THE EFFECT OF UPANAHA SWEDA AND VATARI GUGGULU IN THE MANAGEMENT OF JANUSANDHIGATA VATA (KNEE OSTEOARTHRITIS): A COMPARATIVE STUDY
By : Chandramohan Arya1*, Sanjay Gupta2, G.D.Shukla2 *1M.D.Scholar, 2Associate Professor, Dept. of Panchakarma, Rishikul Campus, Uttarakhand Ayurved University, Haridwar, India.
ABSTRACT Every man derives the happiness and benefit of his life through locomotion i.e., using his joints. For the minute if he loses this power of locomotion he not only feels himself a miserable creature but also becomes a burden both of his family and society. The loss or reduction in his locomotive power is due to dysfunction of the joints causing an impediment to his movements. If not treated in time, the disease makes man disable. Sandhigata Vata is most common articular disorder. It is a type of Vata Vyadhi which mainly occurs in Vriddhavastha, due to Dhatukshaya. Sandhigata Vata can be correlated with osteoarthritis (OA) which is one such chronic, degenerative, inflammatory disease and has a great impact on the quality of the life of an individual. Different modalities of treatment have been explained in the classics to tackle the condition effectively. The present study was aimed to assess clinically the effect of Upanaha Sweda and Vatari Guggulu in the management of Janusandhigata Vata. In this study total 42 patients were divided in 2 groups. In Group A, patients were treated with only Upanaha Sweda and other group patients were treated with Upanaha Sweda and Vatari Guggulu. Results obtained were analyzed for statistical significance which shows group B in which Vatari Guggulu and Upanaha Sweda were given, was more effective in bringing relief in signs and symptoms of Janusandhigata Vata.
KEYWORDS: Janu Sandhigata vata, Knee osteoarthritis, Vatari Guggulu, Upanaha Sweda.
INTRODUCTION
The disease Sandhigata Vata is described under the Vatavyadhi in Ayurvedic classics. In Vriddhavastha, Dhatus undergoes to Kshaya and leading to Vataprakopa. The vitiated Vata when shelter in Sandhisthana causes Shula, Sopha, Stabhdhata, Atopa etc., in joints which is known as Sandhigata Vata. Factors which are responsible for vitiation of Vata are Katu, Tikta and Kashaya Rasa Pradhana Dravya and Avyayama, Dhatukshaya and Abhighata. In modern science this condition closely resembles with knee osteoarthritis. Osteoarthritis is the most common articular disorder. It is characterized by progressive degeneration of articular cartilage of joints. Clinically it is represented as pain in joints during movements, stiffness in joints, tenderness in joints, crepitus, restricted joint movements and radiologically it is characterized by narrowing of joint spaces, osteophytic changes and deformities in contour of joints. The incidence of osteoarthritis in India is as high as 12%. Almost all persons by age 40 have some pathologic change in weight bearing joint 25% females and 16% males have symptomatic osteoarthritis.[4] No treatment is available which can prevent the disease process. In modern science using NSAIDS and surgery are the option for the treatment of osteoarthritis. It can provide either conservative or surgical treatment which gives symptomatic relief and with troublesome side effects, whereas such type of conditions can be better treatable by the management and procedures mentioned in Ayurvedic classics. Upanaha Sweda was selected for the present study as it is shown best for Vata Vyadhis. In another group Upanaha Sweda with Vatari Guggulu was given. Vatari Guggulu has got Vatashamak properties. With this background, it is planned to evaluate the efficacy of Upanaha Sweda and Vatari Guggulu in the management of Janusandhigata Vata.
Aims and Objectives A Comparative Study of the Effect of Upanaha Sweda and Vatari Guggulu in the Management of Janusandhigata Vata (Knee Osteoarthritis).
Materials and Methods
The patients were selected randomly from Outdoor Patient Department (OPD) and Indoor Patient Department (IPD) of Panchakarma Rishikul IJAPR | September 2018 | Vol 6 | Issue 9 18 Ayurvedic College and Hospital, Haridwar, irrespective of gender, caste, religion, occupation, etc.
Inclusion criteria
Ø Patients aged between 40-70 years.
Ø Patients follow the symptomology of Janusandhigata Vata according to Ayurveda classic.
Ø Patients follow the diagnostic criteria of knee osteoarthritis.
Ø Cases of primary knee osteoarthritis only.
Ø Patients without any anatomical deformity.
Exclusion criteria
Ø Patients age below 40 years and above 70 years.
