'A Comparative Clinical Study on the Therapeutic Effect of Trayodashanga Guggulu and Shatavari Guggulu on Janu Sandhighatava w.s.r. on Osteoarthritis of Knee'

1. “A Comparative Clinical Study On The
Therapeutic Effect Of Trayodashanga Guggulu
And Shatavari Guggulu On Janusandhighatavata
W.S.R.To Osteoarthritis Of Knee”
Presented by:
Dr. Laiphrakpam Renu
PG. Scholar,
Department of Kaya Chikitsa.
Ashwini Ayurvedic Medical College
& Research Centre, Karnataka.
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2. According to WHO, Osteoarthritis is the second commonest
musculoskeletal problem in the world population. Sandhighatavata is
the most common joint disorder worldwide. The overall prevalence of
the disease in the population above 40 years of age is about 49%.
“Osteoarthritis disease is the result of both mechanical and
biological events, which destabilize the normal coupling of degradation
and synthesis of articular cartilage, chondrocytes and extracellular
matrix and subchondral bone.”
`
2
Introduction

3. ⮚ To evaluate the efficacy of Trayodashanga guggulu in the
management of Janusandhighatavata w.s.r. to Osteoarthritis of
knee.
⮚ To evaluate the efficacy of Shatavari guggulu in the management of
Janusandhighatavata w.r.s. to osteoarthritis of knee.
⮚ To compare both the groups.
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Aims And Objectives

4. Study Design
⮚ 40 patients diagnosed as sandhighatava were randomly divided
into 2 groups viz, Group A and Group B compromising of 20
patients each.
4
Methodology

5. 1) Inclusion Criteria:
⮚ Patients with clinical features of Janusandhighatavata w.s.r.to
Osteoarthritis of knee.
⮚ Patients aged between 30-70 years of age.
⮚ Patients without any previous anatomical deformity.
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Criteria For Selection Of Patients

6. 2) Exclusion Criteria:
⮚ Patients having history of active inflammatory disease such as RA, Gout,
etc.
⮚ Patients having history of Hypertension, DM, Tuberculosis, Renal diseases.
⮚ Pregnant and Lactating women.
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7. Diagnosis has done according to the signs and symptoms as per
Ayurvedic classics and Contemporary Medical text books.
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Diagnostic Criteria

8. ⮚ Patients were assessed with Subjective and Objective parameters
before and after the treatment.
⮚ Result are analyzed using suitable statistical methods.
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Assessment Criteria

9. Statistical analysis:
Total 40 patients were registered in this study, out of that all 40
patients were studied in this research work. 20 patients were in
group A (Trayodashanga gugglu ) while 20 were in B group (
Shatavari Gugglu ). Each patient was observed thoroughly and noted
neatly. The observations are recorded and necessary charts and
graphs were made.
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Observation And Results

10. EFFECT OF TREATMENT IN GROUP – A
CLASS GRADING NO. OF PATIENTS
0 - 25% No Improvement 0
26 - 50% Mild Improvement 11
51 - 75% Moderate Improvement 6
76 - 99% Marked Improvement 3
100% Completely Cured 0
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Assessment Of Total Effect Of
Therapy In Group A

11. EFFECT OF TREATMENT IN GROUP – B
CLASS GRADING NO. OF PATIENTS
0 - 25% No Improvement 0
26 - 50% Mild Improvement 13
51 - 75% Moderate Improvement 07
76 - 99% Marked Improvement 0
100% Completely Cured 0
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Assessment Of Total Effect Of
Therapy In Group B

12. Characteristics Group - A Group – B
Signs and Symptoms
Mean Score
Percentage
Of Relief
Mean Score
Percentage
Of Relief
BT AT BT AT
Sandi Shula Left Leg 1.85 0.85 54.05% 2.15 1.15 46.51%
Sandi Shula Right Leg 1.8 0.75 58.33% 1.75 1 42.85%
Sandi Shotha Left Leg 0.6 0.3 50% 0.55 0.3 45.45%
Sandi Shotha Right Leg 0.6 0.3 50% 0.45 0.25 55.55%
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Showing the Comparative Results of
Group - A and Group - B

13. Sandhigraha Left Leg 1.2 0.7 41.66% 1.6 0.95 40.62%
Sandhigraha Right Leg 1.2 0.55 54.16% 1.25 0.85 32%
Sandhisphutan Left Leg 0.75 0.15 80% 0.3 0.1 66.66%
Sandhisphutan Right Leg 0.8 0.25 68.75% 0.3 0.05 83.33%
Sparshasahyata Left Leg 0.85 0.3 64.74% 1.25 0.35 72%
Sparshasahyata Right Leg 0.95 0.4 57.89% 1.1 0.5 54.54%
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contd….

