E-ISSN:2456-3110

Case Report

Osteoarthritis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

A case study of Erandadi Guggulu and Sagni Upnaha Sweda in the management of Sandhigata Vata (Osteoarthritis)

Upadhyay B1*, Shyam PS2, Aruna O3, Tribhuwan PS4
DOI:10.21760/jaims.9.10.47

1* Byomesh Upadhyay, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India.

2 Pendro Singh Shyam, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India.

3 Ojha Aruna, Professor and HOD, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India.

4 Pawale Singh Tribhuwan, Lecturer, Department of Panchakarma, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India.

The reported case was a 58-year-old male with late-stage osteoarthritis (OA) (Sandhi Gata Vata) of both knee joints accompanied by pain & mild swelling reducing the movement of both knee joints. The radiology (X-ray) report confirmed it reduces the space between both knee joints. Initially, the knee scores of pain, movement, and stability were poor, and the function score was reduced. Erandadi Guggulu was given continuously for 90 days & External Sagni Upnaha Sweda treatment was given in two regimens for 90 days. A visual analog scale for pain, knee swelling measurement by measuring tape, and knee joint movement score by goniometer and Ayurveda clinical assessment criteria were used to evaluate the effects of treatments on 15 days. After treatment for 90 days, the Knee scores of pain and movement were also improved to a good level and the function score was improved to an excellent level also reducing the swelling of both joints. During the follow-up period, joint symptoms and signs and the knee scores were mildly changed. In conclusion, this OA patient’s quality of life was improved by the treatment of Erandadi Guggulu described in Bangasen Samhita Vatarogadhikara and Sagni Upnaha Sweda which is described in Chikitsa Adarsh.

Keywords: Sagni Upnaha Sweda, Sandhigata Vata, Erandadi Guggulu

Corresponding Author How to Cite this Article To Browse
Byomesh Upadhyay, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt Ayurveda College, Raipur, Chattisgarh, India.
Email: 		Upadhyay B, Shyam PS, Aruna O, Tribhuwan PS, A case study of Erandadi Guggulu and Sagni Upnaha Sweda in the management of Sandhigata Vata (Osteoarthritis). J Ayu Int Med Sci. 2024;9(10):284-289.
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https://jaims.in/jaims/article/view/3573

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-14 2024-09-25 2024-10-05 2024-10-15 2024-10-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.89

© 2024by Upadhyay B, Shyam PS, Aruna O, Tribhuwan PSand 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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Pendro SS et al. A case study in the management of Sandhigata Vata

Introduction

Sandhigata Vata[1] is among the most common degenerative health problems in medical practice nowadays. The prevalence increases dramatically with age. It is the most prevalent disease of all musculoskeletal disorders. It is the most common form of chronic degenerative changes affecting approximately 22 to 39 % of the population.[2] The timing, duration, and quality of dietary habits and patterns are the aspects of life that are most ignored in our day and age of unhealthy lifestyles and erratic eating patterns. Mandagni has a major function in disrupting Doshas and is susceptible to disruptions from a variety of internal and external sources, including environmental variables and food.

Sandhigata Vata is associated with osteoarthritis (OA) in contemporary science the degenerative condition known as osteoarthritis (OA) of the knee severely limits the range of motion in the knee joints patients also feel pain and swelling. In the context of contemporary Ayurvedic science, Janu Sandigata Vata is seen as a similarity of OA in the Knee. Due to the vitiation of Vata Dosha, there is a steady degrading of the body structures with aging, which causes disease of degenerative illnesses, including Sandhigata Vata.

Reducing discomfort while trying to preserve or improve the knee's range of motion and minimizing impairments in activities of daily living are the goals of the treatment. Analgesics and nonsteroidal anti-inflammatory medications (NSAIDs) are part of the conventional pharmacological care of osteoarthritis (OA), yet their use does not effectively relieve pain or slow the progression of the disease.[3] It is a persistent degenerative illness. The dangerous side effects of modern NSAIDs and steroids are a concern for their patients.[4]

Case Report

A 58-year-old male patient presented to the outpatient department of Shri Khudad Dungaji Government Ayurveda College & Hospital at Raipur with a history of pain in the B/L knee joint with crepitations and also mild swelling for the last 6 years followed by an inability to move freely knee joints from 3 years. He was a retired colonel and asymptomatic for 6 years. He takes allopathy medication but does not get proper relief.

