Sandhi Svaras Book

A STUDY ON THE EFFICACY OF AYURVEDA AND
NATUROPATHY IN SANDHI VATA

By
Patil Uday J.
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI
(DOCTOR OF MEDICINE)
In
SWASTHAVRITHA
Under the guidance of
Dr. Sajitha K. M.D. (AYU)
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHA

VRITHA
S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN,
573201
2006
A STUDY ON THE EFFICACY OF AYURVEDA AND

NATUROPATHY IN SANDHI VATA
By
Patil Uday J.
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI
(DOCTOR OF MEDICINE)
In
SWASTHAVRITHA
Under the guidance of
Dr. Sajitha.K, M.D (Ayu)

Asst. Prof, Dept of Swasthavritha
DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA

S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL,
HASSAN -573201
2006
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled A STUDY ON THE

EFFICACY OF AYURVEDA AND NATUROPATHY IN SANDHI VATA is a
bona fide and genuine research work carried out by me under the guidance of Dr.
Sajitha K. Asst. Professor, Department of Post Graduate Studies In SwasthaVritta,
S. D. M. College of Ayurveda and Hospital, Hassan 573 201.
Date:
Place: Hassan
Patil Uday J.
DEPARTMENT OF POST GRADUATE STUDIES IN

SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN 573 201
(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled A STUDY ON THE

bona fide research work done by Patil Uday J in partial fulfilment of the
requirement for the degree of Ayurveda Vachaspati (M.D. Ayurveda) in
Swasthavritha.
Date:
Hassan:
Dr. Sajitha K.
Asst. Professor
P.G. Studies in Dept of Swasthavritha
S D M College of Ayurveda, Hassan
DEPARTMENT OF POST GRADUATE STUDIES IN

SWASTHAVRITHA
S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN 573 201

(Affiliated to Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka)
ENDORSEMENT BY THE H O D; PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled A STUDY ON THE

bona fide research work done by Patil Uday J. under the guidance of Dr. Sajitha K.,
Asst Professor, Department of Post Graduate Studies In Swasthavritha, S.D.M.
College of Ayurveda, Hassan - 573201.
Dr. Ramana G.V.

Professor and Head
P G Studies in SwasthaVritta,
S D M College of Ayurveda,
Hassan.
Dr. Prasanna N Rao

Principal
S D M College of Ayurveda,
Hassan.
Date:
Date:
Place:
Place:
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
Date:
Place: Hassan
Patil Uday J.
Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
I bow my head on the foot of Prof. S. Prabhakar, secretary of SDME society, for
giving me an opportunity to pursue post graduation in SDMCA, Hassan
I owe my humble gratitude and regards to Prof Dr. Gurudip singh, Director of
PG studies, SDMCA&H, HASSAN for evincing keen interest in my endeavours and for
continued encouragement
I am greatly thankful to Dr. P. N. Rao, Principal who provided the necessary
facilities for the completion of this research work.
I express my sincere gratitude and respect to Prof. Dr. Ramana. G. V. for his
guidance and timely suggestions and Dr. Sajitha K, Guide, advice, constant inspiration
enabled me to complete this work.
I am grateful to Dr. Shashikiran, Dr. Suhaskumar Shetty, for timely
information and librarian for his co-operation.
I am thankful to all the teaching and non teaching staffs of S.D.M. College of
Ayurveda and Hospital, Hassan for their support and co-operation.
I am Grateful to Dr. Basant, Dr. Gururaj, Dr. Aditi, Dr. Manish, Dr. Srikant,
Dr. Sanjeev, Dr. Prashant Lande, Dr. Satish Wagh, Dr. Vaibhav and all my
classmates for their never-ending encouragement. I wish my thanks to all my seniors,
juniors and under graduates who helped me in every aspects of my work.
I heartily acknowledge the help rendered to me by Dr. Anand, Dr. Abhijit, Dr.
Prmod, Dr. Shailendra, Dr. Mayur, and Dr. Ashok A.
I feel immensely privileged to credit this work to my parents, brother, wife,
affection of my loving child Parth and other family members who constantly kept me
supporting against all odds.
Dr. Patil Uday Jayawantrao
LIST OF ABBREVIATIONS
-Janu Basti group
A. Hr.
-Ashtanga Hridaya
A. Sa.
-Ashtanga Sangraha
Ath.
-Atharvaveda
-Naturopathy Techniques group
Bh. Pr.
-Bhava Prakash
Bh. Ra.
-Bhaishajya Ratnavali
Ca. Sa.
-Charaka Samhita
Ci.
-Chikitsa
M. M.W.
-Monier. M. Williams
Ma. Ni.
-Madhava Nidana
Mad.Kh.
-Madhyama Khanda
Ni
-Nidanasthana
Pu
-Purvardh
Sh.
-Sharirasthana
Su.
-Sutrasthana
Su. Sa.
-Sushruta Samhita
Ut.
-Uttaraardh
Vi
-Vimanasthana
Yo. Ra.
-Yoga Ratnakara
ABSTRACT
Background
To carry out the daily activities, normal movements of joints are very essential.
Osteoarthritis acts as main hurdle in performing daily activities, in which joints are
mainly affected leading to pain, immobility and discomfort.
Non-pharmacological management is the foundation of treatment of osteoarthritis.
Therefore, naturopathy gives a hope of treating this condition with different techniques
used externally.
Objectives
1. To evaluate the effect of Janu-Basti in the management of Sandhi Vata.
2. To evaluate the effect of Naturopathy techniques in the management of Sandhi Vata.
3. To compare the efficacy of Janu Basti and Naturopathy techniques.
Methods
It is a comparative study with pre-test and post test design with two groups
consisting of 15 patients each.
Group A- Patients of this group were advised Janu Basti with Tila Taila for 7 days.
Group B- Patients of this group were given naturopathy techniques externally for 7 days.
Results
Naturopathy techniques provided significant relief in Shoola (34.64%) in 53.33%
of patients, Shotha (3.83%) in 86.66% of patients, Kriya alpata (43.13%) in 66.66% of
patients, Flexion angle of knee joint (7.20%) in 73.33% of patients, Time taken to cover
50m distances (17.66%) in 100% of patients of Sanhi Vata. Janu-Basti with Tila taila
provided significant relief in Shoola (32.85%) in 46.66% of patients, Shotha (2.65%) in
43.33% of patients, Kriya alpata (39.16%) in 46.66% of patients, Flexion angle of knee
joint (5.19%) in 73.33% of patients, Time taken to cover 50m distance (12.08%) in
73.32% of patients.
Interpretation
By Naturopathy techniques blood circulation increases to joints due to
vasodilatation, relieves congestion, improves nutrition of the joint, reduces muscle spasm
and inflammation; soften adhesions, improves the range of motion and lubrication.
Janu-Basti acts as an effective Bahya Shamana Chikitsa and relieves symptoms
like Stambha, Gaurava and Sheetata.
Conclusion
Clinical study has proved that non pharmacological management in the form of
external treatments gives significant relief in osteoarthritis.
CONTENTS
List of Tables and Figures

Introduction and objectives
1-2
I. Literary Review of Sandhi Vata

Historical
3-4
Considerations
Nirukti-Paribhasha
5-6
Anatomy of Janu-sandhi
7-10
Nidana
11-17
Poorvaroopa and Roopa
18-19
Samprapti
20-25
Vyavachedaka Nidana
26
Sadhyasadhyata
27
Chikitsa
28-30
Osteoarthritis
31-36
Naturopathic techniques for Sandhi Vata
37-44
Janu-Basti
45-47
Mode of Action
48-50
II. Methodology
51-55
Results
56-75
Discussion
76-86
Conclusion
87-88
Summary
89-91
Bibliographic References
92-94
Annexure
95-96
SL.
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LIST OF TABLES AND FIGURES

CONTENT OF TABLE
REFERENCES OF SANDHI VATA
RASA VISHESHA AHARAJA NIDANA
GUNA VISHESHA AHARAJA NIDANA
VIRYA VISHESHA AHARAJA NIDANA
DRAVYA VISHESHA AHARAJA NIDANA
AHARAKRAMA NIDANA
VIHARAJA NIDANA
MANSIKA NIDANA
KALAJA NIDANA
ANYA NIDANA
ROOPA OF SANDHI-VATA MENTIONED IN VARIOUS CLASSICS
CHIKITSA SOOTRA MENTIONED IN DIFFERENT SAMHITA
DRUG REVIEW
AGE WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA
SEX WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI-VATA
RELIGION WISE DISTRIBUTION OF 30 PATIENTS OF SANDHIVATA
OCCUPATION WISE DISTRIBUTION OF 30 PATIENTS OF SANDHIVATA
DEHA PRAKRITI WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
VATA
SARA WISE DISTRIBUTION OF 30 OF SANDHI VATA
SAMHANANA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
PAGE
NO.
4
13
13
13
14
15
15-16
16
16
17
18
28
47
56
56
57
57
59
59
60
VATA
PRAMANA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI VATA

SATMYA (AHARA) WISE DISTRIBUTION OF 30 PATIENTS OF
SANDHI VATA
SATVA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI VATA
ABHYAVAHARANA SHAKTI WISE DISTRIBUTION OF 30 PATIENTS
OF SANDHI VATA
JARANA SHAKTI WISE DISTRIBUTION OF 30PATIENTS OF SANDHI
VATA
VYAYAMA SHAKTI WISE DISTRIBUTION OF 30 PATIENTS OF
SANDHI VATA
CARDINAL SIGNS AND SYMPTOMS RECORDED IN 30 PATIENTS OF
SANDHI VATA
CHRONICITY WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI
VATA
CHARACTERISTIC OF KULAJA VRITTANT REPORTED BY 30 CASES
OF SANDHI VATA
SHOWING DISTRIBUTION OF VIHARATMKA NIDANA RECORDED
IN 30 CASES OF SANDHI VATA
60
60
61
61
61
62
62
62
63
64
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
SHOWING DISTRIBUTION OF AHARATMAKA NIDANA IN 30 CASES

OF SANDHI VATA
EFFECT OF JANU-BASTI ON SYMPTOMS OF SANDHI VATA
PATIENTS
EFFECT OF JANU-BASTI ON CLINICAL SIGNS OF SANDHI VATA
PATIENTS
EFFECT OF NATUROPATHY TECHNIQUES ON SYMPTOMS OF
SANDHI VATA PATIENTS
EFFECT OF NATUROPATHY TECHNIQUES ON CLINICAL SIGNS OF
SANDHI VATA PATIENTS
TOTAL EFFECT ON SHOOLA
TOTAL EFFECT ON ATOPA
TOTAL EFFECT ON KRIYA ALPATA
TOTAL EFFECT ON SHOTHA
TOTAL EFFECT ON TIME TO COVER 5OM DISTANCE
TOTAL EFFECT ON FLEXION ANGLE OF KNEE JOINT
PATIENTS AFTER 15 DAYS
EFFECT OF JANU-BASTI ON CLINICAL SIGNS OF SANDHI VATA
SANDHI VATA PATIENTS AFTER 15 DAYS
EFFECT OF NATUROPATHY TECHNIQUES ON CLINICAL SIGNS OF
SANDHI VATA PATIENTS AFTER 15 DAYS
EFFECT OF JANU-BASTI ON SIGNS OF SANDHI VATA PATIENTS
AFTER 30 DAYS
SANDHI VATA PATIENTS AFTER30 DAYS
EFFECT OF NATUROPATHY TECHNIQUES ON SIGNS OF SANDHI
VATA PATIENTS AFTER 30 DAYS
FIGURE NO.
1
2
3
4
5
6
7
8
9
FIGURE
SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI VATA
SAMPRAPTI IN AVARANA JANYA SHADHI VATA
SAMPRAPTI IN ABHIGHATA JANYA SANDHI VATA
SHOWING AGE WISE DISTRIBUTION
SHOWING SEX WISE DISTRIBUTION
SHOWING RELIGION WISE DISTRIBUTION
SHOWING OCCUPATION WISE DISTRIBUTION
SHOWING CARDINAL SIGNS AND SYMPTOMS
SHOWING CHRONICITY WISE DISTRIBUTION
64
66
66
68
68
69
69
69
70
70
71
71
72
72
73
73
74
74
75
PAGE NO.
23
24
25
58
58
58
59
63
63
Introduction
&
Objectives
INTRODUCTION AND OBJECTIVES

Research is done for establishing new facts Many times research is conduct to
validate old principles with fresh proofs. Research is constructed with suitable
experimental methods and honest observations are made to arrive at a logic conclusion.
In our body, bones form the arms of the lever and fulcrum is at a joint where
movement takes place. To carry out the daily activities, normal movements of joints are
very essential. Sandhi-Vata acts as main hurdle in performing daily activities, in which
joints are mainly affected leading to pain, immobility, and discomfort. Sandhi-vata
described in Ayurveda can be correlated with osteoarthritis mentioned in modern science.
Arth means joint and itis means inflammation. Osteoarthritis is the most
common type of arthritis; occurs due to the breakdown of cartilage in the joint. Among
the elderly and obese persons Osteoarthritis is a leading cause of chronic disability
especially affecting the knee joints. Since knee is the weight bearing joint it is more
susceptible to wear and tear. Other factors like heavy journey, agriculture, housework is
also contributing.
In the age group of 45-65 years 30% of population is suffering from this disease.
More than 355 million people around the world today are suffering from chronic pain of
arthritis. W.H.O. estimates that within the growing population the number of people over
50 years of age will be doubled by the year 2020. Hence, it has declared 2001-2010 as the
Decade of bone and joint diseases.
In the contemporary science treatment is mainly aimed at Nonpharmacological
methods. Now there is a trend to find out non-pharmacological measures as much as
possible for the management of various disorders. Among nonpharmacological
treatment physical heat therapy is given importance. In addition, non-pharmacologic

management is the foundation of osteoarthritis.
Naturopathy is a part of Swasthavritha, which deals with the different nature cure
techniques. Naturopathy utilizes change in temperature as therapy. To regulate various
systems external and easiest access is skin. Skin is a giant sense organ and covers whole
body. So the naturopathy techniques can be correlated to Bahirparimarjan Chikitsa
mentioned in Ayurvedic classic. Treatment in the form of Janu-basti, Abhyanga, Avagaha
etc. have been proved of their efficacy on Sandhi Vata. The naturopathy likes derivative
massage, wax bath, alternate hot and cold pack, exercises, mustard pack etc. also
constitute non-pharmacological interventions, which are harmless, cheap and said to be
effective. Hence a study is planned to study their efficacy along with Janu Basti as
control in Sandhi vata patients.
The objectives of the present study are to provide scientific basis for the therapies that
is practiced are highly beneficial in the treatment of Sandhi vata. The following are
the main objectives of this study.
4.To evaluate the effect of Janu-Basti in the management of Sandhi Vata.
5.To evaluate the effect of Naturopathy techniques in the management of Sandhi Vata.
6.To compare the efficacy of Ayurvedic Bahirparimarjan Chikitsa and naturopathy
techniques employed for the treatment of Sandhi Vata.
Review of literature
HISTORICAL CONSIDERATIOS
History of Indian medicine is usually studied under the headings of Prevedic
period, Vedic period, Samhita Kala, Sangraha Kala, Nighantu Kala and Adhunika Kala.
History of medicine also reveals some aspects of the disease.
In classics the general description of Sandhi Vata is available.
There is no reference regarding Sandhi Vata in Prevedic period. During Vedic

period in Atharvaveda the references regarding the occurrence of Sandhi Vikara (Ath.
2/33/7, 6/14/1), the importance given for Vata (Ath.8/2/3, 2/10/3) and disorders of Vata
(Ath. 9/8/21) are available.
In Samhita period we find systematic description of the diseases according to
Nidana Panchaka.
Caraka Samhita, explained Sandhi Vata in Chikitsa sthana.1
Sushruta Samhita narrates its Lakshana in Nidanasthana2 and Chikitsa in
Cikitsasthana.3
Ashtanga Sangraha Nidanasthana describes its Lakshana4 and Chikitsa of Sandhi

