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“Evaluation of efficacy of Ajamodadi vati in Sandhigatavata(Osteoarthritis)”

By

Dr.Shakuntala.Totar

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D. In

Kayachikitsa

Under the Guidance of

Dr. K.Shiva Rama Prasad M.D,C.O.P(German),M.A(Ph.D)Jyotish Department of Kayachikitsa

Department of Kayachikitsa Post Graduate Studies & Research Center

D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2007-2010

Ayurmitra

TAyComprehended

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER

GADAG, 582 103

This is to certify that the dissertation “Evaluation of efficacy of Ajamodadivati

in Sandhigatavata (Osteoarthritis)” is a bonafide research work done by Dr.

Shakuntala. Totar in partial fulfillment of the requirement for the post graduation

degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of

Health Sciences, Bangalore, and Karnataka.

Date:

Place:

Guide

Prof. Dr. Shiva Rama Prasad Kethamakka

M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish)

Professor in Kayachikitsa

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER

GADAG, 582 103

Endorsement by the H.O.D, principal/ head of the institution

This is to certify that the dissertation entitled “Evaluation of efficacy of

Ajamodadi vati in Sandhigata vata (Osteoarthritis)” is a bonafide research work

done by Dr. Shakuntala. Totar under the guidance of Prof. Dr. Shiva Rama Prasad

Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa in

partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

(Dr. G. B. Patil)

Principal,

DGM Ayurvedic Medical College,

Gadag

Professor & HOD

Dept. of Kayachikitsa

PGS&RC

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “Evalualation of efficacy

of Ajamodadi vati in Sandhigatavata(Osteoarthritis)” is a bonafide and genuine

research work carried out by me under the guidance of , Prof. Dr. Shiva Rama Prasad

Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa,

DGMAMC, PGS&RC, Gadag.

Date:

Place:

Dr.Shakuntala.Totar

Copy right

Declaration by the candidate

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

have the rights to preserve, use and disseminate this dissertation/ thesis in print or electronic

format for the academic / research purpose.

Date:

Place: Dr.Shakuntala.Totar

Acknowledgement:

I take this privilege to express my gratitude to all those distinguished personalities who

inspired me during the course of my study and painted my life book with sweet memories by their moral

support.

I am sincerely grateful to Prof. Dr. K.Shiva Rama Prasad M.D, C.O.P (German), M.A (Ph.D)

Jyotish, Department of Kayachikitsa for his guidance and timely help.

I extend my gratitude to Dr.G.B.Patil, Principal, for his encouragement and providing all

necessary facilities for this research work.

I submit myself with deep sense of gratitude to Dr. R.V.Shettar for his precious guidance, advice

and kind co-operation.

I express my gratitude to Dr.Ashok.Patil for his guidance and support.

I acknowledge with sincere thanks to Dr.P.Shivaramudu, Dr.Purushothamaacharyalu, Dr

S.N.Belwadi, Dr. G.N.Danappagoudar, Dr.J.Mitti, Dr. Kuber.Sankh, Dr. Mulgund, Dr. Nidgundi,

Dr. G.S.Hiremath, Dr. B.G.Swami, Dr. U.V.Purad, Dr. S.D.Yarageri and all other teaching staff

for their help during the trial.

I render my sincere gratitude to Mr. V.M.Mulimani and assistants for providing valuable books in

time throughout the course.

I am also thankful to Shri.B.S.Tippangoudar (lab technician) Shri.Basavraj (X-Ray dept) for their

kind support in my study.

I also thank all other teaching and non-teaching staff for their support.

I express my sincere thanks to my seniors Dr.Veena.Jigalur and Dr.Prasanna.Joshi.

I also express my deepest gratitude to my classmates Dr.Ishwar.Patil, Dr.Naik, Dr. Bodke,

Dr.Kanti, Dr.Asha and Dr.Deepa.

I am especially thankful to my juniors Dr.Vijay, Dr.Bhagyesh, Dr.Surej and Dr.Baba

My main inspiration is - Success is a vehicle which moves on a wheel called smart work but

journey is imposible without fuel called Self confidence.

A smile on my face throughout the work was maintained by my ever-loving son Mr. Achintya.

I express my deepest gratitude to my parents Mr.Siddappa.Totar and Smt.Ratnamma.Totar.

Last but not the least I thank all those unexpressed names who encouraged and helped me a lot

along with my kith and kin and all my friends.

(Dr Shakuntala.Totar)

Abstract

Evaluation of the efficacy of Ajamodadi Vati in Sandhivata (Osteoarthritis)

Abstract

Abstract of management of sandhigatavata by Ajamodadi vati

Dr Shakuntala.S.Totar

Ayurveda opines that Vyadhi is a condition in which body suffers from pain. Hence it is believed

that reliving the pain is the main treatment to state that the disease is subsided. The most common

complaints in the clinics is joints pain which is classically called sandhigata vata. The intensity of

sandhigatavata janya peeda depends upon Vyanavata, Sleshakakapha and sleshmadhara kala vitiation.

The pain flow impels Manas to complete pain cycle. The concept of sandhigata vata even though not

described elaborately in the classics but witness maximum number of patients. Sandhi-Gata-Vata

(osteoarthritis) is common amongst the elderly and obese persons. Since knee is the weight bearing joint

it is more susceptible to wear and tear. Commonly Sandhi-Gata-Vata (osteoarthritis) is resulting in wear

and tear of this joint and mucus membrane. Sandhi-Gata-Vata is largely seen in the elderly population and

known to be major cause for chronic disability.

Ajamodadi vati with the ingredients with Ajamoda, pippali, vrudhadaruka ,vayuvidanga,

Shatapushpa; Chitrakamula; Nagara;Haritaki; Vrudhadaruka; saindhavalavana; Guda express itself as an

anti-inflammatory and analgesic action by regulating the shleshmadhara kala shotha fluid by its drying

capacity of kleda.

Ajamodadi vati proves to be effective on sandhigata vata especially in sandhi vedana by its

vedanahara property and sandhi shopha by its shophahara property. The result observed is with

considerable moderate response of 54% and mild response 23%. Out of the samples only one patient had

marked response. Among 30 patients 6 patients had not responded to the treatment.

Abstract

Evaluation of the efficacy of Ajamodadi Vati in Sandhivata (Osteoarthritis)

LIST OF ABBREVIATIONS USED

A S – Ashtanga Sangraha

A H – Ashtanga Hridaya

Aru. – Arunadatta

A.T – After treatment

B.T – Before Treatment

B.P – Bhavaprakasha

B.R – Bavarajeeyam

Bh.S – Bhela Samhita

Ca.S – Charaka Samhita

Chi. – Chikitsa Sthana

Chak. – Chakrapani

Dal. – Dalhana

Gang. – Gangadhara

K.S – Kashyap Samhita

M.N – Madhav Nidana

M.R-Marked response

Mo.R-Moderate response

Mi.R-Mild response

Ni. – Nidana Sthana

N.R – Not responded

NSAID- NonSteroidal-Anti-Inflamatory drugs

SU.S – Sushruta Samhita

Sa.S – Sharangadhara Samhita

Sha.S – Shareera Sthana

Su. – Sutra Sthana

Si. – Siddhi Sthana

Vi. – Vimana Sthana

Y.R. – Yoga Ratnakara

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Chapter Content

Pages

1 Introduction 1 – 5

2 Objectives 6 – 7

3 Literary Review 8 - 42

4 Materials and Methods 43 – 49

5 Results 50 – 70

6 Discussion 71 – 78

7 Conclusion 79

8 Summary 80 - 83

9 Bibliographic References 1 - 7

10 Annex 1 – Master charts data of trial 1 – 10

11 Annex 2 - Case sheet 1 - 6

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SL TITLE OF TABLE PAGE

1 Samanya Nidana of Vata Vyadhi as Explained in Different Treatises.

14

2 Roopa of Sandhigata vata asmentioned in various classics 22

3 Showing Vyavachedaka nidana between Sandhigatavata and Vataraktha

23

4 Showing Vyavachedakanidana of Sandhigatavata and Amavata 24

5 Showing Vyavachedakanidana of Sandhigatavata &

Kroshtrukasheersha

24

6 Showing Differential diagnosis between OA, RA, Gout and Rheumatic fever.

25

7 Showing Cikitsa Sootra mentioned in different Samhita. 30

8 Showing the demographic data of trial cases 51

9 Distribution of patients by Age Gender 52

10 Results by Gender 52

11 Results of patients by Age Group 53

12 Distribution of patients by Religion 54

13 Distribution of patients by Occupation 55

14 Distribution of patients by Economical Status 55

15 Evaluation of pain data 56

16 Associated complaints: 56

17 Table Showing mode of onset of disease 57

18 Joint involved 57

19 Nature of pain 58

20 Effect on Routin activities affected 58

21 Distribution of patients by Mode of Onset 59

22 Ditribution of patients by Srotas 59

23 Distribution of patients by Ahara Nidana in sandhi shoola 60

24 Distribution of patients by Vihara Nidana 61

25 Distribution of patients by Manasikanidana 61

26 Distribution of patients by Dosha bhedha 62

27 Showing the distribution of patients by different grades of Vatapoorana druti sparsha before and after treatment

63

28 Showing the distribution of patients by Atopa Before and After treatments

63

29 Showing the distribution of patients by Prasanna akunchanayoho savedana pravrutti

64

30 Showing the distribution of patients by different grade of Sandhi shotha Before and After treatment.

65

31 Showing distribution of patients by different grades of Sandhigraha

66

32 Showing distribution of patients by different grades of Sparsha akshamatva

67

33 Showing Total results 68

34 Showing Subjective parameters 69

35 Showing Objective parameters 70

36 Showing subjective Parameters based on Gradings 70

37 Showing Objective Statistical Assesment of Data. Annex-1- 1

38 Showing Subjective Parameters Of Master charts Annex-1- 3

39 Showing Chief Complaints Annex-1- 5

40 Showing Present Illness of Master Chart Annex-1- 7

41 Showing Srotas Annex-1- 9

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SL TITLE OF GRAPH PAGE

1 Distribution of patients by Age Gender 52

2 Results of patients by Gender (Ajamodadi vati) 53

3 Results of patints by Age Group 53

4 Distribution of patients by Religion 54

5 Distribution of patients by Occupation 55

6 Distribution of patients by Economoical Status 56

7 Distribution of patients by Ahara Nidana 60

8 Distribution of patients by Vihara Nidana 61

9 Distribution of patients by Manasika Nidana 62

10 Distribution of patients by Dosha bhedha 63

11 Showing the distribution of patients by different grade of vatapoorana drutisparsha before and after treatment

63

12 Showing the distribution of patients by different grades of Atopa before and after treatment

64

13 Showing the distribution of patients by different grade of prasanna akunchanayoho savedana pravrutti before and after treatment

65

14 Showing the distribution of patients by different grade of Sandhi shotha before and after treatment

66

15 Showing the distribution of patients by differents by different grades of Sandhigraha before and affter treatment

67

16 Showing the distribution of patients by different grades of Sandhigraha before after treatment

68

17 Total Result 68

18 Changes in subjective parametare (before and after treatment) 71

19 % of improvement in subjective parameters 71

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SL TITLE OF FIGURES AND PHOTOS PAGE

1 Samprapti in dhatukshaya janya sandhivata 20

2 Samprapti in Avarana janya Sandhivata 21

3 Showing Knee Osteoarthritis 36

4

Introduction

Evaluation of the efficacy of Ajamodadi Vati in Sandhivata (Osteoarthritis) Page 1

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General introduction:

The Indian subcontinent abounds as it vary in variety and diversity of health traditions. We

have with us what is perhaps the longest unbroken health traditions and the oretical backing in terms

of Ayurvedic system of medicine. They have made their presence felt even outside India. The purpose

of life is four-fold, to achieve Dharma (virtue), Artha (wealth), Kama (enjoyment) and Moksha

(salvation).1 In order to attain success in this four-fold purpose of life, it is essential to maintain life

not only in a disease-free state but also in a positive healthy state of body, mind and spirit. Equal

importance is given to mental health, hence, strict mental discipline and strict adherence to moral

values is considered a pre-requisite for mental health, which influences the physical state of the body.

Introduction


Ayurvedic classics narrate the observations of great sages like Charaka, Susruta, Vagbhata

and Kashyapa. Their accomplishments are available as authoritive classics of this. It emphasizes man

as conglomeration of the panchamahabhutas and atma. The entities viz Panchamahabhutas are present

in the body in the form of dosha, dhatu and malas comprising various organs and organ systems, these

together forms the physical and material aspect of man. A critical, careful and unbiased study of the

classical Ayurvedic texts shows that by the time the samhita granthas were compiled, the science and

art of Ayurveda had reservation of health first and then the correction of its disturbances that is

diseases.

Ayurveda opines disease or vyadhi is a state in which both the mind and body suffers from

pain, misery and even injury.2 The causative factors may vary depending on the different entities but

actually, Tridoshas (Vata, Pitta and Kapha) are the intrinsic Causative factors, which are vitiated due

to extrinsic factors and their balance is disturbed. Ayurveda prescribes various therapeutic measures

either in the form of Purificatory (Samshodhan) or Pacificatory (Samshamna) for the alleviation of the

disease of both mind and physique3

There have been advances in understanding of this disease. No longer is osteoarthritis,

regarded as a simple consequence of aging and cartilage degeneration. Indeed, the former diagnostic

label of ‘degenerative joint disease’ is now recognized to be a ‘Misnomer’. A single definition of

Osteoarthritis remains elusive. A workshop held in 1995 proposes following consensus definition.

“Osteoarthritis disease is the result of both mechanical and biological events, which destabilize the

normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracellular

matrix and subchondral bone.”

Though there is a lot of an advance in understanding of this disease, day by day the disease

has become a problem. As a constellation of clinical and anatomical features, analogous to heart

failure, indeed ‘OA’ might with advantage be renamed ‘joint failure’. Management of this disease is

facing lot of difficulties.

Contemporary science has failed to find a solution for this disease. It is said that current

treatment for osteoarthritis is purely control of symptoms because there is no disease modifying

osteoarthritis drug yet. Intraarticular steroids are widely used, even though they provide marked relief

Introduction


from symptoms but they lost their effect from a week to month. Because studies in animal models

have suggested that glucocortciods produce cartilage, damage and frequent injections of large amount

of steroids have been associated with joint breakdown in humans.

Among the Ayurvedic practitioners, osteoarthritis called as SANDHIVATA. But in all

classical treatises it is mentioned as SANDHIGATA VATA.

This study is an attempt to help the patients suffering from sandhigata vata in our society

though the administration of AJAMODADI VATI. Hence a research has been conducted to evaluate

the efficacy of Ajamodadi vati in sandhigata vata. AJAMODADI VATI is a classical yoga with the

ingredients Ajamoda; Pippali; Vayuvidanga; Shatapushpa; Chitrakamula; Nagara; Haritaki;

Vrudhadaruka; saindhava lavana; Guda.

INCIDENCE AND PREVELENCE:

Sandhigatavata can be compared with Osteoartrhitis of contemprorary medical science.

Osteoarthritis is the second musculoseletal disorder in the world population(30%) after

backpain(50%). The reported prevalence of osteoartrhitis from a study in rural India is (5.78%).

Among 80% of world population the prevelence is usually seen in the age group of 60-65 yrs with

some radiological evidences.Only20-30% of O.A are associated with symptoms4

PURPOSE OF STUDY:

Sandhigatavata is the most common form of joint disorder amongst the elderly and obese

persons. It is a major cause of morbidity and chronic disability as well as burden on health care

resources especially for the elderly. This disease keeps an insidious attack, which runs for many

years causing the loss of function as well as deformity of the joints. Elderly osteoarthritis is the

leading cause of chronic disability and some 1, 00,000 people in the United States are unable to walk

independently from bed to bathroom because of OA4.Because of O.A about 20-30% of people of

India are affected by some complaints of knee joint pain during their lives. Females are found to be

more affected by this disorder5. In spite of the scientific advancement in the field of Medicine, a

large number of people suffer from OA all over the world without a permanent relief from this

disease.

Introduction


According to WHO Osteoarthritis is the second commonest musculoskeletal problem in the

world population. Sandhigatavata is the most common joint disorder worldwide. The overall

prevalence of the disease in the population above 40 years of age is about 49% with a female to male

ratio of 1:16. The man today even in his young adult age suffering from the degenerative diseases

like Sandhivata the condition where the pain and the swelling in the joints are present giving rise to

the restricted movements,7 and also it is not a single disease rather it is the end result of variety of

patterns of joint failure together or lesser extent it is always characterized by the degeneration of

articular cartilage and simultaneously proliferation of new bone. Radiological autopsy studies show

that osteoarthritis preferentially targets only certain small and large joints there is steady rise in over

all prevalence from age 60-65. 80% of people are having some radiological evidence of O.A. though

only 20-30% has associated symptoms.

In the contemporary system of medicine, NSAIDs and surgery are practiced in the

management of this disease, but have their own limitations. it using NSAIDS but larger anti

inflammatory drugs are usually no more effective and carry on increased risk of gastric erosion, or

hemorrhage in elderly distinct women8. In addition a recent reviews of the literature about non-

steroidal anti-inflammatory the chance of hospital admission or death due to serious G. E. event up to

16 per thousand per year.

This disease restricts the normal movements of the affected joint, thereby rendering the

patient incapable of performing his/her normal activities. Contemporary medical science is able to

pacify the painful condition through analgesics and surgery mainly. But, this provides only temporary

relief, as the underlying pathology is not managed. Hence it becomes essential to search a new way

for the treatment of sandhigata vata osteoarthritis which proves to be a ray of hope for further research

works.

Human intellect and intellectual efforts never allowed him to be satisfied. Different remedial

measures keep being increasing in pace with ever increasing medical needs. Anti-inflamatory and

analgesic drugs are the basic choice of community. Unforunately all the analgesic are liable to give

many side effects particularly by repeated and prolonged usage. Occasionaly more effective drug

actions associate with more serious irreversible reactions.

Introduction


So, in Ayurveda the ancient Indian system of medicine has suggested good old techniques and

rectifies the painful condition without causing any complications and thus preventing the further

development of degenerative changes. Thus the present study is under taken 9.

However the management of pain and swelling in the acute condition left a room to work in

terms of AJAMODADI VATI modality to provide relief during acute phases.

RESEARCH QUESTIONS:

• To evaluate the Vedanahara property of Ajamodadi vati in sandhigatavata.

• To evaluate the Shothahara property of Ajamodadi vati in sandhigatavata.

LACUNAE IN CURRENT KNOWLEDGE:

The traditional knowledge is based upon the humeral theory that too management based upon

the Prabhava of a dravya.Thus in Ayurveda presently many researches are undertaken with reference

to that of pharmacodynamics and pharmaco kinetics. The trends are changed where an evidence based

therapeutics are to be shown to the scientific community. It is a thought that there are no proper

disease management techniques or medicaments available with Ayurveda.But many vedanasthapaka

and shothahara dravyas established and recorded from ages. Thus an atempt is made to know the

efficacy of management of sandhigata vata through Ajamodadi vati.

