E-ISSN:2456-3110

Case Report

Post-Viral Arthritis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 12 DECEMBER
Publisherwww.maharshicharaka.in

Efficacy of Ayurvedic Interventions in the management of Post-Viral Arthritis: A Case Study

Shukla RK1*, Chandil A2, Sharma V3, Sharma S4
DOI:10.21760/jaims.9.12.48

1* Ratnesh Kumar Shukla, Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Ayushi Chandil, Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

3 Vivek Sharma, Assistant Professor, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

4 Shraddha Sharma, Assistant Professor, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Introduction: Post-viral arthritis (PVA) is a clinical condition frequently presenting as temporary inflammatory symptoms such as joint pain, stiffness, and swelling, arising in the aftermath of viral infections. According to Acharya Charaka in the Charaka Samhita, post-fever conditions can lead to a Vata-Pradhana Sannipataja condition, causing aggravated Vata Dosha, which results in joint pain, stiffness, heaviness, headaches, and dizziness, along with involvement of Pitta and Kapha Doshas.

Objective: The primary objective of this study is to assess the clinical outcomes of Ayurvedic treatments, particularly Panchakarma therapies like Sarwang Patrapinda Swedana and Janu Basti, in the management of post-viral arthritis.

Methods: A 37-year-old female patient presented to the outpatient department (OPD) with a history of chikungunya fever 15 days prior. She complained of mild swelling in the lower limbs, accompanied by pain and stiffness in the wrist, knee, and shoulder joints. The patient reported significant difficulty in walking without support due to severe stiffness in bilateral knee joints. For this patient regimen encompassed Panchakarma therapies, including Sarwang Patrapinda Swedana and Janu Basti, along with oral medicine.

Results: Substantial improvement was observed in joint mobility, accompanied by notable alleviation of symptoms. After 1month of Ayurvedic treatment, the patient showed significant improvement, with a marked reduction in joint pain, stiffness, and swelling.

Conclusion: Ayurvedic interventions, including Panchakarma therapies and Shamana Yog, offer a promising approach to the management of post-viral arthritis by addressing both symptomatic relief and the underlying Doshic imbalances, contributing to enhanced joint mobility and overall well-being.

Keywords: Post-Viral-Arthritis, Chikungunya, Patrapinda Swedana, Sannipataja Jwara

Corresponding Author How to Cite this Article To Browse
Ratnesh Kumar Shukla, Post Graduate Scholar, Dept of Kayachikitsa, Pandit Khushilal Sharma Govt Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Shukla RK, Chandil A, Sharma V, Sharma S, Efficacy of Ayurvedic Interventions in the management of Post-Viral Arthritis: A Case Study. J Ayu Int Med Sci. 2024;9(12):351-357.
Available From
https://jaims.in/jaims/article/view/4145

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-11-12 2024-11-22 2024-12-02 2024-12-12 2024-12-24
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© 2024by Shukla RK, Chandil A, Sharma V, Sharma 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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Download PDFBack To ArticleIntroductionDisease ReviewAyurvedic ReviewCase ReportResultDiscussionConclusionReferences
Ratnesh KS et al. Management of Post-Viral Arthritis

Introduction

Post-viral arthritis, characterized by transient inflammatory joint manifestations such as pain, stiffness, and swelling, frequently follows viral infections. CHIKF is characterized by an acute phase followed by subacute and chronic phases. Acute CHIKF is often accompanied by high fever, headache, maculopapular rash, myalgias, and severe arthritis/arthralgias. Exanthema and polyarthralgia primarily affect the hands and feet, which cause significant functional disabilities.[1]

As Acharya Charaka mentioned in the Charaka Samhita when Jwara become as Vata-Pradhana Sannipataja condition then Vata Dosha becomes aggravated, it leads to symptoms such as pain in the joints, bones, and head, along with a sense of heaviness, Headache, and dizziness (Sandhi-Asthi-Shirasaḥ Śūlam, Gauravam, Bhramaḥ) and Pitta and Kapha are also involved so additional symptoms such as excessive thirst and dryness of the throat and mouth (Tṛṣṇā, Kaṇṭha-Āsya-Śuṣkatā) may manifest. This highlights the role of Doshic imbalance in joint-related disorders. These descriptions align with the clinical presentation of post-viral arthritis, where joint pain, stiffness, and systemic disturbances often stem from underlying Doshic imbalances triggered by a viral infection. Conventional management relies predominantly on symptom alleviation through the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics, often associated with undesirable side effects. In contrast, Ayurveda offers a holistic approach rooted in natural interventions that aim to address the underlying causative factors, restore doshic equilibrium, and promote systemic well-being.

