Ayurveda Research Work

A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHI GATA VATA.”

“

By

Dr. PRASANTH. D.B.A.M.S Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,Karnataka,Bangalore

In partial fulfilment of the requirements for the degree of AYURVEDA VACHASPATHI DOCTOR OF MEDICINE (AYU)

In PANCHAKARMA Under the guidance of Guide:

Co -Guide:

Dr. K. N. RAJASHEKAR

Dr. PRASANNA AITHAL M.D.(Ayu)

M.D.(Ayu)

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHA KARMA ALVA’S AYURVEDA MEDICAL COLLEGE & HOSPITAL MOODBIDRI 574227.

2009-2010

ALVA’S

AYURVEDA

MEDICAL

COLLEGE

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA MOODBIDRI, KARNATAKA

Declaration

I here by declare that this dissertation entitled “A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHI GATA VATA.” is a bonafide and genuine research work carried out by me,

under the guidance of Dr.K.N.RAJASHEKAR M.D.(Ayu) and Dr. PRASANNA AITHALM.D.(Ayu)

,

Department of Post Graduate Studies in Panchakarma,

Alva’s Ayurveda Medical College, Moodbidri.

Dr. PRASANTH. D

III Year M.D. (Ayu) Dept. of P.G. Studies in Panchakarma,

Date : Place : Moodbidri

Alva’s Ayurveda Medical College Moodbidri 574227.

ALVA’S

AYURVEDA

MEDICAL

COLLEGE

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA MOODBIDRI, KARNATAK A .

This is to certify that the dissertation entitled “A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA” submitted by Dr. PRASANTH D, in partial .

fulfillment for the degree of Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv Gandhi University of Health Sciences, Bangalore, is a record of research work done by him during the period of his study in this institute, under our guidance and supervision and the dissertation has not previously formed the basis to the award of any degree, diploma, fellowship or other similar titles. We recommend this dissertation for the above degree to the University for the Approval.

Co-Guide: Dr. PRASANNA AITHAL

Guide: M.D.(Ayu)

Asst Professor, Dept. of P.G Studies in Panchakarma, Alva’s Ayurveda Medical college Moodbidri – 574227

Date: Place: Moodbidri

Dr. K. N. RAJASHEKAR

M.D.(Ayu)

Asst Professor, Dept. of P.G Studies in Panchakarma, Alva’s Ayurveda Medical college Moodbidri - 574227

ALVA’S

AYURVEDA

MEDICAL

COLLEGE

DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA MOODBIDRI, KARNATAK A .

This is to certify that the dissertation entitled “A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA” is a bonafide research work done by Dr.PRASANTH. D

under the guidance of Dr. K. N. RAJASHEKAR AITHALM.D.(Ayu) in partial fulfilment of the

M.D.(Ayu) and

Dr. PRASANNA

requirement for the award of the

degree in Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

H.O.D. Dept. of P.G Studies in Panchakarma, Alva’s Ayurveda Medical College

Date:

Moodbidri 574227

Place: Moodbidri

ALVA’S

AYURVEDA

MEDICAL

COLLEGE

DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHAKARMA MOODBIDRI, KARNATAK A .

Endorsement

This is to certify that the dissertation entitled “A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA ON JANU SANDHIGATAVATA” is a bonafide research work done by Dr.PRASANTH. D

under the guidance of Dr. K. N. RAJASHEKAR

M.D.(Ayu) and

Dr. PRASANNA

AITHALM.D.(Ayu) , Department of Post Graduate Studies in Panchakarma, Alva’s

Ayurveda Medical College, Moodbidri.

PRINCIPAL,

Alva’s Ayurveda Medical College. Moodbidri 574227, Dakshina Kanada. (Dist) Karnataka

Date : Place : Moodbidri

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic/research purpose.

Date: Place: Moodbidri

Dr. PRASANTH. D III Year M.D. (Ayu) Dept. of P.G. Studies in Panchakarma Alva’s Ayurveda Medical College Moodbidri 574227

Rajiv Gandhi University of Health Sciences, Karnataka

ABSTRACT

4

ABSTRACT ‘Janu Sandhigata Vata’ is one among the most common Vāta Vyādhi. This disease affects the joints with its signs and symptoms like pain, swelling, and restriction of joint movements. Commonly this Sandhigatavata is presented in Janusandhi, which is one among the most important weight bearing joint in body and also considered as a Marma. Osteoarthritis is most common form of arthritis characterized mainly by pain, bony swelling and functional restriction of the joint. This condition too, is commonly presented in knee joint. Due to its similarities in signs and symptoms it can be very much correlated to Janusandhigatavata. Studies reveal there is a steady rise in prevalence of OA from age 30 such that by 65, 80% of people have radiographic evidence of OA, though only 25-30% are symptomatic. It’s a slowly progressing degenerative disorder. Potent analgesics and anti-inflammatory drugs are available in the market, which run the risk of producing side effects like gastric erosion, hepatic and nephro toxicity etc. Even surgery statistically reveals to have a failure rate of 10% in knee replacements. It’s a limitation in contemporary science to provide a comprehensive effective management. So research works in Ayurveda has evident scope in this condition. According to Ayurveda Snehana, Svedana, Dahana and Upanaha are the prime modalities of treatment in the management of Sandhigatavata, which are mostly aimed at Bramhana. Janubasti and Janupichu are the procedures basically evolved from Shirobasti and Shiropichu, which are mentioned among Moordhini Tailas

3b,6

are

also having Bramhana action where Sneha is allowed to stay for a stipulated duration in the affected joint. Murivenna commonly used Anubhuta yoga in Kerala, listed in Kerala Ayurveda pharmacopeia is useful in Sandhi Bhagna has Vedanasthapaka and shothagna effect. Murivenna is also considered as one of the best yoga in Marmabhighata too. Murivenna in the form of Janubasti or Janupichu in managing Janusandhigatavata vata was not studied before. Therefore this study is intended to compare the effect of Janubasti and Janupichu done with Murivenna in the management of Janusandhigatavata.

“A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

ABSTRACT

5

Objectives:

1. Evaluation of effect of Janu Basti with Murivenna on Janusandhigatavata. 2. Evaluation of effect of Janu Pichu with Murivenna on Janusandhigatavata. 3. To compare and ascertain the effect of Janu Basti and Janu Pichu with Murivenna.

Methods:

It is a single blind clinical study with pre-test and post-test design. A special proforma was prepared with all the points of history taking, physical examination and investigations. The study was carried out in 30 Patients of Janu Sandhi Gata Vata with who were divided equally into two groups. In group A, Patients were administered Janu Basti with Murivenna for 45 minutes, for 7 consecutive days.In group B, patients were administered Janu pichu with Murivenna for 45 minutes for 7 consecutive days. Data was collected from the patient on the 1st day before treatment, 8th day after procedure and on 14 th and 22nd day of the study period. Placebo was given internally during the study period in the form of rice flour capsule 1 Bid. Interpretation and Results: 

Assessment inside a group was statistically done using paired “t” test and student “t” test was utilized for comparative assessment in between groups.



The test of significance showed that both the procedures had significant improvement statistically in all the signs and symptoms except for Gait in group B.



On comparison between the groups except for pain and gait none of the symptoms showed statistically significant changes.

Conclusion:

On the overall glance over the study showed that among the 30 patients of Janu Sandhigatavata 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 % relief, 22 (73.4 %) got moderate relief between 60 % and 90 % & 3(10%) got partially improved results.


ABSTRACT

6

On comparative assessment between groups, In Group A, 2 patients (13.4 %) got 100 % relief & 3 patients (20 %) got more than 90 % relief while in Group B, no patients got more than 90 % or 100% relief. 9 patients (60 %) of Group A, got relief in between 60-90 % and whereas 13 ( 87%) patients of Group B got relief in between 60-90 %. Analysis of the results showed that Janu Basti with Murivenna provided a better relief in the signs and symptoms of JanuSandhigatavata mainly in pain, stiffness, gait, tenderness, swelling, crepitus and range of movements compared with Janu Pichu done by the same.

Key words:

JanuSandhigatavata, Janu Basti, Janu pichu, Murivenna.


ACKNOWLEDGEMENT

As always I have known, Gratitude is the best attitude. First of all I would like to remember almighty for making me reach what I am today; in spite of all odds what I had been made to pass through in life. I strongly believe in the silent prayers and invisible presence of my Mother and the constant inspiration of my Father, I am always grateful to them. I can never forget the inspiration and love that my Sister has showered on me, making me responsible without which my life would have been meaningless. Nothing on earth can replace a mother, but I can’t forget the immense support and inspiration that my Step Mother has provided constantly right from the day she chose to be one among us. It is my privilege to thank my guide, Dr. K.N.RAJASEKHAR, who kept constant belief in me and guided me throughout in all my activities, observing me closely, helping me whenever in need. I can’t forget the help, constant support, strong belief and intelligent ideas rendered by my co guide, Dr. S.G. PRASANNA AITHAL. It is a blessing to be under Dr. ZENICA D’SOUZA, my H.O.D who stood as an inspiration and a constant motivation in all my activities including this, and a simple expression of gratitude doesn’t feel worthy enough for all her blessings. It would be really ungrateful if I don’t mention the constant support and timely help provided by Dr. VASANT PATIL, Dr. C. V.RAJASHEKAR, Dr. P.K. MOHANLAL,

Dr. VIKRAM and all staff members of my college throughout my post graduation life. If I have saved anything in my life, all I can count upon are my friends, I can never forget the confidence and help they have rendered me throughout. I would specially like to mention the help rendered by MR. SIDDHARTH, Dr. SHARATH, Dr. ANUPRABHA, Dr.

SREERAJ, Dr. ARUN KUMAR, Dr. ANANTH RAM, Dr. NATRAJ, Dr. SANDEEP, Dr. SUSHA, Dr. NATASHA, Dr. SMITHA, Dr. JESSICA and Dr. RAIBY without whom this work would have never been in this form.

I owe my sincere regards and boundless gratitude to Dr.M.Mohan Alva, Chairman,

Alva’s Education Foundation, Moodbidri, for giving me an opportunity to do my post graduate studies in this prestigious institution. I render my immense and heartfelt thanks to Dean of P.G faculty, Alva’s Education Foundation, Moodbidri, and Principal, Alva’s

Education Foundation, Moodbidri, for their constant help, and support in completing this work.

Also I would never forget the constant sparks and endless support provided by my dear friends & departmental colleagues Dr. CHANNABASAPPA, Dr. PARVATHY and

Dr. PRIYA for the trust that they have entitled in me, without whose help this work would have never been complete as of any other activity of mine. I can never forget all my gurus who have taught me the greatness of this vast ocean of life

AYURVEDA in front of which I’m still a child who is mesmerized by its intense beauty and depth, waiting to feel another wave from shore. Without your blessings I’m incomplete. Last, not least, Also I would take this opportunity to thank all my seniors, juniors,

Panchakarma therapists, the library staff the printing and graphics department for their immense cooperation during the work If I have left anyone, I would like to thank all who have directly or indirectly helped me in the successful completion of this work.

Dr.PRASANTH.D

Sl. No

CONTENTS Abbreviations List of Table List of Graph & Pictures

I

II

Page No

i - ii iii - iv v

Introduction

1-3

Conceptual Study

4 - 21

Historical Review Janu Sandhi Review

4-7 8 - 11

Anatomy of Knee Joint

12 - 14

Twak Review

15 – 16

Anatomy of Skin

17 - 20

Janu Basti Review

21 - 24

Janu Pichu Review

25 - 28

Disease Review

30 - 57

Janu Sandhigata Vata

30 - 35

Nidana

35 - 39

Poorvarupa

40

Rupa

40 - 42

Samprapti & Samprapti Ghataka

42 - 46

Upashaya & Anupashaya

47

Sapeksha Nidana

48 - 49

Sadhyaasadhyata

49 - 50

Chikitsa

51 - 55

Pathya Apathya & Shamana Aushadhi

56 - 57

III

Drug Review

58 - 74

IV

Clinical Study

75 - 110

V

Discussion

111 - 125

VI

Summary & Conclusion

126 - 129

References & Bibliography Annexure

130 - 138 I - XV

i

ABBREVIATIONS

1)

A.H

: Astanga Hridaya

2)

A.S

: Astanga Sangraha

3)

A.T.

: After Treatment

4)

Bel.sa : Bela Samhita

5)

Bh.Pr

: Bhava Prakasha

6)

B.R

: Bhaishajya Ratnavali

7)

B.T.

: Before Treatment

8)

C.D

: Chakra Datta

9)

Cha.S : Charaka Samhita

10)

Comm.: Commentary

11)

Ckr

: Chakrapani.

12)

D.G

: Dravya Guna Vijnana

13)

DL

: Dalhana

14)

D.P.P.M : Davidson’s Priciples And Practice Of Medicine

15)

H.P.I.M: Harrison’s Principle of Internal Medicine

16)

I.P.D. : In Patient Department

17)

K.S

: Kashyapa Samhita

18)

M.N

: Madhava Nidana

19)

Madhu : Madhukosha

20)

O.P.D: Out Patient Department

21)

S.D

: Standard Deviation

22)

S.E

: Standard Error

23)

S.K.D : Shabda Kalpa Druma

24)

S.S

25)

Saha.Y: Sahasra Yogam

26)

Sha.S : Sharangadhara Samhita

27)

Vag

: Susrutha Samhita

: Vagbhata

ii 28)

Vang : Vangasena

29)

Yo.Ra : Yogaratnakara

30)

Yrs.

31)

+

32)

-

33)

%

: Years : Present : Not Present : Percentage

ABBREVIATIONS OF STHANAS OF SAMHITA

1)

Chi

: Chikitsa Sthana

2)

I

: Indriya Sthana

3)

Ka

: Kalpa Sthana

4)

Ma.Kha: Madhyama Khanda

5)

Ni

6)

Po.Kha: Poorva Khanda

7)

Sha

: Shareera Sthana

8)

Si

: Siddhi Sthana

9)

Su

: Sutra Sthana.

10)

Utt

: Uttara Khanda

: Nidana Sthana

iii

List of tables

Sl No

Name of tables

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Aharaja Nidana of Vata Vyadhi. Viharaja Nidana of Vata Vyadhi. Manasika Nidana of Vata Vyadhi. Anya Karana for Vata Vyadhi. Rupa of Sandhivata mentioned in various classics. Sapeksha Nidana of Janu Sandhivata Different Chikitsa procedures indicated for Janu Sandhivata Ingredients of Murivenna Rasa Panchaka of the drugs used in the preparation of Murivenna Distribution of 30 patients according to different age group Sex wise distribution of 30 patients Distribution of 30 patients according to occupation Distribution of 30 patients according to religion Distribution of 30 patients according to socioeconomic status Distribution of 30 patients according to marital Status Distribution of 30 patients according to habitat Distribution of 30 patients according to educational status Distribution of 30 patients according to Prakruti Distribution of 30 patients according to Saara Distribution of 30 patients according to their Satwa

21 22 23 24 25

Distribution of 30 patients according to Samhanana Distribution of 30 patients according to Saatmya Distribution of the 30 patients according to dietary Habits Distribution of 30 patients according to addictions / Vyasana Distribution of 30 patients according to Aahara- Abhyavaharana Shakti Distribution of 30 patients according to Aahara-Jarana shakti Distribution of 30 patients according to Agni Koshtha wise Distribution of 30 Patients of Janu Sandhivata Distribution of 30 patients according to their nature of work/Vihara Distribution of patients according to Vyaayama Shakti Distribution of patients according to their Nidra Sheela Nidana (Ahara) wise Distribution of 30 Patients of Janu Sandhivata Nidana (Vihara) wise Distribution of 30 Patients of Janu 1Sandhivata Nidana (Manasika) wise Distribution of 30 Patients of Janu Sandhivata

26 27 28 29 30 31 32 33 34

Page No. 37 38 39 39 42 48 51 72 74 81 82 82 83 84 85 85 86 87 88 89 89 90 91 91 92 93 93 94 95 96 96 97 98 99

iv

35

Chronicity wise Distribution of 30 Patients of Janu Sandhivata

100

36

Effect of Janu Basti with Murivenna in signs and symptoms of 15 patients of Group A AT. Effect of Janu Basti with Murivenna in signs and symptoms of 15 patients of Group A 14th day. Effect of Janu Basti with Murivenna in signs and symptoms of 15 patients of Group A 22nd day. Effect of Janu Pichu with Murivenna in signs and symptoms of 15 patients of Group B AT.

101

Effect of Janu Pichu with Murivenna in signs and symptoms of 15 patients of Group B 14th day. Effect of Janu Pichu with Murivenna in signs and symptoms of 15 patients of Group B 22nd day. Comparative effect of procedures in signs and symptoms of patients in group A & group B. Comparative effect of procedures in percentage relief after treatment. Comparative effect of procedures in percentage relief on 7th, 14th nd and 22 day. Overall effect of the treatment. Comparative effect of the treatment.

104

37 38 39 40 41 42 43 44 45 46

102 102 103

104 105 106 107 109 110

v

List of Graphs Sl no: 1 2 3 4 5

Distribution of 30 patients according to different age group Distribution of sex of 30 patients Distribution of 30 patients according to occupation Distribution of 30 patients according to religion Distribution of 30 patients according to socioeconomic status

Pg. no 81 82 83 83 84

6 7 8 9 10 11 12 13

Distribution of 30 patients according to marital Status Distribution of 30 patients according to Habitat Distribution of 30 patients according to educational status Distribution of patients according to Prakruti Distribution of patients according to Saara Distribution of patients according to their Satwa Distribution of 30 patients according to the Samhanana Distribution of 30 patients according to their Saatmya

85 86 86 87 88 89 90 90

14 15 16

Distribution of 30 patients according to their dietary Habits Distribution of 30 patients according to addictions / Vyasana Distribution of 30 patients according to Aahara- Abhyavaharana Shakti Distribution of 30 patients according to Aahara-Jarana shakti Distribution of 30 patients according to Agni Koshtha wise Distribution of 30 Patients of Janu Sandhigatavata

91 92 92

17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

Name of graphs

Distribution of patients according to their nature of work / Vihara Distribution of patients according to Vyaayama Shakti Distribution of patients according to their Nidra Sheela Distribution of patients according to their Nidana (Ahara) Nidana (Vihara) wise Distribution of 30 Patients of Janu Sandhigatavata Nidana (Manasika) wise Distribution of 30 Patients of Janu Sandhigatavata Chronicity wise Distribution of 30 Patients of Janu Sandhigatavata Comparative effect of procedures on signs and symptoms expressed in percentage , after treatment Comparative effect of procedures in percentage relief on 7th, 14th and22nd day. Overall effect of the treatment Comparative effect of the treatment Structure of Knee Joint Structure of Skin Illustrations of procedures

93 94 94 95 96 97 98 99 99 100 106 108 109 110 14 20 29

INTRODUCTION

1

INTRODUCTION Vata, which is prime among the Tridoshas, is the major factor responsible for all activities and manifestations of disease in the body. In Vriddhavastha, all Dhatus undergo Kshaya, thus leading to Vata Prakopa. This makes the individual prone to many diseases, among which Sandhivata stands at the top of the list. When this deranged Vata lodges in Sandhi, it is characterized by pain, swelling, and restriction of joint movements. Commonly, this Sandhigata vata manifests in Janusandhi, which is one among the most important weight bearing joints in body. It is also considered as a Marma.

Osteoarthritis is the most common form of arthritis characterized mainly by pain, bony swelling and functional restriction of the joint. It commonly presents unilaterally in the knee joint, which is the most important weight bearing joint in the body. Osteoarthritis of the knee joint is the most common joint disorder seen in elderly people. Due to similarities in signs and symptoms, it can be very much correlated to Janu sandhigata vata.

Osteoarthritis is the most common articular disorder that begins asymptomatically in the 2nd and 3rd decades and is extremely common by age 60. Studies reveal there is a steady rise in prevalence of OA from age 30 such that by 65, 80% of people have radiographic evidence of OA, though only 25-30% are symptomatic. It is a slowly progressing degenerative disorder. Due to the increased prevalence of this disorder it has become a major problem and burden for society, as it indirectly reduces the working potency resulting in dependency. It limits everyday activities such as walking, dressing, bathing etc., thus making individual partially or even fully handicapped. Joint pain and soreness, especially with movement, pain after overuse or after long periods of inactivity, joint swelling and joint fluid accumulation are the features of osteoarthritis.

Potent analgesics and anti-inflammatory drugs are available in the market, which run the risk of producing side effects like gastric erosion, hepatic and nephro toxicity, etc. Even surgery has a statistical failure rate of 10% in knee replacements. One of the


INTRODUCTION

2

current limitations of contemporary science is the lack comprehensive and effective management. Research work in Ayurveda has a large scope in this condition.

Charaka was the first person who separately described the disease named “Sandhigata 1

Anila”, but he has not included it among the 80 types of Nanatmaja Vyadhi . Sushruta and Vagbhata also gave importance to Sandhivata and included in the chapter of Vata 2, 3.

Vyadhi

When Vata involves Janu Sandhi, it is named Janu Sandhigatavata.

According to Ayurveda, Snehana, Svedana, Dahana and Upanaha are the prime modalities of treatment in the management of Sandhigata vata. These are mostly aimed at Bramhana. Sushruta has mentioned the treatment for Sandhigatavata as 4

Snehana, Svedana, Upanaha, Agnikarma, Bandhana and Unmardana . Vagbhata explained that Sneha should be used according to Yukti for Bhakshana, Basti, Nasya, 5

Abhyanga, Gandusha, Murdhni Taila, Karna Poorana and Akshi Tarpana . Janu Basti is one of the modalities of treatment commonly adopted in the management of Janu Sandhi Gata Vata. Research has shown that Janu Basti with Taila gives encouraging results in relieving the signs and symptoms of Janu Sandhi Vata.

Janubasti and Janupichu are the procedures that have basically evolved from Shirobasti and Shiropichu, which are mentioned among Moordhini Tailas. These also have Bramhana action due to the Sneha which is allowed to remain over the affected joint for a stipulated duration.

6

Murivenna is a commonly used Anubhuta yoga in Kerala, and is listed in the Kerala Ayurveda pharmacopeia. It is useful in Sandhi Bhagna due to its Vedanasthapaka and shothagna effect. Most of the ingredients in Murivenna have Katu Rasa, Theekshna

Guna, Ushna Veerya and Katu Vipaka. Murivenna is also considered as one of the best yogas in Marmabhighata. But Murivenna’s role in Janubasti or Janupichu for management of Janusandhigatavata vata has not yet been studied. Currently, the Janu basti procedure is given more importance and is widely practiced, even though in both treatments the principle of management is very similar. The main goal is to allow the sneha to stay in the affected joint for a stipulated period of time. Moreover the cost effectiveness of Janu pichu is much less in comparison to Janu Basti and the procedure is also much simpler. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

INTRODUCTION

3

Considering all of these facts, an observational study was conducted to compare the effectiveness of Janubasti versus Janupichu using Murivenna in the management of Janusandhigatavata.

This is a comparative study which was carried out for 22 days along with follow up assessment. Patients were selected on the basis of clinical assessment depending on signs and symptoms fulfilling specific diagnostic criteria. 30 patients were randomly selected and arranged into two groups of 15 patients each.



Janu Basti Group – Janu Basti with Murivenna for 45 mins



Janu Pichu Group – Janu Pichu with Murivenna for 45 mins

Clinical trials, case study, adopted treatments for each group and methods with subjective and objective parameters, objectives, results, discussion and conclusion are dealt with at the end of this thesis.


HISTORICAL REVIEW

4

HISTORICAL REVIEW

Everything we do in the past, its history. No one can reject the fact that history is the most important among all disciplines. To know any subject, we are supposed to learn history and use it for our benefit and prosperity. History gives us the “today”, by which we can utilize all the things we have to make our lives easier and more comfortable. Man always struggled with the present for creating a better tomorrow. Here, a glimpse is given to the historical sight of Ayurveda science, chiefly on Sandhivata and Swedana Chikitsa and it is presented as follows.

The knowledge of the srcin of a disease is very essential. To obtain the historical background of a disease we have to search deep into the Vedic literature. Vedas are considered to be the oldest literature available and the root of Ayurveda. It’s a known fact that it is difficult to specify the source period of Ayurveda. Therefore it is not possible to fix an exact date of srcin for Ayurveda. History of Indian medicine is usually studied under the heading of Pre-Vedic period, Vedic period, Samhita Kala, Sangraha Kala, Nighantu Kala, and Adhunika Kala (Modern period).

PRE-VEDIC PERIOD:

References of Sandhigata Vata are not available in the Pre-Vedic period.

VEDIC PERIOD:

Vedas are the primary source of all the knowledge and are really the treasures produced as a result of ancient Indian culture. They are the first written documentation of Indian civilization. One can see the basic roots of each and every subject in Vedas. Ayurveda is considered as the Upaveda of Atharva Veda. This treatise describes many Roga, many Aushadha and many other connected factors. Regarding Sandhigata Vata, we do get the references of body parts and the possibilities of joint disorders in Rig Veda and Atharva Veda. It is mentioned that Sandhi Vikriti is caused by Shleshma Vikriti.


HISTORICAL REVIEW

5

In Atharva Veda, two references are available about Sandhi Roga, one deals with the disease situated in Sandhi and other is related with Sandhi Vishlesha [Ath.2/33/6; 6/14/1]. Also some references in Atharva Veda show the importance given for Vata [Ath.8/2/3; 2/10/3], its Bhedha [Ath.10/2/3] and disorders of Vata [Ath.9/8/20]. Two Dravya, Pippli and Vishanka, are considered as Vata Roganashaka [Ath.6/109/3; 6/44/3].

In Vedas even though there are no detailed and vast explanations about Swedana one can see the mentioning about the same. Descriptions about Atapa Sweda are available in Atharva Veda during the explanation of Swedana. It is given that this Swedana is effective in pacifying the bodily disorders. In Rig-Veda, sun is considered as the source of energy and it also states that sun bath has the curative property on Kamala and Hridroga.

