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Table of Contents
CASE REPORTS
Year : 2019  |  Volume : 7  |  Issue : 4  |  Page : 249-253

Comprehensive Ayurvedic management of Sandhigatavata: a case report


Department of Panchakarma, Mahatma Gandhi Ayurved Medical College Hospital and Research Centre, Salod, Wardha 442001, Maharashtra, India

Date of Submission30-Dec-2019
Date of Decision10-Jan-2020
Date of Acceptance29-Jan-2020
Date of Web Publication14-Apr-2020

Correspondence Address:
Dr. Poonam Ashtankar
Department of Panchakarma, Mahatma Gandhi Ayurved Medical College Hospital and Research Centre, Salod, Wardha 442001, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_71_19

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  Abstract 

Background: Osteoarthritis (OA) is the most common musculoskeletal abnormality. In Ayurveda, it is correlated with Sandhigatavata. Many studies have been conducted for the Ayurvedic management of Sandhigatavata but only with respect to clinical feature. Not a single evidence on their efficacy in radiological findings was available. So through this paper, efforts were taken for the successful Ayurvedic management of Sandhigatavata, evidenced over radiological findings. Aim: The aim of this study was to access the efficacy of Ayurvedic management including Shodhan (purification) and Shaman Chikitsa (palliative therapy) in Sandhigatavata. Materials and Methods: It is a single case study of a 50‑year‑old male patient who was diagnosed as case of Sandhigatavata with pain, stiffness, and swelling in right knee joint, difficulty while walking since 1 month. There was a significant joint space reduction with osteophytes in X‑ray of left knee joint. He was advised for local Abhyanga (massage), Swedana (hot fomentation), Niruha Basti (enema of herbal decoction), Janudhara (oil batch at knee joint), along with Lepa (local application of medicament) and palliative treatment. Results: After 1 month, changes were observed in symptoms, and reduction was seen in gross joint space in X‑ray of right knee joint. Conclusion: Patient got satisfactory relief in clinical features as well as in maintaining joint space, no overlapping of lateral epicondyle of femur and tibia, also no osteoporotic changes were observed in X‑ray after 1 month.

Keywords: Ayurvedic management, osteoarthritis, Sandhigatavata


How to cite this article:
Ashtankar P, Sawarkar P. Comprehensive Ayurvedic management of Sandhigatavata: a case report. J Indian Sys Medicine 2019;7:249-53

How to cite this URL:
Ashtankar P, Sawarkar P. Comprehensive Ayurvedic management of Sandhigatavata: a case report. J Indian Sys Medicine [serial online] 2019 [cited 2020 Jun 2];7:249-53. Available from: http://www.joinsysmed.com/text.asp?2019/7/4/249/282386


  Introduction Top


Osteoarthritis (OA) is the most common musculoskeletal abnormality commonly occurring by the age of 70 years. It is a condition that affects especially major joints. In weight-bearing joint, some pathological changes occur by the age of 40 years in almost all people, and symptoms of osteoarthritis are commonly seen in 25% females and 16% males. More rate of OA of knee is observed in Indian population than that in Western population. It induces interference with work disability by inducing limitations due to pain while carrying out daily activities such as walking, dressing, and bathing.[1]

OA can be correlated with Sandhigatavata in Ayurveda. Acharya Charaka had described this disease under Vataj Nanatmaj Vyadhi (different diseases of Vata). He had narrated this condition with symptoms such as inflammation, difficulty and pain while walking, and crepitus present in joint.[2]Acharya Susruta had further added specific symptoms, that is, degenerative changes in joints as the symptoms of Sandhigatavata.[3] Contemporary treatment has its own limitation in managing this disease. In Western medical science, various treatment options in advanced stage of OA are present but they do not provide remarkable recovery and cause multiple side effects. So, there is a great need to find effective management in Sandhigatavata. Such type of rheumatological condition can be better treated with application of various Panchakarma (Ayurveda pentabio purification method) and Shaman Chikitsa (palliative therapy) in Ayurveda. Through this paper, a novel effort was undertaken to enlighten over the great efficacy of Ayurvedic treatment for Sandhigatavata. In this case study, a male patient with Sandhigatavata was prescribed for different local and systemic putative therapy along with palliative treatment, which resulted in excellent recovery in symptoms and in radiological findings of OA.


  History of Present Illness Top


Demographic detail of the patient is mentioned in [Table 1]. A 52-year-old male patient was symptomless before 1 month but gradually he had symptoms such as pain in right knee joint and difficulty while walking since 1 month, stiffness in both knee joints since 20 days, and mild swelling in right knee joint since 15 days, which are briefly mentioned in [Table 2]. He had associated symptoms of recurrent constipation, which are type 1 in consistency [Table 2]. After intake of analgesic also, no relief was obtained, and symptoms were getting worsened day by day. Patient was known case of hypertension since 10 years. So he approached Panchakarma outpatient department, Mahatma Gandhi Ayurvedic Medical College Hospital and Research Centre, Wardha, Maharashtra, India, for Ayurvedic treatment. Examination of the patient including vitals examination, Ashtavidha Pariksha (eight systemic examination), and specific locomotor system examination is mentioned in [Table 3], [Table 4], and [Table 5], respectively, and after obtaining written inform consent, the treatment was started on inpatient department level.
Table 1: Demographic details

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Table 2: Chief complaints with its duration

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Table 3: Vitals examination

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Table 4: Ashtavidha Parikshana

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Table 5: Examination for locomotor system (examinations specific to diagnosis)

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Past History

No history of trauma or fall was reported.

