E-ISSN:2456-3110

Review Article

Osteoarthritis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Ayurvedic management of Sandhivata (Osteoarthritis)

Chandrol U1*, Nagpal S2
DOI:10.21760/jaims.8.12.35

1* Urvashi Chandrol, Post Graduate Scholar, Department of Kayachikitsa, Pt Khushilal Sharma Gov Ayurvedic College, Bhopal, Madhya Pradesh, India.

2 Swati Nagpal, Reader, Department of Kayachikitsa, Pt Khushilal Sharma Gov Ayurvedic College, Bhopal, Madhya Pradesh, India.

Sandhivata is the most common disease in the world which affecting a large population. Sandhivata term is derived from “Sandhi” and “Vata” which means when Vata lodges in Sandhi causes pain, swelling, restriction of joint movements. Clinical presentation of Sandhivata is closely mimics to osteoarthritis. Osteoarthritis is a degenerative disease. According to Ayurveda Sandhivata is a type of Vatavyadhi which more commonly occurs in Vridhavasta. In present era due to its chronicity, incurability, complications, Sandhivata become a challenging disease. Sandhivata commonly affects knee joint, hip joint, and it is more common in weight wearing joint among all joints. If knee joint involved condition become more painful. Early diagnosis of Sandhivata such as through symptoms or screenings, can often lead to better treatment outcomes and a higher likelihood of successful recovery. Timely intervention can help slow down the progression of the disease and increase the chances of achieving positive results within a shorter period, typically within 5-6 days. In the current study main aim to treat Sandhivata in early stage by herbal medicine, Januvasti and physiotherapy.

Keywords: Early stage Sandhivata, osteoarthritis. herbal medicine, Januvasti, physiotherapy

Corresponding Author How to Cite this Article To Browse
Urvashi Chandrol, Post Graduate Scholar, Department of Kayachikitsa, Pt Khushilal Sharma Gov Ayurvedic College, Bhopal, Madhya Pradesh, India.
Email: 		Chandrol U, Nagpal S, Ayurvedic management of Sandhivata (Osteoarthritis). J Ayu Int Med Sci. 2023;8(12):236-240.
Available From
https://jaims.in/jaims/article/view/2837

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-14 2023-10-24 2023-11-04 2023-11-14 2023-11-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.33

© 2023by Chandrol U, Nagpal 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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Urvashi Chandrol et al. Ayurvedic management of Sandhivata (Osteoarthritis)

Introduction

Osteoarthritis is the most common degenerative disorder. Its prevalence is high in the elderly, and the high rate of disability related to disease makes is as a leading cause of disability. The occurrence of Osteoarthritis is on the rise due to faulty lifestyle. Obesity specially imparts significant contribution to the weight bearing joints. Commonly affected joints include the cervical and lumbosacral spine, hip, knee and first metatarsal phalangeal joint. In the hands, the distal and proximal interphalangeal joints and the base of the thumb are often affected. Usually affected joints are wrist, elbow, and ankle. The symptoms can interfere with work and normal daily activities. Among those over 60year old, about 10% of males and 18% of females are affected with OA. In the affected individual, osteoarthritis is the cause of about 2% of years lived with disability.[1]

OA can be correlated with Sandhivata in Ayurveda. Acharya Charaka had described this disease under Vataj Nanatmaj Vyadhi (different diseases of Vata). He had narrated this condition with symptoms such as inflammation, difficulty and pain while walking, and crepitus present in joint.[2] Acharya Shusruta had further added specific symptoms, that is, degenerative changes in joints as the symptoms of Sandhivata.[3] Contemporary treatment has its own limitation in managing this disease. In Western medical science, various treatment options in advanced stage of OA are present but they do not provide remarkable recovery and cause multiple side effects. So, there is a great need to find effective management in Sandhivata. Such type of rheumatological condition can be better treated with application of various Panchakarma procedures and Shaman Chikitsa (palliative therapy) in Ayurveda. Through this paper, a novel effort was undertaken to enlighten over the great efficacy of Ayurvedic treatment for Sandhivata. In this case study, a female patient with Sandhivata was prescribed for palliative treatment along with local therapy, which resulted in excellent recovery in symptoms.[4]

History of present illness

A 38 year-old female patient was symptomless 9 months ago but gradually she had symptoms such as pain in both knee joints and difficulty while walking since 7-8 months, stiffness in both knee joints since 5 months, and mild swelling in right knee joint since 3 months, which are briefly

mentioned in Table 2. She had associated symptoms of recurrent constipation, which are type 1 in consistency [Table 2]. After intake of analgesic also, no relief was obtained, and symptoms were getting worsened day by day. Patient had no history of hypertension. So, she approached Kayachikitsa outpatient department of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal, Madhya Pradesh, India, for Ayurvedic treatment. Examination of the patient including vitals examination, Ashtavidha Pariksha (eight systemic examination), and specific locomotor system examination is mentioned in Tables 3, 4, and 5, respectively, and after obtaining written inform consent, the treatment was started on inpatient department level.

