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Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the management of Sandivata By Dr. Shivakumar.C.Sarvi, Department of Kayachikitsa, Post graduate studies and research …

Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the management of Sandivata By Dr. Shivakumar.C.Sarvi, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • 1. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the management of Sandivata By Dr. Shivakumar.C.SarviDissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. In KAYACHIKITSA Under the guidance of Dr. V. VARADA CHARYULU, M.D. (Ayu) And co-guidance of Dr. RAGAVENDRA. V. SHETTER, M.D. (Ayu) Post graduate department of Kayachikitsa, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006. 1
  • 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled“Evaluation of the Efficacy of Abhadi choorna and Ksheerabala tailaJanubasti in the management of Sandivata.” is a bonafide and genuineresearch work carried out by me under the guidance ofDR. V. VaradaCharyulu, , Professor and H.O.D, Post-graduate M.D. (Ayu)department of Kayachikitsa and co-guidance of Dr. Ragavendra. V. Shetter, , Post graduate department of Kayachikitsa.M.D.(Ayu)Date: Signature of ScholarPlace: Gadag Dr.Shivakumar.C.Sarvi 2
  • 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in themanagement of Sandivata” is a bonafide research work done by Dr.Shivakumar.C.Sarvi in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Kayachikitsa).Date:Place: DR. V. VaradaCharyulu, M.D. (Ayu). Professor & H.O.D Post graduate department of Kayachikitsa. 3
  • 4. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in themanagement of Sandivata” is a bonafide research work done by Dr.Shivakumar.C.Sarvi in partial fulfillment of the requirement for the degreeof Ayurveda Vachaspathi. M.D. (Kayachikitsa).Date: Dr. Ragavendra. V. Shetter, M.D. (Ayu)Place: Assistant Professor, Post graduate Department of Kayachikitsa 4
  • 5. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation ofthe Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in themanagement of Sandivata” is a bonafide research work done by Dr.Shivakumar.C,Sarvi under the guidance of DR. V. VaradaCharyulu, M.D. (Ayu) ,Professor and H.O.D, Postgraduate department of Kayachikitsa and co-guidance of Dr. Ragavendra. V. Shetter, M.D.(Ayu) , assistant professor Postgraduate department of Kayachikitsa.DR. V. VaradaCharyulu, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Kayachikitsa. 5
  • 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation / thesis in print or electronic format for academic / researchpurpose.Date: Signature of ScholarPlace: Gadag Dr. Shivakumar.C.Sarvi© Rajiv Gandhi University of Health Sciences, Karnataka. 6
  • 7. LIST OF ABBREVIATIONS USED AS – Ashtanga Sangraha AH – Ashtanga Hridaya Aru. – Arunadatta A.T – After treatment B.T – Before Treatment B.P – Bhavaprakasha B.R – Bavarajeeyam Bh.S – Bhela Samhita Ca.S – Charaka Samhita Chi. – Chikitsa Sthana Chak. – Chakrapani Dal. – Dalhana S.L.R - Straight leg raising Gang. – Gangadhara K.S – Kashyap Samhita M.N – Madhav Nidana Ni. – Nidana Sthana N.S – Not Significant SU.S – Sushruta Samhita Sa.S – Sharangadhara Samhita Sha.S – Shareera Sthana Su. – Sutra Sthana Si. – Siddhi Sthana Vi. – Vimana Sthana Y.R. – Yoga Ratnakara
  • 8. LIST OF TABLESSl. Contents PageNo No01 Samanya nidana of Sandhivata 1102 Roopa of Sandhivata mentioned in various classics 1903 Vyavachedakanidana between Sandhivata & Vataraktha 2004 Vyavachedakanidana between Sandhivata & Amavata 2105 Vyavachedakanidana between Sandhivata & Krostukashirsha 2106 Differential diagnosis between O.A, R.A,Gout & Rheumatic 22 fever07 Chikitsa sutra mentioned in different Samhita 4208 Grading of parameters09 Demographic data related to evaluation of Abadi churna in 74 Sandhivata10 Demographic data related to Evaluation of Ksheerabala taila 75 Janubasti in Sandivata11 Distribution of patient according to age among groups. 7612 Distribution of patient according sex among groups. 7713 Distribution of patient according to occupation 7814 Distribution of patient according to Economical status 7915 Distribution of patient according to Religion 8016 Distribution of patient according to Diet 8117 Distribution of patient according to affected to leg of Sandhivata 8218 Distribution of patient according to Agni 8319 Distribution of patient according to Koshta 8420 Distribution of patient according to Habits in patients 8521 Distribution of patient according to Prakriti of patients 8622 Distribution of patient according to different nidana bhavas. 8723 Distribution of patient according to Chronicity of the disease 88 among groups24 Showing the incidence of Swelling in the patients 8925 Showing the incidence of walking time in the patients 9026 Showing the incidence of range of Flexion deformity in the 91 patients.27 Showing the incidence of Pain in the patients. 9228 Showing the incidence of Stiffness in the patients. 9329 Showing the incidence of Tenderness in the patients. 9430 Showing the incidence of Crepitus in the patients 9531 Showing the incidence of Weight of the body in the patients 9632 Master Chart – Subjective Parameter – Group- A 9733 Master Chart – Objective Parameter – Group- A 9734 Master Chart – Objective Parameter – Group- B 9835 Master Chart – Subjective Parameter – Group- B 9836 Statistical Assessment of Individual Study Group – A 99 (Subjective& Objective Parameter)37 Statistical Assessment of Individual Study Group – B (Objective 99 Parameter)
  • 9. 38 Statistical Assessment of Comparative study of Group – A with 100 Group – B39 Over all assessment 102 LIST OF PHOTOS, FLOW CHARTS AND GRAPHS Sl. No Name of the Figure Page No 1. Photo showing Drugs used in clinical trail 2. Photo showing Janu basti procedure 3. Flow chart of Samprapti of Sandhivata List of Graphs 1 Distribution of patient according to age among groups. 76 2 Distribution of patient according sex among groups. 77 3 Distribution of patient according to occupation 78 4 Distribution of patient according to Economical status 79 5 Distribution of patient according to Religion 80 6 Distribution of patient according to Diet 81 7 Distribution of patient according to affected to leg of 82 Sandhivata 8 Distribution of patient according to Agni 83 9 Distribution of patient according to Koshta 84 10 Distribution of patient according to Habits in patients 85 11 Distribution of patient according to Prakriti of patients 86 12 Distribution of patient according to different nidana 87 bhavas. 13 Distribution of patient according to Chronicity of the 88 disease among groups 14 Showing the incidence of Swelling in the patients 89 15 Showing the incidence of walking time in the patients 90 16 Showing the incidence of range of Flexion deformity in 91 the patients. 17 Showing the incidence of Pain in the patients. 92 18 Showing the incidence of Stiffness in the patients. 93 19 Showing the incidence of Tenderness in the patients. 94 20 Showing the incidence of Crepitus in the patients 95 21 Showing the incidence of Weight of the body in the 96 patients 22 Over all assessment 102
  • 10. TABLE OF CONTENTS Chapters Page No.1. Introduction 1- 32. Objectives 43. Review of literature 5-574. Methodology 58-725. Observation and Results 73-1026. Discussion 103-1127. Conclusion 1138. Summary 1149. Bibliography 115-12510. Annexure
  • 11. ABSTRACT Sandhi-Gata-Vata (osteoarthritis) is common amongst the elderly andobese persons. Since knee is the weight bearing joint it is more susceptible to wear andtear. Sandhi-Gata-Vata (osteoarthritis) resulting in wear and tear of this joint termed asSandhi-Gata-Vata. It is largely seen in the population and known to be major cause forchronic disability. The objectives of this study are 1) To evaluate the efficacy of abhadichurna in the management of sandhigatavata (osteoarthritis), 2) To evaluate the efficacyof ksheera bala tail janu basti in the management of sandhigatavata (osteoarthritis) and The aim of this study was to find out the effect of Abhadi choorna in themanagement of Sandhigathavata and to check its advantage of ksheera bala tail janu bastiin managing the same disease. Therefore, two groups were made and the results obtainedin both the individual groups. The study design selected for the present study wasprospective clinical trial. In-group A (Abhadi choorna), not a single patient had good response tothe treatment (> 75% improvement in all the parameters) and 4 patients (26.6%) hadmoderate Response to the treatment (50-75% improvement in all parameters) and11(73.3%) patients had poor response. In group B (Ksheera bala tail janu basti), 1 patienthad good response to the treatment and 7(46.6%) patients had moderate response to thetreatment, 7(46.6%) patients had poor response in both the groups A and B theparameters showed high significance but in comparison parameters showed nonsignificant value.
  • 12. Sandhigatavata is a Vatavyadhi affecting people in the vardhakya avastha.The disease is characterized by dhatu kshaya and lakshanas reflective of vitiated Vata.Therefore, the agents/therapies of brimhana-shoolahara-stambhahara-balya propertiesshould be used in this disease. Janu basti imparts Snehana & Swedana and opens up thesrotas in the shareera facilitating more nourishment and free movement of Vata dosha.This results in the relief of stambha and facilitates free movement of the sandhis. All thedrugs in the Abhadi choorna are having shoolahara Srotoshodhaka balya, Rasayanaproperties; it is an ideal treatment of choice in Sandhigatavata.Key words: - Abhadi choorna; Sandhigatavata; Osteoarthritis; Janu basti Dhatu kshaya;Degeneration.
  • 13. Acknowledgement One of the great pleasure of life is doing the things that others says youcannot do it, by the grace of god, bless of eiders I take this opportunity to express myregards to the persons who helped in completing this work. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Gavisiddheshwara mahaswamiji for their divine blessings. I express my obligation to my honorable Guide Dr. V. Varadacharyulu M.D(Ayu), H.O.D., P.G. Department of Kayachikitsa, P.G.S & R, D.G.M.A.M.C, Gadagfor his critical suggestions and expert guidance for the completion of this work. I am extremely grateful and obliged to my co-guide Dr.Raghvendra.V.Shettttar M.D, Asst. Professor, P.G.S.&R, D.G.M.A.M.C, Gadag forhis guidance and encouragement at every step of this work. I acknowledge my sincere gratitude to Dr. K. S. R. Prasad , Professor for theirsincere advices and assistance. I express my sincere and deep gratitude to Dr.G.B.Patil, Principal,D.G.M.A.M.C, Gadag, for his wholehearted encouragement as well as providing allnecessary facilities for this research work. I express my sincere gratitude to Dr. G. Purushothamacharyulu, Dr.M.C.Patil,Dr. Mulgund, Dr. P.Shivaramadu, Dr. Dilipkumar, Dr. Danappagoudar, Dr. KuberSankh, Dr. Santhosh. N.Belavadi, Dr. Jagadish metti, Dr. Nidagundi Dr.Shankergouda and other PG staff for their constant encouragement. I express my sincere thanks to my colleagues and friends Dr. B. L. Kalmat,Dr. Venkareddy, Dr. Uday Kumar, Dr. Ratna Kumar, Dr. S. C. Sarvi, Dr. Krishna. J,Dr. Umesh, Dr. Ashok. Akki, Dr. Ashok. M. G, Dr. Shekar Sharma, Dr. Shivaleela,Dr. K. M. Angandi, Dr. Sulochana, Dr. Sanjeeva, Dr.Niraj kumar, Dr. Prasanna Joshi,Dr. Vijaylakshmi, Dr. Veena. J, Dr. Manjunath. Akki, Dr. Suresh. N. Hakkandi, Dr.Ashwini Dev, Dr. Vijay Hiremath, Dr. L.R.Biradar, Dr. Santhosh.L.Y, Dr. Satish. R,Dr. Sharnbasappa Angadi, Dr. Anand H, Dr. Anitha, Dr. Jagadisha and other postgraduate scholars for their support & my room mates Manju, Santosh, Manthesh. I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moralsupport and special care in providing the all the facilities during this trail work. I thank Dr. B. G. Swami, Dr.U.V.Purad, Dr. Paradi, Dr.Shankergouda,Dr.B.M,Mulkipatil and other undergraduate teachers for their support in the clinical
  • 14. work. I thank to Shri. Nandakumar (Statistician), Shri.V.M.Mundinamani (Librarian),Mr.Surebana and other hospital and office staff for their kind support during mystudy. My cordial thanks to Dr. J.C.Shirol, Dr.V.C.Shirol, Dr. Karanth, Dr.Srinivasinternees for their significant contribution during my profession. Indeed, I will cherish the affectionate of my Mother, my Father,Smt.Shanthabai, Dr. Channaveerappa. Sarvi my sister Laleetha, brother-in-lawShashidar, my brother Mr. Mallikarjun and Babi, Smt. Suma all my family memberswho have been a source of inspiration for my entire carrier. I acknowledge my patients for their wholehearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. Finally I dedicate this work to who are the prime reasons for all my success.Date: Signature of the scholarPlace: (Dr.Shivakumar.Sarvi)
  • 15. IntroductionIntroduction Sandhigatavata is the most common form of joint disorder. It is a majorcause of morbidity and disability as well as burden on healthcare resourcesespecially for the elderly. This disease keeps an insidious attack, which runs formany years causing the loss of function as well as deformity of the jointsespecially weight bearing joints like knee joint. Among elderly knee OA is theleading cause of chronic disability and some 1,00,000 people in the United Statesare unable to walk independently from bed to bathroom because of knee OA.1 The shortest description of this disease is available in Charaka2, Sushruta3and Ashtangahridaya.4 The later authors explained the clinical aspect of thisdisease in the wordings of either Charaka or Sushruta. So detail description ofSandhivata is not available in Ayurveda. But in contemporary science a greatwork has been carried out in this filed. Now researches are going on not only onindividual joints but they are concentrating on different sites within the joints.Eg, patellofemoral compartment Vestibio femoral. There have been advances in understanding of this disease. No longer isosteo-arthrosis regarded as a simple consequence of aging and cartilagedegeneration. Indeed, the former diagnostic label of ‘degenerative joint disease’is now recognized to be a ‘misnomer’. A single definition of Osteoarthritisremains elusive. A workshop held in 1995 proposes following consensusdefinition. “Osteo-arthritis disease is the result of both mechanical and biologicalevents that destabilize the normal coupling of degradation and synthesis ofarticular cartilage chondrocytes and extra cellular matrix and subchondral bone.” Though there is a lot of an advance in understanding of this disease, day-by-day the disease has become a problem. As a constellation of clinical andanatomical features, analogous to heart failure, indeed OA might with advantageEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 1 the management of Sandigatavata
  • 16. Introductionbe renamed ‘joint failure’. Management of this disease is facing lot of difficulties.Contemporary science has failed to find a solution for this disease. It is clearlysaid that current treatment of Osteo-arthrosis is purely to control symptomsbecause there is no disease modifying Osteo-arthrosis drug yet. Intra articularsteroids are widely used in OA particularly for the knee, these injections mayprovide marked symptomatic relief for weeks to month. Because studies inanimal models have suggested that glucocorticoids produce cartilage damage, andfrequent injections of large amounts of steroids have been associated with jointbreakdown in humans, the injection should generally not be repeated in a givenjoint more often than every 4 to 6 months. From the very early ages Indian physicians have identified and recordedan innumerable herbs and minerals. Their studies were so accurate and extensivethat they still continue to provide a strong basis for the practice andexperimentations. In the present study, after consolidating all these views a package therapywas planned, this includes Abhadi choorna5 taken orally & ksheerabalataila Janubasti.6 The present study was carried out to assess the efficacy of classical line oftreatment in Sandhivata, with the aim to study the role of Abhadi choorna orally& Ksheera bala tail, Janubasti in the management of Sandhivata. Assessment wasmade on the basis of symptomatology. In the study an attempt is made to analyzeEtiopathogenesis, nidana and symptoms of Sandhivata based on informationavailable in contemporary science. In spite of the scientific advancement in the field of Medicine, a largenumber of people suffer from OA all over the world without a permanent relieffrom this disease. As such the demand and need for suggesting complete, Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 2 the management of Sandigatavata
  • 17. Introductioncomplacent solace was felt. A sincere, dedicated research work was carried outand the same is humbly placed before ‘scholarly jury’ for consideration andacceptance.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 3 the management of Sandigatavata
  • 18. ObjectivesObjectives of study The life style of the man has become mechanical. The timeand more desires have made the man unable to fallow the Swastha niyamas thereby becoming victim for the diseases. The man today even in his young adult agesuffering from the degenerative diseases like Sandhivata the conditions where thepain and swelling in the joints are present. Giving rise to the restrictedmovements,7 and also it is not a single disease rather it is end result of Varity ofpatterns of joint failure together or lesser extent it is always characterized by thedegeneration of articular cartilage and simultaneously proliferation of new bone.Radiological autopsy studies show that oesteoartritis prefentially targets onlycertain small and large joints there is steady rise in over prevalence from age 60 –65, 80% of people are having some radiological evidence of O.A. though only 20– 30 % have associated symptoms. Knee O.A is more prevalent & the over allprevalence of the disease in the population above 40 years of age is about 49 %with male to female ratio 1:1.8 Contemporary medical science is able to pacify thepain full conditions of above said disease through highly effective analgesics andanti-inflammatory drugs. If needed through the surgical method and ultimatelygive rise to complication & least effective. So to over come the degenerativeprocess in young adult age pacify the pain contemporary medical science is usingNSAIDS but larger anti inflammatory drugs are usually no more effective andcarry on increased risk of gastric erosion or hemorrhage in elderly distinctwomen.9 In addition a recent review of the literature abou5t non-steroidal anti-inflammatory the chance of hospital admission or death due to serious G.E eventup to 16 per thousand per year.10 To evaluate the efficacy of Abhadi churna in sandhigatavata. To evaluate the efficacy of ksheerabala tail janu basti in sandhigatavata.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 4 the management of Sandigatavata
  • 19. Historical ReviewHistorical Review Historical review is necessary to understand origin and progressivedevelopment, that has taken place for centuries together. There is no directreference of the disease sandhigatavata in the vedic period. But indirectreferences in their most rudimentary form are available here and there. Thereferences available in Rigveda and Atarraveda, pertaining to vata, its bhedhashlesaka kapha sthana, and also joint disorders, and drugs used in vata rogas.11Vyadhi Sandhis and the diseases affecting them were well known in the Vedicperiod. One can observe description of body parts in Atharvanaveda where in thewords “Januni and Ashtivantau” were used to denote knee joints.12 The diseaseSandhigatavata had not been mentioned as such in Vedic literature. But inRigveda while describing various skills of Ashwinikumaras had recorded theirskill in treating joint diseases too13. One of the mantras of Rigveda states that, “Iam removing your diseases from each organ, hair and joint”14. Atharvanaveda hadmentioned Parvashoola and Vateekrita15, two diseases similar to Sandhigatavata.In Atharvanaveda, records about Vatavikaras are mentioned16. A mantra says,“destroy the balasa seated in the organs and joints which is responsible for loosingbones and joints”17. In purana kala18, 19 also references regarding sandivata areavailable. Samhitagranthas and Samgrahagranthas except Sharangadhara samhitahad described the disease Sandhigatavata with lakshana-chikitsa under theVatavyadhees20, 21,22, 23, 24, 25, and 26. Even though the description of Sandhigatavatais unavailable in Bhela samhita27, it is assumed that the verses are missing, as thedescription of Gatavatas such as amashayagatavata, pakwashayagatavata andraktagatavata etc. is available. In harita samhita28 also references regarding thisEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 5 the management of Sandigatavata
  • 20. Historical Reviewdisease are available,also in chakradatta29, gadanigraha30 & Basavarajeeyam31mentioned about this disease. Osteoarthritis (OA) is the most common joint disorder in human beingsand other vertebrates. Even in giant dinosaurs, osteophytes leading to ankylosiswere detected. In all mammalian species like whales and dolphins and in fishbirds and some amphibians, Osteoarthritis is observed32. In the early ages, Hippocrates observed the prevalence of OA in agedindividuals (Benard, 1944) 33 Heberden (1803) studied this disease in detail andthe nodes on the fingers in OA disease were named after him34. Osteoarthritis wasdifferentiated from Rheumatoid Arthritis and named as degenerative arthritis byNichols and Richardson (1909) on morbid anatomical grounds35. Although themost ancient of the diseases, OA was first identified as a distinct entity in the 20thcentury36. Gold th ait in 1904 made a distinction between hypertrophic andatrophic arthritis and A.E Garrod recognized OA as a clinical entity in 1907.37Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 6 the management of Sandigatavata
