By

Jairaj. P. Basarigidad

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D. (PANCHAKARMA)

In

PANCHAKARMA

Under the guidance of

Dr. G. Purushothamacharyulu,M.D. (Ayu)

And co-guidance of

Dr. Shashidhar.H. Doddamani,M.D. (Ayu)

Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,

Gadag – 582103.

2005.

A Comparative Clinical Study to EvaluateThe Effect

Of Matrabasti and Parisheka with Shatahvadi Taila

in Sandhigatavata (Osteoarthirits)

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled “A

Comparative Clinical Study to Evaluate The Effect of Matrabasti and

Parisheka with Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a

bonafide and genuine research work carried out by me under the guid-

ance of Dr. G. Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D,

Post-graduate department of Panchakarma and co-guidance of Dr.

Shashidhar. H. Doddamani, M.D.(Ayu), Assistant Professor, Post graduate

department of Panchakarma.

Date:Place: Gadag. Jairaj. P. Basarigidad

I

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Compara-

tive Clinical Study to Evaluate The Effect Of Matrabasti and Parisheka with

Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a bonafide research

work done by Jairaj. P. Basarigidad in partial fulfillment of the

requirement for the degree of Ayurveda Vachaspathi. M.D.

(Panchakarma).

Date:

Place: Gadag Dr. G. Purushothamacharyulu, M.D. (Ayu).

Professor & H.O.D

Post graduate department of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

This is to certify that the dissertation entitled “A Compara-tive Clinical Study to Evaluate The Effect Of Matrabasti and Parisheka

with Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a bonafide

research work done by Jairaj. P. Basarigidad under the guidance

of Dr.G. Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Postgradu-

ate department of Panchakarma and co-guidance of Dr. Shashidhar.H.

Doddamani, M.D. (Ayu), Assistant Professor, Post graduate department of

Panchakarma.

Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.

Professor & H.O.D, Principal.

Post graduate department of Panchakarma.

CERTIFICATE BY THE CO- GUIDE

This is to cert i fy that the dissertat ion enti t led “AComparative Clinical Study to Evaluate The Effect Of Matrabasti and

Parisheka with Shatahvadi Taila in Sandhigatavata (Osteoarthirits)” is a

bonafide research work done by Jairaj. P. Basarigidad in par-

tial fulfil lment of the requirement for the degree of Ayurveda

Vachaspathi. M.D. (Panchakarma).

Date: Dr. Shashidhar.H. Doddamani, M.D. (Ayu).

Place: Assistant Professor,

Post graduate Department of Panchakarma.

COPYRIGHT

Declaration by the candidate

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and dissemi-

nate this dissertation / thesis in print or electronic format for academic /

research purpose.

Date: Jairaj. P. BasarigidadPlace: Gadag.

© Rajiv Gandhi University of Health Sciences, Karnataka.

I

ACKNOWLEDGEMENT

“Knowledge is proud that he has learned so much; wisdom is humble that he

knows no more.”. This work is the result of the combined effort of a good number of

people who include researchers, academicians, friends, colleagues, parents and laymen.

I dedicate this work to my respected parents Shri. P. F. Basarigidad and

Smt. M. P. Basarigidad who are the prime reasons for all my success.

The inspiring forces throughout this research work; was my guide

Dr. G. Purushothamacharyulu M.D.(Ayu), H.O.D. P.G. Department of Panchakarma,

P.G.S & R.C, D.G.M.A.M.C, Gadag, the person who has devoted his life for the

upliftment of this ancient system of medicine, who became a source of light whenever I

was in darkness. I am deeply indebted for his guidance, broadmindedness and affection

towards me.

Words can not express the zeal of ecstasy while depicting my deep source of

gratitude to my proficient co-guide Dr. Shashidhar.H. Doddamani M.D.(Ayu), Asst.

Professor, P.G. Department of Panchakarma, P.G.S.& R.C, D.G.M.A.M.C, Gadag. His

fruitful suggestions, optimistic view shower head on me during this whole period &

inspired me to accomplish this work in all aspects.

I express my deep gratitude to Dr. G. B. Patil, Principal, D.G.M.A.M.C, Gadag,

for his encouragement as well as providing all necessary facilities for this research work.

I express my sincere gratitude to Dr. P. Shivaramudu M.D. (Ayu), Professor and

Dr. Santhosh. N. Belavadi M.D. (Ayu), Lecturer P. G. Department of Panchakarma for their

sincere advices and assistance.

I express my sincere gratitude to a eminent teacher and researchers of

Panchakarma Dr. H. S. Kasture M.D. (Ayu), for his valuable guidelines.

I express my sincere gratitude to Dr. V. Varadacharyulu M.D. (Ayu), Dr. M. C. Patil

M.D. (Ayu), Dr. Mulgund M.D. (Ayu), Dr. K. S. R. Prasad M.D. (Ayu), Dr. Dilip Kumar M.D. (Ayu),

Dr. R.V. Shetter M.D. (Ayu), Dr. Kuber Sankh M.D. (Ayu), Dr. Girish. Danappagoudar M.D. (Ayu),

Dr.B.M.Mulkipatil M.D. (Ayu), Dr.Shashikant Nidagundi M.D. (Ayu), Dr.Jagadish Miti M.D. (Ayu),

Dr.M.D.Samudri M.D. (Ayu), Dr. Shankaragouda M.D. (Ayu), Dr. Veena M.D. (Ayu) and other PG

staff for their constant encouragement.

II

I also express my sincere gratitude to Dr. G. S. Hiremath M.D.(Ayu), Dr.B.G.Swamy,

Dr. V.M. Sajjan, Dr. U.V. Purad, Dr. S.D. Yerageri, Dr. S.H. Redder, Dr. Gacchinamath

and other undergraduate teachers for their support in the clinical work.

I am thankful to Shri. Nandakumar (Statistician), Dr. Arun Baburao Biradar, Shri.

V.M. Mundinamani (Librarian), Shri. B.S. Tippanagoudar (Laboratory technician), Shri.

Basavaraj (X-Ray technician) and other hospital and office staff for their kind support in

my study.

I cann’t move further before thanking to my intimate friends Dr. Santosh, Dr.

Shashi, Dr. Jagadish, Dr. Sharanu, Dr. Girish, Dr. Pradeep, Dr. Kendadamath, Dr. V.M.

Hugar, Dr. Shaila. B., Dr. P. Chandramouleeswaran, Dr V.S. Hiremath, Dr.

Pattanashetti, Dr. Santoji, Dr. Jaggala, Dr. Udaykumar, Dr. Ratnakumar, Dr. Kalmath

B.L., Dr. Venkareddi, Dr. Bingi, Dr. Sajjan, Dr. Ganti, Dr. Pradeep, Dr. Sobagin, Dr.

Shakuntala, Dr. Subin, Dr. Satheesh, Dr. Febin, Dr. Sreenivasa Reddy, Dr. Varsha, Dr.

Vijay Hiremath, Dr. Suresh Hakkandi, Dr. Manjunath Akki, Dr. Ashwini Dev, Dr. L.

Biradar, Dr. Jagadish. H, Dr. Sharanu, Dr. Anand, Dr. Suvarna, Dr. Anita, Dr. Kumbar,

Dr. G. G. Patil, Dr. Sarve, Dr. Jigalur, Dr. Muttu, Dr. Prasannakumar, Dr. Madhushree,

Dr. Sibaprasad, Dr. Payappagoudar. and other post graduate scholars for their support.

I acknowledge my patients for their wholehearted consent to participate in this

clinical trial. I express my thanks to all the persons who have helped me directly and

indirectly with apologies for my inability to identify them individually.

Even though more words can never replace the emotions one feels, still I crave to

convey a cordial thanks to my younger brother cum friend Santosh whose belief & whole

hearted co-operation has always remained as the source of energy to me in this world of

uncertainly.

Date :

Place : Dr. Jairaj. P. Basarigidad.

III

LIST OF ABBREVIATIONS

⇒ A. H. – Ashtanga Hridaya.

⇒ B. P. – Bhavaprakasha.

⇒ C. S. – Charaka Samhita.

⇒ G. R. – Good response.

⇒ M. R. – Moderate response.

⇒ N. R. – No response.

⇒ P. R. – Poor response.

⇒ S. S. – Susruta Samhita.

⇒ AS. – Ashtanga sangraha.

⇒ BR. – Bhaishajya ratnavali.

⇒ MN. – Madhava nidana.

⇒ No. – Number.

⇒ Pt.’s – Patients.

⇒ Sl. – Serial number.

⇒ Vag. – Vagbhata.

⇒ VS. – Vangasena samhitha.

⇒ YR. – Yogaratnakara.

IV

ABSTRACT

Bastikarma and Swedana are the most important among the Panchakarmas. It has

already been proved that the karmas are beneficial in managing the Vatavyadhees.

Sandhigatavata is the most common joint disorder worldwide.

The study “ A comparative clinical study to evaluate the effect of Matrabasti and

Parisheka with shatahvadi Taila in Sandhigatavata (Osteoarthritis)” is focused on

important techniques i.e. Parisheka and Matrabasti and also common clinical entity

Sandhigatavata. Parisheka and Matrabasti with shatahvadi taila are believed to have a

appreciable role in the management of such degenerative conditions by imparting

strength to the body musculature and nervous system.

The objectives of this study are 1)To evaluate the effect of Parisheka in

Sandhigatavata (Osteoarthritis), 2) To evaluate the comparative effect of Matrabasti and

parisheka in Sandhigatavata (Osteoarthritis), 3) To evaluate the additive efficacy of

Matrabasti in Sandhigatavata (Osteoarthritis).

The aim of this study was to find out the effect of Parisheka in the management of

Sandhigatavata, and to check its advantage over Parisheka in association with Matrabasti

in managing the same disease. Therefore, two groups were made and the results obtained

in both the individual groups were compared. The study design selected for the present

study was prospective comparative clinical trial.

V

In group A (Parisheka and Matrabasti) 8 patients (53.33%) had good response to

the treatment (> 60% improvement in all the parameters) and 7 patients (46.33%) had

moderate response to the treatment (31-60% improvement in all the parameters) .

In group B (Parisheka) 13 patients (86%) had moderate response to the treatment

and 2 patients (13.33%) had poor response to the treatment (1-30% in all the parameters).

Among the group A and B the parameters Ruk and Walking time shows highly

significant, where as other parameters are not significant in the comparative study (By

using unpaired t-test, p<0.05).

At the same time overall treatment response was better in the Parisheka and

Matrabasti group as no patient in the Parisheka group got good response. This suggests

that there was considerable improvement in both the groups but Parisheka and Matrabasti

group got more beneficial effects.

Sandhigatavata is a Vatavyadhi affecting people in the vardhakya avastha. The

disease is characterized by dhatu kshaya and lakshanas reflective of vitiated Vata.

Therefore, the agents/therapies of brimhana-shoolahara-stambhahara-balya properties

should be used in this disease. Parisheka imparts Snehana and Swedana and opens up the

srotas in the shareera facilitating more nourishment and free movement of Vata dosha.

Matrabasti is prime treatment for Vatavyadhees inturn plays vital role in correcting

pathology of the disease and gives remarkable results.

This results in the relief of symptomatology of the disease, when these two

procedures performed together by acting locally and systematically. Ingredients of

shatahvadi taila possess properties such as Vedanashamaka, Shotahara and also

Vatanulomaka. Thereby, it is an ideal treatment of choice in Sandhigatavata

Key words: - Parisheka, Matrabasti, Sandhigatavata, Dhatukshaya, Swedana, Basti, Osteoarthritis, Vardhakya.

VI

TABLE OF CONTENTS

Chapters Page No.

1. Introduction 1-3

2. Objectives 4-5

3. Review of literature 6-96

4. Methodology 97-113

5. Results 114-161

6. Discussion 162-177

7. Conclusion 178-179

8. Summary 180

9. Bibliography

10. Annexure

VII

LIST OF TABLES

Table No.

Table Showing the Page No.

01. Different layers of Twak and diseases originating from each layer 02. Sites of different types of sandhis 03. Contraindicated for Anuvasana 04. Measurements of Bastiyantra 05. Netra dosha and Putaka dosha 06. Indications of Matrabasti 07. Dose of Matrabasti according to Age 08. Samyak, Ati and Heena yoga laxanas of Anuvasana basti 09. Properties of Swedana dravyas 10. Sweda yogyas 11. Sweda ayogyas 12. Samyak swinna lakshanas 13. Ati swinna lakshanas 14. Aaharaja nidana of Sandhigatavata 15. Viharaja nidanas of Sandhigatavata 16. Lakshanas of Sandhigatavata 17. Vyavachedaka nidana between Sandhigatavata and Vataraktha 18. Vyavachedaka nidana between Sandhigatavata and Amavata 19. Vyavachedaka nidana between Sandhigatavata and

Kroshtrukasheersha

20. Differential diagnosis between OA, RA, Gout and Rheumatic fever

21. Distribution of patients by Age in both groups 22. Overall response of patients by Age in both Groups 23. Distribution of patients by Sex in both groups 24. Overall response of patients by Sex in both Groups 25. Distribution of patients by Occupation in both groups 26. Overall response of patients by Occupation in both Groups 27. Distribution of patients by Economical status in both groups 28. Distribution of patients by Religion in both groups 29. Distribution of patients by Dietary habits in both groups 30. Distribution of patients by Agni in both groups 31. Overall response of patients by Agni in both Groups 32. Distribution of patients by Koshta in both groups

VIII

33. Overall response of patients by Koshta in both Groups 34. Distribution of patients by Nidra in both groups 35. Distribution of patients by Vyasana in both groups 36. Distribution of patients by Deha prakriti in both groups 37. Overall response of patients by Deha prakriti in both Groups 38. Distribution of patients by Satmya in both groups 39. Distribution of patients by Ruk in both groups 40. Overall response of patients by Ruk in both Groups 41. Distribution of patients by Graha in both groups 42. Overall response of patients by Graha in both Groups 43. Distribution of patients by Sparsha akshamatva in both groups 44. Overall response of patients by Sparsha akshamatva in both

Groups

45. Distribution of patients by Sandhigati asaamarthya in both groups 46. Overall response of patients by Sandhigati asaamarthya in both

Groups

47. Distribution of patients by Atopa in both groups 48. Overall response of patients by Atopa in both Groups 49. Distribution of patients by Shotha in both groups 50. Overall response of patients by Shotha in both Groups 51. Distribution of patients by Presenting complaints in both groups 52. Distribution of patients by Chronicity in both groups 53. Overall response of patients by Chronicity in both Groups 54. Distribution of patients by Mode of onset in both groups 55. Overall response of patients by Mode of onset in both Groups 56. Distribution of patients by Aharaja nidana in both groups 57. Overall response of patients by Aharaja nidana in both Groups 58. Distribution of patients by Viharaja nidana in both groups 59. Overall response of patients by Viharaja nidana in both Groups 60. Distribution of patients by Mansika nidana in both groups 61. Distribution of patients by Radiological interpretation in both

groups

62. Distribution of patients by overall response in both groups 63. Before and after treatment values of all parameters in Group – A 64. Before and after treatment values of all parameters in Group – B 65. Individual study subjective and Objective parameters in Group-A 66. Individual study subjective and Objective parameters in Group-B 67. Inter-group comparison

IX

LIST OF GRAPHS Graph No. Graph Showing the

01. Distribution of Patients by age in both groups 02. Distribution of patients by Sex in both groups 03. Distribution of patients by Occupation in both groups 04. Distribution of patients by Economical status in both groups 05. Distribution of patients by Religion in both groups 06. Distribution of patients by Dietary habits in both groups 07. Distribution of patients by Agni in both groups 08. Distribution of patients by Koshta in both groups 09. Distribution of patients by Nidra in both groups 10. Distribution of patients by Vyasana in both groups 11. Distribution of patients by Deha prakriti in both groups 12. Distribution of patients by Satmya in both groups 13. Distribution of patients by Ruk in both groups 14. Distribution of patients by Graha in both groups 15. Distribution of patients by Sparsha akshamatva in both groups 16. Distribution of patients by Sandhigati asaamarthya in both groups 17. Distribution of patients by Atopa in both groups 18. Distribution of patients by Shotha in both groups 19. Distribution of patients by Presenting complaints in both groups 20. Distribution of patients by Chronicity in both groups 21. Distribution of patients by Mode of onset in both groups 22. Distribution of patients by Aharaja nidana in both groups 23. Distribution of patients by Viharaja nidana in both groups 24. Distribution of patients by Mansika nidana in both groups 25. Distribution of patients by overall response in both groups

LIST OF FLOW CHART

Flow chart No. Flow chart showing 01. The samprapti of Sandhigatavata

LIST OF PHOTOGRAPHS

Photograph No. Photograph showing 01. The anatomy of large intestine and rectum 02. Anatomy of Skin 03. Anatomy of Knee joint 04. Ingredients of Shatahvadi taila, Procedure of Matrabasti and

parisheka

Ayurvedic classics narrate the observations of great sages like Charaka, Susruta,

Vagbhata and Kashyapa. Their accomplishments are available as authouritive classics of

this. It emphasizes man as conglomeration of the panchamahabhutas and atma. The

panchamahabhutas are present in the body in the form of dosha, dhatu and malas

comprising various organs and organ systems, these together forms the physical and

material aspect of man.

A critical, careful and unbiased study of the classical Ayurvedic texts shows that

by the time the samhitagranthas were compiled, the science and art of Ayurveda had

already passed through the stage of specialiazation. So it is time tested and formulated

after conducting various reaserches on the basis of criteria’s available on those days.

Ayurveda speaks about preservation of health first and then the correction of its

disturbances, that is diseases.

Ayurveda opines disease or vyadhi is a state in which both the mind and body

suffer from pain, misery and even injury. The causative factors may vary depending on

the different entities but actually Tridoshas (Vata, Pitta and Kapha) are the intrinsic

causative factors, which get vitiated due to extrinsic factors and their balance is disturbed.

Ayurveda prescribes various therapeutic measures either in the form of

Purificatory (Samshodhan) or Pacificatory (Samshamna) for the alleviation of the disease

of both mind and physique.

Panchakarma comprises five major preventive and therapeutic procedures among

the unique achievements of our science; these are Vamana, Virechana, Niroohabasti,

Anuvasanabasti and Nasyakarma. Acharya Susruta being first and foremost eminent

surgeon incorporates the Raktamokshana also into the above mentioned list, considering

Introduction 1

the two types of Basti under one. Panchakarma which is considered as five fold therapies

occupise unique place among all the therapeutic measures list, because of its unique

nature not only to treat the disease radically but also by fulfilling both the basic goals of

Ayurveda i.e “swasthasya swasthya rakshanam aturasya vikara prashamanam”. The

term Panchakarma even the number is five but the word “pancha” gives the meaning

“vistara” i.e elobarate procedure. Chakrapanidatta vividly emphasized about the

restriction of Panchakarmas number to five, he opined that the term karma denotes the

extensive management and pronounced potency for elimination of impurities. Snehana

and Swedana etc does not fulfill this goal and hence these are not included in it.

For systematic and successful performance of these procedures it includes three

main aspects to consider which are in the form of poorvakarma, pradhanakarma and

paschatkarma. As Dalhana mentioned Pachana, Snehana and Swedana as poorvakarmas.

Pachana is oral administration of certain drugs to relieve ama and strengthens the agni.

Snehana is a oleation therapy which is administered through external or internal route.

Swedana is a application of heat to the body to make perspire.

Eventhough Swedana is included in poorvakarma it stands unique because of its

wide spread application and efficacy. Swedana plays prime role in preparing body for the

Adaptation of Pradhankarmas or Panchakarmas and also it is considered as

pradhanakarma in certain conditions like Swedasadhya vyadhis. Among the varities of

Swedana, Parisheka is also included about which ample descriptions are available in

classics and it governes its own importance due to its systematic application and different

modes of administration under the headings of Sheka, Parisheka and Dhara etc.

Introduction 2

When we consider Panchakarma procedures for their clinical efficiency and

indications, Bastikarma has been placed a prime position by virtue of its wide indications

and applicability like shodhana, shamana, brumhana and karshana etc basing on the

properties of the drugs employed in the procedure. Even it is considered as

“Ardhachikitsa” and mentioned that it eliminates the vitiated doshas from all over the

body because of its wide action like “Aapadatalamastakam”.

Swedana and Bastikarma occupies important place in treating Vatavyadhees,

Vata is the master of all the doshas and is responsible for all types of functions and

movements in the body because of its Gati and Gandhana properties, so 80 varities of

Vatavyadhees are mentioned in the treatises.

The ability of any work of every individual is depends upon the ability of using

his joints. The moment the person looses the power of locomotion the person not only

feels themselves a miserable creature but also becomes a burden to respective family and

society. Sandhigatavata is one such clinical entity among Vatavyadhees which affects the

locomotion of senior citizens of this world in which dhatukshaya is prime factor which is

characterized by certain symptoms like joint stiffness, joint pain, swelling and difficulty

of joint movement etc.

Among all the treatment modalities of Sandhigatavata Parisheka and Matrabasti

are considered here for the study.

Introduction 3

NEED FOR THE STUDY

The principle of Ayurveda chikitsa includes both Swedana and Bastikarma in the

treatment of Vatavyadhees. Swedana being one of the poorvakarma indicated in vataja

and vatakaphaja disorders mainly. Especially Parisheka is one among the Swedana in

which lukewarm taila, kashaya etc poured in a regular stream on the whole or part of the

body, specifically when taila is used it mitigates Vata by accomplishing both Snehana

and Swedana simultaneously. Bastikarma is pradhanakarma which is mentioned as Ardhachikitsa, Matrabasti is

a type of Anuvasanabasti having wide indications. It is well tolerated by the patients

because of its dose, no such complications and it can be administered at any time.

Sandhigatavata is most common clinical entity among Vatavyadhees encountered

in clinical practice. It can be compared with Osteoarthritis of contemporary science as

both are similar in presentation with the symptometology- Pain, Swelling and Restriction

of joint movements etc of affected joints. According to WHO Osteoarthritis is the second

commonest musculoskeletal problem in the world population. Many researches have

been done in modern science to get effective treatment, as NSAIDs (analgesics) are

giving symptomatic relief only and also not safe, but could not found any safe and

effective medicaments. Research is going on even with Ayurvedic therapeutic measures

since 3-4 decades with Guggulu compounds and Shodhana measures. As Sandhigatavata is one among the Vatavyadhees and found very common in

senile conditions. Matrabasti and Parisheka are expected to give better results in this

entity, Shatahvadi taila is used for these two procedures which is indicated in Vatavyadhi

Objectives 4

So present study entitled “A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFECT OF MATRABASTI AND PARISHEKA WITH

SHATAHVADI TAILA IN SANDHIGATAVATA (OSTEOARTHRITIS)” is

undertaken.

OBJECTIVES OF THE STUDY

1) To evaluate the effect of Parisheka in Sandhigatavata.

2) To evaluate the comparative effect of Matrabasti and Parisheka in Sandhigatavata.

3) To evaluate the additive efficacy of Matrabasti in Sandhigatavata.

Objectives 5

HISTORICAL REVIEW

A critical review of the history from the primitive stage to the new millennium

assists one to understand the future in a better way. Man always struggled with present

and attempted for the better future and these can be achieved with a better perspective.

when the past and present experiences and truths are checked and planned at proper time.

History helps to reveal the hidden facts and ideas of the concerned subject.

KARMA

BASTI KARMA

As Matrabasti is a vikalpa of Anuvasana basti which is a variety of Basti, so

historical review is done along with Basti here.

Charaka Samhita1 : The scattered references regarding Basti are available in

various chapters of Charaka Samhita, but in Siddhisthana out of 12 chapters, 8 chapters

contribute to Basti. First two chapters of Siddhisthana deals with properties of Basti

samyak yoga, Ayoga lakshanas, indications and contraindications of Basti. This denotes

the importance of Basti in the field of Panchakarma.

Susruta Samhita2 : In Susruta Samhita, four chapters ( 35th-38th ) have been

devoted completely for the description of the Basti in Chikitsasthana. In which detailed

information regarding Bastinetra, indication, contra-indications, complications,

classification of Basti etc are available.

Ashtanga Sangraha3 : 28th chapter of Sutrasthana has been devoted to Basti

only. In this chapter, classification, indication, contra-indication, dosage, process of

administration etc. have been described in detail. Also four chapters of Kalpasthana have

been contributed to Basti. In these chapters, description regarding importance of Basti,

different types of Basti, Sneha Basti Vyapad etc are available.

Historical Review 6

Ashtanga Hridaya4 : In this Samhita, 19th chapter of Sutrasthana Basti Vidhi and

4th and 5th chapter of Kalpasthana named as Basti Kalpa and Basti Vyapada Siddhi

explain the every aspect of Basti.

Kashyapa Samhita5 : In Kashyapa Samhita, Basti has been explained in detail in

Siddhisthana and Khilasthana. He equated Basti to Amruta.

Bhela Samhita6 : In Bhela Samhita, description of Basti is available in four

chapters of Siddhisthana namely Bastimatriyasiddhi, Upakalpasiddhi, Phalamatrasiddhi

and Dasha Vyapadika Bastisiddhi.

Chakradatta7 : In this text, two chapters named Anuvasanadhikara and

Niruhadhikara are dealt with Anuvasana and Niruha Basti respectively.

Vangasena8 : Vangasena has devoted “Basti Karmadhikara” chapter for

description of Basti.

Sharangadhara Samhita9 : Three chapters of Uttarakhanda namely Basti

Kalpana Vidhi, Niruha Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described

various aspects of Anuvasana Basti, Niruha Basti and Uttara Basti respectively.

As the time progressed in the recent times authors of Ayurveda has also

contributed for the Bastikarma by modifying the Bastiyantra, i.e. replacing the older

equipments by rubber or plastic material.

Historical Review 7

SWEDANA KAMRA

The time during and after the Samhitakala provide ample descriptions on

Swedana.

Charaka Samhita10 : Acharya Charaka was the first to describe Swedakarma

under the Shadupakramas. He explained in detail about definition, classification,

indications, contra-indications and benefits of Swedana.

Susruta Samhita11 : Susruta also given in detail explanation about it, with slight

difference in classification.

Vagbhata12 : He had also allotted separate chapters for Sweda karma in

Ashtanga sangraha and Ashtanga Hridaya.

Bhela Samhita13 : Bhela had also described Swedana in detail in the Sweda

adhyaya of sutrasthana.

Kashyapa Samhita14 : He added Hastasweda and Pradehasweda too in

classification.

Sharangadhara Samhita15 and Chakradatta16 : had also described about

Mridu, Madhya and Mahan Swedana karma.

Bhavaprakasha17, Bhaishajyaratnavali18 and Yogaratnakara19 : had

emphasized the utility of Swedakarma in various clinical conditions.

About Sweda karma various literary works belonging to the Classical Age of

Indian Literature20 like Kasika and Harsacharita had also mentioned its usefulness.

We find the ample description about therapeutic use of Parisheka21a-h in major texts

of Ayurveda. Charaka considered Parisheka as Bahirparimarjana Chikitsa.22

Historical Review 8

SANDHIGATAVATA

Vedic Period

In the Vedic period, like in Atharvaveda the words “Januni and Ashtivantau”

were used to denote knee joints.23 The disease Sandhigatavata had not been mentioned as

such, but Atharvaveda had mentioned Parvashoola and Vateekrita24 two diseases similar

to Sandhigatavata. Rigveda while describing various skills of Ashwinikumaras had

recorded their skill in treating joint diseases too.25 One of the mantras of Rigveda states

that, “I am removing your diseases from each organ, hair and joint”.26 In Atharvaveda,

records about Vatavikaras are mentioned. A mantra says, “destroy the balasa seated in

the organs and joints which is responsible for loosing bones and joints”.27

Samhita Kala

In that period we find systematic description of the disease according to Nidana

Panchaka.

Charaka Samhita28 : Acharya Charaka has mentioned the disease

Sandhigatavata under Vatavyadhi Chikitsa (28th chapter) but hasn’t mentioned any

specific line of treatment for this.

Susruta Samhita29 : Acharya Susruta has added one symptom i.e. “Hanti

Sandhi” and described the lakshanas of Sandhigatavata in Nidanastana (1st chaptr) and in

Chikitsa Sthana (4th chapter) specific line of treatmen has been prescribed.

Bhela Samhita30 : There is no explanation about Sandhigatavata. However he has

explained the asthi-majjagata Vata wherein we find the symptom Sandhi Vichyuthi.

Historical Review 9

Sangraha Kala

Astanga Sangraha31 and Astanga Hridaya32 : In Astanga Sangraha

Nidanasthana (15th chapter) 15 Lakshanas and in Chikitsasthana (21st chapter) 4 varieties

of Chikitsa are explained. The Nidanas are similar to Charaka Samhitha and Chikitsa is

as Susruta Samhitha. In Astanga Hridaya Nidanas are explained in Nidana Sthana (15th

chapter) and chikitsa in Chikitsa sthana (21st chapter).

Madhava Nidana33 : He has mentioned an additional symptom, Atopa in the

symptomatology of Sandhigatavata ( 22 nd chapter) rest are same as in Susruta Samhitha.

Bhavaprakash34 and Yogaratnakara35 : Bhavaprakasha explained the

Lakshanas and treatment of Sandhigatavata in Madhyama khanda Vatavyadhyadhikara

(24th chapter).

Yogaratnakara : also is not left behind in explaining about Lakshanas and

treatment of Sandhigatavata in Vatavyadhyadhikara of Pooravardha.

Chakradutta36 and Bhaisajyaratnavali37 : Description is similar to Susruta

Samhita. Both the texts haven’t dealt with the aspect of Nidana.

Osteoarthritis (OA) is the most common joint disorder arising with greater

number of affected population. Even in giant dinosaurs, osteophytes leading to ankylosis

were detected. In all mammalian species like whales and dolphins and in fish birds and

some amphibians, Osteoarthritis is observed.38

In the early ages, Hippocrates observed the prevalence of OA in aged individuals

(Benard, 1944).39 Heberden (1803) studied this disease in detail and the nodes on the

fingers in OA disease were named after him.40 Osteoarthritis was differentiated from

Rheumatoid Arthritis and named as degenerative arthritis by Nichols and Richardson

(1909) on morbid anatomical grounds.41 Although the most ancient of the diseases, OA

was first identified as a distinct entity in the 20th century.42 Gold th ait in 1904 made a

distinction between hypertrophic and atrophic arthritis and A. E. Garrod recognized OA

as a clinical entity in 1907.43(Rheumatology –Kelly and William).

Historical Review 10

VYUTPATTI AND PARIBHASHA

Basti

The word Basti is derived form ‘vas + tich’ and is masculine gender.

“Vasu nivase”44 - Means residence.

“Vas-aachadane” - That which gives covering

“Vas vasane surabhikarane” - That which gives fragrance

“Vasti vaste aavrunothi moothram” - That which covers the urine.

“Nabheradhobhage mootradhare” - The position of basti is just below the nabhi

(umbilicus) and is the collecting organ of urine in

the body i.e. urinary bladder.

In the context of Panchakarma the term basti is used in different meaning.

“Vastina deeyate iti vasti”45

“Vastibhir deeyate yasmat tasmat vastiriti smritha”46

“Vastina deeyate vastini va Purvamanyattavasto vasti”47

Matrabasti

“Hraswaya snehapanasya matrayaha yojitaha samaha”48

Matrabasti is a type of Anuvasana which is having main ingredient sneha which is

administered in the hraswamatra. The word Basti gives the meaning of urinary bladder.

As it is used as a device for Bastikarma. In Panchakarma therapy the term Basti is used

to designate the procedure.

Vyutpatti & Paribhasha 11

Swedakarma

Sweda49 : - Sweda is a word of masculine gender. Sweda word is coined by the

combination of “Swit” dhathu and “Dhanj” pratyaya. Sweda is a shareeramala, which is

associated with body heat mechanism.

Karma50 : - Karma word is derived from the dhathu “Kru”. Performance of an

act is called karma. Here, swedakarma means the act of producing sweda and it is one

among the Shadupakramas and poorvakarma.

Parisheka51

Pouring of the regular stream of Vasa, Taila, Grita, Kshreera, Mutra, Kanji etc in

lukewarm state.

Sandhigatavata

The word “Sandhigatavata” is comprised of three words, viz. Sandhi, Gata and

Vata.

Sandhi52 :- Sandhi is a word of masculine gender. Sandhi is coined from three

parts ‘Sam’, ‘Dha’ and ‘Kihi’. “Sandhaanamiti, asthidvayasamyogasthanam”- The place

of union of something together is called sandhi. Here, it means the union of bones.

Gata53 : - Gata word exists in all the three genders and it is derived from ‘Gama’

dhathu and ‘Ktin’ pratyaya. “Gachati, janaati, yaateeti va” - That which has went or

reached. Hence, gata word may be used to denote an initiation of movement, carrying

something along with, to reach a particular site, through any particular pathway or

leading to occupancy at a particular site. Here, in the context of Sandhigatavata, the

occupancy is at asthi-sandhis in the body.

Vyutpatti & Paribhasha 12

Vata54 : - Vata is a word of masculine gender. The word is coined from “Vaa”

dhathu and “Ktin” pratyaya. Vata is derived from “Va gati gandhanayoho” i.e. to move,

to make know, to become aware of. The term Gati means prapti, Jnana. Gandhana is like

Utsaha, Prakashana. Considering different meaning of Gati and Gandhana it is

understood that the term Vata act as receptor as well as stimulator. It is one among the

tridoshas. Thus, collectively the word Sandhigatavata means the disease resulting from

the settling of vitiated Vata dosha in the bony joints of the body.

