Sandhivata matravasti pk024_gdg

“Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana

krama – A comparative clinical study”

BY

SSAANNAATTHH KKUUMMAARR DD..GG

Dissertation Submitted to the Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

In partial f ment oulfil f the degree of

AAYYUURR I

A Under the guidance

DR.M.D. (AYU), FRAV (GOI, Delhi)

P.G. Dept. of Panchakarma

And co-guidance of

DR. SM.D. (Ayu)

a

POST GRADU PANCHAKARMA D.G M.AYURVEDIC MEDICA E AND RESEARCH CENTER

GADAG – 582103

2007-2010

VVEEDDAA VVAACCHHAASSPPAATTI IN

PANCHAKARMof

SURESH BABU. S

Professor

ANTOSH N. BELAVADI

Ast. Professor P.G. Dept. of Panchakarm

ATE DEPARTMENT OFL COLLEG

DECLARATION BY THE CANDITATE

duate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,

Signature of the Candidate

lace: Gadag (Sanath Kumar D.G)

I hereby declare that this dissertation / thesis entitled “Evaluation on the effect

of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and

Sadharana krama – A comparative clinical study” is a bonafide and genuine research

work carried out by me under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI,

Delhi) Professor and the co-guidance of Dr. Santosh N. Belavadi M.D(Ayu), Ast.Professor,

Post Gra

Gadag.

Date:

P

CERTIFICATE BY THE GUIDE

of the requirement for the degree of Ayurveda

.D. (Panchakarma).

Place: Gadag

This is to certify that the dissertation entitled “Evaluation on the effect of

Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana

krama – A comparative clinical study” is a bonafide research work done by Sanath

Kumar D.G in partial fulfillment

Vachaspathi. M

Date: Signature of the Guide

Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi) Professor

P.G. Dept of Panchakarma Shri.D.G.M. Ayurvedic Medical College,

Gadag.

CERTIFICATE BY THE CO-GUIDE

This is to certify that the dissertation entitled “Evaluation on the effect

of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and

Sadharana krama – A comparative clinical study” is a bonafide research work done by

Sanath Kumar D.G in partial fulfillment of the requirement for the degree of

Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Co-Guide Place: Gadag

Dr. Santosh N. Belavadi D. (Ayu).

D.G.M Ayurvedic Medical College, Gadag.

M.Ast. Professor

P.G. Dept of Panchakarma

J.S.V.V. SAMSTHE’S

SHRI D.G.M. AYURVEDIC MEDICAL COLLEGE, GADAG POST GRADUATE DEPARTMENT OF PANCHAKARMA

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

This is to certify that the dissertation entitled “Evaluation on the effect of

Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana

krama – A comparative clinical study” is a bonafide research work done by Sanath

Kumar D.G under the guidance of Dr. Suresh Babu. S M.D. (Ayu), FRAV (GOI, Delhi)

Professor, and co-guidance of Dr. Santosh N. Belavad M.D. (Ayu), Ast. Professor, Post

Graduate Department of Panchakarma, Shri. D.G.M.A.M.C, Gadag and contributed

good values to the Ayurvedic research.

Dr. G. B. Patil Principal,

Shri. D.G.M. Ayurvedic Medical College,Gadag

Date: Place: Gadag

Dr. Sivaramudu M.D. (Ayu), M.A (San), M.A (Psy) Prof. and H.O.D. P.G. Dept of Panchakarma Shri. D.G.M. Ayurvedic Medical College, Gadag. Date: Place: Gadag

COPYRIGHT

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 academic / research purpose.

Date: Signature of the Candidate

Place: Gadag. Sanath Kumar D.G

© Rajiv Gandhi University of Health Sciences, Karnataka.

i

ACKNOWLEDGMENT:

I have constantly witnessed Divine Providence in many instances and experiences

of my life. I thank Almighty for helping me soar to a new high today.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Shivananda Mahaswamiji, for their divine blessings.

I give my respect at this moment to my father Sri. Guddappa Gowda. D, my

mother Smt. Nagaveni for their blessings which gave me enough strength. I thank my

sisters Smt. Supriya, Smt. Shwetha and their family for affection and continuous

encouragement.

The inspiring forces throughout this research work; was my guide Dr. Suresh Babu.

S, M.D. (Ayu), FRAV (G.O.I, Delhi). I use this opportunity to express my immense gratitude and

heart full thanks for his timely advises, constant encouragement, critical analysis, untiring

help and rousing clinical knowledge.

I would like to avail the opportunity to express my gratitude to my respected co-

guide Dr.Santosh N. Belavadi, M.D. (AYU), for his humble nature, indulgence, dynamic

supervision and scholarly suggestions during the course of this research work.

I express my gratefulness to professor Dr. P.Sivaramudu, M.D.(Ayu), HOD, Dept of

Panchakarma for his inspiration, critical suggestions, timely help rendered me through

out this work.

I am sincerely thankful to professor Dr.G.Purushothamacharyulu, M.D. (Ayu) who

was former H.O.D. of the department, for his scholarly guidance.

I express my thankfulness to beloved principal Dr. G. B. Patil, for his

encouragement and support by providing all necessary facilities for this research work.

ii

I am very much thankful to my teachers Dr. Jairaj Basarigidad MD (Ayu), Dr.

Yasmeen Paniband MD (Ayu) for their timely help and suggestions during this study.

I express my sincere thanks to Dr. Rajashekar C.V. MD (Ayu), who was former

teacher in the department, for his critical suggestions.

I am grateful to all the PG teachers Dr. K.S.R. Prasad, Dr. M. C. Patil, Dr.

Mulugund, Dr. G. S. Hiremath, Dr. R. V. Shettar, Dr. Girish Danappa Goudar, Dr.

Jagadeesh Mitti, Dr. KuberSankh, Dr. Shashikanth Nidugundi, Dr. B. M. Mulkipatil and

Dr. M.D. Samudri, for their valuable inputs and suggestions.

I extend my immense gratitude to Dr. V. M. Sajjan, Dr.Purad, Dr.Yarageri,

Dr.Suvarna Nidugundi, Dr. Shakuntala and other teaching staff who helped during my

study.

I express my sincere thanks to Sri. Nandakumar, for his help in statistical analysis

of results. I take the privilege to thank Sri. Mundinamani, Librarian. I also extend my

thanks to assistant librarians Mr. Shyavi and Mr. Keroor who provided me all the

necessary books and time for my literary work.

I am very much thankful to Sri Tippanagowdar (Lab Technician), and Sri.

Basavaraj (X-Ray Technician), for their help during the study. I extend my thanks to Sri

Kulakarni, Sri Nabi, Smt. Sunanda and Smt Renuka for their timely help in trail.

I feel extremely thankful to seniors Dr. Ashok M.G, Dr. Prasanna V. Joshi, Dr.

Nataraj, Dr. Udaya Ganesha, Dr. Adarsh, Dr. Sanjeev Chaudary, Dr. Shailej, Dr.

Madhushree, Dr. Payappa Gowdar, Dr. Devandrappa Budi, Dr. Mukta Hiremath, Dr.

Prasanna Kumar, Dr. Siba Prasad and others for valuable suggestions.

I pay sincere regards to my fellow colleagues Dr. Sabareesh, Dr. Rajesh, Dr.

Jayasankar, Dr. Deepak, Dr. Ishwar Patil, Dr. Praveen Nayak, Dr. Bodke, Dr. Kanti,

iii

Dr. Shakunthala, Dr. Asha, Dr. C.C Hiremath, Dr. S.B. Rotti, Dr. Bupesh, Dr. Gorpade,

Dr. Deepa, Dr. Jadav, Dr. Mahantesh Swami Hiremath and Dr. Praveen Palyed for their

truly help and co-operation.

I thank my juniors Dr. Joshi George, Dr. Bhagyesh, Dr. Anish, Dr.

Raghavendrachar, Dr. Suraj, Dr. Vijay Raj, Dr. Vijay Mahanthesh, Dr. Sateesh, Dr.

Vishwajith, Dr. Renukaraj, Dr. Sangamesh, Dr. Jagadeesh, Dr. Maneesh, Dr. Paresh and

Dr. Shilpa for their support.

I thank specially to Internees and UG friends for their help and supports.

I am also very much thankful to Mr. Shakthi (Local Guardian), Mr. Salimat,

Smt. Lalithamma who made my stay comfort through out my P.G. carrier.

Lastly I pay my deepest respect for those patients who took part in the study and I

share my success with them.

“To err is Human” – certain names, who could be directly or indirectly helped in

this work, might have been missed unintentionally. Thanks are due to all of them.

Date : Dr. Sanath Kumar D.G

Place : Gadag

iv

LIST OF ABBREVIATIONS USED:

A.H – Ashtanga Hrudaya

A.S – Ashtanga Samgraha

B.P – Bhavaprakasha

B.S – Bhela Samhita

C.S – Charaka Samhita

M.N – Madhava Nidana

S.S – Sushruta Samhita,

V.S – Vangasena

Y.R – Yogaratnakara

Abstract

v

ABSTRACT:

Sandhigatavata is a disorder where the locomotive functions are affected. In

Ayurvedic classics it explained under Sthana visheshakruta Vatavyadhi, under the

concept of Gatavata. Sandhigatavata can be compared with Osteoarthritis as the clinical

features simulate each other. It is also called as degenerative joint disease or

osteoarthrosis.

Matravasti is very much convenient to administer in present day busy life.

Arohana Krama Matravasti is a specific treatment modality where the dose of Matravasti

is gradually increased daily for nine days. Kethakyadi Taila is considered from

Sahasrayoga, which is indicated in Astigata vata. Here an attempt is made to compare

the efficacy of two varieties of Matravasti with Kethakyadi Taila in Sandhigatavata with

the title “Evaluation on the effect of Matravasti in Sandhigatavata with Kethakyadi

taila in Arohana krama and Sadharana krama – A comparative clinical study”.

Objectives of the study:

• To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days

by using Kethakyadi taila in Sandhigatavata.

• To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed

dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata.

• To evaluate the adverse- effects of Arohana krama Matravasti if any.

• To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as

well as Sadharana karma in Sandhigata vata.

Materials and Methods:

A total of 30 patients were selected from O.P.D and I.P.D of D.G.M.A.M.C & H

after fulfilling the inclusion and exclusion criteria randomly. They were divided in to two

Abstract

vi

groups Group A and Group B. 15 patients of Group A underwent Arohna Krama

Matravasti for Nine days. Group B patients underwent Sadharana Krama Matravasti for

Nine days.

Assessment of results was done by considering the base line data of subjective and

objective parameters to pre and post medication and was compared for assessment of the

results. All the results were analyzed statistically for “P” value using Un-paired t-test.

Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana) and

Sthamba (Morning stiffness)

Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya, Walking

time to cover 21meters of distance, WOMAC

Results:

The overall results of the study were as follows;

Group A: 01 (06.66%) shown Good response to the treatment. 07 (46.66%) were shown

Moderate response and 07 (46.66%) patients shown Poor response.

Group B: 10 (66.66%) were shown Moderate response and 05 (33.33%) patients shown

Poor response.

From the statistical analyses, all parameters shows non-significant (as P>0.05).

i.e., the mean affects of treatment same in all the parameters.

All the parameters shows highly significant in both the Groups as P<0.05.

Comparative efficacy: Overall the group A (Arohana krama Matravasti) is more effective

than group B (Sadharana Krama Matravasti) in almost all the parameters.

Key words: Sandhigatavata, osteoarthritis, Arohana Krama Matravasti, Sadharana

Krama Matravasti.

vii

TABLE OF CONTENTS

SI. No. Contents Page No.

01 Introduction 01

02 Objectives 04

03 Review of Literature 09

04 Materials and Methodology 122

05 Observations and Results 136

06 Discussion 190

07 Conclusion 218

08 Summary 219

09 Bibliography 224

10 Annexures 254

LIST OF TABLES SI. No

Tables Page No.

01 Showing Rachana shareera &Pramana of Gudhavalis 16 02 Showing Gudha valis kriya karma 17 03 Showing Gudha valis Sthana and Modern terminology 18 04 Showing Structure & Function of Rectum 19 05 Showing Sub divisions of large intestines 20 06 Showing Classification of Basti karma based on Route of

administration 24

07 Showing types of Anuvasana vasti and its Matra 25 08 Showing types vasti based on its Karma 26 09 Showing Sankya Bhedha of Vasti Prakara 26 10 Showing Matra bheda of Vasti dravya 28 11 Showing indication of Matra basti acc. to Classics 30 12 Showing Matra of sneha basti mentioned indifferent Classics 32 13 Showing Dose of Matra basti according to Age 32 14 Showing Dose of Arohana krama Matra vasti 33 15 Showing Measurements of Vastiyantra 35 16 Showing Netradosha of Vasti netra 37 17 Showing putakadosha of Vasti Putaka 38 18 Showing Samyak, Heena and Atiyoga yoga of Anuvasana vasti 42 19 Showing Type of Sandhi’s and there sites 57 20 Showing the Viprakrishta nidana of Sandhigatavata 70 21 Showing the Aharaja nidana of Sandhigatavata explained in different

treatises 70

22 Showing the Viharaja nidana of Sandhigatavata explained in different treatises

71

23 Showing the Manasika nidana of Sandhigatavata explained in different treatises

72

24 Showing the Anyata nidana of Sandhigatavata explained in different treatises

72

25 Showing the Roopa of Sandhigatavata explained in different treatise 77 26 Showing the Samprapti ghataka of Sandhigatavata 84 27 Showing the Vyavachedhaka nidana of Sandhigatavata 86 28 Showing Chikitsa modalities as mentioned in different classics 90 29 Showing the Pathyas of Sandhigatavata 93 30 Showing the Apathyas of Sandhigatavata 94 31 Showing Clinical features of Osteoarthritis 108 32 Showing Differential Diagnosis of Osteoarthritis 111 33 Showing Scoring and Interpretation 0f WOMAC 115 34 Showing Guna-Karma of Ingredient of Kethakyadi Taila 123 35 Showing Guna-Karma of Tila 124 36 Showing the distribution of patient’s age group 138 37 Showing the distribution of patients according to sex 139 38 Showing distribution of patients by Religion 140

viii

39 Showing distribution of patients by Economical status: 141 40 Showing distribution of patients by Occupation 142 41 Showing distribution of patients by Type of diet 143 42 Showing distribution of patients by Marital Status 144 43 Showing distribution of patients by Mode of Onset: 145 44 Showing distribution of patients by Vihara (Nature of work) 146 45 Showing distribution of patients by Agni 147 46 Showing distribution of patients by Kosta 148 47 Showing distribution of patients by Nidra 149 48 Showing distribution of patients by Vyasana 150 49 Showing distribution of patients by Deha Prakruti 151 50 Showing distribution of patients by Samhanana 152 51 Showing distribution of patients by Satmya 153 52 Showing distribution of patients by Vyayama Shakti 154 53 Showing distribution of patients by Vaya 155 54 Showing distribution of patients by Joint Involvements 156 55 Showing the distribution of patients by duration of the disease 157 56 Showing the distribution of patients by different grades of Vedana

before Treatment: 158

57 Showing the distribution of patients by different grades of Vedana after Follow-up:

159

58 Showing the distribution of patients by different grades of Sandhi Atopa before Treatment

161

59 Showing the distribution of patients by different grades of Sandhi Atopa after follow-up

162

60 Showing the distribution of patients by different grades of Sandhi shothaha before treatment:

163

61 Showing the distribution of patients by different grades of Sandhi shothaha after follow-up

164

62 Showing the distribution of patients by different grades of Sthamba before treatment

165

63 Showing the distribution of patients by different grades of Sthamba after follow-up:

166

64 Showing the distribution of patients by different grades of Sandhigati Asamarthya

167

65 Showing the distribution of patients by different grades of Sandhigati Asamarthya after follow-up

168

66 Showing the distribution of patients by different grades of Walking Time before treatment:

169

67 Showing the distribution of patients by different grades of Walking Time after follow-up:

171

68 Showing the distribution of Overall Response to the treatment 173 69 Comparative Study of Group A and Group B after treatment 174 70 Individual study of the Group A 174 71 Individual study of the Group B 175 72 Showing the Clinical Parameters before treatment and After Follow-

up of Group A 176

73 Showing the Clinical Parameters before treatment and After Follow-up of Group B

177

ix

74 Showing the percentage improvement in Clinical Parameters in both Groups

178

75 Showing Demographic data in patients of Group A (Arohana Krama) 179 76 Showing Demographic data in patients of Group B (Sadharana

Krama} 180

77 Showing Vayaktika vruttanta of patients (Group A – Arohana Krama 181 78 Showing Vayaktika vruttanta of patients (Group B – Sadharana

Krama) 182

79 Showing data related to Dashavidha pareeksha (Group A – Arohana Krama)

183

80 Showing data related to Dashavidha pareeksha (Group B - Sadharana Krama)

184

81 Showing data related to Disease in patients of Group A (Arohana Krama)

185

82 Showing data related to Disease in patients of Group B (Sadharana Krama)

186

83 Showing data related to Nidana in patients of Group A (Arohana Krama)

187

84 Showing data related to Nidana in patients of Group B (Sadharana Krama)

188

85 Showing average time of Vasti Dravya Retention in patients of both Groups

189

86 Showing response in patients of both Groups 190 87 Showing the Percentage Improvement of Parameters in each patient 209 88 Showing the Percentage Improvement of Parameters 211 89 Indicating retention time of Arohana krama Matravasti 217

x

LIST OF FIGURES SI No Figures Page No 01 Showing the Anatomy of Large Intestine 20 02 Showing types of Sandhi 57 03 Showing types of Joints 58 04 Showing Anatomy of Knee Joint 61 05 Showing Anatomy of Knee Joint 61 06 Showing the Minisci of Knee joint 63 07 Showing the Ligaments of Knee joint 64 08 Showing Knee joint in Flexion and Extension 65 09 Showing Samprapti of Dhatukshaya Janya Sandhigatavata 81 10 Showing Samprapti of Avarana Janya Sandhigatavata 83 11 Showing the Commonly effecting area of Osteo arthritis 98 12 Showing Osteoarthritis of Knee 103 13 Showing Radiological aspect of Osteoatrhritis 110 14 Showing Exercise for Osteoarthritis 119 15 Showing Exercise for Knee Osteoarthritis 120 16 Showing Ingredients of Kethakyadi Taila 126 17 Showing Ingredient of Vasti Pranidana 126 18 Showing Vasti Procedure 136 19 Showing the distribution of patient’s age group. 138 20 Showing the distribution of patient’s sex group. 139 21 Showing distribution of patients by religion 140 22 Showing distribution of patients by Economical status. 141 23 Showing distribution of patients by occupation. 142 24 Showing distribution of patients by type of diet. 143 25 Showing distribution of patients by Marital Status 144 26 Showing distribution of patients by Mode of Onset 145 27 Showing distribution of patients by Vihara (Nature of work) 146 28 Showing distribution of patients by Agni: 147 29 Showing distribution of patients by Kosta: 148 30 Showing distribution of patients by Nidra: 149 31 Showing distribution of patients by Vyasana: 150 32 Showing distribution of patients by Deha Prakruti 151 33 Showing distribution of patients by Samhanana 152 34 Showing distribution of patients by Satmya: 153 35 Showing distribution of patients by Vyayama Shakti 154 36 Showing distribution of patients by Vaya 155 37 Showing distribution of patients by Joint Involvements 156 38 Showing distribution of patients by duration of the disease 158

xi

39 Showing distribution of patients by different grades of Vedana before Treatment

159

40 Showing distribution of patients by different grades of Vedana after follow up

160

41 Showing distribution of patients by different grades of Sandhi Atopa before Treatment

161

42 Showing distribution of patients by different grades of Sandhi Atopa after follow-up

162

43 Showing distribution of patients by different grades of Sandhi shothaha

163

44 Showing distribution of patients by different grades of Sandhi shothaha

164

45 Showing distribution of patients by different grades of Sthamba

165

46 Showing distribution of patients by different grades of Sthamba after follow-up

166

47 Showing distribution of patients by different grades of Sandhigati Asamarthya

168

48 Showing distribution of patients by different grades of Sandhigati Asamarthya after follow-up

169

48 Showing distribution of patients by different grades of Walking Time before treatment

170

50 Showing distribution of patients by different grades of Walking Time after follow-up

172

51 Showing the distribution of Overall Response to the treatment

173

52 Showing the Percentage Improvement of Parameters 212

xii

Introduction:

Movement is the sign of radiant life but unfortunately in some clinical

conditions this vital factor is affected and such person feels himself as a miserable

creature as he depends on others for daily activities. Sandhigatavata is one such

disorder where in these locomotive functions are affected. In Ayurvedic classics it

explained under Sthana visheshakruta Vatavyadhi, under the concept of Gatavata1.

Sandhigatavata can be compared with Osteoarthritis as the clinical features

simulate each other. Osteoarthritis (OA) is the most common type of arthritis, and is

seen especially among older people. It is also called as degenerative joint disease or

osteoarthrosis.

The upset in the fine balance among the bio regulating factors of the body –

vata, pitta and kapha, make the person fall prey to diseases. If one can take care to

maintain the balance among these bio regulating factors, he is assured of good health.

The term Sandhi means ‘sandhana’ i.e. the union of two or more structures

together. According to commentator Dalhana the word Sandhi means Asthisandhi2.

Here, specifically the union of two or more asthis takes place. Asthi is the dhatu

which makes the dharana of the deha. This asthi dhatu and vata dosha are having

ashraya ashrayee sambandha3. When the vata dosha is increased it is prone to get

lodged in the asthis and sandhis. In old age, all Dhatus are deranged leading to Vata

Prakopa and making the individual prone to many vataja diseases. Sandhigata vata is

one of such disease commonly affecting a large number of individuals.

This disease can be compared with Osteoarthritis of contemporary medical

science. According to World Health Organization (W.H.O) Osteoarthritis is the

second commonest musculoskeletal problem in the world population (30%) after back

pain (50%). The reported prevalence of O.A from a study in rural India is 5.78 %4.

1

Osteoarthritis is the most common form of arthritis affecting the weight bearing joints

of the knees, hips, lower spine and peripheral joints of fingers and toes. Only 25-30%

of OA are symptomatic even though prevalence rate is about 80% at age of 65 years5.

Chikitsa is mainly of two types –Shodana and Shamana. Shodana is concerned

with malas, while Shamana deals with doshas. Shodana strikes at the root of malas

and eradicates them and as such the disorders – treated with Samshodana do not

reoccur, while those treated with other methods like Shamana might re-appear6.

Shodana measures eliminate the unwanted/vitiated doshas from the body through the

nearest out lets and purify the system.

The Samshodana therapy is an unique concept of Ayurvedic science. It

envisages not only the visceral cleaning rather it aims at the total bio-purification upto

molecular level. A suitable administrated Samshodana karma is expected to cleanse

the hollow organs, cells, cell membranes and their pores effecting the bio-purity of

intracellular contents and structures. If the body is biologically purified and cleansed

the physiology is restored optimally and pathology reversed. The nutrients reach their

desired destinations easily and their bio-availability is enhanced. The entire process of

Dhatu poshana and Dhatu Parinama is accelerated and the mechanism of Kedara

kulya Nyaya, Khale-Kapota Nyaya and Kshira-Dadhi Nyaya are accomplished well.

Similarly the medicaments administered in Samshuddha sharira reach their sites easily

and effectively and possibly even a relatively smaller dose of a medicine may produce

greater effect.

Shamana therapies include diet and medicine may not be effective unless the

srotas are cleaned and the vitiated doshas and malas are removed from the body so

Shodhana is first among all treatments and the most important. This concept is unique

2

to Ayurveda and is a primary protocol in all treatments. So Panchakarma can play a

prominent and significant role in giving a new impetus in shaping the life style and

can provide answers to many diseases of the modern era.

Vamana, Virechana, Asthapana vasti, Anuvasana vasti and Nasya are the five

procedures comprising Panchakarma7, 8, 9. Some Acharyas included Rakthamokshana

and both varieties of Vasti consider as one karma10. Among these, Vastikarma has

been placed a prime position by virtue of its wide indications and applicability like

shodhana, shamana, brumhana and karshana etc basing on the properties of the drugs

employed in the procedure11.

Sandhigatavata is a Dhatukshayajanya Vyadhi and occurs usually after mid

life stage. Here mainly Astivaha and Majjavaha srotodusti were observed. Prakopita

vata dosha creates Sandhishoola, while due to Kapha kshaya particularly decrease of

Shleshmaka Kapha, Sandhi Garshana take place and Symptoms like sandhi shotha,

Vedana etc occurs. So considering all these above factors here in Sandhigata vata the

required drug should be having two characters like supportive and Supplementary. In

supportive aspect it gives relief in symptoms of sandhigata vata. So the drug which is

having Vatahara properties and Snigda, Picchila etc Kaphavardhaka guna is useful in

better way. In supplementary aspect the drug which is Rasayana-Asti specific is

useful for prevention or to stop further degenerative changes in the body.

In contemporary medical science, treatment of Osteoarthritis is aimed at

• Reducing pain

• Maintaining mobility

• Minimizing disability

In contemporary medical science potent Analgesics, Anti-inflammatory drugs

and also corticosteroids are generally prescribed for this disease. But these drugs are

3

not so effective and pose increased risk of gastric erosion, hepatic and nephrotoxicity

etc adverse effects. And also it is clearly said that, current treatment of Osteoarthrosis

is purely to control symptoms because there is no disease modifying Osteoarthrosis

drug yet. Intra articular steroids are widely used in OA particularly for the knee, these

injections may provide marked symptomatic relief for weeks to month. Because

studies in animal models have suggested that gluco corticoids produce cartilage

damage, and frequent injections of large amounts of steroids have been associated

with joint breakdown in humans, the injection should generally not be repeated in a

given joint more often than every 4 to 6 months.

In Ayurveda, all Acharyas have given prime importance to Snehana Chikitsa

in the management of Sandhigatavata. Snehana can be performed both Bahya and

Abhyantara12. Bahya snehas include abhyanga, tarpana, murdhni taila etc and

Abhyantara snehas include bhojana, pana, nasya and Vasti.

Since sandhigata vata is a degenerative disease it requires some regenerative

therapies. Sneha (Kethakyadi Taila) used in this tril contains Kethaki mula, Bala and

atibala, are Madhura rasa pradhanya dravyas, Madhura is Tarpana dravya which acts

in regeneration of degenerated tissue including Asti dhatu. Moreover these are having

snigdha guna which also regeneratives. The drugs Bala and Atibala are of Sheeta

veerya which are also considered as jeevaneeya or regeneratives. Ushna veerya of

Kethaki may help in penetrating the sheeta veerya Bala and Atibala into the tissues.

All these are generally Tridosha shamaka. Hence the broad spectrum of action.

“xlÉåWûxÉUÉå ArÉÇ mÉÑÂwÉÈ....|” i.e., man is nothing but essence of sneha13. Hence

sneha’s role is important one. In vasti karma, generally it is used in Sadharana karma

i.e in fixed dosage, but there is another method i.e. Arohana karma where in sneha is

administered in a accending order dully increasing dose of sneha 12ml every day upto

4

144ml on 9th day. This is the technique explained by Adamalla in his commentary

“Deepika” while commenting on Matra vasti explained by Acharya Sharghadara14.

Since this technique appears to be innovative, it has been adopted in the present study

expecting some good results than sadharana karma. Final results also strengthened

this opinion as per clinical and statistical observation made after the study.

5

Objective

Objectives:

Sandhigatavata is a major problem as large percentage of population suffers

from this malady. Acharya Charaka has explained Sandhigatavata as one among the

Vatavyadhi and characterized by “Vatapurnadrutisparsha, Shotha, Prasarana

Akunchanayoho Savedana Pravrutti”15.

This can be compared with Osteoarthritis of contemporary medical science.

There is a steady rise in prevalence from age 30 such that by 65, 80% of people have

radiographic evidence of OA16. According to Ayurveda in this age, Vata is in

Pravrudhavastha and may cause degenerative diseases like Sandhigatavata etc.

Only 20-30% of OA are symptomatic even though prevalence rate is about

80% at age of 65 years17. In contemporary medical science potent Analgesics, Anti-

inflammatory drugs and also corticosteroids are prescribed for this disease. But these

drugs are not so effective and pose increased risk of gastric erosion, hepatic and

nephrotoxicity etc adverse effects.

In view of this, designed a clinical study based on the Samanya Vatavyadhi

chikitsa as described by Acharya Charaka18 and Sandhigatavata chikitsa described by

Acharya Sushrutha19. The procedure of Matravasti is selected with the Kethakyadi

Taila (Sahasrayoga) 20 for the proposed study. The Arohana krama of Mathavasti as

explained by Acharya Adamalla in his commentary “Deepika” on Sharangadhara

samhita21 is taken into consideration in planning the study.

Kethakyadi Taila consists of drugs like Kethaki mula, Bala and Atibala, which

are considered as safe for Vasti karma. Hence selected for this trial work.

In Ayurveda Vasti is one of the important line of treatment for Vatayadhis.

Matravasti, a type of Snehavasti, which does not requires strict follow up22. So this is

6

Objective

an easy as well as convenient for patient as well physician. Hence Matravasti is

selected. In Sandhigatavata, where the degeneration of the bone is seen, the proposed

treatment is expected to give the utmost results, because the Ketakyadi Taila is

specially indicated in Asthigata vata. By keeping the hypothesis that, Kethakyadi taila

is not used in Arohana karma Mathravasti, so chosen the research topic to use same

Kethakyadi taila for the two procedure vise in Sadharana karma and Arohana karma

to evaluate the efficacy over the management of Sandhigathavata with reference to

ruk and shotha in affected joint. And undertake this trial with the title, “Evaluation on

the effect of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana krama

and Sadharana krama – A comparative clinical study”

Previous researches on the same diseases:

Many numbers of studies have been done in many P.G. Centers all over India

under various universities. Different therapeutic modalities like, Shamana drugs and

Shodhana procedures have been tried. Some of these are -

i) Shayer Latha B: Role of Snehana (Anuvasana) Vasti in the management of

Sandhigatavata; Dept of Shalya tantra, Govt. Ayurvedic Medical College, Bangalore;

R.G.U.H.S. Bangalore; 1991.

ii) Rajashekhara K: The effect of Gudoochi ksheera- Vasti in Sandhivata; Dept. of

Kayachikitsa, Dr. B.K.R.R. Government Ayurvedic college Hyderbad, AP University,

Vijayawada; 1998.

iii) Bharathi A.P: The role of Matravasti in management of Sandhigatavata ; Dept of

kaya chikitsa, Govt Ayurvedic medical college, Mysore; RGUHS, Bangalore; 1999.

iv) Shinde kalpana: A clinical study on the role of Pancha tiktha Gritha Matravasti

and Pancha tiktha ksheera paka with shuddha gritha in the management of

7

Objective

Sandhigatavata; Dept of Kayachikitsa and pancha karma; Institute for Post graduate

teaching & research in Ayurveda; Gujarata Ayurveda University, Jamnagar; 2000..

v) Madhushree H. S: Evaluation of the comparative efficacy of Matra vasti & Janu

vasti with Bala Taila in sandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag;

RGUHS, Bangalore; 2005.

vi) Natraj C: Evaluation of the efficacy of Panchachatikthaksheera vasti in

sandhigatavata; Dept of Panchakarma, D.G.M.A.M.C Gadag; RGUHS Bangalore;

2006.


a) To evaluate the efficacy of Matravasti administered in Arohana krama for 9

days by using Kethakyadi taila in Sandhigatavata.

b) To evaluate the efficacy of Matravasti administered in Sadharana krama i.e.

fixed dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata.

c) To evaluate the adverse- effects of Arohana krama Matravasti if any.

d) To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma

as well as Sadharana karma in Sandhigata vata.

8

Historical review of Vasti Karma

VASTI REVIEW:

Historical Review:

Man always struggled with present and attempted for the better future and

these can be achieved with a better perspective. So, critical review of the history from

the primitive stage to the new millennium assists one to understand the future in a

better way. History helps to reveal the hidden facts and ideas of the concerned subject.

Even though it is really a difficult task to go in to the fathomless ocean of history of

Ayurveda, it is an interesting task.

MATRAVASTI

Matrabasti is a type of Anuvasanavasti, “iÉxrÉÉÌmÉ ÌuÉMüsmÉÉåÅkÉÉïkÉïqÉÉ§ÉÉuÉM×ü¹ÉåÅmÉËUWûÉrÉÉåï

qÉÉ§ÉÉoÉÎxiÉËUÌiÉ ||” (Su.Chi.35/18) which is quite relevant in present day living condition.

Veda – Purana:

There is some description about Vasti karma in Veda and Puranas. Vastikarma

is indicated as a substitute for minor operation in Kaushika Sutra of Atharvaveda23.

In Agnipurana, vastikarma is indicated as a principle line of treatment in

vataja aliments24.

In Ashwa Chikitsa Kathana, Taila Vasti is recommended in horses to relieve

their fatigue immediately25.

It is also stated that according to season different Sneha dravyas should be

used for Vastikarma26.

However, direct reference on Matravasti is not visible.

9


Samhita Kala:

Charaka Samhita:

Vasti is a part of Panchakarma which has been described for first time in

second chapter of Charaka Samhita (Apamargatanduleeya adhyaya) where Acharya

explaines that Panchakarma chikitsa should be adopted by considering Matra, Kala

etc27. This gives us the some idea about Matravasti. Later Acharya Charaka explained

about Matravasti in detail in fourth chapter of Siddhi sthana, Snehavyapat Siddhi

Adhyaya where he described about its indications, qualities and dose28. Commentator

Chakrapani added his contribution by clarifying dose of Matravasti.

Sushruta Samhita:

In Netravasti pramana pravibhaga Adhyaya (thirty fifth chapter of

Chikitsasthana), Acharya explained about Matravasti as it’s a variety of Snehavasti

based on vasti dravya pramana29.

Ashtanga Sangraha:

Matravasti is described in Vastividhi Adhyaya (twenty eighth chapter of

Sutrasthana). Acharya explained that indication of Matravasti is similar to

Madhutailika Vasti. Along with the dose, indications and qualities of Matravasti, he

has specifically mentioned the contraindication of Matravasti30.

Ashtanga Hridaya:

In Vastividhi Adhyaya (nineteenth chapter of Sutrasthana), Acharya explained

Matravasti. Description is similar to the Ashtanga Sangraha, but the contraindications

of Matravasti are not found in this text31.

10


Sangraha Kala:

Sharangadhara Samhita:

Matravasti is explained in the Vasti Kalpanavidhi (5th chapter of uttarakhanda).

He has explained Matravasti as an Anuvasanavasti bheda. He has described the dose

as 2 pala or even half of it32.

Bhavaprakasha:

In this, fifth chapter of Purvakhanda has been contributed to describe Basti where

Acharya stated that Matravasti as a variety of Anuvasana Vasti. Here Acharya

explained the Uttama, Madyama and Avara Matra of Anuvasana Vasti and gradual

increase in its dose33.

Kashyapa Samhita:

Here Matravasti is described in Vastivisheshaneeya Adhyaya (eighth chapter

of Khilasthana), Where Acharya descibed the uttama, madhyama and kaniyasi matra

of Matravasti. He has also described the dose of Matravasti in children having given

up breast feeding (Annaja) 34.

Bhela Samhita:

The description of Vasti is available in four chapters of Siddhisthana namely

Bastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhi and Dashavyapadika

Vastisiddhi. But, description of Matravasti is not found in the available chapters35.

Chakradatta:

In these text two chapters named Anuvasanadhikara and Niruhadhikara are

dealt with Anuvasana and Niruha Vasti respectively. Matravasti is not mentioned, but

he has described the three doses of anuvasana and their administration in arohana

karma36. The Kaniyasi matra explained in this script can be equated with Matravasti.

11


Vangasena:

In Vasti Karmadhikara chapter Acharya described about Vasti. The

description is similar to Chakradatta. He also described three doses for Anuvasana

Vasti37.

Kalyanakaraka:

In this text, Vastikarma is described in Vatarogadhikara only.

Todarananda:

In this text, Vastikarma is described in the chapter Vasti Vidhi adhyaya.

AROHANA KRAMA MATRAVASTI:

Acharya Adhamalla on commenting Shargandhara samhita Uttara Khanda,

Vasti vidhi Adhyaya (Fifth chapter) described the Arohana krama of matravasti38.

Acharya Bhavamishra in 5th chapter of Purva Khanda39, Acharya Chakradatta

in Anuvasanadhikara40 (72th) and Acharya Vangasena in Vastikarmadhikara chapter41

explained the three doses for Anuvasana vasti and gradual increasing in dose.

From technological point of view certain modified versions like Plastic bags,

Plastic syringe etc are being used in Vasti therapy for easy administration and better

sterilization keeping with the present day need based requirements

12

Etymology of Vasti

Etymology of Vasti:

Etymology reveals the ‘Origin and Developments’ in the meaning of a word.

The word ‘Vasti/Basti’ is derived from the root word “Vas/Bas” and “Chit” pratyaya

and belonging to masculine gender.

According to Siddhanta Kaumdi, the root ‘Vas’ gives following meaning:

“uÉxÉÑ ÌlÉuÉxÉå |” - Means to stay, to reside and to dwell.

“uÉxÉç AÉcNûÉSlÉå |” - Means to wrap

“uÉxÉç uÉÉxÉlÉå xÉÑUÍpÉMüUlÉå | ” - Give fragrance.

“uÉÎxiÉ uÉxiÉå AÉuÉëÑlÉÉåÌiÉ qÉÔ§ÉqÉç ” - That which covers the urine.

“uÉÎxiÉ lÉÉÍpÉUç AkÉÉå pÉÉaÉ xjÉlÉå ” - Reservoir of urine situated in sub

Umbilical area (Site of Bladder)

Paribhasha:

The term basti in the context of Panchakarma can be used in different

sense, it gives the following meaning.

“uÉÎxiÉlÉÉ SÏrÉiÉå uÉÎxiÉÇ uÉÉ mÉÔuÉïqÉluÉåirÉiÉÉå uÉÎxiÉÈ |” (A.xÉ.xÉÔ.28/3)42

“uÉÎxiÉÍpÉSÏïrÉiÉå rÉxqÉÉiÉç iÉxqÉiÉç uÉÎxiÉËUÌiÉ xqÉ×iÉÈ |” (zÉÉ.E.ZÉ.5/1)43

The bag made by animal bladder is termed as “Vasti”. The bladders of

animals were used as the device for bastikarma in olden days. It is also said that

medicines like Kashaya, Ksheera, Tail,Ghritha etc administered through gudamarga

by a basti netra of bastiyantra, first reaches the lower abdominal area of the patient

13

Etymology of Vasti

which contains the organ basti i.e. urinary bladder. Hence the term vasti is used to

designate the process in panchakarma.

Acharya Charaka has defined the Bastikarma as the procedure in which the

drug prepared according to classical reference and administered through gudamarga

which reaches Nabhi Pradesha, Kati, Parshva, Kukshi and churns the accumulated

Dosha and Purisha spreading the veerya of the aushada dravya to whole shareera,

extracting the doshas from whole body by the virtue of veerya of the aushada towards

guda which later is expelled along with the purisha44.

Matravasti: “WØûxuÉrÉÉ xlÉåWûmÉÉlÉxrÉ qÉÉ§ÉrÉÉ rÉÉåÎeÉiÉ: xÉqÉ:|” (A.¾û.xÉÔ.19/67) Matravasti is a type of Anuvasana vasti which is having main ingredient

sneha. The dose of Matravasti is equal to Hruswa sneha pana Matra45.

