Ayurvedic management of Janusandhigata Vata - A Case Report

[Find the meaning and references behind the names: Patil, Janu, Deepak, Jagannath, Mangesh]

CASE REPORT July-Aug 2020 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2020 | Vol. 5 | Issue 4 420 Ayurvedic management of Janusandhigata Vata - A Case Report Vd. Mangesh Jagannath Thamake 1 , Vd. Parag Vishwas Kulkarni 2 1 Associate Professor, Dept. of Samhita and Siddhant, 2 Assistant Professor, Dept. of Rognidan Avum Vikriti Vigyan, Dr. Deepak Patil Ayurvedic Medical College and Research Centre, Panhala, Kolhapur, Maharashtra, INDIA. I NTRODUCTION Osteoarthritis is a chronic, degenerative disorder of unknown cause characterised by gradual loss of articular cartilage. Osteoarthritis also known as degenerative arthritis, degenerative joint disease, or osteoarthrosis, is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially this usually just occurs after exercise but over time may become constant. It is the most prevalent disease in our society, with a world wide distribution. It ranks fourth in health impact in women and eighth in men in the world. Osteoarthritis of knee is the common musculoskeletal problem commonly Address for correspondence: Vd. Mangesh Jagannath Thamake Associate Professor, Dept. of Samhita and Siddhant, Dr. Deepak Patil Ayurvedic Medical College and Research Centre, Panhala, Kolhapur, Maharashtra, INDIA. E-mail: vdmangesh@gmail.com Submission Date: 09/07/2020 Accepted Date: 04/08/2020 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA found by the age of 60 years. This condition generally affects major joints. Knee is weight-bearing joint. Generally pathological changes occurs after the age of 40 years in almost all people. Symptoms of osteoarthritis are commonly seen in 30% females and 18% males. It influences daily work by inducing limitations due to pain while carrying out routine activities such as bending, lifting objects and walking [1] Osteoarthritis can be correlated with Sandhigata Vata in Ayurveda. Acharya Charaka has explained this disease under Vataja Nanatmaja Vyadhi . He had explained this condition with symptoms such as pain while walking, inflammation and crepitus present in joint [2] Acharya Sushruta has added peculiar symptoms like degenerative changes in joints as the symptoms of Sandhigata Vata [3] other treatment pathy has its own limitation in managing osteoarthritis. The pharmacological management of osteoarthritis includes the administration of pain killers and Non Steroidal Anti-Inflammatory Drugs (NSAIDs). But this line of treatment is not adequate for pain relief nor deceleration in disease process. And non steroid anti inflammatory medicines causes many side effects [4] Hence here is a great need to find effective management in Sandhigata Vata . Such type A B S T R A C T Osteoarthritis of knee is one of the major musculoskeletal abnormality found now a days. Osteoarthritis (OA) is the most common joint disorder all over the world. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. In Ayurveda, osteoarthritis is correlated with Sandhigata Vata . Large number of studies have been conducted for the Ayurvedic treatment of Sandhigata Vata . So with help of this paper, efforts were taken for the successful Ayurvedic management of Jaanu Sandhigata Vata. Key words: Osteoarthritis, Sandhigata Vata, Ayurvedic Management.

[Find the meaning and references behind the names: Luke, Good]

Vd. Mangesh Jagannath Thamake et al. Ayurvedic management of Janusandhigata Vata - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2020 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2020 | Vol. 5 | Issue 4 421 of rheumatological condition can be better treated with application of various Shodana ( Panchakarma ) and Shamana Chikitsa (oral medicine) in Ayurveda. The line of treatment in the study is based on the Chikitsa Sootra (recommendation) from classical books of Sandhigata Vata (osteoarthritis). A Ayurvedic therapy in treating a disease is being used in Dr. Deepak Patil Ayurved Medical College and Hospital, Panhala, Kolhapur. Hospital is providing good relief to the patients with Sandhigata Vata . In this case study, a female patient with Sandhigata Vata was prescribed for different local and systemic therapy along with palliative ( Shamana ) treatment. This resulted in recovery in symptoms. C ASE R EPORT A 52 years old female patient came in Dr. Deepak Patil Ayurvedic Medical college and Hospital, OPD with complaints of right knee pain. It was associated with stiffness and swelling. MRI was done. He was not having any history of major medical and surgical illness. Patient was taking allopathic treatment for the osteoarthritis but did not get much relief. So patient approached for Ayurved treatment. M ATERIALS AND M ETHODS Assessment Criteria Subjective Criteria Shool No Shool 0 Mild Shool 1 Moderate Shool 2 Severe Shool 3 Shoph No Shoph 0 Mild Shoph 1 Moderate Shoph 2 Severe Shoph 3 Stambha No Stambha 0 Mild Stambha 1 Moderate Stambha 2 Severe Stambha 3 Crepitus No Crepitus 0 Mild Crepitus 1 Moderate Crepitus 2 Severe Crepitus 3 Treatment given: Pachana Chikitsa follwed by Shamana and Shodhana Chikitsa. Deepana Chikitsa Having Deepana property of Hingwashtaka Churna , it causes the overall absorption of medicine used for Shamana therapy. 3 gm Hingwashtaka Churna was advised twice a day before meals [5] Pachana Chikitsa Maharasnadi Kwatha : Maharasnadi Kwatha is a polyherbal formulation that has the potential for providing relief in arthritic condition. This formulation is very useful for the purpose of reduction of pain, inflammation and antipyretic activity. 50 ml Maharasnadi Kwatha was advised on empty stomach on morning time [6] Lepa : Shigru and Varuna , were used in the Lepa . This Lepa have anti-inflammatory and analgesic property; hence, remarkable reduction was observed in pain and inflammation due to its application [7] 10 gms luke warm lepa was applied over anterior side of right knee. It was kept for a hour and was removed.

