Manisha R. Sharma, Charmi S. Mehta,¹ Dipali J. Shukla,² Kalapi B. Patel,³ Manish V. Patel,⁴ and Shiv Narayan Gupta⁵

Introduction

Physiological functions of the body will be governed by three Doshas, that is, Vata, Pitta, and Kapha. Vitiation of these Doshas leads in disease manifastation. In old age there is progressive decaying in the body structures resulting in various degenerative disorders including Sandhigatavata due to the predominance of Vata.[1] Osteoarthritis[2] (OA) of modern medical science is considered to be its close equivalent.[3]4] According to a survey, osteoarthritis tops all the ailments in the country. In India, the prevalence is more among women, especially menopausal women.[5] The current pharmacological management of osteoarthritis includes the administration of analgesics and Non Steroidal Anti-Inflammatory Drugs (NSAIDs), but their use neither provides adequate pain relief nor deceleration in disease process. In addition, NSAIDs are associated with adverse effects.[6,7] Due to which the use of alternative therapies is on the rise. The plan of the treatment in the study is based on the recommendations from classics for the treatment of Vatavyadhi (diseases essentially caused by Vata). A multimodal therapy in treating a disease is usual Ayurvedic therapy and it is being used in P.D. Patel Ayurved Hospital, Nadiad, since many years, providing good relief to the patients with Sandhigatavata. Yogaraja Guggulu and Ashvagandha Churna have reported to be beneficial in the management of Sandhigatavata (OA).[8] The objective of the present study is to evaluate efficacy of multimodal Ayurvedic management for Sandhigatavata.

Materials and Methods

Fifty clinically diagnosed patients of Sandhigatavata, involving knee joints, were selected from the Outdoor Patient Department (OPD) and hospitalized for a duration of 15 days in the Department of Kaya Chikitsa, in between December 2010 to July 2011. Special clinical proforma was prepared and findings were recorded at regular interval for proper assessment. The enrolled patients were advised to withdraw use of NSAIDs before starting the Ayurvedic management.

The patients were assessed before treatment and after the completion of 15 days of indoor treatment. After completion of indoor treatment, the patients were administered oral medicines. Follow-up with full clinical assessment was done after 15 days and 45 days.

Inclusion criteria

• Individuals between the age group of 30 to 75 years of both genders having clinical features of Sandhigatavata as described in Ayurvedic classics,[9] as well as clinical features of osteoarthritis
• Patients with affection of knee joint, presenting with Sandhishotha (swelling over joints), Sandhishula (pain in joints), Sandhigraha (stiffness in joints), Sprarshasahatva (tenderness), and Sandhisphutna (crepitus)[9,10,11,12]
• Availability of at least 80% of the clinical features in patients was considered as an inclusion criteria for the present study. Radiology of the affected joints was not carried out because those patients who were included in the study have already been diagnosed radiologically.

Exclusion criteria

• Patients below 30 years and above 75 years of age
• Patients suffering with other forms of arthritis like Rheumatoid Arthritis (RA), psoriatic arthritis, gout, ankylosing spondylitis, infective arthritis, and Systemic Lupus Erythematosus (SLE)
• Patients who had an association with other diseases like diabetes mellitus, hyper or hypothyroidism

Management of the patients

• Mriduvirechana (mild purgation) with Eranda Sneha (seed oil of Ricinus communis Linn.), 30 – 35 ml, according to the Koshtha, with warm water, was administered on the third day after admission following Abhyanga and Svedana for two days. Koshtha was assessed on the basis of the patient’s bowel habits and sensitivity. Patients of Mridu Koshtha were given 30 ml of Eranda sneha and patients of Madhyama and Krura Koshtha were given 35 ml of it. After a rest for one day, the following therapies and medicaments were administered
• Abhyanga (oleation therapy) with Narayana Taila (Vata alleviating medicated oil)[13] for 11 days.
• Bashpasvedana (fomentation therapy with evaporation) with Nirgundipatra[14] (fresh leaves of Vitex nigundo Linn.) for 11 days
• Nirgundipatra Upanaha was done for 11 days
• Niruha Basti (proctocolonic administration of decoction) of Dashamula Kvatha (decoction of Dashamula) for one day (before lunch following Abhyanga and Svedana) followed by Matra Basti of 40 ml Narayana Taila (immediately after supper) was given for nine days
• Yogaraja Guggulu,[15] 1 g, thrice a day, with warm water
• Ashvagandha Churna (root powder of Withania somnnifera Dunal.) 3 g with warm milk was given in morning and evening before meals
• Jalaukavacharana (leech application) was done on the patients on the eleventh day, if pain and stiffness were not relieved after Snehana, Svedana, Mriduvirechana, and Basti. This was repeated if required on the fifteenth day.

All formulations like Narayana Taila, Eranda Sneha, Dashamula Kvatha, Yogaraja Guggulu, and Ashvagandha Churna were prepared as per the standard guidelines under the supervision of the subject experts. Fresh leaves of Nirgundi were collected from the medicinal plant garden in the campus.