya ashrayee. Hence this is considered as kashta sadhya. According to the

Nidana Sevana

Vata Prakopa

Prasara of Vata in sarva shareera

Rikta srotas in janusandhi (shleshaka kapha

kshaya) + (Asthi dhatukshaya)

Aggravated vata settles in the rikta srotas

(janusandhi)

Dosha‐ dushya sammurchana

Janusandhigatavata



contemparary science, Knee Osteoarthritis is very difficult to cure till date. No

treatment which can reverse the degenerative process is available. Only palliative

treatment is available which acts as analgesic and medications given helps to slow

down the degenerative process.

Discussion on chikitsa

The treatment principles for janusandhigatavata are snehana, upanaha,

agnikarma, bandhana, unmardana and basti.

Sneha Dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mrudu and

Guru gunas which are just opposite to those of Vata so it alleviates Vata. Snehana

helps in the promotion and regulation of the proper functioning of Vayu. It is stated

that by the regular use of Abhyanga all changes occurring due to old age could be

prevented and cured, if already manifested. Svedana is the procedure which relieves

Stiffness, Heaviness, Cold and which induces sweat. Upanaha is bandaging. The Paste

should be hot and mixed with Sneha. The application of heat causes relaxation of the

muscles and tendons, improves the blood supply. It relieves pain in the affected joints.

To perform Agnikarma on Sandhi, Kshoudra, Guda and Sneha are to be used. By

Agnikarma on Mamsa, diseases located in Shira, Snayu and Asthi gets alleviated.

Bandha is bandaging tightly, the leaves of Vatashamaka drugs on affected Sandhi.

This bandaging does not leave any scope for Vata to inflate the Sandhi. In

januandhigatavata, Shotha appears like a bag inflated with air. Bandhana causes

abatement in Shotha. Unmardana is a type of massage in which pressure is exerted on

diseased Sandhi. It relieves Shotha and enhances blood circulation. And lastly basti

as discussed earlier is the best mode of treatment for janu sandhigata vata.



Discussion on Asthi pradoshaja vikaras vs Sandhigatavata

In the present study, janusandhigatavata is considered one among the Asthi

pradoshaja vikaras due to these following reasons.

Sandhi is Asthi melana sthana. Though there are so many other structures in the

formation of sandhi,but asthi plays a major role in its formation. Hence if there is

any defect in the sandhi i.e, mainly due to the Asthi only. This is has been

identified this clinical work.

The sroto mulas of Asthi are meda, jaghana and Asthi sandhi. Hence asthivaha

sroto dusti definitely affects the sandhi.

The causative factors responsible for the manifestation of janusandhigatavata and

Asthi pradoshaja vikaras are looks similar i.e, in both conditions vata is the

predominant dosha and vatala ahara- viharas like ruksha, alpa matra ahara,

abhighata, ati vyayama, ati sankshobha etc nidanas are similar for

janusandhigatavata and Asthi pradoshaja vikaras.

There is no specific porvarupa observed in both the conditions i.e,

janusandhigatavata and Asthi pradoshaja vikaras. Avyakta or alpa vyakta

lakshanas can be considered as poorvarupa for both janusandhigatavata and Asthi

pradoshaja vikaras.

Among the lakshanas of janusandhigatavata, there are some symptoms which can

be correlated with the lakshanas of Asthi pradoshaja vikaras and these are related

to Asthi. They are adhyasthi which can be co-related to osteophytes, Asthi shoola,

Asthi bheda and Asthi toda which can be correlated to those different forms of pain

occuring in the joint.

The pathological changes occur in the manifestation of Asthi pradoshaja vikaras



and janusandhigatavata are similar. i.e, doshas: vata pradhana, dushya: Asthi and

sroto mula: Asthi sandhi.

The methodology adopted to subside the vitiation in the Asthi pradoshaja vikaras

and janusandhigatavata are similar. i.e, the main line of treatment for Asthi

pradoshaja vikaras are panchakarma, tikta sadhita ksheera sarpi yukta basti,

sthanika abhyanga-sweda, vatahara ahara-vihara and same modalities are utilized

in the treatment of janusandhigatavata.

Hence due to the reasons, janusandhigatavata is considered as one among Asthi

pradoshaja vikaras and it is treated by adopting the treatment principles explained for

Asthi pradoshaja vikaras.

Probable mode of action of basti

Tikta ksheera Basti, regarding this Arunadatta opines that the combination of

Snigdha and Shoshana guna produces Khara guna which is also the guna of Asthi.

This nourishes the Asthi as per the Samanya Siddhanta. The Pachabhoutika

composition of ingredients of basti is similar to Asthi. The ingredients will reach the

asthivaha srotas and will be acted upon by Parthivagni, Vayavagni, and Tejasagni and

gets transformed into Asthi poshakamshas on which the Asthi dhatwagni will act

upon and converts it into sthayi Asthi dhatu. Hence there will be increase of decreased

Asthi.

Cow’s milk is the richest natural source of calcium present on the earth. The

ratio in which calcium and phosphorus are present is ideal for their proper absorption

and assimilation and consequently for bone formation along with vitamin D. Vitamin

D present in cows milk helps in bone formation by maintaining the proper levels of



calcium in the blood along with the parathyroid hormone. Vitamin K activates

osteocalcin the major non collagen protein in the bone. Cow’s milk also contains

lactoferin an iron binding protein that boosts the growth and activity of the

osteoblasts, the cells that build bone and reduces the rate at which these cells die by

up to 50-70%. These also decrease the formation of osteoclasts, the cells responsible

for breaking down of the bone, thus helping to build the bone and prevent

osteoporosis.

