Sandhivata kc002 udp

CLINICAL STUDY ON THE EFFECT OF VATARI RASA IN THE MANAGEMENT OF SANDHIGATA VATA

BY

Shobha R. Itnal. B.A.M.S

Dissertation submitted to Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka. In partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (Ayu)

In

KAYACHIKITSA

GUIDE:

Dr. JONAH.S. M.D. (Ayu), Asst. Professor

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA

S. D. M. COLLEGE OF AYURVEDA, UDUPI

2006 – 2007

Ayurmitra

TAyComprehended

Rajeev Gandhi University of Health Sciences, Karnataka, Bangalore

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation thesis entitled “CLINICAL STUDY ON THE

EFFECT OF VATARI RASA IN THE MANAGEMENT OF SANDHIGATA

VATA” is a bonafide and genuine research work carried out by me under the guidance of

Dr.Jonah.S.M.D (Ayu) Asst.Professor, S.D.M.C.A, Udupi.

Date: Signature of the Candidate

Place: Udupi SHOBHA R.ITNAL.

II

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajeev Gandhi University of health Sciences, Karnataka

shall have all the rights to preserve, use and disseminate this dissertation in print or

electronic format for Academic / Research purpose.

Date: Signature of the Candidate

Place: Udupi SHOBHA R. ITNAL

© Rajeev Gandhi University of Health Sciences, Karnataka

V


ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “CLINICAL STUDY ON THE EFFECT

OF VATARI RASA IN THE MANAGEMENT OF SANDHIGATA VATA ” is a

bonafide research work done by, under the guidance of Dr. Jonah S. M.D (Ayu) G.A.U,

Asst.Professor and Co- Guide Dr. Srikanth.U. M.D. (Ayu), Prof & H.O.D.

Signature of H.O.D Signature of Principal

Dr. G. Srinivasa Acharya. M.D. (Ayu) Dr.U.N.Prasad, M.D(Ayu)

Professor and Head of the Department, Principal, SDMAC.

Post Graduate Studies in Kaya Chikitsa, Udupi.

S.D.M.College of Ayurveda, Udupi.

Date:

Place: Udupi

IV


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “CLINICAL STUDY ON THE EFFECT

OF VATARI RASA IN THE MANAGEMENT OF SANDHIGATA VATA” is a

bonafide research work done by Shobha R. Itnal in partial fulfillment of the requirement

for the degree of Doctor of Medicine in Ayurveda, under my guidance Dr. Jonah.S. M.D.

(Ayu).

Date: Signature of the Guide

Place: Udupi. Dr Jonah.S. M.D (Ayu) Asst. Professor

Department of Post Graduate Studies in Kaya Chikitsa S.D.M.C.A. Udupi

III

LIST OF FIGURES No Figure Page No 1 Nidanajanya Sandhigata Vata 30 2 Dhatukshayajanya sandhigatha vata 31 3 Aavarana janya sandhigata vata 32 4 Age incidence 77 5 Sex incidence 77 6 Religion 78 7 Literacy 78 8 Marital status 78 9 Socio economic 79 10 Occupation 79 11 Habit 80 12 Diet 80 13 Desha 81 14 Prakruti 81 15 Satwa 82 16 Sara 82 17 Samhnana 83 18 Saatmya 83 19. Abhyvarana Shakti 83 20 Jaranashakti 84 21 Nidra 84 22. Vyayam 84 23. Joint involvement 85 24. Duraton 85 25 Pain on walking 86 26. Pain or Discomfort 86 27 Morning Stiffness 87 28. Max dist walked 87 30. Able to climbup 88 31. Able to get down 88 32 Able to squat 89 33. Swelling 89 34. Tendernees 90 35 Crepitus 90

LIST OF CONTENTS

CONTENTS Page No

1.INTRODUCTION 1-4

2.OBJECTIVES 5

3.REVIEW OF LITERATURE 6-71

4.METHODOLOGY 72-76

5.OBSERVATIONS 77-85

6.RESULTS 86-90

7.DISCUSION 91-94

8.CONCLUSION 95

9.SUMMARY 96-97

10.BIBLIOGHAPHY 98-102

LIST OF TABLES No Table Page No 1 Nidana 15-22 2 Roopa 24 3 Chikista 38 4 Family & Latin name 71 5. Age incidence 77 6 Sex incidence 77 7 Religion 78 8 Literacy 78 9 Marital status 78 10 Socio economic 79 11 Occupation 79 12 Habit 80 13 Diet 80 14 Desha 81 15 Prakruti 81 16 Satwa 82 17 Sara 82 18 Samhnana 83 19 Saatmya 83 20 Abhyvarana Shakti 83 21 Jaranashakti 84 22 Nidra 84 23 Vyayam 84 24 Joint involvement 85 25 Duraton 85 26 Pain on walking 86 27 Pain or Discomfort 86 28 Morning stiffness 87 29 Max dist walked 87 30 Able to climbup 88 31 Able to get down 88 32 Able to squat 89 33 Swelling 89 34 Tendernees 90 35 Crepitus 90

ABBREVATIONS

A. Hr. - Ashtanga Hridaya

A. Sa. - Ashtanga Sangraha

Aru - Arunadatta

Bh. Pr. - Bhava Prakash

Bhava - Bhavamishra

Ca. Sa. - Caraka Samhita

Cakra. - Cakrapani

Ci. - Cikitsasthana

Dal. - Daphne

Gaya. - Gayadasa

Ka. - Kalpasthana

M. Kh. - Madhyama Khanda

M.M.W - Monier.M.Williams

Ma. Ni. - Madhava Nidana

Madhu. - Madhukosha

Ni. - Nidanasthana

Pu- Purvardha

Sh. - Shareerasthana

Su. Sa. - Sushruta Samhita

Su. - Sutrasthana

Ut. Kh. - Uttara Khanda

Vat. - Vatavyadhyadhikara

Vi. - Vimanasthana

Yo. Ra. - Yoga Ratnakara

ACKNOWLEDGEMENT

With a Bow to the Lotus feet of my Guru PUJYA ASAVATHI MATHA,

I wish this work to be

DEDICATED TO MY PARENTS

Mr. Ramappa B. Itnal

Mrs. Shakuntala R. Itnal

I render my sincere Thanks to Padmashree Dr.D.Virendra Hegde,

President of the Institution.

I remain indebted to my Mentor Dr. Jonah S. for being wary and guiding

me throughout the Academic years without exhaustion. I am also

beholden to Dr.G. Srinivasa Acharya for his timely advised throughout

the completion of this work.

I convey my sincere Thanks to our Principal Dr. U.N.Prasad and to the

Medical Superintendent Dr. Y.N.Shetty for their unfeigned support.

I am grateful to Dr. K.R. Ramchandra, Dean Prof. and HOD of Shalya

Tantra Department.

My Thanks also go to all of Teachers of the Department of Kayachikitsa

for their unwearied support and even to the Seniors and Camaradaries of

the Department of K.C.

I thank Dr.Chandrashekar my fiancé for his incessant help.

Shobha R Itnal

ABSTRACT Sandhi gata vata is a Vata vyadhi affecting the sandhi and it is one among the

major problems in the elderly.

Sandhi gata vata is characterized by pain and swelling in the joints, which may

produce devastation in the locomotion in the chronic stage. In modern parlance, this can

be counted upon in the degenerative disease of the joints.

Of this Osteoarthritis, is a slowly progressive degenerative disease and also are

the most common and leading cause for chronic disability in the aged.

The present study is focused to evaluate the effect of Vatari Rasa a herbomineral

preparation in Sandhigata vata viz-a –viz Osteoarthritis and to evaluate the changes in

signs and symptoms.

This is a single blind clinical study with pre and post test design where in 20 patients

diagnosed as Sandhigata vata, were administered the trail drug for 30 days with weekly

follow up. The relevant investigations were adopted for diagnosis.

Majority of patients (70%) registered were females and were of the age group

between 51-60 years who were exposed to physical exertion.

The statistics reflected that the Patients were chiefly from the upper Middle class

(40%) and had mixed variety of Diet.

The effect of treatment was evaluated on the basis of the signs and symptoms of

the disease and the results showcased moderate improvement in signs and symptoms in

maximum number of patients (55%).

Key words:

Vatari Rasa, Sandhigatavata, Osteoarthritis.

INTRODUCTION

INTRODUCTION

Practice makes perfect but research makes it refined

Dona Wong

Today research has become an indispensable tool in every field and more so in

the field of medicine.

Statistically significant portion of our population have impairments. These

impairments may be acquired either at birth or through accident or through disease

and many of the impairments result in disabilities are associated with ageing. Ageing

is a universal process, which is slow, silent, and irreversible and it affects most of the

body systems, in that musculoskeletal system seems to be at the forefront.

Untimed modification in the life style and haphazard schedule has made man

succumb to altered state of health or simply each and every person is in a state of

disease in one way or other right from cold to cancer.

Arthritis is a general term for at least hundred rheumatic disorders and of these

DJD (Degenerative Joint Disorder) dates back to B.C and Archeologists have found

evidence of it in Egyptian mummies.

Present statistical study reveals that five million people suffer from Osteo

arthritis per year. And there is a steady rise in degenerative changes from the age of

30 and by the age of 65, 80% of people suffer from Osteo arthritis.

DJD includes list of disorders in that Osteo Arthritis seems to be refulgent, and

it is a disease of movable joints characterized by degeneration of articular cartilage

and formation of new bone at joint surfaces or margins, with concurrent synovial

inflammation, which may not be always present.

Clinical study on the effect of Vatari Rasa in the management of Sandhigatavata

1

INTRODUCTION

There are three common forms of OA (Osteo-Arthritis) and many people have

some of each type. At one instance of time every one may develop to some degree as

the ageing process advances.

The most common site for OA include, base of thumb, knee and hand. The

first mildest form includes spine of neck mid and low back region. The third form

involves the weight bearing joints.

In Ayurveda Sandhigata vata seems to have similar feature, signs and

symptoms as that of OA. In jaravastha, vatadosha is predominant and the prevalence

of vatic disordersis more. Sandhigata Vata is one of the Vatavyadhi characterized by

shoola, sotha and sthabdata. Pain may remain constant or wax and wane. In advanced

cases daily activities will be affected.

Modalities of treatment have been tried in various systems of medicine

including the contemporary system of medicine but the statistical figure of the cured

is still lying low than the expectant and has kept whole medical fraternity on

tenterhooks.

In Ayurveda for Sandhigata vata shodhana and shamana therapies are

explained, like snehana, swedana, basti and guggulu prayoga to bring significant relief

to the patient and with the concurrent views may arrest the disease process.

Despite large investment in research, effective and safe treatments are still

elusive. Now more than ever though there is a wide variety of treatment options

available however deciding which treatment is best both in safety and efficacy can be

challenging, so the remedies that maintain the health and delay the degeneration

should ideally tone up the system and restore and prevent the decline of the function.

Hence Vatari Rasa a herbomineral preparation has the aforementioned actions, is


2

INTRODUCTION

selected for the present study. It mainly contains vatahara drugs like guggulu. This

preparation does shamana of vata to a maximum extent.

The clinical study showed significant improvement in pain and swelling

parameters. Overall this shamana line of treatment showed significant change in

patients of Sandhigata vata.

Few Research Clinical Trail has been carried out in different institutions and

are as follows:

1. A controlled clinical study on the effect of Panchatikta guggulu Ghritha Anuvasana

basti in janu sandhigata vata w.s.r. to OA of knee By Dr.SurekhaPai.

S.D.M.C.A.UDUPI. (RGUHS – KARNATAKA) 19991

Group A- 12 patients were treated with PTGGhritha Anuvasana basti for 10 days, and

Cap-Sallaki 500 mg for 30 days.

Group B – 12 patients treated with cap-Sallaki 500 mg for 30 days

Result: Patients of group A showed better improvement

2. Effect of different preparations of Dashamoola in the form of Janu Sandhigata

Vata2.

By- Dr.Gururaj S.D.M.C.A. Hassan. (RGUHS- KARNATAKA) 2001 – 2002

Group A- 10 patients treated with Dashamoola Taila for 7 days

Result: 30% were improved markedly 70% moderately.

Group B – 12 patients treated with Dashamoola kwatha

Result: 25% improved markedly, 75% moderate improvement was observed.

Group C – 12 patients treated with Dashamoola Ksheerapaka

Result: 27% improvement, 72% moderate improvement.

3. To evaluate the effect of Ashwakatri choorna in Janu Sandhigata Vata

By Dr.Nirmala. S.D.M.C.A.UDUPI. (RGUHS – KARNATAKA) 20043


3

INTRODUCTION

Group A: 12 patient’s treated with AC 10 gms in divided doses for 10 days.

GroupB: 12 patients treated with AC and external application with same, for 28 days.

Result: Group B patients showed marked improvement.

The thesis consists of four chapters. First chapter is about the conceptual study

whish comprises of three separate parts.

In first part, etymological derivation and brief description of the historical

aspect of the disease from Vedic era to the present time is explained

The 2nd part elaborates the general description of the disease Sandhigata vata.

The etiology, pathogenesis, clinical manifestation, prognosis and general line of

treatment are discussed.

The composition of the drug Vatari rasa is explained in 3rd part entitled Drug

review. The properties of the individual herbs and minerals used in the preparation of

the Vatari rasa are explained in brief.

Clinical study is the 2nd chapter of dissertation. The materials and methods of

the present work with complete description of the assessment criteria are given.

The descriptive statistical analysis of the sample taken for the study is

methodically elaborated. The observation, results, and their statistical analysis are

presented in order in the form of tables and diagrams.

In 3rd chapter entitled Discussion, the results obtained are critically analyzed,

to know the efficacy of the herbomineral combination taken for the study. The final

conclusions drawn from the present clinical research work are entitled in the chapter

Summary and Conclusion.

Hence in the present study efforts has been made to evaluate the efficacy of

Shamana chikitsa in the disease Sandhigata Vata.


4

OBJECTIVES

OBJECTIVE OF THE STUDY

1. To study the effect of Vatari Rasa in Sandhigata Vata


5

Clinical Study On The Effect Of Vatari Rasa In the Management Of Sandhigata Vata

VEDIC AND UPANISHAD KALA

6

HISTORICAL REVIEW

What is History but a Fable to be agreed upon?

The Great Ruler Napoleon Bonaparte believed much on history and said that it is no

mullock and that it is the mirror of the Future. As a matter of fact one must brush on with

the history to get the foretaste of the past and the pointer of the Present.

History of Indian medicine for convenience can be categorized with respect to time as

Pre-Vedic period, Vedic period, Samhita Kala, Sangraha Kala, Nighantu Kala and

Adhunika Kala.

