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Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” BY SANATH KUMAR D.G Department of Panchkarma, D.G.M. …

Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” BY SANATH KUMAR D.G Department of Panchkarma, D.G.M. Ayurvedic Medical College, Hospital and P.G. Research Center, Gadag.


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  • 1. “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” BY SANATH KUMAR D.G Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfilment of the degree of AYURVEDA VACHASPATI IN PANCHAKARMA Under the guidance of DR. SURESH BABU. S M.D. (AYU), FRAV (GOI, Delhi) Professor P.G. Dept. of Panchakarma And co-guidance of DR. SANTOSH N. BELAVADI M.D. (Ayu) Ast. Professor P.G. Dept. of Panchakarma POST GRADUATE DEPARTMENT OF PANCHAKARMA D.G M.AYURVEDIC MEDICAL COLLEGE AND RESEARCH CENTER GADAG – 582103 2007-2010
  • 2. DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “Evaluation on the effectof Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama andSadharana krama – A comparative clinical study” is a bonafide and genuine researchwork carried out by me under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI,Delhi) Professor and the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast.Professor,Post Graduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,Gadag.Date: Signature of the CandidatePlace: Gadag (Sanath Kumar D.G)
  • 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Evaluation on the effect ofMatravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharanakrama – A comparative clinical study” is a bonafide research work done by SanathKumar D.G in partial fulfillment of the requirement for the degree of AyurvedaVachaspathi. M.D. (Panchakarma).Date: Signature of the GuidePlace: Gadag Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College, Gadag.
  • 4. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “Evaluation on the effectof Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama andSadharana krama – A comparative clinical study” is a bonafide research work done bySanath Kumar D.G in partial fulfillment of the requirement for the degree ofAyurveda Vachaspathi. M.D. (Panchakarma).Date: Signature of the Co-GuidePlace: Gadag Dr. Santosh N. Belavadi M.D. (Ayu). Ast. Professor P.G. Dept of Panchakarma D.G.M Ayurvedic Medical College, Gadag.
  • 5. J.S.V.V. SAMSTHE’S SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical study” is a bonafide research work done by Sanath Kumar D.G under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor, and co-guidance of Dr. Santosh N. Belavad M.D. (Ayu), Ast. Professor, Post Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and contributed good values to the Ayurvedic research. Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Dr. G. B. Patil Prof. and H.O.D. Principal, P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College,Shri. D.G.M. Ayurvedic Medical College, Gadag Gadag.Date: Date:Place: Gadag Place: Gadag
  • 6. COPYRIGHT Declaration by the Candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation /thesis in print or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Gadag. Sanath Kumar D.G © Rajiv Gandhi University of Health Sciences, Karnataka.
  • 7. ACKNOWLEDGMENT: I have constantly witnessed Divine Providence in many instances and experiencesof my life. I thank Almighty for helping me soar to a new high today. I express my deep sense of gratitude to his great holiness Jagadguru ShriAbhinava Shivananda Mahaswamiji, for their divine blessings. I give my respect at this moment to my father Sri. Guddappa Gowda. D, mymother Smt. Nagaveni for their blessings which gave me enough strength. I thank mysisters Smt. Supriya, Smt. Shwetha and their family for affection and continuousencouragement. The inspiring forces throughout this research work; was my guide Dr. Suresh Babu.S, M.D. (Ayu), FRAV (G.O.I, Delhi). I use this opportunity to express my immense gratitude andheart full thanks for his timely advises, constant encouragement, critical analysis, untiringhelp and rousing clinical knowledge. I would like to avail the opportunity to express my gratitude to my respected co-guide Dr.Santosh N. Belavadi, M.D. (AYU), for his humble nature, indulgence, dynamicsupervision and scholarly suggestions during the course of this research work. I express my gratefulness to professor Dr. P.Sivaramudu, M.D.(Ayu), HOD, Dept ofPanchakarma for his inspiration, critical suggestions, timely help rendered me throughout this work. I am sincerely thankful to professor Dr.G.Purushothamacharyulu, M.D. (Ayu) whowas former H.O.D. of the department, for his scholarly guidance. I express my thankfulness to beloved principal Dr. G. B. Patil, for hisencouragement and support by providing all necessary facilities for this research work. i
  • 8. I am very much thankful to my teachers Dr. Jairaj Basarigidad MD (Ayu), Dr.Yasmeen Paniband MD (Ayu) for their timely help and suggestions during this study. I express my sincere thanks to Dr. Rajashekar C.V. MD (Ayu), who was formerteacher in the department, for his critical suggestions. I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr. M. C. Patil, Dr.Mulugund, Dr. G. S. Hiremath, Dr. R. V. Shettar, Dr. Girish Danappa Goudar, Dr.Jagadeesh Mitti, Dr. KuberSankh, Dr. Shashikanth Nidugundi, Dr. B. M. Mulkipatil andDr. M.D. Samudri, for their valuable inputs and suggestions. I extend my immense gratitude to Dr. V. M. Sajjan, Dr.Purad, Dr.Yarageri,Dr.Suvarna Nidugundi, Dr. Shakuntala and other teaching staff who helped during mystudy. I express my sincere thanks to Sri. Nandakumar, for his help in statistical analysisof results. I take the privilege to thank Sri. Mundinamani, Librarian. I also extend mythanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me all thenecessary books and time for my literary work. I am very much thankful to Sri Tippanagowdar (Lab Technician), and Sri.Basavaraj (X-Ray Technician), for their help during the study. I extend my thanks to SriKulakarni, Sri Nabi, Smt. Sunanda and Smt Renuka for their timely help in trail. I feel extremely thankful to seniors Dr. Ashok M.G, Dr. Prasanna V. Joshi, Dr.Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Sanjeev Chaudary, Dr. Shailej, Dr.Madhushree, Dr. Payappa Gowdar, Dr. Devandrappa Budi, Dr. Mukta Hiremath, Dr.Prasanna Kumar, Dr. Siba Prasad and others for valuable suggestions. I pay sincere regards to my fellow colleagues Dr. Sabareesh, Dr. Rajesh, Dr.Jayasankar, Dr. Deepak, Dr. Ishwar Patil, Dr. Praveen Nayak, Dr. Bodke, Dr. Kanti, ii
  • 9. Dr. Shakunthala, Dr. Asha, Dr. C.C Hiremath, Dr. S.B. Rotti, Dr. Bupesh, Dr. Gorpade,Dr. Deepa, Dr. Jadav, Dr. Mahantesh Swami Hiremath and Dr. Praveen Palyed for theirtruly help and co-operation. I thank my juniors Dr. Joshi George, Dr. Bhagyesh, Dr. Anish, Dr.Raghavendrachar, Dr. Suraj, Dr. Vijay Raj, Dr. Vijay Mahanthesh, Dr. Sateesh, Dr.Vishwajith, Dr. Renukaraj, Dr. Sangamesh, Dr. Jagadeesh, Dr. Maneesh, Dr. Paresh andDr. Shilpa for their support. I thank specially to Internees and UG friends for their help and supports. I am also very much thankful to Mr. Shakthi (Local Guardian), Mr. Salimat,Smt. Lalithamma who made my stay comfort through out my P.G. carrier. Lastly I pay my deepest respect for those patients who took part in the study and Ishare my success with them. “To err is Human” – certain names, who could be directly or indirectly helped inthis work, might have been missed unintentionally. Thanks are due to all of them.Date : Dr. Sanath Kumar D.GPlace : Gadag iii
  • 10. LIST OF ABBREVIATIONS USED: A.H – Ashtanga Hrudaya A.S – Ashtanga Samgraha B.P – Bhavaprakasha B.S – Bhela Samhita C.S – Charaka Samhita M.N – Madhava Nidana S.S – Sushruta Samhita, V.S – Vangasena Y.R – Yogaratnakara iv
  • 11. AbstractABSTRACT: Sandhigatavata is a disorder where the locomotive functions are affected. InAyurvedic classics it explained under Sthana visheshakruta Vatavyadhi, under theconcept of Gatavata. Sandhigatavata can be compared with Osteoarthritis as the clinicalfeatures simulate each other. It is also called as degenerative joint disease orosteoarthrosis. Matravasti is very much convenient to administer in present day busy life.Arohana Krama Matravasti is a specific treatment modality where the dose of Matravastiis gradually increased daily for nine days. Kethakyadi Taila is considered fromSahasrayoga, which is indicated in Astigata vata. Here an attempt is made to comparethe efficacy of two varieties of Matravasti with Kethakyadi Taila in Sandhigatavata withthe title “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyaditaila in Arohana krama and Sadharana krama – A comparative clinical study”.Objectives of the study: • To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days by using Kethakyadi taila in Sandhigatavata. • To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata. • To evaluate the adverse- effects of Arohana krama Matravasti if any. • To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as well as Sadharana karma in Sandhigata vata.Materials and Methods: A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & Hafter fulfilling the inclusion and exclusion criteria randomly. They were divided in to two v
  • 12. Abstractgroups Group A and Group B. 15 patients of Group A underwent Arohna KramaMatravasti for Nine days. Group B patients underwent Sadharana Krama Matravasti forNine days. Assessment of results was done by considering the base line data of subjective andobjective parameters to pre and post medication and was compared for assessment of theresults. All the results were analyzed statistically for “P” value using Un-paired t-test.Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana) andSthamba (Morning stiffness)Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya, Walkingtime to cover 21meters of distance, WOMACResults:The overall results of the study were as follows;Group A: 01 (06.66%) shown Good response to the treatment. 07 (46.66%) were shownModerate response and 07 (46.66%) patients shown Poor response.Group B: 10 (66.66%) were shown Moderate response and 05 (33.33%) patients shownPoor response. From the statistical analyses, all parameters shows non-significant (as P>0.05).i.e., the mean affects of treatment same in all the parameters.All the parameters shows highly significant in both the Groups as P<0.05.Comparative efficacy: Overall the group A (Arohana krama Matravasti) is more effectivethan group B (Sadharana Krama Matravasti) in almost all the parameters.Key words: Sandhigatavata, osteoarthritis, Arohana Krama Matravasti, SadharanaKrama Matravasti. vi
  • 13. TABLE OF CONTENTSSI. No. Contents Page No.01 Introduction 0102 Objectives 0403 Review of Literature 0904 Materials and Methodology 12205 Observations and Results 13606 Discussion 19007 Conclusion 21808 Summary 21909 Bibliography 22410 Annexures 254 vii
  • 14. LIST OF TABLESSI. Tables PageNo No.01 Showing Rachana shareera &Pramana of Gudhavalis 1602 Showing Gudha valis kriya karma 1703 Showing Gudha valis Sthana and Modern terminology 1804 Showing Structure & Function of Rectum 1905 Showing Sub divisions of large intestines 2006 Showing Classification of Basti karma based on Route of 24 administration07 Showing types of Anuvasana vasti and its Matra 2508 Showing types vasti based on its Karma 2609 Showing Sankya Bhedha of Vasti Prakara 2610 Showing Matra bheda of Vasti dravya 2811 Showing indication of Matra basti acc. to Classics 3012 Showing Matra of sneha basti mentioned indifferent Classics 3213 Showing Dose of Matra basti according to Age 3214 Showing Dose of Arohana krama Matra vasti 3315 Showing Measurements of Vastiyantra 3516 Showing Netradosha of Vasti netra 3717 Showing putakadosha of Vasti Putaka 3818 Showing Samyak, Heena and Atiyoga yoga of Anuvasana vasti 4219 Showing Type of Sandhi’s and there sites 5720 Showing the Viprakrishta nidana of Sandhigatavata 7021 Showing the Aharaja nidana of Sandhigatavata explained in different 70 treatises22 Showing the Viharaja nidana of Sandhigatavata explained in different 71 treatises23 Showing the Manasika nidana of Sandhigatavata explained in 72 different treatises24 Showing the Anyata nidana of Sandhigatavata explained in different 72 treatises25 Showing the Roopa of Sandhigatavata explained in different treatise 7726 Showing the Samprapti ghataka of Sandhigatavata 8427 Showing the Vyavachedhaka nidana of Sandhigatavata 8628 Showing Chikitsa modalities as mentioned in different classics 9029 Showing the Pathyas of Sandhigatavata 9330 Showing the Apathyas of Sandhigatavata 9431 Showing Clinical features of Osteoarthritis 10832 Showing Differential Diagnosis of Osteoarthritis 11133 Showing Scoring and Interpretation 0f WOMAC 11534 Showing Guna-Karma of Ingredient of Kethakyadi Taila 12335 Showing Guna-Karma of Tila 12436 Showing the distribution of patient’s age group 13837 Showing the distribution of patients according to sex 13938 Showing distribution of patients by Religion 140 viii
  • 15. 39 Showing distribution of patients by Economical status: 14140 Showing distribution of patients by Occupation 14241 Showing distribution of patients by Type of diet 14342 Showing distribution of patients by Marital Status 14443 Showing distribution of patients by Mode of Onset: 14544 Showing distribution of patients by Vihara (Nature of work) 14645 Showing distribution of patients by Agni 14746 Showing distribution of patients by Kosta 14847 Showing distribution of patients by Nidra 14948 Showing distribution of patients by Vyasana 15049 Showing distribution of patients by Deha Prakruti 15150 Showing distribution of patients by Samhanana 15251 Showing distribution of patients by Satmya 15352 Showing distribution of patients by Vyayama Shakti 15453 Showing distribution of patients by Vaya 15554 Showing distribution of patients by Joint Involvements 15655 Showing the distribution of patients by duration of the disease 15756 Showing the distribution of patients by different grades of Vedana 158 before Treatment:57 Showing the distribution of patients by different grades of Vedana 159 after Follow-up:58 Showing the distribution of patients by different grades of Sandhi 161 Atopa before Treatment59 Showing the distribution of patients by different grades of Sandhi 162 Atopa after follow-up60 Showing the distribution of patients by different grades of Sandhi 163 shothaha before treatment:61 Showing the distribution of patients by different grades of Sandhi 164 shothaha after follow-up62 Showing the distribution of patients by different grades of Sthamba 165 before treatment63 Showing the distribution of patients by different grades of Sthamba 166 after follow-up:64 Showing the distribution of patients by different grades of Sandhigati 167 Asamarthya65 Showing the distribution of patients by different grades of Sandhigati 168 Asamarthya after follow-up66 Showing the distribution of patients by different grades of Walking 169 Time before treatment:67 Showing the distribution of patients by different grades of Walking 171 Time after follow-up:68 Showing the distribution of Overall Response to the treatment 17369 Comparative Study of Group A and Group B after treatment 17470 Individual study of the Group A 17471 Individual study of the Group B 17572 Showing the Clinical Parameters before treatment and After Follow- 176 up of Group A73 Showing the Clinical Parameters before treatment and After Follow- 177 up of Group B ix
  • 16. 74 Showing the percentage improvement in Clinical Parameters in both 178 Groups75 Showing Demographic data in patients of Group A (Arohana Krama) 17976 Showing Demographic data in patients of Group B (Sadharana 180 Krama}77 Showing Vayaktika vruttanta of patients (Group A – Arohana Krama 18178 Showing Vayaktika vruttanta of patients (Group B – Sadharana 182 Krama)79 Showing data related to Dashavidha pareeksha (Group A – Arohana 183 Krama)80 Showing data related to Dashavidha pareeksha (Group B - Sadharana 184 Krama)81 Showing data related to Disease in patients of Group A (Arohana 185 Krama)82 Showing data related to Disease in patients of Group B (Sadharana 186 Krama)83 Showing data related to Nidana in patients of Group A (Arohana 187 Krama)84 Showing data related to Nidana in patients of Group B (Sadharana 188 Krama)85 Showing average time of Vasti Dravya Retention in patients of both 189 Groups86 Showing response in patients of both Groups 19087 Showing the Percentage Improvement of Parameters in each patient 20988 Showing the Percentage Improvement of Parameters 21189 Indicating retention time of Arohana krama Matravasti 217 x
  • 17. LIST OF FIGURESSI No Figures Page No01 Showing the Anatomy of Large Intestine 2002 Showing types of Sandhi 5703 Showing types of Joints 5804 Showing Anatomy of Knee Joint 6105 Showing Anatomy of Knee Joint 6106 Showing the Minisci of Knee joint 6307 Showing the Ligaments of Knee joint 6408 Showing Knee joint in Flexion and Extension 6509 Showing Samprapti of Dhatukshaya Janya Sandhigatavata 8110 Showing Samprapti of Avarana Janya Sandhigatavata 8311 Showing the Commonly effecting area of Osteo arthritis 9812 Showing Osteoarthritis of Knee 10313 Showing Radiological aspect of Osteoatrhritis 11014 Showing Exercise for Osteoarthritis 11915 Showing Exercise for Knee Osteoarthritis 12016 Showing Ingredients of Kethakyadi Taila 12617 Showing Ingredient of Vasti Pranidana 12618 Showing Vasti Procedure 13619 Showing the distribution of patient’s age group. 13820 Showing the distribution of patient’s sex group. 13921 Showing distribution of patients by religion 14022 Showing distribution of patients by Economical status. 14123 Showing distribution of patients by occupation. 14224 Showing distribution of patients by type of diet. 14325 Showing distribution of patients by Marital Status 14426 Showing distribution of patients by Mode of Onset 14527 Showing distribution of patients by Vihara (Nature of work) 14628 Showing distribution of patients by Agni: 14729 Showing distribution of patients by Kosta: 14830 Showing distribution of patients by Nidra: 14931 Showing distribution of patients by Vyasana: 15032 Showing distribution of patients by Deha Prakruti 15133 Showing distribution of patients by Samhanana 15234 Showing distribution of patients by Satmya: 15335 Showing distribution of patients by Vyayama Shakti 15436 Showing distribution of patients by Vaya 15537 Showing distribution of patients by Joint Involvements 15638 Showing distribution of patients by duration of the disease 158 xi
  • 18. 39 Showing distribution of patients by different grades of 159 Vedana before Treatment40 Showing distribution of patients by different grades of 160 Vedana after follow up41 Showing distribution of patients by different grades of 161 Sandhi Atopa before Treatment42 Showing distribution of patients by different grades of 162 Sandhi Atopa after follow-up43 Showing distribution of patients by different grades of 163 Sandhi shothaha44 Showing distribution of patients by different grades of 164 Sandhi shothaha45 Showing distribution of patients by different grades of 165 Sthamba46 Showing distribution of patients by different grades of 166 Sthamba after follow-up47 Showing distribution of patients by different grades of 168 Sandhigati Asamarthya48 Showing distribution of patients by different grades of 169 Sandhigati Asamarthya after follow-up48 Showing distribution of patients by different grades of 170 Walking Time before treatment50 Showing distribution of patients by different grades of 172 Walking Time after follow-up51 Showing the distribution of Overall Response to the 173 treatment52 Showing the Percentage Improvement of Parameters 212 xii
  • 19. Introduction: Movement is the sign of radiant life but unfortunately in some clinicalconditions this vital factor is affected and such person feels himself as a miserablecreature as he depends on others for daily activities. Sandhigatavata is one suchdisorder where in these locomotive functions are affected. In Ayurvedic classics itexplained under Sthana visheshakruta Vatavyadhi, under the concept of Gatavata1. Sandhigatavata can be compared with Osteoarthritis as the clinical featuressimulate each other. Osteoarthritis (OA) is the most common type of arthritis, and isseen especially among older people. It is also called as degenerative joint disease orosteoarthrosis. The upset in the fine balance among the bio regulating factors of the body –vata, pitta and kapha, make the person fall prey to diseases. If one can take care tomaintain the balance among these bio regulating factors, he is assured of good health. The term Sandhi means ‘sandhana’ i.e. the union of two or more structurestogether. According to commentator Dalhana the word Sandhi means Asthisandhi2.Here, specifically the union of two or more asthis takes place. Asthi is the dhatuwhich makes the dharana of the deha. This asthi dhatu and vata dosha are havingashraya ashrayee sambandha3. When the vata dosha is increased it is prone to getlodged in the asthis and sandhis. In old age, all Dhatus are deranged leading to VataPrakopa and making the individual prone to many vataja diseases. Sandhigata vata isone of such disease commonly affecting a large number of individuals. This disease can be compared with Osteoarthritis of contemporary medicalscience. According to World Health Organization (W.H.O) Osteoarthritis is thesecond commonest musculoskeletal problem in the world population (30%) after backpain (50%). The reported prevalence of O.A from a study in rural India is 5.78 %4. 1
  • 20. Osteoarthritis is the most common form of arthritis affecting the weight bearing jointsof the knees, hips, lower spine and peripheral joints of fingers and toes. Only 25-30%of OA are symptomatic even though prevalence rate is about 80% at age of 65 years5. Chikitsa is mainly of two types –Shodana and Shamana. Shodana is concernedwith malas, while Shamana deals with doshas. Shodana strikes at the root of malasand eradicates them and as such the disorders – treated with Samshodana do notreoccur, while those treated with other methods like Shamana might re-appear6.Shodana measures eliminate the unwanted/vitiated doshas from the body through thenearest out lets and purify the system. The Samshodana therapy is an unique concept of Ayurvedic science. Itenvisages not only the visceral cleaning rather it aims at the total bio-purification uptomolecular level. A suitable administrated Samshodana karma is expected to cleansethe hollow organs, cells, cell membranes and their pores effecting the bio-purity ofintracellular contents and structures. If the body is biologically purified and cleansedthe physiology is restored optimally and pathology reversed. The nutrients reach theirdesired destinations easily and their bio-availability is enhanced. The entire process ofDhatu poshana and Dhatu Parinama is accelerated and the mechanism of Kedarakulya Nyaya, Khale-Kapota Nyaya and Kshira-Dadhi Nyaya are accomplished well.Similarly the medicaments administered in Samshuddha sharira reach their sites easilyand effectively and possibly even a relatively smaller dose of a medicine may producegreater effect. Shamana therapies include diet and medicine may not be effective unless thesrotas are cleaned and the vitiated doshas and malas are removed from the body soShodhana is first among all treatments and the most important. This concept is unique 2
  • 21. to Ayurveda and is a primary protocol in all treatments. So Panchakarma can play aprominent and significant role in giving a new impetus in shaping the life style andcan provide answers to many diseases of the modern era. Vamana, Virechana, Asthapana vasti, Anuvasana vasti and Nasya are the fiveprocedures comprising Panchakarma7, 8, 9. Some Acharyas included Rakthamokshanaand both varieties of Vasti consider as one karma10. Among these, Vastikarma hasbeen placed a prime position by virtue of its wide indications and applicability likeshodhana, shamana, brumhana and karshana etc basing on the properties of the drugsemployed in the procedure11. Sandhigatavata is a Dhatukshayajanya Vyadhi and occurs usually after midlife stage. Here mainly Astivaha and Majjavaha srotodusti were observed. Prakopitavata dosha creates Sandhishoola, while due to Kapha kshaya particularly decrease ofShleshmaka Kapha, Sandhi Garshana take place and Symptoms like sandhi shotha,Vedana etc occurs. So considering all these above factors here in Sandhigata vata therequired drug should be having two characters like supportive and Supplementary. Insupportive aspect it gives relief in symptoms of sandhigata vata. So the drug which ishaving Vatahara properties and Snigda, Picchila etc Kaphavardhaka guna is useful inbetter way. In supplementary aspect the drug which is Rasayana-Asti specific isuseful for prevention or to stop further degenerative changes in the body. In contemporary medical science, treatment of Osteoarthritis is aimed at • Reducing pain • Maintaining mobility • Minimizing disability In contemporary medical science potent Analgesics, Anti-inflammatory drugsand also corticosteroids are generally prescribed for this disease. But these drugs are 3
  • 22. not so effective and pose increased risk of gastric erosion, hepatic and nephrotoxicityetc adverse effects. And also it is clearly said that, current treatment of Osteoarthrosisis purely to control symptoms because there is no disease modifying Osteoarthrosisdrug yet. Intra articular steroids are widely used in OA particularly for the knee, theseinjections may provide marked symptomatic relief for weeks to month. Becausestudies in animal models have suggested that gluco corticoids produce cartilagedamage, and frequent injections of large amounts of steroids have been associatedwith joint breakdown in humans, the injection should generally not be repeated in agiven joint more often than every 4 to 6 months. In Ayurveda, all Acharyas have given prime importance to Snehana Chikitsain the management of Sandhigatavata. Snehana can be performed both Bahya andAbhyantara12. Bahya snehas include abhyanga, tarpana, murdhni taila etc andAbhyantara snehas include bhojana, pana, nasya and Vasti. Since sandhigata vata is a degenerative disease it requires some regenerativetherapies. Sneha (Kethakyadi Taila) used in this tril contains Kethaki mula, Bala andatibala, are Madhura rasa pradhanya dravyas, Madhura is Tarpana dravya which actsin regeneration of degenerated tissue including Asti dhatu. Moreover these are havingsnigdha guna which also regeneratives. The drugs Bala and Atibala are of Sheetaveerya which are also considered as jeevaneeya or regeneratives. Ushna veerya ofKethaki may help in penetrating the sheeta veerya Bala and Atibala into the tissues.All these are generally Tridosha shamaka. Hence the broad spectrum of action. “xlÉåWûxÉUÉå ArÉÇ mÉÑÂwÉÈ....|” i.e., man is nothing but essence of sneha13. Hencesneha’s role is important one. In vasti karma, generally it is used in Sadharana karmai.e in fixed dosage, but there is another method i.e. Arohana karma where in sneha isadministered in a accending order dully increasing dose of sneha 12ml every day upto 4
  • 23. 144ml on 9th day. This is the technique explained by Adamalla in his commentary“Deepika” while commenting on Matra vasti explained by Acharya Sharghadara14.Since this technique appears to be innovative, it has been adopted in the present studyexpecting some good results than sadharana karma. Final results also strengthenedthis opinion as per clinical and statistical observation made after the study. 5
  • 24. ObjectiveObjectives: Sandhigatavata is a major problem as large percentage of population suffersfrom this malady. Acharya Charaka has explained Sandhigatavata as one among theVatavyadhi and characterized by “Vatapurnadrutisparsha, Shotha, PrasaranaAkunchanayoho Savedana Pravrutti”15. This can be compared with Osteoarthritis of contemporary medical science.There is a steady rise in prevalence from age 30 such that by 65, 80% of people haveradiographic evidence of OA16. According to Ayurveda in this age, Vata is inPravrudhavastha and may cause degenerative diseases like Sandhigatavata etc. Only 20-30% of OA are symptomatic even though prevalence rate is about80% at age of 65 years17. In contemporary medical science potent Analgesics, Anti-inflammatory drugs and also corticosteroids are prescribed for this disease. But thesedrugs are not so effective and pose increased risk of gastric erosion, hepatic andnephrotoxicity etc adverse effects. In view of this, designed a clinical study based on the Samanya Vatavyadhichikitsa as described by Acharya Charaka18 and Sandhigatavata chikitsa described byAcharya Sushrutha19. The procedure of Matravasti is selected with the KethakyadiTaila (Sahasrayoga) 20 for the proposed study. The Arohana krama of Mathavasti asexplained by Acharya Adamalla in his commentary “Deepika” on Sharangadharasamhita21 is taken into consideration in planning the study. Kethakyadi Taila consists of drugs like Kethaki mula, Bala and Atibala, whichare considered as safe for Vasti karma. Hence selected for this trial work. In Ayurveda Vasti is one of the important line of treatment for Vatayadhis.Matravasti, a type of Snehavasti, which does not requires strict follow up22. So this is 6
  • 25. Objectivean easy as well as convenient for patient as well physician. Hence Matravasti isselected. In Sandhigatavata, where the degeneration of the bone is seen, the proposedtreatment is expected to give the utmost results, because the Ketakyadi Taila isspecially indicated in Asthigata vata. By keeping the hypothesis that, Kethakyadi tailais not used in Arohana karma Mathravasti, so chosen the research topic to use sameKethakyadi taila for the two procedure vise in Sadharana karma and Arohana karmato evaluate the efficacy over the management of Sandhigathavata with reference toruk and shotha in affected joint. And undertake this trial with the title, “Evaluation onthe effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana kramaand Sadharana krama – A comparative clinical study”Previous researches on the same diseases: Many numbers of studies have been done in many P.G. Centers all over Indiaunder various universities. Different therapeutic modalities like, Shamana drugs andShodhana procedures have been tried. Some of these are -i) Shayer Latha B: Role of Snehana (Anuvasana) Vasti in the management ofSandhigatavata; Dept of Shalya tantra, Govt. Ayurvedic Medical College, Bangalore;R.G.U.H.S. Bangalore; 1991.ii) Rajashekhara K: The effect of Gudoochi ksheera- Vasti in Sandhivata; Dept. ofKayachikitsa, Dr. B.K.R.R. Government Ayurvedic college Hyderbad, AP University,Vijayawada; 1998.iii) Bharathi A.P: The role of Matravasti in management of Sandhigatavata ; Dept ofkaya chikitsa, Govt Ayurvedic medical college, Mysore; RGUHS, Bangalore; 1999.iv) Shinde kalpana: A clinical study on the role of Pancha tiktha Gritha Matravastiand Pancha tiktha ksheera paka with shuddha gritha in the management of 7
  • 26. ObjectiveSandhigatavata; Dept of Kayachikitsa and pancha karma; Institute for Post graduateteaching & research in Ayurveda; Gujarata Ayurveda University, Jamnagar; 2000..v) Madhushree H. S: Evaluation of the comparative efficacy of Matra vasti & Januvasti with Bala Taila in sandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag;RGUHS, Bangalore; 2005.vi) Natraj C: Evaluation of the efficacy of Panchachatikthaksheera vasti insandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag; RGUHS Bangalore;2006.Objectives of the study: a) To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days by using Kethakyadi taila in Sandhigatavata. b) To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata. c) To evaluate the adverse- effects of Arohana krama Matravasti if any. d) To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as well as Sadharana karma in Sandhigata vata. 8
  • 27. Historical review of Vasti KarmaVASTI REVIEW:Historical Review: Man always struggled with present and attempted for the better future andthese can be achieved with a better perspective. So, critical review of the history fromthe primitive stage to the new millennium assists one to understand the future in abetter way. History helps to reveal the hidden facts and ideas of the concerned subject.Even though it is really a difficult task to go in to the fathomless ocean of history ofAyurveda, it is an interesting task.MATRAVASTI Matrabasti is a type of Anuvasanavasti, “iÉxrÉÉÌmÉ ÌuÉMüsmÉÉåÅkÉÉïkÉïqÉɧÉÉuÉM×ü¹ÉåÅmÉËUWûÉrÉÉåïqÉɧÉÉoÉÎxiÉËUÌiÉ ||” (Su.Chi.35/18) which is quite relevant in present day living condition.Veda – Purana: There is some description about Vasti karma in Veda and Puranas. Vastikarmais indicated as a substitute for minor operation in Kaushika Sutra of Atharvaveda23. In Agnipurana, vastikarma is indicated as a principle line of treatment invataja aliments24. In Ashwa Chikitsa Kathana, Taila Vasti is recommended in horses to relievetheir fatigue immediately25. It is also stated that according to season different Sneha dravyas should beused for Vastikarma26.However, direct reference on Matravasti is not visible. 9
  • 28. Historical review of Vasti KarmaSamhita Kala:Charaka Samhita: Vasti is a part of Panchakarma which has been described for first time insecond chapter of Charaka Samhita (Apamargatanduleeya adhyaya) where Acharyaexplaines that Panchakarma chikitsa should be adopted by considering Matra, Kalaetc27. This gives us the some idea about Matravasti. Later Acharya Charaka explainedabout Matravasti in detail in fourth chapter of Siddhi sthana, Snehavyapat SiddhiAdhyaya where he described about its indications, qualities and dose28. CommentatorChakrapani added his contribution by clarifying dose of Matravasti.Sushruta Samhita: In Netravasti pramana pravibhaga Adhyaya (thirty fifth chapter ofChikitsasthana), Acharya explained about Matravasti as it’s a variety of Snehavastibased on vasti dravya pramana29.Ashtanga Sangraha: Matravasti is described in Vastividhi Adhyaya (twenty eighth chapter ofSutrasthana). Acharya explained that indication of Matravasti is similar toMadhutailika Vasti. Along with the dose, indications and qualities of Matravasti, hehas specifically mentioned the contraindication of Matravasti30.Ashtanga Hridaya: In Vastividhi Adhyaya (nineteenth chapter of Sutrasthana), Acharya explainedMatravasti. Description is similar to the Ashtanga Sangraha, but the contraindicationsof Matravasti are not found in this text31. 10
  • 29. Historical review of Vasti KarmaSangraha Kala:Sharangadhara Samhita: Matravasti is explained in the Vasti Kalpanavidhi (5th chapter of uttarakhanda).He has explained Matravasti as an Anuvasanavasti bheda. He has described the doseas 2 pala or even half of it32.Bhavaprakasha:In this, fifth chapter of Purvakhanda has been contributed to describe Basti whereAcharya stated that Matravasti as a variety of Anuvasana Vasti. Here Acharyaexplained the Uttama, Madyama and Avara Matra of Anuvasana Vasti and gradualincrease in its dose33.Kashyapa Samhita: Here Matravasti is described in Vastivisheshaneeya Adhyaya (eighth chapterof Khilasthana), Where Acharya descibed the uttama, madhyama and kaniyasi matraof Matravasti. He has also described the dose of Matravasti in children having givenup breast feeding (Annaja) 34.Bhela Samhita: The description of Vasti is available in four chapters of Siddhisthana namelyBastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhi and DashavyapadikaVastisiddhi. But, description of Matravasti is not found in the available chapters35.Chakradatta: In these text two chapters named Anuvasanadhikara and Niruhadhikara aredealt with Anuvasana and Niruha Vasti respectively. Matravasti is not mentioned, buthe has described the three doses of anuvasana and their administration in arohanakarma36. The Kaniyasi matra explained in this script can be equated with Matravasti. 11
  • 30. Historical review of Vasti KarmaVangasena: In Vasti Karmadhikara chapter Acharya described about Vasti. Thedescription is similar to Chakradatta. He also described three doses for AnuvasanaVasti37.Kalyanakaraka: In this text, Vastikarma is described in Vatarogadhikara only.Todarananda: In this text, Vastikarma is described in the chapter Vasti Vidhi adhyaya.AROHANA KRAMA MATRAVASTI: Acharya Adhamalla on commenting Shargandhara samhita Uttara Khanda,Vasti vidhi Adhyaya (Fifth chapter) described the Arohana krama of matravasti38. Acharya Bhavamishra in 5th chapter of Purva Khanda39, Acharya Chakradattain Anuvasanadhikara40 (72th) and Acharya Vangasena in Vastikarmadhikara chapter41explained the three doses for Anuvasana vasti and gradual increasing in dose. From technological point of view certain modified versions like Plastic bags,Plastic syringe etc are being used in Vasti therapy for easy administration and bettersterilization keeping with the present day need based requirements 12
  • 31. Etymology of VastiEtymology of Vasti: Etymology reveals the ‘Origin and Developments’ in the meaning of a word.The word ‘Vasti/Basti’ is derived from the root word “Vas/Bas” and “Chit” pratyayaand belonging to masculine gender.According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning:“uÉxÉÑ ÌlÉuÉxÉå |” - Means to stay, to reside and to dwell.“uÉxÉç AÉcNûÉSlÉå |” - Means to wrap“uÉxÉç uÉÉxÉlÉå xÉÑUÍpÉMüUlÉå | ” - Give fragrance.“uÉÎxiÉ uÉxiÉå AÉuÉëÑlÉÉåÌiÉ qÉÔ§ÉqÉç ” - That which covers the urine.“uÉÎxiÉ lÉÉÍpÉUç AkÉÉå pÉÉaÉ xjÉlÉå ” - Reservoir of urine situated in sub Umbilical area (Site of Bladder)Paribhasha: The term basti in the context of Panchakarma can be used in differentsense, it gives the following meaning. “uÉÎxiÉlÉÉ SÏrÉiÉå uÉÎxiÉÇ uÉÉ mÉÔuÉïqÉluÉåirÉiÉÉå uÉÎxiÉÈ |” (A.xÉ.xÉÔ.28/3)42 “uÉÎxiÉÍpÉSÏïrÉiÉå rÉxqÉÉiÉç iÉxqÉiÉç uÉÎxiÉËUÌiÉ xqÉ×iÉÈ |” (zÉÉ.E.ZÉ.5/1)43 The bag made by animal bladder is termed as “Vasti”. The bladders ofanimals were used as the device for bastikarma in olden days. It is also said thatmedicines like Kashaya, Ksheera, Tail,Ghritha etc administered through gudamargaby a basti netra of bastiyantra, first reaches the lower abdominal area of the patient 13
  • 32. Etymology of Vastiwhich contains the organ basti i.e. urinary bladder. Hence the term vasti is used todesignate the process in panchakarma. Acharya Charaka has defined the Bastikarma as the procedure in which thedrug prepared according to classical reference and administered through gudamargawhich reaches Nabhi Pradesha, Kati, Parshva, Kukshi and churns the accumulatedDosha and Purisha spreading the veerya of the aushada dravya to whole shareera,extracting the doshas from whole body by the virtue of veerya of the aushada towardsguda which later is expelled along with the purisha44.Matravasti: “WØûxuÉrÉÉ xlÉåWûmÉÉlÉxrÉ qÉɧÉrÉÉ rÉÉåÎeÉiÉ: xÉqÉ:|” (A.¾û.xÉÔ.19/67) Matravasti is a type of Anuvasana vasti which is having main ingredientsneha. The dose of Matravasti is equal to Hruswa sneha pana Matra45.Arohana Krama Matravasti: It’s a coined term. The word Arohana is derived from root word “AÉýiÉåÅlÉålÉ”and defined as “lÉÏcÉÉSÕkSïaÉqÉlÉÍqÉÌiÉ”46 means “The act of Rising” or “ascending” or“mounting”. As the dose of Matravasti is gradually increased in this procedure, theword is coined as “Arohana Krama Matravasti”.Sadharana Krama Matravasti: The word Sadharana is used to indicate the Usual or Common. The wordmeaning of xÉÉkÉÉUhÉ given in Shabdakalpadhruma as “xÉqÉÉlÉ:”, “xÉSØzÉ:”, “xÉÉqÉÉlrÉqÉç”etc47.As the dose of Matravasti administered in a fixed dose which is usually practiced isconsidered, so the procedure is termed as Sadharana karma Matravasti. 14
  • 33. ShareeraShareera: The word shareera comprises both structural and functional aspects of thebody. Knowledge of Anatomy and physiology of Rectum and Large intestine isessential for the Panchakarma specialist, where in the Vasti dravya is administered.The Guda is defined as “qÉsÉirÉÉaÉ ²ÉUqÉç|”48 As focus of this study is on Vastikarma, a discussion on Shareera of Guda andalso contemporary approach in the form of the anatomy & physiology of rectum andlarge intestine where this procedure is applied is described below.Guda Shareera: Acharyas have considered guda as one among the Dasha pranayatanas, 49, 50Sadhyo pranahara Marma51, Bhahirmukha srotas52.Paryaya nama of Guda: 1. Apanam, Payu - Amarakosha53 (Shabdakalpa Dhruma) 2. Guhyam, Gudavartma - Shabdakalpa Dhruma54 3. Apana - Vagbhata55 4. Gudantram - Dalhana56 5. Vitmarga - Vachaspati.Rachana shareera & Pramana of Gudhavalis: Acharya Sushruta in the context of Arshoroga has explained elaborately on theanatomical structure of guda. It is a part, which is the extension of sthoolantra withfour and half angula in length. It has got 3 valis (parts) named as Gudavalitrayam57. 15
