An observational study on Nidana of Janusandhigata Vata w.s.r to Knee...

[Full title: An observational study on Nidana of Janusandhigata Vata w.s.r to Knee Osteoarthritis]

[Find the meaning and references behind the names: Bala, Man, Raja, June, Kumar, Vishal, Janu, Main]

ORIGINAL ARTICLE May-June 2020 Journal of Ayurveda and Integrated Medical Sciences | May - June 2020 | Vol. 5 | Issue 3 38 An observational study on Nidana of Janusandhigata Vata w.s.r to Knee Osteoarthritis Dr. Vishal Kumar Shellgi Assistant Professor, Dept. of Roga Nidana, Raja Rajeshwari Ayurvedic Medical college and Hospital, Humnabad, Karnataka, INDIA. I NTRODUCTION Ayurveda , the holistic life science aims at physical, social and spiritual well-being of an individual. The modalities of preventive and curative healthcare have been well expounded in this science and may offer comprehensive solutions for the multifactorial diseases of the humanity, [1] As age advances Vata Dosha increases in an individual. This increasing Vata triggers and accelerates Dhatu Kshaya (depletion of tissues) and Bala Kshaya (reduction of strength). Address for correspondence: Dr. Vishal Kumar Shellgi Assistant Professor, Dept. of Roga Nidana, Raja Rajeshwari Ayurvedic Medical college and Hospital, Humnabad, Karnataka, INDIA. E-mail: vishalkumar 1563@gmail.com Submission Date: 18/05/2020 Accepted Date: 22/06/2020 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.5.3.7 Hence advancing age makes man prone to many diseases including degenerative disorders [2] Asthi (bone) is the main seat of Vata Dosha and Sandhi (joint) is the main seat of Kapha Dosha Vata Dosha present in the body responsible for different body movements like Prasarana (extension) and Akunchana of Sandhi, where as Shleshak Kapha present in Sandhi is meant for nutrition, protection and to minimize the friction during the movement [3] Sandhigata Vata is a commonest disorder, occurs due to Dhatukshya . Vata Dosha plays a main role in the disease. Shoola is the cardinal feature of this disease, associated with Sandhishotha with Vatapurnadrutisparsha. Sandhigata Vata manifests when the deranged Vata lodges in joints. If the condition manifests in Janusandhi , then it is called as Janu Sandhigata Vata [4] In modern science, Sandhigata Vata is co-related with osteoarthritis (OA) [5] Osteoarthritis is a chronic disorder of synovial joints in which there is a progressive softening and disintegration of articular cartilage accompanied by the growth of osteophytes. Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced A B S T R A C T Ayurveda , the holistic life science aims at physical, social and spiritual well-being of an individual. As age advances Vata Dosha increases in an individual. This increasing Vata triggers and accelerates Dhatu Kshaya (depletion of tissues) and Bala Kshaya (reduction of strength). Sandhigata Vata is a commonest disorder, occurs due to Dhatukshya . Vata Dosha plays a main role in the disease. Shoola is the cardinal feature of this disease, associated with Sandhishotha with Vatapurnadrutisparsha . Sandhigata Vata manifests when the deranged Vata lodges in joints. If the condition manifests in Janusandhi , then it is called as Janu Sandhigata Vata. In modern science, Sandhigata Vata is corelated with osteoarthritis (OA). Osteoarthritis is a chronic disorder of synovial joints in which there is a progressive softening and disintegration of articular cartilage accompanied by the growth of osteophytes. So here an effort was made in this study to understand the Nidana of Sandhigata Vata especially Janu Sandhi w.s.r to osteoarthritis of knee joint in all dimensions. Key words: Janusandhigata Vata, Knee Osteoarthritis, Nidana Panchaka.

