Ayurveda Research Work

A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU
WITH MURIVENNA IN JANU SANDHI GATA VATA.

By

Dr. PRASANTH. D.B.A.M.S

Dissertation Submitted to the
Rajiv Gandhi University Of Health Sciences,Karnataka,Bangalore

In partial fulfilment
of the requirements for the degree of

AYURVEDA VACHASPATHI
DOCTOR OF MEDICINE (AYU)

In

PANCHAKARMA

Under the guidance of

Guide: Co -Guide:
Dr. K. N. RAJASHEKAR
M.D.(Ayu)
Dr. PRASANNA AITHAL
M.D.(Ayu)

DEPARTMENT OF POST GRADUATE STUDIES IN
PANCHA KARMA
ALVAS AYURVEDA MEDICAL COLLEGE & HOSPITAL
MOODBIDRI 574227.

2009-2010

ALVAS AYURVEDA MEDICAL COLLEGE
PANCHAKARMA
MOODBIDRI, KARNATAKA

I here by declare that this dissertation entitled A COMPARATIVE STUDY ON
JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU SANDHI
GATA VATA. is a bonafide and genuine research work carried out by me,
under the guidance of Dr.K.N.RAJASHEKAR M.D.(Ayu) and Dr. PRASANNA
AITHAL
M.D.(Ayu)
,Department of Post Graduate Studies in Panchakarma,
Alvas Ayurveda Medical College, Moodbidri.

Date :
Place : Moodbidri

Dr. PRASANTH. D
III Year M.D. (Ayu)
Dept. of P.G. Studies in
Panchakarma,
Alvas Ayurveda Medical College
Moodbidri 574227.
Declaration

PANCHAKARMA
MOODBIDRI, KARNATAKA.

This is to certify that the dissertation entitled A COMPARATIVE
STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN
JANU SANDHIGATAVATA submitted by Dr. PRASANTH. D, in partial
fulfillment for the degree of Ayurveda Vachaspathi (M.D.) in Panchakarma, of
Rajiv Gandhi University of Health Sciences, Bangalore, is a record of research
work done by him during the period of his study in this institute, under our
guidance and supervision and the dissertation has not previously formed the
basis to the award of any degree, diploma, fellowship or other similar titles.
We recommend this dissertation for the above degree to the University for
the Approval.

Co-Guide: Guide:
Dr. PRASANNA AITHAL
M.D.(Ayu)
Dr. K. N. RAJASHEKAR
M.D.(Ayu)
Asst Professor, Dept. of P.G Studies Asst Professor, Dept. of P.G Studies
in Panchakarma, in Panchakarma,
Alvas Ayurveda Medical college Alvas Ayurveda Medical college
Moodbidri 574227 Moodbidri - 574227

Date:
Place: Moodbidri

Certificate
PANCHAKARMA

This is to certify that the dissertation entitled A COMPARATIVE STUDY ON
JANU BASTI AND JANU PICHU WITH MURIVENNA IN JANU
SANDHIGATAVATA is a bonafide research work done by Dr.PRASANTH. D
under the guidance of Dr. K. N. RAJASHEKAR
M.D.(Ayu)
andDr. PRASANNA
AITHAL
M.D.(Ayu)
in partial fulfilment of the requirement for the award of the
degree in Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv Gandhi
University of Health Sciences, Bangalore, Karnataka.

Date:
Place: Moodbidri

H.O.D.
Dept. of P.G Studies in
Panchakarma,
Moodbidri 574227

Certificate
PANCHAKARMA

This is to certify that the dissertation entitledA COMPARATIVE STUDY ON
JANU BASTI AND JANU PICHU WITH MURIVENNA ON JANU
SANDHIGATAVATA is a bonafide research work done by Dr.PRASANTH. D
under the guidance of Dr. K. N. RAJASHEKAR
M.D.(Ayu)
andDr. PRASANNA
AITHAL
M.D.(Ayu)
, Department of Post Graduate Studies in Panchakarma, Alvas
Ayurveda Medical College, Moodbidri.

PRINCIPAL,
Alvas Ayurveda Medical College.
Moodbidri 574227,
Dakshina Kanada. (Dist)
Karnataka
Date :
Place : Moodbidri

Endorsement
COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this
dissertation in print or electronic format for academic/research purpose.

Date:
Place: Moodbidri

Rajiv Gandhi University of Health Sciences, Karnataka

Dr. PRASANTH. D
III Year M.D. (Ayu)
Dept. of P.G. Studies in Panchakarma
Moodbidri 574227

ABSTRACT

4

ABSTRACT

Janu Sandhigata Vata is one among the most common Vta Vydhi. This
disease affects the joints with its signs and symptoms like pain, swelling, and
restriction of joint movements. Commonly this Sandhigatavata is presented in
Janusandhi, which is one among the most important weight bearing joint in body and
also considered as a Marma.
Osteoarthritis is most common form of arthritis characterized mainly by pain,
bony swelling and functional restriction of the joint. This condition too, is commonly
presented in knee joint. Due to its similarities in signs and symptoms it can be very
much correlated to Janusandhigatavata. Studies reveal there is a steady rise in
prevalence of OA from age 30 such that by 65, 80% of people have radiographic
evidence of OA, though only 25-30% are symptomatic. Its a slowly progressing
degenerative disorder. Potent analgesics and anti-inflammatory drugs are available in
the market, which run the risk of producing side effects like gastric erosion, hepatic
and nephro toxicity etc. Even surgery statistically reveals to have a failure rate of 10%
in knee replacements. Its a limitation in contemporary science to provide a
comprehensive effective management. So research works in Ayurveda has evident
scope in this condition.
According to Ayurveda Snehana, Svedana, Dahana and Upanaha are the prime
modalities of treatment in the management of Sandhigatavata, which are mostly
aimed at Bramhana. Janubasti and Janupichu are the procedures basically evolved
from Shirobasti and Shiropichu, which are mentioned among Moordhini Tailas
3b,6
are
also having Bramhana action where Sneha is allowed to stay for a stipulated duration
in the affected joint.
Murivenna

commonly used Anubhuta yoga in Kerala, listed in Kerala
Ayurveda pharmacopeia is useful in Sandhi Bhagna has Vedanasthapaka and
shothagna effect. Murivenna is also considered as one of the best yoga in
Marmabhighata too. Murivenna in the form of Janubasti or Janupichu in managing
Janusandhigatavata vata was not studied before.
Therefore this study is intended to compare the effect of Janubasti and
Janupichu done with Murivenna in the management of Janusandhigatavata.

A COMPARITIVE STUDY ON JANU BASTI AND JANU PICHU WITH MURIVENNA IN
JANU SANDHIGATAVATA.
ABSTRACT

5

Objectives:
1. Evaluation of effect of Janu Basti with Murivenna on Janusandhigatavata.
2. Evaluation of effect of Janu Pichu with Murivenna on Janusandhigatavata.
3. To compare and ascertain the effect of Janu Basti and Janu Pichu with Murivenna.

Methods:
It is a single blind clinical study with pre-test and post-test design. A special
proforma was prepared with all the points of history taking, physical examination and
investigations.
The study was carried out in 30 Patients of Janu Sandhi Gata Vata with who
were divided equally into two groups. In group A, Patients were administered Janu
Basti with Murivenna for 45 minutes, for 7 consecutive days.In group B, patients
were administered Janu pichu with Murivenna for 45 minutes for 7 consecutive days.
Data was collected from the patient on the 1st day before treatment, 8th day
after procedure and on 14
th
and 22nd day of the study period. Placebo was given
internally during the study period in the form of rice flour capsule 1 Bid.
Interpretation and Results:
Assessment inside a group was statistically done using paired t test and
student t test was utilized for comparative assessment in between groups.
The test of significance showed that both the procedures had significant
improvement statistically in all the signs and symptoms except for Gait in
group B.
On comparison between the groups except for pain and gait none of the
symptoms showed statistically significant changes.
Conclusion:
On the overall glance over the study showed that among the 30 patients of
Janu Sandhigatavata 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 %
relief, 22 (73.4 %) got moderate relief between 60 % and 90 % & 3(10%) got partially
improved results.
ABSTRACT

6

On comparative assessment between groups, In Group A, 2 patients (13.4 %) got 100
% relief & 3 patients (20 %) got more than 90 % relief while in Group B, no patients
got more than 90 % or 100% relief. 9 patients (60 %) of Group A, got relief in
between 60-90 % and whereas 13 ( 87%) patients of Group B got relief in between
60-90 %.
Analysis of the results showed that Janu Basti with Murivenna provided a better relief
in the signs and symptoms of JanuSandhigatavata mainly in pain, stiffness, gait,
tenderness, swelling, crepitus and range of movements compared with Janu Pichu
done by the same.

Key words:
JanuSandhigatavata, Janu Basti, Janu pichu, Murivenna.

ACKNOWLEDGEMENT

As always I have known, Gratitude is the best attitude. First of all I would like to
remember almighty for making me reach what I am today; in spite of all odds what I had
been made to pass through in life. I strongly believe in the silent prayers and invisible
presence of my Mother and the constant inspiration of my Father, I am always grateful
to them. I can never forget the inspiration and love that my Sister has showered on me,
making me responsible without which my life would have been meaningless. Nothing on
earth can replace a mother, but I cant forget the immense support and inspiration that
my Step Mother has provided constantly right from the day she chose to be one among
us.
It is my privilege to thank my guide, Dr. K.N.RAJASEKHAR, who kept constant belief
in me and guided me throughout in all my activities, observing me closely, helping me
whenever in need. I cant forget the help, constant support, strong belief and intelligent
ideas rendered by my co guide, Dr. S.G. PRASANNA AITHAL. It is a blessing to be
under Dr. ZENICA DSOUZA, my H.O.D who stood as an inspiration and a constant
motivation in all my activities including this, and a simple expression of gratitude doesnt
feel worthy enough for all her blessings.
It would be really ungrateful if I dont mention the constant support and timely help
provided by Dr. VASANT PATIL, Dr. C. V.RAJASHEKAR, Dr. P.K. MOHANLAL,
Dr. VIKRAM and all staff members of my college throughout my post graduation life. If I
have saved anything in my life, all I can count upon are my friends, I can never forget the
confidence and help they have rendered me throughout. I would specially like to mention
the help rendered by MR. SIDDHARTH, Dr. SHARATH, Dr. ANUPRABHA, Dr.
SREERAJ, Dr. ARUN KUMAR, Dr. ANANTH RAM, Dr. NATRAJ, Dr. SANDEEP,
Dr. SUSHA, Dr. NATASHA, Dr. SMITHA, Dr. JESSICA and Dr. RAIBY without
whom this work would have never been in this form.
I owe my sincere regards and boundless gratitude to Dr.M.Mohan Alva, Chairman,
Alvas Education Foundation, Moodbidri, for giving me an opportunity to do my post
graduate studies in this prestigious institution. I render my immense and heartfelt thanks
to

Dean of P.G faculty, Alvas Education Foundation, Moodbidri, and Principal, Alvas
Education Foundation, Moodbidri, for their constant help, and support in completing
this work.

Also I would never forget the constant sparks and endless support provided by my dear
friends & departmental colleagues Dr. CHANNABASAPPA, Dr. PARVATHY and
Dr. PRIYA for the trust that they have entitled in me, without whose help this work would
have never been complete as of any other activity of mine.
I can never forget all my gurus who have taught me the greatness of this vast ocean of life
AYURVEDA in front of which Im still a child who is mesmerized by its intense beauty
and depth, waiting to feel another wave from shore. Without your blessings Im
incomplete.
Last, not least, Also I would take this opportunity to thank all my seniors, juniors,
Panchakarma therapists, the library staff the printing and graphics department for
their immense cooperation during the work
If I have left anyone, I would like to thank all who have directly or indirectly helped me in
the successful completion of this work.

Dr.PRASANTH.D

Sl. No CONTENTS Page No
Abbreviations i - ii
List of Table iii - iv
List of Graph & Pictures v
Introduction 1 - 3
I Conceptual Study 4 - 21
Historical Review 4 - 7
J anu Sandhi Review 8 - 11
Anatomy of Knee J oint 12 - 14
Twak Review 15 16
Anatomy of Skin 17 - 20
J anu Basti Review 21 - 24
J anu Pichu Review 25 - 28
II Disease Review 30 - 57
J anu Sandhigata Vata 30 - 35
Nidana 35 - 39
Poorvarupa 40
Rupa 40 - 42
Samprapti & Samprapti Ghataka 42 - 46
Upashaya & Anupashaya 47
Sapeksha Nidana 48 - 49
Sadhyaasadhyata 49 - 50
Chikitsa 51 - 55
Pathya Apathya & Shamana Aushadhi 56 - 57
III Drug Review 58 - 74
IV Clinical Study 75 - 110
V Discussion 111 - 125
VI Summary & Conclusion 126 - 129
References & Bibliography 130 - 138

Annexure I - XV
i

ABBREVIATIONS

1) A.H : Astanga Hridaya
2) A.S : Astanga Sangraha
3) A.T. : After Treatment
4) Bel.sa : Bela Samhita
5) Bh.Pr : Bhava Prakasha
6) B.R : Bhaishajya Ratnavali
7) B.T. : Before Treatment
8) C.D : Chakra Datta
9) Cha.S : Charaka Samhita
10) Comm. : Commentary
11) Ckr : Chakrapani.
12) D.G : Dravya Guna Vijnana
13) DL : Dalhana
14) D.P.P.M : Davidsons Priciples And Practice Of Medicine
15) H.P.I.M: Harrisons Principle of Internal Medicine
16) I.P.D. : In Patient Department
17) K.S : Kashyapa Samhita
18) M.N : Madhava Nidana
19) Madhu : Madhukosha
20) O.P.D: Out Patient Department
21) S.D : Standard Deviation
22) S.E : Standard Error
23) S.K.D : Shabda Kalpa Druma
24) S.S : Susrutha Samhita
25) Saha.Y: Sahasra Yogam
26) Sha.S : Sharangadhara Samhita
27) Vag : Vagbhata
ii

28) Vang : Vangasena
29) Yo.Ra : Yogaratnakara
30) Yrs. : Years
31) + : Present
32) - : Not Present
33) % : Percentage

ABBREVIATIONS OF STHANAS OF SAMHITA
1) Chi : Chikitsa Sthana
2) I : Indriya Sthana
3) Ka : Kalpa Sthana
4) Ma.Kha: Madhyama Khanda
5) Ni : Nidana Sthana
6) Po.Kha : Poorva Khanda
7) Sha : Shareera Sthana
8) Si : Siddhi Sthana
9) Su : Sutra Sthana.
10) Utt : Uttara Khanda

iii
List of tables
Sl No Name of tables Page
No.
1 Aharaja Nidana of Vata Vyadhi. 37
2 Viharaja Nidana of Vata Vyadhi. 38
3 Manasika Nidana of Vata Vyadhi. 39
4 Anya Karana for Vata Vyadhi. 39
5 Rupa of Sandhivata mentioned in various classics. 42
6 Sapeksha Nidana of J anu Sandhivata 48
7 Different Chikitsa procedures indicated for J anu Sandhivata 51
8 Ingredients of Murivenna 72
9 Rasa Panchaka of the drugs used in the preparation of Murivenna 74
10 Distribution of 30 patients according to different age group 81
11 Sex wise distribution of 30 patients 82
12 Distribution of 30 patients according to occupation 82
13 Distribution of 30 patients according to religion 83
14 Distribution of 30 patients according to socio- economic status 84
15 Distribution of 30 patients according to marital Status 85
16 Distribution of 30 patients according to habitat 85
17 Distribution of 30 patients according to educational status 86
18 Distribution of 30 patients according to Prakruti 87
19 Distribution of 30 patients according to Saara 88
20 Distribution of 30 patients according to their Satwa 89
21 Distribution of 30 patients according to Samhanana 89
22 Distribution of 30 patients according to Saatmya 90
23 Distribution of the 30 patients according to dietary Habits 91
24 Distribution of 30 patients according to addictions / Vyasana 91
25 Distribution of 30 patients according to Aahara- Abhyavaharana
Shakti
92
26 Distribution of 30 patients according to Aahara-J arana shakti 93
27 Distribution of 30 patients according to Agni 93
28 Koshtha wise Distribution of 30 Patients of J anu Sandhivata 94
29 Distribution of 30 patients according to their nature of
work/Vihara
95
30 Distribution of patients according to Vyaayama Shakti 96
31 Distribution of patients according to their Nidra Sheela 96
32 Nidana (Ahara) wise Distribution of 30 Patients of J anu
Sandhivata
97
33 Nidana (Vihara) wise Distribution of 30 Patients of J anu
1Sandhivata
98
34 Nidana (Manasika) wise Distribution of 30 Patients of J anu
Sandhivata
99
iv
35 Chronicity wise Distribution of 30 Patients of J anu Sandhivata 100

36 Effect of J anu Basti with Murivenna in signs and symptoms of
15 patients of Group A AT.
101
15 patients of Group A 14
th
day.
102
15 patients of Group A 22
nd
day.
102
39 Effect of J anu Pichu with Murivenna in signs and symptoms of
15 patients of Group B AT.
103
15 patients of Group B 14
th
day.
104
15 patients of Group B 22
nd
day.
104
42 Comparative effect of procedures in signs and symptoms of
patients in group A & group B.
105
43 Comparative effect of procedures in percentage relief after
treatment.
106
44 Comparative effect of procedures in percentage relief on 7
th
, 14
th
and 22
nd
day.
107
45 Overall effect of the treatment. 109
46 Comparative effect of the treatment. 110

List of Graphs
Sl no: Name of graphs Pg.
no
1 Distribution of 30 patients according to different age group 81
2 Distribution of sex of 30 patients 82
3 Distribution of 30 patients according to occupation 83
4 Distribution of 30 patients according to religion 83
5 Distribution of 30 patients according to socio- economic status 84
6 Distribution of 30 patients according to marital Status 85
7 Distribution of 30 patients according to Habitat 86
8 Distribution of 30 patients according to educational status 86
9 Distribution of patients according to Prakruti 87
10 Distribution of patients according to Saara 88
11 Distribution of patients according to their Satwa 89
12 Distribution of 30 patients according to the Samhanana 90
13 Distribution of 30 patients according to their Saatmya 90
14 Distribution of 30 patients according to their dietary Habits 91
15 Distribution of 30 patients according to addictions / Vyasana 92
16 Distribution of 30 patients according to Aahara- Abhyavaharana
Shakti
92
17 Distribution of 30 patients according to Aahara-J arana shakti 93
18 Distribution of 30 patients according to Agni 94
19 Koshtha wise Distribution of 30 Patients of J anu Sandhigatavata 94
20 Distribution of patients according to their nature of work / Vihara 95
21 Distribution of patients according to Vyaayama Shakti 96
22 Distribution of patients according to their Nidra Sheela 97
23 Distribution of patients according to their Nidana (Ahara) 98
24 Nidana (Vihara) wise Distribution of 30 Patients of J anu
Sandhigatavata
99
25 Nidana (Manasika) wise Distribution of 30 Patients of J anu
Sandhigatavata
99
26 Chronicity wise Distribution of 30 Patients of J anu Sandhigatavata 100
27 Comparative effect of procedures on signs and symptoms
expressed in percentage , after treatment
106
28 Comparative effect of procedures in percentage relief on 7
th
, 14
th

and22
nd
day.
108
29 Overall effect of the treatment 109
30 Comparative effect of the treatment 110
31 Structure of Knee J oint 14
32 Structure of Skin 20
33 Illustrations of procedures 29

INTRODUCTION

1
INTRODUCTION

Vata, which is prime among the Tridoshas, is the major factor responsible for all
activities and manifestations of disease in the body. In Vriddhavastha, all Dhatus
undergo Kshaya, thus leading to Vata Prakopa. This makes the individual prone to
many diseases, among which Sandhivata stands at the top of the list. When this
deranged Vata lodges in Sandhi, it is characterized by pain, swelling, and restriction
of joint movements. Commonly, this Sandhigata vata manifests in J anusandhi, which
is one among the most important weight bearing joints in body. It is also considered
as a Marma.

Osteoarthritis is the most common form of arthritis characterized mainly by pain,
bony swelling and functional restriction of the joint. It commonly presents unilaterally
in the knee joint, which is the most important weight bearing joint in the body.
Osteoarthritis of the knee joint is the most common joint disorder seen in elderly
people. Due to similarities in signs and symptoms, it can be very much correlated to
J anu sandhigata vata.

Osteoarthritis is the most common articular disorder that begins asymptomatically in
the 2
nd
and 3
rd
decades and is extremely common by age 60. Studies reveal there is a
steady rise in prevalence of OA from age 30 such that by 65, 80% of people have
radiographic evidence of OA, though only 25-30% are symptomatic. It is a slowly
progressing degenerative disorder. Due to the increased prevalence of this disorder it
has become a major problem and burden for society, as it indirectly reduces the
working potency resulting in dependency. It limits everyday activities such as
walking, dressing, bathing etc., thus making individual partially or even fully
handicapped. J oint pain and soreness, especially with movement, pain after overuse
or after long periods of inactivity, joint swelling and joint fluid accumulation are the
features of osteoarthritis.

Potent analgesics and anti-inflammatory drugs are available in the market, which run
the risk of producing side effects like gastric erosion, hepatic and nephro toxicity, etc.
Even surgery has a statistical failure rate of 10% in knee replacements. One of the
INTRODUCTION

2
current limitations of contemporary science is the lack comprehensive and effective
management. Research work in Ayurveda has a large scope in this condition.

Charaka was the first person who separately described the disease named Sandhigata
Anila, but he has not included it among the 80 types of Nanatmaja Vyadhi
1
. Sushruta
and Vagbhata also gave importance to Sandhivata and included in the chapter of Vata
Vyadhi
2, 3.
When Vata involves J anu Sandhi, it is named J anu Sandhigatavata.

According to Ayurveda, Snehana, Svedana, Dahana and Upanaha are the prime
modalities of treatment in the management of Sandhigata vata. These are mostly
aimed at Bramhana. Sushruta has mentioned the treatment for Sandhigatavata as
Snehana, Svedana, Upanaha, Agnikarma, Bandhana and Unmardana
4
. Vagbhata
explained that Sneha should be used according to Yukti for Bhakshana, Basti, Nasya,
Abhyanga, Gandusha, Murdhni Taila, Karna Poorana and Akshi Tarpana
5
. J anu Basti
is one of the modalities of treatment commonly adopted in the management of J anu
Sandhi Gata Vata. Research has shown that J anu Basti with Taila gives encouraging
results in relieving the signs and symptoms of J anu Sandhi Vata.

J anubasti and J anupichu are the procedures that have basically evolved from
Shirobasti and Shiropichu, which are mentioned among Moordhini Tailas. Thesealso
have Bramhana action due to the Sneha which is allowed to remain over the affected
joint for a stipulated duration.

Murivenna
6
is a commonly used Anubhuta yoga in Kerala, and is listed in the Kerala
Ayurveda pharmacopeia. It is useful in Sandhi Bhagna due to its Vedanasthapaka and
shothagna effect. Most of the ingredients in Murivenna have Katu Rasa, Theekshna
Guna, Ushna Veerya and Katu Vipaka. Murivenna is also considered as one of the
best yogas in Marmabhighata. But Murivennas role in J anubasti or J anupichu for
management of J anusandhigatavata vata has not yet been studied. Currently, the J anu
basti procedure is given more importance and is widely practiced, even though in both
treatments the principle of management is very similar. The main goal is to allow the
sneha to stay in the affected joint for a stipulated period of time. Moreover the cost
effectiveness of J anu pichu is much less in comparison to J anu Basti and the
procedure is also much simpler.
INTRODUCTION

3
Considering all of these facts, an observational study was conducted to compare the
effectiveness of J anubasti versus J anupichu using Murivenna in the management of
J anusandhigatavata.

This is a comparative study which was carried out for 22 days along with follow up
assessment. Patients were selected on the basis of clinical assessment depending on
signs and symptoms fulfilling specific diagnostic criteria. 30 patients were randomly
selected and arranged into two groups of 15 patients each.

Janu Basti Group J anu Basti with Murivenna for 45 mins
Janu Pichu Group J anu Pichu with Murivenna for 45 mins

Clinical trials, case study, adopted treatments for each group and methods with
subjective and objective parameters, objectives, results, discussion and conclusion are
dealt with at the end of this thesis.

HISTORICAL REVIEW
4

HISTORICAL REVIEW

Everything we do in the past, its history. No one can reject the fact that history is the
most important among all disciplines. To know any subject, we are supposed to learn
history and use it for our benefit and prosperity. History gives us the today, by
which we can utilize all the things we have to make our lives easier and more
comfortable. Man always struggled with the present for creating a better tomorrow.
Here, a glimpse is given to the historical sight of Ayurveda science, chiefly on
Sandhivata and Swedana Chikitsa and it is presented as follows.

The knowledge of the origin of a disease is very essential. To obtain the historical
background of a disease we have to search deep into the Vedic literature. Vedas are
considered to be the oldest literature available and the root of Ayurveda. Its a known
fact that it is difficult to specify the source period of Ayurveda. Therefore it is not
possible to fix an exact date of origin for Ayurveda. History of Indian medicine is
usually studied under the heading of Pre-Vedic period, Vedic period, Samhita Kala,
Sangraha Kala, Nighantu Kala, and Adhunika Kala (Modern period).

PRE-VEDIC PERIOD:
References of Sandhigata Vata are not available in the Pre-Vedic period.

VEDIC PERIOD:
Vedas are the primary source of all the knowledge and are really the treasures
produced as a result of ancient Indian culture. They are the first written
documentation of Indian civilization. One can see the basic roots of each and every
subject in Vedas. Ayurveda is considered as the Upaveda of Atharva Veda. This
treatise describes many Roga, many Aushadha and many other connected factors.
Regarding Sandhigata Vata, we do get the references of body parts and the
possibilities of joint disorders in Rig Veda and Atharva Veda. It is mentioned that
Sandhi Vikriti is caused by Shleshma Vikriti.
HISTORICAL REVIEW
5
In Atharva Veda, two references are available about Sandhi Roga, one deals with the
disease situated in Sandhi and other is related with Sandhi Vishlesha [Ath.2/33/6;
6/14/1]. Also some references in Atharva Veda show the importance given for Vata
[Ath.8/2/3; 2/10/3], its Bhedha [Ath.10/2/3] and disorders of Vata [Ath.9/8/20]. Two
Dravya, Pippli and Vishanka, are considered as Vata Roganashaka [Ath.6/109/3;
6/44/3].

