C O N T E N T S Sr. No. Page No. Acknowledgement Abbreviations I. Introduction 1-3 II. Aims and Objectives 4 III. A Review 5-77 IV. Materials and Methods 78-122 V. Statististical Analysis & Observations 123-151 VI. Discussion 152-160 VI. Conclusion 160 VII. Summary 161-164 Bibliography Appendices

* * *

ABBREVIATIONS

A.H. Su - As tangahr daya Sutrasthan A.T - After Treatement A.Ve. - Atharva Veda B.P.N.Ka.V. - Bhavaprakas a Nighantu Karpuradi VArga B.P.Pu.PVP. - Bhavaprakas a Purvakhanda Pancakarma vidhi

Prakarnam B.P.M. - Bhavaprakas a Madhyakhanda B.P.N.G.V. - Bhavaprakas a Nighanti Ghrta Varga B.P.N.I.V. - Bhavaprakas a Nighanti Iks u Varga B.T. - Before Treatment C.S.Su. - Caraka Samhita Sutrasthana C.S.Su.A - Caraka Samhita Siddhisthana C.S.Si - Caraka Smhita Siddhisthana C.S.Vi. - Caraka Samhita Vimansthana K.N.Dr.V. - Kaiyadeva Nighanti Drava Varga K.N.G.V. - Kaiyadeva Nighanti Ghrta Varga K.N.O.V. - Kaiyadeva Nighanti Aus adhi Varga K.S.Si - Kasyapa Samhita Siddhisthana

M.N. - Madhavanidana N.A.Ke.V. - Nighanti adarsa Kesaradi Varga R.N.C.V. - Rja Nighanti Candanadi Varga R.N. Kshi.V. - Raja Nighanti KSir adi Varga R.N.Pa.V. - Raja Nighantu Paniyadi Varga S.N.D.V. - Saligrama Nighantu Dugdha Varga S.N.G.V. - Saligrama Nighantu Ghrta Varga S.N.I.V. - Saligrama Nighantu Iks u Varga S.N.Ka.V. - Saligrama Nighantu Karpuradi Varga S.S.Chi - Susruta Samhita Chikisasthana S.S.SU. - Susruta Samhita Sutrasthana Sh.S.U - Sarangdhara Samhita Uttarakhanda V.B.Su - Vagbha ta Sutrasthana V.B.U. - Vagbha ta Uttarasthana Y.R.D.Gu. - Yogaratnakara Dugdha Guna Y.R.G.Gu - Yogaratnakara Ghrta Guna Y.R.I.Gu - Yogaratnakara Iks u Guna Y.R.Ke.Gu - Yogaratnakara Kesara Guna

ACKNOWLEDGEMENT It is a great pleasure to keep this work is front of the great personalities

in the field.

I pray god for with out his blessing the work is not possible for me.

I am very much grateful to my father,Late Sri.Pandurangarao with out

his blessings and encouragement, I am enabling to do this work, and I am

dedicating this work for him.

I am very much happy to express my services gratitude to my guide Dr.

Deshpande for his support, encouragement, providing significant direction and

guidance through out the period for this study

I am very much grateful to Dr. U.R.K Rao, my co. guided for his

encouragement and Dr C. Satyavathi madam for giving me opportunities to

work in Sri Deepthi rheumatology centre for her encouragement and interest in

research.

I would like to thank prof. Dr. D.V. Dhoiphode dean facility of ayurved,

Pune University for his guidance,

I thank Prof P. Vasanth, Prof V. Vjaya babu Prof .V.L.N.Sastry for there

proper guidance for my work

I thank Dr. Suhash Parchure sir Director for his encouragement for my

research work

I thank Principal Dr. Gangal Sir, Dr. D.P. Purank sir for helping me for

the work

I also thank Dr. V.K. Dole Sir for his support Dr. Nandini Dhargalkar

madam for support of my work.

I am very much thankful to Dr. Manjiri Deshpande Madam for kind suggestion

and encouragement of my work,

I thank to prof. S.Y. Wagh for his support and encouragement

I Thank Dr.sarvajeet pal for his support during the project work

I also thank Sri. Shyam sundar, Sri Shastry , Mr. Mani, Sri. Venkateshwarlu ,

Mr.Srinivas & Mr. P. Narendra

I also thank Dr Shivand, Ramaiah, Prasad and venkatesh for then

Contribution to my statistical work,

I thank all physiotherapists who helped me to complete my work.

I also thank all people who helped me directly or indirectly who helped

me to complete my work.

At last to make a special mention of my wife Dr. Manjiri. MD (Pathology)

with out her support and encouragement I could not complete my work,

My special love for encouragement during my work by my children sai

priya and vinay kumar

To make special mention and I am very much thankful to Mr. & Mrs. K.V.

Naik and Mr. & Mrs. Amit Naik

Last but not least, I thank all my well wishers my patients who supported

my work.

1

INTRODUCTION

As one of the famous proverbial saying goes- Health is wealth, it seems

that the concept of health has never been dealt in any medical science as

realistic as inAyurveda. The signs of well being or freedom from illness are well

depicted in the ancient treatise. The integration of body components,

compactness of muscles and other tissues, stability and pleasantness of mind and

senses, good appetite, timely digestion, undisturbed metabolism, elimination of

urine and faeces, tolerance towards affects of hunger, thirst, heat, cold and

exercise, normal sleep - wake pattern and gainof strength colour, complexion

and life span put together define a healthy individual.

The description gains more weightage even in this present modem era

when the concept of health as described by WHO includes the state of physical

and mental well being, appears to be influenced by the ancient theories of

Ayurveda.

In contrary, the pathological picture sets in when the rhythmic

proceedings of above said mechanisms are disturbed and the individual will no

longer be considered to be healthy. This disarray of events leading to ill health

will be caused by the disturbance of the chief humoral factors governing the

body that is the Tridoshas,which again is brought about by exposure to various

etiological factors pertaining to Ahara, Vihara.

2

Among the Tridoshas, Vata is given a prime importance with respect to

either physiological or pathological conditions. The other two doshas being inert,

their equilibrium depends on vata The vayu is considered to be the chief

motivating force behind all the activity as it has been described as the engine

which runs the machine of the body. Vayu is also chief driving force of the all the

movements, which get disturbed when vayu gets vitiated. The vayu vitiated by

the etiological factors flowing in adverse routes produces diseases related to the

site of localization and their disturbed functions.

Once such disease caused due to the predominance of vayu is sandhigata

vata. This is a pathological condition which manifests when the Sandhis hich are

the important seat of Kapha, are affected by Vayu. This disease is often impared

to the degenerative disorder afflicting the joints and having world wide evidence

and prevalence in plenty i.e. Osteoarthritis. The prevalence is 30% in the age

group of 45-65 years and 68% for those older than 65 years. Besides destroying

the joints, this disease makes the person crippled and dependent to attend his

normal duties.

Ayurvedic remedies have always been successful in the treatment of this

element and its effects,. This drug has been selected for trial to asses its

efficacy in reliving one from complaints of Sandhigata vata.

The study highlights both conceptual and clinical aspects related to the

disease andhigata vata, which is divided in to following chapters

3

Chapter 1 - Objectives.

This chapter highlights on main aims of this study.

Chapter II- Review of literature

It deals with the conceptual study of both Sandhigata vata and

Osteoarthritis. It covers all the relevant matters related to the disease.

Chapter III- Methodology

Details of the clinical trial of Chandnbalalakshadi tail will observations

during the study are explained.

Chapter IV – Results

The results of the entire study have been explained with appropriate

graphs for easy understanding.

Chapter V-Discussion

Discussions on Sandhigata vata and Osteoarthritis, discussion on clinical

trial with observations and results have been described.

Chapter VI- Summary and Conclusion

Complete abstract of the dissertation and the conclusion are enumerated.

4

Previous works done:

1)Dr.shashikant Khirasagar etal Oct 2003 Pana study,

2)Dr.Sangeeta jogdand etal oct 2003 Abhyanga study,

3)Dr.Vasudhara Borkade etal oct 2003 Basti study,

OBJECTIVES

The bjectives of the present study are

1) To evaluate the efficacy of chandana bala lakshadi tail lIn the treatment of

Sandhi gatavata.

2)To study in detail about the disease Sandhigata vata covering both Ayurvedic

3)To assess the merits and demerits of the trial drug

4)To assess the merits and demerits of the control drug

5)To compare the efficacy of the trial drug.

6)Study of the trial drug and control drug covenng Classical Ayurvedic literatures.

7)To establish an effective treatment with the trial drug for Sandhigata vata.

a) Null hypothesis:

b) Scientific hypothesis:

is effective in the treatment of Sandhigatavata.

5

Review of literature DISEASE REVIEW

TORICAL ASPECT OF SANDHIGATA VATA:

All the historical aspect related to this work is mentioned under this

heading.

Veda Kala:

Rigveda

In this five types of Vata is considered as Pancha prana.One of the Mantras

of Rigveds described about removing the disease from each organ (hairs and

joints)

Atharvaveda

In Atharvaveda, there are references about the disease pertaining to Sandhi and

Sandhi vishlesa.

Purana Kala:

Ramayana

In this treatise, importance of Vayu in maintenance of health and life is

mentioned. There is also explanation about the pathological effect caused by the

Vayu such as Pain and immobility of Joints.

Mahabharatha

In this treatise, Vata has been given important and it is called as

Panchakarma (having 5 functions) and Bhagavan.

6

Agnipurana:

In Agnipurana total number of joints m human body and treatments for

sandhigata Samavata is mentioned.

Upanishat kala:

Elaborate description of vat a is available in the Upanishats.

Kenopanishat:

In this book, vayu is defined as the one that has constant movement,

motion and continued efforts.

Chandogyopamshat:

This book has highlighted the chala property of vata and has shown its

close asociation with bodily actions and movement.

Samhita kala:

Charaka samhita

charaka mentions Sandhigata vata roga in the chapter Vatavyadhi chikitsa.

He names the disease as Sandhigata anila. He explains this disease with

Dhatugata antla vikaras and not mentioned in Nanatmajavatavikara. A separate

nidana or the treatment principles are not found in the text.

Sushrutha Samhita

Sushruta mentions general nidana in Nidana sthana (vata vyadhi nidana) and

seperate treatment principles mentioned in Chikitsa sthana(Vatavyadhi chikitsa).

Bhela Samhita There is no clear description is available about Sandhigata vata.

But Ashtimajjagata vata, 'Sandhivichyuti'is explained as one ofthe lakshana.

Haritha Samhitha

7

Acharya Haritha explains that there are 84 Vathaja nanathmaja vikaras.

Among these, are Vyana vata prakopaja vikaras. He also mentions that all the

datugata vata vikaras are due to Vyana vata prakopa and further tells about the

tretement aspect of Sandhigata vata. He also makes the mention of 'Sandhi

shotha'inShukragatavata.

Sangraba kala:

Ashtanga Sangraha and Ashtanga Hrudaya

The disease is described with treatment.

Madhava Nidana

Acharya Madhavakara agrees with Acharya Charka with respect to Nidana and

Acharya Sushrutha with respect to lakshanas, except for the term Atopa which he

uses instead of Shopha.

Bhavaprakasha

Bhavarnisra follows Acharya Sushruta while describing the disease and its

management which he discusses in vatavyadhi chapter of Madhyama Khanda.

Chakradatta

Chakrapani Datta gives the same views as Sushruta in treatment aspects of this

Disease.

Bhaishajya ratnavali

The treatment aspect of this disease is mentioned.

Yogaratnakara

He has given the same views as of Charaka and Susrutha but separate treatment

principles are mentioned.

8

Basavarqjeeyam

Vaidya Basavaraja explains this disease as Sandhi Vata. He gIves different

lakshanas of this disease but agrees on nidana mentioned by Charaka. He

explains about the sandhivatari rasa.

Sutra Kala:

Bramhana sutra:

This text has gIven importance to Vyana vata. While explaining the

movements of joints it is said that vyana vata is the one, which resides in the

joints and performs all the movements.

Panini sutra:

Panini was well aware of vata, its kopa and samana. He has mentioned the

vatiki to denote disorders of vata.

TERIMONLOGY OF SANDHIGATA VATA

The term sandhigatavata is a combination of two words i.e,

1. Sandhi

2. Gata vata

Sandhi:

The word sandhi is formed by the combination of the sam+dha+kihi.

In amarctkosa, we get the meaning of the sandhi as slesha which means union

Or combination.

Sandhi is considered as union of two structures. Charaka mentions that sandhi

the samyoga sthana of the two asthis. The asthi sandhis are only considered as

the sandhis and the union of pesi, snayu and siras are not considered.

9

It is the moola of majjavaha srotas and also considered as one of the adhyama

roga marga. There are 210 sandhis are present in our body.

Concept of Gats Vata

Gata vata is further comprised of two words Gata and Vata

Gata

Here the word gata denotes the state of vata.In with,covering,reaching,pervadig

are the meanings of gata

Vata

Among three doshas,Vata is given importance. The word Vata originated from

the root "Va Gati Gandhanayo" which when suffixed by 'Ktan', gives rise to the

word Vata.

There are five types of Vata, ie Prana, Udana, Samana, Vyana, Apana. They

having the seperate functions like, Purana, Udwahana, Viveka (rasa mootra

un ha pruthakkarana), Praspandana and Dharana.

Vynna vata has been given the karma in different treatises such as

Praspandana (Sushruta)

Shareera chalana (Dalhana)

Gati, Apakshepana, Uthkshepa (Vagbhata)

Sandhicharitha (Dalhanana)

Vahana (Rasa samvahana)

Pancha chesta.[Prasarana, Akunchana, Unnamana,Vinamana,Tiryakgamana ]

Pancha chesta [Gati, Prasarana,Uthkshepa, Nimesha, Unmesha]

Although these functions said to be done by vyana vata, it can be seen in other

10

places also. Praspandana karma can be seen in prana vata during swasa praswasa

kriya. By the above reference we infer that any act of praspandana etc. function

happen only with the coordinated union of all the types of vayu. To maintain the

coordinated union of vayu, Vahana is important which is performed by

vyanavata.

In Ayurvedic literatures, Sthitha, Militha, Gata are to be considered as

synonymous words.

The pathogenesis of Gatavata can be occurs in two ways

Margavarana janya - due to margavarana there will be srothorodha

which leads to soshana of dhatus and also vitiation of vata. The

vitiated vata situates the srotas which became rikta by soshana of

dhatu.

Dhatu kshaya janya - the rikta dhatuvaha srotas will be filled by

the vitiated vata.

In gatavastba, the vitiation of vata is given importance. Here vata will be

rather than in avarana. So gata vata condition shows prabala vata lakshana.

In Hareeta samhita, Hareeta explains all the Dhatugata conditions are

explained under the heading of Vyana vata prakopaja vikara.

Anatomical aspect of Sandhi:

There are two types of sandhi present in our body, they are

1. Chestavantha - movable joints, the examples are the sandhis of Shakha,

Hanu, Kati, Greeva.

11

2. Sthira - the remaining sandhis other than chestavantha.

Anothcr classification of sandhis36 is,

No. Types of Sandhi Structure Examples

1 Kora Hinge joint

anguli, manibandha, janu, kurpara,

2 Ulukhala

Ball & socket joint

kaksha, vankshana and dashana

3 Samudga

Saddle joint

Amsapeeta, Guda, Bhaga, Nithamba

4 Prathara Plain gliding joint Greeva, Prishtavamsh

5 Tunnasevani

Sutures Sira, Kati, Kapala

6 Vayasatunda

Condyloid joints Hanu

7 Mandala Circular joint

Kanta, Hrdaya, Kloma, Nadi

8 Sankhavartha

Bony labyrinth

Shrotr, shrungataka

Snayu:

Snayu looks like a Shana jute and it is considered as the part of sandhi. It

is the upadbatu of medas and also moola of mamsavaha srotas. There are 900

snayus are resent in human body. They are classified into four types they are,

Prathanavathi, Vrutha. pruthula and Sushira. Prathanavathi snayu is present in

all the sandhis. The vrutha snayus also considered as Kandara.it has the function

of prasarana and akuchana of body parts.

The ligaments which are present in the joints are separate which leads to

Stability.

Sleshmadara Kala:

This is the fourth kala, the kleda which is present in between the

dhatvashaya will get paka by respective dhatwagni and kalas are produced.

12

Sleshmadhara kala is considered as the seat for the sleshma (Shleshaka

kapha) and it gives integrity to the body.

Just as the application of oil to the axils produce easy movements to the

wheel, the easy movement of the Sandhis is similarly brought about the

lubricating effect the Shleshma dhara kala lining the Sandhis. The Synovial

membrane with compared with Shleshmadhara kala, which Helps to easy

movement of joints by secreting synovial fluid. Type B Synoviocytes will

secrete the synovial fluid.

Siras:

Siras are upadhatu of raktha which helps in sarana. There are four types;

they are vatavaha, pittavaha, kaphavaha and rakthavaha.

are mainly situated in marma and nourishing the snayu, asthi and sandhi.

They are 700 in number.

Pesi:

There are 500 pesis in our body. The sira, snayu, asthi, parva and sandhis

are covered by the pesis and get strength.

Sandhimarma:

Marmas are the vital points of the body. They are 101 in number.

According to Dalhana marmas are situated in mamsa, sira, sandhi etc.

Depending on the structural base marmas are divided into 5. They are

mamsa sira marma, snayu marma, asthi marma and sandhi marma. All the

marmas under these 5 categories.

13

There are 20 types of sandhi marmas. They are janu, kurpara, seemantha,

adipathi gulpha, manibandha, kukundara, avartha and krukatika.

Joints:

Two or more bones unite to form joints.

There are three types of joints explained.

Fibrous joints.

Fibro-cartilagenous joints.

Synovial joints.

Fibrous and Fibro-cartilagenous joints:

In this type, the fibrous or Fibro-cartilaginous tissues unite the two bones.

This joint will present where there is little requirement of movement.

For fibrous joint: joints present in skull bone.

For Fibro-cartilaginous joint: Symphisis pubis, Inter vertebral discs.

Synovial Joints:

This type of joints provides maximum range of movement.

Eg. Most limb joints, Tempero-mandibular joint.

Structures present in synovial joint are,

1. Articular cartilage.

2. Synovial fluid.

3. Intra articular disc.

4. Joint capsule and synovial membrane.

14

Articular cartilage:

In synovial joint, the articular surface is covered with a layer of articular

Cartilage.

In normal cartilage, there are no cell divisions. But in this chondrocytes

there are continuous process of destruction and synthesis of the cartilage matrix

throughout life.

Constituents:

It is an avascular tissue that consists of cartilage cells [Chondrocytes],

Type II collagen and smaller amounts of other proteins which is present in the

matrix of proteo glycans.

The matrix consists of:

1) Type II collagen fibers:

It forms the meshwork in between the proteo glycan molecules.

