This document appears to be a thesis or research paper on evaluating the efficacy of Salavana Upanaha Sweda (fomentation therapy using medicated paste) with and without Siravyadha (bloodletting) in the management of Vatakantaka (painful heel). It includes sections on introduction, literature review, objectives, materials and methods, observations, results, discussion and conclusion. The introduction provides background on Vatakantaka based on Ayurvedic texts and its correlation to painful heel in modern medicine. It also discusses current treatments and the rationale for exploring Ayurvedic therapies like Upanaha Sweda with or without Siravyadha.

1. “A CLINICAL COMPARATIVE STUDY ON EFFICACY OF
SALAVANA UPANAHA SWEDA WITH AND WITH OUT
SIRAVYADHA IN THE MANAGEMENT OF VATAKANTAKA”
Presented by: Dr Sebin Johny
Guide: Dr. N.S. SHETTAR .M.D. (Ayu.)
Co Guidance: Dr Soumya S.V . M.D (Ayu)
POST GRADUATE DEPARTMENT OF PANCHAKARMA, K.V.G. AYURVEDA
MEDICAL COLLEGE AND HOSPITAL, AMBATE ADKA, SULLIA – 574327

2. Contents
 INTRODUCTION
 REVIEW ON LITRATURE
 OBJECTIVES
 MATERIALS AND METHODS
 OBSERVATIONS
 RESULTS
 DISCUSSION
 CONCLUSION

3. INTRODUCTION
 The primary aim of the entire human life is to attain happiness & lead a successful life. These are greatly depending upon
locomotion. Vatakantaka is that disorder, which interfere with the free locomotion of the individual resulting in hindrance to
his daily activities. Acharya Sushrutha was the pioneer (2500 BC) to explain it under Vatavyadhi1; & in due course, other
authors like Vagbhata, Yogarathnakara, Chakradatta, Vangasena and Madhavakara also narrate the same. In Vatakantaka pain in
the heel develops due to walking on uneven surfaces or excessive walking. Due to the Nidanas, Vata gets vitiated and reside at
Gulpha Sandhi, produces pain1. As the disease is affecting the Madhyama roga marga considered to be kashtasadya.
 Vatakantaka can be correlated to painful heel in modern parlance. It accounts for 78% of total cases of painful heel attending
orthopedic clinics. It is commonly seen in strenuous workers who experience severe pain especially in the morning and during
walking after sitting for long time. It is mainly due to painful heel syndrome or tender heel pad or plantar fasciitis2.
Contemporary Science prescribes a number of analgesics, anti-inflammatory drugs & local steroidal injections & surgery in
this condition. But they do not render full cure or satisfaction. More over these are costly & come along with many adverse
effects. Thus an alternative Para-surgical, safe, cost effective and result oriented ayurvedic remedy was tried, expecting to fulfil
the pitfalls of contemporary science.

4.  Acharya Sushruta suggests Snehana, Upanaha, Agnikarma, Bandhana, Unmardana & Siravyadha as remedy for Vatakantaka
in different contexts3
 Upanaha is one among Chaturvidha Swedana explained by Acharya Sushruta4. The pain in Vatakantaka is due to Vata Prakopa.
So Upanaha Sweda can be done as it is Vatahara. Here Salvana Upanaha is considered for Upanaha Sweda. The Salvana
Upanaha explained by Acharya Sushrutha in the context of Vatavyadhi Chikitsa, which is indicated in all Vata Vyadhis. The
Bandhana done in Upanaha Swedha is an added advantage to this condition. So this study is taken up to clinically evaluate the
efficacy of Salvana Upanaha Sweda in conditions pertaining to Vatakantaka.
 Acharya Vangasena gave special emphasis on the therapeutic effects of siravyadha5. The Para-surgical procedure of allowing
the blood to bleed for therapeutic purposes is known as raktamokshana. Siravyadha is a type of raktamokshana where
puncturing of the vein is done with a shastra6. Acharya Sushrutha, considered it as Ardha Chikitsa. Dalhana comments that it is
because siravyadha cures diseases of Mamsa, Meda, Asthi & Majja. He recommends raktamokshana for Vata prakopa in Sira,
Tvak, Mamsa, and Rakta which was not encountered even after the treatment of Panchakarma7.
 The clinical efficacy of Panchakarma procedures deserves appreciation and hence continues to attract the people, physicians
and research workers worldwide. Hence Upanaha sweda with and without Siravyadha was decided to be studied.