Vata in Cikitsasthana.5
Ashtanga Hridaya has described Lakshansa in Nidanasthana6 and line of treatment
in Cikitsasthana.7
In Madhava Nidana Lakshana of Sandhi Vata are given same as that of Sushruta.8
Bhavaprakasha explains the Lakshana and treatment of Sandhi Vata in Madhyama
Khanda Vatavyadhyadhikara.9
Yogaratnakara also explained about Lakshana and treatment of Sandhi Vata in
Vatavyadhyadhikara of Purvardha.10
In Bhaishajya Ratnavali Vatavyadhi Prakarana deals with treatment aspects of
Sandhi Vata.11
The commentators of Samhita and Sangraha especially Chakrapani and Dalhana
contributed a lot for better understanding of the disease.
Table 1
References of Sandhi Vata
Literatures
References
Caraka Samhita
Chikitsasthana 28
Sushruta Samhita
Nidanasthana 1; Chikitsasthana 4
Ashtanga Sangraha
Ashtanga Hridaya
Yogaratnakara
Purvardha, Vatavyadhyadhikara
Bhavaprakasha
Madhyamakhanda Vatavyadhyadhikara 24
Madhava Nidana
Purvardha, Vatavyadhyadhikara 22
Bhaishajyaratnavali
Vatavyadhi Prakarana 23
NIRUKTI AND PARIBHASHA

The word Sandhi-Vata is comprised of 2 words i.e., Sandhi and Vata.
Etymology, definition and specific interpretation of the terms are explained as follows.
Sandhi
Vyutpatti
Sam + Dha + Kihi (Shabda Kalpa Druma)
Nirukti
Asthi Samyogasthane
(Vaiydyaka Sabdasindhuh)
Means junction, connection, combination, and union with containing a conjugation,

transition from one to another
(Sanskrit English dictionary by M.M.W.)
Paribhasha - Sandhi Pullinga, Sandhanamiti, Yuga Sandhini Yugashabde Deha

Sandhini Marmashabde Cha Drishtavyaha (Shabda Kalp Druma).
In general, Sandhi means the junction between two things. In Ayurveda, Shareera
Sandhi is a technical word indicating that it is the place where two or more bones meet
together and the joint may be fixed type or with less or more movement.
Acharya Sushruta explains about the innumerable junctions between Peshi,

Snayu, Sira, Asthi, etc. But the description about Sandhi is concerned Asthi Sandhi1.
Vata
Vyutpatti-
Va - Gati Sevanayoho
Va + Kta
(Shabda Kalpa Druma)
The term Vata is derived by the application of Kta or Krt Pratyaya to the verb
root Va which means Gati and Gandhana.
Nirukti -
Va - Gati Gandhanayoho (Sushruta Samhita)
The term Gati is having meanings like Prapti, Jnana, Gamana, Moksha and the
meaning of Gandhana is like Utsaha, Prakashana, Soocana, (Shabdasthoma) Gandhana,
Prerana (Siddhanta Kaumudi).
Considering the different meanings of Gati and Gandhana it is understood that the
term Vata act as a receptor as well as stimulator. Hence it can be said that Vata is the
biological force, which recognize and stimulate all the activities in the body.
Sandhi -Vata
After going through the different references the definition can be stated as the
vitiated Vata when get lodged at one or more than one Sandhi and producing the features
like pain in the joint, swelling on palpation, crepitus and stiffness in the joint termed as
Sandhi-Vata.
JANU-SANDHI
In Sandhi Vata the vitiated Vata gets lodged at different Sandhi. Therefore before
going to the disease aspects, the anatomy and physiology of Sandhi are to be under stood
properly. Here an attempt is made to study anatomical and physiological consideration of
Sandhi in general and Janu-sandhi in particular.
In Ayurveda, Sandhi is mainly classified into two types.
1) Sthira Sandhi
2) Chala Sandhi12
Again they are sub classified into eight types.
1) Kora
2) Ulookala
5) Tunnasevani
6)Vayasa tunda
3) Samudga
7)Mandala
4) Pratara
8)Shankhavarta
Acharya Sushruta considered Janu-Sandhi under Chala Sandhi and sub classified
under Kora Sandhi.13
Other factors that are to be highlighted in understanding the Sandhi are
Shleshmaka Kapha- Shleshmaka Kapha is one among five variety of Kapha, which
reside in joints. It helps in lubrication of joints.14
Shleshmadhara Kala-It is the fourth Kala, which is situated in all joints. As wheel
moves on well by lubricating the axis, joints also function properly if supported with
Kapha. This helps in formation of synovial fluid and to control friction of bones.15
Vyana Vata- Vata governs every movement in the body. Vyana Vata is one among the
five varieties of Vata, which resides at Hridaya and controls most of the motor functions.
The Gati or physical movement is also one of its functions. Gayadasa commenting on
Sushruta has quoted that the Vyana Vata is functioning all over the body hence it also
resides in the Sandhi.16 Acarya Vagbhata states that Vata is located in the Asthi with
relation to 'Ashrayashrayi Sambandha'. Generally augmentation or diminution of Doshas
would be given similar effect on their respective Dhatus but in case of Vata it is opposite.
With increase in Vata, Asthi Kshaya occurs.17
Sushruta in Sharirasthana explains different structures of the human body. Among
them, structures coming under Janu-Sandhi are listed below.
Snayu- Among nine hundred Snayus ten Snayus of Pratana variety are present in JanuSandhi. As a boat consisting of planks becomes capable of carrying load of passengers in
river after it is tied properly with bundle of ropes, all joints in the body are tied with
many ligaments by which persons are capable of bearing load.18
Peshi- The fleshy mass covering bony structures that can be demarcated from each other
is known as Peshi. Among the five hundred Peshi, five are present in Janu Sandhi. They
are strong structures that help to maintain alignment of the joint.19
Sanghata- Assemblages of bones are known as Sanghata. Out of total fourteen, one is
situated in Janu-Sandhi.20
Knee Joint
The knee joint is the largest and most complex joint of the body. The complexity
is due to the result of fusion of three joints in one. It is formed by fusion of the lateral
femoro-tibial, medial femoro-tibial and femoro-patellar joints.
It is a compound synovial joint, incorporating two condylar joints between the
condoyle of the femur and tibia, one saddle joint between the femur and the patella.
In synovial joints the osseous surfaces concerned are not in continuity although
the bones involved are linked. The synovial joints evolve from fibrous and cartilaginous
joints by subsequent developments. These synovial joints are made up of unique
structures like fibrous capsule, articular surfaces, synovial membrane, synovial fluid,
ligaments, muscles etc.
Articular surfaces- The knee joint is formed by (1) the condyles of the femur, (2) the
condyles of the tibia and (3) the patella. The femoral condyles articulate with the tibial
condyles below and behind with the patella in front.
Fibrous capsule- The fibrous capsule has parallel but interlacing bundles of white
collagen fibers. It is complex, partly deficient and partly augmented by expansions from
adjacent tendons. It forms a cuff with its ends attached continuously round the articular
ends of the Tibia and Femur.
Synovial membrane- Derived from embryonic mesenchyme and lines fibrous capsule,
covers exposed osseous surfaces, intra-capsular ligaments and tendons. It is absent from
intra-articular discs or menisci and ceases at the margins of articular cartilages.
Synovial Intima- Also called as lamina propria synovialis or synovial lining layer. It
consists of pleomorphic synoviocytes embedded in a granular, amorphous, fiber free inter
cellular matrix. It helps in removal of debris and synthesis of components of Synovial
fluid.
Synovial fluid- It occupies synovial joints, bursae and tendon sheaths. It is clear, pale
yellow, viscous, and slightly alkaline. A protein probably lubricin rather than hyaluoric
acid is the lubricating factor but it amplifies its secondary lubricating activity. It provides
liquid environment with small range of pH, nourishes articular cartilage, discs, menisci. It
renders lubrication and reduces erosion.
Menisci- It is a fibro cartilagenous disc which is crescent shaped. It deepens the articular
surfaces of the chondyles of the tibia. It partially divides the joint cavity into upper and
lower compartments. It has two ends, two borders and two surfaces. It helps to make the
articular surfaces more congruent; act as shock absorbers, lubricates the joint cavity and
gives rise to proprioceptive impulse.
Other Structures-Ligaments- The capsules and ligaments of Synovial joints unit the
bones, help to direct bone movement and prevent excessive and undesirable motion. Thus
more the ligaments, stronger are the joints. In knee joint tibial collateral lig, fibular
collateral lig, oblique popliteal lig, arcuate popliteal lig, ligamentum patellae, cruciate
ligament etc. helps to maintain stability.
Muscle tone- Muscle tendons that cross the joints are the most important stabilizing
factors, due to tonicity of the respective muscles. In knee, muscle tone is extremely
important in reinforcing joints. For this the thigh muscles are helpful.
Bursae- Apertures in fibrous capsule through which synovial membranes protrude are
called as Bursae. They are numerous; as many as 13 bursae have been described around
the knee, four anterior, four laterals & five medial.
Blood Supply-1.Five genicular branches of the popliteal artery. 2. The descending
genicular branch of the femoral artery. 3. The descending branch of the lateral circumflex
femoral artery. 4. Two recurrent branches of the anterior tibial artery. 5. The circumflex
fibular branch of the post-tibial artery.
Nerve Supply- 1.Femoral nerve Through its branches to the vastus medialis.2. Sciatic
nerve-Through the genicular branches of the tibial and common peroneal nerves. 3.
Obturator nerve Through its posterior division.
NIDANA
In Bruhatrayees and Laghutrayees we find the description of Sandhi Vata in Vata
Vyadhi, hence Sandhi Vata is considered as a part of Vata Vyadhi.
Acharyas have not mentioned particular Nidana for Sandhi Vata, so we can
take common Nidana given for Vata Vyadhi21 along with Asthi and Majjavahasroto
Dushti Karana.22
These Nidana can be classified under various headings with different contexts.
The complimentary references of the Nidana of Sandhi Vata can be classified on the
following basis.
a) Aharaja
b) Viharaja
c) Manasika
d) Kalaja
e) Anya
Nidana mentioned under the above five groups are tabulated in Table 1to5. Some
of the important Nidana that may cause Sandhi-Vata are being discussed here in details:
Aharaja Nidana- Ahara is the most common contributing factor for the producing of a
disease. Intake of Ahara having Kashaya, Katu, Tikta Rasa; Sheeta, Ruksha, Laghu Guna
and indulgence in Alpashana, Vishmashana, Adhyashana, Pramitashana lead to
aggravation of Vata. Dravyas like Shushkashaka, Vallura, Varaka, Nivara, Koradusha,
Kalaya, Tumba, Kalinga, Chirbhota etc cause Vata vitiation.
Ativyayama- Excessive physical exercises act as one of the important Nidana for Sandhi
Vata. Running, walking, jogging etc if done excessively or violently will affect the
structures of Sandhi. They may affect the joint stability by over exertion. But if done
properly they stabilize and strengthen the Joints.
Bhara-Vahana- Carrying excessive load causes excessive pressure and stretching
effect over the structures of the joint. As knee is a weight-bearing joint, carrying
excessive load will have direct affect on the joint. The constant compression will lead
to wear and tear effect leading to degenerative changes in the joint.
Abhighata- Abhighata to the joint due to Prapatana etc. leads to structural deformity in
the joint. Joint is an organ rather than a single structure as it is stabilized by different
structures like Asthi, Snayu, Peshi, and Kala etc. Hence any trauma to these structures
will alter the structural integrity of the joint. Hence Abhighata is an important Nidana for
Sandhi Vata.
Ati-Sankshobha- It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas is
involved in Sandhi Vata this can be considered as Nidana for the same. Violent activities
like Atyadhva, Plavana, Langhana, Balavat Vigraha, Pradhavana etc. will have adverse
effect on joint. As told earlier knee is the weight-bearing joint, and violent exercises or
activities will alter the structural integrity of the joint.
Marmabhighata-The concept of Marmabhighata in the causation of Sandhi Vata seems
to be more rational. Janu Sandhi is one of Vaikalyakara Sandhi Marma23. Thus Janu
sandhi is a vital point, which comprises of Asthi, Snayu, Sira and Mamsa.
Pain in the joints not necessarily be only associated with bony changes. But
involvement of other joint structures may also give rise to symptoms pertaining to joint.
Therefore, in recent days more study is emphasized on the different structures involved in
the pathology of arthritis like consistency of soft tissue, fibrous material, liquid and
cartilaginous substance of the joint. From this new point the Ayurvedic view towards the
involvement of Marma in the disturbance of the joint is justified. Hence Marmabhighata
as a Nidana in case of Sandhi Vata is to be given importance.
Samanya Nidana of Vatavyadhi as explained in different treatises
(1) Aharaja Nidana
a) Rasa Vishesha Aharaja Nidana (Table-2)
Nidana
Ca.Sa.
Su.Sa.
A.Hr.
Ma.Ni. Yo.Ra.
Bh.Pr.
A.Sa.
Kashaya
Katu
Tikta
b) Guna Vishesha Aharaja Nidana (Table-3)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Rooksha
Laghu
Sheet
Vishtmbhi
Abhishyndi
Heen
Shushka
c) Virya Vishesha Aharaja Nidana (Table-4)
Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Sheeta
d) Dravya Vishesha Aharaja Nidana (Table-5)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Vallura
Varaka
Shuskha Shaka
Uddalaka
Neevara
Mudga
Masura
Kalaya
Harenu
Nishpava
Koradusha
Shyamaka
Adhaki
Tumba
Kalinga
Chirbhita
Bisa
Shaluka
Jambav
Tinduka
Karira
Chanak
Virudhaka
Trunadhany
e) Aharakrama Nidana (Table-6)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni Yo.Ra Bh.Pr
A.Sa .
Pramitashana
Anashana
Vishamashana
Adhyashana
Trusheetashana
kshudhitambupana
Viruddhanna
(2) Viharaja Nidana (Table-7)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Ati Vyayama
Langhana
Plavana
Atyadhwa
Pradhavana
Tarana
Prapatana
Atyuchabhashana
Balavadvigraha
Abhighata
Prapeedana
Bharaharana
Dukhashayya
Dukhasana
Gaja,Ushtra, adi
Atiadhyayana
Ati vyavaya
Jagarana
Vegadharana
Vega-udirana
Shrama
Vicheshta
Sheegrhayana
Ati
kharchapkarshna
Govajigajnigraha
shmadi sahasa
Purhapavana
Divasvapna
Himadana
(3) Manasika Nidana (Table-8)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Chinta
Shoka
Krodha
Bhaya
Utkantha
(4) Kalaja Nidana (Table-9)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Varsha
Greeshma
Shishira
Jeernanna
Ahoratrinta
(5) Anya Nidana (Table-10)

