Sandhigata Vata is one of Vata Vyadhi characterized by the symptoms such as Sandhishoola (joint pain) and Sandhishopha (swelling of joint).
Osteoarthritis (OA) is degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint
OA of knee joint comes under the inflammatory group which is almost identical to Sandhigata Vata described in Ayurveda with respect to etiology, pathology, and clinical features.
Pain is an unfavorable sensation that brings an individual to the physician due to a halt from his routine works.
The condition is more painful when mobile joints such as Janusandhi (knee joint) of the body are involved due to Sandhigata Vata.
The disease Sandhigata Vata is more prone to be affected to knee joint because it is most frequently involved joint in daily routine work, weight bearing joint of the body, and more prone to develop in overweight patients.
In the pathogenesis of Sandhigata Vata, Vata Dosha dominant with symptoms such as Vedana (pain during joint movement) and Shopha (swelling). The joint stiffness and crepitus (specific sound during joint movement) are symptoms that may be co-related in modern parlance with osteoarthritis (OA) of the knee joint.
OA is the second most common rheumatologic problem and is the most frequent joint disease having prevalence of about 22–39% in India. Among them, 29.8% persons between 45 and 64 years of age group report diagnosed arthritis.
OA is the most common form of arthritis and leading cause of chronic disability mostly in all the population.
For the management of OA, patients need to take analgesics for daily and lifelong.
In OA, surgical therapy-like knee joint replacement is very costly and even after surgery patient has to continue some medicine for a long duration.
The use of analgesics and steroids in old age may produce adverse effects such as gastritis, hyperacidity, and sometimes renal failure.
Agnikarma is a nonpharmacological treatment which has definite role in Sandhigata Vata. The emphasis of the Ayurvedic approach of Agnikarma is to relieve the pain in OA. It may be more effective in the management of Janugata Sandhivata (OA of knee joint)
Sushruta has given direction for treatment of the Sandhigata Vata by Agnikarma.While describing the indications of Agnikarma, he also explained that Agnikarma can be done when severe pain occurs in Twaka, Mamsa, Sira, Snayu, Sandhi, and Asthi due to vitiation of Vata Dosha.
Inclusion criteria
Patients suffering from Janugata Sandhivata (OA of knee joint)
Age group of 45–70 years
Patients of either gender.
Exclusion criteria
Patients below 45 years and above 70 years age
Patients with diabetes mellitus (DM), rheumatoid arthritis (RA)
Other diseases such as paralysis, Parkinson's disease, severe anemia, and cancer patients
Secondary OA due to tuberculosis (TB), syphilis, AIDS, leprosy, etc
Sandhigata Vata other than Janugata Sandhivata
Pregnant patients as they are contraindicated for Agnikarma.
Investigations
Routine hematological and biochemical investigations such as blood sugar (fasting and postprandial), uric acid, RA factor, lipid profile, and routine urine analysis were carried out before starting treatment to rule out any other pathology. Radiological examination was carried out before and after completion of treatment.
Requirements
Agnikarma Shalaka: Rajata and Loha Shalaka
Triphala Kwatha (decoction):It was used for the cleaning of local part before Agnikarma
Haridra Churna (powder of Curcuma longa L. rhizome): It was used for dusting after Agnikarma (dressing purpose)
Ghritakumari (Aloe barbadensis Miller. leaf): It was used as soothing effect after Agnikarma (dressing purpose)
Madhu-Sarpi (honey and ghee): It was used after Agnikarma for healing of wound.
Methodology
Procedure of Agnikarma The procedure performed in three stages as Purva Karma, Pradhana Karma, and Paschata Karma mentioned by Acharya Sushruta.
Purva Karma
Snigdha Picchila Annapana (rice and curd) was given prior to the procedure.
The site of Agnikarma is washed with Triphala Kwatha and wiped with dry sterilized gauze and covered with a cut sheet.
Shalaka was heated up to red hot .
(Rajata Shalaka approximately for 3–4 min and Loha Shalaka approximately for 15 min).