SAMHITA KAALA:

This is the period where we find realistic references of various diseases along with the Nidana Panchaka. Specific signs, symptoms and treatment are not mentioned for Janu Sandhigata Vata but in general, the Nidana Panchaka of Sandhigata Vata can be considered for Janu Sandhigata Vata. Many authors described this disease in their treatise during this period.

Charaka Samhita:

This Samhita, written by Acharya Agnivesha and re-edited by Acharya Charaka, has mentioned the disease Sandhigata Anila in the chapter of Vata Vyadhi Chikitsa. Here he has not mentioned any treatment for the Sandhivata7. He has also explained 13 types of Sa Agni Swedana and 10 types of Niragni Swedana8, 9.

Sushruta Samhita:

This treatise, written by Acharya Sushruta, has mentioned about the disease Sandhigata Vata in Nidana Sthana and Chikitsa Sthana. A separate Chikitsa has been mentioned for Sandhigata Vata in this Samhita. He has also added one more symptom “Hanti Sandhi” in the Lakshanas of Sandhivata10,

11

. There are 4 types of Swedana

12

which are explained by Acharya Sushruta .


HISTORICAL REVIEW

6

Bhela Samhita:

Acharya Bhela has not clearly mentioned about this disease. However, under the topic of Asthimajjagata Vata Vyadhi, a description of Sandhi Vichyuti is available

13

in his

Samhita.

Harita Samhita:

Acharya Harita has mentioned in his Samhita about the management of Sandhigata Vata, but the diagnostic aspect of this disease is not mentioned in detail (H. S. 3/20).

SANGRAHA KALA:

This is the period where many authors started compiling the various existing Samhitas and started making their own treatise. Along with the compilation of the previous works they contributed their own knowledge and made the learning process easier for the later ones.

Ashtanga Sangraha & Ashtanga Hridaya:

These books, written by Vriddha Vagbhata & Vagbhata respectively, have mentioned the disease Sandhigata Vata in their treatise. Lakshanas are similar to those which are mentioned by Acharya Sushruta

14, 15, 16&17

.

Madhava Nidana:

Acharya Madhavakara, in his samhita Madhava Nidana, has mentioned an additional 18

symptom Atopa in the symptomatology of Sandhigata Vata . The remaining ,

lakshanas are the same as in Sushruta Samhitha.

Bhava Prakasha:

Bhavamishra explained the Lakshanas and treatment of Sandhigata Vata in 19

Madhyama Khanda Vatavyadhyadhikara

in his treatise Bhava Prakasha.

Yogaratnakara:

In this book the Lakshana and the Chikitsa of Sandhigata Vata are explained in the 20

Vata Vyadhi Adhikara .


HISTORICAL REVIEW

7

A glimpse on these references reveals that the later authors after Acharya Charaka & Sushruta followed their footsteps and made minimal addition to the subject. There are not many changes in the views of different authors who have written about Sandhigata Vata. It also shows the importance of disease in their period as it is mentioned by most of the authors.


JANU SANDHI REVEW

8

JANU SANDHI REVIEW The knowledge of the physiology and structures related to a particular organ as well as its surrounding structures is very important before studying the pathology of any disease related to that region. Hence the anatomy and physiology of the Janu Sandhi should be understood properly. In Janu Sandhigatavata, the Vata lodges in Janu Sandhi. In Ayurvedic classics the details regarding the anatomy and physiology of Sandhi are scattered in various parts. So here an humble attempt is made to gather the references related to Sandhi.

In general, Sandhi means the union of two or more structures of body. But in this context, the word Sandhi is limited to Asthi Sandhi only. 40

The place where there is union of Asthi is called Sandhi .

In Ayurveda, Sandhis are mainly classified into two types 1)

Sthira Sandhi

2)

Cala Sandhi (Chestavanta)

41

42

Again Sandhi is classified into following eight types based on shape : 1)

Kora

5)

Tunnasevani

2)

Ulookala

6)

Vayasa tunda

3)

Samudga

7)

Mandala

4)

Pratara

8)

Shankhavarta

In modern anatomy, joints are classified as:

43

1. Fibrous or fixed joints (Synarthroses) 2. Cartilaginous or ‘slightly movable ‘joints (Amphiarthroses). 3. Synovial or freely movable joints (Diarthroses).

The Asthi Sandhi located at the region of Janu is called Janu Sandhi. It can be classified under the group of Chestavanta and Kora Sandhi according to its features. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

JANU SANDHI REVEW

9

They are two in number (one in each Shakha). The structures that constitute the Sandhi are mentioned below:

1. Asthi 2. Snayu and Kandara 3. Sleshmadhara Kala 4. Sleshma (Shleshaka Kapha) 5. Peshi 6. Sira and Dhamani

Asthi:

Asthi is the basic constituent of any Sandhi. Its main function is Dharana of Sharira . Vata takes Ashraya in Asthi and it has Ashraya Ashrayi Bhava Sambandha i.e., when the Ashrita gets Vriddhi, the Ashrayi also goes on Vriddhi and vice- versa. In Sandhivata, the Prakupita Vata results in Asthi Kshaya 44,45.

Vata can be considered under 5 different names based on its Sthana and Karma. Out of these, there is no direct reference regarding the Vata residing in the Sandhi. The Vyana Vata is said to be Kritsna Deha Charah46 i.e. it moves all over the body, but based on its function of Gati or movement, we may consider Sandhi, as one of its sites. In Tantrantara, a specific reference is available stating Sandhi as one of the sites of Vyana Vata. Also, the functions such as Aakunchana, Prasarana, etc. which are attributed to Vyana Vata, are possible through Sandhi. Further, the primary aim of the Sandhi is to provide movements to the body organs therefore Vata must have one of its seats of action in Sandhi. In addition, while dealing with Vata Vikara, Gati Hanana has been explained as one of the outcome 47. Hence, Vyana Vata can be considered as the one deranged in the disease Sandhivata.

Snayu and Kandara:

Snayu is a structure which binds Asthi, Mamsa and Meda. Out of 900 Snayu, 10 Snayus are present in Janu Sandhi. These are responsible for bearing of body weight. Sushruta has explained this by giving a simile of boat. As a boat made of planks and wood tightened together by means of large number of bindings can float on the water


JANU SANDHI REVEW

10

and is capable of carrying loads of passengers, in the same way, the human body is tightened at the Sandhi by large number of Snayu and is able to bear weight 48.

Kandara is a type of Snayu that is Vritta or cylindrical in shape. It’s functions include 49

Prasarana and Aakunchana of the joint .

Shleshmadhara Kala

Kala is a structure located in between Dhatus and Ashaya that contains Kleda which is described as Dhatu Rasa Vishesha by Acharya Vagbhata. It is the fourth Kala, which is situated in Sarva Sandhi. This helps in lubrication of joints

50

. Just as a wheel

moves well by lubricating the axle, joints also function properly if supported with Kapha. Synovial membrane has similar functions.

Sleshma or Shleshaka Kapha

Sleshma, which is present in the Sandhi, is termed as Shleshaka Kapha

51

. It facilitates

free movement of the Sandhi and provides lubrication to the Sandhi. The function of Shleshmadhara Kala and Sleshma are similar. So, we may consider that Sleshma is the one that is present in Shleshmadhara Kala, and that it does Kleda of Sandhi.

Peshi

Peshi is the fleshy mass which covers the different structures of the body such as Sira Snayu, and Asthi, and it provides strength to those structures and to the Sandhi. In Janu sandhi they are five in number. They are strong structures that help to maintain alignment of the joint

52

.

Sanghata 53

Sanghata, or assemblage of bones, is fourteen. One is situated in Janu Sandhi .

Sira and Dhamani

The Kaphavaha Siras carry Prakrita Kapha, maintain the Sandhi, ensure its Sthirata and increase its Bala. One of the functions of Vatavaha Siras is Cheshta, such as


JANU SANDHI REVEW

11

Prasarana and Akunchana. The Raktavaha Siras does Dhatu Purana, brings about Sthirata and does Poshana. Asthi is one among the Dhatus and hence these functions 54,55,56

are applicable for Asthi Dhatu Poshana also

.

The Sparshavaha Dhamanis are spread in the upward direction and these have the function of carrying the Sparsha Jnana

57

. The Sparsha may be Sukhakara or

Dukhakara.


ANATOMY OF KNEE JOINT

12 KNEE JOINT

The knee joint is a type of Synovial joint. In Synovial joints, the articulating osseous surfaces are not in continuity although the bones involved are linked. Synovial joints evolve from fibrous and cartilaginous joints by subsequent developments. They are made up of a combination of unique structures including the fibrous capsule, articular surfaces, Synovial membrane, Synovial fluid, ligaments, muscles, etc.

The knee joint is one of the largest joints of the human body. Despite its single cavity in man, it is convenient to describe it as two chondylar joints between the Femur and Tibia, and a sellar joint between the Patella and Femur.

Articular surface

Articular surfaces are most dissimilar. The Tibial surface is slightly hollow centrally and flattened peripherally wherein a meniscus rests. Laterally, the Tibial surface is circular and smaller, while medially the Tibial surface is oval with a longer anteroposterior axis.

The lateral and medial femoral chondyles in front have a faint groove. This groove demarks the femoral patellar and chondylar surfaces. Lateral Femoral surfaces are almost circular and medial, while the femoral surface is larger and oval. The Patella’s articular surface is adapted to the femoral surfaces.

Fibrous capsule

The fibrous capsule has parallel but interlacing bundles of white collagen fibers. It is complex, partly deficient and partly augmented by expansions from adjacent tendons. It forms a cuff with its ends attached continuously around the articular ends of the tibia and Femur.

Synovial Membrane

Derived from embryonic mesenchyme, the Synovial membrane lines the fibrous capsule and covers exposed osseous surfaces, intra-capsular ligaments and tendons. It is absent from intra-articular discs or menisci and ceases at the margins of articular cartilages. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”


13

Synovial Intima: It is also called as lamina propria synovialis or Synovial lining layer. It consists of pleomorphic synoviocytes embedded in a granular, amorphous, fiber free inter-cellular matrix. It helps in removal of debris and synthesis of components of Synovial fluid.

Synovial fluid

It occupies the Synovial joints, bursae and tendon sheaths. It is clear, pale, yellow, viscous, and slightly alkaline. Most probably the protein lubricin (rather than hyaluroic acid) is the lubricating factor, which is amplified the secondary lubricating activity of hyaluroic acid. It provides a liquid environment with small range of pH, nutrition for articular cartilage, discs, menisci, lubrication and reduction of erosion.

Menisci

They are the fibrocartilagenous disc-shaped crescents which deepen the articular surfaces of the chondyles of the tibia and also partially divide the joint cavity into upper and lower compartments. They possess two ends, two borders and two surfaces, and act as shock absorbers.

By lubricating the joint cavity, they give rise to

58

proprioceptive impulse . OTHER STRUCTERS: Ligaments

The capsules and ligaments of Synovial joints unite the bones, help to direct bone movement and prevent excessive and undesirable motion. Thus, with more ligaments, the joint becomes stronger. In the knee joint, the tibial collateral ligament, fibular collateral

ligament,

oblique

popliteal

ligament,

arcuate

popliteal

ligament,

ligamentum patellae, cruciate ligament etc. help to maintain stability.

Muscle Tone

The muscle tendons that cross the joints are the most important stabilizing factor. The amount of stability is due to the tone of the respective muscles. In the knee, muscle tone is extremely important for reinforcing joints. The thigh muscles are especially helpful.



14

Bursae

These are apertures in fibrous capsule through which Synovial membranes protrude. They are numerous; as many as 13 burses have been described.

Blood Supply •

5 Genicular branches of the popliteal artery

•

The descending genicular branch of the femoral artery

•

The descending branch of the lateral circumflex femoral artery

•

2 recurrent branches of the anterior tibial artery

•

The circumflex fibular branch of the post-tibial artery

Nerve Supply •

Femoral nerve

•

Sciatic nerve - through the genicular branches of the tibial and

•

Common Peroneal nerve

•

Obturator nerve - through its posterior division .

59

Picture No. 31: Structure of Knee Joint “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

TWAK REVIEW

15

TWAK

Janu Basti & Janu Pichu are the procedures which are done over the Twak. Janu Sandhi is covered by Twak externally. Absorption of the Aushadhi is carried out only through the media of Twak and hence it is very important to study Twak Shareera when we deal with these Bahi Parimarjana Chikistas.

In view of Ayurveda:

Twak is a Sthana of Sparshanendriya. Twacha and Charma are synonymous words which are commonly used to indicate the skin in all Ayurvedic classics. Twak is one of the Indriya Adhishtanas which completely covers Meda, Shonita and all other Dhatus of the body, and it spreads all over the body. It is considered as the seat of Sparshanendriya, as well as one of the main seats of Vata. Bhrajaka Pitta is also situated in Twak60,61.

Formation of Twak:

According to Charaka, Twak is the Upadhatu of Mamsa and is considered to be formed from Mamsa. According to Sushruta, at the time of fertilization, Shukra, Shonita and Atma unite for the formation of Garbha. Its growth is rapid and it is nourished by Tridoshas. The seven folds, or layers of Twak, are formed at that time and are deposited on this rapidly transforming product in the same manner as the layers of cream are formed and precipitated on the surface of boiling milk

62

.

According to Vagbhata, Twak is formed by the Paka of Rakta Dhatu by its Dhatvagni. After the Paka of Rakta, it becomes dry in the form of Twak, similar to the deposition of cream on the surface of the boiling milk. Thus, Twak is also called as “Rakta 63

Santanika” . Layers of Skin (Twak):

There are some different opinions regarding the number of the layers of the skin (Twak) among the ancient Acharyas.


TWAK REVIEW

16

Acharya Charaka has mentioned six layers of skin, but only the first two layers are named while the remaining four are counted as those producing diseases

64

.

1. Udakadhara 2. Ashrukadhara 3. Tritiya 4. Chaturtha 5. Panchami 6. Shashti Acharya Sushruta has mentioned seven layers of skin along with their specific names, thickness and probability in srcin of specific diseases

65

.

1. Avabhasini 2. Lohita 3. Shweta 4. Tamra 5. Vedini 6. Rohini 7. Mamsadhara Acharya Vagbhata has also described seven layers of skin, but the names are not mentioned. Commenting on Vagbhata, Arundatta and Hemadri have named them according to the nomenclature given by Sushruta

66

.

Sharangadhara has also mentioned seven layers of skin along with the probable onset th

of disease. The names of the first six layers are the same as Sushruta, but the 7 layer 67

is called Sthula .


ANATOMY OF SKIN

17

ANATOMY OF SKIN According to modern science: 68

Skin is one of the largest organs of the body in surface area and weight. In adults, the skin covers an area of approximately 2 square meters and weighs between 4.5 to 5 kg. It ranges in thickness from 0.5 to 4.0 mm, depending on the location.

ANATOMY:

The skin consists of two principal parts. The outer thinner portion, called the epidermis, is composed of epithelium. It is attached to the inner, thicker, connective tissue part called the dermis. The dermis is a subcutaneous layer known as the superficial fascia or hypodermis, which consists of Areolar and Adipose Tissue. This subcutaneous layer, in turn, attaches to underlying tissues and organs.

EPIDERMIS:

The epidermis is composed of Stratified Squamous Epithelium and contains four principal types of cells called: (i) Keratinocytes, (ii) Melanocytes, (iii) Langerhan’s cells, and (iv) Marked cells. Four or five distinct layers of cells form the epidermis. In most regions of the body, the epidermis is about 0.1 mm thick and has four layers. Where exposure to friction is greatest, as in the palms and soles, the epidermis is thicker (1 to 2 mm) and has five layers. Constant exposure of thin or thick skin to friction or pressure stimulates formation of a callus, an abnormal thickening of the epidermis.

The names of the five layers, from the deepest to the most superficial layer are as follows:

Stratum basal or germinativum: It forms the lowest layer, consists of a single row of columnar cells and is capable of continuous cellular division. As these cells

multiply, they push up towards the surface and become part of the upper layers. The stratum basal also contains tactile (Merkel) discs that are sensitive to touch.


ANATOMY OF SKIN

18

Stratum spinosum or Malpighi layer: This prickle – cell layer lies upon the basal

layer and has 8 to 10 rows of polyhedral cells that fit closely together. This layer involves most of the pathological conditions of the skin.

Stratum granulosum: It consists of about three to five rows of flattened cells that

develop darkly staining granules of a substance called Keratohyalin. This compound is the precursor of keratin. Keratin forms a barrier that protects deeper layers from injury and microbial invasion and makes the skin waterproof.

Stratum Lucidum: Normally, only the thick skin of the palms and soles has this

layer. It consists of three to five rows of clear, flat, dead cells that contain droplets of an intermediate substance that is formed from keratohyalin and is eventually transformed to Keratin.

Stratum Corneum: This layer consists of 25 to 30 rows of flat, dead cells completely

filled with keratin. These cells are continuously shed and replaced by cells from deeper strata. The Stratum corneum serves as an effective barrier against light and heat waves, bacteria, and many chemicals. DERMIS:

The dermis chiefly consists of white fibrous tissue, elastic fibers and non-stripped muscles, and it contains blood vessels, nerves, hair, sweat glands, sebaceous glands and nerve corpuscles. The outer portion of the dermis, about one fifth of the thickness of the total layer, is called the papillary region. The deeper portion of the dermis is called the reticular region. It consists of dense irregular connective tissue containing interlacing bundles of collagen and coarse elastic fibers. The reticular region is attached with underlying organs, such as bone and muscle, by the subcutaneous layer, and it is also called the hypodermis or superficial fascia.

Keratinization:

In the process of Keratinization, cells newly formed in the basal layers undergo a developmental process as they are pushed to the surface. As the cells relocate, they accumulate keratin, and simultaneously the cytoplasm, nucleus, and other organ cells disappear and the cells die. Eventually, the keratinized cells slough off and are “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

ANATOMY OF SKIN

19

replaced by underlying cells which in turn become keratinized. The whole process by which a cell forms in the basal layer, rises to the surface, becomes keratinized and sloughs off takes two to four weeks.

Pigmentation of the skin:

Three pigments, namely melanin, carotene and hemoglobin, give skin a wide variety of colors. Melanin is located mostly in the epidermis; carotene is mostly in the stratum Corneum and dermis; and hemoglobin is in red blood cells within capillaries in the dermis.

Blood supply of skin:

There are two horizontal and parallel systems of plexuses which maintain vascular supply the skin. These plexuses or networks of blood vessels exist between the dermis and the subcutaneous tissue. Their exact position can never be accurately described. Each arteriole supplies an area of skin, while the corresponding plexus drains the same area.

Nerve supply: The nerve supply of the skin is very complicated, with the pathways of mediation of

sensation through the various nerves being very much under debate. The varied sensations arising from the skin are derived from a diverse population of cutaneous nerve endings or receptors. Thus tactile, temperature and pain sensations are each sub-served by different groups of receptors.

FUNCTIONS OF SKIN68

The skin is a metabolically active organ with vital functions including protection and homeostasis of the body.

Regulation of body temperature: Skin regulates the evaporation of sweat and

converts any elevation of body temperature into a lower temperature or to normal. Changes in the flow of blood to the skin also help the regulation of body temperature.


ANATOMY OF SKIN

20

Protection: The skin is considered under the Integumentary system. It provides a

physical barrier that protects the underlying tissues from physical abrasion, bacterial invasion, and dehydration and UV radiation.

Sensation: The skin contains abundant nerve endings and receptors that detect stimuli

related to temperature, touch, pressure and pain.

Immunity: Sweat of the epidermal cells is one of the important components of the

skin immune system, which wards off foreign invaders.

Excretion: Sweat is the vehicle for loss of a small quantity of ions and several

organic compounds, along with removal of heat and some part of water.

Blood reservoir: The dermis houses extensive networks of blood vessels that carry 8

– 10% of the total blood flow in a resting adult. In moderate exercise this flow increase, which helps to dissipate the heat from the body. During exercise, the skin’s blood vessels can also constrict to allow more blood to circulate through contracting muscles.

Picture No 32: Structure of Skin. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

JANU BASTI REVIEW

21

JANU BASTI Janu basti comprises of two words: “Janu” meaning the Janu Sandhi, and “Basti” the derivative term of urinary bladder whose main function is to withhold. None of our classics have explanations about Janu Basti as such. It is a procedure that has evolved from Shiro Basti. Vagbhata has explained four types of application of Sneha over the head, included in the classification of Murdhni Taila, which includes Shiro21

Abhyanga, Shiro-Seka, Shiro-Picu and Shiro-Basti .

Shiro Basti is the procedure in which the Sneha is retained over the scalp with help of 22

Masha Pishti and a Charma Patta (leather sheet) for a specified period of time . Observing the results of Shiro Basti, the later physicians developed a similar procedure over Janu and named it Janu Basti. In this way, Janu Basti evolved from the Shiro Basti procedure. Today, the same is performed over the Kati and Greeva regions and named respectively as Kati Basti & Greeva Basti.

Derivation

The term "Janu-Basti" consists of the following two words: 1) Janu

2) Basti

Janu

Vyutpatti - Jan - Junn Nirukti - Uru Jangayormadya Bhaga

(Shabda Stoma Mahanidhi)

Janu-Sandhi i.e., the knee joint In general 'Janu' means - the junction between Uru and Jangha.

Basti

“Vas” is formed by the Tich Pratyaya. It belongs to masculine gender. The word “Vas” means – to reside, to abide, to produce effect of aromatic drugs.


JANU BASTI REVIEW

22

Meanings related to organ: “Nabheradhobhage Mutradhare Sthane”

- Organ that lies below the umbilicus (Nabhi). “Bastih- Basteh Avrinoti Mootram”

- Organ in which the urine is collected and retained for some specific period of time.

Meanings related to Karma: The treatment which is administered using a Basti is called as Basti. Here the urinary 23, 24

bladder of animals is used to inject the drugs into the rectum

.

The word 'Basti' is used here with the meaning “to reside” or “to retain”. In 'JanuBasti' the medicine is made to dwell or be retained over the Janu-Sandhi for a prescribed time.

Bahir-Parimarjana Chikitsa

Chikista can be classified as Anta-Parimarjana, Bahi-Parimarjana and ShastraPranidhana on the basis of route of administration. Janu-Basti may be included under 25

Bahir-Parimarjana type of treatment .

Sandhigata Vata is one among the Vata Vyadhi. The symptoms and treatment of Sandhigata Vata is explained in the classics. The principle line of management is 26

Snehana, Svedana, Upanaha and Agnikarma . Among these, Snehana and Svedana are Samprapti Vighatana Chikitsa. Janu-Basti is one such procedure that can provide both Svedana and Snehana effect .

Procedure of Janu-Basti

The procedure of Janu-Basti can be performed in the following three stages: 1. Poorva karma 2. Pradhana karma 3. Paschat karma


JANU BASTI REVIEW

23

Each of the Steps is explained as follows:

1. Poorva Karma

This includes preparatory measures like preparation of patient, preparation of medicine and collection of materials required for the smooth execution of the procedure. It can be conducted under following considerations. a) Atura Pariksha The patient is examined in relation to Dashavidha Pariksha and by applying

Pratyaksha, Anumana and Aptopadesha siddhantas to assess Vyadhi, Bala and Deha 27

Bala . Then, the affected knee joint is examined properly and the region of maximum tenderness is noted. It is also examined for scars & wounds.

b) Sambhara Sangraha

It includes a metal ring, Masha Pishti, Aushadha Dravya (Vasa), spoon, bowl, vessel, water, gas stove and table.

c) Atura Siddhata

Patient is asked to lie in supine position or to sit erect and extend the lower limbs on the table, whichever is more comfortable. The affected knee is exposed properly. Limbs are supported properly so that they are placed horizontally and comfortably.

2. Pradhana Karma: This includes a) Basti Yantra Dharana

First, Masha pishti is prepared by adding sufficient quantity of water to the flour of Black gram. Then, with the use of metal ring and Masha pisti a pit of about 2 Angula height is constructed over the Janu-Sandhi. The concavity of pit (Basti Yantra) should be well sealed to prevent the leakage of the medicine retained in the cavity.

b) Aushadhi Dharana

The bowl containing medicine (Vasa) is heated indirectly by keeping over hot water. Then, the gently heated Luke warm Vasa is poured slowly and carefully on the JanuSandhi along the side of the Basti-Yantra.


JANU BASTI REVIEW

24

The heat of the medicine should be sufficient enough to be tolerated by the patient. The level of the medicine should be two Angula above the highest point inside the cavity.

0

c) Maintenance of constant temperature of medicine (40-45 C)

The medicine in the pit is replaced with heated medicine every 5 minutes so that a constant temperature is maintained throughout the procedure.

d) Removal of Dravya and Basti Yantra

After the specified time, i.e. 45 minutes, the Murivenna is removed from the Basti Yantra and then the Basti Yantra is removed.

e) Samyak Lakshana

The Samyak Lakshanas of Janu-Basti are not described in our classics. Even though Janu-Basti is a modification of Shiro-Basti, those Samyak Lakshanas cannot be interpreted for Janu-Basti. Therefore, the Ayoga, Atiyoga and Samyakyoga bahya Lakshanas of Swedana & Snehana that are mentioned in the classics can be considered as the Lakshanas of Janu-Basti

28, 29

. Among Samyak Sveda Lakshanas,

Sheetoparama, Stambhanigraha, Gauravanigraha and Vyadhihani can be considered for assessment. In case of Samyak Snigdha Lakshanas, Snigdha Gatratva and Mrudu Gatratva can be taken for assessment.

f) Time

In case of Vataja disorders, the Dravya should be retained for Ten thousand Matra 30

Kala . Hence, the procedure is performed for 45 min every day.