The word “Osteoarthritis” is a combination of three words. “Osteon”, “arthron”

and “itis” respectively means bone, joint and inflammation55. The meaning of this word

is “inflammation to the bony joint”. In fact, there is no inflammation in this disease;

hence, the disease is also known as Osteoarthrosis and Degenerative joint disease.

Vyutpatti & Paribhasha 13

SHAREERA

The word shareera comprises both structural and functional aspects of the body.

As focus of this study is on Bastikarma and Parisheka, a discussion on the anatomy and

physiology of skin and also rectum where these procedures are applied, is necessary prior

to the discussion on the anatomy and physiology of joints which are the site of this

disease.

Guda Shareera

In the context of Arsaroga Susruta has explained in detail about the anatomical

structure of guda. Guda is a part, which is the extension of sthoolantra with 41/2 angula

in length. It has got 3 valis (parts) named as Gudavalitrayam.56

Pravahini – That which does pravahana.

Visarjini – That which does visarajana.

Samvarani – That which does samvarana.

Gudostha is a structure present about a distance of 1½ yavapramana from the end

of hairs. The first vali samvarani starts at a distance of 1 angula from gudostha. The width

of each vali will be 1 angula and of the colour of elephant’s palate.57

Charaka considered uttaraguda and adharaguda while describing about the

koshtangani. The modern commentators consider them as rectum and anus respectively.58

All acharyas have considered guda as one among the dashajeevitha dhamani and also one

among the bahyasrotas.59-61

The rectum forms the last 15cm of digestive tract and is an expandable organ for

the temporary storage of fecal material. Movement of fecal material into the rectum

triggers the urge to defecate.

Shareera 14

The last portion of the rectum, the ano-rectal canal, contains small longitudinal

folds, the rectal columns. The distal margins of rectal columns are joined by transverse

folds that mark the boundary between columnar epithelium of the proximal rectum and a

stratified squamous epithelium like that in the oral cavity. Very close to the anus or anal

orifice, the epidermis becomes keratinized and identical to the surface of the skin.

There is a network of veins in the lamina propria and submucosa of the ano-rectal

canal. The circular muscle layer of the muscularis externa in the region forms the internal

sphincter and is not under voluntary control. The external anal sphincter guards the anus

and is under voluntary control. Pudental nerves carry the motor commands.62

Pakwashaya / Large intestine

Susrutha63 and Vagbhata64 opine pakwashaya as one of the ashaya. According to

Arunadatta pakwashaya is the seat of pakwa anna i.e. that which attains pureeshatha.65

Charaka and Vagbhata considered this as one among the koshtangas.66,67 Sharangadhara

has specified the location of pakwashaya (pavanasaya) as below the Tila i.e. the liver.68

The horseshoe shaped large intestine or large bowel begins at the end of ileum

and ends at anus. Average length of about 1.5 meters and width of 7.5cms. It is divided

into 3 parts: -

Caecum – T portion (pouch like)

Colon – Large portion.

Rectum – The last – 15 cm portion.

The caecum collects and stores the chyme and begins the process of compaction.

Colon is being subdivided into ascending, transverse, descending and sigmoid colon. The

major characteristics of colon are the lack of villi. The abundance of goblet cells,

presence of distinctive intestinal glands and mucosa does not exist produces any

enzymes. The reabsorption of water is an important function of large intestine (75%) and

also absorbs number of other substances that remain in the fecal matter or that were

secreted into the digestive tract along its length like Vit. K, B5, biotin, urobilinogen, bile

salts and toxins.69

Shareera 15

Twak shareera

According to Ayurveda twak is an upadhatu of mamsa.70 In the foetal stage of

development of the Garbha, the different layers of the skin are formed due to the

modification of mamsadhatu.71 Susruta72 appreciated the seven layers of twak and the

diseases arising from it.

Table No. 1. Showing the different layers of twak.

Sl. Layer of twak Size Diseases arising from each layer

1 Avabhasini 1/18 Vrihi Sidhma, Padmakantaka

2 Lohitha 1/16 Vrihi Tilakalaka, Nyaccha, Vyanga

3 Swetha 1/12 Vrihi Charmadala, Ajagalli, Mashaka

4 Tamra 1/8 Vrihi Kilasa, Kushta

5 Vedinee 1/5 Vrihi Kushta, Visarpa

6 Rohinee 1 Vrihi Granthi, Apachi,

Arbuda, Shlipada, Galaganda

7 Mamsadhara 2 Vrihi Bhagandara, Vidradhi, Arshas

Susruta, stated that how the cream forms layer after layer in the boiling milk, like

that seven layers of skin forms.

Charaka73 had described only six layers of twak without naming them they are –

1) Udakadhara, 2) Asrigdhara 3) Sidhma-kilasa sambhavadhishthana, 4) Dadrukushta

sambhavadhishthana, 5) Alaji-vidradhi sambhavadhishthana and 6) Arumshika

adhishthana patient goes into shock and develops a very serious skin disease called

arumshika, if injury occurs at the innermost layer i.e arumshika adhistana.

Bhrajakapitta is located in the twak takes up and metabolizes the drugs applied in

the form of abhyanga, parisheka, avagaha, alepa etc.74

Shareera 16

Modern View

Skin is a Large, Highly Complex Organ and as a Structuraly Integrated Organ

System. It includes skin and the associated hairs, nails and exocrine glands. The system

accounts for about 16% of ones body weight.75

Cutaneous membrane has two components – the superficial epithelium or

epidermis and the underlying connective tissues of the dermis. The associated or

accessory structures are located in the dermis and protrude through the epidermis to the

skin surface.

General functions of the skin

◊ Protection of underlying tissues and organs.

◊ Excretion of salts, water and organic wastes.

◊ Maintenance of normal body temperature.

◊ Synthesis of a steroid, vitamin D3 that is subsequently converted to the hormone

calcitriol, important to normal calcium metabolism.

◊ Storage of nutrients.

◊ Detection of touch, pressure, pain and temperature stimuli and the relay of that

information to the nervous system.

Epidermis

It provides mechanical protection and keeps microorganisms outside the body;

this layer consists of a stratified squamous epithelium. The most abundant epithelial cells,

called kertinocytes, form several different layers.

Five layers of epidermis, beginning at the basement membrane and traveling

toward the free surface, are stratum germinativum, stratum spinosum, stratum

granulosum, and stratum lucidum and stratum corneum. Keratinization or cornification

occurs on all exposed skin surfaces except the anterior surface of the eyes.

Shareera 17

Epidermal growth factor (EGF) is one of the peptide growth factors produced by

the salivary glands and glands of the duodenum. This has wide spread effects on

epithelia, especially the epidermis. Its effects include –

Promoting the divisions of germinative cells in the stratum germinativum and

stratum spinosum.

Accelerating the production of keratin in differentiating epidermal cells.

Stimulating epidermal development and epidermal repair after injury.

Stimulating synthetic activity and secretion by epithelial cells.

The colour of the skin is due to an interaction between pigment (carotene and

melanin) composition and concentration and the dermal blood supply.

Dermis

The dermis lying beneath the epidermis has two major components – a superficial

papillary layer and a deeper reticular layer. The papillary layer consists of loose

connective tissue. This region contains the capillaries and the sensory neurons that supply

the surface of the skin. The reticular layer consists of an interwoven meshwork of dense

irregular connective tissue. Accessory organs of epidermal origin, such as hair follicles

and sweat glands, extend into the dermis. The reticular and papillary layers of the dermis

contain networks of blood vessels, lymph vessels and nerve fibers.

Dermal circulation

Arteries supplying the skin form a network in the subcutaneous layer along its

border with the reticular layer of the dermis. This network is called the cutaneous plexus.

Tributaries of these arteries supply the adipose tissues of the subcutaneous layer and the

tissues of the integument. As small arteries travel toward the epidermis, branches supply

the hair follicles, sweat glands, and other structures in the dermis

Shareera 18

Nerve supply

Nerve fibers in the skin control blood flow, adjust gland secretion rates and

monitor sensory receptors in the dermis and the deeper layers of the epidermis. The

epidermis also contains the extensions of sensory neurons that provide sensations of pain

and temperature. The dermis contains similar receptors as well as other more specialized

receptors.

Hypodermis

The connective tissue fibers of the reticular layer are extensively interwoven with

those of the subcutaneous layer. Although the hypodermis is not a part of the integument,

it is important in stabilizing the position of the skin in relation to underlying tissues, such

as skeletal muscles or other organs, while permitting independent movement.76

Sweat glands77

Among the associated structures of the skin, only sweat glands are discussed here

due to their contextual relevance. The skin contains two different types of sweat glands or

sudoriferous glands – apocrine glands and merocrine sweat glands.

Apocrine sweat glands communicate with hair follicles in the armpits (axillae),

around the nipples and in the groin. These are coiled tubular glands that produce a sticky,

cloudy and potentially odorous secretion. Apocrine sweat glands begin secreting at

puberty. The sweat produced is a nutrient sources for bacteria, which intensity its odour.

The secretary activities of the glands cells and the contractions of myoepithelial cells are

controlled by the nervous system and by circulating hormones.

Shareera 19

Merocrine sweat glands, (eccrine sweat glands), are far more numerous and

widely distributed than apocrine glands. These are coiled, tubular glands that discharge

their secretions directly onto the surface of the skin.

The sweat produced by merocrine sweat glands is called sensible perspiration.

Sweat is 99 percent water, but it also contains some electrolytes (chiefly sodium

chloride), organic nutrients and waste products. It has a pH of 4-6.8 and the presence of

sodium chloride gives sweat a salty taste. The functions of merocrine sweat gland

include: (1) cooling the surface of the skin to reduce body temperature, (2) excretion of

water and electrolytes and (3) protection from environmental hazards.

Sweda and Swedavahasrotas

During dhatuparinama Sweda is produced from medodhathu78. The udaka that

comes out from the romakupas when body becomes hot is called sweda79 which is an

apyadravya80. Sweda is brought to the surface of the skin through the swedavaha srotases

by the action of vyanavata.81 The excretion of the sweda bestows moisture and delicate

nature to the skin.82 Hemadri opines that the hair on the skin is supported by the sweda.83

Swedavaha srotas moola are medas and romekoopa.84 The vitiating factors are

ativyayama, atisantapa, indiscriminate indulgence in cold and heat, krodha, shoka and

bhaya85. Their vitiation produces the following lakshanas- aswedana (anhydrosis),

atiswedana (hyperhydrosis), parushya (roughness of the body), atislakshnata (excessive

smoothness of the body), paridaha (general burning sensation) and lomaharsha

(horripulations).86

Shareera 20

SANDHISHAREERA

The term sandhi means ‘sandhana’ i.e. the union of two or more structures

together. Here, specifically the union of two or more asthis including taruna asthis and

dantas.

Saltshaker kapha87:- Among the five varities of kapha, situated in the sandhis. It

keeps the joints firmly, protects their articulaton opposes their seperation and disunion.

Vyanavata 88:- Vata is responsible for every movement in the body. Which is one

among the varities of vata resides in hrudaya and controls most of the motor fuctions.

Vagbhata states that Vata is located in asti, with relation to ashrayaashrayi sambhanda.

Shleshmadharakala89:- It is fourth Kala, resides in all the joints of living being.

Joints functions properly by the support of kapha as wheel moves on well by lubricating

the axis. It is responsible for proper alignment and movements of all joints.

Functionally, Susruta had classified sandhis into two varieties90 chesthavanta

sandhi (movable) and (2) sthira sandhi (immovable). Cheshtavanta sandhis are present in

sakhas (upper and lower limbs), hanu (temporomandibular joint) and kati (hip). All the

remaining i.e. cranial sutures, intervertebral, costovertebral, sternoclavicular, sternocostal

and dental are sthira type of variety (immovable or slightly movable joints).

According to Susruta structurally joints are of eight types.91

Shareera 21

Table No: 2 showing the sites of different sandhis.

Sl. Name of Sandhis Sites

1 Kora (resembling

budding flower)

In anguli (interphalangeal joints),

manibandha (wrist), gulpha (ankle),

janu (knee) & kurpara (elbow)

2 Ulookhala (resembling

a mortar)

Kaksha (shoulder), vankshana (hip),

& danta (alveolar sockets & teeth)

3 Saamudga (as it fitted

One another)

Amsapeetha (sternoclavicular),

guda (sacrococcygeal),

bhaga (symphysis pubis),

& nitamba (lumbosacral)

4 Pratara (floating) Greevaprishta (intervertebral)

5 Tunnasevani (sutural) Shira, kati & kapala (sutural joints)

6 Vaayasatunda (crows beak

like portion of a bone ente-

rs similarly shaped hole)

Hanusandhi (temporomandibular)

7 Mandala(rounded) Kantha (tracheal rings)

8 Sankhaavarta(looks like

Circles of snail)

Shrothra (cochlea)

According to Ayurveda total no of sandhis in the body are 210. 92

MODERN VIEW

The human skeleton is designed with a number of individual bones that are

articulated at joints to allow the movements in different directions, angles and positions.93

In this particular study, only cases with Osteoarthritis of knee have been considered. So,

the descriptions of these are being dealt with in detail here.

Shareera 22

Knee Joint 94

The knee is structurally complex and subjected to severe stresses in the course of

normal activities. Although the knee functions as a hinge joint, the articulation is far more

complex than that of the elbow or even the ankle. The rounded femoral condyles roll

across the top of the tibia, so the points of contact are constantly changing. The joint

permits flexion and extension and very limited rotation. There is no single, unified

capsule at the knee joint, nor is there a common synovial cavity. A pair of fibro cartilage

pads, the medial and lateral menisci, lies between the femoral and tibial surfaces. The

menisci – (1) act as cushions, (2) conform to the shape of the articulating surface as the

femur changes position and (3) provide lateral stability to the joint. Prominent fat pads

cushion the margin of the joint and assist the many bursae in reducing the friction

between the patella and other tissues

Ligaments

Seven major ligaments stabilize the knee joint. They are the patellar ligament, two

popliteal ligaments, the anterior cruciate and posterior cruciate ligaments, the tibial

collateral ligament and the fibular collateral ligament.

Muscles Associated

Flexors of the knee -biceps femoris, semimembranosus, semitendinosus and the

sartorius. The flexion of knee and rotation (lateral) of the thigh is done by sartorius

muscle. The first three flexors are collectively known as hamstring muscles. Collectively,

the knee extensors are known as the quadriceps femoris (Vastus muscles).

Shareera 23

Blood Supply

Genicular branches of the popliteal artery.

The descending genicular branch of the femoral artery.

The descending branch of the lateral circumflex femoral artery.

Recurrent branches of the anterior tibial artery.

The circumflex fibular branch of the post-tibial artery.

Nerve Supply

Femoral nerve – Through its branches to the basti especially the vastus

medialis

Sciatic nerve – Through the genicular branches of the tibial and

common peroneal nerve.

Obturator nerve – Through its posterior division.

Snayu95

Totally there are 900 snayus in the body; among them 600 are in the extremities,

10 in the janu. The pratanavati type of snayus is located in the sandhis of the body. All

the joints are attached with snayus that are responsible for their compactness.

Peshishareera96

There are 500 peshis in body; among them, 400 are in the extremities (upper and

lower), 5 in the janu. All the siras, snayus, asthis, parwas and sandhis are covered by

peshis that protects them.

Marmas97

Marmas are the vital anatomical points in the human body. The janu marma is

located between jangha and urvi and if injured causes khanjata. It is a sandhi marma of 3

angula measurement and is a vaikalyakaramarma.

Shareera 24

Sira and Dhamanis98

The kaphavaha siras carrying prakrita Kapha, maintains the sandhi, ensures its

sthirata, increases its bala etc. One of the functions of vatavaha siras is pancha cesta such

as Prasarna Akunchana etc. the raktavaha siras does dhatu purana brings about sthirata

and does poshana. Asthi is one of the dhatus; hence these functions are applicable for

Asthi dhatu poshana also.

The Sparshavaha dhamanis are spread in the upward direction and these have the

function of carrying the sparsha jnana. The sparsha may be sukhakara or dukhakara.

Synovial fluid

Synovial membrane secretes a liquid, the synovial fluid. It has many functions -

serves as a lubricant, a shock absorber and a nutrient carrier. This belongs to a rather

unusual group of liquids known as dilatent liquids. These liquids are characterized by the

rare quality of becoming thicker when shear is applied to them. Thus, the synovial fluid

in our knees and hips assume a very viscous nature at the moment of shear in order to

protect the joints, and then it thins out again to its normal viscosity instantaneously to

resume its lubricating function between shocks. Synovial fluid is the liquid that must

carry the raw materials from the blood to the cartilage.

Shareera 25

Figure No. 03. Showing the anatomy of Knee joint.

Figure No. 01. Showing the anatomy of Large intestine and Rectum.

Figure No. 02. Showing the anatomy of skin.

BASTI KARMA

Among the Shodhana therapies Bastikarma is considered as the most important

one due to its wide spread application and effect. It is the procedure in which the drug

prepared according to classical reference is administered through rectal canal reaches

upto the Nabhi Pradesha, Kati, Parshva, Kukshi churns the accumulated Dosha and

Purisha spreads the unctuousness (potency of the drugs) all over the body and easily

comes out along with the churned Purisha and Doshas. Even though it has a resemblance

with the enema therapy, it differs in many aspects like principle, mode of application and

the advantages it renders. As the term Basti means bladder but it is used as a device for

Bastikarma. Hence, it is used as a name in Panchakarma therapy to designate the process.

It is also said that the medicine in suspension, administered through the Bastiyantra, first

reaches the lower abdominal part of the patient. The lower abdominal area or the pelvis

also contains the organ basti (urinary bladder). Due to these reasons the term Basti is used

in Panchakarma.

IMPORTANCE OF BASTIKARMA

All major texts of Ayurveda emphasized this treatment considering its efficacy. It

stands unique among all the shodhana therapies because it expels the vitiated Doshas

rapidly and easily from the body and also causes reducing as well as nourishing the body

very fastly.99 Eventhough Vamana and Virechana eliminates the vitiated Doshas form the

body, the drugs used in these therapies contain Katu rasa, Ushna guna and Teekshna

gunas, which cannot be taken easily by children or older people. But Basti can be given

in all age groups without any hesitation.100

Bastikarma 26

Bastikarma is the prime treatment for Vata and Vata dominating other vikaras as

Vata being the chief controller among the causative forces of disease.101 According to

basic principles of Ayurveda, Vata is responsible for each and every movements and

activities in the body whether it is of constructive or of destructive nature. On the other

hand Vata is functionally required to co-ordinate with Pitta and Kapha in order to

accomplish various duties assigned to them in the organization of life.102

As the main seat of Vata is considered as Pakwasaya by the adminstation of Basti

into it, the proper regulation and co-ordination of the functions of Vata dosha occurs in its

own site and also control the related Doshas which are involved in the pathogenesis of

disease.103 Hence, Basti is also called as Ardhachikitsa by Vagbhata.104 Apart form this it

has multidimentonal effect by possessing various therapeutic actions like Samshodhana,

Samshamana and Sangrahana of doshas on the basis of drugs used in it.105

Basti accomplishes rejuvenation, happiness, longevity, strength, improving

memory, voice, digestive power and complexion. It removes noxious matters form the

tissues, pacifies the Doshas. Consequently it affords stability and thus indirectly

strengthens the reproductive capacity in man.106 Kashyapa equated the Bastikarma as

‘Amrutam’, because of its wide application even in both infants and in old age people.107

Classification of Basti

One cannot find any uniformity in classification of Basti among the authors of

classical texts. As Basti is an important method of therapy in Ayurveda, it can be

classified in various ways for better understanding. Generally the term basti has been

used for all types of Bastikarma, which includes Nirooha, Anuvasana, Uttarabasti etc. But

Bastikarma 27

Charaka has used this term Basti exclusively for Nirooha as per the commentary of

Chakrapani.108 Similarly the term Basti has also been referred to the method of

Shirobasti, Urobasti and Vrinabasti etc. So a rational thinking on various aspects of

Bastikarma has brought about the following classification.109

1) Adhishtana bheda : According to the site of application of Basti it is classified into

two types – a. Internal b. External

a. Internal

Pakwashayagata

basti

The administration of medicine via Gudamarga to Pakwashaya

Garbhasayagata

basti

The administration of medicine via Yonimarga to Garbhashaya

Mutrasayagata basti The administration of medicine via Mutramarga to Mutrasaya.

Vranagata basti The medicine administered through the Vrinamukha by the

process of bastikarma

b. External :

In certain diseases the medicated oil is kept over the part of the body using a cap

or with flour paste for prescribed period of time and named after the site of application of

oil such as – Shirobasti, Katibasti, Urobasti, etc.

2. Dravya bheda: It is based on the major ingredients of Bastidravya - kwatha or sneha

and so classified into two types: -

i) Nirooha basti – In Niruha Basti, Kashaya (decoction) is the predominant

content with the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredients

commonly used. Its synonyms are Asthapana Basti,110 Kashaya Basti etc. Its action in the

body is beyond the perception of physician.111

Bastikarma 28

ii) Anuvasana basti – Sneha is the chief ingredient of Anuvasana. The term

Anuvasana is coined due to the unharmful effect of the Bastidravya even if it is retained

inside the koshta. Morever, this type of Basti can be practiced daily without any serious

precautionary measure, as it is less harmful than nirooha.112

3. Karma bheda: Susruta and Vagbhata have made the following classification

according to their actions.113-114

Shodhana basti

Contains Shodhana dravyas and removes vikrita Doshas and Malas from the body

Lekhana

basti

Reduces Medodhatu and produces Lekhana in the body

Sneha basti Contains more of Sneha and produces Snehana in the body

Brumhana basti

Increases the Rasadi dhathus and indirectly it helps in the growth of

body.

Utkleshana basti

Causes Utklesha of malas and doshas by increasing its Pramana and

causes dravabhootha

Doshahara basti

Purificatory or eliminating type.

Shamana basti

Causes Shamana of Doshas.

Sharangadhara added, Shodhana basti to it also he has added Lekhana, Brimhana,

Deepana-pachana types of bastis.115 Vataghna basti, Balavarnakrita basti, Snehaneeya

basti, Sukrakrit basti, Krimighna basti, Vrishatvakrit basti has been explained in various

contexts by Charaka.116

4. Sankhya bheda: It is stated that neither Snehabasti nor Niroohabasti can be applied

alone.117 So, Charaka has made this classification based on the number of Snehabastis

and Niroohabastis in a treatment.118 viz. a) Karma basti119 b) Kala basti120 c) Yoga

basti.121

Bastikarma 29

5. Matra bheda: This classification of basti is based on the quantity of Bastidravya

prescribed. The quantity may vary according to the age, strength of the patient and

severity of the disease.

• Dvadashaprasruta basti – In nirooha, the maximum dose or quantity of Bastidravya

prescribed is Dvadashaprasruta i.e. 24 palas.122

• Prasritayogika basti – Charaka has prescribed various types of Nirooha in

different doses like 4,5,6,7,8,9, and 10 prasrutas, considering the strength of the

patient and condition of the disease.123

• Padaheena basti – In this type of basti, 3 Prasrutas i.e. ¼ of

Dvadashaprasruta is less form from the total quantity of Nirooha used i.e. 9

prasruthis.124

Anuvasana : is also classified into 3 according to the differ quantity of sneha used

• Sneha basti 125 – 6 palas (¼of total quantity of Nirooha)

• Anuvasana basti 126 – ½ of the quantity of Snehabasti.

• Matra basti 127 – The quantity of sneha that will be digested within 6 hrs.

6. Anushangika bheda (Miscellenious)

a) Yapana basti.128 b) Siddha basti129 c) Yuktaratha basti 130

d) Vaitharana basti 131 e) Ksheera basti 132 f)Ardhamatrika nirooha basti133

g) Picha basti 134 h) Mutra basti 135 j) Rakta basti 136

In general approximately 216 kinds of Basti are mentioned by Acharya Charaka

in various chapters of Siddhisthana.

Bastikarma 30

Indications and contraindications of Anuvasana Bastikarma

Basti is one of the prime treatment of Ayurveda, hence the knowledge of the

suitability and unsuitability of patients should be kept in mind. All the acharyas have

been clearly explained as presented below.

Indications for Anuvasana Basti 137-139: Anuvasana is indicated in patients who

are already indicated for asthapana, but special mention has been given to certain

conditions like Rooksha, Kevala vataroga and Atyagni where Anuvasana is more

beneficial.

Table No; 3 Persons unfit for the Anuvasana basti 140-142

No. Contraindications Ch. Su. Vag. Complications 1. Anasthapya + + + 2. Abhuktabhakta + - + Sneha moves upwards 3. Navajwara + - - 4. Kamala + - + 5. Prameha + - +

Leads to udara

6. Arshas + - - Leads to aadhmana 7. Pratishyaya + - - 8. Pandu + + +

9. Arochaka + - - Leads to more annabhilasha 10. Mandagni + - - 11. Durbala + - -

Increases the condition

12. Pleehodara + + + 13. Kaphodara + + +

Leads to more dosha vardhana

14. Oorustambha + - + 15. Garapeeta + - + 16. Kaphabhishyanda + - + 17. Gurukoshta + - + 18. Shleepada + - + 19. Galaganda + - + 20. Apachi + - + 21. Krimikoshta + - + 22. Prameha - + + 23. Kushta - + + 24. Sthaulya - + + 25. Peenasa - - + 26. Krushna - - + 27. Varchobheda + - + 28. Vishapeeta + - +

Bastikarma 31

Basti Yantra : The instrument or device used for basti karma is called as bastiyantra. It

comprises of two parts – 1.Bastinetra 2. Bastiputaka

Bastinetra (Nozzle/Cannula) : The general meaning of netra is eye, but here netra

means nalika (tube). It can be made of gold, silver, copper or such other higher metals or

alloys, long bones of animals, bamboo, wood etc. were used in ancient times. Generally,

it must resemble the tail of cow with a tapering end and a wider base. But, according to

Charaka it is tubular apparatus with round ends and smooth surfaces143. The dimensions

are different to suit the patients of different age group. The following table furnishes the

measurement of bastiyantra.

Table No: 4 Measurements of Bastiyantra144-146

Lumen of netra No. Age in

years

Length in

Angula Diameter of narrow end Diameter of broad end

1. < 1 5 1 angula 2. 1 - 6 6 Size of green gram 1 angula 3. 7- 11 7 Size of black gram 1½ angula 4. 12-15 8 Size of kalayam 2 angula 5. 16- 20 9 Size of wet kalaya 2½ angula 6. > 20 12 Karkandhu 3 angula

Susrutha’s opinion 8. 1 6 Green gram Feather of kanku bird

must pass through. 9. 8 8 Black gram Feather of eagle must

pass through. 10. 16 10 Kalayam Feather of peacock must

through. 11 >25 21 Kolasthi Feather of vulture must

pass through.

Bastikarma 32

Karnika : In order to prevent undue penetration of the bastinetra deep in to the

rectum, a karnika or rim has to be made. It is to be placed at a required point above the

distal end. Two karnikas are provided on the netra at distance of 2 angulas between one,

another at proximal end to tie the bastiputaka properly.147

Bastiputaka : The container or bag used to carry the bastidravya, ready for

application is known as bastiputaka. In ancient days the urinary bladder of matured

animals like cow, buffalo, dear, pig, goat etc were used. It was then processed to make

soft and colorful by removing the blood vessels and other impurities.

It should be made suitable for well fitting with the bastinetra and should not have

any foul smell. If good bladder is not available some other materials are recommended

for the purpose. They are the skin of lower limb or neck of monkeys or other animals,

thick cloth with sufficient strength and size may also be used.148

Now a days, due to technological development various types of materials are

available to make up of bastiputaka and even disposable bastinetra are available. The

rubber bladder and polythene bags are best choice. Presently in most Panchakarma

theaters the disposable bastiyantras with polythene bags are in use.

Bastikarma 33

Table No: 5 Netradosha and putakadosh 149-150

No. Netradosha Features Effect 1. Hraswata Too short Dravya will not reach pakwasaya 2. Deerghata Too long Dravya go beyond the pakwasaya 3. Tanuta Too thin Produces kshobha 4. Sthoolata Too big Produces lakshana 5. Jeernata Old dhatu used Injury to guda 6 Shithilabandhana Not fixed properly to the

putaka Dravya comes out

7. Parshwachhidra Hole on side Leakage of dravya happens 8. Vakrata Curved / irregular Dravyagati becomes irregular 9. Assannakarnika Karnika too near Karma becomes of no use 10. Prakrustakarnika Karnika too far Causes raktasrava by gudamarma

peedana 11. Anusrotata Small hole Cannot perform properly 12. Mahasrotrata Broad hole Cannot perform properly No. Putakadosha Features Effect 1. Vishama Shape not in uniform Gati vishamata happens during

pressing 2. Mamsala Muscular tissue present Produces offensive small 3. Chinnachidrayukta Presence of hole Dravya comes out 4. Sthoola Thick one Does not push dravya 5. Jalayukta Anastamosis present Produces leakage 6. Vatala Excess air space Frothy type of dravya 7. Snigdha Unctuous Slip form the hand 8. Klinnata Wet Difficult to pass through

The procedures and preparations are classified into three parts: - 1.Poorvakarma

(pre-treatment) 2.Pradhanakarma (treatment) 3.Paschatkarma. (post-treatment)

The physician who is administering basti should have good theoretical knowledge

and sufficient practical experiences in the therapy. The classical books have explained so

many complications that are produced due to improper and in efficient administration.

Bastikarma 34

ANUVASANABASTI PROCEDURE

Poorvakarma :

The body of the patient should be anointed with suitable sneha and gently

fomented with hot water. Then he is advised to have his prescribed meal and made to

take a short walk. Having passed stool and urine he is laid on a couch, which is not very

high, and the head must be at lower level. No pillows are used. The patient should lie on

his left side drawing up the right leg and straightening the left leg.151-153

Pradhana karma :

The oil prescribed for Anuvasana taken in the bastiputaka and tied well placing

the bastinetra in position. The trapped air in bastiyantra is expelled by gently pressing the

bastiputaka. Then the anal region and the netra should be smeared with oil. Gently probe

the anal orifice with the index finger of the left hand and introduce the bastinetra through

it into the rectum up to first karnika. Keeping in the same position press the bastiputaka

with right hand with adequate force. Release carefully the bastinetra when a little quantity

of sneha remained inside the bastiputaka.154

Paschatkarma :

The patient is kept lying on his back as long as it would take to count up to

hundread. The patient should be gently struck three times on each of the soles and over

the buttocks. The distal part of the cot should be raised thrice. Allow him to lie for

sometime in the same position. If he gets the urge for defecation he may do it. But in the

event of sneha passed immediately another Anuvasanabasti should be given. After

passing the motion with sneha in proper time the patient is allowed to take light food if he

feels hungry.155-156 Maximum duration of the withdrawal of snehabasti is 3 yama i.e. 9

hours.

Bastikarma 35

MATRABASTI

Matrabasti is a type of Sneha Basti described by the Acharyas. It is termed so

because of the dose of Sneha used in it is very less as compared to the dose of Sneha

Basti.157-159

If we make an effort to understand the meaning of the term Matra, it gives various

meaning with respect to different context, such as Measurement, Quantity, Size,

Duration, Number, Degree, Movement, Unit of time. It also stated it as prosodial instant

i.e. the length of time to pronounce a short vowel. In the present context the term Matra

gives the meaning for the unit of measurement i.e for the quantity of Bastidravya.

Basti also having different meaning according to various context but in present

context it is considered as therapeutic procedure of Panchakarma as discussed earlier in

detail.

Acharya Vagbhata has defined the Matrabasti as the Basti in which the dose of

Sneha is equal to Hraswa matra of Snehapana.160-161

Indications :

According to Charaka, Matrabasti is always applicable to those emaciated due to

overwork, physical exercise, weight lifting, way faring, journey on vehicles, indulgence

in women, in debilitated person as well as in those afflicted with Vata disorders.

Ashtanga Sangraha, 162 emphasized on regular administration of the Matrabasti and it can

be administered at all times and in all seasons just as Madhu Tailika Basti.

Bastikarma 36

Table No: 6 showing indications of Matrabasti 163-165

Sl. No. Indications Ch. A.H. A.S. 01. Karma karshita + - - 02. Bhara karshita + + + 03. Adhva karshita + + + 04. Vyayama karshita + + + 05. Yana karshita + - + 06. Stree karshita + + + 07. Durbala + + + 08. Vata Rogi + + + 09. Bala - + + 10. Vriddha - + + 11. Chintatur - + + 12. Stree - - + 13. Nripa - + + 14. Sukumar - - + 15. Alpagni - + + 16. Sukhatma - + -

Contraindication :165 In classics, there are no major contraindications mentioned

for Matrabasti, but Ashtanga Sangraha has stated that Matrabasti should not be

administered in the persons having Ajirna.

