1.Management of Vedana with Rujahara vati W. S. R.to Sthoola Sandhi A Standard comparative studyBySULOCHANA. B. Dissertation submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D.In Kayachikitsa Under the Guidance of Dr. Shiva Rama Prasad KethamakkaM.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish) Department of KayachikitsaPost Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2005-2008

2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103This is to certify that the dissertation Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi A Standard comparative study is a bonafide research work done by SULOCHANA. B. in partial fulfillment of the requirement for the post graduation degree of Ayurveda Vachaspati M.D. (Kayachikitsa) Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka.Date:GuidePlace: Gadag Prof. Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish) Professor in Kayachikitsa DGMAMC, PGS&RC, Gadag 3. J.S.V.V. SAMSTHES D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103 Endorsement by the H.O.D, principal/ head of the institutionThis is to certify that the dissertation entitled Management of Vedana withRujahara vati W. S. R. to Sthoola Sandhi A Standard comparative study is abonafide research work done by SULOCHANA. B. under the guidance of Prof. Dr. ShivaRama Prasad Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish),Professor in Kayachikitsa in partial fulfillment of the requirement for the post graduationdegree of Ayurveda Vachaspati M.D. (Kayachikitsa) Under Rajeev Gandhi University ofHealth Sciences, Bangalore, Karnataka..(Dr. V. Varadacharyulu)(Dr. G. B. Patil)Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College,PGS&RC GadagDate: Date:Place: GadagPlace: 4. Declaration by the candidate I here by declare that this dissertation / thesis Management of Vedana withRujahara vati W. S. R. to Sthoola Sandhi A Standard comparative studyis abonafide and genuine research work carried out by me under the guidance of Prof. Dr.Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)],Professor in Kayachikitsa, DGMAMC, PGS&RC, Gadag.DatePlace: Gadag SULOCHANA. B. 5. Copy rightDeclaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.DatePlace: GadagSULOCHANA. B. Rajiv Gandhi University of Health Sciences, Karnataka 6. Tv~xwzxx It might be. Almighty made me this effort to make through the many ailed patients.This work carries some sweet memories to express and record about some distinguishedpersonalities by whom I had been inspired during the course of this study. Words fails miserably when I try to express my gratitude to my mentor and respectedguide Prof. Dr. K. Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.] Jyotish,Department of Kayachikitsa, for his guidance and timely help. I express my gratitude to Prof. Dr. V.V. Varadacharyulu M.D. (Ayu), H.O.D ofKayachikitsa (PG) for his advice and encouragement in every step of this work. I am sincerely gratefulness to Dr. G. B. Patil, Principal, for his encouragement andproviding all necessary facilities for this research work. I extend my gratitude to Dr. R. V. Shettar, Dr. Mulki Patil, Dr. P. Shivaramudu, Dr. G.Purushottama charyulu, Dr. M. C. Patil, Dr. G. Danappagoudar, Dr. S. H. Doddamani, Dr. S.N. Belawadi, Dr. Kuber Sankh, Dr.Nidugundi, Dr. Samudri,. Dr.Mulgund, Dr. J.Mitti, Dr.Yasmin A.P. and Mr. Nanda Kumar for his help in statistical analysis of results. I express myimmense gratitude to Dr. G. S. Hiremath, Dr. B. G. Swami, Dr. S. D. Yarageri (RMO), Dr. U.V. Purad and other teaching staff and who helped me during my work. I express my sincere thanks to Shri V. B. Mundinamani librarian and Assistant ShriShyavi and Shri Kerur for providing valuable books in time throughout the study and ShriB.S. Tippangouda, (Lab. Technician), Shri Basavraj (X-Ray Technician) for their kind supportin my study. I express my sincere thanks to Dr. Sanjeev Patil MS (Ortho) and Dr.MilindHukkeri MD (Ayu) for their valuable help at time. My main inspires are My father who gave me wings and taught me to fly andMy husband who gave me an open sky to fly My deep senses of gratification to my inspirations of this study are my husband Dr.Chidanand Hiremath, my parents- Smt & Shri Lalitha Channayya Balaganurmath, my inlaws- Smt & Shri Girija Chandrayya Hiremath. The hidden architect of my career is mybeloved son Akash. Last but not least I express my deepest thankfulness whose names arenot