3. Pashchat Karma

After removing the Dravya and Basti Yantra, Mridu Abhyanga is done over the JanuSandhi for about 5 min. Duration - This treatment is done for 7 days. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

JANU PICHU REVIEW

25

JANUPICHU

Janu Pichu comprises of two words “Janu” meaning the Janu Sandhi and “Pichu” that literally means cloth whose function is to withhold the oil in the affected area. None of our classics have explanations about Janu Pichu as such. It has too evolved from the concept of Moordhini Taila. The various process by which oil is applied over the head is termed Murdhni taila. Shiro pichu among the Moordhini tailas serves as the base for Janu Pichu.

Shiro Pichu is the procedure, in which the Sneha is retained over the scalp with help 30

of plotha or a cloth for a specified period of time . Observing the results of Shiro Pichu the later physicians developed a similar procedure over Janu and named it as Janu Pichu. In this way Janu Pichu procedure is evolved from Shiro Pichu procedure. Now a day’s same is performed over various regions of body and named accordingly.

Derivation

The term "Janu-Pichu" consists of following two words: 1) Janu

2) Pichu

Janu

Vyutpatti - Jan - Junn Nirukti - Uru Jangayormadya Bhaga

(Shabda Stoma Mahanidhi)

Janu-Sandhi i.e., the knee joint In general 'Janu' means - the junction between Uru and Jangha.

Pichu

Pichu plotha sa cha taile tulapatalam nishichya shirasi deya ithi pichusamjna (Sa.S.Dipika)

Pichu plotha tulavastradi tailakthadharanam . (Sa.S Gudharthadipika) Pichu literally means cloth, it is a process of placing a piece of cotton cloth, immersed in oil, over the affected area. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

JANU PICHU REVIEW

26

Indications

In the context of Shirashoola Pichu is advocated. It is clearly stated that in Vataja shirashoola, if the condition is severe the procedure of Pichu is opted rather than Abyanga19.

In Dantapatanaka after its management, Pichu can be performed

continuously using Vatasani taila20. Pichu with Vatasani taila or Dhanvantara taila is 21

indicated in Manyastambha . In children when the nasal passage is blocked with Kapha, Shiropichu is beneficial when done with Sigrupatra rasa and Eranda taila or 22

with the juice of Sahadevi with Trikatu and breast milk . Pichu is extensively used in the context of Pinasa, in Arogyakalpadruma, Pichu for two yama with Manjishtadi yamaka is indicated in Pittajapinasa, Mustadi yamaka in Kaphajapinasa, Talisapatradi yamaka in Dushtapinasa. Pichu is also indicated in the state of unconsciousness in sannipatajwara23.

Procedure of Janu-Pichu

The procedure of Janu-Pichu can be performed in the following three stages: 1. Poorva karma 2. Pradhana karma 3. Paschat karma

Poorva Karma

This includes preparatory measures like preparation of patient, preparation of medicine and collection of materials required for the smooth conduction of the procedure. It can be conducted under following considerations.

a) Atura Pariksha

The patient is examined in relation to Dashavidha Pariksha and by applying Pratyaksha, Anumana and Aptopadesha siddhantas to assess Vyadhi Bala and Deha 35

Bala . Then, the affected knee joint is examined properly and the maximum tender region is noted. It is also examined for scars & wounds.


JANU PICHU REVIEW

27

b) Sambhara Sangraha

It includes the collection of necessary items required for the stable conduction of the procedure. 2 cotton pads (4*1 inch) , Aushadha Dravya (Murivenna), bowl, vessel, water, gas stove and table.

c) Atura Siddhata

Patient is asked to lie in supine position or to sit erect by extending lower limbs on the table, whichever comfortable. The affected knee is exposed properly. Limbs are supported properly so that they are placed horizontally and comfortably.

2. Pradhana Karma: This includes

a) Janu Pichu Dharana

The bowl containing medicine (Murivenna) is heated indirectly by keeping over a coloumn of hotwater. Then in the gently heated Luke warm Murivenna, pichu is dipped slowly and carefully. This is placed along the Janu-Sandhi analyzing the tolerability of the patient .The heat of the medicine should be sufficient enough to be tolerated by the patient..At the area of maximum tenderness Pichu is placed and retained until the temperature of the oil reduces.

0

b) Maintenance of constant temperature of medicine (40-45 C)

The medicine in the initial Pichu is replaced with the heated oil by another Pichu of same size every 5 minutes. In the mean time the oil from the initial Pichu is drained & kept for heating and this process is alternatively continued so that a constant temperature is maintained throughout the procedure.

c) Removal of Dravya and Basti Yantra

After the specified time i.e. 45 minutes the Murivenna is removed along with the pichu.


JANU PICHU REVIEW

28

d) Samyak Lakshana

As the Samyak Lakshanas of Janu-Pichu are not described in our classics, Samyak Lakshanas of Shiro-Pichu cannot be interpreted even though Janu-Pichu is modification of it. Therefore, the Ayoga, Atiyoga and Samyakyoga bahya Lakshanas of Swedana & snehana mentioned in the classics can be taken for Samyak Lakshana of Janu-Pichu

36,37

. Among Samyak Sveda Lakshana Sheetoparama, Stambhanigraha,

Gauravanigraha and Vyadhihani can be considered for assessment. In case of Samyak Snigdha Lakshanas Snigdha Gatratva and Mrudu Gatratva can be taken for assessment.

e) Duration

In case of Vataja disorders the Dravya should be retained for ten thousand Matra 38

Kala . Hence the procedure is performed for 45 min for 7 days.

3. Pashchat Karma

After removing the Pichu along with oil Mridu Abhyanga is done over the JanuSandhi for about 5 min.

Duration - This treatment is done for 7 days.


29

ILLUSTRATIONS

Prerequisite

MURIVENNA

11

JANU

JANU

Picture No 33: Illustrations of Procedures.

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30

JANU SANDHIGATA VATA

The disease 'Janu-SandhiGata-Vata' is to be understood from 3 terminologies i.e., Janu, Sandhi and Gata Vata. Etymology, definition and specific interpretation of these terms i.e., Janu, Sandhi and GataVata are as follows. Janu •

Vyutpatti -

Jan - Junn

•

Nirukti

Uru Janghayor Madhya Bhaga

-

(Shabda Stoma Mahanidhi) •

Paribhasha -

Janu Sandhi i.e., the knee joint Janu - Napumsakalinga

In general 'Janu' is the junction that lies between Uru and Jangha. Sandhi •

Vyutpatti -

Sam + Dha + Kihi

(Shabda Kalpa Druma), (Shabda Stoma Mahanidhi)

•

Nirukti

-

‘Sandhirnamsa Samyogaha’ (Shabda Kalpa Druma) ‘Asthidwaya Samyoga Sthana’ (Shabda Stoma Mahanidhi) ‘Sandhirnama Asthnam Anyonya Sangam Asthnani’ (Brihatsharira 1part, 6th chap)

Junction, connection, combination, and union which contain a conjugation, transition from one to another

69

.


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Paribhasha –

Sandhi Pullinga, Sandhanamiti Yuga Sandhini - Yugashabde Deha Sandhini Marmashabde Cha Drishtavyaha.

(Shabda Kalpa Druma)

Generally, Sandhi means the junction between two structures. In Ayurveda Shareera, Sandhi is a technical word indicating that, it is the place where two or more bones join or articulate together and the joint formed may be fixed type or with less or freely movable. Acharya Sushruta told that, in the body there are innumerable junction between Peshi, Sanyu, Sira, Asthi, etc. but the description given here is only for Asthi Sandhi Dalhana also supports Sushruta’s view that 'Sandhi' means Asthyashrita Sandhi

70

.

71

.

In Parishadya Shabdartha Shareera it is described that the meaning of Sandhi is union or meeting place, but in Shareera the word Sandhi is mostly used for Asthi-Sandhi [bony articulations].

By viewing all these we can say that the word Sandhi denotes only Asthi Sandhi.

Vata •

Vyutpatti

-

Va - Gati Gandhanayoho Va - Gati Sevanayoho Va + Kta (Shabda Kalpa Druma)

The term ‘Vata’ is derived by the application of ‘Kta’ or Krt Pratyaya to the verb root ‘Va’ which means ‘Gati Gandhanayoh’.


DISEASE REVIEW

•

Nirukti

32

-

Sparsha Matra Vishesha Gunake Bhutabheda Pavane - Dehasya Dhatubheda Cha (Shabda Sthoma Mahanidhi)

The term ‘Gati’ is having meanings like Prapti, Jnana (Panini) and the meaning of ‘Gandhana’ is like Utsaha, Prakashana, Soocana, (Shabdasthoma) Gandhana, Prerana (Siddhanta Kaumudi). Considering the different meanings of Gati and Gandhana, if it is understood that the term Vata act as a receptor as well as stimulator. Hence it can be understood that Vata is a biological force, which governs and stimulates all the activities in the body.

Concept of Gatatva

Sandhivata is also named as Sandhi Gata Vata. Different theories have been quoted to explain the Samprapti of various diseases. Gatatva is one such complex phenomenon mentioned in all Ayurvedic classics. Gatatva of Dhatu, Upadhatu, Ashaya, Avayava and Indriya etc. have been described in classics 72.

Synonyms of Gatatva: •

Gata / Gatam

•

Sthite / sthitam

•

Avasthite

•

Ashrite / Samashritam

•

Prapte

•

Sthe / Stha etc.


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33

By the above meanings and synonyms, it can be stated that the word has two implications. One suggests the movement (Subjected to Gati of Vayu) and the other related with occupation of site (subjected to Adhishtana). Hence Gatatva of Vata implies an undesirable movement of Vata and its unwanted occupation at certain sites.

SANDHIVATA & SANDHI GATA VATA

By the use of both terminologies Sandhivata and Sandhigatavata in the context of same disease doubt arises, whether two are synonyms of the same disease? A screening of the available Ayurvedic literature reveals that the disease entity Sandhigata Vata is found in all the major treatises, even than a disease entity by the name of Sandhivata is nowhere to be found. However, in Bhavaprakasha, under the chapter of Vatavyadhi, in the context of Phalashruti of the treatment of Sandhigatavata, the term Sandhivata has been used as analogous to Sandhigatavata. It implies that both Sandhigatavata and Sandhivata are synonyms of the same disease entity

73

.

SANDHIGATA VATA

Disease Sandhivata is described initially by Acharya Charaka as “Sandhigata Anila” with symptoms of Shotha which on palpation feels as bag filled with air and Shula on Prasarana and Aakunchana (pain on flexion and extension of the joints)

74

. Sushruta

also mentioned Shoola and Shotha in this disease leading to the diminution (Hanti) of the movement at joint involved

75

. Another disease Vata Kantaka is mentioned by

Sushruta which occurs due to the vitiated Vata by involving Khuda Sandhi. According to Dalhana and Gayadasa, Khadu means Padajangha Sandhi i.e. ankle


76

.

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34

Another view has been quoted according to which Khadu may be taken as Parshani (calcaneum). Madhava has not explained Shotha but mentioned Atopa as a symptoms of Sandhigata Vata

77

, which may also be taken equivalent to air filled bag. He has

added one more symptom i.e. Hanti Sandhi (restricted flexion and extension). Thus, the disease Sandhigata Vata can be defined as a joint disease with symptom of Shula, which aggravates by movement, along with Shotha & complete restricted movements at later stages. This disease is comparable with Osteoarthritis, a degenerative joint disease, the symptoms of which are same as Sandhigata Vata and usually occurs after the age of 40 years.

RELATION BETWEEN VATA AND SANDHI

There is a relation between the Dosha and Dushya because of their Bhautika constitution, which has been well narrated in Ashtanga Hridaya while describing the properties, actions and importance of Tridosha. This is also called as Ashaya Ashrayai Bhava i.e. inter-relation between Dosha and Dushya. Vata is located in Asthi, Pitta in Sveda and Rakta and Kapha in Rasa, Mamsa, Meda, Majja and Shukra. It is because of this relation that the drugs or dietetic regimens which augment one particular Dosha also have the effect on its dependant Dhatu. By augmentation of the Dosha, there would be similar effect on their respective Dhatu. But, on contrary to this augmentation of Vata (Ashrayi), due to its properties will lead to decrease (Kshaya) in the Asthi (Ashraya) and vice versa. In the similar way it is related with Kapha. Kshaya of Kapha will cause increase in the quantum of Vata and vice versa

78,79

.


DISEASE REVIEW

35

80,81

SYNONYMS

Different authors named this disease according their own views, but most of them are out of views. The probable synonyms of Sandhivata used in the different context or considered equivalent to Sandhivata by the commentators are as follows. • Sandhigata Anila • Sandhigata Vata • Khudavata • Gulphavata - Synonyms meant only for Gulpha Sandhigatavata

NIDANA In Ayurveda, Nidana is a broad term deals with etiology as well as diagnosis of a disease and it disturbs whole physiological system of Shareera. For prevention and cure Nidana plays an important role so it is considered as prime among Nidana Panchaka. Nidana are classified basically into Samanya nidana & Vishesha Nidana. Samanya Nidana is common for all Vatayadhis, whereas Visesha Nidana is specific cause for specific disease. No specific Nidanas are mentioned for Sandhigata Vata in our classical samhitas. are responsible for Sandhigata Vata reflects as Nidana.

However factors which vitiate the Vata Dosa can be considered as Nidana explained under the context of Vata Vyadhi in different Samhitas Karana and Majjavaha Srotodusti Karana

88

82--87

and Asthivaha Srotodusti

may be taken as Nidana of Janu

Sandhivata.


DISEASE REVIEW

36

They can be classified under the concepts of:

•

Sannikrushta Hetu

•

Viprakrushta Hetu

Under Sannikrushta Hetu the following Nidanas can be considered:

Ati Vyayama:

Ati Vyayama includes excessive physical works, running, jogging, walking etc. If these are done excessively then it affects the structure of the Sandhi. The joint stability is affected by the over exertion and leads to Janu Sandhigata Vata. Bharaharana:

Janu Sandhi is the main weight bearing joint in the body. Carrying heavy and excessive loads creates more pressure and exertion over the Janu which leads to destruction of the joint. Abhighata:

As Sandhi is formed by different Asthi, Peshi and Snayu, injury to any of these structures can cause harm to the stability of the Sandhi. Abhighata can cause structural deformity of the joint and hence it is also a main Nidana for Sandhigata Vata. Atisamkshobha:

It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas is involved in Sandhigata Vata this can be considered as Nidana for the same. Violent activities like Atyadhva, Plavana, Langhana, Balavat Vigraha, Pradhavana etc. will have its effect


DISEASE REVIEW

37

on joint. As told earlier knee is the weight-bearing joint, the violent exercises or activities will alter the structural integrity of the joint. Marmabhighata:

Marma is a vital part which includes Asthi, Mamsa, Sira, Snayu and Sandhi. Janu is included under Vaikalyakara Marma and according to the concept of Marmabhighata, it is definitely a Nidana for Sandhigata Vata.

Under Viprakrushta Hetu the following Nidanas Can be considered

Table – 1: Aharaja Nidana of Vata Vyadhi

Rasa Janya

Charaka

Sushruta

Vagbhata

Madhava

Yoga

Bhava

Nidana

Ratnakara

Prakasha

Kashaya

-

+

+

-

-

+

Katu

-

+

+

-

-

+

Tikta

-

+

+

-

-

+

Guna Janya Rooksha

+

+

+

+

+

+

Laghu

+

+

-

+

+

+

Sheeta

+

+

-

+

+

-

Dravya Janya

Vallura

-

+

-

-

-

-

Varaka

-

+

-

-

-

-

Shuskha Shaka

-

+

-

-

-

-


DISEASE REVIEW

38

Uddalaka

+

-

-

-

-

Neevara

-

+

-

-

-

-

Mudga

-

+

-

-

-

-

Masura

-

+

-

-

-

-

Harenu

-

+

-

-

-

-

Kalaya

-

+

-

-

-

-

Nishpava

-

+

-

-

-

-

Table – 2: Viharaja Nidana of Vata Vyadhi

Ati Vyayama

+

+

+

+

+

-

Langhana

+

+

-

+

+

-

Plavana

+

+

-

+

+

-

Atyadhwa

+

-

-

+

+

-

Pradhavana

-

+

-

-

-

-

Pratarana

-

+

-

-

-

-

Atyuchabhashana

-

-

+

-

-

-

Balavadvigraha

-

+

-

-

-

-

Abhighata

+

+

-

+

+

+

Marmaghata

+

-

-

+

+

-

Bharaharana

-

+

-

-

-

-

Dukhashayya

+

-

-

+

+

+

Dukhasana

+

-

-

-

-

-

Gaja,Ushtra,Ashva +

+

-

+

+

-

Sheegrhayana


DISEASE REVIEW

39

Prapeedana

-

+

-

-

-

-

Ati Adhyayana

-

+

-

-

-

-

Ati vyavaya

+

+

+

+

+

+

Atijagarana

+

+

+

+

+

+

Vegadharana

+

+

+

+

+

+

Vishamopachara

+

-

-

+

+

-

Shrama

-

-

-

-

-

+

Upavasa

+

+

+

+

+

+

Puravata sevana

-

-

-

-

-

+

Divaswapna

+

+

+

+

+

-

Table - 3 : Manasika Nidana of Vata Vyadhi

Cinta

+

-

+

+

+

+

Shoka

+

-

+

+

+

+

Krodha

+

-

-

-

-

-

Bhaya

+

-

-

-

-

+

Table - 4 : Anya Karana for Vata Vyadhi

Ati

+

-

-

+

+

-

+

-

-

+

+

+

+

-

-

+

+

+

Rogatikarshana +

-

-

+

+

+

Raktasravana Ati Doshasravana Dhatukshaya


DISEASE REVIEW

40

POORVARUPA

No specific Poorvarupa of Janu Sandhigata Vata is available in any of the classics. Purva Rupa is manifested due to Dosa Dusya samurchana. It takes place at fourth stage (Sthansamsraya) of kriyakala. In the Vata Vyadhi Chikitsa Adhyaya of Charaka 89

Samhita the Poorvarupa of Vata Vyadhi is mentioned as Avyakta Lakshana . The mild manifested or un-manifested features of the actual disease can be considered as Poorvarupa of Vata Vyadhi. Janu Sandhigata Vata being a Vata Vyadhi, clinical features in milder form can be considered as Poorvarupa of Janu Sandhigata Vata.

RUPA

The Rupa of Sandhivata mentioned in different Samhitas are 90--96

Vata Purna Dhruti Sparsha (Sandhi Shotha):

Shotha is explained by most of the authors. The feeling of ‘air filled bag’ when the Sandhi is palpated is the nature of Shotha or Shotha in Sandhigata Vata. This Lakshana is explained by Acharya Charaka and Acharya Vagbhata.

Vedana:

Vedana or Shula is explained by all the authors. Acharya Charaka and Vagbhata specify the presence of Vedana during Prasarana and Akunchana of the body parts.


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Sandhi Hanti (Stabdhata):

This Lakshana is explained by Sushruta firstly and followed by later authors of Madhava Nidana, Bhava Prakasha and Yogaratnakara. While commenting on word Hanti Dalhana and Gayadasa explained it as Akunchanaprasaranayoh Abhavah and 97

Prasaranakuncanayoh Asamarthah respectively . With this we can infer that the word Hanti refers to inability to move the joints. Mudhukoshakara opines that word Hanti refers to Sandhi Vishlesha or Stambha Adi Vikara 98.

Atopa

Madhavakara explained this symptom in his treatise. While commenting on the word Atopa in another context, Madhukoshakara quotes the opinion of Gayadasa and Kartika stating -

‘Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah’. 99

Also Bhavamishra says ‘Atopo – Gudagudashabdaha’ .

Considering the above references we can say that Atopa in this context is the sound produced by the movement of joints i.e., Crepitus.


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42

Table - 5 : Rupa of Sandhigata Vata mentioned in various classics

SYMPTOMS

Sandhi Vedana Sandhi Shotha (Vata Purna dhruti Sparsha) Sandhi Hanti

C.S.

Su.S.

A.H.

A.S.

M.N.

B.P.

Y.R.

+

+

+

+

+

+

+

+

+

+

+

-

+

+

-

+

-

-

+

-

-

-

-

-

-

+

-

-

(Stabdhata) Atopa

SAMPRAPTI

This is a series of pathological process happening in body during the production of a Vyadhi from Nidana sevana to Roga pradurbhava

100

. A proper understanding of

Samprapti is important for the treatment, since Chikitsa explained in the Ayurvedic text is nothing but ‘Samprapti Vighatana’ 101.

The series of pathological events from the onset of Dosha Dushya Dushti till the appearance of Vyadhi comprise various stages. Samprapti is the one which explain this series of events. It explains the total pathogenesis of the disease.

As Janu Sandhigata Vata is not explained as a separate disease with Nidana Panchaka in the classics, so the Samanya Samprapti of Vata Vyadhi can be adopted as Samprapti of Sandhivata or Janu Sandhigata Vata.


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Intake of Vatakara Ahara Vihara does the vitiation of Vata. This vitiated Vata lodges in Rikta Srotas i.e. Srotas in where Shunyata of Snehadi Guna is present. Vata after settling in Rikta Srotas produce disease related to that particular Srotas

102

.

While explaning the Samprapti of Vata Vyadhi Acharya Vagbhata tells that Dhatukshaya aggravates Vata and the same is also responsible to produce Riktata of Srotas. Thus the vitiated Vata travels through out the body and settles in the Rikta Srotas and further vitiates the Srotas leading to the manifestation of Vata Vyadhi

103

.

Explanation of Srotoriktata due to the Nidana Sevana can be given as follows; the chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess. These are the properties, which are necessary for Sthairya and Upacaya of the body. Excessive intake of Dravyas having Laghu, Ruksha, Sukshma, Khara properties lead to Guru and Sneha Guna Abhava due to their opposite quality. Thus it leads to Dhatukshaya in the body. Akasha is the Mahabhuta that produces Sushirata and Laghuta in the body. Vayu Mahabhuta fills up this Sushirata. So due to Dhatukshaya Akasha Mahabhuta increases in the body producing Sushirata and Laghuta simultaneously Vayu fills it up. It can be stated with the support of above explanation that, Riktata is Sushirata (increase of Akasha and Vayu Mahabhuta). Acharya Chakrapani comments on the word ‘Riktata’ stating that it means ‘lack of Snehadi Gunas’

104

.

Samprapti of Janu Sandhivata can be studied under two headings. 1. Dhatu Kshaya Janya Sandhigata Vata

2. Avarana Janya Sandhigata Vata.


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44

Dhatu Kshaya Janya Sandhivata:

Vata Dosha dominates in the body at old age. This will lead to Kapha Abhava. Also Jataragni and Dhatvagni get impaired, by which Dhatus formed will not be of genuine quality. Degeneration of body elements takes place due to predominance of Vata in its Ruksha, Khara, etc. Guna and loss of Kapha in quality and quantity.

As the Shleshma Bhava decreases in the body, the Kapha Bheda i.e. Shleshaka Kapha in the joints also decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi being the main participant of the joint its Kshaya leads Khavaigunya in the joints.

In this condition if Nidana Sevana done further produces Vata Prakopa. If Vata Prakopa is not corrected by appropriate means and simultaneously if the person indulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vata spreads all over the body through these Srotas. In the meantime Sthanasamshraya of Prakupita Vata takes place in the Khavaigunyayukta Janu Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna over power all the properties of Sleshaka Kapha producing disease Sandhigata Vata.

2. Avarana Janya Sandhivata

In Sthula patients usually Sandhivata occurs in weight bearing joints. In these kinds of patients Medodhatu will be produced in excess due to the Atisnehamsha of Amarasa

105

.


DISEASE REVIEW

45

The excessive Medas will produce obstruction for the flow of nutritive materials to the future Dhatus i.e Asthi, Majja and Shukra leads to their Kshaya. It also produces Margavarana of Vata

106

. Prakupita Vata due to Margavarana starts to settle in the

Sandhi where Khavaigunya already exists. After Sthanasamshraya it produces the disease Sandhigata Vata in the same process mentioned in the earlier context.

Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Janu Sandhivata can be divided into Dhatukshaya Janya and Avarana Janya. This will help in deciding the prognosis and planning the treatment of the disease.

Samprapti Ghatakas: Dosha – Vata (Vyana) Vriddhi; Kapha (Shleshaka) Kshaya

Dooshya – Peshi, Snayu, Asthi, Majja Srotas – Mamsavaha, Medovaha, Asthivaha, Majjavaha Agni – Jataragni, Asthi-Dhatvagni Ama – Jataragni Mandya Janya Roga Marga – Madhyama Udbhavasthana – Pakvashaya Sancharasthana - Sarvasharira Adhishtana – Sandhi Vyaktasthana - Sandhi


DISEASE REVIEW

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Schematic representation of Samprapti of Janu Sandhigata Vata

Nidana

Vardhakya

Vata Vardhaka Nidana

Vata Prakopa

Agni Vaishamya

Dhatu Shaithilya

Dhatu Kshaya

Asthivaha Sroto Dushti

Sthana Samshraya in Asthi

Asthigata Vata

Sandhigata Vata

Sandhi Shula

Sandhi Shotha

Sandhigata Vata


DISEASE REVIEW

47

UPASHAYA AND ANUPASHAYA

UPASHAYA

All drugs, diet and regimen that produce long lasting relief in Sandhigata Vata may be considered as Upashaya, for example Abhyanga, Swedana, Ushna Ahara, Ushna Ritu etc. The Upakrama mentioned under Vatasyaopakrma also act as Upashaya for Vata 107

Vyadhi

.

ANUPASHAYA

All drugs, diet and regimen which exaggerate the disease are taken as Anupashaya for that disease. Hetus of that disease can also be taken as Anupashaya. The diet having Laghu, Ruksha, Sheeta Gunas, Anasana, Alpasana, Sheeta Ritu, evening time can be considered as Anupashaya as they increase pain.


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SAPEKSHA NIDANA

Sapeksha Nidana helps in establishing the exact identity of the disease. Wherever there are identical signs and symptoms prevailing in two or more diseases, there is a chance of wrong diagnosis. Hence differential diagnosis is unavoidable for accurate identity of the disease. To get the clear idea regarding the disease Sandhivata, a comparative study of cardinal symptoms of similar diseases entities are given below.