PRE-VEDIC PERIOD

No references regarding the disease Sandhigata Vata.

VEDIC PERIOD:

In Atharvaveda two references are available regarding Sandhi roga, one deals with the

location of the disease that is Sandhi and other deals with the feature viz Sandhi

vishlesha. There is a reference about Balasa, which is a disease of Asthi as well as Parva.

UPANISHAD KAALA:

Upanishad kala details copiously the description of Vata.

Kenopanishad:

Vayu is defined as the one, which has got constant movement.


VEDIC AND UPANISHAD KALA

7

Chandogya Upanishad:

Highlights the chala property of Vata and showcases the close association of Vata with

bodily action and movement.

SAMHITA KAALA: Here systemized description of the disease according to Nidana

Panchaka can be sought.

CHARAKA SAMHITA:

One among the Literature triads of Ayurveda explains Sandhigatavata in Cikitsasthana.

No specific line of treatment has been for the same in particular.

SUSHRUTA SAMHITA:

Lakshana as “Hanti Sandhin” is given in the Nidanasthana 1st chapter and specific line of

treatment in Cikitsasthana 4th chapter.

SANGRAHA KAALA:

In Ashtanga Sangraha Nidanasthana 15thchapter lakshana and in Chikitsa sthana 23rd

chapter Chikitsa of is Sandhigata Vata mentioned.

Ashtanga Hridaya has described Lakshana in Nidanasthana 15thChapter and line of

treatment in Chikitsa sthana 21st chapter.

In both of these, description regarding Sandhigata Vata similiates to that of Charaka

Samhita and line of treatment is as that of Sushruta Samhita.

SAMHITA AND SOOTRA KALA

Madhava Nidana:

Mentions an additional symptom of the disease as Atopa.

Bhavaprakasha:

Explains the Lakshana and treatment of Sandhigata Vata in Madhyama Khanda,

Vatavyadhyadhikara 24th chapter.

Yogaratnakara:

Explains about Lakshana and treatment of Sandhigata Vata in Vatavyadhyadhikara of

Purvardha 24th chapter.

Bhaishajya Ratnavali:

Vatavyadhi prakarana 23th Chapter deals with treatment aspects of Sandhigata Vata.

The commentators of Samhitas and Sangrahas especially Acharya

Chakrapanidatta and Acharya Dalhana have elabouraated the topic for in depth

understanding of the disease.

SOOTRA KAALA:

In Bramhana Sootra description of Vyana Vata is available.

In Panini sootra Vata prakopa and its shamana has been explained.


8

NIRUKTI AND PARIBHASHA: SANDHI

NIRUKTI AND PARIBHASHA:

The word Sandhigata Vata ‘comprises of 3 words i.e.

1. SANDHI

2. GATA

3. VATA.

Sandhi

Vyutpatti - Sam + Dha + Kihi 4

Nirukti - - ‘Sandhirnamsa Samyogaha’4

‘Asthidwaya Samyogasthana’ 10

‘Sandhirnama Asthnam Anyonya Sangam Asthnani’ 5

The junction, connection, combination and union with containing a conjugation,

transition from one to another. 6

Paribhasha - Sandhi Pumlinga, Sandhanamiti, Yuga Sandhini,Yugashabde Deha Sandhini

Marmashabde Cha Drishtavyaha.

In broad, Sandhi means the junction between two things.

According to Ayurveda, Sandhi in a Shareera is the place where two or more bones meet

together and it may be either Stira (fixed type) or Chala (with varied degree of

movement.)

Clinical Study On The Effect Of Vatari Rasa In the Management Of Sandhigata Vata 9

NIRUKTI AND PARIBHASHA: GATA

Our body comprises of innumerable junction between Peshi, Snayu, Sira, Asthi, etc. but

the given description of Sandhi is only for Asthi Sandhi 17. Commentator Dalhana also

supports Acharya Sushruta’s view that 'Sandhi' means Asthyashrita Sandhi 11 .

Gata :

Vyutpatti

Gam –Gamane8

Gam + Ktha10

The term Gata and Gati are derived from the Sanskrit verb root ‘Gam’ by adding ‘kit’

or ‘Ktin’ Pratyaya.

Nirukti

Gamane, Vahane, Margah, Sthane, Prapte, Labdhe, Patite, Sameepe, Abhyupaye10

The word Gata may be used to denote the following:

Initiation of movement, carrying something along with, to reach a particular site, through

any particular pathway, leads to occupancy at a particular site

The contextual meaning would be -Occupancy at Sandhi.

Paribhasha:

Gatam - Streelingam, Gacchati, Janati, Yatteti8


10

NIRUKTI AND PARIBHASHA: VATA

Vata

Vyutpatti

Va - Gati Gandhanayoho9

Va - Gati Sevanayoho

Va + Kta

The term ‘Vata’ is derived by ‘Kta’ or Krt Pratyaya to the verb root ‘Va’ which means

‘Gati Gandhanayoh’.

Nirukti - Sparsha Matra Vishesha Gunake Bhutabheda

Pavane - Dehasya Dhatubheda Cha 10

The term ‘Gati’ has speckled meanings like Prapti, Jnana and ‘Gandhana’ has Utsaha,

Prakashana, Soocana, Prerana.

Considering the different meanings of Gati and Gandhana it can be inferred that the term

‘Vata’ acts as a receptor as well as stimulator.

Hence it can be tacitly understood that Vata is the biological force, which recognizes and

stimulates all the sensory and motor activities of the body.


11

CONCEPT OF GATATVA

Concept of Gatatva

Different opinions have been put forward to explain and understand the

pathogenesis of various diseases regarding Gatavata .

Though mentioned in all Classical texts Gatavata seems to be complex phenomenon.

Gatatva of Dhatu, Upadhatu, Ashaya, Avayava and Indriya etc. have been described in

the dictum.


12

NIDANA

NIDANA

The word Nidana in Ayurveda is used in broad sense. This refers to

etiopathogenis of the disease in general and etiology of the disease in particular.

From treatment perspective, nidana plays an important role.

Though specific nidana for Sandhigatavata is not mentioned, one has to compile the

scattered references mentioned in different contexts. 20-27

Nidana can be classified under various headings adhoc.

Basically Vatavyadhi Nidanas can also be classified into two,based on the pathology viz

1. Dhatuksayajanya.

2. Margavarodhajanya.

Also the Nidanas of Vata Prakopa leading to Vatavyadhi can be grouped as follows:

• Ahaarajah (Dietic factors)

• Viharajah (Behavior factors)

• Agantuja (External factors)

• Manasika (Mental factors)

• Kalajah (Seasonal factors)

• Anya hetuja (Miscellaneous causes)

Clinical study on the Effect of Vatari Rasa in the Management of Sandhigata Vata

13

NIDANA

Aaharajah (Dietic factors):

Excessive consumption of Tikta, Katu, and Kashaya Rasa leads to vitiation of

Vata. Substance having Sita, Ruksha, Laghu Gunas, Vistambi Dravyas and Sita Virya

Dravyas and other food substances like Adaki, Chanaka, Kalaya, Mudga if consumsed in

excess lead to the morbidity of Vata on one hand and on the other Alpa Bhojana,

Alpasana, Vishamasana also leads to Dhatukshaya and as a matter of fact Vata Prakopa.

Vihaarajah (Habit and regimens):

It includes habits and regimen related to body. The factors like Vegadharana,

Ratrijagarana, Asamyak Sodhana, unwanted strain by bodily exercise, excessive

travelling, uncomfortable sitting and sleeping postures are considered as the viharatah

factors for Vaata Prakopa. Also excessive indulgence in walking, talking, swimming,

excessive sexual intercourse and the excessive indulgence in the Nidaanas described

above may finally land up in Dhatukshaya and hence Vaata Prakopa.

Agantujah factors (External factors):

The external factors like Marmaaghata, Abhighata,Bhagna are also considered

under Aguntujah factors.

Manasika (Mental factors):

The Manasika factors like Bhaya, Cinta, Kroda, S’oka, Utkant’ha will also result

in Vaata Prakopa.

Kalatah (Seasonal factors):

Over exposure to air, cold climate, varshakala, summer season, cloudy

atmosphere may also cause Vaata prakopa.


14

NIDANA

Anya Hetu (Miscellaneous causes):

All the other Nidaanas which cannot be included in any of the above groups

comprises this group factors like excessive haemmorrhage (Asrkkshaya), Rogatikarshana,

Visa, Dhatukshaya, Ama and Maargaavarodha may land up in VaataPrakopa.

Hetu of Vaata Prakopa/ VaataVyadhi

Table No: 1 Nidaana

Causes Ca Su A.S A.H B.P

I.Dravyatah (Substantial)

Aadhaki (Cajanus cajan)

- + - - -

Bisa (Nelumbuo nucifera) - + + - -

Chanaka (Cicer arietinum) - - + - -

Chirbhata (Cuccumus melo) - - + - -

Haring (Possums sativum) - + - - -

Jaambava (Eugenia jambolena) - - + - -

Kalaya (Lathyrus sativus) - + + - -

Kalinga (Holarrhena antidysenterica) - - + - -

Kariya (Cappaaris deciduas) - - + - -

Koradusha (Paspalum scrobiculatum) - + - - -

Masoora (Lens culinaris) - + - - -

Mudga (Phaseolus mungo) - + - - -

Nishpaava (Hygroryza aristata) - + - - -

Never (Hygroryza aristata) - + - - -

Shaluka (Nelumbium speciosum) - - + - -


15

NIDANA

Shushkashaaka (Dry vegetable) - + - - -

Shyaamaka (Setaria italica) - + - - -

Tinduka (Diospyros tomentosa) - - + - -

Trunadhaanya (Grassy grain) - - + - -

Tumba (Lagenana valgaris) - - + - -

Uddalaka (A variety of Paspalum scrobiculatum) - + - - -

Varaka (Carthamus tinctorius) - + - - -

Viroodhaka (Germianated Seed) - - + - -

II.Gunatah

Rukshaanna (ununctous diet)

+ + + + +

Laghvanna (light diet) - + + - -

Gurva anna (heavy diet) - - + + -

Sheetaanna (cold diet) + - + - -

III.Rasatah

Kashaayaanna (astringent taste)

- + + + +

Katvanna (acidic taste) - + + + +

Tiktaanna (Bitter taste) - + + + +


16

NIDANA

IV.Karmatah

Vishtambhi (constipative diet)

- - + - -

V. Veeryatah

Sheeta (cold)

- - - - -

VI.Maatratah

Abhojana (fasting)

+ + - - +

Alpaashana (dieting) + - + + -

Vishmaashana (Taking unequal food) - + - - -

VII. Kaalatah

Adhyashana (eating before digestion of previous

meal)

- + - - -

Jeernanta (After digestion) - + + + +

Pramitashana (Taking food in improper time) - - + + +

Vihaaraja (Behaviour):

Mithyayogatah

Asamabhramana (Whirling stone) - - + - -

Asamachalana (Shaking of stone) - - + - -

Asamavikshepa (Throwing of stone) - - + - -

Asamotkshepa (pulling down stone) - - + - -

Balavat vigraha(wrestling with healthy one) - + + - -


17

NIDANA

Damyagaja nigraha (subduing unteameable elephant) cow and horse

- - + - -

Divaasvapna (day sleep) + + - - -

Dukhaasana (uncomfortable sitting) + - - - -

Dukhasayya (uncomfortable sleeping) + - - - -

Ghadhotsadana (strong rubbing) - - + - -

Kashtabhramana (whirling of wood) - - + - -

Kashtachalana (shaking of wood) - - + - -

Kashta vikshepa (throwing of wood) - - + - -

Kashtotkshepa (pulling down wood) - - + - -

Lohabhramana (whirling of metal) - - + - -

Lohachalana (shaking of metal) - - + - -

Lohavikshepa (Throwing of metal) - - + - -

Lohotkshepa (pulling down metal) - - + - -

Paragatana (strike with others) - - + - -

Shilabhtamana (Whirling of rock) - - + - -

Shilachalan (Shaking of rock) - - + - -

Shilavikshepa (Throwing of rock) - - + - -

Shilotkshepa (Pulling down rock) - - + - -

Bhaaraharana (Head loading) - + + - -

Vegadharana (Voluntary suppression of natural

urges)

+ + + + +

Vegodeerana (Forceful drive of natural urges) - - + + -

Vishamopachara (Abnormal gestures) + - - - -


18

NIDANA

Atiyogatah

Atigamana (excessive walking) + - + - -

Atihaasya (Loud laughing) - + + + -

Atijrumbha (Loud yawning) - + - - -

Atikharacapakarshana (Violent stretching of the

bow)

- - + + -

Atilanghana (Leaping over ditch) + + + - -

Atiplavana (Excessive bounding) + + - - -

Atiprabhashana (Countinous talking) - - + + -

Atipradhavana (Excessive running) + + - - -

Atiprajagarana (Excessive awakening) + + + + +

Atiprapatana (Leaping from height) - + - - -

Atiprapidana (Violent pressing blow) - + - - -

Atipratarana (Excessive swimming) - + + - -

Atiraktamokshana (Excusive Blood letting) - - - - +

Atisrama (Over exertion) - - - - +

AtiSthaana (Standing for a long period) - + - - -

Ativyaayaama (Violent exercise) + + + + +

Ativyavaaya (excessive sexual intercourse) + + + + +

Atiadhyayana (excessive study) - + + - -

Adyasana (sitting for a long period) - + - - -

Atyuccabhaashana (speaking loudly) - - - + -

Gajaticarya (excessive riding on elephant) - - + + -


19

NIDANA

Kriyaatiyoga (excessive purification therapy) - - + + +

Padaticarya (walking long distances) - + - - -

Rathaaticarya (excessive riding on chariot) - + - - -

Turangaticarya (excessive riding on horse) - + - - -

Aagantuja (External factors):

Abhighaata (trauma) + - - - -

Gaja, Ushtra, Ashvasighrayanapatamsana

(Falling from speedy, running elephant, camel

and horse)

+ - - - -

Manasika (Mental factors):

Bhaya (fear) + - + + +

Cinta (worry) + - + - -

Krodha (Anger) + - - - -

Mada (Intoxication) - - - - +

Shoka (Grief) + - + + +

Utkant’ha (Anxiety) - - + - -


20

NIDANA

Kalaja (Seasonal factors):

Abhra (cloudy season) - + - - -

Aparaahnna (evening) - + + + +

Apararatra ( the end of the night) - - + + -

Greeshma (summer season) - - + - -

Pravaata (windy day) - + + - -

Sisira (winter day) - - - - +

Sheetakaala (early winter) - + - - +

Varsha (rainy season) - + + - +

Anya Hetuja (Miscellaneous causes):

Aama (undigested article) + - - - -

AsRukshaya (loss of blood) + + + - -

Dhatukshaya (loss of body elements) + - - - -

Doshakshaya (depletion of Dosha) + - - - -

Rogatikarshana (emaciation due to disease) + - - - -

Gadakruta mamskshaya (wasting due to disease) - - - - +


21

NIDANA

Marma vidda lakshana:

Name Type of Marma Location Marma Viddha

Lakshana

Kukundara18 Sandhi Marma

Vaikalyakara

Marma

It is located on

both sides of

Pristavamsha

Sparshaagnana

Chestanasha.