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Dr. Vishal Kumar Shellgi. An observational study on Nidana of Janusandhigata Vata. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2020 Journal of Ayurveda and Integrated Medical Sciences | May - June 2020 | Vol. 5 | Issue 3 39 quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide. The most commonly affected peripheral joints are the knees, hips and small hand joints [6] It is a degenerative disease characterized by gradual development of joint pain, stiffness, swelling and limitations of movements. OA is a chronic disability, the degree of disability depends on the site involved and varies greatly between individuals Almost all persons by age 40 have some pathologic change in weight bearing joint, 25% females and 16% males have symptomatic osteoarthritis., Knee OA is more common in all type of osteoarthritis. A recent WHO report on the world wide burden of the disease indicates that knee osteoarthritis is alone is likely to become the 4 th most important cause of disability in women and 8 th in men [7] So here an effort was made in this study to understand the Nidana of Sandhigata Vata especially Janu Sandhi w.s.r to osteoarthritis of knee joint in all dimensions. O BJECTIVES OF THE STUDY 1 To study in detail and establish the role of Nidana in Janu Sandhigatavata. 2 To study in detail about Osteoarthritis of Knee joint according to modern texts. 3 To understand the co-relation between Janu Sandhigatavata and Knee osteoarthritis. M ATERIALS AND M ETHODS Source of data a) Literary source of data Literary data was collected from the Ayurvedic classics, modern medicinal text books, medical magazines, journals, digital library, conferences and seminars etc. b) Clinical source of data In this study, a minimum of 100 patients were selected from OPD and IPD of Shri Siddharoodha charitable teaching hospital of N.K.J Ayurvedic Medical College and P.G Research Center, Bidar, other Hospitals and Medical Camps. Methods of collection of data Patients having classical signs and symptoms and fulfilling the inclusion criteria were selected for the study irrespective of religion and socio-economical status. Selection Criteria Inclusion Criteria 1 Patients suffering with signs and symptoms of Janu Sandhigatavata as mentioned in classical text of Ayurveda. 2 Patients of age group between 40 to 70 yrs. 3 Patients of either sex. 4 Patients suffering from primary Osteoarthritis of the Knee joint. 5 Patients of radiographic evidence of osteoarthritis like reduced joint spaceand osteophytes. Exclusion Criteria 1 Patients suffering from Amavata, Vatarakta, Kroshtukashirsha . 2 Patients Suffering from fractures, dislocations, bony deformity, TB and tumors of the kneejoint. Sample size estimation It is a clinical observational study of minimum of 100 patients who were suffering from Janusandhigata Vata between the age group of 40-70 years with the help of special case Proforma with the details of history taking, physical signs and symptoms as mentioned in our classics and allied sciences were selected O BSERVATIONS AND R ESULTS Age wise distribution of male and female patients Age (years) M % F % Total 40-45 3 7.69 7 11.48 10 45-50 4 10.26 8 13.11 12 50-55 6 15.38 12 19.67 18

[Find the meaning and references behind the names: Vega, Guru, Rasa]

Dr. Vishal Kumar Shellgi. An observational study on Nidana of Janusandhigata Vata. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2020 Journal of Ayurveda and Integrated Medical Sciences | May - June 2020 | Vol. 5 | Issue 3 40 55-60 4 10.26 9 14.75 13 60-65 9 23.08 13 21.31 22 65-70 13 33.33 12 19.67 25 Total 39 100.00 61 100.00 100 Sex wise distribution Sex Patients % Male 39 39 Female 61 61 Total 100 100 Aharaja Nidana wise distribution of male and female patients. Aharaja Nidana Male % Female % Madhura 36 92.31 53 86.89 Amla 33 84.62 56 91.80 Lavana 30 76.92 36 59.02 Kashaya 26 66.67 30 49.18 Tikta Rasa 29 74.36 46 75.41 Katu Rasa 26 66.67 50 81.97 Alpa Bhojana 3 7.69 8 13.11 Abhojana 2 5.13 3 4.92 Atibhojana 3 7.69 5 8.20 Sheeta 20 51.28 41 67.21 Ushna Bhojana 23 58.97 45 73.77 Guru Bhojana 23 58.97 36 59.02 Lagubhojana 21 53.85 28 45.90 Rooksha Bhojana 6 15.38 10 16.39 Viharaja Nidana wise distribution of male and female patients Viharaja Nidana Male % Female % Vega dharana 35 89.74 54 88.52 Atiuchhabhashana 17 43.59 14 22.95 Ativyavaya 00 00 00 00.00 Ratrijagarana 19 48.72 19 31.15 Plavana 4 10.26 4 6.56 Ativyayama 3 7.69 0 0.00 Divaswapna 29 74.36 51 83.61 Langhana 31 79.49 58 95.08