Table - 6 Sapeksha Nidana of Janu Sandhigata Vata Factors

Amavata

Vatarakta

Koshtrukashirsha

Amapradhanya Absent

Present

Absent

Absent

Jvara

Absent

Present

Absent

Absent

Hridgaurava

Absent

Present

Absent

Absent

Prone age

Old Age

Any age

-

-

Vedana

At

Vrischik

Mushika

Tivra

Prasarana

DanshaVata

Damshavat

Akunchana

and

Vedana

Pravritti

Sanchari

Vatapurna

Sarvang and

Mandal

Koshtruka

Driti

Sandhigata

yukta

Shirshvat

Shotha

Sandhivata

sparsha


DISEASE REVIEW

Sandhi

49 Weight

Big Sandhi

bearing

Small

Only Janu

Sandhi

joint Upashaya

Abyanga

Ruksha

Rakta

Svedana

Shodhana

Rakta Shodhana

SADHYA ASADHYATA

Sadhyaasadhyata gives a clear cut understanding regarding the prognosis of Vyadhi and gives a basic knowledge about its curability. So the knowledge of Sadhyaasadhyata is very essential before heading to any treatment.

Sandhigata Vata is one of the Vata Vyadhi described in all Samhita and Sangraha Grantha. Acharya 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. Further, Dhatukshaya is the chief cause of Vata Vyadhi. Dhatukshaya is difficult to treat as Acharya Vagbhata has elaborated that since body is accustomed to Mala, Dhatukshaya is more troublesome than Dhatu Vriddhi. Sandhigata Vata is one of the Vata Vyadhi, therefore it is Kashta Sadhya

108

.

The ailments of aged persons are Kashta Sadhya and Sandhigata Vata is the affliction of elderly persons. Disease situated in Marma and Madhyama Rogamarga is Kashta “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DISEASE REVIEW

50

Sadhya. Sandhigata Vata is the disease of Sandhi which forms Madhyama Rogamarga.

Further, Vata Vyadhi occurring due to vitiation of Asthi and Majja are most difficult to cure. If there is more destruction of the Asthi in the Janu then again the Vyadhi becomes Kashta Sadhya or Asadhya.

In the list of Kashta Sadhya Vata Vikara, Sandhigata Vata is not mentioned by Charaka, but while commenting on word ‘Khuda Vatata’ Chakrapani explains the meaning of Khuda Vatata as Gulpha Vatata or Sandhigata Vatata. Thus, Sandhivata can be considered as Kashta Sadhya Vata Vyadhi. It may be curable if occurs in strong persons and if it is recently srcinated and if there are no complications.


DISEASE REVIEW

51

CHIKITSA

The aim of Chikitsa is to remove causative factor or disease as well as restoration of the equilibrium of Dosha. The elimination of the Dosha can be achieved by Shodhana and Shamana. Shodhana comprises of Antaha Parimarjana and Bahir Parimarjana Chikitsa. Bahira Parimarjana is achieved by Snehana, Swedana, Mardana, Lepana etc. Shamana types of Chikitsa cures disease without eliminating Doshas.

Sandhigatavata is a Vataja disorder. So, general treatment of Vata Vyadhi can be adopted, considering the etiology of the same. Regarding the specific line of treatment of Sandhigata Vata, Charaka has not mentioned but later authors like Sushruta and others have mentioned effective line of treatment for the same. Other books like Ashtanga Hridaya, Ashtanga Sangraha, Yogaratnakara and Bhavaprakasha have mentioned specific line of treatment.

Table-7: Different Chikitsa procedures indicated in Janu Sandhigata Vata

Treatment

S. S.

A.S.

A.H.

Y.R.

B.P.

B.R.

Snehana

+

-

+

+

+

+

Abhyanga

-

+

-

-

-

-

Mardana

+

+

-

+

-

+

Swedana

-

+

-

+

+

-

Upanaha

+

+

+

+

+

+

Bandana

+

+

-

-

-

+

Agnikarma

+

+

+

-

-

+

109--114


DISEASE REVIEW

52

They are in specific, SNEHANA

Snehana besides being the chief Purvakarma procedure for the Panchakarma therapy, it also happens to be a one of the most significant Chikitsa. Snehana therapy is administered to persons in two different ways as follows. •

Abhyantara Prayoga

•

Bahya Prayoga

115

Both external and internal Snehana are effective in Sandhigata Vata.

o

Abhyantara Snehana

In case of Sandhivata Sneha can be administered orally in the form of Pana, Bhojana, Basti and Nasya. o

Bahya Snehana

Bahya Snehas can be applied in different forms like Abhyanga, Padaghata, Lepa, Gandoosha,

Karnapoorana,

Akshitarpana,

Picchu,

Samvahana,

Mardana,

Murdhnitaila, and Parisheka. Out of these in case of Sandhigata Vata Abhyanga and Mardana are mentioned.

The word Abhyanga refers to do some 'movements' or 'Gati'. For Abhyanga purpose Sukhoshna Taila or other Snehas are used. Abhyanga should be done with slow movements in Anuloma Gati, on joints it should be done in circular manner. Abhyanga should be done minimum for 5 minutes at one region as the Veerya of Medicated Taila will reach up to Majja Dhatu (900 Matra-Kalas).Charka has mentioned Sparshanendriya is the seat for Vata & Twak is Sparshanendriya Adhisthana. Therefore, Abhyanga act as Vatahara, Pushtikara

116,117

.


DISEASE REVIEW

53

Mardana is like Abhyanga but applied pressure is more. Sneha Dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mrudu, Guru Properties, which are due to predominance of Jala and Prithvi Mahabhuta. Sneha alleviates Vata because properties of Sneha are just opposite to those of Vata. The Vayu, in its normal or undisturbed condition, maintains a state of equilibrium between Dosha and Dhatu. Similarly it exercises considerable influence on the functioning of Manasa. Hence, this Vayu should be kept in stage of equilibrium for the individual to be healthy and happy. Snehana helps in the promotion and regulation of the proper functioning of Vayu.

SWEDANA

Swedana is one among the Shadvidhopakrama. It is helpful in neutralizing Stabdhata, Shitata and Gauravata 118. In case of Sandhivata varieties of Swedana Karma like Upanaha & Bandana are indicated.

Upanaha Sweda

Both Sushruta and Charaka consider Upanaha as a variety of Svedana

119,120

.

Roots of Vata Hara drugs should be triturated together with Kanji and mixed with abundant quantity of Saindhava Lavana and Sneha. After making this lukewarm, it should be applied to the affected part.

The paste of drugs included in the Kakolyadi, Eladi or Surasadi groups as well as pastes of Sarshapa, Tila, or Atasi or Krishara, Payasa, Utkarika and Vesavara or the


DISEASE REVIEW

54

drugs of Salvana Sveda should be similarly applied to the affected part folded in piece of thin linen and tied up

121

.

Bandana Dravya in Upanaha :

For the purpose of Bandana, Charaka opines that leather of Ushna Veerya animal can be used.

In the absence of this silk or woolen cloth can be used

Hridayakara opines that 'Vatahara' Patras should be used

123

122.

Ashtanga

and Charaka suggests

Eranda Patra 124. Duration

Upanaha, which is tied in the morning, should be removed in the night and which is tied in the night should be removed in the morning

125

.

Sneha Pramana

According to Vata, Pitta, Kapha, Sneha should be added 1/4,1/6/1/8 th of the Upanaha Dravya. BANDANA

Acharya Sushruta again sub-divides this into 3 types: a) Pradeha b) Sankara c) Bandhana

Pradeha

Thick paste prepared by Amla Kanji with Vataharadravya after adding Saindhava Lavana and Sneha, Svedana is done. Dalhana called this as Upanaha 126.

Sankara Sweda


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55

In Sankara Sveda, paste prepared out of Vatahara Dravyas, Amla Kanji, Saindhava Lavana and Sneha etc., taken in a cloth piece, tied & prepared a Potali. Dalhana considered this as Upanaha

127

.

Bandhana

In Bandhana Upanaha Dravya is tied to the affected apart.

AGNIKARMA

Unique treatment indicated in case of Sandhigata Vata. Here Dahana or cauterization is done at the tender points of the part affected. Dahana Karma should be done in the affected joint according to the structure involved till the Samyak Dahana Lakshana observe.

Hence the different treatment modalities mentioned by different authors can be concise under these

128--132

.


DISEASE REVIEW

56 PATHYA - APATHYA

Specific Pathya and Apathya for Sandhigata Vata are not mentioned in Samhitas, but as this disease belongs to Vata Vyadhi, we should adopt same of Pathyaapathya of general Vata Vyadhi.

Pathya Ahara

Godhuma, Mamsa, Raktashali, Godugdha, Ajadugdha,Ghrita, Draksha, Ama, Madhuka, Ushna Jala, Sura, Surasava, Amlakanjika, Madhura – Amla – Lavana Rasa Pradhana Ahara are Pathya. Pathya Vihara

Atapa Sevana, Mrudu Shayya, Ushnodaka Snana etc.

Apathya Ahara

Yava, Kodrava, Chanaka, Kalaya, Sheeta Jala, Ati Madhya Pana, Sushka Mamsa, Katu-Tikta-Kashaya Rasa Pradhana Ahara are Apathya. Apathya Vihara

Chinta, Ratri Jagarana, Vega Vidharana, Shrama, Anashana, Vyavaya, Vyayama, Chankramana, Kathina Shayya are Apathya.


DISEASE REVIEW

57

SHAMANA AUSHADHI

Vati – Maha Yogaraja Guggulu, Yogaraja Guggulu, Trayodashanga Guggulu,

Amrutadya Guggulu, Rasnadi Guggulu

Kashaya – Maha Rasnadi Kashaya, Rasna Saptaka Kashaya, Rasna Erandadi

Kashaya, Rasnadi Kashaya

Churna – Rasna Churna, Devadaru Churna, Shallaki Churna, Erandamoola Churna

Taila – Maha Narayana Taila, Dhanwantara Taila, Ksheerabala Taila

Gritha – Pancha Tikta Gritha, Pancha Tikta Guggulu Gritha, Maha Tiktaka Gritha,

Rasaushadhi – Maha Vata Vidhwamsa Rasa, Vata Gajankusha Rasa, Ekangaveera

Rasa Arishta – Ashwagandharishta, Balarishta


DRUG REVIEW

58

DRUG REVIEW

Traditional practitioners of Kerala use ‘Murivenna’ as a drug of choice for Abhighatas for external applications. It is widely used for pain and swelling and in the management of fracture and dislocation. Murivenna is not mentioned in any of the classical Ayurvedic texts. There are so many preparations with the same name Murivenna in the Tamil Marma Sastra.

Murivenna promotes healing, also reduces pain & swelling. It is mainly indicated in sandhi muktha, sadyovrana, dagdha vranas, bhagna and sopha. This herbal oil preparation is used as dhara, pichu, thailadroni and bandhana. It is quoted in kerala Ayurveda Pharmocopea presently.

Murivenna

contains

eight

ingredients

–

Karanjathwak,

Kumari,

Thamboolapatra, Sigru patra, Kimsukapatra, Vasukam, Palandu and Sathavari. Murivenna is prepared in Khara paka for external use. It is also used for internal administration in Chikkana paka

During early 1960s a group of eminent and senior Professors from the Govt. Ayurveda College, Trivandrum, Kerala conducted an exhaustive study and found

that maximum clinical effect is available from the combination given above.

Dr.G.Unnikrishnan and Dr.G.S.Raju in the Pharmacy and Dravyaguna department, P.G.Centre, Trivandrum Ayurveda College in the year 1979, conducted a preliminary experiential study on ‘The anti-inflammatory effect of Murivenna’. Statistical analysis of the study showed that the application of Murivenna is highly significant in reducing experimentally induced inflammation in rat paw.

As sandhigatavata is a Vedana Pradhana Vatavyadhi, Murivenna can be utilized for the same. Also Janu being a Marma, the relevance of Murivenna is higher. The individual drugs from Murivenna yoga are discussed below along with their details. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DRUG REVIEW

59

1.KARANJA

:

Family

Fabaceae / Leguminosae :

Botanical name

:

Synonyms

Pongamia glabra Vent

Karanja, Nakthamala, Pootheeka,Prakeerna, Ghrithavarnaka.

Vernacular names

Kannada

:

Hongemara

English

:

Indian beech

Hindi

:

Tidowry, Natakaranja

Malayalam

:

Ungu, Punga maram

Parts used - Seeds, Stem, Leaves, Fruits, Root, Oil from seeds Habitat – Through out India, in tidal and beach forests; cultivated often as a

venue trees. It is distributed in hilly areas up to 4000 feet altitude.

Morphological characters - A medium – sized semi-evergreen glabrous tree

with a short bole and spreading crown up to 18 m or more in height, dark grayish green or brown, very often mottled with dark brown dots, specks, lines or streaks; leaves compound, leaflets 5 7 ovate, acuminate or elliptic; flowers lilac or pinkish white, fragrant in axillary racemes; fruits thick, woody, smooth, compressed, with a short curved beak, seeds 1 or 2 per pod, reniform to nearly round, smooth or wrinkled, 133

testa reddish brown leathery

.

Ayurvedic aspects - Charakacharya has included karanja in kandughna gana,

virechana gana, katu skandha and thiktha skandha. Susruthacharya has included karanja in aragwadhadi gana, varanadi gana, arkadi gana, syamadi gana, siro virechana gana and kaphasamsamana gana.

Uses - The roots are good for cleaning foul ulcers, cleaning teeth,

strengthening gums and gonorrhea. A root paste is used for local application in scrofulous enlargements. The fresh bark is mucilaginous and sweet to taste, soon


DRUG REVIEW

60

becoming bitter and acrid. It is anthelmintic and is used in haemorrhoids, beriberi, ophthalmopathy, dermatopathy, vaginopathy and ulcers. Leaves are digestive, laxative and anthelmintic and are good for flatulence, dyspepsia, diarrhea, leprosy, gonorrhea and cough. A hot infusion of the leaves is good for rheumatalgia and for cleaning ulcers and wounds. Flowers are useful to quench dyspepsia in diabetes and for alleviating Vata and Kapha. The seeds are anthelmintic, haematonic, bitter, acrid and carminative. They are useful in inflammations, otalgia, lumbago, pectral diseases, chronic fevers, hydrocele, haemorrhoids and anaemia. The oil is anthelmintic, styptic and depurative, and is recommended for scabies, ophthalmia, leprosy, haemarrhoids, ulcers, herpes and lumbago134.

Chemical composition - The seeds contain 27% non-volatile oil which

contains glabrin, four furan flavones viz. karanjin, pongapin, karanjone and pongaglabrone. It contains diketonepongamol and also fatty acids. The stem contains karanjin, pongapin, pongamol and a new chromeno-chromene designated as pongaflavone. The flowers contain kaempferol, pongamin, gamma – sitosterol glucoside, quercetin, neoglabrin and glabrosaponin. The leaves showed the presence of glabrachromene I and II, carotene and beta – sitosterol etc. isolation of a new furonoflavone – pongone – from the flowers and its structure determined 135.

2.KUMARI

Family Botanical name

Synonyms

:

Lilliaceae :

Aloe vera Linn

:

Kumari, Grihakanya, Kanyaka, Ghrithakumarika, Kantakapathra

Vernacular names

Kannada

:

Kathaligida

English

:

Indian Aloe

Hindi

:

Gheekuar

Malayalam

:

Kattarvazha

Parts used - Expressed and dried juice of leaves and pulp.


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61

Habitat - The three varities of kumari is distributed all over India and

Sri Lanka.

Morphological characters - A coarse perennial with short stem and shallow

root system; leaves fleshy in rosettes, sessile, often crowded with horny prickles on the margins, convex below, 45 – 60 cm long, tapering to a blunt point, surface pale green with irregular white blotches; flower yellow or orange in racemes; fruits loculicidal capsule.

Uses - The plant is bitter, sweet, cooling, anthelmintic, aperients, carminative,

deobstruent,

depurative,

diuretic,

stomachic,

emmenagogue,

ophthalmic

and

alexeteric. The juice is used in dyspepsis, amenorrhoea, burns, colic, hyperadenosis, hepatopathy, splenopathy, skin diseases, constipation, spanomenorrhea, vitiated conditions of Vata and Pitta, abdominal tumours, dropsy, carbuncles, sciatica, lumbago and flatulence. The elio is used for helminthiasis in children and is a purgative, anthelmintic and emmengogue. It is used for local application in painful inflammations, chronic ulcers and catarrhal and purulent opthalmia

136

.

In inflammatory conditions, associated with pain and swelling, the external application of its leaf extract, bola-elio, is very beneficial. It is also an effective remedy for chronic wounds, as it process vranasodhana and vranaropana properties. The bola effectively reduces haematoma, the accumulation of blood, due to traumatic injuries

137

.

Whole plant: ante helmenthic in children, emmenagogue, stomachic; useful in amenorrhea, piles and rectal fissures, tonic in small doses but in large doses acts as a purgative; leaves; fresh juice in antipyretic, cathartic, cooling; refrigerant; useful in eye, liver and spleen troubles, leishmaniasis, skin diseases and X-ray burns; leaf-juice is an important constituent of a large number of Ayurvedic preparations; mucilage – anti138

inflammatory; root: in colic

.

Chemical composition - The pulp contains a glucoside, barbalin, isobarbaloin

and beta barbalion. The leaves contain glucose, galactose, galacturonic acid, mannose, aloesin and volatile and non-volatile oils, gum, resin, emodin, chrysophanic acid and traces of coumarin. Aloesin and aloesone isolated; malic, citric and tartaric acids from


DRUG REVIEW

62

leaves. The jelly from leaves composed of four partially acetylated glucomannans which differ in their glucose to mannose ratio and acetyl content 139.

3. TAMBOOLA

:

Family

Piperaceae :

Botanical name

:

Synonyms

Piper betle Linn

Tamboola, Nagavallary, Bahula, Kamada, Jeevanthy, Kamarenjiny

Vernacular names

Kannada

:

Villayadele

English

:

Betel

Hindi

:

Pan

Malayalam

:

Vettila

Parts used - Leaves and fruits. Habitat - Cultivated in the hotter and damper parts of India.

Morphological characters - A perennial dioecious root climber, stems semi-

woody, much thickened at nodes; leaves large, 15 – 20 cm long, broadly ovate, slightly cordate, shortly acuminate, acue, entire, glabrous, yellowish or bright green, shining on both sides; males spikes dense, cylindrical, female spikes pendulous, bracts triangular – rotundate, rachis pilose; fruits rarely produced, immersed in the fleshy spikes forming nodular – like structures.

Uses - The whole plant is bitter, acrid, sweet, astringent, carminative,

stomachic, sialagogue, anthelmintic, aromatic, desiccative, exhilarant, aphrodisiac, expectorant, febrifuge, laxative and tonic. It is useful in bronchitis, asthma, catarrh, cough, leprosy, dipsia, alcoholism, syncope, otalgia, fever, halitosis, impotency, rheumatism, dyspepsia, pharyngopathy, and vitiated conditions of Kapha, colic, 140

diarrhea and laryngitis

.


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63

The leaf is pungent, bitter, sweetish, acrid; heating, carminative, stomachic, anthelmintic, tonic, aphrodisiac, laxative; useful in Vata, Kapha, foul smell in the mouh, ozoena, bronchitis, elephantiasis of the leg; improves appetite. The juice of the leaves is dropped int the eye in painful affections of that organ; it is also used to relieve cerebral congestion and satyriasis, and to allay thirst

141

. The chemistry and

physiology of the leaves have been studied by Mann, Sahasrabuddhe and Patwardhan 142

(Memoirs Depart. Agric. Of India; July 1913, June 1916)

.

Chemical composition - Its leaves are known to contain 8.54% moisture,

3.1% protein, 0.8% fat, 6.1% carbohydrate, 2.3 % of fibre and 2.3a5 of mineral matter. Viz.230 mg calcium, 40 mg phosphorus, 7 mg iron, 3.5 mg ionisable iron and carotene etc. Betel leaves contain iodine. They have contents of potassium nitrate, the amount of which depends upon the position of the leaf on the pine. Besides, its leaves also yield an aromatic pungent and sharp taste essential oil, which contain phenol, terpene and other constituents143.

4. SIGRU

Family

:

Moringaceae :

Botanical name

Synonyms

:

Moringa oleifera Lam.

Sigru, Mochaka, Sobhanjan, Theekshagandha, Bahuladala.

Vernacular names

Kannada

:

Nuggi, Murunga

English

:

Drumstick plant, Horse raddish.

Hindi

:

Saijan, Munaga.

Malayalam

:

Muringa

Parts used - Bark, Root, Fruit, Flowers, Leaves, Seeds and Gum. Habitat - Sigru is widely distributed all over India and Burma.


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64

Morphological characters - An unarmed middle sized graceful tree with

corky grey bark and easily breakable branches; leaves usually tripinnate, rachis slender, thickened and articulated at the base, leaflets elliptic or obovate, rounded at the apex, nerves obscure; flowers white in large puberulous axillary panicles; fruits pods, up to 45 cm long, pendulous, greenish, triangular, 9- ribbed, seeds trogonous, the angles winged.

Uses - The roots are bitter, acrid, thermogenic, digestive, carminative,

anthelmintic, constipating, anodyne, anti-inflammatory, emmengogue, sudorific, diuretic, ophthalmic, rubefacient, expextorant, haematinic, antilithic, alexipharmic, stimulant and vesicant. They are useful in vitiated conditions of Vata and Kapha, dyspepsia, anorexia, vermiminosis, diarrhea, colic, flatulence, otalgia, paralysis, inflammations, amenorrhoea, fever, strangury, vesical and renal calculi, ascites, ophthalmopathy, cough, asthma, bronchitis, pectoral diseases, splenomegaly, epilepsy, hysteria, cardiopathy, abscess and pharyngodynia. The bark is acrid, bitter, thermogenic, abortificant, antifungal and cardiac and circulatory stimulant. It is useful in ascites, vitiated conditions of Vata and Kapha and ringworm. The leaves are antiinflammatory, anodyne, anthelmintic, ophthalmic and rich in Vitamin A and C. They are useful in scurvy, vitiated conditions of Kapha and Vata, wounds, tumours, inflammations and helminthiasis. The seeds are acrid, bitter, anodyne, antiinflammatory, purgative, antipyretic and ophthalmic. They are useful in neuralgia, inflammations, intermittent fevers and ophthalmopathy

144

.

Chemical composition - The flowers and fruits contain amino acids viz.

alanine, arginine, glycine, serine, lysine, threonine, valine, aspartic and glutamic acids. The pods and leaves contain vitamin A, nicotinic acid, ascorbic acid and essential amino acids. The flowers contained traces of alkaloids besides quercetin and kaempferol. The stem exudes a gum, which is a polyuronide consisting of arabinose, galactose and glucuronic acid. The seeds showed the presence of stigmasterol and a new glycoside, msrcyne and its structure elucidated. From stem 4-hydroxymellein, vanillin, octacosanoic acid, beta sitosterol and beta sitostenone isolated145.


DRUG REVIEW

65

5. PARIBHADRA

:

Family

Leguminosae :

Botanical name

Erythrina indica Lam.

:

Synonyms

Paribhadra, Kantakeepalasa, Karnakaram,Nimbatharu, Mandara, Rakthapushpa.

Vernacular names

Kannada

:

Varjipe, Harivana

English

:

India coral tree

Hindi

:

Farhad, Mandar

Malayalam

:

Murukku

Parts used - Bark, Juice and Leaves. Habitat - The plant is distributed all over India, irrespective of region and

climate variations.

Morphological characters - A medium sized quick growing tree attaining 18

m in height armed with dark coloured, conical prickles, bark yellowish, smooth, shiny, papery; leaves trifolialate, leaflets 10 – 15 cm long and nearly as broad rhomboid ovate; flowers coral red in dense racemes, corolla papilionaceous; fruits pods, torulose, 15 – 30 cm long, containing upto 12 seeds; seeds red to dark purple or brown.

Uses - The bark is bitter, acrid, thermogenic, anti-inflammatory, sedative,

vulnerary, carminative, digestive, stomachic, anthelmitic, haematinic, expectorant, diuretic, emmengogue, rejuvenating, depurative and febrifuge, and is useful in vitiated conditions of Kapha and Vata, inflammations, conjunctivitis, otalgia, insomnia, anorexia,

flatulence,

dyspepsia,

coloic,

helminthiasis,

cough,

strangury,

dysmenorrhoea, leprosy, skin diseases and fever. The leaves are bitter, diuretic, “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DRUG REVIEW

66

laxative, emmenagogue, stomachic and anthelmintic, and are useful in uropathy, inflammations, vitiated conditions of Pitta, dysmenorrhoea, gastropathy,otalgia, odantalgia, and helminthiasis. The leaf paste isused by tribes to treat fresh cuts and 146

wounds

.

The root is emmenagogue – the bark is used in dysentery; cures Kapha and Vata. The leaves are bitter, hot, stomachic, anthelmintic; improves appetite; cure urinary discharges, inflammations. The flowers are used in biliousness and ear troubles. Susrutha Acharya recommends the plant for the treatment of snake-bite. The bark is used medically as febrifuge and anti-bilious. It is anti helminthic; and is useful as a collyrium in ophthalmia. The leaves are applied externally to disperse venereal buboes, and to relieve pain of the joints. The fresh juice of the leaves is used as an injection into the ear for the relief of ear-ache, and s an anodyne in tooth-ache

147

.

Chemical composition - Its leaves are reported to contain resin, an

nitrogenous inert substance and a mixture of alkaloids viz., hypaphorine, arisodine, arisotrine and arithreyoline. The bark contains a fixed oil, resin and fatty acid and alkaloids including hypaphorine. Its seeds yield a fixed oil, which is extracted from its red-coloured seeds and is pale yellow in colour. Its seeds contain almost all three alkaloids and present in its leaves and the bark. The proportion of alkaloids present therein, is 0.11, 0.035 and 0.082 percent in bark, leaves and the seeds. Besides, its seed-oil contains both saturated and unsaturated fatty acids viz., 53.42 percent oleic 148

acid and 63.3 percent linoleic acid respectively

.