Arohana Krama Matravasti:

It’s a coined term. The word Arohana is derived from root word “AÉÃ½iÉåÅlÉålÉ”

and defined as “lÉÏcÉÉSÕkSïaÉqÉlÉÍqÉÌiÉ”46 means “The act of Rising” or “ascending” or

“mounting”. As the dose of Matravasti is gradually increased in this procedure, the

word is coined as “Arohana Krama Matravasti”.

Sadharana Krama Matravasti:

The word Sadharana is used to indicate the Usual or Common. The word

meaning of xÉÉkÉÉUhÉ given in Shabdakalpadhruma as “xÉqÉÉlÉ:”, “xÉSØzÉ:”, “xÉÉqÉÉlrÉqÉç”etc47.

As the dose of Matravasti administered in a fixed dose which is usually practiced is

considered, so the procedure is termed as Sadharana karma Matravasti.

14

Shareera

Shareera:

The word shareera comprises both structural and functional aspects of the

body. Knowledge of Anatomy and physiology of Rectum and Large intestine is

essential for the Panchakarma specialist, where in the Vasti dravya is administered.

The Guda is defined as “qÉsÉirÉÉaÉ ²ÉUqÉç|”48

As focus of this study is on Vastikarma, a discussion on Shareera of Guda and

also contemporary approach in the form of the anatomy & physiology of rectum and

large intestine where this procedure is applied is described below.

Guda Shareera:

Acharyas have considered guda as one among the Dasha pranayatanas, 49, 50

Sadhyo pranahara Marma51, Bhahirmukha srotas52.

Paryaya nama of Guda:

1. Apanam, Payu - Amarakosha53 (Shabdakalpa Dhruma)

2. Guhyam, Gudavartma - Shabdakalpa Dhruma54

3. Apana - Vagbhata55

4. Gudantram - Dalhana56

5. Vitmarga - Vachaspati.

Rachana shareera & Pramana of Gudhavalis:

Acharya Sushruta in the context of Arshoroga has explained elaborately on the

anatomical structure of guda. It is a part, which is the extension of sthoolantra with

four and half angula in length. It has got 3 valis (parts) named as Gudavalitrayam57.

15

Shareera

Table No. 01: Showing Rachana shareera &Pramana of Gudhavalis: Sl.No Guda valis Pramana

1 Pravahini 1 angula that which does pravahana.(contraction of

intestine)

2 Visarjini 11/2 angula that which does viasrajana(Evacuation)

3 Samvarani 11/2 angula that which does samvarana (Contraction of

Sphincters)

There is another structure called as Gudostha, which is about a distance of 1½

yavapramana from the end of hairs. The first vali samvarani starts at a distance of 1

angula from gudostha. The width of each vali will be 1 angula and of the colour of

elephant’s palate58.

Uttara Guda – Adhara Guda:

Acharya Charaka while describing Panchadasha Kostangas, he had considered

Uttaraguda and Adharaguda59. On commenting this Acharya Chakrapani clarifies that,

Uttara guda helps for storage of Pureesha, where Adhara guda helps in expulsion of

Pureesha. (E¨ÉUaÉÑSÈ rÉ§É mÉÑUÏwÉqÉuÉÌiÉ¹iÉå, rÉålÉ iÉÑ mÉÑUÏwÉÇ ÌlÉw¢üÉqÉÌiÉ iÉSkÉUaÉÑSqÉç | ).

The modern commentators consider them as rectum and anus respectively.

Marma:

Marmas are the vital parts of body. Acharya Sushruta explained such 107

marma sthanas in body60 and Acharya Vagbhata also explained same number of

Marmas61. Knowledge of these vital parts is essential to avoid possible injuries during

Panchakarma procedures.

According to Anatoimical distribution Guda marma comes under Udara

marma62. According to anatomical structure, explained as Mamsa Marma63.

According to effect of injury most importently Sadhyo Pranahara marma64. Its size is

16

Shareera

about four angulas65. Which is attached to Sthulantra and through which Vata and

Purisha is excreted out66.

Pranaaythana:

Pranayathanas are the vital spots where Prana or life resides. Acarya Charaka

explained such Ten points which includes “Guda”67.

Physiological concept of Guda:

Guda is one of the Pancha karmendriyas and its function is to excrete the mala

from the body68.

Guda is on of the site for Apanavata and this sub type of vata helps in the main

function of Guda i.e. expulsion of shakrut69. Pakwashaya is also considered as the

sthana for Apanavata by Acharya Sushruta70.

In this context after administration of basti karma, Apanavata helps in

evacuation of basti dravya along with vitiated vatadosha.

According to Gananath sen Mechanism of defecation through Guda vali and

Apanavata can be understood as below.

Table No. 02: Showing Gudha valis kriya karma: Sl.No. GudaVali Action

1. Pravahini Helps in compression and pushing the stool downwards

2. Visarjini Relaxes during this process and allows stool to pass

further down

3. Samvarani Expels the stool out and constricts immediately, so that

the continuity of the stool cut out and falls down

Physiology of Defecation:

Samana Vayu influences digestion of food separation of nutrients and waste

products, Absorption of nutrients and elimination of waste products71. (A.H Su. 12/8)

17

Shareera

Apana vayu does the act of defecation. This is significantly seen with a

tendency to flow downwards.

Modern View:

Elimination of feces from the rectum is called defecation. Defecation is a

reflex action aided by Voluntary contractions of the diaphragm and abdominal

muscles and relaxation of the external anal sphincter.

The rectum forms the last 15cm of digestive tract and is an expandable organ

for the temporary storage of fecal material. Movement of fecal material into the

rectum triggers the urge to defecate.

The last portion of the rectum, the Ano-rectal canal, contains small

longitudinal folds, the rectal columns. The distal margins of rectal columns are joined

by transverse folds that mark the boundary between columnar epithelium of the

proximal rectum and a stratified squamous epithelium like that in the oral cavity. Very

close to the anus or anal orifice, the epidermis becomes keratinized and identical to

the surface of the skin.

There is a network of veins in the lamina propria and submucosa of the ano-

rectal canal. The circular muscle layers of the muscularis externa in the region forms

the internal Sphincter and is not under voluntary control. The external anal sphincter

guards the anus and is under voluntary control. Pudental nerves carry the motor

commands72.

Table No. 03: Showing Gudha valis Sthana and Modern terminology:

Sl.No Guda Valis Situation Modern Terminology

1. Pravahini Proximal Middle Houston’s Valve

2. Visarjini Middle Inferior Houston’s Valve

3. Samvarani Distal Dentate line

18

Shareera

Table No. 04: Showing Structure & Function of Rectum: Structure Action Function Mucosa Secretes mucosa,

absorbs water and

other soluble

compounds

Lubricates colon and protects mucosa.

Maintains water balance Solidifies Faeces.

Vitamins and electrolytes are absorbed and

toxic substances are sent to the liver for

detoxification.

Lumen Bacterial activity Breaks down Undigested Carbohydrates

Proteins and amino acids into products and

amino acids into products that can be

expelled through faeces or absorbed and

detoxified by liver certain B vitamins and

Vitamin K are synthesized.

Haustral Churning Contents moved from haustrum to

haustrum by muscular contractions.

Peristalsis Contents moved along the length of colon

by contractions of circular and longitudinal

muscles.

Mass Peristalsis Contents forced into Sigmoid colon and

rectum by strong Peristaltic Waves.

Muscularis

Defeacation Faeces eliminated by contractions in the

sigmoid colon and rectum

Pakwashaya / Large intestine:

Pakwashaya is considered as one among the ashaya’s by Acharya Sushrutha73.

Arunadatta comments as pakwashaya is the seat of pakwa anna i.e.that which attains

pureeshatha74. Charaka and Vagbhata considered this as one among the

Koshtangas75,76.

19

Shareera

Sharangadhara has specified the location of pakwashaya (pavanasaya) as

below the Tilam i.e. the Yakrut and Kloma77.

The horseshoe shaped large intestine or large bowel extends from the

ileocaecal valve to the anus. Average length is about 1.5 meters and width of 7.5cms.

Figure No 1: Showing the Anatomy of Large Intestine:

Its Sub division includes:

Table 05: Showing Sub divisions of large intestines:

1. Cecum T portion (pouch like)

2. Colon Large portion 1.5m

3. Rectum 5 inches.

4. Anal canal 4cms

Intestinal mucosa contains many Goblet cells, and Muscularis consists of

taenia coli. Mechanical movements of the large intestine include Haustral churning,

Peristalsis and Mass Peristalsis.

20

Shareera

The last stages of chemical digestion occur in the large intestine through

bacterial action. Substances are further broken down and some vitamins are

synthesized. Large intestine also absorbs water, electrolytes and vitamins. Faeces

consist of water, inorganic Salts, epithelial cells, bacteria and undigested food.

Absorption in the Large Intestine:

The re-absorption of water is an important function of the large intestine.

Although roughly 1500 ml of material enters the colon each day, only about 200 ml of

faeces is ejected. The remarkable efficiency of digestion can best be appreciated by

considering the average composition of faecal wastes 75% water, 5 % bacteria, and

the rest a mixture of indigestible materials, small quantities of inorganic matter, and

the remains of epithelial cells.78 In addition to reabsorbing water, the large intestine

absorbs a number of other substances that remain in the fecal material or that were

secreted into the digestive tract along its length.

21

Vasti karma

Vasti karma:

Vasti is considered as supreme therapy for Vatavyadhis. (mÉUqÉÉæwÉkÉ). Vasti

occupies prime place among Panchakarma keeping in view the present day’s needs as

most of the diseases pertaining to neurological and locomoter disorders are being

treated with Vasti chikitsa successfully. Even our ancient Acharyas are stressed the

same in quotations like

oÉsÉSÉåwÉMüÉsÉUÉåaÉmÉëM×üiÉÏÈ mÉëÌuÉpÉerÉ rÉÉåÎeÉiÉÉÈ xÉqrÉMçü |

xuÉæÈ xuÉæUÉæwÉkÉuÉaÉæïÈ xuÉÉlÉç xuÉÉlÉç UÉåaÉÉÍ³ÉrÉcNûÎliÉ ||

MüqÉÉïlrÉ¯ÎxiÉxÉqÉÇ lÉ ÌuÉkrÉiÉå zÉÏbÉëxÉÑZÉÌuÉzÉÉåÍkÉiuÉÉiÉç |

AÉµÉmÉiÉmÉïhÉiÉmÉïhÉrÉÉåaÉÉŠ ÌlÉUirÉrÉiuÉÉŠ ||

(cÉ. ÍxÉ.10/5)

Acharya Bhela states that, life exists as long as “Vata” lasts in the

body. (rÉÉuÉÌ¨É¸ÌiÉ uÉÉiÉÉå ÌWû SåWûÏ iÉÉuÉ¨ÉÑ eÉÏuÉÌiÉ|)79. Acharya Sharangadhara states that Vata

can influence other doshas, dhatu, malas due to his Chala or Chetana guna80. Acharya

vagbhata considered Vata as “Prabala”among Doshas (...SÉååwÉÉhÉÉÇ mÉëoÉsÉÉåÅÌlÉsÉÈ) 81. So

vitiation vata leads to vitiation of other doshas and disarrangement of body systems.

Basti is supposed to be chikitsa principle for vata vyadhi82. Acharya Arunadatta states

clearly that “iÉålÉ uÉÉiÉxrÉ oÉÎxiÉaÉÑïSmÉëÍhÉkÉårÉxlÉåWûYuÉÉjÉÉÌS mÉUqÉÉæwÉkÉqÉç|”83

Importance of Vasti Karma:

All major texts of Ayurveda emphasized this treatment considering its

efficacy. It stands unique among all the shodhana therapies because it expels the

vitiated Doshas rapidly and easily from the body and also causes reducing as well as

22

Vasti karma

nourishing the body very fastly84. Eventhough Vamana and Virechana eliminates the

vitiated Doshas form the body, the drugs used in these therapies contain Katu rasa,

Ushna guna and Teekshna gunas, which cannot be taken easily by children or older

people. But Vasti can be given in all age groups without any hesitation85.

Vasti is not only indicated in Vataja Vyadhi. It can be used even in pittaja,

kaphaja, rakthaja, samsargaja, sannipataja vyadhis86.

Acarya Charaka considered Vasti as Ardha chikitsa and even as Purna chikitsa

in siddhisthana of Charaka samhita87. In sutrasthana in the context of Agrya dravyas,

Vasti is considered as Agrya for Vata88.

Apart form this it has multidimentonal effect by possessing various therapeutic

actions like Samshodhana, Samshamana and Sangrahana of doshas on the basis of

dravyas used in it89.

Vasti accomplishes rejuvenation, happiness, longevity, strength, improving

memory, voice, digestive power and complexion. It removes noxious matters form the

tissues, pacifies the Doshas. Consequently it affords stability and thus indirectly

strengthens the reproductive capacity in man90. Kashyapa equated the Vastikarma as

‘Amrutam’, because of its widespread applications even in both infants and in old age

people.91

Classification of Vasti:

Since vasti can be of many types according to its Karma, Dravya used, number

of Vasti to be given and many other factores like Vaya, Bala, Satva etc factores of the

Atura. Hence one cannot find any uniformity in classification of Vasti foot fourth by

different Acharyas. Knowledge of the classification is very essential for the better

23

Vasti karma

understanding of Vasti therapy. So Vastikarma has been brought into the following

classifications broadly.92

Adhishtana bheda : The site of application viz abhyantara and bahya

Dravya bheda : On the basis of medicine used viz Niroha vasti,

Anuvasana vasti etc

Karmukata bheda : On the basis of action viz shodana vasti, lekhana

vasti etc

Sankhya bheda : The number of vasti’s given as a course

Anushangika bheda : Here the some vasti yogas explained in classics

with specific name are considered.

Matra bheda : Based on total quantity of vasti dravya

1) Adhishtana bheda : According to the site of application of Vasti, it is classified as

follows

Pakvashayagata Vasti

Garbhashayagata Vasti

Mutrashayagata Vasti

Vranagata Vasti

Table 06: Showing Classification of Basti karma based on Route of administration

i Pakwasayagata vasti: The Vasti dravya administered through Gudhamarga (ano-rectal route) to reach Pakwasaya.

ii Garbhasayagata vasti The Vasti dravya administered through Yonimarga to reach Garbhashaya.

iii Mutrasayagata vasti The Vasti dravya administered through urethral route to reach Mootrasaya

iv Vranagata vasti The Vasti dravya administered through the Vranamukha .

24

Vasti karma

2) Dravya bheda:

It is based on the major ingredients of Bastidravya - kwatha or sneha and so

classified into two types: -

Niroha Vasti

Anuvasana Vasti

i) Nirooha vasti – In Niruha Basti, Kashaya (decoction) is the predominant

content. Along with the Kashaya Madhu, Saindhava, Sneha and Kalka are used

commonly. Its synonyms are Asthapana Basti, Maadhutailika, Yaapana vasti,

Yuktaratha vasti, Siddha vasti93, Kashaya vasti etc.

ii) Anuvasana vasti – Sneha is the chief ingredient of Anuvasana. Literally the

term Anuvasana refers to Vasti that can be administered every day with no risk94.

On the basis of Matra, Anuvasana vasti is sub classified into three types95.

Table No. 07: Showing types of Anuvasana vasti and its Matra

SI. No Anuvasana vasti Bheda Vasti Dravya Matra

01 Snehavasti 6 pala

02 Anuvasana vasti 3 Pala

03 Matra vasti 11/2 Pala

3) Karmukata bheda:

Susruta and Vagbhata have made the following classification according to

their actions96, 97.

25

Vasti karma

Table No. 08: Showing type’s vasti based on its Karma:

SI. No Type of Vasti Action

01 Shodhana vasti Contains Shodhana dravyas and removes vikrita

Doshas and Malas from the body

02 Lekhana vasti Reduces Medodhatu and produces Lekhana in the

body

03 Sneha vasti Contains more of Sneha and produces Snehana in the

body

04 Brumhana vasti Increases the Rasadi dhathus and indirectly it helps

in the growth of body.

05 Utkleshana vasti Causes Utklesha of malas and doshas by increasing

its Pramana and causes dravabhootha

06 Doshahara vasti Purificatory or eliminating type.

07 Shamana vasti Causes Shamana of Doshas.

Vataghna vasti, Balavarnakritavasti, Snehaneeyavasti, Sukrakritvasti,

Krimighnavasti, Vrishatvakritvasti has been explained in various contexts by

Charaka98.

4) Sankhya bheda:

On the basis of total number of Vasti administration, Vasti is classified as

follows99

Table No. 09: Showing Sankya Bhedha of Vasti Prakara:

Vasti Prakara Sankya Anuvasana Sankya Nirooha Sankya

Yoga Vasti 8 5 3

Kala Vasti 16 10 6

Karma Vasti 30 18 12

26

Vasti karma

According to Kashyapa100:

Yoga Vasti 8 5 3

Kala Vasti 15 12 3

Karma Vasti 30 24 6

5) Anushangika bheda:

Here the some vastis yogas explained in classics with specific name are considered.

a) Yapana vasti: Which promotes the life and restores the health101.

b) Siddha vasti: It increases the bala, varna, and prasannatha102, 103.

c) Yuktaratha vasti: Mainly indicated for travelers on vehicles etc104.

d) Vaitharana vasti: It is mainly indicated in Katigraha, Shula, Anaha,

Amavata and does the lekhana105.

e) Ksheera vasti: Explained for shoolam,vitsangam, anaha, &

mootrakrichra106.

f) Ardhamatrika nirooha vasti: Snehana and swedana karmas are not

required. Mainly it is indicated in rajayakhsma,shoola,krimi and in

vatarakta. It improves Shukra and ojus107.

g) Piccha Vasti : It is given with pichhila dravyas like Shalmaliniryasa and

lajjalu. It is indicated in pichhalasrava and jeevashonita. It acts as

Sangrahi108.

(Vangasenasamhitha, Bastikarmaadhikara - 186-190)

h) Mutra Vasti: It is Gomutra pradhana basti it is mridu in nature, safe and

pacifies the doshas109.

27

Vasti karma

i) Rakta Vasti : It is indicated in conditions like adhika rakta srava111.

6) Matra bheda:

The quantity may vary from person to person and it depends on rogi bala, roga

bala and vaya of the patient112, 113.

Table No. 10: Showing Matra bheda of Vasti dravya:

Sl.No. Vasti Quantity of Vasti Dravya

01. Dvadashaprasruta Vasti 12 Prasrutha

02. Prasritayogika Vasti 4,5,6,7,8,9&10 Prasrutha (Acc. strength

of the patient)

03. Padaheena Vasti 1/4th less than Dvadashaprasruta vasti

i.e. 9 Prasrutha

Matravasti:

Matravasti ia a type of Anuvasana vasti based on Matra of vasti dravya. All

Acharyas explained about Matravasti and considered safe and useful in many

conditions where other varities of Vastis are contraindicated.

The term Matra, gives various meaning with respect to different context, such

as Measurement, Quantity, Size, Duration, Number, Degree, Movement, Unit of time.

It also stated it as prosodial instant i.e. the length of time to pronounce a short vowel.

In the present context the term Matra gives the meaning for the unit of measurement

i.e for the quantity of Vastidravya.

Vasti also having different meanings in various contexts but in present context

it is considered as therapeutic procedure of Panchakarma.

28

Vasti karma

Definition:

WØûxuÉÉrÉÉ: xlÉåWûqÉÉ§ÉÉrÉÉ qÉÉ§ÉÉuÉÎxiÉ: xÉqÉÉå pÉuÉåiÉç| (cÉ.ÍxÉ.4/53)

According to Acharya Charaka, Basti in which the dose of Sneha is equal to

Hraswa matra of Snehapana is called as Matravasti. Acharya Sushruta, Vagbhata also

defined matravasti, which also gives same meaning114, 115,116. (Su.Chi.35/18, A.S.Su.

28/8, AH.Su. 19/67)

qÉÉ§ÉÉM×üiÉpÉåSiuÉÉlqÉÉ§ÉÉuÉÎxiÉ:| (SÏÌmÉMü-zÉÉ.E.5/4)

Acharya Adamalla clearly mentioned that Matravasti is variety of Vasti based on the

Matra of Vasti dravya.

Indications:

According to Acharya Charaka, Matravasti is always applicable to those

emaciated due to overwork, physical exercise, weight lifting, way faring, journey on

vehicles, and indulgence in women, in debilitated person as well as in those afflicted

with Vata disorders117.

Vruddha Vagbhata has emphasized on regular administration of the Matravasti

and it can be administered at all times and in all seasons just like Madhu Tailika

Vasti118.

29

Vasti karma

Table No. 11: Showing indication of Matravasti acc. to Classics:

Sl.No Indications C.S A.H A.S

1 Karma karshita + - -

2 Bhara karshita + + +

3 Adhva karshita + + +

4 Vyayama karshita + + +

5 Yana karshita + - +

6 Stri karshita + + +

7 Durbala + + +

8 Vata Rogi + + +

9 Bala - + +

10 Vriddha - + +

11 Chintatur - + +

12 Stri - - +

13 Nripa - + +

14 Sukumar - - +

15 Alpagni - + +

16 Sukhatma - + -

Contraindication:

In classics, there are no major contraindications mentioned for matra Basti, but

Ashtanga Sangrahakara has stated that Matra Basti should not be administered in

Ajeerna condition and to those who resort to Diwaswapna.

30

Vasti karma

Qualities:

The Matravasti promotes strength without any pathyacof diet, causes easy

elimination of Mala and Mutra. It performs the function of Brimhana and cures

Vatavyadhi. It can be administered at all times in all seasons and is harmless119.

Vagbhata has mentioned that Matravasti improves Varna and Bala. He adds

that it can be given regularly, which is indicated for bala, vriddha, and alpagni person.

No need of parihar after adminstration of Matravasti, no such complications arises. He

mentioned it as Varnya, doshaghna etc120. Acharya Hemadri commenting on the term

sukha stated that, it is devoid of complications.

Dose:

The term Matravasti is popular because of its dose only, because sneha is

administered in the hraswamatra. Acharya Charaka mentioned as “Hruswa sneha

Matra” but not mentioned exact quantity121. Whereas Acharya Vagbhata

recommended the dose, equal to the dose of Hruswa Snehapana122, 123. The Matra

which gets digested in Ardhaha i.e. 2 yama (6 hours) is called as Hruswa Matra of

Snehapana124, but the dose required to get digested in 2 Yama is not mentioned.

Sushruta has given the dose as half of the dose of Anuvasanavasti and

according to him the dose of Anuvasanavasti is half of the dose of Snehavasti. In

Snehavasti, the dose given is half of the total dose of Niruhavasti i.e. 6 Pala (24 Tola).

Hence, the does of Matravasti is 1½ Pala125 = 6 Tola = 72ml. According to

Chakrapani, the dose of Snehavasti is 6 Pala, dose of Anuvasanavasti is 3 Pala and of

Matravasti is 1½ Pala126.

Acharya Kashyapa prescribed the quantity of Matravasti as 2 palas as

uttamamatra, 1 ½ pala as madhyama matra and 1 prakuncha as hraswa matra. He even

31

Vasti karma

stated that half pala of sneha can be given in newborn baby; it can be administered

without any hesitation and complication too127, 128.

Sharangandhara mentioned sneha matra of Matravasti as 2 palas (8 tolas)129.

On the basis of above references, it can be said that the dose of Matravasti is 1½ Pala

of Sneha i.e. 6 Tola = 72ml.

Table No. 12: Showing Matra of snehavasti mentioned indifferent Classics:

Sl Author Matra

1 Charaka Sneha vasti is 6 Pala, dose of Anuvasana vasti is 3 Pala and of

Matra vasti is 1½ Pala (6 Tola = 72ml)

2 Sushruta Anuvasana vasti is ½ of the dose of Sneha vasti Hence, the does of

Matra vasti is 1½ Pala (6 Tola = 72ml)

3 Vagbhata Hrsva Snehapana is recommended for matra vasti. The matra

which gets digested in 2 Yama (i.e.6 hrs) is called as Hrsva matra.

Table No. 13: Dose of Matravasti according to Age:

Sl. Age in Years Matra in Tola Sl. Age in Years Matra in Tola

1 1 1/4 11 11 2 ¾

2 2 1/2 12 12 3

3 3 3/4 13 13 3 ½

4 4 1 14 14 4

5 5 11/4 15 15 4 ½

6 6 1 ½ 16 16 5

7 7 1 ¾ 17 17 5 ½

8 8 2 18 18 6

9 9 2 ¼ 19 19-70 6

10 10 2 ½ 20 70 and above 5

32

Vasti karma

Arohana Krama Matravasti:

Acharya Adamalla in his commentary on Sharangadhara samhita, explained

the Arohana krama of Matravasti130.

Table No. 14: Showing Dose of Arohana krama Matravasti:

Start 1 day 2 day 3 day 4 day 5 day 6 day 7 day 8 day 9 day

2 Pala 2 ½ Pala 3 Pala 3 ½

Pala

4 Pala 4 ½ Pala 5 Pala 5 ½ Pala 6 PalaUttama

matra

2

Pala

96 ml 120 ml 144 ml 168 ml 192 ml 216 ml 240 ml 264 ml 288 ml

1 Pala 1 ¼ Pala 1 ½ Pala 1 ¾

Pala

2 Pala 2 ¼ Pala 2 ½

Pala

2 ¾ Pala 3 PalaMadyama

matra

1

Pala

48 ml 60 ml 72 ml 84 ml 96 ml 108 ml 120 ml 132 ml 144ml

0.5Pala 0.625

Pala

0.75

Pala

0.875

Pala

1 Pala 1.125

Pala

1.25

Pala

1.375

Pala

1.5

Pala

Hrusva

matra

½

Pala

24 ml 30 ml 36 ml 32 ml 48 ml 54 ml 60 ml 66 ml 72 ml

In Chakradatta131 and in Vangasena samhita132 three doses are descrbed for

Anuvasana vasti.6 pala is considered as the jyeshtha matrra, 3 pala is madhyama

matra and 1½pala as kaneeyasi matra. In jyeshtha matra 2 pala (96 ml) is

administered in the beginning and then increased by ½ pala (24 ml) everyday and it

becomes 6 pala on the 9th day, in madhyama matra starting dose is 1 pala (48 ml)

increased by ¼ (12 ml) everyday and it will reach to 3 pala on the 9th day and in the

kaneeyasi matra initial dose is ½ pala (24 ml) and increased by 6 ml everyday and on

the 9th day it becomes 1½ pala.

33

Vasti karma

Qualities of Matravasti:

The Matrabasti is promotive of strength without any demand of strict regimen

of diet, causes easy elimination of Mala and Mutra. It performs the function of

Brimhana and cures Vatavyadhi. It can be administered at all times in all seasons and

is harmless133.

Vagbhata has mentioned that Matravasti improves Varna and Bala. He adds

that it can be given regularly, which is indicated for bala, vriddha, and alpagni person.

No need of parihar after adminstration of Matrabasti, no such complications arises. He

mentioned it as Varnya, doshaghna etc134.

Acharya Hemadri commenting on the term sukha stated that, it is devoid of

complications135.

Indications:

According to Charaka, Matravasti is always applicable to those emaciated due

to overwork, physical exercise, weight lifting, way faring, journey on vehicles, and

indulgence in women, in debilitated person as well as in those afflicted with Vata

disorders. Vruddha Vagbhata has emphasized on regular administration of the

Matravasti and it can be administered at all times and in all seasons just like Madhu

Tailika Vasti.136

Contraindication:

In classics, there are no major contraindications mentioned for Matravasti, but

Ashtanga Sangraha has stated that Matravasti should not be administered in the

persons having Ajirna and to those who resort to Diwaswapna137.

34

Vasti karma

Vasti Yantra:

The device used for Vasti karma is called as Vastiyantra.

It comprises of two parts –

1. Vastinetra

2. Vastiputaka

Vastinetra:

The netra should be made of gold, silver, and copper or with other higher

metals, alloys, long bones, bamboo, wood etc. Generally netra must resemble like tail

of cow with a tapering end and a wider base with round ends and smooth surfaces the

dimensions are different for different age group138, 139.

Table No. 15: Showing Measurements of Vastiyantra140, 141

S.l no Age in years Length in

Angula

Lumen of netra

Diameter of narrow

end

Diameter of

broad end

1 < 1 5 1 angula

2 1 - 6 6 Size of green gram

(Mudga)

1 angula

3 7- 11 7 Size of black gram

(Masha)

1½ angula

4 12-15 8 Size of kalayam 2 angula

5 16- 20 9 Size of wet kalaya 2½ angula

6 > 20 12 Karkandhu 3 angula

Uttara vastiyantra

7 - 12 – 14 Sarshapa size -

Susrutha’s opinion142

8 1 6 Green gram Feather of

kanku bird must

pass through.

35

Vasti karma

9 8 8 Black gram Feather of eagle

must pass

through.

10 16 10 Kalayam Feather of

peacock must

through.

11 >25 21 Kolasthi Feather of

vulture must

pass through.

Pramana of vrana vasti netra:

The hole should be of a mudga pramana, with 8 angulas of length143.

Karnika:

In Vasti netra, there should be Three Karnikas. One Karnika should be at a

required point from the tip of the netra, to prevent excessivbe entrey. Remaining two

at the base of the Netra with two angulas distance each other, this used to tie the Vasti

putaka144.

Vastiputaka:

The word Vasti is indicats the urinary bladder. Acharya Chakrapani stated as

“Vastirithi mutrashaya putakam”145 where as Acharya Hemadri defined this as

“Mutradhara charma peshim”146. In this context, the container or bag used to carry the

vastidravya, ready for application is known as vastiputaka. In ancient days the urinary

bladder of matured animals like cow, buffalo, dear, pig, goat etc were used. It was

then processed to make stong, thin, soft, devoid of blood vessels and bad odor. It

should be made suitable for well fitting with the vastinetra and appropriate to

administer vasti dravya147, 148.

36

Vasti karma

If good bladder is not available some other materials are recommended for the

purpose. They are the skin of neck of plava or thick cloth with sufficient strength and

size.

Now a day, various types of materials are available to make up of vastiputaka

and even disposable vastinetra are available. The rubber bladder and polythene bags

are best choice. Presently in most of the Panchakarma centers, the disposable

vastiyantras with polythene are used.

Vasti netra & Vasti putaka Dosha:

In classics, Acharyas explained different improper features of Vasti netra and

Vasti putaka and their advese effects149, 150.

Table No.16: Showing Netradosha of Vasti netra:

No. Netradosha Adverse Effect

1. Hraswata Too short Dravya will not reach pakwasaya

2. Deerghata Too long Dravya go beyond the pakwasaya

3. Tanuta Too thin Produces kshobha

4. Sthoolata Too big Produces lakshana

5. Jeernata Old dhatu used Injury to guda

6 Shithilabandhana Improperly fixed to

putaka

Dravya comes out

7. Parshwachhidra Hole on side Leakage of dravya happens

8. Vakrata Curved / irregular Dravyagati becomes irregular

9. Assannakarnika Karnika too near Karma becomes of no use

10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma

peedana

11. Anusrotata Small hole Cannot perform properly

12. Mahasrotrata Broad hole Cannot perform properly

37

Vasti karma

Table No. 17: Showing putakadosha of Vasti Putaka:

No. Putakadosha Features Effect

1. Vishama Shape not in

uniform

Gati vishamata happens

during pressing

2. Mamsala Muscular tissue

present

Produces offensive small

3. Chinnachidrayukta Presence of hole Dravya comes out

4. Sthoola Thick one Does not push dravya

5. Jalayukta Anastamosis

present

Produces leakage

6. Vatala Excess air space Frothy type of dravya

7. Snigdha Unctuous Slip form the hand

8. Klinnata Wet Difficult to pass through

MATRAVASTI PROCEDURE

As the procedure of Matravasti is not explained separately in classics, the

procedure of Anuvasana Vasti is adopted. The procedures and preparations are

classified into three parts: - 1.Poorvakarma 2.Pradhanakarma 3.Paschatkarma.

Poorvakarma:

The Purvakarma includes Rogi pareeksha, Sambara sangraha and Atura

siddhata. Rogipareeksha: Selected patients for Vasti therapy have to undergo

thoroughly clinical examinations to ascertain the physical as well as the mental

conditions.

Following factors are to be considered for clinical examination151.

1. Dosha 2.Oushada 3.Desa 4.Kala 5.Satmya

6. Agni 7.Satwa 8.Vaya 9.Bala

This will enable the physician to decide, the type of Vasti, number of Vastis,

Vasti dravya, etc to be administered in the particular patient.

38

Vasti karma

Sambara sangraha: It includes collection of Medicine, instruments etc. For Matravasti

Sneha dravya should be kept ready in a clean vessel. The instruments needed are

Vasti netra, Vasti Putaka are should be clean and ready.

Atura siddhata: The body of the patient should be anointed with suitable sneha and

gently fomented with hot water. Then he is advised to have his prescribed meal i.e ¼

less than normal quantity and it should not be excessive snigda or rooksha and should

be Laghu. Then should ask the patient to take a short walk (hundred yards). Vasti

should be administered when the patient is ardrapani which means we should not

delay much time after the intake of food. Having passed stool and urine he is laid on a

couch, which is not very high, and the head must be at lower level. No pillows are

used. The patient should lie on his left side drawing up the right leg and straightening

the left leg152, 153, 154.

Pradhanakarma:

The proper amount of sneha prescribed for Matravasti is filled in the

vastiputaka and tied well placing the vastinetra in position. The trapped air in

vastiyantra is expelled by gently pressing the vastiputaka. Then the anal region and

the netra should be smeared with oil for easy entery of vasti netra. Gently probe the

anal orifice with the index finger of the left hand and introduce the vastinetra through

anal orifice into the rectum up to first karnika in the direction parallel to vertebral

column (Anuprustavamsha). In the same position press the vastiputaka with right

hand with adequate force. Remove carefully the vastinetra when a little quantity of

sneha remained inside the vastiputaka155.

Paschatkarma:

After the administration of oil, the sphik of the patient should be tapped with

the palms to prevent early return of the recipe from the anus. The patient should lie on

39

Vasti karma

the bed in supine position, and the joints of both his legs should be pulled gently. The

soles of his feet should be massaged with oil. His heels, toes, calf regions and such

other parts which are painful should also be massaged with oil. The patient is kept

lying on his back for hundred matrakala. Allow him to lie for sometime in the same

position. If he gets the urge for defecation he may do it. But if the sneha passed

immediately another Matravasti should be given. After passing the motion with sneha

in proper time the patient is allowed to take light food if he feels hungry. Maximum

duration for the return of snehavasti is 3 yama i.e. 9 hours156, 157, 158.

Importance of left lateral position:

Acharya Charaka opines that, Grahani and Guda present in Vama parshwa

(Left side). So vasti dravya reaches these organs easily, if the patient receives vasti in

left lateral position. And also this position helps in relaxation of Guda valis, which in

turn helps in proper spreading of vasti dravyas159.

Gangadhara says; Agni, Grahani and Nabhi are present in the left side. Jejjata

comments Agni is present in left side over the Nabhi, Guda has got a left sided

relation with Sthoolantra. So vastidravya can reach to the large intestine and Grahani,

as they are present in the same level.

Food before Vasti Procedure:

Acharya Sushruta explains that Anuvasana vasti should be administered after

intake of food only. That rule should be followed in Matravasti also, as it’s a type of

Anuvasanavasti only. So patients should be given alpa snehayukta ahara before

Matravasti. It should not be administered after the patient has consumed ati snigdha

ahara because Sneha administered in both route i.e through mouth and through anal

route may gives rise to mada and murccha. And also, the patient should avoid the

intake of ati ruksha ahara because it may cause depletion of Bala and Varna. Patient

40

Vasti karma

may intake Yusha, Ksheera, Mamsarasa etc according to Vyadhi. The quantity of

food should be 1/4th less (Padahina) to his capacity160.

Pathya – Apathya:

The Matravasti does not demand any regimen of diet or behaviour. It can be

given at all times and in all seasons without any restriction161. However, Vriddha

Vagbhata has restricted the day sleep after administration of Matravasti162.

Retention of Matravasti:

The normal Pratyagamana Kala of Snehavasti is 3 Yama i.e. 9 hours. Being a

type of Sneha Vasti, the Pratyagamana Kala of Matravasti can be considered as 3

Yama. There is no harm if Matravasti retains in the body because, while describing

Anuvasanavasti it has been said that it is not harmful to body even in the event of its

being retained in the body for a whole day. Also the dose of Sneha in Matravasti is

very small, which can get easily absorbed in the body without coming out. If vasti

material returns much earlier, it cannot produce the desired effect in the body163.

Samyaka Yoga Lakshana of Matravasti:

Matravasti being a type of Sneha Vasti, Samyaka Yoga lakshana of Sneha

Vasti can be taken as Samyaka Yoga Lakshana of Matravasti164.

41

Vasti karma

Table No.18: Showing Samyak, Heena and Atiyoga yoga of Anuvasana vasti: Samyak yoga Heena yoga Heena yoga pratyetasakta sa shakrut cha tailam

Ruk in adha shareera, udara, bahu, prushtha & parshwa

Hrullasa

Raktadi dhatu prasadana Gatra becomes rukshata & khara

Moha

Buddi prasadana

Klama

Endriya prasadana

Saada

Samyak swapna

Murcha

Laghuta in shareera Bala vridhi Shrusta vega

Vata, vit & mutra graha

Vikartika

Complication of Sneha Vasti:

Though it is said that there is no major complication by the use of Matravasti

but sometimes complication may be produced due to obstruction of Sneha by Vata,

Pitta, Kapha, Mala or food and when given to a person on empty stomach. These are

six conditions of complications likely to arise during the use of Sneha Vasti165.

01) Vata Avrita Sneha 166: If sneha dravya is of excessive cold or small quantity

and such sneha is administered in a condition of excessive agravation of Vata dosha ,

which may get Avrita by Vata and may not able to return

Such Sneha produce Angamarda, Jwara, Adhmana, Stambha, Urupida,

Parshwashula.

Treatment: In such condition Niruha Vasti prepared by Rasna, Pitadaru,

Tilvak, Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra, Panchamula should be

administered to eliminate the Vatavrita Sneha.

42

Vasti karma

02) Pitta Avrita Sneha167: If excessive Ushna Vasti is given in the condition of excess

Pitta, it produces Daha, Raga, Trasa, Moha, Tamaka and Jwara.

Treatment: This condition should be cured with the enema prepared with

Madhura and Tikta Dravyas.

03) Kapha Avrita Sneha168: If Mrudu Vasti is given in condition of excess Kapha, it

causes Tandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and Glani.

Treatment: It should be corrected with Vasti prepared with Kashaya, Katu,

Tikshna and Ushna Dravya and with Sura and Gomutra and mixed with Madana

Phala and Amla Dravya.

04) Anna Avrita Sneha169: If Vasti prepared with Guru Dravya and given after a

heavy meal it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi,

Murccha, Aruchi, Glani, Shula, Nidra, Agnimandya and Ama Lakshanas with Daha.

Treatment: Such condition is treated by stimulating digestion with decoction

and powders of Katu and Lavana Dravyas. Also Mrudu Virechana and the treatment

advised for Ama should be adopted.

05) Purisha Avrita Sneha170: In case of accumulation of Mala, if Vasti having Alpa

Bala is administered it produces symptoms like Purisha Sanga, Mutra Sanga, Vata

Sanga, Shula, Gaurava, Adhmana and Hridaroga.