5. REVIEW OF LITRATURE
 DISEASE REVIEW
Vatakantaka –
In the Ayurvedic classical texts Vatakantaka is a disease mentioned among Vatavyadhies. Susrutha and
Vagbhata explain it under Vatavyadhi. There are explanations of this disease in Chakradatha, Baishajyaratnavali and
Madavanidana. Nidana, Samprapthi and Lakshana are almost similarly explained in all the texts. Among
Bhruhathrayees, Charakacharya didn't specifically explain this disease.
 History Of Vatakantaka
 History of Ayurveda is divided into three
 Vedic period
 Samhitha kala
 Sangraha Kala
 1. Vedic Period:
 References about Vatakantaka is not visible in vedas, but the information is available regarding Vatavyadhi in
general .It is mentioned in Bruhath Jaataka 23-13, Raghuvamsham9-63, Brahma Samhita 87-44, Kaashika 5-2-
1298 .

6. 2. Samhita Kala:
Susrutha Samhita
Acharya Sushrutha explained Lakshanas of Vatakantaka in Nidanasthana9. In Chikithsa Sthana specific line of treatment has been
mentioned as Siravyadhana to be performed10
Charaka Samhitha
Acharya Charaka described it as Khuda Vata, Which is a synonym of Vatakantaka in the chapter Vatavyadhi Chikitsa. He
explained this condition under the “Sthana Bheda Vayu Lakshana11Chakrapani comments that Khuda Vata is Gulpha Vata12 .
Ashtanga Hridaya
In Ashtanga Hridhaya, Vatakantaka are explained in Nidhanasthana and Chikithsa Sthana13
3. Sangraha Kala:
Madhava Nidana14
Vatakantaka is explained in Vatavyadhi nidana
Bhavaprakasha:
He explained the lakshanas and treatment of Vatakantaka in Madhyama Khanda Vatavyadhikara. From the treatment point of
view he had stated Dahana, Snehana, Upanaha swedam and a combination of Indravarunimula, Pippali and Guda for internal
administration15.
Yogarathnakara:
Lakshanas and treatment of Vatakantaka are explained in Vatavyadhi Adhikara of Poorvardha16

7.  Definition Of Vatakantaka
Sushruth Acarya explains that by walking on uneven surfaces, Vata gets vitiated and produces pain .He says this
disease is based on Khuda23. Dalhana explained as the junction of Pada and Jangha or as Parshini24 is Khudaka and
explained that when Ruja (pain) is located in Khuddaka(Khuddaka ashrita) heel region called as Vatakantaka25.
Vatakantaka – Modern Review
Pain in the foot can be classified according to the region affected.
 Pain in the heel
 Pain in the mid foot
 Pain in the fore foot
A. Pain In The Heel
This can be subdivided into
Pain within the heel e.g.: Fracture or disease of the calcaneum (osteo myelitis or tumour or Paget's disease) and
arthritis of the subtaloid joint.
Pain behind the heel e.g.: Tendoachillis bursitis, retrocalcaneum bursitis, apophysitisof the calcaneum (Sever's
disease) and rupture and paratendinitis of the tendoachillis.
Pain beneath the heel e.g.: Infracalcaneum bursitis and plantar fasciitis (Policeman's heel) Calcaneal spur.

8.  B. Pain In The Midfoot
A strain on the inferior calcaneo navicular ligament (spring ligament) occurs when the foot flattens rapidly due to
weakness of the short muscles of the sole or after a prolonged confinement in the bed.
Kohler's disease (osteochondritis of the navicular bone) is another cause of pain in the mid-foot. The usual victim
is the child under 5 years of age. Painful limb and tenderness over the navicular bone are the diagnostic
considerations; the navicular bone becomes dense with altered shape.
An "over-bone" connecting the dorsal surfaces of the medial cuneiform and the base of the first metatarsal bone
give rise to pain in the mid-foot. A tender and bony lump just proximal to the base of first metatarsal bone is the
diagnostic feature of this condition.
C. Pain In The Forefoot Or Metatarsalgia
Disorders of the foot may give rise to pain in the forefoot, e.g.: splay foot associated with hallux valgus, curly toes,
a claw foot with claw toes etc.