6. PALANDU

Family

:

Lilliaceae :

Botanical name

Synonyms

:

Allium cepa Linn

Palandu, Yavaneshta, Mukhadooshana, Durgandha.

Vernacular names

Kannada

:

Nirulli

English

:

Bulb onion

Hindi

:

Pyaz


DRUG REVIEW

67 Malayalam

:

Chuvannully

Parts used - Bulb and seed. Habitat - Bulb onion is widely distributed all over India.

Morphological characters - A biennial or perennial herb with aromatic fleshy

underground bulb; leaves linear, hollow, cylindric and fleshy; flowers are many, white in globular umbels, spathe composed of 2 –

3 reflexed walls.

The underground bulbs which are medicinally used vary in size, colour, shape, firmness, strength of flavor and keeping quality.

Uses - The bulbs are acrid, sweet, aromatic, thermogenic, antiperiodic,

antibacterial,

aphrodisiac,

emmengogue,

emollient,

expectorant,

carmintive,

stomachic, diuretic, anodyne and tonic. They are useful in haemorrhoids, dysentery, flatulence, dyspepsia, colic, jaundice, splenopathy, hepatopathy, pneumonopathy, asthma, bronchitis, ophthalmia, vomiting, otalgia, pharyngodynia, malarial fever, lumbago, epilepsy, tumours, wounds, paralysis, arthralgia, leucoderma and skin diseases

149

.

The bulbs contain an acrid, volatile oil, which acts as a stimulant, diuretic and expectorant. Used externally as rubefacient, and, when roated, as a poultice. Considering, the natives hot and pungent, useful in flatulency. As an external application, onions are used in scorpion – stings and to allay irritation in skin diseases. They have anti-periodic properties attributed to them, and are said to migrate cough in 150

phthisis, and mixed with vinegar, used in sore throat

.

Chemical composition - The bulb contains polyphenols, protocatechuic,

caffeic and ferulic acids, quercetin and its derivatives, carbohydrates, sterols and sterol glycosides, beta-amyrin and beta sitosterol. The essential oil from the bulbs yields various mon-, di-, tri-, and tetra – sulphides, thiols and thiphene 151.


DRUG REVIEW

68

7. VASUKA

Family

:

Rubiaceae :

Botanical name

Synonyms

:

Borreria hispida Linn. (K.Schum)

Madanagandhi

Vernacular names

Kannada English Hindi Malayalam

: : : :

Madanabadu, Megidda Shoggy putton weed Madanagandhi Tharthaval

Parts used - Entire plant. Habitat - All over in India and Srilanka the drug is distributed.

Morphological characters - A hispid procumbent with long branches and

quadrangular stems; leaves simple, opposite, subsessile, oblong or elliptic, scabrid; flowers pale mauve usually long tubed, 4 – 6 in a whorl within the stipular cup; fruits capsules, ellipsoid, rounded at both ends, 5 mm long, rounded on the back with a deep groove on the flat face.

Uses - The plant is acrid, sweet, astringent, mildly thermogenic, emollient and

stomachic.it is used in vitiated conditions of Pitta and Vata, dyspepsia, colic, flatulence and general debility

152

.

Paribhadra works in Kaphaja, Medhojanya, Pittika vikaras, sopha and karna rogas (Bhavaprakasha). In Rajanighatu, Kaideva nighantu and Nighantu ratnakara references are available for its used in Deepana Karma and Kapha Vata rogas. Also mentions about the Sulahara property. Prof. Priyavrat Sharma in his work Dravyagunavinjnan has mentioned about its used in Grandhi rogas, vrana, Agnimandhya, Kasa and Moothrakricha too. The bark and leaves are having anti inflammatory property. The leaf paste is used by some tribes to treat fresh cuts and wounds externally to relieve pain of the joints

153

. The leaves are applied

154

. It is a C.N.S depressant, laxative, diuretic


DRUG REVIEW

69

and galactogogue. Decoction of bark is used in diabetics, dysentery, worms and useful as a coliyrium in ophthalmia.

Chemical composition - Bark contains 2 resins and a bitter poisonous

alkaloid, which is also present in leaves. The alkaloids traced are Erisodin, Erisoin, Erisonin and Erisotrin. Seeds contain about 10 – 30 % of oil.

8. SATHAVARI

Family

:

Lilliaceae

Botanical name

:

Synonyms

Asparagus racemosus wild.

:

Sathavari, Bahusutha, Indeevary, Varee, Sathapady.

Vernacular names

Kannada

:

Callagadda

English

:

Wild asparagus

Hindi Malayalam

: :

Sathavar Sathavari

Parts used - Root and Leaves. Habitat - Grows all over India.

Morphological characters - An armed, climbing under shrub. Woody terete

stems and recurved or rarely straight spines, young stems very delicate, brittle and smooth; leaves reduced to minute chaffy scales and spines; cladodes triquetrous, curved in tufts or 2 – 6; flowers white, fragrant, in simple or branched racemes on the naked nodes of the main shoots or in the axils of the thorns; fruits globular or obscurely 3 lobed, pulpy berries, purplish black when ripe, seeds with hard and brittle testa. The tuberous succulent roots are 30 cm to a meter or more in length, fascicled at the stem base, smooth, tapering at both ends 155.

Uses - Susrutha samhitha, Charaka samhitha and Dhanwanthari nighantu

mentions about the Rasayana guna of Sathavari. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DRUG REVIEW

70

The roots are bitter, sweet, emollient, cooling, nervine tonic, constipating, galctagogue, ophthalmic, anodyne, aphrodisiac, diuretic, rejuvenating, carminative, appetizer, stomachic, antispasmodic and tonic. They are useful in nerve disorders, dyspepsia, diarrhea, dysentery, tumours, inflammations, vitiated conditions of Vata and Pitta, burning sensation, hyperdipsia, opthalmopathy, nephropathy, hepatopathy, strangury, scalding of urine, throat infections, tuberculosis, cough, bronchitis, gleet, gonorrhea, leprosy, epilepsy, fatigue, hyperacidity, colic, haemorrhoids, cardiac debility, hypertension, abortion, agalactia and general debility

156

.

Chemical composition - Saponins are present in all species of Asparagus, but

variations are found, in different species from parts. Mucilage is also present in roots. In leaves, disogenin is also isolated. From the flowers and fruits, rutin, sarsapogenin, glycosided of quercetin and hyperoside are obtained. Sitosterol, stigmasterol and their glucosides, sarsasapogenin and to spirostanolic and two furostanolic saponins isolated from fruits and chemically studied. Four glycosides –compound A, shatavarin I, II and IV- isolated from roots, structure of shatavarin IV elucidated 157.

NALIKERA Family Botanical name

Synonyms

:

Palmaceae :

Cocus nucifera

:

Nalikera, Druthaphal, Thung, Thruna raj, Sadaphal.

Vernacular names

English

:

Coconut palm

Hindi

:

Nariyal

Malayalam

:

Thengu

Parts used - Fruits, flowers, Root, Oil and ash. Habitat - Grows all over India especially in costal areas.

Uses - Vata pitta samaka properties are present. Found effective in

mutraghatha, rajayakshma, krichrarthava and vranas. Oil prepared by taking the milk “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DRUG REVIEW

71

promotes hair growth and is used for burns. Coconut oil is used as substitute for codliver oil in wasting and pulmonary diseases. The liquid fat has anti-inflammatory and healing properties. All the active principles in coconut oil have high lipid solubility.

Chemical composition - From the ripened fruit 60 – 70 % oil is obtained

along with vitamin A and B. From fruit water – sugar, mannitol, gum, tartaric acid and mineral water is obtained. In fresh shell of the fruit nitrogenous substances, fat, ash, lignin etc. are present. In the ash of the leaves, potash is yielded in considerable amount. Coconut oil contains saturated fatty acids like capric, caproic, caprilic, lauric, myristic, palmitic, stearic and arachidic acids. The unsaturated fatty acids present in it are palmitolic, oleic, linolenic and arachidonic acids. The ripped fruit water contains solids, sugar, minerals, fats and proteins. From minerals, potassium and remaining part contains sodium, calcium, phosphorus, copper and iron. The riped water has pH 5.2

158

.

TANDULODAKA

Water obtained from washing red rice. 1 kg of raw rice is soaked in 4 times of water for 9 hours and filter. This filterate is called Tandulodaka. It is effective in pain, burning sensation and inflammation especially in vata pradhana conditons.

159

Preparation of Murivenna

Ingredients for preparing one litre of Murivenna - Karanja (bark), Kumari (leaves), Tamboola (leaves), Sigrupatra (leaves), Paribhadra (leaves), Palandu (bulb) and Vasuka (whole plant) are taken in 384 gms. Sathavari (rhizome) - 144 gms. Nalikera oil and Tandulodaka 1 litre each. The Swarasa of the first 7 drugs and Tandulodaka are prepared in coconut oil medium. To reduce the Theekshna Veerya of ingredients, Sathavari Kalka is added. The medium of the formulation is coconut oil. The Swarasa, coconut oil and the Kalka are boiled to half and kept as such for the day and repeat boiling on the second day too. The mixture is to be stirred continuously and in the third day boiling a stirring is continued. When the Kalka becomes at Khara Paka, it is filtered and after cooling kept in suitable containers.


DRUG REVIEW

72 Table no: -8 Ingredients of Murivenna Image of the drug

Ingredients

Quantity for 1 liter

Parts used

Botanical name – Pongamia pinnata – Pierre Pongamia glabra – vent Family – Fabaceae Karanja

384 gms

Bark

Botanical name Aloe vera – Linn Family - Lilliaceae Kumari

384 gms

Leaves

Tamboola Botanical name Piper betle – Linn Family Piperaceae

384 gms

Leaves

Botanical name - Moringa pterygosperma Gaertn. Family - Moringaceae

384 gms

Leaves

384 gms

Leaves

Sigru

Botanical name – Erythrina indica Lam Family - Leguminosae

Paribhadra


DRUG REVIEW

73 Image of the drug

Ingredients

Quantity f or 1 litre

Parts used

Botanical name – Allium cepa Linn Family - Lilliaceae

384 gms

Bulb

384 gms

Whole plant

144 gms

Rhizome

1 liter

Oil

Palandu

Botanical name – Borreria hispida – K.Schum Family - Rubiaceae

Vasuka

Botanical name – Asparagus racemosus wild. Family - Lilliaceae

Sathavari

Botanical name – Cocus nucifera Family - Paimaceae

Nalikera

Thandulodakam

1 liter


DRUG REVIEW

74

Table No 9: Rasa Panchaka of the drugs used in the preparation of Murivenna

Drugs Karanja Kumari

Rasa Tikta, Katu, Kashaya Tikta, Madhura

Tamboola

Katu, Tikta

Sigru

Katu, Tikta

Paaribhadra Palandu

Katu, Tikta Madhura, Katu

Vasuka

Katu

Sathavari

Tikta, Madhura Madhura

Naarikela

Guna Laghu, TIkshna, Guru, Snigdha, Pichila Laghu, Ruksha, Tikshna Laghu, Ruksha, Tikshna Laghu Guru, Tikshna, Snigdha Laghu, Rooksha Guru, Snigdha Guru, Snigdha

Veerya Ushna

Vipaka Katu

Prabhava -

Sheeta

Katu

-

Ushna

Katu

-

Ushna

Katu

-

Ushna Ishat Ushna

Katu Madhura

-

Anushna Sheeta Sheeta

Katu

-

Madhura

-

Sheeta

Madhura

-


CLINICAL STUDY

75

CLINICAL STUDY

1) INTRODUCTION:

Snehana & swedana are considered to be the prime modalities of chikista in vata vyadhi. Janu basti being an innovative procedure evolved from Shirobasti has been studied with various sneha yogas to conclude remarkable efficacy in the condition of Janu Sandhigatavata. Even though Janu Pichu too advocates the same principle producing Sthanika Snehana & Swedana effect retaining the oil for stipulated time period, no study has been conducted yet to evaluate the efficacy of the same. So in the current study the main objective was to compare and evaluate the efficacy of Janubasti and Janupichu with Murivenna in Janusandhigatavata. If the study could provide better or similar efficacy among the procedures on comparison it can render a primary contribution on the comparative evaluation of the efficacy among the procedures.

2) AIM: 

Evaluation of effect of Janu Basti with Murivenna on Janusandhigatavata.



Evaluation of effect of Janu Pichu with Murivenna on Janusandhigatavata.



To compare and ascertain the effect of Janu Basti and Janu Pichu with Murivenna.

3) RESEARCH DESIGN

This is a randomized comparative, open labeled, parallel clinical study.


CLINICAL STUDY

76

4) MATERIALS AND METHODS FOR THE STUDY A) SELECTION OF PATIENTS:

The patients from both OPD and IPD of Alvas Ayurveda Medical college Moodbidre, irrespective of sex, religion, occupation and marital status etc, showing signs and symptoms of Janu Sandhigatavata were selected. The detailed clinical history was recorded and examination was done as per special case Performa prepared for the same.

B) DIAGNOSTIC CRITERIA:

Signs & symptoms mentioned in various Ayurveda Samhitas for Sandhigata Vata were considered

•

Sandhi shoola.(pain)

•

Sandhi sotha.(swelling)

•

Prasarana aakunchana pravrutttischa vedana.(Pain during

•

movement of kneejoint) Atopa.(crepitus)

C) INCLUSION CRITERIA: 

Patients of either sex between the age group 30-70 years with the features of Janusandhigatavata .



Patients fit to undergo Janubasti and Janupichu procedure will be selected.

D) EXCLUSION CRITERIA: 

Patients with any other systemic disorder, which may interfere with the course of the treatment, will be excluded.



Traumatic cases like fracture.



Pregnancy & lactation.



Diseases like Vatarakta & Amavata.


CLINICAL STUDY

77

5) GROUPING

Patients of Janu Sandhigata Vata were randomly divided into two equal groups which consisted of 15 patients each.

6) INTERVENTION:

In group A, Patients were administered Janu Basti with Murivenna for 45 minutes, for 7 consecutive days. In group B, patients were administered Janu Pichu with Murivenna for 45 minutes for 7 consecutive days.

Administration of Janu Basti & Janu pichu:

Janu Basti & Janu Pichu are Bahya Snehana and Svedana Chikitsa karmas. It was conducted taking in consideration of three steps such as Poorva Karma, Pradhana Karma and Paschat Karma as mentioned in detail before.

7) LABORATORY INVESTIGATIONS: •

Blood and Urine routine.

•

X – Ray in required cases.

•

In necessary cases, other investigations were done as required.

8) FOLLOW UP STUDY:

After completion of 7 days of Janu Basti and Janu Pichu course all the patients were th

followed up for assessment on 14 day & on 22 capsules as placebo.

nd

day with administration of rice flour


CLINICAL STUDY

78

9) ASSESMENT:

After the procedure Samyak Swinna Lakshana such as Sveda Pradurbhava, Shotha Vyuparama, Stambha Nigraha, Gaurava Nigraha, Mardavata or Sveda Ayoga Lakshana such as Asveda, Stabhdata, Guruta or Atisveda Lakshana such as Vidaha, Sandhi Vedana, Sphota etc if any were observed & recorded.

10) ASSESSMENT CRITERIA:

SANDHI SHOOLA/PAIN ON WALK

-

GRADINGS

NO PAIN MILD PAIN ON EXERTION MODERATE INTERMITTENT PAIN ON WALK CONSTANT PAIN ON WALK SEVERE PAIN UNABLE TO WALK

-

0 1 2 3 4

SANDHI GRAHA /STIFFNESS

NORMAL FLEXION MILD RESTRICTION MODERATE RESTRICTION SEVERE RESTRICTION

-

0 1 2 3

GAIT / AAKRUTI

FREE SWINGING , NO LIMP LIMPING GAIT WITH NO ADDITIONAL SUPPORT “ WITH UNILATERAL SUPPORT WITH BILATERAL SUPPORT

-0 -1 -2 -3

TENDERNESS

NO TENDERNESS - 0 PATIENT COMPLAINS OF PAIN ON TOUCH - 1 “ AND WINCES - 2 PATIENT WITHDRAWS JOINT ON TOUCH - 3 PATIENT DOESN’T ALLOW TO TOUCH THE JOINT - 4


CLINICAL STUDY

79

SWELLING/SHOTHA

SWELLING ABSENT - 0 SWELLING PRESENT - 1

CREPITUS/AATOPA

NO CREPITUS - 0 PALPABLE CREPITUS - 1 AUDIBLE CREPITUS - 2

RANGE OF MOVEMENTS USING GONIOMETER 0

NORMAL FLEXION 135 0 0 LESSER THAN 135 & MORE THAN 100 0 0 LESSER THAN 100 & MORE THAN 75 0 LESSER THAN 75

- 0 -1 -2 -3


CLINICAL STUDY

80

TOTAL EFFECT

COMPLETE REMISSION – 100% relief in signs and symptoms of patients without

any complaints were considered as complete remission.

MARKED IMPROVEMENT – > 90% relief in signs and symptoms were

considered as marked improvement.

MODERATE IMPROVEMENT – Between 60 – 90% relief in signs and symptoms

were considered as moderate improvement.

PARTIAL IMPROVEMENT – Between 30 – 60% relief in signs and symptoms

were considered as partial improvement.

UNCHANGED – < 30 % relief in signs and symptoms were considered as

unchanged.

ANALYSIS OF DATA:

Data was analyzed by unpaired ‘t’ test. P < 0.001 – Highly significant P < 0.01 –Moderately significant P < 0.05 – Significant P > 0.05 – Not significant


OBSERVATIONS

81 OBSERVATIONS

The following observations were made during this study. Observations were made before the treatment, during the treatment and after the treatment. In the present study, 30 patients fulfilling the inclusion criteria of Janu Sandhigata vata were studied. Incidence observation:

As per the prepared proforma, observations were made regarding the incidence of Age, sex, occupation, nature of work, religion, socio-economic status, marital status, educational status, habitat, diet, addictions, Prakruti, Saara, Satwa, Samhana, Aahara- Abhyavarana Jarana Shakthi, Agni, Koshta, Vyayama Shakti, Nidra, Ahara Vihara and Manasika Nidana factors, chronicity etc were noted. Distribution of 30 patients according to different age group:

In this study it was found that the incidence was highest in the age group of 51-60 years constituting 43.34% of total numbers of patients.23.33% patients were equally present in the age group of 41-50 and in 61-70 years. The incidences according to age groups are shown in the table below.

Table No 10: Distribution of 30 patients according to different age group

Age (in years)

No of patients GroupA

Total

%

GroupB

31-40

2

1

3

10%

41-50

3

4

7

23.33%

51-60

7

6

13

43.34%

61-70

3

4

7

23.33%

Graph No 1: Distribution of 30 patients according to different age group


OBSERVATIONS

82

Sex wise distribution of 30 patients:

In the sample taken for the study, 33.33% were males in comparison to 66.66% of females.

Table No 11: Sex wise distribution of 30 patients

Sex

No of patients

Total

%

GroupA

GroupB

Male

4

6

10

33.33%

Female

11

9

20

66.66%

Graph No 2: Distribution of sex of 30 patients

Distribution of 30 patients according to occupation: Maximum number of patients

were manual laborers & house wives (33.3%) and other majority belonged to business category (13.3%) other jobs like driving, pipeline seaman etc. The incidence of other occupation is shown in the table below. Table No 12: Distribution of 30 patients according to occupation

Occupation

No of patients

Total

%

2

10

33.3%

2

8

10

33.3%

Businessmen

2

2

4

13.3%

Office

1

0

1

3%

others

2

3

5

16.66%

Group A

Group B

Manual labor

8

Housewife


OBSERVATIONS

83

Graph No 3: Distribution of 30 patients according to occupation

Distribution of 30 patients according to religion:

50% patients were Hindus, 46.66% were Muslims and 3% were Christians. Table No 13: Distribution of 30 patients according to religion

Religion

No of patients

Total

%

GroupA

GroupB

Hindu

8

7

15

50%

Muslim

6

8

14

46.66%

Christian

-

1

1

3%

Graph No 4: Distribution of 30 patients according to religion


OBSERVATIONS

84

Distribution of 30 patients according to socioeconomic status:

Majority of patients belonged to the lower middle class, middle class (40%), 10% each were in upper middle class and poor. The other incidences of socioeconomic status are given in table below. Table No 14: Distribution of 30 patients according to socioeconomic status

Socio-economic status

No of patients

Total

%

Group A

Group B

Poor

2

1

3

10%

Lower middle class

6

6

12

40%

Middle class

7

5

12

40%

Upper middle class

0

3

3

10%

Rich

0

0

0

00%

Graph No 5: Distribution of 30 patients according to socioeconomic status


OBSERVATIONS

85

Distrubution of 30 patients according to marital Status:

Majority of 90% were married and remaining 10% were unmarried.

Table No 15: Distrubution of 30 patients according to marital Status

Marital status

No of patients

Total

%

Group A

Group B

Married

14

13

27

90%

Unmarried

2

1

3

10%

Graph No 6: Distrubution of 30 patients according to marital Status

Distribution of 30 patients according to habitat:

43.33% of the patients in this study were from sub urban area and 33.33% were from rural area & 23.33% urban. Table No 16: Distribution of 30 patients according to habitat

Habitat

No of patients GroupA

Total

%

GroupB

Urban

3

4

7

23.33%

Sub Urban

7

6

13

43.33%

Rural

5

5

10

33.33%


OBSERVATIONS

86

Graph No 7: Distribution of 30 patients according to habitat

Distribution of 30 patients according to educational status:

Majority of patients belonged to high school class (36.66%) and in P.U.C class (20%), about 13.33% had higher primary education and 16.66% were graduates, Rest 6.66% belonged to illiterate & lower primary classification. Table No 17: Distribution of 30 patients according to educational status

Education

No of patients

Total

%

GroupA GroupB Illiterates

2

0

2

6.66%

Lower Primary education

0

2

2

6.66%

Higher Primary education

0

4

4

13.33%

High School

8

3

11

36.66%

P.U.C

3

3

6

20%

Graduation

2

3

5

16.66%

Graph No 8: Distribution of 30 patients according to educational status


OBSERVATIONS

87

Distribution of patients according to Prakruti: A majority of patients belonged to

VaataPitta Prakruti i.e 53.33% and 23.33% belonged to Vaata Kapha Prakruti,13.33% PittaKapha,6.66% Pittavaata,3% kaphavata prakruthi.. The details of other incidence are tabled below.

Table No 18: Distribution of 30 patients according to Prakruti

Prakruti

No of patients

Total

%

GroupA

GroupB

Vaata

0

0

0

0%

Pitta

0

0

0

0%

Kapha

0

0

0

0%

VaataPitta

8

8

16

53.33%

VaataKapha

4

3

7

23.33%

PittaKapha

2

2

4

13.33%

Pittavaata

1

1

2

6.66%

Kaphavata

0

1

1

3%

VaataPittaKapha

0

0

0

0%

Graph No 9: Distribution of 30 patients according to Prakruti


OBSERVATIONS

88

Distribution of patients according to Saara:

Among the groups 36.66% were possessing twak saara lakshana, 23.33% were Rakta Saara, 20% were Mamsa Saara, and 10% each were Meda Saara & asthi saara .The incidence of other Saara were shown in the table below.

Table No 19: Distribution of patients according to Saara

Saara

No of patients

Total

%

GroupA

GroupB

Twak

6

5

11

36.66%

Rakta

3

4

7

23.33%

Mamsa

3

3

6

20%

Meda

1

2

3

10%

Asthi

2

1

3

10%

Majja

0

0

0

00%

Graph No 10: Distribution of 30 patients according to Saara


OBSERVATIONS

89

Distribution of patients according to their Satwa:

The analysis of satwa revealed 63.33% had Madyama Satwa, 16.66% avara and 20% of patients had Pravara Satwa. Table No 20: Distribution of 30 patients according to their Satwa:

Satwa

No of patients

Total

%

GroupA

GroupB

Pravara

3

3

6

20%

Madyama

10

9

19

63.33%

Avara

2

3

5

16.66%

Graph No 11: Distribution of 30 patients according to their Satwa:

Distribution of patients according to Samhanana:

66.66% were of Madyama Samhanana, 13.33% were Avara and 20% were of Pravara Samhanana.

Table No 21: Distribution of 30 patients according to Samhanana

Samhanana

No of patients

Total

%

GroupA

GroupB

Pravara

4

2

6

20%

Madhyama

9

11

20

66.66%

Avara

2

2

4

13.33%


OBSERVATIONS

90

Graph No 12: Distribution of 30 patients according to Samhanana

Distribution of patients according to Saatmya: Analysis of Saatmya revealed that

70% were of Madyama Saatmya,10%were Avara and 20% were of Pravara Saatmya. Table No 22: Distribution of 30 patients according to Saatmya.

Saatmya

No of patients

Total

%

GroupA GroupB Pravara

3

3

6

20%

Madyama Avara

11 1

10 2

21 3

70% 10%

Graph No 13: Distribution of 30 patients according to Saatmya.


OBSERVATIONS

91

Distribution of the 30 patients according to dietary Habits:

33.33% of patients were vegetarians and 66.6% patients consumed mixed diet

Table No 23: Distribution of the 30 patients according to dietary Habits

Dietary Habits

No of patients

Total

%

GroupA

GroupB

Vegetarians

6

4

10

33.33%

Mixed

9

11

20

66.66%

Graph No 14: Distribution of the 30 patients according to dietary Habits

Distribution of patients according to addictions / Vyasana:

Majority of 63.33% had no addiction in comparison to 20% who were addicted to tobacco chewing, 13.33% were addicted to smoking. The incidences of other addictions are shown in the table below.

