E-ISSN:2456-3110

Research Article

Ashwagandha Churna

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Evaluation of the effect of Go-Ghrita Janu Basti along with Ashwagandha Churna in the management of Sandhigata Vata w.s.r. to Osteo-Arthritis - A Clinical Pilot Study

Dhurve M1*, Paliwal S2, Dash B3
DOI:10.21760/jaims.9.7.3

1* Mamta Dhurve, Post Graduate Scholar, Dept of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Shivani Paliwal, Post Graduate Scholar, Dept of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

3 Babita Dash, Lecturer, Dept of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Sandhigata Vata is described under Vatavyadhi in all Samhitas and Sangraha Granthas. In Jaraavastha, Deha Dhatus undergo Kshaya, leading to Vata Prakopa and making individual prone to many degenerative diseases. Sandhigata Vata is one among them, which obviously corelated with osteoarthritis due to its maximum symptomatic similarities. It is a degenerative and chronic articular disorder affecting mainly the weight bearing joints in advancing age. Being a degenerative joint disorder, the concept of Ayurvedic treatment mainly focus on Snehana, Swedana and use of Rasayana drugs to maintain the joint mobility. A pilot study was conducted on 10 patients to evaluate the effectiveness of Janu Basti with Go-Ghrita and Ashwagandha Churna as Shaman drug in Sandhivata. The study duration was 21 days. After the treatment, patient experienced significant relief and observed visible reduction in predominant symptoms.

Keywords: Sandhigata Vata, Osteoarthritis, Janu Basti, Go-Ghrita, Ashwagandha Churna

Corresponding Author How to Cite this Article To Browse
Mamta Dhurve, Post Graduate Scholar, Dept of Panchkarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Dhurve M, Paliwal S, Dash B, Evaluation of the effect of Go-Ghrita Janu Basti along with Ashwagandha Churna in the management of Sandhigata Vata w.s.r. to Osteo-Arthritis - A Clinical Pilot Study. J Ayu Int Med Sci. 2024;9(7):21-27.
Available From
https://jaims.in/jaims/article/view/3592

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-12 2024-05-21 2024-05-30 2024-06-07 2024-06-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.27

© 2024by Dhurve M, Paliwal S, Dash Band 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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Mamta D et al. Management of Sandhigata Vata w.s.r. to Osteo-Arthritis

Introduction

Acharya Charaka has described Sandhivata as a disease under the chapter Vatavyadhi in the name of “Sandhigata Anila” with the symptoms of Sotha in Sandhi, Vata Purna Druti Sparsh (palpable as an air filled bag), Akunchan Prasarano Pravratischa Vedana[1] (pain on flexion and extension), and in the later stage Hanti Sandhigatah (Disability in joints). It is very common in geriatric age group of people due to Vata Prakopa and Kshaya.[2] This disease is Identical to that of osteoarthritis, which is a chronic, degenerative joint disorder mostly affect the weight bearing joints. The most commonly affected joints are knee, ankle, lower spine and shoulder. The disease is characterized by focal loss of articular cartilage, osteophytes formation at the joint margin. Osteoarthritis is getting worst from young age to old age and has become a worldwide problem in present era.

Osteoarthritis of knee joint was found to be more prevalent in female (31.6%) than in male (28.1%), Nearly 45% of women over the age 65 year have symptoms, while 70% over 65 years show radiological evidence of osteoarthritis. According to WHO, 9.6% men and 18.0% of women age over 60 years have symptomatic osteoarthritis worldwide. 80% of those have limitation in movement and 25% cannot perform their major daily activities of life. At present there are so many limitations found while treating OA in Allopathy system of medicine. Usually different kind of NSAIDs, steroid injection, sometime surgeries are used to manage the disease, but all these have their own-side effect such as peptic ulcer, skin rashes, dizziness, GI disturbance, renal disease etc.[3] Hence these medicines cannot be used for longer period and are not safe as a treatment of osteoarthritis. Therefore, in today’s time there is need to find out such effective and safe Ayurvedic treatment which has been mentioned in the ancient text. 

In Ayurveda, all types of Chikitsa mentioned in Vatavyadhi can be applied for Sandhivata like Sthanik Snehana and Swedana. Many Research works for Sthanik Abhyanga has been done for Sandhigata Vata in past with Sthanik Abhyanga which had decent results. But in the present study, Go-Ghrita has been used for the external Snehan instead of oil and Janu Basti along with the oral intake of Rasayana drug i.e., Ashwagandha Churna.

