E-ISSN:2456-3110

Research Article

Osteoarthritis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Clinical efficacy of Paribhadradi Pralepa on Sandhigata Vata (Osteoarthritis)

GUA K.1*, WMDRW W.2, WLARS P.3
DOI: http://dx.doi.org/10.21760/jaims.8.1.1

1* Kumara GUA, MD Scholar, Postgraduate Department of Dravyaguna, Dr. BRKR Government Ayurvedic College, KNR University of Health Sciences, Hyderabad, Telangana, India.

2 Wadimuna WMDRW, Registered Ayurvedic Medical Practitioner, Department of Ayurveda, Sri Lanka.

3 Pushpakumari WLARS, Senior Lecturer, Gampaha Wickramarachchi University of Indigenous Medicine, Sri Lanka.

On the basis of symptomatology Sandhigata Vata has resemblance with osteoarthritis (OA) in modern medical science. In Ayurveda, symptoms of Sandhigata Vata are described as Hanti Sandhigati (restricted movements), Sandhi Shoola (joint pain), Sandhi Shotha (joint swelling or oedema), and Prasarana Akumcana Janya Vedana (pain in flexion and extention of the joints). It mainly affects weight bearing joints of the body especially hip and knee joints and mainly associated with aging, physical occupational activities and obesity. Paribhadradi Pralepa is a traditional preparation practiced at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka in treatment of Sandhigata Vata with successful results. So far, no known scientific study has conducted to evaluate the effect of Paribhadradi Pralepa in Sandhigata Vata. Hence, the present study was carried out. The clinical trial was conducted on 60 patients belonging to the age group of 35 to 60 years old. The prepared Pralepa was recommended to apply in the night for a period of fourteen days continuously. Severity of signs and symptoms were assessed before, during and after completion of the treatment using specially prepared grading scale. The reduction of clinical features was also assessed after two weeks of follow up period. Results were analyzed statistically and reduction of symptoms was statistically significant. It is concluded that Paribhadradi Pralepa is effective in management of Sandhigata Vata.

Keywords: Sandhigata Vata, Osteoarthritis, Vatavyadhi, Paribhadradi Pralepa

Corresponding Author How to Cite this Article To Browse
Kumara GUA, MD Scholar, Postgraduate Department of Dravyaguna, Dr. BRKR Government Ayurvedic College, KNR University of Health Sciences, Hyderabad, Telangana, India.
Email: 		Kumara GUA, Wadimuna WMDRW, Pushpakumari WLARS, Clinical efficacy of Paribhadradi Pralepa on Sandhigata Vata (Osteoarthritis). J Ayu Int Med Sci. 2023;8(1):1-7.
Available From
https://jaims.in/jaims/article/view/2144

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-24 2022-11-26 2022-12-03 2022-12-10 2022-12-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Kumara GUA, Wadimuna WMDRW, Pushpakumari WLARSand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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GUA K et al: Paribhadradi Pralepa on Sandhigata Vata (Osteoarthritis)

Introduction

Sandhigata Vata is a major cause of disability in industrialized countries. The changes in the joints by Prakupita Vata (provoked Vata Dosha) are the main phenomena of Samprapti (pathogenesis) of Sandhigata Vata.[1] Joints are included under Madhyama Roga Marga. Sandhigata Vata is Kashtasadhya Roga due to the involvement of Vata Dosha and Dhatukshaya.

Sandhigata Vata can be correlated with Osteoarthritis (OA). It is the second commonest problem in the world population.[2] The major risk factors associated with osteoarthritis in knee joint are age, gender (female), obesity and occupation (especially with knee bending). Osteoarthritis makes an important cause of disability. It is the most common articular disease begins asymptomatically in the second and third decades and is common over the age of 70 years. Almost all persons by age 40 have some pathologic changes in weight bearing joints. 25% females and 16% males have symptomatic OA.

Ayurveda medicine recommends Snehana (oleation therapy), Swedana (fomentation), Mrudu Samshodhana (mild purification therapy) and Vasti (enema) as therapeutic meassures which can be used in treatment of Sandhigata Vata. In modern medicine, mainly analgesics, anti-inflammatory drugs or surgery are the the treatment procedures use to treat OA. These treatments do not give satisfactory relief and cause great adverse effects.

