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Management of Sandhigata vata with ‘Trayodashanga Guggulu’- A clinical evaluation, Guruprasad. Aggithaya, PG Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G. ...

Management of Sandhigata vata with ‘Trayodashanga Guggulu’- A clinical evaluation, Guruprasad. Aggithaya, PG Studies in Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G. Centre, Koppa.

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Sandhivata kc004 kop Sandhivata kc004 kop Document Transcript

  • BY Dr. Guruprasad Aggithaya B.A.M.S. (R.G.U.H.S, Bangalore) Dissertation submitted toRajiv Gandhi University of Health Sciences, Karnataka, Bangalore in partial fulfillment of the requirements for the degree of “Ayurveda Vachaspati” [M.D.] in KAYACHIKITSA GUIDE Prof. Pramod Kumar Mishra M.D (Ayu) (RSU) HOD. Dept. of KayachikitsaDEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSAA.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE, KOPPA - 577126 CHIKMAGALUR DISTRICT, KARNATAKA, INDIA SEPTEMBER - 2006
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYA CHIKITSA Medical College, Koppa – 577126 Dist: Chikmagalur Declaration I here by declare that this dissertation entitled “Management of Sandhigata vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide and genuine research work carried out by me under the guidance of Prof. Pramod Kumar Mishra Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G. Centre, Koppa. Date: Dr. Guruprasad. Aggithaya Place: Koppa P.G.Scholar, Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYA CHIKITSA Medical College, Koppa – 577126 Dist: Chikmagalur Certificate This is to certify that the dissertation entitled “Management of Sandhigata vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide research work done by Dr. Guruprasad Aggithaya in partial fulfillment of the requirement for the degree of Ayurveda Vachaspati (M.D.) in Kaya Chikitsa, under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. Date: Guide: Place: Koppa Prof. Pramod Kumar Mishra M.D(Ayu) (RSU) HOD, P.G. Studies in Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126
  • Department of Post Graduate A.L.N.Rao Memorial AyurvedicStudies in KAYA CHIKITSA Medical College, Koppa – 577126 Dist: Chikmagalur Endorsement This is to certify that the dissertation entitled “Management of Sandhigata vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide research work done by Dr. Guruprasad Aggithaya under the guidance of Prof. Pramod Kumar Mishra, Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P.G. Centre, Koppa. Date: Dr. Tarani Kanta Mohanta M.D.Ph.D (Ayu)(Jamnagar) Place: Koppa Dean, A.L.N.Rao Memorial Ayurvedic Medical College, Koppa –577126, Dist: Chikmagalur
  • COPYRIGHT I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation in print or electronic format for academic/research purpose. Dr. Guruprasad AggithayaDate: P.G.Scholar,Place: Koppa Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126© Rajiv Gandhi University of Health Sciences, Karnataka
  • INDEX INDEX Page No. INTRODUCTION 1-3Chapter – I OBJECTIVES 4Chapter – II REVIEW OF LITERATURE 5-46 DISEASE REVIEW Historical Review 5-8 Etymiology 8-10 Anatomical aspect of Sandhi 10-15 Nidana 16-23 Poorvarupa 24 Rupa 25-28 Upasaya-Anupasaya 28 Samprapti 29-31 Upadrava 32 Sadhya asadhyata 32 Chikitsa 33-37 Pathya Apathya 38-39 Differencial diagnosis 40 Modern perspective of the disease 41-46 DRUG REVIEW Trial drug 47-56 Standard drug 57-61Chapter –III METHODOLOGY 62-82Chapter –IV RESULTS 83-90Chapter –V DISCUSSION 91-103Chapter –V CONCLUSION 104 SUMMARY 105-106 REFERENCES BIBLIOGRAPHY ANNEXURE
  • ABBREVIATIONS ABBREVIATIONS1. A.F.U - After follow up.2. A.H. - Astanga Hrudaya3. A.K - Amara kosha4. A.P. - Agni Purana5. A.S. - Astanga Sangraha6. A.T - After treatment.7. A.V. - Atharva Veda8. B. P. - Bhava Prakasha9. B.R. - Bhaishajya Ratnavali10. B.Su. - Brahmana sutra11. Bas.Raj. - Basavarajeeyam12. Bh.Sa. - Bhela Samhita13. C.D. - Cakradatta14. Ch - Charaka Samhita15. Chi. - Chiktsa sthana16. Ct. - Chandogyopanisat17. J.L.N - Illustrated text book of Dravyaguna Vol-2 by J.L.N. Shasthry.18. K.S. - Kasyapa samhita19. Khi - Khila sthana20. Ks. - Kausika sutra21. Kt. - Kenopanisat22. M.B - Mahabharatha23. M.K. - Madhyama khanda
  • ABBREVIATIONS24. M.N. - Madhava nidana25. Ni. - Nidana sthana26. P.K. - Purva khanda27. P.Su. - Panini sutra28. Pr. - Prakarana29. Pr.K. - Prathama Khanda30. Pu. - Purana31. R. - Ramayana.32. S.K.D. - Sabda Kalpa druma33. Sha. - Sarira sthana34. Si. - Siddhi sthana35. Su. - Susrutha samhita36. Su. - Suthrasthana.37. Thr. - Thritheeya sthana38. U.K. - Uttara khanda39. Vi. - Vimanasthana40. Y.R. - Yogaratnakara
  • Introduction
  • Objectives
  • Review of literature
  • Methodology
  • Results
  • Discussion
  • Conclusion
  • Summary
  • References
  • Bibliography
  • Annexure
  • CONTENTS LIST OF TABLESNo SUBJECT Pg No1. Types of Sandhis 102. Rasa visheshatha nidana of Sandhigatavata 173. Guna visheshatha nidana of Sandhigatavata 184 Veerya visheshatha nidana of Sandhigatavata 185 Time and forms of Ahara 186. Types of Ahara 197. Vihara nidana of Sandhigatavata 20-218. Manasika nidana of Sandhigatavata 21-229. Kala nidana of Sandhigatavata 2210. Roopa of Sandhigatavata according to various acharyas 2512. Chikitsa sutra of Sandhigatavata according to various acharyas 3313. Pathya for sandhigata vata. 3814 Apathya for Sandhigata vata 3915 Age wise distribution of 40 patients of Sandhigatavata 4016 Sex wise distribution of 40 patients of Sandhigatavata 6717 Religion wise distribution of 40 patients of Sandhigatavata 6818 Marital status wise distribution of 40 patients of Sandhigatavata 6819 Economic status of 40 patients of Sandhigatavata 6920 Occupational incidence of 40 patients of Sandhigatavata 6921 Nature of work in 40 patients of Sandhigatavata 7022 Habitate wise incidence of 40 patients of Sandhigatavata 7023 Main symptoms in 40 patients of Sandhigatavata 7124 Duration of illness in 40 patients of Sandhigatavata 72 Family history of disease of muscular skeletal system in 40 7225 patients of Sandhigatavata26 Dietary habits in 40 patients of Sandhigatavata 7327 Ahara Pramana in 40 patients of Sandhigatavata 7428 Dominant rasa in 40 patients of Sandhigatavata 7429 Dominant ahara guna in 40 patients of Sandhigatavata 7530 Nidra incidence in 40 patients of Sandhigatavata 7631 Pramana of vyayama in 40 patients of Sandhigatavata 76
  • CONTENTS32 Prakruti in 40 patients of Sandhigatavata 7733 Distribution of 40 patients of Sandhigatavata according to Sara 7734 Distribution of 40 patients of Sandhigatavata according to Satwa 7835 Samhanana.in 40 patients of Sandhigatavata 7936 Satmya in 40 patients of Sandhigatavata 7937 Abhyavaharana shakti in 40 patients of Sandhigatavata 8038 Jarana sakthi in 40 patients of Sandhigatavata 8039 Vyayama sakthi in 40 patients of Sandhigatavata 8140 Weight incidence in 40 patients of Sandhigatavata 82 Effect of trial drug on patients of Sandhigatavata after 60 days of 8341 treatment. Effect of Trial drug on patients of Sandhigatavata after 60 days of 8342 follow up. Effect of Standard drug on patients of Sandhigatavata after 60 8443 days of treatment44. Effect of Standard drug on patients of Sandhigatavata after 60 84 days of follow up.45. Comparative effect of therapies in the management of main 85 symptoms on 40 patients after 60 days of treatment46 Comparative effect of therapies in the management of main 86 symptoms on 40 patients after 60 days of follow up47. Overall effect of therapy by Trial drug after 60 days of treatment 8748. Overall effect of therapy by Trial drug after 60 days of follow up. 8749 Overall effect of therapy by Standard drug after treatment 8850. Overall effect of therapy by Standard drug after follow up. 8851. Inter-group comparison after 60 days of treatment 9952. Inter-group comparison after 60 days of follow up 100
  • CONTENTS LIST OF FIGURESNo. Pg No.1. Age wise distribution of 40 patients of Sandhigatavata 672. Sex wise distribution of 40 patients of Sandhigatavata 683. Religion wise distribution of 40 patients of Sandhigatavata 684. Marital status wise distribution of 40 patients of Sandhigatavata 695. Economic status of 40 patients of Sandhigatavata 696. Occupational incidence of 40 patients of Sandhigatavata 707. Nature of work of 40 patients of Sandhigatavata 718. Habitat wise distribution of 40 patients of Sandhigatavata 719. Symptomatology in 40 patients of Sandhigatavata 7210. Duration of illness in 40 patients of Sandhigatavata 7311. Family history of disease in 40 patients of Sandhigatavata. 7312. Dietary habit in 40 patients of Sandhigatavata 7413. Ahara pramana in 40 patients of Sandhigata vata 7414. Dominant rasa in 40 patients of Sandhigatavata 7515. Dominant ahara guna in 40 patients of Sandhigatavata 7616. Nidra incidence in 40 patients of Sandhigatavata 7617. Pramana of vyayama in 40 patients of Sandhigatavata 7718. Prakruti in 40 patients of Sandhigatavata 7819. Distribution in 40 patients of Sandhigatavata according to sara. 7820. Distribution in 40 patients of Sandhigatavata according to Satwa 7921. Distribution in 40 patients of Sandhigatavata according to Samhanana 7922. Distribution in 40 patients of Sandhigatavata according to satmya 8023. Abhyavaharana shakti in 40 patients of Sandhigatavata 8124. Jarana sakthi in 40 patients of Sandhigatavata 8125. Vyayama sakthi in 40 patients of Sandhigatavata 8226. Weight incidence in 40 patients of Sandhigatavata 82
  • CONTENTS27. Comparative effect of therapies in the management of main 85 symptoms on 40 patients after 60 days of treatment28. Comparative effect of therapies in the management of main 86 symptoms on 40 patients after 60 days of follow up29. Comparative effect of overall therapies on patients after 60 days of 89 treatment30. Comparative effect of overall therapies on patients after 60 days of 90 follow up LIST OF CHARTSNo. Pg No. 1. Chart showing etiopathogenesis of Sandhigatavata 31
  • ACKNOWLEDGEMENT ACKNOWLEDGEMENTI am obliged to my beloved parents B.Balakrishna Aggithaya and Shantha.B.Aggithaya for theirconstant efforts, encouragements and inspirations through out the work.On the completion of this thesis work, I extend my sincere gratitude to my revered GuideProf.Pramod Kumar Mishra, M.D(Ayu),(RSU), who was the vital and kinetic force of this thesis;with out his initiation this piece of work would not have been accomplished in stipulated time.I am grateful to Sri. Aroor Ramesh Rao, President, A.L.N. Rao Memorial Ayurvedic MedicalCollege, Koppa for giving me an opportunity to do my post-graduate studies.I express my gratitude to the Dean of our college Prof.T.K.Mohanta M.D,Ph.D. PG Dept. ofKaya chikitsa for his unflinching support during this course of study.My immense thanks to Dr. Sanjaya K. S, M.D (Ayu), Principal, A.L.N Rao Memorial AyurvedicMedical College, Koppa, for his help and support in completing this work.I owe my sincere regards and boundless gratitude to Dr. Rashmi Rekha Mishra M.D (Ayu) andDr. C, B. Singh for their constant encouragement and valuable suggestions.I remain grateful forever to Dr.Shyamalan PhD and my senior Dr.Christy J.T for their completeguidance in the statistical work.I am obliged to the respected teachers of Dept. of Rasa shastra and Bhaishajya kalpana; Dr. D.KMishra, M.D (Ayu) Dr. Galib M.D (Ayu), Dr. Harikrishna M.D (Ayu).for their guidance forpreparing the medicine..My earnest gratitude to the respected teachers of the faculty of Dravya guna; Dr. JagadeehKunjal M.D. (Ayu), Dr. Sreedhar, M.D (Ayu) for their extensive help in the study along withDr.H.R Pradeep, M.D (Ayu).I am glad to express my sincere thanks to Dr. Banamali Das, Dept. of Roganidana and Dr. RajeshKumar, M.D (Ayu) from the Dept. of Shalakya and Dr. Sahana MD (Ayu) from Dept of Shalya.
  • ACKNOWLEDGEMENTI will always treasure the guidance and support given by Dr. Rammohan, Dr. Lalitha Bhasker,Dr. Sreenivas and Dr. Abhinetri Hegde; Consultant Physicians of Ayurvedic college hospital fortheir support during various stages of my work.I will be failing in my duties if I do not express my immense gratitude to my seniors Dr. PrathibhaHullur, Dr.Prashanth B.K,Dr. Krishnakishore, Dr. Sanjeev, Dr. Suja, Dr. Kavitha, andDr.Pankaj, Dr. Purushotham K.G, Dr. Anil P Varkey, Dr. Clarence, and Dr. Leeladhar for theirsupport.I am thankful to my class-mates Naga, Abhay, HHP, Anita, Draksha, Vasu, Joshi, Kamat,Nalini for their helping hand.With immense pleasure, I extend my heart full thanks to my room-mates Ratheesh, Harvin,Susheel Shetty with out whose support this thesis work would not have been complete.My thanks to Raghuram, Daya, Ilanchezian, Binu, Sarat, Ravi, James, Partta,Viji, Chandrakala,Sachin, Sandhesh for their valuable suggestions and moral support.I also thank all my UG class-mates (1996 - 2001).My special thanks to all PG juniors, House surgeons and UG students for their constant support.I would like to express my gratitude to Miss.Amrutha, for sincere support in lab investigations.My sincere thanks to Mrs.Triveni, Miss.Manjula (Librarians), Mrs. Jyothi and other office staffsand hospital staffs for all kinds of support.I am grateful to all the patients who became a part of my study.I am heartily thankful to my sisters Gayathri and Gowri. And also to all family members whohelped me during my study.Finally, I thank all those who helped me directly or indirectly to complete this work.Date :Place : Koppa Dr. Guruprasad. A
  • ABSTRACT ABSTRACTINTRODUCTION: Disorders of the musculoskeletal system are prevalent throughout the worldaffecting all age group. Among this, important one is Sandhigata vata, whichproduces disastrous consequences like physical disability in community. Sandhigatavata can be compared to Osteoarthritis, which is one of the degenerative joint disorderand it represents failure of the disarthroidal part. The present study is done tounderstand the disease which is explained in the classics. Even though this disease isconsidered as Kashta sadhya, it can be managed when proper treatment is given inappropriate time. Here an attempt is made to find the efficacy of the drugTrayodashanga Guggulu on Sandhigata vata.OBJECTIVES:The objectives of the present study are1) To evaluate the efficacy of Trayodashanga Guggulu in Sandhigatavata.2) To study in detail about the disease Sandhigata vata covering both Ayurvedic and modern literatures.3) To assess the merits and demerits of the trial drug Trayodashanga Guggulu.4) To assess the merits and demerits of the standard drug Simhanada Guggulu.5) To compare the efficacy of the trial drug(Trayodashanga Guggulu) with the standard drug(Simhanada Guggulu)6) Study of the trial drug and standard drug covering Classical Ayurvedic literatures.
  • ABSTRACTMETHODOLOGY: Total 40 patients were selected who fulfilled the inclusion criteria wererandomly selected for the study. These persons grouped into two.ie trial and standardgroup. The Trial group patients were given Trayodashanga guggulu in the dose of 3gms twice daily after food with Ushna jala as Anupana. The duration of treatment wasfor 60 days. Follow up study was done for 60 days in every 15 days visit. The Standard drug patients were given Simhanada guggulu in the dose of 3gms twice daily after food with Ushna jala as Anupana. The duration of treatment wasfor 60 days. Follow up study was done for 60 days in every 15 days visit.INTERPRETATION AND RESULTS: At the end of 60 days of treatment schedule Trial drug (Trayodashangaguggulu) showed highly significant effect in Atopa where as moderate significant insandhi shula, Sandhi shotha and tenderness where as standard drug (Simhanadaguggulu) showed highly significant result in Sandhi shotha and moderate significantresult in other symptoms. After 60 days of follow up study, Trial drug showed highly significant resultin the Sandhi shula, Tenderness and Atopa where as Standard drug showed highlysignificant result in Sandhi shotha.CONCLUSION: • Trial drug (Trayodashanga guggulu) provided highly significant result in the Sandhigata vata by reducing Sandhi shula, Atopa, Tenderness. • Trayodashanga guggulu acts as Rasayana, Balya and also Vedana sthapana. • Standard drug has highly significant result in Sandhi shotha.
