This document presents a case study of a 47-year-old male patient presenting with left knee pain and swelling for 2.5 months. After examination and investigations, he was diagnosed with osteoarthritis (sandhivata) of the left knee. In Ayurveda, osteoarthritis is viewed as a condition caused by vitiation of vata dosha, leading to destruction of cartilage and bone in the joint. The patient's treatment included purification therapies like herbal decoction enema and medicated oil enema, followed by pacifying therapies like application of herbal oils and pastes to the affected knee joint.

1. CASE PRESENTATION
 GUIDE : Dr. PRAKASH L HEGDE
 PROFESSOR
 DEPARTMENT OF
DRAVYAGUNA
 SDMCAH HASSAN
 PRESENTER : Dr. Devraj K.C.
 2nd YEAR P.G SCHOLAR
 DEPARTMENT OF DRAVYAGUNA
 SDMCAH HASSAN
1

2. • Name : X
• Age : 47 Years
• Sex : male
• Marital status : Married
• Occupation : Bussiness
• Education : PUC
• Adress : NGW Ward no 8
• Date of admission : 22.1.2018
• Date of discharge : 29.01.2018
• Ward : MGW-131
2

3. PRADANA VEDANA EVAM AVADHI
Patient complaints of pain in the left knee joint associated with swelling
since 2.5 months. Increased since 10 days.
ANUBANDHA VEDANA
Generalized body pain and heaviness of body.
3

4. PRADHANA VEDANA VRUTTANTA
Patient was apparently healthy before 2.5 months. Suddenly while lifting
load, he developed pain in left knee and was marked swelling and burning
sensation with criptus on left knee. For that he consulted an allopathic
physician and some medicine i.e diclofenac, calcium and vitamin D was
given for one month, . During the course of medicine he found relief so he
continued daily activities. 2 month later while doing work in shop pain again
reoccurred in left knee and was swollen hugely. Because of which he was
unable to do daily activities. So for that he consulted in SDMACH and
admitted on 22/1/2o18.
4

5. AGGRAVATING FACTORS :
- On standing continuously for more than 1 hour.
- On walking long distances.
- sitting prolong in lapping position
RELIEVING FACTORS :
- On rest (lying on bed in supine posture)
- Hot water bath.
5

6. PURVA VYADHI VRUTTANTHA
 No history of RTA, fracture or injury, chest infection and
reactive ostioartharitis .
 History of ksharsutra of fistula in ano-2 years back.
6

7. Chikista vruttanta:
1. Tab. Calcium 500mg x 2 month
2. Tab diclofenac 100mg x od x sos
3. Tab vitamin D 5oooo iu x 2 month
4. Oint diclo L/A.
7

8. SAMAJIKA VRUTTANTA
 He belongs to Middle class family.
KAUTUMBIKA VRUTTANTA
There are 6 members in his family, including he, his wife and
their 3 Daughter and 1 son of 2 years old.
Married since 22 years, relation is in harmony.
No positive family history for her present complaint, all members
are said to be healthy.
8

9. VYAVASAYA VRUTTANTA
- Patient is a businessman and works in shop 3 days in a week.
- Duration of work: 10 hr.
- Nature of work: works by lifting the goods and sitting in lapping
position
9

10. VAYAKTIKA VRUTTANTA
Diet : non vegetarian
Appetite : Prakruta
Breakfast: (8.30am-10.30am) ; 5- chapatti, chitranna(1bowl) and vegetable curry.
Lunch: 1.00pm; rice and sambar and ragi ball.
Dinner: 8pm; ragi mudde; anna and Sambar/rasam
Micturition : regular
4-5 times/ day; night -once.
No burning sensation or pain during micturition.
Defecation : regular
1 times in a day.
Normal consistency.
No pain and no history of PR bleeding but pus discharge before ksharsutra
of fistula in ano.
10

11. Sleep :
he sleeps at 10pm, wakes at 5 am.
( due to pain it takes time to fall asleep ,once slept it is sound)
Habbit :
Alcohol- 2 time in a month,
11