Qualities : The Matrabasti is promotive of strength without any demand of strict

regimen of diet, causes easy elimination of Mala and Mutra. It performs the function of

Brimhana and cures Vatavyadhi. It can be administered at all times in all seasons and is

harmless.166 Vagbhata has mentioned that Matrabasti improves Varna and Bala. He

adds that it can be given regularly, which is indicated for bala, vriddha, and alpagni

person. No need of parihar after adminstration of Matrabasti, no such complications

arises. He mentioned it as Varnya, doshaghna etc.165 Acharya Hemadri commenting on

the term sukha stated that, it is devoid of complications.167

Bastikarma 37

Dose : “Hraswayaha snehamatrayaha matrabastihi samo bhaveth”168 Matrabasti

the term is popular because of its dose only, because sneha is administered in the

hraswamatra. According to Vagbhata, Matrabasti is recommended in the dose equal to

the dose of Hraswa Snehapana.169 The Matra which gets digested in 2 Yama i.e. 6 hours

is called as Hraswa Matra of Snehapana, but the dose required to get digested in 2 Yama

is not mentioned.165

Susruta has given the dose as ½ of the dose of Anuvasana Basti and according to

him the dose of Anuvasana Basti is ½ of the dose of Sneha Basti. In Sneha Basti, the dose

given is ¼ of the total dose of Niruha Basti i.e. 6 Pala (24 Tola). Hence, the does of

MatraBasti is 1½ Pala = 6 Tola = 72ml.170 According to Chakrapani, the dose of Sneha

Basti is 6 Pala, dose of Anuvasana Basti is 3 Pala and of Matrabasti is 1½ Pala.171

Acharya Kashyapa prescribed the quantity of Matrabasti as 2 palas as uttamamatra, 1 ½

pala as madhyama matra and 1 prakuncha as hraswa matra. He even stated that half pala

of sneha can be given in newborn baby, it can be administered without any hesitation and

complication too.172 Sharangandhara mentioned sneha matra of Matrabasti as 2 palas (8

tolas).173 On the basis of above references, it can be said that the dose of Matrabasti is 1½

Pala of Sneha i.e. 6 Tola = 72ml.

Table No: 7 Dose of Matra basti according to Age

Sl. Age in Years Matra in Tola Sl. Age in Years Matra in Tola 1 1 1/4 11 11 2 ¾ 2 2 1/2 12 12 3 3 3 3/4 13 13 3 ½ 4 4 1 14 14 4 5 5 11/4 15 15 4 ½ 6 6 1 ½ 16 16 5 7 7 1 ¾ 17 17 5 ½ 8 8 2 18 18 6 9 9 2 ¼ 19 19-70 6 10 10 2 ½ 20 70 and above 5

Bastikarma 38

Food before Basti Procedure: Matrabasti should not be given after the patient

has consumed excessively Snigdha ahara because Sneha taken in double quantity gives

rise to Mada and Murccha. Before Matrabasti, the patient should avoid the intake of

excessively Ruksha ahara because it causes depletion of Bala and Varna. Therefore,

patients should be given low Sneha diet before Matrabasti.174

Pathya – Apathya :175 The Matrabasti does not demand any regimen of diet or

behaviour. It can be given at all times and in all seasons without any restriction.

However, Ashtanga Sangraha has restricted the day sleep after being treated with

Matrabasti.

Retention of Matrabasti : The normal Pratyagamana Kala of Sneha Basti is 3

Yama i.e. 9 hours. Being a type of Sneha Basti, the Pratyagamana Kala of Matrabasti is

also 3 Yama i.e. 9 hours. There is no harm if Matrabasti retains in the body because,

while describing Anuvasana Basti it has been said that it is not harmful to body even in

the event of its being retained in the body for a whole day. Also the dose of Sneha in

Matrabasti is very small, which can get easily absorbed in the body without coming out.

It is believed that Sneha Basti should be retained in the body. If Basti material returns

much earlier, it cannot produce the desire effect in the body.176

Samyaka Yoga Lakshana of Matrabasti : Being a type of Sneha Basti,

Samyaka Yoga Lakshana of Sneha Basti are to be taken as Samyaka Yoga Lakshana of

Matrabasti. The Lakshana of Samyaka Anuvasana are the return of Sneha with the fecal

matter without being stuck up anywhere, the clarity of Rakta, Mamsa etc. Dhatus and

sense organs, good sleep, lightness of body, increase of strength and regulation of the

excretory urges.177

Bastikarma 39

Complication of Sneha Basti : Though it is said that there is no major

complication by the use of Matrabasti but sometimes complication may be produced due

to obstruction of Sneha by Vata, Pitta, Kapha or by excess of Mala or food and when

given to a person on empty stomach. These are six conditions of complications likely to

arise during the use of Sneha Basti.178

01) Vata Avrita Sneha179 –180 : If in a condition of excess of Vata, Sneha is given in cold

condition or in small quantity, it gets Avrita by Vata and will not be able to return as its

course is obstructed by Vata. Such Sneha produce Agnimandya, Jwara, Adhmana,

Stambha, Urupida, Parshwashula.

Treatment: In this condition Niruha Basti prepared by Rasna, Pitadaru, Tilvak,

Sura, Sauviraka, Kola, Kulattha, Yava, Gomutra, Panchamula should be administered to

eliminate the Vatavrita Sneha.

02) Pitta Avrita Sneha 181: If excessive Ushna Basti is given in the condition of excess

Pitta, it produces Daha, Raga, Trasa, Moha, Tamaka and Jwara.

Treatment: This condition should be cured with the enema prepared with

Madhura and Tikta Dravyas.

03) Kapha Avrita Sneha 182: If Mrudu Basti is given in condition of excess Kapha, it

causes Tandra, Sheeta Jwara, Alasya, Praseka, Aruchi, Gaurva, Murccha and Glani.

Treatment: It should be corrected with Basti prepared with Kashaya, Katu,

Tikshna and Ushna Dravya and with Sura and Gomutra and mixed with Madana Phala

and Amla Dravya.

Bastikarma 40

04) Anna Avrita Sneha 183 : If Basti prepared with Guru Dravya and given after a heavy

meal it gets obstructed by Anna. This Annavrita Sneha, leads to Chhardi, Murccha,

Aruchi, Glani, Shula, Nidra, Agnimandya and Ama Lakshanas with Daha.

Treatment: Such condition is treated by stimulating digestion with decoction and

powders of Katu and Lavana Dravyas. Also Mrudu Virechana and the treatment advised

for Ama should be adopted.

05) Purisha Avrita Sneha 184 : In case of accumulation of Mala, if Basti having Alpa

Bala is administered it produces symptoms like Purisha Sanga, Mutra Sanga, Vata Sanga,

Shula, Gaurava, Adhmana and Hridaroga.

Treatment : This condition should be treated with Snehana, Swedana along with

Phalavarti. The Anuvasana Basti and Niruha Basti prepared with Shyama, Bilva etc.

should be used. Also the treatment indicated in Udavarta should be followed.

06) Abhukta Pranita Basti 185: If Basti is given in a person with empty stomach it

reaches upwards due to absence of any obstruction. Also if Basti is administered in a

person with empty bowel with great force it reaches up very high and from there it may

reach the throat and may come out from the upper orifice of the body.

Treatment : In this condition, Niruha Basti and Anuvasana basti of Sneha

prepared with Gomutra, Shyama, Trivritta, Yava, Kola, Kulattha should be given and the

condition where it is coming out the throat, it should be treated by Kashaya Dravyas,

pressure on the throat and by Virechana and Chhardighna measures.

Bastikarma 41

Table No: 8 Showing Samyak, Heena and Atiyoga yoga of Anuvasana basti186

Samyak yoga Heena yoga Atiyoga Expulsion of complete oil with faeces

Low backache Palpitation

Tissues, senses become clear and functioning normal

Dry skin Fainting

Sleep becomes usual Dry stool Convulsions Body becomes light and strengthens Proper flow of natural urges

Obstruction of natural urges

Parikartika

Cutting pain in guda

Importance Of Matrabasti

We can summarize the importance of Matrabasti by considering its advantages

by following points

It can be given to bala, vrudha, sukumara, stree, and everybody.

There are no restrictions of vihara, even one can perform routine works after

administration of Matrabasti.

It does not give any complications as other bastis leads, eventhough matra is less

it has widespread action throughout the body.

Niroohabasti and anuvasanbasti can be administrated alternatively, but Matrabasti

alone can be administered everyday continuously without any complications.

Matrabasti has no restrictions as of Asthapana and Anuvasana.

Matrabasti can be administered anytime irrespective of age, day, and time. No

such ahara sevanakrama before or after the administration of Matrabasti.

It can be administered to durbala purusha where other bastis are contraindicated in

them.

It eliminates vitiated dosas along with mala from the body it acts as shodana,

shamana, brumhana, vatahara and even balya.

Bastikarma 42

Basti Karmukata

As it is said that “Guda moolam hi shareeram”, By maintaining the left lateral

procedure, when lying at the time of basti procedure, the Bastidravya reaches the

Pakwashaya resides in the left side. Charaka opines by attaining this posture, Gudavalees

will be relaxed. He also mentions that the Grahani is situated in the left side.

Chakrapani states that Agni will be in the natural state in the posture while

Gangadhara says; Agni, Grahani and Nabhi are present in the left side. Jejjata comments

Agni is present left side over the Nabhi, Guda has got a left sided relation with

Sthoolantra. So Bastidravya can reach to the large intestine and Grahani, as they are

present in the same level.

Action of basti is possible by Anupravaranabhava of bastidravya i.e. Sneha easily

moves up to grahani, which freely moves in the intestine. Charaka, says bastidravya reach

nabhi, katipradesha and kukshi.

The action of Basti is mainly due to the Veerya. The drug used in the basti karma

will however spread in the body from Pakwashaya due to their veerya, through the

appropriate channels. The veerya is drawn into the body by apanadi vatas i.e. first by

Apana, then Udana and throughout the body by vyana. Also as water sprinkled at the root

of tree circulates all over the tree by its own specific property. So Bastikarma eliminates

the morbid Doshas and Dooshyas from the entire body (by Srotosuddhi) whether lodged

in any part.

Bastikarma 43

Basti acts mainly on Asthi and Majjavaha srotas. Asthi is the seat of Vata dosha.

Dalhana says that Pureeshadharakala and Asthidharakala are one another the same. So we

can assume that if Pureeshadharakala gets purified and nourished; the Asthivaha srotas

will also be purified and nourished. Also another factor is about the relation between

Pittadharakala and Majjadharakala, Pittadharakala and Grahani. As an opinion says about

the spread of Bastidravya till Grahani and Grahani is the seat of Agni, the nutrients may

get absorbed and thereby nourishes the Majjadharakala, which is having a strong bond

with vata and the nervous system.

Probable Mode of Action

It is practically seen that after appropriate administration of Bastikarma the signs

and symptoms of Vatavyadhi will be reduced.

Left lateral position is the best posture for better and effective administration of

basti as anal canal turns to left side to rectum, sigmoid colon and descending colon where

more mala to be dissolved and is present. Moreover, medicines stay at these surfaces, get

absorbed more and show their best effect, especially in Matrabasti. The absorptive area of

mucosa is more on this side. On left side colon area is easily approachable through anus

rather than on the right side and this posture relaxes the ileo-ceacal junction and makes

the easy flow into the sigmoid colon.

According to modern science, as per Basti/Enema concerned, in trans-rectal route,

the rectum has a rich blood and lymph supply and drugs can cross the rectal mucosa like

other lipid membrane. Thus, unionized and lipid soluble substances are readily absorbed

from the rectum. The portion absorbed from the upper rectal mucosa is carried by the

superior haemorrhoidal vein in to the portal circulation, whereas that absorbed from the

lower rectum enters directly into the systemic circulation via the middle and inferior

haemorrhoidal veins.

Bastikarma 44

The advantage of this route is total gastric irritation is avoided and that by using a

suitable solvent the duration of action can be controlled. Moreover, it is often more

convenient to use drugs rectally in the long time in case of geriatric and terminally ill

patients.

Bastidravya enters into the Pakwasaya. It is the place where the water and

minerals are absorbed in proximal colon. Sodium and potassium which are essential

fundamental factors for nerve impulses and Vit B12 which is essential factor for the

development and proper functioning of the nervous system are also absorbed from the

colon i.e. Pakwasaya. bastikarma helps to increase the absorbing capacity of the colon by

its actions.

Behind the Pakwashaya, there are large numbers of nerve plexuses originating

from the hypo gastric plexus and lumbosacral plexus etc. These plexus will get

nourishment and soothing effect from Bastikarma because Basti mainly acts on the

Pakwashaya, here it nourishes, purifies and expels the unwanted toxins from the Body.

Another probable method is based on Veerya. It is possible the Veerya of the

Bastidravya pass through the autonomic nervous system and expels out vitiated Dosha

from the body. It is described in the modern physiology that the wall of the rectum has

pressure receptors. Whenever the stool enters the rectum, these receptors are stimulated

and the defecation reflex is initiated.

When Bastinetra is introduced in the rectum the same phenomenon may take

place, which results in initiation of defecation reflex due to visceral distention and

pressure response.

Bastikarma 45

As regard the absorption of bastidravya, it is reported that the water is absorbed

60%-80% from the gut and normal saline is absorbed freely. Amino acids are also

reported to be absorbed. Absorption in the proximal colon is better than the distal part.

Regulating the Gut Brain :

In 1981, Wood described the Enteric Nervous System (ENS) as ‘The Brain of the

Gut’ that integrates information received and issues an appropriate response. ENS

integrates sensory information from mucosal receptor and organizes an appropriate motor

response from a choice of predetermined programmes. So enteric nervous system of gut

brain is an integrative system with structural and functional properties that are similar to

those in CNS and physiological and pharmacological properties of Basti chikitsa are said

to be the outcome of modification of gut brain up to certain extent.

Bastikarma 46

SWEDA KARMA

Sweda karma is that which relieves Stambha (stiffness), Gourava (heaviness),

Sheeta (coldness) and induces Sweda (sweating).187 In general, Sweda karma represents

the therapy by which a person is made to sweat. Swedana is able to alleviate Vata, Kapha

and Vatakaphaja disorders 188 but, it is contraindicated in Pitta predominant disorders.

Charaka189 included Sweda karma in Shadupakramas and he has emphasized

much about it. Even though it is considered as Poorvakarma for Samshodhana purpose, in

some of conditions it is considered as Pradhanakarma due to its importance in Sweda

sadhya disorders

Properties of Swedana drugs 190

Table No. 9 Showing the properties, action and predominance of Mahabhootas of Swedana dravyas –

Sl. Properties Main actions Mahabhuta

1 Ushna Anutsaha, moorchakrit, swedakrit and dahakrit Agni

2 Teekshna Daha-pakakara, shodhananga, sraavana Agni

3 Snigdha Snehakrit, mardavakrit, bala-varnakrit Aap and Prithwi

4 Rooksha Opposite to snigdha and stambhakara, khara Vayu and Agni

5 Sara Anulomana, prerakata and pravrittisheela Vayu and Agni

6 Sthira Chirakaritha, sthairyakara and stambhakara Prithwi

7 Sookshma Sookshmachidrapraveshayogyata, vivarana

sheelata

Akasha, Vayu and

Agni

8 Guru Sada, upalepa, tarpanakrit and brimhanakrit Prithwi and Aap

9 Drava Kledana, alodana, sandhanakaraka Aap

Swedakarma 47

Swedayogyas (Swedarhas) 191-193

Table No. 10 Showing the persons and diseases that are fit for Swedana.

Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Pratishyaya + - + 30 Uru ruk / graha + - + 2 Kasa + - + 31 Jangha ruk / graha + - + 3 Hikka + - + 32 Kshavathu + - - 4 Swasa + - + 33 Khalli + - + 5 Alaghava + - - 34 Ayama + - + 6 Karna shoola + - - 35 Sheeta + - - 7 Manya shoola + - - 36 Vepathu + - + 8 Shira shoola + - - 37 Vatakantaka + - + 9 Swara bheda + - + 38 Sankocha + - + 10 Gala graha + - - 39 Ayamashoola + - + 11 Ardita + - + 40 Stambha + - + 12 Ekanga roga + - + 41 Gourava + - + 13 Pakshaghata + - + 42 Supti + - + 14 Ardita + - + 43 Nasyarha + + + 15 Vinamaka + - + 44 Bastyarha + + + 16 Koshtanaha + - + 45 Shodhaneeya + + + 17 Vibandha + - + 46 Aahritashalya - + - 18 Mutraghata + - - 47 Anupadrava

moodhagarbha - + -

19 Vijrimbhaka + - + 48 Samyak prajata - + - 20 Parshwagraha + - + 49 Bhagandara - + - 21 Prishtagraha + - + 50 Arsha - + - 22 Kateegraha + - + 51 Ashmari - + - 23 Kukshigraha + - + 52 Shleshma roga - - + 24 Gridhrasi + - + 53 Amaroga - - + 25 Mutrakrichra + - + 54 Hanugraha - - + 26 Vriddhi + - + 55 Arbuda - - + 27. Angamarda + - + 56 Granthi - - + 28 Pada ruk / graha + - + 57 Shukraghata - - + 29 Janu ruk / graha + - + 58 Adhyamaruta

(Urustambha) - - +

Susruta had specified that those who are fit for Nasya, Basti and Shodhana are

Poorvam Swedyas194; Ahritashalya, Moodhagarbha and Samyak prajata are Paschat

Swedyas; and Bhagandara and Arsha are Poorvam cha Paschat cha Swedyas.

Swedakarma 48

We can conclude that, in general, there are three categories of diseases where in

Swedana is indicated – a) Vatapradhana rogas, b) Kaphapradhana rogas and c)

Shodhaneeya and Swedyas.

Sweda ayogyas (Sweda anarhas) 195-197

Table No. 11 Showing the persons and diseases those are unfit for Swedakarma.

Sl. Vyadhi C.S. S.S. A.H. Sl. Vyadhi C.S. S.S. A.H.1 Kashayanitya + - - 24 Adhyaroga

(Vataraktha) + - +

2 Madyanitya + + - 25 Durbala + + + 3 Garbhini + + + 26 Ativisushka + - - 4 Rakthapitha + + - 27 Ksheenaoja + - - 5 Pithakopa + - + 28 Timira + - + 6 Atisara + + - 29 Pandu - + + 7 Rooksha + - - 30 Kshaya - + + 8 Madhumeha + + + 31 Kshama - + + 9 Vidagdhabradhna + - + 32 Ajeerna - + - 10 Bhrashtabhradna + - + 33 Chardi - + - 11 Visha + + - 34 Moorcha - - + 12 Madyavikara + - + 35 Stambhaneeya - - + 13 Shrantha + - - 36 Visarpa - - + 14 Nashtasamjna + - - 37 Kushta - - + 15 Sthoola + - + 38 Peeta dugdha - - + 16 Pittameha + - - 39 Peeta sneha - - + 17 Trishna + + + 40 Peeta dadhi - - + 18 Kshut + - + 41 Peeta madhu - - + 19 Krodha + - + 42 Krita virechana - - + 20 Shoka + - + 43 Glani - - + 21 Kamala + - + 44 Bhaya - - + 22 Udara + + + 45 Pushpitha - - + 23 Kshatha + - + 46 Sootha - - +

Various treatise mentioned the reasons for the excluding these diseases from

Swedana. Susruta opined if Swedana performed in contraindicated condition, either the

body gets destroyed, or the diseases progress to incurable stage. He also permits the

application of Swedana in durbala and ajeernabhaktha, if their vikaras are swedasadhya

Swedakarma 49

only.198 Chakrapani stated that Swedana leads to pervabedha if it is performed in

kashayanityas by making body rooksha and atistabdha gatra; If it is performed in

conditiones viz rakthapitta, pittameha, kamala and pittaprakriti persons even prior to

shodhana it leads further pittakopa. Madhumeha persons develop shareera shaithilya and

in such a condition, Swedana is contra indicated. He also adds that if the condition of the

patient is Sweda eka sadhya, it can be performed.199

Arunadatta states that Swedana if done to an atisthoola person it causes shareera

ksobha by doing medovilayana. For rooksha, durbala, kshataksheena, kshama etc.The

Swedana may cause extreme emaciation. A person having good appetite if undergoes

Swedana suffers from dehaglani. In kamala and pandu rogas, the Swedakarma causes

pitta vidradhi resulting in roga vridhi. In garbhini, the Swedana induces garbha vyapat.

For pushpitha ladies, it causes excessive bleeding and for sotha, it causes emaciation.200

Vagbhata given liberty to physician that if atyayika (due to the inevitability of

swedana) condition is present mrudu sweda can be performed, with caution even on

anarhas.201 Arunadatta 202 and Hemadri 203 also support this view.

Depending on the all above explanations we can make four conditions which are

contraindicated for swedana in general 1) Pitta, (2) rakta, (3) durbala avastha and (4)

sweda asaha.

Swedakarma 50

Samyak swinnalakshanas 204

Table No: 12 showing the lakshanas to be observed on the patient.

Sl. Lakshana C.S. S.S. A.H.

1 Seetha vyuparama + - +

2 Shoola vyuparama + - +

3 Sthambhanigraha + - -

4 Gouravanigraha + - -

5 Sanjathamardava + + +

6 Swedasrava - + -

7 Vyadhihani - + -

8 Laghutva - + -

9 Seetharthiva - + -

Out of these shoola vyuparama, sthambhanigraha, gourvanigraha, laghutva,

mardava and vyadhihani are cannot observed immediately after swedakarma every day,

but manifest after the total course of proper swedana. Sheeta vyuparama, swedasrava and

seetharthitva are to be observed daily at the end of swedakarma .

Aswinnalakshanas

Whenver insufficient swedana is performed, then the lakshanas opposite to the

samyak swinnalakshanas occur. Dalhana adds that heaviness of the body, ushnabhilasha

and hardness of the body also occur. He has stated that mithya swinna means both alpa

swinna and mithya swinna (improper sudation) and that vyadhi vridhi takes place.205

Swedakarma 51

Atiswinnalakshanas206-208

If the swedana performed is in excess, it leads to many complications.

Table No: 13 showing the Atiswinna lakshanas on the patient.

Sl. Lakshana C.S S.S. A.H.

1 Pitta prakopa + + +

2 Murcha + + +

3 Shareerasadana + - -

4 Trishna + + +

5 Daha + + -

6 Swaradourbalya + - +

7 Angadourbalya + - +

8 Sandhipeeda - + +

9 Sphototpathi - + -

10 Rakthaprakopa - + -

11 Bhranthi - + -

12 Vidaha - + -

13 Klama - + -

14 Bhrama - - +

15 Jwara - - +

16 Syava-raktha mandaladarshana - - +

17 Chardi - - +

Management of Atiswinna

Charaka 209 advises for the consumtion of madhura-snigdha-seetha ahara and

upachara and the adoptation of greeshma ritu charya. This includes consumption of

sasharkara mantha, jangala mriga-pakshimamsa, ghee, milk and shashtikashali. Ahara

dravyas with lavana, amla, katu and ushna properties and even madya, viharas like

vyayama and Vyavaya should be avoided. Patient has to live in seethagriha during the

Swedakarma 52

day time and in the room cooled by moon rays in the night. Seethadravyas lepana similar

to chandana to be applied over the body. Mukthamani dharana also can be done. Patient

can also be taken to cool forests and ponds.210 Susruta 211 says that all kinds of seetha

upachara should be performed immediately.

Vagbhata had advocated stambhana chikitsa in case of atiswinna.212 Drugs with

the properties of laghu, manda, seetha, slakshna, rooksha, sookshma, sara and drava and

having tiktha-kashaya-madhura rasas, are stambhana oushadhas. These are to be

administered internally and externally to avoid further complications of the patients.

Classification of Sweda

Several types of classification of Sweda are made with different points of view.

A) According to agni bheda.213

1) Sagni (Thermal) & 2). Niragni (Non-thermal).

B) According to guna bheda.214

1) Rooksha (Dry) & 2). Snigdha (Unctuous).

C) According to sthana bheda.215

1) Ekanga (Local) & 2). Sarvanga (Total).

D) According to rogi bala and roga bala.216

Mrudu (Gentle), Madhyama (Medium) & Mahan (Maximum).

E) According to the source of heat.217-218

Tapa (Direct heat), Ushma (Steam), Upanaha (Poultice) & Drava (Warm liquid).

Swedakarma 53

F) According to the method of sudation.219

1. Sankara (Mixed), 2. Prastara (hot bed), 3.Nadi (Steam kettle), 4. Parisheka

(Affusion), 5. Avagaha (Bath), 6. Jentaka (Sudatorium), 7. Asmaghna (Stone bed), 8.

Karshu (Trench), 9. Kuti (Cabin), 10. Bhu (Ground bed), 11. Kumbhi (Pitcher bed), 12.

Kupa (Pit sudation) and 13. Holaka (Under bed).

G) According to the usefulness in the Chikitsa220

1) Samshamaneeya 2) Samshodhanangabhoota.

H) According to the route of application221;

1) Bahya 2) Abhyantara.

I) On the basis of applicability in children.222

Hasta, Pradeha, Nadi, Prastara, Sankara, Upanaha, Avagaha and Parisheka.

Niragni Sweda is further classified into ten types, viz., vyayama (exercise), ushna

sadana (warm rooms), guru pravarana (heavy blankets), kshudha (hunger), bahupana

(excessive drinking), bhaya (fear), krodha (anger), upanaha (plasters), ahava (war) and

atapa (sun bath).223

Dalhana had said that Jentaka, Karshu, Kuti, Kupa and Holaka are Tapa swedas;

Sankara, Prastara, Ashmaghna, Nadi, Kumbhi and Bhu are Ushma swedas.224

Swedakarma 54

PARISHEKA

Parisheka225a-e is a type of Swedana karma explained by almost all the major

treatise of Ayurveda in different headings like Sheka, Parisheka, Dhara, etc. In general

the meaning of these gives pouring of regular stream of lukewarm fluid like oil,

decoction, and milk et on the body.

Acharya Charaka included Pariseka in the Bahiparimarjana chikitsa226 along with

Abhyanga, Swedana, Pradeha, Unmardana etc. Acharya Susruta227 explained it under

Dravasweda, as he stated that Taila, Grita, Vasa and Dhanyamla etc are to be used for

Parisheka which can be done locally or generally according to the need.228

Acharya Vagbhata also explained it under Dravasweda by giving detailed

discripton about its procedure, he emphasized that drugs such as Shigru, Varuna,

Amrataka, Mulaka, Sarsapa, Surasa, Arjaka, Vasa, Vamsa, Ashmantaka, Ashoka,

Shirisha, Arka, Karanja, Eranda, malati patra, Bhanga, Putika, Dashamoola and such

others which mitigate Vata are boiled in liquids such as mastu, Jala, sura, Dugdha,

shukta (sour butter milk ) etc are used either alone or mixed with other drugs as

described earlier appropriate to the doshas. The liquid is filled into pot or vessels

having spout with sieve in front or into long tubes and poured over the part of the

body, which has been anointed with oil, which pacifies Vata or even without such

anointment, but wrapped with cloth, the patient either sitting or lying on couch, pouring

being done on any part or whole of the body.229 By the detailed explanation of Vagbhata

in Ashtanga sangraha, it shows Parisheka can be done in a particular part also.

Swedakarma 55

In Ashtanga Hridaya230 also ample description available with slight variation in

drugs like Eranda, Karanja, Surasa, Arjaka, Shirisha, Vasa, Vamsa, Arka, Deergavrinta,

etc but he also emphasized same procedure. Bhela given explanation as pouring of

lukewarm fluids like Taila, Ghrita, Dugda, Mutra, Amla, Kanji and even Vasa on the

body of the person who is fit for Swedana karma.231

Charaka while explaning the treatment of Vatavyadhi he recommended Tail,

Grita, Vasa and Majja Parisheka along with Abhyanga and Basti etc, especially

Snigdhaswedha and the measures which causes Brimhana are recomonded.232 Susruta

who is father of surgery, he recommended Snehasheka in case of Sandhivishlesha

particularly in case of Janu, Gulf, and Manibandha sandhi.233

In the context of Dwivraniya cikitsa234 he emphasized importance of Parisheka

specically when there is presence of Vataj sopha he prescribed Taila, Kanji, Grita

Parisheka to relieve the Shopha condition. Even in the context of Vatavyadhi chikitsa he

prescribed Sukhoshna sneha Pariseheka.235

Susruta stated the properties of this procedure under the heading of Sheka as, it

relieves fatigues (Shramagna), pacifies Vata, stabilizes the dislocated joints, and relieves

pain arised out of injury, burn etc. It does the Dhatuvriddhi by the help of sneha as the

tree nourishes by the water.236 Where as Dalhana mentioned Sheka as

Sarvangaparisheka.237 Bhavaprakasha 238 recorded ample discription of Sheka in Netra

chikitsa. Dharakalpa given indication of Ekangasheka in conditions like Gulma, Anaha,

Vrana, Shoola, Avritavata etc.

Swedakarma 56

Cikitsasangraha gives in detail explanation about Parisheka under the heading of

Dhara. Dhara is a method of the Kerala special treatment evolved from the genius of the

medical tradition here many such distinctive forms of treatment, not practiced in other

parts of India are conducted by the Kerala physicians. Dhara one amongst them and the

most important.

Dhara is good for all diseases changing the liquid as per the Dosha condition with

necessary alternates in its processes. It is useful to alleviate any Dosha. For instance oils

medicated with appropriate medicine in Vata, Ghee prepared with Pitta alliavating

medicines in Pitta and more oils in Kapha can be used. According to another version the

suitable liquid for Vata is unctuous liquids (oil, ghee etc), for Pitta milk and for Kapha

buttermilk. Sometimes in Pitta diseases as per the conditions Dhara with tender coconut

water or breast milk or cold water is performed. Similarly Kapha dosha dhara with some

decoctions and in Vata with dhanyamla is also conducted. This can be carried on with

other liquids also as per description looking into the details of the doshas, diseases and

their seats.

There are varieties of dhara they are mainly grouped as Moordhany, Sarvangeena

(all over the body) and Pradeshika (local), out of this pradeshika is done locally in cases

of rheumatoid arthritis, swelling, ascitis, abscesses, wounds etc.

EKANGADHARA (Dhara on one limb or at a locality) :

Ekangadhara does not have many paraphernalia and procedures. But as per the

difference in parts some alterations may become necessary often these are done with

various liquids commonly employed in dhara on the head or Sarvanga dhara (sometimes

Swedakarma 57

the liquids not so commonly employed also) the important once are various decoctions

and juices of certain raw herbs. In some cases cold or warm water is also made use of the

quantity of the liquid and other things are settled as per the locality. For instance for

dhara in the eyes the total quantity needed for both eyes is of measure (225 ml). It should

not be hot to touch. In the strangury etc to do dhara on umbilicus we can either suspend

the dhara vessel or do it by pouring it trough by nozzle of pitcher. Here the quantity of

the liquid is 1 prasta. For wounds on the limbs or for burns and scalds the quantity is to

be half prasta. But this would have to be altered as per the size of these wounds or burns.

Here application of oil on the head is not necessary these can be done as per convenience

in a sitting or lying position. Strict time limit is also not applicable here. If done with

proper attention and due care in all aspects, there is no disease that cannot be cured by

Dhara.239

PROCEDURE OF PARISHEKA

1. Poorvakarma

This includes preparatory measures like preparation of patient, preparation of

medicine and collection of materials required for the smooth conduction of the procedure.

a. Atura Pariksha : The patient is examined in relation to Prakriti, Vikriti etc. by

ten folds of examination and by applying Pratyaksha, Anumana and Aptopadesha to

assess Vyadhi and Deha Bala. Then, the affected knee joint should be examined properly

and mark the tender region. Examine for scares, wounds if any at the joint.

b. Atura Siddhata : Patient is asked to lie in supine position or to sit erect by

extending lower limbs on the table. Exposed the affected knee properly. Support the

limbs, so that they are placed horizontally and comfortably.

Swedakarma 58

2. Pradhana karma

The recommended liquid is filled into pot or vessels having spout with sieve

infront or into long tubes and poured over the part of the body, which has been anointed

with oil, which pacifies Vata or even without such anointment, but wrapped with cloth,

the patient either sitting or lying on couch, pouring being done on any part or whole of

the body at the height of 12 Angula. Ayoga, Atiyoga and Samyakyoga lakshana of Sweda

mentioned in the classics can be taken for Samyak lakshana of Parisheka.

Maintenance of constant temperature of medicine: Keep on changing the

medicine with the heated one so that a constant temperature is maintained through out the

procedure.

Period For Changing The Liquid: When milk is used for Pariseka, it should be

changed everyday. When Dhanyamla is used. It can be used upto 3 days. Oil also should

be changed at 3 days. In the first 3 days, half of the oil used, for next 3 days later half of

its used and on the 7th day all the first and second half both are mixed together, then it

should be discarded (Dharakalpa – Ch. 21 &22)

3. Paschat karma

After removing the liquid, The oil remained on the joint was wiped out with the

help ofcleaned cloth, mild massage was done for a minute and patient was asked to

relaxe.

Swedakarma 59

Swedakarma Karmukata

Swedakarma has four major actions over the body - (1) stambhaghnata, (2)

gouravaghnata, (3) seethaghnata and (4) swedakarakata.

01. Stambhaghnata : Stambha means stiffness. This attribute is a resultant of

excess seetha guna and also influence of factors such as samanavata, sleshakakapha, ama,

mamsa, vasa and medas is contributory to the production of stambha. samanavata is

rooksha gunapradhana and hence if vitiated does excessive shoshana of shareera there by

producing contractures and stiffness. Sleshakakapha is snigdha and pichila and hence if

decreased (kshaya) results in less lubrication of joints causing stiffness.

Swedakarma being snigdha and ushna corrects both these deranged dosha

ghatakas and relieves stiffness. Chakrapani had stated that stambha also means

obstruction or block. Therefore, Swedana not only relieves stiffness, but also clears

blocking of passages (srotorodha). Srotas as a structural entity is Kaphapradhana. Ayana

or transport is the most important function of srotas. This is under the control of Vata.

There by it is evident that there is a predominant influence of Vata and Kapha over the

srotas. Vitiation of these two hampers the structural and functional aspects of the srotas.

We know that swedana has the opposite qualities to that of Vata and Kapha,

thereby producing a palliative effect on them and the srotas is becoming normal. It is well

known that unless there is a srotodushti there is no disease. Thus, it is evident that

Swedana clears the srotodushti or sanga

Swedakarma 60

In other words, by contact of bearable warmth, the area in contact gets more

circulation. The lumina of the contracted body architecture get smoother and wider. This

rendering a stiff entity smooth relieves variety of obstructions. Widening of the core and

simultaneous liquefaction of the solid or semi-solid material makes the flow easier.