2) Hydrated gel of proteo glycan molecules:

In this, the important one is Aggrecan.

Aggrecan consists of:

A] Core protein.

B] Glycosaminoglycan[GAG] : It is the long chain of disaccharides.

The important GAG is Chondroitin sulphate and Keratan sulphate.

3) Hyaluronan:

A long GAG in which numerous aggrecan will be connected.

15

4) Link protein

N- Terminus of aggrecan joins to the hyaluronan by small glycoprotein

called Link protein.

Articular cartilage has two essential functions:

It provides a smooth bearing surface so that with the movement, bone

glide effortlessly over each other. Articular cartilage prevents concentration of

stresses, so do not shatter when the joint is loaded. Large complexes of aggrecan

and lyaJuronan form the articular cartilage. Aggrecan has a strong, negative

charge because of the sulphate and hydroxyl groups in glycosaminoglycan. And

also it binds large number of water molecules. So it occupies the maximum

possible volume available. So the expansive force of charged and hydrated

aggrecan and restrictive force of collagen gives the articular cartilage an

excellent shock absorbing properties.

Synovial fluid:

Surfaces of articular cartilage separated by space called Synovial fluid. It is

basically ultra filtrate of plasma into which synovial cells secrete Hyaluronan and

rotcoglycan. It lubricates the joint.

Intra articular discs:

Intra articular discs are the fibro cartilagenous disc which is present within the

joint space. It is present in some joints only and acts as shock absorbers.

16

Joint capsule:

Joint capsule is a fibrous structure, richly supplied by blood vessels, symphatics

and nerves. It joins the two bones of the synovial joint. Ligaments and a regional

thickening of joint capsule stabilize the joint. Inner surface is lined by synovial

membrane.

This membrane contains outer layer of blood vessels and loose connective

Tissues. Inner layer consists of Type A and Type B synoviocytes. Most of

inflammatory and infiltration by lymphocytes, polymorphs and macrophages.

Many contain bursae which are hollow sacs lined by synovium.

NIDANA

In Ayurvedic classics, the term Nidana has been defined in two different

senses one of these definitions explains Nidana or that which gives a complete

knowledge of a disease or that which helps in diagnosing a disease.

The other part defines Nidana as those which have a tendency to produce

a process after inducing a chain of pathological events in the body like Dosha

prakopa etc or in short, the etiological factors of the disease. The ahita ahara

vihara which vitiates the doshas and the dusta doshas which tend to vitiate the

dushyas are included in to the category of Nidana.

Being an important member of the Nidana Panchakas aiding in roga

pareeksha,nidana not only helps in diagnosis and differential diagnosis, but also

helps in determining the prognosis of the disease. Nidana has an important role

to play in Chikitsa also, as the shortest route of avoiding or getting rid of the

disease is said to Nidana parivarjana.

17

In this context, the terminology Nidana covers the etiological factors causing

The disease entity Sandhigata vata. Sandhigata vata is one of the vata vikara.

Vata vyadhi can be an effect of either of the two pathological events namely

Dhatukshaya of Margavarodha. Each occurring due to different sets of nidana and

so does Sandhigata vata. Since separate etiological factors have not been

mentioned with respect to Sandhi gata vata, the same nidanas which have been

explained in then text of vata vyadhi should be considered.

Notes: · vata prakopaka nidana

. + vata vyadhi nidana.

The nidanas can be categorized into:

Aharatha

Viharatha

Manasika

Kalakrutha

Aharatha:

Ahara is an important factor responsible for the maintenance of health, as it is

Pancha bhoutika. BaJa and ayush is gained by ahara. It is the form of nutrition to

the basic elements of the body or the shareera dhatu. Dhatu kshaya is a main

cause of vataprakopa. So here the cause of dhatu kshaya is been considered

keeping in view of their final effect on the functions of vata. Therefore different

factors relating has been tabulated.

18

A) Rasa visheshatha nidana: Table No: 2 showing Rasa visheshatha nidana:

Rasa Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Kashaya - * + - - - - - Katu - * * + - - - - Tikta - * * + - - - -

* vata prakopaka nidana. + vata vyadhi nidana. Kashaya, katu and tikta are the rasas, which vitiates vata and also leads to

snehadigunasunyatha. So this nidanas can be the cause for sandhigatavata.

Guna vishesatha nidana:

Table No: 3 bowing Guna visheshatha nidana: Guna Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Ruksha + * * + + + + - Shitha + * * - + + + - Laghu + * - + + + + - Sukshma - * * - - - - -

* vata prakopaka nidana. + vata vyadhi nidana.

The gunas like laghu, ruksha, kara etc. leads to the kshaya of the sneha guna of

body, which further leads to dhatukshaya and also vitiation of the vata dosha. So

thesegunas also can also cause sandhigata vata vyadhi.

C) Veerya vishesbatha nidana:

Table No: 4 showing Veerya visheshatha nidana:

Veerya Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Shita - * * - - - - -

* vata prakopaka nidana. + vata vyadhi nidana.

Sheets veerya is the factor for the vitiation of Vata dosha. So this can be

considered as one of the viprakrshta nidana for Sandhi gata vata.

19

D) Time and forms of ahara:

Table No: 5 showing Time and forms of Ahara:

Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Alpa + - * - + + + - Pramitha - - * + - - - - Abhojana + * - + + + + - Virodhi - - + + - - - + Apatharpana - - - - - - - -

* vata prakopaka nidana. + vata vyadhi nidana The forms of Ahara like Virodhi, Alpa, cause Vata vitiation thus produces Sandhi gata vata. E) Type of shara: Table No. 6 showing Type of Ahara:

Nidana Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Shaka - * - - - - - - Vallura - * - - - - - - Varaka - * - - - - - - Uddalaka - * - - - - - - Koradusha - * - - - - - - Syamaka - * - + - - - - Nivara - * - + - - - - Mudga - * - + - - - - Adhaki - * - + - - - - Harenu - * - - - - - - Kalaya - * * - - - - - Nishpava - * * + - - - - Vistambhi - - * - - - - - Virudaka - - * - - - - - Truna dhanya - - * - - - - - Chanaka - - * + - - - - Karira - - * - - - - - Tumba - - * - - - - - Kalinga - - * - - - - - Cirabhita - - * - - - - - Bisa - - * - - - - - Saluka - - * - - - - - Jambava - - * - - - - - Tinduka - - * - - - - - Thriputa - - - + - - - - Satheena - - - + - - - - Makusta - - - + - - - - Mangalyaka - - - + - - - - Masura - * - + - - - -

* vata prakopaka nidana. + vata vyadhi nidana.

20

2) Viharatha nidana:

Various viharas can stimulate or irritate those anatomical sites where a function

of vata (movements) is more required. Particularly the weight bearing joints

which tend to become the target. Initially the injury may be at the molecular

level which further aggravates being able to involve the tissues of the sandhi

generally in case of irreversible injury.

Vyana vata is responsible for different chestas (movements). Here viharaja

nidana means the atiyoga, ayoga or mithyayoga of these chestas which leads to

the vata prakopa. Viharaja nidana is also leads to abhigata of body parts (sandhi)

which also become one of the pre disposing factors for sandhigata vata.

Table No.: 7 showing Viharaja nidana:

Nidana Ch Su A.S B.P M.N. Y.R Ba.Raj H.S Ati vyayama + * * + + + + + Ativyavaya

+ - * + + + + -

Langhana + * * - + + + - Prajagara + * * + + + + + Plavana (pratarana)

+ * * + + + + -

Atiyadhva + - - - + + + + Ativicesta + - * - + + + - Dukhasayya + - - - + + + - Dukha asana (vishamasana)

+ - * - + + + +

Diva swapna + - - - + + + - Vega sandharana

+ * * + + + + -

Vego udeerana

- - * - + + + -

Abhighata + * * + + + + - srama - - - + - - - -

21

Kreeda - - - - - - - +

Dathu Kshaya + - + + - - - -

Ucha Bhashana - - * - - - - -

Abisangha - - - - - - - +

Atiasruk

sravana

+ - * + - - - +

Ati virechana + - * + - - + +

Ativamana + - * + - - - -

Prana apana

samana

sandharana

- - - - - - - +

Vishamopachara + - - - + + + -

Brharaharana - * * - - - - -

Ksheena bala - - - - - - - +

Atimamsa ksaya - - - + - - - -

Gajaturaga

yana

+ * * - + + + -

*vata prakopaka nidana. + vala vyadhi nidana.

22

3) Manasika Karana:

Manas is Ubhayendriya, which is the main part to attain ganhanotpatti. Manas

istrolled by Vata (Niyantha pranetha cha manasaam). Indriyas are also controlled

by vata only.

So manasika nidana considered as one of cause of Vata vyadhi because

Asathmcndriyartha samyoga is one type of nidana.

Table no: 8 showing Manasika nidana:

Nidana

Nidana Ch Su A.S B.P M.N. Y.R Ba.Raj H.S

Chinta + - - + + + + +

Soka + - * + + + + -

Krodha + - - - + + + -

Bhaya + - * + + + + -

Utkanta - - * - - - - -

Ksheena

indriya

- - - - - - - +

Madana kopa - - - + - - - -

*vata prakopaka nidana. + vala vyadhi nidana.

23

4) Kalaja:

Kala is of two types: Nithyaga and Avasthika, Nityaga kala pertains to the kals

related to rtus and Avastika kala is related to pathological state of doshas

according to the age of person.

Table No.: 9 Showing Kalaja nidana:

Nidana Ch Su A.S B.P M.N. Y.R Ba.Raj H.S

Payodasamaya

(Varsa rtu)

- * * + - - - -

3rd part

Dinakshana

- - - + - - - -

Sisira - - - + - - - -

Grishma - - * - + + + -

Bhuktanta - * - - - - - -

Pravrt - * - - - - - -

Seeta Kala - * - - - - - -

Vrudha - * - - - - - -

Usha Kala - * - - - - - -

Aparahna - * * - - - - -

Jeerna anna - * * + - - - -

Apararatri - - * - - - - -

Purvavata - - * + - - - -

* vata prakopaka nidana. + vata vyadhi nidana.

24

Influence of the time factor (kala) on the doshas has been given importance in

Ayurvedic classics. In general the vata is predominant at the end of the

digestion, evening or at the end of the digestion.

Here old age will be main precipitating factor for production of Vatavyadhi.

Although other nidanas can also cause vitiation of vata, it is considered as

Vyabhichari causes for Vatavydhi. In Vrudhavasta, the dhatus are in the state of

Ksheena, that which provides platform for the diseases. They are more prone to

get Sandhi gata vata.

There are six ritus in which tridoshas are having its own state of kshaya or

vrudhi. By considering this, vata is having sanchaya in Greeshma, prakopa in

Varsha and shamana in Sharath. By this we can analyse that due to the rukshata

in Greeshma vata gets Sanchaya, due to sheetata of Varsha gets Prakopa and

ushnata of sharat rtu the Vata sham ana. In Vata prakopaka rtus, person prone to

get Sandhi gata vata. The possible effect of these factors may be due to not

adopting the rules of Rtu charya and the purification measures in the ritu sandhi

as advocated in classics.

Prakruti is also given importance while disease is considered. Vata prakruti

Persons are more prone to vata vyadhi. While explaining Vata prakruti, Charaka

told that Anavasthita sandhi(loosening of joints), because of chala guna and

Sathatha sandhi shabada gami (continuous crepitus in joints while walking)

because of vashadhya guna of Vata.

25

POORVARUPA

The unclear signs and symptoms produced by the vitiated doshas during the

process of sthana samsraya, which indicate the forth coming disease are called

as foorva rupa. This marks the beginning of amalgamation of vitiated doshas and

dushyas. In the context of vata vyadhi, it has been said that the under

manifestation of signs and symptoms or avyakta lakshanas should be regarded as

poorva rupa.

Even in case of sandhigata vata also, feebly manifested signs and symptoms of

the disease can be considered as poorva rupa. In sandhigata vata, shoshana of

shareera takes place due to the localization of the prakupita vata, as a result of

which the person starts feeling laghuta. Lakshanas of sandhigata vata i.e shotha,

shula etc are also found in avyakta avastha.

RUPA

In the disease process, the same unclear signs and symptoms of poorva rupa

when gets clearly manifested so as to indicate an existing disease will be called

as rupa. In short the signs and symptoms of a completely manifested disease are

called as rupa or lakshanas. The same rule holds good with sandhigata vata also,

where in the symptoms of the disease like shotha, shula etc which were unclear

and feeble during the sthana samsraya gets clearly manifested defining the

disease.

26

Table no: 10 showing Roopa of Sandigata vata according to various Acharyas:

Laxanas Ch54 Su55 A.S56 A.H57 B.P58. Y.R59 M.N60 Ba

raj61

Sandhi Soola - + - - + + + +

Sotha or sopha - + - - + + - -

Vatapurna druti

sparsa

+ - + + - - + -

Hanti sandhin - + - - + + - -

Prasarana

akuncanayoho

pravrttisavedana

+ - + + - - - -

Atopa - - - - - - + -

Shareera

gandhaliptata

- - - - - - - +

Anga pecda - * - - - - - +

Romaharsha - * - - - - - +

Vilapana - * * - - - - +

The cardinal symptoms are as follows:

I. Vata poorna druti sparsa

2. Sandhi soola

3. Sandhi sputana or Atopa

4. Prasarana Akunchana pravruthi savedana

5. Sandhi shotha or shopha

27

1) Hanti sandhi:

In the commentary-Nibandha sangraha and Athanka darpana, they gives the

explanation that, Hanti sandheen means abhava in Prasarana akunchana etc

functions of the Sandhi. In Madhukosha commentary, it means complications of

sandhi like Sandhi vishlesha, Sandhi sthambha etc. Gayadasa gives openion about

Sandhi vishlesha as there will be difficulty of movement without the dislocation.

Vata is responsible for the Gati especially vyana vata leads to Pancha chesta of

the body (Prasarana, akuncana, Unnamana, Vinamana, Tiryakgamana). So

impairment ofVyana vata leads to difficulty in movement.

2) Sandhi shula:

Shula is the main symptom of the Vata vitiation. All the Acharyas mentioned

that there is no Shula without the vitiation of vata.

Sandhi shula is the main symptom in the Sandhigata vata. In Asthi-Majjagata

vata also this is the main symptom. So we can conclude that the sandhi shula is

produced due to the effect of Ashrayee dhatu kshaya (Asthi) due to the vitiation

of Vata.

3) Atopa or Sandhi sputana:

This specific symptom is explained by Acharya Madhava. Shabda is the

indriyartha which indicates the predominance of qualities of Vata. Sandhigata

vata is localized vata vyadhi in which prakupita vayu affects Sandhi. This sthana

samsraya is the result of srotoriktata present at sandhi; that means akasa

mahabhuta is increased at the site of sandhi.

The Atopa can be correlated to the crepitus in a joint. This is due to the

28

Osteophyte formation at the time of remodeling of joint. This becomes evident

only when there is marked degeneration.

4) Prasarana akunchana pravruthi savedana:

There is a natural elasticity or contractility in the joint by virtue of which the

movement in different ·direction can be performed. This is destroyed due to the

vitiated vata, with the result the patient is not able to move his joint freely

especially in the extension and contraction. If he tries to move, there will be

severe pain. This phenomenon has been explained by different terminologies

such as Stambha etc.

5) Sandhi shotha:

It is one of the main symptoms in Sandhigata vata. Sushrutha explained it as

Sandhi shopha because Shopha is the swelling which is Ekadesha sthitha. Acharya

Charaka explained as shotha.

By commenting on shotha, Arunadatta explains that, the swelling look like the

air filled bag.

In Ashtanga samgraha, Vagbhata includes shopha as one of the Vyana vata vikara.

6) Vata purana druti sparsha:

Sparsha is of two types, Ushna sparsha and Sheeta sparsha. In Yogarathnakara,

there is reference that the person who is suffering from Yata roga will have

Sheeta sparsha. In Sandhigata vata, usually the joints will be look like air filled

bag to touch and cold.

Acharya Basavaraja also explained some other symptoms like Shareera

Gandha lipta, Romaharsha, Vilapana which shows the chronicity of the disease.

29

UPASAYA AND ANUPASAYA

Upashaya is the temporary relief which is gained by the procedures such as

Oushadhi etc.It is also considered as therapeutic test to attain correct diagnosis

of the disease when it becomes difficUlt due to its effects in manifestation of

signs and symptoms.

Anupasaya and Upasaya is the application of Ahara, Oushadha, Vihara,

prescribed either antagonistic or similar to the nidana, to the Hetu, vyadhi or to

both Hetu and Yyadhi together. It is considered as Upashaya when it decreases

the symptoms and when it aggravates the symptoms it is called Anupashaya.

For example when abhyanga swedana, usna ahara etc reduce the symptoms of

Sandhigatavata. In samavastha, like in Amavatha the same treatments aggravate

the condition. So it is a treatment and also a diagnostic approach.

SAMPRAPTI

For the better understanding ofthe disease, the knowledge of Samprapti Le the

etio pathogenesis of the disease is essential.

Samprapti can be defined as the process of disease from its inceptive phaseto

fully manifestation. This process starts from the Nidana sevana or consumption

of the etiological factor causing dosha prakopa, circulates through out the body,

localization then manifestation and differentiation.

To the pathological point of view, dosha, dhatu, srotas is essencial in relation of

Sandhigata vata.

Srotas is also called as Dhatuavakasha, which is formed from the Akasha

30

mahabhuta. Akasha and Vayu mahabhuta are interrelated and Vayu is situated in

the emptiness [Riktata] created by the Akasha mahabhutha.

In Samprapti, 'Riktata of srotas' present in the sandhi is considered as the

'Khavaigunya', which is the platform for manifestation of disease Sandhigata

vata. Chakrapani gives explanation about Riktata as 'Thuccha' or 'Snehadi guna

shunyata' .

While explaining vata prakopa lakshanas, Charaka has mentioned the term

"Sushirata" which may be taken as Riktata.

In sandhigata vata, we can take the Snehadi guna shunyata in two different

conditions. As the sneha is the main guna of the shleshma, shunyata can be

considered as the Sleshma kshaya. Shleshaka kapha is present in the sandhi

which is responsible for the integrity of joints and proper lubrication. The

depletion of this leads to Riktata of srotas.

Dhatus are the snehayukta dravya present in the body. As the sandhi is made

up of different dhatus, upadhatus and other essential factors, the intake of the

dhatu kshayakara nidana will lead to there will be dhatukshaya which is turn

causes snehadi guna shunyata[riktata]. In short, one can say that the loss of

snehana of the joint is responsible for the pathogenesis of Sandhigata vata.

Vata prakopa can occur in two ways.

1) Dhatukshayajanya and

2) Margavaranajanya (obstruction)

31

Vagbhata. clearly explains that Dhatukshayaja nidanas are also responsible

for the vitiation of the vata along with the riktata. The prakupita vata situates in

the rikta srotas present in the sandhi thus producing the symptoms of Sandhigata

vata.