  • INTRODUCTION INTRODUCTION As one of the famous proverbial saying goes- Health is wealth, it seems thatthe concept of health has never been dealt in any medical science as realistic as inAyurveda. The signs of well being or freedom from illness are well depicted in theancient treatise. The integration of body components, compactness of muscles andother tissues, stability and pleasantness of mind and senses, good appetite, timelydigestion, undisturbed metabolism, elimination of urine and faeces, tolerance towardsaffects of hunger, thirst, heat, cold and exercise, normal sleep – wake pattern and gainof strength colour, complexion and life span put together define a healthy individual.1 The description gains more weightage even in this present modern era whenthe concept of health as described by WHO includes the state of physical and mentalwell being, appears to be influenced by the ancient theories of Ayurveda. In contrary, the pathological picture sets in when the rhythmic proceedings ofabove said mechanisms are disturbed and the individual will no longer be consideredto be healthy. This disarray of events leading to ill health will be caused by thedisturbance of the chief humoral factors governing the body that is the Tridoshas,which again is brought about by exposure to various etiological factors pertaining toAhara, Vihara and Vichara. Among the Tridoshas, Vata is given a prime importance with respect to eitherphysiological or pathological conditions. The other two doshas being inert, theirequilibrium depends on vata.2 The vayu is considered to be the chief motivating forcebehind all the activity as it has been described as the engine which runs the machineof the body3. Vayu is also chief driving force of the all the movements, which getdisturbed when vayu gets vitiated. The vayu vitiated by the etiological factors flowing Page 1
  • INTRODUCTIONin adverse routes produces diseases related to the site of localization and theirdisturbed functions. Once such disease caused due to the predominance of vayu isSandhigata vata. This is a pathological condition which manifests when the Sandhiswhich are the important seat of Kapha, are affected by Vayu. This disease is oftencompared to the degenerative disorder afflicting the joints and having world wideincidence and prevalence in plenty i.e. Osteoarthritis. The prevalence is 30% in theage group of 45-65 years and 68% for those older than 65 years. Men are more likelyto suffer below the age of 45 years and women above 55 years. Besides destroying thejoints, this disease makes the person crippled and dependent to attend his normalduties. Ayurvedic remedies have always been successful in the treatment of thisailment and its effects, especially the preparations of Guggulu. One such formulationconsisting of thirteen in valuable drugs called ‘Thrayodashanga guggulu’ has beenmentioned in Cakradatta, as directly indicated in Sandhisthita vata4. Most of theingredients are bruhmana in nature and more importantly guggulu which is said tohave vata alleviating property. This drug has been selected for trial to asses itsefficacy in reliving one from complaints of Sandhigata vata.This study highlights both conceptual and clinical aspects related to the diseaseSandhigata vata, which is divided in to following chapters- Chapter 1 - Objectives. This chapter highlights on main aims of this study. Chapter II- Review of literature It deals with the conceptual study of both Sandhigata vata and Osteoarthritis. It covers all the relevant matters related to the disease. Page 2
  • INTRODUCTION Chapter III- Methodology Details of the clinical trial of Trayodashanga guggulu and Simhanada guggulu with observations during the study are explained. Chapter IV- Results The results of the entire study have been explained with appropriate graphs for easy understanding. Chapter V- Discussion Discussions on Sandhigata vata and Osteoarthritis, discussion on clinical trial with observations and results have been described. Chapter VI- Summary and Conclusion Complete abstract of the dissertation and the conclusion are enumerated.Previous works done: 1) Kohla PR,Rasnadi guggulu ki nirmithi evam sandhigata vata mein upayukta (Dissertation), Nagpur,1990. 2) Chacha ML, Clinical study of Sandhigata vata with special effect of Parijatha guggulu (Dissertation), Ahamedabad, 1992. 3) Neetha Kumari, Evaluation of Rasnadi guggulu in treatment of Osteoarthritis (Sandhigata vata),(Dissertation), Varanasi, 1998. 4) Lal ji, Clinical study on the effect of Simhanada guggulu and Murivenna taila in the management of Osteoarthritis of Knee joint (Dissertation), Jaipur, 2002 Page 3
  • OBJECTIVES OBJECTIVESThe objectives of the present study are1) To evaluate the efficacy of Trayodashanga Guggulu in the treatment of Sandhigatavata.2) To study in detail about the disease Sandhigata vata covering both Ayurvedic and modern literatures.3) To assess the merits and demerits of the trial drug Trayodashanga Guggulu.4) To assess the merits and demerits of the control drug Simhanada Guggulu.5) To compare the efficacy of the trial drug(Trayodashanga Guggulu) with the control drug(Simhanada Guggulu)6) Study of the trial drug and control drug covering Classical Ayurvedic literatures.7) To establish an effective treatment with the trial drug for Sandhigata vata.Hypothesis:a) Null hypothesis: Trayodashanga Guggulu is not effective in the treatment of Sandhigatavata.b) Scientific hypothesis: Trayodashanga Guggulu is effective in the treatment of Sandhigatavata. Page 4
  • DISEASE REVIEW DISEASE REVIEWHISTORICAL ASPECT OF SANDHIGATA VATA: All the historical aspect related to this work is mentioned under this heading.Veda kala:• Rigveda5 In this five types of Vata is considered as Pancha prana.One of the Mantras ofRigveda described about removing the disease from each organ (hairs and joints)• Atharvaveda6 In Atharvaveda, there are references about the disease pertaining to Sandhi andSandhi vishlesa.Purana Kala:• Ramayana [Before 500B.C] 7 In this treatise, importance of Vayu in maintenance of health and life ismentioned. There is also explanation about the pathological effect caused by the Vayusuch as Pain and immobility of Joints.• Mahabharatha [4th Cent B.C-4th Cent A.D] 8 In this treatise, Vata has been given important and it is called as Panchakarma(having 5 functions) and Bhagavan.• Agnipurana: 9 In Agnipurana total number of joints in human body and treatments forSandhigata Samavata is mentioned.Upanishat kala: Elaborate description of vata is available in the Upanishats. Page 5
  • DISEASE REVIEW• Kenopanishat: 10 In this book, vayu is defined as the one that has constant movement, motionand continued efforts.• Chandogyopanishat: 11 This book has highlighted the chala property of vata and has shown its closeassociation with bodily actions and movement.Samhita kala:• Charaka samhita [1000B.C] 12 Charaka mentions Sandhigata vata roga in the chapter Vatavyadhi chikitsa.He names the disease as Sandhigata anila. He explains this disease with Dhatugataanila vikaras and not mentioned in Nanatmajavatavikara. A separate nidana or thetreatment principles are not found in the text.• Sushrutha Samhita [700-600B.C] 13 Sushruta mentions general nidana in Nidana sthana (vata vyadhi nidana) andseperate treatment principles mentioned in Chikitsa sthana(Vatavyadhi chikitsa).• Bhela Samhita [800-700B.C] 14 There is no clear description is available about Sandhigata vata. But inAshtimajjagata vata, ‘Sandhivichyuti’is explained as one of the lakshana.• Haritha Samhitha [800-700B.C] 15 Acharya Haritha explains that there are 84 Vathaja nanathmaja vikaras.Among these, 32 are Vyana vata prakopaja vikaras. He also mentions that all theDhatugata vata vikaras are due to Vyana vata prakopa and further tells about thetreatment aspect of Sandhigata vata. He also makes the mention of ‘Sandhi shotha’in Shukra gata vata. Page 6
  • DISEASE REVIEWSangraha kala:• Ashtanga Sangraha and Ashtanga Hrudaya [600A.D -1600A.D] 16 The disease is described with treatment.• Madhava Nidana [800A.D] 17 Acharya Madhavakara agrees with Acharya Charka with respect to Nidana andAcharya Sushrutha with respect to lakshanas, except for the term Atopa which he usesinstead of Shopha.• Bhavaprakasha [1400A.D] 18 Bhavamisra follows Acharya Sushruta while describing the disease and itsmanagement which he discusses in vatavyadhi chapter of Madhyama Khanda.Chakradatta [1100A.D] 19 Chakrapani Datta gives the same views as Sushruta in treatment aspects of thisdisease.• Bhaishajya ratnavali 20 The treatment aspect of this disease is mentioned.• Yogaratnakara [1600A.D] 21 He has given the same views as of Charaka and Susrutha but separate treatmentprinciples are mentioned.• Basavarajeeyam[ 1133-1183 A.D] 22 Vaidya Basavaraja explains this disease as Sandhi Vata. He gives different lakshanas of this disease but agrees on nidana mentioned by Charaka. He explains about the sandhivatari rasa. Page 7
  • DISEASE REVIEWSutra kala:Bramhana sutra: 23 This text has given importance to Vyana vata. While explaining themovements of joints it is said that vyana vata is the one, which resides in the jointsand performs all the movements.Panini sutra: 24 Panini was well aware of vata, its kopa and samana. He has mentioned theterm vatiki to denote disorders of vata.ETIMOLOGY OF SANDHIGATAVATA: The term sandhigatavata is a combination of two words i.e, 1. Sandhi 2. Gata vataSandhi: The word sandhi is formed by the combination of the sam+dha+kihi.25 In amarakosa, we get the meaning of the sandhi as slesha which means unionor combination. Sandhi is considered as union of two structures. Charaka mentions that sandhiis the samyoga sthana of the two asthis. The asthi sandhis are only considered as thesandhis and the union of pesi, snayu and siras are not considered.26 It is the moola of majjavaha srotas and also considered as one of themadhyama roga marga. There are 210 sandhis are present in our body.Concept of Gata VataGata vata is further comprised of two words, Gata and VataGata: Here the word gata denotes the state of vata. Page 8
  • DISEASE REVIEWVata Among three doshas,Vata is given importance. The word Vata originated fromthe root “Va Gati Gandhanayo” which when suffixed by ‘Ktan’, gives rise to the wordVata. There are five types of Vata, ie Prana, Udana, Samana, Vyana, Apana. Theyare having the seperate functions like, Purana, Udwahana, Viveka (rasa mootrapurisha pruthakkarana), Praspandana and Dharana.Vyana vata has been given the karma in different treatises such as - Praspandana (Sushruta)27 - Shareera chalana (Dalhana)28 - Gati, Apakshepana, Uthkshepa (Vagbhata)29 - Sandhicharitha (Dalhana)30 - Vahana (Rasa samvahana)31 - Pancha chesta.[Prasarana, Akunchana, Unnamana,Vinamana, Tiryakgamana]32 - Pancha chesta [Gati, Prasarana,Uthkshepa, Nimesha, Unmesha] 33 Although these functions said to be done by vyana vata, it can be seen in othertypes also. Praspandana karma can be seen in prana vata during swasa praswasa kriya.By the above reference we infer that any act of praspandana etc. function happen onlywith the coordinated union of all the types of vayu. To maintain the coordinated unionof vayu, Vahana is important which is performed by vyanavata. In Ayurvedic literatures, Sthitha, Militha, Gata are to be considered as synonymous words. Page 9
  • DISEASE REVIEWThe pathogenesis of Gatavata can be occurs in two ways - Margavarana janya – due to margavarana there will be srothorodha which leads to soshana of dhatus and also vitiation of vata. The vitiated vata situates the srotas which became rikta by soshana of dhatu. - Dhatu kshaya janya – the rikta dhatuvaha srotas will be filled by the vitiated vata. In gatavastha, the vitiation of vata is given importance. Here vata will beprabala state rather than in avarana. So gata vata condition shows prabala vatalakshana. In Hareeta samhita, Hareeta explains all the Dhatugata conditions areexplained under the heading of Vyana vata prakopaja vikara.34Anatomical aspect of Sandhi:There are two types of sandhi present in our body, 35 they are 1. Chestavantha – movable joints, the examples are the sandhis of Shakha, Hanu, Kati, Greeva. 2. Sthira – the remaining sandhis other than chestavantha.Another classification of sandhis36 is, No Type of Sandhi Structure Examples. 1. Kora Hinge joint anguli, manibandha, janu, kurpara, 2. Ulukhala Ball & socket joint kaksha, vankshana and dashana 3. Samudga Saddle joint Amsapeeta, Guda, Bhaga, Nithamba 4. Prathara Plain gliding joint Greeva, Prishtavamsh 5. Tunnasevani Sutures Sira, Kati, Kapala 6. Vayasatunda Condyloid joints Hanu 7. Mandala Circular joint Kanta, Hrdaya, Kloma, Nadi 8. Sankhavartha Bony labyrinth Shrotr, shrungataka Page 10
  • DISEASE REVIEWSnayu: 37 Snayu looks like a Shana (jute) and it is considered as the part of sandhi. It isthe upadhatu of medas and also moola of mamsavaha srotas. There are 900 snayus arepresent in human body. They are classified into four types they are, Prathanavathi,Vrutha, Pruthula and Sushira. Prathanavathi snayu is present in all the sandhis. Thevrutha snayus also considered as Kandara.it has the function of prasarana andakuchana of body parts. The ligaments which are present in the joints are separate which leads tostability.Sleshmadara kala: 38 This is the fourth kala, the kleda which is present in between the dhatvashayawill get paka by respective dhatwagni and kalas are produced. Sleshmadhara kala is considered as the seat for the sleshma (Shleshaka kapha)and it gives integrity to the body. Just as the application of oil to the axils produce easy movements to the wheel, the easy movement of the Sandhis is similarly brought about the lubricating effect the Shleshma dhara kala lining the Sandhis. The Synovial membrane can be compared with Shleshmadhara kala, which leads to easy movement of joints by secreting synovial fluid. Type B Synoviocytes will secrete the synovial fluid.Siras: 39 Siras are upadhatu of raktha which helps in sarana. There are four types; theyare vatavaha, pittavaha, kaphavaha and rakthavaha. Siras are mainly situated in marma and nourishing the snayu, asthi and sandhi.They are 700 in number. Page 11
  • DISEASE REVIEWPesi: 40 There are 500 pesis in our body. The sira, snayu, asthi, parva and sandhis arecovered by the pesis and get strength.Sandhimarma: 41 Marmas are the vital points of the body. They are 101 in number. According toDalhana marmas are situated in mamsa, sira, sandhi etc.42 Depending on the structural base marmas are divided into 5. They are mamsamarma, sira marma, snayu marma, asthi marma and sandhi marma. All the marmascomes under these 5 categories. There are 20 types of sandhi marmas. They are janu, kurpara, seemantha,adhipathi, gulpha, manibandha, kukundara, avartha and krukatika.43JOINTS 44Two or more bones unite to form joints.There are three types of joints explained.• Fibrous joints.• Fibro-cartilagenous joints.• Synovial joints.Fibrous and Fibro-cartilagenous joints: In this type, the fibrous or Fibro-cartilaginous tissues unite the two bones. Thisjoint will present where there is little requirement of movement.Examples: For fibrous joint: joints present in skull bone. For Fibro-cartilaginous joint: Symphisis pubis, Inter vertebral discs. Page 12
  • DISEASE REVIEWSynovial joints: This type of joints provides maximum range of movement.Eg: Most limb joints, Tempero-mandibular joint.Structures present in synovial joint are, 1. Articular cartilage. 2. Synovial fluid. 3. Intra articular disc. 4. Joint capsule and synovial membrane.Articular cartilage: In synovial joint, the articular surface is covered with a layer of articularcartilage.In normal cartilage, there are no cell divisions. But in this chondrocytes there arecontinuous process of destruction and synthesis of the cartilage matrix throughout life.Constituents: It is an avascular tissue that consists of cartilage cells [Chondrocytes], Type IIcollagen and smaller amounts of other proteins which is present in the matrix ofproteo glycans. The matrix consists of:1) Type II collagen fibers: It forms the meshwork in between the proteo glycan molecules.2) Hydrated gel of proteo glycan molecules: In this, the important one is Aggrecan. Aggrecan consists of: A] Core protein. B] Glycosaminoglycan[GAG] : It is the long chain of disaccharides. Page 13
  • DISEASE REVIEW The important GAG is Chondroitin sulphate and Keratan sulphate.3) Hyaluronan: A long GAG in which numerous aggrecan will be connected.4) Link protein: N- Terminus of aggrecan joins to the hyaluronan by small glycoprotein called Link protein.Articular cartilage has two essential functions: It provides a smooth bearing surface so that with the movement, bone glideeffortlessly over each other. Articular cartilage prevents concentration of stresses, sothe bones do not shatter when the joint is loaded. Large complexes of aggrecan andHyaluronan form the articular cartilage. Aggrecan has a strong, negative chargebecause of the sulphate and hydroxyl groups in glycosaminoglycan. And also it bindslarge number of water molecules. So it occupies the maximum possible volumeavailable. So the expansive force of charged and hydrated aggrecan and restrictiveforce of collagen gives the articular cartilage an excellent shock absorbing properties.Synovial fluid: Surfaces of articular cartilage separated by space called Synovial fluid. It isbasically ultra filtrate of plasma into which synovial cells secrete Hyaluronan andproteoglycan. It lubricates the joint.Intra articular discs: Intra articular discs are the fibro cartilagenous disc which is present within thejoint space. It is present in some joints only and acts as shock absorbers.Joint capsule: Joint capsule is a fibrous structure, richly supplied by blood vessels,lymphatics and nerves. It joins the two bones of the synovial joint. Ligaments and a Page 14
