Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda with Rasnashirishadi Kwatha and Ajamodadi Vati: A Case Series

OP Vyas; Nimina Nanu Manikkoth

doi:10.21760/jaims.9.4.54

E-ISSN:2456-3110

Case Report

Osteoarthritis of knee joint

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April

Publisher

www.maharshicharaka.in

Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda with Rasnashirishadi Kwatha and Ajamodadi Vati: A Case Series

Vyas O¹, Nanu Manikkoth N^2*

DOI:10.21760/jaims.9.4.54

¹ OP Vyas, Professor HOD, Dept of Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India.

^2* Nimina Nanu Manikkoth, Post Graduate Scholar, Dept of Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India.

Sandhivata or Osteoarthritis is a degenerative joint disease. It is considered to be the result of inflammation, degeneration and wearing out of joint cartilage over time. Here the top layer of cartilage breaks down and goes away. This makes the bones under the cartilage to rub together. The rubbing results in pain, swelling and loss of motion of the joint. Sandhivata develops in all ages of people, but most probably it occurs after the age of 40. The most commonly affected joints include knee, hips, etc. Gradually O.A worsens as the time passes. Then the bone starts to break down and develops growths called spurs. There is a possibility to chip off the bits of bone or cartilage and float around in the joint. As a result of inflammatory process in the body, cytokines (proteins) and enzymes are produced that will further damage the cartilage. The primary purpose of this study was to establish the efficacy of medicines or treatment and demonstrate freedom from unwanted side effects in human. Suitable medicine plays a paramount role in the success of treatment as it is a main factor lying with the management of a disease. There is a direct proportional relationship between the success of treatment and the genuineness of the medicine. The present study was undertaken to carry out the clinical evaluation of Rasnashirishadi Kwatha and Ajamodadi Vati in Sandhivata patients.

Keywords: Sandhivata, Rasnashirishadi Kwatha, Ajamodadi Vati, Osteoarthritis, Case series

Corresponding Author	How to Cite this Article	To Browse
Nimina Nanu Manikkoth, Post Graduate Scholar, Dept of Kayachikitsa, Govt Auto Dhanwantari Ayurvedic College Hospital, Ujjain, Madhya Pradesh, India. Email:	Vyas O, Nanu Manikkoth N, Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda with Rasnashirishadi Kwatha and Ajamodadi Vati: A Case Series. J Ayu Int Med Sci. 2024;9(4):322-329. Available From https://jaims.in/jaims/article/view/3261

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-02-15	2024-02-25	2024-03-05	2024-03-15	2024-03-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	23.96

© 2024by Vyas O, Nanu Manikkoth Nand 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].

J Ayu Int Med Sci 2024;9(4)322

Download PDF Back To Article Introduction Aims and
Objectives Materials and
Methods Case History Result Discussion Conclusion References

OP Vyas et al. Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda

Introduction

Sandhivata term is derived from words Sandhi and Vata. This is the most common disease affecting large population. As mentioned earlier, this mainly occurs in old age due to Dhathukshaya, which limits everyday activities such as walking, dressing, bathing etc. Among Tridoshas; Vata and Kapha plays an important role in Sandhivata. Vayu regulates all the functional activities

of the body and keep all the Dhathus in their physiological limits. In Sandhivata; Vata become vitiated when different Vataprakopa Nidana is taken. This vitiated Vata, desiccates Sleshaka Kapha in the Sandhi which will ultimately cause the degeneration and difficulty in the movement of joint. This is how the Dhathukshayajanya Sandhivata occurs. In obese people as Medodhathu is produced in excess; their Srotas will be obstructed with Medas. Due to, this Aavarana caused by the Medas; proper nourishment will not occur in the level of Uttarottara Dhathu. Hence Kshaya occurs there. Here this excessive Medas will cause Aavarana of Vata. This Medavrutha Vata when settle down in joints become, the reason to occur the disease Sandhivata.