In Vedas even though there are no detailed and vast explanations about Swedana one
can see the mentioning about the same. Descriptions about Atapa Sweda are available
in Atharva Veda during the explanation of Swedana. It is given that this Swedana is
effective in pacifying the bodily disorders. In Rig-Veda, sun is considered as the
source of energy and it also states that sun bath has the curative property on Kamala
and Hridroga.

SAMHITA KAALA:
This is the period where we find realistic references of various diseases along with the
Nidana Panchaka. Specific signs, symptoms and treatment are not mentioned for J anu
Sandhigata Vata but in general, the Nidana Panchaka of Sandhigata Vata can be
considered for J anu Sandhigata Vata. Many authors described this disease in their
treatise during this period.

Charaka Samhita:
This Samhita, written by Acharya Agnivesha and re-edited by Acharya Charaka, has
mentioned the disease Sandhigata Anila in the chapter of Vata Vyadhi Chikitsa. Here
he has not mentioned any treatment for the Sandhivata
7
. He has also explained 13
types of Sa Agni Swedana and 10 types of Niragni Swedana
8, 9
.

Sushruta Samhita:
This treatise, written by Acharya Sushruta, has mentioned about the disease
Sandhigata Vata in Nidana Sthana and Chikitsa Sthana. A separate Chikitsa has been
mentioned for Sandhigata Vata in this Samhita. He has also added one more symptom
Hanti Sandhi in the Lakshanas of Sandhivata
10, 11
. There are 4 types of Swedana
which are explained by Acharya Sushruta
12
.

HISTORICAL REVIEW
6

Bhela Samhita:
Acharya Bhela has not clearly mentioned about this disease. However, under the topic
of Asthimajjagata Vata Vyadhi, a description of Sandhi Vichyuti is available
13
in his
Samhita.

Harita Samhita:
Acharya Harita has mentioned in his Samhita about the management of Sandhigata
Vata, but the diagnostic aspect of this disease is not mentioned in detail (H. S. 3/20).

SANGRAHA KALA:
This is the period where many authors started compiling the various existing Samhitas
and started making their own treatise. Along with the compilation of the previous
works they contributed their own knowledge and made the learning process easier for
the later ones.

Ashtanga Sangraha & Ashtanga Hridaya:
These books, written by Vriddha Vagbhata & Vagbhata respectively, have mentioned
the disease Sandhigata Vata in their treatise. Lakshanas are similar to those which are
mentioned by Acharya Sushruta
14, 15, 16&17
.

Madhava Nidana:
Acharya Madhavakara, in his samhita Madhava Nidana, has mentioned an additional
symptom, Atopa in the symptomatology of Sandhigata Vata
18
. The remaining
lakshanas are the same as in Sushruta Samhitha.

Bhava Prakasha:
Bhavamishra explained the Lakshanas and treatment of Sandhigata Vata in
Madhyama Khanda Vatavyadhyadhikara
19
in his treatise Bhava Prakasha.

Yogaratnakara:
In this book the Lakshana and the Chikitsa of Sandhigata Vata are explained in the
Vata Vyadhi Adhikara
20
.

HISTORICAL REVIEW
7

A glimpse on these references reveals that the later authors after Acharya Charaka &
Sushruta followed their footsteps and made minimal addition to the subject. There are
not many changes in the views of different authors who have written about
Sandhigata Vata. It also shows the importance of disease in their period as it is
mentioned by most of the authors.
JANU SANDHI REVEW

8

J ANU SANDHI REVIEW

The knowledge of the physiology and structures related to a particular organ as well
as its surrounding structures is very important before studying the pathology of any
disease related to that region. Hence the anatomy and physiology of the J anu Sandhi
should be understood properly. In J anu Sandhigatavata, the Vata lodges in J anu
Sandhi. In Ayurvedic classics the details regarding the anatomy and physiology of
Sandhi are scattered in various parts. So here an humble attempt is made to gather the
references related to Sandhi.

In general, Sandhi means the union of two or more structures of body. But in this
context, the word Sandhi is limited to Asthi Sandhi only.
The place where there is union of Asthi is called Sandhi
40
.

In Ayurveda, Sandhis are mainly classified into two types
41
1) Sthira Sandhi
2) Cala Sandhi (Chestavanta)

Again Sandhi is classified into following eight types based on shape
42
:
1) Kora 5) Tunnasevani
2) Ulookala 6) Vayasa tunda
3) Samudga 7) Mandala
4) Pratara 8) Shankhavarta

In modern anatomy, joints are classified as:
43
1. Fibrous or fixed joints (Synarthroses)
2. Cartilaginous or slightly movable joints (Amphiarthroses).
3. Synovial or freely movable joints (Diarthroses).

The Asthi Sandhi located at the region of J anu is called J anu Sandhi. It can be
classified under the group of Chestavanta and Kora Sandhi according to its features.
JANU SANDHI REVEW

9
They are two in number (one in each Shakha). The structures that constitute the
Sandhi are mentioned below:

1. Asthi
2. Snayu and Kandara
3. Sleshmadhara Kala
4. Sleshma (Shleshaka Kapha)
5. Peshi
6. Sira and Dhamani

Asthi:
Asthi is the basic constituent of any Sandhi. Its main function is Dharana of Sharira.
Vata takes Ashraya in Asthi and it has Ashraya Ashrayi Bhava Sambandha i.e., when
the Ashrita gets Vriddhi, the Ashrayi also goes on Vriddhi and vice- versa. In
Sandhivata, the Prakupita Vata results in Asthi Kshaya
44,45
.

Vata can be considered under 5 different names based on its Sthana and Karma. Out
of these, there is no direct reference regarding the Vata residing in the Sandhi. The
Vyana Vata is said to be Kritsna Deha Charah
46
i.e. it moves all over the body, but
based on its function of Gati or movement, we may consider Sandhi, as one of its
sites. In Tantrantara, a specific reference is available stating Sandhi as one of the sites
of Vyana Vata. Also, the functions such as Aakunchana, Prasarana, etc. which are
attributed to Vyana Vata, are possible through Sandhi. Further, the primary aim of the
Sandhi is to provide movements to the body organs therefore Vata must have one of
its seats of action in Sandhi. In addition, while dealing with Vata Vikara, Gati Hanana
has been explained as one of the outcome
47
. Hence, Vyana Vata can be considered as
the one deranged in the disease Sandhivata.

Snayu and Kandara:
Snayu is a structure which binds Asthi, Mamsa and Meda. Out of 900 Snayu, 10
Snayus are present in J anu Sandhi. These are responsible for bearing of body weight.
Sushruta has explained this by giving a simile of boat. As a boat made of planks and
wood tightened together by means of large number of bindings can float on the water
JANU SANDHI REVEW

10
and is capable of carrying loads of passengers, in the same way, the human body is
tightened at the Sandhi by large number of Snayu and is able to bear weight
48
.

Kandara is a type of Snayu that is Vritta or cylindrical in shape. Its functions include
Prasarana and Aakunchana of the joint
49
.

Shleshmadhara Kala
Kala is a structure located in between Dhatus and Ashaya that contains Kleda which is
described as Dhatu Rasa Vishesha by Acharya Vagbhata. It is the fourth Kala, which
is situated in Sarva Sandhi. This helps in lubrication of joints
50
. J ust as a wheel
moves well by lubricating the axle, joints also function properly if supported with
Kapha. Synovial membrane has similar functions.

Sleshma or Shleshaka Kapha
Sleshma, which is present in the Sandhi, is termed as Shleshaka Kapha
51
. It facilitates
free movement of the Sandhi and provides lubrication to the Sandhi. The function of
Shleshmadhara Kala and Sleshma are similar. So, we may consider that Sleshma is
the one that is present in Shleshmadhara Kala, and that it does Kleda of Sandhi.

Peshi
Peshi is the fleshy mass which covers the different structures of the body such as Sira
Snayu, and Asthi, and it provides strength to those structures and to the Sandhi. In
J anu sandhi they are five in number. They are strong structures that help to maintain
alignment of the joint
52
.

Sanghata
Sanghata, or assemblage of bones, is fourteen. One is situated in J anu Sandhi
53
.

Sira and Dhamani
The Kaphavaha Siras carry Prakrita Kapha, maintain the Sandhi, ensure its Sthirata
and increase its Bala. One of the functions of Vatavaha Siras is Cheshta, such as
JANU SANDHI REVEW

11
Prasarana and Akunchana. The Raktavaha Siras does Dhatu Purana, brings about
Sthirata and does Poshana. Asthi is one among the Dhatus and hence these functions
are applicable for Asthi Dhatu Poshana also
54,55,56
.
The Sparshavaha Dhamanis are spread in the upward direction and these have the
function of carrying the Sparsha J nana
57
. The Sparsha may be Sukhakara or
Dukhakara.

ANATOMY OF KNEE JOINT

12
KNEE JOINT

The knee joint is a type of Synovial joint. In Synovial joints, the articulating osseous
surfaces are not in continuity although the bones involved are linked. Synovial joints
evolve from fibrous and cartilaginous joints by subsequent developments. They are
made up of a combination of unique structures including the fibrous capsule, articular
surfaces, Synovial membrane, Synovial fluid, ligaments, muscles, etc.

The knee joint is one of the largest joints of the human body. Despite its single cavity
in man, it is convenient to describe it as two chondylar joints between the Femur and
Tibia, and a sellar joint between the Patella and Femur.

Articular surface
Articular surfaces are most dissimilar. The Tibial surface is slightly hollow centrally
and flattened peripherally wherein a meniscus rests. Laterally, the Tibial surface is
circular and smaller, while medially the Tibial surface is oval with a longer antero-
posterior axis.

The lateral and medial femoral chondyles in front have a faint groove. This groove
demarks the femoral patellar and chondylar surfaces. Lateral Femoral surfaces are
almost circular and medial, while the femoral surface is larger and oval. The Patellas
articular surface is adapted to the femoral surfaces.

Fibrous capsule
The fibrous capsule has parallel but interlacing bundles of white collagen fibers. It is
complex, partly deficient and partly augmented by expansions from adjacent tendons.
It forms a cuff with its ends attached continuously around the articular ends of the
tibia and Femur.

Synovial Membrane
Derived from embryonic mesenchyme, the Synovial membrane lines the fibrous
capsule and covers exposed osseous surfaces, intra-capsular ligaments and tendons. It
is absent from intra-articular discs or menisci and ceases at the margins of articular
cartilages.

13
Synovial Intima: It is also called as lamina propria synovialis or Synovial lining layer.
It consists of pleomorphic synoviocytes embedded in a granular, amorphous, fiber
free inter-cellular matrix. It helps in removal of debris and synthesis of components of
Synovial fluid.

Synovial fluid
It occupies the Synovial joints, bursae and tendon sheaths. It is clear, pale, yellow,
viscous, and slightly alkaline. Most probably the protein lubricin (rather than
hyaluroic acid) is the lubricating factor, which is amplified the secondary lubricating
activity of hyaluroic acid. It provides a liquid environment with small range of pH,
nutrition for articular cartilage, discs, menisci, lubrication and reduction of erosion.

Menisci
They are the fibrocartilagenous disc-shaped crescents which deepen the articular
surfaces of the chondyles of the tibia and also partially divide the joint cavity into
upper and lower compartments. They possess two ends, two borders and two surfaces,
and act as shock absorbers. By lubricating the joint cavity, they give rise to
proprioceptive impulse
58
.

OTHER STRUCTERS:
Ligaments
The capsules and ligaments of Synovial joints unite the bones, help to direct bone
movement and prevent excessive and undesirable motion. Thus, with more ligaments,
the joint becomes stronger. In the knee joint, the tibial collateral ligament, fibular
collateral ligament, oblique popliteal ligament, arcuate popliteal ligament,
ligamentum patellae, cruciate ligament etc. help to maintain stability.

Muscle Tone
The muscle tendons that cross the joints are the most important stabilizing factor. The
amount of stability is due to the tone of the respective muscles. In the knee, muscle
tone is extremely important for reinforcing joints. The thigh muscles are especially
helpful.

14
Bursae
These are apertures in fibrous capsule through which Synovial membranes protrude.
They are numerous; as many as 13 burses have been described.

Blood Supply
5 Genicular branches of the popliteal artery
The descending genicular branch of the femoral artery
The descending branch of the lateral circumflex femoral artery
2 recurrent branches of the anterior tibial artery
The circumflex fibular branch of the post-tibial artery
Nerve Supply
Femoral nerve
Sciatic nerve - through the genicular branches of the tibial and
Common Peroneal nerve
Obturator nerve - through its posterior division
59
.

Picture No. 31: Structure of Knee Joint
TWAK REVIEW

15
TWAK

J anu Basti & J anu Pichu are the procedures which are done over the Twak. J anu
Sandhi is covered by Twak externally. Absorption of the Aushadhi is carried out only
through the media of Twak and hence it is very important to study Twak Shareera
when we deal with these Bahi Parimarjana Chikistas.

In view of Ayurveda:
Twak is a Sthana of Sparshanendriya. Twacha and Charma are synonymous words
which are commonly used to indicate the skin in all Ayurvedic classics. Twak is one
of the Indriya Adhishtanas which completely covers Meda, Shonita and all other
Dhatus of the body, and it spreads all over the body. It is considered as the seat of
Sparshanendriya, as well as one of the main seats of Vata. Bhrajaka Pitta is also
situated in Twak
60,61
.

Formation of Twak:
According to Charaka, Twak is the Upadhatu of Mamsa and is considered to be
formed from Mamsa. According to Sushruta, at the time of fertilization, Shukra,
Shonita and Atma unite for the formation of Garbha. Its growth is rapid and it is
nourished by Tridoshas. The seven folds, or layers of Twak, are formed at that time
and are deposited on this rapidly transforming product in the same manner as the
layers of cream are formed and precipitated on the surface of boiling milk
62
.

According to Vagbhata, Twak is formed by the Paka of Rakta Dhatu by its Dhatvagni.
After the Paka of Rakta, it becomes dry in the form of Twak, similar to the deposition
of cream on the surface of the boiling milk. Thus, Twak is also called as Rakta
Santanika
63
.
Layers of Skin (Twak):
There are some different opinions regarding the number of the layers of the skin
(Twak) among the ancient Acharyas.
TWAK REVIEW

16
Acharya Charaka has mentioned six layers of skin, but only the first two layers are
named while the remaining four are counted as those producing diseases
64
.

1. Udakadhara
2. Ashrukadhara
3. Tritiya
4. Chaturtha
5. Panchami
6. Shashti
Acharya Sushruta has mentioned seven layers of skin along with their specific names,
thickness and probability in origin of specific diseases
65
.

1. Avabhasini
2. Lohita
3. Shweta
4. Tamra
5. Vedini
6. Rohini
7. Mamsadhara
Acharya Vagbhata has also described seven layers of skin, but the names are not
mentioned. Commenting on Vagbhata, Arundatta and Hemadri have named them
according to the nomenclature given by Sushruta
66
.
Sharangadhara has also mentioned seven layers of skin along with the probable onset
of disease. The names of the first six layers are the same as Sushruta, but the 7
th
layer
is called Sthula
67
.

ANATOMY OF SKIN

17
ANATOMY OF SKIN

According to modern science:
68

Skin is one of the largest organs of the body in surface area and weight. In adults, the
skin covers an area of approximately 2 square meters and weighs between 4.5 to 5 kg.
It ranges in thickness from 0.5 to 4.0 mm, depending on the location.

ANATOMY:
The skin consists of two principal parts. The outer thinner portion, called the
epidermis, is composed of epithelium. It is attached to the inner, thicker, connective
tissue part called the dermis. The dermis is a subcutaneous layer known as the
superficial fascia or hypodermis, which consists of Areolar and Adipose Tissue. This
subcutaneous layer, in turn, attaches to underlying tissues and organs.

EPIDERMIS:
The epidermis is composed of Stratified Squamous Epithelium and contains four
principal types of cells called: (i) Keratinocytes, (ii) Melanocytes, (iii) Langerhans
cells, and (iv) Marked cells. Four or five distinct layers of cells form the epidermis. In
most regions of the body, the epidermis is about 0.1 mm thick and has four layers.
Where exposure to friction is greatest, as in the palms and soles, the epidermis is
thicker (1 to 2 mm) and has five layers. Constant exposure of thin or thick skin to
friction or pressure stimulates formation of a callus, an abnormal thickening of the
epidermis.

The names of the five layers, from the deepest to the most superficial layer are as
follows:

Stratum basal or germinativum: It forms the lowest layer, consists of a single row
of columnar cells and is capable of continuous cellular division. As these cells
multiply, they push up towards the surface and become part of the upper layers. The
stratum basal also contains tactile (Merkel) discs that are sensitive to touch.

ANATOMY OF SKIN

18
Stratum spinosum or Malpighi layer: This prickle cell layer lies upon the basal
layer and has 8 to 10 rows of polyhedral cells that fit closely together. This layer
involves most of the pathological conditions of the skin.

Stratum granulosum: It consists of about three to five rows of flattened cells that
develop darkly staining granules of a substance called Keratohyalin. This compound
is the precursor of keratin. Keratin forms a barrier that protects deeper layers from
injury and microbial invasion and makes the skin waterproof.

Stratum Lucidum: Normally, only the thick skin of the palms and soles has this
layer. It consists of three to five rows of clear, flat, dead cells that contain droplets of
an intermediate substance that is formed from keratohyalin and is eventually
transformed to Keratin.

Stratum Corneum: This layer consists of 25 to 30 rows of flat, dead cells completely
filled with keratin. These cells are continuously shed and replaced by cells from
deeper strata. The Stratum corneum serves as an effective barrier against light and
heat waves, bacteria, and many chemicals.

DERMIS:
The dermis chiefly consists of white fibrous tissue, elastic fibers and non-stripped
muscles, and it contains blood vessels, nerves, hair, sweat glands, sebaceous glands
and nerve corpuscles. The outer portion of the dermis, about one fifth of the thickness
of the total layer, is called the papillary region. The deeper portion of the dermis is
called the reticular region. It consists of dense irregular connective tissue containing
interlacing bundles of collagen and coarse elastic fibers. The reticular region is
attached with underlying organs, such as bone and muscle, by the subcutaneous layer,
and it is also called the hypodermis or superficial fascia.

Keratinization:
In the process of Keratinization, cells newly formed in the basal layers undergo a
developmental process as they are pushed to the surface. As the cells relocate, they
accumulate keratin, and simultaneously the cytoplasm, nucleus, and other organ cells
disappear and the cells die. Eventually, the keratinized cells slough off and are
ANATOMY OF SKIN

19
replaced by underlying cells which in turn become keratinized. The whole process by
which a cell forms in the basal layer, rises to the surface, becomes keratinized and
sloughs off takes two to four weeks.

Pigmentation of the skin:
Three pigments, namely melanin, carotene and hemoglobin, give skin a wide variety
of colors. Melanin is located mostly in the epidermis; carotene is mostly in the
stratum Corneum and dermis; and hemoglobin is in red blood cells within capillaries
in the dermis.

Blood supply of skin:
There are two horizontal and parallel systems of plexuses which maintain vascular
supply the skin. These plexuses or networks of blood vessels exist between the dermis
and the subcutaneous tissue. Their exact position can never be accurately described.
Each arteriole supplies an area of skin, while the corresponding plexus drains the
same area.

Nerve supply:
The nerve supply of the skin is very complicated, with the pathways of mediation of
sensation through the various nerves being very much under debate. The varied
sensations arising from the skin are derived from a diverse population of cutaneous
nerve endings or receptors. Thus tactile, temperature and pain sensations are each
sub-served by different groups of receptors.

FUNCTIONS OF SKIN
68
The skin is a metabolically active organ with vital functions including protection and
homeostasis of the body.

Regulation of body temperature: Skin regulates the evaporation of sweat and
converts any elevation of body temperature into a lower temperature or to normal.
Changes in the flow of blood to the skin also help the regulation of body temperature.

ANATOMY OF SKIN

20
Protection: The skin is considered under the Integumentary system. It provides a
physical barrier that protects the underlying tissues from physical abrasion, bacterial
invasion, and dehydration and UV radiation.

Sensation: The skin contains abundant nerve endings and receptors that detect stimuli
related to temperature, touch, pressure and pain.

Immunity: Sweat of the epidermal cells is one of the important components of the
skin immune system, which wards off foreign invaders.

Excretion: Sweat is the vehicle for loss of a small quantity of ions and several
organic compounds, along with removal of heat and some part of water.

Blood reservoir: The dermis houses extensive networks of blood vessels that carry 8
10% of the total blood flow in a resting adult. In moderate exercise this flow
increase, which helps to dissipate the heat from the body. During exercise, the skins
blood vessels can also constrict to allow more blood to circulate through contracting
muscles.

Picture No 32: Structure of Skin.
JANU BASTI REVIEW

21

JANU BASTI

J anu basti comprises of two words: J anu meaning the J anu Sandhi, and Basti the
derivative term of urinary bladder whose main function is to withhold. None of our
classics have explanations about J anu Basti as such. It is a procedure that has evolved
from Shiro Basti. Vagbhata has explained four types of application of Sneha over the
head, included in the classification of Murdhni Taila, which includes Shiro-
Abhyanga, Shiro-Seka, Shiro-Picu and Shiro-Basti
21
.

Shiro Basti is the procedure in which the Sneha is retained over the scalp with help of
Masha Pishti and a Charma Patta (leather sheet) for a specified period of time
22
.
Observing the results of Shiro Basti, the later physicians developed a similar
procedure over J anu and named it J anu Basti. In this way, J anu Basti evolved from the
Shiro Basti procedure. Today, the same is performed over the Kati and Greeva
regions and named respectively as Kati Basti & Greeva Basti.

Derivation
The term "J anu-Basti" consists of the following two words:
1) J anu 2) Basti
Janu
Vyutpatti - J an - J unn
Nirukti - Uru J angayormadya Bhaga (Shabda Stoma Mahanidhi)
J anu-Sandhi i.e., the knee joint
In general 'J anu' means - the junction between Uru and J angha.

Basti
Vas is formed by the Tich Pratyaya.
It belongs to masculine gender.
The word Vas means to reside, to abide, to produce effect of aromatic
drugs.

JANU BASTI REVIEW

22

Meanings related to organ:
Nabheradhobhage Mutradhare Sthane
- Organ that lies below the umbilicus (Nabhi).
Bastih- Basteh Avrinoti Mootram
- Organ in which the urine is collected and retained for some specific period of
time.

Meanings related to Karma:
The treatment which is administered using a Basti is called as Basti. Here the urinary
bladder of animals is used to inject the drugs into the rectum
23, 24
.

The word 'Basti' is used here with the meaning to reside or to retain. In 'J anu-
Basti' the medicine is made to dwell or be retained over the J anu-Sandhi for a
prescribed time.

Bahir-Parimarjana Chikitsa
Chikista can be classified as Anta-Parimarjana, Bahi-Parimarjana and Shastra-
Pranidhana on the basis of route of administration. J anu-Basti may be included under
Bahir-Parimarjana type of treatment
25
.

Sandhigata Vata is one among the Vata Vyadhi. The symptoms and treatment of
Sandhigata Vata is explained in the classics. The principle line of management is
Snehana, Svedana, Upanaha and Agnikarma
26
. Among these, Snehana and Svedana
are Samprapti Vighatana Chikitsa.

J anu-Basti is one such procedure that can provide both Svedana and Snehana effect.

Procedure of Janu-Basti
The procedure of J anu-Basti can be performed in the following three stages:
1. Poorva karma
2. Pradhana karma
3. Paschat karma

JANU BASTI REVIEW

23
Each of the Steps is explained as follows:

1. Poorva Karma
This includes preparatory measures like preparation of patient, preparation of
medicine and collection of materials required for the smooth execution of the
procedure. It can be conducted under following considerations.
a) Atura Pariksha
The patient is examined in relation to Dashavidha Pariksha and by applying
Pratyaksha, Anumana and Aptopadesha siddhantas to assess Vyadhi, Bala and Deha
Bala
27
. Then, the affected knee joint is examined properly and the region of maximum
tenderness is noted. It is also examined for scars & wounds.

b) Sambhara Sangraha
It includes a metal ring, Masha Pishti, Aushadha Dravya (Vasa), spoon, bowl, vessel,
water, gas stove and table.

c) Atura Siddhata
Patient is asked to lie in supine position or to sit erect and extend the lower limbs on
the table, whichever is more comfortable. The affected knee is exposed properly.
Limbs are supported properly so that they are placed horizontally and comfortably.

2. Pradhana Karma: This includes -
a) Basti Yantra Dharana
First, Masha pishti is prepared by adding sufficient quantity of water to the flour of
Black gram. Then, with the use of metal ring and Masha pisti a pit of about 2 Angula
height is constructed over the J anu-Sandhi. The concavity of pit (Basti Yantra) should
be well sealed to prevent the leakage of the medicine retained in the cavity.

b) Aushadhi Dharana
The bowl containing medicine (Vasa) is heated indirectly by keeping over hot water.
Then, the gently heated Luke warm Vasa is poured slowly and carefully on the J anu-
Sandhi along the side of the Basti-Yantra.
JANU BASTI REVIEW

24
The heat of the medicine should be sufficient enough to be tolerated by the patient.
The level of the medicine should be two Angula above the highest point inside the
cavity.

c) Maintenance of constant temperature of medicine (40-45
0
C)
The medicine in the pit is replaced with heated medicine every 5 minutes so that a
constant temperature is maintained throughout the procedure.

d) Removal of Dravya and Basti Yantra
After the specified time, i.e. 45 minutes, the Murivenna is removed from the Basti
Yantra and then the Basti Yantra is removed.

e) Samyak Lakshana
The Samyak Lakshanas of J anu-Basti are not described in our classics. Even though
J anu-Basti is a modification of Shiro-Basti, those Samyak Lakshanas cannot be
interpreted for J anu-Basti. Therefore, the Ayoga, Atiyoga and Samyakyoga bahya
Lakshanas of Swedana & Snehana that are mentioned in the classics can be
considered as the Lakshanas of J anu-Basti
28, 29
. Among Samyak Sveda Lakshanas,
Sheetoparama, Stambhanigraha, Gauravanigraha and Vyadhihani can be considered
for assessment. In case of Samyak Snigdha Lakshanas, Snigdha Gatratva and Mrudu
Gatratva can be taken for assessment.

f) Time
In case of Vataja disorders, the Dravya should be retained for Ten thousand Matra
Kala
30
. Hence, the procedure is performed for 45 min every day.