taken here but helped me a lot along with my kith and kin and my friends. (Dr. Sulochana B) 7. Tutv y `ttzxx y ixwtt |{ e}t{ttt| jA fA eA f{t ftw{| T ftwtw vtt|x w@ U fv{tt UKey words Vedana, Sleshmadhara kala, Sthoola Sandhi shoolaPain is a four letter word that means suffering. Joint pain is the most powerful or chiefpresenting complaint at clinics. Pain in Ayurveda is presented in different forms as Ruja, Vedana,Shoola, Peeda, etc. The pain concepts in Ayurveda even though not described physiologically andpathologically, it is always associated with disease especially with Vata Vyadhi. Joint pain could bewith old age associated as a degenerative, seldom with joint disease conditions. Joint pain withweight bearing is not an uncommon condition.The intensity of joint pain depends upon Vyanavata, Sleshakakapha and Sleshmadhara Kalalevels of vitiation. The pain flow impels Manas to complete pain cycle. Pain is retarded either byblock of pain impulse from site or to suppress the pain recognition. It is observed in extreme painconditions patient is either local anesthetized or as a result of neurogenic shock goes in to coma.The Shuddha Guggulu acts as Rasayana to induce cellular reconstructive phenomenonespecially with reference to geriatrics. The result shown by Shuddha Guggulu expresses its antiinflammatory action to that of the soshita Sleshmadhara Kala where the Rujahara vati is an analgesicor as a pain blocker than that of anaesthetizes. The Rujahara vati results express a wide range of antiinflammatory and analgesic action by regulating the Sleshmadhara Kala Shotha fluid by its dryingcapacity of kleda.The comparison drawn over the trial is a clear and definitive to state that Shuddha Gugguluaction over geriatric Sleshmadhara Kala sosha yukta Sandhi Shoola (vataja) is more effective andRujahara vati action on Sleshmadhara Kala Shotha yukta Sandhi Shoola (Vatakaphaja). The result ofShuddha Guggulu is 72% of complete remission of Sandhi Shoola and Rujahara vati is 76%. Bothgroups in comparison exhibit a variance inclination of subjective parameters to Rujahara vati andobjective parameters to Shuddha Guggulu. The swelling and Ruja study parameters and chiefcomplaints express inclination towards Rujahara vati.Abbreviations used in the study:SP = substance P, CGRP = calcitonin gene-related peptide, VIP = Vasoactive in testinal peptide, N/OFQ =Nociceptin / Orphanin FQ, NSAID = Non-SteroidalAnti-Inflammatory Drugs, SGR = Substantia GelatinosaRolandi , PAG = Peri-aqueductal Gray, STT= Spino thalamic tract, CR = Complete remission, WR = Wellresponded, MR = Moderate Responded, NR = Not Responded, NS = Not Significant, HS = High Significant 8. Contents ofManagement of Vedana with Rujahara vati W. S. R. toSthoola Sandhi A Standard comparative study BySULOCHANA. B.Chapter ContentPages 1Introduction 1 to 52Objectives6 to 93Literary Review10 to 584 Methods 59 to 685Results69 to 1006 Discussion 101 to 1137 Conclusion 114 to 1158 Summary116 to 1209Bibliographic ReferencesI to X10Annex - Master Charts1 to 1411 Annex Case sheet1 to 7-1- 9. Tables of Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi A Standard comparative studyby SULOCHANA. B.SN TITLE OF TABLEPAGE1Showing Functional categories of joints202Showing Structural categories of joints213Showing the Samanya Vata Vyadhi Ahara Nidana 244Showing the Samanya Vata Vyadhi Vihara Nidana255Showing the Samanya Vata Vyadhi Manasika Nidana266Showing the Samanya Vata Vyadhi Anya Nidana277Chikitsa methods followed by Ayurveda Acharyas 498Showing the ingredients of Rujahara vati 559Table showing the demographic data of Group A (Shuddha Guggulu)7010 Table showing the demographic data of Group B (Rujahara vati)7111 Distribution of Patients by Age- Gender in Group A (Shuddha72 Guggulu) & B (Rujahara vati)12 Results of Patients by Gender in Group A (Shuddha Guggulu) 7213 Results of Patients by Gender in Group B (Rujahara vati) 7314 Results of Patients by Age of Group A (Shuddha Guggulu)7415 Results of Patients by Age of Group B (Rujahara vati)7516 Distribution of Patients by Religion in Group A (Shuddha Guggulu) &77 B (Rujaharavati)17 Result of Patients by Religion in Group A (Shuddha Guggulu)7718 Result of Patients by Religion in Group B (Rujahara vati)7819 Distribution of Patients by Occupation in Group A (Shuddha Guggulu)78 & B (Rujahara vati)20 Results of Patients by Occupation in Group A (Shuddha Guggulu) 7921 Results of Patients by Occupation in Group B (Rujahara vati) 7922 Distribution of Patients by Economical Status in Group A (Shuddha80 Guggulu) & B (Rujahara vati) -2- 10. 