Nidana
Ca.Sa
Su.Sa
A.Hr
Ma.Ni
Yo.Ra
Bh.Pr
A.Sa.
Atiraktasravana
Atidoshasravana
Dhatukshaya
Rogatikarshana
Ama
Marmaghata
Kriyatiyoga
Vishmopachara
Pravata
Sangkshobha
Asthnamativighatana
Utpeshadatya
POORVAROOPA
Poorvaroopa of Sandhi-Vata is not available in classics. In Vatavyadhi

unmanifested symptoms (Avyakta) or mild exhibition of actual features of the disease
itself is considered as its Poorvaroopa.24 Therefore prior to the full manifestation
of Sandhi Vata, appearance of some of its symptoms can be considered as
Poorvaroopa.
ROOPA
The clinical features of Sandhi Vata explained by various Acharyas are listed in table.
Table-11
Roopa of Sandhi-Vata mentioned in various classics
Symptoms
Ca.Sa.
Su.Sa.
A.Hr.
A.Sa.
Ma.Ni.
Bh.Pr.
Yo.Ra.
Sandhi Shoola
Sandhi Shotha
Sandhi Stabdhata
Atopa
Sandhi Shoola
All the Acarya have described this symptom. Charaka and Vagbhata explain that
pain in the joint occurs during Prasarana and Akunchana Pravrutti.
Sandhi Shotha
Most of the classics explained this symptom. Charaka and Vagbhata explained the nature of Shotha
i.e., it is felt like bag filled with air (Vata Poorna Driti Sparsha).
Sandhi Stabdhata
Sushruta initially described this symptom, later by texts like Madhava Nidana,
Yogaratnakara and Bhavaprakasha.
They have coined the term Sandhi Hanana or Hanti. While commenting on this
word Dalhana and Gayadasa explained as Akunchanaprasaranayoh Abhavah and
Prasaranakuncanayoh Asamarthah respectively. With this we can infer that the word
Hanti refers to inability to move the joints.
In the opinion of Madhukoshakara, Hanti refers to Sandhi Vishlesha, Stambha
Adi Vikara. Hence with the above references, Hanti refers to Sandhi Stabdhata.
Atopa
This symptom is explained in Madhava Nidana. While commenting on the word
Atopa in another context, Madhukoshakara quotes the opinion of Gayadasa and Kartika
i.e. Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah. Also
Bhavamishra says Atopo Gudagudashabdaha. Thus we can say that Atopa in this
context is the sound produced by the movement of joints i.e., crepitus.
Thus with the help of different references and by the opinion of commentators it
can be concluded that Sandhi Shoola, Sandhi Shotha, Sandhi Stabdhata and Atopa are the
clinical features of Sandhi Vata.25
SAMPRAPTI
The total course from the Dosha vitiation, resultant Dhatu affliction and evolution
of Vyadhi is Samprapti. Samprapti explains all the series of pathological stages involved.
The Samanya Samprapti of Vata Vyadhi, which is explained in classics, can be
considered as the Samprapti of Sandhi Vata.
Acharya Caraka explained due to the intake of Vatakara Ahara Vihara Vata
vitiation take place. This vitiated Vata lodges in Rikta Srotas i.e. Srotas in where
Shunyata of Snehadi Guna is present. Vata after settling in Rikta Srotas produce
disease related to that Srotas26.
Acharya Vagbhata frames the Samprapti of Vata Vyadhi like Dhatukshaya
aggravates Vata and the same is also responsible to produce Riktata of Srotas. Thus
the vitiated Vata travels through out the body and settles in the Rikta Srotas and
further vitiates the Srotas leading to the manifestation of Vata Vyadhi27.
Srotoriktata occurs due to Nidanasevana as follows.
The chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess. These
properties are necessary for Sthairya and Upacaya of the body. Excessive intake of Dravyas having
Laghu, Ruksha, Sukshma, Khara properties lead to Guru and Sneha Guna Abhava due to their
opposite quality. Thus it leads to Dhatukshaya in the body. Akasha Mahabhuta produces Sushirata and
Laghuta in the body. Vayu Mahabuta fills up this Sushirata. So due to Dhatukshaya Akasha
Mahabhuta increases in the body producing Sushirata and Laghuta simultaneously Vayu fills it up.
From this description it can be stated that the meaning of word Riktata is Sushirata i.e. increase in
Akasha and Vayu Mahabhuta. While commenting on word Riktata Chakrapani says that Riktata
means lack of Snehadiguna.
For the purpose of understanding the Samprapti of Sandhi Vata can be studied under three heading.
They are1. Dhatukshayajanya 2. Avaranajanya 3. Abhighatajanya
1. Dhatukshayajanya Sandhi Vata-In old age Vata Dosha dominates in the body. This
will lead to Kapha Abhava. Also Jataragni and Dhatvagni get impaired so Dhatu will not
be form in good quality. Degeneration of body elements takes place due to predominance
of Vata in its Ruksha, Khara etc Guna and loss of Kapha in quality and quantity.
As the Shleshma Bhava decreases in the body Shleshaka Kapha in the joints also
decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi
Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi
being the main participant of the joint its Kshaya leads Khavaigunya in the joints. In this
condition if Nidana Sevana done leads Vata Prakopa. If Vata Prakopa is not corrected by
appropriate means and simultaneously if the person indulges in Asthivaha and Majjavaha
Sroto Dushtikara Nidana, the Prakupita Vata spreads all over the body through these
Srotas. In the meantime Sthanasamshraya of Prakupita Vata takes place in the
Khavaigunyayukta Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna
over power and undo all properties of Sleshaka Kapha producing disease Sandhi Vata.
2. Avarana Janya Sandhi Vata-In Sthula Sandhi Vata occurs in weight bearing joints.
In them Medodhatu will be produced in excess due to the Atisnehamsha of Amarasa The
excessive Medas will produce obstruction for the flow of nutritive materials to the future
Dhatus that is Asthi, Majja and Shukra leads to their Kshaya28.
The excessive fat deposited all over the body will produce Margavarana of Vata 29
Prakupita Vata due to Margavarana starts to circulate in the body. While traveling it
settles in the joint where Khavaigunya is already exists. After Sthanasamshraya it
produces the disease Sandhi Vata in the same process mentioned in the earlier context.
3. Abhighatajanya Sandhi Vata- Trauma is considered as

secondary cause of Osteoarthritis. By the Abhighata the
integrity of the joint is disturbed. Due to Abhighata to the
Asthi involved in Sandhi leads to provocation of Sthanika
Vata that is. Vyana Vata (Ashrayashrayi Sambandha).
Ruksha Guna of Vata and Ushanata produced by Abhighata
will does the Shoshana of Shlashmaka Kapha in the joint.
This produces the degenerative change in joint cartilage
(lack of nutrition). In another way Vata is vitiated in the joint
by the Siramarga Avarana of Vata due to Abhighata30. This
vitiated Sthanika Vata will produce series of changes in the
joint after Dosha Dushya Sammurchana and produces Sadhi

Vata Lakshana.
Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Sandhi Vata can be divided into Dhatukshaya Janya,
Avarana Janya and Abhighata Janya Sandhi Vata. This will help in deciding the prognosis and planning the treatment of the
disease.
Samprapti Ghataka:
Dosha Vata Vyana Vriddhi; Kapha Shleshaka Kshaya
Dooshya Peshi, Snayu, Asthi, Majja
Srotas Mamsavaha, Medovaha, Asthivaha, Majjavaha
Agni Jataragni, Asthi-Dhatvagni
Ama Jataragni Mandya Janya
Roga Marga Madhyama
Udbhavasthana Pakvashaya
Sancharasthana - Sarvasharira
Adhishtana Sandhi
Vyaktasthana Sandhi
FIGURE - 1
SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI VATA
VARDHAKYA
NIDANA SEVANA
DHATUKSHAYA
VATA PRAKOPA
KSHAYA OF KAPHA BHAVA

IN THE BODY
CIRCULATION THROUGH
SHLESHAKA KAPHA KSHAYA
RASAYANI
IN SANDHI
KHAVAIGUNYA IN SANDHI
STHANASAMSHRAYA IN SANDHI
SANDHI VATA
FIGURE - 2
SAMPRAPTI IN AVARANA JANYA SHADHI VATA
MEDOVRIDDHI
(MEDOVARANA)
(MARGAVARANA TO THE
FLOW OF POSHAKARASA)
VATAPRAKOPA
POSHAKARASA NYUNATA TO
ASTHIDHATU
EXCESSIVE PRESSURE OVER

WEIGHT BEARING JOINT
CIRCULATION THROUGH
ASTHIDHATU KSHAYA
RASAYANI
IN SANDHI
VYANAVATA PRAKOPA
IN SANDHI
STHANASAMSHRAYA IN SANDHI
SANDHI VATA
FIGURE - 3
SAMPRAPTI IN ABHIGHATA JANYA SHADHI VATA
ABHIGHATA
AGHATA TO ASTHI
STHANIKA VATAPRAKOPA
KSHATOSMA
VATA PRAKOPA
DOSHDUSHYA
SAMURCHANA
SHLESHAKA KAPHA KSHAYA
SANDHI VATA
VYAVACHEDAKA NIDANA
Vyavachedaka Nidana or differential diagnosis plays a prime role in arriving at an

exact decision between diseases presenting a similar clinical feature. While making the
diagnosis of Sandhi-Vata the following disorders that are having similar features has to
be excluded. They are
1)
Amavata (Ma.Ni.25/7)
2)
Vatarakta (Ca.Sa.Ci.29/23)
3)
Kroshtukasheersha (Ma.Ni.22/58)
4)
Sandhibhagna (Ma.Ni.44/2)
5)
Asthi Majjagata Vata (Ma.Ni.22/18)
There are some conditions (Dosha Vriddhi Kshaya Lakshana, Panchakarma

Vyapat) where in symptoms related to Sandhi are seen. They are listed below.
1)
Kapha Vruddhi (A.Sa.Su.19/6)
2)
Kapha Kshaya (A.Sa.Su.19/9)
3)
Mamsa Kshaya (A.Sa.Su.19/10)
4)
Medo Kshaya (Ca.Sa.Su.17/66-67)
5)
Asthi Kshaya (Ca.Sa.Su.17/66-67)
6)
Majja Kshaya (Su.Sa.Su.15/13)
7)
Ojo Visramsa (Su.Sa.Su.15/29)
So while diagnosing Sandhi-Vata, factors like Vriddhi or Kshaya of Dosha and

Dhatu should be differentiated apart from above-mentioned disorders. This will help in
successful treatment.
SADHYASADHYATA
Sandhi-Vata is a variety of Vata Vyadhi, and also Madhyama roga Margaja

Vyadhi. The disease in elderly persons is kastasadhya and Sandhi-Vata is usually
afflicted in elderly aged. Diseases of Gambheera dhatu are Yapya and Sandhi-Vata Asthi
dhatu is involved.
In Caraka Samhita it has been stated that Khudavata (Sandhi-Vata) will not yield
to treatment because of its Gambheera sthan31. Further it states that it may cured by full
effort when the disease in new, Upadrava rahita and in strong person32. So Sandhi-Vata
being a disease of old age may not be considered as Sukhsadhya. It may be Krichsadhya
or Yapya depending upon the time of onset and chronicity.
CHIKITSA
The main aim of treatment is to restore Swasthya. It means to restore
normal functions of Agni, Dosha, Dhatu, and Mala and to maintain mental health.
The primary importance of Chikitsa lies in Samprapti Vighatana.
Sandhi-Vata is a Vataja disorder. The general treatment of Vata Vyadhi can be
adopted, keeping an eye on the etiology. Regarding the specific line of treatment of
Sandhi-Vata, Caraka is silent. Later authors like Sushruta had mentioned effective line of
treatment for the same. Other books like Astanga Hridaya, Astanga Sangraha,
Yogaratnakara, and Bhavaprakasha had mentioned specific line of treatment.
The below chart shows Chikitsa sutra mentioned in different texts
Table -12
Chikitsa Sootra mentioned in different Samhita
Treatment
Su.Sa.
Snehana
Abhyanga
Mardana
A.Sa.
A.Hr.
Yo.Ra.
Bh.Pr.
Bh.Ra.
+
+
Svedana
Upanaha
Bandhana
Agnikarma
+
+
SNEHANA
Sandhi-Vata is a variety of Vata Vyadhi, where Snehana would be very effective.
According to the use it can be administered in two ways
Abhyantara Prayoga
Bahya Prayoga33
Abhyantara Sneha: Here Sneha in the form of Pana can be administered in case
of Sandhi Vata.
Bahya Sneha: Bahya Sneha is many like Abhyanga, Lepa, Pichu, Mardana, and
Parisheka. In case of Sandhi Vata we get the mentioning of Abhyanga and
Mardana.
Abhyanga means to do some 'movements' or 'Gati'. For the purpose of Abhyanga
Sukhoshna Taila or Sneha is used. Abhyanga should be done slowly in Anuloma Gati, in
joints it should be done in circular manner. Abhyanga should be done minimum for 5
minutes because the Veerya of Taila will reach Majja Dhatu in 900 Matra-Kalas. It is
Vatahara, Pushtikara34. Mardana is like Abhyanga but applied pressure is more.
SWEDANA
Swedana is a variety of Shadvidhopakrama. It is helpful in neutralizing
Stabdhata, Shitata and Gauravata.35 Vatanashak drugs or drugs having Ushna
Veerya, Guru, Drava, Sthira, Sara, Snigdha, Ruksha, Sukshma, Tikshna can be take
for Swedana.36
UPANAHA
Charaka consider Upanaha as a variety of Swedana.37
Roots of Vatahara drugs should be pasted together with Kanji and mixed with abundant quantity of
Saindhava Lavana and Sneha. After making this lukewarm, it should be applied to the affected part.
The paste of drugs included in the Kakolyadi, Eladi or Surasadi Gana as well as
pastes of Sarshapa, Tila, or Atasi or Krishara, Payasa, Utkarika and Veshavara or the
drugs of Salvana Sweda should be similarly applied to the affected part folded in piece of
thin linen and tied up.38
Duration- Upanaha, which is tied in the morning, should be removed in the night and
which is tied in the night should be removed in the morning.
BANDHANA
In Bandhana Dravya is tied to the affected apart. For the purpose of Bandhana,
Charaka opines that leather of Ushna Veerya animal can be used. In the absence of this
silk or woolen cloth can be used.39 Astanga Hridaya opines that 'Vatahara' Patra40 should
be used and Charaka suggests Eranda Patra.41
AGNIKARMA
Unique treatment indicated in case of Sandhi Vata. Here Dahana or cauterization
is done in the part affected.42 Dahana Karma should be done in the affected joint till the
Samyaka Lakshana appear.
These are the different treatment modalities mentioned by different authors for
Sandhi-Vata.
OSTEOARTHRITIS
Osteoarthritis is also called as Degenerative Joint Disease or Arthrosis or wearand-tear arthritis. It represents the failure of diarthrodial joint.
It is one of the most common joint diseases of humans. Osteoarthritis of knee is
the leading cause of chronic disability in developed countries. Primary Osteoarthritis is
idiopathic and secondary Osteoarthritis is due to many causes like secondary to trauma,
due to endocrinal disorders, metabolic causes, etc.
Risk factors for Osteoarthritis
Age It is one of the powerful risk factor in old age people.
Sex Both Males and females are affected, but osteoarthritis is more generalized
and more severe in older women. It is twice as common in women as in men.
Osteoarthritis of knee is common in women.
Women less than
45 years old 2%
45 65 years 30%
Older than 65 years 68% will suffer.
Genetic Point mutation in the cDNA coding for articular cartilage collagen have
been identified in families with chondrodysplasia and polyarticular osteoarthritis.
Trauma Direct or indirect injuries to the articular cartilage lead to its

degeneration. Fractures of different bones, especially of weight bearing with or
without involving the joint can also cause alteration of ligaments and in articular
surface of joint.
Repetitive stress Abnormal posture, abnormal gait, and unequal length of leg
will exert stress and strain over the joint.
Endocrine disorders Acromegaly, Hyperparathyroidism, Diabetes mellitus,

Obesity, etc. also may lead to osteoarthritis.
Metabolic disorders Like Ochronosis, Wilsons disease may give rise to

