E-ISSN:2456-3110

Research Article

Osteo-arthritis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

An Open Label Single Arm Clinical Study of Asthishrinkhala Ghrita Matrabasti and Asthishrinkhala Vati in Janusandhigatavata (Osteo-arthritis of knee)

Niveditha M N1*, Vasantha B2, Totad M3, Kallimath A4
DOI:10.21760/jaims.8.11.3

1* Niveditha M N, Post Graduate Scholar, Department Of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College Of Ayurveda And Hospital, Hassan, Karnataka, India.

2 Vasantha B, Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Muttappa Totad, Associate Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 Adarsh Kallimath, Associate Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

Background: Osteoarthritis is the most common type of arthritis occurring in weight bearing joints like hip and knee. Main presenting symptoms are pain and functional restriction. With advancement in working pattern and age factor, it has become prime cause for aggravation of Vata Dosha, which does Dhatu Kshaya and Bala Kshaya leading to Sandhigatavata. Due to all these factors and being a Marma sthana, the person will be incapacitated from doing his day-to-day activities.
Aims and objectives: To clinically evaluate the combined effectiveness of Asthishrinkhala Ghrita Matrabasti and Asthishrinkhala Vati in Janusandhigatavata.
Methodology: In the present study, 34 patients of Janusandhigatavata fulfilling diagnostic criteria were given Asthishrinkhala Ghrita Matrabasti for 7days and Asthishrinkhala Vati for 21 days. Assessment were done using Visual Analogue Scale (VAS) for Pain, Ritchie articular index for assessment of tenderness, Swelling and crepitus based on numerical Scoring, Movement of joints measurement is done with Goniometer and physical functions assessed through WOMAC- Index for Osteoarthritis.
Results: Data was analyzed using appropriate statistical test. Significant results (p<0.05) were found in all the cardinal symptoms- Vata Poornadruti Sparsha Shotha, Shula on Prasarana and Akunchana, Atopa and Stabdhata in Janusandhi. Conclusion: Asthishrinkhala Ghrita Matrabasti and Asthishrinkhala Vati is effective in management in Janusandhigatavata.

Keywords: Asthishrinkhala, Osteoarthritis, Sandhigatavata, Matrabasti, Ritchie articular index, WOMAC

Corresponding Author How to Cite this Article To Browse
Niveditha M N, Post Graduate Scholar, Department Of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College Of Ayurveda And Hospital, Hassan, Karnataka, India.
Email: 		Niveditha M N, Vasantha B, Totad M, Kallimath A, An Open Label Single Arm Clinical Study of Asthishrinkhala Ghrita Matrabasti and Asthishrinkhala Vati in Janusandhigatavata (Osteo-arthritis of knee). J Ayu Int Med Sci. 2023;8(11):17-26.
Available From
https://jaims.in/jaims/article/view/2768

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-06 2023-09-11 2023-09-16 2023-09-21 2023-10-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.90%

© 2023by Niveditha M N, Vasantha B, Totad M, Kallimath Aand 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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Niveditha M N. et al. Asthishrinkhala Ghrita and Asthishrinkhala Vati in Janusandhigatavata

Introduction

Janusandhigatavata is one among Sandhigatavata which is explained under Vatavyadhi. Sandhigatavata is first described by Acharya Charaka as Sandhigata Anila with symptoms like Vata Poornadruti Sparsha Shotha, Shula on Prasarana and Akunchana.[1] Charaka has also mentioned Sandhigatavata as one among 80 Nanatmaja Vatavyadhis.[2] With advancement in working pattern and age factor, it has become prime cause for aggravation of Vata Dosha, which does Dhatu Kshaya and Bala Kshaya leading to Sandhigatavata. Due to all these factors and being a Marma Sthana, the person will be incapacitated from doing his day-to-day activities. This necessitates need for search of a remedy leading to study in this area.

Osteoarthritis is the most common type of arthritis[3] occurring in weight bearing joints like hip and knee.[4] Main presenting symptoms are pain and functional restriction. When it occurs in knee, pain is localized to anterior or medial aspect of knee which worsens on climbing up and coming down.[5] The prevalence of osteoarthritis rises progressively with age and it has been estimated that 45% of all people develop osteoarthritis at some point during their life.[6] With 6% incidence of age >30 and 12% incidence >60.[3] The condition is commonly managed with NSAIDS or COX-2 inhibitors and intra articular glucocorticoid injections are also made used in its management.[7] Since the response with this line of management is variable with some patients having little relief whereas others experience relief lasting several months. When the patient with knee osteoarthritis has failed medical treatment modality, patient will be referred for total knee arthroplasty.[8] In order to minimize such intervention, a need arises to conduct study in this area. Acharya Charaka while explaining the importance of Basti mentions that there is none other than Basti which is the best treatment for aggravated Vata, so Charaka has told Basti as Ardha Chikitsa.[9] Basti is considered one among Panchakarma.[10] Hence this mode of treatment is selected for this study.