23 Result of Patients by Economical Status in Group A (Shuddha80 Guggulu)24 Result of Patients by Economical Status in Group -- B(Rujahara vati) 8125 Distribution of Patients by Food Habits in Group A (Shuddha81 Guggulu) & B (Rujahara vati)26 Result of Patients by Food Habits in Group A (Shuddha Guggulu) 8227 Result of Patients by Food Habits in Group B (Rujahara vati) 8328 Distribution of Patients with exclusive Sandhi Shoola and Associated 83 Shotha in Group A & B29 Presenting complaints of Group A & B 8430 Distribution of Patients by Associated Complaint in Group A & B8431 Patients observed in both groups for post disease condition8532 Distribution of Patients by Mode of onset in Group A & B 8533 Distribution of Patients by Course in Group A & B8634 Distribution of Patients by Frequency of pain in Group A & B 8635 Distribution of Patients by Duration of attack in - Group A & B8636 Distribution of Patients by Mode of progress in-Group A & B8737 Distribution of Patients by Periodicity in-Group A & B 8738 Distribution of Patients by Srotas-Group A & B 8839 Distribution of patients by Ahara Nidana in Sandhi Shoola8940 Distribution of patients by Anya Nidana in Sandhi Shoola 9041 Distribution of patients by Dosha bheda in Sandhi Shoola 9142 Results of the Group A (Shuddha Guggulu)9243 Results of the Group B (Rujahara vati)9444 Subjective statistical assessment Group A 9545 Objective statistical assessment Group A9546 Subjective statistical assessment Group B 9647 Objective statistical assessment Group B9648 Comparative Subjective statistical assessment of group A and B 9749 Comparative Objective statistical assessment of group A and B9750 Viability comparison of the Trial drug Rujahara Vati with standard 98 Shuddha Guggulu -3- 11. Figures and Photos of Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi A Standard comparative study by SULOCHANA. B.SN TITLE OF FIGURES AND PHOTOS PAGE1Schematic diagram (Samprapti) of Sandhi Shoola 292Showing schematic representation of central pathway of pain343Nerve pathway of pain354Schematic transmission system for nociceptive message and Pain 37 modulation network5Schematic diagram of Vedana vruttam (Pain circle) in Ayurveda386Showing the ingredients of Rujahara vati and Suddha Guggulu557Photos showing the examination techniques678Results of Patients by Gender in Group A (Shuddha Guggulu) 739Results of Patients by Gender in Group B (Rujahara vati)7410 Results of Patients by age in Group A (Shuddha Guggulu)7511 Results of Patients by age in Group B (Rujahara vati) 7612 Distribution of Patients by Religion in Group A (Shuddha Guggulu) &77 B (Rujaharavati)13 Distribution of Patients by Occupation in Group A (Shuddha Guggulu)79 & B (Rujahara vati)14 Distribution of Patients by Economical Status in Group A (Shuddha81 Guggulu) & B (Rujahara vati)15 Distribution of Patients by Food Habits in Group A (Shuddha82 Guggulu) & B (Rujahara vati)16 Results of the Group A (Shuddha Guggulu)9317 Results of the Group B (Rujahara vati)94 -4- 12. V{tx @ D wv|Health and disease are the two faces of a coin. Ayurveda the Science of life orlongevity is the holistic medical science. Ayurveda deals with two main objectives viz.maintenance / promotion of positive health and cure of the disease. The former is the normalhealth system of a person while the later leads to the disturbance of body mind i.e. whichreflects as pain.Ayurveda assigns the movements and associated motor functions to the fiveKarmendriyas viz. Vak, Pani, Payu, Pada and Upastha 1. Vata is the driving force to performthe normal activities of Karmendriyas. Pitta performs its functions through substantive andmetabolic force, which is the cause of biochemical energies and Kapha through its nourishingand preserving powers where protection of the human organism is possible.A normal daily life without using Karmendriyas is almost impossible for any humanbeing from the time immemorial to ultramodern civilized life. Now-a-days man is climbingthe steps of sophistication by which he is moving away from the nature. Abnormal foodhabits, wrong life style, hurry, worry, and lack of exercise have become a part of his life. Dueto which people are very much suffering from problems like Sandhi Shoola i.e., joint pain.Sandhi Shoola is an