Treatment: This condition should be treated with Snehana, Swedana along

with Phalavarti. The Anuvasana Vasti and Niruha Vasti prepared with Shyama, Bilva

etc. should be used. Also the treatment indicated in Udavarta should be followed.

43

Vasti karma

06) Abhukta Pranita Vasti171: If Vasti is given in a person with empty stomach it

reaches upwards due to absence of any obstruction. Also if Vasti is administered in a

person with empty bowel with great force it reaches up very high and from there it

may reach the throat and may come out from the upper orifice of the body.

Treatment : In this condition, Niruha Vasti and Anuvasana basti of Sneha

prepared with Gomutra, Shyama, Trivritta, Yava, Kola, Kulattha should be given and

the condition where it is coming out the throat, it should be treated by Kashaya

Dravyas, pressure on the throat and by Virechana and Chhardighna measures.

Importance of Matravasti:

The advantage and importance of Matravasti can be summarized by following

points.

1. rÉjÉå¹ÉWûÉUcÉå¹xrÉ, ÌlÉwmÉËUWûÉU - Matravasti has no restrictions as of Asthapana and

Anuvasana, one can perform routine works after administration of Matravasti.

2. xÉuÉï MüÉsÉqÉçç - Matravasti can be administered anytime irrespective of age, day,

and time.

3. It can be administered to SÒoÉïsÉ mÉÑÂwÉ where other vastis are contraindicated in

them.

4. ÌlÉUirÉrÉ, xÉÑZÉqÉç - It does not produce any complications.

5. Even though matra is less it has widespread action throughout the body.

6. Niroohavasti and anuvasanvasti should be administrated alternatively, but

Matravasti alone can be administered everyday continuously without any

complications.

44

Vasti karma

7. SÉåwÉblÉ - It eliminates vitiated dosas along with mala from the body and also it

acts as shamana, brumhana, vatahara and even balya.

8. As the quantity of Matravasti is less, it retains in the body for longer duration

compared to other vasthis and not produces any complications even though it

does not expel out.

Vasti Karmukata.

Bastikarma is having multidimensional therapeutic effects. Matravasti being a

type of vasti, the general mode of action of Vasti karma can be considered for some

extend. Being only sneha dravya is administered in small quantity in Matravasti more

nourishing (Brumhana) effect can be expected rather than cleansing (Shodana) effect.

For better understanding it can be studied under the following headings.

The procedural effect

The left lateral position is advised for administration of Vasti. The reason for

that, anatomically the Gudavalis becomes relaxed there by it helps in easy

administration vasti dravya. And also Acharya Charaka opines that, Grahani and

Guda present in Vama parshwa (Left side). So vasti dravya reaches these organs

easily, if the patient receives vasti in left lateral position172.

Physiologicaly, Vasti dravya having direct effect on Agni, which may be

enhanced by left lateral position as Acharya Gangadhara says; Agni, Grahani and

Nabhi are present in the left side. Jejjata comments Agni is present in left side over

the Nabhi, Guda has got a left sided relation with Sthoolantra. So vastidravya can

reach to the large intestine and Grahani, as they are present in the same level.

Accordin to Modern science also left lateral position is the best posture for

better and effective administration of vasti because anal canal turns to left side to

rectum, sigmoid colon and descending colon where more mala to be dissolved is

45

Vasti karma

present. Moreover, medicines stay at these surfaces, get absorbed more and show their

best effect, especially in Matravasti. The absorptive area of mucosa is more on this

side. On left side colon area is easily approachable through anus rather than on the

right side and this posture relaxes the ileo-ceacal junction and makes the easy flow

into the sigmoid colon.

Action based on drug effect

Action of vasti is possible by Anupravaranabhava of vastidravya i.e. Sneha

easily moves up to grahani, which freely moves in the intestine. Charaka says

vastidravya reach nabhi, katipradesha and kukshi173.

The action of Vasti is mainly due to the Veerya. The drugs used in the vasti

karma will however spread in the body from Pakwashaya due to their veerya, through

the appropriate channels. The veerya is drawn into the body by apanadi vatas i.e. first

by Apana, then Udana and throughout the body by Vyana. As it is said that “Guda

moolam hi shareeram”, Also as water sprinkled at the root of tree circulates all over

the tree by its own specific property. So Vastikarma eliminates the morbid Doshas

and Dooshyas from the entire body.

Vasti acts mainly on Asthi and Majjavaha srotas. Asthi is the seat of Vata

Dosha174. Dalhana says that Pureeshadharakala and Asthidharakala are one another

the same. So we can assume that if Pureeshadharakala gets purified and nourished; the

Asthivaha srotas will also be purified and nourished. Also another factor is about the

relation between Pittadharakala and Majjadharakala, Pittadharakala and Grahani. As

an opinion says about the spread of vastidravya till Grahani and Grahani is the seat of

Agni, the nutrients may get absorbed and thereby nourishes the Majjadharakala,

which is having a strong bond with vata and the nervous system. It is practically seen

that after appropriate administration of Vastikarma the Vatavyadhi will be reduced.

46

Vasti karma

Mode of action of Vasti:

Acharya Sushrutha explains that after proper administration of basti,dravya

remains in the Pakwashaya, Shroni, below the nabhi and through the srotoses, the

veerya of basti spread to entire body. Similarly, though basti remains in the body

only for short time and it is excreted along with mala by the action of apana vayu, due

to the veerya, the doshas situated from head to toe are also forcibly thrown out of the

body.

uÉÏrÉåïhÉ oÉÎxiÉUÉS¨Éå SÉåwÉÉlÉÉmÉSqÉxiÉMüÉiÉç |

mÉYuÉÉzÉrÉxjÉÉãÅqoÉUaÉÉå pÉÔqÉUMüÉåï UxÉÉÌlÉuÉ ||

(xÉÑ.ÍcÉ.35/27)

All these actions of basti can be well explained on the basis of known

Physiological and Pharmacological actions.

The Gastro intestinal tract has a nervous system known as “Enteric Nervous

System” lie entirely in the wall of the gut, beginning in the Esophagus and extending

all the way to anus.

The number of neurons in this enteric system is about 10 crores almost equal

to the number in the Spinal cord. It especially controls gastro intestinal movements

and Secretion

The two plexuses in enteric system are mesenteric plexus and Sub mucosal

plexus. The Sigmoidal, Rectal, and anal regions of the large intestine are considerably

better supplied with parasympathetic fibers than other portions. They are mainly

stimulatory in action especially in the defecation reflexes.

47

Vasti karma

Most of the Absorption in the large intestine occurs in the proximal half of the

colon, giving this portion the naming absorbing colon. Absorption through the

gastrointestinal mucosa occurs by active transport and by diffusion.

The Rectum has rich blood and lymph supply and the drugs can cross the

rectal mucosa like other lipid membranes.

Thus unionized and lipid soluble substances are readily absorbed from the

rectal mucosa. Small quantities of short chain fatty acids Such as those from the

Butterfat are absorbed directly into Portal Circulation rather than being converted into

Triglycerides

This is because short chain fatty acids are more Water Soluble and allows

direct diffusion from the epithelial cells into the Capillary blood of the Villi. More

ever a Volume of about 1000cc of gas is estimated to be present in Gastro intestinal

tract which can be readily expelled by vastikarma.

Absorption of vastidravya:

60%-80% of water absorbed from the gut, Absorption in the proximal colon is

better than the distal part as a result this rout substitute’s oral routs

Changes after administration of Vasti175:

• An increase in the fatty acid and protein content is shown by biochemical

investigations subsequent to administration of snehavasti.

• Colon has a large number of bacterial floras which bestow the body by

producing certain factors of B group of vitamins, and K. researchers have

shown that this flora flourishes abundantly on administration of Snehavasti.

May be fats in it, provides a favorable environment for their growth, thus help

in healing up of intestinal ulcers by providing a coat.

48

Vasti karma

• Visceral afferent stimulation results in activation of the hypothalamus pituitary

adrenal axis and autonomic nervous system, involving the release of

neurotransmitters and hormones.

• Sneha vasti is hypo-osmotic which may get absorbed in to the blood.

• Anuvasana and Matravasti have got a property to regulate sympathetic

activity, decreases adrenalin and noradrenalin secretion and helps in the

balance of autonomic nervous system.

49

Historical Review of Sandhigatavata

DISEASE REVIEW:

Historical Aspect of Sandhigatavata:

History of Ayurveda is studied under the headings of 1.Vedic period,

2.Samhita Kala and 3.Sangraha Kala.

I. Vedic Period:

The specific reference about Sandhi-gata-vata is not visible in Vedas, but the

information is available regarding vatavyadhis in general. It is mentioned in Brhat

Jaataka 23-13, Raghuvamsham 9-63, Brahma samhita 87-44, Kaashika 5-2-129176.

The following anatomical structures related to sandhi-gata-vata are found in

Vedic literature. The term Sandhi is used in Yajurveda177. Further in Atharvaveda

stated that Balasa (Kapha) resides in Sandhi178. The word Janu is mentioned in

Atharvaveda179, 180.

II. Samhita Kala

Charaka Samhita:

Acharya Charaka described it as Sandhi-gata-anila, which is a synonym of

Sandhigata vata in the chapter Vatavyadhi Chikitsa. He explained this condition under

the “Sthana bheda vayu lakshana”181. Sandhigata vata is not directly mentioned under

Vataja nanatmaja vikara but condition “Janu bheda” is mentioned. That can be

compared with Janu sandhigatavata182.

Sushruta Samhita:

Acharya Sushruta explained lakshanas of Sandhigatavata in Nidanasthana183.

In the Chikitsa Sthana specific line of treatment has been mentioned as,

xlÉåWûÉåmÉlÉÉWûÉÎalÉMüqÉï oÉlkÉlÉÉålqÉSïlÉÉÌlÉ cÉ |

xlÉÉrÉÑxÉlkrÉÎxjÉxÉÇmÉëÉmiÉå MÑürÉÉï²ÉrÉÉuÉiÉÎlSìiÉÈ || (xÉÑ.ÍcÉ. 4/8)

50


Astanga Sangraha:

In Astanga Sangraha Lakshanas and four varieties of Chikitsa are explained in

Nidanasthana and Chikitsasthana respectively. The Nidanas are similar to those

explined in Charaka Samhitha184 and has followed Sushruta Samhitha for Chikitsa

aspect185.

Astanga Hridaya:

In Astanga Hridaya, Sandhigata vata lakshanas are explained in

Nidanasthana186 and chikitsa in Chikitsa sthana187.

III. Sangraha Kala:

Madhava Nidana:

Acharya Madavakara explained about Sandhigatavata in Vatavyadhi nidana

Adhyaya, Explanation resembles that of Acharya Sushruta’s opinion, where he has

mentioned an additional symptom Atopa (Sandhi Atopa) in the symptomatology188.

Bhavaprakasha:

Bhavamishra explained the lakshanas and treatment of Sandhigatavata in

Madhyama khanda Vatavyadhyadhikara .From the treatment point of view he had

stated Dahana, Snehana,Upanahana and a combination of indravarunimula, pippali

and Guda for internal administration189.

Yogaratnakara:

Lakshanas and treatment of Sandhigatavata are explained in

Vatavyadhyadhikara of Pooravardha190.

Bhela Samhita:

Even though the description of Sandhigatavata is unavailable in Bhela

samhita, it is assumed that the verses are missing, as the description of Gatavatas such

51


as Amashayagatavata, pakwashayagatavata and raktagatavata etc. is available.

However AcharyaBhela has explained the asthi-majjagata vata where in we find the

symptom SandhiVichyuthi191.

Haritha Samhitha:

Acharya Haritha has not explained the diagnostic part of the disease.

However, we find the symptom Sandhishotha in Sukragatavata but the line of

treatment is found in Vatavyadhi Chikitsa Adhyaya192.

Chakradatta and Bhaisajyaratnavali

Description is similar to Sushruta Samhita. Both the texts haven’t dealt with

the aspect of Nidana. But they have given importance to Upakramas like Upanaha,

Agnikarma, Bandhana, Snehana and Unmardana193, 194.

Siddhanta Nidana:

Gananath Sen in the Vividha Sandhivatanidana Adhyaya has classified joint

diseases as Rasavata, Rakthavata, Vishavata, Jeernavata and Jaravata195.

Basavarajeeyam:

In this text in Vatavyadhi prakarana the term Sandhivata is used to describe

the disease196.

52

Etymology of Sandhigatavata

Etymology of Sandhigatavata:

The term ‘Sandhigata vata’ is composed of three words viz

1. Sandhi

2. Gata

3. Vata

1. Sandhi:

The word ‘Sandhi’ is Masculine gender which derived from the Sanskrit verb

root “xÉÇ+kÉÉ+ÌMüÈ| 197

Nirukti: a. “xÉlkÉÉlÉÍqÉÌiÉ xÉÎlkÉ”198

b. “AÎxjÉ²rÉ xÉqrÉÉåaÉxjÉlÉ”

c. “xÉlkÉrÉÉå lÉÉqÉ, AxjlÉÉqÉlrÉÉålrÉxÉ…¡ûqÉxjÉÉlÉÌlÉ”199

The word “Sandhi” indicates “Sandhana” or union of two or more structures in

body. Acharya Sushruta stated that, in human body there are innumerable junctions

between Peshi, Snayu, Sira, Asthi etc. but the given description of Sandhi is only for

Asthi Sandhi.

AxjlÉÉÇ iÉÑ xÉlkÉrÉÉå ½åiÉå MåüuÉsÉÉÈ mÉËUÌMüÌiÉïiÉÉÈ |

mÉåzÉÏxlÉÉrÉÑÍxÉUÉhÉÉÇ iÉÑ xÉÎlkÉxÉXçZrÉÉ lÉ ÌuÉkrÉiÉå || (xÉÑ.zÉÉ.5/28)

2. Gata:

The term Gata and Gati are derived from the Sanskrit verb root “aÉÇ+ÌMüiÉç(Ì£ülÉç),

which means gone to, situated in, directed to, and arrived at.

Vyutpatti: aÉcNûÌiÉ eÉÉlÉÉÌiÉ rÉÉiÉÏÌiÉ uÉÉ |200

53


The Streelinga word gata is used to denote an initiation of movement,

carrying, something along with to reach a particular site, through any particular

pathway, leads to occupancy at a particular site.

3. Vata:

The Vata originated from the root “‘uÉÉ’ aÉÌiÉ aÉlkÉlÉrÉÉåÈ”201, this means to blow, to

go to move, smell, to strike, to hurt, to enlighten.

Where as Dhallahna clarifies Sushrutas opinion and derives Vata as

“aÉÌiÉaÉlkÉÉåmÉÉSÉlÉÉjÉïxrÉ ‘uÉ’ kÉÉiÉÉåÈ ‘WûÍxÉqÉ×ÎalÉhÉçuÉÉÅÍqÉSÍqÉsÉÔmÉÔkÉÑÌuÉïprÉxiÉlÉç’ CÌiÉ xÉÔ§ÉÉåimÉ³Éå ‘iÉlÉç’ mÉëirÉrÉå

uÉÉiÉ CÌiÉ ÂmÉqÉç ||”

Vyutpatti: The word is coined from “Vaa” dhathu and “Ktin” pratyaya.

The term ‘Gati’ is having meanings like Prapti, Jnana (Panini) and the

meaning of ‘Gandhana’ is like Utsaha, Prakashana, Soocana, (Shabdasthoma)

Gandhana, Prerana (Siddhanta Kaumudi).

Considering the different meanings of Gati and Gandhana it is understood that

the term ‘Vata’ act as a receptor as well as stimulator.

Hence it can be said that Vata is the biological force, which recognize and stimulate

all the activities in the body.

Concept of Gatavata:

There are different theories established to explain the pathogenesis of various

diseases. Gatavata is one such concept explained in all classical texts.

Gatatva of Dhatu, Upadhatu, Ashaya, Avayava, Indriya etc. have been

described in our classics202. The disease sandhigata vata also belongs to Gatavata

group of Vatavyadis. Various terminologies or synonyms like Gate/Gatam,

Sthite/Sthitam, Avasthite, Ashrite / Samashritam, Prapte, and Sthe / Stha are used to

denote Gatatva in the classics.

54


Sandhigatavata:

The Vata which is vitiated by its own cause settle down in the sandhis and

produces the features like Vatapoornadrutisparsha, Shotha, Prasarnaakunchana

savedana, Sandhi atopa, Sandhi stabdatha etc features in the joint is known as Sandhi-

gata-vata. Sandhi-gata-vata is a disease of the joints; which causes severe difficulties

in the movement, ability to work and life style.

Paryaya of Sandhigatavata:

Different authors named Sandhigatavata differently in many contexts.

1. Kudavata203

2. Sandhigata anila204

3. Sandhi vata205

4. Jeerna vata206

55

Sandhi Shareera

Sandhi Shareera:

The Sandhi-gata-vata is the disease comes under the category of Gata vata.

Acharya Charaka explained this condition as Sthana bheda vayu lakshana. Here

vitiated Vata gets lodges in Sandhis and causes impairment of normal function of

Sandhi. This condition termed as Sandhigatavata. The term sandhi means ‘sandhana’

i.e. the union of two or more structures together. According to commentator Dalhana

the word Sandhi means Asthisandhi. Here, specifically the union of two or more

asthis including taruna asthis and dantas.

In classics we have scattered reference of anatomical and physiological

consideration of Sandhi.

In total, there are 210 Sandhis in the body according to Ayurveda207.

Classification of Sandhis:

1. Kriyatmaka Vargikarana (According to Movement)

Mainly classified into two types: Chestavanta and Sthira Sandhis208.

Chestavanta:

This type of sandhi is freely movable and is further subdivided into.

a) Bahuchesta: Sandhis with free movement, mainly present in shakhas.

b) Alpachesta: these Sandhis with comparatively less movement, present in

prustavamsha

Sthira: The immovable sandhis are known as Sthira sandhis

56

Sandhi Shareera

Figure No.02: Showing types of Sandhi:

Sandhhi

Chestavanta Sthira

Alpachesta Bahuchesta

2. Rachanatmaka Vargikarana (According to Structure):

Sandhis are classified in to eight types, they are as follows

Table No. 19: Showing Type of Sandhi’s and there sites: Sl Name of sandhis Correlation Sites 1 Kora Hinge Joint Anguli (interphalangeal joints),

manibandha (wrist), gulpha (ankle), janu (knee) and kurpara (elbow).

2 Ulookhala Ball and Socket Joint

Kaksha (shoulder), vankshana (hip), & danta (alveolar sockets and teeth)

3 Saamudga Saddle Joint Amsapeeta (sternoclavicular), guda (sacrococcygeal), bhaga (symphysis pubis), and nitamba (lumbosacral)

4 Pratara Gliding/Plain Joint Greevaprishtavamsha (intervertebral)

5 Tunnasevani Sutures Shira, kati kapala (sutural joints)

6 Vaayasatunda Condylar Joint Hanusandhi (temporomandibular)

7 Mandala Round-cartilaginous Joint

Kantha (tracheal rings), Netra, Kloma nadi.

8 Shankhaavarta Semicircular Joint Srothra(cochlea)and Shrungataka

57

Sandhi Shareera

So In general Joints are classified as following:

Figure No.03: Showing types of Joints:

Joints (Arthrosis)

Fixed/immovable (Diarthrosis) Movable (Synarthrosis)

Fibrous Cartilagenous Synovial

Sutures Synchondrosis Hinge

Gomphosis Symphysis Ball&Socket

Condyle

Saddle

Plane

Ellipsoid

Pivot

Janu sandhi:

Acharya Sushruta considered Janu-Sandhi under Chala Sandhi on the basis of

kriya and Kora Sandhin on the basis of structure209.

The factors which are helpful in understanding the Shareera of Sandhi are:

Shleshaka Kapha:

Among five variety of Kapha, Shleshaka Kapha resides in joints. It keeps the

joints firmly united and helps in their function210.

58

Sandhi Shareera

Vyana Vata :

Vyana Vata is one among the five varieties of Vata. According to both

Acharya Charaka and Sushruta, Vyana vata governs every movement in the body

including Pancha chestas like Prasarana, Akunchana, Vinamana, Unnamana and

Tiryag gamana211, 212. Gayadasa commenting on Sushruta has quoted the wordings of

an unknown author as the Vyana Vata is resides in the Sandhi213.

Shleshmadhara Kala :

It is the fourth Kala, which is situated in all joints of living beings. Regarding

the proper function of the joint, it is said that Sleshma act as grease on the axle for the

smooth movement of the wheel214.

Janu Sandhi:

Acharya Sushruta in Sharirasthana explains different structures of the human

body. Among them, structures coming under Janu-Sandhi are,

Snayu:

Among nine hundred Snayus, ten are present in Janu-Sandhi. Among four

verities of Snayu, Pratana verity is present in Shaka sandhis including Janu sandhi.

All the joints are attached with snayus that are responsible for their compactness.

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 load215.

Peshishareera:

There are 500 peshis in body; among them 400 are in the Shakha (upper and

lower extremities). Among Shakagata peshi, 5 peshi is present in the janu. All the

59

Sandhi Shareera

siras, snayus, asthis, parvas and sandhis are covered by peshis that covers gives

strength to them216.

Sanghata:

Assemblages of bones are fourteen. Among that one is situated in Janu-

Sandhi217.

Marmas:

Marmas are the vital anatomical points in the human body. Among the

classification on the basis of Anatomical consideration it comes under Sandhi

marma218. On the basis of effect of Marmabhigata, it’s vaikalyakaramarma219. The

janu marma is located between jangha and urvu and if injured causes khanjata220. (It is

having measurement of 3 angula221.

KNEE JOINT:

Before discussing the disease Sandhi-Gata-Vata it is very essential to

understand the structure of knee joint, functional aspects of articular cartilage,

synovial fluid and synovial membrane etc.

Joints or articulations are the site where two or more bones meet. Joints are the

weakest part of the skeleton but their structures resists various forces, such as

crushing or tearing that threaten to force them out of alignment.

Joints are classified structurally and functionally. Fibrous, cartilaginous and

synovial are structural classification. Synarthrosis, amphiarthrosis and diarthrosis are

functional classification.

60

Sandhi Shareera

Figure No 4: Showing Anatomy of Knee Joint:

Kneejoint

The articular surfaces: Knee joint is formed by

1) The condyles of femur

2) The condyles of tibia

3) The patella

Figure No 5: Showing Anatomy of Knee Joint:

Anatomy of Knee

61

Sandhi Shareera

Articular surface:

Articular surfaces are most incongruent. The tibial surface is gently hollow

centrally and flattened peripherally where a meniscus rests. Lateral tibial surface is

circular and smaller, medial tibial surface is oval with longer ant-post axis.

The lateral and medial femoral chondyles have in front and faint groove. This

groove demarcates the femoral patellar and chondylar surfaces. Lateral Femoral

surfaces are almost circular and medial femoral surface is larger and oval. The

patella’s articular surface is adapted to the femoral surfaces.

Fibrous capsule:

The fibrous capsule has parallel but interlacing bundles of white collagen

fibers. It is complex, partly deficient and partly augmented by expansions from

adjacent tendons. It forms a cuff with its ends attached continuously round the

articular ends of the tibia and Femur.

Synovial membrane:

Derived from embryonic mesenchyme, it lines fibrous capsule, covers exposed

osseous surfaces, intra-capsular ligaments and tendons. It is absent from intra-articular

discs or menisci and ceases at the margins of articular cartilages.

Synovial Intima:

Also called as lamina propria synovialis or synovial lining layer. It consists of

pleomorphic synoviocytes embedded in a granular, amorphous, fiber free inter

cellular matrix. It helps in removal of debris and synthesis of components of Synovial

fluid.

62

Sandhi Shareera

Synovial fluid:

It occupies synovial joints, bursae and tendon sheaths. It is clear, pale, yellow,

viscous, and slightly alkaline. A protein probably lubricin rather than hyaluoric acid is

the lubricating factor but it amplifies its secondary lubricating activity. It provides

liquid environment with small range of pH, nutrition for articular cartilage, discs,

menisci, lubrication and reduction of erosion.

Menisci:

It is fibrocartilagenous disc shaped crescent. It deepens the articular surfaces

of the chondyles of the tibia. It partially divides the joint cavity into upper and lower

compartments. It has two ends, two borders and two surfaces. It helps to make the

articular surfaces more congruent, act as shock absorbers, lubricates the joint cavity,

give rise proprioceptive impulse.

Figure No.6: Showing the Minisci of Knee joint:

63

Sandhi Shareera

OTHER STRUCTURES:

Ligaments:

The capsules and ligaments of Synovial joints unit the bones, help to direct

bone movement and prevent excessive and undesirable motion.

Thus more the ligaments, the joint are stronger. In knee joint tibial collateral lig,

fibular collateral lig, oblique popliteal lig, arcuate popliteal lig, ligamentum patellae,

cruciate ligament etc. helps to maintain stability.

Figure No. 7: Showing the Ligaments of Knee joint:

Muscle tone:

Muscle tendons that cross the joints are the most important stabilizing factor,

which is due to tone of the respective muscles. In knee, muscle tone is extremely

important in reinforcing joints. Especially the thigh muscles are helpful.

Bursae:

Apertures in fibrous capsule through which synovial membranes protrude are

called as Bursae. They are numerous; as many as 13 bursae have been described.

64

Sandhi Shareera

MOVEMENTS OF KNEE JOINT

1. Flexion

2. Extension

3. Medial rotation

4. Lateral rotation

Flexion and extension take place in upper compartment of joint, above the `menisci.

They occur in Transverse axis.

Figure No.8: Showing Knee joint in Flexion and Extension:

Rotatory movements at Knee take place around a vertical axis and are

permitted in lower compartment of joint below the menisci.

Rotatory movements can occur independently in partially flexed Knee or adjunct

rotation.

Rotatory movements may be combined with flexion and extension or conjunct

rotation

65

Sandhi Shareera

Blood Supply:

1. Five genicular branches of the popliteal artery.

2. The descending genicular branch of the femoral artery.

3. The descending branch of the lateral circumflex femoral artery.

4. Two Recurrent branches of the anterior tibial artery.

5. The circumflex fibular branch of the post-tibial artery

Nerve Supply:

Femoral nerve : Through its branches to the vastus medialis

Sciatic nerve : Through the genicular branches of the tibial and Common

peroneal nerves.

Obturator nerve: Through its post division.

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.

66

Sandhi Shareera

Each is secreted by 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).

Working function of Healthy Joints:

Joints are parts of body where one bone meets the other and movement occurs

such as elbow, knee, hip and ankle. Backbone or spine also has large numbers of

small joints, which allow us to move our neck, and back in all possible directions.

Ends of bone which meet each other at joint are covered by cartilage.

Cartilage is white, smooth, glistening material and is very specialized which

functions as a cushioning material and a shock absorber so that hard bones do not rub

against each other, and the cartilage also reduces friction during joint movement since

its surface is very smooth. In fact no man made material can match the low friction

and shock absorbing properties of healthy cartilage in the joint.

Cartilage is made up of tough fibres of a protein called collagen - Enmeshed in

these fibres of collagen are the large molecules of another protein called proteoglycan.

Proteoglycan molecules contain lot of water in their interior. Water keeps on moving

in and out of the domain of proteoglycan molecules almost like water being sucked in

and squeezed out of sponge. This property of ability to exchange water so easily gives

an elastic characteristic to the cartilage.

Collagen fibers give desired strength and proteoglycan molecules allow

reversible compression. The combined structure thus makes up for the tough but not

too rigid quality needed for this very specialized tissue.

67

Sandhi Shareera

The bone ends with cartilage covering are enclosed in a membrane called

synovium. The synovium releases a slippery fluid known as synovial fluid and this

fluid further reduces the friction between moving surfaces capped with cartilage and

ensures that the joint moves easily and smoothly.

The synovial fluid or joint fluid formed by synovial membrane is a special

type of fluid that behaves like fluid when the joint is being moved and during walking

when the joint is loaded its character changes to something like jelly to act as an

additional shock absorber. The synovial fluid nourishes the cartilage. The cartilage

has no blood vessels and relies on synovial fluid moving in and out to provide

nutrients and take away the waste products.

Ends of bone, cartilage and synovium are further enclosed in a layer of tissue

called capsule. Capsule is a thick and strong tissue but is capable of stretching when

joint moves. The combination of bone ends with cartilage covering, synovium and

capsule is the joint. The joint is further covered by muscles and tenders, which

support the joint and also provide the power to move the joint.

68

Nidana

Sandhigatavata Nidana:

According to All Acharyas, Sandhigatavata is a Sthanagata Vatavyadhi caused by

the sthanasamshraya of prakupita doshas in the Asthisandhis of the body222.

In Gatavata, first vata gets vitiated by its own etiological factors, following the

specific path of its pathogenesis, when involves some specific site i.e Dhatu, Upadhatu or

Ashaya, then such condition is termed by adjective of that site. E.g. when it gets

dislodged in sandhi is known as Sandhigatavata.

Classically our acharya’s doesn’t specify sandhis like janu sandhi, Amsa sandhi,

Kati sandhi, etc for Sandhigata vata as in Contemporary science.

Nidana panchaka of sandhigatavata:

Nidana Panchaka is the tool to know about the disease, which comprises five

factors. They are Nidana, Purvaroopa, Rupa, Upashaya, Samprapti.

In absence of specific nidana, one can compile the relevant references

mentioned in different contexts like Samanya Vatavyadhi Nidana223, 224, 225, 226, 227, 228,

Asthivaha srotodushtikaarana229, Majjavaha srotodushtikaarana230. Basing above data,

Sandhigatavata nidana can be classified as:-

Sanikrishta and Viprakrista Nidana:

Sannikrishta Hetu:

Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana, Pradhavana,

Atisankshobha.

Viprakrishta Hetu:

They are again sub classified according Rasa, Guna, Dravya etc

69

Nidana

Table No. 20: Showing the Viprakrishta nidana of Sandhigatavata:

Rasa Kashaya, Katu, Tikta

Guna Rooksha, Sheeta, Laghu

Dravya Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura,

Kalaya, Adaki, Harenu, Shushkashaka, Vallura, Varaka.

Aharakrama Alpahara, Vishamashana, Adhyashan, Pramitashana

Manasika Chinta, Shoka, Krodha, Bhaya

Viharaja Atijagarana, Vishamopacara, Ativyavaya, Shrama,

Divasvapna, Vegasandharana, Atyucchabhashana, Dhatu Kshaya

The Nidana of Sandhigata Vata can also be classified in different headings like

Aharaja, Viharaja etc.

Aharaja Nidana:

Table No. 21: Showing the Aharaja nidana of Sandhigatavata explained in different

treatises:

Nidana C.S S. S A.H M.N Y.R B.P

Kashaya - + + - - +

Katu - + + - - +

Tikta - + + - - +

Rooksha + + + + + +

Laghu + - + + + -

Sheeta + - + + - -

Alpabhojana + + + - + +

Abhojana + + - + + +

Pramitabhojana - - + - - -

Dravya vishesha


Vallura + - - - - -

70

Nidana

Varaka + - - - - -

Shuskha Shaka - + - - - -

Uddalaka - + - - - -

Neevara - + - - - -

Mudga + - - - - -

Masura + - - - - -

Harenu + - - - - -

Kalaya + - - - - -

Viharaja Nidana: Table No. 22: Showing the Viharaja nidana of Sandhigatavata explained in different

treatises:

Viharaja C.S S. S A.H M.N Y.R B.P

Ati Vyayama + + + + - -

Langhana + + - + + -

Plavana + + - + + -

Atyadhwa + - - + + -

Pradhavana - + - - - -

Pratarana - + - - - -

Atyuchabhashana - + - - - -

Balavadvigraha - + - - + -

Abhighata + + - + - +

Marmaghata - - + + - -

Bharaharana + - - - + -

Dukhashayya - - + + - -

Dukhasana + - - - - -

Sheegrhayana + - + + - -

Prapeedana - + - - - -

Atiadhyayana + - - - - -

Ati vyavaya + + + + + +

Atijagarana + + + + + +

Vegadharana + + + + + -

71

Nidana

Vishamopachara + - - + + -

Shrama - - - - - +

Upavasa + + + + + +

Puravata sevana - - - - - +

Divasvapna + - - - - -

Manasika karana:

Table No.23: Showing the Manasika nidana of Sandhigatavata explained in different

treatises:


Chinta + - + + + +

Shoka - + + + + -

Krodha - - - - - -

Bhaya - - - - + -

Anyat (other nidanas):

Table No. 24: Showing the Anyata nidana of Sandhigatavata explained in different

treatises:


Atiraktasravana + - - + + -

Atidoshasravana + - - + + +

Dhatukshaya + - - + + +

Rogatikarshana + - - + + +

Divasvapna + - - - - -

As Mentioned above, Vata can get vitiated by Panchakarma apacharas like

Atidoshasravana, Atirakthasravana, Atiyoga of langhana, Apatarpana etc and

dhatukshayakarabhavas like rogakarshana, gadakrita Atimamsakshaya. Both Dhatu

Kshya and Stholya are considered as casautative factor for Vatavyadhi. In Sthoulya, the

meda-avarana is the mechanism, which in turn leads to improper nourishment of Dhatus

causing Kshya in Dhatus except Meda231.

72

Nidana

The Age factor is also a main considering factor as Vata dominates vardhakya

avastha232. During this period, dhatukshaya occurs which in turn causes Vata prakopa.

Living in jangaladesha is another causative factor for Vata prakopa233 and also Vata gets

vitiated in the end of day and night234. According to Ritu Kriyakala,Vata gets started for

accumulat in greeshma ritu, Prakopa in varsha ritu and Shamana in sharad ritu kala. 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 these results 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-

shosha, thereby resulting in looseness of joints is also a major risk factor for

Sandhigatavata.

73

Purvarupa

Purvarupa:

Purvarupa are indications of impending diseases. They occur prior to complete

manifestation of disease and may suggest the forthcoming illness. During the course

of the Samprapti of an illness, the morbid doshas circulating all over the place in the

body tend to localize in an area and produces some of the unique symptoms and is

referred by the name Purvarupa. The Purvaroopa manifests in the Sthana Samsraya

stage of Shatkriya kala. Diagnosis at this stage of the illness gains paramount

importance, as the effective treatment at this stage definitely reduces the possible

organic damage as well as degree of morbidity.

Particular Poorvaroopa of Sandhigatavata is not available in classics. Acharya

Charaka has stated that avyakta lakshanas are to be taken as Purvaroopa for all vata

vyadhi235.

Acharya Vijayarakshita, in commentary on Madhava nidana explains that term

Avyakta indicates the unclear manifestation of upcoming Vatavyadhi and these

diseases are not have any vishista purvaroopa as seen in Jwara etc236.

Hence mild exhibition of actual features of the disease like sandhi shoola,

occasional Sandhi Shotha, slight sandhi atopa may be taken as purvaroopa.

74

Rupa

Rupa:

Rupa of a disease, manifest in the fifth stage of Vyadhi kriyakala i.e

Vyakthavastha. Linga, Akruthi, Lakshana, Chihna, Samsthana, Vyanjana, Rupa etc

are the synonyms of Roopa237. This is the unique stage of the illness, where in it is

clearly recognizable as all its characteristic signs and symptoms manifest. The

intensity of the lakshanas is depending on strength of dosha dushya sammurchana.

Sandhigatavata manifests with the following lakshanas.

Vatapoornadrithisparshaha shothaha: In classics Acharyas explained Shotha as the

important manifestation in Sandhigata vata. Acharya Charaka238 and Vagbhata239, 240

correlated the shotha to air filled bag for touch. The Acharyas like Sushruta241, 242, 243,

244 stated only as Shotha but not specified its nature.

Physical examination of the Sandhi gata vata joint reveals localized soft tissue

swelling of mild degree. It is due to the changes in articular ends themselves,

particularly periarticular lipping.

Prasarana akunchanayoho pravrittischa savedana:

Pain in the joint during Prasarana (Flexion) Akunchana (Extension)

Pravrutti245. Means pain in joints during its normal movements like extension or

flexion. It is often described as a deep ache and is localized to the involved joint.

Usually, the pain of Sandhi gata vata is aggravated by usage of joint and relieved by

rest, later as the disease progresses, it may become persistent.

Hanti sandheen:

This lakshan is explained by Acharya Sushruta. While commenting on this,

Dalhana explained as Akunchanaprasaranayoh Abhavah and Gayadasa explained as

Prasaranakuncanayoh Asamarthah246. So it gives the meaning of inability to do

75

Rupa

normal movement of joint. This can be compared with the Prasarana akunchanayoho

pravrittischa savedana explained by Acharya Charaka.

According to Madhukoshakara, Hanti sandhi referes to Sandhi Vishlesha,

Stambha Adi Vikara247.

Shoola:

All the Acharya have described this symptom. Acharya Sushruta not specified

about this lakshan248, where Charaka and Vagbhata explained that pain in the joint is

elicited during Prasarana Akunchana Pravrutti.

Sandhi Stabdhata:

Sandhi sthabdhata is the symptom explained by Acharya Vijayarakshita while

commenting on word Hanthisandhi249. Acharya Sushruta explained the word Hanthi

sandhi, whereas commentators are silent on that. Bavamishra250, Shodala251,

Yogaratnakara also explained Hanthi Sandhi, but not Sandhi stabdhata.

The commentator while explaining Hanthi sandhi, Dalhana and Gayadasa

explained as Akunchanaprasaranayoh Abhavah and Prasaranakuncanayoh

Asamarthah respectively. So this can be considered as Sandhi Stabdatha.

Atopa:

Atopa is the symptom explained by Madavakara252. This can be compared

with Crepitus (Characteristic sound produced from the joints). 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 Bhavamishr says “Atopo Gudagudashabdaha”253. Thus we can say

that Atopa in this context is the sound produced by the movement of joints i.e.

Crepitus.

76

Rupa

Thus with the help of different references and by the opinion of commentators

it can be concluded that Sandhi Shoola, Sandhi Shotha, Atopa and Sandhi Stabdhata

are the clinical features of Sandhigatavata.

Roopa of Sandhigatavata mentioned in various classics

Table 25: Showing the Roopa of Sandhigatavata explained in different treatise:

Roopa C.S. S.S A.S A.H M.N B.P.

Vatapoornadruti sparsha + - + + - -

Sandhi Shotha/shopha + + + + - +

Prasarnaakunchana sa vedana + - + + - -

Hanti Sandhigata - + - - + +

Sandhi Shoola + + + + + +

Asthishosha - + - - - -

Asthibeda - + - - - -

Atopa - - - - + -

Sandhi Stabdhata - + - - + -

Sandhi vishlesha - - - - + -

77

Samprapti

Samprapti:

The process of Doshic vitiation and the course they follow, culminating in the

development of specific clinical manifestation is known by the name Samprapti254. Jati

and Agati are its synonyms255, 256. An accurate understanding of Samprapti is vital in the

planning of the treatment of any disease, since Chikitsa is nothing but ‘Samprapti

Vighatana’. The term Samprapti is applied to express the course of the episodes of

disease right from Nidanasevana to Vyadhi Utpatti. The knowledge of Samprapti helps in

the comprehension of the specific features of a disease like Dosha, Dushya, Srotodushti,

Ama and Agni etc samprapti ghatakas. Charakacharya has described the types of

‘Samprapti’ namely Sankhya, Vidhi, Vikalpa, Pradhanya, Bala, Kala257. Sushruta has

described Samprapti process in six stages Sanchaya, Prakopa, Prasara, Sthanasamshraya,

Vyakti and Bheda known as Satkriyakala. During Sthansamshraya Avastha the vitiated

Dosha have reached to particular Sthana and get obstructed there and intimately interacts

in a particular region with one, two or more dhatus and render them into dhushyas. This is

the reason that though Nidana of all the Vatavyadhi are same but only due to the

Samprapti Vishesha of disease Vata can produce multiple Vata disorders. If vitiated Vata

is accumulated in sandhi by Srotovaigunya it produces Sandhigata vata. For

sandhigatavata specific samprapti is not seen in classics.

