A STUDY ON THE EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA By Patil Uday J. Dissertation Submitted to the RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA In partial fulfilment of the requirements for the degree of AYURVEDA VACHASPATI (DOCTOR OF MEDICINE) In SWASTHAVRITHA Under the guidance of Dr. Sajitha K. M.D. (AYU) DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHA VRITHA S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN, 573201 2006
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A STUDY ON THE EFFICACY OF AYURVEDA AND
NATUROPATHY IN SANDHI VATA
By
Patil Uday J.
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI
(DOCTOR OF MEDICINE)
In
SWASTHAVRITHA
Under the guidance of
Dr. Sajitha K. M.D. (AYU)
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHA VRITHA
S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN,
573201
2006
Ayurmitra
TAyComprehended
A STUDY ON THE EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA
By
Patil Uday J.
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI (DOCTOR OF MEDICINE)
In
SWASTHAVRITHA
Under the guidance of
Dr. Sajitha.K, M.D (Ayu)
Asst. Prof, Dept of Swasthavritha
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL,
HASSAN -573201
2006
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled “A STUDY ON THE
EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA” is a
bona fide and genuine research work carried out by me under the guidance of Dr.
Sajitha K. Asst. Professor, Department of Post Graduate Studies In SwasthaVritta,
S. D. M. College of Ayurveda and Hospital, Hassan – 573 201.
Date:
Place: Hassan
Patil Uday J.
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201
(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A STUDY ON THE
EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA” is a
bona fide research work done by Patil Uday J in partial fulfilment of the
requirement for the degree of Ayurveda Vachaspati (M.D. Ayurveda) in
Swasthavritha.
Date: Hassan: Dr. Sajitha K. Asst. Professor P.G. Studies in Dept of Swasthavritha
S D M College of Ayurveda, Hassan
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201
(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
ENDORSEMENT BY THE H O D; PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A STUDY ON THE
EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA” is a
bona fide research work done by Patil Uday J. under the guidance of Dr. Sajitha K.,
Asst Professor, Department of Post Graduate Studies In Swasthavritha, S.D.M.
College of Ayurveda, Hassan - 573201.
Dr. Ramana G.V. Dr. Prasanna N Rao Professor and Head Principal P G Studies in SwasthaVritta, S D M College of Ayurveda, S D M College of Ayurveda, Hassan. Hassan. Date: Date:
Place: Place:
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby 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.
I bow my head on the foot of Prof. S. Prabhakar, secretary of SDME society, for
giving me an opportunity to pursue post graduation in SDMCA, Hassan
I owe my humble gratitude and regards to Prof Dr. Gurudip singh, Director of
PG studies, SDMCA&H, HASSAN for evincing keen interest in my endeavours and for
continued encouragement
I am greatly thankful to Dr. P. N. Rao, Principal who provided the necessary
facilities for the completion of this research work.
I express my sincere gratitude and respect to Prof. Dr. Ramana. G. V. for his
guidance and timely suggestions and Dr. Sajitha K, Guide, advice, constant inspiration
enabled me to complete this work.
I am grateful to Dr. Shashikiran, Dr. Suhaskumar Shetty, for timely
information and librarian for his co-operation.
I am thankful to all the teaching and non teaching staffs of S.D.M. College of
Ayurveda and Hospital, Hassan for their support and co-operation.
I am Grateful to Dr. Basant, Dr. Gururaj, Dr. Aditi, Dr. Manish, Dr. Srikant,
Dr. Sanjeev, Dr. Prashant Lande, Dr. Satish Wagh, Dr. Vaibhav and all my
classmates for their never-ending encouragement. I wish my thanks to all my seniors,
juniors and under graduates who helped me in every aspects of my work.
I heartily acknowledge the help rendered to me by Dr. Anand, Dr. Abhijit, Dr.
Prmod, Dr. Shailendra, Dr. Mayur, and Dr. Ashok A.
I feel immensely privileged to credit this work to my parents, brother, wife,
affection of my loving child Parth and other family members who constantly kept me
supporting against all odds.
Dr. Patil Uday Jayawantrao
LIST OF ABBREVIATIONS
A -Janu Basti group
A. Hr. -Ashtanga Hridaya
A. Sa. -Ashtanga Sangraha
Ath. -Atharvaveda
B -Naturopathy Techniques group
Bh. Pr. -Bhava Prakash
Bh. Ra. -Bhaishajya Ratnavali
Ca. Sa. -Charaka Samhita
Ci. -Chikitsa
M. M.W. -Monier. M. Williams
Ma. Ni. -Madhava Nidana
Mad.Kh. -Madhyama Khanda
Ni -Nidanasthana
Pu -Purvardh
Sh. -Sharirasthana
Su. -Sutrasthana
Su. Sa. -Sushruta Samhita
Ut. -Uttaraardh
Vi -Vimanasthana
Yo. Ra. -Yoga Ratnakara
ABSTRACT
Background
To carry out the daily activities, normal movements of joints are very essential.
Osteoarthritis acts as main hurdle in performing daily activities, in which joints are
mainly affected leading to pain, immobility and discomfort.
Non-pharmacological management is the foundation of treatment of osteoarthritis.