  • DISEASE REVIEWregional thickening of joint capsule stabilize the joint. Inner surface is lined bysynovial membrane.Synovial membrane: This membrane contains outer layer of blood vessels and loose connectivetissues. Inner layer consists of Type A and Type B synoviocytes. Most ofinflammatory and degenerative joint diseases associated with thickening of synovialmembrane and infiltration by lymphocytes, polymorphs and macrophages. Manyjoints contain bursae which are hollow sacs lined by synovium. Page 15
  • DISEASE REVIEW NIDANA In Ayurvedic classics, the term Nidana has been defined in two differentsenses. One of these definitions explains Nidana as that which points or indicates adisease or that which gives a complete knowledge of a disease or that which helps indiagnosing a disease.45 The other part defines Nidana as those which have a tendency to produce adisease process after inducing a chain of pathological events in the body like Doshaprakopa etc or in short, the etiological factors of the disease. The ahita ahara viharawhich vitiates the doshas and the dusta doshas which tend to vitiate the dushyas areincluded in to the category of Nidana.46 Being an important member of the Panchakas aiding in roga pareeksha,nidana not only helps in diagnosis and differential diagnosis, but also helps indetermining the prognosis of the disease. Nidana has an important role to play inChikitsa also, as the shortest route of avoiding or getting rid of the disease is said tobe Nidana parivarjana. In this context, the terminology Nidana covers the etiological factors causingthe disease entity Sandhigata vata. Sandhigata vata is one of the vata vikara. Vatavyadhi can be an effect of either of the two pathological events namely Dhatukshayaor Margavarodha. Each occurring due to different sets of nidana and so doesSandhigata vata. Since separate etiological factors have not been mentioned withrespect to Sandhi gata vata, the same nidanas which have been explained in thecontext of vata vyadhi should be considered.Notes: • vata prakopaka nidana 47 • + vata vyadhi nidana.48 Page 16
  • DISEASE REVIEWThe nidanas can be categorized into: Aharatha Viharatha Manasika KalakruthaAharatha: Ahara is an important factor responsible for the maintenance of health, as it ispancha bhoutika. Bala and ayush is gained by ahara. It is the form of nutrition to thebasic elements of the body or the shareera dhatu. Dhatu kshaya is a main cause of vataprakopa. So here the cause of dhatu kshaya is been considered keeping in view oftheir final effect on the functions of vata. Therefore different factors relating to theahara has been tabulated. A) Rasa visheshatha nidana:Table no: 2 showing Rasa visheshatha nidana: Rasa Ch Su A.S B.P M.N Y.R Ba.Raj H.S Kashaya - * * + - - - - Katu - * * + - - - - Tikta - * * + - - - - * vata prakopaka nidana. + vata vyadhi nidana. Kashaya, katu and tikta are the rasas, which vitiates vata and also leads tosnehadigunasunyatha. So this nidanas can be the cause for sandhigatavata. Page 17
  • DISEASE REVIEWB) Guna vishesatha nidana:Table no: 3 Showing Guna visheshatha nidana: Guna Ch Su A.S B.P M.N Y.R Ba.Raj H.S Ruksha + * * + + + + - Shitha + * * - + + + - Laghu + * - + + + + - Sushka - * * - - - - - * vata prakopaka nidana. + vata vyadhi nidana. The gunas like laghu, ruksha, kara etc. leads to the kshaya of the sneha guna ofthe body, which further leads to dhatukshaya and also vitiation of the vata dosha. Sothese gunas also can also cause sandhigata vata vyadhi.C) Veerya visheshatha nidana:Table no: 4 showing Veerya visheshatha nidana: Veerya Ch Su A.S B.P M.N Y.R Ba.Raj H.S Shita - * * - - - - - * vata prakopaka nidana. + vata vyadhi nidana. Sheeta veerya is the factor for the vitiation of Vata dosha. So this can beconsidered as one of the viprakrshta nidana for Sandhi gata vata.D) Time and forms of ahara:Table no: 5 showing Time and forms of Ahara: Ch Su A.S B.P M.N Y.R Ba.Raj H.S Alpa + - * - + + + - Pramitha - - * + - - - - Abhojana + * - + + + + - Virodhi - - + + - - - + Apatharpana - - - - - - - - * vata prakopaka nidana. + vata vyadhi nidana Page 18
  • DISEASE REVIEWThe forms of Ahara like Virodhi, Alpa, causes Vata vitiation thus produces Sandhigata vata.E) Type of ahara:Table no: 6 showing Type of Ahara: Nidana Ch Su A.S B.P M.N Y.R B.Raj H.S Shaka - * - - - - - - Vallura - * - - - - - - Varaka - * - - - - - - Uddalaka - * - - - - - - Koradusha - * - - - - - Syamaka - * - + - - - - Nivara - * - + - - - - Mudga - * - + - - - - Adhaki - * - + - - - - Harenu - * - - - - - - Kalaya - * * - - - - - Nishpava - * * + - - - - Vistambhi - - * - - - - - Virudaka - - * - - - - - Truna dhanya - - * - - - - - Chanaka - - * + - - - - Karira - - * - - - - - Tumba - - * - - - - - Kalinga - - * - - - - - Cirabhita - - * - - - - - Bisa - - * - - - - - Saluka - - * - - - - - Jambava - - * - - - - - Tinduka - - * - - - - - Thriputa - - - + - - - - Satheena - - - + - - - - Makusta - - - + - - - - Mangalyaka - - - + - - - - Masura - * - + - - - - * vata prakopaka nidana. + vata vyadhi nidana. Page 19
  • DISEASE REVIEW2) Viharatha nidana: Various viharas can stimulate or irritate those anatomical sites where afunction of vata (movements) is more required. Particularly the weight bearing jointswhich tend to become the target. Initially the injury may be at the molecular levelwhich further aggravates being able to involve the tissues of the sandhi generally incase of irreversible injury. Vyana vata is responsible for different chestas (movements). Here viharajanidana means the atiyoga, ayoga or mithyayoga of these chestas which leads to thevata prakopa. Viharaja nidana is also leads to abhigata of body parts (sandhi) whichalso become one of the pre disposing factors for sandhigata vata.Table no: 7 showing Viharatha nidana: Nidana Ch Su AS BP MN YR Ba.Raj HS Ati vyayama + * * + + + + + Ativyavaya + - * + + + + - (nidhwana) Langhana + * * - + + + - Prajagara + * * + + + + + Plavana + * * + + + + - (pratarana) Atiyadhva + - - - + + + + Ativicesta + - * - + + + - Dukhasayya + - - - + + + - Dukha asana + - * - + + + + (vishamasana) Diva swapna + - - - + + + - Vega + * * + + + + - sandharana Vego udeerana - - * - + + + - Abhighata + * * + + + + - Srama - - - + - - - - Page 20
  • DISEASE REVIEW Kreeda - - - - - - - + Dathu kshaya + - + + - - - - Ucha bhashana - - * - - - - - Abisangha - - - - - - - + Atiasruk + - * + - - - + sravana Ati virechana + - * + - - - + Ativamana + - * + - - - - Prana apana - - - - - - - + samana sandharana Vishamopacha + - - - + + + - ra Bharaharana - * * - - - - - Ksheena bala - - - - - - - + Atimamsa - - - + - - - - ksaya Gajaturaga + * * - + + + - yana * vata prakopaka nidana. + vata vyadhi nidana.3) Manasika karana: Mana is Ubhayendriya, which is the main part to attain Jnhanotpatti. Manas iscontrolled by Vata (Niyantha pranetha cha manasaam). Indriyas are also controlled byVata only. So manasika nidana considered as one of cause of Vata vyadhi becauseAsathmendriyartha samyoga is one type of nidana.Table no: 8 showing Manasika nidana: Nidana Ch Su AS BP MN YR Ba.Raj HS Chinta + - - + + + + + Soka + - * + + + + - Krodha + - - - + + + - Page 21
  • DISEASE REVIEW Bhaya + - * + + + + - Utkanta - - * - - - - - Ksheena - - - - - - - + indriya Madana - - - + - - - - kopa * vata prakopaka nidana. + vata vyadhi nidana.4) Kalaja: Kala is of two types; Nithyaga and Avasthika. Nityaga kala pertains to the kalarelated to rtus and Avastika kala is related to pathological state of doshas according tothe age of person.Table no: 9 showing Kalaja nidana: Nidana Ch Su AS BP MN YR Ba.Raj HS Payodasamaya - * * + - - - - (Varsa rtu) 3rdpart Dina- - - - + - - - - kshana Sisira - - - + - - - - Grishma - - * - + + + - Bhuktanta - * - - - - - - Pravrt - * - - - - - - Seeta kala - * - - - - - - Vrudha - * - - - - - - Usha kala - * - - - - - - Aparahna - * * - - - - - Jeerna anna - * * + - - - - Apararatri - - * - - - - - Purvavata - - * + - - - - * vata prakopaka nidana. + vata vyadhi nidana. Page 22
  • DISEASE REVIEW Influence of the time factor (kala) on the doshas has been given importance inAyurvedic classics. In general, the vata is predominant at the end of the digestion,evening or at the end of the digestion. Here old age will be main precipitating factor for production of Vatavyadhi.Although other nidanas can also cause vitiation of vata, it is considered asVyabhichari causes for Vatavydhi. In Vrudhavasta, the dhatus are in the state ofksheena, that which provides platform for the diseases. They are more prone to getSandhi gata vata. There are six rtus in which tridoshas are having its own state of kshaya orvrudhi. By considering this, vata is having sanchaya in Greeshma, prakopa in Varshaand shamana in Sharath.49 By this we can analyse that due to the rukshata inGreeshma vata gets Sanchaya, due to sheetata of Varsha gets Prakopa and ushnata ofsharat rtu does the Vata shamana. In Vata prakopaka rtus, person prone to get Sandhigata vata. The possible effect of these factors may be due to not adopting the rules ofRtu charya and the purification measures in the rtu sandhi as advocated in classics. Prakruti is also given importance while disease is considered. Vata prakrutipersons are more prone to vata vyadhi. While explaining Vata prakruti, Charaka toldthat Anavasthita sandhi(loosening of joints), because of chala guna and Sathathasandhi shabda gami( continuous crepitus in joints while walking) because ofvaishadhya guna of Vata.50 Page 23
  • DISEASE REVIEW POORVA RUPA The unclear signs and symptoms produced by the vitiated doshas during theprocess of sthana samsraya, which indicate the forth coming disease are called aspoorva rupa. This marks the beginning of amalgamation of vitiated doshas anddushyas.51 In the context of vata vyadhi, it has been said that the under manifestationof signs and symptoms or avyakta lakshanas should be regarded as poorva rupa.52 Even in case of sandhigata vata also, feebly manifested signs and symptoms ofthe disease can be considered as poorva rupa. In sandhigata vata, shoshana of shareeratakes place due to the localization of the prakupita vata, as a result of which theperson starts feeling laghuta. Lakshanas of sandhigata vata i.e shotha, shula etc arealso found in avyakta avastha. Page 24
  • DISEASE REVIEW RUPA In the disease process, the same unclear signs and symptoms of poorva rupawhen gets clearly manifested so as to indicate an existing disease will be called asrupa.53 In short the signs and symptoms of a completely manifested disease are calledas rupa or lakshanas. The same rule holds good with sandhigata vata also, where inthe symptoms of the disease like shotha, shula etc which were unclear and feebleduring the sthana samsraya gets clearly manifested defining the disease.Table no: 10 showing Roopa of Sandigata vata according to various Acharyas: Laxanas Ch54 Su55 A.S56 A.H57 B.P58 Y.R59 M.N60 Ba raj61 Sandhi Soola - + - - + + + + Sotha or sopha - + - - + + - - Vatapurna druti + - + + - - + - sparsa Hanti sandhin - + - - + + - - Prasarana + - + + - - - - akuncanayoho pravrttisavedana Atopa - - - - - - + - Shareera - - - - - - - + gandhaliptata Anga peeda - - - - - - - + Romaharsha - - - - - - - + Vilapana - - - - - - - + Page 25
  • DISEASE REVIEWThe cardinal symptoms are as follows: 1. Vata poorna druti sparsa 2. Sandhi soola 3. Sandhi sputana or Atopa 4. Prasarana Akunchana pravruthi savedana 5. Sandhi shotha or shopha 1) Hanti sandhin: In the commentary-Nibandha sangraha and Athanka darpana, they gives theexplanation that, Hanti sandheen means abhava in Prasarana akunchana etc functionsof the Sandhi.62 In Madhukosha commentary, it means complications of sandhi likeSandhi vishlesha, Sandhi sthambha etc.63 Gayadasa gives openion about Sandhivishlesha as there will be difficulty of movement without the dislocation.64 Vata is responsible for the Gati especially vyana vata leads to Pancha chesta ofthe body (Prasarana, akuncana, Unnamana, Vinamana, Tiryakgamana). Soimpairment of Vyana vata leads to difficulty in movement.2) Sandhi shula: Shula is the main symptom of the Vata vitiation. All the Acharyas mentionedthat there is no Shula without the vitiation of vata.65 Sandhi shula is the main symptom in the Sandhigata vata. In Asthi-Majjagatavata also this is the main symptom. So we can conclude that the sandhi shula isproduced due to the effect of Ashrayee dhatu kshaya (Asthi) due to the vitiation ofVata. Page 26
  • DISEASE REVIEW3) Atopa or Sandhi sputana: This specific symptom is explained by Acharya Madhava. Shabda is theindriyartha which indicates the predominance of qualities of Vata. Sandhigata vata islocalized vata vyadhi in which prakupita vayu affects Sandhi. This sthana samsraya isthe result of srotoriktata present at sandhi; that means akasa mahabhuta is increased atthe site of sandhi. The Atopa can be correlated to the crepitus in a joint. This is due to theOsteophyte formation at the time of remodeling of joint. This becomes evident onlywhen there is marked degeneration.4) Prasarana akunchana pravruthi savedana: There is a natural elasticity or contractility in the joint by virtue of which themovement in different direction can be performed. This is destroyed due to thevitiated vata, with the result the patient is not able to move his joint freely especiallyin the extension and contraction. If he tries to move, there will be severe pain. Thisphenomenon has been explained by different terminologies such as Stambha etc.5) Sandhi shotha: It is one of the main symptoms in Sandhigata vata. Sushrutha explained it asSandhi shopha because Shopha is the swelling which is Ekadesha sthitha.66 AcharyaCharaka explained as shotha. By commenting on shotha, Arunadatta explains that, the swelling look like theair filled bag.67 In Ashtanga samgraha, Vagbhata includes shopha as one of the Vyana vatavikara.68 Page 27
  • DISEASE REVIEW6) Vata purna druti sparsha: Sparsha is of two types, Ushna sparsha and Sheeta sparsha. InYogarathnakara, there is reference that the person who is suffering from Vata rogawill have Sheeta sparsha.69 In Sandhigata vata, usually the joints will be look like airfilled bag to touch and cold. Acharya Basavaraja also explained some other symptoms like ShareeraGandha lipta, Romaharsha, Vilapana which shows the chronicity of the disease. UPASAYA AND ANUPASAYA Upashaya is the temporary relief which is gained by the procedures such asOushadhi etc.It is also considered as therapeutic test to attain correct diagnosis of thedisease when it becomes difficult due to its effects in manifestation of signs andsymptoms.70 Anupasaya and Upasaya is the application of Ahara, Oushadha, Vihara,prescribed either antagonistic or similar to the nidana, to the Hetu, vyadhi or to bothHetu and Vyadhi together. It is considered as Upashaya when it decreases thesymptoms and when it aggravates the symptoms it is called Anupashaya. For example when abhyanga swedana, usna ahara etc reduce the symptoms ofSandhigatavata. In samavastha, like in Amavatha the same treatments aggravate thecondition. So it is a treatment and also a diagnostic approach. Page 28
  • DISEASE REVIEW SAMPRAPTI For the better understanding of the disease, the knowledge of Samprapti I.e theetio pathogenesis of the disease is essential. Samprapti can be defined as the process of disease from its inceptive phasetofully manifestation. This process starts from the Nidana sevana or consumption of theetiological factor causing dosha prakopa, circulates through out the body, localizationthen manifestation and differentiation.71 To the pathological point of view, dosha,dhatu, srotas is essencial in relation of Sandhigata vata. Srotas is also called as Dhatuavakasha, 72 which is formed from the Akashamahabhuta. Akasha and Vayu mahabhuta are interrelated73 and Vayu is situated in theemptiness [Riktata] created by the Akasha mahabhutha. In Samprapti, ‘Riktata of srotas’ present in the sandhi is considered as the‘Khavaigunya’, which is the platform for manifestation of disease Sandhigata vata.Chakrapani gives explanation about Riktata as ‘Thuccha’ or ‘Snehadi gunashunyata’.74 While explaining vata prakopa lakshanas, Charaka has mentioned the term“Sushirata” which may be taken as Riktata.75 In sandhigata vata, we can take the Snehadi guna shunyata in two differentconditions. As the sneha is the main guna of the shleshma, shunyata can be consideredas the Shleshma kshaya. Shleshaka kapha is present in the sandhi which is responsiblefor the integrity of joints and proper lubrication. The depletion of this leads to Riktataof srotas. Dhatus are the snehayukta dravya present in the body. As the sandhi is madeup of different dhatus, upadhatus and other essential factors, the intake of the dhatukshayakara nidana will lead to there will be dhatukshaya which is turn causes snehadi Page 29
  • DISEASE REVIEWguna shunyata[riktata]. In short, one can say that the loss of snehana of the joint isresponsible for the pathogenesis of Sandhigata vata. Vata prakopa can occur in two ways.76 1) Dhatukshayajanya and 2) Margavaranajanya (obstruction) Vagbhata77 clearly explains that Dhatukshayaja nidanas are also responsiblefor the vitiation of the vata along with the riktata. The prakupita vata situates in therikta srotas present in the sandhi thus producing the symptoms of Sandhigata vata. In margavarodhajanya condition, the other doshas such as Kapha and Pitta fillsthe Srotas present in the sandhi and does the Avarana of vata. Due to avarana, theavruta vata becomes strong and vitiated, leads to further dhatu shoshana78 thusproducing the symptoms of the Sandhigata vata. Medo roga(sthoulya) may also lead to Sandhigata vata as vata vyadhi is saidas one of the complication of the medoroga. Due to the Avarana of meda to thepathway of the vata, there will not be proper nourishment to other dhatus leading tovata vikaras.79Samprapti ghatakas:Dosha - Vatavrudhi, [Vyanavata], Kapha kshaya [sleshaka kapha].Dushya - Asthi, Snayu [sandhi avayava].Srotas - Important srotas are asthi vaha, majja vaha other less important are medovaha and mamsavaha srotas.Agni - Dhatwagni.Rogamarga - Madhyama.Udbhavasthana- Pakwashaya.Sanchara stana- Sarva deha.Vyaktasthana - Sandhi. Page 30