Osteoarthritis.
Calcium deposition diseases Like CPPD deposition may lead to Osteoarthritis.
PATHOLOGY
Although the cardinal pathologic features of osteoarthritis are progressive loss of
articular cartilage, osteoarthritis is not a disease of any single tissue but a disease of an
organ, the synovial joint. The most striking morphologic changes in osteoarthritis are
usually seen in load bearing areas of the articular cartilage.
Osteoarthritis develops in either of two settings:
1. The biomaterial properties of the articular cartilage and sub-chondral bone are
normal, but excessive loading on the joint causes the tissue fail, or
2. The applied load is reasonable, but the material properties of the cartilage or
bone are inferior.
In the early stages the cartilage is thicker than normal. With the progression of
osteoarthritis, joint surface thins then the cartilage softens. The integrity of the surface is
breached and vertical clefts develop. They are called as fibrillation. This is followed by
deep cartilage ulcers, extending to bone. All the cartilage is metabolically active and the
chondrocytes replicate, forming clusters (clones). Later cartilage becomes hypo cellular.
There will be appositional bone growth in the bony sub-chondral region, leading to the
bony sclerosis. Growth of cartilage and bone at the joint margins leads to osteophytes,
which alter the contour of the joint and may resist movement.
The biochemical changes which occur in cartilage in osteoarthritis are increase
in water content, decreased collagen, proteoglycan, monomersize, hyaluronate, keraten
sulphate, and chondrotin sulphate, increase in proteoglycan synthesis, collagenase, and
proteoglycanase.
CLINICAL FEATURES
Symptoms
Joint Pain-
It is often described as a deep ache and is localized to the involved
joint. Typically, the pain of osteoarthritis is aggravated by joint use and relieved
by rest, but as the disease progresses, it may become persistent.
Stiffness- Progressive stiffness of the involved joint upon arising in the morning
or after a period of inactivity may be prominent but usually lasts less than 20 min.
It is due to spasm of muscles. There is no relation between the severity of

degeneration and morning stiffness.
Signs
Swelling- Physical examination of the osteoarthritis joint reveals localized soft
tissue swelling of mild degree. It is due to the changes in articular ends
themselves, particularly peri-articular lipping.
Crepitus- The sensation of bone rubbing against bone evoked by joint movement
is called as crepitus. It is one of the characteristic sign of osteoarthritis joint.
Local Warmth ness- On palpation of the joint local rise in temperature is an
indicative of sign of inflammation.
Muscle Atrophy- Peri-articular muscle atrophy may be due to disuse or due to
reflex inhibition of muscle contraction.
Others- In advanced stage there may be gross deformity, bony hypertrophy,
subluxation and marked loss of joint motion.
Laboratory and Radiological Findings
The Diagnosis of osteoarthritis is usually based on clinical and radiographic
features. In the early stages, the radiograph may be normal, but joint space narrowing
becomes evident, as articular cartilage is lost. Other characteristic radiographic findings
include subchondral bone sclerosis, subchondral cysts, and osteophytosis. A change in
the contour of the joint, due to bony remodeling, and subluxation may be seen. There is
often great disparity between the severity of radiographic findings, the severity of
symptom and functional ability in osteoarthritis.
No laboratory studies are diagnostic for osteoarthritis, but specific laboratory

testing may help in identifying one of the underlying causes of secondary osteoarthritis.
Analysis of synovial fluid reveals mild leukocytosis with a predominance of mononuclear
cells. Approaches such as magnetic resonance imaging and ultrasonography have not
been sufficiently validated to justify their routine clinical use for diagnosis of
osteoarthritis or monitoring of disease progression.
TREATMENT
Treatment of osteoarthritis is aimed to reducing pain, maintaining mobility, and
minimizing disability. The vigor of the therapeutic intervention should be indicated by
the severity of the condition in the individual patient. For those with only mild disease,
reassurance, instruction in joint protection, and an occasional analgesic, may all that
required; for those with more severe osteoarthritis especially of the knee or hip, a
comprehensive programs comprising spectrum of non-pharmacological measures
supplemented by an analgesic and/or NSAID is appropriate.
Non-Pharmacological Measures
Reduction of Joint Loading
Osteoarthritis may be caused or aggravated by poor body mechanics. Correction of
poor posture and a support for excessive lumbar lordosis can be helpful. Excessive
loading of the involved joint should be avoided; patients with osteoarthritis of the knee or
hip should be avoided prolonged standing, kneeling and squatting. Obese patients should
be counseled to loose weight. Patients with medial compartment knee osteoarthritis are
wedged in sole my decrease the pain. Complete immobilization of painful joint is rarely
indicated. In patients with unilateral osteoarthritis of knee or hip, a cane, held in the
contra lateral hand, may reduce joint pain by reducing the joint contact force. Bilateral
disease may necessitate use of crutches or walker.
Physical Therapy
Application of heat to the osteoarthritis joint may reduce pain and stiffness. A variety
of modalities are available; often the least expensive and most convenient is a hot shower
or bath. Occasionally, better analgesia may be obtained with ice than with heat.
It is important to note that patients with osteoarthritis of weight bearing joints are
less active and tend to be less fit with regard to musculo-skeletal and cardiovascular
status than normal controls. An exercise program should be designed to maintain range
of motion, strengthen peri-articular muscles, and improve physical fitness. The benefit of
aerobic exercise includes increase in aerobic capacity, muscle strength, and endurance;
less exertion with a given workload and weight loss. Those who exercise regularly live
longer and are healthier than those who are sedentary. Patients with hip or knee
osteoarthritis can participate safely in conditioning exercises to improve fitness and
health with out increasing their joint pain or need for a analgesics or NSAIDs.
Disuse of the osteoarthritis joint, because of pain will lead to muscle atrophy, because
particular muscles play a major role in protecting the articular cartilage from stress,
strengthening exercise are important. In individuals with knee osteoarthritis strengthening
of a particular muscle may result, with in weeks, in a decrease in joint pain as great as
that seen with NSAIDs.
Drug therapy of osteoarthritis

Therapy for osteoarthritis today is palliative, no pharmacological agent has been
shown to prevent, delay the progression, or reverse the pathologic changes of
osteoarthritis in human. Although claims have been made that some NSAIDs have a
chondroprotective effect. It controlled clinical trails in human with osteoarthritis to
support this view are lacking. In management of osteoarthritic pain, pharmacological
agents should be used as adjuvants to non-pharmacological measures, such as those
described above, which are keystone of osteoarthritis. NSAIDs often decrease joint pain
and improve mobility in osteoarthritis - on an average about 30% reduction in pain and
15% improvement in function. Intra articular injection of hyaluronic acid is being used
for treatment of patients with knee osteoarthritis who have filed a program of nonpharmacological therapy and simple analgesics.
Naturopathy is a drugless system of healing which incorporates the natural

inherent principles like mud, water, sunlight, air and ether in treatment. It is a way of
living. The body corrects by itself and the healing will be faster by undertaking the
various treatment modalities of this system.
People who adopt the natural system of healing will not suffer with diseases and
these treatments enable for elimination of the disease from root. By providing the
elements which are depleted this system works in healing.
Naturopathic techniques for Sandhi-Vata
1. Derivative massage
Massage is employed for eliminating muscle contraction and for breaking of
adhesions.43 Slight pain is often produced by the first manipulation but it subsides within
short time.
In derivative massage Fulling, friction and deep kneading are most effective. In
the manipulation of a joint, begin with light friction and pressure. If these applications are
tolerated, add digital massage, working between the ligaments and following all the
irregularities of the ends of the bones so far as accessible. Later add percussion, first
tapping, afterward hacking. The derivative manipulations which are first employed
should be continued in connection with application to the joint, since the effect of
kneading a joint is to increase the circulation through it, while the effect of derivative
massage is not to carry the blood through the joint, but rather around it, thus relieving
excessive local congestion or hyperemia, by diverting the blood into other channels.
Centripetal friction applied to the tissues relieves painful joints by increasing the
surface circulation and so diverting the blood from the joint itself. Derivative massage
restores the normal secretion, improves nutrition of the joint and may increase vital
activity. In cases of extremely painful joints in which heat and congestion are marked
symptoms, derivative massage may be employed upon the soft parts both above and
below the joint44. Tapping helps the muscles to develop its contractile power. A little
moderate kneading and percussion cause muscles to contract and become stronger. Deep
circular kneading loosens the muscles. Kneading under and around the muscles breaks up
adhesions. These all types should be done with Tila Taila. Material- Tila Taila, chair.
Indication- stiff and swollen joints, inflammatory conditions, tubercular joints, fractures,
sprains, bruises. Contraindication- diphtheria, gonorrhea.45
2. INFRA RED THERAPY

Infra Red lies beyond the red boundaries of visible spectrum. Infrared has
a wavelength ranging from 750nm to 40000 nm and frequency 4x 10 Hz and 7.5
x 10 Hz. These rays have extremely strong heat reaction. According to biological
research far infrared (4-1000microns) rays are absorbed very easily by the
human body. The sources are the Sun, soil, mineral etc. When intensity of
infrared is high in the body we feel healthy and will be able to over come
ailments, however when it begins to decline, the human body will be subjected to
attack by ailments and diseases.
Physiological effect (Metabolic changes)-Infra Red treatment produces heating effect in
the superficial epidermis. Thus, resulting in vasodilation, this increases blood circulation
in that area. This will lead to more oxygen supply and nutrient supply in that area leading
to drainage of waste products resulting in the relief of pain and healing of oedema and
other skin conditions (superficial wounds). The sedative effect on nerve endings lead to
reduction in the muscle spasm.
Neurological effects- I.R.R. are used for muscle relaxation, thus helping in treatment of
inflammation. I.R.R. due to sedative effects on the nerve endings helps in relieving pain,
muscle spasm and neuralgia.
Application-Material required for application are infrared lamp, chair. Patient should
remove cloths from the part, which has to be treated by I.R.R. Patient should be
instructed not to touch the lamp and should not sleep during treatment. Lamp should be
place at a distance of 12-15 inches and at 900 to the affected part so that maximum rays
fall on the affected part. The treatment should end with erthema and not with burns. So
duration should be carefully seen.
Contraindications-1.Area of anesthesia or thermal hypothesia. 2. Patient of arterial
diseases. 3. Disorders with the possibility of hemorrhage, gastric ulcers, haemoptysis etc.
4.Skin diseases like psoriasis, eczema, etc. 5.Vascular insufficiency. 6. Active or acute
pathology of ulcers. 7. In pregnant ladies and during menstruation.46
3. WAX BATH
Mode of Action- It is seen that water at 450 c. temperature would be uncomfortable hot
and ultimately causes damage. The specific heat of water is 4.2 kj/kg/ degree C and
specific heat of wax is 2.72 kj/kg/ degree C. therefore the amount of energy released by
wax is 10 C cooler than that of water.
When the part is immersed in wax the cooler skin causes a thin layer of wax
solidify on the surface. This thin static layer act as insulator of the skin from the hotter
sounding wax, some air may be trapped between these solidified layers and adding to
insulating effect. The wax transmits heat energy to the tissue by giving up energy as it
solidifies. The latent heat of fusion without any temperature change the amount of energy
is 35kj/kg. The low conductivity of wax prevents much heat loss from the skin surface. It
also prevents water loss from skin and skin gets moisture, this moisture helps to soften
adhesions and scar tissue.
The solid wax melts with a temp of 540 C that may cause burns to the human skin. T o
avoid this burn in the treatment of wax bath liquid paraffin is mixed in different ratio that
will reduce the melting point of wax at 400C to 440C in this temp there is no risk of skin
burn. This therapy often named paraffin wax bath as liquid paraffin is mixed with wax in
6:1 or 7:1 ratio. Other material may be used in the form of Vaseline and glycerin to make
the mixture more smooth that to prevent adhesion of wax to the skin. Paraffin liquid wax
is melted and stored for use in a thermostatically controlled stainless steel box.
Method of Application- Preparation of patient- Inspection of the treatment area, shape,
size and location-Elimination of cloths, rings. Identification of skin condition. The patient
should be in comfortable position. Preparation of apparatus- the wax should be melted
completely. The temperature of the wax should be maintained at 450C. In toweling
method the towel is immersed in the melted paraffin wax then it is picked up, removes
extra wax and applied over the area. Repeat 8-12 times. Duration of treatment is 15 to 30
minutes. Material- Wax bath tub, cotton towel, metal strip, and chair.
Advantages- 1. Low specific heat allows for application at a higher temperature than
water without the risk of burn. 2. Low thermal conductivity allows heating of tissues
gradually thus reducing the risk of over heating the tissue. 3. Melted state allows for
even distribution of heat to areas like finger and toes. 4. Oils used in the wax add
moisture to the skin. 5. Wax remains malleable after removal, allowing for use as an
exercise tool. 6. Comfortable moist heat. 7. Relatively in expensive to replace wax.
Indication- Reduction of pain, reduction of muscle spasm, correction of contracted
deformity, softening of adhesive scar, to break stiffness, arthritic joint, increase range of
motion and post operative fracture pain after healing of wounds.
Contraindication- Open wounds, allergic skin, skin condition, defective arterial blood
supply and impaired skin sensation.47
4. EXERCISES
Flexion- patient will be in prone lying position, resistance is applied to the

posterior aspect of the lower leg just above the bed, give the stabilization to the hip and
tell patient to do flexion. Extension- patient should be in the sitting position, give the
resistance to the anterior aspect of the lower leg, give the stabilization to the hip and
thigh, and tell him to do extension.48
For without resistance the patient sits at the edge of bed or chair and actively
flexes and extends the knee joint in free-swinging movement within the limits of pain.49
Resistance can be offered when the test is being performed against the motion and to
assess the strength of a muscle. Manipulation with resistance is for treating for disuse
atrophy. Without resistance is for improving the range of motion and for lubrication of
the joint. It maintains endurance of muscle.50
Advantages- easy to perform, improves the range of motion at the knee, facilitate joint
lubrication, and to provide joint relaxation. Increases blood circulation.51
5. MUSTARD PACK
The Mustard pack is especially applicable to cases in which a very quick and
strong revulsive effect is desired as for the relief of severe pain or to secure strong
derivative effects.
For mustard pack wring a towel or a cloth out of hot water to which ground
mustard will be added in proportion of ounce. Spread this upon the part (knee) to
which the application is to be made. Care must be taken to avoid excessive irritation or
blistering of the skin.52 Material- Cotton towel, gas stove, vessel, water, ground mustard,
and chair.
1. SARSHAPA (Brassica Junca)
Family: Crucifereae
Pharmacological properties:
Rasa: Katu
Guna: Tikshna
Veerya: Ushna.
Vipaka: Katu.
Doshakarma: Kaphavatashamaka.
Part used: Bija churna
Chemical composition: seeds contain 30-38% fixed oil and nitrogenous matter
24.6%
Pharmacological actions: It is Shothahara, Vedanasthapana, Vidahi, Lekhana,
Sphotajanana,
Swedajanana,
Dipana,
Pachana,
Krimighna,
Vamaka,
Plihavriddhihara.
6. THE ALTERNATE HOT AND COLD KNEE PACK

In this form of application the skin is first heated considerably above its
normal temperature, and then the temperature is lowered by the use of cold
water. In alternate applications the heating and cooling are several times
repeated. The reaction which takes place as the result of the applications may be
made chiefly circulatory in character or both circulatory and thermic. This form of
application is therefore a most efficient means of stimulating nutritive changes,
obtaining derivative effects, etc and that without creating thermic disturbances of
any kind in the body.53
It is very strongly influences both the arteries and the veins. It is our most
powerful derivative procedure, its effects being almost wholly derivative in character.54
By lowering the pressure in the veins, the arterial circulation through the affected part is
facilitated, thus encouraging the nutrition and functional activity of the cells which are
engaged in combating living germs, or which are seeking to repair damages which may
have originated in any way.
The hot application diverts the blood into the cutaneous branches of the collateral
arteries or into anastomosing vessels, thus preventing undue accumulation of blood and
consequent embarrassment of the affected tissues. The adjustment of the hot and cold
pack depends on the different parts of body on which it has to be applied and the
circulation of which it is desired. Contraindications- Acute inflammation and pain.
Method- The cold pack should be kept alive by rubbing the parts for one minute each time when the
pack is changed. The hot pack should be exchanged every 15-20 minutes by the cold pack for 30
seconds to 1 minute so as to empty the veins restore the tone of the vessels and prevent great
accumulation of heat in deeper parts. The pack should be changed after every 5-8 minutes or as soon as
the temperature begins to approach that of body. The duration of pack varies from 15 minute to 1 hour
according to condition and tolerance of patient. Continue the application until the desired
effect is
produced.55 Material- cotton packs, Lenin cloth, vessels, chair, water, gas stove.
7. THE HOT FOOT BATH