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

considered as the Samprapti of Sandhigatavata.

Acharya Caraka explained – due to the intake of Vatakara Ahara Vihara Vata

vitiation take place. This vitiated Vata lodges in Rikta Srotas (Snehadi guna shunya

srotas- Chakrapani) and then produce disease related to that Srotas258.

Acharya Vagbhata frames the Samprapti of Vata Vyadhi like – Dhatukshaya

aggravates Vata and the same is also responsible to produce Riktata of Srotas. Thus

the vitiated Vata travels through out the body and settles in the Rikta Srotas and

78

Samprapti

further vitiates the Srotas leading to the manifestation of Vata Vyadhi.and also vata

get aggravated due to Avarana by other doshas to vata259.

Concept of Gatavata

As the Sandhigatavata belongs to Gatavata group of Vatavyadhees, it will be

relevant to discuss the concept of Gatavata here. While mentioning Gatavata,

acharyas have mentioned the gatatva of dhatu, upadhatu, ashaya, avayava etc260. The

various terminologies used to denote this Gatavata are gate, sthithe, avasthite, ashrite,

prapte etc. These all terminologies can imply two important factors – A) related to the

gati of the vitiated Vata and B) related to occupation in the particular site of the body.

When these two factors combine then such condition is termed by adding the

objective of that site, for e.g. Sandhigatavata. Though Vata is present all over the

body, its Gata condition specially indicates its abnormal localization at the particular

Dhatu or Ashaya. In this condition, the etiological factors are only of Vata and not of

dual i.e. not of both Dosha and Dooshya. For example, in Vatarakta, due to rakta

vruddhikara ahara the dravamsha of rakta gets increased and due to vata vruddhikara

vihara vata gets vitiated. Vitiated rakta gets accumulated in the lower part of the body

and obstructs vata in the extremities. Vata gets provoked still more due to the

obstruction to its chala guna, resulting in Vatarakta. While in Sandhigatavata, the

kopa of Vata alone occurs and this vitiated Vata by involving the Sandhis produces

Sandhigatavata. Peculiarities of these Gatavatas are that here the Vata vitiation is

active, Vata dosha is more important, vitiation of Vata is due to its own Nidanas and

there is a state of Dhatukshaya and Rikta srotas.

Samprapti of Sandhigatavata can be discussed under two headings for better

understanding, they are

1. Dhatu Kshaya Janya and 2. Avarana Janya Sandhigatavata.

79

Samprapti

1. DhatuKshaya Janya Sandhigatavata:

Here the process of Samprapti initiation is due to the strong involvement of

nidana factors such as Vardhakya avastha, Abhighata, Ativyayama, Marmaghata etc.

In Vardhakya (Old age) Vata Dosha is dominates in the body. This in turn will cause

Kapha kshaya. As the Shleshma Bhava decreases in the body, Shleshaka Kapha in the

joints gets decreases in both quality and quantity. Reduction of Kapha in Sandhis

makes Sandhi BandhaShithilata. Ashrayashrayi Sambandha also leads Asthidhatu

Kshaya as vatavrudhi leads to Asthidhatu kshaya261. Asthi being the main tissue of the

joint its Kshaya leads Khavaigunya in the joints.

In this condition if Nidana Sevana, 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.

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.

Intake of rooksha-sheeta ahara and vihara like ativyayama, abhighata etc

Reduction of sneha bhava in the body Dhatukshaya where by sushirata in the

channels results Vata purana of these channels Manifestation of symptoms.

80

Samprapti

In the mean time Sthanasamshraya of Prakupita Vata take place in the

Khavaigunyayukta Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi

Guna decreases the properties of Sleshaka Kapha producing disease Sandhi-Gata-

Vata.

Figure No.09: Samprapti of Dhatukshaya Janya Sandhigatavata:

Ruksha Ahara, Ati vyayama etc Nidana Varddhakya

DhatuKshaya

Sandhigatavata

Sthana samshraya in Sandhhi

Circulating throughout Body Khavaigunya

in sandhis

Vata Prakopa Kapha Kshaya

Shleshaka Kapha Kshaya in Sandhis

81

Samprapti

2. Avarana Janya Sandhigatagata :

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

due to the Kaphamedas the margavarana occurs and the Vata gets vitiated and cause

many Vata Vyadhi and one among them is Sandigatavata.

The excessive Medas will produce obstruction in the flow of nutritive

materials to the uttarottara Dhatus i.e Asthi, Majja and Shukra leads to their Kshaya.

The excessive fat deposited all over the body will produce Margavarana of Vata.

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.

82

Samprapti

Figure No. 10: Samprapti of Avarana Janya Sandhigatavata:

Margavarana of Vata by vitiated medas

Asthi Kshaya Vata Prakopa

Sthana samshraya

Khavaigunya In Sandhis

Deformity in Sandhi

Sthoulya

Sandhigatavata

83

Samprapti

Three main factors involving in the production of Sandhigatavata, in any form

of Samprapti are –

1. Kopa of vyana vata, which normally controls all the movements of the body.

2. Kshaya of shleshaka kapha, which normally aligns the joints and maintains its

Compactness.

3. Deterioration of shleshmadhara kala, which lubricates the joints.

Samprapthi Ghataka:

Table 26: Showing the Samprapti ghataka of Sandhigatavata:

Dosha Vata : Vyana Vriddhi;

Kapha : Shleshaka 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

Vyaktasthana Sandhi

Adhishtana Sandhi

84

Upashaya-Anupashaya

Upashaya:

Upashaya is much important; especially during the treatment usually all drugs,

diet and regimen which give long lasting relief in Sandhigatavata may be taken as

Upashaya, having snigdha & ushna gunas are prescribed to pacify the Vata kopa. For

example Abhyanga, Swedana, Ushna ahara, Ushna ritu etc. This should be adopted in

the nirama avastha of Vatavyadhi (Sandhigatavata) only. When the same drugs are

prescribed in the saama avastha of vatavyadhi the disease aggravates.

Anupashaya:

All the drugs, diet and regimen which exaggerate the disease are taken for

Anupashaya for Sandhigatavata. Also hetus of vatavyadhi can also be taken as

Anupashaya. When upashaya method applied during samaavastha can also be

included under Anupashaya. The diet having laghu, ruksha, sheeta gunas, anashana,

alpashana, sheeta rithu can be considered as Anupashaya.

85

Vyavachedaka Nidana

Vyavachedaka Nidana:

Vyavachedaka Nidana or differential diagnosis plays a prime role in arriving

at an exact decision between diseases presenting a similar clinical feature. While

making the diagnosis of Sandhigatavata the following disorders that are having

similar features has to be excluded.

Table 27: Showing the Vyavachedhaka nidana of Sandhigatavata:

Sl. No

Criteria Sandhigata vata

Amavata Vataraktha Krotukashersha

1 Nidana Vatavridhikara ahara-vihara

Viruddha ahara-cheshta

Vidahi, viruddha, Raktha Prakopakara Ahara,Vihara

Vatavridhikara ahara-vihara

2 Purva rupa

Avyaktha rupa lakshana

Hridaya dourbalya, Gourava, Jvara, aruchi, Angamarda

Karshnya, Sparshgnatva, Kshateatiruk, Sandhi shitilyata Vaivarnya, Peedakodhbava SwedaVridior kshaya

Avyaktharupa lakshana

3 Rupa Sandhi- shoola, Prasarana -akunchanayohovedana, Sandhi shopha, Vatapoorna Drithi sparsha

Vrischika damshavat peeda, Utsahahani Shotha Apaka, AngashunyataHrilasa, Trishna, Gaurava

Kandu,Daha, Spurana,Paka, Teevra ruk, Grathita-paki Shvayathu Spreads like mooshikavisha Starting from Smaller joints

Maharuja, Janushopha Thodha Krostuka- shirshastu Sthoola Shopha

4 Adhistana Sandhi Hasta,PadaJanu Gulpha, Trika, etc

Padhamoola, Hasthamoola

Janu Madhya

5 Dosha Vata Vata, Kapha Vata, Rakta Vata, rakta 6 Upashaya Ushna,

snigdha Ushna-rooksha

Sheeta Snigdha, seetha

86

Sadhya-Asadhyata

Sadhya-Asadhyata

It is essential to know the Sadhyasadhyata of a disease before the treatment.

Acharya charaka stated that “A physician who can distinguish between curable and

incurable diseases and initiate the treatment with full knowledge regarding the

different aspect of the therapeutics can certainly accomplish his object of curing the

disease”262.

The Sadhyata-asadhyata or prognosis of a disease depends on many factors

such as the Bala of Nidana or Hetu, the strength of Dosha Prakopa, the Sthana of the

disease, severity of signs and symptoms, duration of the disease etc. It also depends

upon the age, sex, rogamarga, dhatudushti etc263.

In Yogaratnakara Acharya explained that, in general Vatavyadhi’s are

Asadhya in nature, but it can be get cured by the grays of God. So it should be treated

without giving any assurance.

Generally, Vatavyadhis are very difficult to cure due to the deep seated nature

of them. Sandhigatavata usually occurs in the vardhakya kala, the kala, which is

predominant of Vata.

Acharya Sushruta considered Vatavyadhi as one among Astamahagada and

explained that, these are difficult to cure by its swabhava264.

Charaka had mentioned some Vatavyadhi’s, which are either not curable due

to sthana gambheerata or curable with effort in case they are of recent origin, in strong

patients and if without any complications. In the list of Kashtasadhya Vata Vikara,

Acharya Caraka does not mention Sandhigatavata but while commenting on word

‘Khuddavata’ Cakrapani explains the meaning of Khuddavata as Gulphavata or

87

Sadhya-Asadhyata

Sandhi-Gata-Vata. Thus Sandhigatavata can be considered as Kashtasadhya Vata

Vyadhi265.

The ailments of aged persons are Kashtasadhya and Sandhigatavata is the

affliction of elderly persons. Diseases situated in Marma and Madhyama Rogamarga

is Kashtasadhya. Sandhigatavata is a disease of Sandhi, which falls under Madhyama

Rogamarga. Further Vata Vyadhi occurring due to vitiation of Asthi and Majja are

most difficult to cure.

88

Chikitsa

Chikitsa:

The term “Chikitsa” is derived from the Sanskrit root “ÌMüiÉç – UÉåaÉÉmÉlÉrÉlÉå” which

means removing the factors and tendencies related to illness. It is defined as “ÂMçü

mÉëÌiÉÌ¢ürÉÉ266. In brief, the process by which the disease is cured is called as Chikitsa.

The main aim of Chikitsa is to restore the Swasthya by irradiation of disease. The

primary aim of Chikitsa is Samprapti Vighatana. Ayurveda advocates two-fold

approach to cure i.e. Samshodana (Bio-purification) and Shamana (Palliation).

The measures included under Shamana are palliative in nature. As Shamana

will only pacify the deranged doshas and will not eliminate the morbid factors from

the body, there may be an aggravation in future. The Samshodana therapy is a unique

concept. It envisages not only the visceral cleaning rather it aims at the total bio-

purification upto molecular level.

Shodhan mainly includes Panchashodhana’s like Vamana,Virechana, Basti

Nasya, Rakthamookshana therapies along with Purvakarma like Depana-Pachana,

Snehana and Swedana.

The specific line of treatment of Sandhigatavata is first described by Acharya

Sushruta267. Later Vagbhata, Yogaratnakara, Bhavamishra also explained specific line

of treatment. As Sandhigatavata is a Vataja disorder, general treatments of Vata

Vyadhi can be adopted and also vataupakramas268. Acharya Charaka not mentioned

specific line of treatment for Sandhigata vata.

89

Chikitsa

Table 28: Showing Chikitsa modalities as mentioned in different classics:

Treatment S.S269 A.S270 A.H.271 Y.R272 B.P273 B.R274

Snehana + - + + + +

Abhyanga - + - - - -

Mardana + + - + - +

Swedana - + - + + -

Upanaha + + + + + +

Bandhana + + - - - +

Agnikarma + + + - - +

1) Snehana:

In simple terms Snehana chikitsa means imparting softness and greasiness to

the body through administration of fatty substances like Taila, Ghrita, Vasaa, Majja.

The administration of Snehana is an important treatment for Vata disorders. It is one

among Shadupakramas275. In Sandhigata vata as explained in samprapti, vitiated vata

will resides in Asti sandhis, so as to pacify vitiated vata and also to add sneha amsha

which underwent kshaya, snehana can be adopted. According to the use it can be

administered in two ways

1) Abhyantara Prayoga

2) Bahya Prayoga

Abhyantara Sneha:

Here Sneha used in the form of Pana, Bhojana, Vasti and Nasya

Bahya Sneha:

Bahya Snehas mainly Abhyanga, Lepa, Padaghata, Pichu, Mardana, and

Parisheka etc

In context of Sandhigatavata Acharyas mentioned Abhyanga and Mardana.

90

Chikitsa

Abhyanga is a process by which the person’s body is oleated with medicated

oil with specific movement and pressure. For the purpose of Abhyanga Sukhoshna

Sneha is used. Abhyanga should be done slowly in Anuloma Gati and in joints it

should be done in circular manner. In sandhigata vata Abhyanga should be done for

900 matra kala (about 10 minutes) because the Veerya of sneha will reach Asti and

Majja Dhatu in 800 and 900 Matra-Kalas respectively276. Abhyanga is Vatahara,

Dhatu Pushtikara, Bala prada277, 278.

2) Upanaha:

Both Sushruta and Charaka consider Upanaha as a variety of Swedana279, 280.

This is of two types: 1) Saagni 2) Niragni.

Saagni upanaha is nothing but Sankara sweda. Niragni upanaha is the covering

of Vatahara dravyas and tying over the affected body part.

The drugs like Godhuma churna, Yava etc pasted by mixing with Kanji,

Sneha, Lavana. After making this lukewarm, it should be applied to the affected part.

Sugandhi dravyas, Surasadi dravyas are also used for Upanaha281. The paste of drugs

included in the Kakolyadi or Eladi or Surasadi gana as well as pastes of Sarshapa or

Tila or Atasi or Krishara or Paayasa or Utkarika or Vesavara or the drugs of Salvana

Sweda are also used for Upanaha. This is applied to the affected part folded in piece

of thin linen and tied up282.

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

the absence of this, silk or woolen cloth can be used283. Acharya Vagbhata opines that

vatahara patras like Eranda patra also can be used for Upanaha284.

91

Chikitsa

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 morning285.

3) Agnikarma: Unique treatment indicated in case of Sandhigatavata. Here Dahana is

done at the tender points of the part affected. Sushruta states that in the vitiation of

Vata in twak, mamsa, sira, snayu and sandhi Agnikarma provides good relief. Dahana

karma is a synonym of Agnikarma286.

4) Bandhana: For the purpose of Bandhana, Charaka opines that leather of Ushna

Veerya animal can be used. In the absence of this silk or woolen cloth can be used287.

Astanga Hridayakara opines that 'Vatahara' Patras should be used288.

5) Unmardana:

Massage with certain pressure and strokes on the body are known as

Unmardana. This is a massage technique comes under bahya snehana procedures.

6) Swedana:

Swedana is the procedure by which perspiration of the body will be produced.

It removes Sthabdata, Gauravata, and Sheetata. Swedana is also explained under

Shadvidhopakrama289. In case of Sandhigatavata varieties of Svedanakrama like

Upanaha and Bandhana are indicated.

Apart from these, the Basti karma should also be adopted, as it is the parama

oushadha for Vata.

92

Osteoarthritis

Pathya- Apathya:

Those Aharadi Dravyas, which are beneficial to Srotas and have no adverse

effect on body and mind, are termed as Pathya290. Pathya is a major pillar supporting

the line of treatment of any disease; separately Pathya and Apathya of Sandhigatavata

are not described. Hence Pathya and Apathya of Vata Vyadhi in general can be

applied for patients of Sandhigatavata.

Pathya291: Table No. 29: Showing the Pathyas of Sandhigatavata:

Ahara

1 Rasas Madhura-amla-lavana

2 Shukadhanya Nava godhuma, Nava shali, Rakta shali, Shashtika shali.

3 Shimbi varga Nava tila, Masha, Kulatha.

4 Shaka varga Patola, shigru, vartaka, lashuna.

5 Mamsa varga Ushtra, Go, Varaha, Mahisha, Magura, Bheka,

Nakula,Chataka,Kukkuta, Tittira, Kurma.

6 Jala varga Ushnajala, Shrithasheetajala, Narikelajala.

7 Dugdhavarga Go, Aja, Dadhi, Gritha, Kilata, Kurchika.

8 Mutravaga Gomutra.

9 Madyavarga Dhanyamla, Sura.

10 Snehavarga Ghrita, Tila, Vasa, Majja.

11 Present day

food stuffs

Orange juice, carrot, all fibrous fruits and Vegetables.

Vihara

1 Veshtana, Trasana, Mardana, Snana, Bhushayya,

2 Present day & activities: Physiotherapy exercise, Yoga asana’s, Steam bath

93

Osteoarthritis

Apathya292:

Table No. 30: Showing the Apathyas of Sandhigatavata:

Ahara

1 Rasas Katu, Tikta, Kashaya.

2 Shukadhanya Truna, Kangu, Koradusha, Neevara, Syamaka.

3 Shimbi varga Rajamasha, Nishpava, Mudga, Kalaya

4 Phalavarga Jambu, Udumbura, Kramuka, Tinduka.

5 Mamsa varga Sushka mamsa, Kapota, Paravata

6 Jala varga Sheetajala.

7 Dugdhavarga Gardabha.

8 Present day food

stuffs

Fast food: Pizza, Burger, Gobimanchuri, cold

beverages, liquor.

Vihara

1 Manasika: Chinta, Shoka, Bhaya.

2 Present day

activities:

Long standing sitting, driving, staying in AC etc

94

Osteoarthritis

Osteoarthritis:

Pathologically, Osteoarthritis is defined as a condition of synovial joints

characterized by focal loss of articular cartilage and simultaneously proliferation of

new bone with remodelling of joint counter. Inflammation is not a prominent feature.

Osteoarthritis, however, is not a disease or a single condition. It is best viewed as a

dynamic repair process of synovial joints that may be triggered by a variety of insults,

some but not all of which result in symptomatic ‘joint failure’293. Osteoarthritis is by

far the most common form of arthritis. It shows a strong association with ageing and

is a major cause of pain and disability in the elderly.

Terminology of Osteoarthritis294:

The term Osteoarthritis was coined by “John Spendon”. The Osteoarthritis,

Osteoarthrosis, Degenerative joint disease and Hypertrophic arthritis are generally

used to describe Sandhigatavata. Osteoarthritis is less ideal since the primary event is

not inflammatory, although secondary synovitis is usually present. Osteoarthrosis is

perhaps the best because the inflammation is secondary and the suffix denotes an

increase and an invasion, physiologic or pathologic, or a general over production.

Degenerative joint disease is unsuitable, since degenerative implies aging, a running

down, deterioration, a catabolic process; in fact for long periods, often years, the

disease may not be clinically progressive. Hypertrophic arthritis now completely out

of style, describes one phase the osteophytosis or overgrowth of bone.

It is a degenerative “Wear and Tear” process occurring in joints that are

impaired by congenital defect, vascular insufficiency, or previous disease or injury. It

is characterized by focal loss of cartilage with evidence of accompanying periarticular

bone response in the form of subchondral bone sclerosis and attempted new bone

formation in the form of bony over growths called osteophytes.

95

Osteoarthritis

Etymology:

The word “Osteoarthritis” is a combination of three words. “Osteon” “arthron”

and “itis” respectively meaning bone, joint and inflammation.

Epidemiology:

According to W.H.O. Osteoarthritis is the second commonest musculoskeletal

problem in the world population (30%) after back pain (50%).The reported prevalence

of O.A from a study in rural India is (5.78%)

Risk factors for Osteoarthritis295:

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.

Sex factor:

It is told that women are about twice as likely as men to have O.A .The pattern

of joint involvement also differs with gender, with women having a greater number of

joints involved and more frequent complaints of Morning stiffness, Joint swelling,

and Nocturnal pain.

Before age 45 years, however, the disease prevalence is lower than in men,

with marked increase in prevalence occurring after 55 years of age. Particularly in the

knee joint. These gender differences in O.A incidence were first recognized over 150

years ago and were thought to be linked to Post- Menopausal estrogen deficiency.

Hereditary factor296:

Osteoarthritis also appears to have a genetic component. There is significantly

higher concordance of O.A in the all joint areas among monozygotic twins than

96

Osteoarthritis

among Dizygotic twins. Segretion analysis of population data suggests that O.A is

polygenic disorder but the identity of the genes involved remains unknown. Studies of

rare familial form of O.A suggest that an Autosomal dominant mutation in Type - II

collagen may be an important.

Point mutation in the cDNA coding for articular cartilage collagen have been

identified in families with chondrodysplasia and polyarticular osteoarthritis.

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.

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.

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 misalignment may lead to

excessive wear and tear leading to OA.

Repetitive stress:

Abnormal posture, abnormal gait, and unequal length of leg will exert stress

and strain over the joint.

97

Osteoarthritis

Endocrine disorders:

Acromegaly, Hyperparathyroidism, Diabetes mellitus, Obesity, etc. may lead

to osteoarthritis.

Metabolic disorders:

Like Ochronosis, Wilson’s disease may give rise to osteoarthritis.

Calcium deposition diseases:

Like CPPD deposition may lead to osteoarthritis.

Classification based on causes:

1) Primary Osteoarthritis: Predisposing factores are- Genetic, Metabolic disorders,

age, Ideopathic avascular necrosis, endocrinal factores and obesity

2) Secondary Osteoarthritis: usually caused by local factors like – Trauma,

Incongruity, Mal-alignment, Inadequate blood supply, Infections of the joint, diseases

interfering nerve supply of the joint, Inflammatory diseases, Neutritional bone

diseases like Rickets, Osteomalacia. (Das)

Commonly effecting area of Osteo arthritis:

Figure No. 11: Showing the Commonly effecting area of Osteo arthritis:

98

Osteoarthritis

Osteoarthritis most often occurs in the hands (at the ends of the fingers and

thumbs), spine (neck and lower back), knees, and hips.

Pathology297:

The pathology of OA provides evidence of the panarticular involvement of

disease. Cartilage initially shows surface fibrillation and irregularity. As disease

progresses, focal erosions develop there, and these eventually extend down to the

subjacent bone. With further progression, cartilage erosion down to bone expands to

involve a larger proportion of the joint surface, even though OA remains a focal

disease with nonuniform loss of cartilage

After an injury to cartilage, chondrocytes undergo mitosis and clustering.

While the metabolic activity of these chondrocyte clusters is high, the net effect of

this activity is to promote proteoglycan depletion in the matrix surrounding the

chondrocytes. This is because the catabolic activity is greater than the synthetic. As

disease develops, collagen matrix becomes damaged, the negative charges of

proteoglycans get exposed, and cartilage swells from ionic attraction to water

molecules. Because in damaged cartilage proteoglycans are no longer forced into

close proximity, cartilage does not bounce back after loading as it did when healthy,

and cartilage becomes vulnerable to further injury. Chondrocytes at the basal level of

cartilage undergo apoptosis.

With loss of cartilage come alterations in subchondral bone. Stimulated by

growth factors and cytokines, osteoclasts and osteoblasts in the subchondral bony

plate, just underneath cartilage, become activated. Bone formation produces a

thickening and stiffness of the subchondral plate that occurs even before cartilage

99

Osteoarthritis

ulcerates. Trauma to bone during joint loading may be the primary factor driving this

bone response, with healing from injury (including microcracks) producing stiffness.

Small areas of osteonecrosis usually exist in joints with advanced disease. Bone death

may also be caused by bone trauma with shearing of microvasculature, leading to a

cutoff of vascular supply to some bone areas.

At the margin of the joint, near areas of cartilage loss, osteophytes form. These

starts as outgrowths of new cartilage and, with neurovascular invasion from the bone,

this cartilage ossifies. Osteophytes are an important radiographic hallmark of OA. In

malaligned joints, osteophytes grow larger on the side of the joint subject to most

loading stress (e.g., in varus knees, osteophytes grow larger on the medial side).

The synovium produces lubricating fluids that minimize shear stress during

motion. In healthy joints, the synovium consists of a single discontinuous layer filled

with fat and containing two types of cells, macrophages and fibroblasts, but, in OA, it

can sometimes become edematous and inflamed. There is a migration of macrophages

from the periphery into the tissue, and cells lining the synovium proliferate. Enzymes

secreted by the synovium digest cartilage matrix that has been sheared from the

surface of the cartilage.

Additional pathologic changes occur in the capsule, which stretches, becomes

edematous, and can become fibrotic.

The pathology of OA is not identical across joints. In hand joints with severe

OA, for example, there are often cartilage erosions in the center of the joint probably

produced by bony pressure from the opposite side of the joint. Bone remodeling is a

prominent feature of hand OA, in part because of the thin cartilage in each hand joint.

100

Osteoarthritis

In hand OA, pathology has also been noted in ligament site insertions, which may

help propagate disease.

Basic calcium phosphate and calcium pyrophosphate dihydrate crystals are

present microscopically in most joints with end-stage OA. Their role in osteoarthritic

cartilage is unclear, but their release from cartilage into the joint space and joint fluid

likely triggers synovial inflammation, which can, in turn, produce release of enzymes

and trigger nociceptive stimulation.

Sources of Pain298:

Because cartilage is aneural, cartilage loss in a joint is not accompanied by

pain. Thus, pain in OA likely arises from structures outside the cartilage. Innervated

structures in the joint include the synovium, ligaments, joint capsule, muscles, and

subchondral bone. Most of these are not visualized by the x-ray, and the severity of x-

ray changes in OA correlates poorly with pain severity.

Based on MRI studies in osteoarthritic knees comparing those with and

without pain and on studies mapping tenderness in unanesthetized joints, likely

sources of pain include synovial inflammation, joint effusions, and bone marrow

edema. Modest synovitis develops in many but not all osteoarthritic joints. Some

diseased joints have no synovitis, whereas others have synovial inflammation that

approaches the severity of joints with rheumatoid arthritis (Chap. 314). The presence

of synovitis on MRI is correlated with the presence and severity of knee pain.

Capsular stretching from fluid in the joint stimulates nociceptive fibers there, inducing

pain. Increased focal loading as part of the disease not only damages cartilage but

probably also injures the underlying bone. As a consequence, bone marrow edema

101

Osteoarthritis

appears on the MRI; histologically, this edema may signal the presence of

microcracks and scar, which are the consequences of trauma. These lesions may

stimulate bone nociceptive fibers. Also, hemostatic pressure within bone rises in OA,

and the increased pressure itself may stimulate nociceptive fibers, causing pain.

Lastly, osteophytes themselves may be a source of pain. When osteophytes grow,

neurovascular innervation penetrates through the base of the bone into the cartilage

and into the developing osteophyte.

Pain may arise from outside the joint also, including bursae near the joints.

Common sources of pain near the knee are anserine bursitis and iliotibial band

syndrome.

Degeneration & O.A:

OA is caused by the degeneration of the articular cartilage in the joints

involved. In the regions involved, the cartilaginous matrix and the chondrocytes swell.

The proteoglycans in these regions are smaller than the normal. The

proportion of chondrotin sulfate falls and the proportion of keratin sulfate rises. The

change in the character of the proteoglycans exposes the collagen fibers in the

cartilage. Poorly formed type I collagen tends to replace the type II collagen normal in

the cartilage. In the degenerating regions, small fissures develop in the cartilage. The

fissures separate irregular brands of cartilage that project perpendicular to the articular

surface, a change called fibrillation. Clumps of chondrocytes are often present near

the clefts.

As years pass, much or all of the articular cartilage is slowly worn away.

Eventually, only irregular patches of articular cartilage remain on the articular

surfaces of the bones.

102

Osteoarthritis

Weight man has shown that the ability of the articular cartilage to withstand

fatigue testing diminishes progressively with age. Because OA is most common in

aging patients, it is often proposed that the disease is an intrinsic part of the aging

process. The wear and tear theory assumes a decreasing capacity with the age of

articular cartilage to resist mechanical stress.

Figure No.12: Showing Osteoarthritis of Knee:

Natural History:

The course of O.A is highly variable with radiological progression seen in

one-third to two-third of patients. Improvements are rare, symptoms may progress,

improve or may even be arrested spontaneously and do not correlate well with

radiographic progression. Patients with multiple affected joints have more rapid

progression of O.A. Advanced age and obesity is also associated with a more rapid

progression of O.A.

103

Osteoarthritis

Examination of Kneejoint:

History:

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

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

limp.

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

The limits of the swelling were clearly made out.

The gradings were allotted on the basis of criteria explained in the end

of this section.

Observed for any discolouration over swelling

• Any deformities like genus valgum, varum etc. were examined.

• Joint instability or buckling of the joint was examined.

• Any abnormalities in the gait were examined.

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

• Any presence of muscular spasm was examined.

• Muscular wasting above and below the joint was examined.

104

Osteoarthritis

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

The swelling over knee joint may be because of “Effusion”, caused by

excess synovial fluid, blood or occasionally puss. Several techniques are

used for detection of effusion. The commonly used techniques are,

Visible Fluid Wave- Patient is kept in supine position with knee

relaxed and extended. After inspection if mild effusion is suspected,

the hollow on both sides of the knee is pressed with thumb on one side

and the index and long finger on the other side. Then removed the hand

and quickly compressed the suprapatellar pouch with palm and finger

of other hand. This forces the fluid back to the hollow space, resulting

in visible fluid wave. This test is not useful in the obese patients

because the adipose tissue hides the normal hollow even when no

effusion is present.

Palpable Fluid Wave- This technique is used if slightly larger effusion

is present, because the fluid returns hollow space too quickly and can’t

identify. Here the hollows of both side of knee joint are compressed

with thumb in one side and index and long finger in other side. Then

the suprapatellar pouch is squeezed firmly with other hand by keeping

first hand in position. The waves of fluid are felt in fingers kept in

hollows of knee if effusion is present.

105

Osteoarthritis

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 & Extension: Normally, the knee can be flexed until the calf extended

till the thigh and leg form a straight line.

• Abduction & adduction: These movements are virtually absent with knee

straight, but slight degrees of abduction and adduction are possible when the

knee is semi-flexed.

106

Osteoarthritis

• 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. In some cases the crepitation can be

heard. Which is assed by giving grades as explained below.

Clinical feature:

Symptoms:

Joint Pain: It is often described as a deep ache and is localized to the involved joint.

Typically, the pain of osteoarthritis is aggravated by joint use and relieved by rest, but

as the disease progresses, it may become persistent.

Stiffness: Progressive stiffness of the involved joint upon arising in the morning or after

a period of inactivity may be prominent but usually lasts less than 20 minutes.

It is due to spasm of muscles. There is no relation between the severity of

degeneration and morning stiffness.

Signs:

Swelling: Physical examination of the osteoarthritis joint reveals localized soft tissue

swelling of mild degree. It is due to the changes in articular ends themselves,

particularly periarticular lipping.

Crepitus: The sensation of bone rubbing against bone evoked by joint movement is

called as crepitus. It is one of the characteristic sign of osteoarthritis joint.

107

Osteoarthritis

Local Warmth ness: On palpation of the joint, the local rise in temperature is indicative sign of

inflammation.

Muscle Atrophy: Periarticular muscle atrophy may be due to disuse or due to reflex inhibition

of muscle contraction.

Others:

In advanced stage there may be gross deformity, bony hypertrophy,

subluxation and marked loss of joint motion

Table No. 31: Showing Clinical features of Osteoarthritis:

Sl. No

Symptoms of O.A Signs of O.A

1. No Systemic manifestation Joints, enlarged synovium and capsule synovial fluid and bony cartilage

2. Pain on use, pain at rest in severe and advanced condition

Tenderness at local joints, crepitus, creaking, grating, cracking.

3. Localized stiffness 15-30 minutes in morning

Warmth without redness o joints.

4. Muscle spasm Joint effusion of normal or high viscosity fluid. 5. Limitation of motion in advancing

disease symptoms uncommon before age 40 except in secondary O.A Pain related to specific joints

Deformity of joints with preservation of function with exception of hip joint and first carpometacarpal joint. Sometimes episodic course e.g. primary generalized O.A

6. Joints most commonly involved: Distal interpalangeal joints Proximal interphalangeal joints First carpometatarsal joint Scaphotrapezoid joints Knees, Hips often unilateral Spine, Cervical, and Lumbar First metatarsophalangeal joint

Soft synovial proliferation without bony proliferation are: Genu varus and valgus Hallux valgus Herbedens and bouchar,s nodes and first carpometacarpal enlargement. Rare involvement: Elbows,Shoulder, Metacarpophalangeal, Lateralmetatarsophalangeal, proximal interphalangeal and joints of feet, ankle, Subtalar, Midtarsal, Thoracic spine

108

Osteoarthritis

Diagnosis of OA is made accurately by clinical history, physical examination

radiological study, and when etiology and pathogenesis are not clear, by certain

laboratory examinations. The symptoms and signs are usually confined to one or only

a few joints. If many joints are involved, the diagnosis is more likely a systemic form

of rheumatic disease.

Radiological characteristics of Osteoarthritis:

Normal radiographic findings occur in early OA. Joint space narrowing follows

degeneration and disappearance of hyaline cartilage. Early in the disease with effusion

and swelling of cartilage, there may be joint space widening. Subchondral bony

sclerosis or eburnation is very characteristic and represents deposition of excessive

new bone. Marginal osteophytes in a variety of patterns in various joints reflect bone,

cartilage and synovial cell proliferation. Sub location and gross deformities with loose

bodies in the joint appears late. Radiological criteria for diagnosis of osteoarthritis as

defined in the Atlas on standard radiographs are given below:

Radiological Classification:

GRADE: O Normal

GRADE: 1 Partial Osteophytes

GRADE: 2 Definite Osteophytes

GRADE: 3 Moderate multiple Osteophytes

GRADE: 4 Large Osteophytes

109

Osteoarthritis

Figure No. 13: Showing Radiological aspect of Osteoatrhritis:

Loss of joint space: Due to destruction of articular cartilage

Laboratory characteristics of Osteoarthritis:

There are no specific laboratory abnormalities in primary OA. The synovial

fluid is essentially normal, a few cells above normal counts, a slightly reduced

viscosity or string test, a normal mucin clot and total protein concentration.

An increased concentration of inorganic pyrophosphate (PPi) is found in OA

and is positively correlated with the severity of radiologic OA.

The application of thermography and scintillation scans of joints has little or

no clinical usefulness but has shown negligible evidence of inflammation in OA

compared to the inflammatory arthropathies.

Association of OA has also been noted with elevated Westergren

sedimentation rate, elevated C-reactive protein, serum uric acid and ASO titers.

In primary generalized OA, elevated serum cholesterol and transient rises in

other acute phase reactants occur, Specific laboratory studies may be needed for

diagnosis of secondary OA associated with specific primary disease.

110

Osteoarthritis

Table No. 32: Showing Differential Diagnosis of Osteoarthritis: Sl. Criteria O.A RA Gout R.F

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

Poly-articular

4 Systemic Features

- Autoimmune disease, rise in temperature, anemia etc.

- Carditis, fever, chorea

5 Pathological phenomenon

Degeneration Autoimmune and Vasculitis

Hyper uricaemia

Infection

6 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.

Abbrevation used: O.A: Osteoarthritis, R.A: Rhemautic arthritis, R.F: Rhemautic fever

The WOMAC (Western Ontario and McMaster Universities) Index of

Osteoarthritis:299

The WOMAC (Westren Ontario and McMaster Universities) index is used to

assess patients with osteoarthritis of the hip or knee using 24 parameters. It can be

used to monitor the course of the disease or to determine the effectiveness of anti-

rheumatic medications.

111

Osteoarthritis

Objectives:

The WOMAC™

Index is a disease-specific, tri-dimensional self-administered

questionnaire, for assessing health status and health outcomes in osteoarthritis of the

knee and/or hip.

Target population:

Patients with hip and/or knee osteoarthritis.

Method of use: The questionnaire contains 24 questions, targeting areas of pain, stiffness and

physical function, and can be completed in less than 5 minutes. Usually patient self-

administered, the Index is amenable to electronic data capture (EDC) formats using

mouse-driven curser, touch screen, and to interview administration by telephone.

Available in over 60 alternative language forms, there are several different forms of

the WOMAC™

Index suitable for different clinical practical and clinical research

applications. Available in 5-point adjectival, 100 mm visual analogue and 11-point

numerical rating scale format.

Pain:

(1) Walking

(2) Stair climbing

(3) Nocturnal

(4) Rest

(5) Weight bearing

112

Osteoarthritis

Stiffness:

(1) Morning stiffness

(2) Stiffness occurring later in the day

Physical function:

(1) Descending stairs

(2) Ascending stairs

(3) Rising from sitting

(4) Standing

(5) Bending to floor

(6) Walking on flat

(7) Getting in or out of car

(8) Going shopping

(9) Putting on socks

(10) Rising from bed

(11) Taking off socks

(12) Lying in bed

(13) Sitting

(14)In/outbath

(15) Getting on or off toilet

(16) Heavy domestic duties

(17) Light domestic duties

113

Osteoarthritis

While the index was being developed performance of social functions and the status

of emotional function were also included. These were not included in the final

instrument.

Social function:

(1) Leisure activities

(2) Community events

(3) Church attendance

(4) With spouse

(5) With family

(6) With friends

(7) With others

Emotional function:

(1) Anxiety

(2) Irritability

(3) Frustration

(4) Depression

(5) Relaxation

(6) Insomnia

(7) Boredom

(8) Loneliness

(9) Stress

(10) Well-being

114

Osteoarthritis

Scoring and Interpretation:

Table 33: Showing Scoring and Interpretation 0f WOMAC

SI No Response Points

01 None 0

02 Slight 1

03 Moderate 2

04 Severe 3

05 Extreme 4

Alternatively a visual analogue scale (VAS) may be used ranging from 0 to 10.

Score = SUM (points for relevant items)

Average score = (total score) / (number of items)

Interpretation:

• Minimum total score: 0

• Maximum total score: 96

• Minimum pain sub score: 0

• Maximum pain sub score: 20

• Minimum stiffness sub score: 0

• Maximum stiffness sub score: 8

• Minimum physical function sub score: 0

• Maximum physical function sub score: 68

115

Osteoarthritis

Management of Osteoarthritis:

Treatment of osteoarthritis is aimed to reducing pain, maintaining mobility,

and minimizing disability. The vigor of the therapeutic intervention should be dictated

by the severity of the condition in the individual patient.

Pharmacological Measures:

I. Drug therapy of osteoarthritis:

Therapy for osteoarthritis today is palliative, no pharmacological agent has

been shown to prevent, delay the progression of, or reverse the pathologic changes of

osteoarthritis in human. Although claims have been made that some NSAIDs have a

“chondroprotective effect”. Adequately controlled clinical trails in human with

osteoarthritis to support this view are lacking. In the management of osteoarthritic

pain, pharmacological agents should be used as adjuncts to non-pharmacological

measures, such as those described above, which are keystone of osteoarthritis.

