1. CLINICAL EVALUATION OF DASHMOOLA PANCHTIKTA BALA KSHEERA BASTI ANDJANU BASTI IN THE MANAGEMENTOF SANDHIGATA VATA VIS--VIS OSTEOARTHRITSDr. Pravin Kumar Rai Lecturer J.D.Ay. College & Hospital, Bhankari, AligarhDr. K.K. Sharma Reader & HOD Rishikul Govt. Ay. P.G. College & Hospital, Haridwar

2. SANDHIGATA VATA is briefly described in Ayuurvedic Samhitas. In Charaka Samhita, it has described for the first time in the name SANDHIGATA ANILA and defined it as Vatapurna driti sparsha (on palpation it feels like air filled bag), Sopha (swelling), Prasaranakunchanyoh pravrittischasavedana(painful on flexion and extension movement).(Ch. Chi. 28/37)Acharya Susruta in nidanasthana (Su. Ni. 1/28 ) has described it as SANDHIGATA VATA anddefined it as sandhihanti (destruction of joints), sandhisoola (painful joints ), sandhisopha (swollen joints). Acharya Vagbhatta has described it as SANDHIGATA KUPITA VATA. (As. Hr. Ni. 16)Clinically, it is represented as (A) Pain in joints during movements, (B) Stiffness in joints especially after prolong rest and at the onset of movement, (C) Tenderness in joints, (D) Crepitus fine/coarse, (E) Restricted joint movements. Radiologically, Osteoarthritis is characterized by narrowing of joint spaces, osteophytic changes anddeformities in contour of joints. 3. Besides much works on this has been done but a successful treatment is yet to be discovered in alliedsystems of medicine. The present work entitled Clinical evaluation of DASHMOOLA PANCHATIKTA BALA KSHEERA BASTI and JANU BASTI in the management of Sandhigata vata vis-a-vis Osteoarthritis is an attempt in this direction. We have desined this research work to evaluate the efficacy of Basti (purificatoy measures) and Janu basti (palliative measures) .In this research work, 59 patients were randomly selected and the whole work has been categorized into three groups viz. A, B and C. In group A -20 patients were administered Dashmoola Panchatikta Bala Ksheera Basti. In group B-17 patients for Janu Basti and in group C-22 patients for both Dashmoola Panchatikta Bala ksheera Basti and Janu Basti were selected for trial period of three months. The entire work has been presented in thesis under following heads--Review of Ayurvedic literature. Review of modern literature. Drug review. Clinical study.Discussion. Summary and conclusion. References , Bibliography and Appendix. 4. DRUGSUSEDINDASHMOOLAKSHEERA BASTI Dashmoola Panchatikta Bala Ksheera (Milk) Makshik (Honey) Lavana (Saindhava salt) Sneha (Mahanarayana oil) Kalka (Shatapuspa Powder) DRUGS USED IN JANU BASTI Mahanarayana OilPANCHATIKTABALA 5. CRITERIAFORSELECTIONOFWITH THEIR CONSTITUENTSTHERAPIESALONG:If we consider samprapti of Sandhigata Vata , it is clearly mentioned that vitiated Vata is chiefly responsible for the disease. If we will go through our Ayurvedic classics, we will find that Basti therapy is superior to the other Panchakarma ther apies for vitiated Vata along with SnehanaSwedana. Since ,the disease is Asthyaasrita and Asthi is the site of Vata. Acharya Dalhana (on the commentary of Susruta Kalpa 4/40) has mentioned that Purisadhara Kala (fifth Kala) is same ASTHIDHARA KALA. So, Basti therapy is mor e