Nitamba

Asthi Marma

Kalantara Pranahara

It is located upon

the Shroni on both

the sides

Adhakayas’osha

Daurbalya

Marana.

Kurcha Snaayu Marma

Vaikalyakara

Marma

It is located above

the Kshipra Marma

in both the legs.

Pada Bramana

Pada Vepana.

Kurchasira Snaayu Marma

Rujakara Marma

It is located below

the Gulpha Sandhi.

Ruja

Sopha

Gulpha Sandhi Marma

Rujakara Marma

It is located in

between Pada and

Jangha.

Ruja

Stabdapada

Khanjata

Ani Snaayu Marma

Vaikalyakara

Marma

It is located 3

Angulas above the

Janu Sandhi.

Sophabhivriddhi

Stabdhasakti

Urvi Sira & Vaikalyakara

marma

It is located in the

middle of the Uru.

Sonitaksaya

Saktis’osha


22

POORVAROOPA

POORVAROOPA

The signs and symptoms which indicate the impending disease are collectively

called as Poorva roopa. This is noted during the Sthanasamsrayavastha of Vyadhi Kriya

Kala.

Vatavyadhi is said to have unmanifested symptoms (Avyakta) or exhibit

symptoms in mild form of the actual disease itself (Ishad vyakta) .29 So for

Sandhigatavata also specific Poorva roopa is though not mentioned the clinical

features of Sandhigatavata in milder form by itself can be considered as

Poorva roopa.

Clinical Study on the Effect of Vatari Rasa in the Management of Sandhi Gata Vata.

23

ROOPA

ROOPA

In this stage Pratyatmaka linga of the disease is seen, among sanchayadi Kriya

kala during vyktavastha roopa is seen. The clinical features of Sandhigatavata explained

by various Acharya are listed in Table below.

Table 2

Lakshanas Ca.Sa. Su.Sa. A.Hr. A.Sa. Ma.Ni. Y.R. B.P

Vedana/shoola + + + + + + +

Shopha/Shotha _ + _ _ + + +

Vatapoorndhritisparsha + _ + + + _ _

Hantisandhin _ + _ _ _ + +

Parasaranakunchanapravritt

Vedana.

+ _ + + _ _ _

Atopa _ _ _ _ + _ _

Sthabdata _ + _ _ + _ _

Sandhi Vedana 30

All the Acharya seem to have described this symptom. It is explained that pain in

the joint is elicited during Prasarana and Akunchana.

Sandhi Sotha 31

Acharya Charaka and Acharya Vagbhata have explained the nature of Sotha and

similiated it with Vata Poorna Driti Sparsha (a bag filled with air).

Sandhi Sthabdata 32

Snayu is one of the component of the joint structure and when this is effected the

apravritti of the joint occurs in the form of restricted or complete loss of the movement.

The term Sandhi Hanana or Hanti is used by some of the Acharyas intending the same

meaning. While commenting on this word Dalhana and Gayadasa explained as

Akunchanaprasaranayoh Abhavah and Prasaranakuncanayoh Asamarthah respectively.

With this we can infer that the word Hanti refers to inability to move the joints.


24

ROOPA

In the opinion of madhukoshakara, Hanti refers to Sandhi Vishlesha, Stambha Adi

Vikara.

Hence with the above references, Hanti refers to Sandhi Sthabdata.

Atopa 33

This symptom explained in Madhava Nidana. While commenting on the word Atopa in

another context, Madhukoshakara quotes the opinion of Gayadasa and Kartika.

I.e.Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah’. Also

Bhavamishra says ‘Atopo – Gudagudashabdaha’

Thus we can say that Atopa in this context is the sound produced by the

movement of joints i.e., Crepitus.

Thus with the help of different references and by the opinion of commentators it

can be concluded that Sandhi Shoola, Sandhi Sotha, Sandhi Sthabdata and Atopa are the

clinical features of Sandhigatavataor Janu-Sandhigatavata


25

UPASHAYAANUPASHAYA

UPASHAYAANUPASHAYA

This concept is explained in Pancha lakshana nidana to confirm the diagnosis of the

disease. By Upashaya patient gets relieved from the symptomatology. Anupasaya

worsens the condition.

Upashaya for sandhigata vata

Application of oil, Madhura- snigdha Ahara.

Anupashaya for sandhigata vata

Exertion, Excess intake of Katu- Tikta Ahara.

Clinical Study On The Effect Of Vatari Rasa In the Management Of Sandhigata Vata 26

SAMPRAPTI

SAMPRAPTI

Samprapti is the process of disease in the body i.e., etiopathogenesis of the

disease. From the onset of dosha dooshya sammoorchana till the evolution of the vyadhi

there various Vikriti occur. Samprapti explains such series of pathological stages.

The Samanya Samprapti for Vata Vyadhi that is explained in classics can be

considered as the Samprapti of Sandhigatavata and Janu-Sandhi-Gata-Vata.in particular .

Acharya Vagbhata 35 hierarchy in the Samprapti of Vata Vyadhi –

Dhatukshaya aggravates Vata and in turn is responsible to produce Riktata of Srotas.

Thus the vitiated Vata travels through out the body and settles in the Rikta Srotas and

further vitiates the Srotas leading to the manifestation of Vata Vyadhi (A.Hr.Ni.15/5-6).

Here-to -fore an effort has been made to explain how the Srotoriktata occurs due

to nidanasevana:

The chief properties of Parthiva Dravya are Guru, Sthula, Sthira and Gandha Guna in

predominance. These are the properties, which are necessary for Sthairya and Upachaya

of the body. Excessive intake of Dravyas having Laghu, Rooksha, Sukshma, Khara

properties lead to Abhava or depletion of Guru and Sneha Guna owing to their opposite

quality. This leads to Dhatukshaya. Akasha is the Maha bhuta that produces Sushirata

and Laghuta in the body. Vayu Maha bhuta fills up this Sushirata. So due to Dhatukshaya

Akasha Maha bhuta increases in the body producing Sushirata and Laghuta consequently

Vayu fills it up.

From this it can be stated that the meaning of word ‘Riktata’ is Sushirata 36 i.e.

increase in Akasha and Vayu Maha bhuta. While commenting on word ‘Riktata’ it is said

that ‘Riktata’ means lack of Snehadiguna.

Samprapti of Janu-Sandhi-Gata-Vata can be studied under three headings:

1.Swanidanajanya 37

2 Dhatukshayajanya and

3. Avarana Janya Sandhi-Gata-Vata.38


27

SAMPRAPTI

1.Swanidanajanya:

Nidanas like Ati Vyayama i.e. excessive physical exertion, jogging, affects the

structure of the sandhi.

Bharavahana- As knee is the weight bearing joint excess weight on it has direct

effect on the articular facets and due to this constant pressure the joint will may give

away at some instance of time.

Abhighata: Any trauma to joint structures be it Asthi, Snayu or Peshi may put the

joint integrity at stake.

Atisankshobha: Explained as one of the nidana for Asthivaha srotodushti.

Marmabhighata: Janu sandhi belongs to the Vaikalykara Marma type and hence if

this vital point faces Abhighata it may lead to impairment in the normal functioning of

the joint.

It is obvious that the above Nidanas will lead to the provocation of Vata and the morbid

vata gets lodged in Rikta Srotas and after settling in Rikta Srotas it circulates through out

the body and if the Sthanasamsraya in the Sandhi it produces Sandhigata vata 39

2. Dhatukshaya janya Sandhi-Gata-Vata

In old age Vata Dosha dominates in the body. This will lead to Kapha Abhava.

Also Jataragni and Dhatwagni gets impaired, by which Dhatus formed will not be of

good quality. Degeneration of body elements takes place due to predominance of Vata in

its Rooksha, Khara, etc. Guna and loss of Kapha in quality and quantity.

As the Shleshmabhava decreases in the body, the Kapha Bheda i.e. Shleshaka

Kapha in the joints also decreases in quality and quantity. Reduction of Kapha in Sandhis

makes Sandhi Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthi dhatu

Kshaya. Asthi being the main participant of the joint its Kshaya leads Kha vaigunya in

the joints.

In this condition if Nidana Sevana done further produces Vata Prakopa. If Vata

Prakopa is not corrected by appropriate means and simultaneously if the person indulges

in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vata spreads all over

the body through these Srotas. In the meantime Sthanasamsraya of Prakupita Vata take

place in the Khavaigunyayukta Janu-Sandhi. This localized Vayu due to its Ruksha,


28

SAMPRAPTI

laghu, Kharadi Guna over powers and undoes all properties of Shleshaka Kapha

producing disease Sandhi-Gata-Vata.

3. Avaranajanya Sandhi-Gata-Vata

In Sthula usually Sandhi-Gata-Vata occurs in weight bearing joints. In them

Medodhatu will be produced in excess due to the Atisnehamsha of Amarasa 40 The

excessive Meads will produce obstruction for the flow of nutritive materials to the future

Dhatus i.e. Asthi, Majja and Shukra leads to their Kshaya.

The excessive fat deposited all over the body will produce Margavarana of

Vata 31Prakupita Vata due to Margavarana starts to circulate in the body. While traveling

it settles in the joint where Kha vaigunya is already exists. After Sthanasamsraya it

produces the disease Sandhi-Gata-Vata in the same process mentioned in the earlier

context.

Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Janu-

Sandhi-Gata-Vata can be divided into Dhatukshaya Janya and Avarana Janya. This will

help in deciding the prognosis and planning the treatment of the disease.

Samprapti Ghataka:

Dosha – Vata – Vyana – Vriddhi

Kapha – Shleshaka – Kshaya

Dooshya – Peshi, Snayu, Asthi, Majja

Srotas – Mamsavaha, Medovaha, Asthivaha, Majjavaha

Agni – Jataragni, Asthi-Dhatvagni

Ama – Jataragni Mandya Janya

Roga Marga – Madhyama

Udbhavasthana – Pakvashaya

Sancharasthana - Sarvasharira

Adhishtana – Sandhi

Vyaktasthana – Sandhi


29

SAMPRAPTI

1.Nidanajanaya

FIGURE - 1

Nidanasevana

Vataprakopa

Circulation through rasayanis

Sthanasamsraya in sandhi

Khavigunyata in sandhi

Sandhigata vata


30

SAMPRAPTI

FIGURE - 2

2.SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI-GATA-VATA

UKTA NIDANA SEVANA VARDHAKYA

DHATUKSHAYA

VATA PRAKOPA KSHAYA OF KAPHA BHAVA

IN THE BODY

CIRCULATION THROUGH SHLESHAKA KAPHA KSHAYA

RASAYANI IN SANDHI

KHAVAIGUNYA IN SANDHI

STHANASAMSHRAYA IN SANDHI

SANDHI-GATA-VATA


31

SAMPRAPTI

SAMPRAPTI IN AVARANA JANYA SHADHI-GATA-VATA

FIGURE - 3

MEDOVRIDDHI

(MEDOVARANA) (MARGAVARANA TO THE

FLOW OF POSHAKARASA)

VATAPRAKOPA POSHAKARASA NYUNATA TO

ASTHIDHATU

EXCESSIVE PRESSURE OVER

WEIGHT BEARING JOINT

ASTHIDHATU KSHAYA

IN SANDHI

VYANAVATA PRAKOPA

IN SANDHI

KHAVAIGUNYA IN SANDHI

SANDHI-GATA-VATA


32

VYAVACHCHEDHAKA NIDANA

VYAVACHCHEDHAKA NIDANA Vyavachchedhaka Nidana or differential diagnosis plays a prime role in arriving

at an exact decision between diseases presenting a similar clinical feature. While making

the diagnosis of SandhiGataVata the following disorders that are having similar features

has to be excluded. They are

1) Amavata

2) Vatarakta

3) Kroshtukasheersha

4) Sandhibhagna

5) Asthi Majjagata Vata

There are some conditions (Dosha Vriddhi Kshaya Lakshana, Panchakarma Vyapat)

where in symptoms related to Sandhi are seen.

They are listed below.

1) Kapha Vruddhi

2) Kapha Kshaya

3) Mamsa Kshaya

4) Medo Kshaya

5) Asthi Kshaya

6) Majja Kshaya

7) Ojo Visramsa

So while diagnosing Sandhi-Gata-Vata, factors like Vriddhi or Kshaya of Dosha and

Dhatu should be differentiated apart from above-mentioned disorders. This will help in

successful treatment.

Clinical study on the effect of Vatari Rasa in the management of Sandhigata vata.

33

VYAVACHCHEDHAKA NIDANA

Amavata and Vatarakta 41,42::Due to involvement of sandhi, shoth and shoola

Kroshtukasheerhaka 43Due to involvement of janu sanhi and maharuja

Sandhibhagna 44: Here the symptom is explained as prasaranakunchanayo agra ruk.

Asthimajjagata vata45 :Here the symptom is explained as Bhedo asthi parvanaam,sandhi

shool.

Kapha vriddi 46:As sandhi is the sthana of shleshaka kapha here the symptom is explained

as Sandhyasthivishlesh.

Kapha kshya 47:Here the symptoms explained as Shleshmashaya shoonyatva,shlata

sandhita and sandhi shaitilya.

Mamsa kshya And medo kshaya: 48,49Here sandhi vedana and sandhi sputana,sandhi

shoonyata are axplained respectly.

Asthi kshya 50 Sandhi shithilata is explained as one of the symptom.

Majja kshya51As asthi is ashraya for majja when there is majja kshya it leads to durbalata

of asthi, so the symptoms are mentioned in our classics as parvabheda and

asthishoonyata.

Ojo visramsa:52 Here sandhi vishlesha is mentioned as one of the symptom.

Clinical study on the effect of Vatari Rasa in the management of Sandhigata vata.

34

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SADHYASADHYATA

SADHYASADHYATA

It gives the clear picture about prognosis of the disease, i.e. whether the disease is

curable or, difficult to cure or incurable. It depends on the nature of the disease. An

elegant physician can 53 distinguish between curable and incurable disease and initiate the

treatment in time it leads to the successful management of that disorder. So the

knowledge of Sadhyasadhyata is very essential before the administration of any

therapeutics or medicaments.