Widening of the tract and fluid character of the material inside makes the obstructions

released slowly.

02. Gouravaghnata : Heaviness of the body is being relieved by Swedana. By

means of Swedana, the fluids in the body are being excreted through the sweda (sweat)

and hence the feeling of lightness in the body. Swedana stimulates the nerve endings and

promotes muscle strength.

03. Sheethaghnata : Seethaghnata has to be understood as the patient is relieved of

the coldness existing prior (the Ushna guna pradhana sweda karma is performed). In fact,

by the excretion of sweat, the heat in the body is being transferred out.

04. Swedakarakata : Swedana induces sweda it is a mala (excretory product)

which includes the wastes of all the layers of skin, muscles, nerves, rasa, rakta, meda etc

are mixed. Therefore, it is a mechanism of excreting the metabolic wastes in the body

tissues.

Apart from these major actions, Swedana also produces the following effects.

Doshadraveekarana : Swedana (snigdha) makes the doshas mridu and eradicates

the mala sanga, penetrates to each and every channel in the body and liquefies the doshas.

These liquefied doshas has to be eliminated from the body means of shodhana karma.

Swedakarma 61

Vata shamana : Snigdhasweda pacifies the Vata dosha, thereby curing the

pureesha-mutra-shukra sanga. By its properties opposite to that of Vata, it pacifies the

Vata. Swedana is also one of the upakramas of Vata.

Gatra vinamana : Charaka says that by application of oil and heat, even dry wood

can be bent then what is the wonder about shareera. It cures harsha, ruk, ayama, shopha,

stambha and graha and produces mardava, thereby permitting normal flexible body

movements.

Agnideepana : As Swedana is Ushna guna pradhana, it does the Ama pachana

there by promoting the Agni in the body.

Twak mardava and Prasadana : Perspiration is dependent on skin, where in the

hair follicles which are the Moolas of Swedavaha srotas are situated. Due to sweating

and excretion of wastes, the skin becomes soft and pleasant.

Bhakthasradha : As the Swedana promotes agni, more interest on food

consumption is resulting.

Srotosuddhi : The mechanism of making srotosuddhi has been explained under

the action of stambhaghnata.

Nidra-Tandra nasha : Swedana pacifies Vata. Vata is responsible for the functions

of Indriyas where in Nidra and Tandra are affecting. Sweda also pacifies Kapha thereby

making the body light, and providing relaxation. Thus it prevents excessive sleep and

drowsiness.

Swedakarma 62

Sandhicheshtakara : Swedana relieves Stambha and Graha thereby promoting the

Sandhicheshta.

Dosha shodhana : The Doshas situated in the Dhathus, Koshta and Sakha-asthi

and those Leena in the Srotas gets Kledana by Snehana and gets liquefied by the

Swedana and comes to the Koshta and get ready for elimination by means of

Shodhanakarma.

Acharya Susruta stated that out of the four Tiryak dhamanis, each divides

gradually hundred and thousand times and thus become innumerable. These cover the

body like network and their openings are attached to Romakoopa. Through them only

Veeryas of Abhyanga, Parisheka, Avagaha, Alepa enter into the body after under going

Paka with Bhrajaka Pitta in skin. One more reference in Susruta cikitsasthana explains –

Sneha used in Avagaha produces Shareera bala by saturating through siramukha,

Romakoopa and dhamani. In Sutrasthana he explains, lepa like Bahirparimarjana

treatments yield result by entering to Romakoopa thereby circulating through Swedavaha

Srotas.

Modern View on Mechanism of Action

Cell membrane act as a barrier to the passage of water soluble molecules but

provide free passage to lipid and lipid soluble substances. Rapid diffusion of lipid soluble

substances through cell membranes and the dependency of the rate of diffusion on

solubility in lipids have been proved. Application of heat through an unctuous substance

causes the generation of a temperature gradient across the cell membrane. Besides

facilitating the diffusion of liquid substances through the cell membrane, this plays key

Swedakarma 63

role in the formation of lipoid vesicles from the dropouts in the membrane in areas of

flow temperature. This causes an expansion in the cell volume as well as surface area.

But it cannot expand freely especially in the peripheral direction as it is bound by other

cells around. This makes the blebbing of cell membrane inside. The temperature gradient

and pressure gradient caused by the heat further helps in blebbing in this particular

direction. These lipoid vesicles or blebs detached from the cell organelle or other side of

membrane and remain there till a critical surface is reached. This membrane then blebs

out and spread further. The whole phenomenon of dropping of cell membrane vesicles

and their incorporation into other membranous structure was described as “Membrane

flow hypothesis” by Palade in 1959.

Absorption depends upon lipid solubility of the drug. Drugs in oils and other lipid

soluble carriers can penetrate the epidermis as it is a lipid barrier. The movement is slow,

particularly through the layers of cell membranes in the stratum corneum. But once the

drug reaches the underlying tissues it will be absorbed into the circulation. Suspending

the drug in an oily vehicle can enhance absorption through the skin. Because hydrated

skin is more permeable than dry skin (Placing a drug in a solvent that is lipid soluble can

assist its movement through the lipid barriers).

Now, it can be said that it is in this way that the Sneha reaches deep into the body

tissues, causing partial rejuvenation of cell organelles and cell membrane by replacing

their order components with new ones. Thus the additive efficacy of Snigdha sweda can

be justified.

Swedakarma 64

SANDHIGATAVATA

Sandhigatavata is one among the Vatavyadhees described by all acharyas.240 It

comes under the various Gatavatas explained in Vatavyadhiprakarana 241 caused by the

localization of vitiated doshas in the Asthi sandhis of the body.

Terminology of Osteoarthritis242

Four names, none of which are adequate are used interchangeably to describe the

disease. They are Osteoarthritis, Osteoarthrosis, Degenerative joint disease and

Hypertrophic arthritis. Osteoarthritis is less than ideal since the primary event is not

inflammatory, although secondary synovitis is usually present. Osteoarthrosis is perhaps

the best because the inflammation is secondary and the suffix denotes an increase and an

invasion, physiologic or pathologic, or a general over production. This early on, is a

relatively clear description of what the disorder is. Degenerative joint disease is

unsuitable, since degenerative implies aging, a running down, deterioration, a catabolic

process; in fact for long periods, often years, the disease may not be clinically

progressive. Hypertrophic arthritis now completely out of style, describes one phase the

osteophytosis or overgrowth of bone. (Rheumatology Kelly Willium, ch-89)

Disease Review 65

NIDANA

Even though classics of Ayurveda do not mention the Nidanas of Sandhigatavata,

one has to compile the relevant references mentioned in different contexts like

Vatavyadhi Nidana (Ch.Ci.28/15-17, Su.Su.21/19, A.Hr.Ni.1/14-15, Yo.Ra.Pu.Vat.1-4,

Bh.Pr.Chi.Vat.1-2, Ma.Ni.Pu.22/1-3), Asthivaha srotodushtikarana (Ch.Vi.5/27),

Majjavaha srotodushtikarana (Ch.Vi.5/28).

Nidana can be classified under various headings with different views. Among

them one classification is Sannikrishta and Viprakrishta Karana. Here, with the

complimentary references the Nidanas of Sandhigatavata is classified on this basis.

Sannikrishta Hetu : Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana,

Pradhavana, Atisankshobha.

Viprakrishta Hetu :

A. Rasa – Kashaya, Katu, Tikta

B. Guna – Rooksha, Sheeta, Laghu

C. Dravya – Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura, Kalaya,

Adaki, Harenu, Shushkashaka, Vallura, Varaka.

D. Aharakrama – Alpahara, Vishamashana, Adhyashana, Pramitashana

E. Manasika – Chinta, Shoka, Krodha, Bhaya

F. Viharaja – Atijagarana, Vishamopacara, Ativyavaya, Shrama, Divasvapna,

Vegasandharana, Atyucchabhashana, Dhatu Kshaya.

The nidanas of Vatavyadhi are listed under the following headings –

1. Aharaja, 2.Viharaja, 3.Manasika, 4.Abhighataja and 5.Anyat.

Disease Review 66

Table No: 14 Showing the Aharaja nidana 243-246

Sl. Nidana C.S. S.S. A.H. B.P.1 Rooksha bhojana + + + + 2 Laghu bhojana + + - + 3 Seethanna + + - + 4 Alpa bhojana + + + - 5 Ama + - - + 6 Abhojana + + - + 7 Pramita bhojana - - + - 8 Vishama bhojana - + - - 9 Tikta-katu-kashaya rasa - + + + 10 Adhyashana - + - - 11 Sushkasaka - + - - 12 Vallura-varaka-uddalaka-koradusha-syamaka-adhakee-

harenu-kalaya-nishpava - + - -

Table No: 15 Showing the Viharaja nidana.

Sl. Nidana C.S. S.S. A.H. B.P. 1 Ativyavaya + + + + 2 Atiprajagara + + + + 3 Vishama upachara + - + - 4 Plavana + + - - 5 Atyadhva + + - - 6 Ativyayama + + + + 7 Dukshashayya + - - - 8 Dukhaasana + - - - 9 Divaswapna + - - - 10 Vegadharana + + + + 11 Gaja-ashwa-ushtra-sheeghrayana + + - - 12 Vega udeerana - - + - 13 Atyuchhabhashana - - + - 14 Prapatana + + - - 15 Pradhavana - + - - 16 Prapeedana - + - - 17 Bharaharana - + - -

Disease Review 67

Manasika Nidanas

Psychological factors like Chinta, Shoka, Krodha, Bhaya etc are the aggravating

factors of Vata. As Vata is the controller of Manas, any affliction to Manas vitiates the

Vatadosha. Some of the important Nidanas are discussed below –

Ativyayama : Excessive physical exercises act as one of the important Nidana for

Sandhigatavata. Running, walking, jogging etc. if done excessively or violently will

affect the structures of Sandhi. They mainly affect the Joint stability by over exertion. But

if done properly they stabilize the Joint.

Bharaharana : As knee is weight bearing joint, carrying excessive load causes

excessive pressure and stretching effect over the structures of the joint which have direct

effect on articular disc. The constant compression will lead to wear and tear effect

leading to degenerative changes in the discs.

Abhighata : Abhighata to joints due to Prapatana etc, lead to structural deformity

in the joints. Joint is an organ rather than a single structure. It is stabilized by different

structures like Asthi, Snayu, Peshi, and Kala etc. Hence any trauma to these structures

will alter the structural integrity of the joint. Hence Abhighata is an important Nidana for

Sandhigatavata.

Atisankshobha : It is a Nidana for Asthivaha Sroto Dushti.247 Since Asthivaha

Srotas is involved in Sandhigatavata this can be considered as Nidana for the same.

Violent activities like Atyadhva, Plavana, Langhana, Balavat Vigraha, Pradhavana etc.

will have its effect on joint. As told earlier knee is the weight-bearing joint, the violent

exercises or activities will alter the structural integrity of the joint.

Disease Review 68

Marmabhighata : The concept of Marmabhighata in the causation of

Sandhigatavata sounds more rational. Janu-Sandhi is a variety of Vaikalyakara Sandhi-

Marma.248 Marma is a vital point, which comprises of Asthi, Snayu, Sira, Mamsa and

Sandhi. Hence any Marma is made up of all these structures, like wise the Janu-Sandhi.

Pain in the joints not necessarily be only associated with bony changes. But

involvement of other joint structures may also give rise to symptoms pertaining to joint.

Therefore, in recent days more study is emphasized on the different structures involved in

the pathology of Arthritis like consistency of soft tissue, fibrous material, liquid and

cartilaginous substance of the joint. From this new point the Ayurvedic view towards the

involvement of certain Marma in the disturbance of the joint i.e. painful joint will be

anticipated. Hence Marmabhighata as a Nidana in case of Sandhigatavata is to be given

importance.

Anyataha (Other Nidanas) : Panchakarma apacharas like Atidoshasravana,

Atirakthasravana, Atiyoga of langhana, Apatamsana, etc and Dhatukshayakarabhavas

like Rogakarshana, Gadakrita atimamsakshaya, etc vitiate Vata. Dhatukshaya is an

important vitiating factor of Vata.

Sthoulya is another causative factor for Vata prakopa. The Meda-avarana of Vata

is the mechanism causing inter-relationship between Sthoulya and Vatavyadhis.249 All

types of avaranas are also important vitiating factors of Vata. Vardhakya avastha

dominate by Vata.250 During this period, Dhatukshaya occurs which causes Vata prakopa.

Disease Review 69

Living in Jangaladesha is another cause of Vata prakopa.251 Vata gets vitiated in

the end of day and night.252 Vata also get vitiated during the end of Greeshma ritu,

Varsha ritu and Shishira kala.253 Vata prakriti persons are more susceptible to Vata

vikaras. Persons who are Rooksha-kashaya-katu-tikta satmya are also more susceptible to

Vata vikaras.

Risk factors for Osteoarthritis (OA) 254

Age factor : Age is the most powerful risk factor for OA. The association

between OA and aging is non-linear. It usually begins after a person is 40 or more years

old. By the age of 60 years, almost everyone has OA. More than 80% of people over 60

years old have radiological evidence of OA in one or both knees and 30% in one or both

hips.

Sex factor : It is told that women are at high risk than men in developing OA.

Over 30% of women (elderly) have OA in the interphalangeal joints of the hands. Except

in the hands, men and women are affected equally, though the lesions often appear at a

young age in men. Only 3% of elderly men have primary OA in the hands.

Hereditary factor : The relation of heredity is less ambiguous. Thus, the mother

and sister of a woman with distal interphalangeal joint OA are respectively twice and

thrice as likely to exhibit OA as the mother and sister of an unaffected woman.

Disease Review 70

Race factor : Racial difference exists in both the prevalence of OA and the pattern

of joint involvement. OA is more frequent in Native Americans than in whites. The

Chinese in Hong Kong have a lower incidence of hip OA than in whites. Interphalangeal

joint OA and especially hip OA are much less common in South African blacks than in

whites in the same population. Whether these differences are genetic or due to differences

in joint usage related to life style or occupation is unknown.

Obesity factor : Obese persons have a high risk of OA. For those in the highest

quintile for body mass index at base line examination, the relative risk for developing

knee OA in the ensuing 36 years was 1.5 for men and 2.1 for women. For severe knee

OA, the relative risk rose to 1.9 for men and 3.9 for women, suggesting that obesity plays

an even larger role in the etiology of the most serious cases of knee OA.

Occupational factor : Repetitive movements may leads to excessive strain leading

to erosion and joint damage. Men whose jobs require knee bending and at least medium

physical demand had a higher rate of radiographic evidence of knee OA and more severe

radiographic changes.

Traumatic factors : Trauma to the joint seems to enhance the occurrence of

arthritis. It disturbs the alignment of the joints and over a period of time, this mal-

alignment may lead to excessive wear and tear leading to OA.

According to the cause of OA, it is classified as primary and secondary. Primary

OA is the term used when the disorder arises form unknown or hereditary causes.

Secondary OA describes cases in which direct causes for the disorder are known.

Disease Review 71

Classification based on causes 255

I. Primary

A) Idiopathic, B) Primary generalized osteoarthritis and C) Erosive osteoarthritis.

II. Secondary

A. Congenital or developmental defects (Hip dysplasias, shallow acetabulum, Morquio’s

syndrome, etc),

B. Traumatic

a. Acute b. Chronic and c. Charcot’s arthropathy,

C. Inflammatory (RA, psoriatic arthritis, septic arthritis, pseudogout)

D. Endocrinal influence (Acromegaly, diabetes mellitus, sex hormone abnormalities,

hypothyroidism with myxedema) and Metabolic (Gout, Itemochromatosis, Ochronosis,

Chondrocalcinosis, Paget’s disease).

POORVAROOPA

Particular mentioning of Poorvaroopa of Sandhigatavata is not available in

classics. In Vatavyadhi also unmanifested symptoms (Avyakta) or mild exhibition of

actual features of the disease itself (Alpa vyakta) is considered as its Poorvaroopa.256

Hence clinical features of Sandhigatavata in milder form can be considered as

Poorvaroopa. Observations based on the present clinical trail reveal that sandhi-gurutva

(heaviness of joints) and occasional pain in the joints, which were ignored by the patients,

were the Poorvaroopas.

Disease Review 72

SAMANYA SAMPRAPTI

The treatment of the disease may be taken as the reversion of the Samprapti. So, it

is very important to know the Samprapti or pathology before starting the treatment. From

the onset of Dosha-Dushya Dusti, till the evolution of the Vyadhi there occur various

stages. Samprapti explains such series of pathological stages involved.

The Samanya Samprapti of Vatavyadhi that is explained in classics can be

considered as the Samprapti of Sandhigatavata.

Charaka and Vagbhata had stated that the kupitavata circulate through the empty

channels in the body (riktasrotas) and fills them.257 This settling in the channels produces

Vata specific symptoms in the Avayavas related to those channels. Another possibility is

that the Kupitavata entering the Srotas can get Avarana by other doshas etc and manifest

the symptoms.258-259 Both these mechanisms are possible in case of Sandhigatavata. The

general pattern of Samprapti is as follows: –

Intake of rooksha-sheeta ahara and vihara like ativyayama, abhighata etc

Reduction of sneha bhava in the body Dhatukshaya where by Sushirata in the

channels results Vata purana of these channels Manifestation of symptoms.

That is, the above said Ahara vihara induces reduction of Snehabhava and

simultaneously produces Vatakopa due to the dhatu kshaya. Reduction of Shleshaka

kapha occurs and this allows the settling of vitiated vata (vyana vata) in the joints thereby

gradually resulting in the manifestation of Sandhigatavata.

Disease Review 73

Concept of Gatavata

As the disease belongs to Gatavata group of Vatavyadhees, it will be relevant to

discuss the concept of Gatavata here. While mentioning Gatavata, acharyas have

mentioned the gatatva of dhatu, upadhatu, ashaya, avayava etc.260 The various

terminologies used to denote this Gatavata are gate, sthithe, avasthite, ashrite, prapte, etc.

These all terminologies can imply two important factors – A) related to the gati of the

vitiated Vata and B) related to the occupation of a particular site.

When these two factors combine then such a condition is termed by adding

objective of that site, for e.g. Sandhigatavata. Though Vata is present all over the body,

its Gata condition specially indicates its abnormal localization at the particular Dhatu or

Ashaya. In this condition, the etiological factors are only of Vata and not of dual, i.e., not

of both Dosha and Dooshya. For example, in Vatarakta, the Atisevana of ahara vihara

vitiating Vata and Rakta at a time leads to the Prakopa of both simultaneously, resulting

in Vatarakta. While in Sandhigatavata, the kopa of Vata alone occurs and this vitiated

Vata by involving the Sandhis produces Sandhigatavata. Peculiarities of these Gatavatas

are that here the Vata vitiation is active, Vata dosha is more important, vitiation of Vata is

due to it’s own Nidanas and there is a state of Dhatukshaya and Rikta srotas.261

Also the Samprapti of Sandhigatavata can be discussed under two headings for

better understanding – 1. Dhatukshayajanya and 2. Margavaranajanya.

Dhatukshayajanya : Here the process of Samprapti initiation is due to the strong

involvement of nidana factors such as Vardhakya avastha, Abhighata, Ativyayama,

Marmaghata etc. These factors lead to the Vata vridhi followed by Kapha kshaya. This

results in agni mandya. Then the state of dhatukshaya is the resultant and hence there is

Kshaya of asthi dhatu too. Kapha kshaya reflects in the decrease of Shleshaka kapha also.

This permits the settling of vitiated Vata in the Sandhis and then the manifestation of the

symptoms.

Disease Review 74

Margavaranajanya : Here the samprapti process is initiated by the nidana ghataka,

sthoulya. In Sthulas usually Sandhigatavata affects the weight bearing joints. In these

persons Meda dhatu will be produced in excess quantity due to the Atisnehamsha of

Amarasa.262 The excessive Medas will produce obstruction for the flow of nutritive

materials to the future Dhatus i.e. Asthi, Majja and Shukra leads to their improper

formation. The excessive fat deposited all over the body will produce Margavarana of

Vata.263 Prakupita Vata due to Margavarana starts to circulate in the body. While

traveling it settles in the joint. Where Khavaigunya already exists, after Sthanasamshraya

it produces the disease Sandhigatavata.

Three main factors involving in the production of Sandhigatavata, in any form of Samprapti are –

Kopa of vyana vata, which normally controls all the movements of the body.

Kshaya of shleshaka kapha, which normally aligns the joints and maintains its

Compactness.

Deterioration of sleshmadhara kala, which lubricates the joints.

Samprapti ghatakas

01. Dosha – Vata – Vyana vata vridhi and Kapha – Shleshaka kapha

02. Dushya – Asthi, Majja, Peshi, Snayu, Sleshmadhara kala

03. Srotas – Asthivaha, Medovaha, Majjavaha, Mamsavaha

04. Agni – Jatharagni, Asthidhatwagni, Medodhatwagni

05. Ama – Jatharagni mandyajanya, Asthidhatwagni mandyajanya,

Medodhatwagni mandyajanya

06. Udbhava – Pakwashaya

07. Rogamarga – Madhyama

08. Adhisthana – Sandhi

Disease Review 75

Pathogenesis of Osteoarthritis 264

The association between OA and aging is non-linear; the prevalence increases

exponentially beyond the age of fifty. About 80% to 90 % of the individuals, of both

sexes, have evidence of OA by the time they reach the age of 65. The age related changes

in cartilage include alteration in proteoglycans and shorten fatigue life. Despite this

relationship, it is an over simplification to consider OA as merely a disease cartilage wear

and tear.

Chondrocytes play a primary role in the process and constitute the cellular basis

of the disease. For example, the chondrocytes in the osteoarthritic cartilage produce IL-1

and TNE-alpha, which are known to stimulate the production of catabolic

metalloproteinases and inhibit the synthesis of both type 2 collagen and proteoglycans.

The effects of these cytokines are potentiated because their receptors show an increased

sensitivity. Other mediators, such as prostaglandin derivatives and IL-6, also have a role

in this cascade of matrix degradation. Most of these cytokines also have pro-

inflammatory properties, and inflammatory cells are present in many osteoarthritic joints.

The precise events that lead to the secretion of cytokines however are not clear.

Degeneration and OA

OA is caused by the degeneration of the articular cartilage in the joints involved.

In the regions involved, the cartilaginous matrix and the chondrocytes swell. The

proteoglycans in these regions are smaller then the normal. The proportion of chondrotin

sulfate falls and the proportion of keratin sulfate rises. The change in the character of the

proteoglycans exposes the collagen fibers in the cartilage. Poorly formed type I collagen

Disease Review 76

tends to replace the type II collagen normal in the cartilage. In the degenerating regions,

small fissures develop in the cartilage. The fissures separate irregular brands of cartilage

that project perpendicular to the articular surface, a change called fibrillation. Clumps of

chondrocytes are often present near the clefts. As years pass, much or all of the articular

cartilage is slowly worn away. Eventually, only irregular patches of articular cartilage

remain on the articular surfaces of the bones.

Degeneration of the synchondral joints of the spine causes loss of water from

the nucleus pulposus. It becomes smaller and less resilient and often is fissured or

calcified. Chondrotin sulfate is lost from the nucleus. Keratin sulfate and collagen

accumulate in it. The thin cartilaginous plates that separate the intervertebral disc from

the vertebrae degenerate, becoming fissured or fibrillated like the articular cartilages in

the osteoarthritic diarthrodial joints. Often the nucleus pulposus herniate through the

cartilaginous plate into one or both of the adjacent vertebrae. The herniated part of the

nucleus pulposus is usually 1-2cm across and is called a Schmorl’s node. The annulus

fibrosis of the disc is weakened, allowing the disc to bulge anteriorly and laterally.

Weightman has shown that the ability of the articular cartilage to withstand

fatigue testing diminishes progressively with age. Because OA is most common in aging

patients, it is often proposed that the disease is an intrinsic part of the aging process. The

wear and tear theory assumes a decreasing capacity with the age of articular cartilage to

resist mechanical stress. (Cotran Sr, Pathologic basis of disease –28 chapter) .

Disease Review 77

ROOPA

Sandhigatavata manifests in the body with the following lakshanas.

01. Vatapoornadrithisparshaha shothaha: - Swelling over the joint resembling an air–

filled bag on touch. Arunadatta says that the shopha is similar to an air –filled bag.265

02. Prasarana akunchanayoho savedana pravritti: - Painful flexion and extension is

another feature of Sandhigatavata.266

03. Hanti sandheen: - This, according to Dalhana, is the absence of joint movements

(flexion and extension) implying the joint damage. According to Gayadasa, it is the

difficulty in joint movements. According to the Madhukosha commentary on Madhava

nidana, it means that the Vata vitiated in the joints either hampers the functioning of

joints or produce stiffness etc.267

04. Shoola: - Pain in the joints.268

05. Atopa: - Crepitus (Characteristic sound produced from the joints).269

Table No: 16 Showing the lakshanas of Sandhigatavata.

Sl Lakshana C.S. S.S. A.H. Others 1 Shoola - + - Madhavanidana

Bhavaprakasha Gadanigraha

2 Shotha + + + Bhavaprakasha Gadanigraha

5 Hanti sandheen - + - Madhavanidana Bhavaprakasha Gadanigraha

6 Atopa - - - Madhavanidana 7 Sandivishlesha - - - Madhukosha 8 Sandhi stambha - - - Madhukosha 9 Prasarana akunchanayoho abhava - - - Dalhana 10 Prasarana akunchanayoho

asamarthya - - - Gayadasa

Disease Review 78

Acharyas have not mentioned that Sandhigatavata affects only any particular

sandhi of the body. Modern medicine also supports this view.

Clinical features of Osteoarthritis 270

SYMPTOMS

No systemic manifestations

Pain on use; pain at rest in severe and advanced diseases

Localized stiffness 15-30 minutes in morning and after immobilization in day

time

Muscle spasm

Limitation of motion in advancing disease

Symptoms uncommon before age 40, except in secondary OA

Pain related to specific joints

Joints most commonly involved –

Distal interphalangeal joints

Proximal interphalangeal joints

First carpometatarsal joint

Scaphotrapezoid joints

Knees

Hips, often unilateral

Spine, cervical and lumbar

First metatarsophalangeal joint

Disease Review 79

SIGNS

Joints, enlarged, synovium and capsule synovial fluid, and bony and cartilage.

Proliferation.

Tenderness, local at joints.

Crepitus, creaking, grating, cracking.

Warmth without redness of joints.

Palpable osteophytes.

Joint effusion of normal or high viscosity fluid.

Deformity of joint with preservation of function with exception of hip joint and first

carpometacarpal joint.

Sometimes episodic course, e.g. primary generalized OA.

Soft synovial proliferation without bony proliferation, rare.

Genu varus and valgus.

Hallux valgus.

Heberdens and Bouchar’s nodes and first carpometacarpal enlargement.

Rare involvement: elbows, shoulder, metacarpophalangeal, lateral

metatarsophalangeal, proximal interphalangeal and joints of feet, ankle, subtalar

and midtarsal, thoracic spine.

Diagnosis of OA is made accurately by clinical history, physical examination

radiological study, and when etiology and pathogenesis are not clear, by certain

laboratory examinations. The symptoms and signs are usually confined to one or only a

few joints. If many joints are involved, the diagnosis is more likely a systemic form of

rheumatic disease.271

Disease Review 80

Radiologic and laboratory characteristics of Osteoarthritis 272

Normal radiographic findings occur in early OA. Joint space narrowing follows

degeneration and disappearance of hyaline cartilage. Early in the disease with effusion

and swelling of cartilage, there may be joint space widening. Subchondral bony sclerosis

or eburnation is very characteristic and represents deposition of excessive new bone.

Marginal osteophytes in a variety of patterns in various joints reflect bone, cartilage and

synovial cell proliferation. Sub location and gross deformities with loose bodies in the

joint appears late. Radiologic criteria for diagnosis of osteoarthritis as defined in the Atlas

on standard radiographs are given below:

Formation of osteophytes in the joints margins or at ligamentous attachments, e.g.

tibial spine

Periarticular ossicles, mainly distal and proximal interphalangeal joints

Narrowing of the joints space associated with sclerosis of subchondral bone and

Altered shape of bone end e.g. head of the femur.

The following five step grading system is used according to the number of criteria present.

01. 0 = No OA. 02. 1 = Doubtful OA. 03. 2 = Minimal OA

04. 3 = Moderate OA 05. 4 = Severe OA.

There are no specific laboratory abnormalities in primary OA. The synovial fluid

is essentially normal, a few cells above normal counts, a slightly reduced viscosity or

string test, a normal mucin clot and total protein concentration. An increased

concentration of inorganic pyrophosphate (PPi) is found in OA and is positively

correlated with the severity of radiologic OA. The application of thermography and

scintillation scans of joints has little or no clinical usefulness but has shown negligible

evidence of inflammation in OA compared to the inflammatory arthropathies.

Disease Review 81

Association of OA has also been noted with elevated Westergren sedimentation

rate, elevated C-reactive protein, serum uric acid and ASO titers. In primary generalized

OA, elevated serum cholesterol and transient rises in other acute phase reactants occur,

Specific laboratory studies may be needed for diagnosis of secondary OA associated with

specific primary disease. Arthroscopy thus far has little practical use in OA.

Vyavachedakanidana

Sandhigatavata is a disease affecting the bony joints. So virtually every disease

that affects the joints has to be differentiated with Sandhigatavata. The most common

differentiation is to be made with Amavata (Ma.Ni.25\7), Vatarakta (C.S.Chi.29/23 ) and

Kroshtrukasheersha. (Ma.Ni.22/48)

Table No. 17 Showing Vyavachedakanidana between Sandhigatavata and Vataraktha

Sl. Criteria SGV Vatarakta

1 Nidana Vatavridhikara ahara-

vihara

Vidahi, viruddha, Vata

rakthaprakopakara ahara

2 Poorva roopa Avyaktharoga lakshana Visista poorvaroopa

3 Roopa Sandhishoola, rasarana

akunchanayoho vedana,

Sandhi shopha,

Vatapoornadrithi sparsha

Teevra ruk, Grathita-paki

shvayathu

4 Adhisthana Sandhi Padamoola, Hastamoola

5 Doshas Vata Vata, Rakta

6 Upashaya Ushna - snigdha Sheeta

Disease Review 82

Table No. 18 Showing Vyavachedakanidana of Sandhigatavata and Amavata

Sl. Criteria SGV Amavata

1 Nidana Vatavridhikara hara-vihara Viruddha ahara-cheshta

2 Poorva

roopa

Avyaktharoga lakshana Hridaya dourbalya, gourava

3 Roopa Sandhishoola, rasarana

akunchanayoho vedana,

Sandhi shopha,

Vatapoornadrithi sparsha

Angamarda,Aruchi,trusna,Alasya,

Gourava ,Jwara,Apaka,Angashoonyata

4 Adhisthana Sandhi (Dependent joint) Bahusandi (Hasta, Pada, Gulpha, Trika,

Janu etc.)

5 Dosha Vata Vata, Kapha

6 Upashaya Ushna, snigdha Ushna-rooksha

Table No: 19 Showing Vyavachedakanidana of Sandhigatavata and Kroshrukasheersha.

Sl. Criteria Sandhigatavata Kroshtrukasheersha

1 Nidana Vatavridhikara ahara-vihara Vata & raktha

vridhikaraahara-vihara

2 Roopa Sandhishoola, rasarana akunchanayoho

vedana, Sandhi shopha,

Vatapoornadrithi sparsha

Maharuja, Janushopha,

kroshtrukasheershavat

3 Adhisthana Sandhi Janu Madhya

4 Dosha Vata Vata, rakta

5 Upashaya Ushna, snigdha Snigdha, seetha

Disease Review 83

Table No: 20 Showing Differential diagnosis between OA, RA, Gout and Rheumatic

fever.

Sl. Criteria OA RA Gout Rheumatic Fever

1 Symptoms Pain & swelling on major weight earing joints, stiffness, crepitations, tenderness, enlargement of joint space

Inflammation n multiple joints, morning stiffness

>30ms

Polyarticular pain, swelling & inflammation,

exquisite tenderness

Painful and tender joints

2 Mode of On set

Gradual Abrupt Acute Acute

3 Joints

Involved

Weight bearing joints

Polyarticular Metatarso-phalangeal joints

Polyarticular

4 Systemic Features

- Autoimmune disease, rise in temperature, anemia etc.

- Carditis, fever, chorea

5 Investigations RA-ve, ESR

normal, X-ray- narrowing of joint space, subchondral bony sclerosis, osteophytes etc.

ESR raised,

X-ray-soft

tissue swelling.

Serum uric acid raised,

punched out lesions in subchondral bone.

ESR increased,

CRP high,

WBC elevated.

Upadravas (Complications) 273

Upadrava is produced after the manifestation of the pradhana vyadhi and it is

dependent on it. Susruta stated that Bala kshaya, Mamsa kshaya, Thrishna, Dhatushosha,

Jwara, Vamana, Murcha, Atisara, Hikka, Shota, Suptata, Bhagna, Kampa, Admana as

upadravas of Vatavyadhees. Osteoarthritis if long standing will be having complications

like muscle wasting, various deformity, intra articular loose bodies etc. This state is very

complicated one where the patient feds much difficulty in managing the daily routines.

Disease Review 84

Upashaya-anupashaya274

Upashaya is a judicious use of drugs, diet and practices (vihara) results in relief

of symptoms. Upashaya is antagonistic to the cause of disease and to the disease itself

(M.Ni.1/8 Madhukosha). Anupashaya is the one, which aggravates the symptoms.