Therefore, naturopathy gives a hope of treating this condition with different techniques
used externally.
Objectives
1. To evaluate the effect of Janu-Basti in the management of Sandhi Vata.
2. To evaluate the effect of Naturopathy techniques in the management of Sandhi Vata.
3. To compare the efficacy of Janu Basti and Naturopathy techniques.
Methods
It is a comparative study with pre-test and post test design with two groups
consisting of 15 patients each.
Group A- Patients of this group were advised Janu Basti with Tila Taila for 7 days.
Group B- Patients of this group were given naturopathy techniques externally for 7 days.
Results
Naturopathy techniques provided significant relief in Shoola (34.64%) in 53.33%
of patients, Shotha (3.83%) in 86.66% of patients, Kriya alpata (43.13%) in 66.66% of
patients, Flexion angle of knee joint (7.20%) in 73.33% of patients, Time taken to cover
50m distances (17.66%) in 100% of patients of Sanhi Vata. Janu-Basti with Tila taila
provided significant relief in Shoola (32.85%) in 46.66% of patients, Shotha (2.65%) in
43.33% of patients, Kriya alpata (39.16%) in 46.66% of patients, Flexion angle of knee
joint (5.19%) in 73.33% of patients, Time taken to cover 50m distance (12.08%) in
73.32% of patients.
Interpretation
By Naturopathy techniques blood circulation increases to joints due to
vasodilatation, relieves congestion, improves nutrition of the joint, reduces muscle spasm
and inflammation; soften adhesions, improves the range of motion and lubrication.
Janu-Basti acts as an effective Bahya Shamana Chikitsa and relieves symptoms
like Stambha, Gaurava and Sheetata.
Conclusion
Clinical study has proved that non pharmacological management in the form of
external treatments gives significant relief in osteoarthritis.
CONTENTS
List of Tables and Figures
Introduction and objectives 1-2
I. Literary Review of Sandhi Vata
Historical Considerations
3-4 Nirukti-Paribhasha
5-6
Anatomy of Janu-sandhi 7-10
Nidana 11-17
Poorvaroopa and Roopa 18-19
Samprapti 20-25
Vyavachedaka Nidana 26
Sadhyasadhyata 27
Chikitsa 28-30
Osteoarthritis 31-36
Naturopathic techniques for Sandhi Vata 37-44
Janu-Basti 45-47
Mode of Action 48-50
II. Methodology 51-55
Results
56-75
Discussion 76-86
Conclusion 87-88
Summary 89-91
Bibliographic References 92-94
Annexure 95-96
LIST OF TABLES AND FIGURES SL. NO.
CONTENT OF TABLE PAGE NO.
1 REFERENCES OF SANDHI VATA 4 2 RASA VISHESHA AHARAJA NIDANA 13 3 GUNA VISHESHA AHARAJA NIDANA 13 4 VIRYA VISHESHA AHARAJA NIDANA 13 5 DRAVYA VISHESHA AHARAJA NIDANA 14 6 AHARAKRAMA NIDANA 15 7 VIHARAJA NIDANA 15-16 8 MANSIKA NIDANA 16 9 KALAJA NIDANA 16 10 ANYA NIDANA 17 11 ROOPA OF SANDHI-VATA MENTIONED IN VARIOUS CLASSICS 18 12 CHIKITSA SOOTRA MENTIONED IN DIFFERENT SAMHITA 28 13 DRUG REVIEW 47 14 AGE WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA 56 15 SEX WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA 56
16 RELIGION WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA
57
17 OCCUPATION WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA
57
18 DEHA PRAKRITI WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
VATA 59
19 SARA WISE DISTRIBUTION OF 30 OF SANDHI VATA 59
20 SAMHANANA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
VATA 60
21 PRAMANA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI VATA 60
22 SATMYA (AHARA) WISE DISTRIBUTION OF 30 PATIENTS OF
SANDHI VATA 60
23 SATVA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI VATA 61
24 ABHYAVAHARANA SHAKTI WISE DISTRIBUTION OF 30 PATIENTS
OF SANDHI VATA 61
25 JARANA SHAKTI WISE DISTRIBUTION OF 30PATIENTS OF SANDHI
VATA 61
26 VYAYAMA SHAKTI WISE DISTRIBUTION OF 30 PATIENTS OF
SANDHI VATA 62
27 CARDINAL SIGNS AND SYMPTOMS RECORDED IN 30 PATIENTS OF
SANDHI VATA 62
28 CHRONICITY WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
VATA 62
29 CHARACTERISTIC OF KULAJA VRITTANT REPORTED BY 30 CASES
OF SANDHI VATA 63
30 SHOWING DISTRIBUTION OF VIHARATMKA NIDANA RECORDED
IN 30 CASES OF SANDHI VATA 64
31 SHOWING DISTRIBUTION OF AHARATMAKA NIDANA IN 30 CASES
OF SANDHI VATA 64
32 EFFECT OF JANU-BASTI ON SYMPTOMS OF SANDHI VATA
PATIENTS 66
33 EFFECT OF JANU-BASTI ON CLINICAL SIGNS OF SANDHI VATA
PATIENTS 66
34 EFFECT OF NATUROPATHY TECHNIQUES ON SYMPTOMS OF
SANDHI VATA PATIENTS 68
35 EFFECT OF NATUROPATHY TECHNIQUES ON CLINICAL SIGNS OF