In margavarodhajanya condition, the other doshas such as Kapha and Pitta fills

the Srotas present in the sandhi and does the A varana of vata. Due to avarana,

the avruta vata becomes strong and vitiated, leads to further dhatu shoshana

thus producing the symptoms of the Sandhigata vata.

Medo roga(sthoulya) may also lead to Sandhigata vaPl as vata vyadhi is said

as one of the complication of the medoroga. Due to the A varana of meda to the

pathway of the vata, there will not be proper nourishment to other dhatus

leading to vata vikaras.

Samprapti ghatakas: Dosha Vatavrudhi, [Vyanavata], Kapha kshaya [sleshaka kapha]. Dushya Asthi, Snayu [sandhi avayava]. Srotas Important srotas are asthi vaha, majja vaha other less

important are medovaha and mamsavaha srotas. Agni Dhatwagni. Rogamarga Madhyama. Udbhavasthana Pakwashaya. Sanchara stana Sarva deha. Vyaktasthana _ Sandhi.

32

Chart No.1. Showing E tio-pathogenesis of Sandhigata vata:

Nidana

Ahara Vihara Manasika Kala Gada Kruta

Vata prakopa Dhatu kshaya Anyadosa prakopa

Vata prasara Rikta srotas

Fills in the Srotas

Avarana of Vata

Vata prakopa

Sthana samshraya in sandhi

Sira Impared sravana

Asti Snayu Kandara Sleshmaa Sleshmadhara kala

Shoshana

Stambha

Kshaya

Vatapuma drthi

sparsha Sotha Atopa Sula

33

UPADRAVA

Upadrava is the Complication of a disease. The Dosha which causes the main

disease is itself responsible for the upadrava.

Upadrava will be manifested in three ways i.e. complications that starts along

with the disease, complications after full manifestation of the disease and

complications produced after cure of the disease.

Asthi shithilata, pesi kshaya can be considered as the complication which

manifests along with Sandhigata vata and Sandhi vishlesha will be its after

effect.

Complications such as deformity and immobility of joints will interfere the

routine works.

SADHYASADHYATHA

Sushrutha and Vagbhata have included Vata vyadhi under the Ashta maha

gada, 81 because of its ashukarita and Upadrava. As the disease Sandhi gata vata

is one of the Vata vyadhi, it is difficult to cure.

Charaka while explaining sadhyasadhyata, mentions that 'Khuda vata is Kasta

sadhya or asadhya. Commenting on Khuda vata, Chakrapani opines that

Khudavata itself is Gulphavata or Sandhi gata vata.

Acharya Hareeta concludes that the Mamsa gata, medo gata vata is Sadhya,

rest of Gata vata is Kasta sadhya or Asadhya for treatment.

As Sandhi gata vata is the disease of Madhyama roga marga. It is considered

as Kashta sadhya.

34

CHIKITSA

The mam scopes of the Chikitsa are of two. They are promotion and,

preservation of health in healthy individual, and elimination of the disease ailing

and afflicted i.e. curative treatment. According to the Amarakosha chikitsa is

Ruk prathikriyawhere as in Vaidyaka shabda sindhu, it is defined as 'roga nidana

pratheekara' .

The term rogapanayana and ruk pratikriya convey nearly the same meaning

viz. measures calculated to the removal of disease and treatment of the disease

respectively. The term roga nidana pratikriya stresses on the removal of

causation factors of the diseases.

Acharya Sushruta was the first to mention the treatment principles of

Sandhigatavata. Although Charaka has not mentioned about specific chikitsa, the

general Vatavyadhi chikitsa is taken in to consideration.

Treatment principles according to different Acharyas are tabulated below:

Table no: 11 showing Chikitsa sutra of Sandigata vata

Chikitsasutra Ch Su85 A.S86 A.H87 B.P88. Y.R89 B.R90 C.D.91 Sneha - + - + - + + + Abhyanga - - + - - - - - Upanaha - + + + - + + + Agnikarma - + + - - - + + Bandhana - + + + - - + + Unmardana - + + - - + + + Sweda - - - - - + - - Raktavaseean - - - - - - - - Pradeha - - + - - - - - Samana - - - - + + + +

35

1) Snehana;

The procedure which induces qualities like Snigdhata, Mruduta, Kledata and

Vishyandata in the body, following the internal and external administration of

sneha dravyas are called as Snehana. Snehana is said to be the best treatment in

case of all the diseases produced by the Vata, since it is totally antagonist to the

qualities of Vata. Sneha is also said to be tridoshagna as it alleviates vata, pitta

and kapha due to its Snigdhata, Shaityata and samskarasyanuvarthana (yogavahi)

respectively. According to prayoga bheda there are two types of snehana

procedures, they are

. Bahya sneha - in this the sneha dravyas are applied externally as done In

procedures like abhyanga, avagaha, sirovasthi etc.

. Abhyanthara sneha - In this the sneha is administered internally in the form of

pana and basthi.

In the disease Sandhigata vata, the administration of Snehana will be very

effective since Prithwi and Ambu mahabhoota, which are mainly present in the

Snehadravyas are exactly opposite to the Akasha mahabhuta predominantly

prevails in the main factor in the disease pathology i.e. Sroto riktata.

There are two types of sneha i.e sthavara and jangama. Among these snehas,

four snehas are considered as pravara and also their quality has been mentioned.

Among these, ghrita is considered as best one and it is pittanila hara, rasa shukra

ojo hitha. Thaila is maruthaghna,balya, sthirakara and it does not increases

kapha. Vasa is best known for eradicating the maharuja which is affecting to

36

Asthi, Sandhi, Sira, Snayu, Marma and balavan marutha which is situated in the

srotas. Majja is considered. as bala- rasa- meda- shleshma and majja vardhaka.

2) Abhyanga:

Abhyanga is a type of snehana karma where massage is done by applying the

thaila on the body.96 It is said that by abhyanga both kapha and vata will be

pacified. It is also considered as balakari, and dhatu pustikara. Dalhana has given

the explanation regarding the time required for the Sneha dravyas to enter deep

to the dhatus following Abhyanga. According to his explanation, sneha is situated

in romakupa up to 300 matrakala. In 400 matrakala, it enters twacha, in 500 to

rakta,in 600 matrakalato mamsa. It reaches medodhatu in 700 matra kala. The

sneha reaches asthi in 800 matrakala. In 900 matrakala sneha enters in to majja

thus inducing snigdhata in all the dhatus. Thus it is considered as the dhatu

pustikara.

Since Sandhigata vata is a disease of Madhyama roga marga where the Asthi,

majja and sandhis are involved; the penetration of sneha dravyas deep in to the

dhatus during abhyanga as said above will be of high therapeutic value.

In 5th century B.C, Hippocratus wrote..' "the physician must be experienced in

many things, but assurely in rubbing, because rubbing can bind a joint that is too

loose and can loosen a joint that is too rigid".

Upanaha:

The word meaning of Upanaha is bandhana. According to sushruta, it is one

among 4 types of swedana karma. In this moola kalka, kanji, pista, lavana, is

added with sneha and thick application is done over the affected part. Then that

37

area is tied in a cloth. In case of Pittanugata vata, kakolyadi, surasadi or eladi

gana dravyas are used. In kaphanugata vata, tila atasi etc dravyas and in kevala

vata, veshavara, salvana upanaha is adviced. He is also explained that Upanaha

is best for Vata.

Acharya Caraka explains Upanaha as one of the Niragni swedana.

By commenting on this Chakrapani explains there are two types of Upanaha.

They are Saagni and Niragni upanaha. In Saagni upanaha, tila or masha kalka are

made in to hot and kept on affected part. This is also called as the Sankara

sweda. In Niragni upanaha, ushna veerya drugs are applied and tied by charma,

cloth etc.

Vagbhata explains Vachadi Upanaha in kevala vata.

Acharya Sivadas sen explains the mechanism of the Upanaha as swedana. Due

to the blocking of the heat generated by the body, there will be production of

the sweda in that part.

Agni karma:

The procedures done with the help of agni or the drugs having Agni guna is

called as Agnikarna.103 The severe complications of Sira, Snayu, Asthi and

Sandhi, caused by the vitiation of vata are cured by the Agni karma.

In snayu- asthi and sandhi gata vata and kaphaja vikara, by usmg

Kshaudra(Honey), Guda(jaggery) or Sneha, the procedure of Agnikarma should be

done. It is indicated in all ritus except in Sharat and Grishma.

The importance of this procedure is, the diseases which are not cured by the

38

other procedures like Bhesaja, Shastra, Kshara, and Rasa can be cured by using

this procedure.

Bandhana:

Bandhana leads to Sarnhathi. It is the procedure in which the effected part will

be tied by using Rajj u etc.

By doing Bandhana procedure, there will be strength to the joints and also

pressure to the joints will be minimized.

VIMARDANA;

It is the procedure of massaging of effected part by Hastatala after application

of oil. By the gentle massage there will be proper circulation to the joints.

Swedana:

Swedana is of two typesO9 according to Agni samyoga. They are,

I) Agni sweda- They are of 13 types, namely Sankara, Prastara, Nadi, Pariseka,

Avagaha, Jhentaka, Ashmaghana, Karshoo, Kuti, Bhoo, Kumbhika, Koopa and

Holaka.

2) Niragni sweda: They are of 10 types namely, Vyayama, Ushnasadana,

Gurupravarana, Kshudha, Bahupana, Bhaya, Krodha, Upanaha, Athapa, Yudha.

In Ashtanga Sangraha, Vagbhata has said that swedana is the best remedy to

remove the sthabdatha of the Sandhi (Sandhi sthabdathapaham).

In case of Sandhigata vata, by doing swedana, there will be Vata nigrahana

which results in decreasing the pathology.

39

Raktavasechana:

Acharya Vagbhata (Ashtanga samgraha) explained it as avastika chikitsa. In

sira-snayu-sandhi gata vata, if the person is having Svapa(numbness),

raktavasechana is indicated in alpa pramana. If the person feels angamlana with

numbness, raktavasechana is contra indicated because there will be the chance

of shosha.

After raktavasechana, pradeha is applied by taila, lavana, agara dhuma.

PATHYAAPATHYA

Pathya means wholesome or conducive to health. Pathya is related to Patha

which is having different meanings. It indicates the channels of circulation which

is called as Srotas. Chakrapani comments that Patha is the dosha and dhatus

which is present in srotas. He also quotes that Pathya is the Swastha rakshana

and also Vyadhi prashamana.

So the food and activities which is performed and which is Anpayakari(not

harmful) to person and also to disease is called as Pathya it depends on the

Matra, Kala, Kriya, Bhumi,Deha, Desha and Gunanthara

Pathya has been given importance that no medicine is needed if Pathya is

followed properly and there is no use of medicine if Pathya is not followed

properly.

Although specific Pathya is not mentioned for Sandhi gata vata, the

wholesome food and regimens explained for Vata vyadhi is taken as Pathya.

40

Table No: 12 Pathya for Sandhi gata vata:

Ahara Yogarathnaka113 Bhaishajya rathnavali114

Sneha - Thaila

Shaka varga Patola, Kushmanda, Shigru, Carthaka -

Shuka dhanya

varga

Godhuma, Rakta shali Godhuma, purana dhanya

Shimbi dhanya Masha, Kulatha Masha, Kulatha

Mamsa Kukkuta, Tittiri, Barhi, Chataka,

Jangala mamsa

-

Mathsya varga Shilendra, Nakra, Khudisha,

Parvathe, Gargara, Jhasha

-

Phhala varga Dadima, Parooshaka, Badara,

Draksha

-

Gavya varga Ghrutha, Dugdha, Kilaata, Dadhi,

koorchika

-

Oushadha

dravya

Lashuma, Tambula, Masthsyandika Brihati, Vastuka,

Kasamarda, Dunduka,

Mishi, Kataka

Lavana Saindhava -

Apathya for Sandhi gata vata:

In Yogarathnakara and Bhaishajya rathnavali, some of unwholesome foods are

explained which is enlisted below.

41

Table No: 13

Apathya ahara Yogarathnakara115 Bhaishajya

rathnavali116

Vihara Chintha, Prajagara, Vegavidharana,

Sharama, Vyavaya, Chankaramana,

Khatwas (sleeping in cot). Hasthyashwa

yana, Dwija gharshana

Sheeta pravata

Karma Chardi -

Food intaken Anashana Guru, Abhishyandi

Shuka dhanya - Nava dhanya

Shimbi dhanya Mudga,Nivara, Shyamaka, Kuruvinda,

Kalaya, Chanaka

Mudga, Sharshapa,

Nishpava

Shakha varga Koshataki, Kareera Kareera

Jala varga Thataka, Thatini, Pradusta salila Sheetambu

Rasa Kashaya, katu, Tikta -

Other substances Kshudra, Kangu, Nimba Mrunali, Sarasi, Nimba

DIFFERENCIAL DIAGNOSIS

For the accurate diagnosis of the disease, Vyavachedaka nidana (differential

diagnosis) is important. By seeing difference in the causative factors, mode of

onset, clinical features,upashaya- anupashaya, we can conclude the differential

diagnosis. Sandhi gata vata is the disease pertaining to joints, other joint

diseases such as Vatarakta, Amavata will be considered for the differential

diagnosis.

42

Table No: 14

Symptoms Sandhigata vata Vatarakta117 Amavata118

Dosha Vata Thridoshaja Vata-Kaphaja

Onset Gradual Gradual Sudden

Progression Constant Increase & Decrease Constant

Joint involvement Big Small Big

Spreading (joint) - Small to Big Big to Small

Swelling Articular & Puffy Articular, Engorged Extra articular,

Pitting

Tenderness (paint) Mild Severe, Burning Severe, Like

Scorpion bite

Crepitus Severe Moderate Absent

Stiffness Severe Severe Moderate

Skin involvement Not involved Involved Not involved

Deformity Present Present Absent

Function Painful, Restricted Restricted, Immobile Painful, Restricted

Response to oil Marked relief Moderate relief Aggreavates

43

OSTEOARTHRITIS Osteoarthritis is a degenerative disorder of the joint and it is classified as

. Primary

. Secondary Primary Osteoarthritis:

Primary OA is also called 'wear and tear' arthritis and degenerative joint

disease. In this, due to risk factors there will be degradation of articular

cartilage which leads to joint narrowing, remodeling of joint by forming

osteophytes and eventually a non functioning, painful joint. Although OA is a non

inflammatory process mild inflammatory changes occur in the synovium. It is also

called idiopathic OA as no predisposing factor is apparent.

Secondary OA:

It has known underlying cause including congential or acquired incongruity of

joints, trauma, crystal deposits etc. But it cannot be distinguished from primary

OA pathologically.

Osteoarthritis is considered as the dynamic repair process of synovial joints. It

is more prevalent in aged persons and it is considered as the very common form

of arthritis.

Osteo arthritis is characterised by:

A Loss of articular cartilage where there is maximum pressure.

A Formation of new bone (Osteophyte) with remodeling of joints.

Most effected joints are knee and hip joint where as knee is most effected than

hip. Osteoarthritis is very common in Elbow, Glenohumeral joint and Ankle joint

also.

44

Effected joints:

Interphallangeal joints

Heberden 's nodes: Enlargement of distal interphallangeal joints.

Bouchard's nodes: Enlargement of proximal interphallangealjoints.

Erosive osteoarthritis: This is present in distal and/or proximal interphallangeal

joints.

Generalised osteoarthritis: Characterised by involvement of three or more joints

or group of joints.

Thumb base osteoarthritis: In this, there will be squared appearance of thumb

base.

Hip osteoarthritis: In this, the pain will be in inguinal area but may be referred

to buttock or proximal thigh. Flexion may be painless initially but internal

rotation will have pain. Loss of internal rotation occurs early, followed by loss of

extension, adduction, and flexion due to capsular fibrosis and/or osteophytes.

Knee osteoarthritis: Knee osteoarthritis will be manifested in these ways.

In medial femotibial compartment: It leads to varus deformity [Bow-leg]

In lateral femotibial compartment: It leads to valgus deformity [Knock-knee]

In patellofemoral OA: There will be positive shrug sign.

Spine osteoarthritis: This involve Apophysial joint, Intervertibral disc,and also

there maybe involvement of paraspinous ligaments.

Pathogenesis:

For the normal functions of the joint, there should be normalcy of the joint

tissues such as cartilage, bone synovium, capsule, ligament, and muscles.

45

In the case of Primary osteoarthritis, the cause is considered as unknown. But

in case of Secondary osteoarthritis, a clear cause of Trauma or ligament rupture

may be important. By the mechanical, metabolic, genetic, and constitutional

loads there may be damage to the parts of synovial joint and there may be need

to repair.

Some times due to the causes, there will be slow but efficient process of

manifestation that lead to anatomically altered but pain free functioning joint.

This is called as Compensated osteoarthritis.

Some times due to the chronic causes or due to poor repair response, there will

be progressive tissue damage and association with more frequent symptoms and

this is called as OA patient with Joint failure.

Cartilage changes:

In normal cartilage, there are no cell division but in the articular cartilage,

chondrocytes metabolically active the cells that are responsible for the synthesis

of cartilage matrix throughout life. Matrix degradation is done by proteolytic

enzymes such as Aggrecanase, which degrades the aggrecan, matrix proteinases[

degrades metal I oproteins ], Collagenase, and Stromelysin.

Chondrocytes increase their production of matrix components and devide to

produce nests of metabolically active chondrocytes. So there will be maximum

degradation and also production of Aggrecan components. But there will be fall

in the concentration of the Aggrecan. The decrease in the size of hydrophilic

Aggrecan molecules increases the water concentration and swelling pressure in

cartilage. There will be further destruction of the Type II collagen and it makes

46

the cartilage incapable to bearing weight. By this condition of cartilage there

will be fissuring of the cartilage surface [Fibrillation], development of deep

vertical clefts, localised chondrocyte death and decreased cartilage thickness.

These all changes are maximum in weight bearing Part of the joint rather than

whole part. The changes in cartilage surface leads to the deposition of Calcium

pyro phosphate and Apatite crystals especially in mid and superficial zones. The

bone below the compromised cartilage increases its trabecularthickness. Holes

(cystS) may develop. As a result there is increased pressure in bones

because cartilages fail in load transmitting function. So there will be production

of new fibrocartilage in the margins of the joints which undergoes endochondral

ossification and forms as Osteophytes. This remodeling and cartilage thickening

slowly alter the shape and the size of the joints. The synovium also shows various

changes in manifestation of Osteoarthritis. Osteochondral bodies commonly

occur in synovium. The Joint capsule also thickens and contracts, usually

retaining the stability of remodeling joint. The skeletal muscle which gives the

strength to joint will shows some fibre atrophy.