3. Pashchat Karma
After removing the Dravya and Basti Yantra, Mridu Abhyanga is done over the J anu-
Sandhi for about 5 min.
Duration - This treatment is done for 7 days.
JANU PICHU REVIEW

25

JANUPICHU

J anu Pichu comprises of two words J anu meaning the J anu Sandhi and Pichu that
literally means cloth whose function is to withhold the oil in the affected area. None
of our classics have explanations about J anu Pichu as such. It has too evolved from
the concept of Moordhini Taila. The various process by which oil is applied over the
head is termed Murdhni taila. Shiro pichu among the Moordhini tailas serves as the
base for J anu Pichu.

Shiro Pichu is the procedure, in which the Sneha is retained over the scalp with help
of plotha or a cloth for a specified period of time
30
. Observing the results of Shiro
Pichu the later physicians developed a similar procedure over J anu and named it as
J anu Pichu. In this way J anu Pichu procedure is evolved from Shiro Pichu procedure.
Now a days same is performed over various regions of body and named accordingly.

Derivation
The term "J anu-Pichu" consists of following two words:
1) J anu 2) Pichu
Janu
Nirukti - Uru J angayormadya Bhaga (Shabda Stoma Mahanidhi)
J anu-Sandhi i.e., the knee joint
In general 'J anu' means - the junction between Uru and J angha.

Pichu
Pichu plotha sa cha taile tulapatalam nishichya shirasi deya ithi pichusamjna
(Sa.S.Dipika)
Pichu plotha tulavastradi tailakthadharanam . (Sa.S Gudharthadipika)

Pichu literally means cloth, it is a process of placing a piece of cotton
cloth, immersed in oil, over the affected area.
JANU PICHU REVIEW

26

Indications

In the context of Shirashoola Pichu is advocated. It is clearly stated that in Vataja
shirashoola, if the condition is severe the procedure of Pichu is opted rather than
Abyanga
19
.

In Dantapatanaka after its management, Pichu can be performed
continuously using Vatasani taila
20
. Pichu with Vatasani taila or Dhanvantara taila is
indicated in Manyastambha
21
. In children when the nasal passage is blocked with
Kapha, Shiropichu is beneficial when done with Sigrupatra rasa and Eranda taila or
with the juice of Sahadevi with Trikatu and breast milk
22
. Pichu is extensively used in
the context of Pinasa, in Arogyakalpadruma, Pichu for two yama with Manjishtadi
yamaka is indicated in Pittajapinasa, Mustadi yamaka in Kaphajapinasa, Talisapatradi
yamaka in Dushtapinasa. Pichu is also indicated in the state of unconsciousness in
sannipatajwara
23
.

Procedure of Janu-Pichu
The procedure of J anu-Pichu can be performed in the following three stages:
1. Poorva karma
2. Pradhana karma
3. Paschat karma

Poorva Karma
This includes preparatory measures like preparation of patient, preparation of
medicine and collection of materials required for the smooth conduction of the
procedure. It can be conducted under following considerations.

a) Atura Pariksha
The patient is examined in relation to Dashavidha Pariksha and by applying
Pratyaksha, Anumana and Aptopadesha siddhantas to assess Vyadhi Bala and Deha
Bala
35
. Then, the affected knee joint is examined properly and the maximum tender
region is noted. It is also examined for scars & wounds.

JANU PICHU REVIEW

27

b) Sambhara Sangraha
It includes the collection of necessary items required for the stable conduction of the
procedure. 2 cotton pads (4*1 inch) , Aushadha Dravya (Murivenna), bowl, vessel,
water, gas stove and table.

c) Atura Siddhata
Patient is asked to lie in supine position or to sit erect by extending lower limbs on the
table, whichever comfortable. The affected knee is exposed properly. Limbs are
supported properly so that they are placed horizontally and comfortably.

2. Pradhana Karma: This includes

a) Janu Pichu Dharana

The bowl containing medicine (Murivenna) is heated indirectly by keeping over a
coloumn of hotwater. Then in the gently heated Luke warm Murivenna, pichu is
dipped slowly and carefully. This is placed along the J anu-Sandhi analyzing the
tolerability of the patient .The heat of the medicine should be sufficient enough to be
tolerated by the patient..At the area of maximum tenderness Pichu is placed and
retained until the temperature of the oil reduces.

b) Maintenance of constant temperature of medicine (40-45
0
C)
The medicine in the initial Pichu is replaced with the heated oil by another Pichu of
same size every 5 minutes. In the mean time the oil from the initial Pichu is drained &
kept for heating and this process is alternatively continued so that a constant
temperature is maintained throughout the procedure.

c) Removal of Dravya and Basti Yantra
After the specified time i.e. 45 minutes the Murivenna is removed along with the
pichu.

JANU PICHU REVIEW

28

d) Samyak Lakshana
As the Samyak Lakshanas of J anu-Pichu are not described in our classics, Samyak
Lakshanas of Shiro-Pichu cannot be interpreted even though J anu-Pichu is
modification of it. Therefore, the Ayoga, Atiyoga and Samyakyoga bahya Lakshanas
of Swedana & snehana mentioned in the classics can be taken for Samyak Lakshana
of J anu-Pichu
36,37
. Among Samyak Sveda Lakshana Sheetoparama, Stambhanigraha,
Gauravanigraha and Vyadhihani can be considered for assessment. In case of Samyak
Snigdha Lakshanas Snigdha Gatratva and Mrudu Gatratva can be taken for
assessment.

e) Duration
In case of Vataja disorders the Dravya should be retained for ten thousand Matra
Kala
38
. Hence the procedure is performed for 45 min for 7 days.

3. Pashchat Karma
After removing the Pichu along with oil Mridu Abhyanga is done over the J anu-
Sandhi for about 5 min.

Duration - This treatment is done for 7 days.

29

ILLUSTRATIONS
MURIVENNA
11
Prerequisite

JANU JANU
Picture No 33: Illustrations of Procedures.
DISEASE REVIEW

30

JANU SANDHIGATA VATA

The disease 'J anu-SandhiGata-Vata' is to be understood from 3 terminologies i.e.,
J anu, Sandhi and Gata Vata. Etymology, definition and specific interpretation of these
terms i.e., J anu, Sandhi and GataVata are as follows.
Janu
Nirukti - Uru J anghayor Madhya Bhaga
(Shabda Stoma Mahanidhi)
- J anu Sandhi i.e., the knee joint
Paribhasha - J anu - Napumsakalinga
In general 'J anu' is the junction that lies between Uru and J angha.
Sandhi
Vyutpatti - Sam +Dha +Kihi (Shabda Kalpa Druma),
Nirukti - Sandhirnamsa Samyogaha
(Shabda Kalpa Druma)
Asthidwaya Samyoga Sthana
Sandhirnama Asthnam Anyonya Sangam Asthnani
(Brihatsharira 1part, 6
th
chap)
J unction, connection, combination, and union which contain a conjugation, transition
from one to another
69
.

DISEASE REVIEW

31
Paribhasha
Sandhi Pullinga, Sandhanamiti Yuga Sandhini - Yugashabde Deha Sandhini
Marmashabde Cha Drishtavyaha. (Shabda Kalpa Druma)

Generally, Sandhi means the junction between two structures. In Ayurveda Shareera,
Sandhi is a technical word indicating that, it is the place where two or more bones join
or articulate together and the joint formed may be fixed type or with less or freely
movable.
Acharya Sushruta told that, in the body there are innumerable junction between Peshi,
Sanyu, Sira, Asthi, etc. but the description given here is only for Asthi Sandhi
70
.
Dalhana also supports Sushrutas view that 'Sandhi' means Asthyashrita Sandhi
71
.

In Parishadya Shabdartha Shareera it is described that the meaning of Sandhi is union
or meeting place, but in Shareera the word Sandhi is mostly used for Asthi-Sandhi
[bony articulations].

By viewing all these we can say that the word Sandhi denotes only Asthi Sandhi.

Vata
Vyutpatti - Va - Gati Gandhanayoho
Va - Gati Sevanayoho
Va +Kta
(Shabda Kalpa Druma)
The term Vata is derived by the application of Kta or Krt Pratyaya to the verb root
Va which means Gati Gandhanayoh.
DISEASE REVIEW

32

Nirukti - Sparsha Matra Vishesha Gunake Bhutabheda
Pavane - Dehasya Dhatubheda Cha
(Shabda Sthoma Mahanidhi)
The term Gati is having meanings like Prapti, J nana (Panini) and the meaning of
Gandhana is like Utsaha, Prakashana, Soocana, (Shabdasthoma) Gandhana, Prerana
(Siddhanta Kaumudi).
Considering the different meanings of Gati and Gandhana, if it is understood that the
term Vata act as a receptor as well as stimulator. Hence it can be understood that Vata
is a biological force, which governs and stimulates all the activities in the body.

Concept of Gatatva
Sandhivata is also named as Sandhi Gata Vata. Different theories have been quoted to explain
the Samprapti of various diseases. Gatatva is one such complex phenomenon mentioned in all
Ayurvedic classics. Gatatva of Dhatu, Upadhatu, Ashaya, Avayava and Indriya etc. have been
described in classics
72
.

Synonyms of Gatatva:
Gata / Gatam
Sthite / sthitam
Avasthite
Ashrite / Samashritam
Prapte
Sthe / Stha etc.
DISEASE REVIEW

33
By the above meanings and synonyms, it can be stated that the word has two
implications. One suggests the movement (Subjected to Gati of Vayu) and the other
related with occupation of site (subjected to Adhishtana).
Hence Gatatva of Vata implies an undesirable movement of Vata and its unwanted
occupation at certain sites.

SANDHIVATA & SANDHI GATA VATA
By the use of both terminologies Sandhivata and Sandhigatavata in the context of
same disease doubt arises, whether two are synonyms of the same disease? A
screening of the available Ayurvedic literature reveals that the disease entity
Sandhigata Vata is found in all the major treatises, even than a disease entity by the
name of Sandhivata is nowhere to be found. However, in Bhavaprakasha, under the
chapter of Vatavyadhi, in the context of Phalashruti of the treatment of
Sandhigatavata, the term Sandhivata has been used as analogous to Sandhigatavata. It
implies that both Sandhigatavata and Sandhivata are synonyms of the same disease
entity
73
.

SANDHIGATA VATA
Disease Sandhivata is described initially by Acharya Charaka as Sandhigata Anila
with symptoms of Shotha which on palpation feels as bag filled with air and Shula on
Prasarana and Aakunchana (pain on flexion and extension of the joints)
74
. Sushruta
also mentioned Shoola and Shotha in this disease leading to the diminution (Hanti) of
the movement at joint involved
75
. Another disease Vata Kantaka is mentioned by
Sushruta which occurs due to the vitiated Vata by involving Khuda Sandhi.
According to Dalhana and Gayadasa, Khadu means Padajangha Sandhi i.e. ankle
76
.
DISEASE REVIEW

34
Another view has been quoted according to which Khadu may be taken as Parshani
(calcaneum). Madhava has not explained Shotha but mentioned Atopa as a symptoms
of Sandhigata Vata
77
, which may also be taken equivalent to air filled bag. He has
added one more symptom i.e. Hanti Sandhi (restricted flexion and extension). Thus,
the disease Sandhigata Vata can be defined as a joint disease with symptom of Shula,
which aggravates by movement, along with Shotha & complete restricted movements
at later stages. This disease is comparable with Osteoarthritis, a degenerative joint
disease, the symptoms of which are same as Sandhigata Vata and usually occurs after
the age of 40 years.

RELATION BETWEEN VATA AND SANDHI
There is a relation between the Dosha and Dushya because of their Bhautika
constitution, which has been well narrated in Ashtanga Hridaya while describing the
properties, actions and importance of Tridosha. This is also called as Ashaya Ashrayai
Bhava i.e. inter-relation between Dosha and Dushya. Vata is located in Asthi, Pitta in
Sveda and Rakta and Kapha in Rasa, Mamsa, Meda, Majja and Shukra. It is because
of this relation that the drugs or dietetic regimens which augment one particular
Dosha also have the effect on its dependant Dhatu. By augmentation of the Dosha,
there would be similar effect on their respective Dhatu. But, on contrary to this
augmentation of Vata (Ashrayi), due to its properties will lead to decrease (Kshaya) in
the Asthi (Ashraya) and vice versa. In the similar way it is related with Kapha.
Kshaya of Kapha will cause increase in the quantum of Vata and vice versa
78,79
.

DISEASE REVIEW

35

SYNONYMS
80,81
Different authors named this disease according their own views, but most of them are
out of views. The probable synonyms of Sandhivata used in the different context or
considered equivalent to Sandhivata by the commentators are as follows.
Sandhigata Anila
Sandhigata Vata
Khudavata
Gulphavata - Synonyms meant only for Gulpha Sandhigatavata

NIDANA
In Ayurveda, Nidana is a broad term deals with etiology as well as diagnosis of a
disease and it disturbs whole physiological system of Shareera. For prevention and
cure Nidana plays an important role so it is considered as prime among Nidana
Panchaka.
Nidana are classified basically into Samanya nidana & Vishesha Nidana. Samanya
Nidana is common for all Vatayadhis, whereas Visesha Nidana is specific cause for
specific disease. No specific Nidanas are mentioned for Sandhigata Vata in our
classical samhitas. are responsible for Sandhigata Vata reflects as Nidana.
However factors which vitiate the Vata Dosa can be considered as Nidana explained
under the context of Vata Vyadhi in different Samhitas
82--87
and Asthivaha Srotodusti
Karana and Majjavaha Srotodusti Karana
88
may be taken as Nidana of J anu
Sandhivata.

DISEASE REVIEW

36
They can be classified under the concepts of:

Sannikrushta Hetu
Viprakrushta Hetu

Under Sannikrushta Hetu the following Nidanas can be considered:

Ati Vyayama:
Ati Vyayama includes excessive physical works, running, jogging, walking etc. If
these are done excessively then it affects the structure of the Sandhi. The joint
stability is affected by the over exertion and leads to J anu Sandhigata Vata.
Bharaharana:
J anu Sandhi is the main weight bearing joint in the body. Carrying heavy and
excessive loads creates more pressure and exertion over the J anu which leads to
destruction of the joint.
Abhighata:
As Sandhi is formed by different Asthi, Peshi and Snayu, injury to any of these
structures can cause harm to the stability of the Sandhi. Abhighata can cause
structural deformity of the joint and hence it is also a main Nidana for Sandhigata
Vata.
Atisamkshobha:
It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas is involved in
Sandhigata Vata this can be considered as Nidana for the same. Violent activities like
Atyadhva, Plavana, Langhana, Balavat Vigraha, Pradhavana etc. will have its effect
DISEASE REVIEW

37
on joint. As told earlier knee is the weight-bearing joint, the violent exercises or
activities will alter the structural integrity of the joint.
Marmabhighata:
Marma is a vital part which includes Asthi, Mamsa, Sira, Snayu and Sandhi. J anu is
included under Vaikalyakara Marma and according to the concept of Marmabhighata,
it is definitely a Nidana for Sandhigata Vata.

Under Viprakrushta Hetu the following Nidanas Can be considered

Table 1: Aharaja Nidana of Vata Vyadhi

Rasa Janya

Charaka

Sushruta

Vagbhata

Madhava
Nidana

Yoga
Ratnakara

Bhava
Prakasha
Kashaya - + + - - +
Katu - + + - - +
Tikta - + + - - +
Guna Janya
Rooksha + + + + + +
Laghu + + - + + +
Sheeta + + - + + -
Dravya Janya
Vallura - + - - - -
Varaka - + - - - -
Shuskha Shaka - + - - - -
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38
Uddalaka + - - - -
Neevara - + - - - -
Mudga - + - - - -
Masura - + - - - -
Harenu - + - - - -
Kalaya - + - - - -
Nishpava - + - - - -

Table 2: Viharaja Nidana of Vata Vyadhi
Ati Vyayama + + + + + -
Langhana + + - + + -
Plavana + + - + + -
Atyadhwa + - - + + -
Pradhavana - + - - - -
Pratarana - + - - - -
Atyuchabhashana - - + - - -
Balavadvigraha - + - - - -
Abhighata + + - + + +
Marmaghata + - - + + -
Bharaharana - + - - - -
Dukhashayya + - - + + +
Dukhasana + - - - - -
Gaja,Ushtra,Ashva
Sheegrhayana
+

+ - + + -
DISEASE REVIEW

39
Prapeedana - + - - - -
Ati Adhyayana - + - - - -
Ati vyavaya + + + + + +
Atijagarana + + + + + +
Vegadharana + + + + + +
Vishamopachara + - - + + -
Shrama - - - - - +
Upavasa + + + + + +
Puravata sevana - - - - - +
Divaswapna + + + + + -

Table - 3 : Manasika Nidana of Vata Vyadhi
Cinta + - + + + +
Shoka + - + + + +
Krodha + - - - - -
Bhaya + - - - - +

Table - 4 : Anya Karana for Vata Vyadhi
Ati
Raktasravana
+

- - + + -
Ati
Doshasravana
+

- - + + +
Dhatukshaya + - - + + +
Rogatikarshana + - - + + +

DISEASE REVIEW

40

POORVARUPA

No specific Poorvarupa of J anu Sandhigata Vata is available in any of the classics.
Purva Rupa is manifested due to Dosa Dusya samurchana. It takes place at fourth
stage (Sthansamsraya) of kriyakala. In the Vata Vyadhi Chikitsa Adhyaya of Charaka
Samhita the Poorvarupa of Vata Vyadhi is mentioned as Avyakta Lakshana
89
. The
mild manifested or un-manifested features of the actual disease can be considered as
Poorvarupa of Vata Vyadhi. J anu Sandhigata Vata being a Vata Vyadhi, clinical
features in milder form can be considered as Poorvarupa of J anu Sandhigata Vata.

RUPA

The Rupa of Sandhivata mentioned in different Samhitas are
90--96

Vata Purna Dhruti Sparsha (Sandhi Shotha):
Shotha is explained by most of the authors. The feeling of air filled bag when the
Sandhi is palpated is the nature of Shotha or Shotha in Sandhigata Vata. This
Lakshana is explained by Acharya Charaka and Acharya Vagbhata.

Vedana:
Vedana or Shula is explained by all the authors. Acharya Charaka and Vagbhata
specify the presence of Vedana during Prasarana and Akunchana of the body parts.

DISEASE REVIEW

41
Sandhi Hanti (Stabdhata):
This Lakshana is explained by Sushruta firstly and followed by later authors of
Madhava Nidana, Bhava Prakasha and Yogaratnakara. While commenting on word
Hanti Dalhana and Gayadasa explained it as Akunchanaprasaranayoh Abhavah and
Prasaranakuncanayoh Asamarthah respectively
97
. With this we can infer that the word
Hanti refers to inability to move the joints. Mudhukoshakara opines that word Hanti
refers to Sandhi Vishlesha or Stambha Adi Vikara
98
.

Atopa
Madhavakara explained this symptom in his treatise. While commenting on the word
Atopa in another context, Madhukoshakara quotes the opinion of Gayadasa and
Kartika stating -

Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah.
Also Bhavamishra says Atopo Gudagudashabdaha
99
.

Considering the above references we can say that Atopa in this context is the sound
produced by the movement of joints i.e., Crepitus.

DISEASE REVIEW

42
Table - 5 : Rupa of Sandhigata Vata mentioned in various classics

SAMPRAPTI

This is a series of pathological process happening in body during the production of a
Vyadhi from Nidana sevana to Roga pradurbhava
100
. A proper understanding of
Samprapti is important for the treatment, since Chikitsa explained in the Ayurvedic
text is nothing but Samprapti Vighatana
101
.

The series of pathological events from the onset of Dosha Dushya Dushti till the
appearance of Vyadhi comprise various stages. Samprapti is the one which explain
this series of events. It explains the total pathogenesis of the disease.

As J anu Sandhigata Vata is not explained as a separate disease with Nidana Panchaka
in the classics, so the Samanya Samprapti of Vata Vyadhi can be adopted as
Samprapti of Sandhivata or J anu Sandhigata Vata.
SYMPTOMS C.S. Su.S. A.H. A.S. M.N. B.P. Y.R.
Sandhi Vedana + + + + + + +
Sandhi Shotha
(Vata Purna dhruti
Sparsha)
+ + + + - + +
Sandhi Hanti
(Stabdhata)
- + - - + - -
Atopa - - - - + - -
DISEASE REVIEW

43

Intake of Vatakara Ahara Vihara does the vitiation of Vata. This vitiated Vata lodges
in Rikta Srotas i.e. Srotas in where Shunyata of Snehadi Guna is present. Vata after
settling in Rikta Srotas produce disease related to that particular Srotas
102
.

While explaning the Samprapti of Vata Vyadhi Acharya Vagbhata tells that
Dhatukshaya aggravates Vata and the same is also responsible to produce Riktata of
Srotas. Thus the vitiated Vata travels through out the body and settles in the Rikta
Srotas and further vitiates the Srotas leading to the manifestation of Vata Vyadhi
103
.

Explanation of Srotoriktata due to the Nidana Sevana can be given as follows; the
chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess.
These are the properties, which are necessary for Sthairya and Upacaya of the body.
Excessive intake of Dravyas having Laghu, Ruksha, Sukshma, Khara properties lead
to Guru and Sneha Guna Abhava due to their opposite quality. Thus it leads to
Dhatukshaya in the body. Akasha is the Mahabhuta that produces Sushirata and
Laghuta in the body. Vayu Mahabhuta fills up this Sushirata. So due to Dhatukshaya
Akasha Mahabhuta increases in the body producing Sushirata and Laghuta
simultaneously Vayu fills it up.
It can be stated with the support of above explanation that, Riktata is Sushirata
(increase of Akasha and Vayu Mahabhuta). Acharya Chakrapani comments on the
word Riktata stating that it means lack of Snehadi Gunas
104
.

Samprapti of J anu Sandhivata can be studied under two headings.
1. Dhatu Kshaya J anya Sandhigata Vata 2. Avarana J anya Sandhigata Vata.
DISEASE REVIEW

44

Dhatu Kshaya Janya Sandhivata:
Vata Dosha dominates in the body at old age. This will lead to Kapha Abhava. Also
J ataragni and Dhatvagni get impaired, by which Dhatus formed will not be of genuine
quality. Degeneration of body elements takes place due to predominance of Vata in its
Ruksha, Khara, etc. Guna and loss of Kapha in quality and quantity.

As the Shleshma Bhava decreases in the body, the Kapha Bheda i.e. Shleshaka Kapha
in the joints also decreases in quality and quantity. Reduction of Kapha in Sandhis
makes Sandhi Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu
Kshaya. Asthi being the main participant of the joint its Kshaya leads Khavaigunya in
the joints.

In this condition if Nidana Sevana done further produces Vata Prakopa. If Vata
Prakopa is not corrected by appropriate means and simultaneously if the person
indulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vata
spreads all over the body through these Srotas. In the meantime Sthanasamshraya of
Prakupita Vata takes place in the Khavaigunyayukta J anu Sandhi. This localized Vayu
due to its Ruksha, Laghu, Kharadi Guna over power all the properties of Sleshaka
Kapha producing disease Sandhigata Vata.

2. Avarana Janya Sandhivata
In Sthula patients usually Sandhivata occurs in weight bearing joints. In these kinds of
patients Medodhatu will be produced in excess due to the Atisnehamsha of
Amarasa
105
.
DISEASE REVIEW

45
The excessive Medas will produce obstruction for the flow of nutritive materials to
the future Dhatus i.e Asthi, Majja and Shukra leads to their Kshaya. It also produces
Margavarana of Vata
106
. Prakupita Vata due to Margavarana starts to settle in the
Sandhi where Khavaigunya already exists. After Sthanasamshraya it produces the
disease Sandhigata Vata in the same process mentioned in the earlier context.

Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of J anu
Sandhivata can be divided into Dhatukshaya J anya and Avarana J anya. This will help
in deciding the prognosis and planning the treatment of the disease.

Samprapti Ghatakas:
Dosha Vata (Vyana) Vriddhi; Kapha (Shleshaka) Kshaya
Dooshya Peshi, Snayu, Asthi, Majja
Srotas Mamsavaha, Medovaha, Asthivaha, Majjavaha
Agni J ataragni, Asthi-Dhatvagni
Ama J ataragni Mandya J anya
Roga Marga Madhyama
Udbhavasthana Pakvashaya
Sancharasthana - Sarvasharira
Adhishtana Sandhi
Vyaktasthana - Sandhi

DISEASE REVIEW

46
Schematic representation of Samprapti of Janu Sandhigata Vata

Sandhi
Shula
Sandhigata
Vata
Asthigata
Vata
Sandhi
Shotha
Sandhigata Vata
Asthivaha
Sroto Dushti
Nidana
Vardhakya Vata Vardhaka
Nidana
Vata Prakopa
Dhatu Shaithilya
Agni Vaishamya
Dhatu Kshaya
Sthana Samshraya in Asthi
DISEASE REVIEW

47

UPASHAYA AND ANUPASHAYA

UPASHAYA
All drugs, diet and regimen that produce long lasting relief in Sandhigata Vata may be
considered as Upashaya, for example Abhyanga, Swedana, Ushna Ahara, Ushna Ritu
etc. The Upakrama mentioned under Vatasyaopakrma also act as Upashaya for Vata
Vyadhi
107
.

ANUPASHAYA
All drugs, diet and regimen which exaggerate the disease are taken as Anupashaya for
that disease. Hetus of that disease can also be taken as Anupashaya. The diet having
Laghu, Ruksha, Sheeta Gunas, Anasana, Alpasana, Sheeta Ritu, evening time can be
considered as Anupashaya as they increase pain.