SANDHI VATA PATIENTS 68
36 TOTAL EFFECT ON SHOOLA 69 37 TOTAL EFFECT ON ATOPA 69 38 TOTAL EFFECT ON KRIYA ALPATA 69 39 TOTAL EFFECT ON SHOTHA 70 40 TOTAL EFFECT ON TIME TO COVER 5OM DISTANCE 70 41 TOTAL EFFECT ON FLEXION ANGLE OF KNEE JOINT 71
42 EFFECT OF JANU-BASTI ON SYMPTOMS OF SANDHI VATA
PATIENTS AFTER 15 DAYS 71
43 EFFECT OF JANU-BASTI ON CLINICAL SIGNS OF SANDHI VATA
PATIENTS AFTER 15 DAYS 72
44 EFFECT OF NATUROPATHY TECHNIQUES ON SYMPTOMS OF
SANDHI VATA PATIENTS AFTER 15 DAYS 72
45 EFFECT OF NATUROPATHY TECHNIQUES ON CLINICAL SIGNS OF
SANDHI VATA PATIENTS AFTER 15 DAYS 73
46 EFFECT OF JANU-BASTI ON SYMPTOMS OF SANDHI VATA
PATIENTS AFTER 30 DAYS 73
47 EFFECT OF JANU-BASTI ON SIGNS OF SANDHI VATA PATIENTS
AFTER 30 DAYS 74
48 EFFECT OF NATUROPATHY TECHNIQUES ON SYMPTOMS OF
SANDHI VATA PATIENTS AFTER30 DAYS 74
49 EFFECT OF NATUROPATHY TECHNIQUES ON SIGNS OF SANDHI
VATA PATIENTS AFTER 30 DAYS 75
FIGURE NO. FIGURE PAGE NO.
1 SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI VATA 23 2 SAMPRAPTI IN AVARANA JANYA SHADHI VATA 24 3 SAMPRAPTI IN ABHIGHATA JANYA SANDHI VATA 25 4 SHOWING AGE WISE DISTRIBUTION 58 5 SHOWING SEX WISE DISTRIBUTION 58 6 SHOWING RELIGION WISE DISTRIBUTION 58 7 SHOWING OCCUPATION WISE DISTRIBUTION 59 8 SHOWING CARDINAL SIGNS AND SYMPTOMS 63 9 SHOWING CHRONICITY WISE DISTRIBUTION 63
Introduction &
Objectives
INTRODUCTION AND OBJECTIVES
Research is done for establishing new facts Many times research is conduct to
validate old principles with fresh proofs. Research is constructed with suitable
experimental methods and honest observations are made to arrive at a logic conclusion.
In our body, bones form the arms of the lever and fulcrum is at a joint where
movement takes place. To carry out the daily activities, normal movements of joints are
very essential. Sandhi-Vata acts as main hurdle in performing daily activities, in which
joints are mainly affected leading to pain, immobility, and discomfort. Sandhi-vata
described in Ayurveda can be correlated with osteoarthritis mentioned in modern science.
‘Arth’ means joint and ‘itis’ means inflammation. Osteoarthritis is the most
common type of arthritis; occurs due to the breakdown of cartilage in the joint. Among
the elderly and obese persons Osteoarthritis is a leading cause of chronic disability
especially affecting the knee joints. Since knee is the weight bearing joint it is more
susceptible to wear and tear. Other factors like heavy journey, agriculture, housework is
also contributing.
In the age group of 45-65 years 30% of population is suffering from this disease.
More than 355 million people around the world today are suffering from chronic pain of
arthritis. W.H.O. estimates that within the growing population the number of people over
50 years of age will be doubled by the year 2020. Hence, it has declared 2001-2010 as the
‘Decade of bone and joint diseases’.
In the contemporary science treatment is mainly aimed at Non–pharmacological
methods. Now there is a trend to find out non-pharmacological measures as much as
possible for the management of various disorders. Among non–pharmacological
treatment physical heat therapy is given importance. In addition, non-pharmacologic
management is the foundation of osteoarthritis.
Naturopathy is a part of Swasthavritha, which deals with the different nature cure
techniques. Naturopathy utilizes change in temperature as therapy. To regulate various
systems external and easiest access is skin. Skin is a giant sense organ and covers whole
body. So the naturopathy techniques can be correlated to Bahirparimarjan Chikitsa
mentioned in Ayurvedic classic. Treatment in the form of Janu-basti, Abhyanga, Avagaha
etc. have been proved of their efficacy on Sandhi Vata. The naturopathy likes derivative
massage, wax bath, alternate hot and cold pack, exercises, mustard pack etc. also
constitute non-pharmacological interventions, which are harmless, cheap and said to be
effective. Hence a study is planned to study their efficacy along with Janu Basti as
control in Sandhi vata patients.
The objectives of the present study are to provide scientific basis for the therapies that
is practiced are highly beneficial in the treatment of Sandhi vata. The following are
the main objectives of this study.