Step wise mode of action of Basti

Ama Pachana- To clear the obstruction (Sanga) in asthivaha srotas caused by

ama and to combat the other lakshanas of Ama, ama pachana was done with trikatu

churna. When Amapachana is achieved (Pakat) the srotomukaha becomes clear and

the stage is set to bring back the vitiated Doshas from Shaakha to Koshtha.

Snehana- Sneha is said to reach the Asthi Dhatu by performing Abhyanga for

800 Matra kala approximately 15 minutes. Sneha enyters the body through minute

pores of skin by the virtue of its Anupravana bhava. Thus entering the Asthivaha

srotas, it causes Vishyandana. It destroys the obstruction in Asthivaha Srotas

(Malanam Vinihanti Sangam ). Sneha is Vata Nashaka (Sneho anilam hanti). So it

pacifies vata.

Swedana- Swedana also pacifies Vata especially, when performed after

Snehana. If Swedana is done after proper Snehana, it liquefies the Doshas which

causes obstruction in the minute channels. Hence by the combined effect of

Amapachana, Snehana and Swedana the morbid Doshas are brought to Koshtha. The

Pharmacodynamics of these three procedures is nothing but Paka, Vishyandana,

Srotomuka Vishodhana and Vayu nigrahana.These factors are responsible for the



movement of doshas from Shaakha to koshtha. Here paka is by Amapachana and

swedana, Vishyanadana is by snehana and swedana; Sroto mukha vishodhana is done

by amapachana, Snehana and swedana and Vayu nigraha is achieved by Snehana and

swedana.

Basti- After proper Snehana and Swedana, when the doshas come from

Shakaha to Koshtha, Tikta Ksheera Basti is given to expel these Doshas from the

body to nourish the Kshina Asthi Dhatu. Sushruta opines that eighth basti enters the

Asthi Dhatu. Thus entering the Asthi its action can be explained on the following

factors.

The action of tikta ksheera basti on Asthi Dhatu can also be explained on the

basis of Pancha Mahabhoutika composition. Predominance wise the Panchabhoutika

composition of Asthi is Prithvi, Vayu, Agni, Akasha and Jala Mahabhuta. The Basti

contains Ksheera , Ghrita Madhu, Guggulu, and Tikta dravya as its main ingredients.

Anuvasana basti mainly contains tikta rasa and madhura rasa where as Niruha basti

contains katu rasa along with tikta rasa and madhura rasa. If we analyze the

Panchabhoutika composition of Madhura, Tikta and Katu rasa it is Prithvi+ Jala,

Vayu+ Akasha, and Agni+ Vayu respectively. Hence the total Panchabhoutika

composition of Basti dravya is similar to the Asthi dhatu and hence nourishes the

Asthi.

Due to the Vataghna property of Niruha and Anuvasana basti there is shaman

of aggravated Vata, by this the ksheena Asthi Dhatu returns to normalcy. The Ksheera

Basti reaches the Pakwashaya which is Purishadhara kala and the ingredients of basti

ie Ksheera, Ghrita and Madhu nourishes the Purishadhara kala and thus also nourishes

the Asthidhara kala. According to Modern embryology both bone tissue and the large



intestine are formed by the mesenchymal cells of the mesoderm.

Probable Pharmacokinetics and Pharmacodynamics of Tikta Ksheera Basti

according to scientific parameters.

According to modern science basti is a process which can be compared with enema.

There are 2 types of enemas. 1. Evacuation enema and 2. Retention enema. Ksheera

basti may be considered as the nourishing retention enema.

Retention enema:- The fluid containing the drugs is retained in the rectum so that the

drug may act locally e.g. steroid enema in ulcerative colitis. The rectum has rich

blood and lymph supply and drugs can cross the rectal mucosa like the other lipid

membranes; thus unionized and lipid soluble substances are readily absorbed from the

rectum, through the rectal venous plexus. The portion of the absorbed drugs from the

upper rectal mucosa is carried to the portal circulation where as that absorbed from

the lower rectum enters directly into the systemic circulation.

The absorption of the drug from the rectum follows the laws of transfer of the

molecules across the biological membranes. Most drugs are absorbed by passive

diffusion, a few by active transport or carrier mediated transport. Pinocytosis is a

mechanism for transport of molecules across membranes. Usually unionized and lipid

soluble substances are absorbed by simple diffusion or passive diffusion. “Diffusion is

a law of transport of molecules from the region of higher concentration to the region

of lower concentration”. The absorption of the basti dravya is also by diffusion and

many factors influence this rate of diffusion and thus absorption. These factors are as

follows.

Physical state: Liquids are absorbed better than solids.



Ingredients of basti, their solubility and their homogenous mixing : Lipids and lipid

soluble drugs penetrate into the cell more rapidly than the water soluble drugs. The

homogenous mixture of basti dravyaa is important.

Temperature- Luke warm solutions are rapidlu absorbed because of vasodilatation,

whereas cold solutions are absorbed slowly.