Disease Review

Post viral arthritis is a condition often overlooked, arising from systemic viral infections. It differs from bacterial or autoimmune arthritis, presenting as acute joint pain, swelling, and stiffness that can resemble other inflammatory forms of arthritis, such as rheumatoid arthritis. Although most cases are self-limiting, some infections may lead to prolonged joint complications.[2-4]

Etiology: Numerous viruses are linked to post-viral arthritis, including:

  • Enteroviruses: Coxsackievirus, Echovirus
  • Arboviruses: Chikungunya, Zika, Dengue
  • Retroviruses: Human Immunodeficiency Virus (HIV)
  • Hepatitis Viruses: Hepatitis B, Hepatitis C
  • Others: Influenza, Rubella, Parvovirus B19, Epstein-Barr virus, and Cytomegalovirus

The arthritis may manifest during an active infection or as a delayed immune response. Mechanisms of joint involvement vary, with some viruses directly affecting synovial tissues, while others provoke immune-related inflammation.

Pathophysiology: The mechanisms of post-viral arthritis can be classified into:

  • Direct Infection of Joint Tissue: Some viruses invade synovial cells, triggering localized inflammation.
  • Immune Complex Deposition: Immune complexes form in response to viral antigens and settle in the joints, activating inflammatory processes.
  • Molecular Mimicry: Shared features between viral proteins and host tissues may lead to autoimmunity.

Clinical Features: Symptoms of post-viral arthritis can range from mild to severe and include:

  • Sudden joint pain and swelling, commonly symmetrical and involving multiple joints.
  • Joint stiffness, especially after periods of inactivity.
  • Systemic symptoms like fever, more noticeable during the acute phase of the viral illness.

While symptoms typically resolve within a few weeks, some infections, such as Chikungunya or Hepatitis, may lead to chronic joint issues.

Diagnostic Approaches: Accurate diagnosis is based on clinical evaluation supported by laboratory findings:

  • Evidence of viral-specific antibodies (IgM and rising IgG titers).
  • Detection of viral genetic material through Polymerase Chain Reaction (PCR) in blood or synovial fluid.
  • Synovial fluid analysis, which typically shows mild inflammation with low white blood cell counts.

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Ratnesh KS et al. Management of Post-Viral Arthritis

Prognosis and Long-Term Outcomes: Most cases resolve within weeks. However, prolonged joint issues, particularly in infections such as Chikungunya, can occur.

In these cases, persistent symptoms are likely linked to immune-mediated mechanisms rather than active viral replication. Complications may be occurred If untreated Arthritis (joint inflammation), Chronic neurological disorders (e.g., vertigo, paralysis), Severe dehydration or dryness in the body.

Ayurvedic Review

सन्ध्यस्थिशिरसःशूलंप्रलापोगौरवंभ्रमः|
वातोल्बणेस्याद्द्व्यनुगेतृष्णाकण्ठास्यशुष्कता||९४||[4]

1. Sandhi- Shūlam - Pain in Multiple joints.
2. Asthi Shulam - Pain in Bones.
3. Shirasaḥ Shulam - Headache.
4. Pralāpo - Delirium or incoherent speech.
5. Gauravaṃ - Heaviness in the body.
6. Bhramaḥ - Dizziness or vertigo.
7. Tṛṣṇā - Excessive thirst.
8. Kaṇṭhāsyaśuṣkatā - Dryness of throat and mouth.

Samprapti Chakra

Nidana (Vata-aggravating causes)
↓
Vata aggravation occurs due to the causative factors, spreading its influence across the body.
↓
Aggravated Vata spreads throughout the body, manifesting symptoms like pain, dizziness, and heaviness.
↓
Sthanasamshraya in

Sandhi (joints): Causing pain and stiffness.
Shiras (head): Causing headache or dizziness.
Asthi (bones): Causing bone pain.

Case Report

Name: XYZ

Age/Gender: 37-year-old female

Chief Complaints: Joint pain, stiffness (wrist, knee, shoulder), lower limb swelling, difficulty walking without support

Duration: 15 days post-chikungunya fever

Appearance: Small and Moderate body built

Physical and mental disposition: Normal

Occupation and socio-economic status: House-wife/Upper Middle class

History of Present Illness: The patient, a 37-year-old female, reported a history of chikungunya fever 15 days ago. Following recovery from fever, she developed mild swelling in the lower limbs accompanied by pain and stiffness in multiple joints, including the wrist, knee, and shoulder. The stiffness is most pronounced in the bilateral knee joints, severely restricting mobility and making it difficult for her to walk without external support. She denies associated fever, redness, or warmth in the affected joints but reports significant discomfort and reduced physical strength. So for the further management she came to our OPD.