  • 21. Disease reviewAyurvedic reviewVyutpatti & Paribhasha1. Sandhi Vyutpatti - SAM + DHA + KIHI Nirukti - • Sandirnama Samyogaha38 • Asthidwaya Samyogasthana39 Sandhyarnama, asthanam, anyonya, sangam, asthani, junction, connection,combination, union with containing a conjugation, transition from one toanother40.Paribhasha: Sandhi pullinga, sandhanamiti, Yuga sandhini yugashabde dehasandhini marmashabde cha drishtavyaha41 In general, sandhi means the junction between two things in Ayurvedashareera sandhi is a technical word indicating that it is the place where two aremore bones meet together and the joint may be fixed type or of less or moremovement. Acharya Sushrutha told that, in our body there are innumerable2) GataVyutpatti- Gam – gamane42 Gam + Ktha43 Nirukti- Vata, Prapte, labdhe, Patite, Cha, Sameepe44, Come to, approached, arrived at, Being in, situated in, continued in, Paribhasha45- Gatam - thrillingam, gacchati, Janati, Yatteti3) Vata Vyutpatti - Va - Gati gandhanayoho Va - Gati sevanayoho Va + Kthaha46Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 7 the management of Sandigatavata
  • 22. Disease review Pullinga Va + Kthaha47 Nirukti - Sparsha matra vishesha gunake bhutabheda - Pavane - dehasya dhatubheda cha48 - Wind, Air,as one of the humours of the body49 The word ‘Osteoarthritis’ is a combination of three words. ‘Osteon’,‘arthron’ and ‘it is’ respectively means bone, joint and inflammation50. Themeaning of this word is ‘inflammation to the bony joint’. In fact, there is noinflammation in this disease; hence, the disease is also known as Osteoarthrosisand degenerative joint disease.Prayaya of Sandhigata Vata Different authors named this disease according to their own views, ie. asfollows. • Sandhigata anila51 • Kudavata52 • Sandhi vata53 • Jeerna vata54Terminology of Osteoarthritis55 :- Four names, none of which are adequate are used interchangeablyto describe the disease. They are Osteoarthritis, Osteoarthrosis, Degenerative jointdisease and Hypertrophic arthritis. Osteoarthritis is less than ideal since theprimary event is not inflammatory, although secondary synovitis is usuallypresent. Osteoarthrosis is perhaps the best because the inflammation is secondaryand the suffix denotes an increase and an invasion, physiologic or pathologic, or ageneral over production. This early on, is a relatively clear description of what thedisorder is. Degenerative joint disease is unsuitable, since degenerative impliesaging, a running down, deterioration, and a catabolic process; in fact for longEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 8 the management of Sandigatavata
  • 23. Disease reviewperiods, often years, the disease may not be clinically progressive. Hypertrophicarthritis now completely out of style, describes one phase the osteophytosis orovergrowth of bone.Nidana56, 57, 58, 59, 60, 61, 62, 63 Even though classics of Ayurveda do not mention the Nidanas of Sandhi-Gata-Vata, one has to compile the relevant references mentioned in differentcontexts like Vata Vyadhi Nidana (Ca.Sa.Ci.28/15-17, Su.Sa.Su.21/19,A.Hr.Ni.1/14-15, Yo.Ra.Pu.Vat.1-4, Bh.Pr.Ci.Vat.1-2, Ma.Ni.Pu.22/1-3),Asthivahasroto Dushtikarana (Ca.Sa.Vi.5/27), Majjavahasroto Dushtikarana(Ca.Sa.Vi.5/28). Nidana can be classified under various headings with different views.Among them one classification is Sannikrishta and Viprakrishta Karana. Herewith the complimentary references the Nidanas of Sandhi-Gata-Vata is classifiedon this basis.Sannikrishta Hetu – Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana,Pradhavana, Atisankshobha.Viprakrishta Hetu –Rasa – Kashaya, Katu, TiktaGuna – Rooksha, Sheeta, LaghuDravya – Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura, Kalaya,Adaki, Harenu, Shushkashaka, Vallura, Varaka.Aharakrama – Alpahara, Vishamashana, Adhyashana, PramitashanaManasika – Chinta, Shoka, Krodha, BhayaViharaja – Atijagarana, Vishamopacara, Ativyavaya, Shrama, Divasvapna,Vegasandharana, Atyucchabhashana. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 9 the management of Sandigatavata
  • 24. Disease reviewSome of the important Nidanas are discussed below-Ativyayama Excessive physical exercises act as one of the important Nidana forSandhi-Gata-Vata. Running, walking, jogging etc. if done excessively or violentlywill affect the structures of Sandhi. They mainly affect the Joint stability by overexertion. But if done properly they stabilize the Joint.Bharaharana Carrying excessive load causes excessive pressure and stretching effectover the structures of the joint. As knee is weight bearing joint, carrying excessiveload will have direct affect on articular disc. The constant compression will leadto wear and tear effect leading to degenerative changes in the discs.Abhighata Abhighata to joints due to Prapatana etc., lead to structural deformity inthe joints. Joint is an organ rather than a single structure. It is stabilized bydifferent structures like Asthi, Snayu, Peshi, and Kala etc. Hence any trauma tothese structures will alter the structural integrity of the joint. Hence Abhighata isan important Nidana for Sandhi-Gata-Vata.Atisankshobha It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas isinvolved in Sandhi-Gata-Vata this can be considered as Nidana for the same.Violent activities like Atyadhva, Plavana, Langhana, Balavat Vigraha,Pradhavana etc. will have its effect on joint. As told earlier knee is the weight-bearing joint, the violent exercises or activities will alter the structural integrity ofthe joint.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 10 the management of Sandigatavata
  • 25. Disease reviewMarmabhighata The concept of Marmabhighata in the causation of Sandhi-Gata-Vatasounds more rational. Janu-Sandhi is a variety of Vaikalyakara Sandhi-Marma64.Marma is a vital point, which comprises of Asthi, Snayu, Sira, Mamsa andSandhi. Hence any Marma is made up of all these structures, like wise the Janu-Sandhi. Pain in the joints not necessarily be only associated with bony changes.But involvement of other joint structures may also give rise to symptomspertaining to joint. Therefore, in recent days more study is emphasized on thedifferent structures involved in the pathology of Arthritis like consistency of softtissue, fibrous material, liquid and cartilaginous substance of the joint. From thisnew point the Ayurvedic view towards the involvement of certain Marma in thedisturbance of the joint i.e. painful joint will be anticipated. HenceMarmabhighata as a Nidana in case of Sandhi-Gata-Vata is to be givenimportance.TABLE.2SAMANYA NIDANA OF VATA VYADHI AS EXPLAINED IN DIFFERENT TREATISESNidana Ca. Sam Su. Sam A.H MN YR BPAharaja NidanaKashaya - + + - - +Katu - + + - - +Tikta - + + - - +Rooksha + + + + + +Laghu + - + + + -Sheeta + - + + - -Vallura + - - - - -Varaka + - - - - -Shuskha Shaka - + - - - -Uddalaka - + - - - -Neevara - + - - - -Mudga + - - - - -Masura + - - - - -Harenu + - - - - -Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 11 the management of Sandigatavata
  • 26. Disease reviewKalaya + - - - - -Nishpava - + - - - -Viharaja NidanaAti Vyayama + + + + - -Langhana + + - + + -Plavana + + - + + -Atyadhwa + - - + + -Pradhavana - + - - - -Pratarana - + - - - -Atyuchabhashana - + - - - -Balavadvigraha - + - - + -Abhighata + + - + - +Marmaghata - - + + - -Bharaharana + - - - + -Dukhashayya - - + + - -Dukhasana + - - - - -Sheegrhayana + - + + - -Prapeedana - + - - - -Atiadhyayana + - - - - -Ati vyavaya + + + + + +Atijagarana + + + + + +Vegadharana + + + + + -Vishamopachara + - - + + -Shrama - - - - - +Upavasa + + + + + +Puravata sevana - - - - - +Divasvapna + - - - - -Manasika karanaCinta + - + + + +Shoka - + + + + -Krodha - - - - - -Bhaya - - - - + -4) Anyat (other nidanas): - Panchakarma apacharas like atidoshasravana, atirakthasravana, atiyoga oflanghana, apatamsana etc and dhatukshayakarabhavas like rogakarshana,gadakrita atimamsakshaya, etc vitiate Vata. Dhatukshaya is an important vitiatingfactor of Vata. Sthoulya is another causative factor for Vata prakopa. The meda-avarana of Vata is the mechanism causing inter-relationship between sthoulya andVatavyadhis65. All types of avaranas are also important vitiating factors of Vata.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 12 the management of Sandigatavata
  • 27. Disease reviewVata dominates vardhakya avastha66. During this period, dhatukshaya occurscausing Vata prakopa. Living in jangaladesha is another causative of Vata prakopa67. Vata getsvitiated in the end of day and night68. Vata also get vitiated during the end ofgreeshma ritu, varsha ritu and shishira kala69. Vata prakriti persons are moresusceptible to Vata vikaras. Persons who are rooksha-kashaya-katu-tikta satmyaare also more susceptible to Vata vikaras. Among all the types of nidanas mentioned some need special attention.Adhyashana leads to excessive body weight and this results in more pressure overweight bearing joints. This gradually weakens the sandhis and producesSandhigatavata. Excess exercise may not only vitiate Vata but further leads toshleshaka kapha kshaya contributing to Sandhigatavata. Excess walking andexcessive weight bearing also are important in the context of Sandhigatavata.Abhighata to marmas or sandhis is another important risk factor forSandhigatavata. Vardhakya avastha characterized by dhatukshaya leading topeshi-snayu-marma shosha, thereby resulting in looseness of joints is also a majorrisk factor for Sandhigatavata. The factors like that vitiate asthivahasrotas(ativyayama, atisamkshobhana, asthivighattana and vatalasevana) 70also need tobe mentioned in the nidana of Sandhigatavata.Risk factors for Osteoarthritis (OA)71Age factor – Age is the most powerful risk factor for OA. The association between OAand aging is non-linear. It usually begins after a person is 40 or more years old.By the age of 60 years, almost everyone has OA. More than 80% of people over60 years old have radiological evidence of OA in one or both knees and 30% inone or both hips.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 13 the management of Sandigatavata
  • 28. Disease reviewSex factor – It is told that women are at high risk than men in developing OA. Over30% of women (elderly) have OA in the interphalangeal joints of the hands.Except in the hands, men and women are affected equally, though the lesionsoften appear at a young age in men. Only 3% of elderly men have primary OA inthe hands.Hereditary factor – The relation of heredity is less ambiguous. Thus, the mother and sister of awoman with distal interphalangeal joint OA are respectively twice and thrice aslikely to exhibit OA as the mother and sister of an unaffected woman.Race factor – Racial difference exists in both the prevalence of OA and the pattern ofjoint involvement. OA is more frequent in Native Americans than in whites. TheChinese in Hong Kong have a lower incidence of hip OA than in whites.Interphalangeal joint OA and especially hip OA are much less common in SouthAfrican blacks than in whites in the same population. Whether these differencesare genetic or are due to differences in joint usage related to life style oroccupation is unknown.Obesity factor – Obese persons have a high risk of OA. For those in the highest quintile forbody mass index at base line examination, the relative risk for developing kneeOA in the ensuing 36 years was 1.5 for men and 2.1 for women. For severe kneeOA, the relative risk rose to 1.9 for men and 3.9 for women, suggesting thatobesity plays an even larger role in the etiology of the most serious cases of kneeOA.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 14 the management of Sandigatavata
  • 29. Disease reviewOccupational factor – Repetitive movements may leads to excessive strain leading to erosion andjoint damage. Men whose jobs require knee bending and at least medium physicaldemand had a higher rate of radiographic evidence of knee OA and more severeradiographic changes.Traumatic factors – Trauma to the joint seems to enhance the occurrence of arthritis. Itdisturbs the alignment of the joints and over a period of time, this malalignmentmay lead to excessive wear and tear leading to OA. According to the cause of OA, it is classified as primary and secondary.Primary OA is the term used when the disorder arises form unknown or hereditarycauses. Secondary OA describes cases in which direct causes for the disorder areknown.Classification based on causes72I. PrimaryIdiopathic, Primary generalized osteoarthritis and Erosive osteoarthritis.II. SecondaryCongenital or developmental defects (Hip dysplasias, shallow acetabulum,Morquio’s syndrome, etc.),Traumatica. Acute, b. Chronic and c. Charcot’s arthropathy,Inflammatory RA, psoriatic arthritis, septic arthritis, pseudogout,Endocrinal influence Acromegaly, diabetes mellitus, sex hormone abnormalities,hypothyroidism with myxedema and Metabolic Gout, itemochromatosis,ochronosis, chondrocalcinosis, paget’s disease.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 15 the management of Sandigatavata
  • 30. Disease reviewSamprapti From the onset of Dosha Dushya Dushti till the evolution of the Vyadhithere occurs various Vikriti. Samprapti explains such series of pathological stagesinvolved. It tells us about the total pathogenesis of a disease. The Samanya Samprapti of Vata Vyadhi that is explained in classics canbe considered as the Samprapti of Sandhi-Gata-Vata or a base to understand theSamprapti of Janu-Sandhi-Gata-Vata. Acarya Caraka explained73 – due to the intake of Vatakara Ahara ViharaVata vitiation take place. This vitiated Vata lodges in Rikta Srotas i.e. Srotas inwhere Shunyata of Snehadi Guna is present. Vata after settling in Rikta Srotasproduce disease related to that Srotas. Acarya Vagbhata frames the Samprapti of Vata Vyadhi like –Dhatukshaya aggravates Vata and the same is also responsible to produce Riktataof Srotas. Thus the vitiated Vata travels through out the body and settles in theRikta Srotas and further vitiates the Srotas leading to the manifestation of VataVyadhi 74. Here an attempt has been made to explain how this Srotoriktata occurs dueto Nidanasevana. The chief properties of Parthiva Dravya are Guru, Sthula,Sthira, Gandha Guna in excess. These are the properties, which are necessary forSthairya and Upacaya of the body. Excessive intake of Dravyas having Laghu,Ruksha, Sukshma, Khara properties lead to Guru and Sneha Guna Abhava due totheir opposite quality. Thus it leads to Dhatukshaya in the body. Akasha is theMahabhuta that produces Sushirata and Laghuta in the body. Vayu Mahabuta fillsup this Sushirata. So due to Dhatukshaya Akasha Mahabhuta increases in thebody producing Sushirata and Laghuta simultaneously Vayu fills it up.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 16 the management of Sandigatavata
  • 31. Disease review From this description it can be stated that the meaning of word ‘Riktata’ isSushirata i.e. increase in Akasha and Vayu Mahabhuta. While commenting onword ‘Riktata’ Cakrapani says that ‘Riktata’ means lack of Snehadiguna. For thepurpose of understanding the Samprapti of SandhiVata can be studied under twoheading.They are -1. DhatuKshaya Janya and2. Avarana Janya Sandhi-Gata-Vata.1. DhatuKshaya Janya Sandhi-Gata-Vata In old age Vata Dosha dominates in the body. This will lead to KaphaAbhava. Also Jataragni and Dhatvagni gets impaired, by which Dhatus formedwill not be of good quality. Degeneration of body elements takes place due topredominance of Vata in its Ruksha, Khara, etc. Guna and loss of Kapha inquality and quantity. As the Shleshma Bhava decreases in the body, the Kapha Bheda i.e.Shleshaka Kapha in the joints also decreases in quality and quantity. Reduction ofKapha in Sandhis makes Sandhi Bandhana Shithilata. Ashrayashrayi Sambandhaalso leads Asthidhatu Kshaya. Asthi being the main participant of the joint itsKshaya leads Khavaigunya in the joints. In this condition if Nidana Sevana done further produces Vata Prakopa. IfVata Prakopa is not corrected by appropriate means and simultaneously if theperson indulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, thePrakupita Vata spreads all over the body through these Srotas. In the meantimeSthanasamshraya of Prakupita Vata take place in the Khavaigunyayukta Janu-Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna over powerand undo all properties of Sleshaka Kapha producing disease SandhiVata.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 17 the management of Sandigatavata
  • 32. Disease review2. Avarana Janya Sandhi-Gata-Vata In Sthulas usually Sandhi-Gata-Vata occurs in weight bearing joints. Inthem Medodhatu will be produced in excess due to the Atisnehamsha ofAmarasa75. The excessive Medas will produce obstruction for the flow of nutritivematerials to the future Dhatus i.e Asthi, Majja and Shukra leads to their Kshaya. The excessive fat deposited all over the body will produce Margavarana ofVata76 (Su.Sa.Su. 15/32 – Dal.). Prakupita Vata due to Margavarana starts tocirculate in the body. While traveling it settles in the joint where Khavaigunya isalready exists. After Sthanasamshraya it produces the disease Sandhi-Gata-Vatain the same process mentioned in the earlier context. Thus with the help of Samanya Samprapti of Vata Vyadhi the Sampraptiof Janu-Sandhi-Gata-Vata can be divided into Dhatukshaya Janya and AvaranaJanya. This will help in deciding the prognosis and planning the treatment of thedisease.Samprapti Ghataka:Dosha – Vata – Vyana – Vriddhi; Kapha – Shleshaka – KshayaDooshya – Peshi, Snayu, Asthi, MajjaSrotas – Mamsavaha, Medovaha, Asthivaha, MajjavahaAgni – Jataragni, Asthi-DhatvagniAma – Jataragni Mandya JanyaRoga Marga – MadhyamaUdbhavasthana – PakvashayaSancharasthana - SarvashariraAdhishtana – SandhiVyaktasthana – SanEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 18 the management of Sandigatavata
  • 33. Disease reviewPoorvaroopa77 Particular mentioning of Poorvaroopa of Sandhi-Gata-Vata is not availablein classics. In Vatavyadhi also unmanifested symptoms (Avyakta) or mildexhibition of actual features of the disease itself (Alpa vyakta) is considered as itsPoorvaroopa. Hence clinical features of Sandhi-Gata-Vata in milderform can be considered as Poorvaroopa.ROOPA The clinical features of Sandhi-Gata-Vata explained by various Acarya arelisted in TableRoopa of Sandhi-Gata-Vata mentioned in various classicsSymptoms Ca.Sa. Su.Sa. A.Hr. A.Sa. Ma.Ni. Bh.Pr. Yo.Ra.Sandhi Vedana + + + + + + +Sandhi Shotha + + + + + +Sandhi Stabdhata + +Atopa +Sandhi Vedana All the Acarya have described this symptom. Caraka77 and Vagbhatas78explain that pain in the joint is elicited during Prasarana Akunchana Pravrutti.Sandhi Shotha Most of the authors explained this symptom. Caraka and Vagbhatasexplained the nature of Shotha i.e., it is felt like bag filled with air (Vata PoornaDriti Sparsha).Sandhi Stabdhata Sushruta79 initially described this symptom, later by texts like MadhavaNidana80, Yogaratnakara81 and Bhavaprakasha82. They have coined the term Sandhi Hanana or Hanti. While commenting onthis word Dalhana83 and Gayadasa explained as AkunchanaprasaranayohEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 19 the management of Sandigatavata
  • 34. Disease reviewAbhavah and Prasaranakuncanayoh Asamarthah respectively. With this we caninfer that the word Hanti refers to inability to move the joints. In the opinion of madhukoshakara84, Hanti referes to Sandhi Vishlesha,Stambha Adi Vikara. Hence with the above references, Hanti refers to SandhiStabdhata.Atopa This symptom explained in Madhava Nidana85. While commenting on theword Atopa in another context, Madhukoshakara quotes the opinion of Gayadasaand Kartika.I.e.‘Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah’.Also Bhavamishra86 says ‘Atopo – Gudagudashabdaha’ Thus we can say that Atopa in this context is the sound produced by themovement of joints i.e., Crepitus. Thus with the help of different references andby the opinion of commentators it can be concluded that Sandhi Shoola, SandhiShotha, Sandhi Stabdhata and Atopa are the clinical features of Sandhi-Gata-Vataor Janu-Sandhi-Gata-VataVyavachedakanidana Sandhigatavata is a disease affecting the bony joints. So virtually everydisease that affects the joints has to be differentiated with Sandhigatavata. Themost common differentiation is to be made with Vatarakta, Amavata andKroshtrukasheersha.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 20 the management of Sandigatavata
  • 35. Disease reviewShowing Vyavachedakanidana between Sandhigatavata and Vataraktha Sl. Criteria SGV Vatarakta 1 Nidana Vatavridhikara Vidahi,viruddha, Ahara-vihara rakthaprakopakara ahara 2 Poorva roopa Avyaktharoga lakshana Kushtasama 3 Roopa Sandhishoola, Teevra ruk, Prasarana akunchanayoho Grathita-paki vedana, Sandhi shopha, shvayathu Vatapoornadrithi sparsha 4 Adhisthana Sandhi Padamoola, Hastamoola 5 Doshas Vata Vata, Rakta 6 Upashaya Ushna - snigdha SheetaTable No. . Showing Vyavachedakanidana of Sandhigatavata and Amavata Sl. Criteria SGV Amavata 1 Nidana Vatavridhikara, ahara-vihara Viruddhaahara- cheshta 2 Poorva roopa Avyaktharoga lakshana Hridaya dourbalya, gourava 3 Roopa Sandhishoola, Vrischika Prasarana akunchanayoho damshavat vedana, Sandhi shopha, peeda, Vatapoornadrithi sparsha Pidakayukta shopha 4 Adhisthana Sandhi Hasta,Pada, Gulpha, Trika, Janu 5 Dosha Vata Vata, Kapha 6 Upashaya Ushna, snigdha Ushna-rookshaShowing Vyavachedakanidana of Sandhigatavata & KroshtrukasheershaSl. Criteria Sandhigatavata Kroshtrukasheersha1 Nidana Vatavridhikara Vatavridhikara ahara-vihara ahara-vihara2 Poorva roopa Avyaktharoga lakshana Avyaktharoga lakshana3 Roopa Sandhishoola, Maharuja, Prasarana akunchanayoho Janushopha vedana, Sandhi shopha, Vatapoornadrithi sparsha4 Adhisthana Sandhi Jan Madhya5 Dosha Vata Vata, rakta6 Upashaya Ushna, snigdha Snigdha, seethaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 21 the management of Sandigatavata