Size of the molecule, its disintegration time and dissolution time: Simpler and

smaller the size of the molecule, faster is the absorption. If the disintegration and

dissolution time of the compound is less then the absorption is faster.

Quantity and concentration gradient of the basti dravya : Higher the quantity

lesser is the retention time. Concentrated solutions are absorbed more rapidly than the

weak solutions.

pH of the GI fluid- Alkaline drugs are absorbed in the alkaline medium i.e distal

ileum and large intestine, where as acidic drugs are absorbed in the stomach and

proximal part of the small intestines.

Ionization: Unionized component predominantly lipid soluble are absorbed rapidly.

Surface area of absorption- Absorption is more in intestines than in stomach, because

of the larger surface area of the former .

Vascularity- Richer the vascularity greater the absorption.

Structural and functional status of the rectum:

In the healthy and empty rectum the absorption is more and in the diseased condition,

the presence of stool delays the absorption.

The concentration of the basti dravyas is higher in the lumen of the rectum and

in the cells surrounding the rectum. Hence the molecules of basti move from higher



concentration to the lower concentration i.e from the rectum to the surrounding cells

and there, they are absorbed into the rectal veins. The lipid soluble substances like

vitamin- A D and K and essential minerals such as calcium, phosphorus , magnesium,

sodium, and chlorine etc present in the milk are in unionized form and hence absorbed

rapidly. The surface area of the small intestine and rectum is more and it has very rich

blood supply, moreover the basti was given in the morning after the patient has passed

the stool i.e when the rectum was empty. Hence all these factors enhance the

absorption of the basti dravyas from the rectum through the rectal mucosa.

The cow’s milk which is the main ingredient of the Ksheera Basti is rich in

calcium, phosphorus, magnesium, potassium, sodium, chlorine etc. It also contains fat

soluble vitamins like vitamin –A, D and K. These minerals and vitamins help in bone

formation. A study conducted by Finnish researchres, published in November-2005

issue of American Journal of Clinical nutrition revealed that, only dairy calcium is

better than synthetic calcium supplements for growing girl’s bones. The superiority of

milk over other calcium supplements is because the bone health is not a mono-

nutrient issue and milk contains all the essential vitamins and mineral nutrients

required for bone formation. Apart from this the ghee contains phospholipids which

plays an important role in the mineralization of bones.

Discussion on Materials and Methods

Discussion on selection of drugs

Trikatu churna is attributed with like deepana, pachana, vatanulomana,

shothahara, shula prashamana. This is easily available and cost effective also very

less.



Panchatikta is said to be shreshta among the tikta rasa pradhana dravyas. These drugs

are attributed with karmas like vedanasthapana, shothahara, anulomana, rasayana,

deepana, pachana

Bala has the karmas like vatahara, balya, vedanasthapana and brumhana.

Godugdha and goghrita possess the karmas like vata nashaka, jeevaniya, balya,

bruhmana, and rasayana. The chemical composition of godugdha includes calcium,

magnesium, potassium etc.

Saindhava, madhu and shatapushpa are mainly used in administration of basti. These

facilitate the drug absorption. Hence, these drugs are selected for the present study.

Discussion on Instruments

There are many devices to administer basti but in present study douche set,

enema syringe and rubber catheter were selected because they are easily available

and it can be used very safely.

Discussion on Aims

The present work was under taken for the analytical study of asthi pradoshaja

vikaras supported by the study on the effect of panchatikta ksheera sarpi and bala

sadhita ksheera sarpi in sandhigatavata.

The contemporary science aids us to understanding Ayurvedic concepts better, hence

in the present work sandhigatavata was taken for the study.

Discussion on Inclusion criteria

Individuals of either sex between the age group 30-60 years were selected, as



the degeneration of articular cartilage in primary OA starts with the process of ageing

i.e. after 30 years. OA is seen in the lower age groups are usually secondary. The

individuals willing for the treatment were selected because the duration of the

treatment is long.

Discussion on Exclusion criteria

Pregnant women were excluded because the kala basti is contraindicated

during this period and also to avoid the complications. Individuals with other systemic

disorders like bleeding piles etc were excluded to avoid the interference in the action

of drug and also to avoid complications.

Discussion on Diagnostic criteria

Pain, stiffness, crepitus and swelling were considered as the diagnostic criteria

as there is no evidence of inflammatory infiltration in all cases of OA. Osteoarthritis

with radiological changes were taken , because in most of the pathologies of the knee

joint, X-ray fails to show any abnormality as the cartilaginous pathologies outnumber

the bony pathologies. Therefore in order to maintain the homologenesity in between

the groups, radiological changes were considered under diagnostic criteria.

Discussion on Intervention

The study was designed in such way so as to get a clear picture regarding efficacies of

the drugs which were used in the present study.

Discussion on Statistical Analysis -

Contingency Co-efficient: It is applied when Categorical Data Analysis is to be done.



Then a contingency table can be used to express the relationship between the variables

Descriptive statistics: The Descriptive procedure displays univariate summary statistics

for several variables in a single table and calculates standardized values (z scores).

Variables can be ordered by the size of their means (in ascending or descending order),

alphabetically, or by the order in which one selects the variables (the default).