Aim and Objectives

To evaluate the efficacy of Janu Basti with Go-Ghrita along with Ashwagandha Churna in the management of Sandhigata Vata.

Materials and Methods

In the present study, 10 Patients attending OPD and IPD of Pt. Khushilal Sharma Govt. Ayurvedic Hospital Bhopal with clinical sign and symptoms of Sandhivata were selected for the study.

Criteria for Diagnosis

Diagnosis of Sandhigata Vata (Osteoarthritis) has made on basis of signs and symptoms as described in Ayurvedic classics and modern medicine texts.

1. Sandhi-Shoola (pain in joint)
2. Sandhi-Shoth (swelling in joint)
3. Sandhi-Graha (stiffness)
4. Sparsh-Asahyata (tenderness)
5. Akunchan-Prasarnayo Vedana (pain during Flexion and Extension)
6. Sandhi-Sphutana (crepitus)

Inclusion Criteria

1. Patients between the age group 41-60 years of either sex.
2. Patients BMI ≥18.5 Kg/M2 and ≤24.9 Kg/M2
3. Those who have given written consent to participate in the study.

Exclusion Criteria

1. Pregnant women and lactating mothers.
2. Severe mental illness.
3. Patients having, any type of Malignancy, Chronic Renal failure, acute illness likes CVA, MI, and Severe Hypertension and Hormonal imbalance.
4. Knee replacement surgery

Study Duration: 21 Days

Treatment Regimen

ProcedureDurationDrugs/ ProcedureDoseTime
Sthanik Abhyanga [4]21 days for 20 minutesGo-Ghrita[5,6]As per requirementBefore Meal
Janu Basti21 days for 20 minutesGo-Ghrita[5,6]As per requirementBefore Meal
Shamana Drug21 daysAshwagandha Churna[8]
(Mool)		5 gm twice a day with milkAfter meal

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Gradation of Subjective Parameters[9]

Sandhi Shoola (Pain)

SymptomsScore/ grading
No pain0
Mild pain, no difficulty in walking1
Slightly difficulty in walking due to pain2
Severe difficulty in walking3

Sandhi Shoth (Swelling)

SymptomsScore/ grading
No swelling at all0
Swelling noticeable, but not masking the bony prominence1
Swelling sufficient to cover the bony prominence2 
Swelling with positive fluctuation3

Sandhi Graha (Stiffness)

SymptomsScore/ grading
No stiffness0
Mild stiffness1
Moderate stiffness2
Severe stiffness more than 10 min3

Akunchan Prasarne Vedana (Pain during flexion and extension)

SymptomsScore/ grading
No pain0
Pain without winching of face1
Pain with winching of face2
Prevent complete flexion3
Does not allow passive movement4

Sparsh Asahyata (Tenderness)

SymptomsScore/ grading
No tenderness0
Patient say tenderness1
Winching of face on touch2
Does not allow to touch the joint3

Sandhi Sphutan (Crepitus)

SymptomsScore/ grading
No crepitus0
Palpable crepitus1
Palpable but not audible2
Audible crepitus3

Criteria for overall assessment

The total effect of the therapies will be graded as follows:

Complete remission : 100% relief

Marked improvement : <100% to ≥75% relief

Moderate improvement : <75% to ≥50% relief

Mild improvement : <50% to ≥25% relief

No improvement : < 25% relief

Statistical Analysis

After completion of the treatment, results were statistically analyzed in the terms of mean score, standard deviation (SD), standard error (SE), paired t – test and p value at various levels.

Result

SNSymptomsMeanDifference% of ReliefSDSEtP
BTAT
1.Pain2.70.62.10077%0.6990.2217.5840.0001
2.Swelling1.300.11.20092%0.3160.1003.3430.0086
3.Stiffness2.500.52.00080%0.5270.1667.7460.0001
4.Tenderness1.10.001.100100%0.000.002.4000.0399
5.Crepitation1.70.5001.20070.5%0.5270.1669.0000.0001
6.Pain during flexion and extension2.50.71.80072%0.6740.2139.0000.0001

Pain

In pain, mean was 2.7 before treatment which was reduce to 0.6 with percentage of relief (77) which is Statistical Highly significant with p value 0.0001.