Sandhi-Gata-Vata is not a fatal disease, but it cripples the patient and make him/her

burden to others. Due to its tendency to be fatal or incurable, Vata Vyadhi considered as

Maha gada by almost all Acharyas.

Dhatukshaya is the chief cause of Vata Vyadhi. Dhatukshaya is difficult to treat as

Acharya Vagbhata has elaborated that since body is accustomed to Mala, Dhatukshaya is

more troublesome than Dhatu Vriddhi. Sandhi-Gata-Vata is one of the Vata Vyadhi

therefore it is Kashtasadhya.

The ailments of aged persons are Kashtasadhya and Sandhi-Gata-Vata is the

affliction of elderly persons. Diseases situated in Marma and Madhyama Roga marga is

Kashtasadhya. Sandhi-Gata-Vata is a disease of Sandhi, which falls under Madhyama

Roga marga. Further Vata Vyadhi occurring due to vitiation of Asthi and Majja are most

difficult to cure.

In the list of Kashtasadhya Vata Vikara, Acharya Charaka 54 mentioned

Sandhichyuti (dislocation of the joint), pangutva (inability to walk) khuda vata (affliction


35

SADHYASADHYATA

of the joint by vayu or arthritis). Chakrapani commented on the word khudavata as

sandhigata vata.

As it becomes chronic it involves the gambheera dhatus, it becomes Kashta

Sadhya. Acharya Sushruta explained by nature itself all vatavyadhis are difficult to cure.

According to Yogaratnakara vatavyadhis are always are asadhya, sometimes Daivavasha

may cure them. According to Acharya Charaka in initial stage of the illness, in balavan

rogi, if it is not associated with any upadrava it is easy to cure. Thus Sandhi-Gata-Vata

can be considered as Kashtasadhya Vata Vyadhi.


36

UPADRAVA

UPADRAVA 62

Upadrava is the disesae produced after the manifestation of the main disease it

may be major or minor. During the course of the illness as the disease progresses it will

produce the upadrava.

As janu sandhi is the weight bearing joint, when body weight increases further

there will be wear and tear of the articular facet leading to further worsening of the

condition.Along with this when there is provocation of vata the peshi covering the asthi

undergies kshaya which results in increased pain, and stiffness of the joint. Further

worsening of this may lead to khanj and pangu.


37

CHIKITSA

CHIKITSA

The physician who is wellversed in diagnosing the diseases, who is proficient in

the administration of medicines and who knows about the dosage of the therapy that

varies from place to, should treat the disease.The primary importance of Cikitsa lies in

Samprapti Vighatana.

Sandhi-Gata-Vata is a Vataja disorder. So general treatment of Vata Vyadhi can

be adopted, keeping an eye on the etiology of the same. Regarding the specific line of

treatment of Sandhi-Gata-Vata, Caraka is silent. Later authors like Sushruta had

mentioned effective line of treatment for the same. Other books like Astanga Hridaya,

Astanga Sangraha, Yogaratnakara, Bhavaprakasha had mentioned specific line of

treatment.

The below chart shows Chikitsa sutra mentioned in different texts.

Table 3

Cikitsa Sootra mentioned in different Samhita.

Treatment Su.Sa. A.Sa. A.Hr. Yo.Ra. Bh.Pr. Bh.Ra.

Snehana + + + + +

Abhyanga +

Mardana + + + +

Svedana + + +

Upanaha + + + + + +

Bandhana + + +

Agnikarma + + + +

Clinical Study On The Effect Of Vatari Rasa In The Management Of Sandhigatavata

38

SNEHANA

• SNEHANA 55

Sandhi-Gata-Vata is a variety of Vata Vyadhi, where Snehana would be very

effective.While explaining the vatasyopakrama snehana,swedana,are mentioned first.Acc.

to the use it can be administered in two ways –Abhyantara and bahya

o Abhyantara Sneha:56

Here Sneha in the form of Pana, Bhojana, Basti and Nasya can be administered in

case of Sandhi-Gata-Vata.

o Bahya Sneha:57

Bahya Snehas are many like Abhyanga, Lepa, Udvartana, Padaghata, Gandoosha,

Karnapoorana, Akshitarpana, Picu, Samvahana, Mardana, Murdhnitaila, and Parisheka.

In case of Sandhi-Gata-Vata we get the mentioning of Abhyanga and Mardana.

Abhyang: It is one among bahirparimajana chikitsa,for abhyanga

Sukhoshna taila is used. Abhyanga should be done slowly in Anuloma Gati, in joints it

should be done in circular manner. Abhyanga should be done minimum for 5 minutes

because the Veerya of Taila will reach Majja Dhatu in 900 Matra-Kalas. It is Vatahara,

Pushtikara (Ca.Sa.Su.5/85; Su.Sa.Ci.24/30).


39

SWEDANA AND AGNIKARMA

SWEDANA58

Swedana is a variety of Shadvidhopakrama. It is helpful in

neutralizing Stabdhata, Shitata and Gauravata (Ca.Sa.Su.22/11).

In Sandhi-Gata-Vata varieties of Svedanakrama like Upanaha and

Bandhana are indicated.

As a dry wod can be slowly bent,as desired by the application of snehana and

swedana,similarly stiff limb can also be brought back to normalcy by the administration

of snehana and swedana therapies.

AGNIKARMA 59,60

Unique treatment indicated in case of Sandhi-Gata-Vata. Here Dahana or

cauterization is done in the part affected.

Dahana Karma should be done in the affected joint till the Samyak Laxana.

Hence the different treatment modalities mentioned by different authors can be

concise under these five (Su.Sa.Ci.4/8 & Dal; A.Sa.Ci.23/13; A.Hr.Ci.21/22;

Yo.Ra.Ci.Vat; Bh.Pr.Ci.24/259).


40

PATHYAPATHYA

PATHYAPATHYA

PATHYA:61

According to Acharya Charaka the drug and the regimen which do not adversely affect

the body and mind are regarded as pathya and those which adversely affect them are

considered as apathya.

As per guidelines of samhitas this can be classified as

AHRA:

ANNAVARGA: masha,godhoom,raktashali,naveenataila,purana shalyodana,

PHALAVARGA:Aml rasayuktaphala,dadima,draksha,jambeer,badar.

SHAKVARGA:vartaka,patola,sheegru,rasona.

DUGDHAVARGA: ksheera,navaneeta.

DRAVYAVARGA: mamsarasa,mudga,yoosha,dhaanyamla.

SNEHAVARGA:Tilataila,sarshpataila,erandataila.

VIHARA:

Sukhoshna parisheka,nirvata sthana,samvahana,avagaha,abhyanga,brmhacharya,ushna

pravarana,agni aatapa sevana.snigda ushnalepa.

APATHYA:

AHARA:

Kalaya,chanaka,kodrava,shyamak,nivar,nishpava,kareer,jambu,tinduka,shushka

mamsa,dooshit jala,tiktarasa atisevana.

VIHARA:Vegavarodh,vyayam,vyaya,vamana,raktamokshana,prajagarana,divaswapna,

adhva,gaja,ushtra,ashwa yana.


41

SANDHI

JANU-SANDHI

In Janu-Sandhi-Gata-Vata the vitiated Vata get lodges at Janu-Sandhi. Therefore

before going to the disease aspects, the anatomy and physiology of Janu-Sandhi are to be

under stood properly. In classics we have scattered reference of anatomical and

physiological consideration of Janu-Sandhi. Here an attempt is made to enumerate those

structures, which are helpful in maintaining the stability of the joints.

In Ayurveda, Sandhis are mainly classified into two types 11

1) Sthira Sandhi

2) Cala Sandhi

Again they are sub classified into eight types12

1) Kora 5) Tunnasevani

2) Ulookala 6) Vayasa tunda

3) Samudga 7) Mandala

4) Pratara 8) Shankhavarta

Acharya Sushruta- father of Surgery considered Janu-Sandhi under Chala Sandhi

and sub classified under Kora Sandhi

Other factors which are to be highlighted in understanding the Sandhi are-

Shleshaka Kapha 13

Among five variety of Kapha, Shleshaka Kapha resides in joints. It keeps the

joints firmly united, protects their articulation opposes their separation and disunion


42

SANDHI

Shleshmadhara Kala 14

It is the fourth Kala, which is situated in all joints of living beings. As wheel

moves on well by lubricating the axis, joints also function properly if supported with

Kapha. This helps in lubrication of joints

Vyana Vata 15

Vata governs every movement in the body. Vyana Vata is one among the five

varieties of Vata, which resides at Hridaya and controls most of the motor functions. The

Gati or physical movement is also one of its functions.

Gayadasa commenting on Sushruta has quoted the wordings of an unknown

author as though the Vyana Vata is functioning all over the body it resides in the Sandhi

Acharya Vagbhata states that Vata is located in the Asthi with relation to

'Ashrayashrayi Sambandha'. Generally augmentation or diminution of Doshas would be

given similar effect on their respective Dhatus but in case of Vata it is opposite; with

increase in Vata, Asthi Kshaya occurs 16

Sushruta in Shareera sthana explains different structures of the human body.

Among them, structures coming under Janu-Sandhi are listed below.

Snayu 17

Among nine hundred Snayus, ten are present in Janu-Sandhi. More over in Sakha

and Sandhi, Pratana variety of Snayu is present.

Importance – As a boat consisting of planks becomes capable of carrying load of

passengers in river after it is tied properly with bundle of ropes, all joints in the body are

tied with many ligaments by which persons are capable of bearing load


43

SANDHI

Peshi 18

The fleshy mass demarcated from each other is known as Peshi. In Janu they are

five in number. They are strong structures that help to maintain alignment of the joint

Sanghata 19

Assemblages of bones are fourteen. One is situated in Janu-Sandhi 9

Janu-Sandhi - Knee joint 20

Before discussing the disease Janu-Sandhi-Gata-Vata it is very essential to

understand the structure of knee joint, functional aspects of articular cartilage, synovial

fluid and synovial membrane etc.

Joints or articulations are the site where two or more bones meet. Joints are the

weakest part of the skeleton but their structures resists various forces, such as crushing or

tearing that threaten to force them out of alignment.

Joints are classified structurally and functionally. Fibrous, cartilaginous and

synovial are structural classification. Synarthrosis, amphiarthrosis and diarthrosis are

functional classification.

Knee Joint

Knee joint is a variety of synovial joint. In synovial joints the osseous surfaces

concerned are not in continuity although the bones involved are linked. The synovial

joints evolved from fibrous and cartilaginous joints by subsequent developments. These


44

SANDHI

synovial joints made up of source of the unique structures like Fibrous capsule, Articular

surfaces, Synovial membrane, and Synovial fluid, Ligaments, Muscles etc.

Knee joint is largest of human joints. Despite its single cavity in man, it is

convenient to describe it as 2 chondylar joints between the femur and tibia and a sellar

joint between the patella and femur.

Articular surface

Articular surfaces are most incongruent. The tibial surface is gently hollow

centrally and flattened peripherally where a meniscus rests. Lateral tibial surface is

circular and smaller, medial tibial surface is oval with longer ant-post axis.

The lateral and medial femoral chondyles have in front a faint groove. This

groove demarcates the femoral patellar and chondylar surfaces. Lateral Femoral surfaces

are almost circular and medial femoral surface is larger and oval. The patella’s articular

surface is adapted to the femoral surfaces.

Fibrous capsule

The fibrous capsule has parallel but interlacing bundles of white collagen fibers. It

is complex, partly deficient and partly augmented by expansions from adjacent tendons.

It forms a cuff with its ends attached continuously round the articular ends of the tibia

and Femur.

Synovial membrane

Derived from embryonic mesenchyme, it lines fibrous capsule, covers exposed

osseous surfaces, intra-capsular ligaments and tendons. It is absent from intra-articular

discs or menisci and ceases at the margins of articular cartilages.


45

SANDHI

Synovial Intima: Also called as lamina propria synovialis or synovial lining layer. It

consists of pleomorphic synoviocytes embedded in a granular, amorphous, fiber free inter

cellular matrix. It helps in removal of debris and synthesis of components of Synovial

fluid.

Synovial fluid

It occupies synovial joints, bursae and tendon sheaths. It is clear, pale, yellow,

viscous, and slightly alkaline. A protein probably lubricin rather than hyaluoricacid is the

lubricating factor but it amplifies its secondary lubricating activity. It provides liquid

environment with small range of pH, nutrition for articular cartilage, discs, menisci,

lubrication and reduction of erosion.

Menisci

It is fibro-cartilaginous disc shaped crescent. It deepens the articular surfaces of

the chondyles of the tibia. It partially divides the joint cavity into upper and lower

compartments. It has two ends, two borders and two surfaces. It helps to make the

articular surfaces more congruent, act as shock absorbers, lubricates the joint cavity, give

rise proprioceptive impulse.

OTHER STRUCTURES

Ligaments

The capsules and ligaments of Synovial joints unit the bones, help to direct bone

movement and prevent excessive and undesirable motion. Thus more the ligaments, the

joint are stronger. In knee joint tibial collateral ligament, fibular collateral ligament,

oblique popliteal ligament, arcuate popliteal ligament, ligamentum patellae, cruciate

ligament etc. helps to maintain stability.


46

SANDHI

Muscle tone

Muscle tendons that cross the joints are the most important stabilizing factor,

which is due to tone of the respective muscles. In knee, muscle tone is extremely

important in reinforcing joints. Especially the thigh muscles are helpful.

Bursae

Apertures in fibrous capsule through which synovial membranes protrude are

called as Bursae. They are numerous; as many as 13 bursae have been described.

Blood Supply

1. 5 Genicular branches of the popliteal artery.

2. The descending Genicular branch of the femoral artery.

3. The descending branch of the lateral circumflex femoral artery.

4. 2 Recurrent branches of the anterior tibial artery.

5. The circumflex fibular branch of the post-tibial artery.

Nerve Supply

Femoral nerve – Through its branches to the vastii.

Sciatic nerve - Through the Genicular branches of the tibial and Common

peroneal nerves.

Obturator nerve – Through its post division.


47

DISEASE REVIEW

OSTEOARTHRITIS 63

Osteoarthritis is also erroneously called as Degenerative Joint Disease or

Arthrosis or wear-and-tear arthritis. It represents the failure of diarthrodial joint. It is the

most common joint disease of humans. Osteoarthritis of knee is the leading cause of

chronic disability in developed countries

It can be classified as primary and secondary.The cause of primary osteo arthritis

is idiopathic,where as secondary osteo arthritis presents with specific causes

like,trauma,neuropathic,inflammatory,endocrine,metabolic,miscellaneous.

It is the most common joint disease of humans. Osteoarthritis of knee is the

leading cause of chronic disability in developed countries. Primary osteoarthritis is

idiopathic and secondary osteoarthritis is due to many causes like secondary to trauma,

due to endocrinal disorders, metabolic causes, etc.