  • 34. ShareeraTable No. 01: Showing Rachana shareera &Pramana of Gudhavalis: Sl.No Guda valis Pramana 1 Pravahini 1 angula that which does pravahana.(contraction of intestine) 2 Visarjini 11/2 angula that which does viasrajana(Evacuation) 3 Samvarani 11/2 angula that which does samvarana (Contraction of Sphincters) There is another structure called as Gudostha, which is about a distance of 1½yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1angula from gudostha. The width of each vali will be 1 angula and of the colour ofelephant’s palate58.Uttara Guda – Adhara Guda: Acharya Charaka while describing Panchadasha Kostangas, he had consideredUttaraguda and Adharaguda59. On commenting this Acharya Chakrapani clarifies that,Uttara guda helps for storage of Pureesha, where Adhara guda helps in expulsion ofPureesha. (E¨ÉUaÉÑSÈ rÉ§É mÉÑUÏwÉqÉuÉÌiɹiÉå, rÉålÉ iÉÑ mÉÑUÏwÉÇ ÌlÉw¢üÉqÉÌiÉ iÉSkÉUaÉÑSqÉç | ). The modern commentators consider them as rectum and anus respectively.Marma: Marmas are the vital parts of body. Acharya Sushruta explained such 107marma sthanas in body60 and Acharya Vagbhata also explained same number ofMarmas61. Knowledge of these vital parts is essential to avoid possible injuries duringPanchakarma procedures. According to Anatoimical distribution Guda marma comes under Udaramarma62. According to anatomical structure, explained as Mamsa Marma63.According to effect of injury most importently Sadhyo Pranahara marma64. Its size is 16
  • 35. Shareeraabout four angulas65. Which is attached to Sthulantra and through which Vata andPurisha is excreted out66.Pranaaythana: Pranayathanas are the vital spots where Prana or life resides. Acarya Charakaexplained such Ten points which includes “Guda”67.Physiological concept of Guda: Guda is one of the Pancha karmendriyas and its function is to excrete the malafrom the body68. Guda is on of the site for Apanavata and this sub type of vata helps in the mainfunction of Guda i.e. expulsion of shakrut69. Pakwashaya is also considered as thesthana for Apanavata by Acharya Sushruta70. In this context after administration of basti karma, Apanavata helps inevacuation of basti dravya along with vitiated vatadosha. According to Gananath sen Mechanism of defecation through Guda vali andApanavata can be understood as below.Table No. 02: Showing Gudha valis kriya karma: Sl.No. GudaVali Action 1. Pravahini Helps in compression and pushing the stool downwards 2. Visarjini Relaxes during this process and allows stool to pass further down 3. Samvarani Expels the stool out and constricts immediately, so that the continuity of the stool cut out and falls downPhysiology of Defecation: Samana Vayu influences digestion of food separation of nutrients and wasteproducts, Absorption of nutrients and elimination of waste products71. (A.H Su. 12/8) 17
  • 36. Shareera Apana vayu does the act of defecation. This is significantly seen with atendency to flow downwards.Modern View: Elimination of feces from the rectum is called defecation. Defecation is areflex action aided by Voluntary contractions of the diaphragm and abdominalmuscles and relaxation of the external anal sphincter. The rectum forms the last 15cm of digestive tract and is an expandable organfor the temporary storage of fecal material. Movement of fecal material into therectum triggers the urge to defecate. The last portion of the rectum, the Ano-rectal canal, contains smalllongitudinal folds, the rectal columns. The distal margins of rectal columns are joinedby transverse folds that mark the boundary between columnar epithelium of theproximal rectum and a stratified squamous epithelium like that in the oral cavity. Veryclose to the anus or anal orifice, the epidermis becomes keratinized and identical tothe surface of the skin. There is a network of veins in the lamina propria and submucosa of the ano-rectal canal. The circular muscle layers of the muscularis externa in the region formsthe internal Sphincter and is not under voluntary control. The external anal sphincterguards the anus and is under voluntary control. Pudental nerves carry the motorcommands72.Table No. 03: Showing Gudha valis Sthana and Modern terminology: Sl.No Guda Valis Situation Modern Terminology 1. Pravahini Proximal Middle Houston’s Valve 2. Visarjini Middle Inferior Houston’s Valve 3. Samvarani Distal Dentate line 18
  • 37. ShareeraTable No. 04: Showing Structure & Function of Rectum: Structure Action Function Mucosa Secretes mucosa, Lubricates colon and protects mucosa. absorbs water and Maintains water balance Solidifies Faeces. other soluble Vitamins and electrolytes are absorbed and compounds toxic substances are sent to the liver for detoxification. Lumen Bacterial activity Breaks down Undigested Carbohydrates Proteins and amino acids into products and amino acids into products that can be expelled through faeces or absorbed and detoxified by liver certain B vitamins and Vitamin K are synthesized. Haustral Churning Contents moved from haustrum to haustrum by muscular contractions. Peristalsis Contents moved along the length of colon Muscularis by contractions of circular and longitudinal muscles. Mass Peristalsis Contents forced into Sigmoid colon and rectum by strong Peristaltic Waves. Defeacation Faeces eliminated by contractions in the sigmoid colon and rectumPakwashaya / Large intestine: Pakwashaya is considered as one among the ashaya’s by Acharya Sushrutha73.Arunadatta comments as pakwashaya is the seat of pakwa anna i.e.that which attainspureeshatha74. Charaka and Vagbhata considered this as one among theKoshtangas75,76. 19
  • 38. Shareera Sharangadhara has specified the location of pakwashaya (pavanasaya) asbelow the Tilam i.e. the Yakrut and Kloma77. The horseshoe shaped large intestine or large bowel extends from theileocaecal valve to the anus. Average length is about 1.5 meters and width of 7.5cms.Figure No 1: Showing the Anatomy of Large Intestine:Its Sub division includes:Table 05: Showing Sub divisions of large intestines: 1. Cecum T portion (pouch like) 2. Colon Large portion 1.5m 3. Rectum 5 inches. 4. Anal canal 4cms Intestinal mucosa contains many Goblet cells, and Muscularis consists oftaenia coli. Mechanical movements of the large intestine include Haustral churning,Peristalsis and Mass Peristalsis. 20
  • 39. Shareera The last stages of chemical digestion occur in the large intestine throughbacterial action. Substances are further broken down and some vitamins aresynthesized. Large intestine also absorbs water, electrolytes and vitamins. Faecesconsist of water, inorganic Salts, epithelial cells, bacteria and undigested food.Absorption in the Large Intestine: The re-absorption of water is an important function of the large intestine.Although roughly 1500 ml of material enters the colon each day, only about 200 ml offaeces is ejected. The remarkable efficiency of digestion can best be appreciated byconsidering the average composition of faecal wastes 75% water, 5 % bacteria, andthe rest a mixture of indigestible materials, small quantities of inorganic matter, andthe remains of epithelial cells.78 In addition to reabsorbing water, the large intestineabsorbs a number of other substances that remain in the fecal material or that weresecreted into the digestive tract along its length. 21
  • 40. Vasti karmaVasti karma: Vasti is considered as supreme therapy for Vatavyadhis. (mÉUqÉÉæwÉkÉ). Vastioccupies prime place among Panchakarma keeping in view the present day’s needs asmost of the diseases pertaining to neurological and locomoter disorders are beingtreated with Vasti chikitsa successfully. Even our ancient Acharyas are stressed thesame in quotations like oÉsÉSÉåwÉMüÉsÉUÉåaÉmÉëM×üiÉÏÈ mÉëÌuÉpÉerÉ rÉÉåÎeÉiÉÉÈ xÉqrÉMçü | xuÉæÈ xuÉæUÉæwÉkÉuÉaÉæïÈ xuÉÉlÉç xuÉÉlÉç UÉåaÉÉͳÉrÉcNûÎliÉ || MüqÉÉïlrɯÎxiÉxÉqÉÇ lÉ ÌuÉkrÉiÉå zÉÏbÉëxÉÑZÉÌuÉzÉÉåÍkÉiuÉÉiÉç | AɵÉmÉiÉmÉïhÉiÉmÉïhÉrÉÉåaÉÉŠ ÌlÉUirÉrÉiuÉÉŠ || (cÉ. ÍxÉ.10/5) Acharya Bhela states that, life exists as long as “Vata” lasts in thebody. (rÉÉuĘ́ɸÌiÉ uÉÉiÉÉå ÌWû SåWûÏ iÉÉuɨÉÑ eÉÏuÉÌiÉ|)79. Acharya Sharangadhara states that Vatacan influence other doshas, dhatu, malas due to his Chala or Chetana guna80. Acharyavagbhata considered Vata as “Prabala”among Doshas (...SÉååwÉÉhÉÉÇ mÉëoÉsÉÉåÅÌlÉsÉÈ) 81 . Sovitiation vata leads to vitiation of other doshas and disarrangement of body systems.Basti is supposed to be chikitsa principle for vata vyadhi82. Acharya Arunadatta statesclearly that “iÉålÉ uÉÉiÉxrÉ oÉÎxiÉaÉÑïSmÉëÍhÉkÉårÉxlÉåWûYuÉÉjÉÉÌS mÉUqÉÉæwÉkÉqÉç|”83Importance of Vasti Karma: All major texts of Ayurveda emphasized this treatment considering itsefficacy. It stands unique among all the shodhana therapies because it expels thevitiated Doshas rapidly and easily from the body and also causes reducing as well as 22
  • 41. Vasti karmanourishing the body very fastly84. Eventhough Vamana and Virechana eliminates thevitiated Doshas form the body, the drugs used in these therapies contain Katu rasa,Ushna guna and Teekshna gunas, which cannot be taken easily by children or olderpeople. But Vasti can be given in all age groups without any hesitation85. Vasti is not only indicated in Vataja Vyadhi. It can be used even in pittaja,kaphaja, rakthaja, samsargaja, sannipataja vyadhis86. Acarya Charaka considered Vasti as Ardha chikitsa and even as Purna chikitsain siddhisthana of Charaka samhita87. In sutrasthana in the context of Agrya dravyas,Vasti is considered as Agrya for Vata88. Apart form this it has multidimentonal effect by possessing various therapeuticactions like Samshodhana, Samshamana and Sangrahana of doshas on the basis ofdravyas used in it89. Vasti accomplishes rejuvenation, happiness, longevity, strength, improvingmemory, voice, digestive power and complexion. It removes noxious matters form thetissues, pacifies the Doshas. Consequently it affords stability and thus indirectlystrengthens the reproductive capacity in man90. Kashyapa equated the Vastikarma as‘Amrutam’, because of its widespread applications even in both infants and in old agepeople.91Classification of Vasti: Since vasti can be of many types according to its Karma, Dravya used, numberof Vasti to be given and many other factores like Vaya, Bala, Satva etc factores of theAtura. Hence one cannot find any uniformity in classification of Vasti foot fourth bydifferent Acharyas. Knowledge of the classification is very essential for the better 23
  • 42. Vasti karmaunderstanding of Vasti therapy. So Vastikarma has been brought into the followingclassifications broadly.92Adhishtana bheda : The site of application viz abhyantara and bahyaDravya bheda : On the basis of medicine used viz Niroha vasti, Anuvasana vasti etcKarmukata bheda : On the basis of action viz shodana vasti, lekhana vasti etcSankhya bheda : The number of vasti’s given as a courseAnushangika bheda : Here the some vasti yogas explained in classics with specific name are considered.Matra bheda : Based on total quantity of vasti dravya1) Adhishtana bheda : According to the site of application of Vasti, it is classified asfollows Pakvashayagata Vasti Garbhashayagata Vasti Mutrashayagata Vasti Vranagata VastiTable 06: Showing Classification of Basti karma based on Route of administration i Pakwasayagata vasti: The Vasti dravya administered through Gudhamarga (ano-rectal route) to reach Pakwasaya. ii Garbhasayagata vasti The Vasti dravya administered through Yonimarga to reach Garbhashaya. iii Mutrasayagata vasti The Vasti dravya administered through urethral route to reach Mootrasaya iv Vranagata vasti The Vasti dravya administered through the Vranamukha . 24
  • 43. Vasti karma2) Dravya bheda: It is based on the major ingredients of Bastidravya - kwatha or sneha and soclassified into two types: - Niroha Vasti Anuvasana Vasti i) Nirooha vasti – In Niruha Basti, Kashaya (decoction) is the predominantcontent. Along with the Kashaya Madhu, Saindhava, Sneha and Kalka are usedcommonly. Its synonyms are Asthapana Basti, Maadhutailika, Yaapana vasti,Yuktaratha vasti, Siddha vasti93, Kashaya vasti etc. ii) Anuvasana vasti – Sneha is the chief ingredient of Anuvasana. Literally theterm Anuvasana refers to Vasti that can be administered every day with no risk94. On the basis of Matra, Anuvasana vasti is sub classified into three types95.Table No. 07: Showing types of Anuvasana vasti and its MatraSI. No Anuvasana vasti Bheda Vasti Dravya Matra01 Snehavasti 6 pala02 Anuvasana vasti 3 Pala03 Matra vasti 11/2 Pala3) Karmukata bheda: Susruta and Vagbhata have made the following classification according totheir actions96, 97. 25
  • 44. Vasti karmaTable No. 08: Showing type’s vasti based on its Karma:SI. No Type of Vasti Action01 Shodhana vasti Contains Shodhana dravyas and removes vikrita Doshas and Malas from the body02 Lekhana vasti Reduces Medodhatu and produces Lekhana in the body03 Sneha vasti Contains more of Sneha and produces Snehana in the body04 Brumhana vasti Increases the Rasadi dhathus and indirectly it helps in the growth of body.05 Utkleshana vasti Causes Utklesha of malas and doshas by increasing its Pramana and causes dravabhootha06 Doshahara vasti Purificatory or eliminating type.07 Shamana vasti Causes Shamana of Doshas. Vataghna vasti, Balavarnakritavasti, Snehaneeyavasti, Sukrakritvasti,Krimighnavasti, Vrishatvakritvasti has been explained in various contexts byCharaka98.4) Sankhya bheda: On the basis of total number of Vasti administration, Vasti is classified asfollows99Table No. 09: Showing Sankya Bhedha of Vasti Prakara: Vasti Prakara Sankya Anuvasana Sankya Nirooha Sankya Yoga Vasti 8 5 3 Kala Vasti 16 10 6 Karma Vasti 30 18 12 26
  • 45. Vasti karma According to Kashyapa100: Yoga Vasti 8 5 3 Kala Vasti 15 12 3 Karma Vasti 30 24 65) Anushangika bheda:Here the some vastis yogas explained in classics with specific name are considered. a) Yapana vasti: Which promotes the life and restores the health101. b) Siddha vasti: It increases the bala, varna, and prasannatha102, 103. c) Yuktaratha vasti: Mainly indicated for travelers on vehicles etc104. d) Vaitharana vasti: It is mainly indicated in Katigraha, Shula, Anaha, Amavata and does the lekhana105. e) Ksheera vasti: Explained for shoolam,vitsangam, anaha, & mootrakrichra106. f) Ardhamatrika nirooha vasti: Snehana and swedana karmas are not required. Mainly it is indicated in rajayakhsma,shoola,krimi and in vatarakta. It improves Shukra and ojus107. g) Piccha Vasti : It is given with pichhila dravyas like Shalmaliniryasa and lajjalu. It is indicated in pichhalasrava and jeevashonita. It acts as Sangrahi108. (Vangasenasamhitha, Bastikarmaadhikara - 186-190) h) Mutra Vasti: It is Gomutra pradhana basti it is mridu in nature, safe and pacifies the doshas109. 27
  • 46. Vasti karma i) Rakta Vasti : It is indicated in conditions like adhika rakta srava111.6) Matra bheda: The quantity may vary from person to person and it depends on rogi bala, rogabala and vaya of the patient112, 113.Table No. 10: Showing Matra bheda of Vasti dravya: Sl.No. Vasti Quantity of Vasti Dravya 01. Dvadashaprasruta Vasti 12 Prasrutha 02. Prasritayogika Vasti 4,5,6,7,8,9&10 Prasrutha (Acc. strength of the patient) 03. Padaheena Vasti 1/4th less than Dvadashaprasruta vasti i.e. 9 PrasruthaMatravasti: Matravasti ia a type of Anuvasana vasti based on Matra of vasti dravya. AllAcharyas explained about Matravasti and considered safe and useful in manyconditions where other varities of Vastis are contraindicated. The term Matra, gives various meaning with respect to different context, suchas Measurement, Quantity, Size, Duration, Number, Degree, Movement, Unit of time.It also stated it as prosodial instant i.e. the length of time to pronounce a short vowel.In the present context the term Matra gives the meaning for the unit of measurementi.e for the quantity of Vastidravya. Vasti also having different meanings in various contexts but in present contextit is considered as therapeutic procedure of Panchakarma. 28
  • 47. Vasti karmaDefinition: WØûxuÉÉrÉÉ: xlÉåWûqÉɧÉÉrÉÉ qÉɧÉÉuÉÎxiÉ: xÉqÉÉå pÉuÉåiÉç| (cÉ.ÍxÉ.4/53) According to Acharya Charaka, Basti in which the dose of Sneha is equal toHraswa matra of Snehapana is called as Matravasti. Acharya Sushruta, Vagbhata alsodefined matravasti, which also gives same meaning114, 115,116. (Su.Chi.35/18, A.S.Su.28/8, AH.Su. 19/67) qÉɧÉÉM×üiÉpÉåSiuÉÉlqÉɧÉÉuÉÎxiÉ:| (SÏÌmÉMü-zÉÉ.E.5/4)Acharya Adamalla clearly mentioned that Matravasti is variety of Vasti based on theMatra of Vasti dravya.Indications: According to Acharya Charaka, Matravasti is always applicable to thoseemaciated due to overwork, physical exercise, weight lifting, way faring, journey onvehicles, and indulgence in women, in debilitated person as well as in those afflictedwith Vata disorders117. Vruddha Vagbhata has emphasized on regular administration of the Matravastiand it can be administered at all times and in all seasons just like Madhu TailikaVasti118. 29
  • 48. Vasti karmaTable No. 11: Showing indication of Matravasti acc. to Classics: Sl.No Indications C.S A.H A.S 1 Karma karshita + - - 2 Bhara karshita + + + 3 Adhva karshita + + + 4 Vyayama karshita + + + 5 Yana karshita + - + 6 Stri karshita + + + 7 Durbala + + + 8 Vata Rogi + + + 9 Bala - + + 10 Vriddha - + + 11 Chintatur - + + 12 Stri - - + 13 Nripa - + + 14 Sukumar - - + 15 Alpagni - + + 16 Sukhatma - + -Contraindication: In classics, there are no major contraindications mentioned for matra Basti, butAshtanga Sangrahakara has stated that Matra Basti should not be administered inAjeerna condition and to those who resort to Diwaswapna. 30
  • 49. Vasti karmaQualities: The Matravasti promotes strength without any pathyacof diet, causes easyelimination of Mala and Mutra. It performs the function of Brimhana and curesVatavyadhi. It can be administered at all times in all seasons and is harmless119. Vagbhata has mentioned that Matravasti improves Varna and Bala. He addsthat it can be given regularly, which is indicated for bala, vriddha, and alpagni person.No need of parihar after adminstration of Matravasti, no such complications arises. Hementioned it as Varnya, doshaghna etc120. Acharya Hemadri commenting on the termsukha stated that, it is devoid of complications.Dose: The term Matravasti is popular because of its dose only, because sneha isadministered in the hraswamatra. Acharya Charaka mentioned as “Hruswa snehaMatra” but not mentioned exact quantity121. Whereas Acharya Vagbhatarecommended the dose, equal to the dose of Hruswa Snehapana122, 123 . The Matrawhich gets digested in Ardhaha i.e. 2 yama (6 hours) is called as Hruswa Matra ofSnehapana124, but the dose required to get digested in 2 Yama is not mentioned. Sushruta has given the dose as half of the dose of Anuvasanavasti andaccording to him the dose of Anuvasanavasti is half of the dose of Snehavasti. InSnehavasti, the dose given is half of the total dose of Niruhavasti i.e. 6 Pala (24 Tola).Hence, the does of Matravasti is 1½ Pala125 = 6 Tola = 72ml. According toChakrapani, the dose of Snehavasti is 6 Pala, dose of Anuvasanavasti is 3 Pala and ofMatravasti is 1½ Pala126. Acharya Kashyapa prescribed the quantity of Matravasti as 2 palas asuttamamatra, 1 ½ pala as madhyama matra and 1 prakuncha as hraswa matra. He even 31
  • 50. Vasti karmastated that half pala of sneha can be given in newborn baby; it can be administeredwithout any hesitation and complication too127, 128. Sharangandhara mentioned sneha matra of Matravasti as 2 palas (8 tolas)129.On the basis of above references, it can be said that the dose of Matravasti is 1½ Palaof Sneha i.e. 6 Tola = 72ml.Table No. 12: Showing Matra of snehavasti mentioned indifferent Classics: Sl Author Matra 1 Charaka Sneha vasti is 6 Pala, dose of Anuvasana vasti is 3 Pala and of Matra vasti is 1½ Pala (6 Tola = 72ml) 2 Sushruta Anuvasana vasti is ½ of the dose of Sneha vasti Hence, the does of Matra vasti is 1½ Pala (6 Tola = 72ml) 3 Vagbhata Hrsva Snehapana is recommended for matra vasti. The matra which gets digested in 2 Yama (i.e.6 hrs) is called as Hrsva matra.Table No. 13: Dose of Matravasti according to Age: Sl. Age in Years Matra in Tola Sl. Age in Years Matra in Tola 1 1 1/4 11 11 2¾ 2 2 1/2 12 12 3 3 3 3/4 13 13 3½ 4 4 1 14 14 4 5 5 11/4 15 15 4½ 6 6 1½ 16 16 5 7 7 1¾ 17 17 5½ 8 8 2 18 18 6 9 9 2¼ 19 19-70 6 10 10 2½ 20 70 and above 5 32
  • 51. Vasti karma Arohana Krama Matravasti: Acharya Adamalla in his commentary on Sharangadhara samhita, explained the Arohana krama of Matravasti130. Table No. 14: Showing Dose of Arohana krama Matravasti: Start 1 day 2 day 3 day 4 day 5 day 6 day 7 day 8 day 9 dayUttama 2 2 Pala 2 ½ Pala 3 Pala 3 ½ 4 Pala 4 ½ Pala 5 Pala 5 ½ Pala 6 Palamatra Pala Pala 96 ml 120 ml 144 ml 168 ml 192 ml 216 ml 240 ml 264 ml 288 mlMadyama 1 1 Pala 1 ¼ Pala 1 ½ Pala 1 ¾ 2 Pala 2 ¼ Pala 2 ½ 2 ¾ Pala 3 Palamatra Pala Pala Pala 48 ml 60 ml 72 ml 84 ml 96 ml 108 ml 120 ml 132 ml 144mlHrusva ½ 0.5Pala 0.625 0.75 0.875 1 Pala 1.125 1.25 1.375 1.5matra Pala Pala Pala Pala Pala Pala Pala Pala 24 ml 30 ml 36 ml 32 ml 48 ml 54 ml 60 ml 66 ml 72 ml In Chakradatta131 and in Vangasena samhita132 three doses are descrbed for Anuvasana vasti.6 pala is considered as the jyeshtha matrra, 3 pala is madhyama matra and 1½pala as kaneeyasi matra. In jyeshtha matra 2 pala (96 ml) is administered in the beginning and then increased by ½ pala (24 ml) everyday and it becomes 6 pala on the 9th day, in madhyama matra starting dose is 1 pala (48 ml) increased by ¼ (12 ml) everyday and it will reach to 3 pala on the 9th day and in the kaneeyasi matra initial dose is ½ pala (24 ml) and increased by 6 ml everyday and on the 9th day it becomes 1½ pala. 33
  • 52. Vasti karmaQualities of Matravasti: The Matrabasti is promotive of strength without any demand of strict regimenof diet, causes easy elimination of Mala and Mutra. It performs the function ofBrimhana and cures Vatavyadhi. It can be administered at all times in all seasons andis harmless133. Vagbhata has mentioned that Matravasti improves Varna and Bala. He addsthat it can be given regularly, which is indicated for bala, vriddha, and alpagni person.No need of parihar after adminstration of Matrabasti, no such complications arises. Hementioned it as Varnya, doshaghna etc134. Acharya Hemadri commenting on the term sukha stated that, it is devoid ofcomplications135.Indications: According to Charaka, Matravasti is always applicable to those emaciated dueto overwork, physical exercise, weight lifting, way faring, journey on vehicles, andindulgence in women, in debilitated person as well as in those afflicted with Vatadisorders. Vruddha Vagbhata has emphasized on regular administration of theMatravasti and it can be administered at all times and in all seasons just like MadhuTailika Vasti.136Contraindication: In classics, there are no major contraindications mentioned for Matravasti, butAshtanga Sangraha has stated that Matravasti should not be administered in thepersons having Ajirna and to those who resort to Diwaswapna137. 34
  • 53. Vasti karmaVasti Yantra:The device used for Vasti karma is called as Vastiyantra.It comprises of two parts – 1. Vastinetra 2. VastiputakaVastinetra: The netra should be made of gold, silver, and copper or with other highermetals, alloys, long bones, bamboo, wood etc. Generally netra must resemble like tailof cow with a tapering end and a wider base with round ends and smooth surfaces thedimensions are different for different age group138, 139.Table No. 15: Showing Measurements of Vastiyantra140, 141 S.l no Age in years Length in Lumen of netra Angula Diameter of narrow Diameter of end broad end 1 <1 5 1 angula 2 1-6 6 Size of green gram 1 angula (Mudga) 3 7- 11 7 Size of black gram 1½ angula (Masha) 4 12-15 8 Size of kalayam 2 angula 5 16- 20 9 Size of wet kalaya 2½ angula 6 > 20 12 Karkandhu 3 angula Uttara vastiyantra 7 - 12 – 14 Sarshapa size - Susrutha’s opinion142 8 1 6 Green gram Feather of kanku bird must pass through. 35
  • 54. Vasti karma 9 8 8 Black gram Feather of eagle must pass through. 10 16 10 Kalayam Feather of peacock must through. 11 >25 21 Kolasthi Feather of vulture must pass through.Pramana of vrana vasti netra: The hole should be of a mudga pramana, with 8 angulas of length143.Karnika: In Vasti netra, there should be Three Karnikas. One Karnika should be at arequired point from the tip of the netra, to prevent excessivbe entrey. Remaining twoat the base of the Netra with two angulas distance each other, this used to tie the Vastiputaka144.Vastiputaka: The word Vasti is indicats the urinary bladder. Acharya Chakrapani stated as“Vastirithi mutrashaya putakam”145 where as Acharya Hemadri defined this as“Mutradhara charma peshim”146. In this context, the container or bag used to carry thevastidravya, ready for application is known as vastiputaka. In ancient days the urinarybladder of matured animals like cow, buffalo, dear, pig, goat etc were used. It wasthen processed to make stong, thin, soft, devoid of blood vessels and bad odor. Itshould be made suitable for well fitting with the vastinetra and appropriate toadminister vasti dravya147, 148. 36
  • 55. Vasti karma If good bladder is not available some other materials are recommended for thepurpose. They are the skin of neck of plava or thick cloth with sufficient strength andsize. Now a day, various types of materials are available to make up of vastiputakaand even disposable vastinetra are available. The rubber bladder and polythene bagsare best choice. Presently in most of the Panchakarma centers, the disposablevastiyantras with polythene are used.Vasti netra & Vasti putaka Dosha: In classics, Acharyas explained different improper features of Vasti netra andVasti putaka and their advese effects149, 150.Table No.16: Showing Netradosha of Vasti netra:No. Netradosha Adverse Effect1. Hraswata Too short Dravya will not reach pakwasaya2. Deerghata Too long Dravya go beyond the pakwasaya3. Tanuta Too thin Produces kshobha4. Sthoolata Too big Produces lakshana5. Jeernata Old dhatu used Injury to guda6 Shithilabandhana Improperly fixed to Dravya comes out putaka7. Parshwachhidra Hole on side Leakage of dravya happens8. Vakrata Curved / irregular Dravyagati becomes irregular9. Assannakarnika Karnika too near Karma becomes of no use10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma peedana11. Anusrotata Small hole Cannot perform properly12. Mahasrotrata Broad hole Cannot perform properly 37
  • 56. Vasti karmaTable No. 17: Showing putakadosha of Vasti Putaka: No. Putakadosha Features Effect 1. Vishama Shape not in Gati vishamata happens uniform during pressing 2. Mamsala Muscular tissue Produces offensive small present 3. Chinnachidrayukta Presence of hole Dravya comes out 4. Sthoola Thick one Does not push dravya 5. Jalayukta Anastamosis Produces leakage present 6. Vatala Excess air space Frothy type of dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass throughMATRAVASTI PROCEDURE As the procedure of Matravasti is not explained separately in classics, theprocedure of Anuvasana Vasti is adopted. The procedures and preparations areclassified into three parts: - 1.Poorvakarma 2.Pradhanakarma 3.Paschatkarma.Poorvakarma: The Purvakarma includes Rogi pareeksha, Sambara sangraha and Aturasiddhata. Rogipareeksha: Selected patients for Vasti therapy have to undergothoroughly clinical examinations to ascertain the physical as well as the mentalconditions.Following factors are to be considered for clinical examination151.1. Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya6. Agni 7.Satwa 8.Vaya 9.Bala This will enable the physician to decide, the type of Vasti, number of Vastis,Vasti dravya, etc to be administered in the particular patient. 38
  • 57. Vasti karmaSambara sangraha: It includes collection of Medicine, instruments etc. For MatravastiSneha dravya should be kept ready in a clean vessel. The instruments needed areVasti netra, Vasti Putaka are should be clean and ready.Atura siddhata: The body of the patient should be anointed with suitable sneha andgently fomented with hot water. Then he is advised to have his prescribed meal i.e ¼less than normal quantity and it should not be excessive snigda or rooksha and shouldbe Laghu. Then should ask the patient to take a short walk (hundred yards). Vastishould be administered when the patient is ardrapani which means we should notdelay much time after the intake of food. Having passed stool and urine he is laid on acouch, which is not very high, and the head must be at lower level. No pillows areused. The patient should lie on his left side drawing up the right leg and straighteningthe left leg152, 153, 154.Pradhanakarma: The proper amount of sneha prescribed for Matravasti is filled in thevastiputaka and tied well placing the vastinetra in position. The trapped air invastiyantra is expelled by gently pressing the vastiputaka. Then the anal region andthe netra should be smeared with oil for easy entery of vasti netra. Gently probe theanal orifice with the index finger of the left hand and introduce the vastinetra throughanal orifice into the rectum up to first karnika in the direction parallel to vertebralcolumn (Anuprustavamsha). In the same position press the vastiputaka with righthand with adequate force. Remove carefully the vastinetra when a little quantity ofsneha remained inside the vastiputaka155.Paschatkarma: After the administration of oil, the sphik of the patient should be tapped withthe palms to prevent early return of the recipe from the anus. The patient should lie on 39
  • 58. Vasti karmathe bed in supine position, and the joints of both his legs should be pulled gently. Thesoles of his feet should be massaged with oil. His heels, toes, calf regions and suchother parts which are painful should also be massaged with oil. The patient is keptlying on his back for hundred matrakala. Allow him to lie for sometime in the sameposition. If he gets the urge for defecation he may do it. But if the sneha passedimmediately another Matravasti should be given. After passing the motion with snehain proper time the patient is allowed to take light food if he feels hungry. Maximumduration for the return of snehavasti is 3 yama i.e. 9 hours156, 157, 158.Importance of left lateral position: Acharya Charaka opines that, Grahani and Guda present in Vama parshwa(Left side). So vasti dravya reaches these organs easily, if the patient receives vasti inleft lateral position. And also this position helps in relaxation of Guda valis, which inturn helps in proper spreading of vasti dravyas159. Gangadhara says; Agni, Grahani and Nabhi are present in the left side. Jejjatacomments Agni is present in left side over the Nabhi, Guda has got a left sidedrelation with Sthoolantra. So vastidravya can reach to the large intestine and Grahani,as they are present in the same level.Food before Vasti Procedure: Acharya Sushruta explains that Anuvasana vasti should be administered afterintake of food only. That rule should be followed in Matravasti also, as it’s a type ofAnuvasanavasti only. So patients should be given alpa snehayukta ahara beforeMatravasti. It should not be administered after the patient has consumed ati snigdhaahara because Sneha administered in both route i.e through mouth and through analroute may gives rise to mada and murccha. And also, the patient should avoid theintake of ati ruksha ahara because it may cause depletion of Bala and Varna. Patient 40
  • 59. Vasti karmamay intake Yusha, Ksheera, Mamsarasa etc according to Vyadhi. The quantity offood should be 1/4th less (Padahina) to his capacity160.Pathya – Apathya: The Matravasti does not demand any regimen of diet or behaviour. It can begiven at all times and in all seasons without any restriction161. However, VriddhaVagbhata has restricted the day sleep after administration of Matravasti162.Retention of Matravasti: The normal Pratyagamana Kala of Snehavasti is 3 Yama i.e. 9 hours. Being atype of Sneha Vasti, the Pratyagamana Kala of Matravasti can be considered as 3Yama. There is no harm if Matravasti retains in the body because, while describingAnuvasanavasti it has been said that it is not harmful to body even in the event of itsbeing retained in the body for a whole day. Also the dose of Sneha in Matravasti isvery small, which can get easily absorbed in the body without coming out. If vastimaterial returns much earlier, it cannot produce the desired effect in the body163.Samyaka Yoga Lakshana of Matravasti: Matravasti being a type of Sneha Vasti, Samyaka Yoga lakshana of SnehaVasti can be taken as Samyaka Yoga Lakshana of Matravasti164. 41
  • 60. Vasti karmaTable No.18: Showing Samyak, Heena and Atiyoga yoga of Anuvasana vasti:Samyak yoga Heena yoga Heena yogapratyetasakta sa shakrut Ruk in adha shareera, Hrullasacha tailam udara, bahu, prushtha & parshwaRaktadi dhatu prasadana Gatra becomes rukshata & Moha kharaBuddi prasadana Vata, vit & mutra graha KlamaEndriya prasadana SaadaSamyak swapna MurchaLaghuta in shareera VikartikaBala vridhiShrusta vegaComplication of Sneha Vasti: Though it is said that there is no major complication by the use of Matravastibut sometimes complication may be produced due to obstruction of Sneha by Vata,Pitta, Kapha, Mala or food and when given to a person on empty stomach. These aresix conditions of complications likely to arise during the use of Sneha Vasti165. 16601) Vata Avrita Sneha : If sneha dravya is of excessive cold or small quantityand such sneha is administered in a condition of excessive agravation of Vata dosha ,which may get Avrita by Vata and may not able to return Such Sneha produce Angamarda, Jwara, Adhmana, Stambha, Urupida, Parshwashula. Treatment: In such condition Niruha Vasti prepared by Rasna, Pitadaru,Tilvak, Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra, Panchamula should beadministered to eliminate the Vatavrita Sneha. 42
  • 61. Vasti karma02) Pitta Avrita Sneha167: If excessive Ushna Vasti is given in the condition of excessPitta, it produces Daha, Raga, Trasa, Moha, Tamaka and Jwara. Treatment: This condition should be cured with the enema prepared withMadhura and Tikta Dravyas.03) Kapha Avrita Sneha168: If Mrudu Vasti is given in condition of excess Kapha, itcauses Tandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and Glani. Treatment: It should be corrected with Vasti prepared with Kashaya, Katu,Tikshna and Ushna Dravya and with Sura and Gomutra and mixed with MadanaPhala and Amla Dravya.04) Anna Avrita Sneha169: If Vasti prepared with Guru Dravya and given after aheavy meal it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi,Murccha, Aruchi, Glani, Shula, Nidra, Agnimandya and Ama Lakshanas with Daha. Treatment: Such condition is treated by stimulating digestion with decoctionand powders of Katu and Lavana Dravyas. Also Mrudu Virechana and the treatmentadvised for Ama should be adopted.05) Purisha Avrita Sneha170: In case of accumulation of Mala, if Vasti having AlpaBala is administered it produces symptoms like Purisha Sanga, Mutra Sanga, VataSanga, Shula, Gaurava, Adhmana and Hridaroga. Treatment: This condition should be treated with Snehana, Swedana alongwith Phalavarti. The Anuvasana Vasti and Niruha Vasti prepared with Shyama, Bilvaetc. should be used. Also the treatment indicated in Udavarta should be followed. 43
  • 62. Vasti karma06) Abhukta Pranita Vasti171: If Vasti is given in a person with empty stomach itreaches upwards due to absence of any obstruction. Also if Vasti is administered in aperson with empty bowel with great force it reaches up very high and from there itmay reach the throat and may come out from the upper orifice of the body. Treatment : In this condition, Niruha Vasti and Anuvasana basti of Snehaprepared with Gomutra, Shyama, Trivritta, Yava, Kola, Kulattha should be given andthe condition where it is coming out the throat, it should be treated by KashayaDravyas, pressure on the throat and by Virechana and Chhardighna measures.Importance of Matravasti: The advantage and importance of Matravasti can be summarized by followingpoints. 1. rÉjÉå¹ÉWûÉUcÉå¹xrÉ, ÌlÉwmÉËUWûÉU - Matravasti has no restrictions as of Asthapana and Anuvasana, one can perform routine works after administration of Matravasti. 2. xÉuÉï MüÉsÉqÉçç - Matravasti can be administered anytime irrespective of age, day, and time. 3. It can be administered to SÒoÉïsÉ mÉÑÂwÉ where other vastis are contraindicated in them. 4. ÌlÉUirÉrÉ, xÉÑZÉqÉç - It does not produce any complications. 5. Even though matra is less it has widespread action throughout the body. 6. Niroohavasti and anuvasanvasti should be administrated alternatively, but Matravasti alone can be administered everyday continuously without any complications. 44
  • 63. Vasti karma 7. SÉåwÉblÉ - It eliminates vitiated dosas along with mala from the body and also it acts as shamana, brumhana, vatahara and even balya. 8. As the quantity of Matravasti is less, it retains in the body for longer duration compared to other vasthis and not produces any complications even though it does not expel out.Vasti Karmukata. Bastikarma is having multidimensional therapeutic effects. Matravasti being atype of vasti, the general mode of action of Vasti karma can be considered for someextend. Being only sneha dravya is administered in small quantity in Matravasti morenourishing (Brumhana) effect can be expected rather than cleansing (Shodana) effect.For better understanding it can be studied under the following headings.The procedural effect The left lateral position is advised for administration of Vasti. The reason forthat, anatomically the Gudavalis becomes relaxed there by it helps in easyadministration vasti dravya. And also Acharya Charaka opines that, Grahani andGuda present in Vama parshwa (Left side). So vasti dravya reaches these organseasily, if the patient receives vasti in left lateral position172. Physiologicaly, Vasti dravya having direct effect on Agni, which may beenhanced by left lateral position as Acharya Gangadhara says; Agni, Grahani andNabhi are present in the left side. Jejjata comments Agni is present in left side overthe Nabhi, Guda has got a left sided relation with Sthoolantra. So vastidravya canreach to the large intestine and Grahani, as they are present in the same level. Accordin to Modern science also left lateral position is the best posture forbetter and effective administration of vasti because anal canal turns to left side torectum, sigmoid colon and descending colon where more mala to be dissolved is 45
  • 64. Vasti karmapresent. Moreover, medicines stay at these surfaces, get absorbed more and show theirbest effect, especially in Matravasti. The absorptive area of mucosa is more on thisside. On left side colon area is easily approachable through anus rather than on theright side and this posture relaxes the ileo-ceacal junction and makes the easy flowinto the sigmoid colon.Action based on drug effect Action of vasti is possible by Anupravaranabhava of vastidravya i.e. Snehaeasily moves up to grahani, which freely moves in the intestine. Charaka saysvastidravya reach nabhi, katipradesha and kukshi173. The action of Vasti is mainly due to the Veerya. The drugs used in the vastikarma will however spread in the body from Pakwashaya due to their veerya, throughthe appropriate channels. The veerya is drawn into the body by apanadi vatas i.e. firstby Apana, then Udana and throughout the body by Vyana. As it is said that “Gudamoolam hi shareeram”, Also as water sprinkled at the root of tree circulates all overthe tree by its own specific property. So Vastikarma eliminates the morbid Doshasand Dooshyas from the entire body. Vasti acts mainly on Asthi and Majjavaha srotas. Asthi is the seat of VataDosha174. Dalhana says that Pureeshadharakala and Asthidharakala are one anotherthe same. So we can assume that if Pureeshadharakala gets purified and nourished; theAsthivaha srotas will also be purified and nourished. Also another factor is about therelation between Pittadharakala and Majjadharakala, Pittadharakala and Grahani. Asan opinion says about the spread of vastidravya till Grahani and Grahani is the seat ofAgni, the nutrients may get absorbed and thereby nourishes the Majjadharakala,which is having a strong bond with vata and the nervous system. It is practically seenthat after appropriate administration of Vastikarma the Vatavyadhi will be reduced. 46
  • 65. Vasti karmaMode of action of Vasti: Acharya Sushrutha explains that after proper administration of basti,dravyaremains in the Pakwashaya, Shroni, below the nabhi and through the srotoses, theveerya of basti spread to entire body. Similarly, though basti remains in the bodyonly for short time and it is excreted along with mala by the action of apana vayu, dueto the veerya, the doshas situated from head to toe are also forcibly thrown out of thebody. uÉÏrÉåïhÉ oÉÎxiÉUÉS¨Éå SÉåwÉÉlÉÉmÉSqÉxiÉMüÉiÉç | mÉYuÉÉzÉrÉxjÉÉãÅqoÉUaÉÉå pÉÔqÉUMüÉåï UxÉÉÌlÉuÉ || (xÉÑ.ÍcÉ.35/27) All these actions of basti can be well explained on the basis of knownPhysiological and Pharmacological actions. The Gastro intestinal tract has a nervous system known as “Enteric NervousSystem” lie entirely in the wall of the gut, beginning in the Esophagus and extendingall the way to anus. The number of neurons in this enteric system is about 10 crores almost equalto the number in the Spinal cord. It especially controls gastro intestinal movementsand Secretion The two plexuses in enteric system are mesenteric plexus and Sub mucosalplexus. The Sigmoidal, Rectal, and anal regions of the large intestine are considerablybetter supplied with parasympathetic fibers than other portions. They are mainlystimulatory in action especially in the defecation reflexes. 47
