Pain management (Vedanasthapana) with Svadanstra Taila in Janu Sandhigata...

[Full title: Pain management (Vedanasthapana) with Svadanstra Taila in Janu Sandhigata Vata by two different Ausadha Sevana Margas - A Clinical Study]

[Find the meaning and references behind the names: Mohammed, Man, Asif, Renu, Janu, Main, Vijaya, Reddy]

ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 28 Pain management ( Vedanasthapana ) with Svadanstra Taila in Janu Sandhigata Vata by two different Ausadha Sevana Margas - A Clinical Study Asif Mohammed 1 , Dixit Renu 2 , Reddy KV Vijaya Bhaskara 3 1 Post Graduate Scholar, Dept. of Dravyaguna, S.V. Ayurvedic College, Tirupati, Andhrapradesh, India. 2 Professor and HOD, Dept. of Dravyaguna, S.V. Ayurvedic College, Tirupati, Andhrapradesh, India. 3 Professor, Dept. of Shalyatantra, S.V. Ayurvedic College, Tirupati, Andhrapradesh, India. I NTRODUCTION Sandhigata Vata is end result of routine faulty dietetic, irregular life style and responsible for early degenerative changes in bodily tissue and play a vital role in the manifestation of such degenerative disorder. Osteoarthritis is most common articular disorder begin asymptomatically in 3 rd decade and is extremely common by the age of 60. Almost all persons by the age of 40 have some pathological changes in Address for correspondence: Dr. Asif Mohammed Post Graduate Scholar, Dept. of Dravyaguna, S.V. Ayurvedic College, Tirupati, Andhrapradesh, India. E-mail: asifmohd 2223@gmail.com Submission Date: 16/11/2021 Accepted Date: 20/12/2021 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.6.6.5 knee joint as it is the weight bearing joint. The ability to do various works depends upon the ability of using joints. As soon as the man learned to stand erect, he has used this special ability to overcome the obstacles of nature, which depends on the strength of the joints. The moment a person loses ambulation, he not only becomes a burden to respective family and society but also has to lead a miserable and pathetic life. In this way, this disease is now becoming a significant threat to the working population. Among all the Sandhi , Janu Sandhi is the most involved. Number of patients suffering from Janu Sandhigata Vata is more than other joint disorders. Its incidence and prevalence is also surprisingly increasing. Globally approximately 250 million people have osteoarthritis of the knee (3.6% of the population) and in India it is as high as 12%. Ageing is the foremost cause of Sandhigata Vata and Ayurveda says that in Vriddhavasta all Dhatus undergo Kshaya thus leading to Vata Prakopa. The trouble to Sandhi by Prakupita Vata is the main phenomenon in A B S T R A C T Sandhigata Vata is a Sula and Sotha Pradhana Vataja Nanatmaja Vyadhi affecting loco-motor system leaving person disable and make him unable to do his daily routine works. Acarya Vagbhata and Sushruta have considered Vata Vyadhi as Mahagada . It is so called due to the fact that the treatment is time consuming and prognosis is uncertain. Sandhigata Vata is one of the Vata Vyadhi , situated in Marma and Madhyama Rogamarga makes it Kastasadhya . In Ayurvedic classics, there is mention of different formulations for the treatment of Sandhigata Vata one among them is Svadanstra Taila . A study was conducted where patients having symptoms of Sandhigata Vata were selected and divided into two Groups A and B. These two Groups containing 30 patients each were treated with Svadanstra Taila by two different Ausadha Sevana Margas i.e., Bahya and Mukha respectively. The data shows Svadanstra Taila given internally as Snehana has provided better relief. Key words: Janu Sandhigata Vata, Osteoarthritis, Svadanstra Taila, Ausadha Sevana Marga.

