INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE

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1 p-issn e-issn Vol - 3 / Issue - 5 / Sept - Oct Free Full I J A A M INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE Bi-Monthly Peer Reviewed Indexed International Journal

2 RESEARCH ARTICLE Impact Factor (2014) by International Scientific Indexing (ISI) UAE MANAGEMENT OF OSTEO-ARTHRITIS WITH AYURVEDA Mayur Pawaskar 1*, V. C. Bawane 2, Nikhil Joglekar 3 1. Assistant professor, Dept. of Shalyatantra, School of Ayurveda, D. Y. Patil University, School of Ayurveda, Nerul, Navi Mumbai, Contact No , - mail@drmayur.com 2. Associate professor, Dept. of Streerog & Prasutitantra, School of Ayurveda, D. Y. Patil University, School of Ayurveda, Nerul, Navi Mumbai. Contact No , drvcbawane@gmail.com 3. Assistant Professor, Dept. of Kayachikitsa, School of Ayurveda, D.Y.Patil University, School of Ayurveda, Nerul, Navi Mumbai. Ph. No , drnikhiljoglekar@gmail.com Article Received on - 10 th Aug 2015 Article Revised on - 25 th Nov 2015 Article Accepted on - 26 th Nov 2015 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 Page 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 MANAGEMENT OF OSTEO-ARTHRITIS WITH AYURVEDA *Corresponding Author Mayur Pawaskar Assistant professor, Dept. of Shalyatantra, School of Ayurveda, D. Y. Patil University, School of Ayurveda, Nerul, Navi Mumbai, Contact No , - mail@drmayur.com QR Code IJAAM ABSTRACT: Osteoarthritis or degenerative Joint Disease (DJD) may first appear without symptoms between 20 and 30 years of age. The symptoms, such as pain and inflammation, appear in middle age. Till the age of 55 it occurs equally in both sexes; after 55 the incidence is higher in women. It is estimated that approximately four out of 100 people are affected. The incidence of osteoarthritis in India is as high as 12%. By 2030, 20% of Americans which is about 70 million people who have passed their 65th birthday will suffer from Osteoarthritis. Osteoarthritis will be common before age of 45 more in men than women and after age of 45 more common in women. Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by age 70. Almost all persons by age 40 have some pathologic change in weight bearing joint. 25% females and 16% males have symptomatic OA. Osteoarthritis can be considered as Sandhigatavataand it is described under Vatavyadhi in all the Samhita and Sangrahagrantha. In Vriddhavastha, all Dhatus undergo Kshaya, thus leading to Vataprakopa and making an individual prone to many diseases and among these SandhigataVata tops the list.till date SandhigataVata is a challenging disease and is the number one cause of disability in industrialized countries. The affliction of Sandhis by PrakupitaVata is the main phenomena in Samprapti of SandhigataVata.Sandhis come under the MadhyamaRogaMarga and thus, involvement of MadhyamaRogaMarga, VataDosha and Dhatukshaya figures disease KashtaSadhya.A common treatment for VataVyadhi has been described by Acharya Charaka i.e. Repeated use of SnehanaandSwedana,Basti and MruduVirechana. Acharya Sushruta has mentioned the treatment for SandhigataVata clearly i.e. Snehana, Upanaha, Agnikarma, Bandhana andunmardana.in this Clinical study, A Shamana yoga has been prescribed in patients of Osteoarthritis. 150 patients have been treated withshamanmedicines. The results have shown to be satisfactory in terms of relief in osteoarthritis. Key Words:Sandhigatavata,Vaatvyadhi, Osteoarthritis, Degenative disorder, Shaman chikitsa INTRODUCTION Ayurveda is an ancient and effective medical science and according to Ayurveda, Health is not merely freedom from disease. To be healthy, a person should be happy mentally, physically, socially and also spiritually. Sandhigatavata is described under Vatavyadhi in all the Samhita and Sangraha Grantha. In Vriddhavastha, all Dhatus undergo Kshaya, thus leading to Vataprakopa and making an individual prone to many diseases and among these Sandhigata Vata tops the list. [1] Acharya Charaka was the first person who described the disease separately named Sandhigata Anila, but has not included it under 80 types of Nanatmaja Vyadhi. [2] Acharya Vagabhatta has also considered VataVyadhi as a Maharoga. Till date Sandhigata Vata is a challenging disease and is the number one cause of disability in industrialized countries. The affliction of Sandh is by Prakupita Vata is the main phenomena in Samprapti of Sandhigata Vata. Sandhis come under the Madhyama Roga Marga and thus, involvement of Madhyama Roga Marga, Vata Dosha and Dhatukshaya figures disease Kashta Sadhya. Osteoarthritis or degenerative Joint Disease (DJD) may first appear without symptoms between 20 and 30 years of age. The symptoms, such as pain and inflammation, appear in middle age. Till the age of 55 it occurs equally in both sexes; after 55 the incidence is higher in women. It is estimated that approximately four out of 100 people are affected. The incidence of osteoarthritis in India is as high as 12%. By 2030, 20% of Americans which is about 70 million people who have passed their 65th birthday will suffer from Osteoarthritis. Osteoarthritis will be common before age of 45 more in men than women and after age of 45 more Page258