[Find the meaning and references behind the names: Narayana, Main]

Vd. Mangesh Jagannath Thamake et al. Ayurvedic management of Janusandhigata Vata - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2020 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2020 | Vol. 5 | Issue 4 422 Yogaraja Guggulu : In this patient, there was a moderate pain over the knee joint; hence, Yogaraja Guggulu was prescribed to reduce the pains due to its anti-arthritic property. 2 tablets of Yogaraja Guggulu were given twice daily with lukewarm water [8] Abhyanga (massage) with Mahanarayana Taila : Abhyanga appease vitiated Vata , which is responsible for the degeneration of Sapta Dhatus and for the manifestation of Sandhigata Vata. Abhyanga causes vasodilatation, absorption of drugs, and increases effect of Snehana (oleation). Oil is the best Shamana drug for Vata and many of the drugs of Narayana Taila possess Datuposhana (nourishing) properties. In this case, owing to local Abhyanga (oleation), there was reduction in pain, stiffness, and improvement in knee joint movement. Mahanarayana Taila acts on Vatadosha or Asthigata and Sandhigata due to its analgesic and antiinflammatory action. 10 ml of warm Mahanarayana Taila was advised for massage of right knee [10] Nadi Sweda : After Nadi Sweda , reduction in stiffness and pain was observed as it relaxes muscles and provides better relief in osteoarthritis ( Sandhigata Vata ). Nadi Sweda was advised for 10 minutes. Yoga Basti Day 1 :- Matra Basti of 40 ml Narayana Taila (immediately after supper) Day 2 :- Matra Basti of 40 ml Narayana Taila (immediately after supper) Day 3 :- Niruha Basti of Dashamula Kvatha (decoction of Dashamula ) 500 ml following Abhyanga and Svedana ) Day 4 :- Matra Basti of 40 ml Narayana Taila (immediately after supper) Day 5 :- Niruhbastiof Dashamula Kvatha (decoction of Dashamula ) 500 ml following Abhyanga and Svedana ) Day 6 :- Matra Basti of 40 ml Narayana Taila (immediately after supper) Day 7 :- Matra Basti of 40 ml Narayana Taila (immediately after supper) This Yoga Basti Krama was advised for seven days. It was started after a week of Dipana-Pachana Chikitsa [11] With above mentioned line of treatment patient got satisfactory relief from the symptoms of right knee osteoarthritis. Treatment was given for 3 months. It can be well appreciated on Table 2. Table 2: Showing results before and after treatment. Shoola Shopha Stambha Creitus BT AT BT AT BT AT BT AT 3 1 2 0 3 0 2 0 BT - Before Treatment, AT - After Treatment DISCUSSION In above case study patient got excellent relief from symptoms of right knee osteoarthitis. Different types of treatment like Deepan, Pachana, Abhyang, Swedan, Dhara, Lepam, Bandh, Agnikarm, Raktamokshna, are mentioned in Ayurveda. Ayurveda has Panchakarma Chikitsa as its specialty. In this case study Yogaraja Guggulu showed good results along with Deepana-Pachana . In Sandhigata Vata Chikitsa according to Acharya, Shodhana Chikitsa should be given to the patient. Basti Chikitsa is indicated for vitiated Vata Dosha. In this case patient was having symptoms of Vata vitiation. Basti Chikitsa helps to remove vitiated Vaat Dosha from body. Shaman Yoga was given as a combination of Yogaraja Guggulu 500 mg bid and Maharasnadi Kwatha 20 ml along with local application of Mahanarayana Taila . Main content of Kaishora Guggulu is Guggulu, Triphala, Trikatu . This Kalpa is useful for vitiated Vata Dosha & Rakta Dushti. Guggulu is very useful medicine for vitiated Vata Kapha Rakta. And other content like Chavya, Chitrak, Dhanyaka, Pippali Moola, Tamala Patra, Danti are very good medicine for Aamapachana . Adopted treatment protocol mainly comprised Aampachaka , Vedanasthapaka (pain killer), Shothahara (antiinflammatory), and was Vatadosha Shamana (pacification of Vata ) in nature. This line of treatment