Chi-square test: The Chi-Square Test procedure tabulates a variable into categories and

computes a chi-square statistic. This goodness-of-fit test compares the observed and

expected frequencies in each category to test either that all categories contain the same

proportion of values or that each category contains a user-specified proportion of values.

Discussion on Observations and Results

Discussion on General observations

Age: In the present series of 30 cases, it has been observed that this disease most

commonly manifests in the 4th decade (50.0%). Increase in age is one of the risk

factor for OA observed in the study. Especially patients belonging to the age group

41–50 years were engaged in their household and other jobs.

Sex: In the present study, it has been observed that the incidence of this disease more

in females. Here the lack of female hormone (oestrogen) in the peri-menopausal

period also plays an important role. Biosynthesis of articular cartilage is influenced by

sex hormone in females.

Marital status: Married patients showed more susceptiblity (96.6%) for

janusandhigatavata. Though it is not a risk factor for Sandhigata Vata, but the disease

was prevalent in the post marital age.



Education: In this study, maximum numbers of patients i.e. 26.7% were illiterate. It

was revealed from the study that due to illiteracy, people had to involve in more

strenuous work and were not taking nutritious diet, which lead to Dhatukshaya.

Religion: In this clinical study, most of the patients i.e. 96.7% were Hindus. This data

indicates that there is predominance of hindu population in Mysore district.

Habitat: In this clinical study, maximum numbers of patients i.e. 60.0% were from

urban area. It may because the study was carried out on urban population.

Socio-economical status: Middle class patients were more susceptible (76.7%) to

janusandhigatavata. It is quite natural that the people from middle class are exposed to

more physical stress and strain which acts as a risk factor for OA.

Occupation: In the present series of 30 cases, it has been observed that, the incidence

of this disease was more in housewives (50.0%). This percentage of patients implies

that mostly they were performing household work for long duration in standing

posture and had to lift heavy loads.

Diet: The present study revealed that, the patients who were consuming mixed diet

were more susceptible (56.7%) to janusandhigatavata. The study however could not

generalize the fact that vegetarians are on safer side from the disease as the sample

size taken was very small.

Prakruti: Patients belonging to Vata pitta prakruti (43.3%) and pitta kapha prakruti

(43.3%) showed equal incidence in the manifestation of janusandhigatavata. The



study however could not generalize, as the sample size taken was very small.

Sara: In the present study all the 30 patients (100%) were having madhyama sara.

Samhanana: Among 30 patients, 21 patients (70.0%) were of madhyama samhananain the present study. Pramana: Among 30 patients 26 patients (86.66%) were of madhyama pramana.

Sattva: Among 30 patients, 22 patients (76.66%) were of madhyama sattva in the present study.

Satmya: In the present study all the 30 patients (100%) were of madhyama satmya.

Koshta: In the present study among 30 patients, 24 patients (80.0%) were of

madhyama koshta.

Agni: Among 30 patients 15 patients (50.0%) had Vishamagni in the present study.

Bala: In the present study among the 30 patients, 28 patients (93.33%) of them had

madhyama bala.

Vyayama shakti: Among 30 patients, 28 patients (93.33%) had madhyama vyayama

shakti in the present study.

Joint involvement: Among the 30 patients, 28 patients (86.6%) had bilateral joint

involvement in the present study. This shows the Chronicity of the disease.



Discussion on Results

Joint pain

On observing the results, it was noted that there was improvement in both the groups

and statistically highly significant with P value 0.001 in Group A and Group B is

statistically significant with P value 0.008. But comparatively Group A shows high

significance than Group B. (Rt Knee)

On observing the results, it was noted that there was improvement seen in both the

groups and statistically highly significant with P value 0.000 in the both groups. But

Group A shows high significance than Group B. (Lt Knee)

Hence it can be said that panchatikta ksheera sarpi had good effect on joint pain due

to vedanasthapana and vatahara properties.

Joint stiffness



statistically significant with P value 0.004. But comparatively Group B shows

significance than Group A. (Rt Knee)


and statistically highly significant with P value 0.002 in Group B and Group A is


significant result than Group A. (Lt Knee)

Hence it can be said that bala ksheera sarpi had good effect on joint stiffness due to

snehana and vatahara properties.



Joint swelling



statistically significant with P value 0.031. But comparatively Group A shows

significant result than Group B. (Rt Knee)

Hence it can be said that panchatikta ksheera sarpi had good effect on joint stiffness

due to shothahara property.




significant result than Group A. (Lt Knee)

Hence it can be said that bala ksheera sarpi had good effect on joint stiffness due to

shothahara property.

Joint crepitus




significant result than Group B.





Hence it can be said that panchatikta ksheera sarpi had effect on joint crepitus due to

snehana and vatahara properties.



Overall assessment

On observing overall results, it was noted that there was improvement in both the

groups and statistically significant with P value 0.042 in Group A and Group B is

statistically non significant with P value 0.819. But comparatively Group A has got


The above findings support the statement of Charaka samhita regarding superiority of

tikta ksheera sarpi basti. Finally it can be concluded that panchatikta ksheera sarpi has

a better result in janusandhigatavata

Radiological findings

In the present study radiology (X-ray) was used to restablish the involvment of Asthi

in janusandhigatavata and also to observe the changes occurinng in the Asthi, after the

kala basti. Due to this reason X-ray was taken for all the 30 patients, before treatment

to rule out the involvement of Asthi and after the treatment and after the end of follow

up to find out the changes. In radiological findings of before treatment all the 30

patients showed the osteophytes and joint space narrowing in the Asthi. But after the

treatment and at the end of follow up there were no marked changes in the

osteophytes which imply that there is no increase of osteophytes in the Asthi. It may

need longer observation to find the osteophytes changes (reduction in osteophytes) in

the Asthi.