Upashaya and anupashaya are very much important; especially during the treatment

usually drugs having snigdha and ushna gunas are prescribed as these pacify the Vata

kopa. This should be adopted in the nirama avastha of Vatavyadhi only. This is the

upashaya method. When the same drugs are prescribed in the Saama avastha of

Vatavyadhi the disease aggravates. This is the anupashaya.

Sadhyaasadhyata

Vatavyadhees are considered as one among the mahagadas by acharyas.275

Generally, Vata rogas are very difficult to cure due to the deep seated nature of them.

Sandhigatavata usually occurs in the vardhakya kala, which is predominant of Vata.

Charaka had mentioned some Vatavyadhees, which are either not curable due to sthana

gambheerata or curable with effort in case they are of recent origin, in strong patients and

if without any complications. Khudavatata is one among them, which according to

Chakrapani is Sandhigatavata.276

Diseases situated in Marma and Madhyama Rogamarga is Kashtasadhya.

Sandhigatavata is a disease of Sandhi, which falls under Madhyama Rogamarga. Further

Vatavyadhi occurring due to vitiation of Asthi and Majja are most difficult to cure.

Disease Review 85

CHIKITSA

The main aim of treatment is to restore Swasthya. It means to restore normal

functions of Agni, Dosha, Dhatu, and Mala and to maintain mental health. The primary

importance of Chikitsa lies in Samprapti Vighatana.

Genera line of treatment of Sandhigatavata

(1) Snehana 277

In order to pacify Vridhavata and also to fulfill sneha amsha which underwent

kshaya all types of bahya and abhyantara snehana are to be adopted in treatment.

Abhyantara snehana like bhojana, pana, nasya and snehabasti. Bahya snehana in the form

abhyanga, lepa, mardana, udvartana, samvahana, moordha taila, gandusha, karnapoorana,

akshitarpana, parisheka and pichu.

(2) Upanaha 278

Upanaha is therapeutically two types- 1) saagni and 2) niragni. Saagni upanaha is

nothing but Sankara sweda. Niragni upanaha is the tying of Vatahara dravyas over the

affected body part for a time period of 12 hours.

(3) Agnikarma 279

Unique treatment indicated in case of Sandhigatavata. Here Dahana or

cauterization is done at the tender points of the part affected. Susruta states that in the

vitiation of Vata in twak, mamsa, sira, snayu and sandhi Agnikarma provides good relief.

Dahana karma is a synonym of Agnikarma.

Chikitsa 86

(4) Bandhana 280

For the purpose of Bandhana, Charaka opines that leather of Ushna Veerya

animal can be used. In the absence of this silk or woolen cloth can be used.281 Astanga

Hridayakara 282 opines that 'Vatahara' Patras should be used.

(5) Unmardana 283

This is a massage technique utilized in case of bahya snehana procedures. The

massage is performed by applying gentle pressure. Apart from these, the Basti karma

should also be adopted, as it is the parama oushadha for Vata. No other chikitsa has the

capacity to tolerate not regulate the force of Vata apart from Basti. 284

Shamana Oushadhees

1) Kwatha : - Maharasnadi, Rasnadi, Dhanvantaram, Sahacharadi.

2) Choorna : - Alambushadi choorna, Abhadi choorna.

3) Vati : - Ajamodadi vati, Tab. Sallaki, Tab. Shallaki plus.

4) Guggulu : - Kaishoraguggulu, Yogarajaguggulu, Brihat yogaraja,

Adityapakaguggulu, Simhanadaguggulu.

5) Rasaoushadhi : - Panchanana rasa, Vatarakshasa, Brihat vatachintamani.

6) Sneha : - Dhanvantaram taila, Kottam chukkadi taila, Sahacharadi taila,

Vatashani taila. Shatahvadi taila.

Chikitsa 87

PATHYA 285

Ahara

1. Rasas : - Madhura-amla-lavana

2. Shukadhanya : - Nava godhuma, Nava shali, Rakta shali, Shashtika shali.

3. Shimbi varga : - Nava tila, Masha, Kulatha.

4. Shaka varga : - Patola, shigru, vartaka, lashuna.

5. Mamsa varga : - Ushtra, Go, Varaha, Mahisha, Magura, Bheka, Nakula, Chataka,

Kukkuta, Tittira, Kurma.

6. Jala varga : - Ushnajala, Shrithasheetajala, Narikelajala.

7. Dugdhavarga : - Go, Aja, Dadhi, Ghritha, Kilata, Kurchika.

8. Mutravaga : - Gomutra.

9. Madyavarga : - Dhanyamla, Sura.

10. Snehavarga : - Tilaja, Ghrita, Vasa, Majja.

Vihara

Veshtana, Trasana, Mardana, Snana, Bhushayya, etc.

Among present day food stuffs and activities-

1. Can be taken: - Orange juice, carrot, all fibrous fruits and certainoids.

2. Should do: - Slight walking, swimming, steam bath etc.

Chikitsa 88

APATHYA 286

Ahara

1. Rasa : - Katu, Tikta, Kashaya.

2. Shimbivarga : - Rajamasha, Nishpava, Mudga, Kalaya.

3. Shukavarga : - Truna, Kangu, Koradusha, Neevara, Syamaka.

4. Phalavarga : - Jambu, Udumbura, Kramuka, Tinduka.

5. Mamsavarga : - Sushka mamsa, Kapota, Paravata.

6. Jalavarga : - Sheeta jala.

7 .Ksheeravarga : - Gardabha.

Vihara

1. Manasika : - Chinta, Shoka, Bhaya.

2. Shareerika : - Jagarana, Shrama, Vyayama, Vyavaya, Chankramana,

Vegadharana etc.

Among the present day food stuffs and activities-

1. Can be taken: - Fast food, cold beverages, liquor.

2. Should be avoided: - Long standing sitting, driving, staying in AC etc.

Chikitsa 89

MEDICAL MANAGEMENT OF OSTEOARTHRITIS 287

This involves many measures like pharmacological means, non-pharmacological

means and surgery.

Pharmacological means –

1. Simple analgesics

A large number of medicines are prescribed for relief of pain. The recognition

that pain in OA is not necessarily due to inflammation has led to an increased awareness

of the role of simple analgesics in the treatment. The ACR guidelines emphasize the use

of acetaminophen (Tylenol) as the first line treatment for OA.

2. Opioid containing analgesics

Code line and propoxyphene can be used for short periods to treat exacerbations

of pain.

3. NSAID’s

Trials comparing simple analgesics and NSAIDs found that acetaminophen

along can control pain in a substantial number of patients with OA celecoxib, a cox-2

inhibitor, and rofecoxib are recent advances among NSAIDs.

4. Local analgesics – Among the local applications, capsaicin cream is used commonly.

5. Intra articular cortico-steroid injections.

6. Intra articular administration of hyaluronic acid like products.

Chikitsa 90

Agents used to treat Osteoarthritis

Acetaminophen, NSAIDS (Salicylates, Propionic acids, Acetic acid, Oxicams),

Cyclo-oxgenase inhibitors, Irritants/Counter irritants, Hyaluronic acids and

Glucocorticoids.

Exercise – To maintain range of motion, muscle strength and general

health. Patients may also be referred to aerobic exercise programs such as fitness

walking or swimming.

Assistive devices – Many patients with OA of hips and knee are more

comfortable; wearing shoes with good shock-absorbing properties

Non-pharmacological means

Patient education.

Exercise: - To maintain range of motion, muscle strength and general health.

Patients may also be referred to aerobic exercise programs such as fitness walking

or swimming.

Assistive devices: - Many patients with OA of hips and knee are more

comfortable; wearing shoes with good shock-absorbing properties orthoses. The

use of an appropriately selected cane can reduce hip loading by 20-30%. Patients

with specific physical disabilities may benefit from physical and occupational

therapy.

Weight management: - There is a longitudinal association between obesity and

OA of knee in men and women. Therefore, primary preventive strategies may

include measures to avoid weight gain, or to achiever weight loss in over weight

patients.

Supplements: - Glucosamine sulphate and chondrotin sulfate.

Chikitsa 91

SURGERICAL LINE OF MANAGEMENT288

Surgical procedures are of value in the management of OA. They may be grouped

under 3 major categories. Procedures to correct mal alignment and eliminate abnormal

joint stresses (osteotomies) not only may slow down disease progression but may-also

bring healthier articular cartilages into opposition and provide symptomatic relief.

Debridement with removal of free bits of cartilage or large ecostoses may relieve pain

and locking and help in prevention of rapid and extensive cartilage degeneration. In

advanced disease, arthroplasty or joint replacement may be required to reduce pain and

improve function; at times arthrodesis is required to control pain, even though motion

must be sacrificed.

Chikitsa 92

DRUG REVIEW

The ingredients of Shatahvadi taila 289 are as follows.

Shatahva 290 a, b

Latin name – Anethum sowa.

Family – Umbeliferae

Sanskrit – Shaleeya, Shatapatrika, Shatapushpika.

Composition – Dried ripe dill fruit contains a volatile oil 3-4% which is

composed of anethine, phellanndriene and di-limonene, apiol, also contain

carvotie and hydrocarbone.

Rasa – Katu,Tikta

Guna – Laghu, Rooksha, Teekshna

Veerya – Ushna

Vipaka – Katu

Dosha – Kapha and Vata shamaka

Parts used – Phala, Taila

Uses – Carminative, Vedanashamaka, Shothahara, Swedajanana.

Methodology 93

Bilva 291 a, b

Latin name – Aegle marmelos

Family – Rutaceae

Sanskrit – Shandilya, Shaitusha, Shreephala, Sadaphala

Composition – Phalamajja contains mucilage, pectine, sugar, tannin, volatile oil.

Rasa – Kashaya,Tikta

Guna – Laghu, Rooksha,

Veerya – Ushna

Vipaka – Katu

Dosha – Kapha and Vatashamaka

Parts used – Moola,Twaka, Patra, Phala.

Uses – Shothahara, Vedanashamaka.

Tila 292 a-c

Latin name – Sesamum indicum

Family – Pedaliaceae

Sanskrit – Homadhanya, Pavitra, Papaghana, Jartila.

Composition – Seeds contain fixed oil 50-60%, priteids 22%, Carbohydrate

mucilage 4%.

Rasa – Madhura, Anurasa -Kashaya and Tikta.

Guna – Guru, Snigdha.

Veerya – Ushna

Vipaka – Madhura

Dosha – Vata shamaka, Tridoshashamaka (due to samskara)

Parts used – Seed, oil

Uses – Vedanashamaka, Sandhaneeya

Methodology 94

Tila taila (Moorchhita) 293-294

By Taila moorchana the unpleasant odour of the oil is changed, Amadosha is

removed and good color and fragrance are obtained. It enhances the potency of the taila

also.

Composition – Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%),

oleic acid (45.4%), linoleic acid (40.4%).

Rasa – Madhura, Tikta accompanying kashaya.

Guna – Sukshma, Vyavai, Vishada, Guru, Sara, Vikashi, Teekshna,

Himasparsha.

Properties – Vatagni, aggravates pitta, does not aggravate kapha, Deepana-

pachana, Brimhana, Balya, Preenana, Lekhana, promotes skin health, intellect,

digestive power, health of eyes, complexion, strength and stability of

Mamsadhatu, Krimigna, reduces the quantity of urine, good for hairs, cleanses the

Garbhasaya and yoni, helps in overcoming aging process.

Indication – Vrina, Prameha, pain in ears, yoni and head. All kinds of injuries are

relieved with Tila taila. It is used for alleviation of Vata, as Bastidravya,

Nasyadravya, for internal administration and in Abhyanga and dietary articles.

Methodology 95

Yava 295 a, b

Latin name – Hordeum vulgare

Family – Graminae

Sanskrit – Yava.

Composition – Fixed oil or fat, starch, cellulose, nitrogenous principles and ash

containing salicic acid, phosphoric acid, iron and lime. Church in his Food grains

of India gives followlng analysis of barley. Water –12.5%, Albinoids – 11.5%,

Starch- 70%, Fat- 1.3%, Fiber-2.6%, and Ash-2.1%.

Rasa – Kashaya, Madhura.

Guna – Rooksha, Laghu.

Veerya – Sheeta

Vipaka – Katu

Dosha – Kapha, Pitta shamaka.

Uses – Balya, Deepana, Lekhana (in Sthoola).

Kanji 296 a, b:

Varga – Madhyavarga

Sanskrit – Kanji.

Guna – Laghu, Teekshna.

Dosha – Vata, Kapha shamaka.

Uses – Deepaka, Pachaka, Trishna and Dahanashaka.

Methodology 96

CLINICAL STUDY

The therapeutic measures, drugs and procedures of Ayurveda have remained in

the practice since long on the basis of methodology prevalent in ancient times. This is the

time that the rationality of Ayurvedic therapeutic approach is explained on rational lines.

Clinical trial is a way of research and its best method to evaluate any drug or line of

treatment. The trial is a carefully designed experiment with the aim of solving

unrewarding problems conducted on scientific lines.

Research Approach.

Experimentation is the most powerful research approach. In the present study, the

objective is to “A COMPARATIVE CLINICAL STUDY TO EVALUATE THE

EFFECT OF MATRABASTI AND PARISHEKA WITH SHATAHVADI TAILA

IN SANDHIGATAVATA (OSTEOARTHRITIS)” The efficacy can be determined by

finding out the difference between the baseline data and after follow up data. So

Parisheka alone was compared with Parisheka in association with Matrabasti to study

advantage of Parisheka with Matrabasti.

Study Design

The study design set for the present study is ‘Prospective comparative clinical

trial’. In this Parisheka and Matrabasti group of patients compared with Parisheka group

of patients. Study was done in two groups. Demographic data and disease-specific data

are collected according to the case-record form given in the appendix.

Source Of Data

Patients suffering from Sandhigatavata were selected from the P.G.S and R

(Panchakarma) OPD and IPD of Shri D G Melmalgi Ayurvedic College Hospital.

Methodology 97

Sample Size and Grouping

The sample size for the present study was thirty patients suffering from

Sandhigatavata as per the selection criteria. Patients were randomly distributed to both

the groups of equal size. In Group A, 15 patients received Parisheka and Matrabasti

and in Group B, 15 patients received Parisheka only.

Reasons For Selection Of The Study Design

The results and conclusions of a clinical trial depends on the study design. The

aim of this study was to find out the effect of Parisheka in the management of

Sandhigatavata and to check additive efficacy of Matrabasti in association with Parisheka

in the management of Sandhigatavata. Therefore, two groups were made and the results

obtained in both the individual groups were compared.

Selection Criteria

The cases were selected strictly as per the pre-set inclusion and exclusion criteria.

A) Inclusion Criteria

Patients between 35 and 65 years of age

Patients with the clinical features of Sandhigatavata (Osteoarthritis)

Patients fit for Basti and Swedana.

Patients with radiological findings of Osteoarthritis along with clinical features

B) Exclusion Criteria

Patients developed deformity.

Patients with severe form of systemic disorders

Pregnant women and lactating mother

Patients unfit for Basti and Swedana

Methodology 98

Duration Of The Study

The total study duration was 24 days, i.e. In group A; 8 days Parisheka along

with Matrabasti, 16 days pariharakala. In group B; 8days Parisheka, 16 days pariharakala.

After treatment follow up was done for one month.

Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed

history pertaining to the mode of onset, previous ailment, previous treatment history,

family history, habits, ashtavidhapareeksha and dashavidhapareeksha and physical

examination findings were noted. Routine investigations were done to exclude other

pathologies. Radiological features also were investigated.

Joint Examination (Knee Joint)297

History

The common symptoms with which a patient generally presents are pain,

swelling, stiffness, mechanical disorders (e.g. Locking, giving way, click etc.) and limp.

Inspection

• Both the lower limbs were fully exposed

• Patient was first examined in the standing position, both from front and behind,

secondly in the seated position, thirdly in the supine position and lastly in the

prone position.

Methodology 99

• Swelling

a) The limits of the swelling were clearly made out.

b) The gradings were allotted on the basis of criteria explained in the end of this

section.

c) The Varna of the Shopha was examined (Raga, Shyava or Prakrutha).

d) Any deformities like genus valgum, varum etc. were examined.

e) Joint instability or buckling of the joint was examined.

f) Any abnormalities in the gait were examined.

g) Walking time was recorded (the time taken to cover 21 metres).

h) Any presence of muscular spasm was examined.

i) Muscular wasting above and below the joint was examined.

Palpation

• Local temperature was examined with the back of the hand and compared to that of

the other side.

• Local tenderness was also examined.

• Swelling

A) Fluctuation test was performed by pressing the suprapatellar pouch with one hand

and feeling the impulse with the thumb and the fingers of the other hand placed

on either side of the patella or the ligamentum patellae.

B) Patellar tap was elicited by pressing the suprapatellar pouch with one hand driving

the whole of its fluid into the joint proper as to float the patella in front of the

joint. With the index finger of the other hand, the patella is pushed backwards

towards the femoral condyles with a sharp and jerky movement. The patella can

be felt to strike on the femur, which is known as the patellar tap.

Methodology 100

• Palpation of popliteal fossa - The patient was made to lie down prone on the table.

The knee joint was flexed and the popliteal fossa was palpated. The knee joint,

popliteal artery, areolar tissue, veins and nerves and the tendons in and around the

popliteal fossa were all palpated carefully to detect any pathology here.

• Significance of click - If the click was associated with discomfort or pain, careful

examination was done. Commonest cause of intra-articular click is OA.

• Patello-femoral and femoro-tibial components were palpated for any tenderness

or irregularity.

Movements

The movements permitted in the knee joint are mainly flexion and extension.

Minor degrees of abduction, adduction and rotations may be permitted when the joint is

partly flexed. Both active and passive movements were examined.

• Flexion and Extension: Normally, the knee can be flexed until the calf extended till

the thigh and leg form a straight line.

• Abduction and adduction: These movements are virtually absent with knee straight,

but slight degrees of abduction and adduction are possible when the knee is semi-

flexed.

• Rotation: This movement is also not possible when the knee is straight. When the hip

and knee are flexed to 90 degrees, some degree of rotation is possible.

Auscultation

During active or passive movement, the palm of one hand of the physician was

placed over the patella and crepitus was felt.

Methodology 101

Treatment schedule

Group-A: Parisheka and Matrabasti Group.

PARISHEKA

Poorvakarma

The patient was asked to attend his natural urges prior to entry in the

Panchakarma theatre. The procedure was done between 8 to10 AM. After performing the

sacred rights, the 1000ml of Shatahvadi taila is taken and kept in a vessel containing hot

water. Then the patient was asked to sit comfortably in Taila droni by extending his both

legs, two trays are placed under the knees for the purpose of collecting and reuse of the

taila in a cyclic manner.

Pradhanakarma

The lukewarm oil was supplied to the Panchakarma technicians standing on either

side of the patient. The oil was checked for excess heat or insufficiency.

Fixing the duration : The duration of karma was fixed 30 minutes for 8 days.

Cleaned sponges were dipped in Sukhoshna taila (Bearable warmth to the patient)

and squeezed by right mist and made to flow on knee joint in a regular stream along with

the direction of inverted thumb. The height of the stream was maintained about 12 angula

throughout the procedure. Mild massage was made with left hand continuously along

with the Pariseka. The temperature of the taila was maintained throughout the procedure.

The fresh oil was taken on every fourth day of the procedure. The snap taken at the time

of procedure is displayed in the photograph.

Paschatkarma

The oil remained on the joint was wiped out with the help of cleaned cloth, mild massage was done and patient was asked to relax and instructed to be ready for the Matrabasti as explained below.

Methodology 102

MATRABASTI

The procedure of administration of Matrabasti in general can be divided into three stages

Poorvakarma

The patients were instructed to come after taking light diet (neither too Snigdha

nor too Ruksha) and after elimination of stool and urine. The patients were also advised

not to take diet more than 3/4th of routine quantity. The patients were mainly subjected

for local Abhyanga and Mridu Swedana prior to the administration of Matrabasti.

Abhyanga : The local Abhyanga over abdomen, buttock and thighs for 5 – 10

minutes was done by lukewarm Shatahvadi taila.

Swedana : After Snehana, the patients were subjected for local Mrudu Sweda, by

using Nadi Sweda. Swedana was done on abdomen, buttocks and on thighs for 5 – 10

minutes.

Pradhanakarma

After this Purva Karma the patient was advised to lie down on left lateral position

on the Basti table with left lower extremity straight and right lower extremity flexed on

knee and hip joint. The patient was asked to keep his left hand below the head.

Shatahvadi Taila was applied to anus in small amount, 75ml of lukewarm Shatahvadi

Taila was taken in enema syringe. Rubber catheter oleated with Shatahvadi Taila was

attached to enema syringe. After removing the air from enema syringe, rubber catheter

was administered into the anus of the patient’s upto the length of 4 inches. The patient

was asked to take deep breath and not to shake his body while introducing the catheter

and the drug. The total Taila was not administered in order to avoid entrance of Vayu into

the Pakwashaya which may produce pain.

Methodology 103

Pashchatkarma

After the administration of Basti, the patient was advised to lie in supine position

with hand and legs freely spread over the table. There after patient’s both legs were raised

few times so as to raise the waist and gently tapped over the hips. Simultaneously taps

were also given on his soles, over elbow and palms, so that the Matrabasti may spread

throughout the body and may be retained for the required period. After sometime patient

was advised to get up from the table and take rest in his bed and also not to take day

sleep. Basti Pratyagamana Kala was noted in each case.

Group –B: Only Parisheka Group.

In this group only Parisheka was done as explained in Group –A about Parisheka.

Pathyapathya during treatment period and pariharakala

The pathyacharana is an important factor which was followed for 24 days

including the treatment period. The regimen prescribed for Snehapanavidhi was followed

by the patients. Patients were advised to take katu-tiktha-kashaya-rooksha varjitha

aharadravyas in light quantity. Rice gruel with little milk was advised as the ideal food.

Patient was advised to drink hot water only. Patient was advised to avoid sexual

intercourse, suppression of natural urges, traveling, exercise, excessive speech, uneven

sitting and lying postures, exposure to wind, cold, heat and dust, anger and grief.

Methodology 104

Assessment of Clinical Response

Subjective parameters and objective parameters were made out to assess the

clinical response in both the groups.

Subjective Parameters

Objective parameters

Ruk (Pain)

01. Grade 0 – No Complaints

02. Grade 1 – Tells on Enquiry

03. Grade 2 – Complains Frequently

04. Grade 3 – Excruciating Condition

Graha (Stiffness)

01. Grade 0 – Absent

02. Grade 1 – Present

Sandhigathi-Asaamarthya (Limitation of joint movement)

01. Grade 0 – No movement

02. Grade 1 – Up to 50% of the full range of joint motion

03. Grade 2 – 50-75% of the full range of joint motion

04. Grade 3 – >75% & <full range

05. Grade 4 – Full Range of joint Motion

Sparshaakshamatva (Tenderness)

01. Grade 0 – No Complaints

02. Grade 1 – Says the joint is tender

03. Grade 2 – Winces the affected joint

04. Grade3 –Winces and withdraws the affected joint.

Methodology 105

All these parameters of baseline data to post-medication data (24th day) were

compared for clinical assessment of the results (assessment was also recorded on the 8th

day too).

Overall Assessment of Clinical Response

Atopa (Crepitations)

01. Grade 0 – None

02. Grade 1 – Felt Walking time 298 to cover 21meters distance

01. Grade 0 – Up to 20seconds

02. Grade 1 – 21-30seconds

03. Grade 2 – 31-40seconds

Shotha (Swelling)

01. Grade 0 – No Complaints

02. Grade 1 – Slightly obvious

Good Response – >60% improvement in subjective and objective parameters.

Moderate Response – 31-60% improvement in subjective and objective parameters.

Poor Response – 1-30% improvement in subjective and objective parameters.

No Response – 0 % or No improvement in subjective and objective parameters

Methodology 106

39 patients were registered for the present study. Out of this, 9 patients were

excluded. (4 drop outs and 5 not fulfilling the criteria for diagnosis) Hence, their data has

not been included here. The remaining 30 patients of Sandhigatavata fulfilling the criteria

for diagnosis, were treated in the following two Groups –

Group A – Parisheka and Matrabasti – 15 patients.

Group B – Parisheka – 15 patients.

All the patients were examined before and after the treatment according to the

case sheet format given in the appendix. Both the subjective and objective changes were

recorded. The data recorded are presented under the following heading –

I. Demographic data

II. Data related to the disease

III. Data related to over all response to the treatment

IV. Statistical analysis of the clinical and functional parameters and inter Group

comparison.

Observations & Results 107

1. DEMOGRAPHIC DATA

A. Table No.21. Showing the distribution of patients by age in both Groups.

Age Groups Group A % Group B % Total %

35-44 1 6.66 0 0 1 3.33

45-54 5 33.3 3 20 8 26.6

55-64 9 60 12 80 21 70

B. Table No.22. Showing the overall response of patients by Age in both Groups.

Group A Group B Total Age

Group No GR MR No MR PR No GR MR PR

35-44 1 0 1 0 0 0 1 0 1 0

45-54 5 2 3 3 2 1 8 2 5 1

55-64 9 6 3 12 11 1 21 6 14 1

Among the 15 patients in Group A, the only 1 patient (6.66%) was in the age

group of 35–44 and responded moderately; whereas in the 5 patients (33.33%) were in

the age group of 45–54, 2 patients had good response (40 %) and 3 patients had moderate

response (60%) and 9 patients (60%) were in the age group of 55-65, 6 patients had good

response (66.66 %) and 3 patients had moderate response (33.33 %).

Among the 15 patients in Group B, no patients were in age group of 35-44 years.

3 patients (20%) were in the age group of 45–54, 2 had shown moderate response and 1

patient had poor response and 12 patients (80%) in the age group of 55–65, 11 patients

had moderate response (91.66%) and 1 patient responded poorly (8.33 %).

In the study as a whole (30 patients), 1 patient (3.33%) in the age group 35–44

had moderate response; in the 8 patients (26.6%) in the age group 45–54, 2 patients had

good response (25%) and 5 patients had moderate response (62.5%), 1 patient (12.5%)

had poor response and in the 21 patients (70%) in the age group 55-64, 6 patients had

good response (28.57 %), 14 patients had moderate response (66.66%) and 1 patient

responded poorly (4.76 %).

Observations & Results 108

2. A. Table No. 23. Showing the distribution of patients by sex in both Groups.

Sex Group A % Group B % Total %

Male 6 40 7 46.6 13 43.3

Female 9 60 8 53.3 17 56.6

B. Table No. 24. Showing the overall response of patients by sexes in both Groups.

Group A Group B Total Sex

No GR MR No MR PR No GR MR PR

Male 6 4 2 7 6 1 13 4 8 1

Female 9 4 5 8 7 1 17 4 12 1

Among the 15 patients in the Group A, 6 patients (40%) were males, 4 males

(66.66%) had good response where as 2 males (33.33%) had moderate response; in the

same Group, among 9 females (60%), 4 females (44.44%) had good response and 5

females (55.55%) had moderate response.

Among the 15 patients in the Group B, 7 patients (46.66%) were male, 6 males

(85.71%) had moderate response and 1 male (14.2%) had poor response, where in the

same Group 8 patients (53.33%) were females, among these 7 patients (87.5%) had

moderate response and 1 patient (12.5%) had poor response.

In the study as a whole (30 patients), among the 13 males (43.3%), 4 (30.76%)

had good response and 8 (61.5%) had moderate response and 1 patient (7.69%) had poor

response; among the 17 females (56.66%), 4 (23.52%) had good response and 12

(70.58%) had moderate response and one (5.88%) had poor response.

Observations & Results 109

3. A Table No. 25. Showing the distribution of patients by Occupation in both Groups.

Occupation Group A % Group B % Total %

Sedentary 4 26.66 6 40 10 33.33

Active 7 46.6 7 46.6 14 46.6

Labour 4 26.6 2 13.3 6 20

Others 0 0 0 0 0 0

B. Table No.26. Showing the overall response in patients by occupations in both Groups.

Group A Group B Total

Occupation No GR MR No MR PR No GR MR PR

Sedentary 4 2 2 6 6 0 10 2 8 0

Active 7 4 3 7 6 1 14 4 9 1

Labour 4 2 2 2 1 1 6 2 3 1

Others 0 0 0 0 0 0 0 0 0 0

Among the 15 patients in Group A, in the 4 sedentary patients (26.66%), 2

patients (50%) got good response and 2 (50%) got moderate response where as in the 7

active patients (46.66%), 4 patients (57.14%) got good response and 3 patients (42.85%)

got moderate response and in the 4 labour patients (26.66%), 2 patients (50%) got good

response and 2 patients (50%) got moderate response.

Among the 15 patients in the Group B, the 6 sedentary patients (40%) got

moderate response (100%) and in the 7 (46.66%) active patients, 6 (85.71%) got

moderate response, 1 (14.2%) patient got poor response. in the 2 labour patients (33.3%),

1 patient (50%) got good response and 1 patient (50%) got moderate response.

In the study as a whole, among the 10 sedentary patients (33.33%), 2 patients got

good response (20%) and 8 patients (80%) got moderate response where as in the 14

active patients (46.66%), 4 patients got good response (28.57%) and 9 patients (64.28%) ,

one patient (7.14%) got poor response and in the 6 labour patients (20%), 2 patients got

good response (33.33%), 3 patients got moderate response (50%) and 1 patient got poor

response (16.6%).

Observations & Results 110

4. Table No. 27. Showing the distribution of patients by Economical status in both

Groups.

Economical status Group A % Group B % Total %

Poor 3 20 7 46.66 10 33.33

Middle class 7 46.66 7 46.66 14 46.66

High class 5 33.33 1 6.66 6 20

Among the 15 patients in Group A, 3 patients were poor (20%), 7 patients were of

the middle class (46.66%) and 5 patients were high-class (33.33%). Among the 15

patients in the Group B, 7 patients were poor (46.66%), 7 patients were of middle class

(46.66%) and 1 patient was high-class (6.66%). In the study as a whole (30 Patients), 10

patients were poor (33.33%), 14 patients were of the middle class (46.66%) and 6

patients were of high-class (20%).

5.Table No. 28. Showing the distribution of patients by Religion in both Groups.

Religion Group A % Group B % Total %

Hindu 11 73.3 14 93.33 25 83.3

Muslim 4 26.66 1 6.66 5 16.6

Christian 0 0 0 0 0 0

Among the 15 patients in Group A, 11patients were Hindus (73.3%), 4 patients

were Muslims (26.66%). Among the 15 patients in Group B, 14 patients were Hindus

(93.33%) and 1 patient were Muslims (6.66%). In the study as a whole (30 patients), 25

patients were Hindus (83.3%), 5 patients were Muslims (16.6%).

Observations & Results 111

6. Table No. 29. Showing the distribution of Patients by Dietary habit in both Groups.

Dietary habits Group A % Group B % Total %

Vegetarian 5 33.3 8 53.3 13 43.33

Mixed 10 66.6 7 46.6 17 56.66

Among the 15 patients in Group A, 5 patients were vegetarians (33.3%) and 10

patients were having mixed dietary habits ( 66.6%). Among the 15 patients in Group B, 8

patients were vegetarians (53.3%) and 7 patients were having mixed dietary habits

(46.6%). In this study as a whole (30 patients), 13 patients were vegetarians (43.33%) and

17 patients were having mixed dietary habits (56.66%).

7. A Table No. 30. Showing the distribution of Patients by Agni in both Groups.

Agni Group A % Group B % Total %

Manda 6 40 10 66.6 16 53.33

Teekshna 0 0 0 0 0 0

Vishama 7 46.6 4 26.66 11 36.6

Sama 2 13.3 1 6.6 3 10

B. Table No. 31. Showing the overall response of patients by Agni in both Groups.

Group A Group B Total Agni

No GR MR No MR PR No GR MR PR

Manda 6 3 3 10 9 1 16 3 12 1

Teekshna 0 0 0 0 0 0 0 0 0 0

Vishama 7 3 4 4 3 1 11 3 7 1

Sama 2 2 0 1 1 0 3 2 1 0

In the Group A, among the 6 patients (40%) of Manda agni, 3 patients had good

response (50%) and 3 patients had moderate response (50%) whereas among the 7

patients (46.66%) of Vishama agni, 3 patients had good response (42.85%) and 4 patients

had moderate response (57.14%) and among the 2 patients (13.33%) of Sama agni, 2

patients had good response (100%).

Observations & Results 112

In Group B, among the 10 patients (66.66%) of Manda agni, 9 patients had

moderate response (90%) and 1 patient had poor response (10%) where as among the 4

patients (26.66%) of Vishama agni 3 patients (75%) moderate response and 1 patient

(25%) got poor response. and 1 patient (6.66%) of Sama agni responded moderately.

In the study as a whole (30 patients), among the 16 patients (53.33%) of Manda

agni, 3 patients had good response (18.75%), 12 patients had moderate response (75%)

and 1 patient had poor response (6.25 %) whereas among the 11 patients (36.66%) of

Vishama agni, 3 patients had good response (27.27%) and 7 patients had moderate

response (63.63%) and 1 patient (9.09%) poor response, and among the 3 patients (10%)

of Sama agni 2 patients had good response (66.66%) and 1 patient had moderate response

(33.33%).