  • 36. Disease reviewTable No. 15. Showing Differential diagnosis between OA, RA, Gout andRheumatic fever.Sl. Criteria OA RA Gout Rheumatic Fever1 Symptoms Pain & swelling Inflammation Polyarticular Painful and on in multiple pain, swelling tender joints major weight joints, & bearing joints, morning inflammation, stiffness, stiffness exquisite crepitations, >30ms tenderness tenderness, enlargement of joint space2 Mode of Gradual Abrupt Acute Acute On set3 Joints Weight bearing Polyarticular Metatarso- Polyarticular Involved joints phalangeal joints4 Systemic - Autoimmune - Carditis, Features disease, rise fever, chorea in temperature, anemia etc.5 Investigations RA-ve, ESR ESR raised, Serum uric ESR normal, X-ray- X-ray-soft acid raised, increased, narrowing of tissue punched out CRP high, joint space, swelling. lesions in WBC subchondral subchondral elevated. bony sclerosis, bone. osteophytes etc.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 22 the management of Sandigatavata
  • 37. Figure - 1Samprapti in dhatukshaya janya sandhivata UKTA NIDANA SEVANA VARDHAKYA DHATUKSHAYA VATA PRAKOPA KSHAYA OF KAPHA BHAVA IN THE BODY CIRCULATION THROUGH SHLESHAKA KAPHA KSHAYA RASAYANI IN SANDHI KHAVAIGUNYA IN SANDHI STHANASAMSHRAYA IN SANDHI SANDHIVATA
  • 38. FIGURE - 2SAMPRAPTI IN AVARANA JANYA SHADHIVATA MEDOVRIDDHI (MEDOVARANA) (MARGAVARANA TO THE FLOW OF POSHAKARASA)VATAPRAKOPA POSHAKARASA NYUNATA TO ASTHIDHATU EXCESSIVE PRESSURE OVER WEIGHT BEARING JOINTCIRCULATION THROUGH ASTHIDHATU KSHAYA RASAYANI IN SANDHI VYANAVATA PRAKOPA IN SANDHI KHAVAIGUNYA IN SANDHI STHANASAMSHRAYA IN SANDHI SANDHIGATAVATA
  • 39. Disease reviewJanu Sandhi - Knee Joint In Janu-Sandhi-Gata-Vata the vitiated Vata get lodges at Janu-Sandhi.Therefore before going to the disease aspects, the anatomy and physiology of Janu-Sandhi are to be under stood properly. In classics we have scattered reference ofanatomical and physiological consideration of Janu-Sandhi. Here an attempt is madeto enumerate those structures, which are helpful in maintaining the stability of thejoints.In Ayurveda, Sandhis are mainly classified into two types; 1) Sthira Sandhi 2) Cala Sandhi 87Again they are sub classified into eight types.88 1) Kora 5) Tunnasevani 2) Ulookala 6) Vayasa tunda 3) Samudga 7) Mandala 4) Pratara 8) Shankhavarta Acarya Sushruta- father of Surgery considered Janu-Sandhi under Cala Sandhiand sub classified under Kora Sandhi (Su.Sa.Sh.5/27).Shleshaka Kapha- Among five variety of Kapha, Shleshaka Kapha resides in joints.It keeps the joints firmly united, protects their articulation opposes their separationand disunion 89.Shleshmadhara Kala - It is the fourth Kala, which is situated in all joints of livingbeings. As wheel moves on well by lubricating the axis, joints also function properlyif supported with Kapha. This helps in lubrication of joints90. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 23 management of Sandigatavata
  • 40. Disease reviewVyana Vata - Vata governs every movement in the body. Vyana Vata is one amongthe five varieties of Vata, which resides at Hridaya and controls most of the motorfunctions. The Gati or physical movement is also one of its functions. Gayadasa commenting on Sushruta has quoted the wordings of an unknownauthor as though the Vyana Vata is functioning all over the body it resides in theSandhi91. Acarya Vagbhata states that Vata is located in the Asthi with relation toAshrayashrayi Sambandha. Generally augmentation or diminution of Doshas wouldbe given similar effect on their respective Dhatus but in case of Vata it is opposite;with increase in Vata, Asthi Kshaya occurs92. Sushruta in Sharirasthana explains different structures of the human body.Among them, structures coming under Janu-Sandhi are listed below.Snayu - Among nine hundred Snayus, ten are present in Janu-Sandhi. More over inShakha and Sandhi, Pratana variety of Snayu is present. Importance – As a boatconsisting of planks becomes capable of carrying load of passengers in river after it istied properly with bundle of ropes, all joints in the body are tied with many ligamentsby which persons are capable of bearing load93.Peshi- The fleshy mass demarcated from each other is known as Peshi. In Janu theyare five in number. They are strong structures that help to maintain alignment of thejoint94.Sanghata - Assemblages of bones are fourteen. One is situated in Janu-Sandhi95. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 24 management of Sandigatavata
  • 41. Modern reviewKnee joint Before discussing the disease Janu-Sandhi-Gata-Vata it is very essential tounderstand the structure of knee joint, functional aspects of articular cartilage,synovial fluid and synovial membrane etc. Joints or articulations are the site where two or more bones meet. Joints are theweakest part of the skeleton but their structures resists various forces, such ascrushing or tearing that threaten to force them out of alignment. Joints are classified structurally and functionally. Fibrous, cartilaginous andsynovial are structural classification. Synarthrosis, amphiarthrosis and diarthrosis arefunctional classification. The present study was undertaken to assess the efficacy of janubasti in themanagement of sandhi gata vata. Before discussing the disease sandhigata vata it isvery essential to understand the structure of knee joint, functional aspects of articularcartilage, synovial fluid and synovial membrane so all these points are summarisedhere.The articular surfaces- Knee joint is formed by 1) The condyles of femur 2) The condyles of tibia 3) The patella The femoral condyles articulate with tibial condyles below and behind andwith patella in front.Condyles of Femur - The lower end of femur is widely expanded to form two largecondyles a medial and a lateral. The condyles are partially covered by a largearticular surface, which is divisible into patellar parts. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 25 management of Sandigatavata
  • 42. Modern review The patellar surface covers the anterior surfaces of both condyles and extendson more lateral condyle than on the medial. The tibial surfaces cover the inferior and posterior surfaces of the twocondyles and merge anteriorly with the patellar surface. The lateral part of the surfaceis short and straight anteroposteriorly. The medial part is longer and curved withconvexity directed medially.Tibia Medial condyle -superior articular surface is oval anterio posteriorly. Theperipheral part is flat and articulates with medial memiscus, the central part is slightlyconcave and articulates with medial condyles of femur. The raised lateral margincovers the medial inter condylar tubercle.Lateral Condyle - The superior articular surface is mearly circular. The peripheralpart is flat and articulates with lateral meniscus. The central part is slightly concaveand articulates with the lateral condyle of femur.Patella -Patella is the largest sessamoid bone in the body. It is triangular in shapewith its apex directed downwards, which is non articular posteriorly. Anterior surface is rough and non-articular, the upper 3/4th of the posteriorsurface are smooth and articular. The posterior articular surface divided by a verticleridge into a large lateral area and a smaller medial area. Structurally knee is a weekjoint, because the articular surfaces are non congruent. The tibial condyles are toosmall and shallow to hold the large convex femoral condyles. The femero patellararticulation is also quite insecure because of their shallow surfaces and also theoutward angulation between the axes of thigh and leg. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 26 management of Sandigatavata
  • 43. Modern review The stability of the knee joint is maintained by many factors. Knee joint issupported by fibrus capsule. The fibrous capsule is very thin and is deficientanteriorly when it is replaced by quadriceps femoris, patella and ligamentum patella.Synovial Membrane - It lines the capsule except posteriorly where it is reflectedforwards by the cruciate ligaments forming a common covering for both ligaments.Semilunar Cartilage (Menisci) - These are two fibro cartilaginons crescents. Whichtry to deeper the articular surfaces of the condyles of tibia and partially divides thejoint cavity into the upper and lower compartments.Ligaments Ligamentum patella, tibial, collateral ligament, femoral collateral ligament,oblique popliteal ligament, arcuate popliteal ligament, cruciate ligament. Explanation of janukapala (patella) is available in Sushruta and Charakasamhita. Acharya Charaka and Kashyapa while explaining the asthisankhya denotes.Janvasthini dose, sankyate, chatwaryosthini jangayoho, dwarunalakau, dwechakhyathe janukapale. In the olden days also our acharyas had an idea of synovial membrane.Sushruta clearly mentioned that the fourth kala is Shleshmadharakal a which issituated in every sandhis and performs lubrication for movement. How a wheelwhich is lubricated by oleation functioning normally. Likewise all the sandhisfunction normally in the presence of shleshmadhara kala and also protects it formdestruction .Synovial Fluid - It is found in the cavities of synovial joints. The main function of itis lubrication and also nourishment of the articular cartilage. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 27 management of Sandigatavata
  • 44. Modern review The physical nature of this is a clear or pale yellow, viscous glariry fluid ofslightly alkaline pH at rest. This nature varies widely between different joints andspaces. The physical properties of synovial fluid changes according to theenvironment in the joint. Viscosity is very sensitive to changes in dilution and that itfalls with increasing temperature and increasing pH. The elasticity property is alsoaffected similarly. The composition of synovial fluid is some protein (about 0.9mgm/ml) andwith added mucin. Hyalouronic acid which is sulphate free mucopolysaccharidecomposed of basic units that are polymerised. The synovial fluid also consists of moncytes, lympocytes, macrophages freesynovial cells and occasional polymorphonuclear leucocytes. Amorphous,metachromatic particles and fragments of cells and fibrous tissue sometimes found insynovial fluid are resulted by the slow wear and tear of joint surfaces. It is very clear by Vagbhatas statement that, shleshmaka kapha not onlysupports sandhis but also provides movements in the normal direction.AcharyaSushruta states that it holds and nourishes the sandhi.Articular Cartilage Majority of bones are formed a special variety of hyaline cartilage. Articularcartilage has a wear resistant, low friction lubricated surface, both slightlycompressible and elastic which is ideally constructed for easy movements over asimilar surface but also absorb enormous forces of compression and shear generatedduring weight bearing and muscle action. This is due to the Shleshaka kapha in the joint. Due to its snigdha and picchilaguna it lubricates the joints and avoids friction on movement. Thus the cartilage acts Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 28 management of Sandigatavata
  • 45. Modern reviewas wear resistant. Elasticity and compressibility of the cartilage is due to themridhutwa and shlakshna guna of kapha.The Extracellular Matrix of Normal Articular Cartilage Articular cartilage is composed of two major macromolecular species:Proteoglycans (PGS), which are responsible for the compressive stiffness of the tissueand its ability to withstand load and collagen, which provides tensile strength andresistance to shear. Although lysosomal proteases have been demonstrated within thecells and matrix of normal articular cartilage, their low pH optimum makes it likelythat the proteglycanase activity of these enzymes will be confined to an intracellularsite or the immediate pericellular area. However cartilage also contains a family ofmatrix metalloproteinases (MMPs) including stromelysin, collagenase and gelatinasewhich can degrade all the components of the extra cellular matrix at neutral pH. Eachis secretedby the chondrocyte as a latent pro enzyme that must be activated byproteolytic cleavage of its N-terminal sequence. The level of MMP activity in thecartilage at any given time represents the balance between activation of theproenzyme and inhibition of the active enzyme by tissue inhibitor (Keneeth, 1996). Osteoarthritis is the commonest form of arthritis or joint disease and is a veryimportant cause of pain and disability in advancing years of life. Some degree ofosteoarthritis will develop in everyone in old age and it is estimated that three out offour persons of more than 60 years of age will have definite evidence of osteoarthritisin at least one joint, and one out of ten persons beyond the age of 60 years will havesufficiently advanced disease and have so much trouble that medical advise will besought. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 29 management of Sandigatavata
  • 46. Modern review In the next two decades the proportion of aged in population is going toincrease steadily and so will increase in the incidence of osteoarthritis and with acommensurate increase in the cost of treatment of this most common joint disease.The natural history of osteoarthritis is variable and joint specific. Osteoarthritis mayremain stable or static for many years, or be progressive, or may have periods ofwaxing and warning of symptoms.Osteoarthritis has no effect on longevity of persons affected with this disease, but canbe quite debilitating in terms of limiting activities and diminishing overall quality oflife. These limitations in activities, usually with pain occurring at or just oftenretirement can add an element of anxiety and depression and make the matters worse.It is therefore necessary for everyone to know what is osteoarthritis, how it develops,what are the risk factors, and what can be done to alleviate the suffering anddiscomfort. With better understanding and knowledge about osteoarthritis along withavailability of medicines and development of operations with successful jointreplacement surgery much can be done to alleviate the pain and deformity and makethe person regain functional ability.How Healthy Joints Work Joints are parts of body where one bone meets the other and movement occurssuch as elbow, knee, hip and ankle. Backbone or spine also has large numbers ofsmall joints, which allow us to move our neck, and back in all possible directions.Ends of bone which meet each other at joint are covered by cartilage. Cartilage iswhite, smooth, glistening material and is very specialized which functions as acushioning material and a shock absorber so that hard bones do not rub against eachother, and the cartilage also reduces friction during joint movement since its surface is Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 30 management of Sandigatavata
  • 47. Modern reviewvery smooth. In fact no man made material can match the low friction and shockabsorbing properties of healthy cartilage in the joint. Cartilage is made up of toughfibres of a protein called collagen - Enmeshed in these fibres of collagen are the largemolecules of another protein called proteoglycan. Proteoglycan molecules contain lotof water in their interior. Water keeps on moving in and out of the domain ofproteoglycan molecules almost like water being sucked in and squeezed out ofsponge. This property of ability to exchange water so easily gives an elasticcharacteristic to the cartilage. Collagen fibres give desired strength and proteoglycanmolecules allow reversible compression. The combined structure thus makes up forthe tough but not too rigid quality needed for this very specialized tissue. The bone ends with cartilage covering are enclosed in a membrane calledsynovium. The synovium releases a slippery fluid know as synovial fluid and thisfluid further reduces the friction between moving surfaces capped with cartilage andensures that the joint moves easily and smoothly. The synovial fluid or joint fluidformed by synovial membrane is a special type of fluid that behaves like fluid whenthe joint is being moved and during walking when the joint is loaded its characterchanges to something like jelly to act as an additional shock absorber. The synovialfluid nourishes the cartilage. The cartilage has no blood vessels and relies on synovialfluid moving in and out to provide nutrients and take away the waste products. Ends of bone, cartilage and synovium are further enclosed in a layer of tissuecalled capsule. Capsule is a thick and strong tissue but is capable of stretching whenjoint moves. The combination of bone ends with cartilage covering, synovium andcapsule is the joint. The joint is further covered by muscles and tenders, whichsupport the joint and also provide the power to move the joint.What Happens in Osteoarthritis Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 31 management of Sandigatavata
  • 48. Modern reviewIn osteoarthritis changes occur both in the cartilage and the synovial fluid. Changes inthe cartilage are easily seen even without microscope and are therefore well known,whereas changes in the synovial fluid are not discernible without the use ofspecialized tests and equipments. The synovial fluid changes in character andcomposition and it loses its characteristic capacity to behave in a jelly like manner andact as a shock absorber when the joint is loaded. The cartilage therefore has to sustainmore load and impact. At the same time the cartilage also undergoes subtle changes in chemicalcomposition in a way that proteoglycans decrease and water content increases. As aresult the collagen fibrils become disrupted and disorganized. The cartilage has nowbecome soft due to disorganization of tight collagen fibrils, and also swollen due toincreased water content. It has thus become less resistant to forces gradually developscracks or fissures, breaks into fragments usually known as fibrillations, becomes thinand completely disappears in places. Over a period of time most or all of the cartilage covering at the end of bonemay disappear. This is seen on x-ray as gradual decrease and then disappearance ofjoint space. The loss of cartilage leaves the bone end exposed. Similar changes occuron both sides of the joint and therefore now instead of cartilage moving againstcartilage, a situation develops where bone is moving against bone. These changesabolish smooth and frictionless movement at the joint. The broken pieces of cartilageand bone fragments lie in the synovial fluid and this irritates synovial membrane toproduce more fluid. This fluid, of course, is not of the same composition and physicalcharacter as the normal synovial fluid. The joint swells up due to excessive fluid in it. Bone rubbing against bone, stretching of joint capsule due to excessive fluidand increased friction in the joint, all three elements produce pain and difficulty in Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 32 management of Sandigatavata
  • 49. Modern reviewmoving the joint. This is perceived as stiffness in the joint as the increased effortrequired to move the joint. Along with this, the range of joint movements becomesless. The bone ends gradually become misshapen and develop bony spurn at themargins called osteophytes. With advancing disease a part of the end of bone may beextensively rubbed of and this produces severe deformity of the joint. The jointdeformity is most easily seen at the knee joint. In advanced osteoarthritis of knee theleg does not remain straight but bends to one side commonly towards insideproducing bow leg deformity or sometimes bends outwards to produce knock-kneedeformity. Very briefly changes in the joint is like getting dirt in your eye. Similarlythe cartilage wears down and becomes fragmented into little pieces, which continuesto grind inside the joint.Which Joints Are Affected?Although any synovial joint in the body may be affected with osteoarthritis, certainjoints are more often affected and these are as below: -Knee - is the most commonly involved joint and gives rise to considerable problemwith walking and sitting on floor. The deformity of leg when disease has progressedbeyond a certain point is also seen and recognized by the person himself and others.The deformity is usually of bowlegs and sometimes of knock-knees. Usually bothknee joints start to give trouble together, but in some persons disease may be seen tostart and produce symptoms in one knee first and the other knee start to give troubleafter a period of some months.Hip - is the joint next in frequency to the knee where osteoarthritis develops. In Indiahip osteoarthritis is less frequent than knee osteoarthritis due to many reasons, someof which are not yet understood and defined. The trouble may start first in one hip andthen after some months the other hip starts to give trouble, or both hips can become Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 33 management of Sandigatavata
  • 50. Modern reviewsymptomatic within a few weeks of each other. Hips affected with osteoarthritisbecome stiff and move less in range than a normal hip. This produces not only painbut also trouble in sitting on floor, sitting cross-legged and going up and down thestairs. Eventually it may become impossible for the person to squat on floor, using thestairs becomes a slow and painful ordeal, one leg appears to have become shorter andthe person limps while walking.Spine - All parts of spine do not move. The spine can be divided into four parts. Thetopmost section is cervical spine which is in the neck area, next is dorsal spine whichcovers the length of chest, followed next by lumbar spine which covers length ofspine in relation to abdomen or lower back, and last portion is sacral and cocygealspine which covers the area of pelvic and ends at the tip of tailbone. Neck (cervicalspine) and lower back (lumbar spine) are the areas where wide range of movements inall directions can occur and this is why it is possible for us to look around so easilyand bend our back in every direction. There are many small sized joints in spine andthey all share a part of motion. These small synovial joints can also developosteoarthritis and produce backache and difficulty in getting up from sitting and lyingposition. Curiously the pain due to osteoarthritis of these small spinal joints is of twodifferent types. Some persons will get pain and stiffness in back after a period of restand will get relief after walking for few minutes. Opposite to that some persons willget pain and stiffness after being up and about for past of the day and get relief withrest. In addition swelling at these joints can press on the nerves and produce symptomof sciatica or the pain radiating to leg and thigh. Similarly pain from swelling of jointsin cervical spine can radiate to arm and hand. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 34 management of Sandigatavata