Table 1: Demographic details

Age38
SexFemale
AddressIndrapuri, Bhopal
OccupationHousewife
OPD no. / IPD no.20230052176/20232761
Marital statusMarried
Socioeconomic statusMiddle class family

Table 2: Chief complaints

SNChief complaintGradeDuration
1.Pain in both knee joint+2Since 7 months
2.Difficulty and pain while walking+2Since 7 months
3.Stiffness+1Since 5 months
4.Mild swelling in right knee joints+1Since 3 months

Associated complaints

SNAssociated complaintGradeDuration
1.ConstipationTypeOn and off

Table 3: Vitals examination

Blood pressure130/80 mmHg
Respiratory rate18/min
Pulse76/min

Past History - No history of trauma or fall was reported.

Medication History - Patient had not taken any previous treatment.

Personal History

Food Habits: excessive intake of spicy food

Sleep: disturbed sleep

Addiction: no any addiction


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Family History: No significant family history was reported.

Nidan Panchak (The Procedure of Etiopathogenesis of Sandhigatavata as per Ayurveda)

Hetu (etiology or causative factors):

Ahara: Katu Rasa (spicy food items), Ruksha (dry or shrunken food items)

Table 4: Ashtavidha Pariksha

Nadi (pulse)76/min
Mala (stool)Sama Mala
Mutra (urine)Normal
Jivha (tongue)Nirama
Shabda (speech)Prakrut
Sparsha (skin)Sheetushana
Druka (eyes)Prakruta
Aakruti (posture)Medium

Examination for locomotor system (examinations specific to diagnosis)

Inspections

  • Difficulty and pain in both knee joints while walking for long duration
  • mild Swelling over right knee joint
  • Knee flexion deformity on right knee
  • Reflexes are intact
  • No any scar
  • No varicosities are seen
  • No any structural deformity in left knee joint

Palpation

  • Crepitus present in both knee joints
  • Affected flexion and extension of right knee joint

Range of movement (ROM) Right knee

  • Flexion at right knee joint, 70°– 80° extension of right knee joint Rest of movements are normal
  • Left knee joint - No occurrence of any deformity

Vihara: Atijagarana (excessive awakening at night), Ativyayama (excessive body exertion), Chinta (worry), Shoka (grief), Vegdharana (suppression of natural urges)

Aggravating factor: Constipation, age-related degeneration.[5]

Purvarupa (prodromal symptoms): stiffness in both knee joints, mild discomfort during walking

Roopa (manifestation): Right knee joint pain, trouble walking, crepitus in both knee joints, stiffness in both knee joints since 20 days, and little swelling over the right knee joint since 15 days.

Samprapti (pathophysiology of the disease):

The abore mentioned contributing elements cause Rasadushti (inadequate blood plasma generation) and Vataprokopa (Vitiation of Vata), which spreads Vatadosha throughout the entire body and obstructs many channels and wedged over joints. Joints experience degenerative changes as a result of blockage which results in Sandhivata.[6]

Investigations: X-ray of both knee joint Anteroposterior view had showed space reduction in knee joint, and osteoporotic changes as shown in figure.

jaims_2837_01.JPG

Diagnosis: Sandhivata (osteoarthritis)

Treatment advised: A therapy plan was suggested after investigating the disease's pathophysiology in this patient. This is included in below table.

Observations and Results

Assessment of the patient was performed in terms of clinical features.[7] After completion of therapy,


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the patient got significant relief in pain while walking, stiffness, and swelling of knee joint. Constipation was relieved in this duration.