DISEASE REVIEW

48

SAPEKSHA NIDANA

Sapeksha Nidana helps in establishing the exact identity of the disease. Wherever
there are identical signs and symptoms prevailing in two or more diseases, there is a
chance of wrong diagnosis. Hence differential diagnosis is unavoidable for accurate
identity of the disease. To get the clear idea regarding the disease Sandhivata, a
comparative study of cardinal symptoms of similar diseases entities are given below.

Table - 6
Sapeksha Nidana of Janu Sandhigata Vata
Factors Sandhivata Amavata Vatarakta Koshtrukashirsha
Amapradhanya Absent Present Absent Absent
Jvara Absent Present Absent Absent
Hridgaurava Absent Present Absent Absent
Prone age Old Age Any age - -
Vedana

At
Prasarana
Akunchana
Pravritti
Vrischik
DanshaVata
and
Sanchari

Mushika
Damshavat
Vedana

Tivra
Shotha

Vatapurna
Driti
sparsha
Sarvang and
Sandhigata

Mandal
yukta

Koshtruka
Shirshvat
DISEASE REVIEW

49
Sandhi

Weight
bearing
joint
Big Sandhi Small
Sandhi

Only J anu
Upashaya

Abyanga Ruksha
Svedana
Rakta
Shodhana

Rakta Shodhana

SADHYA ASADHYATA

Sadhyaasadhyata gives a clear cut understanding regarding the prognosis of Vyadhi
and gives a basic knowledge about its curability. So the knowledge of
Sadhyaasadhyata is very essential before heading to any treatment.

Sandhigata Vata is one of the Vata Vyadhi described in all Samhita and Sangraha
Grantha. Acharya Vagbhata and Sushruta have considered Vata Vyadhi as Mahagada.
It is so called due to the fact that the treatment is time consuming and prognosis is
uncertain. Further, Dhatukshaya is the chief cause of Vata Vyadhi. Dhatukshaya is
difficult to treat as Acharya Vagbhata has elaborated that since body is accustomed to
Mala, Dhatukshaya is more troublesome than Dhatu Vriddhi. Sandhigata Vata is one
of the Vata Vyadhi, therefore it is Kashta Sadhya
108
.

The ailments of aged persons are Kashta Sadhya and Sandhigata Vata is the affliction
of elderly persons. Disease situated in Marma and Madhyama Rogamarga is Kashta
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50
Sadhya. Sandhigata Vata is the disease of Sandhi which forms Madhyama
Rogamarga.

Further, Vata Vyadhi occurring due to vitiation of Asthi and Majja are most difficult
to cure. If there is more destruction of the Asthi in the J anu then again the Vyadhi
becomes Kashta Sadhya or Asadhya.

In the list of Kashta Sadhya Vata Vikara, Sandhigata Vata is not mentioned by
Charaka, but while commenting on word Khuda Vatata Chakrapani explains the
meaning of Khuda Vatata as Gulpha Vatata or Sandhigata Vatata. Thus, Sandhivata
can be considered as Kashta Sadhya Vata Vyadhi. It may be curable if occurs in
strong persons and if it is recently originated and if there are no complications.

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51

CHIKITSA

The aim of Chikitsa is to remove causative factor or disease as well as restoration of
the equilibrium of Dosha. The elimination of the Dosha can be achieved by Shodhana
and Shamana. Shodhana comprises of Antaha Parimarjana and Bahir Parimarjana
Chikitsa. Bahira Parimarjana is achieved by Snehana, Swedana, Mardana, Lepana etc.
Shamana types of Chikitsa cures disease without eliminating Doshas.

Sandhigatavata is a Vataja disorder. So, general treatment of Vata Vyadhi can be
adopted, considering the etiology of the same. Regarding the specific line of treatment
of Sandhigata Vata, Charaka has not mentioned but later authors like Sushruta and
others have mentioned effective line of treatment for the same. Other books like
Ashtanga Hridaya, Ashtanga Sangraha, Yogaratnakara and Bhavaprakasha have
mentioned specific line of treatment.

Table-7: Different Chikitsa procedures indicated in Janu Sandhigata Vata
109--114

Treatment S. S. A.S. A.H. Y.R. B.P. B.R.
Snehana + - + + + +
Abhyanga - + - - - -
Mardana + + - + - +
Swedana - + - + + -
Upanaha + + + + + +
Bandana + + - - - +
Agnikarma + + + - - +

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52
They are in specific,
SNEHANA
Snehana besides being the chief Purvakarma procedure for the Panchakarma therapy,
it also happens to be a one of the most significant Chikitsa. Snehana therapy is
administered to persons in two different ways as follows.
Abhyantara Prayoga
Bahya Prayoga
115

Both external and internal Snehana are effective in Sandhigata Vata.

o Abhyantara Snehana
In case of Sandhivata Sneha can be administered orally in the form of Pana, Bhojana,
Basti and Nasya.
o Bahya Snehana
Bahya Snehas can be applied in different forms like Abhyanga, Padaghata, Lepa,
Gandoosha, Karnapoorana, Akshitarpana, Picchu, Samvahana, Mardana,
Murdhnitaila, and Parisheka. Out of these in case of Sandhigata Vata Abhyanga and
Mardana are mentioned.

The word Abhyanga refers to do some 'movements' or 'Gati'. For Abhyanga purpose
Sukhoshna Taila or other Snehas are used. Abhyanga should be done with slow
movements in Anuloma Gati, on joints it should be done in circular manner.
Abhyanga should be done minimum for 5 minutes at one region as the Veerya of
Medicated Taila will reach up to Majja Dhatu (900 Matra-Kalas).Charka has
mentioned Sparshanendriya is the seat for Vata & Twak is Sparshanendriya
Adhisthana. Therefore, Abhyanga act as Vatahara, Pushtikara
116,117
.
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53

Mardana is like Abhyanga but applied pressure is more.
Sneha Dravya possesses Drava, Sukshma, Sara, Snigdha, Manda, Mrudu, Guru
Properties, which are due to predominance of J ala and Prithvi Mahabhuta. Sneha
alleviates Vata because properties of Sneha are just opposite to those of Vata. The
Vayu, in its normal or undisturbed condition, maintains a state of equilibrium between
Dosha and Dhatu. Similarly it exercises considerable influence on the functioning of
Manasa. Hence, this Vayu should be kept in stage of equilibrium for the individual to
be healthy and happy. Snehana helps in the promotion and regulation of the proper
functioning of Vayu.

SWEDANA
Swedana is one among the Shadvidhopakrama. It is helpful in neutralizing Stabdhata,
Shitata and Gauravata
118
.
In case of Sandhivata varieties of Swedana Karma like Upanaha & Bandana are
indicated.

Upanaha Sweda
Both Sushruta and Charaka consider Upanaha as a variety of Svedana
119,120
.
Roots of Vata Hara drugs should be triturated together with Kanji and mixed with
abundant quantity of Saindhava Lavana and Sneha. After making this lukewarm, it
should be applied to the affected part.

The paste of drugs included in the Kakolyadi, Eladi or Surasadi groups as well as
pastes of Sarshapa, Tila, or Atasi or Krishara, Payasa, Utkarika and Vesavara or the
DISEASE REVIEW

54
drugs of Salvana Sveda should be similarly applied to the affected part folded in piece
of thin linen and tied up
121
.

Bandana Dravya in Upanaha:
For the purpose of Bandana, Charaka opines that leather of Ushna Veerya animal can
be used. In the absence of this silk or woolen cloth can be used
122
. Ashtanga
Hridayakara opines that 'Vatahara' Patras should be used
123
and Charaka suggests
Eranda Patra
124
.
Duration
Upanaha, which is tied in the morning, should be removed in the night and which is
tied in the night should be removed in the morning
125
.
Sneha Pramana
According to Vata, Pitta, Kapha, Sneha should be added 1/4,1/6/1/8
th
of the Upanaha
Dravya.
BANDANA
Acharya Sushruta again sub-divides this into 3 types:
a) Pradeha
b) Sankara
c) Bandhana

Pradeha
Thick paste prepared by Amla Kanji with Vataharadravya after adding Saindhava
Lavana and Sneha, Svedana is done. Dalhana called this as Upanaha
126
.

Sankara Sweda
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In Sankara Sveda, paste prepared out of Vatahara Dravyas, Amla Kanji, Saindhava
Lavana and Sneha etc., taken in a cloth piece, tied & prepared a Potali. Dalhana
considered this as Upanaha
127
.

Bandhana
In Bandhana Upanaha Dravya is tied to the affected apart.

AGNIKARMA
Unique treatment indicated in case of Sandhigata Vata. Here Dahana or cauterization
is done at the tender points of the part affected. Dahana Karma should be done in the
affected joint according to the structure involved till the Samyak Dahana Lakshana
observe.

Hence the different treatment modalities mentioned by different authors can be
concise under these
128--132
.

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56
PATHYA - APATHYA

Specific Pathya and Apathya for Sandhigata Vata are not mentioned in Samhitas, but
as this disease belongs to Vata Vyadhi, we should adopt same of Pathyaapathya of
general Vata Vyadhi.

Pathya Ahara
Godhuma, Mamsa, Raktashali, Godugdha, Ajadugdha,Ghrita, Draksha, Ama,
Madhuka, Ushna J ala, Sura, Surasava, Amlakanjika, Madhura Amla Lavana Rasa
Pradhana Ahara are Pathya.
Pathya Vihara
Atapa Sevana, Mrudu Shayya, Ushnodaka Snana etc.

Apathya Ahara
Yava, Kodrava, Chanaka, Kalaya, Sheeta J ala, Ati Madhya Pana, Sushka Mamsa,
Katu-Tikta-Kashaya Rasa Pradhana Ahara are Apathya.
Apathya Vihara
Chinta, Ratri J agarana, Vega Vidharana, Shrama, Anashana, Vyavaya, Vyayama,
Chankramana, Kathina Shayya are Apathya.

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SHAMANA AUSHADHI

Vati Maha Yogaraja Guggulu, Yogaraja Guggulu, Trayodashanga Guggulu,
Amrutadya Guggulu, Rasnadi Guggulu

Kashaya Maha Rasnadi Kashaya, Rasna Saptaka Kashaya, Rasna Erandadi
Kashaya, Rasnadi Kashaya

Churna Rasna Churna, Devadaru Churna, Shallaki Churna, Erandamoola Churna

Taila Maha Narayana Taila, Dhanwantara Taila, Ksheerabala Taila

Gritha Pancha Tikta Gritha, Pancha Tikta Guggulu Gritha, Maha Tiktaka Gritha,

Rasaushadhi Maha Vata Vidhwamsa Rasa, Vata Gajankusha Rasa, Ekangaveera
Rasa
Arishta Ashwagandharishta, Balarishta

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DRUG REVIEW

Traditional practitioners of Kerala use Murivenna as a drug of choice for
Abhighatas for external applications. It is widely used for pain and swelling and in the
management of fracture and dislocation. Murivenna is not mentioned in any of the
classical Ayurvedic texts. There are so many preparations with the same name
Murivenna in the Tamil Marma Sastra.

Murivenna promotes healing, also reduces pain & swelling. It is mainly
indicated in sandhi muktha, sadyovrana, dagdha vranas, bhagna and sopha. This
herbal oil preparation is used as dhara, pichu, thailadroni and bandhana. It is quoted in
kerala Ayurveda Pharmocopea presently.

Murivenna contains eight ingredients Karanjathwak, Kumari,
Thamboolapatra, Sigru patra, Kimsukapatra, Vasukam, Palandu and Sathavari.
Murivenna is prepared in Khara paka for external use. It is also used for internal
administration in Chikkana paka

During early 1960s a group of eminent and senior Professors from the Govt.
Ayurveda College, Trivandrum, Kerala conducted an exhaustive study and found
that maximum clinical effect is available from the combination given above.

Dr.G.Unnikrishnan and Dr.G.S.Raju in the Pharmacy and Dravyaguna
department, P.G.Centre, Trivandrum Ayurveda College in the year 1979, conducted a
preliminary experiential study on The anti-inflammatory effect of Murivenna.
Statistical analysis of the study showed that the application of Murivenna is highly
significant in reducing experimentally induced inflammation in rat paw.

As sandhigatavata is a Vedana Pradhana Vatavyadhi, Murivenna can be
utilized for the same. Also J anu being a Marma, the relevance of Murivenna is higher.
The individual drugs from Murivenna yoga are discussed below along with their
details.
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1.KARANJA

Family : Fabaceae / Leguminosae
Botanical name : Pongamia glabra Vent

Synonyms : Karanja, Nakthamala,
Pootheeka,Prakeerna,
Ghrithavarnaka.
Vernacular names
Kannada : Hongemara
English : Indian beech
Hindi : Tidowry, Natakaranja
Malayalam : Ungu, Punga maram
Parts used - Seeds, Stem, Leaves, Fruits, Root, Oil from seeds
Habitat Through out India, in tidal and beach forests; cultivated often as a
venue trees. It is distributed in hilly areas up to 4000 feet altitude.

Morphological characters - A medium sized semi-evergreen glabrous tree
with a short bole and spreading crown up to 18 m or more in height, dark grayish
green or brown, very often mottled with dark brown dots, specks, lines or streaks;
leaves compound, leaflets 5 7 ovate, acuminate or elliptic; flowers lilac or pinkish
white, fragrant in axillary racemes; fruits thick, woody, smooth, compressed, with a
short curved beak, seeds 1 or 2 per pod, reniform to nearly round, smooth or wrinkled,
testa reddish brown leathery
133
.

Ayurvedic aspects - Charakacharya has included karanja in kandughna gana,
virechana gana, katu skandha and thiktha skandha. Susruthacharya has included
karanja in aragwadhadi gana, varanadi gana, arkadi gana, syamadi gana, siro
virechana gana and kaphasamsamana gana.

Uses - The roots are good for cleaning foul ulcers, cleaning teeth,
strengthening gums and gonorrhea. A root paste is used for local application in
scrofulous enlargements. The fresh bark is mucilaginous and sweet to taste, soon
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60

becoming bitter and acrid. It is anthelmintic and is used in haemorrhoids, beriberi,
ophthalmopathy, dermatopathy, vaginopathy and ulcers. Leaves are digestive, laxative
and anthelmintic and are good for flatulence, dyspepsia, diarrhea, leprosy, gonorrhea
and cough. A hot infusion of the leaves is good for rheumatalgia and for cleaning
ulcers and wounds. Flowers are useful to quench dyspepsia in diabetes and for
alleviating Vata and Kapha. The seeds are anthelmintic, haematonic, bitter, acrid and
carminative. They are useful in inflammations, otalgia, lumbago, pectral diseases,
chronic fevers, hydrocele, haemorrhoids and anaemia. The oil is anthelmintic, styptic
and depurative, and is recommended for scabies, ophthalmia, leprosy, haemarrhoids,
ulcers, herpes and lumbago
134
.

Chemical composition - The seeds contain 27% non-volatile oil which
contains glabrin, four furan flavones viz. karanjin, pongapin, karanjone and
pongaglabrone. It contains diketonepongamol and also fatty acids. The stem contains
karanjin, pongapin, pongamol and a new chromeno-chromene designated as
pongaflavone. The flowers contain kaempferol, pongamin, gamma sitosterol
glucoside, quercetin, neoglabrin and glabrosaponin. The leaves showed the presence
of glabrachromene I and II, carotene and beta sitosterol etc. isolation of a new
furonoflavone pongone from the flowers and its structure determined
135
.

2.KUMARI

Family : Lilliaceae
Botanical name : Aloe vera Linn

Synonyms : Kumari, Grihakanya, Kanyaka,
Ghrithakumarika, Kantakapathra
Vernacular names
Kannada : Kathaligida
English : Indian Aloe
Hindi : Gheekuar
Malayalam : Kattarvazha
Parts used - Expressed and dried juice of leaves and pulp.
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Habitat - The three varities of kumari is distributed all over India and
Sri Lanka.

Morphological characters - A coarse perennial with short stem and shallow
root system; leaves fleshy in rosettes, sessile, often crowded with horny prickles on
the margins, convex below, 45 60 cm long, tapering to a blunt point, surface pale
green with irregular white blotches; flower yellow or orange in racemes; fruits
loculicidal capsule.

Uses - The plant is bitter, sweet, cooling, anthelmintic, aperients, carminative,
deobstruent, depurative, diuretic, stomachic, emmenagogue, ophthalmic and
alexeteric. The juice is used in dyspepsis, amenorrhoea, burns, colic, hyperadenosis,
hepatopathy, splenopathy, skin diseases, constipation, spanomenorrhea, vitiated
conditions of Vata and Pitta, abdominal tumours, dropsy, carbuncles, sciatica,
lumbago and flatulence. The elio is used for helminthiasis in children and is a
purgative, anthelmintic and emmengogue. It is used for local application in painful
inflammations, chronic ulcers and catarrhal and purulent opthalmia
136
.
In inflammatory conditions, associated with pain and swelling, the external
application of its leaf extract, bola-elio, is very beneficial. It is also an effective
remedy for chronic wounds, as it process vranasodhana and vranaropana properties.
The bola effectively reduces haematoma, the accumulation of blood, due to traumatic
injuries
137
.
Whole plant: ante helmenthic in children, emmenagogue, stomachic; useful in
amenorrhea, piles and rectal fissures, tonic in small doses but in large doses acts as a
purgative; leaves; fresh juice in antipyretic, cathartic, cooling; refrigerant; useful in eye,
liver and spleen troubles, leishmaniasis, skin diseases and X-ray burns; leaf-juice is an
important constituent of a large number of Ayurvedic preparations; mucilage anti-
inflammatory; root: in colic
138
.

Chemical composition - The pulp contains a glucoside, barbalin, isobarbaloin
and beta barbalion. The leaves contain glucose, galactose, galacturonic acid, mannose,
aloesin and volatile and non-volatile oils, gum, resin, emodin, chrysophanic acid and
traces of coumarin. Aloesin and aloesone isolated; malic, citric and tartaric acids from
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62

leaves. The jelly from leaves composed of four partially acetylated glucomannans
which differ in their glucose to mannose ratio and acetyl content
139
.

3. TAMBOOLA

Family : Piperaceae
Botanical name : Piper betle Linn

Synonyms : Tamboola, Nagavallary, Bahula,
Kamada, J eevanthy, Kamarenjiny
Vernacular names
Kannada : Villayadele
English : Betel
Hindi : Pan
Malayalam : Vettila

Parts used - Leaves and fruits.
Habitat - Cultivated in the hotter and damper parts of India.

Morphological characters - A perennial dioecious root climber, stems semi-
woody, much thickened at nodes; leaves large, 15 20 cm long, broadly ovate,
slightly cordate, shortly acuminate, acue, entire, glabrous, yellowish or bright green,
shining on both sides; males spikes dense, cylindrical, female spikes pendulous, bracts
triangular rotundate, rachis pilose; fruits rarely produced, immersed in the fleshy
spikes forming nodular like structures.

Uses - The whole plant is bitter, acrid, sweet, astringent, carminative,
stomachic, sialagogue, anthelmintic, aromatic, desiccative, exhilarant, aphrodisiac,
expectorant, febrifuge, laxative and tonic. It is useful in bronchitis, asthma, catarrh,
cough, leprosy, dipsia, alcoholism, syncope, otalgia, fever, halitosis, impotency,
rheumatism, dyspepsia, pharyngopathy, and vitiated conditions of Kapha, colic,
diarrhea and laryngitis
140
.
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63

The leaf is pungent, bitter, sweetish, acrid; heating, carminative, stomachic,
anthelmintic, tonic, aphrodisiac, laxative; useful in Vata, Kapha, foul smell in the
mouh, ozoena, bronchitis, elephantiasis of the leg; improves appetite. The juice of the
leaves is dropped int the eye in painful affections of that organ; it is also used to
relieve cerebral congestion and satyriasis, and to allay thirst
141
. The chemistry and
physiology of the leaves have been studied by Mann, Sahasrabuddhe and Patwardhan
(Memoirs Depart. Agric. Of India; J uly 1913, J une 1916)
142
.

Chemical composition - Its leaves are known to contain 8.54% moisture,
3.1% protein, 0.8% fat, 6.1% carbohydrate, 2.3 % of fibre and 2.3a5 of mineral
matter. Viz.230 mg calcium, 40 mg phosphorus, 7 mg iron, 3.5 mg ionisable iron and
carotene etc. Betel leaves contain iodine. They have contents of potassium nitrate, the
amount of which depends upon the position of the leaf on the pine. Besides, its leaves
also yield an aromatic pungent and sharp taste essential oil, which contain phenol,
terpene and other constituents
143
.

4. SIGRU

Family : Moringaceae
Botanical name : Moringa oleifera Lam.

Synonyms : Sigru, Mochaka, Sobhanjan,
Theekshagandha, Bahuladala.
Vernacular names
Kannada : Nuggi, Murunga
English : Drumstick plant, Horse raddish.
Hindi : Saijan, Munaga.
Malayalam : Muringa

Parts used - Bark, Root, Fruit, Flowers, Leaves, Seeds and Gum.
Habitat - Sigru is widely distributed all over India and Burma.

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Morphological characters - An unarmed middle sized graceful tree with
corky grey bark and easily breakable branches; leaves usually tripinnate, rachis
slender, thickened and articulated at the base, leaflets elliptic or obovate, rounded at
the apex, nerves obscure; flowers white in large puberulous axillary panicles; fruits
pods, up to 45 cm long, pendulous, greenish, triangular, 9- ribbed, seeds trogonous,
the angles winged.

Uses - The roots are bitter, acrid, thermogenic, digestive, carminative,
anthelmintic, constipating, anodyne, anti-inflammatory, emmengogue, sudorific,
diuretic, ophthalmic, rubefacient, expextorant, haematinic, antilithic, alexipharmic,
stimulant and vesicant. They are useful in vitiated conditions of Vata and Kapha,
dyspepsia, anorexia, vermiminosis, diarrhea, colic, flatulence, otalgia, paralysis,
inflammations, amenorrhoea, fever, strangury, vesical and renal calculi, ascites,
ophthalmopathy, cough, asthma, bronchitis, pectoral diseases, splenomegaly,
epilepsy, hysteria, cardiopathy, abscess and pharyngodynia. The bark is acrid, bitter,
thermogenic, abortificant, antifungal and cardiac and circulatory stimulant. It is useful
in ascites, vitiated conditions of Vata and Kapha and ringworm. The leaves are anti-
inflammatory, anodyne, anthelmintic, ophthalmic and rich in Vitamin A and C. They
are useful in scurvy, vitiated conditions of Kapha and Vata, wounds, tumours,
inflammations and helminthiasis. The seeds are acrid, bitter, anodyne, anti-
inflammatory, purgative, antipyretic and ophthalmic. They are useful in neuralgia,
inflammations, intermittent fevers and ophthalmopathy
144
.

Chemical composition - The flowers and fruits contain amino acids viz.
alanine, arginine, glycine, serine, lysine, threonine, valine, aspartic and glutamic
acids. The pods and leaves contain vitamin A, nicotinic acid, ascorbic acid and
essential amino acids. The flowers contained traces of alkaloids besides quercetin and
kaempferol. The stem exudes a gum, which is a polyuronide consisting of arabinose,
galactose and glucuronic acid. The seeds showed the presence of stigmasterol and a
new glycoside, morigyne and its structure elucidated. From stem 4-hydroxymellein,
vanillin, octacosanoic acid, beta sitosterol and beta sitostenone isolated
145
.

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65

5. PARIBHADRA

Family : Leguminosae
Botanical name : Erythrina indica Lam.

Synonyms : Paribhadra, Kantakeepalasa,
Karnakaram,Nimbatharu,
Mandara, Rakthapushpa.

Vernacular names
Kannada : Varjipe, Harivana
English : India coral tree
Hindi : Farhad, Mandar
Malayalam : Murukku

Parts used - Bark, J uice and Leaves.
Habitat - The plant is distributed all over India, irrespective of region and
climate variations.

Morphological characters - A medium sized quick growing tree attaining 18
m in height armed with dark coloured, conical prickles, bark yellowish, smooth,
shiny, papery; leaves trifolialate, leaflets 10 15 cm long and nearly as broad
rhomboid ovate; flowers coral red in dense racemes, corolla papilionaceous; fruits
pods, torulose, 15 30 cm long, containing upto 12 seeds; seeds red to dark purple or
brown.

Uses - The bark is bitter, acrid, thermogenic, anti-inflammatory, sedative,
vulnerary, carminative, digestive, stomachic, anthelmitic, haematinic, expectorant,
diuretic, emmengogue, rejuvenating, depurative and febrifuge, and is useful in vitiated
conditions of Kapha and Vata, inflammations, conjunctivitis, otalgia, insomnia,
anorexia, flatulence, dyspepsia, coloic, helminthiasis, cough, strangury,
dysmenorrhoea, leprosy, skin diseases and fever. The leaves are bitter, diuretic,
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66

laxative, emmenagogue, stomachic and anthelmintic, and are useful in uropathy,
inflammations, vitiated conditions of Pitta, dysmenorrhoea, gastropathy,otalgia,
odantalgia, and helminthiasis. The leaf paste isused by tribes to treat fresh cuts and
wounds
146
.
The root is emmenagogue the bark is used in dysentery; cures Kapha and
Vata. The leaves are bitter, hot, stomachic, anthelmintic; improves appetite; cure
urinary discharges, inflammations. The flowers are used in biliousness and ear
troubles. Susrutha Acharya recommends the plant for the treatment of snake-bite. The
bark is used medically as febrifuge and anti-bilious. It is anti helminthic; and is useful
as a collyrium in ophthalmia. The leaves are applied externally to disperse venereal
buboes, and to relieve pain of the joints. The fresh juice of the leaves is used as an
injection into the ear for the relief of ear-ache, and s an anodyne in tooth-ache
147
.