Risk factors for Osteoarthritis

o Age –. It is considered to be one of the powerful risk factor. Old age people are

prone to suffer with osteoarthritis and causes disability in them.

o The process appears to begin in the second decade of life and the degenerative

changes are not apparent in middle age,and from 55yrs to 65yrs ofage

approximately 85% have radiological evidence of the disease. It is considered to

be one of the powerful risk factor. Old age people are prone to suffer with

osteoarthritis and causes disability in them.

o Sex – Distribution of OA in men and women is similar after the age of 55. Knee

OA is more common in wiomenhere as hip OA is more common in men.

o Genetic – Point mutation in the cDNA coding for articular cartilage collagen have

been identified in families with chondrodysplasia and polyarticular

osteoarthritis.An epidemiological study suggest that osteo arthritis is an articular

expression of a generalized constitutional condition resulting from inherited

metabolic abnormalities. Heberden`s nodes may be inherited as a single

autosomal gene,sex influnced to be dominant in female and recessive in male.

Clinical study on the effect of Vatari Rasa in the management of Sandhigatavata 48

DISEASE REVIEW

o Trauma – Direct or indirect injuries to the articular cartilage lead to its

degeneration. Fractures of different bones, especially of weight bearing with or

without involving the joint can also cause alteration of ligaments and in articular

surface of joint.

o Repetitive stress – Abnormal posture, abnormal gait, and unequal length of leg

will exert stress and strain over the joint.

o Endocrine disorders – Acromegaly, Hyperparathyroidism, Diabetes mellitus,

Obesity, etc. may lead to osteoarthritis.

o Metabolic disorders – Like Ochronosis, Wilson’s disease may give rise to

osteoarthritis.

o Calcium deposition diseases – Like CPPD deposition may lead to osteoarthritis.

PATHOLOGY 64

Although the cardinal pathologic features of osteoarthritis is a progressive loss of

articular cartilage, osteoarthritis is not a disease of any single tissue but a disease of an

organ

Articular cartilage is the major target of degeneration.Normal articular cartilage

strategically located at the ends of bones performsfunction viz, absorption of

shock,friction free movements,spreads the load across the joint surface.Pathology

occursin following stages

1. Changes in the bone and articular cartilage:

The pathological changes of the articular cartilage are mostly seen on the pressure

points.the articularcartilage becomes soft and irregular,gradually becomes thin at

thestressed area. And inn pressure area it becomes thickened this is called as lipping of

thearticular cartilage.similarly calcification takesplace in the deeper layers of the

cartilage.Thus the subcondral bone becomes dense,hard and polished and resembles ivory

and the process is known as eburnation.similarly calcification occurs in the nonpressur

area at the periphery of the joint which is covered with the layer of fibro cartilage.This is

called osteophyte.Gradually these osteophytes enlarge.


DISEASE REVIEW

2. Changes in the synovial membrane:

The synovial membrane rarely shows any pathological changes,until the first sign of

lipping appears.The membrane becomes thick and shaggy.These villi become enlarged

andnew villi also develop,gradually become infiltrated with adipose tissue.This ios due to

deposition of cartilaginous detritus into the synovial membrane.Thus the synovial

membrane looks shaggy with series of fringes and tags particularly at the places of

attachment with the capsule.Many of these tags show cartilaginous changes and they

may be detached giving rise to loose bodies in the joint which are known as joint mice.

3. Changes in the Capsule and Ligament: The fibrous tissue of the capsule becomes

more dense.At the point of attachment to the articular cartilage it may be transformed in

to fibro cartilage.Some times nodules appear at these places.So the joint movement will

become restricted.On the other hand ligaments show gradual process of dissolution

causing great disorganization of the joint.

CLINICAL FEATURES

Symptoms

Joint Pain

This is the initial and leading symptom, often described as a deep ache and is

localized to the involved joint. .In early case pain occurs after a night rest and gradually

disappears after use. As the disease progresses pain becomes more severe and more

constant and it may disturb the sleep. At this time the pain gets more severe as the joint is

used. Pain at night becomes more troublesome and is an important symptom. As the pain

increases the joint gradually loses movement due to spasm.

Stiffness

This is also important symptom which follows pain. Progressive stiffness of the

involved joint upon arising in the morning or after a period of inactivity may be


DISEASE REVIEW

prominent but usually lasts less than 20 min. It is due to spasm of muscles. There is no

relation between the severity of degeneration and morning stiffness.

Signs

Swelling

Physical examination of the osteoarthritis joint reveals localized soft tissue

swelling of mild degree. It is due to the changes in articular ends themselves, particularly

periarticular lipping.

Crepitus

The sensation of bone rubbing against bone evoked by joint movement is called

as crepitus. It is one of the characteristic sign of osteoarthritis joint.

Local Warmth ness

On palpation of the joint local rise in temperature indicative of sign of

inflammation.

Muscle Atrophy

Periarticular muscle atrophy may be due to disuse or due to reflex inhibition of

muscle contraction.

Others

In advanced stage there may be gross deformity, bony hypertrophy, subluxation

and marked loss of joint motion.

Laboratory and Radiological Findings 65

The Diagnosis of osteoarthritis is usually based on clinical and radiographic

features.

No laboratory studies are diagnostic,but specific laboratory testing may help in

identifying the underlying causes of secondary osteo arthritis.Analysis of synovial fluid

reavels mild leukocytosis with a predominance of mononuclear cells.

In the early stages, the radiograph may be normal, but joint space narrowing

becomes evident, as articular cartilage is lost. Other characteristic radiographic findings

include subchondral bone sclerosis, subchondral cysts, and osteophytosis. A change in


DISEASE REVIEW

the contour of the joint, due to bony remodeling, and subluxation may be seen. There is

often great disparity between the severity of radiographic findings, the severity of

symptom and functional ability in osteoarthritis.

No laboratory studies are diagnostic for osteoarthritis, but specific laboratory

testing may help in identifying one of the underlying causes of secondary osteoarthritis.

Analysis of synovial fluid reveals mild leukocytosis with a predominance of mononuclear

cells.

Approaches such as magnetic resonance imaging and ultrasonography have not

been sufficiently validated to justify their routine clinical use for diagnosis of

osteoarthritis or monitoring of disease progression.

TREATMENT 66

Treatment of osteoarthritis is aimed to reducing pain, maintaining mobility, and

minimizing disability. The vigor of the therapeutic intervention should be dictated by the

severity of the condition in the individual patient. For those with only mild disease,

reassurance, instruction in joint protection, and an occasional analgesic, may all that

required; for those with more severe osteoarthritis especially of the knee or hip, a

comprehensive programs comprising spectrum of non-pharmacological measures

supplemented by an analgesic and/or NSAID is appropriate.

The principles of management include:

Prevention of the disease – only applicable to secondary osteo arthritis.

Early diagnosis and identification of its cause,complication.

Assessment of main symptom and dysfunction.

Assessment of the patient`s emotional,cognitive,psychological response to the

disease.

Treatment modalities can be classified as

Non-Pharmacological Measures

• Reduction of Joint Loading

Osteoarthritis may be caused or aggravated by poor body mechanics. Correction of

poor posture and a support for excessive lumbar lordosis can be helpful. Excessive


DISEASE REVIEW

loading of the involved joint should be avoided; patients with osteoarthritis of the knee or

hip should be avoided prolonged standing, kneeling and squatting. Obese patients should

be counseled to loose weight. In patients with medial compartment knee osteoarthritis, a

wedged in sole my decrease the pain. Complete immobilization of painful joint is rarely

indicated. In patients with unilateral osteoarthritis of knee or hip, a cane, held in the

contraleteral hand, may reduce joint pain by reducing the joint contact force. Bilateral

disease may necessitate use of crutches or walker.

Other nonpharmacological measures include

• Patellar taping:

Medial taping of the patella can significantly reduce the pain,it is simple but

expensive and patients can learn to apply their own tape after minimal instruction.

• Orthosis:

Wedge insoles may be useful in conservative treatment of osteo arthritis of medial tibial

femoral compartment. Use of lateral wedged insoles may result in a significant decrease

in NSAID consumption.

• Thermal Modalities:

Application of heat to the osteoarthritis joint may reduce pain and stiffness. A variety

of modalities are available; often the least expensive and most convenient is a hot shower

or bath. Occasionally, better analgesia may be obtained with ice than with heat.

• Exercise:

Those who exercise regularly live longer and are healthier than those are sedentary,

because osteo arthritis of weight bearing joints limits physical activity and the amount of

exercise than an individual can perform. Even if we can not cure Osteo arthritis of

lowere extremity joints who are Able to perform modulate to vigorous exercise at least

three days per week, an intensity that permits an individual to talk while exercise

continuously for 20 to 60 min, which will improve their fitness and health without

exacerbating their joint pain or increasing their need for analgesic drugs, and there will be

improvement in function and quality of life and exhibit improved gait and walking speed.

• Education:

For the effective management of many patients with osteoarthritis, encouragement,

reassurance, advice about exercise and recommendation of measures to unhold the


DISEASE REVIEW

arthritic joint may all be that is required. Patients education interventions provide an

additive benefit 20 to 30% as great as that of NSAID treatment alone.

Drug therapy of osteoarthritis

Therapy for osteoarthritis today is palliative, no pharmacological agent has been

shown to prevent, delay the progression of, or reverse the pathologic changes of

osteoarthritis in human. Although claims have been made that some NSAIDs have a

“chondroprotective effect”. Adequately controlled clinical trails in human with

osteoarthritis to support this view are lacking. In management of osteo arthritic pain,

pharmacological agents should be used as adjuncts to non-pharmacological measures,

such as those described above, which are keystone of osteoarthritis.

NSAIDs often decrease joint pain and improve mobility in osteoarthritis - on an

average about 30% reduction in pain and 15% improvement in function.

In the management of osteoarthritic pain pharmacological agents are used as adjuncts to

non pharmacological measures. For slowing the progression of structural damage

DMOAD s (Disease Modifying OA Drugs)

Intra articular injection of hyaluronic acid is being used for treatment of patients

with knee osteoarthritis who have filed a program of non-pharmacological therapy and

simple analgesics.

Capsaicin cream reduces joint pain and tenderness when applied topically pts with

knee and hand osteoarthritis.


DRUG REVIEW

DRUG REVIEW 67

In our classics along with shodhana chikitsa many shamana drugs are also

mentioned for sandhigata vata. As vata dosha plays an important role in the pathogenesis

of the disease, vatahara treatment should be adopted. So the drug vatari rasa, which

contains the drugs, like Parada, Gandhaka, Guggulu, Triphala, Chitraka and Eranda,

which does the vata shamana is used in this clinical study. The details of the ingredients

of the medicine are given below.

Ingredients

1.Shudda parada - 1 tola

2.Shudda gandhaka – 2tola

3.Triphala - 3 tola

4.Chitraka moola – 4 tola

5.Guggulu – 5 tola q.s.

Method of preparation

Shudda Parada and Gandhaka each one part is taken in khalva yantra and kajjali is

prepared, guggulu is added, to this choorna of Triphala and Chitraka are mixed and

triturated with Eranda Taila then the pills were made of uniform size of 500gm and are

dried and stored in airtight bottle. Maximum drugs have tridoshaghna qualities.

Jaravastha rasayana and agni deepana is needed and prevalence of Sandhigata Vata is

more in old age, the contents of this preparation also possess rasayana, balya, deepana

qualities. So due to the combined effect the drug may act.


55

PARADA

PARADA 68

Vernacular Names:

Sanskrit - Bramha dhatu

English - Mercury

Hindi - Para

Common name – Para

Industrial name – Quick silver

Latin name: Hydragyrum

Synonyms: Maha teja, Mishraka, Trilochana, Khechara

Physical properties: Physical properties are clearly mentioned as Antaha suneela,

Bhirujwala, which is considered as best. It is quick moving element, resembles melted

silver. It can dissolve all metals easily and specific gravity is 13.595 at 25º C.

Varieties: 1) Shweta 2) Rakta 3) Peeta 4) Krishna

Rasa: Shudda rasa

Guna:Snigda,sara,guru.

Veery: Ushna

Vipaka: Madhura

Karma:Yogavahi,rasayana,balya.Dehasiddi,Lohasiddi,Jaramrutyu nashaka

Doshagnata:Tridoshagnata.


56

GANDHAKA

GANDHAKA 69-70

Vernacular Names:

Sanskrit - Gandhaka

English - Sulphur

Hindi - Gandhaka or Bali

Kannada – Gandhaka

Latin – Sulphur Brimston

Synonyms – Sulvqari, Sougandhika, Gouripushpaprabhava.

Properties:

It is a non-metallic element, occurs naturally in some parts of Kahan and Kashmir in

India and in Afghanistan and Burma. It is constituent of various vegetable and animal

substances such as egg albumin etc .It is used in the preparation of sulfa drugs which are

used regularly are having many advantages along with disadvantages. It acts as a mild

laxative.

Boiling point – 444º C

Specific gravity – 2.06

Varieties: 1) Rakta 2) Peeta 3) Shukla 4) Krishna

Rasa: Tikta, katu

Guna: Teekshna

Veerya: Ushna

Vipaka: Katu

Doshaghnata: Vata Kapha

Karma: Rasayana, balya, Agnikaraka, Vishanashaka


57

HARITAKI

HARITAKI 71

Vernacular Names:

Sanskrit - Haritaki

Kannada – Alalekai

Hindi - Har, Harara

English – Black myrobalan, Chebulic myrobalan

Latin - Terminalia Chebula. Retz.

Synonames: Abhaya, Kayastha,Rohini,Pootana,Pathya.

Family: Combretaceae

Gana: Triphala, Amalakyadi, Parushaka, Trivrit, Prajasthapana, Jwaraghna,Kasaghna,

Arshoghna.

Varga: Haritakyadi

Distribution:

Utpatti sthana – Throughout the greater part of India, Burma and Ceylon, up to

5000 Ft in the outer Himalaya and up to 6000ft in Travancore

Morphology: It is a big tree, 25-30mtrs in height. Its wood is hard and bulky.

Leaves - 15-30 cm in length and are pointed. The vasculature of the leaves has 6 to 8

pairs of veins. The inferior aspect of the leaves shows two small nodules near its

attachment with stalk.

Flowers – The flowers have short stalks, white or yellow in colour.

Fruit – Seven types of Hareetaki based on shape, size and geographical origin have been

mentioned in Ayurvedic texts. The fruit is having following characters.

Colour – Yellowish brown

Odour – Odourless

Taste – Astringent, slightly bitter and sweetish.

Size – 20to25mm long and 25mm wide.