Clinical features:

1. Joint pain:

Joint pain is mainly related to the movement, weight bearing and it is relieved

by the rest. Here usually only one or a few joints are painful. The causes for

joint pain in osteoarthritis patients are,

47

Source

1. Synovium Inflammation.

2. Sub chondral bone Medullary hypertension, Micro fractures

3. Osteophyte stretching of periosteal nerve endings.

4. Ligaments Stretch.

5. Capsule Inflammation, Distention.

6. Muscle Spasm.

2. Restricted movement:

Restricted movement is due to Capsular thickening and also by the blocking of

Osteophytes.

3. Crepitus:

Crepitus will be palpable or sometimes audible due to the rough articular

surfaces.

4. Bony swelling:

Bony swelling is seen around joint margins due to the presence of osteophytes.

5. Joint tenderness:

Tenderness is present in joint line or periarticular surfaces.

6. Joint instability.

7. Wasting of muscles.

8. No or only mild synovitis.

Radiographic findings of Osteoarthritis:

The main use of a Radiograph is to assess the severity of structural changes in

the joints.

48

· Focal narrowing of the joint space without evidence of destruction of margins.

Formations of osteophytes at the margins of articular surface osteophytes

areosseous outgrowths of cortical and cancellous bone, which blends with

normalbone beneath it.

·Sub chondral sclerosis.

·Cyst like lesions are seen.

·Osteo chondra' (loose) bodies are sometimes seen.

.Deformities of joints are seen.

.Chondrocalcinosis may be an additional feature particularly in Knee OA

Treatment:

There is no specific treatment for OA. Treatment is mainly advised for

reducing the pain, minimise the disability and also to reduce structural

abnormalities. The following steps are considered as the management of

Osteoarthritis.

For reducing the Pain:

Uses of NSAIDs are advised. Non Steroidal Anti-inflammatory drugs are

medications which, as well as having pain relieving (analgesic) effects, have the

effect of reducing inflammation when used over a period of time.

Full explanation about Osteoarthritis:

· This is to avoid risk factors such as Trauma, Obesity etc.

· Advice about appropriate exercise:

· This should cover both strengthening and aerobics, to strengthening of joints.

· Total joint replacement is required for the minority of people with large joint

Osteoarthritis.

49

In 21st century dietary system, varieties of foods, transportation, style of

work, daily expenditure season's changes are alter alot. But the perpetual concept

of Tridosha Siddhanta mentioned in Veda is still applicable."

The purposes of Ayurveda are to cure the diseases, good dietary system and good

daily expenditures of human beings for four yuga i.e. Ages, therefore Ayurveda is

serviceable in 21st century.

The formation and degeneration of body and diseases is mentioned in

charak Samhita Rasayan Addhyaya Pada two that Total human being diseases are

performed due to dietary consumption system.

(1) Excessive intake of sour, Pungent Salty Rasas.

(2) Food with excess Kshara.

(3) Dry vegetables or preserved vegetables.

(4) Dry meat or preserved meat.

(5) Food with excessive starch contains.

(6) Grain prior to one year like wheat Barley.

(7) Legumes like beans, gram etc.

(8) In compatible food.

(9) Dry food.

(10) Food with various forms like paste, powder of sesame.

(11) Non obeisance/ obesinal food

(12) Sprouted food grains.

(13) Lap

(14) Excessive consumption of food.

50

(15) Daily alcohol comsumption.

(16) ï ï ï ï ï ïï ï ï Abhishyandi food, Mucusy food.

(17) Improper meal timings.

(18) Over coiter.

(19) Excessive exercise

20) Excessive Anger,

Sorrow frighteened.

Due to this

Vitiation and Increase ofVatadi Dashas.

loosening in muscles and tendons

loosening of joints

Vitiation of Rakta Dosha

Less formation of Bone marrow in Bones

Lossening of Body

Low production of shukra Dhatu

Dyspnoea

Loss of Immunity Power Thus human beings cannot enjoy the life of hundred years and he suffers from several diseases.

51

Purpose of selected subject.

In our routine practise we commonly get the patients complaining of joints

and degeneration of bones.

This is now increasing day by day. If we look, defective food habits,

alnutrition factors, defeciency of essential vitamins and minerals in male, health

of female is also badly neglected. Improper diet, post dilevary nigliances worsons

their condition more. Also due to menopause leads to calcium defeciency which

precipitates degenerative bone diseases

There are multiple theropies for the degeneration of bones. But I have

choosen this subject for dessertation because Ayurvedic sages inspried me for

definite remedy of degenerative joint diseases and this is my effort to put a

rayon effective treatment for the same.

52

DRUG REVIEW

Yogaratnakar has described the use of chandanbalalakshadi tail in Sandigata vata

Vyadhi

ï ï ï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï

ï ïï ï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ïï ï ï ï ï ï ï ïï ï ï ïï ïï ï ï ï

ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ïï ïï ï ï ï ï ïï ï ïï ï ï ï ïï ïï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï

ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï

ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ï ï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ïï ïï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ïï ï ïï ïï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï

53

CHANDANïï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï Name - Chandan

Gan - Dahaprashaman, Angamardaprashaman, Trushnanigrahan Varnya,

Tiktaskandha, Kandughna, Vishaghna.

Kul- Chandankul.

Latin Name - Santalum album.

Synonyms – Gandhasar, Malaya, Bhadrashri, Shwetchandan.

Location - Karnataka, Kerala, Tamilnadu, mostly in Malabar.

Useful Part - Kandasar and Tail.

Rasa – Tikta

Vipak - Katu

Veerya - Sheeta

Guna - Ruksha, Laghu

Doshaghnata - Pittaghna, Kaphaghnd, Vatakar.

BALA ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ïï ï ï

ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï Name - Bala Gan - Balya, Brihaniya, Madhurskandha (cha.) Vatasanshaman (su.) Kul - Karpaskul Latin Name - Sida Cordifolia

Synonyms - Bala, Vattyalika, Kharayashtika, Chikatla.

Location - All over India about 1200 metres hights.

Useful Part - Root, Seed, Leaf.

Rasa – Madhur

Vipak - Madhur

Vecrya - Sheet

Guna - Laghu. Snigdha, Pichhil.

Doshaghnata - Vataghna pittaghna

Rogaghnata - Acts as a rasayan, Vajikar used in Dhaurbalya.

54

LAKSHA ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï Name - Laksha

Gana: Stambhana, Savarnikaran, Sandhaniya, Kushthaghna, Krimighna,

Shonitsthapana, Jwaraghna.

Kul- Lakshakul

Latin Name- Coccus Lacca.

Location _ On the branchers of big trees.

Useful Part _ Niryasa.

Rasa _ Kashaya

Guna _ Laghu Snigdha.

Vipak _ Katu

Veerya _ Sheet

Doshaghnata _ Kaphaghna, Pittaghna.

Rogaghnata - Kasa, Jwara, Kushtha, Krimi, acts as a rasayana and Balya.

LAMAJJAKA ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ïï ï ï ï

Name - Lamajjaka.

Latin name - Andropogan jwarancusa

Rasa - Tikta

Vipaka - Katu

Veerya - Anushna

Useful Part - Kanda Taila

Doshaghnata - Tridoshaghna

Rogaghnata - Daha, Raktapitta.

55

USHEER ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ïï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ïï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name - Usheer

Gana - Varnya, Stanyajanan, Dahashaman, Tiktaskandha (cha.) Sariviidi,

Pittasanshamana, (su.)

Kul - Yavkul

Latin Name - Vetiveria Zizanioidis

Synonyms - Nalad, Sevya, Ammrinal, Varitar, Bahumulak, Vala.

Location - South India, Bengal, Rajasthan, Bihar,nagpur, Watery place.

Useful Part - Root

Rasa - Tikta, Madhur

Vipak - Katu

Veerya - Sheeta

Guna - Laghu, Ruksha.

Doshaghnata - Pittaghna, Kaphaghna. Vatakar

Rogaghnata - Jwara, Trushna.

MADHUK

ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ïï ïï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï

ï ïï ï ï ïï ï ï ï Name - Madhuk

Kul - Madhukakul

Latin Name - Madhuca indica.

Synonym - Moh

Location - All over in India about too Mtrs. Hights.

Useful Part - Pushpa, Beeja, Tail, Twachii.

Rasa - Madhur, Kashaya,

Vipak - Madhur

56

Veerya - Sheet

Guna - Guru, Snigdha.

Doshaghnata - Vataghna, Pittaghna

Rogaghnata - Atisar, Grahani, Shwas, Kas Hikka, Mlitrakruchhra, Daha.

SHATAVHA ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name – Satavha

Kul- Shatapushpakul

Latin Name - Foeniculilm Vulgare.

Synonyms - Maclhurika, Aahichhatra, Karvi.

Location - All Over India

Useful Part - Fruit, Root, Tail

Rasa - Madhur, Tikta, Kalu

Vipak - Katu

Veerya -- Sheeta.

Guna - Laghu, Snigdha.

Doshaghnata - Vataghna, Pittaghna

Rogaghnata - Shool, Jwara, acts as deep an and hridya.

KATUKI ï ï ï ïï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï

ï ï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï Name - Katuki

Guna - Bhedaniya, Lekhaniya, Stanyashodhan, Tiktaskandha (cha.) Patoladi,

Pippalyadi, Mustadi (su.)

Kul- Tiktakakul

Latin Name - Picrorhiza, Kurroa.

57

Synonyms - Tikta, Kandaruhii, Shalaparva, Simhi, Chakrangi, Mahaushadhi

Location - In Himalaya, Kashmir, Sikkim.

Useful Part- Steem

Rasa - Tikta

Vipak - Katu

Veerya -- Sheta

Guna- Laghu, Ruksha.

Doshaghnata - Pittaghna, Kaphaghna, Vatakar.

Rogaghnata - Daha, Kushtha, Krimi, acts as a deepan and Hridya.

DEVDARU ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name - Devdaru.

Guna - Stanyashodhan, Anuvasanopag, K'atukaskandha (cha.) Patoladi,Pippalyadi,

Mustiidi (su.)

Kul - Saralkul

Latin Name - Cedrus deodara

Synonyms - Bhadradaru, Shambhay. Snehadaru, Bhutahari.

Location - In Himalaya about 1000 Mtrs. Hights.

Useful Part - Kandasar, Tail

Rasa - Tikta

Vipak - Katu

Veerya - Ushna

Guna - Laghu, Shigdha

Doshaghnata - Kaphaghna , Vataghna, Pittakar

Rogaghnata - Shotha, Jwar, Kandu, Raktashodhak, Amapachak.

58

HARIDRA ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï Name :- Haridra

Guna: - Kushthaghna, Lekhaniya, kandughna, Vishaghna, Titktaskandha,

Shirovirechan( cha.), Haridradi, Mustadi, Shleshmasanshaman( su.).

Latin name- Curcuma longa.

Synonyms- Kanchani, Neesha, Gauri, Krimighna, Varavarini.

Location- Allover India, espetially in South Maharashtra, Bengal,Tamilnadu.

Useful part- Kand

Rasa- Tikta, Katu

Vipak- Katu

Veerya- Katu

Guna- Laghu, Ruksha.

Doshaghnata- Kaphaghna,Pittaghna.

Rogaghnata- Shoth, Kushtha, Shool, acts as a deepan and Vamak.

Kushtha ï ïï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name- Kushtha

Guna- Shukrashodhan, lekhaniya, Asthapanopag( cha)Eladi( su.)

Kul- Bhringarajkul

Latin name- Sasura leppa

Synonyms- Varnya, Utpala, Kashmir, Paushkar,Saugandhik, Padmapatrak

Location- Kashmir, Gadhawal, Himachal Pradesh

Useful part- Root

Rasa- Tikta, Katu, Madhur

Vipak- Katu

Veerya- Ushna

59

Guna- Laghu, Teekshna,Snigdha

Doshaghnata- kaphaghna, Vataghna.

Rogaghnata- kasa, Visarpa, Kushtha, acts as a rasayana and shoolaghna.

Manjishtha ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ïï ï ïï ï ïï ïï ï ï ï

ï ï ï ï ï ï Name- Manjishtha

Guna- Varnya, Vishaghna, Jwaraghna( cha.), priyangwadi, Pittasarishaman(su.)

Kul- Manjishthakul

Latin name- Rubia cordifolia

Synonyms- Vikasa, Rakta, samanga, rohini, tamravalli, vastraranjini.

Location- On hills about 2700mtr. Hights

Useful part- kand

Rasa- Tikta, madhur, Kashaya

Vipak- katu

Veerya- Ushna

Guna- Guru,Ruksha

Doshaghnata- Tridoshaghna

Rogaghnata- Acts as a Raktashodhak and vedanasthapak.

AGARU ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï Name- Agaru

Guna-Sheetaprashamana, Swashar, Shirovirechan( cha.)

Eladi, Shleshmasanshamana( su.)

Kul- Agarukul

Latin name- Aquilaria agallocha

Synonyms- Loha, Krimij, Bhringaj, KIileya, keshya, Vanadrum.

Location-East Himalaya, Asam, Manipur, Bangladesh, Bhutan, Sumatra, Malaya.

Useful part- KIlIidasar,Tail

60

Rasa- Tikta,Katu

Vipak- Katu

Veerya- Ushna

Guna- Laghu, Ruksha, Teekshra

Doshaghnata- Kaphaghna, Viitaghna, Pittavardhak

Rogaghnata- Kasa, Shoth, Shool, acts as a rasayana and vajikarana.

VALA ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

Name :_ Vala

Latin name :- Poyonia odorata wild

Veerya :- Sheet

Uscful part :- Root

Doshaghnata :- Pittaghna, Kaphaghna

Rogaghnata :- Hridrog, Visarpa, Atisar, Acts as Vatanulomak, Balya and Deepan.

ASHWAGANDHA

ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï

ï ï ï ï ï ï Name :- Ashwagandha

Guna :_ Balya, Bhruhaniya, Madhuraskandha ( ch. )

Kul :- Kantakari kul

Latin name :- Withania somnifera.

Synonyms :- Vajigandha, Varada, Balada, Vrusha, Hayapriya.

Location :- All over India, In Himalaya about 1500 m. hights.

Useful part :- Root

Rasa :- Madhur, Tikta, Kashaya.

Vipak :- Madhur

Veerya:- Ushna

Guna :- Laghu, Snigdha

61

Doshaghnata :- Viitaghna, Kaphaghna

Rogaghnata :- Daurbalya, Shool, Acts as Vatanulomak & Deepan.

DARVI

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ïï ï ïï ïï ï ï

ï ï ï ïï ïï ï ïï ï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ïïï ï ï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï Name :- Daruharidra

Guna :- Arshoghna, Kandughna, Lekhaniya (Ch.), Haridradi, Mulyadi, Lakshiidi

(Su.).

Kul :- Haridrakul

Latin Name :- Barberis aristata.

Synonyms :- Kantakari, Pachampacha, Peetikii, Darunishii.

Location :- In Himalaya about 2000 to 3000 m. hights.

Useful part ;- Kanda, Root, Fruit, Rasanjan.

Rasa :- Tikta, Kashaya

Vipak :- Katu

Veerya :- Ushna

Guna ;- Laghu, Ruksha

Doshaghnata :- Pittaghna, Kaphaghna

Rogaghnata ;- Karlashool, Netrabhishyanda, Kandu.

MURVA ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï Name ;- Murva

Kul ;- Arkakul

Latin name :- Marsdenia tenacissma

Synonym :- Morvel

Location :- Himalaya. Assam, South India

Useful part :- Root

Rasa :- Tikta, Kasaya

62

Vipak :- Katu

Veerya :- Ushna

Guna :- Guru, Ruksha

Doshaghnata :- Tridoshaghna

Rogaghnata :- Trishna, Jwara, Kushtha, Kandu, Hridrog.

MUSTAK ï ïï ï ïï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï

ï ï ï ï ï Name :- Nagarmotha

Guna :- Truptighna, Lekhan, Kandughna, Stanyashodhan (Cha.) Mustadi, Vachadi

(Su.)

Kul :- Mustakul

Latin Name :- Cyprus rotundus

Synonyms :- Varid, Jalad, Ghana, Ambuj, Kachhruha, Nagarmotha

Location :- All over India about 2000 m. hights.

Useful part :- Kanda

Rasa :- Tikta, Katu, Kashaya

Vipak :- Katu

Veerya :- Sheeta

Guna :- Laghu, Ruksha

Doshaghnata :- Pittaghna, Vatakar, Kaphaghna

Rogaghnata :-Trishna, Jwara, Acts as Vatanulomak and Deepan.

MULAK ï ï ïï ïï ïï ï ï ï ïï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï

ï ï ïï ï ï ï ï ï ï ï

Namee :- Mulak

Kul :- Rajeekiikul

Latin'Name :- Raphanus sativus

63

Synonyms :- Mula

Location :- All over India about 5000 m. hights.

Useful part :- Kanda, Parna, Beeja.

Rasa :- Katu

Vipak :- Katu

Veerya :- Ushna

Guna :- Teekshna

Doshaghnata :- Tridoshaghna

Rogaghnata :- Jwara, Acts as pachak.

ELA

ï ïï ï ïï ï ï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï

ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï

ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïïï ï ïï ï ïï ï ï ïï ï ïï ï ï ï

ï ï ï ï ï ï Name:- Ela

Gana :- Katukaskandha, Shwashara, Shirovirechan (Cha.) Angamardaprashamana (Su.)

Kul :- Ardrakakul

Latin Name :- Eletlaria cardamomum

Synonyms :- Veldoda, Velchi.

Location :- Karnataka, Kerala, Shrilanka, Brahmadesh, Konkan.

Useful part :- Fruit, Seed.

Rasa :- Katu, Madhur

Vipak :- Madhur

Veerya :- Sheeta Guna :- Laghu, Snigdha, Sukshma. Doshaghnala :- Tridoshaghna Rogaghnata :- Trishna, Jwara, Acts as Vatanulomak and Deepan.

64

TWAK ï ï ï ïï ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï Name :- Twak

Guna :- Eladi (Su), Trijat (Cha.).

Kul :- Karpurkul

Latin Name :- Cinamonum zeylonicum

Synonyms :- Utkta, Tanutwak, Mukhashodhan, Bahugandha

Location :- South India, Shrilanka.

Useful part :- Twak

Rasa :- Katu, Tikta, Madhur.

Vipak :- Madhur

Veerya :- Ushna

Guna :- Laghu, Ruksha, Teekshna.

Doshaghnata :- Tridoshaghna

Rogaghnata :- Trishna, Acts as Balya and Amapachak.

NAGKESAR ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name-- Nagkesar

Guna _ Elacii, Sugandhivarga, priyangwadi, Anjanadi(su.) Chaturjat (Bh. Pr.)