  • 66. Vasti karma Most of the Absorption in the large intestine occurs in the proximal half of thecolon, giving this portion the naming absorbing colon. Absorption through thegastrointestinal mucosa occurs by active transport and by diffusion. The Rectum has rich blood and lymph supply and the drugs can cross therectal mucosa like other lipid membranes. Thus unionized and lipid soluble substances are readily absorbed from therectal mucosa. Small quantities of short chain fatty acids Such as those from theButterfat are absorbed directly into Portal Circulation rather than being converted intoTriglycerides This is because short chain fatty acids are more Water Soluble and allowsdirect diffusion from the epithelial cells into the Capillary blood of the Villi. Moreever a Volume of about 1000cc of gas is estimated to be present in Gastro intestinaltract which can be readily expelled by vastikarma.Absorption of vastidravya: 60%-80% of water absorbed from the gut, Absorption in the proximal colon isbetter than the distal part as a result this rout substitute’s oral routsChanges after administration of Vasti175: • An increase in the fatty acid and protein content is shown by biochemical investigations subsequent to administration of snehavasti. • Colon has a large number of bacterial floras which bestow the body by producing certain factors of B group of vitamins, and K. researchers have shown that this flora flourishes abundantly on administration of Snehavasti. May be fats in it, provides a favorable environment for their growth, thus help in healing up of intestinal ulcers by providing a coat. 48
  • 67. Vasti karma• Visceral afferent stimulation results in activation of the hypothalamus pituitary adrenal axis and autonomic nervous system, involving the release of neurotransmitters and hormones.• Sneha vasti is hypo-osmotic which may get absorbed in to the blood.• Anuvasana and Matravasti have got a property to regulate sympathetic activity, decreases adrenalin and noradrenalin secretion and helps in the balance of autonomic nervous system. 49
  • 68. Historical Review of SandhigatavataDISEASE REVIEW:Historical Aspect of Sandhigatavata: History of Ayurveda is studied under the headings of 1.Vedic period,2.Samhita Kala and 3.Sangraha Kala.I. Vedic Period: The specific reference about Sandhi-gata-vata is not visible in Vedas, but theinformation is available regarding vatavyadhis in general. It is mentioned in BrhatJaataka 23-13, Raghuvamsham 9-63, Brahma samhita 87-44, Kaashika 5-2-129176. The following anatomical structures related to sandhi-gata-vata are found inVedic literature. The term Sandhi is used in Yajurveda177. Further in Atharvavedastated that Balasa (Kapha) resides in Sandhi178. The word Janu is mentioned inAtharvaveda179, 180.II. Samhita KalaCharaka Samhita: Acharya Charaka described it as Sandhi-gata-anila, which is a synonym ofSandhigata vata in the chapter Vatavyadhi Chikitsa. He explained this condition underthe “Sthana bheda vayu lakshana”181. Sandhigata vata is not directly mentioned underVataja nanatmaja vikara but condition “Janu bheda” is mentioned. That can becompared with Janu sandhigatavata182.Sushruta Samhita: Acharya Sushruta explained lakshanas of Sandhigatavata in Nidanasthana183.In the Chikitsa Sthana specific line of treatment has been mentioned as, xlÉåWûÉåmÉlÉÉWûÉÎalÉMüqÉï oÉlkÉlÉÉålqÉSïlÉÉÌlÉ cÉ | xlÉÉrÉÑxÉlkrÉÎxjÉxÉÇmÉëÉmiÉå MÑürÉÉï²ÉrÉÉuÉiÉÎlSìiÉÈ || (xÉÑ.ÍcÉ. 4/8) 50
  • 69. Historical Review of SandhigatavataAstanga Sangraha: In Astanga Sangraha Lakshanas and four varieties of Chikitsa are explained inNidanasthana and Chikitsasthana respectively. The Nidanas are similar to thoseexplined in Charaka Samhitha184 and has followed Sushruta Samhitha for Chikitsaaspect185.Astanga Hridaya: In Astanga Hridaya, Sandhigata vata lakshanas are explained inNidanasthana186 and chikitsa in Chikitsa sthana187.III. Sangraha Kala:Madhava Nidana: Acharya Madavakara explained about Sandhigatavata in Vatavyadhi nidanaAdhyaya, Explanation resembles that of Acharya Sushruta’s opinion, where he hasmentioned an additional symptom Atopa (Sandhi Atopa) in the symptomatology188.Bhavaprakasha: Bhavamishra explained the lakshanas and treatment of Sandhigatavata inMadhyama khanda Vatavyadhyadhikara .From the treatment point of view he hadstated Dahana, Snehana,Upanahana and a combination of indravarunimula, pippaliand Guda for internal administration189.Yogaratnakara: Lakshanas and treatment of Sandhigatavata are explained inVatavyadhyadhikara of Pooravardha190.Bhela Samhita: Even though the description of Sandhigatavata is unavailable in Bhelasamhita, it is assumed that the verses are missing, as the description of Gatavatas such 51
  • 70. Historical Review of Sandhigatavataas Amashayagatavata, pakwashayagatavata and raktagatavata etc. is available.However AcharyaBhela has explained the asthi-majjagata vata where in we find thesymptom SandhiVichyuthi191.Haritha Samhitha: Acharya Haritha has not explained the diagnostic part of the disease.However, we find the symptom Sandhishotha in Sukragatavata but the line oftreatment is found in Vatavyadhi Chikitsa Adhyaya192.Chakradatta and Bhaisajyaratnavali Description is similar to Sushruta Samhita. Both the texts haven’t dealt withthe aspect of Nidana. But they have given importance to Upakramas like Upanaha,Agnikarma, Bandhana, Snehana and Unmardana193, 194.Siddhanta Nidana: Gananath Sen in the Vividha Sandhivatanidana Adhyaya has classified jointdiseases as Rasavata, Rakthavata, Vishavata, Jeernavata and Jaravata195.Basavarajeeyam: In this text in Vatavyadhi prakarana the term Sandhivata is used to describethe disease196. 52
  • 71. Etymology of SandhigatavataEtymology of Sandhigatavata:The term ‘Sandhigata vata’ is composed of three words viz1. Sandhi2. Gata3. Vata1. Sandhi: The word ‘Sandhi’ is Masculine gender which derived from the Sanskrit verbroot “xÉÇ+kÉÉ+ÌMüÈ| 197 Nirukti: a. “xÉlkÉÉlÉÍqÉÌiÉ xÉÎlkÉ”198 b. “AÎxjɲrÉ xÉqrÉÉåaÉxjÉlÉ” c. “xÉlkÉrÉÉå lÉÉqÉ, AxjlÉÉqÉlrÉÉålrÉxÉ…¡ûqÉxjÉÉlÉÌlÉ”199 The word “Sandhi” indicates “Sandhana” or union of two or more structures inbody. Acharya Sushruta stated that, in human body there are innumerable junctionsbetween Peshi, Snayu, Sira, Asthi etc. but the given description of Sandhi is only forAsthi Sandhi. AxjlÉÉÇ iÉÑ xÉlkÉrÉÉå ½åiÉå MåüuÉsÉÉÈ mÉËUÌMüÌiÉïiÉÉÈ | mÉåzÉÏxlÉÉrÉÑÍxÉUÉhÉÉÇ iÉÑ xÉÎlkÉxÉXçZrÉÉ lÉ ÌuÉkrÉiÉå || (xÉÑ.zÉÉ.5/28)2. Gata: The term Gata and Gati are derived from the Sanskrit verb root “aÉÇ+ÌMüiÉç(Ì£ülÉç),which means gone to, situated in, directed to, and arrived at.Vyutpatti: aÉcNûÌiÉ eÉÉlÉÉÌiÉ rÉÉiÉÏÌiÉ uÉÉ |200 53
  • 72. Etymology of Sandhigatavata The Streelinga word gata is used to denote an initiation of movement,carrying, something along with to reach a particular site, through any particularpathway, leads to occupancy at a particular site.3. Vata: The Vata originated from the root “‘uÉÉ’ aÉÌiÉ aÉlkÉlÉrÉÉåÈ”201, this means to blow, togo to move, smell, to strike, to hurt, to enlighten. Where as Dhallahna clarifies Sushrutas opinion and derives Vata as“aÉÌiÉaÉlkÉÉåmÉÉSÉlÉÉjÉïxrÉ ‘uÉ’ kÉÉiÉÉåÈ ‘WûÍxÉqÉ×ÎalÉhÉçuÉÉÅÍqÉSÍqÉsÉÔmÉÔkÉÑÌuÉïprÉxiÉlÉç’ CÌiÉ xÉÔ§ÉÉåimɳÉå ‘iÉlÉç’ mÉëirÉrÉåuÉÉiÉ CÌiÉ ÂmÉqÉç ||”Vyutpatti: The word is coined from “Vaa” dhathu and “Ktin” pratyaya. The term ‘Gati’ is having meanings like Prapti, Jnana (Panini) and themeaning of ‘Gandhana’ is like Utsaha, Prakashana, Soocana, (Shabdasthoma)Gandhana, Prerana (Siddhanta Kaumudi). Considering the different meanings of Gati and Gandhana it is understood thatthe term ‘Vata’ act as a receptor as well as stimulator.Hence it can be said that Vata is the biological force, which recognize and stimulateall the activities in the body.Concept of Gatavata: There are different theories established to explain the pathogenesis of variousdiseases. Gatavata is one such concept explained in all classical texts. Gatatva of Dhatu, Upadhatu, Ashaya, Avayava, Indriya etc. have beendescribed in our classics202. The disease sandhigata vata also belongs to Gatavatagroup of Vatavyadis. Various terminologies or synonyms like Gate/Gatam,Sthite/Sthitam, Avasthite, Ashrite / Samashritam, Prapte, and Sthe / Stha are used todenote Gatatva in the classics. 54
  • 73. Etymology of SandhigatavataSandhigatavata: The Vata which is vitiated by its own cause settle down in the sandhis andproduces the features like Vatapoornadrutisparsha, Shotha, Prasarnaakunchanasavedana, Sandhi atopa, Sandhi stabdatha etc features in the joint is known as Sandhi-gata-vata. Sandhi-gata-vata is a disease of the joints; which causes severe difficultiesin the movement, ability to work and life style.Paryaya of Sandhigatavata: Different authors named Sandhigatavata differently in many contexts. 1. Kudavata203 2. Sandhigata anila204 3. Sandhi vata205 4. Jeerna vata206 55
  • 74. Sandhi ShareeraSandhi Shareera: The Sandhi-gata-vata is the disease comes under the category of Gata vata.Acharya Charaka explained this condition as Sthana bheda vayu lakshana. Herevitiated Vata gets lodges in Sandhis and causes impairment of normal function ofSandhi. This condition termed as Sandhigatavata. The term sandhi means ‘sandhana’i.e. the union of two or more structures together. According to commentator Dalhanathe word Sandhi means Asthisandhi. Here, specifically the union of two or moreasthis including taruna asthis and dantas. In classics we have scattered reference of anatomical and physiologicalconsideration of Sandhi.In total, there are 210 Sandhis in the body according to Ayurveda207.Classification of Sandhis:1. Kriyatmaka Vargikarana (According to Movement)Mainly classified into two types: Chestavanta and Sthira Sandhis208.Chestavanta: This type of sandhi is freely movable and is further subdivided into.a) Bahuchesta: Sandhis with free movement, mainly present in shakhas.b) Alpachesta: these Sandhis with comparatively less movement, present inprustavamshaSthira: The immovable sandhis are known as Sthira sandhis 56
  • 75. Sandhi Shareera Figure No.02: Showing types of Sandhi: Sandhhi Chestavanta SthiraAlpachesta Bahuchesta 2. Rachanatmaka Vargikarana (According to Structure): Sandhis are classified in to eight types, they are as follows Table No. 19: Showing Type of Sandhi’s and there sites: Sl Name of sandhis Correlation Sites 1 Kora Hinge Joint Anguli (interphalangeal joints), manibandha (wrist), gulpha (ankle), janu (knee) and kurpara (elbow). 2 Ulookhala Ball and Socket Kaksha (shoulder), vankshana Joint (hip), & danta (alveolar sockets and teeth) 3 Saamudga Saddle Joint Amsapeeta (sternoclavicular), guda (sacrococcygeal), bhaga (symphysis pubis), and nitamba (lumbosacral) 4 Pratara Gliding/Plain Joint Greevaprishtavamsha (intervertebral) 5 Tunnasevani Sutures Shira, kati kapala (sutural joints) 6 Vaayasatunda Condylar Joint Hanusandhi (temporomandibular) 7 Mandala Round-cartilaginous Kantha (tracheal rings), Netra, Joint Kloma nadi. 8 Shankhaavarta Semicircular Joint Srothra(cochlea)and Shrungataka 57
  • 76. Sandhi ShareeraSo In general Joints are classified as following:Figure No.03: Showing types of Joints: Joints (Arthrosis)Fixed/immovable (Diarthrosis) Movable (Synarthrosis)Fibrous Cartilagenous Synovial Sutures Synchondrosis Hinge Gomphosis Symphysis Ball&Socket Condyle Saddle Plane Ellipsoid PivotJanu sandhi: Acharya Sushruta considered Janu-Sandhi under Chala Sandhi on the basis ofkriya and Kora Sandhin on the basis of structure209.The factors which are helpful in understanding the Shareera of Sandhi are:Shleshaka Kapha: Among five variety of Kapha, Shleshaka Kapha resides in joints. It keeps thejoints firmly united and helps in their function210. 58
  • 77. Sandhi ShareeraVyana Vata : Vyana Vata is one among the five varieties of Vata. According to bothAcharya Charaka and Sushruta, Vyana vata governs every movement in the bodyincluding Pancha chestas like Prasarana, Akunchana, Vinamana, Unnamana andTiryag gamana211, 212. Gayadasa commenting on Sushruta has quoted the wordings ofan unknown author as the Vyana Vata is resides in the Sandhi213.Shleshmadhara Kala : It is the fourth Kala, which is situated in all joints of living beings. Regardingthe proper function of the joint, it is said that Sleshma act as grease on the axle for thesmooth movement of the wheel214.Janu Sandhi: Acharya Sushruta in Sharirasthana explains different structures of the humanbody. Among them, structures coming under Janu-Sandhi are,Snayu: Among nine hundred Snayus, ten are present in Janu-Sandhi. Among fourverities of Snayu, Pratana verity is present in Shaka sandhis including Janu sandhi.All the joints are attached with snayus that are responsible for their compactness.Importance: As a boat consisting of planks becomes capable of carrying load ofpassengers in river after it is tied properly with bundle of ropes, all joints in the bodyare tied with many ligaments by which persons are capable of bearing load215.Peshishareera: There are 500 peshis in body; among them 400 are in the Shakha (upper andlower extremities). Among Shakagata peshi, 5 peshi is present in the janu. All the 59
  • 78. Sandhi Shareerasiras, snayus, asthis, parvas and sandhis are covered by peshis that covers givesstrength to them216.Sanghata: Assemblages of bones are fourteen. Among that one is situated in Janu-Sandhi217.Marmas: Marmas are the vital anatomical points in the human body. Among theclassification on the basis of Anatomical consideration it comes under Sandhimarma218. On the basis of effect of Marmabhigata, it’s vaikalyakaramarma219. Thejanu marma is located between jangha and urvu and if injured causes khanjata220. (It ishaving measurement of 3 angula221.KNEE JOINT: Before discussing the disease 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. 60
  • 79. Sandhi ShareeraFigure No 4: Showing Anatomy of Knee Joint: KneejointThe articular surfaces: Knee joint is formed by 1) The condyles of femur 2) The condyles of tibia 3) The patellaFigure No 5: Showing Anatomy of Knee Joint: Anatomy of Knee 61
  • 80. Sandhi ShareeraArticular surface: Articular surfaces are most incongruent. The tibial surface is gently hollowcentrally and flattened peripherally where a meniscus rests. Lateral tibial surface iscircular and smaller, medial tibial surface is oval with longer ant-post axis. The lateral and medial femoral chondyles have in front and faint groove. Thisgroove demarcates the femoral patellar and chondylar surfaces. Lateral Femoralsurfaces are almost circular and medial femoral surface is larger and oval. Thepatella’s articular surface is adapted to the femoral surfaces.Fibrous capsule: The fibrous capsule has parallel but interlacing bundles of white collagenfibers. It is complex, partly deficient and partly augmented by expansions fromadjacent tendons. It forms a cuff with its ends attached continuously round thearticular ends of the tibia and Femur.Synovial membrane: Derived from embryonic mesenchyme, it lines fibrous capsule, covers exposedosseous surfaces, intra-capsular ligaments and tendons. It is absent from intra-articulardiscs or menisci and ceases at the margins of articular cartilages.Synovial Intima:Also called as lamina propria synovialis or synovial lining layer. It consists ofpleomorphic synoviocytes embedded in a granular, amorphous, fiber free intercellular matrix. It helps in removal of debris and synthesis of components of Synovialfluid. 62
  • 81. Sandhi ShareeraSynovial fluid: It occupies synovial joints, bursae and tendon sheaths. It is clear, pale, yellow,viscous, and slightly alkaline. A protein probably lubricin rather than hyaluoric acid isthe lubricating factor but it amplifies its secondary lubricating activity. It providesliquid environment with small range of pH, nutrition for articular cartilage, discs,menisci, lubrication and reduction of erosion.Menisci: It is fibrocartilagenous disc shaped crescent. It deepens the articular surfacesof the chondyles of the tibia. It partially divides the joint cavity into upper and lowercompartments. It has two ends, two borders and two surfaces. It helps to make thearticular surfaces more congruent, act as shock absorbers, lubricates the joint cavity,give rise proprioceptive impulse.Figure No.6: Showing the Minisci of Knee joint: 63
  • 82. Sandhi ShareeraOTHER STRUCTURES:Ligaments: The capsules and ligaments of Synovial joints unit the bones, help to directbone movement and prevent excessive and undesirable motion.Thus more the ligaments, the joint are stronger. In knee joint tibial collateral lig,fibular collateral lig, oblique popliteal lig, arcuate popliteal lig, ligamentum patellae,cruciate ligament etc. helps to maintain stability.Figure No. 7: Showing the Ligaments of Knee joint:Muscle tone: Muscle tendons that cross the joints are the most important stabilizing factor,which is due to tone of the respective muscles. In knee, muscle tone is extremelyimportant in reinforcing joints. Especially the thigh muscles are helpful.Bursae: Apertures in fibrous capsule through which synovial membranes protrude arecalled as Bursae. They are numerous; as many as 13 bursae have been described. 64
  • 83. Sandhi ShareeraMOVEMENTS OF KNEE JOINT1. Flexion2. Extension3. Medial rotation4. Lateral rotationFlexion and extension take place in upper compartment of joint, above the `menisci.They occur in Transverse axis.Figure No.8: Showing Knee joint in Flexion and Extension: Rotatory movements at Knee take place around a vertical axis and arepermitted in lower compartment of joint below the menisci.Rotatory movements can occur independently in partially flexed Knee or adjunctrotation.Rotatory movements may be combined with flexion and extension or conjunctrotation 65
  • 84. Sandhi ShareeraBlood Supply:1. Five genicular branches of the popliteal artery.2. The descending genicular branch of the femoral artery.3. The descending branch of the lateral circumflex femoral artery.4. Two Recurrent branches of the anterior tibial artery.5. The circumflex fibular branch of the post-tibial arteryNerve Supply:Femoral nerve : Through its branches to the vastus medialisSciatic nerve : Through the genicular branches of the tibial and Common peroneal nerves.Obturator nerve: Through its post division.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 the cells andmatrix of normal articular cartilage, their low pH optimum makes it likely that theproteglycanase activity of these enzymes will be confined to an intracellular site orthe immediate pericellular area. However cartilage also contains a family of matrix metalloproteinases(MMPs) including stromelysin, collagenase and gelatinase which can degrade all thecomponents of the extra cellular matrix at neutral pH. 66
  • 85. Sandhi Shareera Each is secreted by the chondrocyte as a latent pro enzyme that must beactivated by proteolytic cleavage of its N-terminal sequence. The level of MMPactivity in the cartilage at any given time represents the balance between activation ofthe proenzyme and inhibition of the active enzyme by tissue inhibitor (Keneeth,1996).Working function of Healthy Joints: 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 is white, smooth, glistening material and is very specialized whichfunctions as a cushioning material and a shock absorber so that hard bones do not rubagainst each other, and the cartilage also reduces friction during joint movement sinceits surface is very smooth. In fact no man made material can match the low frictionand shock absorbing properties of healthy cartilage in the joint. Cartilage is made up of tough fibres of a protein called collagen - Enmeshed inthese fibres of collagen are the large molecules of another protein called proteoglycan.Proteoglycan molecules contain lot of water in their interior. Water keeps on movingin and out of the domain of proteoglycan molecules almost like water being sucked inand squeezed out of sponge. This property of ability to exchange water so easily givesan elastic characteristic to the cartilage. Collagen fibers give desired strength and proteoglycan molecules allowreversible compression. The combined structure thus makes up for the tough but nottoo rigid quality needed for this very specialized tissue. 67
  • 86. Sandhi Shareera The bone ends with cartilage covering are enclosed in a membrane calledsynovium. The synovium releases a slippery fluid known 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 fluid formed by synovial membrane is a specialtype of fluid that behaves like fluid when the joint is being moved and during walkingwhen the joint is loaded its character changes to something like jelly to act as anadditional shock absorber. The synovial fluid nourishes the cartilage. The cartilagehas no blood vessels and relies on synovial fluid moving in and out to providenutrients 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. 68
  • 87. NidanaSandhigatavata Nidana: According to All Acharyas, Sandhigatavata is a Sthanagata Vatavyadhi caused bythe sthanasamshraya of prakupita doshas in the Asthisandhis of the body222. In Gatavata, first vata gets vitiated by its own etiological factors, following thespecific path of its pathogenesis, when involves some specific site i.e Dhatu, Upadhatu orAshaya, then such condition is termed by adjective of that site. E.g. when it getsdislodged in sandhi is known as Sandhigatavata. Classically our acharya’s doesn’t specify sandhis like janu sandhi, Amsa sandhi,Kati sandhi, etc for Sandhigata vata as in Contemporary science.Nidana panchaka of sandhigatavata: Nidana Panchaka is the tool to know about the disease, which comprises fivefactors. They are Nidana, Purvaroopa, Rupa, Upashaya, Samprapti. In absence of specific nidana, one can compile the relevant referencesmentioned in different contexts like Samanya Vatavyadhi Nidana223, 224, 225, 226, 227, 228,Asthivaha srotodushtikaarana229, Majjavaha srotodushtikaarana230. Basing above data,Sandhigatavata nidana can be classified as:-Sanikrishta and Viprakrista Nidana:Sannikrishta Hetu: Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana, Pradhavana,Atisankshobha.Viprakrishta Hetu: They are again sub classified according Rasa, Guna, Dravya etc 69
  • 88. NidanaTable No. 20: Showing the Viprakrishta nidana of Sandhigatavata:Rasa Kashaya, Katu, TiktaGuna Rooksha, Sheeta, LaghuDravya Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura, Kalaya, Adaki, Harenu, Shushkashaka, Vallura, Varaka.Aharakrama Alpahara, Vishamashana, Adhyashan, PramitashanaManasika Chinta, Shoka, Krodha, BhayaViharaja Atijagarana, Vishamopacara, Ativyavaya, Shrama, Divasvapna, Vegasandharana, Atyucchabhashana, Dhatu Kshaya The Nidana of Sandhigata Vata can also be classified in different headings likeAharaja, Viharaja etc.Aharaja Nidana:Table No. 21: Showing the Aharaja nidana of Sandhigatavata explained in differenttreatises:Nidana C.S S. S A.H M.N Y.R B.PKashaya - + + - - +Katu - + + - - +Tikta - + + - - +Rooksha + + + + + +Laghu + - + + + -Sheeta + - + + - -Alpabhojana + + + - + +Abhojana + + - + + +Pramitabhojana - - + - - -Dravya visheshaNidana C.S S. S A.H M.N Y.R B.PVallura + - - - - - 70
  • 89. NidanaVaraka + - - - - -Shuskha Shaka - + - - - -Uddalaka - + - - - -Neevara - + - - - -Mudga + - - - - -Masura + - - - - -Harenu + - - - - -Kalaya + - - - - -Viharaja Nidana:Table No. 22: Showing the Viharaja nidana of Sandhigatavata explained in differenttreatises:Viharaja C.S S. S A.H M.N Y.R B.PAti Vyayama + + + + - -Langhana + + - + + -Plavana + + - + + -Atyadhwa + - - + + -Pradhavana - + - - - -Pratarana - + - - - -Atyuchabhashana - + - - - -Balavadvigraha - + - - + -Abhighata + + - + - +Marmaghata - - + + - -Bharaharana + - - - + -Dukhashayya - - + + - -Dukhasana + - - - - -Sheegrhayana + - + + - -Prapeedana - + - - - -Atiadhyayana + - - - - -Ati vyavaya + + + + + +Atijagarana + + + + + +Vegadharana + + + + + - 71
  • 90. NidanaVishamopachara + - - + + -Shrama - - - - - +Upavasa + + + + + +Puravata sevana - - - - - +Divasvapna + - - - - -Manasika karana:Table No.23: Showing the Manasika nidana of Sandhigatavata explained in differenttreatises:Nidana C.S S. S A.H M.N Y.R B.PChinta + - + + + +Shoka - + + + + -Krodha - - - - - -Bhaya - - - - + -Anyat (other nidanas):Table No. 24: Showing the Anyata nidana of Sandhigatavata explained in differenttreatises:Nidana C.S S. S A.H M.N Y.R B.PAtiraktasravana + - - + + -Atidoshasravana + - - + + +Dhatukshaya + - - + + +Rogatikarshana + - - + + +Divasvapna + - - - - - As Mentioned above, Vata can get vitiated by Panchakarma apacharas likeAtidoshasravana, Atirakthasravana, Atiyoga of langhana, Apatarpana etc anddhatukshayakarabhavas like rogakarshana, gadakrita Atimamsakshaya. Both DhatuKshya and Stholya are considered as casautative factor for Vatavyadhi. In Sthoulya, themeda-avarana is the mechanism, which in turn leads to improper nourishment of Dhatuscausing Kshya in Dhatus except Meda231. 72
  • 91. Nidana The Age factor is also a main considering factor as Vata dominates vardhakyaavastha232. During this period, dhatukshaya occurs which in turn causes Vata prakopa.Living in jangaladesha is another causative factor for Vata prakopa233 and also Vata getsvitiated in the end of day and night234. According to Ritu Kriyakala,Vata gets started foraccumulat in greeshma ritu, Prakopa in varsha ritu and Shamana in sharad ritu kala. Vataprakriti persons are more susceptible to Vata vikaras. Persons who are rooksha-kashaya-katu-tikta satmya are also more susceptible to Vata vikaras. Among all the types of nidanas mentioned some need special attention.Adhyashana leads to excessive body weight and these results in more pressure overweight bearing joints. This gradually weakens the sandhis and produces Sandhigatavata.Excess exercise may not only vitiate Vata but further leads to shleshaka kapha kshayacontributing to Sandhigatavata. Excess walking and excessive weight bearing also are important in the context ofSandhigatavata. Abhighata to marmas or sandhis is another important risk factor forSandhigatavata. Vardhakya avastha characterized by dhatukshaya leading to peshi-snayu-shosha, thereby resulting in looseness of joints is also a major risk factor forSandhigatavata. 73
  • 92. Purvarupa Purvarupa: Purvarupa are indications of impending diseases. They occur prior to completemanifestation of disease and may suggest the forthcoming illness. During the courseof the Samprapti of an illness, the morbid doshas circulating all over the place in thebody tend to localize in an area and produces some of the unique symptoms and isreferred by the name Purvarupa. The Purvaroopa manifests in the Sthana Samsrayastage of Shatkriya kala. Diagnosis at this stage of the illness gains paramountimportance, as the effective treatment at this stage definitely reduces the possibleorganic damage as well as degree of morbidity. Particular Poorvaroopa of Sandhigatavata is not available in classics. AcharyaCharaka has stated that avyakta lakshanas are to be taken as Purvaroopa for all vatavyadhi235. Acharya Vijayarakshita, in commentary on Madhava nidana explains that termAvyakta indicates the unclear manifestation of upcoming Vatavyadhi and thesediseases are not have any vishista purvaroopa as seen in Jwara etc236. Hence mild exhibition of actual features of the disease like sandhi shoola,occasional Sandhi Shotha, slight sandhi atopa may be taken as purvaroopa. 74
  • 93. RupaRupa: Rupa of a disease, manifest in the fifth stage of Vyadhi kriyakala i.eVyakthavastha. Linga, Akruthi, Lakshana, Chihna, Samsthana, Vyanjana, Rupa etcare the synonyms of Roopa237. This is the unique stage of the illness, where in it isclearly recognizable as all its characteristic signs and symptoms manifest. Theintensity of the lakshanas is depending on strength of dosha dushya sammurchana.Sandhigatavata manifests with the following lakshanas.Vatapoornadrithisparshaha shothaha: In classics Acharyas explained Shotha as theimportant manifestation in Sandhigata vata. Acharya Charaka238 and Vagbhata239, 240correlated the shotha to air filled bag for touch. The Acharyas like Sushruta241, 242, 243,244 stated only as Shotha but not specified its nature. Physical examination of the Sandhi gata vata joint reveals localized soft tissueswelling of mild degree. It is due to the changes in articular ends themselves,particularly periarticular lipping.Prasarana akunchanayoho pravrittischa savedana: Pain in the joint during Prasarana (Flexion) Akunchana (Extension)Pravrutti245. Means pain in joints during its normal movements like extension orflexion. It is often described as a deep ache and is localized to the involved joint.Usually, the pain of Sandhi gata vata is aggravated by usage of joint and relieved byrest, later as the disease progresses, it may become persistent.Hanti sandheen: This lakshan is explained by Acharya Sushruta. While commenting on this,Dalhana explained as Akunchanaprasaranayoh Abhavah and Gayadasa explained asPrasaranakuncanayoh Asamarthah246. So it gives the meaning of inability to do 75
  • 94. Rupanormal movement of joint. This can be compared with the Prasarana akunchanayohopravrittischa savedana explained by Acharya Charaka. According to Madhukoshakara, Hanti sandhi referes to Sandhi Vishlesha,Stambha Adi Vikara247.Shoola: All the Acharya have described this symptom. Acharya Sushruta not specifiedabout this lakshan248, where Charaka and Vagbhata explained that pain in the joint iselicited during Prasarana Akunchana Pravrutti.Sandhi Stabdhata: Sandhi sthabdhata is the symptom explained by Acharya Vijayarakshita whilecommenting on word Hanthisandhi249. Acharya Sushruta explained the word Hanthisandhi, whereas commentators are silent on that. Bavamishra250, Shodala251,Yogaratnakara also explained Hanthi Sandhi, but not Sandhi stabdhata. The commentator while explaining Hanthi sandhi, Dalhana and Gayadasaexplained as Akunchanaprasaranayoh Abhavah and PrasaranakuncanayohAsamarthah respectively. So this can be considered as Sandhi Stabdatha.Atopa: Atopa is the symptom explained by Madavakara252. This can be comparedwith Crepitus (Characteristic sound produced from the joints). While commenting onthe word Atopa in another context, Madhukoshakara quotes the opinion of Gayadasaand Kartika. i.e. “Atopaha Chalachalanamiti Gayadasaha, Gudaguda ShabdamitiKartikah”. Also Bhavamishr says “Atopo Gudagudashabdaha”253. Thus we can saythat Atopa in this context is the sound produced by the movement of joints i.e.Crepitus. 76
  • 95. Rupa Thus with the help of different references and by the opinion of commentatorsit can be concluded that Sandhi Shoola, Sandhi Shotha, Atopa and Sandhi Stabdhataare the clinical features of Sandhigatavata.Roopa of Sandhigatavata mentioned in various classicsTable 25: Showing the Roopa of Sandhigatavata explained in different treatise: Roopa C.S. S.S A.S A.H M.N B.P. Vatapoornadruti sparsha + - + + - - Sandhi Shotha/shopha + + + + - + Prasarnaakunchana sa vedana + - + + - - Hanti Sandhigata - + - - + + Sandhi Shoola + + + + + + Asthishosha - + - - - - Asthibeda - + - - - - Atopa - - - - + - Sandhi Stabdhata - + - - + - Sandhi vishlesha - - - - + - 77
  • 96. SampraptiSamprapti: The process of Doshic vitiation and the course they follow, culminating in thedevelopment of specific clinical manifestation is known by the name Samprapti254. Jatiand Agati are its synonyms255, 256. An accurate understanding of Samprapti is vital in theplanning of the treatment of any disease, since Chikitsa is nothing but ‘SampraptiVighatana’. The term Samprapti is applied to express the course of the episodes ofdisease right from Nidanasevana to Vyadhi Utpatti. The knowledge of Samprapti helps inthe comprehension of the specific features of a disease like Dosha, Dushya, Srotodushti,Ama and Agni etc samprapti ghatakas. Charakacharya has described the types of‘Samprapti’ namely Sankhya, Vidhi, Vikalpa, Pradhanya, Bala, Kala257. Sushruta hasdescribed Samprapti process in six stages Sanchaya, Prakopa, Prasara, Sthanasamshraya,Vyakti and Bheda known as Satkriyakala. During Sthansamshraya Avastha the vitiatedDosha have reached to particular Sthana and get obstructed there and intimately interactsin a particular region with one, two or more dhatus and render them into dhushyas. This isthe reason that though Nidana of all the Vatavyadhi are same but only due to theSamprapti Vishesha of disease Vata can produce multiple Vata disorders. If vitiated Vatais accumulated in sandhi by Srotovaigunya it produces Sandhigata vata. Forsandhigatavata specific samprapti is not seen in classics. The Samanya Samprapti of Vata Vyadhi that is explained in classics can beconsidered as the Samprapti of Sandhigatavata. Acharya Caraka explained – due to the intake of Vatakara Ahara Vihara Vatavitiation take place. This vitiated Vata lodges in Rikta Srotas (Snehadi guna shunyasrotas- Chakrapani) and then produce disease related to that Srotas258. Acharya Vagbhata frames the Samprapti of Vata Vyadhi like – Dhatukshayaaggravates Vata and the same is also responsible to produce Riktata of Srotas. Thusthe vitiated Vata travels through out the body and settles in the Rikta Srotas and 78
  • 97. Sampraptifurther vitiates the Srotas leading to the manifestation of Vata Vyadhi.and also vataget aggravated due to Avarana by other doshas to vata259.Concept of Gatavata As the Sandhigatavata belongs to Gatavata group of Vatavyadhees, it will berelevant to discuss the concept of Gatavata here. While mentioning Gatavata,acharyas have mentioned the gatatva of dhatu, upadhatu, ashaya, avayava etc260. Thevarious terminologies used to denote this Gatavata are gate, sthithe, avasthite, ashrite,prapte etc. These all terminologies can imply two important factors – A) related to thegati of the vitiated Vata and B) related to occupation in the particular site of the body.When these two factors combine then such condition is termed by adding theobjective of that site, for e.g. Sandhigatavata. Though Vata is present all over thebody, its Gata condition specially indicates its abnormal localization at the particularDhatu or Ashaya. In this condition, the etiological factors are only of Vata and not ofdual i.e. not of both Dosha and Dooshya. For example, in Vatarakta, due to raktavruddhikara ahara the dravamsha of rakta gets increased and due to vata vruddhikaravihara vata gets vitiated. Vitiated rakta gets accumulated in the lower part of the bodyand obstructs vata in the extremities. Vata gets provoked still more due to theobstruction to its chala guna, resulting in Vatarakta. While in Sandhigatavata, thekopa of Vata alone occurs and this vitiated Vata by involving the Sandhis producesSandhigatavata. Peculiarities of these Gatavatas are that here the Vata vitiation isactive, Vata dosha is more important, vitiation of Vata is due to its own Nidanas andthere is a state of Dhatukshaya and Rikta srotas. Samprapti of Sandhigatavata can be discussed under two headings for betterunderstanding, they are 1. Dhatu Kshaya Janya and 2. Avarana Janya Sandhigatavata. 79
  • 98. Samprapti1. DhatuKshaya Janya Sandhigatavata: Here the process of Samprapti initiation is due to the strong involvement ofnidana factors such as Vardhakya avastha, Abhighata, Ativyayama, Marmaghata etc.In Vardhakya (Old age) Vata Dosha is dominates in the body. This in turn will causeKapha kshaya. As the Shleshma Bhava decreases in the body, Shleshaka Kapha in thejoints gets decreases in both quality and quantity. Reduction of Kapha in Sandhismakes Sandhi BandhaShithilata. Ashrayashrayi Sambandha also leads AsthidhatuKshaya as vatavrudhi leads to Asthidhatu kshaya261. Asthi being the main tissue of thejoint its Kshaya leads Khavaigunya in the joints. In this condition if Nidana Sevana, further produces Vata Prakopa. If VataPrakopa is not corrected by appropriate means and simultaneously if the personindulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vataspreads all over the body through these Srotas. The chief properties of Parthiva Dravya are Guru, Sthula, Sthira, GandhaGuna in excess. These are the properties, which are necessary for Sthairya andUpacaya of the body. Excessive intake of Dravyas having Laghu, Ruksha, Sukshma,Khara properties lead to Guru and Sneha Guna Abhava due to their opposite quality.Thus it leads to Dhatukshaya in the body. Akasha is the Mahabhuta that producesSushirata and Laghuta in the body. Vayu Mahabuta fills up this Sushirata. So due toDhatukshaya, Akasha Mahabhuta increases in the body producing Sushirata andLaghuta simultaneously Vayu fills it up. Intake of rooksha-sheeta ahara and vihara like ativyayama, abhighata etcReduction of sneha bhava in the body Dhatukshaya where by sushirata in thechannels results Vata purana of these channels Manifestation of symptoms. 80
  • 99. Samprapti In the mean time Sthanasamshraya of Prakupita Vata take place in the Khavaigunyayukta Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna decreases the properties of Sleshaka Kapha producing disease Sandhi-Gata- Vata.Figure No.09: Samprapti of Dhatukshaya Janya Sandhigatavata:Ruksha Ahara, Ati vyayama etc Nidana Varddhakya DhatuKshaya Vata Prakopa Kapha Kshaya Circulating throughout Body Khavaigunya Shleshaka Kapha in sandhis Kshaya in Sandhis Sthana samshraya in Sandhhi Sandhigatavata 81
  • 100. Samprapti2. Avarana Janya Sandhigatagata : In Sthulas usually Sandhi-Gata-Vata occurs in weight bearing joints. In themdue to the Kaphamedas the margavarana occurs and the Vata gets vitiated and causemany Vata Vyadhi and one among them is Sandigatavata. The excessive Medas will produce obstruction in the flow of nutritivematerials to the uttarottara Dhatus i.e Asthi, Majja and Shukra leads to their Kshaya.The excessive fat deposited all over the body will produce Margavarana of Vata.Prakupita Vata due to Margavarana starts to circulate in the body. While traveling itsettles in the joint where Khavaigunya is already exists. After Sthanasamshraya itproduces the disease Sandhi-Gata-Vata in the same process mentioned in the earliercontext. 82
  • 101. SampraptiFigure No. 10: Samprapti of Avarana Janya Sandhigatavata: Sthoulya Margavarana of Vata by vitiated medas Asthi Kshaya Vata Prakopa Deformity in Sandhi Khavaigunya In Sandhis Sthana samshraya Sandhigatavata 83
  • 102. Samprapti Three main factors involving in the production of Sandhigatavata, in any formof Samprapti are –1. Kopa of vyana vata, which normally controls all the movements of the body.2. Kshaya of shleshaka kapha, which normally aligns the joints and maintains itsCompactness.3. Deterioration of shleshmadhara kala, which lubricates the joints.Samprapthi Ghataka:Table 26: Showing the Samprapti ghataka of Sandhigatavata:Dosha Vata : Vyana Vriddhi; Kapha : Shleshaka KshayaDooshya Peshi, Snayu, Asthi, MajjaSrotas Mamsavaha, Medovaha, Asthivaha, MajjavahaAgni Jataragni, Asthi-DhatvagniAma Jataragni Mandya JanyaRoga Marga MadhyamaUdbhavasthana PakvashayaSancharasthana SarvashariraVyaktasthana SandhiAdhishtana Sandhi 84
  • 103. Upashaya-AnupashayaUpashaya: Upashaya is much important; especially during the treatment usually all drugs,diet and regimen which give long lasting relief in Sandhigatavata may be taken asUpashaya, having snigdha & ushna gunas are prescribed to pacify the Vata kopa. Forexample Abhyanga, Swedana, Ushna ahara, Ushna ritu etc. This should be adopted inthe nirama avastha of Vatavyadhi (Sandhigatavata) only. When the same drugs areprescribed in the saama avastha of vatavyadhi the disease aggravates.Anupashaya: All the drugs, diet and regimen which exaggerate the disease are taken forAnupashaya for Sandhigatavata. Also hetus of vatavyadhi can also be taken asAnupashaya. When upashaya method applied during samaavastha can also beincluded under Anupashaya. The diet having laghu, ruksha, sheeta gunas, anashana,alpashana, sheeta rithu can be considered as Anupashaya. 85
  • 104. Vyavachedaka NidanaVyavachedaka Nidana: Vyavachedaka Nidana or differential diagnosis plays a prime role in arrivingat an exact decision between diseases presenting a similar clinical feature. Whilemaking the diagnosis of Sandhigatavata the following disorders that are havingsimilar features has to be excluded.Table 27: Showing the Vyavachedhaka nidana of Sandhigatavata: Sl. Criteria Sandhigata Amavata Vataraktha Krotukashersha No vata 1 Nidana Vatavridhikar Viruddha Vidahi, Vatavridhikar a ahara- viruddha, a ahara-vihara cheshta Raktha ahara-vihara Prakopakara Ahara,Vihara 2 Purva Avyaktha Hridaya Karshnya, Avyaktharupa rupa rupa dourbalya, Sparshgnatva, lakshana lakshana Gourava, Kshateatiruk, Jvara, Sandhi aruchi, shitilyata Angamarda Vaivarnya, Peedakodhbava SwedaVridior kshaya 3 Rupa Sandhi- Vrischika Kandu,Daha, Maharuja, shoola, damshavat Spurana,Paka, Janushopha Prasarana - peeda, Teevra ruk, Thodha akunchanayoh Utsahahani Grathita-paki Krostuka- ovedana, Shotha Shvayathu shirshastu Sandhi Apaka, Spreads like Sthoola shopha, Angashunya mooshikavisha Shopha Vatapoorna taHrilasa, Starting from Drithi Trishna, Smaller joints sparsha Gaurava 4 Adhistana Sandhi Hasta,PadaJ Padhamoola, Janu Madhya anu Gulpha, Hasthamoola Trika, etc 5 Dosha Vata Vata, Kapha Vata, Rakta Vata, rakta 6 Upashaya Ushna, Ushna- Sheeta Snigdha, snigdha rooksha seetha 86
  • 105. Sadhya-AsadhyataSadhya-Asadhyata It is essential to know the Sadhyasadhyata of a disease before the treatment.Acharya charaka stated that “A physician who can distinguish between curable andincurable diseases and initiate the treatment with full knowledge regarding thedifferent aspect of the therapeutics can certainly accomplish his object of curing thedisease”262. The Sadhyata-asadhyata or prognosis of a disease depends on many factorssuch as the Bala of Nidana or Hetu, the strength of Dosha Prakopa, the Sthana of thedisease, severity of signs and symptoms, duration of the disease etc. It also dependsupon the age, sex, rogamarga, dhatudushti etc263. In Yogaratnakara Acharya explained that, in general Vatavyadhi’s areAsadhya in nature, but it can be get cured by the grays of God. So it should be treatedwithout giving any assurance. Generally, Vatavyadhis are very difficult to cure due to the deep seated natureof them. Sandhigatavata usually occurs in the vardhakya kala, the kala, which ispredominant of Vata. Acharya Sushruta considered Vatavyadhi as one among Astamahagada andexplained that, these are difficult to cure by its swabhava264. Charaka had mentioned some Vatavyadhi’s, which are either not curable dueto sthana gambheerata or curable with effort in case they are of recent origin, in strongpatients and if without any complications. In the list of Kashtasadhya Vata Vikara,Acharya Caraka does not mention Sandhigatavata but while commenting on word‘Khuddavata’ Cakrapani explains the meaning of Khuddavata as Gulphavata or 87