[Find the meaning and references behind the names: Sita, Rasa, Gur, Pala]

Asif Mohammed et al. Pain management (Vedanasthapana) with Svadanstra Taila ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 29 Samprapti of Sandhigata Vata. Sandhis are one of the types of Marma and form a part of Madhyama Roga Marga and thus, involvement of Madhyama Roga Marga, Vata Dosa and Dhatuksaya figures disease Kastasadhya . Allopathic treatment has its own limitations in managing the disease. It is either conservative or surgical and leading to many side effects. The same can be better managed with Ayurvedic treatment. So, considering all above points effort is made in this regard to evaluate the efficacy of Svadanstra Taila in Sandhigata Vata by two different Ausadha Sevana Margas as the subject work. A IMS & O BJECTIVES 1 To observe the effect of Svadanstra Taila in different Ausadha Sevana Margas - Mukha (internal administration) and Bahya (external application). 2 To study the effect of different Paka - Mridhu Paka given internally, Khara Paka as external application. 3 To compare and observe the difference of results in the two treatment groups. Grouping: 60 patients are selected and 30 patients are allocated into two groups randomly and each group was given Svadanstra Taila of two different Paka Table 1: Dose, Duration of Treatment and Follow up. Grouping Group - A Group - B Name of the medicine Svadanstra Taila ( Khara Paka ) Svadanstra Taila ( Mrdu Paka ). Dosage Depending on the area of Janu Sandhi, applied externally as Abhyanga. 10 ml of Taila given orally with Warm Milk as Anupana twice a day before food. ▪ All the patients were followed up at interval of 15 days. ▪ Total duration of treatment was 3 months. M ATERIALS AND M ETHODS Ausadhi Yoga : Svadanstra Taila (C.S.Ci 28/147) Contents of Svadanstra Taila 1 Gokshura ( Tribulus terrestris Linn) - 2 Prastha 2 Sunthi ( Zingiber officianale Rosc) - 6 Pala 3 Gokshira - 2 Prastha 4 Guda - 8 Pala 5 Tila Taila - 1 Prastha Table 2: Showing the ingredients of Svadanstra Taila and their properties Name Rasa Gun a Viry a Vipa ka Doshag hnata Karmukat a Goksh ura ( Tribu lus terres tris Linn) Mad hura Gur u, Snig dha Sita Mad hura Vatapit ta Hara Brmhana, Vasti Sodhana, Vatahara. Sunth i ( Zingi ber officia nale Rosc) Katu Lag hu, Snig dha Usn a Mad hura Vataka pha Samaka Anuloman a, Dīpana, Hrdya, Pacana. Goksh ira Mad hura Gur u, Snig dha Sita Mad hura Vatapit ta Hara Ojovardha ka, Medhya, Balya. Guda Mad hura Snig dha Nati sita Mad hura Vatahar a Kaphavrd dhikara, Balya, Vrsya. Tila Taila Mad hura, Tikta. Kasay a Gur u, Snig dha Vya vayi Usn a Mad hura Vatagh na Snehana, Snehopag a, Balya.

[Find the meaning and references behind the names: Ana, Param]

