E-ISSN:2456-3110

Case Report

Osteoarthritis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 9 September
Publisherwww.maharshicharaka.in

Effect of Dashmoola Siddha Ksheera Janu Basti and Jatamayadi Upanaha in Sandhigatavata (Osteoarthritis) - A Case Study

Chaturvedi P1,Chouhan M2*, Paliwal S3
DOI:10.21760/jaims.8.9.29

1 Preeti Chaturvedi, Reader, Post Graduate Scholar, PG Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

2* Minakshee Chouhan, Post Graduate, Department Of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

3 Shivani Paliwal, Post Graduate Scholar, PG Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

Sandhigatavata is one of the Vata Vyadhi characterized by the symptoms as Sandhi Shoola and Sandhi Sphot. Most middle-aged and older adults experience degenerative joint disorders with symptoms such as swelling, pain on flexion and extension. Symptoms of Sandhigatavata exhibit apparent similarity with that of osteoarthritis, a degenerative disorder that occurs when articular cartilage wears down and the failure of diarthrodial joint. A Single clinical case study was conducted to evaluate the effectiveness of Dashmoola Ksheera Janu Basti and Jatamayadi Upanaha in Janu Sandhigatavata. Dashmoola Siddha Khseera was freshly prepared, used in Sthanik Janu Basti and Jatamayadi Upanaha applied externally over the affected knee joints of the patient for 1-2 hrs daily, for 21 days. After the treatment, the patient experienced significant relief and observed visible reduction in predominant symptoms.

Keywords: Sandhigatavata, Dashmoola Kheera Janu Basti, Jatamayadi Upanaha, Osteoarthritis, Degenerative joint disease

Corresponding Author How to Cite this Article To Browse
Minakshee Chouhan, Post Graduate, Department Of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.
Email: 		Chouhan M, Chouhan M, Paliwal S, Effect of Dashmoola Siddha Ksheera Janu Basti and Jatamayadi Upanaha in Sandhigatavata (Osteoarthritis) - A Case Study. J Ayu Int Med Sci. 2023;8(9):178-182.
Available From
https://jaims.in/jaims/article/view/2775

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-07-14 2023-07-18 2023-07-24 2023-07-31 2023-08-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 23.89%

© 2023by Chouhan M, Chouhan M, Paliwal Sand 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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Preeti Chaturvedi et al. Dashmoola Siddha Ksheera Janu Basti and Jatamayadi Upanaha

Introduction

The word Sandhivata mainly having two parts, Sandhi - anatomical aspect and Vata - physiological aspect of the body, which is described under Vata Vyadhi in Samhita and Samgrah Granth. Acharya Charaka has described Sandhivata as a separate disease under the chapter of Vata Vyadhi with the name of “Sandhigata Anila” with the symptoms of Sotha in Sandhi, palpable as  an  air-filled  bag (Vata Purna Driti Sparsha), pain on flexion and extension [Akunchana Prasarana Pravrittisch Vedana][1] and in the later stage Hanti Sandhigatah.[2]

Osteoarthritis of knee joint comes under the inflammatory group which is almost similar to the Janu Sandhigata Vata in Ayurveda. The disease that is frequently seen in clinical practice as chronic progressive degenerative joint disease that affects the articular cartilage, subchondral bone, ligaments, capsule and synovium. It commonly involved major joints and weight bearing joints, characterized by pain and swelling in joints, stiffness, impairment of movement and bony crepitations. There are two type of osteoarthritis is seen in clinical practice- primary OA and secondary OA. Primary OA occurs in the elderly, more commonly in women than man.[3] At the end of 4th decade clinical symptoms are progressively and steadily increase. Secondary OA may appear at any age and is the result of any previous injury, fracture, inflammation, loose bodies and congenital dislocation of the joint. According to WHO, osteoarthritis is the second commonest musculoskeletal problem among the world population (30%) after back pain (50%). Worldwide osteoarthritis of hip joint is very prevalent but in India OA of knee joint is very frequent.[4]

Contemporary science treats the disease with calcium supplementation and analgesics which might have adverse effects like gastric irritation, hepatotoxicity, on the contrary Ayurveda treatments like Snehan (oleation), Swedan (steam), Upanaha (poultice), Lepa (topical application) and Bandhan (Bandage) yield better relief from pain and swelling thus to restore the mobility without any side effects.