important clinical manifestation seen in many diseases that afflictsthe Sandhi. The diseases of Sandhi are becoming more and more common in these days due tothe prevalent habits and life style in the present era. Amavata, Sandhigata Vata,Krostukshirsha, Vatarakta etc., are presenting most troublesome complaints affects the Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Introduction 1 13. locomotor system in the most productive period of life i.e., between 30-60 years i.e., SandhiShoola, hence the management of pain becomes first priority of the physician. Even though Sandhi Shoola (joint pain) is not proved to be fatal, it cripples theaffected patients. It can affect many facets of a patients life, such as Family relationships,occupational relationships and even community relationships. It affects not only the social andeconomical situations and his family but also leads to the draining of national resource due tothe work hours lost, resulting in diminished production. Musculoskeletal conditions are a diverse group with regard to pathophysiology but arelinked anatomically and by their association with pain and impaired physical function. Theyencompass a spectrum of conditions, from those of acute onset and short duration to lifelongdisorders; including osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Theprevalence of many of these conditions increases markedly with age, and many are affectedby lifestyle factors, such as obesity and lack of physical activity. The increasing number ofolder people and the changes in lifestyle throughout the world mean that the burden on peopleand society will increase dramatically. This has been recognized by the United Nations andWHO, with their endorsement of Bone and Joint Decade 20002010 2. Asathmya sparsha initiates pain in the Indriyas distributed at specified sites of thebody. This Asathmya sparsha is produced by vitiation of Dosha by the provocation of VataDosha. It is said that the reason for Vata prakopa is either dhatu kshaya or Avarana 3. All the4-5-6authorities of Ayurveda have been dealt these Vata disorders under a separate chapterentitled as Vata Vyadhi. Vata a component of Tridosha has been designed as inevitable factor for the existenceof life. Bhela stated 7, As long as Vata lasts in the body so long does life exist. And the Vata Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Introduction 2 14. is indicative of the continuity of life as per Charaka 8. In other words of Charaka 9- it is clearand evidential that Vata is only responsible for all activities of the body.Pain: The fifth vital sign Incidences and Prevalence10 The American pain society (APS) has created the phrasePain the fifth vital signto elevate awareness of pain treatment among healthcare professionals. The slogan wasdeveloped to remind health practitioners of the importance of monitoring and treating patientswith pain. Pain is the bodys message that something is wrong 11. Pain is a subjective experienceand it cannot be defined in worlds, which would mean anything to a person who has notexperienced it. The intensity of pain suffered differs enormously from person to person. Eventhough it is a distressing symptom in many diseases, it is a beneficial mechanism to the man. There is no individual who has not suffered from pain, in shoulder, elbow, wrists, hips,knees and ankles or any other part of body, if not today, it will come tomorrow. Pain is the 12most prominent symptom in most people with arthritisand is the most importantdeterminant of disability in patients with osteoarthritis 13 number of population-based surveysto assess the prevalence of musculoskeletal conditions; it affects up to 20% of adults 14. Both environmental and genetic factors may contribute to the development of jointpain For example, farming contributes to increased frequency of joint pain 15-18 and that beingoverweight is also associated with increased prevalence of joint pain 19. Burden of four major musculoskeletal conditions viz. osteoarthritis, rheumatoidarthritis, osteoporosis, and low back pain makes ones to suffer as they become old.Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss offunction primarily in the knees and hips, affects 9.6% of men and 18% of women aged >60 Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Introduction3 15. years. Increases in life expectancy and ageing populations are expected to make osteoarthritisthe fourth leading cause of disability by the year 2020 20.Purpose of the study Human intellect and intellectual efforts never allowed him to be satisfied. Differentremedial measures keep being increasing in pace with ever increasing medical needs. Anti-inflammatory or analgesic drugs are the choice of community. Unfortunately all theanalgesics are liable to give many side effects particularly by repeated and prolonged usage.Occasionally more effective drug actions associate with more serious and irreversiblereactions. However the management of pain and swelling in the acute condition left a room towork in terms of Rujahara and shothahara modality to provide relief during the acute phases.Lacunae in current knowledge The traditional knowledge is based upon the humoral theory that too managementbased upon the Prabhava of a dravya. Thus in Ayurveda presently many researches areundertaken with reference to that of pharmaco dynamics and pharmaco kinetics. The trendsare changed where an Evidence Based Therapeutics are to be shown to the scientificcommunity. It is a thought that there are no proper pain management techniques ormedicaments available with Ayurveda. But many Vedanasthapaka and Rujahara dravyas areestablished and recorded from ages. Thus the present trial is conducted to know the efficacyof the Pain management in Ayurveda, through Rujahara Vati which is rationally formulated.Hypothesis It is clear to state that the Ruja or Vedana synonyms to the term Pain whereanalgesics are drug of choices. In Ayurveda as Rujahara and Vedana shamaka terms arereferred to Pain management. These herbs acting as Vedanasthapaka and shothahara are Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Introduction 4 16. suggestive of the pain relievers. Thus in this study an effort is being made to discuss on symptoms and the treatment to be adopted in different Joint pain conditions found in day- to- day practice. This approach is based on the symptomatic management in Ayurveda viz. lakshnika Chikitsa.It is the hope that the present study will open new areas of research and provide the platform for further investigative drives in Ayurvedic field that are searching for a fast pain relief management by contemporary scientific methods. Similar researches undertaken1) Dr. Rajurkar. H.R., effect of Swetha Arka kalpa on Vatika Vedana w.s.r. Shoola and Graha, Kayachikitsa dept (PG), Shree Ayurveda Mahavidyalaya, Nagapur 212) Dr. Jyothi.K., Management of Vedana in vatavyadhi w.s.r. Sandhigatavata and Manyasthambha, Kayachikitsa dept (PG), G.A.M.C, Mysore 223) Dr. Prabhudesai Vidya B, 23 Sandhi shotha evam Vedana mein Jalookavacharana Amavata ke sandarbh mein, Kayachikitsa dept (PG), Smt. K.G.M. Punarvasu Ayurvedic college, Mumbai4) Dr. Deshpande R.R, Sandhishoola Sandhishotha (Arthralgia Arthritis) and Amrutadi Guggulu, 1987, Kayachikitsa dept (PG), Tilak Ayurveda Mahavidyalaya, Pune 245) Dr. Khare . V. A, Study of effects of Agnikarma with Swarna shalaka on Sandhigata Shoola, 1995, Kayachikitsa dept (PG), Tilak Ayurveda Mahavidyalaya, Pune 256) Dr. Mahajan M.P, efficiency for Jalookavacharana in Sandhi Shoola and shotha, 1996, Kayachikitsa dept (PG), Tilak Ayurveda Mahavidyalaya, Pune 267) Dr. Khale Varsha.S., To assess the efficacy of siddha taila abhyanga in management of sandhishoola, 2005, Panchakarma dept (PG), Tilak Ayurveda Mahavidyalaya, Pune 27 Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Introduction 5 17. V{tx @ E bu}xv|x Joint pain affects millions of people worldwide yet we still have only a limitedunderstanding of what makes our joints ache. According to a recent report released by the28World Health Organization, musculo skeletal disorders are the most frequent cause ofdisability in the modern world, and the prevalence of these diseases is rising at an alarmingrate. The most prominent reason for loss of joint mobility and functions with chronic orepisodic pain, which leads to psychological distress and impaired quality of life is pain.Current therapies helps to alleviate joint pain have limited effectiveness and certain drugsproduce unwanted negative side effects, there by precluding their long-term use. In short,millions of patients are suffering from the debilitating effects of joint pain for which there isno satisfactory treatment. The present study intended to focus on the symptom evaluation i.e. Sandhi Shoola(joint pain) and to compare the trial drug Rujahara vati with a standard drug ShuddhaGuggulu internally. 