NSAIDs often decrease joint pain and improve mobility in osteoarthritis - on an

average about 30% reduction in pain and 15% improvement in function.

Intra articular injection of hyaluronic acid is being used for treatment of patients with

knee osteoarthritis who have filed a program of non-pharmacological therapy and

simple analgesics.

Capsaicin cream reduces joint pain and tenderness when applied topically

patients with knee and hand osteoarthritis

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.

116

Osteoarthritis

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) NSAIDS:

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.

a) Intra articular cortico-steroid injections.

b) Intra articular administration of hyaluronic acid like products.

5) Agents used to treat Osteoarthritis:

Acetaminophen, NSAIDS (Salicylates, Propionic acids, Acetic acid,

Oxicams), Cyclo-oxgenase inhibitors, Irritants/Counter irritants, Hyaluronic acids and

Glucocorticoids.

II. Non-Pharmacological Measures:

Reduction of Joint Loading:

Osteoarthritis may be caused or aggravated by poor body mechanics. Correction of

poor posture and a support for excessive lumbar lordosis can be helpful. Excessive

loading of the involved joint should be avoided;

117

Osteoarthritis

Patients with osteoarthritis of the knee or hip should be avoided prolonged standing,

kneeling and squatting. Obese patients should be counseled to loose weight.

In patients with medial compartment knee osteoarthritis, a wedged in sole may

decrease the pain. Complete immobilization of painful joint is rarely indicated. In

patients with unilateral osteoarthritis of knee or hip, a cane, held in the contralateral

hand, may reduce joint pain by reducing the joint contact force. Bilateral disease may

necessitate use of crutches or walker.

Patient education:

Patients with hip or knee osteoarthritis can participate safely in conditioning

exercises to improve fitness and health with out increasing their joint pain or need for

an analgesics or NSAIDs

Exercise:

Regular physical activity plays a key role in self-care and wellness. Three

types of exercise are important in osteoarthritis management. The first type,

strengthening exercises, help keep or increase muscle strength. Strong muscles help

support and protect joints affected by arthritis. The second type, aerobic conditioning

exercises, improve cardiovascular fitness, help control weight, and improve overall

function. The third type, range-of-motion exercises, helps reduce stiffness and

maintain or increase proper joint movement and flexibility.

118

Osteoarthritis

Figure No.14: Showing Exercise for Osteoarthritis:

119

Osteoarthritis

Figure No. 15: Showing Exercise for Knee Osteoarthritis:

Straight Leg Raises: Supine, Abduction, Adduction

Knee Flexion

Knee Extension

Hip Flexion

Calf Raises

Squats

Front Step-Ups

Side Step-Ups

Standing Terminal Knee Extensions

Heel Slides

120

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.

Surgery:

Surgical procedures are of value in the management of OA. They may be

grouped under 3 major categories.

1) 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.

2) 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.

3) 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

sacrificed.

121

Materials

Materials:

The materials used for the study were

1. Kethakyadi Taila (Sahasrayoga)

2. Murchita Tila Taila

Kethakyadi Taila is used for Matravasti and Murchita Tila Taila is used for

Abhyanga as Purvakarma measure before administration of Matravasti

Drug review:

The ingredients of Kethakyadi Taila (Sahasrayoga)300:

Kethaki Mula

Bala

Atibala

Thushodaka

Murchita Tila Taila

The preparation was done in accordance with the Taila paka vidhi, dully added

with the Moorchita taila. The properties of drugs are mentioned below.

Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in Sandhigata vata

122

Materials

Table 34: Showing Guna-Karma of Ingredient of Kethakyadi Taila:

SI No

Drug Latin name Family Synonyms Rasa Guna Veerya Vipaka Doshakarma Karma Composition Parts Used

01 Kethaki3

01

Pandanus

odoratissimus,

wild (linn)

Pandanaceae Kethaka,

Suchipushpa,

Krakachchada,

Trunashunya

Tikta,

madhura,

Katu

Laghu,

Snigda

Ushna Katu Tridosha

shamaka

Vedana

Sthapana,

Balya

Flower contains a volatile oil

Pushpa,

Mula

02 Bala302

Sida cordifolia

Linn.

Malvaceae Bala,

Vaatyaalika,

Kharayashtika

Madhura Laghu,

Snigda,

Picchila

Sheeta Madhura Vata PittaShamaka

Vatahara,

Balya,

Vedana

Sthapana,

Shotahara

0.085%-Alkaloids, Main Alkaloid-Eqhedrine Also contains- Steroids, Phytosterol, resin, mucins, and potassium nitrate.

Mula,

Beeja

03 Atibala303

Abutilon

indicum Linn.

Malvaceae Atibala,

Kankatikaa

Madhura Laghu,

Snigda,

Picchila

Sheeta Madhura Vata Pitta

Shamaka

Vatahara,

Balya,

Vedana

Sthapana,

Shotahara

Leaves contain Mucilage, Tanin, Carbolic acid, traces of Asparagin and Ashes. Roots also contains Asparagin

Mula,

Beeja

Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in Sandhigata vata 123

Materials

The base of Kethakyadi tala is Tila Taila. The properties of Tila304 are,

Table 35: Showing Guna-Karma of Tila:

S.No Tila

01 Latin name Sesamum indicum Linn.

02 Family Sesamum

03 Sanskrit Tila

04 Rasa Madhura

05 Anurasa Kashaya-Tikta

06 Guna Guru, Snigda

07 Veerya Ushna

08 Vipaka Madhura

09 Doshakarma Tridosha Shamaka

10 Composition

(Beeja)

Moisture – 4.1-6.5%

Oil – 43-56.8%

Protein – 16.6-26.4%

Fibers – 2.9-8.6%

Carbohydrate – 9.1-25.2%

Minerals – 4.1-7.4%

Calcium – 1.06-1.45%

Phosphorus – 0.47-0.62%

11 Parts used Beeja, Taila

Tila Taila Murchana:

A total 35 liter of Moorchita tila taila was prepared in the department of

Rasashastra and Bhaishajya kalpana, D.G.M.A.M.C. and H. Gadag. And taila paka

was done according to Sharngdhara Samhita305.

Importance of murchana:


124

Materials

Tila taila Murchana procedure306:

For the taila Murchana 1/16th part of Manjistha, 1/64th part of Haritaki

,Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera,

Nalika,Ketakipushpa,1 part of Tila taila, and 4 parts of jala was taken and done paka

in mandagni till Taila paka siddhi lakshana.

By murchana, Amadosha, durgandhata and ugrata of crude oil is removed; it

imparts good smell and colour. Apart from these Sneha will get the qualities of the

drugs used for Murchana and also the veerya of the Sneha is enhanced.

Kethakyadi Taila Preparation:

The ingredient of Kethakyadi Taila- Kethaki mula, Balamula and Atibala mula

was collected in local area and cleaned properly. The Astavashesha kashaya is

prepared from these drugs. The kalka of same drugs are prepared. Then Taila paka is

done by using drugs in following proportions,

Murchita tila taila – 1 part (30 liters)

Kashaya – 2 parts (60 liters)

Tushodaka – 2 parts (60 liters)

Kalka – ¼ part (7.5 kg)

Materials or tools for therapeutic intervention:

To administer Matra vasti: Vasti Syringe, Artery Forceps, Gloves, Cotton

Swab, Bowl, Nadisweda yantra, Oil for Abhyanga was used.


125

Materials


126

Observations and Results

METHODOLOGY:

CLINICAL STUDY:

It is said that, Research is the only way available to re-establish old facts

through modern methodology307. Research means searching of knowledge which is

forgotten or which is hidden in us under the cover of ignorance.

Research is a scientific study through which one can establish new facts,

discarding the old facts or modifying the present facts. Utmost care is taken in

designing the methodology for conducting this study. Clinical research involves the

experimentation of a drug/therapy on a selected population and recording the

feedback based on which postulations are made regarding the usefulness of the

drug/therapy in the disease.

Research Approach:

In the present study, the main objective is to “Evaluate the effect of Matravasti

in Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana karma”.

The efficacy was determined by finding out the difference between the base line data

of the parameters to the after follow-up data.

Study Design:

The study design set for the present study is ‘comparative clinical study’. The

study was done in two groups. In this Arohana krama matravasti group of patients are

compared with Sadharana krama matravsti group of patients. Demographic data and

disease-specific data are collected according to the case-record form given in the

appendix.

Reasons for selection of the study design:

The aim of this study was to find out the effect of Matravasti in

Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana karma, to


127


compare their efficacy. Therefore, two groups were made and the results obtained in

both the individual groups were compared.

Source of Data:

Patient suffering from Sandhigatavata were selected from O.P.D and I.P.D. of

D.G.M.A.M.C & H., Gadag, duly following the Inclusion and Exclusion criteria.

Sample size and Grouping:

The sample size for the present study was 30 patients suffering from

Sandhigathavata as per the selection criteria. Patients were randomly distributed to

both the groups of equal size.

Group A - 15 patients received Arohana krama Matravasti

Group B - 15 patients received Sadharana krama Matravasti.

Selection Criteria:

The cases were selected strictly as per the pre-set inclusion and exclusion criteria.

Inclusion criteria:

1. Patients suffering from classical signs and symptoms of

Sandhigatavata like shotha in sandhi, shoola in sandhi, atopa in sandhi.

2. Patient fit for Vasti karma (Vasti yogya)

3. Patient between age group of 30 to 70 yrs.

4. No discrimination of sex and chronicity.

Exclusion criteria:

1. Patient below 30 yrs and above 70 yrs of age will be excluded.

2. Pregnant women.

3. Associated with any other severe systemic diseases like Diabetes,

Hypertensions and Obesity etc.


128


Study duration:

Group A (Arohana group): Arohana krama Matravasti – 09 days

Follow up – 30 days

Total study duration – 39 days

Group B (Sadharana group): Sadharana karma Matravasti - 09 days

Follow up - 30 days

Total study duration - 39 days

Posology:

Arohana Krama Matra vasti: Here Matra vasti is administered for nine days in

increasing order of the dose of Taila. First day started with 48ml (1pala). Daily 12ml

(1/4th pala) was increased till 9th day i.e. 144 ml.

Sadharana Krama Matra vasti: Here Matra vasti is administered in fixed dose of 72ml

(1½ pala) for nine days.

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, ashtavidha pareeksha and dashavidhapareeksha and

physical examination findings were noted. Routine investigations were done to

exclude other pathologies. Radiological features were also investigated.

Examination Of Kneejoint :

History:

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

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

limp.


129


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

• The limits of the swelling were clearly made out.

• The gradings were allotted on the basis of criteria explained in the end of this

section.

• Any deformities like genus valgum, varum etc. were examined.

• Joint instability or buckling of the joint was examined.

• Any abnormalities in the gait were examined.

• Walking time was recorded (the time taken to cover 21 meters).

• Any presence of muscular spasm was examined.

• 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

• 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.

• 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


130


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.

• 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 & Extension: Normally, the knee can be flexed until the calf extended till the

thigh and leg form a straight line.

Abduction & 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.


131


Auscultation:

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

patella and crepitus was felt.

Treatment schedule

In both group of patients, the matravasti is administered. The difference

between the groups is, in the dose of the medicine only. The procedure of

administration in general is devided into three stages in both group and is identical.

Poorvakarma:

The patients were instructed to come after taking light diet (neither ati Snigdha

nor ati Ruksha) and after elimination of stool and urine. The patients were also

advised not to take diet more than 3/4th of routine quantity. The patients were

subjected to sthanika Mridu Abhyanga and Swedana prior to the administration of

Matravasti.

Abhyanga: The Sthanika Abhyanga over abdomen, buttock for 10 minutes was done

by sukoshna Murchita taila.

Swedana: After Snehana, the patients were subjected for Sthanika Mrudu Sweda with

Nadi Sweda by using leaves of Eranda, Chincha, Nirgundi and Shigru. Swedana was

done on abdomen, buttocks for 10 minutes.

Pradhanakarma:

• After this Purvakarma the patient was advised to lie down on left lateral

position without pillow on the Vasti table with left lower extremity straight

and right lower extremity flexed at knee and hip joint. The patient was

asked to keep his left hand below the head.

• Anal region is anointed with small quantity of Kethakyadi taila taila.


132


• Exact quantity of Kethakyadi taila (72ml in Sadharana krama group

patients and 48-144ml in Arohana krama group patients) was taken in

enema syringe.

• The nozzle of Vasti syringe was oleated with Kethakyadi taila.

• After removing the air from enema syringe, nozle was inserted into the

anus of the patient up to the length of 4 inches.

• The patient was asked to take deep breath and not to shake his body while

introducing the catheter and the drug. The entry of Vayu inside the guda

was avoided by leaving little amount of Taila in Vasti syringe.

Pashchatkarma

After the administration of Vasti, the patient was advised to lie in supine

position with hand and legs freely spread over the table. There after both legs were

raised and slightly flexed in knee joint few times and gently tapped over the hips.

After 10 minutes patient was advised to get up from the table and take rest in his bed

and also not to sleep. Vasti Pratyagamana Kala was noted in each case.

The patient was asked to follow a pariharakala of 18days and was asked to

report on 27th day counting from the day the treatment schedule started. On the 27th

day the final assessment readings were taken for the Statistical study.

Methods of Assessment of Clinical Response:

Subjective parameters and objective parameters were made out to assess the

Clinical response.

Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana)

and Sthamba (Morning stiffness)

Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya,

Walking time to cover 21meters of distance, WOMAC


133


Prasarana Aakunchanayoho savedana pravruthihi (Vedana):

Grade 0 - No complaint

Grade 1 - Reveals on enquiry (mild)

Grade 2 - Complaints frequently when moves joints (moderate)

Grade 3 - continues pain (Sevier)

Atopa:

Grade 0 - None

Grade 1 - felt on clinical examination of joint.

Grade 2 - Heard on clinical examination of joint

Sandhishothaha:

Grade 0 - No complaint.

Grade 1 - Slightly obvious.

Grade 2 - Covers well over the bony prominence.

Grade 3 - Much elevated

Sthamba (Morning stiffness):

Grade 0 - Absent

Grade 1 - Present

Sandigati Asamarthya:

Grade 0 - Full range of Movement.

Grade 1 - >75% and <full range.

Grade 2 - 50-75% of the full range of joint motion.

Grade 3 - Up to 50% of the full range of joint motion.

Grade 4 - No movement.


134


Walking time to cover 21meters of distance308:

Grade 0 - up to 20sec.

Grade 1 - 21-30 sec.




WOMAC: (Western Ontario and McMaster Universities) Index of Osteoarthritis:

The questionnaire contains 24 questions, targeting areas of pain, stiffness and physical

function

None - 0

Slight - 1

Moderate - 2

Severe - 3

Extreme - 4

Interpretation:

• Minimum total score: 0

• Maximum total score: 96

Overall Assessment Of Clinical Response:

• Good Response : >75 % improvement in overall clinical parameters.

• Moderate Response : 50-75% improvement in overall clinical parameters.

• Poor Response : Up to 50% improvement in overall clinical parameters.

• No Response : 0 % or No improvement in overall clinical parameters.


135



136


Observation:

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. Both the subjective and objective changes

were recorded.

The observations were done in the following heading and are depicted in form

and graphs are used where ever necessary;

1. Observation of demographic data.

2. Observation of the patient.

3. Observation of the disease.

4. Observation of the data related to the response of the patient.

5. Observation of the statistical out comes of the study.


137


Observation of demographic data:

Table No. 36: Showing the distribution of patient’s age group:

No of patients and percentage Group A Group B Total

Age group

No. of patients % No. of patients % No. of patients % 31-40 00 00.00 01 6.66 01 03.3341-50 02 13.33 02 13.33 04 13.3351-60 07 46.66 05 33.33 12 40.00

61-70 06 40.00 07 46.66 13 43.33

Group A: Out of fifteen patients 02 (13.33%) were belonging to 41-50 age group, 07

(46.66%) was from 51-60 age group, 06 (40%) were 61-70 aged.

Group B: Out of fifteen patients 01 (06.66%) fell under 31-40 age group, 02 (13.33%)

were from 41-50 age group, 07(46.66%) were from 51-60 age group and 07 (46.66%)

were from 61-70 age group.

Overall: Out of thirty patients 01 (03.33%) were from 31-40 group, 04 (13.33%) from

41-50 age group, 12 (40.00%) from 51-60 group and 13 (43.33%) were from 61-70

group.

Figure No. 19: Showing the distribution of patient’s age group:

0

2

76

12

5

7

1

4

1213

0

2

4

6

8

10

12

14

Gro up A Gro up B T o tal

31-4041-5051-6061-70


138


Table No. 37: Showing the distribution of patients according to sex: Sex Group A no. and % Group B no. and % Group A and B no. and % Male 07 (46.66%) 07 (46.66%) 14 (46.66%) Female 08 (53.33%) 08 (53.33%) 16 (53.33%)

Group A: Among 15 numbers of patients 07(46.66%) were males and 08 (53.33%)

were females.

Group B: Among 15 numbers of patients 07 (46.66%) were males and 08 (53.33%)

were females.

Overall: Distribution of sex was; male were14 (46.66%) and females were 16 (53.33%) in 30 patients.

Figure No. 20: Showing the distribution of patient’s sex group:

78

78

14

16

0

2

4

6

8

10

12

14

16

Group A Group B Total

MaleFemale


139


Table No. 38: Showing distribution of patients by Religion: Religion

Group A no. and % Group B no. and % Group A and B no. and %

Hindu 11 (73.33%) 12 (80%) 23 (76.66%) Muslim 04 (26.66%) 03 (20%) 07 (23.33%) Christian 00 (00%) 00 (00%) 00 (00%) Others 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients 11 (73.33%) were Hindus, 04 (26.66%) were

Muslims and none were Christians and others

Group B: Out of fifteen patients 12 (80%) were Hindus, 03 (20%) were Muslims.

Overall: Among thirty number of patients, Hindus were 23 (76.66%), 07 (23.33%)

were Muslims and none were from Christian and other category.

Figure No.21: Showing distribution of patients by religion:

11

4

0 0

12

3

0 0

23

7

0 00

5

10

15

20

25


Hindu Muslim Christian Others


140


Table No. 39: Showing distribution of patients by Economical status: Economical status Group A no. and % Group B no. and % Group A and B

no. and % Poor 01 (06.66%) 03 (20.00%) 04 (13.33%) Lower Middle class 10 (66.66%) 06 (40.00%) 16 (53.33%) Upper Middle class 04 (26.66%) 06 (40.00%) 10 (33.33%) Rich 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients 01 (06.66%) were belonging to poor status, 10

(66.66%) were of lower middle class, 4 (26.66%) were of upper middle class and

none were rich.

Group B: Out of fifteen patients 03 (20.00%) were belonging to poor status, 06

(40.00%) were of lower middle class, 06 (40.00%) were of upper middle class and

none were from rich status

Overall: Out of thirty patients 04 (13.33%) were poor, 16 (53.33%) were of lower

middle class, 10 (33.33%) were of upper middle class and none were from rich status

Figure No.22: Showing distribution of patients by Economical status:

1

10

4

0

3

66

0

4

16

10

00

2

46

8

16

1412


Poor L.Middle ClassU.Middle ClassRich

10


141


Table No. 40: Showing distribution of patients by Occupation: Occupation


Labor 03 (20.00%) 05(33.33%) 08 (26.66%) Student 00 (00%) 00(00%) 00 (00%) Executive 01 (06.66%) 01 (06.66%) 02 (06.66%) Sedentary 11 (73.33%) 09 (60.00%) 20 (66.66%)

Group A: Out of fifteen patients 3 (20.00%) were labors, none (00%) were students, 1

(6.6%) was executive and 11(73.33%) were sedentary by occupation.

Group B: Out of fifteen patients 05 (33.3%) were labors, none (00%) were students, 1

(6.6%) was executive and 09 (60.00%) was of sedentary by occupation.

Overall: Out of thirty patients 08 (26.66%) were labors, (00%) were students, 02

(6.66%) was executive and 20 (66.66%) were belonging to sedentary category.

Figure No. 23: Showing distribution of patients by occupation:

3

0 1

11

5

0 1

98

02

20

0

2

4

6

8

10

12

14

16

18

20


LaborStudentExecutive Sedentary


142


Table No. 41: Showing distribution of patients by Type of diet: Vegetarian Mixed Group A 05 (33.33%) 10 (66.66%) Group B 05 (33.33%) 10 (66.66%) Overall 10 (33.33%) 20(66.66%)

Group A: Out of fifteen, 05 (33.33%) were vegetarians and 10 (66.66%) were mixed

diet

Group B: Out of fifteen, 05 (33.33%) were vegetarians and 10 (66.66%) were mixed

diet

Overall: Out of thirty patients, 10 (33.33%) were vegetarians and 20 (66.66%) were of

mixed diet

Figure No. 24: Showing distribution of patients by type of diet:

5

10

5

10 10

20

0

6

10

12

14

16

18

20


VegetarianMixed8

4

2


143


Table No. 42: Showing distribution of patients by Marital Status: Un Married Married Group A 00 (00%) 15 (100%) Group B 00 (00%) 15 (100%) Overall 00 (00%) 30 (100%)

Group A: Out of fifteen, all were married.

Group B: Out of fifteen, all were married and none were unmarried

Overall: Out of thirty patients, all were married.

Figure No.25: Showing distribution of patients by Marital Status:

0

15

0

15

0

30

0

5

10

15

20

25

30


UnMarriedMarried


144


Observation of the patient: Table No. 43: Showing distribution of patients by Mode of Onset: Mode of Onset


Chronic 12 (80.00%) 11(73.33%) 23 (76.66%) Insidious 00 (00%) 00(00%) 00 (00%) Acute 02 (13.33%) 02 (13.33%) 04 (13.33%) Traumatic 01 (06.66%) 02 (13.33%) 03 (10.00%)

Group A: Out of fifteen patients 12 (80.00%) were had Chronic onset, none (00%)

were had Insidious onset, 02 (13.33%) were had Acute onset and 01(6.66%) were had

Traumatic onset.

Group B: Out of fifteen patients 11 (73.33%) were had Chronic onset, none (00%)

were had Insidious onset, 02 (13.33%) were had Acute onset and 02(13.33%) were

had Traumatic onset.

Overall: Out of thirty patients 23 (76.66%) were had Chronic onset, none (00%) were

had Insidious onset, 04 (13.33%) were had Acute onset and 03(10.00%) were had

Traumatic onset.

Figure No. 26: Showing distribution of patients by Mode of Onset:

12

02

1

11

0 2 2

23

0

43

0

5

10

15

20

25


ChronicInsidiousAcuteTraumatic


145


Table No. 44: Showing distribution of patients by Vihara (Nature of work): Vihara


Hard 08 (53.33%) 08(53.33%) 16 (53.33%) Moderate 07 (46.66%) 06(40.00%) 13 (43.33%) Sedentary 00 (00%) 01 (6.66%) 01(3.33%)

Group A: Out of fifteen patients 8 (53.33%) were hard workers, 7 (46.66%) were

moderate, none were Sedentary.

Group B: Out of fifteen patients 8 (53.33%) were hard workers, 6 (40.00%) were

moderate and 0ne (3.33%) sedentary.

Overall: Out of thirty patients 16 (53.33%) were hard workers, 13 (43.33%) were

moderate and one (3.33%) sedentary worker.

Figure No. 27: Showing distribution of patients by Vihara (Nature of work):

87

0

8

6

1

16

13

10

2

4

6

8

10

12

14

16


HardModerateSedentary


146


Table No. 45: Showing distribution of patients by Agni: Agni


Samagni 10(66.66%) 09(60.00%) 19 (63.33%) Mandagni 05(33.33%) 06(40.00%) 11 (36.66%) Teekshnagni 00 (00%) 00 (00%) 00 (00%) Vishamagni 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients, 10(66.66%) were had Samagni, 05(33.33%) were

had Mandagni, none had Teekshna and Vishamagni.

Group B: Out of fifteen patients, 09(60.00%) were had Samagni, 06(40.00%) were

had Mandagni, none had Teekshna and Vishamagni.

Overall: Out of thirty patients, 19 (63.33%) were had Samagni, 11 (36.66%) were had

Mandagni, none had Teekshna and Vishamagni.

Figure No. 28: Showing distribution of patients by Agni:

10

5

0 0

9

6

0 0

19

6

0 00

2

4

6

8

10

12

14

16

18

20


SamagniMandagniTeekshnagniVishamagni


147


Table No.46: Showing distribution of patients by Kosta: Kosta


Mrudu 00(00%) 00(00%) 00(00%) Madyama 14(93.33%) 10(66.66%) 24 (80.00%) Krura 01 (6.66%) 05(33.33%) 06(20%)

Group A: Out of fifteen patients none were had Mrudu kosta, 14(93.33%) were had

Madyama kosta and one (6.66%) had Krura kosta.

Group B: Out of fifteen patients none were had Mrudu kosta, 10(66.66%) were had

Madyama kosta and 05(33.33%) had Krura kosta.

Overall: Out of thirty patients none were had Mrudu kosta, 24 (80.00%) were had

Madyama kosta and 06(20%) had Krura kosta.

Figure No. 29: Showing distribution of patients by Kosta:

0

14

10

10

5

0

24

6

0

5

10

15

20

25


MruduMadyamaKrura


148


Table 47: Showing distribution of patients by Nidra: Nidra


Prakruta 05 (33.33%) 06 (40.00%) 11 (36.66%) Alpa 10 (66.66%) 09 (60.00%) 19 (63.33%) Ati 00 (00%) 00 (00%) 00 (00%) Divaswapna 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients 05 (33.33%) were had Prakruta nidra, 10 (66.66%)

were complained that, they had Alpa nidra, none were had Ati nidra and habit of

Diwaswapna.

Group B: Out of fifteen patients 06 (40.00%) were had Prakruta nidra, 09 (60.00%)

were complained that, they had Alpa nidra, none were had Ati nidra and habit of

Diwaswapna.

Overall: Out of thirty patients 11 (36.66%) were had Prakruta nidra, 19 (63.33%)

were complained Alpa nidrata, none were had Ati nidra and habit of Diwaswapna.

Figure No. 30: Showing distribution of patients by Nidra:

5

10

0 0

6

9

0 0

11

19

0 00

2

4

6

8

10

12

14

16

18

20


PrakrutaAlpaAtiDivaswapna


149


Table No. 48: Showing distribution of patients by Vyasana:

Nidra


None 11 (73.33%) 08 (53.33%) 19(63.33%) Tobacco 02 (13.33%) 03 (20.00%) 05 (16.66%) Smoking 02 (13.33%) 02 (13.33%) 04 (13.33%) Alcohal 00 (00%) 02 (13.33%) 02 (6.66%) Tea/Coffee 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients, 11 (73.33%) were not had any Vyasana, 02

(13.33%) were had the habit of Tobacco chewing, 02 (13.33%) were had the habit of

Smoking, none were had habit of Alcohal intake and excess intake of Coffee/Tea.

Group B: Out of fifteen patients, 08 (53.33%) were not had any Vyasana, 03 (20.00%)

were had the habit of Tobacco chewing, 02 (13.33%) were had the habit of Smoking,

02 (13.33%) were had habit of Alcohal intake and no one had habit of excess intake

of Coffee/Tea.

Overall: Out of thirty patients, 19(63.33%) were not had any Vyasana, 05 (16.66%)

were had the habit of Tobacco chewing, 04 (13.33%) were had the habit of Smoking,

02 (6.66%) were had habit of Alcohal intake and no one had habit of excess intake of

Coffee/Tea.

Figure No. 31: Showing distribution of patients by Vyasana:

Table No.49: Showing distribution of patients by Deha Prakruti:

11

22

0 0

8

3

2 2

0

19

5

4

2

00

2

4

6

8

10

12

14

16

18

20


NoneTobaccoSmokingAlcohalTea/Coffee


150


Prakruti


Vataja 00 (00%) 00 (00%) 00 (00%) Pittaja 00 (00%) 00 (00%) 00 (00%) Kaphaja 00 (00%) 00 (00%) 00 (00%) Vata Pittaja 05 (33.33%) 06 (40.00%) 11 (36.66%) Vata Kaphaja 10 (66.66%) 09 (60.00%) 19(63.33%) Pittakaphaja 00 (00%) 00 (00%) 00 (00%) Sama 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients, 05 (33.33%) patients of Vata–pittaja prakriti and 10

(66.66%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,

Kapha, Pitta–kaphaja, Sannipathaja (Sama) prakriti in this study.

Group B: Out of fifteen patients, 06 (40.00%) patients of Vata–pittaja prakriti and 09

(60.00%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,


Overall: Out of therty patients, total 11 (36.66%) patients of Vata–pittaja prakriti and

19(63.33%) patients of Vata–kaphaja prakriti. No patients reported with Vata, Pitta ,


Figure No. 32: Showing distribution of patients by Deha Prakruti:

0 0 0

5

10

0 0 0 0 0

6

9

0 0 0 0 0

11

19

0 00

2

4

6

8

20

12

18


VatajaPittajaKaphajaVata-PittajaVata-KaphajaPittakaphajaSama

16

14

10


151


Table No.50: Showing distribution of patients by Samhanana: Samhanana


Susamhita 07 (46.66%) 05 (33.33%) 12 (40.00%) Madyama Samhita 08 (53.33%) 10 (66.66%) 18 (60.00%) Hina Samhita 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients 07 (46.66%) were had Susamhita shareera, 08

(53.33%) were had Madyama samhita shareera and none were had Hina samhita

shareera.

Group B: Out of fifteen patients 05 (33.33%) were had Susamhita shareera, 10

(66.66%) were had Madyama samhita shareera and none were had Hina samhita

shareera.

Overall: Out of thirty patients 12 (40.00%) were had Susamhita shareera, 18 (60.00%)

were had Madyama samhita shareera and none were had Hina samhita shareera.

Figure No. 33: Showing distribution of patients by Samhanana:

78

0

5

10

0

16

13

00

2

4

6

8

10

12

14

16

18


SusamhitaMadyama Samhita Hina samhita

Table No.51: Showing distribution of patients by Satmya: Satmya Group A no. and % Group B no. and % Group A and B no.


152


and % Ruksha 14 (93.33%) 15 (100%) 29 (96.66%) Snigda 01 (06.66%) 00 (00%) 01 (06.66%)

Group A: Out of fifteen patients, 14 (93.33%) were had Ruksha satmya, only one

(06.66%) had Snigda satmya.

Group B: Out of fifteen patients, all (100%) were had Ruksha satmya.

Overall: Out of fifteen patients, 29 (96.66%) were had Ruksha satmya, only one

(06.66%) had Snigda satmya.

Figure No.34: Showing distribution of patients by Satmya:

14

1

15

0

29

1

0

5

10

15

20

25

30


Ruksha SatmyaSnigda Satmya


153


Table No. 52: Showing distribution of patients by Vyayama Shakti: Vyayama Shakti


Pravara 00 (00%) 00 (00%) 00 (00%) Madyama 01 (06.66%) 01 (06.66%) 02 (06.66%) Avara 14 (93.33%) 14 (93.33%) 28 (93.33%)

Group A: Out of fifteen patients, none (00%) had Pravara Vyayama Shakti, only one

(06.66%) had Madyama Vyayama Shakti and 14 (93.33%) were had Avara Vyayama

Shakti.

Group B: Out of fifteen patients, none (00%) had Pravara Vyayama Shakti, only one


Shakti.

Overall: Out of thirty patients, none (00%) had Pravara Vyayama Shakti, only two


Shakti.

Figure No. 35: Showing distribution of patients by Vyayama Shakti:

0

1

14

01

14

02

28

0

5

10

15

20

25

30


Pravara Vyayama ShaktiMadyama Vyayama ShaktiAvara Vyayama Shakti


154


Table No. 53: Showing distribution of patients by Vaya:

Vaya


Balya 00 (00%) 00 (00%) 00 (00%) Madyama 08 (53.33%) 09 (60.00%) 17 (56.66%) Vrudda 07 (46.66%) 06(40.00%) 13 (43.33%)

Group A: Out of fifteen patients, none (00%) were of Balya Vaya, 08 (53.33%) were

had Madyama Vaya and 07 (46.66%) were Vrudda.

Group B: Out of fifteen patients, none (00%) were of Balya Vaya, 09 (60.00%) were

had Madyama Vaya and 06(40.00%) were Vrudda.

Overall: Out of thirty patients, none (00%) were of Balya Vaya, 17 (56.66%) were

had Madyama Vaya and 13 (43.33%) were Vrudda.

Figure No.36: Showing distribution of patients by Vaya:

0

8

7

0

9

6

0

17

13

0

2

4

6

8

10

12

14

16

18


BalyaMadyamaVrudda


155


Data Related to Disease: Table No.54: Showing distribution of patients by Joint Involvements:

Joint


Right 05 (33.33%) 09 (60.00%) 14 (46.66%) Left 10 (66.66%) 06 (40.00%) 16 (53.33%)

Group A: In the study, among the15 patients of knee involvement, 05 (33.33%)

patients had Right Knee involvement and 10 (66.66%) patients had left Knee

involvement.

Group B: Out of fifteen patients of knee involvement, 09 (60.00%) patients had Right

Knee involvement and 06 (40.00%) patients had left Knee involvement.

Overall: Out of thirty patients of knee involvement, 14 (46.66%) patients had Right

Knee involvement and 16 (53.33%) patients had left Knee involvement.

Figure No. 37: Showing distribution of patients by Joint Involvements:

5

109

6

14

16

0

2

4

6

8

10

12

14

16


RightLeft


156


Table No. 55: Showing the distribution of patients by duration of the disease:

Duration Group A no. and % Group B no. and % Group A and B no. and %

<1year 04 (26.66%) 04 (26.66%) 08 (26.66%) 1-2years 04 (26.66%) 02 (13.33%) 06 (20.00%) 2-3year 03 (20.00%) 04 (26.66%) 07 (23.33%) 3-4year 01 (06.66%) 02 (13.33%) 03 (10.00%) 4-5years 03 (20.00%) 02 (13.33%) 05 (16.66%) >5years 00 (00%) 01 (06.66%) 01 (03.33%)

Group A: Out of fifteen patients, 04 (26.66%) were had the chronicity less then 1

years. 04 (26.66%) were had the chronicity in between 1-2 years, 03 (20.00%)

patients were had chronicity in between 2-3 years. Only one (06.66%) in between 3-4

years and 03 (20.00%) were had chronicity in between 4-5 years but none were had

chronicity more than 5 years.

Group B: Out of fifteen patients, 04 (26.66%) were had the chronicity less then 1

years. 02 (13.33%) were had the chronicity in between 1-2 years, 04 (26.66%)

patients were had chronicity in between 2-3 years. 02 (13.33%) patients were in

between 3-4 years and 4-5 years. Only one (06.66%) had chronicity more than 5

years.

Overall: Out of thity patients, 08 (26.66%) were had the chronicity less then 1 years.

06 (20.00%) were had the chronicity in between 1-2 years, 07 (23.33%) patients were

had chronicity in between 2-3 years. 03 (10.00%) were in between 3-4 years and 05

(16.66%) were had chronicity in between 4-5 years. Only one (06.66%) had

chronicity more than 5 years.


157


Figure No. 38: Showing distribution of patients by duration of the disease:

4 4

3

1

3

0

4

2

4

2 2

1

8

6

7

3

5

1

0

1

2

3

4

5

6

7

8


<1 Year1-2 Years2-3 Years3-4 Years4-5 Years>5 Years

Data Related to clinical features before treatment and after follow-up: A. Prasarana Akunchanayoho savedana pravruthihi:

Table No. 56: Showing the distribution of patients by different grades of Vedana

before Treatment:

Vedana


Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 00 (00%) 00 (00%) 00 (00%) Grade 2 13 (86.66%) 12(80.00%) 25 (83.33%) Grade 3 02 (13.33%) 03 (20.00%) 05 (16.66%)

Group A: Out of fifteen patients, 02 (13.33%) were complained continues pain

(Sever), 13 (86.66%) were complained pain frequently when moves the joint and none

were had mild pain which reveals on enquiry and without pain before the treatment.

Group B: Out of fifteen patients, 03 (20.00%) were complained continues pain

(Sever), 12(80.00%) were complained pain frequently when moves the joint and none

were had mild pain which reveals on enquiry and without pain before the treatment.


158


Overall: Out of thirty patients, 05 (16.66%) were complained continues pain (Sever),

25 (83.33%) were complained pain frequently when moves the joint and none were

had mild pain which reveals on enquiry and without pain before the treatment.

Figure No. 39: Showing distribution of patients by different grades of Vedana before Treatment:

0 0

13

20 0

12

3

0 0

25

5

0

5

20

15

10

25


Grade 0Grade 1Grade 2Grade 3

Table No. 57: Showing the distribution of patients by different grades of Vedana after

Follow-up:

Vedana


Grade 0 02 (13.33%) 02 (13.33%) 04 (13.33%) Grade 1 12(80.00%) 10 (66.66%) 22 (73.33%) Grade 2 01 (06.66%) 03(20.00%) 04 (13.33%) Grade 3 00 (00%) 00 (00%) 00 (00%)

Group A: After the follow up period of treatment, Out of fifteen patients, none (00%)

were complained continues pain (Sever, Grade 3), 01 (06.66%) was complained pain

frequently when moves the joint (Grade 2), 12 (80.00%) were complained mild pain

(Grade 1) and 2 (13.33%) patients were reported with no pain (Grade 0).


159


Group B: In this group, Out of fifteen patients, none (00%) were complained

continues pain (Sever, Grade 3), 03(20.00%) were complained pain frequently when

moves the joint (Grade 2), 10 (66.66%) were complained mild pain (Grade 1) and 2

(13.33%) patients were reported with no pain (Grade 0).

Overall: Out of thirty patients, none (00%) were complained continues pain (Sever,

Grade 3), 04 (13.33%) were complained pain frequently when moves the joint (Grade

2), 22 (73.33%) were complained mild pain (Grade 1) and 4 (13.33%) patients were

reported with no pain (Grade 0).

Figure No. 40: Showing distribution of patients by different grades of Vedana after follow up:

2

12

10

2

10

3

0

4

22

4

00

5

10

15

20

25




160


B. Sandhi Atopa

Table No. 58: Showing the distribution of patients by different grades of Sandhi Atopa before Treatment: Sandhi Atopa Group A no. and % Group B no. and % Group A and B no.

and % Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 09 (60.00%) 08 (53.33%) 17 (56.66%) Grade 2 06 (40.00%) 07(46.66%) 13 (43.33%)

Group A: Out of fifteen patients, on clinical examination, Sandhi Atopa (Crepitation)

was heard in 06 (40.00%) number of Patients (Grade 2); In 09 (60.00%) patient’s

crepitation is only felt (Grade 1).

Group B: Out of fifteen patients, on clinical examination, Sandhi Atopa (Crepitation)

was heard in 08 (53.33%) number of Patients (Grade 2), In 07(46.66%) patients

crepitation is only felt (Grade 1).

Overall: Before the treatment, out of thirty patients on clinical examination, Sandhi

Atopa (Crepitation) was heard in 13 (43.33%) number of Patients (Grade 2), In 17

(56.66%) patients crepitation is only felt (Grade 1).