Ø Patients with secondary knee osteoarthritis.
Ø Patients having past traumatic history.
Ø History of systemic illness like Diabetes mellitus, liver disease, Tuberculosis, Renal disease, Cardiac disease.
Ø Patients having past history of RA, Gout, Psoriasis etc.
Study design Vatari Guggulu [5] Drug – Vatari Guggulu, Matra-1 gm (1masha)
Sevankala – Pratha Kala
Details of the Group Groups | No. of Registered Patients | No. of Patients Completed the Treatment | Treatment module | Duration |
A | 22 | 15 | Upanaha Sweda | 3 sittings (one sitting of 15 days) with the gap of 7 days, for two months. |
B | 20 | 18 | Upanaha Sweda with Vatari Guggulu | 3 sittings of Upanaha Sweda (one sitting of 15 days) with the gap of 7 days & Vatari Guggulu 2 TDS for two months. |
Anupana – Lukewarm water, Duration – 60 Days Vatari Guggulu It was prepared according to the description given in Bhaishajya Ratnavali 9/154-155 which contains. Drugs | Part |
Eranda tail | 1 part |
Gandhaka | 1 part |
Haritaki | 1 part |
Amalaki | 1 part |
Bibheetak | 1 part |
Guggulu | 1 part |
Upanaha Sweda[6] Drug –Upanaha Sweda –It was prepared according to the description given in Charaka samhita 14/35-36. Drugs | Part |
Godhoma | 1 part |
Yava | 1 part |
Tila taila | 20 ml |
Saindhav lavana | 3 gm |
Kanji | |
Criteria for assessment Subjective Parameters Parameter | Finding | Grading | |||
Pain during rest | No pain Mild (pain not interfering with activities or sleep) Moderate (pain interfering activities or sleep) Severe (pain reducing activities or sleep) | : : : : | 0 1 2 3 | ||
Pain on standing | No pain Pain increases for standing 30min. | : : | 0 1 | ||
Ability to climb up/ down on stairs | Without difficulty Mild difficulty Moderate difficulty Severe difficulty | : : : : | 0 1 2 3 | ||
Ability to squat | Without difficulty Mild difficulty Moderate difficulty Severe difficulty | : : : : | 0 1 2 3 | ||
Duration of morning stiffness | Absent < 15 Min | : : | 0 1 | ||
Swelling | No swelling Mild swelling Moderate swelling Severe swelling | : : : : | 0 1 2 3 |
Tenderness | No tenderness Pt. Complains of pain Pt. Complains of pain & winces Pt. Withdraws the joint | : : : : | 0 1 2 3 |
Crepitus | No crepitus Palpable crepitus Audible crepitus | : : : | 0 1 2 |
Range of movement of joints | Full range of the joint movement >50% &< full range of joint movement Up to 50% of the joint movement No movement | : : : : | 0 1 2 3 |
Table 1: Group B – Upanaha sweda Parameters | Sample size | Mean | MD | % Changes | W | N | P | Significance | |||||||||
BT | AT | ||||||||||||||||
Pain on Rest (Sandhishula) | 15 | 1.67 | 0.13 | 1.53 | 92 | -105.000 | 15 | <0.0001 | ES | ||||||||
Pain on Standing (Sandhishula) | 14 | 1.86 | 0.86 | 0.93 | 50.25 | -105.000 | 14 | <0.001 | HS | ||||||||
Ability to Climb Up/ Downstairs | 15 | 1.60 | 0.40 | 1.20 | 75 | -120.000 | 15 | <0.001 | HS | ||||||||
Ability to Squat | 15 | 1.47 | 0.47 | 1.00 | 68.18 | -91.000 | 15 | <0.005 | S | ||||||||
Stiffness (Stabhdhta) | 15 | 1.67 | 0.07 | 1.60 | 100 | -120.000 | 15 | <0.0001 | ES | ||||||||