4 common in women. [3] Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by age 70. Almost all persons by age 40 have some pathologic change in weight bearing joint. 25% females and 16% males have symptomatic OA. [4] The disease Osteoarthritis may be regarded as a reward of longevity. It seems man has paid price for standing on hind limbs in form of osteoarthritis of weight bearing joints of the body. The disease Arthritis causes work disability. It limits everyday activities such as walking, dressing, bathing etc., thus making individual handicapped. No treatment is available which can prevent the disease process. In western medical science, mainly analgesics, anti-inflammatory drugs or surgery are the options for the treatment of Osteoarthritis; don t provide remarkable recovery, but causes greater adverse effects. Researchers are trying their level best for making drugs which can prevent or slows down or reverse joint damage. A common treatment for Vata Vyadhi has been described by Acharya Charaka i.e. Repeated use of Snehana and Swedana, Basti and Mrudu Virechana. [5] Acharya Sushruta has mentioned the treatment for Sandhigata Vata clearly i.e. Snehana, Upanaha, Agnikarma, Bandhanaand Unmardana. [6] OBJECTIVES OF THE STUDY 1. To identify the stage of osteoarthritis based on the clinical features. 2. To evaluate the effect of shaman treatment in the management of osteoarthritis. MATERIALS AND METHODS Institutional Ethics Committee Approval and Regulatory Compliance Before the initiation of the study, the study protocol and related documents were reviewed and approved by Institutional Ethics Committee at D. Y. Patil School Of Ayurveda, Nerul, Navi Mumbai. The study was conducted in accordance with Schedule Y of Drugs and Cosmetics act, India, amended in 2005 and ICMR ethical guidelines for biomedical research on human participants Ethical clearance was obtained for the present study. (Letter No: PDDYPU/AYU/587/2014) Type of study- Randomized uncontrolled open study. Patients were randomly selected on the basis of clinical features of the disease. Criteria for Inclusion of patients Age- The patients of yrs of age. Sex- Male & female both. Patients having signs & symptoms of sandhigata Vata (Vatavyadhi) mentioned in ayurvedic texts. Patients with X-ray findings suggestive of osteoarthritis Criteria for Exclusion of patients The patients with signs & symptoms of lumber spondylosis, ankylosing spondylosis, R.A., T.B. spine, cervical spondylitis etc. Patients suffering from systemic diseases like DM, HTN & cardiac diseases etc. Treatment Tab GokshuradiGuggulu1 t.d.s. Tab VishamusthiVati1 t.d.s. Avipathikara Choorna ½ tsp b.d. Gokshuradi Guggulu: [7] This combination contains Gokshura, Guggulu, Trikatu, Triphala, Musta. Gokshura which is a best Rasayana,Guggulu acts as Vatahara, Shoolahara. Vishamusti Vati: [8] This combination contains ShudhaKuchala, Yavaani, Saindhava, Visha, Ajamodha, Nadihingu, Vatsanabha, Maricha, Latakarnja, Vaaranga, Nagara, Pippali, Pippalimoola, Indraja, Devakusuma. Kupeelu acts a best VedhanaShamaka. AvipathikaraChoorna: [9] This contains Shunti, Amalakhi, Trijataka, Amboda, Krmighna, Trivruth, Sitha. This combination acts as Vataanulomana. Patients were further evaluated on the basis of Proforma prepared for the study. Duration of Treatment: Medicines were administered for 90 days. Assessment Parameters &Grading: Pain: Pain was assessed on the basis of VAS scale. Swelling: Absent - 0 Mild 1 Moderate 2 Severe 3 Page259 Source of Data: 150 patients diagnosed to have osteoarthritis of the knee joint. Methods of collection of data: Degenerative Changes: Absent 0 Palpable crepitus 1 Audible crepitus 2