HYPOTHESIS:

It is clear to state that the vedana and shotha are the main features of sandhigatavata, wherein

vedanahara and shothahara are the drugs of choices. In Ayurveda the herbs acting as vedanahara and

shothahara are suggestive of pain releivers.Thus in this study an effort is being made to discuss on

symptoms and the treatment to be adopted in the patients suffering from sandhigata vata.This

approach is based on the symptomatic management in Ayurveda viz lakshanika chikitsa.

It is the hope that the present study will open new areas of research and provide the platform

for further investigation drives in Ayurveda field that are searching for a fast pain relief management

by contemporary scientific methods.

Objectives


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Millions of people worldwide affected with Joint pain yet we have a limited knowledge of what

makes our joints painful. As recent reports released by the WHO, musculo skeletal disorders are

the most frequent cause of disability in the modern world, and the prevalence of these diseases is

rising at an alarming rate. The most prominent reason for either pain or loss of joint mobility as

degeneration along with loss of functions with chronic or episodic pain is leading one’s to not

Objectives


only distress but also impaired quality of life. Current clinical trial helps to lessen joint pain with

the effectiveness of drug combination that produces unwanted negative side effects, there by

precluding their long-term use. In short, patients who are suffering from the debilitating

degenerating effects with joint pain for which there is no satisfactory treatment is treated with the

present study combination which is intended to focus on the symptom evaluation i.e. Sandhi

Shoola (joint pain).

1) To evaluate the Vedanahara property (analgesic effect) of Ajamodadi vati in Sandhigata

vata.

Ajamodadi vati by virtue of its Ushna guna dominance is a Vata hara that comprises of

Tridosha hara properties because of the sheeta guna addatives, which reduces pain in the joint

and acts as Rasayana, which will take care of Vata vitiation there by restores the Vata to its

normal functions along with restructuring the joint structure. The Laghu and snigdha guna

with their penetrability and unctuous enters deep in to the synovial cavity of joint very fast to

act locally as analgesic and intactness makes the reconstruction of joints with its embedded

quality of unctuousness. The Ajamodadi Vati assessment in this trial as general pain reliever

is estimated through the subjective and objective assessment.

2) To evaluate the Shothahara prabhava (anti-inflammatory effect) of Ajamodadi vati in

Sandhigata Vata

Ajamodadi vati as discussed above substantiates the structure and pacify the Vata thus the effect

of sothahara, reduction of sopha in the joint takes place. In turn which will take care of Vata

vitiation there by restores the Vata to its normal functions. The Laghu guna with its penetrability

to deep enters the joint very fast to act as anti-inflammatory. The Ajamodadi Vati assessment in

this trial as inflammation reliever is estimated through the subjective and objective assessments.

Review of literature


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HISTORICAL REVIEW:

A critical review of the history from the primitive stage to the new millennium assists one to

understand the future in a better way. Man always struggled with present and attempted for the better

future by this can we achieve with a better perspective, when the past and present experiences and truths

are checked and planned at proper time. History helps to reveal the hidden facts and ideas of the

concerned subject.

Sandhis and the diseases affecting them were well known in the Vedic period. One can observe

description of body parts in Atharvanaveda where in the words “Januni and Ashtivantau”10 were used to

denote knee joints. The disease Sandhigatavata had not been mentioned as such in Vedic literature.

However, Rigveda while describing various skills of Ashwinikumaras had recorded their skill in treating

joint diseases too11. One of the mantras of Rigveda states that, “I am removing your diseases from each

organ, hair and joint.” Atharvanaveda had mentioned Parvashoola and Vateekrita, two diseases similar

to Sandhigatavata12. In Atharvanaveda, records about Vatavikaras are mentioned.13 A mantra says,

“Destroy the balasa seated in the organs and joints which is responsible for loosing bones and joints”14

As stated in agnipurana total number of joints in human body and treatment of sandhigata

samavata denotes the knowledge of joints,15 since then Charakaacharya-mentioned about sandhigata vata

as sandhigatoanila in Chi. Sushruta samita gives references in vatavyadhi nidana about sandhivata.16

Astanga samgrahakara and hridayakara also states same as charaka and sushrutaacharya17.

Asthimajjagata vatavyadhi a description of sandhivichyuti has been explained in Bhela samhita18.

Sandhigata vata has been explained in Harita samhita.19 In madhyama and aadunika kala some aacharyas

mentioned about the diseases. NIDANE MADHAVA SHRESTA HA & hence has explained about this

disease,under vatavyadi chapter sandhigata vata lakshanas along with treatment20.



Yogaratnakar;gadanigraha; vangasena both treatment aspect & clinical entity has been found

either in words of charaka or sushruta. Sandhigatavata can be correlated as osteoarthritis in modern

scince. this is due to the nature of the disease & its similarity of cardinal symptoms.

Osteoarthritis (OA) is the most common joint disorder in human beings and other vertebrates.

Even in giant dinosaurs, osteophytes leading to alkalosis were detected21. In all mammalian species like

whales and dolphins and in fish birds and some amphibians, Osteoarthritis is observed22.

In the early ages, Hippocrates observed the prevalence of OA in aged individuals (Benard,

1944)23. Heberden (1803) studied this disease in detail and the nodes on the fingers in OA disease were

named after him24. Osteoarthritis was differentiated from Rheumatoid Arthritis and named as

degenerative arthritis by Nichols and Richardson (1909) on morbid anatomical grounds25. Although the

most ancient of the diseases, OA was first identified as a distinct entity in the 20th century. Gold thait in

1904 made a distinction between hypertrophic and atrophic arthritis and A. E Garrod recognized OA as a

clinical entity in 190726.

Approximation of Herberdon nodes in relation with age; sex and hereditary factors was

mentioned by Strecher(1940)27. Intermitent claudicstion in osteoarthritis of lower limb including hip;

knee & ankle joints were observed by Boyd(1949)28

The term osteoarthritis was used to signify the absence of synovial thickening or inflammatory

infiltration in uncomplicated condition by Kellgren(1961)

The term osteoarthritis; Hypertrophic arthritis are mentioned under degenerative arthritis by

Samuel.L.Turek(1989)29



SANDHI SHAREERA:

JANU SANDHI - KNEE JOINT

The present study was undertaken to assess the efficacy of ajamodadi vati in the management of

sandhi gata vata. Before discussing the disease sandhigata vata it is very essential to understand the

structure of knee joint, functional aspects of articular cartilage, synovial fluid and synovial membrane so

all these points are summarised here.

In Ayurveda, sandhis are mainly classified into two types;

1) Sthira sandhi

2) Chala sandhi30

Again they are subclassified into eight types.31

1) Kora sandhi 5) Tunnasevani

2) Ulookala 6) Vayasa tunda

3) Samudga 7) Mandala

4) Pratara 8) Shankhavarta

Acharya Sushruta father of Surgery consider janu sandhi under chala sandhi and sub

classification under kora sandhi.

Shleshaka kapha:Among five variey of kapha,shleshaka kapha resides in joints.it keeps the joints

firmly united,proects their articulationopposes their seperation and disunion.32 Shleshmadhara Kala - It is

the fourth Kala, which is situated in all joints of living

beings. As wheel moves on well by lubricating the axis, joints also function properly

if supported with Kapha. This helps in lubrication of joints

ETYMOLOGY OF SANDHIGATA VATA

1) Sandhi

Vyutpatti - SAM + DHA + KIHI

Nirukti -

Sandirnama Samyogaha33

Asthidwaya Samyogasthana34



Sandhyarnama, asthanam, anyonya, sangam, asthani, junction, connection, combination, union

with containing a conjugation, transition from one to another.35

Paribhasha : Sandhi pullinga, sandhanamiti, Yuga sandhini yugashabde deha sandhini marmashabde

cha drishtavyaha.36

In general, sandhi means the junction between two things in Ayurveda shareera sandhi is a

technical word indicating that it is the place where two are more bones meet together and the joint may

be fixed type or of less or more movement. Acharya Sushrutha told that, in our body there are

innumerable sandhi are present.

2) Vata

Vyutpatti - Va - Gati gandhanayoho

Va - Gati sevanayoho

Va + Kthaha37

Pullinga Va + Kthaha 38

Nirukti - Sparsha matra vishesha gunake bhutabheda

- Pavane - dehasya dhatubheda cha 39

- Wind, Air, as one of the humours of the body40-41

The word ‘Osteoarthritis’ is a combination of three words. ‘Osteon’, ‘arthron’ and ‘itis’

respectively means bone, joint and inflammation42. The meaning of this word is ‘inflammation to the

bony joint’. In fact, there is no inflammation in this disease, hence, the disease is also known as

Osteoarthritis and Degenerative joint disease.

Paryaya of Sandhigata Vata

Different authors named this disease according to their own views, ie. as follows.

Sandhigata anila43

Khuda vata44

Sandhi vata45

Jeerna vata46



Nidana (47,48,49,50,51,52,53,54)

Even though classics of Ayurveda do not mention the Nidanas of Sandhi-Gata-Vata, one has to

compile the relevant references mentioned in different contexts like Vata Vyadhi Nidana (Ca. Sa. Ci.

28/15-17, Su. Sa. Su. 21/19, A. Hr. Ni. 1/14-15, Yo. Ra. Pu.Vat.1-4, Bh. Pr. Ci.Vat. 1-2, Ma. Ni. Pu.

22/1-3), Asthivahasroto Dushtikarana (Ca.Sa.Vi.5/27), Majjavahasroto Dushtikarana (Ca.Sa.Vi.5/28).

Nidana can be classified under various headings with different views. Among them one

classification is Sannikrishta and Viprakrishta Karana. Here with the complimentary references the

Nidanas of Sandhi-Gata-Vata is classified on this basis.

i) Sannikrishta Hetu –

Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana, Pradhavana, Atisankshobha.

ii) Viprakrishta Hetu –

Rasa – Kashaya, Katu, Tikta

Guna – Rooksha, Sheeta, Laghu

Dravya – Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura, Kalaya, Adaki, Harenu,

Shushkashaka, Vallura, Varaka.

Aharakrama – Alpahara, Vishamashana, Adhyashana, Pramitashana

Manasika – Chinta, Shoka, Krodha, Bhaya

Viharaja – Atijagarana, Vishamopacara, Ativyavaya, Shrama, Divasvapna, Vegasandharana,

Atyucchabhashana.

Some of the important Nidanas are discussed below-

Ativyayama

Excessive physical exercises act as one of the important Nidana for Sandhi-Gata-Vata. Running,

walking, jogging etc. if done excessively or violently will affect the structures of Sandhi. They mainly

affect the Joint stability by over exertion. But if done properly they stabilize the Joint.



Bharahvahana

Carrying excessive load causes excessive pressure and stretching effect over the structures of the

joint. As knee is weight bearing joint, carrying excessive load will have direct affect on articular disc.

The constant compression will lead to wear and tear effect leading to degenerative changes in the discs.

Abhighata

Abhighata to joints due to Prapatana etc., lead to structural deformity in the joints. Joint is an

organ rather than a single structure. It is stabilized by different structures like Asthi, Snayu, Peshi, and

Kala etc. Hence, any trauma to these structures will alter the structural integrity of the joint. Hence,

Abhighata is an important Nidana for Sandhi-Gata-Vata.

Atisankshobha

It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas is involved in Sandhi-Gata-

Vata this can be considered as Nidana for the same. Violent activities like Atyadhva, Plavana, Langhana,

Balavat Vigraha, Pradhavana etc. will have its effect on joint. As told earlier knee is the weight-bearing

joint, the violent exercises or activities will alter the structural integrity of the joint.

Marmabhighata

The concept of Marmabhighata in the causation of Sandhi-Gata-Vata sounds more rational. Janu-

Sandhi is a variety of Vaikalyakara Sandhi-Marma (Su. Sa. Sh. 6/7, 12, 13)55. Marma is a vital point,

which comprises of Asthi, Snayu, Sira, Mamsa and Sandhi. Hence any Marma is made up of all these

structures, likewise the Janu-Sandhi.

Pain in the joints not necessarily be only associated with bony changes. But involvement of other

joint structures may also give rise to symptoms pertaining to joint. Therefore, in recent days more study

is emphasized on the different structures involved in the pathology of Arthritis like consistency of soft

tissue, fibrous material, liquid and cartilaginous substance of the joint. From this new point the

Ayurvedic view towards the involvement of certain Marma in the disturbance of the joint i.e. painful

joint will be anticipated. Hence Marmabhighata as a Nidana in case of Sandhi-Gata-Vata is to be given

importance.



Table No. 1 - Samanya Nidana of Vata Vyadhi as Explained in Different Treatises. Nidana Cha. Sam Su. Sam A.H MN YR BP Aharaja Nidana Kashaya - + + - - + Katu - + + - - + Tikta - + + - - + Rooksha + + + + + + Laghu + - + + + - Sheeta + - + + - - Vallura + - - - - - Varaka + - - - - - Shuskha Shaka - + - - - - Uddalaka - + - - - - Neevara - + - - - - Mudga + - - - - - Masura + - - - - - Harenu + - - - - - Kalaya + - - - - - Nishpava - + - - - - Viharaja Nidana Ati Vyayama + + + + - - Langhana + + - + + - Plavana + + - + + - Atyadhwa + - - + + - Pradhavana - + - - - - Pratarana - + - - - - Atyuchabhashana - + - - - - Balavadvigraha - + - - + - Abhighata + + - + - + Marmaghata - - + + - - Bharaharana + - - - + - Dukhashayya - - + + - - Dukhasana + - - - - - Sheegrhayana + - + + - - Prapeedana - + - - - - Atiadhyayana + - - - - - Ati vyavaya + + + + + + Atijagarana + + + + + + Vegadharana + + + + + - Vishamopachara + - - + + - Shrama - - - - - + Upavasa + + + + + + Puravata sevana - - - - - + Divasvapna + - - - - - Manasika karana Cinta + - + + + + Shoka - + + + + - Krodha - - - - - - Bhaya - - - - + -



Anyat (other nidanas): -

Panchakarma apacharas like atidoshasravana, atirakthasravana, atiyoga of langhana, apatamsana

etc and dhatukshayakarabhavas like rogakarshana, gadakrita atimamsakshaya, etc vitiate Vata.

Dhatukshaya is an important vitiating factor of Vata.

Sthoulya is another causative factor for Vata prakopa. The meda-avarana of Vata is the

mechanism causing inter- relationship between sthoulya and Vatavyadhis.56 All types of avaranas are also

important vitiating factors of Vata. Vata dominates vardhakya avastha57. During this period, dhatukshaya

occurs causing Vata prakopa.

Living in jangaladesha is another causative of Vata prakopa.58 Vata gets vitiated in the end of day

and night59. Vata also vitiated during the end of greeshma ritu, varsha ritu and shishira kala.60 Vata

prakriti persons are more susceptible to Vata vikaras. Persons who are rooksha-kashaya-katu-tikta satmya

are also more susceptible to Vata vikaras.

Among all the types of nidanas mentioned some need special attention. Adhyashana leads to

excessive body weight and this result in more pressure over weight bearing joints. This gradually

weakens the sandhis and produces Sandhigatavata. Excess exercise may not only vitiate Vata but further

leads to shleshaka kapha kshaya contributing to Sandhigatavata. Excess walking and excessive weight

bearing also are important in the context of Sandhigatavata. Abhighata to marmas or sandhis is another

important risk factor for Sandhigatavata. Vardhakya avastha characterized by dhatukshaya leading to

peshi-snayu-marma shosha, thereby resulting in looseness of joints is also a major risk factor for

Sandhigatavata. The factors like that vitiate asthivahasrotas (ativyayama, atisamkshobhana,

asthivighattana and vatalasevana).61 also need to be mentioned in the nidana of Sandhigatavata.

Risk factors for Osteoarthritis (OA)62

i) Age factor –

Age is the most powerful risk factor for OA. The association between OA and aging is non-

linear. It usually begins after a person is 40 or more years old. By the age of 60 years, almost everyone



has OA. More than 80% of people over 60 years old have radiological evidence of OA in one or both

knees and 30% in one or both hips.

ii) Sex factor –

It is told that women are at high risk than men in developing OA. Over 30% of women (elderly)

have OA in the interphalangeal joints of the hands. Except in the hands, men and women are affected

equally, though the lesions often appear at a young age in men. Only 3% of elderly men have primary

OA in the hands.

iii) Hereditary factor –

The relation of heredity is less ambiguous. Thus, the mother and sister of a woman with distal

interphalangeal joint OA are respectively twice and thrice as likely to exhibit OA as the mother and sister

of an unaffected woman.

iv) Race factor –

Racial difference exists in both the prevalence of OA and the pattern of joint involvement. OA is

more frequent in Native Americans than in whites. The Chinese in Hong Kong have a lower incidence of

hip OA than in whites. Interphalangeal joint OA and especially hip OA are much less common in South

African blacks than in whites in the same population. Whether these differences are genetic or are due to

differences in joint usage related to life style or occupation is unknown.

v) Obesity factor –

Obese persons have a high risk of OA. For those in the highest quintile for body mass index at

base line examination, the relative risk for developing knee OA in the ensuing 36 years was 1.5 for men

and 2.1 for women. For severe knee OA, the relative risk rose to 1.9 for men and 3.9 for women,

suggesting that obesity plays an even larger role in the etiology of the most serious cases of knee OA.

vi) Occupational factor –

Repetitive movements may leads to excessive strain leading to erosion and joint damage. Men

whose jobs require knee bending and at least medium physical demand had a higher rate of radiographic

evidence of knee OA and more severe radiographic changes.



vii) Traumatic factors –

Trauma to the joint seems to enhance the occurrence of arthritis. It disturbs the alignment of the

joints and over a period of time, this malalignment may lead to excessive wear and tear leading to OA.

According to the cause of OA, it is classified as primary and secondary. Primary OA is the term

used when the disorder arises from unknown or hereditary causes. Secondary OA describes cases in

which direct causes for the disorder are known.

Classification based on causes63

I. Primary

Idiopathic, Primary generalized osteoarthritis and Erosive osteoarthritis.

II. Secondary

Congenital or developmental defects (Hip dysplasias, shallow acetabulum, Morquio’s syndrome, etc.),

III. Traumatic

a. Acute, b. Chronic and c. Charcot’s arthropathy,

Inflammatory RA, psoriatic arthritis, septic arthritis, pseudogout,

Endocrinal influence Acromegaly, diabetes mellitus, sex hormone abnormalities, hypothyroidism with

myxedema and Metabolic Gout, itemochromatosis, ochronosis, chondrocalcinosis, paget’s disease.

Samprapti

From the onset of Dosha Dushya Dushti till the evolution of the Vyadhi there occurs various

Vikriti. Samprapti explains such series of pathological stages involved. It tells us about the total

pathogenesis of a disease.

The Samanya Samprapti of Vata Vyadhi that is explained in classics can be considered as the

Samprapti of Sandhi-Gata-Vata or a base to understand the Samprapti of Janu-Sandhi-Gata-Vata.

Acarya Caraka explained64 – due to the intake of Vatakara Ahara Vihara Vata vitiation take

place. This vitiated Vata lodges in Rikta Srotas i.e. Srotas in where Shunyata of Snehadi Guna is present.

