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RANJITH KUMAR SHETTY, CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.R TO MANAGEMENT OF SANDHIGATAVATA, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. ...

RANJITH KUMAR SHETTY, CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.R TO MANAGEMENT OF SANDHIGATAVATA, DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, MYSORE. 2010

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  • 1. I  “CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.R TOMANAGEMENT OF SANDHIGATAVATA”ByDR. RANJITH KUMAR SHETTY, B.A.M.S.Dissertation submitted to theRajiv Gandhi University of Health Sciences,Karnataka, Bangalore.In the partial fulfillment of the requirements for the degree ofDOCTOR OF MEDICINE (AYURVEDA)inAYURVEDA SIDDHANTAUnder The Guidance ofDr. N.ANJANEYA MURTHY M.D. (Ayu)Professor,Department of Post-Graduate Studies in Ayurveda Siddhanta,G.A.M.C., Mysore.Co-GuideDR.VASUDEV A. CHATE, M.D. (Ayu)Lecturer,Department of Post-Graduate Studies in Ayurveda SiddhantaGAMC Mysore – 570021&DR.KIRAN KALAIH, M.S. (Ortho)Professor and Orthopedic surgeon,Mysore Medical College and Research center,Mysore – 570021DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA,GOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.2010
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  • 8. VIII  ACKNOWLEDGEMENTI bow to the sacred feet of Almighty, without the blessings of whom this study wouldnot have been completed.I sincerely express my indebtedness and profound gratitude to my GuideDr. N. Anjaneya Murthy, Professor, Department of PG Studies in AyurvedaSiddhanta, Government Ayurveda Medical College, Mysore for his valuable guidance& encouragement throughout my study.I sincerely acknowledge my reverend teacher and Co- guide Dr.Vasudev A Chate,Lecturer, Department of PG Studies in Ayurveda Siddhanta, Government AyurvedaMedical College, Mysore and another Co-guide Dr.Kiran Kalaih, Professor &Orthopedic surgeon, Mysore Medical College and Research center, Mysore for hisvaluable guidance and support throughout my study.I am highly thankful to Dr. K.Naseema Akhtar, Professor and HOD, Department ofPG Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore,for her constant support and encouragement at every stage of this study.I am highly thankful to Late. Dr.G.N.Shakuntala, Former HOD, Department of PGStudies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore, forher constant guidance, continuous supervision and help at every stage of this study.I am grateful to Principal Dr.Ashok D.Satpute, Principal, Government AyurvedaMedical College, and Mysore for his support and encouragement.I owe my deep sense of gratitude to all my teachers Dr.T.D.Ksheera Sagar,Dr.H.M.Chandramouli, Dr.G.Gopinath, Dr.Shantaram, Dr.Rajendra, Dr.T.R.ShantalaPriyadarshini, Dr.Shrivathsa, Dr.Mythrey, Dr. Anand Katti, Dr.Ananth Desai, Dr.Nalini, Dr.Adarsh and all other teachers for their support in this study.I am thankful to physician Dr.Anuradha Nadakarni and all other hospital staffs fortheir help during the course of study.
  • 9. IX  I owe my special thanks to my classmates and friends Dr.Kalyani, Dr.Geetha,Dr.Ramesh and Dr.Kavitha for their comments, cooperation and timely advises, theystood beside and inspired me through out the completion of this study.I thank my younger colleagues Dr. Athika Jan, Dr. Aravind B.S, Dr.Pallavi G,Dr.Rekha A.R Dr.Preetha and Dr.Arhanth for their help and support throughout mywork.I am thankful to my senior colleagues Dr.Savitha Shenoy, Dr.Soubhagya, Dr.KedarSharma, Dr. Vijayalakshmi, Dr.Yogesh, Dr.Aparna, Dr.Annapoorani, Dr.PankajPathak and Dr.Rajesh Bhat for their help.I acknowledge my special thanks to my friend Dr.Kiran Kumar Agadi, for his supportand encouragement throughout my study.I am thankful to my colleagues Dr.Vyasaraj Tantry, Dr.Parveen, Dr.Pallavi,Dr.Ranjani, Dr.Ananthshayan, Dr.Sameena and to my younger colleagues Dr.Mahesh,Dr.Adhitya, Dr.Sowmya, Dr.Shubharani, Dr.Geetha and Dr.Sridharmurthy,Department of P.G.studies in Kayachikitsa, for their help.I wish to place my sincere gratitude to my friends Dr.Rajaram, Dr.Ravi, Dr.SowmyaM.D and Dr.Sharif for their support.I also owe my heart felt gratitude to my teacher Dr.Hariprasad Shetty and all otherteachers of under graduation who initiated and instilled in me the knowledge of thisholy science.This acknowledgement would not be complete without paying obeisance to myparents Mr. Ramayya Shetty and Late. Jyothi R Shetty. Their constantencouragement and guidance propelled me to achieve my goal.I convey my special thanks enveloped with affection to my beloved younger sistersMs.Rajani Kumari and Ms.Nisha Shetty and younger brother Mr. Vignesh Shettyfor their valuable timely help and support.I wish to convey my thanks to U.G. and PG Librarian Mrs Varalakshmi and MrSomasundar for providing library facilities.
  • 10. X  I thank Dr.Lancy D’souza for his valuable help and guidance in the statisticalanalysis and interpretations.I convey my heartfelt thanks to Manager, M/s SDM Ayurveda Pharmacy , KuthpadyUdupi who helped me in procuring drugs for my dissertation.I thank Mr.Mahesh C, Maneesh printers Mysore, for bringing this work in adocumented form.Last but not the least, I express my thanks to all my patients , without whom Iwouldn’t have completed this dissertation and I thank all those who helped medirectly or indirectly in my studies with apologies for my inability to identify andthank them individually.Date:Place: Mysore Dr. Ranjith Kumar Shetty
  • 11. XI  LIST OF ABBREVATIONSA.H: Ashtanga HrudayaA.K: Amara KoshaA.S: Ashtanga SangrahaB.P:Bhava PrakashaB.S: Bhela SamhitaC.D: ChakradattaC.S: Charaka SamhitaH.S: Harita SamhitaM.N: Madhava NidanaS.K.D: Shabda kalpa DrumaS.S: Sushruta SamhitaSha.Sa: Sharangdhara SamhitaY.R: Yoga Ratnakara
  • 12. XII  ABSTRACTBackground of the StudyAsthi pradoshaja vikara is a condition in which Asthi gets vitiated extremelyby the doshas and changes its natural form and leads to many disorders like adhyasthiadhidanta etc. Classical texts mention that tikta ksheera sarpi is the best line oftreatment for Asthi pradoshaja vikaras. Sandhi mainly constitutes Asthi. Hence thisresearch is undertaken to study the concept of Asthi pradoshaja vikaras and toevaluate the efficacy of tikta ksheera sarpi in Janusandhigatavata.Objectives of the study To review in detail about Asthi and Asthi pradoshaja vikaras. To assess the involvement of Asthi with the help of radiology (x-ray). To assess the role of Asthi in manifestation of sandhigatavata. To study the role of tiktaka dravyas in the management of sandhigatavata.MethodA Comparative Single Blind Clinical Study was conducted with pre and postdesign. Patients of janusandhigatavata were categorised into two groups namelyGroup A and Group B, consisting of 15 patients each.InterventionThe intervention of clinical study was carried according to the individual group asmentioned below.Group-A Trikatu churna was administered for ama pachana. After attaining niramavastha patients were subjected to abhyanga withksheerabala taila followed by nadi sweda.
  • 13. XIII   The sequence of 15 bastis in the form of kala basti was administered starting fromanuvasana with panchatikta ghrita (total 9 anuvasana bastis) and niruha basti withpanchatikta ksheera sarpi (total 6 niruha bastis) .Group-B Trikatu churna was administered for ama pachana. After attaining niramavastha patients were subjected to abhyanga withksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form of kala basti was administered starting fromanuvasana with bala ghrita (total 9 anuvasana bastis) and niruha basti with balasadhita ksheera sarpi (total 6 niruha bastis) .ResultsAll the patients considered for the study showed improvement in both thegroups, which is statistically significant. But comparatively Group A showed goodresult clinically when compared to Group B.Interpretation and ConclusionBased on both the literary and clinical aspects of the study, Janusandhigatavatawas considered under Asthi pradoshaja vikaras.Group A showed good result with statistical significance ( p value 0.042 )compared to Group B with no statistical significance ( p value 0.819).Keywords Asthi pradoshaja vikaras Janusandhigatavata Kala basti Panchatikta ghrita Bala ghrita
  • 14. XIV  CONTENTSSl. No Particular Page No.1. Introduction 1-22. Objectives 33. Review of literature4. Review on Asthi Pradoshaja vikaras 4-425. Review on Sandhigatavata 43-646. Review on Basti 65-727. Drug review 73-798. Materials and methods 80-949. Observation and results 95-13010. Discussion 131-16211. ConclusionRecommendations for further study163-16412. Summary 165-16613. Bibliographic reference 167-18414 Annexure I-XI
  • 15. XV  List of TablesTableNoParticular PageNo.1 Showing the Paryayas of Asthi 62 Showing the Panchabhoutika sanghatana of Asthi 73 Showing the Sroto mulas of Asthi 84 Showing the Numbers of Asthi 85 Showing the Types of Asthi 96 Showing the Malas of Asthi 107 Showing the Vruddhi lakshanas of Asthi 118 Showing the Kshaya lakshanas of Asthi 129 Showing the different Asthi pradoshaja vikaras 1410 Showing the Nidanas for Janusandhigatavata 4511 Showing the Lakshanas of Janusandhigatavata 4912 Showing the Saapeksha nidanas for Janusandhigatavata 5113 Showing the Chikitsa for Janusandhigatavata 5314 Showing Differential diagnosis of Knee osteoarthritis 6115 Showing Differential diagnosis of Knee osteoarthritis 6216 Showing the Properties of Trikatu 7317 Showing the Properties of Panchatikta & Bala 7418 Showing distribution of patients according to Age 9519 Showing distribution of patients according to Sex 9620 Showing distribution of patients according to Marital status 9621 Showing distribution of patients according to Education 9622 Showing distribution of patients according to Religion 9723 Showing distribution of patients according to Socio-economicstatus97
  • 16. XVI  24 Showing distribution of patients according to Occupation 9825 Showing distribution of patients according to Habitat 9826 Shows distribution of patients according to Diet 9927 Showing distribution of patients according to Prakruti 9928 Showing distribution of patients according to Samhanana 10029 Showing distribution of patients according to Pramana 10030 Showing distribution of patients according to Sattva 10031 Showing distribution of patients according to Koshtha 10132 Showing distribution of patients according to Agni 10133 Showing distribution of patients according to Bala 10234 Showing distribution of patients according to Vyayama 10235 Showing distribution of patients according to Joint involvement 10336 Showing results of Joint pain ( Rt Knee ) 11237 Showing Systemic measures in Joint pain (Rt Knee) 11338 Showing results of Joint pain ( Lt knee ) 11439 Showing Systemic measures in Joint pain (Lt Knee) 11440 Showing results of Joint stiffness ( Rt knee ) 11541 Showing Systemic measures in Joint stiffness (Rt Knee) 11642 Showing results of Joint stiffness ( Lt knee ) 11743 Showing Systemic measures in Joint stiffness ( Lt knee ) 11744 Showing results of Joint swelling ( Rt knee ) 11845 Showing Systemic measures in Joint swelling ( Rt knee ) 11946 Showing results of Joint swelling ( Lt knee ) 12047 Showing Systemic measures in Joint swelling ( Lt knee ) 12048 Showing results of Joint crepitus ( Rt knee ) 12149 Showing Systemic measures in Joint crepitus ( Rt knee ) 12150 Showing results of Joint crepitus (Lt Knee) 122
  • 17. XVII  51 Showing Systemic measures in Joint crepitus (Lt Knee) 12352 Showing the Overall results within the groups 12453 Showing the Overall results of the groups 12554 Showing the significance of overall results 12555 Showing sadhyaasadhyata of Asthi pradoshaja vikaras 13956 Showing the chikitsa of Asthi Pradoshaja Vikaras 141List of IllustrationsSl.No Particulars Page No.1 Showing Age wise distribution of 30 patients 1042 Showing Sex wise distribution of 30 patients 1043 Showing Marital status wise distribution of 30 patients 1044 Showing Education wise distribution of 30 patients 1055 Showing Religion wise distribution of 30 patients 1056 Showing Occupation wise distribution of 30 patients 1057 Showing Habitat wise distribution of 30 patients 1068 Showing Diet wise distribution of 30 patients 1069 Showing Prakruti wise distribution of 30 patients 10610 Showing Samhanana wise distribution of 30 patients 10711 Showing Pramana wise distribution of 30 patients 10712 Showing Sattva wise distribution of 30 patients 10713 Showing Koshtha wise distribution of 30 patients 10814 Showing Agni wise distribution of 30 patients 10815 Showing Bala wise distribution of 30 patients 108
  • 18. XVIII  16 Showing Vyayamashakti wise distribution of 30 patients 10917 Showing joint involvement wise distribution of 30 patients 10918 Showing results of Joint pain (Rt Knee) 12619 Showing results of Joint pain (Lt Knee) 12620 Showing results of Joint stiffness (Rt Knee) 12721 Showing results of Joint stiffness (Lt Knee) 12722 Showing results of Joint swelling (Rt Knee) 12823 Showing results of Joint swelling (Lt Knee) 12824 Showing results of Joint crepitus (Rt Knee) 12925 Showing results of Joint crepitus (Lt Knee) 12926 Showing overall results within the groups 13027 Showing overall results in 30 patients 130List of flow chartsChartNo.Particular Page No.1 Showing Samanya Samprapti of Asthi Pradoshaja Vikaras 232 Showing the Vishesha Samprapti of Asthi pradoshajavikaras1383 Showing the probable Samprapti of Janusandhigatavata 146
  • 19.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          1  INTRODUCTIONBeing an eternal science, Ayurveda, the science of human life, deals withphysical, psychological as well as spiritual well being of an individual. It covers allthe spheres of human life. It is not merely a materialistic science, but a philosophicaland factful truth, which our great ancestral sages, through their experience, logic andpower of wisdom, had found true and proved it to the truth of time. To keep it in pacewith advancing or so called modern age or scientific age is the present day task. Toproceed with such an incredibly rewarding task, is not more a challenge but anexhaustive endeavour.Human creatures have emerged as specialized species in the process ofevolution. The study of human being includes both physiological & pathologicalentities. Ancient seers of Ayurveda have classified the elements of the body underthree fundamental components- Dosha, Dhatu and Mala. These three entities areresponsible for the maintenance of structural and functional integrity of the body.Among these basic elements Dhatus are especially meant for dharana & poshana ofshareera. The equilibrium state of these dhatus results in arogya, where as anyimbalance in it produces vikara.Dhatu pradoshaja vikara is a condition in which the dhatus are in vitiated state.Among the dhatu pradoshaja vikaras, Asthi pradoshaja vikaras include adhyasthi,asthibheda, asthishula etc. Acharya Charaka mentions that Panchakarma ,ksheera,sarpi & tikta dravya basti are the treatment modalities for Asthi pradoshaja vikaras.Sandhigatavata is a vata vyadhi, with characteristic features of Vatapurnadhruti sparsha, shotha, vedana, sandhi shaithilyata & atopa. Here sandhi means asthi
  • 20.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          2  melana, so in pathological condition, Asthi is also found to be vitiated & it can becorrelated to osteoarthritis as per the contemporary science.According to World Health Organization, OA is the second commonestmusculoskeletal problem in the world (30%). The reported prevalence of OA from astudy in rural India is 5.78%. The major risk factors associated with knee OA seen inpopulation study were; age, females, obesity, smoking, occupational knee bending,physical labor and chondrocalcinosis. Symptomatic and radiographic OA increaseswith age.Osteoarthritis is defined as degenerative condition of the articular surfaces ofthe joint, particularly weight bearing joints. The clinical features are joint stiffness,diminished mobility, discomfort & pain. The pathological changes occur in articularcartilages, adjacent bones & synovium.Evidence based medicine is the mantra of the modern era. So revalidation &revitalization is essential through research in both fundamental & applied aspect ofAyurveda. Asthi is one entity which can be visualized easily by radiology. Therevalidation of Asthi pradoshaja vikaras is possible with the help of radiologicalinvestigations.Hence, this work is undertaken to study the Asthi pradoshaja vikaras w.s.r.torole of Asthi in manifestation of sandhigatavata & its management with tikta ksheerasneha basti. 
  • 21.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          3  OBJECTIVES OF THE STUDY To review in detail about Asthi and Asthi pradoshaja vikaras. To assess the involvement of Asthi with the help of radiology (X-ray). To assess the role of Asthi in manifestation of sandhigatavata. To study the role of tiktaka dravyas in the management of sandhigatavata.                  
  • 22.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          4  ASTHI PRADOSHAJA VIKARASThe shareera is made up of dosha, dhatu and mala. Among them dhatu ismeant for deha dharana. When this dhatu gets vitiated by doshas it leads to a specificcondition known as dhatu pradoshaja vikara. Among the dhatu pradushaja vikaras,Asthi pradoshaja vikara is one.DerivationThe term ‘Asthi pradoshaja vikaras’ consists of three terms. They are Asthi,Pradoshaja and Vikara.1. AÎxjÉThe term ‘asthi’ is a napumsaka linga pada. The vyutpatti of which is as follows: AxÉç + YÍjÉlÉç AÎxjÉ 1It is derived from the mula dhatu ‘AxÉç’ and ‘YÍjÉlÉç’suffix.AÎxjÉ: MüÐMüxÉ, MÑüsrÉqÉç, MümÉÉsÉ.2Dictionary meanings: hard or firm, a bone, skull bones.32. mÉëSÉåwÉeÉ: mÉë+SÉåwÉ+eÉ 4The term ‘mÉëSÉåwÉeÉ’ is a pullinga pada. The vyutpatti of which is as follows.mÉë: mÉëM×ü¹ålÉ, EiMüwÉåï, AÉUqpÉ.5Dictionary meanings: excessively, commencement, beginning.6SÉåwÉ: SÉåwÉhÉqÉç, SÒ¹qÉç, mÉÉmÉqÉç.7,8Dictionary meanings: a fault, defect, sinfulness. 9eÉ: eÉlrÉiuÉÉiÉç, eÉlqÉÌlÉ,eÉlÉɬïlÉå.10,11
  • 23.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          5  Dictionary meanings: born from, produced, caused by.3. ÌuÉMüÉUThe term ‘ÌuÉMüÉU’ is a pullinga pada .The vyutpatti of which is as follows. ÌuÉ+M×ü+bÉgÉç ÌuÉMüÉU.12The term ÌuÉMüÉU is derived from moola dhatu ‘M×ü’ with ‘ÌuÉ’ upasarga and ‘bÉgÉç’pratyaya.ÌuÉMüÉU: mÉËUhÉÉqÉ, ÌuÉM×üÌiÉ, ÌuÉÌ¢ürÉÉ.13Dictionary meanings: change of form or nature, an alteration, transformation.14Collectively Asthi pradoshaja vikaras means the excessively vitiated doshastakes shelter in the asthi and changes its natural form and produces different disorders.Asthi Pradoshaja Vikaras have been selected for the applied study of thiswork. These diseases occur due to vitiation of Asthi Dhatu, so it is important to knowthe Asthi Dhatu, before describing Pradoshaja Vikara. Therefore now in the sequenceof concepts, concept of Asthi has been described here.Asthi dhatuDefinition zÉUÏUxjÉxÉmiÉkÉÉiuÉliÉaÉïiÉ kÉÉiÉÑÌuÉzÉåwÉ |15It is one among the sapta dhatus which are present in the shareera. qÉÉÇxÉÉprÉliÉUxjÉå (WûÉQèû) CÌiÉ ZrÉÉiÉå kÉÉiÉÑpÉåSå |16Form of dhatu which is present inside the mamsa dhatu is known as Asthi.
  • 24.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          6  SynonymsFollowing synonyms are used for Asthi; 17,18,19 Keekasa = hard, firm. Kulyam = a bone. Kapala = the skull, cranium, skull bone. Astri = not feminine, masculine. Medojam = which is produced from meda.Table No.1: Showing the Paryayas of AsthiSl.no Paryaya S.K.D A.K1. Keekasa + +2. Kulyam + +3. Medojam + -4. Kapala - +5. Astri - +Asthi Utpatti and PoshanaThe formation of dhatu takes place in the following order- from annarasa rasawill form, then rasa to rakta, rakta to mamsa, mamsa to meda, meda to asthi, asthi tomajja, from majja shukra will form, in this way uttarottara dhatu will be formed bythe previous dhatu. During this process heat produced by the combination of pruthvi,agni and vayu acts on medas giving rise to kharatva (hardness) and thus produces theasthi. This is in the form of krama parinama paksha or theory of transformation. Theuttarottara dhatu is nourished by the previous dhatu. 20Food composed of Panchabhutas which is predominantly composed of Pruthvi, Tejasand Vayu does poshana of the asthi dhatu. 21
  • 25.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          7  Time taken for asthi formationThere are two opinions regarding formation of Asthi depending upon the time factor. Asthi is formed on the 6thday. 22 Asthi is formed on 20thday. 23Asthi swarupa (nature)‘Kathina’ and ‘sthira’ are the swarupa of Asthi. 24Asthi Panchabhoutika sanghatanaThe panchabhoutika sanghatana of asthi which are mentioned in different samhitasare tabulated below. 25,26Table No.2: Showing the Panchabhoutika sanghatana of AsthiSl.no Panchabhutas C.S S.S1. Pruthvi + +2. Agni/ tejas + +3. Anila + +Asthidhara kalaPurishadhara kala is considered as asthidhara kala. 27Asthivaha sroto mula28, 29, 30The asthivaha sroto mulas which are mentioned in different samhitas are listed below.
  • 26.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          8  Table No.3: Showing the Sroto mulas of AsthiSl.no Sroto mula C.S A.H A.S1. Medo dhatu + + +2. Jaghana + + +3. Asthi sandhi + - -Asthi Sankhya31, 32, 33, 34,35,36,37The numbers of asthis in the shareera according to different samhitas are as follows.Table No.4: Showing the Numbers of AsthiSl.no Text books Numbers1. Charaka Samhita 3602. Sushruta Samhita 3003. Astanga Hrudaya 3604. Astanga Sangraha 3605. Bhavaprakasha 3006. Kashyapa Samhita 3607. Bhela Samhita 360The distributions of asthis in the shadanga of shareera are as follows.According to Sushruta samhita38 Shaakha : 140 Shroni, parshva, prushtha, uras: 117 Greevordhva : 63
  • 27.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          9  According to Ashtanga sangraha39 Shaakha :140 Madhya shareera:120 Urdhva shareera: 100Asthi Bhedas40,41,42Depending upon size, shape, position of asthis in the body totally asthis are dividedinto five types. These are tabulated below.Table No.5: Showing the Types of AsthiSl.no Types S.S A.S B.P1. Kapala + + +2. Ruchaka + + +3. Taruna + + +4. Valaya + + +5. Nalaka + + + Asthi’s present in the janu, nitamba, amsa, ganda, talu, shankha, vankshana andmadhyashira are known as kapalasthi. The dashanas are known as ruchakasthi. Asthi’s present in the ghrana, karna, greeva and akshikuta are called astarunasthi. Asthi’s in pani, pada, parshva and prustha are valayasthi.