Chemical composition - Its leaves are reported to contain resin, an
nitrogenous inert substance and a mixture of alkaloids viz., hypaphorine, arisodine,
arisotrine and arithreyoline. The bark contains a fixed oil, resin and fatty acid and
alkaloids including hypaphorine. Its seeds yield a fixed oil, which is extracted from its
red-coloured seeds and is pale yellow in colour. Its seeds contain almost all three
alkaloids and present in its leaves and the bark. The proportion of alkaloids present
therein, is 0.11, 0.035 and 0.082 percent in bark, leaves and the seeds. Besides, its
seed-oil contains both saturated and unsaturated fatty acids viz., 53.42 percent oleic
acid and 63.3 percent linoleic acid respectively
148
.

6. PALANDU

Family : Lilliaceae
Botanical name : Allium cepa Linn

Synonyms : Palandu, Yavaneshta,
Mukhadooshana, Durgandha.
Vernacular names
Kannada : Nirulli
English : Bulb onion
Hindi : Pyaz
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67

Malayalam : Chuvannully

Parts used - Bulb and seed.
Habitat - Bulb onion is widely distributed all over India.

Morphological characters - A biennial or perennial herb with aromatic fleshy
underground bulb; leaves linear, hollow, cylindric and fleshy; flowers are many,
white in globular umbels, spathe composed of 2 3 reflexed walls.
The underground bulbs which are medicinally used vary in size, colour, shape,
firmness, strength of flavor and keeping quality.

Uses - The bulbs are acrid, sweet, aromatic, thermogenic, antiperiodic,
antibacterial, aphrodisiac, emmengogue, emollient, expectorant, carmintive,
stomachic, diuretic, anodyne and tonic. They are useful in haemorrhoids, dysentery,
flatulence, dyspepsia, colic, jaundice, splenopathy, hepatopathy, pneumonopathy,
asthma, bronchitis, ophthalmia, vomiting, otalgia, pharyngodynia, malarial fever,
lumbago, epilepsy, tumours, wounds, paralysis, arthralgia, leucoderma and skin
diseases
149
.
The bulbs contain an acrid, volatile oil, which acts as a stimulant, diuretic and
expectorant. Used externally as rubefacient, and, when roated, as a poultice.
Considering, the natives hot and pungent, useful in flatulency. As an external
application, onions are used in scorpion stings and to allay irritation in skin diseases.
They have anti-periodic properties attributed to them, and are said to migrate cough in
phthisis, and mixed with vinegar, used in sore throat
150
.

Chemical composition - The bulb contains polyphenols, protocatechuic,
caffeic and ferulic acids, quercetin and its derivatives, carbohydrates, sterols and
sterol glycosides, beta-amyrin and beta sitosterol. The essential oil from the bulbs
yields various mon-, di-, tri-, and tetra sulphides, thiols and thiphene
151
.

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68

7. VASUKA

Family : Rubiaceae
Botanical name : Borreria hispida Linn. (K.Schum)

Synonyms : Madanagandhi
Vernacular names
Kannada : Madanabadu, Megidda
English : Shoggy putton weed
Hindi : Madanagandhi
Malayalam : Tharthaval

Parts used - Entire plant.
Habitat - All over in India and Srilanka the drug is distributed.

Morphological characters - A hispid procumbent with long branches and
quadrangular stems; leaves simple, opposite, subsessile, oblong or elliptic, scabrid;
flowers pale mauve usually long tubed, 4 6 in a whorl within the stipular cup; fruits
capsules, ellipsoid, rounded at both ends, 5 mm long, rounded on the back with a deep
groove on the flat face.

Uses - The plant is acrid, sweet, astringent, mildly thermogenic, emollient and
stomachic.it is used in vitiated conditions of Pitta and Vata, dyspepsia, colic,
flatulence and general debility
152
.
Paribhadra works in Kaphaja, Medhojanya, Pittika vikaras, sopha and karna
rogas (Bhavaprakasha). In Rajanighatu, Kaideva nighantu and Nighantu ratnakara
references are available for its used in Deepana Karma and Kapha Vata rogas. Also
mentions about the Sulahara property. Prof. Priyavrat Sharma in his work
Dravyagunavinjnan has mentioned about its used in Grandhi rogas, vrana,
Agnimandhya, Kasa and Moothrakricha too.
The bark and leaves are having anti inflammatory property. The leaf paste is
used by some tribes to treat fresh cuts and wounds
153
. The leaves are applied
externally to relieve pain of the joints
154
. It is a C.N.S depressant, laxative, diuretic
DRUG REVIEW

69

and galactogogue. Decoction of bark is used in diabetics, dysentery, worms and useful
as a coliyrium in ophthalmia.

Chemical composition - Bark contains 2 resins and a bitter poisonous
alkaloid, which is also present in leaves. The alkaloids traced are Erisodin, Erisoin,
Erisonin and Erisotrin. Seeds contain about 10 30 % of oil.

8. SATHAVARI

Family : Lilliaceae
Botanical name : Asparagus racemosus wild.

Synonyms : Sathavari, Bahusutha, Indeevary,
Varee, Sathapady.
Vernacular names
Kannada : Callagadda
English : Wild asparagus
Hindi : Sathavar
Malayalam : Sathavari

Parts used - Root and Leaves.
Habitat - Grows all over India.

Morphological characters - An armed, climbing under shrub. Woody terete
stems and recurved or rarely straight spines, young stems very delicate, brittle and
smooth; leaves reduced to minute chaffy scales and spines; cladodes triquetrous,
curved in tufts or 2 6; flowers white, fragrant, in simple or branched racemes on the
naked nodes of the main shoots or in the axils of the thorns; fruits globular or
obscurely 3 lobed, pulpy berries, purplish black when ripe, seeds with hard and brittle
testa. The tuberous succulent roots are 30 cm to a meter or more in length, fascicled at
the stem base, smooth, tapering at both ends
155
.

Uses - Susrutha samhitha, Charaka samhitha and Dhanwanthari nighantu
mentions about the Rasayana guna of Sathavari.
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70

The roots are bitter, sweet, emollient, cooling, nervine tonic, constipating,
galctagogue, ophthalmic, anodyne, aphrodisiac, diuretic, rejuvenating, carminative,
appetizer, stomachic, antispasmodic and tonic. They are useful in nerve disorders,
dyspepsia, diarrhea, dysentery, tumours, inflammations, vitiated conditions of Vata
and Pitta, burning sensation, hyperdipsia, opthalmopathy, nephropathy, hepatopathy,
strangury, scalding of urine, throat infections, tuberculosis, cough, bronchitis, gleet,
gonorrhea, leprosy, epilepsy, fatigue, hyperacidity, colic, haemorrhoids, cardiac
debility, hypertension, abortion, agalactia and general debility
156
.

Chemical composition - Saponins are present in all species of Asparagus, but
variations are found, in different species from parts. Mucilage is also present in roots.
In leaves, disogenin is also isolated. From the flowers and fruits, rutin, sarsapogenin,
glycosided of quercetin and hyperoside are obtained. Sitosterol, stigmasterol and their
glucosides, sarsasapogenin and to spirostanolic and two furostanolic saponins isolated
from fruits and chemically studied. Four glycosides compound A, shatavarin I, II
and IV- isolated from roots, structure of shatavarin IV elucidated
157
.

NALIKERA

Family : Palmaceae
Botanical name : Cocus nucifera

Synonyms : Nalikera, Druthaphal, Thung,
Thruna raj, Sadaphal.
Vernacular names
English : Coconut palm
Hindi : Nariyal
Malayalam : Thengu

Parts used - Fruits, flowers, Root, Oil and ash.
Habitat - Grows all over India especially in costal areas.

Uses - Vata pitta samaka properties are present. Found effective in
mutraghatha, rajayakshma, krichrarthava and vranas. Oil prepared by taking the milk
DRUG REVIEW

71

promotes hair growth and is used for burns. Coconut oil is used as substitute for cod-
liver oil in wasting and pulmonary diseases. The liquid fat has anti-inflammatory and
healing properties. All the active principles in coconut oil have high lipid solubility.

Chemical composition - From the ripened fruit 60 70 % oil is obtained
along with vitamin A and B. From fruit water sugar, mannitol, gum, tartaric acid
and mineral water is obtained. In fresh shell of the fruit nitrogenous substances, fat,
ash, lignin etc. are present. In the ash of the leaves, potash is yielded in considerable
amount. Coconut oil contains saturated fatty acids like capric, caproic, caprilic, lauric,
myristic, palmitic, stearic and arachidic acids. The unsaturated fatty acids present in it
are palmitolic, oleic, linolenic and arachidonic acids. The ripped fruit water contains
solids, sugar, minerals, fats and proteins. From minerals, potassium and remaining
part contains sodium, calcium, phosphorus, copper and iron. The riped water has pH
5.2
158
.

TANDULODAKA
Water obtained from washing red rice. 1 kg of raw rice is soaked in 4 times of
water for 9 hours and filter. This filterate is called Tandulodaka. It is effective in pain,
burning sensation and inflammation especially in vata pradhana conditons.

Preparation of Murivenna
159
Ingredients for preparing one litre of Murivenna - Karanja (bark), Kumari
(leaves), Tamboola (leaves), Sigrupatra (leaves), Paribhadra (leaves), Palandu (bulb)
and Vasuka (whole plant) are taken in 384 gms. Sathavari (rhizome) - 144 gms.
Nalikera oil and Tandulodaka 1 litre each.
The Swarasa of the first 7 drugs and Tandulodaka are prepared in coconut oil
medium. To reduce the Theekshna Veerya of ingredients, Sathavari Kalka is added.
The medium of the formulation is coconut oil. The Swarasa, coconut oil and the
Kalka are boiled to half and kept as such for the day and repeat boiling on the second
day too. The mixture is to be stirred continuously and in the third day boiling a
stirring is continued. When the Kalka becomes at Khara Paka, it is filtered and after
cooling kept in suitable containers.

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72

Table no: -8 Ingredients of Murivenna
Ingredients
Image of the drug
Quantity
for 1 liter
Parts used
Botanical name
Pongamia pinnata Pierre
Pongamia glabra vent
Family Fabaceae
Karanja

384 gms

Bark

Botanical name Aloe vera
Linn
Family - Lilliaceae
Kumari

384 gms

Leaves
Tamboola
Botanical name Piper betle
Linn
Family Piperaceae

384 gms

Leaves
Botanical name - Moringa
pterygosperma Gaertn.
Family - Moringaceae
Sigru

384 gms

Leaves
Botanical name
Erythrina indica Lam
Family - Leguminosae
Paribhadra

384 gms

Leaves
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73

Ingredients
Image of the drug
Quantity for 1
litre
Parts used
Botanical name
Allium cepa Linn
Family - Lilliaceae
Palandu
384 gms

Bulb

Botanical name
Borreria hispida K.Schum

Family - Rubiaceae
Vasuka

384 gms

Whole plant
Botanical name
Asparagus racemosus wild.
Family - Lilliaceae
Sathavari

144 gms

Rhizome
Botanical name
Cocus nucifera
Family - Paimaceae
Nalikera
1 liter Oil
Thandulodakam 1 liter

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74

Table No 9: Rasa Panchaka of the drugs used in the preparation of Murivenna

Drugs Rasa Guna Veerya Vipaka Prabhava
Karanja Tikta, Katu,
Kashaya
Laghu,
TIkshna,
Ushna Katu -
Kumari Tikta,
Madhura
Guru,
Snigdha,
Pichila
Sheeta Katu -
Tamboola Katu, Tikta Laghu,
Ruksha,
Tikshna
Ushna Katu -
Sigru Katu, Tikta Laghu,
Ruksha,
Tikshna
Ushna Katu -
Paaribhadra Katu, Tikta Laghu Ushna Katu -
Palandu Madhura,
Katu
Guru,
Tikshna,
Snigdha
Ishat Ushna Madhura -
Vasuka Katu Laghu,
Rooksha
Anushna
Sheeta
Katu -
Sathavari Tikta,
Madhura
Guru,
Snigdha
Sheeta Madhura -
Naarikela Madhura Guru,
Snigdha
Sheeta Madhura -

CLINICAL STUDY

75

1) INTRODUCTION:
Snehana & swedana are considered to be the prime modalities of chikista in
vata vyadhi. J anu basti being an innovative procedure evolved from Shirobasti has
been studied with various sneha yogas to conclude remarkable efficacy in the
condition of J anu Sandhigatavata. Even though J anu Pichu too advocates the same
principle producing Sthanika Snehana & Swedana effect retaining the oil for
stipulated time period, no study has been conducted yet to evaluate the efficacy of the
same. So in the current study the main objective was to compare and evaluate the
efficacy of J anubasti and J anupichu with Murivenna in J anusandhigatavata. If the
study could provide better or similar efficacy among the procedures on comparison it
can render a primary contribution on the comparative evaluation of the efficacy
among the procedures.

2) AIM:
Evaluation of effect of J anu Basti with Murivenna on J anusandhigatavata.
Evaluation of effect of J anu Pichu with Murivenna on J anusandhigatavata.
To compare and ascertain the effect of J anu Basti and J anu Pichu with
Murivenna.

3) RESEARCH DESIGN

This is a randomized comparative, open labeled, parallel clinical study.

CLINICAL STUDY
CLINICAL STUDY

76
4) MATERIALS AND METHODS FOR THE STUDY
A) SELECTION OF PATIENTS:
The patients from both OPD and IPD of Alvas Ayurveda Medical college Moodbidre,
irrespective of sex, religion, occupation and marital status etc, showing signs and
symptoms of J anu Sandhigatavata were selected. The detailed clinical history was
recorded and examination was done as per special case Performa prepared for the
same.

B) DIAGNOSTIC CRITERIA:
Signs & symptoms mentioned in various Ayurveda Samhitas for Sandhigata Vata
were considered

Sandhi shoola.(pain)
Sandhi sotha.(swelling)
Prasarana aakunchana pravrutttischa vedana.(Pain during
movement of kneejoint)
Atopa.(crepitus)

C) INCLUSION CRITERIA:
Patients of either sex between the age group 30-70 years with the features of
J anusandhigatavata .
Patients fit to undergo J anubasti and J anupichu procedure will be selected.

D) EXCLUSION CRITERIA:
Patients with any other systemic disorder, which may interfere with the course
of the treatment, will be excluded.
Traumatic cases like fracture.
Pregnancy & lactation.
Diseases like Vatarakta & Amavata.

CLINICAL STUDY

77
5) GROUPING
Patients of J anu Sandhigata Vata were randomly divided into two equal groups which
consisted of 15 patients each.

6) INTERVENTION:
In group A, Patients were administered J anu Basti with Murivenna for 45 minutes, for
7 consecutive days.
In group B, patients were administered J anu Pichu with Murivenna for 45 minutes for
7 consecutive days.

Administration of Janu Basti & Janu pichu:
J anu Basti & J anu Pichu are Bahya Snehana and Svedana Chikitsa karmas. It was
conducted taking in consideration of three steps such as Poorva Karma, Pradhana
Karma and Paschat Karma as mentioned in detail before.

7) LABORATORY INVESTIGATIONS:
Blood and Urine routine.
X Ray in required cases.
In necessary cases, other investigations were done as required.

8) FOLLOW UP STUDY:
After completion of 7 days of J anu Basti and J anu Pichu course all the patients were
followed up for assessment on 14
th
day & on 22
nd
day with administration of rice flour
capsules as placebo.

CLINICAL STUDY

78

9) ASSESMENT:
After the procedure Samyak Swinna Lakshana such as Sveda Pradurbhava, Shotha
Vyuparama, Stambha Nigraha, Gaurava Nigraha, Mardavata or Sveda Ayoga
Lakshana such as Asveda, Stabhdata, Guruta or Atisveda Lakshana such as Vidaha,
Sandhi Vedana, Sphota etc if any were observed & recorded.

10) ASSESSMENT CRITERIA:

SANDHI SHOOLA/PAIN ON WALK - GRADINGS

NO PAIN - 0
MILD PAIN ON EXERTION - 1
MODERATE INTERMITTENT PAIN ON WALK - 2
CONSTANT PAIN ON WALK - 3
SEVERE PAIN UNABLE TO WALK - 4

SANDHI GRAHA /STIFFNESS

NORMAL FLEXION - 0
MILD RESTRICTION - 1
MODERATE RESTRICTION - 2
SEVERE RESTRICTION - 3

GAIT / AAKRUTI

FREE SWINGING , NO LIMP - 0
LIMPING GAIT WITH NO ADDITIONAL SUPPORT - 1
WITH UNILATERAL SUPPORT - 2
WITH BILATERAL SUPPORT - 3

TENDERNESS
NO TENDERNESS - 0
PATIENT COMPLAINS OF PAIN ON TOUCH - 1
AND WINCES - 2
PATIENT WITHDRAWS J OINT ON TOUCH - 3
PATIENT DOESNT ALLOW TO TOUCH THE J OINT - 4

CLINICAL STUDY

79

SWELLING/SHOTHA

SWELLING ABSENT - 0
SWELLING PRESENT - 1

CREPITUS/AATOPA

NO CREPITUS - 0
PALPABLE CREPITUS - 1
AUDIBLE CREPITUS - 2

RANGE OF MOVEMENTS USING GONIOMETER

NORMAL FLEXION 135
0
- 0
LESSER THAN 135
0
& MORE THAN 100
0
- 1
LESSER THAN 100
0
& MORE THAN 75
0
- 2
LESSER THAN 75
0
- 3

CLINICAL STUDY

80

TOTAL EFFECT

COMPLETE REMISSION 100% relief in signs and symptoms of patients without
any complaints were considered as complete remission.

MARKED IMPROVEMENT > 90% relief in signs and symptoms were
considered as marked improvement.

MODERATE IMPROVEMENT Between 60 90% relief in signs and symptoms
were considered as moderate improvement.

PARTIAL IMPROVEMENT Between 30 60% relief in signs and symptoms
were considered as partial improvement.

UNCHANGED < 30 % relief in signs and symptoms were considered as
unchanged.

ANALYSIS OF DATA:

Data was analyzed by unpaired t test.

P <0.001 Highly significant

P <0.01 Moderately significant

P <0.05 Significant

P >0.05 Not significant

OBSERVATIONS

81

OBSERVATIONS
The following observations were made during this study. Observations were made
before the treatment, during the treatment and after the treatment. In the present study,
30 patients fulfilling the inclusion criteria of J anu Sandhigata vata were studied.
Incidence observation:
As per the prepared proforma, observations were made regarding the incidence
of Age, sex, occupation, nature of work, religion, socio-economic status, marital
status, educational status, habitat, diet, addictions, Prakruti, Saara, Satwa, Samhana,
Aahara- Abhyavarana J arana Shakthi, Agni, Koshta, Vyayama Shakti, Nidra, Ahara
Vihara and Manasika Nidana factors, chronicity etc were noted.
Distribution of 30 patients according to different age group:
In this study it was found that the incidence was highest in the age group of
51-60 years constituting 43.34% of total numbers of patients.23.33% patients were
equally present in the age group of 41-50 and in 61-70 years. The incidences
according to age groups are shown in the table below.

Table No 10: Distribution of 30 patients according to different age group
No of patients Age (in years)
GroupA GroupB
Total %
31-40 2 1 3 10%
41-50 3 4 7 23.33%
51-60 7 6 13 43.34%
61-70 3 4 7 23.33%

Graph No 1: Distribution of 30 patients according to different age group

OBSERVATIONS

82

Sex wise distribution of 30 patients:
In the sample taken for the study, 33.33% were males in comparison to
66.66% of females.

Table No 11: Sex wise distribution of 30 patients
No of patients Sex
GroupA GroupB
Total %
Male 4 6 10 33.33%
Female 11 9 20 66.66%

Graph No 2: Distribution of sex of 30 patients

Distribution of 30 patients according to occupation: Maximum number of patients
were manual laborers & house wives (33.3%) and other majority belonged to business
category (13.3%) other jobs like driving, pipeline seaman etc. The incidence of other
occupation is shown in the table below.
Table No 12: Distribution of 30 patients according to occupation
No of patients Occupation
Group A Group B
Total %
Manual labor 8 2 10 33.3%
Housewife 2 8 10 33.3%
Businessmen 2 2 4 13.3%
Office 1 0 1 3%
others 2 3 5 16.66%

OBSERVATIONS

83

Graph No 3: Distribution of 30 patients according to occupation

Distribution of 30 patients according to religion:
50% patients were Hindus, 46.66% were Muslims and 3% were Christians.
Table No 13: Distribution of 30 patients according to religion
No of patients Religion
GroupA GroupB
Total %
Hindu 8 7 15 50%
Muslim 6 8 14 46.66%
Christian - 1 1 3%

Graph No 4: Distribution of 30 patients according to religion

OBSERVATIONS

84

Distribution of 30 patients according to socio- economic status:
Majority of patients belonged to the lower middle class, middle class (40%),
10% each were in upper middle class and poor. The other incidences of socio-
economic status are given in table below.
Table No 14: Distribution of 30 patients according to socio- economic status
No of patients Socio-economic status
Group A Group B
Total %
Poor 2 1 3 10%
Lower middle class 6 6 12 40%
Middle class 7 5 12 40%
Upper middle class 0 3 3 10%
Rich 0 0 0 00%

Graph No 5: Distribution of 30 patients according to socio- economic status

OBSERVATIONS

85

Distrubution of 30 patients according to marital Status:
Majority of 90% were married and remaining 10% were unmarried.

Table No 15: Distrubution of 30 patients according to marital Status
No of patients Marital status
Group A Group B
Total %
Married 14 13 27 90%
Unmarried 2 1 3 10%

Graph No 6: Distrubution of 30 patients according to marital Status

Distribution of 30 patients according to habitat:
43.33% of the patients in this study were from sub urban area and 33.33%
were from rural area & 23.33% urban.
Table No 16: Distribution of 30 patients according to habitat
No of patients Habitat
GroupA GroupB
Total %
Urban 3 4 7 23.33%
Sub Urban 7 6 13 43.33%
Rural 5 5 10 33.33%

OBSERVATIONS

86

Graph No 7: Distribution of 30 patients according to habitat

Distribution of 30 patients according to educational status:
Majority of patients belonged to high school class (36.66%) and in P.U.C class
(20%), about 13.33% had higher primary education and 16.66% were graduates, Rest
6.66% belonged to illiterate & lower primary classification.
Table No 17: Distribution of 30 patients according to educational status
No of patients Education
GroupA GroupB
Total %
Illiterates 2 0 2 6.66%
Lower Primary education 0 2 2 6.66%
Higher Primary education 0 4 4 13.33%
High School 8 3 11 36.66%
P.U.C 3 3 6 20%
Graduation 2 3 5 16.66%

Graph No 8: Distribution of 30 patients according to educational status

OBSERVATIONS

87

Distribution of patients according to Prakruti: A majority of patients belonged to
VaataPitta Prakruti i.e 53.33% and 23.33% belonged to Vaata Kapha Prakruti,13.33%
PittaKapha,6.66% Pittavaata,3% kaphavata prakruthi.. The details of other incidence
are tabled below.

Table No 18: Distribution of 30 patients according to Prakruti
No of patients Prakruti
GroupA GroupB
Total %
Vaata 0 0 0 0%
Pitta 0 0 0 0%
Kapha 0 0 0 0%
VaataPitta 8 8 16 53.33%
VaataKapha 4 3 7 23.33%
PittaKapha 2 2 4 13.33%
Pittavaata 1 1 2 6.66%
Kaphavata 0 1 1 3%
VaataPittaKapha 0 0 0 0%

Graph No 9: Distribution of 30 patients according to Prakruti

OBSERVATIONS

88

Distribution of patients according to Saara:
Among the groups 36.66% were possessing twak saara lakshana, 23.33%
were Rakta Saara, 20% were Mamsa Saara, and 10% each were Meda Saara & asthi
saara .The incidence of other Saara were shown in the table below.

Table No 19: Distribution of patients according to Saara
No of patients Saara
GroupA GroupB
Total %
Twak 6 5 11 36.66%
Rakta 3 4 7 23.33%
Mamsa 3 3 6 20%
Meda 1 2 3 10%
Asthi 2 1 3 10%
Majja 0 0 0 00%

Graph No 10: Distribution of 30 patients according to Saara

OBSERVATIONS

89

Distribution of patients according to their Satwa:
The analysis of satwa revealed 63.33% had Madyama Satwa, 16.66% avara
and 20% of patients had Pravara Satwa.
Table No 20: Distribution of 30 patients according to their Satwa:
No of patients Satwa
GroupA GroupB
Total %
Pravara 3 3 6 20%
Madyama 10 9 19 63.33%
Avara 2 3 5 16.66%

Graph No 11: Distribution of 30 patients according to their Satwa:

Distribution of patients according to Samhanana:
66.66% were of Madyama Samhanana, 13.33% were Avara and 20% were of
Pravara Samhanana.

Table No 21: Distribution of 30 patients according to Samhanana
No of patients Samhanana
GroupA GroupB
Total %
Pravara 4 2 6 20%
Madhyama 9 11 20 66.66%
Avara 2 2 4 13.33%

OBSERVATIONS

90

Graph No 12: Distribution of 30 patients according to Samhanana

Distribution of patients according to Saatmya: Analysis of Saatmya revealed that
70% were of Madyama Saatmya,10%were Avara and 20% were of Pravara Saatmya.
Table No 22: Distribution of 30 patients according to Saatmya.
No of patients Saatmya
GroupA GroupB
Total %
Pravara 3 3 6 20%
Madyama 11 10 21 70%
Avara 1 2 3 10%

Graph No 13: Distribution of 30 patients according to Saatmya.

OBSERVATIONS

91

Distribution of the 30 patients according to dietary Habits:
33.33% of patients were vegetarians and 66.6% patients consumed mixed diet

Table No 23: Distribution of the 30 patients according to dietary Habits
No of patients Dietary Habits
GroupA GroupB
Total %
Vegetarians 6 4 10 33.33%
Mixed 9 11 20 66.66%

Graph No 14: Distribution of the 30 patients according to dietary Habits

Distribution of patients according to addictions / Vyasana:
Majority of 63.33% had no addiction in comparison to 20% who were
addicted to tobacco chewing, 13.33% were addicted to smoking. The incidences of
other addictions are shown in the table below.