4. To evaluate the effect of Janu-Basti in the management of Sandhi Vata.
5. To evaluate the effect of Naturopathy techniques in the management of Sandhi Vata.
6. To compare the efficacy of Ayurvedic Bahirparimarjan Chikitsa and naturopathy
techniques employed for the treatment of Sandhi Vata.
Review of literature
HISTORICAL CONSIDERATIOS
History of Indian medicine is usually studied under the headings of Prevedic
period, Vedic period, Samhita Kala, Sangraha Kala, Nighantu Kala and Adhunika Kala.
History of medicine also reveals some aspects of the disease.
In classics the general description of Sandhi Vata is available.
There is no reference regarding Sandhi Vata in Prevedic period. During Vedic
period in Atharvaveda the references regarding the occurrence of Sandhi Vikara (Ath.
2/33/7, 6/14/1), the importance given for Vata (Ath.8/2/3, 2/10/3) and disorders of Vata
(Ath. 9/8/21) are available.
In Samhita period we find systematic description of the diseases according to
Nidana Panchaka.
Caraka Samhita, explained Sandhi Vata in Chikitsa sthana.1
Sushruta Samhita narrates its Lakshana in Nidanasthana2 and Chikitsa in
Cikitsasthana.3
Ashtanga Sangraha Nidanasthana describes its Lakshana4 and Chikitsa of Sandhi
Vata in Cikitsasthana.5
Ashtanga Hridaya has described Lakshansa in Nidanasthana6 and line of treatment
in Cikitsasthana.7
In Madhava Nidana Lakshana of Sandhi Vata are given same as that of Sushruta.8
Bhavaprakasha explains the Lakshana and treatment of Sandhi Vata in Madhyama
Khanda Vatavyadhyadhikara.9
Yogaratnakara also explained about Lakshana and treatment of Sandhi Vata in
Vatavyadhyadhikara of Purvardha.10
In Bhaishajya Ratnavali Vatavyadhi Prakarana deals with treatment aspects of
Sandhi Vata.11
The commentators of Samhita and Sangraha especially Chakrapani and Dalhana
contributed a lot for better understanding of the disease.
All the Acarya have described this symptom. Charaka and Vagbhata explain that
pain in the joint occurs during Prasarana and Akunchana Pravrutti.
Sandhi Shotha
Most of the classics explained this symptom. Charaka and Vagbhata explained the nature of Shotha
i.e., it is felt like bag filled with air (Vata Poorna Driti Sparsha).
Sandhi Stabdhata
Sushruta initially described this symptom, later by texts like Madhava Nidana,
Yogaratnakara and Bhavaprakasha.
They have coined the term Sandhi Hanana or Hanti. While commenting on this
word Dalhana and Gayadasa explained as ‘Akunchanaprasaranayoh Abhavah’ and
‘Prasaranakuncanayoh Asamarthah’ respectively. With this we can infer that the word
Hanti refers to inability to move the joints.
In the opinion of Madhukoshakara, Hanti refers to Sandhi Vishlesha, Stambha
Adi Vikara. Hence with the above references, Hanti refers to Sandhi Stabdhata.
Atopa
This symptom is explained in Madhava Nidana. While commenting on the word
Atopa in another context, Madhukoshakara quotes the opinion of Gayadasa and Kartika
i.e. ‘Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah’. Also
Bhavamishra says ‘Atopo – Gudagudashabdaha’. Thus we can say that Atopa in this
context is the sound produced by the movement of joints i.e., crepitus.
Thus with the help of different references and by the opinion of commentators it
can be concluded that Sandhi Shoola, Sandhi Shotha, Sandhi Stabdhata and Atopa are the
clinical features of Sandhi Vata.25
SAMPRAPTI
The total course from the Dosha vitiation, resultant Dhatu affliction and evolution
of Vyadhi is Samprapti. Samprapti explains all the series of pathological stages involved.
The Samanya Samprapti of Vata Vyadhi, which is explained in classics, can be
considered as the Samprapti of Sandhi Vata.
Acharya Caraka explained due to the intake of Vatakara Ahara Vihara Vata
vitiation take place. This vitiated Vata lodges in Rikta Srotas i.e. Srotas in where
Shunyata of Snehadi Guna is present. Vata after settling in Rikta Srotas produce
disease related to that Srotas26.
Acharya Vagbhata frames the Samprapti of Vata Vyadhi like Dhatukshaya
aggravates Vata and the same is also responsible to produce Riktata of Srotas. Thus
the vitiated Vata travels through out the body and settles in the Rikta Srotas and
further vitiates the Srotas leading to the manifestation of Vata Vyadhi27.
Srotoriktata occurs due to Nidanasevana as follows.
The chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess. These
properties are necessary for Sthairya and Upacaya 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 Mahabhuta produces Sushirata and
Laghuta in the body. Vayu Mahabuta fills up this Sushirata. So due to Dhatukshaya Akasha
Mahabhuta increases in the body producing Sushirata and Laghuta simultaneously Vayu fills it up.
From this description it can be stated that the meaning of word ‘Riktata’ is Sushirata i.e. increase in
Akasha and Vayu Mahabhuta. While commenting on word ‘Riktata’ Chakrapani says that ‘Riktata’
means lack of Snehadiguna.