Shape – Oval


58

HARITAKI

Extra Features:

The fruits are hard and strong with single seed which is slightly yellow in colour and 15

to 32 mm in length and pulp is not adherent to the seeds. In winter season fruits are

grown, collected in January month.

Types: 1) Vijaya 2) Rohini 3) Pootana

4)Amrita 5) Abhaya 4) Jeevanti

7) Chetaki – It is again of two types viz, Shweta and Krishna.

Useful parts: Fruit

Pharmacological Properties:

Rasa:Pancha rasa

Guna: Laghu, Rooksha.

Veerya: Ushna

Vipaka: Madhura

Prabhava: Tridoshaghna.

Doshagnata: Tridosha

Karma:Virechaka,Vranaropaka.

Chemical composition: Fruits are rich in tannins. The tannins are of pyrogallol type,

which on hydrolysis yield chebulagic acid, chebulinic acid, Corilagin and d- galloyl

glucose, ellagic and gallic acids are the other contents of myrobalan moisture 10%

Tannin 25.32% water insoluble matter 40 to 50%.


59

VIBHITAKI

VIBHITAKI 72

Vernacular Names:

Sanskrit - Vibhitaki

Kannada – Tarekai

Hindi - Bahera

English – Belliric myrobalan

Latin - Terminalia belerica Roxb.

Synonyms: Akshaphala, Kalidruma, Karsaphala, Telpushpak,Klivruksha, Bhutavasa.


Gana: Jwarahara,Virechanopaga (Charaka)

Triphala,Mustadi (Sushruta)

Varga: Haritakyadi

Distribution:

Utpattisthana – Through India, Burma and Ceylon.

Morphology: The tree grows up to a height of 16 to 32 mtrs. The bark is brownish in

colour and the wood of the trunk is hard.

Leaves – The leaves resemble banyan tree and are 8 to 16 cms in length. The leaves may

be circular or long. There are two small nodules at the base of the leaf.

Flowers – These are very small and yellow has five large five small stamens.

Seeds – The seed pulp is sweet it may produce mild intoxication.

Fruit – Hard ovoid more often pentagonal drupe suddenly narrowed into a short stalk or

scar of pedicle up to 2.5cm long and 2cm broad, surface is velvety covered with a close


60

VIBHITAKI

fulvous tomentam having light amber colour the fruit contains hard strong seeds with five

longitudinal ridges.

Useful part – Fruit


Rasa: Kashaya

Guna: Laghu,Rooksha.

Veerya: Ushna

Vipaka: Madhura

Doshaghnata: Tridoshaghna, Kaphahara.

Karma:Keshya,Bhedana.

Chemical composition: The fruit contains about 20 to 30% of tannins and 40 to 45%

water-soluble extracts. It also contains coloring matter, galic acid, chebulegic acid,

B.sitosterol, ellagic acid, phyllemblin, ethyl gallate and galloyl glucose. The seeds

contain non-edible oil. The plant produces a gum.


61

AAMALAKAI

AAMALAKAI 73-74

Vernacular Names:

Sanskrit - Dhatree

Kannada – Neellikai

Hindi - Avala

English – Myrobalan

Latin - Emblica officinalis.Gaertn

Synonyms: Vayastha, Amraphala, Jatiphala, Amrita, Kayasta, Bhupala, Shiva, Vrishya


Gana: Triphala, Amalakyadi, Parushaka, Trivrit, Prajasthapana, Jwaraghna, Kushtaghna,

Kasaghna, Arshoghna.

Varga: Haritakyadi

Family: Euphorbiaceae

Gana: Vayastapana,Virechanopaga(Charaka)

Triphala,Parooshakadi(Sushruta)

Varga – Haritakyadi

Distribution:

Utpatti sthana – Grows throughout India.

Morphology: This is a deciduous small or middle-sized tree with crooked trunk and

spreading branches bark is greenish grey.

Leaves – Sub sessile,10 – 13cm long, 2.5 mm broad closely set along the branch lets

distichous light glabrous, narrowly linear, obtuse, imbricate when young, having the

appearance of pinnate leaves stipules – ovate finely acute.


62

AAMALAKAI

Flowers: Greenish yellow in axillary fascicles on the leaf-bearing branch lets often on the

naked portion below the leaves, with fimbriate bracts at the base sepals.

Fruit: 1.3 to 1.6 cms in diameter, fleshy, globose with 6 obscure vertical furrows pale

yellow, of three 2 seeded crustaceous cocci.

Useful parts: Fruit


Rasa:Amla pradhana pancharasa.

Guna:Laghu,Rooksha.

Veerya:Sheet.

Vipaka:Madhura

Doshagnata: Tridoshagnata.

Karma: Rasayana,Vrashya,Chakshushya

Chemical composition:

Preliminary phytochemical screening of the extracts showed the presence of

alkaloids tannins, phenolic compounds, carbohydrate and aminoacids, which may be

responsible for analgesic activities. Fruit contains gallic acid, gum sugar, albumin and

cellulose, vitamin C, Ethanol and aqueous extracts are used in several experimental

models.Key active constituents are Emblicanin A and B,puniglucanin,pedunculagin,2

keto gluconolactone, ellegic acid, hexahydroxy diphenic acid and conjugates.


63

CHITRAKA

CHITRAKA 75

Vernacular Names:

Sanskrit - Chitraka

Kannada – Bilay chitramoola

Hindi - Cheeta

English – Leadwart

Latin – Plumbago zelynica Linn

Synonyms: Agni,Anal,Darun,Vanhi,Chitrapali

Family: Plumbaginaceae

Gana: Truptigna, Shoolaprashaman.

Varga: Pippalyadi

Ditribution: Utpattisthana:

White Chitraka – Bengal, Uttar Pradesh, South India and Srilanka.

Red chitraka – Sikkim hills, Kuchabihara

Morphology: It is a herb of 1 to 2.5 mtrs height. Stem is thin nodular, round, and delicate

having vertical striations.

Leaves: Oval shaped resembling Bilva leaves, 10 cm long 4 cm broad.

Flowers: Legumes, Oval shaped with cover, sticky in nature.

Seeds: Each fruit has one oval seed

Roots: Red colored

Varieties: Depending on the flowers it is of four types.

1) White 2) Yellow 3) Black 4) Red

White and red Chitraka are being used widely used in practice. Red Chitraka is more

potent.


64

CHITRAKA

Useful parts: Root bark

Pharmacological properties:

Rasa: Katu

Guna:Laghu,RookshaTeekshn.

Veerya:Ushna

Vipaka:Katu

Doshagnata:Vataka kapha shamana.

Karma:Deepana,Pachana,Grahi,Krimigna,Pitta saraka.

Chemical composition: Pungent having yellow and irritant principle

Plumbagin 91%, Glucose, Fructose, Protease.


65

ERANDA

ERANDA 76

Vernacular Names:

Sanskrit - Eranda

Kannada – Oudala

Hindi -Redi

English – Caster

Latin - Ricinus comminis Linn.

Synonyms: Gandharva hasta,Urubaka,Panchangula,Vyaghra puccha.

Family:Euphorbiaceae

Gana: Bhedaneeya,Swedopaga,Angamarda prashamana,Madhraskanda(Charaka)

Vidharigandhadi, Adhobhagahara, Vatasamshamana (Sushruta).

Distribution: Cultivated in India and many tropical and sub tropical areas of the world.

Morphology: It is a perennial shrub of 1 to 3 mtrs height. Stem is succulent, herbaceous

7to 15 cm in diameter. Leaves are alternate, orbicular, palmately compound, 6cm in

breadth.

Flowers – Long inflorescence

Fruit – Globose capsule 2.5 cm in diameter, on an elongated pedicle, spiny, and green

turning brown on ripening, usually contains three seeds.

Seed – Ovoid, thick, shiny 0.5 to 1.5 cm long.

Useful Parts: Root, Leaf, Seeds, Oil


66

ERANDA


Rasa: Madhura, Katu, Kashaya.

Guna: Snigdha, Teekshna, Sukshma.

Veerya:Ushna

Vipaka: Madhura

Doshaghnata: Kapha vatahara, Vrishya.

Karma: Vrishya,

Chemical composition: N.Demethylricinine, Pyridine alkaloids,Triglycerides.Ricin has

immunomodulatory activity.Castor oil consists of ricinoleic acid with only small amount

of dihydroxysteric, kinoleic,oleic and stearic acids.

Toxicity: Seeds contain 2.8 – 3% toxic substances.


67

GUGGULU

GUGGULU 77-78

Vernacular Names:

Sanskrit -Guggulu

Kannada – Guggulu

Hindi - Gugal, Gogil

English – Indian Bedillium

Latin - Commiphora mukul Engl.

Synonams: Koushika, Devadhoopa, Palankaasha. Mahishaksha, Bhutahara

Family: Burseraceae

Gana: Eladi(Sushruta) Vedanasthapana(Charaka)

Varga: Karpuradi Varga

Morphology: It is a woody shrub of 4 to 6 ft height. The branches are grayish in colour

Guggulu Exudates: Guggulu is the oleo-gum resin obtained by the incision of the bark of

the plant. Fresh exuded guggulu is moist, viscid, fragrant and golden in colour. It is

rounded or agglomerated tears in shape and tears are transparent with waxy surfaces and

brittle in nature.

Season: The exudates are collected in January.

Types:

1) Mahishaksha

2) Mahaneela

3)Kumuda

4)Padma

5)Hiranya


68

GUGGULU

Distribution: It is well distributed in Rajasthan, Karnataka, Maharastra and Gujarat.

Useful part: Exudate


Rasa: Tikta, Katiu.

Guna:Laghu,Rooksha,Teekshna,Vishada,Sookshma,Sra,Sugandhi.(Purana guggulu)

Snigdha, Picchila.(naveena guggulu)

Veerya: Ushna

Vipaka: Katu

Doshagnata - Tridosha hara,specially vatakapha shamana

Karma:Shothagna,Lekhana,Vrashya

Rogagnata – Krimi,Ashmari,Prameha,Kushta,Amavta,Granthi, Arshas, Vata roga

Chemical composition: Guggulu contains Approximately 60% of resin, 30% of gum,0.5

-1.5% of volatile oil,5% of moisture and 3.4% of organic matter, volatile oil of Guggulu

contains myrcene, dimyrcene, poly myrcene and carypdhllene. The resin contains

therapeutically active steroids. Oleoresin-Z-guggulsterone, E-guggulsterone have

hypolipidemic action. Acidic fraction of Resin is having anti-inflammatory action.

Guggulosterone is used to treat Osteo- arthritis and fractures, and it suppresses NF-kappa

B and NF kappa B regulated gene may explain its anti inflammatory effect.


69

PROBABLE MODE OF ACTION

Probable Mode of action of Vatari Rasa:

Vata shamana is the main line treatment in the maladies due to Vata .

Sandhigatavata is a Vata demoninat vyadhi and Vatari Rasa used in the present study is a

herbo mineral preparation which possess the quality to set right the Morbid Vata. Since

Sandhigatavata is confronted in the later decades of the lifespan and the Shareera bala is

diminished as the age progresses and also it is stated in the dictum that for the Bala and

the Vruddha the purificatory methods are contraindicated and the disease should be

palliated with the help of Shamana Chikitsa itself.

Most of the drugs have Madhura and Kashaya rasa and Ushna veerya and Madhura

vipaka are capable of mitigating and setting right the morbid Vata.

Rasayana and Balya are the fringe benefits of the medication.


70

DRUG REVIEW

Drug review chart:

Table no. 4

Drug name Rasa Guna Veerya Vipaka Doshaghnata Karma

Parada

Hydragyrium

Shad Rasa Snigda, Sara

Guru

Ushna Madhura Tridosha Rasayana

Yogavahi

Gandhaka

Sulphur

Madhura Teekshna Ushna Katu Vata kapha Rasayana

Agnikaraka

Haritaki

Terminalia

chebula

Pancha rasa Laghu

Rooksha

Ushna Madhura Tridosha/

vata

Virechaka

Vranaropaka

Bibhitaki

Terminalia

bellirica

Kashaya Laghu

Rooksha

Ushna Madhura Tridosha/

Kaphahara

Keshya

Bhedana

Aamalaki

Emblica

officinalis

Pancharasa Guru

Rooksha

Teekshna

Sheeta Madhura Tridosha/

Pitta

Rasayana

Chakshushya

Chitraka

Plumbago

zelynica

Katu Laghu

Rooksha

Teekshna

Ushna Katu Vatakapha Deepana

Pachana

Grahi

Eranda

Ricinus

communis

Madhura

kashaya

Snigda

Teekshna

Sookshma

Ushna Madhura Kaphavata Vrishya

Guggulu

Commiphora

mukul

Tikta

Katu

Laghu

Rooksh

Teekshna

Sara,vishad.

Ushna Katu Vata kapha Shothagna

Lekhana

Vrushya


71

METHODOLOGY

CLINICAL STUDY

Ayurveda is not only a healing science, but an art of living based on sound

philosophy and the principles of Ayurveda are constant, because it explains only the

truth irrespective of time and place and to know more about established facts one has

to do research. Research is a scientific and elegant study, the research may be in the

form of clinical trial, observation study, drug research or experimental research, and

the method of experiment is well established in the epistemology of Ayurveda, which

is based on pratyksha, anuman aaptopadesh and yukti.

Clinical trial can rigorously study specific components of Ayurvedic

formulations. Any laboratory experiment or other evaluation of the drug in animals

has a limited value and this data can not be directly extrapolated to the human beings,

that is why the clinical evaluation of the ayurvedic drugs is needed of the hour

Osteo arthritis is common rheumatologic disorder, commonly affects the

weight bearing joints such as knee, hip, feet and spine. It presents with symptoms like

pain, swelling, stiffness and the pain is clinical hallmark of the disease. Although the

symptoms occur earlier in women the prevalence among men and women is equal.

According to W.H.O. Osteo arthritis is the second commonest musculoskeletal

problem in the world (30%) after back ache (50%). Five million suffer from

osteoarthritis per year, Radiological and autopsy survey shows steady rise in

degenerative changes in joints from the age of 30.By the age of 65, 80% of people

have some radiograhic evidence of osteoarthritis

.

Different treatment modalities are explained in Ayurvedic classics for

Sandhigata vata. As vata dosha plays an important role in the pathogenesis of the

disease,vatahara treatment should be adopted. It may be either in the form of

shodhana or shaman. So the herbomineral preparation vatari rasa which mainly

contains vatahara drugs is selected for the present study.

Clinical study on the effect of Vatari Rasa in the Management of Sandhigatavata

72

METHODOLOGY

So in the present study to achieve the objectives of study. The sandhigata roga

is carefully and ethically designed by taking definite subjective and objective

parameters which as are taken before and after treatment. Study conducted on

scientific lines to come to satisfying conclusions.