  • 51. Modern reviewHands - Osteoarthritis in hand, most often causes trouble at joint at the base of thumb.This joint has peculiar shape to allow wide range of thumb movements in alldirections. With this joint becoming stiff and painful the person starts to feel difficultyin gripping and holding objects. Next commonly affected joints in hand are the smalljoints at the end of fingers. At these joints osteoarthritis causes limitation ofmovements and some irregular swellings. The end of finger may not straighten fullyand the shape starts to look odd. Fortunately the functional at end of fingers, whilefunctional difficulty is much more when joint at the base of thumb is affected.Osteoarthritis Osteoarthritis is also called as Degenerative Joint Disease or Arthrosis orwear-and-tear arthritis. It represents the failure of diarthrodial joint.It is the most common joint disease of humans. Osteoarthritis of knee is the leadingcause of chronic disability in developed countries. Primary osteoarthritis is idiopathicand secondary osteoarthritis is due to many causes like secondary to trauma, due toendocrinal disorders, metabolic causes, etc.Risk factors for OsteoarthritisAge – It is considered to be one of the powerful risk factor. Old age people are proneto suffer with osteoarthritis and causes disability in them.Sex – Both Males and females are affected, but osteoarthritis is more generalized andmore sever in older women. It is twice as common in women as in men. Osteoarthritisof knee is common in women.Women less than 45 years old – 2% 45 – 65 years – 30% Older than 65 years – 68% will suffer. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 35 management of Sandigatavata
  • 52. Modern reviewGenetic – Point mutation in the cDNA coding for articular cartilage collagen havebeen identified in families with chondrodysplasia and polyarticular osteoarthritis.Trauma – Direct or indirect injuries to the articular cartilage lead to its degeneration.Fractures of different bones, especially of weight bearing with or without involvingthe joint can also cause alteration of ligaments and in articular surface of joint.Repetitive stress – Abnormal posture, abnormal gait, and unequal length of leg willexert stress and strain over the joint.Endocrine disorders – Acromegaly, Hyperparathyroidism, Diabetes mellitus, Obesity,etc. may lead to osteoarthritis.Metabolic disorders – Like Ochronosis, Wilson’s disease may give rise toosteoarthritis.Calcium deposition diseases – Like CPPD deposition may lead to osteoarthritis.Pathology Although the cardinal pathologic features of osteoarthritis is a progressive lossof articular cartilage, osteoarthritis is not a disease of any single tissue but a disease ofan organ, the Synovial Joint. The most striking morphologic changes in osteoarthritisare usually seen in load bearing areas of the articular cartilage.Osteoarthritis develops in either of two settings:1.The biomaterial properties of the articular cartilage and subchondral bone arenormal, but excessive loading of the joint causes the tissue fail, or2. The applied load is reasonable, but the material properties of the cartilage or boneare inferior.In the early stages the cartilages thicker than normal. With the progression ofosteoarthritis, joint surface thins then the cartilage softens. Then the integrity of thesurface is breached and vertical clefts develops. They are called as fibrillation. Then Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 36 management of Sandigatavata
  • 53. Modern reviewthere develops deep cartilage ulcers, extending to bone. All the cartilage ismetabolically active and the chondrocytes replicate, forming clusters (clones). Latercartilage becomes hypo cellular. There will be appositional bone growth in the bonysubchondral region, leading to the bony sclerosis. Growth of cartilage and bone at thejoint margins leads to osteophytes, which alter the contour of the joint and may resistmovement. The biochemical changes in osteoarthritis cartilage are increase in watercontent, decrease collagen, proteoglycan, monomersize, hyaluronate, keratensulphate, and chondrotin sulphate, increase in proteoglycan synthesis, collagenase,and proteoglycanase.Clinical FeaturesSymptomsJoint Pain It is often described as a deep ache and is localized to the involved joint.Typically, the pain of osteoarthritis is aggravated by joint use and relieved by rest, butas the disease progresses, it may become persistent.StiffnessProgressive stiffness of the involved joint upon arising in the morning or after aperiod of inactivity may be prominent but usually lasts less than 20 min. It is due tospasm of muscles. There is no relation between the severity of degeneration andmorning stiffness.SignsSwellingPhysical examination of the osteoarthritis joint reveals localized soft tissue swellingof mild degree. It is due to the changes in articular ends themselves, particularlyperiarticular lipping.Crepitus Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 37 management of Sandigatavata
  • 54. Modern reviewThe sensation of bone rubbing against bone evoked by joint movement is called ascrepitus. It is one of the characteristic sign of osteoarthritis joint.Local Warmth nessOn palpation of the joint local rise in temperature indicative of sign of inflammation.Muscle AtrophyPeriarticular muscle atrophy may be due to disuse or due to reflex inhibition ofmuscle contraction.OthersIn advanced stage there may be gross deformity, bony hypertrophy, subluxation andmarked loss of joint motion.Laboratory and Radiological Findings The Diagnosis of osteoarthritis is usually based on clinical and radiographicfeatures. In the early stages, the radiograph may be normal, but joint space narrowingbecomes evident, as articular cartilage is lost. Other characteristic radiographicfindings include subchondral bone sclerosis, subchondral cysts, and osteophytosis. Achange in the contour of the joint, due to bony remodeling, and subluxation may beseen. There is often great disparity between the severity of radiographic findings, theseverity of symptom and functional ability in osteoarthritis. No laboratory studies are diagnostic for osteoarthritis, but specific laboratorytesting may help in identifying one of the underlying causes of secondaryosteoarthritis. Analysis of synovial fluid reveals mild leukocytosis with apredominance of mononuclear cells. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 38 management of Sandigatavata
  • 55. Modern review Approaches such as magnetic resonance imaging and ultrasonography havenot been sufficiently validated to justify their routine clinical use for diagnosis ofosteoarthritis or monitoring of disease progression.Treatment Treatment of osteoarthritis is aimed to reducing pain, maintaining mobility,and minimizing disability. The vigor of the therapeutic intervention should be dictatedby the severity of the condition in the individual patient. For those with only milddisease, reassurance, instruction in joint protection, and an occasional analgesic, mayall that required; for those with more severe osteoarthritis especially of the knee orhip, a comprehensive programs comprising spectrum of non-pharmacologicalmeasures supplemented by an analgesic and/or NSAID is appropriate.Non-Pharmacological MeasuresReduction of Joint Loading Osteoarthritis may be caused or aggravated by poor body mechanics.Correction of poor posture and a support for excessive lumbar lordosis can be helpful.Excessive loading of the involved joint should be avoided; patients with osteoarthritisof the knee or hip should be avoided prolonged standing, kneeling and squatting.Obese patients should be counseled to loose weight. In patients with medialcompartment knee osteoarthritis, a wedged in sole my decrease the pain. Completeimmobilization of painful joint is rarely indicated. In patients with unilateralosteoarthritis of knee or hip, a cane, held in the contraleteral hand, may reduce jointpain by reducing the joint contact force. Bilateral disease may necessitate use ofcrutches or walker.Physical Therapy Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 39 management of Sandigatavata
  • 56. Modern reviewApplication of heat to the osteoarthritis joint may reduce pain and stiffness. A varietyof modalities are available; often the least expensive and most convenient is a hotshower or bath. Occasionally, better analgesia may be obtained with ice than withheat. It is important to note that patients with osteoarthritis of weight bearing jointsare less active and tend to be less fit with regard to musculo-skeletal andcardiovascular status than normal controls. An exercise program should be designedto maintain range of motion, strengthen periarticular muscles, and improve physicalfitness. The benefit of aerobic exercise includes increase in aerobic capacity, musclestrength, and endurance; less exertion with a given workload and weight loss. Thosewho exercise regularly live longer and are healthier than those who are sedentary.Patients with hip or knee osteoarthritis can participate safely in conditioning exercisesto improve fitness and health with out increasing their joint pain or need for aanalgesics or NSAIDs. Disuse of the osteoarthritis joint, because of pain will lead to muscle atrophy,because particular muscles play a major role in protecting the articular cartilage fromstress, strengthening exercise are important. In individuals with knee osteoarthritisstrengthening of a particular muscle may result, with in weeks, in a decrease in jointpain as great as that seen with NSAIDs.Drug therapy of osteoarthritis Therapy for osteoarthritis today is palliative, no pharmacological agent hasbeen shown to prevent, delay the progression of, or reverse the pathologic changes ofosteoarthritis in human. Although claims have been made that some NSAIDs have a“chondroprotective effect”. Adequately controlled clinical trails in human withosteoarthritis to support this view are lacking. In management of osteoarthritic pain, Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 40 management of Sandigatavata
  • 57. Modern reviewpharmacological agents should be used as adjuncts to non-pharmacological measures,such as those described above, which are keystone of osteoarthritis. NSAIDs often decrease joint pain and improve mobility in osteoarthritis - onan average about 30% reduction in pain and 15% improvement in function. Intra articular injection of hyaluronic acid is being used for treatment ofpatients with knee osteoarthritis who have filed a program of non-pharmacologicaltherapy and simple analgesics. Capsaicin cream reduces joint pain and tenderness when applied topically ptswith knee and hand osteoarthritis. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 41 management of Sandigatavata
  • 58. ChikitsaChikitsa The main aim of treatment is to restore Svasthya. It means to restorenormal functions of Agni, Dosha, Dhatu, and Mala and to maintain mental health.The primary importance of Cikitsa lies in Samprapti Vighatana. Sandhi-Gata-Vata is a Vataja disorder. So general treatment of VataVyadhi can be adopted, keeping an eye on the etiology of the same. Regarding thespecific line of treatment of Sandhi-Gata-Vata, Caraka is silent. Later authors likeSushruta had mentioned effective line of treatment for the same. Other books likeAstanga Hridaya, Astanga Sangraha, Yogaratnakara, Bhavaprakasha hadmentioned specific line of treatment. The below chart shows Chikitsa sutra mentioned in different texts.TableCikitsa Sootra mentioned in different Samhita.Treatment Su.Sa. A.Sa. A.Hr. Yo.Ra. Bh.Pr. Bh.Ra.Snehana + + + + +Abhyanga +Mardana + + + +Svedana + + +Upanaha + + + + + +Bandhana + + +Agnikarma + + + +Snehana Sandhi-Gata-Vata is a variety of Vata Vyadhi, where Snehana would bevery effective. Acc. to the use it can be administered in two ways – Abhyantara Prayoga Bahya Prayoga96Abhyantara Sneha: Here Sneha in the form of Pana, Bhojana, Basti and Nasya can beadministered in case of Sandhi-Gata-Vata.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 42 the management of Sandigatavata
  • 59. ChikitsaBahya Sneha:Bahya Snehas are many like Abhyanga, Lepa, Udvartana, Padaghata, Gandoosha,Karnapoorana, Akshitarpana, Picu, Samvahana, Mardana, Murdhnitaila, andParisheka. In case of Sandhi-Gata-Vata we get the mentioning of Abhyanga andMardana. Abhyanga means to do some movements or Gati. For the purpose ofAbhyanga Sukhoshna Taila or Sneha is used. Abhyanga should be done slowly inAnuloma Gati, in joints it should be done in circular manner. Abhyanga shouldbe done minimum for 5 minutes because the Veerya of Taila will reach MajjaDhatu in 900 Matra-Kalas. It is Vatahara, Pushtikara97, 98 . Mardana is likeAbhyanga but applied pressure is more.Svedana Svedana is a variety of Shadvidhopakrama. It is helpful in neutralizingStabdhata, Shitata and Gauravata99. In case of Sandhi-Gata-Vata varieties ofSvedanakrama like Upanaha and Bandhana are indicated.Upanaha Both Sushruta and Caraka consider Upanaha as a variety of Svedana100,101 . Roots of Vatahara drugs should be pasted together with Kanji and mixed withabundant quantity of Saindhava Lavana and Sneha. After making this lukewarm,it should be applied to the affected part. The paste of drugs included in theKakolyadi, Eladi or Surasadi groups as well as pastes of Sarshapa, Tila, or Atasior Krishara, Payasa, Utkarika and Vesavara or the drugs of Salvana Sveda shouldbe similarly applied to the affected part folded in piece of thin linen and tied up102.Bandhana Dravya in Upanaha For the purpose of Bandhana, Caraka opines that leather of Ushna Veeryaanimal can be used. In the absence of this silk or woolen cloth can be used103. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 43 the management of Sandigatavata
  • 60. ChikitsaAstanga Hridayakara opines that Vatahara Patras should be used104 and Carakasuggests Eranda Patra105.Duration Upanaha, which is tied in the morning, should be removed in the night andwhich is tied in the night should be removed in the morning106.Sneha PramanaAccording to Vata, Pitta, Kapha, Sneha should be added 1/4,1/6/1/8th of theUpanaha Dravya.Bandhana Acharya Susrutha again subdivides this into 3 types: a) Pradeha b) Sankara c) BandhanaPradeha Thick paste prepared by Amla Kanji in Vataharadravya after addingSaindhava Lavana and Sneha, Svedana is done. Dalhana called this asUpanaha107.Sankara Sweda In Sankara Sveda, paste made out of Vatahara Dravyas, Amla Kanji,Saindhava Lavana and Sneha etc., taken in a piece of cloth and Potali is prepared.Dalhana considered this as Upanaha108.Bandhana In Bandhana Upanaha Dravya is tied to the affected apart.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 44 the management of Sandigatavata
  • 61. ChikitsaAgnikarma Unique treatment indicated in case of Sandhi-Gata-Vata. Here Dahana orcauterization is done in the part affected. Dahana Karma should be done in theaffected joint till the Samyak Laxana. Hence the different treatment modalities mentioned by different authorscan be concise under these three (Su.Sa.Ci.4/8 & Dal; A.Sa.Ci.23/13;A.Hr.Ci.21/22; Yo.Ra.Ci.Vat; Bh.Pr.Ci.24/259).Janu-Basti Vagbahta has described four types of oil application on head underMurdha Taila, which are Shiro-Abhyanga, Shiro-Seka, Shiro-Picu and Shiro-Basti. In Shiro-Basti the head is immersed with oil by putting a cap on the head.As one of the meanings of Basti is to fill and reside, therefore the word Basti hasbeen added to Shiro. Shiro-Basti, where oil is kept on head by making an artificialpit for prescribed time. Later on some physicians made an artificial pit around the Kati with thehelp of Masha powder to keep hot oil for prescribed period and named it as Kati-Basti. Later on the process was carried out on the affected knee with the name ofJanu-Basti; and now crazy people even start doing Hridaya-Basti on the cardiacregion.DerivationHere the term "Janu-Basti" consists of two words i.e., 1. Janu 2. BastiJanu Vyutpatti - Jan - Junn Nirukti - Uru Jangayormadya Bhaga109(Shabda Stoma Mahanidhi) Janu-Sandhi i.e., the knee jointEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 45 the management of Sandigatavata
  • 62. Chikitsa In general Janu means - the junction between Uru and Jangha.Basti“Vas” is formed by the Tich Pratyaya.It belongs to masculine gender.The word “Vas” means – to reside, to abide, to produce effect of aromatic drugs.Meanings related to organ- Organ that lies below the umbilicus (Nabhi).-Organ in which the urine is collected and retained for some specific Period oftime. (“Bastih- Basteh Avrinoti Mootram”, Nabheradhobhage MutradhareSthane).-Ashaya.Meanings related to Karma- Here the urinary bladder of animals is used to inject the drugs into the rectum(“Bastinadeyate Eti Bastih”, “Bastibhirdeeyate Yasmaat TasmatBastiritismrutah”110, 111. The word Basti is used here with the meaning of “to reside”, “to retain”.In Janu-Basti the medicine is made to dwell or retain over the Janu-Sandhi for aprescribed time.Bahya Shamana ChikitsaIn the 11th chapter of Sutrasthana Caraka has classified Trividha Aoushadhi asAnta-Parimarjana, Bahi-Parimarjana and Shastra-Pranidhana. Janu-Basti may beincluded in Bahi-Parimarjana type of treatment. Again on the basis of mode of application, the Bahya procedures may beclassified into - 1.Massaging type – Abhyanga, Mardana, Udvartana etc. 2.Pouring type – Kaya-Seka, Shiro-Dahra etc.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 46 the management of Sandigatavata
  • 63. Chikitsa 3.Applying type – Picu, Alepa etc. 4.Retaining type – Shiro-Basti, Kavala, Gandoosha, Karnapoorana etc. In massaging type body is massaged with the help of suitable drugs. Againthey are sub classified on the basis of nature of drugs used (Abhyanga – oilMassage, Udvartana – powder Massage), force exerted (Samvahana – gentleMassage, Abhyanga – pressure Massage), direction of movement (Abhyanga –towards the direction of hair, Udvartana – Against the direction of hair) etc. In pouring type medicated Kvatha, Ksheera or Sneha etc., are poured froma specific distance over the required places. It may be Ekanga like Shiro -Dhara orSarvanga like Kaya-Seka. In application type the paste is applied to the affectedpart. In Picu a piece of cotton is to be dipped in medicated oil and tied over theeffected part. In case of Alepa, paste of drug is prepared and applied to the part.In retaining type medicine is made to retain in specific part of the body for aprescribed time. Eg: Shiro-Basti - The word Basti is used here to indicate, "tostagnate". In this procedure medicated oil is made to retain for a particular time inhead by constructing a pit.Janu-Basti procedure is evolved from Shiro-Basti procedure. Hence Janu-Basti isa Bahya Samshamana Chikitsa (Retaining type).Sandhi-Gata-Vata is a variety of Vata Vyadhi. The symptoms and treatment of -Sandhi-Gata-Vata is explained under this chapter in all the classics. The principleline of management is Snehana, Svedana and Agnikarma. Among which Snehanaand Svedana are Samprapti Vighatana Chikitsa. Janu-Basti is one such procedure that may do both Svedana and Snehana.In Janu-Basti the prepared medicine (medicated oil,) is made to retain over theJanu-Sandhi for a prescribed time.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 47 the management of Sandigatavata
  • 64. ChikitsaProcedure of Janu-BastiAll the procedures are performed in systematic manner. According to Sushruta itcan be performed in three stages like 1. Poorva karma 2. Pradhana karma 3. Paschat karma112The procedure of Janu-Basti is explained accordinglyI. POORVA KARMAThis includes preparatory measures taken for smooth conduction of the procedure.They are1.Atura PareekshaThe patient is examined with reference to Prakriti, Vikriti etc. ten factors byapplying Pratyaksha, Anumana and Aptopadesha. Which will assess Vyadhibalaand Dehabala113.Then affected knee should be Examined properly and mark the tender area.Examine for scares, wounds in the joint.2.Sambhara Sangraha Materials required for Smooth conduction of Janu-Basti procedure has tobe collected. They include – A metal ring, Masha powder, medicine KsheeraBalaTaila spoon, bowl, vessel, water, gas stove, and cotton.3.Atura Siddhata Patient is asked to lie down or to sit erect on the table. Expose the affectedknee properly. Support the limbs so that they are placed horizontally andcomfortably.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 48 the management of Sandigatavata
  • 65. ChikitsaII. PRADHANA KARMA1.Basti Yantra Dharana Initially paste of Masha powder is prepared by adding sufficient quantityof water to it. Then with the help of a metal ring and Paste of Masha a pit isconstructed around Janu-Sandhi of about 2-3 Angula height. The concavity of pit(Basti Yantra) should be well sealed to retain the medicine.2.Taila Dharana The bowl containing Medicine Taila Ksheera Bala tail is heated gently bykeeping over hot water. Then gently heated Luke warm Medicine is pouredslowly and carefully on the Janu-Sandhi along the side of the BastiYantra. Theheat of the medicine should be sufficient enough to tolerate by the patient. Thequantity of the medicine should be two Angulas above the skin surface.3.Maintenance of constant temperature of medicine Keep on changing the medicine with the heated one so that a constanttemperature is maintained through out the procedure.4.Removal of Taila and Basti Yantra After the prescribed time the oil should be removed from the BastiYantra.Then BastiYantra is to be removed.5.Samyak Lakshana Samyak Lakshana of Janu-Basti is not mentioned in classics. SamyakLakshana of Shiro-Basti cannot be interpreted even though Janu-Basti ismodification of it. Since it is a type of Sveda and Sneha, Samyak Sveda andSamyak Sneha Lakshanas can consider. Among Samyak Sveda Lakshana Sheetoparama, Stambhanigraha,Gauravanigraha and Vyadhihani can be considered for assessment. In case ofEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 49 the management of Sandigatavata
