INTRODUCTION:

SandhigataVatavis-a-vis Osteoarthritis is a type of Vatavyadhi. The vitiated Vata when takes shelter in joints causes pain, swelling, stiffness, crepitus is known as Sandhivata. Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis¹, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

It is most common type of arthritis in men over 40 years. It can affect the hands, hips, shoulders, knees etc. It is one of the most frequent causes of joint pain and physical disabilities in advancing years of life. Globally approximately 250 million people have osteoarthritis of the knee (3.6% of the population)².

Sandhigata Vata is briefly described in Ayuurvedic Samhitas. In Charaka Samhita, it has described for the first time in the name “Sandhigata Anila” and defined it as “Vatapurna Driti Sparsha” (on palpation it feels like air filled bag), “Sopha” (swelling) , “Prasaranakunchanyoh Pravrittischa Savedana” (painful on flexion and extension movement)³. Acharya Susruta in Nidanasthana has described it as “Sandhigata Vata” and defined it as Sandhihanti (destruction of joints), Sandhisoola (painful joints), Sandhisopha (swollen joints)⁴. Acharya Vagbhat has described it as “Sandhigata Kupita Vata”.

Clinically, it is represented as—

· Pain in joints during movements,

· Stiffness in joints especially after prolong rest and at the onset of movement

· Tenderness in joints,

· Crepitus fine/coarse,

· Restricted joint movements.

Radiologically, Osteoarthritis is characterized by narrowing of joint spaces, osteophytic changes and deformities in contour of joints.

About the etiopathogenesis of Sandhigata Vata much descriptions are seldom witnessed. On the basis of common etiopathogenesis of Vatavyadhies it is clear that vitiated Vata (Vyanavayu) when takes shelter in Sandhisthana leading to degeneration of Asthidhatus and decrease of Shlesaka Kapha and disturbs the normal structure and functions of joints and produces the Sandhivata. The present work entitled “Clinical study of Dashmoola Panchatikta Bala Ksheera Basti in the management of Sandhigata Vatavis-a-vis Osteoarthritis” is an attempt in this direction.

MATERIAL AND METHODS:

Criteria for selection of therapies along with their constituents:

If we consider Samprapti of Sandhigata Vata, it is clearly mentioned that vitiated Vata is chiefly responsible for the disease. If we will go through our Ayurvedic classics, we will find that Basti therapy is superior to the other Panchakarma therapies for vitiated Vata along with Snehana-Swedana.

Since, the disease is Asthyaasrita and Asthi is the site of Vata. Acharya Dalhana (on the commentary of Susruta Kalpa 4/40) has mentioned that Purisadhara Kala (fifth Kala) is same Asthidhara Kala. So, Basti therapy is more valuable than the others.

Dashmoola is said to be a good combination of Vata Shamaka drugs. Tikta rasa drugs are Vayu and AkashMahabhutadominant⁵, so they have tendency to reach at those places who are Vata and Akash Mahabhuta dominant like Asthi and Asthivaha Srotasa. Acharya Charaka has mentioned that “Bastayah Ksheerasarpeesih Tiktakopahitani Cha”⁶. On this basis, I have selected Dashmoola Panchatikta Bala Ksheera Basti.

Selection of the patients and grouping:

A series of 20 patients suffering from Sandhigata Vata vis-à-vis Osteoarthritis were randomly selected from O.P.D. and I.P.D. of Panchkarma P.G. Department, Rishikul Govt. Ayurvedic P.G. College and Hospital, Hardwar, Uttarakhand, for the purpose of clinical trials of present study. The patients were randomly selected regardless their age, sex, socio-economic status, marital status etc. but they were fully gratifying the criteria of diagnosis of Osteoarthritis in modern medicine as well as clinical features of Sandhigata Vata as in Ayurvedic literatures. Out of 20 patients, only 16 patients could complete their full follow-up i.e. 3 months. 04 patients had left against their medical advice.

Hence, final assessment of the result was done only in 16 patients.