Method- The temperature required for getting positive effects is 1040F to 1220F. The
bath should begin at a temperature of 1020F to 1040F, and should be gradually increased
until by the end of two or three minutes a maximum temperature of 1150F to 1220F is
reached. The duration may be from 5 minutes to half an hour as per condition. The feet
should be completely immersed in water; increasing the depth of the water may intensify
the effect. Material- Foot bath tub, water, gas stove, vessels, and chair.
Physiological Effects- Hot Foot Bath produces same effects as the general hot bath. At
first the pulse is slowed and the brain congested, but after three or four minutes the pulse
rate is increased, and the brain becomes anemic, these conditions persist for some time
after the bath is terminated. The footbath at 1080 to 1150 for 20 minutes causes elevation
of the temperature in the external auditory canal amounting to one degree Fahrenheit. The
rectal temperature at the same time fell to the same extent. Arterial tension was increased
by 8 mm.
Therapeutic Applications- This bath is more commonly used as a derivative measure.
At a temperature of 1030F to 1100F the hot footbath is an exceedingly useful means of
balancing the circulation, by the dilatation of the blood vessels of the legs relieving
congestion of the brain and other organs in the upper half of the body.
The hot footbath is also of very great service as a means of relieving or preventing
a cold resulting from accidental chilling of the feet, if applied soon after exposure. The
prolonged hot footbath (980F to 1060F) dilates the vessels of feet, and produces collateral
anemia of the pelvic viscera.56
Bahya Shamana Chikitsa
A patient can be administered Aoushadhi as Anta-Parimarjana, Bahi-Parimarjana
and Shastra-Pranidhana.57 Janu-Basti may be included in Bahi-Parimarjana type of
treatment. Janu-Basti is a Bahya Samshamana Chikitsa (Retaining type).
JANU-BASTI
Vagbhata has described four types of oil application on head under Murdha Taila,
which are Shiro-Abhyanga, Shiro-Seka, Shiro-Picu and Shiro-Basti.
As one of the
meanings of Basti is to fill and reside, therefore the word Basti has been added to word
Shiro. In Shiro-Basti, oil is kept on head by putting a cap for prescribed period of time.
Later on some physicians made an artificial pit around the knee with the help of
Masha powder to keep hot oil for prescribed period and named it as Janu-Basti.
Basti
Meanings related to organ- Organ that lies below the umbilicus (Nabhi).
Meanings related to Karma- Here the urinary bladder of animals is used to inject the
drugs into the rectum Bastina Deyata Eti Bastih Tasya Vidhi58.
The word 'Basti' is used here with the meaning of to reside, to retain. In
'Janu-Basti' the medicine is made to retain over the Janu-Sandhi for a prescribed time.
Procedure of Janu-Basti- All the procedures are performed in systematic manner.
According to Sushruta it can be performed in three stages like
1. Poorva karma
2. Pradhana karma
3. Paschat karma59.
The procedure of Janu-Basti is explained accordingly

I. Poorva karma- This includes preparatory measures taken for smooth conduction of
the procedure. They are
1. Atura Pareeksha- The patient is examined with reference to Prakriti, Vikriti etc. ten
factors by applying Pratyaksha, Anumana and Aptopadesha. This will assess Vyadhibala
and Dehabala
60
. Then affected knee should be Examined properly and mark the tender
area. Examine for scares, wounds in the joint.
2. Sambhara Sangraha- Materials required for Smooth conduction of Janu-Basti

procedure have to be collected. They include A metal ring, Masha powder, medicine
(Tila Taila), spoon, bowl, vessel, water, gas stove, and cotton.
3. Atura Siddhata- Patient is asked to lie down on the table. Expose the affected knee.
II. Pradhana
karma -This includes
1. Basti Yantra Dharana- Initially paste of Masha powder is prepared by adding

sufficient quantity of water to it. Then with the help of a metal ring and Paste of Masha a
pit is constructed around Janu-Sandhi of about 2-3 Angula heights. The concavity of pit
(Basti Yantra) should be well sealed to retain the medicine.
2. Taila Dharana- The bowl containing Medicine (Tila Taila) is heated gently by
keeping over hot water. Then gently heated luke warm medicine is poured slowly and
carefully on the Janu-Sandhi along the side of the Basti Yantra. The heat of the medicine
should be sufficient enough to tolerate by the patient. The quantity of the medicine
should be two Angulas above the skin surface.
3. Maintenance of constant temperature of medicine- Keep on changing the medicine
with the heated one so that a constant temperature is maintained through out the
procedure.
4. Removal of Taila and Basti Yantra- After the prescribed time the oil should be
removed from the Basti Yantra. Then BastiYantra is to be removed.
Since it is a type of Sweda and Sneha, Samyak Sweda and Samyak Sneha
Lakshanas
can
consider.
Among
Samyak
Sweda
Lakshana
Sheetoparama,
Stambhanigraha, Gauravanigraha and Vyadhihani can be considered for assessment. In
case of Samyak Snigdha Lakshanas Snigdha Gatratva and Mrudu Gatratva can take for
assessment. The procedure is performed for 30min each day.
III. Paschat
karma- After removing the oil and Basti Yantra, Mrudu Abhyanga is done
over the Janu-Sandhi for about 5 min. Duration - This treatment is done for 7days.
Benefits of Janu-Basti- It relieves the symptoms like Shoola, Stabdhata.The procedure
acts on various properties of Vata that are instrumental in the pathology of Sandhi Vata
mainly due to Snehana and Swedana. Also medicines used in the procedure help in
alleviating Vata.
Drug Review
The trial drug selected for doing Janu-basti is Tila Taila. The pharmacological
properties, chemical constituents and pharmacological actions of Tila Taila are
summarized below.
Table No- 13- Drug review
Madhura
Rasa
Veerya
Ushna
Vipaka
Madhura
Guna
Guru, Drava, Picchila, Sara, Manda, Sookshma, and Teekshna
Doshakarma
Vatakaphahara
Pharmacological
Used in different traumatic conditions, Promotes bodily strength. It
actions
is Sanghatakara, does Snehana.
ABSORPTION THROUGH SKIN

Acarya Sushruta in Shareerasthana explains Out of the four Tiryak Dhamanis,
each divides gradually hundred and thousand times and thus become innumerable. These
cover the body like network and their openings are attached to Romakoopa. Through
them Veeryas of Abhyanga, Parisheka, Avagaha, Alepa enter into the body after under
going Paka with Bhrajaka Pitta in skin61.
Sushruta in Sutrasthana explains, Lepa like Bahirparimarjana treatments yield result by
entering to Romakoopa thereby circulating through Swedavaha Srotas62.
Vagbhata in Ashtanga Hridaya while explaining the functions of Bhrajaka Pitta
narrated that Bhrajaka Pitta do the Pachana of drugs used in Abhyanga, Parisheka, and
Lepa63.
Thus with the above references it can be said that drugs used in Bahya
Samshamana Chikitsa (Naturopathy techniques, Janu-basti) get absorbed through and
produce action according to the property of the medicine.
The skin anatomically consists of three distinct layers.
Epidermis- It consists of keratinocytes, melanocytes, langerhans cells and merkel cells.
The terminal point of keratinocytes differentiation is the formation of the stratum
corneum. Formation of this layer is the most important function of the epidermis. It
protects the skin against water loss, prevents the absorption noxious agents, and can be
thought of as consisting of bricks and mortar. Corneocytes forms the bricks and barrier
lipids form the mortar. Granular cells which are stratum corneum helps in maintaining
skin hydration and their products serve as ultra violet filters. Lamellar granules also are
found within granular cells. These contain probarrier lipids.
Dermis-It is a thick, highly vascular layer made up of ground substance, fibroblasts and
collagen fibers, together with appendages of skin, sweat glands and pilo-sebaceous
follicles. It is metabolically active part of the skin.
Subcutaneous Tissue-It is a fibro fatty layer with varying quantities of adipose tissue in
different regions of the body. It provides physical and thermal protection to the deeper
structures of the body.64
Drug Delivery- The primary barrier to absorption of exogenous substances through the
skin is stratum corneum. Rate of absorption is directly proportional to concentration of
drug in vehicle, partition co-efficient, diffusion co-efficient and thickness of the stratum
corneum. Physiological factors that effect per cutaneous absorption include hydration,
occlusion, age, intact versus disrupted skin, temperature and anatomic site.
Among vehicles greases are anhydrous preparations that are either water insoluble
or fatty. Fatty agents are more occlusive than water-soluble. They restrict trans-epidermal
water loss and hence preserve hydration of the stratum corneum.
Absorption depends upon lipid solubility of the drug since the epidermis as a lipid
barrier. The dermis however is freely permeable to many solutes. Suspending the drug in
an oily vehicle can enhance absorption through the skin. Because hydrated skin is more
permeable than dry skin.
Application of medicaments, heat and massage definitely helps in eliminating the
number of noxious elemtes through skin. The application of heat in different forms of
Swedana promotes local circulation and metabolic activities and also opens the pores of
the skin to permit transfer of medicaments and nutrients towards to needed sites and
elimination of vitiated Doshas and Malas through skin and perspiration.65
Biophysical effect of temperature
Circulatory effect- There is stimulation of superficial capillaries and arteriole causing

local hyperemic and reflex vasodilation. This will affect increased blood flow at the site.
The temperature must be controlled between 104F to 113F. This hyperemia may result
systemic change such as decrease in mean blood pressure, increase in pulmonary minute
ventilation.
Metabolic reaction- Temperature will raise the chemical activity in cell and metabolic
rate will increase. The energy expenditure will increase and protein denaturation will
occur in human tissue.
Vascular effect- There are three factors that cause vasodilation- an axon reflex, release
of chemical mediators, secondary to temp elevation, local spinal cord reflex.
Neuromuscular effect- Heat is Effective to provide analgesic and assist resolution of
pain muscle guarding spasm. Heating of peripheral nerve elevate pain threshold
remarkably reduce muscle spasm.
Connective tissue effect- Temperature elevation in combination with a stretch can alter
visco-elastic properties of connective tissue. The elastic properties of connective tissues
result in plastic elongation.
Effect on the skin Skin becomes moist and pliable following wax application. This
helps to soften adhesion and scar in the skin prior to mobilization and stretching
procedures.66
METHODOLOGY
Sandhi vata is a major social problem as large percentage of population suffers from this affliction.
This being a degenerative type of disease, its progress is more in geriatric age, posing difficulty in dayto-day life of the person. This is the age in which all Dhatu begin to degenerate, ultimately leading to
Vata Prakopa. When this Prakupita Vata gets lodged in Sandhi, it gives rise to the disease Sandhi Vata.
Non-pharmacologic management is the foundation of treatment of osteoarthritis. Therefore,

naturopathy gives a hope of treating this condition with different techniques used externally. These
techniques can be correlated to Bahirparimarjan Chikitsa mentioned in Ayurvedic classics. Hence,
study is planned with the following aims to prevent the suffering of the patients.
AIMS
7. To evaluate the effect of Janu-Basti in the management of Sandhi Vata.
8. To evaluate the effect of Naturopathy techniques in the management of Sandhi Vata.
9. To compare the efficacy of Janu Basti-an Ayurvedic Bahirparimarjan Chikitsa and Naturopathy
techniques employed for the treatment of Sandhi Vata.
SELECTION OF PATIENTS
The patients were selected from OPD and IPD of S.D.M.College and Hospital of Ayurveda, Hassan
irrespective of age, sex, religion, occupation, marital status etc. The detail clinical history was taken
and examination was done as per case proforma prepared for this purpose.
Laboratory investigations
1.
Hematological Total count, Differential count, E.S.R., Hb%.
2.
Radiograph X-rays wherever necessary.
Inclusion Criteria
1.
Patients complaining of pain, swelling, and restricted mobility of knee joints.
2.
Patients between the ages of 40 to 60 yrs.
3.
Patients with unilateral or bilateral knee joint involvement were included.
Exclusion Criteria
1.
Patients with deformities in knee joints.
2.
Patients suffering from other systematic disorders such as obesity (BMI above 30), infective
arthritis, injury to joints etc.
Diagnostic criteria
Diagnosis of patient was established on the basis of signs and symptoms mentioned in classics as
follows.
Symptoms- Shoola (Pain in knee joints)
Kriya alpata (Difficulty in movements of knee joints)
Shotha (edema of knee joints)
Atopa (Crepitus in knee joints)
RESEARCH DESIGN
For a scientific trial, proper design is required so as to assess the efficacy of the therapy, in turn to
achieve the objectives. This study is a comparative study with pre-test and post-test design.
30 patients of Sandhi Vata were randomly divided into the following two groups each group consisting
of 15 patients.
Janu Basti (A) Group
The patients of this group were given Janu-basti with Tila Taila in the morning for 30 minutes.
For this purpose the patient was asked to lie down on the table and then with the help of a paste made
from black gram (Masha) flour by adding little water, a two inches high wall was erected around the
knee joint. Then tolerable hot oil was poured in this artificial cavity and the oil was changed to
maintain the temperature. The process was done once daily continuously for 7 days.
Naturopathy (B) Group
The naturopathy techniques were given externally to the patients of this group.
Morning- Naturopathy technique of derivative massage with Tila taila followed by infrared
therapy was done.
Afternoon- Wax bath with molten wax and flexion and extension exercises with and without
resistance of knee joint was done.
Evening- Mustard pack, Alternative hot and cold knee pack and hot footbath were done. The
temperature of taila and these techniques was of tolerable heat. The total duration of these techniques
was of approximately 60 min.
The patients were allowed to take their routine light diet during the period of the study. No other
medicine was given internally.
ASSESSMENT CRITERIA
Efficacy of therapy was assessed in the reduction of signs and symptoms before and
after the course of study. Following symptoms were mainly considered for assessing the
effect of the therapies.
Symptoms
Shoola
Kriya alpata
Shotha
Atopa
Variations in the intensity of symptoms were observed.

For assessing functional improvement, following criteria was considered.
1. Flexion movement at the knee joint.

2. Extension movement at knee joint.
3. Circumference of knee joint.
4. Time taken to cover 50-meter distance in walking.
Grading: Following scoring scale was adopted for signs and symptoms assessment.
1. Shoola:
No Shoola - 0
During movement - 1
During rest 2
2. Kriya Alpata
Normal functioning - 0
Can do mild to moderate work -1
Cannot do any work -3

3. Crepitus
No crepitus - 0
Palpable crepitus - 1
Audible crepitus 2
FOLLOW UP
After completion of 7 days course, the patients were asked to report for the follow up study every
15 days for the next one-month period.
Materials
Measuring tape was used for measuring the circumference of Knee Joint, Goniometer for
counting the flexion angle of knee joint and Hand Watch for counting the time taken for covering fifty
meters.
Thumb Kneading
Infrared Therapy
Circular Friction
Mustard Pack
Alternate Hot & Cold Pack
Hot Foot Bath
Wax Pack
Janu-Basti
GENERAL OBSERVATIONS
For any research work, the data should be collected systemically and must be
presented in a way that the reader can understand in a better manner.
30 patients of Sandhi-Vata were included for this clinical study. They were
assigned into two groups viz. Janu basti / control Group (A Gp), and Naturopathy
/Experimental Group (B Gp). The age, sex, religion, occupation and other observations
noted in the patients of this study were as follows.
Table -14 Age wise distribution of 30 patients of Sandhi-Vata
Age group
In years
n = 15
40-45
20
45-50
50-55
55-60
Total
00
10
6.66
26.66
16.66
13.33
20
16.66
60
53.33
17
56.66
n = 15
Age: It is observed that 10% patients were of 40-45yrs of age, 16.66% were of 45-50yrs,
16.66% were of 50-55yrs of age and 56.66% were of 55-60yrs of age.
Table - 15 Sex wise Distribution of 30 Patients of Sandhi-Vata
A
Sex group
n = 15
B
%
n = 15
Total
Male
53.33
20
11
36.66%
Female
46.66
12
80
19
63.33%
Sex: It is observed that 36.66% patients were males and 63.33% were females.
Table-16 Religion wise Distribution of 30 Patients of Sandhi-Vata
A
Religion
n = 15
n = 15
Total
Hindu
14
93.33
11
73.33
25
83.33%
Muslim
13.33
6.66%
Christian
6.66
13.33
10.00%
Religion: Majority of the subjects in the study were Hindus i.e.83.33% followed by
Muslim -6.66% and Christian -10.00%.
Table 17 Occupation wise Distribution of 30 Patients of Sandhi-Vata
Occupation
n = 15
n= 15
Total
Business
26.66
00
13.33%
House wife
40.00
10
66.66
16
53.33%
Teacher
6.66
6.66
6.66%
Agriculturist
0.00
13.33
6.66%
Office work
13.33
6.66
10.00%
Others
13.33
6.66
10.00%
Occupation: Maximum numbers of patients of this study were housewives (53.33%)

followed by businessmen (13.33%). Also 6.66% of agriculturists, 10.00% of office
workers and other non-specific nature of workers were observed in the study.
Figure- 4- Showing Agewise Distrbution
20
15
40-45
45-50
50-55
55-60
10
5
0
A
Total
Figure-5- Showing Sexwise Distribution
20
15
Male
Female
10
5
0
A
Total
Figure-6-Showing Religionwise Distribution

