Sandhivata kc004 kop

BY Dr. Guruprasad Aggithaya

B.A.M.S. (R.G.U.H.S, Bangalore)

Dissertation submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore in partial fulfillment

of the requirements for the degree of “Ayurveda Vachaspati” [M.D.]

in

KAYACHIKITSA

GUIDE Prof. Pramod Kumar Mishra

M.D (Ayu) (RSU) HOD. Dept. of Kayachikitsa

DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA A.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE, KOPPA -

577126 CHIKMAGALUR DISTRICT, KARNATAKA, INDIA

SEPTEMBER - 2006

Ayurmitra

TAyComprehended

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYA CHIKITSA

Declaration

I here by declare that this dissertation entitled “Management of Sandhigata

vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide and

genuine research work carried out by me under the guidance of Prof. Pramod Kumar

Mishra Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao Memorial

Ayurvedic Medical College and P. G. Centre, Koppa.

Date:

Place: Koppa

Dr. Guruprasad. Aggithaya P.G.Scholar,

Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

Ayurmitra

TAyComprehended



Certificate

This is to certify that the dissertation entitled “Management of Sandhigata

vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide research

work done by Dr. Guruprasad Aggithaya in partial fulfillment of the requirement for

the degree of Ayurveda Vachaspati (M.D.) in Kaya Chikitsa, under Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka.

Date:

Place: Koppa

Guide:Prof. Pramod Kumar Mishra

M.D(Ayu) (RSU) HOD, P.G. Studies in Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126



Endorsement

This is to certify that the dissertation entitled “Management of Sandhigata

vata with ‘Trayodashanga Guggulu’- A clinical evaluation” is a bonafide research

work done by Dr. Guruprasad Aggithaya under the guidance of Prof. Pramod

Kumar Mishra, Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao

Memorial Ayurvedic Medical College and P.G. Centre, Koppa.

Date:

Place: Koppa

Dr. Tarani Kanta Mohanta M.D.Ph.D (Ayu)(Jamnagar)

Dean, A.L.N.Rao Memorial Ayurvedic Medical College, Koppa –577126, Dist: Chikmagalur

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation in print or electronic format for academic/research purpose.

Date:

Place: Koppa

Dr. Guruprasad Aggithaya

P.G.Scholar, Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

© Rajiv Gandhi University of Health Sciences, Karnataka

INDEX

INDEX

Page No.

INTRODUCTION 1-3

Chapter – I OBJECTIVES 4

Chapter – II REVIEW OF LITERATURE 5-46

DISEASE REVIEW

Historical Review 5-8

Etymiology 8-10

Anatomical aspect of Sandhi 10-15

Nidana 16-23

Poorvarupa 24

Rupa 25-28

Upasaya-Anupasaya 28

Samprapti 29-31

Upadrava 32

Sadhya asadhyata 32

Chikitsa 33-37

Pathya Apathya 38-39

Differencial diagnosis 40

Modern perspective of the disease 41-46

DRUG REVIEW

Trial drug 47-56

Standard drug 57-61

Chapter –III METHODOLOGY 62-82

Chapter –IV RESULTS 83-90

Chapter –V DISCUSSION 91-103

Chapter –V CONCLUSION 104

SUMMARY 105-106

REFERENCES

BIBLIOGRAPHY

ANNEXURE

ABBREVIATIONS

ABBREVIATIONS

1. A.F.U - After follow up.

2. A.H. - Astanga Hrudaya

3. A.K - Amara kosha

4. A.P. - Agni Purana

5. A.S. - Astanga Sangraha

6. A.T - After treatment.

7. A.V. - Atharva Veda

8. B. P. - Bhava Prakasha

9. B.R. - Bhaishajya Ratnavali

10. B.Su. - Brahmana sutra

11. Bas.Raj. - Basavarajeeyam

12. Bh.Sa. - Bhela Samhita

13. C.D. - Cakradatta

14. Ch - Charaka Samhita

15. Chi. - Chiktsa sthana

16. Ct. - Chandogyopanisat

17. J.L.N - Illustrated text book of Dravyaguna

Vol-2 by J.L.N. Shasthry.

18. K.S. - Kasyapa samhita

19. Khi - Khila sthana

20. Ks. - Kausika sutra

21. Kt. - Kenopanisat

22. M.B - Mahabharatha

23. M.K. - Madhyama khanda

ABBREVIATIONS

24. M.N. - Madhava nidana

25. Ni. - Nidana sthana

26. P.K. - Purva khanda

27. P.Su. - Panini sutra

28. Pr. - Prakarana

29. Pr.K. - Prathama Khanda

30. Pu. - Purana

31. R. - Ramayana.

32. S.K.D. - Sabda Kalpa druma

33. Sha. - Sarira sthana

34. Si. - Siddhi sthana

35. Su. - Susrutha samhita

36. Su. - Suthrasthana.

37. Thr. - Thritheeya sthana

38. U.K. - Uttara khanda

39. Vi. - Vimanasthana

40. Y.R. - Yogaratnakara

Introduction

Objectives

Review of literature

Methodology

Results

Discussion

Conclusion

Summary

References

Bibliography

Annexure

CONTENTS

LIST OF TABLES

No SUBJECT Pg No

1. Types of Sandhis 10

2. Rasa visheshatha nidana of Sandhigatavata 17

3. Guna visheshatha nidana of Sandhigatavata 18

4 Veerya visheshatha nidana of Sandhigatavata 18

5 Time and forms of Ahara 18

6. Types of Ahara 19

7. Vihara nidana of Sandhigatavata 20-21

8. Manasika nidana of Sandhigatavata 21-22

9. Kala nidana of Sandhigatavata 22

10. Roopa of Sandhigatavata according to various acharyas 25

12. Chikitsa sutra of Sandhigatavata according to various acharyas 33

13. Pathya for sandhigata vata. 38

14 Apathya for Sandhigata vata 39

15 Age wise distribution of 40 patients of Sandhigatavata 40

16 Sex wise distribution of 40 patients of Sandhigatavata 67

17 Religion wise distribution of 40 patients of Sandhigatavata 68

18 Marital status wise distribution of 40 patients of Sandhigatavata 68

19 Economic status of 40 patients of Sandhigatavata 69

20 Occupational incidence of 40 patients of Sandhigatavata 69

21 Nature of work in 40 patients of Sandhigatavata 70

22 Habitate wise incidence of 40 patients of Sandhigatavata 70

23 Main symptoms in 40 patients of Sandhigatavata 71

24 Duration of illness in 40 patients of Sandhigatavata 72

25 Family history of disease of muscular skeletal system in 40

patients of Sandhigatavata

72

26 Dietary habits in 40 patients of Sandhigatavata 73

27 Ahara Pramana in 40 patients of Sandhigatavata 74

28 Dominant rasa in 40 patients of Sandhigatavata 74

29 Dominant ahara guna in 40 patients of Sandhigatavata 75

30 Nidra incidence in 40 patients of Sandhigatavata 76

31 Pramana of vyayama in 40 patients of Sandhigatavata 76

CONTENTS

32 Prakruti in 40 patients of Sandhigatavata 77

33 Distribution of 40 patients of Sandhigatavata according to Sara 77

34 Distribution of 40 patients of Sandhigatavata according to Satwa 78

35 Samhanana.in 40 patients of Sandhigatavata 79

36 Satmya in 40 patients of Sandhigatavata 79

37 Abhyavaharana shakti in 40 patients of Sandhigatavata 80

38 Jarana sakthi in 40 patients of Sandhigatavata 80

39 Vyayama sakthi in 40 patients of Sandhigatavata 81

40 Weight incidence in 40 patients of Sandhigatavata 82

41 Effect of trial drug on patients of Sandhigatavata after 60 days of

treatment.

83

42 Effect of Trial drug on patients of Sandhigatavata after 60 days of

follow up.

83

43 Effect of Standard drug on patients of Sandhigatavata after 60

days of treatment

84

44. Effect of Standard drug on patients of Sandhigatavata after 60

days of follow up.

84

45. Comparative effect of therapies in the management of main

symptoms on 40 patients after 60 days of treatment

85

46 Comparative effect of therapies in the management of main

symptoms on 40 patients after 60 days of follow up

86

47. Overall effect of therapy by Trial drug after 60 days of treatment 87

48. Overall effect of therapy by Trial drug after 60 days of follow up. 87

49 Overall effect of therapy by Standard drug after treatment 88

50. Overall effect of therapy by Standard drug after follow up. 88

51. Inter-group comparison after 60 days of treatment 99

52. Inter-group comparison after 60 days of follow up 100

CONTENTS

LIST OF FIGURES

No. Pg No.

1. Age wise distribution of 40 patients of Sandhigatavata 67

2. Sex wise distribution of 40 patients of Sandhigatavata 68

3. Religion wise distribution of 40 patients of Sandhigatavata 68

4. Marital status wise distribution of 40 patients of Sandhigatavata 69

5. Economic status of 40 patients of Sandhigatavata 69

6. Occupational incidence of 40 patients of Sandhigatavata 70

7. Nature of work of 40 patients of Sandhigatavata 71

8. Habitat wise distribution of 40 patients of Sandhigatavata 71

9. Symptomatology in 40 patients of Sandhigatavata 72

10. Duration of illness in 40 patients of Sandhigatavata 73

11. Family history of disease in 40 patients of Sandhigatavata. 73

12. Dietary habit in 40 patients of Sandhigatavata 74

13. Ahara pramana in 40 patients of Sandhigata vata 74

14. Dominant rasa in 40 patients of Sandhigatavata 75

15. Dominant ahara guna in 40 patients of Sandhigatavata 76

16. Nidra incidence in 40 patients of Sandhigatavata 76

17. Pramana of vyayama in 40 patients of Sandhigatavata 77

18. Prakruti in 40 patients of Sandhigatavata 78

19. Distribution in 40 patients of Sandhigatavata according to sara. 78

20. Distribution in 40 patients of Sandhigatavata according to Satwa 79

21. Distribution in 40 patients of Sandhigatavata according to Samhanana 79

22. Distribution in 40 patients of Sandhigatavata according to satmya 80

23. Abhyavaharana shakti in 40 patients of Sandhigatavata 81

24. Jarana sakthi in 40 patients of Sandhigatavata 81

25. Vyayama sakthi in 40 patients of Sandhigatavata 82

26. Weight incidence in 40 patients of Sandhigatavata 82

CONTENTS


symptoms on 40 patients after 60 days of treatment

85


symptoms on 40 patients after 60 days of follow up

86

29. Comparative effect of overall therapies on patients after 60 days of

treatment

89

30. Comparative effect of overall therapies on patients after 60 days of

follow up

90

LIST OF CHARTS

No. Pg No.

1. Chart showing etiopathogenesis of Sandhigatavata 31

ACKNOWLEDGEMENT

ACKNOWLEDGEMENT

I am obliged to my beloved parents B.Balakrishna Aggithaya and Shantha.B.Aggithaya for their

constant efforts, encouragements and inspirations through out the work.

On the completion of this thesis work, I extend my sincere gratitude to my revered Guide

Prof.Pramod Kumar Mishra, M.D(Ayu),(RSU), who was the vital and kinetic force of this thesis;

with out his initiation this piece of work would not have been accomplished in stipulated time.

I am grateful to Sri. Aroor Ramesh Rao, President, A.L.N. Rao Memorial Ayurvedic Medical

College, Koppa for giving me an opportunity to do my post-graduate studies.

I express my gratitude to the Dean of our college Prof.T.K.Mohanta M.D,Ph.D. PG Dept. of

Kaya chikitsa for his unflinching support during this course of study.

My immense thanks to Dr. Sanjaya K. S, M.D (Ayu), Principal, A.L.N Rao Memorial Ayurvedic

Medical College, Koppa, for his help and support in completing this work.

I owe my sincere regards and boundless gratitude to Dr. Rashmi Rekha Mishra M.D (Ayu) and

Dr. C, B. Singh for their constant encouragement and valuable suggestions.

I remain grateful forever to Dr.Shyamalan PhD and my senior Dr.Christy J.T for their complete

guidance in the statistical work.

I am obliged to the respected teachers of Dept. of Rasa shastra and Bhaishajya kalpana; Dr. D.K

Mishra, M.D (Ayu) Dr. Galib M.D (Ayu), Dr. Harikrishna M.D (Ayu).for their guidance for

preparing the medicine..

My earnest gratitude to the respected teachers of the faculty of Dravya guna; Dr. Jagadeeh

Kunjal M.D. (Ayu), Dr. Sreedhar, M.D (Ayu) for their extensive help in the study along with

Dr.H.R Pradeep, M.D (Ayu).

I am glad to express my sincere thanks to Dr. Banamali Das, Dept. of Roganidana and Dr. Rajesh

Kumar, M.D (Ayu) from the Dept. of Shalakya and Dr. Sahana MD (Ayu) from Dept of Shalya.

ACKNOWLEDGEMENT

I will always treasure the guidance and support given by Dr. Rammohan, Dr. Lalitha Bhasker,

Dr. Sreenivas and Dr. Abhinetri Hegde; Consultant Physicians of Ayurvedic college hospital for

their support during various stages of my work.

I will be failing in my duties if I do not express my immense gratitude to my seniors Dr. Prathibha

Hullur, Dr.Prashanth B.K,Dr. Krishnakishore, Dr. Sanjeev, Dr. Suja, Dr. Kavitha, and

Dr.Pankaj, Dr. Purushotham K.G, Dr. Anil P Varkey, Dr. Clarence, and Dr. Leeladhar for their

support.

I am thankful to my class-mates Naga, Abhay, HHP, Anita, Draksha, Vasu, Joshi, Kamat,

Nalini for their helping hand.

With immense pleasure, I extend my heart full thanks to my room-mates Ratheesh, Harvin,

Susheel Shetty with out whose support this thesis work would not have been complete.

My thanks to Raghuram, Daya, Ilanchezian, Binu, Sarat, Ravi, James, Partta,Viji, Chandrakala,

Sachin, Sandhesh for their valuable suggestions and moral support.

I also thank all my UG class-mates (1996 - 2001).

My special thanks to all PG juniors, House surgeons and UG students for their constant support.

I would like to express my gratitude to Miss.Amrutha, for sincere support in lab investigations.

My sincere thanks to Mrs.Triveni, Miss.Manjula (Librarians), Mrs. Jyothi and other office staffs

and hospital staffs for all kinds of support.

I am grateful to all the patients who became a part of my study.

I am heartily thankful to my sisters Gayathri and Gowri. And also to all family members who

helped me during my study.

Finally, I thank all those who helped me directly or indirectly to complete this work.

Date :

Place : Koppa Dr. Guruprasad. A

ABSTRACT

ABSTRACT

INTRODUCTION:

Disorders of the musculoskeletal system are prevalent throughout the world

affecting all age group. Among this, important one is Sandhigata vata, which

produces disastrous consequences like physical disability in community. Sandhigata

vata can be compared to Osteoarthritis, which is one of the degenerative joint disorder

and it represents failure of the disarthroidal part. The present study is done to

understand the disease which is explained in the classics. Even though this disease is

considered as Kashta sadhya, it can be managed when proper treatment is given in

appropriate time. Here an attempt is made to find the efficacy of the drug

Trayodashanga Guggulu on Sandhigata vata.

OBJECTIVES:

The objectives of the present study are

1) To evaluate the efficacy of Trayodashanga Guggulu in Sandhigatavata.

2) To study in detail about the disease Sandhigata vata covering both Ayurvedic

and modern literatures.

3) To assess the merits and demerits of the trial drug Trayodashanga Guggulu.

4) To assess the merits and demerits of the standard drug Simhanada Guggulu.

5) To compare the efficacy of the trial drug(Trayodashanga Guggulu) with the

standard drug(Simhanada Guggulu)

6) Study of the trial drug and standard drug covering Classical Ayurvedic

literatures.

ABSTRACT

METHODOLOGY:

Total 40 patients were selected who fulfilled the inclusion criteria were

randomly selected for the study. These persons grouped into two.ie trial and standard

group.

The Trial group patients were given Trayodashanga guggulu in the dose of 3

gms twice daily after food with Ushna jala as Anupana. The duration of treatment was

for 60 days. Follow up study was done for 60 days in every 15 days visit.

The Standard drug patients were given Simhanada guggulu in the dose of 3

gms twice daily after food with Ushna jala as Anupana. The duration of treatment was

for 60 days. Follow up study was done for 60 days in every 15 days visit.

INTERPRETATION AND RESULTS:

At the end of 60 days of treatment schedule Trial drug (Trayodashanga

guggulu) showed highly significant effect in Atopa where as moderate significant in

sandhi shula, Sandhi shotha and tenderness where as standard drug (Simhanada

guggulu) showed highly significant result in Sandhi shotha and moderate significant

result in other symptoms.

After 60 days of follow up study, Trial drug showed highly significant result

in the Sandhi shula, Tenderness and Atopa where as Standard drug showed highly

significant result in Sandhi shotha.

CONCLUSION:

• Trial drug (Trayodashanga guggulu) provided highly significant result in the

Sandhigata vata by reducing Sandhi shula, Atopa, Tenderness.

• Trayodashanga guggulu acts as Rasayana, Balya and also Vedana sthapana.

• Standard drug has highly significant result in Sandhi shotha.

INTRODUCTION

INTRODUCTION

As one of the famous proverbial saying goes- Health is wealth, it seems that

the concept of health has never been dealt in any medical science as realistic as in

Ayurveda. The signs of well being or freedom from illness are well depicted in the

ancient treatise. The integration of body components, compactness of muscles and

other tissues, stability and pleasantness of mind and senses, good appetite, timely

digestion, undisturbed metabolism, elimination of urine and faeces, tolerance towards

affects of hunger, thirst, heat, cold and exercise, normal sleep – wake pattern and gain

of strength colour, complexion and life span put together define a healthy individual.1

The description gains more weightage even in this present modern era when

the concept of health as described by WHO includes the state of physical and mental

well being, appears to be influenced by the ancient theories of Ayurveda.

In contrary, the pathological picture sets in when the rhythmic proceedings of

above said mechanisms are disturbed and the individual will no longer be considered

to be healthy. This disarray of events leading to ill health will be caused by the

disturbance of the chief humoral factors governing the body that is the Tridoshas,

which again is brought about by exposure to various etiological factors pertaining to

Ahara, Vihara and Vichara.