[Find the meaning and references behind the names: Moha, Ama, Kala, Ras]

Dr. Vishal Kumar Shellgi. An observational study on Nidana of Janusandhigata Vata. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2020 Journal of Ayurveda and Integrated Medical Sciences | May - June 2020 | Vol. 5 | Issue 3 41 Manasika Nidana wise distribution of male and female patients. Manasika Nidana Male % Female % Chinta 33 12.54 57 20.56 Shoka 34 12.92 51 21.18 Bhaya 27 10.26 10 16.82 Kama 2 0.76 2 1.25 Krodha 27 10.26 49 16.82 Moha 1 0.38 0 0.62 Abhighataja Nidana wise distribution of male and female patients. Abhighataja Male Female Total Marmabhighata 18 20 38 Shighrayana 2 4 6 DISCUSSION Research based knowledge is the key for the development in this scientific world. All the researches require methodical work, coherent thoughts, logical ideas and vivid discussions on the different aspects of the topic to arrive at a rational conclusion. In this present study various aspects of Janu sandhigata Vata have been explored. Discussion on literary review of Janusandhigatavata All the Acharayas described Vata Vyadhi as the first among the Mahagada and Sandhigata Vata being one of it, deduce the importance and Chronicity. Even though there are no direct references of Sandhigata Vata till Samhita Kala , the prevalence of Sandhi Roga and their management in Vedic literature indicates that this condition was present even during the vedic period. During Samhita Kala and Sangraha Kala , we find the direct references of this Vyadhi along with Chikitsa. Discussion on observations Age: Among the total observations 39 males, 61 females were having the age group between 40-70 years, among them 47 were in the age group between 60-70 years, as because the age group which is lying above sixty years is called as Vrudhavastha as well as in Vrudhavastha Vatadosha is more predominant, and Sandhigatavata is being a Vatavyadhi . Hence more no of patients were in the age group of 60-70 years. Sex: Among the total observations 39 males and 61 females were seen, female populations were more because of longstanding work in home, repeated trauma. In females, menopause contributes the degenerative changes which will produces pressure as well as structural instability in joints, and also the prevalence of osteoarthritis is more in female. Discussion on Nidana Panchaka Aharaja Nidana: Among the total observations 89 persons consumes Madhura Rasa , 89 consumes Amla Rasa , 66 consumes Lavana Ras a, 76 Katu Rasa , 75 Tikta Rasa , 56 Kashaya Rasa , Alpa Bhojana 11 persons, Abhojana 5, Ati Bhojana 8, Sheeta 61, Ushna 68, Guru 59 and 49 peoples were consuming Laghu Ahara . Among them Madhura, Amla, Katu and Tikta Rasa consumption was high as excess of Madhura Rasa produces weight gain and Ama , in turn Ama produces Srotorodha as well as it will hamper the Uttarottara Dhatu formation. Katu and Tikta Rasa directly involved in the Vata Vrudhi . Viharaja Nidana Among the total observations 89 persons were having the Vegadharana as Viharaja Nidana followed by Atiucchabhashana 31, Ratrijagarana 38, Plavana 08, Ativyayama 03, Diwaswapna 81 and Langhana 89. Among them Vegadharana and Langhana were seen 0 10 20 30 40 50 60 1 2 3 4 5 6 Male Percentage Female Percentage

[Find the meaning and references behind the names: Sri, Sharma, Ayu, Ansari, Nil, Med, Shalini, Jan]