Asif Mohammed et al. Pain management (Vedanasthapana) with Svadanstra Taila ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 30 Study Design Selection of patients ▪ Patients were selected on the basis of Inclusive and Exclusive criteria. ▪ All the vital data along with the details of parameters studied and results are recorded in specifically made Case record form. Each of the patients also explained about the trial and their informed consent is taken in specific form. Inclusion Criteria A Patient’s age group between 30 - 80 years are selected. B Patient’s having classical signs and symptoms of Sandhigata Vata like Sula, Sotha, Sparsa Asahisnuta, Sputana, Akuncana Prasarana Vedana . C Patient with Osteoporosis and Osteophyte changes. D Obese patients. E Patients with history of Trauma. F Patients with Endocrine disorders mainly menopausal women. Exclusive criteria 1 Patients age below 30 and above 80 years 2 Patients suffering from Carcinoma and Psoriatic arthritis. 3 Patients suffering from Vatarakta and Ankolysing arthritis. 4 Patients suffering from Polymyalgia and Rheumatoid arthritis. 5 Patients suffering from Tuberculosis. O BSERVATIONS AND R ESULTS The total study was done on demographic profile and on results of therapeutic tests. After the initial registration the subjects were advised for treatment as per the schedule for three months. Patients were assessed from the Therapeutic response at an interval of 15 days. Thus, to analyze and to compare the effect of two groups with the statistical study, all the values were calculated, the Mean and Variance (S.D) were calculated, by using these values paired t – test was done and ‘t’ values and ‘p’ values were no ted. For the assessment of Clinical efficacy of the drug subjects were called up for follow upon every 15 th day. At each follow up the subjects were assessed for clinical symptoms of Sandhigata Vata . Table 3: Effect of therapy on Subjective Parameters in subjects of Sandhigata Vata in Group A Svadanstra Taila ( Khara Paka ) for Abhyanga. Param eter B. T m e a n A. T m e a n Me an Diff ere nce R el ie f % S.D S. E ‘t’ ‘p’ Inf ere nce B T A T Sula 2. 7 0 0. 5 0 2.2 0 8 1. 4 8 0 . 4 7 0 . 6 8 0. 1 4 7 14. 96 59 <0. 00 01 ESS Sotha 2. 7 0 0. 5 0 2.2 0 8 1. 4 8 0 . 4 7 0 . 6 8 0. 1 4 7 14. 96 59 <0. 00 01 ESS Akunc ana Prasar ana Vedan a 2. 4 0 0. 3 0 2.1 0 8 4 0 . 8 1 0 . 4 7 0. 1 7 1 12. 26 62 <0. 00 01 ESS Sparsh asahis nuta 2. 3 0 0. 4 0 1.9 0 8 2. 6 9 0 . 7 9 0 . 5 0 0. 1 7 1 11. 09 80 <0. 00 01 ESS Atopa 2. 3 7 0. 6 0 1.7 7 7 4. 6 8 0 . 6 7 0 . 6 7 0. 1 7 3 10. 18 69 <0. 00 01 ESS N = 30, ESS - Extremely statistically significant

Asif Mohammed et al. Pain management (Vedanasthapana) with Svadanstra Taila ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 31 Assessment criteria of 30 Subjects in this study by applying student paired t test shows Extremely statistically significant results in the all the Subjective parameters like SandhiSula, Sotha, Akuncana Prasarana Vedana, SparSasahisnuta, Atopa in Group A. Table 4: Effect of therapy on subjective Parameters in Subjects of Sandhigata Vata in Group B Svadanstra Taila ( Mrdu Paka ) internally. Param eter B. T m e a n A. T M e a n Me an Diff ere nce R el ie f % S.D S. E ‘t’ ‘p’ Inf ere nce B T A T Sula 2. 2 0 0. 4 0 1.8 0 8 1. 8 1 0 . 7 6 0 . 5 0 0. 1 6 6 10. 83 74 <0. 00 01 ESS Sotha 2. 5 0 0. 4 0 2.1 0 8 4 0 . 6 8 0 . 6 7 0. 1 3 9 15. 15 73 <0. 00 01 ESS Akunc ana Prasar ana Vedan a 2. 4 0 0. 3 0 2.1 0 8 3. 3 3 0 . 6 7 0 . 4 7 0. 1 5 0 14. 02 69 <0. 00 01 ESS Sparsh asahis nuta 2. 1 3 0. 4 0 1.7 3 8 1. 2 2 0 . 7 8 0 . 5 0 0. 1 6 8 10. 29 41 <0. 00 01 ESS Atopa 2. 2 0 0. 5 0 1.7 0 7 7. 2 7 0 . 8 9 0 . 6 8 0. 2 0 4 8.3 22 5 <0. 00 01 ESS N = 30, ESS - Extremely statistically significant Effect of therapy on assessment criteria of 30 Subjects in this study shows Extremely statistically significant results in the all the Subjective parameters like Sandhi Sula, Sotha, Akuncana Prasarana Vedana, Sparshasahisnuta, Atopa in Group B. Table 5: Comparing overall assessment of the results in Group - A & B SN Subjective Parameters Group A Svadanstra Taila (Khara Paka) for Abhyanga Group B Svadanstra Taila ( Mrdu Paka ) internally 1. Sula 81.48% 81.81% 2. Sotha 81.48% 84% 3. Akuncana Prasarana Vedana 84% 83.33% 4. Sparshasahisnuta 82.69% 81.22% 5. Atopa 74.68% 77.27% ▪ The above table represents the comparison between subjective parameters of Group A and Group B. ▪ It is observed that the percentage of Relief in Sula (81.81%), Sotha (84%), Atopa (77.27%) in Group-B has shown better improvement when compared to Sula (81.48%), Sotha (81.48%) and Atopa (74.68%) of Group- A. ▪ When it comes to Akuncana Prasarana Vedana (84%), Sparshasahisnuta (82.69%) of Group-A shows maximum percentage of relief when compared with percentage of Akuncana Prasarana Vedana (83.33%), Sparshasahisnuta (81.22%) of Group-B. 70 72 74 76 78 80 82 84 Per ce n tage Subjective parameters Group A % Group B %