25
20
Hindu
Muslim
Christian
15
10
5
0
A
Total
Figure-7-Showing Occupationwise Distribution
20
Buisiness
House wife
Teacher
Agriculturist
Office work
Others
15
10
5
0
A
Total
Table -18 Deha Prakriti wise Distributions of 30 Patients of Sandhi Vata

A
Deha Prakriti
n = 15
n= 15
Total
Vatakapha
60
33.33
14
46.66
Vatapitta
13.33
53.33
10
33.33
Kaphapitta
6.66
00
3.33
Kaphavata
00
6.66
3.33
Pittakapha
13.33
00
6.66
Pittavata
6.66
6.66
6.66
Out of the total 30 patients 46.66% were of Vatakapha prakriti, 33.33% of

Vatapitta and 3.33% of Kaphapitta, 3.33% of Kaphavata, 6.66% of Pittakapha and 6.66%
were of Pittavata.
Table 19 Sara wise Distribution of 30 of Sandhi Vata
A
Characteristic
n= 15
n= 15
Total
Pravara
46.66
20.00
10
33.33
Madhyama
46.66
60.00
16
53.33
Avara
6.66
20.00
14
13.33
Sara: Majority of the patients of this study falls under Madhyama Sara (53.33%). Where
as 33.33% were having Pravara Sara and 13.33% Avara Sara.
Table 20 Samhanana wise Distribution of 30 Patients of Sandhi Vata
A
B
Characteristic
n= 15
n= 15
Total
Pravara
33.33
26.66
30
Madhyama
60
10
66.66
19
63.33
Avara
6.66
6.66
6.66
Samhanana: Majority of the individuals 63.33% were having Madhyama Samhanana

followed by 30% of Pravara Samhanana and 6.66% of Avara Samhanana.
Table 21 Pramana wise Distribution of 30 Patients of Sandhi Vata
A
Characteristic
n= 15
n = 15
Total
Pravara
26.66
6.66
16.66
Madhyama
11
73.33
13
86.66
24
80
Avara
00
6.66
3.33
Pramana: 80% of the patients were having Madhyama Pramana followed by 16.66% of
Pravara Pramana and 3.33% of Avara Pramana.
Table -22 Satmya (Ahara) wise Distribution of 30 Patients of Sandhi Vata
A
Characteristic
n = 15
n = 15
Total
Pravara
Madhyama
15
100
15
100
30
100
Avara
Satmya: 100% patients of this study were having Madhyama Satmya.
Table- 23 Satva wise Distribution of 30 Patients of Sandhi Vata

A
Characteristic
n =15
n=15
Total
Pravara
33.33
33.33
10
33.33
Madhyama
10
6.66
46.66
17
56.66
Avara
20
10
Satva: 56.66% were Madhyama Satva followed by 33.33% having Pravara Satva and
10% with Avara Satva.
Table - 24 Abhyavaharana Shakti wise Distribution of 30 Patients of Sandhi Vata

A
Characteristic
n = 15
n = 15
Total
Pravara
20
20
20
Madhyama
12
80
10
66.66
22
73.33
Avara
00
13.33
6.66
Abhyavaharana Shakti- It is observed that 73.33% of patients was Madhyama,

followed by Pravara-20% and Avara- 6.66% Abhyavaharana Shakti.
Table 25 Jarana Shakti wise Distribution of 30Patients of Sandhi Vata
A
Characteristic
n = 15
n = 15
Total
Pravara
20
20
20
Madhyama
12
80
10
66.66
22
73.33
Avara
13.33
6.66
Jarana Shakti: The Jarana Shakti of this study shows Madhyama (73.33%) followed by
Pravara (20%) and Avara (6.66%).
Table 26 Vyayama Shakti wise Distribution of 30 Patients of Sandhi Vata

Characteristic
n = 15
n = 15
Total
Pravara
46.66
26.66
11
36.66
Madhyama
46.66
53.33
15
50.00
Avara
6.66
20.00
13.33
Vyayama Shakti: Madhyama Vyayama Shakti was found in 50% followed by Pravara in
36.66% and Avara in 13.33% of patients.
Table 27 Cardinal signs and symptoms recorded in 30 Patients of Sandhi Vata
Clinical features
n = 15
n = 15
Total %
Shoola
14
93.33
15
100
96.66
Shotha
46.66
14
63.64
70.00
Atopa
11
73.33
14
81.82
83.33
Kriya alpta
15
100
15
100
100
Cardinal Features: All the patients of this study were complaining of Kriya alpta that is
100%, Shoola in 96.66%, Atopa in 83.33% and shotha in 70.00%.
Table 28 Chronicity wise Distribution of 30 Patients of Sandhi Vata
A
Chronicity
n = 15
n= 15
Total
0-3years
60
53.33
17
56.66
3-6years
20
20
20.00
Above 6years
20
26.66
23.33
Chronicity: 56.66% of the patients of this study had the chronicity between 0-3years,
20.00% for 3-6years, and 23.33% more than 6years.
Figure-8-Showing Cardinal Signs and Symptoms

16
14
12
10
8
6
4
2
0
Shoola
Shotha
Atopa
Kriya alpta
Figure-9-Showing Chronicitywise Distribution
20
15
0-3years
3-6years
10
Above 6years
5
0
A
Total
Table 29 Characteristic of Kulaja Vrittant reported by 30 cases of Sandhi Vata
Kulaja vrittant
A
n = 15
B
n = 15
Total
Present
26.66
40
10
33.33
Absent
11
73.33
60
20
66.66
In this study 33.33% patients had Kulaja Vrittant and in 66.66% patients, it was absent.
Table 30
Showing Distribution of Viharatmka nidana recorded in 30 cases of Sandhi Vata
A
Character
n =15
B
%
n = 15
Total
BharVahana
53.33
10
66.66
18
60.00
SukhaAsana
6.66
6.66
6.66
Ati chankramana
33.33
26.66
30.00
Pradhavana
6.66
00
00
3.33
In this study Bhar vahana as Viharatmka Nidana is seen in 60%, Ati-chankraman

in 30%, Sukhasana in 6.66% and Pradhavana in 3.33%.
Table 31Showing Distribution of Aharatmaka nidana in 30 cases of Sandhi Vata
Character
n = 15
n = 15
Total
Veg
46.66
60
16
53.33%
Mixed
53.33
40
14
46.66%
In this study from both groups 53.33% patients were of Veg and 46.66% patients
were taking mixed diet.
EFFECT OF THE THERAPIES

In the present study 30 patients of Sandhi Vata were treated in two groups. In group
A 15 patients were given Janu-Basti with Tila Taila and in group B 15 patients were
subjected to different Naturopathy techniques. The signs and symptoms were
assessed before and after treatment based on the assessment criteria mentioned
earlier. The effects of the therapies are being presented here under separate headings.
Effect of Janu-Basti
15 patients of Sandhi Vata were treated with Janu-Basti for 30 minutes each day for 7
days. Its effects on the clinical signs and symptoms were as follows.
Effect on Symptoms
The effect of Janu-Basti on symptoms of Sandhi Vata is shown in Table 32.
Mean pain of knee joint was significantly (p<0.01) reduced from 1.4 to 0.93 with the
improvement of 32.85%.
Mean score of Kriya Alpata decreased from 1.2 to 0.73 with the improvement of 39.16 %
and was significant (p >0.001).
Effect on signs
The effect of Janu-Basti on signs of Sandhi Vata is shown in Table 33. The
mean score of swelling reduced from 17.33 cm. to 16.86 cm. with 2.65% improvement,
which was statistically significant (p>0.02).
Atopa was unchanged and insignificant p-00.
The mean score of Flexion angle of knee was increased from 110.26 to114.66
with the improvement of 5.19% highly significant (p<0.001).
The mean score of Time taken to cover 50m distance was reduced from 80
seconds to 70.33 with the improvement of 12.08% and significant (p>0.01).
Table 32 Effect of Janu-Basti on Symptoms of Sandhi Vata Patients

Symptoms
Mean
Relief
BT AT
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
Shoola
1.4
0.93
0.46
32.85
0.51
0.13
3.5
<0.01
Kriya Alpata
1.2
0.73
0.47
39.16
0.52
0.13
3.50
>0.001
Table 33 Effect of Janu-Basti on Clinical Signs of Sandhi Vata Patients

Signs
Shotha
Atopa
Flexion angle
of knee
Mean
Score
BT
AT
16.8
17.33
6
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
0.46
2.65
0.74
0.19
2.43
>0.02
0.73
0.73
00
00
00
00
00
00
110.
26
114.
66
5.73
5.19
3.82
0.98
5.80
<0.001
80
70.3
3
9.67
12.08
13.2
9
3.43
2.81
>0.01
Time to
cover 50m
distance
Effect of Naturopathy Techniques

15 patients of Sandhi Vata were treated with Naturopathy techniques for 7 days. Its effect
on the clinical signs and symptoms were as follows.
Effect on Symptoms
The effect of Naturopathy techniques on symptoms of Sandhi Vata is shown in
Table 34.
Mean pain was reduced from 1.53 to 1.00 with the improvement of 34.64% and was
highly significant (p>0.001).
Mean score of Kriya Alpata improved from 1.53 to 0.8 on an average it is improved by
43.13%, which was also highly significant (p<0.001).
Effect on signs
The effect of Naturopathy techniques on signs of Sandhi Vata is shown in Table
35.
The mean score of Shotha was reduced from 35.46cm to 34.10cm with 1.36%
improvement, which was significant (p<0.01).
The mean score of Atopa was unchanged and insignificant (p-00).
The mean score of Flexion angle of knee was increased from 111.06 to118.53
with the improvement of 8%, which is highly significant (p<0.001).
The mean score of Time taken to cover 50m distance was reduced from 88.66seconds to 73seconds with an improvement of
15.66%, which is highly significant (p<0.001).
Table - 34
Effect of Naturopathy techniques on Symptoms of Sandhi Vata Patients
Symptoms
Shoola
Kriya Alpata
Mean
Score
BT AT
1.5
1.00
3
1.5
3
0.8
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
0.53
34.64
0.51
0.13
>0.001
0.66
43.13
0.48
0.12
5.29
<0.001
Table 35
Effect of Naturopathy techniques on Clinical Signs of Sandhi Vata Patients
Signs
Shotha
Atopa
Flexion angle
of knee
Mean
Score
BT
AT
34.1
35.46
0
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
1.36
3.83
0.71
0.18
7.36
<0.001
1.13
1.13
00
00
00
00
00
00
111.
06
118.
53
7.20
4.32
1.11
7.16
<0.001
88.66
73.
00
15.66
17.66
8.20
2.11
7.39
<0.001
Time to
cover 50m
distance
Overall results of all criteria [Sandhi-Vata] on the bases of reduction/ improvement

[after treatment of 7 days]
Table No. 36
Total effect on Shoola
Difference
Group
Group
Response
in grade
Poor
53.33
46.66
Moderate
46.66
53.33
Good
The response of Shoola in group A is 46.66% (7) patients shown moderate and
53.33% (8) patients shown poor and for group B it is 53.33% (8) patients shown
moderate and 46.66% (7) shown poor.
Table-37 Total effect on Atopa
Difference
Group
Group
Response
in grade
Poor
15
100
15
100
Moderate
00
00
Good
00
00
Both group A and B shows poor response in Atopa.

Table-38 Total effect on Kriya Alpata
Difference
Group
Group
Response
in grade
Poor
53.33
33.33
Moderate
46.66
10
66.66
Good
00
00
In Kriya Alpata 46.66% of group A and 66.66% of group B patients shows

moderate response.
Table-39 Total Effect on Shotha
Changes
Group
Group
Response
In cm.
Nil
10
66.66
6.66
Mild
20
60
Moderate
13.33
26.66
Good
6.66
In-group B 13 patients show mild to moderate relief. In group A 10 patients

shown no change, 3 had mild change and 2 had moderate change.
Table-40 Total Effect on Time to cover 5om distance
Difference
Group
Group
Response
In second
Nil
20
00
Mild
0-20
10
66.66
12
80
Moderate
21-40
6.66
20
Good
>41
6.66
In present study 73.32% of group A and all patients of group B shows mild to
moderate change in time taken to cover 50m distance.
Table-41 Total effect on flexion angle of knee joint
Response
Increase in
Group
angle
Group
%
Nil
20
6.66
Mild
0-5
60
40
Moderate
6-10
13.33
33.33
Good
11-15
6.66
20
In present study 11 patients of group A and 11 of group B shows mild to moderate

improvement in flexion angle of knee joint. 1 patient of group A and 3 of group B show
good improvement in flexion.
Table - 42
Effect of Janu-Basti on Symptoms of Sandhi Vata Patients after 15 days
Symptoms
Shoola
Mean Score
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
p
>0.001
BT
AT
1.4
0.86
0.53
37.85
0.71
0.13
0.73
0.47
39.16
0.52
0.13
3.50
Kriya alpata 1.2
>0.001
Table - 43
Effect of Janu-Basti on Clinical Signs of Sandhi Vata Patients after 15 days
Signs
Mean
Difference
Mean Score
% of
Relief
S.D
+
-
S.E.
+
-
p
>0.01
BT
AT
Shotha
17.33
16.80
0.53
3.05
0.74
0.19
2.77
Atopa
0.73
0.73
00
00
00
00
00
111.
26
114.8
5.2
4.72
4.69
1.21
4.29
<0.001
10.66
13.32
13.
61
3.51
3.03
>0.001
Flexion angle
of knee
00
Time to
cover 50m
80
69.33
distance
Table-44
Effect of Naturopathy techniques on Symptoms of Sandhi Vata Patients after 15
days
Symptoms
Mean score
BT
AT
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
Shoola
1.53
1.2
0.33
21.56
0.48
0.125
2.64
>0.01
Kriya alpata
1.53
0.73
0.8
52.28
0.56
0.144
5.52
<0.001
Table- 45
Effect of Naturopathy techniques on Clinical Signs of Sandhi Vata Patients after 15

days
Signs
Shotha
Atopa
Flexion angle
of knee
Mean
Score
BT
AT
33.
35.46
93
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
1.53
4.31
0.91
0.23
6.48
<0.001
1.13
1.13
00
00
00
00
00
00
111.
06
119.
06
8.53
7.68
4.27
1.10
7.73
<0.001
88.66
72.
00
16.66
18.79
11.1
2
2.87
5.80
<0.001
Time to
cover 50m
distance
Table - 46
Effect of Janu-basti on Symptoms of Sandhi Vata Patients after 30 days
Symptoms
Shoola
Mean Score
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
p
>0.001
BT
AT
1.53
1.00
0.53
34.64
0.51
0.13
0.73
0.47
39.16
0.52
0.13
3.50
Kriya alpata 1.2
>0.001
Table 47
Effect of Janu-basti on Signs of Sandhi Vata Patients after 30 days
Signs
Mean Score
BT
AT
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
p
>0.01
Shotha
17.33
16.8
0
0.53
3.05
0.74
0.19
2.77
Atopa
0.73
0.73
00
00
00
00
00
114.
8
5.2
4.72
4.69
1.21
4.29
<0.001
10.66
13.32
13.6
1
3.51
3.03
>0.001
Flexion angle
of knee
111.
26
00
Time to
cover 50m
80
distance
69.3
3
Table 48
Effect of Naturopathy techniques on Symptoms of Sandhi Vata Patients after
30 days
Symptoms
Mean Score
BT
AT
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
Shoola
1.53
1.2
0.33
21.56
0.48
0.125
2.64
>0.01
Kriya alpata
1.53
0.73
0.8
52.28
0.56
0.144
5.52
<0.001
Table - 49
Effect of Naturopathy techniques on Signs of Sandhi Vata Patients after 30 days
Signs
Mean Score
BT
AT
Mean
Difference
% of
Relief
S.D
+
-
S.E.
+
-
p
<0.001
Shotha
35.46
33.
93
1.53
4.31
0.91
0.23
6.48
Atopa
1.13
1.13
00
00
00
00
00
111.
06
119.
06
8.53
7.68
4.27
1.10
7.73
<0.001
88.66
72.
00
16.66
18.79
11.
12
2.87
5.80
<0.001
Flexion angle
of knee
00
Time to
cover 50m
distance
Methodology
Observation
&
Results
Discussion
DISCUSSION
Discussion on literary view of Sandhi vata