Dr. Vishal Kumar Shellgi. An observational study on Nidana of Janusandhigata Vata. ISSN: 2456-3110 ORIGINAL ARTICLE May-June 2020 Journal of Ayurveda and Integrated Medical Sciences | May - June 2020 | Vol. 5 | Issue 3 42 more in number because of more no of females. Vegadharana as it causes Vata Vrudhi , and Langhana is one among the Apatarpana remedy so there will be increase of Vata in the body. And also Langhana produces Dhatukshya. Manasika Nidana Among the total observations 90 were having Chinta as major issue, 85 Shoka , 37 Bhaya , 04 persons were having Kama as Nidana , 76 Krodha and 01 Moha persons were seen. From the above Chinta , Shoka, Kroda patients were more as because personal issues as well as old age. All these Nidana will increases Vata and helps in production of disease. Abhighataja Nidana Through out the total observations in this study 38 were having Marmabhighata as Viharaja Nidana followed by 6 Shighrayana . As Marmabhighata produces Raktadushti and inturn produces Vata Vruddhi and leads to Sandhigata Vata. Janusandhi belongs to Vaikalyakara type and injury to this leads to impairment in normal functioning. CONCLUSION From the above discussion it can be concluded that Janusandhigata Vata is more commonly seen in Vrudhavastha as well as in females. Excessive intake of Madhura, Amla, Katu and Tikta Rasa will lead to Janusandhigata Vata . Vegadharana and Langhana are the Viharaja Nidana in the causation of Janusandhigatavata. Excess of Chinta, Shoka and Krodha leads to Janusandhigata Vata . Marmabhighata and Vishama Upachara is the superior cause in the production of Janusandhigata Vata . REFERENCES 1 Sharma Ahahlya, T.V.Shalini, A management stratargies for Janusandhigatavata vis-à-vis Osteoarthrities of knee joint A – Narrative Review, 2016 Vol-37 Pp:11. 2 Desoza Zenica, Acharya Shrinivas, (JAHM) Effect of shallaki on knee osteoarthritis janusandhigatavata,Vol - 1,No 3(2013) Pp:1 3 Anatomical changes in Janusandhigata Vata w.s.r to knee osteoarthritis, IAMJ Vol-6 june 2018,Pp :1232. 4 Aktarbabu, Mahatorajaram, An international quarterly journal of research in ayurveda, Gujurat ayurved university Jamnagar.pmc(ayu) Jan 2010 ;31(1): Pp 53- 57. 5 Pathargekamalpeera, an International journal of research in Ayurveda, institute of indigenous medicine,edition 2014, Colombo,Sri lanka 6 Care and management of osteoarthritis in adults national clinical guidelines center 2014 book shelf ID no NBK 333078 Pp:1 7 A.H.Ansari, Malikitrat, An International journal of herbal medicine edition 2014:2(2), 61 Pp. 8 Vashishta shivaram Sharma Shrimad Valmikhi, 7 th chapter Ramayana, Chaukambha Vidhyabhavana, Varanasi, edition 2002 Pp 35,60,61 ******************************* How to cite this article: Dr. Vishal Kumar Shellgi. An observational study on Nidana of Janusandhigata Vata w.s.r to Knee Osteoarthritis. J Ayurveda Integr Med Sci 2020;3:38-42. http://dx.doi.org/10.21760/jaims.5.3.7 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2020 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kashaya, Moha, Kama, Nidana, Madhura, Ayurveda, Ama, Plavana, Langhana, Lavana, Sandhi, Shoka, Sandhigata Vata, Asthi, Prasarana, Amla, Krodha, Vatavyadhi, Chinta, Atibhojana, Abhojana, Amlarasa, Janusandhi, Dhatukshaya, Ratrijagarana, Madhurarasa, Marmabhighata, Vatadosha, Kaphadosha, Katurasa, Vaikalyakara, Tikta Rasa, Raktadushti, Nidana Panchaka, Viharaja Nidana, Manasika Nidana, Ativyayama, Shoola, Knee osteoarthritis, Srotorodha, Divaswapna, Bala kshaya, Janusandhigata Vata, Aharaja Nidana, Vegadharana, Dhatukshya, Sandhishotha, Osteoarthritis (OA), Laghu ahara, Vata vruddhi, Shleshak kapha, Sheeta, Vata vrudhi, Uttarottara Dhatu.