The procedure of Basti therapy:

Contents of Basti

A. AsthapanaBasti⁷:

Makshika (Honey) = 100ml

Lavanam (Saindhava) = 15gm

Sneha (Mahanarayana oil) = 175ml

Kalka (Soya powder) = 60gm

Kwatha (with Ksheera) of the following:

Dashmoola

Panchtikta

Bala = 250ml

The contents of Kwatham total 50 gm/day were taken and boiled with 800 ml. of water and 200 ml. of milk until ¼ th (250ml) of the decoction is left.

Total amount of Basti material prepared was kept around 600ml.

B. Anuvasana Basti:

Mahanarayana oil = 60 ml

Saindhava salt = 2.5 gm

Clinical assessment of diseases:

Symptoms and their grading score:

The procedures are as follows:

· Gradation of pain score

0 = Nil; no pain in the joints

1 = Mild pain; pain complained but tolerable

2 = Moderate pain; pain complained and disturbs routine work

3 = Severe pain; severe pain completely interrupting routine work

· Gradation of swelling of joints

0 = Nil; no swelling

1 = Mild; feeling of swelling with heaviness of joints

2 = Moderate; apparent swelling

3 = Severe; huge swelling

· Gradation of tenderness of joints

0 = Nil; no tenderness

1 = Mild; elicited on much pressure

2 = Moderate; elicited on moderate pressure

3 = Severe; elicited even on slight touch

· Restriction of movements

0 = Absence of movement restriction

1 = 10% restriction of movement

2 = 25% restriction of movement

3 = 50% restriction of movement

· Gradation of stiffness

0 = Nil; no morning stiffness

1 = Mild; morning stiffness of 5-10 minutes duration

2 = Moderate; morning stiffness of 10-15 minutes duration

3 = Severe; morning stiffness of 15-30 minutes duration.

· Gradation of crepitus

0 = Absence of crepitus

1 = Mild; perception on touch

2 = Moderate; audible on attention

3 = Severe; clearly audible

VAS scale for pain⁸

Visual analogue scale- It is an analogue scale grading from 0 to 10. Here 0 indicates no pain whereas, 10 indicates worst pain ever.

OBSERVATION AND RESULTS:

Out of 16 patients, 07 were males and 09 were females. Incidence of disease is found notably higher in females than in males. During the study maximum no. of patients were belonging to age group between 51-60 years of age (50 %), then to group between 40-50 (31.25 %) and 61-70 years of age (18.75%).

Out of 16 patients, majority of patients were House-wives (50%) followed by Labour and Farmers (25 %).

In present study, it was found that in case of pain and crepitus, distribution of cases were 100 %. In case of Tenderness, stiffness and swelling 87.5 % cases and restriction of movement in 81.25 % cases. It reveals that these are major sign and symptoms in osteoarthritis. (Table- 1).

Total effects of therapy in pain improvement was 62.5%, in swelling 70.59%, in tenderness 68.40%, in crepitus 18.92%, in restriction of movement 61.52%, in joint stiffness was 66.67 %, in severity index of OA 67.50%, in VAS for pain 67.5% and in health satisfaction was 44.53 %. Improvement in Hb%, ESR value and Serum Ca was not significant. (Table- 2).

In X-ray of the affected joint, after completion of third follow up, there was some increase in the joint space but osteophytic changes and sclerotic changes were decreased. In urine, there was no change significantly.

After full observation of therapies, it was found that no. of patient unchanged was 0, whereas, observed mild improvement was found in 5 patients (31.25 %), moderate improvement was observed in 8 patients (50 %), marked improvement was observed in 3 patients (18.75 %). (Table-3).

DISCUSSION:

Dashmoola is said to have the properties of Shothhara as well as it is good Vatashamaka. Tikta dravyas may have the properties of blood purifier, detoxification, analgesia and antibacterial as well as it may facilitate the Poshaka Tatvas to the asthivaha and Majjavaha Srotas due to its Vata and Akash Guna predominance. Ksheera Basti is a good nutritive measure in degenerative disorders. Hence, a combination of theses in trial therapy “Dashmoola Panchtikta Bala Ksheera Basti” may provide good results in the disease. It may produce reduction in pain, swelling, restriction of movement, stiffness and a little bit in crepitations, whereas Basti therapy may improve the health and may cause the slowing of degenerative process of the body.