  • 66. ChikitsaSamyak Snigdha Lakshanas Snigdha Gatratva and Mrudu Gatratva can taken forassessment.5.Time In case of Vataja disorders the medicine should be retained for tenthousand Matra Kala. Hence the procedure is performed for 50min each day.III. PASCHAT KARMA After removing the oil and BastiYantra Mrudu Abhyanga is done over theJanu-Sandhi for about 5 min.Duration - This treatment is done for 14 days. 1. Benefits of Janu-Basti 2. It relieves the symptoms like Shoola, Stabdhata, and Atopa. 3. The procedure acts on various properties of Vata that are instrumental in the pathology of Janu-Sandhi-Gata-Vata mainly due to Snehana and Svedana. Also medicines used in the procedure help in alleviating Vata. 4. It is a very safe procedure. 5. The materials required for Janu-Basti are easily available. 6. It is cost effective. 7. Janu-Basti can be done in an outpatient set up also.Absorption Through Skin It is very difficult to explain the mode of action of Janu-Basti. Here anattempt is made to explain the probable mode of action of Janu-Basti.Janu-Basti is a Bahya Svedana, Snehana (if oil is used) and more over it is anSthanika Shamana Cikitsa.Acarya Sushruta in Shareerasthana explains – Out of the four Tiryak Dhamanis,each divides gradually hundred and thousand times and thus become innumerable.These cover the body like network and their openings are attached to Romakoopa.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 50 the management of Sandigatavata
  • 67. ChikitsaThrough them only Veeryas of Abhyanga, Parisheka, Avagaha, Alepa enter intothe body after under going Paka with Bhrajaka Pitta in skin114.One more reference in Sushruta Cikitsasthana explains – Sneha used in Avagahaproduces Shareera Bala by saturating through Siramukha, Romakoopa andDhamani115. Sushruta in Sutrasthana explains, Lepa like Bahirparimarjana treatmentsyield result by entering to Romakoopa thereby circulating through SvedavahaSrotas116. Vagbhata in Ashtanga Hridaya while explaining the functions of BhrajakaPitta narrated that – Bhrajaka Pitta will be do Pacana of drugs used in Abhyanga,Parisheka, and Lepa117, 118.Thus with the above references it can be said that drugs used in Janu-Bastiprocedure get absorbed through and produce action according to the property ofthe medicine.The skin anatomically consists of three distinct layers.The epidermisIt consists of keratinocytes, melanocytes, langerhan’s cells and merkel cells. Theterminal point of keratinocytes differentiation is the formation of the stratumcorneum. Formation of this layer is the most important function of the epidermis.It protects the skin against water loss, prevents the absorption noxious agents, andcan be thought of as consisting of bricks and mortar. Corneocytes forms the bricksEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 51 the management of Sandigatavata
  • 68. Chikitsaand barrier lipids form the mortar. ‘Granular cells’ which are stratum corneumhelps in maintaining skin hydration and their products serve as ultra violet filters.Lamellar granules also are found within granular cells. These contain probarrierlipids.Dermis It is a thick, highly vascular layer made up of ground substance,fibroblasts and collagen fibers, together with appendages of skin, sweat glandsand pilosebaceous follicles. It is metabolically active part of the skin.Subcutaneous Tissue It is a fibro fatty layer with varying quantities of adipose tissue in differentregions of the body. It provides physical and thermal protection to the deeperstructures of the body.Drug Delivery The primary barrier to absorption of exogenous substances through theskin is stratum corneum. Rate of absorption is directly proportional toconcentration of drug in vehicle, partition co-efficient, diffusion co-efficient andthickness of the stratum corneum. Physiological factors that effect per cutaneousabsorption include hydration, occlusion, age, intact versus disrupted skin,temperature and anatomic site. Among vehicles greases are anhydrous preparations that are either waterinsoluble or fatty. Fatty agents are more occlusive than water-soluble. Theyrestrict transepidermal water loss and hence preserve hydration of the stratumcorneum. Absorption depends upon lipid solubility of the drug since the epidermisas a lipid barrier. The dermis however is freely permeable to many solutes.Suspending the drug in an oily vehicle can enhance absorption through the skin. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 52 the management of Sandigatavata
  • 69. ChikitsaBecause hydrated skin is more permeable than dry skin. Application ofmedicaments, heat and massage definitely helps in eliminating the number ofnoxious elemtes through skin. The application of heat in different forms ofSvedana promotes local circulation and metabolic activities and also opens thepores of the skin to permit transfer of medicaments and nutrients towards toneeded sites and elimination of vitiated Doshas and Malas through skin andperspiration.PHYSIOLOGICAL EFFECTS OF HEAT Heating the tissues results in increased metabolic activity, increased bloodflow and stimulation of neural receptors in the skin or tissues and many otherindirect effects.Increased metabolismThe increase in metabolism is greatest in the region where most heat is produced,which is in the superficial tissues. As a result of the increased metabolism there inany increased demand for oxygen and foodstuffs, and an increased output ofwaste products, including metabolites.Increased blood supplyAs a result of increased metabolism, the output of waste products from the cells isincreased. These include metabolites, which act on the walls of the capillaries andarterioles causing dilatation of there vessels. In addition, the heat has a directeffect on the blood vessels, causing vasodilatation, particularly in the superficialtissues where the heating is greatest. Stimulation of superficial nerve endings canalso cause a reflex dilatation of the arterioles. As a result of vasodilatation there isan increased flow of blood through the area so that the necessary oxygen andnutritive materials are supplied and waste products are removed.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 53 the management of Sandigatavata
  • 70. ChikitsaEffects of heating on nervesHeat appears to produce definite sedative effects. The effect of heat on nerveconduction has still to be thoroughly investigated. Heat has been applied as acounter irritant, which is the thermal stimulus, may effect the pain sensation asexplained by the gate theory of Melzack and Wall.Indirect effects of heatingMuscle tissue – Rise in temperature induces muscle relaxation and increases theefficiency of muscle action, as the increased blood supply ensures the optimumconditions for muscle contraction.General Rise in temperature – As blood passes through the tissues in which therise of the temperature as occurred, it becomes heated and carries the heat to otherparts of the body, so that if heating is extensive and prolonged a general rise intemperature occur.Fall in blood pressure – If there is generalized vasodilatation the peripheralresistance is reduced, and this causes a fall in blood pressure. Heat reduces theviscosity of the blood, and this also tends to reduce the blood pressure.Increased activity of sweat glands – There is reflex stimulation of the sweatglands in the area exposed to the heat, resulting from the effect of the heat on thesensory nerve endings. As the heated blood circulates throughout the body itaffects the centers concerned with regulation of temperature, and there isincreased activity of the sweat glands throughout the body.(Ref. The pharmacological basis of therapeutics – Goodman and Gillman,Physiology by Robert M. Berne, Clayton’s Electro therapy by Angela Forster,Nigel Palastanga, Text book of Pharmacology by K.D. Tripati)Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 54 the management of Sandigatavata
  • 71. ChikitsaSadhyasadhyata If Sadhyasadhyata of a particular disease is well under stood and analyzedby a physician, it leads to the successful management of that disorder. So theknowledge of Sadhyasadhyata is very essential before the administration of anytherapeutics or medicaments.Sandhi-Gata-Vata is not a fatal disease, but it cripples the patient and makehim/her burden to others. Due to its tendency to be fatal or incurable, Vata Vyadhiconsidered as Mahagadha by almost all Acaryas.Dhatukshaya is the chief cause of Vata Vyadhi. Dhatukshaya is difficult to treat asAcarya Vagbhata has elaborated that since body is accustomed to Mala,Dhatukshaya is more troublesome than Dhatu Vruddhi. Sandhi-Gata-Vata is oneof the Vata Vyadhi therefore it is Kashtasadhya.The ailments of aged persons are Kashtasadhya and Sandhi-Gata-Vata is theaffliction of elderly persons. Diseases situated in Marma and MadhyamaRogamarga is Kashtasadhya. Sandhi-Gata-Vata is a disease of Sandhi, which fallsunder Madhyama Rogamarga. Further Vata Vyadhi occurring due to vitiation ofAsthi and Majja are most difficult to cure.In the list of Kashtasadhya Vata Vikara, Acarya Caraka does not mention Sandhi-Gata-Vata but while commenting on word ‘Khuddavata’ Cakrapani explains themeaning of Khuddavata as Gulphavata or Sandhi-Gata-Vata. Thus Sandhi-Gata-Vata can be considered as Kashtasadhya Vata Vyadhi.Pathya- Apaathya The Ahara and vihara that prevents aggravation of the disease and aids inthe relief at the same time without initiating another disease are known as pathya.Acharya Charaka is one step ahead by saying Pathya is one which is suitable tothe body and mind both in health as well as diseased condition.Though no oneEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 55 the management of Sandigatavata
  • 72. ChikitsaAcharyas has mentioned pathya and apathya for sandhigatavata directly, as thisdisease being a vatavyadhi we should adapt the samanya vatavyadhi patyapathya.PathyaA. Rasavarga - Madhura, Amla, lavana rasaShukadhanyavarga - Naveena godhuma, Samvatsarothitashali, Rakta Shali,Shashtikashali.Shimbi varga - Naveena tila, Naveena masha, kulathaShaka varga - Patola, shigru, vartaka, lasunaPhala varga - Draksha, dadara, pakva amra, parushaka, jambeera, dadima,pakvatala phalaMamsa varga - Ushtra, go, varaha, mahisha, hamsa, mayura, bheka, nakula,chataka, kukkuta, tithira, sheelindra, kurma, thimingila, rohita etc.Jalavarga - Ushna jala, Shritasheetajala, NarikelajalaDugdha varga - Go, aja ksheera, dadhi, grita, kilata, kurchilaMutra varga - GomutraMadhya - Dhanyamla, suraSneha - Tila, gritha, vasa majjaVihara - Bhushayya, snana, samhvahana etc.Chikitsa - Abhynga, brimhana, sanbrpana, tiladroni, shirobasti, avagaha, nasya,upanaha, agnikarma.ApathyaAhara - Katu, tikka, kashayarasaShimbi dhanya - Rajamasha, nishpara, mudga, kalayaShuka dhanya - Trunadhanya, trunaka, kangu, koradhusha, neevara,shyamaka, chanakaPhala varga - Jambu, udumbara, kramuka, tindukaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 56 the management of Sandigatavata
  • 73. ChikitsaMamsa varga - Sushkamamsa (Vallura), kapotha, paravataJalavarga - Nadeejala, Sheetambu, tadajalaKsheera - Gardaba ksheera ViharaVihara - Chinta, jagarana, shrama, vyavaya, vyayama, chankramana, Hastiashwayana, vegadharanaChikitsa - Vamana, RaktamokshanaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 57 the management of Sandigatavata
  • 74. Materials and methodsMaterial and MethodsSources of data: a. Patients suffering from Sandhivata will be selected from PG S&R PG O.P.D of DGM Ayurvedic medical college and hospital by pre-set inclusion and exclusion criteria. b. Literary: Literary aspect of study will be collected from classical ayurvedic and modern texts updated with recent medical journals and previous work done in different research center. c. Trial drug Abhadi churna Ingredients Botanical name quantity Abha Acasica Arebica 1 part Rasna Plucha lansiolata 1 part Guduchi Tinospora cardifolia 1 part Shatavari Asparagus recemosa 1 part Shunthi Gingeber officinalis 1 part Shoufa Anethum sowa 1 part Aswagandha Withenia sominifera 1 part Hrivera juniperous communies 1 part Vidhara Desmodium gungenticum 1 part Yavani Roxburghiamum ammi 1 part Composition Ksheera Bala tailam : Bala moola twak sida cardifolia 1 part Ksheera milk 4 part Tila taila sesamum indicum 4 partEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 58 the management of Sandigatavata
  • 75. Materials and methodsAbha119Latin name : Acacia arebicaFamily : MimosaceaeSynonyms : Vabboola, Vabbula, BarbaraRasa : KashayaGuna : Guru, RookshaVirya : SheetaVipaka : KatuDoshaghnata : KaphapittaPart Used : Bark, Gum, Leaves, Seeds & podsKarma : Kusta, Krimi, raktatisara, Prameha, Pradaranashana.Chemical Composition: Arabic acid, calcium, magnesium & potassium, Malicacid, sugar, ash, Tannin.Action and Uses:120 Astringent, demulcent, aphrodisiac, nutritive & expectorant.It is used gonorrhea, cystitis, vaginitis, leucorrhoea, and coughs.Rasna121Latin name :pluchea lanciolataFamily :zingberaceaSynonyms :suganda kulananjanaGanas :vedanastapaka anuvasanopaka vayastapaka arkadiganaRasa :tikta katuGuna :guruVeerya :ushanaVipaka :katuDoshagnata :kapha vata shamakaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 59 the management of Sandigatavata
  • 76. Materials and methodsParts used :RhizomesKarma : vata shamaka vedana shamana kasa swasa vatarakta jwaravishagna rasayanaChemical composition122:it consists of campharide galnin alpenin it contains anvolatile oilConsists of methyle cinnamate cineole camphor pinene it also contains oilypungent galangon alpinol galanginand di_oxyflaanolGuduchi123Latin name : Tinospora cordifoliaFamily : MenispermaceaeSynonyms : Amrita, Madhuparni, Chhinna, RasayaniGana : Vayasthapana, Dahaprashaman, Trishnanigrahana, Stanyashodhan, Truptighna.124 Guduchyadi, Patoladi, Aragvadhadi, Kakolyadi, Vallipanchmoola125Rasa : Tikta, KashayaGuna : Laghu, SnigdhaVirya : UshnaVipaka : MadhurDoshaghnata : TridoshashamakParts used : StemKarma : Rasayan, Dipan, Balya, SamgrahiRogaghnata : Jvara, Pandu, Kushtha, Vatarakta, KrimiChemical Composition:126 Giloin, a glycoside, Gilenin a non-glycoside and Gilosterol are found instem. Presence of bitter principles of columbin, chasmonthin and palmarin in theEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 60 the management of Sandigatavata
  • 77. Materials and methodsdrug has been reported (Chopra et al 1958). Tinosporin, tinosporic acid andtinosporal have been reported in the stem. (Anon 1976)Action and Uses: Guduchi is considered as bitter tonic, astringent, diuretic and a potentaphrodisiac. Its use has been indicated in heart diseases, hypertension andrheumatoid arthritis.The drug has been observed to relax smooth muscles of intenstine, uterus andinhibit constrictor response of histamine and acetylcholine on smooth muscles(Gupta et al, 1967). The drug has proved to be effective as antirheumatic anddiuretic as well as having anti-inflammatory properties. (Rai and Gupta, 1966).The drug is reported to possess one fifth of the analgesic effect of sodiumsalicylate.Sathavari127Latin name : Aspragus RacemosesFamily : LliaceaeGana : Balya vayastapana Madhuraskanda128 Vidarigandadi kantaka panchamoola pitta prashamana129Synonyms : shatavariRasa : madhura tiktaGuna : Guru snigdaVirya : sheetaVipaka : madhurDoshaghnata : tridosha shamkaPart Used : Root LeavesKarma :. Vata pitta hara Vrashya RasayanaChemical Composition: Large number of saponin are found in shatavariEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 61 the management of Sandigatavata
  • 78. Materials and methodsAction and Uses: 130Root empolyed in diarroheaShunthi131Latin name : Zingiber officinaleFamily : ZingiberaceaeGana : Truptighna, Arshoghna, Deepaniya, Shoolaprashamana, Sheetaprashamana,Trishna Nigrahana.132 Pippalyadi, Trikatu133 Panchkola, Shadushana134Synonyms : Vishwa, Nagar, Shrungavera, KatubhadraRasa : KatuGuna : Laghu, SnigdhaVirya : UshnaVipaka : MadhurDoshaghnata : KaphavataghnaPart Used : Dried VhizomeKarma : Pachan, Ruchya, Shothaghna, Shoolaghna,Anulomana.Chemical Composition: Camphene, Phellandrene, Zingiberine, Cineol and borneol, ginerol.Gingerin is the active principle. Other resins and starch, K-Oxalate are alsopresent .Action and Uses:135 It is aromatic, carminative, stimulant to the gastrointestinal tract andstomachic. It removes viscid matter, strengthens memory, and removesobstruction in the vessels. It is used is nervous diseases, incontinence of urine.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 62 the management of Sandigatavata
  • 79. Materials and methodsShoupha136Latin name : Anathum soaa KurzFamily : UmbelliferaeGana : Asthapana -SuSynonyms : Shoupha, Chatra,Rasa : Katu, TeektaGuna : Laghu, Ruksha, TeekshnaVirya : UshnaVipaka : KatuDoshaghnata : VatakaphaPart Used : PhalatailaKarma : Jwarahara, Shelsmahara, VrunashoolaChemical Composition: Volatile oil, Epinol, Karvoal, HydrocarbonAction and Uses: Carminatives, Somatic, Aromatic, Stimulant and Diuretic. It isused in Hiccough, Colic & Abdominal pain. Application of roots in Rheumatic &swellings of the joints.Ashwaghanda137Latin name : Withania somnifraFamily : SolanacaeGana : Balya Branhaneeya Madhura skanda138Synonyms : Ashvagandha Varka parniRasa : Katu, Tiktha, KashayaGuna : Laghu, SnigdaVirya : UshnaVipaka : MadhuraDoshaghnata : Kaphavata shamakaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 63 the management of Sandigatavata
  • 80. Materials and methodsPart Used : Moola, seedsKarma : Balya, Hridroga, Ksaya, ShoosaChemical Composition: Alkaliod somniferin Resin Phyto sterolAction and Uses: Vajeekara balya Rasayana Root &leaves are used as hypo tonic inalcoholism leaves used as anti helmentic fruits &seeds are used as diuretics rootapplication is done in rheumatism in all cases of general debility nervousexhurationHavubera139Latin name : Juniperus communis linnFamily : PinaceaeSynonyms : Havubera, Hapusha, HahusaRasa : Katu, TikataGuna : Laghu, Ruksha, TeekshnaVirya : UshnaVipaka : KatuDoshaghnata : KaphavataPart Used : PhalaKarma : Pittodara,Arsha, Grahini, Gulma, ShoolaChemical Composition: Volatile Oil, Grape Sugar, Resin, Formic & Acetic acidAction and Uses: Fruit is aromatic, carminative and stimulant, digestive, diuretic.It is used in scanty urine chronic bright’s disease, Hepatic dropsy, coughGonorrhea, Leucorrhoea & Skin diseases.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 64 the management of Sandigatavata
  • 81. Materials and methodsVridhadarak140Latin name : Argyrea speciosa sweetFamily : convolvulaceaeSynonyms : vridhadaraka vidhara samudra shophaRasa : katu tikta kashayaVirya : UshnaDoshaghnata : Kapha vata shamakaPart Used : MoolaKarma :Rasayana vata amavata arsha shootha haraChemical Composition: Acidic materialAction and Uses: Kaphagna shothahara balya rasayanaYavani141Latin name : TachyspermumammiFamily : UmblliferaeGana : Sheetaprashamana142 Caturbeeja143Synonyms : Yavani, Ajamodika, DipyakaRasa : Katu tiktaGuna : Laghu, Ruksha, TeekshnaVirya : UshnaVipaka : KatuDoshaghnata : Kaphavata ShamakaPart Used : PhalaKarma : Rochana, deepana, vatanulomana, shoolapra shamanaChemical Composition: Ajavon oil, Thaimol, Carvacrol, Thymene, Carotin,potassium, and thiamine, Raiboflovin.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 65 the management of Sandigatavata
  • 82. Materials and methodsAction and Uses: As abhyanga in Shoota & vedanayukta vikara, Kasa, Swasa,Hrddourbalya, Aruchi Agnimandya, Gulma, Phelha, Krimiroga.Ajamoda144Latin name : Carum roxbur giahumFamily : UmbelliferaeGana : Shoolaprashama, Deepaniya145 Pippalyadi146Synonyms : Ajamoda, KarashwaRasa : Katu, TiktaGuna : Laghu, Sukshma, TeekshnaVirya : UshnaVipaka : KatuDoshaghnata : Kaphavata shamakaPart Used : PhalaKarma :. Deepana, vatanulomana, shulaprashamanaChemical Composition: Volatile oil, & Stable oil,Action and Uses: Balya krimigna hridya balyaIngrediants of ksheera bala tail.Ksheera147, 148Out of eight types of ksheera Go ksheera is the one, which is hitamComposition; It is made up of 87.4% water 12.6% milk solids.3.4% of protein4.8% of minerals varios enzymes & nitrogenous compound.Rasa MadhuraGuna :snigdhaVeerya .SheetaVipaka :MadhuraEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 66 the management of Sandigatavata
  • 83. Materials and methodsProperties: Brihmana vrishya medhya balya jeevaneeya sandhanaka sarva satmya Shwasa hara kasa hara .Uses: pandu shwas Atisara jwara yoni roga &pitta rogaTila Tail149, 150Latin name: Sesum IndicumComposition: Plamatic acid steoric acid olenic acid.Rasa: MadhuraGuna Sookshma vyavai vishada guru saraPropeties:vatagna aggravates pitta kapha deepana pachana .It gives strength&stability to the body ,It is krimigna in nature .Bala151, 152Latin name :Sida cardi foliaGana:Balya brihmaneeya Praja stapana madhura skanda (ca) Vatasanshamana(su)Kula : MalvaceaeSynonyms: bala khara yastikaGuna : Laghu snigdhaRasa: madhuraVipaka: madhuraVeerya: sheetaDosha gnata :pitta shamakaKarma:grahee pittasra kshata shamana vatahara bala ojo vardhakaPrayojya Anga :Moola BeejaChemical composition: Alkaliods fatty oil photo sterolAction Uses: cooling astringent Aromatic, Roots are used in nervous &urinarydiscards Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 67 the management of Sandigatavata
  • 84. Materials and methodsMethod of Prepration of drug The trail drug abhadi churna is prepared as per the churna vidhi. Ie.all the drugs with there use full parts are collected and made them into choorna form, and all are taken in equal part.Method of preparation of Ksheera bala tail All the drugs are collected required for the preparation of ksheera balatail .after collecting kashaya and kalka of bala is prepared ,and equal quantity ofmilk is added to that and paka is done for hundered times . . Method of collection of data:- a) The samples are selected for by using S. R. S. techniques. b) Groups two each having 15 patients. c) Group A treated with Abhadi churna D) Group B treated with Ksheera bala taila Janu basti Study duration: 30 days and fallow –up 30 days Exclusion criteria • Patients below 30 years &above 70 years • Pregnant woman Lactating mother • Associated with simple or compound fractures • Associated with trauma • Associated with any other systematic or metabolic disorders • Patients on steroid therapy • Patient undergone surgery Inclusion criteriaEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 68 the management of Sandigatavata