For the purpose of understanding the Samprapti of Sandhi Vata can be studied under three heading. They are1. Dhatukshayajanya 2. Avaranajanya 3. Abhighatajanya
1. Dhatukshayajanya Sandhi Vata-In old age Vata Dosha dominates in the body. This
will lead to Kapha Abhava. Also Jataragni and Dhatvagni get impaired so Dhatu will not
be form in good quality. Degeneration of body elements takes place due to predominance
of Vata in its Ruksha, Khara etc Guna and loss of Kapha in quality and quantity.
As the Shleshma Bhava decreases in the body Shleshaka Kapha in the joints also
decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi
Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi
being the main participant of the joint its Kshaya leads Khavaigunya in the joints. In this
condition if Nidana Sevana done leads Vata Prakopa. If Vata Prakopa is not corrected by
appropriate means and simultaneously if the person indulges in Asthivaha and Majjavaha
Sroto Dushtikara Nidana, the Prakupita Vata spreads all over the body through these
Srotas. In the meantime Sthanasamshraya of Prakupita Vata takes place in the
Khavaigunyayukta Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna
over power and undo all properties of Sleshaka Kapha producing disease Sandhi Vata.
In them Medodhatu will be produced in excess due to the Atisnehamsha of Amarasa The
excessive Medas will produce obstruction for the flow of nutritive materials to the future
Dhatus that is Asthi, Majja and Shukra leads to their Kshaya28.
The excessive fat deposited all over the body will produce Margavarana of Vata 29
Prakupita Vata due to Margavarana starts to circulate in the body. While traveling it
settles in the joint where Khavaigunya is already exists. After Sthanasamshraya it
produces the disease Sandhi Vata in the same process mentioned in the earlier context.
3. Abhighatajanya Sandhi Vata- Trauma is considered as
secondary cause of Osteoarthritis. By the Abhighata the
integrity of the joint is disturbed. Due to Abhighata to the
Asthi involved in Sandhi leads to provocation of Sthanika
Vata that is. Vyana Vata (Ashrayashrayi Sambandha).
Ruksha Guna of Vata and Ushanata produced by Abhighata
will does the Shoshana of Shlashmaka Kapha in the joint.
This produces the degenerative change in joint cartilage
(lack of nutrition). In another way Vata is vitiated in the joint
by the Siramarga Avarana of Vata due to Abhighata30. This
vitiated Sthanika Vata will produce series of changes in the
joint after Dosha Dushya Sammurchana and produces Sadhi
Vata Lakshana.
Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Sandhi Vata can be divided into Dhatukshaya Janya, Avarana Janya and Abhighata Janya Sandhi Vata. This will help in deciding the prognosis and planning the treatment of the disease.
The procedure of Janu-Basti is explained accordingly
I. Poorva karma- This includes preparatory measures taken for smooth conduction of
the procedure. They are
1. Atura Pareeksha- The patient is examined with reference to Prakriti, Vikriti etc. ten
factors by applying Pratyaksha, Anumana and Aptopadesha. This will assess Vyadhibala
and Dehabala 60. Then affected knee should be Examined properly and mark the tender
area. Examine for scares, wounds in the joint.
2. Sambhara Sangraha- Materials required for Smooth conduction of Janu-Basti
procedure have to be collected. They include – A metal ring, Masha powder, medicine
(Tila Taila), spoon, bowl, vessel, water, gas stove, and cotton.
3. Atura Siddhata- Patient is asked to lie down on the table. Expose the affected knee.
II. Pradhana karma -This includes
1. Basti Yantra Dharana- Initially paste of Masha powder is prepared by adding
sufficient quantity of water to it. Then with the help of a metal ring and Paste of Masha a
pit is constructed around Janu-Sandhi of about 2-3 Angula heights. The concavity of pit
(Basti Yantra) should be well sealed to retain the medicine.
2. Taila Dharana- The bowl containing Medicine (Tila Taila) is heated gently by
keeping over hot water. Then gently heated luke warm medicine is poured slowly and
carefully on the Janu-Sandhi along the side of the Basti Yantra. The heat of the medicine
should be sufficient enough to tolerate by the patient. The quantity of the medicine
should be two Angulas above the skin surface.
3. Maintenance of constant temperature of medicine- Keep on changing the medicine
with the heated one so that a constant temperature is maintained through out the
procedure.
4. Removal of Taila and Basti Yantra- After the prescribed time the oil should be
removed from the Basti Yantra. Then BastiYantra is to be removed.
Since it is a type of Sweda and Sneha, Samyak Sweda and Samyak Sneha
Lakshanas can consider. Among Samyak Sweda Lakshana Sheetoparama,
Stambhanigraha, Gauravanigraha and Vyadhihani can be considered for assessment. In
case of Samyak Snigdha Lakshanas Snigdha Gatratva and Mrudu Gatratva can take for
assessment. The procedure is performed for 30min each day.
III. Paschat karma- After removing the oil and Basti Yantra, Mrudu Abhyanga is done
over the Janu-Sandhi for about 5 min. Duration - This treatment is done for 7days.