OPD: 5106212, Start of procedure:-22/12/2023, Name:-xxxx, Age:- 58, Sex -Male, Address:-Nava Raipur C.G, Religion :- Hindu, Education:-UG, Marital Status :-Married, Socio – economic status :-High Class,

Occupation: Retired colonel in the navy, Habitation: Urban

Table 1: Clinical Findings.

ComplaintDetails
Sandhishoola (Pain)Bilateral knee joint, Pain increases gradually, Dull ache type of pain, and pain is going worse by cold weather.
VAS scale - 6
Sandhishotha (Swelling)Measurement of joints (in Cm):- (Measured by)
JointRightLeft
Knee41.5cm41.8cm
Prasaran - Akunchan (Flexion-Extension) both knee joint movementMeasurement of flexion-Extension in knee joints by goniometer
Associate complaintsUtsahahani, Gauravata, Nidra Viparyaya, Agngamarda

Table 2: General Examination

B.P130/90 MmhgP/R79/min
Height170 cmWeight95 kg

Ashtavidha Pariksha[5]

Nadi (Pulse) - Vat-Pitta
Mutra (Urine) - Prakruta
Mala (Stool) - Vibandha
Jivha (Tounge) - Shwetabha
Shabda (Voice) - Prakrit
Sparsh (Skin) - Ruksha
Drika (Eye) - Samanya
Akriti (General Appearance) - Sthula

Dashvidha Pariksha[6]

Prakriti - VK,
Vikriti - Dosha-VPK, Dushya-Rasa,Rakta,Asthi
Sara - Pravara
Samhanana - Madhyama
Pramana - Madhyama
Satmya - Madhyama
Satva - Pravara
Ahara Shakti - Madhyama
Vyayam Shakti - Pravara
Vaya - Madhyam

Family History: No H/O - DM/HTN/OA/RA/PTB/HIV


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Assessment Criteria[7]

G0 - No Symptoms.
G1 - Mild Symptoms.
G2 - Moderate Symptoms sufficient to cause Distress/Difficulty in performing routine work.
G3 - Symptoms very severe/patient unable to perform routine work.

Knee Joint pain

SymptomGrading ScoreBefore treatmentAfter treatment
No. Pain031
Mild Pain + no difficulty in walking1
Moderate pain but no. difficulty in moving2
Much difficulty in moving the body parts3

Severity of Swelling

Symptom’sGrading ScoreBefore treatmentAfter treatment
No swelling / not making the bony landmark of joints020
Just covering the bony prominences1
Considerably above the landmark may be with positive fluctuation.2
More than3

Prasan Ankuchanvedana (Pain in movement of knee joint)

Symptom’sGrading ScoreBefore treatmentAfter treatment
Absent031
Without wincing at face1
With wincing of face2
Shout or prevent the movement of a joint3

Associate complaints: Crepitation sound found B/L knee joints.

Objective parameters: Investigations

InvestigationBefore trialAfter trial
Aam Pariksha[8]6 (Moderate)3 (Mild)
Agni Assessment[9]MandagniSamagni
Weight95 kg93.4 kg
BMI32.87 kg/m232.18 kg/m2
BMR1847.64 K/Cal1820.85 K/Cal
X-rayBoth joints are very close to each otherA proper gap in joints
Swelling
Right Knee Joint41.5 C.M.40.7 C.M.
Left Knee Joint41.8 C.M.40.8 C.M.

Therapeutic Procedure

1. Oral medication: Erandadi Guggulu was given 500 Mg before meal two times in a day with lukewarm water for 90 days.
2. Sagni Upnaha Sweda: Local application for a minimum of 4 hours for 15 days regularly. Then gap of 15 days and then repeat this process for 3 months.