Acharya Charaka has described the disease first by the name of Sandhigata Anila under the chapter of Vatavyadhi.[3] No separate etiological factors are mentioned for Sandhigata Vata. Two main causes of Vata Prakopa are Dhatukshaya (depletion of tissues) and Margawarodha (obstruction of channel).[4] In case of Sandhigata Vata, Kshaya is the main cause. Acharya Charaka defined it as a disease, which occurs due to indulgence of Vata Prakopa Ahara and Viharaṇa, with the symptoms of Vata Purna Druti Sparsha (oedema, which is palpable as air filled bag) and Prasarana Akumcana Janya Vedana (pain in flexion and extention of the joints).

Acharya Sushruta has described Sandhi Shoola (pain in joints), Sandhi Shotha (swelling in joints) and Hanti Sandhigati (diminution of the movements in joints) as symptoms of Sandhigata Vata.[5]

Acharya Madhavakara is in the opinion of Sushruta. Acharya Vagbhata and other Acharyas have described that the disease, Sandhigata Vata as same as in Charaka Samhita and Sushruta Samhita.

Sandhigata Vata is Kashtasadhya due to the involvement of Marma and Vata Dosha, situated in Madhyama Roga Marga and mainly occurs in Vruddhavastha (Dhatukshaya Janya Kala). Acharya Charaka has mentioned repeated use of Snehana, Swedana, Vasti and Mrudu Virecana as treatment modalities for Vatavyadhi. Acharya Sushruta has mentioned therapeutic measures like Snehana, Upanaha, Agnikarma, Bandhana and Mardana for the same.[6] Along with these therapeutic measures, Rasayana therapy may also effective in managing the degenerative joint disorders like Sandhigata Vata.[7] It slows down the process of destruction (ageing) in the body and helps in rejuvenation of Navya Dhatu (new tissues).

Paribhadradi Pralepa is a Sri Lankan traditional preparation widely practiced at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka in treatment of Sandhigata Vata (Osteoarthritis), Gambheera Vatarakta (Gout), and Amavata Sandhi Shotha (Rheumatoid arthritis)

The present study was carried out to evaluate the effectiveness of Paribhadradi Pralepa in management of Sandhigata Vata.

Materials and Methods

Selection of Patients: Sixty patients aged between 35 to 60 years, diagnosed as Sandhigata Vata were recruited in this study. Hanti Sandhigati (restricted movements), Sandhi Shoola (joint pain), Sandhi Shotha (joint swelling or oedema), and Prasarana Akumcana Janya Vedana (pain in flexion and extention of the joints) were the subjective parameters for the assessment of improment of Sandhigata Vata. The patients suffering from Amavata Sandhi Shotha, Gambheera Vatarakta and Asthigata Vata and patients who are on any other oral or external medications for the last 7 days were also excluded from the study. After collecting details of the patients’ history, the selected patients were thoroughly examined. The patients who gave written consent were included in the study.

Severity of signs and symptoms were recorded before, during and after completion of treatment and also at the end of follow up


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period using a specially prepared five point grading scale. Grading scale is given below.

Sandhi Shoola (joint pain)

0 = absent = no pain in joints

1 = minimal = occasionally feels pain in joints

2 = moderate = intermittently feels pain in joints

3 = intense = often feels pain in joints

4 = severe = always feels pain in joints

Sandhi Shotha (joint swelling or oedema)

0 = absent = no swelling in joints

1 = minimal = slight swelling in joints

2 = moderate = moderate swelling in joints

3 = intense = severe swelling in joints

4 = severe = very severe swelling in joints

Hanti Sandhigati (restricted movements)

0 = absent = no restricted movements in joints

1 = minimal = stiffness lasting for 5-15 minutes

2 = moderate = stiffness lasting for 30 minutes

3 = intense = stiffness lasting for more than 30 minutes

4 = severe = unable to move the joints

Prasarana Akumcana Janya Vedana (pain in flexion and extention of the joints)

0 = absent = no pain in flexion and extention of the joints

1 = minimal = pain without wincing of face

2 = moderate = pain with wincing of face

3 = intense = shouts or prevents complete flexion

4 = severe = doesn’t allow the passive movement

Overall responses to therapy were rated as excellent, good, fairly good and poor.

