E-ISSN:2456-3110

Case Report

Joint Disorders

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Ayurvedic approach to managing Joint Disorders: Case Studies

Joshi K1*, LC Harjpal2, Singh S3
DOI:10.21760/jaims.9.8.36

1* Kriti Joshi, Post Graduate Scholar, Department of Samhita Evum Siddhant, SNPA Govt Ayurvedic College, Raipur, Chhattisgarh, India.

2 LC Harjpal, HOD Professor, Department of Samhita Evum Siddhant, SNPA Govt Ayurvedic College, Raipur, Chhattisgarh, India.

3 Shweta Singh, Lecturer, Department of Samhita Evum Siddhant, SNPA Govt Ayurvedic College, Raipur, Chhattisgarh, India.

Around the world, Bone and Joint-related disorders are common and can be extremely painful and impairing. Due to long-term disability and the high expense of surgical procedures, these conditions not only harm people's quality of life but also place a significant financial burden on them. Commonly Joint diseases like Sandhivata, Aamvata and Vatarakta have been mentioned in most classic Ayurvedic texts from ancient times. Another group of disorders known as Vatavyadhi assembles neuro-musculoskeletal conditions with varying etiopathogenesis. An Ayurvedic approach to disease classification involves arranging the various clinical conditions into a particular place, mainly based on their defining characteristics. Ayurvedic treatment offers a comprehensive and successful approach to managing joint disorders by reducing inflammation, improving range of motion, and promoting overall joint health and by integrating conventional knowledge with contemporary research, giving patients sustainable and natural relief and recovery. This article case report has been presented for every bone and joint-related disorder with their treatment protocol given in Ayurvedic Classics.

Keywords: Joint disorders, Sandhivata, Aamvata, Vatarakta, Vatavyadhi, Management

Corresponding Author How to Cite this Article To Browse
Kriti Joshi, Post Graduate Scholar, Department of Samhita Evum Siddhant, SNPA Govt Ayurvedic College, Raipur, Chhattisgarh, India.
Email: 		Joshi K, LC Harjpal, Singh S, Ayurvedic approach to managing Joint Disorders: Case Studies. J Ayu Int Med Sci. 2024;9(8):239-246.
Available From
https://jaims.in/jaims/article/view/3428

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-05 2024-07-15 2024-07-25 2024-08-05 2024-08-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.36

© 2024by Joshi K, LC Harjpal, Singh 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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Introduction

When it comes to joint disorder, Ayurveda, an ancient Indian system of medicine offers a holistic perspective on how to comprehend and manage it. The healing philosophy that is more than 3,000 years old puts much emphasis on balancing body, mind and soul in order to keep healthy and heal diseases. Joint disorders in Ayurveda are majorly related with imbalances in the body’s Doshas; Vata, Pitta and Kapha. Vata Dosha: Movement is governed by Vata Dosha and it also helps in lubricating and making joints elastic. Too much dryness, cracking, joint stiffness are the signs of Vata imbalance and this often leads to such conditions as degenerative arthritis.

Pitta Dosha: It controls the mechanisms of metabolism that includes digestion and inflammation. Out of balance Pitta can bring about inflammation in the joints resulting into rheumatoid arthritis diseases.

Kapha Dosha: This is responsible for structure and lubrication. Inadequate Kapha causes excessive fluid retention in the joints which results in swelling; heaviness thus leading to conditions like joint disorders.

Classification of Joint Disorders

It can be classified as:

  • Degenerative disorders
  • Inflammatory disorders
  • Auto-immune disorders
  • Idiopathic/ Traumatic

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Principles of Treatment[1]

Hetu: Hetu Vipreet Chikitsa[2]

Linga: Vyadhi Vipreet Chikitsa

Aushadh: Kasthoushadhis ( Herbal) and Rasoushadhis (Mineral)

Disease can be diagnosed on the basis of Clinical, Hematological, and Radiological investigations. Treatment should be followed thereafter. Treatment modalities include Pathya Ahara, Pathya Vihara, Aushadh (Externally / Internally).

Degenerative Joint Disorders

Causes[3]: Diseases can be caused by dryness, cold, inadequate and light food, excessive sexual activity, insomnia, irregular treatments or activities, and excessive secretion of doshas and blood. Fasting, excessive swimming, excessive travelling, over-exercising, excessive physical activities, depletion of body tissues, worry, grief, diseases, and excessive emaciation. Additionally, diseases can arise from painful beds or seats, anger, daytime sleep, fear, suppression of natural urges, undigested food or toxins, trauma, and not eating.