9. TREATMENT REVIEW
 Swedana:
Chikitsa is classified into three varieties as Antahparimarjana, Bahirparimarjana and Shastrapranidhana. The presently discussed subject
Swedana Karma is one among the Bahirparimarjana and Shat-Upakrama. However the concept of Abhyantara Sveda is also mentioned in
the context of Jwara and Kushta. Swedana is the Upakrama which is exactly opposite to the Sthambana. A separate chapter can be seen in
Ayurvedic literatures, illustrating this therapy which represents its importance in treating diseases and maintenance of health.
UPANAHA SWEDA
Etimology Of Upanaha:
Upanahyate Asmin – Upa + Nah (Bandhane) “Dhanj” Prathyaya139
-To tie, to cover or to wrap.
Upa – is a prefix to noun/verb and denotes near by/ together.
Nah – is a verb and denotes to bind/ to tie.
Upanaha means -To tie or to cover or to wrap 140
Definition:
Vranaalepa pinda141– The act of application of paste in form of Kalka is Upanaha.
Pralepa iti bhasha – Upanaha is also called as Pralepa.
Upanaha sweda visheshe lep142– Upanaha is a mode of fomentation in the form of application of medicinal drugs.
Vranaadi upashamanartham lepane draye ca143 – Upanaha means application of different drugs in a specific form for
the purpose of Shamana of wound.

10. DRUG REVIEW:-
Sankrit Name Botanical Name Family Rasa Guna Virya Vipaka Karma Part used
Vidarika Ipomea digittata Convolvulaceae Madhura Guru,
Snigdha
Sheeta Madhura Vata-Pittahara Tuber
Mudgaparni Phaseolus trilibus Fabaceae Madhura Laghu,
Ruksha
Sheeta Madhura Tridoshahara Seed
Mashaparni Teramnus labialis Fabaceae Madhura Laghu,
Snigdha
Sheeta Madhura Vata-Pittahara Seed
Shatavari Asparagus
recemosus
Liliaceae Madhura,
Tikta
Guru,
Snigdha
Sheeta Madhura Vata-Pitttahara Tuberous
root
Chinnaruha Tinospora cordifolia Menispermaceae Tikta,
Kashaya
Guru,
Snigdha
Ushna Madhura Tridoshahara Whole plant
Karkatashringi Pistacia
integerrima
Anacardiaceae Kashaya,
Tikta
Laghu,
Ruksha
Ushna Katu Kapha-Vathahara Galls
Vamshalochana Bambusa
arundinacia
poaceae Madhura,
Kashaya
Laghu,
Ruksha
Sheeta Madhura Kapha-Pittahara Root
Nodes
Leaves
Padmaka Prunus puddum Rosaceae Kashaya,
Tikta
Laghu,
Snigdha
Sheeta Katu Kapha-Pittahara Stem bark
Seeds
Mrdvika Vitis vinifera Vitaceae Madhura Snigdha,
Guru,
Sheeta Madhura Vata-Pittahara Fruit

11. Jeevanti Leptadenia reticulate Asclepiadaceae Madhura Laghu, Snigdha Sheeta Madhura Raktha-Pittahara Root
Madhuka Glycyrrhiza glabra Fabaceae Madhura Guru, Snigdha Sheeta Madhura Tridosha Hara Root
Bhadradharu/
Devadaaru
Cedrus deodar Pinaceae Tikta, Katu,
Kashaya
Laghu, Ruksha Ushna Katu Kapha-Vatahara Bark, Heart-
wood
Kusta Saussurea lappa Asteraceae Tikta, Katu,
Madhura
Laghu, Ruksha,
Teekshna
Ushna Katu Vata-Kaphahara Root
Haridra Curcuma longa Scitaminae Tikta, Katu Ruksha, Laghu Ushna Katu Kapha-Vathahara Rhizome
Varuna Cretaeva religiosa Capparidaceae Tikta, Kashaya Lagu,
Ruksha
Ushna Katu Kapha-Vathahara Root bark, stem
bark
Bala Sida cordifolia Malvaceae Madhura Laghu,
Snigdha,
Picchila
Sheeta Madhura Vatha-Pittahara Root
Atibala Sida rhombifolia Malvaceae Madhura Laghu,
Snigdha
Sheeta Madhura Vata-Pittahara Root
Kacchura Curcuma zedoaria Zingiberacear Katu,
Tikta,
Kashaya
Laghu,
Teekshna
Ushna Katu Kapha-Vatahara Tuber
Leaf
Shallaki Boswellia serrata Bursuraceae Kashaya,
Tikta
Laghu,
Ruksha
Sheeta Katu Kapha-Pittahara Bark
Gum
Lathakaranja/
Kuberaksha
Caesalpinia borduc Caesalipiniaceae Tikta,
Kashaya
Laghu,
Ruksha
Ushna Katu Tridosha
Hara
Root bark
Leaf
Seed