Benefits of Janu-Basti- It relieves the symptoms like Shoola, Stabdhata.The procedure
acts on various properties of Vata that are instrumental in the pathology of Sandhi Vata
mainly due to Snehana and Swedana. Also medicines used in the procedure help in
alleviating Vata.
Drug Review
The trial drug selected for doing Janu-basti is Tila Taila. The pharmacological properties, chemical constituents and pharmacological actions of Tila Taila are summarized below. Table No- 13- Drug review Rasa Madhura
Veerya Ushna
Vipaka Madhura
Guna Guru, Drava, Picchila, Sara, Manda, Sookshma, and Teekshna
Doshakarma Vatakaphahara
Pharmacological
actions
Used in different traumatic conditions, Promotes bodily strength. It
is Sanghatakara, does Snehana.
ABSORPTION THROUGH SKIN
Acarya Sushruta in Shareerasthana explains – Out of the four Tiryak Dhamanis,
each divides gradually hundred and thousand times and thus become innumerable. These
cover the body like network and their openings are attached to Romakoopa. Through
them Veeryas of Abhyanga, Parisheka, Avagaha, Alepa enter into the body after under
going Paka with Bhrajaka Pitta in skin61.
Sushruta in Sutrasthana explains, Lepa like Bahirparimarjana treatments yield result by
entering to Romakoopa thereby circulating through Swedavaha Srotas62.
Vagbhata in Ashtanga Hridaya while explaining the functions of Bhrajaka Pitta
narrated that – Bhrajaka Pitta do the Pachana of drugs used in Abhyanga, Parisheka, and
Lepa63.
Thus with the above references it can be said that drugs used in Bahya
Samshamana Chikitsa (Naturopathy techniques, Janu-basti) get absorbed through and
produce action according to the property of the medicine.
The skin anatomically consists of three distinct layers.
Epidermis- It consists of keratinocytes, melanocytes, langerhan’s cells and merkel cells.
The terminal point of keratinocytes differentiation is the formation of the stratum
corneum. Formation of this layer is the most important function of the epidermis. It
protects the skin against water loss, prevents the absorption noxious agents, and can be
thought of as consisting of bricks and mortar. Corneocytes forms the bricks and barrier
lipids form the mortar. ‘Granular cells’ which are stratum corneum helps in maintaining
skin hydration and their products serve as ultra violet filters. Lamellar granules also are
found within granular cells. These contain probarrier lipids.
Dermis-It is a thick, highly vascular layer made up of ground substance, fibroblasts and
collagen fibers, together with appendages of skin, sweat glands and pilo-sebaceous
follicles. It is metabolically active part of the skin.
Subcutaneous Tissue-It is a fibro fatty layer with varying quantities of adipose tissue in
different regions of the body. It provides physical and thermal protection to the deeper
structures of the body.64
Drug Delivery- The primary barrier to absorption of exogenous substances through the
skin is stratum corneum. Rate of absorption is directly proportional to concentration of
drug in vehicle, partition co-efficient, diffusion co-efficient and thickness of the stratum
corneum. Physiological factors that effect per cutaneous absorption include hydration,
occlusion, age, intact versus disrupted skin, temperature and anatomic site.
Among vehicles greases are anhydrous preparations that are either water insoluble
or fatty. Fatty agents are more occlusive than water-soluble. They restrict trans-epidermal
water loss and hence preserve hydration of the stratum corneum.
Absorption depends upon lipid solubility of the drug since the epidermis as a lipid
barrier. The dermis however is freely permeable to many solutes. Suspending the drug in
an oily vehicle can enhance absorption through the skin. Because hydrated skin is more
permeable than dry skin.
Application of medicaments, heat and massage definitely helps in eliminating the
number of noxious elemtes through skin. The application of heat in different forms of
Swedana promotes local circulation and metabolic activities and also opens the pores of
the skin to permit transfer of medicaments and nutrients towards to needed sites and
elimination of vitiated Doshas and Malas through skin and perspiration.65
Biophysical effect of temperature
Circulatory effect- There is stimulation of superficial capillaries and arteriole causing
local hyperemic and reflex vasodilation. This will affect increased blood flow at the site.
The temperature must be controlled between 104F to 113F. This hyperemia may result
systemic change such as decrease in mean blood pressure, increase in pulmonary minute
ventilation.
Metabolic reaction- Temperature will raise the chemical activity in cell and metabolic
rate will increase. The energy expenditure will increase and protein denaturation will
occur in human tissue.
Vascular effect- There are three factors that cause vasodilation- an axon reflex, release
of chemical mediators, secondary to temp elevation, local spinal cord reflex.
Neuromuscular effect- Heat is Effective to provide analgesic and assist resolution of
15 patients of Sandhi Vata were treated with Naturopathy techniques for 7 days. Its effect
on the clinical signs and symptoms were as follows.
Effect on Symptoms
The effect of Naturopathy techniques on symptoms of Sandhi Vata is shown in
Table – 34.
Mean pain was reduced from 1.53 to 1.00 with the improvement of 34.64% and was
highly significant (p>0.001).
