INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Bi-Monthly Peer Reviewed International Journal

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1 Vol- / Issue - 6 / Nov - Dec Free Full I J A A M INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Bi-Monthly Peer Reviewed International Journal

2 RESEARCH ARTICLE A CLINICAL STUDY ON THE EFFECT OF LAKSHADI GUGGUL WITH STHANIK SNEHAN SWEDAN IN THE MANAGEMENT OF SANDHIGATA VATA Sushil Vilas Chawre 1*, Vinod Badole, Yogita Bhalchim 3, H.S. Bhivgade 4, P.R.Kabra 5 1. Assistant Professor, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Maharashtra, Contact , sushilvilaschawre@gmail.com. P. G. Scholar, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Contact , -badoledrvinod@gmail.com 3. P. G. Scholar, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Contact yogitabhalchim@gmail.com 4. Associate Professor, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Contact , hary_bhivgade@gmail.com 5. H.O.D. and Professor, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Contact , - prakashkabra@rocketmail.com Article Received on - 4 th Sept 014 Article Revised on - 6 th Nov 014 Article Accepted on - 9 th Nov 014 All articles published in IJAAM are peer-reviewed and can be downloaded, printed and distributed freely for non-commercial purpose (see copyright notice below). (Full Text Page7 013 IJAAM This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 RESEARCH ARTICLE A CLINICAL STUDY ON THE EFFECT OF LAKSHADI GUGGUL WITH STHANIK SNEHAN SWEDAN IN THE MANAGEMENT OF SANDHIGATA VATA *Corresponding Author Sushil Vilas Chawre Assistant Professor, Dept. of Kayachikitsa, Govt. Ayurved College, Nagpur, Maharashtra, Contact , sushilvilaschawre@gmail.com QR Code IJAAM ABSTRACT: The very basic Tridosha theory of Ayurveda, explains about the physiological traits of Vata, Pitta and Kapha. The normal functions of the body are carried out by these three principles co-operating each other to maintain the positive health. In our institution lots of patients come for management of Sandhigata vata. In OPD of GAC, we maintain patient s data with some specific drugs given for specific disease. This study is also data maintaining study in above manner. Sandhigatavata (Osteoarthritis) is a disease in which degeneration of joint cartilage and adjacent bone that can cause joint pain and stiffness. This is the most common of all joint disorders affects men and women. The management of Sandhigata vata is described in various Ayurveda texts; Charaka has stated the management of Asthipradoshaja Vyadhi (C.Su.8/7). Lakshadi Guggul is one of them which are useful in Sandhigata vata. Lakshadi Guggul has contains Laksha (Laccifer Lacca), Asthisamhar (Cissus Quadrangularis), ArjunTwak (Terminalia arjuna), Ashwagandha (Withania somnifera), Nagbalamul (Grewia Hirsuta) and Guggul (commiphora mukul). Lakshadi Guggul is mostly used in Asthigata vikara such as Bhagna (fracture), pain and trauma. In Sandhigata vata local Snehan (oiling) and Swedan (hot fomentation) is mostly used such as Narayan Tail, Bala tail, Til tail and Nadiswed, Bashpaswed (types of hot fomentation).in this study Lakshadi Guggul two Tablets twice in a day. Narayan Tail Snehan (oiling) and Nadi swedan (types of hot fomentation) used for 8 days. During this study 0 patients of Sandhigatavata (Osteoarthritis) are selected randomly. This management on osteoarthritis has fruitful results as statistical manner and gives new aura for research study on large scale. Key Words: Sandhigatvata, LakshadiGuggul, Narayan Tail, Nadiswedan. INTRODUCTION The very basic Tridosha theory of Ayurveda, explains about the physiological traits of Vata, Pitta and Kapha. The normal functions of the body are carried out by these three principles cooperating each other to maintain the positive health [1]. In old age, all Dhatu being to undergo Kshaya, thus leading to Vata Prakopa, which making the individual prone to many diseases. Among them, Sandhigata Vata stands top in the list. The