E-ISSN:2456-3110

Case Report

Osteoarthritis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

Effect of Marma Chikitsa in pain management of Sandhivata (Osteoarthritis) - A Single Case Study

Asthana M1*, Marwaha R2, Gupta P3, Bhalerao N4, S D Panda5
DOI:10.21760/jaims.9.5.51

1* Mahima Asthana, Post Graduate Scholar, Dept of Rachna Sharir Professor, Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, Professor HOD, Dept of Rachna Sharir, Professor Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.

3 Pankaj Gupta, Associate Professor, Dept of Rachna Sharir Professor, Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.

4 Nisha Bhalerao, Associate Professor, Dept of Rachna Sharir Professor, Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.

5 S D Panda, Assistant Professor, Dept of Rachna Sharir Professor, Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.

Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone. It is believed to be the fourth leading cause of disability in the world, affecting 1 in 7 adults in the United States alone. The most common symptoms are joint pain and stiffness. Usually, the symptoms progress slowly over years. In this paper there is a case of 52 year old female patient that came to our institute with complain of pain, swelling and stiffness of right knee joint since 1 year. X - ray suggested narrowing of the space between the bones in the joint. X - ray also shows spurs around the joint. In this case study of Marma Chikitsa is done in the pain management of Osteoarthritis.

Keywords: Marma Chikitsa, osteoarthritis, Sandhivata, Case Report

Corresponding Author How to Cite this Article To Browse
Mahima Asthana, Post Graduate Scholar, Dept of Rachna Sharir Professor, Pt Khushilal Sharma Govt Ayurved College Institute, Bhopal, Madhya Pradesh, India.
Email: 		Asthana M, Marwaha R, Gupta P, Bhalerao N, S D Panda, Effect of Marma Chikitsa in pain management of Sandhivata (Osteoarthritis) - A Single Case Study. J Ayu Int Med Sci. 2024;9(5):303-306.
Available From
https://jaims.in/jaims/article/view/3406

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-15 2024-03-25 2024-04-05 2024-04-15 2024-04-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.88

© 2024by Asthana M, Marwaha R, Gupta P, Bhalerao N, S D Pandaand 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(5)303
Mahima Asthana et al. Effect of Marma Chikitsa in Sandhivata (Osteoarthritis)

Introduction

Since ancient times, Ayurveda has been a part of Indian society and offers a variety of holistic methods for managing health. Ayurvedic holistic medicine focuses on treating illnesses by restoring the body's balance.

Marma is the vital energy point located on the surface of the body. Marma Sthana is defined as Anatomical site where Mamsa, Sira, Snayu, Asthi and Sandhi meet together. As the body is alive and pulsating with energy there is a numerous energy points within it and upon the surface. These points are known as Marma points. The Sanskrit word Marma actually means mortal or vulnerable points means the area that is weak, tender or sensitive.[1] They are the seats of Prana within the body stimulation of this points in proper manner causes increase in flow of Prana within the body.

There is a specific Marma points for specific disease, Stimulation of these points in proper manner causes chemical changes and signals the body to produce neurochemicals that heals the body and causes relief in pain. Marma is a hidden gem of Ayurveda; it is a non-pharmacological treatment which gives instant and permanent relief.

Osteoarthritis is a chronic, degenerative, disorder of unknown case characterized by gradual loss of articular cartilage. it is the most prevalent disease in our society, with a worldwide distribution. it ranks fourth in health impact in human and eighth in men in the western world.[2] In England between 1.3 and 1.75 million people have symptomatic osteoarthritis.[3] It is a long-term chronic disease which results in bones rubbing together and creating stiffness, pain, and impaired movement. The disease most commonly affects the joints in the knee, hand, spine and is also present in shoulder and hip joint. it is related to ageing, it is associated with a variety of both modifiable and non- modifiable risk factor including obesity, lack of exercise, occupational injury, trauma.

Osteoarthritis is classified into two groups. Primary osteoarthritis can be localised or generalised, the latter more commonly found in postmenopausal women, with development of Heberden’s nodes. Secondary osteoarthritis has an underlying cause, such as trauma, obesity, Paget’s disease, or inflammatory arthritis.

Altogether 10-15% of adults over 60 have some degree of osteoarthritis, and with an ageing population it is becoming an increasingly important disease. More than 80,000 hip or knee replacement were performed in 2000 in the UK.[4]

In Ayurveda osteoarthritis is corelated with Janusandhigatavata. Acharya Charaka explained Sandhigata Vata under Vatavyadhi. When the vitiated Vata lodges in Janu Sandhi it is considered Janusandhigata Vata. He had explained this condition with symptoms such as pain while walking, inflammation, crepitus present in joint.[5] Acharya Sushruta has added peculiar symptoms like degenerative changes in joints as the symptoms of Sandhigata Vata.[6]

Other treatment pathies has its own limitations the pharmacological intervention involved administration of NSAIDs, they only relieve the pain but not completely cure the disease, they cause many side effects also. Hence there is a great need to find an effective way to treat the disease, in this aspect Marma therapy gives a new ray of hope, it is completely non pharmacological way of treatment, which gives prompt relief to the patient.

Case Study

A 52-year-old female patient came in an outpatient department (OPD) at, Pt. Khushilal Sharma Govt. (Autonomous) Ayurveda College and Institute, Bhopal (M.P.) Patient has a complain of right knee pain in the last 1 year, it was associated with stiffness, swelling and crepitus. Pt. has undertaken X-ray and diagnosed with osteoarthritis, she has taken allopathic medicine but didn’t get any permanent relief, so she approached for Ayurvedic treatment. Her Marma therapy was started, after the therapy of 21 days she got significant relief in her pain, and stiffness.