  • 28.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          10   The remaining asthi’s are nalakasthi.Asthi KarmasThe asthi karmas are as follows Deha dharana. 43 Majja pushti. 44 Asthi supports the mamsa, sira and snayu. 45Asthi UpadhatuThe upadhatu of Asthi is danta 46.Asthi MalasDuring the formation of any dhatu it will produce their own malas. Similarly Asthialso has malas, as per different texts. 47,48,49Table No.6: Showing the Malas of AsthiSl.no Asthi mala C.S S.S B.P1. Kesha + - -2. Loma + - +3. Nakha - + +4. Roma - + -Sara lakshanasAccording to Charaka samhita, the asthi sara lakshanas are prominent parshni(heel),gulpha (ankles), janu (knee), aratni (elbows), jatru (collar bones), chibuka
  • 29.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          11  (chin), shira (head) and parva (joints) and also asthi (bone), nakha (nails) and danta(teeth). Such individuals are endowed with qualities such as mahotsaha (enthusiastic),kriyavanta (active), kleshasaha (enduring), sarasthi and shareera (having strong &firm body) as well as ayushmanta (longivity). 50As per Sushruta samhita, asthisara purusha lakshanas are mahashira (bighead), mahaskandha (big shoulders) and drudha danta (strong teeth), drudha hanu(strong jaws), drudha asthi (strong bones) and drudha nakha (strong nails). 51Asthi Vruddhi and kshaya lakshanasLakshanas of Asthi Kshaya and Vruddhi have been explained by almost all thesamhitas. Charaka samhita has not mentioned the Vruddhi Lakshanas of the Dhatusbut in Susruta samhita, Ashtanga sangraha and Ashtanga hrudaya vruddhi lakshanashave been mentioned. The Lakshanas of the asthi vruddhi and Kshaya are as follows.Asthi Vruddhi lakshanas 52,53,54Table No.7: Showing the Vruddhi lakshanas of AsthiSl.no Vruddhi lakshanas S.S A.H A.S1. Adhyasthi + + +2. Adhidanta + + +3. Kesha vruddhi + - -4. Nakha vruddhi + - -
  • 30.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          12  Asthi Kshaya lakshanas 55,56,57,58,59Table No.8: Showing the Kshaya lakshanas of AsthiSl.no Kshaya lakshanas C.S S.S A.H A.S H.S1. Prapatana of kesha, loma,nakha, smashru and dwija+ - - - -2. Shrama + - - - -3. Sandhi shaithilyata + - - - -4. Asthi shoola - + - - -5. Danta and nakha bhanga - + - - -6. Roukshyata of danta andnakha- + - - -7. Deha roukhsyata - + - - -8. Asthi toda - - + + -9. Sadana of danta, kesha,nakha, loma.- - + - -10. Shaatana of danta, nakha,roma, kesha.- - - + -11. Roukshyata of danta, nakha,roma, kesha.- - - + -12. Parushyata of danta, nakha,roma, kesha.- - - + -13. Asthi baddha mamsaabhilasha- - - + -14. Atimanda chesta - - - - +15. Veerya maandya - - - - +16. Medasa kshaya - - - - +17. Visamnyata - - - - +18. Kampana - - - - +
  • 31.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          13  Asthi vyapathija rogas 60According to Bhela Samhita, asthi vyapattija rogas are danta roga, ativruddhi of asthiand abhipatana of nakha, smashru, kesa, roma.ASTHI PRADOSHAJA VIKARASDefinition of Asthi pradoshaja vikaras“SÉåwÉSÕÌwÉiÉåwuÉirÉjÉïÇ kÉÉiÉÑwÉÑ xÉÇ¥ÉÉ– UxÉeÉÉåÅrÉÇ, zÉÉåÍhÉiÉeÉÉåÅrÉÇ, qÉÉÇxÉeÉÉåÅrÉÇ, qÉåSÉåeÉÉåÅrÉÇ, AÎxjÉeÉÉåÅrÉÇ....|”61When the Dhatus are vitiated extremely by the Doshas then it causesrespective "Dhatu Pradosaja Vikaras” it may be rasa pradoshaja vikaras, raktapradoshaja vikaras or asthi pradoshaja vikaras etc.Importance of Dhatu pradoshaja vikarasDalhana mentioned the reason behind explaining the Dhatu Pradosaja Vikaraseparately, these are, 6219. Kaarshyata - - - - +20. Angabhanga - - - - +21. Vamana - - - - +22. Kathorata - - - - +23. Vatadi dosha shaithilyata - - - - +24. Shopha - - - - +25. Vikampana - - - - +26. Shosha - - - - +27. Ruja - - - - +
  • 32.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          14  1. Chikitsa Vishesa Vijnanartha2. Sukhasadhyatvadi Karma BodharthamKnowledge of these two is very much essential for a Vaidya, to avoid failurein practice. Chakrapani distinctly revealed that in some cases only dosha viparitachikitsa will not bring complete relief to the patient. One should treat dhatu alsobecause of ashraya prabhava.“ mÉëuÉ×®zÉÉåÍhÉiÉÉ´ÉrÉÉxiÉÑ uÉÉiÉÉSrÉ AÉ´ÉrÉmÉëpÉÉuÉÉ³É xuÉÍcÉÌMüixÉÉqÉɧÉåhÉ mÉëzÉÉqrÉÌiÉ||” 63Chakrapani has used the term "Ashraya Prabhava" to indicate the significance ofDhatu in the treatment.Asthi pradoshaja vikaras 64,65The Asthi pradoshaja vikaras which are mentioned in different classics are tabulatedbelow.Table No.9: Showing the different Asthi pradoshaja vikarasSl.no Vyadhi C.S S.S1. Adhyasthi + +2. Adhidanta + +3. Dantabheda + -4. Dantashoola + -5. Asthibheda + -6. Asthishoola + +7. Vivarnata + -
  • 33.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          15  8. Kesa, Loma, Nakha, SmashruDosha+ -9. Kunakha - +10. Asthi Toda - +Yogendranath sen in commentary of Charaka samhita mentioned that kesha,loma and smashru are malas of the asthi dhatu. This is the reason to consider keshadidoshas as one among the asthi pradoshaja vikaras. 66Nidanas for Asthi pradoshaja vikarasThe nidanas of asthi pradoshaja vikaras can be classified into samanya and vishesanidana. These are as follows.Samanya nidana 67,68In Charaka samhita and Astanga hrudaya, samanya nidanas are mentioned for all thedhatu pradoshaja vikaras. These are;A. Dosha guna sama ahara and viharaB. Dhatu viguna ahara and viharaC. Rutu viguna ahara and vihara Dosha guna sama ahara and vihara: The intake of nidanas in the form of ahara andvihara which are having similar gunas to that of particular dosha gunas leads todosha vruddhi by samanyam vruddhikaranam siddhanta. E.g: if person consumesrukshadi guna yukta ahara and vihara then there will be vata vruddhi.
  • 34.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          16   Dhatu viguna ahara and vihara: The intake of nidanas in the form of ahara andvihara which are having dissimilar gunas to that of particular dhatu gunas i.e dhatuvirodhaka swabhava by vishesa siddhanta. Rutu viguna ahara and vihara: The particular ahara and vihara which are dealt foreach rutu if not followed leads to dosha vitiation i.e. vipareeta to rutucharyapalana.Vishesa nidana 69,70,71In Charaka samhita some specific nidanas are mentioned for Asthi pradoshaja vikaras.These are;A. AtivyayamaB. Ati sankshobhaC. Ati vighattanaD. Vatala ahara and vihara Ativyayama: ativyayama means excessive shareera ayasa janaka karma. Atisankshobha: Atisankshobha means abhighata (Yogindranath sen). It meansinjury or excessive jerk or violence or commotion. Ativigattana: Ativighattana means atichaalana (Yogindranath sen). It meansexcessive movements or separated or loosened or shaking. Vatala ahara and vihara sevana: Vata guna samana ahara and vihara sevana. Fore.g, Vatala ahara: ruksha – sheeta- laghu guna pradhana ahara sevana, alpa matraahara sevana, mudga, masoora, vaartaaka, kalinga, harenuka etc.
  • 35.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          17   Vatala vihara: ativyavaya, ati jagarana, krodha, bhaya, vegadharana, abhighata,upavasa, shoka, plavana etc.Poorvarupa 72None of the Ayurvedic classics have mentioned poorvarupa of Asthipradoshaja vikaras. Avyakta lakshanas or alpa vyakta lakshanas are considered aspoorvarupa.RupaEach Asthi pradoshaja vikara is having its own lakshana. These are as follows. Adhyasthi 73Adyasthi means adhika asthi i.e, additional bone or extra bone. Adhidanta 74Adhidanta means adhika danta i.e, additional tooth or extra tooth.Dosha: VataCharacteristic features: There will be an extra tooth eruption over the tooth and duringthe eruption pain associates and after the eruption pain subsides. This condition iscalled adhidanta. Dantabheda 75,76It is a condition were cutting type of pain in danta is seen and is called as dantabheda.It is also called as ‘bhanjanaka’.
  • 36.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          18  Dosha: Vata (Vagbhata)Vata + Kapha (Sushruta)Characteristic features: It is a vataja vyadhi and there will be toda, bheda, ruk andsphutana in the danta. This is known as dantabheda.It is a kapha- vataja vyadhi in which teeth falls down due to mukha vaktrata andassociated with teevra ruja. This is known as bhanjanaka. Dantashoola 77,78There will be a severe or acute pain in the tooth is called as dantashoola.Other names: Dalhana (Sushruta)Sheetadanta (Vagbhata)Dosha: VataCharacteristic features: The vitiated vata dosha causes untolerable cutting type of painin the teeth and is called dalana.Ashtanga hrudaya also opines same, but called it as sheeta danta because the patient isnot able to eat or drink sheeta padarthas. Asthibheda 79It is a condition in which bhidhyamanasya vyatha (cutting type or splitting type ofpain) will be present in asthi. This is known as asthibheda. Asthishoola 80It is a condition in which severe or acute pain in asthi like shanka sphutanavat. This isknown as asthishoola.
  • 37.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          19   Asthitoda 81It is a condition in which vicchinna shoola (pricking or breaking type of pain) will bepresent in asthi. This is known as asthitoda. VivarnataThese disorders are two in number. They are shyavadanta and krimidanta. Shyavadanta 82,83The blackish discoloration of tooth is called as shyavadanta.Dosha: Rakta + Pitta (Sushruta)Rakta + Pitta + Vata (Vagbhata)Characteristic features: The vitiated rakta along with pitta, burns the danta twacha andcauses the shyavata (blackish) or neela (blue) varnata of danta. This is known asshyavadanta.The danta becomes shyava varna due to the vitiation of rakta, pitta and vata is knownas shyavadanta. Krimidanta 84,85The condition in which decaying of tooth takes place is called as krimidanta.Dosha: VataCharacteristic features: Due to the vitiation of vata dosha, danta becomes krishnavarna, chidra yukta, chalayukta, sravayukta, teevra rujayukta or sometime intermittentshoola. This is known as krimi danta.Ashtanga hrudaya explained krimidanta in a more ellaborate manner, which is asfollows.
  • 38.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          20  Vata vitiation danta moola shothaDanta kshata sushiraDanta majja shosha production of krimiDanta shoola, srava chala dantaPuya rakta srava danta vidradi Kesha, loma and smashru vikarasThe kesha, loma and smasru vikaras are indralupta, ruhya, khalitya and palitya. Indralupta 86,87,88The partial or complete loss of hair from all over the body is called as indralupta.Synonyms: Ruhya, ChachaDosha: Tridosha + RaktaCharacteristic features: The vitiated vata and pitta affects the roma kupas and causesroma patana, then the vitiated kapha and rakta obstructs the roma kupas. So there isno chance for regrowth of hairs. This condition is called as indralupta.Ashtanga hrudaya also opines same.Karteeka opines that if hair loss is from all over the body is called as Ruhya and fallof smashru is known as indralupta. Khalitya 89,90,91The condition in which gradual loss of hair takes place in the scalp is called askhalitya.Dosha: Tridosha (Charaka)Tridosha + Rakta (Sushruta & Vagbhata)
  • 39.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          21  Characteristic features: The vitiated vatadi doshas along with increased shareeraushnata removes the snigdata in kesha moolas leading to gradual hair loss is called askhalitya.The vitiated vata and pitta affects the roma kupas and causes roma patana, then thevitiated kapha and rakta obstructs the roma kupas. So there is no chance for regrowthof hairs. The complete loss of scalp hair is called khalitya.The pathology of khalitya is like indralupta i.e, vata and pitta causes kesha shatana,kapha and rakta obstructs the kesha moolas so there is no chance of re growth of hairbut in khalitya kesha shatan is g radual or slow, not sudden as in indralupta. Palitya 92,93,94The condition in which discoloration of hair takes place is called as palitya.Dosha: Tridosha (Charaka)Pitta (Sushruta & Vagbhata)Characteristic features: The vitiated vatadi doshas and increased shareera ushnataremoves the snigdhata in kesha moolas causing discoloration of hair, it becomeskapila varna.Due to krodha, shoka and shrama the increased shaeera ushnata and vitiated pittacauses pachana or discoloration of keshas in the shiras which is called as palitya.Ashtanga hrudaya also opines same as Sushruta samhita and mentions some otherlakshanas depending upon predominance of doshas.In vata predominance, hair becomes shyava varna, ruksha, khara and jalaprabha.In pitta predominance, hair becomes peetabha with daha.In kapha predominance, hair becomes snigdayukta, shukla varna and sthula.
  • 40.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          22  In tridosha vitiation all the above symptoms together present. Kunakha 95,96A disease of the nails which is ugly in appearance. This condition is called askunakha.Syonyms: Kuleena (Sushruta)Dosha: Pitta +VataCharacteristic features: The vitiated pitta and vata localizes at the sides of the nailbeds producing daha, paka and vedana and is called as chippa. When this condition isin mild form, it is known as kunkha and nakha attains rukshatva, kharatva and asitavarna. Other causes for kunakha include abhighata.Ashtanga hrudaya also opines same and added one more lakshana i.e, jwara.Samprapti 97The nidanas of the asthi pradoshaja vikara are ativyayama, atisankshobha,ativighattana and vatala ahara- vihara which leads to agni dushti and is the cause ofproduction of abnormal asthi. In such conditions if the patient continues the intake ofcausative factors (Nidana Sevana), there will be excessive vitiation of doshas as theyhave been already vitiated earlier. These excessive vitiated doshas when lodges inasthi dhatu, the manifestation of asthi pradosaja vikara takes place at various sites inthe body according to sthana dusti or Khavaigunya.
  • 41.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          23  Flow chart No.1: Showing Samanya Samprapti of AsthiPradoshaja VikaraSadhyasadhyata 98,99Among the Asthi pradoshaja vikaras, some are considered as asadhya vyadhisand some are considered as yapya vyadhis and some are kashta sadhya vyadhis.Dalana, bhanjanaka, shyavadanta, tridoshaja khalitya, tridoshaja palitya anddantashoola are considered as asadhya vyadhis. Indralupta, ekadoshaja khalitya andNidana sevana Dosha gunasama ahara‐vihara Dhatu viguna ahara‐viharaRutu vigunaa ahara‐vihara    Dhatu dushti    Dosha dushti     Dosha dushti       Asthi dhatu dushti       Khavaigunya                Dosha‐dushya sammurchanaParticular Asthi pradoshaja vikaras 
  • 42.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          24  ekadoshaja palitya are considered as yapya vyadhis. The remaining diseases areconsidered as kashtasadhya vyadhis i.e adhyasthi, adhidanta, dantabheda, asthibheda,asthi toda, asthishoola and kunakha.UpadravaNone of the Ayurvedic classics have mentioned upadravas of Asthi pradoshajavikaras.Arishta lakshanasRegarding arishta lakshanas, there is no direct reference in the context of Asthiprradoshaja vikaras.ChikitsaAccording to Charaka Samhita, Asthyashrita vyadhis are treated byPanchakarma, especially by Basti, which is prepared out of Ksheera, Sarpi, and TiktaDravyas. While commenting on chikitsa sutra Chakrapani opines that tikta ksheerasarpi basti is ‘hita’ for asthi pradoshaja vikaras. 100Other treatment modalities which are expalined in different classical texts can beadopted to treat Asthi pradoshaja vikaras. These are as follows. According to Sushruta Samhita, snayu and sandhyasthi gata rogas are treated bysneha, upanaha, agnikarma, bandhana and unmardana. 101
  • 43.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          25   According to Ashtanga hrudaya, diseases due to vitiation of Asthidhatu are treatedby basti, which is prepared by Ksheera, Sarpi, and Tikta Dravyas. Ashtangasangrahakara also opines same treatment. 102,103 According to Yogaratnakara, bahya and abhyantara snehana karma are adopted totreat asthimajjagata rogas. 104 According to Harita Samhita, asthi kshaya is treated by processed ghrita, usage ofdifferent types of ksheeras, chandana, drakshadi churna, all types of jangala deshapraani mamsa sevana and all types of Madura pradhana annas. 105Chikitsa for Adhidanta 106,107 Kshara karma When danta is jarjarita, then krimidantavat chikitsa is to be adopted i.e. swedana,rakta visravana, gandusha, nasya, agnikarma. Danta nirharana, then vranavat chikitsa.Chikitsa for Danta bheda108 All the vata-kapha nashaka kriya. Arditavat chikitsa Abhyanga with narayana taila. Swedana and vasti. Kavala with aakara karabhadi yoga. Eranda taila pana. Gandusha dharana: ksheera prepared out of tila + yashtimadhu.
  • 44.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          26  Chikitsa for Danta shoola109 According to Sushruta samhita, it is an asadhya vyadhi. Gandusha with hingvadi taila or eranda + dvivyaghri + bhukadamba siddha tailaor yastimadhu taila. Danta nirharana with danta nirgatana yantra. Danta pali lekhana, then agni karma with ushna taila. Danta pali gharshana or pratisarana with fine powders of musta, saindhava,dadima tvacha, triphala, rasanjana, shunti + madhu. Kavala with ksheeri vruksha kashaya Nasya with anu taila or ksheera prepared out of yashtimadhu + vidari +shrungataka + kasheru.Chikitsa for Krimidanta110,111 Immovable teeth: swedana, rakta mokshana, vataghna avapeeda nasya, snehagandusha, bhadradarvadi lepa, snigdha bhojana. Movable teeth: danta nirharana and agni karma. If tooth is perforated: filling the gap with guda or madhuchista and agnikarma,filling the gap with the milk of saptacchada or arka.Chikitsa for Indralupta112,113 First siravyadhana is done at the nearer site of lesion, then application of the pastewhich is prepared by kaseesa, manashila, tuttha and maricha or pippali to thehead.
  • 45.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          27   Application of bhrungaraja taila or bruhati taila + gunja moola or bhrungarajaswarasa + taila (pakwa) or gomutra + japa pushpa or root and fruit of gunja orlangali moola + ksheera or karaveera patra swarasa or kantakari swarasa + madhuor dhattura patra swarasa with madhu or ghrita, bhallataka rasa with madhu orghrita, tila pushpa + gokshura with madhu or ghrita, hastidanta masi with tila taila. Upto completion of treatment snana is not adviced.Chikitsa for Khalitya and Palitya114,115,116 Shareera shodana : vamana and virechana Nasya karma with vidarigandhadi taila or sahacharadi taila or bhrungaraja taila orprapoundarikadi taila or mahaneela taila or laghupanchamooladi taila or nimbataila or bhruhatyadi taila or jeevaniya gana taila. Shiroabhyanga with mahaneela taila or bhrungaraja taila Lepa with priyaladi yoga or tiladi yoga. Palitanashaka loha yoga for oral administration. Application of jatamamsi + kushta + tila + Krishna sariva + neelotpala + gomutra+ madhu. Oral intake of ksheera daily. Bramhacharya palana.Chikitsa for Kunakha117 Shastra karma: swedana with the part being immersed in ushna jala and nail hasto be removed.
  • 46.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          28   Agni karma Chakra taila for application. Sarja churna for application Madhuroushadha siddha taila for application. Application of haridra + agaru and kalimaka kalka.
  • 47.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          29  BONE AND BONE DISORDERSBone is essentially a highly vascular, living, constantly changing mineralizedconnective tissue. It is remarkable for its hardness, resilience and regenerativecapacity, as well as its characteristic growth mechanisms. 118Synonyms of bones: bone, off-white, os, pearl, ivory, osseous tissue. 119Number of bones120The human skeleton consists of 206 bones. Upper limbs- 64 Lower limbs- 62 Vertebrae- 26(33) Skull- 29 Ribs- 24 Sternum- 1Classification of bones121(A). According to position1. Axial: bones forming the axis of the body. e.g, skull, ribs, sternum and vertebrae.2. Appendicular: bones forming the skeleton of limbs.(B). According to size and shape1. Long bones: present in upper and lower limbs.
  • 48.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          30  2. Short long bones: same as above but are miniature in size. e.g, metacarpals,metatarsals and phalanges.3. Short bones: small, polyhedral and generally cuboidal in shape.e.g, carpel andtarsal bones.4. Flat bones: expanded and plate like. e.g, scapula, sternum, ribs, parietal andfrontal bones.5. Irregular bones: irregular in general outline and do not fit in any of the categaries.e.g, vertebrae and some skull bones.6. Pneumatic bones: flat or irregular bones possessing a hollow space within theirbody which contains air. e.g, ethmoid, maxilla, mastoid part of temporal bone.7. Sesamoid bones: sesamoid means ‘seed- like’. They are nodules of bones. e.g,pisiform, patella.(C). According to gross structure1. Compact bone: the outer cortical part of long bones, which is hard and has ahomogenous appearance.2. Spongy bone: the inner part of bone which is less hard and presents a spongyappearance. E.g, flat, short and irregular bones and ends of long bones.3. Diploic bone: consists of inner and outer tables of compact bone with anintervening porous layer which is occupied by a spongy substance consisting ofbone marrow and diploic veins. Eg, most of cranial bones.(D). According to development1. Membranous bones: which develop in membrane.2. Cartilaginous bones: which develop in cartilage.
  • 49.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          31  Development of bones122Both cartilages and bones are mesodermal in origin. They develop from theembryonic mesenchyme which is the loose cellular connective tissue with a fluidmatrix.Structure of cartilage and bone1231. Cartilage: Cartilage is a variety of hard connective tissue.Characteristic feature: translucent, firm (less hard than bone) and elastic. It iscompressible and can withstand considerable pressure, pull and torsion.Histological structure: Cartilage consists of two basic structuresi. Chondrocytes: usually large, rounded and encapsulated. They are embedded inthe matrix.ii. Matrix: it depends upon the character and properties of the cartilage of a gellike ground substance which makes the cartilage solid. It contains cartilagecells and fibres.Types of cartilage: Depending upon the type of fibers in the matrix and number ofcells cartilages are divided into 3 types. (a) Hyaline cartilage(b) White fibro cartilage(c) Elastic cartilage(2) Bone: Bone is a type of hard connective tissue and is the hardest structure in thebody
  • 50.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          32  Composition of bone124i. Organic matter: Forms1/3 weight of bone; consists of fibrous material andcells; responsible for the toughness and resilience of bone.ii. Inorganic matter: Forms 2/3 weight of bone; consists of the following mineralssalts-calcium phosphate, calcium carbonate, calcium fluoride and magnesiumphosphate; responsible for the rigidity and hardness of bone.Bone cells: These are (i) Osteoblasts (ii) Osteocytes (iii) Osteoclasts. 125Osteoblasts: These are ovoid cells with basophilic cytoplasm and an oval nucleus.They lie against the surface of bone in the inner layer of periosteum and theendosteum i.e. at the sites where active bone formation is in progress. They formprotein elements of the matrix and control deposition of mineral salts in relation tocollagen fibres. They produce alkaline phosphatase which helps in precipitation ofcalcium phosphate and other salts.Osteocytes: Osteoblasts becomes Osteocytes by forming matrix around itself andbecoming dormant when active bone formation is not required. They occupy thelacunae.Osteoclasts: These are large multi nucleated giant cells with acidophilic cytoplasm,which contains many vacuoles. They arise by fusion of Osteoblasts and Osteocytesand are concerned with resorption of bone during growth and remodeling of skeleton.They produce acid phosphatase which dissolves inorganic constituents of bone.