valuable than the others. Dashmoola is said to be a good combination of Vata shamaka drugs. Tikta rasa dr ugs are Vayu and Akash mahabhuta dominant , so they have tenden cy to reach at those places who are Vata and Akash mahabhuta dominant like ASTHI and ASTHIVAHA SROTASA. Acharya Charaka Sutrasthana28/27hasmentionedthatBastayahinksheerasarpeesihtiktakopahitani cha . On this basis , I have selected Dashmoola Panchatikta Bala Ksheera Basti. Janu Basti is applied locally andgood combined ther apyincluding both Snehana and Swedana in it. It is well known that SnehanaSwedana is the basic Shamana (Palliative measur es) therapy for localized Vata. So, I have selected this therapy in my trial. 6. SELECTION OF THE PATIENTS A series of 59 patients suffering from Sandhigata Vata vis--vis Osteoarthritis were randomly selected from O.P.D. and I.P.D. of Panchkarma P.G. Department ,Rishikul Govt. Ayurvedic P.G. College & Hospital, Hardwar, Uttarakhand, for the purpose of clinical trials of present study. The patients were randomly selected regardless their age, sex, socio-economic status, marital status etc. but they were fully gratifying the criteria of diagnosis of Osteoarthritis in modern medicine as well as clinical features of Sandhigata Vata as in Ayurvedic literatures. Out of 59 patients, only 48 patients could complete their full follow-up i.e. 3 months. 11 patients had left against their medical advice. CRITERIA FOR INCLUSION Patients aged between 35 70 years. According to Ayurveda classic, to follow the literary symptomatology viz. Vatapurnadritisparsha sopha (air filled bag like swelling), Prasaranaakunchanyoh Pravrittischa Savedana (painful flexion and extension movements), Shoola (pain), Stambh (joint stiffness), Sankocha (muscular spasm) etc. . To follow the diagnostic criteria of Osteoarthritis. Cases of primary Osteoarthritis only. Patients without any anatomical deformity. Patients with involvement of knee joints. CRITERIA FOR EXCLUSION Patients aged below 35 years and above 70 years. Patients without knee joint involvement. Patients with secondary Osteoarthritis. Patients having past traumatic history. History of systemic diseases viz. Diabetes mellitus, liver diseases, renal diseases, cardiac diseases and endocrinal diseases etc. . Patients having past history of RA, Gout, Psoriasis etc. . 7. DIAGNOSTIC CRITERIA OF OSTEOARTHRITIS OF KNEE-American Rheumatism Association (ARA) has developed criteria for diagnosis ofidiopathic Osteoarthritis of Knee asCLINICAL CRITERIA Knee pain + atleast 3 of 6 Age > 50 years Stiffness < 30 minutes Crepitus Bony tenderness Bony enlargement No palpable warmthCLINICAL & LABORATORY Knee pain + atleast 5 of 9 Age > 50 years Stiffness < 30 minutes Crepitus Bony tenderness Bony enlargement No palpable warmth ESR < 40 mm/Hr RF < 1:40 Synovial fluid OAclear/ viscous/ WBCs 50 years Stiffness < 30 minutes Crepitus + Osteophytes 8. Osteoarthritis of hip Hip pain At least two of the following: ESR (WG) < 20 mm/hr Radiographic femoral/acetabular osteophytes Radiographic joint space narrowing Osteoarthritis of hands Hand pain aching and stiffness Three/four of the following: Hand tissue enlargement of 2 or more of 10 selected