Discussion

Accordingly factors are responsible for pathogenesis of Sandhivata, principle of treatment was planned in this Sandhivata patient. The treatment was as

MedicineDoseDays
Rasanadi Guggulu2 BD5 days
Trifala Guggulu2 HS5 days
Sahcharadi Kwatha10ml BD5 days
Tablet Nucart OA2 BD5 days
Sukumar Ghrita15 ml BD5 days
Combination of Godanti 250mg and Kamduda Rasa 125 mg125 mg BD5 days
Swadist Virechan Churna5 gm HS5 days
Janu BastiWith Mahanaraya Oil5 days
Physiotherapy5 days

Probable mode of action of these drugs and procedures are as follow

Rasanadi Guggulu - Rasana has painkiller property.[8]

Trifala Guggulu - In this patient constipation was present, and Trifala has laxative property.[9]

Sahcharadi Kwath - Sahcharadi Kwath has anti-inflammatory and antiarthritic action of this medicine helps to alleviate the various symptoms including improving the blood circulation in the affected areas, body pain and debility.[10]

Sukumar Ghrita - Ghrita has rich in Snigda Guna which reduces Rukshta in Sandis and Shamana of the Vata Dosha.[11]

Combination of Godanti and Kamdudha Rasa - Kamdudha Rasa is a polyherbal formulations as a powerful digestive tonic and treating various health aberrations including Deepan, Pachan, Aaahara, Vatahara etc. This combination also gives calcium which is responsible for bone density.[12]

Swadista Virechan Churna - In this patient constipation is also a symptom, and this Churna has laxative property.[13]

Tablet Nucart OA - this tablet is a nutritional supplement which is used to provide nutrition to the cartilages in conditions such as osteoarthritis. Its content extract of Boswellia serrata, and Chingali Satva acts as active ingredients which improves joint mobility and prevents cartilage deterioration.[14]

Janu Basti - It induces reduction in stiffness without damaging structures in joint. In this patient, it increases strength and circulation with reduction in pain.[15]

Physiotherapy - In physiotherapy isometric exercise, knee band in supine and prone position, hemstring muscle stretching with ultrasound therapy were included. It helps to restore movement and function of joints.

Assessment - Assessment is based on subjective and objective criteria.

Subjective CriteriaBefore TreatmentAfter Treatment
Pain in right knee joint (VAS score) +2 0+20
Difficulty and pain while walking + 2 0+20
Stiffness in both knee joints +1 0+10
Crepitus present in both knee joint + 2 0+20
Mild swelling over right knee joint +2 0+20
ConstipationType1normal bowel
Objective criteria
Range of movement: (Right leg)Grade 2 (71°–80° flexion)Grade (101°–120° flexion)

Conclusion

If Sandhivata diagnosed in early stage than it can be cured effectively by Shaman medicines and physiotherapy.

References

1. Kayachikitsa book part 4 by Dr. ajay kumar pandey.

2. Trikamji Y, editor. Chikitsasthan; Vatavyadhichikitsa Adhyaya. Verse 37. In: Charakasamhita of Agnivesha. Varanasi, India: Chaukamba Publication; 2011. p. 690.

3. Shastri K, editor. Nidhanasthana; Vatavyadhinidan Adhyaya. Verse 29. In: Sushruta, Sushruta Samhita. Varanasi, India: Chaukhamba Sanskrit Sansthan; 2012. p. 460

4. Comprehensive Ayurvedic management of Sandhigatavata: case report Article in Journal of Indian System of Medicine · January 2019 DOI: 10.4103/JISM.JISM_71_1 by Poonam Ashtankar, Punam Sawarkar


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Urvashi Chandrol et al. Ayurvedic management of Sandhivata (Osteoarthritis)

5. Tripathi B, editor. Chikitsasthana; Vatavyadhichikitsa Adhyaya. Verse 15–18. In: Charak, Charak Samhita. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2011. p. 93.

6. Gupt A, editor. Nidanasthana; Vatavyadhinidan Adhyaya. Verse 5–6. In: Shrimadvagbhat, Astanghrudayam. Varanasi, India: Chaukhambha Sanskrit Samsthan; 2005. p. 375.

7. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997;32:920-4.

8. Ayurveda saarsanghra, guggul prakarana page no. 523

9. Ayurveda saarsanghra, guggul prakarana page no. 517

10. sahstrayoga kasaya yoga page no. 113

11. sahstrayoga ghrita yoga

12. Rajnighantu and sharangdhar Samhita,

13. Rastantrasaar rogadhikar vivandh

14. Gufic biosciences limited

15. Pathak R, editor. Taila Prakarana. In: Ayurveda Sara Sangraha. 12th ed. Nagpur, India: Vaidhyanath Ayurveda Bhavan Limited; 2007. p. 663-4.


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