29 Ingredients of Rujahara vati are among the Vedanasthapana gana mentioned byCharaka. The Rujahara vati with its Vata pacification property reduces pain and swellingalong with anti-degenerative properties of joint. So, the combination is assumed as mostsuitable in the management of Sandhi Shoola, especially gross joints. As this symptom is very common and easily available at the geographical area of thepresent study, the efficacy of trial drug is compared with said standard drug. In this regard theobjectives proposed in the study are Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Objectives 6 18. I) Assessment of the Rujahara prabhava (analgesic effect) 30 Generally the disease manifestation is either from Amashaya or PakvashayaHerethe Vedana is because of Vata but not sure its genesis is from pakvashaya alone. Always the31.Vata diseases are manifested because of two reasons either dhatu kshaya or margavaranaMany a times the pain is a reactive response to stimuli or pathology in the body, other wiseunderstood as the cry of the body. Vata is a force, which moves to perform its functions carrying the incapable and lame32.Pitta, Kapha, Dhatu and Mala individually Vata is not only powerful but also having thecontrol over all the functional aspects of the body and it is capable of the traverse all minutechannels of the body 33. Thus Vata vitiation interferes with the normal functions of Indriyas 34.a) To assess the Rujahara prabhava (analgesic effect) of Shuddha Guggulu (standard) inSthoola Sandhi Shoola Shuddha Guggulu, a standard medicine used to pacify pain in Ayurveda by virtue ofits qualities viz. Vedana shamakata, Dhatu vardana, and Rasayana effect pacifies the Vata andrelieves pain locally and generally. Here in this trial the local and general pain relief isestimated through the subjective and objective assessment.b) To assess the Rujahara prabhava (analgesic effect) of Rujahara vati (trial) in SthoolaSandhi Shoola Rujahara vati by virtue of its Teekshna and Ushna guna basically a Vata haracomprises of Tridosha hara properties, which reduces pain in the joint, which will take care ofVata vitiation there by restores the Vata to its normal functions. The Laghu and teekshna gunawith their penetrability enters deep in to the synovial cavity of joint very fast to act locally asanalgesic and grahi guna makes the reconstruction of joints with its embedded quality of Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Objectives 7 19. unctuousness. The Rujahara Vati assessment in this trial as local and general pain reliever isestimated through the subjective and objective assessment as done for the standard drug.II) Assessment of the Shophahara prabhava (anti-inflammatory) Generally the sopha manifestation is either from Agantuja or Nija. Here the sotha isbecause of sleshmadhara kala impairment but not sure its genesis is from Sandhi alone.Always the Sandhi Shotha is manifested because of two reasons either sleshmadhara kalasosha or sleshmadhara kala Shotha. Many a times the Shotha is a reactive response to stimulior pathology in the body, other wise understood as the cry of the body.a) To assess the Shophahara prabhava (anti-inflammatory) of Shuddha Guggulu(standard) in Sthoola Sandhi Shoola Shuddha Guggulu, a standard medicine used to pacify Sopha in Ayurveda by virtue ofits qualities viz. sopha haratwa / shamakata, Dhatu vardana, and Rasayana effect pacifies theVata and relieves logging edema locally and generally. Here in this trial the local and generalinflammation relief is estimated through the subjective and objective assessment.b) To assess the Shophahara prabhava (anti-inflammatory) of Rujahara vati (trial) inSthoola Sandhi Shoola Rujahara vati by virtue of its qualities basically a Vata hara comprises of Tridoshahara with special effect of sothahara, which reduces sopha in the joint. In turn which will takecare of Vata vitiation there by restores the Vata to its normal functions. The Laghu andteekshna guna with their penetrability to deep enters in to the synovial cavity of joint very fastto act locally as anti-inflammatory and Grahi guna makes the reconstruction of joints with itsembedded quality of unctuousness. The Rujahara Vati assessment in this trial as inflammationManagement of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Objectives 8 20. reliever is estimated through the