Medication History

Patient had taken tablet amlodipine 5mg once a day on regular basis, and tablet diclofenac 75mg when necessary for rheumatic complaints.

Personal History

Food habits: mixed diet, excessive intake of spicy food and bakery products

Sleep: disturbed sleep due to pain

Addiction: alcohol consumption (weekly twice) and tobacco chewing daily (since 3 years)

Family History

No significant family history was reported.

Nidan Panchak (The Procedure of Etiopathogenesis of Sandhigatavata as per Ayurveda)

Hetu (etiology or causative factors):

Ahara: Katu Rasa (spicy food items), Ruksha (dry or shrunken food items)[1]

Vihara: Atijagarana (excessive awakening at night), Ativyayama (excessive body exertion), Chinta (worry), Shoka (grief), Vegdharana (suppression of natural urges)

Aggravating factor: Constipation, age-related degeneration[4]

Purvarupa (prodromal symptoms): Stiffness in both knee joints, mild discomfort during walking

Roopa (manifestation): Pain in right knee joint and difficulty, crepitus present in both knee joints, and pain while walking from 1 month, stiffness in both knee joints from 20 days, and mild swelling over right knee joint since 15 days.

Samprapti (pathophysiology of the disease): Due to above causative factors lead to Rasadushti (improper formation of blood plasma) and Vataprokopa (Vitiation of Vata), which spreads Vatadosha in all body channels, which creates obstruction of various channels and in weded over joints. Owing to obstruction, degenerative changes occur joints, which produces Sandhigatavata.[5]

Investigations: X-ray right knee Anteroposterior and lateral view had showed space reduction in knee joint, joint overlapping of lateral epicondyle of right femur over tibia, and gross osteoporotic changes as shown in [Figure 1].
Figure 1: Before treatment

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Diagnosis: Sandhigatavata (osteoarthritis)

Treatment advised: By analyzing the aforementioned pathogenesis of disease in this patient, treatment plan was prescribed. It can be classified under two categories, that is, Shodhana (purification) and Shamana Chikitsa [Table 6] and [Table 7].
Table 6: Shodhana Chikitsa

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Table 7: Shamana Chikitsa

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  Observations and Results Top


Assessment of the patient was performed in terms of clinical features[6] and radiological findings shown in [Table 8]. After completion of therapy, the patient got significant relief in pain while walking, stiffness, and swelling of knee joint. Constipation was relieved in this duration, also it helped in maintaining joint space, now there was no overlapping of lateral epicondyle of femur and tibia and no osteoporotic changes as shown in [Table 8] and [Figure 2]. No undue effect was found after this treatment.
Table 8: Assessment on the basis of subjective and objective criteria

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Figure 2: After treatment

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  Discussion Top


By taking into consideration all factors, which were involved in the pathogenesis of Sandhigatavata in this patient, treatment principles for Vatavyadhi Chikitsa (treatment of Vata diseases) was applied here. The treatment protocol for this patient can be divided into Shodhana Chikitsa, especially Basti Karma (medicated enema) along with Shamana Chikitsa. After 1 month, the patient got significant relief clinically, and a significant improvement was observed in the radiological findings, especially in terms of maintenance of good joint space and absence of overlapping as shown in [Table 8]. Adopted treatment protocol mainly comprised Vedanasthapana (pain reliever), Shothahara (anti-inflammatory), and was Vatadosha Shamana (pacification of Vata) in nature, which helped to strengthen various musculatures and various structures in knee region.[7]

Probable mode of action of all interventions can be explained as follows:

Abhyanga (massage) with Dashmool Taila: Abhyanga pacifies Vata, which is ultimately responsible for the degeneration of Dhatus and for the manifestation of Sandhigatavata. It induces vasodilatation, absorbs the drug, and enhances the effect of Snehana (oliation). In this case, owing to local Abhyanga (oliation), there was reduction in pain, improvement in muscle strength, and improvement in joint flexibility. Dashmool Taila acts on Vatadosha or Asthigata and Sandhigata Vyadhi (diseases involving bones and joint) due to its analgesic and anti-inflammatory action.[8]

Nadi Sweda: Owing to application of Nadi Sweda, reduction in stiffness and pain was observed as it relaxes muscles and provides symptomatic relief in osteoarthritis.