Janu Basti is one of the modalities of treatment commonly adopted in the management of Janusandhigatvata. It gives combined effects of Snehan and Swedan Karma. Most of the Drugs in Dashmoola are having Madhura & Kashaya Rasa, Laghu Ruksha Guna, Ushna Veerya,

Madhura Vipaka, which mainly act on Vata Dosh. When Dashmoola is processed with the Ksheera, it provides Dhatu Poshan and alleviates Vata.[5] Upanaha Swedana is a standard treatment modality used in the Ayurveda for the management of pain and inflammation. The ingredients of Jatamayadi Upanaha are having Kapha-Vata Shamaka and Vedanasthapaka properties.[6] So for the better management of Sandhigatavata by the local Panchkarma therapy with less time consuming, Dashmoola Sidhha Ksheera Janu Basti and Jatamayadi Upanaha are taken for the study.

Case Report

A case of 57year old female patient visited in P.K. OPD with chief complain of bilateral knee joint pain swelling over the joint since 7 months. Pain aggravated during walking and climbing the stairs and pain is relieved by resting. Pain had affected her daily living activities. On examination reveals tenderness, swelling, crepitus and range of movement of both legs are reduced. The patient was taking NSAIDS, but there was no satisfactory relief. In radiographical examination narrow joint space and osteophytes was found.

Subjective Criteria

Following sign and symptoms will be considered for diagnosis:[7]

1. Pain in joints (Sandhi-Shoola)
2. Swelling in joints (Sandhi-Shotha)
3. Stiffness (Sandhigraha)
4. Pain on pressure (Sparsha Vedana)
5. Muscle weakness and impairment of movement with pain (Akunchan-Prasaranayo Vedana)
6. Bony crepitation (Sandhi-Sphutan).

Examination of Patient

Ashtavidha Pariksha[8]

1. Nadi - 80/min
2. Mutra - 3-4 time /day, normal in colour
3. Mala - once per day with Niram Mala
4. Jivha - Non coated
5. Shabda - Spashta
6. Sparsha - Samsheetoshna
7. Druk - Normal
8. Akruti - Sthula

Aturbala Pramana Pariksha[9]

1. Prakriti - Pitta Pradhan Kapha Anubandha


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2. Vikruti - Sandhigatavata
3. Sara - Madhyam
4. Samhanan - Madhyam
5. Pramana - Madhyam
6. Satmayatah - Avar
7. Satva - Avar
8. Ahar Shakti - Madhyam
9. Vyayam Shakti - Avar
10. Vaya - Madhyama Avastha

Treatment Protocol

1. Local Abhyanga with Vata Shamak oil over the affected knee joint.
2. Dashmoola Siddha Ksheera Janu Basti - 35 min/day for 21 days
3. Jatamayadi Upnaha Swedan - 1hr 30 min /day for 21 days

Material required

Table 1: Material required for Dashmoola Siddha Ksheera Janu Basti preparation[10]

SNDrugQuantity/Dose
1.Dashmoola (Yava Koota Churna)50gm
2.Ksheera400ml
3.Water1600ml
4.Black gram flour350gm
5.Vessel3
6.Spoon1
7.CottonQ.S.

Table 2: Material required for Jatamayadi Upanaha Swedana[11]

SNDrugQuantity/Dose
1.Jatamansi (Fine Powder)20gm
2.Chandana (Fine Powder)20gm
3.Tagara (Fine Powder)20gm
4.Kushta (Fine Powder)20gm
5.Kundurushka (Fine Powder)20gm
6.Sarala (Fine Powder)20gm
7.Rasna (Fine Powder)20gm
8.Ashwagandha (Fine Powder)20gm
9.Saindhava Lavan20gm
10.Godhuma40gm
11.Murchit Tila Tail40ml
12.Kanji As required

Procedure

Purva Karma:

For Janu Basti drug- Dashmoola, Milk and Water are considered in the ratio of 1:8:32. All these are taken in a clean stainless-steel vessel and boiled over mild flame until Ksheera Avashesh (only milk part remains). Make thick dough with black gram powder by mixing some adequate quantity of water.[12]

For Upanaha Swedan - Jatamansi (Nardostachys jatamansi), Chandana (Santalum album), Tagara (Valeriana jatamansi), Kushta (Saussurea lappa), Kundurushka

(Boswellia serrata), Sarala (Pinus roxburghii), Ashwagandha (Withenia somnifera), Rasna (Pluchea lanceolata), Godhuma (Tritcum sativum), Moorcchita Tila Taila (Sesamum indicum) and Saindhava Lavana. Above said ingredients were mixed with sufficient quantity of Kanji and homologous semi-solid paste was prepared. Paste was heated till it attains sticky uniform consistency.

Pradhan Karma:[13]

The patient should sit in comfortable position with extended legs and expose the Knee area. Using the thick dough make a rim and fix it firmly on the affected area. Take the warm Dashmoola Siddha Ksheera and pour on the inner wall of rim taking care not to ooze out. When Ksheera becomes cool, remove it with syringe & again refill with warm medicated Ksheera.