  • 106. Sadhya-AsadhyataSandhi-Gata-Vata. Thus Sandhigatavata can be considered as Kashtasadhya VataVyadhi265. The ailments of aged persons are Kashtasadhya and Sandhigatavata is theaffliction of elderly persons. Diseases situated in Marma and Madhyama Rogamargais Kashtasadhya. Sandhigatavata is a disease of Sandhi, which falls under MadhyamaRogamarga. Further Vata Vyadhi occurring due to vitiation of Asthi and Majja aremost difficult to cure. 88
  • 107. ChikitsaChikitsa: The term “Chikitsa” is derived from the Sanskrit root “ÌMüiÉç – UÉåaÉÉmÉlÉrÉlÉå” whichmeans removing the factors and tendencies related to illness. It is defined as “ÂMçümÉëÌiÉÌ¢ürÉÉ266. In brief, the process by which the disease is cured is called as Chikitsa.The main aim of Chikitsa is to restore the Swasthya by irradiation of disease. Theprimary aim of Chikitsa is Samprapti Vighatana. Ayurveda advocates two-foldapproach to cure i.e. Samshodana (Bio-purification) and Shamana (Palliation). The measures included under Shamana are palliative in nature. As Shamanawill only pacify the deranged doshas and will not eliminate the morbid factors fromthe body, there may be an aggravation in future. The Samshodana therapy is a uniqueconcept. It envisages not only the visceral cleaning rather it aims at the total bio-purification upto molecular level. Shodhan mainly includes Panchashodhana’s like Vamana,Virechana, BastiNasya, Rakthamookshana therapies along with Purvakarma like Depana-Pachana,Snehana and Swedana. The specific line of treatment of Sandhigatavata is first described by AcharyaSushruta267. Later Vagbhata, Yogaratnakara, Bhavamishra also explained specific lineof treatment. As Sandhigatavata is a Vataja disorder, general treatments of VataVyadhi can be adopted and also vataupakramas268. Acharya Charaka not mentionedspecific line of treatment for Sandhigata vata. 89
  • 108. ChikitsaTable 28: Showing Chikitsa modalities as mentioned in different classics:Treatment S.S269 A.S270 A.H.271 Y.R272 B.P273 B.R274Snehana + - + + + +Abhyanga - + - - - -Mardana + + - + - +Swedana - + - + + -Upanaha + + + + + +Bandhana + + - - - +Agnikarma + + + - - +1) Snehana: In simple terms Snehana chikitsa means imparting softness and greasiness tothe body through administration of fatty substances like Taila, Ghrita, Vasaa, Majja.The administration of Snehana is an important treatment for Vata disorders. It is oneamong Shadupakramas275. In Sandhigata vata as explained in samprapti, vitiated vatawill resides in Asti sandhis, so as to pacify vitiated vata and also to add sneha amshawhich underwent kshaya, snehana can be adopted. According to the use it can beadministered in two ways1) Abhyantara Prayoga2) Bahya PrayogaAbhyantara Sneha: Here Sneha used in the form of Pana, Bhojana, Vasti and NasyaBahya Sneha: Bahya Snehas mainly Abhyanga, Lepa, Padaghata, Pichu, Mardana, andParisheka etc In context of Sandhigatavata Acharyas mentioned Abhyanga and Mardana. 90
  • 109. Chikitsa Abhyanga is a process by which the person’s body is oleated with medicatedoil with specific movement and pressure. For the purpose of Abhyanga SukhoshnaSneha is used. Abhyanga should be done slowly in Anuloma Gati and in joints itshould be done in circular manner. In sandhigata vata Abhyanga should be done for900 matra kala (about 10 minutes) because the Veerya of sneha will reach Asti andMajja Dhatu in 800 and 900 Matra-Kalas respectively276. Abhyanga is Vatahara,Dhatu Pushtikara, Bala prada277, 278.2) Upanaha: Both Sushruta and Charaka consider Upanaha as a variety of Swedana279, 280.This is of two types: 1) Saagni 2) Niragni. Saagni upanaha is nothing but Sankara sweda. Niragni upanaha is the coveringof Vatahara dravyas and tying over the affected body part. The drugs like Godhuma churna, Yava etc pasted by mixing with Kanji,Sneha, Lavana. After making this lukewarm, it should be applied to the affected part.Sugandhi dravyas, Surasadi dravyas are also used for Upanaha281. The paste of drugsincluded in the Kakolyadi or Eladi or Surasadi gana as well as pastes of Sarshapa orTila or Atasi or Krishara or Paayasa or Utkarika or Vesavara or the drugs of SalvanaSweda are also used for Upanaha. This is applied to the affected part folded in pieceof thin linen and tied up282. For the purpose of Bandhana, leather of Ushna Veerya animal can be used. Inthe absence of this, silk or woolen cloth can be used283. Acharya Vagbhata opines thatvatahara patras like Eranda patra also can be used for Upanaha284. 91
  • 110. ChikitsaDuration: Upanaha, which is tied in the morning, should be removed in the night andwhich is tied in the night should be removed in the morning285.3) Agnikarma: Unique treatment indicated in case of Sandhigatavata. Here Dahana isdone at the tender points of the part affected. Sushruta states that in the vitiation ofVata in twak, mamsa, sira, snayu and sandhi Agnikarma provides good relief. Dahanakarma is a synonym of Agnikarma286.4) Bandhana: For the purpose of Bandhana, Charaka opines that leather of UshnaVeerya animal can be used. In the absence of this silk or woolen cloth can be used287.Astanga Hridayakara opines that Vatahara Patras should be used288.5) Unmardana: Massage with certain pressure and strokes on the body are known asUnmardana. This is a massage technique comes under bahya snehana procedures.6) Swedana: Swedana is the procedure by which perspiration of the body will be produced.It removes Sthabdata, Gauravata, and Sheetata. Swedana is also explained underShadvidhopakrama289. In case of Sandhigatavata varieties of Svedanakrama likeUpanaha and Bandhana are indicated. Apart from these, the Basti karma should also be adopted, as it is the paramaoushadha for Vata. 92
  • 111. OsteoarthritisPathya- Apathya: Those Aharadi Dravyas, which are beneficial to Srotas and have no adverseeffect on body and mind, are termed as Pathya290. Pathya is a major pillar supportingthe line of treatment of any disease; separately Pathya and Apathya of Sandhigatavataare not described. Hence Pathya and Apathya of Vata Vyadhi in general can beapplied for patients of Sandhigatavata.Pathya291:Table No. 29: Showing the Pathyas of Sandhigatavata: Ahara 1 Rasas Madhura-amla-lavana 2 Shukadhanya Nava godhuma, Nava shali, Rakta shali, Shashtika shali. 3 Shimbi varga Nava tila, Masha, Kulatha. 4 Shaka varga Patola, shigru, vartaka, lashuna. 5 Mamsa varga Ushtra, Go, Varaha, Mahisha, Magura, Bheka, Nakula,Chataka,Kukkuta, Tittira, Kurma. 6 Jala varga Ushnajala, Shrithasheetajala, Narikelajala. 7 Dugdhavarga Go, Aja, Dadhi, Gritha, Kilata, Kurchika. 8 Mutravaga Gomutra. 9 Madyavarga Dhanyamla, Sura. 10 Snehavarga Ghrita, Tila, Vasa, Majja. 11 Present day Orange juice, carrot, all fibrous fruits and Vegetables. food stuffs Vihara 1 Veshtana, Trasana, Mardana, Snana, Bhushayya, 2 Present day & activities: Physiotherapy exercise, Yoga asana’s, Steam bath 93
  • 112. OsteoarthritisApathya292:Table No. 30: Showing the Apathyas of Sandhigatavata: Ahara 1 Rasas Katu, Tikta, Kashaya. 2 Shukadhanya Truna, Kangu, Koradusha, Neevara, Syamaka. 3 Shimbi varga Rajamasha, Nishpava, Mudga, Kalaya 4 Phalavarga Jambu, Udumbura, Kramuka, Tinduka. 5 Mamsa varga Sushka mamsa, Kapota, Paravata 6 Jala varga Sheetajala. 7 Dugdhavarga Gardabha. 8 Present day food Fast food: Pizza, Burger, Gobimanchuri, cold stuffs beverages, liquor. Vihara 1 Manasika: Chinta, Shoka, Bhaya. 2 Present day Long standing sitting, driving, staying in AC etc activities: 94
  • 113. OsteoarthritisOsteoarthritis: Pathologically, Osteoarthritis is defined as a condition of synovial jointscharacterized by focal loss of articular cartilage and simultaneously proliferation ofnew bone with remodelling of joint counter. Inflammation is not a prominent feature.Osteoarthritis, however, is not a disease or a single condition. It is best viewed as adynamic repair process of synovial joints that may be triggered by a variety of insults,some but not all of which result in symptomatic ‘joint failure’293. Osteoarthritis is byfar the most common form of arthritis. It shows a strong association with ageing andis a major cause of pain and disability in the elderly.Terminology of Osteoarthritis294: The term Osteoarthritis was coined by “John Spendon”. The Osteoarthritis,Osteoarthrosis, Degenerative joint disease and Hypertrophic arthritis are generallyused to describe Sandhigatavata. Osteoarthritis is less ideal since the primary event isnot inflammatory, although secondary synovitis is usually present. Osteoarthrosis isperhaps the best because the inflammation is secondary and the suffix denotes anincrease and an invasion, physiologic or pathologic, or a general over production.Degenerative joint disease is unsuitable, since degenerative implies aging, a runningdown, deterioration, a catabolic process; in fact for long periods, often years, thedisease may not be clinically progressive. Hypertrophic arthritis now completely outof style, describes one phase the osteophytosis or overgrowth of bone. It is a degenerative “Wear and Tear” process occurring in joints that areimpaired by congenital defect, vascular insufficiency, or previous disease or injury. Itis characterized by focal loss of cartilage with evidence of accompanying periarticularbone response in the form of subchondral bone sclerosis and attempted new boneformation in the form of bony over growths called osteophytes. 95
  • 114. OsteoarthritisEtymology: The word “Osteoarthritis” is a combination of three words. “Osteon” “arthron”and “itis” respectively meaning bone, joint and inflammation.Epidemiology: According to W.H.O. Osteoarthritis is the second commonest musculoskeletalproblem in the world population (30%) after back pain (50%).The reported prevalenceof O.A from a study in rural India is (5.78%)Risk factors for Osteoarthritis295:Age 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 theage of 60 years, almost everyone has OA. More than 80% of people over 60 years oldhave radiological evidence of OA in one or both knees and 30% in one or both hips.Sex factor: It is told that women are about twice as likely as men to have O.A .The patternof joint involvement also differs with gender, with women having a greater number ofjoints involved and more frequent complaints of Morning stiffness, Joint swelling,and Nocturnal pain. Before age 45 years, however, the disease prevalence is lower than in men,with marked increase in prevalence occurring after 55 years of age. Particularly in theknee joint. These gender differences in O.A incidence were first recognized over 150years ago and were thought to be linked to Post- Menopausal estrogen deficiency.Hereditary factor296: Osteoarthritis also appears to have a genetic component. There is significantlyhigher concordance of O.A in the all joint areas among monozygotic twins than 96
  • 115. Osteoarthritisamong Dizygotic twins. Segretion analysis of population data suggests that O.A ispolygenic disorder but the identity of the genes involved remains unknown. Studies ofrare familial form of O.A suggest that an Autosomal dominant mutation in Type - IIcollagen may be an important. Point mutation in the cDNA coding for articular cartilage collagen have beenidentified in families with chondrodysplasia and polyarticular osteoarthritis.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 knee OA inthe ensuing 36 years was 1.5 for men and 2.1 for women. For severe knee OA, therelative risk rose to 1.9 for men and 3.9 for women, suggesting that obesity plays aneven larger role in the etiology of the most serious cases of knee OA.Occupational 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. It disturbs thealignment of the joints and over a period of time, this misalignment may lead toexcessive wear and tear leading to OA.Repetitive stress: Abnormal posture, abnormal gait, and unequal length of leg will exert stressand strain over the joint. 97
  • 116. OsteoarthritisEndocrine disorders: Acromegaly, Hyperparathyroidism, Diabetes mellitus, Obesity, etc. may leadto osteoarthritis.Metabolic disorders: Like Ochronosis, Wilson’s disease may give rise to osteoarthritis.Calcium deposition diseases: Like CPPD deposition may lead to osteoarthritis.Classification based on causes:1) Primary Osteoarthritis: Predisposing factores are- Genetic, Metabolic disorders,age, Ideopathic avascular necrosis, endocrinal factores and obesity2) Secondary Osteoarthritis: usually caused by local factors like – Trauma,Incongruity, Mal-alignment, Inadequate blood supply, Infections of the joint, diseasesinterfering nerve supply of the joint, Inflammatory diseases, Neutritional bonediseases like Rickets, Osteomalacia. (Das)Commonly effecting area of Osteo arthritis:Figure No. 11: Showing the Commonly effecting area of Osteo arthritis: 98
  • 117. Osteoarthritis Osteoarthritis most often occurs in the hands (at the ends of the fingers andthumbs), spine (neck and lower back), knees, and hips.Pathology297: The pathology of OA provides evidence of the panarticular involvement ofdisease. Cartilage initially shows surface fibrillation and irregularity. As diseaseprogresses, focal erosions develop there, and these eventually extend down to thesubjacent bone. With further progression, cartilage erosion down to bone expands toinvolve a larger proportion of the joint surface, even though OA remains a focaldisease with nonuniform loss of cartilage After an injury to cartilage, chondrocytes undergo mitosis and clustering.While the metabolic activity of these chondrocyte clusters is high, the net effect ofthis activity is to promote proteoglycan depletion in the matrix surrounding thechondrocytes. This is because the catabolic activity is greater than the synthetic. Asdisease develops, collagen matrix becomes damaged, the negative charges ofproteoglycans get exposed, and cartilage swells from ionic attraction to watermolecules. Because in damaged cartilage proteoglycans are no longer forced intoclose proximity, cartilage does not bounce back after loading as it did when healthy,and cartilage becomes vulnerable to further injury. Chondrocytes at the basal level ofcartilage undergo apoptosis. With loss of cartilage come alterations in subchondral bone. Stimulated bygrowth factors and cytokines, osteoclasts and osteoblasts in the subchondral bonyplate, just underneath cartilage, become activated. Bone formation produces athickening and stiffness of the subchondral plate that occurs even before cartilage 99
  • 118. Osteoarthritisulcerates. Trauma to bone during joint loading may be the primary factor driving thisbone response, with healing from injury (including microcracks) producing stiffness.Small areas of osteonecrosis usually exist in joints with advanced disease. Bone deathmay also be caused by bone trauma with shearing of microvasculature, leading to acutoff of vascular supply to some bone areas. At the margin of the joint, near areas of cartilage loss, osteophytes form. Thesestarts as outgrowths of new cartilage and, with neurovascular invasion from the bone,this cartilage ossifies. Osteophytes are an important radiographic hallmark of OA. Inmalaligned joints, osteophytes grow larger on the side of the joint subject to mostloading stress (e.g., in varus knees, osteophytes grow larger on the medial side). The synovium produces lubricating fluids that minimize shear stress duringmotion. In healthy joints, the synovium consists of a single discontinuous layer filledwith fat and containing two types of cells, macrophages and fibroblasts, but, in OA, itcan sometimes become edematous and inflamed. There is a migration of macrophagesfrom the periphery into the tissue, and cells lining the synovium proliferate. Enzymessecreted by the synovium digest cartilage matrix that has been sheared from thesurface of the cartilage. Additional pathologic changes occur in the capsule, which stretches, becomesedematous, and can become fibrotic. The pathology of OA is not identical across joints. In hand joints with severeOA, for example, there are often cartilage erosions in the center of the joint probablyproduced by bony pressure from the opposite side of the joint. Bone remodeling is aprominent feature of hand OA, in part because of the thin cartilage in each hand joint. 100
  • 119. OsteoarthritisIn hand OA, pathology has also been noted in ligament site insertions, which mayhelp propagate disease. Basic calcium phosphate and calcium pyrophosphate dihydrate crystals arepresent microscopically in most joints with end-stage OA. Their role in osteoarthriticcartilage is unclear, but their release from cartilage into the joint space and joint fluidlikely triggers synovial inflammation, which can, in turn, produce release of enzymesand trigger nociceptive stimulation.Sources of Pain298: Because cartilage is aneural, cartilage loss in a joint is not accompanied bypain. Thus, pain in OA likely arises from structures outside the cartilage. Innervatedstructures in the joint include the synovium, ligaments, joint capsule, muscles, andsubchondral bone. Most of these are not visualized by the x-ray, and the severity of x-ray changes in OA correlates poorly with pain severity. Based on MRI studies in osteoarthritic knees comparing those with andwithout pain and on studies mapping tenderness in unanesthetized joints, likelysources of pain include synovial inflammation, joint effusions, and bone marrowedema. Modest synovitis develops in many but not all osteoarthritic joints. Somediseased joints have no synovitis, whereas others have synovial inflammation thatapproaches the severity of joints with rheumatoid arthritis (Chap. 314). The presenceof synovitis on MRI is correlated with the presence and severity of knee pain.Capsular stretching from fluid in the joint stimulates nociceptive fibers there, inducingpain. Increased focal loading as part of the disease not only damages cartilage butprobably also injures the underlying bone. As a consequence, bone marrow edema 101
  • 120. Osteoarthritisappears on the MRI; histologically, this edema may signal the presence ofmicrocracks and scar, which are the consequences of trauma. These lesions maystimulate bone nociceptive fibers. Also, hemostatic pressure within bone rises in OA,and the increased pressure itself may stimulate nociceptive fibers, causing pain.Lastly, osteophytes themselves may be a source of pain. When osteophytes grow,neurovascular innervation penetrates through the base of the bone into the cartilageand into the developing osteophyte. Pain may arise from outside the joint also, including bursae near the joints.Common sources of pain near the knee are anserine bursitis and iliotibial bandsyndrome.Degeneration & O.A: OA is caused by the degeneration of the articular cartilage in the jointsinvolved. In the regions involved, the cartilaginous matrix and the chondrocytes swell. The proteoglycans in these regions are smaller than the normal. Theproportion of chondrotin sulfate falls and the proportion of keratin sulfate rises. Thechange in the character of the proteoglycans exposes the collagen fibers in thecartilage. Poorly formed type I collagen tends to replace the type II collagen normal inthe cartilage. In the degenerating regions, small fissures develop in the cartilage. Thefissures separate irregular brands of cartilage that project perpendicular to the articularsurface, a change called fibrillation. Clumps of chondrocytes are often present nearthe clefts. As years pass, much or all of the articular cartilage is slowly worn away.Eventually, only irregular patches of articular cartilage remain on the articularsurfaces of the bones. 102
  • 121. Osteoarthritis Weight man has shown that the ability of the articular cartilage to withstandfatigue testing diminishes progressively with age. Because OA is most common inaging patients, it is often proposed that the disease is an intrinsic part of the agingprocess. The wear and tear theory assumes a decreasing capacity with the age ofarticular cartilage to resist mechanical stress.Figure No.12: Showing Osteoarthritis of Knee:Natural History: The course of O.A is highly variable with radiological progression seen inone-third to two-third of patients. Improvements are rare, symptoms may progress,improve or may even be arrested spontaneously and do not correlate well withradiographic progression. Patients with multiple affected joints have more rapidprogression of O.A. Advanced age and obesity is also associated with a more rapidprogression of O.A. 103
  • 122. OsteoarthritisExamination of Kneejoint:History: The common symptoms with which a patient generally presents are pain,swelling, stiffness, mechanical disorders (e.g. Locking, giving way, click etc.) andlimp.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. • Swelling The limits of the swelling were clearly made out. The gradings were allotted on the basis of criteria explained in the end of this section. Observed for any discolouration over swelling • Any deformities like genus valgum, varum etc. were examined. • Joint instability or buckling of the joint was examined. • Any abnormalities in the gait were examined. • Walking time was recorded (the time taken to cover 21 metres). • Any presence of muscular spasm was examined. • Muscular wasting above and below the joint was examined. 104
  • 123. OsteoarthritisPalpation: • Local temperature was examined with the back of the hand and compared to that of the other side. • Local tenderness was also examined. • Swelling The swelling over knee joint may be because of “Effusion”, caused by excess synovial fluid, blood or occasionally puss. Several techniques are used for detection of effusion. The commonly used techniques are, Visible Fluid Wave- Patient is kept in supine position with knee relaxed and extended. After inspection if mild effusion is suspected, the hollow on both sides of the knee is pressed with thumb on one side and the index and long finger on the other side. Then removed the hand and quickly compressed the suprapatellar pouch with palm and finger of other hand. This forces the fluid back to the hollow space, resulting in visible fluid wave. This test is not useful in the obese patients because the adipose tissue hides the normal hollow even when no effusion is present. Palpable Fluid Wave- This technique is used if slightly larger effusion is present, because the fluid returns hollow space too quickly and can’t identify. Here the hollows of both side of knee joint are compressed with thumb in one side and index and long finger in other side. Then the suprapatellar pouch is squeezed firmly with other hand by keeping first hand in position. The waves of fluid are felt in fingers kept in hollows of knee if effusion is present. 105
  • 124. Osteoarthritis 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. • 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 and extension.Minor degrees of abduction, adduction and rotations may be permitted when the jointis partly flexed. Both active and passive movements were examined. • 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. 106
  • 125. Osteoarthritis • 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 wasplaced over the patella and crepitus was felt. In some cases the crepitation can beheard. Which is assed by giving grades as explained below.Clinical feature:Symptoms:Joint 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.Stiffness: Progressive stiffness of the involved joint upon arising in the morning or aftera period of inactivity may be prominent but usually lasts less than 20 minutes. It is due to spasm of muscles. There is no relation between the severity ofdegeneration and morning stiffness.Signs:Swelling: Physical examination of the osteoarthritis joint reveals localized soft tissueswelling of mild degree. It is due to the changes in articular ends themselves,particularly periarticular lipping.Crepitus: The sensation of bone rubbing against bone evoked by joint movement iscalled as crepitus. It is one of the characteristic sign of osteoarthritis joint. 107
  • 126. Osteoarthritis Local Warmth ness: On palpation of the joint, the local rise in temperature is indicative sign of inflammation. Muscle Atrophy: Periarticular muscle atrophy may be due to disuse or due to reflex inhibition of muscle contraction. Others: In advanced stage there may be gross deformity, bony hypertrophy, subluxation and marked loss of joint motion Table No. 31: Showing Clinical features of Osteoarthritis:Sl. Symptoms of O.A Signs of O.ANo1. No Systemic manifestation Joints, enlarged synovium and capsule synovial fluid and bony cartilage2. Pain on use, pain at rest in severe and Tenderness at local joints, crepitus, creaking, advanced condition grating, cracking.3. Localized stiffness 15-30 minutes in Warmth without redness o joints. morning4. Muscle spasm Joint effusion of normal or high viscosity fluid.5. Limitation of motion in advancing Deformity of joints with preservation of function disease symptoms uncommon before with exception of hip joint and first age 40 except in secondary O.A Pain carpometacarpal joint. Sometimes episodic related to specific joints course e.g. primary generalized O.A6. Joints most commonly involved: Soft synovial proliferation without bony Distal interpalangeal joints proliferation are: Proximal interphalangeal joints Genu varus and valgus First carpometatarsal joint Hallux valgus Scaphotrapezoid joints Herbedens and bouchar,s nodes and first Knees, Hips often unilateral carpometacarpal enlargement. Spine, Cervical, and Lumbar Rare involvement: First metatarsophalangeal joint Elbows,Shoulder, Metacarpophalangeal, Lateralmetatarsophalangeal, proximal interphalangeal and joints of feet, ankle, Subtalar, Midtarsal, Thoracic spine 108
  • 127. Osteoarthritis Diagnosis of OA is made accurately by clinical history, physical examinationradiological study, and when etiology and pathogenesis are not clear, by certainlaboratory examinations. The symptoms and signs are usually confined to one or onlya few joints. If many joints are involved, the diagnosis is more likely a systemic formof rheumatic disease.Radiological characteristics of Osteoarthritis: Normal radiographic findings occur in early OA. Joint space narrowing followsdegeneration and disappearance of hyaline cartilage. Early in the disease with effusionand swelling of cartilage, there may be joint space widening. Subchondral bonysclerosis or eburnation is very characteristic and represents deposition of excessivenew bone. Marginal osteophytes in a variety of patterns in various joints reflect bone,cartilage and synovial cell proliferation. Sub location and gross deformities with loosebodies in the joint appears late. Radiological criteria for diagnosis of osteoarthritis asdefined in the Atlas on standard radiographs are given below:Radiological Classification: GRADE: O Normal GRADE: 1 Partial Osteophytes GRADE: 2 Definite Osteophytes GRADE: 3 Moderate multiple Osteophytes GRADE: 4 Large Osteophytes 109
  • 128. OsteoarthritisFigure No. 13: Showing Radiological aspect of Osteoatrhritis: Loss of joint space: Due to destruction of articular cartilageLaboratory characteristics of Osteoarthritis: There are no specific laboratory abnormalities in primary OA. The synovialfluid is essentially normal, a few cells above normal counts, a slightly reducedviscosity or string test, a normal mucin clot and total protein concentration. An increased concentration of inorganic pyrophosphate (PPi) is found in OAand is positively correlated with the severity of radiologic OA. The application of thermography and scintillation scans of joints has little orno clinical usefulness but has shown negligible evidence of inflammation in OAcompared to the inflammatory arthropathies. Association of OA has also been noted with elevated Westergrensedimentation rate, elevated C-reactive protein, serum uric acid and ASO titers. In primary generalized OA, elevated serum cholesterol and transient rises inother acute phase reactants occur, Specific laboratory studies may be needed fordiagnosis of secondary OA associated with specific primary disease. 110
  • 129. OsteoarthritisTable No. 32: Showing Differential Diagnosis of Osteoarthritis: Sl. Criteria O.A RA Gout R.F 1 Symptom Pain& swelling on Inflammation Polyarticular Painful s major weight in multiple pain, and bearing joints, joints, swelling & tender stiffness, morning inflammatio joints crepitations, stiffness n, tenderness, >30ms exquisite enlargement of tenderness joint space 2 Mode of Gradual Abrupt Acute Acute On set 3 Joints Weight bearing Polyarticular Metatarso- Poly- Involved joints phalangeal articular joints 4 Systemic - Autoimmune - Carditis, Features disease, rise in fever, temperature, chorea anemia etc. 5 Pathologi Degeneration Autoimmune Hyper Infection cal and Vasculitis uricaemia phenome non 6 InvestigatRA-ve, ESR ESR raised, Serum uric ESR ions normal, X-ray- X-ray-soft acid raised, increased, narrowing of joint Tissue Punched out CRP space, subchondral swelling. lesions in high, bony sclerosis, subchondral WBC osteophytes etc. bone. elevated.Abbrevation used: O.A: Osteoarthritis, R.A: Rhemautic arthritis, R.F: RhemauticfeverThe WOMAC (Western Ontario and McMaster Universities) Index ofOsteoarthritis:299 The WOMAC (Westren Ontario and McMaster Universities) index is used toassess patients with osteoarthritis of the hip or knee using 24 parameters. It can beused to monitor the course of the disease or to determine the effectiveness of anti-rheumatic medications. 111
  • 130. OsteoarthritisObjectives: ™ The WOMAC Index is a disease-specific, tri-dimensional self-administeredquestionnaire, for assessing health status and health outcomes in osteoarthritis of theknee and/or hip.Target population: Patients with hip and/or knee osteoarthritis.Method of use: The questionnaire contains 24 questions, targeting areas of pain, stiffness andphysical function, and can be completed in less than 5 minutes. Usually patient self-administered, the Index is amenable to electronic data capture (EDC) formats usingmouse-driven curser, touch screen, and to interview administration by telephone.Available in over 60 alternative language forms, there are several different forms of ™the WOMAC Index suitable for different clinical practical and clinical researchapplications. Available in 5-point adjectival, 100 mm visual analogue and 11-pointnumerical rating scale format.Pain:(1) Walking(2) Stair climbing(3) Nocturnal(4) Rest(5) Weight bearing 112
  • 131. OsteoarthritisStiffness:(1) Morning stiffness(2) Stiffness occurring later in the dayPhysical function:(1) Descending stairs(2) Ascending stairs(3) Rising from sitting(4) Standing(5) Bending to floor(6) Walking on flat(7) Getting in or out of car(8) Going shopping(9) Putting on socks(10) Rising from bed(11) Taking off socks(12) Lying in bed(13) Sitting(14)In/outbath(15) Getting on or off toilet(16) Heavy domestic duties(17) Light domestic duties 113
  • 132. OsteoarthritisWhile the index was being developed performance of social functions and the statusof emotional function were also included. These were not included in the finalinstrument.Social function:(1) Leisure activities(2) Community events(3) Church attendance(4) With spouse(5) With family(6) With friends(7) With othersEmotional function:(1) Anxiety(2) Irritability(3) Frustration(4) Depression(5) Relaxation(6) Insomnia(7) Boredom(8) Loneliness(9) Stress(10) Well-being 114
  • 133. OsteoarthritisScoring and Interpretation:Table 33: Showing Scoring and Interpretation 0f WOMACSI No Response Points01 None 002 Slight 103 Moderate 204 Severe 305 Extreme 4Alternatively a visual analogue scale (VAS) may be used ranging from 0 to 10.Score = SUM (points for relevant items)Average score = (total score) / (number of items)Interpretation:• Minimum total score: 0• Maximum total score: 96• Minimum pain sub score: 0• Maximum pain sub score: 20• Minimum stiffness sub score: 0• Maximum stiffness sub score: 8• Minimum physical function sub score: 0• Maximum physical function sub score: 68 115
  • 134. OsteoarthritisManagement of Osteoarthritis: 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.Pharmacological Measures:I. 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 the management of osteoarthriticpain, pharmacological agents should be used as adjuncts to non-pharmacologicalmeasures, such as those described above, which are keystone of osteoarthritis.NSAIDs often decrease joint pain and improve mobility in osteoarthritis - on anaverage about 30% reduction in pain and 15% improvement in function.Intra articular injection of hyaluronic acid is being used for treatment of patients withknee osteoarthritis who have filed a program of non-pharmacological therapy andsimple analgesics. Capsaicin cream reduces joint pain and tenderness when applied topicallypatients with knee and hand osteoarthritis1) Simple analgesics: A large number of medicines are prescribed for relief of pain. The recognitionthat pain in OA is not necessarily due to inflammation has led to an increasedawareness of the role of simple analgesics in the treatment. 116
  • 135. OsteoarthritisThe ACR guidelines emphasize the use of acetaminophen (Tylenol) as the first linetreatment for OA.2) Opioid containing analgesics: Code line and propoxyphene can be used for short periods to treatexacerbations of pain.3) NSAIDS: Trials comparing simple analgesics and NSAIDs found that acetaminophenalong can control pain in a substantial number of patients with OA celecoxib, a cox-2inhibitor, and rofecoxib are recent advances among NSAIDs.4) Local analgesics: Among the local applications, capsaicin cream is used commonly.a) Intra articular cortico-steroid injections.b) Intra articular administration of hyaluronic acid like products.5) Agents used to treat Osteoarthritis: Acetaminophen, NSAIDS (Salicylates, Propionic acids, Acetic acid,Oxicams), Cyclo-oxgenase inhibitors, Irritants/Counter irritants, Hyaluronic acids andGlucocorticoids.II. Non-Pharmacological Measures:Reduction of Joint Loading:Osteoarthritis may be caused or aggravated by poor body mechanics. Correction ofpoor posture and a support for excessive lumbar lordosis can be helpful. Excessiveloading of the involved joint should be avoided; 117
  • 136. OsteoarthritisPatients with osteoarthritis of the knee or hip should be avoided prolonged standing,kneeling and squatting. Obese patients should be counseled to loose weight. In patients with medial compartment knee osteoarthritis, a wedged in sole maydecrease the pain. Complete immobilization of painful joint is rarely indicated. Inpatients with unilateral osteoarthritis of knee or hip, a cane, held in the contralateralhand, may reduce joint pain by reducing the joint contact force. Bilateral disease maynecessitate use of crutches or walker.Patient education: Patients with hip or knee osteoarthritis can participate safely in conditioningexercises to improve fitness and health with out increasing their joint pain or need foran analgesics or NSAIDsExercise: Regular physical activity plays a key role in self-care and wellness. Threetypes of exercise are important in osteoarthritis management. The first type,strengthening exercises, help keep or increase muscle strength. Strong muscles helpsupport and protect joints affected by arthritis. The second type, aerobic conditioningexercises, improve cardiovascular fitness, help control weight, and improve overallfunction. The third type, range-of-motion exercises, helps reduce stiffness andmaintain or increase proper joint movement and flexibility. 118
  • 137. OsteoarthritisFigure No.14: Showing Exercise for Osteoarthritis: 119
  • 138. OsteoarthritisFigure No. 15: Showing Exercise for Knee Osteoarthritis: Straight Leg Raises: Supine, Abduction, Adduction Knee Extension Hip Flexion Knee Flexion Calf Raises Squats Front Step-Ups Side Step-Ups Standing Terminal Knee Extensions Heel Slides 120
  • 139. OsteoarthritisAssistive devices: Many patients with OA of hips and knee are more comfortable; wearing shoeswith good shock-absorbing properties orthoses. The use of an appropriately selectedcane can reduce hip loading by 20-30%. Patients with specific physical disabilitiesmay benefit from physical and occupational therapy.Weight management: There is a longitudinal association between obesity and OA of knee in menand women. Therefore, primary preventive strategies may include measures to avoidweight gain, or to achiever weight loss in over weight patients.Supplements: Glucosamine sulphate and chondrotin sulfate.Surgery: Surgical procedures are of value in the management of OA. They may begrouped under 3 major categories.1) Procedures to correct mal alignment and eliminate abnormal joint stresses(osteotomies) not only may slow down disease progression but may-also bringhealthier articular cartilages into opposition and provide symptomatic relief.2) Debridement with removal of free bits of cartilage or large ecostoses may relievepain and locking and help in prevention of rapid and extensive cartilage degenerationin advanced disease.3) Arthroplasty or joint replacement may be required to reduce pain and improvefunction; at times arthrodesis is required to control pain, even though motion must besacrificed. 121
  • 140. MaterialsMaterials:The materials used for the study were1. Kethakyadi Taila (Sahasrayoga)2. Murchita Tila Taila Kethakyadi Taila is used for Matravasti and Murchita Tila Taila is used forAbhyanga as Purvakarma measure before administration of MatravastiDrug review:The ingredients of Kethakyadi Taila (Sahasrayoga)300: Kethaki Mula Bala Atibala Thushodaka Murchita Tila Taila The preparation was done in accordance with the Taila paka vidhi, dully addedwith the Moorchita taila. The properties of drugs are mentioned below. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 122 Sandhigata vata
  • 141. MaterialsTable 34: Showing Guna-Karma of Ingredient of Kethakyadi Taila: SI Drug Latin name Family Synonyms Rasa Guna Veerya Vipaka Doshakarma Karma Composition Parts No Used 01 Kethaki3 Pandanus Pandanaceae Kethaka, Tikta, Laghu, Ushna Katu Tridosha Vedana Flower Pushpa, 01 contains a odoratissimus, madhura, Snigda shamaka Sthapana, Mula Suchipushpa, volatile oil wild (linn) Katu Balya Krakachchada, Trunashunya 02 Bala Sida cordifolia Malvaceae Bala, Madhura Laghu, Sheeta Madhura Vata Pitta Vatahara, 0.085%- Mula, 302 Shamaka Alkaloids, Linn. Vaatyaalika, Snigda, Balya, Beeja Main Kharayashtika Picchila Vedana Alkaloid- Eqhedrine Sthapana, Also contains- Shotahara Steroids, Phytosterol, resin, mucins, and potassium nitrate. 03 Atibala Abutilon Malvaceae Atibala, Madhura Laghu, Sheeta Madhura Vata Pitta Vatahara, Leaves contain Mula, 303 Mucilage, indicum Linn. Kankatikaa Snigda, Shamaka Balya, Beeja Tanin, Picchila Vedana Carbolic acid, traces of Sthapana, Asparagin and Shotahara Ashes. Roots also contains Asparagin Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in Sandhigata vata 123
  • 142. Materials The base of Kethakyadi tala is Tila Taila. The properties of Tila304 are,Table 35: Showing Guna-Karma of Tila: S.No Tila 01 Latin name Sesamum indicum Linn. 02 Family Sesamum 03 Sanskrit Tila 04 Rasa Madhura 05 Anurasa Kashaya-Tikta 06 Guna Guru, Snigda 07 Veerya Ushna 08 Vipaka Madhura 09 Doshakarma Tridosha Shamaka 10 Composition Moisture – 4.1-6.5% (Beeja) Oil – 43-56.8% Protein – 16.6-26.4% Fibers – 2.9-8.6% Carbohydrate – 9.1-25.2% Minerals – 4.1-7.4% Calcium – 1.06-1.45% Phosphorus – 0.47-0.62% 11 Parts used Beeja, Taila Tila Taila Murchana: A total 35 liter of Moorchita tila taila was prepared in the department of Rasashastra and Bhaishajya kalpana, D.G.M.A.M.C. and H. Gadag. And taila paka was done according to Sharngdhara Samhita305. Importance of murchana: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 124 Sandhigata vata
  • 143. MaterialsTila taila Murchana procedure306: For the taila Murchana 1/16th part of Manjistha, 1/64th part of Haritaki,Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera,Nalika,Ketakipushpa,1 part of Tila taila, and 4 parts of jala was taken and done pakain mandagni till Taila paka siddhi lakshana. By murchana, Amadosha, durgandhata and ugrata of crude oil is removed; itimparts good smell and colour. Apart from these Sneha will get the qualities of thedrugs used for Murchana and also the veerya of the Sneha is enhanced.Kethakyadi Taila Preparation: The ingredient of Kethakyadi Taila- Kethaki mula, Balamula and Atibala mulawas collected in local area and cleaned properly. The Astavashesha kashaya isprepared from these drugs. The kalka of same drugs are prepared. Then Taila paka isdone by using drugs in following proportions,Murchita tila taila – 1 part (30 liters)Kashaya – 2 parts (60 liters)Tushodaka – 2 parts (60 liters)Kalka – ¼ part (7.5 kg)Materials or tools for therapeutic intervention: To administer Matra vasti: Vasti Syringe, Artery Forceps, Gloves, CottonSwab, Bowl, Nadisweda yantra, Oil for Abhyanga was used. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 125 Sandhigata vata