Kul- Nagkesarkul

Latin Name - Musua Ferrea

Synonyms - Nagpushpa, Chinnpeya, Kesar, Kanak, Nagiya kanchanNag

Location - Nepal, Andaman, South India, Konkan

Useful Parts: Punkesar

Rasa - Kashay, Tikta

Vipak - Katu

Veerya - Eshat Ushna

65

Guna - Laghu, Ruksha

Doshghnata - Pittaghna, Kaphaghna, 'Vatakar

Rogaghnata - Shoth, Shoola, All types of vatavyadi

RASNA ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï Name - Rasna,

Kul- Bhrungarajkul

Latin Name - Pluchea Lanceolata,

Synonyms - Yuktarasa, Suvahil, Vasa, Shreyasi, Gandhamula

Useful Parts: Patra, Mula, Panchallg

Rasa - Tikta

Vipak - Katu

Veerya- Ushna

Doshghnata - Kaphaghna,

Rogaghnata - ShooI, Amvat, Vatavyadhi

KETAKI ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ïï ï ïï ïï ï ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï Name - Ketaki

Kul- Ketaki

Latin Name - Pandanus Odorotissimus

Synonyms - Kewada

Location - At Seashore, Watery Place, Orissa, Andhra, Tamilnadu, Konkan

Useful Parts: Pushpa, Root,

Rasa - Madhur, Tikta, Katu

66

Vipak - Katu

Veerya - Ushna

Guna - Laghu, Snigdha

Doshghnata - Tridoshghna Especially Kaphapittaghna

Rogaghnata - Shoth, Krumi, Raktavikar

CHAMPAK ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï Name - Champak

Kul- Champak kul

Latin Name - Michelia Champaca

'synonyms - Sonchapha, Champha,

Location - Allover India.

Useful Parts: Pushpa, Twacha

Rasa - Tikta, Katu, Kasaya,

Vipak - Katu

Veerya - Sheet

Guna - Laghu, Ruksha

Doshghnata - Pittaghna, Kaphaghna,

Rogaghnata - Shoth, Raktavikar

SARIVA

ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ï ïï ïï ï ï ï ïï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï Name - Sariva

Guna - Stanyashodhan, Dahaprashaman, Jwarahara (cha.) Sarivadi,

Vidarigandhadi, Vallipanchamula, (Su.)

Kul - Ark kul

Latin Name - Hemidesmus indicus+

67

Synonyms - Shweta, Sugandha, Sharadi, Gopi, Krushodari

Location - All Over India

Useful Parts: Root

Rasa - Madhur, Tikta

Vipak - Madhur

Veerya - Sheet

Guna - Guru, Snigdha

Doshghnata - Vataghna, Pittaghna, Kaphaghna,

Rogaghnata - .Jwara , Kasa acts as a rasayana, Balya.

SHILA RAS Synonyms - Shaileya, Ashmaj, Adrijat, Gaireya, Girija, Shilaswed, Shilamaya,

Ashmalaksha. Black Bitumen, mineral Pitch.

Composition- Minerals, Organic Products, water, Nitrogenous Products, Lime,

Mica Location - Kashmir, Bhutan, Tibet, in Mountainious area

Types: 1) Gomutra Shilajatu, 2) Karpur Shiliijatu

Rasa - Teekta, Katll

Vipak - Katu

Veerya - Ushna

Guna - Rasayan, Yogwahi, Chhedi

Doshaghnata -'Kaphaghna,

Rogaghnata - Prameha, Mutrashmari, mutrajkruchhtra, Pandu, skin disease,

medohar.

KHADISAKHAR Name: Sugarcane (Ikshu)

Latin Name: Saccharum Officinarum

Rasa : Madhur

Vipak : Madhur

Veerya: Sheet

Guna: Guru, Sheet

Doshghnata : Pittaghna, Kaphakar.

68

SAINDHAV

Location: Mountainous area, in the river bed of Sindhu

Physical Properties: Red Coloured Crystals .

Composition: Sodium Chloride & Minerals

Synonyms: Shendelon

Uses: Used in Medicine, In North India used in foods

BIDALAVAN

Composition : Saindhav, Haritaki & Sodium Carbonate or Romak Lavan & Amalki

Powder

Properties: Ruchya, Pachan, Deepan, Vatanulomana.

TILA TAIL

In this preparation of tail, Tila tail is used as a base.

ï ï ïïï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï

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ï

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ï ïï ï ïï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ïï ï ï ïï ï

ï ï ïï ïï ï ï ïï ï ï ï ï ïï ï ï ïï ï ïï ï

ï ïï ï ï ïï ï ï ï ï ï ï ï

69

In all types of sneha mostly tail is used.In all types of tails tila tail is the best.

Tila tail is guru(heavy), it increases body strength, helps to make complexion

fair, helps to reach the drug at proper site quickly. It is madhur with kashaya

anuras, Tikta vipak and Ushna veerya. It decreases vata dosha and kaphadosha

therefore used in vataj and kaphaj disorders. It causes Raktapitta vyadhi when

used In excess quantity. It acts as a lekhana, garbhashayashodhana, deepana

medhya, vyavayi, i.e. helps in wound healing and diabetic disorders. Shrotra,

yoni and shira shoolnashak i.e. it acts as a pain killer, laghutekar, helps in

nourishment of the skin, helps in growing hairs, helps in sprain and in

physiotherapy after accidents. Used in basti, pana, abhyanga, nasya and

karnapoorana. It is very effective in seka, abhyanga and avagaha.

Tila tail increases the property of drugs with which it get mixed i.e. it acts as a

catalyst.

Tila tail is Agneya i.e. Ushna,Teekshna, vishada, vikasi, sara,Krumighna. It sesses

urine and stool (it stops expelling of urine and stool out of body), makes body

soft.

INDICATIONS FOR TILA TAIL ABHYANGA:

1) Patients having kaphavruddhi and medovruddhi.

2) Patients of vatavyadhi.

3) Patients of vatapradhan prakruti.

4) For increasing strength.

5) To reduce obesity.

6) To make the body laghu.

70

7) To make the body organs strong.

8) To make the skin snigdha (oily), tanu and shlakshlna(soft).

9) Patients having krurkoshtha.

10) For healing Nadivrana.

CHANDANBALALAKSHADI TAIL contains the following drugs or medicines.Its Name,

Kul, Latine name, Useful parts, Properties i.e. rasa, vipak, veerya and guna,

Doshaghnata and Rogaghnata, etc. mentioned in the chart given below.

SNEHANA Internal and External

ï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ïï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ï ï Def:- The process in which body becomes Snigdha (unctous), Mrudu (soft), Drava

(Liquid) & Picchila (Sliney) is called Snehana.

Snehana is essential for to get rid of vatapradhan disorders. For Snehana various

Snehanadravyas are used in various forms.

Snehana is the first 'Upakrama' of six upakramas (Shadupakrama) described

Samhita.

ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ïï ï ïï ï ïï ïï ï ï

Shadupakramas are as follows:

I. Snehan

2. Swedan

3. Langhan

4. Rukshan

5. Stambhan

6. Brumhana

71

Properties of Snehadravyas:-

Properties of Snehadravyas are as described in following sutra:-

ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ïï ï ï ï ïï ï ï

ï ï ïï ï ïï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï

i.e.

I) Guru (heavy)

2) Sheeta (cold).

3) Sara (spreader)

4) Snigdha (unctous)

5) Manda (Sluggish)

6) Sukshma (subtile)

7) Mrudu (Soft)

8) Drava (liquid)

Classification of Sneha: On the basis of following criteria various types of Sneha has been described:

1. Origin

2. Action on body

3. Quantity

4. Process of-Formulation

5. Combination with other Sneha

6. Sneha Administration

7. Defination

1. According to its origin there are two types of sneha:

a. Sthavar Sneha: plant originated

b. Jangam Sneha: animal originated

72

2. According to its action on the body there are three types of Sneha:

a. Shodhan Sneha - by its doshvilayan and doshotkleshan action it brings

vitiated doshas in koshtha and they are expelled out by urdhva and adho

marg.

b. Shaman Sneha - This reduced and pacifies the provocated doshas.

c. BruhanSneha - by its agnideepan action mansa, meda, majja and shukra

dhatus are increased which gives strength to the body.

3. according Matra (quantity) there are four ty'pes of sneha:

a.Hrasiyasi Matra (Test Dose) - it is given to confirm the dose of sneha

according to dosh, dushya, Sharirabal and agnibala of the patient. It is

usually given to Bala & Vruddha Patient

b. Hraswa Matrta - it digests in six hours patients whose koshtha is mrudu

and agni is alpa are given hraswa matra.

c. Madhyam matra- patient whose koshtha, bala, dosh and agni is

madhyam are given sneha in madhyam matra. The matra should be

digested with in twelve hours.

d. Uttama Matra - patient whose dosha and bala are maxImum and agni is

tekhna) are given sneha in uttam matra. This matra should be digested in

24 hours.

4. Accoring to piikabheda (method of preparation):

There are three types of snehaa pakas.

a. Mrudu pak - it is heated for small time. It is used for nasyakarma.

73

b. Madhyam Pak- it is heated for well preparation. It is used for pan and

basti.

c. Kharapak- it is heated till becomes Khara. It is used for abhyang.

5. According to Mishrama Bhed or combination with other sneha:

There are three types of sneha

a. yamal sneha: the sneha in which two sneha are mixed with each other

Le. sarpi+tail

b. trivrutta sneha: the sneha in which three snehas are mixed with each

other that is sarpi+tail + vasa.

c. Mahasneha: the sneha in which four snehas are mixed with each other

Le. sarpi +tail+vasa+majja

6. According to upayog bheda that is way of administration:

There are two types of sneha

a. Bahya sneha - Abhyang, lep, mardan, udvartan, sarhvahan,

padaghataja, murdhatail, gandush, karnapuran, netratarpan, parishek. Pichu etc

are included in bahya sneha.

b. Abhyantar Sneha- bhojan nasya, pan, basti, etc are included abhyantar

sneha.

7. According to satidnyabheda i.e. definition;

There are three types of sneha

a. Achhapan- without mixing any other drug when only sneha is given to

the patient it is called as acchapan. It is large in quantity and acts rapidly

74

b. Sadyasneha - when snehan occurs within short period of time it is called

as sadyasneha.

c. Panchprasutiki peya - by taking Ghrut, tail, vasa, majja, and shali (rice)

One pal each pancha prasutiki peya is prapared.

In this thesis we discuss about chandan-bala-Iakshadi tail pan in

dhatukshyajanya dah (i.e. abhyantar snehan). After that we also discussed about

bahyasneha pan.

ABHYANTAR SNEHAPAN

Abhyaritar Snehapan is one of the important theropy in Ayurvedic chikitsa which

is commonly used to treat various vat Vyadhis as well as pitta and kapha vyadhis.

In abhyantar snehan sneh which is liquid form is to be given orally.

According to its action on the body that is according to karmabhed there are

three types of sneha

1. Shaman shena;

2. Brumha sneha:

3. Shodhan Sneha:

as described before

Indications for snehan:

ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ïïï ï ï ï ïï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

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ï ï ïï ï ï ï ï

75

The patients who require snehan chikitsa are as follows:

1. patients requiring swedan

2.Patients who requires shodhan i.e. vaman, virechan, nasya etc

3. Patients having rukshata (dryness)

4. Patients having vat vyadhi

5. Patients exsoting regularly

6. Patients consuming alcohol regularly

7. Patients who worries continuously

8. Patients who has worriers

9. Patients having lean and thin body

10. Old, young and female patients

II. Patients having kshinarakta, kshinavirya,

12. Patients having abhishyanda, teemir and krushtrnomilana

Contra indications of sneha:

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ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ï ïï ï ï ïï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ïï ï ï

ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï Patient who dose not require snehana chikitsa are as follows

I. Patient who has been asked to undergo rukshasa chikitsa only.

2. Patients having excessive kapha and meda.

3. Patients having abhishyaInna anana and abhishyanna guda

76

4. Patients having manda agni i.e. low digestive capacity

5. Patients having trushna and murccha

6. Pregnant women

7. Patients having talu shosh i.e. dryness of palate

8. Patients of anorexia i.e. annadwesha, aruchi

9. Patients having chhardi

10. Patients of udar rog, amadosh and visharoga

11. Weak patients

12. Patients having klama i.e fatique

13. Patients who are indicated for nasya

14. Patients who are indicated for basti

15. Patients having indigestion

16. Patients of tarni jwara, akala prasuti

17. Patients of urustarhbha and atittkshna agni

18. Obese patients

SHAMANA SNEHANA ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï The sneha which does not allow to provocate doshas and pacifies them (a

provocated doshas) is called as shaman snehana.

Indication:

When patients feel hungry then in empty stomach only,sneha is given. It should

be given in madhyam matra. Food should not be given to the patient till sneha

get totally digested. Sneha should be given in medicated or in plane form. As it is

given in empty stomach before breakfast and before dinner it gets absorbed

77

quickly. As sneha matra is madhyam it get digested a properly and patients get

relief immediately in vatpradhan vyadhi.

Uses of sneha:

1.Sneha helps to decrease the vata dosha

2. It also helps to treat the other doshas.

3.It increases digestive power i.e.agnideepti---Dhatwagni deepti

jataharagni deepti

4. It clears the digestive system (koshtha shuddhi)

5. It has ability to form new cells i.e. Dhatunirmiti

6. Built up the body

7. Increases strength of body.

8. It provides vital strength to body which helps to keep good health.

9. Delays ageing prosess.

10. It helps to keep skin smooth make it shiney and. improves the general

complexion.

II. It also increase immunity power

12. It neurishes all seven dhatus

13. It destroys malasanghat

14. It helps to make indriyas stronge. so that they works actively.

I5. It increases Life span

78

Material And Methods While conducting this project the material used and methodology adopted as

Follows:-

1) Literary Review : Review of Ayurvedic text and samhitas was done thoroughly. References of

Dhatukshayajanya sandigata vata and Chandanbalalakshadi Tail from

Yogratnakar, Haritsarhhita, Sharangdhar samhita, Madhav nidan, Vangasen were

collected and studied.

There is no direct mention of Dhatukshayajanya sandigata vata in Bruhadtrayi

but concept of Dhatukshaya has been mentioned in it. It was also studied

thoroughly there is involvement of vatadosha in Dhatukshayajana

sadndigatavata.To understand the pathogenesis of Dharukshayajana

sandigatavata study of vata dosha is useful. Refferences from different·

manuscripts were collected and compiled. Research work done previously by

different scholars in this field was also collected and studied thoroughly. It was

used as preliminary data for present study.

Thus the references from research work done previously were collected, studied

and compiled in the proper manner.

79

Materials:

In the present investigations/ study following materials have been used.

1. Patients of Dhatukshayajana sandigata vata

a) Inclusion crateria

i) Patients were selected according to signs and symptoms mentioned in samhitas

for Dhatukshayajanya sadigatavata

ii) Patients were selected irrespective of sex, prakruti, religion etc.

iii) Adults of age bet 20 to 70 years

b) Exclusion criteria i) The patient who could not come for follow up as per shedulc

ii) Patients below 20 yrs. and above 70 yrs

iii) Patients having pregnancy

v) Snehavarjit Patients

Place of Reseach :- This study was carried out at the centre for Post Graduate Studies and Research

in Ayurved, Tilak Ayurved Maha Vidyalaya, Pune and Seth Tarachand Ramnath

Ayurved Hospital Pune.Srideepthi rheumatology center,Hyderabad.

Informed Consnt

The Subjects undergoing this study were informed about the same and written concnt

for each subject in all groups was taken.

Selection and prepration of drug Chandanbalalakshadi Tail.

80

Chandanbalalakshadi Tail prepared by Ayurved Rasasala Pune, India was used for

internal and Basti medication in each study groups respectively.

Methodology

Clinical Study:

The present study is totally based on clinical observations and information

provided by the patient. The patients selected for this study have been treated

with chandanbalalakshadi Tail to see the efficacy of tail it is used externally as

bahyasneha and internally as pan (abhyafltar snehan).

DETAILED RESERCH PLAN

This study was carried at two levels

Level –

standardization & Toxicity studies of the drug (Chandanabala lakshadhi tail and

tila tail)standardization done at Institute of preventive medicine, public

health, food and labs. Narayanaguda Hyderabad.Toxicity study or (LD50 study)

were carried out in same above referred laboratory. As per report drug dose was

admitted.

This drug prepared by AYURVEDA RASA SHALA, PUNE is already used by

M.D. students of Tilak Ayurved Mahavidyalaya, Pune. Dr. Sashikhanth

kshirasagar,for Pana study Dr.Sangeetha jogdand for abyangana study and

Dr.Vasundhara Borahade for Basti study.

Level – 2

Study of 200 patients of different route of administration

81

STUDY DESIGN

A study was designed as a parallel group drug controlled 3 weeks duration

determining efficacy of Chandana Bala Lakshadi Tail in Dhatukshaya Janya

Sandigatavata, enrolled patients were randomly assigned to Chandana Bala

Lakshadi Tail and Til tail group. Efficacy and safety data were collected on

every visit.

S.No. Particulars Day 1 Day 8 Day 15 Day 22 Day 28

1 Complete History

2 Informed Consent

3 Physical Examination

4 Body Weight

5 Blood Pressure

6 Case Paper recording

7 Pain assessment

8 Assessment of degenerative symptoms

9 SLR test

10 Doctor’s assessment

11 Laboratory Investigation

12 WOMAC & VAS

82

STUDY FLOW CHART

Screening of Subject

(Counseling and Written informed Concern)

Randomization (Investigations & Xrays)

Group A Group B Group C Group D Chandabala LakshadiTail Chandabala LakshadiTail Til Tail Til Tail

Pana Basti Pana Basti

Initial Assesment

Womac Scale VAS Physion Global Assisment Patient Global Assisment

Intervention

follow up of day 8th ,14th ,21st,28th, and Assessment

Final Assessment

Statistical Analysis

Conclusion

83

DRUG ADMINISTRATION:-

IS ON THE BASIS OF STANDARD OPRTATION PROCEDURE(SOP): Treatment Given

Group A Group B Group C Group D

Dosage 30ml CBL Tail 60ml CBL Tail 30ml Til Tail 60ml Til Tail Time Morning 8A.M.

on Empty Stomach

Morning 8A.M. on Empty Stomach

Morning 8A.M. on Empty Stomach

Morning 8A.M. on Empty Stomach

Anupan Warm Water Warm Water Route of Administration

Oral Anal Oral Anal

Treatment Period

21 days 21 days 21 days 21 days

Follow of Days 0-7-14-21-28 0-7-14-21-28 0-7-14-21-28 0-7-14-21-28 Note follow up was every month up to 1 year. END POINTS

Patients were evaluated at week 1,2,3 and week 4. The global pain intensity of

the studied knee during physical action for the 4 weeks. 100mm VAS the

patients global assessment of knee OA for the past 3 weeks. The WOMAC for

physical function 24 subscal 100mm VAS and score was assessed signs and

symptoms suggestive of Shota also recorded nocturnal pain interfering with sleep

duration of morning stiffness, joint effusion and a sudden increase of pain during

previous weeks. The primary end point was 40% decrease of the global pain

intensity during physical activities for the past 4 weeks. Secondary end point

were responses to treatment with the maximum decrease in global pain intensity

set by 50% and 80% differences in score from the baseline for global pain

intensity and patient’s global assent of knee OA seventy. Normalized WOMAC

Score. A patient was defined as a responder when they had a 45% decrease of

pain intensity and 30-40mm decrease of VAS.