Vata after settling in Rikta Srotas produce disease related to that Srotas (Ca.Sa.Ci.28/18-19).



Acarya Vagbhata frames the Samprapti of Vata Vyadhi like – Dhatukshaya aggravates Vata and

the same is responsible to produce Riktata of Srotas. Thus the vitiated Vata travels throughout the body,

settles in the Rikta Srotas, and further vitiates the Srotas leading to the manifestation of Vata Vyadhi

(A.Hr.Ni.15/5-6).65

Here an attempt has been made to explain how this Srotoriktata occurs due to Nidanasevana. The

chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess. These are the

properties, which are necessary for Sthairya and Upacaya of the body. Excessive intake of Dravyas

having Laghu, Ruksha, Sukshma, Khara properties lead to Guru and Sneha Guna Abhava due to their

opposite quality. Thus, it leads to Dhatukshaya in the body. Akasha is the Mahabhuta that produces

Sushirata and Laghuta in the body. Vayu Mahabuta fills up this Sushirata. So due to Dhatukshaya Akasha

Mahabhuta increases in the body producing Sushirata and Laghuta simultaneously Vayu fills it up.

From a description it can be stated that the meaning of word ‘Riktata’ is Sushirata i.e. increase in

Akasha and Vayu Mahabhuta. While commenting on word ‘Riktata’ Cakrapani says that ‘Riktata’ means

lack of Snehadiguna. For understanding, the Samprapti of SandhiVata can study under two heading.

They are -

1. Dhatu Kshaya Janya and

2. Avarana Janya Sandhi-Gata-Vata.

1. Dhatu Kshaya Janya Sandhi-Gata-Vata

In old age, Vata Dosha dominates in the body. This will lead to Kapha Abhava. Also Jataragni

and Dhatvagni gets impaired, by which Dhatus formed will not be of good quality. Degeneration of body

elements takes place due to predominance of Vata in its Ruksha, Khara, etc. Guna and loss of Kapha in

quality and quantity.

As the Shleshma Bhava decreases in the body, the Kapha Bheda i.e. Shleshaka Kapha in the

joints also decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi Bandhana

Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi being the main participant of

the joint its Kshaya leads Khavaigunya in the joints.



In this condition if Nidana Sevana done further produces Vata Prakopa. If Vata Prakopa is not

corrected by appropriate means and simultaneously if the person indulges in Asthivaha and Majjavaha

Sroto Dushtikara Nidana, the Prakupita Vata spreads all over the body through these Srotas. In the

meantime, Sthanasamshraya of Prakupita Vata take place in the Khavaigunyayuta Janu-Sandhi. This

localized Vayu due to its Ruksha, Laghu, Kharadi Guna over power and undo all properties of Sleshaka

Kapha producing disease SandhiVata.

2. Avarana Janya Sandhi-Gata-Vata

In Sthulas usually Sandhi-Gata-Vata occurs in weight bearing joints. In them Medodhatu will be

produced in excess due to the Atisnehamsha of Amarasa (Su.Sa.Su. 15/32)66. The excessive Medas will

produce obstruction for the flow of nutritive materials to the future Dhatus i.e Asthi, Majja and Shukra

leads to their Kshaya.

The excessive fat deposited all over the body will produce Margavarana of Vata67 (Su.Sa.Su.

15/32 – Dal.). Prakupita Vata due to Margavarana starts to circulate in the body. While traveling it settles

in the joint where Khavaigunya is already exists. After Sthanasamshraya it produces the disease Sandhi-

Gata-Vata in the same process mentioned in the earlier context.

Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Janu-Sandhi-Gata-

Vata can be divided into Dhatukshaya Janya and Avarana Janya. This will help in deciding the prognosis

and planning the treatment of the disease.

Samprapti Ghataka:

Dosha – Vata – Vyana – Vriddhi; Kapha – Shleshmaka – Kshaya Dooshya – Peshi, Snayu, Asthi, Majja Srotas – Mamsavaha, Medovaha, Asthivaha, Majjavaha Agni – Jataragni, Asthi-Dhatvagni Ama – Jataragni Mandya Janya Roga Marga – Madhyama Udbhavasthana – Pakvashaya Sancharasthana - Sarvasharira Adhishtana – Sandhi Vyaktasthana – Sandhi



FIGURE NO - 1

SAMPRAPTI IN DHATUKSHAYA JANYA SANDHIVATA

UKTA NIDANA SEVANA VARDHAKYA

DHATUKSHAYA

VATA PRAKOPA KSHAYA OF KAPHA BHAVA

IN THE BODY

CIRCULATION THROUGH SHLESHAKA KAPHA KSHAYA

RASAYANI IN SANDHI

KHAVAIGUNYA IN SANDHI

STHANASAMSHRAYA IN SANDHI

SANDHIVATA



FIGURE NO - 2

SAMPRAPTI IN AVARANA JANYA SHADHIVATA

MEDOVRIDDHI

(MEDOVARANA) (MARGAVARANA TO THE

FLOW OF POSHAKARASA)

VATAPRAKOPA POSHAKARASA NYUNATA TO

ASTHIDHATU

EXCESSIVE PRESSURE OVER

WEIGHT BEARING JOINT

CIRCULATION THROUGH ASTHIDHATU KSHAYA

RASAYANI IN SANDHI

VYANAVATA PRAKOPA

IN SANDHI

KHAVAIGUNYA IN SANDHI

STHANASAMSHRAYA IN SANDHI

SANDHIVATA



POORVAROOPA68

Particular mentioning of Poorvaroopa of Sandhi-Gata-Vata is not available in classics. In

Vatavyadhi also unmanifested symptoms (Avyakta) or mild exhibition of actual features of the disease

itself (Alpa vyakta) is considered as its Poorvaroopa (Ca.Sa.Ci.28/19). Hence clinical features of

Sandhi-Gata-Vata in milder form can be considered as Poorvaroopa.

ROOPA

The clinical features of Sandhi-Gata-Vata explained by various Acharya are listed in Table2

Roopa of Sandhi-Gata-Vata mentioned in various classics

Table No 2 : Roopa of Sandhigata vata asmentioned in various classics

SYMPTOMS Ca.Sa. Su.Sa. A.Hr. A.Sa. Ma.Ni. Bh.Pr. Yo.Ra.

Sandhi Vedana + + + + + + +

Sandhi Shotha + + + + _ + +

Sandhi Stabdhata _ + _ _ + _ _

Atopa _ _ _ _ + _ _

Sandhi Vedana

All the Acarya have described this symptom. Caraka69 and Vagbhatas70 explain that pain in the

joint is elicited during Prasarana Akunchana Pravrutti.

Sandhi Shotha

Most of the authors explained this symptom. Caraka and Vagbhatas explained the nature of

Shotha i.e., it is felt like bag filled with air (Vata Poorna Driti Sparsha).

Sandhi Stabdhata

Sushruta71 initially described this symptom, later by texts like Madhava Nidana,72

Yogaratnakara,73 and Bhavaprakasha74.



They have coined the term Sandhi Hanana or Hanti. While commenting on this word Dalhana75

and Gayadasa explained as “Akunchanaprasaranayoh Abhavah” and “Prasaranakuncanayoh Asamarthah”

respectively. With this we can infer that the word Hanti refers to inability to move the joints.

In the opinion of madhukoshakara76, Hanti referes to Sandhi Vishlesha, Stambha Adi Vikara. Hence with

the above references, Hanti refers to Sandhi Stabdhata.

Atopa

This symptom explained in Madhava Nidana77. While commenting on the word Atopa in another

context, Madhukoshakara quotes the opinion of Gayadasa and Kartika. I.e.‘Atopaha Chalachalanamiti

Gayadasaha, Gudaguda Shabdamiti Kartikah’. Also Bhavamishra says ‘Atopo – Gudagudashabdaha’

(Bhavamishra on Bh.Pr.Ci.24/93).78

Thus we can say that Atopa in this context is the sound produced by the movement of joints i.e.,

Crepitus. Thus with the help of different references and by the opinion of commentators it can be

concluded that Sandhi Shoola, Sandhi Shotha, Sandhi Stabdhata and Atopa are the clinical features of

Sandhi-Gata-Vata or Janu-Sandhi-Gata-Vata (Ca.Sa.Ci.28/37 & Cakra; Su.Sa.Ni.1/28 & Dal, Gaya;

A.Hr.Ni.15/14; Bh.Pr.Ci.24/258; Yo.Ra.Vat.Ni; Ma.Ni.22/21 & Madhu).

Vyavachedakanidana

Sandhigatavata is a disease affecting the bony joints. So virtually, every disease that affects the

joints has to be differentiated with Sandhigatavata. The most common differentiation is to be made with

Vatarakta, Amavata and Kroshtrukasheersha.

Table No. 3. Showing Vyavachedaka nidana between Sandhigatavata and Vataraktha

Sl. Criteria SGV Vatarakta Vatavridhikara ahara-vihara

Vidahi, viruddha, rakthaprakopakara ahara

2 Poorva roopa Avyaktharoga Lakshana

Kushtasama

3 Roopa Sandhishoola, Prasarana akunchanayoho vedana, Sandhi shopha, Vatapoornadrithi Sparsha

Teevra ruk, Grathita-paki shvayathu



4 Adhisthana Sandhi Padamoola, Hastamoola

5 Doshas Vata Vata, Rakta 6 Upashaya Ushna – snigdha Sheeta

Table No. 4. Showing Vyavachedakanidana of Sandhigatavata and Amavata

Sl. Criteria SGV Amavata

1 Nidana Vatavridhikara

ahara-vihara

Viruddha ahara-cheshta

2 Poorva roopa Avyaktharoga

Lakshana

Hridaya dourbalya,

Gourava

3 Roopa Sandhishoola,

Prasarana akunchanayoho

vedana,

Sandhi shopha,

Vatapoornadrithi

Sparsha

Vrischika damshavat

peeda,

Pidakayukta shopha

4 Adhisthana Sandhi Hasta, Pada, Gulpha,

Trika, Janu etc.

5 Dosha Vata Vata, Kapha

6 Upashaya Ushna, snigdha Ushna-rooksha

Table No. 5. Showing Vyavachedakanidana of Sandhigatavata & Kroshtrukasheersha

Sl. Criteria Sandhigatavata Kroshtrukasheersha

1 Nidana Vatavridhikara

ahara-vihara

Vatavridhikara

ahara-vihara

2 Poorva roopa Avyaktharoga lakshana Avyaktharoga lakshana

3 Roopa Sandhishoola,

Prasarana akunchanayoho

vedana,

Sandhi shopha,

Vatapoornadrithi

Sparsha

Maharuja,

Janushopha

4 Adhisthana Sandhi Jan Madhya

5 Dosha Vata Vata, rakta



6 Upashaya Ushna, snigdha Snigdha, seetha

Table No. 6. Showing Differential diagnosis between OA, RA, Gout and Rheumatic fever.

Sl. Criteria OA RA Gout Rheumatic Fever

1 Symptoms Pain & swelling on major weight bearing joints, stiffness, crepitations, tenderness, enlargement of joint space

Inflammation in multiple joints, morning stiffness >30ms

Polyarticular pain, swelling & inflammation, exquisite tenderness

Painful and tender joints

2 Mode of On set

Gradual Abrupt Acute Acute

3 Joints Involved

Weight bearing Joints

Polyarticular Metatarso- phalangeal joints

Polyarticular

4 Systemic Features

- Autoimmune disease, rise in temperature, anemia etc.

- Carditis, fever, chorea

5 Investigations RA-ve, ESR normal, X-ray- narrowing of joint space, subchondral bony sclerosis, osteophytes etc.

ESR raised, X-ray-soft tissue swelling.

Serum uric acid raised, punched out lesions in subchondral bone.

ESR increased, CRP high, WBC elevated.

Vyana Vata - Vata governs every movement in the body. Vyana Vata is one among the five varieties of

Vata, which resides at Hridaya and controls most of the motor functions. The Gati or physical movement

is also one of its functions. Gayadasa commenting on Sushruta has quoted the wordings of an unknown

author as though the Vyana Vata is functioning all over the body it resides in the Sandhi83. Acarya

Vagbhata states that Vata is located in the Asthi with relation to 'Ashrayashrayi Sambandha'. Generally

augmentation or diminution of Doshas would be given similar effect on their respective Dhatus but in

case of Vata it is opposite; with increase in Vata, Asthi Kshaya occurs84 Sushruta in Sharirasthana

explains different structures of the human body. Among them, structures coming under Janu-Sandhi are

listed below. Snayu - Among nine hundred Snayus, ten are present in Janu-Sandhi. More over in Shakha



and Sandhi, Pratana variety of Snayu is present. Importance – As a boat consisting of planks becomes

capable of carrying load of passengers in river after it is tied properly with bundle of ropes, all joints in

the body are tied with many ligaments by which persons are capable of bearing load85 Peshi- The fleshy

mass demarcated from each other is known as Peshi. In Janu they are five in number. They are strong

structures that help to maintain alignment of the joint86 Sanghata - Assemblages of bones are fourteen.

One is situated in Janu-Sandhi87

Modern review

Knee Joint - The knee joint, largest of the human joints, is most complex joint of the body. The

complexity is the result of fusion of three joints in one. The original three joints includes the lateral

femorotibial, medial femorotibial and famoro patellar

The articular surfaces - Knee joint is formed by

1) The condyles of femur

2) The condyles of tibia

3) The patella

The femoral condyles articulate with tibial condyles below and behind and with patella infront.

Condyles of Femur - The lower end of femur is widely expanded to form two large condyles a medial

and a lateral. The condyles are partially covered by a large articular surface which is divisible into

patellar parts.

The patellar surface covers the anterior surfaces of both condyles and extends on more

lateral condyle than on the medial. The tibial surfaces cover the inferior and posterior surfaces of

the two condyles and merge anteriorly with the patellar surface. The lateral part of the surface is

short and straight anteroposteriorly. The medial part is longer and curved with convexity

directed medially.

Tibia

Medial condyle -superior articular surface is oval anterio posteriorly. The peripheral part is flat and

articulates with medial memiscus, the central part is slightly concave and articulates with medial

condyles of femur. The raised lateral margin covers the medial inter condylar tubercle.



Lateral Condyle - The superior articular surface is mearly circular. The peripheral part is flat and

articulates with lateral meniscus. The central part is slightly concave and articulates with the lateral

condyle of femur.

Patella -Patella is the largest sessamoid bone in the body. It is triangular in shape with its apex directed

downwards, which is non articular posteriorly.

Anterior surface is rough and non-articular, the upper 3/4th of the posterior surface are smooth

and articular. The posterior articular surface divided by a verticle ridge into a large lateral area and a

smaller medial area. Structurally knee is a week joint, because the articular surfaces are non congruent.

The tibial condyles are too small and shallow to hold the large convex femoral condyles. The femero

patellar articulation is also quite insecure because of their shallow surfaces and also the outward

angulation between the axes of thigh and leg.88

The stability of the knee joint is maintained by many factors. Knee joint is supported by fibrus

capsule. The fibrous capsule is very thin and is deficient anteriorly when it is replaced by quadriceps

femoris, patella and ligamentum patella.

Synovial Membrane - It lines the capsule except posteriorly where it is reflected forwards by the

cruciate ligaments forming a common covering for both ligaments.

Semilunar Cartilage (Menisci) - These are two fibro cartilaginons crescents. Which try to deeper the

articular surfaces of the condyles of tibia and partially divides the joint cavity into the upper and lower

compartments.

Ligaments - Ligamentum patella, tibial, collateral ligament, femoral collateral ligament, oblique

popliteal ligament, arcuate popliteal ligament, cruciate ligament. Explanation of janukapala (patella) is

available in Sushruta and Charaka samhita.

Acharya Charaka and Kashyapa while explaining the asthisankhya denotes. Janvasthini dose,

sankyate, chatwaryosthini jangayoho, dwarunalakau, dwecha khyathe janukapale.

In the olden days also our acharyas had an idea of synovial membrane. Sushruta clearly

mentioned that the fourth kala is Shleshmadharakal a which is situated in every sandhis and performs



lubrication for movement. How a wheel which is lubricated by oleation functioning normally. Likewise

all the sandhis function normally in the presence of shleshmadhara kala and also protects it form

destruction .

Synovial Fluid - It is found in the cavities of synovial joints. The main function of it is lubrication and

also nourishment of the articular cartilage.89

The physical nature of this is a clear or pale yellow, viscous glariry fluid of slightly alkaline pH

at rest. This nature vary widely between different joints and spaces. The physical properties of synovial

fluid changes according to the environment in the joint. Viscosity is very sensitive to changes in dilution

and that it falls with increasing temperature and increasing pH. The elasticity property is also affected

similarly. The composition of synovial fluid is some protein (about 0.9mgm/ml) and with added mucin.

Hyalouronic acid which is sulphate free mucopolysaccharide composed of basic units that are

polymerised.

The synovial fluid also consists of moncytes, lympocytes, macrophages free synovial cells and

occasional polymorphonuclear leucocytes. Amorphous, metachromatic particles and fragments of cells

and fibrous tissue sometimes found in synovial fluid are resulted by the slow wear and tear of joint

surfaces. It is very clear by Vagbhata's statement that, shleshmaka kapha not only supports sandhis but

also provides movements in the normal direction.Acharya Sushruta states that it holds and nourishes the

sandhi.

Articular Cartilage

Majority of bones are formed a special variety of hyaline cartilage. Articular cartilage has a wear

resistant, low friction lubricated surface, both slightly compressible and elastic which is ideally

constructed for easy movements over a similar surface but also absorb enormous forces of compression

and shear generated during weight bearing and muscle action.

This is due to the Shleshaka kapha in the joint. Due to its snigdha and picchila guna it lubricates

the joints and avoids friction on movement. Thus the cartilage acts as wear resistant. Elasticity and

compressibility of the cartilage is due to the mridhutwa and shlakshna guna of kapha.



The Extracellular Matrix of Normal Articular Cartilage

Articular cartilage is composed of two major macromolecular species: Proteoglycans (PGS),

which are responsible for the compressive stiffness of the tissue and its ability to withstand load and

collagen, which provides tensile strength and resistance to shear. Although lysosomal proteases have

been demonstrated within the cells and matrix of normal articular cartilage, their low pH optimum makes

it likely that the proteglycanase activity of these enzymes will be confined to an intracellular site or the

immediate pericellular area. However cartilage also contains a family of matrix metalloproteinases

(MMPs) including stromelysin, collagenase and gelatinase which can degrade all the components of the

extra cellular matrix at neutral pH. Each is secretedby the chondrocyte as a latent pro enzyme, that must

be activated by proteolytic cleavage of its N-terminal sequence. The level of MMP activity in the

cartilage at any given time represents the balance between activation of the proenzyme and inhibition of

the active enzyme by tissue inhibitor (Keneeth, 1996).

INVESTIGATIONS:

Lab Investigations:

Usually in primary OA theESR may be normal or slightly accelerated.Anemia and leukocytosis are

absent.Rheumatic factor studies are absent.Synovial fluid analysis revels minimal abnormalities useful

in the differetial diagnosis.Viscosity is good and musin clot formation with glacial acetic acid is

normal.Slight increases in cell count are noted.

