E-ISSN:2456-3110

Review Article

Pharmacotherapeutic

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Ayurveda based Non Pharmacotherapeutic Integrated Intervention in Sandhivata w.s.r. to Osteoarthritis

Gani VP1*, Padmaveer PS2, Patil A3
DOI:10.21760/jaims.9.7.32

1* Vidya P Gani, Post Graduate Scholar, Dept of Swasthavritta and Yoga, Kaher S Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

2 Padmaveer PS, Post Graduate Scholar, Dept of Swasthavritta and Yoga, Kaher S Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

3 Ashok Patil, Professor and HOD, Dept of Swasthavritta and Yoga, Kaher S Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.

Sandhivata also known as Osteoarthritis, is a degenerative disease of the joints that mostly affects weight-bearing joints such as the elbow, knee, and so on. It causes discomfort and limits movement in the affected joint. The Sandhivata (Osteoarthritis) may be a form of Vatavyadhi, which usually manifests in adulthood due to Dhatukshaya (emaciation of tissues). Among the Vatavyadhi, Sandhivata is one such clinical entity that affects locomotion; Dhatukshaya is a major factor in this condition, which is characterised by specific symptoms including joint discomfort, swelling, stiffness, painful and restricted joint movement, etc. Osteoarthritis (OA), the most prevalent degenerative joint disease, results in excruciating swelling and irreversible destruction to the body's joints. As of now, the molecular causes of OA remain unknown. The development of osteoarthritis (OA) is a diverse illness that affects the entire joint and changes a number of different tissues. Classics have listed several Ayurvedic formulations for treating Sandhivata, including Kwatha, Guggulu Kalpana, Ghreeta, Taila, Gutika, and Rasa Aushadhi, as well as Panchakarma procedures including Abhyanaga, Swedana, Basti, Janubasti, Rasayana therapy, and Agnikarma, along with these dietetics also plays a major role to reduce the disease severity. In this article we try to collect and compile all the dietary preparations, food articles and Yoga Asanas explained in Samhithas which will be easier to adopt for people suffering from Sandhivata.

Keywords: Sandhivata, Osteoarthritis, Diet, Pathya-Apathya, Non-Pharmacotherapeutic integrated interventions (NPI)

Corresponding Author How to Cite this Article To Browse
Vidya P Gani, Post Graduate Scholar, Dept of Swasthavritta and Yoga, Kaher S Shri Bmk Ayurveda Mahavidyalaya, Belagavi, Karnataka, India.
Email: 		Gani VP, Padmaveer PS, Patil A, Ayurveda based Non Pharmacotherapeutic Integrated Intervention in Sandhivata w.s.r. to Osteoarthritis. J Ayu Int Med Sci. 2024;9(7):212-218.
Available From
https://jaims.in/jaims/article/view/3606

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-13 2024-05-22 2024-06-01 2024-06-12 2024-06-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.21

© 2024by Gani VP, Padmaveer PS, Patil Aand 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

Sandhigata Vata is a type of Vata Vyadhi, characterized by manifestations like joint pain (Sandhishoola) and joint swelling (Sandhishopha). Osteoarthritis (OA) is a degenerative joint condition that signifies the breakdown of movable, synovial-lined joints. The knee joint's OA falls into the category of inflammatory disorders, closely resembling Sandhigata Vata in Ayurveda in terms of causes, progression, and clinical characteristics.[1] The clinical presentations of osteoarthritis (OA) vary from mild to severe, impacting joints in the hands and weight-bearing joints like the knees, hips, feet, and spine. OA is identified as a clinical syndrome marked by joint pain, tenderness, restricted movement, crepitus, occasional swelling, and varying levels of inflammation, all without systemic effects. [2]

As per epidemiological data, osteoarthritis (OA) in India is prevalent in the range of 22-39%. Radiographic signs of OA are observed in a significant proportion of individuals aged 65 and above, with 80% of them being over 75 years old. Approximately 11% of those aged over 65 experience symptomatic OA in the knee. In India, 5.3% of males and 4.8% of females are in the age group exceeding 65 years.[3] In Worldwide the data suggests that prevalence of Osteoarthritis ranges from 14.3%-17.8%.[4]