  • 51.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          33  Periosteum: It is a thick layer of fibrous tissue which covers bone surfaces exceptover its articular surfaces where it is replaced by articular cartilage. Through its bloodvessels it nourishes the bone and if torn, the underlying bone dies. Periosteum hasbone forming activity in times of need.Endosteum: It is highly vascular membrane which lines the medullary cavity on theinner surface of a compact bone.Bone minerals, Calcitropic hormones and bone mineral homeostasis126Three major ions, calcium, phosphorous and magnesium; three major Calcitropichormones, parathyroid hormone (PTH), 1,25dihydro vitamin D3 and calcitonin; andthree major target organs, bone, kidney and gut are involved in the metabolism ofbone, bone mineral and bone growth.MineralsCalcium: The total body content of calcium is about 1000gms. More than 99% of thisis in the bone. Normally, 90% of the filtered calcium is reabsorbed in the proximaltubule and loop of henley and 8% in the distal tubule and collecting duct.Reabsorption at the latter site is increased by PTH and decreased by metabolicacidosisand phosphate depletion. Tubular intestinal absorption of calcium adjusts sothat the plasma level set by the prevailing secretion rate of PTH can be maintainedwithout the loss of calcium from bone.
  • 52.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          34  Phosphate: The total body content of phosphate is about 700gms, of which 85% is inbone and most of the remainder is inside cells. Inorganic phosphate is an integral partof bone mineral. The concentrations of inorganic phosphate in glomerular filtrate aresimilar to that in plasma. Normally, about 85% of the filtered load is reabsorbed, 75%in the proximal tubules and 10% in the distal tubules. Both proximal and distalreabsorption of phosphate is decreased by PTH and calcium.Magnesium: The total body content of magnesium is about 20gm, of which 65% inbone and most of the remainder is intracellular. Net gastrointestinal absorption ofmagnesium is about 40% intake. Normally, about 96% of filtered magnesium isreabsorbed. Magnesium is an important component of the adenylate cyclase systemand is required in the process of vitamin-D activation. Severe and prolongedhypomagnesaemia inhibits PTH release and induces resistance to the action of PTHon bone.Calcitropic hormonesVitamin-D: Intestinal absorption of dietary vitamin-D occurs mainly in jejunum.Both viaminD2 and vitamin D3 are prohormonal forms and are inert until activated inthe liver and kidney through sequential hydroxylations. The production of1,25(OH)2D3 is directly related to body needs; its formation is enhanced by vitamin Ddepletion,PTH, hypocalcaemia and hypophosphataemia. The effect 1,25(OH)2D3 onthe intestineis to increase the absorption of calcium and phosphorus. In the skeleton1,25(OH)2D3 has two actions; mobilization of calcium and phosphorus from
  • 53.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          35  previously formed bone and probably promotion of maturation and mineralization ofthe organic matrix.Parathyroid hormone: The function of PTH is to maintain ionized calciumconcemtration in the ECF. PTH secretion increases with a fall and decreases with arise in plasma ionized calcium. The extracellular concentration of ionized calcium isthe most important physiological regulator minute to minute secretion of PTH. PTHhas a dual action on bone, of calcium release and bone remodeling. PTH increasesosteoclastic bone resorption by first acting on Osteoblasts or stromal fibroblasts,which release osteoclast activating cytokines.Calcitonin: Calcitonin is the only hormone in humans capable of actively loweringserum calcium. The hypocalcimic action of CT results from the inhibition of boneresorption and decreased in the absolute number of Osteoclasts and increased bonemineral deposition. It also affects Osteocytes causing decreased calcium ion fluxacross the cell membranes. These effects are opposite of PTH. Calcitonin secretion isstimulated by hypercalcaemia and inhibited by hypocalcaemia. Calcitonin protectsagainst hypercalcaemia. Calcitonin levels are lowered by oestrogen deficiency.Oestrogen: The limited number of estrogen binding sites is on Osteoblasts as well asOsteoclasts. Its decline at menopause results in a rapid bone loss, associated withincreased osteoclastic bone resorption, particularly trabecular.
  • 54.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          36  Other systemic hormones: Other hormones, which regulate bone growth andmetabolism, include growth hormone, somatomedins, insulin, glucocorticoids, thyroidhormones, prolactin and gonadotropins.Local factors: Most of the local regulators of bone remodeling are synthesized byskeletal cells and include growth factors, cytokines and prostaglandins.Functions of bones: 127 Constitute framework of the body and hence gives shape and form to the body. Forms central axis of the body. Supports and transmits weight of the body. Provides the levers essential for locomotion by forming articulations and givingattachment to muscles and ligaments. Provide mechanical protection to vital organs such as brain, heart and lungs. Stores calcium. Forms blood in their marrow.Blood supply of bones: Derived from 4 sources. They are; 128i. Nutrient arteryii. Periosteal arteryiii. Metaphyseal arteryiv. Epiphysial artery
  • 55.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          37  Lymphatic drainage of bones: The lymphatics of the haversian systems drain intothe periosteal lymph vessels. 129Nerve supply of bones: They apparently consist of both sensory and motor(autonomic) fibres. 130Bone disorders131,132Some of the bone disorders are as follows. Bone SpurA bone spur (osteophyte) is a bony growth formed on normal bone. Bone spur is justextra bone. It’s usually smooth, but it can cause wear and tear or pain if it presses orrubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body.Common places for bone spurs include the spine, shoulders, hands, hips, knees, andfeet. Bone painChronic bone pain: Subacute or chronic bone pain usually has the followingcharacteristics. Localized to the affected bone, rather than the joint Present at rest and worse at night-time Not clearly worsened by movement or usage (unlike joint or periarticular pain) Not readily reproduced by joint movement Focal tenderness on local pressure.Other features in the enquiry usually points to the most likely cause. For example;
  • 56.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          38   Slowly but relentlessly progressive pain suggests a destructive disease likemalignancy or chronic infection. Malignancy is usually associated with weightloss, fatigue and symptoms relating to the primary site. Pain that is experienced over a wider area of a bone and accompanied bydeformity strongly suggests Pagets disease. Osteomalacia is associated with bone tenderness and limb girdle weakness. Pain from osteonecrosis is initially bony and progressive but then may developsuperadded features of joint pain (worse on usage or weight-bearing, with orwithout radiation, reproduced by examination) as the adjacent joint cartilagecollapses and the joint is involved (mainly hips, shoulders or elbows). Severe arthropathy with subchondral bone attrition and collapse most commonlyosteoarthritis, may also cause bone pain, though this inevitably superimposedupon a chronic history of usage –related joint pain.Acute bone pain: FractureSudden onset pain that is very well localized, severe and worsened by even slightmovement should always suggest a fracture. This is the major clinical manifestationof metabolic bone disease. Fragility fractures occur spontaneously or as the result of relatively minor trauma;they are typical of osteoporosis. Pathological fractures occur in bone that is structurally abnormal, such as inPagets disease, osteomalacia, bone metastasis and parathyroid bone disease. Likefragility fractures, they can occur spontaneously or follow minor trauma. High-energy fractures result from major trauma (e.g. car crash, falls from a
  • 57.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          39  height) and can affect normal bones. The same is true of stress (fatigue) fracturesin healthy individuals, such as athletes and military recruits, who are exposed torepetitive trauma. ToothacheA toothache, also known as odontalgia or, less frequently, as odontalgy, is an achingpain in or around a tooth. In most cases toothaches are caused by problems in thetooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, amarginally cracked tooth, infected dental pulp (necessitating root canal treatment orextraction of the tooth), jaw disease, or exposed tooth root. Causes of a toothache mayalso be a symptom of diseases of the heart, such as angina or a myocardial infarction,due to referred pain. Dental cariesDental caries, also known as tooth decay or a cavity, is a disease where bacterialprocesses damage hard tooth structure (enamel, dentin, and cementum). These tissuesprogressively break down, producing dental caries (cavities, holes in the teeth). Twogroups of bacteria are responsible for initiating caries: Streptococcus mutans andLactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and,in severe cases, death. HyperdontiaHyperdontia is the condition of having supernumerary teeth, or teeth which appear inaddition to the regular number of teeth. The most common supernumerary tooth is amesiodens, which is a mal-formed, peg-like tooth that occurs between the maxillary
  • 58.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          40  central incisors. Fourth and fifth molars that form behind the third molars are anotherkind of supernumerary teeth. Fissure or cracked teethThe deep pits and fissures in teeth are where some 80% of cavities begin. In referenceto the teeth, fissures are thin grooves in the biting surfaces (frequently extending ontothe sides). They are significant because of their tendency to accumulate food andbacterial plaque. It may not be possible to remove plaque from deep pits and fissuresin teeth, and some 80% of cavities are believed to originate there. Tooth discolorationTooth discoloration is caused by multiple local and systemic conditions. Extrinsicdental stains are caused by predisposing factors(poor oral hygiene) and other factorssuch as dental plaque and calculus, foods and beverages, tobacco, chromogenicbacteria, metallic compounds, and topical medications. Intrinsic dental stains arecaused by dental materials (eg, tooth restorations), dental conditions and caries,trauma, infections, medications, nutritional deficiencies and other disorders (eg,complications of pregnancy, anemia and bleeding disorders, bile duct problems), andgenetic defects and hereditary diseases. (eg, those affecting enamel and dentindevelopment or maturation). OnychogryphosisOnychogryphosis is a thickening and distortion of the toenails usually due to tight or
  • 59.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          41  ill fitting shoes. These types of nails are caused by damage to the cells that grow thenail. This can be sudden acute damage such as dropping a heavy object onto the toe orcan be due to a gradual damage over the years with the toes impacting into the toe boxof the shoes or with various sporting activities. Alopecia areataAlopecia areata is a condition affecting humans, in which hair is lost from some or allareas of the body, usually from the scalp. Because it causes bald spots on the scalp,especially in the primary stages, it is sometimes called spot baldness. In 1%–2% ofcases, the condition can spread to the entire scalp (Alopecia totalis) or to the entireepidermis (Alopecia universalis). Hair may also be lost more diffusely over the whole scalp, in which case thecondition is called diffuse alopecia areata. Alopecia areata monolocularis describes baldness in only one spot. It may occuranywhere on the head. Alopecia areata multilocularis refers to multiple areas of hair loss. The disease may be limited only to the beard, in which case it is called Alopeciaareata barbae. If the patient loses all the hair on his/her scalp, the disease is then called Alopeciaareata totalis. If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopeciaareata universalis.
  • 60.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          42   Grey HairGrey hair is usually associated with ageing, but this is not always the case. Earlygreying of the hair is basically hereditary, and can inherit it from one of our parents orgrandparents. Grey hair can also be influenced by stress. A person experiencing aprolonged period of stress and anxiety may notice, over a period of time, white hairsgradually appearing. Malnutrition, worry, shock, deep sorrow, tension and othersimilar conditions may also slow down the production of melanin resulting in greyhair.Investigations 133The following investigations are usually done in bone disorders. Bone mineral profile Calcitropic hormone assay Imaging technique Plain radiography Bone scan or Scintigraphy Bone densitometry Quantitative ultrasound Quantitative computed tomography Magnetic resonance imaging Bone biopsy and Histomorphometry
  • 61.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          43  SANDHIGATAVATASandhigatavata is mentioned under Vatavyadhi by all the samhitas.Janusandhigatavata represents the variety of sandhigatavata. The knowledge ofdisease is obtained by the study of Nidana, Purvarupa, Rupa, Upashaya and Sampraptiwhich are termed as Nidana Panchaka.DerivationJanuSandhigata vata is a compound word with 4 words combined. Janu, Sandhi, Gataand Vata. JanuVyutpatti: eÉlÉç +gÉÑhÉç 134The term ‘janu’ is derived from the mula dhatu ‘eÉlÉç’ and ‘lÉÑhÉç’ suffix.Nirukti: E eÉÇbÉrÉÉåUç qÉkrÉ pÉÉaÉ:| 135The region between the uru and jangha is called janu. SandhiVyutpatti: xÉÇ+ kÉÉ+ ÌMü: 136The term is derived from ‘sam’ upasarga and ‘dhaa’ dhatu. It means that which doesthe sandhaana is nothing but sandhi.Nirukti: AxjlÉÉÇ iÉÑ xÉlkÉrÉÉå ¾ûÉåiÉå MåüuÉsÉ: mÉËUMüÐÌiÉïiÉÉ:| 137Place where the joining of bone takes place is known as sandhi.
  • 62.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          44   GataVyutpatti: aÉÇ + £ü: 138The term gata is derived from ‘gam’ dhatu and ‘kta’ upasarga.Nirukti: aÉqÉç- aÉqÉlÉå|139This is approached or situated. VataVyutpatti : uÉÉ + iÉlÉç 140The term vata is derived from mula dhatu ‘vaa’ and ‘tan’ suffix.Nirukti: uÉÉ aÉÌiÉ aÉlkÉlÉrÉÉå: CÌiÉ| 141Which is having mobility or movement is called vata.The vitiated vata when gets lodged in janu sandhi leads to the manifestation ofjanusandhigatavata.Paryaya of Sandhigata vata. 142 Sandhivata Sandhigatavata Khudavata Jeerna vataNidanaThere are no special set of nidanas mentioned in classics for sandhigatavata orjanusandhigatavata. The set of nidanas mentioned for vatavyadhi can be considered
  • 63.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          45  for janusandhigatavata. These are listed below. 143,144,145,146,147,148,149Table No.10: Showing the Nidanas for JanusandhigatavataNidana C.S S.S A.H A.S M.N Y.R B.PAharaja Nidanaa) RasavisheshaKatu - + + + - - +Tikta - + + + - - -Kashaya - + + + - - -b) Guna VisheshaRooksha + + + + + + +Laghu + + - + + + +Sheeta + + - + + + +c) Dravya Vishesha- + - - - - -Varaka - + - - - - -Shushka shakha - + - - - - -Uddalaka - + - - - - -Neevaara - + - - - - -Mudga - + - - - - -Masoora - + - - - - -
  • 64.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          46  Harenu - + - - - - -Kalaaya - + - + - - -Nishpaava - + - - - - -Virudhaka dhanya - - - + - - -Vistambhi dhanya - - - + - - -Trina dhanya - - - + - - -Chanaka - - - + - - -Kareera - - - + - - -Thumba - - - + - - -Kalinga - - - + - - -Chirbhata - - - + - - -Bisa - - - + - - -Shabooka - - - + - - -Jambava - - - + - - -Tinduka - - - + - - -ViharaAtivyayama + + + + + + +Langhana + + - + + + -Plavana + + - + + + -Atyadhwa + + - + + + -
  • 65.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          47  Pradhavana - + - + - - -Pratarana - + - + - - +Atyuccha bhashana - - + + - - -Balavadnigraha - + - + - - -Abhighata + + - + + + +Marmaghata + - - - + + -Bharaharana - + - + - - -Dukhasana + - - - - - -Gaja, ushtra ashwasheeghrayana patina+ + - + + + -Prapeedana - + - - - - -Atiadhyayana - + - + - - -Ativyavaya + + + + + + +Ati jagarana + + + + + + +Vegadharana + + + + + + +Vegodeerana - - - + - - -Vishamopachara + - - + + + -Shrama - - - - - - +Upavasa + + + + + + +Prakvatasevana - - - + - - +Ama + - - - + + +
  • 66.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          48  Divaswapna + - - - - - -Ashma, shila, lohakastha Utkshepana,vikshepa, bhramanachalana- - - + - - -Manasika KaranaChinta + - + - + + +Shoka + - + + + + +Krodha + - - - + + +Bhaya + - - + - - -Anya NidanaAtiraktasravana + - + + + - -Atidosha sravana + - + + + - -Dhatukshaya + - + + + - -Rogatikarshana + - + + + - -Purvarupa150Classical text book of Ayurveda do not ennumarate any of the purvarupa forjanusandhigatavata. The lakshanas of janusandhigatavata in subtle form can beconsidered as purva roopa.
  • 67.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          49  RoopaThe four cardinal features of sandhigatavata or janusandhigatavata explainedby various samhitas are tabulated below.151,152,153,154,155,156Table No.11: Showing the Lakshanas of Janusandhigatavata1) Prasarana akunchana vedana: Shula is a main symptom in Sandhigatavata.Shula usually increases by movements like Akunchana, Prasarana because of vataprakopa.2) Vatapurna druti shotha: Shotha which is similar toVatapurna druti sparsha hasbeen described. Srotorodha occurs due to vata Sanga which is responsible for shotha.Being a variety of vata, on palpation the swelling is felt like a bag filled with air.3) Sandhihanti: First sushruta samhita explained this symptom followed byMadhavakara. This word is explained by Dalhana and Gayadaha as inability toperform actions like prasarana and akunchana.Sl.no Lakshanas C.S S.S A.H A.S M.N B.P1. Vatapurna druti sparshvatshotha/shopha+ + + + - +2. Prasarana akunchanayopravritischa vedana/shoola+ + + + + +3. Sandhi hanti - + - - + +4. Atopa - - - - + -
  • 68.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          50  4) Atopa: Atopa means gud-gudaya shabda. That means there will be peculiar typeof sound in the sandhi during movemensts. This is mentioned in madhava nidana.Samprapti 157,158Sandhigatavata has not been explained in classics of ayurveda. It is explainedunder the heading of the Vata Vyadhi. So samanya samprapti of vatavyadhi can beconsidered the samprapti of sandhigatavata or janusandhigatavata.The aggravated vata pervades into the rikta srotus in the body and produces variousdisorders either generalized (pertaining to entire body) or localized (single part ofbody). Here the term rikta srotus refers to snehadiguna shunya.According to Ashtanga hrudaya, dhatukshaya aggravates vata and alsoresponsible for to produce rikta srotus. Vitiated vata travels throughout the body andsettles in the rikta srotus and further vitiates the srotus leading to the manifestation ofvatavyadhi. When this type of process occurs in the janu sandhi it leads to themanifestation of janusandhigatavata.UpashayaAll drugs, diet and regimen which give long lasting relief in Sandhigatavatamay be taken as Upashaya. For example; Abhyanga, Swedana, Ushna Ahara, UshnaRitu etc.AnupashayaAll drugs, diet and regimen which exaggerate the disease are taken as
  • 69.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          51  Anupashaya for that disease. Also Hetus of that disease can also be taken asAnupashaya. The diet having Laghu, Ruksha, Sheeta Gunas, Anashana, Alpashana,Sheeta Ritu, can be considered as Anupashaya.Sadhyasadhyata159Sandhigata Vata is a kashta sadhya vyadhi.Sapeksha Nidana160To get a clear idea regarding the disease Sandhigatavata, a comparative study ofcardinal symptoms of similar disease entities are given below. Amavata Vatarakta Kroshtuka Sheersha SandhigatavataTable No.12: Showing the Sapeksha nidanas for JanusandhigatavataFactors Sandhigata vata Amavata Vatarakta KroshtukasheershaAmapradhanya Absent Present Absent AbsentJvara Absent Present Absent AbsentHridgaurava Absent Present Absent AbsentVedana DuringPrasaranaAkunchanaPravrittiVrischikaDamshavatand SanchariMushikaDamshavatVedanaTeevraShotha VatapurnaDritisparshaSarvanga andSandhigataMandalayuktaKroshtukaSheershavat
  • 70.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          52  Sandhi WeightbearingjointsBig and Smalljoints,Big joints Only knee jointUpashaya Abyanga RukshaSvedanaRaktaShodhanaRaktaShodhanaChikitsaCharaka samhita does not mention any specific line of treatment forsandhigatavata but the general measures mentioned for vatavyadhi are to beconsidered i.e, usage of sarpi, taila, vasa and majja in the form of seka, abhyanjanaand basti, snigdha sveda, nivata sthana, pravarana, mamsa rasa sevana, payas sevana,bhojana prepared out of madhura, amla and lavana and other brumhana measures. 161Sushruta samhita, collectively mentions the treatment for snayu, sandhi and asthigatavata which includes; Snehana Upanaha Agnikarma Bandhana MardanaIn commentary Acharya Dalhana enumerates that these treatments have to becontinued for a long time i.e., chirakala. The chikitsa which is mentioned in Sushrutasamhita is followed by other samhitas and are tabulated below. 162,163,164,165,166,167,168
  • 71.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          53  Table No.13: Showing the Chikitsa for JanusandhigatavataDifferent shamanoushadhis suggested in janusandhigatavata 169,170,171Kalka Tagaramula kalka with takra Indravaruni mula + pippali + gudaChurna Alambushadya churna Aabhadi churnaKwatha Maharasnadi kwatha Rasna panchaka kwataVati Ajamodadi vatiChikitsa S.S A.S A.H C.D Y.R B.R B.PSnehana + - + + + + -Abhyanga - + - - - - -Mardana + + - + + + -Swedana - + - - + - +Bhandana + + - + - + -Agnikarma + + + + - + +
  • 72.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          54  Guggulu Adityapaka guggulu Trayodashanga guggulu Yogaraja guggulu Yogaraja guggulu brihat Shodasheeti guggulu Simhanada gugguluRasaushadi Panchananarasa lauha Vatarakshasa rasaSneha Phalatrikadi sneha Dashamula siddamajja sneha Majja sneha Panchatikta guggulu ghrita Prasarani taila Vishnu taila Siddartha tailaPathyapathya172,173According to this general rule of Pathyapathya, the nidanas, which cause the diseases,
  • 73.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          55  are to be considered as apathya. Hence in this study the nidanas, which have beendescribed earlier, are apathya for the patients of janusandhigatavata. Pathya Ahara – Internal and external use of Sneha, viz. ghrita, taila, vasa andmajja, mamsarasa, ksheera, mamsa, snehanvita bhojana, fruits having amla rasalike dadima, recipes having madhura, amla and lavana Rasa. Pathya Vihara – Nirvatasthana, atapa Sevana, garbhagriha, agnisantapa,gurupravarana, mrudu shayya, brahmacharya . Pathya Ausadha – Sukhoshna parisheka, abhyanga, snigdha sveda, basti, snehavirechana, shiro basti, shirah sneha, snaihika dhumapana, snaihika nasya,sukhoshna sneha gandusha, samvahana . Drugs like kumkum, agaru, tejapatra,kustha, ela, tagara.
  • 74.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          56  OSTEOARTHRITISOsteoarthritis is one among the common musculoskeletal diseases affectingthe human being making an important cause of disability. There is no simpledefinition of osteoarthritis as it requires consideration of 3 overlapping areas-pathological changes, radiological changes & clinical consequences. Pathologicallythere is an alteration in cartilage structure; radiologically there are osteophytes & jointspace narrowing and clinically pain, disability.Knee osteoarthritis is the most common form of osteoarthritis. It is usuallyunilateral in the beginning but becomes bilateral over a period of time. Obesity,female gender and knee bending are predominant risk factors. .It may involvepredominantly medial femorotibial, lateral femorotibial or patellofemoralcompartment.174,175Etymology176The term osteoarthritis is composed of two terms i.e, osteo and arthritis.Osteo-The world Osteo comes from the Greek word ‘Osteon’.The word osteo means bone.Arthritis-The prefix ‘Arth’ means joint. The suffix ‘itis’ is defined as inflammation.Hence, Arthritis means inflammation of joint.So, Osteoarthritis can be defined as inflammation of the bony part of the joint.