X-Ray reveals:

Loss of joint space due to destruction of articular cartilage

Sclerosis due to increased cellularity and bony deposition

Subchondral cyst due to synovial fluid inttusion into the bone

Osteophytes due to revascularisation of remaining cartilage and capsular traction

Bony collapse due to compression of weakened bone

Loose bodies due to fragmentation of osteochondral surface

Deformity and malalignment due to destruction of capsules and ligaments



Bone scan shows increased up take technetium-99m;MRI and CT scan also helps to

diagnose subchondral cyst;osteophytes etc.

CHIKITSA

The main aim of treatment is to restore Svasthya. It means to restore normal functions of Agni,

Dosha, Dhatu, and Mala and to maintain mental health. The primary importance of Cikitsa lies in

Samprapti Vighatana.

Sandhi-Gata-Vata is a Vataja disorder. So general treatment of Vata Vyadhi can be adopted,

keeping an eye on the etiology of the same. Regarding the specific line of treatment of Sandhi-Gata-Vata,

Caraka is silent. Later authors like Sushruta had mentioned effective line of treatment for the same. Other

books like Astanga Hridaya, Astanga Sangraha, Yogaratnakara, Bhavaprakasha had mentioned specific

line of treatment.

The below chart shows Chikitsa sutra mentioned in different texts.

Table No. 7 Showing Cikitsa Sootra mentioned in different Samhita.

Treatment Su.Sa. A.Sa. A.Hr. Yo.Ra. Bh.Pr. Bh.Ra.

Snehana + + + + +

Abhyanga +

Mardana + + + +

Svedana + + +

Upanaha + + + + + +

Bandhana + + +

Agnikarma + + + +

SNEHANA

Sandhi-Gata-Vata is a variety of Vata Vyadhi, where Snehana would be very effective. Acc. to

the use it can be administered in two ways –

Abhyantara Prayoga

Bahya Prayoga (Su.Sa.Ci.31/2)

Abhyantara Sneha:



Here Sneha in the form of Pana, Bhojana, Basti and Nasya can be administered in case of

Sandhi-Gata-Vata.

Bahya Sneha:

Bahya Snehas are many like Abhyanga, Lepa, Udvartana, Padaghata, Gandoosha, Karnapoorana,

Akshitarpana, Picu, Samvahana, Mardana, Murdhnitaila, and Parisheka. In case of Sandhi-Gata-Vata we

get the mentioning of Abhyanga and Mardana. Abhyanga means to do some 'movements' or 'Gati'. For

the purpose of Abhyanga Sukhoshna Taila or Sneha is used. Abhyanga should be done slowly in

Anuloma Gati, in joints it should be done in circular manner. Abhyanga should be done minimum for 5

minutes because the Veerya of Taila will reach Majja Dhatu in 900 Matra-Kalas. It is Vatahara,

Pushtikara (Ca.Sa.Su.5/85; Su.Sa.Ci.24/30). Mardana is like Abhyanga but applied pressure is more.

Svedana

Svedana is a variety of Shadvidhopakrama. It is helpful in neutralizing Stabdhata, Shitata and

Gauravata (Ca.Sa.Su.22/11). In case of Sandhi-Gata-Vata varieties of Svedanakrama like Upanaha and

Bandhana are indicated

Upanaha

Both Sushruta and Caraka consider Upanaha as a variety of Svedana (Su.Sa.Ci.32/3;

Ca.Sa.Su.14/35). Roots of Vatahara drugs should be pasted together with Kanji and mixed with abundant

quantity of Saindhava Lavana and Sneha. After making this lukewarm, it should be applied to the

affected part. The paste of drugs included in the Kakolyadi, Eladi or Surasadi groups as well as pastes of

Sarshapa, Tila, or Atasi or Krishara, Payasa, Utkarika and Vesavara or the drugs of Salvana Sveda should

be similarly applied to the affected part folded in piece of thin linen and tied up (Su.Sa.Ci.32/12).

Bandhana Dravya in Upanaha

For the purpose of Bandhana, Caraka opines that leather of Ushna Veerya animal can be used. In

the absence of this silk or woolen cloth can be used (Ca.Sa.Su.14/35-37). Astanga Hridayakara opines

that 'Vatahara' Patras should be used (A.Hr.Su.17/5) and Caraka suggests Eranda Patra

(Ca.Sa.Ci.28/115).



Duration

Upanaha, which is tied in the morning, should be removed in the night and which is tied in the

night should be removed in the morning (Ca.Sa.Ci.14/38).

Sneha Pramana

According to Vata, Pitta, Kapha, Sneha should be added 1/4,1/6/1/8th of the Upanaha Dravya.

Bandhana

Acharya Susrutha again subdivides this into 3 types:

a) Pradeha

b) Sankara

c) Bandhana

Pradeha

Thick paste prepared by Amla Kanji in Vataharadravya after adding Saindhava Lavana and

Sneha, Svedana is done. Dalhana called this as Upanaha (Su.Sa.Su.18/7 & Dal).

Sankara Sweda

In Sankara Sveda, paste made out of Vatahara Dravyas, Amla Kanji, Saindhava Lavana and

Sneha etc., taken in a piece of cloth and Potali is prepared. Dalhana considered this as Upanaha (Su. Sa.

Ci. 32/12 & Dal).

Bandhana

In Bandhana Upanaha Dravya is tied to the affected apart.

AGNIKARMA

Unique treatment indicated in case of Sandhi-Gata-Vata. Here Dahana or cauterization is done in

the part affected.

Dahana Karma should be done in the affected joint till the Samyak Laxana.

Hence the different treatment modalities mentioned by different authors can be concise under

these three (Su.Sa.Ci.4/8 & Dal; A.Sa.Ci.23/13; A.Hr.Ci.21/22; Yo.Ra.Ci.Vat; Bh.Pr.Ci.24/259).

SHAMANAUSHADIS:

Kwatha: Maharsnaadi kwatha



Dhanwantaram kwatha

Sahacharadi kwatha

Kalka: Takaramoola kalka with takra

Choorna: Alambhushadya choorna

Aabhadi choorna

Vati: Ajamodaadi vati

Guggulu preparations: Kaishora guggulu

Yogaraj guggulu

Brihatyogaraj guggulu

Trayodashanga guggulu

Adityapake guggulu

Simhanaada guggulu

Rasaushadi: Panchananarasa loha

Vatarakshasa rasa

Sneha: Dhanwantaram tailam

Phalatrikaadi taila

Majja sneha

Prasarini tailam

Siddharta tailam

Nakula tailam

PATHYPAATHYA

The Ahara and vihara which prevents aggravation of the disease and aids in the relief at the same time

without initiating another disease are known as pathya.

Acharya Charaka is one step ahead by saying Pathya is one which is suitable to the body and mind both

in health as well as diseased condition.Though no one Acharyas has mentioned pathya and apathya for

sandhigatavata directly, as this disease being a vatavyadhi we should adapt the samanya vatavyadhi

patyapathya.

PATHYA

• Rasavarga - Madhura, Amla, lavana rasa

• Shukadhanyavarga - Naveena godhuma, Samvatsarothitashali, Rakta Shali, Shashtikashali.

• Shimbi varga - Naveena tila, Naveena masha, kulatha



• Shaka varga - Patola, shigru, vartaka, lasuna

• Phala varga - Draksha, dadara, pakva amra, parushaka, jambeera, dadima, pakvatala phala

• Mamsa varga - Ushtra, go, varaha, mahisha, hamsa, mayura, bheka, nakula, chataka, kukkuta,

tithira, sheelindra, kurma, thimingila, rohita etc.

• Jalavarga - Ushna jala, Shritasheetajala, Narikelajala

• Dugdha varga - Go, aja ksheera, dadhi, grita, kilata, kurchila

• Mutra varga - Gomutra

• Madhya - Dhanyamla, sura

• Sneha - Tila, gritha, vasa majja

• Vihara - Bhushayya, snana, samhvahana etc.

• Chikitsa - Abhynga, brimhana, sanbrpana, tiladroni, shirobasti, avagaha, nasya, upanaha,

agnikarma [104]

APATHYA

• Ahara - Katu, tikka, kashayarasa

• Shimbi dhanya - Rajamasha, nishpara, mudga, kalaya

• Shuka dhanya - Trunadhanya, trunaka, kangu, koradhusha, neevara, shyamaka, chanaka

• Phala varga - Jambu, udumbara, kramuka, tinduka

• Mamsa varga - Sushkamamsa (Vallura), kapotha, paravata

• Jalavarga - Nadeejala, Sheetambu, tadajala

• Ksheera - Gardaba ksheera Vihara

• Vihara - Chinta, jagarana, shrama, vyavaya, vyayama, chankramana, Hasti ashwayana,

vegadharana

• Chikitsa - Vamana, Raktamokshana



MANAGEMENT OF OSTEOARTRITIS:

Treatment of osteoartritis is aimed at reducing the pain, maintaing mobility and minimising

disability. The vigor of the therapeutic intervention should be detected by the severity of the condition in

the individual patient. For those only with mild disease, reassurance, instruction in joint protection and an

occasional analgesic may be all required, For those with severe O.A a comperensive programme

comprising a spectrum of non pharmacological measures supplimented by an analgesic or anti

inflammatory drug is appropriate. This involves many measures like pharmacological means, non-

pharmacological means and surgery.

Pharmacological means –

1. Simple analgesics

A large number of medicines are prescribed for relief of pain. The recognition that pain in OA is

not necessarily due to inflammation has led to an increased awareness of the role of simple analgesics in

the treatment. The ACR guidelines emphasize the use of acetaminophen (Tylenol) as the first line

treatment for OA.

2. Opioid containing analgesics Code line and propoxyphene can be used for short periods to treat

exacerbations of pain.

3. NSAID’s

Trials comparing simple analgesics and NSAIDs found that acetaminophen along can control pain in a

substantial number of patients with OA celecoxib, a cox-2 inhibitor, and rofecoxib are recent advances

among NSAIDs.

4. Local analgesics – Among the local applications, capsaicin cream is used commonly.

5. Intra articular cortico steroid injections.

6. Intra articular administration of hyaluronic acid like products. Chikitsa 90

Agents used to treat Osteoarthritis



Acetaminophen, NSAIDS (Salicylates, Propionic acids, Acetic acid, Oxicams), Cyclo-oxgenase

inhibitors, Irritants/Counter irritants, Hyaluronic acids and Glucocorticoids.

� Exercise – To maintain range of motion, muscle strength and general health. Patients may also be

referred to aerobic exercise programs such as fitness walking or swimming. Mainly two types of

exercises are adviced viz flexibility and strengthening exercises.

� Assistive devices – Many patients with OA of hips and knee are more comfortable; wearing shoes with

good shock-absorbing properties

Non-pharmacologi

� Patient education.

� Exercise: - To maintain range of motion, muscle strength and general health. Patients may also be

referred to aerobic exercise programs such as fitness walking or swimming.

Figure No 3: Showing Knee Osteoarthritis



Assistive devices: - Many patients with OA of hips and knee are more comfortable; wearing shoes with

good shock-absorbing properties orthoses. The use of an appropriately selected cane can reduce hip

loading by 20-30%. Patients with specific physical disabilities may benefit from physical and

occupational therapy.

Weight management: - There is a longitudinal association between obesity and OA of knee in men and

women. Therefore, primary preventive strategies may include measures to avoid weight gain, or to

achiever weight loss in over weight patients.

Supplements: - Glucosamine sulphate and chondrotin sulfate.

Yoga: It is one of the ancient science which inter relates with our culture. It s pratices in daily life

restores the health and relieves the symptoms. The Asanas which give relief to artritis is

Pavanamuktaasana. These Asana sare very easy to practise and help him releiving stress by loosening

the joints.

Rehabilitation: Simple changes around the home and daily activites can cause drastic improvement in

the symptomatology of O.A.

• Use of higher chair, which requires less effort to get in and out should be considered

• To reduce the force acting across the injured joint patient is advised to use a walking stick which

acts as a third limb.

• Footwear with hard soles and high heels should be avoided.

• Mental and physical support from the family members will be useful in the rehabilitation of the

patient.

SURGERICAL LINE OF MANAGEMENT:

Surgical procedures are of value in the management of OA. They may be grouped under 3 major

categories.

• Procedures to correct mal alignment and eliminate abnormal joint stresses (osteotomies), not only

may slow down disease progression but may-also bring healthier articular cartilages into

opposition and provide symptomatic relief.

• Debridement with removal of free bits of cartilage or large ecostoses may relieve pain and

locking and help in prevention of rapid and extensive cartilage degeneration.

• In advanced disease, arthroplasty or joint replacement may be required to reduce pain and

improve function; at times arthrodesis is required to control pain, even though motion must be

sacrificed101.



DRUG REVIEW

AJAMODA(101,102,103,104)

Botanica Name :- Apium leptophyllum

Family :- Apiaceae

Vernacular name :- Hindi – Ajamoda, English –Celery fruit

Synonymes : - Deepyaka,Karavi,Gandhala,Shikimoda,Kriminashini

Introduction : - It is bennial stem consisting of small ovoid fruit bulk colour yellowish brown in colour.

Chemical compositin : - essential oils and fixed oils

Properties : - Rasa – Katu,Tikta

Guna - Laghu,Ruksha

Virya - Ushna

Vipaka - Katu

Karma : - Vata Kapha shamaka, Rasayana, Vrushya,

Indication : - Agnideepaka,krimighna,vatashamaka,mutrala,balya

Usefull Part :- Seeds

PIPPALI(105,106,107,108)))

Botanical Name :- Piper longum

Family :- Piperaceae

Vernacular name :- Hindi – Pipal English –Long pepper

Synonymes : - Maagadhi,Vaidehi,Kana,Chapala,Shaundi

Introduction : - It is a large creeper,the fruits are long after supuration becomes red in colour and after

drying becomes black colour.

Chemical compositin : -

Properties : - Rasa – Katu

Guna - Laghu, Snigdha,Teekshna



Virya - Anushnasheeta

Vipaka - madhura

Karma : - Vata Kapha vardhaka, Rasayana, Vrushya,

Indication : - Amavata, Arsas, Sotha, Prameha, Agnimandya,Shwasa,Kasa,Hikka

Usefull Part :- Root,fruit

VELAM (Vayuvidanga) (109,110,111,112,113)

Botanical Name :- Embelica rebes

Family :- Myrsinaceae

Synonymes :- Krimigna, Tandula, Vella, Amogha, Jantuhantri,

Gana :- Krimigna, Kushtagna, Truptigna (Ca)

Surasadi gana, Pippalyadi (Vag & Su)

Botanical discription :- A large shurb slender branches long the bark studded with lenticles Fruits are

globose 3-4 mm smooth black when ripe like pepper corn

Properties :- Rasa - Katu, Kashaya

Virya - Usna

Guna - Laghu, Rooksha, Teekshna

Vipaka - Katu

Karma :- Vatahara, Vishagna

Krimigna – Shotahara

SHATAPUSHPA(113,114,115,116,117)

Botanical name :- Foeniculum vulgare

Family :- Umbelliferae

Synonyms :- Atlambi, Karavi, Madhura, Sitachatra

Gana :- Asthapanopaga, Anuvasanopaga. (Ca)

Varieties :- A graveolens and A sowa have been concidered as two varites



Botanical discription :- A glabrous perenal herb 30 - 90 cm hight leaves are bipinnet white flowers,

fruits are slender vittae large etc

Chemical constituents :- Fruit are seed oil carvone dihydrocarvone, limonene, apiol dils- apial, Anethol,

Fenchone, etc

Properties : - Rasa - Katu, Tikta

Guna - Laghu, Tikshna

Veerya - Ushna,

Vipaka – Katu

Karma :- Vata kapha hara, Dipana

Usefull part :- Beeja

CHITRAKAMOOLA(118,119,120,121,122))

Latin name :- Plumbago zeylanica

Family :- Plumbaginaceae

Synonames :- Anala, Dahana, Agni, Jyoti, Agnika, Sikhi, Hutasana.

Gana :- Dipaniya, Sulapr, Ashamana, Arshogna, Lekhaneeya. (Ca)

Pippalyadi, Mustadi, Amalaky, Adi, Varunadi. (Su)

Vaghbhata quoted 3 Varites sweta pita and Asita

Botanical discription :- A perinnial herb leaves thin ovate subacute flowers in elongata spikes fruits

capsule, oblong pointed thick pericarp

Chemical composition :- Root contain plumbagin chitranone, plumbagic acid acts on control nervous

system

Properties : Rasa - Katu

Guna - Laghu, Ruksha, Teekshna

Veerya - Ushna

Vipaka - Katu

Karma : - Agnideepaka, Grahi, Shoolhara, Rasayana, Vata-Kapha hara, Garbhashaya sankochaka, etc.



Part used :- Root bark

SHUNTI(123,124,125,126,127)

Latin name :- Zingiber officinale

Family :- Zingiberaceae

Synonames : - Mahoshadha, Vishwa, Nagara, Vishoushadha, Sringavera, Katubhadra.

Varnacular Name : - Hindi - Soth

Kannada - Sunti

Malayalam - Chukku

Tamil - Chukku

Oriya - Shunthis

Habitat : - Mostly seen in southern states of India,Bengal, Punjab etc.

Discription :- it is a rhizome, growing under the ground

Part used :- Steem

Properties : - Rasa - Katu

Guna - Laghu, Snigdha

Veerya - Ushna

Vipaka - Madhura

HARITAKI(128,129,129,130,131)

Latin name :- Terminalia chebula

Family :- Combretacae

Synonames :- Abhaya, Patya, Prapatya, Amruta, Jaya, Avyata, Shiva, Nandini, Vijaya

Properties :- Rasa- Madhura, Amla, Katu, Tikta, Kashya

Doshakarma :- Kapha- Vata Shamaka

VRUDHADARUK(132,133,134)

Botanica Name :- Ipoemia petalodea

Family :- Convolvulaceae



Vernacular name :- Hindi - Bidhara

English - Elephant creepar

Telegu - Samudraphena

Synonymes : - Chagantri, Avegi

Introduction : - It is alarge creepar and is cavered with haer all over . Flowers are either pink or red as

purple

Chemical compositin : - Seed contain oloic acid nercetion and kaempferol from leaves

Properties : - Rasa - Kasaya, Katu, Tikta

Guna - Laghu, Snigdha

Virya - Ushna

Vipaka - Ushna

Karma : - Vata Kapha hara, Rasayana, Vrushya,

Indication : - Amavata, Arsas, Sotha, Prameha, Agnimandya

Usefull Part :- Root

SAINDHAVA LAVANA(135,136,137,138)

This is the best in the lavanavarga, Rock salt is the common name for the mineral halite

Sanskrit :- Saindhava, Stitashiva, Manimantha, Sindooja

Vernacular name :- Hindi :- Senda namak

English :- Rock salt

Kannada :- Saindava

Varga :- Lavana varga

Properties : - Rasa - Lavana

Guna - Snigda, Rooksha, Sukshma

Veerya - Sheeta

Vipaka -

Karma :- Tridoshahara, Rochana, Deepana



Indications :- Ajeerna, Anaha, Vataviara, Gulma, Shoola & Udara roga

Materials & Methods


V{tÑàxÜ @G MM `tàxÜ|tÄá 9 `xà{Éwá

Methodological approach is the backbone of research.Utmost care is taken in designing a

methodology for conducting a result. The therapeutic measures, drugs and procedures of Ayurveda

have remained in the practice since long on the basis of methodology prevalent in ancient times. This

is the time that the rationality of Ayurvedic therapeutic approach is explained on rational lines.