Clinical Assessment

Physical Examination: Weak, fatigued, requiring support for walking.

Subjective Grading: Pain, stiffness, swelling, and functional limitations were graded based on severity.

Treatment: The patient received Panchakarma therapies including Sarwang Patrapinda Swedana and Janu Basti, along with oral Ayurvedic medicines like Shallaki Ghanavati, Kaishor Guggul, and Swarna Bhasma combinations.

Dashavidha Pariksha

1.  Prakriti: Vata-Kapha dominance.
2.  Vikruti: Vatapradhana tridoshaja aggravation post-viral fever.
3.  Sara: Moderate Asthi Sara, likely impaired Majja Sara.
4.  Samhanana: Madhyama.
5.  Pramana: Moderate build.
6.  Satmya: Madhyama
7.  Satva: Avara
8.  Aahara Shakti: Avara
9.  Vyayama Shakti: Avara
10.  Vaya: Madhyama

Examination

General: Weak, fatigued, dependent on support for walking.
Vitals: Normal pulse, afebrile.
Musculoskeletal: Tenderness, swelling, stiffness in joints


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Assessment

Subjective Grading[6-9]

1.  Pain (Visual Analog Scale, VAS 0–10):
§ 0: No pain (VAS 0).
§ 1: Mild pain, tolerable without medication (VAS 1–3).
§ 2: Moderate pain, occasionally requiring medication (VAS 4–6).
§ 3: Severe pain, frequent need for medication, affecting daily activities (VAS 7–10).
2.  Stiffness Duration (Morning Stiffness):
§ 0: No stiffness.
§ 1: Stiffness lasting <15 minutes.
§ 2: Stiffness lasting 15–30 minutes.
§ 3: Stiffness lasting >30 minutes or persisting throughout the day.
3.  Swelling (Patient-reported feeling of heaviness or swelling):
§ 0: No swelling.
§ 1: Mild swelling, no visible changes.
§ 2: Moderate swelling, visible but not restricting movement.
§ 3: Severe swelling, visible and restricting joint movement.
4.  Functional Limitation:
§ 0: No limitation, can perform all activities.
§ 1: Mild difficulty in performing some activities.
§ 2: Moderate difficulty, dependent on support for some activities.
§ 3: Severe limitation, completely dependent on support for basic activities.

Objective Grading[10-12]

1.  Range of Motion (ROM) Limitation (% of normal ROM):
§ 0: Full ROM.
§ 1: ROM reduced by <25%.
§ 2: ROM reduced by 25–50%.
§ 3: ROM reduced by >50%.
2.  Tenderness (Tenderness Grading Scale):
§ 0: No tenderness.
§ 1: Tenderness on palpation, no grimace.
§ 2: Tenderness with grimace or flinch.
§ 3: Tenderness with withdrawal or verbal complaint.
3.  Functional Mobility (Timed Up and Go Test):
§ 0: Completes in <10 seconds (normal).
§ 1: Completes in 10–15 seconds (mild limitation).
§ 2: Completes in 15–20 seconds (moderate limitation).
§ 3: Takes >20 seconds (severe limitation).
4.  Laboratory Markers (Inflammation):
§ 0: ESR and CRP within normal limits.
§ 1: Mild elevation of ESR (20–30 mm/hr) or CRP (5–10 mg/L).
§ 2: Moderate elevation of ESR (30–50 mm/hr) or CRP (10–20 mg/L).
§ 3: Severe elevation of ESR (>50 mm/hr) or CRP (>20 mg/L).

Treatment

Panchakarma
Sarwang Patrapinda SwedanVatashamka Taila
Janu BastiSahacharadi Taila
Shamana Oushadha
Shallaki Ghanavati600 mgBiD
Kaishor Guggul500 mgBiD
Swarna Bhasma 1 mg + Vanga Bhasma 5 mg + Naga Bhasma 5 mg + Lauha Bhasma 5 mg + Makshika Bhasma 5 mg + Mandoora Bhasma 5 mg + Rasa sindoora 5 mg + Yograj Guggul 30 mg + Abhraka Bhasma 5mg + Maharasnadi Kwath Ghana 234mg300 mgBiD

Result

Subjective Criteria

SymptomsBefore TreatmentAfter TreatmentPercentage Relief
Pain3166.67%
Morning Stiffness3233.33%
Swelling20100%
Functional Limitation3166.67%

Mean Relief was 66.67%.