  • 75.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          57  Synonyms177,178The osteoarthritis has following synonyms. Osteoarthritis Arthrosis Degenerative Joint Disease Wear and Tear Arthritis Hypertrophic Osteoarthritis.Classification 1791. Primary OA - is the most common form of the disease, no predisposing factor isapparent.2. Secondary OA- is pathologically indistinguishable from idiopathic OA. but isattributable to an underlying cause.Causes of osteoarthritis180 Primary OA:No known cause. Secondary OAPre-existing joint damage; Rheumatoid arthritis Gout Seronegative spondyloarthropathy Septic arthritis
  • 76.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          58   Paget’s disease Avascular necrosis e.g; corticosteroid therapyMetabolic disease; Chondrocalcinosis Hereditary haem0chromatosis AcromegalySystemic diseases; Haemophilia- recurrent haemoarthrosis Haemoglobinopathies e.g; sickle cell disease NeuropathiesFactors predisposing to osteoarthritis181 Obesity: predicts later risk of radiological and symptomatic OA. Hereditary: familial tendency to develop nodal and generalized OA. Gender: polyarticular OA is more common in women; a higher prevalence afterthe menopause suggests a role of sex hormones. Hypermobility: increased range of joint movements and reduced stability leads toOA. Osteoporosis: commonest risk factor for OA. Trauma: a fracture through any joint. Meniscal and cruciate ligament tears causeOA of the knee.
  • 77.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          59   Congenital joint dysplasia: alters joint biomechanics and leads to OA. Joint congruity: congenital dislocation of the hip or a slipped femoral epiphysis orosteonecrosis causes early onset of OA. Occupation: miners develop OA of the hip, knee and shoulder. Sports: repetitive use and injury in some sports causes a high incidence of lowerlimb OA.e.g; football.Pathogenesis 182Normal hyaline cartilage consists of chondrocytes embedded in extracelluarmatrix composed of water, type II collagen and proteoglycon. The cartilage remainsstable with active degeneration and regeneration occurring in equilibrium. OA resultsfrom excessive degeneration compared to regeneration.Earliest identifiable changes are loss of proteoglycons and decreasedmetachromasia in cartilage. There is focal loss of cartilage, associated with reactiveproliferation of chondrocytes to form clusters. Progression of these changes leads tobreach of surface integrity, fissures, pitting, flaking of cartilage and development ofvertical clefts. This fissure deepens and may expose to subchondral bone, whichbecomes ivory like, due to thickening and vascularisation. Associated bone growth insubchondral region leads to sclerosis, while growth in the margin leads to theformation of osteophytes which alters the contour of the joint and may restrictmovement.
  • 78.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          60  Clinical features183 Symptoms Joint pain Joint gelling (stiffening & pain after immobility) Crepitus Joint instability Loss of function Signs Joint tenderness Crepitus on movement Limitation of range of movement Joint instability Joint effusion Wasting of musclesDifferential diagnosis184Osteoarthritis of the knee has to be differentiated from following conditions. Acute suppurative arthritis Gonococcal arthritis Tubercular arthritis Rheumatoid arthritis Gout Rheumatic fever
  • 79.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          61  Table No.14: Showing Differential diagnosis of Knee osteoarthritisKneeOsteoarthritisRheumatoidarthritisGoutyarthritisCauses Primary unknown,secondarydegenerativechanges due to localor systemicinvolvement.unknown unknownPattern ofjointinvolvementMono or polyarticular arthritislarge or sometimessmall joints, Kneejoint mostfrequently, may ormay not besymmetricalarthritis.Poly articular, largejoint, both upper andlower joints,symmetricalarthritis.Mono orpolyarticular smallMTP joints, greattoe and kneeaffected indecreasingpercentage.Symptomsrelated tojointsInitially intermittentaching provoked byuse and relieved byrest. Swelling,stiffness, muscularspasm, Osteophyteformation.Continuous painprovoked by jointuse, swelling,morning stiffnessmore than 1 hour,anorexia, fever, painall over body.Acute agonizingpain especially atnight, swelling,severe functionalimpairment,anorexia, nausea,change in mood.LabinvestigationNot specific RA test positive,ESR is raised.Serum uric acid israised.
  • 80.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          62  Table No.15: Showing Differential diagnosis of Knee osteoarthritisAcuteSuppurativearthritisGonococcalarthritisTuberculararthritisRheumaticfeverCause Primaryinfection,secondaryinfection toacuteOsteomyelitis.Infection byGonococciUsuallysecondary toestablishedfocus in lungsor other area.JointinvolvementpatternLarge jointsand Kneeasymmetricalarthritis.Large joints,asymmetricalarthritis.Large joints,asymmetricalarthritisJointinvolvementin the form offleeting andtransientpolyarthritis.SystemicfeaturesFluctuatingfever.Maculopustular orvesicularrashes.Anorexia,weight loss,night sweats,evening rise oftemperature.Chorea,carditis fever,subcutaneousnodules.LabinvestigationESR raised Demonstration ofgonococci inurethraldischarge.ESR raised. ESR raised,ASLO titerabove200,Leucocytosis common.
  • 81.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          63  Investigations 185Primary investigations X-rays are abnormal only when the damage is advanced; joint space narrowingand osteophytes. MRI demonstrates early cartilage & subchondral bone damages. Arthroscopy reveals early fissuring & surface erosion of the cartilage.Secondary investigations Blood tests: there is specific tests; the ESR, rheumatoid factor & nuclearantibodies are negative.Management186The treatment of OA is aimed at minimizing pain, optimizing function and reducingdisability. Management of OA requires a comprehensive approach involving nonpharmacological, pharmacological and surgical therapies. Non – pharmocolgical therapy Education: e.g; avoidance of poor posture. Weight reduction Exercises Application of hot pack, ice pack, hydrotherapy, massage. Uses of devices like knee brace. Pharmacological therapy Non steroidal anti inflammatory drugs like aceclofenac, acetaminophen celecixib. Intra-articular steroid injections.
  • 82.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          64   Chondroitin and glucosamine were used as nutritional agents. Surgical therapy Arthroplasty; total or unicompartmental knee replacement. Arthrodesis Osteotomy
  • 83.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          65  BASTIBasti is the one among the major procedures in panchakarma. The classicalliteratures attaches a great significance to this form of treatment and points out thevivid scope of its applicability. Depending upon the uses of different drugs, basti actas a dosha shodhaka, dosha shamaka, restoration of shukra, brumhana in krushaindividuals, karshana in obese individuals, improvement in vision, prevention ofaging, improvement in lusture, strength and longevity. 187Derivation188“ uÉxÉÑ – ÌlÉuÉxÉå oÉxÉç-AÉcNûÉSlÉå uÉxÉç –uÉÉxÉlÉå xÉÑUÍpÉMüUhÉå,oÉÎxiÉ-uÉxiÉå: AÉuÉ×hÉÉãÌiÉ qÉÔ§ÉÇ| uÉxÉç-ÌiÉcÉç|lÉÉpÉåUkÉÉåpÉÉaÉå qÉÔ§ÉÉkÉÉUå xjÉÉlÉ å(mÉÑ.)||AÉæwÉkÉ SÉlÉÉjÉåï SìurÉpÉåSå|” (uÉÉcÉxmÉirÉqÉç)The word Basti is derived from the root Vas by adding Tich Pratyaya and it belongsto pullinga pada. Means to reside, to stay or to dwell. Means to cover/to coat. Coating of Sneha for the elimination. Gandha denotes bad smell hence it refers to Mala and verb Ardaneis derivedfrom Ardagatau "Yachane Cha" denotes the movement (in the colon) and to beg(drawing of waste material in the colon from all over the body). To produce the effect of pleasant smell.
  • 84.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          66   It denotes an organ, which covers the urine. It denotes an organ situated below the umbilicus, which hold the urine. It denotes an instrument used for the administration of the medicine.Definition:1. oÉÎxiÉlÉÉ SÏrÉiÉå CÌiÉ oÉÎxiÉ:| 1892. oÉÎxiÉÍpÉ: SÏrÉiÉå rÉxqÉÉiÉç iÉxqÉÉiÉç oÉÎxiÉËUÌiÉ xqÉ×iÉ:| 190Basti means urinary bladder of animal which were being used to introduce medicationthrough different routes.Classification191A. Depending upon Adhishthana bhedaa. Pakvashayagatab. Garbhashyagatac. Mutrashayagatad. VranagataB. Depending upon Dravya bhedaa. Niruha bastib. Anuvasana bastii. Sneha bastiii. Anuvasana bastiiii.Matra basti
  • 85.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          67  C. Depending upon kaarmukataAccording to Charaka samhitaa. Vataghna bastib. Balavarnakrut bastic. Snehaneeya bastid. Shukrakrut bastie. Krimighna bastif. Vrushyatvakrut bastiAccording to Sushruta samhitaa. Shodhana bastib. Lekhana bastic. Snehana bastid. Brhumana bastiAccording to Ashtanga sangrahaa. Uthkleshana bastib. Doshahara bastic. Shaman bastiD. Depending upon sankhya bhedaa. Karma bastib. Kala bastic. Yoga basti
  • 86.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          68  E. Depending upon anushangika bhedaa. Yaapana bastib. Siddha bastic. Prasruta yogika bastid. Dvadasha prasrutika bastie. Paada heena bastiKala bastiThis is is a form of basti which is classified depending upon the number ofbastis, which includes both anuvasana and niruha basti.Charaka samhita opines that Kala Basti includes half the number of Basti to that ofKarma Basti. Here, Chakrapani opines that it includes 16 Basti. On the first day 1anuvasana is to be given then afterwards 6 anuvasana and 6 niruha can be givenalternatively. Lastly, 3 anuvasana are to be given. 192Ashtanga hrudaya opines thatKala Basti includes the group of 15 Basti. i.e, a group of 15 bastis, with oneanuvasana basti at the beginning and 3at the end, with 6 niruha bastis and 5 anuvasanabastis alternatively in the middle. 193 Niruha basti xÉ SÉåwÉ ÌlÉWïûUåiÉç zÉUÏUå SÉåwÉ WûUhÉÉSè lÉÏUÉåWû uÉÉxjÉmÉlÉqÉç AÉrÉÑ xjÉÉmÉlÉÉiÉç AxjÉÉmÉlÉqÉç|194That which expels the doshas from the body is called as niruha, due to itsvayasthapana karma it is called as asthapana.
  • 87.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          69   Anuvasana basti AlÉÑuÉÉxÉlÉ iÉ§É rÉjÉÉ mÉëqÉÉhÉqÉç aÉÑhÉ ÌuÉÌWûiÉ: xlÉåWû oÉÎxiÉÌWû ÌuÉMüsmÉÉå AlÉÑuÉÉxÉlÉ: mÉÉSuÉM×ü¹:|195This is the vikalpa of niruha basti but it contains more quantity of sneha hence it iscalled as a sneha basti and basti dravya is quarter of niruha basti.Yogyayogya for basti 196,197,198 Indications of niruha bastiVataja roga, sarvanga roga, kukshi roga, bala mamsa kshaya, mutra-vata-mala sanga,janu shoola, hrudroga, parva asthi shoola etc. Contraindications of niruha bastiAjeerna, athisnigdha, kshudhartha, vamita, virikta, pandu, arochaka, amadosha, kshataksheena, alpavarcha etc. Indications of anuvasana bastiWhich are already mentioned under the indications of niruha basti. Contraindications of anuvasana bastiAnasthapya, navajwara, pandu, pleehodara, vishapeeta, shleepada, sthoulya, kushta,prameha etc.Basti yantra199Basti yantra contains two parts. They are;i.Basti netraii.Basti putaka
  • 88.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          70  Basti netraThis is nalika which is connected to the basti putaka, is measures about 12 angulis (formore than 20 years aged patients and for bellow 20 years different size is mentioned)and it is having 2-3 karnikas.Basti putakaIt is made up of bladder of animals or plastic bags or thick cloth or rubber bag.Yoga-ayoga-atiyoga lakshanas of basti200,201Niruha basti Samyak niruha lakshanasPrasrushta vit-mutra-vata, ruchi vriddhi, agni vriddhi, ashaya laghuta, roga upashanti,prakruti sthapanashareera laghuta, upachaya. Ayoga niruha lakshanasRuja in shira-hrudaya-nabhi-basti-guda-medhra or yoni, shotha, pratishyaya, gudakartika, hrullasa, vata-mutra sanga, aruchi, shareera jadyata. Atiyoga niruha lakshanasAngasupti, angamarda, klama, kampa, nidra, dourbalya, tama pravesha, unmada,hikka. Anuvasana basti Samyak anuvasana lakshanasSnehayukta shakrut pravritti, raktadi dhatu vruddhi, indriya prasada, samyak swapna,shareera laghuta, bala vrudhi, vega swapravruti, na osha and chosha.
  • 89.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          71   Ayoga anuvasana lakshanasRuja in adhoshareera- udara- baahu-prushta, rukshata and kharatva of shareera,avarodha of mutra and vata, vishtabdhata of anila-vata-mutra. Atiyoga anuvasana lakshanasHrullasa, moha, klama, sada, murcha, vikartika, daha, pravahana, arti, pipasa.Basti karmukataThe basti karmukata which is explained in different classics are as follows.When Basti is administered, the basti dravyas enters the pakwashaya which is themain Sthana of Vata Dosha, there by sub siding the vitiated vata and destroys vikaras,since vata dosha is responsible for all the vikaras. By sub siding the Vata, all Vikaraslocated in the other parts of the body are also destroyed. This is better understood withthe help of a simile that when the root of a plant is destroyed then naturally the stem,branches, sprouts, fruits, leaves are destroyed.Commentator Chakrapani has quoted that Guda is the Mula of the body where allSiras are located. So the basti dravyaas reaches siras and performs its functions. 202The action of basti dravyas are illustrated with a simile, just as a tree fed with water atits roots, puts forth green leaves and delicate sprouts, and in due course of time growsinto a big tree, full of blossom and fruits, similarly the basti dravyas reaches all partsof the body and does its functions.This is further elaborated in sushruta samhita andstates that The veerya of basti dravya reachs all over the body through the srotas in thesame way as the water poured at the root of the plant reaches upto leaves. Eventhough basti dravyas quickly comes out alone or with mala, their veerya acts over thewhole body by the action of Apana and the other Vayu. This action takes place just
  • 90.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          72  like sun draws moisture from the earth. The method of administration of anuvasanabasti is as follows. The administration of 1stbasti does the snehana of basti andvankshana. The properly administered 2ndbasti tends to restore the vayu in themurdha bhaga to its normalcy. The 3rdbasti increases the bala and varna. The 4thand5thanuvasana basti does the snehana of rasa and rakta. The 6thand 7thbasti thennourishes the mamsa and meda. The 8thand 9thbastis nourishes the asthi and majja.During the intervals the niruha basti should be given. 203Basti dravyas in Pakvashaya acts on whole body in the same way as that of sun, thoughplaced in the sky, causes evaporation of water on the earth.The Virya (potency) ofcollective Basti drug is first taken up by Apana Vayu, i.e. it acts or influences the Gunasof Apana Vayu with which it comes in contact first.Consequently the Samana Vayu isalsoaffected followed by Vyana, Prana and Udana. By the Gunas of Basti Dravya, thevitiatedVayu regains their normal state and supports the body. They also bring vitiatedPitta andKapha in their normal state, and the five types of Vayu nourishs their respective Sharira-Bhuta Guna.The Virya (potency) of Dravya (substance) is propogated by the Vyana inTiryak or lateral direction, by the Apana in downward direction and in upward directionby Prana, just as water pipes carry water to the different parts of the field similarlythe“Harini” (Channels) carry the Gunas of the Basti Dravya to every part the body, henceBasti which is appropriate will with the help of Vata, Pitta and Kapha through the Siraswill spread all over the body and cures even the most difficult disease. 204
  • 91.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          73  DRUG REVIEWThe drugs which are used in this study are Trikatu churna, Panchatikta ghrita and Balaghrita.1. Trikatu churna has been used for amapachana. The ingrediants of which areexplained below. 205,206Table No.16: Showing the Properties of Trikatu DrugSl.noName LatinnameRasapanchakaKarmas PartsusedChemicalcomposition1. Shunti ZingiberofficinaleRasa: Katu  Guna:Laghu,snigdha Veerya:Ushna Vipaka:Madhura Doshaghnata: Kapha-vatashamaka Shothahara,vedanasthapana,rochana,shulaprashamanaKanda Zingiberin,zingiberol,gingerin2. Pippali PiperlongumRasa: KatuGuna:Laghu,snigdha,teekshnaVeerya:AnushnasheetaVipaka:MadhuraDoshaghnata:Kapha-vatashamakaDeepana,vatanulomana,shulaprashamanaPhala,mulaPiperin,piplasterol
  • 92.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          74  3. Maricha PipernigrumRasa: Katu  Guna:Laghu,teekshna Veerya:UshnaVipaka:Katu  Doshaghnata: Vata-kaphashamakaLekhana,deepana,pachana,vatanulomanaPhala  Piperin,piperdine 2. Panchatikta (Guduchi, Nimba, Vaasa, Kantakari, Patola), Bala, Godugda, Goghrita,Shatapushpa, Madhu and Saindhava are used for basti . The explanations of thesedrugs are given below. 207.208Table No.17: Showing the Properties of Panchatikta & BalaSl.noName LatinnameRasapanchakaKarmas PartsusedChemicalcomposition1. Guduchi   Tinosporacordifolia Rasa:Tikta,kashaya Guna:Guru,snigdha Veerya:UshnaVipaka:MadhuraDoshaghnata:Tridoshashamaka Vedanasthapana,deepana,pachana,rasayana Kanda Berberin,giloin,tinosporin2. Nimba  Azadirectaindica Rasa:Tikta,kashaya Guna:Laghu  Veerya:Jantughna,dahaprashamana,vedasthapana,grahi Tvak,patra,pushpa, beeja Nimbin,nimbidin,nimbosterol 
  • 93.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          75  Sheeta Vipaka:Katu DoshaghnataKapha-pittashamana 3. Vaasa   Adhatodavesica Rasa:Tikta,kashaya Guna:Ruksha,laghu Veerya:Sheeta Vipaka:Katu  Doshaghnata:Kapha-pittashamana Shothahara,vedasthapana,stambhana Mula ,patra,pushpaVasicine,adhatodicacid 4. Kantakari Solanumxanthocarpum Rasa:Katu,tikta Guna:Laghu,ruksha,teekshna  Veerya:UshnaVipaka:Katu  Doshaghnata:Kapha-vatashamana Deepana,pachana,shothahara PanchangaSolasinine,carpesterol,solasodine 5. Patola   Trichosanthes dioica Rasa:Tikta Guna:Laghu,ruksha Veerya:Deepana,pachana,anulomana,shotahara Phala,patra,mula Trichisanthin,cucurbita 
  • 94.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          76  Ushna  Vipaka:Katu  Doshaghnata:Kapha-pittashamaka 6. Bala Sidacardifolia  Rasa:Madhura Guna:Laghu,  picchila snigdha,  Veerya:Sheeta Vipaka:madhura Doshaghnata:Vata-pittashamaka Balya,vedasthapana,bruhmana Mula   Ephidrin,hypaphorine Godugda 209,210Properties and actionRasa: MadhuraGuna: Mridu, snigdha, slakshana, picchila, guru, manda, prasannaVeerya: SheetaVipaka: MadhuraDoshagnata: Vata-pitta shamakaKarmas: Jivaneeyam, Preenanam, Rasayanam, Brimhanam, Vrishyam, Medhya,Balya, Deepaniya.Chemical composition: 87.3% water,3.9% milk fat,8.8% solids- not fat, Protein –
  • 95.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          77  3.25%, Lactose – 4.6%, Minerals – 0.65% - Ca, P, Mg, K, Na, Zn, CO, Fe, Cu,sulphates, bicarbonates, Acid – 0.18% - citrates, formates, acetate, lactate, oxalate.,Enzymes – peroxidase, catalase, phosphatase, lipase., Gases – oxygen, nitrogen.,Vitamins – A, C, D, thiamine, riboflavin, others.Goghrita211,212Biological name: Bos taurusProperties and actionRasa: MadhuraGuna: ,Guru, Snigdha, Mrudu, Yoghavahi,Veerya: SheetaVipaka: MadhuraDoshagnata: Vata-pitta shamakaKarmas: Jeevaniyam, Rasayanam, Medhya, Vishanashaka, Chakshushya,Arogyakara,Vrushya,Chemical composition: Triglyceride (1) Saturated: Short chain (%) 37.6 Butyric 8.8,Long chain (%) 62.4 Caproic 3.5Trisaturated (%) 39.0 Caprylic 2.2, High Melting 4.9Capric 3.0, Partial glyceride : Lauric 8.8Diglycerides (%) 4.3 Myristic 9.9,Monoglycerides (%) 0.7Palmitic 26.1, Phospholipids : Stearic 9.1Total cholesterol(mg%) 330.0 High Sat 1.0, Lanosterol (mg%) 9.32 (2) Unsaturated, Lutein(microg/g 4.2 Lower unsaturated 1.8, Squalene (microg/g 59.2 Hexadecenoic 2.8,Carotene 7.2 Oleic 24.7,Vit. A 9.2 Unsat. Polyethenoid 3.5, Vit. E 30.5.
  • 96.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          78  Shatapushpa 213,214Botanical name: Anethum sowaProperties and actionRasa: KatuGuna: Laghu, Teekshna,Veerya: UshnaVipaka: KatuDoshaghnata: Vata-kapha shamakaKarmas: Deepana, vedanasthapana, shothahara, anulomanaParts used:PhalaChemical composition: Carvone, limonene, cugenol.Madhu215,216Bilological name: ApisProperties and actionRasa: Madhura, kashayaGuna: Sheeta, Laghu, ruksha,Veerya: UshnaVipaka: KatuDoshaghnata: Tridosha shamakaKarmas: Chakshushya, vishaharaChemical composition: glucose, sucrose, alkaloids, iron, wax volatile oil, water.
  • 97.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          79  Saindhava 217,218Biological name: Rock saltProperties and actionRasa: LavanaGuna: Laghu, snigdhaVeerya: SheetaVipaka: MadhuraDoshagnata: Tridosha shamakaKarmas: Deepana, pachana, rochaka, chakshushya, hrudya.Chemical composition: Potassium, Chlorides.
  • 98.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          80  MATERIALS AND METHODSIt is essential to mention the materials and methods used for the study based onwhich the literary and clinical work has been carried out. The materials used for thestudy were categorized in to following three headings.Materials1. Literary2. Drugsa. Deepana- Pachana: Trikatu churnab. Abhyangartha : Ksheerabala tailac. Avuvasanartha :i. Panchtikta ghrita (Group-A)ii.Bala ghrita (Group-B)d. Niruhartha: Group-A: MadhuSaindhavaPanchatikta ghritaShatapushpa kalkaPanchatikta ksheera pakaGroup -B: MadhuSaindhavaBala ghritaShatapushpa kalkaBalamula ksheera paka
  • 99.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          81  3. Instruments : i. Douche setii.Enema Syringeiii.Rubber catheterCollection of materialsA) Literary: The literary source for the present study was obtained from vedicscriptures, classical texts of Ayurveda, western medical text books, published articlesin reputed journals and also from the various media like internet followed byretrospective study of related research works.B) Drugs Panchatikta ghrita, bala ghrita, panchatikta kwatha churna, balamula kwathachurna and shatapushpa kalka was purchased from Sri DharmasthalaManjunatheshwara Ayurveda Pharmacy, Kuthpady, Udupi – 574 118. Trikatu churna and ksheerabala taila was taken from Government AyurvedaMedical College & Hospital, Mysore. Honey was purchased from B.R. hills, Chamarajanagar district. Saindhava lavana was purchased from Govindraj setty & sons, D.D.Urs. RoadMysore. Fresh Ksheera was purchased from Nandini dairy Mysore.C) InstrumentsDouche set (Basti pranidhanartha)Douche set contents:1. Douche can- with 1000ml capacity
  • 100.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          82  2. Douche tube with 2 openings and length about 41/2 inches long and 6mm diameter.3. Douche F set containing two units 1stunit which is attached to the douche tube, ithas a valve at proximal end to maintain the flow.4. Second unit which is attached to the 1stunit at proximal end and distal end is bluntand is has got two lateral and one distal openings, both will measure about fourinches long and one and half mm diameter.5. Assembly and calibrations of douche set.i. All the units of douche set were properly sterilized and dried.ii. Douche tube is connected firmly to the exit nozzle at the bottom of the douche can.iii. The distal end of the tube was properly conncted to the 1stunit of ‘F’ set whichconnects the wall.iv. Nozzle part of the douche ‘F’ set was connected with 1stunit of the ‘F’ set.Collabartion of the Douche set1. The prepared basti dravya was carefully poured into the douche can and held itvertically.2. The valve was opened and the drawn basti dravya was allowed to flow through thetube and ‘F’ set easily.3. Precaution was taken to remove all the air present in tube and ‘F’ set.4. Keeping it vertical the basti dravya was made to flow till it reaches the requiredlevel marked on douche can.5. Then the valve was closed.