  • Excellent : Complete relief in all symptoms of Sandhigata Vata (100%)
  • Good : Substantial relief of Sandhigata Vata (76 - 99%).
  • Fair : Partial relief of Sandhigata Vata (51 - 75%).
  • Poor : Poor relief of deterioration of Sandhigata Vata (0 - 50%).

Method and duration of drug administration

Patients were advised to apply the Paribhadradi Pralepa only in the night and made to keep it till following morning (approximately eight hours). Before application of Pralepa, affected area was oleated (Snehana) by application of sesame oil. This treatment was carried out for a period of fourteen (14) days continuously.

Preparation of Paribhadradi Pralepa

40g each of fresh leaves and stem bark of Erythrina variegata Linn (Family: Fabaceae; Sanskrit name: Paribhadra)[7], fresh leaves of Plumeria apiculata Linn (Family: Apocynaceae; Sanskrit name: Shweta Champaka)[8] and tender inflorescence of King Coconut (Cocos nucifera Linn, Family: Arecaceae; Sanskrit name: Narikela)[9] were taken. 4g each of fresh rhizome of Curcuma longa Linn (Family: Zingiberaceae; Sanskrit name: Haridra)[10] and Samudra Lavana (Sodium Chloride, common salt)[11] and 1g of latex of Ferula asafoetida Linn (Family: Apiaceae; Sanskrit name: Hingu Niryasa)[12] were also taken. Aforesaid all the ingredients were mixed together and grounded well. Then the mixture was mixed with 20ml of sesame oil (Sesamum indicum Linn, Family: Pedaliaceae; Sanskrit name: Tila Taila)[13] and heated on a pan to prepare Paribhadradi Pralepa.

jaims_2144_01.JPGErythrina variegata
jaims_2144_02.JPGPlumeria apiculata


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jaims_2144_03.JPGCocos nucifera
jaims_2144_04.JPGCommon salt
jaims_2144_05.JPGCurcuma longa
jaims_2144_06.JPGFerula asafoetida

Statistical Analysis: Statistical analysis was carried out using the paired samples t-test of Microsoft Excel.

Observations and Results

In the present study, it was observed that 16% - 25% patient showed excellent response (complete relief) in symptoms such as Sandhi

Shotha, Hanti Sandhigati, Sandhi Shoola and Prasarana Akumcana Janya Vedana and poor response was observed in 5- 13% patients.

Good response (substantial relief) in above mentioned symptoms were observed in 55% -58% patients and fair response (partial relief) were observed in 15% - 27% patients (table 1 and figure 1).

Table 1: Overall improvement of signs and symptoms (patients’ overall response to therapy)

Sign and Symptom Response to therapy
Excellent Good Fair Poor
Sandhi Shotha 21.67 % 56.67 % 16.6 % 5 %
Hanti Sandhigati 18.33 % 53.33 % 15 % 13.3 %
Sandhi Shoola 25 % 58.33 % 13.33 % 3.3 %
Prasarana Akumcana Janya Vedana 16.67 % 55 % 21.67 % 6.67%

jaims_2144_07.JPG

Figure 1: Overall improvement of signs and symptoms (patients’ overall response to therapy)

Table 2: Symptomatic relief with the treatment Erabadu Pothu Melluma in Sandhigata Vata

Clinical feature Before treatment Mean ± SE After treatment Mean ± SE P value
Sandhi Shotha (joint swelling / oedema) 2.73 ± 0.66 0.45 ± 0.62 0.0000
Hanti Sandhigati (restricted movement in the joints) 2.37 ± 0.82 0.23 ± 0.5 0.0000
Sandhi Shoola (joint pain) 1.75 ± 0.7 0.32 ± 0.47 0.0000
Prasarana Akumcana Janya Vedana (pain in flexion and extention of joints) 1.87 ± 0.81 0.55 ± 0.62 0.0000
P < 0.05 significant

Table 2 represents the symptomatic relief with the treatment Erabadu Pothu Melluma in Sandhigata Vata and reduction of symptoms after treatment is statistically significant (P < 0.05).