subjective and objective assessment as done for the standarddrug.III) To compare and assess the Rujahara (analgesic effect) and Shophahara prabhava(anti-inflammatory) of Rujahara vati (trail drug) to the Shuddha Guggulu (standard).The study is a standard comparative clinical trial where the effect of Rujahara vati andShuddha Guggulu internally to pacify the Dosha in Sthoola Sandhi Shoola are compared. Inthis attempt the group-A (Shuddha Guggulu) and group-B (Rujahara vati) designatedmedicaments are observed for a period of 20 days and the Rujahara (analgesic) andShothahara (anti inflammatory) effects are compared. Thus the Rujahara vati efficacy interms of analgesic and anti-inflammatory are established by chosen subjective and objectiveparameters.Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Objectives 9 21. V{tx @ F_|xt ex|x In Ayurveda management is done in different ways such as Dosha pratyaneeka,Vyadhi pratyaneeka and Lakshanika Chikitsa. The former Dosha pratyaneeka is mainly meantfor the disease condition management at the level of Dosha sanchaya and prakopa withreference to the Rutukrita Vyadhi. The second, Vyadhi pratyaneeka Chikitsa is specific todisease management after the Sthaana samshraya of the disease where the disease symptomsare precipitated as Vyakta Vyadhi. The last Lakshanika Chikitsa is any way managementwhich is made irrespective of the disease to treat a condition or a symptom of a disease whichis annoying the patient. Thus the present study is undertaken to fulfil the TriskandhaAyurveda Lakshanika Chikitsa of Vedana/ Ruja in Sandhi Shoola conditions.Pada Vyutpatti Paryaya - ParibhashaPada Vyutpatti of Vedana +x ii{: n 0.05 NS B0.56 0.5830.116KriyaA0.28 0.5410.1080.147 0.544>0.05 NS B0.20.50.1Sandhi sthitiA0.24 0.4350.0871 0.161 0.248>0.05 NS B0.20.4080.136Shopha A0.20.4080.0816 0.132 0.303>0.05 NS B0.24 0.5220.104 Table - 49 Comparative Objective statistical assessment of group A and BParameterGroupMean SDSEPSE Z valueP value RemarkHemoglobin A11.016 1.185 0.237 0.353 0.453>0.05 NS B10.856 1.310 0.262ESRA9.24 12.82 2.564 2.736 1.315>0.05 NS B5.64 4.786 0.957DC A56.6 4.6 0.921.64491.265>0.05 NSPolymorphs B54.526.819 1.363DC A38.245.271.054 1.58891.082>0.05 NSLymphocytes B38.965.947 1.189Joint pain A1.81.118 0.223 0.309 0.517>0.05 NS B1.64 1.075 0.215LocalA98.148 0.787 0.15740.171 0.023>0.05 NStemperature B98.144 0.348 0.069RednessA63.6 11.5032.3 3.234 0.247>0.05 NS B62.8 11.3722.274Swelling A307.96 109.8521.97130.1470.337>0.05 NS B297.8103.2220.644Mobility A90.0 7.071 1.414 2.271 0.176>0.05 NS B90.4 8.888 1.777McGills A2.60.866 0.173 0.246 0.65 >0.05 NSQuestioner B2.76 0.879 0.175 Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Results 97 109. d) Viability comparison of the Trial drug Rujahara Vati with standard Shuddha GugguluTable - 50Viability comparison of the Trial drug Rujahara Vati with standard Shuddha GugguluParameterGroup MeanMean After Difference % of Remark BeforevariabilityRuja A 2.560.84 1.76 2.27 0.05).Management of Vedana with Rujahara vati W. S. R. to Sthoola Sandhi Results 99 111. Among the subjective parameters the mean effect of the parametersRuja, Kriya and Sandhi sithiti is more in group A after the treatment with morevariations. But the parameter sopha the mean effect is more in group B afterthe treatment with more variations (By comparing mean and S.D from table48). The mean effect of the objective parameters are more in group A afterthe treatment, the parameters Hb%, ESR, Joint pain, Redness, Swelling withmore variations. Where as the parameter Dc polymorphs shows more meaneffect in group A with more variation in group B after the treatment. Theparameter DC lymphocytes, mobility and McGills the mean effect is morevariations. But in the parameter local temperature the mean effect of the drugis almost same in group A and B after the treatment with more variations ingroup A (By comparing mean and S.D from table 49).Statistical Conclusion The subjective parameters in group A Sandhi sthiti and sopha showsmore highly significant than group B where as the parameter Ruja and kriyashows more highly significant in group B. The kriya is having more net meaneffect in group B with some variation in both the groups. From the analysis theobjective parameters, DC Polymorphs, DC Lymphocytes, Joint pain, Localtemperature, Redness, Swelling and mobility shows more highly significant ingroup A than group B (at P