So, this disease is seen in both types of patients like in Sthula due to Avarana and in Krisa, in the old age, may be due to Prakopa of Vayu resulted from Dhatukshaya. It is more difficult to manage, when it is caused due to Avarana of Meda, Kapha or Ama. This may be the reason that the patients suffer from Sandhi Vata for their whole of remaining life. Osteoarthritis is the most common articular disorder begins asymptomatically in the 2nd and 3rd decades of life and is extremely common by 60 years of age. Almost all persons after the age of 40 have some pathologic change in weight bearing joint. Osteoarthritis (O.A.) is a most frequent joint disease with prevalence of 22% to 39% in India. Almost 25% females and 16% males have symptomatic Osteoarthritis.

Aims and Objectives

1. To evaluate the efficacy of Rasnashirishadi Kwatha in the management of

2. To evaluate the efficacy of Ajamodadi Vati in the management of

3. To assess the clinical effectiveness of Rasnashirishadi Kwatha and Ajamodadi Vati in the combined form to manage

Materials and Methods

Literary Review

A thorough review of literature in traditional Ayurvedic texts, and online databases was carried out. Pharmacological properties of the drugs are analyzed and data are arranged. Detailed literary review about osteoarthritis from the modern medicine text books are also carried out.

Clinical Study

Clinical trial was started after getting approval from ethical committee. Registered patients from Dhanwantari ayurvedic hospital have been taken for the study after getting written consent from them to include in the study. Here presents 3 cases from, each of the trial group. All the selected patients were properly informed about the nature of the disease process and treatment. Diagnostic medical history was taken according to both Ayurveda and modern clinical methods. X-ray of the patient was taken before the treatment for the proper diagnostic purpose and assessment of the case and CBC, ESR, CRP of the patients were assessed before and after the treatment. Detailed Proforma was made to record the progress and status of the patient under trial.

Methodology / Treatment Plan

Trial medicines were prepared in the pharmacy of Govt. Auto. Dhanwantari Ayurvedic Medical College Ujjain and the selected patients under trial were treated in the Kayachikitsa OPD of Dhanwantari Ayurvedic Hospital, Ujjain. Study was carried out for 2 months and follow-up has been done on every 10 days.

Details of the medicines given

Drug administration	Rasnashirishadi Kwatha	Ajamodadi Vati	Both Rasnashirishadi Kwatha and Ajamodadi Vati
Dose	20ml BD	1Tab BD	Kwatha - 20ml BD Vati - 1Tab BD
Route of administration	Oral	Oral	Oral
Anupana	Lukewarm water	Luke warm water	Luke warm water
Follow-up	Every 10 days	Every 10 days	Every 10 days
Duration	2 months	2 months	2 months
Case name	Case 01	Case 02	Case 03

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Composition of Rasnashirishadi Kwatha

Drug	Latin Name	Family	Part Used	Rasa	Guna	Virya	Vipaka	Dosha Karma
Rasna	Pluchea lanceolata	Compositae	Mula	Tiktha	Guru	Ushna	Katu	Kapha Vata Samana
Shirisha	Albizzia lebbeck	Leguminosae	Mula	Kashaya Tikta Madhura	Laghu Ruksh Tikshna	Ishad ushna	Katu	Tridosha Samana
Yasthimadhu	Glycyrhiza glabra	Leguminosae	Mula	Madhura	Guru Snigdha	Sita	Madhura	Vata Pitta Samana
Shunthi	Zingiber officinale	Zingiberaceae	Mula	Katu	Laghu Snigdha	Ushna	Katu	Kapha Vata Samaka
Sahachara	Barleria cristata	Acanthaceae	Mula	Tikta Madhura	Laghu	Ushna	Katu	Kaphavata Samana
Amruta	Tinospora cordifolia	Menispermaceae	Stem	Tikta Kasaya	Guru Snigdha	Ushna	Madhura	Vata Pitta Samana
Shyonyaka	Oroxylum indicum	Bignoniaceae	Mula	Madhura Tikta Kashaya	Laghu Ruksha	Ushna	Katu	Kapha Vata Samana
Devadaru	Cedrus deodara	Pinaceae	Bark	Tikta	Laghu Snigdha	Ushna	Katu	Kapha Vata Shamana
Shampaka	Cassia fistula	Leguminosae	Mula	Madhura	Guru Mrud Snigdha	Sita	Madhura	Vata Pitta Samana
Ashwagandha	Withania somnifera	Solanaceae	Mula	Tikta Katu Madhura	Laghu Snigdha	Ushna	Madhura	Kapha Vata Samana
Trikantaka	Tribulus terrestris	Zygophyllaceae	Fruit	Madhura	Guru Snigdha	Sita	Madhura	VatapittaSamana