Case Study: 1

Patient Profile:

  • Age: 58 years
  • Gender: Female
  • Occupation: Office Worker
  • History: For the past five (5) years, joint pain which has now increased gradually. The joints ache most in the mornings when she wakes up and when performing daily activities. There is a history of osteoarthritis in the family.

Chief Complaints:

  • Joint Pain and Stiffness: Severe knee, hip and finger pain especially in the morning and after long periods of rest.
  • Swelling: Visible swelling around affected joints.
  • Difficulty in Movement: Pain while bending or straightening joints.

Ayurvedic Diagnosis: Sandhivata

Sandhivata is that condition brought about by Vata dosha getting disturbed leading to its effect on the joints Sandhi. This is marked by deterioration of tissues within the joint that leads to pain as well as limited mobility.

Symptoms Analysis[4]

  • वातपूर्णदृतिस्पर्शः Air or gas gets into these joints (crepitus) when they are touched.

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  • शोथ: Swelling in the joints.
  • सन्धिगतेऽनिले: Vata dosha being localized at the joints.
  • प्रसारणाकुञ्चनयोः प्रवृत्तिश्च सवेदना: Pain during extension (Prasāraṇa) and flexion (Akuñcana) of the joints.

Case Study: 2

Patient Profile:

  • Age: 62 years old
  • Sex: Male
  • Job: Retired engineer
  • Medical History: This patient has had awful chronic joint pains and weakness during the past eight years, progressively deteriorating to affect his day-to-day activities and general quality of life, without any close relatives suffering from any joint disorders.

Chief Complaints:

  • Severe Joint Pain: Pains that do not stop in the hip and knees.
  • Weakness and Muscle Wasting: Mass and strength seem considerably reduced.
  • Insomnia: He can’t sleep because of pain
  • Continuous Pain: The body has been aching all through.

Ayurvedic Diagnosis: Asthi-Majjagat Vata

Asthimajjagat Vata, is a condition characterized by above described degenerative changes in bones (Asthi) and bone marrow (Majja) due to increased Vata Dosha leading to chronic joint pains.

Symptoms Analysis[5]

  • भेदः Breaking pain in the bones.
  • अस्थिपर्वणां सन्धिशूलं: Joint ache within bone joints.
  • मांसबलक्षयः Muscular atrophy and weakness.
  • अस्वप्नः The condition of not sleeping; insomnia.
  • सन्तता रुक्: Perpetual pain.
  • मज्जास्थिकुपितेऽनिले: Aggravation of Vata in the bone marrow and bones.

Case Study: 3

Patient Profile:

  • Age: 50 years
  • Gender: Female
  • Occupation: Office Worker
  • History: The patient has been suffering from osteoarthritis and general muscle and bone discomfort passed over the last 3 years. For instance, symptoms have gradually escalated and they have impacted on work and performance of most activities. The family has a history of anxiety and stress as some of the common conditions.

Chief Complaints:

  • Generalized Body Pain: Chronic pain affecting the different parts of the body.
  • Muscle Twitching and Cramps: Tremors or muscle twitches and twitch and involuntary spasms or jerking movements.
  • Joint Pain: Stabbing and sudden episodes of pain that established in a number of joints, especially during the physical activities.
  • Continuous Discomfort: Continuous nagging soreness and a feeling of pain right down to the bones and joints.

Ayurvedic Diagnosis: Sarvangagat Vata.

In Sarvanga Gat Vata the pathologies are found all over the body due to the predominance of Vata and have influence in various systems and organs.

Symptoms Analysis:[6]

  • सर्वाङ्गकुपिते वाते: Vata is increased throughout the whole body.
  • गात्रस्फुरणभञ्जने: Cramp and soreness, Twitchiness and cracking.
  • वेदनाभिः परीतश्च : Surrounded by pain.
  • स्फुटन्तीवास्य सन्धयः Feels that joints are bending and breaking as if they are split or crackling.

Chikitsa Siddhant[7,8] for Degenerative Diseases

Sandhigat Vata

Snehana (Oleation Therapy)

  • Internal Oleation: Administration of Mahayogaraj Guggulu.
  • External Oleation: Application of Mahanarayan Taila for daily massage.

Swedana (Sudation Therapy)

  • Localized Steam Therapy: Using Dashamoola Kwatha (decoction).

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Panchakarma Procedures

  • Virechana (Purgation): Administered using Trivrit Lehya.
  • Basti (Enema Therapy): Administered Anuvasana Basti with Ksheerabala Taila followed by Niruha Basti with Dashamooladi Niruha.

Herbal Remedies

  • Shallaki (Boswellia serrata)
  • Ashwagandha Churna: Mixed with warm milk.