  • 85. Materials and methods • Patients suffering from the symptoms of sandhi vata • Other than the above declared exclusion criteriaCriteria of diagnosis On the basis of sign symptoms mentioned in the Ayurvedic textsPosology Abhadi choorna - 3 gm /day in divided doses Ksheera bala taila Q.SSubjective parameters As designed in the classical Ayurvedic and modern textsObjective parameters • Swelling • Walking time • Flexion deformity • ESRExamination of knee jointHistory The common symptoms with which a patient generally presentsare pain, swelling, stiffness, mechanical disorders (e.g. Locking, giving way, clicketc.) and limp.Inspection • Both the lower limbs were fully exposed • Patient was first examined in the standing position, both from front and behind, secondly in the seated position, thirdly in the supine position and lastly in the prone position. • SwellingEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 69 the management of Sandigatavata
  • 86. Materials and methods A) The limits of the swelling were clearly made out. B) The gradings were allotted on the basis of criteria explained in the end of this section. C) The Varna of the Shopha was examined (Raga, Shyava or Prakrutha). D) Any deformities like genus valgum, varum etc. were examined. E) Joint instability or buckling of the joint was examined. F) Any abnormalities in the gait were examined. G) Walking time was recorded (the time taken to cover 21 meters). H) Any presence of muscular spasm was examined. I) Muscular wasting above and below the joint was examined.Palpation • Local temperature was examined with the back of the hand and compared to that of the other side. • Local tenderness was also examined. • Swelling A) Pressing the suprapatellar pouch with one hand and feeling the impulse with the thumb performed fluctuation test and the fingers of the other hand placed on either side of the patella or the ligamentum patellae. B) Patellar tap was elicited by pressing the suprapatellar pouch with one hand driving the whole of its fluid into the joint proper as to float the patella in front of the joint. With the index finger of the other hand, the patella is pushed backwards towards the femoral condyles with a sharp and jerky movement. The patella can be felt to strike on the femur, which is known as the patellar tap.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 70 the management of Sandigatavata
  • 87. Materials and methods • Palpation of popliteal fossa - The patient was made to lie down prone on the table. The knee joint was flexed and the popliteal fossa was palpated. The knee joint, popliteal artery, areolar tissue, veins and nerves and the tendons in and around the popliteal fossa were all palpated carefully to detect any pathology here. • Significance of click - If the click was associated with discomfort or pain, careful examination was done. Commonest cause of intra-articular click is OA. • Patello-femoral and femoro-tibial components were palpated for any tenderness or irregularity.Movements The movements permitted in the knee joint are mainly flexion andextension. Minor degrees of abduction, adduction and rotations may be permittedwhen the joint is partly flexed. Both active and passive movements wereexamined. • Flexion & Extension: Normally, the knee can be flexed until the calf extended till the thigh and leg form a straight line. • Abduction & adduction: These movements are virtually absent with knee straight, but slight degrees of abduction and adduction are possible when the knee is semi-flexed. • Rotation: This movement is also not possible when the knee is straight. When the hip and knee are flexed to 90 degrees, some degree of rotation is possible.Auscultation During active or passive movement, the palm of one hand of the physician was placed over the patella and crepitus was felt.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 71 the management of Sandigatavata
  • 88. Materials and methodsAssessment of results Subjective objective parameters of base line data to post medication datacomparison is used for clinical Assessment of resultsGrading of parametersPain 0-No complaints 2-Complains frequently 1-Tells on enquiry 3-Excruciating conditionSwelling 0-No complaints 2-Covers well over the bony prominence 1-Slightly obvious 3-Much elevatedStiffness 0-Absent 1-PresentTenderness 0-No complaints 2-Winces the affected joint 1-Says the joint is tender 3-Winces and withdraws the jointWalking time 0- Up to 20seconds 3- 41-50seconds(to cover 21 1- 21-30seconds 4- 51-60secondsmeters) 2- 31-40secondsFlexion 0- Full range of flexion 3- Up to 50%deformity 1->75% & < Full range 2- 50-75%, 4- No MovementCrepitus 0-None 1-Felt 2-HeardE.S.R 0 – None, 1 - PresentAims Grading 1-Very Satisfied 4- Somewhat Dissatisfied 2- Somewhat Satisfied 5- Very Dissatisfied 3- Never SatisfiedOverall Assessment Of Clinical Response • Good Response : >75% improvement in clinical parameters • Moderate Response : 50-75% improvement in clinical parameters • Poor Response : up to 50% improvement in clinical parameters • No Response : 0 % or No improvement in clinical parametersEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 72 the management of Sandigatavata
  • 89. ResultsObservation and Results In the present clinical study subjective and objective changes wereconsidered for the assessment of Ayurvedic management of Sandigatavatas withAbhadi churna taken orally & Ksheerabala taila janu basti. Thirty patients wereselected for the study, and were divided into two groups viz. in group A, 15patients were administered with Abhadi churna taken orally & in group B, 15patients were given janu basti with ksheerabala taila. All the patients wereassessed before and after the treatment. Both subjective and objective changeswere recorded according to the guidelines of proforma of case sheet. The data were collected as follows: - 1. Demographic data 2. Data related to etiological factors, type and duration of chief complaints. 3. Data related to subjective and objective parameters before and after treatment. 4. Data related to incidence of disease. 5. Statistical analysis and assessment for response.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 73 the management of Sandigatavata
  • 90. Table No. A. Demographic data related to Evaluation of Abadi churna in Sandivata.Sl. O.P.D Age Sex Religion Occupation Economical Food habits ResponseNo. status 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 4226 - + - - - - - + - - - + - - + - - + - 2 3284 - + + - - - - - + - - + - + - - - + - 3 3885 - + + - - - - + - - - + - + - - - - - 4 3489 + - + - - - - - + - - + - + - - - + - 5 4020 + - + - - - + - - - + - - + - - - + - 6 4035 - + + - - - - - - + - + - + - - - + - 7 4096 - + + - - - - - + - - + - - + - - + - 8 3051 - + + - - - + - - - - + - + - - + - - 9 160 + - - + - - - - + - + - - - + - + - -10 380 - + + - - - - + - - + - - + - - - + -11 514 + - + - - - + - - - + - - + - - - + -12 1194 + - + - - - - - + - - + - + - - + - -13 178 + - + - - - - + - - - + - + - - - + -14 188 + - + - - - + - - - - + - + - - - + -15 510 + - + - - - - - + - - + - + - - - + -1 – Male, 2 – Female, 3 – Hindu, 4 – Muslim, 5 – Christian, 6 – Others, 7 – Sendentary, 8 – Active, 9 – Lobour, 10 – Others, 11 – Higher class,12 – Middle class, 13 – Poor class, 14 – Veg, 15 – Mixed, 16 – Good, 17 – Moderate, 18 – Mild, 19 –Poor. 74
  • 91. Table No. B Demographic data related to Evaluation of Ksheerabala taila Janubasti in Sandivata.Sl. O.P.D Age Sex Religion Occupation Economical Food habits ResponseNo. status 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 3974 + - + - - - - - + - - + - + - - + - - 2 3670 + - + - - - + - - - - + - + - - + - - 3 3911 - + + - - - + - - - - + - + - - + - - 4 3915 + - + - - - - - + - - + - + - - - + - 5 4006 + - + - - - - - + - + - - + - + - - - 6 4184 + - + - - - + - - - - - + - + - - + - 7 150 - + + - - - - - - + - + - + - - + - - 8 4051 - + - + - - - - - + - - + - + - + - - 9 4111 + - + - - - - + - - - - + + - - - + -10 4220 + - + - - - - + - - - + - + - - - + -11 3650 + - + - - - - - + - - - + + - - + - -12 4253 - + - + - - - - + - - - + + - - + - -13 192 - + + - - - - - - + - - + + - - - + -14 226 - + - + - - + - - - - - + - + - + - -15 221 - + + - - - - - - + - - + - + - - + -1 – Male, 2 – Female, 3 – Hindu, 4 – Muslim, 5 – Christian, 6 – Others, 7 – Sendentary, 8 – Active, 9 – Lobour, 10 – Others, 11 – Higher class,12 – Middle class, 13 – Poor class, 14 – Veg, 15 – Mixed, 16 – Good, 17 – Moderate, 18 – Mild, 19 –Poor. 75
  • 92. ResultsTable.11 Distribution of patient according to age among groups. Age in Yrs Group A Group B No. of Patient % No. of % Patient 30-40 1 6.66% 0 0% 40-50 8 53.33% 11 73.33% 50-60 5 33.33% 2 13.33% 60-70 1 6.66% 2 13.33%Above chart shows most of the patients were of age group of 40 –50yrs is of 8(53.3%)in number.. Minimum number of patients were5 (33.3%) of age groups of 60 –70yrs&age group of 30-40 yrs is of 1 in number. &The other patients were belonging to theage group of 50-60 yrs is of 5 in number in group A. and in group B maximum of11(73.3%)patients were belonging to the age group of 40-50 years, and minimum of2(13.3%) patients were belonging to the age group of 50-60&60-70 respectively. 12 10 30-40 8 40-50 6 50-60 4 60-70 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 76 management of Sandigatavata
  • 93. ResultsTable.12 Distribution of patient according sex among groups. Sex Group A Group B No. of Patient % No. of Patient % Male 8 53.33% 8 53.33% Female 7 46.66% 7 46.66%Above chart shows most of the patients were belonging male category i.e. 8in numberin both the group i.e. (53.33%) & other patients were belonging to the femalecategory i.e. 7in number (46.66%) 8.2 8 7.8 7.6 7.4 Male 7.2 Female 7 6.8 6.6 6.4 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 77 management of Sandigatavata
  • 94. ResultsTable.13 Distribution of patient according to occupation. Occupation Group A Group B No. of Patient % No. of Patient % Sedentary 4 26.6 5 33.3 Active 4 26.6 2 13.33 Labor 6 40.6 5 33.3 Others 1 6.6 3 20.0Table shows among 15 patients in Group A, maximum are Labor, i.e. 6(40.6%).4(26.6%) are Sedentary & Active. Only 1(6.6%) was others. In Group B maximumpatient were Sedentary & Labor i.e., 5(3.33%), active were 2(13.33%) & 3(20%) wereothers. 7 6 5 Sedentary 4 Active 3 Labour 2 Others 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 78 management of Sandigatavata
  • 95. ResultsTable.14 Distribution of patient according to Economical status Economical Group A Group B status No. of Patient % No. of Patient % Poor 4 26.6 8 53.3 Middle class 10 66.6 6 40.0 High class 1 6.6 1 6.6Among 15 patients in Group A, maximum patient belongs to middle class i.e. 10innumber (66.6%), whereas 1 patient was of higher class i.e.(6.6%) & other patientswere of poor class.4in number(26.6%). In Group B maximum patients belongs to poorclass i.e. 8 in number (53.3%)where as 6 patients were of middle class (40.0%) &only 1patient belonging to higher class (6.6%) 12 10 8 Poor 6 Middle class 4 High class 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 79 management of Sandigatavata
  • 96. ResultsTable.15 Distribution of patient according to ReligionReligion Group A Group B No. of Patient % No. of Patient %Hindu 13 86.6 12 86.4Muslim 2 13.4 3 13.4Christian 0 00.0 0 00Others 0 00.0 0 00Among 15 patients in Group A maximum 13 patients belongs to Hindu (86.6%).where as 2 patients were of Muslim,(13.4%) Christians & other religions were notreported in present study. In Group B maximum of12 patients belongs to Hindu(86.4%) where as 3 patients were of Muslim (13.4%) Christians & other religionswere not reported in present study. 14 12 10 Hindu 8 Muslim 6 Christian 4 Others 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 80 management of Sandigatavata
  • 97. ResultsTable.16 Distribution of patient according to DietDiet Group A Group B No. of Patient % No. of Patient %Vegetarian diet 12 80 11 73.3Mixed diet 3 20 5 33.3In the above table it was observed that maximum patients were of Vegetarian diet,were12 in number (80%) and 3(20%0) were of mixed diet in Group A in group B Themaximum patients were of Vegetarian diet11 (73.3%), &5(33.3%) were of mixed. 14 12 10 8 Vegetarian diet 6 Mixed diet 4 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 81 management of Sandigatavata
  • 98. ResultsTable.17 Distribution of patient according to affected to leg of Sandhivata. Leg affected Group A Group B No. Of Patient % No. of Patient % Right 5 33.33% 3 20% Left 4 26.66% 4 26.66% Both 9 60% 8 53.33% From above table it shows that among 15 Patient in Group A, maximum of9(60%) patient presented with Sandhivata to the both legs. & 5(33.35) patients wereeffected with Right leg. &5 patients were reported with left leg .In Group B maximum8 (53.3) patients presented with Sandhivata to both legs, & 4(26.6%) patients werereported with right leg,& 3 (20%) patients were reported with Sandhivata to left leg. 10 9 8 7 6 Right 5 Left 4 Both 3 2 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 82 management of Sandigatavata
  • 99. ResultsTable.18 Distribution of patient according to Agni Agni Group A Group B No. of Patient % No. of Patient % Manda 4 26.6 5 33.4 Vishama 5 33.4 4 26.6 Teekshna 2 13.4 3 20.0 Sama 4 26.4 3 20.0 From the above table it shows that in group A maximum of 5(33.4%) patientsare having agni and minimum of 2(13.4) patients are having teekshagni and remaining4(26.6%) patients are having manda agni &samagni. In group B maximum of5(33.3%). Patients are having mandagni and minimum of 3(20.0%)patients are havingteekshagni 6 5 Manda 4 Vishama 3 Teekshna 2 Sama 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 83 management of Sandigatavata
  • 100. ResultsTable.19 Distribution of patient according to Koshta Koshta Group A Group B No. of Patient % No. of Patient % Mridu 4 26.6 5 33.3 Madhya 5 33.3 4 26.6 Kroora 2 13.4 3 13.4 Sama 4 26.6 3 33.4 From the above table it shows that in group A maximum of 5(33.4%)patients are having madhyma kosta and minimum of 2(13.4%) patients are havingkroora and remaining 4(26.6%) patients are having mridu &sama kosta agni &. Ingroup B maximum of 5(33.3%) Patients are having madhyma kosta and minimum of3(20.0%)patients are having kroora &Sama kosta. And remaining 4(26.6%) patientsare having kroora kosta 6 5 4 Mridu Madhya 3 Kroora 2 Sama 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 84 management of Sandigatavata
  • 101. ResultsTable.20 Distribution of patient according to Habits in patients. Types of Group A Group B Habits No. of Patient % No. of Patient % Smoking 3 20 1 6.6 Tobacco 3 20 1 6.6 Alcohol 2 13.4 5 33.3 None 7 16.6 8 53.3The above chart shows that in group A maximum of 3(20.0%)patients smoking habit,and 3(20.0%) patients are having tobacco chewing minimum of habit 2(13.4%)patients are having habit of alcohol in take, and remaining 7 patients are having nohabits. In-group B maximum of 5(33.3%) patients are having. habit of alcohol in take, andminimum of 1(6.6%) of patients having smoking and tobacco chewing habit. other8(53.3%) patients are having no habits. 9 8 7 6 Smoking 5 Tobacco 4 Alcohol 3 None 2 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 85 management of Sandigatavata
  • 102. ResultsTable.21 Distribution of patient according to Prakriti of patients. Prakriti Group A Group B No. of Patient % No. Of % Patient Vatapitta 6 40 5 33.4 Vatakapha 5 33.4 6 40 Kaphapitta 4 26.6 4 26.6The above chart shows that maximum of 6(40.0%) patients were belonging to vatapitta prakriti, and minimum of 4(26.6%) patients were belonging to the vata kaphaprakriti. remaining were 5(33.4%) patients were belonging to vata kapha prakriti ingroup A.In group B maximum of 6(40.0%) patients are having vata kapha prakriti.andminimum of 4(26.6%)patients are having kapha pitta prakriti, remaining were5(33.4%) patients were belonging to vata kapha prakriti in group B 7 6 5 Vatapitta 4 Vatakapha 3 Kaphapitta 2 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 86 management of Sandigatavata
  • 103. ResultsTable.22 Distribution of patient according to different nidana bhavas. Type of Group A Group B nidana No. of Patient No. of Patient Swaprakopaka 8 9 Marmaghataka 3 3 Dathukshaya 4 3 The above chart shows that among 15 patients in group A 8(53.3%) patients arehaving swaprakopaka nidana, &4(26.6%) patients are having dhatu kshya janyanidana. other 3(20.0%) patients are having marmaabhigata janya nidana.In groupBamong 15 patients9(60.0%) patients are having swaprakopaka nidana &3(26.6%)patients are havingmarmabhighata janya nidana. other 3(2606%)patients are having dhatu kshya janyanidana. 10 9 8 7 6 Sw aprakopaka 5 Marmaghataka 4 Dathukshaya 3 2 1 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 87 management of Sandigatavata
  • 104. ResultsTable.23 Distribution of patient according to Chronicity of the disease amonggroups. Duration in Group A Group B months No. of Patient % No. of Patient % Up to 1 month 3 20 1-6 months 2 13.3 3 20.0 1-2 year 4 26.6 3 20.0 2-3year 3 20.0 4 26.6 3-4 year 2 13.3 2 13.3 4-5 year 1 6.6 3 20.0The above chart shows that maximum of 4(26.6%) patients are having chronicity of 1-2year. and 3(20.0%) patients are having chronicity of 2-3 year, 2(13.3%) patients arehaving chronicity of 3-4year, &1(6.6%)patients are having chronicity of 4-5 year.other 3(20.0%) patients are having duration of 1month in-group A. While in group Bmaximum of 4(26.6%) patients are having chronicity of 2-3 years, & 3(20.0%)patients are having chronicity of 1-2 years, 3(20.0%) patients are having chronicity of4-5 years, and 2(13.3%) patients are having chronicity of 3-4 years. Other3(20.0%) patients are having chronicity of 1-6 months. 4.5 4 Up to 1 month 3.5 3 1-6 months 2.5 1-2 year 2 2-3year 1.5 3-4 year 1 4-5 year 0.5 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 88 management of Sandigatavata
  • 105. ResultsTable.24 Showing the incidence of Swelling in the patients. Swelling Group A Group B No. of Patient % No. of Patient % Grade 0 0 0% 0 0% Grade 1 0 0% 1 6.66% Grade 2 5 33.33% 4 26.66% Grade 3 10 66.66% 10 66.66%The above chart shows that maximum of 10(66.6%) patients are having severity ofswelling Grade 3, and minimum of 5(33.3%) patients are having swelling severity ofgrade 2in group A .In group B maximum of 10(66.66%) patients are having swellingseverity of grade 3&Minimum of 4(26.6%) patients are having swellingseverity ofgrade 2,remaining 1(6.6%) Patient having severity of grade 1 12 10 8 Grade 0 Grade 1 6 Grade 2 4 Grade 3 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 89 management of Sandigatavata
  • 106. ResultsTable.25 Showing the incidence of walking time in the patients. Walking time Group A Group B in Grade No. Of Patient % No. Of % Patient Grade 0 0 0% 0 0% Grade 1 3 20% 1 6.66% Grade 2 2 13.33% 1 6.66% Grade 3 10 66.66% 10 66.66% Grade 4 0 0% 3 20%The above chart shows that maximum of 10(66.6%) patients are having walking timeof grade 3, & 3(20.0%) patients having walking time of grade1.remaining 2(13.3%)patients are having grade 2.In group B maximum of 10(66.6%) patients are havingwalking time of grade 3, and minimum of 1(6.66%) patient having grade 1&2respectively. 14 12 Grade 0 10 Grade 1 8 Grade 2 6 4 Grade 3 2 Grade 4 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 90 management of Sandigatavata
  • 107. ResultsTable.26 Showing the incidence of range of Flexion deformity in the patients. Flexion Group A Group B deformity No. of Patient % No. of Patient % Grade 0 0 0% 0 0% Grade 1 0 0% 0 0% Grade 2 4 26.66% 4 26.66% Grade 3 9 60% 11 73.33%The above chart shows that maximum of 9(60.0%) patients are having flexiondeformity of grade 3, and minimum of 4(26.6%) patients are having grade2 in-groupA. In group BMaximum of 11(73.3%) patients are having flexion deformity of grade 3, andminimum of 4(26.6%) patients are having grade 2. 12 10 8 Grade 0 Grade 1 6 Grade 2 4 Grade 3 2 0 No. of Patient No. of Patient Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 91 management of Sandigatavata
  • 108. ResultsTable.27 Showing the incidence of Pain in the patients. Group A Group B Pain No. Of Patient % No. Of % Patient Grade 0 0 0% 0 0% Grade 1 0 0% 0 0% Grade 2 11 73.33% 3 20% Grade 3 4 26.66% 12 80% The above chart shows that maximum of 11(73.3%) patients were having painseverity of grade 2, and minimum of 4(26.6%) patients are having grade 3 in groupA.In group B maximum of 12(80.0%) patients are having pain severity of grade 3,and3(20.0%) patients are having grade2. 14 12 10 Pain Grade 0 8 Grade 1 6 Grade 2 4 Grade 3 2 0 Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 92 management of Sandigatavata
  • 109. ResultsTable.28 Showing the incidence of Stiffness in the patients. Group A Group B Stiffness No. Of Patient % No. Of % Patient Grade 0 3 20% 2 13.33% Grade 1 12 80% 13 86.66%The above chart shows that in-group A maximum of 12(80%) patients are havingstiffness of grade 1,and remaining 3(20.0%) patients are having grade 0.In group B maximum of 13(86.6%) patients are having stiffness of grade 1,andminimum of 2(13.3%) patients are having grade 0. 14 12 10 Stiffness 8 Grade 0 6 Grade 1 4 2 0 Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 93 management of Sandigatavata
  • 110. ResultsTable.29 Showing the incidence of Tenderness in the patients. Group A Group B Tenderness No. of Patient % No. of Patient % Grade 0 0 0% 0 0% Grade 1 0 0% 1 6.66% Grade 2 9 60% 6 40% Grade 3 6 40% 8 53.33%The above chart maximum of 9(60.0%) patients are having tenderness of grade 2,andremaining 6(40%) patients are having grade 3.In group B maximum of 8(53.3%)patients are having tenderness of grade 3, &remaining 6(40.0%) patients are havinggrade 2. 10 8 Tenderness 6 Grade 0 Grade 1 4 Grade 2 2 Grade 3 0 Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 94 management of Sandigatavata