Mode of action of Rasnashirishadi Kwatha

Rasna is known to be Agrya for Vataharatva (Rasna Vataharanam). It is having Ushna Virya and Vatakaphahara properties. Rasna is specially known to be Vayasthapana, Vatanulomana, and Vatakaphahara in nature. Shirisha is Vedanasthapana and Shothahara. Susrutha included Shirisha in Salasaradigana, while Vagbhata included it in Asanadigana. Shunti is having Shulaprasamana, Shophahara, Deepana, Amapachana and Bhedini properties. Susrutha included it in Pippalyadi and Trikatugana and Vagbhata also included it in Pippalyadigana. Yashtimadhu is having Rasayana properties and improves digestion as well. Sahachara is Vedanasthapana, Deepana, Pachana, Shophahara, Balya, and Rasayana in nature. Guduchi is having Deepana, Balya, Rasayana, Tridoshasamana etc. properties. Shyonaka is Vedanasthapana, Deepana and Shothahara in nature. Susrutha

included the other drug Devadaru in Vatasamsamana group, it is Aamapachana and Shophahara also. Aragvadha possess Shulahara property. Aswagandha has been used in Ayurveda thousands of years as a Rasayana and it is Shulahara in nature. Gokshura possess Deepana, Anilahara, Tridoshasamana, Shulahara, Balakrith, and Pushtikrit properties. Charaka included this drug, in Shothahara group. Over all we get an idea that this Yoga is having a potent role in the management of Sandhivata.

Composition of Ajamodadi Vati

Drug	Latin Name	Family	Part Used	Rasa	Guna	Virya	Vipaka	Dosha Karma
Ajamoda	Carum roxburghianum	Umbelliferae	Phala	Katu Tikta	Laghu Ruksha Tikshna	Ushna	Katu	Kaphavata Samana
Kanaa	Piper longum	Piperaceae	Phala	Katu	Laghu Snigdha Tikshna	Anushna sita	Madhura	Kapha Vata Samana
Vellam	Embelia ribes	Myrsinaceae	Phala	Katu Kasaya	Laghu Ruksha Tikshna	Ushna	Katu	Kapha Vata Samana
Shatapushpa	Anethum sowa	Umbelliferae	Phala	Katu Tikta	Laghu Ruksha Tikshna	Ushna	Katu	Kapha Vata Samana
Chitraka	Plumbago zeylanica	Plumbaginaceae	Mula	Katu	Laghu Ruksha Tikshna	Ushna	Katu	Kapha Vata Samana
Nagara	Zingiber officinale	Zingiberaceae	Kanda	Katu	Laghu Snigdha	Ushna	Katu	Kaphavata Samaka
Maricha	Piper nigrum	Piperaceae	Phala	Katu	Laghu Tikshna	Ushna	Katu	Kaphavata Samana
Saindhava	Rock salt			Lavana	Laghu Snigdha	Sheeta	Madhura	Tridoshahara
Devadaru	Cedrus deodara	Pinaceae	Kandasara	Tikta	Laghu Snigdha	Ushna	Katu	Kapha Vata Shamana
Haritaki	Terminalia chebula	combretaceae	Phala	Kasaya pradhana pancharasa	Laghu Ruksha	Ushna	Madhura	Tridosahara
Vruddhadaru	Argyreia speciosa	Convolvulaceae	Mula	Katu Tikta Kasaya	Laghu Snigdha	Ushna	Madhura	Kapha Vata Shamaka
Guda	Saccharum officinarum			Madhura	Guru Snigdha	Sheeta	Madhura	Vata Pitta Shamaka

