Three doshas will govern the physiological functions of the body, that is, Vata, Pitta, and Kapha. Vitiation of these doshas leads to disease manifestation. In old age, there is progressive decaying in the body structures resulting in various degenerative disorders including Sandhigatavata due to the predominance of Vata. Osteoarthritis (OA) of modern medical science is considered to be its close equivalent. According to a survey, osteoarthritis tops all the ailments in the country. In India, the prevalence is higher among women, especially menopausal women. The current pharmacological management of osteoarthritis includes the administration of analgesics and non-steroidal anti-inflammatory Drugs (NSAIDs), but their use neither provides adequate pain relief nor deceleration in the disease process. In addition, NSAIDs are associated with adverse effects. Due to this, the use of alternative therapies is on the rise.
Management of the patients
- On the third day after admission, administer 30 – 35 ml of Eranda Sneha (seed oil of Ricinus communis Linn.) for mild purgation called Mriduvirechana. This follows Abhyanga and Svedana given for two days. Assess the Koshtha based on the patient’s bowel habits and sensitivity. Patients with Mridu Koshtha should receive 30 ml of Eranda Sneha, while those with Madhyama and Krura Koshtha should be given 35 ml.
- After a day of rest, proceed with the following therapies and medications.
- Abhyanga (oleation therapy) with Narayana Taila (Vata alleviating medicated oil) for 11 days.
- Bashpasvedana (fomentation therapy with evaporation) with Nirgundipatra (fresh leaves of Vitex nigundo Linn.) for 11 days
- Nirgundipatra Upanaha should be done for 11 days
- Niruha Basti (proctocolonic administration of decoction) of Dashamula Kvatha (decoction of Dashamula) for one day (before lunch following Abhyanga and Svedana) followed by Matra Basti of 40 ml Narayana Taila (immediately after supper) should be given for nine days
- Yogaraja Guggulu, 1 g, thrice a day, with warm water
- Ashvagandha Churna (root powder of Withania somnnifera Dunal.) 3 g with warm milk should be given in morning and evening before meals
- If pain and stiffness persist after Snehana, Svedana, Mriduvirechana, and Basti, practitioners should apply leeches to the patients on the eleventh day. If necessary, this procedure should be repeated on the fifteenth day.
Pathyapathya (food regimen and behavioral advice)
During Mriduvirechana, patients should consume a semi-liquid meal comprising equal parts rice and mung beans in the evening. Subsequently, they should follow the customary diet suggested in ancient texts for Vata-related ailments. This diet includes Mudgayusha (mung bean soup), wheat flour chapatis, boiled vegetables, and rice. It’s crucial to avoid sour, fermented, or spicy foods. Additionally, patients should steer clear of heavy exertion (Atishrama), staying awake at night (Ratrijagarana), and daytime napping (Divasvapa).
Mode of action
The treatment of Sandhigatavata usually begins with a basic process like Mriduvirechana. It cleanses the body to restore patency of the Srotasa, which improves the access of healing material as well as nourishment to the body components. In addition, this also helps in maintaining or restoring the optimum equilibrium in Tridosha. Eranda Taila is recommended for Mriduvirechana in Vatavyadhichikitsa. It utilizes Eranda Beeja, which possesses Vibhedana (purgative), Srotoshodhana (channel-cleansing), and Anulomana (directing Vata in the right direction) actions for Mriduvirechana purposes. Eranda Taila exhibits Vatahara action and stands out as the foremost among medicaments used for Virechana (purgative therapy).
Mriduvirechana performed with Eranda Taila after Purvakarma (the preparatory procedures), that is, Abhyanga and Svedana, eliminates the Dosha from the body through Koshtha, without any complication.