RECOMMENDATION FOR FURTHER STUDY

Same study can be done in a larger sample and for a long duration.

An experimental study can be carried out ,to identify the exact action of

panchatikta ghrita on various components of the body

The same study can be done in different age groups so as to assess the efficacy

of the drug.

With other investigations like BMD the same study can be carried out to

evaluate the efficacy of panchatikta ghrita.



CONCLUSION

Asthi pradoshaja vikara is a condition in which Asthi gets vitiated extremely by

the vata dosha and changes its natural form and leads to many disorders.

Ativyayama, ati sankshobha, ati vighattana and vatala ahara-vihara are the four

nidanas for Asthi pradoshaja vikaras.

Avyakta or alpavyakta lakshanas of Asthi pradoshaja vikaras are considered as

poorvarupa.

Asthi pradoshaja vikaras are classified into various types based on the

involvement of Asthi, danta, kesha and nakha.

As Asthi pradoshaja vikaras are marmasthigata vyadhis, so panchakarma is the

best choice of treatment.

Janusandhigatavata is one among the Asthi pradoshaja vikaras.

Vata is the main dosha involved in the manifestation of janusandhigatavata.

Prevalence of janusandhigatavata was more in females, housewives and between

the age group of 41-50 years.

The panchatikta ksheera sarpi was more effective in subsiding joint pain, joint

crepitation and joint swelling and bala sadhita ksheera sarpi was effective in

reducing joint stiffness and swelling.

The overall effect of thearapy was significant in Group A with p value 0.042

when compared to Group B at the p value 0.819.



SUMMARY

The Present study entitled “Concept of Asthi pradoshaja vikaras w.s.r.to

management of Sandhigtavata” was aimed at understanding the concept of Asthi

pradoshaja vikaras and applying the concept of chikitsa Siddhanta of Asthi pradoshaja

vikaras i.e, tikta ksheera basti in the management of janusandhigatavata.

The present dissertation work was divided into 2 parts. The first chapter deals

with the introduction and concept of Asthi pradoshaja vikaras supported by the

contemporary science view. In the second chapter, concepts of Janusandhigatavata

contemporary view in detail are explained. In the third chapter, concept of basti

especially Kala basti is explained. The fourth chapter deals with the, Drug review

(trikatu, panchatikta, bala, godugdha, goghrita, shatapushpa, madhu and saindhava)

was dealt.

In the second part, Materials & Methods, Observation of clinical trials, Results,

Statistical tables & graphs, Discussion, Conclusions along with recommendation for

future study were dealt. A total of 30 Patients in two groups (each group contains

15patients each) were selected for the study.

The patients of group A were administered with trikatu churna for ama

pachana. After attaining niramavastha patients were subjected to abhyanga with

ksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form of

kala basti administered starting from anuvasana with panchatikta ghrita (9 anuvasana)

and niruha basti with panchatikta ksheera sarpi (6 niruha) and were advised 30 days

parihara kala. The patients of group B were administered with trikatu churna for ama

pachana. After attaining niramavastha patients were subjected to abhyanga with



ksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form of

kala basti administered starting from anuvasana with bala ghrita (9 anuvasana) and

niruha basti with bala sadhita ksheera sarpi (6 niruha) and adviced 30 days parihara

kala.

The different parameters of the study were observed and recorded before

treatment, after treatment and after the follow up. The observations and results were

statistically analyzed for better interpretation. Based on result statistical analysis and

general observations, Group A showed significant result with p value 0.042 and with

no statistical significance in Group B with p value 0.819. Radiological changes were

not seen in both the groups after the treatment and follow up.

The conclusion was derived on the basis of observations & results. Future

perspective of the study is highlighted as an aid for the future research workers.



BIBLIOGRAPHY

1. Raja Radha Kantha Deva, Shabda Kalpa Druma, part one, 3rd

Edition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:155.



3. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,

Reprinted 1990, PP: 122.

4. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part four, Varanasi,

Chowkambha Sanskrit Series Office, 1969, PP: 4468.

5. Raja Radha Kantha Deva, Shabda Kalpa Druma, part three, 3rd


6. V.S.Apte, Sanskrit English Dictionary, Varanasi, Motilal Banarsidass, 1968, PP: 350.

7. Raja Radha Kantha Deva, Shabda Kalpa Druma, part two, 3rd


8. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part five, Varanasi,

Chowkambha Sanskria Series Office, 1969, PP: 3793.





Chowkambha Sanskrit Series Office, 1969, PP: 3003.

12. Raja Radha Kantha Deva, Shabda Kalpa Druma, part four, 3rd









16. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part one, Varanasi,




18. Laxman Sastri Pansikar, Amarakosha, 7th Edition, Bombay, Nirnaya Sagar Press,

1934, PP: 1210.

19. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,

Reprinted 1990, PP: 122, 250,289,296.