Mode of action of Ajamodadi Vati

Vata has the properties like Ruksha, Laghu, Sita, Khara, Sukshma, Chala, etc. when the aggravation

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of Vataguna occurs in the body the disease Sandhivata manifests. Contents of Ajamodadi Vati are Ajamoda, Vidanga, Shunti etc. Most of the drugs of Ajamodadi Vati are having Deepana, Pachana, Ushna, Tiksna, Amapachana and Vatanulomana properties. Ajamoda is also having Srothogamini property which will also help to manage Sandhivata. Other drugs like Chitraka, Pippali, Maricha, etc. are also helpful to pacify Vata. Charakacharya mentioned most of the ingredients of Ajamodadi Vati in Shulaprasamana Gana and Susruthacharya mentioned most of the drugs in Pippalyadigana, which act as Deepana, Vatakaphahara, Amapachana, Aruchi, Gulma and Shulahara. The drugs possessing these properties will help to eliminate Vata out of the body and reducing the pain.

Case History

Case 01 Presentation - A 65 year old male patient came to our OPD on 09/05/23 with chief complaints of bilateral knee joint pain and swelling of the right knee joint. Pain had a gradual onset eventually developed swelling on the right knee joint.

Case 02 Presentation - A 55 year male patient came to our Kayachikitsa OPD ON 07/01/23 with bilateral knee joint pain and difficulty in walking. Symptoms have a gradual onset associated mild swelling of both the knee joints.

Case 03 Presentation - A 45 year old male patient came to the Kayachikitsa OPD of our hospital on 20/04/23 with bilateral knee joint pain. Symptoms had a gradual onset.

Demographic data of presented cases

Data	Case 01	Case 02	Case 03
Name	Xxx	Yyy	Zzz
O.P.D	18267	384	11140
DOA	09/05/23	07/01/23	20/04/23
Age	65	55	45
Sex	Male	Male	Male
Marital Status	Married	Married	Married
Occupation	Service	Laborer	Laborer
Diet and Habits	Veg	Veg	Veg
Addiction	Nil	Nil	Tea
Koshta	Krura	Madhyama	Madhyama
Emotional status	Normal	Normal	Tensile
Sleep	Sound	Sound	Sound
Family history	Nothing relevant	Nothing relevant	Nothing relevant

Treatment Given

Case Name	Case 01	Case 02	Case 03
Name of medicines	Rasnashirishadi Kwatha	Ajamodadi Vati	Both Rasnashirishadi Kwatha and Ajamodadi Vati
Dose	20 ml after meal	1 Tab BD Empty stomach	Kwatha - 20 ml after meal & Vati - 1 tab Empty stomach
Anupana	Lukewarm water	Lukewarm water	Lukewarm water
Duration	2 months	2 months	2 months