Mean score of Kriya Alpata improved from 1.53 to 0.8 on an average it is improved by
43.13%, which was also highly significant (p<0.001).
Effect on signs
The effect of Naturopathy techniques on signs of Sandhi Vata is shown in Table –
35.
The mean score of Shotha was reduced from 35.46cm to 34.10cm with 1.36%
improvement, which was significant (p<0.01).
The mean score of Atopa was unchanged and insignificant (p-00).
The mean score of Flexion angle of knee was increased from 111.06 to118.53
with the improvement of 8%, which is highly significant (p<0.001).
The mean score of Time taken to cover 50m distance was reduced from 88.66seconds to 73seconds with an improvement of 15.66%, which is highly significant (p<0.001).
Table - 34
Effect of Naturopathy techniques on Symptoms of Sandhi Vata Patients
Table –35
Effect of Naturopathy techniques on Clinical Signs of Sandhi Vata Patients
Overall results of all criteria [Sandhi-Vata] on the bases of reduction/ improvement
[after treatment of 7 days]
Mean Score
Symptoms
BT AT
Mean Difference
% of Relief
S.D + -
S.E. + -
t p
Shoola 1.53
1.00 0.53 34.64 0.51 0.13 4 >0.001
Kriya Alpata 1.53
0.8 0.66 43.13 0.48 0.12 5.29 <0.001
Mean Score
Signs
BT AT
Mean Difference
% of Relief
S.D + -
S.E. + -
t p
Shotha 35.46 34.1
0 1.36 3.83 0.71 0.18
7.36 <0.001
Atopa 1.13 1.13 00 00 00 00 00 00
Flexion angle
of knee 111. 06
118. 53
8 7.20 4.32 1.11 7.16 <0.001
Time to
cover 50m
distance
88.66 73. 00
15.66 17.66 8.20 2.11 7.39 <0.001
Table No. 36 Total effect on Shoola
Response
Difference
in grade
Group
A
%
Group
B
%
Poor 0 8 53.33 7 46.66
Moderate 1 7 46.66 8 53.33
Good 2 0 0 0 0
The response of Shoola in group A is 46.66% (7) patients shown moderate and
53.33% (8) patients shown poor and for group B it is 53.33% (8) patients shown
moderate and 46.66% (7) shown poor.
Table-37 Total effect on Atopa
Response
Difference
in grade
Group
A
%
Group
B
%
Poor 0 15 100 15 100
Moderate 1 0 00 0 00
Good 2 0 00 0 00
Both group A and B shows poor response in Atopa.
Table-38 Total effect on Kriya Alpata
Response
Difference
in grade
Group
A
%
Group
B
%
Poor 0 8 53.33 5 33.33
Moderate 1 7 46.66 10 66.66
Good 2 0 00 0 00
In Kriya Alpata 46.66% of group A and 66.66% of group B patients shows
moderate response.
Table-39 Total Effect on Shotha
Response
Changes
In cm.
Group
A
%
Group
B
%
Nil 0 10 66.66 1 6.66
Mild 1 3 20 9 60
Moderate 2 2 13.33 4 26.66
Good 3 0 0 1 6.66
In-group B 13 patients show mild to moderate relief. In group A 10 patients
shown no change, 3 had mild change and 2 had moderate change.
Table-40 Total Effect on Time to cover 5om distance
Response
Difference
In second
Group
A
%
Group
B
%
Nil 0 3 20 0 00
Mild 0-20 10 66.66 12 80
Moderate 21-40 1 6.66 3 20
Good >41 1 6.66 0 0
In present study 73.32% of group A and all patients of group B shows mild to
moderate change in time taken to cover 50m distance.
Table-41 Total effect on flexion angle of knee joint
Response
Increase in
angle
Group
A
%
Group
B
%
Nil 0 3 20 1 6.66
Mild 0-5 9 60 6 40
Moderate 6-10 2 13.33 5 33.33
Good 11-15 1 6.66 3 20
In present study 11 patients of group A and 11 of group B shows mild to moderate
improvement in flexion angle of knee joint. 1 patient of group A and 3 of group B show
good improvement in flexion.
Table - 42
Effect of Janu-Basti on Symptoms of Sandhi Vata Patients after 15 days
Table - 43
Effect of Janu-Basti on Clinical Signs of Sandhi Vata Patients after 15 days
41. Ca. Sa.Ci. 28/115. 42. A. Sa. Ci. 23/13 43. A Complete Handbook of Nature cure, page-205. 44. The Art of Massage by J. H. Kellogg, page 148-151. 45. A Complete Handbook of Nature cure, page-205. 46. Goel’s Physiotherapy Chap-11/555-557. 47. Goel’s Physiotherapy Chap-14/576-579. 48. Goel’s Physiotherapy Chap-11/142,143. 49. Goel’s Physiotherapy Chap-6/92. 50. Goel’s Physiotherapy Chap-12/154. 51. Goel’s Physiotherapy Chap-6/87. 52. Rational Hydrotherapy, Page 814,956. 53. Rational Hydrotherapy Part-I page-161,188. 54. Rational Hydrotherapy Part-III page-751. 55. Rational Hydrotherapy Part-III page-840-842. 56. Rational Hydrotherapy, part-III, /756-758. 57. Ca. Sa. Su. 11/55. 58. A. Hr. Su.19/1. 59. Su. Sa. Su.5/3. 60. Ca. Sa. Vi. 8/94-96. 61. Su. Sa.Sh.9/9. 62. Su.Sa.Su.18/4. 63. A. Hr. Su. 12/14. 64. Physiology by Robert M. Berne. 65. Essentials of Pharmacology by K. D. Tripathi Cha.2/13. 66. Goel’s Physiotherapy Chap-14/579.