joints Hard tissue enlargement of two or more distal interphalangeal joints Less than 3 swollen metacarpophalangeal joints Deformity of at least one of the 10 selected casesOsteoarthritis of spines : Pain Stiffness < 30 minutes Radiographic osteophytes Selected ten joints - 2nd and 3rd distal IP joints - 2nd and 3rd PIP joints - 1st CMC joints 9. BASAL STUDY : The selected patients were interviewed along with their family members and relatives to obtain detailed information about the patients as well as the disease and collected in different data for the study as follows 1. Demographic profile 2. Clinical profile Then all the patients were subjected to thorough physical examination, certain laboratory tests (TLC, DLC, ESR, Hb%, blood sugar, serium uric acid, serum calcium and phosphate, Rheumatoid factor, CRP etc.) and radiological investigations (plain X- ray). 10. METHOD OF STUDY : GROUPING : Present study has been divided into three groups based on the type of therapy to which patients were subjected GROUPSTYPE OF THERAPYGROUP A DASHMOOL PANCHTIK BAL K A TA A SHEERA BASTI GROUP B J ANU BASTI GROUP C DASHMOOL PANCHTIK BAL K A TA A SHEERA BASTI + J ANU BASTI 11. DETAILS OF THE GROUPS DETAILS GR OUP SNO.OFNO.P AT NT IE ST HE A Y GIVE R P NP AT NT IE SR GIST R E E DOFT HE A Y R P DUR T A IONSCOMP E E L T D F OL OW- UP L SA2016DA SHMOOL A10 Days for 3PA NCHTIK TA B L A AmonthsK SHE R B STI E A A B1713JA NU B STI A10 Days for 3 monthsC2219DA SHMOOL A10 Days for 3PA NCHTIK TA B L A AmonthsK SHE R E AB ASTIJA NU B STI A+ 12. Contents of Basti A. Asthapana Basti: Makshikam (Honey)= 100mlLavanam= 15gm(Saindhava)Sneham (mahanarayana tail) Kalkam (soya powder)= 175ml = 60gmKwatham (with ksheera) of the following: * Dashmoola * Panchtikta * Bala moola* Ksheera= 250mlThe contents of kwatham total 50 gm/day were taken and boiled with 800 ml. of water and 200 ml. of milk until th (250ml) of the decoction is left. Total amount of Basti material prepared was kept around 600ml.B. Anuvasana Basti:Mahanarayana tail Saindhava lavana= 60 ml = 2.5 gm 13. (i) Procedure of Basti followed : The Basti consisted of both anuvasana (predominantly oil based) and asthapana of Nirooha (predominantly decoction based) measures. The ratio of anuvasana and asthapana has been provided as per classical referenced of KALA BASTI . Abhyanga (massage) and swedana (sudation) were carried out in all the patients for Basti therapy as a preparatory procedure. Following the above procedures, patients was advised to lie down in a left lateral position with his left leg kept straight, whereas, right knee kept in a semi flexed position and Basti was given. After that, patients were advised strictly to avoid taking asta mahadoshkara bhavas. 14. GENERAL OBSERVATIONS The observations are displayed in the tables and followed by necessary comment. Detailed discussion has been mentioned in next chapter. TABL : 1 AGE & SEX WISE DISTRIBUTION OF THE PATIENTS E AGE GROUPS GROUP AGROUP- B GROUP- C TOTAL(IN YEARS)MFMFMF40 - 500204030302051932.251 - 600406010603052542.361- 700103010305021525.4(%)Out of 59 patients , 22 were males and 37 were females. Incidence of disease is found notably higher in females than in males. During the study maximum no. of patients were belonging to age group between 51- 60 years of age ( 42.3 %), then to group between 40- 50 ( 32.2 %) & 61- 70 years of age ( 25.4 %). 