Acharya Charaka initially identified the condition as Sandhigata Anila within category of Vata Vyadhi. He characterized it as a distinct ailment marked by symptoms such as swelling (Sotha), which is detectable through touch as Vatapurna Driti Sparsha, and pain during flexion and extension of joints, known as Akunchana Prasarana Vedana.[5]

Chakrapani acknowledges Sandhivata as Gulpha Vata or Sandhigata Vata, categorizing it as Kashtasadhya, implying that its treatment is challenging and requires significant effort. Acharya Sushruta has detailed the ailment in the Vatavyadhi section, specifically under the heading of Sandhigata Vata. Sandhivata is recognized as both a Marma (vital point) and a disorder occurring along the Madhyama Roga Marga (intermediate disease pathway). It encompasses various structures such as Snayu (tendons), Sira (vessels), Asthi (bones), Peshi (muscles), Kandara (ligaments), and more.[6]

Nonpharmacological interventions (NPI) encompass treatments that do not involve medications, such as physical activity and psychosocial interventions like speech-based therapies. These approaches aim to prevent, manage, or alleviate health issues, taking various forms such as products, methods, programs, or services. Users must understand the content of these interventions, which are linked to biological mechanisms and/or psychological processes.

NPI encompasses a range of techniques, including physiotherapy (e.g., manual manipulations, electromagnetic radiations, electrical and ultrasound sources), assistive devices, psychotherapy, behavioural modifications (e.g., lifestyle habits, nutrition), occupational therapy, speech, and language therapy, as well as complementary and alternative medicine.[7] Pathya refers to the dietary and lifestyle practices that have a calming effect on the mind, are beneficial to the body, and provide essential nutrients. On the other hand, Apathya represents the opposite, signifying practices that are not conducive to well-being or are not beneficial for the body and mind.[8]

Ayurveda emphasises on Pathya-Apathya more than drugs, so that the food itself will be considered as Bheshaja (medicine). The significance of Pathya and Apathya in Ayurveda is highlighted by the fact that Acharya Charaka explicitly detailed Pathya as a synonym for treatment. This emphasizes the critical role of appropriate dietary and lifestyle practices in maintaining health and facilitating therapeutic interventions in Ayurvedic principles.[9] Most people followed inconsistent and incompatible dietary habits in their daily lives. This behaviour leads to an imbalance in the digestive system (Agni Vaishamya) and an aggravation of the Vata Dosha (Vataprakopa), ultimately causing a reduction in bodily tissues (Dhatukshaya). When coupled with the aging process, these factors contribute to the onset of joint-related conditions referred to as Sandhivata.[10]

Studies indicate that engaging in regular exercise can be effective in managing symptoms associated with osteoarthritis. These symptoms include pain, reduced flexibility, decreased strength, and morning stiffness. By addressing and controlling these symptoms through exercise, overall function can improve, leading to an enhancement in the individual's quality of life.[11]


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In a recent study conducted by Ebnezar et al. (2012) examining the impact of Yoga exercises on pain, morning stiffness, and anxiety in 250 patients with knee osteoarthritis. The participants were divided into two groups: a control group receiving only physical therapy and an experimental group receiving both physical therapy and yoga. The findings of the study suggested that simultaneous participation in yoga and physical therapy yielded more positive effects compared to receiving physical therapy alone. [12]

The practice of Hatha Yoga proves to be a valuable non-medicinal approach in the rehabilitation of patients with knee osteoarthritis. It is associated with a noteworthy reduction in pain and symptoms, as well as a substantial increase in daily activities, sports and spare-time activities, ultimately leading to an improvement in overall quality of life.[11]

Aim and Objectives

To develop an integrated non pharmacotherapeutic intervention protocol for Sandhivata (OA)

Objectives

To compile and develop Ayurveda based integrated non pharmacotherapeutic protocol for Sandhivata.

Materials and Methods

Literature search of Sandhivata have been done on Charaka Samhitha, Raja Nighantu, Kashyapa Samhitha, Madanaphala Nighantu, Baishajya Ratnavalli, Yoga Rathnakara and Bhaishjya Ratnavali and other Yoga related textbooks.