  • DISEASE REVIEWChart No. 1. Showing Etio-pathogenesis of Sandhigata vata: Nidana Ahara Vihara Manasika Kala Gada kruta Vata prakopa Dhatu kshaya Anya dosa prakopa Vata prasara Rikta srotas Fills in the Srotas Avarana of Vata VATA PRAKOPA Sthana samshraya in sandhi Sira- Asti Snayu Kandara Sleshma Sleshma Impared dhara sravana kala Shoshana Kshaya Vatapurnadrthi sparsha Sotha Stambha Atopa Sula Page 31
  • DISEASE REVIEW UPADRAVA Upadrava is the Complication of a disease. The Dosha which causes the maindisease is itself responsible for the upadrava. Upadrava will be manifested in three ways i.e. complications that starts alongwith the disease, complications after full manifestation of the disease andcomplications produced after cure of the disease.80 Asthi shithilata, pesi kshaya can be considered as the complication whichmanifests along with Sandhigata vata and Sandhi vishlesha will be its after effect. Complications such as deformity and immobility of joints will interfere theroutine works. SADHYASADHYATHA Sushrutha and Vagbhata have included Vata vyadhi under the Ashta mahagada, 81 because of its ashukarita and Upadrava. As the disease Sandhi gata vata is oneof the Vata vyadhi, it is difficult to cure. Charaka while explaining sadhyasadhyata, mentions that ‘Khuda vata is Kastasadhya or asadhya. Commenting on Khuda vata, Chakrapani opines that Khudavataitself is Gulphavata or Sandhi gata vata.82 Acharya Hareeta concludes that the Mamsa gata, medo gata vata is Sadhya,rest of Gata vata is Kasta sadhya or Asadhya for treatment.83 As Sandhi gata vata is the disease of Madhyama roga marga. It is consideredas Kashta sadhya. Page 32
  • DISEASE REVIEW CHIKITSA The main scopes of the Chikitsa are of two. They are promotion andpreservation of health in healthy individual, and elimination of the disease ailing andafflicted i.e. curative treatment. According to the Amarakosha chikitsa is Rukprathikriya84 where as in Vaidyaka shabda sindhu, it is defined as ‘roga nidanapratheekara’. The term rogapanayana and ruk pratikriya convey nearly the same meaningviz, measures calculated to the removal of disease and treatment of the diseaserespectively. The term roga nidana pratikriya stresses on the removal of causationfactors of the diseases. Acharya Sushruta was the first to mention the treatment principles ofSandhigatavata. Although Charaka has not mentioned about specific chikitsa, thegeneral Vatavyadhi chikitsa is taken in to consideration. Treatment principles according to different Acharyas are tabulated below:Table no: 11 showing Chikitsa sutra of Sandigata vataChikitsasutra Ch. Su.85 A.S86 A.H87 B.P88 Y.R89 B.R90 C.D91Sneha - + - + - + + +Abhyanga - - + - - - - -Upanaha - + + + - + + +Agni karma - + + + - - + +Bandhana - + + - - - + +Unmardana - + + - - + + +Sweda - - - - - + - -Raktavasecan - - + - - - - -Pradeha - - + - - - - -Samana - - - + + + + + Page 33
  • DISEASE REVIEW1) Snehana: The procedure which induces qualities like Snigdhata, Mruduta, Kledata andVishyandata in the body, following the internal and external administration of snehadravyas are called as Snehana.92 Snehana is said to be the best treatment in case of allthe diseases produced by the Vata, since it is totally antagonist to the qualities ofVata. Sneha is also said to be tridoshagna as it alleviates vata, pitta and kapha due toits Snigdhata, Shaityata and samskarasyanuvarthana (yogavahi) respectively.93According to prayoga bheda there are two types of snehana procedures, they are• Bahya sneha – in this the sneha dravyas are applied externally as done in procedures like abhyanga, avagaha, sirovasthi etc.• Abhyanthara sneha – In this the sneha is administered internally in the form of pana and basthi. In the disease Sandhigata vata, the administration of Snehana will be veryeffective since Prithwi and Ambu mahabhoota, which are mainly present in theSnehadravyas are exactly opposite to the Akasha mahabhuta predominantly prevailsin the main factor in the disease pathology i.e. Sroto riktata. There are two types of sneha94 i.e sthavara and jangama. Among these snehas,four snehas are considered as pravara and also their quality has been mentioned.Among these, ghrita is considered as best one and it is pittanila hara, rasa shukra ojohitha. Thaila is maruthaghna,balya, sthirakara and it does not increases kapha. Vasa isbest known for eradicating the maharuja which is affecting to Asthi, Sandhi, Sira,Snayu, Marma and balavan marutha which is situated in the srotas. Majja isconsidered as bala- rasa- meda- shleshma and majja vardhaka.95 Page 34
  • DISEASE REVIEW2) Abhyanga: Abhyanga is a type of snehana karma where massage is done by applying thethaila on the body.96 It is said that by abhyanga both kapha and vata will be pacified. It is alsoconsidered as balakari, and dhatu pustikara. Dalhana has given the explanationregarding the time required for the Sneha dravyas to enter deep to the dhatusfollowing Abhyanga. According to his explanation, sneha is situated in romakupa upto 300 matrakala. In 400 matrakala, it enters twacha, in 500 to rakta,in 600 matrakalato mamsa. It reaches medodhatu in 700 matra kala. The sneha reaches asthi in 800matrakala. In 900 matrakala sneha enters in to majja thus inducing snigdhata in all thedhatus. Thus it is considered as the dhatu pustikara.97 Since Sandhigata vata is a disease of Madhyama roga marga where the Asthi,majja and sandhis are involved; the penetration of sneha dravyas deep in to the dhatusduring abhyanga as said above will be of high therapeutic value. In 5th century B.C, Hippocratus wrote- “the physician must be experienced inmany things, but assurely in rubbing, because rubbing can bind a joint that is tooloose and can loosen a joint that is too rigid”.98Upanaha: The word meaning of Upanaha is bandhana.99 According to sushruta, it is oneamong 4 types of swedana karma. In this moola kalka, kanji, pista, lavana, is addedwith sneha and thick application is done over the affected part. Then that area is tiedin a cloth. In case of Pittanugata vata, kakolyadi, surasadi or eladi gana dravyas areused. In kaphanugata vata, tila atasi etc dravyas and in kevala vata, veshavara, salvanaupanaha is adviced. He is also explained that Upanaha is best for Vata.100 Acharya Caraka explains Upanaha as one of the Niragni swedana.101 Page 35
  • DISEASE REVIEW By commenting on this Chakrapani explains there are two types of Upanaha.They are Saagni and Niragni upanaha. In Saagni upanaha, tila or masha kalka aremade in to hot and kept on affected part. This is also called as the Sankara sweda. InNiragni upanaha, ushna veerya drugs are applied and tied by charma, cloth etc.102 Vagbhata explains Vachadi Upanaha in kevala vata. Acharya Sivadas sen explains the mechanism of the Upanaha as swedana. Dueto the blocking of the heat generated by the body, there will be production of thesweda in that part.Agni karma: The procedures done with the help of agni or the drugs having Agni guna iscalled as Agnikarma.103 The severe complications of Sira, Snayu, Asthi and Sandhi,caused by the vitiation of vata are cured by the Agni karma.104 In snayu- asthi and sandhi gata vata and kaphaja vikara, by usingKshaudra(sugar candy), Guda(jaggery) or Sneha, the procedure of Agnikarma shouldbe done. It is indicated in all rtus except in Sharat and Grishma.105 The importance of this procedure is, the diseases which are not cured by theother procedures like Bhesaja, Shastra, Kshara, and Rasa can be cured by using thisprocedure.106Bandhana: Bandhana leads to Samhathi. It is the procedure in which the effected part willbe tied by using Rajju etc.107 By doing Bandhana procedure, there will be strength to the joints and alsopressure to the joints will be minimized. Page 36
  • DISEASE REVIEWUnmardana: It is the procedure of massaging of effected part by Hastatala after applicationof oil. By the gentle massage there will be proper circulation to the joints.108Swedana: Swedana is of two types109 according to Agni samyoga. They are,1) Agni sweda- They are of 13 types, namely Sankara, Prastara, Nadi, Pariseka,Avagaha, Jhentaka, Ashmaghana, Karshoo, Kuti, Bhoo, Kumbhika, Koopa andHolaka.2) Niragni sweda: They are of 10 types namely, Vyayama, Ushnasadana,Gurupravarana, Kshudha, Bahupana, Bhaya, Krodha, Upanaha, Athapa, Yudha. In Ashtanga Sangraha, Vagbhata has said that swedana is the best remedy toremove the sthabdatha of the Sandhi (Sandhi sthabdathapaham).110 In case of Sandhigata vata, by doing swedana, there will be Vata nigrahanawhich results in decreasing the pathology.Raktavasechana: Acharya Vagbhata (Ashtanga samgraha) explained it as avastika chikitsa. Insira-snayu-sandhi gata vata, if the person is having Svapa(numbness), raktavasechanais indicated in alpa pramana. If the person feels angamlana with numbness,raktavasechana is contra indicated because there will be the chance of shosha.111 After raktavasechana, pradeha is applied by taila, lavana, agara dhuma. Page 37
  • DISEASE REVIEW PATHYAAPATHYA Pathya means wholesome or conducive to health. Pathya is related to Pathawhich is having different meanings. It indicates the channels of circulation which iscalled as Srotas. Chakrapani comments that Patha is the dosha and dhatus which ispresent in srotas. He also quotes that Pantha is the Swastha rakshana and also Vyadhiprashamana. So the food and activities which is performed and which is Anpayakari(notharmful) to person and also to disease is called as Pathya112 it depends on the Matra,Kala, Kriya, Bhumi,Deha, Desha and Gunanthara Pathya has been given importance that no medicine is needed if Pathya isfollowed properly andthere is no use of medicine if Pathya is not followed properly. Although specific Pathya is not mentioned for Sandhi gata vata, thewholesome food and regimens explained for Vata vyadhi is taken as Pathya.Table No: 12Pathya for Sandhi gata vata:Ahara Yogarathnaka 113 Bhaishajya rathnavali 114Sneha ---- ThailaShaka varga Patola, Kushmanda, Shigru, VarthakaShuka dhanya Godhuma, Rakta shali Godhuma, purana dhanya.vargaShimbi Masha, Kulatha Masha, KulathadhanyaMamsa Kukkuta, Tittiri, Barhi, Chataka, Jangala mamsa. ---Mathsya Shilendra, Nakra, Khudisha, Parvathe, ---varga Gargara, JhashaPhala varga Dadima, Parooshaka, Badara, Draksha ---Gavya varga Ghrutha, Dugdha, Kilaata, Dadhi --- koorchikaOushadha Lashuna, Tambula, Masthsyandika, Brihati, Vastuka,dravya Kasamarda, Dunduka, Mishi, KatakaLavana Saindhava --- Page 38
  • DISEASE REVIEWApathya for Sandhi gata vata: In Yogarathnakara and Bhaishajya rathnavali, some of unwholesome foods areexplained which is enlisted below.Table No: 13Apathya ahara Yogarathnakara 115 Bhaishajya rathnavali 116Vihara Chintha, Prajagara, Sheeta pravata Vegavidharana, Shrama, Vyavaya, Chankramana, Khatwa(sleeping in cot), Hasthyashwa yana, Dwija gharshana.Karma Chardi,Food intaken Anashana Guru, Abhishyandi.Shuka dhanya Nava dhanyaShimbi dhanya Mudga, Nivara, Shyamaka, Mudga, Sharshapa, Kuruvinda, Kalaya, Nishpava. Chanaka.Shakha varga Koshataki, Kareera. KareeraJala varga Thataka, Thatini, Pradusta Sheetambu salilaRasa Kashaya, katu, Tikta -----Other substances Kshudra, Kangu, Nimba Mrunali, Sarasi, Nimba Page 39
  • DISEASE REVIEW DIFFERENCIAL DIAGNOSIS For the accurate diagnosis of the disease, Vyavachedaka nidana (differentialdiagnosis) is important. By seeing difference in the causative factors, mode of onset,clinical features,upashaya- anupashaya, we can conclude the differential diagnosis. Sandhi gata vata is the disease pertaining to joints, other joint diseases such asVatarakta, Amavata will be considered for the differential diagnosis.Table No: 14 Symptoms Sandhigata vata Vatarakta 117 Amavata 118 Dosha Vata Thridoshaja Vata-Kaphaja Onset Gradual Gradual Sudden Progression Increase & Constant Constant Decrease Joint involvement Big Small Big Spreading [joint] - Small to Big Big to Small Swelling Articular, Extra articular, Articular & Puffy Engorged Pitting Tenderness[pain] Severe, Like Mild Severe, Burning Scorpion bite Crepitus Severe Moderate Absent Stiffness Severe Severe Moderate Skin involvement Not involved Involved Not involved Deformity Present Present Absent Function Painful, Restricted, Painful, Restricted Immobile Restricted Response to oil Marked relief Moderate relief Aggravates Page 40
  • DISEASE REVIEW OSTEOARTHRITIS119 Osteoarthritis is a degenerative disorder of the joint and it is classified as • Primary • SecondaryPrimary Osteoarthritis: Primary OA is also called ‘wear and tear’ arthritis and degenerative jointdisease. In this, due to risk factors there will be degradation of articular cartilagewhich leads to joint narrowing, remodeling of joint by forming osteophytes andeventually a non functioning, painful joint. Although OA is a non inflammatoryprocess mild inflammatory changes occur in the synovium. It is also called idiopathicOA as no predisposing factor is apparent.Secondary OA: It has known underlying cause including congenial or acquired incongruity ofjoints, trauma, crystal deposits etc. But it cannot be distinguished from primary OApathologically. Osteoarthritis is considered as the dynamic repair process of synovial joints. Itis more prevalent in aged persons and it is considered as the very common form ofarthritis.Osteo arthritis is characterised by: Loss of articular cartilage where there is maximum pressure. Formation of new bone (Osteophyte) with remodeling of joints. Most effected joints are knee and hip joint where as knee is most effected thanhip. Osteoarthritis is very common in Elbow, Glenohumeral joint and Ankle jointalso. Page 41
  • DISEASE REVIEWEffected joints:Interphallangeal jointsHeberden’s nodes: Enlargement of distal interphallangeal joints.Bouchard’s nodes: Enlargement of proximal interphallangeal joints.Erosive osteoarthritis: This is present in distal and/or proximal interphallangealjoints.Generalised osteoarthritis: Characterised by involvement of three or more joints orgroup of joints.Thumb base osteoarthritis: In this, there will be squared appearance of thumb base.Hip osteoarthritis: In this, the pain will be in inguinal area but may be referred tobuttock or proximal thigh. Flexion may be painless initially but internal rotation willhave pain. Loss of internal rotation occurs early, followed by loss of extension,adduction, and flexion due to capsular fibrosis and/or osteophytes.Knee osteoarthritis: Knee osteoarthritis will be manifested in these ways.In medial femotibial compartment: It leads to varus deformity [Bow-leg]In lateral femotibial compartment: It leads to valgus deformity [Knock-knee]In patellofemoral OA: There will be positive shrug sign.Spine osteoarthritis: This involve Apophysial joint, Intervertibral disc,and also theremay be involvement of paraspinous ligaments.Pathogenesis: For the normal functions of the joint, there should be normalcy of the jointtissues such as cartilage, bone synovium, capsule, ligament, and muscles. In the case of Primary osteoarthritis, the cause is considered as unknown. Butin case of Secondary osteoarthritis, a clear cause of Trauma or ligament rupture may Page 42
  • DISEASE REVIEWbe important. By the mechanical, metabolic, genetic, and constitutional loads theremay be damage to the parts of synovial joint and there may be need to repair. Some times due to the causes, there will be slow but efficient process ofmanifestation that lead to anatomically altered but pain free functioning joint. This iscalled as Compensated osteoarthritis. Some times due to the chronic causes or due to poor repair response, there willbe progressive tissue damage and association with more frequent symptoms and thisis called as OA patient with Joint failure.Cartilage changes: In normal cartilage, there are no cell division but in the articular cartilage,chondrocytes metabolically active the cells that are responsible for the synthesis ofcartilage matrix throughout life. Matrix degradation is done by proteolytic enzymessuch as Aggrecanase, which degrades the aggrecan, matrix proteinases[degradesmetalloproteins], Collagenase, and Stromelysin. Chondrocytes increase their production of matrix components and devide toproduce nests of metabolically active chondrocytes. So there will be maximumdegradation and also production of Aggrecan components. But there will be fall in theconcentration of the Aggrecan. The decrease in the size of hydrophilic Aggrecanmolecules increases the water concentration and swelling pressure in cartilage. Therewill be further destruction of the Type II collagen and it makes the cartilage incapableto bearing weight. By this condition of cartilage there will be fissuring of the cartilagesurface [Fibrillation], development of deep vertical clefts, localised chondrocyte deathand decreased cartilage thickness. These all changes are maximum in weight bearingpart of the joint rather than whole part. The changes in cartilage surface leads to thedeposition of Calcium pyro phosphate and Apatite crystals especially in mid and Page 43