12. Agnimantha Clerodendrum phlomidis Verbinaceae Tikta,
Katu,
Kashaya,
Madhura
Ruksha,
Laghu
Ushna Katu Kapha-Vatahara Root-bark
Leaves
Eranda Ricinus communis Euphorbiaceae Madhura,
Katu,
Kashaya
Snigdha,
Teekshna,
Sukshma
Ushna Madhura Kapha-Vatahara Root
Leaf
Seed oil
Asmabhedha Saxeifraceae lingulata Saxifragaceae Kashaya,
Tikta
Ruksha Sheeta Katu Tridosha Hara Root
Leaf
Flower
Fruit
Arka Calotropis gigantean Asclepiadaceae Katu,
Tikta
Laghu,
Ruksha,
Teekshna
Ushna Katu Vatahara Root-bark
Leaf
Flower
Latex
Seed
Punarnava Boerhavia diffusa Nyctaginacea Madhura,
Tikta,
Kashaya
Laghu,
Ruksha
Ushna Katu Kapha-Vatahara Whole plant
Dhathura Datura metal Solanaceae Tikta,
Katu
Laghu,
Ruksha
Ushna Katu Kapha-Vatahara Root
Fruit
Seed
Flower
Leaf
Bharangi Clerodendrum indicum Verbinaceae Tikta,
Katu
Lagu,
Ruksha
Ushna Katu Kapha-Vatahara Root
Karpasa Gossypium herbaceum Malvaceae Madhura Laghu Ushna Madhura Vatahara Seed
Flower
Badara Ziziphus mauritiana Rhamnaceae Madhura,
Amla
Guru,
Snigda
Sheeta Madhura,
Amla
Vata- Pittahara Root
Leaf
Fruit
Yava Mordeum vulgare Graminae Kashaya,
Madhura
Ruksha Sheeta Katu Tridosha
Hara
Seed

13. The some of the drugs of Kakolyadi Gana are not
available, for that Acharya Bhava Mishra explains
some of substitute drugs
Sl .No DRUG SUBSTITUTE DRUG
1. Kakoli (Fritillaria roylei) Ashwagandha (Withania somnifera)
2. Ksheera kakoli(Lillium polyphyllum) Ashwagandha (Withania somnifera)
3. Jeevaka (Microstylis wallichil) Vidarika (Ipomea digitata)
4. Rushabhaka (Microstylis musifera) Vidarika (Ipomea digitata)
5. Meda (Polygonatumcirrhifolium) Shatavari(Asparagus racemosus)
6. Mahameda (Polygonatum verticillatum) Shatavari(Asparagus racemosus)
7. Vriddhi (Habenaria intermedia) Varahikanda (Dioscoera bulbiflora)
8. Ruddhi (Habenaria edgeworthii) Varahikanda (Dioscoera bulbiflora)

14.  Tila:
Latin Name : Sesamum indicum
Family : Pedaliaceae
Rasa : Madhura
Anurasa : Kashaya, Tikta
Guna : Guru, Snigdha
Veerya : Ushna
Vipaka : Madhura
Doshagnatha : Vatashamana
Rogaghnata : Vatavyadhi, Arsha, Prameha,
 Saindhava:
Chemical name: Sodii chloridum
impura
English Name: Rock Salt
Rasa : Lavana, Madhura
Guna : Laghu, Snigdha,
Sookshma
Veerya : Ushna
Vipaka : Madhura
Doshaghnata : Tridoshashamana
 Maha Snehas: 181
SARPI (ghee-butter fat), MAJJA (marrow), VASA
(muscle fat) and TAILA, are ideal among all fats and
ghee is best of all, because of its ability to acquire the
properties of processing. (with addition of other drugs
etc.)

15. Kanji:
The liquor prepared with Manda (gruel) of half boiled
Kulmasha (blackgram), Dhaanya (rice, barley etc.) is Kanjika.
Mamsarasa:
Preparation:
If Ganamamsa Rasa is suppose to be prepared 8 Palas of Mamsa and one Prastha
of water are taken.
If Madhyama Mamsa Rasa suppose to be prepared 6 Palas of Mamsa and one
Prastha of water are taken.