Duration of Treatment: 90 days.

Ingredient of Erandadi Guggulu: Reference Bangsena Samhita Vatarogadhikara.[10] In Sandhigatavata, the main symptoms are pain, swelling and restricted movements of joints. This is a Vata Dosha predominant disease. When Vata gets disturbed causes disorders in the joints. Erandadi Guggulu are mainly effective in eliminating all Vata disorders, relieving digestion, reducing inflammation, reducing Vata dosha and removing the contaminated Kapha Dosha located in the source like knee joints. They are mainly anti-inflammatory, pain reliever; improve the digestion, Kapha Dosha suppressant medicines.

Ingredients

ErandaSahacharaNagarmothaDuralabha
AjvainDevdaruKutakiShati
PippaliPippali MulaChavyaChitraka
ShunthiBalaHaritakiKantakari
VrihatiPunarnavaAtivishaVacha
AshvagandhaShatavariVasaDhanyak
GiloyaVidangAmaltasGokshur
VidharaHaridraDaruharidraAjmoda
Guggulu

Ingredient of Sagni Upanaha Sweda: Reference Chikitsa Adarsh[11] Khanda

The process of producing sweat by removing stiffness, heaviness and cold from the body is called Swedana. Swedana[12] or Sikai in Ayurveda is a treatment procedure that involves inducing sweating in a person by the process of heat in the form of steam or other hot medicines or methods. In the process, the body starts sweating, due to which stiffness, heaviness, and coldness of the body goes away. Due to which pain, numbness, swelling and stiffness are reduced.

Upanaha[13]: The literal meaning of Upanah is - bond. Grinding medicines and tying them at a particular place for treatment is called Upanah.


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The purpose of Upanah Sweda is to remove local Ama Dosha from the body by applying plaster on the affected joints and through the sweat generated from it, so that pain, swelling and stiffness in the joints can be reduced. It includes oils, powders, medicinal leaves and Cotton cloth is used for binding. In this process, oil is applied on the affected area and massage is done, after which medicinal paste are applied, covered with leaves and tied. The total duration of treatment in Upanah was 90 days. In which first 15 days of Upanah and 15 days break were followed by 15 days of Upanah, thus a total of 3 times Upanah and 3 times break was given. Upanah Sagni Sweda has been done for a total 45 days.

jaims_3573_02.JPG
Before treatment

jaims_3573_01.JPG
After treatment

First sitting (day 1-15): A volume of 40 ml of Eranda Taila and 5 grams each of Shunthi, Haridra and Saindhava Lavana Churna with the Kalka of Eranda, Nirgundi, Dahtura and Shigru Patra. The Mahanarayana Taila was applied on both Janu Pradesha (knee joints). Then, in every morning at 10.00 a.m., 150g each joint of paste (made previously before application of oil) was applied on both knee region & it was kept on for 4-6 hours.

Day 16-30: Gap.
Second sitting (days 31–45): Same as first regimen.
Day 46 to 60: Gap.

Table 3: Method of preparation administration of Sagni Upanaha Sweda.

Eranda PatraNirgundi PatraDhatura Patra
Shigru PatraHaridra ChurnaNimbu Phala
Saindhava LavanaEranda TailaShunthi Churna

Discussion

In Sandhigata Vata, joint inflammation initially causes pain (Sandhishula) and later swelling (Sandhishotha). Mainly due to pain and swelling, the mobility of joints is restricted (Stabdha) at the initial stage, and later it is aggravated by the anatomical changes that occur in the articular surfaces and the joint capsule, and the ligaments. When and if the patient tries to move the joint, it may result in excruciating pain (Prasarana Akunchanayoho Vedana).

However, according to the description in Ayurvedic text, the signs, symptoms, and signs with a scoring system were noted to evaluate the severity. This assessment was done twice (i.e., in pre‑ and post-treatment phases). The severity of symptoms and sign was categorized as follows: Mild: 1, moderate: 2, and severe 3.