Treatment assessment on the basis of subjective parameters

Case 01

Lakshana	BT			AT
Lakshana	Lt		Rt	Lt		Rt
Sandhi Shula (Joint Pain)
No Pain	0			0		1
Occasional Pain	1
Pain during excess work	2
Constant pain disturbing routine	3	3	3
Severe pain	4
Sandhi-Shotha (Joint-Swelling)
No Swelling	0	0		0		0
Mild Swelling	1
Moderate Swelling	2		2
Severe Swelling	3
Akunchana Prasaranajanya Vedana (Pain during flexion and extention of the joint)
No Pain	0			0		0
Pain without winching of face	1	1	1
Pain with winching of face	2
Shouts or Prevent complete flexion	3
Does not allow passive movement	4
Stambha (Stiffness)
No Stiffness	0				0	0
Stiffness for few minutes after sitting for long duration but relieved by mild movements	1	1	1
Stiffness more than 1 hour or more than once in a day but routine works are not disturbed.	2
Stiffness lasting for more than 1 hour or many times a day mildly affecting the daily routine.	3
Episodes of stiffness lasting for 2-6 hours daily routines are hampered severely	4
Sandhi Sphutana (Crepitus)
No Crepitus	0				0	0
Mild Palpable Crepitus	1
Moderate Palpable Crepitus	2	2	2
Moderate Palpable & Mild Audible Crepitus	3
Audible Crepitus	4
Sparshasahyata (Tenderness)
No Tenderness	0				0	0
Patient says the joint is tender	1	1	1
The patient winces	2
The patient winces and withdrawal of the affected joint	3
The patient will not allow the joint to be touched	4

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Case 02

Lakshana	BT					AT
Lakshana	Lt		Rt			Lt			Rt
Sandhi Shula (Joint Pain)
No Pain	0					0			0
Occasional Pain	1
Pain during excess work	2
Constant pain disturbing routine	3	3	3
Severe pain	4
Sandhi-Shotha (Joint-Swelling)
No Swelling	0					0			0
Mild Swelling	1	1		1
Moderate Swelling	2
Severe Swelling	3
Akunchana Prasaranajanya Vedana (Pain during flexion and extention of the joint)
No Pain	0				0				0
Pain without winching of face	1	1		1
Pain with winching of face	2
Shouts or Prevent complete flexion	3
Does not allow passive movement	4
Stambha (Stiffness)
No Stiffness	0						0	0
Stiffness for few minutes after sitting for long duration but relieved by mild movements	1	1		1
Stiffness more than 1 hour or more than once in a day but routine works are not disturbed.	2
Stiffness lasting for more than 1 hour or many times a day mildly affecting the daily routine.	3
Episodes of stiffness lasting for 2-6 hours daily routines are hampered severely	4
Sandhi Sphutana (Crepitus)
No Crepitus	0	0					0	0
Mild Palpable Crepitus	1
Moderate Palpable Crepitus	2			2
Moderate Palpable & Mild Audible Crepitus	3
Audible Crepitus	4
Sparshasahyata (Tenderness)
No Tenderness	0	0		0			0	0
Patient says the joint is tender	1
The patient winces	2
The patient winces and withdrawal of the affected joint	3
The patient will not allow the joint to be Touched	4

Case 03

Lakshana	BT				AT
Lakshana	Lt		Rt		Lt	Rt
Sandhi Shula (Joint Pain)
No Pain	0				0	0
Occasional Pain	1
Pain during excess work	2
Constant pain disturbing routine	3	3	3
Severe pain	4
Sandhi-Shotha (Joint-Swelling)
No Swelling	0	0		0	0	0
Mild Swelling	1

Lakshana	BT					AT
Lakshana	Lt		Rt			Lt			Rt
Moderate Swelling	2
Severe Swelling	3
Akunchana Prasaranajanya Vedana (Pain during flexion and extention of the joint)
No Pain	0			0	0				0
Pain without winching of face	1	1
Pain with winching of face	2
Shouts or Prevent complete flexion	3
Does not allow passive movement	4
Stambha (Stiffness)
No Stiffness	0	0		0			0	0
Stiffness for few minutes after sitting for long duration but relieved by mild movements	1
Stiffness more than 1 hour or more than once in a day but routine works are not disturbed.	2
Stiffness lasting for more than 1 hour or many times a day mildly affecting the daily routine.	3
Episodes of stiffness lasting for 2-6 hours daily routines are hampered severely	4
Sandhi Sphutana (Crepitus)
No Crepitus	0						0	0
Mild Palpable Crepitus	1	1
Moderate Palpable Crepitus	2			2
Moderate Palpable & Mild Audible Crepitus	3
Audible Crepitus	4
Sparshasahyata (Tenderness)
No Tenderness	0	0		0			0	0
Patient says the joint is tender	1
The patient winces	2
The patient winces and withdrawal of the affected joint	3
The patient will not allow the joint to be Touched	4

Result

Both the drugs Rasnashirishadi Kwatha and Ajamodadi Vati could successively manage the symptoms of Sandhivata. All the 3 cases showed excellent improvement from the symptoms.