After Janu Basti warmed paste was applied over affected joints. Then covered with Eranda Patra (leaves of Ricinus Communis) and it was firmly bandaged with Cotton cloth. Upanaha was retained for 1-2 hours and then removed; the part was cleaned with warm water.

Study Duration: 21 Days

Assessment

Table 3: Assessment was done on the basis of WOMAC Criteria [14]

Sandhi Shool (Pain)

SymptomsScore/ grading
No pain0
Mild pain with no difficulty in walking1
Slightly difficulty in walking due to pain2
Severe difficulty in walking3

Sandhi Shoth (Swelling)

SymptomsScore/ grading
No swelling at all0
Swelling noticeable but not masking the bony prominence1
Swelling sufficient to cover the bony prominence2
Swelling with positive fluctuation3

Sandhi Graha (Stiffness)

SymptomsScore/ grading
No stiffness0
Mild stiffness1
Moderate stiffness2
Severe stiffness more than 10 min3

Akunchan Prasarnaya Vadana (Pain during flexion and extension)

SymptomsScore/ grading
No pain0
Pain without winching of face1
Pain with winching of face2
Prevent complete flexion3
Does not allow passive movement4

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Sparsh Ashyata (Tenderness)

SymptomsScore/ grading
No tenderness0
Patient say tenderness1
Winching of face on touch2
Does not allow to touch the joint3

Sandhi Sphutan (Crepitus)

SymptomsScore/ grading
No crepitus0
Palpable crepitus1
Audible crepitus2

Overall Assessment Criteria

Thus, the total effect of the therapies will be graded as follows:
Complete remission 100% relief
Marked improvement <100% to ≥75% relief
Moderate improvement <75% to ≥50% relief
Mild improvement <50% to ≥25% relief
No improvement < 25% relief

Result & Discussion

As per objective assessment criteria, the patient signs were analyzed before treatment & after treatment and during the followed period. The result is shown in table no. 4

Table 4: Patient symptoms evaluation.

SNJoint PainJoint SwellingJoint StiffnessCrepitationTendernessPain During Flexion & Extension
BTATBTATBTATBTATBTATBTAT
Right Knee Joint312020112131
Left Knee Joint201010101021

As observed in the above table, the patient score of right & left knee joint was 13 and 8 respectively at the time of admission & was reduced to 4 and 1 at the time of discharge. It showed moderate improvement (69.23%) in right knee & marked improvement (87.5%) in left knee joint.

Conclusion

As ageing occurs Dhatu Khsaya limited daily activities such as walking, dressing, bathing etc. and making the patient disabled. Global osteoarthritis prevalence increased more than 113% between 1990 and 2019, with the most cases appearing in China, India and the United States. Osteoarthritis has been affecting more than 15 million adults annually, with India contributing 22% to 39% share to the global numbers.


Sandhigatavata comes under Vatavyadhi but not include in eighty type of Vata Nanatmaj Vikar. Vata stimulating factors are accepted as Nidan. Vyan Vayu and Shleshka Kapha are crucial component for pathogenesis of Sandhigatvata. Snadhigatavata can correlated with Osteoarthritis. Osteoarthritis is a chronic degenerative joint disease, On the basis of clinical manifestation, pathogenesis and complication. In OA patient is suffering from Pain, Stiffness, Tenderness, Swelling and Crepitus in knee joint and pain during movement as common symptoms. Modern pathy has its own limitation in managing the OA. It has either conservatives or surgical treatment with some trouble and hazardous side effects with financial burden. Where as in Ayurveda this type of disease can be fully treatable by the Panchkarma therapy. Janu Basti and Local Upanaha have shown best for the Vata Vyadhi. In our case study Sandhivata is treated from Dashmoola Siddha Ksheera Janu Basti and Jatamayadi Upnaha Sweda for 21 days. This treatment has provided better relief in the sign and symptoms of Sandhigatavata and patient can walk comfortably without any trouble. This may be because of Vata and Kapha propitiating effect of Dashmoola Siddha Ksheera Janu Basti and Jatamayadi Upanaha Sweda Karma. Our intention is searching the simple, effective, convenient, patient friendly, pocket friendly Panchkarma therapy with easily available substances without any hazardous side effects. So, this type of study has been planned, which can be done on a large scale.

References

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3. Mohan H. Chapter 28, The musculoskeletal system, in Text Book of Pathology, p.g. no. 893, 8th edition, Publication Jaypee Brothers Medical Publishers (p) Ltd;2019

4. H.V. Happy, Vikram Kumar, A comparative clinical study on the effect of Mustadi and Devdarvadi Upanaha Sweda in Sandhigata


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Vata. Alvas Ayurveda Medical College, Moodbidri, Karnataka, India. (Sep-Oct 2021)

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7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583445/[As adopted by NCBI Orthop Surg. Feb 2010 ]

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