Diet and Lifestyle

  • Vata-pacifying diet with warm, cooked foods.
  • Suggested gentle Yoga and exercises to maintain joint mobility.

Asthi-Majjagat Vata:(Snehana[9] – Internal & External)

Sarvangagat Vata:(Massage , Enema)[10]

Inflammatory Joint Disorders

Causes[11]: Salty, sour, pungent, alkaline, oily, and hot foods are those that aggravate Vata and Pitta doshas. Fruits and vegetables that belong to the subgroups of damp as well as dry, and miscellaneous items that include foods found in water, trenches, or marshes, meats, oil cakes, and root vegetables, lead to Dosha vitiation. Moreover, eating incompatible foods (Viruddha Ahara), anger, day sleep, and night walking disturb the rhythm and thus aggravate Vata and Pitta Doshas. It more affects to the delicate or the individuals having sedentary lifestyle because of their unpreparedness to handle the stress the body goes through. Trauma, impurities in the blood, and fasting or inadequate eating can further aggravate the condition. The specific factors include exercises like horse or camel rid; excessive travel; the rigors of too many sports & exercises; retention of natural calls; being out in the sun, especially in the hot noon; and excess indulgence of sex. All these factors culminate in the aggravation of Vata and Pitta Doshas resulting in inflammatory condition.

Case Study: 1

Patient Profile:

  • Age: 50
  • Sex: Female
  • Occupation: Teacher
  • History: The patient has been experiencing symptoms of Joint pain and redness of joints within the past year. Her lifestyle includes work that involves extensive standing and walking, eating spicy food a lot, consuming plenty of processed food and being very stressed up because of her job.

Chief complaints:

  • Persistent knee, elbow or wrist pain and stiffness.
  • Itching, redness as well as occasional rashes especially over joints.
  • Digestive Issues may manifest as indigestion symptoms such as flatulence, bloating or abdominal gas.
  • Fatigue is associated with general tiredness and low energy levels.

Ayurvedic Diagnosis: Vata Rakta[12] (Inflammatory Joint Disorder) Vata Rakta is characterized by simultaneous aggravation of Vata dosha and vitiation of Rakta dhatu (blood). This condition primarily affects joints, leading to pain, swelling, and other symptoms indicative of inflammation. कण्डू (Itching) दाह (Burning sensation), रुज (Pain), आयाम (Stretching pain), तोद (Pricking pain) स्फुरण (Throbbing), कुञ्चन (Contracture), श्यावरक्ता त्वग् (Dark red or purple discoloration of skin), बाह्ये ताम्रा (Coppery red appearance on external skin). Gambhir Vata Rakta[13] is characterized by deeper symptoms affecting muscles, bones, and joints. The symptoms include swelling, stiffness, hardness, deep-seated intense pain, dark or bluish skin, and reddish discoloration. It also involves burning sensation, pricking sensation, twitching or pulsation, and suppuration or formation of pus. These symptoms indicate a more severe and deeper involvement of tissues compared to Uttana Vata Rakta.

AspectUttana Vata RaktaGambhir Vata Rakta
Depth of InvolvementSuperficial (Skin and subcutaneous tissues)Deep (Muscles, bones, and joints)
Main SymptomsItching, burning sensation, pain, stretching, pricking, twitching, contraction, dark red/bluish skinSwelling, stiffness, hardness, deep- seated intense pain, dark/bluish skin, redness, suppuration
Skin AppearanceDark red or bluish with external rednessDark or bluish skin, reddish discoloration
Pain IntensityMild to moderate painIntense deep-seated pain
Additional SymptomsContraction, twitchingSwelling, stiffness, hardness, suppuration

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Case Study: 2

Patient Profile:

  • Age: 65 years
  • Gender: Male
  • Occupation: Retired Farmer
  • History: The patient’s symptoms include, joint pain and inflammation, which has been present for two years now. Following the onset of his symptoms, he has scooter-mobilized; his functional capacity is strikingly impaired, and he experiences great challenges in executing most basic requirements for independence.

Chief Complaints:

  • Severe Joint Pain: Severe erosive arthritis characterized by pain largely in the knees, hips and shoulders enough to limit the activities of the patient.
  • Disability: Stiffness in movement, having problems in the most basic activities, and reduced in functional activity.
  • Skin Symptoms: Joint pain and swelling with elevated temperature and dark red or purple bruise-like discolouration and rashes surrounding the joints noted.
  • Systemic Symptoms: Gradually develops weakness of the body, fatigue and general physical emaciation of the body.