5 Follow up: Follow up was carried out after every 15 days. OBSERVATIONS Graph 1 Effect on Pain in Osteoarthritis day 15 day 30 day 45 day 60 day 75 day 90 Graph 2 Effect on Swelling in Osteoarthritis day 15 day 30 day 45 day 60 day 75 day 90 Graph 3 Effect on degenerative changes in Osteoarthritis day 15 day 30 day 45 day 60 day 75 day 90 Page260 DISCUSSION Starting from the etiology of this disease we found that the major etiological factors which leads to this disease were sheet gunasevana i.e. excessive work in cold water, air conditioned offices, food preserved in refrigerators, cold drinks, kind of

6 work i.e. housewives doing excessive domestic work, tailoring job, clerical job, increased travelling, sitting in front of computers, irregular dietary habits etc. physical as well as mental stress & strain causing vitiation of Vatadosha. Thus, all these play an important role in the generation of this disease. Osteoarthritis is not simply a disease of wear and tear that happens in joints as people get old. It is a degenerative disease that can leave people unable to walk. Arthritis can affect a person at any time. Vatavikara are usually due to Dhatukshaya or Margavarana. Different manifestations like pain and deformity can be due to Dhatukshaya where as swelling can be related to Margavarana. Probable mode of action of Drug Chikitsa means nothing but the treatment given to disintegrate or destroy the Samprapti or pathogenesis of the disease. Generally Samprapti is found in the genesis of the disease. Sandhigata Vata is produced mainly due to Vata with Agnimandya, Asthimajjavaha Strotodushti, Dhatukshaya like symptoms with vitiation of VataDosha giving rise to symptoms like Sandhi Shoola, Sandhi Graha, Mansabala Kshaya etc. For the disintegration of Samprapti of Sandhigata Vata, the drug must possess some essential properties like Vata Shamaka, Vata Dushtihara, Agnivardhaka, Dhatvagnivardhaka, strengthen the joints, Dhatuvardhan along with Vedanashamak & Snehana actions. The drug Gokshuradi Guggul is a combination of 6 herbs including Guggulu processed in ghee. The constituents like Gokshura & Trikatu are known as rejuvenators & provides strength to Dhatus. & Jatharagni where as Guggulu is especially acting on Asthidhatwagni. Ghee with its yogavahi property helps in better absorption &penetration of the drug. Thus, Gokshuradiguggulu directly impacts on the etiology of Sandhigata Vata & helps in the disintegration of the Samprapti & settles down the vitiated Vatadosha. Vishamusti Vati helps in reducing the pain in osteoarthritis & contents of Avipattikarachurna helps in vatanulomana & regularize vatadosha. CONCLUSION In Osteoarthritis associated with Dhatukshaya, Gokshuradi Guggulu predominantly acts as Vatahara and Rasayana thereby supplementing Ksheena Dhatu. Vishamustivati contains Kupeelu which depresses the inhibitory post synaptic potentials in the Spinal cord. Gokshuradi Guggulu is also a drug of choice in Shotha. Avipathkara Choorna acts as Vata Anulomana and is useful in all above conditions which removes excess vata from its moolasthana. So, it can be firmly said that Pain, Swelling and degenerative changes in Osteoarthritis can be effectively managed with Ayurveda. REFERENCES 1. Acharya Yadavji Trikamji, Sushruth samhita: Choukambha publication,varanasi, 2000 p Acharya Yadavji Trikamji Agnivesha: Charaka samhitha,, Chaukambha Orientalia, 5 th Edition 2001, Varanasi. p Otis, James AD, and Brian McGeeney. "Managing pain in the elderly." Clinical Geriatrics 8 (2000): Felson, David T., and Yuqing Zhang. "An update on the epidemiology of knee and hip osteoarthritis with a view to prevention." Arthritis & Rheumatism 41.8 (1998): Acharya Jadavji Trikamji Agnivesha: Charaka samhitha, Chaukambha Orientalia, 5 th Edition 2001, Varanasi. p.738, Acharya Yadavji Trikamji, Sushruth samhita, Choukambha publication,varanasi, 2000 p [accessed on 20th Aug 2015] 8. [accessed on 20th Aug 2015] 9. [accessed on 20th Aug 2015] CITE THIS ARTICLE AS Mayur Pawaskaret.al., Management of Osteo-Arthritis with Ayurveda, Int. J. Ayu. Alt. Med., 2015; 3(5): Source of Support Nil Conflict of Interest None Declared Page261

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