  • 101.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          83  MethodologyBasti dana vidhi- Basti dana vidhi includes purva karma, pradhana karma and paschatkarma.Purva karma1. Examination of patients: Dosha, oushadha, desha, kala, satmya, agni, sattva, oka,vaya and bala, are examined before administration of basti.2. Preparation of the medicine.3. Matra nirnaya: Matra of anuvasana and niruha basti was fixed to 80ml and 600mlrespectively. The ingredients are as follow.Anuvasanartha dravyai.For Group A: Panchatikta ghrita - 80mlii. For Group B: Balaghrita -80ml.Niruhartha dravyai.For Group-AMadhu- 50mlSaindhava- 5gmPanchatikta ghrita- 80mlShatapushpa kalka- 5gmPanchatikta ksheera paka- 450mlTotal -600ml
  • 102.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          84  ii. For Group-BMadhu- 50mlSaindhava- 5gmBala ghrita- 80mlShatapushpa kalka- 5gmBalamula ksheera paka- 450mlTotal – 600mlMixing of basti dravyaMixing of basti dravya is done according to the quotation‘makshikam lavanam sneham kalkam kwatham’.Deepana – PachanaThe amapachana is essential before administration of basti. Trikatu churna wasadministered for ama pachana to all the patients.Pradhana karmaThis includes basti pranidhana vidhi.Anuvasana bastipranidana vidhiSnehana & swedanaPatient was subjected for abhyanga by ksheerabala taila for 15 mins and swedana for10 mins.Basti poorva bhojanaSpecially cooked rice was administered in precise quantity before administration ofanuvasana basti.
  • 103.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          85  Procedures of basti pranidhanaAnuvasana basti procedurePosition Patient was made to lie on the table in left lateral position with left lowerextremity straight and right lower extremity flexed on knee and hip joint andasked the patient was asked to keep head on his flexed left hand. Oleation of anus was done by applying the ghrita. Patient was asked to take deep breath while administration of basti. Assembled and clabbered douche set was taken and the douche can was kept 4ftheight from the patient. Ghrita was applied to the 2ndunit of douche F set and was slowly introduced in tothe anus and valve was opened. Valve was closed when can becomes empty and some quantity of medicine was intube. Precautions were taken to avoid shivering of hands, quicker insertion and too slowinsertion. The douche F set 2ndunit was removed slowly and asked the patient was asked toremain in the same posture for 1min. After that, patient was asked to lie down in supine position and mardana was doneover the udara, paada and hasta. Then patients were advised to take rest and eliminate mala when there is an urgeand time was recorded.
  • 104.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          86  Paschat karmaBasti pratyagamana and nireekshanaa. Duration of elimination of basti is known as basti pratyagamana kala(Su.chi.38/5). The kala is one muhurtha (48 mins) for niruha basti and foranuvasana upto 24 hours and patient was kept under observation for anycomplication.b. Patients were advised to take prescribed food on feeling hungry.c. Patients were asked to avoid the following.i.Aharaja: apathya, adhika matrayukta, guru, sheeta and ati snigdha etc.ii.Vihara: maithuna, apathya vihara.Niruha basti procedure On next day morning patients were asked to eliminate mala and mootra. The patients were examined for complications if any. Ksheerabala taila abhyanga was done properly for 15mins and swedana by nadisweda for 10 mins. Niruha basti medicines were properly prepared mixed in the manner ofmakshikam lavanam sneha kalka & kwatha. Procedure of administration of basti- the anuvasana basti procedure was followedby the niruha basti, only basti poorva ahara was not administered. Like above procedure on 3rd, 5th, 7th, 9th, 11th, 13th, 14th, 15thday anuvasana bastiwas administered and on 2nd, 4th, 6th, 8th,10thand 12thday niruha basti wasadministered.
  • 105.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          87  Samsarjana karmaFor basti karma there is no such reference of samsarjana karma as advised in vamanaand virechana, but patients were advised to take restricted ahara and vihara and avoidthe pariharya vishayas for 30 days. Advised ahara are only laghu and ushna ahara,mainly dugda yukta yavagu or dugda yukta anna. Vihara – bed rest and pariharyavishayas- to avoid astamaha doshakara vishayas i.e;i.Avoid sitting, standing posture for long time.ii.Avoid excessive talking, travelling, day sleep, vega dharana, sheetopachara, atapasevana.iii. Avoid shoka, krodha.iv.Avoid akala and ahita ahara.v.Avoid astanga maithuna.
  • 106.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          88  METHODSAimThe present work was under taken for the analytical study of asthi pradoshaja vikarassupported by the study on the effect of panchatikta ksheera sarpi and bala sadhitaksheera sarpi in sandhigatavata.Objectives of the study To review in detail about asthi and asthi pradoshaja vikaras. To assess the involvement of asthi with the help of radiology (x-ray). To assess the role of asthi in manifestation of sandhigatavata. To study the role of tiktaka dravyas in the management of sandhigatavata.Research Design A comparative literary study of Ayurvedic literature on asthipradoshaja vikaraswith current updated view (western medicine). A comparative clinical study where the incidentally selected patients weresystematically allotted to Group A and B respectively.Source of the patientsPatients of either sex diagnosed as janusandhigatavata were selected from the O.P.Dand I.P.D of GAMC Hospital Mysore. A special free camp was conducted forjanusandhigatavata in the campus of GAMC Hospital Mysore.
  • 107.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          89  Selection criteria Patients were diagnosed as janusandhigatavata after preliminary examination. Patients were selected with respect to age and irrespective of sex, caste,occupation and socioeconomic status. Patients fulfilling inclusion criteria. Patients willing to participate in the study were selected by explaining them theintervention in detail.Inclusion criteria The individuals having janusandhigatavata lakshanas will be selected. The individuals yogya for basti will be selected. The individuals of either sex between the age group 30-60 years will be selected.Exclusion criteria Any other systemic disorders which interferes the course of treatment will beexcluded. Pregnant women will be excluded.Diagnostic criteriaSubjective parameters Vedana Shotha Atopa Stabdhata
  • 108.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          90  Objective parameters Antalogic gait Osteophytes Bony swelling around the jointSampling MethodSystemic method was adopted for group A and B, patients No.1 and 2 respectivelywere fixed as a starting number and uniform difference of the two patients weremaintained for each group till the required size of 15 patients for each group wasattained.InvestigationFollowing investigation was performed before treatment, after treatment and at theend of the follow up to assess the severity and clinical improvement respectively. X-ray of knee joint.InterventionThe intervention of clinical study was carried according to the individual group asmentioned below.Group-A The patients of group A were administered with trikatu churna in appropriatedoses for deepana and pachana till niramavastha was attained. After attaining niramavastha patient was aubjected to abhyanga (udara, kati andjanusandhi) with ksheerabala taila followed by nadi sweda.
  • 109.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          91   The sequence of 15 bastis in the form of kala basti was administered starting fromanuvasana with panchatikta ghrita (total 9 anuvasana basti) and niruha basti withpanchatikta ksheera sarpi (total 6 niruha basti) by maintaining the proper durationbetween them and performing abhyanga and swedana before each basti. Afterpratyagamana of each basti patients were advised to take cooked rice and maintainthe pariharya vishayas.Group-B The patients of group B were administered with trikatu churna in appropriatedoses for deepana and pachana till niramavastha was attained. After attaining niramavastha patients were subjected to abhyanga (udara, kati andjanusandhi) with ksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form of kala basti were administered startingfrom anuvasana with bala ghrita (total 9 anuvasana basti) and niruha basti withbala sadhita ksheera sarpi (total 6 niruha basti) by maintaining the proper durationbetween them and performing abhyanga and swedana before each basti. Afterpratyagamana of each basti patients were advised to take cooked rice and maintainthe pariharya vishayas.Assessment criteriaThe results were evaluated by subjective and objective criteria mainly based onclinical observation by grading method.Shoola /painGrade0: No pain.
  • 110.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          92  Grade1: Mild pain (working for 8hrs pain starts & reduces after 1/2hr rest)Grade2: Moderate pain (working for 4hrs pain starts & reduces after 1hr rest)Grade3: Severe pain (working for an 1hr pain starts &does not subside even aftertaking rest)Shotha/swellingGrade0: No swelling.Grade1: Mild swelling (working for 8hrs swelling starts & reduces after 1/2hr rest)Grade2: Moderate swelling (working for 4hr swelling starts & reduces after 1hr rest)Grade3: Severe swelling (working for an 1hrs swelling starts &does not subsides evenafter taking rest)Stabdatha/stiffnessGrade0: No stiffness.Grade1: Mild stiffness (knee flexion upto 100-120 degree & no difficulty in walking)Grade2: Moderate stiffness (knee flexion upto 80-100 degree & slight difficulty inwalking)Grade3: Severe stiffness ((knee flexion upto 60-80 degree & difficulty in walking)Atopa/crepitusGrade0: No crepitation.Grade1: Palpable crepitusGrade2: Palpable + Audible crepitusGrade3: Crepitus always audible
  • 111.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          93  X-ray changesGrade0: Normal knee joint (no loss of cartilage & no deformation).Grade1: Mild changes (some loss of articular cartilage, minute osteophytes, jointspace narrowing <3mm)Grade2: Moderate changes (rough edges, definite osteophytes, moderate boneattrition <5mm)Grade3: Severe changes (definite deformity of bone ends, definite osteophytes withsevere joint space >5mm)Overall assessmentBased on the grading given in the assessment criteria the improvement will beassessed as below. Complete remission, all signs and symptoms relieved. Marked improvement, all signs and symptoms brought to the lower grading thanbefore. Moderate improvement, at least three signs and symptoms brought to the lowergrade than before. Minor improvement, at least two signs and symptoms brought to the lower gradethan before. No improvement, all signs and symptoms persisting.Statistical Analysis to assess Individual and comparative effects of the groups wasdone using Chi- Square test, Contingency Co-efficient Test and Descriptive statistics.All the statistical methods were carried out through the SPSS (Statistical presentation
  • 112.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          94  system software) for Windows (version 16.0).Data CollectionData was collected before treatment, after treatment and at the end of follow up.
  • 113.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          95  OBSERVATIONSTotal 30 patients coming under the inclusion criteria were randomly taken for theclinical study and made into group A and B. Observations in the present study weredone in three stages.i) General Observations for all the patientsii) Observations during interventioniii) Observation on resultsGeneral observationsIn the present study total 32 patients were registered, out of which 2 patientsdiscontinued the treatment during various stages of the clinical study and with 30patients the clinical study was completed.AgeTable No.18: Showing distribution of patients according to AgeAge No. of patients Percentage (%)30-40yrs 5 16.7%41-50yrs 15 50.0%51-60yrs 10 33.3%In present study there was limitation for age. The patients of the age between 30-60years were selected. It was found that the patients of age group between 30-40 yearswere 5 (16.77%) 41-50 years were 15 (50.0%) and 51-60years were 10(33.3%).
  • 114.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          96  SexTable No.19: Showing distribution of patients according to SexSex No. of patients Percentage (%)Males 9 30.0%Females 21 70.0%In the present study it was observed that more number of patients were females i.e.21,(70.0%) and male patients were 9 (30.0%).Marital statusTable No.20: Showing distribution of patients according to Marital statusMarital status No. of patients Percentage (%)Married 29 96.66%Unmarried 1 3.33%In the present study it was observed that majority of patients were married .i.e. 29(96.66%) and unmarried were only 1 (3.33%).EducationTable No.21: Showing distribution of patients according to EducationEducation No of patients Percentage (%)Illiterate 8 26.66%Primary school 7 23.33%
  • 115.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          97  Middle school 3 10.0%Higher school 6 20.0%Graduate 4 13.33%Postgraduate 2 6.66%In the present study it was found that the majority of patients were illiterate i.e., 8(26.66%) , 7(23.33%) had completed primary education ,3 (10.0%) had completedmiddle school education, 6(20.0%) had completed higher school education ,4(13.33%) were graduates and 2 (6.66%) were post graduates.ReligionTable No.22: Showing distribution of patients according to ReligionReligion No. of patients Percentage (%)Hindu 29 96.660%Muslim 1 3.33%In the present study it was observed that majority of patients were from Hinducommunity i.e., 29 (97.0%) and from Muslim community were only 1(3.0%).Socio-economic statusTable no.23: Showing distribution of patients according to Socio-economic statusSocio-economic status No. of patients Percentage (%)Poor class 5 16.66%Middle class 23 76.66%
  • 116.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          98  Rich class 2 6.66%In the present study it was found that majority of the patients belonged to middle classi.e., 23 (76.66%), 5 (16.66 %) patients belonged to poor class and 2 (6.66%) patientsbelonged to rich class.OccupationTable No.24: Showing distribution of patients according to OccupationOccupation No.of patients Percentage (%)Farmer 6 20.0%Housewife 15 50.0%Professional 9 30.0%In this study it was observed that majority of the patients were housewives i.e 15(50.0%) professionals were 9 (30.9%) and farmers were 6 (10.0%).HabitatTable No.25: Showing distribution of patients according to HabitatHabitat No. of patients Percentage (%)Urban 18 60.0%Rural 12 40.0%In the present study it was found that the patients from urban residency were morei.e., 18 (60.0%) and patients belonging to Rural were 12 (40.0%).
  • 117.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          99  DietTable No.26: Showing distribution of patients according to DietDiet No. of patients Percentage (%)Vegetarian 13 43.33%Mixed 17 56.66%In the present study it was found that the patients with vegetarian diet were 13(43.33%) and mixed diet were 17 (56.66%) both were equally present.PrakrutiTable No.27: Showing distribution of patients according to PrakrutiPrakruti No. of patients Percentage (%)Vatapittaja 13 43.33%Pittakaphaja 13 43.33%Kaphavataja 4 13.33%In the present study among 30 patents 13 patients (43.33%) were of Vata pittaprakruthi, 13 patients (43.33%) were of pittakaphaja prakruthi and 4 patients(13.33%) were of kapha vataja prakruthi.SaraIn the present study all the 30 patients (100%) were having madhyama sara.Samhanana
  • 118.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          100  Table No.28: Showing distribution of patients according to SamhananaSamhanana No.of patients Percentage(%)Pravara 2 6.66%Madhyama 21 70.0%Avara 2 6.66%Among 30 patients 21 patients (70.0%) were of madhyama samhanana, 2 patients(6.66%) were of avara samhanana and 2 patients (6.66%) were of pravarasamhanana. PramanaTable No.29: Showing distribution of patients according to PramanaPramana No. of patients Percentage (%)Madhyama 26 86.66%Avara 4 13.33%In the present study among the 30 patients 26 patients (86.66%) were havingmadhyama pramana and 4 patients (13.33%) were having avara pramana.SatvaTable No.30: Showing distribution of patients according to SatvaSatva No. of patients Percentage (%)Pravara 1 3.33%Madhyama 23 76.66%Avara 6 20.0%
  • 119.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          101  Among 30 patients 22 patients (76.66%) were of madhyama sattva, 7 patients (20.0%)were of avara sattva and 1 patient (3.33%) had pravara sattva.SatmyaIn the present study all the 30 patients (100%) were having madhyama satmya.KoshtaTable No.31: Showing distribution of patients according to KoshtaIn the present study most of the patients i.e., 24(80.0%) of them had madhyamakoshtha, while only 3(10.0%) of them had krura koshtha and 3(10.0%) had mrudukoshtha.AgniTable No.32: Showing distribution of patients according to AgniAgni No.of patients Percentage (%)Manda 9 30.0%Teeksha 4 13.33%Sama 2 6.66%Vishama 15 50.0%Koshtha No. of patients Percentage (%)Krura 3 10.0%Madhyama 24 80.0%Mrudu 3 10.0%
  • 120.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          102  Among 30 patients 15 patients (50.0%) had Vishamagni, 9 patients (30.0%) hadmandagni and 4 patients (13.33%) had teekshna agni and 2 patients (6.66%) hadsamagni.BalaTable No.33: Showing distribution of patients according to BalaBala No.of patients Percentage (%)Pravara 1 3.33%Madhyama 28 93.33%Avara 1 3.33%In the present study most of the patients i.e., 28(93.33%) of them had madhyama bala,while only 1 patient (3.33%) of them had pravara bala and 1patient (3.33%) had avarabala.Vyayama shaktiTable No.34: Showing distribution of patients according to VyayamaVyayama shakti No.of patients Percentage (%)Pravara 1 3.33%Madhyama 28 93.33%Avara 1 3.33%Among 30 patients, 28 patients (93.33%) had madhyama vyayama shakti, 1 patient(3.33%) had avara vyayama shakti and 1 patient (3.33%) had pravara vyayamashakti.
  • 121.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          103  Joint involvementTable No.35: Showing distribution of patients according to Joint involvementSide involvement No. of patients Percentage (%)Unilateral 2 13.33%Bilateral 28 86.66%Among 30 patients, 28 patients (86.6%) had bilateral joint involvement and only 2patients (13.3%) had unilateral involvement of joint.
  • 122.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          104  ObservationsIllustration No.1: Showing age wise distribution of 30 patientsIllustration No.2: Showing sex wise distribution of 30 patientsIllustration No.3: Showing marital status wise distribution of 30 patients
  • 123.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          105  Illustration No.4: Showing education wise distribution of 30 patientsIllustration No.5: Showing religion wise distribution of 30 patientsIllustration No.6: Showing occupation wise distribution of 30 patients
  • 124.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          106  Illustration No.7: Showing habitat wise distribution of 30 patientsIllustration No.8: Showing diet wise distribution of 30 patientsIllustration No.9: Showing prakruti wise distribution of 30 patients
  • 125.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          107  Illustration No.10: Showing samhanana wise distribution of 30 patientsIllustration No.11: Showing pramana wise distribution of 30 patientsIllustration No.12: Showing satva wise distribution of 30 patients
  • 126.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          108  Illustration No.13: Showing koshta wise distribution of 30 patientsIllustration No.14: Showing agni wise distribution of 30 patientsIllustration No.15: Showing bala wise distribution of 30 patients
  • 127.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          109  Illustration No.16: Showing vyayamashakti wise distribution of 30 patientsIllustration No.17: Showing joint involvement wise distribution of 30 patients
  • 128.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          110  Observations during interventionGroup-A All the patients were presenting with varied degree of sama lakshanas. Patients received trikatu churna; thrice daily in a dose of 4gm till niramavastha wasattained. It was observed that the duration taken to attain niramavastha was 2-3 days. All the patients received Kalabasti regularly for 15 days. All the patients received panchatiktaka ghrita for anuvasana basti and pancatiktaksheera sarpi for niruha basti. The dose was adjusted to 80ml for anuvasana and 600ml for niruha basti. It was observed that pratyagamana kala was 30mins to 24 hrs for anuvasana bastiand 5mins to 40 mins for niruha basti. Patients were comfortable at the end of the treatment. There were no complications observed. Patients received samsarjana karma (pathyapathya) for 30 days.Group-B All the patients were presenting with varied degree of sama lakshanas. Patients received trikatu churna; thrice daily in a dose of 4gm till niramavastha wasattained. It was observed that the duration taken to attain niramavastha was 2-3 days. All the patients received Kalabasti regularly for 15 days.
  • 129.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          111   All the patients received bala ghrita for anuvasana basti and bala sadhita ksheerasarpi for niruha basti. The dose was adjusted to 80ml for anuvasana and 600ml for niruha basti. It was observed that pratyagamana kala was 30mins to 24 hrs for anuvasana basti and5mins to 40 mins for niruha basti. Patients were comfortable at the end of the treatment. There were no complications observed. Patients received samsarjana karma (pathyapathya) for 30 days.
  • 130.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          112  RESULTSResults based on observationsThe results on lakshanas of Janusandhigatavata before treatment, after treatment andafter follow up based on the subjective and objective parameters are explained below.Results based on subjective parametersJoint PainTable No.36: Showing results of Joint pain ( Rt Knee )SessionGroups Pain R Before After Follow upNo 0 (0%) 2(13.3%) 2(13.3%)Mild 2(13.3%) 13(86.7%) 12(80.0%)Moderate 8(53.3%) 0(0%) 1(6.7%)Group ASevere 5(33.3%) 0(0%) 0(0%)No 1(6.7%) 5(33.3%) 3(20.0%)Mild 3(20.0%) 10(66.7%) 11(73.3%)Moderate 10(66.7%) 0(0%) 1(6.7%)Group BSevere 1(6.7%) 0(0%) 0(0%)Total 30 (100 %) 30 (100%) 30 (100%)
  • 131.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          113  Table No.37: Showing Systemic measures in Joint pain (Rt Knee)Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases65045.000Group B Nominal by Nominal Contingency CoefficientN of Valid cases60545.000In Group A before treatment 5 patients had severe pain, 8 patients had moderate painand 2 patients had mild pain. After treatment 13 patients attained mild pain and 2patients attained no pain. After the follow up, 12 patients’ attained mild pain, 1patientattained moderate pain and 2 patients attained no pain.In Group B before treatment 1 patient had severe pain, 10 patients had moderate pain,3 patients had mild pain and 1 patient had no pain. After treatment 10 patients attainedmild pain and 5 patients attained no pain. After follow up, 1 patient attained moderatepain, 11 patients had mild pain and 3 patients attained no pain.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.000 in the both groups.But comparatively Group A shows high significance than Group B.
  • 132.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          114  Table No.38: Showing results of Joint pain ( Lt knee )SessionGroups Pain L Before After Follow upNo 0 (0%) 9 (60 %) 10 (66.7%)Mild 9 (60%) 6 (40%) 5 (33.3%)Moderate 5 (33.3%) 0 (0%) 0 (0%)Group ASevere 1 (6.7%) 0 (0%) 0(0%)No 1 (6.7%) 9 (60%) 8 (53.3%)Mild 7 (46.7%) 6 (40%) 6 (40.0%)Moderate 6 (40%) 0 (0%) 1 (6.7%)Group BSevere 1 (6.7%) 0 (0%) 0 (0% )Total 30 (100 %) 30 (100%) 30 (100%)Table No.39: Showing Systemic measures in Joint pain (Lt Knee)Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases58145.001Group B Nominal by Nominal Contingency CoefficientN of Valid cases52745.008In Group A before treatment 1 patient had severe pain, 5 patients had moderate painand 9 patients had mild pain. After treatment 6 patients attained mild pain and 9patients attained no pain. After the follow up, 5 patients attained mild pain and 10patients attained no pain.In Group B before treatment 1 patient had severe pain, 6 patients had moderate pain, 7
  • 133.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          115  patients had mild pain and 1 patient had no pain. After treatment 6 patients attainedmild pain and 9 patients attained no pain. After follow up, 1 patient attained moderatepain, 6 patients had mild pain and 8 patients attained no pain.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.001 in Group A andGroup B is statistically significant at P value 0.008. But Group A shows better resulthan Group B.Joint stiffnessTable No.40: Showing results of Joint stiffness ( Rt knee )SessionGroups Stiffness R Before After Follow upNo 3 (20%) 11 (73.3%) 11 (73.3%)Mild 6 (40%) 4 (26.7%) 3 (20%)Group AModerate 6 (40%) 0 (0%) 1 (6.7%)No 3 (20%) 9 (60 %) 9 (60%)Mild 6 (40%) 6 (40%) 6 (40%)Group BModerate 6 (40%) 0 (0%) 0 (0%)Total 30 (100%) 30 (100%) 30 (100%)
  • 134.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          116  Table No.41: Showing Systemic measures in Joint stiffness (Rt Knee)Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases50145.005Group B Nominal by Nominal Contingency CoefficientN of Valid cases50545.004In Group A before treatment 6 patients had moderate stiffness, 6 patients had mildstiffness and 3 patients had no stiffness. After treatment 4 patients attained mildstiffness and 11patients attained no stiffness. After the follow up, 1 patient attainedmoderate stiffness, 3 patients’s attained mild stiffness and 11 patients attained nostiffness.In Group B before treatment, 6 patients had moderate stiffness, 6 patients had mildstiffness and 3 patients had no stiffness. After treatment 6 patients attained mildstiffness and 9 patients attained no stiffness. After follow up, 6 patients had mildstiffness and 9 patients attained no stiffness.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.005 in Group A andGroup B is statistically significant at P value 0.004. But Group B shows moresignificance than Group A.