Ayurvedic Diagnosis: Ubhaya Vata Rakta[14] (Very Severe Vata Rakta)

Case Study: 3

Patient Profile:

  • Age: 58 years
  • Gender: Female
  • Occupation: Office Worker
  • History: The patient has been experiencing severe joint pain and inflammation in the knees and elbows for the past year. Her condition has progressively worsened, affecting her ability to perform daily activities.

Chief Complaints:

  • Severe Joint Pain: Intense pain in the knee joints, particularly in the region around the patella (kneecap).
  • Swelling and Inflammation: Noticeable swelling and inflammation in the knees and elbows.
  • Reduced Mobility: Difficulty in moving and performing routine tasks due to joint pain and stiffness.
  • Skin Symptoms: Reddish discoloration and warmth around the affected joints.

Ayurvedic Diagnosis: Krostukshirsha[15] (Severe Inflammatory Joint Disorder)

  • वातशोणितजः Caused by an imbalance of Vata and Rakta (blood).
  • शोथः
  • जानुमध्ये: Located in the knee region.
  • महारुजः Severe pain.
  • स्थूलः Thickened or swollen.
  • क्रोष्टुकशीर्षवत्: Resembling a jackal head like knee joint condition.

Chikitsa Siddhant for Inflammatory Joint Diseases[16]

External Therapies:

  • External Application (Bahyamaalepa): The employment of medicated pastes and ointments for management of the pain and the level of inflammation experienced.
  • Oil Massage (Abhyanga): This will involve going for massages with warm medicated oils that will help increase the blood flow to the affected areas as well as help in easing the rigidity and the pains.
  • Therapeutic Bath (Parisheka): Inflammations of the limbs, warm medicated water or decoctions may be taken for bathing in.
  • Poultices (Upanaha): Cupping, or applying poultices of herbs to specific regions of the body to decrease inflammation and help in un-moistening painful tumors.

Internal Therapies:

  • Purgation (Virechana): Therapeutic purgation to clear toxins and the imbalances in the three Doshas.
  • Medicated Enema (Basti): Employment of herbal enema which helps to kindle ‘fat’/Vata Dosha and assist the body’s natural processes of elimination.

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  • Oral Intake of Medicated Oils and Ghee (Sneha Pana): Taking medicines like Sarpi, which is ghee, Taila or oils, Vasa which is animal fat and Majja which is marrow to bring in lubrication inside the body and benefit the specific areas of joint and tissues.

Advanced Therapies:

  • Combination Therapies: Sarpi (Ghee): Both inside and out to feed the body and astringent and become swollen. Taila (Oil): used and taken internally to soothe Vata and nourish the joints. Vasa (Animal Fat) and Majja (Bone Marrow): Eaten to extract their nutrient values that help in promoting healthy joints.
  • Warm Poultices (Upanaha): As a remedy for inflammation of joints using warm poultices of herbs to treat inflammation.

Specific Treatments for Vata Dominance:

  • Medicated Oils and Enemas: Including ghee, oils and medicated enemas which are prepared from the herbs.
  • Warm Poultices and Fomentation: Warm therapies for the relief of pain and rigidity of the Vata Dosha.

Specific Treatments for Rakta Dominance:

  • Purgation with Ghee and Milk: Thus, therapeutic purgation with ghee and milk was used to moderate the Rakta levels and inflammation.
  • Cold Applications (Seka and Nirvapana): Basemaring with cold application for the reduction of symptoms arising from the inflammation of tissues and hyperactivity of Rakta and Pitta Doshas.
  • Herbal Decoctions and Poultices: The results include application of herbal decoctions and poultice that are used to cool and heal inflammations of joints.
  • Auto-Immune Joint Disorders

Causes[17]: A sedentary lifestyle with little or no physical activity (Nischalasya) further exacerbates the condition; eating heavy, oily, rich, and difficult-to-digest foods (Snigdha Bhuktavato Hyannam) and exercising right after heavy meals (Vyayama Kuruvatastatha) are important factors in the formation and aggravation of Ama. The main causes are the consumption of incompatible foods and engaging in activities that contradict the body's natural rhythms (Viruddha Ahara Chesta),

which results in a weak digestive fire (Mandagni) and improper digestion and accumulation of toxins (Ama).

Case Study: 1

Patient Profile:

  • Age: 52 years
  • Gender: Female
  • Occupation: Office Job
  • History: Eight months ago, the patient began experiencing joint pain, stiffness and swelling. The symptoms have become progressively worse and now cause significant discomfort and make it difficult to carry out normal daily tasks.