15. AGE & SEX WISE DISTRIBUTION 45 40 35 30 25 40 -502051 -60 61-7015 10 5 0 MF GROUP AMF GROUP-BMF GROUP-C(%) TOTAL 16. TABLE : 2 OCCUPATION WISE DISTRIBUTION OF THE PATIENTS Out of 59 patients, majority of patients were House wives (45.76 %) and Labour & Farmer (22.03 %), followed by Service & Businessmen (20.3 %). OCCUPATION GROUP-AEx-servicemanGROUP- BGROUP CTOTA L(%)0102040813.5Service business&0403051220.3Labour Farming&0504041322.031008092745.76House-wives 17. OCCPATION WISE DISTRIBUTION 50 45 40 35 30 Ex-serviceman25Service & business20Labour & Farming15House-wives10 5 0 (%) GROUP-AGROUP- BGROUP CTOTAL 18. TABLE : 3 RELIGION WISE DISTRIBUTION OF THE PATIENTSOut of 59 patients, 46 (77.97 %) were hindu and only 13 (22.03 %) were muslim. RELIGIO N Hindu MuslimGROUP-A 14 06GROUPB 13 04GROUPC 19 03TOTAL%46 1377.97 22.03RELIGION WISE DISTRIBUTION 80 70 60 50 Hindu40Muslim 30 20 10 0 GROUP-A GROUP-B GROUP-CTOTAL% 19. TABLE :4 SOCIOECONOMIC STATUS OF THE PATIENTS This diseases is more prevalent in Lower middle class (49.15 %) followed by Lower class (27.12 %). Though this pattern of socio-economic status can not be realistically generalized, but it appears to be typical pattern of patients of this region. INCO ME GROU PGROU P-AGROU P-BGROU P-CTOTA L%Higher010102046.78Higher middle0303041016.95SOCIO-ECONOMIC STATUS OF PATIENTS 35 30 25Lower middle1009102949.15GROUP-A20GROUP-B15GROUP-C10Lower0604061627.125TOTAL 6.78%16.95%49.15%27.12%0 HigherHigher middleLower middleLower% 20. TABLE : 5 DISTRIBUTION OF AREA OF PATIENTS AREAGROUP-A GROUP- B GROUP-C TOTAL%URBAN13111539RURAL07060720AREA WISE DISTRIBUTION66.2 33.8URBANRURAL 66.2During this study, it has been found that this diseases is more prevalent in Urban population (66.2 %) than the Rural (33.8 %). This may be due to their food habits, life style and general practiced.39 1371115 633.8 207 21. TABLE : 6 FAMILY HISTORY OF THE DISEASE FAMILY HISTORYNO. OF PATIENTSPERCENTAGES (%)Present1118.64 %Absent4881.36 %FAMILY HISTORY WISE DISTRIBUTION PresentIn present study, family history was present only in 11 patientsAbsent48(18.64 %). It reveals some specific genetic interactions in etiopathogenesis of diseases. 11 18.64% 81.36% NO. OF PATIENTSPERCENTAGES (%) 22. T ABL E : 7 DUR AT ION OF IL NE L SS CHR ONICIT YGR OUP A -GR OUP B -GR OUP C -T OT AL%(IN Y AR E S) < 1Y AR E S0402030915.251- 3Y AR E S0503031118.643 5Y AR E S0708092440.68>5Y AR E S0404071525.43In pr esent study, maximum cases h ave dur ation of pr esent illness in gr oup of 3- 5 year s (4 0.68 %), followed by the gr oup of > 5 year s (25.4 3 %)CHRONICITY WISE DISTRIBUTION 45 40 35 (IN YEARS)30 255YEARS5 0 GROUP-AGROUP-BGROUP-CTOTAL% 23. TABLE : 8 DRUG HISTORYOut of 59 patients, 39 patients had taken irregular dose of drugs whereas 20 patients had regular doses only. DRUG HISTORY REGULAR IRREGUL ARGROUP-A08 12GROUP-BGROUP-C07 1005 17TOTAL20 39%33.8 66.2DRUG HISTORY WISE DISTRIBUTION 70 60 50 GROUP-A40GROUP-B GROUP-C30TOTAL %20 10 0 REGULARIRREGULAR 