Among the Tridoshas, Vata is given a prime importance with respect to either

physiological or pathological conditions. The other two doshas being inert, their

equilibrium depends on vata.2 The vayu is considered to be the chief motivating force

behind all the activity as it has been described as the engine which runs the machine

of the body3. Vayu is also chief driving force of the all the movements, which get

disturbed when vayu gets vitiated. The vayu vitiated by the etiological factors flowing

Page 1

INTRODUCTION

in adverse routes produces diseases related to the site of localization and their

disturbed functions.

Once such disease caused due to the predominance of vayu is

Sandhigata vata. This is a pathological condition which manifests when the Sandhis

which are the important seat of Kapha, are affected by Vayu. This disease is often

compared to the degenerative disorder afflicting the joints and having world wide

incidence and prevalence in plenty i.e. Osteoarthritis. The prevalence is 30% in the

age group of 45-65 years and 68% for those older than 65 years. Men are more likely

to suffer below the age of 45 years and women above 55 years. Besides destroying the

joints, this disease makes the person crippled and dependent to attend his normal

duties.

Ayurvedic remedies have always been successful in the treatment of this

ailment and its effects, especially the preparations of Guggulu. One such formulation

consisting of thirteen in valuable drugs called ‘Thrayodashanga guggulu’ has been

mentioned in Cakradatta, as directly indicated in Sandhisthita vata4. Most of the

ingredients are bruhmana in nature and more importantly guggulu which is said to

have vata alleviating property. This drug has been selected for trial to asses its

efficacy in reliving one from complaints of Sandhigata vata.

This study highlights both conceptual and clinical aspects related to the disease

Sandhigata vata, which is divided in to following chapters-

Chapter 1 - Objectives.

This chapter highlights on main aims of this study.

Chapter II- Review of literature

It deals with the conceptual study of both Sandhigata vata and Osteoarthritis.

It covers all the relevant matters related to the disease.

Page 2

INTRODUCTION

Chapter III- Methodology

Details of the clinical trial of Trayodashanga guggulu and Simhanada guggulu

with observations during the study are explained.

Chapter IV- Results

The results of the entire study have been explained with appropriate graphs for

easy understanding.

Chapter V- Discussion

Discussions on Sandhigata vata and Osteoarthritis, discussion on clinical trial

with observations and results have been described.

Chapter VI- Summary and Conclusion

Complete abstract of the dissertation and the conclusion are enumerated.

Previous works done:

1) Kohla PR,Rasnadi guggulu ki nirmithi evam sandhigata vata mein upayukta

(Dissertation), Nagpur,1990.

2) Chacha ML, Clinical study of Sandhigata vata with special effect of Parijatha

guggulu (Dissertation), Ahamedabad, 1992.

3) Neetha Kumari, Evaluation of Rasnadi guggulu in treatment of Osteoarthritis

(Sandhigata vata),(Dissertation), Varanasi, 1998.

4) Lal ji, Clinical study on the effect of Simhanada guggulu and Murivenna taila

in the management of Osteoarthritis of Knee joint (Dissertation), Jaipur, 2002

Page 3

OBJECTIVES

OBJECTIVES

The objectives of the present study are

1) To evaluate the efficacy of Trayodashanga Guggulu in the treatment of

Sandhigatavata.

2) To study in detail about the disease Sandhigata vata covering both Ayurvedic

and modern literatures.

3) To assess the merits and demerits of the trial drug Trayodashanga Guggulu.

4) To assess the merits and demerits of the control drug Simhanada Guggulu.

5) To compare the efficacy of the trial drug(Trayodashanga Guggulu) with the

control drug(Simhanada Guggulu)

6) Study of the trial drug and control drug covering Classical Ayurvedic

literatures.

7) To establish an effective treatment with the trial drug for Sandhigata vata.

Hypothesis:

a) Null hypothesis:

Trayodashanga Guggulu is not effective in the treatment of Sandhigatavata.

b) Scientific hypothesis:

Trayodashanga Guggulu is effective in the treatment of Sandhigatavata.

Page 4

DISEASE REVIEW

DISEASE REVIEW

HISTORICAL ASPECT OF SANDHIGATA VATA:

All the historical aspect related to this work is mentioned under this heading.

Veda kala:

• Rigveda5

In this five types of Vata is considered as Pancha prana.One of the Mantras of

Rigveda described about removing the disease from each organ (hairs and joints)

• Atharvaveda6

In Atharvaveda, there are references about the disease pertaining to Sandhi and

Sandhi vishlesa.

Purana Kala:

• Ramayana [Before 500B.C] 7

In this treatise, importance of Vayu in maintenance of health and life is

mentioned. There is also explanation about the pathological effect caused by the Vayu

such as Pain and immobility of Joints.

• Mahabharatha [4th Cent B.C-4th Cent A.D] 8

In this treatise, Vata has been given important and it is called as Panchakarma

(having 5 functions) and Bhagavan.

• Agnipurana: 9

In Agnipurana total number of joints in human body and treatments for

Sandhigata Samavata is mentioned.

Upanishat kala:

Elaborate description of vata is available in the Upanishats.

Page 5

DISEASE REVIEW

• Kenopanishat: 10

In this book, vayu is defined as the one that has constant movement, motion

and continued efforts.

• Chandogyopanishat: 11

This book has highlighted the chala property of vata and has shown its close

association with bodily actions and movement.

Samhita kala:

• Charaka samhita [1000B.C] 12

Charaka mentions Sandhigata vata roga in the chapter Vatavyadhi chikitsa.

He names the disease as Sandhigata anila. He explains this disease with Dhatugata

anila vikaras and not mentioned in Nanatmajavatavikara. A separate nidana or the

treatment principles are not found in the text.

• Sushrutha Samhita [700-600B.C] 13

Sushruta mentions general nidana in Nidana sthana (vata vyadhi nidana) and

seperate treatment principles mentioned in Chikitsa sthana(Vatavyadhi chikitsa).

• Bhela Samhita [800-700B.C] 14

There is no clear description is available about Sandhigata vata. But in

Ashtimajjagata vata, ‘Sandhivichyuti’is explained as one of the lakshana.

• Haritha Samhitha [800-700B.C] 15

Acharya Haritha explains that there are 84 Vathaja nanathmaja vikaras.

Among these, 32 are Vyana vata prakopaja vikaras. He also mentions that all the

Dhatugata vata vikaras are due to Vyana vata prakopa and further tells about the

treatment aspect of Sandhigata vata. He also makes the mention of ‘Sandhi shotha’

in Shukra gata vata.

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DISEASE REVIEW

Sangraha kala:

• Ashtanga Sangraha and Ashtanga Hrudaya [600A.D -1600A.D] 16

The disease is described with treatment.

• Madhava Nidana [800A.D] 17

Acharya Madhavakara agrees with Acharya Charka with respect to Nidana and

Acharya Sushrutha with respect to lakshanas, except for the term Atopa which he uses

instead of Shopha.

• Bhavaprakasha [1400A.D] 18

Bhavamisra follows Acharya Sushruta while describing the disease and its

management which he discusses in vatavyadhi chapter of Madhyama Khanda.

Chakradatta [1100A.D] 19

Chakrapani Datta gives the same views as Sushruta in treatment aspects of this

disease.

• Bhaishajya ratnavali 20

The treatment aspect of this disease is mentioned.

• Yogaratnakara [1600A.D] 21

He has given the same views as of Charaka and Susrutha but separate treatment

principles are mentioned.

• Basavarajeeyam[ 1133-1183 A.D] 22

Vaidya Basavaraja explains this disease as Sandhi Vata. He gives different

lakshanas of this disease but agrees on nidana mentioned by Charaka. He explains

about the sandhivatari rasa.

Page 7

DISEASE REVIEW

Sutra kala:

Bramhana sutra: 23

This text has given importance to Vyana vata. While explaining the

movements of joints it is said that vyana vata is the one, which resides in the joints

and performs all the movements.

Panini sutra: 24

Panini was well aware of vata, its kopa and samana. He has mentioned the

term vatiki to denote disorders of vata.

ETIMOLOGY OF SANDHIGATAVATA:

The term sandhigatavata is a combination of two words i.e,

1. Sandhi

2. Gata vata

Sandhi:

The word sandhi is formed by the combination of the sam+dha+kihi.25

In amarakosa, we get the meaning of the sandhi as slesha which means union

or combination.

Sandhi is considered as union of two structures. Charaka mentions that sandhi

is the samyoga sthana of the two asthis. The asthi sandhis are only considered as the

sandhis and the union of pesi, snayu and siras are not considered.26

It is the moola of majjavaha srotas and also considered as one of the

madhyama roga marga. There are 210 sandhis are present in our body.

Concept of Gata Vata

Gata vata is further comprised of two words, Gata and Vata

Gata:

Here the word gata denotes the state of vata.

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Vata

Among three doshas,Vata is given importance. The word Vata originated from

the root “Va Gati Gandhanayo” which when suffixed by ‘Ktan’, gives rise to the word

Vata.

There are five types of Vata, ie Prana, Udana, Samana, Vyana, Apana. They

are having the seperate functions like, Purana, Udwahana, Viveka (rasa mootra

purisha pruthakkarana), Praspandana and Dharana.

Vyana vata has been given the karma in different treatises such as

- Praspandana (Sushruta)27

- Shareera chalana (Dalhana)28

- Gati, Apakshepana, Uthkshepa (Vagbhata)29

- Sandhicharitha (Dalhana)30

- Vahana (Rasa samvahana)31

- Pancha chesta.[Prasarana, Akunchana, Unnamana,Vinamana,

Tiryakgamana]32

- Pancha chesta [Gati, Prasarana,Uthkshepa, Nimesha, Unmesha] 33

Although these functions said to be done by vyana vata, it can be seen in other

types also. Praspandana karma can be seen in prana vata during swasa praswasa kriya.

By the above reference we infer that any act of praspandana etc. function happen only

with the coordinated union of all the types of vayu. To maintain the coordinated union

of vayu, Vahana is important which is performed by vyanavata.

In Ayurvedic literatures, Sthitha, Militha, Gata are to be considered as

synonymous words.

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The pathogenesis of Gatavata can be occurs in two ways

- Margavarana janya – due to margavarana there will be srothorodha

which leads to soshana of dhatus and also vitiation of vata. The

vitiated vata situates the srotas which became rikta by soshana of

dhatu.

- Dhatu kshaya janya – the rikta dhatuvaha srotas will be filled by

the vitiated vata.

In gatavastha, the vitiation of vata is given importance. Here vata will be

prabala state rather than in avarana. So gata vata condition shows prabala vata

lakshana.

In Hareeta samhita, Hareeta explains all the Dhatugata conditions are

explained under the heading of Vyana vata prakopaja vikara.34

Anatomical aspect of Sandhi:

There are two types of sandhi present in our body, 35 they are

1. Chestavantha – movable joints, the examples are the sandhis of Shakha,

Hanu, Kati, Greeva.

2. Sthira – the remaining sandhis other than chestavantha.

Another classification of sandhis36 is,

No Type of Sandhi Structure Examples. 1. Kora Hinge joint anguli, manibandha, janu,

kurpara, 2. Ulukhala Ball & socket joint kaksha, vankshana and

dashana 3. Samudga Saddle joint Amsapeeta, Guda, Bhaga,

Nithamba 4. Prathara Plain gliding joint Greeva, Prishtavamsh 5. Tunnasevani Sutures Sira, Kati, Kapala 6. Vayasatunda Condyloid joints Hanu 7. Mandala Circular joint Kanta, Hrdaya, Kloma,

Nadi 8. Sankhavartha Bony labyrinth Shrotr, shrungataka

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Snayu: 37

Snayu looks like a Shana (jute) and it is considered as the part of sandhi. It is

the upadhatu of medas and also moola of mamsavaha srotas. There are 900 snayus are

present in human body. They are classified into four types they are, Prathanavathi,

Vrutha, Pruthula and Sushira. Prathanavathi snayu is present in all the sandhis. The

vrutha snayus also considered as Kandara.it has the function of prasarana and

akuchana of body parts.

The ligaments which are present in the joints are separate which leads to

stability.

Sleshmadara kala: 38

This is the fourth kala, the kleda which is present in between the dhatvashaya

will get paka by respective dhatwagni and kalas are produced.

Sleshmadhara kala is considered as the seat for the sleshma (Shleshaka kapha)

and it gives integrity to the body.

Just as the application of oil to the axils produce easy movements to the wheel,

the easy movement of the Sandhis is similarly brought about the lubricating

effect the Shleshma dhara kala lining the Sandhis.

The Synovial membrane can be compared with Shleshmadhara kala, which

leads to easy movement of joints by secreting synovial fluid. Type B

Synoviocytes will secrete the synovial fluid.

Siras: 39

Siras are upadhatu of raktha which helps in sarana. There are four types; they

are vatavaha, pittavaha, kaphavaha and rakthavaha.

Siras are mainly situated in marma and nourishing the snayu, asthi and sandhi.

They are 700 in number.

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Pesi: 40

There are 500 pesis in our body. The sira, snayu, asthi, parva and sandhis are

covered by the pesis and get strength.

Sandhimarma: 41

Marmas are the vital points of the body. They are 101 in number. According to

Dalhana marmas are situated in mamsa, sira, sandhi etc.42

Depending on the structural base marmas are divided into 5. They are mamsa

marma, sira marma, snayu marma, asthi marma and sandhi marma. All the marmas

comes under these 5 categories.

There are 20 types of sandhi marmas. They are janu, kurpara, seemantha,

adhipathi, gulpha, manibandha, kukundara, avartha and krukatika.43

JOINTS 44

Two or more bones unite to form joints.

There are three types of joints explained.

• Fibrous joints.

• Fibro-cartilagenous joints.

• Synovial joints.

Fibrous and Fibro-cartilagenous joints:

In this type, the fibrous or Fibro-cartilaginous tissues unite the two bones. This

joint will present where there is little requirement of movement.

Examples:

For fibrous joint: joints present in skull bone.

For Fibro-cartilaginous joint: Symphisis pubis, Inter vertebral discs.

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Synovial joints:

This type of joints provides maximum range of movement.

Eg: Most limb joints, Tempero-mandibular joint.

Structures present in synovial joint are,

1. Articular cartilage.

2. Synovial fluid.

3. Intra articular disc.

4. Joint capsule and synovial membrane.

Articular cartilage:

In synovial joint, the articular surface is covered with a layer of articular

cartilage.

In normal cartilage, there are no cell divisions. But in this chondrocytes there are

continuous process of destruction and synthesis of the cartilage matrix throughout life.

Constituents:

It is an avascular tissue that consists of cartilage cells [Chondrocytes], Type II

collagen and smaller amounts of other proteins which is present in the matrix of

proteo glycans.

The matrix consists of:

1) Type II collagen fibers:

It forms the meshwork in between the proteo glycan molecules.

2) Hydrated gel of proteo glycan molecules:

In this, the important one is Aggrecan.

Aggrecan consists of:

A] Core protein.

B] Glycosaminoglycan[GAG] : It is the long chain of disaccharides.

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The important GAG is Chondroitin sulphate and Keratan sulphate.

3) Hyaluronan:

A long GAG in which numerous aggrecan will be connected.

4) Link protein:

N- Terminus of aggrecan joins to the hyaluronan by small glycoprotein called

Link protein.

Articular cartilage has two essential functions:

It provides a smooth bearing surface so that with the movement, bone glide

effortlessly over each other. Articular cartilage prevents concentration of stresses, so

the bones do not shatter when the joint is loaded. Large complexes of aggrecan and

Hyaluronan form the articular cartilage. Aggrecan has a strong, negative charge

because of the sulphate and hydroxyl groups in glycosaminoglycan. And also it binds

large number of water molecules. So it occupies the maximum possible volume

available. So the expansive force of charged and hydrated aggrecan and restrictive

force of collagen gives the articular cartilage an excellent shock absorbing properties.

Synovial fluid:

Surfaces of articular cartilage separated by space called Synovial fluid. It is

basically ultra filtrate of plasma into which synovial cells secrete Hyaluronan and

proteoglycan. It lubricates the joint.

Intra articular discs:

Intra articular discs are the fibro cartilagenous disc which is present within the

joint space. It is present in some joints only and acts as shock absorbers.

Joint capsule:

Joint capsule is a fibrous structure, richly supplied by blood vessels,

lymphatics and nerves. It joins the two bones of the synovial joint. Ligaments and a

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regional thickening of joint capsule stabilize the joint. Inner surface is lined by

synovial membrane.

Synovial membrane:

This membrane contains outer layer of blood vessels and loose connective

tissues. Inner layer consists of Type A and Type B synoviocytes. Most of

inflammatory and degenerative joint diseases associated with thickening of synovial

membrane and infiltration by lymphocytes, polymorphs and macrophages. Many

joints contain bursae which are hollow sacs lined by synovium.

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NIDANA

In Ayurvedic classics, the term Nidana has been defined in two different

senses. One of these definitions explains Nidana as that which points or indicates a

disease or that which gives a complete knowledge of a disease or that which helps in

diagnosing a disease.45

The other part defines Nidana as those which have a tendency to produce a

disease process after inducing a chain of pathological events in the body like Dosha

prakopa etc or in short, the etiological factors of the disease. The ahita ahara vihara

which vitiates the doshas and the dusta doshas which tend to vitiate the dushyas are

included in to the category of Nidana.46

Being an important member of the Panchakas aiding in roga pareeksha,

nidana not only helps in diagnosis and differential diagnosis, but also helps in

determining the prognosis of the disease. Nidana has an important role to play in

Chikitsa also, as the shortest route of avoiding or getting rid of the disease is said to

be Nidana parivarjana.

In this context, the terminology Nidana covers the etiological factors causing

the disease entity Sandhigata vata. Sandhigata vata is one of the vata vikara. Vata

vyadhi can be an effect of either of the two pathological events namely Dhatukshaya

or Margavarodha. Each occurring due to different sets of nidana and so does

Sandhigata vata. Since separate etiological factors have not been mentioned with

respect to Sandhi gata vata, the same nidanas which have been explained in the

context of vata vyadhi should be considered.

Notes:

• vata prakopaka nidana 47

• + vata vyadhi nidana.48

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The nidanas can be categorized into:

Aharatha

Viharatha

Manasika

Kalakrutha

Aharatha:

Ahara is an important factor responsible for the maintenance of health, as it is

pancha bhoutika. Bala and ayush is gained by ahara. It is the form of nutrition to the

basic elements of the body or the shareera dhatu. Dhatu kshaya is a main cause of vata

prakopa. So here the cause of dhatu kshaya is been considered keeping in view of

their final effect on the functions of vata. Therefore different factors relating to the

ahara has been tabulated.