Swelling

In Swelling, the mean was 1.30 before treatment which was reduce to 0.1 with the percentage of relief (92) which is Statistical Highly significant with p value-0.0086.

Stiffness

In Stiffness, the mean was 2.50 before treatment which was reduce to 0.5 with the percentage of relief (80) which is Statistical Highly significant with p value-0.0001.

Tenderness

In Tenderness, the mean was 1.1 before treatment which was reduce to 0.00 with the percentage of relief (100) which is Statistical Highly significant with p value-0.0399.


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Crepitation

In Crepitation, mean was 1.7 before treatment which was reduce to 0.500 with percentage of relief (70.5) which is Statistical Highly significant with p value-0.0001.

Pain during flexion and extension

In Pain during flexion and extension, mean was 2.5 before treatment which was reduce to 0.7 with percentage of relief (72) which is Statistical Highly significant with p value-0.0001.

Discussion

Discussion of Disease

The most prevalent type of Arthritis is OA. It is a major cause of discomfort and disability in elderly and closely linked with aging. Hip OA affects 25% of persons and knee OA affects up to 45% of people at some time in their lives. This is characterized by localized articular cartilage loss, proliferation of new bone, and joint shape remodelling. Certain large and tiny joints are preferred targets of OA. The two main major joints implicated are knee and hip. Obesity, advanced age, female sex, significant joint trauma, repetitive stress, genetics, history of inflammatory joint diseases, metabolic and endocrine disorders are risk factors linked to osteoarthritis. Among Nanatmaja Vata Vikara listed by Acharya Charaka is Vata Khudatata. Khuda Vata is mentioned in Kashta Sadhya Vata Vyadhi list. Chakrapani defines "Khudavata" as a "Gulpha Vata" or Sandhigata Vata while making a statement on it. Therefore, Sandhigata Vata is a Nanatmaja Vata Vikara, according to Chakarapani and according to Sushruta, this is Haani stage of Madhyama Vaya.

Rupa of Sandhigata Vata has been explained by Acharya Charak are Sandhishula, Sandhishotha, Akunchana Prasarana Janya Vedana and Hanti Sandhi Gati. Here Sandhishula and Sandhishotha occurs due to Vataprakopa. A specific type of Shotha i.e. Vatapurna Driti Sparsha is described which indicates Vata dominancy of Shotha. Akunchana Prasaranjanya Vedana and Hanti Sandhi Gati generally occur due to Kaphakshya and Vata Prakopa. Sandhigata Vata can also occur as a complication of some other diseases or due to Dushti of Vata, Meda, Asthi and Majja as main pathological factors which are generally seen among patient of Sandhigata Vata.

According to Acharya Charaka, the treatment of Sandhigata Vata is same as the treatment of Asthidushti i.e., Panchakarma, especially Basti Chikitsa. Acharya Sushruta has described specific treatment for the Sandhigata Vata for the first time i.e., Snehana, Upanaha Swedana, Agnikarma, Bandhana and Unmardana.

Samprapti (pathogenesis of Janu Sandhivata)

Ushna (hot), Kapah Vatahara, Deepana (Appetizer), Pachana (Carminative), Sothahara, Vedana Sthapana (analgesic), Balya (strength promoting factor) and Rasayana Dravyas (anti-inflammatory and anti-oxidant) is essential.

For this reason, the regiment like Sneha Abhyanga is consider to be best treatment in Vata Vyadhi for his Vedana Sthapana property. Ghrita has rich in Snigdha Guna which reduces Rukshta in Sandis and Shamana of the Vata Dosha.

Discussion of Drug

Ayurvedic herb is that the Sanskrit word “Ashwagandha” translates as “the smell of a horse,” (Ashwa - horse,Gandha - smell), which refers to its ability to bring strength and stamina while nourishing the reproductive and nervous systems.

Somniferatranslates as “sleep-inducing” reflecting its relaxing and calming properties that bring us energy by supporting deeper rest.

Benefits

  • Supports sustained energy levels, strength, and vitality, including with physical activity.
  • Supports healthy muscles and joints.
  • Active constituents include alkaloids, steroidal lactones, saponins, and withanolides. Ashwagandha has neuroprotective and anti-inflammatory properties which may protect against cartilage damage in osteoarthritis.

Mechanism of action of Ashwagandha - Ashwagandha's mode of action is complex and not entirely understood. Researchers believe that its therapeutic properties are due to its effect on various signaling pathways and biological processes in the body, including the immune system, central nervous system, and stress response.