Table No 24: Distribution of 30 patients according to addictions / Vyasana

Habit

No of patients

Total

%

GroupA GroupB Smoking

2

2

4

13.33%

Alcohol

1

0

1

3%

Tobacco chewing

3

3

6

20%

None

9

10

19

63.33%


OBSERVATIONS

92

Graph No 15: Distribution of 30 patients according to addictions / Vyasana

Distribution of patients according to Aahara- Abhyavaharana Shakti:

66.66% had Madyama- Abhyavaharana Shakti,13.33% were avara and 20% had Pravara- Abhyavaharana Shakti. Table No 25: Distribution of 30 patients according to Aahara- Abhyavaharana Shakti

Aahaara - Abhyava harana sakti

No of patients A B

Total

%

Pravara

4

2

6

20%

Madyama

9

11

20

66.66%

Avara

2

2

4

13.33%

Graph No 16: Distribution of 30 patients according to Aahara- Abhyavaharana Shakti


OBSERVATIONS

93

Distribution of patients according to Aahara-Jarana shakti:

63.33% had Madyama- Jarana Shakti, 30% Pravara and 6.66% had avaraJarana Shakti. Table No 26: Distribution of 30 patients according to Aahara-Jarana shakti

Aahara- Jarana Shakti

No of patients

Total

%


5

4

9

30%

Madyama

9

10

19

63.33%

Avara

1

1

2

6.66%

Graph No 17: Distribution of 30 patients according to Aahara-Jarana shakti

Distribution of patients based on Agni:

Among 30 patients of Janu Sandhivata 50% had Samagni, 23.33% had Mandagni and 23.33% patients suffered from vishamgni.

Table no 27: Distribution of 30 patients according to Agni Sl. No.

Agni

No. of patients

Total

%

A

B

1

Samagni

9

6

15

50

2

Mandagni

3

4

07

23.33

3

Teekshnagni

0

1

01

03.33

4

Vishamagni

3

4

07

23.33


OBSERVATIONS

Graph No: 18

94

Distribution of 30 patients according to Agni

Distribution of patients based on Koshtha:

Table no. 28 shows that among 30 patients of Janu Sandhivata 53.33% had Madhyama Koshta and 46.66% had Krura Koshtha.

Table - 28: Koshtha wise Distribution of 30 Patients of Janu Sandhivata Sl. No.

Koshtha

No. of patients A

Total

%

B

1

Mrudu

0

0

0

00

2

Madhyama

9

7

16

53.33

3

Krura

6

8

14

46.66

Graph No 19: Koshtha wise Distribution of 30 Patients of Janu Sandhivata


OBSERVATIONS

95

Distribution of patients according to their nature of work/ Vihara:

A maximum of 33.33% of patients were doing manual work & labor each,13.33% had sedentary nature of work, &10% were travelling.

Table No 29: Distribution of 30 patients according to their nature of -work/ Vihara

Nature of work

No of patients

Total

%

GroupA

GroupB

Manual work

2

8

10

33.33%

labor

8

2

10

33.33%

sedentary

2

2

4

13.33%

Travelling

1

2

3

10%

Others

2

1

3

10%

Graph No 20: Distribution of patients according to their nature of work / Vihara


OBSERVATIONS

96

Distribution of patients according to Vyaayama Shakti:

56.66% had Madyama Vyaayama Shakti and 43.33% had Avara Vyaayama Shakti. Table No 30: Distribution of patients according to Vyaayama Shakti

Vyaayama Saktitah

No of patients

Total

%


0

0

0

00%

Madyama

8

9

17

56.66%

Avara

7

6

13

43.33%

Graph No 21: Distribution of patients according to Vyaayama Shakti

Distribution of patients according to their Nidra Sheela:

63.33% had disturbed sleep whereas only 36.66% had sound sleep.

Table No 31: Distribution of patients according to their Nidra Sheela

Nidra

No of patients

Total

%

GroupA GroupB Sound

5

6

11

36.66%

Disturbed

10

9

19

63.33%


OBSERVATIONS

97

Graph No 22: Distribution of patients according to their Nidra Sheela

Distribution of patients according to Nidana (Ahara):

Table no. 33 shows that among 30 patients of Janu Sandhivata 53.33% of them did Atyupayoga of Katu Rasa, 23.33% of them did Alpa Bhojana, again 23.66% of them did Rooksha Bhojana.

Table No 32: Nidana (Ahara) wise Distribution of 30 Patients of Janu Sandhivata Sl. No.

Nidana (Ahara)

No. of patients A

Total

%

B

1

Tikta Rasa Atyupayoga

0

0

0

00%

2

Kashaya Rasa Atyupayoga

0

0

0

00%

3

Katu Rasa Atyupayoga

9

7

16

53.33%

4

Alpa Bhojana

4

3

7

23.33%

5

Pramita Bhojana

0

0

0

00%

6

Rooksha Bhojana

3

4

7

23.33%


OBSERVATIONS

98

Graph No 23: Distribution of patients according to their Nidana (Ahara)

Distribution of patients based on Nidana (Vihara):

Table no. 34 shows that among 30 patients of Janu Sandhivata 63.33% did Ratri Jagarana and 33.33% did Ati Vyayama.

Table No 33: Nidana (Vihara) wise Distribution of 30 Patients of Janu Sandhivata Sl. No.

Nidana (Vihara)

No. of patients A

B

Total

%

1

Vega Dharana

0

1

1

3.33%

2

Ati Vyavaya

0

0

0

00%

3

Ratri Jagarana

10

9

19

63.33%

4

Atyuchha Bhashana

0

0

0

00%

5

Ati Vyayama

6

4

10

33.33%


OBSERVATIONS

99

Graph No 24: Distribution of patients according to their Nidana (Vihara) 12 10 8 6 4 2 0

10

9 6 Group A

4 0

Group B

1

0 0

Vega dharana

Ati vyavaya

0 0 Ratri jagarana

Column1

Atyucha Ati vyayama Bhashana

Distribution of patients based on Nidana (Manasika):

Table no. 35 shows that among 30 patients of Janu Sandhivata 20% of patients had Ati Bhaya, 3.33% had Ati Shoka and 76.66% of them had Ati Chinta

Table No 34: Nidana (Manasika) wise Distribution of 30 Patients of Janu Sandhivata Sl. No.

Nidana (Manisika)

No. of patients A

B

Total

%

1

Ati Bhaya

2

4

6

20%

2

Ati Shoka

1

0

1

3.33%

3

Ati Chinta

13

10

23

76.66%

Graph No 25: Nidana (Manasika) wise Distribution of 30 Patients of Janu Sandhivata


OBSERVATIONS

100

Distribution of patients according to Chronicity:

Table no. 30 shows that among 30 patients of Janu Sandhivata 63.33% had the chronicity between 0 – 2 yrs, 33.33% had between 2 – 4 yrs, 3.33% had between 8 – 10 yrs.

Table No 35: Chronicity wise Distribution of 30 Patients of Janu Sandhivata Sl. No.

Chronicity

No. of patients A

B

Total

%

1

0 – 2 yrs

11

8

19

63.33

2

2 – 4 yrs

6

4

10

33.33

3

4 – 6 yrs

0

0

00

00

4

6 – 8 yrs

0

0

00

00

5

8 – 10 yrs

0

1

01

3.33

Graph No 26: Chronicity wise Distribution of 30 Patients of Janu Sandhivata


RESULTS

101

RESULTS The basis for the assessment of the results was the response shown by the patient on signs and symptoms of the Janu Sandhigatvata . For the assessment of effect of treatment, subjective and objective parameters were considered such as

Sandhi Shoola (Pain), Sandhi Graha (Stiffness), Aakruti (Gait), Tenderness, Shotha(Swelling),Aatopa(Crepitus) & Range Of Movement. Both the individual effect (using paired t test)and the comparative effect of procedures (using t test) in subjective and objective parameters on 7th 14 th and 22nd day in Group A and Group B were computed. Finally the overall effect of the treatment and also the comparative effect of treatment between Group A and Group B were computed. TABLE NO 36- EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS AND SYMPTOMS ON 15 PATIENTS IN GROUP A AT

MEAN SIGNS & SYMPTOMS PAIN STIFFNESS GAIT TENDERNESS SWELLING CREPITUS RANGE OF MOVEMENT

(%)

SD

SE

“t” VALUE

“P” VALUE

1.267

59

0.862

0.223

t = 8.088

P = <0.001

2.000

0.867

57

0.640

0.165

t = 6.859

P = <0.001

1.133

0.267

76

0.352

0.0909

t = 9.539

P = <0.001

1.933

0.933

52

1.000

0.258

t = 3.873

P = 0.002

1.000

0.400

60

0.507

0.131

t = 4.583

P = <0.001

1.133

0.533

53

0.632

0.163

t = 3.674

P = 0.003

1.267

0.667

47

0.632

0.163

t = 3.674

P = 0.003

BT

AT

3.067

As per the table above for the complaint Pain the‘t’ value is t=8.088; P<0.001, where it is found to be statistically highly significant. In the above table the ‘t’ value for Stiffness is t=6.859, where it is found to be statistically highly significant with P<0.001. The‘t’ value for the symptom Gait is t=9.539, and it is found to be statistically highly significant with P<0.001, as per the above table. As per the table above for the complaint Tenderness the‘t’ value is t=3.873; P=0.002, where it is found to be statistically significant. In the above table the ‘t’ value for Swelling is t=4.583, where it is found to be statistically highly significant with P<0.001.


RESULTS

102

The‘t’ value for the symptom Crepitus is t=3.674, and it is found to be statistically significant with P=0.003, as per the above table. As per the table above for the Range of movement the‘t’ value is t=3.674; P=0.003, where it is found to be statistically significant. TABLE NO 37: EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS TH AND SYMPTOMS OF 15 PATIENTS IN GROUP A ON 14 DAY. MEAN SIGNS & SYMPTOMS

BT

14THDAY

(%)

SD

SE

“t” VALUE

“P” VALUE

PAIN

3.067

0.467

85

0.632

0.163

t = 15.922

P = <0.001

STIFFNESS

2.000

0.333

83

0.488

0.126

t = 13.229

P = <0.001

GAIT

1.133

0.200

82

0.258

0.0667

t = 14.000

P = <0.001

TENDERNESS

1.933

0.400

79

0.834

0.215

t = 7.122

P = <0.001

SWELLING

1.000

0.133

87

0.352

0.0909

t = 9.539

P = <0.001

CREPITUS

1.133

0.400

65

0.594

0.153

t = 4.785

P = <0.001

RANGE OF MOVEMENT

1.267

0.333

74

0.594

0.153

t = 6.089

P = <0.001

There is highly significant change statistically in all the signs and symptoms. All the signs and symptoms have P = <0.001, and respective‘t’ as shown in table above. TABLE NO 38: EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS ND AND SYMPTOMS OF 15 PATIENTS OF GROUP A ON 22 DAY.

MEAN SE

“t” VALUE

“P” VALUE

SIGNS & SYMPTOMS

BT

22NDDAY

(%)

SD

PAIN

3.067

0.267

91

0.414

0.107

t = 26.192

P = <0.001

STIFFNESS GAIT

2.000 1.133

0.133 0.133

93 88

0.352 0.000

0.0909 0.000

t = 20.546 t = + inf

P = <0.001 P = <0.001

TENDERNESS

1.933

0.200

90

0.704

0.182

t = 9.539

P = <0.001

SWELLING

1.000

0.000

100

0.000

0.000

t = + inf

P = <0.001

CREPITUS

1.133

0.200

82

0.594

0.153

t = 6.089

P = <0.001

RANGE OF MOVEMENT

1.267

0.133

89

0.516

0.133

t = 8.500

P = <0.001

There is highly significant change statistically in all the signs and symptoms. All the signs and symptoms have P = <0.001, as shown in table above.


RESULTS

103

TABLE NO 39- EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS AND SYMPTOMS OF 15 PATIENTS IN GROUP B AT

SIGNS & SYMPTOMS

MEAN BT AT

(%)

SD

SE

“t” VALUE

“P” VALUE

PAIN

2.667

1.467

45

0.676

0.175

t = 6.874

P =<0.001

STIFFNESS

2.000

1.067

47

0.704

0.182

t = 5.137

P =<0.001

GAIT

1.067

1.000

06

0.258

0.0667

t = 1.000

P = 0.334

TENDERNESS

2.067

1.133

45

0.594

0.153

t = 6.089

P =<0.001

SWELLING

0.733

0.400

45

0.488

0.126

t = 2.646

P = 0.019

CREPITUS RANGE OF MOVEMENT

1.333

0.600

55

0.458

0.118

t = 6.205

P =<0.001

1.200

0.733

39

0.516

0.133

t = 3.500

P = 0.004

As per the table above for the complaint Pain the‘t’ value is t=6.874; P<0.001, where it is found to be statistically highly significant. In the above table the‘t’ value for Stiffness is t=5.137, where it is found to be statistically highly significant with P<0.001. The‘t’ value for the symptom Gait is t=1.000, and it is found to be statistically insignificant with P=0.334, as per the above table. As per the table above for the complaint Tenderness the‘t’ value is t=6.089; P<0.001, where it is found to be statistically highly significant. In the above table the‘t’ value for Swelling is t=2.646, where it is found to be statistically significant with P=0.019. The‘t’ value for the symptom Crepitus is t=6.205, and it is found to be statistically highly significant with P<0.001, as per the above table.

As per itthe the Range of movement the‘t’ value is t=3.500; P=0.004, where is table foundabove to be for statistically significant.


RESULTS

104

TABLE NO 40: EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS TH AND SYMPTOMS OF 15 PATIENTS OF GROUP B ON 14 DAY.

SIGNS & SYMPTOMS

MEAN 14TH BT DAY

(%)

SD

SE

“t” VALUE

“P” VALUE P=< 0.001 P=< 0.001

PAIN

2.667

1.200

55

0.640

0.165

t = 8.876

STIFFNESS

2.000

1.000

50

0.655

0.169

t = 5.916

GAIT

1.067

0.933

12

0.352

0.0909

t = 1.468

TENDERNESS

2.067

0.933

55

0.640

0.165

t = 6.859

SWELLING

0.733

0.333

55

0.507

0.131

t = 3.055


1.333

0.600

55

0.458

0.118

t = 6.205

P = 0.009 P=< 0.001

1.200

0.733

39

0.516

0.133

t = 3.500

P = 0.004

P = 0.164 P=< 0.001

There is highly significant statistical changes in most of the signs and symptoms with (P = <0.001) except for Gait (P = 0.164) which is statistically insignificant, whereas swelling (P= 0.009) & Range of movement (P= 0.004) are statistically significant, as shown in the table above. TABLE NO 41: EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS ND AND SYMPTOMS OF 15 PATIENTS OF GROUP B ON 22 DAY.

SIGNS & SYMPTOMS

BT

MEAN ND 22 DAY

(%)

SD

SE

“t” VALUE

“P” VALUE

PAIN

2.667

0.800

70

0.834

0.215

t = 8.671

P=<0.001

STIFFNESS

2.000

GAIT

1.067

0.867

57

0.743

0.192

t = 5.906

P= <0.001

0.933

12

0.352

0.0909

t = 1.468

P = 0.164

TENDERNESS

2.067

0.733

64

0.816

0.211

t = 6.325

P =<0.001

SWELLING

1.000

0.267

73

0.458

0.118

t = 6.205

p= <0.001


1.333

0.533

60

0.640

0.165

t = 4.583

P= <0.001

1.267

0.667

47

0.632

0.163

t = 3.674

P = 0.003

There is highly significant statistical changes in most of the signs and symptoms with (P = <0.001) except for Gait (P = 0.164) statistically insignificant and Range of movement (P= 0.003) which is statistically significant as per the above table.


RESULTS

105

COMPARITIVE EFFECT OF PROCEDURES IN SIGNS AND SYMPTOMS OF GROUP A & GROUP B

The comparative percentage relief in various signs and symptoms of Group A and Group B after treatment is as shown in the Table No.33 and Graph No.3 TABLE NO 42: COMPARITIVE EFFECT OF PROCEDURES IN SIGNS AND SYMPTOMS OF PATIENTS IN GROUP A & GROUP B

SIGNS & SYMPTOMS

MEAN DIFFERENCE

STANDARD DEVIATION

“t” value

“p” value

0.676

2.121

0.043

0.640

0.704

1.616

0.117

0.0667

0.352

0.258

7.102

< 0.001

1.000

0.933

1.000

0.594

0.223

0.825

SWELLING

0.600

0.333

0.507

0.488

1.470

0.153

CREPITUS

0.600

0.733

0.632

0.458

-0.660

0.515

0.600

0.467

0.632

0.516

0.631

0.533

Group -A

Group –B

Group A

Group B

PAIN

1.800

1.200

0.862

STIFFNESS

1.133

0.933

GAIT

0.867

TENDERNESS

RANGE OF MOVEMENT

The mean difference of pain in group A (1.800) is greater than (1.200) in group B, with a statistically significant change with p = 0.043. The mean difference of stiffness in group A (1.330) is less than (0.933) in group B, with a statistically insignificant change with p = 0.117. The mean difference of Gait in group A (0.867) is greater than (0.0667) in group B, with a statistically significant change with p < 0.001. The mean difference of Tenderness in group A (1.000) is greater than (0.933) in group B, with a statistically insignificant change with p = 0.825. The mean difference of Swelling in group A (0.600) is greater than (0.333) in group B, with a statistically insignificant change with p = 0.153. The mean difference of Crepitus in group A (0.600) is less than (0.733) in group B, with a statistically insignificant change with p = 0.515. The mean difference of Range of movement in group A (0.600) is greater than (0.467) in group B, with a statistically insignificant change with p = 0.533.


RESULTS

106

TABLE NO 43: COMPARITIVE EFFFECT OF PROCEDURES IN PERCENTAGE RELIEF AFTER TREATMENT

Signs and symptoms

% RELIEF – GROUP A DAY7th

% RELIEF – GROUP B 7

th

DAY

PAIN

59

45

STIFFNESS

57

47

GAIT

76

06

TENDERNESS

52

45

SWELLING

60

45

CREPITUS

53

55

RANGE OF MOVEMENT

47

39

GRAPH NO 27: COMPARITIVE EFFECT OF PROCEDURES ON SIGNS AND SYMPTOMS EXPRESSED IN PERCENTAGE AFTER TREATMENT


RESULTS

107

TABLE NO 44: COMPARITIVE EFFFECT OF PROCEDURES IN TH TH ND PERCENTAGE RELIEF ON 7 , 14 & 22 DAY

The percentage relief in Group A & Group B on 7 th, 14th and 22nd day on each of the assessment criteria is shown below as in the table.

Signs and symptoms

PAIN STIFNESS GAIT TENDERNESS SWELLING CREPITUS RANGE OF MOVEMENT

% RELIEF – GROUP A

% RELIEF – GROUP B

7th

14th

22nd

7th

14th

22nd

59

85

91

45

55

70

57

83

93

47

50

57

76

82

88

06

12

12

52

79

90

45

55

64

60

87

100

45

55

73

53

65

82

55

55

60

47

74

89

39

39

47


RESULTS

108

GRAPH NO 28: COMPARITIVE EFFFECT OF PROCEDURES IN PERCENTAGE TH TH ND RELIEF ON 7 , 14 & 22 DAY Group A

120% 91% 85%

100%

93% 83%

80% 59%

100% 87% 81% 75%

89% 79%

87%

74% 60%

57%

60%

50%

89%

82% 65% 60% 47%

7th day

40%

14th day

20%

22nd day

0%

Group B

80% 70% 60% 50% 40% 30% 20% 10% 0%

70% 55% 45%

64% 64% 60% 55% 55% 55% 45% 45% 44% 39% 55%

57% 47% 50% 12% 6% 12%

39%

7th day 14th day 22nd day


RESULTS

109

OVERALL EFFECT OF THE TREATMENT

The effect of the treatment is classified into four as mentioned in the chapter Clinical Study. Out of 30 patients, 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 % relief, 22 (73.4 %) got moderate relief between 60 % and 90 % & 3 (10%) got partially improved results which is shown in Table No.34 and Graph No.4

TABLE NO 45: OVERALL EFFECT OF THE TREATMENT Effect of Therapy

Group A

Group B

Total

(%)

Complete Remission ( 100 % Relief)

02

00

02

06.6

Markedly Improved ( >90 % Relief)

03

00

03

10.0

Moderately Improved ( 60-90 % Relief)

09

13

22

73.4

Partially Improved ( 30-60 % Relief)

01

02

03

10.0

No Change ( <30 % Relief)

00

00

00

00.0

GRAPH NO 29: OVERALL EFFECT OF THE TREATMENT


RESULTS

110

COMPARITIVE EFFECT OF THE TREATMENT

In Group A, 2 patients (13.4 %) got 100 % relief & 3 patients (20 %) got more than 90 % relief and in Group B, no patients got more than 90 % or 100% relief. 9 patients (60 %) of Group A, got relief in between 60-90 % and whereas 13 ( 87%) patients of Group B got relief in between 60-90 % as shown in Table No.35 and Graph No.5 TABLE NO 46: COMPARITIVE EFFECT OF THE TREATMENT Effect of Therapy

Group A

(%)

Group B

(%)

Complete Remission (100 % Relief)

02

13.4

00

00.0

Markedly Improved (>90 % Relief)

03

20.0

00

00.0

Moderately Improved (60-90 % Relief)

09

60.0

13

87.0

Partially Improved (30-60 % Relief)

01

06.6

02

13.0

No Change (<30 % Relief)

00

00.0

00

00.0

GRAPH NO 30: COMPARITIVE EFFECT OF THE TREATMENT


DISCUSSION

111

DISCUSSION

Vata prime among the Tridosha plays a very important role in the formation of all Vyadhis. It is the one which is responsible for the movement of other two Doshas all over the body. Vata due to its Chala Guna moves all over the body. The movement or Gati of individual component of Vata has to be analyzed properly. The word Gata or Gatatva has two implications one subjected to activities and second subjected to abode of activities. In case of Gatatva the aggravated Vata finds a suitable place for its lodgment. Those will be such as Dhatu, Upadhatu, Ashaya, and Avayava. Due to Vata Vardhaka Ahara, Vihara, and Manasika Nidanas the aggravated Vata while moving throughout the body lodges in Khavaigunya Yukta Srotas. After getting lodged at those parts it impairs the functions of particular structure and produces disease.

In Ayurveda Sandhi is described as the conjoininig place where two or more structures unite together. In the context of Janu SandhigataVata, Janu Sandhi can be understood as conjoining place of two or more bones along with other structures which combine together to form a Sandhi such as Asthi, Snayu and Peshi. These are different structures, which helps in maintaining the stability of the joint. Snayu helps in proper binding of the joint. They unite the bones and help to direct the bone movement and prevent the excessive and undesirable motion. Peshi helps to maintain the alignment of the joint. Shleshaka Kapha, provides the lubricant factor &, nutrition thereby keeping the joint firmly united. Shleshmadharakala situated in the joints supported by Shleshaka Kapha helps in normal movement.

The Samprapti of Sandhi-Gata-Vata may be divided into Dhatukshaya Janya and Avarana Janya. Even the contemporary science explains the pathology in two settings. One is due to the sub standard biomaterial of the joint (Dhatukshaya). Second is due to increased applied pressure over the joint (Avarana). In Dhatukshya Janya SandhiGata-Vata due to old age, Vatakara Ahara Vihara there will be qualitative change in the joint material gradually leading to disease manifestation. The other set of Samprapti where in due to continuous pressure due to obesity the joint may get


DISCUSSION

112

affected (Due to Avarana) leading to disease manifestation. This demarcation in Samprapti helps in planning the treatment.

We can find the description of Sandhigatavata in all Samhita and Sangraha Granthas under the concept of Vata Vyadhi and when the involved Sandhi is Janu Sandhi it can be called as Janu Sandhigatavata. In Vriddhavastha the Dhatukshya that takes place leads to Vata Prakopa. Vata and Asthi have Ashraya-Ashrayi Sambandha which means Vata takes shelter in Asthi. Vriddha Vata reduces the Snehamsha or Snigdhatva from Janu Sandhi by its nature of opposite qualities to Sneha. Due to diminution of Sneha, Khavaigunya occurs in Asthi and the Sandhi, which is responsible for the production of Sandhivata.

Acharyas have described the Lakshanas of SandhiVata as Sandhi Shula, Sandhi Shotha, Atopa, Prasarana Akunchana Pravrutti Vedana and Hanti Sandhi. Sandhi Shula and Sandhi Shotha are direct features of Vata Prakopa. Vata Purna Driti Sparsha is the type of shotha mentioned which indicates Vata dominant Shotha which feels like air filled leather bag. Prasarana Akunchana Vedana and Hanti Sandhi occur due to Kaphakshaya and Vata Prakopa. In the Samprapti of Sandhigatavata, Prakupita Vata takes shelter in Sandhi where Khavaigunya and Rikta Srotas is already present. Then Dosha Dushya Sammurcchana takes place in Sandhi and the disease Sandhivata appears with its symptoms.

Sandhigatavata is a Kashta Sadhya Vyadhi alike all the Vata Vyadhis which are difficult to cure. They are considered one among the Mahagadas too. Also factors like Madhyama Rogamarga involving Marma, Asthi, Sandhi, along with vitiation of Asthi and Majja, associated with Dhatukshaya and the incidence in Vriddhavastha precipite the Kashta Sadhyatva of Vyadhi.

In the Chikista aspect Acharyas have commonly mentioned the use of Snehana and Svedana for the treatment of Vata Vyadhi. Individually considering the treatment principles explained by Acharyas, Charaka has not mentioned the treatment of Sandhigatavata separately, instead he explains common treatment principle for Vatavyadhi such as Snehana and Svedana Basti and Mrudu Virechana. Where as


DISCUSSION

113

Acharya Sushruta has described specific treatment for the Sandhigatavata first time i.e, Snehana, Upanaha, Agnikarma, Bandhana and Unmardana.