14. The percentage of improvement in group A :
⮚ Sandhi shula left leg is 54.05%, Sandi shula right leg is 58.33%,
⮚ Sandhi shotha left leg is 50%, Sandi shotha right leg is 50%,
⮚ Sandhigraha left leg 41.66%, Sandhigraha right leg 54.16%,
⮚ Sandhisphutan left leg 80%, Sandhisphutan right leg 68.75%,
⮚ Sparshasahyata left leg 64.74% ,Sparshasahyata right leg is 57.89%.
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Result of Group A

15. The percentage of improvement in group on the
⮚ Sandhi shula left leg is 46.51%, Sandi shula right leg is 42.85%,
⮚ Sandhi shotha left leg is 45.45%, Sandi shotha right leg is 55.55%,
⮚ Sandhigraha left leg is 40.62%, Sandhigraha right leg is 32%
⮚ Sandhisphutan left leg is 66.66%, Sandhisphutan right leg is 83.33%,
⮚ Sparshasahyata left leg is 72% , Sparshasahyata right leg is 54.54%.
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Result of Group B

16. Probable mode of Action
⮚ In Trayodashanga Guggulu 10 drugs out of total 13 drugs ( Babul,
Ashwagandha, Hapusha, Guduchi, Shatavari, Gokshura, Vridhadaru, Rasana,
Shatahavya, Shati, Yavani, Shunthi, Gugglu) are of Ushna veerya. Due to
Ushna veerya it pacifies Vata, vata remains mainly responsible for all types of
pains and hence relieves pain , stiffness and other symptoms of sandhi gata
vata.
⮚ Out of 13 drugs in Trayodashanga Guggulu , 8 are having katu vipaka and 6 are
having Madhura vipaka, both Madhura and katu vipaka are potent to pacify
vata of sandhighata vata.
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Discussions

17. 17
⮚ In Shatavari Guggulu 9 drugs out of 13 drugs (Shatavari, Guduchi, Prasarini,
Gokshura, Pippal, Shatahavya, Deepayaka, Rasana, Ashwagandha,
Chorpushpi, Kachura, Shunthi, Gugglu) are of Ushna virya. Due to ushna
veerya it pacifies vata, hence relieves pain , stiffness and other symptoms ,
but upto a lesser extent as compared to Trayodashanga Guggulu.
⮚ Out of 13 drugs 8 are having Katu vipaka and 5 are having Madhura Vipaka,
hence pacifies vata, but to a lesser extent as compared to trayodashanga
guggulu.
contd. . .

18. The present study entitled ‘A Comparative Clinical Study on The Therapeutic
Effect of Trayodashanga Guggulu and Shatavari Guggulu on Janu
Sandhigatavata w.s.r. knee osteoarthritis” has been summarized as:
⮚ Introduction: This chapter provides general glimpse of the concept of
Sandhighatavata and Osteoarthritis, criteria for selection of the trial drug and
also the clinical study design.
⮚ Objectives: In this chapter, the main objectives of the study have been
mentioned.
⮚ Review of literature: This study includes disease review, drug review.
⮚ Drug review: An attempt has been made to furnish complete review of the
trial drug after undertaking a thorough study of the contemporary texts and
recent publications.
⮚ Disease review: Review of the disease- from various samhitas – charaka
samhita, sushruta samhita, kashayapa samhita, madhava nidana ,
yogaratnakara etc, was done and also the review of Osteoarthritis was done
from modern literature. Chikitsa was derived based on classical references.
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Summary

19. ⮚ Methodology:
Clinical study: Criteria for selection of drug, preparation of drug, grouping
of patients, determination of dose, time & duration of administration,
selection of sample, assessment criteria etc. under appropriate headings
are discussed.
⮚ Observation and Results: This chapter includes the observations and the
results obtained during the clinical studies. The results are suitably
tabulated and statistically analyzed in between the groups. The results
obtained are depicted in the form of graph.
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contd…

20. 20
⮚Discussion: Under this chapter an attempt has been made to discuss about the
disease, drug and clinical part of the study. And also an attempt is made to discuss
about the probable mode of action of the trial drug and the scope of the further
study.
⮚Conclusion: This chapter includes the conclusion on the usage of the drug in
Sandhighatavata and the inferences and conclusions drawn from the clinical
study.

21. ⮚ Study should be carried out in higher number of samples.
⮚ Study should be carried out with modification of life style and with pathya
and apathaya.
⮚ Study should be carried out with local application of Snehana and
Swedana along with oral medication.
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Scope For Further Study

22. Sandhighatavata can be defined as a joint disease with symptoms of
shoola, which aggravates by movement, Shotha with complete restricted
movements at later stages. Ayurvedic literature does not reveal the special
etiological factors for sandhighata vata however, the aggravative factors for
vata can be adopted for it, vata particularly vyana vayu has a close
relationship with the movement of sandhi, so its agravative factors can
produce sandhighatavata.
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Conclusion

23. Osteoarthritis is the most common type of arthritis, especially
among older people, it is a joint disease that mostly affect the cartilage.
Cartilage is slippery tissue that covers the end of bones in a joint. Healthy
cartilage allows the bone to glide over one another. In osteoarthritis the
surface layer of cartilage break down under and wears away. This allow
bones under the cartilage rub together , causing pain, swelling and loss
of motion of the joint. Over the time the joint may lose its normal shape.
In the present study it was found that Trayodashanga Guggulu and
Shatavari Guggulu both reduces the lakshanas of Sandhighata vata. But
Trayodashanga Guggulu is much more efficient as compare to Shatavari
Guggulu in condition of Sandhighatavata.
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contd….