Review of Literature

Pathya Ahara: according to different Samhitas exclusively for Sandhivata are as follows -

Charaka Samhitha: Kulattha (Horse Gram), Lasuna (Garlic), Shigru (Moringa Leaves), Amla (Indian Gooseberry), Draksha (Raisins)

Raja Nighantu: Hitakara Dravya Samooha - Ghrita (Ghee), Saindhava (Salt), Dhanyaka (Coriander), Jeeraka (Cumin Seeds), Ardraka (Ginger), Tanduleeyaka (Thorny Amaranth), Patola (Pointed Gourd), Alabu (Bottle Gourd), Godhuma (Wheat), Jeerna Shali, Gokshura (Tribulus), Hamsodaka and Mudga (Green Gram).

Yoga Rathnakara: Kulatha (Horse Gram), Shamaka (Barnyaed millet), Kodrava (Kodo millet), Raktashali (Red Rice), Vastuka, Shigru (Moringa oliefera), Varshabu (Boerhavia diffusa), Karavella (Bitter Gourd), Patola (Pointed Gourd) , Kushmanda (Ash Gourd), Godhuma (Wheat), Masha (Black Gram), Adraka (Ginger), Tapatanirr, Lasuna (Garlic) With Buttermilk, Jangala Mamsa (Kukkuta, Tittiri, Barhi, Chataka) Shilendra, Takra (Butter milk), Garjara (Carrot), Parvathe, Dadima (Pomegranate), Parushaka (Falsa Fruit), Badara (Ber Fruit), Draksha (Resins), Tambula, Matsyandika.

Bhaishjya Ratnavali:Vatahara (Vata pacifying), Madhura (Sweet), Amla (Sour), Lavana (Salt) and Snigdha (Unctuous), Sarpi (Ghee), Taila (Oil), Vasa (Fat), Majja (Bone Marrow), Godhuma (Wheat), Purana Dhanya, Masha (Black Gram), Kulattha (Horse Gram), Mamsa, Mishi (Fennel Seed), Dunduka, Kataka, Raktashali (Red Rice),

Madanapala Nighantu:Dadima-Amlaka Yusha

Kashyapa Samhitha Khillasthana:Kambalika Yusha, Lashuna Yusha

Apathya Aharas which are found in classical texts are as follows:

Yavanala (Great Millet), Yava (Barley), Kodrava (Kodo Millet), Gavedhuka, Shali (Rice), Nartaki (Finger Millet), Adhaki (Pigeon Pea), Masura (Lentil), Chanaka (Chickpea), Satina (Pea), Nishpawa (Indian Bitter Bean), Rajamasha (Cow Pea), Shushka Mamsa (Dry Meat), Palaka (Spinach), Karkati (Cucumber), Apakawa Kadali (Unripe Banana), Shita Jala, Kusumbha Taila, Shringataka (Water Chest Nut), Jambu (Jambhul), Apakva Amra, Areca Nut.

Therapeutic diet advices for Sandhivata in Samhitas:[13-17]

A Madhyama Roga Margagata Vatika illness called Sandhigata Vata occurs when vitiated Vata lodges in Sandhi. Therefore, medications that work on both Vata and Asthi should be chosen in order to treat Sandhigata Vata.

Charaka says that Tikta Dravya and Kshira should be the treatments for Asthi Dhatu Dushti. Vayu and Akasha Mahabhuta are the dominant figures of Tikta Rasa. As a result, it has attraction for bodily elements like Vayu-dominant Asthi and Akasha Mahabhuta.