16. SIRAVYADHA REVIEW
Saranath sira– that which conveys is called sira
 Poorva karma
Selection of Sira
The Sira which are invisible and which are not prominent should not be selected. Out of 700 Siras, 16 Siras in Shaka, 32 in
Madhya Shareera, 50 in Urdvajatru are regarded as contraindicated for Siravyadha.
 Pradhana karma of siravyadha193
The patient should be duly anointed (Sneha) and fomented (Sweda) before the procedure. Drava Anna and Yavagu should be
given (liquid food is recommended for the purposeof liquefying the blood so as to bleed easily.). Then at proper season the patient
should be brought near the physician and made to sit or lie down and the part to be punctured upon should be tied (Yantrana),
neither too loosely (e.g., in the Shakha) nor too tightly (e.g., in the Uttamanga) with any of the accessories, such as Patta Vastra,
Charma, Antarvalkala, Lata etc, so as not to create any pain or agitation in patients mind. Then the Sira should be duly opened with
proper instrument with a care regarding the local Marma.
 The physician should raise the vein by tapping on it with his middle finger. On finding that the vein has risen up and felt by
touch, he should hold the Kutarika with his left hand keeping its handle up, place it on the vein in its centre, tap it with his
middle finger triggered by the thumb or press it with the middle of the thumb. At places where the vein is hidden or the skin is
thick, pressing with the thumb to cut the vein should be done carefully.

17. Amount of bloodletting:
 The maximum amount of blood to be let out is one Prastha according to Acharya Sushruta (one prastha is 13 ½ pala) 193.
 According to Dalhanacharya the amount has to be fixed according to the strength of the patient, strength of the Doshas and strength of
the disease196. An intelligent surgeon should allow a part of the vitiated blood to remain rather than drain it excessively. Palliative
measures should be followed to pacify the remaining Dosha in the blood197.
 In the first stage of the disease (Vatashonita), blood should be let out in small quantity only. Excess blood let may cause aggravation of
Vata.198
Paschat karma
After bloodletting is done the food or diet, which is neither hot nor cold and is light, which can be easily digested and that which
stimulates the digestion are recommended. The power of digestion as well as the power of metabolism is to be carefully maintained. If the
food and drinks are extremely cold then it impairs digestion and metabolism and if the food is too hot it creats vitiation of the blood. The
food which consists of buttermilk with yoosha, yavagu, peya must be given to the patient. With this intake of diet which promotes the
formation of blood, grutha and sheeta jala parisheka must be advised.


18. Objectives of the Study
 Evaluate the efficacy of Upanaha Sweda in Vatakantaka.
 Evaluate the efficacy of Upanaha Sweda done after Siravyadha in Vatakantaka.
 Compare the efficacy of Upanaha Sweda with and without Siravyadha in Vatakantaka.

19. Hypothesis
 H - There is no effect of Siravyadha and Upanaha sweda In Vata Kantaka
 H - There is significant effect of Upanaha Sweda in Vatakantaka
 H - There is significant effect of Siravyadha with Upanaha Sweda in Vatakantaka

20. SOURCE OF DATA
 Patients who attended the O.P.D and I.P.D, Department of Panchakarma of K.V.G Ayurveda
Medical College and Hospital, Sullia, during the period from May 2015 to February 2017 having
the complaints of Vatakantaka were screened. Among them 30 patients fulfilling the inclusion
criteria of the present study were taken. Detailed history taking and physical examinations were
carried out in these patients. Relevant data along with the elaborate assessment of Pain, Functional
Ability & Functional Disability were registered in the designed case pro forma.

21.  Inclusion Criteria:
1. Age group between 20 and 60 years, Irrespective of religion, sex and occupation.
2. Patients with symptoms of Vatakantaka.
3. Patient fit for Swedana Karma.
4. Patient fit for Siravyadha
 Exclusion Criteria:
1. Persons contra-indicated for Swedana and Siravyadha7 according to classics.
2. Open wounds, fractures.
3. Allergic skin condition.
4. Impaired skin sensation condition.
5. Known case of hypertension, hypotension, diabetes mellitus, malignancy,
bleeding disorders and anemic patients
 Laboratory investigations:
1. Hb%, CT, BT, RBS.
2. X-Ray- if necessary

22. Assessment criteria
 Assessment of the condition will be done based on a detailed proforma and
will be analyzed statistically before treatment, after treatment and follow up
period.
Subjective Parameters: Heel pain.
Objective Parameters: Tenderness.