Ghritakumari pulp, Haridra Churna kept ready for dressing.
Pradhana Karma
In OA of the knee joint, supine position was adopted as it is comfortable to the patient. Irrespective of a specific site, Agnikarma was done at maximum tender site affected at the knee joint.
The minimum space was kept between two Agnikarma points to avoid overlapping of Dagdha Vrana.
After Agnikarma, fresh Ghritakumari pulp was applied on Dagdha to relieve burning pain.
Paschat Karma
After wiping of Ghritakumari pulp, honey and ghee was applied on Dagdha Vrana, after that dusting of Haridra Churna was done. Patient was observed for 30 min after procedure and advised Pathyapathya as mentioned in Sushruta Samhita until the healing of Samyak Dagdha Vrana.
Patients were strictly advised not to allow water contact at Dagdha Vrana site for 24 h.
Assessment criteria
The grade of pain, crepitus, and tenderness were noted before and after treatment.
The measurement of swelling at knee joint was recorded at three sites that are midpoint of patella, 2 inches above and below patella.
The goniometric reading of knee joint on flexion and extension was measured with the goniometer.
In goniometric observation, angle of extension was found increased .
Angle of flexion was found reduced .
Pathology of Sandhigata Vata
Viruddhashana in routine diet which leads to Agni Vaishamya and Vataprakopa resulting in Dhatukshaya which coupled with old age leads to Sandhigata Vata.
This type of dietary habit affects the Agni resulting in formation of Aama, leading to Agnimandya and Dhatvagnimandya, which ultimately obstructs the Srotas.
Due to obstruction of Srotas, Vata gets vitiated and affects Sandhi of knee resulting into Janugata Sandhivata.
Sthaulya (obesity) causes excess Vriddhi (increase) of Dushita Medas and deprive nutrition to later Dhatus, especially Asthi and Majja which are the Dushyas of Sandhigata Vata.
In Madhyama built patients, the cause of Sandhigata Vata is taking Apathyakara Ahara and Vihara as prevailing in the modern lifestyle.
tobacco chewing plays role on OA of knee joint
Vata Prakriti patients in which Vata vitiation played an important role in initiation and manifestation of Sandhigata Vata.
All the Yapya Vyadhis (disease which are difficult to cure) are chronic in nature as mentioned in classics chronicity of Sandhigata Vata.
Osteoporotic changes occur at the stage of menopause in female, postmenopausal hormonal variations is responsible for bone demineralization leading to osteoporosis and ultimately produces OA changes.
Vedana (knee joint pain) and Sandhi Sphutana (crepitus) these all symptoms occur due to Vataprakopa and Kaphakshaya, as well as Majja Dhatu Dusti.
unilateral OA is most common in male while bilateral OA is observed in mostly female patients.
Probable mode of action of Agnikarma
After Agnikarma, the Ushna (hot) Guna of Agni pacifies the Shita (cold) Guna of Vayu and reduces the joint pain in the case of Sandhigata Vata.
Acharya Charaka described that Agni is the best treatment for Shoola (pain).Ushna Guna of Agni helps to removes the Avarana effectively and stabilizes the movement of Vata, which provide relief from Shoola.
As per the modern medicine, therapeutic heat increases blood circulation at knee joint leads to the proper nutrition of the tissue. This induced circulation help to flush away pain producing substances from affected site and ultimately reduces the local inflammation.
The osteophytes was recorded unchanged after Agnikarma because it was a structural defect.
the Ashukari (quick acting) property of Agni also provided improvement in the movement of joints resulted in relief of crepitus.
The heat application is indicated in cases of chronic inflammation.Heat leads to vasodilatation, exudation of fluid, increase in white blood cells and antibodies.
Shita Guna of Vata in the tissue and muscle is normalized by Agnikarma, the muscle spasm releases which improve flexion and extension of knee joint.
Acharyas have quoted that Agnikarma is superior in treating Stambha (stiffness).
Comments
Post a Comment