Janusandhigata Vata being a Vata Vyadhi with Dhatukshaya as its resultant, Snehana and Svedana would be an ideal line of treatment. In the parallel sciences treatment is mainly aimed at Non–pharmacological methods and analgesics. Among Non–pharmacological treatment physical heat therapy is given importance. Janu Sandhi-Gata-Vata is characterized by joint pain, stiffness, swelling and crepitus. The heat applied to the joint helps in combating many of the symptoms. In present clinical study, Janu-Basti & Janu Pichu may act both as Snehana and Svedana. Since in this disease degeneration is predominant, with Vata Dosha predomonance, Kshaya of Snehadi Guna is seen, Snehana would be an ideal line of management. Snehana also helps in bringing back the sthanika Kapha Dosha to normalcy due to its similarities in Gunas.

Keeping an eye on this ideology the present study was planned in which Murivenna was used in the form of Janu Basti & Janu Pichu. They act as Snehana due to presence of the Snehamsha in Murivenna and Svedana due to the presence of heat during the procedure. It was a comparative clinical study with two equal groups of 15 patients each. Group A was administered Janu Basti with Murivenna for 45 minutes a day for 7 days and Group B was administered Janu Pichu with Murivenna for 45 minutes a day for 7 days.

DISCUSSION ON OBSERVATIONS

The observations related to the various aspects of 30 patients of Janu Sandhivata are discussed below under different headings.

Age: The eligibility criteria of age group for this study were between 30 and 70 years.

Majority of the patients belonged to the age group of 51–60 years (43.34%), followed by 61 – 70 years (23.33%), 41 – 50 yrs (23.33%), 31 – 40 yrs (10%) . After a person attains the age of 50 years, the Hanti Avastha starts and as the age progresses there will be natural process of degeneration of Shareera Bala and Dhatu, “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DISCUSSION

114

which provoke Vata and also reduces Jatharagni and Dhatvagni. Pre menopausal stage contributes in the degenerative process of females. The degenerative process in the males also starts at the age of 50 years.

Sex: Among the 30 patients of Janu Sandhivata, majority of them are were females

(66.66%) and remaining were males (33.33%). Even the universal data says the prevalence of osteoarthritis is more in elderly women. In females, menopause contributes the degenerative changes. Even in males the degenerative process starts from the age of 50 years.

Occupation: Among the 30 patients taken for this study, majority of them were

housewives (33.3%) and manual labor (33.3%) followed by businessmen (13.3%) and office workers (3%) and remaining others (16.66%). As housewives and labor class individuals will be having a much intensified physical exertion which inturn aggrevate the Vata dosha and resulting in Janu Sandhigatavata.

Religion: The religion wise distribution of the patients was a projection of

geographical predominance of Hindu community in the selected area of study. Hence the cases reported were belonging to the Hindu community (50%) followed by Muslims (46.66%) and Christians (3%).

Socio-Economical Status: The patients visiting the hospital mainly belong to middle

and lower middle class socio-economical status. Among the total patients majority were from middle and lower middle class (40% each) followed by upper middle class and poor class (10% each).

Marital status: As the degenerative changes takes place in the older population

majority of patients in this study belonged to married group (90%) and very few of about belonged to unmarried group (10 %) even though were above 30 years.

Habitat: as the degenerative changes are more common in working as well as older

population, both the rural and urban people share almost the equal incidence of the


DISCUSSION

115

pathology. In the present study it’s found that sub urban patients are more (43.33%) followed by rural patients (33.33%) and urban (23.33%).

Education: Most of the patients visiting the hospital usually belonged to rural area.

Among the 30 patients of Janu Sandhivata majority of them had the education upto th

10

std. (36.66%), followed by patients who studied above 10

graduation (16.66%), up to 7th std (13.33%), up to 5

th

th

std. (20%), up to

std (6.66%) and illiterates

(6.66%).

Prakruti: Among the 30 patients of Janu Sandhivata majority of the patients were of

Vata Pittaja Prakruti (53.33%) followed by Vata Kaphaja Prakruti (23.33%), Pitta Kaphaja Prakruti (13.33%), Pitta Vataja Prakruti (6.66%), and KaphaVataja Prakruti (3%) . The study showed majority of patients who suffered from Janu Sandhigatavata had the dominance of Vata and Pitta Dosha.

Sara: Out of 30 patients of Janu Sandhivata majority of the patients were of Tvak

Sara (36.66%) followed by Rakta Sara (23.33%), Mamsa Sara (20%) Meda Sara (10%), and Asthi Sara (10%). The study showed that the greater part of patients suffered from Janu Sandhigatavata was of Twak and Rakta Sara.

Satwa: Among the 30 patients of Janu Sandhivata major subjects were found to be

having Madhyama Satwa(63.33%), followed by Pravara Satwa(20%) and Avara satwa(16.66%). The study showed that most of the patients with Janu Sandhigata vata are having Madhyama Satwa.

Samhanana: Amongst the 30 subjects of Janu Sandhivata , Madhyama Samhanana

(66.66%), followed by Pravara Samhanana (20%) and Avara Samhanana (13.33%) were found. The present observation tells that most of the patients with Janu Sandhigata vata are having Madhyama Samhanana.

Saatmya : Out of 30 patients of Janu Sandhivata , its found that majority of them

were Madhyama Saatmya (70%), followed by Pravara Saatmya (20%) and Avara Saatmya (10%). In the present study most of the patients with Janu Sandhigata vata are known to be Madhyama Saatmya. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DISCUSSION

116

Dietary Habits: Among the 30 patients of Janu Sandhivata, majority was having a

mixed kind (66.6%) of dietary habits and rest were Vegetarians (33.33%). As per the present study it shows that Janu Sandhigata Vata is more prevalent in people having mixed dietary regimen.

Vyasana : Majority of 63.33% had no addiction in comparison to 20% who were

addicted to tobacco chewing,13.33% were addicted to smoking . As per the present study majority of patients of Janu Sandhigata Vata doesn’t have any kind of addictions.

Aahara – Abhyavaharana Shakti:

66.66% had Madyama- Abhyavaharana Shakti, 13.33% were Avara and 20% had Pravara- Abhyavaharana Shakti. As per the present study most of the patients of Janu Sandhigata Vata are having Madhyama abhyavaharana Shakti.

Aahara-Jarana shakti : 63.33% had Madyama- Jarana Shakti, 30% Pravara and

6.66% had avara- Jarana Shakti. Agni: Among 30 patients of Janu Sandhivata 50% had Samagni, 23.33% had

Mandagni or Vishamagni and 3.33% patients suffered from Teekshnagni

Koshtha: among 30 patients of Janu Sandhivata 53.33% had Madhyama Koshta and

46.66% had Krura Koshta.

Vihara: A maximum of 33.33% of patients were doing manual work & labour

each,13.33% had sedentary nature of work, &10% were travelling.

Vyaayama Shakti:

56.66% had Madyama Vyaayama Sakti and 43.33% had Avara

Vyaayama Sakti.

Nidra Sheela: 63.33% had disturbed sleep whereas only 36.66% had sound sleep.


DISCUSSION

117

Nidana (Ahara): among 30 patients of Janu Sandhivata 53.33% of them did

Atyupayoga of Katu Rasa, 23.33% of them did Alpa Bhojana, and again 23.33% of them did Rooksha Bhojana.

Nidana (Vihara): among 30 patients of Janu Sandhivata 63.33% did Ratri Jagarana

and 33.33% did Ati Vyayama.

Nidana (Manasika): among 30 patients of Janu Sandhivata 20% of patients had Ati

Bhaya, 3.33% had Ati Shoka and 76.66% of them had Ati Chinta

Chronicity:

among 30 patients of Janu Sandhivata 63.33% had the chronicity

between 0 – 2 yrs, 33.33% had between 2 – 4 yrs, and 3.33% had between 8 – 10 yrs.

DISCUSSION ON CLINICAL STUDY

Discussion about Clinical study:

The study was carried out in Patients of Janu Sandhigatavata in two groups of which Group A received Janu Basti & Group B received Janu Pichu for a period of 45 minutes for 7days each. Total of 34 patients complaining of Janu Sandhigatavata were registered in the study, of which 30 patient completed the study (15 in each group). The details are as follows. Total patients registered in the study

- 34

Patients who received Janu Basti

-15

Patients who received Janu Pichu

-15

Completed Total Attrition

-30 -03

Attrition in Group A

-01

Attrition in Group B

-03


DISCUSSION

118 th

Out of the three drop outs, one person could not attend the Janu Basti from 5 day due to personal inconvenience, and 2 patients in Janu Pichu group were considered as drop out, as they didn’t attend during the follow up period. Discussion on Janu Basti

From the present study follow things could be analysed:

1. Quantity of the oil 2. Quantity of Masha 3. Height of the Janu Basti pit 4. Temperature of the oil 5. Duration

1. Quantity of the oil: During the study it was observed that minimum 100-150ml of oil was needed Janu Basti for 3 days again fresh oil was used for remaining 4 days. On an average 300 - 400ml of oil is required per patient during the procedure for 7 days.

2. Quantity of the Masha: During the study it was observed that minimum 400gm- 500 gm of Masha was needed for Janu Basti for 3 days again fresh Masha was used for remaining 4 days. On an average 1 kg of Masha is required per patient during the procedure for 7 days

3. Height of the Janu Basti pit: During the study it was observed that, the height of the Janu Basti pit constructed was on an average of 3 – 4 inches. 3. Temperature of the oil: From the present study, it was observed that, most of the patients were able to tolerate only luke warm temperature of the oil (40-45 0C).


DISCUSSION

119

4. Duration: In the present study the duration of procedure was fixed to 45 minutes. A range of minimum of 45 minutes and maximum of 1hr may be considered as ideal depending upon the patient’s ability to maintain the posture for given duration of treatment.

Discussion on Janu Pichu

The following factors were observed during the study: 1. Quantity of the oil 2. Size of Pichu 3. Duration of the procedure

1. Quantity of the oil

From the present study, it was observed that the quantity of the oil needed was 50 - 60ml per day and for 3 days and fresh oil was used from 4 th day till 7th day. On an average 150 -200 ml of oil was needed for 7 days. 2. Size of Pichu

In the present study the size of Pichu depended upon the size of knee joint of the patient. On an average the size of pichu accounted from 3* 3 inches to 4*4 inches. 3. Duration of the procedure

In the present study the duration of procedure was fixed to 45 mins. It was observed that some patients were showing the willingness to maintain the Janu Pichu for a longer duration. Even though it varied from patients to patients, on an average it may be considered as ideal from 45 mins – 1hr.


DISCUSSION

120

EFFECT OF THERAPY

The external Snehana and Svedana therapies are extensively practiced in Sandhigatavata. The present clinical study has been conducted to evaluate the efficacy of Murivenna Taila in the form of Janu Basti and Janu Pichu in Janu Sandhigata Vata. The effect of therapy is being discussed here along with its efficacy on individual signs and symptoms of Janu Sandhigata vata.

Effect of Therapy on Pain: In this study the mean score of pain was reduced from

3.067 to 1.267 and 2.667 to 1.467 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 59% and 45% which was highly significant statistically at ‘P’ value <0.001. Murivenna has Vata Shamaka property. It has the Gunas of the drugs involved are that help in the Shamana of aggravated Vata and, due to the Shamana of Vata which is the prime reason for shoola, it will be subsided.

Effect of Therapy on Stiffness: The mean score of Stiffness was reduced from

2.000 to 0.867 and 2.000 to 1.067 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 57% and 47% which was highly statistically significant at ‘P’ value <0.001. The joint stiffness is due to the Rooksha & Sheeta Guna of Vata, which in turn causes the Kharatwa of Mamsa, Snayu, Kandara of Asthi leading to stiffness. It is reduced by Ushna Veerya of the Aushadhas and the warmth produced during the procedure. When the Rooksha & Sheeta Guna is subsided the stiffness is also reduced. Similarly as explained by Acharyas one among the effects of swedana is Sthambha Nigraha.

Effect of therapy on Gait: The mean score of Gait was reduced from 1.133 to 0.267

and 1.067 to 1.000 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 49.62% which is highly significant at ‘P’ value <0.001. Gait is a factor that is mainly dependant on the pain and stiffness as there was very much relief in the pain and stiffness during the procedure, gait was also improved. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DISCUSSION

121

Effect of Therapy on Tenderness: The mean score of Tenderness was reduced from

1.933 to 0.933 and 2.067 to 1.133 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 52% and 45% which were significant at ‘P’ value = 0.002 and highly significant at ‘P’ value <0.001. Murivenna has Vata Shamaka property. It has the Gunas of the drugs involved which are vedana shamaka in nature. They help in the Shamana of aggravated Vata .Due to the Shamana of Vata which is the prime reason for tenderness, it will be subsided.

Effect of Therapy on Swelling: The mean score of swelling was reduced from 1.000

to 0.400 and 0.733 to 0.400 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 60% and 45% which was highly significant at ‘P’ value <0.001 in Group A and significant at ‘P’ value 0.019 in GroupB Murivenna is Shothahara and by virtue of its property 6 drugs in Murivenna with Ushna Veerya - pacify Vata, promote circulation and have soshana property reducing swelling it drains the Sanchita Kleda from the affected part. Even the heat applied to the affected part increases the circulation thus helping in reducing swelling. The procedures also increase the local circulation and helps in reducing the localized swelling.

Effect of Therapy on Crepitus: The mean score of crepitus reduced from 1.133 to

0.533 and 1.333 to 0.600 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 53% and 55% with P= 0.003 and P< 0.001, of both which were statistically significant. There could have been probably soft tissue changes due to the procedural effects induced by both Janu Basti & Janu Pichu with Murivenna which has Snigdha property that would have led to the reduction in crepitus or Atopa which is caused due to the Rooksha Guna of vata.

Effect of Therapy on Range of Movement: The mean score of Range of movement

was reduced from 1.267 to 0.667 and 1.200 to 0.733 after the course of seven days of Janu Basti and Janu Pichu respectively. The percentage of relief was 47% and 39%


DISCUSSION

122

which was highly significant at ‘P’ value =0.003 in Group A and significant at ‘P’ value =0.004 in Group B. The coordinated activity of muscles and joint structures helps in the flexion and extension of knee joint. The therapy reduces pain, swelling and stiffness and thus helps in facilitating the flexion and extension of the joint, thereby increasing the Range of movement in the joints.

Overall Effect of Therapy: Consideration of overall effect of therapy showed

that among the 30 patients of Janu Sandhgataivata, 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 % relief, 22 ( 73.4 %) got moderate relief between 60 % and 90 % & 3 (10%) got partially improved results.

Comparative Effect Of Therapy: In Group A, 2 patients (13.4 %) got 100 %

relief (complete remission) & 3 patients (20 %) got more than 90 % relief (marked improvement). whereas in Group B, no patients got more than 90 % or 100% relief. 9 patients (60 %) among Group A, got relief in between 60-90 % (moderate improvement) and whereas 13 ( 87%) patients of Group B got relief in between 6090 %,. Also 1 among the 30 patients (6.6%) got partial improvement ie; between 3060% in Group A & 2 among Group B showed the same at (13%).

Probable Mode of Action of Janu Basti & Janu Pichu: Janu Basti & Janu Pichu

are procedures evolved from Shiro Basti & Shiro Pichu. It is a kind of Bahya Snehana and Svedana procedure. Snehana mainly acts against the Rooksha Guna caused by Vata and Swedana mainly acts against the Sheeta Guna. It also reduces the Stambha and Gauravata.

Sushruta explains that out of four Tiryak Dhamani, each Dhamani divides into hundred and thousand times and become innumerable. These Dhamani form a network and spread all over body. They have their openings in the Loma Koopa. The Dravya applied over the skin is absorbed through these openings and undergo Pachana by the help of Bhrajaka Pitta which is situated in the skin. The Dravya can be applied in various forms such as Abhyanga, Parisheka, Avagaha etc. All the drugs applied in any of these forms undergo Pachana in the way explained above.


DISCUSSION

123

Vagbhata explained the same mode of absorption of the drugs applied over the skin. Thus by above references it can be said the Dravya used in Janu Basti & Janu Pichu is absorbed through skin and produce an action according to the properties of drug.

The Vata Dosha, which is the key factor in the causation of Janu Sandhivata, has almost opposite quality of Murivenna. Moreover Murivenna has similar property to that of Kapha Dosha. In Janu Sandhivata Sthanika Kapha Kshaya is due to Agantu Vata Dosha. Thus on one hand Murivenna neutralizes the Vata Dosha and on the other hand nourishes the Sthanika Kapha Dosha. This helps in Samprapti Vighatana.

Shoola is one among the features of Janu Sandhigatavata which is almost present in all the patients. The properties of Murivenna such as Snigdha, Guru, Ushna are totally opposite to the properties of Vata. Thus these properties of Murivenna acts against Vata and help in subsiding the Shoola. Joint stiffness or Stabdhata is also a feature in Janu Sandhigatavata which is caused by the Rooksha, Sheeta Guna of Vata. The heat applied through the retention of Murivenna during the procedures and the Ushna veerya of Murivenna along with its Snigdhatva tackle Sheeta, Rooksha Gunas and reduce the stiffness of joint. The relief in the stiffness & pain of joint increase the Sandhi Gati Samarthya and helps to increase the range of movement of knee joint.

Atopa is due to Vata Vriddhi and Sthanika Kapha Kshaya. This symptom is due to Khara, Rooksha and Vishada properties of Vata. Snigdha, Picchila and Mrudhu qualities of Sneha Dravya i.e., Murivenna opposite to the qualities of Vata and helps in reducing the Atopa.

The Ushnata applied by the procedure and Ushna Veerya of drug do the Pachana of the Dushya involved in the formation of Shotha. Due to this action the Shotha is reduced.

Drug absorption: The principal fence for absorption of exogenous material through

the skin is stratum corneum. Pace of absorption is directly proportional to concentration of drug in vehicle, partition co-efficient, diffusion co-efficient and thickness of the stratum corneum. The physiological factors that effect per cutaneous “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

DISCUSSION

124

absorption include hydration, occlusion, age, intact versus disrupted skin, temperature and anatomical site.

Among vehicles oils or greases are anhydrous preparations that are either water insoluble or fatty. Fatty agents are more occlusive than water-soluble. They restrict trans epidermal water loss and hence preserve hydration stratum corneum.

Absorption depends upon lipid solubility of the drug since the epidermis act as a lipid barrier. The dermis however is freely permeable to many solutes. Suspending the drug in an oily vehicle can enhance absorption through the skin. Because hydrated skin is more permeable than dry skin. It has been scientifically proven that vegetable oils act as permeation enhancers (US Patent No- 5229130). Thus the Narikela Taila which is a vegetable oil, used as the base for the preparation of the Murivenna, helps to increase the permeability of the layer of the stratum corneum of the skin and in turn also increases the bioavailability of the drugs. Effect of Application of Heat: Application of medicaments, heat and massage

definitely helps in eliminating the number of noxious elements through skin

160

. The

application of heat in different forms of Svedana promotes local circulation and metabolic activities and also opens the pores of the skin to permit transfer of medicaments and nutrients towards to needed sites and elimination of vitiated Dosha and Mala through skin and perspiration.

The application of heat on skin induces increased metabolic activity, increased circulation and stimulation of the nerve endings on skin & tissues. It also has many indirect effects in the body mechanism.

The metabolical activity is increased in the part where more heat is applied. This increased metabolism creates demand for oxygen and nutrients. Also there is increased output of waste products and metabolites. The output of waste products and metabolites which act on the walls of the capillaries & arteries cause the dilation of the vessels. Even the heat applied has direct effect on the blood vessels which cause


DISCUSSION

125

them to dilate and increase in the amount of blood circulation. The applied heat also stimulates the nerve endings which causes reflux dilation in the arterioles. Due to all these reason the blood circulation is increased and the active ingredients of the drug are supplied to the target cells. Also there is elimination of waste products from the localized area such as prostaglandins which play a vital role in pain pathology.

Probable Efficacy Of Janu Basti In Comparison With Janu Pichu : The probable mode of action of Janu Basti and Janu Pichu can be ascertained on the base of

pharmacodynamics and pharmacotheraupetics which were mentioned above. But the comparative advantage of Janu Basti over Janu Pichu can be hypothetically related to the difference they posses in the procedure on the base of temperature, dermal contact and pressure effects.

During the procedure of Janu Basti the temperature is constantly or better uniformly maintained than Janu Pichu through out the procedure, as the lipid medium is directly applied over the skin and retention of temperature is more by the oil in comparison to the Pichu or Plotha used for the procedure of Janu Pichu. Also the dermal contact for absorption is more in Janu Basti in comparison to Janu Pichu due to the direct application of oil above skin. Analyzing the pressure difference which may also influence the rate of absorption the oil applied through Janu Basti. The oil may exert more pressure over skin due to the retention of oil media in larger volume which is maintained as a column during the procedure of Janu Basti.

Due to the above quoted reasons it may be analysed that Janu Basti have shown relatively more efficacy in comparison to Janu Pichu during the clinical study apprehending Acharyas view on the priority given to Shiro Basti in comparison with Shiro Pichu among Moordhini Tailas, which are the basic derivative procedures for Janu Basti and Janu Pichu.


SUMMARY & CONCLUSION

126


The clinical study entitled “A comparative study on Janu-Basti and Janu Pichu with Murivenna in Janu-Sandhi-Gata-Vata” is presented in six parts viz. Conceptual Study, Disease Review, Drug Review, clinical Study, Discussion, Summary and Conclusion. First part designated as Conceptual Study at the outset, presents the historical background of Janu-Sandhi-Gata-Vata, along with a brief account of the anatomy of the structures involved in the joint such as Janu Sandhi, Knee joint, Tvak, and Skin with illustrations followed by the description of procedure of Janu-Basti & Janu pichu at the end.

The second part Disease Review includes Nidana Panchaka of disease Janu Sandhivata along with Sapeksha Nidana, Sadhyaasadhyata and a brief description about the treatment principles explained in classics along with Pathya Apathyas. The yoga selected for this study was Murivenna which consisted of eight drugs. The details of each of these eight drugs & its Pharmacodynamics along with the details of the preparation of yoga and illustrations have been mentioned under the heading of Drug Review, the third part

The section ‘Clinical study’ starts with the description about the aims and objectives of the study, selection of the patients, criteria for inclusion and exclusion, research design and assessment criteria. Thereafter observations on demographical data pertaining to 30 patients of Janu Sandhigatavata of this series on the base of each group is analyzed and presented in the tabular & graphical form .Later results obtained in this clinical study carried out on the 30 patients of Janu Sandhigatavata with Janu Basti & Janu Pichu are depicted in tabular and graphical form along with statistical analysis and brief comments on each data. The effect of treatment on each signs and symptoms at various days of assessment, comparative & overall effects of procedures are statistically analyzed and represented in tabular and graphical form.



127

.

The observations associated to the literary aspect and the clinical studies are discussed in the fifth section entitled ‘Discussion’ along with probable mode of action of procedures and relative efficacy of Janu Basti in comparison to Janu Pichu. The discussed matter is drawn into logical conclusions which are as follows:

Among 30 patients of Janu Sandhivata majority were of age group of 51 – 60 years (43.34%), female sex (66.6%), housewives and manual labor by occupation (33.3%), Hindu by religion (50%), middle and lower middle socio-economical class (40% each), married (90%), adapted in sub urban (43.3%) and education within 10 th std. (36.66%).

Most of the patients were of Vata Pittja Prakruti (53.33%), Twak Sara (36.66%), Madhyama Satva (63.33%), Madhyama samhanana (66.66%), Madhyama Saatmya (70%), Mixed dietary habits (66.6%), No addictions (63.33%), Madhyama Abhyavarana Shakti (66.66%), Madhyama Jarana Shakti (63.33%), Samagni (50%), Madhyama Koshtha (53.33%), Manual and Labor class (33.33%), Madhyama Vyayama Shakti (56.66%), Disturbed sleep (63.33%).

Maximum patients had the chronicity of symptoms <2 years (63.33%).

Maximum patients suffering with Janu Sandhivata consumed excessive Katu Rasa Ahara Sevana as Nidana (53.33%), Ratri Jagarana (63.33%) , Manasika Nidana as Ati Chinta (76.66%).

CLINICAL STUDY & RESPONSE TO TREATMENT

In this study the assessment of patients was done before treatment, 7 day, and 14th day and on 22

nd

th

day. All cardinal signs and symptoms were scored

according to the severity grade formulated. The clinical response of the procedures was assessed on the basis of change in severity score after treatment. The cardinal signs and symptoms evaluated were pain, stiffness, gait, tenderness, swelling, crepitus,& range of movement. “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”


128

Effect of Janu Basti with Murivenna: Janu Basti with Murivenna was done for 45

minutes for 7 days. It provided significant results statistically in pain (59%), joint stiffness (57%), Gait (76%), Tenderness (52%), Swelling (60%), crepitus (53%) & th

Range of movement (47%) on the 7 day. Also the results shown on on these signs th

nd

and symptoms were statistically significant on 14 and 22 day.

Effect of Janu Pichu with Murivenna: Janu Pichu with Murivenna was done for 45

minutes for 7 days. It provided significant results in pain (45%), joint stiffness (47%), Gait (06%), Tenderness (45%), Swelling (45%), crepitus (55%) & Range of movement (39%). Other than gait all the symptoms proved to be statistically th

nd

significant on7th day, and along with gait on 14 & 22 day.

Overall Effect of Procedures With Murivenna:

On the overall glance of study, it showed that among the 30 patients of Janu Sandhigatavata 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 % relief, 22 (73.4 %) got moderate relief between 60 % and 90 %

&

3(10%) got partially

improved results. Comparative Effect of Procedures with Murivenna:

In Group A, 2 patients (13.4 %) got 100 % relief (complete remission) & 3 patients (20 %) got more than 90 % relief (marked improvement). whereas in Group B, no patients got more than 90 % or 100% relief. 9 patients (60 %) among Group A, got relief in between 60-90 % (moderate improvement) and whereas 13 ( 87%) patients of Group B got relief in between 60-90 %,. Also 1 among the 30 patients (6.6%) got partial improvement ie; between 30-60% in Group A & 2 among Group B showed the same at (13%). Statistically symptoms pain and gait showed significant results on comparison between the groups, proving Group A with Janu Basti was efficacious than Group B Janu Pichu with Murivenna in Janu Sandhigata Vata, both on statistical and clinical basis.