Janu Dhara: It induces reduction in stiffness without damaging structures in joint. In this patient, it increases strength and circulation with reduction in pain.[8]

Lepa: Punarnava, Sunthi, and Haridra, which were used in the Lepa, are anti-inflammatory and analgesic in nature; hence, gross reduction was observed in inflammation and pain due to its application. Owing to intensity of these symptoms, the range of motion increased.[8]

Dashmooladi Niruha Basti: This Basti was given for the purpose of Koshta Shuddhi (cleansing the intestines), which had created good cleansing surface area for Anuvasana Basti, which was administered later. It potentiates other medicinal effect of Shamana therapy along with that it induces Vatanulomana, which is ultimately the aim of this therapy.

Anuvasana Basti: Anuvasana Basti, which was given with Mahanarayana Taila, induces anabolic effect. As this is purely Vataj Nanatmaj Vyadhi, and the Pakwashaya (large intestines) is considered as the main seat of Vata, so here ultimate regimen of Dashamooladi Niruha Basti and Anuvasana Basti with Mahanarayana Taila was used to conquer the Vata. In additional, Mahanarayana Taila induces nourishment of various musculature involved in the knee joint of this patient.[9]

Hingwashtak Churna: Owing to Deepana Pachana therapy of Hingwashtak Churna, it potentiates the overall absorption of medicine used for Shamana therapy.[10]

Punarnava Guggul: In this patient, there was a mild inflammation over the knee joint; hence, Punarnava Guggul was prescribed to reduce the swelling due to its anti-inflammatory and anti-arthritic property.[11]

Maharasnadi Kwath: Maharasnadi Kwath 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.[12]

Tab Sallaki Forte: It is a proprietary Ayurvedic medicine, which was manufactured by Gufic Bioscience. It is mainly used in the treatment of musculoskeletal entity as it contains Salai Guggul, Haridra, and Sunthi, which has anti-inflammatory and analgesic property.[13] The combined effect of overall therapy helped to decrease swelling, stiffness, and pain by breaking the pathogenesis of disease; hence, an optimum positive result was obtained.


  Conclusion Top


The results revealed that Sandhigatavata (OA) can be cured effectively with collaborative approach of various Shodhana procedures, including Niruha Basti, Janu Dhara, local Snehan, and Nadi Sweda, and Shamana Chikitsa. As present study is a single case report hence result obtained in this study are needed to be reaccessed by conducting similar work on larger sample size. In other words validation of present findings is expected to create specific guideline for management of Sandhigatavata.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rathod D, Dattani K. Effect of Yoga Basti in Sandhivata w.s.r. to osteoarthritis of knee joint. Int J Ayur Med 2017;8:73-9.  Back to cited text no. 1
    
2.
Trikamji Y, editor. Chikitsasthan; Vatavyadhichikitsa Adhyaya. Verse 37. In: Charakasamhita of Agnivesha.Varanasi, India: Chaukamba Publication; 2011. p. 690.  Back to cited text no. 2
    
3.
Shastri K, editor. Nidhanasthana; Vatavyadhinidan Adhyaya. Verse 29. In: Sushruta, Sushruta Samhita. Varanasi, India: Chaukhamba Sanskrit Sansthan; 2012. p. 460.  Back to cited text no. 3
    
4.
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
    
5.
Gupt A, editor. Nidanasthana; Vatavyadhinidan Adhyaya. Verse 5–6. In: Shrimadvagbhat, Astanghrudayam. Varanasi, India: Chaukhambha Sanskrit Samsthan; 2005. p. 375.  Back to cited text no. 5
    
6.
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997;32:920-4.  Back to cited text no. 6
    
7.
Sawarkar G, Suple Y. Prevention and management of osteoarthritis. Int J Res Ayurveda Pharm 2013;4:22.  Back to cited text no. 7
    
8.
Pathak R, editor. Taila Prakarana. In: Ayurveda Sara Sangraha. 12th ed. Nagpur, India: Vaidhyanath Ayurveda Bhavan Limited; 2007. p. 663-4.  Back to cited text no. 8
    
9.
Singh A, Desale V, Srivastava P. Review on manufacturing protocol for Mahanarayana oil. World J Pharm Pharm Sci 2018;7:421.  Back to cited text no. 9
    
10.
The Ayurvedic Formulary of India.2nd ed. Part 1, Chapter 7, Verse 37. New Delhi, India: Ministry of Health and Family Welfare; 2003. p. 117-8.  Back to cited text no. 10
    
11.
Mishra S, editor. Mandagani Chikitsa Prakarana. Verse 109. In: Govind D. Bhaisajyaratnavali. Varanasi, India: Chaukhamba Surbharati Prakashan; 2007. p. 258-9.  Back to cited text no. 11
    
12.
Patel S, Shah P. Evaluation of anti-inflammatory potential of the multidrug herbomineral formulation in mail Wistar rats against rheumatoid arthritis. J Ayur Integr Med 2013;4;86-93.  Back to cited text no. 12
    
13.
Gufic Sallaki Forte Tablets. Available from: https://ayurmedinfo.com/2018/11/16sallaki-forte-tablet/. [Last accessed on 2018 Nov 16].  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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