In general, Asthishrinkhala has Madhura Rasa, Laghu Ruksha Guna, Ushna Veerya and Madhura Vipaka.[11] It is said to be Vata Vyadhihara and Asthi Sandhanakarini.[12] It is said to be Vatahara, Bala Prada

and due to its Ushna Veerya is again Vatadoshahara. This was an effort to systematically document and validate the effort of said combination in the management of Janusandhigatavata.

Aim and Objectives

To clinically evaluate the combined effectiveness of Asthishrinkhala Ghrita Matrabasti and Asthishrinkhala Vati in Janusandhigatavata.

Materials and Methods

Screening: Subjects attending OPD and IPD in SDM ayurveda hospital, Hassan were screened by a form prepared with all aspects of history, symptoms of Janusandhigatavata.

Diagnostic criteria: The diagnosis is mainly based on clinical presentation of patients according to signs & Symptoms of janusandhigatavata mentioned in classics like Vatapurnadhrutisparsha Shotha, Prasarana Akunchana Pravritisavedana, Sandhishula, Sandhi Aatopa & supported with signs & symptoms of Osteoarthritis of Knee joint and X-ray of knee joint.

Inclusion criteria: Subjects presenting with the signs and symptoms of Janusandhigata Vata will be selected of either gender irrespective of caste, religion and locality, Subjects between the age group of 30-70 years,[13] Radiologic changes in knee x-ray (Kellgren`s Lawrence index Grade1 and Grade2), Subjects fit for Matra Bast[14] and Subjects who are willing to participate and sign the informed consent

Exclusion criteria: H/O mono arthritis/ poly arthritis other than knee OA such as gouty arthritis, Rheumatoid arthritis, Psoriatic arthritis and Traumatic cases like fracture, Diagnosed any unstable cardiovascular disease, uncontrolled hypertension (>160/100 mm Hg) and uncontrolled diabetes mellitus (blood sugar fasting >160 mg/dL), History of HIV, HbSAg and Pregnant woman and lactating mother.

Ethical clearance and CTRI registration

Ethics clearance certificate (IEC No: SDM/IEC/79/2021) was attained from institutional Ethics Committee. Trial was registered on Indian clinical trial registry (CTRI/2022/05/042687).



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Niveditha M N. et al. Asthishrinkhala Ghrita and Asthishrinkhala Vati in Janusandhigatavata

Study Design

The study was an open label, single arm, prospective clinical trial on Janusandhigatavata (osteo-arthritis of knee) (n=34) selected using the convenience (non-random) sampling technique with pre and post design conducted in SDM college of ayurveda and hospital, Hassan Karnataka.

Intervention:

Oral medication: Asthishrinkhala Vati for 21 days

Basti: Matrabasti with Asthishrinkhala Ghrita for 7days.

Duration of intervention: 21 Days.

Source and authentication of drug: Asthishrinkhala Raw drug was obtained from Anamaya drug store, Udupi (GMP Certified Pharmacy) and was authenticated from Department of Dravya Guna, SDM college of Ayurveda and Hospital, Hassan.

Kashaya preparation: 1part (20kg) coarse powder of Asthishrinkhala taken and 16 parts (320 liters) of water added and reduced to 1/4th.

Method of preparation of Asthishrinkhala Ghrita: Kalka preparation: 1 Part (2800gm) of fine powder of Asthshrinkhala taken and quantity sufficient of water (1.8 liters) was added and Kalka prepared.

Ghrita - 17 liters

All the above ingredients were taken in vessel and heated on moderate flame according to Ghrita Paka until Ghrita Siddha Lakshanas was obtained. Later the Ghrita is filtered and stored for further use. Dosage: 70 ml[15] once a day, Route of administration: Rectal and Duration: 7 days.[16]

Matrabasti Karma (SOP)

Materials required: Tila Taila for Sthanika Abyanga and Asthishrinkhala Ghrita 70ml for Matrabasti, Measuring glass, Syringe-Cathereter (Basti Yantra), vessels.