A) Rasa visheshatha nidana:

Table no: 2 showing Rasa visheshatha nidana:

Rasa Ch Su A.S B.P M.N Y.R Ba.Raj H.S

Kashaya - * * + - - - -

Katu - * * + - - - -

Tikta - * * + - - - -

* vata prakopaka nidana. + vata vyadhi nidana.

Kashaya, katu and tikta are the rasas, which vitiates vata and also leads to

snehadigunasunyatha. So this nidanas can be the cause for sandhigatavata.

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B) Guna vishesatha nidana:

Table no: 3 Showing Guna visheshatha nidana:

Guna Ch Su A.S B.P M.N Y.R Ba.Raj H.S

Ruksha + * * + + + + -

Shitha + * * - + + + -

Laghu + * - + + + + -

Sushka - * * - - - - -


The gunas like laghu, ruksha, kara etc. leads to the kshaya of the sneha guna of

the body, which further leads to dhatukshaya and also vitiation of the vata dosha. So

these gunas also can also cause sandhigata vata vyadhi.

C) Veerya visheshatha nidana:

Table no: 4 showing Veerya visheshatha nidana:

Veerya Ch Su A.S B.P M.N Y.R Ba.Raj H.S

Shita - * * - - - - -


Sheeta veerya is the factor for the vitiation of Vata dosha. So this can be

considered as one of the viprakrshta nidana for Sandhi gata vata.

D) Time and forms of ahara:

Table no: 5 showing Time and forms of Ahara:

Ch Su A.S B.P M.N Y.R Ba.Raj H.S

Alpa + - * - + + + -

Pramitha - - * + - - - -

Abhojana + * - + + + + -

Virodhi - - + + - - - +

Apatharpana - - - - - - - -

* vata prakopaka nidana. + vata vyadhi nidana

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The forms of Ahara like Virodhi, Alpa, causes Vata vitiation thus produces Sandhi

gata vata.

E) Type of ahara:

Table no: 6 showing Type of Ahara:

Nidana Ch Su A.S B.P M.N Y.R B.Raj H.S Shaka - * - - - - - - Vallura - * - - - - - - Varaka - * - - - - - -

Uddalaka - * - - - - - - Koradusha - * - - - - - Syamaka - * - + - - - - Nivara - * - + - - - - Mudga - * - + - - - - Adhaki - * - + - - - - Harenu - * - - - - - - Kalaya - * * - - - - - Nishpava - * * + - - - - Vistambhi - - * - - - - - Virudaka - - * - - - - - Truna dhanya - - * - - - - - Chanaka - - * + - - - - Karira - - * - - - - - Tumba - - * - - - - - Kalinga - - * - - - - - Cirabhita - - * - - - - - Bisa - - * - - - - - Saluka - - * - - - - - Jambava - - * - - - - - Tinduka - - * - - - - - Thriputa - - - + - - - - Satheena - - - + - - - - Makusta - - - + - - - - Mangalyaka - - - + - - - - Masura - * - + - - - -


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2) Viharatha nidana:

Various viharas can stimulate or irritate those anatomical sites where a

function of vata (movements) is more required. Particularly the weight bearing joints

which tend to become the target. Initially the injury may be at the molecular level

which further aggravates being able to involve the tissues of the sandhi generally in

case of irreversible injury.

Vyana vata is responsible for different chestas (movements). Here viharaja

nidana means the atiyoga, ayoga or mithyayoga of these chestas which leads to the

vata prakopa. Viharaja nidana is also leads to abhigata of body parts (sandhi) which

also become one of the pre disposing factors for sandhigata vata.

Table no: 7 showing Viharatha nidana:

Nidana Ch Su AS BP MN YR Ba.Raj HS

Ati vyayama + * * + + + + +

Ativyavaya (nidhwana)

+ - * + + + + -

Langhana + * * - + + + -

Prajagara + * * + + + + +

Plavana (pratarana)

+ * * + + + + -

Atiyadhva + - - - + + + +

Ativicesta + - * - + + + -

Dukhasayya + - - - + + + -

Dukha asana (vishamasana)

+ - * - + + + +

Diva swapna + - - - + + + -

Vega sandharana

+ * * + + + + -

Vego udeerana - - * - + + + -

Abhighata + * * + + + + -

Srama - - - + - - - -

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Kreeda - - - - - - - +

Dathu kshaya + - + + - - - -

Ucha bhashana - - * - - - - -

Abisangha - - - - - - - +

Atiasruk sravana

+ - * + - - - +

Ati virechana + - * + - - - +

Ativamana + - * + - - - -

Prana apana samana sandharana

- - - - - - - +

Vishamopachara

+ - - - + + + -

Bharaharana - * * - - - - -

Ksheena bala - - - - - - - +

Atimamsa ksaya

- - - + - - - -

Gajaturaga yana

+ * * - + + + -


3) Manasika karana:

Mana is Ubhayendriya, which is the main part to attain Jnhanotpatti. Manas is

controlled by Vata (Niyantha pranetha cha manasaam). Indriyas are also controlled by

Vata only.

So manasika nidana considered as one of cause of Vata vyadhi because

Asathmendriyartha samyoga is one type of nidana.

Table no: 8 showing Manasika nidana:


Chinta + - - + + + + +

Soka + - * + + + + -

Krodha + - - - + + + -

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Bhaya + - * + + + + -

Utkanta - - * - - - - -

Ksheena indriya

- - - - - - - +

Madana kopa

- - - + - - - -


4) Kalaja:

Kala is of two types; Nithyaga and Avasthika. Nityaga kala pertains to the kala

related to rtus and Avastika kala is related to pathological state of doshas according to

the age of person.

Table no: 9 showing Kalaja nidana:


Payodasamaya (Varsa rtu)

- * * + - - - -

3rdpart Dina-kshana

- - - + - - - -

Sisira - - - + - - - -

Grishma - - * - + + + -

Bhuktanta - * - - - - - -

Pravrt - * - - - - - -

Seeta kala - * - - - - - -

Vrudha - * - - - - - -

Usha kala - * - - - - - -

Aparahna - * * - - - - -

Jeerna anna - * * + - - - -

Apararatri - - * - - - - -

Purvavata - - * + - - - -


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Influence of the time factor (kala) on the doshas has been given importance in

Ayurvedic classics. In general, the vata is predominant at the end of the digestion,

evening or at the end of the digestion.

Here old age will be main precipitating factor for production of Vatavyadhi.

Although other nidanas can also cause vitiation of vata, it is considered as

Vyabhichari causes for Vatavydhi. In Vrudhavasta, the dhatus are in the state of

ksheena, that which provides platform for the diseases. They are more prone to get

Sandhi gata vata.

There are six rtus in which tridoshas are having its own state of kshaya or

vrudhi. By considering this, vata is having sanchaya in Greeshma, prakopa in Varsha

and shamana in Sharath.49 By this we can analyse that due to the rukshata in

Greeshma vata gets Sanchaya, due to sheetata of Varsha gets Prakopa and ushnata of

sharat rtu does the Vata shamana. In Vata prakopaka rtus, person prone to get Sandhi

gata vata. The possible effect of these factors may be due to not adopting the rules of

Rtu charya and the purification measures in the rtu sandhi as advocated in classics.

Prakruti is also given importance while disease is considered. Vata prakruti

persons are more prone to vata vyadhi. While explaining Vata prakruti, Charaka told

that Anavasthita sandhi(loosening of joints), because of chala guna and Sathatha

sandhi shabda gami( continuous crepitus in joints while walking) because of

vaishadhya guna of Vata.50

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POORVA RUPA

The unclear signs and symptoms produced by the vitiated doshas during the

process of sthana samsraya, which indicate the forth coming disease are called as

poorva rupa. This marks the beginning of amalgamation of vitiated doshas and

dushyas.51 In the context of vata vyadhi, it has been said that the under manifestation

of signs and symptoms or avyakta lakshanas should be regarded as poorva rupa.52

Even in case of sandhigata vata also, feebly manifested signs and symptoms of

the disease can be considered as poorva rupa. In sandhigata vata, shoshana of shareera

takes place due to the localization of the prakupita vata, as a result of which the

person starts feeling laghuta. Lakshanas of sandhigata vata i.e shotha, shula etc are

also found in avyakta avastha.

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RUPA

In the disease process, the same unclear signs and symptoms of poorva rupa

when gets clearly manifested so as to indicate an existing disease will be called as

rupa.53 In short the signs and symptoms of a completely manifested disease are called

as rupa or lakshanas. The same rule holds good with sandhigata vata also, where in

the symptoms of the disease like shotha, shula etc which were unclear and feeble

during the sthana samsraya gets clearly manifested defining the disease.

Table no: 10 showing Roopa of Sandigata vata according to various Acharyas:

Laxanas Ch54 Su55 A.S56 A.H57 B.P58 Y.R59 M.N60 Ba raj61

Sandhi Soola - + - - + + + +

Sotha or sopha - + - - + + - -

Vatapurna druti sparsa

+ - + + - - + -

Hanti sandhin - + - - + + - -

Prasarana akuncanayoho pravrttisavedana

+ - + + - - - -

Atopa - - - - - - + -

Shareera gandhaliptata

- - - - - - - +

Anga peeda - - - - - - - +

Romaharsha - - - - - - - +

Vilapana - - - - - - - +

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The cardinal symptoms are as follows:

1. Vata poorna druti sparsa

2. Sandhi soola

3. Sandhi sputana or Atopa

4. Prasarana Akunchana pravruthi savedana

5. Sandhi shotha or shopha

1) Hanti sandhin:

In the commentary-Nibandha sangraha and Athanka darpana, they gives the

explanation that, Hanti sandheen means abhava in Prasarana akunchana etc functions

of the Sandhi.62 In Madhukosha commentary, it means complications of sandhi like

Sandhi vishlesha, Sandhi sthambha etc.63 Gayadasa gives openion about Sandhi

vishlesha as there will be difficulty of movement without the dislocation.64

Vata is responsible for the Gati especially vyana vata leads to Pancha chesta of

the body (Prasarana, akuncana, Unnamana, Vinamana, Tiryakgamana). So

impairment of Vyana vata leads to difficulty in movement.

2) Sandhi shula:

Shula is the main symptom of the Vata vitiation. All the Acharyas mentioned

that there is no Shula without the vitiation of vata.65

Sandhi shula is the main symptom in the Sandhigata vata. In Asthi-Majjagata

vata also this is the main symptom. So we can conclude that the sandhi shula is

produced due to the effect of Ashrayee dhatu kshaya (Asthi) due to the vitiation of

Vata.

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3) Atopa or Sandhi sputana:

This specific symptom is explained by Acharya Madhava. Shabda is the

indriyartha which indicates the predominance of qualities of Vata. Sandhigata vata is

localized vata vyadhi in which prakupita vayu affects Sandhi. This sthana samsraya is

the result of srotoriktata present at sandhi; that means akasa mahabhuta is increased at

the site of sandhi.

The Atopa can be correlated to the crepitus in a joint. This is due to the

Osteophyte formation at the time of remodeling of joint. This becomes evident only

when there is marked degeneration.

4) Prasarana akunchana pravruthi savedana:

There is a natural elasticity or contractility in the joint by virtue of which the

movement in different direction can be performed. This is destroyed due to the

vitiated vata, with the result the patient is not able to move his joint freely especially

in the extension and contraction. If he tries to move, there will be severe pain. This

phenomenon has been explained by different terminologies such as Stambha etc.

5) Sandhi shotha:

It is one of the main symptoms in Sandhigata vata. Sushrutha explained it as

Sandhi shopha because Shopha is the swelling which is Ekadesha sthitha.66 Acharya

Charaka explained as shotha.

By commenting on shotha, Arunadatta explains that, the swelling look like the

air filled bag.67

In Ashtanga samgraha, Vagbhata includes shopha as one of the Vyana vata

vikara.68

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6) Vata purna druti sparsha:

Sparsha is of two types, Ushna sparsha and Sheeta sparsha. In

Yogarathnakara, there is reference that the person who is suffering from Vata roga

will have Sheeta sparsha.69 In Sandhigata vata, usually the joints will be look like air

filled bag to touch and cold.

Acharya Basavaraja also explained some other symptoms like Shareera

Gandha lipta, Romaharsha, Vilapana which shows the chronicity of the disease.

UPASAYA AND ANUPASAYA

Upashaya is the temporary relief which is gained by the procedures such as

Oushadhi etc.It is also considered as therapeutic test to attain correct diagnosis of the

disease when it becomes difficult due to its effects in manifestation of signs and

symptoms.70

Anupasaya and Upasaya is the application of Ahara, Oushadha, Vihara,

prescribed either antagonistic or similar to the nidana, to the Hetu, vyadhi or to both

Hetu and Vyadhi together. It is considered as Upashaya when it decreases the

symptoms and when it aggravates the symptoms it is called Anupashaya.

For example when abhyanga swedana, usna ahara etc reduce the symptoms of

Sandhigatavata. In samavastha, like in Amavatha the same treatments aggravate the

condition. So it is a treatment and also a diagnostic approach.

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SAMPRAPTI

For the better understanding of the disease, the knowledge of Samprapti I.e the

etio pathogenesis of the disease is essential.

Samprapti can be defined as the process of disease from its inceptive phaseto

fully manifestation. This process starts from the Nidana sevana or consumption of the

etiological factor causing dosha prakopa, circulates through out the body, localization

then manifestation and differentiation.71 To the pathological point of view, dosha,

dhatu, srotas is essencial in relation of Sandhigata vata.

Srotas is also called as Dhatuavakasha, 72 which is formed from the Akasha

mahabhuta. Akasha and Vayu mahabhuta are interrelated73 and Vayu is situated in the

emptiness [Riktata] created by the Akasha mahabhutha.

In Samprapti, ‘Riktata of srotas’ present in the sandhi is considered as the

‘Khavaigunya’, which is the platform for manifestation of disease Sandhigata vata.

Chakrapani gives explanation about Riktata as ‘Thuccha’ or ‘Snehadi guna

shunyata’.74

While explaining vata prakopa lakshanas, Charaka has mentioned the term

“Sushirata” which may be taken as Riktata.75

In sandhigata vata, we can take the Snehadi guna shunyata in two different

conditions. As the sneha is the main guna of the shleshma, shunyata can be considered

as the Shleshma kshaya. Shleshaka kapha is present in the sandhi which is responsible

for the integrity of joints and proper lubrication. The depletion of this leads to Riktata

of srotas.

Dhatus are the snehayukta dravya present in the body. As the sandhi is made

up of different dhatus, upadhatus and other essential factors, the intake of the dhatu

kshayakara nidana will lead to there will be dhatukshaya which is turn causes snehadi

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DISEASE REVIEW

guna shunyata[riktata]. In short, one can say that the loss of snehana of the joint is

responsible for the pathogenesis of Sandhigata vata.

Vata prakopa can occur in two ways.76

1) Dhatukshayajanya and

2) Margavaranajanya (obstruction)

Vagbhata77 clearly explains that Dhatukshayaja nidanas are also responsible

for the vitiation of the vata along with the riktata. The prakupita vata situates in the

rikta srotas present in the sandhi thus producing the symptoms of Sandhigata vata.

In margavarodhajanya condition, the other doshas such as Kapha and Pitta fills

the Srotas present in the sandhi and does the Avarana of vata. Due to avarana, the

avruta vata becomes strong and vitiated, leads to further dhatu shoshana78 thus

producing the symptoms of the Sandhigata vata.

Medo roga(sthoulya) may also lead to Sandhigata vata as vata vyadhi is said

as one of the complication of the medoroga. Due to the Avarana of meda to the

pathway of the vata, there will not be proper nourishment to other dhatus leading to

vata vikaras.79

Samprapti ghatakas:

Dosha - Vatavrudhi, [Vyanavata],

Kapha kshaya [sleshaka kapha].

Dushya - Asthi, Snayu [sandhi avayava].

Srotas - Important srotas are asthi vaha, majja vaha other less important

are medovaha and mamsavaha srotas.

Agni - Dhatwagni.

Rogamarga - Madhyama.

Udbhavasthana- Pakwashaya.

Sanchara stana- Sarva deha.

Vyaktasthana - Sandhi.

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DISEASE REVIEW

Page 31

Chart No. 1. Showing Etio-pathogenesis of Sandhigata vata:

Sthana samshraya in sandhi

Sleshma Sira-Impared sravana

Sleshma dhara kala

Asti Snayu Kandara

Vatapurna drthi sparsha Sula

Ahara Vihara Manasika

Rikta srotas

Nidana

Gada krutaKala

Vata prakopa Dhatu kshaya

VATA PRAKOPA

Vata prasara

Avarana of Vata

Fills in the Srotas

Sotha

Shoshana

Stambha

Kshaya

Atopa

Anya dosa prakopa

DISEASE REVIEW

UPADRAVA

Upadrava is the Complication of a disease. The Dosha which causes the main

disease is itself responsible for the upadrava.

Upadrava will be manifested in three ways i.e. complications that starts along

with the disease, complications after full manifestation of the disease and

complications produced after cure of the disease.80

Asthi shithilata, pesi kshaya can be considered as the complication which

manifests along with Sandhigata vata and Sandhi vishlesha will be its after effect.

Complications such as deformity and immobility of joints will interfere the

routine works.

SADHYASADHYATHA

Sushrutha and Vagbhata have included Vata vyadhi under the Ashta maha

gada, 81 because of its ashukarita and Upadrava. As the disease Sandhi gata vata is one

of the Vata vyadhi, it is difficult to cure.

Charaka while explaining sadhyasadhyata, mentions that ‘Khuda vata is Kasta

sadhya or asadhya. Commenting on Khuda vata, Chakrapani opines that Khudavata

itself is Gulphavata or Sandhi gata vata.82

Acharya Hareeta concludes that the Mamsa gata, medo gata vata is Sadhya,

rest of Gata vata is Kasta sadhya or Asadhya for treatment.83

As Sandhi gata vata is the disease of Madhyama roga marga. It is considered

as Kashta sadhya.

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DISEASE REVIEW

CHIKITSA

The main scopes of the Chikitsa are of two. They are promotion and

preservation of health in healthy individual, and elimination of the disease ailing and

afflicted i.e. curative treatment. According to the Amarakosha chikitsa is Ruk

prathikriya84 where as in Vaidyaka shabda sindhu, it is defined as ‘roga nidana

pratheekara’.