Vata is a force, which has got two functions; one is to recognize and other is to
stimulate all the activities in the body. Due to its Cala Guna it moves all over the body.
The movement or Gati of individual component of Vata has to be analyzed properly.
The aggravated Vata finds a suitable place for its lodgment. The suitable place
may be Dhatu, Upadhatu, Ashaya, and Avayava. Due to consumption of Vata Vardhaka
Ahara and Vihara the aggravated Vata while moving throughout the body lodges in
Khavaigunya Yukta Srotas. After getting lodged at those parts it impairs the functions of
particular structure and produces disease.
Sandhi is a place where two or more structure unites. In the context of Asthi
Sandhi means a junction between two bones. Sandhi is not a single structure rather it is
considered as an organ. There are different structures, which helps in maintaining the
stability of the joint. Snayu or ligament helps in proper binding of the joint. They unite
the bones and help to direct the bone movement and prevent the excessive and
undesirable motion. Muscle tone helps to maintain the alignment of the joint. Shleshaka
Kapha or Synovial fluid, which fills up the cavities, occupies the Synovial joint, bursae
and tendon sheaths. It provides the lubricant factors, nutrient to the cartilage, disc, and
helps in keeping the joint firmly united. Shleshmadharakala situated in the joints
supported by Shleshaka Kapha helps in lubrication.
The Samprapti of Sandhi Vata may be divided into Dhatukshaya Janya, Avarana
Janya and Abhighata Janya.
Even the contemporary science explains the pathology in three settings. One is
due to the sub standard biomaterial of the joint (Dhatukshaya). In this due to old age,
Vatakara Ahara Vihara there will be qualitative change in the joint material gradually
leading to disease manifestation.
Avaranajanya is may be due to increased applied pressure over the joint. In it
complication of obesity leads to disease manifestation. This demarcation in Samprapti
helps in planning the treatment. In abhighata the integrity of the joint is disturbed. Due to
abhighata provocation of Vata occurs. Ruksha guna of Vata and Ushanata produced by
abhighata will do the shoshana of shlashmaka kapha in the joint. This vitiated vata will
produce series of changes in the joint after dosha dushya sammurchana and produces
sadhi vata lakshana (Figure-1, 2and 3).
Sandhi Shoola, Sandhi Shotha, Sandhi Stabdhata and Atopa are the clinical
features of Sandhi Vata.
The Chikitsa Sootra of Sandhi Vata is Snehana, Swedana and Agnikarma. Since it
is a Vata Vikara and Dhatukshaya is the resultant, Snehana and Swedana would be an
ideal line of treatment.
Discussion on observation
The observations pertaining to the Incidence study (Nidanatmaka aspects) of 30
patients, registered for the study, discussed here under in the separate headings.
Age incidence: For this study the inclusion criteria of age group was between 40 and
60 years. Majority of the patients belongs to the age group of 5560 years (56.66 %),
followed by 45-50 and 50-55 years each (21.2%) as shown in Table14. The prevalence
of Osteoarthritis of knee is more common in age group of 45 65 years -30 %, more then
65 years -68 % (Harrison.2001).
Sex incidence: Majority of the patients (63.33%) were females (Table - 15). The
universal data also says prevalence of Osteoarthritis is more in older women.
Above 50 years pradhanya kala starts. As the age increases there will be
natural process of degeneration of Sharira Bala and Dhatu which provokes Vata
and also diminishes Jatharagni. In females menopause contributes the

degenerative changes. Even in males the degenerative process starts from the
age of 50 years onwards.
Incidence of family history: 33.33% of the patients had the family history.
(Table-29)
Viharamtaka incidence: Majority of patients shows (60%) Bhar vahana as
viharatmaka nidana as over weight is one of the contributing factors in the
disease (Table-30).
Dietary incidence: 53.33% of the patients were taking veg diet (Table-31).
Religion incidence: Study records larger number of Hindus (83.33 %) while
compared to other religions. Data reflects more on the geographical
predominance of a particular area (Table 16).
Occupational incidence: Most of the patients registered in the study were
housewife (53.33%), who was accustomed to moderate work (Table-17).
Incidence of Deha prakruti: Maximum patients (46.66%) of Sandhi
Vata were of vata kaphaja prakruti (Table-18).
The selected individuals were predominantly belonging to Madhyama Sara
(53.33%), Madhyama Samhanana (63.33 %), Madhyama Satva (56.66 %), Madhyama
Pramana (80.00 %), and Madhyama Satmya (100 %) and with Madhyama Vyayama
Shakti (50.00 %) as shown in Table 19, 20, 21, 22, 23, and 26.
Incidence of Aaharasakti: Majority of the patients (73.33%) had Madhyama
abhyavarana sakti and jarana sakti (Table-24and 25).
Incidence of joint involvement: Majority of the patients (70%) had the

involvement of both the joints.
Incidence of Bowel habits: 20% of the patients had the complaint of
constipation and other had normal bowel habits.
Incidence of addiction: Out of 36.66% male patients majority were having the habit
of chewing tobacco, smoking and alcohol. These are the contributing factors for disease.
Sleep pattern: Maximum number of patients (60%) had the history of
disturbed sleep. Due since the age group is of Vata predominance this may be
justified.
Incidence of Clinical Features and Chronicity: In the present clinical study patients
were diagnosed on the basis of clinical features of Sandhi Vata. The most common
complaints of the patients of this series were Kriya alpata (100%), joint pain (96.66%),
joint crepitus (83.33 %) and joint swelling (70%).
In group A all the patients had Kriya alpata but Shotha was present only in
46.66%, Shoola in 93.33% and Atopa in 73.33%. In group B all the patients had Kriya
alpata and Shoola but Shotha was present only in 63.64%, Atopa in 81.82%.
It is very interesting to note the relation between manifestation of clinical features
and age, chronicity. In-group A majority patients had chronic history (0-3 years 60 %),
belong to the age group 55-60 (60 %). In-group B also about 53.33% of the patients had
the chronicity between 0-3years; belong to the age group 55-60 (53.33%). The above
observation reveals that age and chronicity contribute in the manifestation of symptoms
and severity of the diseases (Table 27 and 28).
Discussion effect of therapies (Results)

The external oleation therapies and heat therapies are extensively
practiced in Sandhi Vata. The present clinical study has been conducted to
evaluate the effect of different naturopathy techniques like derivative massage,
infrared therapy, etc. The effects of therapies are being discussed here on
individual signs and symptoms of Sandhi Vata.
Effect of therapies on Shoola: In patients of group A the pain was reduced significantly
by 32.85%, in group B the improvement was also significant (34.64%). On this basis of
above results can be said that the effect of Naturopathy techniques is slightly better than
Janu basti group in reducing Shoola (Table-32 and 34).
Effect of therapies on Shotha: In patients of group A the joint swelling was significantly
reduced (p<0.05) by 2.65%. In group B the reduction was 3.83% that was also significant
(p<0.01). On this basis it can be said that Naturopathy techniques have better effect than
Janu-basti in reducing swelling (Table 33 and 35).
Effect of therapy on Atopa: The mean score of Atopa in both group A and B was not
reduced both were insignificant (Table 33 and 35).
Effect of therapy on Kirya alpata: In patients of group A there was an
improvement of 39.16% which is significant at p>0.001, in group B improvement
was 43.13% is also highly significant at p<0.001. By the above results it can be
said that Naturopathy techniques is having better efficacy in Kriya Alpata (Table 32 and 34).
Effect of therapy on Flexion angle of knee joint: In patients of group A the mean score
increment is from110.26 to 114.66 with the improvement of 5.19%. In group B also mean
increment in flexibility is there that is from 111.06 to 118.53 with the improvement of
7.20% both were highly significant (Table - 33 and 35).
Effect of therapy on time to cover 50m distance: In patients of group A the mean score
increment is from 80.00 to 70.33 with the improvement of 12.08% it was significant at
P>0.01. In patients of group B the mean increment from 88.66 to 73.00 with the
improvement of 15.66% and highly significant at P<0.001 Thus it can be said that
average improvement and increment in flexibility was better in naturopathy group (Table
33 and 35).
Overall Effect of the Therapies: The overall effect on Shoola was moderate in 46.66%
of the patients of Group A, and 53.33% in Group B. On Atopa there was poor response in
both groups. In Kriya alpata 46.66% of patients of group A and 66.66% of group B were
found moderate improvement. On Shotha 33.33% of patients of group A and 86.66% of
group B was found mild to moderate improvement. In time to cover 50m distance
73.32% patients group A and all (100%) patients of group B shows mild to moderate
change. And in flexion angle of knee joint 73.33% patients of each group A and B shows
mild to moderate improvement. None of the patients were completely recovered or
remain unchanged (Table 36, 37, 38, 39, 40, 41).
Hence from the above statement it may be summarized that both the therapies
recovery provided better overall effect to the patients of Sandhi Vata.
Effect of Naturopathy techniques: Naturopathy techniques provided significant relief in
Shoola (34.64%), Shotha (3.83%), Kriya alpata (43.13%), and flexion angle of knee joint
(7.20%), time taken to cover 50m distance (17.66%) shows in Table 34 and 35.
Effect of Janu-Basti with tila taila: Janu-Basti with tila taila provided significant relief
in Shoola (32.85%), Shotha (2.65%), Kriya alpata (39.16%), flexion angle of knee joint
(5.19%), Time taken to cover 50m distance (12.08%) shows in Table 32 and 33.
Probable mode of action of Naturopathy techniques

Naturopathy utilizes change in temperature as therapy.
In derivative massage fulling, friction and deep kneading are most effective.
Kneading a joint is to increase the circulation through it, while the effect of derivative
massage is not to carry the blood through the joint, but rather around it, thus relieving
excessive local congestion or hyperemia, by diverting the blood into other channels.
Friction relieves painful joints by increasing the surface circulation and so diverting the
blood from the joint itself.
Derivative massage restores the normal secretion, improves nutrition of the joint
and may increase vital activity. Tapping helps the muscles to develop its contractile
power. Percussion cause muscles to contract and become stronger.
Infra Red treatment produces heating effect in the superficial epidermis is
vasodilatation. This will lead to more blood supply and nutrient supply in that area
leading to drainage of waste products resulting in the relief of pain and healing of edema
and other skin conditions. The sedative effect on nerve endings lead to reduction in the
muscle spasm and relax the muscle, thus helping in treatment of inflammation.
Wax pack adds to insulating effect. The wax transmits heat energy to the tissue by
giving up energy as it solidifies. The low conductivity quality of wax prevents much heat
loss from the skin surface. It also prevents water loss from skin and skin gets moisture,
this moisture helps to soften adhesions and scar tissue.
Manipulation by exercises with resistance is for treating disuse atrophy. Without
resistance is for improving the range of motion and for lubrication of the joint. It
maintains endurance of muscle. Mustard pack has strong revulsive effect for the relief of
severe pain.
In alternate hot and cold pack reaction takes place as circulatory and
thermal. They strongly influence both the arteries and the veins. By lowering the
pressure in the veins, the arterial circulation through the affected part is
facilitated, thus encouraging the nutrition and functional activity of the cells which
are engaged in combating germs, or which are seeking to repair damages which
may have originated in any way.
The hot pack application diverts the blood into the cutaneous branches of the
collateral arteries, thus preventing undue accumulation of blood and consequent
embarrassment of the affected tissues.
By Hot Foot Bath at first the pulse is slowed and the brain congested, but after
three or four minutes the pulse rate gets increased, and the brain becomes anemic, these
conditions persist for some time after the bath is terminated. The rectal temperature at the
same time fell to the same extent. Arterial tension gets increases by 8 mm. dilate the
vessels of feet, and produces collateral anemia of the pelvic viscera.
Overall all these factors help in break down the pathology occurs in Sandhi vata
and relief from sign and symptoms.
Probable mode of action of Janu-Basti

Janu-Basti procedure is a Bahya Shamana Cikitsa. It is Bahya Swedana and
Snehana (If Sneha is used) therapy. Swedana has the functions of neutralizing Stambha,
Gaurava and Sheetata. In Sandhi Vata joint stiffness is one of the clinical features. JanuBasti may have action on this symptom. The Stabdhata of Sandhi is mainly due to Sheeta
property of Vata. Ushna Guna of retained medicine neutralizes this Sheeta Guna.
If Sneha Dravya is used as media in case of Janu-Basti their action further
facilitates in alleviating Vata. Sneha Dravya has Drava, Sara, Snigdha, Picchila, Guru,
Sheeta, Mrudhu and Manda Guna predominantly. The Vata Dosha, which is the key
factor in the casuation of Sandhi Vata, has almost opposite quality to this. Moreover
Sneha Dravya has similar property to that of Kapha Dosha. In Janu-Sandhi Vata Sthanika
Kaphakshaya is due to Agantu Vata Dosha. Thus only one hand Sneha Dravya
neutralizes the Vata Dosha and on the other hand nourishes the Sthanika Kapha Dosha.
This helps in Samprapti Vighatana.
Biophysical effect of temperature

Circulatory effect- There is stimulation of superficial capillaries and arteriole causing
local hyperemic and reflex vasodilation. This will affect increased blood flow at the site.
The temperature must be controlled between 104F to 113F. This hyperemia may result
systemic change such as decrease in mean blood pressure, increase in pulmonary minute
ventilation.
Metabolic reaction- Temperature will raise the chemical activity in cell and metabolic
rate will increase. The energy expenditure will increase and protein denaturation will
occur in human tissue.
Vascular effect- There are three factors that cause vasodilation- an axon reflex, release
of chemical mediators, secondary to temp elevation, local spinal cord reflex.
Neuromuscular effect- Heat is Effective to provide analgesic and assist resolution of
pain muscle guarding spasm. Heating of peripheral nerve elevate pain threshold
remarkably reduce muscle spasm.
Connective tissue effect- Temperature elevation in combination with a stretch can alter
visco-elastic properties of connective tissue. The elastic properties of connective tissues
result in plastic elongation.
Effect on the skin Skin becomes moist and pliable following wax application. This
helps to soften adhesion and scar in the skin prior to mobilization and stretching
procedures. 6
COMPARISION OF EFFECTS OF THERAPIES

The results of this study showed that the effect of Naturopathy techniques and
Janu-Basti provided significant relief in the signs and symptoms of the disease.
Naturopathy techniques provided better relief than Janu basti in all the signs and
symptoms of Sandhi Vata that is Shoola, Shotha, Kriya Alipata, Flexion angle of knee
joint, and Time taken to cover 50m distance (Table 32, 33, 34 and 35).
Hence with the above comparison it can be said that Naturopathy techniques
provided better relief than Janu basti with Tila Taila. Though the efficacy is better in
Group B patients, this may be attributed to the more number of treatment modalities
employed in this group like derivative massage, infrared therapy, wax bath, exercises, hot
foot bath, hot and cold pack, and mustard pack where as in group A patients only Janubasti was employed with tila taila. The reduction of Shoola, Shotha, Kriya Alpata, and
improvement of flexion at the joint and time to cover 50m distances indicate the efficacy
of Bahya Shaman Chikitsa.
Conclusion
CONCLUSION
The observations pertaining to the literary and clinical study are discussed to
draw the logical conclusions in the second part of the thesis. The conclusions thus drawn
are as follows.
Nidanatmaka aspects of Sandhi Vata: Among 30 patients of Sandhi Vata

registered for the study; majority was belonging to the age group of 55-60 years
(56.66%), female sex (63.33%) and were housewives by occupation (53.33%).
Maximum numbers of patients were of Vatakapha Prakriti (46.66%), Madhyama

Samhanana (63.33%), Madhyama Satva (56.66%), Madhyama Pramana (80%),
Madhyama Satmya (100%), Madhyama Abhyavaharana (73.33%), Madhyama
Jarana Shakti (73.33%), Madhyama Sara (53.33%), and Madhyama Vyayama
Shakti (50%).
As per the clinical presentation all the patients were having Kriya Alpata,
amongst the other main symptoms, Sandhishoola was present in 96.66%,
Sandhishotha was present in 70% and Atopa was in 83.33% of patients.
Chronicity was 0-3 years in 56.66% of patients.
Effect of Janu-Basti with Tila Taila: Janu-Basti with Tila taila provided
significant relief in Shoola (32.85%) in 46.66% of patients, Shotha (2.65%) in
43.33% of patients, Kriya alpata (39.16%) in 46.66% of patients, Flexion angle of
knee joint (5.19%) in 73.33% of patients, Time taken to cover 50m distance
(12.08%) in 73.32% of patients.
Effect of Naturopathy techniques: Naturopathy techniques provided significant

relief in Shoola (34.64%) in 53.33% of patients, Shotha (3.83%) in 86.66% of
patients, Kriya alpata (43.13%) in 66.66% of patients, Flexion angle of knee joint
(7.20%) in 73.33% of patients, Time taken to cover 50m distances (17.66%) in
100% of patients.
Comparison of the effects of therapies: Naturopathy techniques provided better

relief in Shoola, Shotha, Kriya Alpata, Flexion angle of knee joint, Time taken to
cover 50m distances than Janu-Basti with Tila Taila.
Recommendation for further study

Present study pattern can be contributed in the form of prospective clinical study
with increased sample size. Further it is recommended to study the effect of individual
naturopathy techniques separately.
Summary
SUMMARY
The dissertation entitled A study on the efficacy of Ayurveda and
Naturopathy in Sandhi Vata comprises of chapters on Disease review,
Naturopathy techniques and Janu-basti review, Methodology, Discussion,
Summary and Conclusion. The study is divided into 2 parts.
Part 1: Literary view of Sandhi Vata.