Swelling (Sopha) | 10 | 1.00 | 0.00 | 1.00 | 90 | -55.000 | 10 | <0.0001 | ES | ||||||||
Tenderness (Sparsashatwama) | 5 | 1.00 | 0.00 | 1.00 | 90 | -15.000 | 5 | <0.0001 | ES | ||||||||
Crepitus (Sandhisphutana) | 11 | 1.18 | 0.91 | 0.27 | 23.07 | -6.000 | 11 | <0.05 | NS | ||||||||
Range of Movement (Ankunchanyo prsaranjanyo Vedana) | 15 | 1.47 | 0.40 | 1.07 | 72.72 | -105.000 | 15 | <0.005 | S | ||||||||
X Ray Finding | 13 | 1.46 | 1.46 | 0.00 | 0 | 0.000 | 13 | >0.005 | NS | ||||||||
Table 2: Group B – Upanaha sweda with Vatari Guggulu Parameters | Sample size | Mean | MD | % Changes | W | N | P | Significance | |||||||||
BT | AT | ||||||||||||||||
Sandhishula on rest (Sandhishula) | 18 | 2.22 | 0.22 | 2.00 | 90 | -171.000 | 18 | <0.001 | ES | ||||||||
On Standing (Sandhishula) | 18 | 2.06 | 0.06 | 2.00 | 88 | -171.000 | 18 | <0.001 | ES | ||||||||
Ability to Climb Up/Downstairs | 18 | 2.00 | 0.44 | 1.56 | 77.77 | -148.000 | 18 | <0.01 | HS | ||||||||
Ability to Squat | 18 | 2.00 | 0.50 | 1.50 | 75 | -171.000 | 18 | <0.01 | HS | ||||||||
Stabhdtha (stiffness) | 18 | 1.67 | 0.22 | 1.44 | 86.66 | -171.000 | 18 | <0.001 | ES | ||||||||
Sandhisopha (swelling) | 16 | 1.13 | 0.00 | 1.13 | 90 | -136.000 | 16 | <0.001 | ES | ||||||||
Tenderness (Sparsashatwama) | 10 | 1.30 | 0.00 | 1.30 | 90 | -55.000 | 10 | <0.01 | HS | ||||||||
Sandhisphutna (Crepitus) | 17 | 1.29 | 0.47 | 0.82 | 63.63 | -105.000 | 17 | <0.005 | S | ||||||||
Ankunchan prsaranjanyo vedana (range of movement) | 18 | 1.44 | 0.28 | 1.17 | 80.76 | -153.000 | 18 | <0.01 | HS | ||||||||
X -Ray Finding | 17 | 1.29 | 0.76 | 0.53 | 40.90 | -45.000 | 17 | <0.05 | S | ||||||||
RESULTS The response of the patients to the treatment done was observed according to the subjective and objective parameters before and after the treatment.
Table 3: Effect on Sandhishool (on Rest) Group | Mean | N | MD | % Relief | W | P | Sig | ||||||||
BT | AT | ||||||||||||||
A | 1.67 | 0.13 | 15 | 1.53 | 92 | -105.000 | <0.001 | HS | |||||||
B | 2.22 | 0.22 | 18 | 0.22 | 97 | -171.000 | <0.001 | HS | |||||||
Effect on Sandhishula (pain in joints): In group A out of 15 patients, observed % relief was 92.9% and p- value was < 0.001. It shows that the relief was highly significant statistically. In group B, out of 18 patients observed relief was 97% and p- value was < 0.001.It shows that the relief was highly significant statistically.
Table 4: Effect on Sandhishool (on Standing, Walking)
Group | Mean | N | MD | % Relief | W | P | Sig | |||||||||
BT | AT | |||||||||||||||
A | 1.86 | 0.86 | 14 | 0.93 | 50.25 | -105.00 | <0.001 | HS |
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B | 2.06 | 0.06 | 18 | 2.00 | 97.29 | -171.00 | <0.001 | HS |
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In group A out of 15 patients, observed % relief was 50.25% and p- value was < 0.001. It shows that the relief was highly significant statistically. In group – B out of 18 patients, observed relief was 97.29% and p- value was < 0.001. It shows that the relief was highly significant statistically.