Table No 24: Distribution of 30 patients according to addictions / Vyasana
No of patients Habit
GroupA GroupB
Total %
Smoking 2 2 4 13.33%
Alcohol 1 0 1 3%
Tobacco chewing 3 3 6 20%
None 9 10 19 63.33%

OBSERVATIONS

92

Graph No 15: Distribution of 30 patients according to addictions / Vyasana

Distribution of patients according to Aahara- Abhyavaharana Shakti:
66.66% had Madyama- Abhyavaharana Shakti,13.33% were avara and 20%
had Pravara- Abhyavaharana Shakti.
Table No 25: Distribution of 30 patients according to Aahara- Abhyavaharana
Shakti
No of patients Aahaara - Abhyava
harana sakti A B
Total %
Pravara 4 2 6 20%
Madyama 9 11 20 66.66%
Avara 2 2 4 13.33%

Graph No 16: Distribution of 30 patients according to Aahara- Abhyavaharana
Shakti

OBSERVATIONS

93

Distribution of patients according to Aahara-Jarana shakti:
63.33% had Madyama- J arana Shakti, 30% Pravara and 6.66% had avara-
J arana Shakti.
Table No 26: Distribution of 30 patients according to Aahara-Jarana shakti
No of patients Aahara- J arana Shakti
GroupA GroupB
Total %
Pravara 5 4 9 30%
Madyama 9 10 19 63.33%
Avara 1 1 2 6.66%

Graph No 17: Distribution of 30 patients according to Aahara-Jarana shakti

Distribution of patients based on Agni:
Among 30 patients of J anu Sandhivata 50% had Samagni, 23.33% had Mandagni
and 23.33% patients suffered from vishamgni.

Table no 27: Distribution of 30 patients according to Agni
No. of patients Sl. No. Agni
A B
Total %
1 Samagni 9 6 15 50
2 Mandagni 3 4 07 23.33
3 Teekshnagni 0 1 01 03.33
4 Vishamagni 3 4 07 23.33

OBSERVATIONS

94

Graph No: 18 Distribution of 30 patients according to Agni

Distribution of patients based on Koshtha:
Table no. 28 shows that among 30 patients of J anu Sandhivata 53.33% had
Madhyama Koshta and 46.66% had Krura Koshtha.

Table - 28: Koshtha wise Distribution of 30 Patients of Janu Sandhivata
No. of
patients
Sl. No. Koshtha
A B
Total %
1 Mrudu 0 0 0 00
2 Madhyama 9 7 16 53.33
3 Krura 6 8 14 46.66

Graph No 19: Koshtha wise Distribution of 30 Patients of Janu Sandhivata

OBSERVATIONS

95

Distribution of patients according to their nature of work/ Vihara:
A maximum of 33.33% of patients were doing manual work & labor
each,13.33% had sedentary nature of work, &10% were travelling.

Table No 29: Distribution of 30 patients according to their nature of -
-work/ Vihara
No of patients Nature of work
GroupA GroupB
Total %
Manual work 2 8 10 33.33%
labor 8 2 10 33.33%
sedentary 2 2 4 13.33%
Travelling 1 2 3 10%
Others 2 1 3 10%

Graph No 20: Distribution of patients according to their nature of work / Vihara

OBSERVATIONS

96

Distribution of patients according to Vyaayama Shakti:
56.66% had Madyama Vyaayama Shakti and 43.33% had Avara Vyaayama
Shakti.
Table No 30: Distribution of patients according to Vyaayama Shakti
No of patients Vyaayama Saktitah
GroupA GroupB
Total %
Pravara 0 0 0 00%
Madyama 8 9 17 56.66%
Avara 7 6 13 43.33%

Graph No 21: Distribution of patients according to Vyaayama Shakti

Distribution of patients according to their Nidra Sheela:
63.33% had disturbed sleep whereas only 36.66% had sound sleep.

Table No 31: Distribution of patients according to their Nidra Sheela
No of patients Nidra
GroupA GroupB
Total %
Sound 5 6 11 36.66%
Disturbed 10 9 19 63.33%

OBSERVATIONS

97

Graph No 22: Distribution of patients according to their Nidra Sheela

Distribution of patients according to Nidana (Ahara):
Table no. 33 shows that among 30 patients of J anu Sandhivata 53.33% of them did
Atyupayoga of Katu Rasa, 23.33% of them did Alpa Bhojana, again 23.66% of them
did Rooksha Bhojana.

Table No 32: Nidana (Ahara) wise Distribution of 30 Patients of Janu Sandhivata
No. of
patients
Sl. No. Nidana (Ahara)
A

B

Total %
1 Tikta Rasa Atyupayoga 0 0 0 00%
2 Kashaya Rasa Atyupayoga 0 0 0 00%
3 Katu Rasa Atyupayoga 9 7 16 53.33%
4 Alpa Bhojana 4 3 7 23.33%
5 Pramita Bhojana 0 0 0 00%
6 Rooksha Bhojana 3 4 7 23.33%

OBSERVATIONS

98

Graph No 23: Distribution of patients according to their Nidana (Ahara)

Distribution of patients based on Nidana (Vihara):
Table no. 34 shows that among 30 patients of J anu Sandhivata 63.33% did Ratri
J agarana and 33.33% did Ati Vyayama.

Table No 33: Nidana (Vihara) wise Distribution of 30 Patients of Janu
Sandhivata

No. of patients Sl. No. Nidana (Vihara)
A B
Total %
1 Vega Dharana 0 1 1 3.33%
2 Ati Vyavaya 0 0 0 00%
3 Ratri J agarana 10 9 19 63.33%
4 Atyuchha Bhashana 0 0 0 00%
5 Ati Vyayama 6 4 10 33.33%

OBSERVATIONS

99

Graph No 24: Distribution of patients according to their Nidana (Vihara)

0 0
10
0
6
1
0
9
0
4
0
2
4
6
8
10
12
Vega
dharana
Ativyavaya Ratri
jagarana
Atyucha
Bhashana
Ativyayama
GroupA
GroupB
Column1

Distribution of patients based on Nidana (Manasika):
Table no. 35 shows that among 30 patients of J anu Sandhivata 20% of patients had
Ati Bhaya, 3.33% had Ati Shoka and 76.66% of them had Ati Chinta

Table No 34: Nidana (Manasika) wise Distribution of 30 Patients of Janu
Sandhivata
No. of patients Sl. No. Nidana (Manisika)
A B
Total %
1 Ati Bhaya 2 4 6 20%
2 Ati Shoka 1 0 1 3.33%
3 Ati Chinta 13 10 23 76.66%

Graph No 25: Nidana (Manasika) wise Distribution of 30 Patients of Janu
Sandhivata

OBSERVATIONS

100

Distribution of patients according to Chronicity:
Table no. 30 shows that among 30 patients of J anu Sandhivata 63.33% had the
chronicity between 0 2 yrs, 33.33% had between 2 4 yrs, 3.33% had between 8
10 yrs.

Table No 35: Chronicity wise Distribution of 30 Patients of Janu Sandhivata
No. of patients Sl. No. Chronicity
A B
Total %
1 0 2 yrs 11 8 19 63.33
2 2 4 yrs 6 4 10 33.33
3 4 6 yrs 0 0 00 00
4 6 8 yrs 0 0 00 00
5 8 10 yrs 0 1 01 3.33

Graph No 26: Chronicity wise Distribution of 30 Patients of Janu Sandhivata

RESULTS

101

RESULTS
The basis for the assessment of the results was the response shown by the
patient on signs and symptoms of the Janu Sandhigatvata. For the assessment of
effect of treatment, subjective and objective parameters were considered such as
Sandhi Shoola (Pain), Sandhi Graha (Stiffness), Aakruti (Gait), Tenderness,
Shotha(Swelling),Aatopa(Crepitus) & Range Of Movement. Both the individual effect
(using paired t test)and the comparative effect of procedures (using t test) in
subjective and objective parameters on 7
th
14
th
and 22
nd
day in Group A and Group B
were computed. Finally the overall effect of the treatment and also the comparative
effect of treatment between Group A and Group B were computed.
TABLE NO 36- EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS
AND SYMPTOMS ON 15 PATIENTS IN GROUP A AT

As per the table above for the complaint Pain thet value is t=8.088; P<0.001, where
it is found to be statistically highly significant.

In the above table the t value for Stiffness is t=6.859, where it is found to be
statistically highly significant with P<0.001.

Thet value for the symptom Gait is t=9.539, and it is found to be statistically highly
significant with P<0.001, as per the above table.

As per the table above for the complaint Tenderness thet value is t=3.873; P=0.002,
where it is found to be statistically significant.

In the above table the t value for Swelling is t=4.583, where it is found to be

MEAN
SIGNS &
SYMPTOMS
BT AT
(%) SD SE
t
VALUE
P
VALUE
PAIN
3.067 1.267 59 0.862 0.223 t =8.088 P =<0.001
STIFFNESS
2.000 0.867 57 0.640 0.165 t =6.859 P =<0.001
GAIT
1.133 0.267 76 0.352 0.0909 t =9.539 P =<0.001
TENDERNESS
1.933 0.933 52 1.000 0.258 t =3.873 P =0.002
SWELLING
1.000 0.400 60 0.507 0.131 t =4.583 P =<0.001
CREPITUS
1.133 0.533 53 0.632 0.163 t =3.674 P =0.003
RANGE OF
MOVEMENT
1.267 0.667 47 0.632 0.163 t =3.674 P =0.003
RESULTS

102

Thet value for the symptom Crepitus is t=3.674, and it is found to be statistically
significant with P=0.003, as per the above table.

As per the table above for the Range of movement thet value is t=3.674; P=0.003,

TABLE NO 37: EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS
AND SYMPTOMS OF 15 PATIENTS IN GROUP A ON 14
TH
DAY.
There is highly significant change statistically in all the signs and symptoms. All the
signs and symptoms have P =<0.001, and respectivet as shown in table above.

TABLE NO 38: EFFECT OF JANU BASTI WITH MURIVENNA IN SIGNS
AND SYMPTOMS OF 15 PATIENTS OF GROUP A ON 22
ND
DAY.

There is highly significant change statistically in all the signs and symptoms. All the
signs and symptoms have P =<0.001, as shown in table above.

MEAN
SIGNS &
SYMPTOMS
BT 14
TH
DAY
(%) SD SE
t
VALUE
P
VALUE
PAIN 3.067 0.467 85 0.632 0.163 t =15.922 P =<0.001
STIFFNESS 2.000 0.333 83 0.488 0.126 t =13.229 P =<0.001
GAIT 1.133 0.200 82 0.258 0.0667 t =14.000 P =<0.001
TENDERNESS 1.933 0.400 79 0.834 0.215 t =7.122 P =<0.001
SWELLING 1.000 0.133 87 0.352 0.0909 t =9.539 P =<0.001
CREPITUS 1.133 0.400 65 0.594 0.153 t =4.785 P =<0.001
RANGE OF
MOVEMENT 1.267 0.333 74 0.594 0.153 t =6.089 P =<0.001

MEAN
SIGNS &
SYMPTOMS
BT 22
ND
DAY
(%) SD SE
t
VALUE
P
VALUE
PAIN 3.067 0.267 91 0.414 0.107 t =26.192 P =<0.001
STIFFNESS 2.000 0.133 93 0.352 0.0909 t =20.546 P =<0.001
GAIT 1.133 0.133 88 0.000 0.000 t =+inf P =<0.001
TENDERNESS 1.933 0.200 90 0.704 0.182 t =9.539 P =<0.001
SWELLING 1.000 0.000 100 0.000 0.000 t =+inf P =<0.001
CREPITUS 1.133 0.200 82 0.594 0.153 t =6.089 P =<0.001
RANGE OF
MOVEMENT 1.267 0.133 89 0.516 0.133 t =8.500 P =<0.001
RESULTS

103

TABLE NO 39- EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS
AND SYMPTOMS OF 15 PATIENTS IN GROUP B AT

MEAN SIGNS &
SYMPTOMS BT AT (%) SD SE
t
VALUE
P
VALUE
PAIN 2.667 1.467 45 0.676 0.175 t =6.874 P =<0.001
STIFFNESS 2.000 1.067 47 0.704 0.182 t =5.137 P =<0.001
GAIT 1.067 1.000 06 0.258 0.0667 t =1.000 P =0.334
TENDERNESS 2.067 1.133 45 0.594 0.153 t =6.089 P =<0.001
SWELLING 0.733 0.400 45 0.488 0.126 t =2.646 P =0.019
CREPITUS 1.333 0.600 55 0.458 0.118 t =6.205 P =<0.001
RANGE OF
MOVEMENT 1.200 0.733 39 0.516 0.133 t =3.500

As per the table above for the complaint Pain thet value is t=6.874; P<0.001, where
it is found to be statistically highly significant.

In the above table thet value for Stiffness is t=5.137, where it is found to be

Thet value for the symptom Gait is t=1.000, and it is found to be statistically
insignificant with P=0.334, as per the above table.

As per the table above for the complaint Tenderness thet value is t=6.089; P<0.001,
where it is found to be statistically highly significant.

In the above table thet value for Swelling is t=2.646, where it is found to be
statistically significant with P=0.019.

Thet value for the symptom Crepitus is t=6.205, and it is found to be statistically
highly significant with P<0.001, as per the above table.

As per the table above for the Range of movement thet value is t=3.500; P=0.004,

P =0.004
RESULTS

104

TABLE NO 40: EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS
AND SYMPTOMS OF 15 PATIENTS OF GROUP B ON 14
TH
DAY.

MEAN
SIGNS &
SYMPTOMS BT
14
TH

DAY (%) SD SE
t
VALUE
P
VALUE
P =<
0.001 PAIN 2.667 1.200 55 0.640 0.165 t =8.876
P =<
0.001 STIFFNESS 2.000 1.000 50 0.655 0.169 t =5.916
GAIT 1.067 0.933 12 0.352 0.0909 t =1.468 P =0.164
P =<
0.001 TENDERNESS 2.067 0.933 55 0.640 0.165 t =6.859
SWELLING 0.733 0.333 55 0.507 0.131 t =3.055 P =0.009
P =<
0.001 CREPITUS 1.333 0.600 55 0.458 0.118 t =6.205
RANGE OF
MOVEMENT 1.200 0.733 39 0.516 0.133 t =3.500 P =0.004

There is highly significant statistical changes in most of the signs and symptoms with
(P =<0.001) except for Gait (P =0.164) which is statistically insignificant, whereas
swelling (P=0.009) & Range of movement (P=0.004) are statistically significant, as
shown in the table above.

TABLE NO 41: EFFECT OF JANU PICHU WITH MURIVENNA IN SIGNS
AND SYMPTOMS OF 15 PATIENTS OF GROUP B ON 22
ND
DAY.
MEAN SIGNS &
SYMPTOMS BT 22
ND
DAY (%) SD SE
t
VALUE
P
VALUE
PAIN 2.667 0.800 70 0.834 0.215 t =8.671 P=<0.001
STIFFNESS 2.000 0.867 57 0.743 0.192 t =5.906 P=<0.001
GAIT 1.067 0.933 12 0.352 0.0909 t =1.468 P =0.164
TENDERNESS 2.067 0.733 64 0.816 0.211 t =6.325 P =<0.001
SWELLING 1.000 0.267 73 0.458 0.118 t =6.205 p=<0.001
CREPITUS 1.333 0.533 60 0.640 0.165 t =4.583 P=<0.001
RANGE OF
MOVEMENT 1.267 0.667 47 0.632 0.163 t =3.674

There is highly significant statistical changes in most of the signs and symptoms with
(P =<0.001) except for Gait (P =0.164) statistically insignificant and Range of
movement (P=0.003) which is statistically significant as per the above table.
P =0.003
RESULTS

105

COMPARITIVE EFFECT OF PROCEDURES IN SIGNS AND SYMPTOMS
OF GROUP A & GROUP B

The comparative percentage relief in various signs and symptoms of Group A
and Group B after treatment is as shown in the Table No.33 and Graph No.3

TABLE NO 42: COMPARITIVE EFFECT OF PROCEDURES IN SIGNS AND
SYMPTOMS OF PATIENTS IN GROUP A & GROUP B

MEAN DIFFERENCE
STANDARD
DEVIATION SIGNS &
SYMPTOMS
Group -A Group B
Group -
A
Group -
B
t value p value
PAIN 1.800 1.200 0.862 0.676 2.121 0.043
STIFFNESS 1.133 0.933 0.640 0.704 1.616 0.117
GAIT 0.867 0.0667 0.352 0.258 7.102 <0.001
TENDERNESS 1.000 0.933 1.000 0.594 0.223 0.825
SWELLING 0.600 0.333 0.507 0.488 1.470 0.153
CREPITUS 0.600 0.733 0.632 0.458 -0.660 0.515
RANGE OF
MOVEMENT
0.600 0.467 0.632 0.516 0.631

The mean difference of pain in group A (1.800) is greater than (1.200) in group B,
with a statistically significant change with p =0.043.

The mean difference of stiffness in group A (1.330) is less than (0.933) in group B,
with a statistically insignificant change with p =0.117.

The mean difference of Gait in group A (0.867) is greater than (0.0667) in group B,
with a statistically significant change with p <0.001.

The mean difference of Tenderness in group A (1.000) is greater than (0.933) in group
B, with a statistically insignificant change with p =0.825.

The mean difference of Swelling in group A (0.600) is greater than (0.333) in group
B, with a statistically insignificant change with p =0.153.

The mean difference of Crepitus in group A (0.600) is less than (0.733) in group B,
with a statistically insignificant change with p =0.515.

The mean difference of Range of movement in group A (0.600) is greater than (0.467)
in group B, with a statistically insignificant change with p =0.533.

0.533
RESULTS

106

TABLE NO 43: COMPARITIVE EFFFECT OF PROCEDURES IN
PERCENTAGE RELIEF AFTER TREATMENT

% RELIEF GROUP
A

% RELIEF GROUP
B

Signs and
symptoms
7
th
DAY 7
th
DAY
PAIN
59 45
STIFFNESS

57
47
GAIT

76
06
TENDERNESS

52
45
SWELLING

60
45
CREPITUS

53
55
RANGE OF
MOVEMENT

47 39

GRAPH NO 27: COMPARITIVE EFFECT OF PROCEDURES ON SIGNS
AND SYMPTOMS EXPRESSED IN PERCENTAGE AFTER TREATMENT

RESULTS

107

TABLE NO 44: COMPARITIVE EFFFECT OF PROCEDURES IN
PERCENTAGE RELIEF ON 7
TH
, 14
TH
& 22
ND
DAY

The percentage relief in Group A & Group B on 7
th
, 14
th
and 22
nd
day on each of the
assessment criteria is shown below as in the table.

% RELIEF GROUP A

% RELIEF GROUP B

Signs and symptoms
7th 14
th
22nd 7th 14th 22nd
PAIN
59
85 91 45 55 70
STIFNESS

57
83 93 47 50 57
GAIT

76
82 88 06 12 12
TENDERNESS

52
79 90 45 55 64
SWELLING

60
87 100 45 55 73
CREPITUS

53
65 82 55 55 60
RANGE OF MOVEMENT

47
74 89 39 39 47

RESULTS

108

GRAPH NO 28: COMPARITIVE EFFFECT OF PROCEDURES IN PERCENTAGE
RELIEF ON 7
TH
, 14
TH
& 22
ND
DAY

Group A

59%
57%
75%
50%
60% 60%
47%
85%
83%
81%
79%
87%
65%
74%
91%
93%
87%
89%
100%
82%
89%
0%
20%
40%
60%
80%
100%
120%
7thday
14thday
22ndday

Group B

45%
47%
6%
45% 45%
55%
39%
55%
50%
12%
55% 55%
55%
39%
70%
57%
12%
64% 64%
60%
44%
0%
10%
20%
30%
40%
50%
60%
70%
80%
7thday
14thday
22ndday

RESULTS

109

OVERALL EFFECT OF THE TREATMENT
The effect of the treatment is classified into four as mentioned in the chapter
Clinical Study. Out of 30 patients, 2 (06.6 %) got 100 % relief, 03 (10 %) got more
than 90 % relief, 22 (73.4 %) got moderate relief between 60 % and 90 % & 3
(10%) got partially improved results which is shown in Table No.34 and Graph No.4

TABLE NO 45: OVERALL EFFECT OF THE TREATMENT
Effect of Therapy Group A Group B Total (%)
Complete Remission ( 100 % Relief) 02 00 02 06.6
Markedly Improved ( >90 % Relief) 03 00 03 10.0
Moderately Improved ( 60-90 % Relief) 09 13 22 73.4
Partially Improved ( 30-60 % Relief) 01 02 03 10.0
No Change ( <30 % Relief) 00 00 00 00.0

GRAPH NO 29: OVERALL EFFECT OF THE TREATMENT

RESULTS

110

COMPARITIVE EFFECT OF THE TREATMENT
In Group A, 2 patients (13.4 %) got 100 % relief & 3 patients (20 %) got more
than 90 % relief and in Group B, no patients got more than 90 % or 100% relief. 9
patients (60 %) of Group A, got relief in between 60-90 % and whereas 13 ( 87%)
patients of Group B got relief in between 60-90 % as shown in Table No.35 and
Graph No.5
TABLE NO 46: COMPARITIVE EFFECT OF THE TREATMENT
Effect of Therapy Group A (%) Group B (%)
Complete Remission (100 % Relief) 02 13.4 00 00.0
Markedly Improved (>90 % Relief) 03 20.0 00 00.0
Moderately Improved (60-90 % Relief) 09 60.0 13 87.0
Partially Improved (30-60 % Relief) 01 06.6 02 13.0
No Change (<30 % Relief) 00 00.0 00 00.0

GRAPH NO 30: COMPARITIVE EFFECT OF THE TREATMENT

DISCUSSION

111

DISCUSSION

Vata prime among the Tridosha plays a very important role in the formation of
all Vyadhis. It is the one which is responsible for the movement of other two Doshas
all over the body. Vata due to its Chala Guna moves all over the body. The movement
or Gati of individual component of Vata has to be analyzed properly. The word Gata
or Gatatva has two implications one subjected to activities and second subjected to
abode of activities. In case of Gatatva the aggravated Vata finds a suitable place for its
lodgment. Those will be such as Dhatu, Upadhatu, Ashaya, and Avayava. Due to Vata
Vardhaka Ahara, Vihara, and Manasika Nidanas the aggravated Vata while moving
throughout the body lodges in Khavaigunya Yukta Srotas. After getting lodged at
those parts it impairs the functions of particular structure and produces disease.

In Ayurveda Sandhi is described as the conjoininig place where two or more
structures unite together. In the context of J anu SandhigataVata, J anu Sandhi can be
understood as conjoining place of two or more bones along with other structures
which combine together to form a Sandhi such as Asthi, Snayu and Peshi. These are
different structures, which helps in maintaining the stability of the joint. Snayu helps
in proper binding of the joint. They unite the bones and help to direct the bone
movement and prevent the excessive and undesirable motion. Peshi helps to maintain
the alignment of the joint. Shleshaka Kapha, provides the lubricant factor &, nutrition
thereby keeping the joint firmly united. Shleshmadharakala situated in the joints
supported by Shleshaka Kapha helps in normal movement.

The Samprapti of Sandhi-Gata-Vata may be divided into Dhatukshaya J anya and
Avarana J anya. Even the contemporary science explains the pathology in two settings.
One is due to the sub standard biomaterial of the joint (Dhatukshaya). Second is due
to increased applied pressure over the joint (Avarana). In Dhatukshya J anya Sandhi-
Gata-Vata due to old age, Vatakara Ahara Vihara there will be qualitative change in
the joint material gradually leading to disease manifestation. The other set of
Samprapti where in due to continuous pressure due to obesity the joint may get
DISCUSSION

112
affected (Due to Avarana) leading to disease manifestation. This demarcation in
Samprapti helps in planning the treatment.

We can find the description of Sandhigatavata in all Samhita and Sangraha Granthas
under the concept of Vata Vyadhi and when the involved Sandhi is J anu Sandhi it can
be called as J anu Sandhigatavata. In Vriddhavastha the Dhatukshya that takes place
leads to Vata Prakopa. Vata and Asthi have Ashraya-Ashrayi Sambandha which
means Vata takes shelter in Asthi. Vriddha Vata reduces the Snehamsha or
Snigdhatva from J anu Sandhi by its nature of opposite qualities to Sneha. Due to
diminution of Sneha, Khavaigunya occurs in Asthi and the Sandhi, which is
responsible for the production of Sandhivata.

Acharyas have described the Lakshanas of SandhiVata as Sandhi Shula, Sandhi
Shotha, Atopa, Prasarana Akunchana Pravrutti Vedana and Hanti Sandhi. Sandhi
Shula and Sandhi Shotha are direct features of Vata Prakopa. Vata Purna Driti
Sparsha is the type of shotha mentioned which indicates Vata dominant Shotha which
feels like air filled leather bag. Prasarana Akunchana Vedana and Hanti Sandhi occur
due to Kaphakshaya and Vata Prakopa. In the Samprapti of Sandhigatavata, Prakupita
Vata takes shelter in Sandhi where Khavaigunya and Rikta Srotas is already present.
Then Dosha Dushya Sammurcchana takes place in Sandhi and the disease Sandhivata
appears with its symptoms.

Sandhigatavata is a Kashta Sadhya Vyadhi alike all the Vata Vyadhis which are
difficult to cure. They are considered one among the Mahagadas too. Also factors like
Madhyama Rogamarga involving Marma, Asthi, Sandhi, along with vitiation of Asthi
and Majja, associated with Dhatukshaya and the incidence in Vriddhavastha precipite
the Kashta Sadhyatva of Vyadhi.

In the Chikista aspect Acharyas have commonly mentioned the use of Snehana and
Svedana for the treatment of Vata Vyadhi. Individually considering the treatment
principles explained by Acharyas, Charaka has not mentioned the treatment of
Sandhigatavata separately, instead he explains common treatment principle for
Vatavyadhi such as Snehana and Svedana Basti and Mrudu Virechana. Where as
DISCUSSION

113
Acharya Sushruta has described specific treatment for the Sandhigatavata first time
i.e, Snehana, Upanaha, Agnikarma, Bandhana and Unmardana.