Disease Review:
Disease Sandhi Vata and Osteoarthritis are elaborately discussed in
this chapter. Definition, risk factors, pathology, investigations, symptoms
and treatment of Osteoarthritis are included.
From the etymology of Sandhi Vata it is understood that Vata is the
sole responsible Dosha involved in this disease.
Sandhi Vata Nidana though is not separately mentioned, the Nidana
responsible for Vatavyadhi can be considered here and broadly classified into
Aharaja and Viharaja; most of the Nidana are Vatakara and are directly
responsible for the functional derangement of Vata.
Purvarupa in Vatavyadhi is said to be in Avyaktavastha. Rupa
according to different authors has been explained. Samprapti is dealt in
detail.
Anatomy of Sandhi, Chikitsa, Sadhyasadhyata, and Vyavachedaka

Nidana is reviewed according to different authors.
Chikitsa is mainly of 2 types Shodhana and Samana. Chikitsa as
followed for Vatayadhi is explained. Here all patients were given Bahya
Shamana Chikitsa.
Literary views of therapies
It is collection of literary views of Naturopathy techniques and Janubasti. It deals with the information available regarding the naturopathy
techniques and Janu basti in different texts. Method, mode of action,
indication, contraindication, advantages and the studies conducted earlier
have been included.
Part 2: Methodology
Clinical study describes the aims and the objectives, criteria of selection of
patients, details of inclusion and exclusion criteria, diagnostic criteria,
assessment criteria for assessing the effects of the therapies, the investigations
conducted, and treatment.
After registration, patients were randomly distributed into two Groups as Group A and Group B.
Group A: Janu basti with Tila Taila was givenexternally for 7 days.
Group B: Naturopathy techniques were given externally for 7 days.
After completion of 7 days course, the patients were asked to report for the follow up
study every 15 days for the next one-month period.
Observations
Various observations regarding incidence study like patients age, sex,
etc, clinical findings like Aharasakti, Vyayama, Pramana, etc. incidence of
clinical features of Sandhi Vata are tabulated and shown.
Results
Results of the clinical trial were assessed on the basis of grading given for
assessment criteria. Observations were subjected to standard statistical
analysis, the data of which have been presented in the chapter.
Discussion
Here the discussion of Disease review, the probable mode of action of
the therapies, interpretations of the results of the clinical trial has been
included along with the results of the experimental study conducted.
Both observations and results related to the study are discussed with
derivation of possible inferences.
Bibliographic
References
Bibliographic References
List of References
1. Ca. Sa. Ci. 28/37
2. Su. Sa. Ni 1/28
3. Su.Sa. Ci. 4/8
4. A. Sa. Ni 15/17
5. A. Sa. Ci. 23/13
6. A. Hr. Ni 15/14
7. A. Hr. Ci. 21/22
8. Ma. Ni. Pu. 22/21
9. Bh.Pr. Ut. Mad. Kh. 24/258-259
10. Yo.Ra Vatavyadhi Ni/25,119
11. Bh.Ra. 26/14
12. Su.Sa. Sh. 5/26.
13. Su. Sa.Sh. 5/32.
14. A.Hr. Ni 12/18.
15. Su. Sa.Sh. 4/14, 15.
16. Su.Sa. Ni 1/13.
17. A.Hr. Su. 11/26-28.
18. Su.Sa. Sh. 5/34-42.
19. Su.Sa. Sh. 5/46.
20. Su. Sa. Sh. 5/28.
21. Ca.Sa. Ci. 28/15-18.
22. Ca. Sa.Vi. 5/17-18.
23. Su.Sa. Sh. 6/7, 12, 13.
24. Ca.Sa. Ci. 28/19
25. Ca.Sa. Ci. 28/37
26. Ca.Sa. Ci. 28/18.
27. A. Hr. Ni 15/5, 6.
28. Su.Sa. Su.15/37.
29. Su.Sa. Su.15/32
30. Su. Sa.Ni 9/12
31. Ca.Sa. Ci. 28/73, 74.
32. Ca. Sa.Ci. 28/73, 74.
33. Su.Sa. Ci. 31/2
34. Su. Sa.Ci. 24/30.
35. Ca.Sa. Su. 22/11.
36. A. Hr. Su.17/18,19
37. Ca.Sa Su. 14/35.
38. Su.Sa. Ci. 32/12.

39. Ca.Sa. Su. 14/37.
40. A.Hr. Su. 17/5.
41. Ca. Sa.Ci. 28/115.

42. A. Sa. Ci. 23/13
43. A Complete Handbook of Nature cure, page-205.
44. The Art of Massage by J. H. Kellogg, page 148-151.
45. A Complete Handbook of Nature cure, page-205.
46. Goels Physiotherapy Chap-11/555-557.
47. Goels Physiotherapy Chap-14/576-579.
48. Goels Physiotherapy Chap-11/142,143.
49. Goels Physiotherapy Chap-6/92.
52. Rational Hydrotherapy, Page 814,956.
53. Rational Hydrotherapy Part-I page-161,188.
54. Rational Hydrotherapy Part-III page-751.
55. Rational Hydrotherapy Part-III page-840-842.
56. Rational Hydrotherapy, part-III, /756-758.
57. Ca. Sa. Su. 11/55.
58. A. Hr. Su.19/1.
59. Su. Sa. Su.5/3.
60. Ca. Sa. Vi. 8/94-96.
61. Su. Sa.Sh.9/9.
62. Su.Sa.Su.18/4.
63. A. Hr. Su. 12/14.
64. Physiology by Robert M. Berne.
65. Essentials of Pharmacology by K. D. Tripathi Cha.2/13.
Printed Publications
1. A Complete Handbook of Nature cure of H. K. Bakharu, Jaico Publishing
House, 121, M.G. Road, Mumbai.
2. Bhaisajyaratnavali Vidyotini Hindi commentary By Kaviraja Ambikadatta Shastri
Chaukhamba sanskrut sansthan, Varanasi 2001.
3. Bhavamisra- Bhavaprakasa (ed) Vidyotini Hindi commentary By Bhisagaratna
Pandit Sri. Brahma Sankara Misra Chaukhamba Sanskrit Sansthan Varanasi,
2003.
4. Charaka- Charaka Samhita of Chakrapanidatta (ed) By Vaidya Jadavji Trikmaji

Acharya Chowkhamba Sanskrit Sansthan, Varanasi 2001.
5. Charaka- Charaka Samhita,with Charaka Chandrika Hindi commentary by Dr.
Brahmanand Tripathi, (ed) chaukhamba surbharti prakashan, Varanasi 2004.
6. Goels Physiotherapy by Dr. R. N. Goel, Shubham publication, F-2 sanchi
complex, Shivaji Nagar, Bhopal, Vol-I, 2004
7. Madhava Nidanam- Sri Madhavakara Madhukosa Sanskrit commentary by
Vijayaraksita and Srikanthaadatta (ed) Vimala Madhuhara Hindi commentary by
Dr. Brahmanand Tripathi, Vol-I, Chaukhamba Surbharati Prakashan, Varanasi
2003.
8. Rational Hydrotherapy by Dr. John Harvey Kellogg, Part I, II, III, IV.
9. Sushruta-Sushruta Samhita with Nibandha Sangraha commentary by Dalhana
(ed) Vaidya Jadavji Trikmaji Acarya Chowkhamba Krishnadas Academy,
Varanasi, 2004.
10. Sushuruta- Sushruta samhita with Ayurveda Tavtta sandipika Hindi commentary
by Kaviraja Ambikadatta Shastri Chaukhamba sanskrut sansthan, Varanasi 2004.
11. Sushruta- Sushruta samhita with Nibandha Sangrha commentary of Sri.
Dalhanacharya and Nayachandrika Panjika of Sri. Gayadasacharya (ed) Vaidya
Jadavji Trikmaji Acarya Chowkhamba Krishnadas Academy, Varanasi, 2004.
12. The Art of Massage by J. H. Kellogg, Teach services Inc, New York, 254,
Donovan Road, Brushton, 1998.
13. Vagabhat- Ashtang Hrdayam with Nirmala Hindi commentary by Dr.
Brahmanand Tripathi, (ed) Chaukhamba Sanskrit Prakashan, Delhi 2003.
14. Vagbhata- Ashtang Sangrah with Hindi commentary by Kaviraj Atrideva Gupta
Krishnadas Academy, Varanasi 1993.
15. Vagabhat- Ashtang Hrdayam with Ayurveda Rasayana commentary by Hemadri
and Sarvangasundara commentary by Arundatta(ed) Pandit Bhisagacharay
Harishastri Prabhakar Vaidya,Krishnadas Academy Varanasi 2000.
16. Yogaratnakara with Vaidyaprabha Hindi commentary By Dr. Indradev Tripathi
and Dr. Daya Shankar Tripathi, Krishnadas Academy Varanasi, 1998.
Annexure
Case proforma
S.D.M. College of Ayurveda and Hospital, Hassan
Dept. of P.G. studies in Swasthavritha
A study on the efficacy of Ayurveda & Naturopathy in Sandhi-Vata
Sl. No.
Date:
OPD / IPD No:
Group- A/B
DOA / DOD:
Name:
Age:
Sex:
Religion:
Wt.-
Postal Address:
Occupation:
Main Complaints:
Shoola Shotha Kriya-alpata Atopa in Rt, Lt Knee Joint
Duration: 0-3yrs, 3-6yrs, above 6yrs
Anubandha vedana:
Kula vrittant:
Atura Charya1.
2.
Ahara:
Vihara-
a.
Quality- Alpa
Pramita
b.
Dominant rasa-
c.
Guna Ruksha Snigdha Ushna
d.
Dietetic habit
e.
Addiction-
Bhar vahan , Sukha asana, Atichankramana,
Pulse:
/min
R/R:
Blood pressure:
L
Sheeta
K
Guru
Laghu
Matrashana, Vishamanasana, Adhyasana, Anasana
General Examination:
1.
2.
3.
Atipramana (veg/mixed)
/mm of Hg
Pradhavana
4.
5.
6.
7.
Mala:
Mutra:
Jihwa:
Nidra:
Dasha Vidha Pareeksha
1.
Prakrititah :
2.
Vaya :
3.
Vikrititah :
4.
Samhanana:
5.
Satva :
6.
Pramana :
7.
Satmya :
8.
Aharashakti :
Abhyavarana
Jarana
9.
Sara:
10. Vyayama Shakti :
Investigations:
1.
Hematological
a. Hb%
b. E.S.R.
c. D.C.: N ____%, L ____%, B____%, E____%, M_____%
d. T.C.
2.
X-Ray (if done)
Assessment criteriaComplaints
B. T.
Shoola-Shotha-(circumference)
Kriya alpta-Atopa-Flexion movement
at knee joint--
A. T.
Rt
Rt
Lt
Lt
Rt
Rt
Lt
Lt
Rt
Rt
Lt
Lt
Rt
Rt
Lt
Lt
Rt
Lt
Rt
Lt
Time taken to cover

50mt.distance--

Sandhi Svaras Book

Hochgeladen von

Dokumentinformationen

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Sandhi Svaras Book

Hochgeladen von

Copyright:

Verfügbare Formate

A STUDY ON THE EFFICACY OF AYURVEDA AND

NATUROPATHY IN SANDHI VATA

Dr. Sajitha K. M.D. (AYU)

DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHA

A STUDY ON THE EFFICACY OF AYURVEDA AND

In partial fulfilment of the requirements for the degree of

Dr. Sajitha.K, M.D (Ayu)

DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITHA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation / thesis entitled A STUDY ON THE

DEPARTMENT OF POST GRADUATE STUDIES IN

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled A STUDY ON THE

DEPARTMENT OF POST GRADUATE STUDIES IN

S. D. M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN 573 201

ENDORSEMENT BY THE H O D; PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled A STUDY ON THE

Dr. Ramana G.V.

Dr. Prasanna N Rao

DECLARATION BY THE CANDIDATE

Rajiv Gandhi University of Health Sciences, Karnataka

Dr. Patil Uday Jayawantrao

-Janu Basti group

-Naturopathy Techniques group

List of Tables and Figures

I. Literary Review of Sandhi Vata

Poorvaroopa and Roopa

Naturopathic techniques for Sandhi Vata

LIST OF TABLES AND FIGURES

PRAMANA WISE DISTRIBUTION OF 30 PATIENTS OF SANDHI VATA

SHOWING DISTRIBUTION OF AHARATMAKA NIDANA IN 30 CASES

INTRODUCTION AND OBJECTIVES

treatment physical heat therapy is given importance. In addition, non-pharmacologic

There is no reference regarding Sandhi Vata in Prevedic period. During Vedic

Ashtanga Sangraha Nidanasthana describes its Lakshana4 and Chikitsa of Sandhi

Nidanasthana 15; Chikitsasthana 23

Nidanasthana 15; Chikitsasthana 21

NIRUKTI AND PARIBHASHA

Sam + Dha + Kihi (Shabda Kalpa Druma)

Means junction, connection, combination, and union with containing a conjugation,

Paribhasha - Sandhi Pullinga, Sandhanamiti, Yuga Sandhini Yugashabde Deha

Acharya Sushruta explains about the innumerable junctions between Peshi,

Va - Gati Gandhanayoho (Sushruta Samhita)

b) Guna Vishesha Aharaja Nidana (Table-3)

c) Virya Vishesha Aharaja Nidana (Table-4)

d) Dravya Vishesha Aharaja Nidana (Table-5)

e) Aharakrama Nidana (Table-6)

Ma.Ni Yo.Ra Bh.Pr

(2) Viharaja Nidana (Table-7)

(3) Manasika Nidana (Table-8)

(4) Kalaja Nidana (Table-9)

(5) Anya Nidana (Table-10)

Poorvaroopa of Sandhi-Vata is not available in classics. In Vatavyadhi

3. Abhighatajanya Sandhi Vata- Trauma is considered as

joint after Dosha Dushya Sammurchana and produces Sadhi

KSHAYA OF KAPHA BHAVA

SHLESHAKA KAPHA KSHAYA

EXCESSIVE PRESSURE OVER

SHLESHAKA KAPHA KSHAYA

Vyavachedaka Nidana or differential diagnosis plays a prime role in arriving at an

Asthi Majjagata Vata (Ma.Ni.22/18)

There are some conditions (Dosha Vriddhi Kshaya Lakshana, Panchakarma

Kapha Vruddhi (A.Sa.Su.19/6)