The term rogapanayana and ruk pratikriya convey nearly the same meaning

viz, measures calculated to the removal of disease and treatment of the disease

respectively. The term roga nidana pratikriya stresses on the removal of causation

factors of the diseases.

Acharya Sushruta was the first to mention the treatment principles of

Sandhigatavata. Although Charaka has not mentioned about specific chikitsa, the

general Vatavyadhi chikitsa is taken in to consideration.

Treatment principles according to different Acharyas are tabulated below:

Table no: 11 showing Chikitsa sutra of Sandigata vata

Chikitsasutra Ch. Su.85 A.S86 A.H87 B.P88 Y.R89 B.R90 C.D91

Sneha - + - + - + + +

Abhyanga - - + - - - - -

Upanaha - + + + - + + +

Agni karma - + + + - - + +

Bandhana - + + - - - + +

Unmardana - + + - - + + +

Sweda - - - - - + - -

Raktavasecan - - + - - - - -

Pradeha - - + - - - - -

Samana - - - + + + + +

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DISEASE REVIEW

1) Snehana:

The procedure which induces qualities like Snigdhata, Mruduta, Kledata and

Vishyandata in the body, following the internal and external administration of sneha

dravyas are called as Snehana.92 Snehana is said to be the best treatment in case of all

the diseases produced by the Vata, since it is totally antagonist to the qualities of

Vata. Sneha is also said to be tridoshagna as it alleviates vata, pitta and kapha due to

its Snigdhata, Shaityata and samskarasyanuvarthana (yogavahi) respectively.93

According to prayoga bheda there are two types of snehana procedures, they are

• Bahya sneha – in this the sneha dravyas are applied externally as done in

procedures like abhyanga, avagaha, sirovasthi etc.

• Abhyanthara sneha – In this the sneha is administered internally in the form of

pana and basthi.

In the disease Sandhigata vata, the administration of Snehana will be very

effective since Prithwi and Ambu mahabhoota, which are mainly present in the

Snehadravyas are exactly opposite to the Akasha mahabhuta predominantly prevails

in the main factor in the disease pathology i.e. Sroto riktata.

There are two types of sneha94 i.e sthavara and jangama. Among these snehas,

four snehas are considered as pravara and also their quality has been mentioned.

Among these, ghrita is considered as best one and it is pittanila hara, rasa shukra ojo

hitha. Thaila is maruthaghna,balya, sthirakara and it does not increases kapha. Vasa is

best known for eradicating the maharuja which is affecting to Asthi, Sandhi, Sira,

Snayu, Marma and balavan marutha which is situated in the srotas. Majja is

considered as bala- rasa- meda- shleshma and majja vardhaka.95

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DISEASE REVIEW

2) Abhyanga:

Abhyanga is a type of snehana karma where massage is done by applying the

thaila on the body.96

It is said that by abhyanga both kapha and vata will be pacified. It is also

considered as balakari, and dhatu pustikara. Dalhana has given the explanation

regarding the time required for the Sneha dravyas to enter deep to the dhatus

following Abhyanga. According to his explanation, sneha is situated in romakupa up

to 300 matrakala. In 400 matrakala, it enters twacha, in 500 to rakta,in 600 matrakala

to mamsa. It reaches medodhatu in 700 matra kala. The sneha reaches asthi in 800

matrakala. In 900 matrakala sneha enters in to majja thus inducing snigdhata in all the

dhatus. Thus it is considered as the dhatu pustikara.97

Since Sandhigata vata is a disease of Madhyama roga marga where the Asthi,

majja and sandhis are involved; the penetration of sneha dravyas deep in to the dhatus

during abhyanga as said above will be of high therapeutic value.

In 5th century B.C, Hippocratus wrote- “the physician must be experienced in

many things, but assurely in rubbing, because rubbing can bind a joint that is too

loose and can loosen a joint that is too rigid”.98

Upanaha:

The word meaning of Upanaha is bandhana.99 According to sushruta, it is one

among 4 types of swedana karma. In this moola kalka, kanji, pista, lavana, is added

with sneha and thick application is done over the affected part. Then that area is tied

in a cloth. In case of Pittanugata vata, kakolyadi, surasadi or eladi gana dravyas are

used. In kaphanugata vata, tila atasi etc dravyas and in kevala vata, veshavara, salvana

upanaha is adviced. He is also explained that Upanaha is best for Vata.100

Acharya Caraka explains Upanaha as one of the Niragni swedana.101

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DISEASE REVIEW

By commenting on this Chakrapani explains there are two types of Upanaha.

They are Saagni and Niragni upanaha. In Saagni upanaha, tila or masha kalka are

made in to hot and kept on affected part. This is also called as the Sankara sweda. In

Niragni upanaha, ushna veerya drugs are applied and tied by charma, cloth etc.102

Vagbhata explains Vachadi Upanaha in kevala vata.

Acharya Sivadas sen explains the mechanism of the Upanaha as swedana. Due

to the blocking of the heat generated by the body, there will be production of the

sweda in that part.

Agni karma:

The procedures done with the help of agni or the drugs having Agni guna is

called as Agnikarma.103 The severe complications of Sira, Snayu, Asthi and Sandhi,

caused by the vitiation of vata are cured by the Agni karma.104

In snayu- asthi and sandhi gata vata and kaphaja vikara, by using

Kshaudra(sugar candy), Guda(jaggery) or Sneha, the procedure of Agnikarma should

be done. It is indicated in all rtus except in Sharat and Grishma.105

The importance of this procedure is, the diseases which are not cured by the

other procedures like Bhesaja, Shastra, Kshara, and Rasa can be cured by using this

procedure.106

Bandhana:

Bandhana leads to Samhathi. It is the procedure in which the effected part will

be tied by using Rajju etc.107

By doing Bandhana procedure, there will be strength to the joints and also

pressure to the joints will be minimized.

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Unmardana:

It is the procedure of massaging of effected part by Hastatala after application

of oil. By the gentle massage there will be proper circulation to the joints.108

Swedana:

Swedana is of two types109 according to Agni samyoga. They are,

1) Agni sweda- They are of 13 types, namely Sankara, Prastara, Nadi, Pariseka,

Avagaha, Jhentaka, Ashmaghana, Karshoo, Kuti, Bhoo, Kumbhika, Koopa and

Holaka.

2) Niragni sweda: They are of 10 types namely, Vyayama, Ushnasadana,

Gurupravarana, Kshudha, Bahupana, Bhaya, Krodha, Upanaha, Athapa, Yudha.

In Ashtanga Sangraha, Vagbhata has said that swedana is the best remedy to

remove the sthabdatha of the Sandhi (Sandhi sthabdathapaham).110

In case of Sandhigata vata, by doing swedana, there will be Vata nigrahana

which results in decreasing the pathology.

Raktavasechana:

Acharya Vagbhata (Ashtanga samgraha) explained it as avastika chikitsa. In

sira-snayu-sandhi gata vata, if the person is having Svapa(numbness), raktavasechana

is indicated in alpa pramana. If the person feels angamlana with numbness,

raktavasechana is contra indicated because there will be the chance of shosha.111

After raktavasechana, pradeha is applied by taila, lavana, agara dhuma.

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PATHYAAPATHYA

Pathya means wholesome or conducive to health. Pathya is related to Patha

which is having different meanings. It indicates the channels of circulation which is

called as Srotas. Chakrapani comments that Patha is the dosha and dhatus which is

present in srotas. He also quotes that Pantha is the Swastha rakshana and also Vyadhi

prashamana.

So the food and activities which is performed and which is Anpayakari(not

harmful) to person and also to disease is called as Pathya112 it depends on the Matra,

Kala, Kriya, Bhumi,Deha, Desha and Gunanthara

Pathya has been given importance that no medicine is needed if Pathya is

followed properly andthere is no use of medicine if Pathya is not followed properly.

Although specific Pathya is not mentioned for Sandhi gata vata, the

wholesome food and regimens explained for Vata vyadhi is taken as Pathya.

Table No: 12 Pathya for Sandhi gata vata: Ahara Yogarathnaka 113 Bhaishajya rathnavali 114 Sneha ---- Thaila Shaka varga Patola, Kushmanda, Shigru, Varthaka Shuka dhanya varga

Godhuma, Rakta shali Godhuma, purana dhanya.

Shimbi dhanya

Masha, Kulatha Masha, Kulatha

Mamsa Kukkuta, Tittiri, Barhi, Chataka, Jangala mamsa.

---

Mathsya varga

Shilendra, Nakra, Khudisha, Parvathe, Gargara, Jhasha

---

Phala varga Dadima, Parooshaka, Badara, Draksha --- Gavya varga Ghrutha, Dugdha, Kilaata, Dadhi

koorchika ---

Oushadha dravya

Lashuna, Tambula, Masthsyandika, Brihati, Vastuka, Kasamarda, Dunduka, Mishi, Kataka

Lavana Saindhava ---

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Apathya for Sandhi gata vata:

In Yogarathnakara and Bhaishajya rathnavali, some of unwholesome foods are

explained which is enlisted below.

Table No: 13

Apathya ahara Yogarathnakara 115 Bhaishajya rathnavali 116 Vihara Chintha, Prajagara,

Vegavidharana, Shrama, Vyavaya, Chankramana, Khatwa(sleeping in cot), Hasthyashwa yana, Dwija gharshana.

Sheeta pravata

Karma Chardi, Food intaken Anashana Guru, Abhishyandi. Shuka dhanya Nava dhanya Shimbi dhanya Mudga, Nivara, Shyamaka,

Kuruvinda, Kalaya, Chanaka.

Mudga, Sharshapa, Nishpava.

Shakha varga Koshataki, Kareera. Kareera Jala varga Thataka, Thatini, Pradusta

salila Sheetambu

Rasa Kashaya, katu, Tikta ----- Other substances Kshudra, Kangu, Nimba Mrunali, Sarasi, Nimba

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DISEASE REVIEW

DIFFERENCIAL DIAGNOSIS

For the accurate diagnosis of the disease, Vyavachedaka nidana (differential

diagnosis) is important. By seeing difference in the causative factors, mode of onset,

clinical features,upashaya- anupashaya, we can conclude the differential diagnosis.

Sandhi gata vata is the disease pertaining to joints, other joint diseases such as

Vatarakta, Amavata will be considered for the differential diagnosis.

Table No: 14

Symptoms Sandhigata vata Vatarakta 117 Amavata 118

Dosha Vata Thridoshaja Vata-Kaphaja

Onset Gradual Gradual Sudden

Progression Constant

Increase &

Decrease Constant

Joint involvement Big Small Big

Spreading [joint] - Small to Big Big to Small

Swelling Articular & Puffy

Articular,

Engorged

Extra articular,

Pitting

Tenderness[pain] Mild Severe, Burning

Severe, Like

Scorpion bite

Crepitus Severe Moderate Absent

Stiffness Severe Severe Moderate

Skin involvement Not involved Involved Not involved

Deformity Present Present Absent

Function Painful,

Restricted

Restricted,

Immobile

Painful,

Restricted

Response to oil Marked relief Moderate relief Aggravates

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DISEASE REVIEW

OSTEOARTHRITIS119

Osteoarthritis is a degenerative disorder of the joint and it is classified as

• Primary

• Secondary

Primary Osteoarthritis:

Primary OA is also called ‘wear and tear’ arthritis and degenerative joint

disease. In this, due to risk factors there will be degradation of articular cartilage

which leads to joint narrowing, remodeling of joint by forming osteophytes and

eventually a non functioning, painful joint. Although OA is a non inflammatory

process mild inflammatory changes occur in the synovium. It is also called idiopathic

OA as no predisposing factor is apparent.

Secondary OA:

It has known underlying cause including congenial or acquired incongruity of

joints, trauma, crystal deposits etc. But it cannot be distinguished from primary OA

pathologically.

Osteoarthritis is considered as the dynamic repair process of synovial joints. It

is more prevalent in aged persons and it is considered as the very common form of

arthritis.

Osteo arthritis is characterised by:

Loss of articular cartilage where there is maximum pressure.

Formation of new bone (Osteophyte) with remodeling of joints.

Most effected joints are knee and hip joint where as knee is most effected than

hip. Osteoarthritis is very common in Elbow, Glenohumeral joint and Ankle joint

also.

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DISEASE REVIEW

Effected joints:

Interphallangeal joints

Heberden’s nodes: Enlargement of distal interphallangeal joints.

Bouchard’s nodes: Enlargement of proximal interphallangeal joints.

Erosive osteoarthritis: This is present in distal and/or proximal interphallangeal

joints.

Generalised osteoarthritis: Characterised by involvement of three or more joints or

group of joints.

Thumb base osteoarthritis: In this, there will be squared appearance of thumb base.

Hip osteoarthritis: In this, the pain will be in inguinal area but may be referred to

buttock or proximal thigh. Flexion may be painless initially but internal rotation will

have pain. Loss of internal rotation occurs early, followed by loss of extension,

adduction, and flexion due to capsular fibrosis and/or osteophytes.

Knee osteoarthritis: Knee osteoarthritis will be manifested in these ways.

In medial femotibial compartment: It leads to varus deformity [Bow-leg]

In lateral femotibial compartment: It leads to valgus deformity [Knock-knee]

In patellofemoral OA: There will be positive shrug sign.

Spine osteoarthritis: This involve Apophysial joint, Intervertibral disc,and also there

may be involvement of paraspinous ligaments.

Pathogenesis:

For the normal functions of the joint, there should be normalcy of the joint

tissues such as cartilage, bone synovium, capsule, ligament, and muscles.

In the case of Primary osteoarthritis, the cause is considered as unknown. But

in case of Secondary osteoarthritis, a clear cause of Trauma or ligament rupture may

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DISEASE REVIEW

be important. By the mechanical, metabolic, genetic, and constitutional loads there

may be damage to the parts of synovial joint and there may be need to repair.

Some times due to the causes, there will be slow but efficient process of

manifestation that lead to anatomically altered but pain free functioning joint. This is

called as Compensated osteoarthritis.

Some times due to the chronic causes or due to poor repair response, there will

be progressive tissue damage and association with more frequent symptoms and this

is called as OA patient with Joint failure.

Cartilage changes:

In normal cartilage, there are no cell division but in the articular cartilage,

chondrocytes metabolically active the cells that are responsible for the synthesis of

cartilage matrix throughout life. Matrix degradation is done by proteolytic enzymes

such as Aggrecanase, which degrades the aggrecan, matrix proteinases[degrades

metalloproteins], Collagenase, and Stromelysin.

Chondrocytes increase their production of matrix components and devide to

produce nests of metabolically active chondrocytes. So there will be maximum

degradation and also production of Aggrecan components. But there will be fall in the

concentration of the Aggrecan. The decrease in the size of hydrophilic Aggrecan

molecules increases the water concentration and swelling pressure in cartilage. There

will be further destruction of the Type II collagen and it makes the cartilage incapable

to bearing weight. By this condition of cartilage there will be fissuring of the cartilage

surface [Fibrillation], development of deep vertical clefts, localised chondrocyte death

and decreased cartilage thickness. These all changes are maximum in weight bearing

part of the joint rather than whole part. The changes in cartilage surface leads to the

deposition of Calcium pyro phosphate and Apatite crystals especially in mid and

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DISEASE REVIEW

superficial zones. The bone below the compromised cartilage increases its trabecular

thickness. Holes (cysts) may develop. As a result there is increased pressure in bones

because cartilages fail in load transmitting function. So there will be production of

new fibrocartilage in the margins of the joints which undergoes endochondral

ossification and forms as Osteophytes. This remodeling and cartilage thickening

slowly alter the shape and the size of the joints. The synovium also shows various

changes in manifestation of Osteoarthritis. Osteochondral bodies commonly occur in

synovium. The Joint capsule also thickens and contracts, usually retaining the stability

of remodeling joint. The skeletal muscle which gives the strength to joint will shows

some fibre atrophy.

Clinical features:

1. Joint pain:

Joint pain is mainly related to the movement, weight bearing and it is relieved

by the rest. Here usually only one or a few joints are painful.

The causes for joint pain in osteoarthritis patients are,

Source Mechanism

1. Synovium Inflammation.

2. Sub chondral bone Medullary hypertension,Micro fractures

3. Osteophyte stretching of periosteal nerve endings.

4. Ligaments Stretch.

5. Capsule Inflammation, Distention.

6. Muscle Spasm.

2. Restricted movement:

Restricted movement is due to Capsular thickening and also by the blocking of

Osteophytes.

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DISEASE REVIEW

3. Crepitus:

Crepitus will be palpable or sometimes audible due to the rough articular

surfaces.

4. Bony swelling:

Bony swelling is seen around joint margins due to the presence of osteophytes.

5. Joint tenderness:

Tenderness is present in joint line or periarticular surfaces.

6. Joint instability.

7. Wasting of muscles.

8. No or only mild synovitis.

Radiographic findings of Osteoarthritis:

The main use of a Radiograph is to assess the severity of structural changes in

the joints.

• Focal narrowing of the joint space without evidence of destruction of margins.

• Formations of osteophytes at the margins of articular surface osteophytes are

osseous outgrowths of cortical and cancellous bone, which blends with normal

bone beneath it.

• Sub chondral sclerosis.

• Cyst like lesions are seen.

• Osteo chondral (loose) bodies are sometimes seen.

• Deformities of joints are seen.

• Chondrocalcinosis may be an additional feature particularly in Knee OA

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DISEASE REVIEW

Treatment:

There is no specific treatment for OA. Treatment is mainly advised for

reducing the pain, minimise the disability and also to reduce structural abnormalities.

The following steps are considered as the management of Osteoarthritis.

For reducing the Pain:

Uses of NSAIDs are advised. Non Steroidal Anti-inflammatory drugs are

medications which, as well as having pain relieving (analgesic) effects, have the effect

of reducing inflammation when used over a period of time.

Full explanation about Osteoarthritis:

• This is to avoid risk factors such as Trauma, Obesity etc.

• Advice about appropriate exercise:

• This should cover both strengthening and aerobics, to strengthening of joints.

• Total joint replacement is required for the minority of people with large joint

Osteoarthritis.

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DRUG REVIEW

DRUG REVIEW

This study contains two sub headings; Compound drug study and Individual

drug study. The trial drug Thrayodashanga guggulu and control drug Simhanada

guggulu explained under this heading.