[Find the meaning and references behind the names: Sharma, Manisha, Singh, Wang, Ayu, Mar, Shah, Arya, Jun, Sah, Akhilesh, Patel, Nil, Med, Jan]

Vd. Mangesh Jagannath Thamake et al. Ayurvedic management of Janusandhigata Vata - A Case Report ISSN: 2456-3110 CASE REPORT July-Aug 2020 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2020 | Vol. 5 | Issue 4 423 helped to strengthen various musculatures and various structures in knee region. By taking into consideration all factors, which were involved in the pathogenesis of Sandhigata Vata in this patient, treatment principles for Vatavyadhi Chikitsa (treatment of Vata diseases) was applied here. CONCLUSION In this case study marked improvement was seen in patient of knee osteoarthritis ( Janusandhigata Vata ). The treatment so planned was helpful in Aamapachana , removal of vitiated Doshas from body and bringing Samyavastha (balanced condition) of Doshas . It also improved routine movements of patient and hence the treatment was effective to relieve the symptoms. REFERENCES 1 Minchen Wang, Degenerative Osteoarthritis Revisited- Thinking outside the Box. Journal of Clinical Medicine and Therapeutics, 2018. 2 Shastri R, Upadhaya Y, editors. Charaka Samhita of Agnivesha, Chikitsa Sthana, Ch. 28, Ver. 37, Edition reprint. Varanasi: Chaukhambha Bharti Academy; 2007. p. 783. 3 Shastri K, editor. Nidhanasthana; Vatavyadhinidan Adhyaya. Verse 29. In: Sushruta, Sushruta Samhita. Varanasi, India: Chaukhamba Sanskrit Sansthan; 2012. p. 460. 4 webmd.com/osteoarthritis/osteoarthritis-pain-relief 5 Sawarkar G, Suple Y. Prevention and management of osteoarthritis. Int J Res Ayurveda Pharm 2013;4:22. 6 Patel S, Shah P. Evaluation of anti-inflammatory potential of the multidrug herbomineral formulation in mail Wistar rats against rheumatoid arthritis. J AyurIntegr Med 2013;4;86-93 7 Tripathi B, editor. Chikitsasthana; Vatavyadhichikitsa Adhyaya. Verse 15 – 18. In: Charak, Charak Samhita. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2011. p. 93. Back to cited text no. 4 8 Arya S et al/Int.J.Res.AyurvedaPharm.10(2),2019 9 Antarkar D S et al. Tolerability study of Yogarajguggulu--a popular ayurvedic drug. J Postgrad Med 1984;30:111 10 Akhilesh K Singh and Om P Singh. A preliminary clinical evaluation of external snehan and asanas in the patients of sciatica Int J Yoga. 2013 Jan-Jun; 6(1): 71 – 75. 11 Manisha R. Sharma et/al Multimodal Ayurvedic management for Sandhigata Vata (Osteoarthritis of knee joints) Ayu. 2013 Jan-Mar; 34(1): 49 – 55. ******************************* How to cite this article: Vd. Mangesh Jagannath Thamake, Vd. Parag Vishwas Kulkarni. Ayurvedic management of Janusandhigata Vata - A Case Report. J Ayurveda Integr Med Sci 2020;4:420-423. 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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Sandhigata Vata, Stambha, Shothahara, Yogarajaguggulu, Vatavyadhichikitsa, Vatadosha, Shool, Mahanarayanataila, Palliative treatment, Shamanacikitsa, Panchakarma chikitsa, Case report, Osteoarthritis, Ayurvedic Management, Shodhana Chikitsa, Vedanasthapaka, Knee osteoarthritis, Crepitus, Knee joint, Basti Chikitsa, Nadi Sweda, Aamapachana, Systemic therapy, Yoga Basti, Degenerative arthritis, Arthritis, Pachana Chikitsa, Joint Disease, Local therapy, Maharasnadi Kwatha, Hingwashtaka churna, Anti-inflammatory drug, Shaman Yoga.