[Find the meaning and references behind the names: Guna, Sneha, Anila]

Asif Mohammed et al. Pain management (Vedanasthapana) with Svadanstra Taila ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 32 DISCUSSION In this study 50% (30) patients were found between 41- 50 years of age group which shows that Sandhigata Vata is predominant from the 4 th decade. According to Gender, majority were female patients, which indicates it is common in female as many women are either in pre-menopausal state or about to attain Menopause. In menopausal condition deficiency of Estrogen lead to different joint problems. While 50% (30) of subjects were habituated to sedentary life style and did not have regular physical activity. Lack of activity lead to weight gain and patient ultimately end up with Sandhigata Vata . In case of chronicity, 60% (36) patients were found with gradual onset. Probable mode of action Ḍ alhana has described the use of Taila , Ghrta and other Snehas . He opines that Bahya and Abhyantara Snehapana must be adopted in cases of Sandhigata Vata . In Caraka Samhita , Siddhi Sthana , while dealing with Snehana , Caraka vividly explains Abhayantara Snehana as “ Sneho Anila Hanti” which directly refers to Vata Samaka property of Sneha. As Sneha is has exactly opposite Guna to Vata . Svadanstra Taila when given internally, it subsides the Vata and helps in the proper Gati of Vayu . In Janu Sandhigata Vata , Probably the Asthi , Majja and Snayu of the affected limb will get nourished and gain strength, the vital activities of body also strengthened and restored. Bahya Sneha like Abhyanga is also mentioned by Ḍ alhana . External application (dermal route) of Svadanstra Taila directly to the surface of the skin leads to absorption of the drug in the effected part and produces local effects. Vagbhata states, Abhyanga is “ Jara Srama Vata Ha ” which helps to overcome and corrects Srama , Vata Roga and nourishes dhatus. Hence, Management of Sandhigata Vata by Mukha Marga - oral administration and Bahya Marga - External application is useful to improve the quality of life. ▪ The Sandhigata Vata is the disease of Vata Vyadhi due to the Prakopa of Vata . When there is vitiation of Vata , it increases the Ruksadi gunas by the influence of Ahara and Vihara . ▪ The second important part of the disease Sandhigatavata is Sandhi . Asthi is the principle structure of sandhi. ▪ Asthi is the prime seat of Vata and is an important part of sandhi. Acarya Vagbhata has described the “ Ashraya - Ashrayi Bhava ” i.e. inter -relation between Dosa and Dusya , but in case of Asthi Dhatu and Vata Dosa are inversely proportional to each other i.e., Vata Prakopa leads to Asthi Ksaya and vice versa. ▪ The Ksaya of Majja increase Akasha Mahabhuta in the Asthi which aggravates Vata resulting in Sandhi Sula, Sandhi Sputana and osteoporosis. It is mentioned that Majja Ksaya makes the person afflicted by Vata Roga . ▪ On the other hand, the Sthanika Dosa in Sandhi is Kapha and the Agantuja Dosa is Vayu . Both contain Sīta Guna in common. By taking all these things into consideration, drugs of Usna , Snigdha , Rasayana , Brmhana properties have to be administered. ▪ Sunthi – the Madhura Vipaka , Usna Viīya of this drug alleviates Vata helps in combating Sandhi Sula . ▪ Sunthi being Katu Rasa, Usna Vīrya and Laghu Guna causes Medohara leading to loss of weight which indirectly reduces the pressure on knee joint and reduces pain. ▪ Gokshura – Madhura Viapaka , Snigdha Guna of the drug increases Slesaka Kapha which alleviates Khavaigunya thereby decreasing symptoms like Akuncana Prasarana Vedana and Sandhi Sphutana . ▪ Gokshura is best Svayathu Hara Dravya , Sunthi is best Sula PraSamana Dravya which helps to combat the major symptoms of Sandhigata Vata and makes it a best drug of choice in this condition.