Objective Criteria

SymptomsBefore TreatmentAfter TreatmentPercentage Relief
Range of Motion3166.67%
Laboratory Markers10100%
Functional Assessment3166.67%
Tenderness3166.67%

Mean relief was 75%.

Discussion

Shallaki Ghanavati: Shallaki (Boswellia serrata) is renowned for its therapeutic properties, characterized by its bitter (Tikta), sweet (Madhura), and astringent (Kashaya) taste profiles. It is classified as dry (Ruksha), light (Laghu), and sharp (Tikshna) in quality, with a pungent (Katu) post-digestive effect and warm (Ushna) potency. Shallaki is traditionally recognized for its ability to balance the Kapha and Pitta Doshas while alleviating Vata-related disorders. Its primary bioactive components include volatile oils (4–8%), acid resin (56–65%), and gum (20–36%), with triterpenoids,


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collectively known as boswellic acids, serving as the primary active constituents. The gum resin of Shallaki typically contains around 43% boswellic acids, including 3-acetyl-11-keto boswellic acids (AKBA), which are instrumental in supporting joint cartilage integrity and modulating immune responses.

These compounds are particularly effective in reducing pain and inflammation associated with post-viral arthritis by inhibiting leukotriene synthesis and suppressing the activity of the 5-lipoxygenase enzyme through a non-redox mechanism.[13,14]

Kaishora Guggulu: The Rookshana property of herbs such as Danti (Baliospermum montanum), Triphala (a combination of Terminalia chebula, Terminalia bellerica, and Emblica officinalis), Vidanga (Embelia ribes), and Guggulu (Commiphora mukul) is thought to target the abnormal accumulation of Kapha Dosha and Medas (fat tissue). Additionally, Tikshna (sharp) and Ushna (hot) drugs, including Pippali, Shunthi, Maricha, Vidanga, and Danti, are components of formulations like Kaishora Guggulu.

Guggulu is particularly noted for its positive impact on Srotovishodhana (channel purification). Clinical observations indicate improvements in mobility, with notable gains in walking ability and a slight enhancement in peripheral pulses. This suggests a tangible improvement in circulation, which in turn helps reduce Margavarana (obstruction in the channels), leading to a reduction in the morbidity associated with Vata Dosha.[15]

Combination Drug:Post-viral arthritis can be a debilitating condition. Ayurveda offers a holistic approach to managing it, focusing on balancing the body’s Doshas (Vata, Pitta, and Kapha) and supporting the immune system.

Herbal preparations like Vanga Bhasma (Tin Calx), Naga Bhasma (Lead Calx), Lauha Bhasma (Iron Calx), Makshika Bhasma (Pyrite Calx), Mandura Bhasma (Iron Oxide), Abhraka Bhasma (Mica Calx), Rasa Sindura (Ayurvedic medicine), Yogaraja Guggulu (Ayurvedic medicine), and Maha Rasnadi Kwath (solid extract) are often used in Ayurvedic treatments for arthritis. These herbs can help reduce inflammation, ease pain, and improve joint mobility. Additionally, Swarna Bhasma is believed to balance the Doshas and support overall health.[16]

Patra Pinda Swedana:Patra Pinda Swedana is a therapeutic treatment that uses herbs with specific properties to induce sweating and support detoxification. The herbs involved typically possess qualities such as Guru (heavy), Teekshna (sharp), and Ushna (hot), which help stimulate perspiration and enhance metabolic activity. These herbs also have characteristics like Sara, Snigdha, Ruksha (dry), Sukshma, Drava (liquid), and Sthira (stable), which work synergistically to promote therapeutic effects.

This treatment is known to alleviate stiffness (Stambhagna), heaviness (Gauravghna), and coldness (Shitaghna), while encouraging sweating (Swedakaraka) to expel toxins from the body. The Ushna and Teekshna qualities further boost the metabolic rate, leading to capillary dilation (vasodilation) and improved circulation. As a result, waste products are more efficiently eliminated, and the absorption of therapeutic oils (Sneha) through the skin nourishes tissues. Additionally, the treatment aids in reducing Aama (toxins), balancing Doshas, and supporting digestive health by enhancing Agni (digestive fire) and promoting overall rejuvenation.[17]

Janu Basti:Janu Basti is an external therapeutic procedure classified as Bahya Snehana, which involves the application of medicinal oils to the knee region to relieve Vata-related conditions. This process primarily counters the Ruksha (dry) quality of Vata Dosha, providing relief from stiffness (Stambha) and heaviness (Gauravata) in the joints. According to Acharya Vagbhata, the therapeutic oils and herbs used in Janu Basti are absorbed through the skin, allowing the active ingredients to exert their beneficial effects based on their inherent properties. The key components in oils like Sahcharadi oil are typically imbued with Tikta (bitter) taste, Ushna (hot) potency, and Katu (pungent) post-digestive effect. The Tikta Rasa of the oil helps to stimulate the Dhatwagni (metabolic fire) of the body, enhancing the nutritional absorption and metabolic processes of all tissues (Dhatus). This improved metabolic activity leads to the effective reduction of stiffness, pain, and swelling in the affected areas. Moreover, the Ushna quality of the oil aids in alleviating the coldness and heaviness associated with Vata imbalances, while the Katu Vipaka further supports the digestion and assimilation of the herbs used.