  • DISEASE REVIEWsuperficial zones. The bone below the compromised cartilage increases its trabecularthickness. Holes (cysts) may develop. As a result there is increased pressure in bonesbecause cartilages fail in load transmitting function. So there will be production ofnew fibrocartilage in the margins of the joints which undergoes endochondralossification and forms as Osteophytes. This remodeling and cartilage thickeningslowly alter the shape and the size of the joints. The synovium also shows variouschanges in manifestation of Osteoarthritis. Osteochondral bodies commonly occur insynovium. The Joint capsule also thickens and contracts, usually retaining the stabilityof remodeling joint. The skeletal muscle which gives the strength to joint will showssome fibre atrophy.Clinical features:1. Joint pain: Joint pain is mainly related to the movement, weight bearing and it is relievedby the rest. Here usually only one or a few joints are painful. The causes for joint pain in osteoarthritis patients are, Source Mechanism 1. Synovium Inflammation. 2. Sub chondral bone Medullary hypertension,Micro fractures 3. Osteophyte stretching of periosteal nerve endings. 4. Ligaments Stretch. 5. Capsule Inflammation, Distention. 6. Muscle Spasm.2. Restricted movement: Restricted movement is due to Capsular thickening and also by the blocking ofOsteophytes. Page 44
  • DISEASE REVIEW3. Crepitus: Crepitus will be palpable or sometimes audible due to the rough articularsurfaces.4. Bony swelling: Bony swelling is seen around joint margins due to the presence of osteophytes.5. Joint tenderness: Tenderness is present in joint line or periarticular surfaces.6. Joint instability.7. Wasting of muscles.8. No or only mild synovitis.Radiographic findings of Osteoarthritis: The main use of a Radiograph is to assess the severity of structural changes inthe joints. • Focal narrowing of the joint space without evidence of destruction of margins. • Formations of osteophytes at the margins of articular surface osteophytes are osseous outgrowths of cortical and cancellous bone, which blends with normal bone beneath it. • Sub chondral sclerosis. • Cyst like lesions are seen. • Osteo chondral (loose) bodies are sometimes seen. • Deformities of joints are seen. • Chondrocalcinosis may be an additional feature particularly in Knee OA Page 45
  • DISEASE REVIEWTreatment: There is no specific treatment for OA. Treatment is mainly advised forreducing the pain, minimise the disability and also to reduce structural abnormalities.The following steps are considered as the management of Osteoarthritis.For reducing the Pain: Uses of NSAIDs are advised. Non Steroidal Anti-inflammatory drugs aremedications which, as well as having pain relieving (analgesic) effects, have the effectof reducing inflammation when used over a period of time.Full explanation about Osteoarthritis:• This is to avoid risk factors such as Trauma, Obesity etc.• Advice about appropriate exercise:• This should cover both strengthening and aerobics, to strengthening of joints.• Total joint replacement is required for the minority of people with large joint Osteoarthritis. Page 46
  • DRUG REVIEW DRUG REVIEW This study contains two sub headings; Compound drug study and Individualdrug study. The trial drug Thrayodashanga guggulu and control drug Simhanadaguggulu explained under this heading.THRAYODASHANGA GUGGULU: Reference - Chakradatta Chapter - Vatavyadhi [chapter no.22]1) Compound drug study: Ingredients Abha, Ashwagandha, Hapusha, Guduchi, Shatavari, Gokshura, 250 Grams each [1 part each] Vrudhadaru, Rasna, Shathahwa, Shati, Yavani, Nagara, Shudda Guggulu 3 kilo grams [12 parts] Ghrita 1.5 kilo grams [6 parts] Method of preparation: All the ingredients from Bakula to Nagara was taken separately and poundedwell. Then the powder was passed through a sieve to get the filtered form. Shuddaguggulu was taken, pounded well along with Goghritha, and also the filtered powdersshould be added. After the proper pounding and mixing, the tablet is rolled of 1 gmeach. The tablets are properly dried in sunlight and stored. Dose : 6 gms. Anupana : Sura, Yusha, Madya, Ushna jala, Ksheera,Mamsa rasa. Page 47
  • DRUG REVIEW Individual drug study: 1) ABHA:120 Botanical name : Acacia Arabica willd. Sanskrit names :Yugalaksha, Bakula Hindi names :Babbula, Kikara Kannada names Karijali, ShamerukaChemical Composition: Bark and legumes contain TanninProperties: Rasa - Kashaya Guna - Guru, Ruksha Veerya - Sheeta Vipaka - Madhura Dosha - Kapha-pitta shamaka Karma - Grahi, Kaphahara, VishagnaTherapeutic uses: Kusta, Krimigna, Kasa, AtisaraPart used: Stem bark 2) ASHWAGANDHA:121 Botanical name Withania somnifera, Dunal Sanskrit names: Vajigandha, Vatagni Hindi name: Asagandha Kannada names: Hiremaddina gida, Angara beru.Chemical composition: In roots, there is Hallucinogen called somniferin and alsosucrose gum, resin, pigment dyes along with alkaloids and withanolides. Page 48
  • DRUG REVIEWProperties: Rasa - Madhura, Kashaya, Tiktha Guna - Laghu, Snigdha Vipaka- Madhura Veerya- Ushna Dosha - Kapha vata shamaka Karma - Balya, Rasayana, VijikarnaTherapeutic uses: Kshaya, Dourbalya, Vataroga, Shotha, Klaibya.Part used: Roots3) HAPUSHA: 122 Botanical name: Juniperus communis Sanskrit names: Vapusha, Vishagni Hindi names : Havuber, Havubair Kannada names: PadmabeejaChemical composition: It contains essential oil, flavanoids and fruits contain 50%volatile oil, oxalic acid and fructose.Properties: Rasa - Katu, Tikta, Kashaya Guna - Gum, Ruksha, Teekshna Veerya- Ushna Vipak - Katu Dosha - Kaphavata shamaka Karma - Kaphagna, Vatagna, Agnideepana, VishagnaTherapeutic uses: Pittodara, Arsha, Grahani, Gulma, Shoola, Krumi, Vatodara.Part used: Fruit Page 49
  • DRUG REVIEW4) GUDUCHI: 123 Botanical name: Tinospora cordifolia Willd Sanskrit names: Amruta, Madhuparnika Hindi names: Gurcha, Giloe Kannada name: Amrutha balliChemical composition: Alkaloids and terpenoidsProperties: Rasa - Tikta, Kashaya Guna - Laghu, Snigdha Veerya - Ushna Vipaka - Madhura Dosha - Tridoshagna and pittasaraka Karma - Balya, Deepana, Jwaragna, Raktashodhaka, Rasayana.Therapeutic uses: Kusta, Vatarakta, Jwara, Kamala, Pandu, Premeha.Part used: Bark stem5) SHATAVARI: 124 Botanical name: Asparagus racemoses Willd Sanskrit names: Shataveerya, Vrushya Hindi name: Shatavari Kannada name ShatavariChemical composition: Fresh tuber is water soluble is 52%, fiber 33% and water 9%in which 7% of sugar and some mucilaginous principle. Page 50
  • DRUG REVIEWProperties: Rasa - Madhura, Tikta Guna - Guna, Snigdha Veerya - Sheeta Vipaka - Madhura Dosha - Vata pitta shamaka Karma - Shoola-hara, Pachaka, Vata vyadhihara, DebilityTherapeutic uses: Shoola roga, Vataroga, DourbalyaPart used: Tuber6) GOKSHURA: 125 Botanical name: Tribulus terrestris Linn Sanskrit names: Trikantaka, Gokantaka Hindi name: Gokhru Kannada names: Sanne Neggilu, Neggilu – MulluChemical composition: Alkaloids, Saponins, Potassium nitrate, Sterols, Sepogenin, Diosgenin, Gitogenin, and Hecogenin.Properties: Rasa - Madhura Guna - Guru, Snigdha Veerya - Sheeta Vipaka - Madhura Dosha - Tridosha shamaka Karma - Vayugna, Mootrala, Vrushya, BruhmanaTherapeutic uses: Shoolaroga, Vataroga, Mootra kruchra, Ashmari, debility.Part used: Panchanga Page 51
  • DRUG REVIEWRAASNA:126 Botanical name: Pluchea lanceolata Sanskrit names: Sugadha, Suvaha Hindi name: Rasayana Kannada names: Dumme raasnaChemical composition: Clavanoids, Quercetin, Isorhammetin.Properties: Rasa - Tikta Guna - Guru Veerya - Ushna Vipaka - Katu Dosha - Kaphavatahara Karma - Amapachaka, VirechakaTherapeutic uses: Shotha, Vatavyadhi, Kasa-Shwasa, Adyavata, Jwara, Udararoga, Amavata, Vatarakta.Part used: Leaves7) SHATAPUSHPA:127 Botanical name: Anethum sowa. Roxb Sanskrit names: Shatavah, Mishreye Hindi names: Soya, Sova Kannada name: SabasigeChemical composition: 3-4% volatile oil and stable oil Page 52
  • DRUG REVIEWProperties: Rasa - Katu, Tikta Guna - Laghu, Ruksha, Teekshna Veerya - Ushna Vipaka - Katu Dosha - Vata kapha shamaka Karma - Vatahara,kaphahara, Shoolahara, DeepanaTherapeutic uses: Jwara, Shoola, Vrana, Netraroga, atisaraPart used: Seed8) SHATI:128 Botanical name: Hedychium spicatum Sanskrit names: Kachur, Gandhasara Hindi name: Kapur kachri Kannada names: Seena Kachora, KachoraChemical composition: Essential oilsProperties: Rasa - Katu, Tikta, Kashaya Guna - Laghu, Teekshna Veerya - Ushna Vipaka - Katu Dosha - Kaphavata shamaka Karma - Shoolahara, Grahi, MukhashodhakaTherapeutic uses: Shoola, Chardi, Kandu, Kasa, Shwasa, Mukharoga.Part used: Fruit Page 53
  • DRUG REVIEW9) AJAMODA: 129 Botanical name: Trachyspermum ammi Sanskrit names: Yavani, Ugragandhi Hindi names: Ajwain, Jevain Kannada names: Omu, YomChemical composition: Essential oil and fixed oil, which is volatile in natureProperties: Rasa - Katu, Tikta Guna - Laghu, Ruksha, Teekshna Veerya - Ushna Vipaka - Katu Dosha - Kaphavata shamaka Karma - Shoolahara, Krimihara, Deepana, Pachana, Anulomana.Therapeutic uses: Admana, Anaha, Udararoga, Gulma, Shoolahara, Krimiroga.Part used: Seeds10) SHUNTI: 130 Botanical name Zinziber officinale, Rosce Sanskrit names: Nagara, Vishwa bheshaja Hindi name: Sonth Kannada name: ShuntiChemical composition: Yellow volatile oil, Gingerol, Gingerin (Resin), Shogaol, Carbohydrates and starch are present. Page 54
  • DRUG REVIEWProperties: Rasa - Katu Guna - Laghu, Snigdha Veerya - Ushna Vipaka - Madhura Dosha - Kaphavatagna Karma - Deepana, Pachana, Amadoshahara, Shoola prashamakaTherapeutic uses: Amavata, Udararoga, Agnimandhya, Pandu, Shwasa, Admana.Part used: Rhizome11) VRUDHADARU:131 Botanical name: Argyria speciosa Sanskrit names: Jeernadaru, Ajara Hindi names: Bidaraa, Dhavapatha Kannada name: VidharaChemical composition: Contains Amlarala and Kashaya dravyaProperties: Rasa - Katu, Tikta, Kashaya Guna - Snigdha Veerya - Ushna Vipaka - Madhura Dosha - Kaphavata shamaka Karma - Vatarogagna, Dourbalyahara, Vrushyakaraka, Agnivardhaka Page 55
  • DRUG REVIEWTherapeutic uses: Vataroga, Kshayaroga, Dourbalya, ShothaPart used: Root12) GUGGULU 132 Botanical name : Commiphora mukul Sanskrit names : Deva dhupa, Kausika, Pura Hindi names : Guggulu Kannada names : GugguluChemical Composition: Essential oil, Myrcene, DimyrceneProperties: Rasa - Tikta, Katu, Kashaya. Guna - Laghu, Ruksha, Teekshna, vishada, Sukshma, Sara, Lekhana Veerya - Ushna Vipaka - Katu Dosha - Tridosha hara Karma - Sotha hara, vedhanastaphana, Vatanulomana, NadibhalyakaraTherapeutic uses: Vata roga, Ama vata, Vata rakta, Bhagna.Part used: Gum resin. Page 56
  • DRUG REVIEW STANDARD DRUGSIMHANADA GUGGULUReference: Cakradatta, Bhaishajya RatnavaliContext: Amavata adhikaraIngredients: Hareetaki - 1 Pala. Vibhitaki - 1 Pala Amalaki - 1 Pala Sh. Gandhaka - 1 Pala Sh. Guggulu - 1 Pala Eranda taila - 4 PalaMethod of preparation: First Thriphala kwatha is prepared by using the thriphala yavakuta churna asabove mentioned. Eranda thaila and Guggulu were mixed with the Triphala kwathaand boiled in low flame. Gradually guggulu dissolved and concentrated. When itattains bolus like soft mass, then taken from the fire and left for self cooling.Gandhaka powder was added and mixed well. Then vati is prepared. This vati ismanually dried and preserved.Individual drug study 1) HAREETAKI 133 Botanical name : Terminalia chebula Retz. Sanskrit names : Amruta, Vijaya, Abhaya. Hindi names : Haradar Kannada names : AlalekayiChemical Composition: 30% of Astringent substance, Chebulic acid, Page 57
  • DRUG REVIEWProperties: Rasa - Kashaya pradhana pancha rasa. Guna - Laghu, Ruksha. Veerya - Ushna Vipaka - Madhura Dosha - Tridosha hara specially vata samaka Karma - Medhya Rasayana Bruhmana Anulomana Ayushya, Chakshusya.Therapeutic uses: Swasa, Kasa, Prameha, Arsha, Eye diseases, Twak roga, Kamala.Part used: Fruit (without seed). 2) VIBHITAKI 134 Botanical name : Terminalia bellirica Roxb. Sanskrit names : Kalidruma, Aksha, Karsha phala Kannada names : Santhi kayiChemical Composition: Mannitol, Glucose, Chebulagic acid, Bellericanin, Fatty oil.Properties: Rasa - Kashaya pradhana pancha rasa. Guna - Laghu, Ruksha. Veerya - Ushna Vipaka - Madhura Dosha - Tridosha samaka specially kapha hara Karma - Deepana, Anulomana, Grahi.Chakshusya.Therapeutic uses: Kapha roga, Swasa, Kasa, Sotha, Vata vyadhi. Page 58
  • DRUG REVIEWPart used: (Fruit without seed). 3) AMALAKI 135 Botanical name : Emblica officinalis Gaertn. Sanskrit names : Dhatri, Vayastha Hindi names : Amla Kannada names : NellikayiChemical Composition: Carbohydrate, Fe, Nicotinic acid, Tannin, Galic acid, Emblicol.Properties: Rasa - Amla pradhana pancha rasa. Guna - Guru, Ruksha. Veerya - Sheeta Vipaka - Madhura Dosha - Tridosha hara specially pitta samaka Karma - Medhya Rasayana, Vrushya, Vayasthapana, Anulomana Chakshusya,Therapeutic uses: Swasa, Kasa, Kshaya, Pandu, Eye diseases, Raktapitta.Part used: Fruit (without seed)4) ERANDA 136 Botanical name : Ricinus communis .Linn Sanskrit names : Chitra beeja, Gandharvahasta. Hindi names : ArandChemical Composition: Castor oil is composed of Triricinolein. Page 59
  • DRUG REVIEWProperties: Rasa - Madhura Guna - Snigdha, Teekshna, Sukshma Veerya - Ushna Vipaka - Madhura Dosha - Kaphavata samaka Karma - Vata kapha hara, Deepana Bhedhana, Ama shodhana, Sotha hara..Therapeutic uses: Amavata, Katisula, Grudrasi.Sandhi sotha.Part used: seed oil.5) GUGGULU 132 Botanical name : Commiphora mukul Sanskrit names : Deva dhupa, Kausika, Pura Hindi names : Guggulu Kannada names : GugguluChemical Composition: Essential oil, Myrcene, DimyrceneProperties: Rasa - Tikta, Katu, Kashaya. Guna - Laghu, Ruksha, Teekshna, vishada, Sukshma, Sara, Lekhana Veerya - Ushna Vipaka - Katu Dosha - Tridosha hara Karma - Sotha hara, vedhanastaphana, Vatanulomana, Nadibhalyakara Page 60
  • DRUG REVIEWTherapeutic uses: Vata roga, Ama vata, Vata rakta, Bhagna.Part used: Gum resin.6) GANDHAKA 138Synonym: Atigandha, GandhapashanaGuna karma:Rasa : Katu MadhuraGuna : Laghu SnigdhaVirya : UshnaVipaka : KatuDoshakarma: Kapha vata haraKarma: Rasayana, Deepana, Pachana, Rakta shodhana.Therapeutic uses: Kantu, Kusta, Amadosha, Visha dosha.Dose: 1-8 Ratti. Page 61
  • METHODOLOGY METHODOLOGY Research is a scientific and intelligent study, investigation or experimentationin order to establish facts and their significance. This is the only way available to re-establish old facts through modern methodology. It is also useful in case of gainingknowledge, helps to develop and advance in new directions. Ayurveda is the science of life. Being an ancient medical science, it isformulated on the scientific parameters available in those times. And a clinical trial,which is carefully designed to answer the present generation who are conscious andwants a scientific explanation for everything that is happening in this world. So aclinical study is conducted on scientific line with the aim of solving the unsolvedproblems is the only way to achieve the above objectives. This study is an attempt to prove the efficacy scientifically of TrayodashangaGuggulu on Sandhigatavata, by comparing it with Simhanada Guggulu. Efficacy canbe determined by finding out the difference between the base line data and assessmentdata.Study design: It is a single blind comparative clinical study with pretest and posttest designwhere in 40 patients suffering from Sandhigatavata of either sex of age group inbetween 25-65 were selected and randomly allocated into test group and controlgroup. Duration of study is 60 days.Source of data: Patients who were attending the O.P and I.P section of Kayachikitsadepartment A.L.N.Rao Ayurveda Medical College Hospital Koppa were taken up forthe study. 40 patients were registered for the study. Page 62
  • METHODOLOGYCriteria of selection: Patient who presented the complaints of joint pain, were examined in detailregarding the present and past history, food and activity, treatment status etc. and wasrecorded in a specially prepared Performa. The patients were investigated with serumRA, ASO titer and X-ray of joint (AP and Lat).Inclusion criteria: 1. Patients diagnosed as Sandhi gata vata on the basis of signs and symptoms according to classical Ayurvedic texts. 2. Patients of either sex between the age of 25-65 years. 3. Early onset of Sandhi gata vata is included.Exclusion criteria: 1. Sandhigata vata due to congenital development disorders, post traumatic, neurological and endocrine origin 2. Patients having secondary complications. 3. During pregnancy and lactation period.Investigations: Blood - Serum RA factor, ASO titer. X-ray of effected joints- both AP and Lat.Preparation of Trial drug: The trial drug Trayodashanga Guggulu is mentioned in Chakradatta. In thisGuggulu preparation the quantity of the individual drugs is mentioned in the text thatthe twelve drugs should be taken in one part, Guggulu is taken twelve parts and Ghritais six parts. Page 63
  • METHODOLOGY Ingredients:Abha, Ashwagandha, Hapusha,Guduchi, Shatavari, Gokshura, 250 Grams each [1 part each]Vrudhadaru, Rasna, Shathahwa,Shati, Yavani, Nagara,Shudda Guggulu 3 kilo grams [12 parts]Ghrita 1.5 kilo grams [6 parts] Method of preparation: All the ingredients from Bakula to Nagara was taken separately and poundedwell. Then the powder was passed through a sieve to get the filtered form. Shuddaguggulu was taken, pounded well along with Goghritha, and also the filtered powdersshould be added. After the proper pounding and mixing, the tablet is rolled of 1 gmeach. The tablets are properly dried in sunlight and stored.INTERVENTIONTrial group: Sample size - 20 patients. Medicine - Trayodashanga Guggulu Dose - 3 grams twice daily after food. Duration - 60 days. Anupana - Ushna jala.Standard group: Sample size - 20 patients. Medicine - Simhanada Guggulu Page 64