Aims & Objectives of the study

• To evaluate the effect of Vatari Rasa in sandhigata vata.

(Osteo arthritis).

Source of data:

Minimum of 20 patients diagnosed as sandhigata vata (osteo arthritis) was taken for

the study from out patient Department and in patient Department of S.D.M.

Ayurveda Hospital, Udupi.

Method of data collection:

It is a single blind clinical study with pre-test and post- test design. A

special proforma was prepared with all points of history taking, examination,

laboratory and roentgenologic investigations to confirm the diagnosis as mentioned in

our classics and allied sciences.

Inclusion criteria:

• Patients diagnosed as Sandhigata vata

• Roentgenologic evidence of osteo arthritis

• Patients in between the age of 30-60 yrs.

Exclusion criteria:

• Reactive arthritis

• Secondary OA of diseases such as rheumatoid arthritis

• Malignant conditions

• Traumatic conditions


73

METHODOLOGY

Assessment Criteria

• Change in the signs and symptoms.

Investigations

X – ray of knee joint

Blood routine

Urine routine

Interventions

• Drug – Vatari rasa

• Dose – 1gm tid

• Duration – 30 days

• Followup – Weekly.

ASSESMENT CRITERIA-

PARAMETER

FINDING

POINTS

1)

Pain on Walking

- None Only after walking some

Distance.- Early after starting

0 1 2

2)

Pain or discomfort after up from

- No - Yes

0 1

3)

Sitting without use of arms.

- No - Yes

0 1

4) Maximum distance walked.

- Unlimited - > one kilometer but limited - About one kilometer. - About 500 - 900 meters - From 300 - 500 meters - From 100 – 300 meters - > 100 meters

0 1 2 3 4 5 6


74

METHODOLOGY

5)

Walking aids required

- None -Walking stick or crutch

0 1

6)

Able to climb down flaight of stairs

- Easily - With mild difficulty - With moderate -With marked difficulty - Impossible

0 0.5 1 1.5 2

7)

Able to climb up flaight of stairs

- Easily - With mild difficulty - With moderate -With marked difficulty - Impossible

0 0.5 1 1.5 2

8) Able to squat or bend at knee

- Easily - With mild difficulty - With moderate - Withmarked difficulty - Impossible

0 0.5 1 1.5 2

9)

Swelling

- No swelling - Slight swelling - Moderate Swelling - Gross swelling

0 1 2 3

10)

Tenderness

- No tenderness - Patient complains of pain Patient complains and withdraws the joint - Patient does not allow to touch the patient

0 1 2

3

11) Crepitus - No Crepitus - Palpable Crepitus - Audible Crepitus

0 1 2

12) Range of movements

Flexion-Rt -Lt Extension -Rt -Lt


75

METHODOLOGY

CRITERIA FOR ASSESSMENT OF TOTAL EFFECT OF THE THERAPY

The sum points of all the 12 parameters of assessment before, after treatment

and after follow-up were taken into consideration to assess the total effect of the

therapy.

CRITERIA FOR ASSESSMENT OF THE TOTAL EFFECT OF THE

THERAPY

1. Total cure - 100%

2. Marked improvement- Relief above

3. Moderate improvement- 40% - 60% relief

4. Improving- less than 40%

5. Deterioration – worsening of the condition

STATISTICAL ANALYSIS:

The effect of the therapy was analyzed statistically by calculating the mean,

standard deviation, standard error, T and P values by using paired ‘t’ test, by using

sigma stat 3.1.


76

OBSERVATIONS

OBSERVATIONS

The following observations were taken during the study. Observations were made before

the treatment, during the treatment and after the treatment. In the present study 20

patients having the criteria of Sandhigata Vata are studied.

Age wise distribution:

Table No 5 Fig No: 4

40-4545-5050-5555-60

Age No of Patients % 30 - 35 0 - 35 - 40 0 - 40 - 45 2 1045 - 50 4 2050 - 55 2 1055-60 12 60

Above table shows maximum number of patients belongs to the age group of 55 to

60(60%),20% patients belongs to the age group of 45 to 50,where as 10% patients were

of 40 to 45.

Sexwise distribution: Table No 6

Sex No of patients % Male 3 15 Female 17 85

The table shows maximum patients were female ie, 17(85%)

Fig No: 5

MaleFemale


77

OBSERVATIONS

Religionwise distribution:

Table No 7 Fig No:6

Religion No of Patients

%

Hindu 16 80 Muslim 3 15

Christian 1 5

The above table shows 80% patients were Hindu,15% were muslim and remaining 5%

christian.

Literacywise distribution:


Education No of

patients %

Literate 18 80 Illiterate 2 20

The above table shows that 80% patients were literate and remaining 20% were illiterate.

Marital Status distribution:


Marital status No of patient %

Married 20 100 Unmarried 0 0

All the patients were married (100%)

Married

Un married

LiterateIlliterate

HinduMuslimChristian


78

OBSERVATIONS

Socio Economic status wised distribution:

Table No 10 Fig No:9

S.E.Status No of Patients %

Poor 1 5 Lower middle 7 35Middle 8 40Upper middle 4 20Rich 0 0

Poor

L middle

Middle

U middle

Table shows 40% patients were of middle class, 35% lower middle class,20% upper

middle class, and 5% poor.

Occupationwise distribution


Occupation No of Patients %

Sedanary 6 30

Phy.Exertion 8 40

Phy and Mental

Exertion

6 30 Sd

P E

P and M

The above table shows that maximum patients (40) were doing physical exertion and

30% were doing both physical and mental exertion, where as 30% were leading sedentary

life style.


79

OBSERVATIONS

Habitwise distribution:


A

S

T

None

Habit No of

Patients

%

Alcohol 2 10

Smoking 3 15

Tobaco 2 10

None 13 65

Table shows that 10% patients were addicted to alcohol, and tobacco.15% were addicted

to smoking, remaining were 65%.

Dietwise distribution:

Table No 13 Fig. No. 12

VegMixed

Type of diet

No of patients

%

Vegetarian 6 30 Mixed 14 70

Table shows that maximum 70% patients were mixed of mixed diet and remaining 30%

patients were vegetarian.


80

OBSERVATIONS

Desh wise distribution:

Table No 14 Fig No 13

Desh No of patients

%

Jangala 2 10 Anupa 16 80 Sadharana 2 10

Table shows that maximum80% patients were from anupa,10% patients were from jangal

and sadharan desha.

Prakriti wise distribution:


Desh No of patients

%

Vata 1 5 Pitta - 0 Kapha - 0 Vatapitta 10 50 Vatakapha 9 45 Pittakapha - 0 Sama 0 0

v ata

pitta

kapha

v p

v k

pk

J a nga l

Anupa

S d

The above table shows that 50% patients belongs to vatapitta prakritiand 45% patients

were of vatakapha and 5% were belonging to vata prakriti.


81

OBSERVATIONS

Satwataha distribution:


pravara

madyama

avara

Satwa No of patients

%

Pravara 2 10 Madyama 10 50 Avara 8 40

Table shows 50% patients were of madyama satwa and 40% patients were avara and 10%

were Pravara satwa.

Sarataha distribution:


PravaraMadyamaAvara

Sara No of patients

%


Table shows 90% patients were of madyama sara and 5% patients were of pravara and

avra sara.


82

OBSERVATIONS

Samhana distribution:


pravara

Madyama

Avara

Samhana No of patients

%


The table shows 80% patients were madyama samhanana, 5% patients were pravara

samhana and 15% patients were of avara samhanana.

Satmyataha distribution: Table No 19 Fig No 18

Pravara

Madyama

Avara

Satmya No of patients

%

Pravara 2 10 Madyama 14 70 Avara 4 20 Table shows maximum 70% patients were of madyama satmya, 20% patients were of

avara satmy and 10 patients were belonging to pravara group.

Abhyavaharana Shakti distribution: Table No 20 Fig No 19

Ahara Abhyaharanashakti

No of patients

%


Pravara

Madyama

Avara

The table shows 60% patients were of madyama abhyavaharanashakti,25% patients were

of avara and 15% patients were of pravara abhyavarana shakti.


83

OBSERVATIONS

Ahara Jarana Shakti distribution: Table No21 Fig No20

pravaraMacyamaAvara

Ahara

Jaranashakti No of

patients %

Pravara 2 10 Madyama 14 70

Avara 4 20 The table shows that 70% patients had madyama jarana shakti,20% had avara jarana

shakti and remaining 10% had pravara jarana shakti.

Nidra wise distribution: Table No 22 Fig No 21

sound

Disturbed

Nidra No of patients % Sound 5 25

Disturbed 15 75

Maximum number of patients (75%) had disturbed sleep.and remaining 25% had sound

sleep

Vyamataha distribution:


Vyayama Shakti No of patients % Pravara 0 0 Madhyama 11 55Avara 9 45

Table shows that 55% patients were of

Madhyama Vyayamashakti and 45% were of Avara Vyayamashakti.

Pravara

Madyama

Avara


84

OBSERVATIONS

Joint involvement:


Joint involvement No of patients

%

Right 3 15Left 1 5 Both 16 80

According to the observation 80% patients gave a history of pain in both the joints, while

15% patients gave the history of pain in right knee joint and 5% patients had pain in left

knee joint.

Duration of illness:


Duration of illness

No of patients

%

<1year 15 75 1-5 year 3 15 >5year 2 10

<1yr

1-5yr

>5yr

RightLeftBoth

Maximum patients gave the history of less than one year and 15% patients gave the

history of 1to 5 years, remaining 20% gave the history of more than 5years.


85

RESULTS

RESULTS 1. Pain on walking: Table No 26 No pts

MeanBT MnAT2 MnAT Paired t-Test %

D Sd t p 20 1.400 + 0.112

0.625 +0.095

0.600 + 0.112 0.800 0.410 8.718 <0.001

57.142

The mean score observed in the symptom pain, during bed rest before the treatment

recorded as 1.400, after 14 days it reduced to 0.625, after completion of treatment it

became 0.600.

Fig No 25

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Pain on walking

BTAT2AT

2. Pain or discompfort after gettingup: Table No27 No pts

MeanBT Mn AT2 MnAT Paired t-Test %

D Sd t p 20 0.950 + 0.050

0.500 + 0.115

0.250 + 0.099 0.700 0.470 6.658 <0.001

73.684

The mean score observed before treatment was 0.950 and after treatment which was

reduced to 0.250 after treatment.

Fig No 26

0

0.2

0.4

0.6

0.8

1

Discomfort

BTAT2AT


86

RESULTS

3. Morning Stiffness: Table No 28 No pts

Mean BT

Mean AT2

Mean AT

Paired t - Test %

D Sd t p 20 1.400 + 0.184

1.050 +0.153

0.250 + 0.109 0.550 0.605 4.06

7 <0.001

39.285

The mean score of morning stiffness before treatment was 1.400 which was reduced to

1.050 on 14th day and 0.250 after treatment and the P value was significant at the level of

<0.001

Fig No 27

0

0.20.40.6

0.81

1.21.4

Morning stiffness

BTAT2AT

4. Maximum distance walked: Table No 29 No pts

MnBT MnAT2 MnAT Paired t-Test %

D Sd t p 20 3.350 + 0.379

2.850 +0.335

2.600 + 0.343 o.758 o.550 6.097 <0.001

22.388

The mean score observed before the treatment was 3.350 and during treatment the value

reduced to 2.8, and after treatment the value was 2.600 Pvalue was statistically

significant

Fig No 28

0

0.51

1.52

2.5

33.5

Maximum distance walked

BTAT2AT


87

RESULTS

5. Ability to climb up a standard flight of stairs: Table No 30 No Pts MnBT Mn AT2 MnAT Paired t-Test %

D Sd t p 20 0.875 + 0.120

0.525 +0.128

0.375 + 6.080 0.500 0.487 4.595 <0.001

57.14

The above values shows significant relief and the Pvalue was significant at <0.001

Fig No 29

00.10.20.30.40.50.60.70.80.9

Ability to climb up

BTAT2AT

6. Ability to climb down a standard flight of stairs: Table No 31

No Pts MnBT Mn AT2 MnAT Paired t-Test % D Sd t p 20 0.775

+ 0.112

0.500 +0.103

0.350 + 0.0819 0.425 0.245 7.765 <0.001

54.838

The initial mean value was 0.775 which reduced to 0.350 after treatment,and the Pvalue

was significant at the level of <0.001

Fig no 30

00.10.20.30.40.50.60.70.8

Ability to climbdown

TBTAT2AT


88

RESULTS

7. Able to Squat or bend at knee: Table No 32 No pts


D Sd t p 20 1.125 + 0.080

0.775 + 0.099

0.658 + 0.094 0.475 0.262 7.877 <0.001

42.133

The patient`s ability to squat or bend at knee was improved by 0.658 after treatment and

the Pvalue was <0.001

Fig No 31

8. Swelling:

0

0.2

0.4

0.6

0.8

1

1.2

Ability to squat

BTAT2AT

Table No 33 No pts


D Sd t p 20 1.400 + 0.245

1.00 +0.178

0.850 + 0.182 0.550 0.605 4.067 <0.001

39.285

The swelling in the joint was 1.400 and reduced to 1.00 ON 14th day.Further

improvement was noticed after full course of the treatment i.e., 0.850

Fig No: 32

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Swelling

BTAT2AT


89

RESULTS

9. Tenderness: Table No 34 No pts


D Sd t p 20 1.850 + 0.150

1.050 + 0.198

0.800 + 0.138 1.050 0.605 7.764 <0.001

56.756

There was decline in the tenderness after the treatment and the P value was significant at

the level of <0.001

Fig No: 33

0

0.5

1

1.5

2

Tenderness

BTAT2AT

10. Crepitus Table 35 No pts


D Sd t p 20 0.950 + 0.050

0.950 + 0.05

0.950 + 0.05 0 0 0 1.00

0

There was no any noticeable change in the crepitus after the treatment as Fig No 34

0

0.2

0.4

0.6

0.8

1

Crepitus

BTAT2AT


90

DISCUSSION

DISCUSSION

Sandhigata vata is one among the vata vyadhi,affecting the sandhi.It compells

the patients to lead unproductive life due to physical disability and the disease is

known since vedicperiod.

Sandhi gata vata is caused by morbid vata dosh sometimes kaph dosha may

also be involvedPain is the clinical hallmark of the disease.The morbid vata dosh does

shoshana of shleshaka kaph situated in sandhies.and it is more evident in asthi dhatu

as asthi and vata are having aashraya ashrayi sambandha.It clinically presents as

shoth,shoola,stabdata and sandhi sputana.

In modern parlanceit can be compared with degenerative disease of joints

ie,Osteo arthritis. Osteoarthritis is common among musculoskeletal disorders and is

important cause of disability.It is the second commonest musculoskeletal problem in

the world (30%) after back ache(50%).