History of Past Illness

No history of Hypertension, Diabetes Mellitus, or any other serious illness.

Family History

No any family history related to Diabetes and Hypertension is present.

Treatment History

History of taking analgesic oral pills


J Ayu Int Med Sci 2024;9(5)304
Mahima Asthana et al. Effect of Marma Chikitsa in Sandhivata (Osteoarthritis)

Personal History

  • Appetite - Normal
  • Bowel - Clear
  • Sleep - Disturbed
  • Micturition - Normal

Physical Examination

  • Body weight - 63 kg
  • Heart rate - 97/min
  • Respiration rate - 24/min
  • Blood pressure - 140/80 mmhg

On Examination

  • Duration of pain - 1 year
  • Site - unilateral
  • Location - right knee joint pain
  • Pain - severe in nature (grade - 4)
  • Swelling - severe (grade - 4)
  • Stiffness - present, for 10-15 min (grade - 4)
  • Crepitus - audible (grade - 3)
  • Restricted movements - does not allow passive movements (grade - 4)

Investigation

  • CBC with ESR
  • X-ray

Treatment

Treatment involved administration of Marma therapy. Present study includes stimulation of 3 Marma that is Indrabasti, Gulfa, Janu. These will be stimulated for 15-18 times on an average in single sitting.[7]

Total duration - 21 days

SNMarmaStimulation timeSitting of Marma ChikitsaTotal time
1.Indrabasti0.8 secThree times a day21 days
2.Gulf0.8 secThree times a day21 days
3.Janu0.8 secThree times a day21 days

A steady and moderate pressure will be applied slowly and gently.

Pressure will be increased depending upon patient strength.

During the therapy, therapist was supposed to continuously watch the facial expression of the patients.

Assessment Criteria

1. Pain (Sandhi Shola)

SNCriteriaGrading
1.No pain0
2.Mild pain1
3.Moderate pain without difficulty in walking2
4.Moderate pain with difficulty in walking3
5.Severe pain with difficulty in walking4

2. Swelling (Sandhi Shoth)

SNCriteriaGrading
1.No swelling0
2.Slightly obvious1
3.Covers well over the bony prominence2
4.Marked and much elevated3
5.Severe and very much elevated4

3. Stiffness (Sandhi Graha)

SNCriteriaGrading
1.No stiffness0
2.<5 min1
3.5-10 min2
4.10-15 min3
5.>15 min4

4. Crepitus (Sandhi Sphutan)

SNCriteriaGrading
1.No crepitus0
2.Occasional crepitus1
3.Persistent and palpable crepitus2
4.Persistent and audible crepitus3

5. Restricted Movement (Akunchan Prasaranjanya Vedana)

SNCriteriaGrading
1.No pain0
2.Pain without winching of face1
3.Pain with winching of face2
4.Prevent complete flexion3
5.Does not allow passive movement4

Observation

SymptomsBefore treatmentAfter treatment
Pain40
Swelling42
Stiffness41
Crepitus30
Restricted movement41

J Ayu Int Med Sci 2024;9(5)305
Mahima Asthana et al. Effect of Marma Chikitsa in Sandhivata (Osteoarthritis)

Discussion

At this study most of our knowledge of the aetiology and epidemiology of osteoarthritis is from observational studies. Our diagnostic measures are based on clinical findings. Osteoarthritis is currently a major public health problem and the impact of the ageing boomers will further increase the burden to society. None of the therapeutic intervention are curative for osteoarthritis with many patients needed joint replacement.

Due to the fact that Marmas are the seats of Prana, the vital life force that controls both the body's subtle and physical processes, stimulating Marmas can modulate Prana flow in various body parts, removing blockages and enhancing physical energy currents within the body to have corresponding healing effects. According to Ayurveda, vitiated Vata is the primary causative component of Sandhivata. Prana is associated with Vata Dosha, which is why Marma Therapy is particularly helpful in treating Vata illnesses. Of the five Vata Doshas, the one most closely related to the Marmas is Vyana Vayu, which is connected to the skin and the flow and circulation of Prana. After Marma therapy patient is getting prompt relief in pain and stiffness of joints. Her joint movements also get improved. This treatment helped to strengthen various musculatures and various structures in knee region. Although not all symptoms are cured significantly, still pain management through Marma Chikitsa is a new approach towards the problem of osteoarthritis.

Conclusion

The case report demonstrates a noteworthy advancement in symptoms such as pain, stiffness, and restricted movements. Therefore, Marma Chikitsa can be utilized as an alternate therapy for osteoarthritis pain management if it is conducted correctly. It is a non-pharmacological way of treatment that not only give relief in the pain but also heals the disease.

References

1. Vasant Lad, Anisha Dhurve; Marma points of Ayurveda. First paperback edition

2. Murray CJL, Lopez AD. The global burden of disease. Geneva: World Health Organisation, 1996. 2 Reginster J-Y. The prevalence and burden of arthritis. Rheumatology

3. Reginster J-Y. The prevalence and burden of arthritis. Rheumatology 2002;41(suppl 1):3–6

4. Arthritis Research Campaign. Available at: http://www.arc.org.uk/ about_arth/astats.ht

5. Shastri R, Upadhaya Y, editors. Charaka Samhita of Agnivesha, Chikitsa Sthana, Ch, 28, Ver. 37, Edition reprint. Varanasi: Chaukhamba Bharti Academy; 20o7. P. 783

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

7. Joshi SK. Marma Science and Principles of Marma Therapy. 1st Delhi: Vani Publications, 2010.


J Ayu Int Med Sci 2024;9(5)306