84

- 45% decrease of pain intensity and 40mm decrease on ,VAS.

- 55% decrease of OA seven and 60mm of VAS.

- 70% decrease of the WOMAC (function) score – 60mm of VAS.

The primary end point criteria of Therapeutic intervention with Chandana Bala

Lakshadi Tail in Dhatu Janya Sandigata Vata. The secondary end point to

confirm the efficacy of Chandana Bala Laksha Tail in different route of

administration in group IIB trial.

PREDICTIVE FACTORS OF RESPONSE

The following patient’s characteristics were collected at baseline. Because they

were expected to be predictive factors of the response to treatment

demographic (age, weight, height, sex) residence (rural or town) occupation

(sedentary physical or other) details of the condition (OA location on the studied

knee and involvement of other particular locations) signs and symptoms

suggestive of inflammation (Shota) on physical examination local or systemic

etiological factors were collected in order to classify Sandigata Vata Assessment

of the Radiographic severity grading of the Sandigata Vata was by Kellgren and

Lawrence grading scale.

SAMPLE SIZE DETERMINATION

Sample size calculation was based on the primary end point i.e. the percentage

of patients responding treatment after 3 weeks in the drug control group and

estimated percentage of responders was 60-70% in CBL Group.

85

The number of patients is treated in this study is 200Cross over study method

Three groups of 50patients each were made

1) Group A – 50 (PANA) 30 ml of Chandana bala lakhadi tail by orally.with

anupana of ushna jal.

2) Group B – 50 (BASTI) 60 ml of Chandana bala lakhadi tail matra basti.

2) Group C – 50 (CONTROL) Tila Tail Pana

4) Group D – 50 (CONTROL) Tilatail Basti

Follow ups:

Follow ups had been taken on 7th, 14th and 21 th days. Each patient was

followed / thoroughly after every week or 7 days for three weeks i.e. 21 days.

Three follow ups after initial notings were done of each patient. Detail history of

the patient was noted on the case paper with signs and symptoms according to

severity. Changes in the signs and symptoms in each follow up were observed and

noted in the case paper in tabular form.

Study Evaluation:

According to Ayuvedic symptomatology all the signs and symptoms were noted.

As per need subjective criteria were counted in the severity index. They were

graded according to severity. For objective, evaluated severity index was

prepared.

For this VAS [visual Analog Scale] index was considered.AII the clinical

observations have been made and also recorded in tabular & graphical form. The

results after treatment of each group have been compared with each other.

86

Womac scale: - The western Ontario and McMaster Osteoarhthrits

Index(WOMAC)is a disease specific,Self-administered, health status measure of

symptoms and physical disability.The WOMAC is considered the leading outcome

measure for patients with OA of the lower extremities,Evidence for the scales

test-retest reliability, validiy, and responsiveness in OA.

The WOMAC has 24 questions that evaluate 3 areas :pain:stiffness,and physical

funcation.Each question that using a likert scale from 0 to 4, with lower scores

indicating lower levels of health.Summing the scores of each area produses a

global WOMAC score.The higher the score, the better the health status.

Studies of Symptom Modification

Disease-Specific Measures

As pain is the most important symptom of OA, measurement of pain and its

improvement with therapy is often the primary outcome variable in RCI’s of

symptom-modifying therapy. In 1981, Bellamy undertook the development of an

evaluative index, the Western Ontario and McMaster Universities (WOMAC) OA

Index, using self-report to assess specifically OA of the knee and hip. The

conceptual basis of the index, derivation of the item inventory, and results of

validatioin studies have been described extensively elsewhere and are only

briefly reviewed here. Questionnaire items were selected according to responses

from 100 patients with OA on the basis of their prevalence, frequency and

importance to the patient. The final WOMAC includes a total of 24 questioins

87

divided into three sections; pain (five questioins), stiffness (two questioins), and

function (seventeen questions) (Table). The questions probe symptoms of, and

clinically important events affected by lower limb OA and are answered by use of

either a 5-point Likert scale of a 10-cm VAS. An eight-item short form of the

WOMAC has been validated to enhance efficiency of use in RCT s and clinical

practice. The WOMAC has been translated into most European languages and has

been shown to be valid, reliable and responsive in studies of patients undergoing

total joint arthroplasty and in clinical trials of nonsteroidal anti inflammatory

drugs (NSAIDs) and traditional Chinese acupuncture. Although results have been

reported on the basis of a single questioin in the pain section, such as pain with

walking on a flat surface and as a total WOMAC score summing the three

subscales, the use of domain-specific scores, especially for pain and functioin, is

preferable.

Pain Subscale Walking on a flat surface

Going up or down stairs

At night while in bed

Sitting or lying

Standing upright

Stiffness Subscale

Severity after first awakening in the morning

Severity afte sitting, lying, or resting later in the

day

88

Physical Function Subscale Going down stairs

Going up stairs

Standing up fom sitting

Standing

Bending to the floor

Walking on a flat surface

Getting in or out of the car,

Or getting on or off a bus

Going shopping

Putting on your socks or stockings

Rising from bed

Taking off your socks or stockings

Lying in bed

Getting in or out of the bath

Sitting

Getting on or off the toilet

Performing heavy domestic duties

Performing light domestic duties

Creamer and colleagues examined the relationship between the pain subscale of

the WOMAC OA index, the McGill Pain Questionnaire and a single 10-cm VAS pain

rating scale in 68 outpatients with OA of the knee. Although all three scales

correlated with one another, the strongest correlation was between the WOMAC

89

paina scale and the single 10-cm VAS pain scale. Severity of anxiety, depression

and fatigue all showed significant modest correlation with the McGill pain score,

whereas none significantly correlated with the WOMAC pain score. On the other

hand, total osteophyte score combining the tibiofemoral and patellofemoral

joints correlated significantly with the WOMAC pain score but not with the McGill

pain score. Largely on the basis of these findings, the authors concluded that

the WOMAC pain scale should be the preferred measure of pain in clinical studies

of patients with knee OA.

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91

Method of Assesement of Severity Index Visual Analog scale (VAS) There is a 10 cm horizontal line, for each week pain marking.

There is a 'O'cm marking on left hand side end and marking of 10 cm on right

hand side end.

0-------indicates obsolutely no pain 10-----indicates severe most pain

92

each centimetre indicates digits from 0 to 10. Patients were asked to grade their

pain and define according in numbers. Then draw a line on VAS chart.

i.e.

*------------------------------------------*

Ocm 10 cm The relif in Pain for VAS is calculated according to following formula.

IpO - IpL Precentage Pain reIief == -------------------- x 100 IpO where, IpO = Intensity of Burning sensation/ pain on Olh day i.e. before treatment.

IpL = Intensity or Burning sensation/ pain on last day of treatment. Criteria of Assessement:-

Change in the severity index was the prIme criteria of assessement. The

changes in the signs and symptoms were observed carefully and noted

properly.Change in burning sensation assessment by VAS pain chart is considered

as desiding factor.Graphical and Tabular analysis was done and proper statistical

methods were applied.

Observations:-

Total 200 patients were registered in this study. There was 1 to2 dropout. Each

patient was observed thoroughly and noted neatly. The observations were

recorded and necessary charts and graphs were made.

Statistical method:-

All observations are noted Changes in mean of severity before and after

treatment was calculated.standerd errors, standerd deviation and D.F.were also

calculated. Proper statistical methods were applied for the analysis of the

collected data. The cross over study between two groups of subject and

assessment of drug before and after between two groups was done.

A disscusion on the result was done and proper conclusion on the basis of

observation and all findings was drawn.

93

The details are explained in next topics.

Vata Dosha Gati. Vata Dosha when balanced causes heath vice versa Progression of vitiated vata

dosha along with various pathways leads to menifestation of the disease . Thus

different modes of Dosha Gati have to be considered.

Dosha Gati listed in Charak Samhita. ï ï ï Decrease ï ï ï ï Normality ï ïï ï ï ï Increase ï ï ï ïï Urdhva Upward direction. ï ï Adha Downward direction ï ï ï ïï ï ïï Tiryak Slanting direction from koshtha to shakha.

ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï Internal Channel

ï ï ï ï ï ï ï ï ï ï ï ï ïï ï External Channel

ï ï ï ïï ï ï ï ï ïï ï ï ï Middle Channel.

Types ï ï ï ïï ï ï ï ï Normal ï ïï ïï ï ï ï ï Abnormal Normal Gati of Dosha IS responsible for health and equilibrium. The disequilibrium ( ï ï ï ï ï ) is of 3 types. 1) Dusti - Vitiation

2) Vruddhi - Increase.

3) Kshaya - Decrease.

Here we will consider vanous stages of manifestation of degeneration of bone by

increased vata dosha.

94

The Abnormal condition of vata Dosha IS responsible for manifestation of

degeneration of bones.

Various stages of manifestation of degeneration of bones by increased vata.

1) Sanchaya - Stage of accumulation.

2) Prakopa - Stage of provocation.

3) Prasara - Stage of diffusion.

4) Sthansanshraya - Stage of location.

5) Vyakti - Representation of signs of disease.

6) Bheda - Stage of termination.

Symptoms of vata Dosha.

1) Sanchava - Stage of accumulation.

ï ï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï

Owing to vata Stiffness, full ness of the abdomen.

2)Prakopa - State of provocation.

ï ïï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï

ï

ï ï ï ï ï ï Vitiated vata when increases upto maximum limits it creates pricking

pain, gas distension and movements in the Kostha.

3) Prasara - State of diffusion.ï

ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï

ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ïï ïïï ï ï ï ï ï ï ïï ï ï ïï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï

ï ïï ï ï ïï ï ï ï Vata dosha have Rajo Guna ( ï ï ï ïï ïï ) which is known as stimulent for

activity. So vata dosha have only motion than other dosha, dhatu & mala.

95

Route of vitiated vata dosha is to speread all over body through 3 margas

i.e.channels and creates the several diseases, Here we consider middle channel

as bones and Joints.

4) Sthansanshraya - State of location. ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï

ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Here vitiated and increased vata plays an important role. When it spreads

& moves and comes in contact with impared bones & joints, it gets stagnated

and causes degenerative bone diseases.

5) Vvakti (Manifestation) ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï

There is actual menifestation of signs of Asthi kshaya.

6) Bheda (Stage of termination)

Here termination of vitiation process takes place. If the invading factors are too

strong the person may suffer dissolution.

In Asthi Kshaya in Bheda vastha dislocation of joints and fracture may happen.

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï

Standard Treatment of Vata Dosha

ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ïï ï ïï ï ïï ïï ï ï

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ï

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ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï

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ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï

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ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ïï ï ïï ïï ï ï ï ïï ï ïï ï ï ï

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ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ï

ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ïï ï ïï ï ïï ï ïï ï ïï ï ïï ïï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï

ï

ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ïï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ïï ï ï ïï ï ïï ïï ï ï ï ï ï ï

ï

ï

ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ïïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï

ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï

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ï

ï ïï ï ïï ï ï ï ï ïï ï ïï ï ïï ï ï ï ïï ï ïï ï ï ï ïï ï ï

99

ï ï ï ïï ï ïï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïïï ïï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï

ï

ï

ï ï ï ï ï ï

ï ï ïï ï ï ï ï ï ï

ï ï ï ï ï ïï ï

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ï

ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï

ï

ï ï ïï ï ïï ï ï ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ïï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï

of enema spreads all over the body through channels as essence of water irrigated at the root of tree pervodes the entire tree.

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

If unctuous enema is administered to them the diseases become incurable and in case of incurability there is severe malaise in the body parts.

ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ïï ï ï ï ï

100

ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï

ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ïï ï ï ï ï ï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï

The essence of medicated enema acts first on Aapana Vayu, then acts on samana vayu. Then it acts on vyana, udana and prana vayu. Thus medicated enema spreads all over the body which gives nourishment of body ultimately. Also the conversion of essence of enema takes place with the help of Bhootagni and Dhatwagni. It nourishes all the body.

Action of Basti Basti

Apana

Samana

Vyana Udana Prana

Normal direction of vata

Prana Site

Upwards Murdha

Udana Urasthana

Upwards

101

Vyana Hridaya Samana Aanta Kostha

Near Agni

Apana Site

Down wards Pakwashaya

ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï

ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Though enema by its force comes back alone or with excrements the

active fraction is carried to all parts of body by Apana etc.

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï

Enema though situated in large intestines draws out impurities from head

to feet by its essence as sun takes away sap of earth even staying in the sky. The

enema properly applied stirs up accumulation of doshas located in waist back

lumber region and eliminates after eradicating it. ï

ï ï ï ïïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ïï ïï ï ï ï ïïï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïïï ï ï ï ïï ï ïï ï ïï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Vata is the master in the aggravation of three doshas and such when it is

much advanced and afflicts the body no other remedy except enema can check

its force as coast checks the force of tides of sea.

102

Enema applied properly and regularly promotes development complexion

strength immunity and life span.

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ïï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï

ï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï

ï ïï ï ï ïï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Route of sneha Basti

ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ïï ï ï ïï ïï ï ï ï

ï ï ï ïï ïï ï ï ï ï ï ïïï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï

ï ï ïï ï ï ïï ï ïïï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ïï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï

ï ï ïï ï ïï ïï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ïï ïï ï ï ï ï ïï ï ï ï ïï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï

1. Enema applied first provides unction to pelvis and inguinal region.

2. The second one over comes vata situated in the head.

3. The third pro mates strength and complexion.

4. Fourth provide unction of Rasa.

5. Fifth provide unction ofRatka.

6. Sixth provide unction of Mamsa.

7. Seventh provide unction ofMeda.

8. Eighth provides unction of Asthi.

9. Ninth provides unction ofMajja.

103

Similarly eighteen such enema properly applied eliminate the disorder of

seman.

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ïï ï ï

ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï

ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ïï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï

One who uses regularly course of eighteen enemas such with aforesaid

method and prescribed restrictions attains strength of elephant power of horse,

and becomes like god free of sins with excellent memory and have life span of

thousand years.

Basti performs these actions mainly due to its essence. The essence of drug is

observed through out its stay / existence in the body beginning from its

introduction in the body.

Dravya Sahacharya ( Adhivasa ) with Aashaya and Kala

Basti has action on Kala (Membranes and permiability)

Upsnehana and upswedana (Effusion and obsorption of Basti drug)

It prevedes from kala to other (Permeates) in Rasa dhatu

Enters in to Rasa dhatu.

Moves all over the body and performs different actions.

It acts on middle channel, osteogenic action of bones takes place from

Rasa to Asthi by , Ksheer Dadhi Nyaya ' .

104

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï

Purish dhara kala is known as Asthi dhara kala means nourishment and

osteogenic action takes place in Purisha dhara kala.

Vata Dosha and Agni two important factors are related to Purish dhara

kala. When purisha is vitiated it effects vata which have interdependent

relationship with bones and when vata dosha is vitiated and increased

degeneration process at bones starts. Agni is affected the process of disjoining

also affects. Osteogenetic action can not take properly and the process of

degeneration starts. Chandan Bala lakshadi Tail matra Basti conteracts vitiated

and increased vata due its opposite properties related vata dosha and further

degeneration of bones stops.

Enema gIves good lubrication to Purisha Dhara Kala. It removes waste

products from purisha dhara kala. Work of agni improves and disjoining and

formation of nourishing part and waste part also improves.

Method of Administration of Basti.

Matra Basti were administrated by standard textual method.

Position

Left lateral position was given to patient for Matra Basti. ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

As the organ of assimilation and the rectum are situated on left side of the

body, the enema will be taken well by the person who is lying on his left side,

and as the fold is lying on his left side, and as the folds and valves of the rectum

get straightened out it is said that get straightened out it is said, that the enema

should be administered to the patient while he is lying on his left side.

Instruments - 1. Glycerine syringe

105

2. Simple rubber catheier No.9.

Preperation of Patient.

Sneha basti should not be gIVen when patient is empty stomach. Matra

basti should be given to patient after his food or light break fast. External

oleation and Fomentation should be done as preprocedure.

Process of Administration of Basti

60 ml. Of Chandan Bala Lakshadi Tail should be make luke worm. Oil

should be taken in glycerine syringe. Simple rubber catheter should joined to

glycerine synnge. Oleation of catheter should be done for easy passage through

anus. Air from the catheter should be removed by pushing some oil into catheter.

Left lateral position should be given to the patient. Patient should make deep

breath which relaxes spincter of anus and catheter could pass easily in the anus.

Push the oil from glycerine syringe slowly during the procedure. Remove catheter

from anus when procedure is overed.

Ask the patient to lie down in same position for 10 to 15 minutes for

retension of Basti. Light strokes should be given on back, gluteal region and legs.

When Purisha Vega with Vata prakopa comes during the process of giving basti,

allow the patient to pass his stool. Basti should be given again to patient.

Pathya for Basti.

1. Mudga Yusha 2. Mansa Rasa 3. Cow Milk Next matra basti should be given on next day after excretion of urine and

stool. i.e. Pratyagama of previous basti.

Complications can be happen by giving sneha basti on empty stomach.

1. A varana of sneha to vata

2. A varana of sneha to pitta

3. A varana of sneha to kapha.

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When food is taken metabolic actions ofvatadi dosha activates. Process of

formation of Aahara Rasa also starts. When sneha basti given after food essence

ofbasti help to formation of Rasadi dhatu intermixing with Aahar Rasa. Flowing of

essence ofBasti in to Rasadi dhatu after food only because after food the

conversional factors i.e. jatharagni, Pancha Bhoutikagni and Dhatwagni activates

more.

Treatment Principle for Degeneration joints ï ï ï ï ï ï ïï ïï ï ïï ï ïï ï ïï ï ï ïï ï ï ïï ï ï ï ï ïï ï ïï ïï ï ïï ï ïïï ï ï ïï ï ï

ï ï ï ï ï ï ïï ï ïïï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ïï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

There are two types of medicines 1) Langhan medicines- medicine creates lightness in the body. 2) Brumhan medicines- medicine nourishes all seven dhatus of the body.

Here Hemadri adviced to give Bruhan treatment for Asthi Kshaya. Charak

mentioned to give panchakarma treatmet especially Basti having combination of

bitter taste cow milk and cow ghee. Here this basti is mentioned due to classical

variation in treatment of vata & Asthi. Asthi get nourishment from any type of

oleation like milk ghee or oil. Hence we choosen chandan Bala lakshadi Tail Basti

in Asthi Kshaya. Which have many herbs having bitter taste and osteogenic

action.

ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ïï ïï ï ï ï

ï ï ïï ïï ï ï ïï ï ïï ï ï ï ï ïï ïï ï ï ï ïï ïï ï ï ï ï ïï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

There are two types of treatments for vitiated and increased Vata Dosha. They are

107

(1) Shodhana - Purification (2) Shaman - Regular Oral Treatment According to Sushrut Samhita - Depletion is the treatment for increased Dosha- (1) Langhana - For less quantity of vitiated Vata. ( ï ï ï ï ï ï ïï ï )ï

(2) Langhana and Panchana - For moderate vitiation of Dosha. ( ï ï ï ï ï ï ï ïï )

(3) Doshavasechana - For severe vitiation and increased Vata Dosha. ( ï ï ïï ï ï ïï )ï

The Process of Purification

If Vata Dosha is increased & vitiated a lot then the condition is severe nd

process of purification is essential. Process of purification acts on elementary

factor of disease. Hence the disease cured by the process of purification then

recurrence of disease is very less.

Importance of Purification.

ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï

ï ïï ïï ï ïï ï ïï ï ïï ï ïï ïï ï ï ï ï ï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

The reccurence of disease may happen by shamana treatment i.e. regular oral

treatment.

The disease don't have reccurence if we treats with the methods of purification.

Effects of Purification

1. Apettite improves

2. Quality improvisation of sense organs.

3. Intellect, complexion occurs in good manner

4. Improvement in vitality

5. Reduction in ageing process

Dosha gati from Shakha to Kostha ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

108

ï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï

Doshas can be brought from Shakha External Channel to Kostha internal

channel by Snehana (Oleation) and Swedana(Fomentation) Process of oleation

should be done externally as well as internally. Dosha starts to move from

External to internal channel because they get oleation and liquifies and

lubricated by the process of oleation and fomentation. They comes easily in the

internal channel and it helps alot in the process of purification.

Method of oleation and fomentation

ï ï ïï ï ï ïï ïï ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï

ï ïï ï ï ïï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï

Process of Oleation can be done externally and internally. Externally as

Abhyanga should be done to whole body. Then the process of fomentation should

followed.

The vitiated doshas with their property of stickiness remains in Kostha,

shakha, and dhatu. Dosha gets lubricated due to oleation and liquifies due to

fomentation and they can brought easily in the Kostha.

So External Oleation and Fomentation IS an essential preparation before

the process of purification.

Method of Purification ï ïï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï

Vitiated and increased Vata dosha creates degeneration of body a lot. So

if give strongest purification again it may causes increase and vitiation of vata

more. To avoid these Mrudu Sanshodhana mild purification has been advised as

treatment of Vata Dosha.

The purification should be in such a manner which

1. Purifies vitiated and increased vata.

109

2. Avoids further increase of vata.

3. Helps in regeneration of body.

This type of purification is nothing but Basti treatment.

Basti Treatment - (Sneha Basti)

Basti treatment advised for vitiated and increased vata dosha.

It has properties of

1. Oleation more

2. Ushna hot in nature - opposite to sheet gun a of vata

3. Stops the degeneration of dhatu.

4. Regenerates dhatus again.

Properties of Sheha 1. Snigadha - Unctuous

2. Guru - Heavy

3. Drava - Liquid

4. Sheeta - Cold

5. Sookshma - Subtle

6. Mrudu - Soft

7. Sara - Moving

8. Manda - Slow

9. Picchila - Slimy

Information About Basti

ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ïï ïï ï ï ï ï ïï ï ï ï ïï ï ï

ï ï ï ïï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï

110

Medicated enemas given through anarectal canal with the help of Basti

Yantra in the intestines for specific period is called Basti.

Basti is prime treatment for Vata Dosha.

Definition of Basti

ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ïï ï ï ïï ï ï ï ï ïï ïï ï ï ï

ï ïï ï ïï ï ïï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ïï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Enema is that which reaching up to umbilical, iliac, lumber and

hypochondriac regions and churning up the fecal and morbid matter and

spreading the unctuous effect in whole body, draws out fecal and morbid matter

with ase.

Enema by elimination of impurities checks ageing and pacifies all the

disorders.

ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ïï ï ïï ïï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï

The prime medicines with prime treatment for Tri-doshas are Dosha Prime medicine Prime treatments 1. Vata Sesamum Oil Basti

2. Pitta Cow ghee Virechana

3. Kapha Honey Vamana

Properties of Basti

ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï

ï ï ï ïï ïï ï ï ï ï ï ï ï ï ïï ï ïï ïï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

111

The enema is an agent of rejuvenation and promoter of happiness life

strength, gastric fire, intelligence, voice and color. It is beneficial in every way

for all whether young adult or old. It is free from risks and cures all the diseases.

ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïïï ï ï

ï ï ï ïï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ïïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Oleation imparts color and strength to the body. There is no remedy more beneficial than the administration of oil

particularly in afflictions of vata.

ï ï ïï ïï ï ï ï ïï ï ïï ï ï ïï ï ïï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ïï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï

Oil by its unctuous quality counteracts the dryness, by its heaviness

counteracts the light-ness, by its heat the quality counteracts coldness due to

vata and thus quickly imparts clarity of mind virility, strength, color, and

increase of the gastric fire.

ï ïï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Just as a tree fed with water and its roots put forth green leaves and

delicate sprouts and in due time grows into big tree full of blossom and fruit

similarly does a man grow strong by means of the unctuous enema.

ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ïï ï ïï ï ï ï ïï ï ïï ï ïï ï ï ï ïï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ïï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ï ïïï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

Of all the measures enemation is mentioned as the most important one by

one scholars. Why? Because it performs many functions (Such as) enema, because

of having combination of various drugs performs evacuation pacification and

checking of doshas acts as aphrodisiac for one whose seme!1 is diminished;

112

promotes development of body in the emaciated; slims the obese, nourishes the

eyes, removes wrinkles and graying of hairs and stabilises youthfulness.

Enema used properly promotes physical development, complexion strength

immunity and life span.

ï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï

ï ïï ï ï ïï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ïï ï ïï ï ïï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ïï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ïï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

When the passages are cleansed by niruha, sneha proceeds on well as

water flows in pipe from which all rubbish has been removed. This niruha

eliminates all doshas and promotes vitality and as such unctuous enema is

applied after the body is cleansed by niruha.

Oil as a prime medicine.

ï ïï ï ï ï ï ïï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï

ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïïï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï

ï ïï ï ï ï ïï ï ï ïï ï ï

ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï

ï ï ï ï ïï ï ï ï ï ïï ï ï ïï ïï ï ï ï ïï ïï ï ï ïï ï ï ï ïï ï ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï

ï ïï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ïï ï ïï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Sneha means material which contains fatty substances some taking taila

generally for sneha, prescribe ghee also but rightly oil should be taken as it is

chief vata allevaiting while ghee is not so.

113

Ghee do not have property of heat. Tail do have this property which Counteracts on cold property of vata dosha, tail is more heavy than ghee Aama sneha creates Abhishyandan of Anus. Hence we should used Pakwa Tail.

Properties of sesamum oil and vata dasha Sesamum oil and vata dosha have classical opposite properties by which

vitiated vata get counteracts by sesasum oil. ï

ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï

ï ïï ï ï

ï ï ïï ï ïï ï ïï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï

ï ïï ï ïï ïï ï ï ïï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ïïï ï ï ï ï ïï

ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï

Vata and sesamum oil have some common properties like Anutwa, and

sokshmatwa i.e. penetrating properties i.e. subtle

Vata have functional relationship with micro cells parts of the body.

Sesasmum oil also has the penetrating power to reach the mIcro cells. These

properties are useful for concept of Srotasa Gamitwa as effect of medicine

comes ultimately good.

So it is easy to counteract the vitiated vata upto cellular level with the

help of other properties like unctuous heat, heavy, liquid, etc.

ï ïï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ïï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

The concept of Mula i.e. root of the body is known as 'Anus'. Oleation of

Anus by Basti treatment effect oleation of whole body with media as sira which

spreads all over the body.

Common indicated Vata Diseases for Basti treatment

ï ï ï ï ï ï ïï ï ïï ï ïï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï

ï ïï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ïï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ïï ïï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

114

Enema is specially indicated the persons whose limbs have become stiff

and contracted, who are suffering from numbeness in both legs, who have

suffered from Fractures and dislocations and who suffers from rheumatic lesions

affecting the extremities.

Clinical signs in which Basti should be given ï

ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ïï ï ï ïï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ïï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï Enema should be indicated in 1. Distension of abdomen

2. Scybalous stools

3. Colic

4. Inappetence

5. Similar other disorders affecting the gastro intestinal tract.

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï

ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï Enema is considered the sovereign remedy in cases of women who have

been afflicted with complications due to vata who are not and in the case of

persons whose semen is weak and who are emaciated.

ï ï ï ï ï ï ï ïï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ïï ïï ï ï ï ï ïï ï ïï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï

ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï

The wise are of opinion that a cold enema should be given to patients

afflicted with excessive heat and in a genially warm enema where the patients

afflicted with cold. In this manner the nature of enema should generally be

determined in all conditions and mixed with drugs possessing the qualities

contrary to the characteristics of disease - condition.

Diseases with Properties Basti with Properties

Dryness Oleation

Lightness Heavy

Basti According to Bruhana and Langhana Concept

115

ï ï ï ïïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ïï ï ï ïï ïï ï ïï ï ï ï ï

ï ïï ï ï ï ï ï ïï ï ï ï ï ïï ï ïï ïï ïï ïï ï ï ïï ïï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

The robonant enema should not be administered in the disease conditions

indicating depletion therepy such as dermatitis, urinary disorders etc as also to

men with excessive adiposity who need to be given purificatory and depletory

treatment. ï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ïï ï ïï ïï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ïï ï ïï ï ï ï ïï ïï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

And the evacuative enema should not be given to persons who are

cachetic due to pectoral lesions; who are dehydrated; who are extremely

debilated, who are unconscious and who are already purged as also in conditions

where the excretory matter is the only hold for life.

Action of Basti ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïïï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïïï ï ïï ï ï ï ï ï ï

ï ï ïï ï ï ï In a human body there are three channels through which pathogenesis of

diseases occurs.

There are Antar Marga Kostha, (Internal Channel) Shakha Bhaya Marga (External

Channel), Marma (Vital points) Madhyam Marga (Middle Channel as bones -

joints).

ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ïï ï ï ïï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïïï ï ï ï ï ï ï ï

116

ï ï ï ïï ï ï ïï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ïï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï

ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ïïï ï ï ï ïï ï ï ï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ïï ï ï ï ï

Vital points Bones and joints are considered as middle channel. The word'

Urdhva ' is considered as diseases occurred due to upward direction of vitiated

dosha.

Adha - Down ward direction of vitiated dosha Tiyarka - Slanting direction of dosha from Internal channel to External channel.

These are 3 channels for the pathogenesis of disease. The diseases that

occur all over the body are known as " Sarvangaja ". ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ïï ïï ï ï

ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ïï

ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ïï ï ï ïï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï

ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ïï ïï ï ï ï ï ï ï ïï ï ïï ï ïï ï ïï ï ï ï ï ï ïï ï ïï ï ï ï ï ïï ï ï ï ïï ïï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ïï ï ï ï

ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï ïï ï ï ï ï

Vata dosha have prime role in causation of diseases even kapha and pitta

are considered as effective factors but they are not motive. Dhatu mala and

'Kha' mala are also considered as effective factors for causation of disease.

Aashaya means a container in which nourishing part of dhatu can be stored. As

Vata itself combines and disjoins dosha dhatus and malas it also plays main role

in the causation of diseases produced by combination of dosha and dushyas. It

causes nutrition or degeneration of body. Combination of mala and dosha with

Dushya i.e. Dhatu is caused by vitiated vata and this combination causes various

diseases. The word Aashaya also means containers of mala and 'khat mala.

Another cause of this disease is combination and separation of kha mala and

mala from Aashaya. It is also done by vitiated vata. Basti treatment counteracts

117

on vitiated vata hence it controls storage of excessive waste products in the

body and controls the diseases. Hence Basti carries half important of the

treatment.

There is no cause greater than vata in manifestation of diseases affecting

the peripheral regions or alimentary tracts or vital organs or the upper part of

the body or whole body or part of the body. Since the vata is the motive force

behind the function of elimination or retention of feces, urine, bile and other

excreta in their respective emunctories there is no remedy other than enema in

the alliviation of vata that is excessively provoked. It is therefore that some

physicians are of opinion that enema constitutes half of the treatment while

other hold it to be not half but the whole of the treatment.

ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï

ï ï ï ïïï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï ïï ï ï ï ïïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ïï ï ï ï ï ï ï ïï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ï

ï ï ï ï ï ïï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ïï ï ïï ïï ïï ï ï ï ï ï ï ï ï ï ï

ï ï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ïï ï ïï ïïï ï ï ïï ï ïï ï ï ï ï

ï ïï ï ï ïï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ï ïï ï ï ï ïï ï ïï ï ï ï ï ï ï ïï ï ï ï ï ï ï ï ï ï ï ï ï ï ï

Enema properly applied stays in intestines, pelvis and all around below the

umbilicus from large intestines the active fraction.

118

Distribution of Patients By sex

The total number of patients were two hundred,male are 42and female

are 158,21% of male and 79% of Females

DISTRIBUTION OF PATIENTS BY SEX GENDER FREQUENCY Male 42Female 158Total 200

119

OCCUPATION MALE FEMALEEmployee 37 33retied/housewife 5 125

120

PANA MALE FEMALE Tiltail 7 43 cbltail 9 41

121

BASTI MALE FEMALE TILLTAIL 10 40 CBL TAIL 9 41

122

DISRIBUTION OF PATIENTS ACCORDING TO PRAKRUTHI MALE FEMALE VATA 14 63PITTA 10 41KAPHA 11 29SANIMPATAJA 8 24

123

DISTRIBUTION OF PATIENTS BY AGE WISE

AGE GROUP MALE FEMALE 35-45 8 56

46-55 15 4656-65 13 3666-70 6 20

124

GRADUATION OF IMPROVEMENT RESPONSE GROUPA GROUPB GROUPC GROUPDEXCELLENT 8 12 2 4GOOD 16 22 14 22FAIR 20 15 25 18POOR 6 1 9 6

125

CBL TAIL BastiIMPROVEMENT IN AGE GROUPWISE 

cbl tail  35‐45  46‐55  56‐65  66‐75 

Male  3  2  2 2

Female  18  8  7 8

126

Til TAIL BASTHI IMPROVEMENT IN AGE GROUPWISE 

Til tail  35‐45  46‐55  56‐65  66‐75 

Male  2  2  2 1

Female  16  10  9 8

127

CBL TAIL PANA IMPROVEMENT IN AGE GROUPWISE 

cbl tail  35‐45  46‐55  56‐65  66‐75 

Male  2  3  2 2

Female  14  10  9 8

128

TIL TAIL PANA IMPROVEMENT IN AGE GROUPWISE 

cbl tail  35‐45  46‐55  56‐65  66‐75 

Male  4  2  2 1

Female  16  9  9 7

129

PHYSICIAN GLOBAL ASSESMENT

RESPONSE GROUPA GROUPB GROUPC GROUPD FAIR 12 23 8 15 GOOD 18 22 14 18 POOR 16 4 25 14 VERYPOOR 4 1 3 3

130

PATIENT GLOBAL ASESMENT RESPONSE GROUPA GROUPB GROUPC GROUPD FAIR 10 14 8 12 GOOD 30 26 24 26 POOR 8 6 14 10 VERYPOOR 2 4 4 2

131

DISTRIBUTION OF PATIENTS ACCORDING TO

132

DESHA

MALE FEMALE JANGALA DESHA 8 20ANUPA 18 10SADARANA 16 128

133

WOMAC SCALE DRUG VISIT1 VISIT2 VISIT3 VISIT4 P-VALUE COMMENTS

GROUPA 74 47.75 45.294 41.71 0.049

As per obtained value group A is significant and has significant difference by visist wise

GROUPB 83.175 57.5 51 50 0.006

As per obtained value group B is significant and has significant difference by visist wise

GROUPC 65.6 53.7 33.725 33.08 0.245As per obtained value group c is not significant

GROUPD 82.4 52.5 38.2 38.16 0.149As per obtained value group c is not significant

P-value <0.05 highly significant p-value >0.05 non significant

134

VAS SCALE

GROUPA GROUPB GROUPC GROUPD P-VALUE STATISTICAL METHOD COMMENTS

VISIT1 53 43.125 64 62.105 0.042 TTEST

SINCE THE CALCULATED PROBABILITY IS LESSTHAN 5%(0.05).HENCE DRUG IS SIGNIFICANT.AND THERE IS SIGNIFICANT DIFFERENCE BETWEEN VISITS

VISIT2 74 69.8 79 77.105 0.02 TTEST

SINCE THE CALCULATED PROBABILITY IS LESSTHAN 5%(0.05).HENCE DRUG IS SIGNIFICANT.AND THERE IS SIGNIFICANT DIFFERENCE BETWEEN VISITS

VISIT3 41 30.25 38.4 36 0.16 TTEST

AS PER OBTAINED VALUE IT IS GRATER THAN 5%(0-05).HENCE THE DRUG IS NOT SIGNIFICANT.

VISIT4 39.5 28.721 41 36.656 0.095 TTEST

AS PER OBTAINED VALUE IT IS GRATER THAN 5%(0-05).HENCE THE DRUG IS NOT SIGNIFICANT.

P-value <0.05 highly significant p-value >0.05 non significant

OBSERVATION OF SUBJECTIVE PARAMETER PARAMETER GROUPA GROUPB GROUPC GROUPD

135

BT AT BT AT BT AT BT AT

VATAPOORNA DRUSTI SPARSHA 44 3 46 2 36 14 34 6SANDINSHOOLA 48 6 48 4 40 18 40 12

SANDI SPUTAN OR ATOPA 40 8 44 3 41 14 44 8

SANDI SHOTHA/SHOPA 46 2 48 2 38 10 36 12

PRASASRA AKUNCHANA PRAVURT SAMVIDHANA 40 4 41 2 32 10 38 14

SAFETY RESULTS

The analysis of clinical AE was conducted on the whole population patients. No

significant AE was noted in all groups.

136

SUBJECTIVE PARAMETERS

In subjective Parameters all the four groups were compared for Vata Poorna

druti Sparsa, Sandi Shoola Sandi Sputana or Atopa Prasara Akunchana Pravrith

Samvedana Sandi Shota or Shopa, more number of patients improvements seen in

Group B and Group A compared to Group C and Group D.