affliction of joints by vitiated Vayu is the chief phenomena in Samprapti (pathogenesis) of Sandhigata Vata. Sandhis (joints) are one of the types of Marma and form a part of Madhyama Rogamarga. Thus, involvement of Marma, Madhyama Rogamarga, VataDosha and Dhatukshaya make disease Yapya. useful in Sandhigata Vata. Lakshadi Guggul has contains Laksha (Laccifer lacca), Asthisamhar (Cissus quadrangularis), Arjun Twak (Terminalia Arjun), Ashwagandha (Withania somnifera), Nagbalamul (Grewia hirsuta) and Guggul (Commiphera mukul) [3]. Lakshadi Guggul is mostly used in Asthigata vikara such as Bhagna (fracture), pain and trauma. In Sandhigat Vata, sthanic (local) snehan (oiling) and swedan (hot fomentation) is mostly used such as Narayan Tail, Bala tail, Til tail and Nadiswed and Bashpa swed respectively. In this study, Lakshadi Guggul 500mg, Tablet twice in a day. Narayan Tail Snehan and Nadiswedan used for 8 days. During this study 0 patients of Sandhigata Vata are selected randomly. Page8 Sandhigata Vata (Osteoarthritis) is a disease in which degeneration of joint cartilage and adjacent bone that can cause joint pain and stiffness. This is the most common of all joint disorders affects men and women. The management of Sandhigata Vata is described in various Ayurvedic texts; Charaka has stated the management of Asthipradoshaja Vyadhi [] Lakshadi Guggul is one of them which Aim and Objectives To study the literary review of SandhigataVata To study the management of SandhigataVata by Ayurved Principles. To assess the effect of LakshadiGuggul with sthanik (local)snehanandswedan in the patients of Sandhigata Vata.

4 Materials and Method While working on any research project several factors are required to make the project more meaningful such as preview of that work, historical glimpses. In the same way clinical study of any disease also requires certain materials and methods to complete the study. Materials mean the measures which are going to be used for the study which consists of patients, drugs, investigations. These things are arranged in scientific way along with complete Rugna Parichaya to carry out the clinical trials. The research paper number of this clinical study is GACN/KC/PGD/RP/6/013 Dated Materials Patients suffering from Sandhigata Vata attending the O.P.D. and I.P.D. department, affiliated to the concern college, were selected randomly, irrespective of their age, sex, religions and socioeconomic status. Patients suffering from Sandhigata Vata attending to the OPD and IPD of the department were selected for the study. Those patients fulfilling criteria of diagnosis, inclusion criteria and exclusion criteria were selected 0 patients of Sandhigata Vata were studied. Drug Lakshadi Guggul Tablets (500mg tablet) twice in a day for 8 days along with sthanik (local) Snehan (oiling) and Swedan (hot fomentation) on OPD Basis Criteria of diagnosis 1) Diagnosis of Sandhigata Vata was done on the basis of classical signs and symptoms mentioned in Ayurvedic text, as well as the diagnostic criteria for osteoarthritis of knee which is described in Allopathic textbook 4. Some of the symptoms based on Ayurvedic criteria such as [5]. a. Sandhi Shula(pain in joints) b. SandhiShotha (swelling in joints) c. Aatop at joint d. Sparshasahatva(tenderness) e. AakunchanPrasaranayoShulam(pain on extension and flexion).. Case record form of each patient is prepared, consisting vital data, symptoms, present history, signs, family history, Samanya Parikshan, Ashtavidha Parikshan, Dashvidha Parikshan, Strotas Parikshan. Inclusion Criteria 1. Age group primarily above 40 years.. Patients of both sexes will be considered 3. Established cases mainly of knee joint by clinical finding Exclusion Criteria 1. Patients suffering from inflammatory pathologies like Gout, Rheumatoid arthritis etc.. Congenital bone and joint deformity. 