23. GRADING OF PARAMETERS
 PAIN GRADE
No pain 0
Tolerable (And does not prevent any activities) 1
Tolerable (But does prevent some activities) 2
Intolerable (But can do Walking , jogging, Running,Play activicties, Daily work etc) 3
Intolerable (Cannot do Walking, Jogging, Running, Play Activicties, Daily work etc) 4
Intolerable ( Unable to verbally communicate because of pain) 5

24. PAIN ASSESSEMENT SCALE (VAS)
0-10 NUMERIC PAIN RATING SCALE
0 1 2 3 4 5 6 7 8 9 10
No Moderate Worst
Pain Pain Possible Pain

25. Tenderness Grading
Grade 1 The patient says the joint is tender
Grade 2 The patient winces
Grade 3 The patient winces and withdraw the affect part
Grade 4 The patient will not allow the joints to be touched

26. Materials & Methods
 Materials required for Upanaha Sweda:
Drugs of Kakolyadi Gana, Bhadradarvadi Gana, Kanji, Mamsarasa, Mahasneha and Saindava Lavana.

28. MAHASNEHA(Except Majja)
Procedure for Upanaha
S I No Sneha Quantity
1 Sarpi 10ml
2 Taila/Tila taila 10ml
3 Vasa 10ml
4. MAMSARASA - 20ml
5. KANJI -20 ml
6. SAINDHAVA LAVANA - 10 Grams
7. Cotton cloth for Bandana
8. Steel bowl
9. Gas Stove
10. Steel Vessels
11. Eranda Patras
12. Steel Spoon.

29.  Materials Used for Siravyadha
Tila taila- Sufficient quantity
Gas stove-one
Towel-one
Hot water
Tourniquet-one
18. no. Needle –one
Sterile glove
Measuring jar-one
Sterile Gauze & pad- Sufficient quantity
Roller bandage

30. Material used for both procedure

31. OBSERVATIONS AND RESULTS
 BASED ON SEX – 50% MALE & 50% FEMALE
 Based on Marital Status- 80% Married & 20% Unmarried
 Based on Age- Middle age is more effected
 Based on Occupation: 26% Of House wife
 Based on Religion :76.6% Hindu’s
 Based on Socio Economic Status: 40% of Both Poor & High
 Based on Education: 30% 0f Both Primary and Graduates
 Based on Prakrithi: 56.7% of Vata Kapha
 Based on Duration of Illness :86.7% up to one year
 Based on Weight :43.3% between 61-70 Kg

32. 

34. Results
 Effects of Upanaha Sweda
Effect of Group-B on Pain of Vatakantaka
SYMPTOM
Mean score
% S.D (±) S.E (±) t value p value
BT BT-AT
PAIN 2.87
AT 1.73 1.13 39.53 0.352 0.091 3.80 <0.001
FU 1.40 1.47 51.16 0.516 0.133 5.82 <0.001
Statistical analysis showed that the mean score which was 2.87 before the treatment was reduced to 1.73 after the treatment and
after follow up it became 1.40 with 51.16% improvement and there is a statistically highly significant. (P<0.001)
SYMPTOM
Mean score
% S.D (±) S.E (±) t value p value
BT BT-AT
PAIN
3.73
AT 1.87 1.87 50 0.743 0.192 6.63 <0.001
FU 0.93 2.80 75 0.862 0.223 10.19 <0.001
Statistical analysis showed that the mean score which was 3.73 before the treatment was reduced to 1.87 after the treatment and
after follow up it became 0.93 with 75% improvement and there is a statistically significant change. (P<0.001

35. Effect of Group - A and B on Pain of Vatakantaka Effect of Group-A and B Tenderness of Vatakantaka
Effect of Group-A Tenderness of Vatakantaka
In patients registered in GROUP-A group showed highly significant improvement (P<0.001). The mean score which was 2.47
before treatment reduced to 1.60 after the treatment and after follow up it become 1.27 with 48.65% improvement
Effect of Group-B on Tenderness of Vatakantaka
In patients registered in GROUP-B group showed statistically significant improvement (P<0.001). The mean score which was 3.07
before treatment reduced to 1.40 after the treatment andafter follow up it become 0.93 with 70% improvement

36. Result on group A
EFFECT OF TREATMENT IN GROUP - A
Class Grading No of patients
0-25% No Improvement 0
26% -50% Mild Improvement 3
51% - 75% Moderate Improvement 12
76% - 100% Marked Improvement 0
Result on group B
EFFECT OF TREATMENT IN GROUP - B
Class Grading No of patients
0-25% No Improvement 0
26% -50% Mild Improvement 0
51% - 75% Moderate Improvement 5
76% - 100% Marked Improvement 10