Discussion

Most of the drugs of Rasnashirishadi Kwatha possess the properties like Madhura, Tiktha and Kasayarasa, Ushna Virya, Vatahara, Vedanasthapana, Shothahara, Dipana, Pachana, Balakruth, Pushtikruth, Rasayana etc. properties. Most of the ingredients of Ajamodadi Vati are having Tikta Kasaya Rasa, Ushnavirya, Dipana, Pachana, Vata Kaphahara, Shulaprasamana, Rasayana etc. properties.

Vatahara properties of the Yogas

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will reduce the aggravation of Vata. Reduction in Vata will help to restore the Snehamsa in the joints. Restoration of Snehamsa as well as Vedanasthapana and Shothahara properties of medicines will help to relieve the pain and swelling of the joints. Balkruth and Pushtikruth properties of the drugs help to strengthen bones and joints while, Rasayana properties of the drugs will reduce the degeneration of the joints. Relieving of symptoms by above medications facilitates the easy movements of the joints and removes the difficulty in flexion and extension of joints.

Conclusion

Sandhivata is one of the most common diseases affecting a large population. When severe degeneration of joint occurs, it will lead to unbearable pain and other symptoms like restricted movement of joint, inflammation etc. So, Sandhivata is a disease which interfere the day today activities of a person. The disease Sandhivata or Osteoarthritis may be regarded as a reward of longevity. There is no absolute cure for O.A. in modern medicine. Nowadays, management of osteoarthritis is going on with analgesic and non-steroidal anti-inflammatory drugs. These drugs are very costly and causing various unwanted effects leading to peptic ulcer etc. Osteoarthritis become cause of distress to modern medical science and satisfactory treatment is yet to be discovered. Furthermore, the complications arising from Osteoarthritis have been entrusted to the surgery, which too has its limitation. All such factors show the gravity of the disease and compelled to go for a better remedial search from Ayurveda.

References

1. Charaka Samhita by Agnivesa, revised by Charaka and Dridhabala with the Ayurveda Deepika Commentary of Chakrapanidatta Edited by Vaidya Jadavji Trikamji Acharya. Choukhambha Prakashan, edition Reprint 2009, Vimanasthana 5/8

2. Susruta Samhita of Maharshi Susruta edited with Ayurveda Tatva Sandipika,Hindi Commentary, Scientific Analysis, Notes etc. By Kaviraja Ambika Dutta Shastri Part 1, Choukhambha Sanskrit Sansthan, edition Reprint 2020, Sharirasthana 5/24-25.

3. Ashtanga Sangraha of

Vagbhata (Text, Translation, Notes and Indexes) Prof. K.R. Srikanthamurthy, Choukhambha Orientalia, Varanasi,3^rd edition 2001, vol.1.Sutra Sthana

4. Vagbhata’s Ashtanga Hridayam (Text, English translation, Notes and Indexes), Prof. K.R. Srikanthamurthy, Choukhambha Krishnadas Academy Varanasi, Reprint 2006, Sutra Sthana 12/7.

5. Davidsons Principles and Practice of Medicine, 23^rdedition.

J Ayu Int Med Sci 2024;9(4)327

Case Report

Osteoarthritis of knee joint

Journal of Ayurveda and Integrated Medical Sciences

Management of Sandhivata (osteoarthritis of knee joint) in Ayurveda with Rasnashirishadi Kwatha and Ajamodadi Vati: A Case Series

Vyas O1, Nanu Manikkoth N2*

Introduction

Aims and Objectives

Materials and Methods

Case History

Result

Discussion

Conclusion

References

Vyas O¹, Nanu Manikkoth N^2*