3. Steroid dependant patients for relief. Management Of The patient: The patients were mainly subjected for Abhyanga (oiling) and Nadi Sweda at the sight of Janu Pradesh (knee joint). Abhyanga The Abhyang was done by lukewarm Narayana tail for about 15 to 0 minutes. Nadi Sweda-After Snehana, the patients was subjected for Sweda by using (Dashmula and Nirgundi kwatha) Nadi Swedana for about 15 to0 minutes. Lakshadi Guggul, Tablets (500mg) bd for 8 days along with sthanik Snehan and Nadi sweda. Criteria of Assessment: After treating the patients, group wise patients were strictly assessed after completion of the therapy as follows Combine effects of Lakshadi Guggul, Sthanik Snehan and Swedan, on symptoms and sign of Sandhigatvata. Combine effects of therapy, on range of movements of joints. Effects of therapy, on Dosha Vriddhi-kshaya Lakshana score. Effect of therapy assessed on routine examinations. Before starting the therapy all the patients was examined and investigated as per criteria of diagnosis to the start of treatment. All of these values were termed as Before Treatment (BT) values. After completion of course of Lakshadi Guggul along with sthanik Snehan and Swedan, the systemic effect of therapy was evaluated on following signs and symptoms with investigations and these values was termed as After Treatment (AT) values. Gradation of symptoms was done which is described below. 1) Pain (Shoola) No Pain - 0 Mild Pain - 1 Moderate pain but no difficulty in walking - Moderate pain and slight difficulty in walking - 3 Severe pain which prevents walking -4 ) Pain on Extension and Flexion (Passive movement) a) No pain -0 b) Pain without wincing of face -1 Page9

5 c) Pain with wincing of face d) Prevents complete flexion 3 e) Doesn t allow passive movement -4 3) Shotha (swelling) on Joint No Shotha 0 Mild Shotha 1 Moderate Shotha Severe Shotha - 3 4) Crepitus No Crepitus 0 Palpable Crepitus 1 Audible crepitus - 5) Tenderness at joint No tenderness 0 Patients says tenderness 1 Wincing of face Wincing of face and patient withdraws the affected part 3 Not allow to touch the joint - 4 6) Nature of Pain No pain - 0 Only in morning 1 In morning and evening Pain present at whole day - 3 Total Effect of Therapy: 1) Complete relieved: Total relief in cardinal signs and symptoms will be considered in this category. ) Markedly Relieved: 50% or more average improvement in signs and symptoms will be termed as Markedly Relieved. 3) Relieved: Improvement ranging in between 5 to 50% in signs and symptoms will be termed as Relieved. 4) Unchanged: Patients presenting with less than 5% improvement will be categorized as Unchanged. 5) LAMA: Patients discontinuing treatment due to some unavoidable circumstances will be included in LAMA group (Left Against Medical Advice). Observations In the present study patients were diagnosed with the help of clinical features and physical examinations in both Ayurvedic and modern perspective. Table-1-Age Wise Distribution of 0 Patients OfSandhigatavata Age Group of Patients % 1 Balyavastha 0 0 Madhyamavastha (30-60 yrs) 08 40% 3 Vriddhavastha (>60 yrs) 1 60% Age: While dealing with age wise classification of the 0 patients of Sandhigatavata, Classification was done according Charaka. 40% patients were belonging to Madhyama-Avastha, 60% patients were from Praudhavastha. Table- - Sex Wise Distribution of 0 Patients of Sandhigata vata Sex Of Patients % 1 Male 11 51% Female 09 49% Sex: In this group there is 11 numbers of male and 09 female patients. Table-3 Deha Prakriti Wise Distribution of 0 Patients of Sandhigata vata Deha Prakriti of Patients % 1 Vata-Pittaj 03 Vata-Kaphaja 08 40% 3 Pitta-Kaphaj 03 4 Kapha-Vataj 06 30% In this group, there is 40% of Vatakaphaja, 30% Kaphavataj, Vatapittaj and Kaphavataj Dehaprakruti respectively. Table-4 - Incidence of Involvement of Vyadhi Ghatak in 0 Patients of Sandhigata vata Vyadhi Ghatak (Dosha and Dushya) No of Patients % 1 Vata-Kaphaj 08 40% Kapha-Vataj 07 35% 3 Vata-Pittaj 03 4 Kapha-Pittaj 0 10% 1 Asthi-Majja 13 65% Asthi-Majja-Meda 07 35% It was observed that all the patients of Sandhigata Vata were having Vata Dominance (90%), because it is a