J anusandhigata Vata being a Vata Vyadhi with Dhatukshaya as its resultant,
Snehana and Svedana would be an ideal line of treatment. In the parallel sciences
treatment is mainly aimed at Nonpharmacological methods and analgesics. Among
Nonpharmacological treatment physical heat therapy is given importance. J anu
Sandhi-Gata-Vata is characterized by joint pain, stiffness, swelling and crepitus. The
heat applied to the joint helps in combating many of the symptoms. In present clinical
study, J anu-Basti & J anu Pichu may act both as Snehana and Svedana. Since in this
disease degeneration is predominant, with Vata Dosha predomonance, Kshaya of
Snehadi Guna is seen, Snehana would be an ideal line of management. Snehana also
helps in bringing back the sthanika Kapha Dosha to normalcy due to its similarities in
Gunas.

Keeping an eye on this ideology the present study was planned in which Murivenna
was used in the form of J anu Basti & J anu Pichu. They act as Snehana due to presence
of the Snehamsha in Murivenna and Svedana due to the presence of heat during the
procedure. It was a comparative clinical study with two equal groups of 15 patients
each. Group A was administered J anu Basti with Murivenna for 45 minutes a day for
7 days and Group B was administered J anu Pichu with Murivenna for 45 minutes a
day for 7 days.

DISCUSSION ON OBSERVATIONS

The observations related to the various aspects of 30 patients of J anu Sandhivata are
discussed below under different headings.

Age: The eligibility criteria of age group for this study were between 30 and 70 years.
Majority of the patients belonged to the age group of 5160 years (43.34%), followed
by 61 70 years (23.33%), 41 50 yrs (23.33%), 31 40 yrs (10%) .
After a person attains the age of 50 years, the Hanti Avastha starts and as the age
progresses there will be natural process of degeneration of Shareera Bala and Dhatu,
DISCUSSION

114
which provoke Vata and also reduces J atharagni and Dhatvagni. Pre menopausal stage
contributes in the degenerative process of females. The degenerative process in the
males also starts at the age of 50 years.

Sex: Among the 30 patients of J anu Sandhivata, majority of them are were females
(66.66%) and remaining were males (33.33%). Even the universal data says the
prevalence of osteoarthritis is more in elderly women. In females, menopause
contributes the degenerative changes. Even in males the degenerative process starts
from the age of 50 years.

Occupation: Among the 30 patients taken for this study, majority of them were
housewives (33.3%) and manual labor (33.3%) followed by businessmen (13.3%) and
office workers (3%) and remaining others (16.66%).
As housewives and labor class individuals will be having a much intensified physical
exertion which inturn aggrevate the Vata dosha and resulting in J anu Sandhigatavata.

Religion: The religion wise distribution of the patients was a projection of
geographical predominance of Hindu community in the selected area of study. Hence
the cases reported were belonging to the Hindu community (50%) followed by
Muslims (46.66%) and Christians (3%).

Socio-Economical Status: The patients visiting the hospital mainly belong to middle
and lower middle class socio-economical status. Among the total patients majority
were from middle and lower middle class (40% each) followed by upper middle class
and poor class (10% each).

Marital status: As the degenerative changes takes place in the older population
majority of patients in this study belonged to married group (90%) and very few of
about belonged to unmarried group (10 %) even though were above 30 years.

Habitat: as the degenerative changes are more common in working as well as older
population, both the rural and urban people share almost the equal incidence of the
DISCUSSION

115
pathology. In the present study its found that sub urban patients are more (43.33%)
followed by rural patients (33.33%) and urban (23.33%).

Education: Most of the patients visiting the hospital usually belonged to rural area.
Among the 30 patients of J anu Sandhivata majority of them had the education upto
10
th
std. (36.66%), followed by patients who studied above 10
th
std. (20%), up to
graduation (16.66%), up to 7th std (13.33%), up to 5
th
std (6.66%) and illiterates
(6.66%).

Prakruti: Among the30 patients of J anu Sandhivata majority of the patients were of
Vata Pittaja Prakruti (53.33%) followed by Vata Kaphaja Prakruti (23.33%), Pitta
Kaphaja Prakruti (13.33%), Pitta Vataja Prakruti (6.66%), and KaphaVataja Prakruti
(3%) . The study showed majority of patients who suffered from J anu Sandhigatavata
had the dominance of Vata and Pitta Dosha.

Sara: Out of 30 patients of J anu Sandhivata majority of the patients were of Tvak
Sara (36.66%) followed by Rakta Sara (23.33%), Mamsa Sara (20%) Meda Sara
(10%), and Asthi Sara (10%). The study showed that the greater part of patients
suffered from J anu Sandhigatavata was of Twak and Rakta Sara.

Satwa: Among the 30 patients of J anu Sandhivata major subjects were found to be
having Madhyama Satwa(63.33%), followed by Pravara Satwa(20%) and Avara
satwa(16.66%). The study showed that most of the patients with J anu Sandhigata vata
are having Madhyama Satwa.

Samhanana: Amongst the 30 subjects of J anu Sandhivata , Madhyama Samhanana
(66.66%), followed by Pravara Samhanana (20%) and Avara Samhanana (13.33%)
were found. The present observation tells that most of the patients with J anu
Sandhigata vata are having Madhyama Samhanana.

Saatmya : Out of 30 patients of J anu Sandhivata , its found that majority of them
were Madhyama Saatmya (70%), followed by Pravara Saatmya (20%) and Avara
Saatmya (10%). In the present study most of the patients with J anu Sandhigata vata
are known to be Madhyama Saatmya.
DISCUSSION

116

Dietary Habits: Among the 30 patients of J anu Sandhivata, majority was having a
mixed kind (66.6%) of dietary habits and rest were Vegetarians (33.33%). As per the
present study it shows that J anu Sandhigata Vata is more prevalent in people having
mixed dietary regimen.

Vyasana : Majority of 63.33% had no addiction in comparison to 20% who were
addicted to tobacco chewing,13.33% were addicted to smoking . As per the present
study majority of patients of J anu Sandhigata Vata doesnt have any kind of
addictions.

Aahara Abhyavaharana Shakti:
66.66% had Madyama- Abhyavaharana Shakti, 13.33% were Avara and 20% had
Pravara- Abhyavaharana Shakti. As per the present study most of the patients of J anu
Sandhigata Vata are having Madhyama abhyavaharana Shakti.

Aahara-Jarana shakti : 63.33% had Madyama- J arana Shakti, 30% Pravara and
6.66% had avara- J arana Shakti.

Agni: Among 30 patients of J anu Sandhivata 50% had Samagni, 23.33% had
Mandagni or Vishamagni and 3.33% patients suffered from Teekshnagni

Koshtha: among 30 patients of J anu Sandhivata 53.33% had Madhyama Koshta and
46.66% had Krura Koshta.

Vihara: A maximum of 33.33% of patients were doing manual work & labour
each,13.33% had sedentary nature of work, &10% were travelling.

Vyaayama Shakti: 56.66% had Madyama Vyaayama Sakti and 43.33% had Avara
Vyaayama Sakti.

Nidra Sheela: 63.33% had disturbed sleep whereas only 36.66% had sound sleep.

DISCUSSION

117
Nidana (Ahara): among 30 patients of J anu Sandhivata 53.33% of them did
Atyupayoga of Katu Rasa, 23.33% of them did Alpa Bhojana, and again 23.33% of
them did Rooksha Bhojana.

Nidana (Vihara): among 30 patients of J anu Sandhivata 63.33% did Ratri J agarana
and 33.33% did Ati Vyayama.

Nidana (Manasika): among 30 patients of J anu Sandhivata 20% of patients had Ati
Bhaya, 3.33% had Ati Shoka and 76.66% of them had Ati Chinta

Chronicity: among 30 patients of J anu Sandhivata 63.33% had the chronicity
between 0 2 yrs, 33.33% had between 2 4 yrs, and 3.33% had between 8 10 yrs.

DISCUSSION ON CLINICAL STUDY

Discussion about Clinical study:
The study was carried out in Patients of J anu Sandhigatavata in two groups of
which Group A received J anu Basti & Group B received J anu Pichu for a period of 45
minutes for 7days each.
Total of 34 patients complaining of J anu Sandhigatavata were registered in the
study, of which 30 patient completed the study (15 in each group). The details are as
follows.
Total patients registered in the study - 34
Patients who received J anu Basti -15
Patients who received J anu Pichu -15
Completed -30
Total Attrition -03
Attrition in Group A -01
Attrition in Group B -03

DISCUSSION

118
Out of the three drop outs, one person could not attend the J anu Basti from 5
th
day due
to personal inconvenience, and 2 patients in J anu Pichu group were considered as
drop out, as they didnt attend during the follow up period.
Discussion on Janu Basti
From the present study follow things could be analysed:

1. Quantity of the oil
2. Quantity of Masha
3. Height of the J anu Basti pit
4. Temperature of the oil
5. Duration

1. Quantity of the oil:
During the study it was observed that minimum 100-150ml of oil was
needed J anu Basti for 3 days again fresh oil was used for remaining 4
days. On an average 300 - 400ml of oil is required per patient during the
procedure for 7 days.

2. Quantity of the Masha:
During the study it was observed that minimum 400gm- 500 gm of Masha
was needed for J anu Basti for 3 days again fresh Masha was used for
remaining 4 days. On an average 1 kg of Masha is required per patient
during the procedure for 7 days

3. Height of the J anu Basti pit:
During the study it was observed that, the height of the J anu Basti pit
constructed was on an average of 3 4 inches.
3. Temperature of the oil:
From the present study, it was observed that, most of the patients were
able to tolerate only luke warm temperature of the oil (40-45
0
C).

DISCUSSION

119
4. Duration:
In the present study the duration of procedure was fixed to 45 minutes. A
range of minimum of 45 minutes and maximum of 1hr may be considered
as ideal depending upon the patients ability to maintain the posture for
given duration of treatment.

Discussion on Janu Pichu
The following factors were observed during the study:
2. Size of Pichu
3. Duration of the procedure


From the present study, it was observed that the quantity of the oil needed was
50 - 60ml per day and for 3 days and fresh oil was used from 4
th
day till 7
th

day. On an average 150 -200 ml of oil was needed for 7 days.
2. Size of Pichu

In the present study the size of Pichu depended upon the size of knee joint of
the patient. On an average the size of pichu accounted from 3* 3 inches to 4*4
inches.
3. Duration of the procedure

In the present study the duration of procedure was fixed to 45 mins. It was
observed that some patients were showing the willingness to maintain the J anu
Pichu for a longer duration. Even though it varied from patients to patients, on
an average it may be considered as ideal from 45 mins 1hr.

DISCUSSION

120

EFFECT OF THERAPY

The external Snehana and Svedana therapies are extensively practiced in
Sandhigatavata. The present clinical study has been conducted to evaluate the efficacy
of Murivenna Taila in the form of J anu Basti and J anu Pichu in J anu Sandhigata
Vata. The effect of therapy is being discussed here along with its efficacy on
individual signs and symptoms of J anu Sandhigata vata.

Effect of Therapy on Pain: In this study the mean score of pain was reduced from
3.067 to 1.267 and 2.667 to 1.467 after the course of seven days of J anu Basti and
J anu Pichu respectively. The percentage of relief was 59% and 45% which was highly
significant statistically at P value <0.001.
Murivenna has Vata Shamaka property. It has the Gunas of the drugs involved are
that help in the Shamana of aggravated Vata and, due to the Shamana of Vata which
is the prime reason for shoola, it will be subsided.

Effect of Therapy on Stiffness: The mean score of Stiffness was reduced from
J anu Pichu respectively. The percentage of relief was 57% and 47% which was highly
statistically significant at P value <0.001.
The joint stiffness is due to the Rooksha & Sheeta Guna of Vata, which in turn causes
the Kharatwa of Mamsa, Snayu, Kandara of Asthi leading to stiffness. It is reduced by
Ushna Veerya of the Aushadhas and the warmth produced during the procedure.
When the Rooksha & Sheeta Guna is subsided the stiffness is also reduced. Similarly
as explained by Acharyas one among the effects of swedana is Sthambha Nigraha.

Effect of therapy on Gait: The mean score of Gait was reduced from 1.133 to 0.267
and 1.067 to 1.000 after the course of seven days of J anu Basti and J anu Pichu
respectively. The percentage of relief was 49.62% which is highly significant at P
value <0.001.
Gait is a factor that is mainly dependant on the pain and stiffness as there was very
much relief in the pain and stiffness during the procedure, gait was also improved.
DISCUSSION

121

Effect of Therapy on Tenderness: The mean score of Tenderness was reduced from
J anu Pichu respectively. The percentage of relief was 52% and 45% which were
significant at P value =0.002 and highly significant at P value <0.001.
Murivenna has Vata Shamaka property. It has the Gunas of the drugs involved which
are vedana shamaka in nature. They help in the Shamana of aggravated Vata .Due to
the Shamana of Vata which is the prime reason for tenderness, it will be subsided.

Effect of Therapy on Swelling: The mean score of swelling was reduced from 1.000
to 0.400 and 0.733 to 0.400 after the course of seven days of J anu Basti and J anu
Pichu respectively. The percentage of relief was 60% and 45% which was highly
significant at P value <0.001 in Group A and significant at P value 0.019 in
GroupB
Murivenna is Shothahara and by virtue of its property 6 drugs in Murivenna with
Ushna Veerya - pacify Vata, promote circulation and have soshana property -
reducing swelling it drains the Sanchita Kleda from the affected part. Even the heat
applied to the affected part increases the circulation thus helping in reducing swelling.
The procedures also increase the local circulation and helps in reducing the localized
swelling.

Effect of Therapy on Crepitus: Themean score of crepitus reduced from 1.133 to
0.533 and 1.333 to 0.600 after the course of seven days of J anu Basti and J anu Pichu
respectively. The percentage of relief was 53% and 55% with P=0.003 and P<0.001,
of both which were statistically significant.
There could have been probably soft tissue changes due to the procedural effects
induced by both J anu Basti & J anu Pichu with Murivenna which has Snigdha property
that would have led to the reduction in crepitus or Atopa which is caused due to the
Rooksha Guna of vata.

Effect of Therapy on Range of Movement: The mean score of Range of movement
was reduced from 1.267 to 0.667 and 1.200 to 0.733 after the course of seven days of
J anu Basti and J anu Pichu respectively. The percentage of relief was 47% and 39%
DISCUSSION

122
which was highly significant at P value =0.003 in Group A and significant at P
value =0.004 in Group B.
The coordinated activity of muscles and joint structures helps in the flexion and
extension of knee joint. The therapy reduces pain, swelling and stiffness and thus
helps in facilitating the flexion and extension of the joint, thereby increasing the
Range of movement in the joints.

Overall Effect of Therapy: Consideration of overall effect of therapy showed
that among the 30 patients of J anu Sandhgataivata, 2 (06.6 %) got 100 % relief, 03
(10 %) got more than 90 % relief, 22 ( 73.4 %) got moderate relief between 60 % and
90 % & 3 (10%) got partially improved results.

Comparative Effect Of Therapy: In Group A, 2 patients (13.4 %) got 100 %
relief (complete remission) & 3 patients (20 %) got more than 90 % relief (marked
improvement). whereas in Group B, no patients got more than 90 % or 100% relief. 9
patients (60 %) among Group A, got relief in between 60-90 % (moderate
improvement) and whereas 13 ( 87%) patients of Group B got relief in between 60-
90 %,. Also 1 among the 30 patients (6.6%) got partial improvement ie; between 30-
60% in Group A & 2 among Group B showed the same at (13%).

Probable Mode of Action of Janu Basti & Janu Pichu: J anu Basti & J anu Pichu
are procedures evolved from Shiro Basti & Shiro Pichu. It is a kind of Bahya Snehana
and Svedana procedure. Snehana mainly acts against the Rooksha Guna caused by
Vata and Swedana mainly acts against the Sheeta Guna. It also reduces the Stambha
and Gauravata.

Sushruta explains that out of four Tiryak Dhamani, each Dhamani divides into
hundred and thousand times and become innumerable. These Dhamani form a
network and spread all over body. They have their openings in the Loma Koopa. The
Dravya applied over the skin is absorbed through these openings and undergo
Pachana by the help of Bhrajaka Pitta which is situated in the skin. The Dravya can be
applied in various forms such as Abhyanga, Parisheka, Avagaha etc. All the drugs
applied in any of these forms undergo Pachana in the way explained above.
DISCUSSION

123

Vagbhata explained the same mode of absorption of the drugs applied over the skin.
Thus by above references it can be said the Dravya used in J anu Basti & J anu Pichu is
absorbed through skin and produce an action according to the properties of drug.

The Vata Dosha, which is the key factor in the causation of J anu Sandhivata, has
almost opposite quality of Murivenna. Moreover Murivenna has similar property to
that of Kapha Dosha. In J anu Sandhivata Sthanika Kapha Kshaya is due to Agantu
Vata Dosha. Thus on one hand Murivenna neutralizes the Vata Dosha and on the
other hand nourishes the Sthanika Kapha Dosha. This helps in Samprapti Vighatana.

Shoola is one among the features of J anu Sandhigatavata which is almost present in
all the patients. The properties of Murivenna such as Snigdha, Guru, Ushna are totally
opposite to the properties of Vata. Thus these properties of Murivenna acts against
Vata and help in subsiding the Shoola. J oint stiffness or Stabdhata is also a feature in
J anu Sandhigatavata which is caused by the Rooksha, Sheeta Guna of Vata. The heat
applied through the retention of Murivenna during the procedures and the Ushna
veerya of Murivenna along with its Snigdhatva tackle Sheeta, Rooksha Gunas and
reduce the stiffness of joint. The relief in the stiffness & pain of joint increase the
Sandhi Gati Samarthya and helps to increase the range of movement of knee joint.

Atopa is due to Vata Vriddhi and Sthanika Kapha Kshaya. This symptom is due to
Khara, Rooksha and Vishada properties of Vata. Snigdha, Picchila and Mrudhu
qualities of Sneha Dravya i.e., Murivenna opposite to the qualities of Vata and helps
in reducing the Atopa.

The Ushnata applied by the procedure and Ushna Veerya of drug do the Pachana of
the Dushya involved in the formation of Shotha. Due to this action the Shotha is
reduced.

Drug absorption: The principal fence for absorption of exogenous material through
the skin is stratum corneum. Pace of absorption is directly proportional to
concentration of drug in vehicle, partition co-efficient, diffusion co-efficient and
thickness of the stratum corneum. The physiological factors that effect per cutaneous
DISCUSSION

124
absorption include hydration, occlusion, age, intact versus disrupted skin, temperature
and anatomical site.

Among vehicles oils or greases are anhydrous preparations that are either water
insoluble or fatty. Fatty agents are more occlusive than water-soluble. They restrict
trans epidermal water loss and hence preserve hydration stratum corneum.

Absorption depends upon lipid solubility of the drug since the epidermis act as a lipid
barrier. The dermis however is freely permeable to many solutes. Suspending the drug
in an oily vehicle can enhance absorption through the skin. Because hydrated skin is
more permeable than dry skin.
It has been scientifically proven that vegetable oils act as permeation enhancers (US
Patent No- 5229130). Thus the Narikela Taila which is a vegetable oil, used as the
base for the preparation of the Murivenna, helps to increase the permeability of the
layer of the stratum corneum of the skin and in turn also increases the bioavailability
of the drugs.
Effect of Application of Heat: Application of medicaments, heat and massage
definitely helps in eliminating the number of noxious elements through skin
160
. The
application of heat in different forms of Svedana promotes local circulation and
metabolic activities and also opens the pores of the skin to permit transfer of
medicaments and nutrients towards to needed sites and elimination of vitiated Dosha
and Mala through skin and perspiration.

The application of heat on skin induces increased metabolic activity, increased
circulation and stimulation of the nerve endings on skin & tissues. It also has many
indirect effects in the body mechanism.

The metabolical activity is increased in the part where more heat is applied. This
increased metabolism creates demand for oxygen and nutrients. Also there is
increased output of waste products and metabolites. The output of waste products and
metabolites which act on the walls of the capillaries & arteries cause the dilation of
the vessels. Even the heat applied has direct effect on the blood vessels which cause
DISCUSSION

125
them to dilate and increase in the amount of blood circulation. The applied heat also
stimulates the nerve endings which causes reflux dilation in the arterioles. Due to all
these reason the blood circulation is increased and the active ingredients of the drug
are supplied to the target cells. Also there is elimination of waste products from the
localized area such as prostaglandins which play a vital role in pain pathology.

Probable Efficacy Of Janu Basti In Comparison With Janu Pichu : The probable
mode of action of J anu Basti and J anu Pichu can be ascertained on the base of
pharmacodynamics and pharmacotheraupetics which were mentioned above. But the
comparative advantage of J anu Basti over J anu Pichu can be hypothetically related to
the difference they posses in the procedure on the base of temperature, dermal contact
and pressure effects.

During the procedure of J anu Basti the temperature is constantly or better uniformly
maintained than J anu Pichu through out the procedure, as the lipid medium is directly
applied over the skin and retention of temperature is more by the oil in comparison to
the Pichu or Plotha used for the procedure of J anu Pichu. Also the dermal contact for
absorption is more in J anu Basti in comparison to J anu Pichu due to the direct
application of oil above skin. Analyzing the pressure difference which may also
influence the rate of absorption the oil applied through J anu Basti. The oil may exert
more pressure over skin due to the retention of oil media in larger volume which is
maintained as a column during the procedure of J anu Basti.

Due to the above quoted reasons it may be analysed that J anu Basti have shown
relatively more efficacy in comparison to J anu Pichu during the clinical study
apprehending Acharyas view on the priority given to Shiro Basti in comparison with
Shiro Pichu among Moordhini Tailas, which are the basic derivative procedures for
J anu Basti and J anu Pichu.
SUMMARY & CONCLUSION

126


The clinical study entitled A comparative study on J anu-Basti and J anu Pichu
with Murivenna in J anu-Sandhi-Gata-Vata is presented in six parts viz. Conceptual
Study, Disease Review, Drug Review, clinical Study, Discussion, Summary and
Conclusion.

First part designated as Conceptual Study at the outset, presents the historical
background of J anu-Sandhi-Gata-Vata, along with a brief account of the anatomy of
the structures involved in the joint such as J anu Sandhi, Knee joint, Tvak, and Skin
with illustrations followed by the description of procedure of J anu-Basti & J anu pichu
at the end.

The second part Disease Review includes Nidana Panchaka of disease J anu
Sandhivata along with Sapeksha Nidana, Sadhyaasadhyata and a brief description
about the treatment principles explained in classics along with Pathya Apathyas.

The yoga selected for this study was Murivenna which consisted of eight
drugs. The details of each of these eight drugs & its Pharmacodynamics along with
the details of the preparation of yoga and illustrations have been mentioned under the
heading of Drug Review, the third part

The section Clinical study starts with the description about the aims and
objectives of the study, selection of the patients, criteria for inclusion and exclusion,
research design and assessment criteria. Thereafter observations on demographical
data pertaining to 30 patients of J anu Sandhigatavata of this series on the base of each
group is analyzed and presented in the tabular & graphical form .Later results
obtained in this clinical study carried out on the 30 patients of J anu Sandhigatavata
with J anu Basti & J anu Pichu are depicted in tabular and graphical form along with
statistical analysis and brief comments on each data. The effect of treatment on each
signs and symptoms at various days of assessment, comparative & overall effects of
procedures are statistically analyzed and represented in tabular and graphical form.


127
.

The observations associated to the literary aspect and the clinical studies are discussed
in the fifth section entitled Discussion along with probable mode of action of
procedures and relative efficacy of J anu Basti in comparison to J anu Pichu. The
discussed matter is drawn into logical conclusions which are as follows:

Among 30 patients of J anu Sandhivata majority were of age group of 51 60 years
(43.34%), female sex (66.6%), housewives and manual labor by occupation (33.3%),
Hindu by religion (50%), middle and lower middle socio-economical class (40%
each), married (90%), adapted in sub urban (43.3%) and education within 10
th
std.
(36.66%).

Most of the patients were of Vata Pittja Prakruti (53.33%), Twak Sara (36.66%),
Madhyama Satva (63.33%), Madhyama samhanana (66.66%), Madhyama Saatmya
(70%), Mixed dietary habits (66.6%), No addictions (63.33%), Madhyama
Abhyavarana Shakti (66.66%), Madhyama J arana Shakti (63.33%), Samagni (50%),
Madhyama Koshtha (53.33%), Manual and Labor class (33.33%), Madhyama
Vyayama Shakti (56.66%), Disturbed sleep (63.33%).

Maximum patients had the chronicity of symptoms <2 years (63.33%).

Maximum patients suffering with J anu Sandhivata consumed excessive Katu Rasa
Ahara Sevana as Nidana (53.33%), Ratri J agarana (63.33%) , Manasika Nidana as Ati
Chinta (76.66%).

CLINICAL STUDY & RESPONSE TO TREATMENT

In this study the assessment of patients was done before treatment, 7
th

day, and 14th day and on 22
nd
day. All cardinal signs and symptoms were scored
according to the severity grade formulated. The clinical response of the procedures
was assessed on the basis of change in severity score after treatment. The cardinal
signs and symptoms evaluated were pain, stiffness, gait, tenderness, swelling,
crepitus,& range of movement.

128

Effect of Janu Basti with Murivenna: J anu Basti with Murivenna was done for 45
minutes for 7 days. It provided significant results statistically in pain (59%), joint
stiffness (57%), Gait (76%), Tenderness (52%), Swelling (60%), crepitus (53%) &
Range of movement (47%) on the 7
th
day. Also the results shown on on these signs
and symptoms were statistically significant on 14
th
and 22
nd
day.

Effect of Janu Pichu with Murivenna: J anu Pichu with Murivenna was done for 45
minutes for 7 days. It provided significant results in pain (45%), joint stiffness (47%),
Gait (06%), Tenderness (45%), Swelling (45%), crepitus (55%) & Range of
movement (39%). Other than gait all the symptoms proved to be statistically
significant on7th day, and along with gait on 14
th
& 22
nd
day.