  • 135.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          117  Table No.42: Showing results of Joint stiffness ( Lt knee )SessionGroups Stiffness L Before After Follow upNo 5 (33.3%) 13 (86.7 %) 12 (80%)Mild 9 (60%) 2 (13.3 %) 3 (20%)Group AModerate 1 (6.7%) 0 (0%) 0 (0%)No 3 (20%) 12 (80%) 14 (93.3%)Mild 10 (66.7 %) 3 (20%) 1(6.7%)Moderate 1 (6.7 %) 0 (0%) 0 (0%)Group BSevere 1 (6.7 %) 0 (0%) 0 (0%)Total 30 (100%) 30 (100%) 30 (100%)Table No.43: Showing Systemic measures in Joint stiffness ( Lt knee )Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases45845.018Group B Nominal by Nominal Contingency CoefficientN of Valid cases56145.002In Group A before treatment 1 patient had moderate stiffness, 9 patients had mildstiffness and 5 patients had no stiffness. After treatment 2 patients attained mildstiffness and 13 patients attained no stiffness. After the follow up, 3 patients attainedmild stiffness and 12 patients attained no stiffness.In Group B before treatment 1 patient had severe stiffness, 1 patient had moderatestiffness, 10 patients had mild stiffness and 3 patients had no stiffness. After treatment
  • 136.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          118  3 patients attained mild stiffness and 12 patients attained no stiffness. After follow up,1 patient had mild stiffness and 14 patients attained no stiffness.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.002 in Group B andGroup A is statistically significant with P value 0.018. But Group B shows significantvalue than Group A.Joint SwellingTable No.44: Showing results of Joint swelling ( Rt knee )SessionGroups Swelling R Before After Follow upNo 8 (53.3%) 13 (86.7%) 15 (100%)Mild 5 (33.3%) 2 (13.3%) 0 (0%)Group AModerate 2 (13.3%) 0 (0%) 0 (0%)No 9 (60%) 14 (93.3%) 15 (100%)Mild 5 (33.3%) 1 (6.7%) 0 (0%)Group BModerate 1 (6.7%) 0 (0%) 0 (0%)Total 30 (100%) 30 (100%) 30 (100%)
  • 137.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          119  Table No.45: Showing Systemic measures in Joint swelling ( Rt knee )Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases45345.021Group B Nominal by Nominal Contingency CoefficientN of Valid cases43745.031In Group A before treatment 2 patients had moderate swelling, 5 patients had mildswelling, and 8 patients had no swelling. After treatment 2 patients attained mildswelling and 13 patients attained no swelling. After the follow up all the 15 patientsattained no swelling.In Group B before treatment 1 patient had moderate swelling, 5 patients had mildswelling and 9 patients had no swelling. After treatment 1 patients attained mildswelling and 9 patients attained no swelling. After follow up all the 15 patientsattained no swelling.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.021 in Group A andGroup B is statistically significant with P value 0.031. But Group A showssignificance than Group B.
  • 138.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          120  Table No.46: Showing results of Joint swelling ( Lt knee )SessionGroups Swelling L Before After Follow upNo 9 (60%) 13 (86.7%) 15 (100%)Mild 4 (26.7%) 2 (13.3%) 0 (0%)Group AModerate 2 (13.3%) 0 (0%) 0 (0%)No 9 (60%) 15 (100%) 14 (93.3%)Group BMild 6 (40%) 0 (0%) 1 (6.7%)Total 30 (100%) 30 (100%) 30 (100%)Table No.47: Showing Systemic measures in Joint swelling ( Lt knee )Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases41845.049Group B Nominal by Nominal Contingency CoefficientN of Valid cases43545.005In Group A before treatment 2 patients had moderate swelling, 4 patients had mildswelling and 9 patients had no swelling. After treatment 2 patients attained mildswelling and 13 patients attained no swelling. After the follow up all the 15 patientsattained no swelling.In Group B before 6 patients had mild swelling and 9 patients had no swelling. Aftertreatment all the 15 patients attained no swelling. After follow up, 1 patient attainedmild swelling and 14 patients attained no swelling.By observing the results, it has been noted that there was improvement seen in both
  • 139.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          121  the groups and statistically highly significant with P value 0.005 in Group B andGroup A is statistically significant with P value 0.049. But Group B showssignificance than Group A.Joint CrepitusTable No.48: Showing results of Joint crepitus ( Rt knee )SessionGroups Crepitus R Before After Follow upNo 5 (33.3%) 10 (66.7%) 7 (46.7%)Palpable 4 (26.7%) 5 (33.3%) 8 (53.3%)Group AAudible 6 (40%) 0(0%) 0(0%)No 4 (26.7%0 12 (80%) 8(53.3%)Palpable 7 (46.7%) 3 (20%) 7 (46.7%)Group BAudible 4 (26.7 %) 0 (0%) 0 (0%)Total 30 (100%) 30 (100%) 30 (100%)Table NO.49: Showing Systemic measures in Joint crepitus ( Rt knee )Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases50345.004Group B Nominal by Nominal Contingency CoefficientN of Valid cases48645.008In Group A before treatment 6 patients had audible crepitus, 4 patients had palpablecrepitus and 5 patients had no crepitus. After treatment 5 patients’ attained palpablecrepitus and 10 patients attained no crepitus. After the follow up, 8 patients attained
  • 140.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          122  audible crepitus and 7 patients attained no crepitus.In Group B before 4 patients had audible crepitus, 7 patients had palpable crepitus and4 patients had no crepitus. After treatment, 3 patients attained palpable crepitus and12 patients attained no crepitus. After follow up, 7 patient attained palpable crepitusand 8 patients attained no crepitus.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.004 in Group A andGroup B is statistically significant with P value 0.008. But Group A shows highsignificance than Group B.Table No.50: Showing results of Joint crepitus (Lt Knee)SessionGroups Crepitus L Before After Follow upNo 5 (33.3%) 14 (93.3%) 13 (86.7%)Palpable 9 (60%) 1 (6.7%) 2 (13.3%)Group AAudible 1 (6.7%) 0 (0%) 0 (0%)No 5 (33.3%) 13 (86.7%) 13 (86.7%)Palpable 9 (60%) 2 (13.3%) 2 (13.3%)Group BAudible 1 (6.7%) 0 (0%0 0 (0%)Total 30 (100%) 30 (100%) 30 (100%)
  • 141.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          123  Table No.51: Showing Systemic measures in Joint crepitus (Lt Knee)Groups Value Approx sigGroup A Nominal by Nominal Contingency CoefficientN of Valid cases51345.003Group B Nominal by Nominal Contingency CoefficientN of Valid cases48345.008In Group A before treatment 1 patient had audible crepitus, 9 patients had palpablecrepitus and 5 patients had no crepitus. After treatment 1 patient attained palpablecrepitus and 14 patients attained no crepitus. After the follow up, 2 patients attainedaudible crepitus and 13 patients attained no crepitus.In Group B before 1 patient had audible crepitus, 9 patients had palpable crepitus and5 patients had no crepitus. After treatment, 2 patients attained palpable crepitus and13 patients attained no crepitus. After follow up, 2 patient attained palpable crepitusand 13 patients attained no crepitus.By observing the results, it has been noted that there was improvement seen in boththe groups and statistically highly significant with P value 0.003 in Group A andGroup B is statistically significant at P value 0.008. But Group A shows significancethan Group B.Result based on the Objective parameterRadiological findingsX-ray was done before treatment, after treatment and after the end of follow up inGroup A and Group B. But no changes were observed radiologically in both thegroups after the treatment and after the end of follow up.
  • 142.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          124  Overall assessmentObservation was done for 45 days with 15 days treatment and 30 days withouttreatment. The results were evaluated by the parameters mainly based on clinicalobservations that are janusandhi shula, shotha, stabdhata and atopa by gradingmethod.For each follow up the scores were compared with the pre-test scores and thestatistical analysis was done.Table No.52: Showing the Overall results within the groupsGroupsResult Group A Group BMarked improvement 6(40.0%) 4(26.7%)Moderate improvement 7(46.7%) 6(40.0%)Mild improvement 1(6.7%) 5(33.3%)No improvement 1(6.7%) 0(0%)Total 15(100.0%) 15(100.0%)In the present study among the 30 patients, in Group A 6patients (40.0%) attainedmarked improvement, 7 patients (46.7%) attained moderate improvement, 1 patient(6.7%) attained mild improvement and only 1 patient (6.7%) attained noimprovement. In Group B, 4 patients (26.7%) attained marked improvement, 6patients (40.0%) attained moderate improvement and 5 patients (33.3%) attained mildimprovement.
  • 143.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          125  Table No.53: Showing the Overall results of the groupsResult No. of patients Percentage (%)Marked improvement 10 33.3%Moderate improvement 13 43.3%Mild improvement 6 20.0%No improvement 1 3.3%Total 30 100.0%Table No.54: Showing the significance of overall resultsGroup A Group BChi-square test .042 .819In the present study among 30 patients, 10 patients (33.3%) attained markedimprovement, 13 patients (43.3%) attained moderate improvement, 6 patients (20.0%)attained mild improvement and only 1 patient (3.3%) attained no improvement.By observing the overall results, it has been noted that there was improvement seenin both the groups and statistically highly significant with P value P value 0.042 inGroup A and Group B is statistically non significant with P value 0.819. By this, itcan be concluded that Group A has got significant result than Group B.
  • 144.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          126  ResultsIllustration No.18: Showing results of Joint pain (Rt Knee) Illustration No.19: Showing results of Joint pain (Lt Knee)  
  • 145.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          127  Illustration No.20: Showing results of Joint stiffness (Rt Knee) Illustration No.21: Showing results of Joint stiffness (Lt Knee)   
  • 146.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          128  Illustration No.22: Showing results of Joint swelling (Rt Knee) Illustration No.23: Showing results of Joint swelling (Lt Knee)  
  • 147.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          129  Illustration No.24: Showing results of Joint crepitus (Rt Knee) Illustration No.25: Showing results of Joint crepitus (Lt Knee) 
  • 148.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          130  Illustration No.26: Showing overall results within the groups Illustration No.27: Showing overall results in 30 patients
  • 149.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          131  DISCUSSION Discussion is the interpretation of observations and results obtained from theclinical study along with the review. So the relevant points are discussed here.Discussion on the title“Concept of Asthi Pradoshaja vikaras w.s.r to Management of Sandhigatavata.”Ayurveda is a science of life, which is framed on many concepts. All these conceptsare proved and established facts. The methodology adopted to establish these facts washolds good for that respective era. In the present era due to globalization of Ayurvedaand to easily convince the common people, these olden techniques are not sufficient.sothese old principles should be restablished with the help of modern advanced technology.As Asthi is one among the sapta dhatu and it does the function of dharana. The normalcyand abnormalcy of Asthi can easily be visualized with the help of so many techniques,one among them is X-ray. By this extra growth, fracture, increase of porocity,calcification etc deformities which can be ruled out and this is one among best technologyto rule out sandhigatavata. Sandhigatavata is a common joint disorder occurs due to thedeformity mainly in the Asthi. As per the World Health Organization OA is the secondcommonest musculoskeletal problem in the world. The reported prevalence of OA from astudy in rural India is 5.78%. Hence the present study is undertaken to restablish theconcept of Asthi pradoshaja vikaras with the help of radiology and supported byconsidering sandhigatavata as an Asthi pradoshaja vikara treating as per the chikitsa sutraexplained in the Asthi pradoshaja vikaras.
  • 150.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          132  Discussion on Asthi pradoshaja vikarasDiscussion on definitionWhen the Asthi gets vitiated extremely by the vata dosha along with other doshasand changes its natural form and leads to a specific condition which is known as Asthipradoshaja vikaras.Classification of Asthi pradoshaja vikarasDepending upon involvement of different parts, the Asthi pradoshaja vikaras can beclassified into four types. They are; Asthi pradoshaja vikaras due to involvement of AsthiE.g; Adhyasthi, Asthi shoola. Asthi pradoshaja vikaras due to involvement of DantaE.g; Danta shoola, Danta bheda. Asthi pradoshaja vikaras due to involvement of Kesha, smashru and lomaE.g; Indralupta, Khalitya, Palitya Asthi pradoshaja vikaras due to involvement of NakhaE.g; KunakhaDiscussion on nidanaThe nidanas which are mentioned for Asthi pradoshaja vikaras can be classified asfollows.1. Aharaja nidana: vatala ahara.
  • 151.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          133  2. Viharaja nidana: ativyayama, ati vighattana.3. Manasika nidana: ati sankshobhaAharaja nidanaVatala ahara and vihara sevana: Over indulgence in ruksha, laghu and alpa matraahara aggravates vata in the shareera. The chief qualities of vata are ruksha, laghu,sukshma etc. these are similar to each other. So it will lead to vata vitiation. Viharaslike ati chesta, abhigata, etc cause the vata vitiation. When the vitiated vata getslodges in Asthi, it leads to different disorders.Viharaja nidanaAti vyayama: Ativyayama means excessive shareera ayasa janaka karma i.e morethan ardha shakti vyayama. When person performs the ati vyayama continuously itleads to the increase in laghu, ruksha, sukshma, teekshna guna in the shareera. Later itinvariably leads to vata vitiation. Because vata havs the same gunas like laghu,ruksha, sukshma etc on the basis of samanya siddhanta. As per the contemporaryscience, excessive exercise causes the injury to the body like bone fracture, bone painetc.Ati vighattana: ati vighattana means excessive movements or separation or injury. Itdirectly affects the particular part of the body. It is considered as the abhighatajanidana. Here it directly affects the Asthi dhatu initially later vitiation of vata doshatakes place due to ashraya ashrayee bhava. Then it leads to different disorders likeAsthi bheda, Asthi shoola etc. even in the contemporary science, it is mentioned thatexternal injury is one of the main causative factor for the manifestation of bone
  • 152.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          134  disorders like osteoarthritis etc.Manasika nidanaAti sankshobha: ati sankshobha means excessive manasika kshobha (mental stress ordisturbance). When the person is under mental stress, then it will leads to increase inrajo guna in the shareera. As per the classics, rajo guna is one among the vata guna.So it invariably increases the vata dosha in the shareera. As per the contemporaryscience mental disturbance is the cause for all most all the disorders.Discussion on poorvarupaAll the Asthi pradoshaja vikaras have avyakta or alpa vyakta lakshanas aspoorvarupa. So it is difficult to consider particular poorvarupa for all Asthi pradoshajavikaras.e.g, Danta shoola: mild tooth ache can be considered has a poorva rupa for dantashoola.Kunakha: mild discoloration can be considered has a poorva rupa for kunaka.Discussion on rupaAdhyasthi (Bone spur): It refers to additional bone or extra bone. It generally formsin response to pressure, rubbing, or stress that continues over a long period of time. Itis usually smooth, but it can cause wear and tear or pain if it presses on the otherbones or soft tissues. Bone spurs usually limit joint movement and typically causepain. Has such bone spur may originate anywhere in the body like ankle, knee,shoulder etc. e.g; calcaneal spur.
  • 153.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          135  Adhidanta (Hyperdontia): It refers to additional or extra teeth. Which appear inaddition to the regular number of teeth and is mal-formed. There is evidence ofhereditary factors along with some evidence of environmental factors leading to thiscondition. Many supernumerary teeth never erupt, but they may delay eruption ofnearby teeth or cause other dental problems.Danta bheda and Danta shoola (Odontalgia): As per Ayurvedic classics these aretwo different disorders. Here patient suffers from different form of pain like cutting;pricking etc. This pain can often be aggravated somewhat by chewing or by hot orcold temperature. Causes of tooth ache may also be a symptom of the heart, such asangina or myocardial infarction due to referred pain.Asthi bheda, Asthi shoola and Asthi toda (Bone pain): As per Ayurvedic classicsthese are the different Asthi pradoshaja vikaras. Details regarding each disorder arenot available in any of the classics. The individual feels different forms of pain in thebone due to different disorders. In the contemporary science there are conditionscharacterized by bony pain which includes both acute and chronic. Chronic pain willbe present in some disorders like Osteoarthritis; Paget’s disease etc. Acute pain willbe present in the fractures.Shyavadanta (Tooth discoloration): The blackish or kapila varnata of the tooth iscalled as shyavadanta. Tooth discoloration is caused by multiple local and systemicconditions. Extrinsic dental strains are caused by poor oral hygiene etc. Intrinsicdental strains are caused by dental materials (eg, tooth restorations), dental conditionsand caries, trauma, infections, medications, nutritional deficiencies and otherdisorders (eg, complications of pregnancy, anemia and bleeding disorders, bile duct
  • 154.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          136  problems), and genetic defects and hereditary diseases (eg, those affecting enamel anddentin development or maturation).Krimidanta (Dental caries): In this condition danta becomes Krishna varnata, chidrayukta, sravayukta or sometimes with shoola. When it is neglected then it leads tocomplications like danta vidradi. Dental caries is a disease where bacterial processesdamage hard tooth structure, if left untreated, the disease can lead to pain, infectionand in severe cases death may occur. When the pH at the surface of the tooth dropsbelow 5.5, demineralization proceeds faster than remineralization (meaning that thereis a net loss of mineral structure on the tooths surface). This results in the ensuingdecay.Indralupta (Alopecia areata): The partial or complete loss of hair from all over thebody is called as indralupta. It can be correlated to alopecia areata or some times it iscalled as spot baldness, in which hair is lost from the localized area or all areas of thebody, usually from the scalp. This disease may be limited only to the beard, in whichcase it is called alopecia areata barbae. The area of hair loss may tingle or be veryslightly painful. It occurs more frequently in individuals who have affected familymembers, suggesting that heredity may be a factor.Khalitya (Alopecia areata universalis): The condition in which partial loss of hairtakes place in the scalp and there is no chance for regrowth of hair. This condition canbe correlated to alopecia universalis. If all body hair, including pubic hair is lost thenit called s alopecia areata universalis. Alopecia universalis can occur at any age, and iscurrently believed to be an autoimmune disorder. Alopecia Universalis may be acuteand short-lived or remain permanently.
  • 155.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          137  Palitya (Grey hair): When the hair becomes kapila varna in the early age then it iscalled as palitya. This condition can be correlated to the premature grey hair. Early orpremature greying of hair is basically hereditary and other causes are stress, anxietyand malnutrition. An individual who is under a prolonged period of stress and anxietymay notice, over a period of time, white hairs gradually appearing. Malnutrition,worry, shock, deep sorrow, tension and other similar conditions may also slow downthe production of melanin resulting in grey hair.Kunakha (Onychogyphosis): This is a condition in which daha, paka, vedana andasita varnata will be present in the nakha. This can be correlated to theonychogryphosis. These types of nails are caused due to damage to the cells that growthe nail. Discomfort can result when footwear or even bed sheets press on thickenednails, because the surface beneath the nails (the nail plate) is also thickened andtender. The thickening of a nail, which is common in older people, may be caused byseveral factors including injury (such as that caused by ill-fitting shoes), infection,poor blood supply, diabetes, or inadequate intake of nutrients.Discussion on sampraptiProbabal pathogenesis which is involved in the manifestation of Asthi pradoshajavikaras can be understood by this flow chart.