Nanatmaj Vata Vyadhi. While 5% patients were having Pitta Anubandha and Kapha Anubandha was found in 85% patients. However in almost all the patients who were observed, it can be said that, involvement of Asthi and Majja Dhatu was there as a Adhishtan. Both of them were involved in all the patients so not mentioned in the table. During this project study, involvement of Asthivaha- Majjavaha, Asthivaha-Majjavaha- Medovaha was noted, which was observed in 65% and 35% of patients respectively. Table-5 Samhanan-Satva Parikshan of 0 Patients of Sandhigata vata No 1 Type of Parikshan Samhanan a)pravara b)madhyam c)avara Satva a)pravara b)madhyam c) Avara Of Patients % % 80% 10% 80% 10% Each of the 0 patients of Sandhigata Vata was examined with respect to Samhanan-Satva. Percentage of these factors is presented in Table-5. Page30

6 Table-06 Agni Parikshan by Abhyavaharana and Jarana Shakti Parikshan of 0 Patients of Sandhigata vata 1 Type of Parikshan Jarana Shakti a) Pravara b) Madhyam c) Avara Abhyavaharana Shakti a) Pravara b) Madhyam c) Avara of Patients % % 60% Status of Agni, of all 0 patients was acknowledged with respect to Abhyavaharana and Jarana Shakti. Percentage of these factors is presented in Table, by judging the status of Abhyavaharan and Jaran Shakti. Status of Agni is important in any treatment protocol of Ayurveda. Table-7- Effect of Therapy on General Symptoms Score of 0 Patients of Sandhigata vata Symptoms Score % of Symptoms Relief BT AT Diff (Diff/BT) 1 Pain % Pain On Extension And Flexion % 3 Shotha(swelling) % 4 Crepitus % 5 Tenderness % 6 Nature Of Pain % 7 Total Score % Incidence of more relief in the symptoms score was observed in the symptoms like Pain, Pain on extension and flexion, Shotha, Crepitus, Tenderness, Nature of pain such as80.64%,60%, 4%,.7%, 44%,60% respectively. Total score of symptoms 5.8% relief was found in project. Table-8- Table Showing Effect of Therapy on Symptoms of 0 Patients of Sandhigat vata By Wilcoxon- Ranked Singed Test S N Symptoms Groups W T+ T_ Mean ± SD SD Z BT AT P 1 Pain TG s <0.05 Pain On Extension And TG n <0.05 Flexion 3 Shotha(swelli ng) TG s < Crepitus TG s < Tenderness TG n < Nature Of Pain TG s <0.05 Z = [(T-m)-0.5] / SD SD = [n (n+1) (n+1)]/ 4 m = [n (n+1)]/ 4 W = sum of all rank T+ = sum of all positive rank T- = sum of all negative rank Table 9- Total Effect Of Therapy On Total 0 Patients Of Sandhigatavata In this study, none of the patients of Sandhigata vata were categorised in complete remission and markedly relieved. However, 85% patients were relieved and patients were unchanged after completing the treatment. RESULTS This management on osteoarthritis has fruitful results as statistical manner and gives new aura for research study on large scale. In this study age wise classification of the 0 patients of Sandhigata vata, 40% patients were belonging to Madhyama- Avastha, 60% patients were from Praudhavastha. Total Effect of Total of No Therapy Patients % 1 Complete remission Markedly Relieved Relieved 17 85% 4 Unchanged 03 5 LAMA In sex-wise distribution, there is 11 numbers of male and 09 female patients. As per Dosha dominancy 90% patients were having Vata Dominance, because it is a Nanatmaj Vata Vyadhi. While 5% patients were having Pitta Anubandha and Kapha Anubandha was found in 85% patients. During this study, involvement of Asthivaha-Majjavaha, Asthivaha-Majjavaha- Medovaha was noted, which was observed in 65% and 35% of patient s respectively.80% patients having Madhyam Satva and Samhanan. While, 5% and patients having Pravar and Avar Satva respectively. In this study 10% patients having Page31