Clinical trial is a way of research and its best method to evaluate any drug or line of treatment. The

trial is a carefully designed experiment with the aim of solving unrewarding problems conducted on

scientific lines. Research is a careful investigation or inquiry in a systematized manner to establish

new facts and discarding the old facts or correcting them. The ultimate aim of any research is in the

field of medical science is to find out suitable remedies for particular ailment and to promote health.

The clinical trial is experiment therapeutics. The Ayurvedic therapeutic measures, drugs, procedures

have mentioned in practice since long on the basis of the methodology prevailed in ancient times .

Clinical research involves the experimentation of drug or therapy on a population and recording the

feed back based on which postulations are made regarding the usefulnes of drug.The clinical trials

which is carefully designed experiment with the aim of solving the unrewading problems conducted

on scientific line is the only way to achieve the above objects. Research methodolgy involves the

systematic procedures by which the researcher starts from initial identification of the problem to its

final conclusion.

a)RESEARCH AAPROACH:

In the present study the investigators objective is to study Management of Sandhigata vata

by Ajamodadi vati by its vedanahara and shothahara property. The efficacy of trial drug is determined

by finding out the difference between the baseline data of the parameters to the after treatment data.

b)STUDY DESEIGN:

The study design selected for present study is Single random sampling technique clinical trial.

C) SAMPLE SIZE AND GROUPING:

In the sample size for the present study were 30 patients suffering from sandhigata vata.

Materials & Methods


D) SOURCE OF DATA:

a) Patients suffering from Sandhigata vata were selected from the Post graduation studies

and research centre,Department of Kayachikitsa,O.P.D and I.P.D of Shri. D.G.M.A.M.C &

Hospital,Gadag, with pre-set inclusion and exclusion criteria.

b) Literary aspect of the study will be collected from classical Ayurvedic and contemporary

text and updated with recent medical journals, previous research work done on same topic.

c) Trial drug Ajamodadi vati

e)SELECTION CRITERIA:

• Exclusion criteria:

o Patients below 30 years and above 70 year of age

o Pregnant woman & lactating mother.

o Associated with simple or compound fractures.

o Associated with any other systemic or metabolic disorders.

o Patient on steroid therapy

o Patient under gone surgery

• Inclusion criteria:

o Patients suffering from the symptoms of Sandhivata (Osteo-arthritis)

o Patients of either gender aged between 30-70 years are included-as the condition is

commonly found in the either sex,but not specific to the old age.

CRITERIA OF DIAGNOSIS:

The diagnosisis made on the basis of signs and symptomsof the patient. By methodical examination of

the patient especially joints.

DURATION OF STUDY:

Ajamodadi vati were given to the patient for the duration of 30 days with fixed /dose of 3grms/24 hrs

in divided doses observing the patient closely at the interval of 3 days and recording the events for

every 10 days.The medicine is withdrawn after the trial period of 30 days and a follow up period of 15

days.

Materials & Methods


Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed history pertaining to

the mode of onset, previous ailment, previous treatment history,family history, habits,

ashtavidhapareeksha and dashavidhapareeksha and physical examination findings were noted.

Routine investigations were done to exclude other pathologies. Radiological features also were

investigated.

History

The common symptoms with which a patient generally presents are pain,swelling, stiffness,

mechanical disorders (e.g. Locking, giving way, click etc.)

Joint Examination:161

Examination of the joints can be summerised simply as”look,feel and move’’ the joint(i.e

inspection,palpation and then the range of movements along with jerks)With practise the Clinician

can develop a systematic review of the joints.Compare the corresponding joints on the two sides of

the body and always take care to avoid causing undue discomfort.

Inspection

• Both the lower limbs were fully exposed

• Patient was first examined in the standing position, both from front and behind secondly in

the seated position, thirdly in the supine position and lastly in the prone position.

• Swelling

a) The limits of the swelling were clearly made out.

b) The gradings were allotted on the basis of criteria explained in the end of this section.

c) The Varna of the Shopha was examined (Raga, Shyava or Prakrutha).

d) Any deformities like genus valgum, varum etc. were examined.

e) Joint instability or buckling of the joint was examined.

f) Any abnormalities in the gait were examined.

g) Walking time was recorded (the time taken to cover 21 metres).

h) Any presence of muscular spasm was examined.

Materials & Methods


i) Muscular wasting above and below the joint was examined.

Palpation

• Local temperature was examined with the back of the hand and compared to that of the other

side.

• Local tenderness was also examined.

• Swelling

A) Fluctuation test was performed by pressing the suprapatellar pouch with one hand and feeling the

impulse with the thumb and the fingers of the other hand placed on either side of the patella or the

ligamentum patellae.

B) Patellar tap was elicited by pressing the suprapatellar pouch with one hand driving the whole of its

fluid into the joint proper as to float the patella in front of the joint. With the index finger of the other

hand, the patella is pushed backwards towards the femoral condyles with a sharp and jerky movement.

The patella can be felt to strike on the femur, which is known as the patellar tap.

• Palpation of popliteal fossa - The patient was made to lie down prone on the table. The knee

joint was flexed and the popliteal fossa was palpated. The knee joint, popliteal artery, areolar

tissue, veins and nerves and the tendons in and around the popliteal fossa were all palpated

carefully to detect any pathology here.

• Significance of click - If the click was associated with discomfort or pain, careful

examination was done. Commonest cause of intra-articular click is OA.

• Patello-femoral and femoro-tibial components were palpated for any tenderness or

irregularity.

Movements

The movements permitted in the knee joint are mainly flexion and extension. Minor degrees of

abduction, adduction and rotations may be permitted when the joint is partly flexed. Both active and

passive movements were examined.

• Flexion and Extension: Normally, the knee can be flexed until the calf extended till the thigh

and leg form a straight line.

Materials & Methods


• • Abduction and adduction: These movements are virtually absent with knee straight,

but slight degrees of abduction and adduction are possible when the knee is semi-

flexed.

• Rotation: This movement is also not possible when the knee is straight. When the hip

and knee are flexed to 90 degrees, some degree of rotation is possible.

Auscultation

During active or passive movement, the palm of one hand of the physician was placed over the patella

and crepitus was felt.

JOINT CREPITUS:

This can be detected by feeling the joint with one handwhile it is moved passively with other hand.

This may indicate osteoartritis, or loose bodies in the joint spaces but should be differentiated from

non-specific clicking of joints.

Mobility grading:VAS(0-100)

Mobility is measured in visual analogue scale which is used to notice the movement extension of

affected joints.

ASSEMENT OF CLINICAL RESPONSE:

Subjective and objective parameters were made out to asses the clinical response in the total number

of patients.

I) Subjective parameters:

Ruk (Pain)

01. Grade 0 – No Complaints

02. Grade 1 – Tells on Enquiry

03. Grade 2 – Complains Frequently

04. Grade 3 – Excruciating Condition

Graha (Stiffness)

01. Grade 0 – Absent

02. Grade 1 – Present

Materials & Methods


Sparshaakshamatva (Tenderness)


02. Grade 1 – Says the joint is tender

03. Grade 2 – Winces the affected joint

04. Grade3 –Winces and withdraws the affected joint.

Shotha (Swelling)


02. Grade 1 – Slightly obvious

03 Grade 2-covers well over the bony prominence

04 Grade 3-Much elevated

Atopa (Crepitations)

01. Grade 0 – None

02. Grade 1 – Felt

03 Grade 2-Heard

All these parameters of baseline data to post-medication data (31st day) were compared for clinical

assessment of the results (assessment was also recorded on the 8th day too).

II) Objective parameters:

A) Hemoglobin %

The haemoglobin content of the whole blood is reported in terms of grams of Hb per 100 ml

of blood(g/dl).Normal ranges are 14- 18 g/dl in males and 12-16 g/dl in females. Hemoglobin

is responsible for the cell’s ability to transport oxygen and carbon di oxide it is estimated.

B) Erythrocyte sedimentation rate:

Erythrocyte sedimentation rate is measured in the graduated tubes under Westergren’s method

(pippete method).This facilitates to understand possible presence of organic disease or to

follow the course of the disease. It is universally accepted that it is a good prognostic method

in clinical laboratory.

Materials & Methods


C) Differential count:

It is of a daily routine investigation to estimate the polymorphs. eosinophils. lymphocytes, etc

where the general health of the patient is estimated.

D) Joint pain grading 0 to 10

Joint pain grading is based upon the moderate universal pain assessment tool which is a visual

analouge scale to asses pain patients.

E)Local temperature:

Increase of the temperature is common in joint swelling and pain conditions. A surface digital

skin thermometer is used to check the local temperature.

F) Redness

Redness is measured in visual analouge scale which is used from light red to dark red.

G) Swelling in mm:

It is measured with a tape graded with mm and cms.

H) X-rayof affected joints:

It is an optional for further assesment of the pain condition and to notice the fulfilment of

exclusion criteria.

Walking time to cover 21meters was recorded and distributed into the following grades.

Grade 0 – Up to 20seconds

Grade 1 – 21-30seconds




All these parameters of baseline data to post-medication data (28th day) were compared for clinical

assessment of the results (assessment was also recorded on the 14th day too).

Overall Assessment Of Clinical Response

Good Response : 3.33% improvement in clinical and functional parameters

Moderate Response: 53.33% improvement in clinical and functional parameters

Poor Response : 23.33% improvement in clinical and functional parameters

No Response : 20% clinical and functional parameter

Results

Evaluation of the efficacy of Ajamodadi Vati in Sandhivata (Osteoarthritis) Page

50

V{tÑàxÜ @H MM exáâÄàá

Present study registers 30 patients, out of 38 approached patients as the patients who

discontinued their data has not been included. The remaining 30 patients of Sandhigata vata viz Osteo

arthritis is an individual, fulfilling the criteria of diagnosis and inclusive criteria were included in the

study for the evaluation of efficacy of Ajamodadi vati in Sandhigata Vata.

All the patients were examined before and after the trial according to the case sheet format

given in the annex. Both subjective and objective criteria were recorded. The data recorded are

presented under the following headings.

I) Demographic data

II) Evaluating Pain Data

III) Results of 30 patients

IV) Statistical evaluations

Results


51

Table No 8 : Showing the demographic data of trial cases

Sl, No

OPD,No Age Gender Religion Occupation Economic status Results

1 1040 43 Male Hindu Active Middle Moderate 2 1326 38 Female Hindu Labor Middle Moderate 3 1791 55 Female Muslim Active Middle Moderate 4 2132 38 Male Hindu Labor Poor Moderate 5 1043 60 Male Hindu Active Higher middle Moderate 6 2450 52 Male Hindu Active Higher middle Mild 7 2452 45 Female Hindu Active Middle Moderate 8 2079 72 Male Hindu Active Higher middle Moderate 9 1824 40 Female Hindu Active Higher middle Mild 10 1722 60 Female Hindu Active Middle Moderate 11 7973 50 Male Hindu Active Higher middle Mild 12 2152 55 Female Muslim Active Middle Moderate 13 4414 65 Female Hindu Labor Poor Moderate 14 2916 57 Female Hindu Active Middle Moderate 15 2131 52 Female Hindu Active Middle Mild 16 2512 51 Female Hindu Active Higher middle Mild 17 3271 35 Female Hindu Labor Poor Not

respond 18 5360 60 Male Hindu Active Middle Not

respond 19 1041 42 Female Hindu Labor Middle Marked 20 1770 55 Female Muslim Labor Middle Mild 21 2136 57 Male Hindu Labor Middle Moderate 22 3154 55 Male Hindu Active Higher middle Not

respond 23 3271 57 Male Hindu Sedentary Higher class Moderate 24 2757 49 Female Hindu Active Middle Moderate 25 3791 57 Female Hindu Active Higher middle Moderate 26 3017 54 Male Hindu Active Middle Not

respond 27 3197 48 Female Muslim Active Middle Not

respond 28 4001 50 Female Hindu Active Higher middle Not

respond 29 4007 47 Female Hindu Active Higher middle Mild 30 4127 56 Male Hindu Active Middle Moderate

a) Distribution of patients by Gender and Age.

There is no specificity observed with reference to the gender because the prevalence of

Sandhigata vata is common in both males and females,but females may be more prone due to

osteoporosis in post menapausal period, but the age certainly has effect because as age advances the

kapha kshaya goes on increasing and vrudhapya is Vatadhikya avastha. So it can be ruled out that Age

factor is considerable criteria in Sandhigata vata.

Results


52

Table No. 9 : Distribution of patients by Age Gender

Male Female Age Nos % Nos %

Total %

20-30 00 00 00 00 00 00 30-40 31 03.33 03 10 04 13.33 40-50 72 06.66 06 20 08 26.66 50-60 08 26.66 08 26.66 16 53.33 60-70 01 03.33 01 03.33 02 06.66 12 39.98 18 59.99 30 99.98

02468

10121416

20 - 30 30 - 40 40 - 50 50 - 60 60 - 70 70 -80

Graph 1 : Distribution of patients by Age Gender

By observing the tabulation only 1 Female Patients had marked response. But maximum Male

i,e 7 among 12 had moderate response among 18 Female patients had moderate response. This proves

the result to be 50-60% as an analgesic. Mild response was seen in 2 male patients among 12 and 5

female patients among 18. This proves the result to be 15-25% and both 3 in each male and female

among 12 and 18 respectively.

Table No. 10 : Results by Gender

Gender Total no of patients

% Marked Response

% Moderate Response

% Mild % Not responded

%

Male 12 40 0 0 7 58.33 2 16.66 3 25 Female 18 60 1 5,55 9 50 5 27.77 3 16.6 Total 30 100 1 16 7 6

Results


53

Table No. 11 : Results of patients by Age Group

Age Total % Marked Response

% Moderate Response

% Mild Response

% Not Respoded

%

20-30 0 0 0 0 0 0 0 0 0 0 30-40 4 13.33 0 0 2 50 1 25 1 25 40-50 8 26.66 1 12.50 3 37.50 2 25 2 25 50-60 16 53.33 0 0 9 56.25 5 31.25 2 12.

50 60-70 2 06.66 0 0 2 100 0 0 0 0 Total 30 1 12.50 16 8 5

Results :

After chronological tabulation of the patients under the age groups of decade wise it can be concluded

that majority of Sandhigata Vata is seen among the age group of 50-60 prevalence is approximetly

0123456789

Marked Respons

Moderate Respons

Mild Response Not Responded

Graph 3 : Results of patients by Age Group

20 -30

30 - 40

40 - 50

50 - 60

60 -70

0

2

4

6

8

10

Male Female

Graph 2 : Results of Patients by Gender (Ajamodadi Vati)

Marked ResponseModerate ResponseMild ResponseNot Responded

Results


54

55% in this age group and an analgesic shows efficacy of moderate response up to 53% and mild

response up to 31%. In the rest of age groups, moderate response is seen considerably.

Distribution of patients by Religion

Religion does not have any impact in giving rise to painful condition but due to circumstances

prevailing in the religion may lead to aggrevation of pain. The area of trial is Hindu dominant thus the

population is of more Hindus, the table is self-explanatory shown. The result of trial also exhibits the

same ratios of response shown in tables

Table No.12 : Distribution of patients by Religion

Religion Nos Marked % Moderate % Mild % Not

responded

%

Hindu 26 1 3.84 14 53.84 6 23.07 5 19.23

Muslim 4 0 0 2 50 1 25 1 25

Christian 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0

Total 30 1 3.84 16 7 6

02468

101214

Marked Responded

Moderae Responded

Mild Responded Not Responded

Graph 4 : Distribution of patients by Religion

Hindu

Muslim

Christion

Other

Distribution of patients by Occupation

The occupation at the trial is classified as three categories viz Sedentary, Active, and labor.

The distributions of these classes are observed as active group dominance w,r,t pain is exhibited and

Results


55

can be interrelated as more chalatva to the joins leads to kapha kshaya literally to the decrease of

synovial fluid in the articular cartilage.

Table No. 13 : Distribution of patients by Occupation

Occupation Nos % Marked % Moderate % Mild % Not responded

%

Sedentary 1 3.33 0 1 100 0 0 Active 22 73.33 0 12 54.54 6 21.21 4 18.18Labor 7 23.33 1 14.28 4 57.14 1 14.28 1 14.28Total 30 1 17 11 5

02468

1012

Marked Responded

Moderate Responded

Mild Responded

Not Responded

Graph 5 : Distribution of patients by Occupation

Sedentary

Active

Labor

Table No.14 : Distribution of patients by Economical Status

Economical

status

Number

s

% Marked

response

% Moderate % Mild % Not

respon

d

%

Poor 3 0.10 0 2 66.66 0 1 33.33

Middle 16 53.33 1 6.25 10 62.5 2 12.5 3 18.75

Higher

middle

8 26.66 0 3 37.5 4 50 1 12.5

Higher

class

3 0.10 0 1 33.33 1 33.3

3

1 33.33

Total 30 16 7 6

Results


56

0

2

4

6

8

10

Marked Response

Moderate Respond

Mild Respond

Not Respond

Graph 6 : Distribution of patients by Economical Status

Poor

Middle

Higher middle

Higher class

Results

The economical class plays an important role in disease manifestation and also at the

pacification of the disease. Thus, the study of the economical status with reference to the clinical trial

is necessary. The no of middle class people have more considerable analgesic effect is seen i.e

moderate response in middle class people.

Evaluating pain data:

The data collected at trial is very valuable at the evaluation of pain in different conditions with

special references to shoola and shotha of sthoola sandhi mainly associated complaints are noticed at

the study. All these symptoms of prime and associated are tabulated according to complaints of the

patients.

Table No. 15 : Evaluation of pain data

Complaints Number of patients % Sandhi shotha 29 96.66

Prasarana akunchana savedana pravrutti

30 100

Sandhi graham 28 93.33 Sandhigati asmarthata 23 76.66 Sparsha akshamatwa 24 80

Table No.16 : Associated complaints:

Complaints Number of patients % Klama 20 66.66 Jwara 13 43.33

Angamarda 15 50

Results


57

Results:

Among 30 patients all of them suffered from pain with variable intensity.29 of them had sandhi

shotha either grading 1 or 2 and 93% of them had sandhigraha which restricted their activities. Nearly

75-80% patients had sandhigatiasmarthata and sparsha akshamatwa.

The associated complaints were klama for 20 patients(67%)and jwara for 43% and angamarda

for 50%.