THRAYODASHANGA GUGGULU:

Reference - Chakradatta

Chapter - Vatavyadhi [chapter no.22]

1) Compound drug study:

Ingredients

Abha, Ashwagandha, Hapusha,

Guduchi, Shatavari, Gokshura, 250 Grams each [1 part each]

Vrudhadaru, Rasna, Shathahwa,

Shati, Yavani, Nagara,

Shudda Guggulu 3 kilo grams [12 parts]

Ghrita 1.5 kilo grams [6 parts]

Method of preparation:

All the ingredients from Bakula to Nagara was taken separately and pounded

well. Then the powder was passed through a sieve to get the filtered form. Shudda

guggulu was taken, pounded well along with Goghritha, and also the filtered powders

should be added. After the proper pounding and mixing, the tablet is rolled of 1 gm

each.

The tablets are properly dried in sunlight and stored.

Dose : 6 gms.

Anupana : Sura, Yusha, Madya, Ushna jala, Ksheera,Mamsa rasa.

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DRUG REVIEW

Individual drug study:

1) ABHA:120

Botanical name : Acacia Arabica willd.

Sanskrit names :Yugalaksha, Bakula

Hindi names :Babbula, Kikara

Kannada names Karijali, Shameruka

Chemical Composition: Bark and legumes contain Tannin

Properties:

Rasa - Kashaya

Guna - Guru, Ruksha

Veerya - Sheeta

Vipaka - Madhura

Dosha - Kapha-pitta shamaka

Karma - Grahi, Kaphahara, Vishagna

Therapeutic uses: Kusta, Krimigna, Kasa, Atisara

Part used: Stem bark

2) ASHWAGANDHA:121

Botanical name Withania somnifera, Dunal

Sanskrit names: Vajigandha, Vatagni

Hindi name: Asagandha

Kannada names: Hiremaddina gida, Angara beru.

Chemical composition: In roots, there is Hallucinogen called somniferin and also

sucrose gum, resin, pigment dyes along with alkaloids and withanolides.

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DRUG REVIEW

Properties:

Rasa - Madhura, Kashaya, Tiktha

Guna - Laghu, Snigdha

Vipaka- Madhura

Veerya- Ushna

Dosha - Kapha vata shamaka

Karma - Balya, Rasayana, Vijikarna

Therapeutic uses: Kshaya, Dourbalya, Vataroga, Shotha, Klaibya.

Part used: Roots

3) HAPUSHA: 122

Botanical name: Juniperus communis

Sanskrit names: Vapusha, Vishagni

Hindi names : Havuber, Havubair

Kannada names: Padmabeeja

Chemical composition: It contains essential oil, flavanoids and fruits contain 50%

volatile oil, oxalic acid and fructose.

Properties:

Rasa - Katu, Tikta, Kashaya

Guna - Gum, Ruksha, Teekshna

Veerya- Ushna

Vipak - Katu

Dosha - Kaphavata shamaka

Karma - Kaphagna, Vatagna, Agnideepana, Vishagna

Therapeutic uses: Pittodara, Arsha, Grahani, Gulma, Shoola, Krumi, Vatodara.

Part used: Fruit

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DRUG REVIEW

4) GUDUCHI: 123

Botanical name: Tinospora cordifolia Willd

Sanskrit names: Amruta, Madhuparnika

Hindi names: Gurcha, Giloe

Kannada name: Amrutha balli

Chemical composition: Alkaloids and terpenoids

Properties:

Rasa - Tikta, Kashaya


Veerya - Ushna

Vipaka - Madhura

Dosha - Tridoshagna and pittasaraka

Karma - Balya, Deepana, Jwaragna, Raktashodhaka, Rasayana.

Therapeutic uses: Kusta, Vatarakta, Jwara, Kamala, Pandu, Premeha.

Part used: Bark stem

5) SHATAVARI: 124

Botanical name: Asparagus racemoses Willd

Sanskrit names: Shataveerya, Vrushya

Hindi name: Shatavari

Kannada name Shatavari

Chemical composition: Fresh tuber is water soluble is 52%, fiber 33% and water 9%

in which 7% of sugar and some mucilaginous principle.

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DRUG REVIEW

Properties:

Rasa - Madhura, Tikta

Guna - Guna, Snigdha

Veerya - Sheeta

Vipaka - Madhura

Dosha - Vata pitta shamaka

Karma - Shoola-hara, Pachaka, Vata vyadhihara, Debility

Therapeutic uses: Shoola roga, Vataroga, Dourbalya

Part used: Tuber

6) GOKSHURA: 125

Botanical name: Tribulus terrestris Linn

Sanskrit names: Trikantaka, Gokantaka

Hindi name: Gokhru

Kannada names: Sanne Neggilu, Neggilu – Mullu

Chemical composition: Alkaloids, Saponins, Potassium nitrate, Sterols,

Sepogenin, Diosgenin, Gitogenin, and Hecogenin.

Properties:

Rasa - Madhura

Guna - Guru, Snigdha

Veerya - Sheeta

Vipaka - Madhura

Dosha - Tridosha shamaka

Karma - Vayugna, Mootrala, Vrushya, Bruhmana

Therapeutic uses: Shoolaroga, Vataroga, Mootra kruchra, Ashmari,

debility.

Part used: Panchanga

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DRUG REVIEW

RAASNA:126

Botanical name: Pluchea lanceolata

Sanskrit names: Sugadha, Suvaha

Hindi name: Rasayana

Kannada names: Dumme raasna

Chemical composition: Clavanoids, Quercetin, Isorhammetin.

Properties:

Rasa - Tikta

Guna - Guru

Veerya - Ushna

Vipaka - Katu

Dosha - Kaphavatahara

Karma - Amapachaka, Virechaka

Therapeutic uses: Shotha, Vatavyadhi, Kasa-Shwasa, Adyavata, Jwara,

Udararoga, Amavata, Vatarakta.

Part used: Leaves

7) SHATAPUSHPA:127

Botanical name: Anethum sowa. Roxb

Sanskrit names: Shatavah, Mishreye

Hindi names: Soya, Sova

Kannada name: Sabasige

Chemical composition: 3-4% volatile oil and stable oil

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DRUG REVIEW

Properties:

Rasa - Katu, Tikta

Guna - Laghu, Ruksha, Teekshna

Veerya - Ushna

Vipaka - Katu

Dosha - Vata kapha shamaka

Karma - Vatahara,kaphahara, Shoolahara, Deepana

Therapeutic uses: Jwara, Shoola, Vrana, Netraroga, atisara

Part used: Seed

8) SHATI:128

Botanical name: Hedychium spicatum

Sanskrit names: Kachur, Gandhasara

Hindi name: Kapur kachri

Kannada names: Seena Kachora, Kachora

Chemical composition: Essential oils

Properties:


Guna - Laghu, Teekshna

Veerya - Ushna

Vipaka - Katu


Karma - Shoolahara, Grahi, Mukhashodhaka

Therapeutic uses: Shoola, Chardi, Kandu, Kasa, Shwasa, Mukharoga.

Part used: Fruit

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DRUG REVIEW

9) AJAMODA: 129

Botanical name: Trachyspermum ammi

Sanskrit names: Yavani, Ugragandhi

Hindi names: Ajwain, Jevain

Kannada names: Omu, Yom

Chemical composition: Essential oil and fixed oil, which is volatile in nature

Properties:

Rasa - Katu, Tikta

Guna - Laghu, Ruksha, Teekshna

Veerya - Ushna

Vipaka - Katu


Karma - Shoolahara, Krimihara, Deepana, Pachana, Anulomana.

Therapeutic uses: Admana, Anaha, Udararoga, Gulma, Shoolahara,

Krimiroga.

Part used: Seeds

10) SHUNTI: 130

Botanical name Zinziber officinale, Rosce

Sanskrit names: Nagara, Vishwa bheshaja

Hindi name: Sonth

Kannada name: Shunti

Chemical composition: Yellow volatile oil, Gingerol, Gingerin (Resin),

Shogaol, Carbohydrates and starch are present.

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DRUG REVIEW

Properties:

Rasa - Katu


Veerya - Ushna

Vipaka - Madhura

Dosha - Kaphavatagna

Karma - Deepana, Pachana, Amadoshahara, Shoola prashamaka

Therapeutic uses: Amavata, Udararoga, Agnimandhya, Pandu, Shwasa,

Admana.

Part used: Rhizome

11) VRUDHADARU:131

Botanical name: Argyria speciosa

Sanskrit names: Jeernadaru, Ajara

Hindi names: Bidaraa, Dhavapatha

Kannada name: Vidhara

Chemical composition: Contains Amlarala and Kashaya dravya

Properties:


Guna - Snigdha

Veerya - Ushna

Vipaka - Madhura


Karma - Vatarogagna, Dourbalyahara, Vrushyakaraka,

Agnivardhaka

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DRUG REVIEW

Therapeutic uses: Vataroga, Kshayaroga, Dourbalya, Shotha

Part used: Root

12) GUGGULU 132

Botanical name : Commiphora mukul

Sanskrit names : Deva dhupa, Kausika, Pura

Hindi names : Guggulu

Kannada names : Guggulu

Chemical Composition: Essential oil, Myrcene, Dimyrcene

Properties:

Rasa - Tikta, Katu, Kashaya.

Guna - Laghu, Ruksha, Teekshna, vishada, Sukshma, Sara,

Lekhana

Veerya - Ushna

Vipaka - Katu

Dosha - Tridosha hara

Karma - Sotha hara, vedhanastaphana, Vatanulomana,

Nadibhalyakara

Therapeutic uses: Vata roga, Ama vata, Vata rakta, Bhagna.

Part used: Gum resin.

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DRUG REVIEW

STANDARD DRUG

SIMHANADA GUGGULU

Reference: Cakradatta, Bhaishajya Ratnavali

Context: Amavata adhikara

Ingredients:

Hareetaki - 1 Pala.

Vibhitaki - 1 Pala

Amalaki - 1 Pala

Sh. Gandhaka - 1 Pala

Sh. Guggulu - 1 Pala

Eranda taila - 4 Pala


First Thriphala kwatha is prepared by using the thriphala yavakuta churna as

above mentioned. Eranda thaila and Guggulu were mixed with the Triphala kwatha

and boiled in low flame. Gradually guggulu dissolved and concentrated. When it

attains bolus like soft mass, then taken from the fire and left for self cooling.

Gandhaka powder was added and mixed well. Then vati is prepared. This vati is

manually dried and preserved.

Individual drug study

1) HAREETAKI 133

Botanical name : Terminalia chebula Retz.

Sanskrit names : Amruta, Vijaya, Abhaya.

Hindi names : Haradar

Kannada names : Alalekayi

Chemical Composition: 30% of Astringent substance, Chebulic acid,

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DRUG REVIEW

Properties:

Rasa - Kashaya pradhana pancha rasa.

Guna - Laghu, Ruksha.

Veerya - Ushna

Vipaka - Madhura

Dosha - Tridosha hara specially vata samaka

Karma - Medhya Rasayana Bruhmana Anulomana Ayushya,

Chakshusya.

Therapeutic uses: Swasa, Kasa, Prameha, Arsha, Eye diseases, Twak roga,

Kamala.

Part used: Fruit (without seed).

2) VIBHITAKI 134

Botanical name : Terminalia bellirica Roxb.

Sanskrit names : Kalidruma, Aksha, Karsha phala

Kannada names : Santhi kayi

Chemical Composition: Mannitol, Glucose, Chebulagic acid, Bellericanin, Fatty

oil.

Properties:

Rasa - Kashaya pradhana pancha rasa.

Guna - Laghu, Ruksha.

Veerya - Ushna

Vipaka - Madhura

Dosha - Tridosha samaka specially kapha hara

Karma - Deepana, Anulomana, Grahi.Chakshusya.

Therapeutic uses: Kapha roga, Swasa, Kasa, Sotha, Vata vyadhi.

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DRUG REVIEW

Part used: (Fruit without seed).

3) AMALAKI 135

Botanical name : Emblica officinalis Gaertn.

Sanskrit names : Dhatri, Vayastha

Hindi names : Amla

Kannada names : Nellikayi

Chemical Composition: Carbohydrate, Fe, Nicotinic acid, Tannin, Galic acid,

Emblicol.

Properties:

Rasa - Amla pradhana pancha rasa.

Guna - Guru, Ruksha.

Veerya - Sheeta

Vipaka - Madhura

Dosha - Tridosha hara specially pitta samaka

Karma - Medhya Rasayana, Vrushya, Vayasthapana, Anulomana

Chakshusya,

Therapeutic uses: Swasa, Kasa, Kshaya, Pandu, Eye diseases, Raktapitta.

Part used: Fruit (without seed)

4) ERANDA 136

Botanical name : Ricinus communis .Linn

Sanskrit names : Chitra beeja, Gandharvahasta.

Hindi names : Arand

Chemical Composition: Castor oil is composed of Triricinolein.

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DRUG REVIEW

Properties:

Rasa - Madhura

Guna - Snigdha, Teekshna, Sukshma

Veerya - Ushna

Vipaka - Madhura

Dosha - Kaphavata samaka

Karma - Vata kapha hara, Deepana Bhedhana, Ama shodhana,

Sotha hara..

Therapeutic uses: Amavata, Katisula, Grudrasi.Sandhi sotha.

Part used: seed oil.

5) GUGGULU 132

Botanical name : Commiphora mukul

Sanskrit names : Deva dhupa, Kausika, Pura

Hindi names : Guggulu

Kannada names : Guggulu

Chemical Composition: Essential oil, Myrcene, Dimyrcene

Properties:

Rasa - Tikta, Katu, Kashaya.

Guna - Laghu, Ruksha, Teekshna, vishada, Sukshma, Sara,

Lekhana

Veerya - Ushna

Vipaka - Katu

Dosha - Tridosha hara

Karma - Sotha hara, vedhanastaphana, Vatanulomana,

Nadibhalyakara

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DRUG REVIEW

Therapeutic uses: Vata roga, Ama vata, Vata rakta, Bhagna.

Part used: Gum resin.

6) GANDHAKA 138

Synonym: Atigandha, Gandhapashana

Guna karma:

Rasa : Katu Madhura

Guna : Laghu Snigdha

Virya : Ushna

Vipaka : Katu

Doshakarma: Kapha vata hara

Karma: Rasayana, Deepana, Pachana, Rakta shodhana.

Therapeutic uses: Kantu, Kusta, Amadosha, Visha dosha.

Dose: 1-8 Ratti.

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METHODOLOGY

METHODOLOGY

Research is a scientific and intelligent study, investigation or experimentation

in order to establish facts and their significance. This is the only way available to re-

establish old facts through modern methodology. It is also useful in case of gaining

knowledge, helps to develop and advance in new directions.

Ayurveda is the science of life. Being an ancient medical science, it is

formulated on the scientific parameters available in those times. And a clinical trial,

which is carefully designed to answer the present generation who are conscious and

wants a scientific explanation for everything that is happening in this world. So a

clinical study is conducted on scientific line with the aim of solving the unsolved

problems is the only way to achieve the above objectives.

This study is an attempt to prove the efficacy scientifically of Trayodashanga

Guggulu on Sandhigatavata, by comparing it with Simhanada Guggulu. Efficacy can

be determined by finding out the difference between the base line data and assessment

data.

Study design:

It is a single blind comparative clinical study with pretest and posttest design

where in 40 patients suffering from Sandhigatavata of either sex of age group in

between 25-65 were selected and randomly allocated into test group and control

group. Duration of study is 60 days.

Source of data:

Patients who were attending the O.P and I.P section of Kayachikitsa

department A.L.N.Rao Ayurveda Medical College Hospital Koppa were taken up for

the study. 40 patients were registered for the study.

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METHODOLOGY

Criteria of selection:

Patient who presented the complaints of joint pain, were examined in detail

regarding the present and past history, food and activity, treatment status etc. and was

recorded in a specially prepared Performa. The patients were investigated with serum

RA, ASO titer and X-ray of joint (AP and Lat).

Inclusion criteria:

1. Patients diagnosed as Sandhi gata vata on the basis of signs and symptoms

according to classical Ayurvedic texts.

2. Patients of either sex between the age of 25-65 years.

3. Early onset of Sandhi gata vata is included.

Exclusion criteria:

1. Sandhigata vata due to congenital development disorders, post traumatic,

neurological and endocrine origin

2. Patients having secondary complications.

3. During pregnancy and lactation period.

Investigations:

Blood - Serum RA factor, ASO titer.

X-ray of effected joints- both AP and Lat.

Preparation of Trial drug:

The trial drug Trayodashanga Guggulu is mentioned in Chakradatta. In this

Guggulu preparation the quantity of the individual drugs is mentioned in the text that

the twelve drugs should be taken in one part, Guggulu is taken twelve parts and Ghrita

is six parts.

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METHODOLOGY

Ingredients:

Abha, Ashwagandha, Hapusha,

Guduchi, Shatavari, Gokshura, 250 Grams each [1 part each]

Vrudhadaru, Rasna, Shathahwa,

Shati, Yavani, Nagara,

Shudda Guggulu 3 kilo grams [12 parts]

Ghrita 1.5 kilo grams [6 parts]


All the ingredients from Bakula to Nagara was taken separately and pounded

well. Then the powder was passed through a sieve to get the filtered form. Shudda

guggulu was taken, pounded well along with Goghritha, and also the filtered powders

should be added. After the proper pounding and mixing, the tablet is rolled of 1 gm

each.

The tablets are properly dried in sunlight and stored.

INTERVENTION

Trial group:

Sample size - 20 patients.

Medicine - Trayodashanga Guggulu

Dose - 3 grams twice daily after food.

Duration - 60 days.

Anupana - Ushna jala.

Standard group:

Sample size - 20 patients.

Medicine - Simhanada Guggulu

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METHODOLOGY

Dose - 3 grams twice daily after food.

Duration - 60 days.

Anupana - Ushna jala.

Observation period:

Follow period was done for 60 days.

Assessment criteria:

Scoring methods given to the clinical signs and symptoms and functional

capacity of the patients assesses the improvement in the signs and symptoms. Signs

and symptoms recorded on interval of 15 days for 60 days.