  • 144. MaterialsArohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 126 Sandhigata vata
  • 145. Observations and ResultsMETHODOLOGY:CLINICAL STUDY: It is said that, Research is the only way available to re-establish old factsthrough modern methodology307. Research means searching of knowledge which isforgotten or which is hidden in us under the cover of ignorance. Research is a scientific study through which one can establish new facts,discarding the old facts or modifying the present facts. Utmost care is taken indesigning the methodology for conducting this study. Clinical research involves theexperimentation of a drug/therapy on a selected population and recording thefeedback based on which postulations are made regarding the usefulness of thedrug/therapy in the disease.Research Approach: In the present study, the main objective is to “Evaluate the effect of Matravastiin Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana karma”.The efficacy was determined by finding out the difference between the base line dataof the parameters to the after follow-up data.Study Design: The study design set for the present study is ‘comparative clinical study’. Thestudy was done in two groups. In this Arohana krama matravasti group of patients arecompared with Sadharana krama matravsti group of patients. Demographic data anddisease-specific data are collected according to the case-record form given in theappendix.Reasons for selection of the study design: The aim of this study was to find out the effect of Matravasti inSandhigatavata with Kethakyadi taila in Arohana krama and Sadharana karma, to Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 127 Sandhigata vata
  • 146. Observations and Resultscompare their efficacy. Therefore, two groups were made and the results obtained inboth the individual groups were compared.Source of Data: Patient suffering from Sandhigatavata were selected from O.P.D and I.P.D. ofD.G.M.A.M.C & H., Gadag, duly following the Inclusion and Exclusion criteria.Sample size and Grouping: The sample size for the present study was 30 patients suffering fromSandhigathavata as per the selection criteria. Patients were randomly distributed toboth the groups of equal size. Group A - 15 patients received Arohana krama Matravasti Group B - 15 patients received Sadharana krama Matravasti.Selection Criteria:The cases were selected strictly as per the pre-set inclusion and exclusion criteria.Inclusion criteria: 1. Patients suffering from classical signs and symptoms of Sandhigatavata like shotha in sandhi, shoola in sandhi, atopa in sandhi. 2. Patient fit for Vasti karma (Vasti yogya) 3. Patient between age group of 30 to 70 yrs. 4. No discrimination of sex and chronicity.Exclusion criteria: 1. Patient below 30 yrs and above 70 yrs of age will be excluded. 2. Pregnant women. 3. Associated with any other severe systemic diseases like Diabetes, Hypertensions and Obesity etc. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 128 Sandhigata vata
  • 147. Observations and ResultsStudy duration:Group A (Arohana group): Arohana krama Matravasti – 09 days Follow up – 30 days Total study duration – 39 daysGroup B (Sadharana group): Sadharana karma Matravasti - 09 days Follow up - 30 days Total study duration - 39 daysPosology:Arohana Krama Matra vasti: Here Matra vasti is administered for nine days inincreasing order of the dose of Taila. First day started with 48ml (1pala). Daily 12ml(1/4th pala) was increased till 9th day i.e. 144 ml.Sadharana Krama Matra vasti: Here Matra vasti is administered in fixed dose of 72ml(1½ pala) for nine days.Data Collection: Patients were thoroughly examined both subjectively and objectively.Detailed history pertaining to the mode of onset, previous ailment, previous treatmenthistory, family history, habits, ashtavidha pareeksha and dashavidhapareeksha andphysical examination findings were noted. Routine investigations were done toexclude other pathologies. Radiological features were also investigated.Examination Of Kneejoint :History: The common symptoms with which a patient generally presents are pain,swelling, stiffness, mechanical disorders (e.g. Locking, giving way, click etc.) andlimp. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 129 Sandhigata vata
  • 148. Observations and ResultsInspection: • 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. • Swelling • The limits of the swelling were clearly made out. • The gradings were allotted on the basis of criteria explained in the end of this section. • Any deformities like genus valgum, varum etc. were examined. • Joint instability or buckling of the joint was examined. • Any abnormalities in the gait were examined. • Walking time was recorded (the time taken to cover 21 meters). • Any presence of muscular spasm was examined. • 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 • Fluctuation test was performed by pressing the suprapatellar pouch with one hand and feeling the impulse with the thumb and the fingers of the other hand placed on either side of the patella or the ligamentum patellae. • 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 Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 130 Sandhigata vata
  • 149. Observations and Results 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. • 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. • Patello-femoral and femoro-tibial components were palpated for any tenderness or irregularity.Movements: The movements permitted in the knee joint are mainly flexion and extension.Minor degrees of abduction, adduction and rotations may be permitted when the jointis partly flexed. Both active and passive movements were examined.Flexion & Extension: Normally, the knee can be flexed until the calf extended till thethigh and leg form a straight line.Abduction & adduction: These movements are virtually absent with knee straight, butslight 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 hipand knee are flexed to 90 degrees, some degree of rotation is possible. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 131 Sandhigata vata
  • 150. Observations and ResultsAuscultation: During active or passive movement, the palm of one hand was placed over thepatella and crepitus was felt.Treatment schedule In both group of patients, the matravasti is administered. The differencebetween the groups is, in the dose of the medicine only. The procedure ofadministration in general is devided into three stages in both group and is identical.Poorvakarma: The patients were instructed to come after taking light diet (neither ati Snigdhanor ati Ruksha) and after elimination of stool and urine. The patients were alsoadvised not to take diet more than 3/4th of routine quantity. The patients weresubjected to sthanika Mridu Abhyanga and Swedana prior to the administration ofMatravasti.Abhyanga: The Sthanika Abhyanga over abdomen, buttock for 10 minutes was doneby sukoshna Murchita taila.Swedana: After Snehana, the patients were subjected for Sthanika Mrudu Sweda withNadi Sweda by using leaves of Eranda, Chincha, Nirgundi and Shigru. Swedana wasdone on abdomen, buttocks for 10 minutes.Pradhanakarma: • After this Purvakarma the patient was advised to lie down on left lateral position without pillow on the Vasti table with left lower extremity straight and right lower extremity flexed at knee and hip joint. The patient was asked to keep his left hand below the head. • Anal region is anointed with small quantity of Kethakyadi taila taila. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 132 Sandhigata vata
  • 151. Observations and Results • Exact quantity of Kethakyadi taila (72ml in Sadharana krama group patients and 48-144ml in Arohana krama group patients) was taken in enema syringe. • The nozzle of Vasti syringe was oleated with Kethakyadi taila. • After removing the air from enema syringe, nozle was inserted into the anus of the patient up to the length of 4 inches. • The patient was asked to take deep breath and not to shake his body while introducing the catheter and the drug. The entry of Vayu inside the guda was avoided by leaving little amount of Taila in Vasti syringe.Pashchatkarma After the administration of Vasti, the patient was advised to lie in supineposition with hand and legs freely spread over the table. There after both legs wereraised and slightly flexed in knee joint few times and gently tapped over the hips.After 10 minutes patient was advised to get up from the table and take rest in his bedand also not to sleep. Vasti Pratyagamana Kala was noted in each case. The patient was asked to follow a pariharakala of 18days and was asked toreport on 27th day counting from the day the treatment schedule started. On the 27thday the final assessment readings were taken for the Statistical study.Methods of Assessment of Clinical Response: Subjective parameters and objective parameters were made out to assess theClinical response.Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana)and Sthamba (Morning stiffness)Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya,Walking time to cover 21meters of distance, WOMAC Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 133 Sandhigata vata
  • 152. Observations and ResultsPrasarana Aakunchanayoho savedana pravruthihi (Vedana): Grade 0 - No complaint Grade 1 - Reveals on enquiry (mild) Grade 2 - Complaints frequently when moves joints (moderate) Grade 3 - continues pain (Sevier)Atopa: Grade 0 - None Grade 1 - felt on clinical examination of joint. Grade 2 - Heard on clinical examination of jointSandhishothaha: Grade 0 - No complaint. Grade 1 - Slightly obvious. Grade 2 - Covers well over the bony prominence. Grade 3 - Much elevatedSthamba (Morning stiffness): Grade 0 - Absent Grade 1 - PresentSandigati Asamarthya: Grade 0 - Full range of Movement. Grade 1 - >75% and <full range. Grade 2 - 50-75% of the full range of joint motion. Grade 3 - Up to 50% of the full range of joint motion. Grade 4 - No movement. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 134 Sandhigata vata
  • 153. Observations and ResultsWalking time to cover 21meters of distance308: Grade 0 - up to 20sec. Grade 1 - 21-30 sec. Grade 2 - 31-40 sec. Grade 3 - 41-50 sec. Grade 4 - 51-60 sec.WOMAC: (Western Ontario and McMaster Universities) Index of Osteoarthritis:The questionnaire contains 24 questions, targeting areas of pain, stiffness and physicalfunction None - 0 Slight - 1 Moderate - 2 Severe - 3 Extreme - 4Interpretation:• Minimum total score: 0• Maximum total score: 96Overall Assessment Of Clinical Response: • Good Response : >75 % improvement in overall clinical parameters. • Moderate Response : 50-75% improvement in overall clinical parameters. • Poor Response: Up to 50% improvement in overall clinical parameters. • No Response : 0 % or No improvement in overall clinical parameters. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 135 Sandhigata vata
  • 154. Observations and ResultsArohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 136 Sandhigata vata
  • 155. Observations and ResultsObservation: All the patients were examined before and after the treatment according to thecase sheet format given in the appendix. Both the subjective and objective changeswere recorded. The observations were done in the following heading and are depicted in formand graphs are used where ever necessary; 1. Observation of demographic data. 2. Observation of the patient. 3. Observation of the disease. 4. Observation of the data related to the response of the patient. 5. Observation of the statistical out comes of the study. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 137 Sandhigata vata
  • 156. Observations and Results Observation of demographic data: Table No. 36: Showing the distribution of patient’s age group: Age group No of patients and percentage Group A Group B Total No. of patients % No. of patients % No. of patients % 31-40 00 00.00 01 6.66 01 03.33 41-50 02 13.33 02 13.33 04 13.33 51-60 07 46.66 05 33.33 12 40.00 61-70 06 40.00 07 46.66 13 43.33 Group A: Out of fifteen patients 02 (13.33%) were belonging to 41-50 age group, 07 (46.66%) was from 51-60 age group, 06 (40%) were 61-70 aged. Group B: Out of fifteen patients 01 (06.66%) fell under 31-40 age group, 02 (13.33%) were from 41-50 age group, 07(46.66%) were from 51-60 age group and 07 (46.66%) were from 61-70 age group. Overall: Out of thirty patients 01 (03.33%) were from 31-40 group, 04 (13.33%) from 41-50 age group, 12 (40.00%) from 51-60 group and 13 (43.33%) were from 61-70 group. Figure No. 19: Showing the distribution of patient’s age group:14 13 1212108 3 1- 4 0 7 7 4 1- 5 0 66 5 1- 6 0 5 6 1- 7 0 44 2 22 1 1 00 G ro up A G ro up B T o tal Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 138 Sandhigata vata
  • 157. Observations and Results Table No. 37: Showing the distribution of patients according to sex: Sex Group A no. and % Group B no. and % Group A and B no. and % Male 07 (46.66%) 07 (46.66%) 14 (46.66%) Female 08 (53.33%) 08 (53.33%) 16 (53.33%) Group A: Among 15 numbers of patients 07(46.66%) were males and 08 (53.33%) were females. Group B: Among 15 numbers of patients 07 (46.66%) were males and 08 (53.33%) were females. Overall: Distribution of sex was; male were14 (46.66%) and females were 16 (53.33%) in 30 patients. Figure No. 20: Showing the distribution of patient’s sex group: 1616 14141210 8 88 Male 7 7 Fem ale6420 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 139 Sandhigata vata
  • 158. Observations and Results Table No. 38: Showing distribution of patients by Religion: Religion Group A no. and % Group B no. and % Group A and B no. and % Hindu 11 (73.33%) 12 (80%) 23 (76.66%) Muslim 04 (26.66%) 03 (20%) 07 (23.33%) Christian 00 (00%) 00 (00%) 00 (00%) Others 00 (00%) 00 (00%) 00 (00%) Group A: Out of fifteen patients 11 (73.33%) were Hindus, 04 (26.66%) were Muslims and none were Christians and others Group B: Out of fifteen patients 12 (80%) were Hindus, 03 (20%) were Muslims. Overall: Among thirty number of patients, Hindus were 23 (76.66%), 07 (23.33%) were Muslims and none were from Christian and other category. Figure No.21: Showing distribution of patients by religion:25 232015 Hindu 12 11 Muslim10 Christian 7 Others5 4 3 0 0 0 0 0 00 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 140 Sandhigata vata
  • 159. Observations and ResultsTable No. 39: Showing distribution of patients by Economical status:Economical status Group A no. and % Group B no. and % Group A and B no. and %Poor 01 (06.66%) 03 (20.00%) 04 (13.33%)Lower Middle class 10 (66.66%) 06 (40.00%) 16 (53.33%)Upper Middle class 04 (26.66%) 06 (40.00%) 10 (33.33%)Rich 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients 01 (06.66%) were belonging to poor status, 10(66.66%) were of lower middle class, 4 (26.66%) were of upper middle class andnone were rich.Group B: Out of fifteen patients 03 (20.00%) were belonging to poor status, 06(40.00%) were of lower middle class, 06 (40.00%) were of upper middle class andnone were from rich statusOverall: Out of thirty patients 04 (13.33%) were poor, 16 (53.33%) were of lowermiddle class, 10 (33.33%) were of upper middle class and none were from rich statusFigure No.22: Showing distribution of patients by Economical status: 16161412 10 1010 Poor 8 L.Middle Class 6 6 U.Middle Class 6 4 4 Rich 4 3 2 1 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 141 Sandhigata vata
  • 160. Observations and Results Table No. 40: Showing distribution of patients by Occupation: Occupation Group A no. and % Group B no. and % Group A and B no. and % Labor 03 (20.00%) 05(33.33%) 08 (26.66%) Student 00 (00%) 00(00%) 00 (00%) Executive 01 (06.66%) 01 (06.66%) 02 (06.66%) Sedentary 11 (73.33%) 09 (60.00%) 20 (66.66%) Group A: Out of fifteen patients 3 (20.00%) were labors, none (00%) were students, 1 (6.6%) was executive and 11(73.33%) were sedentary by occupation. Group B: Out of fifteen patients 05 (33.3%) were labors, none (00%) were students, 1 (6.6%) was executive and 09 (60.00%) was of sedentary by occupation. Overall: Out of thirty patients 08 (26.66%) were labors, (00%) were students, 02 (6.66%) was executive and 20 (66.66%) were belonging to sedentary category. Figure No. 23: Showing distribution of patients by occupation:20 2018161412 Labor 1110 Student 9 8 8 Executive Sedentary 6 5 4 3 2 2 0 1 0 1 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 142 Sandhigata vata
  • 161. Observations and ResultsTable No. 41: Showing distribution of patients by Type of diet: Vegetarian MixedGroup A 05 (33.33%) 10 (66.66%)Group B 05 (33.33%) 10 (66.66%)Overall 10 (33.33%) 20(66.66%)Group A: Out of fifteen, 05 (33.33%) were vegetarians and 10 (66.66%) were mixeddietGroup B: Out of fifteen, 05 (33.33%) were vegetarians and 10 (66.66%) were mixeddietOverall: Out of thirty patients, 10 (33.33%) were vegetarians and 20 (66.66%) were ofmixed dietFigure No. 24: Showing distribution of patients by type of diet:20 201816141210 10 10 10 Vegetarian8 Mixed6 5 5420 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 143 Sandhigata vata
  • 162. Observations and ResultsTable No. 42: Showing distribution of patients by Marital Status: Un Married MarriedGroup A 00 (00%) 15 (100%)Group B 00 (00%) 15 (100%)Overall 00 (00%) 30 (100%)Group A: Out of fifteen, all were married.Group B: Out of fifteen, all were married and none were unmarriedOverall: Out of thirty patients, all were married.Figure No.25: Showing distribution of patients by Marital Status:30 30252015 15 15 UnMarried Married10 5 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 144 Sandhigata vata
  • 163. Observations and Results Observation of the patient: Table No. 43: Showing distribution of patients by Mode of Onset: Mode of Onset Group A no. and % Group B no. and % Group A and B no. and % Chronic 12 (80.00%) 11(73.33%) 23 (76.66%) Insidious 00 (00%) 00(00%) 00 (00%) Acute 02 (13.33%) 02 (13.33%) 04 (13.33%) Traumatic 01 (06.66%) 02 (13.33%) 03 (10.00%) Group A: Out of fifteen patients 12 (80.00%) were had Chronic onset, none (00%) were had Insidious onset, 02 (13.33%) were had Acute onset and 01(6.66%) were had Traumatic onset. Group B: Out of fifteen patients 11 (73.33%) were had Chronic onset, none (00%) were had Insidious onset, 02 (13.33%) were had Acute onset and 02(13.33%) were had Traumatic onset. Overall: Out of thirty patients 23 (76.66%) were had Chronic onset, none (00%) were had Insidious onset, 04 (13.33%) were had Acute onset and 03(10.00%) were had Traumatic onset. Figure No. 26: Showing distribution of patients by Mode of Onset:25 232015 Chronic 12 Insidious 1110 Acute Traumatic5 4 3 2 0 2 2 0 1 00 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 145 Sandhigata vata
  • 164. Observations and Results Table No. 44: Showing distribution of patients by Vihara (Nature of work): Vihara Group A no. and % Group B no. and % Group A and B no. and % Hard 08 (53.33%) 08(53.33%) 16 (53.33%) Moderate 07 (46.66%) 06(40.00%) 13 (43.33%) Sedentary 00 (00%) 01 (6.66%) 01(3.33%) Group A: Out of fifteen patients 8 (53.33%) were hard workers, 7 (46.66%) were moderate, none were Sedentary. Group B: Out of fifteen patients 8 (53.33%) were hard workers, 6 (40.00%) were moderate and 0ne (3.33%) sedentary. Overall: Out of thirty patients 16 (53.33%) were hard workers, 13 (43.33%) were moderate and one (3.33%) sedentary worker. Figure No. 27: Showing distribution of patients by Vihara (Nature of work):16 1614 131210 Hard 8 88 7 Moderate 66 Sedentary42 1 10 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 146 Sandhigata vata
  • 165. Observations and Results Table No. 45: Showing distribution of patients by Agni: Agni Group A no. and % Group B no. and % Group A and B no. and % Samagni 10(66.66%) 09(60.00%) 19 (63.33%) Mandagni 05(33.33%) 06(40.00%) 11 (36.66%) Teekshnagni 00 (00%) 00 (00%) 00 (00%) Vishamagni 00 (00%) 00 (00%) 00 (00%) Group A: Out of fifteen patients, 10(66.66%) were had Samagni, 05(33.33%) were had Mandagni, none had Teekshna and Vishamagni. Group B: Out of fifteen patients, 09(60.00%) were had Samagni, 06(40.00%) were had Mandagni, none had Teekshna and Vishamagni. Overall: Out of thirty patients, 19 (63.33%) were had Samagni, 11 (36.66%) were had Mandagni, none had Teekshna and Vishamagni. Figure No. 28: Showing distribution of patients by Agni:20 1918161412 Samagni10 10 Mandagni 9 8 Teekshnagni 6 6 6 5 Vishamagni 4 2 0 0 0 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 147 Sandhigata vata
  • 166. Observations and Results Table No.46: Showing distribution of patients by Kosta: Kosta Group A no. and % Group B no. and % Group A and B no. and % Mrudu 00(00%) 00(00%) 00(00%) Madyama 14(93.33%) 10(66.66%) 24 (80.00%) Krura 01 (6.66%) 05(33.33%) 06(20%) Group A: Out of fifteen patients none were had Mrudu kosta, 14(93.33%) were had Madyama kosta and one (6.66%) had Krura kosta. Group B: Out of fifteen patients none were had Mrudu kosta, 10(66.66%) were had Madyama kosta and 05(33.33%) had Krura kosta. Overall: Out of thirty patients none were had Mrudu kosta, 24 (80.00%) were had Madyama kosta and 06(20%) had Krura kosta. Figure No. 29: Showing distribution of patients by Kosta:25 242015 14 Mrudu10 10 Madyama Krura 6 55 1 0 0 00 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 148 Sandhigata vata
  • 167. Observations and Results Table 47: Showing distribution of patients by Nidra: Nidra Group A no. and % Group B no. and % Group A and B no. and % Prakruta 05 (33.33%) 06 (40.00%) 11 (36.66%) Alpa 10 (66.66%) 09 (60.00%) 19 (63.33%) Ati 00 (00%) 00 (00%) 00 (00%) Divaswapna 00 (00%) 00 (00%) 00 (00%) Group A: Out of fifteen patients 05 (33.33%) were had Prakruta nidra, 10 (66.66%) were complained that, they had Alpa nidra, none were had Ati nidra and habit of Diwaswapna. Group B: Out of fifteen patients 06 (40.00%) were had Prakruta nidra, 09 (60.00%) were complained that, they had Alpa nidra, none were had Ati nidra and habit of Diwaswapna. Overall: Out of thirty patients 11 (36.66%) were had Prakruta nidra, 19 (63.33%) were complained Alpa nidrata, none were had Ati nidra and habit of Diwaswapna. Figure No. 30: Showing distribution of patients by Nidra: 192018161412 10 11 Prakruta 910 Alpa 8 Ati 6 6 5 Divaswapna 4 2 0 0 0 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 149 Sandhigata vata
  • 168. Observations and ResultsTable No. 48: Showing distribution of patients by Vyasana: Nidra Group A no. and % Group B no. and % Group A and B no. and %None 11 (73.33%) 08 (53.33%) 19(63.33%)Tobacco 02 (13.33%) 03 (20.00%) 05 (16.66%)Smoking 02 (13.33%) 02 (13.33%) 04 (13.33%)Alcohal 00 (00%) 02 (13.33%) 02 (6.66%)Tea/Coffee 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients, 11 (73.33%) were not had any Vyasana, 02(13.33%) were had the habit of Tobacco chewing, 02 (13.33%) were had the habit ofSmoking, none were had habit of Alcohal intake and excess intake of Coffee/Tea.Group B: Out of fifteen patients, 08 (53.33%) were not had any Vyasana, 03 (20.00%)were had the habit of Tobacco chewing, 02 (13.33%) were had the habit of Smoking,02 (13.33%) were had habit of Alcohal intake and no one had habit of excess intakeof Coffee/Tea.Overall: Out of thirty patients, 19(63.33%) were not had any Vyasana, 05 (16.66%)were had the habit of Tobacco chewing, 04 (13.33%) were had the habit of Smoking,02 (6.66%) were had habit of Alcohal intake and no one had habit of excess intake ofCoffee/Tea.Figure No. 31: Showing distribution of patients by Vyasana: 20 19 18 16 14 None 12 11 Tobacco 10 8 Smoking 8 5 Alcohal 6 3 4 Tea/Coffee 4 2 2 2 2 2 2 0 0 0 0 0 Group A Group B TotalTable No.49: Showing distribution of patients by Deha Prakruti: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 150 Sandhigata vata
  • 169. Observations and ResultsPrakruti Group A no. and % Group B no. and % Group A and B no. and %Vataja 00 (00%) 00 (00%) 00 (00%)Pittaja 00 (00%) 00 (00%) 00 (00%)Kaphaja 00 (00%) 00 (00%) 00 (00%)Vata Pittaja 05 (33.33%) 06 (40.00%) 11 (36.66%)Vata Kaphaja 10 (66.66%) 09 (60.00%) 19(63.33%)Pittakaphaja 00 (00%) 00 (00%) 00 (00%)Sama 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients, 05 (33.33%) patients of Vata–pittaja prakriti and 10(66.66%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,Kapha, Pitta–kaphaja, Sannipathaja (Sama) prakriti in this study.Group B: Out of fifteen patients, 06 (40.00%) patients of Vata–pittaja prakriti and 09(60.00%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,Kapha, Pitta–kaphaja, Sannipathaja (Sama) prakriti in this study.Overall: Out of therty patients, total 11 (36.66%) patients of Vata–pittaja prakriti and19(63.33%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,Kapha, Pitta–kaphaja, Sannipathaja (Sama) prakriti in this study.Figure No. 32: Showing distribution of patients by Deha Prakruti:20 191816 Vataja14 Pittaja12 11 10 Kaphaja10 9 8 Vata-Pittaja 6 6 5 Vata-Kaphaja 4 Pittakaphaja 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sama 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 151 Sandhigata vata
  • 170. Observations and Results Table No.50: Showing distribution of patients by Samhanana: Samhanana Group A no. and % Group B no. and % Group A and B no. and % Susamhita 07 (46.66%) 05 (33.33%) 12 (40.00%) Madyama Samhita 08 (53.33%) 10 (66.66%) 18 (60.00%) Hina Samhita 00 (00%) 00 (00%) 00 (00%) Group A: Out of fifteen patients 07 (46.66%) were had Susamhita shareera, 08 (53.33%) were had Madyama samhita shareera and none were had Hina samhita shareera. Group B: Out of fifteen patients 05 (33.33%) were had Susamhita shareera, 10 (66.66%) were had Madyama samhita shareera and none were had Hina samhita shareera. Overall: Out of thirty patients 12 (40.00%) were had Susamhita shareera, 18 (60.00%) were had Madyama samhita shareera and none were had Hina samhita shareera. Figure No. 33: Showing distribution of patients by Samhanana: 13181614 1612 1010 Susamhita 88 7 Madyama Samhita6 5 Hina samhita42 0 0 00 Group A Group B Total Table No.51: Showing distribution of patients by Satmya: Satmya Group A no. and % Group B no. and % Group A and B no. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 152 Sandhigata vata
  • 171. Observations and Results and % Ruksha 14 (93.33%) 15 (100%) 29 (96.66%) Snigda 01 (06.66%) 00 (00%) 01 (06.66%) Group A: Out of fifteen patients, 14 (93.33%) were had Ruksha satmya, only one (06.66%) had Snigda satmya. Group B: Out of fifteen patients, all (100%) were had Ruksha satmya. Overall: Out of fifteen patients, 29 (96.66%) were had Ruksha satmya, only one (06.66%) had Snigda satmya. Figure No.34: Showing distribution of patients by Satmya: 29302520 15 1415 Ruksha Satmya Snigda Satmya105 1 1 00 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 153 Sandhigata vata
  • 172. Observations and Results Table No. 52: Showing distribution of patients by Vyayama Shakti: Vyayama Shakti Group A no. and % Group B no. and % Group A and B no. and % Pravara 00 (00%) 00 (00%) 00 (00%) Madyama 01 (06.66%) 01 (06.66%) 02 (06.66%) Avara 14 (93.33%) 14 (93.33%) 28 (93.33%) Group A: Out of fifteen patients, none (00%) had Pravara Vyayama Shakti, only one (06.66%) had Madyama Vyayama Shakti and 14 (93.33%) were had Avara Vyayama Shakti. Group B: Out of fifteen patients, none (00%) had Pravara Vyayama Shakti, only one (06.66%) had Madyama Vyayama Shakti and 14 (93.33%) were had Avara Vyayama Shakti. Overall: Out of thirty patients, none (00%) had Pravara Vyayama Shakti, only two (06.66%) had Madyama Vyayama Shakti and 28 (93.33%) were had Avara Vyayama Shakti. Figure No. 35: Showing distribution of patients by Vyayama Shakti:30 282520 14 14 Pravara Vyayama Shakti15 Madyama Vyayama Shakti10 Avara Vyayama Shakti5 2 1 1 0 0 00 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 154 Sandhigata vata
  • 173. Observations and Results Table No. 53: Showing distribution of patients by Vaya: Vaya Group A no. and % Group B no. and % Group A and B no. and % Balya 00 (00%) 00 (00%) 00 (00%) Madyama 08 (53.33%) 09 (60.00%) 17 (56.66%) Vrudda 07 (46.66%) 06(40.00%) 13 (43.33%) Group A: Out of fifteen patients, none (00%) were of Balya Vaya, 08 (53.33%) were had Madyama Vaya and 07 (46.66%) were Vrudda. Group B: Out of fifteen patients, none (00%) were of Balya Vaya, 09 (60.00%) were had Madyama Vaya and 06(40.00%) were Vrudda. Overall: Out of thirty patients, none (00%) were of Balya Vaya, 17 (56.66%) were had Madyama Vaya and 13 (43.33%) were Vrudda. Figure No.36: Showing distribution of patients by Vaya: 17181614 1312 910 Balya 8 7 Madyama 8 6 Vrudda 6 4 2 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 155 Sandhigata vata
  • 174. Observations and Results Data Related to Disease: Table No.54: Showing distribution of patients by Joint Involvements: Joint Group A no. and % Group B no. and % Group A and B no. and % Right 05 (33.33%) 09 (60.00%) 14 (46.66%) Left 10 (66.66%) 06 (40.00%) 16 (53.33%) Group A: In the study, among the15 patients of knee involvement, 05 (33.33%) patients had Right Knee involvement and 10 (66.66%) patients had left Knee involvement. Group B: Out of fifteen patients of knee involvement, 09 (60.00%) patients had Right Knee involvement and 06 (40.00%) patients had left Knee involvement. Overall: Out of thirty patients of knee involvement, 14 (46.66%) patients had Right Knee involvement and 16 (53.33%) patients had left Knee involvement. Figure No. 37: Showing distribution of patients by Joint Involvements: 1616 141412 1010 98 Right 66 5 Left420 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 156 Sandhigata vata
  • 175. Observations and ResultsTable No. 55: Showing the distribution of patients by duration of the disease:Duration Group A no. and % Group B no. and % Group A and B no. and %<1year 04 (26.66%) 04 (26.66%) 08 (26.66%)1-2years 04 (26.66%) 02 (13.33%) 06 (20.00%)2-3year 03 (20.00%) 04 (26.66%) 07 (23.33%)3-4year 01 (06.66%) 02 (13.33%) 03 (10.00%)4-5years 03 (20.00%) 02 (13.33%) 05 (16.66%)>5years 00 (00%) 01 (06.66%) 01 (03.33%)Group A: Out of fifteen patients, 04 (26.66%) were had the chronicity less then 1years. 04 (26.66%) were had the chronicity in between 1-2 years, 03 (20.00%)patients were had chronicity in between 2-3 years. Only one (06.66%) in between 3-4years and 03 (20.00%) were had chronicity in between 4-5 years but none were hadchronicity more than 5 years.Group B: Out of fifteen patients, 04 (26.66%) were had the chronicity less then 1years. 02 (13.33%) were had the chronicity in between 1-2 years, 04 (26.66%)patients were had chronicity in between 2-3 years. 02 (13.33%) patients were inbetween 3-4 years and 4-5 years. Only one (06.66%) had chronicity more than 5years.Overall: Out of thity patients, 08 (26.66%) were had the chronicity less then 1 years.06 (20.00%) were had the chronicity in between 1-2 years, 07 (23.33%) patients werehad chronicity in between 2-3 years. 03 (10.00%) were in between 3-4 years and 05(16.66%) were had chronicity in between 4-5 years. Only one (06.66%) hadchronicity more than 5 years. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 157 Sandhigata vata
  • 176. Observations and Results Figure No. 38: Showing distribution of patients by duration of the disease: 88 77 66 5 <1 Year5 1-2 Years 4 4 4 44 2-3 Years 3 3 33 3-4 Years 2 2 2 4-5 Years2 1 1 1 >5 Years1 00 Group A Group B Total Data Related to clinical features before treatment and after follow-up: A. Prasarana Akunchanayoho savedana pravruthihi: Table No. 56: Showing the distribution of patients by different grades of Vedana before Treatment: Vedana Group A no. and % Group B no. and % Group A and B no. and % Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 00 (00%) 00 (00%) 00 (00%) Grade 2 13 (86.66%) 12(80.00%) 25 (83.33%) Grade 3 02 (13.33%) 03 (20.00%) 05 (16.66%) Group A: Out of fifteen patients, 02 (13.33%) were complained continues pain (Sever), 13 (86.66%) were complained pain frequently when moves the joint and none were had mild pain which reveals on enquiry and without pain before the treatment. Group B: Out of fifteen patients, 03 (20.00%) were complained continues pain (Sever), 12(80.00%) were complained pain frequently when moves the joint and none were had mild pain which reveals on enquiry and without pain before the treatment. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 158 Sandhigata vata
  • 177. Observations and ResultsOverall: Out of thirty patients, 05 (16.66%) were complained continues pain (Sever),25 (83.33%) were complained pain frequently when moves the joint and none werehad mild pain which reveals on enquiry and without pain before the treatment.Figure No. 39: Showing distribution of patients by different grades of Vedana beforeTreatment: 25252015 13 Grade 0 12 Grade 110 Grade 2 5 Grade 3 5 3 2 0 0 0 0 0 0 0 Group A Group B TotalTable No. 57: Showing the distribution of patients by different grades of Vedana afterFollow-up:Vedana Group A no. and % Group B no. and % Group A and B no. and %Grade 0 02 (13.33%) 02 (13.33%) 04 (13.33%)Grade 1 12(80.00%) 10 (66.66%) 22 (73.33%)Grade 2 01 (06.66%) 03(20.00%) 04 (13.33%)Grade 3 00 (00%) 00 (00%) 00 (00%)Group A: After the follow up period of treatment, Out of fifteen patients, none (00%)were complained continues pain (Sever, Grade 3), 01 (06.66%) was complained painfrequently when moves the joint (Grade 2), 12 (80.00%) were complained mild pain(Grade 1) and 2 (13.33%) patients were reported with no pain (Grade 0). Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 159 Sandhigata vata
  • 178. Observations and ResultsGroup B: In this group, Out of fifteen patients, none (00%) were complainedcontinues pain (Sever, Grade 3), 03(20.00%) were complained pain frequently whenmoves the joint (Grade 2), 10 (66.66%) were complained mild pain (Grade 1) and 2(13.33%) patients were reported with no pain (Grade 0).Overall: Out of thirty patients, none (00%) were complained continues pain (Sever,Grade 3), 04 (13.33%) were complained pain frequently when moves the joint (Grade2), 22 (73.33%) were complained mild pain (Grade 1) and 4 (13.33%) patients werereported with no pain (Grade 0).Figure No. 40: Showing distribution of patients by different grades of Vedana afterfollow up: 25 22 20 15 Grade 0 12 Grade 1 10 10 Grade 2 Grade 3 4 4 5 3 2 2 1 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 160 Sandhigata vata
  • 179. Observations and ResultsB. Sandhi AtopaTable No. 58: Showing the distribution of patients by different grades of SandhiAtopa before Treatment:Sandhi Atopa Group A no. and % Group B no. and % Group A and B no. and %Grade 0 00 (00%) 00 (00%) 00 (00%)Grade 1 09 (60.00%) 08 (53.33%) 17 (56.66%)Grade 2 06 (40.00%) 07(46.66%) 13 (43.33%)Group A: Out of fifteen patients, on clinical examination, Sandhi Atopa (Crepitation)was heard in 06 (40.00%) number of Patients (Grade 2); In 09 (60.00%) patient’screpitation is only felt (Grade 1).Group B: Out of fifteen patients, on clinical examination, Sandhi Atopa (Crepitation)was heard in 08 (53.33%) number of Patients (Grade 2), In 07(46.66%) patientscrepitation is only felt (Grade 1).Overall: Before the treatment, out of thirty patients on clinical examination, SandhiAtopa (Crepitation) was heard in 13 (43.33%) number of Patients (Grade 2), In 17(56.66%) patients crepitation is only felt (Grade 1).Figure No. 41: Showing distribution of patients by different grades of Sandhi Atopabefore Treatment: 171816 131412 9 Grade 010 8 7 8 6 Grade 1 6 Grade 2 4 2 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 161 Sandhigata vata
  • 180. Observations and ResultsTable No. 59: Showing the distribution of patients by different grades of SandhiAtopa after follow-up:Sandhi Atopa Group A no. and % Group B no. and % Group A and B no. and %Grade 0 01 (06.66%) 00 (00%) 01 (03.33%)Grade 1 12 (80.00%) 09 (60.00%) 21 (70.00%)Grade 2 02 (13.33%) 06(40.00%) 08 (26.66%)Group A: After follow up, Out of fifteen patients, Sandhi Atopa (Crepitation) washeard in 02 (13.33%) number of Patients (Grade 2); In 12 (80.00%) patient’screpitation as only felt (Grade 1), and 01 (06.66%) patient reported with nocrepitation (Grade 0).Group B: Out of fifteen patients, Sandhi Atopa (Crepitation) was heard in 06(40.00%)number of Patients (Grade 2); In 09 (60.00%) patient’s crepitation as only felt (Grade1) and none were reported with No crepitations (Grade 0).Overall: After follow up, out of thirty patients on clinical examination, Sandhi Atopa(Crepitation) was heard in 08 (26.66%) number of Patients (Grade 2), In 21 (70.00%)patients crepitation is only felt (Grade 1) and one (03.33%) reported with nocrepitations.Figure No. 42: Showing distribution of patients by different grades of Sandhi Atopaafter follow-up: 25 21 20 15 12 Grade 0 9 8 Grade 1 10 6 Grade 2 5 2 1 1 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 162 Sandhigata vata
  • 181. Observations and ResultsC. Sandhi shothahaTable No. 60: Showing the distribution of patients by different grades of Sandhishothaha before treatment:Shothaha Group A no. and % Group B no. and % Group A and B no. and %Grade 0 03 (20.00%) 01 (06.66%) 04 (13.33%)Grade 1 04 (26.66%) 05 (33.33%) 09 (30.00%)Grade 2 06 (40.00%) 09 (60.00%) 15 (50.00%)Grade 3 02 (13.33%) 00 (00%) 02 (06.66%)Group A: Out of fifteen patients, 03 (20.00%) were not had any Shotha (Grade 0), 04(26.66%) were had slightly obvious shotha (Grade 1), 06 (40.00%) were had Shothawhich covers well over the bony prominence (Grade 2), 02 (13.33%) were had muchelevated shotha over sandhi before the treatment.Group B: Out of fifteen patients, 01 (06.66%) were not had any Shotha (Grade 0), 05(33.33%) were had slightly obvious shotha (Grade 1), 09 (60.00%) were had Shothawhich covers well over the bony prominence (Grade 2), none were had much elevatedshotha over sandhi before the treatment.Overall: Out of thirty patients, 04 (13.33%) were not had any Shotha (Grade 0), 09(30.00%) were had slightly obvious shotha (Grade 1), 15 (50.00%) were had Shothawhich covers well over the bony prominence (Grade 2), 02 (06.66%) were had muchelevated shotha over the sandhi before the treatment.Figure No.43: Showing distribution of patients by different grades of Sandhishothaha: 15 16 14 12 10 9 9 Grade 0 8 6 Grade 1 5 6 4 4 Grade 2 3 4 2 2 Grade 3 1 2 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 163 Sandhigata vata
  • 182. Observations and ResultsTable No. 61: Showing the distribution of patients by different grades of Sandhishothaha after follow-up:Shothaha Group A no. and % Group B no. and % Group A and B no. and %Grade 0 12 (80.00%) 07 (46.66%) 19(63.33%)Grade 1 02 (13.33%) 08 (53.33%) 10(33.33%)Grade 2 01 (06.66%) 00 (00%) 01(03.33%)Grade 3 00 (00%) 00 (00%) 00 (00%)Group A: After follow up, Out of fifteen patients, 12 (80.00%) were not had anyShotha (Grade 0), 02 (13.33%) were had slightly obvious shotha (Grade 1), 01(06.66%) had Shotha which covers well over the bony prominence (Grade 2), nonewere reported with much elevated shotha over sandhi.Group B: Out of fifteen patients, 07 (46.66%) were not had any Shotha (Grade 0), 08(53.33%) were had slightly obvious shotha (Grade 1) and none were had Shothawhich covers well over the bony prominence (Grade 2) or much elevated shotha oversandhi (Grade 3) after the follow-up.Overall: Out of thirty patients, after the follow-up, 19(63.33%) were presented withno Shotha (Grade 0), 10(33.33%) were had slightly obvious shotha (Grade 1), only01(03.33%) had Shotha which covers well over the bony prominence (Grade 2), nonewere had much elevated shotha over the sandhi (Grade 3).Figure No.44: Showing distribution of patients by different grades of Sandhishothaha: 15 16 14 12 10 9 9 Grade 0 8 6 Grade 1 5 6 4 4 Grade 2 3 4 2 2 Grade 3 1 2 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 164 Sandhigata vata
  • 183. Observations and ResultsD.Sthamba:Table No. 62: Showing the distribution of patients by different grades of Sthambabefore treatment:Sthamba Group A no. and % Group B no. and % Group A and B no. and %Grade 0 00 (00%) 00 (00%) 00 (00%)Grade 1 15 (100%) 15 (100%) 30 (100%)Group A: Out of fifteen patients, all (100%) were had Sthamba in Sandhi beforetreatment.Group B: Out of fifteen patients, all (100%) were had Sthamba in Sandhi beforetreatment.Overall: Out of thirty patients, all (100%) were had Sthamba in Sandhi beforetreatment.Figure No.45: Showing distribution of patients by different grades of Sthamba: 30302520 15 1515 Grade 0 Grade 110 5 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 165 Sandhigata vata
  • 184. Observations and ResultsTable No. 63: Showing the distribution of patients by different grades of Sthambaafter follow-up:Sthamba Group A no. and % Group B no. and % Group A and B no. and %Grade 0 10 (66.66%) 11 (73.33%) 21 (70.00%)Grade 1 05 (33.33%) 04 (26.66%) 09 (30.00%)Group A: Out of fifteen patients, after follow-up 10 (66.66) patient’s relieved fromcomplaint Sthamba and 5 (33.33%) patient had.Group B: In this Group, 11 (73.33%) patient relieved and 4 (26.66%) patient hadcomplaint of Sthamba.Overall: Out of thirty patients, 21 (70%) patients relieved the where 9 (30%) hadcomplaint Sthamba.Figure No. 46: Showing distribution of patients by different grades of Sthamba afterfollow-up:25 212015 11 10 Grade 0 910 Grade 1 5 4 5 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 166 Sandhigata vata