20. Acharya Y.T, Charaka Samhita of Agnivesha, 5th Edition, Varanasi,

Chaukhambha Prakashan, 2007, PP: 514.

21. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, Chaukhamba

Surabharati Prakashan, Reprinted 2008, PP: 59.





24. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9th Edition,

Varanasi, Chaukhambha Orientalia, 2009, PP: 187.













30. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 1st edition, Varanasi,

Choukhamba Sanskrit Series Office, 2006, PP: 314.




Surabharati Prakashan, Reprinted 2008, PP: 365-366.





35. Brahma Sankara Misra, Bhavaprakasha of Bhavamishra Vol 2, 11th Edition,

Varanasi, Chaukhambha Sanskrit Sansthan, 2009, PP: 48-49.

36. Satyapala, Kasyapa Samhita of Vriddha Jivaka, Varanasi, Chaukambha Sanskrit

Sansthan, 2006, PP: 75.

37. Giriraja Dhayalu Shukla, Bhela Samhita of Bhela, 1st Edition, Varanasi,



Chowkamba Vidya Bhavan, 1959, PP: 100.










Varanasi, Chaukhambha Sanskrit Sansthan, 2009, PP: 49.







46. Parashuram Shastri Vidyasagar, Sarngadhara Samhita of Sarngadhara, Varanasi,

Chaukhamba Surbharati Prakashan, 2006, PP: 46.



























59. Kshemaraj Shri Krishnadas, Harita Samhita of Harita, Mumbai, Vunkateshwar

Mudranalaya, 1984, PP: 267-268.

60. Giriraja Dhayalu Shukla, Bhela Samhita of Bhela, 1st Edition, Varanasi,

Chowkamba Vidya Bhavan, 1959, PP: 21.













66. Yogindra Nath Sen, Charaka Samhita of Charaka, 2nd Vol, Banaras, Chowkhamba

Sanskrit Series Office, 1922, PP: 988.



















75. Vaidhya Harishatri Paradakara, Ashtanga Hrudaya of Vagbhata, 9th Edition,










80. Yadunandana Upadhyaya, Madava Nidana Vol 1, Varanasi, Chaukhambha

Sanskrit Sansthan, 2003, PP: 513.













98. Dingari Lakshmana Chary, Shalakya Tantra, Reprinted, Delhi, Chuakhamba

Sanskrit Pratishthan, 2007, PP: 253-253.

99. Dingari Lakshmana Chary, Shalakya Tantra, Reprinted, Delhi, Chuakhamba

Sanskrit Pratishthan, 2007, PP: 29-31.









104. Indradev Tripathi & Dayashankar Tripati, Yogaratnakara, 1st Edition, Varanasi,

KrishnadasAcademy, 1998, PP: 412.

105. Kshemaraj Shri Krishnadas, Harita Samhita of Harita, Mumbai, Vunkateshwar

Mudranalaya, 1984, PP: 267-268.



























118. Siddharth N Shah, API Text book of Medicine, 8th Edition, Mumbai, The

Association of Physicians of India, 2008, PP: 214.

119. Catherine Soanes, Oxford Dictionary Theaurus and Worldwide Guide, 25th

Edition, New Delhi, Oxford University Press, 2005, PP: 90.

120. Poddar S, Ajay Bhagat, Handbook of Osteology, 11th Edition, Patna, Scientific

Book Company, 2002, PP: 1.




Book Company, 2002, PP: 1-3.




Book Company, 2002, PP: 4-5.






Association of Physicians of India, 2008, PP: 215-217.









131. www.ncbi.nlm.nih.gov/pubmed

132. Davidson’s Principles and Practice of Medicine, 19th Edition, Churchill

Livingstone, 2002, PP: 985.


Association of Physicians of India, 2008, PP: 218-223.





135. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part two, Varanasi,


136. Raja Radha Kantha Deva, Shabda Kalpa Druma, part five, 3rd








140. Raja Radha Kantha Deva, Shabda Kalpa Druma, part four, 3rd















Varanasi, Chaukhambha Orientalia, 2009, PP: 530-531.




Sanskrit Sansthan, 2003, PP: 575, 560-561, 541, 520.









165. Ravidatta Shastry, Chakradatta of Chakrapanidataa, 4th edition, Varanasi,

Chaukhamba Surbharati Prakashan, 2006, PP:



167. Siddhi Nandan Mishra, Bhaisajya Ratnavali of Kaviraj Govind Das Sen,

Reprinted, Varanasi, Chaukhamba Surbharati Prakashan, 2007, PP: 527.




KrishnadasAcademy, 1998, PP: 434, 437, 418, 420-423.



170. Siddhi Nandan Mishra, Bhaisajya Ratnavali of Kaviraj Govind Das Sen,

Reprinted, Varanasi, Chaukhamba Surbharati Prakashan, 2007, PP: 546, 610, 604-

605,608.

171. Ravidatta Shastry, Chakradatta of Chakrapanidataa, 4th Edition, Varanasi,

Chaukhamba Surbharati Prakashan, 2006, PP: 139, 148, 150,153.





174. Kumar & Clark, Clinical Medicine, 6th Edition, Elsevier Limited, 2005, PP: 550.



176. www.wiktionary.com

177. www.thefreedictionary.com

178. www.dictionary.sensagent.com







184. L.C.Gupta etl, Differential Diagnosis, 7th Edition, New Delhi, Jaypee Brothers

Medical Publishers (P) Ltd, 2005, PP: 121-123.








