This disease can be correlated
with Osteoarthritis in modern science.
In Sandhigata Vata due to pain and
swelling, the mobility of joints is restricted and on movement patients feel
excruciating pain, which becomes unbearable. It is a major cause of morbidity
limiting the daily activities and impairing the quality of life especially
among the elderly.
It is a degenerative joint
disorder, where joint inflammation initially causes pain and later on swelling.
Due to pain and swelling, the mobility of joints is restricted and patients
feel excruciating pain. Pain becomes unbearable even on mild touch in the form
of tenderness. The degenerative changes later results in manifestation of
crepitus around involved joints.
It is more
common in females than males. Almost all the persons by age of 40 years have
some pathological changes in weight bearing joints. It limits everyday life activities
such as walking, dressing, bathing etc. thus making individual handicapped.
There is no absolute cure in modern medicine.
Acharya Charaka has explained Sandhivata
as one among the Vatavyadhi and characterized by “vata purna
druti sparsha” associated with shotha and pain during the movement
of the joint. Acharya Bhavaprakasha while explaining Vatavyadhi explained
about Sandhivata.
There are different structures
in the sandhi ( joint), which helps in maintaining the stability of the joint. Snayu
or ligament 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. Muscle tone helps to maintain the alignment of the joint. Shleshaka
Kapha or Synovial fluid, which fills up the cavities, occupies the Synovial
joint, bursae and tendon sheaths. It provides the lubricant factors, nutrient
to the cartilage, disc and helps in keeping the joint firmly united. Shleshmadharakala
situated in the joints supported by Shleshaka Kapha helps in
lubrication. These all structures get damaged/ degenerated due to execessive
Vata & various factors which results in progression of Sandhivata.
Hetu
( causative factors)-
Ativyayama,(excessivexercises)
Abhighata,(trauma/injury)
Marmaghata, (trauma)
Bharaharana,( ligting heavy objects)
Sheeghrayana,( long traveling in
vehicles)
Kashaya, Katu, Tikta rasatmak & Ruksha, Sheeta, Laghu Diet.
Dravya – Shyamaka,
Uddalaka, Masura, Kalaya, Adaki, Harenu, Shushkashaka, Vallura, Varaka
Aharakrama – Alpahara, Vishamashana, Adhyashana, Pramitashana
Viharaja – Atijagarana, Vishamopachara, Ativyavaya, Shrama,
Divasvapna,Vegasandharana, Atyucchabhashana, Dhatu Kshaya.
Manasika – Chinta, Shoka,
Krodha, Bhaya
Age- After 40 years of age
degenerative changes starts in many peoples but can form disease in 20 to 35%
population.
Female sex- Females are more
prone to this disease
Genetic factors-
Major joint trauma
Repetitive stress e.g. vocational
Obesity
Congenital / Developmental defects
Prior inflammatory joint disease
Metabolic / Endocrine disorders
Lakshana (Symptoms) -
Shula,
- pain,
Vata purna druti sparsha -on
touch feels like a bag filled with air
Shopha,- swelling
Prasarana
Akunchanayoh Savedana pravrutti,- ,
pain during movements
Hanti sandhi - Restriction of movements
Atopa.
local
crepitations and morning stiffness.
Sandhishula : Shula
is the chief symptom of Prakupita Vata. It is stated
that
without Vata Shula does not occur. It is obvious to experience Shula
in the
diseases which are dominated by Vata. In case of Vata situated in
Sandhi
gives rise to Sandhi Shula.
Sandhishotha
: Dosha Sanchaya in specific site is the
main causative
factor
for Sotha. In Sandhigatavata, Prakupita Vata gets enlodged in
Sandhi
where Srotoriktata already exists. So there is wide scope of Vata
to get
accumulated there resulting in Sotha. Here Vatapurna Druti
Sparsha
type of Sotha has been described by Acharya Charaka. Because
Sotha
is Vatic type, on palpation the swelling is felt like a bag filled with
air.
(Vatapurna Druti Sparsha) Acharya Madhavakara has given a new
name
i.e. Atopa.
Hanti Sandhi Gatah
: First Sushruta explains this symptom
followed by
Madhavakar
while commenting on this word, Dalhana and Gayadas
explain
it as inability to flexion and extension. However, this symptom
may not
to be seen in early stages. When the disease aggravates the
vitiated
Vata may produce inability of movements.
Akunchan Prasaranayoh Vedana :
Acharya Charaka has shown this
symptom.
Sandhi are made to perform the function of Akunchana and
Prasarana.
When Prakupita Vata gets located in Sandhi, it hampers the
normal
function of Sandhi which results in vedana during Akunchana
and
Prasarana.
Sandhisphutana
: This symptom is not mentioned in our
classics
directly.
In allopathy texts, it is mentioned clearly as crepitation -
Sandhisphutana.
Sandhigatavata
is localised Vatavyadhi in which Prakupita Vata affect
Sandhi.
This Sthana Sansraya is result of Srotoriktata present at Sandhi.
This
symptom may occur due to Vatasanga in Sandhi.
Apathya kara Ahara-
Chanaka(horse
gram), Kalaya (peas)etc
Madhu(Honey)
Nadi-samudra(
river & sea water), Shita (cold)Jala, Dushita Jala( impure water) etc
Navamadya(
new brevarages), Atimadyapana (excessive alcohol intake)
Jambu,
Kramuka etc.
Katu(spicy),
Tikta(bitter), Kasaya( astringent) Rasa
Chinta,
Jagarana, Vega Sandharana, Shrama, Anashana, Vyavaya,
Vyayama,
Pravata, Chankramana, Kathin Shayya, Yana Gamana etc.
Treatment-
sandhigatavata
comes under the general classification of Vatavikara
(Vatic ailments), all the treatment modalities like Snehana (internal
and external oleation), Swedana (Sudation) and vasti karma are highly
useful.
Panchakarma
modalities of treatment being explained in Asthivaha srotogata vikaras (Disorders
of Channels of bone tissue) by Acharya Charaka.Further he has emphasized the tikta
rasa dravyasadhita vastikarma (Enema therapy with drug possessing bitter
taste) in the same.
Even
Acharya Charaka and Vagbhata have mentioned the importance of internal and
external oleation therapies in bone and bone marrow tissue related ailments.
Here internal oleation include snehapana (drinking of medicated ghee,
oil etc), vastikarma (fat enema) etc. External oleation therapy include Abhyanga
(Oil massage), Januvasti (Retaining medicated liquid over the knee
joint in a specific manner), Januseka (Pouring of medicated liquid on
knee) etc.
Snehana
(Oleation), Upanaha (A kind of sudation), Agni
Karma (Cauterization), Bandhana (Bandaging) and Mardana (A
kind of massage technique) are the treatment modalities mentioned by Acharya
Sushruta.