  • 185. Observations and ResultsE. Sandhigati Asamarthya:Table No.64: Showing the distribution of patients by different grades of SandhigatiAsamarthya:Sandhigati Group A no. and % Group B no. and % Group A and B no.Asamarthya and %Grade 0 00 (00%) 00 (00%) 00 (00%)Grade 1 01 (06.66%) 01 (06.66%) 02 (06.66%)Grade 2 09 (60.00%) 13(86.66%) 22 (73.33%)Grade 3 05 (33.33%) 01 (06.66%) 06 (20.00%)Grade 4 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients, none (00%) were had full range of movement(Grade 0), One (06.66%) was had >75% and <full range of movement (Grade 1), 09(60.00%) were had 50-75% of the full range of joint motion (Grade 2), 05 (33.33%)were had up to 50% of the full range of joint motion (Grade 3) and none (00%) werehad complete loss of joint motion (Grade 4).Group B: Out of fifteen patients, none (00%) were had full range of movement (Grade0), One (06.66%) was had >75% and <full range of movement (Grade 1), 13(86.66%)were had 50-75% of the full range of joint motion (Grade 2), 0ne (06.66%) had up to50% of the full range of joint motion (Grade 3) and none (00%) were had completeloss of joint motion (Grade 4).Overall: Out of thirty patients, none (00%) were had full range of movement (Grade0), 02 (06.66%) were had >75% and <full range of movement (Grade 1), 22 (73.33%)were had 50-75% of the full range of joint motion (Grade 2), 06 (20.00%) were hadup to 50% of the full range of joint motion (Grade 3) and none (00%) were hadcomplete loss of joint motion (Grade 4).Figure No.47: Showing distribution of patients by different grades of SandhigatiAsamarthya: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 167 Sandhigata vata
  • 186. Observations and Results 25 22 20 Grade 0 15 13 Grade 1 9 Grade 2 10 6 Grade 3 5 5 Grade 4 2 1 1 1 0 0 0 0 0 0 0 Group A Group B TotalTable No. 65: Showing the distribution of patients by different grades of SandhigatiAsamarthya after follow-up:Sandhigati Group A no. and % Group B no. and % Group A and B no.Asamarthya and %Grade 0 04 (26.66%) 02 (13.33%) 06 (20.00%)Grade 1 09 (60.00%) 12 (80.00%) 21 (70.00%)Grade 2 02 (13.33%) 01(06.66%) 03 (10.00%)Grade 3 00 (00%) 00 (00%) 00 (00%)Grade 4 00 (00%) 00 (00%) 00 (00%)Group A: After follow-up, Out of fifteen patients, 04 (26.66%) were had full range ofmovement (Grade 0), 09 (60.00%) were had >75% and <full range of movement(Grade 1), 02 (13.33%) were had 50-75% of the full range of joint motion (Grade 2)and none were had up to 50% of the full range of joint motion (Grade 3) or completeloss of joint motion (Grade 4).Group B: Out of fifteen patients, 02 (13.33%) were had full range of movement(Grade 0), 12 (80.00%) were had >75% and <full range of movement (Grade 1),01(06.66%) had 50-75% of the full range of joint motion (Grade 2), and none werehad up to 50% of the full range of joint motion (Grade 3) or complete loss of jointmotion (Grade 4). Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 168 Sandhigata vata
  • 187. Observations and ResultsOverall: Out of thirty patients, 06 (20.00%) were had full range of movement (Grade0), 21 (70.00%) were had >75% and <full range of movement (Grade 1), 03 (10.00%)were had 50-75% of the full range of joint motion (Grade 2), and none were had up to50% of the full range of joint motion (Grade 3) or complete loss of joint motion(Grade 4) after the follow-up period.Figure No. 48: Showing distribution of patients by different grades of SandhigatiAsamarthya after follow-up: 25 21 20 Grade 0 15 12 Grade 1 9 Grade 2 10 6 Grade 3 5 4 3 Grade 4 2 2 1 0 0 0 0 0 0 0 Group A Group B TotalF. Walking Time:Table No. 66: Showing the distribution of patients by different grades of WalkingTime before treatment:Walking Time Group A no. and % Group B no. and % Group A and B no. and %Grade 0 00 (00%) 00 (00%) 00 (00%)Grade 1 00 (00%) 00 (00%) 00 (00%)Grade 2 06 (40.00%) 06 (40.00%) 12 (40.00%)Grade 3 09 (60.00%) 09 (60.00%) 18 (60.00%)Grade 4 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients, none (00%) were completed 21 meter distancewithin 30 seconds - Grade 0 (up to 20 sec) and Grade1 (21-30 sec). 06 (40.00%) werecompleted 21 meters in between 31- 40 sec (Grade 2), 09 (60.00%) were had Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 169 Sandhigata vata
  • 188. Observations and Resultscompleted within 41-50 sec (Grade 3), none (00%) were taken more than 51 sec(Grade 4) before the treatment.Group B: Out of fifteen patients, none (00%) were completed 21 meter distancewithin 30 seconds (Grade 0 - up to 20 sec and Grade1- 21-30 sec). 06 (40.00%) werecompleted 21 meters in between 31- 40 sec (Grade 2), 09 (60.00%) were hadcompleted within 41-50 sec (Grade 3), none (00%) were taken more than 51 sec(Grade 4) before the treatment.Overall: Out of thirty patients, none (00%) were completed 21 meter distance within30 seconds (Grade 0 - up to 20 sec and Grade1- 21-30 sec). 12 (40.00%) werecompleted 21 meters in between 31- 40 sec (Grade 2), 18 (60.00%) were hadcompleted within 41-50 sec (Grade 3), none (00%) were taken more than 51 sec(Grade 4) before the treatment in this study.Figure No. 49: Showing distribution of patients by different grades of Walking Timebefore treatment: 18 18 16 14 12 12 Grade 0 10 9 9 Grade 1 8 Grade 2 6 6 6 Grade 3 4 Grade 4 2 0 0 0 0 0 0 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 170 Sandhigata vata
  • 189. Observations and ResultsTable No.67: Showing the distribution of patients by different grades of WalkingTime after follow-up:Walking Time Group A no. and % Group B no. and % Group A and B no. and %Grade 0 01 (06.66%) 02 (13.33%) 03 (10.00%)Grade 1 10 (66.66%) 05 (33.33%) 15 (50.00%)Grade 2 04 (26.66%) 07 (46.66%) 11 (36.66%)Grade 3 00 (00%) 01 (60.00%) 01 (03.33%)Grade 4 00 (00%) 00 (06.66%) 00 (00%)Group A: Out of fifteen patients, after follow-up, 01 (06.66%) completed 21 meterdistance within 20 seconds (Grade 0), 10 (66.66%) were covered 21 meter distance inbetween 21-30sec (Grade 1). 04 (26.66%) were completed 21 meters in between 31-40 sec (Grade 2), none were took more than 41sec complete 21 meter distance.Grade 3 and Grade 4, after the follow-up.Group B: Out of fifteen patients, after follow-up, 02 (13.33%) were completed 21meter distance within 20 seconds (Grade 0), 05 (33.33%) were covered 21 meterdistance in between 21-30sec (Grade 1). 07 (46.66%) were completed 21 meters inbetween 31- 40 sec (Grade 2), 01 (60.00%) had taken 41-50 sec to cover 21 meterdistance (Grade 3). None were took more than 51sec to complete 21 meter distance(Grade 4), after the follow-up.Overall: Out of thirty patients, after follow-up, 03 (10.00%) were completed 21 meterdistance within 20 seconds (Grade 0), 15 (50.00%) were covered 21 meter distance inbetween 21-30sec (Grade 1). 11 (36.66%) were completed 21 meters in between 31-40 sec (Grade 2), 01 (60.00%) had taken 41-50 sec to cover 21 meter distance (Grade3). None were took more than 51sec to complete 21 meter distance (Grade 4), afterthe follow-up. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 171 Sandhigata vata
  • 190. Observations and ResultsFigure No. 50: Showing distribution of patients by different grades of Walking Timeafter follow-up: 16 15 14 12 11 10 Grade 0 10 Grade 1 8 7 Grade 2 6 5 4 Grade 3 4 3 2 Grade 4 2 1 1 1 0 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 172 Sandhigata vata
  • 191. Observations and ResultsObservation of the data related to the response of the patientTable No.68: Showing the distribution of Overall Response to the treatment:Duration Group A no. and % Group B no. and % Group A and B no. and %Good Response 01 (06.66%) 00 (00%) 01 (03.33%)Moderate Response 07 (46.66%) 10 (66.66%) 17 (56.66%)Poor Response 07 (46.66%) 05 (33.33%) 12 (40.00%)No Response 00 (00%) 00 (00%) 00 (00%)Group A: Out of fifteen patients, 01 (06.66%) shown Good response to the treatment.07 (46.66%) were shown Moderate response and 07 (46.66%) patients shown Poorresponse. None were shown No response.Group B: Out of fifteen patients none were shown Good response to the treatment. 10(66.66%) were shown Moderate response and 05 (33.33%) patients shown Poorresponse. None were shown No response.Overall: Out of thirty patients, only 01 (03.33%) patient shown Good response to thetreatment. 17 (56.66%) were shown Moderate response and 12 (40.00%) patientsshown Poor response. None were shown No response.Figure No. 51: Showing the distribution of Overall Response to the treatment: 17 18 16 14 12 12 10 Good Response 10 7 7 Moderate Response 8 5 Poor Response 6 4 No Response 1 1 2 0 0 0 0 0 Group A Group B Total Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 173 Sandhigata vata
  • 192. Observations and Results Observation of the statistical out comes of the study: Comparative Study of Group A and Group B after treatment Table No.69: Comparative Study of Group A and Group B after treatment: Parameter Group Mean SD SE PSE T- P- Remarks Value Value Vedana A 0.933 0.457 0.118 0.193 0.688 >0.05 NS B 1.066 0.593 0.153 Atopa A 1.06 0.457 0.118 0.175 1.94 >0.05 NS B 1.4 0.507 0.130 Shota A 0.266 0.593 0.153 0.202 1.321 >0.05 NS B 0.533 0.516 0.133 Sthamba A 0.333 0.487 0.126 0.172 0.388 >0.05 NS B 0.266 0.457 0.118 Sandigathi A 0.866 0.639 0.165 0.202 0.331 >0.05 NS Asamarthahtha B 0.933 0.457 0.118 Walking time A 1.2 0.560 0.144 0.258 1.031 >0.05 NS B 1.466 0.833 0.215 WOMAC A 19.933 3.432 0.886 1.435 1.021 >0.05 NS B 21.4 4.371 1.129 To compare the effectiveness of the treatment procedure, the statistical analyses is done by using Un-paired t-test, by assuming that the mean effect treatment procedures is same in both the groups after treatment procedure. From the analyses all parameters shows non-significant (as P>0.05). i.e., the mean effects of treatment same in all parameters. Individual study of the Group A: Table No.70: Individual study of the Group A: Parameter Mean Net SD SE T- P-value Remarks BT AT Mean value Vedana 2.133 0.933 1.2 0.560 0.144 8.333 <0.001* HS Atopa 1.4 1.066 0.333 0.487 0.126 2.64 <0.01 HS Shota 1.466 0.266 1.2 0.861 0.22 5.454 <0.001* HS Sthamba 1.0 0.333 0.666 0.487 0.126 7.936 <0.001* HS Sandigathi 2.266 0.866 1.4 0.507 0.130 10.76 <0.001* HSAsamarthahthaWalking time 2.6 1.2 1.4 0.507 0.130 10.76 <0.001* HS WOMAC 41.33 19.933 19.933 3.432 0.886 3.87 <0.01 HS * = More highly significant Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 174 Sandhigata vata
  • 193. Observations and ResultsIndividual study of the Group B:Table No.71: Individual study of the Group B: Parameter Mean Net SD SE T- P-value Remarks BT AT Mean value Vedana 2.2 1.066 1.133 0.516 0.133 8.518 <0.001* HS Atopa 1.466 1.4 0.066 0.258 0.066 1.00 >0.05 NS Shota 1.533 0.533 1.0 0.534 0.138 7.246 <0.001* HS Sthamba 1.0 0.266 0.733 0.457 0.118 6.211 <0.001* HS Sandigathi 2.0 0.933 1.066 0.258 0.066 16.16 <0.001* HS Asamarthahtha Walking time 2.6 1.466 1.133 0.516 0.133 8.518 <0.001* HS WOMAC 42.86 21.4 21.466 4.596 1.187 8.08 <0.001* HS* = More highly significant To know among which Group treatment procedure is more effective, thestatistical analyses is done by using paired t-test, by assuming that the drug is notresponsible for changes in before and after the treatment procedures.From Table No.70 and Table No.71, all the parameters shows highly significance inboth the Groups as P<0.05 The parameter atopa shows more significance in group Arather than group B which is not significant. In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba,Sandhigati Asamarthata and Walking time shows more highly significant (Bycomparing t-values) than Group B . In Group-B the parameters Shota, SandigathiAsamarthatha and WOMAC shows more highly significant than group A.Conclusion: By comparing results of Group A and Group B, it is concluded thatGroup A (Arohana Krama Matravasti) is more effective than Group B (SadharanaKrama Matravasti) in almost all parameters (Except the Atopa, which is notsignificant). The study reviles that in both Group A and Group B, therapy is effectiveas it decreases Sandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana,Walking time and Stahmaba. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 175 Sandhigata vata
  • 194. Observations and ResultsClinical Parameters (Group A – Arohana Krama)Table 72: Showing the Clinical Parameters before treatment and After Follow-up ofGroup A:SI OPD Clinical Parameters (Group A)No No Vedana Atopa Sandhi Sthamba Sadhigati Walking WOMAC Shota Asamarthata Time B A B A B A B A B A B A B A01 4125 2 1 1 1 2 0 1 0 3 1 2 1 35 1702 4360 2 0 1 1 2 1 1 1 3 2 3 2 47 2903 4375 2 1 1 1 0 0 1 0 2 0 2 0 35 1104 4412 2 1 2 1 0 0 1 0 3 1 3 1 40 1805 4435 2 0 1 0 1 0 1 0 2 0 2 1 38 0906 4478 2 1 2 1 2 0 1 1 2 0 2 1 43 2107 4480 2 1 1 1 0 0 1 0 2 1 3 1 40 2208 5697 2 1 1 1 1 0 1 0 2 1 2 1 38 2209 6197 2 1 2 2 2 1 1 1 2 1 3 1 44 2510 6203 2 1 1 1 3 0 1 0 3 2 3 1 43 2311 6337 3 1 2 1 2 0 1 0 2 1 3 2 45 2412 7874 2 2 2 2 3 2 1 1 2 1 3 2 43 2513 8230 3 1 1 1 2 0 1 0 2 1 3 1 43 2214 8234 2 1 2 1 1 0 1 1 3 1 3 2 44 2815 8335 2 1 1 1 1 0 1 0 1 0 2 1 42 25Abbreviations Used: B – Before treatment A – After follow-up Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 176 Sandhigata vata
  • 195. Observations and ResultsClinical Parameters (Group B – Sadharana Krama)Table 73: Showing the Clinical Parameters before treatment and After Follow-up ofGroup A:SI OPD Clinical Parameters (Group B)No No Vedana Atopa Sandhi Sthamba Sadhigati Walking WOMAC Shota Asamarthata Time B A B A B A B A B A B A B A01 4249 2 1 1 1 2 1 1 0 2 1 3 2 42 2602 4246 2 1 1 1 1 0 1 0 2 1 2 0 31 1403 4340 2 0 2 2 2 1 1 0 2 1 2 1 43 2004 4367 2 1 2 2 2 1 1 1 2 1 3 1 47 2105 4775 3 2 2 2 2 1 1 1 2 1 3 2 38 2306 4981 2 1 1 1 1 0 1 0 2 1 3 2 43 1907 5646 2 1 2 2 2 1 1 1 3 2 3 2 45 2908 5688 2 1 2 1 2 1 1 0 2 1 2 1 48 1909 6284 3 1 1 1 0 0 1 0 1 0 3 2 37 1710 6312 2 2 1 1 1 1 1 0 2 1 2 1 47 2911 6814 2 1 2 2 1 0 1 0 2 1 2 1 45 1812 1310 3 2 1 1 2 1 1 1 2 1 3 3 44 2513 1426 2 1 2 2 1 0 1 0 2 1 3 2 41 2014 2327 2 1 1 1 2 0 1 0 2 1 3 2 47 2315 6448 2 0 1 1 2 0 1 0 2 0 2 0 45 18Abbreviations Used: B – Before treatment A – After follow-up Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 177 Sandhigata vata
  • 196. Observations and ResultsTable 74: Showing the percentage improvement in Clinical Parameters in both Groups:Group A – Arohana Krama Group B – Sadharana KramaSI No OPD No % improvement SI No OPD No % improvement01 4125 54.34 % 01 4249 39.62 %02 4360 38.98 % 02 4246 57.50 %03 4375 69.76 % 03 4340 53.70 %04 4412 56.86 % 04 4367 52.54 %05 4435 78.72 % 05 4775 37.25 %06 4478 53.70 % 06 4981 54.71 %07 4480 46.93 % 07 5646 34.48 %08 5697 44.68 % 08 5688 59.32 %09 6197 42.85 % 09 6284 54.34 %10 6203 50.00 % 10 6312 37.50 %11 6337 50.00 % 11 6814 58.18 %12 7874 37.50 % 12 1310 39.28 %13 8230 52.72 % 13 1426 50.00 %14 8234 39.28 % 14 2327 51.72 %15 8335 44.00 % 15 6448 65.45 % Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 178 Sandhigata vata
  • 197. Observations and ResultsTable 75: Showing Demographic data in patients of Group A (Arohana Krama):SI OPD Age Age category Sex Religion Occupation Economic Mode of MaritalNo No in Status Onset Status Yrs 31- 41- 51- 61- M F H M C O L S E S P L U R C I A T U M 40 50 60 70 M M M01 4125 54 + + + + + + +02 4360 58 + + + + + + +03 4375 54 + + + + + + +04 4412 65 + + + + + + +05 4435 47 + + + + + + +06 4478 65 + + + + + + +07 4480 55 + + + + + + +08 4597 65 + + + + + + +09 6197 64 + + + + + + +10 6203 58 + + + + + + +11 6337 48 + + + + + + +12 7874 55 + + + + + + +13 8230 70 + + + + + + +14 8234 62 + + + + + + +15 8335 59 + + + + + + +Abbreviations used:Sex: M – male, F – female,Religion: H- Hindu, M – Muslim, C – Christian, O – others,Occupation: S – student, L – labor, E – executive, S – sedentaryEconomical status: P – poor, LM– lower middle class UM– middle class, R – richMode of onset: C– chronic, I – insidious, A – acute, T–traumaticResponse: G–good response, M –moderate response, P– poor response, N–No response Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 179 Sandhigatavata
  • 198. Observations and ResultsTable 76: Showing Demographic data in patients of Group B (Sadharana Krama):SI OPD Age Age catogary Sex Religion Occupation Economic Mode of MaritalNo No in Status Onset Status Yrs 31- 41- 51- 61- M F H M C O L S E S P L U R C I A T U M 40 50 60 70 M M M01 4249 62 + + + + + + +02 4246 35 + + + + + + +03 4340 63 + + + + + + +04 4367 48 + + + + + + +05 4775 57 + + + + + + +06 4981 67 + + + + + + +07 5646 68 + + + + + + +08 5688 55 + + + + + + +09 6284 60 + + + + + + +10 6312 65 + + + + + + +11 6814 58 + + + + + + +12 1310 64 + + + + + + +13 1426 58 + + + + + + +14 2327 64 + + + + + + +15 6448 42 + + + + + + +Abbreviations used:Sex: M – male, F – female,Religion: H- Hindu, M – Muslim, C – Christian, O – others,Occupation: S – student, L – labor, E – executive, S – sedentaryEconomical status: P – poor, L– lower middle class U– middle class, R – rich,Mode of onset: C– chronic, I – insidious, A – acute, T–traumaticResponse: G–good response, M –moderate response, P– poor response, N–No response Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 180 Sandhigatavata
  • 199. Observations and ResultsTable 77: Showing Vayaktika vruttanta of patients (Group A – Arohana Krama):Sl. OPD Ahara Vihara Agni Koshta Nidra Vysana Jointsno No. involved V M H M S S M T V Mr M K P A Ad D N T S A R L B01 4125 + + + + + + +02 4360 + + + + + + +03 4375 + + + + + + +04 4412 + + + + + + +05 4435 + + + + + + +06 4478 + + + + + + +07 4480 + + + + + + +08 4597 + + + + + + +09 6197 + + + + + + +10 6203 + + + + + + +11 6337 + + + + + + +12 7874 + + + + + + +13 8230 + + + + + + +14 8234 + + + + + + +15 8335 + + + + + + +Abbreviations used:Ahara: V –Vegetarian, M –Mixed,Vihara: H- Hard, M – Moderate, S –Sedentary,Agni: S – Sama, M – manda, T – teekshna, V –vishamaKoshta: Mr – mridu,M– madhyama, K– krura,Nidra: P– prakruta, A – alpa, Ad – adhika,D–diwasapnaVysana: N–none, T –tobacco, S– smoking,A–alcholJoints involved: R–Right, L–left, B– both Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 181 Sandhigatavata
  • 200. Observations and ResultsTable 78: Showing Vayaktika vruttanta of patients (Group B – Sadharana Krama):Sl. OPD Ahara Vihara Agni Koshta Nidra Vysana Jointsno No. involved V M H M S S M T V Mr M K P A Ad D N T S A R L B01 4249 + + + + + + +02 4246 + + + + + + +03 4340 + + + + + + +04 4367 + + + + + + +05 4775 + + + + + + + +06 4981 + + + + + + +07 5646 + + + + + + +08 5688 + + + + + + + +09 6284 + + + + + + +10 6312 + + + + + + + +11 6814 + + + + + + +12 1310 + + + + + + +13 1426 + + + + + + +14 2327 + + + + + + + + +15 6448 + + + + + + +Abbreviations used:Ahara: V –Vegetarian, M –Mixed,Vihara: H- Hard, M – Moderate, S –Sedentary,Agni: S – Sama, M – manda, T – teekshna, V –vishamaKoshta: Mr – mridu,M– madhyama, K– krura,Nidra: P– prakruta, A – alpa, Ad – adhika,D–diwasapnaVysana: N–none, T –tobacco, S– smoking,A–alcholJoints involved: R–Right, L–left, B– both Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 182 Sandhigatavata
  • 201. Observations and ResultsTable 79: Showing data related to Dashavidha pareeksha (Group A – Arohana Krama)Sl. OPD Prakruti Sara Pramana Samhanana Satmya Satva Ahara Vyama Vayano No. shakti shakti A.S J.S01 4125 VK MS S M R M M M A M02 4360 VP MS S S R M M M A V03 4375 VP MS S S R M M M M M04 4412 VP MS S M R M M M A V05 4435 VK MS S M R M M M A M06 4478 VK MDS S S R M M M A V07 4480 VK AS S M R M A A A M08 5697 VK MS S S R M A A A V09 6197 VP AS S M R M M M A V10 6203 VK MS S M R M A A A M11 6337 VK MDS S S S M M M A M12 7874 VK MDS S S R M M M A M13 8230 VK MS S M R M A A A V14 8234 VP MS S M R M A A A V15 8335 VK MDS S S R M M M A MAbbreviations used:Prakruti: VP – vatapittaja, VK – vatakaphaja.Sara: MS – mamsasara, MDS – medasara, AS– asthisaraSamhanana: S – susamhata, M – madhyama, A – asamhata.Satmya: R – rookshaSatwa: P – prvara, M – madhyama, A – avara.Ahara shakti: A.S –Abhyavarana Shakti , J.S – Jarana Shakti P – prvara, M – madhyama, A – avara.Vyamashakti: P – pravara, M – madhyama, A – avara.Vaya: M – madhyama, V – vruddha Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 183 Sandhigatavata
  • 202. Observations and ResultsTable 80: Showing data related to Dashavidha pareeksha (Group B - Sadharana Krama)Sl. OPD Prakruti Sara Pramana Samhanana Satmya Satva Ahara Vyama Vayano No. shakti shakti A.S J.S01 4249 VK MS S M R M A A A V02 4246 VK MS S M R M M M M M03 4340 VK MDS S M R M A A A V04 4367 VK MS S S R M M M A M05 4775 VP AS S M R M A A A M06 4981 VK MS S S R M A A A V07 5646 VP MS S M R M M M A V08 5688 VP MS S S R M M M A M09 6284 VK MDS S S R M M M A V10 6312 VP AS S M R M M M A V11 6814 VP MS S M R M M M A M12 1310 VK MDS S M R M A A A V13 1426 VK MS S M R M A M A V14 2327 VP AS S M R M A A A V15 6448 VK MS S S R M M M A MAbbreviations used:Prakruti: VP – vatapittaja, VK – vatakaphaja.Sara: MS – mamsasara, MDS – medasara, AS– asthisaraSamhanana: S – susamhata, M – madhyama, A – asamhata.Satmya: R – rookshaSatwa: P – prvara, M – madhyama, A – avara.Ahara shakti: A.S –Abhyavarana Shakti , J.S – Jarana Shakti P – prvara, M – madhyama, A – avara.Vyamashakti: P – pravara, M – madhyama, A – avara.Vaya: M – madhyama, V – vruddha Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 184 Sandhigatavata
  • 203. Observations and ResultsTable 81: Showing data related to Disease in patients of Group A (Arohana Krama):SI OPD Chronicity Shotha Deformity Joint Range of Gait Muscle WastingNo No instability Movement <1yr 1- 2 - 3 - 4 - >5 P A P A P A E P RM NA Above Below 2yr 3yr 4yr 5yr yrs M M b Joint Joint P A P AP A P A P A01 4125 + + + + + + + +02 4360 + + + + + + + +03 4375 + + + + + + + +04 4412 + + + + + + + +05 4435 + + + + + + + +06 4478 + + + + + + + +07 4480 + + + + + + + +08 5697 + + + + + + + +09 6192 + + + + + + + +10 6203 + + + + + + + +11 6337 + + + + + + + +12 7874 + + + + + + + +13 8230 + + + + + + + +14 8234 + + + + + + + +15 8335 + + + + + + + + 4 4 3 1 3 12 3 2 `3 1 14 8 7 3 12 6 9 15Abbreviations used:P- Present; A- Absent; EM – Easy Movement; PM – Painful Movement; RM – Restricted Movement; N – Normal; Ab – Abnormal Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 185 Sandhigatavata
  • 204. Observations and ResultsTable 82: Showing data related to Disease in patients of Group B (Sadharana Krama):SI OPD Chronicity Shotha Deformity Joint Range of Movement Gait MascleN No instability Wastingo <1yr 1- 2- 3- 4- >5y P A P A P A EM PM RM N Ab Abo Below 2yr 3yr 4yr 5yr rs ve Joint Joint P A P A P A P A P A01 4249 + + + + + + + +02 4246 + + + + + + + +03 4340 + + + + + + + +04 4367 + + + + + + + +05 4775 + + + + + + + +06 4981 + + + + + + + +07 5646 + + + + + + + +08 5688 + + + + + + + +09 6284 + + + + + + + +10 6312 + + + + + + + +11 6814 + + + + + + + +12 1310 + + + + + + + +13 1426 + + + + + + + +14 2327 + + + + + + + +15 6448 + + + + + + + + 4 2 4 2 2 1 14 1 5 10 1 14 5 10 4 11 7 8 15Abbreviations used:P- Present; A- Absent; EM – Easy Movement; PM – Painful Movement; RM – Restricted Movement; N – Normal; Ab – Abnormal Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 186 Sandhigatavata
  • 205. Observations and ResultsTable 83: Showing data related to Nidana in patients of Group A (Arohana Krama)SI OPD Aharaja Nidana ViharajaNidanaNo No Tikta Kashaya Katu Alpashana Pramitashana Ruksha VD VU A.VyaVaya Ni. Ati Ati J Bhashana Vyayama01 4125 + + +02 4360 + + +03 4375 + + + +04 4412 + + + +05 4435 + + +06 4478 + + +07 4480 + + +08 5697 + + +09 6197 + + +10 6203 + + + + +11 6337 + + +12 7874 + +13 8230 + + + +14 8234 + + + +15 8335 + + + + 1 13 6 14 2 15Abbreviations used:VD – Vega dhaarana; VU – vegoodeerana; Ni.J – Nishs Jagarana Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 187 Sandhigatavata
  • 206. Observations and ResultsTable 84: Showing data related to Nidana in patients of Group B (Sadharana Krama)SI OPD Aharaja Nidana ViharajaNidanaNo No Tikta Kashaya Katu Alpashana Pramitashana Ruksha VD VU A.VyaVaya Ni. Ati Ati Vyayama J Bhashana01 4249 + + +02 4246 + +03 4340 + + + + +04 4367 + + +05 4775 + + + +06 4981 + + +07 5646 + +08 5688 + + + +09 6284 + +10 6312 + + +11 6814 + + +12 1310 + + + +13 1426 + + + +14 2327 + + + +15 6448 + + + 2 10 5 13 6 13Abbreviations used:VD – Vega dhaarana; VU – vegoodeerana; Ni.J – Nishs Jagarana Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 188 Sandhigatavata
  • 207. Observations and ResultsTable 85: Showing average time of Vasti Dravya Retention in patients of both Groups:Group A Group BSI No OPD No Average time of Vasti SI No OPD No Average time of Vasti Dravya Retention (In hrs) Dravya Retention (In hrs) 01 4125 06.7 01 4249 10.1 02 4360 06.3 02 4246 08.1 03 4375 08.4 03 4340 06.0 04 4412 03.9 04 4367 10.5 05 4435 08.4 05 4775 06.1 06 4478 09.0 06 4981 10.1 07 4480 07.2 07 5646 06.2 08 5697 09.7 08 5688 07.6 09 6192 04.2 09 6284 08.6 10 6203 07.6 10 6312 06.9 11 6337 07.4 11 6814 05.1 12 7874 08.8 12 1310 05.0 13 8230 03.6 13 1426 05.1 14 8234 08.8 14 2327 09.5 15 8335 09.2 15 6448 04.4Average 07.2 Average 08.3 Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 189 Sandhigatavata
  • 208. Observations and ResultsTable 86: Showing response in patients of both Groups:Group A Group BSI OPD Result SI OPD ResultNo No Good Moderate Poor No No No Good Moderate Poor No Response Responce Responce Responce Response Responce Responce Responce01 4125 + 01 4249 +02 4360 + 02 4246 +03 4375 + 03 4340 +04 4412 + 04 4367 +05 4435 + 05 4775 +06 4478 + 06 4981 +07 4480 + 07 5646 +08 5697 + 08 5688 +09 6192 + 09 6284 +10 6203 + 10 6312 +11 6337 + 11 6814 +12 7874 + 12 1310 +13 8230 + 13 1426 +14 8234 + 14 2327 +15 8335 + 15 6448 + Total 1 7 7 - Total - 10 5 - Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 190 Sandhigatavata
  • 209. DiscussionDiscussion:“The aim of discussion should not be victory, but progress.” - Joseph Joubert. It is said that, in each and every study, it may be either conceptual or clinical, isalways required to be proved on the basis of logic, fruitful reasoning, supported byachieved practical data as Pramana and then only it can be taken as a principle of thatscience. Hence the discussion and interpretation of the research study becomes anessential and important thing for a research scholar to put their study on the scientificplatform and then only it can be granted to be considered as a true study. Fulfilling andFollowing the same requirement, here an attempt has been made to critically discuss andinterpret the whole clinical study on “Evaluation on the effect of Matravasti inSandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – Acomparative clinical study”.Discussion on this study is based in the following headings: 1. Sandhigatavata vis-à-vis Osteoarthritis. 2. The materials and methods. 3. Clinical study. 4. The patients of Sandhigatavata who underwent the trial. 5. Observations made on results. 6. Probable mode of action of the Matravasti. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 191 Sandhigatavata
  • 210. Discussion1. Sandhigatavata vis-à-vis Osteoarthritis: Movement is the sign of life. Vata is responsible for such chesta or movement. Chestaincludes the entire activity of a living body, even action that is subtle enough in theirlatent stage. The word Vata is defined by Acharya Sushruta as “Va gati gandhanayoh”. Itmeans that Vata indicates both ‘Gati’ and ‘Gandana’. The meanings of the word Gati are:motion, moving and going. The meanings of Gandhana are: intimation, information andhint. Therefore it is clear that this somatic factor ‘vata’ has two main functions i.e.movement (chesta) and knowledge (jnana). In gatavata’s the provocation of vata is the prime factor whether it occurs due tomarga avarna or Dhatu kshaya. The aggravated Vata while moving throughout the bodylodges in Khavaigunya Yukta Srothas. After getting lodged at those parts, it impairs thefunctions of particular structure and produces the disease. In case of Gatatva theaggravated Vata finds a suitable place for its lodgment such as Dhatu, Upadhatu, Ashaya,and Avayava. In Sandhigatavata, vitiated Vata lodges in Sandhis. Sandhi is a place where two ormore structures unite. In this context Asthi Sandhi means a junction between two bones.Sandhi is not a single structure rather it is considered as an organ. There are differentstructures, which helps in maintaining the stability of the joint. Snayu or ligament helpsin proper binding of the joint. They unite the bones and help to direct the bone movementand prevent the excessive and undesirable motion. Muscle tone helps to maintain thealignment of the joint. Shleshaka Kapha or Synovial fluid, which fills up the cavities,occupies the Synovial joint, bursae and tendon sheaths. It provides the lubricant factors,nutrient to the cartilage, disc, and helps in keeping the joint firmly united. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 192 Sandhigatavata
  • 211. DiscussionShleshmadharakala situated in the joints supported by Shleshaka Kapha helps inlubrication. Nidana: The excessive intake of dravyas having, Laghu, Ruksha, Sukshma etcproperties vitiates the vata which gets lodged in sandhis where khavaigunya is alreadypresent. That sthanasamshrita vitiated vata then by the property of Rukshana, dries up theSnehana present in that joint and causes the features like Vatapoornadrutisparsha, Shotha,Prasarnaakunchana sa vedana, Sandhi atopa etc and hampers the normal function sandhiis known as Sandhi gata vata. Samprapti: The samprapti of Sandhigatavata may be divided into DhatukshayaJanya and Avarana Janya. Even the contemporary science explains the pathology in twosettings. One is due to the sub standard biomaterial of the joint (Dhatukshaya). Second isdue to increased applied pressure over the joint (Avarana). In Dhatukshya Janya Sandhigatavata due to old age, because of vatakara aharavihara there will be qualitative change in the joint material gradually leading to diseasemanifestation. The other set of samprapti where in due to continuous pressure due to obesity thejoint may get affected leading to disease manifestation. This demarcation in sampraptihelps in planning the treatment. Lakshana: The different lakshanas of Sandhigatavata like, viz. Vata purna drutisparsha, Sandhishothaha, Prasarana akunchanayoho savedana pravruthihi, Sandhi Atopa,Sandhi sthamba, Sandhigati asamarthata, Sandhi vishleshya etc are explained by varioustext books of Ayurveda. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 193 Sandhigatavata
  • 212. Discussion Modern science has also listed the same features along with other symptomspertaining to individual joints. Also tenderness and joint stiffness (implied by therestriction of joint movements) find special mentioning in Modern science. It hasmentioned that any joint can get affected with Osteoarthritis. In this view, they haveconsidered the weight bearing joints of the knees, hips, lower spine and peripheral jointsof fingers and toes and conditions of Lumbar spondylosis also as the Osteoarthritis of theintervertebral joints. Sandhigatavata is commonly observed in Janu sandhi because it is a majorweight bearing and mobile joint of body. It is more prone to trauma as a result of obesityand physical activities like jumping , running, squanting and long standing.Whichinterferes not only with the physical activity but entire quality of life and in the presentclinical study all 30 patients reported complaints of knee joint involvement. The degeneration of Bone (asthidathu) is the emerging lifestyle disease in thepresent era. Osteoarthritis being a degenerative type of disease, its manifestation is morein old age persones. As explained in Ayurvedic classics, this is the age in which all Dhatuare already deranged because of vata prakopa. It is explained in contemporary sciencethat, there is a steady raise in overall prevalence from age 30 such that by 65, 80% ofpeople have some radiological evidence of Osteoarthritis, though only 25-30% haveassociated symptoms. In this study, only one patient recorded in age group between 31-40yrs, four in between 41-50yrs, 12 in between 51-60yrs and 13 patients were fall under61-70 age group. This view supports the ayurvedic concept. Vatakara nidanas including Vardhakya avastha characterized by dhatu kshayaleads to vata prakopa in the body, which in turn, vitiates the Kapha, (shleshaka kapha) Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 194 Sandhigatavata
  • 213. Discussionpresent in Sandhis thereby resulting in karma hani of the sandhis. Dhatusaithilya isanother feature in vardhakya, which applies to mamsa dhatu, also reflecting in peshis andsnayus thereby reducing their functional competency in supporting the joints. This is amajor risk factor for Sandhigatavata. Sadyasadyata: Eventhough Sandhigatavata is not a fatal disease, it cripples themovement of patient and makes him/her dependent on others i.e. Paratantra accordingAyurveda. In general Vatavyadhis are considered as one among the Mahagadas byacharyas309 as there are structural changes in the joints. Astivaha srotas: Medas and Jaghana are considered as Astivaha srotomula. TheMedas possibly related to red marrow which is known as ‘sarakta medas’. It can beunderstood by the view of modern medicine as they stated that Human skeletal systemdevelops from mesoderm and neural crest. Mesenchyme is also of mesoderm in origin. Itcan migrate and differentiate in many ways and can become fibroblasts, chondroblasts orosteoblasts. Chikitsa: The chikitsa sutra of Sandhigatavata is Snehana, Svedana andAgnikarma and for the Asthi pradoshaja vikaras Panchakarma is specificaly indicated.Since it is a Vata Vikara related to Asti sandhis and Dhatukshaya is the resultant,Snehana in the form of Vasti would be an ideal line of treatment. S0 in present clinicalstudy, Matravasti is administered with Kethakyadi taila. Where in contemporary science,treatment is non-specific and symptomatic which mainly based on Non–pharmacologicalmethods and analgesics. Among Non–pharmacological treatment much importance isgiven to physical heat therapy, physiotherapy etc. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 195 Sandhigatavata
  • 214. Discussion2. Discussions on the materials and methods:A. Drugs used in the trial work:Kethakyadi Taila: The Kethakyadi taila, which is explained in Sahasra yoga, Taila prakarana isselected for present study. This taila is indicated in the Astigata vata, as the Astidhatu isthe main composition in forming Asti sandhis along with Peshi, Snayu etc. The composition of this Taila includes Kethaki Mula, Bala and Atibala. TheAstavashesha kashaya of these drugs were used in preparation. As the separate KalkaDravya is not mentioned in this yoga, the kalka of same drugs were used. Thecomposition of Kalka, Taila and Drava dravya were taken in the proposition of 1:4:16respectively as the general rule of Taila Kalpana. For the Drava dravya equal quantity ofKashaya and Tushodaka was used as mentioned in Yoga. The Kethakyadi Taila is also explained in Baishajya Ratnavali, VangasenaSamhita but the composition defers as they mentioned the Naga bala instead of Bala andnot specified the part of Kethaki. Other ingredients and indications are same.Moorchita Tila Taila: The Murchita Tila Taila is used for the sthanika abhyanga in the Kati and Udarapradesha before the Matravasti, as explaine in clasics that Vasti should be administeredafter Snehana and Swedana.B. Posology:Arohana Krama Matra vasti: Here Matra vasti is administered for nine days in increasingorder of the dose of Taila. First day started with 48ml (1pala). Daily 12ml (1/4th pala) wasincreased till 9th day i.e. 144 ml. This posology is formulated on the basis of Acharya Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 196 Sandhigatavata
  • 215. DiscussionAddamall’s opinion on three doses of Matra vasti explained in Sharangadhara Samhita310.The Madyama Matra is considered here. In Chakradatta, Acharya explained the Arohanakarma of Anuvasana vasti. The doses were identical to that of Acharya Adamalla’sopinion311.Sadharana Krama Matra vasti: Here Matra vasti is administered in fixed dose of 72ml(1½ pala) for nine days. The dose was fixed on the basis of Commentator Chakrapanisopinion on the dose of Matravasti explained in Charaka samhita312. The AcharyaSushruta’s opinion was also considered as he explained that, the dose of Matravasti ishalf of that of Anuvasana vasti313. Acharya Chakradatta (Chkradatta. 72/3) andVangasena (Vangasena samhita 83/20) also mentioned the three doses of Anuvasanavasti. The hruswa matra is identical that of dose of Matra vasti.In Sadharana Krama Matra vasti: It was administered for Nine days. It was framed byconsidering the opinion of Acharya Sushruta that, Snehavasti administered for 8 daysreaches upto Astidhatu and which administered for 9 days reaches upto Majja Dhatu. AsAsti and Majja dhatu were interrelated to each other, it was administered for 9 days.3. Discussion on Clinical Study: The Patients were selected from OPD and IPD of D.G.M. Ayurvedic MedicalCollege & Hospital, Gadag after applying the Inclusion and Exclusion criteria. Then theyare randomly distributed into two groups- Group A and Group B and treatment wasadministered. Totally 34 patients were registered out of which 4 patients discontinued thetrial because of personal problems. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 197 Sandhigatavata
  • 216. Discussion The laboratory tests like Hb%, TC, DC, ESR were done to assess the generalcondition of the patient and to exclude the other systemic diseases. RBS was performedto rule out Diabetes, as in Prameha continuous administration of Snehavasti wascontraindicated. The radiology of the affected joint was performed in each patient asdiagnostic criteria and also to exclude the conditions associated with simple or compoundfractures. After scrutinizing the Ayurvedic literature, Prasarana Aakunchanayoho savedanapravruthihi, Atopa, sandhishothaha, Sthamba, Sandhigati asamarthata, Walking time (tocover 21meters) and WOMAC were fixed as the parameters for clinical assessment. In Both group the Matra vasti was administered in Morning hours between 8AMto 10AM after light breakfast. The Sthanika Snehan and Swedana was performed aspurvakarma, as explained by all Acharyas that Vasti should be administered afterSnehana and Swedana. The Sthanika Abhyanga was done to kati, prushta, udarapradesha with Murchita Tila Taila and Mrudu Swedana was performed by Nadi Sweda. Then Vasti was administered in lying on left lateral position as explained inclassics. After Vasti pranidhana, patient was asked to be in supine position for about 10minutes to avoid quick pratyagamana of vasti dravya. After taking rest for 1 hour,patients were asked to take bath with hot water and also instructed to note down the timeof Vasti dravya pratyagamana as the patients were from OPD.Total duration of Vasti Dravya Retentions: The total period of Vasti dravya retention was calculated by note downing thetime of Vasti pranidhana and Vasti Pratyagamana. The average duration of retention wascalculated. In Group A (Arohana krama) it was 7.2 hours and in Group B (Sadharana Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 198 Sandhigatavata
  • 217. Discussionkrama) it was 8.3hours. Even though comparatively large dose of sneha was administeredin Group A, there is no much difference in both groups. This supports the assumptionthat, gradual increase in dose of Matravasti facilitates the longer duration of retention.Assessment results: The efficacy of Matravasti in Sandhigatavata with Kethakyadi taila in Arohanakrama and Sadharana krama was accessed by setting of criteria as discussed in materialsand methods section earlier. Here the base line data was compared with the data takenafter 18 days of therapy; this is because the parihara kala of basti is told as double thedays of administration of basti karma. Hence it is postulated that the result of basti can bebest seen after parihara kala or to show the efficacy, basti requires double the days of itscoarse. In this study the course of therapy was 9 days and hence the results were accessed18 days after the therapy i.e. on 27 thday after the first day of Bastikarma initiation.4. Discussions on the patients of Sandhigatavata who underwent the trial.Age: In this clinical study, among 30 patients, 25 patients (83.33%) belonged to the agegroup 50-70 there by supporting the association of vardhakya avasthaSex: In this clinical study, among 30 patients14 patients (46.66%) were males and 16patients (53.33%) were females. It is told that women are at high risk than men indeveloping OA. This substantiates the observation made by earlier researchers that thisdisease prevalence is more in women than men.Religion: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 199 Sandhigatavata
  • 218. Discussion This study shows a greater prevalence of sandhigatavta in Hindu 23 (76.66%)patients. Higher geographical proportion of Hindus in and around this area may be thereason for its higher incidence in Hindu.Occupation: In the present study, 08 (26.66%) patients belonged to the Labor group, 20(66.66%) were belonging to sedentary category and 02 patient (06.66%) belonged to theexecutive group of occupation. In this study the more peoples are belonged to sedentary group, this may bebecause of the appearance of features of Sandhi-gata-vata triggered by the ageing, whowere in retired life but had the history of hard work. It was also evidenced that, excessivehard work usually seen in labor group is more prevalence to Sandhigata vata. Thisstrengthens the view point that this disease is triggered by excessive physical activity likeexcessive hard work/labour (ati vyayama).Economical status: Socio-economical status showed 16 patients (53.33%) were belonged to lowermiddle class, 10 patients (33.33%) were of upper middle class and 04 patients (13.33%)were belonged to the poor class. None were from rich. This evidenced thatSandhigatavata is more prevalent in lower middle class, who were hard workers andfemales from this group usually housewives and busy in continuous home activities.Diet: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 200 Sandhigatavata