Clinical assessment:

Sandhi shula Points

No pain [no pain at rest / no pain while walking] - 0

Mild pain [no pain at rest or

mild tolerable pain while walking] - 1

Moderate pain [mild pain at rest, tolerable and

moderate pain while working] - 2

Severe pain [disturbance of sleep due to pain or

pain at rest or un tolerable pain during working] - 3

Atopa of sandhi

No crepitus - 0

Palpable crepitus - 1

Audible crepitus - 2

Tenderness:

No pain on pressure - 0

Pain on pressure and winces - 1

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METHODOLOGY

Patient withdraws affected part while giving pressure - 2

Patient does not allow to touch - 3

Sandhi shotha:

No swelling - 0

Swelling is present slightly in joints - 1

Swelling covering the bony prominence of affected joints - 2

Swelling much elevated so that

the joints seems grossly deformed - 3

Criteria for assessment of total effects of the therapy:

The sum points of all the parameters of assessment before and after treatment

were taken into consideration to assess the total effect of the therapy. It was graded in

terms of percentage of relief in the signs and symptoms.

Total cure - 100% relief

Marked improvement - relief of above 60%

Moderate improvement - 40 to 60% of relief

Improved - relief of more than 40%

Unchanged - 0% of relief

Deterioration - worsening of the signs and symptoms

Statistical analysis:

All data was analysed statistically by calculating the mean, percentage of

change, standard deviation, standard error, t and p values by using student ‘t’ test.

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METHODOLOGY

Observations

In this study on Sandhigata vata, 20 patients were taken in each group (trial

group, control group) totally 40 patients were registered. Here from both groups by

considering Age, Sex, Religion, Deha prakruti, and also by Roga and Rogi pareeksha,

the observations were derived.

1. Age wise distribution in 40 patients of Sandhigata vata

In this study about Sandhigata vata showed maximum number of patients

(50%) between the ages 55-65 yrs. 30% of the patients were in the age group of 45-55

yrs, 15% were in 35- 45 yrs, while 5% of the patients between the ages 25-35 yrs.

Table No. 15 Showing Age Incidence

Sl.No. Age in Years No. of Patients Percentage 1. 25-35 2 5 2 35-45 6 15 3. 45-55 12 30 4. 55-65 20 50

Graph No. 1 Showing Age Incidence :

0

20

40

60

80

100

25-35 35-45 45-55 55-65

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METHODOLOGY

2. Distribution of 40 patients of Sandhigata vata according to sex

In this study, 55% of the patients were females and 45% of patients were

males.

Table No.16 Showing sex incidence

Sl.No. Sex No. of Patients Percentage 1. Male 18 45 2. Female 22 5

Graph No. 2 – Showing sex incidence

0

20

40

60

80

100

Male Female

3. Distribution of 40 patients of Sandhigata vata according to religion.

In this study, maximum numbers of patients were Hindu i.e. 77.5%, Muslims

were 15% and minimum patients were Christian i.e.7.5%

Table No. 17 Showing religion incidence

Sl.No. Religion No. of Patients Percentage 1. Hindu 31 77.5 2. Muslim 6 15 3. Christian 3 7.5

Graph No. 3 Showing religion incidence

0

20

40

60

80

100

Hindu Muslim Christian

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METHODOLOGY

4. Distribution of 40 patients of Sandhigata vata according to marital status

Among 40 patients, 37 patients (92.5%) were married, while 7.5% i.e. 3

patients were unmarried.

Table No. 18 Showing Marital status

Sl.No. Marital status No. of Patients Percentage 1. Married 37 92.5 2. Unmarried 3 7.5

Graph No. 4 Showing Marital status

0

20

40

60

80

100

Married Unmarried

5. Economic status of 40 patients of Sandhigata vata

Maximum of patients got belongs to poor class i.e.70%, 22.5% belonged to

middle class and minimum of 7.5% came from rich class for this study.

Table No. 19 Showing Economic status

Sl.No. Social economic status

No. of Patients Percentage

1. Poor 28 70 2. Middle 9 22.5 3. Rich 3 7.5

Graph No. 5 Showing Economic status

0

20

40

60

80

100

Poor Middle Rich

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METHODOLOGY

6. Occupational incidence of 40 patients of Sandhigata vata

While considering occupation of the patients, maximum patients are House

wife i.e. 45%, then Agriculture i.e. 32.5%, those who are in service are 7.5%,

Business persons are 5% and those who are having occupation other than this

considered together i.e. 10%

Table No. 20 Showing Occupational incidence

Sl.No. Occupation No. of Patients Percentage 1. Business 2 5 2. House wife 18 45 3. Service 3 7.5 4. Agriculture 13 32.5 5. Others 4 10

Graph No.6 Showing Occupational incidence

0

20

40

60

80

100

House wife Agriculture Service Business Others

7. Nature of work of 40 patients of Sandhigata vata:

Maximum number of patients performed their work by walking for long hours

i.e. 47.5%, while 45% performed their work by standing for long hours; 7.5%

developed this disease after sitting for long time.

Table No. 21 Showing Nature of work

Sl.No. Nature of work No. of Patients Percentage 1. Standing 18 45 2. Sitting 3 7.5 3. Walking 19 47.5

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METHODOLOGY

Graph No.7 – Showing Nature of work

0

20

40

60

80

100

Standing Sitting Walking

8. Habitat wise distribution of 40 patients of Sandhigata vata

92.5% of the patients belonged to Anupa desa, while 5% belonged to

Sadharana and 2.5% of patients belonged to Jangala desas.

Table No. 22 Showing the Habitat

Sl.No. Habitat No. of Patients Percentage 1. Sadharana 2 5 2. Jangala 1 2.5 3. Anupa 37 92.5

Graph No. 8 Showing the Habitat

0

20

40

60

80

100

Sadharana Janghala Anupa

9. Distribution of 40 patients according to Lakshanas:

Sandhishula was the common symptom which is present in all the patients

i.e.100%, then Prasarana akunchana pravrthi savedana was present in 95% patients,

stambha was present in 85% patients, in 77.5% patients suffered from Shotha, Atopa

in 70% patients.

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METHODOLOGY

Table No.23 Showing Symptoms

Sl.No. Symptomatology No. of Patients Percentage 1. Sandhi Sula 40 100 2. Sandhi Shotha 31 77.5 3. Sandhi Stambha 34 85 4. Prasarana akunchana

pravrthi savedana 38 95

5. Atopa 28 70

Graph No.9 Showing Symptoms of Sandhi gata vata

0

20

40

60

80

100

Sandhi sula Atopa Prasaranaakunchana

vedana

Sotha Stambha

10. Duration of illness in 40 patients of Sandhigata vata

Maximum patients suffered from this disease below one year (45%), 32.5%

have history in between 1-3 years and 22.5% of patients gave a history of suffering

above 3 years.

Table No. 24 Showing Duration of illness:

Sl.No. Duration of illness No. of Patients Percentage 1. Below 1 year 18 45 2. In between 1-3 years 13 32.5 3. Above 3 years 9 22.5

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METHODOLOGY

Graph No. 10 Showing Duration of illness:

0

20

40

60

80

100

<1 yr 1-3 yrs > 3 yrs

11. Family history of this disease in 40 patients of Sandhigata vata:

Majority of the patients show no family history about this disease (80%). 20%

of patients show family history about this disease.

Table No. 25 Showing incidence of family history:

Sl.No. Family history No. of Patients Percentage

1. Yes 8 20 2. No 32 80

Graph No. 11 Showing incidence of family history:

0

20

40

60

80

100

Yes No

12. Dietary Habit in 40 patients of Sandhigata vata

Maximum no. of patients was consuming mixed type of diet (55%), while

45% of patients are Vegetarian.

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METHODOLOGY

Table No. 26 Showing the Dietary Habit:

Sl.No. Dietary habit No. of Patients Percentage 1. Vegetarian 18 45 2. Mixed 22 55

Graph No. 12 Showing the Dietary Habit:

0

20

40

60

80

100

Veg Mixed

13. Ahara pramana in 40 patients of Sandhigata vata

Most of the patients were taken Sama pramana of Food i.e. 57.5%. While 25%

of patients were taken Alpa pramana of Ahara and minimum of 17.5% patients were

habit of consuming Ati pramana of Ahara.

Table no. 27 showing Ahara pramana:

Sl.No. Ahara pramana No. of Patients Percentage 1. Alpa 10 25 2. Sama 23 57.5 3. Ati 7 17.5

Graph No.13 Showing the Ahara pramana

0

20

40

60

80

100

Alpa Sama Ati

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METHODOLOGY

14. Dominant rasa in 40 patients of Sandhigata vata

Most of the patients consumed the Food which is katu rasa pradhana i.e.

37.5%, and 20% of the patients taken the Ahara which is Lavana rasa pradhana and

17.5% patients took Amla rasa predominant food. 12.5% of the patients took Tikta

rasa pradhana ahara in more quantity while 7.5% of the patients were habituated

to kasaya rasa predominantly in their food and 5% of patients were taken food which

is Madhura rasa dominant.

Table No. 28 Showing Dominant rasa:

Sl.No. Dominant rasa No. of Patients Percentage 1. Madhura 2 5 2. Amla 7 17.5 3. Lavana 8 20 4. Katu 15 37.5 5. Tikta 5 12.5 6. Kasaya 3 7.5

Graph No. 14 Showing Dominant rasa

0

20

40

60

80

100

Madhura Amla Lavana Katu Tikta Kashaya

15. Dominant ahara guna in 40 patients of Sandhigata vata

Here analysis of main qualities of food has been done. Among this 32.5% of

the patients took Laghu guna yukta ahara, while 30% took Ruksha ahara, 20% of

patients took Ushna ahara, 10% of patients took Sheeta ahara, 2% of patients were

habituated to Guru ahara and only 2.5% took Snigdha guna predominant food.

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METHODOLOGY

Table No. 29 Showing Dominant ahara guna:

Sl.No. Dominant ahara

guna No. of Patients Percentage

1. Rooksha 12 30 2. Snigdha 1 2.5 3. Ushna 8 20 4. Sheeta 4 10 5. Guru 2 5 6. Laghu 13 32.5

Graph No. 15 Showing Dominant Ahara guna:

0

20

40

60

80

100

Ruksha Seeta Laghu Snigdha Guru Ushna

16. Nidra incidence in 40 patients of Sandhigata vata

Majority of the patients complained of disturbed sleep i.e. 77.5%, while 22.5%

had sound sleep.

Table No. 30 Showing Nidra incidence:

Sl.No. Nidra No. of Patients Percentage 1. Sound 9 22.5 2. Disturbed 31 77.5

Graph No. 16 Showing Nidra incidence:

0

20

40

60

80

100

Sound Disturbed

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METHODOLOGY

17. Pramana of vyayama in 40 patients of Sandhigata vata

In 40 patients of Sandhi gata vata, 62.5% of the patients developed this disease

after performing Ati vyayama, while 30% of them did in sama pramana and 10% did

less pramana of Vyayama.

Table No. 31 Showing the Pramana of vyayama:

Sl.No. Vyayama No. of Patients Percentage 1. Hina 3 7.5 2. Sama 12 30 3. Ati 25 62.5

Graph No.17 Showing the Pramana of vyayama:

0

20

40

60

80

100

Heena Sama Ati

18. Prakruti in 40 patients of Sandhigata vata

Prakruti was accessed according to classical description. Majority of the

patients belonged to Vata pitta(dwandwaja) prakruti I.e. 55%. Then the patients of

Vata kapha i.e.30% and 10% were Sannipataja prakruti, 5% if the patients belonged to

Vata slesmala praktuti. No patients were observed Ekadoshaja prakruti.

Table No.32 Showing the Prakruti:

Sl.No. Prakruti No. of Patients Percentage 1. Vatapittaja 22 55 2. Vatakaphaja 12 30 3. Pittakaphaja 2 5 4. Sannipataja 4 10 5. Vataja 0 0 6. Pittaja 0 0 7. Kaphaja 0 0

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METHODOLOGY

Graph No.18 Showing the Prakruti:

0

20

40

60

80

100

V P P K V K V P K V P K

19. Distribution of 40 patients of Sandhigata vata according to Sara

Most of the patients had madhyama sara i.e. 82.5%, while 15% had avara sara

and 2.5% patients were having pravara sara.

Table No. 33 According to Sara:

Sl.No. Sara No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 33 82.5 3. Avara 6 15

Graph No.19 According to Sara:

0

20

40

60

80

100

Pravara Madhyama Avara

20. Distribution of 40 patients of Sandhigata vata according to Satwa

Maximum number of patients had madhyama satwa i.e. 77.5%, while 20% had

avara satwa and pravara satwa 2.5%.

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METHODOLOGY

Table No. 34 According to Satwa:

Sl.No. Satwa No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 31 77.5 3. Avara 8 20

Graph No.20 According to Satwa:

0

20

40

60

80

100


21. Distribution of 40 patients of Sandhigata vata according to Samhanana

Maximum number of patients had madhyama samhanana i.e. 67.5%, while

17.5% had avara samhanana and 15% of the patients had pravara samhanana.

Table No.35 According to Samhanana

Sl.No. Samhanana No. of Patients Percentage 1. Pravara 6 15 2. Madhyama 27 67.5 3. Avara 7 17.5

Graph No.21 According to Samhanana

0

20

40

60

80

100


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METHODOLOGY

22. Satmya in 40 patients of Sandhigata vata

Maximum number of patients had madhyama satmya i.e. 70%, while 25% was

avara satmya and pravara satmya is 5%.

Table No.36 According to Satmya:

Sl.No. Satmya No. of Patients Percentage 1. Pravara 2 5 2. Madhyama 28 70 3. Avara 10 25

Graph No.22 According to Satmya:

0

20

40

60

80

100


23. Distribution of 40 patients of Sandhigata vata according to Ahara shakti

In ahara sakti there are two divisions, they are abhyavarana sakti and jarana

sakti. They are tabulated separately.

a) Distribution according to abhyavarana sakti:

Majority of the patients had madhyama abhyavarana sakti i.e. 80% and 15%

are having avara abhyavarana sakti. 5% of patients had pravara abhyavarana sakti.

Table No. 37 According to Abhyavarana sakti

Sl.No. Abhyavarana sakti No. of Patients Percentage 1. Pravara 2 5 2. Madhyama 32 80 3. Avara 6 15

Page 80

METHODOLOGY

Graph no: 23 showing Abhyavarana sakti

0

20

40

60

80

100


b) Distribution of 40 patients according to Jarana sakti

Most of the patients had madhyama jarana sakti i.e. 72.5% and 22.5% are

having avara jarana sakti. 5% of patients had pravara jarana sakti.

Table No.38 showing Jarana shakti:

Sl.No. Jarana sakti No. of Patients Percentage

1. Pravara 2 5 2. Madhyama 29 72.5 3. Avara 9 22.5

Graph no:24 Showing Jarana shakti:

0

20

40

60

80

100


24. Distribution of 40 patients of Sandhigata vata according to Vyayama sakti

While considering Vyayama shakti, majority of the patients had avara

vyayama sakti i.e. 80%, while 17.5% had madhyama vyayama sakti and 2.5%

performed pravara vyayama.

Page 81

METHODOLOGY

Table No. 39 According to Vyayama sakti

Sl.No. Vyayama sakti No. of Patients Percentage 1. Pravara 1 2.5 2. Madhyama 7 17.5 3. Avara 32 80

Graph No. 25 According to Vyayama sakti

0

20

40

60

80

100


23. Weight incidence in 40 patients of Sandhigata vata

Majority of patients having weight in between 45-55 kg i.e. 40%. Patients

having 55-65 kg are 35%, while 17.5% patients are having weight in between 35-45

kg. 17.5% were between 65-75 kg.

Table No. 40 Showing the Weight incidence

Sl.No. Weight (Kg) No. of Patients Percentage 1. 41-50 7 17.5 2. 51-60 14 35 3. 61-70 16 40 4. 71.80 3 7.5

Graph No. 26 Showing the Weight incidence

0

20

40

60

80

100

35-45 45-55 55-65 65-75

Page 82

RESULTS

RESULTS

Table No:41

Therapeutic effect of Trial drug Thrayodashanga Guggulu in the management of

Sandhigata vata after 60 days treatment:

Mean Sl.

No.

Main

symptoms BT AT BT-AT

% S.D S.E t P

1. Sandhi shula 1.75 1.35 0.40 35 0.598 0.133 2.990 <0.010

2. Tenderness 1.90 1.40 0.50 40 0.688 0.153 3.248 <0.010

3. Atopa 1.90 1.30 0.60 55 0.598 0.133 4.485 <0.001

4. Sandhi sotha 1.90 1.55 0.35 30 0.587 0.131 2.665 <0.020

The trial drug Thrayodashanga Guggulu gives highly significant (< 0.001)

result in the Atopa (crepitus) i.e. 55%. It provided 40% relief in Tenderness which is

moderately significant (<0.010). Also it is moderately significant (<0.010) in Sandhi

shula (35%)

Table No:42

Therapeutic effects of Trial drug Thrayodashanga Guggulu in the management

of Sandhigata vata after 60 days of follow up:

Mean Sl.

No.

Main

symptoms BT AFU BT-AFU

% S.D S.E t P

1. Sandhi shula 1.75 1.05 0.70 60 0.656 0.146 4.765 <0.001

2. Tenderness 1.90 1.15 0.75 65 0.638 0.142 5.251 <0.001

3. Atopa 1.90 1.25 0.65 60 0.587 0.131 4.950 <0.001

4. Sandhi sotha 1.90 1.45 0.45 40 0.600 0.135 3.327 <0.010

The trial drug Thrayodashanga Guggulu showed highly significant (< 0.001)

result in Tenderness (65%). It showed highly significant result (< 0.001) in Sandhi

shula and Atopa (60%).

Page 83

RESULTS

Table No: 43

Effect of standard drug (Simhanada Guggulu) in the management of Sandhigata

vata after 60 days of treatment:

Mean Sl.

No.

Main

symptoms BT AT BT-AT

% S.D S.E t P

1. Sandhi shula 1.85 1.55 0.30 30 0.470 0.105 2.853 <0.020

2. Tenderness 2.00 1.65 0.35 30 0.587 0.131 2.665 <0.020

3. Atopa 1.80 1.40 0.40 35 0.598 0.133 2.990 <0.010

4. Sandhi sotha 2.15 1.55 0.60 50 0.680 0.152 3.942 <0.001

The standard drug simhanada guggulu showed highly significant result

(<0.001) in the Sandhi shotha (50%). It provided moderate significant (<0.010) result

in the Atopa (35%). And in the sandhi shula and tenderness showed moderate

significant (<0.020) and the relief is 30%.