CONCLUSION:

Effect of Dashmoola Panchtikta Bala Ksheera Basti (Samsodhana/ purificatory measures) for Sandhigata Vata (OA) is undoubtful due to its systemic effect on Dhatukshaya and vitiated Vata.

Since sample size was very small, so it is very difficult to give a definite conclusion, but it may be a better approach of management in SandhigataVatavis-a-vis Osteoarthritis without any side effects.

Table:1 %Distribution of Sign and Symptoms in Groups à

Symptoms and Signs	Group	%
Pain	16	100
Swelling	14	87.50
Tenderness	14	87.50
Restriction of Movement	13	81.25
Stiffness	14	87.50
Crepitus	16	100

Table -2: Effect of Therapy on Symptoms and Signs in Group:

Symptoms and signs	Mean		X	n	% Relief	S.D.	S.E.		P
Symptoms and signs	BT	AT	X	n	% Relief	S.D.	S.E.		P
Pain	2.50	0.94	1.56	16	62.50	0.51	0.13	12.20	<.001
Swelling	2.13	0.63	1.50	14	70.59	0.52	0.13	11.62	<.001
Tenderness	2.38	0.75	1.63	14	68.40	0.50	0.13	13.00	<.001
Crepitus	2.31	1.88	0.44	13	18.92	0.62	0.16	2.79	> .01
Restriction of movement	1.63	0.63	1.00	14	61.52	0.52	0.13	7.75	<.001
Joint stiffness	1.69	0.56	1.13	16	66.72	0.50	0.13	9.00	<.001
Severity Index of Disease	2.50	0.81	1.69	16	67.50	0.48	0.12	14.10	<.001
VAS Scale Of Pain	7.50	2.44	5.06	16	67.50	1.95	0.49	10.39	<.001
Health Satisfaction	6.13	3.56	2.57	16	44.53	2.10	0.63	4.30	<.001

Table-3:Total Effect of Therapies in Different Groups :

Results	Group	%
Complete Improvement	0	0
Marked Improvement	3	18.75
Moderate Improvement	8	50.00
Mild Improvement	5	31.25
Unchanged	0	0

REFERENCES:

1. http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/con-20014749 retrieved on29.10 2012

2. Vos T, Flaxman AD, et al.(December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: asystematic analysis for the Global Burden of Disease Study 2010". Lancet 380 (9859): 2163–96.

3. Agnivesha, Charaka Samhita, Elabourated Vidyotini Hindi commentary, Pt. Kashinath Shastri and Dr. Gorakhnath Chaturvedi, Chaukhambha Bharti Academy, Varanasi; Edition 2004; Part 2; page 783.

4. Sushruta, Sushruta Samhita, Ayurveda Tattva Sandipika Hindi commentary; Kaviraja Ambika Dutt Shastri; Chaukhambha Sanskrita Sansthana, Varanasi, Edition 2003; Part 1; Page: 230 (Su. Ni. 1/28).

5. Agnivesha, Charaka Samhita, Elabourated Vidyotini Hindi commentary, Pt. Kashinath Shastri and Dr. Gorakhnath Chaturvedi, Chaukhambha Bharti Academy, Varanasi; Edition 2001; Part 1; page 502 (Ch. Su. 26/40).

6. Agnivesha, Charaka Samhita, Elabourated Vidyotini Hindi commentary, Pt. Kashinath Shastri and Dr. Gorakhnath Chaturvedi, Chaukhambha Bharti Academy, Varanasi; Edition 2001; Part 1; page 573 (Ch. Su.28/27).

7. Vagbhat, Ashtanga Hridayam; Vidyotini Hindi commentary; Kaviraj Atri Dev Gupta; Chaukhmbha Sanskrita Sansthana; Edition :2005; page no. 123; (A.Hr.Su. 19/45).

8. Huskisson EC (1982). "Measurement of pain". J. Rheumatol. 9 (5): 768–9.PMID 6184474

Received on 05.09.2014 Modified on 10.09.2014

Res. J. Pharmacology and P’dynamics. 6(4): Oct. - Dec.2014; Page 177-180