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SNVargas
1.ShookaRakta Shaali (Red rice)Kodaraa (Anupa)Shashtika Shaali (Navara Rice)Godhuma (Wheat)
2.Shami Kulatha (Horse gram)Masha (Black gram)Tila (Sesame seeds)Sarshapa (Mustard seeds)Atasi (Flax seeds)
3.MamsaAnupa Mamsa, Chataka (Sparrow)Matsya (fish)
Kukkuta (Chicken)		Chaga (Goat)
Mesha (Sheep)		Vrshabha (Male cattle)
Mahisha (Buffalo)		Tittiri (partridge), Barhi (Peacock),
4.Shaka Kushmanda (Ash Gourd)
Changeri (Creeping wood sorrel)		Potaki / Upodaki (spinach)
Chinchinda (snake gourd)		Mahakoshataki (sponge gourd)
Bimbi (ivy gourd)		Koshavati (ridge gourd)
Grnjanaka (Carrot)		Patola (Bottle guard)
Shigru (Moringa)
5.PhalaPakva Amraphala (Riped Mango) Amrataka (Guava)
Panasa (Jackfruit)		Pakwa Kadali (Unripe banana) Narikela (Coconut) Pakwa Kalinda (Watermelon)Pakva Kapittha (Wood apple) Naranga (Orange) Dadima (Pomegranate)Nimbuphala (Lemon)
Amlika (Gooseberry)
Apkva Vrkshamla (Kokum)		Parushaka (false fruit)
Badara (Indian Bear fruit) Draksha (dried grapes)
6.Harita Ardraka (Ginger)
Jambira (Lemon)		Balamulaka (Tender radish)Palandu (Onion)Dhanyaka (Coriander leaves)Lasuna (Garlic)
7.Madhya Sura (Strong water)Madira (Strong water)Surasava (Alcoholic Preparation)Amlakanjika (Fermented rice water)
8.Jala Ushna Jala (Hot water)Shritashita Jala (Boiled and cooled water)
9.Gorasa Gavya Paya (Cow milk)
Avika Paya (Sheep milk)		Dadhi (Curd)Navaneeta (Butter)
Go 		Takra (Butter milk)Ghrtha (Cow ghee)
10IkshuIkshu (Sugar cane)Guda (Jaggery)Sita (Sugar)Khanda Sharkara (Sugar candy)
11KrutannaManda (Gruel water)
Peya (Gruel)		Vilepi (Tick gruel)
Odana (Cooked rice)		Mamsa RASA (Meat soup)
Rasala (Sweet preparation)		Raaga (Chutney)
Shadava (Pickle) Vesawara (Boneless meat soup)		Payasa Krishara Kulatha Yusha (Horse gram soup)
12AharopayogiTila Taila (Sesame oil)
Eranda Taila (Castor oil)		Atasi Taila (Flax seed oil)
Sharshapa Taila (Mustard oil)		Maricha (Pepper) Hingu (Asafoetida) Saindhava (Salt)Shushka Ardraka (Dry ginger)Pippali (Long pepper)

Fundamental idea of Ayurvedic medicine is Sthanam Jayate Purvam, even if Tikta Rasa aggravates Vayu and may intensify pathogenic process of Sandhigata Vata. Sandhi, location of Shleshaka Kapha, is principal site of Sandhigata Vata.

So, Tikta Rasa satisfies the concept of reducing the Kapha Dosha. The majority of the Ahara Dravya mentioned here include Madhura, Katu Vipaka, Ushna Virya, and Tikta Rasa. The metabolic stage, or Dhatvagni, is elevated by Tikta Rasa. All of the Dhatus will receive more nourishment as Dhatvagni increases.

As a result, Majja Dhatu and Asthi Dhatu Kshaya may diminish and Asthi Dhatu and Majja Dhatu may stabilize. Therefore, Asthi Dhatu degeneration might not happen quickly. One could argue that it slows down the processes of deterioration. Deepana, Pachana, and Rochana qualities are present in Tikta Rasa. Thus, it strengthens all of the body's joints and contributes to the enhancement of overall health.[18]

On other side, Tikta Rasa has Lekhana property, which aids in patients' weight loss and osteoarthritis management. Additionally, Tikta Rasa possesses qualities of Jwaraghna and Daha Prashamana, which may function as an anti-inflammatory and lessen joint discomfort and swelling.[19] In addition to Balya, Agnivardhaka, Madhura, Saumya, Sheeta Virya, Shulahara, Jwarahara, Vrishya, and Vayasthapaka, Ghrita is Vata-Pittashamaka.[20] As a result, it calms Vata, enhances body's general health, and revitalizes body. Aids Sandhigata Vata's Samprapti Vighatana as a result. Similar to Yogavahi, Ghrita has properties that help increase bioavailability of other medications without sacrificing any of their own unique qualities. Additionally, Ghrita contains Vitamin D, which is crucial for utilization of calcium and phosphorus in synthesis of blood and bones. Most of above-mentioned Ahara Dravya are Ushna in Veerya. It functions as a Medohara because of its Ruksha and Vishada Guna. Research indicates that medicine is mostly present in Ushna Virya, which aids in calming down agitated Vata and relieving pain.