Line of treatment of all the vatavyadhies is mentioned as Snehana, swedana,

mrudu shodana and shamana. In shamana vatahara drugs can be prescribed.

Vatari rasa an herbomineral preparation contening mainly vatahara drugs was

selected for the study in the dose of 1gm tid .

CLINICAL STUDY:-

Total 20 patients Sandhigata vata were selected for the study and vatari

rasa in the dose of 1gm tid was administered with lukewarm water for 30 days.

The details are as follows:

• Total patients registered in the study - 20

• Patients who received Vatari rasa - 20

• Completed - 20

• Dropout - 00

OBSERVATIONS:-

AGE: - Maximum number of patients in the study was reported from the age

group of 51-60 yrs (70%). This was followed by 41-50 30%. From above data

we can conclude that the disease is more prevalent between 50 to 60 years.

SEX: Osteoarthrits is more common in women than in men,becoz the study

reavels that maximum number of patients belongs to female sex(85%) and

male were only 15%.


91

DISCUSSION

RELIGION: Maximum number of patients (80%) belongs to Hindu

community. This shows the geographical predominance of Hindus in this area

but it is not having any relation with the disease Sandhigata vata.

EDUCATION: Maximum number of patients was registered as literate (80%).

However there is no relation between pattern of education with sandhi gata

vata.

MARTIAL STATUS: -

All the patients registered in this study were married. The lower limit of age

was 40 yrs and most number of people get married by this age. However it is not

possible to draw a definite conclusion that married persons are more prone to get

sandhi gata vata.

SOCIO_ECONOMIC STATUS:

Maximum numbers of patients were from middle class i.e. 40%. 35% were

from lower middle class and 20% were from upper middle class only 5% were poor.

However nature of work in maximum number of patients was working for long hours

in standing position, walking long distance, which exerts stress on joint. Hence it may

be thought that the condition which forced certain class to do standing, walking long

distance etc. work may be causative factor.

OCCUPATION

Occupation of specific types may affect the individual in this disease. Physical

exertion (40%), physical and mental exertion (30%) are more seen in this study. This

is corresponding to the etiology of sandhi gata vata.

HABIT: Minimum number of patients had addiction of alcohol(10%)

smoking(15%), and tobacco chewing (10%), whereas 65% had no addictions.

This has no relevance from the point of study.

DIET:-

Maximum numbers of patients were consuming mixed diet(70%). But no

definite conclusion may be drawn in this sample size on the nature of diet in relation

to this disease.

DESHA: -

Maximum numbers of patients (80%) were belonging to anoopa desha, as udupi

is considered as anoopa desha; naturally patients belonging to such group are

common. But no definite conclusion can be drawn with this specific study.

PRAKRITI:


92

DISCUSSION

Maximum number of patients belonged to samsargaja type of prakruti. 5%

patients were having eka doshaja.Maximum of 50% of patients belonged to vata-

kapha prakruti, while 45% of the patients belonged to vata-pitta prakruti. This

observation supports occurrence of vataja disorders like sandhi gata vata in persons

having vata prakruti and other dosha where vata is also involved.But as the sample is

too small it can not be predicted.

AMOUNT OF VYAYAMA SHAKTI:

The study showed that 55% of patients had madhya vyayama shakti and 45%

of patients were having avara vyayama shakti.

NIDRA:

Maximum number of patients (75%) had disturbed sleep, while 25% had

sound sleep. It is quite evident that the character of pain in this disease disturbs the

sleep which in turn again causes vata prakopa.

SATWA, SAARA AND SAMHANANA: -

Analysis of satwa revealed that 70% of patients beloning to madhyama satwa.

The analysis of saara revealed that 90% of patients had madhyama saara. Madhyama

samhanana was recorded in 80% of patients. Analysis of ahara- abhyavaharana shakti

revealed 60% of patients having madhyama abhyavaharana shakti and 20% having

madyam jarana shakti.

SYMPTOMOLOGY:

Sandhi shoola observed in 100% patients.Sandhi sphutan observed in 96%

patients.where as shota and stabdta observed only 64% of patients.

EFFECTS OF TREATMENT

The assessment of results was made by adopting the standard methods of

scoring questionnaires and the signs and symptoms of sandhigata vata. It included the

assessment of pain, swelling, tenderness, Crepitus and functional disability.

EFFECT ON PAIN OR DISCOMFORT

The mean score observed in the symptom of pain, pain during bed rest before

the treatment was recorded as 0.950, it was 0.250 after treatment. The mean value in

pain on walking before treatment was 1.400 and after treatment it was reduced to

0.600.which is statistically significant P=<0.001


93

DISCUSSION

EFFECT ON MAXIMUM DISTANCE WALKED The mean value before

the treatment 3.350 and reduced to 2.600 after the treatment and. Which is statistically

highly significant (P< 0.001).

EFFECT IN ACTIVITIES OF DAILY LIVING

The mean score of climbing the stairs up before treatment it was 0.875 and

reduced to 0.375 after treatment .This is statistically highly significant (P< 0.001).

EFFECT ON SWELLING

The mean score observed in swelling, before the treatment was 1.400 and

reduced to 0.850 after the treatment. This is statistically highly significant (P< 0.001).

EFFECT ON TENDERNESS

The mean value of tenderness was 1.850 before treatment which reduced

to 0.800. This is statistically highly significant (P< 0.001).

EFFECT ON CREPITUS

Mean score of Crepitus before and after treatment was 0.950 and which is.

P=1.00 which is statistically insignificant.


94

CONCLUSION

CONCLUSION

Overall Effect of the treatment:

• Highly significant result in reduction of the Pain.

• Significant result in reduction of the swelling

• Tenderness is reduced significant.

• However improvement in crepitus parameter is not significant.

• Marked improvement was seen in one patient

• Moderate improvement was observed in 11 patients

• Remaining 8 patients are improving

100%60%>40-60%40%<


95

SUMMARY

SUMMARY

The dissertation entitled “CLINICAL STUDY ON THE EFFECT OF

VATARI RASA IN THE MANAGEMENT OF SANDHIGATA VATA” the

present work is elaborated in 4 parts viz Conceptual study, Clinical study, Discussion

and Conclusion

In Conceptual part

description of Sandhigata vata, Vyutpatti, Nirukti, Historical Review are elaborated.

Description of Vatari rasa,its composition and mode of action are explained in drug

review.

In Clinical study, the materials and methods including the selection of the

patients for the study, plan of the study and assessment criteria of results are

explained. The results explained were analyzed by statistical methods and are

presented in the chapter Observations and Results.

In the present sample taken for the study the patients belonged to the age group of

30 - 60 years. Maximum number of patients belonged to the age group of 51-60(70%)

years. Majority of the patients were females in the study i.e. 85%. Majority of the

patients recorded were Hindus. Maximum 80% patients are literate. Most of the males

in the study were physical exertion. About the socio-economic status of patients,

maximum numbers of patients were of middle 40% class. 35% patients had habit of

Smoking, tobacco and alcoholism in the study. Maximum number of patients had

mixed variety of Dietary habits, As this study shows 70% of patients had the habit of

mixed diet. Majority of patients studied in this group i.e. 50% showed Vāta-Kapha

Prakruti. Data showed maximum patients were belonging to Anoopa desha.

Madhyama Samhanana was recorded in 80% of the patients. Madhyama Satwa was

observed in 50% of Patients and 90 patients were of madyama sara. Maximum 60%


96

SUMMARY

patients were of Madhyama Abhyavaharana and 70% Avara Jarana Sakti. Data

showed that 75% people were having disturbed sleep. Maximum 55% patients do

madayama Vyayama. Patients gave a history of pain in both knee joints i.e. 80%.

Maximum patients gave a history of less than 1 years duration of illness i.e. 75%. All

the patients in this study complained of shoola in the region of Janu, where as shotha

and observed only 96% of patients stabdata in 64% patients. 96% of patients

complained of sphutana on examination.

• The severity of Pain was markedly decreased and the results were

Statistically highly significant (P = <0.001).

• The mean score of severity of Swelling showed a better reduction.

Further, the reduction in the mean Swelling score was statistically

highly significant as assessed by the paired ‘t’ test, P= <0.001.-

• Better response was observed in the Tenderness: after the treatment

which is Statistically significant (P<=0.001)

• There was significant relief in pain on walking,score was stastically

significant (P= <0.001)

• There was no change in crepitus, P = 1.00

• There was no any noticeable change in range of movement.P = 0.044


97

Annexure

S D M College Of Ayurveda & Hospital, Udupi Dept of P G Studies in Kaya Chikitsa

--------------------------------------------------------------PROFORMA FOR THE CLINICAL STUDY ON THE EFFECT OF

VATARI RASA IN THE MANAGEMENT OF SANDHIGATA VATA

Guide : Dr. JONAH S. M. D(Ayu) Scholar : Dr. SHOBHA R. ITNAL _____________________________________________________________________ Name Serial No.: Date: Age: OPD/IPD: Bed No. Sex: Female/Male DOA: DOD: Religion: H M Ch Others Education: ILL P M HS GR PG Intervention: Marital Status: M UM W D Post Address: Social Status: VP P LM M UM R Desha: Jn /An/ Sad Occupation: Sd/ Phy Exertion/ Phy & Ment Exertion

Main complaints :

Rt Joint Lt Joint Duration Sandhi Shoola Sandhi Shotha Stabdahata Sandhi Sphutana Associated Symptoms:(Sarvadaihika): Krishatwa Bala Bhramsha Ushna kamitwa Nidra Bhramsha Kampa Pralaapa Anaha Deenata


Annexure History of present illness 1. Shoola : Onset: Sudden / Gradual Course: Progressive / Intermittent / Continuous Character: Dull aching / Deep pain / Pricking / Shooting / Excruciating Aggravating Factor : Diurnal: M/ A/ E/ N Seasonal: S / V / U Movement: Squatting / Walking / Climbing stairs Releiving Factor: Diurnal - M / A / E / N Seasonal - S / V / U Rest - Yes / No 2. Shotha : Onset: Sudden / Gradual Course : Progressive / Intermittent / Continuous Character: Pidithe unnamati / Pidithe Na uunnamati Site: Anterior / Posterior Colour: Aruna / Syama / Swetha Aggravation: M / A / E / N Relieves: M / A / E / N 3. Stabdhata: Onset: Sudden / Gradual Course: Progressive / Intermittent / Continuous Aggravation: M / A / E / N Relieves: M / A / E / N Relation with movement: Increases / Decreases Relation with rest : Increases / Decreases 4. Atopa : Palpable / Audible / Fine Coarse


Annexure Poorva Vyadhi Vrittaanta: Kula Vrittaanta: Chikitsa Vrittaanta: Artava Vrittaanta: M.C: Regular / Irregular Menarche: Menopause: Prasooti Vrittaanta : G / P / A / D / L Vayaktika Vrittaanta: Habits Duration/continued Occasional

/Regular Stopped/reduced Relationship

to Symptom Smoking Alcohol Tobacco Snuff Others Ahara : a) Quantity: Alpa / Pramitha / Sama / Atipramana b) Dominant rasa: M / A / L / KA / T / K c) Guna: Ruksha / Snigdha / Usna / Sita / Guru / Laghu d) Dietic habit: Samashana/Vishamasana /Adhyasana/ Anasana e) Type: Veg / Mixed


Annexure Nature of work: Manual / Sedentary / Labour/ Travelling / Walking /Standing / Sitting / Day / Night Vishrama: Hours /.Proper / Less / Excessive Vyayama: No / Less / Proper / Excessive / Regular / Irregular Nidra: Sound / Disturbed /Ratri jagarana / hrs Mutra Pravrutti: Frequency / Colour / Quantity / Discomfort Mala Pravrutti: Frequency / Colour / Quantity / Discomfort General Examination: 1. Built: Well / Moderate / Poor 2. Nourishment Well / Moderate / Poor 3. Height …………cms 4. Weight ………….kgs 5. Temperature ………….F 6. Pulse …………./min R / Irre / RIR / Full / Bounding / Feeble 7. Blood pressure …………/mm of Hg 8. Respiratory rate ……..…/min 9. Lymphnodes Palpable / Non palpable 10. Pallor Present / Absent 11. Nails Cynosis:Present / Absent Clubbing:Present / Absent Dashavidha Pareeksha: Prakrititah: V / P / K / VP / VK / VP / VPK Vaya: Bala / Madhya / Vriddha Samhanana: P / M / A Satwa: P / M / A Pramana: P / M / A Satmya: P / M / A Ahara shakti: a)Abhyavarana: P / M / A b)Jarana: P / M / A Sara: P / M / A Vyayama Shakti: P / M / A Vikrititah:


Annexure Sroto Praeeksha: 1. Pranavaha: Prakrita / Vaikrita 2. Udakavaha: Prakrita / Vaikrita 3. Annavaha: Prakrita / Vaikrita 4. Rasavaha: Prakrita / Vaikrita 5. Raktavaha: Prakrita / Vaikrita 6. Mamsavaha: Prakrita / Vaikrita 7. Medovaha: Prakrita / Vaikrita 8. Asthivaha: Prakrita / Vaikrita 9. Majjavaha: Prakrita / Vaikrita 10. Sukravaha: Prakrita / Vaikrita 11. Artavavaha: Prakrita / Vaikrita 12. Swedavaha: Prakrita / Vaikrita 13. Mutravaha: Prakrita / Vaikrita 14. Purishavaha Prakrita / Vaikrita

Systemic Examination: 1. C.V.S: 2. R.S: 3. C.N.S: 4. P/A: 5. Locomotorsystem: Examination of joint involved:

Inspection: Redness / Swelling / Deformity Palpation: Tenderness Area- Temperature: Swelling: Movement: Painful: Flexion / Extension Restricted: Flexion / Extension


Annexure Investigations:

1) X-Ray:

2) Hematological:

3) Urine: Samprapti ghataka: Nidana: Aharaja Viharaja Roopa: Dosha: Dooshya: Srotas: Udbhava sthana: Sanchara sthana: Agni: Ama: Roga marga: Sthana samshrya: Vyakta sthana: Adhishtana: Samprapti: Vyadhi vinischaya: Sadhya sadhyata: Chikitsa: Upadrava: Result


Annexure

Subjective BT AT FOLLOWUP

1. Pain on walking

2. Pain or discomfort after up from

3. Morning stiffness

4. Maximum distance walked

5. Walking aids required

6. Able to climb flight of stairs

7. Able to climb down flight of stairs

8. Able to Squat or bend at knee

9. Swelling

10. Tenderness

11. Crepitus

12. Range of movement

Sign of Guide Sign of Scholar


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