12. VITAL SIGNS :
 Pulse : 100 bpm
 B.P : 110/70 mmHg
 Temperature : Afebrile
 Respiratory rate : 26 times / min
Heart rate :100 beats/min
12

13. SAMANYA PAREEKSHA:
Consciousness : Awake, Alert and Responsive
General appearance: Ill looking
Built : Endomorphic
Pallor: Absent on lower palpebral conjunctiva, absent on creases
of palmar surface of hands, skin, soles, nail bed, oral mucosa and
tongue.
Icterus: No yellowish discoloration seen on skin, sclera, mucous
membrane, hard palate, palpebral conjunctiva.
13

14. Cyanosis: Peripheral (skin) and central cyanosis absent (lip, oral mucosa and
tongue).
Clubbing: Absent
Oedema: localized in left kne
Lymphadenopathy: Localized Lymphadenopathy : Absent
Generalized lymphadenopathy : Absent
 Gait: altered. (antalgic)
14

15. ASHTA STHANA PAREEKSHA:
 Nadi - 100 bpm
 Mutra - Prakruta (4-5 times/ day; night -once.)
 Mala - Prakruta (1 times a day, normal consistency)
 Jihwa - Alipta
 Sabda - Vikruta( criptus in left knee)
 Sparsha – Vikruta ( tenderness in left knee)
 Druk - Prakruta
 Akruthi - Madhyama (BMI-30) 15

16. Dashavidha Pareeksha:
1. Prakriti: vata kapha
2. Vikriti: vata
3. Sara: Madhyama
4. Samhanana: Madhyama
5. Pramana: Height: 158cms
Weight: 75 kg
6. Satmya: sarvarasa satmya
7. Satva: Madhyama
8. Aahara sakti: Madhyama
9. Vyayama sakti: pravara
10. Vaya: praudha
16

17. Systemic Examinations :
Respiratory System :
Inspection – shape of chest is bilaterally symmetrical, with abdomino-
thoracic movement.
Palpation – Trachea centrally placed, tenderness absent, symmetrical
chest expansion
Percussion – Resonant all over the lung field.
Auscultation – Normal bronchial and vesicular sounds.
17

18. GIT examination :
 Inspection – Scars, dilated veins, rashes and lesions over
abdomen absent. Umbilicus is normal in contour and location
Contour of the abdomen is flat and is symmetric. No visible
peristalsis and pulsations .
 Auscultation – Bowel sounds heard - 3 – 5 per minute.
 Palpation – No tenderness, No organomegaly
 Percussion – tympanic.
18

19. Cardiovascular System :
 Inspection:
Precordial bulge:
Position of apical impulse:
 Palpation:
Apical impulse:
Palpable pulsation:
Jugular venous pressure:
Persussion
Cardiac border
Auscultation:
1st and 2nd heart sound: Heard
Murmurs: No added sounds
19

20. CENTRAL NERVOUS SYTEM
Higher Mental function:
Consciousness: conscious
Orientation: oriented to time, place and person
Intelligence: intact
Memory: intact
Emotional disturbances: absent
Disturbances of speech: absent
Hallucinations and Delusions: absent
20

21. MOTOR SYSTEM
1. Attitude of limbs: Normal
2. Power: normal on bilateral lower limbs
3. Nutrition: Well nourished
4. Coordination: Intact
5. Tone: Normal
6. Involuntary Movements: Absent
7. Reflexes : Intact
21

22. SENSORY SYSTEM
1. Touch: Intact
2. Pain: Intact
3. Temperature: intact
4. Vibration:intact
5. Pressure sense:intact
6. Two point discrimination: intact
22

23. INVESTIGATIONS
 HAEMATOLOGY REPORT
- HB : 12gm%
- Total WBC : 7700 Cells/CMM
- E.S.R : 82mm/ hour
- Diffrential count:
- Neutrophils- 76%
- Lymphocytes- 19%
- Monocytes - 1%
- Eosinophils - 04%
- Platelet count- 2.99 lakhs/CMM
- RBC count- 5.82 millions/ CMM
23