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Through this method, the oil penetrates deeply into the tissues, reducing inflammation and promoting circulation, thereby offering both immediate relief and lasting therapeutic benefits.[18]

Conclusion

The Ayurvedic management of post-viral arthritis has shown promising results through the use of herbal formulations and Panchakarma therapies that focus on balancing the Doshas and alleviating inflammation, pain, and functional limitations. The treatment resulted in significant improvements in both subjective and objective criteria, with mean relief observed at 66.67% for subjective symptoms and 75% for objective assessments, such as range of motion and inflammatory markers.

The combination of powerful Ayurvedic Aushadha ingredients, such as Shallaki (Boswella serrata), Guggulu (Commiphora mukul), and various Bhasmas (including Vanga Bhasma, Naga Bhasma, Lauha Bhasma, and others), effectively addressed the symptoms of post-viral arthritis by reducing pain, swelling, and improving joint function. Additionally, therapies like Patra Pinda Swedana and Janu Basti offered supportive care to further reduce stiffness and promote circulation.

These findings underscore the efficacy of Ayurvedic interventions in managing post-viral arthritis, providing a holistic approach that complements modern medical practices by emphasizing immune support, detoxification, and Dosha balance. Future research can build upon these results to further validate and refine Ayurvedic treatments for arthritis.

References

1. Rolph MS, Foo SS, Mahalingam S. Emergent chikungunya virus and arthritis in the Americas. Lancet Infect Dis. 2015;15:1007-8.

2. Chen CI. Overview of viral arthritis. Curr Rheumatol Rep. 2017;19(6):34.

3. Suhrbier A, Jaffar-Bandjee MC, Gasque P. Arthritogenic alphaviruses – an overview. Nat Rev Rheumatol. 2012;8(7):420-9.

4. Miner JJ, Diamond MS. Zika virus pathogenesis and tissue tropism. Cell Host Microbe. 2016;19(2):150-9.

5. Charaka Samhita. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. (Kasi Sanskrit Series 228), Chikitsa 3/94.

6. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), and Chronic Pain Grade Scale (CPGS). Arthritis Care Res (Hoboken). 2011;63(S11):S240-52.

7. Van der Heijde DM, van ‘t Hof MA, van Riel PL, van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993;20(3):579-81.

8. Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia: F.A. Davis Company; 2016.

9. Lassere MN, van der Heijde D. Imaging in Rheumatology: Joint Damage Assessment in Rheumatoid Arthritis Using MRI and Ultrasound. Best Pract Res Clin Rheumatol. 2007;21(3):499-520.

10. Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia: F.A. Davis Company; 2016.

11. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448-54.

12. Podsiadlo D, Richardson S. The Timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.

13. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in the treatment of osteoarthritis of knee: A randomized double-blind placebo-controlled trial. Phytomedicine. 2003;10(1):37-44.

14. Dev SA. Selection of Prime Ayurvedic Plant Drugs: Ancient-modern Concordance. New Delhi: Anamaya Publishers; 2006. p. 113-7.

15. Ramachandran AP, Prasad SM, Prasad UN, Jonah S. A comparative study of Kaishora Guggulu and Amrita Guggulu in the management of Utthana Vatarakta. Ayu. 2010;31:410-5.


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16. Rhumayog Gold Tablet [Internet]. 2019 Aug 1 [cited 2025 Feb 28]. Available from: https://www.ayurmedinfo.com/2019/08/01/rhumayog-gold-tablet

17. Juyal R, Mahajan K, Agrawal AK. A comparative clinical study of Patra Pinda Swedana and Parisheka in Avabahuka. J Ayurveda Integr Med Sci. 2024;9(7):36-47.

18. Kumain K, Gupta R, Kumar P, Mahajan K. A comparative clinical evaluation of Janu Basti with and without Upnaha in Janu Sandhigata Vata (osteoarthritis of knee). Int J Ayurveda Pharma Res. 2024;12(8):25-33.

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