Ashwagandha has been shown to reduce inflammation markers in the body and may have a protective effect against these diseases.


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Discussion of therapy

Snehana: (Oleation Therapy) - It is the first line of treatment explained in the classics for Sandhivata as Sneha is antagonist to the degeneration process which is caused by excessive Ruksha Guna (dry quality) and Khara Guna (rough quality) of vitiated Vata. Go-Ghrita Abhyanga reduces the provoked Vata, which is responsible for the decay in the Dhatus and for manifestation of features like pain, stiffness, and crackers.

According to modern studies, massage stimulates blood circulation and assists the lymphatic system, improving the elimination of waste throughout the body. Absorption through the skin can be enhanced by rubbing it on the skin. In cases of osteoarthritis, a study found significant improvement in joint movement and reduction in joint swelling with Go- Ghrita applications.

Absorption of Sneha

The oil applied to the body surface in different procedures of Abhyanga, were absorbed and distributed to the whole body and show systemic or generalized effect. The absorption as well as distribution of the oil with the herbal ingredients impregnated in it takes specific duration and the same is detailed in the following lines (Table 1).

Table 1: Shows the Abhyanga Kaala (Penetrating time of ghee) of different Dhatu of the body.[10]

SNName of the Dhatu (body tissue)Penetrating time of oil
1.Roma Kupa300 Maatra (95 sec)
2.Twak400 Maatra (133 sec)
3.Rakta500 Maatra (160 sec)
4.Mamsa600 Maatra (190 sec)
5.Meda700 Maatra (228 sec)
6.Asthi800 Maatra (240 sec)
7.Majja900 Maatra (280 sec)

Absorption through skin

In humans, mainly subcutaneous absorption occurs from the body surface through the hair follicles. But the follicles in humans occupy a very small portion of the total integument to be of concerned matter. Absorption through the sweat gland and sebaceous glands generally appears to be minor. When the medicament is rubbed on vigorously, the total quantity of substance (medicated or non-medicated oil) that is forced into the hair follicles and glands is increased.

Rubbing also forces some material through the stratum corneum without molecular dispersion and diffusion through the barrier. By this explanation, we can say that massaging the skin with Go-Ghrita may help in the absorption of it through skin layers.

Role of Bhrajaka Pitta in mode of action of Abhyanga

Bhrajaka Pitta is located in the skin. It imparts the characteristics of color and luster, so it is termed as Bhrajaka. Acharya Charaka has also described that normal Pitta is basic cause for production of normal and abnormal color of the skin as well as the normal and abnormal temperature of the body. The variations in the colour of the skin are the functions of the Bhrajaka Pitta which is presenting in the skin. Arunadutta the Commentator of Ashtanga Hridaya described the Bhrajaka Pitta and its functions like Deepana and Pachana. The substances applied on the skin by Abhyanga, Lepana and Parisheka are being absorbed and assimilated by the Bhrajaka Pitta. Thus Abhyanga. Do their action properly only after being digested by Bhrajaka Pitta, as no substance can act properly without digestion. Commentator Acharya Indu stated that roughness and hardness of skin is reduced after proper Abhyanga procedure, so from the above explanation it can be said that Abhyanga helps to improve the quality of skin by getting digested by the Bhrajaka Pitta. Acharya Bhaavprakasha has also followed the elderly Acharayas, while describing Bhrajaka Pitta. He has accepted Bhrajaka Pitta to be seated in the skin and digest the medicines externally appliedontheskin.[11]

Go-Ghrita

Lipophilic action of Ghrita facilitates transportation to a target organ and final delivery inside the cell, because cell membrane also contains lipid. This lipophilic nature of Ghrita, facilitates entry of the formulation into the cell and its delivery to the mitochondrion, microsome and nuclear membrane. When herbs are mixed with Ghrita their activity and utility potentiate many times.

Pharmacodynamics

Rasa: Madhura

Guna: Guru, Snigdha, Mridu

Virya: Shita

Vipaka: Madhura


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Karma: Medhya, Agni-Deepana

Mode of action of Go-Ghrita

It pacifies Vata by Snigddha Guna, Pitta by Madhura Rasa and Shaityata and Kapha by processing with Kaphahara drugs. It should be taken in small quantities for longer duration to pacify Pitta and in large amounts to pacify Vata.

