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Asthivikara ss-mys

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 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. 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 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. 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 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 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. 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 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. 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 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. 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 Vruddhi lakshanas S.S A.H A.S1. Adhyasthi + + +2. Adhidanta + + +3. Kesha vruddhi + - -4. Nakha vruddhi + - -
  30. 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 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. 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. 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 Vyadhi C.S S.S1. Adhyasthi + +2. Adhidanta + +3. Dantabheda + -4. Dantashoola + -5. Asthibheda + -6. Asthishoola + +7. Vivarnata + -
  33. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.