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jaims_2144_08.JPG

Figure 2: Symptomatic relief with the treatment Paribhadradi Pralepa in Sandhigata Vata 

jaims_2144_09.JPG

Figure 3: Symptomatic relief with the treatment Paribhadradi Pralepa in Sandhigata Vata

Discussion

According to the Ayurveda Acharyas, Sneha (oleation) and Swedana (fomentation) are highly effective treatment techniques in management of joint diseases.

Ayurveda Pharmaco-dynamical properties of ingredients of Paribhadradi Pralepa are tabulated below (Table 3).

Table 3: Ayurveda Pharmaco-dynamical properties of ingredients of Erabadu Pothu Melluma

Name of ingredient Rasa Guna Veerya Vipaka Prabhava / Karma
Narikela (Cocos nucifera Linn) Madhura Guru, Snigdha Sheeta Madhura Pittahara, Vrishya, Vrimhana
Haridra (Curcuma longa Linn) Katu, Tikta Ruksha, Ushna Katu Kandhugna Shophahara, Kaphapittahara, Varnya
Paribhadra (Erythrina variegata Linn) Katu - Ushna - Vatakaphahara, Shophahara, Deepana
Hingu Niryasa (Ferula asafetida Linn. Katu Laghu Snigdha,Sara Ushna Katu Deepana, Pacana, Vatakaphahara
Shweta Champaka (Plumeria apiculata Linn. Katu, Tikta Sara, Ushna - Kandughna Shoolahara Kaphavatahara
Tila taila (Sesamum indicum Linn.) Katu, Tikta, Mdhura, Kashaya Guru, Snigdha, Grahi Ushna Katu (Madhura) Vataghna, Balya, Keshya
Samudra lavana (Sodium Chloride) Lavana Tikta, Madhura Guru Sama Sheeta Ushna Madhura Anulomana, Deepana, Bhedana

Sandhigata Vata is a disease occurred by vitiation of Vata Dosha. Most of ingredients of Paribhadradi Pralepa having Kaphavata Shamaka properties as these ingredients possess Madhura, Katu and Tikta Rasa, Guru and Snigdha Guna, Ushna Veerya and Madhura and Katu Vipaka. Further, these ingredients contain Shophahara and Shoolahara properties which help to reduce oedema and pain occurred in Sandhigata Vata. Due to these properties Paribhadradi Pralepa is beneficial in treatment of Sandhigata Vata.

Analgesic action of Cocos nucifera Linn[14], Erythrina variegata Linn[15] and Curcuma longa Linn[16] are scientifically proven. Anti-inflammatory action of Erythrina variegata Linn[17], Plumeria apiculata Linn[18], Cocos nucifera Linn[14], Curcuma longa Linn[19], Sesamum indicum Linn[20] and Ferula asafoetida Linn[21] are scientifically proven. Due to analgesic and anti-inflammatory properties Paribhadradi Pralepa helps to reduce pain and swelling in Sandhigata Vata.



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Antioxidant property of Erythrina variegata Linn[22], Plumeria apiculata Linn[23], Cocos nucifera Linn[24], Curcuma longa Linn[19], Sesamum indicum Linn[25], Ferula asafoetida Linn[26] and Sodium chloride[27] are scientifically proven. Sandhigata Vata is described as Jara Vata in Ayurveda. Osteoarthritis is a degenerative disease. Paribhadradi Pralepa helps to regenerate tissues due to antioxidant property of its ingredients.

Conclusion

Paribhadradi Pralepa is effective traditional formulation in reducing the signs and symptoms of Sandhigata Vata. It is concluded that, Paribhadradi Pralepa is significant in the management of Sandhigata Vata.

Reference

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