Chief Complaints:

  • Joint Pain and Swelling: Continuing pain and swellings in many joints especially hands, wrists, and knees.
  • Morning Stiffness: Severe joint stiffness upon waking up which lasts for some hours.
  • Fatigue: Abnormally tired and heavy body feeling.
  • Digestive Issues: Indigestion, lack of appetite, bloating after eating food.

Ayurvedic Diagnosis: Aamvata[18]

  • Angamarda: feverishness
  • Aruchi: loss of taste
  • Trishna: thirstiness
  • Alasya: laziness or fatigue
  • Gauravam: heaviness of the body
  • Jvara: fever
  • Apaka: indigestion
  • Shunata Anganam: Body swelling

Chikitsa Siddhant for Auto-Immune Joint Diseases[19]

Detoxification and Reduction of Ama (Toxins)

  • लङ्घन (Langhana): Fasting or consuming a light diet helps reduce the Ama (toxins) from the body.
  • Swedana स्वेदन (): Inducing sweating through steam or other methods to eliminate toxins.

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Enhancement of Digestion and Metabolism

  • तिक्त (Bitter): Use of bitter herbs like Neem, Guduchi, and Kutki for detoxification and purification.
  • दीपन (Dipana): Digestive stimulants like Ginger, Black Pepper, and Pippali to enhance digestive fire.
  • कटु (Pungent): Pungent herbs to aid digestion and elimination of Ama.

Therapeutic Cleansing Procedures

  • विरेचन ( Purgation Therapy): Detoxification through purgation to cleanse the gastrointestinal tract.

Lubrication and Nourishment

  • स्नेहपान (Oleation Therapy): Internal administration of medicated ghee or oils for joint lubrication and Vata

Enema Therapies

  • बस्ति (Enema): Medicated enema to cleanse and nourish the colon and balance Vata. Medicated Oil Enema with Saindhava (Rock Salt) Oil enema containing rock salt to soften stools and reduce pain and inflammation.
  • क्षारवस्ति (Alkaline Enema): For detoxification and balancing Doshas.

Differential Diagnosis

ConditionVataraktaKrostuka SirsaAmavataSandhigatavata
SandhishulaPresentPresent (Maharuj)PresentPresent
SandhishothaPresentPresentPresentPresent
Arambha SandhiParva SandhiKevala Janu SandhiBruhata SandhiBruhata Sandhi
Jvara as Arambhi LakshanaMay Be/May Be NotNot PresentPresentNot Present
Sparsh-AsahtvamPresentTivraPresentMay Be/May Be Not
Ushna SparshaPresentNot PresentPresentMay Be/May Be Not
Itar LakshanaSandhi Pradesh Pidiko-Utapatti, Spread like Akhu VishaKnee Joint Look Like Jackal's HeadPain like Scorpion BiteVata Purna Dhruti Sparsha-Prasaran, Akunchan Sah-Vedana

Conclusion

According to Ayurveda, joint disorders can be effectively treated holistically since the treatment aims at the origin of the problem as well as at the manifestations of the disease, which may entail dietary, lifestyle changes and specific therapies. Ayurveda has a holistic approach to the disorders of joints, the main strategies being the restoration of Dosha balance and elimination of Ama.

References

1. Vaidya Trikamji Jadavaji Acharya, Charaksamhita with Ayurvedadipika commentary by Sri Cakrapanidatta, published by Chaukhamba Surbharti Prakashan, Varanasi, 2017, Sutra Sthan 1/24.
2. Murthy K. R. Shrikant, Editor Asthang Hridaya of Vagbhatta, Nidan Sthan, Ch.1 ver 6-7, Varanasi, Chaukhambha Orientaliya, Edition 1996.
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4. Vaidya Trikamji Jadavaji Acharya, Charaksamhita with Ayurvedadipika commentary by Sri Cakrapanidatta, published by Chaukhamba Surbharti Prakashan, Varanasi,2017, Chikitsa Sthan 28/37.
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9. Vaidya Trikamji Jadavaji Acharya, Charaksamhita with Ayurvedadipika commentary by Sri Cakrapanidatta, published by Chaukhamba Surbharti Prakashan, Varanasi,2017,Chikitsa Sthan 28/93.
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12. Vaidya Trikamji Jadavaji Acharya, Charaksamhita with Ayurvedadipika commentary by Sri Cakrapanidatta, published by Chaukhamba Surbharti Prakashan, Varanasi, 2017, Chikitsa Sthan 29/20.
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15. Madhav Nidana, Madhukosh Tika Vatavyadhi /52.
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18. Madhav nidana, Madhukosh Tika Aamvata Nidana Adhyay/6-10.
19. Bhaisajya Ratnavali Aamvata Adhyaya/1.


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