Figure No. 41: Showing distribution of patients by different grades of Sandhi Atopa

before Treatment:

0

9

6

0

87

0

17

13

0

2

4

6

8

10

18

16

14

12


Grade 0Grade 1Grade 2


161


Table No. 59: Showing the distribution of patients by different grades of Sandhi Atopa after follow-up: Sandhi Atopa Group A no. and % Group B no. and % Group A and B no.

and % Grade 0 01 (06.66%) 00 (00%) 01 (03.33%) Grade 1 12 (80.00%) 09 (60.00%) 21 (70.00%) Grade 2 02 (13.33%) 06(40.00%) 08 (26.66%)

Group A: After follow up, Out of fifteen patients, Sandhi Atopa (Crepitation) was

heard in 02 (13.33%) number of Patients (Grade 2); In 12 (80.00%) patient’s

crepitation as only felt (Grade 1), and 01 (06.66%) patient reported with no

crepitation (Grade 0).

Group B: Out of fifteen patients, Sandhi Atopa (Crepitation) was heard in 06(40.00%)

number of Patients (Grade 2); In 09 (60.00%) patient’s crepitation as only felt (Grade

1) and none were reported with No crepitations (Grade 0).

Overall: After follow up, out of thirty patients on clinical examination, Sandhi Atopa

(Crepitation) was heard in 08 (26.66%) number of Patients (Grade 2), In 21 (70.00%)

patients crepitation is only felt (Grade 1) and one (03.33%) reported with no

crepitations.

Figure No. 42: Showing distribution of patients by different grades of Sandhi Atopa

after follow-up:

1

12

20

9

6

1

21

8

0

5

10

15

20

25


Grade 0Grade 1Grade 2


162


C. Sandhi shothaha

Table No. 60: Showing the distribution of patients by different grades of Sandhi shothaha before treatment:

Shothaha Group A no. and % Group B no. and % Group A and B no. and %

Grade 0 03 (20.00%) 01 (06.66%) 04 (13.33%) Grade 1 04 (26.66%) 05 (33.33%) 09 (30.00%) Grade 2 06 (40.00%) 09 (60.00%) 15 (50.00%) Grade 3 02 (13.33%) 00 (00%) 02 (06.66%) Group A: Out of fifteen patients, 03 (20.00%) were not had any Shotha (Grade 0), 04

(26.66%) were had slightly obvious shotha (Grade 1), 06 (40.00%) were had Shotha

which covers well over the bony prominence (Grade 2), 02 (13.33%) were had much

elevated shotha over sandhi before the treatment.

Group B: Out of fifteen patients, 01 (06.66%) were not had any Shotha (Grade 0), 05


which covers well over the bony prominence (Grade 2), none were had much elevated

shotha over sandhi before the treatment.

Overall: Out of thirty patients, 04 (13.33%) were not had any Shotha (Grade 0), 09



elevated shotha over the sandhi before the treatment.

Figure No.43: Showing distribution of patients by different grades of Sandhi shothaha:

34

6

21

5

9

0

4

9

15

2

0

2

4

6

8

10

12

14

16




163


Table No. 61: Showing the distribution of patients by different grades of Sandhi

shothaha after follow-up:

Shothaha Group A no. and % Group B no. and % Group A and B no. and %

Grade 0 12 (80.00%) 07 (46.66%) 19(63.33%) Grade 1 02 (13.33%) 08 (53.33%) 10(33.33%) Grade 2 01 (06.66%) 00 (00%) 01(03.33%) Grade 3 00 (00%) 00 (00%) 00 (00%)

Group A: After follow up, Out of fifteen patients, 12 (80.00%) were not had any

Shotha (Grade 0), 02 (13.33%) were had slightly obvious shotha (Grade 1), 01

(06.66%) had Shotha which covers well over the bony prominence (Grade 2), none

were reported with much elevated shotha over sandhi.

Group B: Out of fifteen patients, 07 (46.66%) were not had any Shotha (Grade 0), 08

(53.33%) were had slightly obvious shotha (Grade 1) and none were had Shotha

which covers well over the bony prominence (Grade 2) or much elevated shotha over

sandhi (Grade 3) after the follow-up.

Overall: Out of thirty patients, after the follow-up, 19(63.33%) were presented with

no Shotha (Grade 0), 10(33.33%) were had slightly obvious shotha (Grade 1), only

01(03.33%) had Shotha which covers well over the bony prominence (Grade 2), none

were had much elevated shotha over the sandhi (Grade 3).

Figure No.44: Showing distribution of patients by different grades of Sandhi

shothaha:

34

6

21

5

9

0

4

9

15

2

0

2

4

6

8

10

12

14

16




164


D.Sthamba:

Table No. 62: Showing the distribution of patients by different grades of Sthamba

before treatment:

Sthamba


Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 15 (100%) 15 (100%) 30 (100%)

Group A: Out of fifteen patients, all (100%) were had Sthamba in Sandhi before

treatment.

Group B: Out of fifteen patients, all (100%) were had Sthamba in Sandhi before

treatment.

Overall: Out of thirty patients, all (100%) were had Sthamba in Sandhi before

treatment.

Figure No.45: Showing distribution of patients by different grades of Sthamba:

0

15

0

15

0

30

5

0

10

15

20

25

30


Grade 0Grade 1


165


Table No. 63: Showing the distribution of patients by different grades of Sthamba

after follow-up:

Sthamba


Grade 0 10 (66.66%) 11 (73.33%) 21 (70.00%) Grade 1 05 (33.33%) 04 (26.66%) 09 (30.00%)

Group A: Out of fifteen patients, after follow-up 10 (66.66) patient’s relieved from

complaint Sthamba and 5 (33.33%) patient had.

Group B: In this Group, 11 (73.33%) patient relieved and 4 (26.66%) patient had

complaint of Sthamba.

Overall: Out of thirty patients, 21 (70%) patients relieved the where 9 (30%) had

complaint Sthamba.

Figure No. 46: Showing distribution of patients by different grades of Sthamba after

follow-up:

10

5

11

4

21

9

5

0

10

15

20

25


Grade 0Grade 1


166


E. Sandhigati Asamarthya:

Table No.64: Showing the distribution of patients by different grades of Sandhigati Asamarthya:

Sandhigati Asamarthya


Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 01 (06.66%) 01 (06.66%) 02 (06.66%) Grade 2 09 (60.00%) 13(86.66%) 22 (73.33%) Grade 3 05 (33.33%) 01 (06.66%) 06 (20.00%) Grade 4 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients, none (00%) were had full range of movement

(Grade 0), One (06.66%) was had >75% and <full range of movement (Grade 1), 09

(60.00%) were had 50-75% of the full range of joint motion (Grade 2), 05 (33.33%)

were had up to 50% of the full range of joint motion (Grade 3) and none (00%) were

had complete loss of joint motion (Grade 4).

Group B: Out of fifteen patients, none (00%) were had full range of movement (Grade

0), One (06.66%) was had >75% and <full range of movement (Grade 1), 13(86.66%)

were had 50-75% of the full range of joint motion (Grade 2), 0ne (06.66%) had up to

50% of the full range of joint motion (Grade 3) and none (00%) were had complete

loss of joint motion (Grade 4).

Overall: Out of thirty patients, none (00%) were had full range of movement (Grade

0), 02 (06.66%) were had >75% and <full range of movement (Grade 1), 22 (73.33%)

were had 50-75% of the full range of joint motion (Grade 2), 06 (20.00%) were had

up to 50% of the full range of joint motion (Grade 3) and none (00%) were had

complete loss of joint motion (Grade 4).

Figure No.47: Showing distribution of patients by different grades of Sandhigati Asamarthya:


167


01

9

5

0 01

13

10 0

2

22

6

00

5

10

15

20

25


Grade 0Grade 1Grade 2Grade 3Grade 4

Table No. 65: Showing the distribution of patients by different grades of Sandhigati Asamarthya after follow-up:

Sandhigati Asamarthya


Grade 0 04 (26.66%) 02 (13.33%) 06 (20.00%) Grade 1 09 (60.00%) 12 (80.00%) 21 (70.00%) Grade 2 02 (13.33%) 01(06.66%) 03 (10.00%) Grade 3 00 (00%) 00 (00%) 00 (00%) Grade 4 00 (00%) 00 (00%) 00 (00%)

Group A: After follow-up, Out of fifteen patients, 04 (26.66%) were had full range of

movement (Grade 0), 09 (60.00%) were had >75% and <full range of movement

(Grade 1), 02 (13.33%) were had 50-75% of the full range of joint motion (Grade 2)

and none were had up to 50% of the full range of joint motion (Grade 3) or complete

loss of joint motion (Grade 4).

Group B: Out of fifteen patients, 02 (13.33%) were had full range of movement

(Grade 0), 12 (80.00%) were had >75% and <full range of movement (Grade 1),

01(06.66%) had 50-75% of the full range of joint motion (Grade 2), and none were

had up to 50% of the full range of joint motion (Grade 3) or complete loss of joint

motion (Grade 4).


168


Overall: Out of thirty patients, 06 (20.00%) were had full range of movement (Grade

0), 21 (70.00%) were had >75% and <full range of movement (Grade 1), 03 (10.00%)

were had 50-75% of the full range of joint motion (Grade 2), and none were had up to

50% of the full range of joint motion (Grade 3) or complete loss of joint motion

(Grade 4) after the follow-up period.

Figure No. 48: Showing distribution of patients by different grades of Sandhigati

Asamarthya after follow-up:

4

9

20 0

2

12

10 0

6

21

3

0 00

5

10

15

20

25



F. Walking Time:

Table No. 66: Showing the distribution of patients by different grades of Walking Time before treatment: Walking Time Group A no. and % Group B no. and % Group A and B no.

and % Grade 0 00 (00%) 00 (00%) 00 (00%) Grade 1 00 (00%) 00 (00%) 00 (00%) Grade 2 06 (40.00%) 06 (40.00%) 12 (40.00%) Grade 3 09 (60.00%) 09 (60.00%) 18 (60.00%) Grade 4 00 (00%) 00 (00%) 00 (00%)

Group A: Out of fifteen patients, none (00%) were completed 21 meter distance

within 30 seconds - Grade 0 (up to 20 sec) and Grade1 (21-30 sec). 06 (40.00%) were

completed 21 meters in between 31- 40 sec (Grade 2), 09 (60.00%) were had


169



170

completed within 41-50 sec (Grade 3), none (00%) were taken more than 51 sec

(Grade 4) before the treatment.

Group B: Out of fifteen patients, none (00%) were completed 21 meter distance

within 30 seconds (Grade 0 - up to 20 sec and Grade1- 21-30 sec). 06 (40.00%) were



(Grade 4) before the treatment.

Overall: Out of thirty patients, none (00%) were completed 21 meter distance within

30 seconds (Grade 0 - up to 20 sec and Grade1- 21-30 sec). 12 (40.00%) were



(Grade 4) before the treatment in this study.

Figure No. 49: Showing distribution of patients by different grades of Walking Time

before treatment:

0 0

6

9

0 0 0

6

9

0 0 0

12

18

00

2

4

6

8

10

12

14

16

18




Table No.67: Showing the distribution of patients by different grades of Walking Time after follow-up: Walking Time Group A no. and % Group B no. and % Group A and B no.

and % Grade 0 01 (06.66%) 02 (13.33%) 03 (10.00%) Grade 1 10 (66.66%) 05 (33.33%) 15 (50.00%) Grade 2 04 (26.66%) 07 (46.66%) 11 (36.66%) Grade 3 00 (00%) 01 (60.00%) 01 (03.33%) Grade 4 00 (00%) 00 (06.66%) 00 (00%)

Group A: Out of fifteen patients, after follow-up, 01 (06.66%) completed 21 meter

distance within 20 seconds (Grade 0), 10 (66.66%) were covered 21 meter distance in

between 21-30sec (Grade 1). 04 (26.66%) were completed 21 meters in between 31-

40 sec (Grade 2), none were took more than 41sec complete 21 meter distance.

Grade 3 and Grade 4, after the follow-up.

Group B: Out of fifteen patients, after follow-up, 02 (13.33%) were completed 21

meter distance within 20 seconds (Grade 0), 05 (33.33%) were covered 21 meter

distance in between 21-30sec (Grade 1). 07 (46.66%) were completed 21 meters in

between 31- 40 sec (Grade 2), 01 (60.00%) had taken 41-50 sec to cover 21 meter

distance (Grade 3). None were took more than 51sec to complete 21 meter distance

(Grade 4), after the follow-up.

Overall: Out of thirty patients, after follow-up, 03 (10.00%) were completed 21 meter

distance within 20 seconds (Grade 0), 15 (50.00%) were covered 21 meter distance in

between 21-30sec (Grade 1). 11 (36.66%) were completed 21 meters in between 31-

40 sec (Grade 2), 01 (60.00%) had taken 41-50 sec to cover 21 meter distance (Grade

3). None were took more than 51sec to complete 21 meter distance (Grade 4), after

the follow-up.


171



172

Figure No. 50: Showing distribution of patients by different grades of Walking Time after follow-up:

1

10

4

0 0

2

5

7

10

3

15

11

10

0

2

4

6

8

10

12

14

16





173

Observation of the data related to the response of the patient Table No.68: Showing the distribution of Overall Response to the treatment: Duration Group A no. and % Group B no. and % Group A and B no.

and % Good Response 01 (06.66%) 00 (00%) 01 (03.33%) Moderate Response 07 (46.66%) 10 (66.66%) 17 (56.66%) Poor Response 07 (46.66%) 05 (33.33%) 12 (40.00%) No Response 00 (00%) 00 (00%) 00 (00%) Group A: Out of fifteen patients, 01 (06.66%) shown Good response to the treatment.

07 (46.66%) were shown Moderate response and 07 (46.66%) patients shown Poor

response. None were shown No response.

Group B: Out of fifteen patients none were shown Good response to the treatment. 10

(66.66%) were shown Moderate response and 05 (33.33%) patients shown Poor

response. None were shown No response.

Overall: Out of thirty patients, only 01 (03.33%) patient shown Good response to the

treatment. 17 (56.66%) were shown Moderate response and 12 (40.00%) patients

shown Poor response. None were shown No response.

Figure No. 51: Showing the distribution of Overall Response to the treatment:

1

7 7

0 0

10

5

01

17

12

0

0

2

4

6

8

10

12

14

16

18


Good ResponseModerate ResponsePoor ResponseNo Response


Observation of the statistical out comes of the study: Comparative Study of Group A and Group B after treatment Table No.69: Comparative Study of Group A and Group B after treatment:

Parameter Group Mean SD SE PSE T-

Value P-

Value Remarks

A 0.933 0.457 0.118Vedana B 1.066 0.593 0.153

0.193 0.688 >0.05 NS

A 1.06 0.457 0.118Atopa B 1.4 0.507 0.130

0.175 1.94 >0.05 NS

A 0.266 0.593 0.153Shota B 0.533 0.516 0.133

0.202 1.321 >0.05 NS

A 0.333 0.487 0.126Sthamba B 0.266 0.457 0.118

0.172 0.388 >0.05 NS

A 0.866 0.639 0.165Sandigathi Asamarthahtha B 0.933 0.457 0.118

0.202 0.331 >0.05 NS

A 1.2 0.560 0.144Walking time B 1.466 0.833 0.215

0.258 1.031 >0.05 NS

A 19.933 3.432 0.886WOMAC B 21.4 4.371 1.129

1.435 1.021 >0.05 NS

To compare the effectiveness of the treatment procedure, the statistical

analyses is done by using Un-paired t-test, by assuming that the mean effect treatment

procedures is same in both the groups after treatment procedure.

From the analyses all parameters shows non-significant (as P>0.05). i.e., the mean

effects of treatment same in all parameters.

Individual study of the Group A:

Table No.70: Individual study of the Group A: Mean Parameter

BT AT Net

Mean SD SE T-

value P-value Remarks

Vedana 2.133 0.933 1.2 0.560 0.144 8.333 <0.001* HS Atopa 1.4 1.066 0.333 0.487 0.126 2.64 <0.01 HS Shota 1.466 0.266 1.2 0.861 0.22 5.454 <0.001* HS

Sthamba 1.0 0.333 0.666 0.487 0.126 7.936 <0.001* HS Sandigathi

Asamarthahtha 2.266 0.866 1.4 0.507 0.130 10.76 <0.001* HS

Walking time 2.6 1.2 1.4 0.507 0.130 10.76 <0.001* HS WOMAC 41.33 19.933 19.933 3.432 0.886 3.87 <0.01 HS

* = More highly significant


174


Individual study of the Group B: Table No.71: Individual study of the Group B:

Mean Parameter BT AT

Net Mean

SD SE T-value

P-value Remarks

Vedana 2.2 1.066 1.133 0.516 0.133 8.518 <0.001* HS Atopa 1.466 1.4 0.066 0.258 0.066 1.00 >0.05 NS Shota 1.533 0.533 1.0 0.534 0.138 7.246 <0.001* HS

Sthamba 1.0 0.266 0.733 0.457 0.118 6.211 <0.001* HS Sandigathi

Asamarthahtha 2.0 0.933 1.066 0.258 0.066 16.16 <0.001* HS

Walking time 2.6 1.466 1.133 0.516 0.133 8.518 <0.001* HS WOMAC 42.86 21.4 21.466 4.596 1.187 8.08 <0.001* HS

* = More highly significant To know among which Group treatment procedure is more effective, the

statistical analyses is done by using paired t-test, by assuming that the drug is not

responsible for changes in before and after the treatment procedures.

From Table No.70 and Table No.71, all the parameters shows highly significance in

both the Groups as P<0.05 The parameter atopa shows more significance in group A

rather than group B which is not significant.

In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba,

Sandhigati Asamarthata and Walking time shows more highly significant (By

comparing t-values) than Group B . In Group-B the parameters Shota, Sandigathi

Asamarthatha and WOMAC shows more highly significant than group A.

Conclusion: By comparing results of Group A and Group B, it is concluded that

Group A (Arohana Krama Matravasti) is more effective than Group B (Sadharana

Krama Matravasti) in almost all parameters (Except the Atopa, which is not

significant). The study reviles that in both Group A and Group B, therapy is effective

as it decreases Sandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana,

Walking time and Stahmaba.


175


Clinical Parameters (Group A – Arohana Krama) Table 72: Showing the Clinical Parameters before treatment and After Follow-up of Group A:

Clinical Parameters (Group A) Vedana Atopa Sandhi

Shota Sthamba Sadhigati

Asamarthata Walking Time

WOMAC SI No

OPD No

B A B A B A B A B A B A B A 01 4125 2 1 1 1 2 0 1 0 3 1 2 1 35 17 02 4360 2 0 1 1 2 1 1 1 3 2 3 2 47 29 03 4375 2 1 1 1 0 0 1 0 2 0 2 0 35 11 04 4412 2 1 2 1 0 0 1 0 3 1 3 1 40 18 05 4435 2 0 1 0 1 0 1 0 2 0 2 1 38 09 06 4478 2 1 2 1 2 0 1 1 2 0 2 1 43 21 07 4480 2 1 1 1 0 0 1 0 2 1 3 1 40 22 08 5697 2 1 1 1 1 0 1 0 2 1 2 1 38 22 09 6197 2 1 2 2 2 1 1 1 2 1 3 1 44 25 10 6203 2 1 1 1 3 0 1 0 3 2 3 1 43 23 11 6337 3 1 2 1 2 0 1 0 2 1 3 2 45 24 12 7874 2 2 2 2 3 2 1 1 2 1 3 2 43 25 13 8230 3 1 1 1 2 0 1 0 2 1 3 1 43 22 14 8234 2 1 2 1 1 0 1 1 3 1 3 2 44 28 15 8335 2 1 1 1 1 0 1 0 1 0 2 1 42 25 Abbreviations Used: B – Before treatment A – After follow-up


176


Clinical Parameters (Group B – Sadharana Krama) Table 73: Showing the Clinical Parameters before treatment and After Follow-up of Group A:

Clinical Parameters (Group B) Vedana Atopa Sandhi

Shota Sthamba Sadhigati

Asamarthata Walking Time

WOMAC SI No

OPD No

B A B A B A B A B A B A B A 01 4249 2 1 1 1 2 1 1 0 2 1 3 2 42 26 02 4246 2 1 1 1 1 0 1 0 2 1 2 0 31 14 03 4340 2 0 2 2 2 1 1 0 2 1 2 1 43 20 04 4367 2 1 2 2 2 1 1 1 2 1 3 1 47 21 05 4775 3 2 2 2 2 1 1 1 2 1 3 2 38 23 06 4981 2 1 1 1 1 0 1 0 2 1 3 2 43 19 07 5646 2 1 2 2 2 1 1 1 3 2 3 2 45 29 08 5688 2 1 2 1 2 1 1 0 2 1 2 1 48 19 09 6284 3 1 1 1 0 0 1 0 1 0 3 2 37 17 10 6312 2 2 1 1 1 1 1 0 2 1 2 1 47 29 11 6814 2 1 2 2 1 0 1 0 2 1 2 1 45 18 12 1310 3 2 1 1 2 1 1 1 2 1 3 3 44 25 13 1426 2 1 2 2 1 0 1 0 2 1 3 2 41 20 14 2327 2 1 1 1 2 0 1 0 2 1 3 2 47 23 15 6448 2 0 1 1 2 0 1 0 2 0 2 0 45 18 Abbreviations Used: B – Before treatment A – After follow-up


177


Table 74: Showing the percentage improvement in Clinical Parameters in both Groups: Group A – Arohana Krama Group B – Sadharana Krama SI No OPD No % improvement

01 4125 54.34 % 02 4360 38.98 % 03 4375 69.76 % 04 4412 56.86 % 05 4435 78.72 % 06 4478 53.70 % 07 4480 46.93 % 08 5697 44.68 % 09 6197 42.85 % 10 6203 50.00 % 11 6337 50.00 % 12 7874 37.50 % 13 8230 52.72 % 14 8234 39.28 % 15 8335 44.00 %

SI No OPD No % improvement 01 4249 39.62 % 02 4246 57.50 % 03 4340 53.70 % 04 4367 52.54 % 05 4775 37.25 % 06 4981 54.71 % 07 5646 34.48 % 08 5688 59.32 % 09 6284 54.34 % 10 6312 37.50 % 11 6814 58.18 % 12 1310 39.28 % 13 1426 50.00 % 14 2327 51.72 % 15 6448 65.45 %


178


Table 75: Showing Demographic data in patients of Group A (Arohana Krama):

Age category Sex Religion Occupation Economic Status

Mode of Onset

Marital Status

SI No

OPD No

Age in Yrs 31-

40 41-50

51-60

61-70

M F H M C O L S E S P L M

U M

R C I A T U M

M

01 4125 54 + + + + + + + 02 4360 58 + + + + + + + 03 4375 54 + + + + + + + 04 4412 65 + + + + + + + 05 4435 47 + + + + + + + 06 4478 65 + + + + + + + 07 4480 55 + + + + + + + 08 4597 65 + + + + + + + 09 6197 64 + + + + + + + 10 6203 58 + + + + + + + 11 6337 48 + + + + + + + 12 7874 55 + + + + + + + 13 8230 70 + + + + + + + 14 8234 62 + + + + + + + 15 8335 59 + + + + + + + Abbreviations used: Sex: M – male, F – female, Religion: H- Hindu, M – Muslim, C – Christian, O – others, Occupation: S – student, L – labor, E – executive, S – sedentary Economical status: P – poor, LM– lower middle class UM– middle class, R – rich Mode of onset: C– chronic, I – insidious, A – acute, T–traumatic Response: G–good response, M –moderate response, P– poor response, N–No response

Arohana krama and Sadharana krama Matra vasti with Kethakyadi Taila in Sandhigatavata

179


Table 76: Showing Demographic data in patients of Group B (Sadharana Krama):

Age catogary Sex Religion Occupation Economic Status

Mode of Onset

Marital Status

SI No

OPD No

Age in Yrs 31-

40 41-50

51-60

61-70

M F H M C O L S E S P L M

U M

R C I A T U M

M

01 4249 62 + + + + + + + 02 4246 35 + + + + + + + 03 4340 63 + + + + + + + 04 4367 48 + + + + + + + 05 4775 57 + + + + + + + 06 4981 67 + + + + + + + 07 5646 68 + + + + + + + 08 5688 55 + + + + + + + 09 6284 60 + + + + + + + 10 6312 65 + + + + + + + 11 6814 58 + + + + + + + 12 1310 64 + + + + + + + 13 1426 58 + + + + + + + 14 2327 64 + + + + + + + 15 6448 42 + + + + + + + Abbreviations used: Sex: M – male, F – female, Religion: H- Hindu, M – Muslim, C – Christian, O – others, Occupation: S – student, L – labor, E – executive, S – sedentary Economical status: P – poor, L– lower middle class U– middle class, R – rich, Mode of onset: C– chronic, I – insidious, A – acute, T–traumatic Response: G–good response, M –moderate response, P– poor response, N–No response


180


Table 77: Showing Vayaktika vruttanta of patients (Group A – Arohana Krama):

Abbreviations used: Ahara: V –Vegetarian, M –Mixed, Vihara: H- Hard, M – Moderate, S –Sedentary, Agni: S – Sama, M – manda, T – teekshna, V –vishama Koshta: Mr – mridu,M– madhyama, K– krura, Nidra: P– prakruta, A – alpa, Ad – adhika,D–diwasapna Vysana: N–none, T –tobacco, S– smoking,A–alchol Joints involved: R–Right, L–left, B– both

Ahara Vihara Agni

Koshta Nidra Vysana Joints involved

Sl. no

OPD No.

V M H M S S M T V Mr M K P A Ad D N T S A R L B 01 4125 + + + + + + + 02 4360 + + + + + + + 03 4375 + + + + + + + 04 4412 + + + + + + + 05 4435 + + + + + + + 06 4478 + + + + + + + 07 4480 + + + + + + + 08 4597 + + + + + + + 09 6197 + + + + + + + 10 6203 + + + + + + + 11 6337 + + + + + + + 12 7874 + + + + + + + 13 8230 + + + + + + + 14 8234 + + + + + + + 15 8335 + + + + + + +


181



182

Table 78: Showing Vayaktika vruttanta of patients (Group B – Sadharana Krama):

Abbreviations used: Ahara: V –Vegetarian, M –Mixed, Vihara: H- Hard, M – Moderate, S –Sedentary, Agni: S – Sama, M – manda, T – teekshna, V –vishama Koshta: Mr – mridu,M– madhyama, K– krura, Nidra: P– prakruta, A – alpa, Ad – adhika,D–diwasapna Vysana: N–none, T –tobacco, S– smoking,A–alchol Joints involved: R–Right, L–left, B– both

Ahara Vihara Agni

Koshta Nidra Vysana Joints involved

Sl. no

OPD No.

V M H M S S M T V Mr M K P A Ad D N T S A R L B 01 4249 + + + + + + + 02 4246 + + + + + + + 03 4340 + + + + + + + 04 4367 + + + + + + + 05 4775 + + + + + + + + 06 4981 + + + + + + + 07 5646 + + + + + + + 08 5688 + + + + + + + + 09 6284 + + + + + + + 10 6312 + + + + + + + + 11 6814 + + + + + + + 12 1310 + + + + + + + 13 1426 + + + + + + + 14 2327 + + + + + + + + + 15 6448 + + + + + + +


Table 79: Showing data related to Dashavidha pareeksha (Group A – Arohana Krama)

Ahara shakti

Sl. no

OPD No.

Prakruti Sara Pramana Samhanana Satmya Satva

A.S J.S

Vyama shakti

Vaya

01 4125 VK MS S M R M M M A M 02 4360 VP MS S S R M M M A V 03 4375 VP MS S S R M M M M M 04 4412 VP MS S M R M M M A V 05 4435 VK MS S M R M M M A M 06 4478 VK MDS S S R M M M A V 07 4480 VK AS S M R M A A A M 08 5697 VK MS S S R M A A A V 09 6197 VP AS S M R M M M A V 10 6203 VK MS S M R M A A A M 11 6337 VK MDS S S S M M M A M 12 7874 VK MDS S S R M M M A M 13 8230 VK MS S M R M A A A V 14 8234 VP MS S M R M A A A V 15 8335 VK MDS S S R M M M A M Abbreviations used: Prakruti: VP – vatapittaja, VK – vatakaphaja. Sara: MS – mamsasara, MDS – medasara, AS– asthisara Samhanana: S – susamhata, M – madhyama, A – asamhata. Satmya: R – rooksha Satwa: P – prvara, M – madhyama, A – avara. Ahara shakti: A.S –Abhyavarana Shakti , J.S – Jarana Shakti P – prvara, M – madhyama, A – avara. Vyamashakti: P – pravara, M – madhyama, A – avara. Vaya: M – madhyama, V – vruddha


183


Table 80: Showing data related to Dashavidha pareeksha (Group B - Sadharana Krama)

Ahara shakti

Sl. no

OPD No.

Prakruti Sara Pramana Samhanana Satmya Satva

A.S J.S

Vyama shakti

Vaya

01 4249 VK MS S M R M A A A V 02 4246 VK MS S M R M M M M M 03 4340 VK MDS S M R M A A A V 04 4367 VK MS S S R M M M A M 05 4775 VP AS S M R M A A A M 06 4981 VK MS S S R M A A A V 07 5646 VP MS S M R M M M A V 08 5688 VP MS S S R M M M A M 09 6284 VK MDS S S R M M M A V 10 6312 VP AS S M R M M M A V 11 6814 VP MS S M R M M M A M 12 1310 VK MDS S M R M A A A V 13 1426 VK MS S M R M A M A V 14 2327 VP AS S M R M A A A V 15 6448 VK MS S S R M M M A M Abbreviations used: Prakruti: VP – vatapittaja, VK – vatakaphaja. Sara: MS – mamsasara, MDS – medasara, AS– asthisara Samhanana: S – susamhata, M – madhyama, A – asamhata. Satmya: R – rooksha Satwa: P – prvara, M – madhyama, A – avara. Ahara shakti: A.S –Abhyavarana Shakti , J.S – Jarana Shakti P – prvara, M – madhyama, A – avara. Vyamashakti: P – pravara, M – madhyama, A – avara. Vaya: M – madhyama, V – vruddha


184


Table 81: Showing data related to Disease in patients of Group A (Arohana Krama):

Chronicity Shotha Deformity Joint instability

Range of Movement

Gait Muscle Wasting

EM

PM

RM N Ab

Above Joint

Below Joint

SI No

OPD No

<1yr 1-2yr

2 -3yr

3 -4yr

4 -5yr

>5 yrs

P A P A P A

P A P A P A P A P A 01 4125 + + + + + + + + 02 4360 + + + + + + + + 03 4375 + + + + + + + + 04 4412 + + + + + + + + 05 4435 + + + + + + + + 06 4478 + + + + + + + + 07 4480 + + + + + + + + 08 5697 + + + + + + + + 09 6192 + + + + + + + + 10 6203 + + + + + + + + 11 6337 + + + + + + + + 12 7874 + + + + + + + + 13 8230 + + + + + + + + 14 8234 + + + + + + + + 15 8335 + + + + + + + + 4 4 3 1 3 12 3 2 `3 1 14 8 7 3 12 6 9 15 Abbreviations used: P- Present; A- Absent; EM – Easy Movement; PM – Painful Movement; RM – Restricted Movement; N – Normal; Ab – Abnormal


185


Table 82: Showing data related to Disease in patients of Group B (Sadharana Krama):

Chronicity Shotha Deformity Joint instability

Range of Movement Gait Mascle Wasting

EM

PM RM N Ab Above Joint

Below Joint

SI No

OPD No

<1yr 1-2yr

2-3yr

3-4yr

4-5yr

>5yrs

P A P A P A

P A P A P A P A P A 01 4249 + + + + + + + + 02 4246 + + + + + + + + 03 4340 + + + + + + + + 04 4367 + + + + + + + + 05 4775 + + + + + + + + 06 4981 + + + + + + + + 07 5646 + + + + + + + + 08 5688 + + + + + + + + 09 6284 + + + + + + + + 10 6312 + + + + + + + + 11 6814 + + + + + + + + 12 1310 + + + + + + + + 13 1426 + + + + + + + + 14 2327 + + + + + + + + 15 6448 + + + + + + + + 4 2 4 2 2 1 14 1 5 10 1 14 5 10 4 11 7 8 15 Abbreviations used: P- Present; A- Absent; EM – Easy Movement; PM – Painful Movement; RM – Restricted Movement; N – Normal; Ab – Abnormal


186


Table 83: Showing data related to Nidana in patients of Group A (Arohana Krama)

Aharaja Nidana ViharajaNidana SI No

OPD No Tikta Kashaya Katu Alpashana Pramitashana Ruksha VD VU A.VyaVaya Ni.

J Ati Bhashana

Ati Vyayama

01 4125 + + + 02 4360 + + + 03 4375 + + + + 04 4412 + + + + 05 4435 + + + 06 4478 + + + 07 4480 + + + 08 5697 + + + 09 6197 + + + 10 6203 + + + + + 11 6337 + + + 12 7874 + + 13 8230 + + + + 14 8234 + + + + 15 8335 + + + + 1 13 6 14 2 15 Abbreviations used: VD – Vega dhaarana; VU – vegoodeerana; Ni.J – Nishs Jagarana


187


Table 84: Showing data related to Nidana in patients of Group B (Sadharana Krama)

Aharaja Nidana ViharajaNidana SI No

OPD No Tikta Kashaya Katu Alpashana Pramitashana Ruksha VD VU A.VyaVaya Ni.

J Ati Bhashana

Ati Vyayama

01 4249 + + + 02 4246 + + 03 4340 + + + + + 04 4367 + + + 05 4775 + + + + 06 4981 + + + 07 5646 + + 08 5688 + + + + 09 6284 + + 10 6312 + + + 11 6814 + + + 12 1310 + + + + 13 1426 + + + + 14 2327 + + + + 15 6448 + + + 2 10 5 13 6 13 Abbreviations used: VD – Vega dhaarana; VU – vegoodeerana; Ni.J – Nishs Jagarana


188


Table 85: Showing average time of Vasti Dravya Retention in patients of both Groups: Group A Group B SI No OPD No Average time of Vasti

Dravya Retention (In hrs) 01 4125 06.7 02 4360 06.3 03 4375 08.4 04 4412 03.9 05 4435 08.4 06 4478 09.0 07 4480 07.2 08 5697 09.7 09 6192 04.2 10 6203 07.6 11 6337 07.4 12 7874 08.8 13 8230 03.6 14 8234 08.8 15 8335 09.2

Average 07.2

SI No OPD No Average time of Vasti Dravya Retention (In hrs)

01 4249 10.1 02 4246 08.1 03 4340 06.0 04 4367 10.5 05 4775 06.1 06 4981 10.1 07 5646 06.2 08 5688 07.6 09 6284 08.6 10 6312 06.9 11 6814 05.1 12 1310 05.0 13 1426 05.1 14 2327 09.5 15 6448 04.4 Average 08.3


189


Table 86: Showing response in patients of both Groups: Group A Group B

Result SI No

OPD No Good

Response Moderate Responce

Poor Responce

No Responce

01 4125 + 02 4360 + 03 4375 + 04 4412 + 05 4435 + 06 4478 + 07 4480 + 08 5697 + 09 6192 + 10 6203 + 11 6337 + 12 7874 + 13 8230 + 14 8234 + 15 8335 +

Total

1

7

7

-

Result SI No

OPD No Good

Response Moderate Responce

Poor Responce

No Responce

01 4249 + 02 4246 + 03 4340 + 04 4367 + 05 4775 + 06 4981 + 07 5646 + 08 5688 + 09 6284 + 10 6312 + 11 6814 + 12 1310 + 13 1426 + 14 2327 + 15 6448 +

Total

-

10

5

-


190

Discussion

Discussion:

“The aim of discussion should not be victory, but progress.” - Joseph Joubert

It is said that, in each and every study, it may be either conceptual or clinical, is

always required to be proved on the basis of logic, fruitful reasoning, supported by

achieved practical data as Pramana and then only it can be taken as a principle of that

science. Hence the discussion and interpretation of the research study becomes an

essential and important thing for a research scholar to put their study on the scientific

platform and then only it can be granted to be considered as a true study. Fulfilling and

Following the same requirement, here an attempt has been made to critically discuss and

interpret the whole clinical study on “Evaluation on the effect of Matravasti in

Sandhigatavata with Kethakyadi taila in Arohana krama and Sadharana krama – A

comparative clinical study”.

Discussion on this study is based in the following headings:

1. Sandhigatavata vis-à-vis Osteoarthritis.

2. The materials and methods.

3. Clinical study.

4. The patients of Sandhigatavata who underwent the trial.

5. Observations made on results.

6. Probable mode of action of the Matravasti.

.


191

Discussion

1. Sandhigatavata vis-à-vis Osteoarthritis:

Movement is the sign of life. Vata is responsible for such chesta or movement. Chesta

includes the entire activity of a living body, even action that is subtle enough in their

latent stage. The word Vata is defined by Acharya Sushruta as “Va gati gandhanayoh”. It

means that Vata indicates both ‘Gati’ and ‘Gandana’. The meanings of the word Gati are:

motion, moving and going. The meanings of Gandhana are: intimation, information and

hint. Therefore it is clear that this somatic factor ‘vata’ has two main functions i.e.

movement (chesta) and knowledge (jnana).

In gatavata’s the provocation of vata is the prime factor whether it occurs due to

marga avarna or Dhatu kshaya. The aggravated Vata while moving throughout the body

lodges in Khavaigunya Yukta Srothas. After getting lodged at those parts, it impairs the

functions of particular structure and produces the disease. In case of Gatatva the

aggravated Vata finds a suitable place for its lodgment such as Dhatu, Upadhatu, Ashaya,

and Avayava.

In Sandhigatavata, vitiated Vata lodges in Sandhis. Sandhi is a place where two or

more structures unite. In this context Asthi Sandhi means a junction between two bones.

Sandhi is not a single structure rather it is considered as an organ. There are different

structures, which helps in maintaining the stability of the joint. Snayu or ligament 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 or Synovial fluid, which fills up the cavities,

occupies the Synovial joint, bursae and tendon sheaths. It provides the lubricant factors,

nutrient to the cartilage, disc, and helps in keeping the joint firmly united.


192

Discussion

Shleshmadharakala situated in the joints supported by Shleshaka Kapha helps in

lubrication.

Nidana: The excessive intake of dravyas having, Laghu, Ruksha, Sukshma etc

properties vitiates the vata which gets lodged in sandhis where khavaigunya is already

present. That sthanasamshrita vitiated vata then by the property of Rukshana, dries up the

Snehana present in that joint and causes the features like Vatapoornadrutisparsha, Shotha,

Prasarnaakunchana sa vedana, Sandhi atopa etc and hampers the normal function sandhi

is known as Sandhi gata vata.

Samprapti: The samprapti of Sandhigatavata may be divided into Dhatukshaya

Janya and Avarana Janya. Even the contemporary science explains the pathology in two

settings. One is due to the sub standard biomaterial of the joint (Dhatukshaya). Second is

due to increased applied pressure over the joint (Avarana).

In Dhatukshya Janya Sandhigatavata due to old age, because of vatakara ahara

vihara there will be qualitative change in the joint material gradually leading to disease

manifestation.

The other set of samprapti where in due to continuous pressure due to obesity the

joint may get affected leading to disease manifestation. This demarcation in samprapti

helps in planning the treatment.

Lakshana: The different lakshanas of Sandhigatavata like, viz. Vata purna druti

sparsha, Sandhishothaha, Prasarana akunchanayoho savedana pravruthihi, Sandhi Atopa,

Sandhi sthamba, Sandhigati asamarthata, Sandhi vishleshya etc are explained by various

text books of Ayurveda.