  • 111. ResultsTable.30 Showing the incidence of Crepitus in the patients. Group A Group B Crepitus No. of Patient % No. of Patient % Grade 0 0 0% 1 6.66% Grade 1 5 33.33% 4 26.66% Grade 2 10 66.66% 10 66.66% The chart shows that maximum of 10(66.6%) patients are having crepitus pf grade2,and remaining 5(33.3%) are having grade 1in group A. In-group B maximum of10(66.6%) patients are having grade2, and remaining 4(26.6%) patients are havinggrade1. 12 10 8 Crepitus Grade 0 6 Grade 1 4 Grade 2 2 0 Group A Group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 95 management of Sandigatavata
  • 112. ResultsTable.31 Showing the incidence of Weight of the body in the patients Group A Group B Weight in Kg No of pts % No of pts % 30-40 0 00 1 6.6 40-50 1 6.6 1 6.6 50-60 3 20.0 3 20.0 60-70 9 60.0 8 53.3 70-80 2 13.3 1 6.6 80-90 0 0 0 0 90-100 0 0 1 6.6 Above chart shows that in group A maximum of 9(60%) patients are in the 60– 70 kg weight group. Only 1(6.6%) patients are in the 40 – 50 kg weight group. 80 60 40 20 0 Group A Group B Column 1 30-40 40-50 50-60 60-70 70-80 80-90 90-100 Column 9 Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 96 management of Sandigatavata
  • 113. ResultsTable.32 Master Chart – Subjective Parameter – Group- A s.n o.p.d pain stiffness Tenderness Crepitus B A B A B A B A 1 4226 2 1 1 0 2 2 2 1 2 3284 2 1 1 0 3 1 2 1 3 3885 2 1 1 0 2 1 2 1 4 3489 2 1 1 0 3 2 2 1 5 4020 2 2 1 1 1 1 2 1 6 4035 2 1 1 0 2 1 2 1 7 4096 2 1 1 1 2 2 2 1 8 3051 3 2 1 1 2 1 2 1 9 160 2 1 1 0 3 2 2 1 10 380 2 1 1 0 1 1 2 1 11 514 2 1 1 0 1 1 2 1 12 1194 2 2 1 0 1 1 2 2 13 178 3 2 1 0 1 0 2 1 14 188 3 2 1 0 3 1 2 1 15 510 3 2 1 0 3 1 2 1Table.33 Master Chart –objective parameter– Group- A Sl.No. Opd.no swelling Walking Flexion E.S.R time deformity B A B A B A B A 1 4226 2 1 43 33 2 1 15 10 2 3284 2 1 45 36 2 1 16 10 3 3885 2 1 48 32 2 1 10 10 4 3489 3 2 44 38 2 2 13 10 5 4020 3 2 42 32 3 1 20 20 6 4035 3 2 28 23 2 0 12 10 7 4096 3 2 43 36 2 0 13 10 8 3051 2 2 38 29 3 2 12 10 9 160 2 2 32 21 3 2 15 13 10 380 3 2 43 39 3 2 12 10 11 514 3 2 47 39 3 1 14 12 12 1194 3 2 48 22 3 2 11 10 13 178 3 1 41 22 3 1 10 10 14 188 3 1 43 22 3 2 12 10 15 510 3 1 48 24 3 2 15 13Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 97 management of Sandigatavata
  • 114. ResultsTable.34 Master Chart –Objective-Parameter – Group- B Sl.No. Opd.no swelling Walking Flexion E.S.R time deformity B A B A B A B A 1 3974 2 1 43 31 2 1 18 15 2 3670 2 0 48 39 3 1 16 10 3 3911 2 1 32 21 3 2 20 25 4 3915 3 2 43 33 3 1 15 18 5 4006 3 2 46 32 3 2 18 15 6 4184 3 2 43 28 3 2 20 22 7 150 3 2 54 43 3 1 18 15 8 4051 3 2 45 38 3 2 21 15 9 4111 1 0 32 15 2 2 20 15 10 4220 3 2 43 35 3 1 18 13 11 3650 3 2 56 49 3 2 19 15 12 4253 2 1 48 29 3 0 14 10 13 192 3 2 54 43 3 2 15 13 14 226 3 2 43 29 2 0 16 12 15 221 3 2 48 28 2 0 12 10Table.35 Master Chart – Subjective Parameter – Group- B Sl.No. O.p.d Pain Stiffness Tenderness Crepitus B A B A B A B A 1 3974 3 2 1 1 2 1 2 1 2 3670 2 1 1 0 2 2 2 1 3 3911 3 2 1 0 2 1 2 1 4 3915 3 1 1 0 3 1 2 1 5 4006 3 2 1 1 2 2 2 1 6 4184 3 1 1 0 3 1 2 0 7 150 3 2 1 1 3 2 2 1 8 4051 3 2 1 0 3 2 2 1 9 4111 2 1 1 0 3 1 2 0 10 4220 3 2 1 0 2 1 1 1 11 3650 3 2 1 0 3 2 1 1 12 4253 2 1 1 1 2 2 2 1 13 192 3 2 1 0 3 2 1 0 14 226 3 2 1 0 3 2 2 1 15 221 3 2 1 0 2 1 1 0Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 98 management of Sandigatavata
  • 115. ResultsTable.36 Statistical Assessment of Individual Study Group – A(Subjective& Objective Parameter)Sl.No Parameters Mean S.D S.E t- value P - value Remarks1 Pain 0.466 0.516 0.133 3.503 <0.01 H.S2 Stiffness 0.8 0.414 0.106 7.547 <0.001 H.S3 Tenderness 1.0 0.654 0.169 5.917 <0.001 HS4 Cripatus 0.933 0.258 0.066 14.0 <0.001 H.S5 Swelling 1.066 0.593 0.153 6.791 <0.001 H.S6 Walking 12.33 7.077 1.827 6.748 <0.001 H.S Time7 Flexion 1.2 0.676 0.174 6.68 <0.001 H.S deformity8 ESR 2.133 1.684 0.434 4.914 <0.001 H.STable.37 Statistical Assessment of Individual Study Group – B(Objective Parameter)Sl. Parameters Mean S.D S.E t- value P - value RemarksNo1 Pain 1.133 0.351 0.0908 12.477 <0.001 H.S2 Stiffness 0.733 0.457 0.118 6.211 <0.001 HS3 Tenderness 1.00 0.654 0.169 5.917 <0.001 HS4 Crepatus 1.00 0.534 0.138 7.24 <0.001 H.S5 Swelling 1.2 0.414 0.106 11.32 <0.001 H.S6 Walking Time 11.8 3.509 0.906 13.02 <0.001 H.S7 Flexion 1.466 0.743 0.191 7.67 <0.001 H.S Deformity8 ESR 3.8 1.373 0.354 10.734 <0.001 H.S Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 99 management of Sandigatavata
  • 116. Results Table.38 Statistical Assessment of Comparative study of Group – A with Group – BSl. Remark Parameters Group Mean S.D S.E P.S.E t- value P - valueNo s Pain A 1.4 1.507 0.1301 0.180 1.44 >0.05 NS B 1.666 0.487 0.125 A 0.2 0.414 0.1062 Stiffness 0.106 1.886 >0.05 NS B 0.266 0.457 0.118 Tenderness A 1.8 0.774 0.23 0.240 1.107 >0.05 NS B 1.533 0.516 0.133 A 1.066 0.258 0.0664 Crepatus 0.135 2.46 <0.05 HS B 0.733 0.457 0.118 A 1.6 0.507 0.1315 Swelling 0.231 0.29 >0.05 NS B 1.533 0.743 0.191 Walking A 29.86 6.93 1.7916 2.88 1.043 >0.05 NS time B 32.866 8.76 2.2637 Flexion 0.277 0.241 >0.05 A 1.333 0.723 0.186 NS Deformity B 1.266 0.798 0.2068 ESR A 11.2 2.67 0.691 0.699 5.23 <001 HS B 14.86 4.22 1.090 Conclusion To compare mean effect of two groups we used un pared t test by assuming that The mean effect of two groups is same in all the parameters. From the analysis the objective parameter ESR shows highly significance than the other, (From table 1by comparing P value) The objective parameter ESR walking time, the mean effect is more in-group B Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 100 management of Sandigatavata
  • 117. ResultsWith more variation after the treatment .the parameter FD& swelling the mean effectis more, the variation in-group B of swelling FD is more (by comparing mean &SD). Among sub parameters pain in group-B.the mean effect is more after thetreatment, the parameter crepitus having more mean effect is more with less variationin group A after the treatment. To know the individual effect of group A&B the analysis is done bypaired t test by assuming that the drug is not responsible for the changes in theobservation before &after the treatment. The groupB in the objective parameters swelling walking time flexiondeformity& ESR shows more highly significance than group A, where as in thesubjective parameter the pain in groupB and crepitus in group A shows more highlysignificance. (Comparing t, p value from table 2&3) and tender ness in-group B ismore highly significant than group A. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 101 management of Sandigatavata
  • 118. ResultsTable.39 Over all assessment Group A Group B Response No. of Patient % No. of Patient % Good Response 0 0% 1 6.66% Moderate Response 4 26.66% 7 46.66% Poor Response 11 73.33% 7 46.66% No Response 0 0% 0 0% In-group A, 4 patients (26.66%) had Moderate response to the treatment and11 patients (73.33%) had Poor response to the treatment. In-group B, 1 patients(6.66%) had good response to the treatment and 7 patients (46.66%) had Moderate &poor response to the treatment,. In the study as a whole, 1patients (3.33%) had goodresponse, 11 patients (36.66%) had moderate response and 18 patient (60%) had poorresponse. 12 10 8 6 4 2 0 Group A Group B Good Response Moderate Response Poor Response No Response Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 102 management of Sandigatavata
  • 119. DiscussionDiscussionDiscussions on this study are made under the following headings: 1. Sandhigatavata vis-a-vis Osteoarthritis 2. Clinical study 3. Probable mode of action of Abhadi churna 4. Probable mode of action of Janu bastiSandhigatavata vis-à-vis Osteoarthritis Sandhigatavata is the most common joint disorder worldwide. It isa disorder caused by the localization of the vitiated Vata dosha in the asthi sandhisof the body. It is one among the many Vatavyadhis described by all the acharyasof Ayurveda. It comes under the various Gatavatas explained in Vatavyadhiprakarana. It is characterized by the symptoms pertaining to the asthi sandhis likesandhi shoola, sandhi shopha etc. Osteoarthritis is a disease coming under the arthritis group of diseasesdescribed by the modern science, which is almost identical to Sandhigatavata inetiology, pathology and clinical features. Hence, the discussion is made here stepby step starting from the shareera to the roopa. Sandhis are the union of the asthis and in them are located the SleshakaKapha and Sleshmadhara kala, both of which lubricate the sandhis, therebyreducing the friction during various joint movements. Various snayus and peshisare responsible for the compactness of the joints and support in their functions.Also, several marmas are located in the Sandhis whose protection is inevitable inmaintaining the normal functions of these sandhis. Role of Vyanavata is mostimportant in the movements of the joints. The human skeleton is designed with anumber of individual bones that are articulated at joints to allow movements indifferent directions, angles and positions. Knee functions as a hinge joint, but theEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 103 the management of Sandigatavata
  • 120. Discussionarticulation is far more complex than other hinge joints. Seven major ligamentsand flexor & extensor muscles support the movements of the knee joint. The fivelumbar vertebrae are the largest of the vertebrae and those are interconnected andstabilized by the deep muscles of the spine. The synovial fluid in the synovialjoint serves as a lubricant, a shock absorber and a nutrient carrier. Functions of the Sleshaka Kapha and Sleshmadhara kala described inAyurveda can be co-related to that of the synovial fluid that lubricates the kneejoint and the intervertebral disc that reduces the friction between the vertebrae.The marmas can be considered as the various points of nervous, vascular andmuscular system, which are vital in the functioning of the joints. Functions of thepeshis and snayus are exactly identical to that of the muscles and ligamentsrelated to the joints. From the nidana point of view, Ayurveda had highlighted all the Vataprakopakara nidanas in the generation of Sandhigatavata. Vardhakya avasthacharacterized by dhatu kshaya leads to reduced sneha bhava in the body, which inturn, vitiates the Vata dosha and reduces the Kapha, thereby resulting in karmahani of the sandhis. Also, dhatusaithilya is another feature in vardhakya, whichreflects in peshis and snayus thereby reducing their functional efficiency insupporting the joints. This is a major risk factor for Sandhigatavata. Age is themost powerful risk factor for Osteoarthritis. More than 80% of the people over theage of 60 have radiological evidence of Osteoarthritis in the joints. Various physical activities such as pradhavana, bharaharana andabhighatas due to prapatana, marma abhighata, dukha shayya and dukha asana areimportant nidanas for Sandhigatavata. Repetitive movements may lead toexcessive strain leading to erosion and joint damage. Trauma to the joint enhancesthe occurrence of arthritis.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 104 the management of Sandigatavata
  • 121. Discussion Sthoulya is another causative factor for Sandhigatavata. The meda avaranaof the Vata is the mechanism causing the inter-relationship between Sthoulya andVatavyadhis. Obese persons have a high risk of Osteoarthritis. The relative riskfor developing Osteoarthritis, in the population belonging to the highest quintilefor body mass index at the baseline examination is very high. Another point noteworthy here is that Sandhigatavata being one among theGatavatas is caused due to the factors vitiating Vata alone, but the nidanasspecific to the localization of Vata in Sandhis also have some role in theproduction of the disease. The dhatu kshaya samprapti characterized by thefunctional deterioration of the Vata dosha can be co-related with the degenerativechanges in the joints associated with ageing which causes the cartilagedegradation; whereas the marga avaranajanya samprapti initiated by the nidanaghataka Sthoulya involving the avarana of Vata by Kapha and medas can be co-related with the complications of obesity leading to excessive pressure on theweight bearing joints. The lakshanas of Sandhigatavata, viz., vedanayukta pravritti of sandhis,shopha (vatapoorna dritisparshavat), atopa and sandhigati asaamarthya areexplained by various textbooks of Ayurveda. Modern science has listed the samefeatures along with other symptoms pertaining to individual joints. Alsotenderness and joint stiffness (implied by the restriction of joint movements) findspecial mentioning in Modern science. Acharyas of Ayurveda have not mentionedthat particularly any one sandhi only gets affected with Sandhigatavata. Modernscience has mentioned that any joint can get affected with Osteoarthritis. In thisview, they have considered the condition of Lumbar spondylosis also as theOsteoarthritis of the intervertebral joints.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 105 the management of Sandigatavata
  • 122. DiscussionClinical Study Patients of Sandhigatavata were selected the OPD & IPD of Shri D.G.M.Ayurvedic Medical college by pre-set inclusion and exclusion criteria. Data of 30patients who had satisfied the diagnostic criteria, underwent the treatment andreported for the follow-up are discussed here. The patients were randomlydistributed into two groups and the patients of group-A were administered withAbhadi churna and the patients of group-B were administered with KBT Janubasti. The laboratory investigations like ESR, TC, DC, RA, Hb% and RBS wereperformed to rule out the associated systemic diseases. The radiology of theaffected joint was performed in each and every patient. After scrutinizing thewhole literature of Ayurveda and Modern Medicine, Ruk, Graha Sparshyasahyta,and Atopa were fixed as the subjective parameters for clinical assessment;swelling, walking time, ESR were fixed as the objective parameters for clinicalassessment. Most of the patients in this clinical study belonged to the age group 40-50(53.3%) thereby supporting the association of vardhakya avastha andSandhigatavata. 33.33% of the patients belonged to the age group 50-60 and6.66% of the patients belonged to the age group 30-40. 36.66% of the patientsbelonged to the labor group of occupational status and 30% of the patientsbelonged to the active group. This strengthens the viewpoint this disease istriggered by excessive physical demand on the joint. 53.33% of the patients werefemales and 46.66% of the patients were males supporting the male to femaleincidence ratio of 1:1.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 106 the management of Sandigatavata
  • 123. Discussion 53.33% of the patients were of the middle class and 6.6% were of the poorclass and 40% were of the middle class and this observation is inconclusive tomake any comments. 86.6% of the patients were Hindus, 13.4% were Muslims.This is reflective of the geographical dominance of the religion and do not haveany association with the disease. 76.7% of the patients were vegetarians and23.3% were of the mixed diet and this is reflective of the diet habit prevalent inthe society. 23.33% of the patients were having tobacco chewing as a habit,13.3% were having alcohol intake as a habit and 13.3% had smoking habit; thishas no association with the disease state. 36.6% of the patients were of the Vata-pitta prakriti, 30% of the patientswere of the Vata-kapha prakriti, 23.33% of the patients were of the Pitta-kaphaprakriti, 10% of the patients were of the Tridoshaja prakriti.Response to the treatmentGroup-A 1) Ruk: - 33.3%of the patients reported with grade 3 and 73.3%reported with grade 2 before the treatment after the treatment 40.0%of the patients got grade 2 and 60.0%of the patients got grade 1 In the statistical analysis, the parameter showed high significance (p-value<0.001) and corresponding t- value 3.503. 2) Graha: - All the patients of group-A presented with (100%) stiffness before the treatment after the treatment 80.0%of the patients got grade 0,and 20.0%of the patients got grade1this shows highly significant value i.e (p-value<0.001) and corresponding t-value 7.54. 3) Sparsha akshamatva: -20% patients reported with grade3 tenderness whereas 40%patients reported with grade 2 tenderness and 40%patientsEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 107 the management of Sandigatavata
  • 124. Discussion reported with grade 1 tenderness before the treatment. After the treatment26.6%patients got grade 2, response and 60.0%patients got grade 1,13.3% of patients got grade0 response. In the statistical analysis the parameter showed high significance (p-value<0.001) and corresponding t- value 6.511. 4) Flexion deformity: 60.0of the patients reported with grade 3 and 40% of the patients reported with grade 2 flexion deformity before the treatment. 46.6%of the patients with grade2 and 53.3%of the patients got grade 1&13.3% of the patients with grade0 after the treatment. In the statistical analysis the parameter showed high significance (p-value<0.001) with corresponding t-value 8.588. 5) Shopha: - 66.6%of the patients reported with grade 3 Shopha, 33.4% with grade2before the treatment after the treatment 60.0% with grade 2 and 40.0%with grade1. In the statistical analysis the parameter Shopha showed high significance (p-value<0.001) with corresponding t-value 4.58. 6) Atopa: - 100.0%of the patients reported with grade 2 atopa, before the treatment after the treatment 93.4% with grade 1 and 6.66% with grade 2. In the statistical analysis the parameter showed high significance (p- value<0.02) with corresponding t-value 3.503. 7) Walking time: - 80% of the patients with grade 3,13.3% of patients with grade2&6.6% of the patients having grade1before the treatment after the treatment 55.5% of the patients with grade 2,45.5% of the patients with grade1.in the statistical analysis parameter walking time shows high significance ( p-value<0.001) with corresponding t-value 6.748. 8) ESR: The parameter shows highly significant p-value. ( p-value<0.001) corresponding t value 4.914Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 108 the management of Sandigatavata
  • 125. Discussion Group-B 1) Ruk: - 73.3% of the patients with grade 3 ruk and 26.6% of patients with grade2.before the treatment after the treatment 66.6%of patients having grade 2, &33.3% of the patients with grade1.in the statistical analysis the parameter pain shows highly significant p-value (<0.001) with corresponding t value 12.477 2) Graha: - All the patients had grade 1 graha. 100.0% before the treatment showed high significance (p-value<0.001) with corresponding t-value 6.211. 3) Sparsha akshamatva: - 53.3% of the patients had grade 3 tenderness, 46.66% had grade 2 before treatment, and after the treatment 60% of the patients got grade 2 &40% of the patients got grade1 in the statistical analysis the parameter showed high significance (p-value<0.001) with corresponding t-value 5.917. 4) Flexion deformity: 73.3% of the patients gad grade 3 and 26.6%of the patients had grade 2.before the treatment, after the treatment 46.6% of the patients had grade2, 33.3% of the patients had grade1&13.6% of the patients got grade0. In the statistical analysis this parameter showed high significance (p-value<0.001) with corresponding t-value 7.67 5) Shopha: - 60.0%of the patients had grade 3 shopha, 33.33% had grade 2and 1.5% had grade 1 before the treatment. After the treatment 66.6% of the patients with grade 2, 20.0%of the patients got grade1 In the statistical analysis this parameter showed high significance (p-value<0.01) with corresponding t-value 11.32Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 109 the management of Sandigatavata
  • 126. Discussion 6) Atopa: - 73.3% of the patients had grade 2atopa and 26.6% had grade 1before the treatment. After the treatment 73.3%of the patients got grade1&. 26.66% of the patients with grade 0. In the statistical analysis, this parameter showed high significance (p-value<0.01) with corresponding t-value 7.24. 7) Walking time: - 20%of the patients had grade4walking time, 66.6%of the patients had grade3&13.3% of the patients had grade2before the treatment. After the treatment20.0%patients had grade3and40.0%of the patients had grade2, 33.3%of the patients had grade1&6.6%of the patients had grade0.in the stasticle analysis parameter showed high significance (p- value<0.001) and corresponding t-value13.02 8) ESR: the parameter ESR showed highly significant value (p-value<0.001) corresponding t value 10.734 9) Inter group comparison shows non-significant values but individual group shows highly significant values. But compared with group A & group B, Group B shows highly significant values than that of group A.3. Probable mode of action of Abhadi churna` Acharya Yogaratnakara has mentioned Abadi churna in context of Vatavyadichikitsa. This is indicated for all types of vatavyadies so it considered treatingSandhivata. The ingredients of this compound drug are acting as shoolahara,balya. Deepana, pachana and rasayana, this has been discussed as fallows. The ingredients such as Ashwagandha, Shatavari, Guduchi are acts as Rasayana. This is very helpful in the management of Sandhivata in which the dhatu kshaya is the main symptom. The same drug is cmbined with Shunthi, Ajavayana, Ajamoda and Shopa will act as deepana and pachana in action, which help in samprapti vigatana of sandhivata, and does srotoshodhana.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 110 the management of Sandigatavata