Preparation of Basti: Prescribed amount of about 70ml Asthishrinkhala Ghrita was taken and made warm and then filled in Basti Yantra /syringe with this Ghrita.

Purvakarma: Consent for the procedure taken and evaluated patient safety before procedure

as per pre-procedure checklist. Sthanika Abhyanga with Tila Taila and Nadi Sveda was done on the lower abdomen, back and thighs of the patient. The procedure done immediately after meal (Lunch).

Pradhana Karma: Patient was made to lie in the left lateral position by keeping left leg straight and right leg flexed at the knee joint. Applied Tilataila for lubrication on local anal region as well as on the catheter. Air removed from Basti instrument and slowly Basti Netra/nozzle was inserted into the anal canal up to 4 Angula. Then Basti Dravya was administered by steady pressure. Patient was asked to take deep breath with mouth during the procedure. Cotton pieces was placed at anal region and patient was asked to lie down in supine position.

Paschat Karma: After the procedure patient was asked to take rest. Advised patient to go for motion whenever he feels for urges.

Method of preparation of Vati:

Step 1: 1 Part (1kg) Asthishrinkhala coarse powder was taken, 16parts of water was added, boiled and reduced to 1/4th.

Step 2: Then 1 part (3kg) Asthishrinkhala powder taken to which sufficient quantity of Kashaya was added and Bhavana was given till contents attain Subhavitha Lakshana. Then contents were dried in sunlight and hot air oven followed by pulverization and made into granules, later pressed in tablet punching machine in the size of 500 mg each.

Dosage: Two tablets thrice a day (1 tablet = 500 mg), Time of administration: After food, Route of administration: Oral and Duration: 21days.

Packaging: Asthishrinkhala Vati was packed in sachets containing 126 tablets each and was properly labelled with the name of the drug, reference, details of the manufacturer, batch number.

Follow up during treatment: Patient was assessed on 1st day, 7th day and 22nd day after completion of treatment.

Statistical Analysis:

Statistical analysis was done with Pair T test was used to analyze the significance of changes in scale data and Wilcoxon signed rank test was used to analyze the significance of changes in ordinal data.


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Assessment Criteria:

I. Primary outcome measures

1. VAS: 0-10
2. Ritchies articular index for Tenderness ( Table no. 1)

Table 1: Ritchies articular index for Tenderness

Grade 0NormalAbsent or no tender
Grade 1Mildtender
Grade 2ModerateTenderness and wincing
Grade 3SevereTenderness, wincing and withdrawal

II. Secondary outcome measures

1. Swelling (table no. 2)

Table 2: Swelling

Grade 0NormalNo Swelling
Grade 1MildMild Less than 10% circumference of affected joint
Grade 2ModerateModerate More than 10% circumference of affected joint
Grade 3SevereSevere More than 20% circumference of affected joint

2. Crepitus (table no. 3)

Table 3: Crepitus

Grade 0NormalNo crepitus
Grade 1MildCrepitus complained by patient but not felt on examination
Grade 2ModerateCrepitus felt on examination
Grade 3SevereCrepitus felt and heard on examination

3. WOMAC (fig. no. 1)

Fig. 1: Western Ontario and Mcmaster Osteoarthritis Index (WOMAC)

Rate your pain when…NoneSlightModerateSevereExtreme
Walking01234
Climbing stairs01234
Sleeping at night01234
Resting01234
Standing01234
Rate your stiffness in the…NoneSlightModerateSevereExtreme
Morning01234
Evening01234
Rate Your Difficulty When…NoneSlightModerateSevereExtreme
Descending stairs01234
Ascending stairs01234
Rising from sitting01234
Standing01234
Bending to floor01234
Walking on even floor01234
Getting in/out of car01234
Going shopping01234
      
Putting on socks01234
Rising from bed01234
Taking off socks01234
Lying in bed01234
Getting in/out of bath01234
Sitting01234
Getting on/off toilet01234
Doing light domestic duties (cooking, dusting)01234
Doing heavy domestic duties (moving furniture)01234
Total (out of 96) 