History of present illness

The criteria’s for consideration are

I) Mode of onset

a) Chronic

b) Insidious

c) Acute

d) Traumatic

II) Joints involved

a) Axial b) Cervical c) Lumbar d) Spine

e) Knee f) Ankle g) Hip h) Inter phalangeal

III) Nature of pain

a) Pricking b) Aching c) Generalised d) Burning

IV) Routine activities affected

a) Yes b) No

Table No.17 : Table Showing mode of onset of disease

Mode of onset No of patients % Chronic 12 40 Insidious 03 10

Acute 15 50 Traumatic 0 0

Table No.18 : Joint involved

Joints involved No of Patients % Axial 02 06.66

Cervical 02 06.66 Lumbar 05 16.66 Spine 02 06.66 Knee 21 70 Ankle 08 26.66 Hip 03 10

Inter phalangeal 14 46.66

Results


58

TableNo. 19 : Nature of pain

Nature of pain No of patients % Pricking 03 10 Aching 13 43.33

Generalized 14 46.66 Burning

Table No. 20 : Effect on Routin activities affected

Routine activities affected No of patients % Yes 20 66.66 No 10 33.33

Total 30 Results

a) Mode of Onset

By observing the tabulation, it can be concluded that 50% of patients suffered with acute pain

and 40% with chronicity and insidious was 10%

b) Joints involved

As the most weight bearing joint is knee joint and hence 21 patients among 30 i,e 70% had

knee joint pain.14 patients i,e aprox 47% patients had interphalangeal pain and 2 patients each had

axial cervical and spinal joint pain, 5 patients (17%) had lumbar and 8 patients had ankle and 3

patients had hip joint pain.

c) Nature of pain

By resulting the tabulation 14 patients i.e 47% had generalized pain and 13 patients had aching

type of pain and 3 patients have pricking type of pain

d) Affect on routine activities

Among 30 patients the routine activities of 20 patients were affected i.e Sandhigata vata has

67% affect an routine activities hurdles.

Results


59

Table No. 21 : Distribution of patients by Mode of Onset

Sl, No Mode of onset Joint Involved Nature of pain Rotine 01 Chronic Cervical Aching Yes 02 Acute Cervical, lumbar, ankle, hip Pricking Yes 03 Chronic Lumbar, knee, ankle Aching Yes 04 Acute Knee Pricking Yes 05 Chronic Knee Pricking Yes 06 Acute Lumbar, knee Generalized Yes 07 Chronic Knee, lumbar Generalized Yes 08 Acute Knee Aching Yes 09 Acute Axial, knee Generalized Yes 10 Acute Axial, knee Aching Yes 11 Insidious Knee Aching Yes 12 Chronic Knee Generalized Yes 13 Insidious Knee,Interphalangeal Generalized Yes 14 Chronic Knee, hip Generalized Yes 15 Chronic Knee, interphalangeal Generalized Yes 16 Acute Knee, interphalangeal Generalized Yes 17 Acute Knee, interphalangeal Generalized Yes 18 Acute Knee, interphalangeal Aching Yes 19 Acute Ankle, hip Aching Yes 20 Chronic Knee, interphalangeal Generalised Yes 21 Chronic Knee, interphalangeal Aching Yes 22 Acute Knee, interphalangeal Generalized Yes 23 Insidious Lumbar, knee Generalized Yes 24 Acute Knee, interphalangeal Aching Yes 25 Chronic Knee, spine Aching Yes 26 Acute Ankle, interphalangeal Aching Yes 27 Chronic Ankle, interphalangeal Aching Yes 28 Chronic Knee, interphalangeal Aching Yes 29 Chronic Ankle, interphalangeal Aching Yes 30 Acute Interphalangeal, knee Generalised Yes Table No. 22 : Ditribution of patients by Srotas

Annavaha Nos of patients % Ajeerna 7 23.33

Agnimandya 11 36.66 Rasavaha 0 0

Aruchi 8 26.66 Jwara 3 10

Majjavaha 0 0 Astinistoda 10 33.33

Sandhi saithilya 16 53.33 Sandhi shopha 16 53.33

Sthabdha 0 0 Asthitoda 4 13.33

Asthi shoola 25 83.33 Roukshyam 3 10

Results


60

Evaluation of pain in Srotas

Sroto dusti lakshanas are the main evaluating criteria in Ayurveda. The main srotas involved in

the samprapti of sandhigata vata are Annavaha srotas exhibiting Ajeerna and Agnimandya lakshanas,

Rasavaha viz Aruchi and Jwara the main srotas involved are Asthi and Majja vaha srotas the

symptoms of – are tabulated.

This tabulation shows approx 83% of patients have pain, which may restrict day-to-day

activities along with 54% of shithilata, and shophatwa are seen Among 30 patients suffer from

Asthinistoda, 36% of patients suffer from agnimandya and 30% patients suffer from Astitoda.

Table No 23: Distribution of patients by Ahara Nidana in sandhi shoola

Ahara Nidana Group % Sheetanna 23 76.66 Rookshanna 22 73.33 Laghwanna 15 50 Shuskanna 10 33.33 Katu Rasa 12 40 Tikta Rasa 09 30 Kashaya Rasa 12 40 Upavasa 20 66.66

0

5

10

15

20

25

Graph, 7 : Distribution of patients by Ahara Nidana

Sheetanna

RookshannaLaghwanna

Shuskanna

Katu Rasa

Results


61

Table No. 24: Distribution of patients by Vihara Nidana

Vihara Nidana Group % Ratrijagarana 22 73.33 Pradhavana (Running) 00 00 Bharavahana 08 26.66 Yanam (Riding) 02 06.66 Vyayama 03 10 Walking 09 30 Pratarana (Swimming) 0 0

05

10152025

Graph, 8 : Distribution of patients by Vihara Nidana RatrijagaranaPradhavanaBharavahanaYanamVyayamaWalkingPratarang

Table No. 25 : Distribution of patients by Manasikanidana

Manasika Nidanas Group % Chinta 24 80 Shoka 22 73.33 Bhaya 17 56.66 Krodha 17 56.66

Results


62

0

5

10

15

20

25

Graph, 9: Distribution of patients by Manasika Nidana

Chinta

Shoka

Bhaya

Kroda

Aharaja Nidana

Among 30 patients, 77% Sheetanna, 73% Rookshanna, 50% Laghwana, 33% Shukranna, 40% Katu

Rasa pradhana, 30% Tikta Rasa pradhana, 40%Kashya Rasa pradhana ahara and 67% of patients

follow upavasa repeatedly.

Viharajanya Nidana

74% among 30 patients have the practice of ratrijagarana, 30% Walk beyond limits everyday 27%

Lift heavy weights, 10% patients does vyayama, All these constitute viharja nidana.

Manasika Nidanas

Among 30 patients 80% suffer from Chinta, 73% Shoka and 57% are under bhaya and krodha. All

these are manasika Nidana for Sandhigata Vata.

Table No. 26 : Distribution of patients by Dosha bhedha

Dosha bhedha No of Patients % Vataja 04 13.33 Pittaja 0 0

Kaphaja 0 0 Vata-pittaja 14 46.66

Pitta- kaphaja 01 03.33 Kapha – vataja 09 30

Sanipataja 02 06.66

Results


63

Vataja15%Pittaja

0%

Kaphaja0%Vata-pittaja

52%

Pitta-kaphaja0%

Kapha-vataja33%

Distribution of patients by Dosha bhedha

The predominance of Vata – pitta with 47% is seen along with Kapha – vata of 30%, Vataja

of 13%, Sannipataja of 06% and Kaphaja of 03%.

Table No. 27 : Showing the distribution of patients by different grades of Vatapoorana druti sparsha before and after treatment.

Grade Before Treatment No of

Patients

% After Treatment No of Patients

%

III 01 03.33 0 0 II 02 06.66 0 0 I 27 90.00 14 46.66 0 0 0 16 53.33

Total 30

05

1015202530

Before Treatment After Treatment

Graph, 11 : Showing the distribution of patients by different grades of Vatapoorana druti sparsha before and after

treatment.

Grade III

Grade II

Grade I

Grade 0

Results: It is observed that vatapoorna druti sparsha was 3% in III grade and 90% in I grade before

treatment. But after treatment there were no patients found in III and II grade but 47% were enrolled

Results


64

in I grade and 53% in 0 grade .These results conclude that there was marked reduction in vata poorna

druti sparsha.

Table 28: Showing the distribution of patients by Atopa Before and After treatments

Group Before

Treatment No of

Patients

% After Treatment

No of Patients

%

III 02 06.66 0 0

II 10 33.33 03 10

I 16 53.33 22 73.33

0 02 6.66 05 16.66

Total 30

05

1015202530


Graph, 12 : Showing the distribution of patients by different grades of Atopa before and after treatment.

Grade III

Grade II

Grade I

Grade 0

Results:

Atopa the main characteristic feature of sandhigata vata is 7% in III grade,33% in II

grade ,53% in I grade and 7% in 0 grade .After administration of medicine for 45 days 10% in II

grade, 73% in I grade and 17% in 0 grade were observed.

Table No. 29 : Showing the distribution of patients by Prasanna akunchanayoho savedana pravrutti Group Before Treatment

No of Patients % After Treatment

No of Patients %

III 06 20 0 0

Results


65

II 15 50 04 13.33 I 08 26.66 18 60 0 01 03.33 08 26.66 Total 30

0

10

20

30


Showing the distribution of patients by different grades of Prasanna akunchanayoho savedana pravrutti

before and after treatment.

Grade III

Grade II

Grade I

Grade 0

Results:

All 30 out of 30 patients had pain on flexion and extension among them 6 patients had III

grade pain and 15% had II grade and 8 had I grade and only 1 patient had 0 grade pain.After treatment

only 4 patients had II grade pain,18 had I

grade and 8 patients had 0 grade pain,. Marked decrease in the grades of pain is seen.

Table No. 30: Showing the distribution of patients by different grade of Sandhi shotha Before and After treatment. Group Before

Treatment No of Patients


%

III 0 0 0 0 II 16 53.33 04 13.33 I 12 40 20 66.66 0 02 06.66 06 20 Total 30

Results


66

Results:

There were no III grade swelling fond among 30 patients but 16 patients among 30 had II grade

and 12 had I grade and only 2 had 0 grade. After treatment 4 patients had II grade 20 had I grade and

6 patients had 0 grade pain.

Table No. 31: Showing distribution of patients by different grades of Sandhigraha

Group Before Treatment No of Patients


%

III 0 0 0 0 II 0 0 0 0 I 25 83.33 20 66.66 0 05 16.66 10 33.33 Total 30 99.99 30 99.99

Results


67

05

10152025

Before Treatment

After Treatment

Graph, 15 : Showing the distribution of patients by different grades of Sandhigraha


Grade III

Grade II

Grade I

Grade 0

Results:

25 patients before treatment had I grade stiffness and 5 had 0 grade stiffness but after

treatment there was 16% reduction in the grade only 20 patients had I grade and 6 patients had 0 grade

pain.

Table No. 32: Showing distribution of patients by different grades of Sparsha akshamatva

Group Before

Treatment No of

Patients

% After Treatment

No of Patients

%

III 01 03.33 0 0

II 09 30 04 13.33

I 15 50 14 46.66

0 05 16.66 12 40

Total 30

Results


68

0

5

10

15


Graph, 16 : Showing the distribution of patients by different grades of Sandhigraha


Grade III

Grade II

Grade I

Grade 0

Result:

Only 1 patient among 30 had III grade tenderness and 9 had II grade, 15 had I grade and 5 had

0 grade. After treatment 4 patients had II grade 14 had I grade and 12 had 0 grade tenderness.

Table No. 33: Table Showing Total results

Results Number of patients % Marked response 1 3.33

Moderate response 16 53.33 Mild response 7 23.33 Not responded 6 20

Total 30

Marked response

3%

Moderate response

54%Mild response

23%

Not responded20%

Graph 17 : Total Results

Results


69

Results:

The results of trial drug are observed with subjective and objective parameters. The

assessment is done as a comparison to the baseline data to the final data obtained. Initially almost

patients are observed with ruja and shotha further are observed with diminished grades of severity.

The trial drug AJAMODADI VATI has moderate response with 53% and mild response 23% and

20% patients not responded to the treatment and only 1 patient had marked response.

STATISTICAL ASSESMENT:

Table No 34: Showing Subjective parameters

RESULTS:

The subjective parameters viz vatapoornadruti sparsha has highly sinificant decrease compared

to the reading gradient before and after treatment with trasparency of results abt 55%, atopa has 30%

result. The charecteristic feature of sandhigata vata prasarana akunchanavoho savedana pravrutti has

been reduced by 55% proving the efficacy of ajamodadi vati as an analgesic. The shotha hara property

of ajamodadi vati is well established by 36% result. Sandhigraha and sparshaakshamatva has result of

23% and 43% respectively. Hence all the subjective parameters have highly significant result.

Sl no

Subjective parameters

Mean BT

Mean AT

% of Improvement

SD SEM t value

P Value Remarks

01 Vataporna driti Sparsha

1.033 0.466 54.88 0.568 0.103 5.504 <0.001 Highly Significant

02 Atopa


03 Prasrna Akunchanayoho Vedana


04 Sandhi Shota


05 Sandhigraha


06 Akshamatwam


Results


70

OBJECTIVE PARAMETERS:

Table No 35 : Showing Objective parameters

RESULT:

Joint pain, local temperature, Mc gills, Hb%, E.S.R, T.C, mobility, D.C-Polymorphs, walking time

all these objective parameters show highly significant result, while swelling and Dc lymphocytes have

no significant result.

Table No 36: Showing subjective Parameters based on Gradings

Sl no

Objective parameters

Mean BT

Mean AT

% of Improvement

SD SEM t value

P Value

Remarks

01 Joint pain


02 Local Temp


03 Swelling

309.533 309.066

05.25 9.722 1.775 00.262 <0.40 Not Significant

04 MC Gills 13.10 09.16 30.00 1.874 0.0003 13.13 <0.001 Highly Significant

05 Hb% 11.436 11.826 03.00 0.486 0.088 04.43 <0.001 Highly Significant

06 ESR 24.2 20.86 13.80 2.454 0.448 07.455 <0.001 Highly Significant

07 TC 6600.367 6979.36 57.00 548.40 100.12 03.785 <0.001 Highly Significant

08 Mobility 43.33 87.33 101.00 16.938 03.092 14.230 <0.001 Highly Significant

09 DC-Polymorph


10 Dc-Lympocytes

32.00 30.866 03.54 3.536 0.645 1.758 <0.10 Not significant

11 Walking time


Sl no

Subjective parameters

Mean BT

Mean AT

% of Improvement

SD SEM t value P Value Remarks

01 All subjective parameters


Results


71

Overall improvement in subjective Parameters based on Gradings

0

0.5

1

1.5

2

Changes in subjective parameters (before and after treatment)

0102030405060

1 2 3 4 5 6 7 8 9 10 11

subjective parameters

% of improvement in subjective parameters

Series1

Discussion


71

V{tÑàxÜ @I MMW|ávâáá|ÉÇ M

Tadvidha sambhasha i.e., a healthy discussion paves a way for untying the bundle of thoughts

to bring out new dimension for the better evaluation of problem Sandhigata vata (O,A) which is most

commonest type of arthritis and the most common joint disorder in the word, the number one cause of

disability. As it has been mentioned under, the vatavyadhis by Bruhatrayis and these vatavyadhis are

at the topmost position among the mahagadas due to its chronicity.

According to Ayurveda vatakara ahara constitutes triggering of vata. Sthoulya is also a major

cause for vata prakopa in sandhis. Due to over weight of body, weight bearing joints, especially knee

joint has to bear the whole weight. This causes wear and tear of articular cartilage there by, causing

Sandhigata vata. On the contrary, vata prakopa occurs due to kaphakshaya in sandhis, due to each

shleshaka kapha gets qualitatively and quantitatively decreased leading to Sandhigata Vata.

Brihatrayees mentiond that vata which gets vitiated in sandhis is causative factor for

Sandhigata vata. The symptoms like vatapoorna druti sparsh, shopha, prasarana, akunchna, vedana,

are also mentioned.

Acharya madhava considered to be Nidana shresta specifies the symptom as Atopa. This is

characteristic sound produced from joints during its movement, which can be co-related with

contemporary science. Osteoarthritis, symptom, crepitation. This disease is also called as crippting

disease due to inability to perform routine activities properly. Now a-days this disease has become

much popular resulting in the formation of Arthritis organizations around the world.

To clear the miss belief that participation in the sports leads to O, A. there is no any

convincing reason to support the statement of an association between specific athletic activities and

arthritis if major lacuna is excluded. Neither long distance wall running or jogging has been shown to

cause O, A. this apparent lack of association may be due to lack of association may be due to lack of

good long teem studies and the selection basic early discontinuation of the activity by those incurable

joint damage.

Discussion


72

This Sandhigata vata usually occurs in old ages in this age only vata dosha is predominant,

mainly asthi and majjavaha srotas are involved. but if continues which can be defined as

mamsakshaya, in our science due to vitiation of mamsavaha srotas and pratiloma kshaya hence

indirectly the involvement of mamsavaha srotas in disease also takes place.

A praposed hypothesis always needs prof for its justification from all the angles, this was

stated by Acharya Charaka, long back. After the formation of a hypothesis, it has to be tested and

observed by various methods and eventually the results are obtained. All these should be well

established as the grounds of proper reasoning or logic, and finally concluded thus a proposed

hypothesis becomes a principal if the reasoning is satisfactory “Rujakaratwat rogaha” here ruja refers

to all those pain with a body and mind suffer hence pain is universally understood as a signal of

disease and is the most common symptom in many diseases “Pain” very easy to say and ask but most

difficult to suffer. Because pain is the alaem of actual or potential tissue damage, its protective value

becomes unbearable when we are its victims patient tends to sit with the hand over the joint offected

wich is indicative of extent of stress impact over afflicted even though joint pain is not proved to be

fatal, it cripples the affected patients.

Objectives at discussion

Discussion is a sort of engulfing the knowledge of other brains by feeding a little from ours.

Discussion with science becomes base establishment of concept. Thus discussion is most essential

phase of any reserch work keeping this in view certain facts which have emerged from study can be

studied under following heading.

i) Discussion on demographic data

ii) Discussion on Sandhi shoola

iii) Discussion on probable mode of action of Ajamodadhi vati

iv) Statistical discussion of parameters

v) Limitation of study and suggestions

i) Discussion on demogrphic data

Discussion


73

The efficacy of a drug cannot be proved unless it is subjected to clinical trials and analyzed

statistically. The clinical study is conducted for 30 patients and observations were systematically

represented in foregons pages.

a) Age distributions in study

Balya with Kapha predominence, youvana with pitta and Vruddhapya with vata

predominence, are the 3 stages of life since Sandhigata vata is seen to prevail more in vruddhavatha

and main etiology is kapha kshaya on other hand there is vaya avstha janya vata vruddhi and vyadhi

janya vata vruddhi leading to Sandhigata vata.

During trial study it is observed that approx 56% of patients in the age group 50-60 are prone

to Sandhi vata and nearly 27% of patients in the age group 40-50 are prone to the same. The subjects

of old age are relieved with pain in weight beraring joints.