8. A. Table No. 32. Showing the distribution of patients by Koshta in both Groups.

Koshta Group A % Group B % Total %

Madhya 6 40 3 20 9 30

Mridu 1 6.6 2 13.3 3 10

Krura 8 53.3 10 66.66 18 60

B. Table No. 33. Showing the overall response of patients by Koshta in both Groups.

Group A Group B Total Koshta

No GR MR No MR PR No GR MR PR

Madhya 6 5 1 3 3 0 9 5 4 0

Mridu 1 1 0 2 2 0 3 1 2 0

Krura 8 2 6 10 8 2 18 2 14 2

In Group A, among the 6 patients (40%) of Madhya koshta, 5 patients got good

response (83.33%) and 1 patient got moderate response (16.66%), where as the one

patient (6.6%) of Mridu koshta got good response and among the 8 patients (53.3%) of

Krura koshta, 2 patients got good response (25%) and 6 patients got moderate response

(75%).

Observations & Results 113

In Group B, all the 3 patients (20%) of Madhya koshta got moderate response

and the 2 patients (13.3%) of Mridu koshta got moderate response, whereas among the 10

patients (66.66%) of Krura koshta, 8 patients got moderate response (80%) and 2 patients

got poor response (20%).

In the study as a whole (30 patients), among the 9 patients (30%) of Madhya

koshta, 5 patients got good response (55.55%) and 4 patients got moderate response

(44.44%) where as among the 3 patients (10%) of Mridukoshta 0ne patient (33.33%) got

good response and 2 patients (66.6%) got moderate response and among the 18 patients

(60%) of Krura koshta, 2 patients got good response (11.11%), 14 patients got moderate

response (77.77%) and 2 patients got poor response (11.11%).

9. Table No. 34. Showing the distribution of patients by Nidra in both Groups.

Nidra Group A % Group B % Total %

Sukha 0 0 0 0 0 0

Alpa 10 66.6 11 73.33 21 70

Ati 0 0 0 0 0 0

Vishama 5 33.3 4 26.6 9 30

Among the 15 patients in Group A, 10 patients had alpa nidra (66.6%) and 5

patients had Vishama nidra (33.3%). Among the 15 patients in Group B, 11 patients had

Alpa nidra (73.33%) and 4 patients had Vishama nidra (26.6%). In the study as a whole

(30 patients), 21 patients had Alpa nidra (70%) and 9 patients had Vishana nidra (30%).

No patient reported with Sukha and Ati nidra in this study.

Observations & Results 114

10. Table No. 35. Showing the distribution of patients by Vyasana in both Groups.

Vyasana Group A % Group B % Total %

Smoking 3 20 3 20 6 20

Tobacco 6 40 7 46.6 13 43.33

Alcohol 4 26.6 2 13.3 6 20

Others 0 0 0 0 0 0

None 2 13.33 3 13.33 5 16.66

Among the 15 Patients in Group A, 3 patients had smooking habit (20%), 6

patients had tobacco habit (40%), 4 patients had alcohol habit (26.6%) and 2 patients had

no habits (13.33%). Among the 15 patients in Group B, 3 patients had smooking habit

(20%), 7 patients had tobacco habit (46.6%), 2 patients had alcohol habit (13.3%) and 3

patients had no habits (20%). In the study as a whole, 6 patients had smooking habit

(20%), 13 patients had tobacco habit (43.33%), 6 patients had Alcohol habit (20%) and 5

patients had no habits (16.66%). No patient reported in this study with any other habits.

11. A.Table No.36. Showing the distribution of patients by Deha prakriti in both Groups.

Deha Prakriti Group A % Group B % Total %

Vata 2 13.33 1 6.6 3 10

Pitta 0 0 0 0 0 0

Kapha 0 0 0 0 0 0

Vata-pitta 7 46.6 8 53.3 15 50

Vata-kapha 5 33.33 4 26.6 9 30

Pitta-kapha 1 6.66 2 13.3 3 10

Sannipataja 0 0 0 0 0 0

Observations & Results 115

B. Table No. 37. Showing the overall response of patients by Deha prakriti in both Groups.

Group A Group B Total Deha prakriti No GR MR No MR PR No GR MR PR Vata 2 1 1 1 1 0 3 1 2 0 Pitta 0 0 0 0 0 0 0 0 0 0 Kapha 0 0 0 0 0 0 0 0 0 0 Vata-pitta 7 4 3 8 7 1 15 4 10 1 Vata-kapha 5 2 3 4 3 1 9 2 6 1 Pitta-kapha 1 1 0 2 2 0 3 1 2 0 Sannipataja 0 0 0 0 0 0 0 0 0 0

In Group A, among the 2 patients (13.33%) of Vata prakriti, 1 patient got good

response (50%) and 1 patient got moderate response (50%). Among 7 patients (46.6%) of

Vata-pitta prakriti, 4 patients got good response (57.14%) and 3 patients got moderate

response (42.85%). Among 5 patients (33.33%)of Vata-kapha prakriti, 2 patients got

good response (40%) and 3 patients got moderate response (60%). The patient (6.66%) of

Pitta-kapha prakriti got good response.

In Group B, among the 1 patient (6.6%) of Vata prakriti got moderate response

Among the 8 patients (53.3%) of Vata–pitta prakriti 7 patients (87.5%) got moderate

response and 1 patient got poor response (12.5%). Among the 4 patients (26.6%) of Vata-

kapha prakriti 3 patients (75%) got moderate response and 1 (25%) got poor response, all

the 2 (13.3%) patients of Pitta–kapha prakriti got moderate response.

In the study as a whole (30 patients), among the 3 patients of Vata prakriti, 1

patient got good response (33.33%), 2 patients got moderate response (66.66%). Among

the 15 patients of Vata-pitta prakriti, 4 patients got good response (26.667%) and 10

patients got moderate response (66.66%). Among the 9 patients of Vata-kapha prakriti, 2

patients got good response (22.22%) and 6 patients got moderate response (66.66%) and

1 patient (11.11%) Among the 3 patients of Pitta–kapha prakriti, 1 patient got good

response (33.33%) and 2 patients got moderate response (66.66%).

Observations & Results 116

12. Table No: 38. Showing the distribution of patients by Satmya in both Groups.

Satmya Group A % Group B % Total %

Rooksha 14 93.3 13 86.6 27 90

Snigdha 1 6.6 2 13.3 3 10

Among the 15 patients in Group A, 14 patients were of Rooksha satmya (93.3%)

and 1 patient was of Snigdha satmya (6.6%). Among the 15 patients of Group B, 13

patients were of Rooksha satmya (86.6 %) and 3 patients were of snigdha satmya (10%).

of Rooksha satmya. In the study as a whole (30 patients), 27 patients were of Rooksha

satmya (90%) and 3 patients were of Snigdha satmya.(10%).

II. DATE RELATED TO THE DISEASE

1. CHIEF COMPLAINTS:

A. RUK A1. Table No. 39. Showing the distribution of patients by grades of Ruk in both Groups.

Ruk Group A % Group B % Total %

Grade 0 0 0 0 0 0 0

Grade 1 0 0 0 0 0 0

Grade 2 5 33.33 7 46.6 12 40

Grade 3 10 66.66 8 53.33 18 60

A2. Table No: 40. Showing the overall response of patients by grades of Ruk in both

Groups.

Group A Group B Total Ruk

No GR MR No MR PR No GR MR PR

Grade 0 0 0 0 0 0 0 0 0 0 0

Grade 1 0 0 0 0 0 0 0 0 0 0

Grade 2 5 3 2 7 6 1 12 3 8 1

Grade 3 10 5 5 8 7 1 18 5 12 1

Observations & Results 117

In the Group A, among the 5 patients (33.33%) of Ruk grade–2, 3 patients got

good response (60 %) and 2 patients got moderate response (40 %); among the 10

patients (66.66%) of Ruk grade–3, 5 patients good response (50 %) and 5 patients got

moderate response (50 %).

In the Group B, among the 7 patients (46.66%) of Ruk grade–2, 6 patients got

moderate response (85.7%) and 1 patient got poor response (14.28%); among the 8

patients (53.33%) of Ruk grade–3, 7 patients got moderate response (87.5 %) and 1

patient got poor response (12.5%).

In the study as a whole (30 patients), among 12 patients (40%) of Ruk grade–2, 3

patients got good response (25%), 8 patients got moderate response (66.66%) and one

patient got poor response (12.5%); whereas among the 18 patients (60%) of Ruk grade–3,

5 patients got good response (27.77%), 12 patients got moderate response (66.66%) and 1

patient got poor response (5.55%).

B. GRAHA

B1. Table No41. Showing the distribution of patients by grades of Graha in both Groups.

Graha Group A % Group B % Total %

Grade 0 0 0 0 0 0 0

Grade 1 15 100 15 100 30 100

B2. Table No 42. Showing the overall response of patients by grades of Graha in both

Groups.

Group A Group B Total Graha

No GR MR No MR PR No GR MR PR

Grade 0 0 0 0 0 0 0 0 0 0 0

Grade 1 15 8 7 15 13 2 30 8 20 2

Observations & Results 118

In Group A among the 15 patients of grade–1 Graha, 8 patients got good response

(53.33%) and 7 patients got moderate response (46.66 %).

In Group B among the 15 patients of grade–1 Graha, 13 patients got moderate

response (86.66%) and 2 patient got poor response (13.33%).

In the study as a whole (30 patients), among the 30 patients of grade–1 Graha, 8

patients got good response (26.66%), 20 patients got moderate response (66.66%) and 2

patient got poor response (6.6%).

C. 1. SPARSHAAKSHAMATVA

Table No. 43. Showing the distribution of patients by grades of Sparsha akshmatva in

both Groups.

Sparsha

Akshamatva

Group A % Group B % Total %

Grade 0 3 20 3 20 6 20

Grade 1 3 20 7 46.66 10 33.33

Grade 2 9 60 5 33.33 14 46.66

Grade 3 0 0 0 0 0 0

C. 2. Table No. 44. Showing the overall response of patients by grades of Sparsha

akshmatva in both Groups.

Group A Group B Total Sparshaak

-shamatva No GR MR No MR PR No GR MR PR

Grade 0 3 1 2 3 3 0 6 1 5 0

Grade 1 3 2 1 7 6 1 10 2 7 1

Grade 2 9 5 4 5 4 1 14 5 8 1

Grade 3 0 0 0 0 0 0 0 0 0 0

Observations & Results 119

In the Group A, among the 3 patients (20%) of grade-0, 1 patient got good

response (33.33%) and 2 patients got moderate response (66.66%); whereas among the 3

patients (20%) of grade–1, 2 patients got good response (66.66%) and 1 patient got

moderate response (33.33%) and among the 9 patients (60%) of grade–2, 5 patients got

good response (55.55%) and 4 patients got moderate response (44.44%).

In the Group B, among the 3 patients (20%) of grade–0, 3 patients got moderate

response, whereas among the 7 patients (46.66%) of grade–1, 6 patients (85.71%) got

moderate response and 1 patient (14.28%) got poor response and among the 5 patients

(33.33%) of grade–2, 4 patients moderate response (80%) and 1 patient got poor response

(20%).

In the study as a whole (30 patients), among the 6 patients (20%) of grade–0, 1

patient got good response (16.66%), 5 patients got moderate response (83.33%) where as

among the 10 patients (33.33%) of grade–1, 2 patients got good response (20%) and 7

patients got moderate response (70%) and patient (10%) got poor response ; among the

14 patients (46.66%) of grade–2, 5 patients got good response (35.71%) and 8 patients

got moderate response (57.14%) and 1 patient (7.14%) got poor response .

D.1. Table No. 45. Showing the distribution of patients by grades of Sandhigati

asamarthya in both Groups.

Sandhigati

Asamarthya

Group A % Group B % Total %

Grade 0 0 0 0 0 0 0

Grade 1 11 73.33 5 33.33 16 53.33

Grade 2 4 26.66 10 66.66 14 46.66

Grade 3 0 0 0 0 0 0

Grade 4 0 0 0 0 0 0

Observations & Results 120

D. 2. Table No. 46. Showing the overall response of patients by grades of Sandhigati

asamarthya in both Groups.

Group A Group B Total Sandhigati

asaamarthya No GR MR No MR PR No GR MR PR

Grade 0 0 0 0 0 0 0 0 0 0 0

Grade 1 11 5 6 5 4 1 16 5 10 1

Grade 2 4 3 1 10 9 1 14 3 10 1

Grade 3 0 0 0 0 0 0 0 0 0 0

Grade 4 0 0 0 0 0 0 0 0 0 0

In the Group A, among the 11 patients (73.33%) with grade–1, 5 patients got

good response (45.44%) and 6 patients got moderate response (54.54%) where as among

the 4 patients (26.66%) with grade–2, 3 patients got good response (75 %) and 1 patients

got moderate response (25%).

In the Group B, among the 5 patients (33.33%) with grade–1,4 patients (80%) got

moderate response 1 patient (20%) got poor response . while among the 10 patients

(66.66%) with grade–2, 9 patients got moderate response (90%) and 1 patient got poor

response (10%).

In the study as a whole (30 patients), among the 16 patients (53.33%) of grade–1,

5 patients got good response (31.25%) and 10 patients got moderate response (62.25%), 1

patient got poor response (12.5%) .Where as among the 14 patients (46.66%) with grade

2, 3 patients got good response (21.41%), 10 patients got moderate response (71.14%)

and 1 patient got poor response (7.14%).

Observations & Results 121

E. ATOPA

E1. Table No. 47. Showing the distribution of patients by grades of Atopa in both

Groups.

Atopa Group A % Group B % Total %

Grade 0 4 26.66 4 26.66 8 26.66

Grade 1 10 66.66 11 73.33 21 70

Grade 2 1 6.66 0 0 1 3.33

E. 2. Table No. 48. Showing the overall response of patients by grades of Atopa in both

Groups.

Group A Group B Total Atopa

No GR MR No MR PR No GR MR PR

Grade 0 4 3 1 4 3 1 8 3 4 1

Grade 1 10 5 5 11 10 1 21 5 15 1

Grade 2 1 0 1 0 0 0 1 0 0 1

In the Group A, among the 4 patients (26.66%) with grade-0 Atopa, 3 patients had

good response (75%) and 1 patient had moderate response (25%); whereas among the 10

patients (66.66%) with grade-1 Atopa 5 patients had good response (50%) and 5 patients

had moderate response (50%), 1 patient (6.66%) of grade-2 got moderate response.

In the Group B, among the 4 patients (26.66%) with grade-0 Atopa, 3 patients had

moderate response (66.66%), 1 patient had poor response (33.33%); where as among the

11 patients (73.33%) with grade-1 Atopa 10 patients had moderate response(90.9%) and

1 patient got poor response (9.09%).

In the study as a whole, among the 8 patients (26.66%) with grade-0 Atopa, 3

patients had good response (37.5%) and 4 patients had moderate response (50%) and 1

patient had poor response (12.5%); whereas among the 21 patients (70%) with grade-1

Atopa, 5 patients had good response (23.80%) and the 15 patients had moderate response

(71.42%) and the 1 patient got poor response(4.76%), 1 patient (3.33%) with grade-2

Atopa had poor response.

Observations & Results 122

F. SHOTHA

F.1. Table No.49. Showing the distribution of patients by grades of Shotha in both

Groups.

Shotha Group A % Group B % Total %

Grade 0 4 26.6 5 33.33 9 30

Grade 1 6 40 4 26.6 10 33.33

Grade 2 4 26.6 6 40 10 33.33

Grade 3 1 6.66 0 0 1 3.33

F2. Table No. 50. Showing the overall response of patients by grades of Shotha in both

Groups.

Group A Group B Total Shotha

No GR MR No MR PR No GR MR PR

Grade 0 4 3 1 5 5 0 9 3 6 0

Grade 1 6 2 4 4 3 1 10 2 7 1

Grade 2 4 4 0 6 5 1 10 4 5 1

Grade 3 1 0 1 0 0 0 1 0 1 0

In the Group A, among the 4 patients (26.66%) with grade-0, 3 patients got good

response (75%) and 1 patients got moderate response (25%); where as among the 6

patients (40%) with grade-1, 2 patients got good response (33.33%) and 4 patients got

moderate response (66.66%) and the 4 patients (26.66%) with grade-2, all got good

response and 1 patient (6.66%) with grade-3 got moderate response.

In the Group B, among the 5 patients (33.33%) with grade-0, all 5 patients got

moderate response, whereas among the 4 patients (26.66%) with grade-1, 3 patients got

moderate response (75%) and 1 patient got poor response (25%). Among the 6 patients

(40%) with grade-2, 5 patients got moderate response (83.33%) and 1 patient got poor

response (16.66%).

Observations & Results 123

In the study as a whole (30 patients), among the 9 patients (30%) with grade-0, 3

patients got good response (33.33%), 6 patients got moderate response (66.66%), where

as among the 10 patients (33.33%) with grade-1, 2 patients got good response (20%) and

7 patients got moderate response (70%) and 1 patient got poor response (10%); among

the 10 patients (33.33%) with grade-2, 4 patients got good response (40%) and 5 patients

got moderate response( 50%) and 1 patient got poor response (10%) the only 1 patient

(3.33%) with grade-3 got moderate response.

G. Table No. 51. Showing the distribution of patients by presenting complaints.

Sl. Presenting complaint No. of Pt.’s %

1 Prasarana akunchanayoho savedana pravritti 26 86.66

2 Ruk 30 100

3 Vatapoorna dritisparsha 3 10

4 Shopha 21 70

5 Sandhigraha 30 100

6 Sandhigati asaamarthya 30 100

7 Sparsha akshamatva 24 80

8 Atopa 22 73.33

Among the 30 patients included in this study, all the patients had the symptoms

Ruk, Sandhi graha and Sandhigati asaamarthya. 26 patients had the symptom prasarana

akunchanayoho savedana pravritti (86.66%). Only 3 patients had the symptom

Vatapoorna dritisparsha (10%) whereas 21 patients had the symptom Shopha (70%) and

24 patients had the symptom Sparsha akshamatva (80%) and 22 patients had the

Symptom Atopa (73.33%).

Observations & Results 124

2.A. Table No. 52 Showing the distribution of patients by chronicity in both Groups.

Chronicity Group A % Group B % Total %

>2 years (A) 5 33.33 2 13.33 7 23.33

1-2years (B) 7 46.66 10 66.66 17 56.66

<1year (C) 3 20 3 20 6 20

2. B. Table No. 53. Showing the overall response of patients by Chronicity of the disease

in both Groups.

Group A Group B Total Duration No GR MR No MR PR No GR MR PR

>2 years (A) 5 4 1 2 1 1 7 4 2 1

1-2years (B) 7 3 4 10 9 1 17 3 13 1

<1year (C) 3 1 2 3 3 0 6 1 5 0

In the Group A, among the 5 patients (33.33%) with >2 years duration, only 4

patient had good response (80%) while 1 patient had moderate response (20%); among

the 7 patients (46.66%) with 1-2 years duration, 3 patients had good response (42.85%)

while 4 patients had moderate response (57.14%); among the 3 patients (20%) with <1

year duration, 1 patient had good response (33.33%) while 2 patients had moderate

response (66.66%).

In the Group B, the 2 patients (13.33%) with >2 years, 1 patient got moderate

response and 1 patient got poor response. Among the 10 patients (66.66%) with 1-2 years

duration, 9 patients got moderate response (90%) and 1 patient got poor response (10%),

while among the 3 patients (20%) with <1 year duration, all patients got moderate

response.

In the study as a whole (30 patients), among the 7 patients (23.33%) with > 2

years duration, 4 patients got good response (57.14%) and 2 patients got moderate

response (28.57 %) and 1 patient got poor response (14.28%), among the 17 patients

(56.66%) with 1-2 years duration, 3 patients got good response (17.64%) and 13 patients

got moderate response (76.47%) and 1 patient got poor response (5.88%), among the 6

patients (20%) with <1 year duration, 1 patient got good response (16.66%), 5 patients

got moderate response (83.33%).

Observations & Results 125

3.A. Table No. 54. Showing the distribution of patients by Mode of onset in both Groups.

Mode of Onset Group A % Group B % Total %

Chronic 11 73.33 12 80 23 76.66

Insidious 4 26.66 1 6.66 5 16.66

Acute 0 0 1 6.66 1 3.33

Traumatic 0 0 1 6.66 1 3.33

3.B. Table No. 55 Showing the overall response of patients by Mode of onset of the

disease in both Groups.

Group A Group B Total Mode of

onset No GR MR No MR PR No GR MR PR

Chronic 11 5 6 12 12 0 23 5 18 0

Insidious 4 3 1 1 1 0 5 3 2 0

Acute 0 0 0 1 0 1 1 0 0 1

Traumatic 0 0 0 1 0 1 1 0 0 1

In the Group A, among 11 patients (73.33%) of chronic onset, 5 patients got good

response (45.45%) and 6 patients got moderate response (54.54%); among the 4 patients

(26.66%) of insidious onset, 3 patient got good response (75%) and 1 patients got

moderate response (25%);

In the Group B, all the 12 patients (80%) of chronic onset got moderate response

1 patient (6.66%) of insidious onset got moderate response, while the 1 patient (6.66%)

of acute onset got poor response and 1 patient (6.66%) of traumatic onset got poor

response.

In the study as a whole (30 patients), among the 23 patients (76.66%) of chronic

onset, 5 patients got good response (21.73%) and 18 patients got moderate response

(78.26%); among the 5 patients (16.66%) of insidious onset, 3 patient got good response

(60%) and 2 patients got moderate response (40%), both the patients of acute and

traumatic onset got poor response.

Observations & Results 126

4. 1.A Table No. 56. Showing the distribution of patients by Aharaja nidana in both

Groups.

Aharaja Nidana Group A % Group B % Total %

Tikta rasa 2 13.33 2 13.33 4 13.33

Kashaya rasa 5 33.33 6 40 11 36.6

Katu rasa 13 86.6 14 93.33 27 90

Alpa bhojana 8 53.33 10 66.66 18 60

Pramita bhojana 1 6.6 2 13.33 3 10

Rooksha bhojana 12 80 12 80 24 80

4.1. B Table No. 57. Showing the overall response of patients by Aharaja nidana of the

disease in both Groups:

Group A Group B Total Aharaja nidana No GR MR No MR PR No GR MR PR

Tikta rasa

2 1 1 2 1 1 4 1 2 1

Kashaya rasa

5 4 1 6 6 0 11 4 7 0

Katu rasa

13 7 6 14 14 0 29 7 20 0

Alpa bhojana

8 3 5 10 9 1 18 3 14 1

Pramita bhojana

1 0 1 2 2 0 3 0 3 0

Rooksha bhojana

12 6 6 12 11 1 24 6 17 1

In Group A, among 2 patients (13.33%) having Tikta rasa nidana, 1 patients got

good response (50%) and 1 patient got moderate response (50%); among 5 patients

(33.33%) having Kashaya rasa nidana, 4 patients got good response (80%) and 1 patient

got moderate response (20%); among 13 patients (86.6%) having Katu rasa nidana, 7

patients got good response (53.84%) and 6 patients got moderate response (46.15%);

Observations & Results 127

among 8 patients (53.33%) having Alpa bhojana nidana, 3 patients got good response

(37.5%) and 5 patients got moderate response (62.5%); among 1 patient (6.66%) having

pramita bhojana got moderate response; among 12 patients (80%) having rooksha

bhojana nidana, 6 patients had good response (50%) and 6 patients had moderate

response (50%).

In Group B, the 2 patients (13.33%) having Tikta rasa nidana 1 patient got

moderate response and 1 patient got poor response. all the 6 patients(40%) having

Kashaya rasa nidana got moderate response; all the 14 patients (93.33%) having Katu

rasa nidana got moderate response; among the 10 patients (66.66%) having Alpa bhojana

nidana, 9 patients got moderate response (90%) and 1 patient got poor response (10%);

all the 2 patients (13.33%) having Pramita bhojana got moderate response; among the 12

patients (80%) having Rooksha bhojana nidana, 11 patients got moderate response

(91.66%) and 1 patient got poor response (8.33%).

In the study as a whole (30 patients), among the 4 patients (13.3%) of Tikta rasa

nidana, 1 patient got good response (25%) and 2 patients got moderate response (50%)

and 1 patient got poor response (25%); among the 11 patients (36.66%) of Kashaya rasa

nidana 4 patients got good response (36.36%) and 7 patients got moderate response

(63.36%); among the 27 patients (90%) of Katu rasa nidana, 7 patients got good response

(25.92%), 20 patients got moderate response (74%); among the 18 patients (60%) of Alpa

bhojana nidana, 3 patients got good response (16.66%) and 14 patients got moderate

response (77.77%) and 1 patient got poor response (5.55%); all the 3 patients (10%) of

Pramita bhojana got moderate response; among the 24 (80%) patients of Rooksha

bhojana, 6 patients got good response (25%), 17 patients got moderate response (70.8%)

and 1 patient got poor response (4.16 %).

Observations & Results 128

4.2. A Table No. 58. Showing the distribution of patients by Viharaja nidana in both Groups.

Viahraja Nidana Group A % Group B % Total %

Vega dharana 11 73.33 10 66.66 21 70

Vega udeerana 2 13.33 5 33.3 7 23.33

Ati vyavaya 1 6.66 0 0 1 3.33

Nisha jagarana 9 60 9 60 18 60

Atyucha bhashana 1 6.66 3 20 4 13.33

Ativyayama 10 66.66 9 60 19 63.3

4.2. B Table No. 59. Showing the overall response of patients by Aharaja nidana of the

disease in both Groups.

Group A Group B Total Viharaja nidana No GR MR No MR PR No GR MR PR

Vega dharana

11 6 5 10 9 1 21 6 11 1

Vega udeerana

2 1 1 5 5 0 7 1 6 0

Ati vyavaya 1 0 1 0 0 0 1 0 1 0 Nisha jagarana

9 6 3 9 9 0 18 6 12 0

Athyucha bhashana

1 1 0 3 3 0 4 1 3 0

Ativyayama 10 5 5 9 8 1 19 5 13 1 In the Group A, among 11 patients (73.33%) of Vega dharana nidana, 6 patients

had good response (54.54%) and 5 patients had moderate response (45.45%); among the

2 patients (13.33%) of Vega udeerana 1 patient got good response and 1 patient got

moderate response ; 1 patient (6.66%) of Ativyavaya got moderate response ; among 9

patients (60%) of Nisha jagarana, 6 patients had good response (66.66%) and 3 patients

had moderate response (33.33%); 1 patients of Athyucha bhashana got good response ;

among the 10 patients (66.66%) of Ativyayama, 5 patients got good response (50%) and

5 patients got moderate response (50%).

Observations & Results 129

In the Group B, among 10 patients (66.66%) of Vega dharana nidana, 9 patients

had moderate response (90%) and 1 patient had poor response (10%); all the 5 patients

(33.33%) of Vega udeerana, 9 patients (60%) of Nisha jagarana and 3 patients (20%) of

Athyucha bhashana had moderate response; among the 9 patients (60%) of Ativyayama,

8 patients had moderate response (88.88%) and 1 patient had poor response (11.11%).

In the study as a whole (30 patients), among the 21 patients (70%) of Vega

dharana nidana, 6 patients had good response (28.57%), 11 patients had moderate

response (52.38%) and 1 patient had poor response (7.76%); among 7 patients (23.33%)

of Vega udeerana one patient had good response (14.28%) and 6 patients had moderate

response (85.71%); 1 patient (3.33%) of Ati vyavaya had moderate response; among the

18 patients (60%) of Nisha jagarana, 6 patients had good response (33.33%) and 12

patients had moderate response (66.66%); among the 4 patients (13.33%) of Athyucha

bhashana, 1 patient had good response (25%) and 3 patients had moderate response

(75%); among the 19 patients (63.3%) of Ativyayama, 5 patients got good response

(26.31%), 13 patients got moderate response (68.42%) and 1 patient got poor response

(5.26 %).

Observations & Results 130

4.3 Table No. 60. Showing the distribution of Patients by various Manasika Vatakopa

nidanas in both the treatment Groups (A &B):

Manasika

Nidana

Group A % Group B % Total %

Bhaya 1 6.66 3 20 4 13.33

Shoka 1 6.66 1 6.66 2 6.66

Chinta 12 80 8 53.33 20 66.66

Among the 15 patients in Group A, Only 1 patient had Bhaya (6.66%),1 patient

had Shoka (6.66%) and 12 patients had Chinta (80%). Among the 15 patients in Group B,

Only 3 patient had Bhaya (20%),1 patient had Shoka (6.66%) and 8 patients had Chinta

(53.33%). In the study whole (30 patients), 4 patients had Bhaya (13.33%), 2 patients

had Shoka (6.66%), and 20 patients had Chinta (66.66%).

5. Table No: 61. Showing the distribution of patients by Radiological interpretation in

both Groups.

Radiological

interpretation

Group A % Group B % Total %

Incr. 2 13.33 0 0 2 6.66

Decr. 10 66.66 9 60 19 63.33

Joint

space

Unalt. 3 20 2 13 33 5 16.66

Sub. Bon. Scl. 4 26.66 3 20 7 23.33

Osteophytes 15 10 14 93.33 29 96.66

Peri.Art.Oss. 1 6.66 1 6. 66 2 6.66

Alt. Bne. End 0 0 0 0 0 0

Among the 30 patients in this study, 2 patients had their affected joint space

increased (6.66%), 19 patients had their affected joint space reduced (63.33%), 5 patients

had their affected joint space unaltered (16.66%), 7 patients had subchondral bony

sclerosis (23.33%), 29 patients had osteophytes formation (96.66%), 2 patients had

periarticular ossicles (6.66%) and no patient had altered bone end.

Observations & Results 131

III. Data Related to Overall Response to the treatment

III. Table No. 62. Showing the overall response in both Groups.

Response Group A % Group B % Total %

Good 8 53.33 0 0 8 26.6

Moderate 7 46.66 13 86.66 20 66.6

Poor 0 0 2 13.33 2 6.6

No response 0 0 0 0 0 0

In Group A, 8 patients (53.33%) had good response to the treatment (> 60%

improvement in all the parameters) and 7 patients (46.66%) had moderate Response to

the treatment (31-60% improvement in all the parameters). In Group B, 13 patients

(86.66%) had moderate response to the treatment and 2 patients (13.33%) had poor

response to the treatment (1-30% in all the parameters). In the study as a whole, 8

patients (26.6%) had good response, 20 patients (66.6%) had moderate response and 2

patient (6.6%) had poor response.

Observations & Results 132

IV. Statastical analysis of the Subjective and Objective Parameters & InterGroup comparision Table No. 63. Showing the before and after treatment values of all parameters in Gr. A.

Subjective parameters

0bjective parameters

Ruk Graha Sp.Ak. SGA Atopa Shotha Walking time

Sl. No.

OPD No.

B A B A B A B A B A B A B A 01. 5193 3 2 1 0 3 2 1 3 1 0 0 0 45 33 02. 5198 2 1 1 0 3 1 1 3 1 0 0 0 58 42 03. 1503 3 2 1 0 3 1 1 3 1 1 0 0 42 34 04. 204 3 2 1 1 3 2 1 3 1 0 1 0 56 36 05. 1224 3 2 1 1 2 2 1 2 2 1 1 0 45 48 06. 1015 3 1 1 1 2 2 1 2 1 1 1 0 44 35 07. 991 2 1 1 0 3 0 1 3 1 0 0 0 38 26 08. 5427 2 1 1 0 3 2 1 3 0 0 1 0 43 38 09. 2566 2 1 1 0 3 2 2 3 0 0 2 1 55 45 10. 5210 3 2 1 0 2 2 1 2 1 0 3 2 56 48 11. 5265 3 2 1 1 3 1 2 3 0 0 2 1 58 37 12. 5189 2 1 1 0 3 2 1 3 1 0 1 1 42 32 13. 706 3 2 1 0 3 0 2 3 0 0 1 0 54 47 14. 1992 2 1 1 0 3 2 2 3 1 0 2 1 46 33 15. 1223 2 1 1 0 3 0 1 3 1 0 2 1 56 38 Table No. 64. Showing before and after treatment values of all parameters in Gr. B.

Subjective parameters

0bjective parameters

Ruk Graha Sp.Ak. SGA Atopa Shotha Walking time

Sl. No.

OPD No.

B A B A B A B A B A B A B A 16 1185 3 1 1 0 2 1 1 2 1 0 1 1 44 42 17 2243 2 1 1 0 1 1 2 3 0 0 2 1 48 46 18 5225 2 1 1 0 1 1 2 3 1 1 1 0 48 36 19 5263 3 1 1 0 1 0 1 2 1 0 2 1 56 48 20 1315 3 2 1 0 2 1 2 3 1 1 2 1 43 42 21 0902 3 1 1 0 0 0 1 2 0 0 0 0 55 44 22 1070 2 0 1 1 0 0 2 2 0 0 0 0 57 56 23 5293 2 0 1 0 0 0 2 3 0 0 0 0 58 57 24 5120 2 1 1 1 2 1 1 2 1 0 1 0 42 34 25 5010 3 2 1 0 1 1 2 3 1 1 2 1 59 42 26 5176 3 1 1 0 2 1 2 3 1 1 2 0 52 52 27 5466 3 1 1 0 1 0 1 2 1 1 0 0 47 35 28 5160 3 1 1 0 1 1 2 3 1 0 2 1 42 32 29 1450 3 1 1 1 1 0 2 3 1 1 1 0 56 54 30 5299 3 1 1 0 2 1 2 3 1 0 0 0 35 33

Observations & Results 133

Table No. 65. Showing the individual study of Group-A

Parameters Mean S.D S.E t-value p-value Remarks

Ruk 1.066 0.258 0.066 16.15 <0.001 H.S.

Graha 0.866 0.352 0.09 9.62 <0.001 H.S.

Sparsha akshamatva 0.933 0.594 0.153 6.09 <0.001 H.S.