[Find the meaning and references behind the names: Sharma, Ram, Murthy, Krishnadas, Guru, Nil, Med, Bharathi, Karan]

Asif Mohammed et al. Pain management (Vedanasthapana) with Svadanstra Taila ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2021 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2021 | Vol. 6 | Issue 6 33 ▪ Simultaneously Guru Guna , Madhura Rasa , Madhura Vipaka of the Gokshura helps in Uttarottara Dhatu Posana . ▪ Guda - is Madhura , Laghu , Anabhisyandhi , Balyam , Pusti Kara , and Vrsya . These properties make it better Vata Hara Dravya . ▪ Milk - which has got properties similar to the Ojas makes it Best Vata Hara Dravya , Ojoskara Along with this it is best Dhatu Posaka Dravya , Rasayana (B.P.Ni. Dugdha Varga ). ▪ All these four ingredients have Rasayana Karma , when given in combination in Taila form gave better results in Sandhigata Vata . CONCLUSION Osteoporotic changes are the one of the prime cause of disease Sandhigata Vata , Ashraya Ashrayi Bhava between Vata and Asthi is inversely proportional. So, Svadanstra Taila administered in different Ausadha Sevana Marga found beneficial due to virtue of its Guna Karma and Rasayana properties, brings down the vitiated Vata which is the ultimate aim of the therapy. The data shows that maximum improvement was observed in both the therapies. Svadanstra Taila ( Mrdu Paka ) when administered internally i.e., Group B has provided better relief in the present study and no patients were found unchanged. Current study reveals that the selected management has potential effect on Sandhigata Vata with added advantage of being free from side effects. REFERENCES 1 Dr. Sharma Ram Karan, Caraka Sa ṃ hita , Vol. I-V, Edited and Published Chaukhambha Sanskrit Series Office, Varanasi, Reprint 2008. 2 Prof. Srikantha Murthy K. R., SuSruta Sa ṃ hita ,Vol. I-III, Edited and Published Chaukhambha Orientalia, Varanasi, Reprint 2010. 3 Prof. Srikantha Murthy K. R., Astanga Hrdayam, Vol. I-III, Edited Chaukhambha Krishnadas Academy, Varanasi, Reprint 2012. 4 Chunekar K.C, Commentary on BhavaPrakasa Nighantu, Choukhmaba Bharathi Academy, Varanasi, 2004 (Hindi). 5 Harrison’s Principles of Internal medicine, McGraw Hill medical publishing division, 16 th edition 2005. 6 Sastry J.L.N., Illustrated Dravyaguna Vijnana, Chaukhambha Orientalia, Varanasi, 2000 ******************************* How to cite this article: Asif Mohammed, Dixit Renu, Reddy KV Vijaya Bhaskara. Pain management (Vedanasthapana) with Svadanstra Taila in Janu Sandhigata Vata by two different Ausadha Sevana Margas - A Clinical Study. J Ayurveda Integr Med Sci 2021;6:28-33. http://dx.doi.org/10.21760/jaims.6.6.5 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 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 (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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