  • 219. Discussion It was observed that 10 (33.33%) patients were vegetarians and 20(66.66%)patients were taking mixed diet in this study. But there is no specific incidence of diseasewith diet.Prakruti: In the present study, it was observed 11 patients (36.66%) of were of the Vata-pitta prakriti, 19 patients (63.33%) of were of the Vata-kapha prakriti. Hence, majority ofthe patients were having the existence of Vata dosha in their prakriti constitution. Thisshows the Vata prakriti person is more prone to vataja set of diseases.Nidra: Among 30 patients, 19 (63.33%) were had Alpa nidra, 11 (36.66%) were hadPrakrutha nidra. This shows that, ratri jagarna (alpa nidra) is a predisposing factor forVata vriddhi.Satmya: Among 30 patients, 29 patients (96.66%) were Rooksha satmya and only onepatient (06.66%) was Snigda satmya. This is because of normal food habit of this regioni.e. peoples will use Kadak rotti, more spicy food article etc in daily food. As explained inclassics, this rooksha stmya can be considered as a contributing factor for Vata prakopaand in turn leads to Sandhi-gata-vata.Nidana:Among 30 patients, 23 patients had katu rasa atisevana, 03 patients had tikta rasaatisevana, 11 patients had alpa bhojana, 23 patients had rooksha bhojana, 07 patients hadNisha jagarana and 23 patients had Ativyayama. These are the some factors explained in Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 201 Sandhigatavata
  • 220. Discussionthe Samanya Vatavyadhi Nidana. This supports and validates the presumption that madeearlier that Vatavyadhi samanya nidana can be taken as nidana for sandhigatvata.Presenting complaints:Prasarana akunchanayoho savedana pravritti: Among the 30 patients included in thisstudy, all the patients had this symptom. In fifteen patients of Group A, 02 (13.33%) werecomplained continues pain (Sever), 13 (86.66%) were complained pain frequently whenmoves the joint and none were had mild pain which reveals on enquiry and without pain,in Group B, 03 (20.00%) were complained continues pain (Sever), 12(80.00%) werecomplained pain frequently when moves the joint and none were had mild pain whichreveals on enquiry and without pain. Overall out of thirty patients, 05 (16.66%) werecomplained continues pain (Sever), 25 (83.33%) were complained pain frequently whenmoves the joint and none were had mild pain which reveals on enquiry and without pain.It is explained in contemporary science that, Pain may directly related to theOsteoarthritis process through increased pressure in subcondral bone, trabecular microfractures, capsular distention and low-grade synovitis or result from bursitis andenthesopathy secondary to the altered joint mechanism. The typical characteristic of painincludes, pain mainly related to movement and weight bearing, relieved by rest.(Davidson’s Pg no: 998). This closely simulates the main features of Sandhigatavataexplained in Ayurvedic classics and also supports the observations made in this study.After follow-up: In Group A, none (00%) were complained continues pain (Sever, Grade3), 01 (06.66%) was complained pain frequently when moves the joint (Grade 2), 12(80.00%) were complained mild pain (Grade 1) and 2 (13.33%) patients were reportedwith no pain (Grade 0). So, there was 56.25% improvement in this group. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 202 Sandhigatavata
  • 221. DiscussionIn Group B, none (00%) were complained continues pain (Sever, Grade 3), 03(20.00%)were complained pain frequently when moves the joint (Grade 2), 10 (66.66%) werecomplained mild pain (Grade 1) and 2 (13.33%) patients were reported with no pain(Grade 0). So, there was 51.54% improvement in this group.Overall: Out of thirty patients, none (00%) were complained continues pain (Sever,Grade 3), 04 (13.33%) were complained pain frequently when moves the joint (Grade 2),22 (73.33%) were complained mild pain (Grade 1) and 4 (13.33%) patients were reportedwith no pain (Grade 0). So there was 53.89% of improvement was noted in this clinicalfeature.Sandhi Atopa: Palpable, sometimes audible, coarse cripitus indicative of rough articularsurface is seen in Osteoarhritis can compare with Sandhi Atopa. In all patients undergonethis clinical trail had the crepitations either palpable or audible. In Group A, it was heardin 06 (40.00%) number of Patients (Grade 2); in 09 (60.00%) patient’s crepitation is onlyfelt (Grade 1). In Group B, heard in 08 (53.33%) number of Patients (Grade 2), in07(46.66%) patients it was only felt (Grade 1). Overall in 13 (43.33%) patients it wasaudible and in 17 (56.66%) it was only palpable.After follow-up: In Group A, Sandhi Atopa (Crepitation) was heard in 02 (13.33%)Patients (Grade 2); In 12 (80.00%) patient’s only felt (Grade 1), and 01 (06.66%) patientreported with no crepitation (Grade 0). So there was 23.85% improvement in Atopa inthis Group. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 203 Sandhigatavata
  • 222. DiscussionIn Group B, heard in 06(40.00%) Patients (Grade 2); In 09 (60.00%) patient’s only felt(Grade 1) and none were reported with No crepitations (Grade 0). So there was 04.50%improvement in Atopa in this Group.Overall, out of thirty patients it was heard in 08 (26.66%) Patients (Grade 2), In 21(70.00%) only felt (Grade 1) and one (03.33%) reported with no crepitations. So therewas 14.17% improvement in Atopa.Shothaha: Out of thirty patients, 26 patients (86.66%) had shothaha over sandhi. Eventhough Acharyas like Charaka, Vagbhata etc were explained Vatapurna druti sparsha asone of the feature of Sandhi-gata-vata. But no explanations are available about how toelicit this feature. Even commentators were silent on this aspect. The swelling over jointslightly resembling air filled bladder can be compared with shotaha. So in this study onlyShotha was considered for diagnosis and assessment.In GroupA, Out of fifteen patients, 03 (20.00%) were not had any Shotha (Grade 0), 04(26.66%) were had slightly obvious shotha (Grade 1), 06 (40.00%) were had Shothawhich covers well over the bony prominence (Grade 2), 02 (13.33%) were had muchelevated shotha over sandhiIn Group B, 01 (06.66%) were not had any Shotha (Grade 0), 05 (33.33%) were hadslightly obvious shotha (Grade 1), 09 (60.00%) were had Shotha which covers well overthe bony prominence (Grade 2), none were had much elevated shotha.Overall, Out of thirty, 04 (13.33%) were not had any Shotha (Grade 0), 09 (30.00%) werehad slightly obvious shotha (Grade 1), 15 (50.00%) were had Shotha which covers well Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 204 Sandhigatavata
  • 223. Discussionover the bony prominence (Grade 2), 02 (06.66%) were had much elevated shotha overthe sandhi before the treatment.After follow-up: In Group A, 12 (80.00%) were not had any Shotha (Grade 0), 02(13.33%) were had slightly obvious shotha (Grade 1), 01 (06.66%) had Shotha whichcovers well over the bony prominence (Grade 2), none were reported with much elevatedshotha over sandhi. So there was 81.85% improvement in clinical feature Shota.In Group B, 07 (46.66%) were not had any Shotha (Grade 0), 08 (53.33%) were hadslightly obvious shotha (Grade 1) and none were had Shotha which covers well over thebony prominence (Grade 2) or much elevated shotha over sandhi (Grade 3). So there was65.23% improvement in clinical feature Shota.Overall, 19(63.33%) were presented with no Shotha (Grade 0), 10(33.33%) were hadslightly obvious shotha (Grade 1), only 01(03.33%) had Shotha which covers well overthe bony prominence (Grade 2), none were had much elevated shotha over the sandhi(Grade 3). So overall improvement, in this clinical feature was 73.54%.Sthamba: Brief (<15minutes) morning stiffness and brief (<1 minutes) getting after rest isseen in Osteoarthritis. The feature of Sandhigatavata, Sthamba explained in classics cancompare with this. In present study all were complained about brief morning stiffness andgetting after rest before treatment.After follow-up: In Group A, Out of fifteen patients, 10 (66.66) patient’s relieved fromcomplaint Sthamba and 5 (33.33%) patient had. So, there was 66.7% improvement in thisclinical feature. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 205 Sandhigatavata
  • 224. DiscussionIn Group B, 11 (73.33%) patient relieved and 4 (26.66%) patient had complaint ofSthamba. So, there was 73.4% improvement in this clinical feature.Overall, 21 (70%) patients relieved the where 9 (30%) had complaint Sthamba. So,improvement was 70.05%.Sandhigati Asamarthytha: Restricted movement in joints because of capsular thickening,blocking by osteophytes are commonly seen in Osteoarthritis. Before the treatment thedistribution of patients with this complaint were as follows,In Group A, Out of fifteen patients, none (00%) were had full range of movement (Grade0), One (06.66%) was had >75% and <full range of movement (Grade 1), 09 (60.00%)were had 50-75% of the full range of joint motion (Grade 2), 05 (33.33%) were had up to50% of the full range of joint motion (Grade 3) and none (00%) were had complete lossof joint motion (Grade 4).In Group B, none (00%) were had full range of movement (Grade 0), One (06.66%) washad >75% and <full range of movement (Grade 1), 13(86.66%) were had 50-75% of thefull range of joint motion (Grade 2), 0ne (06.66%) had up to 50% of the full range ofjoint motion (Grade 3) and none (00%) were had complete loss of joint motion (Grade 4).Over all, among thirty patients, none (00%) were had full range of movement (Grade 0),02 (06.66%) were had >75% and <full range of movement (Grade 1), 22 (73.33%) werehad 50-75% of the full range of joint motion (Grade 2), 06 (20.00%) were had up to 50%of the full range of joint motion (Grade 3) and none (00%) were had complete loss ofjoint motion (Grade 4). Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 206 Sandhigatavata
  • 225. DiscussionAfter follow-up: In Group A, 04 (26.66%) were had full range of movement (Grade 0),09 (60.00%) were had >75% and <full range of movement (Grade 1), 02 (13.33%) werehad 50-75% of the full range of joint motion (Grade 2) and none were had up to 50% ofthe full range of joint motion (Grade 3) or complete loss of joint motion (Grade 4). So,there was improvement in this clinical feature was 61.78%.In Group B, 02 (13.33%) were had full range of movement (Grade 0), 12 (80.00%) werehad >75% and <full range of movement (Grade 1), 01(06.66%) had 50-75% of the fullrange of joint motion (Grade 2), and none were had up to 50% of the full range of jointmotion (Grade 3) or complete loss of joint motion (Grade 4). So improvement was53.35%.Over all, Out of thirty patients, 06 (20.00%) were had full range of movement (Grade 0),21 (70.00%) were had >75% and <full range of movement (Grade 1), 03 (10.00%) werehad 50-75% of the full range of joint motion (Grade 2), and none were had up to 50% ofthe full range of joint motion (Grade 3) or complete loss of joint motion (Grade 4). Soimprovement in this clinical feature was 57.56%.Duration of the disease: Among the 30 patients, 08 (26.66%) were had the chronicity less then 1 years, 06(20.00%) were had the chronicity in between 1-2 years, 07 (23.33%) patients were hadchronicity in between 2-3 years. 03 (10.00%) were in between 3-4 years and 05 (16.66%)were had chronicity in between 4-5 years. Only one (06.66%) had chronicity more than 5years. This indicates the long standing nature of Vatavyadhi. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 207 Sandhigatavata
  • 226. DiscussionRadiological interpretations: Among 30 patients in this study, 9 Patients of Group A (60%) and 7 patients ofGroup B(46.66%), Overall 16 patients had their affected joint space Reduced (53.33%),One patient from Group A (6.66%)and Two from Group B (13.33%), totally 03 patientshad their affected joint space unaltered (10%), none patients had their affected joint spaceincreased. 22 patients had subchondral bony sclerosis (73.33%), 16 patients hadosteophytes formation (53.33%), 08 Patients had altered bone end (26.67%) and nopatient had periarticular ossicles.5. Discussions on observations made on results: Assessment of the results was done by considering the subjective criteriaand objective criteria. Totally 7 criteria were taken with different gradings as explained inMethodology. The statistical result showing the significance has already been discussedin the observation part. Here % of improvement is calculated to know the efficacy and netimprovement in the condition. For this purpose the values were observed numerically which are given thegradings.Step 1 – All the values of before treatment of subjective and objective parameters wereadded to get the sum. Now this is the condition in which the patient had approached us,so it becomes the base line data. This is taken as 100%.Step 2 – The readings of after treatment was then added to get the sum, which is thestatus of the patient after the treatment. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 208 Sandhigatavata
  • 227. DiscussionStep 3 – Now the % of the condition after the treatment is calculated by dividing thisnumber with the base line data obtained by the step 1. This should then multiply by 100to get the % after the treatment.Step 4 – The % of improvement is calculated by subtracting the value got by step 3 by100 will yield the net improvement in the disease.Step 5 – This value was referred for the table postulated to declare the results.Table No.87: Showing the Percentage Improvement of Parameters in each patient:Group A – Arohana Krama Group B – Sadharana KramaSI No OPD No % improvement SI No OPD No % improvement01 4125 54.34 % 01 4249 39.62 %02 4360 38.98 % 02 4246 57.50 %03 4375 69.76 % 03 4340 53.70 %04 4412 56.86 % 04 4367 52.54 %05 4435 78.72 % 05 4775 37.25 %06 4478 53.70 % 06 4981 54.71 %07 4480 46.93 % 07 5646 34.48 %08 5697 44.68 % 08 5688 59.32 %09 6197 42.85 % 09 6284 54.34 %10 6203 50.00 % 10 6312 37.50 %11 6337 50.00 % 11 6814 58.18 %12 7874 37.50 % 12 1310 39.28 %13 8230 52.72 % 13 1426 50.00 %14 8234 39.28 % 14 2327 51.72 %15 8335 44.00 % 15 6448 65.45 %1 >75% GR - Good Response2 50-75% MR - Moderate responseSl. No.3 Up to 50% improvement % Range of net Remarks response PR - Poor Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 209 Sandhigatavata
  • 228. Discussion4 0% NR - No responseDeclaration of the result by above method:Group ASl.No. Impression No. of patients % of patients1 Good Response 01 06.66 %2 Moderate response 07 46.66 %3 Poor response 07 46.66 %4 No response 00 00 % In this group, the chief complaint Prasaarana Aakunchanayoho SavedanaPravruthi i.e Pain in joint while Flexion and Extension was reduced up to 50% in most ofthe patients on 5th or 6th day. The sign Sandhi Sothaha was observed to decrease slowly;on the fifth or sixth day more than 50% decrease was noted. The complaint SandhigatiAsamarthata and Sandhi sthamba were improved about 75% on 9th day. The othercomplaint, Sandhi atopa not shown much change during the period of treatment, Only in5 patients changes were noted after follow up. The recurrences of the complaints werenot observed during the period of follow up.Group BSl.No. Impression No. of patients % of patients1 Good Response 00 00 %2 Moderate response 10 66.66 %3 Poor response 05 33.33 %4 No response 00 00 % There was no much difference in response was noted during the treatment periodin both group. Here also the complaint Prasarana Akonchanayoho Savedana Pravruthi Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 210 Sandhigatavata
  • 229. Discussionwas reduced about 50% on 5th or 6th day. Other complaints were also responded similarlyas seen in Group A patients. Only the Parameter Atopa not had shown any changes infourteen patients even after follow up.Mean Percentage improvement in each Parameter: The mean percentage of improvement in each parameter was calculated to knowthe effect of treatment on individual parameters. These was calculated by using thefollowing formula. (Before Treatment Mean) – (After treatment Mean) X 100Mean % Improvement = (Before Treatment Mean)The obtained values are as follows:Table No. 88: Showing the Percentage Improvement of Parameters:SI No Parameter Group A Group B Overall01 Prasarana Akonchanayoho 56.25 % 51.54 % 53.89 % Savedana pravrutti02 Sandhi Atopa 23.85 % 4.50 % 14.17 %03 Sandhi Shota 81.85 % 65.23 % 73.54 %04 Sthamba 66.7 % 73.4 % 70.05 %05 Sandhigati Asamarthata 61.78 % 53.35 % 57.56 %06 Walking Time 53.84 % 43.61 % 48.72 %07 WOMAC 51.77 % 50.07 % 50.92 % Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 211 Sandhigatavata
  • 230. DiscussionFigure No.52: Showing the Percentage Improvement of Parameters:908070 Vedana60 Atopa50 Shota40 Stham ba Sandhigati Asam arthata30 Walking Tim e20 WOMAC100 Group A Group B Total By the above observations, except the Parameter Sthamba, all other parametersare shown the better improvement in group A than Group B. Among all parameter theSandhi Shota had shown the highest percentage (81.85 %) improvement in group A andin Group B the Stamba had shown highest percentage (73.4 %) of improvement.Overall response of patients: In group A, one patient (06.66%) shown Good response (> 75% improvement insubjective and objective parameters), where 7 patients (46.66 %) were shown Moderateresponse (50-75% improvement in subjective and objective parameters) and 7 (46.66 %)were shown Poor response (<50% improvement in subjective and objective parameters)to the treatment. In Group B, 10 patients (66.66 %) were shown Moderate response (50-75%improvement in subjective and objective parameters) and 5 patients (33.33 %) were Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 212 Sandhigatavata
  • 231. Discussionshown Poor response (<50% improvement in subjective and objective parameters) to thetreatment. None were shown Good response or No response. In total thirty patients, only 01 (03.33%) patient shown Good response to thetreatment. 17 (56.66%) were shown Moderate response and 12 (40.00%) patients shownPoor response. None were shown No response. To compare the effectiveness of the treatment procedure, the statistical analyses isdone by using Un-paired t-test, by assuming that the mean effect treatment procedures issame in both the groups after treatment procedure. From the analyses all parametersshows non-significant (as P>0.05). i.e., the mean effects of treatment same in allparameters. To know among which Group treatment procedure is more effective, thestatistical analyses is done by using paired t-test, by assuming that the drug is notresponsible for changes in before and after the treatment procedures.All the parameters shows highly significance in both the Groups as P<0.05 the parameteratopa shows more significance in group A rather than group B which is not significant.In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba, SandhigatiAsamarthata and Walking time shows more highly significant (By comparing t-values)than Group B . In Group-B the parameters Shota, Sandigathi Asamarthatha and WOMACshows more highly significant than group A.Statistical Conclusion: By comparing results of Group A and Group B, it is concludedthat Group A (Arohana Krama Matravasti) is more effective than Group B (SadharanaKrama Matravasti) in almost all parameters (Except the Atopa which is not significant).The study reviles that in both Group A and Group B, therapy is effective as it decreases Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 213 Sandhigatavata
  • 232. DiscussionSandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana, Walking time andStahmaba.6. Mode of Action Of Therapy: Here in this study the two different varieties of Matravasti i.e. Arohana Kramaand Sadharana Krama, was administered and their efficacy in Sandhigata vata is assessed.The probable modes of action of the therapy can be understood by considering thegeneral mode of action of Vasti, which are explained earlier in the context of literaryreview of Vasti karma. The drugs administered though the anal route i.e. Pakwashaya gata vasti directlyact over the Udbhavasthana of Vatavyadhi including Sandhigata vata as Pakwashaya isconsidered as Udbhavasthana of Vatavyadhi. The Matravasti was administered in Left lateral position as explained inAyurvedic classics. The benefits of this position were explained elaborately in classics.Acharya Charaka opines that, gudavalees will be relaxed in this posture and also Grahaniand Guda present in Vama parshwa (Left side). So vasti dravya reaches these organseasily, if the patient receives vasti in left lateral position. Acharya Gangadhara says;Agni, Grahani and Nabhi are present in the left side. Jejjata comments Agni is present inleft side over the Nabhi, Guda has got a left sided relation with Sthoolantra. Sovastidravya can reach to the large intestine and Grahani, as they are present in the samelevel. So can do the persuasion that, Agni may act over the sneha administered throughmatravasti and help in the action of that Snehadravya. The modern Anatomy supports thisview as – In this posture; anal canal turns to left side to rectum, sigmoid colon and Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 214 Sandhigatavata
  • 233. Discussiondescending colon. Moreover, medicines stay at these surfaces and gets absorbed moreand show its effect. The absorptive area of mucosa is more on left side and it is easilyapproachable through anus rather than on the right side and this posture relaxes the ileo-ceacal juction and makes the easy flow of Vastidravya into the sigmoid colon. Action of Matravasti is possible by Anupravaranabhava of vastidravya, whichcontains sneha. Sneha easily moves up to Grahani by Anupravanabhava guna. Matravastiacts mainly on Asthi and Majjavaha srotas. Asthi is the Ashrayasthana of Vata dosha.Dalhana says that Pureeshadharakala and Asthidharakala are one and the same. So wecan assume that if pureeshadharakala gets purified and nourished; the asthivaha srotaswill also be purified and nourished. Pittadharakala and Majjadharakala and Grahani parttakes in the action of Matravasti. Vastidravya enters till Grahani (Pittadhara Kala) whichis the seat of agni. The nutrients may get absorbed and thereby nourishes theMajjadharakala, which is having a strong bond with Pittadharakala and Vata. Matravastiof Kethakyadi taila comprises Kethaki mula, Bala, Atibala and Tilataila, having theproperties like Snigdha guna and Vatashamaka and acts as balya and vatahara. Thusprovides significant effect on almost all the symptoms of Sandhigatavata. The absorption of Taila is enhanced by the longer duration of retentions of Vastidravya. According to modern science, the rectum has a rich blood and lymph supply.Drugs can readily cross the rectal mucosa like other lipid membrane. As per Vasti/Enemaconcerned, in trans-rectal route, the unionized and lipid soluble substances are readilyabsorbed from the rectum. The concentration gradient of Matravasti dravya is moreinside the lumen of intestine as compared to rectal venous plexus, which facilitates theabsorption. This rectal venous plexus further divided into internal venous plexus and Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 215 Sandhigatavata
  • 234. Discussionexternal venous plexus. Internal venous plexus, situated in the submocosal layer of analcanal and carries into superior rectal vein and to external venous plexus. Vasti dravya isalso absorbed from external venous plexus in three parts, i.e. in lower part throughinferior rectal veins and drained into internal pudendal vein, in middle part throughmiddle rectal vein which is having tributaries, those drains from bladder, prostate andseminal vesicle into internal iliac vein, in upper part through superior rectal vein intoinferior mesenteric vein a tributary of portal vein. Matravasti dravya is also absorbedfrom the upper rectal mucosa, and is carried by the Superior mesenteric vein into theportal circulation and enters into Liver. Secondly, the portion absorbed from the lowerrectum enters directly into systemic circulation via middle and inferior hemorrhoidalveins. This indicates that due to more vascularity in this area absorption rate is high. Other major advantage of this route is total gastric irritation is avoided and alsoMetabolism as some portion of absorption from lower rectum directly enters intosystemic circulation. The absorption of Sneha also enhasced by its Hypo osmotic nature.Some studies shown Matravasti have got a property to regulate sympathetic activity,decreases adrenalin and noradrenalin secretion and helps in the balance of autonomicnervous system and also plays major role in maintaining normal bacterial flora. Sandhigata vata required drug which is having two characters like supportive andSupplementary. In supportive aspect it gives relief in symptoms of sandhigata vata. Sothe drug which is having Vatahara properties and Sigda, Picchila etc Kaphavardhakaguna is useful in better way. In supplementary aspect the drug which is having dhatuvardhaka property is useful for prevention or to stop further degenerative changes in thebody. The Kethakyadi Taila having both these properties as its ingredient Kethaki mula, Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 216 Sandhigatavata
  • 235. DiscussionBala and Atibala are known for its Vatahara property; The Tilataila is having snigda,picchila etc Kaphavardhaka guna. The dhatu vardhaka property is seen in all ingredient ofKethakyadi Taila. By considering above explanation it is clear that Vasti dravya is absorbed throughrectal mucosa and carried throughout the general circulation gives local and systemiceffects by controlling Vata which is backbone of the disease pathology.Arohana Krama- Sadharana Krama Matravasti: The Meterials & Methodology in both groups were same except the dose of theSnehadravya. The response in the Arohana Krama Matra vasti group was better compareto Sadharana Krama Matravasti Group. This may be due to the administration ofcomparatively large dose of Sneha in this group and gradual increase in dose whichfacilitated long duration of retention which lead to better absorption.Table No. 89: Indicating retention time of Arohana krama Matravasti:SI No 1st 2nd 3rd 4th 5th 5th 6th 7th 8th 9th Day Day Day Day Day Day Day Day Day Day01 4125 2 3 5.5 5 8 7.5 8 11 1102 4360 1.5 4 5 8 9 10 10 5 503 4375 10 7.5 7.5 2 9 11 11 10 804 4412 3.5 3 4 5.5 4 5 5 4 2.505 4435 7 10 10 11 10 7 7 6.5 7.506 4478 2.5 9.5 10 11.5 12 12 12 4.5 807 4480 4 5.5 6.5 6.5 10 9.5 9.5 6.5 708 5697 6 10 9 11.5 11.5 12.5 11.5 8 809 6197 2 3 6 4 4 7.5 4 4 410 6203 7 3.5 7.5 9.5 9.5 7.5 7 9.5 7.511 6337 6.5 5 6 8.5 9.5 7.5 7.5 7.5 912 7874 5 7 10 10.5 11.5 10.5 10.5 7.5 713 8230 2 2.5 3 3 4.5 3.5 3.5 3.5 3.514 8234 2 5 6 8 8 4 4 6 615 8335 7 9 7 11 12 11 11 9 9Average 4.5 5.8 6.86 7.7 8.8 8.46 8.1 6.83 6.86 Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 217 Sandhigatavata
  • 236. Discussion There is a gradual increase in the duration of retention in initial days. Themaximum time of retention noted on 5th day with the dose of 96 ml. Then the timegradually decreases for small extent in succeeding four days as dose of Matravastiincreases. This comparative long duration of retention may be because of adoptivemechanism of organs to withhold the dose of Vasti. This supports the view thatSandhigata vata requires the large dose of sneha internally and Vasti can be consider as aroute of administer this sneha. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 218 Sandhigatavata
  • 237. ConclusionConclusion:Finally the following conclusions are drawn:- • Arohana krama matravasti can be practiced safely without any adverse effect. • Overall the group A is more effective clinically and statistically than group B in almost all the parameters. • Arohana Krama matra vasti can be considered for future studies in Uttama Matra. (As explained by Acharya Adamalla). • This study should be done on large sample so that definite conclusions can be drawn as the present study is limited to small sample of 30 patients. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 219 Sandhigatavata
  • 238. SummarySummary: The thesis entitled “Evaluation on the effect of Matravasti in Sandhi gata vatawith Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinicalstudy” is summarized as under. The Sandhigata Vata explained in Ayurvedic classics as Sthana vishesha krutaVatavyadhi, under the concept of Gatavata. The vitiated Vata dosha get lodged in Astisandhis and give raise to Sandhigata vata. This is one of such disease commonly affectinga large number of elderly individuals. This disease can be compared with Osteoarthritisof contemporary medical science. Osteoarthritis is an important cause of disability inhuman beings. It is characterized by focal loss of cartilage with evidence ofaccompanying periarticular bone response in the form of sub condral sclerosis andattempted new bone overgrowths called osteophytes. It cleanically presents as joint painand crepitus in the elderly age group. According to W.H.O Osteoarthritis is the secondcommonest musculoskeletal problem in the world population (30%) after back pain(50%). The reported prevalence of O.A from a study in rural India is 5.78 %. InAyurveda, all Acharyas have given prime importance to Snehana Chikitsa in themanagement of Sandhigatavata. Snehana can be performed both Bahya and Abhyantara.Bahya snehas include abhyanga, tarpana, murdhni taila etc and Abhyantara snehasinclude bhojana, pana, nasya and Vasti. These suggest that treatment measures proposedin case of Sandhigatavata are mainly aimed at Brumhana. Matravasti is a variety ofAnuvasana vasti which does not produce any complications. It can be performed indurbala and vruddha, where other vastis are usually contraindicated. As Sandhigatavata isthe disease of elderly, Matravasti which acts as vatahara, brumhana and balya can be Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 220 Sandhigatavata
  • 239. Summaryconsidered as best line of treatment. But in Matravasti comparatively small quantity ofSneha is administering. To administer a large dose of Sneha in this condition, Arohanakarma as explained by Acharya Adamalla was considered in this study.Objectives of the study: e) To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days by using Kethakyadi taila in Sandhigatavata. f) To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata. g) To evaluate the adverse- effects of Arohana krama Matravasti if any. h) To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as well as Sadharana karma in Sandhigata vata. Matravasti is a variety of Snehavasti based on vasti dravya pramana. The dose isequal to Hruswa sneha pana Matra. Direct reference on Matravasti is not visible in Vedasbut detailed descriptions were found in most of all Ayurvedic classics. Matravasti is atype of Anuvasana vasti which is having main ingredient sneha. Arohana krama ofMatravasti was described by Acharya Adhamalla on commenting Shargandhara samhitaUttara Khanda, Vasti vidhi Adhyaya (Fifth chapter). The dose of Sadharana kramaMatravasti is equal to Hruswa sneha pana Matra. The chikitsa sootra of Sandhigatavata is Snehana, Svedana and Agnikarma andfor the Asthi pradoshaja vikaras Panchakarma is indicated. Since it is a Vata Vikararelated to Asti sandhis and Dhatukshaya is the resultant, Snehana in the form of Vastiwould be an ideal line of treatment. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 221 Sandhigatavata
  • 240. Summary Sandhigata vata required drug which is having two characters like supportive andSupplementary. In supportive aspect it gives relief in symptoms of sandhigata vata. Sothe drug which is having Vatahara properties and Sigda, Picchila etc Kaphavardhakaguna is useful in better way. In supplementary aspect the drug which is having dhatuvardhaka property is useful for prevention or to stop further degenerative changes in thebody. The Kethakyadi Taila having both these properties as its ingredient Kethaki mula,Bala and Atibala are known for its Vatahara property; The Tilataila is having snigda,picchila etc Kaphavardhaka guna. The dhatu vardhaka property is seen in all ingredient ofKethakyadi Taila.Study Design: The study design set for the present study is ‘comparative clinical study’.Sample size and Grouping: The sample size for the present study was 30 patientssuffering from Sandhigathavata as per the selection criteria and was randomly distributedto both the groups of equal size. In Group A, 15 patients received Arohana kramaMatravasti and in Group B, 15 patients received Sadharana krama Matra vasti.Inclusion criteria: Patients suffering from classical signs and symptoms of Sandhigatavatalike shotha in sandhi, shoola in sandhi, atopa in sandhi, fit for Vasti karma (Vasti yogya)and between age group of 30 to 70 yrs, No discrimination of sex and chronicity.Exclusion criteria: Patient below 30 yrs & above 70 yrs of age, pregnant women,associated with any other severe systemic diseases like Diabetes, Hypertensions andObesity etc were excluded.Study duration: In both group, Matravasti was administered for 9 days and follow upperiod was 18 days. Total study duration was 27 days.Posology: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 222 Sandhigatavata
  • 241. SummaryArohana Krama: Here Matra vasti is administered for nine days in increasing order ofthe dose of Taila. First day started with 48ml (1pala). Daily 12ml (1/4th pala) wasincreased till 9th day i.e. 144 ml.Sadharana Krama: Here Matra vasti is administered in fixed dose of 72ml (1½ pala) fornine days.Methods of Assessment of Clinical Response: Subjective parameters and objectiveparameters were made out to assess the Clinical response.Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana) andSthamba (Morning stiffness)Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya, Walkingtime to cover 21meters of distance, WOMACResult: All these parameters of baseline data to post-medication data (27th day) werecompared for clinical assessment of the results.In this study, in group A one patient (06.66%) shown Good response (> 75%improvement in subjective and objective parameters) where 7 patients (46.66 %) wereshown Moderate response (50-75% improvement in subjective and objective parameters)and 7 (46.66 %) were shown Poor response (<50% improvement in subjective andobjective parameters).In Group B, 10 patients (66.66 %) were shown Moderate response (50-75% improvementin subjective and objective parameters) and 5 patients (33.33 %) were shown Poorresponse (<50% improvement in subjective and objective parameters).The calculated, mean percentage of improvement in each parameter shown except theParameter Sthamba, all other parameters are shown the better improvement in group A Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 223 Sandhigatavata
  • 242. Summarythan Group B. Among all parameter the Sandhi Shota had shown the highest percentage(81.85 %) improvement in group A and in Group B the Stamba had shown highestpercentage (73.4 %) of improvement.Statastical Analysis: To know among which Group treatment procedure is more effective, thestatistical analyses is done by using paired t-test, by assuming that the drug is notresponsible for changes in before and after the treatment procedures. In analysis, all the parameters shown highly significance in both the Groups asP<0.05. The parameter atopa shows more significance in group A rather than group Bwhich is not significant. In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba,Sandhigati Asamarthata and Walking time shows more highly significant (By comparingt-values) than Group B . In Group-B the parameters Shota, Sandigathi Asamarthatha andWOMAC shows more highly significant than group A.Conclusion: By comparing results of Group A and Group B, it is concluded that GroupA (Arohana Krama Matravasti) is more effective than Group B (Sadharana KramaMatravasti) in almost all parameters (Except the Atopa, which is not significant). Thestudy reviles that in both Group A and Group B, therapy is effective as it decreasesSandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana, Walking time andStahmaba. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 224 Sandhigatavata
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  • 247. Bibliography42. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.2, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.212.43. Acharya Sharangadhara, Sharangadhara Samhita, Uttara Khanda, Chapter 5, Shloka No.1, edited by Pandit Parashurama Shastri Vidyasagar, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.319.44. Acharya Agnivesha, Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka no. 40- 41, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition: Reprint 2008, Page No 684.45. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No. 67-69, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 283.46. Raja Radha Kanta Deva edited Shabda Kalpadruma, 1st volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.189.47. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.328.48. Raja Radha Kanta Deva edited Shabda Kalpadruma, IIth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.338.49. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 29, Shloka no. 5, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 181.50. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Shareera Sthana, Chapter 3, Shloka No.13, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.388.51. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.9, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.52. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.10, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 364.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 229 Sandhigatavata
  • 248. Bibliography53. Pt. Haragovinda Shastri edited Amarakosha, Dwiteeya Khanda, Manushya Varga, Shloka No.73, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthana, Varanasi, Page No. 29354. Raja Radha Kanta Deva edited Shabda Kalpadruma, IIth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.338.55. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Shareera Sthana, Chapter 12, Shloka No.19, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.193.56. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibandhasangraha Commentory on Nidana Sthana, Chapter 2, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 272.57. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 2, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 272.58. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 2, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 272.59. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Shareera Sthana, Chapter 7, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 338.60. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.3, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 369.61. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Shareera Sthana, Chapter 4, Shloka No.1, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.409.62. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 230 Sandhigatavata
  • 249. Bibliography63. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.7, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.64. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.9, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.65. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.29, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 375.66. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.25, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 373.67. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 29, Shloka No.3, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 181.68. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Shareera Sthana, Chapter 1, Shloka No.26, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 289.69. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 616.70. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.19, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.71. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka No.8, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.193.72. Martini.F.H edited, Fundamentals of Anatomy and Physiology, chapter 24, 4th edition1998, Pub: New Jersey: Prentice Hall Inc. Simon & Schuster, Page no. 899.73. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.8, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 364.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 231 Sandhigatavata