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Planning of dietary preparations for a day

PreparationsOption 1Option 2Option 3Option 4
Morning beverages Lemon grass teaCinnamon teaArdraka tea
Breakfast Kulatha YooshaVeg UpmaOats UpmaMudga Yusha
Mid-day snacksFruitsDry fruits & seeds
Mid-day beverageLasuna Ksheerapaka Haridra Ksheerapaka Butter milkRasanadi Ksheerapaka
Lunch
Roti (in Numbers)Jawar RotiShigru stuffed ChapatiChapati Multi millet Roti
Vegetable sabji (in portions) PatolaShigruKushmandaPotaki
Rice item (in portions)Brown riceDashamoola YavaguKhichadi
Dinner
Roti (in Numbers)Ragi rotiRice roti with dill leavesMethi stuffed chapati
Vegetable sabji (in portions) KoshavatiMahakosha
Rice item (in portions)Manda/
Peya		Vilepi

Yoga Asanas and Pranayama advised for Sandhivata

Option 1Option 2Option 3Option 4Option 5Option 6
AsanaTadasana (mountain pose)
Shavasana (corpse pose, palms up)		Katichakrasana (lateral arc pose)
Paschimottanasana
Setubandhasana		Konasana (angle pose)
Virabhadrasana
Dhanurasana		Urdhwa hastottanasana (upstretched arms posture)
Chakravakasana		Pavanamuktasana (wind removing pose)
Trikonasana		Bhujangasana (cobra pose)
Vrikshasana
PranayamaNadishodhana Pranayama (alternate nostril breathing)Surya BhedanaBhramari (humming bee breathing)UjjayiBhastrika
MudraVayu MudraSandhi MudraPrithvi mudraVarun / Jal MudraVata-Nashak / Vaata Shamak / Vishnu Hasta Mudra
Exercises(Exercising muscles controlling the arms)(Exercising muscles controlling the wrists)exercising muscles controlling the palmsexercising muscles controlling the kneesexercising muscles controlling the ankles and feetStanding leg lifts
Sit and stand
Kick-backs

Yoga is mind-body interventions, that impart stress management with physical activity may be well suited for osteoarthritis. The potential mechanism for yoga therapy-related changes in OA symptoms is unknown. The multifactorial approach of Yoga therapy includes physical postures (Asanas), breathing exercises (Pranayama), meditation (Dhyana), mental and emotional cultures can help relieve symptoms of OA. Yoga therapy procedures can increase cartilage proteoglycan content and prevent cartilage degeneration. This helps strengthen the periarticular muscles that normally contract to stabilize pain.

Yoga practice can also prevent synovial fluid loss by stretching and strengthening different parts of the body, massaging and bringing fresh blood to internal organs, while rejuvenating the nervous system and lubricating joints, muscles and ligaments. It is said to have various effects on the nervous and circulatory systems, coordination and concentration, and a calming effect on the body. It also suggests that yoga practice can help reduce some psychological factors such as stress, anxiety, depression, mood disorders, and improve self-esteem and quality of life in people with chronic pain and arthritis. [21]

Discussion

Sandhivata (Osteoarthritis) is a prevailing condition in today’s era because of the increased prevalence of obesity and unhealthy lifestyle.[22] Osteoarthritis (OA) is a complex condition with multiple contributing factors, and the mechanism leading to joint degradation appears to be more intricate than initially anticipated. Although a correlation exists between obesity and OA, it is not solely attributable to heightened mechanical stresses on joint tissues resulting from weight gain. Other soluble elements, like adipokines, may also significantly contribute to the initiation of OA in individuals with obesity.[23]

The combined effect of mechanical stress because of weight gain and adipokines together gives rise to the increased symptoms of disease. The Samprapthi of Sandhivata mentions that the Vata increases and Kapha depletes in the joints, which in turn decreases the Shleshaka Kapha in joints.[24] Thus leading to degenerative changes and causing Sandhivata. So, the Vata should be controlled as much as possible to get better results in Sandhivata management.


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Conclusion

The aim for treatment of Sandhivata in an obese individual should be reduction of weight.[20] For achieving weight reduction, the best methods are adhering to strict diet and life style modifications. So, the Ayurveda emphasises the Vatahara diet is best in reducing the complications along with local treatment with Sleshmavardhaka Dravyas for Sandhivata. Yoga also has beneficial effect on reducing the symptoms as it increases joint mobility and flexibility there by reduction in pain and inflammation. So, Vata Hara diet and Yoga can be included in the management protocol for better results.

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