Observations

90 subjects were screened, 34 subjects were enrolled and completed the study. Majority among 34 subjects, 14(41.2%) subjects belonged to age group of 61-70 years, 24(70%) subjects were females, 12(35.3%) subjects were uneducated, 29(85.3%) subjects were Married, 23 (67.6%) subjects belonged to Homemaker, 16 (50%) subjects belonged to Middle Class, 32 (47.1%) subjects had Vatapoorna Driti Sarsha Shotha, 67 (98.5%) subjects had Vedana during Prasarana and Akunchana , 39 (57.4%) subjects had Stambha, 50 (73.5%) subjects had Atopa, 34 (100) subject had Gradual Mode of onset, 16 (47.1%) subjects had Difficulty in sitting, 29 (85.3% ) subjects had Difficulty in standing, 29 (85.3%) subjects had Difficulty in walking, 34 (100%) subjects had Difficulty In climbing stairs, 4 (11.8%) subjects had Difficulty in lying down, 22 (64.7%) subjects had Difficulty in squatting, 34 (100%) subjects had Grade 2 x-ray of knee joint (kellegrence Lawrence index), 5 (7.4%) subjects had Redness over knee joint, 13 (32.2%) subjects had Antalgic Gait 32(47%) subjects Local temperature over knee joint Raised and 22 (64.7%) subjects were of BMI-25-29.9.

Table 4: Results of Paired t Test

ParametersMean differenceSDSESig.95% CIRemarks
LowerUpper
VAS BT-22nd day4.4701.1777.142<0.0164.1854.755S
R.O.M flexion BT-22nd day-12.3526.076-13.823<0.016-13.823-10.8822S
R.O.M-Extension BT-22nd day9.3383.756.4554<0.01610.24720.502S
Total score Pain (WOMAC)BT-22nd day5.0881.311.224<0.0164.6305.545S
Total score Stiffness (WOMAC)BT-22nd day1.0581.391.238<0.016.573.573S
Total score on difficulty in physical function (WOMAC)BT-22nd day17.5293.863.662<0.01616.18118.877S
Total WOMAC score kneeBT-22nd day22.6174.592.787<0.01621.01524.220S

Table 5: Results of Wilcoxan Signed Rank Test

 Negative ranksPositive ranksTies TotalZ valueP valueRemarks
NMRSRNMRSR
Ritchies articular index for tenderness for knee BT-22nd day2412.503000.00.004468-4.490<0.016S
Swelling of knee BT-22nd day2211.50253.000.00.004668-4.284<0.016S
Crepitus of knee BT-22nd day4221.50903.000.00.002668-6.016<0.016S

Discussion

Effect of therapy on VAS: Asthishrinkhala has Vedanasthapana


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property and when processed with Ghrita, the potency was probably enriched. Friction of bony parts was reduced by increasing Snehatva of Sthanika Sleshaka Kapha thereby lubricates joints. The pain got reduced by Vata Shamana and Asthidhatu Prasadanam. Cissus quadrangularis, which has been proved to be highly effective in relieving pain, reduction of swelling in arthritic conditions. The mechanism through which Cissus exerts its analgesic and anti- inflammatory properties by preventing the conversion of arachidonic acid to inflammatory prostaglandins.[17]

Effect of therapy on Tenderness: Administration of Asthishrinkhala might have reduced the inflammation in the subjects, which in turn reduced localized tenderness in the knee joint. The above results were observed, probably due to property of Madhura Rasa like Tarpayathi, Shlesmanam Abhi Vardhayati. Because of this quality it will increase the Shleshaka Kapha in the joint and helps in easy movement of the joint. Madhura Rasa being Pruthvi and Ap Mahabhuta Pradhana thereby helps in increasing the Snigdha and Picchila Guna in the Sandhi region and stabilizes the joint (Sthairyakara). It also possesses Shothahara and Vedanasthapana property. By all this property it helps in reducing the symptom of tenderness in the joint.

Effect of therapy on Vatapoornadritisparsha Shotha: Shotha is having Chala and Asthira Laxana indicating role of Vikrita Vata. Because when Vata Prakopa takes place there is decrease in Shleshaka Kapha in the joint. This leads to wear and tear in the joint giving Vishesha Laxana of Vatapoornadrutisparsha (air filled bag) of Janusandhivata. Asthishrinkhala by means of its Shothahara property, its Ushna Veerya and Basti being the prime Shodana helps to pacify Vata and thereby reduce Shotha. The anti-inflammatory features of cissus quadrangularis suggest that it acts by preventing the conversion of arachidonic acid to inflammatory prostaglandins. These properties helped in reducing the swelling.