Mode of action of Janu Basti

Janu Basti is an effective therapy for people experiencing ailments in the knee. The medicated oil used in the therapy effectively soothes pain, stiffness, and inflammation in the joints. Additionally, toxins are eliminated and joints are strengthened. The treatment involves pouring warm medicated oil on affected areas to rejuvenate the joints from within.

Helps dissipate stiffness: Janu Basti increases the flow of oxygen and nutrient-rich blood, and therefore helps in stiffness.

Increases circulation: Increases blood circulation around the knee; thus, strengthening and nourishing the joints.

Improves mobility and flexibility: Janu Basti is known to improve mobility of the knee joints (knee flexion and knee extension).

Lower inflammation: The medicated ghee possesses anti-inflammatory properties that help with inflammation and pain.

Among disease of loco motor system, Osteoarthritis is most commonly condition which causes wear and tear of joints and leads to disability.

It is an inflammatory disorder causes pain, swelling, restricted movements of joints. This patient suffering with excruciating pain which becomes unbearable even on mild touch and results in the formation of crepitus.

Conclusion

Sandhivata is a joint disorder in Ayurveda which can be correlated with Osteoarthritis as per modern perspective on the basis of similarities in the symptoms, occurrence, onset and nature of the disease. It manifests mostly in women in their fourth and fifth decades of life. In the present study, as external therapy Janu Basti was done.

It showed significant improvement in symptoms of pain- which is statistically highly significant with the percentage of relief 77, Swelling- It has a statistically significant correlation with the alleviation percentage 92, Stiffness - which, when combined with the proportion of relief, is statistically very significant 80, Tenderness- This, when combined with the alleviation percentage, is statistically highly significant 100, Crepitation - It has a statistically significant correlation with the alleviation percentage 70.5, Pain during flexion and extension -In conjunction with the alleviation percentage, it exhibits high statistical significance 72, Range of movement and walking distance after treatment. Thus, it can be concluded that Sandhigata Vata can be managed well utilizing the treatment regimen of Janu Basti with Go-Ghrita and Ashwagandha Churna orally. It is cost effective and easily available.

References

1. Kashinath shastri and Gorkhanath Chaturvedi Vidyotani Hindi commentary Charak Samhita Chikitsa Sthana chapter 28,sholkno.37

2. Charaka Samhita of Agnivesa volume-2 Charaka Samhita Chikitsa Sthan (28/37) edited by Pt. Kashinath Shashtri. Chaukhamba Sanskrit Sansthan, Varanasi. Page no. 697.

3. Davidson’s Principles and practice of medicine, Edited by Stuart H. Ralston, Ian D Penman, Mark W.J. Strachan, Richard P Hobson 23rd Edition Part 2 chapter no 24.

4. Sushruta Samhita, Ayurved Tatva Sandepika commentary, edited by Kaviraj Dr. Ambikadatta Shastri, Chaukhamba Sanskrit Sansthan, Varanasi, Fourteenth Edition: 2003, Chikitsa 24/34.

5. Charaka Samhita of Agnivesa volume-1 Charaka Samhita Sutra Sthan (1/86, 87) edited by Pt. Kashinath Shashtri Chaukhamba Sanskrit Sansthan Varansi Page no. 34.

6. Bhavprakash volume-1 Shri Brahmshankar Shashtri (Ghrita Varga 4,5) Chaukhamba Sanskrit Sansthan Page no. 775.

7. Charaka Samhita of Agnivesa volume-1 Charaka Samhita Sutra Sthan (14/31-33) edited by Pt. Kashinath Shashtri, Chaukhamba Sanskrit Sansthan Varansi Page no. 201, 202.


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8. Dravyaguna Vigyana, volume 2, Prof (Dr) Shanth Kumar Lukas, Chapter 83, Chaukhambha Vishvabharti Varanasi, Page no. 301-304.

9. A comparative study for evaluation of vallitarvadi gutika and shigrutwachadi gutika along with bastikarma in the managementofsandhivata" (Kayachikitsa Department) Government Ayurveda Mahavidhyalaya Bhopal, Madhya pradesh (2019-2022) By Dr jitendra bhalse.

10. Vasant Patil. Shushrut Samhita vol-2 chikitsa sthan choukhamba publication p.479

11. Ramtej pandey. Bhavmishra, Bhav Prakasha Nighantu, Purvakhand. Reprint edition. Varanasi: Choukhamba subhartiprakashan,2002


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