  • 250. Bibliography74. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Shareera Sthana, Chapter 3, Shloka No.10-11, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.387.75. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Shareera Sthana, Chapter 7, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 338.76. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya- Sarvangasundara Commentory on Shareera Sthana, Chapter 3, Shloka No.10-11, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.387.77. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Prathama Khanda, Chapter 5, Shloka No.9, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.44.78. Martini.F.H, edited, Fundamentals of Anatomy and Physiology, Chapter 24, 4th ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998, Page No. 900.79. Prof. Priyavrat Sharma edited Bhela Samhita, Sutra Sthana, Chapter 16, Shloka No.2, Edition:Reprint 2005, Pub: Chaukambha Visvabharati, Varanasi (UP), Page No.7080. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Prathama Khanda, Chapter 5, Shloka No.25, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.50.81. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Shareera Sthana, Chapter 3, Shloka No.84, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.402.82. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka No.25, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.16.83. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sarvangasundara Commentory on Sutra Sthana, Chapter 1, Shloka No.25, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.16.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 232 Sandhigatavata
  • 251. Bibliography84. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 10, Shloka No.5, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 724.85. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 10, Shloka No.6-7, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 724.86. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 525.87. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka No.40, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 683.88. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 25, Shloka No.40, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 131.89. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.3, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 525.90. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka No.27-28, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 682.91. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Khila Sthana, Chapter 8, Shlokha No. 54, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 147.92. Dr.Suresh Babu edited The principles and practice of Kaya cikitsa, Vol IV, Chapter 6, Edition: First 2008, Pub:Chaukhambha Orientalia, Post box No.1032, Gokul Bhawan, K.37/109, Gopal Mandir lane,Golghar, Maidagin, Varanasi (UP), Page No.6593. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 233 Sandhigatavata
  • 252. Bibliography94. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.95. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.96. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.19, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 527.97. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.61, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.282.98. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713- 715.99. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 1,Shloka No. 47-49, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 684.100. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Khila Sthana, Chapter 8, Shlokha No.6-15, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 147.101. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 12, Shloka No. 16, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 731-732.102. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 6, Shloka No.33, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.335.103. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83 (Vastikarmadhikara), Shloka no. 177-178, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1163.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 234 Sandhigatavata
  • 253. Bibliography104. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 6, Shloka No.32, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.335.105. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83 (Vastikarmadhikara), Shloka no. 186-190, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1164.106. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 8,Shloka No. 4, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713.107. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83 (Vastikarmadhikara), Shloka no. 191-196, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1165.108. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 6, Shloka No.23-24, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.334.109. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83 (Vastikarmadhikara), Shloka no. 182-186, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1164.110. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83 (Vastikarmadhikara), Shloka no.186-190, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1164.111. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 6, Shloka No.82-84, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 708.112. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 8, Shloka No. 2-14, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713.113. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 38, Shloka No.37-41, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 542-543.Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 235 Sandhigatavata
  • 254. Bibliography114. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.115. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.116. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.67, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.283.117. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.52, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.118. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.119. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.120. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.68, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.283.121. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.122. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.123. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.67, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.283. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 236 Sandhigatavata
  • 255. Bibliography124. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 13, Shloka No.29, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 83.125. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.126. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Ayurveda Deepika commentory by Chakrapanidatta on Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.127. Sri. Satyapala Bhishagacharya edited Kashyapa Samhita, Siddhi Sthana, Chapter 1, Shloka No.11-20, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthan, Post box No.1139, K.37/116, Gopal Mandir lane, Varanasi (UP), Page No 147.128. Sri. Satyapala Bhishagacharya edited Kashyapa Samhita, Kkila Sthana, Chapter 8, Shloka No.104-105, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthan, Post box No.1139, K.37/116, Gopal Mandir lane, Varanasi (UP), Page No 285.129. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.130. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Deepika commentory by Adamalla on Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.131. Priyavrat Sharma edited Chakradatta, Chapter 72 (Anuvasanadhikara), Shloka No.3-4, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K- 37/109, Gopal Mandir lane, Varanasi (UP), Page No. 619.132. Dr.Nirmal Sexena edited Vangasena Samhita, Vol II, Chapter 79 (Anuvasanadhikara), Shloha No.20-22, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1147.133. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.52-54, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.134. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 237 Sandhigatavata
  • 256. Bibliography135. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Ayurved Rasayana Commentory by Hemadri on Sutra Sthana, Chapter 19, Shloka No.69, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.283.136. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.137. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.138. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.7-8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.139. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.12, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.140. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.7-9, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.141. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.12-13, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.273.142. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.9, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 525-526.143. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.11, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.144. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.15, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.274.145. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Ayurveda deepika commentory by Chakrapani on Siddhi Sthana, Chapter 3, Shloka No.10, Edition: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 238 Sandhigatavata
  • 257. Bibliography Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.146. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Ayurved Rasayana Commentory by Hemadri on Sutra Sthana, Chapter 19, Shloka No.16, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.274.147. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.148. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.16-17, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.274.149. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 5, Shloka No.4-7, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 702.150. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 36, Shloka No.6-11, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 529.151. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.6, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.152. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.6, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.153. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 37, Shloka No.54-59, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 534.154. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.21-23, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.275.155. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.24-26, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.276. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 239 Sandhigatavata
  • 258. Bibliography156. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.28-29, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 694.157. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 37, Shloka No.60-62, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 534.158. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.26-30, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.276-277.159. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.24, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 693.160. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 37, Shloka No.54-57, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 534.161. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.162. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.163. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka No.27-29, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.276.164. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka No.44-46, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 684.165. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.25, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 699. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 240 Sandhigatavata
  • 259. Bibliography166. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.26-30, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 699-700.167. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.31, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.168. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.33, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.169. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.34-35, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.170. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.36-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.171. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.38-40, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.172. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 3, Shloka No.24, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 700.173. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka No.40, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 684.174. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 11, Shloka No.26, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.186.175. Dr. M.R. Vasudevan Nampoothiri and Dr. L. Mahadevan edited Principles and Practice of Vasti, Chapter 11, Second Edition-November 2007, Pub: Dr. Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital, Derisanamcope, Kanyakumari Dist, Tamilnadu, Page No.176. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 241 Sandhigatavata
  • 260. Bibliography176. Dr. P.V. Sharma edited India Medicine in Classical Age, Second edition 2000, Pub: Chaukhamba Amarabharati Prakashana, Post box No. 1138, K.37/130, Gopal Mandir Lane, Varanasi, Page No.63-64.177. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Yajurveda Samhita, 18th Suktha, Shloka No. 3, 10th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No. 181.178. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Atharvaveda Samhita, Vol I, 6th Khanda, 14th suktha, Shloka No. 1 (1330), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.7 (6th Khanda).179. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Atharvaveda Samhita, Vol I, 9th Khanda, 14th suktha, Shloka No. 21 (2607), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.36(9th Khanda).180. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Atharvaveda Samhita, Vol II, 11th Khanda, 10th suktha, Shloka No. 14 (3226), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.36(11th Khanda).181. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.182. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 20, Shloka No.11, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 113.183. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.184. Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15, Shloka No.12, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.414.185. Dr. Shivprasad Sharma edited Astanga Sangraha, Chikitsa Sthana, Chapter 23, Shloka No.11, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.565186. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 15, Shloka No.14, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 242 Sandhigatavata
  • 261. Bibliography187. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Chikitsa Sthana, Chapter 21, Shloka No.22, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.724.188. Prof. Yadunandana Upadhyaya edited, Madhava Nidanam, Vol I, Chapter 22 (Vatavyadhi Nidanam), Shloka No. 21, Thirtyth Edition:2000, Pub: Chaukhambha Sanskrit Bhawan, Post box No. 1160, CHOWK, Varanasi, Page No. 418189. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 258-259, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.190. Dr. Indradev tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara, Vatavyadhi Nidana, Shloka No. 25 and Vatavyadhi Chikitsa, Shloka No. 119, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 403 and 412.191. Prof. Priyavrat Sharma edited Bhela Samhita, Chikitsa Sthana, Chapter 24, Shloka No.48-49, Edition:Reprint 2005, Pub: Chaukambha Visvabharati, Oriental Publishers and Distributer, Post Box No. 1084, K.37/109, Gopal Mandir Lane, Varanasi (UP), Page No.455.192. Ramavalamba Shastri edited Harita Samhita, thriteeya Sthana, Chapter 20, Edition: First 1985, Pub: Prachya Prakashan, Varanasi, Page No. 308193. Priyavrat Sharma edited Chakradatta, Chapter 22 (Vatavyadhi chikitsa), Shloka No.9, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K- 37/109, Gopal Mandir lane, Varanasi (UP), Page No. 184.194. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 14, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 529.195. Mahamahopadhyaya Gananathsen edited,Siddhanta Nidanam part 2, chapter 7thshloka 513-514, edition, 1966 Varanasi: Chaukamba Sanskrit Series.Page no. 210.196. Shree Govardhana Sharm edited, Basavarajeeyam, chapter 6th Pub:Choukamba Vidyabhavan, Varanasi; 1984 Page no .106.197. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.240. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 243 Sandhigatavata
  • 262. Bibliography198. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.240.199. Vaidyaratnam P.S. Varier edited Brihaccareeram, Vol I, Pratikavibhagaadhyaya, Edition: 1942, Pub: P. Madhava Warrier, Kottakal, Page No. 25.200. Raja Radha Kanta Deva edited Shabda Kalpadruma, IInd volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.298.201. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter 21, Shloka No.5, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 99.202. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.24-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617-618.203. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.73, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 620.204. • Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No. 618. • Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15, Shloka No.12, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.414. • Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Chikitsa Sthana, Chapter 15, Shloka No.14, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531.205. Shree Govardhana Sharma edited,Basavarajeeyam, chapter 6th Pub: Choukamba Vidyabhavan, Varanasi; 1984.Page .no106.206. Mahamahopadhyaya Gananathsen edited,Siddhanta Nidanam part 2, chapter 7th , shloka 513-514, edition, 1966 Varanasi: Chaukamba Sanskrit Series. Page no.210. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 244 Sandhigatavata
  • 263. Bibliography207. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.26, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 366.208. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.24-25, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 366.209. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.24 & 27, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 366-367.210. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 12, Shloka No.17, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.194.211. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.9, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 616.212. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.17-18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 260.213. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nyayachandrika commentory by Gayadasa on Nidana Sthana, Chapter 1, Shloka No.13, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 259.214. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 4, Shloka No.15, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 356.215. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.29-36, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No.367.216. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.37-38, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 367-368.217. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.16, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 365. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 245 Sandhigatavata
  • 264. Bibliography218. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.7, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.219. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.12, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.220. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.24, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 372-373.221. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 374.222. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.223. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No 15-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617-618.224. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter 21, Shloka No.19, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 103.225. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 1, Shloka No.14-15, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.444.226. Dr. Indradev tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara, Vatavyadhi Nidana, Shloka No. 1-4, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 402.227. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 1-2, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 340. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 246 Sandhigatavata
  • 265. Bibliography228. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No. 1-3, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 404.229. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, Chapter 5, Shloka No.27, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 252.230. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, Chapter 5, Shloka No.28, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 252.231. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter 15, Shloka No.32, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 73.232. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka No.7, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.7.233. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka No.23, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.15.234. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 1, Shloka No.8, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.7.235. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.19, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.236. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Madukosha Commentory on Chapter22, Shloka No. 5, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 410.237. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, Chapter 1, Shloka No.9, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 195. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 247 Sandhigatavata
  • 266. Bibliography238. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.239. Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15, Shloka No.12, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.414.240. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 15, Shloka No.14, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531.241. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.242. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No. 21, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 418.243. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.244. Dr. Indradev tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara, Vatavyadhi Nidana, Shloka No. 14, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 407.245. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.246. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.247. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No. 21, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 418. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 248 Sandhigatavata
  • 267. Bibliography248. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.249. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No. 21, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 418.250. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.251. Sri. Ganga Sahaya Pandeya edited Gadanigraha, Part II, Ist Edition 1969, Pub: Choukhamba Sanskrit Series office, Varanasi, Page No. 473.252. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No. 21, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 418.253. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 258-259, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 347.254. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 1, Shloka No.8, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.443.255. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, Chapter 1, Shloka No.11, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 196.256. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 1, Shloka No.8, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.443.257. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, Chapter 1, Shloka No.12, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 197258. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.18, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 249 Sandhigatavata
  • 268. Bibliography Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617.259. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Nidana Sthana, Chapter 15, Shloka No.6, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531.260. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.24-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617.261. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Vimana Sthana, Chapter 5, Shloka No.17, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 251.262. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 10, Shloka No.7, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 66.263. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 10, Shloka No.11-20, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 66-67.264. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 33, Shloka No.4-5, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 144.265. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.72-74, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 620.266. Pt. Haragovinda Shastri edited Amarakosha, Dwiteeya Khanda, Chapter 6 (Manushya Varga), Shloka No.50, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthana, Varanasi, Page No. 281.267. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 4, Shloka No.8, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 420.268. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 13, Shloka No.1-3, Reprint 2007, Pub:Chaukhamba Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 250 Sandhigatavata
  • 269. Bibliography Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.211.269. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 4, Shloka No.8, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 420.270. Dr. Shivprasad Sharma edited Astanga Sangraha, Chikitsa Sthana, Chapter 23, Shloka No.11, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.565.271. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Chikitsa Sthana, Chapter 21, Shloka No.22-23, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.825.272. Dr. Indradev tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara, Vatavyadhi Chikitsa, Shloka No. 119, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No.412.273. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter 24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.274. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 14, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 529.275. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 22, Shloka No.3-4, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 120.276. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibandha Sangraha commentory on Chikitsa Sthana, Chapter 24, Shloka No.30, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 488.277. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 5, Shloka No.86, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 120.278. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 24, Shloka No.30, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 488. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 251 Sandhigatavata
  • 270. Bibliography279. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.35-38, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 89.280. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.3, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 513.281. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.35-36, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 89.282. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.12, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 513.283. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.35-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 89.284. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.5, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.254.285. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 14, Shloka No.38, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 89.286. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.8, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 513.287. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 32, Shloka No.8, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 513.288. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Sutra Sthana, Chapter 17, Shloka No.5, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.254. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 252 Sandhigatavata
  • 271. Bibliography289. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 22, Shloka No.11, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 120.290. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 25, Shloka No.45, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 133.291. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 611-625, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 586.292. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No. 626-630, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 587.293. Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker and John A.A. Hunter edited Davidson’s Principles and Practice of Medicine, 20th edition 2006, Pub: Churchill Livingstone, Elsevier, Page No. 1096.294. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Pub: Philadelphia WB Saunders Company; 1997. p. 1471295. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L. Longo, J.Larry Jameson, Joseph Loscolzo edited Harrison’s Principles of Internal Medicine, Vol II, 17th Edition, Pub: Mc Graw-Hill Companies, Newyork, Page No.2159.296. Kenneth. J. Koval, edited, Orthopedic Knowledge Update-7th first Indian edition, 2004, pub: Jaypee Brothers Medical publication Page .no.193.297. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L. Longo, J.Larry Jameson, Joseph Loscolzo edited Harrison’s Principles of Internal Medicine, Vol II, 17th Edition, Pub: Mc Graw-Hill Companies, Newyork, Page No.2161.298. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L. Longo, J.Larry Jameson, Joseph Loscolzo edited Harrison’s Principles of Internal Medicine, Vol II, 17th Edition, Pub: Mc Graw-Hill Companies, Newyork, Page No.2162.299. http:/www.fda.gov/ohrms/DOCKETS/ac/08/briefing/2008-4404bi- 05%20WOMAC%20questionnarie.pdf on 06-09-09300. Dr. K. Nishteswar and Dr. R.Vidyanath edited Sahasrayogam, Taila prakarana, Edition: Second 2008, Pub: Chowkhamba Sanskrit series office, K.37/99, Gopal Mandir lane,Golghar, Post box No.1008, Varanasi (UP), Page No.112. Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 253 Sandhigatavata
  • 272. Bibliography301. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub: Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.141.302. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub: Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.734.303. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub: Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.736.304. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub: Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.120.305. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Madhyama Khanda, Chapter 9, Shloka No.1-2, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.212.306. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 5, Shloka No. 1286-1287, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 185-186.307. Dr. Suresh Babu edited Research Methodology for Ayurvedic Scholars, Chapter 1, Edition: Second 2004, Pub: Chaukhambha Orientalia, Varanasi, Page No. 2.308. Nair.P.R, Management of Khanja and Pangu with Panchakarma, New Delhi; CCRAS: 1999, Page No.40.309. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter 33, Shloka No.4, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 144.310. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.311. Priyavrat Sharma edited Chakradatta, Chapter 72 (Anuvasanadhikara), Shloka No.3, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K- 37/109, Gopal Mandir lane, Varanasi (UP), Page No. 619.312. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.313. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526 Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 254 Sandhigatavata
  • 273. Annexure SPECIAL CASE SHEET FOR SANDHIGATAVATA (Ketakyadi Taila Matravasti in Sadarana & Arohana krama) Post Graduate Research And Studies Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag.Guide: Dr.Suresh Babu Co-Guide: Dr.Santosh N Belavadi. MD (Ayu) MD (Ayu)PG Scholar: Sanath kumar D.G1. Name of the patient : ____________________ SL.No O.P.D. No2. Father’s / Husband’s Name : ____________________ I.P.D. No3. Age _______ yrs. Place of Birth __________________4. Sex M F Education __________________5. Marital Status Married ( ) Unmarried ( )6. Religion Hindu ( ) / Muslim ( ) / Christian ( ) / Others ( )7. Occupation Labour ( ) Student ( ) Executive ( ) Sedentary ( )8. Economical Status Poor ( )/ Lower Middle ( ) / Upper Middle ( )/ Rich ( )9. Address _______________________ E-mail ID _____________ _______________________ Phone No _____________ _______________________ Pin __________________ D M Y D M Y10. Date of commencement of treatment: Completion:11. Result: Good Moderate Poor Response Response Response No Response CONSENTI am fully educated with the disease and treatment there by I got satisfied. I accept formedical trial on me happily. Signature of Patient Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 255 Sandhigatavata
  • 274. AnnexurePradana Vedana with duration: Sl. No Pradhana vedana Avadhi 1 Prasaarana Aakunchanayoho Savedana Pravruthihi 2 Sandhi atopa SI. No Anubandhi vedana Avadhi 1 Sandhisothaha 2 Sandhisthamba 3 Sandhigathi asaamarthyaA. Vyadhi vruttanta: a) Mode of onset Chronic Insidious Acute Traumatic b) Nature of pain Pricking Aching Generalized Tearing Burning c) Variation of pain in Joint Increased on move Increased in rest Nocturnal d) Routine activities affected: 1) Descending stairs YES [ ] NO [ ] 2) Ascending stairs YES [ ] NO [ ] 3) Rising from sitting YES [ ] NO [ ] 4) Standing YES [ ] NO [ ] 5) Bending to floor YES [ ] NO [ ] 6) Walking on Flat surface YES [ ] NO [ ] 7) Rising from bed YES [ ] NO [ ] Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 256 Sandhigatavata
  • 275. Annexure 8) Lying in bed YES [ ] NO [ ] 9) Getting on/off toilet YES [ ] NO [ ]B. Purva vyadhi vruttanta:Episodes of same illness Yes NoObesity Yes NoTrauma/fracture of Yes Noinvolved or related jointsDiabetes Mellitus Yes NoHypertension Yes NoOther Vatavyadhis Yes NoFever Yes NoOthers Yes NoC. Chikitsa Vruttanta:D. Kula vruttanta:Maternal ParentalE. Vayuktika vruttanta :1 Ahara Vegetarian ( ) Mixed ( ) Rasa: M( ) A( ) L( ) K( ) T( ) K( ) SR( )2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )3 Agni Samagni ( ) Mandagni ( ) Teekshnagni ( ) Vishamagni ( )4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )5 Nidra Prakruta ( ) Alpa ( ) Ati ( ) Diwaswapna ( )6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( ) Tea/coffee ( )7 Artava Regular ( ) Irregular ( ) Menopause ( ) Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 257 Sandhigatavata
  • 276. AnnexureSAMANYA PAREEKSHA:A. Asta sthana Pareeksha : B. Vital examination :1. Nadi /Min 1. Heart rate /Min2 Mala 2 Resp rate /Min3 Mootra 3 Blood pressure mm of Hg4 Jihwa 4 Body Temp /F5 Shabda 5 Body weight Kgs6 Sparsha7 Druk8 AkrutiB. Dasha vidha Pareeksha1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( )2. VikruthiHethu AL M A Prakruthi Aasukaari ChirakaariDosha AL M A Desha AL M ADushya AL M A Kaala AL M ABala AL M A Linga AL M A ( AL- Alpa, M- Madhyama, A- Adhika)3 Sara Twak( ) Rakta( ) Mamsa( ) Meda( ) Asthi( ) Shukra( ) Majja ( ) Satwa( )4 Samhanana Susamhita ( ) Madhyama samhita ( ) Heena Samhita ( )5 Pramana Supramanita ( ) Adhika ( ) Heena ( )6 Satmya Ekarasa ( ) Sarva rasa ( ) Vyamishra ( ) Rooksha satmya ( ) Snigda satmya ( )7 Satva Pravara ( ) Madhyama ( ) Avara ( )8 Ahara Shakti a) Abhyavaharana shakti : P ( ) M ( ) A ( ) b) Jarana shakti : P ( ) M ( ) A ( )9 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )10 Vaya Balya( ) Madhyama ( ) Vrudda ( ) Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 258 Sandhigatavata
  • 277. AnnexureC. Srotho pareeksha (Examination of Musculoskeletal System) Srotas Observed Lakshana Mamsavaha Medovaha Asthivaha MajjavahaSpecial Examination of JointsJoints involvedKnee Right LeftHip Right LeftAnkle Right LeftFirst carpo meta carpal Right LeftDistal inter phalangeal Right LeftProximal inter phalangeal Right LeftA) Darshana: 1) Shotha: Present Absent 2) A) Deformity: b) Joint instability: Present Absent Present Absent 3) Gait: Normal Abnormal Type 4) Walking time: Time taken to cover 21 meters Gr.0 Gr. I Gr. II Gr. III Gr. IV Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 259 Sandhigatavata
  • 278. Annexure 5) Joint Movement Active Completely Restricted Partially Restricted Free Passive Completely Restricted Partially Restricted Free 6) Muscular wasting: Above the affected joint Yes No Below the affected joint Yes NoB) Sparshana: 1) Vaatapoornadruthisparsha Yes No 2) Range Of Movements: Ease Movement Yes No Without Ease Movement & Pain Yes No Restricted yes No C) Shravana (Auscultation) 1) Sandhi Atopa: Crepitus Heard Felt None Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 260 Sandhigatavata
  • 279. Annexure VYADHI VISHESHA PAREEKSHA: Vikruti Pareeksha: 1)Nidana Pareeksha Tiktharasa Athyupayoga Kashayarasa Katurasa Athyupayoga Athyupayoga Alpa Bhojana Pramitha Bhojana Rooksha BhojanaAhara Vega Dhaarana Vegoodeerana AtivyavayaVihara Nisaajaagarana Atyucha Bhaashana AtivyaayamaMaanasika Atibhaya Atishoka AtichinthaOccupationalChikitsa Aparaadhaja Shodhanakarma Atiyogaja Yes No2)Upashaya/Anupashya Ushna Sheetha Rooksha Snigdha 3)RoopaVatapoornadrutisparsha Sandhi AtopaShota SandhivishleshaPrasarna Akunchanasa Vedana Sandhigraha/ Sthamba 4)Samprapti GhatakasDoshaDushyaSrothasAgniAmaUdbhavasthanaRogamargaAdhistana Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 261 Sandhigatavata
  • 280. AnnexureLab Investigations:SL.No Name of the test Values1 Hb% G/dl2 E.S.R. MM/1st hour3 Total Count Cells/ cumm4 Differential count P L E M B % % % % %5 Random Blood Sugar mg/dl6 Serum R ARadiological Examination Of Joints: ( Antero posterior and Lateral View)Radiological reports ………………………………………………………………..1 Formation of Osteophytes on joint Present Absent margin2 Periarticular ossicles Present Absent3 Narrowing of joint cartilages Reduced Increased Unaltered4 Small pseudocytic area in the Present Absent subchondral bone5 Alltered shape of bony ends- head of Present Absent the Femur Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 262 Sandhigatavata
  • 281. Annexure Chikitsa: Matravasti: Sadharana 72ml 9days After Food krama (Around 9AM) Arohana 48-144ml 9 days After Food karma (Around 9AM) Group A Group B Sadharana Krama Arohana KramaVasti Karma Nireekshana : Date of Vasti initiation: Date of Vasti completion:Observations:Day Time Amount Time of Time of No. of times Upadrava if Introduced Pratyagamana Retention Motion passed anyI DayII DayIII DayIV DayV DayVI DayVII DayVIII DayIX DayObservations: Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 263 Sandhigatavata
  • 282. Annexure Day Before Vasti Karma After Vasti karma BP Pulse Respiration Temp BP Pulse Respiration Temp rate rate I Day II DayIII DayIV Day V DayVI DayVII DayVIII DayIX DaySamyak Anuvasita lakshana: 1 2 3 4 5 6 7 8 I Day II Day III Day IV Day V Day VI Day VII Day VIII Day IX DayNote: 1- Prathyetyasaktham sa shakruccha tailam 2- Rakthadi dhatu prasadana 3- Buddi prasadana 4- Endriya prasadana 5- Samyak swapna 6- Laghuta in shareera 7- Bala vridhi 8- Shrusta vega Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 264 Sandhigatavata
  • 283. AnnexureCriteria’s for assessment of results:Pradhana Vedana:SI. No Parameter Day 0 Day 09 Day 27 1 Prasarana Aakunchanayoho savedana pravruthihi 2 AtopaAnubhanda Vedana:SI. No Parameter Day 0 Day 09 Day 27 3 Sandhishothaha 4 Sthamba 5 Sandhigati asamarthata6. Walking timeDay 0 Day 09 Day 277. WOMAC Day 0 Day 09 Day 27Total ScorePain Sub ScoreStiffness Sub ScorePhysical function Sub scoreINVESTIGATERS: Scholar’s signature Signature of Co-guide Signature of Guide Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 265 Sandhigatavata
  • 284. Annexure Work Sheet ScoringSI No Day 0 Day 9 Day 27Pain01 Walking02 Stair climbing03 Nocturnal04 Rest05 Weight bearingStiffness06 Morning stiffness07 Stiffness occurring later in the dayPhysical function08 Descending stairs09 Ascending stairs10 Rising from sitting11 Standing12 Bending to floor13 Walking on flat14 Getting in or out of car15 Going shopping16 Putting on socks17 Rising from bed18 Taking off socks19 Lying in bed20 Sitting21 In/out bath22 Getting on or off toilet23 Heavy domestic duties24 Light domestic dutiesPain Sub ScoreStiffness Sub ScorePhysical function Sub score Total ScoreSI No Response Points01 None 002 Slight 103 Moderate 204 Severe 305 Extreme 4 Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in 266 Sandhigatavata