24. TABLE :9 NATURE OF DIETIn present study, it is found that most of the patients were vegetarian (61.01 %) and their diet nature of diet was irregular (62.71 %). Rest of the patients had mixed and regular nature of diet NATURE DIETOF GROUP-AGROUP-BGROUP-CTOTAL%VEGETARIAN1312113661.01MIXED0705112338.98REGULAR0806082237.29IRREGULAR1211143762.71DIET WISE DISTRIBUTION 70 60 50 VEGETARIAN40MIXED 30REGULAR IRREGULAR20 10 0 GROUP-AGROUP-BGROUP-CTOTAL% 25. TABLE : 10 BOWEL PATTERN Out of 59 patients, 67.8 % patients had irregular bowel pattern. 40.7 % patients were sufferer of constipation BOWEL PATTERN REGULAR IRREGULAR CONSTIPATIO NGROUP-AGROUP-BGROUP-CTOTAL07 13 0506 11 0706 16 1219 40 2432.2 67.8 40.7BOWEL PATTERN WISE DISTRIBUTION 70 60 50 REGULAR40IRREGULAR30CONSTIPATION20 100 GROUP-AGROUP-BGROUP-CTOTAL%% 26. TABLE : 11 % DISTRIBUTION OF ADDICTIONDuring study, it was found that only 37.3 % of cases had tobacco addiction and 27.1 % cases had alcohol addiction. 57.6 % cases had no addiction ADDICTIO N TOBACCOGROUP-A GROUP-B GROUP-C TOTAL%0805092237.3ALCOHOL0903041627.1NOT PRESENT1113103457.6ADDICTION WISE DISTRIBUTION 605040 TOBACCO 30ALCOHOL NOT PRESENT20100 GROUP-AGROUP-BGROUP-CTOTAL% 27. TABLE : 12 % DISTRIBUTION OF PRAKRITIAssessment of deha prakriti was done in all 59 patients. Majority of cases were belonging to the vata-kaphaja prakriti (28.8 %) ,kaphaja prakriti (20.3 %) and vataja prakriti (18.6 %). Thus, these three prakritis are most vulnerable to the disease.PRAKRIT I VATAJA PITTAJA KAPHAJA VATAPITTAJA PITTAKAPHAJA VATAKAPHAJA TRIDOSAJ AGROUP-A GROUP-B GROUP-CTOTAL%04 02 05 0103 03 04 0204 03 03 0111 08 12 0418.6 13.6 20.3 06.80201010406.80504081728.80100020305.1 28. 30 VATAJA 25 PITTAJA KAPHAJA20VATA-PITTAJA 15PITTA-KAPHAJA VATA-KAPHAJA10 TRIDOSAJA 50 GROUP-AGROUP-BGROUP-CTOTAL% 29. TABLE : 13 % DISTRIBUTION OF SAARATable reveals that most of the patints were belonging to the madhyama saara (74.6 %) followed by avara saara (16.9 % SAARAGROUP-AGROUP-BGROUP-CPRAVARA MADHYAM A AVARA02 1402 1301 17TOTA % L 05 08.5 44 74.60402041016.9SAARA WISE DISTRIBUTION 80 70 60 50PRAVARA MADHYAMA40AVARA 30 20 10 0 GROUP-AGROUP-BGROUP-CTOTAL% 30. TABLE : 14 % DISTRIBUTION OF SAMHANANA Out of 59 patients, most of the patients had madhyama samhanana (69.5 %) followed by avara samhanana (18.6 %). SAMHANAN A PRAVARA MADHYAMA AVARAGROUP-AGROUP-BGROUP-C01 14 0502 12 03TOTA L 07 41 1104 15 03SAMHANANA WISE DISTRIBUTION PRAVARAMADHYAMAAVARA69.54114 112 5GROUP-A218.615 3GROUP-B43GROUP-C7TOTAL1111.9%% 11.9 69.5 18.6 31. TABLE : 15 % DISTRIBUTION OF SATMYATable reveals maximum cases of madhyama satmya (71.2 %) followed by avra satmya (16.9 %). SATMYAGROUP-AGROUP-BGROUP-CPRAVARA MADHYAM A AVARA02 1402 1203 16TOTA % L 07 11.9 42 71.20403031016.9SATMYA WISE DISTRIBUTION PRAVARAMADHYAMAAVARA71.24214 24GROUP-A216.91612 3GROUP-B33GROUP-C7TOTAL1011.9% 32. TABLE : 16 % DISTRIBUTION OF SATVAOut of 59 patients , 41 patients had madhyama satva (69.5 %) ,whereas, 18.6 % and 11.9 % patients had pravara and avara satva respectively SATVAGROUP-AGROUP-BGROUP-CPRAVARA MADHYAM A AVARA04 1303 1204 16TOTA % L 11 18.6 41 69.50302020711.9SATVA WISE DISTRIBUTION PRAVARAMADHYAMAAVARA 