The trial drug Ajamodadi vati, a rational combination chosen form vedana sthapana gana is

basically a pain relieves. These are of kashaya skanda dravyas. The action over the pain to assess here

we have observed that in the age group of 50-60 are more prone to Sandhigata vata and considerable

moderate response is seen upto 56% in the same age group

The bone and joint intact is lost, pain in the joint exist, thus a fair conclusion is drawn that

Ajamodadi vati is a pain killer acts as Vata(Sosha) and Kapha(Shotha) hara. The Sandhibandha

moksha(Subluxation) occurs due to Vata aggrevation with is regulated by kapha function of

promoting the same. The lost integrity of ligaments surrounded and joint edge part of the bone is

regulated by the Ajamodadi vati to regulate the pain in Sandhigata vata.

b) Gender

There is no spcificity in Sandhigata Specially with reference to genders. Becoz it is equally

distributed among males and females. But slight variation in the incidence rates are seen due to

increased susceptibility of females for low calcium in advancing ages. This may be due to haemoral

imbalance either in premenopausal or post menopasal period. Hence 60% of females among 30

patients were prone to Sandhigata vata while only 40% of male were prone to the same. So 50-60%

of marked response is seen.

Discussion


74

c) Religion distributions in study

As data is only areflection of geographical predomince of community living in a limited area of study

with has predominence of hindus. Hence during study 87% of hindu and 13% of muslims are

observed as patients of Sandhigata Vata.

d) Occupational distribution in the study

It was observed that 7(23%) among 30 lead life as labors, 22(73%) lead Active life and only

1(3%) patients lend sedentary life. As the manual workers and active group patients are with vitiation

of vata more and susceptible for sandhishoola, these categories are recorded more. This strengthens

the view of vata implications to cause the symptom I,e Sandhishoola is triggered by excessive

physical demand of the joint utility.

When the results are observed 57% moderate response was seen in labor group and 55%

moderate response was seen in active group of people and only 1 patients had sedentary life style and

after treatment it showed moderate response.

e) Economical status distributions in study.

Socio-economic condition plays an important role in the path of research work sometimes it

may be cause even. Here as observed middle class patients are more I,e 53% poor (10%), higher

middle (27%) and higher class (10%)

Possibility crestes that middle class people are more prone to get loint pains as they are

subjected to stress and strain. Apart from the above said reason, the locality near the trial area and

population in sureoundings may alter the data. The response of the drug may vary if balanced diet

and balanced rest is not maintained.

II) Discussion on sandhishoola:

Sandhishoola is a symptom in which the integrity and quality of the joints are reduced,leading

to weakness of the body.Sandhigata vata is the most prevelent major problem in elderly and the most

important cause of physical disability.Prevelence of this disease is rising at an alarming rate.In

developing countries it occurs mainly in middle aged and elderly population wherein it may cause

severe disability and impaired quality of life.

Discussion


75

SANDHIGATAVATA vis-à-vis OSTEOARTHRITIS.

Sandhigatavata is the most common joint disorder arising with greater number of affected

population in the world. It comes under the various Gatavatas explained in Vatavyadhi prakarana. It

is caused by the localization of the vitiated Vata dosha in the asthi sandhis of the body. It is

characterized by the symptoms pertaining to the asthi sandhis like sandhi shoola, sandhi shotha etc.

Osteoarthritis is a disease coming under the arthritis group of diseases described by the

modern science, which is almost identical to Sandhigatavata in etiology, pathology and clinical

features. Hence, the discussion is made accordingly.

Discussion On Shareera.

In the context of Asthi sandhi means a junction between two or more bones. Sandhi is not a

single structure rather it is considered as an organ. There are different structures, which supports the

stability of the joint like Sanyu or ligament, which helps in proper binding of the joint. They unite the

bones and help to direct the bone movement and prevent the excessive and undesirable motion.

Muscle tone helps to maintain the alignment of the joint. Shleshaka Kapha present in the Sandhis

provides the lubricant factors, Shleshmadharakala situated in the joints supported by Shleshaka

Kapha, helps in lubrication.

Functions of the Shleshaka Kapha and Shleshmadhara kala described in Ayurveda can be co-

related to the synovial fluid situated in synovial joint, that lubricates the knee joint, a nutrient carrier

to the cartilage disc, and helps in keeping the joint firmly united.

Role of Vyanavata is most important in the movements of the joints. The Marmas are

considered as the point of union of nerves, vessels and muscular system, which are vital in the

structure and functioning status of the joints. Functions of the peshis and snayus are exactly identical

to that of the muscles and ligaments, related to the joints. Knee works as a hinge joint, but the

articulation is more complex than other hinge joints. Seven major ligaments, flexor and extensor

muscles support the movements of the knee joint.

Discussion


76

Discussion On Nidana.

Ayurvedic philosophy mainly emphasized on Vatakara ahara-vihara in the manifestation of

Sandhigatavata. Vardhakya is predominated by Vata dosha and characterized by Dhatu kshaya leads

to reduced Sneha bhava in the body, which in turn, vitiates the Vata dosha and reduces the Kapha,

thereby resulting in Karmahani of the sandhis. Also, dhatushaithilya is another feature in Vardhakya,

which reflects in peshis and snayus thereby reducing their functional efficiency in supporting the

joints. This is a major risk factor for Sandhigatavata. Various physical activities such as Pradhavana,

Bharaharana and Abhighatas due to prapatana, Marma abhighata, Dukha shayya and Dukha asana are

important Nidanas for Sandhigatavata. Repetitive movements may lead to excessive strain leading to

erosion and joint damage. Trauma to the joint enhances the occurrence of arthritis. Sthoulya is another

causative factor for Sandhigatavata. Vatavyadhee and Sthoulya are having interrelated pathogenesis.

(i.e. Medavrita vata) Obese person have a high risk of Osteoarthritis. The relative risk of developing

Osteoarthritis, is more in the population belonging to the high quintile body mass index.

Discussion On Samprapti

Samprapti of Sandhigatavata may be divided into Dhatukshayajanya and Avaranajanya.

Modern science explains the pathogenesis of Osteoarthirits in two ways –

01. Sub-standard biomaterial of the joint (Dhatukshaya).

02. Increased applied pressure over the joint (Avarana).

In Dhatukshyajanya Sandhigatavata due to old age and excess use of Vatakara ahara-vihara

causes qualitative changes in the joint material gradually leading to disease manifestation i.e. age

related degenerative changes. Samprapti of Margavaranajanya sandhigatavata initiated by the nidana

ghataka Sthoulya involving the avarana of Vata by Kapha and medas, which can be correlated with

complications of obesity where in due to continuous pressure, joints get affected (due to Avarana)

leading to disease manifestation.

Discussion


77

Discussion On Symptomatology.

The lakshanas of Sandhigatavata viz. Vedanayukta pravritti of sandhis, Shotha (Vatapoorna

dritisparshavat), Atopa and Sandhigati asaamarthya,etc are explained by various treatises of

Ayurveda.

Modern science, has mentioned similar features along with other symptoms pertaining to

individual joints. Tenderness and joint stiffness (implied by the restriction of joint movements) are

specially monitored in Modern science and further added that any joint can get affected with

Osteoarthritis.

Acharyas have not paid their attention towards the site of particular joint involvement. When

there are structural changes in the joints the disease can be categorized as Asadhya

Discussion on DOSHA consideration:

In sandhigata vata vyanavata and sleshakakapha has got prime importancein its manifestation.

The type of vata that invades throughout the body being responsible for all the movements is called

vyanavata and shleshakakapha resides in joints and helps in movements of joints.The vyanavata and

shleshaka kapha gets vitiated by nidana and gets loddged itself in sandhi leading to sandhigatavata.

It is not concluded that the alone vyanavata is responsible for the pain anywhere.iin the flow

diagram shownat samprapti describes the involvement of rest of vata.

Discussion on DHATUS :

Authors of Ayurveda have explained that asthi dhatu will be predominant of prithvi

mahabhuta and they have placed asthi dhatu among parthiva dravya.And Dulhana comenting on this

states that apart from pritvi their will be presence of vata and agni mahabhuta as these two are having

kharatwa,rukshatwa,parushatw a properties.The properties of asthi are steera, kathina, chirasthayi and

bharadharana ksamata.These qualities mimick that of kapha which is the binding force between two

structures.Here in this word structure can be taken as shlesmadhara kala.

Asthidhatu with its aashrayaashrayi bhava sambandha to the vata impacts the sandhi with

which it is joined to make a joint structure.The joints are very much needed for locomotion.

Thenourishment disturbances action to vitiate the vata and causing the joints pathology.

Discussion


78

Disscussion on probable mode of action of Ajamodadi vati :

As stated earlier Ajamodadi vati is a combination of drugs of Vedanasthapana gana, thus the

action of drug over the vata which is a prime partner of producing pain anywhere in the body

hereespecially at joints.As the pain is an action of vata

As the pain is an action of vata never all vatahara dravyas are indicated to vedana. Only a

small group of drugs reduce pain. Here the Ajamodadi vati action is substantiated. Stastical discussion

on Parameters:

Statistical disscussion of parameters:

The subjective parameters have shown highly significant result but the objective parameters

except swelling and Dc-polymorphs havenot shown any significant results rest parameters viz

Hb%,E.S.R,Dc-lymphocytes,Mc gills,mobility all have shown highly significant results.

Limitation of the study:

1. The sample size was small

2. The study period was limited.

3. Limited area of experiment restrics the results.

4. Drug is experimented in only one form

5. The drug is only oral to restrict or influence the result.

Suggestions :

1. More specific pain relieving herbs or compound medicines in Ayurveda should be evaluated.

2. A clear understanding and protocol to check the pain pathways in Ayurveda should be

developed under the limelight of contemporary science.

3. To understand the medicine response as vedana hara and shothahara property as a specified

protocol is to be established.

4. The same study can be extended to multi centric study.

Conclusion


79

V{tÑàxÜ @J MMVÉÇvÄâá|ÉÇM

1) There is an intimate relation between vata and kapha in sandhigata vata disease.Restoration of

vata to its normal state helps in the treatment of Sandhigata vata

2) Awareness of unwholesome dietory habits and exercise can prevent Sandhigata Vata

3) The pathological entities in sandhivata are vyanavata sleshakapha and sleshmadhara kala

4) Sandhivata even though is explaind as one of the vata derivatives there is no specific nidanas has

been explined for sandhivata. general vata vyadhi nidana can be considered for sandhivata

5) The maximum number of patients are in 50-60 age group, which is suggestive of influence of

vata dosh and the symptoms of joint pain is being age related.

SUGGESTIONS FOR FUTURE STUDIES:

1. The study can be conducted in a massive sample.

2. The treatment schedule can be extended for further benefits.

3. For better results it can be accompanied with panchakarma procedures.

Summary


80

V{tÑàxÜ @K MMfâÅÅtÜç

The thesis entitled “Evaluation of the efficacy of Ajamodadi vati in Sandhigatavata”

comprises following points:

1. Introduction

2. Objectives of the study

3. Review of literature

4. Methodology

5. Observation and results

6. Discussions

7. Conclusion

• Disorders of the musculoskeletal system are prevalent through the world affecting all

age group among this; important one is Sandhigatavata which produces disastrous

consequences like physical disability in community

Summary


81

• The present study is done to understand the disease which is explained in classics

even though this disease is considered as Kashta sadhya, itcan be managed when

proper treatment is given in appropriate time Here an attempt is made to find the

efficacy of the drug “Ajamodadi drug” in sandhivata

Introduction

• Gives the explanation about qualities of healthy person importance of vata as well as

pathologically and introduction of trial drug “Ajamodadi vati”

Objectives

• The main aim and objectives of the study has been mentioned


• This chapter comprises of following headings disease review and drug review

• Disease review dealt under the following headings. Disease review and Drug review

Historical aspect gives the historical glimpses with regards to the disease Sandhigata vata

and traces the various developments rights from the vedic period to preset era under the

heading of etymology the description about sandhi and different constituents which forms

the sandhi and also concept about gatavata has been mentioned.

• Detailed data wise collection about Nidana, Roopa, Samprapti, Sadhya-sadhyata

upadrava and Chikitsa along with pathya-apathya of the disease along with some

contemporary of coomperative statements.

• In Drug review section, a thorough study of ingradients of the compound preparations

covering the botanical nomenclature, rasa, guna, veerya, vipaka, chemical constituents

etc.

•

Summary


82

Clinical study

• It contains the study design Details of study subjects (Cases), under clinical study

description of the patients, grouping, selection, inclusion and exclusion criteria, protocol

criteria for assessment of the study.

Observational study

• Detailed explanation is given on the distribution of the patients according to age, sex,

economical status, diet, habits, material status are represented along with

Prepartionof the drug

• Here a detailed expiation regarding the preparation of the compound drug is mentioned

detail.

Results

• In this results of the study analyzed statistically under this demographic data, analyzed,

results are studied under demographic data, evaluating pain data.

• Results of so patients and statistical evaluations

Discussion

• In this chapter the nidana panchakas, demographic data, Sandhi shoola, Probable mode of

action of Ajamodadi vati, statistical parameters, limitations of study and suggestions were

the points discussed along with the obtained results with the variable gradient before and

after treatment.

Conclusion

• An outcome of the whole work conducted is concluded by the justification of the result

obtained.

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71) Susruta, Susrutasamhita Nidansthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 1 – 28th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-261-262

72) Madhavakara, Madhavanidana chapter 22 sloka 21. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 418.

73) Yogaratnakara Vatavyadhinidana, Vatavyadhichikitsa Chapter1 Sloka 4,Vaidya Lakshmipatisastry editor. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 528.

74) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24 sloka 258. 5th ed. Varanasi: Chaukhambha Orientalia; 1988. p. 264-265.

75) Susruta, Susrutasamhita Nidansthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 1 – 28th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-261-262


Bibliography



78) Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 24sloka 93. 5th ed.Varanasi: Chaukhambha Orientalia; 1988. p. 264-265.

79) Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5– 24th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-366.

80) Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-367.

81) Vagbhata, Ashtangahridaya Sutrasthana chapter 12 sloka 18-Varanasi:Krishnadas Academy; 1982. P.7.

82) Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 4 – 14th -15th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-365.

83) Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-265.

84) Vagbhata, Ashtangahridaya Sutrasthana chapter 11 sloka 26-28 Varanasi: Krishnadas Academy; 1982. P.7.

85) Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 29th -36th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-367.

86) Susruta, Susrutasamhita Shareersthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 37th -38th Sloka.Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-.364.

87) Susruta, Susrutasamhita Shareerasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 5 – 16th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-365.

88) Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 31– 2nd Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-488.

89) Agnivesa, Charakasamhitha Sutrasthana chapter 5 sloka 85th, 4th ed. Varanasi:Chaukhambha Sanskrit Sansthan; 1994. p. 42.

90) Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 8 – 17th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-488.

91) Agnivesa, Charakasamhitha Sutrasthana chapter 22 sloka 11 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 120.

92) Susruta, Susrutasamhita Chikitsasthana, NibandhasangrahaCommentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32–3 Sloka.Varanasi: 17th Chaukhambha Orientalia; 4th edi, 1980 p-513.

93) Agnivesa, Charakasamhitha Sutrasthana chapter 14 sloka 35-37 4th ed.Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618.

94) Susruta, Susrutasamhita Chikitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32–12 Sloka.Varanasi: 17th Chaukhambha Orientalia; 4th edi, 1980 p-514.

Bibliography


95) Agnivesa, Charakasamhitha Sutrasthana chapter 14 sloka 35-37 4th ed.Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 89.

96) Vagbhata, Asthangahrudaya Sutrasthana, Sarvanga sundara commentary; P.V. Sharma, editor. Chapter 27 –5th sloka. Varanasi: Chaukhambha Orientalia; 1978, p- 254.

97) Agnivesa, Charakasamhita Chikitsasthana, chapter 28 – 115th sloka , editor, Vaidya Jadavaji Trikamji Acharya,. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-622.

98) Agnivesa, Charakasamhita Sutrasthana, chapter 14 – 38th sloka , editor,Vaidya Jadavaji Trikamji Acharya,. Varanasi: Chaukhambha Sanskrit Sansthan; Reprint 2004, p-89.

99) Susruta, Susrutasamhita Sutrasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 18 –7th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-95.

100) Susruta, Susrutasamhita Chitsasthana, Nibandhasangraha Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 32 – 12th Sloka. Varanasi: Chaukhambha Orientalia; 4th edi, 1980 p-513.

101) Dhanwantari Nighantu,edited by Acharya Priyavrut Sharma,I edision 1982,published by Chaukhamba Orientalia,Varanasi p-88

102) Dravya-guna Vigyana vol-II by J.L.N.Shashtri I edition -2004,published by Chaukambha Orientalia, Varanasi p-

103) Raja nighantu,edited by Indradev Tripathi,II edition 1998,published by Chaukambha Orientalia,Varanasi p-156.

104) Kaiyadeva nighantu edited by Priyavrutt.Sharma,I edition 1979, published by Chaukambha Orientalia,Varanasi p-222.


106) Dravya-guna Vigyana vol-II by J.L.N.Shashtri I edition -2004,published by Chaukambha Orientalia,Varanasi p-

107) Raja nighantu,edited by Indradev Tripathi,II edition 1998,published by Chaukambha Orientalia,Varanasi p-136.




111) Raja nighantu,edited by Indradev Tripathi,II edition 1998,published by Chaukambha Orientalia,Varanasi p-143,144


113) Bhavaprakasha nighantuof Bhavamishra,6 edition,1982,published by Chaukambha Orientalia,Varanasi p-52.



116) Raja nighantu,edited by Indradev Tripathi,II edition 1998,published by Chaukambha Orientalia,Varanasi p-143,144


Bibliography


118) Bhavaprakasha nighantuof Bhavamishra,6 edition,1982,published by Chaukambha Orientalia,Varanasi p-52.


120) Dravya-guna Vigyana vol-II by J.L.N.Shashtri I edition -2004,published by Chaukambha Orientalia,Varanasi p-314,315

121) Raja nighantu,edited by Indradev Tripathi,II edition 1998,published by Chaukambha Orientalia,Varanasi p-136


123) Bhavaprakasha nighantuof Bhavamishra,6 edition,1982,published by Chaukambha Orientalia,Varanasi p-22,


125) Dravya-guna Vigyana vol-II by J.L.N.Shashtri I edition -2004,published by Chaukambha Orientalia,Varanasi p-318


127) Kaiyadeva nighantu edited by Priyavrutt.Sharma,I edition 1979, published by Chaukambha Orientalia,Varanasi p-213


129) Bhavaprakasha nighantuof Bhavamishra,6 edition,1982,published by Chaukambha Orientalia,Varanasi p-121



132) Kaiyadeva nighantu edited by Priyavrutt.Sharma,I edition 1979, published by Chaukambha Orientalia,Varanasi p-45


134) Dravya-guna Vigyana vol-II by J.L.N.Shashtri I edition -2004,published by Chaukambha Orientalia,Varanasi p-857,858





139) Methods in Biostatistics for medical students and research workers byB.K.Mahajan sixth edition published by Jaypee brothers medical publishers.

Annex-1


Table No. 37: Showing Objective Statistical Assesment of Data.

