Objective:
To assess the efficacy of Mahamasha taila Januvasti- a Bahirparimarjana Chikitsa and Panchatiktaghrita guggulu Matravasti and Panchatikta guggulu ghrita as Shamana aushadi in janusandhigata vata- Degenerative osteoarthritis.
Concept:
- Dhatugata vatavyadhi is one amongst the physiopathogenesis of vatavyadhis.
- It is due to sheeta and ruksha guna vikruti of vata dosha.
- Asthi, Snayu, Sira, Kandara and Sleshaka kapha are the dushyas.
- The Principles of treatment are Snigdha Brumhana, Snehanam swedayutam or Swedanam snehayutam, Asthi majja pratyaneeka Rasayana, Balya etc.
- Hence the role of Januvasti with Mahamasha taila externally, Matravasti with Panchatiktaghrita 60ml per day in Yogavasti Schedule and Panchatiktaghrita guggulu vati as Naimittika Rasayana were taken up in the protocol.
Hetu:
- Aaharaja: Ruksha, sheeta, alpa-laghu bhojana & asatmya aahara.
- Viharaja: Ativyayama, adhika ratrijagarana, ativyavaya, vegadharan, upavasa and adhikayana.
- Manasika: Chinta, krodha, shoka, bhaya.
- Abhighataja: Chedhana, bhedhana, prahara adi.
- Panchakarma vyapath.
Samprapti:
Pathogenesis:
- The main pathology in Osteo-arthritis is in the articular cartilage. The cartilage degenerates, becomes thin, gets softened and the underlying bone may be exposed.
- The nutrition of the cartilage is imbibed from neighbouring sub-chondral blood vessels and the synovial fluid. The fibrillation of the cartilage occurs mostly in the weight bearing area, because of improper nutrition. The surface of the exposed sub chondral bone becomes smooth and polished to an ivory-like consistency.
- There is cyst formation, due to the fracture of surface trabeculae. Cysts are formed due to the leakage of synovial fluid.
Lakshanas:
- “Vatapurnadhruthi sparshaha shothaha sandhigateanile
- Prasaranakunchanayo pravrutthischa savedana” [cha.chi.28/37]
- “Hanti sandhigataha sandhinashoola shopho karothischa” [su.su 1 chap]
Clinical signs:
- Pain, mainly related to movement and weight bearing.
- Restricted movement (capsular thickening, blocking by osteophyte).
- Palpable, sometimes audible, coarse crepitus (rough articular surfaces).
- Bony swelling (osteophyte) around joint margins.
- Deformity, usually without instability.
- Periarticular tenderness.
- Muscle weakness, wasting and spasm.
- Effusion
Diagnostic methods:
X-Ray
- Narrowing of the
- Joint space.
- Sub chondral sclerosis.
- Osteophyte formation.
- Subchondral cyst.
Line of Treatment:
- Sandhigata vata – Shoola and Shotha pradhana.
- Langhana Shamana Upakrama in Sthambha, shotha, graham and kapha-vata lakshanas.
- Pachana, Deepana, Swedana, Upavasa etc.
- Langhana Shodhana Upakrama in Sheeta ruksha guna pradhana and chala guna hraasa with pruthvi, aap guna vriddhi.
- Swedana, Upanaha, Sammardana, Snehana, Daha, Agnikarma, Bandana etc., are to be adopted.
- Kapha-sthana-gata vata lakshanas then the upakramas will be started from swedana and after kapha-aama-shopha shamana, snehana upakrama is to be adopted.
- Aashraya-aashrayi bhava and asthigata vata with degenerative changes then after observing nirama lakshanas, sneha upakramas are to be initially done followed by sweda upakramas.
Hence in short the chikitsa sutra of Sandhigata vata, as per classics can be summarized as:
“Sneha samyuktam swedanam”
“Swedanam sneha samyuktam”
Janubasti
Concept:
- It is one of the varieties of bahya snehana.
- It is safe and gives quick relief to the patient.
- Being an external therapy (BPC), it has no side effects and complications.
- It gives immediate results because it acts at the site and pacify vata dosha.
- It is also known as janu tarpana.
- Duration of Treatment : 15 to 21 days
Materials required:
- Masha powder – 100g
- Maha masha taila – 150ml
Procedure:
- Poorva karma (Pre operative procedure)
- Pradhana karma (Operative procedure)
- Paschat karma (Post operative procedure)
Matra Basti
- Matra basti is one of the safest and uncomplicated amongst all the bastis.
- Its dose is equal to hraswa sneha matra.
Materials Required :
- 100 ml of metal or plastic syringe.
- Rubber catheter – according to age.
- Panchatikta ghrita – 60 ml per day.
Duration : 8 days or 16 days
Schedule : Yogavasti
Rationality :
- Janu-sandhigata vata or knee-joint degenerative osteo-arthritis is one of the most prevailing disease.
- MMT is used in Janu basti for its effectiveness as it is Balya, Brumhaniya, Asthi-dhathu poshaka and vata shamaka.
- PTGG is used in Matra basti. As it is Balya, Rasayana ,Asthi-dhatu poshaka, Majja dhathu stairayakara.
- By the adoption of the above mentioned treatment both the sthanika dosha sthana and moola dosha sthana ie., Janu sandhi and pakwashaya are targeted.
- Pureesha and Asthivaha – srotases are sister-concern srotases.
- Hence Matra-basti becomes a very eftective way of management of Janu-Sandhigata vata.
- It acts at Pureeshavaha srotas and vatamula sthana. There by it reaches Asthi-majjadhara Kala.
Conclusion:
- It is Snehana, Brumhana, Vata shamana Upakrama.
- Hence Bahya snehana and Matravasti makes a package for Sandhi-shula and Nirupastambhita Sandhigata vata-vyadhi.
Author:
Dr. Keerthi Shetty
Ayurveda Doctor
Panchakarma Specialist
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