24. INVESTIGATIONS
HAEMOGRAM REPORTS
PCV:- 37.9%
MCV:-71.8%
MCH:-23.5%
MCHC:-32.7%
RDW:-40 FL
BIO-CHEMISTRY REPORT
FBS:- 99.4mg/dl
Blood Urea:-18.3mg/dl
Serum Creatinine:-0.9mg/dl
24

25. 25

26. NIDANA : athivyavama
PROOVA ROOPA :- Criptus on joints
ROOPA : Severe pain in left knee, marked swelling and burning sensation.
UPASAYA/ ANUPASAYA:
Upasaya: Rest, Lying down in bed.
Anupasaya: On standing continuously for more than for 1 hour.
sitting in lapping position.
On walking long distance.
26

27. SAMPRAPTHI :
ativyama
Vata sanchaya
Vata prakopa
Prasarana of prakupitha vata
In sira snayu kandara and asthi of janu
Sthana samsraya in janu and distruction of
slesmadhara kala, asthi, slesaka kapha
Janu Sandhigata Vata
27

28. SAMPRAPTI GHATAKA:
 Dosha: Vata
 Dushya: snayu, asthi, sira
 Agni: sama jatharagni
 Ama: nirama
 Srotas: asthivaha srotas
 Srotodusti prakara: sanga,
 Udbhava sthana: pakwasaya
 Sancharana sthana: uru, janu, jangha, pada
 Vyakta sthana: Janu
 Adhisthana: janu
 Rogamarga: Madhyama
28

29. VYAVACHEDAKA NIDANA
Sandhigata vata
upaghatajanya vata
Amavata
Reactive ostioartharitis
29

30. VYADHI VINISCHAYA:
Samvata Niramvata
Vibandha x Vishada
Agnisada x Rukshya
Tandra x Nirvivandha
Antrakujana x Alpa vedana
Vedana yes
Sopha yes
Nistoda yes
Anga Nirpidayana yes
30

31. VYADHI VINISCHAYA:
Sandhigata vata
31

32. TREATMENT GIVEN
1.pariseka with dasamoola kashayam + dhanyamla
2. Sthanika pinda sweda with Chincha + Lavana + Kottam chukkadi
tailum + dhanyamla.
3. Shiva Gutika 1 tab x BD
4. Varunadi kashayam 4 tsf x TDS
5. Tab Saddharana 2tab x TDS
6.YOGAVASTI
Tiktaka kshira vasti:-
Honey- 80gm + Saidhava lavana - 8 gm + kalka of yasthimadhu
and guduchhi 20gm of each + guduhhi kshirapaka 300ml +
mahatiktaka ghrita 80gm.
Anuvasana vasti with mahatiktaka ghrita – 80ml
7. Jalaukavacharana
32

33. Osteoarthritis
#Osteoarthritis (degenerative joint disease or
osteoarthrosis) is the most common form of arthritis,
affecting millions of people around the world.
#Often called wear-and-tear arthritis
#occurs when the protective cartilage on the ends of bones
wears down over time.
#It causes pain, swelling and reduced motion in joints.
#can occur in any joint, but usually it affects hands, knees,
hips or spine
#involves the entire joint, including the nearby muscles,
underlying bone, ligaments, joint lining (synovium), and
the joint cover (capsule)
#A variety of causes—hereditary, developmental,
metabolic, and mechanical—may initiate processes
leading to loss of cartilage.