193

Discussion

Modern science has also listed the same features along with other symptoms

pertaining to individual joints. Also tenderness and joint stiffness (implied by the

restriction of joint movements) find special mentioning in Modern science. It has

mentioned that any joint can get affected with Osteoarthritis. In this view, they have

considered the weight bearing joints of the knees, hips, lower spine and peripheral joints

of fingers and toes and conditions of Lumbar spondylosis also as the Osteoarthritis of the

intervertebral joints.

Sandhigatavata is commonly observed in Janu sandhi because it is a major

weight bearing and mobile joint of body. It is more prone to trauma as a result of obesity

and physical activities like jumping , running, squanting and long standing.Which

interferes not only with the physical activity but entire quality of life and in the present

clinical study all 30 patients reported complaints of knee joint involvement.

The degeneration of Bone (asthidathu) is the emerging lifestyle disease in the

present era. Osteoarthritis being a degenerative type of disease, its manifestation is more

in old age persones. As explained in Ayurvedic classics, this is the age in which all Dhatu

are already deranged because of vata prakopa. It is explained in contemporary science

that, there is a steady raise in overall prevalence from age 30 such that by 65, 80% of

people have some radiological evidence of Osteoarthritis, though only 25-30% have

associated symptoms. In this study, only one patient recorded in age group between 31-

40yrs, four in between 41-50yrs, 12 in between 51-60yrs and 13 patients were fall under

61-70 age group. This view supports the ayurvedic concept.

Vatakara nidanas including Vardhakya avastha characterized by dhatu kshaya

leads to vata prakopa in the body, which in turn, vitiates the Kapha, (shleshaka kapha)


194

Discussion

present in Sandhis thereby resulting in karma hani of the sandhis. Dhatusaithilya is

another feature in vardhakya, which applies to mamsa dhatu, also reflecting in peshis and

snayus thereby reducing their functional competency in supporting the joints. This is a

major risk factor for Sandhigatavata.

Sadyasadyata: Eventhough Sandhigatavata is not a fatal disease, it cripples the

movement of patient and makes him/her dependent on others i.e. Paratantra according

Ayurveda. In general Vatavyadhis are considered as one among the Mahagadas by

acharyas309 as there are structural changes in the joints.

Astivaha srotas: Medas and Jaghana are considered as Astivaha srotomula. The

Medas possibly related to red marrow which is known as ‘sarakta medas’. It can be

understood by the view of modern medicine as they stated that Human skeletal system

develops from mesoderm and neural crest. Mesenchyme is also of mesoderm in origin. It

can migrate and differentiate in many ways and can become fibroblasts, chondroblasts or

osteoblasts.

Chikitsa: The chikitsa sutra of Sandhigatavata is Snehana, Svedana and

Agnikarma and for the Asthi pradoshaja vikaras Panchakarma is specificaly indicated.

Since it is a Vata Vikara related to Asti sandhis and Dhatukshaya is the resultant,

Snehana in the form of Vasti would be an ideal line of treatment. S0 in present clinical

study, Matravasti is administered with Kethakyadi taila. Where in contemporary science,

treatment is non-specific and symptomatic which mainly based on Non–pharmacological

methods and analgesics. Among Non–pharmacological treatment much importance is

given to physical heat therapy, physiotherapy etc.


195

Discussion

2. Discussions on the materials and methods:

A. Drugs used in the trial work:

Kethakyadi Taila:

The Kethakyadi taila, which is explained in Sahasra yoga, Taila prakarana is

selected for present study. This taila is indicated in the Astigata vata, as the Astidhatu is

the main composition in forming Asti sandhis along with Peshi, Snayu etc.

The composition of this Taila includes Kethaki Mula, Bala and Atibala. The

Astavashesha kashaya of these drugs were used in preparation. As the separate Kalka

Dravya is not mentioned in this yoga, the kalka of same drugs were used. The

composition of Kalka, Taila and Drava dravya were taken in the proposition of 1:4:16

respectively as the general rule of Taila Kalpana. For the Drava dravya equal quantity of

Kashaya and Tushodaka was used as mentioned in Yoga.

The Kethakyadi Taila is also explained in Baishajya Ratnavali, Vangasena

Samhita but the composition defers as they mentioned the Naga bala instead of Bala and

not specified the part of Kethaki. Other ingredients and indications are same.

Moorchita Tila Taila:

The Murchita Tila Taila is used for the sthanika abhyanga in the Kati and Udara

pradesha before the Matravasti, as explaine in clasics that Vasti should be administered

after Snehana and Swedana.

B. Posology:

Arohana Krama Matra vasti: Here Matra vasti is administered for nine days in increasing

order of the dose of Taila. First day started with 48ml (1pala). Daily 12ml (1/4th pala) was

increased till 9th day i.e. 144 ml. This posology is formulated on the basis of Acharya


196

Discussion

Addamall’s opinion on three doses of Matra vasti explained in Sharangadhara Samhita310.

The Madyama Matra is considered here. In Chakradatta, Acharya explained the Arohana

karma of Anuvasana vasti. The doses were identical to that of Acharya Adamalla’s

opinion311.

Sadharana Krama Matra vasti: Here Matra vasti is administered in fixed dose of 72ml

(1½ pala) for nine days. The dose was fixed on the basis of Commentator Chakrapanis

opinion on the dose of Matravasti explained in Charaka samhita312. The Acharya

Sushruta’s opinion was also considered as he explained that, the dose of Matravasti is

half of that of Anuvasana vasti313. Acharya Chakradatta (Chkradatta. 72/3) and

Vangasena (Vangasena samhita 83/20) also mentioned the three doses of Anuvasana

vasti. The hruswa matra is identical that of dose of Matra vasti.

In Sadharana Krama Matra vasti: It was administered for Nine days. It was framed by

considering the opinion of Acharya Sushruta that, Snehavasti administered for 8 days

reaches upto Astidhatu and which administered for 9 days reaches upto Majja Dhatu. As

Asti and Majja dhatu were interrelated to each other, it was administered for 9 days.

3. Discussion on Clinical Study:

The Patients were selected from OPD and IPD of D.G.M. Ayurvedic Medical

College & Hospital, Gadag after applying the Inclusion and Exclusion criteria. Then they

are randomly distributed into two groups- Group A and Group B and treatment was

administered. Totally 34 patients were registered out of which 4 patients discontinued the

trial because of personal problems.


197

Discussion

The laboratory tests like Hb%, TC, DC, ESR were done to assess the general

condition of the patient and to exclude the other systemic diseases. RBS was performed

to rule out Diabetes, as in Prameha continuous administration of Snehavasti was

contraindicated. The radiology of the affected joint was performed in each patient as

diagnostic criteria and also to exclude the conditions associated with simple or compound

fractures.

After scrutinizing the Ayurvedic literature, Prasarana Aakunchanayoho savedana

pravruthihi, Atopa, sandhishothaha, Sthamba, Sandhigati asamarthata, Walking time (to

cover 21meters) and WOMAC were fixed as the parameters for clinical assessment.

In Both group the Matra vasti was administered in Morning hours between 8AM

to 10AM after light breakfast. The Sthanika Snehan and Swedana was performed as

purvakarma, as explained by all Acharyas that Vasti should be administered after

Snehana and Swedana. The Sthanika Abhyanga was done to kati, prushta, udara

pradesha with Murchita Tila Taila and Mrudu Swedana was performed by Nadi Sweda.

Then Vasti was administered in lying on left lateral position as explained in

classics. After Vasti pranidhana, patient was asked to be in supine position for about 10

minutes to avoid quick pratyagamana of vasti dravya. After taking rest for 1 hour,

patients were asked to take bath with hot water and also instructed to note down the time

of Vasti dravya pratyagamana as the patients were from OPD.

Total duration of Vasti Dravya Retentions:

The total period of Vasti dravya retention was calculated by note downing the

time of Vasti pranidhana and Vasti Pratyagamana. The average duration of retention was

calculated. In Group A (Arohana krama) it was 7.2 hours and in Group B (Sadharana


198

Discussion

krama) it was 8.3hours. Even though comparatively large dose of sneha was administered

in Group A, there is no much difference in both groups. This supports the assumption

that, gradual increase in dose of Matravasti facilitates the longer duration of retention.

Assessment results:

The efficacy of Matravasti in Sandhigatavata with Kethakyadi taila in Arohana

krama and Sadharana krama was accessed by setting of criteria as discussed in materials

and methods section earlier. Here the base line data was compared with the data taken

after 18 days of therapy; this is because the parihara kala of basti is told as double the

days of administration of basti karma. Hence it is postulated that the result of basti can be

best seen after parihara kala or to show the efficacy, basti requires double the days of its

coarse. In this study the course of therapy was 9 days and hence the results were accessed

18 days after the therapy i.e. on 27 thday after the first day of Bastikarma initiation.

4. Discussions on the patients of Sandhigatavata who underwent the trial.

Age:

In this clinical study, among 30 patients, 25 patients (83.33%) belonged to the age

group 50-70 there by supporting the association of vardhakya avastha

Sex:

In this clinical study, among 30 patients14 patients (46.66%) were males and 16

patients (53.33%) were females. It is told that women are at high risk than men in

developing OA. This substantiates the observation made by earlier researchers that this

disease prevalence is more in women than men.

Religion:


199

Discussion

This study shows a greater prevalence of sandhigatavta in Hindu 23 (76.66%)

patients. Higher geographical proportion of Hindus in and around this area may be the

reason for its higher incidence in Hindu.

Occupation:

In the present study, 08 (26.66%) patients belonged to the Labor group, 20

(66.66%) were belonging to sedentary category and 02 patient (06.66%) belonged to the

executive group of occupation.

In this study the more peoples are belonged to sedentary group, this may be

because of the appearance of features of Sandhi-gata-vata triggered by the ageing, who

were in retired life but had the history of hard work. It was also evidenced that, excessive

hard work usually seen in labor group is more prevalence to Sandhigata vata. This

strengthens the view point that this disease is triggered by excessive physical activity like

excessive hard work/labour (ati vyayama).

Economical status:

Socio-economical status showed 16 patients (53.33%) were belonged to lower

middle class, 10 patients (33.33%) were of upper middle class and 04 patients (13.33%)

were belonged to the poor class. None were from rich. This evidenced that

Sandhigatavata is more prevalent in lower middle class, who were hard workers and

females from this group usually housewives and busy in continuous home activities.

Diet:


200

Discussion

It was observed that 10 (33.33%) patients were vegetarians and 20(66.66%)

patients were taking mixed diet in this study. But there is no specific incidence of disease

with diet.

Prakruti:

In the present study, it was observed 11 patients (36.66%) of were of the Vata-

pitta prakriti, 19 patients (63.33%) of were of the Vata-kapha prakriti. Hence, majority of

the patients were having the existence of Vata dosha in their prakriti constitution. This

shows the Vata prakriti person is more prone to vataja set of diseases.

Nidra:

Among 30 patients, 19 (63.33%) were had Alpa nidra, 11 (36.66%) were had

Prakrutha nidra. This shows that, ratri jagarna (alpa nidra) is a predisposing factor for

Vata vriddhi.

Satmya:

Among 30 patients, 29 patients (96.66%) were Rooksha satmya and only one

patient (06.66%) was Snigda satmya. This is because of normal food habit of this region

i.e. peoples will use Kadak rotti, more spicy food article etc in daily food. As explained in

classics, this rooksha stmya can be considered as a contributing factor for Vata prakopa

and in turn leads to Sandhi-gata-vata.

Nidana:

Among 30 patients, 23 patients had katu rasa atisevana, 03 patients had tikta rasa

atisevana, 11 patients had alpa bhojana, 23 patients had rooksha bhojana, 07 patients had

Nisha jagarana and 23 patients had Ativyayama. These are the some factors explained in


201

Discussion

the Samanya Vatavyadhi Nidana. This supports and validates the presumption that made

earlier that Vatavyadhi samanya nidana can be taken as nidana for sandhigatvata.

Presenting complaints:

Prasarana akunchanayoho savedana pravritti: Among the 30 patients included in this

study, all the patients had this symptom. In fifteen patients of Group A, 02 (13.33%) were

complained continues pain (Sever), 13 (86.66%) were complained pain frequently when

moves the joint and none were had mild pain which reveals on enquiry and without pain,

in Group B, 03 (20.00%) were complained continues pain (Sever), 12(80.00%) were

complained pain frequently when moves the joint and none were had mild pain which

reveals on enquiry and without pain. Overall out of thirty patients, 05 (16.66%) were

complained continues pain (Sever), 25 (83.33%) were complained pain frequently when

moves the joint and none were had mild pain which reveals on enquiry and without pain.

It is explained in contemporary science that, Pain may directly related to the

Osteoarthritis process through increased pressure in subcondral bone, trabecular micro

fractures, capsular distention and low-grade synovitis or result from bursitis and

enthesopathy secondary to the altered joint mechanism. The typical characteristic of pain

includes, pain mainly related to movement and weight bearing, relieved by rest.

(Davidson’s Pg no: 998). This closely simulates the main features of Sandhigatavata

explained in Ayurvedic classics and also supports the observations made in this study.

After follow-up: In Group A, none (00%) were complained continues pain (Sever, Grade

3), 01 (06.66%) was complained pain frequently when moves the joint (Grade 2), 12

(80.00%) were complained mild pain (Grade 1) and 2 (13.33%) patients were reported

with no pain (Grade 0). So, there was 56.25% improvement in this group.


202

Discussion

In Group B, none (00%) were complained continues pain (Sever, Grade 3), 03(20.00%)

were complained pain frequently when moves the joint (Grade 2), 10 (66.66%) were

complained mild pain (Grade 1) and 2 (13.33%) patients were reported with no pain

(Grade 0). So, there was 51.54% improvement in this group.

Overall: Out of thirty patients, none (00%) were complained continues pain (Sever,

Grade 3), 04 (13.33%) were complained pain frequently when moves the joint (Grade 2),

22 (73.33%) were complained mild pain (Grade 1) and 4 (13.33%) patients were reported

with no pain (Grade 0). So there was 53.89% of improvement was noted in this clinical

feature.

Sandhi Atopa: Palpable, sometimes audible, coarse cripitus indicative of rough articular

surface is seen in Osteoarhritis can compare with Sandhi Atopa. In all patients undergone

this clinical trail had the crepitations either palpable or audible. In Group A,

in 06 (40.00%) number of Patients (Grade 2); in 09 (60.00%) patient’s crepitation is only

felt (Grade 1). In Group B, heard in 08 (53.33%) number of Patients (Grade 2), in

07(46.66%) patients it was only felt (Grade 1). Overall in 13 (43.33%) patients it was

audible and in 17 (56.66%) it was only palpable.

After follow-up: In Group A, Sandhi Atopa (Crepitation) was heard in 02 (13.33%)

Patients (Grade 2); In 12 (80.00%) patient’s only felt (Grade 1), and 01 (06.66%) patient

reported with no crepitation (Grade 0). So there was 23.85% improvement in Atopa in

this Group.

it was heard


203

Discussion

In Group B, heard in 06(40.00%) Patients (Grade 2); In 09 (60.00%) patient’s only felt

(Grade 1) and none were reported with No crepitations (Grade 0). So there was 04.50%

improvement in Atopa in this Group.

Overall, out of thirty patients it was heard in 08 (26.66%) Patients (Grade 2), In 21

(70.00%) only felt (Grade 1) and one (03.33%) reported with no crepitations. So there

was 14.17% improvement in Atopa.

Shothaha: Out of thirty patients, 26 patients (86.66%) had shothaha over sandhi. Even

though Acharyas like Charaka, Vagbhata etc were explained Vatapurna druti sparsha as

one of the feature of Sandhi-gata-vata. But no explanations are available about how to

elicit this feature. Even commentators were silent on this aspect. The swelling over joint

slightly resembling air filled bladder can be compared with shotaha. So in this study only

Shotha was considered for diagnosis and assessment.

In GroupA, not had any Shotha (Grade 0), 04



elevated shotha over sandhi

In Group B, 01 (06.66%) were not had any Shotha (Grade 0), 05 (33.33%) were had

slightly obvious shotha (Grade 1), 09 (60.00%) were had Shotha which covers well over

the bony prominence (Grade 2), none were had much elevated shotha.

Overall, Out of thirty, 04 (13.33%) were not had any Shotha (Grade 0), 09 (30.00%) were

had slightly obvious shotha (Grade 1), 15 (50.00%) were had Shotha which covers well

Out of fifteen patients, 03 (20.00%) were


204

Discussion

over the bony prominence (Grade 2), 02 (06.66%) were had much elevated shotha over

the sandhi before the treatment.

After follow-up: In Group A, 12 (80.00%) were not had any Shotha (Grade 0), 02

(13.33%) were had slightly obvious shotha (Grade 1), 01 (06.66%) had Shotha which

covers well over the bony prominence (Grade 2), none were reported with much elevated

shotha over sandhi. So there was 81.85% improvement in clinical feature Shota.

In Group B, 07 (46.66%) were not had any Shotha (Grade 0), 08 (53.33%) were had

slightly obvious shotha (Grade 1) and none were had Shotha which covers well over the

bony prominence (Grade 2) or much elevated shotha over sandhi (Grade 3). So there was

65.23% improvement in clinical feature Shota.

Overall, 19(63.33%) were presented with no Shotha (Grade 0), 10(33.33%) were had

slightly obvious shotha (Grade 1), only 01(03.33%) had Shotha which covers well over

the bony prominence (Grade 2), none were had much elevated shotha over the sandhi

(Grade 3). So overall improvement, in this clinical feature was 73.54%.

Sthamba: Brief (<15minutes) morning stiffness and brief (<1 minutes) getting after rest is

seen in Osteoarthritis. The feature of Sandhigatavata, Sthamba explained in classics can

compare with this. In present study all were complained about brief morning stiffness and

getting after rest before treatment.

After follow-up: In Group A, Out of fifteen patients, 10 (66.66) patient’s relieved from

complaint Sthamba and 5 (33.33%) patient had. So, there was 66.7% improvement in this

clinical feature.


205

Discussion

In Group B, 11 (73.33%) patient relieved and 4 (26.66%) patient had complaint of

Sthamba. So, there was 73.4% improvement in this clinical feature.

Overall, 21 (70%) patients relieved the where 9 (30%) had complaint Sthamba. So,

improvement was 70.05%.

Sandhigati Asamarthytha: Restricted movement in joints because of capsular thickening,

blocking by osteophytes are commonly seen in Osteoarthritis. Before the treatment the

distribution of patients with this complaint were as follows,

In Group A, Out of fifteen patients, none (00%) were had full range of movement (Grade

0), One (06.66%) was had >75% and <full range of movement (Grade 1), 09 (60.00%)

were had 50-75% of the full range of joint motion (Grade 2), 05 (33.33%) were had up to

50% of the full range of joint motion (Grade 3) and none (00%) were had complete loss

of joint motion (Grade 4).

In Group B, none (00%) were had full range of movement (Grade 0), One (06.66%) was

had >75% and <full range of movement (Grade 1), 13(86.66%) were had 50-75% of the

full range of joint motion (Grade 2), 0ne (06.66%) had up to 50% of the full range of

joint motion (Grade 3) and none (00%) were had complete loss of joint motion (Grade 4).

Over all, among thirty patients, none (00%) were had full range of movement (Grade 0),

02 (06.66%) were had >75% and <full range of movement (Grade 1), 22 (73.33%) were

had 50-75% of the full range of joint motion (Grade 2), 06 (20.00%) were had up to 50%

of the full range of joint motion (Grade 3) and none (00%) were had complete loss of

joint motion (Grade 4).


206

Discussion

After follow-up: In Group A, 04 (26.66%) were had full range of movement (Grade 0),


had 50-75% of the full range of joint motion (Grade 2) and none were had up to 50% of

the full range of joint motion (Grade 3) or complete loss of joint motion (Grade 4). So,

there was improvement in this clinical feature was 61.78%.

In Group B, 02 (13.33%) were had full range of movement (Grade 0), 12 (80.00%) were

had >75% and <full range of movement (Grade 1), 01(06.66%) had 50-75% of the full

range of joint motion (Grade 2), and none were had up to 50% of the full range of joint

motion (Grade 3) or complete loss of joint motion (Grade 4). So improvement was

53.35%.

Over all, had full range of movement (Grade 0),


had 50-75% of the full range of joint motion (Grade 2), and none were had up to 50% of

the full range of joint motion (Grade 3) or complete loss of joint motion (Grade 4). So

improvement in this clinical feature was 57.56%.

Duration of the disease:

Among the 30 patients, 08 (26.66%) were had the chronicity less then 1 years, 06

(20.00%) were had the chronicity in between 1-2 years, 07 (23.33%) patients were had

chronicity in between 2-3 years. 03 (10.00%) were in between 3-4 years and 05 (16.66%)

were had chronicity in between 4-5 years. Only one (06.66%) had chronicity more than 5

years. This indicates the long standing nature of Vatavyadhi.

Out of thirty patients, 06 (20.00%) were


207

Discussion

Radiological interpretations:

Among 30 patients in this study, 9 Patients of Group A (60%) and 7 patients of

Group B(46.66%), Overall 16 patients had their affected joint space Reduced (53.33%),

One patient from Group A (6.66%)and Two from Group B (13.33%), totally 03 patients

had their affected joint space unaltered (10%), none patients had their affected joint space

increased. 22 patients had subchondral bony sclerosis (73.33%), 16 patients had

osteophytes formation (53.33%), 08 Patients had altered bone end (26.67%) and no

patient had periarticular ossicles.

5. Discussions on observations made on results:

Assessment of the results was done by considering the subjective criteria

and objective criteria. Totally 7 criteria were taken with different gradings as explained in

Methodology. The statistical result showing the significance has already been discussed

in the observation part. Here % of improvement is calculated to know the efficacy and net

improvement in the condition.

For this purpose the values were observed numerically which are given the

gradings.

Step 1 – All the values of before treatment of subjective and objective parameters were

added to get the sum. Now this is the condition in which the patient had approached us,

so it becomes the base line data. This is taken as 100%.

Step 2 – The readings of after treatment was then added to get the sum, which is the

status of the patient after the treatment.


208

Discussion

Step 3 – Now the % of the condition after the treatment is calculated by dividing this

number with the base line data obtained by the step 1. This should then multiply by 100

to get the % after the treatment.

Step 4 – The % of improvement is calculated by subtracting the value got by step 3 by

100 will yield the net improvement in the disease.

Step 5 – This value was referred for the table postulated to declare the results.

Table No.87: Showing the Percentage Improvement of Parameters in each patient:

Group A – Arohana Krama Group B – Sadharana Krama

SI No OPD No % improvement

01 4125 54.34 % 02 4360 38.98 % 03 4375 69.76 % 04 4412 56.86 % 05 4435 78.72 % 06 4478 53.70 % 07 4480 46.93 % 08 5697 44.68 % 09 6197 42.85 % 10 6203 50.00 % 11 6337 50.00 % 12 7874 37.50 % 13 8230 52.72 % 14 8234 39.28 % 15 8335 44.00 %

SI No OPD No % improvement

01 4249 39.62 % 02 4246 57.50 % 03 4340 53.70 % 04 4367 52.54 % 05 4775 37.25 % 06 4981 54.71 % 07 5646 34.48 % 08 5688 59.32 % 09 6284 54.34 % 10 6312 37.50 % 11 6814 58.18 % 12 1310 39.28 % 13 1426 50.00 % 14 2327 51.72 % 15 6448 65.45 %

Sl. No. Range of net improvement % Remarks

1 >75% GR - Good Response 2 50-75% MR - Moderate response 3 Up to 50% PR - Poor response


209

Discussion

Declaration of the result by above method: Group A Sl.No. Impression No. of patients % of patients 1 Good Response 01 06.66 % 2 Moderate response 07 46.66 % 3 Poor response 07 46.66 % 4 No response 00 00 % In this group, the chief complaint Prasaarana Aakunchanayoho Savedana

Pravruthi i.e Pain in joint while Flexion and Extension was reduced up to 50% in most of

the patients on 5th or 6th day. The sign Sandhi Sothaha was observed to decrease slowly;

on the fifth or sixth day more than 50% decrease was noted. The complaint Sandhigati

Asamarthata and Sandhi sthamba were improved about 75% on 9th day. The other

complaint, Sandhi atopa not shown much change during the period of treatment, Only in

5 patients changes were noted after follow up. The recurrences of the complaints were

not observed during the period of follow up.

Group B

Sl.No. Impression No. of patients % of patients 1 Good Response 00 00 % 2 Moderate response 10 66.66 % 3 Poor response 05 33.33 % 4 No response 00 00 % There was no much difference in response was noted during the treatment period

in both group. Here also the complaint Prasarana Akonchanayoho Savedana Pravruthi

4 0% NR - No response


210

Discussion


211

was reduced about 50% on 5th or 6th day. Other complaints were also responded similarly

as seen in Group A patients. Only the Parameter Atopa not had shown any changes in

fourteen patients even after follow up.

Mean Percentage improvement in each Parameter:

The mean percentage of improvement in each parameter was calculated to know

the effect of treatment on individual parameters. These was calculated by using the

following formula.

The obtained values are as follows:

Table No. 88: Showing the Percentage Improvement of Parameters:

SI No Parameter Group A Group B Overall

01 Prasarana Akonchanayoho

Savedana pravrutti

56.25 % 51.54 % 53.89 %

02 Sandhi Atopa 23.85 % 4.50 % 14.17 %

03 Sandhi Shota 81.85 % 65.23 % 73.54 %

04 Sthamba 66.7 % 73.4 % 70.05 %

05 Sandhigati Asamarthata 61.78 % 53.35 % 57.56 %

06 Walking Time 53.84 % 43.61 % 48.72 %

07 WOMAC 51.77 % 50.07 % 50.92 %

(Before Treatment Mean) – (After treatment Mean) X 100

Mean % Improvement = (Before Treatment Mean)

Discussion


212

Figure No.52: Showing the Percentage Improvement of Parameters:

By the above observations, except the Parameter Sthamba, all other parameters

are shown the better improvement in group A than Group B. Among all parameter the

Sandhi Shota had shown the highest percentage (81.85 %) improvement in group A and

in Group B the Stamba had shown highest percentage (73.4 %) of improvement.

Overall response of patients:

In group A, one patient (06.66%) shown Good response (> 75% improvement in

subjective and objective parameters), where 7 patients (46.66 %) were shown Moderate

response (50-75% improvement in subjective and objective parameters) and 7 (46.66 %)

were shown Poor response (<50% improvement in subjective and objective parameters)

to the treatment.

In Group B, 10 patients (66.66 %) were shown Moderate response (50-75%

improvement in subjective and objective parameters) and 5 patients (33.33 %) were

0

10

20

30

40

50

60

70

80

90


VedanaAtopaShotaSthambaSandhigati AsamarthataWalking TimeWOMAC

Discussion

shown Poor response (<50% improvement in subjective and objective parameters) to the

treatment. None were shown Good response or No response.

In total thirty patients, only 01 (03.33%) patient shown Good response to the

treatment. 17 (56.66%) were shown Moderate response and 12 (40.00%) patients shown

Poor response. None were shown No response.

To compare the effectiveness of the treatment procedure, the statistical analyses is

done by using Un-paired t-test, by assuming that the mean effect treatment procedures is

same in both the groups after treatment procedure. From the analyses all parameters

shows non-significant (as P>0.05). i.e., the mean effects of treatment same in all

parameters.

To know among which Group treatment procedure is more effective, the



All the parameters shows highly significance in both the Groups as P<0.05 the parameter

atopa shows more significance in group A rather than group B which is not significant.

In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba, Sandhigati

Asamarthata and Walking time shows more highly significant (By comparing t-values)

than Group B . In Group-B the parameters Shota, Sandigathi Asamarthatha and WOMAC

shows more highly significant than group A.

Statistical Conclusion: By comparing results of Group A and Group B, it is concluded

that Group A (Arohana Krama Matravasti) is more effective than Group B (Sadharana

Krama Matravasti) in almost all parameters (Except the Atopa which is not significant).

The study reviles that in both Group A and Group B, therapy is effective as it decreases


213

Discussion

Sandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana, Walking time and

Stahmaba.

6. Mode of Action Of Therapy:

Here in this study the two different varieties of Matravasti i.e. Arohana Krama

and Sadharana Krama, was administered and their efficacy in Sandhigata vata is assessed.

The probable modes of action of the therapy can be understood by considering the

general mode of action of Vasti, which are explained earlier in the context of literary

review of Vasti karma.

The drugs administered though the anal route i.e. Pakwashaya gata vasti directly

act over the Udbhavasthana of Vatavyadhi including Sandhigata vata as Pakwashaya is

considered as Udbhavasthana of Vatavyadhi.

The Matravasti was administered in Left lateral position as explained in

Ayurvedic classics. The benefits of this position were explained elaborately in classics.

Acharya Charaka opines that, gudavalees will be relaxed in this posture and also Grahani

and Guda present in Vama parshwa (Left side). So vasti dravya reaches these organs

easily, if the patient receives vasti in left lateral position. Acharya Gangadhara says;

Agni, Grahani and Nabhi are present in the left side. Jejjata comments Agni is present in

left side over the Nabhi, Guda has got a left sided relation with Sthoolantra. So

vastidravya can reach to the large intestine and Grahani, as they are present in the same

level. So can do the persuasion that, Agni may act over the sneha administered through

matravasti and help in the action of that Snehadravya. The modern Anatomy supports this

view as – In this posture; anal canal turns to left side to rectum, sigmoid colon and


214

Discussion

descending colon. Moreover, medicines stay at these surfaces and gets absorbed more

and show its effect. The absorptive area of mucosa is more on left side and it is easily

approachable through anus rather than on the right side and this posture relaxes the ileo-

ceacal juction and makes the easy flow of Vastidravya into the sigmoid colon.

Action of Matravasti is possible by Anupravaranabhava of vastidravya, which

contains sneha. Sneha easily moves up to Grahani by Anupravanabhava guna. Matravasti

acts mainly on Asthi and Majjavaha srotas. Asthi is the Ashrayasthana of Vata dosha.

Dalhana says that Pureeshadharakala and Asthidharakala are one and the same. So we

can assume that if pureeshadharakala gets purified and nourished; the asthivaha srotas

will also be purified and nourished. Pittadharakala and Majjadharakala and Grahani part

takes in the action of Matravasti. Vastidravya enters till Grahani (Pittadhara Kala) which

is the seat of agni. The nutrients may get absorbed and thereby nourishes the

Majjadharakala, which is having a strong bond with Pittadharakala and Vata. Matravasti

of Kethakyadi taila comprises Kethaki mula, Bala, Atibala and Tilataila, having the

properties like Snigdha guna and Vatashamaka and acts as balya and vatahara. Thus

provides significant effect on almost all the symptoms of Sandhigatavata.

The absorption of Taila is enhanced by the longer duration of retentions of Vasti

dravya. According to modern science, the rectum has a rich blood and lymph supply.

Drugs can readily cross the rectal mucosa like other lipid membrane. As per Vasti/Enema

concerned, in trans-rectal route, the unionized and lipid soluble substances are readily

absorbed from the rectum. The concentration gradient of Matravasti dravya is more

inside the lumen of intestine as compared to rectal venous plexus, which facilitates the

absorption. This rectal venous plexus further divided into internal venous plexus and


215

Discussion

external venous plexus. Internal venous plexus, situated in the submocosal layer of anal

canal and carries into superior rectal vein and to external venous plexus. Vasti dravya is

also absorbed from external venous plexus in three parts, i.e. in lower part through

inferior rectal veins and drained into internal pudendal vein, in middle part through

middle rectal vein which is having tributaries, those drains from bladder, prostate and

seminal vesicle into internal iliac vein, in upper part through superior rectal vein into

inferior mesenteric vein a tributary of portal vein. Matravasti dravya is also absorbed

from the upper rectal mucosa, and is carried by the Superior mesenteric vein into the

portal circulation and enters into Liver. Secondly, the portion absorbed from the lower

rectum enters directly into systemic circulation via middle and inferior hemorrhoidal

veins. This indicates that due to more vascularity in this area absorption rate is high.

Other major advantage of this route is total gastric irritation is avoided and also

Metabolism as some portion of absorption from lower rectum directly enters into

systemic circulation. The absorption of Sneha also enhasced by its Hypo osmotic nature.

Some studies shown Matravasti have got a property to regulate sympathetic activity,

decreases adrenalin and noradrenalin secretion and helps in the balance of autonomic

nervous system and also plays major role in maintaining normal bacterial flora.

Sandhigata vata required drug which is having two characters like supportive and

Supplementary. In supportive aspect it gives relief in symptoms of sandhigata vata. So

the drug which is having Vatahara properties and Sigda, Picchila etc Kaphavardhaka

guna is useful in better way. In supplementary aspect the drug which is having dhatu

vardhaka property is useful for prevention or to stop further degenerative changes in the

body. The Kethakyadi Taila having both these properties as its ingredient Kethaki mula,


216

Discussion

Bala and Atibala are known for its Vatahara property; The Tilataila is having snigda,

picchila etc Kaphavardhaka guna. The dhatu vardhaka property is seen in all ingredient of

Kethakyadi Taila.

By considering above explanation it is clear that Vasti dravya is absorbed through

rectal mucosa and carried throughout the general circulation gives local and systemic

effects by controlling Vata which is backbone of the disease pathology.

Arohana Krama- Sadharana Krama Matravasti:

The Meterials & Methodology in both groups were same except the dose of the

Snehadravya. The response in the Arohana Krama Matra vasti group was better compare

to Sadharana Krama Matravasti Group. This may be due to the administration of

comparatively large dose of Sneha in this group and gradual increase in dose which

facilitated long duration of retention which lead to better absorption.

Table No. 89: Indicating retention time of Arohana krama Matravasti: SI No 1st

Day 2nd Day

3rd Day

4th Day

5th Day

5th Day

6th Day

7th Day

8th Day

9th Day

01 4125 2 3 5.5 5 8 7.5 8 11 11 02 4360 1.5 4 5 8 9 10 10 5 5 03 4375 10 7.5 7.5 2 9 11 11 10 8 04 4412 3.5 3 4 5.5 4 5 5 4 2.5 05 4435 7 10 10 11 10 7 7 6.5 7.5 06 4478 2.5 9.5 10 11.5 12 12 12 4.5 8 07 4480 4 5.5 6.5 6.5 10 9.5 9.5 6.5 7 08 5697 6 10 9 11.5 11.5 12.5 11.5 8 8 09 6197 2 3 6 4 4 7.5 4 4 4 10 6203 7 3.5 7.5 9.5 9.5 7.5 7 9.5 7.5 11 6337 6.5 5 6 8.5 9.5 7.5 7.5 7.5 9 12 7874 5 7 10 10.5 11.5 10.5 10.5 7.5 7 13 8230 2 2.5 3 3 4.5 3.5 3.5 3.5 3.5 14 8234 2 5 6 8 8 4 4 6 6 15 8335 7 9 7 11 12 11 11 9 9 Average 4.5 5.8 6.86 7.7 8.8 8.46 8.1 6.83 6.86


217

Discussion

There is a gradual increase in the duration of retention in initial days. The

maximum time of retention noted on 5th day with the dose of 96 ml. Then the time

gradually decreases for small extent in succeeding four days as dose of Matravasti

increases. This comparative long duration of retention may be because of adoptive

mechanism of organs to withhold the dose of Vasti. This supports the view that

Sandhigata vata requires the large dose of sneha internally and Vasti can be consider as a

route of administer this sneha.


218

Conclusion

Conclusion:

Finally the following conclusions are drawn:-

• Arohana krama matravasti can be practiced safely without any adverse effect.

• Overall the group A is more effective clinically and statistically than group B in

almost all the parameters.

• Arohana Krama matra vasti can be considered for future studies in Uttama Matra.

(As explained by Acharya Adamalla).

• This study should be done on large sample so that definite conclusions can be

drawn as the present study is limited to small sample of 30 patients.


219

Summary

Summary:

The thesis entitled “Evaluation on the effect of Matravasti in Sandhi gata vata

with Kethakyadi taila in Arohana krama and Sadharana krama – A comparative clinical

study” is summarized as under.

The Sandhigata Vata explained in Ayurvedic classics as Sthana vishesha kruta

Vatavyadhi, under the concept of Gatavata. The vitiated Vata dosha get lodged in Asti

sandhis and give raise to Sandhigata vata. This is one of such disease commonly affecting

a large number of elderly individuals. This disease can be compared with Osteoarthritis

of contemporary medical science. Osteoarthritis is an important cause of disability in

human beings. It is characterized by focal loss of cartilage with evidence of

accompanying periarticular bone response in the form of sub condral sclerosis and

attempted new bone overgrowths called osteophytes. It cleanically presents as joint pain

and crepitus in the elderly age group. According to W.H.O Osteoarthritis is the second

commonest musculoskeletal problem in the world population (30%) after back pain

(50%). The reported prevalence of O.A from a study in rural India is 5.78 %. In

Ayurveda, all Acharyas have given prime importance to Snehana Chikitsa in the

management of Sandhigatavata. Snehana can be performed both Bahya and Abhyantara.

Bahya snehas include abhyanga, tarpana, murdhni taila etc and Abhyantara snehas

include bhojana, pana, nasya and Vasti. These suggest that treatment measures proposed

in case of Sandhigatavata are mainly aimed at Brumhana. Matravasti is a variety of

Anuvasana vasti which does not produce any complications. It can be performed in

durbala and vruddha, where other vastis are usually contraindicated. As Sandhigatavata is

the disease of elderly, Matravasti which acts as vatahara, brumhana and balya can be


220

Summary

considered as best line of treatment. But in Matravasti comparatively small quantity of

Sneha is administering. To administer a large dose of Sneha in this condition, Arohana

karma as explained by Acharya Adamalla was considered in this study.


e) To evaluate the efficacy of Matravasti administered in Arohana krama for 9 days

by using Kethakyadi taila in Sandhigatavata.

f) To evaluate the efficacy of Matravasti administered in Sadharana krama i.e. fixed

dose of 1 ½ pala for 9 days by using Kethakyadi taila in Sandigatavata.

g) To evaluate the adverse- effects of Arohana krama Matravasti if any.

h) To evaluate the efficacy of Kethakyadi taila administered as Arhohana karma as

well as Sadharana karma in Sandhigata vata.

Matravasti is a variety of Snehavasti based on vasti dravya pramana. The dose is

equal to Hruswa sneha pana Matra. Direct reference on Matravasti is not visible in Vedas

but detailed descriptions were found in most of all Ayurvedic classics. Matravasti is a

type of Anuvasana vasti which is having main ingredient sneha. Arohana krama of

Matravasti was described by Acharya Adhamalla on commenting Shargandhara samhita

Uttara Khanda, Vasti vidhi Adhyaya (Fifth chapter). The dose of Sadharana krama

Matravasti is equal to Hruswa sneha pana Matra.

The chikitsa sootra of Sandhigatavata is Snehana, Svedana and Agnikarma and

for the Asthi pradoshaja vikaras Panchakarma is indicated. Since it is a Vata Vikara

related to Asti sandhis and Dhatukshaya is the resultant, Snehana in the form of Vasti

would be an ideal line of treatment.


221

Summary

Sandhigata vata required drug which is having two characters like supportive and

Supplementary. In supportive aspect it gives relief in symptoms of sandhigata vata. So

the drug which is having Vatahara properties and Sigda, Picchila etc Kaphavardhaka

guna is useful in better way. In supplementary aspect the drug which is having dhatu

vardhaka property is useful for prevention or to stop further degenerative changes in the

body. The Kethakyadi Taila having both these properties as its ingredient Kethaki mula,

Bala and Atibala are known for its Vatahara property; The Tilataila is having snigda,

picchila etc Kaphavardhaka guna. The dhatu vardhaka property is seen in all ingredient of

Kethakyadi Taila.