  • METHODOLOGY Dose - 3 grams twice daily after food. Duration - 60 days. Anupana - Ushna jala.Observation period: Follow period was done for 60 days.Assessment criteria: Scoring methods given to the clinical signs and symptoms and functionalcapacity of the patients assesses the improvement in the signs and symptoms. Signsand symptoms recorded on interval of 15 days for 60 days.Clinical assessment:Sandhi shula PointsNo pain [no pain at rest / no pain while walking] - 0Mild pain [no pain at rest or mild tolerable pain while walking] - 1Moderate pain [mild pain at rest, tolerable and moderate pain while working] - 2Severe pain [disturbance of sleep due to pain orpain at rest or un tolerable pain during working] - 3Atopa of sandhiNo crepitus - 0Palpable crepitus - 1Audible crepitus - 2Tenderness:No pain on pressure - 0Pain on pressure and winces - 1 Page 65
  • METHODOLOGYPatient withdraws affected part while giving pressure - 2Patient does not allow to touch - 3Sandhi shotha:No swelling - 0Swelling is present slightly in joints - 1Swelling covering the bony prominence of affected joints - 2Swelling much elevated so that the joints seems grossly deformed - 3Criteria for assessment of total effects of the therapy: The sum points of all the parameters of assessment before and after treatmentwere taken into consideration to assess the total effect of the therapy. It was graded interms of percentage of relief in the signs and symptoms. Total cure - 100% relief Marked improvement - relief of above 60% Moderate improvement - 40 to 60% of relief Improved - relief of more than 40% Unchanged - 0% of relief Deterioration - worsening of the signs and symptomsStatistical analysis: All data was analysed statistically by calculating the mean, percentage ofchange, standard deviation, standard error, t and p values by using student ‘t’ test. Page 66
  • METHODOLOGY Observations In this study on Sandhigata vata, 20 patients were taken in each group (trialgroup, control group) totally 40 patients were registered. Here from both groups byconsidering Age, Sex, Religion, Deha prakruti, and also by Roga and Rogi pareeksha,the observations were derived.1. Age wise distribution in 40 patients of Sandhigata vata In this study about Sandhigata vata showed maximum number of patients(50%) between the ages 55-65 yrs. 30% of the patients were in the age group of 45-55yrs, 15% were in 35- 45 yrs, while 5% of the patients between the ages 25-35 yrs.Table No. 15 Showing Age Incidence Sl.No. Age in Years No. of Patients Percentage 1. 25-35 2 5 2 35-45 6 15 3. 45-55 12 30 4. 55-65 20 50Graph No. 1 Showing Age Incidence : 100 80 60 40 20 0 25-35 35-45 45-55 55-65 Page 67
  • METHODOLOGY2. Distribution of 40 patients of Sandhigata vata according to sex In this study, 55% of the patients were females and 45% of patients weremales.Table No.16 Showing sex incidence Sl.No. Sex No. of Patients Percentage 1. Male 18 45 2. Female 22 5Graph No. 2 – Showing sex incidence 100 80 60 40 20 0 Male Female3. Distribution of 40 patients of Sandhigata vata according to religion. In this study, maximum numbers of patients were Hindu i.e. 77.5%, Muslimswere 15% and minimum patients were Christian i.e.7.5%Table No. 17 Showing religion incidence Sl.No. Religion No. of Patients Percentage 1. Hindu 31 77.5 2. Muslim 6 15 3. Christian 3 7.5Graph No. 3 Showing religion incidence 100 80 60 40 20 0 Hindu Muslim Christian Page 68
  • METHODOLOGY4. Distribution of 40 patients of Sandhigata vata according to marital status Among 40 patients, 37 patients (92.5%) were married, while 7.5% i.e. 3patients were unmarried.Table No. 18 Showing Marital status Sl.No. Marital status No. of Patients Percentage 1. Married 37 92.5 2. Unmarried 3 7.5Graph No. 4 Showing Marital status 100 80 60 40 20 0 Married Unmarried5. Economic status of 40 patients of Sandhigata vata Maximum of patients got belongs to poor class i.e.70%, 22.5% belonged tomiddle class and minimum of 7.5% came from rich class for this study.Table No. 19 Showing Economic status Sl.No. Social economic No. of Patients Percentage status 1. Poor 28 70 2. Middle 9 22.5 3. Rich 3 7.5Graph No. 5 Showing Economic status 100 80 60 40 20 0 Poor Middle Rich Page 69
  • METHODOLOGY6. Occupational incidence of 40 patients of Sandhigata vata While considering occupation of the patients, maximum patients are Housewife i.e. 45%, then Agriculture i.e. 32.5%, those who are in service are 7.5%,Business persons are 5% and those who are having occupation other than thisconsidered together i.e. 10%Table No. 20 Showing Occupational incidence Sl.No. Occupation No. of Patients Percentage 1. Business 2 5 2. House wife 18 45 3. Service 3 7.5 4. Agriculture 13 32.5 5. Others 4 10Graph No.6 Showing Occupational incidence 100 80 60 40 20 0 House wife Agriculture Service Business Others7. Nature of work of 40 patients of Sandhigata vata: Maximum number of patients performed their work by walking for long hoursi.e. 47.5%, while 45% performed their work by standing for long hours; 7.5%developed this disease after sitting for long time.Table No. 21 Showing Nature of work Sl.No. Nature of work No. of Patients Percentage 1. Standing 18 45 2. Sitting 3 7.5 3. Walking 19 47.5 Page 70
  • METHODOLOGYGraph No.7 – Showing Nature of work 100 80 60 40 20 0 Standing Sitting Walking8. Habitat wise distribution of 40 patients of Sandhigata vata 92.5% of the patients belonged to Anupa desa, while 5% belonged toSadharana and 2.5% of patients belonged to Jangala desas.Table No. 22 Showing the Habitat Sl.No. Habitat No. of Patients Percentage 1. Sadharana 2 5 2. Jangala 1 2.5 3. Anupa 37 92.5Graph No. 8 Showing the Habitat 100 80 60 40 20 0 Sadharana Janghala Anupa9. Distribution of 40 patients according to Lakshanas: Sandhishula was the common symptom which is present in all the patientsi.e.100%, then Prasarana akunchana pravrthi savedana was present in 95% patients,stambha was present in 85% patients, in 77.5% patients suffered from Shotha, Atopain 70% patients. Page 71
  • METHODOLOGYTable No.23 Showing Symptoms Sl.No. Symptomatology No. of Patients Percentage 1. Sandhi Sula 40 100 2. Sandhi Shotha 31 77.5 3. Sandhi Stambha 34 85 4. Prasarana akunchana 38 95 pravrthi savedana 5. Atopa 28 70Graph No.9 Showing Symptoms of Sandhi gata vata 100 80 60 40 20 0 Sandhi sula Atopa Prasarana Sotha Stambha akunchana vedana10. Duration of illness in 40 patients of Sandhigata vata Maximum patients suffered from this disease below one year (45%), 32.5%have history in between 1-3 years and 22.5% of patients gave a history of sufferingabove 3 years.Table No. 24 Showing Duration of illness: Sl.No. Duration of illness No. of Patients Percentage 1. Below 1 year 18 45 2. In between 1-3 years 13 32.5 3. Above 3 years 9 22.5 Page 72
  • METHODOLOGYGraph No. 10 Showing Duration of illness: 100 80 60 40 20 0 <1 yr 1-3 yrs > 3 yrs11. Family history of this disease in 40 patients of Sandhigata vata: Majority of the patients show no family history about this disease (80%). 20%of patients show family history about this disease.Table No. 25 Showing incidence of family history: Sl.No. Family history No. of Patients Percentage 1. Yes 8 20 2. No 32 80Graph No. 11 Showing incidence of family history: 100 80 60 40 20 0 Yes No12. Dietary Habit in 40 patients of Sandhigata vata Maximum no. of patients was consuming mixed type of diet (55%), while45% of patients are Vegetarian. Page 73
  • METHODOLOGYTable No. 26 Showing the Dietary Habit: Sl.No. Dietary habit No. of Patients Percentage 1. Vegetarian 18 45 2. Mixed 22 55Graph No. 12 Showing the Dietary Habit: 100 80 60 40 20 0 Veg Mixed13. Ahara pramana in 40 patients of Sandhigata vata Most of the patients were taken Sama pramana of Food i.e. 57.5%. While 25%of patients were taken Alpa pramana of Ahara and minimum of 17.5% patients werehabit of consuming Ati pramana of Ahara.Table no. 27 showing Ahara pramana: Sl.No. Ahara pramana No. of Patients Percentage 1. Alpa 10 25 2. Sama 23 57.5 3. Ati 7 17.5Graph No.13 Showing the Ahara pramana 100 80 60 40 20 0 Alpa Sama Ati Page 74
  • METHODOLOGY14. Dominant rasa in 40 patients of Sandhigata vata Most of the patients consumed the Food which is katu rasa pradhana i.e.37.5%, and 20% of the patients taken the Ahara which is Lavana rasa pradhana and17.5% patients took Amla rasa predominant food. 12.5% of the patients took Tiktarasa pradhana ahara in more quantity while 7.5% of the patients were habituatedto kasaya rasa predominantly in their food and 5% of patients were taken food whichis Madhura rasa dominant.Table No. 28 Showing Dominant rasa: Sl.No. Dominant rasa No. of Patients Percentage 1. Madhura 2 5 2. Amla 7 17.5 3. Lavana 8 20 4. Katu 15 37.5 5. Tikta 5 12.5 6. Kasaya 3 7.5Graph No. 14 Showing Dominant rasa 100 80 60 40 20 0 Madhura Amla Lavana Katu Tikta Kashaya15. Dominant ahara guna in 40 patients of Sandhigata vata Here analysis of main qualities of food has been done. Among this 32.5% ofthe patients took Laghu guna yukta ahara, while 30% took Ruksha ahara, 20% ofpatients took Ushna ahara, 10% of patients took Sheeta ahara, 2% of patients werehabituated to Guru ahara and only 2.5% took Snigdha guna predominant food. Page 75
  • METHODOLOGYTable No. 29 Showing Dominant ahara guna: Sl.No. Dominant ahara No. of Patients Percentage guna 1. Rooksha 12 30 2. Snigdha 1 2.5 3. Ushna 8 20 4. Sheeta 4 10 5. Guru 2 5 6. Laghu 13 32.5Graph No. 15 Showing Dominant Ahara guna: 100 80 60 40 20 0 Ruksha Seeta Laghu Snigdha Guru Ushna16. Nidra incidence in 40 patients of Sandhigata vata Majority of the patients complained of disturbed sleep i.e. 77.5%, while 22.5%had sound sleep.Table No. 30 Showing Nidra incidence: Sl.No. Nidra No. of Patients Percentage 1. Sound 9 22.5 2. Disturbed 31 77.5Graph No. 16 Showing Nidra incidence: 100 80 60 40 20 0 Sound Disturbed Page 76
  • METHODOLOGY17. Pramana of vyayama in 40 patients of Sandhigata vata In 40 patients of Sandhi gata vata, 62.5% of the patients developed this diseaseafter performing Ati vyayama, while 30% of them did in sama pramana and 10% didless pramana of Vyayama.Table No. 31 Showing the Pramana of vyayama: Sl.No. Vyayama No. of Patients Percentage 1. Hina 3 7.5 2. Sama 12 30 3. Ati 25 62.5Graph No.17 Showing the Pramana of vyayama: 100 80 60 40 20 0 Heena Sama Ati18. Prakruti in 40 patients of Sandhigata vata Prakruti was accessed according to classical description. Majority of thepatients belonged to Vata pitta(dwandwaja) prakruti I.e. 55%. Then the patients ofVata kapha i.e.30% and 10% were Sannipataja prakruti, 5% if the patients belonged toVata slesmala praktuti. No patients were observed Ekadoshaja prakruti.Table No.32 Showing the Prakruti: Sl.No. Prakruti No. of Patients Percentage 1. Vatapittaja 22 55 2. Vatakaphaja 12 30 3. Pittakaphaja 2 5 4. Sannipataja 4 10 5. Vataja 0 0 6. Pittaja 0 0 7. Kaphaja 0 0 Page 77
  • METHODOLOGYGraph No.18 Showing the Prakruti: 100 80 60 40 20 0 VP PK VK VPK V P K19. Distribution of 40 patients of Sandhigata vata according to Sara Most of the patients had madhyama sara i.e. 82.5%, while 15% had avara saraand 2.5% patients were having pravara sara.Table No. 33 According to Sara: Sl.No. Sara No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 33 82.5 3. Avara 6 15Graph No.19 According to Sara: 100 80 60 40 20 0 Pravara Madhyama Avara20. Distribution of 40 patients of Sandhigata vata according to Satwa Maximum number of patients had madhyama satwa i.e. 77.5%, while 20% hadavara satwa and pravara satwa 2.5%. Page 78
  • METHODOLOGYTable No. 34 According to Satwa: Sl.No. Satwa No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 31 77.5 3. Avara 8 20Graph No.20 According to Satwa: 100 80 60 40 20 0 Pravara Madhyama Avara21. Distribution of 40 patients of Sandhigata vata according to Samhanana Maximum number of patients had madhyama samhanana i.e. 67.5%, while17.5% had avara samhanana and 15% of the patients had pravara samhanana.Table No.35 According to Samhanana Sl.No. Samhanana No. of Patients Percentage 1. Pravara 6 15 2. Madhyama 27 67.5 3. Avara 7 17.5Graph No.21 According to Samhanana 100 80 60 40 20 0 Pravara Madhyama Avara Page 79
  • METHODOLOGY22. Satmya in 40 patients of Sandhigata vata Maximum number of patients had madhyama satmya i.e. 70%, while 25% wasavara satmya and pravara satmya is 5%.Table No.36 According to Satmya: Sl.No. Satmya No. of Patients Percentage 1. Pravara 2 5 2. Madhyama 28 70 3. Avara 10 25Graph No.22 According to Satmya: 100 80 60 40 20 0 Pravara Madhyama Avara23. Distribution of 40 patients of Sandhigata vata according to Ahara shakti In ahara sakti there are two divisions, they are abhyavarana sakti and jaranasakti. They are tabulated separately.a) Distribution according to abhyavarana sakti: Majority of the patients had madhyama abhyavarana sakti i.e. 80% and 15%are having avara abhyavarana sakti. 5% of patients had pravara abhyavarana sakti.Table No. 37 According to Abhyavarana sakti Sl.No. Abhyavarana sakti No. of Patients Percentage 1. Pravara 2 5 2. Madhyama 32 80 3. Avara 6 15 Page 80
  • METHODOLOGYGraph no: 23 showing Abhyavarana sakti 100 80 60 40 20 0 Pravara Madhyama Avarab) Distribution of 40 patients according to Jarana sakti Most of the patients had madhyama jarana sakti i.e. 72.5% and 22.5% arehaving avara jarana sakti. 5% of patients had pravara jarana sakti.Table No.38 showing Jarana shakti: Sl.No. Jarana sakti No. of Patients Percentage 1. Pravara 2 5 2. Madhyama 29 72.5 3. Avara 9 22.5Graph no:24 Showing Jarana shakti: 100 80 60 40 20 0 Pravara Madhyama Avara24. Distribution of 40 patients of Sandhigata vata according to Vyayama sakti While considering Vyayama shakti, majority of the patients had avaravyayama sakti i.e. 80%, while 17.5% had madhyama vyayama sakti and 2.5%performed pravara vyayama. Page 81
  • METHODOLOGYTable No. 39 According to Vyayama sakti Sl.No. Vyayama sakti No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 7 17.5 3. Avara 32 80Graph No. 25 According to Vyayama sakti 100 80 60 40 20 0 Pravara Madhyama Avara23. Weight incidence in 40 patients of Sandhigata vata Majority of patients having weight in between 45-55 kg i.e. 40%. Patientshaving 55-65 kg are 35%, while 17.5% patients are having weight in between 35-45kg. 17.5% were between 65-75 kg.Table No. 40 Showing the Weight incidence Sl.No. Weight (Kg) No. of Patients Percentage 1. 41-50 7 17.5 2. 51-60 14 35 3. 61-70 16 40 4. 71.80 3 7.5Graph No. 26 Showing the Weight incidence 100 80 60 40 20 0 35-45 45-55 55-65 65-75 Page 82
  • RESULTS RESULTSTable No:41Therapeutic effect of Trial drug Thrayodashanga Guggulu in the management ofSandhigata vata after 60 days treatment: Sl. Main Mean % S.D S.E t P No. symptoms BT AT BT-AT 1. Sandhi shula 1.75 1.35 0.40 35 0.598 0.133 2.990 <0.010 2. Tenderness 1.90 1.40 0.50 40 0.688 0.153 3.248 <0.010 3. Atopa 1.90 1.30 0.60 55 0.598 0.133 4.485 <0.001 4. Sandhi sotha 1.90 1.55 0.35 30 0.587 0.131 2.665 <0.020 The trial drug Thrayodashanga Guggulu gives highly significant (< 0.001)result in the Atopa (crepitus) i.e. 55%. It provided 40% relief in Tenderness which ismoderately significant (<0.010). Also it is moderately significant (<0.010) in Sandhishula (35%)Table No:42Therapeutic effects of Trial drug Thrayodashanga Guggulu in the managementof Sandhigata vata after 60 days of follow up:Sl. Main Mean % S.D S.E t PNo. symptoms BT AFU BT-AFU 1. Sandhi shula 1.75 1.05 0.70 60 0.656 0.146 4.765 <0.001 2. Tenderness 1.90 1.15 0.75 65 0.638 0.142 5.251 <0.001 3. Atopa 1.90 1.25 0.65 60 0.587 0.131 4.950 <0.001 4. Sandhi sotha 1.90 1.45 0.45 40 0.600 0.135 3.327 <0.010 The trial drug Thrayodashanga Guggulu showed highly significant (< 0.001)result in Tenderness (65%). It showed highly significant result (< 0.001) in Sandhishula and Atopa (60%). Page 83
  • RESULTSTable No: 43Effect of standard drug (Simhanada Guggulu) in the management of Sandhigatavata after 60 days of treatment:Sl. Main Mean % S.D S.E t PNo. symptoms BT AT BT-AT 1. Sandhi shula 1.85 1.55 0.30 30 0.470 0.105 2.853 <0.020 2. Tenderness 2.00 1.65 0.35 30 0.587 0.131 2.665 <0.020 3. Atopa 1.80 1.40 0.40 35 0.598 0.133 2.990 <0.010 4. Sandhi sotha 2.15 1.55 0.60 50 0.680 0.152 3.942 <0.001 The standard drug simhanada guggulu showed highly significant result(<0.001) in the Sandhi shotha (50%). It provided moderate significant (<0.010) resultin the Atopa (35%). And in the sandhi shula and tenderness showed moderatesignificant (<0.020) and the relief is 30%.Table No: 44Effect of standard drug (Simhanada Guggulu) in the management of Sandhigatavata after 60 days of follow up:Sl. Main Mean % S.D S.E t PNo. symptoms BT AF BT- U AFU1. Sandhi shula 1.85 1.40 0.45 40 0.604 0.135 3.327 <0.0102. Tenderness 2.00 1.50 0.50 40 0.688 0.153 3.298 <0.0103. Atopa 1.80 1.25 0.55 45 0.686 0.153 3.583 <0.0104. Sandhi sotha 2.15 1.40 0.75 60 0.716 0.160 4.682 <0.001 The standard drug Simhanada Guggulu provided highly significant (<0.001)result in the Sandhi shotha (60%). It showed moderate significant (<0.010) result inthe Atopa (45%) and in the sandhi shula and tenderness it provides moderatesignificant (<0.010) result and relieved the symptoms 40%. Page 84
  • RESULTSTable No: 45Comparative effect of therapies in the management of Main symptoms of 40patients of Sandhigata vata after treatment: Group Sandhishoola Tenderness Atopa Sandhi shotha Trial group 35 40 55 30 Std group 30 30 35 50 While comparing the effect of therapies on main symptoms, it was found thatTrial group showed 35%, 40%, 55% and 30% relief in managing the symptoms likeSandhi shula, Tenderness, Atopa and Sandhi shotha respectively were as Standardgroup showed 30%, 30%, 35% and 50% relief in the symptoms like Sandhi shula,Tenderness, Atopa and Sandhi shotha respectively.Graph No: 27Comparative effect of therapies in the management of Main symptoms of 40patients of Sandhigata vata after treatment: 100 80 60 40 20 0 shula tenderness Atopa shotha trial std Page 85