69.541418.6161312 3GROUP-A311.911 2GROUP-B47 2GROUP-CTOTAL% 33. TABL : 17 % DISTRIBUTION OF AHARA- SHAKTI EAHARA- SHAKTI GROUP- A GROUP- B GROUP- C TOTAL % PRAVARA0503031118.6MADHYAMA1012163864.4AVARA0502031016.9Out of 59 patients, 38 patients had madhyama ahara shakti (64.4 %), whereas, 18.6 % and 16.9 % patients had pravara and avara ahara shakti respectivelyAHARA-SHAKTI WISE DISTRIBUTION PRAVARAMADHYAMAAVARA64.4385105GROUP-A318.61612 2GROUP-B31116.9103GROUP-CTOTAL% 34. TABL : 18 % DISTRIBUTION OF VYAYAMA- SHAKTI EVYAYAMA- SHAKTI GROUP- A GROUP- B GROUP- C TOTAL%PRAVARA0101020406.8MADHYAMA1713174881.3AVARA0203030813.6In present study , it was found that 48 patients had madhyama vyayama shakti i.e. 81.3 %, followed by avra vyayama shakti patients (13.6 %).VYAYAMA-SHAKTI WISE DISTRIBUTION PRAVARAMADHYAMAAVARA81.34817 11713 2GROUP-A13GROUP-B213.6 3GROUP-C4TOTAL86.8% 35. TABL : 19 % DISTRIBUTION OF VAYA EVAYAGROUP- AGROUP- BGROUP- CTOTALBAL YA0000000000.0MADHYAMA 1613154474.6J EERNA04071525.404%Out of 59 patients , 74.6 % patients were belonged to madhyama vaya and 25.4 % were belonged to jeerna vaya. It reveals that it is age- related diseae and mostly in madhyamavastha and jeernavstha of lifeVAYA WISE DISTRIBUTION 80 70 60 50 BALYA 40MADHYAMA JEERNA30 20 10 0 GROUP-AGROUP-BGROUP-CTOTAL% 36. TABL : 20 % DISTRIBUTION OF PRAMANA E PRAMANAGROUP- AGROUP- BGROUP- CTOTALPRAVARA0101020406.8MADHYAMA 1512174474.6AVARA04031118.604%Out of 59 patients, 44 patients had madhyama pramana (74.6 %) followed by avara pramana (18.6 %).PRAMANA WISE DISTRIBUTION PRAVARAMADHYAMAAVARA 74.644118.6171512 4GROUP-A111 4GROUP-B23GROUP-C4TOTAL6.8% 37. T B E A L:21% DIS R UT T IB ION OF NIDA NA NIDA NAGR OUP A -GR OUP B -GR OUP C -TOTA L%A HA A R JA Usn a060805193 2 .2Tiksh n a060805193 2 .2Madya090304162 7 .1L avan a111308325 4 .2K atu070605183 0 .5A mla080603172 8 .8K latth a u050306142 3 .7Taila121008305 0 .9Mamsa070511233 8 .9Dadh i040711223 7 .3V isamasan a081110294 9 .2V u ddh asan a ir050703152 5 .4A tyasan a030205101 6 .9A dh yasan a010402071 1 .9A jir n asan a020603111 8 .6R atr ijagar an a120907284 7 .5S r ama h161410406 7 .8A bh ighata010201040 6 .8A tich an kr aman a080712274 5 .8K odh a r060402122 0 .3S an tapa010204071 1 .9V IHA A R JAMA NA IK S A 38. NIDANA WISE DISTRIBUTION 80706050403020100Series1Series2Series3Series4Series5Series6Series7Series8 39. TABL : 22) E%DISTR IBUTION OF SIGN & SYMPTOMS IN GROUPS SYMPTOMS& GROUP- A GROUP- B GROUP- CTOTAL%SIGNS PAIN20172259100SWEL ING L1812174779.7TENDER NESS1814195186.4RESTR ICTION OF 1512174474.5MOVEMENT STIFFNESS1614184881.4CR EPITUS20172259100In present study, it was found that in case of pain and crepitus , distribution of cases were 100 %. Tenderness was present in 86.5 % cases, stiffness in 81.4 % cases, swelling in 79.7 % cases and restriction of movement in 74.5 % cases. It reveals that these are major sign and symptoms in osteoarthritis. 40. SYMPTOMS & SIGNS WISE DISTRIBUTION 100 90 80 70 60 50 40 30 20 100GROUP-A GROUP-B GROUP-C TOTAL % 41. TABL E: 23) % OF EFFECT OF THERAPY IN SEVERITY OF PAIN ,BEFORE AND AFTERTHERAPY GROUPMEAN BTGROUP- A 2.5X AT%S.D.S.E.tPRELIEF0.9375 1.5625 62.50.5123 0.1281 12.199