Effect of therapy on Atopa: Vata localized in Janusandhi causes Stanika Shleshaka Kapha Kshaya causing Rukshata and Kharata in Sandhi which affects Samshleshana Karma, this causes Atopa in Sandhi. Kharatva and Rukshatva in Sandhi was reduced by supplementation of Sneha through Basti and Asthishrinkhala by virtue of its Madhurarasa

was helpfull in increasing the Shleshaka Kapha in the joint and by means of its Pruthvi and Apmahabhuta Pradhanata it was helpfull in increasing the Snigdha and Picchilaguna in the Sandhi region and thereby stabilizes the joint (Sthairyakara). This might have reduced the Atopa.

Effect of therapy on ROM-flexion and Extension: In Janu Prasarana and Akunchana function is carried out by Kandara. Sandhi Vedana during prasarana Akunchana of Janu Sandhi is due to localised Vata Prakopa. According to contemporary science, Range of Motion is affected by Pain, Swelling, and Stiffness factors. The trial drug Asthishrinkhala by virtue of its Bala Prada gives strength to Kandara and has significantly reduced all symptoms by virtue of its properties such as Shoolahara, Shothahara and Ushna Veerya in present condition. This in turn helped in improvement of Range of Motion of affected joints (Restoration of function of Sandhis).

Effect of therapy on Total score Pain (WOMAC): Asthishrinkhala has Vedanasthapana property. The pain got reduced by Vata Shamana and Asthidhatu Prasadanam.

Total score stiffness (WOMAC): Stambha or Stabdhata in Janu was manifested as a result of Sthanika Vruddhi of Sheeta Ruksha and Khara Guna of Vata. Sheeta Guna causes Stambha in Sandhi, Ruksha and Khara Gunas decreases Snigdhata and Shlakshnata (Shleshaka Kapha) in Janusandhi causing restricted movement in knee joint. Snigdhata and Shlakshnata are very essential for free movement of knee joint. Asthishrinkhala due to its Ushna Veerya counteract Sheeta Guna of Vata and Snigdha Guna of Ghrita counteracts the Ruksha and Kharaguna thereby helps to reduce Stambha in Janu Sandhi.

Effect of therapy on total score Difficulty in activities (WOMAC): The flexion and extension of the knee is possible with the coordinated activity of the muscles and the joint structures. Sandhana property of Asthishrinkhala will give strength to the knee. Snigdha Guna of Asthishrinkhala and Ghrita counteracts Ruksha and Khara Guna of Vata thereby subsiding wear and tear of joints, hence functional capacity of the joint hindered due to pain and stiffness of joints improved.

Effect of therapy on Total score WOMAC: WOMAC score indicates about the course of the


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disease. Reduction in WOMAC score indicates that trial drug has control over the pathology of disease by virtue of its properties such as Shoolahara, Shothahara, Ushna Veerya, Snigdha Guna (Matrabasti) which resulted in symptomatic relief from pain, stiffness and difficulty in movement regarding knee joints, thus reduction in womac score was observed.

Probable Mode of Action of Asthishrinkhala Asthishrinkhala is explained in all the Nighantus. Asthishrinkhala by virtue of its Madhura Rasa does Tarpayathi, Shlesmanam Abhi Vardhayati and this quality is helpfull in increasing the Shleshaka Kapha in the joint thereby helps in easy movement of the joint. Madhura Rasa being Pruthvi and Ap Mahabhuta Pradhanata helps in increasing the Snigdha and Picchilaguna in the Sandhi region and stabilizes the joint (Sthairyakara). This property counteracts Vata and increases Sheshaka Kapha in Sandhi, thereby reduces Shotha and Atopa.

Asthishrinkhala due to its Ushna Veerya counteract Sheeta Guna of Vata and helps to reduce Stambha in Janusandhi. Asthi-Sandhana property of Asthishrinkhala helps in Sandhana of Asthidhatu thereby mechanical injury of Sandhi is prevented, hence inflammatory process is arrested. Asthishrinkhala by virtue of its Bala Prada gives strength to Kandara and has significantly reduced all symptoms by virtue of its properties such as Shoolahara, Shothahara, Ushna Veerya in present condition. This in turn helps in improvement of Range of Motion of affected joints (Restoration of function of Sandhis). Asthishrinkhala has Vedanasthapana and Shothahara property by which it helps in relieving pain and swelling thereby reduces stiffness followed by improvement in Range of motion in knee.

Anti-inflammatory activity of Cissus Quadrangularis.[18] Flavanoids presents in Cissus quadrangularis such as tetraterpenoids, β-sitosterol, Calcium oxalate, carotene, amyrin and anabolic ketosteroids which are responsible for acceleration of healing and possess analgesic and anti-inflammatory activity helps in inhibiting the inflammatory process, presence of luteolin and β sitosterol in Cissus quadrangularis gives an anti-inflammatory effect. This substance prevents the conversion of arachidonic acid to inflammatory prostaglandins.