188. H.S.Kasture, Ayurvediya Panchakarma Vignana, 8th Edition, Patna, Shri

Bhaidyanath Ayurveda Bhavan Ltd, 2005, PP: 187.



190. Parashuram Shastri Vidyasagar, Sarngadhara Samhita of Sarngadhara, Varanasi,

Chaukhamba Surbharati Prakashan, 2006, PP: 319.

191. H.S.Kasture, Ayurvediya Panchakarma Vignana, 8th Edition, Patna, Shri

Bhaidyanath Ayurveda Bhavan Ltd, 2005, PP: 346-350.










Chaukhambha Prakashan, 2007, PP: 688-689.


Surabharati Prakashan, Reprinted 2008, PP: 525,527.




Varanasi, Chaukhambha Orientalia, 2009, PP: 271-272.






Surabharati Prakashan, Reprinted 2008, PP: 540,535.


Chaukhambha Prakashan, 2007, PP: 114-115,682.


Surabharati Prakashan, Reprinted 2008, PP: 527-528,535.



205. P.V.Sharma, Dravya Guna Vignana, part two, 16th Edition, Varanasi,

Chowkhamba Vishwabharati, 1994, PP: 331,275,362.

206. J.L.N.Shastry, Illustrated Dravya Guna Vignana, 2nd Edition, Varanasi,

Chaukhamba Orientalia, 2005, PP: 871, 448, 452.


Chowkhamba Vishwabharati, 1994, PP: 761,149,242,280,697,735.


Chaukhamba Orientalia, 2005, PP: 265, 123, 407, 367, 250, 93.





210. www.milkfacts.org



212. www.indiadiets.com


Chowkhamba Vishwabharati, 1994, PP: 403.


Chaukhamba Orientalia, 2005, PP: 258.



216. www.indiadiets.com



218. Vishwanath Dwiedi, Bharatiya Rasashastra, 2nd Edition, Varanasi, Sharma

Ayurveda Mandir, 1987, PP: 376.

219. Sanjay Kadlimatti,P.G Subbanna gouda- Clinical Evaluation of the role of tikta

ksheera basti and ajasthi bhasma in the management of Asthi kshaya vis-a-vis

Osteoporosis- Ayu Journal Vol-30 N0-2 (April-June) 2009 PP-131-141.

Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata

Dr.Ranjith Kumar Shetty I

CASESHEET

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA

GOVERNMENT AYURVEDA MEDICAL COLLEGE,

MYSORE.

“CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.R TO MANAGEMENT OF SANDHIGATA VATA.”

HEAD OF THE DEPARTMENT : Dr. N.Anjaneya Murthy M.D. (Ayu) GUIDE : Dr. N.Anjaneya Murthy M.D. (Ayu) CO-GUIDE : Dr. Kiran Kalaiah M.S (Ortho) CO-GUIDE : Dr. V.A.Chate M.D.(Ayu) RESEARCHER : Dr.Ranjith Kumar Shetty B.A.M.S

Part A- History taking and Examination Sl. No: Name of the patient: Case No: Age: O.P. No: Sex: Male/female I.P No: Religion: H/M/C/Others Ward No: Marital Status: M/UM/W/D Bed No: Socio-economic class: VP/P/LM/M/UM/R Date of Commencement: Education: UE/PS/MS/HS/G/PG Date of Completion: Occupation: Result: Address: Phone No:


Dr.Ranjith Kumar Shetty II

I. VEDANA VRITTANTA:

A. PRADHANA VEDANA: DURATION

Janu sandhi shoola

Janu sandhi shotha

Atopa

Stabdhatha

Others

B. ANUBANDHA VEDANA: DURATION

Difficulty in walking

Disturbed sleep

Others

II. ADYATANA VYADHI VRITTANTA:

A. JANU SANDHI SHOOLA

1. Presentation: Unilateral ( ) Bilateral ( )

2. Mode of Onset : Gradual ( ) Sudden ( )

3. Severity of Pain: Deep ache ( ) Dull ache ( )

4. Duration of pain : Lasts for minutes ( ), Hours ( )

5. Aggravating factors : Aahara:

Vihara:

Kala:

B. JANU SANDHI SHOTHA

1. Mode of Onset: Gradual ( ) , Sudden ( )

2. Time of onset: Precedes pain ( ), Recedes pain ( )

3. Inflammatory changes : Present ( ), Absent ( )

C. ATOPA

Present ( ) Absent ( )


Dr.Ranjith Kumar Shetty III

D. STABDHATA

Range of different movements of knee joints: Restricted ( ), Not Restricted ( )

Time:

E. OTHERS

III. POORVA VYADHI VRITTANTA

A. H/O Previous illness

B. H/O Previous treatment

IV. KULAJA VRITTANTA

A. Pitruja: Present ( ) , Absent ( )

B. Matrija: Present ( ), Absent ( )

V. VAYAKTIKA VRITTANTA

A. Occupation : Hard ( ), Moderate ( ), Sedentary ( )

B. Diet: Veg/Non veg ( Regular/ Irregular )

C. Appetite: Poor ( ), Moderate ( ) , Good ( )

D. Habits: Tea ( ) Beedi ( )

Coffee ( ) Tobacco chewing ( )