129

Scope for further study:

Further studies with larger samples will be beneficial to authenticate the

•

results obtained in the present study. A comparative study can be done to evaluate the effect of Janu Pichu and Janu

•

Parisheka. A study can be done to find out the efficacy of different formulations prepared

•

out of Vata Hara drugs such as Nirgundi, Rasna, Dashamula etc as Janu Basti & Janu Pichu. Pharmaceutical and analytical chemistry study of the ingredients of Murivenna

•

for better understanding of the mode of action.

Limitations of study: •

Limited period of study.

•

Small sample group

On the analysis of results, individual assessment of procedures proved statistically significant results in most of the signs and symptoms of Janu Sandhigata Vata in both the procedures. On comparison between the procedures it showed that Janu Basti with Murivenna provided a better relief in the signs and symptoms of Janu Sandhigatavata mainly in pain, stiffness, gait, tenderness, swelling, crepitus and range of movements clinically, and on pain and gait statistically compared to Janu Pichu. Murivenna being a Sneha, has Vata Hara property. Janu Basti with Murivenna acted both as Snehana and Svedana, along with the combination of pharmacokinetics of the drugs it brought better relief in the signs & symptoms of Janu Sandhigatavata. The procedural differences that it possesses with Janu Pichu would have brought about a better result on comparison between the procedures.

On the basis of above mentioned effects of Janu Basti, it can be concluded that Janu Basti done with Murivenna for 45 minutes, for 7 days gives a significant amount of relief in the signs & symptoms of Janu Sandhigatavata in comparison with Janu Pichu done with Murivenna for 45 minutes, for 7 days. It can be adopted as a cost effective simple treatment procedure on O.P.D basis too with no adverse reactions and better results.


References & Bibliography

130

LIST OF REFERENCES

1. C.S.Chi. 28/37 2. Su.S.Ni.1/28, 3. A.S.Ni.15/14 4. Su.S.Chi.4/8 5. A.S.Su.25/16 6. C.S.Chi. 28/37 7. C.S/.Chi 28/37 8. C.S.Su. 14/39-40 9. C.S.Su. 14/39-40 10. Su.S.Ni.1/28 11. Su.S.Chi 4/8 12. Su.S.Chi.32/3 13. B.S.Chi. 4/48-50 14. A.S.Ni. 15/16 15. A.S.Chi.23/13 16. A.H.Ni. 15/14-15 17. A.H.Chi. 21/19,22 18. M.N.22/21 19. B.P.Mad.Kh.24/258 20. Y.R. 30/119 21. A.S.Su.31/16 22. A.H.Su.22/27-29 23. A.H.Su.19/1 24. C.S.Su.11/55 25. C.S.Su.11/55 26. Su.S.Chi.4/82 27. C.S.Vi.8/94-96 28. C.S.Su.14/13 29. C.S.Su.14/14 30. Su.S.Ut.18/51 31. Su.S.Chi 4/8 An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of Janu Sandhivata (Osteoarthritis)

References & Bibliography 32. Su.S.Chi.32/3 33. B.S.Chi. 4/48-50 34. A.S.Ni. 15/16 35. A.S.Chi.23/13 36. C.S.Vi.8/94-96 37. C.S.Su.14/13 38. C.S.Su.14/14 39. Su.S.Ut.18/51 40. C.S.Sh.7/14 41. Su.S.Sh.5/24 42. Su.S.Sh.5/27 43. Priniciples of Anatomy & Physiology, Gerard J. Tortora 44. A.H.Su.11/4 45. A.H.Su.11/26 46. A.H.Su.12/6-7 47. S.S.Ni.1/13 - Dal 48. Su.S.Sh. 5/29-36 49. Sha.S. Pu. Kh.5/40 50. Su.S.Sh.4/14-15 51. A.H.Su.12/7 52. Su.S.Sh.5/37-38 53. Su.S.Sh. 5/16 54. Su.S.Sh.7/8 55. Su.S.Sh.7/12 56. Su.S.Sh.7/14 57. Su.S.Sh.9/5 58. Priniciples of Anatomy & Physiology - Gerard J. Tortora 59. Priniciples of Anatomy & Physiology - Gerard J. Tortora 60. C.S. Su. 8/10 61. Su.S. Sha. 1/7 62. Su.S. Sha. 4/4 63. A.H. Sh. 3/8-9 64. C.S. Sha. 7/4 65. Su.S. Sha. 4/4 An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of Janu Sandhivata (Osteoarthritis)

131

References & Bibliography 66. A.H. Sh. 3/8 67. Sha.S. Pu. Kh. 5/18 68. Priniciples of Anatomy & Physiology, Pg. No. 145 69. Sanskrit – English Dictionary by M.M.W. 70. Su.S.Sh.5/28 71. Su.S.Sh.5/24 - Dal. 72. C.S.Chi.28/26-37 73. B.P.Mad. Kh. 24/25/-259 74. C.S. Chi.28/37 75. Su.S.Ni. 1/28,29 76. Su.S. Ni. 1/79 77. M. N. 22/21 78. Su.S. Su. 15/7 79. A.H. Su. 11/26-28 80. C.S. Chi.28/72 81. Su.S. Ni.1/28 82. C.S.Chi. 28/15-18 83. Su.S.Su.21/19 84. A.H.Ni.1/14-15 85. Y.R. 30/1-4 86. B.P.Chi.Vat.12 87. M.N.Pu.22/1-3 88. C.S.Vi.5/17,18 89. C.S.Chi. 28/19 90. C.S.Chi 28/37 91. Su.S.Ni.1/28 92. A.H.Ni.15/14 93. A.S.Ni 15/12 94. M.N. 22/21 95. B.P.Ci. 24/258 96. Y.R. 30/119 97. Su.S.Ni. 1/28 - Dal, Gaya 98. M.N. 22/21 – Vij, Sri 99. B.P.Ci. 24/93 An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of Janu Sandhivata (Osteoarthritis)

132

References & Bibliography 100. A.H.Ni. 1/8 101. A. S.Ni. 2/31 102. C.S.Chi.28/18-19 103. A.H.Ni.15/5-6 104. C.S.Chi.28/15-18 - Chakra 105. Su.S.Su. 15/32 106. Su.S. Su. 15/32 – Dal. 107. A.H.Su.13/1-3 108. A.H.Su.11/25 109. Su.S.Chi 4/8 110. A.S.Chi.23/13 111. A.H.Chi. 21/19,22 112. Y.R. 30/119 113. B.P.Mad.Kh. 24/258 114. B.R. 26/14 115. Su.S.Chi.31/2 116. C.S.Su.5/85 117. Su.S.Chi.24/30 118. C.S.Su.22/11 119. Su.S.Chi.32/3 120. C.S.Su.14/35 121. Su.S.Chi.32/12 122. C.S.Su.14/35-37 123. A.H.Su.17/5 124. C.S.Chi.28/115 125. C.S.Chi.14/38 126. Su.S.Su.18/7 & Dal 127. Su.S.Chi.32/12 & Dal 128. Su.S.Chi.4/8 & Dal 129. A.S.Chi.23/13 130. A.H.Chi.21/22 131. Y.R.30/119 132. B.P.Chi.24/259 133. Orient Longman, Indian medicinal plants, Vol 4, Page No: 339. An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of Janu Sandhivata (Osteoarthritis)

133


134

134. Orient Longman, Indian medicinal plants, Vol 4, Page No: 339-340. 135. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page

no: 128. 136. Orient Longman, Indian medicinal plants, Vol 1, Page No: 103. 137. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page no: 144. 138. Asima chatterjee, Satyesh Chandraprakrashi, The treatise on Indian medicinal plants, Vol.6, National institute of science communication, NewDelhi, 1997, Page no:

97 139. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page

no: 143 140. Orient Longman, Indian medicinal plants, Vol 4, Page No: 279. 141. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book distributors, Vol 3, page 2132. 142. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book distributors, Vol 9, page 2945. 143. Anil Kumar Dhinam, Ayurvedic drug plants, Daya publishing house, 2006, page no: 376. 144. Orient Longman, Indian medicinal plants, Vol 4, Page No: 59 -61. 145. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page no: 244 146. Orient Longman, Indian medicinal plants, Vol 2, Page No: 379.

An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of Janu Sandhivata (Osteoarthritis)


135

147. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book distributors, Vol 4, page 1094. 148. Anil Kumar Dhinam, Ayurvedic drug plants, Daya publishing house, 2006, page no: 291. 149. Orient Longman, Indian medicinal plants, Vol 1, Page No: 88. 150. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book distributors, Vol 10, page 3468 - 3469. 151. Purushotam Kaushik, Anil Kumar Dhiman, Medicinal plants and raw drugs of India, Chaukhambha publication, page no: 536.

152. Orient Longman, Indian medicinal plants, Vol 5, Page No: 177. 153. Orient Longman, Indian medicinal plants, Vol 2, Page No: 379 – 381. 154. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book distributors, Vol 1, page 782. 155. Orient Longman, Indian medicinal plants, Vol 1, Page No: 218. 156. Orient Longman, Indian medicinal plants, Vol 1, Page No: 218. 157. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page

no: 241. 158. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page

no: 183. 159. Dr.B.Syleswariamma et al, Pharmacopea, Published by Govt. Ayurveda College Trivandrum, 1996, Page no: 174. 160. The pharmacological basis of therapeutics – Goodman and Gillman, Physiology by Robert M. Berne, Clayton’s Electro therapy by Angela Forster, Nigel Palastanga, Text book of Pharmacology by K.D. Tripati



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BIBLIOGRAPHY

1. Agnivesha - Charaka Samhita revised by Charaka and Drdhabala with Ayurveda Dipika commentary by Chakrapani Datta (ed.), Vaidya Jadavji Trikramji Acharya, Krishnadas Academy, Varanasi, 2000. 2. Agnivesha - Charaka Samhita revised by Charaka and Drdhabala with Ayurveda Dipika commentary by Chakrapani Datta and Vidyotini Hindi commentary by Pt. Kashinatha Shastri (ed.), Dr. Gangasahaya Pandeya, (Part I th

& II), Chaukhambha Sanskrit Sansthan, Varanasi, 8 ed., 2004. 3. Sushruta - Sushruta Samhita with Nibandha Sangraha commentary by Dalhana (ed.)Vaidya Jadavji Trikramji Acharya, Krishnadas Academy, Varanasi 4. Sushruta - Sushruta Samhita edited with Ayurveda Tatva Sandipika Hindi commentary by Kaviraja Ambikadutta Shastri (Part I & II), Chaukhambha Sanskrit Sansthan, Varanasi 5. Vriddha Vagbhata – Asthanga Sangraha with Shashilekha commentary by Indu ed. by Dr. Shivaprasad Sharma, Chowkambha Sanskrit Series Office, Varanasi, 2006 6. Vagbhata – Astanga Hridaya with Ayurveda Rasayana commentary by Hemadri and

Sarvangasundara commentary

by

Arunadatta (ed.) Pt.

Bhisagacharya Harishastri Paradhkar Vaidya, Krishnadas Academy, Varanasi, 2000 7. Bhela- Bhela Samhita text with English translation commentary and critical notes by K.H. Krishna murthy, Varanasi: Chaukumbha Viswabharati, 1st edition, 2000: 8. Vijayarakshitha – Madhava Nidana of Madhavakara with Madhukosha Sanskrit commentary by Vijayarakshitha and Srikantha Datta & Vidyotini Hindi commentary and notes by Sudarsana Sastri, Chaukumbha Sanskrit Sansthan, Varanasi XXII (Edn) 1993:



137

9. Bhavamishra: Bhava Prakasha, edited with Vidyotini Hindi commentary by Brahmasankara Mishra and Rupalalaji Vaisya, published by Chaukumbha Sanskrit Sansthan, 1999 edition: Madhyama khanda. 10. Yogaratnakara: With Vidyotini Hindi commentary, edited by Bhisagratna Brahmasankar Sastri, published by Chaukumbha Sanskrit Sansthan.. 11. Chakrapani Datta – Cakra Datta, edited by Priyavrat Sharma, published by Chaukumbha Publishers, 1998. 12. Sharngadhara – Sharangadhara Samhita, commentary by Adhamalla’s Dipika & Kasirama’s Gudhartha Dipika Ed. By Parasurama Sastri, Vidyasagar, Chaukumbha Orientala, Varanasi, 2002; 13. Govinda Das – Bhaishajya Ratnavali, revised by Sri Brahmashankar Mishra, ed. by Kaviraja Sri Ambikadatta Shastri, Published by Chaukhambha Sanskrit Samsthana, Varanasi, 2001 14. Sir Moneir Williams: Sanskrit English Dictionary, Motilal Banarasi Das, Delhi.1970 15. Acharya Mukundilal Dwivedi – Ayurvediya Chaukhambha Sanskrit Pratishthan, Delhi, 1990

Panchakarma

Chikitsa,

16. S H Kasture:Ayurvediya Panchakarma Vijnana, published by Chaukhambha Orientalia, Varanasi, Eighth edition, 2005 17. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson: Harrison’s Principles of th

Internal Medicine, 15 ed., Published by Mc Graw Hill Medical Publishing Division, 2001. 18. Christopher Haslett, Edwin R. Chilvers, John .A. A. Hunter, Nicholas A. Boon - Davidson’s Principles & Practice of Medicine, 19 th ed., Published by Churchill Livingston, 2002. 19. K. Sembulingam & Prema Sembulingam – Essentials of Medical Physiology, Published by Jaypee Brothers Medical Publishers (P) Ltd., 2 nd ed., 2003. 20. Gerard J. Tortora, Bryan Derrickson – Principles of Anatomy & Physiology, Published by John Wiley & Sons, Inc., 11th ed., 2007.



138

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29. Satoskar R.S. - Pharmacology and Pharmacotherapeutics, Revised 17 edtn., Popular Prakashana, Mumbai, 2002 30. www.wrongdiagnosis.com 31. www.elkusa.com 32. www.wikipedia.com 33. www.medicinenet.com 34. www.osteoarthritis.net 35. www.oarsi.org 36. www.arthritis.org


I

SPECIAL CASE SHEET FOR JANU SANDHIGATA VATA

P.G. DEPARTMENT OF PANCHAKARMA

ALVAS AYURVEDA MEDICAL COLLEGE – MOODBIDRI, D.K GUIDE

– Dr. K.N.RAJASEKHAR. M.D (AYU) AITHAL. M.D (AYU) P.G. SCHOLAR

1.

NAME :

2.

AGE :

3.

SEX : M / F

4.

RELIGION: H/M/C/O

5.

EDUCATION : IL/ P/M//HS/GR/PG

6.

MARITAL STATUS : M/U/D/W

7.

DESHA : AN/SA/JA PLACE:

8.

OCCUPATION:

9.

SOCIAL STATUS :

CO – GUIDE

– Dr. PRASANNA

– Dr. PRASANTH.D

SL.NO: DATE: O.P.D.NO: I.P.D NO: D.O.A: D.O.D:

10. .POSTAL ADDRESS:

TEL: MOB:

CONSENT


II

I HEREBY DECLARE THAT IM COMPLETELY AWARE OF MY HEALTH CONDITION AND THE TREATMENT PROCEDURE TO BE ADOPTED. I WHOLE HEARTEDLY ACCEPT TO UNDERGO THE SAME.

PATIENTS SIGNATURE

I.

CHIEF COMPLAINT: KNEE JOINT AFFECTED: RT/LT

DURATION:

A) SANDHI SHOOLA:

B) SANDHI SHOTHA:

C) PRASARANA AAKUNCHANA VEDANA:

D) AATOPA:

II.

ASOCIATED COMPLAINT IF ANY WITH DURATION:

III.

HISTORY OF PRESENT ILLNESS: PAIN OR SANDHI SHOOLA

a) Onset of pain : Sudden/Gradual

b) Character of pain : Dull aching /Deep aching/Shooting pain/Excruciating

c) Course of pain : Progressive/Intermittent/Continuous

d) Aggravating factor : Diurnal – M /A/E/N

e) Radiation of pain : Upwards/Downwards “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

III

f) Pain along with movement : Present/Absent

SWELLING OR SANDHISHOTHA

a) Onset : sudden / Gradual b) Site : Anterior / Posterior c) Colour : Aruna / Swetha /Tamra d) Aggravates : Diva / Ratri e) Other factors if any : STIFFNESS OR PRASARANA AAKUNCHANA PRAVRUTTI VEDANA

a) Present / Absent b) Others

AATOPA OR CREPITUS

a) Present / Absent : b) If present: Palpable / Audible / Fine / Coarse

IV.

HISTORY OF PAST ILLNESS a) H/O D.M b) H/O C.H.D c) H/O Endocrinal disorders d) e) f) g)

H/O H/O H/O H/O

Direct injury Other Vata Vyadhis C.A T.B


IV

h) Others significant

V.

TREATMENT HISTORY a) H/O Chemotherapy or Cyto toxic Drugs: b) H/O Radiation therapy: c) H/O Hormonal therapy: d) H/O Steroidal drugs intake: e) H/O Anti epileptics: f) Other significant treatment history:

g) Ayurvedic Treatment History If Any:

VI.

FAMILY HISTORY

a) H/O Cardiac Disorders: b) H/O Endocrinal Disorders: c) H/O Musculo Skeletal Disorders: d) Other Significant History If Any:


V

VII.

GYANEAC HISTORY

VIII.

a) M.C. Bleeding days : b) Periods : Regular/ Irregular c) Menopause Attained : Yes /No PERSONAL HISTORY

AAHARA a)Quantity : Alpa/Prathima/Sama/Atiprama b)Dominant rasa : ,M /A/L/K/T/KS c)Guna Pradhana : Ruksha/Snigdha/Ushna/Sheeta/Guru/Laghu d) Dietary Habits :Matrashana/VIshamashana/Adhyashana/Anashana AGNI a)Type : Mandhagni/Vishamagni/Teekshnagni/Samagni b) Koshta : Mrudu koshta /Madhyama koshta/Krura koshta

VIHARA a) Nature : Mild/Moderate/Severe b) Duration: c) Habits: Regular Occasional Smoking: Alcohol: Tobacco: Snuff: Others :

Reduced

Stopped

Rel’n wid J.S.V

d) Nidra : Nature: sound sleep/disturbed sleep Duration: Others: e) Mala pravrutti: Frequency: “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

VI

Consistency: Others: f) Mutra Pravrutti Frequency: Colour: Others: IX.

GENERAL PHYSICAL EXAMINATION Vital DataPulse: B.P: Temp: Resp Rate: Weight: Height: Tongue: Palour: Cyanosis: Kolenychia: Lymph enlargement: Oedema: Others:

X.

SYSTEMIC EXAMINATION A) RESPIRATORY SYSTEM Inspection: Palpation: Percussion: Auscultation:

B) CARDIO VASULAR SYTEM Inspection: “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

VII

Palpation: Percussion: Auscultation: C) GASTRO INTESTINAL SYSTEM Inspection: Palpation: Percussion: Auscultation: D) CENTRAL NERVOUS SYSTEM Higher Mental Functions: Memory/Orientation/Conscious level/Emotions Cranial nerves: Motor Examination: Bulk /Tone /Power of muscle Sensory Examination: Reflexes – superficial/deep Organic Examination: Bowel cntrl / Bladder cntrl / Deglutin’n / Cgh rflx E) LOCOMOTORY SYSTEM EXAMINATION

Knee Joint Examination

Inspection :

Redness

Palpation :

Tenderness

Temperature :

:

Swelling

Deformity

Area

Swelling : “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

VIII

Movement

:

Painful restricted

Flexion

Extension

INVESTIGATIONS

XI.

a) HEAMATOLOGICAL Hb %: E.S.R: D.C : N -

%, L-

%, B-

%, E-

%, M-

b) URINE ANALYSIS Albumin: Sugar: Microscopy: c) OTHERS IF ANY

XII.

DASHA VIDHA AATURA PARREKSHA Sroto Pareeksha: Pranavaha : Prakruta / Vaikruta Udakavaha : Prakruta / Vaikruta Annavaha : Prakruta / Vaikruta Rasavaha : Prakruta / Vaikruta Rakthavaha : Prakruta / Vaikruta Mamsavaha: Prakruta / Vaikruta Medovaha : Prakruta / Vaikruta Asthivaha : Prakruta / Vaikruta Majjavaha : Prakruta / Vaikruta Shukravaha: Prakruta / Vaikruta Artavavaha : Prakruta / Vaikruta Swedavaha : Prakruta / Vaikruta Purishavaha : Prakruta / Vaikruta


%

IX

Mootravaha : Prakruta / Vaikruta Prakruti: Saara: Samhanana: Satva: Saatmya: Aahara Shakthi: Abhyavarana shakthi – P/ M /A Jarana Shakthi – P/ M /A Vyayama Shakthi: P/ M /A Pramana: P/ M /A Vaya: B / M / V XIII.

VIKARA PAREEKSHA NIDANA – PANCHAKA

A)

NIDANA: Aahara: Tikta rasa atyupoayoga / Kashaya rasa atyupayoga / Katu rasa atyupayoga /Katu rasa atyupayoga Alpa bhojana /Pramita bhojana /Rooksha bhojana/ Sheeta bhojana/ Langhana Vihara: Vega dharana /Ati vyavaya /Raatri jaagarana/ Atyucha bhashana / Plavana/Ati adhva/Divaswapana/ Dukha shayyasana/ Marmaghata / Sheegra yaana Manasika : Ati bhaya / Ati chinta / Ati krodha Panchakarma Apachara : vishama apcahara /asruk sravana Occupational factors : Anya Nidanas If Any :

B)

ROOPA: Vata poorna druti sparsha: Prasarana aakunchana pravrutti vedana : Sandhi shotha : Shoola : Aatopa :


X

C)

SAMPRAPTHI GHATAKA Dosha : Dushya: Srothas: Ama : Udbhava sthana: Sanchara sthana : Vyaktha sthana: Sadhya asadhyatha:

D)

VYADHI VINISCHAYA : XIV.

CHIKISTA

JANU BASTI / JANU PICHU TREATMENT SCHEDULE INITIATION DATE COMPLETION DATE

A)

POORVA KARMA Aatura parreksha ; Sambhara samgraha : Aatura siddhata :

B)

PRADHANA KARMA

- WITH MURUVENNA FOR 45 MINUTES – 7 DAYS – –

JANU BASTI : JANU PICHU :

DATE INITIATION


XI

TIME COMPLETION TIME

OBSERVATIONS: BAHYA SNIGDHA LAKSHANAS : (JANU SANDHI) DAYS 1 2 3 4

5

6

7

SAMYAK BAHYA SNIGDHA MARDAVATA

SNIGDHATA ASNIGDHA LAKSHANA KHARATWA RAUKSHYA ATI SNIGDHA LAKSHANA GAURAVA JAADYA BAAHYA SWINNA LAKSHANAS DAYS

1

2

3

4

5

6

SAMYAK SWINNA SWEDA PRADURBHAVA SHOTHA “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

7

XII

UPARAMA LAGHUTVA STAMBHA NIGHRAHA LAKSHANA PRASHAMA MARDAVATA SWEDA AYOGA LAKSHANA ASVEDA STABDHATA GURUTWA ATI SWEDA LAKSHANA VIDHAHA SANDHI VEDANA SPHOTA UTPATTI

C) PASCHAT KARMA MRUDU ABHYANGA : SWEDANA

:

ASSESMENT OF CHIKISTA “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

XIII

DAILY ASSESMENT - GRADINGS

DAYS

1

2

3

4

5

6

7

SUBJECTIVE PAIN IN KNEE STIFFNESS GAIT OBJECTIVE TENDERNESS SWELLING CREPITUS

OVERALL ASSESMENT – GRADINGS

DAYS

B.T.DAY- 1

A.T – DAY -7

FOLLOW UP-DAY 14

FOLLOW UP DAY 21

SUBJECTIVE PAIN IN KNEE STIFFNESS GAIT


XIV

OBJECTIVE TENDERNESS SWELLING CREPITUS RANGE OF MOVEMENTS

GRADING CRIETERIAS ADOPTED

1) SANDHI SHOOLA/PAIN ON WALK

- GRADINGS NO PAIN - 0 MILD PAIN ON EXERTION - 1 MODERATE INTERMITTENT PAIN ON WALK - 2 CONSTANT PAIN ON WALK - 3 SEVERE PAIN UNABLE TO WALK - 4

2) SANDHI GRAHA /STIFFNESS NORMAL FLEXION MILD RESTRICTION MODERATE RESTRICTION SEVERE RESTRICTION

-

0 1 2 3

3) GAIT / AAKRUTI FREE SWINGING , NO LIMP - 0 LIMPING GAIT WITH NO ADDITIONAL SUPPORT - 1 “A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHIGATAVATA.”

XV

“

WITH UNILATERAL SUPPORT - 2 WITH BILATERAL SUPPORT - 3

4) TENDERNESS NO TENDERNESS

-0

PATIENT COMPLAINS OF PAIN - 1 “ AND WINCES - 2 PATIENT WITHDRAWS JOINT ON TOUCH - 3 PATIENT DOESN’T ALLOW TO TOUCH THE JOINT - 4

5) SWELLING/SHOTHA SWELLING ABSENT - 0 SWELLING PRESENT - 1

6) CREPITUS/AATOPA NO CREPITUS - 0 PALPABLE CREPITUS - 1 AUDIBLE CREPITUS - 2

7) RANGE OF MOVEMENTS USING GONIOMETER NORMAL FLEXION 1350 - 0 0 0 LESSER THAN 135 & MORE THAN 100 - 1 LESSER THAN 1000 & MORE THAN 750 - 2 LESSER THAN 750

-3


XVI

Signature of the guide

Signature of co‐guide


Ayurveda Research Work

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