  • 127. DiscussionProbable mode of action of Janu-Basti Janu-Basti procedure is a Bahya Shamana Cikitsa. It is Bahya Svedanaand Snehana (If Sneha is used) therapy. Svedana has the functions of neutralizingStambha, Gaurava and Sheetata. In JanuSandhi-Gata-Vata joint stiffness is one ofthe clinical feature. Janu-Basti may have action on this symptom. The Stabdhataof Sandhi is mainly due to Sheeta property of Vata. This Sheeta Guna isneutralized by Ushna Guna of retained medicine. If Sneha Dravya is used as media in case of Janu-Basti their action furtherfacilitates in alleviating Vata. Sneha Dravya has Drava, Sara, Snigdha, Picchila,Guru, Sheeta, Mrudhu and Manda Guna predominantly. The Vata Dosha, whichis the key factor in the casuation of Janu-Sandhi-Gata-Vata, has almost oppositequality to this. Moreover Sneha Dravya has similar property to that of KaphaDosha. In Janu-Sandhi-Gata-Vata Sthanika Kaphakshaya is due to Agantu VataDosha. Thus only one hand Sneha Dravya neutralizes the Vata Dosha and on theother hand nourishes the Sthanika Kapha Dosha. This helps in SampraptiVighatana. Atopa is due to Vata Vriddhi and Sthanika Kapha kshaya. This symptomis due to Khara, Rooksha and Vishada properties of Vata. Snigdha, Picchila andMrudhu qualities of Sneha Dravya oppose these qualities. In Shotha - Rasa, Rakta and Mamsa Dhatus are generally found involved.They attain or pose in the form of either Sandra or Ghana state. By virtue of TiktaRasa, Katu Vipaka and Ushna Veerya of Dashamula Chedana and Visravana ofDushyas of Shotha will occur. Thus acts as Shothahara. Among Dashamulaexcept Gokshura all have Ushna Veerya. Even though Gokshura is Sheeta Veeryaby virtue of Madhura Vipaka it privileges to drain the Sanchita Dushtha Kleda atEvaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 111 the management of Sandigatavata
  • 128. Discussionthe site of Shotha. Also Dashamula has Vedanashamaka and Vatahara property.With the help of above quality it subsides Shoola.Role of media Amount of heat given to the Taila, Kvatha or Ksheerapaka materialsprivilege interchange of Gunamsha of both the media and Dravyas. Both Vayuand Agni among Pancha Maha Bhootas processes Laghu, Sookshma Gunaspredominantly. In the process of Taila, Ksheerapaka and Kvatha the indirect Agniis given to the material. Ions of media will receive the Ushma and they trespassinto the Dravya, which already drenched or sunken in the fluid and got soften.Thus ions of water, milk or oil penetrate into the drug and release entireGunamsha of Dravya. When such Kvatha, Ksheerapaka or Taila is administeredeither externally or internally induces the effects of the Dravya.Criteria for selection of Ksheera bala tail1. Ksheerabala taila is indicated in vata vyadhis2. Ingredients of ksheerabala taila are easily available3. All the ingredients of ksheerabala taila are having vatashamaka, balya andbrahmana properties.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in 112 the management of Sandigatavata
  • 129. ConclusionConclusion1. Sandhivata equals Osteo-arthrosis, as such difference is only in terminology.2. Occupation, physiological stress and strain play a vital role in the causation ofsandhi vata OA.3. Overweight is also a major risk factor in OA.4. Incidence of OA is more in females.5. Except in obese patients symptoms were limited to kneejoint, including doshadushtilaxana and srotodushti laxana.6. Pain is the main clinical feature that draws the attention of a patient and brings himto doctor.7. Abhadi churna is beneficial in the initial stage of the disease.8. The therapy janu basti is very effective in krusha and normal weight patients.9. Drug was less effective in sthulas, when compared with krushas, which suggeststhat reduction of weight is highly essential.10. Though the therapy was found to be beneficial in decreasing symptoms in intraarticular steroid dependent patients, the present fixed therapy was not successful ingiving a complete remession.11. The study failed to find out radiological changes.12 Janu basti is effective in decreasing pain and other symptoms. Complete remissionwas observed in patients.13. Janu basti has got a long lasting effect.14. Therapy is very effective in Fresh cases. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 113 management of Sandigatavata
  • 130. SummarySummary The dissertation work entitled “evaluation of efficacy of AbhadiChoorna&KsheeraBala tail janu basti in the management of Sandhigatavata (Osteoarthritis)”consists of seven parts. They are 1. Introduction 2. Objectives 3. Review of literature 4. Methodology 5. Results 6. Discussion 7. Conclusion. The introduction highlights on Incidence of Sandhigatavata andavailibity of shortest description in the classics. The objectives part describes the needfor the study, title of the present study and the objectives of the present study. Reviewof literature part covers the historical view on Sandhigatavata, Nirukti and Paribhashaof Sandhigatavata.Shareera of Janu Sandhi, description of Janu Basti in particular anddescription of Sandhigatavata. Methodology part contains review of the propertiesand chemical composition of the drugs used, methodology of the clinical study,procedures of Janu basti and the parameters for clinical assessment. The results partcontain demographic data, data related to the disease, data related to the overallresponse to the treatment, statistical analysis of the Subjective& Objective parameters& Inter group comparison of Abhadi Choorna & K.B.T janu basti. Discussion partconsists of the headings Sandhigatavata vis-à-vis Osteoarthritis, clinical study,probable Mode of action of Abhadi choorna and probable Mode of action of janu bastiare discussed. Conclusion part contains the conclusions of the present study andsuggestions for future study. Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 114 management of Sandigatavata
  • 131. Bibliography 1. Harrison’s, Principles of Internal medicene, edited by Fauci, Breanwald, Isselbacher, Wilson, Martin, Kasper & Longo, Vol 1, 1998,Mc Grawttill health professions division, 3 Section 22nd chapter, page no. 1935. 2. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 36. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 617. 3. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-261-262 4. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 14- Chikitsasthan chapter 21 sloka 22. Varanasi: Krishnadas Academy; 1982. p.531, 724. 5. Yogaratnakara Vatavyadhinidana – Vatavyadhichikitsa. Vaidya Lakshmipatisastry editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 528. 6. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 14- Chikitsasthan chapter 21 sloka 22. Varanasi: Krishnadas Academy; 1982. p.531. 7. Christpher Haslett Edwin R Chilrers, Nicholas A boon Nicki R,Devidsons principles and practice of medicine,19th edition ,2002 published by Churchil Livingston, PP no 997. 8. Lawrence R.C. Hocherg M. C. Duffic F.C. Nedsger A.jr. Felts WR Etc.Estimates of prevalence of selected arthritic and musculo-skeletal diseases jr.rhuatil 1989 16:427-41 9. Christpher Haslett Edwin R Chilrers, Nicholas A boon Nicki R,Devidsons principles and practice of medicine,19th edition ,2002 published by Churchil Livingston, PP no 996. 10. BMJ South asia edition. Intermittent cases report, sep, 2004 issue p.no. 65 11. Atravaveda Samhitha, edited by Vedamurthy Taponistam Sri Mansharma achrya Delhi, Parimala publication, 19/60/2, page no. 12. Rugveda Sanhita, edited by H.H.Wilson Ravi prakasha arya Dehli parimala publication, 10/163/6 page no 588 13. Rugveda Sanhita, edited by H.H.Wilson Ravi prakasha arya Dehli parimala publication, 10/163/6 page no 588 14. Atravaveda Samhitha, edited by Vedamurthy Taponistam Sri Mansharma achrya Delhi, Parimala publication, 19/60/2, page no. 15. Atravaveda Samhitha, edited by Vedamurthy Taponistam Sri Mansharma achrya Delhi, Parimala publication, 19/60/2, page no.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 115 management of Sandigatavata
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  • 135. Bibliography 62. Agnivesa, Charakasamhitha Vimanasthana chapter 5sloka 17 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. P251. 63. Agnivesa, Charakasamhitha Vimanasthana chapter 5sloka 284th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. P251 (Kasi Sanskrit series 228). 64. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 6 – 7th12th13th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p 370. 65. Vagbhata, Ashtangahridaya Sutrasthana chapter 1 sloka 7- Varanasi: Krishnadas Academy; 1982. P.7. 66. Vagbhata, Ashtangahridaya Sutrasthana chapter 1 sloka 23- Varanasi: Krishnadas Academy; 1982. P.15. 67. Vagbhata, Ashtangahridaya Sutrasthana chapter 1 sloka 7- Varanasi: Krishnadas Academy; 1982. P.7 68. Vagbhata, Ashtangahridaya Sutrasthana chapter 1 sloka 15- Varanasi: Krishnadas Academy; 1982. P11 69. Vagbhata, Ashtangahridaya Sutrasthana chapter 1 sloka 7- Varanasi: Krishnadas Academy; 1982. P.7 70. Harrison’s, Principles of Internal medicene, edited by Fauci, Breanwald, Isselbacher, Wilson, Martin, Kasper & Longo, Vol 1, 1998,Mc Grawttill health professions division, 3 Section 22nd chapter, page no. 122 71. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1472. 72. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 18-19 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618. 73. Vagbhata, Ashtangahridaya Nidansthana chapter 15 sloka 5-6- Varanasi: Krishnadas Academy; 1982. p.430-431. 74. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-73 75. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-73 76. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 18-19 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 119 management of Sandigatavata
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  • 137. Bibliography 91. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-265. 92. Vagbhata, Ashtangahridaya Sutrasthana chapter 11 sloka 26-28 Varanasi: Krishnadas Academy; 1982. P.7. 93. Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 29th-36th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-367. 94. Susruta, Susrutasamhita Shareersthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 37th-38th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-.364. 95. Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 16th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-365. 96. Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 31– 2nd Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-488. 97. Agnivesa, Charakasamhitha Sutrasthana chapter 5 sloka 85th, 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 42. 98. Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-488. 99. Agnivesa, Charakasamhitha Sutrasthana chapter 22 sloka 11 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 120. 100. Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32–3 Sloka. Varanasi: 17t Chaukhambha Orientalia; 4th edi, 1980 p-513. 101. Agnivesa, Charakasamhitha Sutrasthana chapter 14 sloka 35-37 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618. 102. Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32–12 Sloka. Varanasi: 17t Chaukhambha Orientalia; 4th edi, 1980 p-514. 103. Agnivesa, Charakasamhitha Sutrasthana chapter 14 sloka 35-37 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 89. 104. Vagbhata, Asthangahrudaya Sutrasthana, Sarvanga sundara commentary; P.V. Sharma, editor. Chapter 27 –5th sloka. Varanasi: Chaukhambha Orientalia; 1978, p- 254.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 121 management of Sandigatavata
  • 138. Bibliography 105. Agnivesa, Charakasamhita Chikitsasthana, chapter 28 – 115th sloka , editor, Vaidya Jadavaji Trikamji Acharya,. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-622. 106. Agnivesa, Charakasamhita Sutrasthana, chapter 14 – 38th sloka , editor, Vaidya Jadavaji Trikamji Acharya,. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-89. 107. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 18 –7th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-95. 108. Susruta, Susrutasamhita Chitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32 – 12th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-513. 109. Bhattacharya T.T. (1967). Shabdastoma Mahanidhi, Chowkamba Sanskrit Series, Varanasi, pp. 184. 110. Vagbhata, Asthangahrudaya Sutrasthana, Sarvanga sundara commentary; P.V. Sharma, editor. Chapter 19 –1 sloka. Varanasi: Chaukhambha Orientalia; 1978, p- 280. 111. Susruta, Susrutasamhita Uttaratantra Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 1 Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 17. 112. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 3 Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 18. 113. Agnivesa, Charakasamhita Vimanasthana, chapter 8 –94-96 sloka , editor, Vaidya Jadavaji Trikamji Acharya,. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-273. 114. Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 9 – 9 Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 385. 115. Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 24– 33 Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 488. 116. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 18– 4 Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 94-95 117. Vagbhata, Asthangahrudaya Sutrasthana, Sarvanga sundara commentary; P.V. Sharma, editor. Chapter 12 –14 sloka. Varanasi: Chaukhambha Orientalia; 1978, p- 194.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 122 management of Sandigatavata
  • 139. Bibliography 118. Vriddha Vagbhata, Asthangasamgraha Sutrasthana, edited by Dr. Ravidutt Tripathi, chapter 20 –Sloka. Delhi: Chaukhamba Sanskrit Pratishthan; 2003, p- 119. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 474. 120. Dr K.M.Nadkarni’s, Indian Matria medica, Bombay Popular Prakashan, 1996, Vol – 1, page no 980. 121. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 39. 122. Dr K.M.Nadkarni’s, Indian Matria medica, Bombay Popular Prakashan, 1996, Vol – 1, page no 1220. 123. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 761. 124. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34 125. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, edited by Vaidya Jadavaji Trikamji Acharya, Chapter 46. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 202. 126. Dr K.M.Nadkarni’s, Indian Matria medica, Bombay Popular Prakashan, 1996, Vol – 1, page no 153. 127. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 562. 128. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34 129. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, edited by Vaidya Jadavaji Trikamji Acharya, Chapter 46-301st sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 208. 130. Dr K.M.Nadkarni’s, Indian Matria medica, Bombay Popular Prakashan, 1996, Vol – 1, page no 1308. 131. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 331.Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 123 management of Sandigatavata
  • 140. Bibliography 132. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34 133. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, edited by Vaidya Jadavaji Trikamji Acharya, Chapter 46. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 203. 134. Bhavamishra, Bhavaprakasha Uttarakhanda, edited by Bishakrathna Sri Brhmashanker Misra, chapter 24 sloka 133-135.Varanasi: Chaukhambha Sanskrit Sadana; 1988. P.12 135. Dr K.M.Nadkarni’s, Indian Matria medica, Bombay Popular Prakashan, 1996, Vol – 1, page no 1292. 136. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 403. 137. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 763. 138. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34 139. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 644. 140. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 766. 141. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 494. 142. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34 143. Bhavamishra, Bhavaprakasha Uttarakhanda, edited by Bishakrathna Sri Brhmashanker Misra, chapter 24 sloka 133-135.Varanasi: Chaukhambha Sanskrit Sadana; 1988, p.675 144. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 497. 145. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 124 management of Sandigatavata
  • 141. Bibliography 146. Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, edited by Vaidya Jadavaji Trikamji Acharya, Chapter 46. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p- 203. 147. Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 542. 148. Jensen.R.G, Handbook of milk composition. New York: Academic press; 1995. Available from: www.dairyhealth.com. Accessed on 4th July 2006. 149. Rubin.K.Dr, Chemical components of Rock salt. University of Hawaii, 2003. Available from: www.geophysics.com/hawaii/HI96822. Accessed on 4th July 2006. 150. Bhavamishra, Bhavaprakasha Uttarakhanda, edited by Bishakrathna Sri Brhmashanker Misra, chapter 24 sloka 133-135.Varanasi: Chaukhambha Sanskrit Sadana; 1988. p. 243-244. 151. Prof. P.V.Sharma’s, Dravyaguna Vijnana, Varanasi Chaukhambha Bharati Academy, 1999, Vol. II, page no 735. 152. Agnivesa, Charakasamhitha, Sutrasthana, 4th chapter 41st & 46th sloka, Ayurveda deepika commentary, editor- Vaidya Jadavaji Trikamji Acharya, Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-34Evaluation of the Efficacy of Abhadi choorna and Ksheerabala taila Janubasti in the 125 management of Sandigatavata
  • 142. SPECIAL CASE SHEET FOR SANDIVATA` Post Graduate Research and Studies Centre (Kayachikitsa) Shri. D.G.M.Ayurvedic Medical College, Gadag.Guide : Dr. Vardhacharula M. D (Ayu)Co-Guide : Dr. R. V. Shettar M. D.(Ayu)P.G.S Scholar : S. C. Sarvi1. Name of the patient : Sl. No.2. Father’s/Husband’s Name : OPD No.3. Age : ………... yrs IPD No.4. Sex : Male/Female Bed No.5. Religion : Hindu Muslim Christian Others6. Occupation : Sedentary Active Labor Others7. Economical Status : Poor Middle class Higher class8. Address : …………………………. Phone No. …………………………. E- Mail: …………………………. Pin code:9. Date of Schedule Initiation:10. Date of Schedule Completion:11. Result : Completely Marked Moderate Mild Un Discont Relieved Response Response Response Changed inued12. Consent : I here by agree that, I have been fully educated with the disease and treatment. Here by satisfied whole heartedly, and accept the medical trial over me.Investigator’s Signature Patient’s Signature
  • 143. COMPLAINTS WITH DURATION: Sl. Chief complaints Duration No 1 Sandhisotha (Swelling) 2 Prasaarana Aakunchanayoho Savedana Pravruthi (Pain on extension & flexion) 3 Sandhigraha (Joint Stiffness) A. Morning stiffness (15-30 ms) B. Sandhigati asamarthya (limitation of joint movement). C. Stiffness after disuse 4 Sparsha akshamatva (Tenderness)HISTORY OF PRESENT ILLNESS:Mode of onset Chronic Insidious Acute Traumatic Joint involved Axial Cervical Lumbar Spine Distal joints Knee Right Left Ankle Right Left Hip Right Left First carpometacarpal Right Left Distal metaphalageal Right Left Proximal interphalageal Right Left Nature of pain Pricking Aching Generalized Tearing Burning Routine activities affected Yes NoHISTORY OF PAST ILLNESS: Episodes of same illness Yes/No Obesity Yes/No Trauma/Fracture of involved or related Yes/No joint Diabetes Mellitus Yes/No Hypertension Yes/No Other Vatavyadhees Yes/No Fever Yes/No Others Yes/No 3
  • 144. 4. Treatment History Modern Ayurvedic OthersRelief with previous treatment : Partially relieved No relief at all5. Family history – relevant : Yes No6. Personal HistoryAhara : Veg MixedAgni : Manda Theekshna Vishama SamaKoshta : Mrudu Madhya KrooraMutra pravurti- frequency : Day NightVyasana : Smoking Tobacco Alcohol None chewingMalapravurthi- frequency : 1 time 2 time More ConstipatedAarthavapravruti : Alpa Ati Vishama Rajonivrutti7.Samanya PareekshaA. Asta sthāna Pareeksha : B. Vital examination1 Nadi /Min 1 Temp /F 2 Mala Frequency 2 Pulse /min3 Mootra Day Night 3 Resp.rate /min4 Jihwa5 Shabda 4 B.P ______mm of Hg6 Sparsha7 Druk 5 Height cms8 Akruti 6 Weight Kgs. 4
  • 145. C. Dasha vidha Pareeksh :1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Tridoshaja ( )2 S ra Pravara. ( ) Madhyama. ( ) Avara ( )3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )5 S tmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( ) Rooksha satmya ( ) Snigda satmya ( )6 Satva Pravara ( ) Madhyama ( ) Avara ( )7 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( ) b) Jarana shakti P ( ) M ( ) A ( )8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )9 Vaya Bala ( ) Yuva ( ) Vrudda ( )8. Srotopareeksha SROTAS OBSERVED LAKSHNA Annavaha Rasavaha Astivaha Majjavaha9.SPECIAL EXAMINATION OF JOINTSA. Darshana (Inspection)1. Joint Swelling Grading 0 1 2 3 Varna Raaga Shyaava Prakrutha2.a. Deformity Present Absent b. Joint Instability Present Absent3. Gait Nature Walking Time (Grade)4. Joint Movement Active Completely Restricted Partially Restricted Free Passive Completely Restricted Partially Restricted Free5. Muscular spasm Present Absent6.Muscular Wasting Above the affected joint Yes No Below the affected joint Yes No 5
  • 146. B. Sparshana (Palpitation)1. Vaatapoornadruthisparsha Yes No2. Local Temperature Raised Not raised3. Tenderness Grading 0 1 2 34. Limitation of Joint Movement (In terms of Grading) Axial Joints Cervical Lumbar Spine Distal Joints Knee Right Left Hip Right Left Ankle Right Left First Carpometametacarpal Right Left Distal Interphalangeal Right Left Proximal Interphalangel Right Left C. Shravana (Auscultation) Crepitus Heard Felt None10. Nidana1) Swaprakopakara nidana :a) Ahara Guna : Seeta Rooksha Laghu Rasa : Katu Tiktha Kashaya Shuskanna : Yes No Upavasa : Yes Nob) Vihara Ratrijagaran Yanam Bharavahana Vyayama a (Riding) (Weight lifting) Pradhavana Jumping Pratarana Walking (Running) (Swimming)c) Manasika : Chinta Shoka Bhaya Krodha (worry) (grief) (fear) (anger) 6
  • 147. 2) Marmaghatakara nidana :3) Dhatukshayakaraka nidana :11.LAB INVESTIGATIONS :Blood TC DC P L E M B ESR RBS Hb%Urine Sugar Albumin MicroscopeSerum alkaline phospate12.RADIOLOGICAL EXAMINATION OF JOINTS( Antero posterior and Lateral View) 1 Joint space Reduced Increased Unaltered 2 Subchondral bony sclerosis Present Absent 3 Formation of osteophytes Present Absent 4 Periarticular ossicles Present Absent 5 Altered shape of bone end Present Absent13.ASSESSMENT OF RESULTSA.CLINICAL PARAMETERSChief and Associated Complaints 0 Day 15th Day 30th day 60th DayRuk(pain)Stabdhata(Stiffness)Sparsha akshamatva (Tenderness)Atopa (Criptus)B. Objective Parameters Day 0 Day 7 Day 14 Swelling Walking time Flexion deformity ESR 7
  • 148. C.FUNCTIONAL PARAMETERS Parameters BT AT After Follow-up Mobility Level Walking & Bending Hand & Finger Function Arm Function Self care tasks (Exercise & Wt. Bearing) Household tasks Social activity Support from family & friends Arthritis Pain Work Level of tension Mood14. INVESTIGATORS NOTE :Signature of Co-Guide Signature of Guide 8

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