  • 156.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          138  Flow chart No.2: Showing the vishesha samprapti of Asthi pradoshaja vikarasNidanaAti vyayama Ati sankshobha Ati vighattana Vatala ahara & viharaVata dushti Vata dushti Asthi dushti Vata dushtiAsthi dhatu dustiDosha dushya sammurchanaSthaana samshraya in particular angaavayava(Asthi, Danta, Kesha, Nakha)Particular Asthi pradoshaja vikaras (Adhyasthi,Danta shoola, Khalitya, Kunakha) 
  • 157.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          139  Discussion on upashaya and anupashayaOn careful observation of Asthi pradoshaja vikaras, we find that eall are mainlyrelated to vitiation of vata dosha only. So the upashaya and anupashaya which arementioned for vatavyadhis can also be considred for Asthi pradoshaja vikaras. Forexample; abhyanaga, swedana, ushna ahara, ushna rutu etc are the upashaya.Anashana, alpashana, sheeta rutu, vyayama etc are the anupashaya.Discussion on sadhyaasadhyataTable No.55:- Showing sadhyaasadhyata of Asthi pradoshaja vikarasVyadhis Asadhya Yapya KashtaDhaalana + - -Bhanjanaka + - -Shyavadanta + - -Tridoshaja khalitya + - -Tridoshaja palitya + - -Danta shoola + - -Indralupta - + -Ekadoshaja khalitya - + -Ekadoshaja palitya - + -Adhyasthi - - +Adhidanta - - +Dantabheda - - +Asthi shoola - - +Asthi toda - - +Kunakha - - +
  • 158.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          140  Among the Asthi pradoshaja vikaras dhaalana, bhanjanaka, shyavadanta, tridoshajakhalitya, tridoshaja palitya and dantashoola are considered as asadhya vyadhisbecause these are tridoshaja vyadhis and treatment modality in such cases are notsatisfactory and prognosis is very poor. The diseases like indralupta, ekadoshajakhalitya and ekadoshaja palitya are considered as yapya vyadhis because it requireslong duration of treatment and some times it gets may cured but chances ofreccurrence are more. Other diseases like adhyasthi, adhidanta, dantabheda, Asthishoola, Asthi toda and kunaka are considered as kashta sadhya vyadhis because itrequires both shamana aoushadhis and shastra karma.Discussion on treatmentIn Charaka samhita the treatment principles are explained for Asthi pradoshajavikaras. But in other samhitas like sushruta samhita, Ashtanga hrudaya, Ashtangasangraha the direct reference for the treatment of Asthi pradoshaja vikaras is notavailable, but treatment principles explained for Asthi kshaya and vruddi looks similaras explained in Charaka samhita. The treatment modalities are panchakarama (tiktaksheera sarpi basti) and vatahara ahara-vihara.Panchakarma: This is the major treatment modality, which is always used toeradicate the diseases which are located in shaakha, marma, asthisandhi and this is isthe best treatment for chronic disorders. By adopting panchakarma one can subsidethe doshas which are located all over the body and by this diseases can be eradicatedcompletely. Ability of evacuation, superiority and enormity of the procedures ,targetof dosha eradication and multitude of action are characterstics of pachakarma. Bonesare present all over the body and are the hardest structures in the body. Due to these
  • 159.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          141  reasons panchakarma is the major procedure for Asthi pradoshaja vikaras.Basti: Basti is the best treatment modality for vata and the vitiated doshas locatedbelow the nabhi pradesha. The administered basti reaches the pakvashaya which is theplace of purushadhara kala. Pakvashaya and Asthi are the main seats of vata dosha,therefore increased or decreased formation of vata affects all the sites of vataespecially Asthi. Hence purishadhara kala is also considered Asthidhara kala. So itinvariably nourishes the Asthi also.Especially tikta sadhita ksheera sarpi basti is indicated in Asthi pradoshaja vikaras.Tikta rasa has predomonently vayu and akasha mahabhuta and as per arunadatta tiktarasa has a unique property to maintain the kharatva of Asthi dhatu. Asthi also haspreodominently pruthvi, vayu and teja mahabhuta.so tikta invariably increases thekharatva in the Asthi. Ksheera and sarpi has predominantly pruthvi, jala mahabhutaand madhura rasa yukta. These properties will check the vitiated vata dosha. Theprovocation of Vata will result into Asthi Dhatu dushti Basti is the best treatmentexplained for Vata Dosha so the Tikta Rasa in combination with Sneha Dravyas in theform of Basti have a bifold nature i.e it provides sufficient nourishment to the AsthiDhatu as well as check the Vata Dosha also.Table No.56:- Showing the chikitsa of Asthi Pradoshaja VikarasChikitsaAsthi pradoshajavikarasPanchakarma Shastra karma Shamana karmaAdhidanta Rakta mokshana,NasyaKshara karma,Agni karma,Danta nirharanaGandusha
  • 160.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          142  Danta bheda Vasti - KavalaGandushaAbhyangaSwedanaDanta shoola Nasya Danta nirharanaDantapali lekhanaGandushaPratisaranaKavalaKrimidanta Rakta mokshanaAvapeeda nasyaDanta nirharanaAgni karmaGandushaLepaIndralupta Rakta mokshana Siravyadha LepaShiroabhyangaKhalitya & Palitya Nasya - ShiroabhyangaLepaAdhyasthi,Asthi shoolaAsthi bhedaAsthi todaBasti - AbhyangaSwedanaAmong the Asthi pradoshaja vikaras adhidanta, danta bheda, danta shoola,krimidanta, indralupta, khalitya and palitya occurs in the jatru urdhva pradesha. Sonasya, kavala, gandusha, shiroabhyanga are considered to be the main treatmentmodalities. Asthi shoola, Asthi bheda, Asthi toda and adhyasthi are may manifest anywhere in the body, so basti is considered as main treatment principle.Discussion on JanusandhigatavataSandhigata Vata is described in all Samhitas and Sangraha Granthas as aseparate clinical entity under the heading of Vata Vyadhi. While commenting on theword “Khudavata” Chakrapani explains the meaning of Khudavata as “Gulpha Vata”
  • 161.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          143  or Sandhigata Vata. Hence, it can be said that according to Chakarapani, SandhigataVata (janusandhigatavata) is the Nanatmaja Vata Vikara.Discussion on definitionThe disease Janusandhigatavata can be defined as a disease of Janu Sandhi(Joint) with symptoms of Sandhishula, Sandhishotha and pain during akunchana andprasarana and in the later stage affects the joint (Hanti Sandhi). In contemporaryscience a similar condition is explained and is called as Osteoarthritis which is adegenerative joint disorder with the symptoms of Joint Pain, Joint Swelling,Restricted and Painful Movements of the Joints and Joint Instability.Discussion on nidanaThe nidanas of janusandhigatavata are vatakara and kapha-majjahara.Shleshaka kapha is the major component of sandhi and performs the normal functionof sandhi. Due to the above said nidana sevana, the rukshatva and achalatva gunaincreases. Simultaneously these properties also influences the kapha ashraya sthanaand majja dhatu which is present within the Asthi. Due to majja kshaya Asthisoushiryata occurs. In another way as Asthi and vata are ashraya ashrayee, wheneverAsthi increases vata decreases and vice versa. Due to above said nidana sevana thevata dosha increases which is present in the Asthi. By this vitiation occurs in theAsthi. In this way these nidanas will lead to the manifestation of janusandhigatavata.Discussion on purvarupaJansandhigatavata is one among the vatavyadhi, so avyakta or alpavyaktalakshanas are considered as poorvrupa. Mild sandhi shula or shotha prior to the
  • 162.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          144  manifestation of disease janusandhigatavata may be taken as its Purvarupa.Discussion on rupaThe janusandhigatvata lakshanas can be classified as follows.Sandhishula: Shula is the main symptom of prakupita vata. Shula usally increases bymovements like akunchana, prasarana because of vata prakopa. It is worst duringevening because of the tendency of vata which naturally aggravates at evening period,hence the shula. It can be correlated te joint pain, which occurs due to bone attritionand pressure of osteophytes over the soft tissues.Sandhishotha: Due to nidana sevana vata gets prakupita and affects the srotus bydecreasing kapha, creates the shotha in the sandhi pradesha so it senses like avatapoorna druti. It means on palpation the swelling is felt like a bag filed with air.Contemporary science mentions that joint swelling occurs due to inflammation.Sandhiatopa: Janusandhigatavata is a localized vatavyadhi in which prakupita vayuaffects janusandhi which means akasha mahabhuta is increased at the site ofjanusandhi and shabda is a guna of akasha. Hence shabda is heard or palpated.Contemporary science, mentions clearly regarding crepitations due to the rubbing ofadjacent bony surface against each other during movement.Sandhihanti: This occurs in the chronic stage of janusandhigatavata. In thepreliminary stage of janusandhigatavata due to above said symptoms there isrestriction of movements. Due to this reason the sanga in the srotus increases the vata
  • 163.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          145  dosha, by that the sandhi loses movement . This condition is called as sandhihanti.This can be correlated to the knock knee deformity.Discussion on sampraptiThe Vata Dosha is aggravated due to different factors and Vata moves out ofits Ashaya to circulate in the entire body and its constituents. During circulation itgets localized in the roots of Asthivaha and Majjavaha Srotas. i.e. Asthi Sandhi. In theAsthi and Majjavaha Srotas. The chief qualities of Vata are Khara, Ruksha, Vishada,and Laghu. Sandhi gives Ashraya to Shleshaka Kapha which has Guru, Snigdha andMrudu guna. When aggravated Vata gets localized in Sandhi, it over powers all thequalities of Kapha. The chief task of Kapha is dharana or to sustain. This chief aim ofkapha is destroyed by the influence of aggravated Vata. When aggravated Vata islocalized into a single joint, the disease will be reflected in only one Joint but if Vatais localised in many joints, the disease may be presented by multiple jointinvolvements.Samprapti GhatakaDosha - Vata -Vyana vata vruddhiKapha - Sleshaka kapha kshayaDushya - Asthi, Majja, Snayu, Peshi.Srotas - Asthivaha, majjavahaRogamarga - MadhyamaUdbhava sthana - PakwashayaSanchara sthana - Rasayani
  • 164.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          146  Roga Marga - MadhyamaAdhisthana - Janu SandhiVyaktasthana - Janu SandhiFlow chart No.3: Showing the probable samprapti of JanusandhigatavataDiscussion on sadhyasadhyataJanusandhigatavata is one of the Vatavyadhi and is considerd as Mahagada.This diseaseis situated in Marma pradesha and Madhyamarogamarga. The Asthi andvata are ashraya ashrayee. Hence this is considered as kashta sadhya. According to theNidana SevanaVata Prakopa Prasara of Vata in sarva shareera Rikta srotas in janusandhi (shleshaka kapha kshaya) + (Asthi dhatukshaya)Aggravated vata settles in the rikta srotas (janusandhi) Dosha‐ dushya sammurchana Janusandhigatavata
  • 165.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          147  contemparary science, Knee Osteoarthritis is very difficult to cure till date. Notreatment which can reverse the degenerative process is available. Only palliativetreatment is available which acts as analgesic and medications given helps to slowdown the degenerative process.Discussion on chikitsaThe treatment principles for janusandhigatavata are snehana, upanaha,agnikarma, bandhana, unmardana and basti.Sneha Dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mrudu andGuru gunas which are just opposite to those of Vata so it alleviates Vata. Snehanahelps in the promotion and regulation of the proper functioning of Vayu. It is statedthat by the regular use of Abhyanga all changes occurring due to old age could beprevented and cured, if already manifested. Svedana is the procedure which relievesStiffness, Heaviness, Cold and which induces sweat. Upanaha is bandaging. The Pasteshould be hot and mixed with Sneha. The application of heat causes relaxation of themuscles and tendons, improves the blood supply. It relieves pain in the affected joints.To perform Agnikarma on Sandhi, Kshoudra, Guda and Sneha are to be used. ByAgnikarma on Mamsa, diseases located in Shira, Snayu and Asthi gets alleviated.Bandha is bandaging tightly, the leaves of Vatashamaka drugs on affected Sandhi.This bandaging does not leave any scope for Vata to inflate the Sandhi. Injanuandhigatavata, Shotha appears like a bag inflated with air. Bandhana causesabatement in Shotha. Unmardana is a type of massage in which pressure is exerted ondiseased Sandhi. It relieves Shotha and enhances blood circulation. And lastly bastias discussed earlier is the best mode of treatment for janu sandhigata vata.
  • 166.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          148  Discussion on Asthi pradoshaja vikaras vs SandhigatavataIn the present study, janusandhigatavata is considered one among the Asthipradoshaja vikaras due to these following reasons. Sandhi is Asthi melana sthana. Though there are so many other structures in theformation of sandhi,but asthi plays a major role in its formation. Hence if there isany defect in the sandhi i.e, mainly due to the Asthi only. This is has beenidentified this clinical work. The sroto mulas of Asthi are meda, jaghana and Asthi sandhi. Hence asthivahasroto dusti definitely affects the sandhi. The causative factors responsible for the manifestation of janusandhigatavata andAsthi pradoshaja vikaras are looks similar i.e, in both conditions vata is thepredominant dosha and vatala ahara- viharas like ruksha, alpa matra ahara,abhighata, ati vyayama, ati sankshobha etc nidanas are similar forjanusandhigatavata and Asthi pradoshaja vikaras. There is no specific porvarupa observed in both the conditions i.e,janusandhigatavata and Asthi pradoshaja vikaras. Avyakta or alpa vyaktalakshanas can be considered as poorvarupa for both janusandhigatavata and Asthipradoshaja vikaras. Among the lakshanas of janusandhigatavata, there are some symptoms which canbe correlated with the lakshanas of Asthi pradoshaja vikaras and these are relatedto Asthi. They are adhyasthi which can be co-related to osteophytes, Asthi shoola,Asthi bheda and Asthi toda which can be correlated to those different forms of painoccuring in the joint. The pathological changes occur in the manifestation of Asthi pradoshaja vikaras
  • 167.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          149  and janusandhigatavata are similar. i.e, doshas: vata pradhana, dushya: Asthi andsroto mula: Asthi sandhi. The methodology adopted to subside the vitiation in the Asthi pradoshaja vikarasand janusandhigatavata are similar. i.e, the main line of treatment for Asthipradoshaja vikaras are panchakarma, tikta sadhita ksheera sarpi yukta basti,sthanika abhyanga-sweda, vatahara ahara-vihara and same modalities are utilizedin the treatment of janusandhigatavata.Hence due to the reasons, janusandhigatavata is considered as one among Asthipradoshaja vikaras and it is treated by adopting the treatment principles explained forAsthi pradoshaja vikaras.Probable mode of action of bastiTikta ksheera Basti, regarding this Arunadatta opines that the combination ofSnigdha and Shoshana guna produces Khara guna which is also the guna of Asthi.This nourishes the Asthi as per the Samanya Siddhanta. The Pachabhoutikacomposition of ingredients of basti is similar to Asthi. The ingredients will reach theasthivaha srotas and will be acted upon by Parthivagni, Vayavagni, and Tejasagni andgets transformed into Asthi poshakamshas on which the Asthi dhatwagni will actupon and converts it into sthayi Asthi dhatu. Hence there will be increase of decreasedAsthi.Cow’s milk is the richest natural source of calcium present on the earth. Theratio in which calcium and phosphorus are present is ideal for their proper absorptionand assimilation and consequently for bone formation along with vitamin D. VitaminD present in cows milk helps in bone formation by maintaining the proper levels of
  • 168.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          150  calcium in the blood along with the parathyroid hormone. Vitamin K activatesosteocalcin the major non collagen protein in the bone. Cow’s milk also containslactoferin an iron binding protein that boosts the growth and activity of theosteoblasts, the cells that build bone and reduces the rate at which these cells die byup to 50-70%. These also decrease the formation of osteoclasts, the cells responsiblefor breaking down of the bone, thus helping to build the bone and preventosteoporosis.Step wise mode of action of BastiAma Pachana- To clear the obstruction (Sanga) in asthivaha srotas caused byama and to combat the other lakshanas of Ama, ama pachana was done with trikatuchurna. When Amapachana is achieved (Pakat) the srotomukaha becomes clear andthe stage is set to bring back the vitiated Doshas from Shaakha to Koshtha.Snehana- Sneha is said to reach the Asthi Dhatu by performing Abhyanga for800 Matra kala approximately 15 minutes. Sneha enyters the body through minutepores of skin by the virtue of its Anupravana bhava. Thus entering the Asthivahasrotas, it causes Vishyandana. It destroys the obstruction in Asthivaha Srotas(Malanam Vinihanti Sangam ). Sneha is Vata Nashaka (Sneho anilam hanti). So itpacifies vata.Swedana- Swedana also pacifies Vata especially, when performed afterSnehana. If Swedana is done after proper Snehana, it liquefies the Doshas whichcauses obstruction in the minute channels. Hence by the combined effect ofAmapachana, Snehana and Swedana the morbid Doshas are brought to Koshtha. ThePharmacodynamics of these three procedures is nothing but Paka, Vishyandana,Srotomuka Vishodhana and Vayu nigrahana.These factors are responsible for the
  • 169.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          151  movement of doshas from Shaakha to koshtha. Here paka is by Amapachana andswedana, Vishyanadana is by snehana and swedana; Sroto mukha vishodhana is doneby amapachana, Snehana and swedana and Vayu nigraha is achieved by Snehana andswedana.Basti- After proper Snehana and Swedana, when the doshas come fromShakaha to Koshtha, Tikta Ksheera Basti is given to expel these Doshas from thebody to nourish the Kshina Asthi Dhatu. Sushruta opines that eighth basti enters theAsthi Dhatu. Thus entering the Asthi its action can be explained on the followingfactors.The action of tikta ksheera basti on Asthi Dhatu can also be explained on thebasis of Pancha Mahabhoutika composition. Predominance wise the Panchabhoutikacomposition of Asthi is Prithvi, Vayu, Agni, Akasha and Jala Mahabhuta. The Basticontains Ksheera , Ghrita Madhu, Guggulu, and Tikta dravya as its main ingredients.Anuvasana basti mainly contains tikta rasa and madhura rasa where as Niruha basticontains katu rasa along with tikta rasa and madhura rasa. If we analyze thePanchabhoutika composition of Madhura, Tikta and Katu rasa it is Prithvi+ Jala,Vayu+ Akasha, and Agni+ Vayu respectively. Hence the total Panchabhoutikacomposition of Basti dravya is similar to the Asthi dhatu and hence nourishes theAsthi.Due to the Vataghna property of Niruha and Anuvasana basti there is shamanof aggravated Vata, by this the ksheena Asthi Dhatu returns to normalcy. The KsheeraBasti reaches the Pakwashaya which is Purishadhara kala and the ingredients of bastiie Ksheera, Ghrita and Madhu nourishes the Purishadhara kala and thus also nourishesthe Asthidhara kala. According to Modern embryology both bone tissue and the large
  • 170.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          152  intestine are formed by the mesenchymal cells of the mesoderm.Probable Pharmacokinetics and Pharmacodynamics of Tikta Ksheera Bastiaccording to scientific parameters.According to modern science basti is a process which can be compared with enema.There are 2 types of enemas. 1. Evacuation enema and 2. Retention enema. Ksheerabasti may be considered as the nourishing retention enema.Retention enema:- The fluid containing the drugs is retained in the rectum so that thedrug may act locally e.g. steroid enema in ulcerative colitis. The rectum has richblood and lymph supply and drugs can cross the rectal mucosa like the other lipidmembranes; thus unionized and lipid soluble substances are readily absorbed from therectum, through the rectal venous plexus. The portion of the absorbed drugs from theupper rectal mucosa is carried to the portal circulation where as that absorbed fromthe lower rectum enters directly into the systemic circulation.The absorption of the drug from the rectum follows the laws of transfer of themolecules across the biological membranes. Most drugs are absorbed by passivediffusion, a few by active transport or carrier mediated transport. Pinocytosis is amechanism for transport of molecules across membranes. Usually unionized and lipidsoluble substances are absorbed by simple diffusion or passive diffusion. “Diffusion isa law of transport of molecules from the region of higher concentration to the regionof lower concentration”. The absorption of the basti dravya is also by diffusion andmany factors influence this rate of diffusion and thus absorption. These factors are asfollows.Physical state: Liquids are absorbed better than solids.
  • 171.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          153  Ingredients of basti, their solubility and their homogenous mixing : Lipids and lipidsoluble drugs penetrate into the cell more rapidly than the water soluble drugs. Thehomogenous mixture of basti dravyaa is important.Temperature- Luke warm solutions are rapidlu absorbed because of vasodilatation,whereas cold solutions are absorbed slowly.Size of the molecule, its disintegration time and dissolution time: Simpler andsmaller the size of the molecule, faster is the absorption. If the disintegration anddissolution time of the compound is less then the absorption is faster.Quantity and concentration gradient of the basti dravya : Higher the quantitylesser is the retention time. Concentrated solutions are absorbed more rapidly than theweak solutions.pH of the GI fluid- Alkaline drugs are absorbed in the alkaline medium i.e distalileum and large intestine, where as acidic drugs are absorbed in the stomach andproximal part of the small intestines.Ionization: Unionized component predominantly lipid soluble are absorbed rapidly.Surface area of absorption- Absorption is more in intestines than in stomach, becauseof the larger surface area of the former .Vascularity- Richer the vascularity greater the absorption.Structural and functional status of the rectum:In the healthy and empty rectum the absorption is more and in the diseased condition,the presence of stool delays the absorption.The concentration of the basti dravyas is higher in the lumen of the rectum andin the cells surrounding the rectum. Hence the molecules of basti move from higher
  • 172.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          154  concentration to the lower concentration i.e from the rectum to the surrounding cellsand there, they are absorbed into the rectal veins. The lipid soluble substances likevitamin- A D and K and essential minerals such as calcium, phosphorus , magnesium,sodium, and chlorine etc present in the milk are in unionized form and hence absorbedrapidly. The surface area of the small intestine and rectum is more and it has very richblood supply, moreover the basti was given in the morning after the patient has passedthe stool i.e when the rectum was empty. Hence all these factors enhance theabsorption of the basti dravyas from the rectum through the rectal mucosa.The cow’s milk which is the main ingredient of the Ksheera Basti is rich incalcium, phosphorus, magnesium, potassium, sodium, chlorine etc. It also contains fatsoluble vitamins like vitamin –A, D and K. These minerals and vitamins help in boneformation. A study conducted by Finnish researchres, published in November-2005issue of American Journal of Clinical nutrition revealed that, only dairy calcium isbetter than synthetic calcium supplements for growing girl’s bones. The superiority ofmilk over other calcium supplements is because the bone health is not a mono-nutrient issue and milk contains all the essential vitamins and mineral nutrientsrequired for bone formation. Apart from this the ghee contains phospholipids whichplays an important role in the mineralization of bones.Discussion on Materials and MethodsDiscussion on selection of drugsTrikatu churna is attributed with like deepana, pachana, vatanulomana,shothahara, shula prashamana. This is easily available and cost effective also veryless.
  • 173.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          155  Panchatikta is said to be shreshta among the tikta rasa pradhana dravyas. These drugsare attributed with karmas like vedanasthapana, shothahara, anulomana, rasayana,deepana, pachanaBala has the karmas like vatahara, balya, vedanasthapana and brumhana.Godugdha and goghrita possess the karmas like vata nashaka, jeevaniya, balya,bruhmana, and rasayana. The chemical composition of godugdha includes calcium,magnesium, potassium etc.Saindhava, madhu and shatapushpa are mainly used in administration of basti. Thesefacilitate the drug absorption. Hence, these drugs are selected for the present study.Discussion on InstrumentsThere are many devices to administer basti but in present study douche set,enema syringe and rubber catheter were selected because they are easily availableand it can be used very safely.Discussion on AimsThe present work was under taken for the analytical study of asthi pradoshajavikaras supported by the study on the effect of panchatikta ksheera sarpi and balasadhita ksheera sarpi in sandhigatavata.The contemporary science aids us to understanding Ayurvedic concepts better, hencein the present work sandhigatavata was taken for the study.Discussion on Inclusion criteriaIndividuals of either sex between the age group 30-60 years were selected, as
  • 174.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          156  the degeneration of articular cartilage in primary OA starts with the process of ageingi.e. after 30 years. OA is seen in the lower age groups are usually secondary. Theindividuals willing for the treatment were selected because the duration of thetreatment is long.Discussion on Exclusion criteriaPregnant women were excluded because the kala basti is contraindicatedduring this period and also to avoid the complications. Individuals with other systemicdisorders like bleeding piles etc were excluded to avoid the interference in the actionof drug and also to avoid complications.Discussion on Diagnostic criteriaPain, stiffness, crepitus and swelling were considered as the diagnostic criteriaas there is no evidence of inflammatory infiltration in all cases of OA. Osteoarthritiswith radiological changes were taken , because in most of the pathologies of the kneejoint, X-ray fails to show any abnormality as the cartilaginous pathologies outnumberthe bony pathologies. Therefore in order to maintain the homologenesity in betweenthe groups, radiological changes were considered under diagnostic criteria.Discussion on InterventionThe study was designed in such way so as to get a clear picture regarding efficacies ofthe drugs which were used in the present study.Discussion on Statistical Analysis -Contingency Co-efficient: It is applied when Categorical Data Analysis is to be done.
  • 175.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          157  Then a contingency table can be used to express the relationship between the variablesDescriptive statistics: The Descriptive procedure displays univariate summary statisticsfor several variables in a single table and calculates standardized values (z scores).Variables can be ordered by the size of their means (in ascending or descending order),alphabetically, or by the order in which one selects the variables (the default).Chi-square test: The Chi-Square Test procedure tabulates a variable into categories andcomputes a chi-square statistic. This goodness-of-fit test compares the observed andexpected frequencies in each category to test either that all categories contain the sameproportion of values or that each category contains a user-specified proportion of values.Discussion on Observations and ResultsDiscussion on General observationsAge: In the present series of 30 cases, it has been observed that this disease mostcommonly manifests in the 4thdecade (50.0%). Increase in age is one of the riskfactor for OA observed in the study. Especially patients belonging to the age group41–50 years were engaged in their household and other jobs.Sex: In the present study, it has been observed that the incidence of this disease morein females. Here the lack of female hormone (oestrogen) in the peri-menopausalperiod also plays an important role. Biosynthesis of articular cartilage is influenced bysex hormone in females.Marital status: Married patients showed more susceptiblity (96.6%) forjanusandhigatavata. Though it is not a risk factor for Sandhigata Vata, but the diseasewas prevalent in the post marital age.