Table No: 44

Effect of standard drug (Simhanada Guggulu) in the management of Sandhigata

vata after 60 days of follow up:

Mean Sl.

No.

Main

symptoms BT AF

U

BT-

AFU

% S.D S.E t P

1. Sandhi shula 1.85 1.40 0.45 40 0.604 0.135 3.327 <0.010

2. Tenderness 2.00 1.50 0.50 40 0.688 0.153 3.298 <0.010

3. Atopa 1.80 1.25 0.55 45 0.686 0.153 3.583 <0.010

4. Sandhi sotha 2.15 1.40 0.75 60 0.716 0.160 4.682 <0.001

The standard drug Simhanada Guggulu provided highly significant (<0.001)

result in the Sandhi shotha (60%). It showed moderate significant (<0.010) result in

the Atopa (45%) and in the sandhi shula and tenderness it provides moderate

significant (<0.010) result and relieved the symptoms 40%.

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RESULTS

Table No: 45

Comparative effect of therapies in the management of Main symptoms of 40

patients of Sandhigata vata after treatment:

Group Sandhishoola Tenderness Atopa Sandhi shotha

Trial group 35 40 55 30

Std group 30 30 35 50

While comparing the effect of therapies on main symptoms, it was found that

Trial group showed 35%, 40%, 55% and 30% relief in managing the symptoms like

Sandhi shula, Tenderness, Atopa and Sandhi shotha respectively were as Standard

group showed 30%, 30%, 35% and 50% relief in the symptoms like Sandhi shula,

Tenderness, Atopa and Sandhi shotha respectively.

Graph No: 27


patients of Sandhigata vata after treatment:

0

20

40

60

80

100

shula tenderness Atopa shotha

trial std

Page 85

RESULTS

Table No: 46


patients of Sandhigata vata after follow up:

Group Sandhishoola Tenderness Atopa Sandhi shotha

Trial group 60 65 60 40

Std group 40 40 45 60

While comparing the effect of therapies on main symptoms, it was found that

Trial group showed 60%, 65%, 60% and 40% relief in managing the symptoms like

Sandhi shula, Tenderness, Atopa and Sandhi shotha respectively were as Standard

group showed 40%, 40%, 45% and 60% relief in the symptoms like Sandhi shula,

Tenderness, Atopa and Sandhi shotha respectively.

Here trial group showed better results in the management of Sandhi shula,

Tenderness, Atopa where as standard group (Simhanada guggulu) given better result

in the Sandhi shotha.

Graph No: 28


patients of Sandhigata vata after follow up:

0

20

40

60

80

100

shula tenderness Atopa shothatrial std

Page 86

RESULTS

Table No: 47

Overall effect of therapy by trial drug Trayodashanga guggulu on patients of

Sandhigata vata after 60 days of treatment:

Result No. of patients %

Complete relief 00 00

Marked improvement 04 20

Moderate improvement 04 20

Improved 09 45

Unchanged 03 15

In this group, 45% of the patients were assessed under improved category.20% of

patients showed moderate and marked improvement. 15% showed no response to the

treatment. No body showed complete relief.

Table No: 48

Overall effect of therapy by trial drug Trayodashanga guggulu on patients of

Sandhigata vata after 60 days of follow up





Improved 07 35

Unchanged 03 15

After 60 days of follow up period 35% of patients showed Moderate

improvement were as 35% patients came under improved category. 15% of patients

showed marked relief in the symptoms.15% of patients came under unchanged

category.

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RESULTS

Table No: 49

Overall effect of therapy by Standard drug Simhanada guggulu on patients of

Sandhigatha vata after 60 days of treatment:





Improved 07 35

Unchanged 03 15

In this group after 60 days of treatment the standard group showed 40%

Moderate relief in the symptoms. 35% of the patients showed improved relief.10% of

the patients showed Marked improvement and 15% remained unchanged.

Table No: 50

Overall effect of therapy by control drug Simhanada guggulu on patients of

Sandhigata vata after 60 days of follow up.





Improved 11 55

Unchanged 04 20

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RESULTS

55% of patients showed improvement in the symptoms, 15% belonged marked

improvement. 10% Showed moderate improvement where as remaining 20%

belonged to unchanged category. No body showed complete relief.

Graph No: 29

Comparative effect of overall therapy of 40 patients of Sandhigata vata after 60

days of treatment:

0

20

40

60

80

100

Completerelief

Markedimprovement

Moderate imp Improved Unchanged

trial std

Complete relief was not noted in both the groups. 20% of patients of Trial

group showed marked improvement while it was 10% in Standard group. 20%

showed moderate improvement in Trial group and 40% in Standard group.

Improvement was noted in 45% in Trial group and 35% of patients in Standard group.

15% of patients in Trial group showed no change after the treatment while in Standard

group also it is 15%.

Page 89

RESULTS

Graph No: 30

Comparative effect of overall therapy of 40 patients of Sandhigata vata after 60

days of follow up:

0

20

40

60

80

100

Completerelief

Markedimprovement

Moderate imp Improved Unchanged

trial std

After follow up, complete relief was not noted in both the groups. 15% of

patients of Trial group showed marked improvement and also it was 15% in Standard

group. 35% showed moderate improvement in Trial group and 10% in Standard

group. Improvement was noted in 35% in Trial group and 55% of patients in Standard

group. 15% of patients in Trial group showed no change after the treatment while in

Standard group also it is 20%.

Page 90

DISCUSSION

DISCUSSION

The pathological condition in which either of the localized or generalized

symptomatology gets manifested along with severe pain as an effect of localization of

the vitiated vata dosha in different dushyas as the condition may be called as vata

vyadhi. It is also said that vata vyadhi is a consequent result of a special type of

dosha-dushya sammurchana occurring in the body, manifested by either localized or

generalized symptamatology, brought about by the localization of vitiated vata in the

respected dushyas.

Sandhi gata vata is one of the vata vyadhi. Supportive evidences are found in

the Ayurvedic classics indicates that sandhigata vata does possess an etio-

pathogenesis of its own as it is said that a vyadhi is formed only after the completion

of the dosha-dushya sammurchana in the Sthana samshrayavastha marked by a clear

cut manifestation of signs and symptoms. In this context the vata is getting vitiated by

its etiological factors runs through all the pathological stages and on getting localized

in its dushyas which in this case being sandhi produces a specialized form of dosha-

dushya sammurchana and manifest with its clear cut symptoms like shotha shula, so

as to be called as sandhigata vata.

In modern, Sandhi gata vata is compared with the Osteo arthritis which is one

of the degenerative joint disorders. Females are found to be more affected by this

disorder. It causes pain and disability there by hampering man power resources of the

nation. So the priority for health system assumes an important place as the population

becomes older.

Page 91

DISCUSSION

Discussion on Etiology:

Although separate etiological factors not mentioned for the disease sandhigata

vata, samanya nidana for vata vyadhi itself is taken in to consideration. The

etiological factors can be divided into aharata, viharata, manasika, kalakruta and gada

kruta.

In proper diet and dietic regimen plays importance in the process of this

disease because ahara provides the nutrients to all the dhatus. By the improper food

and dietic regimen quantitatively or qualitatively produces changes in the process of

digestion and absorption. This leads to dhatu kshaya which in turn causes the vata

prakopa results in sandhigata vata.

The viharaja nidans which pertaining to this disease can stimulates or irritates

the anatomical sites (sandhis), where the depletion of dhatus (sleshma, snayu) takes

place which in turn causes the riktata and also vata prakopa. Vyana vata is responsible

for pancha chesta, the etiological factors will directly causes vyana vata pakopa. This

produces difficulty in movement.

The mental health always contributes the physical well being. The anxiety,

stress, nervousness and mental disturbances reflect on body mechanism and impair

the functions. Vata being essential factor in the maintenance of manas and indriyas,

disturbances in that aspect directly influence over vata.

Page 92

DISCUSSION

Discussion on Samprapti:

The samprapti of sandhigata vata follows either of the two different pathways.

The different mechanisms can be explained as said below-

1. The consumption of aharaja, viharaja, manasika, kalaja or gadakruta nidanas

having the tendency to vitiate the vata, either individually or in combination

sill kead to the sanchaya of the vata. The accumulated vata heads towards the

steps of prakopa and prasara. The same etiological factors having the tendency

to destroy the dhatus simultaneously with vitiation of vata will produce dhatu

kshaya. The dhatu kshaya will ultimately results in riktata of the srothas.

The prasarita vata moving all through the body occupies the rikta

srotas and further undergoes vitiation. As the pathology progresses vata gets

stana samsraya in the sandhis, where it undergoes sammurchana with the

dushyas concerned there in. Later when dosha dushya sammurchana gets

completed the conditions gets manifested with clear cut signs and symptoms

and will acquire the name sandhigata vata. The symptoms manifested depend

on the structures involved in it. Sandhi shota gets manifested following

impaired sravana when siras get involved during sthana samshraya. Similarly

stambha may cause due to shoshana of asthi, snayu, and kandara. And Atopa is

due to kshaya of shleshma and shleshma dhara kala. Eventually sandhi shula

and vata purna druti sparsha will occur due to localized Vata in joints.

Ultimately the condition can get worsen leading to destruction the joints

making men crippled and dependent when the disease is not attended to.

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DISCUSSION

2. The consumption of above said nidanas similarly lead to prakopa of other

doshas i.e. pitta and kapha. These doshas get filled in the srothas and cause

avarana of vata. As a result vata prakopa takes place. The vitiated vata later

attains prasara and get localized in the sandhis. At the site of localization, the

vayu undergoes sammurchana with the dushyas there in and in due course gets

manifested with clear cut symptamatology. This causes the pathological entity

called sandhigata vata.

The condition can further progresses to the stage where complications

are produced leading to destruction of the joints, if attention is not given in

proper time.

Discussion on Treatment principles:

All Acharyas are given more importance to Palliative treatment than the

Purificatory measures. Here main procedures explained are, Snehana and its different

forms like Abhyanga and Unmardana, Swedana (Upanaha), Bandhana and

Agnikarma.

Sandhigata vata is a disease which is restricted to individual joints and hence

localized treatments for specific joints will be beneficial.

Discussion on plan of study:

The present study has been carried out on 40 patients treated in two groups,

trial and standard selected from the OPD and IPD of A.L.N Rao Memorial Ayurvedic

Medical College and Hospital, Koppa. The criteria for selection of patients were

based upon the classical signs and symptoms.

Page 94

DISCUSSION

20 patients of sandhigata vata were selected for trial group in which

Trayodashanga guggulu was given in the dose of 3 gms twice daily with ushna jala as

anupana. Duration of the treatment is 60 days.

20 patients of sandhigata vata were selected for standard group in which

Simhanada guggulu was given in the dose of 3 gms twice daily with ushna jala as

anupana. Duration of the treatment is 60 days.

Follow up study was done for 60 days in 15 days visits.

The improvement in the symptoms of diseases after the treatment was the

main criteria of assessment. The total effects of the therapy were also assessed in

terms of complete relief, marked improvement, moderate improvement, improved and

unchanged.

Discussion on observation during study:

57 patients were registered for this study, 17 patients were dropped due to

various reasons. Discussion regarding Observations of all the factors related to disease

is as follows.

1. Age wise distribution – maximum patients in this study was around 55 – 65

years. The probable cause may be due to the hard work, degeneration due to

old age.

2. Sex wise distribution – maximum patients were females nearly about 55%. In

this, most of the females suffer from Janu sandhigata vata. The excess work

load over the knee joint may be pre disposing factor for this disease.

Page 95

DISCUSSION

3. Religion wise distribution – 77.5% among the selected patients were Hindus

because the area of the study were Hindu dominated area.

4. Marital status – 92.5% of the patients in this study were married. Since this

disease very commonly seen in last part of middle age majority of the patient

were married.

5. Economical status – maximum number of patients belongs to poor class,

which is 70%. Due to lack of proper nourishment as well as excessive strains

due to manual labor may be the predisposing factor for the disease.

6. Occupational – 45% of this study were house wives and 32.5% were

agriculturists.

7. Habitat wise distribution – 92.5% were from Anupa pradesha since the area

where the study belongs to Anupa desha.

8. Discussion on duration of illness – duration of illness seen in to less than one

year in majority of cases.

9. Family history – maximum patients shown negative family history to this

disease (80%).

Page 96

DISCUSSION

10. Discussion on nidra incidence – maximum number of patients suffered from

disturbance of sleep (77.5%). It may be due to the pain and stiffness which

does not allow sleeping.

11. Discussion on prakruti of the patient – in most of the cases studied, the

patients were vatapittaja prakruti.

12. Discussion on weight incidence – in this study, most of the patients had the

body weight in between the range of 61-70 kgs.

13. Discussion on incidence of main lakshanas. –

• Sandhishula – it was seen in all the patients.

• Prasarana akunchana savedana – was seen in most of patients which disturbed

their routine work.

• Sandhi sthambha – was the symptom which reduced the working capacity of

patients.

• Sandhi shotha, atopa were also seen in most of the patients.

Page 97

DISCUSSION

Discussion on effect of treatment:

Effect of treatment was assessed clinically.

• After treatment

The trial drug Thrayodashanga Guggulu gives highly significant (< 0.001)

result in the Atopa (crepitus) i.e. 55%. It provided 40% relief in Tenderness which is

moderately significant (<0.010). Also it is moderately significant (<0.010) in Sandhi

shula (35%). The standard drug simhanada guggulu showed highly significant result

(<0.001) in the Sandhi shotha (50%). It provided moderate significant (<0.010) result

in the Atopa (35%). And in the sandhi shula and tenderness showed moderate

significant (<0.020) and the relief is 30%.

• After follow up

The trial drug Thrayodashanga Guggulu showed highly significant (< 0.001)

result in Tenderness (65%). It showed highly significant result (< 0.001) in Sandhi

shula and Atopa (60%).The standard drug Simhanada Guggulu provided highly

significant (<0.001) result in the Sandhi shotha (60%). It showed moderate significant

(<0.010) result in the Atopa (45%) and in the sandhi shula and tenderness it provides

moderate significant (<0.010) result and relieved the symptoms 40%. So the trial drug

showed very significant result in the shula, atopa and tenderness. Where as standard

drug showed efficiency in Sandhi shotha.

Over all effect of treatment on sandhigata vata:

During the time of treatment (60 days) trial drug showed high significant

result in the Atopa (crepitus) and showed moderate significant result in the Sandhi

shula, Tenderness and Sandhi shotha where as the standard drug Simhanada guggulu

Page 98

DISCUSSION

showed high significant result in the Sandhi shotha and given moderate significant

result in the Sandhi shula, Tenderness and also in Atopa.

In the follow period of 60 days, the patients observed in each 15 days visit.

After that period the trial drug showed high significant result in the Sandhi shula,

Tenderness and Atopa where as moderate significant result in the Sandhi shotha. The

control group Simhanada guggulu had given high significant result in the Sandhi

shotha and moderate significant result in Atopa, Sandhi shula and Tenderness.

Overall picture of the results obtained showed that both group were effective

in reducing all the symptoms but trial drug Trayodashanga guggulu showed highly

significant in reducing symptoms such as Sandhi shula, Atopa and Tenderness. It also

brought about long standing relief. The control drug Simhanada guggulu found highly

significant in the Sandhi shotha and in rest symptoms it showed moderately

significant result.

COMPARISON OF GROUPS

Inter group comparison after treatment

NO GROUPS SYMPTOMS t- VALUE P- VALUE REMARKS

1 Trial &Std drugs Sandhi shula 0.587 >0.200 Trial = Std

2 Trial &Std drugs Tenderness 0.7417 >0.200 Trial = Std

3 Trial &Std drugs Atopa 1.057 >0.200 Trial = Std

4 Trial &Std drugs Sandhi shotha 0.083 >0.200 Trial = Std

Page 99

DISCUSSION

On the statistical analysis to compare the result obtained after 45 days of

treatment for Sandhi shula between the two groups, an insignificant result was

obtained which indicates that both the groups were equally effective in the

management of Sandhi shula. Even on the other main complaints, Atopa, Tenderness

and Sandhi shotha an insignificant result was obtained on the inter group statistical

evaluation which indicates that both the drugs were equally effective in the

management of chief complaints.

Inter group comparison after follow up

NO GROUPS SYMPTOMS t- VALUE P- VALUE REMARKS

1 Trial &Std drugs Sandhi shula 1.253 >0.200 Trial = Std

2 Trial &Std drugs Tenderness 1.191 >0.200 Trial = Std

3 Trial &Std drugs Atopa 0.995 >0.200 Trial = Std

4 Trial &Std drugs Sandhi sotha 1.436 <0.200 Trial = Std

Statistical evaluation for the inter group comparison after follow up period

showed an insignificant result on all the chief complaints. A highly significant result

was obtained for the Trial drug on Sandhishula, Atopa and Tenderness after the

follow up period compared to a moderate significant relief for the standard drug. But

the inter group comparison between the two groups showed only a statistical

insignificance.

Thus it may be concluded that both the standard and trial drug were equally

effective in management of chief complaints after the treatment as well as after the

follow up

Page 100

DISCUSSION

Probable mode of action of TRAYODASHANGA GUGGULU:

Ayurveda the science with a holistic attitude has considered all aspects of

drug action, interaction, synergism, antagonism etc, in formulating the various yogas

to make them safe and acceptable. In order to achieve this, the Ayurvedic seers have

formulated hundreds of formulations which could be selected depending upon the

necessity. Poly herbal and herbo mineral preparations have two basic components as

ingredients

• Pharmocological components – This is divided in to Pharacodynamic

and Pharmacokinetic components.

• Pharmaceutical components – It includes media (Base), colouring

agents, binding agents, flavouring agents, thinners, preservatives, etc.

In a nut shell there are five basic components present in compound

formulations as ingredients. They are Activators, Potentiators, Antidotes, Bio

availability enhancers and Pharmaceutical agents.

Activators: They are main ingredients, responsible foe achieving the required

therapeutic action.

Potentiator: This group enhances the activity of the formulations.

Antidote: It will minimize or nullify the adverse drug reactions if any.

Page 101

DISCUSSION

Bio availability enhancers: The drugs in this group enhance the bio availability of

the drug in the body.

Pharmaceutical agents: the ingredients useful in preparation of formulations such as

binding, colouring agents, etc.

Thus every formulation will have one or the other ingredient which resulting

in to safe easily acceptable by the system and exhibits utmost therapeutic effects.