Objective parameters like weight, Blood Pressure gait, 50 feet walking on

Flat Surface and Hematological Bio Chemical changes observed. There is a mild

improvement in 50 feet walk in flat surface little the proved in Group B and

there is no significant changes seen in Hematological & Bio Chemical, Blood

Pressure and weight in all groups.

Discussion

The present trail designed is not only to evaluate efficacy of the chandan bala

lakshadi tail in Dhatu Kshya Janya Sandigate Vata to see the which route of

administration is effective.

The present work has been concentrated on Dhatu Kshya Janya Sandigate Vata.

Some of the points are Following

Worth mentioning as regards in the present trail.

1) According to the trail designing more patients having acute & infective

Dhatu Kshya Janya Sandigate Vata, were not selected there is no

particular use of treatment and management.

2) All patients asked to stop NASIDS and given 24 hours wash out period.

3) To take care of an individual fluctuations & to provide a broader

relevance to the trial a large population of patients is desirable.

Takingthis point into consideration, patients of chronic history of illness

along with acute illness were also included in the trial. Although it would

have been more desirable to prove the efficacy of the drug by including

Chronic cases only. Also more number of patients are desirable to take

care of trial drop-outs.

4) According to the statically data the effects Chandana bala lakhsadi tail

seen in the parameters of symptoms & signs, more number of patients is

improved in the signf & symptoms relevance shown that the chandana

137

bala lakshadi tail very best in Dhata Kshya Janya Sandigata Vata in Group

B, and better in Group A. However for the same parameter changes

indicating that there may not be any real difference between group C &

Group D Thus shows chandana Bala Lakshadi Tail is very effective in the

Datu Khsya Janya Sandigata Vata.

5) Parameter liks Shota, Shopa Vata Poorna Drushti Sparsha Prasara

Akunchana Pravruth Samvedana have shown improvement in Both Group in

B & A. But during course of trail all patients were asked for the Pathya –

Apathya. The pain was decreased in two groups compare than C & D Group

A & B.

6) Parameter of WOMAC Scale in all 24 questioner shows improvement in

Group B whereas in Group A and placebo Group C & D shows mild to

moderate improvement.

7) In parameters like VAS (Visual Analog Scale) has shown improvement in

Group B & A, Group C & d shows mild improvement in scores.

8) Patients Global Assessment was shown Good to fair in Group B & A, Fair to

in Group B & C.

9) Physicians global Assessment was shown good improvement than placebo

group.

10) Radiological findings like Xrays of Both knees AP Standing view with

medial compartment narrowing Grade II to III found no significant changes

in all groups.

The above mentioned discrepancy have been to an excellent taken care of by

induction a placebo group. The results of drug administration (Group a &

Group B) have been compared with the control group B & C. Statistically

again the results of Group A compared with Group B.

DISCUSSION

The pathological condition in which either of the localized or generalized

symptomatology gets manifested along with severe pain as an effect of

localization of the vitiated vata dosha in different dushyas as the condition may

138

be called as vata vyadhi. It is also said that vata vyadhi is a consequent result of

a special type of dosha-dushya sammurchana occurring in the body, manifested

by either localized or generalized symptamatology, brought about by the

localization of vitiated vata in the respected dushyas.

Sandhi gata vata is one of the vata vyadhi. Supportive evidences are found

in the Ayurvedic classics indicates that sandhigata vata does possess an

etiopathogenesis of its own as it is said that a vyadhi is formed only after the

completion of the dosha-dushya sammurchana in the Sthana samshrayavastha

marked by a clear cut manifestation of signs and symptoms. In this context the

vata is getting vitiated by its etiological factors runs through all the pathological

stages and on getting localized in its dushyas which in this case being sandhi

produces a specialized form of dosha-dushya sammurchana and manifest with its

clear cut symptoms like shotha shula, so as to be called as sandhigata vata.

In modern, Sandhi gata vata is compared with the Osteo arthritis which is

one of the degenerative joint disorders. Females are found to be more affected

by this disorder. It causes pain and disability there by hampering man power

resources of the nation. So the priority for health system assumes animportant

places as the population becomes older.

Discussion on Etiology: Although separate etiological factors not mentioned for the disease

sandhigata vata, samanya nidana for vata vyadhi itself is taken in to

consideration. The etiological factors can be divided into aharata, viharata,

manasika, kalakruta and gada kruta.

In proper diet and dietic regimen plays importance in the process of this

disease because ahara provides the nutrients to all the dhatus. By the improper

food and dietic regimen quantitatively or qualitatively produces changes in the

process of prakopa results in sandhigata vata.

139

The viharaja nidans which pertaining to this disease can stimulates or

irritates the anatomical sites (sandhis), where the depletion of the (sleshma,

snayu) takes place which in turn causes the riktata and also vata prokopa. Vyana

vata is responsible for pancha chesta, the etiological factors wil directly causes

vyana vata pakopa. This produces difficulty in movement.

The mental health always contributes the physical well being. The

anxiety, stress, nervousness and mental disturbances reflect on body mechanism

and impair the functions. Vata being essential factor in the maintenance of

manas and indriyas, disturbances in that aspect directly influence over vata.

Discussion on Samprapti :

The samprapti of sandhigata vata follows either of the two different

pathways. The different mechanisms can be explained as said below-

1. The consumption of aharaja, viharaja, manasika, kalaja or gadakruta

nidanas havin the tendency to vitiate the vata, either individually or in

combination sill kead to the sanchaya of the vata. The accumulated

vata heads towards the steps of prakopa and prasara. The same

etiological factors having the tendency to destroy the dhatus

simultaneously with vitiation of vata will produces dhatu kshaya. The

dhatu kshaya will ultimately results in riktata of the srothas.

The prasarita vata moving all through the body occupies the rikta

srotas ansd further undergoes vitiation. As the pathology progresses

vata gets stana samsraya in the sandhis, where it undergoes

sammurchana with the completed the condition gets manifested with

clear cut signs and symptoms on the structures involved in ti. Sandhi

shota gets manifested following stambha may cause due to shoshana of

140

asthi, snayu, and kandara. And Atopa is due to kshaya of shleshma and

shleshma dhara kala. Eventually sandhi shula and vata purna druti

sparsha will occur due to localized Vata in joints. Ultimately the

condition can get worsen leading to destruction the joints making men

crippled and dependent when the disease is not attended to.

2. The consumption of above said nidanas similarly lead to prakopa of

other doshas i.e. pitta and kapha. These doshas get filled in the

srothas and cause avarana of vata. As a result vata prakopa takes

place. The vitiated vata later attains prasaa and get localized in the

sandhis. At the site of localization, the vayu undergoes sammurchana

with the dushyas there in and in due course gets manifexted with clear

cut symptamatology. This causes the pathological entity called

sandhigata vata.

The condition can further progresses to the stage where

complication are produced leading to destruction of the joints, if

attention is not given in proper time.

Discussion on Treatment principles:

All Acharyas are given more importance to Palliative treatment than the

purificatory measures. Here main procedures explained are, Snehana and

its different form like Abhyanga Unmardana, Swedana (Upanaha),

Bandhana and Agnikarma.Sandhigata vata is a disease which is restricted

to individual joints and hence localized treatments for specific joints will

be beneficial.

Discussion on plan of study:

141

The present study has been carried out on 200 patients treated in four

groups, trial and standard selected from the OPD of SDRC.Hyderabad, and

STRH of pune, The criteria for selection of patient were based upon the

classical signs and symptoms.

50patients of sandhigata vata were selected for trail group in which

Chandanabala lakhadi tailwas given in the dose of 30ml Pana With ushna

jala as anupana. Duration of the treatment is 21 days.

50patients of sandhigata vata were selected for trail group in which

Chandanabala lakhadi tailwas given in the dose of 60ml matra Basti.

Duration of the treatment is 21 days.

50patients of sandhigata vata were selected for standard group in which

Tila tail was given in the dose of 30ml pana daily with ushna jala as

anupana. Duration of the treatment is 21 days.

Follow up study was done forevery 7-14-21 days.

The improvement in the symptoms of diseases after the treatment was the

main criteria of assessment. The total effects of the therapy were also

assessed in terms of complete relief, marked improvement, moderate

improvement, improved and unchanged.

Discussion on observation during study:

213 patients were registered for this study, 13 patients were dropped due

to various reasons. Discussion regarding Observations of the all the factors

related to disease is as follows.

142

1. Age wise distribution – maximum patients in this study was around 35-

75 years. The probable cause may be due to the hard work,

degeneration due to old age.

2. Sex wise distribution – maximum patients were females nearly about

72%. In this, most of the females suffer from Janu sandhigata vata.

The excess work load over the knee joint may be pre disposing factor

for this disease.

3. Religion wise distribution –33.56% Muslims 56.72% Others are 9.72%.

4. Marital status – 92.5% of the patients in the study were married. Since

this disease very commonly seen in last part of middle age majority of

the patient were marriend.

5. Economical status – maximum number of patients belongsl to poor

class, which is 70%. Due to lack of proper nourishment6 as well as

excessive strains due to manual labor may be the predisposing factor

for the disease.

6. Occupational – 45% of this study were house wives and 32.5% were

agriculturists.

7. Habitat wise distribution – 92.5% were from anupa pradesha since the

area where the study belongs to anupa desha.

8. Discussion on duration of illness – duration of illness seen in to less

than one year in majority of cases.

9. Family history – maximum patients shown negative family history to

this disease (80%).

143

10. Discussion on nidra incidence – maximum number of patient suffered

from disturbance of sleep (77.5%). It may be due to the pain and

stiffness which does not allow sleeping.

11. Discussion on prakruti of the patient – in most of the cases studied, the

patient were vatapittaja prakruti.

12. Discussion on weight incidence – in this study, most of the patients had

the body weight in between the range of 61-71 kgs.

13. Discussion on incidence of main lakshanas.

a. Sandhishula – it was seen in all the patients.

b. Prasarana akunchana savedana – was seen in most of patients

which disturbed their routine work.

c. Sandhi sthambha – was the symptom which reduced the working

capacity of patients.

d. Sandhi shotha, atopa were also seen in most of the patients.

Discussion on effect of treatment: Effect of treatment was assessed clinically.

1. After treatment

The trial drug Chandanbala lakhadi tailgives highly significant

(<0.001) result in the Atopa (crepitus) i.e. 55%. It provided 40%

relief in Tenderness which is moderately significant (<0.010) in

Sandhi shula (35%). The Tiltail significant result (<0.001) in the

Sandhi Shotha (50%). It provided moderate significant (<0.010)

144

result in the Atopa (35%). And in the sandhi shula and tenderness

showed moderate significant (<0.020) and the relief is 30%).

2. After follow up

The trial drug Chandanbala lakhadi tail showed highly significant

(<0.001) result in Tenderness (65%). It showed highly significant

result (<0.001) in Sandhi shula and Atopa (60%). The Tiltail

significant (<0.001) result in the Sandhi shotha (60%). It showed

moderate significant (<0.010) result in the Atopa (45%) and in the

sandhi shula and tenderness it provides moderate significant

(<0.010) result and relieved the symptoms 40%. So the trial drug

showed very significant result in the shula, atopa and tenderness.

Whereas standard drug showed efficiency in Sandhi shotha.

Other all effect of treatment on sandhigata vata:

During the time of treatment (21days) trial drug showed high

significant result in the Atopa (crepitus) and showed moderate

significant result in the Sandhi shula, Tenderness and Sandhi shotha

whereas the Tilatail significant result in the Sandhi shotha and

given moderate significant result in the Sandhi shula, Tenderness

and also in Atopa.

In the follow period of 21 days, the patients observed in each 15

days visit. After that period, the trial drug showed high significant

result in the Snadhi shula, Tenderness and Atopa whereas moderate

significant result in the Sandhi shotha. The control group Tilatail

had given significant result in the Sandhi shotha and moderate

significant result in Atopa, Sandhi shula and Tenderness.

145

Overall picture of the results obtained showed that both group

were effective in reducing all the symptoms but trial drug

Chandanbala lakhadi tail showed highly significant in

reducing symptoms such as Sandhi shula, Atopa and

Tenderness. It also brought about long standing relief. The

control drug Tilatila found highly significant in the Sandhi

shotha and in rest symptoms it showed moderately

significant result.

On the statistical analysis to compare the result obtained after 45

days of treatment for Sandhi shula between the two groups, an

insignificant result was obtained which indicates that both the

groups were equally effective in the management of Sandhi shula.

Even on the other main complaints, Atopa, Tenderness and Sandhi

shotha an insignificant result was obtained on the inter group

statistical evaluation which indicates that both the dugs were

equally effective in the management of chief complaints.

Statistical evaluation for the inter group comparison after follow up

period showed an insignificant result on all the chief complaints. A

highly significant result was obtained for the Trial drug on

Sandhishula, Atopa and Tenderness after the follow up period

compared to a moderate significant relief for the standard drug.

But the inter group comparison between the two groups showed

only a statistical insignificance.

Thus it may be concluded that both the standard and trial drug

were Higheffective in management of chief complaints after the

treatment as well as after the follow up.

146

CONCLUSION

Sandhigata vata is a vyadhi produced due to the Vyana vata prakopa. Gata vata is the condition in which Vata will be in predominant state and

the condition of the vata should be cared while applying treatment principles.

While considering nidanas, both Dhatukshayakara and margavarodhakara

are responsible for producing the disease Sandhigata vata. This disease is considered as Yapya, because it affects joints which are the

madhyama roga marga. The treatment or treatment procedures which give snigdhata, ushnata,

Ghana is useful in this condition. In classics, they more emphasized on palliative measures than the

purificatory treatments. Sandhigata vata afflicts predominantly in elder persons (51-70 yrs), hard

workers and also in females. The trial drug showed excellent response on reduction of the symptoms

and in degenerative process. The standard drug showed outstanding result in the reduction of

Sandhishotha. Sandhigata vata is easy to cure if the disease is of recent origin.

Limitations:

147

The size of sample was small to draw a generalized conclusion. The period of study was limited.

The study was limited to the patients who attended the OPD wing of

SDRC,Hyderabad,and STRH. Of Pune

Recommendatiion of further study: The study can be repeated with large sample and longer duration. Same formulation can be tried along with specific panchakarma therapies

and other drugs.

SUMMARY

The dissertation entitled “STANDARDISE USAGE PROTOCAL OF CHANDANBALALAKSHADI TAIL

IN DHATUKSHYAJANYA SANDHIGATA VATAACCORDING TO DIFFERENT ROUTES OF ADMINISTRATION”

” has been carried to find out the clinical efficacy of Therapeutic drug This

study comprises of following topics.

Introduction:

Gives the explanation about qualities of healthy person, importance of vata

physiologically as well as pathologically and brief introduction about trial durg.

Objectives:

The main aim and objective of the study has been mentioned along with the

hypothesis under this heading.

1. Review of Literature: This chapter comprises of following headings, Disease

review and Drug review.

148

Disease review dealt under the following headings. Historical aspect – gives the

historical glimpses with regards to the disease sandhigata vata and traces the

various developments right from the vedic period to present era. Here

references regarding the vata dosha, its diseases and the diseases of joints are

presented.

Under the heading of etymology the description about Sandhi and different

constituents which forms the Sandhi and also concept about gata vata has been

mentioned.

Detailed data wise collection aboaut Nidana, Poorva roopa, Roopa, Samprapti,

Sadhya-asadhyata, Upadrava and Chikitsa along with Pathya-apathya of the

disease aloang with some modern aspects of Osteoarthritis have been dealt.

In drug review section, a thorough study of the ingredients of the compound

preparations covering the botanical nomenclature, rasa, guna, veerya, vipaka,

chemical constituents etc.

2. Methodology:

Clinical Study - Under this heading detailed description of the clinical

study with specific reference to patients, grouping, selection, inclusion

and exclusion criteria, protocol, criteria for assessment of signs and

symptoms, dose, duration of the study is mentioned.

Observational study – Here a detailed explanation is given on the

distribution of the patients according to age, sex, economical status, diet,

habits, marital status are represented alaong with tables and charts.

3. Results: In this, results of the study analyzed statistically, compared and

are presented in tables and graphs.

149

4. Discussion: Under this heading, discussion regarding nidanapanchaka,

chikitsa and results obtained from this study have been described. The

probable mode of action of the trial drug and control drug was discussed on

the basis of rasapanchakas.

5. Conclusion: In this chapter the conclusion of the above study is done by

highlighting the outcome of the study along with limitation of study and the

scope of further improvement.

150

151

~

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Pfizer Protocol A4091025

Kellgren-Lawrence Grading for Radiographic Eligibility

Please use these criteria to assist in determining Kellgren-Lawrence grading of the target knee. Please note that all features listed for each grade must be present to qualify.

K-L grades 2-4 are eligible for this study.

K-L Grade 0:

Normal No radiographic findings of OA

K-L Grade 1: Doubtful Osteoarthritis

Minute osteophyte(s), doubtful significance Doubtful narrowing of joint space (JSN)

minute Osteophyte

1

doubtful JSN

0

Pfizer Protocol A4091025

4

K-L Grade 2: Minimal Osteoarthritis

Definite osteophyte(s) Possible narrowing of joint space

(< 50% loss of joint space width)

K-L Grade 3: Moderate Osteoarthritis

Definitive narrowing of joint space (> 50% loss of joint space width)

K-L Grade 4: Severe Osteoarthritis

Joint space greatly impaired (bone-on-bone)

Subchondral sclerosis

References: 1. Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis 1957;16:494-501. 2. Altman R.D. and G.E. Gold. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007; 15 (Suppl. A):1–56.

3

Definite JSN> 50%

Bone-on-bone

sclerosis

Bone-on-bone

sclerosisPossible JSN<50%

definite osteophyte

2

Pfizer Protocol A4091025

Kellgren-Lawrence Grading for Radiographic Eligibilityrence Grading for Radiographic Eligibility Please use these criteria to assist in determining Kellgren-Lawrence grading of the target hip.

Please note that all features listed for each grade must be present to qualify. K-L grades 2-4 are eligible for this study.

K-L Grade 0:

Normal No radiographic findings of OA

K-L Grade 1: Doubtful Osteoarthritis

Minute osteophyte(s), doubtful significance Doubtful narrowing of joint space (JSN)

10

Pfizer Protocol A4091025

K-L Grade 2: Minimal Osteoarthritis

Definite osteophyte(s) Possible narrowing of joint space

(< 50% loss of joint space width)

K-L Grade 3: Moderate Osteoarthritis

Definitive narrowing of joint space (> 50% loss of joint space width)

K-L Grade 4: Severe Osteoarthritis

Joint space greatly impaired (bone-on-bone)

Subchondral sclerosis

References: 1. Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis 1957;16:494-501. 2. Hip images were reprinted by permission from Altman R.D. and G.E. Gold. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007; 15 (Suppl. A):1–56.

42definite

osteophytes

Possible 50% JSN<

Joint space greatly

impaired 3

Definite JSN> 50%

sclerosis