34. 34

35. 35

36. 36

37. Ayurvedic view of OA
In Ayurveda OA is called as Sandhivata
Cause:
The main factor responsible for OA is vata, which after getting vitiated leads
to the pain and all remaining symptoms of OA. All possible reason that leads
to OA are classified into 4 categories:
1. Aaharaj Karan
a) dried diet b) cold diet c) less diet d) light diet d) incompatible diet e)
bitter & pungent diet f) poisonous diet
2. Viharaj Karan
a) excessive awakening at night b) unequal activities c) over exercise d)
stop of natural urges e) injuries f) excessive floating f) opposite actions g)
excesssive sexual indulgence h) loss of appropriate rest i) sleep at day
3. Manasik Karan
a) anxeity b) fear c) anger d) sorrow e) irshya

38. 4. Other causes
a) quantitative loss of tissue b) severe debility c) trauma to vital part d) severe
laxation e) excessive outletting of body fluids (blood & other fluid) f) excessive
vomitting g) Amdosha
Steps of Pathogenesis:
1) vitiation of vaata due to nidaan factors
2) consequent kshaya in Asthi & shleshaka kapha, shleshmadhara kala
3) invasion of vaata in sandhi causing destruction of sandhi
4) manifestation of disease.

39. General line of treatment for OA
1) Samsodhana therapy (purifying)
2) Samsaman therapy (pacifying)
Samsodhana therapy includes:
(a) Mridu Virechan:-
-Cassia fistula (decoction) 20-40 ml HS or -
Operculina turpethum (powder) 6gm HS
(b) Vasti :- 2 types of vasti can be preffered
1) Anuwasan (oil rich )
- Ksheera bala taila 120ml+ satpushpa pdr. 5gm + Saindhava
lavan 6 gm or,
- maha narayan taila or,
2) Niruha (decoction rich)
- Dashmoola niruha vasti 250 ml or,
- ricinus communis root decoction 250ml

40. procedure of samsodhan
1) proper snehan with vatahar oils like ghee, oil, fat, marrow. the oil of
eranda, tila etc can be used.
2) prover swedan is done after the snehan. it is done according to mono or
polyarticular involvement. eg :(eranda leaves+water)
3) A.V.( 2 day)+ N.V. (1 day) + A.V.(1 day) +N.V. (1 day) + A.V. (1 day) +N.V.
(1day)+ A.V. (1 day)
Samsaman Therapy:-
it can be divided into following procedures
1) Avyang:- local application of med. oil over affected joints by: -
Mahanarayan oil, mahamasha oil ....BD for 15 days
2) Upanaha:- application of packing of cooked leaves and meat over
affected part by:- sigru leaves or meat ...OD for 15 days

42. 3) Awagah:- in this procedure whole patient or affected joint is kept in lukewarm vata
pacifying oil, or milk.....for 10 days for 10 min/day
4) lepa:- external application of thick paste of drugs to the joints. Vridha darvyadi lepa
or sigrutwachadi lepa BD for 10 days
5) seka :- pouring of oils or medicated kashaya on osteo-arthitic joints in lukewarm
state
-sesamum indicum oil... 20 min./day for 10 days
- kshirabala taila
6) medications
(A) Metal praparation
-Vrihat vaat chintamani rasa 125mg BD for 15 days or
-Yogendra rasa 125 mg BD for 15 Days or
- Vatgajankush 125-250 mg BD for 15 days or
- Rasaraj rasa 125-250 mg. BD for 15 days or

44. (B) Decoction
- maharasnadi kwath 20-30ml BD for 15 days or
- balaeranda kwath DO OR
(C) Arishta
- balarishta 20-30 ml BD with equal water or
- ashwagandharishta DO or
- Dashmoolarishta DO or
(D) Tablets
- mahayograj gugglu 100-200mg BD 15 days or
- rasnadi gugglu 250-500mg DO
- trayodoshanga gugglu 250-500mg DO
- shigru twachadi vati 200 mg DO
(E) Powder
- ashwagandha churna 5gm BD 30 Days with milk
-shad-dharan churna 5 gm DO

45. Dravya prayoga in Sandhigata
vata
45

46. Herbal plant for OA
Withania somnifera Moringa oliefera Boswellia serrata
Asparagus racemosus Curcuma longa Sida cordifolia

47. RASNA [ Pluchae lanceolata ,
Asteraceae]
RASONA [ Allium sativum , Liliaceae]
ERANDA [ Ricinis communis,
Euphorbiaceae]
PARIJATA [ Nyctanthes arbor , Oleaceae
]