Sandhigati asamarthya 1.533 0.156 0.04 38.32 <0.001 H.S.

Shotha 0.666 0.488 0.126 5.285 <0.001 H.S.

Atopa 0.6 0.507 0.13 4.615 <0.001 H.S.

Walking time 11.3 5.576 1.439 7.873 <0.001 H.S.

Table No. 66. Showing the individual study of Group-B

Parameters Mean S.D S.E t-value p-value Remarks

Ruk 1.667 0.488 0.126 13.23 <0.001 H.S.

Graha 0.8 0.414 0.106 7.547 <0.001 H.S.

Sparsha akshamatva 0.6 0.507 0.13 4.615 <0.001 H.S.

Sandhigati asamarthya 0.533 0.516 0.13 4.1 <0.01 H.S.

Shotha 0.666 0.617 0.159 4.18 <0.001 H.S.

Atopa 0.333 0.487 0.125 2.664 <0.02 H.S.

Walking time 6.8 5.08 1.313 5.17 <0.001 H.S.

Table No. 67. Showing the inter Group comparison.

Parameters Group Mean S.D S.E P.S.E t-value

p-value

Remarks

A 1.466 0.516 0.133Ruk B 1.0 0.534 0.137

0.191 2.44 <0.05 HS

A 0.133 0.352 0.09 Graha B 0.2 0.414 0.106

0.139 0.482 >0.05 NS

A 0.466 0.516 0.133Sparsha akshamatva B 0.6 0.507 0.131

0.186 0.720 >0.05 NS

A 2.8 0.414 0.106Sandhigati asamarthya B 2.6 0.507 0.131

0.168 1.19 >0.05 NS

A 0.467 0.639 0.165Shotha B 0.4 0.507 0.131

0.21 0.319 >0.05 NS

A 0.2 o.414 0.106Atopa B 0.4 o.507 0.131

0.168 1.19 >0.05 NS

A 37.866 6.22 1.606Walking time B 43.46 8.416 2.173

2.702 2.070 <0.05 HS

Observations & Results 134

When we compare the Group A and B the parameter Ruk and Walking time

shows. Highly significant than the other by comparing the mean effect of the two Groups

after the treatment (As P<0.05). But all other parameters shows non significant. The

mean effect after treatment in the parameter Graha , Sandhigati asamarthy, Sopha is more

in Group –A with less variationce. (By comparing mean, S.D).

Indivisually both the two Groups shows highly significant before and after the

treatment (By comparing P-values). But Group-A more highly significant than Group-B

in all the parameters (By comparing t-values).

The mean net effect of the parameter Walking time, Sandhigati asamarthy, and

Sparsha akshamatva is more in Group-A with more variation (By comparing mean, S.D.)

Overall the Group-A is more significant than Group-B in all the parameters. (By

comparing t- value).

In Group A, 53.33% patients had good response and 46.33% patients had moderate

response to the treatment. Where as in Group-B, 86% patients had moderate response and

13.33% patients had poor response to the treatment hence it conveys that the Parisheka

and Matrabasti group responded in comparision wiyh the Parisheka group.

Observations & Results 135

I

Graph No. 01. Showing the distribution of patients by Age in both groups.

Distribution of Pt.'s by Age in both Groups

15

9

03

12

1

8

21

0

5

10

15

20

25

35-44 45-54 55-64

Age groups

No.

of P

t.'s

Group A Group B Total

Graph No. 02. Showing the distribution of patients by Sex in both groups.

Distribution of Pt.'s by Sex in both groups

69

7 8

13

17

0

5

10

15

20

Male Female

Sex

No.

of P

t.'s

Group A Group B Total

Graph No. 03. Showing the distribution of patients by Occupation in both groups.

Distribution of Pt.'s by Occupation in both Grs

4

7

4

0

6 7

20

10

14

6

002468

10121416

Sed Act Lab Oth

Occupation

No.

of P

t.'s

Group A Group B Total

II

Graph No. 04. Showing the distribution of patients by Economical status in both groups.

3

75

7 7

1

10

14

6

02468

10121416

Poor Middle class High class

Economical Status

No.

of P

t.'s

Group A Group B Total

Distribution of Pt.’s by Economical status in both groups

Graph No. 05. Showing the distribution of patients by Religion in both groups.

Distribution of Pt.'s by Religion in both Grs

11

40

14

1 0

25

50

05

1015202530

Hindu Muslim Christian

Religions

No.

of P

t.'s

Group A Group B Total

Graph No. 06. Showing the distribution of patients by Dietary habits in both groups.

5

108

7

13

17

02468

1012141618

Vegetarian MixedDietary Habits

No.

of P

t.'s

Group A Group B Total

Distribution of Pt.’s by Dietary habits in both groups

III

Graph No. 07. Showing the distribution of patients by Agni in both groups.

Distribution of Pt.'s by Agni in both Grs

6

0

7

2

10

0

41

16

0

11

3

0

5

10

15

20

Md Tk Vi Sa

Agni

No.

of P

t.'s

Group A Group B Total

Graph No. 08. Showing the distribution of patients by Koshta in both groups.

Distribution of Pt.'s by Koshta in both Grs

6

1

8

3 2

109

3

18

0

5

10

15

20

Madhya Mridu Krura

Koshta

No.

of P

t.'s

Group A Group B Total

Graph No. 09. Showing the distribution of patients by Nidra in both groups.

Distribution of Pt.'s by Nidra habits in both

grs

0

10

0

5

0

11

04

0

21

0

9

0

5

10

15

20

25

Sukha Alpa Ati Vishama

Nidra Habits

No.

of P

t.'s

Group A Group B Total

IV

Graph No. 10. Showing the distribution of patients by Vyasana in both groups.

Distribution of Pt.'s by Vyasana in both Grs

3

64

02

3

7

20

3

6

13

6

0

5

02468

101214

Smk Tbc Alc Oth None

Vyasana

No.

of P

t.'s

Group A Group B Total

Graph No. 11. Showing the distribution of patients by Prakriti in both groups.

20 0

75

10

10 0

8

42

0

3

0 0

15

9

3

002468

10121416

V P K VP VK PK T

Deha Prakriti

No.

of P

t.'s

Group A Group B Total

Distribution of Pt.’s by Deha prakriti in both groups

Graph No. 12. Showing the distribution of patients by Satmya in both groups.

Distribution of Pt.'s by Satmya in both Grs

14

1

13

2

27

3

0

5

10

15

20

25

30

Rooksha Snigdha

Satmya

No.

of P

t.'s

Group A Group B Total

V

Graph No. 13. Showing the distribution of patients by different grades of Ruk in both

groups. Distribution of Pt.'s by Ruk in both Groups

0 0

5

10

0 0

7 8

0 0

12

18

0

5

10

15

20

Grade 0 Grade 1 Grade 2 Grade 3

Ruk assessment Gradings

No.

of P

t.'s

Group A Group B Total

Graph No. 14. Showing the distribution of patients by different grades of Graha in both

groups. Distribution of Pt.'s by Graha in both Groups

0

15

0

15

0

30

0

5

10

15

20

25

30

Grade 0 Grade 1

Graha assessment Gradings

No.

of P

t.'s

Group A Group B Total

Graph No. 15. Showing the distribution of patients by different grades of

Sparshaakshmatva in both groups.

3 3

9

0

3

75

0

6

10

14

002468

10121416

Grade 0 Grade 1 Grade 2 Grade 3

Sparshaakshamatva assement gradings

No.

of P

t.'s

Group AGroup BTotal

Distribution of Pt.’s by Sparshaakshmatva in both groups

VI

Graph No. 16. Showing the distribution of patients by different grades of Sandhigati

asamarthya in both groups.

0

11

4

0 00

5

10

0 00

1614

0 002468

1012141618

Grade 0 Grade 1 Grade 2 Grade 3 Grade 4

Sandhigati Asamarthya assessment gradings

No.

of P

t.'s

Group AGroup BTotal

Distribution of Pt.’s by Sandhigati Asamarthya in both groups

Graph No. 17. Showing the distribution of patients by different grades of Atopa in both

groups

Distribution of Pt.'s by Atopa in both Groups

4

10

14

11

0

8

21

10

5

10

15

20

25

Grade 0 Grade 1 Grade 2

Atopa assessment gradings

No.

of P

t.'s

Group A Group B Total

Graph No. 18. Showing the distribution of patients by different grades of Shotha in both

groups Distribution of Pt.'s by Shotha in both Groups

4

6

4

1

54

6

0

910 10

1

0

2

4

6

8

10

12

Grade 0 Grade 1 Grade 2 Grade 3

Shotha assessement gradings

No.

of P

t.'s

Group A Group B Total

VII

Graph No. 19. Showing the distribution of patients by Presenting complaints in both

groups. Distribution of Pt.'s by presenting complaints

2630

3

21

30 30

24 22

05

101520253035

A B C D E F G H

Presenting complaint

No.

of P

t.'s

No. of Patients

Graph No. 20. Showing the distribution of patients by Chronicity in both groups.

Distribution of Pt.'s by Chronicity in both Grs

57

32

10

3

7

17

6

02468

1012141618

>2 years (A) 1-2years (B) <1year (C)

Chronicity

No.

of P

t.'s

Group A Group B Total

Graph No. 21. Showing the distribution of patients by Mode of onset in both groups.

Distribution of Pt.'s by Mode of onset in both Grs

11

4

0 0

12

1 1 1

5

1 1

23

0

5

10

15

20

25

Chr Ins Ac Tr

Mode of Onset

No.

of P

t.'s

Group A Group B Total

VIII

Graph No. 22. Showing the distribution of patients by Aharaja Nidana in both groups.

Distribution of Pt.'s by Aharaja Nidana in both Groups

25

13

8

1

12

26

1410

2

12

4

11

27

18

3

24

0

5

10

15

20

25

30

A B C D E FAharaja Nidana

No.

of P

t.'s

Group A Group B Total

Graph No. 23. Showing the distribution of patients by Viahraja nidana in both groups.

Distribution of Pt.'s by VIharaja Nidana in both Grs

11

2 1

9

1

1010

5

0

9

3

9

21

7

1

18

4

19

0

5

10

15

20

25

A B C D E F

Viharaja Nidana

No.

of P

t.'s

Group A Group B Total

Graph No. 24. Showing the distribution of patients by Manasika nidana in both groups.

1 1

12

31

8

42

20

0

5

10

15

20

25

Bhaya Shoka Chinta

Manasika Nidana

No.

of P

t.'s

Group A Group B Total

Distribution of Pt.’s by Manasika Nidana in both groups

IX

Graph No. 25. Showing the distribution of patients by Overall response in both groups.

8 7

0 00

13

20

8

20

20

0

5

10

15

20

25

GR MR PR NR

Overall response

No.

of P

t.'s

Group A Group B Total

Distribution of Pt.’s by Overall response in both groups

Science is the only media to observe and analyze the all kinds of events in the

universe. The systematic arrangement of facts and events, ascertained by observations

and interpretation makes the facts a part of the science.

Discussions on the study are made under the following headings:

1. Sandhigatavata vis-à-vis Osteoarthritis

2. Probable mode of action of Parisheka in the management of Sandhigatavata

3. Probable mode of action of Matrabasti in the management of Sandhigatavata

4. Clinical study

SANDHIGATAVATA vis-à-vis OSTEOARTHRITIS

Sandhigatavata is the most common joint disorder arising with greater number of

affected population in the world. It comes under the various Gatavatas explained in

Vatavyadhi prakarana. It is caused by the localization of the vitiated Vata dosha in the

asthi sandhis of the body. It is characterized by the symptoms pertaining to the asthi

sandhis like sandhi shoola, sandhi shotha etc.

Osteoarthritis is a disease coming under the arthritis group of diseases described

by the modern science, which is almost identical to Sandhigatavata in etiology, pathology

and clinical features. Hence, the discussion is made accordingly.

Discussion On Shareera

In the context of Asthi sandhi means a junction between two or more bones.

Sandhi is not a single structure rather it is considered as an organ. There are different

structures, which supports the stability of the joint like Sanyu or ligament, which helps in

proper binding of the joint. They unite the bones and help to direct the bone movement

and prevent the excessive and undesirable motion. Muscle tone helps to maintain the

Discussion 136

alignment of the joint. Shleshaka Kapha present in the Sandhis provides the lubricant

factors, Shleshmadharakala situated in the joints supported by Shleshaka Kapha helps in

lubrication. Functions of the Shleshaka Kapha and Shleshmadhara kala described in

Ayurveda can be co-related to the synovial fluid situated in synovial joint that lubricates

the knee joint, a nutrient carrier to the cartilage, disc, and helps in keeping the joint firmly

united. Role of Vyanavata is most important in the movements of the joints. The Marmas

are considered as the point of union of nerves, vessels and muscular system, which are

vital in the structure and functioning status of the joints. Functions of the peshis and

snayus are exactly identical to that of the muscles and ligaments related to the joints.

Knee works as a hinge joint, but the articulation is more complex than other hinge

joints. Seven major ligaments, flexor and extensor muscles support the movements of the

knee joint.

Discussion On Nidana

Ayurvedic philosophy mainly emphasized on Vatakara ahara-vihara in the

manifestation of Sandhigatavata. Vardhakya is predominated by Vata dosha and

characterized by Dhatu kshaya leads to reduced Sneha bhava in the body, which in turn,

vitiates the Vata dosha and reduces the Kapha, thereby resulting in Karmahani of the

sandhis. Also, dhatushaithilya is another feature in Vardhakya, which reflects in peshis

and snayus thereby reducing their functional efficiency in supporting the joints. This is a

major risk factor for Sandhigatavata.

Age is the most powerful risk factor for Osteoarthritis. More than 80% of the

people over the age of 60 have radiological evidence of Osteoarthritis in the joints.

Discussion 137

Various physical activities such as Pradhavana, Bharaharana and Abhighatas due

to prapatana, Marma abhighata, Dukha shayya and Dukha asana are important Nidanas

for Sandhigatavata. Repetitive movements may lead to excessive strain leading to erosion

and joint damage. Trauma to the joint enhances the occurrence of arthritis.

Sthoulya is another causative factor for Sandhigatavata. Vatavyadhee and

Sthoulya are having interrelated pathogenesis. (i.e. Medavrita vata) Obese person have a

high risk of Osteoarthritis. The relative risk of developing Osteoarthritis, is more in the

population belonging to the high quintile body mass index.

Discussion On Samprapti

The Samprapti of Sandhigatavata may be divided into Dhatukshayajanya and

Avaranajanya. Modern science explains the pathogenesis of Osteoarthirits in two ways –

01. Sub-standard biomaterial of the joint (Dhatukshaya).

02. Increased applied pressure over the joint (Avarana).

In Dhatukshyajanya Sandhigatavata due to old age and excess use of Vatakara

ahara-vihara causes qualitative changes in the joint material gradually leading to disease

manifestation i.e. age related degenerative changes.

Samprapti of Margavaranajanya sandhigatavata initiated by the nidana ghataka

Sthoulya involving the avarana of Vata by Kapha and medas, which can be correlated

with complications of obesity where in due to continuous pressure, joints get affected

(due to Avarana) leading to disease manifestation.

Discussion 138

Discussion On Symptomatology

The lakshanas of Sandhigatavata, viz. Vedanayukta pravritti of sandhis, Shotha

(Vatapoorna dritisparshavat), Atopa and Sandhigati asaamarthya, etc are explained by

various treatises of Ayurveda. Modern science, has mentioned similar features along with

other symptoms pertaining to individual joints. Tenderness and joint stiffness (implied by

the restriction of joint movements) are specially monitored in Modern science and further

added that any joint can get affected with Osteoarthritis. Acharyas have not paid their

attention towards the site of particular joint involvement. When there are structural

changes in the joints the disease can be categorized as Asadhya.

Discussion On Chikitsa

The chikitsa of Sandhigatavata is Snehana, Swedana and Agnikarma Since it is a

Vata vikara and Dhatukshaya of resultant, Snehana and Swedana would be an ideal line

of treatment. In the contemporary science treatment is mainly aimed at Non–

pharmacological methods and analgesics. Among Non–pharmacological treatment much

importance is given to physical heat therapy.

PROBABLE MODE OF ACTION OF PARISHEKA

Parisheka is a variety of the Swedana, which is described as Poorvakarma for

Panchakarma and included in Shada upakramas. Sneha dravya is used as media in case of

Parisheka. Its dual action facilitates in alleviating Vata effectively. The Vata dosha,

which is the key factor in the casuation of Sandhigatavata, has almost opposite quality to

Sneha. Moreover, properties of Sneha dravya resembles property to that of Kapha. In

Sandhigatavata sthanika kaphakshaya occurs due to Agantu vata dosha. Thus, Parisheka

neutralizes the Vata dosha and simultaneously nourishes the Sthanika kapha dosha. This

helps in Samprapti Vighatana of Sandhigatavata.

Discussion 139

Sandhigatavata is characterized by joint pain, stiffness, swelling and crepitus.

The heat applied to the joint helps in combating many of the symptoms. Parisheka acts

both Snehana as well as Swedana. In this disease degeneration is predominant, Vata is in

the Prakupita avastha and there is Kshaya of sneha bhava. Snigdha sweda would be an

ideal line of management.

The main theme of Vatasyopakrama emphasizes on Snigdha and Ushnabhava.

Parisheka is a type of Snigdha sweda through which Snehana and Swedana are carried

out. Snehana corrects the Shuska dhatus which are the root cause for the Vata vitiation

and imparts strength. Swedana relieves Toda, Ruk, Ayama, Shotha, Stambha, etc of

symptoms of Vata and smoothens the body parts. Repetitive uses of this karma is

essential for the total control of Vata and restoration of its normal functions.

Sandhigatavata is a disease of the madhyama rogamarga involving the asthi

sandhis of the body. Asthis are the ashraya of the Vata dosha and the vitiation of Vata

hampers the nourishment of asthis, which reflects in Sandhis. Such a mal-nourishment

involves the reduction of the Sleshaka kapha and deterioration of the Sleshmadharakala.

Snehana provides the Snehabhava needed for the nourishment of these in turn controls

the vitiated Vata.

Swedana relieves the Stambha and Gourava of the joints and related structures

involved in the joint movements. Stambha means stiffness, this attribute is a resultant of

excess of seetha guna and also influence of factors such as Samanavata, Shleshakakapha,

Ama, Mamsa, Vasa and Medas, which were contributory to occurrence of Stambha.

Samanavata is Rooksha guna pradhana and in vitiated state it does excessive Shoshana of

shareera there by resulting in contractures and stiffness. Sleshakakapha is Snigdha and

Picchila and in decreased state (Kshaya) results in less lubrication of joints causing

Stiffness. Parisheka being Snigdha and Ushna corrects both these deranged Dosha

ghatakas and relieves stiffness.

Discussion 140

The ingredients of Shatahvadi taila are Shatahva, Yava, Bilva, Kanji and Tila

which having properties viz Vatashamaka, Kaphashamaka and possessing actions like

Vedanashamaka, Shotahara and Vatanulomana which plays vital role in correcting the

pathology.

Susruta stated that out of the four tiryak dhamanis, each divides gradually

hundred and thousand times and thus become innumerable. These cover the body like

network and their openings are attached to Romakoopa. Through them only Veeryas of

Abhyanga, Parisheka, Avagaha, Alepa enters into the body after under going Paka with

Bhrajaka pitta located in skin. In Sutrasthana he explains, Lepa in Bahirparimarjana

treatments yield result by entering into Romakoopa thereby enters in circulating through

Swedavaha srotas.

Cell membrane act as a barrier to the passage of water soluble molecules but

provide free passage to lipid and lipid soluble substances. Rapid diffusion of lipid soluble

substances through cell membranes and the dependency of the rate of diffusion on

solubility in lipids have been proved. Lipoid substances which are similar to the cell

membrane lipids get directly in corporated into the cell membrane. Some of the lipids and

lipid soluble substances directly reach the cytoplasm trough cell membrane.

Application of heat through unctuous substance causes the generation of a

temperature gradient across the cell membrane. Besides facilitating the diffusion of liquid

substances through the cell membrane, this plays key role in the formation of lipoid

vesicles from the dropouts in the membrane in areas of flow temperature. This causes an

expansion in the cell volume as well as surface area. But it cannot expand freely

especially in the peripheral direction as it is bound by other cells around. This makes the

blebbing of cell membrane inside.

Discussion 141

The temperature gradient and pressure gradient caused by the heat further helps in

blebbing in this particular direction. These lipoid vesicles or blebs detached from the cell

organelle or other side of membrane and remain there till a critical surface is reached.

This membrane then blebs out and spread further thus providing nourishment to the

tissues. The whole phenomenon of dropping of cell membrane vesicles and their

incorporation into other membranous structure was described as “Membrane flow

Hypothesis” by Palade in 1959.

Thermal therapy acts by increasing the circulation and local metabolic process

with the relaxation of the musculature. Application of heat causes relaxation of muscles

and tendons, improves the blood supply, venous drainage, lymph supply and activates the

local metabolic processes which are responsible for the relief of pain, swelling,

tenderness and stiffness.

Trans-dermal absorption depends upon lipid solubility of the drug. Drugs in oils

and other lipid soluble carriers can penetrate the epidermis as it is a lipid barrier. The

movement is slow, particularly through the layers of cell membranes in the stratum

corneum. But once the drug reaches the underlying tissues it will be absorbed into the

circulation. Suspending the drug in an oily vehicle can enhance absorption through the

skin. Because hydrated skin is more permeable than dry skin (Placing a drug in a solvent

that is lipid soluble can assist its movement through the lipid barriers).

Sneha reaches deep into the body tissues, causing partial rejuvenation of cell

organelles and cell membrane by replacing their order components with new ones.

Discussion 142

By this mechanism Parisheka fulfills the expected changes in Sandhigatavata. No

one single mechanism appears to be solely responsible for the therapeutic effects of

Parisheka. All these are hypothetically proposed aspects.

PROBABLE MODE OF ACTION OF MATRABASTI

Udbhavasthana of Sandhigatavata is Pakwashaya and Vyaktasthana is Sandhi.

Hence, Matrabasti chikitsa has nectarous effect over it. Matrabasti is a type of Snehabasti

classified on the basis of quantity of Sneha dravya used in it. So this can conquer the

vitiated vayu in Sandhigatavata effectively.

Vyanavata invariably plays an immense role in pathogenesis of Sandhigatavata.

The sneha of Bastidravya acts over the Vyanavayu predominantly. So Matrabasti could

be the best mode of drug administration so far as taste of drug, dosage and Agni is

concerned, in comparison to oral drug administration.

Guda is Pradhana marma and the Moola of Siras, that nourishes the whole body.

By maintaining the left lateral procedure at the time of Matrabasti procedure, the

bastidravya reaches the pakwasaya resides in the left side. Charaka opines that by

attaining this posture, gudavalees will be relaxed and the grahani is situated in the left

side. Chakrapani states that agni will be in the natural state in the posture while

Gangadhara says agni, grahani and nabhi are present in the left side. Jejjata comments

agni is present left side over the nabhi, guda has got a relation with sthoolantra on left

side. So bastidravya can reach to the large intestine and grahani, as they are present in the

same level.

Discussion 143

Left lateral position is the best posture for better and effective administration of

Matrabasti. Because – In this posture, anal canal turns to left side to rectum, sigmoid

colon and descending colon. Moreover, medicines stay at these surfaces and gets

absorbed more and show its effect, especially in Matrabasti. The absorptive area of

mucosa is more on left side and it is easily approachable through anus rather than on the

right side and this posture relaxes the ileo-ceacal juction and makes the easy flow of

Bastidravya into the sigmoid colon.

The drug given through the Matrabasti reaches to the site of the origin of the

disease. As Susruta mentioned that the veerya of the Basti dravya spreads all over the

body just as water poured at the root reaches all parts of the tree through the micro and

macro channels. While Charaka mentions that Matrabasti by reaching up to the umbilical

region (transverse colon), sacroiliac region (rectum), flanks and hypochondrial regions

(ascending and descending colon) and churning of the fecal and morbid matters present

there in and at the same time by spreading its unctuous effect in whole body, drawn out

the fecal and morbid matter.

While dealing with the action of Basti Vagbhata says, the veerya of Basti being

conveyed to Apana to Samana Vata which may regulate the function of agni then to

Udana, Vyana and Apana thus providing its efficacy all over the body. At the same time

this effect of Matrabasti by specifying Vata, restores the displaced Kapha and Pitta at

their original seats. The control gained over Vata leads to the Samprapti vighatana of

disease.

The same action of Basti drugs has been described by Charaka. Administered

Matrabasti enters into Pakwashaya, Nabhi, Katipradesha and Kukshi. It spreads to all

over the body by its Veerya to drain out the morbid dosha lodged in the entire body from

the foot to the head, just as the sun situated in the sky sucks up the moisture from the

earth.

Discussion 144

Action of Matrabasti is possible by Anupravaranabhava of bastidravya, which

contains sneha. Sneha easily moves up to Grahani by Anupravanabhava guna similar to

that of dravya, which freely moves in the utensil.

Matrabasti acts mainly on Asthi and Majjavaha srotas. Asthi is the Ashrayasthana

of Vata dosha. Dalhana says that Pureeshadharakala and Asthidharakala are one and the

same. So we can assume that if pureeshadharakala gets purified and nourished; the

asthivaha srotas will also be purified and nourished.

Pittadharakala and Majjadharakala and Grahani part takes in the action of

Matrabasti. Bastidravya enters till Grahani (Pittadhara Kala) which is the seat of agni.

The nutrients may get absorbed and thereby nourishes the Majjadharakala, which is

having a strong bond with Pittadharakala and Vata.

Matrabasti of Shatahvadi taila comprises mainly, Shatahva, Yava, Bilva, Kanji

and Tila having the properties like Snigdha guna, Ushna veerya and Vata-kaphashamaka

and acts as Vedanashamaka, Shothahara and Vatanulomana. Thus provides significant

effect on almost all the symptoms of Sandhigatavata.

Matrabasti contains Sneha (i.e. Shatahvadi taila) with above mentioned properties

which are capable to pacify Vata by their potencies. Due to its less quantity, it facilitate to

stay longer period in Pakwashaya (9-10 hours which was observed in this study) and

may acts both locally and systemically.

Sandhigatavata possess aggravation of Vata which in turn leads to reduction of

Snehabhava and Dhatukshaya condition. Its incidence is predominant in senile condition

where Matrabasti is indicated. Hence, Matrabasti can be administered in all the ages

without any complications. It plays vital role in the management of Sandhigatavata. It

induces Snehabhava and corrects Vata in turn checks the pathology of the disease.

Discussion 145

According to modern science, the rectum has a rich blood and lymph supply.

Drugs can readily cross the rectal mucosa like other lipid membrane. As per Basti/Enema

concerned, in trans-rectal route, the unionized and lipid soluble substances are readily

absorbed from the rectum.

The concentration gradient of Matrabasti dravya is more inside the lumen of

intestine as compared to rectal venous plexus, which facilitates the absorption. This rectal

venous plexus further divided into internal venous plexus and external venous plexus.

Internal venous plexus, situated in the submocosal layer of anal canal and carries into

superior rectal vein and to external venous plexus.

Basti dravya is also absorbed from external venous plexus in three parts, i.e. in

lower part through inferior rectal veins and drained into internal pudendal vein, in middle

part through middle rectal vein which is having tributaries, those drains from bladder,

prostate and seminal vesicle into internal iliac vein, in upper part through superior rectal

vein into inferior mesenteric vein a tributary of portal vein.

Matrabasti dravya is also absorbed from the upper rectal mucosa, and is carried by

the Superior mesenteric vein into the portal circulation and enters into Liver. Secondly,

the portion absorbed from the lower rectum enters directly into systemic circulation via

middle and inferior hemorrhoidal veins. This indicates that due to more vascularity in this

area absorption rate is high. Acharyas also said that “Guda moolam hi shareeram”.

The advantage of this route is total gastric irritation is avoided and that by using a

suitable solvent the duration of action can be controlled. Moreover, it is often more

convenient to use drugs rectally in the long time in case of geriatric and terminally ill

patients. Matrabasti plays major role in maintaining normal bacterial flora by virtue of its

action which is supported by some of the studies conducted already.

Discussion 146

Pakwashaya is supplied with large numbers of nerve plexuses originating from

the hypo-gastric plexus and lumbosacral plexus, etc. These plexus will receive

nourishment and soothening effect by Matrabasti. Because Matrabasti mainly acts on the

Pakwashaya, here it nourishes, purifies and expels the unwanted toxins from the body

and facilitates the normal functions in the body.

Regulating the Gut Brain.

In 1981, Wood described the Enteric Nervous System (ENS) as ‘The Brain of the

Gut’ that integrates information received and issues an appropriate response. ENS

integrates sensory information from mucosal receptor and organizes an appropriate motor

response from a choice of predetermined programmes. So enteric nervous system of gut

brain is an integrative system with structural and functional properties that are similar to

those in CNS and physiological and pharmacological properties of Matrabasti chikitsa are

said to be the outcome of modification of gut brain up to certain extent.

By considering above explanation it is clear that Basti dravya is absorbed through

rectal mucosa either by chemically altered or un-altered state and carried throughout the

general circulation gives local and systemic effects by controlling Vata which is

backbone of the disease pathology.

When Parisheka and Matrabasti these two procedures performed together,

as Parisheka is a Poorvakarma and Matrabasti is a Pradhanakarma. In Sandhigatavata it

fulfills both local and generalized effects. Matrabasti plays vital role in by proving

snehabhava and enhancing the strength of dhatus helps in checks out the samprapti.

Action of Matrabasti is “Aapadatalamastakam,” it is ideal for all the age groups and can

be given without any complications for longer period. It produces the long-term and

stable effect over the body which is being found in the study rather than Parisheka.

Discussion 147

The locality of the disease is Sandhi, Parisheka is Snigdha and Ushna in nature

which is beneficial in Sandhigatavata. As it was performed locally on affected knee joints

it does not cause systemic complications even in old age group. It helps in relieving the

symptoms of the disease by comprising Snehana and Swedana simultaneously. The

procedural effect of Parisheka can be taken as shamana part of chikitsa in Sandhigatavata.

For both Parisheka and Matrabasti procedures Shatahvadi taila was used which is

indicated in Vatavyadhi chikitsa, to get unbiased results about the effect of the

procedures in Sandhigatavata and to avoid interference of the biastiy by the effect of

drug action.

Discussion On Clinical study

Patients of Sandhigatavata were selected from the OPD and IPD of Shri. D.G.M.

Ayurvedic Medical College by pre-set inclusion and exclusion criteria. Data of 30

patients who had satisfied the diagnostic criteria, underwent the treatment and reported

for the follow-up are discussed here. The patients were randomly distributed into two

groups and the patients of group-A were administered Parisheka and Matrabasti; the

patients of group-B were administered Parisheka only. Patients of both the groups were

advised to take hot water bath after the karma every day and also were advised to follow

the same pathya acharana.

The laboratory investigations like ESR, TC, DC, Hb% and RBS were performed

to rule out the associated systemic diseases. The radiology of the affected joint was

performed in all patients. After scrutinizing the whole literature of Ayurveda and Modern

Medicine, Ruk and Graha were fixed as the subjective parameters; Sparsha akshamatva,

Sandhigati asaamarthya, Shotha, Atopa and walkingtime (to cover 21meters) were fixed

as the objective parameters. The pre and post treatment data of above mentioned

parameters recorded timely as per the special case sheet proforma.

Discussion 148

Discussion on Demographic Data

Most of the patients in this clinical study belonged to the age group 55-64 (70%)

thereby supporting the association of Vardhakya avastha and Sandhigatavata. 26.66% of

the patients belonged to the age group 45-54 and 3.33% of the patients belonged to the

age group 35-44. 46.66% of the patients belonged to the active group of occupational

status and 20% of the patients belonged to the labour group. This strengthens the

viewpoint that this disease is triggered by excessive physical demand on the joint.

56.66% of the patients were females and 43.33% of the patients were males supporting

the male to female incidence ratio of 1:1.

46.66% of the patients were of the middle class and 33.33% were of the poor

class and 20% were of the high class and this observation is inconclusive to make any

comments. 83.3% of the patients were Hindus, 20% were Muslims. This is reflective of

the geographical dominance of the religion and do not have any association with the

disease. 43.33% of the patients were vegetarians and 56.66% were of the mixed diet and

this is reflective of the diet habit prevalent in the society.

53.33% patients were inflicted with Mandagni, 36.66% patients were inflicted

with Vishamagni. Vikritavastha of Agni directly reflects over the status of Tridoshas. The

Vishama and Manda avastha of Jatharagni is closely related with Vata vitiation which is

related with Sandhigatavata. 60% of the patients were having Krura koshta, This shows

the predominance of Vata in patients by the nature of Koshta itself. 70% of the patients

had the complaint of Alpa nidra, 30% of the patients had the complaint of Vishama nidra.

These both are closely related with Vata vriddhi. 40% of the patients were having

tobacco chewing as a habit, 20% were having alcohol intake as a habit and 16.6% had

smoking habit, this has no association with the disease state. So the data of present study

support the existence of the pre-disposing factors of Sandhigatavata.

Discussion 149

50% of the patients were of the Vata-pitta prakriti, 30% of the patients were of the

Vata-kapha prakriti, 10% of the patients were of the Pitta-kapha prakriti, 10% of the

patients were of the Shuddha vata prakriti. Hence, majority of the patients were having

the existence of Vata dosha in their prakriti constitution. This shows the dominancy of

Vata dosha in prakriti related with the disease condition has been well proven. 90% of the

patients were of the rooksha satmya and 10% were of the snigdha satmya, which is

reflective of the nature of the diet. This also may have contributed to the Vata kopa. 70%

of the patients had Vegadharana as a nidana, 63.3% of the patients had Ativyayama as a

nidana and 96.66% of the patients were having katurasa bhojana, 80% of the patients

were accustomed to Rooksha bhojana. Sandhigatavata is a Vatapradhana vyadhi which is

being supported in this study, showing the higher values in particularly Vatakara nidanas.