Table 5: Effect on Ability to Climb Up/ Down on Stairs
Group | Mean | N | MD | % Relief | W | P | Sig |
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BT | AT | |||||||||||||||
A | 1.60 | 0.40 | 15 | 1.20 | 75.75 | -120.000 | <0.01 | HS | ||||||||
B | 2.00 | 0.44 | 18 | 1.56 | 77.77 | -148.000 | <0.01 | HS | ||||||||
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In group A out of 15 patients, observed % relief was 75.75% and p- value was < 0.001. It shows that the relief was highly significant statistically. In group – B out of 18 patients, observed relief was 77.77% and p- value was < 0.001. It shows that the relief was highly significant statistically
Table 6: Effect on Ability to Squat Group | Mean | N | MD | % Relief | W | P | Sig | ||||||||
BT | AT | ||||||||||||||
A | 1.47 | 0.47 | 15 | 1.00 | 68.18 | -91.000 | <0.05 | S | |||||||
B | 2.00 | 0.50 | 18 | 1.50 | 75 | -171.000 | <0.01 | HS | |||||||
In group A out of 15 patients, observed % relief was 68.18% and p- value was < 0.005. It shows that the relief was significant statistically. In group – B out of 18 patients,
DISUCSSION
Acharya Charaka very clearly stated that Swedana is the procedure which relieves Stiffness, heaviness, cold, and which induces sweating. According to Acharya Sushruta, Upanaha Sweda is used in Vata predominant disorders. The drugs selected for the Upanaha yoga are having the properties that are mentioned in Swedopaga group. Upanaha Sweda is Vatashamaka properties due to its Ushana and Snigdha Guna. In Upanaha Sweda due to local rise of temperature, metabolic wastes are removed through increased blood circulation. The secretion of sweat is under nervous control especially autonomous. Thus the Swedana can bring about changes indirectly on the autonomic nervous system and the heat may reduce pain by acting over nerve stimuli. The application of heat over the joint promotes local circulation and metabolic activities and opens the pores of the skin to permit the medicines towards the affected site. So it is clearly said that Upanaha Sweda may be reduce the symptoms of Sandhigata Vata. Composition of Vatari Guggulu is collectively having Vata-shamaka, Kaphashamaka, Aamapachana, Deepana, Vedna-sthapana and Rasayana properties. Due to Ushana veerya and Vatanuloman properties, it normalizes the movement of Apana Vayu and Vyana Vayu which in turn helps in relieve pain. Furthermore the Kaphasamaka properties of Eranda and Guggulu by its Laghu, Ushana, Sukshma, Srotoshudhika properties, it checks the blockage of path occurred due to Kapha Dosha and so helps to relieve Stambha and Sotha.
CONCLUSION
The clinical study reveals that there is significant relief in symptoms of Janusandhigata vata after use of Vatari Guggulu with Upanaha sweda. Improvement was observed in all signs and symptoms. Effect of Upanaha Sweda in Group-A (Upanaha) has significant results except on crepitus and X-ray finding. While in Group-B (Upanaha Sweda with Vatariguggulu) was found highly effective in all symptoms of Janusandhigata vata along with radiographic changes. In Overall assessment it was found that the combination (Group-B) treatment modules highly effective than individual group. Clinical trials of the drug conclude that it possesses properties like Shoolhara (analgesic), Vatahara and Kaphahara without any toxic effects. Preventive aspect and patient’s education such as proper information about causes, Pathya-apathya (Do’s and Don’ts) play an important role in the management of Janusandhigata vata.
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- Harrision Principles of Internal Medicine Vol-2, Mc Graw Hill Education, 2015 page no-2226.
- Daksha Rathod, Kalpesh Dattani. Effect of Yoga Basti in Sandhivata w.s.r. to Osteoarthritis of
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- Bhaishajyaratnavali, Sidhiprada-Hindi Commentary by Prof. Siddhi Nandan Mishra, Chapter 29/154-155 Chaukhamba Surbharati Prakashan, Varanasi, 2015.
- Charak Samihta, Vidhyotani Hindi Commentary by Pandit Kashinath Shastri, evam Gorakhnath Chaturvedi Sutrasthana, 14/35-36, Chaukhamba Surbharati Prakashan, Varanasi, 2011, page no. 289.
- Prof P.V.Sharma, Dravyaguna Vijnana, Vol. 2, Chaukhambha Bharati Academy, Varanasi Reprint: 2006; p58.
- Ibid
- Prof P.V.Sharma, Dravyaguna Vijnana, Vol. 2, Chaukhambha Bharati Academy, Varanasi Reprint: 2006; p54.
- Prof P.V.Sharma, Dravyaguna Vijnana, Vol. 2, Chaukhambha Bharati Academy, Varanasi Reprint: 2006; p758.
- Prof P.V.Sharma, Dravyaguna Vijnana, Vol. 2, Chaukhambha Bharati Academy, Varanasi Reprint: 2006; p239.
- The Ayurvedic Pharmacopoeia of India. Monogrpahs1. Department of ISM, MoHFW, Goverment of India. (2001 (Reprint)). The Ayurvedic Pharmacopoeia of India. New Delhi.
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