Cigarette ( ) Alcohol ( )

Others:

VI. GYNAECOLOGICAL & OBSTETRIC HISTORY

A. Gynecological history

Menstrual Cycle: Regular/ Irregular intervals

B. Obstetric history: G P D A L

VII. EXAMINATION

A. Asta sthana pareeksha:

Nadi: V/P/K/VP/VK/VPK

Mutra: __ times per day, __ times at night


Dr.Ranjith Kumar Shetty IV

Mala: Drava/Baddha/samyak

Jihwa: Alipta/Alpa lipta/ Lipta

Shabda: Prakruta /Vikruta

Sparsha: Prakruta/Vikruta

Druk: Prakruta/Vikruta

Aakruti: Pravara/Madhyama/Avara

B. Janu sandhi pareeksha

Darshana:

Gait- Swinging gait ( ), Limping gait ( )

Swelling: Present ( ), Absent ( )

Muscle wasting: Present ( ), absent ( )

Sparshana

Local temperature: Present ( ), Absent ( )

Local tenderness: Present ( ), Absent ( )

Swelling

Fluctuation: Positive ( ) , Negative ( )

Patellar tap: Positive ( ), Negative ( )

Crepitus: Audible ( ), Palpable ( )

Sandhi Chalana

Flexion:

Extension:

External Rotation:

Internal rotation:

Maana

Apparent shortening:

True shortening:

C. Dashavidha pareeksha

i. Prakruti: V/P/K/VP/PK/KV/VPK

ii. Vikruti: a) Dosha: V/P/K/VP/PK/KV/VPK

b) Dushya: R/Ra/Ma/Me/As/Mj/Sh/Others

iii Sara: Pravara ( ), Madhyama ( ), Avara ( )

iv Samhanana : Pravara ( ), Madhyama ( ), Avara ( )


Dr.Ranjith Kumar Shetty V

v Pramana: Pravara ( ), Madhyama ( ), Avara ( )

vi Satmya : Pravara ( ), Madhyama ( ), Avara ( )

vii Sattva: Pravara ( ), Madhyama ( ), Avara ( )

viii Ahara Shakti

a) Abhyavaharana : Pravara ( ), Madhyama ( ), Avara ( )

b) Jarana: Pravara ( ), Madhyama ( ), Avara ( )

ix Vyayama Shakti: Pravara ( ), Madhyama ( ), Avara ( )

x Vaya: Bala ( ) , Madhyama ( ), Vruddha ( )

D. Prayogashala pareeksha

X-ray of knee joint

Part –B Interpretation

1. Nidana

Aharaja:

Viharaja:

Manasika:

2. Poorvarupa:

3. Rupa :

4. Upashaya- Anupashaya:

5. Samprapti ghataka

a. Dosha

b. Dushya

c. Ama

d. Srotas

e. Sroto dushti prakara

f. Udhbhava sthana

g. Sanchara sthana

h. Adhisthana

i. Roga marga

6. Vyadhi vinishchaya

Chikitsa:

Type of Basti: Kala basti


Dr.Ranjith Kumar Shetty VI

POORVAKARMA

Deepana pachana from ______ to ______

Yoga: Trikatu Churna

Matra: 12gm

Kala: Morning ( ). Afternoon ( ), Evening ( )

Anupana: Ushna jala

Nirama lakshana attained on ______ day

Ama lakshana

Jeerna lakshana

Stimita koshta

Guru koshta

Annaabhilasha

Angamarda

Snehana: Bahya abhyanaga

Dravya:

Sthana:

Kala:

Swedana

Kala:

Bastipoorva ahara

Bastipoorva vihara

Basti dravya prepared properly.

PRADHANA KARMA

Sthiti- Vama parshwa

Group A ( )

Yoga : Anuvasana: Pancha tiktaka ghrita

Niruha:Madhu

Saindhava

Pancha tiktaka ghrita

Shatapushpa Kalka


Dr.Ranjith Kumar Shetty VII

Pancha tikta saadhita ksheera paka

Duration : 15days, from _________ to ________

Follow up: 30 days from _________ to ________

Group B ( )

Yoga: Anuvasana : Bala ghrita

Niruha : Madhu

Saindhava

Bala ghrita

Shatapushpa kalka

Bala saadhita ksheera paka

Duration :15days from __________ to __________

Follow up : 30 days from __________ to _________

Basti A N A N A N A N A N A N A A A

Date

Bastidana kala

Basti pratyagamana kala

PASCHAT KARMA

Pathya: Aahara Vihara

Part C- Observation and Assessment Subjective Parameters

Before treatment After treatment After follow up

Lakshanas Rt Lt Rt Lt Rt Lt

Sandhishula Sandhishotha Sandhi stabdhata Atopa


Dr.Ranjith Kumar Shetty VIII

Objective parameters: X-ray examination

X-ray Before treatment

After treatment

After follow up

Normal Mild changes of OA Moderate changes of OA Severe changes of OA Signature of the Researcher Signature of the Observer

Bala Ghrita Panchatikta Ghrita Panchtikta kwatha churna Balamula kwatha churna

Saindhava Madhu Shatapushpa Ksheera

Asthivikara ss-mys

Health & Medicine

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