Printed Publications
1. A Complete Handbook of Nature cure of H. K. Bakharu, Jaico Publishing House, 121, M.G. Road, Mumbai.
2. Bhaisajyaratnavali Vidyotini Hindi commentary By Kaviraja Ambikadatta Shastri Chaukhamba sanskrut sansthan, Varanasi 2001.
3. Bhavamisra- Bhavaprakasa (ed) Vidyotini Hindi commentary By Bhisagaratna Pandit Sri. Brahma Sankara Misra Chaukhamba Sanskrit Sansthan Varanasi, 2003.
4. Charaka- Charaka Samhita of Chakrapanidatta (ed) By Vaidya Jadavji Trikmaji Acharya Chowkhamba Sanskrit Sansthan, Varanasi 2001.
5. Charaka- Charaka Samhita,with Charaka Chandrika Hindi commentary by Dr. Brahmanand Tripathi, (ed) chaukhamba surbharti prakashan, Varanasi 2004.
6. Goel’s Physiotherapy by Dr. R. N. Goel, Shubham publication, F-2 sanchi complex, Shivaji Nagar, Bhopal, Vol-I, 2004
7. Madhava Nidanam- Sri Madhavakara Madhukosa Sanskrit commentary by Vijayaraksita and Srikanthaadatta (ed) Vimala Madhuhara Hindi commentary by Dr. Brahmanand Tripathi, Vol-I, Chaukhamba Surbharati Prakashan, Varanasi 2003.
8. Rational Hydrotherapy by Dr. John Harvey Kellogg, Part I, II, III, IV. 9. Sushruta-Sushruta Samhita with Nibandha Sangraha commentary by Dalhana
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11. Sushruta- Sushruta samhita with Nibandha Sangrha commentary of Sri. Dalhanacharya and Nayachandrika Panjika of Sri. Gayadasacharya (ed) Vaidya Jadavji Trikmaji Acarya Chowkhamba Krishnadas Academy, Varanasi, 2004.
12. The Art of Massage by J. H. Kellogg, Teach services Inc, New York, 254, Donovan Road, Brushton, 1998.
13. Vagabhat- Ashtang Hrdayam with Nirmala Hindi commentary by Dr. Brahmanand Tripathi, (ed) Chaukhamba Sanskrit Prakashan, Delhi 2003.
14. Vagbhata- Ashtang Sangrah with Hindi commentary by Kaviraj Atrideva Gupta Krishnadas Academy, Varanasi 1993.
15. Vagabhat- Ashtang Hrdayam with Ayurveda Rasayana commentary by Hemadri and Sarvangasundara commentary by Arundatta(ed) Pandit Bhisagacharay Harishastri Prabhakar Vaidya,Krishnadas Academy Varanasi 2000.
16. Yogaratnakara with Vaidyaprabha Hindi commentary By Dr. Indradev Tripathi and Dr. Daya Shankar Tripathi, Krishnadas Academy Varanasi, 1998.
Annexure
Case proforma
S.D.M. College of Ayurveda and Hospital, Hassan Dept. of P.G. studies in Swasthavritha
A study on the efficacy of Ayurveda & Naturopathy in Sandhi-Vata Name: Sl. No. Date: Age: OPD / IPD No: Group- A/B Sex: DOA / DOD: Religion: Wt.- Postal Address: Occupation: Main Complaints: Shoola Shotha Kriya-alpata Atopa in Rt, Lt Knee Joint Duration: 0-3yrs, 3-6yrs, above 6yrs Anubandha vedana: Kula vrittant:
Atura Charya- 1. Ahara:
a. Quality- Alpa Pramita Atipramana (veg/mixed) b. Dominant rasa- M A L K T K
c. Guna – Ruksha Snigdha Ushna Sheeta Guru Laghu
d. Dietetic habit – Matrashana, Vishamanasana, Adhyasana, Anasana
4. Mala: 5. Mutra: 6. Jihwa: 7. Nidra: Dasha Vidha Pareeksha 1. Prakrititah : 2. Vaya : 3. Vikrititah : P M A 4. Samhanana: P M A 5. Satva : P M A 6. Pramana : P M A 7. Satmya : P M A 8. Aharashakti : Abhyavarana P M A Jarana P M A 9. Sara: P M A 10. Vyayama Shakti : P M A Investigations:
1. Hematological a. Hb% b. E.S.R. c. D.C.: N ____%, L ____%, B____%, E____%, M_____% d. T.C.
2. X-Ray (if done)
Assessment criteria- Complaints B. T. A. T. / / / /
Shoola-- Shotha-- (circumference) Kriya alpta-- Atopa-- Flexion movement at knee joint--