Abhyanga Taila (oil) used in Abhyanga has Snigdha (unctuous), Gur (heavy), and Mridu (soft) properties, which are opposite to the properties of Vata. Abhyanga reduces the provoked Vata, which is responsible for the decay in the Dhatus and for manifestation of features like pain, stiffness, and crackes. According to modern studies, massage stimulates blood circulation and assists the lymphatic system, improving the elimination of waste throughout the body. Absorption through the skin can be enhanced by suspending the drug in an oily vehicle and rubbing it on the skin.Thus, the medicaments used as massage are absorbed through the skin.
Svedana is specially indicated in symptoms like Sankocha (contraction or flexion), Ayama (extension), Shula (pain), Stambha (stiffness), Gaurava (heaviness), and Supti (numbness). These are the usual clinical manifestations of Sandhigatavata. Svedana has actions like Stambhaghna (cures stiffness), Svedakarakatva (creates perspiration), Gauravaghna (cures heaviness), and so on.
The classics indicate Upanaha (poultice sudation) as part of Sandhigatavata treatment. Studies show that lipid mediums aid drug penetration through the skin’s stratum corneum. In Nirgundipatra Upanaha, the oil acts as a lipoidal medium for Nirgundi’s drug molecules, providing immediate anti-inflammatory effects. Applying heat with Nirgundipatra Upanaha enhances local circulation and drug absorption rates. Nirgundi offers Vedanasthapana (analgesic) and Shothahara (anti-inflammatory) actions. It’s commonly used in Nighantus to address Shopha (swelling) and Shula (pain) disorders. Studies also support Nirgundi’s preventive impact on formaldehyde-induced experimental arthritis, aligning with earlier Nighantus‘ recommendations and observations.
This Basti given for one day before Matrabasti, cleanses the colon and prepares a good atmosphere for the Matrabasti material to come in contact with the colon wall and exert its medicinal effect.
Matrabasti is a form of Sneha Basti. It is convenient and comfortable in administration. It nourishes the body, promotes strength, and cures Vata-related diseases.Basti, through its action on Vata and Agni, promotes the formation of Dhatus. The colon houses Vata, making it the primary seat of this dosha. When Vata-alleviating substances are administered through the rectocolonic route in Matrabasti, they can optimally affect the seat of Vata. This route allows these substances to exert their maximum impact on the Vata dosha.
Sandhigatavata was previously labeled as osteoarthrosis, but it is now more accurately identified as osteoarthritis. This condition primarily affects the Sandhi structures but may also encompass involvement of Rakta Dhatu, alongside its classification as a Vata disorder. As per Charaka Samhita, when remedies based on contrasting principles like cold-hot or unctuous-dry fail to mitigate a disease, it could indicate the vitiation of Rakta Dhatu. Consequently, this understanding has led to the adoption of Raktamokshana (blood-letting) through the application of leeches (Jalauka) in managing Sandhigatavata.
Guggulu possesses Tridosha Shamaka (pacifying Vata, Pitta, Kapha) and Rasayana (rejuvenative) actions, making it recommended for managing all Vata Rogas. It exhibits anti-inflammatory and analgesic properties, aiding in preventing degenerative changes in bones and joints caused by arthritis. Guggulu reduces inflammation, joint stiffness, and arthritis-related pain while enhancing joint mobility. Previous pharmacological studies in albino rats have confirmed its anti-inflammatory and anti-arthritic effects in formaldehyde-induced arthritis. The oleo-gum resin of Guggulu has shown significant anti-inflammatory and anti-arthritic activities against carrageenan-induced rat paw edema, granuloma pouch, and adjuvant arthritis.
When combined with Vatashamaka drugs like Patala, Ashvagandha, Agnimantha, Atibala, among others, Narayana Taila becomes a potent reliever of Vata. Sesame oil inherently reduces Vata, and this effect intensifies in Narayana Taila. It is applicable through any administration route for treating Vata Roga.
It possesses Shothahara (anti-inflammatory), Vatahara, Vedanasthapana, Shulaprashamana (analgesic), and Rasayana (rejuvenative) actions.Withania somnifera (Ashvagandha), has shown a significant anti inflammatory activity.