  • RESULTSTable No: 46Comparative effect of therapies in the management of Main symptoms of 40patients of Sandhigata vata after follow up: Group Sandhishoola Tenderness Atopa Sandhi shotha Trial group 60 65 60 40 Std group 40 40 45 60 While comparing the effect of therapies on main symptoms, it was found thatTrial group showed 60%, 65%, 60% and 40% relief in managing the symptoms likeSandhi shula, Tenderness, Atopa and Sandhi shotha respectively were as Standardgroup showed 40%, 40%, 45% and 60% relief in the symptoms like Sandhi shula,Tenderness, Atopa and Sandhi shotha respectively. Here trial group showed better results in the management of Sandhi shula,Tenderness, Atopa where as standard group (Simhanada guggulu) given better resultin the Sandhi shotha.Graph No: 28Comparative effect of therapies in the management of Main symptoms of 40patients of Sandhigata vata after follow up: 100 80 60 40 20 0 shula tenderness Atopa shotha trial std Page 86
  • RESULTSTable No: 47Overall effect of therapy by trial drug Trayodashanga guggulu on patients ofSandhigata vata after 60 days of treatment: Result No. of patients % Complete relief 00 00 Marked improvement 04 20 Moderate improvement 04 20 Improved 09 45 Unchanged 03 15In this group, 45% of the patients were assessed under improved category.20% ofpatients showed moderate and marked improvement. 15% showed no response to thetreatment. No body showed complete relief.Table No: 48Overall effect of therapy by trial drug Trayodashanga guggulu on patients ofSandhigata vata after 60 days of follow up Result No. of patients % Complete relief 00 00 Marked improvement 03 15 Moderate improvement 07 35 Improved 07 35 Unchanged 03 15 After 60 days of follow up period 35% of patients showed Moderateimprovement were as 35% patients came under improved category. 15% of patientsshowed marked relief in the symptoms.15% of patients came under unchangedcategory. Page 87
  • RESULTSTable No: 49Overall effect of therapy by Standard drug Simhanada guggulu on patients ofSandhigatha vata after 60 days of treatment: Result No. of patients % Complete relief 00 00 Marked improvement 02 10 Moderate improvement 08 40 Improved 07 35 Unchanged 03 15 In this group after 60 days of treatment the standard group showed 40%Moderate relief in the symptoms. 35% of the patients showed improved relief.10% ofthe patients showed Marked improvement and 15% remained unchanged.Table No: 50Overall effect of therapy by control drug Simhanada guggulu on patients ofSandhigata vata after 60 days of follow up. Result No. of patients % Complete relief 00 00 Marked improvement 03 15 Moderate improvement 02 10 Improved 11 55 Unchanged 04 20 Page 88
  • RESULTS 55% of patients showed improvement in the symptoms, 15% belonged markedimprovement. 10% Showed moderate improvement where as remaining 20%belonged to unchanged category. No body showed complete relief.Graph No: 29Comparative effect of overall therapy of 40 patients of Sandhigata vata after 60days of treatment: 100 80 60 40 20 0 Complete Marked Moderate imp Improved Unchanged relief improvement trial std Complete relief was not noted in both the groups. 20% of patients of Trialgroup showed marked improvement while it was 10% in Standard group. 20%showed moderate improvement in Trial group and 40% in Standard group.Improvement was noted in 45% in Trial group and 35% of patients in Standard group.15% of patients in Trial group showed no change after the treatment while in Standardgroup also it is 15%. Page 89
  • RESULTSGraph No: 30Comparative effect of overall therapy of 40 patients of Sandhigata vata after 60days of follow up: 100 80 60 40 20 0 Complete Marked Moderate imp Improved Unchanged relief improvement trial std After follow up, complete relief was not noted in both the groups. 15% ofpatients of Trial group showed marked improvement and also it was 15% in Standardgroup. 35% showed moderate improvement in Trial group and 10% in Standardgroup. Improvement was noted in 35% in Trial group and 55% of patients in Standardgroup. 15% of patients in Trial group showed no change after the treatment while inStandard group also it is 20%. Page 90
  • DISCUSSION DISCUSSION The pathological condition in which either of the localized or generalizedsymptomatology gets manifested along with severe pain as an effect of localization ofthe vitiated vata dosha in different dushyas as the condition may be called as vatavyadhi. It is also said that vata vyadhi is a consequent result of a special type ofdosha-dushya sammurchana occurring in the body, manifested by either localized orgeneralized symptamatology, brought about by the localization of vitiated vata in therespected dushyas. Sandhi gata vata is one of the vata vyadhi. Supportive evidences are found inthe Ayurvedic classics indicates that sandhigata vata does possess an etio-pathogenesis of its own as it is said that a vyadhi is formed only after the completionof the dosha-dushya sammurchana in the Sthana samshrayavastha marked by a clearcut manifestation of signs and symptoms. In this context the vata is getting vitiated byits etiological factors runs through all the pathological stages and on getting localizedin its dushyas which in this case being sandhi produces a specialized form of dosha-dushya sammurchana and manifest with its clear cut symptoms like shotha shula, soas to be called as sandhigata vata. In modern, Sandhi gata vata is compared with the Osteo arthritis which is oneof the degenerative joint disorders. Females are found to be more affected by thisdisorder. It causes pain and disability there by hampering man power resources of thenation. So the priority for health system assumes an important place as the populationbecomes older. Page 91
  • DISCUSSIONDiscussion on Etiology: Although separate etiological factors not mentioned for the disease sandhigatavata, samanya nidana for vata vyadhi itself is taken in to consideration. Theetiological factors can be divided into aharata, viharata, manasika, kalakruta and gadakruta. In proper diet and dietic regimen plays importance in the process of thisdisease because ahara provides the nutrients to all the dhatus. By the improper foodand dietic regimen quantitatively or qualitatively produces changes in the process ofdigestion and absorption. This leads to dhatu kshaya which in turn causes the vataprakopa results in sandhigata vata. The viharaja nidans which pertaining to this disease can stimulates or irritatesthe anatomical sites (sandhis), where the depletion of dhatus (sleshma, snayu) takesplace which in turn causes the riktata and also vata prakopa. Vyana vata is responsiblefor pancha chesta, the etiological factors will directly causes vyana vata pakopa. Thisproduces difficulty in movement. The mental health always contributes the physical well being. The anxiety,stress, nervousness and mental disturbances reflect on body mechanism and impairthe functions. Vata being essential factor in the maintenance of manas and indriyas,disturbances in that aspect directly influence over vata. Page 92
  • DISCUSSIONDiscussion on Samprapti: The samprapti of sandhigata vata follows either of the two different pathways.The different mechanisms can be explained as said below- 1. The consumption of aharaja, viharaja, manasika, kalaja or gadakruta nidanas having the tendency to vitiate the vata, either individually or in combination sill kead to the sanchaya of the vata. The accumulated vata heads towards the steps of prakopa and prasara. The same etiological factors having the tendency to destroy the dhatus simultaneously with vitiation of vata will produce dhatu kshaya. The dhatu kshaya will ultimately results in riktata of the srothas. The prasarita vata moving all through the body occupies the rikta srotas and further undergoes vitiation. As the pathology progresses vata gets stana samsraya in the sandhis, where it undergoes sammurchana with the dushyas concerned there in. Later when dosha dushya sammurchana gets completed the conditions gets manifested with clear cut signs and symptoms and will acquire the name sandhigata vata. The symptoms manifested depend on the structures involved in it. Sandhi shota gets manifested following impaired sravana when siras get involved during sthana samshraya. Similarly stambha may cause due to shoshana of asthi, snayu, and kandara. And Atopa is due to kshaya of shleshma and shleshma dhara kala. Eventually sandhi shula and vata purna druti sparsha will occur due to localized Vata in joints. Ultimately the condition can get worsen leading to destruction the joints making men crippled and dependent when the disease is not attended to. Page 93
  • DISCUSSION 2. The consumption of above said nidanas similarly lead to prakopa of other doshas i.e. pitta and kapha. These doshas get filled in the srothas and cause avarana of vata. As a result vata prakopa takes place. The vitiated vata later attains prasara and get localized in the sandhis. At the site of localization, the vayu undergoes sammurchana with the dushyas there in and in due course gets manifested with clear cut symptamatology. This causes the pathological entity called sandhigata vata. The condition can further progresses to the stage where complications are produced leading to destruction of the joints, if attention is not given in proper time.Discussion on Treatment principles: All Acharyas are given more importance to Palliative treatment than thePurificatory measures. Here main procedures explained are, Snehana and its differentforms like Abhyanga and Unmardana, Swedana (Upanaha), Bandhana andAgnikarma. Sandhigata vata is a disease which is restricted to individual joints and hencelocalized treatments for specific joints will be beneficial.Discussion on plan of study: The present study has been carried out on 40 patients treated in two groups,trial and standard selected from the OPD and IPD of A.L.N Rao Memorial AyurvedicMedical College and Hospital, Koppa. The criteria for selection of patients werebased upon the classical signs and symptoms. Page 94
  • DISCUSSION 20 patients of sandhigata vata were selected for trial group in whichTrayodashanga guggulu was given in the dose of 3 gms twice daily with ushna jala asanupana. Duration of the treatment is 60 days. 20 patients of sandhigata vata were selected for standard group in whichSimhanada guggulu was given in the dose of 3 gms twice daily with ushna jala asanupana. Duration of the treatment is 60 days. Follow up study was done for 60 days in 15 days visits. The improvement in the symptoms of diseases after the treatment was themain criteria of assessment. The total effects of the therapy were also assessed interms of complete relief, marked improvement, moderate improvement, improved andunchanged.Discussion on observation during study: 57 patients were registered for this study, 17 patients were dropped due tovarious reasons. Discussion regarding Observations of all the factors related to diseaseis as follows. 1. Age wise distribution – maximum patients in this study was around 55 – 65 years. The probable cause may be due to the hard work, degeneration due to old age. 2. Sex wise distribution – maximum patients were females nearly about 55%. In this, most of the females suffer from Janu sandhigata vata. The excess work load over the knee joint may be pre disposing factor for this disease. Page 95
  • DISCUSSION3. Religion wise distribution – 77.5% among the selected patients were Hindus because the area of the study were Hindu dominated area.4. Marital status – 92.5% of the patients in this study were married. Since this disease very commonly seen in last part of middle age majority of the patient were married.5. Economical status – maximum number of patients belongs to poor class, which is 70%. Due to lack of proper nourishment as well as excessive strains due to manual labor may be the predisposing factor for the disease.6. Occupational – 45% of this study were house wives and 32.5% were agriculturists.7. Habitat wise distribution – 92.5% were from Anupa pradesha since the area where the study belongs to Anupa desha.8. Discussion on duration of illness – duration of illness seen in to less than one year in majority of cases.9. Family history – maximum patients shown negative family history to this disease (80%). Page 96
  • DISCUSSION10. Discussion on nidra incidence – maximum number of patients suffered from disturbance of sleep (77.5%). It may be due to the pain and stiffness which does not allow sleeping.11. Discussion on prakruti of the patient – in most of the cases studied, the patients were vatapittaja prakruti.12. Discussion on weight incidence – in this study, most of the patients had the body weight in between the range of 61-70 kgs.13. Discussion on incidence of main lakshanas. –• Sandhishula – it was seen in all the patients.• Prasarana akunchana savedana – was seen in most of patients which disturbed their routine work.• Sandhi sthambha – was the symptom which reduced the working capacity of patients.• Sandhi shotha, atopa were also seen in most of the patients. Page 97
  • DISCUSSIONDiscussion on effect of treatment: Effect of treatment was assessed clinically.• After treatment The trial drug Thrayodashanga Guggulu gives highly significant (< 0.001)result in the Atopa (crepitus) i.e. 55%. It provided 40% relief in Tenderness which ismoderately significant (<0.010). Also it is moderately significant (<0.010) in Sandhishula (35%). The standard drug simhanada guggulu showed highly significant result(<0.001) in the Sandhi shotha (50%). It provided moderate significant (<0.010) resultin the Atopa (35%). And in the sandhi shula and tenderness showed moderatesignificant (<0.020) and the relief is 30%.• After follow up The trial drug Thrayodashanga Guggulu showed highly significant (< 0.001)result in Tenderness (65%). It showed highly significant result (< 0.001) in Sandhishula and Atopa (60%).The standard drug Simhanada Guggulu provided highlysignificant (<0.001) result in the Sandhi shotha (60%). It showed moderate significant(<0.010) result in the Atopa (45%) and in the sandhi shula and tenderness it providesmoderate significant (<0.010) result and relieved the symptoms 40%. So the trial drugshowed very significant result in the shula, atopa and tenderness. Where as standarddrug showed efficiency in Sandhi shotha.Over all effect of treatment on sandhigata vata: During the time of treatment (60 days) trial drug showed high significantresult in the Atopa (crepitus) and showed moderate significant result in the Sandhishula, Tenderness and Sandhi shotha where as the standard drug Simhanada guggulu Page 98
  • DISCUSSIONshowed high significant result in the Sandhi shotha and given moderate significantresult in the Sandhi shula, Tenderness and also in Atopa. In the follow period of 60 days, the patients observed in each 15 days visit.After that period the trial drug showed high significant result in the Sandhi shula,Tenderness and Atopa where as moderate significant result in the Sandhi shotha. Thecontrol group Simhanada guggulu had given high significant result in the Sandhishotha and moderate significant result in Atopa, Sandhi shula and Tenderness. Overall picture of the results obtained showed that both group were effectivein reducing all the symptoms but trial drug Trayodashanga guggulu showed highlysignificant in reducing symptoms such as Sandhi shula, Atopa and Tenderness. It alsobrought about long standing relief. The control drug Simhanada guggulu found highlysignificant in the Sandhi shotha and in rest symptoms it showed moderatelysignificant result.COMPARISON OF GROUPSInter group comparison after treatment NO GROUPS SYMPTOMS t- VALUE P- VALUE REMARKS 1 Trial &Std drugs Sandhi shula 0.587 >0.200 Trial = Std 2 Trial &Std drugs Tenderness 0.7417 >0.200 Trial = Std 3 Trial &Std drugs Atopa 1.057 >0.200 Trial = Std 4 Trial &Std drugs Sandhi shotha 0.083 >0.200 Trial = Std Page 99
  • DISCUSSION On the statistical analysis to compare the result obtained after 45 days oftreatment for Sandhi shula between the two groups, an insignificant result wasobtained which indicates that both the groups were equally effective in themanagement of Sandhi shula. Even on the other main complaints, Atopa, Tendernessand Sandhi shotha an insignificant result was obtained on the inter group statisticalevaluation which indicates that both the drugs were equally effective in themanagement of chief complaints.Inter group comparison after follow up NO GROUPS SYMPTOMS t- VALUE P- VALUE REMARKS 1 Trial &Std drugs Sandhi shula 1.253 >0.200 Trial = Std 2 Trial &Std drugs Tenderness 1.191 >0.200 Trial = Std 3 Trial &Std drugs Atopa 0.995 >0.200 Trial = Std 4 Trial &Std drugs Sandhi sotha 1.436 <0.200 Trial = Std Statistical evaluation for the inter group comparison after follow up periodshowed an insignificant result on all the chief complaints. A highly significant resultwas obtained for the Trial drug on Sandhishula, Atopa and Tenderness after thefollow up period compared to a moderate significant relief for the standard drug. Butthe inter group comparison between the two groups showed only a statisticalinsignificance. Thus it may be concluded that both the standard and trial drug were equallyeffective in management of chief complaints after the treatment as well as after thefollow up Page 100