Sl,

No

OPD Joint pain Local Temp Swelling

mm

MC Gills Hb% ESR TC Mobility DC-Polymorph

Dc-Lympocytes

Walking time

01 1040 09 01 99.1 99 430 425 05 03 12 13 35 30 7750 7860 70 90 50 55 29 24 03 2

02 1326 08 02 99 98 460 455 11 08 10 12 22 18 6750 8120 70 100 52 59 39 30 03 2

03 1791 08 02 98 98 320 218 14 10 9.8 11 24 20 4076 5108 70 90 50 61 30 20 02 1

04 2132 07 01 99 98 180 175 11 08 12 12.7 28 20 5078 6121 30 90 52 59 39 30 03 2

05 1043 06 01 99 98 240 230 10 08 9.8 10 19 19 6050 7712 30 90 52 61 45 37 02 1

06 2450 07 01 98.5 98 250 245 12 08 13 13 26 20 7050 8275 70 90 51 57 40 32 01 0

07 2452 08 02 98 97 460 455 16 11 12 12 25 20 6580 6719 70 100 50 57 32 30 03 2

08 2079 06 01 98 98 260 255 10 06 11.5 12 20 20 6750 7125 30 90 50 59 32 20 03 2

09 1824 07 01 99 98 400 590 10 06 9.6 10 19 18 6050 8100 30 90 52 54 45 30 03 1

10 1722 08 02 99 98 230 224 17 12 9.8 10 20 18 8560 9333 30 90 50 55 42 35 03 2

11 7973 08 01 98 97 170 164 11 07 14.8 15 22 20 5790 6010 70 100 45 50 36 32 03 1

12 2152 08 02 102 107 350 348 15 10 12 12 30 25 8750 8916 50 70 47 51 28 31 02 1

13 4414 06 02 99 98 460 454 19 10 10 11 30 22 8750 9120 70 100 59 65 36 40 03 2

14 2916 07 02 98 97 260 255 13 07 09 10 25 20 5675 5710 30 90 60 65 30 35 03 2

15 2131 08 02 99 98 315 298 18 15 09 10 30 28 8150 8215 30 90 57 63 30 34 03 2

Annex-1


16 2512 08 03 99 97 190 186 11 08 12.5 13 20 20 6175 6256 30 90 47 51 39 40 02 1

17 3271 07 03 99 97 240 230 07 07 10.2 10.2 25 25 8150 8216 40 90 52 59 39 40 03 2

18 5360 09 03 99 98 210 202 12 10 12.2 13 20 20 6415 6720 40 70 49 53 30 34 02 1

19 1041 07 02 100 99 271 268 17 13 12.3 13 28 24 6050 6127 40 100 57 60 28 31 03 2

20 1770 08 01 101 99 321 318 17 15 12.2 12.5 20 18 8614 8650 40 60 52 59 31 35 02 0

21 2136 08 03 99 98 247 244 16 07 12 12 20 16 4565 4710 40 90 52 55 29 30 03 2

22 3154 09 05 99 97 910 401 12 07 13 13 20 20 8496 8612 20 90 48 52 27 30 03 2

23 3271 09 02 100 98 312 368 14 10 12 12 28 22 6170 6215 40 90 48 54 21 25 03 2

24 2757 07 03 98 98 248 248 10 07 11 11 20 17 4560 4791 30 50 51 54 29 30 03 2

25 3791 08 02 99 97 347 341 13 10 13 13.2 22 18 7195 7201 40 90 51 55 22 27 02 1

26 3017 08 02 99 98 347 339 10 08 13 13 21 18 4351 3401 40 90 47 52 27 30 03 2

27 3197 08 06 99 97 347 341 14 10 11 11.2 22 19 4196 4207 50 90 48 53 22 27 02 2

28 4001 09 01 99 97 417 409 15 10 10.7 11 27 25 6945 7120 30 90 47 52 29 30 03 2

29 4007 08 02 101 99 347 345 18 14 12.7 12 30 22 7125 7201 40 70 51 54 29 30 03 2

30 4127 09 02 98 97 247 241 15 10 11 11 28 24 7195 7510 30 90 52 55 25 27 02 1

233 63 2971.6 2943 9786 9272 393 275 343.1 354.8 726 626 198011 209381 1300 2620 1529 1689 960 926 79 47

Annex-1


Table No. 38: Showing Subjective Parameters Of Master charts

Sl,No OPD,No Vataporna driti Sparsha

Atopa Prasrna Akunchanayoho Vedana

Sandhi Shota Sandhigraha Akshamatwa

01 1040 01 01 01 00 02 01 02 02 01 01 02 02

02 1326 01 00 02 01 02 01 01 01 01 01 01 01

03 1791 01 01 02 02 01 00 02 02 01 01 01 00

04 2132 01 01 01 00 02 01 02 01 01 01 02 00

05 1043 01 00 02 01 02 01 01 00 00 00 01 01

06 2450 01 00 01 00 01 00 02 00 00 02 01

07 2452 01 00 02 01 02 00 02 02 01 00 00 00

08 2079 01 01 02 01 03 02 02 01 01 00 00 00

09 1824 01 00 01 01 02 01 01 00 01 01 01 00

10 1722 01 00 01 01 02 01 02 01 01 01 01 01

11 7973 01 01 01 01 02 01 01 01 01 01 01 01

12 2152 01 01 02 02 02 01 02 01 01 01 02 02

13 4414 01 01 01 01 02 01 01 01 01 01 01 00

14 2916 01 01 01 01 02 01 01 01 01 01 02 01

15 2131 01 01 02 01 02 01 02 01 01 01 01 01

Annex-1


16 2512 01 01 01 01 02 01 02 02 01 01 01 01

17 3271 01 00 00 00 01 01 01 01 01 01 01 01

18 5360 01 00 01 01 03 01 02 01 01 00 00 00

19 1041 01 00 01 01 02 01 01 01 01 01 02 01

20 1770 01 01 01 01 02 01 02 01 01 01 01 01

21 2136 01 00 01 01 00 00 01 01 01 00 02 01

22 3154 02 00 01 01 02 00 01 00 01 00 01 00

23 3271 01 00 01 01 01 00 02 00 01 00 01 00

24 2757 01 00 03 01 02 01 01 00 00 00 02 01

25 3791 01 00 01 01 01 00 02 01 01 01 00 00

26 3017 01 01 00 00 02 01 01 01 01 01 03 02

27 3197 01 01 02 02 03 02 01 01 01 01 00 00

28 4001 01 00 02 01 03 02 00 00 01 01 02 01

29 4007 01 01 01 01 02 00 01 01 00 00 01 00

30 4127 01 00 02 01 03 02 00 00 01 01 02 01

31 14 40 28 58 26 42 26 26 20 37 21

Annex-1


Table No. 39: Showing Chief Complaints

Chief Compleints Associated Compleints

Sl,No OPD, No Sandhi Sootha

Pain Sandhigraha Smarthta Akshmatva Klama Jwara Angamarda

01 1040 + + + + + + + +

02 1326 + + + - - + + +

03 1791 + + + + + + + +

04 2132 + + + + + + - +

05 1043 + + + - + + + -

06 2450 + + + + + + - -

07 2452 + + + + - - - -

08 2079 + + + - - - - -

09 1824 + + + + + - - +

10 1722 + + + + + - - +

11 7973 + + + - _ + - -

12 2152 + + + + + - + -

13 4414 + + + + - - - -

14 2916 + + + + + + + -

Annex-1


15 2131 + + + + + + + -

16 2512 + + + + + + + -

17 3271 + + + + + + - -

18 5360 + + + + + + - +

19 1041 + + + - + - - +

20 1770 + + + + + + + +

21 2136 + + - - - + + -

22 3154 - + + + + + - -

23 3271 + + - - + - + -

24 2757 + + + + + - - -

25 3791 + + + + + + - +

26 3017 + + + + + + - +

27 3197 + + + + + + + +

28 4001 + + + + + + + +

29 4007 + + + + + + - +

30 4127 + + + + + - - +

Annex-1


Table No. 40: Showing Present Illness of Master Chart. Sl,No OPD Mode of onset Joints involved Nature of Pain Roatine

activities affected

C I A T A C L S K An H I P A G B Yes No

01 1040 + - - - - + - - - - - + - - + -

02 1326 - - + - - + + - - + + - + - - - + -

03 1791 + - - - - - + - + + - - - + - - + -

04 2132 - - + - - - - - + - - - + - - - + -

05 1043 + - - - - - - - + - - - + - - - - +

06 2450 - - + - - - + - + - - - - - + - + -

07 2452 + - - - - - + - + - - - - - + - + -

08 2079 - - + - - - - - + - - - - + - - + -

09 1824 - - + - - - - - + + - - - - + - + -

10 1722 - - + - - - - - + + - - - + - - + -

11 7973 - + - - - - - - + - - - - + - - - +

12 2152 + - - - - - - - + - - - - - + - + -

13 4414 - + - - - - - - + - - + - - + - - +

14 2916 - - + - - - - - + - + - - - + - + -

Annex-1


15 2131 + - - - - - - - + - - + - - + - - +

16 2512 - - + - - - - - + - - + - - + - + -

17 3271 - - + - - - - - + - - + - - + - - +

18 5360 - - + - - - - - - + - + - + - - - +

19 1041 - - + - - - - - - + + - - + - - + -

20 1770 + - - - - - - - - + - + - - + - - +

21 2136 + - - - - - - + - + - + - + - - + -

22 3154 - - + - - - - - + - - + - - + - + -

23 3271 - + - - - - + - + - - - - - + - + -

24 2757 - - - - - - - - - + - + - + - - + -

25 3791 + - - - - - - + + - - - - + - - + -

26 3017 - - - - - - - - - + - + - + - - - +

27 3197 + - - - - - - - - + - + - - + - + -

28 4001 + - - - - - - - + + - + - + - - + -

29 4007 + - - - - - - - - + - + - + - - - +

30 4127 - - - - - - - - + - - + - - + - - +

Annex-1


Table No 41: Showing Srotas Sl,No OPD,No Annavaha Rasavaha Majjavaha Asthivaha

Ajeerna Agnimandya Aruchi Jwara Asthinisthoda Sandhi Shaithilya

Sandhi Shopa

Sthabdha Asthitoda Asthishoola Roukshyam

01 1040 - + + + + + + - + + +

02 1326 + - + + + + + - + + +

03 1791 + - - - + + + - + + +

04 2132 + - - + - - + - - + -

05 1043 + + + - - + + - - + -

06 2450 + + + + + + + - - + -

07 2452 - - - + - - + - - + -

08 2079 + + - - + + + - - + -

09 1824 - - - - - - + - - + -

10 1722 - - + + + + + - + + -

11 7973 - - - + - - + - - + -

12 2152 - - - - - - + - - + -

13 4414 - - - + - - + - - + -

14 2916 - - - + - - + - - + -

15 2131 - + + + - - + - - - -

Annex-1


16 2512 - - - - - + + - - - -

17 3271 - - - + - - + - - + -

18 5360 - + + - - - + - - + -

19 1041 + + + - + + + - - + -

20 1770 - + - - - - + - - + -

21 2136 - + - + + + + - - -

22 3154 - - - + - + + - - + -

23 3271 - - - - + + - - - + -

24 2757 - + - - + + + - - -

25 3791 - - - - - - + - - + -

26 3017 - - - - - + + - - + -

27 3197 - + - - - - + - - + -

28 4001 - - - - - + + - - + -

29 4007 - - - - - - + - - + -

30 4127 - - - - - - + - - + -

SPECIAL CASE SHEET FOR “Evaluation of the efficacy of Ajamodadi Vati in Sandhivata

(Osteoarthritis)” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Guide:

Dr. K. Shiva Rama Prasad

Scholar:

Shakuntala. S. Totar

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

9) Selection Included Excluded

10) Schedule dates Initiation Completion /

Discontinuation

11) Result Marked

Response

Moderate

Response

Mild

Response

Not

Responded

INFORMED CONSENT

I Son/Daughter/Wife of am

exercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, by

the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware

of my right to opt out of the treatment schedule, at any time during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æÃªÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ PÉÆqÀÄªÀ

aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀÄªÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ

0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature

1) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints - Lakshana Duration Remarks

1 Sandhi shotha (Swelling)

2 Prasaarana Aakunchanayoho Savedana Pravruthi (Pain on extension & flexion)

3 Sandhigraha (Joint Stiffness)

4 Sandhigati asamarthya (limitation of joint movement)

5 Sparsha akshamatva (Tenderness)

2) ASSOCIATED COMPLAINTS Associated Complaints –

Anubandha LakshanaDuration Remarks

1 Klama (fatigue)

2 Jwara (Fever)

3 Angamarda

4 Any other specify

3) OCCUPATIONAL HISTORY (if any)

4) PERSONAL HISTORY

Food habits Vegetarian Mixed diet

Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna

Kosta Mrudu Madhyama Krura

Nidra Day Night Sound Disturbed

Addictions Tobacco Alcohol Drugs

Bowel habits Normal Loose Constipated

Menstrual History Regular Irregular Amenorrhea Menopause

Family history – Specify if any has the same disease

Other system medications Pain relievers Treatment history Since how long Anti inflammatory

History of past illness

Are you pregnant Yes ( ) No ( ) Any steroid therapy Yes ( ) No ( ) Any surgical therapy Yes ( ) No ( )

5) HISTORY OF PRESENT ILLNESS: Mode of onset Chronic Insidious Acute Traumatic Joint involved Axial Cervical Lumbar Spine Distal joints Knee Ankle Hip Inter

phalangeal

Nature of pain Pricking Aching Generalized Burning Routine activities affected

Yes No

6) HISTORY OF PAST ILLNESS: Complaint Yes No Episodes of same illness Obesity Trauma/Fracture of involved or related joint Diabetes Mellitus Hypertension Other Vatavyadhees Fever Others

7) TREATMENT HISTORY Are you undertaking any treatment? Yes No If yes, what type? Allopathy Ayurvedic Homeopathy other Relief with previous treatment Partially relieved No relief at all

8) SAMANYA PAREEKSHA A. Asta sthāna Pareeksha :

B. Vital examination 1 Temp /F 4 Blood Pressure mm of Hg 2 Pulse /min 5 Height cms 3 Respiration /min 6 Weight Kgs.

C. Dasha vidha Pareekshā : 1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Tridoshaja ( ) 2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( ) 3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( ) 4 Pramana Pravara ( ) Madhyama. ( ) Avara ( ) 5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( ) 6 Satva Pravara ( ) Madhyama ( ) Avara ( ) 7 Ahara Shakti a) Abhyavaharana shakti P ( ) M ( ) A ( )

b) Jarana shakti P ( ) M ( ) A ( ) 8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( ) 9 Vaya Bala ( ) Yuva ( ) Vrudda ( )

1 Nadi Dosha V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) VPK ( ) Gati 2 Mala 3 Mootra Frequency Day Night 4 Jihwa 5 Shabda 6 Sparsha 7 Druk 8 Akruti

9) SROTO PAREEKSHA Srotas Observation

Annavaha Rasavaha Astivaha Majjavaha

10) SPECIAL EXAMINATION OF JOINTS A) Darshana (Inspection) Before After Joint Swelling Grading 0 1 2 3 0 1 2 3

Varna Raaga Shyaava Prakrutha Raaga Shyaava Prakrutha

Deformity Present Absent Present Absent

Joint Instability Present Absent Present Absent

Gait Nature

Walking Time

Active Completely Restricted

Partially Restricted

Free Completely Restricted


Free Joint Movement

Passive Completely Restricted


Free Completely Restricted


Free

Muscular spasm Present Absent Present Absent

Above affected joint

Yes No Yes No Muscular Wasting

Below affected joint

Yes No Yes No

B) Sparshana (Palpitation) Before After

Vaatapoorna druthisparsha

Yes No Yes No

Local Temperature

Raised Not raised Raised Not raised

Tenderness Grading 0 1 2 3 0 1 2 3

Limitation of Joint Movement

Axial Joints Cervical Lumbar Spine

Axial Joints Cervical Lumbar Spine

Hip Knee Ankle Hip Knee Ankle Right Carpo meta metacarpal

Distal Inter phalangeal

Proximal Inter

phalangel

Carpo meta metacarpal


Proximal Inter

phalangel Hip Knee Ankle Hip Knee Ankle

Distal Joints

Left Carpo meta metacarpal


Proximal Inter

phalangel

Carpo meta metacarpal


Proximal Inter

phalangel C) Shravana (Auscultation) Crepitus

11) RADIOLOGICAL EXAMINATION OF JOINTS ( Antero posterior and Lateral View) Joint space Reduced /Increased /Unaltered

Subchondral bony sclerosis Present / Absent

Formation of osteophytes Present / Absent

Periarticular ossicles Present / Absent

Altered shape of bone end Present / Absent

12) NIDANA Swa prakopakara nidana Ahara Guna Seeta Rooksha Laghu Rasa Katu Tiktha Kashaya Shuskanna Yes No Upavasa Yes No Vihara Ratrijagarana Yes ( ) No ( ) Yanam (Riding) Yes ( ) No ( ) Pradhavana

(Running) Yes ( ) No ( ) Jumping Yes ( ) No ( )

Bharavahana (Weight lifting)

Yes ( ) No ( ) Vyayama Yes ( ) No ( )

Pratarana (Swimming)

Yes ( ) No ( ) Walking Yes ( ) No ( )

Manasika Chinta (worry) Yes ( ) No ( ) Shoka (grief) Yes ( ) No ( ) Bhaya (fear) Yes ( ) No ( ) Krodha (anger) Yes ( ) No ( ) Marmaghatakara nidana Dhatukshayakaraka nidana

13) LAB INVESTIGATIONS: TC DC P L E M B RBS

Blood

Hb%

Urine Sugar: Albumin: Microscope:

14) ASSESSMENT OF RESULTS PARAMETERS Before After Follow up

Subjective Vatapoorna Dhruti Sparsha Atopa (Criptus) Prasaarana Aakunchanayoho Savedana Pravruthi (Pain on extension & flexion)

Sandhi shotha (Swelling) Sandhigraha (Joint Stiffness) Sparsha akshamatva (Tenderness) Objective ESR in mm Joint Pain grading 0 to 10 (UPA) Local temperature ° F Mc Gill’s pain questioner Mobility grading in VAS 0 - 100 Swelling in mm Walking time in sec

TREATMENT SCHEDULE

Oral Ajamodadi vati: 3gms/ 24 hrs (1 gm TDS) Schedule Date Observation / instructions 0 day = Initiation 11th day = 1st observation 21st day = 2nd observation 31st day = Test completion 45th day = Final Follow Up SCORE SHEET Condition Grading Pain (subjective) 0-No complaints 2-Complains frequently

1-Tells on enquiry 3-Excruciating condition Swelling 0-No complaints 2-Covers well over the bony prominence

1-Slightly obvious 3-Much elevated Stiffness Vatapoorna Dhruti Sparsha

0-Absent 1-Present

Tenderness 0-No complaints 2-Winces the affected joint 1-Says the joint is tender 3-Winces and withdraws the joint

Crepitus 0-None 1-Felt 2-Heard

Haemoglobin, Local Temperature, ESR, Walking time, Mc Gill’s pain questioner, Universal Pain assessment Joint pain grade - are scored as per the readings

Universal Pain assessment Joint pain grade

Mc Gill’s pain questioner

15) INVESTIGATORS NOTE:

Scholar: Shakuntala. S. Totar Guide: Dr. K. Shiva Rama Prasad

Sandhivata kc045gdg

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