37. Comparative results of Group-A and Group-B
Characteristics Group-A Group-B
Signs and
Symptoms
Mean score Percentage
of relief
Mean score Percentage
of reliefBT FU BT FU
PAIN 2.87 1.40 51 3.73 0.93 75
VAS 6.60 2.53 62 7.33 0.80 89
TENDERNESS 2.47 1.27 49 3.07 0.93 70
Group A Group B Mean
Difference
SE (±) T value P value
56.62 81.49 24.87 3.75 6.22 <0.001
Comparative analysis of the overall effect of the treatments in both the groups was done by statistically with paired t test. The
test shows that the treatment is statistically significant in Group B when compared to Group A. Group A overall result is 56.62%
and Group B overall result is 81.49%.

38. DISCUSSION
 Discussion on Vatakantaka
Acharya Sushrutha gives the description of Vatakantaka under Vatavyadhi chapter. The features of Vatakantaka are severe
pain in the pada and ankle joint caused by the improper placement of the feet on the ground , by walking on an uneven ground
frequently, placing the feet improperly while walking, running etc., causes exertion there by vata that is localized in Gulpha gets
aggravated and produces severe pain in Pada.
 Discussion on Upanaha Sweada:
Upanaha is one among Chaturvidha Swedana explained by Acharya Sushruta. Keeping these views of Acharyas in mind we
have selected to treat the condition with Upanaha Sweda. The Yoga for Upanaha Sweda was selected from Sushruta Sutrastana,
38th and 39th Chapter. Dharanakala of this Salvana Upanaha was between10- 12 hours. Duration of treatment was 07days.
 MODE OF ACTION OF UPANAHA SWEDA
Swedana drugs by ushna and teekshna guna are capable of penetrating the micro circulatory channels(srothas), where they
activate the sweat glands to produce more sweat. After dilatation of srothas, laghu and sara guna of these drugs enable them to
act on dosha sangatha in channels, remove the stagnation, making the sticky contents mobile & direct them towards koshta or
excrete them through micro pores of the skin in the form of sweat, resulting in srotho shodhana. During fomentation, heating the
tissues results in rise of temperature , leading to increased metabolism. This in turn increases vasodilatation , increased blood
flow ,supply of more oxygen & nutrients with simultaneous removal of accumulated metabolic wastes .

39.  DISCUSSION ON SIRAVYADHANA:
Siravyadha is considered to be the ardha chikitsa . The procedure of siravyadha as explained in classics is difficult
to put in vogue practice. Hence its technique is modified in this study. The procedure is carried out with the help of 18.no needle
where the tip of the needle is yavakara/vreehimukha akara. Based on the shape at its tip it can be called as vreehi mukha shastra.
This needle would be better substitute for classical vreehimukha shastra, the advantages being free availability, well sterilized
condition, seldom occurrence of complications, possibility of accurate measurement of extracted blood and over to all these it
causes minimum discomfort.
 Probable mode of action of siravyadha:
Prakupita vata circulating through the rakta present in siras of pada .According to the concept of shodhana,
always deranged dosha should be removed from nearest routes. Siravyadha is also one of the shodhana therapy, so according to
roga adhisthana, different sites of siravyadha are selected in different diseases. In vatakantaka, padadaha, padadari…. And others,
the site of siravyadha mentioned is -‘Two angulas above kshipra marma’ was taken.
In Ayurvedic references particularly in Sharangadhara samhitha it has been described that when blood is vitiated, there will be
pain and odema. Also both Sushrutha & Sharangadhara quotes that by siravyadhana there will be vedanashanthi ie relief of pain.
By this it can be understood that siravyadha has the efficacy of relieving the pain in vatakantaka.
Dalhana tells shonithavasechana helps in curing diseases of mamsa, meda, asthi majjagata .It will clean dhamani,dusta raktha
& twak.

40.  Discussion on patients of Vatakantaka who underwent the trial
 Sex: Out of 30 patients in group A and Group B, 15 patients were female and 15 patients were male.The sample is too small to
convey definite conclusion.
 Marital Status: Out of 30 patients in group A and Group B, 24 patients were married and 6 patients were Unmarried. The
sample is too small to convey definite conclusion.
 Age : Out of total 30 patients in group A and group B, maximum patients were in age Group 30-49, 40-59 and 50-69 years.
They were 26.7%, 26.67 and 26.7% respectively. Group wise division: They were 20%, 13.3% and 33.3%, 40% respectively in
A and B Group. May be in this age group of 30-49, 40-59 and 50-69 this disease is common because of their strenuous long
standing work and due to their Ahara Swabhava.
 Occupation : Out of total 30 patients in Group A and Group B, maximum patients were found housewife. They were 8
(26.7%).Group wise division: In, Group A, they were 26.7% and Group B they were 26.7%.Due to their long standing and
walking through uneven surface may be the reason for that.
 Religion:Out of total 30 patients in group A and Group B, maximum patients were of Hindu religion (76.7%).
Group wise division: In, Group A they were 86.7% of Hindus, while in Group B they were 66.7% of Hindus and 33.33%
Christians. The sample is too small to convey definite conclusion.