  • DISCUSSIONProbable mode of action of TRAYODASHANGA GUGGULU: Ayurveda the science with a holistic attitude has considered all aspects ofdrug action, interaction, synergism, antagonism etc, in formulating the various yogasto make them safe and acceptable. In order to achieve this, the Ayurvedic seers haveformulated hundreds of formulations which could be selected depending upon thenecessity. Poly herbal and herbo mineral preparations have two basic components asingredients • Pharmocological components – This is divided in to Pharacodynamic and Pharmacokinetic components. • Pharmaceutical components – It includes media (Base), colouring agents, binding agents, flavouring agents, thinners, preservatives, etc. In a nut shell there are five basic components present in compoundformulations as ingredients. They are Activators, Potentiators, Antidotes, Bioavailability enhancers and Pharmaceutical agents.Activators: They are main ingredients, responsible foe achieving the requiredtherapeutic action.Potentiator: This group enhances the activity of the formulations.Antidote: It will minimize or nullify the adverse drug reactions if any. Page 101
  • DISCUSSIONBio availability enhancers: The drugs in this group enhance the bio availability ofthe drug in the body.Pharmaceutical agents: the ingredients useful in preparation of formulations such asbinding, colouring agents, etc. Thus every formulation will have one or the other ingredient which resultingin to safe easily acceptable by the system and exhibits utmost therapeutic effects. While considering Trayodashanga guggulu the ingredients can be classified inthe similar way.Activator: The formulation has the main therapeutic action as vedana sthapana andshothahara which is attributed by the presence of Guggulu as a major ingredient.Potentiator: The ingredients namely Vrudhadaru, Guduchi, Shathavari,Ashwagandha, Rasna and Grutha are included under this category as it does theregeneration of bodily elements by their properties such as Vatasamana, Rasayana andBalya. Thus it enhances the action of the formulations and are useful in thelongstanding usage of the drug.Antidote: Guggulu being a resin does not dissolve in the system easily. In largerdoses it can cause constipation, burning sensation in G I tract-urine-eyes etc. This iscounteracted by Vrudhadaru which is a mild laxative, Thriphala which is used at thetime of Shodhana of the Guggulu acts as chakshushya. Gokshura and Hapusha are Page 102
  • DISCUSSIONDiuretics and Shothahara. Abha acts as potent Shothahara dravya and is helpful inreducing GIT, GUT inflammations.Bio availability enhancers: Nagara, Shati, Shathapushpa, Ajamodha, Yavani, Gruthaare having Deepana, Pachana activity and it is said to improve the dhathwagni.Various studies have shown the effect of Nagara as bio availability enhancers.Probable mode of action of SIMHANADA GUGGULU:Activator: The formulation has the main therapeutic action as vedana sthapana andshothahara which is attributed by the presence of Guggulu as a major ingredient.Potentiator: Here Triphala is considered as potenciator as it does the action of antiinflammatory. Eranda thaila also considered as Vatanulomaka so it reduces pain andshotha.Bio availability enhancer: Gandhaka is considered as bio availability enhancer as itenhances the bio availability of the other active principles present in the formulation. Page 103
  • CONCLUSION CONCLUSION • Sandhigata vata is a vyadhi produced due to the Vyana vata prakopa. • Gata vata is the condition in which Vata will be in predominant state and the condition of the vata should be cared while applying treatment principles. • While considering nidanas, both Dhatukshayakara and margavarodhakara are responsible for producing the disease Sandhigata vata. • This disease is considered as Yapya, because it affects joints which are the madhyama roga marga. • The treatment or treatment procedures which give snigdhata, ushnata, Ghana is useful in this condition. • In classics, they more emphasized on palliative measures than the purificatory treatments. • Sandhigata vata afflicts predominantly in elder persons (51-70yrs), hard workers and also in females. • The trial drug showed excellent response on reduction of the symptoms and in degenerative process. • The standard drug showed outstanding result in the reduction of Sandhishotha. • Sandhigata vata is easy to cure if the disease is of recent origin.Limitations: • The size of sample was small to draw a generalized conclusion. • The period of study was limited. • The study was limited to the patients who attended the OPD wing of A.L.N.Rao Memorial Ayurvedic Medical College, Koppa.Recommendation of further study:• The study can be repeated with large sample and longer duration.• Same formulation can be tried along with specific panchakarma therapies and other drugs. Page 104
  • SUMMARY SUMMARY The dissertation entitled “Management of Sandhigata vata withTrayodashanga guggulu – A Clinical evaluation” has been carried to find out theclinical efficacy of Therapeutic drug combination Trayodashanga guggulu on thepatients of Sandhigata vata. This study comprises of following topics,Introduction: Gives the explanation about qualities of healthy person, importance of vataphysiologically as well as pathologically and brief introduction about trial drugTrayodashanga guggulu.Objectives: The main aim and objectives of the study has been mentioned along with thehypothesis under this heading. 1. Review of literature: This chapter comprises of following headings, Diseasereview and Drug review. Disease review dealt under the following headings. Historical aspect – givesthe historical glimpses with regards to the disease sandhigata vata and traces thevarious developments right from the vedic period to present era. Here referencesregarding the vata dosha, its diseases and the diseases of joints are presented. Under the heading of etymology the description about Sandhi and differentconstituents which forms the Sandhi and also concept about gata vata has beenmentioned. Page 105
  • SUMMARY Detailed data wise collection about Nidana, Poorva roopa, Roopa, Samprapti,Sadhya-asadhyata, Upadrava and Chikitsa along with Pathya-apathya of the diseasealong with some modern aspects of Osteoarthritis have been dealt. In drug review section, a thorough study of the ingredients of the compoundpreparations covering the botanical nomenclature, rasa, guna, veerya, vipaka,chemical constituents etc. 2. Methodology: • Clinical study – Under this heading detailed description of the clinical study with specific reference to patients, grouping, selection, inclusion and exclusion criteria, protocol, criteria for assessment of signs and symptoms, dose, duration of the study is mentioned. • Observational study – Here a detailed explanation is given on the distribution of the patients according to age, sex, economical status, diet, habits, marital status are represented along with tables and charts. • Preparation of the drug - Here a detailed explanation regarding the preparation of the compound drug has been mentioned in detail. 3. Results: In this, results of the study analyzed statistically, compared and are presented in tables and graphs. 4. Discussion: Under this heading, discussion regarding nidanapanchaka, chikitsa and results obtained from this study have been described. The probable mode of action of the trial drug and control drug was discussed on the basis of rasapanchakas. 5. Conclusion: In this chapter the conclusion of the above study is done by highlighting the outcome of the study along with limitation of study and the scope of further improvement. Page 106
  • REFERENCES ReferencesIntroduction: 1. Ch.Su. 21/18-19Ka.Khi. 5/6-8. 2. Ch.Su 12. 3. Ch.Su. 13/8 4. C.D. 22/72-75.Disease review: 5. R.V. 10/163/6. 6. A.V. 6.14.1, 1/12/3. 7. R VII 35, 60, 61. 8. M.B. 12.46.3, 47..66, 155.6, 185, 24-25, 328.26-53 9. A.G.Pu 370//33, 28/40-41. 10. Kt 3/10. 11. Ct 4/16/1, 4/3/1 12. Ch.Chi 28/37. 13. Su. Ni 1, Su.Chi. 5/50-54. 14. Bh. Sa. Ci 24/48-54. 15. H.S.Tr. 20/14. 16. AH. Ni 15/4, AS. Ni. 1/5. 17. M.N 22/21 18. B.P 24/258 19. C.D Chi. 22/9 20. B.R 26/14 21. Y.R 30/119 22. Bas. Raj 6ht prakarana 23. B.Su 25/36, 26/23 24. P.Su 5/1/38, 5/2/129Etymology : 25. S.K.D Vol. 5 P. 240-2 26. Su.Sha 5/28, Ch.Sha 7/14, Ch.Vi 5/8, A.H Sha 3/16 27. Su.Su 15/1 28. Dalhana – Su.Su 15/1 29. A.H Su 12/7 30. Dalhana Su.Su 15/4 31. Su Ni 1/18 32. Dalhana – Su Ni 1/18 33. Gayadasa – Su Ni 1/18 34. H.S Thritheeya sthanaAnatomical aspect of Sandhi: 35. Su Su 5/24-5 36. Su Sha 5/27 37. A.H Sha 3, Su Sha 5/30 38. A.H Sha 3/10, Su Sha 4/15 39. Su Sha 6/18-20 40. Su Sha 6/38 41. Su Sha 6/4 42. Su Sha 6/15
  • REFERENCES 43. Dalhana – Su Sha 6/4 44. Davidson Pg no. 761Nidana: 45. Su Su 3/14 46. Ma Ni 1/5 47. Ch.Su 12/7, Su Su 21/19, A.S Ni 1/5 48. Ch. Chi 28/15-18,Su Ni 1,B.P MK 24/122,Y.R, Bas. Raj 6th , H.S Thr. 20th 49. A.H Su 12/24-5 50. Ch Vi 8/99Poorvarupa: 51. M.N 1/6 52. Ch Chi 28/24Roopa: 53. M.N 1/7 54. Ch Chi 28/48 55. Su Ni 1/28 56. A.S Ni 15/12 57. A.H Ni 15/14-5 58. B.P MK 24/258 59. Y.R 30/24 60. M.N 22/21 61. Bas. Raj 6th prakarana 62. Dalhana – Su Ni 1/28, A.D – M.N 22/21 63. Madhukosha – M.N 22/21 64. Gayadasa – Su Ni 15/7 65. Su Su 17/7 66. Su Su 17/3 67. Arunadatta – A.H Ni 15/14-5 68. A.S Ni 16/28 69. Y.R 1stUpashaya and Anupashaya: 70. M.N 1/8-9Samprapthi: 71. M.N 1/10 72. Ch Vi 5/9 73. A.S Su 20/2 74. Chakrapani – Ch Chi 28/18-9 75. Ch Su 12/7 76. Ch Ci 28/59 77. A.H Ni 15/5-6 78. Ch Chi 28/61 79. M N 43/8, Su Su 15/5, Ch su 21
  • REFERENCESUpadrava: 80. Ch Chi 21/40Sadhyasadhyatha: 81. Su Su 33/4 82. Ch Chi 28 83. H.S Thr. 20Chikitsa: 84. A.K 2/6/50 85. Su Chi 4/18 86. A.S Chi 23/3 87. A.H Chi 21/22 88. B.P MK 24/259 89. Y.R 30/119 90. B.R 26/14 91. CD 22/9 92. Ch Su 22/11 93. Ch Ni 1/39 94. Ch Su 13/9 95. Ch su 13/14-7 96. Ch Su 5/86 97. Dalhana – Su Chi 24/30-4 98. M.F.H.H pg.no:14 99. Dalhana – Su Chi 32/12 100. Su Chi 33/14 101. Ch Su 14/64 102. Chakrapani – Ch Su 14/64 103. Su Su 12/1 104. Su Su 12/10 105. Su Su 12/4-5 106. Su Su 12/3 107. Su Su 41/4 108. Ch Sha 8/32 109. Ch Su 14/13 110. A.S Su 26/10 111. A.S Chi 23Pathyapathya: 112. Ch Su 25/45 113. Y.R 30/414-17 114. B.R 26 115. Y.R 30/418-9 116. B.R 26Differential diagnosis: 117. M.N 23/13, Ch Chi 29/24-9 118. M.N 25/6 119. H.P.I.M
  • REFERENCESDrug review: 120. J.L.N. Pg. no 826. 121. J.L.N. Pg. no 375 122. J.L.N. Pg. no 968. 123. J.L.N. Pg. no 33. 124. J.L.N. Pg. no 540. 125. J.L.N. Pg. no 98. 126. J.L.N. Pg. no 821. 127. J.L.N. Pg. no 258. 128. J.L.N. Pg. no 972. 129. J.L.N. Pg. no 269. 130. J.L.N. Pg. no 871. 131. J.L.N. Pg. no 857. 132. J.L.N. Pg. no 113. 133. J.L.N. Pg. no 209. 134. J.L.N. Pg. no 216. 135. J.L.N. Pg. no 220. 136. J.L.N. Pg. no 483. 137. R.R.S 3/18-19
  • BIBLIOGRAPHY BIBLIOGROPHY1. A.F.I of India, Part-1, Published by The controller of publications civil lines, Delhi, 2000.2. Acharya Bhavamishra - Bhavaprakasha Nighantu, commented by Ganga Sahay Pandey & Dr. K.C.Chunekar Chaukambha Bharati Academy, Varanasi.Reprint- 1999.3. Acharya Bhavamishra – Bhavaprakasha Samhita, Hindi commentary by Shree Brahmashankara Mishra and Shree Rupalaji Vaishya, Chaukhamba Sanskrit sansthan, Varanasi, 6th edition; 1997.4. Acharya Cakrapani Datta- Cakradatta, English translation by Sharma P.V., Chaukhamba publishers, Varanasi, 2nd edition; 1998.5. Acharya Charaka - Charaka Samhita, English translation by Sharma P.K. and Bhagawan Dash, Chaukamba Sanskrit Series Office, Varanasi, 2nd edition; 1996.6. Acharya Charaka – Charaka samhitha, with Ayurveda dipika commentary of Chakrapani, Krishnadas Academy series, Varanasi, edition; 20007. Acharya Kashyapa- Kashyapa Samhitha, English translation by Tewari P.V.Chaukhamba Visvabharati, Varanasi, 1st edition; 1996.8. Acharya Madhavakara- Madhavanidana English translation by Srikantha Murthy K.R., Chaukhamba Orientalia, Varanasi, 2nd edition; 2001.9. Acharya Madhavakara- Madhavanidana, with Madhukosha commentary of Srikantadatta and Atanka darpana commentary by Vachaspathi, Chaukhamba Orientalia, Varanasi, 2nd edition; 2001.6th edition;2001.10. Acharya Nripa Madanapala – Madanapala Nighantu, Laxmi Venkateswara Press, Bombay, 1st edition; 1969.
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  • DEPARTMENT OF KAYACHIKITSA A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE , KOPPA-577126. CASE PEROFORMA FOR MANAGEMENT OF SANDHIGATA VATA WITH THRAYODASHANGA GUGGULU A CLINICAL EVALUATIONP.G.Scholar : Dr.Guruprasad.A. .B.A.M.S Guide: Dr.P.K.Mishra M.D(Ayu)., (RSU) PART-A –EXAMINATIONName: Group:Age ……… Yrs,Sex M/F Sl.no :Religion: H/M/C/J OPD/IPD:Education: UE / P/ M / H /G Ward/Bed no:Marital status: M / U / W / D D.O.A :Social status: VP/ P/ LM / M /UM / R / VR D.O.D :Occupation: HW / W / B / S / E Diagnosis:Desa : J /A/SLocality: Urban /Rural Result :Address:Main complaints: Duration B.T A.T A.F.U I II III1. Sandhi Sotha2. Sandhi Shoola3. Tenderness4. Sandhi AtopaHistory of Present illness: 1. Sandhi shoola: Onset : Insidious / Gradual / Acute Course : Progressive / Relapsing / Stationary Character : Dull aching / Deep pain / Pricking Shooting / Excruciating Aggravating factor :- Food : BF / AF Time : M / A / E /N Movement : Squatting / Walking / Climbing stairs / Rest 1
  • Relieving factor :- Food : BF / AF Time : M / A / E /N Rest : Yes / No Seasonal : SHI / V /G/ VA/ SHA/ H NSAIDs : Yes / No 2. Sandhi shotha : Onset: Sudden / Gradual Course: Progressive / Relapsing / Stationary Character: Pitting / Non pitting Site: Anterior / Posterior Colour: Aruna / Shyama / Swetha Aggravation: Food : BF / AF Time : M / A / E /N Movement : Squatting / Walking / Climbing stairs / Rest Relieving factor :- Food : BF / AF Time : M / A / E /N Rest : Yes / No Seasonal : SHI / V /G/ VA/ SHA/ H NSAIDs : Yes / No 3. Stiffness: Morning…….min / After walking…..Min / After rest…min 4.Atopa (Crepitus): Palpable / Audible / Fine coarsePast History : Past illness : Injury to the joint : Yes / No Treated : Yes/ No : If treated Ayurveda / Allopathic / Homeopathic /OtherFamily History: 2
  • Gynaec History : M.C. day R IR : Menarche yr : Menopause yr Menorrhagia / Dysmenorhoea / Metrorrhagia / LeucorrhoeaPersonal History :Habits : Habits Duration / Occasional / Stopped / Relationship Continued Regular Reduced to Symptom Smoking Alcohol Tobacco Snuff OthersAhara : Nature : Veg / mixed Quality : Alpa / Pramita / Sama / Atipramana Rasa: M / A / L / K / T / Ka / Sarva rasa Guna : Ruksha / Snigdha / Ushna / Sheeta / Guru / Laghu Dietetic habit : Matrashana / Vishamanasana / Adhyasana Virudha ashana / AnasanaNature of work : Sedentary / Labour / Sitting / Travelling / Walking / Standing / Day / NightVishrama : Proper / Less / ExcessiveVyayama : No / Less / Proper / Excessive / IrregularNidra : Sound / Disturbed / Ratri Jagarana / Divaswapa 3
  • General Examination :1. Pulse : /min R IR RIR IIR Full Bounding Feeble2. Blood pressure : / mm of Hg3. Temperature : F4. Respiratory rate : /min5. Nourishment : Good / Moderate / PoorDasha Vidha Pareeksha : Prakrititah : V / P / K / VP / VK / PK / VPK Vaya : Bala / Yuva /Madhyama / Vriddha Vikrititah : P/M/A Samhanana: P/M/A Satva : P/M/A Pramana : P/M/A Satmya : P/M/A Aharashakti : * Abhyavarana P/M/A * Jarana P/M/A Sara : P/M/A Vyayama Shakti : P/M/ASroto Pareeksha : Pranavaha : Prakrita Vaikrita Udakavaha : Prakrita Vaikrita Annavaha : Prakrita Vaikrita Rasavaha : Prakrita Vaikrita Raktavaha : Prakrita Vaikrita Mamsavaha : Prakrita Vaikrita Medovaha : Prakrita Vaikrita 4
  • Asthivaha : Prakrita Vaikrita Majjavaha : Prakrita Vaikrita Sukravaha : Prakrita Vaikrita Artavavaha : Prakrita Vaikrita Swedavaha : Prakrita Vaikrita Mutravaha : Prakrita Vaikrita Purishavaha : Prakrita VaikritaSystemic Examination : C.V.S. : R.S. : C.N.S. : P/A :Locomotor System : Examination of effected joint: Effected joint(joints): Inspection: Redness / Swelling / Deformity Palpation : Tenderness :- Present /Absent Temperature : - Present /Absent Swelling :- Present /Absent Movement : Painful / No pain / RestrictedInvestigations: Hematological : E.S.R. R.A 5
  • X-Ray Rt / Lt Ap / LSamprapthi GhatakaNidana : Aharata Viharata Sannikrishta ViprakrishtaRoopa :Dosha :Dooshya :Srothas :Udbhava sthana :Sanchara sthana :Roga marga :Sthana samshraya:Vyakta sthana :Adhishtana :SampraptiVyadhi vinischayaSadhya SadhyataChikitsaResultDiscussionSignature of Student Signature of GuideDr. Guruprasad. A Dr. Pramod Kumar Mishra BAMS. M.D (Ayu),(RSU) 6
  • ASSESSMENT CRITERIASandhi shula PointsNo pain [no pain at rest / no pain while walking] - 0Mild pain [no pain at rest or mild tolerable pain while walking] - 1Moderate pain [mild pain at rest, tolerable and moderate pain while working] - 2Severe pain [disturbance of sleep due to pain orpain at rest or untolerable pain during working] - 3Atopa of sandhi:No crepitus - 0Palpable crepitus - 1Audible crepitus - 2Tenderness:No pain on pressure - 0Pain on pressure and winces - 1Patient withdraws affected part while giving pressure - 2Patient does not allow to touch - 3Sandhi shotha:No swelling - 0Swelling is present slightly in joints - 1Swelling covering the bony prominence of affected joints - 2Swelling much elevated so that the joints seems grossly deformed - 3 7
  • POST GRADUATE STUDIES AND RESEARCH CENTRE DEPARTEMENT OF KAYACHIKITSA A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE KOPPA-CHIKMAGALUR PATIENT CONSENT FORMI __________________________________________ exercising my free power of choice, hereby giveyou my complete consent to be included as a subject in the Clinical trial on “Management ofSandhigata vata with Trayodashanga guggulu – A Clinical evaluation”. I have been informed tomy satisfaction by the attending Doctor, the purpose of the Clinical Trial and the nature of drugtreatment, therapeutic procedures, follow-up and probable complications. I am also ready to undergonecessary Laboratory Investigations to monitor and safeguard my body functions. I am also aware of my right to opt out of the trial at any time during the course of the trialwithout having to give the reasons for doing so.Signature of the Doctor Signature of the Patient/ Guardian (£Á£ÀÄ N¢/ N¢¹ CxÀð ªÀiÁrPÉÆAqÀÄ ¸À» ºÁQgÀÄvÉÛãÉ.) 8