Cissus possesses anabolic and/or androgenic properties.

In addition to speeding the remodeling process of the healing bone, Cissus also leads to a much faster increase in bone tensile strength and very much helpful in degenerative conditions of bone.[19]

Probable Mode of Action of Ghrita

The reason behind selecting Ghrita as base for Asthishrinkhala in Matrabasti was because Ghrita is considered as Sarva-Snehottama and Ajanma Satmya, because of its Yogavahi and Samskarasya Anuvartanat property it potentiates action of the drug processed with it.[20] In general, Ghrita has Brumhana, Shlakshana, Guru and Deepana Guna.[21] It is also said to be Sapta-Dhatu Vardaka and acts as Rasayana. It has Madhura Rasa and Madhura Vipaka and possesses Gunas like Soumya and Mridu. Ghrita also contains vitamin D which plays an important role to utilize calcium and phosphorous in blood and bone building.[22]

Probable Mode of Action of Matra Basti

Basti is the nearest route of administration of Aushadha to Pakvashaya, which is the main Sthana of Vata. In Janusandhigatavata, there occurs vitiation of Vata. Thus, Basti help to tackle Vata in Janusandhigatavata. Basti has been indicated as the line of treatment for Marma Vikaras and Janusandhi being Marmasthana, thereby Basti helps in the management of Janusandhigatavata. Basti acts mainly due to the Veerya of the Aushadha, which in turn depends on the Gunas of the Aushadha as well. In the classics, the mode of action of Basti is explained by the help of similies by which we can understand the concepts in a better way.

a) The Veerya of Basti Dravya administered through Guda into the Pakwashaya reaches whole Shareera through “Srotasas” just like the active principles in water reaches to the whole plant when it is poured at the root of plant. This explains the systemic action of Basti.

b) A tree fed with water at its roots gives green leaves, delicate sprouts and with Kala it grows to a big tree, similarly Shareera grow strong by the administration of Sneha Basti. This explains the nutritive action of Basti.

Rectal route of administration has been given importance in present day pharmacology considering drug assimilation and bioavailability just like the intravenous mode of administration.



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Susruta has described Pakvashaya as Purishadharakala in Shareere Sthana. Dalhana again correlates this Purishadharakala to Asthidharakala in Kalpa Sthana. Hence Basti administered to Pakvashaya is beneficial to Asthi, As there occurs Asthi Dhatu Kshaya in Sandhigata Vata, Basti is the best line of treatment for Sandhigatavata.

Sneha given at Guda which is considered as the Moola of the body, reaches the whole body and nourishes all Dhatus even upto Shukra Dhatu. Thus, Basti nourishes and replenishes all the Dhatus, thereby combating Dhatukshaya.

In case of Matra Basti, one of the important factors that help drug absorption is its lipid solubility. When the drugs are lipid soluble, they will be absorbed readily from the intestinal mucosa.

Asthishrinkhala Ghrita given as Matra Basti does Snehana and Brumhana in the body including Sandhis and does nourishment of Kapha by the action of Snehana, which helps to counteract Ruksha, Khara Gunas of morbid Vata Dosha. It also does Sandhi Samshleshana and gives Sthirata for Sandhi as it nourishes Kapha in the body. By these actions, Matra Basti does Shamana of morbid Vata and helps in improvement of joint functioning and causes reduction of signs and symptoms of Janusandhigatavata i.e., Sandhi Vedana, Sandhi Shotha, Sandhi Hanthi and Sandhi Atopa.

Conclusion

Combination of Asthishrinkhala Ghrita Matra Basti and orally Asthishrinkhala Vati showed marked effect on the signs and symptoms of Janusandhigatavata- Vatapoornadritisparsha Shotha (joint swelling), Vedana during Prasarana and Akunchana (Pain on movements), Stambha (Restricted movements) Atopa (Crepitus) by means of its Rasa, Guna, Veerya, Shothahara and Vedanasthapanahara property. There was marked improvement in signs and symptoms of Janusandhigatavata in the first 7 days of treatment that constituted Matra Basti along with Shamana Aushadhis. There was significant Improvement in primary outcome measures like VAS, Ritchie articular index for assessment of tenderness and in secondary outcome measures like R.O.M, Swelling, Crepitus and WOMAC.


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