Overall Effect of Procedures With Murivenna:
On the overall glance of study, it showed that among the 30 patients of J anu
Sandhigatavata 2 (06.6 %) got 100 % relief, 03 (10 %) got more than 90 % relief, 22
(73.4 %) got moderate relief between 60 % and 90 % & 3(10%) got partially
improved results.

Comparative Effect of Procedures with Murivenna:
In Group A, 2 patients (13.4 %) got 100 % relief (complete remission) & 3
patients (20 %) got more than 90 % relief (marked improvement). whereas in Group
B, no patients got more than 90 % or 100% relief. 9 patients (60 %) among Group A,
got relief in between 60-90 % (moderate improvement) and whereas 13 ( 87%)
patients of Group B got relief in between 60-90 %,. Also 1 among the 30 patients
(6.6%) got partial improvement ie; between 30-60% in Group A & 2 among Group B
showed the same at (13%). Statistically symptoms pain and gait showed significant
results on comparison between the groups, proving Group A with J anu Basti was
efficacious than Group B J anu Pichu with Murivenna in J anu Sandhigata Vata, both
on statistical and clinical basis.


129
Scope for further study:
Further studies with larger samples will be beneficial to authenticate the
results obtained in the present study.
A comparative study can be done to evaluate the effect of J anu Pichu and J anu
Parisheka.
A study can be done to find out the efficacy of different formulations prepared
out of Vata Hara drugs such as Nirgundi, Rasna, Dashamula etc as J anu Basti
& J anu Pichu.
Pharmaceutical and analytical chemistry study of the ingredients of Murivenna
for better understanding of the mode of action.

Limitations of study:
Limited period of study.
Small sample group

On the analysis of results, individual assessment of procedures proved statistically
significant results in most of the signs and symptoms of J anu Sandhigata Vata in both
the procedures. On comparison between the procedures it showed that J anu Basti with
Murivenna provided a better relief in the signs and symptoms of J anu Sandhigatavata
mainly in pain, stiffness, gait, tenderness, swelling, crepitus and range of movements
clinically, and on pain and gait statistically compared to J anu Pichu. Murivenna being
a Sneha, has Vata Hara property. J anu Basti with Murivenna acted both as Snehana
and Svedana, along with the combination of pharmacokinetics of the drugs it brought
better relief in the signs & symptoms of J anu Sandhigatavata. The procedural
differences that it possesses with J anu Pichu would have brought about a better result
on comparison between the procedures.

On the basis of above mentioned effects of J anu Basti, it can be concluded that J anu
Basti done with Murivenna for 45 minutes, for 7 days gives a significant amount of
relief in the signs & symptoms of J anu Sandhigatavata in comparison with J anu Pichu
done with Murivenna for 45 minutes, for 7 days. It can be adopted as a cost effective
simple treatment procedure on O.P.D basis too with no adverse reactions and better
results.
References & Bibliography
130
LIST OF REFERENCES

1. C.S.Chi. 28/37
2. Su.S.Ni.1/28,
3. A.S.Ni.15/14
4. Su.S.Chi.4/8
5. A.S.Su.25/16
6. C.S.Chi. 28/37
7. C.S/.Chi 28/37
8. C.S.Su. 14/39-40
9. C.S.Su. 14/39-40
10. Su.S.Ni.1/28
11. Su.S.Chi 4/8
12. Su.S.Chi.32/3
13. B.S.Chi. 4/48-50
14. A.S.Ni. 15/16
15. A.S.Chi.23/13
16. A.H.Ni. 15/14-15
17. A.H.Chi. 21/19,22
18. M.N.22/21
19. B.P.Mad.Kh.24/258
20. Y.R. 30/119
21. A.S.Su.31/16
22. A.H.Su.22/27-29
23. A.H.Su.19/1
24. C.S.Su.11/55
25. C.S.Su.11/55
26. Su.S.Chi.4/82
27. C.S.Vi.8/94-96
28. C.S.Su.14/13
29. C.S.Su.14/14
30. Su.S.Ut.18/51
An observational study to evaluate the effect of Vasa in the form of Janu Basti in the management of
Janu Sandhivata (Osteoarthritis)
31. Su.S.Chi 4/8
131
32. Su.S.Chi.32/3
33. B.S.Chi. 4/48-50
34. A.S.Ni. 15/16
35. A.S.Chi.23/13
36. C.S.Vi.8/94-96
37. C.S.Su.14/13
38. C.S.Su.14/14
39. Su.S.Ut.18/51
40. C.S.Sh.7/14
41. Su.S.Sh.5/24
42. Su.S.Sh.5/27
43. Priniciples of Anatomy & Physiology, Gerard J . Tortora
44. A.H.Su.11/4
45. A.H.Su.11/26
46. A.H.Su.12/6-7
47. S.S.Ni.1/13 - Dal
48. Su.S.Sh. 5/29-36
49. Sha.S. Pu. Kh.5/40
50. Su.S.Sh.4/14-15
51. A.H.Su.12/7
52. Su.S.Sh.5/37-38
53. Su.S.Sh. 5/16
54. Su.S.Sh.7/8
55. Su.S.Sh.7/12
56. Su.S.Sh.7/14
57. Su.S.Sh.9/5
58. Priniciples of Anatomy & Physiology - Gerard J . Tortora
59. Priniciples of Anatomy & Physiology - Gerard J . Tortora
60. C.S. Su. 8/10
61. Su.S. Sha. 1/7
62. Su.S. Sha. 4/4
63. A.H. Sh. 3/8-9
64. C.S. Sha. 7/4
65. Su.S. Sha. 4/4
132
66. A.H. Sh. 3/8
67. Sha.S. Pu. Kh. 5/18
68. Priniciples of Anatomy & Physiology, Pg. No. 145
69. Sanskrit English Dictionary by M.M.W.
70. Su.S.Sh.5/28
71. Su.S.Sh.5/24 - Dal.
72. C.S.Chi.28/26-37
73. B.P.Mad. Kh. 24/25/-259
74. C.S. Chi.28/37
75. Su.S.Ni. 1/28,29
76. Su.S. Ni. 1/79
77. M. N. 22/21
78. Su.S. Su. 15/7
79. A.H. Su. 11/26-28
80. C.S. Chi.28/72
81. Su.S. Ni.1/28
82. C.S.Chi. 28/15-18
83. Su.S.Su.21/19
84. A.H.Ni.1/14-15
85. Y.R. 30/1-4
86. B.P.Chi.Vat.12
87. M.N.Pu.22/1-3
88. C.S.Vi.5/17,18
89. C.S.Chi. 28/19
90. C.S.Chi 28/37
91. Su.S.Ni.1/28
92. A.H.Ni.15/14
93. A.S.Ni 15/12
94. M.N. 22/21
95. B.P.Ci. 24/258
96. Y.R. 30/119
97. Su.S.Ni. 1/28 - Dal, Gaya
98. M.N. 22/21 Vij, Sri
99. B.P.Ci. 24/93
133
100. A.H.Ni. 1/8
101. A. S.Ni. 2/31
102. C.S.Chi.28/18-19
103. A.H.Ni.15/5-6
104. C.S.Chi.28/15-18 - Chakra
105. Su.S.Su. 15/32
106. Su.S. Su. 15/32 Dal.
107. A.H.Su.13/1-3
108. A.H.Su.11/25
109. Su.S.Chi 4/8
110. A.S.Chi.23/13
111. A.H.Chi. 21/19,22
112. Y.R. 30/119
113. B.P.Mad.Kh. 24/258
114. B.R. 26/14
115. Su.S.Chi.31/2
116. C.S.Su.5/85
117. Su.S.Chi.24/30
118. C.S.Su.22/11
119. Su.S.Chi.32/3
120. C.S.Su.14/35
121. Su.S.Chi.32/12
122. C.S.Su.14/35-37
123. A.H.Su.17/5
124. C.S.Chi.28/115
125. C.S.Chi.14/38
126. Su.S.Su.18/7 & Dal
127. Su.S.Chi.32/12 & Dal
128. Su.S.Chi.4/8 & Dal
129. A.S.Chi.23/13
130. A.H.Chi.21/22
131. Y.R.30/119
132. B.P.Chi.24/259
133. Orient Longman, Indian medicinal plants, Vol 4, Page No: 339.
134
134. Orient Longman, Indian medicinal plants, Vol 4, Page No: 339-340.
135. Dr.Prakash Parajpe, Indian medicinal plants. Forgotten healers A guide to
Ayurvedic herbal medicines, 2001, Chaukhamba Sanskrit pratishtham Delhi, page
no: 128.
no: 144.
138. Asima chatterjee, Satyesh Chandraprakrashi, The treatise on Indian medicinal
plants, Vol.6, National institute of science communication, NewDelhi, 1997, Page no:
97
no: 143
141. Kirtikar.K.R and Basu.B.U, Indian medicinal plants, International Book
distributors, Vol 3, page 2132.
143. Anil Kumar Dhinam, Ayurvedic drug plants, Daya publishing house, 2006,
page no: 376.
144. Orient Longman, Indian medicinal plants, Vol 4, Page No: 59 -61.
no: 244
135
148. Anil Kumar Dhinam, Ayurvedic drug plants, Daya publishing house, 2006,
page no: 291.
distributors, Vol 10, page 3468 - 3469.
151. Purushotam Kaushik, Anil Kumar Dhiman, Medicinal plants and raw drugs of
India, Chaukhambha publication, page no: 536.
153. Orient Longman, Indian medicinal plants, Vol 2, Page No: 379 381.
no: 241.
no: 183.
159. Dr.B.Syleswariamma et al, Pharmacopea, Published by Govt. Ayurveda College
Trivandrum, 1996, Page no: 174.
160. The pharmacological basis of therapeutics Goodman and Gillman, Physiology by
Robert M. Berne, Claytons Electro therapy by Angela Forster, Nigel Palastanga, Text book
of Pharmacology by K.D. Tripati

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Ayurveda Dipika commentary by Chakrapani Datta (ed.), Vaidya J adavji
Trikramji Acharya, Krishnadas Academy, Varanasi, 2000.
2. Agnivesha - Charaka Samhita revised by Charaka and Drdhabala with
Ayurveda Dipika commentary by Chakrapani Datta and Vidyotini Hindi
commentary by Pt. Kashinatha Shastri (ed.), Dr. Gangasahaya Pandeya, (Part I
& II), Chaukhambha Sanskrit Sansthan, Varanasi, 8
th
ed., 2004.
3. Sushruta - Sushruta Samhita with Nibandha Sangraha commentary by Dalhana
(ed.)Vaidya J adavji Trikramji Acharya, Krishnadas Academy, Varanasi
4. Sushruta - Sushruta Samhita edited with Ayurveda Tatva Sandipika Hindi
commentary by Kaviraja Ambikadutta Shastri (Part I & II), Chaukhambha
Sanskrit Sansthan, Varanasi
5. Vriddha Vagbhata Asthanga Sangraha with Shashilekha commentary by
Indu ed. by Dr. Shivaprasad Sharma, Chowkambha Sanskrit Series Office,
Varanasi, 2006
6. Vagbhata Astanga Hridaya with Ayurveda Rasayana commentary by
Hemadri and Sarvangasundara commentary by Arunadatta (ed.) Pt.
Bhisagacharya Harishastri Paradhkar Vaidya, Krishnadas Academy, Varanasi,
2000
7. Bhela- Bhela Samhita text with English translation commentary and critical
notes by K.H. Krishna murthy, Varanasi: Chaukumbha Viswabharati, 1st
edition, 2000:
8. Vijayarakshitha Madhava Nidana of Madhavakara with Madhukosha
Sanskrit commentary by Vijayarakshitha and Srikantha Datta & Vidyotini
Hindi commentary and notes by Sudarsana Sastri, Chaukumbha Sanskrit
Sansthan, Varanasi XXII (Edn) 1993:
137
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Brahmasankara Mishra and Rupalalaji Vaisya, published by Chaukumbha
Sanskrit Sansthan, 1999 edition: Madhyama khanda.
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Brahmasankar Sastri, published by Chaukumbha Sanskrit Sansthan..
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Chaukumbha Publishers, 1998.
12. Sharngadhara Sharangadhara Samhita, commentary by Adhamallas Dipika
& Kasiramas Gudhartha Dipika Ed. By Parasurama Sastri, Vidyasagar,
Chaukumbha Orientala, Varanasi, 2002;
13. Govinda Das Bhaishajya Ratnavali, revised by Sri Brahmashankar Mishra,
ed. by Kaviraja Sri Ambikadatta Shastri, Published by Chaukhambha Sanskrit
Samsthana, Varanasi, 2001
14. Sir Moneir Williams: Sanskrit English Dictionary, Motilal Banarasi Das,
Delhi.1970
15. Acharya Mukundilal Dwivedi Ayurvediya Panchakarma Chikitsa,
Chaukhambha Sanskrit Pratishthan, Delhi, 1990
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Orientalia, Varanasi, Eighth edition, 2005
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Internal Medicine, 15
th
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Division, 2001.
18. Christopher Haslett, Edwin R. Chilvers, J ohn .A. A. Hunter, Nicholas A. Boon
- Davidsons Principles & Practice of Medicine, 19
th
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Published by J ohn Wiley & Sons, Inc., 11
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th
edition, published by
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th
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Published by Hawvrt (India) Pvt. Ltd., New Delhi, 2003
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th
edtn.,
Popular Prakashana, Mumbai, 2002
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National clinical guideline for care and management in adults, Published by
Royal College of Physicians, London, 2008.
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rd
ed., Published by
ELBS, 1994
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th
edtn.,
Popular Prakashana, Mumbai, 2002
30. www.wrongdiagnosis.com
31. www.elkusa.com
32. www.wikipedia.com
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34. www.osteoarthritis.net
35. www.oarsi.org
36. www.arthritis.org

I
SPECIALCASESHEETFORJANUSANDHIGATAVATA
P.G. DEPARTMENT OF PANCHAKARMA
ALVAS AYURVEDA MEDICAL COLLEGE MOODBIDRI, D.K
GUIDE Dr. K.N.RAJASEKHAR. M.D (AYU) CO GUIDE Dr. PRASANNA
AITHAL. M.D (AYU)
P.G. SCHOLAR Dr. PRASANTH.D

1. NAME :

2. AGE :

3. SEX : M / F

4. RELIGION: H/M/C/O

5. EDUCATION : IL/ P/M//HS/GR/PG

6. MARITAL STATUS : M/U/D/W

7. DESHA : AN/SA/J A
PLACE:

SL.NO:

DATE:

O.P.D.NO:

I.P.D NO:

D.O.A:

D.O.D:

8. OCCUPATION:

9. SOCIAL STATUS :

10. .POSTAL ADDRESS: TEL:
MOB:

CONSENT
II
I HEREBY DECLARE THAT IM COMPLETELY AWARE OF MY HEALTH CONDITION AND THE

TREATMENT PROCEDURE TO BE ADOPTED. I WHOLE HEARTEDLY ACCEPT TO UNDERGO
THE SAME.

PATIENTS SIGNATURE

I. CHIEF COMPLAINT:

KNEE JOINT AFFECTED: RT/LT DURATION:

A) SANDHI SHOOLA:

B) SANDHI SHOTHA:

C) PRASARANA AAKUNCHANA VEDANA:

D) AATOPA:

II. ASOCIATED COMPLAINT IF ANY WITH DURATION:

III. HISTORY OF PRESENT ILLNESS:

PAIN OR SANDHI SHOOLA

a) Onset of pain : Sudden/Gradual

b) Character of pain : Dull aching /Deep aching/Shooting pain/Excruciating

c) Course of pain : Progressive/Intermittent/Continuous

d) Aggravating factor : Diurnal M /A/E/N

e) Radiation of pain : Upwards/Downwards
III

f) Pain along with movement : Present/Absent

SWELLING OR SANDHISHOTHA

a) Onset : sudden / Gradual

b) Site : Anterior / Posterior

c) Colour : Aruna / Swetha /Tamra

d) Aggravates : Diva / Ratri

e) Other factors if any :

STIFFNESS OR PRASARANA AAKUNCHANA PRAVRUTTI VEDANA

a) Present / Absent

b) Others

AATOPA OR CREPITUS

a) Present / Absent :

b) If present: Palpable / Audible / Fine / Coarse

IV. HISTORY OF PAST ILLNESS

a) H/O D.M
b) H/O C.H.D
c) H/O Endocrinal disorders
d) H/O Direct injury
e) H/O Other Vata Vyadhis
f) H/O C.A
g) H/O T.B
IV
h) Others significant

V. TREATMENT HISTORY

a) H/O Chemotherapy or Cyto toxic Drugs:

b) H/O Radiation therapy:

c) H/O Hormonal therapy:

d) H/O Steroidal drugs intake:

e) H/O Anti epileptics:

f) Other significant treatment history:

g) Ayurvedic Treatment History If Any:

VI. FAMILY HISTORY

a) H/O Cardiac Disorders:

b) H/O Endocrinal Disorders:

c) H/O Musculo Skeletal Disorders:

d) Other Significant History If Any:


VII. GYANEAC HISTORY

a) M.C. Bleeding days :
b) Periods : Regular/ Irregular
c) Menopause Attained : Yes /No
VIII. PERSONAL HISTORY

AAHARA

a)Quantity : Alpa/Prathima/Sama/Atiprama
b)Dominant rasa : ,M /A/L/K/T/KS
c)Guna Pradhana : Ruksha/Snigdha/Ushna/Sheeta/Guru/Laghu
d) Dietary Habits :Matrashana/VIshamashana/Adhyashana/Anashana

AGNI
a)Type : Mandhagni/Vishamagni/Teekshnagni/Samagni
b) Koshta : Mrudu koshta /Madhyama koshta/Krura koshta

VIHARA

a) Nature : Mild/Moderate/Severe
b) Duration:
c) Habits:
Regular Occasional Reduced Stopped Reln wid J .S.V
Smoking:
Alcohol:
Tobacco:
Snuff:
Others :

d) Nidra :
Nature: sound sleep/disturbed sleep
Duration:
Others:

e) Mala pravrutti:
Frequency:
VI
Consistency:
Others:
f) Mutra Pravrutti
Frequency:
Colour:
Others:

IX. GENERAL PHYSICAL EXAMINATION

Vital Data-
Pulse:
B.P:
Temp:
Resp Rate:
Weight:
Height:
Tongue:
Palour:
Cyanosis:
Kolenychia:
Lymph enlargement:
Oedema:
Others:

X. SYSTEMIC EXAMINATION

A) RESPIRATORY SYSTEM

Inspection:

Palpation:

Percussion:

Auscultation:

B) CARDIO VASULAR SYTEM

Inspection:
VII

Palpation:

Percussion:

Auscultation:

C) GASTRO INTESTINAL SYSTEM

Inspection:

Palpation:

Percussion:

Auscultation:

D) CENTRAL NERVOUS SYSTEM

Higher Mental Functions: Memory/Orientation/Conscious level/Emotions
Cranial nerves:
Motor Examination: Bulk /Tone /Power of muscle
Sensory Examination: Reflexes superficial/deep
Organic Examination: Bowel cntrl / Bladder cntrl / Deglutinn / Cgh rflx

E) LOCOMOTORY SYSTEM EXAMINATION

Knee J oint Examination

Inspection : Redness Swelling Deformity

Palpation : Tenderness Area
Temperature: :
Swelling:
VIII
Movement: Painfulrestricted Flexion Extension


XI. INVESTIGATIONS

a) HEAMATOLOGICAL
Hb %:
E.S.R:
D.C : N - %, L- %, B- %, E- %, M- %

b) URINE ANALYSIS
Albumin:
Sugar:
Microscopy:

c) OTHERS IF ANY

XII. DASHA VIDHA AATURA PARREKSHA
Sroto Pareeksha:
Pranavaha : Prakruta / Vaikruta
Udakavaha : Prakruta / Vaikruta
Annavaha : Prakruta / Vaikruta
Rasavaha : Prakruta / Vaikruta
Rakthavaha : Prakruta / Vaikruta
Mamsavaha: Prakruta / Vaikruta
Medovaha : Prakruta / Vaikruta
Asthivaha : Prakruta / Vaikruta
Majjavaha : Prakruta / Vaikruta
Shukravaha: Prakruta / Vaikruta
Artavavaha : Prakruta / Vaikruta
Swedavaha : Prakruta / Vaikruta
Purishavaha : Prakruta / Vaikruta
IX
Mootravaha : Prakruta / Vaikruta

Prakruti:
Saara:
Samhanana:
Satva:
Saatmya:
Aahara Shakthi: Abhyavarana shakthi P/ M /A
J arana Shakthi P/ M /A
Vyayama Shakthi: P/ M /A

Pramana: P/ M /A

Vaya: B / M / V

XIII. VIKARA PAREEKSHA

NIDANA PANCHAKA

A) NIDANA:
Aahara: Tikta rasa atyupoayoga / Kashaya rasa atyupayoga /
Katu rasa atyupayoga /Katu rasa atyupayoga
Alpa bhojana /Pramita bhojana /Rooksha bhojana/ Sheeta bhojana/
Langhana
Vihara: Vega dharana /Ati vyavaya /Raatri jaagarana/ Atyucha bhashana /
Plavana/Ati adhva/Divaswapana/ Dukha shayyasana/ Marmaghata /
Sheegra yaana
Manasika : Ati bhaya / Ati chinta / Ati krodha
Panchakarma Apachara : vishama apcahara /asruk sravana
Occupational factors :
Anya Nidanas If Any :

B) ROOPA:
Vata poorna druti sparsha:
Prasarana aakunchana pravrutti vedana :
Sandhi shotha :
Shoola :
Aatopa :


C) SAMPRAPTHI GHATAKA
Dosha :
Dushya:
Srothas:
Ama :
Udbhava sthana:
Sanchara sthana :
Vyaktha sthana:
Sadhya asadhyatha:

D) VYADHI VINISCHAYA :

XIV. CHIKISTA

J ANU BASTI / J ANU PICHU - WITH MURUVENNA FOR 45 MINUTES
TREATMENT SCHEDULE 7 DAYS
INITIATION DATE
COMPLETION DATE

A) POORVA KARMA
Aatura parreksha ;
Sambhara samgraha :
Aatura siddhata :

B) PRADHANA KARMA

J ANU BASTI :

J ANU PICHU :

DATE
INITIATION
XI
TIME
COMPLETION
TIME

OBSERVATIONS:

BAHYA SNIGDHA LAKSHANAS : (J ANU SANDHI)
DAYS 1 2 3 4 5 6 7
SAMYAK
BAHYA
SNIGDHA

MARDAVATA
SNIGDHATA
ASNIGDHA
LAKSHANA

KHARATWA
RAUKSHYA
ATI
SNIGDHA
LAKSHANA

GAURAVA
J AADYA
BAAHYA SWINNA LAKSHANAS

DAYS 1 2 3 4 5 6 7
SAMYAK
SWINNA

SWEDA
PRADURBHAVA

SHOTHA
XII
UPARAMA
LAGHUTVA
STAMBHA
NIGHRAHA

LAKSHANA
PRASHAMA

MARDAVATA
SWEDA
AYOGA
LAKSHANA

ASVEDA
STABDHATA
GURUTWA
ATI SWEDA
LAKSHANA

VIDHAHA
SANDHI
VEDANA

SPHOTA
UTPATTI

C) PASCHAT KARMA

MRUDU ABHYANGA :

SWEDANA :

ASSESMENT OF CHIKISTA
XIII

DAILY ASSESMENT - GRADINGS

DAYS 1 2 3 4 5 6 7
SUBJ ECTIVE
PAIN IN
KNEE

STIFFNESS
GAIT
OBJ ECTIVE
TENDERNESS
SWELLING
CREPITUS

OVERALL ASSESMENT GRADINGS

DAYS B.T.-
DAY- 1
A.T
DAY -7
FOLLOW
UP-DAY -
14
FOLLOW
UP DAY
21
SUBJ ECTIVE
PAIN IN
KNEE

STIFFNESS
GAIT
XIV
OBJ ECTIVE
TENDERNESS
SWELLING
CREPITUS
RANGE OF
MOVEMENTS

GRADING CRIETERIAS ADOPTED

1) SANDHI SHOOLA/PAIN ON WALK - GRADINGS
NO PAIN - 0
MILD PAIN ON EXERTION - 1
MODERATE INTERMITTENT PAIN ON WALK - 2
CONSTANT PAIN ON WALK - 3
SEVERE PAIN UNABLE TO WALK - 4

2) SANDHI GRAHA /STIFFNESS
NORMAL FLEXION - 0
MILD RESTRICTION - 1
MODERATE RESTRICTION - 2
SEVERE RESTRICTION - 3

3) GAIT / AAKRUTI
FREE SWINGING , NO LIMP - 0
LIMPING GAIT WITH NO ADDITIONAL SUPPORT - 1
XV
WITH UNILATERAL SUPPORT - 2

WITH BILATERAL SUPPORT - 3

4) TENDERNESS
NO TENDERNESS - 0
PATIENT COMPLAINS OF PAIN - 1
AND WINCES - 2
PATIENT WITHDRAWS J OINT ON TOUCH - 3
PATIENT DOESNT ALLOW TO TOUCH THE J OINT - 4

5) SWELLING/SHOTHA
SWELLING ABSENT - 0
SWELLING PRESENT - 1

6) CREPITUS/AATOPA
NO CREPITUS - 0
PALPABLE CREPITUS - 1
AUDIBLE CREPITUS - 2

7) RANGE OF MOVEMENTS USING GONIOMETER
NORMAL FLEXION 135
0
- 0
LESSER THAN 135
0
& MORE THAN 100
0
- 1
LESSER THAN 100
0
& MORE THAN 75
0
- 2
LESSER THAN 75
0
- 3

XVI
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A COMPARATIVE STUDY ON JANU BASTI AND JANU PICHU

WITH MURIVENNA IN JANU SANDHI GATA VATA.

References & Bibliography 130 - 138

35 Chronicity wise Distribution of 30 Patients of J anu Sandhivata 100

1. Agnivesha - Charaka Samhita revised by Charaka and Drdhabala with

I HEREBY DECLARE THAT IM COMPLETELY AWARE OF MY HEALTH CONDITION AND THE

Movement: Painfulrestricted Flexion Extension

Mootravaha : Prakruta / Vaikruta

WITH UNILATERAL SUPPORT - 2

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