So the data of present study support the existence of the pre-disposing factors of

Sandhigatavata.

All the patients had the complaints Ruk, Graha and Sandhigati asaamarthya, while

80% had Sparsha akshamatva, 73.33% had Atopa, 86.66% reported with Prasaarna

aakunchanayoho savedana pravritti, 70% with Shotha and 10% with Vatapoorna

dritisparsha.

Discussion On Effect Of Therapies

Group-A

1) Ruk : - 60% of the patients reported with grade 3 ruk and 40% reported with

grade 2 ruk. 60% of the grade 2 got good response and 40% got moderate

response. 50% of the grade 3 got good response and 50% got moderate response.

In the statistical analysis, the parameter showed high significance (p-value<0.001)

and corresponding t-value16.15

Discussion 150

2) Graha : - All the patients of group-A presented with Sandhigraha (100%).

Among them 53.33% got good response and 46.66% got moderate response. In

the statistical analysis Graha showed high significance (p-value<0.001) and

corresponding t-value 9.62.

3) Sparsha akshamatva : - 20% of the patients reported with grade 0 tenderness

whereas 20% reported with grade 1 tenderness and 60% reported with grade 2

tenderness. 33.33% of grade 0 got good response and 66.66% of grade 0 got

moderate response. 66.66% of grade 1got good response and 33.33% got

moderate response. 55.55% of grade 2 got good response and 44.44% got

moderate response. In the statistical analysis the parameter showed high

significance (p-value<0.001) and corresponding t-value 6.09.

4) Sandhigati asaamarthya : - 73.33% of the patients reported with grade 1

Sandhigati asaamarthya and 26.66% of the patients reported with grade 2

Sandhigati asaamarthya. 45.49% of the patients with grade 1 got good response

and 54.54% got moderate response. 75% of the patients with grade 2 got good

response and 25% got moderate response. In the statistical analysis the parameter

showed high significance (p-value<0.001) with corresponding t-value 38.32.

5) Shotha : - 33.33% of the patients reported with grade 0 Shotha, 46.66% with

grade 1, 13.33% with grade 2 and 6.66% with grade 3. 40% of the patients with

grade 0 got good response and 60% got moderate response. 42.85% of the

patients with grade 1 got good response and 57.14% got moderate response. 100%

of the patients with grade 2 got good response and 100% of the patients with

grade 3 got moderate response. In the statistical analysis the parameter Shotha

showed high significance (p-value<0.001) with corresponding t-value 4.58.

Discussion 151

6) Atopa : - 26.66% of the patients reported with grade 0 atopa, 40% with grade 1,

26.66% with grade 2 and 6.66% of the patients reported with grade 3. 75% of the

patients with grade 0 showed good response and 25% got moderate response.

33.33% of the patients with grade 1 showed good response and 66.66% showed

moderate response. 100% of patients with grade 2 showed moderate response. In

the statistical analysis the parameter showed high significance (p-value<0.02)

with corresponding t-value 5.285.

7) Walking time : - The parameter walking time (to cover 21meters) showed

high significance (p-value<0.001) with corresponding t-value 7.873.

Group-B

1) Ruk : - 33.33% of the patients had grade 2 ruk and 66.66% had grade 3 ruk.

85.71% of the patients with grade 2 ruk got moderate response and 14.28% got

poor response.. 87.5% of the patients with grade 3 ruk got moderate response and

12.5% got poor response. In the statistical analysis the parameter showed high

significance (p-value<0.001) with corresponding t-value 13.23.

2) Graha : - All the patients had grade 1 graha. 86.66% of the patients got moderate

response and 13.33% got poor response. In the statistical analysis the parameter

showed high significance (p-value<0.001) with corresponding t-value 7.547.

3) Sparsha akshamatva : - 20% of the patients had grade 0 tenderness, 46.66% had

grade 1 and 33.33% had grade. All the patients of the grade 0 got moderate

response. 85.71% of the patients of grade 1 got moderate response and 14.28% of

patients got poor response. In the statistical analysis the parameter showed high

significance (p-value<0.001) with corresponding t-value 4.615.

4) Sandhigati asaamarthya : - 33.33% of the patients had grade 1 and 66.66% had

grade 2. 80% of the patients with grade 1 got moderate response and 20% of the

patients got poor response. 90% with grade 2 got moderate response and 10% got

poor response. In the statistical analysis this parameter showed high significance

(p-value<0.001) with corresponding t-value 4.1.

Discussion 152

5) Shotha : - 33.33% had grade 0 shotha, 26.66% had grade 1 and 40% had grade 2.

All the patients with grade 0 got moderate response. 75% of the patients with

grade 1 got moderate response and 25% of the patients got poor response. 83.33%

of the grade 2 patients got moderate response and 16.66% 0f the patient got poor

response. In the statistical analysis this parameter showed high significance (p-

value<0.01) with corresponding t-value 4.18

6) Atopa : - 26.66% of the patients had grade 0 atopa and 73.33% had grade 1. 75%

of the patients with grade 0 got moderate response and 25% got poor response.

90.90% of the patients of grade 1 got moderate response and 9.09% of patients

got poor response. In the statistical analysis, this parameter showed high

significance (p-value<0.01) with corresponding t-value 2.664.

7) Walking time : - This parameter showed high significance (p-value<0.01) with

corresponding t-value 5.17.

When we compare the group A and B the parameter Ruk and Walking time shows

highly significant than the other by comparing the mean effect of the two groups after the

treatment (As P-value<0.05). But all other parameters shows non significant. The mean

effect after treatment in the parameter Graha, Sandhigati asamarthya, Shotha is more in

Group –A with less variance. (By comparing mean, S.D).

In Group-a 53.33% of the patients had good response and 46.66% of the patients

had moderate response. But whereas in Group-B no patients had god response, 86.66% of

the patients had moderate response and 13.33% of the patients had poor response.

Hence, it clearly states that overall the Group-A (Parisheka and Matrabasti) is more

significant than Group-B (Parisheka) in all the parameters (By comparing t- value). The

parameter Atopa shows least mean net effect in group A and B after the treatment.

Discussion 153

Conclusions are the essence of whole study. In ancient research

methodology it is described as "Nigamana". In the discussion part of the study, the

work is discussed on the basis of concepts, supported by data and logical

reasoning. The conclusions drawn from the scientific discussion are as follows :

Matrabasti is a type of Anuvasana which is very effective in Vatavyadhees can be

practiced safely.

Parisheka is a type of Sweda belongs to Dravasweda.

Sandhigatavata is a type of Vatavyadhi commonly associated with the vardhakya

avastha and dhatu kshaya is a prominent feature in its manifestation.

Sandhigatavata can be correlated with Osteoarthritis of contemporary science.

Parisheka was selected as the therapy in this study as the treatment line of

Sandhigatavata emphasizes Snehana and Swedana and this particular karma is

capable of exerting both these effects.

Matrabasti was selected as the additional therapy in association with Parisheka as

it is prime treatment for vatavyadhi like Sandhigatavata.

Treatment response of all parameters was highly significant in both the groups,

but in intergroup comparison Ruk and Walking time score was found significant

in Parisheka and Matrabasti group than Parisheka group.

Overall treatment response was better in the Parisheka and Matrabasti group as no

patient in the Parisheka group got good response. This suggests that there was

considerable improvement in both the groups but Parisheka and Matrabasti group

got more beneficial effects.

Conclusion 154

During the follow-up period (after the 24th day) the results attained seemed to

wear out in the Parisheka group, but results lasted throughout follow-up period in

the Parisheka and Matrabasti group.

No complications were observed in this study.

Parisheka and Matrabasti can be practiced together for better results in

Sandhigatavata.

Shatahvadi Taila was found very effective in the management of Sandhigatavata.

SUGGESTIONS FOR FUTURE STUDIES

The study should be conducted in a large sample.

The study should be conducted for a longer duration so as to know the lasting of

the clinical effects.

Conclusion 155

The dissertation work entitled “A comparative clinical study to evaluate the effect

of Matrabasti and Parisheka with shatahvadi taila in Sandhigatavata (Osteoarthritis)”

consists of seven parts. They are 1. Introduction

2. Objectives

3. Review of literature

4. Methodology

5. Results

6. Discussion

7. Conclusion.

The introduction highlights on Panchakarmas, Basti, Matrabasti, Swedana,

Parisheka and Sandhigatavata.

The objectives part describes the need for the study, title of the present study and

the objectives of the present study.

Review of literature part covers the historical view on Basti, Swedana and

Sandhigatavata, Nirukti and Paribhasha of Basti, Swedana and Sandhigatavata, Shareera

of Guda, Twak and Sandhi, description of Basti, Matrabasti, Swedakarma, Parisheka in

particular and description of Sandhigatavata.

Methodology part contains review of the properties and chemical composition of

the drugs used, methodology of the clinical study, procedures of Matrabasti and

Parisheka and the subjective and objective parameters for assessment.

The results part contain demographic data, data related to the disease, data related

to the overall response to the treatment, statistical analysis of the subjective and objective

parameters & Intergroup comparison.

Discussion part consists of the headings Sandhigatavata vis-à-vis Osteoarthritis,

role of Parisheka in the management of Sandhigatavata and Role of Matrabasti in the

management of Sandhigatavata, clinical study.

Conclusion part contains the conclusions of the present study and suggestions for

future study.

Summary 156

A

1. Agnivesa, Charakasamhitha Siddhisthana chapter 1-5, 7, 8, 10-12. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 680-703,709-715, 734-738. (Kasi Sanskrit series 228).

2 Susruta, Susrutasamhitha Chikitsasthana chapter 35, 36, 37, 38. Varanasi: Krishnadas Academy; 1980. p. 525-548. (Krishnadas Ayurveda series 51).

3 Ashtangasangraha Suthrasthana chapter 28 - Kalpasthana chapters 4, 5, 6, Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 485, 579-606. (Jaikrishnadas Ayurvedic series 79).

4 Vagbhata, Ashtangahridaya Suthrasthana chapter 19 – Kalpasiddhi chapter Varanasi: Krishnadas Academy; 1982. p. 270, 753, 763. (Krishnadas Academic series 4).

5 Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 289. (Kasi Sanskrit series 154).

6. Bhelacharya, Bhelasamhitha Suthrasthana chapter 23. Girijadayal Shukla editor. Varanasi: Chaukhambha Vidyabhavan; 1959. P.267-285.

7. Chakrapanidatta, Chakradatta chapter 72- 73. 1st ed. P.V.Sharma editor. Varanasi: Chaukhambha Publishers; 1994. p. 619-629. (Kasi Ayurveda series 17).

8. Vangasena, Vangasenasamhitha Bastikarmaadhikara. Jain Sankarlalji Vaidya, editor. Mumbai: Khemnath Srikrishnadas publishers; 1996. p. 952.

9. Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, 6, 7. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p. 318-338. (Jaikrishnadas Ayurveda Granthamala 53).

10. Agnivesa, Charakasamhitha Suthrasthana chapter 14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 87-92. (Kasi Sanskrit series 228).

11. Susruta, Susrutasamhitha Chikitsasthana chapter 32. Varanasi: Krishnadas Academy; 1980. p. 513-515. (Krishnadas Ayurveda series 51).

12 a) Vaghbhata, Ashtangasangraha with Sashilekha teeka Suthrasthana chapter 26 Rudraparasava editor. Trichur: Mangalodayam publication; 1913.p. 192-199.

b) Vagbhata, Ashtangahridaya Suthrasthana chapter 17. Varanasi: Krishnadas Academy; 1982. p.253-259. (Krishnadas Academic series 4).

13.. Bhelacharya, Bhelasamhitha Suthrasthana chapter 23. Girijadayal Shukla editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p. 38-40.

Bibliographic References

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b) Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 13. Varanasi: Krishnadas Academy; 1980. p.514. (Krishnadas Ayurveda series 51).

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f) Vrudhajeevaka, Kashyapasamhita Sutrastana chapter 23 sloka 26. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 26. (Kasi Sanskrit series 154).

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120. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).

121. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).

122. Susruta, Susrutasamhitha Chikitsasthana chapter 37 sloka 39. Varanasi: Krishnadas Academy; 1980. p. 533. (Krishnadas Ayurveda series 51).

123. Agnivesa, Charakasamhitha Siddhisthana chapter 8 sloka 2-14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 713. (Kasi Sanskrit series 228).

124. Susruta, Susrutasamhitha Chikitsasthana chapter 38 sloka 118. Varanasi: Krishnadas Academy; 1980. p. 548. (Krishnadas Ayurveda series 51).

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134. Vagbhata, Ashtangahridaya Chikitsasthana chapter 9 sloka 72-76. Varanasi: Krishnadas Academy; 1982. p. 661. (Krishnadas Academic series 4).

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141. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 8. Varanasi: Krishnadas Academy; 1982. p. 272. (Krishnadas Academic series 4).

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153. Susruta, Susrutasamhitha Chikitsasthana chapter 38 sloka 1-6. Varanasi: Krishnadas Academy; 1980. p. 539-540. (Krishnadas Ayurveda series 51).

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156. Agnivesa, Charakasamhitha Siddhisthana chapter 3 sloka 28-29. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 694. (Kasi Sanskrit series 228).

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162. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).

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170. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 35 sloka 18. Varanasi: Krishnadas Academy; 1980. p. 526-527. (Krishnadas Ayurveda series 51).

171. Chakrapani, Ayurvedadeepika teeka on Charakasamhitha Siddhisthana chapter 4 sloka 54. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 701. (Kasi Sanskrit series 228).

172. Vrudhajeevaka, Kashyapasamhita Khilasthana chapter 8 sloka 104-105. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 285. (Kasi Sanskrit series 154).

173. Sharangadhara, Sharngadharasamhitha Utharakhanda chapter 5, sloka 5. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983. p 320. (Jaikrishnadas Ayurveda Granthamala 53).

174. Susruta, Susrutasamhitha Chikitsasthana chapter 37 sloka 55-56. Varanasi: Krishnadas Academy; 1980. p. 534. (Krishnadas Ayurveda series 51).

175. Ashtangasangraha Suthrasthana chapter 28 sloka 8. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.503, ( Vrajajivan ayurvijnan Granthamala 6 ).

176. Vagbhata, Ashtangahridaya Suthrasthana chapter 19 sloka 29-30. Varanasi: Krishnadas Academy; 1982. p.276-277. (Krishnadas Academic series 4).

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184. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 36-37. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.700. (Kasi Sanskrit series 228).

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190. Kasture VG, Ayurvediyapanchakarmavigyan chapter 3. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 159.

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192. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 17-19. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

193. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 25-27. Varanasi: Krishnadas Academy; 1982. p.259. (Krishnadas Academic series 4).

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195. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 16-19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228).

196. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 25. Varanasi: Krishnadas Academy; 1980. p. 515. (Krishnadas Ayurveda series 51).

197. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 21-24. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4).

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199. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 16-19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228).

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205. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 32 sloka 22-24. Varanasi: Krishnadas Academy; 1980.p. 514. (Krishnadas Ayurveda series 51).

206. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 14-15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228).

207. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

208. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 16-17. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4).

209. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 15. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 88. (Kasi Sanskrit series 228).

210. Agnivesa, Charakasamhitha Suthrasthana chapter 6 sloka 27-32. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 47. (Kasi Sanskrit series 228).

211. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 24. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

212. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 18. Varanasi: Krishnadas Academy; 1982. p.258. (Krishnadas Academic series 4).

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217. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 1. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51).

218. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 1. Varanasi: Krishnadas Academy; 1982. p.255. (Krishnadas Academic series 4).

219. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 39-40. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 90. (Kasi Sanskrit series 228).

220. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 32 sloka 22. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

221. Kasture VG, Ayurvediyapanchakarmavigyan chapter 3. 6th ed. Nagpur: Shree Baidyanath Ayurved Bhavan Ltd.; 1998. p. 164.

222. Vrudhajeevaka, Kashyapasamhita Suthrasthana chapter 23 sloka 26. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1988. p. 277. (Kasi Sanskrit series 154).

223. Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 64. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 92. (Kasi Sanskrit series 228).

224. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 32 sloka 3. Varanasi: Krishnadas Academy; 1980. p. 513. (Krishnadas Ayurveda series 51).

225. a) Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 44. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 90. (Kasi Sanskrit series 228).

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c) Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 10. Varanasi: Krishnadas Academy; 1982. p.256. (Krishnadas Academic series 4).

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226. Susruta, Susrutasamhitha Sutrastanasasthana chapter 11 sloka 55. Varanasi: Krishnadas Academy; 1980. p. 78. (Krishnadas Ayurveda series 51).

227. Susruta, Susrutasamhitha Chikitsasthana chapter 32 sloka 13. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

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229. Ashtangasangraha Suthrasthana chapter 26 sloka 6. Dr. Ravidatta Tripathi, editor. Delhi: Chaukhambha Sanskrita Pratishtanaa; 1996. p.466, ( Vrajajivan ayurvijnan Granthamala 6 ).

230. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 10. Varanasi: Krishnadas Academy; 1982. p.256. (Krishnadas Academic series 4).

231. Bhelacharya, Bhelasamhitha Suthrasthana chapter 23, sloka 18-19. Girijadayal Shukla editor. Varanasi: Chaukhambha Vidyabhavan; 1959. p.39.

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233. Susruta, Susrutasamhitha Chikitsasthana chapter 3 sloka 32-33. Varanasi: Krishnadas Academy; 1980. p. 417. (Krishnadas Ayurveda series 51).

234. Susruta, Susrutasamhitha Chikitsasthana chapter 1 sloka 17. Varanasi: Krishnadas Academy; 1980. p.399. (Krishnadas Ayurveda series 51).

235. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 4 sloka 22-24. Varanasi: Krishnadas Academy; 1980. p. 422. (Krishnadas Ayurveda series 51).

236. Susruta, Susrutasamhitha Chikitsasthana chapter 24 sloka 31-32. Varanasi: Krishnadas Academy; 1980. p.488. (Krishnadas Ayurveda series 51).

237. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Chikitsasthana chapter 32 sloka 13. Varanasi: Krishnadas Academy; 1980. p. 514. (Krishnadas Ayurveda series 51).

238. Bhavamishra, Bhavaprakasha Madhyamakhanda chapter 63. sloka 140-142 4th ed.Varanasi: Chaukhambha Sanskrit series 130; 1984. p. 655-666.

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248. Susruta, Susrutasamhitha Shareeasthana chapter 6 sloka 7, 12, 13. Varanasi: Krishnadas Academy; 1980. p. 370. (Krishnadas Ayurveda series 51).

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253. Vagbhata, Ashtangahridaya Suthrasthana chapter 1 sloka 15. Varanasi: Krishnadas Academy; 1982. p.11. (Krishnadas Academic series 4).

254. Harrisons principles of internal medicine vol 2 Petersdorf R G editor. 10th ed. India: Mcgrawhill; 1987.

255. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1472.

256. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 617. (Kasi Sanskrit series 228).

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257. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 617. (Kasi Sanskrit series 228).

258. Vagbhata, Ashtangahridaya Nidanasthana chapter 15 sloka 6. Varanasi: Krishnadas Academy; 1982. p. 531. (Krishnadas Academic series 4).

259. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 24-37. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 617-618. (Kasi Sanskrit series 228).

260. Singh Gurdip Prof, Avrithavata and its importance in clinical practice- Souvenir on National Seminar on Vatavyadhis: 2001. p. 15.

261. Susruta, Susrutasamhitha Suthrasthana chapter 15 sloka 32. Varanasi: Krishnadas Academy; 1980. p. 73. (Krishnadas Ayurveda series 51).

262. Dalhana, Nibandhasangraha teeka on Susrutasamhitha Suthrasthana chapter 15 sloka 32. Varanasi: Krishnadas Academy; 1980. p. 74. (Krishnadas Ayurveda series 51).

263. Cotran SR, Pathologic Basis of Disease chapter 28. 6th ed. Philadelphia: Saunders; 2003. p. 1246.

264. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 37. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618. (Kasi Sanskrit series 228).

265. Agnivesa, Charakasamhitha Chikitsasthana chapter 28 sloka 37. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 618. (Kasi Sanskrit series 228).

266. Susruta, Susrutasamhitha Nidanasthana chapter 1 sloka 28. Varanasi: Krishnadas Academy; 1980. p. 261. (Krishnadas Ayurveda series 51).

267. Susruta, Susrutasamhitha Nidanasthana chapter 1 sloka 28. Varanasi: Krishnadas Academy; 1980. p. 261. (Krishnadas Ayurveda series 51).

268. Madhavakara, Madhavanidana chapter 22 sloka 21. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 521. (Chaukhambha Ayurvijnana Granthamala 46).

269. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1479.

270. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1479.

271. Kelly William, Textbook of Rheumatology chapter 89. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1479-1480.

272. Susruta, Susrutasamhitha Suthrasthana chapter 33 sloka 5,6,7. Varanasi: Krishnadas Academy; 1980. p. 144. (Krishnadas Ayurveda series 51).

273. Madhavakara, Madhavanidana chapter 1 sloka 8. Varanasi: Chaukhambha Surbharathi Prakashan; 1998. p. 45. (Chaukhambha Ayurvijnana Granthamala 46).

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274. Agnivesa, Charakasamhitha Indriyasthana chapter 9 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 368. (Kasi Sanskrit series 228).

275. Chakrapani, Ayurvedadipika teeka on Charakasamhitha Chikitsasthana chapter 28 sloka 12-14. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 620. (Kasi Sanskrit series 228).

276. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

277. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

278. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

279. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

280. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

281.Agnivesa, Charakasamhitha Suthrasthana chapter 14 sloka 35-37. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p. 89. (Kasi Sanskrit series 228).

282. Vagbhata, Ashtangahridaya Suthrasthana chapter 17 sloka 5. Varanasi: Krishnadas Academy; 1982. p.254. (Krishnadas Academic series 4).

283. Susruta, Susrutasamhitha Chikitsasthana chapter 4 sloka 8. Varanasi: Krishnadas Academy; 1980. p. 420. (Krishnadas Ayurveda series 51).

284. Vagbhata, Ashtangahridaya Suthrasthana chapter 1 sloka 25. Varanasi: Krishnadas Academy; 1982. p. 16. (Krishnadas Academic series 4).

285. Govindadasa, Bhaishajyaratnavali Vatavyadhi prakarana sloka 442-446. 7th ed. Kaviraj Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983. p. 130. (Kasi Sanskrit series 152).

286. Govindadasa, Bhaishajyaratnavali Vatavyadhi prakarana sloka 447-449. 7th ed. Kaviraj Ambikadatta Shastri editor. Varanasi: Chaukhambha Orientalia; 1983. p. 130. (Kasi Sanskrit series 152).

287. Manek J Nisha, Lane E Nancy, Osteoarthritis:- Current concepts in diagnosis and management. American academy of family physicians 2000. Available from:www. Aafp. Org. Accessed on 15th March 2003.

288. Kelly William, Textbook of Rheumatology chapter 90. 5th ed. Philadelphia: WB Saunders Company; 1997. p. 1497.

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289. Agnivesa, Charakasamhitha Siddhisthana chapter 4 sloka 8. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p 689. (Kasi Sanskrit series 228).

290 a) Dr.gyanendra pandey. Dravya guna vignana part 3. 2 nd ed.Varanasi : chaukambha Krishnadas Academy. 2002. p.428-429.

b) Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 935-936.

291. a) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 441-442.

b) Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular parkas han; 1976. p. 45-46.

292. a) Dr.gyanendra pandey. Dravya guna vignana part 3. 2 nd ed. Varanasi: Chaukambha Krishnadas Academy. 2002. p.621-623.

b) Gogte.V.M, Ayurvedic Pharmacology and Therapeutic uses of Medicinal plants. Mumbai: Bharatheeya Vidyabhavan; 2000. p. 629-630.

c) Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 1126-1127.

293.Govindadasa, Bhaishajyaratnavali Jwarachikitsa prakarana. 7th ed. Kaviraj Ambikadatta Shastri, editor. Varanasi: Chaukhambha Orientalia; 1983. p. 130. (Kasi Sanskrit series 152).

294. Susruta, Susrutasamhitha Suthrasthana chapter 45 sloka 113. Varanasi: Krishnadas Academy; 1980. p. 205. (Krishnadas Ayurveda series 51).

295. a) Susruta, Susrutasamhitha Suthrasthana chapter 46 sloka 42. Varanasi: Krishnadas Academy; 1980. p. 190. (Krishnadas Ayurveda series 51).

b) Nadkarni KM Dr, Indian Materia Medica vol 1. 3rd ed. Bombay: Popular prakashan; 1976. p. 653-654.

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297. Das Somen, A manual on Clinical Surgery chapter 15. 4th ed. Calcutta: Dr.S.Das; 1996. p. 188-192

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i

SPECIAL CASE SHEET FOR SANDHIGATAVATA

Post Graduate Research And Studies Center (Panchakarma) Shree DGM Ayurvedic Medical College, Gadag.

Guide : Dr. G.Purushothamacharyulu, PG Scholar : J. P. Basarigidad

MD (Ayu). Co-Guide: Dr. Shashidhar.H. Doddamani, MD (Ayu). 1. Name of the patient : Sl. No : 2. Father’s / Husband’s Name : OPD No : 3. Age : IPD No : 4. Sex : Bed No : 5. Religion : 6. Occupation : 7. Economical Status : 8. Address : _____________________________ Phone No : ____________________________ Email ID :

___________________________

9. Type of treatment : Group A Group B

10.Date of Schedule Initiation :

M F

Poor Middle High

Hindu Muslim Christian Others

Sedentary Active Labor Others

Date of Schedule Completion : 11. Result:

Good Response

Moderate Response

Poor Response

No Response

12. Consent: I here by agree that, I have been fully educated with the disease

treatment, here by satisfied whole heartedly, and accept the medical trial over me.

Investigator’s Signature Patient’s Signature

ii

I. COMPLAINTS WITH DURATION

Sl.

No

Chief complaints Before

Treatment

Duration After

Treatment

After

Follow-

up

1 Sandhisothaha (Swelling)

2 Prasaarana

Aakunchanayoho

Savedana Pravruthihi

(Pain on extension &

flexion)

3 Sandhigraha (Joint

Stiffness)

- Morning stiffness

(15-30 ms)

- Stiffness after disuse

4 Sandhigathi asaamarthya

(Limitation of joint

movement)

5

6

Sparsha akshamatva

(Tenderness)

Atopa (Crepitation)

II. HISTORY OF PRESENT ILLNESS :

Mode of onset Chronic Insidious Acute Traumatic

Nature of pain

Pricking Aching Generalized Tearing Burning

Variation of pain

Increased on use Increased on disuse Nocturnal

iii

Routine activities affected Yes No

III. HISTORY OF PAST ILLNESS :

Episodes of same illness Yes/No

Obesity Yes/No

Trauma/Fracture of involved or related joint Yes/No

Diabetes Mellitus Yes/No

Hypertension Yes/No

Other Vatavyadhees Yes/No

Vataraktha Yes/No

Acromegaly Yes/No

Septic arthritis Yes/No

Psoriatic arthritis Yes/No

Rheumatoid arthritis Yes/No

Fever Yes/No

Others Yes/No

IV. TREATMENT HISTORY :

Modern Medicine

Ayurveda Medicine/Therapy

Other Systems

Relief with previous treatment Partial / No relief

V. FAMILY HISTORY RELEVANT :

If Yes, specify the relation No

iv

VI. PERSONAL HISTORY :

01. Ahaara

Veg Mixed

02. Agni

Manda Teekshna Vishama Sama

03. Koshta

Madhya Mrudu Kroora

04. Nidra

Sukha Alpa Ati Vishama

05. Vyasana

Smoking Tobacco Alcohol Others None

06. Aarthavapravruthi

Alpa Ati Vishama Rajonivruthi

07. Malapravruthi (Frequency)

08. Muthrapravruthi(Frequency)

Day Night

VII A. VITAL EXAMINATION

Weight in kgs Height in cms Temperature in degree Celsius

Pulse rate per Minute

Heart rate per Minute

Blood pressure in mm Hg

Respiration per Minute

v

B. ASHTASTHAANAPAREEKSHA

1. Nadee :

Dosha

Gati

Poornata

Spandana

Kathinya

2. Muthra :

3. Mala :

4. Jihwa :

5. Sabda :

6. Sparsha :

7. Druk :

8. Aakruthi :

VIII. DASAVIDHAPAREEKSHA

A. PRAKRUTHI

V P K VP VK PK SANNIPATHA

B. VIKRUTHI

Hethu AL M A Prakruthi Aasukaari Chirakaari

Dosha AL M A Desa AL M A

Dushya Al M A Kaala AL M A

Bala AL M A Linga AL M A

( AL- Alpa, M- Madhyama, A- Adhika)

vi

C. SAARA

Pravara Madhyama Avara

D. SAMHANANA

Susamhatha Madhyasamhatha Asamhatha

E. PRAMAANA

Sama Heena Adhika

F. SAATMYA

Ekarasa Sarvarasa Vyamishra

Rookshasaatmya Snigdhasaatmya

G. SATVA

Pravara Madhya Avara

H. AAHAARASAKTHI

Abhyavahaara Pravara Madhyama Avara

Jaranasakthi Pravara Madhyama Avara

I. VYAAYAAMASAKTHI

Pravara Madhyama Avara

J. VAYAHA

Baala Madhya Vrudha

IX. SROTOPAREEKSHA

Srotas Observed Lakshana

Pranavaha

Annavaha

Udakavaha

Rasavaha

Rakthavaha

Mamsavaha

Medovaha

vii

Asthivaha

Majjavaha

Sukravaha

Pureeshavaha

Muthravaha

Swedovaha

Aarthavavaha

X. SPECIAL EXAMINATION OF JOINTS

A. Darshana (Inspection)

1. Joint Swelling

Grading 0 1 2 3

Varna a v Raag Shyaa a Prakrutha

Herbeden’s N odes Present Absent

2.a. Deformity

Present Absent

b. Joint Instability

Present Absent

3. Gait

Nature

Walking Time (Grade)

4. Joint Movement

Active Completely Restricted Partially Restricted Free

Passive Completely Restricted Partially Restricted Free

5. Muscular spasm

Present Absent

viii

6. Muscular Wasting

Above the affected joint Yes No

Below the affected joint Yes No

B. Sparshana (Palpitation)

1. Vaatapoornadruthisparsha

Yes No

2. Local Temperature

Raised Not raised

3. Tenderness

Grading 0 1 2 3

4. Limitation of Joint Movement (In Terms Of Grading)

Axial Joints Cervical Lumbar Spine

Distal Joints

Knee Right Left

Hip Right Left

Ankle Right Left

First Carpometametacarpal Right Left

Distal Interphalangeal Right Left

Proximal Interphalangel Right Left

C. Shravana (Auscultation)

Crepitus Heard Felt None

ix

X1. NIDAANAPAREEKSHA

1. Nidaanapareeksha

a. Aahaara

Tiktharasa Athyupayoga Kashayarasa Athyupayoga Katurasa Athyupayoga

Alpa Bhojana Pramitha Bhojana Rooksha Bhojana

b. Vihaara

Vega Dhaarana Vegoodeerana Ativyavaya

Nisaajaagarana Atyucha Bhaashana Ativyaayama

c. Maanasika

Atibhaya Atishoka Atichintha

d. Occupational

e. Chikitsa Aparaadhaja

Shodhanakarma Atiyogaja Yes No

2. Poorvarupa :

3. Upashaya/Anupashaya :

Ushna Seetha

Rooksha Snigdha

4. Rupa :

5. Samprapthi :

XII. SAADHYAASAADHYATA:

x

XIII. LAB INVESTIGATIONS :

Sl.No Name of the Test Values

1. ESR /1st Hr.

2. Hb% Gm%

3. Total Count

WBC Per cm

RBC Per cm

4. Differential Count

N E B M L

5.

Blood Glucose Mg/dl

6.

RA Factor +ve -ve

7. Serum Alkaline Phosphatase : unit/L.

XIV. RADIOLOGICAL EXAMINATION OF JOINTS

( Antero posterior and Lateral View)

1 Joint space Reduced Increased Unaltered

2 Subchondral bony sclerosis Present Absent

3 Formation of osteophytes Present Absent

4 Periarticular ossicles Present Absent

5 Altered shape of bone end Present Absent

xi

XV. PARISHEKA DAINANDINA NIREEKSHANA

DAY TIME DURATION LAKSHANAS

OBSERVED

ANY

UPADRAVAS

UPACHARAS

ADVISED

I Day

II Day

III Day

IV Day

V Day

VI Day

VII

Day

VIII

Day

XVI. BASTI KARMA NIREEKSHANA : Date of Basti initiation Date of Basti completion Observations Time Amount

Introduced Time of

Retention No. of times

Motion passed

Upadrava if any

I Day

II Day

III Day

IV Day

V Day

VI Day

VII Day

VIII Day

xii

XVI. ASSESSMENT OF RESULTS

A. CLINICAL PARAMETERS

Subjective Parameters Day 0 Day 08 Day 24

Ruk (Pain)

Graha (Stiffness)

Objective

Parameters Day 0 Day 08 Day 24

Sparsha Akshamatva (Tenderness)

Sandhigati Atisaamarthya (Range of Joint Movement)

Sotha (Swelling)

Atopa (Crepitations)

Walking time

XV11. INVESTIGATORS NOTE

Signature of Co-Guide Signature of Guide