A statistically significant relief was observed in cardinal symptoms of Sandhivata (OA) in the patient. This proves that the procedure is effective in reducing the cardinal symptoms of OA. The drugs which used in procedure are having Vata pacifying properties due to their Ushna (digestive and metabolism stimulating) and Tikshna (penetrating) properties. It would have acted on vitiated Vata and helped to relieve in pain of the affected joints. Stiffness and tenderness are produced due to the presence of Ama.


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The drugs have Deepana (enhance digestive power) and Srotoshodhaka (remove obstruction of the micro channels) properties, which reduces local Ama formation.[14]

Conclusion

As per the Ayurveda in chronic stage of disease Vata Dosha is dominant of the patients and Vyadikshamatva[15] (immunity) of the patients are reduced. Hence, it was difficult to achieve better result with short duration of therapy in such cases. Most of the ingredients of Sagni Upanaha Sweda have analgesic and anti‑inflammatory actions, and hence, statistically significant improvement was observed in symptoms of Sandhivata. Hence, it can be concluded that Sagni Upanaha Sweda is effective drugs to manage acute and moderate cases of Sandhivata (OA).

With Ayurvedic combination therapy, the described patient with end-stage OA and an improvement in quality of life after this procedure. The current case study prove that this could be effective and the safest and easiest in treatment plan. Further research into the chemical analysis of these treatment plan utilizing contemporary fractionation and molecular techniques may be possible in the future.

References

1. Shastri Kashinath & Chaturvedi Gorakhnatha, Charak Samhita, Uttrardh, Chaukhambha Bharti, Varanasi, Punarmudrit 2013, Charak Chikitsa Sthan 28/37
2. The prevalence of chronic pain among adults in india by A.K.Saxena, all Indian J.paliate care 2018 oct-dec 24(4), 472-477
3. Tripathi,K.D, Essentials of medical pharmacology, jaypee brothers medical publishers, 8th edition, chapter 14, NSAIDS & antipyretic analgesics
4. Americal Journal of health research 2014 (4). 106-112/July 20-2014
5. Vaidya Lakshmipati Shastri, Yogaratnakar Purvardh Vidyotini Tika, Vikram Samvat 2072, ashtavidh pariksha
6. Shastri Kashinath & Chaturvedi Gorakhnatha, Charak Samhita, Purvardh, Chaukhambha Bharti, Varanasi, Punarmudrit 2013, charak viman sthan 8/69-78

7. Clinical research protocols for traditional health science CCRAS department of AYUSH, MoHFW, GOI edition 2010
8. Validation & Assessment of Aam and Agni in Aamvata, WJPMR, 2022, 8(8), 186-189
9. Validation & assesement of aam and agni in aamvata, WJPMR,2022,8(8), 186-189
10. Shastri Ambikadutta, Sushruta Samhita, Bhaga- 1, Chaukhambha Sanskriti Sansthana Varanasi Puramudran Vi.Sam. 2075, Sushruta Chikitsa Sthana 32/03
11. Shastri Rajeshwardutt Vaidya, Sanjeevani Aushadhalaya Prakashan Varanasi, 1961, A chikitsa Adarsh khanda 2, page no 220
12. Shastri Ambikadutta, Sushruta Samhita, Bhaga- 1, Chaukhambha Sanskriti Sansthana Varanasi Puramudran Vi.Sam. 2075, Sushruta Chikitsa Sthana 32/12-14 page no.134
13. Shastri Ambikadutta, Sushruta Samhita, Bhaga- 1, Chaukhambha Sanskriti Sansthana Varanasi Puramudran Vi.Sam. 2075, Sushruta Sutra Sthana 27/326, page no.564
14. Database on medicinal plants used ayurveda volume – 4, Year-2000 CCRAS Dept. of ISM & H, MoHFW, New Delhi, GOI, Page no.-122-125
15. Acharya Yadav Ji Tikram Ji, Ayurveddipika Charak Samhita Chakrapani Teeka, Chaukhambha Prakashan Pratishthan Varanasi, 2011 charaka sutra 28/7


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