Sandhigata vata (osteoarthritis)

Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.

1. Dr. Rajtilak Tiwari M.D. ( Kayachikitsa) Assistant Professor in Kayachikitsa dept. in Shivshakti lal sharma Ayurvedic College Ratlam (M.P.) [email protected] Mob-9406841574/7987265922 SANDHIGATA VATA (OSTEOARTHRITIS)

2. INTRODUCTION Sandhigata Vata is the type of pathogenesis involved in various disease conditions affecting the joints, e.g. osteoarthritis, rheumatoid arthritis, etc. and causing pain in affected joints.1

3. Case Definition: Painful condition of joints involving single or multiple joints restricting the movements, with or without swelling and crepitus ( Sandhi Sphutana ).

4. Differential Diagnosis:- Amavata Vatarakta • Katigraha • Gridhrasi • Ansashoola • Krostrukshirsha • Ankylosing spondylitis

5. LEVEL 1: AT SOLO AYURVEDIC PHYSICIAN’S CLINIC/PHC Clinical diagnosis: On the basis of history and clinical presentation

6. Medicines at level 1 for Sandhivata Drug Dose form dose administretion indication Anupan Ashwagandha Churna Churna 3-5 gm Twice daily 2-3 months With milk Shuddha Vishtinduka churna 250 mg Twice a day 2 week water Pippalimoola Churna churna 500mg Twice a day 1 month water

7. Sunthi-Haritaki Churna Churna 3-5 gm Twice a daily 1 month water Rasnadi Kwatha2 decotion 30-40ml Empty stomach twice daily 15 days to 1 months Dashamula Kwatha decotion 30-40 ml Empty stomach 15 days to one month water Rasna-Erandadi Kwatha3 decoction 30-40ml Empty stoach twice a day 15 days to 1 month

8. Yogaraja Guggulu4 vati 1-2 vati 500mg Thrice a days after meals 15 days to 1 months Simhanada Guggulu vati 1-2 After meals /thrice a days 15 days to 1 months

9. Abhyanga : Local : On the affected joints with warm medicated oils like Bala Taila , Sahachara Taila , Vishagarbha Taila , Nirgundi Taila , Mahanarayana Taila , Brihat Saindhavadi Taila , Dhanvantara Taila , Kottamchukadi Taila . Swedana : With hot water bag, Nadi Sveda , Baluka Pottali Sweda , Nirgundi Patra Pinda Sveda , Parisheka .

10. Pathya-apathya (diet and life style): Do’s ( Pathya ) • Ahara : Purana Shali , green gram, milk, grape, Luke warm water, Paraval , drum stick, garlic. • Vihara : Massage, warm water bath, posture correction, follow the Dinacharya and Rutucharya . Don’ts: • Ahara : Dried vegetables, lentils, sprouts, raw vegetables and salads, refined foods such as white flour, excessive use of leafy green vegetables, mushrooms, peas, Excessive intake of pungent food, cold drinks, beverages, chilled food and ice cream, Continuously fasting or taking limited food for a very long duration.

11. Vihara : Inadequate sleep or frequent changes in sleep pattern, suppression of natural urge especially of hunger, bowel and urine and emotions, Excessive physical strain like swimming, climbing, walking, running, sports which involve straining of joints like in badminton, football etc., all such occupation which involves excessive movement of joints, resulting in joint injuries.

12. Referral Criteria: Refer to Level 2 1. Cases that are not responding to above management and develop complications or severe painful condition. 2. Need further investigations.

13. Clinical diagnosis: The diagnosis is made on the basis of criteria mentioned in Level-1 for fresh cases. The case referred from Level-1 or

14. Clinical diagnosis: The diagnosis is made on the basis of criteria mentioned in Level-1 for fresh cases. The case referred from Level-1 or

15. fresh case must be evaluated thoroughly for any complication. Investigations: • Haemogram • Serum uric acid • Serum calcium • RA Factor • S. alkaline phosphatase • X-Ray of affected joint • CRP Treatment :.

16. Medicines at level 2 for Sandhivata Drug Dose form dose time duration Anupana Mahayograj guggulu vti 1-2 vati 500 to 1 gm After meal /twice a days 15 days to 1 monhs Rasnadi Kwatha , Triphala Kwatha Kaishora Guggulu6 vati 500-1 gm Twice a days after meals 15 days to 1 months Dashamula Kwatha , Luke warm water Vatavidhvamsa Rasa7 powder 125-250 mg Twice a days 15 days to 1 month Water/honey Narsimha Churna8 churna 1.5 gm Twice a days 15 days to 1 month water

17. Dashamool - arishta decotion 15-30ml Twice a days /after meals 15 days to 1 months nil Ashwagandh - arista 15-30ml Twice a days /after meals 15 days to 1 months nil Amrita Bhallataka Avaleha 5-10 gm Once daily 1 monyhs milk

18. Local management: • Upanaha with leaves of Eranda , Nirgundi , Arka , Chincha etc. on affected joints. • Lepa with Dashanga Lepa , Lepaguti , Gandhabiroja Lepa etc. • Janubasti / Greevabasti / Katibasti : Mahanarayana Taila9, Masha Taila , Prabhanjana Vimardana Taila,10 Vishagarbha Taila,11 Bala Taila12 etc • Abhyanga / Sthanika Mridu Snehana : Medicated oil such as Mahanarayana Taila,13 Masha Taila , Kshirbala Taila , Ashwagandha Balalakshadi Taila • Swedana (medicated fomentation): 1. Ekanga (local fomentation) or Sarvanga Sweda (whole body fomentation) with decoction of Nirgundi , Dashamula , Eranda , Balamula , etc Patra Pinda Sweda : local fomentation by Pottali made from leaves of Nirgundi , Eranda etc.

19. Pathya-apathya (diet and life style): Same as Level 1 Referral Criteria: The cases those are not responding to above mentioned therapy and suffering from advanced stages of disease like severe effusion, contractures, osteoporosis or deformities or Patients with some other uncontrolled conditions like obesity, hypothyroidism, diabetes mellitus and hypertension etc.

20. LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT HOSPITAL/ INTEGRATED AYURVEDIC HOSPITALS Clinical Diagnosis: Same as level 1 for a fresh case reporting directly . Investigations: 1. Investigations mentioned in level 2 may be repeated if necessary. 2. BMD Treatment: In addition to the treatment prescribed in level-1 and 2, following procedures can be done. 1. Basti Karma: Tiktaksheera Basti , Yapana Basti &Yoga Basti 2. Agni karma (cauterization): Agni Karma on the affected joints 3. Virechana : obese patients may be given Virechana 4. Siravedha Pathya-Apathya (Diet and life style):- Same as level 1