While considering Trayodashanga guggulu the ingredients can be classified in

the similar way.

Activator: The formulation has the main therapeutic action as vedana sthapana and

shothahara which is attributed by the presence of Guggulu as a major ingredient.

Potentiator: The ingredients namely Vrudhadaru, Guduchi, Shathavari,

Ashwagandha, Rasna and Grutha are included under this category as it does the

regeneration of bodily elements by their properties such as Vatasamana, Rasayana and

Balya. Thus it enhances the action of the formulations and are useful in the

longstanding usage of the drug.

Antidote: Guggulu being a resin does not dissolve in the system easily. In larger

doses it can cause constipation, burning sensation in G I tract-urine-eyes etc. This is

counteracted by Vrudhadaru which is a mild laxative, Thriphala which is used at the

time of Shodhana of the Guggulu acts as chakshushya. Gokshura and Hapusha are

Page 102

DISCUSSION

Diuretics and Shothahara. Abha acts as potent Shothahara dravya and is helpful in

reducing GIT, GUT inflammations.

Bio availability enhancers: Nagara, Shati, Shathapushpa, Ajamodha, Yavani, Grutha

are having Deepana, Pachana activity and it is said to improve the dhathwagni.

Various studies have shown the effect of Nagara as bio availability enhancers.

Probable mode of action of SIMHANADA GUGGULU:

Activator: The formulation has the main therapeutic action as vedana sthapana and

shothahara which is attributed by the presence of Guggulu as a major ingredient.

Potentiator: Here Triphala is considered as potenciator as it does the action of anti

inflammatory. Eranda thaila also considered as Vatanulomaka so it reduces pain and

shotha.

Bio availability enhancer: Gandhaka is considered as bio availability enhancer as it

enhances the bio availability of the other active principles present in the formulation.

Page 103

CONCLUSION

CONCLUSION

• Sandhigata vata is a vyadhi produced due to the Vyana vata prakopa.

• Gata vata is the condition in which Vata will be in predominant state and the

condition of the vata should be cared while applying treatment principles.

• While considering nidanas, both Dhatukshayakara and margavarodhakara are

responsible for producing the disease Sandhigata vata.

• This disease is considered as Yapya, because it affects joints which are the

madhyama roga marga.

• The treatment or treatment procedures which give snigdhata, ushnata, Ghana

is useful in this condition.

• In classics, they more emphasized on palliative measures than the purificatory

treatments.

• Sandhigata vata afflicts predominantly in elder persons (51-70yrs), hard

workers and also in females.

• The trial drug showed excellent response on reduction of the symptoms and in

degenerative process.

• The standard drug showed outstanding result in the reduction of Sandhishotha.

• Sandhigata vata is easy to cure if the disease is of recent origin.

Limitations:

• The size of sample was small to draw a generalized conclusion.

• The period of study was limited.

• The study was limited to the patients who attended the OPD wing of

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa.

Recommendation of further study:

• The study can be repeated with large sample and longer duration.

• Same formulation can be tried along with specific panchakarma therapies and

other drugs.

Page 104

SUMMARY

SUMMARY

The dissertation entitled “Management of Sandhigata vata with

Trayodashanga guggulu – A Clinical evaluation” has been carried to find out the

clinical efficacy of Therapeutic drug combination Trayodashanga guggulu on the

patients of Sandhigata vata. This study comprises of following topics,

Introduction:

Gives the explanation about qualities of healthy person, importance of vata

physiologically as well as pathologically and brief introduction about trial drug

Trayodashanga guggulu.

Objectives:

The main aim and objectives of the study has been mentioned along with the

hypothesis under this heading.

1. Review of literature: This chapter comprises of following headings, Disease

review and Drug review.

Disease review dealt under the following headings. Historical aspect – gives

the historical glimpses with regards to the disease sandhigata vata and traces the

various developments right from the vedic period to present era. Here references

regarding the vata dosha, its diseases and the diseases of joints are presented.

Under the heading of etymology the description about Sandhi and different

constituents which forms the Sandhi and also concept about gata vata has been

mentioned.

Page 105

SUMMARY

Detailed data wise collection about Nidana, Poorva roopa, Roopa, Samprapti,

Sadhya-asadhyata, Upadrava and Chikitsa along with Pathya-apathya of the disease

along with some modern aspects of Osteoarthritis have been dealt.

In drug review section, a thorough study of the ingredients of the compound

preparations covering the botanical nomenclature, rasa, guna, veerya, vipaka,

chemical constituents etc.

2. Methodology:

• Clinical study – Under this heading detailed description of the clinical study

with specific reference to patients, grouping, selection, inclusion and exclusion

criteria, protocol, criteria for assessment of signs and symptoms, dose,

duration of the study is mentioned.

• Observational study – Here a detailed explanation is given on the distribution

of the patients according to age, sex, economical status, diet, habits, marital

status are represented along with tables and charts.

• Preparation of the drug - Here a detailed explanation regarding the

preparation of the compound drug has been mentioned in detail.

3. Results: In this, results of the study analyzed statistically, compared and are

presented in tables and graphs.

4. Discussion: Under this heading, discussion regarding nidanapanchaka,

chikitsa and results obtained from this study have been described. The

probable mode of action of the trial drug and control drug was discussed on

the basis of rasapanchakas.

5. Conclusion: In this chapter the conclusion of the above study is done by

highlighting the outcome of the study along with limitation of study and the

scope of further improvement.

Page 106

REFERENCES

References Introduction:

1. Ch.Su. 21/18-19Ka.Khi. 5/6-8. 2. Ch.Su 12. 3. Ch.Su. 13/8 4. C.D. 22/72-75.

Disease review: 5. R.V. 10/163/6. 6. A.V. 6.14.1, 1/12/3. 7. R VII 35, 60, 61. 8. M.B. 12.46.3, 47..66, 155.6, 185, 24-25, 328.26-53 9. A.G.Pu 370//33, 28/40-41. 10. Kt 3/10. 11. Ct 4/16/1, 4/3/1 12. Ch.Chi 28/37. 13. Su. Ni 1, Su.Chi. 5/50-54. 14. Bh. Sa. Ci 24/48-54. 15. H.S.Tr. 20/14. 16. AH. Ni 15/4, AS. Ni. 1/5. 17. M.N 22/21 18. B.P 24/258 19. C.D Chi. 22/9 20. B.R 26/14 21. Y.R 30/119 22. Bas. Raj 6ht prakarana 23. B.Su 25/36, 26/23 24. P.Su 5/1/38, 5/2/129

Etymology :

25. S.K.D Vol. 5 P. 240-2 26. Su.Sha 5/28, Ch.Sha 7/14, Ch.Vi 5/8, A.H Sha 3/16 27. Su.Su 15/1 28. Dalhana – Su.Su 15/1 29. A.H Su 12/7 30. Dalhana Su.Su 15/4 31. Su Ni 1/18 32. Dalhana – Su Ni 1/18 33. Gayadasa – Su Ni 1/18 34. H.S Thritheeya sthana

Anatomical aspect of Sandhi: 35. Su Su 5/24-5 36. Su Sha 5/27 37. A.H Sha 3, Su Sha 5/30 38. A.H Sha 3/10, Su Sha 4/15 39. Su Sha 6/18-20 40. Su Sha 6/38 41. Su Sha 6/4 42. Su Sha 6/15

REFERENCES

43. Dalhana – Su Sha 6/4 44. Davidson Pg no. 761

Nidana: 45. Su Su 3/14 46. Ma Ni 1/5 47. Ch.Su 12/7, Su Su 21/19, A.S Ni 1/5 48. Ch. Chi 28/15-18,Su Ni 1,B.P MK 24/122,Y.R, Bas. Raj 6th , H.S Thr. 20th 49. A.H Su 12/24-5 50. Ch Vi 8/99

Poorvarupa: 51. M.N 1/6 52. Ch Chi 28/24

Roopa: 53. M.N 1/7 54. Ch Chi 28/48 55. Su Ni 1/28 56. A.S Ni 15/12 57. A.H Ni 15/14-5 58. B.P MK 24/258 59. Y.R 30/24 60. M.N 22/21 61. Bas. Raj 6th prakarana 62. Dalhana – Su Ni 1/28, A.D – M.N 22/21 63. Madhukosha – M.N 22/21 64. Gayadasa – Su Ni 15/7 65. Su Su 17/7 66. Su Su 17/3 67. Arunadatta – A.H Ni 15/14-5 68. A.S Ni 16/28 69. Y.R 1st

Upashaya and Anupashaya: 70. M.N 1/8-9

Samprapthi: 71. M.N 1/10 72. Ch Vi 5/9 73. A.S Su 20/2 74. Chakrapani – Ch Chi 28/18-9 75. Ch Su 12/7 76. Ch Ci 28/59 77. A.H Ni 15/5-6 78. Ch Chi 28/61 79. M N 43/8, Su Su 15/5, Ch su 21

REFERENCES

Upadrava: 80. Ch Chi 21/40

Sadhyasadhyatha: 81. Su Su 33/4 82. Ch Chi 28 83. H.S Thr. 20

Chikitsa: 84. A.K 2/6/50 85. Su Chi 4/18 86. A.S Chi 23/3 87. A.H Chi 21/22 88. B.P MK 24/259 89. Y.R 30/119 90. B.R 26/14 91. CD 22/9 92. Ch Su 22/11 93. Ch Ni 1/39 94. Ch Su 13/9 95. Ch su 13/14-7 96. Ch Su 5/86 97. Dalhana – Su Chi 24/30-4 98. M.F.H.H pg.no:14 99. Dalhana – Su Chi 32/12

100. Su Chi 33/14 101. Ch Su 14/64 102. Chakrapani – Ch Su 14/64 103. Su Su 12/1 104. Su Su 12/10 105. Su Su 12/4-5 106. Su Su 12/3 107. Su Su 41/4 108. Ch Sha 8/32 109. Ch Su 14/13 110. A.S Su 26/10 111. A.S Chi 23

Pathyapathya:

112. Ch Su 25/45 113. Y.R 30/414-17 114. B.R 26 115. Y.R 30/418-9 116. B.R 26

Differential diagnosis:

117. M.N 23/13, Ch Chi 29/24-9 118. M.N 25/6 119. H.P.I.M

REFERENCES

Drug review: 120. J.L.N. Pg. no 826. 121. J.L.N. Pg. no 375 122. J.L.N. Pg. no 968. 123. J.L.N. Pg. no 33. 124. J.L.N. Pg. no 540. 125. J.L.N. Pg. no 98. 126. J.L.N. Pg. no 821. 127. J.L.N. Pg. no 258. 128. J.L.N. Pg. no 972. 129. J.L.N. Pg. no 269. 130. J.L.N. Pg. no 871. 131. J.L.N. Pg. no 857. 132. J.L.N. Pg. no 113. 133. J.L.N. Pg. no 209. 134. J.L.N. Pg. no 216. 135. J.L.N. Pg. no 220. 136. J.L.N. Pg. no 483. 137. R.R.S 3/18-19

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DEPARTMENT OF KAYACHIKITSA A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE , KOPPA-577126.

CASE PEROFORMA FOR MANAGEMENT OF SANDHIGATA VATA WITH THRAYODASHANGA GUGGULU A CLINICAL EVALUATION

P.G.Scholar : Dr.Guruprasad.A. .B.A.M.S Guide: Dr.P.K.Mishra M.D(Ayu)., (RSU)

PART-A –EXAMINATION

Name: Group: Age ……… Yrs, Sex M / F Sl.no : Religion: H / M / C / J OPD/IPD: Education: UE / P/ M / H /G Ward/Bed no: Marital status: M / U / W / D D.O.A : Social status: VP/ P/ LM / M /UM / R / VR D.O.D : Occupation: HW / W / B / S / E Diagnosis: Desa : J /A/S Locality: Urban /Rural Result : Address: Main complaints:

Duration B.T A.T A.F.U I II III 1. Sandhi Sotha 2. Sandhi Shoola 3. Tenderness 4. Sandhi Atopa History of Present illness:

1. Sandhi shoola: Onset : Insidious / Gradual / Acute

Course : Progressive / Relapsing / Stationary

Character : Dull aching / Deep pain / Pricking

Shooting / Excruciating Aggravating factor :-

Food : BF / AF Time : M / A / E / N Movement : Squatting / Walking / Climbing stairs / Rest

1

Relieving factor :- Food : BF / AF Time : M / A / E / N

Rest : Yes / No Seasonal : SHI / V /G/ VA/ SHA/ H NSAIDs : Yes / No

2. Sandhi shotha :

Onset: Sudden / Gradual

Course: Progressive / Relapsing / Stationary

Character: Pitting / Non pitting

Site: Anterior / Posterior

Colour: Aruna / Shyama / Swetha

Aggravation: Food : BF / AF Time : M / A / E / N Movement : Squatting / Walking / Climbing stairs / Rest

Relieving factor :-

Food : BF / AF Time : M / A / E / N

Rest : Yes / No Seasonal : SHI / V /G/ VA/ SHA/ H NSAIDs : Yes / No

3. Stiffness:

Morning…….min / After walking…..Min / After rest…min 4.Atopa (Crepitus):

Palpable / Audible / Fine coarse Past History :

Past illness : Injury to the joint : Yes / No

Treated : Yes/ No

: If treated Ayurveda / Allopathic / Homeopathic /Other

Family History:

2

Gynaec History :

M.C. day R IR : Menarche yr : Menopause yr

Menorrhagia / Dysmenorhoea / Metrorrhagia / Leucorrhoea Personal History : Habits :

Habits Duration / Continued

Occasional / Regular

Stopped / Reduced

Relationship to Symptom

Smoking Alcohol Tobacco Snuff Others

Ahara :

Nature : Veg / mixed

Quality : Alpa / Pramita / Sama / Atipramana

Rasa: M / A / L / K / T / Ka / Sarva rasa

Guna : Ruksha / Snigdha / Ushna / Sheeta / Guru / Laghu

Dietetic habit : Matrashana / Vishamanasana / Adhyasana

Virudha ashana / Anasana Nature of work :

Sedentary / Labour / Sitting / Travelling / Walking / Standing / Day / Night

Vishrama :

Proper / Less / Excessive Vyayama :

No / Less / Proper / Excessive / Irregular Nidra :

Sound / Disturbed / Ratri Jagarana / Divaswapa

3

General Examination : 1. Pulse : /min R IR RIR IIR Full Bounding Feeble 2. Blood pressure : / mm of Hg 3. Temperature : F 4. Respiratory rate : /min 5. Nourishment : Good / Moderate / Poor Dasha Vidha Pareeksha :

Prakrititah : V / P / K / VP / VK / PK / VPK

Vaya : Bala / Yuva /Madhyama / Vriddha

Vikrititah : P / M / A

Samhanana: P / M / A Satva : P / M / A Pramana : P / M / A Satmya : P / M / A Aharashakti :

* Abhyavarana P / M / A * Jarana P / M / A

Sara : P / M / A

Vyayama Shakti : P / M / A Sroto Pareeksha :

Pranavaha : Prakrita Vaikrita

Udakavaha : Prakrita Vaikrita

Annavaha : Prakrita Vaikrita

Rasavaha : Prakrita Vaikrita

Raktavaha : Prakrita Vaikrita

Mamsavaha : Prakrita Vaikrita

Medovaha : Prakrita Vaikrita

4

Asthivaha : Prakrita Vaikrita

Majjavaha : Prakrita Vaikrita

Sukravaha : Prakrita Vaikrita

Artavavaha : Prakrita Vaikrita

Swedavaha : Prakrita Vaikrita

Mutravaha : Prakrita Vaikrita

Purishavaha : Prakrita Vaikrita

Systemic Examination :

C.V.S. :

R.S. :

C.N.S. :

P/A : Locomotor System : Examination of effected joint:

Effected joint(joints):

Inspection: Redness / Swelling / Deformity

Palpation :

Tenderness :- Present /Absent Temperature : - Present /Absent Swelling :- Present /Absent

Movement : Painful / No pain / Restricted Investigations:

Hematological :

E.S.R. R.A

5

X-Ray Rt / Lt Ap / L

Samprapthi Ghataka Nidana : Aharata Viharata Sannikrishta Viprakrishta Roopa : Dosha : Dooshya : Srothas : Udbhava sthana : Sanchara sthana : Roga marga : Sthana samshraya: Vyakta sthana : Adhishtana : Samprapti Vyadhi vinischaya Sadhya Sadhyata Chikitsa Result Discussion Signature of Student Signature of Guide

Dr. Guruprasad. A Dr. Pramod Kumar Mishra BAMS. M.D (Ayu),(RSU)

6

ASSESSMENT CRITERIA

Sandhi shula Points

No pain [no pain at rest / no pain while walking] - 0

Mild pain [no pain at rest or

mild tolerable pain while walking] - 1

Moderate pain [mild pain at rest, tolerable and

moderate pain while working] - 2

Severe pain [disturbance of sleep due to pain or

pain at rest or untolerable pain during working] - 3

Atopa of sandhi:

No crepitus - 0

Palpable crepitus - 1

Audible crepitus - 2

Tenderness:

No pain on pressure - 0

Pain on pressure and winces - 1

Patient withdraws affected part while giving pressure - 2

Patient does not allow to touch - 3

Sandhi shotha:

No swelling - 0

Swelling is present slightly in joints - 1

Swelling covering the bony prominence of affected joints - 2

Swelling much elevated so that

the joints seems grossly deformed - 3

7

POST GRADUATE STUDIES AND RESEARCH CENTRE

DEPARTEMENT OF KAYACHIKITSA

A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE

KOPPA-CHIKMAGALUR

PATIENT CONSENT FORM I __________________________________________ exercising my free power of choice, hereby give

you my complete consent to be included as a subject in the Clinical trial on “Management of

Sandhigata vata with Trayodashanga guggulu – A Clinical evaluation”. I have been informed to

my satisfaction by the attending Doctor, the purpose of the Clinical Trial and the nature of drug

treatment, therapeutic procedures, follow-up and probable complications. I am also ready to undergo

necessary Laboratory Investigations to monitor and safeguard my body functions.

I am also aware of my right to opt out of the trial at any time during the course of the trial

without having to give the reasons for doing so.

Signature of the Doctor Signature of the Patient/ Guardian

(£Á£ÀÄ N¢/ N¢¹ CxÀð ªÀiÁrPÉÆAqÀÄ ¸À» ºÁQgÀÄvÉÛÃ£É.)

8

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