7 Pravar and Avar Samhanan respectively.60% patients having Madhyam Jaran and Abhyavaran Shakti while patients having Pravar and Avar Jaran and Abhyavaran Shakti respectively. Incidence of more relief in the symptoms score was observed in the symptoms like Pain, Pain on extension and flexion, Shotha, Crepitus, Tenderness, Nature of pain such as 80.64%,60%, 4%,.7%, 44%,60% respectively. Total score of symptoms 5.8% relief was found in study. This study was carryon only one group so that in the statistical analysis only Wilcoxon- Ranked Singed Test is applicable for single group and nonparametric data. In this test t value cannot be calculate so that is not shown in the table. In symptoms score it is shown significant results on pain, Shotha, crepitus and nature of pain. While, it is moderately significant on Pain on extension and flexion and Tenderness. DISCUSSION Ayurveda has adopted the concept of total health which is related to the unique multidimensional concept of human life. It is a state of well-being referred to physical, censorial, mental and spiritual wellbeing. A living being which is a Composite entity, consisting of Physical body, superadded with highly sensitive apparatus such as different Indriyas, Mana and Atma. Ayurveda has holistic approach for maintaining the health. Sandhigata Vata is one of the Vataj disorder, in which patient has to face difficulties to carry on his routine activities. Considering the foregoing concept of Osteoarthritis in Modern Medicine, relief from pain is there but patient has to face hazardous complications of drug. Therefore people in the Present era are opting for successful Ayurvedic treatment.0 patients of Sandhigata Vata were diagnosed and selected as per criteria of selection were registered in this study. Above management of Sandhigat Vata is very useful in for Vat shaman without any side effect. CONCLUSION The present study entitled A Clinical Study on the Effect of Lakshadi Guggul with Sthanik Snehan Swedan in the Management of Janu Sandhigata Vata comprises sections like Introduction, Aims and Objectives, Materials and Methods, Observations and Results, Discussion and Conclusion. 0 patients showing classical symptoms and signs of Sandhigata Vata i.e. Osteoarthritis and fulfilling the criteria of diagnosis were randomly selected from hospital. Based upon the results of clinical study displayed in the form of table and conclusions of this study are as follows- Total 0 patients selected for the study. Age wise classification of the 0 patients of Sandhigata Vata, Classification was done according Charaka. 40% patients were belonging to Madhyama-Avastha, 60% patients were from Praudhavastha. There is 40% of Vatakaphaja, 30% Kaphavataj, Vatapittaj and Kaphavataj Dehaprakruti respectively. All the patients of Sandhigata Vata were having Vata Dominance (90%), because it is a Nanatmaj Vata Vyadhi. While 5% patients were having Pitta Anubandha and Kapha Anubandha was found in 85% patients. Involvement of Asthivaha-Majjavaha, Asthivaha- Majjavaha - Medovahawas noted, which was observed in 65% and 35% of patients respectively. More relief in the symptoms score was observed in the symptoms like Pain, Pain on extension and flexion, Shotha (swelling), Crepitus, Tenderness, Nature of pain such as 80.64%,60%, 4%,.7%, 44%,60% respectively. Total score of symptoms 5.8% relief was found in project. 90% patients were relieved and 3.33% patients were unchanged after completing the treatment. Statistical values show significantly improvement in the symptoms. So that, it is encouraging for the study on large population. This will be helpful for enlightens and encouraging Ayurvedic practice. REFERENCES 1. Ganesh Krushna Garde, Sarth Vagbhat, Published by Chaukhambha Surbharati Prakashan, Varanasi 011. p. 51. Yadavaji Trikamaji, editor, Charak Samhita, Chaukhamba Surbharati Prakashan Varanasi 005. p Shree Baidyanath Ayurved Bhavan PVT.LMT; Ayurved Sar Sangrah, 0 th edition, 004. p John A.A. Hunter, Davidson s Principles and Practice of Medicine, 19 th ed. 00. p Yadavaji Trikamaji, Charak Samhita, Chaukhamba Surbharati Prakashan Varanasi 005. p. 618 Page3 CITE THIS ARTICLE AS Sushil Vilas Chawre, et. al., A Clinical Study on the Effect of Lakshadi Guggul with Sthanik Snehan Swedan in the Management of Source of Support Nil Conflict of Interest None Declared

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