Study Design: The study design set for the present study is ‘comparative clinical study’.

Sample size and Grouping: The sample size for the present study was 30 patients

suffering from Sandhigathavata as per the selection criteria and was randomly distributed

to both the groups of equal size. In Group A, 15 patients received Arohana krama

Matravasti and in Group B, 15 patients received Sadharana krama Matra vasti.

Inclusion criteria: Patients suffering from classical signs and symptoms of Sandhigatavata

like shotha in sandhi, shoola in sandhi, atopa in sandhi, fit for Vasti karma (Vasti yogya)

and between age group of 30 to 70 yrs, No discrimination of sex and chronicity.

Exclusion criteria: Patient below 30 yrs & above 70 yrs of age, pregnant women,

associated with any other severe systemic diseases like Diabetes, Hypertensions and

Obesity etc were excluded.

Study duration: In both group, Matravasti was administered for 9 days and follow up

period was 18 days. Total study duration was 27 days.

Posology:


222

Summary

Arohana Krama: Here Matra vasti is administered for nine days in increasing order of

the dose of Taila. First day started with 48ml (1pala). Daily 12ml (1/4th pala) was

increased till 9th day i.e. 144 ml.

Sadharana Krama: Here Matra vasti is administered in fixed dose of 72ml (1½ pala) for

nine days.

Methods of Assessment of Clinical Response: Subjective parameters and objective

parameters were made out to assess the Clinical response.

Subjective Parameters: Prasarana Aakunchanayoho savedana pravruthihi (Vedana) and

Sthamba (Morning stiffness)

Objective parameters: Sandhi Atopa, Sandhishothaha, Sandigati Asamarthya, Walking

time to cover 21meters of distance, WOMAC

Result: All these parameters of baseline data to post-medication data (27th day) were

compared for clinical assessment of the results.

In this study, in group A one patient (06.66%) shown Good response (> 75%

improvement in subjective and objective parameters) where 7 patients (46.66 %) were

shown Moderate response (50-75% improvement in subjective and objective parameters)

and 7 (46.66 %) were shown Poor response (<50% improvement in subjective and

objective parameters).

In Group B, 10 patients (66.66 %) were shown Moderate response (50-75% improvement

in subjective and objective parameters) and 5 patients (33.33 %) were shown Poor

response (<50% improvement in subjective and objective parameters).

The calculated, mean percentage of improvement in each parameter shown except the

Parameter Sthamba, all other parameters are shown the better improvement in group A


223

Summary

than Group B. Among all parameter the Sandhi Shota had shown the highest percentage

(81.85 %) improvement in group A and in Group B the Stamba had shown highest

percentage (73.4 %) of improvement.

Statastical Analysis:

To know among which Group treatment procedure is more effective, the



In analysis, all the parameters shown highly significance in both the Groups as

P<0.05. The parameter atopa shows more significance in group A rather than group B

which is not significant.

In Group-A the parameters, Prasarana Akunchanayoho Savedana, Sthamba,

Sandhigati Asamarthata and Walking time shows more highly significant (By comparing

t-values) than Group B . In Group-B the parameters Shota, Sandigathi Asamarthatha and

WOMAC shows more highly significant than group A.

Conclusion: By comparing results of Group A and Group B, it is concluded that Group

A (Arohana Krama Matravasti) is more effective than Group B (Sadharana Krama

Matravasti) in almost all parameters (Except the Atopa, which is not significant). The

study reviles that in both Group A and Group B, therapy is effective as it decreases

Sandhigathi Asamarthatha, Prasarana Akunchanayoho Savedana, Walking time and

Stahmaba.


224

Bibliography

Bibliography:

1. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No. 37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 618.

2. Vaidya Jadavaji Trikamji Acharya edited Acharya edited Sushruta Samhita,

Nibhandhasangraha commentory by Dalhana on Shareera Sthana, Chapter 05, Shloka no.28, Edition: Reprint: 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 367.

3. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited Ashtanga Hrudaya,

Sutra Sthana, Chapter 11, Shloka No.126, Edition: Reprint, 2007, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No. 186.

4. Siddharth N. Shah edited API text book of Medicine, 8th edition 2008, Pub: The

Association of Physicians of India, Page No. 279.

5. Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker and John A.A. Hunter edited Davidson’s Principles and Practice of Medicine, 20th edition 2006, Pub: Churchill Livingstone, Elsevier, Page No. 97.

6. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra sthana, Chapter

16, Shloka No.20, Edition:2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No 618.

7. Pandit Parashurama Shastri edited Sharangadhara Samhita, Uttara Khanda,

Chapter 8, Shloka No.63, Edition: 3rd 1983, Vidyasagar, Pub: Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.346.

8. Prof. K.R. Srikantha Murthy edited Bhavaprakasha, Purvakhanda, 5nd Chapter,

Shloka no. 1, Edition First !998, Pub: Krishnadas Academy, Varanasi (UP), Page no. 562.

9. Dr.Nirmal Sexena edited Vangasena Samhita, Vol II, 79nd Chapter, Shloka No.1,

1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1127.

10. Vaidya Jadavaji Trikamji Acharya edited Acharya edited Sushruta Samhita,

Nibhandhasangraha commentory by Dalhana on Sutra Sthana, Chapter 05, Shloka no.3, Edition: Reprint: 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 19.


225

Bibliography

11. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, 35th chapter, Shloka no.3, Edition: Reprint: 2008,Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 525.

12. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibhandhasangraha

commentory by Dalhana on Chikitsa Sthana, Chapter 4, Shloka no.8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 420.

13. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, 31th

chapter, Shloka no.3, Edition: Reprint 2008, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No. 507.

14. Pandit Parashurama Shastri Vidyasagar edited Sharangadhara Samhita, Deepika

Commentory by Adamalla on Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.

15. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, chikitsa sthana,

Chapter 28, Shloka no. 37, Edition:2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No 618.

16. Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker and John A.A. Hunter

edited Davidson’s Principles and Practice of Medicine, 20th edition 2006, Pub: Churchill Livingstone, Elsevier, Page No. 1096.

17. Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker edited Davidson’s

Principles and Practice of Medicine, 20th edition 2006, Pub: Churchill livingstone, Elsevier, Page No. 1096.

18. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa sthana,

Chapter 28, Shloka no.104-106, Edition:Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 621.

19. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana,

Chapter 4, Shloka No.8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 420.

20. Dr. K. Nishteswar and Dr. R.Vidyanath edited Sahasrayogam, Taila prakarana,

Edition:Second 2008, Pub: Chowkhamba Sanskrit series office, K.37/99, Gopal Mandir lane,Golghar, Post box No.1008, Varanasi (UP), Page No.112.


226

Bibliography

21. Pandit Parashurama Shastri Vidyasagar edited Sharangadhara Samhita, Deepika Commentory by Adamalla on Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.

22. Acharya Agnivesha, Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka no.53,

Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition:Reprint 2008, Page No 701.

23. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 229. shloka

63. Second edition, . Pub:Varanasi Sanskrita University, Varanasi, Page no. 335.

24. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 279. shloka 63, Second edition, . Pub: Varanasi Sanskrita University, Varanasi Page no. 412.

25. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 289, shloka

14, Second edition, Pub:Varanasi Sanskrita University, Varanasi Page no. 428.

26. Acharya Baladeva Upadhyaya, edited, Agnipurana adhyaya, sankhya 289, Shloka 46, Second edition, Pub: Varanasi Sanskrita University, Varanasi Page no. 429.

27. Acharya Agnivesha, Charaka Samhita, Sutra Sthana, Chapter 2, Shloka No.15,

Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition: Reprint 2008, Page No 25.

28. Acharya Agnivesha, Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka no. 52-

54, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition: Reprint 2008, Page No 701.

29. Acharya Sushruta, Sushruta Samhita, Chikitsa Sthana, 35th chapter, Shloka no.18,

Edited by Vaidya Jadavaji Trikamji Acharya, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.

30. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28,

Shloka No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.

31. Acharya Laghu Vagbhatta, Ashtanga Hrudaya, Sutra Sthana, Chapter 19, Shloka

no. 67-69, annotated by Dr. Anna Moreshwar Kunte and Krshna Ramachandra Shasti Navre, editted by Pt. Hari Sadashiva shastri Paradakara Bishagacharya,


227

Bibliography

Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint, 2007, Page No. 283.

32. Acharya Sharangadhara, Sharangadhara Samhita, Uttara Khanda, Chapter 5,

Shloka No.5, edited by Pandit Parashurama Shastri, Vidyasagar, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.320.

33. Acharya Bhavamishra, Bhavaprakasha, Purvakhanda, 5nd Chapter, Shloka no.

101, Edited by Prof. K.R. Srikantha Murthy, Pub: Krishnadas Academy, Varanasi (UP), First edition !998, Page no. 575.

34. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Siddhi Sthana, Chapter

1, Shlokha No. 18-19, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 147.

35. Acharya Bhela, Bhela Samhita, Siddhi Sthana, Chapter 5-8, Edited by Prof.

Priyavrat Sharma, Pub: Chaukambha Visvabharati, Varanasi (UP), Edition:Reprint 2005, Page No.542-563.

36. Acharya Chakrapanidatta, Chakradatta, Chapter 72 (Anuvasanadhikara), Shloka

No.3-4, Edited by Priyavrat Sharma, Pub:Chaukhambha Publishers, Varanasi(UP), Edition: Second1998, Page No.619.

37. Acharya Vangasena, Vangasena Samhita, Vol II, Chapter 83, Shloka no.20-22,

Edited by Dr.Nirmal Sexena, Chawkhambha Sanskrit Series office, Varanasi (UP), Edition: First 2004, Page No.1147.

38. Acharya Adamalla, Deepika Commentory on Sharangadhara Samhita, Uttara

Khanda, Chapter 5, Shloka No.5, edited by Pandit Parashurama Shastri, Vidyasagar, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.320.

39. Acharya Bhavamishra, Bhavaprakasha, Purvakhanda, 5nd Chapter, Shloka no.

101, Edited by Prof. K.R. Srikantha Murthy, Pub: Krishnadas Academy, Varanasi (UP), First edition !998, Page no. 575.

40. Priyavrat Sharma edited Chakradatta, Chapter 72 (Anuvasanadhikara), Shloka

No.3-4, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K-37/109, Gopal Mandir lane, Varanasi (UP), Page No. 619.

41. Dr.Nirmal Sexena edited Vangasena Samhita, Vol II, Chapter 79 (Anuvasanadhikara), Shloka No.1, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1147.


228

Bibliography

42. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka No.2, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.212.

43. Acharya Sharangadhara, Sharangadhara Samhita, Uttara Khanda, Chapter 5,

Shloka No.1, edited by Pandit Parashurama Shastri Vidyasagar, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), 3rd edition 1983, Page No.319.

44. Acharya Agnivesha, Charaka Samhita, Siddhi Sthana, Chapter 1, Shloka no. 40-

41, Edited by Vaidya Jadavaji Trikamji Acharya, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Edition: Reprint 2008, Page No 684.

45. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya,

Sutra Sthana, Chapter 19, Shloka No. 67-69, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No. 283.

46. Raja Radha Kanta Deva edited Shabda Kalpadruma, 1st volume, Edition:

Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.189. 47. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition:

Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.328.

48. Raja Radha Kanta Deva edited Shabda Kalpadruma, IIth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.338.

49. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter

29, Shloka no. 5, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 181.


Shareera Sthana, Chapter 3, Shloka No.13, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.388.

51. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana,

Chapter 6, Shloka No.9, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.




229

Bibliography

53. Pt. Haragovinda Shastri edited Amarakosha, Dwiteeya Khanda, Manushya Varga, Shloka No.73, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthana, Varanasi, Page No. 293

54. Raja Radha Kanta Deva edited Shabda Kalpadruma, IIth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.338.



56. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibandhasangraha

Commentory on Nidana Sthana, Chapter 2, Shloka No.6, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 272.

57. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana,




59. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Shareera Sthana,

Chapter 7, Shloka No.10, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 338.








230

Bibliography

63. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 6, Shloka No.7, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 370.








29, Shloka No.3, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 181.



69. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana,





Sutra Sthana, Chapter 12, Shloka No.8, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.193.

72. Martini.F.H edited, Fundamentals of Anatomy and Physiology, chapter 24, 4th

edition1998, Pub: New Jersey: Prentice Hall Inc. Simon & Schuster, Page no. 899.




231

Bibliography


Shareera Sthana, Chapter 3, Shloka No.10-11, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.387.



76. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya-

Sarvangasundara Commentory on Shareera Sthana, Chapter 3, Shloka No.10-11, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.387.

77. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Prathama

Khanda, Chapter 5, Shloka No.9, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.44.

78. Martini.F.H, edited, Fundamentals of Anatomy and Physiology, Chapter 24, 4th

ed. New Jersey: Prentice Hall Inc. Simon & Schuster; 1998, Page No. 900.

79. Prof. Priyavrat Sharma edited Bhela Samhita, Sutra Sthana, Chapter 16, Shloka No.2, Edition:Reprint 2005, Pub: Chaukambha Visvabharati, Varanasi (UP), Page No.70

80. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Prathama







Sarvangasundara Commentory on Sutra Sthana, Chapter 1, Shloka No.25, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.16.


232

Bibliography

84. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 10, Shloka No.5, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 724.

85. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana,

Chapter 10, Shloka No.6-7, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 724.





88. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana,





Chapter 1, Shloka No.27-28, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 682

. 91. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Khila Sthana, Chapter

8, Shlokha No. 54, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 147.

92. Dr.Suresh Babu edited The principles and practice of Kaya cikitsa, Vol IV,

Chapter 6, Edition: First 2008, Pub:Chaukhambha Orientalia, Post box No.1032, Gokul Bhawan, K.37/109, Gopal Mandir lane,Golghar, Maidagin, Varanasi (UP), Page No.65




233

Bibliography

94. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.








Chapter 8, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713-715.


Chapter 1,Shloka No. 47-49, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 684.

100. Sri Satyapala Bhishagacharya edited Kashyapa Samhita, Khila Sthana, Chapter

8, Shlokha No.6-15, Edition: Reprint 2006, Pub: Chaukhambha Sanskrit Sansthan, Varanasi, Page No. 147.


Chapter 12, Shloka No. 16, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 731-732.

102. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara


103. Dr.Nirmal Sexena edited, Vangasena Samhita, Vol II, Chapter 83

(Vastikarmadhikara), Shloka no. 177-178, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1163.


234

Bibliography

104. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Uttara Khanda, Chapter 6, Shloka No.32, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.335.




Chapter 8,Shloka No. 4, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713.




Khanda, Chapter 6, Shloka No.23-24, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.334.




(Vastikarmadhikara), Shloka no.186-190, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1164.




Chapter 8, Shloka No. 2-14, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 713.


Chapter 38, Shloka No.37-41, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 542-543.


235

Bibliography

114. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Chikitsa Sthana, Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.




















236

Bibliography

124. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 13, Shloka No.29, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 83.


Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526.

126. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Ayurveda Deepika

commentory by Chakrapanidatta on Siddhi Sthana, Chapter 4, Shloka No.53, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.

127. Sri. Satyapala Bhishagacharya edited Kashyapa Samhita, Siddhi Sthana, Chapter 1,

Shloka No.11-20, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthan, Post box No.1139, K.37/116, Gopal Mandir lane, Varanasi (UP), Page No 147.

128. Sri. Satyapala Bhishagacharya edited Kashyapa Samhita, Kkila Sthana, Chapter 8,

Shloka No.104-105, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthan, Post box No.1139, K.37/116, Gopal Mandir lane, Varanasi (UP), Page No 285.



130. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Deepika commentory by Adamalla on Uttara Khanda, Chapter 5, Shloka No.5, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.320.


No.3-4, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K-37/109, Gopal Mandir lane, Varanasi (UP), Page No. 619.

132. Dr.Nirmal Sexena edited Vangasena Samhita, Vol II, Chapter 79

(Anuvasanadhikara), Shloha No.20-22, 1st edition 2004, Pub: Chawkhambha Sanskrit Series office, Varanasi (UP), Page No.1147.

133. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter

4, Shloka No.52-54, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 701.

134. Dr. Shivprasad Sharma edited Astanga Sangraha, Sutra Sthana, Chapter 28, Shloka

No.8, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.213.


237

Bibliography

135. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Ayurved Rasayana Commentory by Hemadri on Sutra Sthana, Chapter 19, Shloka No.69, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.283.












Sutra Sthana, Chapter 19, Shloka No.12-13, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.273.


Chapter 35, Shloka No.9, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 525-526.





145. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Ayurveda deepika

commentory by Chakrapani on Siddhi Sthana, Chapter 3, Shloka No.10, Edition:


238

Bibliography

Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 691.


Ayurved Rasayana Commentory by Hemadri on Sutra Sthana, Chapter 19, Shloka No.16, Reprint, 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.274.








Chapter 36, Shloka No.6-11, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 529.












239

Bibliography






Sutra Sthana, Chapter 19, Shloka No.26-30, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.276-277.










Sutra Sthana, Chapter 19, Shloka No.27-29, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Page No.276.






240

Bibliography

166. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Siddhi Sthana, Chapter 4, Shloka No.26-30, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 699-700.
















Sutra Sthana, Chapter 11, Shloka No.26, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.186.

175. Dr. M.R. Vasudevan Nampoothiri and Dr. L. Mahadevan edited Principles and

Practice of Vasti, Chapter 11, Second Edition-November 2007, Pub: Dr. Y. Mahadeva Iyer’s Sri Sarada Ayurvedic Hospital, Derisanamcope, Kanyakumari Dist, Tamilnadu, Page No.176.


241

Bibliography

176. Dr. P.V. Sharma edited India Medicine in Classical Age, Second edition 2000, Pub: Chaukhamba Amarabharati Prakashana, Post box No. 1138, K.37/130, Gopal Mandir Lane, Varanasi, Page No.63-64.

177. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Yajurveda Samhita, 18th

Suktha, Shloka No. 3, 10th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No. 181.

178. Vedamurti Taponista Pt. Sriram Sharma Acharya edited Atharvaveda Samhita, Vol

I, 6th Khanda, 14th suktha, Shloka No. 1 (1330), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.7 (6th Khanda).


I, 9th Khanda, 14th suktha, Shloka No. 21 (2607), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.36(9th Khanda).


II, 11th Khanda, 10th suktha, Shloka No. 14 (3226), 7th edition 2005, Pub: Brahmavarchas, Shantikunja, Haridwar (Uttaranchal), Page No.36(11th Khanda).







184. Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15,


185. Dr. Shivprasad Sharma edited Astanga Sangraha, Chikitsa Sthana, Chapter 23,

Shloka No.11, Edition: First 2006, Pub:Chowkhamba Sanskrit Series Office, K.37/99, Gopal Mandir lane, Post box No.1008, Varanasi (UP),Page No.565


Nidana Sthana, Chapter 15, Shloka No.14, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531.


242

Bibliography

187. Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya, Chikitsa Sthana, Chapter 21, Shloka No.22, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.724.

188. Prof. Yadunandana Upadhyaya edited, Madhava Nidanam, Vol I, Chapter 22

(Vatavyadhi Nidanam), Shloka No. 21, Thirtyth Edition:2000, Pub: Chaukhambha Sanskrit Bhawan, Post box No. 1160, CHOWK, Varanasi, Page No. 418

189. Prof. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda,

Chapter 24, shloka No. 258-259, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.

190. Dr. Indradev tripathi and Dr. Daya Shankar Tripathi edited Yogaratnakara,

Vatavyadhi Nidana, Shloka No. 25 and Vatavyadhi Chikitsa, Shloka No. 119, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 403 and 412.

191. Prof. Priyavrat Sharma edited Bhela Samhita, Chikitsa Sthana, Chapter 24, Shloka

No.48-49, Edition:Reprint 2005, Pub: Chaukambha Visvabharati, Oriental Publishers and Distributer, Post Box No. 1084, K.37/109, Gopal Mandir Lane, Varanasi (UP), Page No.455.

192. Ramavalamba Shastri edited Harita Samhita, thriteeya Sthana, Chapter 20, Edition:

First 1985, Pub: Prachya Prakashan, Varanasi, Page No. 308 193. Priyavrat Sharma edited Chakradatta, Chapter 22 (Vatavyadhi chikitsa), Shloka

No.9, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K-37/109, Gopal Mandir lane, Varanasi (UP), Page No. 184.

194. Shri. Rajeshwardatta Shastri edited Bhaishajya Ratnavali, Chapter 26, Shloka No.

14, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 529.

195. Mahamahopadhyaya Gananathsen edited,Siddhanta Nidanam part 2, chapter

7thshloka 513-514, edition, 1966 Varanasi: Chaukamba Sanskrit Series.Page no. 210.

196. Shree Govardhana Sharm edited, Basavarajeeyam, chapter 6th Pub:Choukamba

Vidyabhavan, Varanasi; 1984 Page no .106. 197. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition:

Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.240.


243

Bibliography

198. Raja Radha Kanta Deva edited Shabda Kalpadruma, Vth volume, Edition: Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.240.

199. Vaidyaratnam P.S. Varier edited Brihaccareeram, Vol I, Pratikavibhagaadhyaya,

Edition: 1942, Pub: P. Madhava Warrier, Kottakal, Page No. 25. 200. Raja Radha Kanta Deva edited Shabda Kalpadruma, IInd volume, Edition:

Third1967, Pub:The chowkhamba Sanskrit Series office, Varanasi, Page No.298. 201. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter

21, Shloka No.5, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 99.


Chapter 28, Shloka No.24-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617-618.



204.

• Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Chikitsa Sthana, Chapter 28, Shloka No.37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No. 618.

• Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15,


• Pt. Hari Sadashiva shastri Paradakara Bishagacharya edited, Ashtanga Hrudaya,

Chikitsa Sthana, Chapter 15, Shloka No.14, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.531.

205. Shree Govardhana Sharma edited,Basavarajeeyam, chapter 6th Pub: Choukamba

Vidyabhavan, Varanasi; 1984.Page .no106. 206. Mahamahopadhyaya Gananathsen edited,Siddhanta Nidanam part 2, chapter 7th ,

shloka 513-514, edition, 1966 Varanasi: Chaukamba Sanskrit Series. Page no.210.


244

Bibliography

207. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Shareera Sthana, Chapter 5, Shloka No.26, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 366.




Chapter 5, Shloka No.24 & 27, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 366-367.







213. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nyayachandrika

commentory by Gayadasa on Nidana Sthana, Chapter 1, Shloka No.13, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 259.




Chapter 5, Shloka No.29-36, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No.367.


Chapter 5, Shloka No.37-38, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 367-368.




245

Bibliography






Chapter 6, Shloka No.24, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 372-373.






Chapter 28, Shloka No 15-37, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617-618.

224. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter



Nidana Sthana, Chapter 1, Shloka No.14-15, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.444.


Vatavyadhi Nidana, Shloka No. 1-4, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 402.




246

Bibliography

228. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No.

1-3, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 404.

229. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Vimana Sthana,




231. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter










236. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Madukosha

Commentory on Chapter22, Shloka No. 5, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 410.

237. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Nidana Sthana, Chapter



247

Bibliography



239. Dr. Shivprasad Sharma edited Astanga Sangraha, Nidana Sthana, Chapter 15,







21, Edition: Thirtyth 2000, Pub: Chaukhamba Sanskrit Bhavan, Post Box No. 1160, Varanasi, Page No. 418.

243. K.R. Srikantha Murthy editeed Bhavaprakasha, Vol II, Madhyama Khanda, Chapter

24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.


Vatavyadhi Nidana, Shloka No. 14, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 407.








248

Bibliography

248. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nidana Sthana, Chapter 1, Shloka No.28, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 261.




Chapter 24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.

251. Sri. Ganga Sahaya Pandeya edited Gadanigraha, Part II, Ist Edition 1969, Pub:

Choukhamba Sanskrit Series office, Varanasi, Page No. 473. 252. Prof. Yadunadana Upadhyaya edited Madava Nidana, Part I, Chapter22, Shloka No.











1, Shloka No.12, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 197


Chapter 28, Shloka No.18, Edition: Reprint 2008, Pub: Chaukhamba Surbharati


249

Bibliography

Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 617.










10, Shloka No.11-20, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 66-67.





266. Pt. Haragovinda Shastri edited Amarakosha, Dwiteeya Khanda, Chapter 6

(Manushya Varga), Shloka No.50, Edition: Reprint 2006, Pub: Chaukhamba Sanskrit Sansthana, Varanasi, Page No. 281.




Sutra Sthana, Chapter 13, Shloka No.1-3, Reprint 2007, Pub:Chaukhamba


250

Bibliography

Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.211.



270. Dr. Shivprasad Sharma edited Astanga Sangraha, Chikitsa Sthana, Chapter 23,



Chikitsa Sthana, Chapter 21, Shloka No.22-23, Reprint 2007, Pub:Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No.825.


Vatavyadhi Chikitsa, Shloka No. 119, Edition: First 1998, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No.412.


Chapter 24, shloka No. 258, Edition: Reprint 2002, Pub: Krishnadas Acadamy, Oriental Publishers and Distributer, Post Box No. 1118, K.37/118, Gopal Mandir Lane, Varanasi, Page No. 348.


14, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 529.



276. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Nibandha Sangraha

commentory on Chikitsa Sthana, Chapter 24, Shloka No.30, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 488.






251

Bibliography






















252

Bibliography

289. Vaidya Jadavaji Trikamji Acharya edited Charaka Samhita, Sutra Sthana, Chapter 22, Shloka No.11, Edition: Reprint 2008, Pub: Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box No.1129, Varanasi (UP), Page No 120.




611-625, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 586.


626-630, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 587.

293. Nicholas A. Boon, Nicki R. Colledge, Brian R. Walker and John A.A. Hunter

edited Davidson’s Principles and Practice of Medicine, 20th edition 2006, Pub: Churchill Livingstone, Elsevier, Page No. 1096.

294. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Pub: Philadelphia

WB Saunders Company; 1997. p. 1471 295. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L.

Longo, J.Larry Jameson, Joseph Loscolzo edited Harrison’s Principles of Internal Medicine, Vol II, 17th Edition, Pub: Mc Graw-Hill Companies, Newyork, Page No.2159.

296. Kenneth. J. Koval, edited, Orthopedic Knowledge Update-7th first Indian edition, 2004, pub: Jaypee Brothers Medical publication Page .no.193.

297. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L.


298. Anthony S. Fauci, Engene Braun Wall, Dennis L.Kasper, Stephen L.Hauser, Dan L.


299. http:/www.fda.gov/ohrms/DOCKETS/ac/08/briefing/2008-4404bi-05%20WOMAC%20questionnarie.pdf on 06-09-09

300. Dr. K. Nishteswar and Dr. R.Vidyanath edited Sahasrayogam, Taila prakarana,

Edition: Second 2008, Pub: Chowkhamba Sanskrit series office, K.37/99, Gopal Mandir lane,Golghar, Post box No.1008, Varanasi (UP), Page No.112.


253

Bibliography

301. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub: Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.141.

302. Prof. P.V. Sharma edited Dravyaguna Vijnana, Vol II, Edition: Reprint 2001, Pub:

Chaukhambha Bharati Academy, Post Box No. 1065, Gokul Bhawan, K.37/109, Gopal Mandir Lane, Varanasi, Page No.734.



305. Pandit Parashurama Shastri Vidyasagar edited, Sharangadhara Samhita, Madhyama

Khanda, Chapter 9, Shloka No.1-2, 3rd edition 1983, Pub:Chawkambha Orientalia, P.B.32, K, 37/109, Gopal Mandir lane, Varanasi (UP), Page No.212.


1286-1287, Edition: Eighteenth Revised Edition 2005, Pub: Chaukhambha Sanskrit Sansthan, varanasi, Page No. 185-186.

307. Dr. Suresh Babu edited Research Methodology for Ayurvedic Scholars, Chapter 1,

Edition: Second 2004, Pub: Chaukhambha Orientalia, Varanasi, Page No. 2. 308. Nair.P.R, Management of Khanja and Pangu with Panchakarma, New Delhi;

CCRAS: 1999, Page No.40. 309. Vaidya Jadavaji Trikamji Acharya edited Sushruta Samhita, Sutra Sthana, Chapter





No.3, Edition: Second1998, Pub: Chawkhambha Publishers, Gokul Bhawan, K-37/109, Gopal Mandir lane, Varanasi (UP), Page No. 619.




Chapter 35, Shloka No.18, Chaukhamba Surbharati Prakashan K.37/117, Gopal Mandir lane, post box No.1129, Varanasi (UP), Reprint: 2008, Page No. 526


254

Annexure

Arohana krama and Sadharana kram Sandh

SPECIAL CASE SHEET FOR SANDHIGATAVATA (Ketakyadi Taila Matravasti in Sadarana & Arohana krama)

Post Graduate Research And Studies Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag.

Guide: Dr.Suresh Babu Co-Guide: Dr.Santosh N Belavadi. MD (Ayu) MD (Ayu)

PG Scholar: Sanath kumar D.G 1. Name of the patient : ____________________ 2. Father’s / Husband’s Name : ____________________ 3. Age _______ yrs. Place of Birth __________________ 4. Sex Education __________________ 5. Marital Status Married ( ) Unmarried ( ) 6. Religion Hindu ( ) / Muslim ( ) / Christian ( ) / Others ( ) 7. Occupation Labour ( ) Student ( ) Executive ( ) Sedentary ( ) 8. Economical Status Poor ( )/ Lower Middle ( ) / Upper Middle ( )/ Rich ( ) 9. Address _______________________ E-mail ID _____________

_______________________ Phone No _____________

_______________________ Pin __________________

D M Y 10. Date of commencement of treatment: Completion:

11. Result:

COI am fully educated with the disease and tmedical trial on me happily.

R

D M Y

M

a Matra vasti with Kethakyaigatavata

NSENT reatment there by I got satisfie

Sig

SL.No O.P.D. No I.P.D. No

F

di

d.

nat
Good esponse
Moderate Response

Poor Response No

Response

Taila in 255

I accept for

ure of Patient

Annexure

Pradana Vedana with duration:

Sl. No Pradhana vedana Avadhi

1 Prasaarana Aakunchanayoho

Savedana Pravruthihi

2 Sandhi atopa

A. Vyadhi vruttanta:

a) Mode of onset Chronic Insidious Acute Traumatic

b) Nature of pain

Pricking Aching Generalized Tearing Burning

c) Variation of pain in Joint

Increased on move Increased in rest Nocturnal

d) Routine activities affected:

1) Descending stairs YES [ ] NO [ ]

2) Ascending stairs YES [ ] NO [ ]

3) Rising from sitting YES [ ] NO [ ]

4) Standing YES [ ] NO [ ]

5) Bending to floor YES [ ] NO [ ]

6) Walking on Flat surface YES [ ] NO [ ]

7) Rising from bed YES [ ] NO [ ]

SI. No Anubandhi vedana Avadhi

1 Sandhisothaha

2 Sandhisthamba

3 Sandhigathi asaamarthya


256

Annexure

8) Lying in bed YES [ ] NO [ ]

9) Getting on/off toilet YES [ ] NO [ ]

B. Purva vyadhi vruttanta:

Episodes of same illness Yes No

Obesity Yes No

Trauma/fracture of

involved or related joints

Yes No

Diabetes Mellitus Yes No

Hypertension Yes No

Other Vatavyadhis Yes No

Fever Yes No

Others Yes No

C. Chikitsa Vruttanta:

D. Kula vruttanta:

Maternal Parental

E. Vayuktika vruttanta :

1 Ahara Vegetarian ( ) Mixed ( )

Rasa: M( ) A( ) L( ) K( ) T( ) K( ) SR( )

2 Vihara Nature of work : Hard ( ) Moderate ( ) Sedentary ( )

3 Agni Samagni ( ) Mandagni ( ) Teekshnagni ( ) Vishamagni ( )

4 Kostha Mrudu ( ) Madhyama ( ) Krura ( )

5 Nidra Prakruta ( ) Alpa ( ) Ati ( ) Diwaswapna ( )

6 Vyasana None ( ) Tobacco ( ) Smoking ( ) Alcohol ( ) Tea/coffee ( )

7 Artava Regular ( ) Irregular ( ) Menopause ( )


257

Annexure

SAMANYA PAREEKSHA:

B. Vital examination :

1. Heart rate /Min

2 Resp rate /Min

3 Blood pressure mm of Hg

4 Body Temp /F

5 Body weight Kgs

A. Asta sthana Pareeksha :

1. Nadi /Min

2 Mala

3 Mootra

4 Jihwa

5 Shabda

6 Sparsha

7 Druk

8 Akruti


258

B. Dasha vidha Pareeksha 1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Sama ( ) 2. Vikruthi

Hethu AL M A Prakruthi Aasukaari Chirakaari

Dosha AL M A Desha AL M A

Dushya AL M A Kaala AL M A

Bala AL M A Linga AL M A

( AL- Alpa, M- Madhyama, A- Adhika)

3 Sara Twak( ) Rakta( ) Mamsa( ) Meda( ) Asthi( ) Shukra( ) Majja ( ) Satwa( )

4 Samhanana Susamhita ( ) Madhyama samhita ( ) Heena Samhita ( )

5 Pramana Supramanita ( ) Adhika ( ) Heena ( ) 6 Satmya Ekarasa ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( ) 7 Satva Pravara ( ) Madhyama ( ) Avara ( )

a) Abhyavaharana shakti : P ( ) M ( ) A ( ) 8

Ahara Shakti b) Jarana shakti : P ( ) M ( ) A ( )

9 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( ) 10 Vaya Balya( ) Madhyama ( ) Vrudda ( )

Annexure

C. Srotho pareeksha (Examination of Musculoskeletal System) Srotas Observed Lakshana

Mamsavaha

Medovaha

Asthivaha

Majjavaha

Special Examination of Joints Joints involved

Knee Right Left

Hip Right Left

Ankle Right Left

First carpo meta carpal Right Left

Distal inter phalangeal Right Left

Proximal inter phalangeal Right Left

A) Darshana:

1) Shotha:

Present Absent

2) A) Deformity: b) Joint instability:

3) Gait:

Normal Abnormal Type

4) Walking time:

Time taken to cover 21 meters

Gr.0 Gr. I Gr. II Gr. III Gr. IV

Present Absent Present Absent


259

Annexure

5) Joint Movement

Active Completely Restricted Partially Restricted Free

Passive Completely Restricted Partially Restricted Free

6) Muscular wasting:

Above the affected joint Yes No

Below the affected joint Yes No

B) Sparshana:

1) Vaatapoornadruthisparsha

Yes No

2) Range Of Movements:

Ease Movement Yes No

Without Ease Movement & Pain Yes No

Restricted yes No

C) Shravana (Auscultation)

1) Sandhi Atopa:

Crepitus Heard Felt None


260

Annexure

VYADHI VISHESHA PAREEKSHA:

Vikruti Pareeksha:

1)Nidana Pareeksha

Tiktharasa Athyupayoga Kashayarasa Athyupayoga

Katurasa Athyupayoga

Alpa Bhojana Pramitha Bhojana Rooksha Bhojana

Ahara

Vega Dhaarana Vegoodeerana Ativyavaya Nisaajaagarana Atyucha Bhaashana Ativyaayama

Vihara

Maanasika Atibhaya Atishoka Atichintha Occupational

Chikitsa Aparaadhaja Shodhanakarma Atiyogaja Yes No

Ushna

Sheetha

Rooksha

Snigdha

2)Upashaya/Anupashya

3)Roopa Vatapoornadrutisparsha Sandhi Atopa Shota Sandhivishlesha Prasarna Akunchanasa Vedana Sandhigraha/ Sthamba 4)Samprapti Ghatakas Dosha

Dushya

Srothas

Agni

Ama

Udbhavasthana

Rogamarga

Adhistana


261

Annexure

Lab Investigations:

SL.No Name of the test Values

1 Hb% G/dl

2 E.S.R. MM/1st hour

3 Total Count Cells/ cumm

P L E M B 4 Differential count

%

%

%

%

%

5 Random Blood Sugar mg/dl

6 Serum R A

Radiological Examination Of Joints: ( Antero posterior and Lateral View)

Radiological reports ………………………………………………………………..

1 Formation of Osteophytes on joint

margin

Present Absent

2 Periarticular ossicles Present Absent

3 Narrowing of joint cartilages Reduced Increased Unaltered

4 Small pseudocytic area in the

subchondral bone

Present Absent

5 Alltered shape of bony ends- head of

the Femur

Present Absent


262

Annexure

Arohana krama and Sadharana krama Matra vasti w Sandhigatavata

Chikitsa: Matravasti:

Sadharana krama

72ml 9days After Food (Around 9AM)

Arohana karma

48-144ml 9 days After Food (Around 9AM)

Group A Group B Sadharana Krama Arohana Krama

Vasti Karma Nireekshana : Date of Vasti initiation: Date of Vasti completion:

Observations: Day Time Amount

Introduced

Time of

Pratyagamana R

I Day

II Day

III Day

IV Day

V Day

VI Day

VII Day

VIII Day

IX Day

Observations:

ith Kethakyadi Taila in 263

Time of

etention

No. of times

Motion passed

Upadrava if

any

Annexure

Day Before Vasti Karma After Vasti karma

BP Pulse Respiration rate

Temp BP Pulse Respiration rate

Temp

I Day II Day III Day IV Day V Day VI Day VII Day VIII Day IX Day Samyak Anuvasita lakshana: 1 2 3 4 5 6 7 8

I Day II Day III Day IV Day V Day VI Day VII Day VIII Day IX Day

Note:

1- Prathyetyasaktham sa shakruccha tailam 2- Rakthadi dhatu prasadana 3- Buddi prasadana 4- Endriya prasadana 5- Samyak swapna 6- Laghuta in shareera 7- Bala vridhi 8- Shrusta vega


264

Annexure

Criteria’s for assessment of results: Pradhana Vedana: SI. No Parameter Day 0 Day 09 Day 27

1 Prasarana Aakunchanayoho savedana pravruthihi

2 Atopa Anubhanda Vedana: SI. No Parameter Day 0 Day 09 Day 27

3 Sandhishothaha 4 Sthamba 5 Sandhigati asamarthata

6. Walking time Day 0 Day 09 Day 27 7. WOMAC Day 0 Day 09 Day 27

Total Score

Pain Sub Score

Stiffness Sub Score

Physical function Sub score

INVESTIGATERS:

Scholar’s signature Signature of Co-guide

Signature of Guide


265

Annexure

Work Sheet

Scoring SI No

Day 0 Day 9 Day 27

Pain 01 Walking 02 Stair climbing 03 Nocturnal 04 Rest 05 Weight bearing Stiffness 06 Morning stiffness 07 Stiffness occurring later in the day Physical function 08 Descending stairs 09 Ascending stairs 10 Rising from sitting 11 Standing 12 Bending to floor 13 Walking on flat 14 Getting in or out of car 15 Going shopping 16 Putting on socks 17 Rising from bed 18 Taking off socks 19 Lying in bed 20 Sitting 21 In/out bath 22 Getting on or off toilet 23 Heavy domestic duties 24 Light domestic duties Pain Sub Score Stiffness Sub Score Physical function Sub score

Total Score

SI No Response Points 01 None 0 02 Slight 1 03 Moderate 2 04 Severe 3 05 Extreme 4


266

Sandhivata matravasti pk024_gdg

Documents

Transcript of Sandhivata matravasti pk024_gdg