41.  Socio Economic StatuS:Out of total 30 patients in group A and Group B, maximum patients are high and Poor (40%).
Group wise division: In, Group A, High class are 33.3% and poor are 46.7%.In, Group B , High class are 46.7% and poor are
33.3%. Due to their strenuous and long working hours may be the reason for that .
 Education:Out of total 30 patients in Group A and Group B, maximum patients’ Education were primary and Graduate ie: 9
(30%).Group wise: In, Group A, maximum patients Education were primary 40% and graduate were 40%.In, Group B,
maximum patients Education were primary 20% and Graduate were 40%.Due to their long working hours may be the reason
for that
 Prakruthi:Out of total 30 patients in Group A and Group B, maximum patients were found vata kapha prakruthi followed by
Vata Pitta prakruthi. They were 17 (56.7%) and 9 (30%) Respectively. Group wise division: In, Group A, they were 66.7% and
33.3% respectively. In, Group B. Thus the observation of prakrithi shows that Vata Kapha Pradanatha may be important in
Vatakantaka.
 Duration: In the study as a whole (30 patients) 26 patients fall under upto 1 years (86.7%).Among 15 patients in group A, 14
patients fall under upto 1 years (93.3%) Among 15 patients in group B, 12 patients fall under upto 1 years (80%).
 Weight: Out of total 30 patients in Group A and Group B, maximum patients’ weight were 61-70 kg ie: 13 (43.3%).Group
wise: In, Group A, , maximum patients’ weight were 51-60 kg ie: 7 (46.7%).In, Group B, , maximum patients’ weight were
61-70 kg ie: 9 (60%).Over weight may be the cause for the vatakantaka.

42.  Over All Assessment Of Result:
The percentage of improvement in Group A on Pain is 51%, VAS is 62%. And
Tenderness is 49% and the percentage of improvement in Group B on Pain is 75%,
VAS is 89%. And Tenderness is 70%.
 The comparison of two groups denotes that Group B is superior than Group A.
 Comparative results of Group A and Group B
Comparative analysis of the overall effect of the treatments in both the groups was
done by statistically with paired t test. The test shows that the treatment is statistically
significant in Group B when compared to Group A. Group A overall result is 56.62%
and Group B overall result is 81.49%.

43. CONCLUSION
 To conclude Vatakantaka is a disease commonly found . Vatakantaka is common in both sex. It mainly effect lower and
higher class due to their strenuous work. It causes severe pain especially in the morning and during walking after long
hours of rest. Vatakantaka causes difficulty in walking and effects daily activities. Increased body weight is also one of
precipitating factor.
 There was not much relief noticed with other modalities of medicine. It took a long time to cure and patient’s
satisfaction was less.
 Vatakantaka was more common in middle age and maximum number of the case had chronicity was within One year.
 For desparate patients Upanaha Sweda with and without Siravyadha are therapies to give results. Both the procedures
were very simple, safe, economical and effective procedure. They don’t need much preparation and can be done in OPD as
well as IPD. Both showed better improvement in symptomology .Out of this Upanaha Sweda With Siravyadha (Group B)
showed better improvement in symptomology than Upanahs Sweda(Group A) There was a marked improvement in pain
and tenderness.
 Main Conclusions are Drawn :
 Both the procedures (Upanaha Sweda with and without Siravyadha ) are effective in treating Vatakantaka .
 Over all the Group B is more effective clinically and statistically than Group A in almost all the parameters.
 Both are beneficial in Vatakantaka
 It is having instant effect and can be accepted as a suitable treatment modality for current era

44. REFERENCES
 Sushruta Samhita
 Charaka Samhita
 Vangasena
 Bhavapraksha
 Madhvanidana
 Astangasangraha
 Bharata Bhaisjiya Ratanakara
 Bhavprakash Nighantu
 Chakradata
 Harita Samhita
 Astangahridayam