  • 176.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          158  Education: In this study, maximum numbers of patients i.e. 26.7% were illiterate. Itwas revealed from the study that due to illiteracy, people had to involve in morestrenuous work and were not taking nutritious diet, which lead to Dhatukshaya.Religion: In this clinical study, most of the patients i.e. 96.7% were Hindus. This dataindicates that there is predominance of hindu population in Mysore district.Habitat: In this clinical study, maximum numbers of patients i.e. 60.0% were fromurban area. It may because the study was carried out on urban population.Socio-economical status: Middle class patients were more susceptible (76.7%) tojanusandhigatavata. It is quite natural that the people from middle class are exposed tomore physical stress and strain which acts as a risk factor for OA.Occupation: In the present series of 30 cases, it has been observed that, the incidenceof this disease was more in housewives (50.0%). This percentage of patients impliesthat mostly they were performing household work for long duration in standingposture and had to lift heavy loads.Diet: The present study revealed that, the patients who were consuming mixed dietwere more susceptible (56.7%) to janusandhigatavata. The study however could notgeneralize the fact that vegetarians are on safer side from the disease as the samplesize taken was very small.Prakruti: Patients belonging to Vata pitta prakruti (43.3%) and pitta kapha prakruti(43.3%) showed equal incidence in the manifestation of janusandhigatavata. The
  • 177.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          159  study however could not generalize, as the sample size taken was very small.Sara: In the present study all the 30 patients (100%) were having madhyama sara.Samhanana: Among 30 patients, 21 patients (70.0%) were of madhyama samhananain the present study.Pramana: Among 30 patients 26 patients (86.66%) were of madhyama pramana.Sattva: Among 30 patients, 22 patients (76.66%) were of madhyama sattva in thepresent study.Satmya: In the present study all the 30 patients (100%) were of madhyama satmya.Koshta: In the present study among 30 patients, 24 patients (80.0%) were ofmadhyama koshta.Agni: Among 30 patients 15 patients (50.0%) had Vishamagni in the present study.Bala: In the present study among the 30 patients, 28 patients (93.33%) of them hadmadhyama bala.Vyayama shakti: Among 30 patients, 28 patients (93.33%) had madhyama vyayamashakti in the present study.Joint involvement: Among the 30 patients, 28 patients (86.6%) had bilateral jointinvolvement in the present study. This shows the Chronicity of the disease.
  • 178.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          160  Discussion on ResultsJoint painOn observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.001 in Group A and Group B isstatistically significant with P value 0.008. But comparatively Group A shows highsignificance than Group B. (Rt Knee)On observing the results, it was noted that there was improvement seen in both thegroups and statistically highly significant with P value 0.000 in the both groups. ButGroup A shows high significance than Group B. (Lt Knee)Hence it can be said that panchatikta ksheera sarpi had good effect on joint pain dueto vedanasthapana and vatahara properties.Joint stiffnessOn observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.005 in Group A and Group B isstatistically significant with P value 0.004. But comparatively Group B showssignificance than Group A. (Rt Knee)On observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.002 in Group B and Group A isstatistically significant with P value 0.018. But comparatively Group B showssignificant result than Group A. (Lt Knee)Hence it can be said that bala ksheera sarpi had good effect on joint stiffness due tosnehana and vatahara properties.
  • 179.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          161  Joint swellingOn observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.021 in Group A and Group B isstatistically significant with P value 0.031. But comparatively Group A showssignificant result than Group B. (Rt Knee)Hence it can be said that panchatikta ksheera sarpi had good effect on joint stiffnessdue to shothahara property.On observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.005 in Group A and Group B isstatistically significant with P value 0.049. But comparatively Group B showssignificant result than Group A. (Lt Knee)Hence it can be said that bala ksheera sarpi had good effect on joint stiffness due toshothahara property.Joint crepitusOn observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.004 in Group A and Group B isstatistically significant with P value 0.008. But comparatively Group A showssignificant result than Group B.On observing the results, it was noted that there was improvement in both the groupsand statistically highly significant with P value 0.003 in Group A and Group B isstatistically significant with P value 0.008. But comparatively Group A showssignificant result than Group B.Hence it can be said that panchatikta ksheera sarpi had effect on joint crepitus due tosnehana and vatahara properties.
  • 180.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          162  Overall assessmentOn observing overall results, it was noted that there was improvement in both thegroups and statistically significant with P value 0.042 in Group A and Group B isstatistically non significant with P value 0.819. But comparatively Group A has gotsignificant result than Group B.The above findings support the statement of Charaka samhita regarding superiority oftikta ksheera sarpi basti. Finally it can be concluded that panchatikta ksheera sarpi hasa better result in janusandhigatavataRadiological findingsIn the present study radiology (X-ray) was used to restablish the involvment of Asthiin janusandhigatavata and also to observe the changes occurinng in the Asthi, after thekala basti. Due to this reason X-ray was taken for all the 30 patients, before treatmentto rule out the involvement of Asthi and after the treatment and after the end of followup to find out the changes. In radiological findings of before treatment all the 30patients showed the osteophytes and joint space narrowing in the Asthi. But after thetreatment and at the end of follow up there were no marked changes in theosteophytes which imply that there is no increase of osteophytes in the Asthi. It mayneed longer observation to find the osteophytes changes (reduction in osteophytes) inthe Asthi.
  • 181.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          163  RECOMMENDATION FOR FURTHER STUDY Same study can be done in a larger sample and for a long duration. An experimental study can be carried out ,to identify the exact action ofpanchatikta ghrita on various components of the body The same study can be done in different age groups so as to assess the efficacyof the drug. With other investigations like BMD the same study can be carried out toevaluate the efficacy of panchatikta ghrita.
  • 182.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          164  CONCLUSION Asthi pradoshaja vikara is a condition in which Asthi gets vitiated extremely bythe vata dosha and changes its natural form and leads to many disorders. Ativyayama, ati sankshobha, ati vighattana and vatala ahara-vihara are the fournidanas for Asthi pradoshaja vikaras. Avyakta or alpavyakta lakshanas of Asthi pradoshaja vikaras are considered aspoorvarupa. Asthi pradoshaja vikaras are classified into various types based on theinvolvement of Asthi, danta, kesha and nakha. As Asthi pradoshaja vikaras are marmasthigata vyadhis, so panchakarma is thebest choice of treatment. Janusandhigatavata is one among the Asthi pradoshaja vikaras. Vata is the main dosha involved in the manifestation of janusandhigatavata. Prevalence of janusandhigatavata was more in females, housewives and betweenthe age group of 41-50 years. The panchatikta ksheera sarpi was more effective in subsiding joint pain, jointcrepitation and joint swelling and bala sadhita ksheera sarpi was effective inreducing joint stiffness and swelling. The overall effect of thearapy was significant in Group A with p value 0.042when compared to Group B at the p value 0.819.
  • 183.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          165  SUMMARYThe Present study entitled “Concept of Asthi pradoshaja vikaras w.s.r.tomanagement of Sandhigtavata” was aimed at understanding the concept of Asthipradoshaja vikaras and applying the concept of chikitsa Siddhanta of Asthi pradoshajavikaras i.e, tikta ksheera basti in the management of janusandhigatavata.The present dissertation work was divided into 2 parts. The first chapter dealswith the introduction and concept of Asthi pradoshaja vikaras supported by thecontemporary science view. In the second chapter, concepts of Janusandhigatavatacontemporary view in detail are explained. In the third chapter, concept of bastiespecially Kala basti is explained. The fourth chapter deals with the, Drug review(trikatu, panchatikta, bala, godugdha, goghrita, shatapushpa, madhu and saindhava)was dealt.In the second part, Materials & Methods, Observation of clinical trials, Results,Statistical tables & graphs, Discussion, Conclusions along with recommendation forfuture study were dealt. A total of 30 Patients in two groups (each group contains15patients each) were selected for the study.The patients of group A were administered with trikatu churna for amapachana. After attaining niramavastha patients were subjected to abhyanga withksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form ofkala basti administered starting from anuvasana with panchatikta ghrita (9 anuvasana)and niruha basti with panchatikta ksheera sarpi (6 niruha) and were advised 30 daysparihara kala. The patients of group B were administered with trikatu churna for amapachana. After attaining niramavastha patients were subjected to abhyanga with
  • 184.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          166  ksheerabala taila followed by nadi sweda. The sequence of 15 bastis in the form ofkala basti administered starting from anuvasana with bala ghrita (9 anuvasana) andniruha basti with bala sadhita ksheera sarpi (6 niruha) and adviced 30 days pariharakala.The different parameters of the study were observed and recorded beforetreatment, after treatment and after the follow up. The observations and results werestatistically analyzed for better interpretation. Based on result statistical analysis andgeneral observations, Group A showed significant result with p value 0.042 and withno statistical significance in Group B with p value 0.819. Radiological changes werenot seen in both the groups after the treatment and follow up.The conclusion was derived on the basis of observations & results. Futureperspective of the study is highlighted as an aid for the future research workers. 
  • 185.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          167  BIBLIOGRAPHY1. Raja Radha Kantha Deva, Shabda Kalpa Druma, part one, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:155.2. Raja Radha Kantha Deva, Shabda Kalpa Druma, part one, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:155.3. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 122.4. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part four, Varanasi,Chowkambha Sanskrit Series Office, 1969, PP: 4468.5. Raja Radha Kantha Deva, Shabda Kalpa Druma, part three, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:275.6. V.S.Apte, Sanskrit English Dictionary, Varanasi, Motilal Banarsidass, 1968, PP: 350.7. Raja Radha Kantha Deva, Shabda Kalpa Druma, part two, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:753.8. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part five, Varanasi,Chowkambha Sanskria Series Office, 1969, PP: 3793.9. V.S.Apte, Sanskrit English Dictionary, Varanasi, Motilal Banarsidass, 1968, PP: 261.10. Raja Radha Kantha Deva, Shabda Kalpa Druma, part two, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:496.11. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part four, Varanasi,Chowkambha Sanskrit Series Office, 1969, PP: 3003.12. Raja Radha Kantha Deva, Shabda Kalpa Druma, part four, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:372.
  • 186.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          168  13. Raja Radha Kantha Deva, Shabda Kalpa Druma, part two, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:372.14. V.S.Apte, Sanskrit English Dictionary, Varanasi, Motilal Banarsidass, 1968, PP: 506.15. Raja Radha Kantha Deva, Shabda Kalpa Druma, part one, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:155.16. Taranath Tarkavachaspathy Bhattacharya, Vachaspathyam, part one, Varanasi,Chowkambha Sanskria Series Office, 1969, PP: 568.17. Raja Radha Kantha Deva, Shabda Kalpa Druma, part one, 3rdEdition,Varanasi,The Choukhamba Sanskrit Series Office,1967,PP:155.18. Laxman Sastri Pansikar, Amarakosha, 7thEdition, Bombay, Nirnaya Sagar Press,1934, PP: 1210.19. Williams M.M, Sanskrit-English Dictionary, Varanasi, Motilal Banarsidass,Reprinted 1990, PP: 122, 250,289,296.20. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 514.21. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 59. 22. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 516.23. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 59. 24. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9thEdition,Varanasi, Chaukhambha Orientalia, 2009, PP: 187.25. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,
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  • 188.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          170  Chowkamba Vidya Bhavan, 1959, PP: 100.38. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 365. 39. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 1stedition, Varanasi,Choukhamba Sanskrit Series Office, 2006, PP: 305.40. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 366. 41. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 1stedition, Varanasi,Choukhamba Sanskrit Series Office, 2006, PP: 69.42. Brahma Sankara Misra, Bhavaprakasha of Bhavamishra Vol 2, 11thEdition,Varanasi, Chaukhambha Sanskrit Sansthan, 2009, PP: 49.43. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 67. 44. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 1stedition, Varanasi,Choukhamba Sanskrit Series Office, 2006, PP: 69.45. Brahma Sankara Misra, Bhavaprakasha of Bhavamishra Vol 2, 11thEdition,Varanasi, Chaukhambha Sanskrit Sansthan, 2009, PP: 46.46. Parashuram Shastri Vidyasagar, Sarngadhara Samhita of Sarngadhara, Varanasi,Chaukhamba Surbharati Prakashan, 2006, PP: 46.47. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 515.48. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 253. 49. Brahma Sankara Misra, Bhavaprakasha of Bhavamishra Vol 2, 11thEdition,
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  • 199.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          181  170. Siddhi Nandan Mishra, Bhaisajya Ratnavali of Kaviraj Govind Das Sen,Reprinted, Varanasi, Chaukhamba Surbharati Prakashan, 2007, PP: 546, 610, 604-605,608.171. Ravidatta Shastry, Chakradatta of Chakrapanidataa, 4thEdition, Varanasi,Chaukhamba Surbharati Prakashan, 2006, PP: 139, 148, 150,153.172. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 621.173. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 422. 174. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 550.175. Siddharth N Shah, API Text book of Medicine, 8thEdition, Mumbai, TheAssociation of Physicians of India, 2008, PP: 279.176. www.wiktionary.com177. www.thefreedictionary.com178. www.dictionary.sensagent.com179. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 551.180. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 552.181. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 552.182. Siddharth N Shah, API Text book of Medicine, 8thEdition, Mumbai, TheAssociation of Physicians of India, 2008, PP: 280.183. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 552.184. L.C.Gupta etl, Differential Diagnosis, 7thEdition, New Delhi, Jaypee BrothersMedical Publishers (P) Ltd, 2005, PP: 121-123.185. Kumar & Clark, Clinical Medicine, 6thEdition, Elsevier Limited, 2005, PP: 553.
  • 200.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          182  186. Siddharth N Shah, API Text book of Medicine, 8thEdition, Mumbai, TheAssociation of Physicians of India, 2008, PP: 282.187. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 525. 188. H.S.Kasture, Ayurvediya Panchakarma Vignana, 8thEdition, Patna, ShriBhaidyanath Ayurveda Bhavan Ltd, 2005, PP: 187.189. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9thEdition,Varanasi, Chaukhambha Orientalia, 2009, PP: 270.190. Parashuram Shastri Vidyasagar, Sarngadhara Samhita of Sarngadhara, Varanasi,Chaukhamba Surbharati Prakashan, 2006, PP: 319.191. H.S.Kasture, Ayurvediya Panchakarma Vignana, 8thEdition, Patna, ShriBhaidyanath Ayurveda Bhavan Ltd, 2005, PP: 346-350.192. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 684.193. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9thEdition,Varanasi, Chaukhambha Orientalia, 2009, PP: 282.194. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 526. 195. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 526. 196. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 688-689.197. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 525,527. 
  • 201.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          183  198. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9thEdition,Varanasi, Chaukhambha Orientalia, 2009, PP: 271-272.199. Vaidhya Harishastri Paradakara, Ashtanga Hrudaya of Vagbhata, 9thEdition,Varanasi, Chaukhambha Orientalia, 2009, PP: 273.200. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 684.201. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 540,535. 202. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 114-115,682.203. Acharya Y.T, Acharya NR, Sushruta Samhita of Sushruta, Varanasi, ChaukhambaSurabharati Prakashan, Reprinted 2008, PP: 527-528,535. 204. Shivprasad Sharma, Ashtanga Sangraha of Vagbhata, 1stedition, Varanasi,Choukhamba Sanskrit Series Office, 2006, PP: 605.205. P.V.Sharma, Dravya Guna Vignana, part two, 16thEdition, Varanasi,Chowkhamba Vishwabharati, 1994, PP: 331,275,362.206. J.L.N.Shastry, Illustrated Dravya Guna Vignana, 2ndEdition, Varanasi,Chaukhamba Orientalia, 2005, PP: 871, 448, 452.207. P.V.Sharma, Dravya Guna Vignana, part two, 16thEdition, Varanasi,Chowkhamba Vishwabharati, 1994, PP: 761,149,242,280,697,735.208. J.L.N.Shastry, Illustrated Dravya Guna Vignana, 2ndEdition, Varanasi,Chaukhamba Orientalia, 2005, PP: 265, 123, 407, 367, 250, 93.209. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 165.
  • 202.                               Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigatavata  Dr.Ranjith Kumar Shetty                                                                                                                          184  210. www.milkfacts.org211. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 166.212. www.indiadiets.com213. P.V.Sharma, Dravya Guna Vignana, part two, 16thEdition, Varanasi,Chowkhamba Vishwabharati, 1994, PP: 403.214. J.L.N.Shastry, Illustrated Dravya Guna Vignana, 2ndEdition, Varanasi,Chaukhamba Orientalia, 2005, PP: 258.215. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 167.216. www.indiadiets.com217. Acharya Y.T, Charaka Samhita of Agnivesha, 5thEdition, Varanasi,Chaukhambha Prakashan, 2007, PP: 170.218. Vishwanath Dwiedi, Bharatiya Rasashastra, 2ndEdition, Varanasi, SharmaAyurveda Mandir, 1987, PP: 376.219. Sanjay Kadlimatti,P.G Subbanna gouda- Clinical Evaluation of the role of tiktaksheera basti and ajasthi bhasma in the management of Asthi kshaya vis-a-visOsteoporosis- Ayu Journal Vol-30 N0-2 (April-June) 2009 PP-131-141.
  • 203. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   I CASESHEETDEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDASIDDHANTAGOVERNMENT AYURVEDA MEDICAL COLLEGE,MYSORE.“CONCEPT OF ASTHI PRADOSHAJA VIKARAS W.S.RTO MANAGEMENT OF SANDHIGATA VATA.”HEAD OF THE DEPARTMENT : Dr. N.Anjaneya Murthy M.D. (Ayu)GUIDE : Dr. N.Anjaneya Murthy M.D. (Ayu)CO-GUIDE : Dr. Kiran Kalaiah M.S (Ortho)CO-GUIDE : Dr. V.A.Chate M.D.(Ayu)RESEARCHER : Dr.Ranjith Kumar Shetty B.A.M.SPart A- History taking and ExaminationSl. No:Name of the patient: Case No:Age: O.P. No:Sex: Male/female I.P No:Religion: H/M/C/Others Ward No:Marital Status: M/UM/W/D Bed No:Socio-economic class: VP/P/LM/M/UM/R Date of Commencement:Education: UE/PS/MS/HS/G/PG Date of Completion:Occupation: Result:Address:Phone No:
  • 204. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   II I. VEDANA VRITTANTA:A. PRADHANA VEDANA: DURATION Janu sandhi shoola Janu sandhi shotha Atopa Stabdhatha OthersB. ANUBANDHA VEDANA: DURATION Difficulty in walking Disturbed sleep OthersII. ADYATANA VYADHI VRITTANTA:A. JANU SANDHI SHOOLA1. Presentation: Unilateral ( ) Bilateral ( )2. Mode of Onset : Gradual ( ) Sudden ( )3. Severity of Pain: Deep ache ( ) Dull ache ( )4. Duration of pain : Lasts for minutes ( ), Hours ( )5. Aggravating factors : Aahara:Vihara:Kala:B. JANU SANDHI SHOTHA1. Mode of Onset: Gradual ( ) , Sudden ( )2. Time of onset: Precedes pain ( ), Recedes pain ( )3. Inflammatory changes : Present ( ), Absent ( )C. ATOPAPresent ( ) Absent ( )
  • 205. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   III D. STABDHATARange of different movements of knee joints: Restricted ( ), Not Restricted ( )Time:E. OTHERSIII. POORVA VYADHI VRITTANTAA. H/O Previous illnessB. H/O Previous treatmentIV. KULAJA VRITTANTAA. Pitruja: Present ( ) , Absent ( )B. Matrija: Present ( ), Absent ( )V. VAYAKTIKA VRITTANTAA. Occupation : Hard ( ), Moderate ( ), Sedentary ( )B. Diet: Veg/Non veg ( Regular/ Irregular )C. Appetite: Poor ( ), Moderate ( ) , Good ( )D. Habits: Tea ( ) Beedi ( )Coffee ( ) Tobacco chewing ( )Cigarette ( ) Alcohol ( )Others:VI. GYNAECOLOGICAL & OBSTETRIC HISTORYA. Gynecological historyMenstrual Cycle: Regular/ Irregular intervalsB. Obstetric history: G P D A LVII. EXAMINATIONA. Asta sthana pareeksha:Nadi: V/P/K/VP/VK/VPKMutra: __ times per day, __ times at night
  • 206. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   IV Mala: Drava/Baddha/samyakJihwa: Alipta/Alpa lipta/ LiptaShabda: Prakruta /VikrutaSparsha: Prakruta/VikrutaDruk: Prakruta/VikrutaAakruti: Pravara/Madhyama/AvaraB. Janu sandhi pareekshaDarshana:Gait- Swinging gait ( ), Limping gait ( )Swelling: Present ( ), Absent ( )Muscle wasting: Present ( ), absent ( )SparshanaLocal temperature: Present ( ), Absent ( )Local tenderness: Present ( ), Absent ( )SwellingFluctuation: Positive ( ) , Negative ( )Patellar tap: Positive ( ), Negative ( )Crepitus: Audible ( ), Palpable ( )Sandhi ChalanaFlexion:Extension:External Rotation:Internal rotation:MaanaApparent shortening:True shortening:C. Dashavidha pareekshai. Prakruti: V/P/K/VP/PK/KV/VPKii. Vikruti: a) Dosha: V/P/K/VP/PK/KV/VPKb) Dushya: R/Ra/Ma/Me/As/Mj/Sh/Othersiii Sara: Pravara ( ), Madhyama ( ), Avara ( )iv Samhanana : Pravara ( ), Madhyama ( ), Avara ( )
  • 207. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   V v Pramana: Pravara ( ), Madhyama ( ), Avara ( )vi Satmya : Pravara ( ), Madhyama ( ), Avara ( )vii Sattva: Pravara ( ), Madhyama ( ), Avara ( )viii Ahara Shaktia) Abhyavaharana : Pravara ( ), Madhyama ( ), Avara ( )b) Jarana: Pravara ( ), Madhyama ( ), Avara ( )ix Vyayama Shakti: Pravara ( ), Madhyama ( ), Avara ( )x Vaya: Bala ( ) , Madhyama ( ), Vruddha ( )D. Prayogashala pareekshaX-ray of knee jointPart –B Interpretation1. NidanaAharaja:Viharaja:Manasika:2. Poorvarupa:3. Rupa :4. Upashaya- Anupashaya:5. Samprapti ghatakaa. Doshab. Dushyac. Amad. Srotase. Sroto dushti prakaraf. Udhbhava sthanag. Sanchara sthanah. Adhisthanai. Roga marga6. Vyadhi vinishchayaChikitsa:Type of Basti: Kala basti
  • 208. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   VI POORVAKARMADeepana pachana from ______ to ______Yoga: Trikatu ChurnaMatra: 12gmKala: Morning ( ). Afternoon ( ), Evening ( )Anupana: Ushna jalaNirama lakshana attained on ______ dayAma lakshanaJeerna lakshanaStimita koshtaGuru koshtaAnnaabhilashaAngamardaSnehana: Bahya abhyanagaDravya:Sthana:Kala:SwedanaKala:Bastipoorva aharaBastipoorva viharaBasti dravya prepared properly.PRADHANA KARMASthiti- Vama parshwaGroup A ( )Yoga : Anuvasana: Pancha tiktaka ghritaNiruha:MadhuSaindhavaPancha tiktaka ghritaShatapushpa Kalka
  • 209. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   VII Pancha tikta saadhita ksheera pakaDuration : 15days, from _________ to ________Follow up: 30 days from _________ to ________Group B ( )Yoga: Anuvasana : Bala ghritaNiruha : MadhuSaindhavaBala ghritaShatapushpa kalkaBala saadhita ksheera pakaDuration :15days from __________ to __________Follow up : 30 days from __________ to _________Basti A N A N A N A N A N A N A A ADateBastidanakalaBastipratyagamanakalaPASCHAT KARMAPathya: AaharaViharaPart C- Observation and AssessmentSubjective ParametersBefore treatment After treatment After follow upLakshanasRt Lt Rt Lt Rt LtSandhishulaSandhishothaSandhi stabdhataAtopa
  • 210. Concept of Asthi pradoshaja vikaras w.s.r to management of Sandhigata vata Dr.Ranjith Kumar Shetty   VIII Objective parameters:X-ray examinationX-ray BeforetreatmentAftertreatmentAfterfollow upNormalMild changes of OAModerate changes of OASevere changes of OASignature of the Researcher Signature of the Observer
  • 211.                               IX 
  • 212.                                  X 
  • 213.                                                                                                                                                                                                                                                             XI 
  • 214.            Bala Ghrita Panchatikta Ghrita Panchtikta kwatha churna Balamula kwatha churna              
  • 215. Saindhava Madhu Shatapushpa Ksheera