Friday, 26 January 2018

Sandhigata Vata (Osteoarthritis)

Sandhigata Vata is most common articular disease  which is slowly progressive & can be seen in late forty’s of life. It is one of the Vata vyadhi which mainly occurs due to dhatukshaya ( Degenrative changes). Being a Vata vyadhi, located in Marmasthisandhi and its occurrence in old age makes it kashtasadhya.
This disease can be correlated with Osteoarthritis in modern science.
   Osteoarthritis is a degenerative joint disorder, where joint inflammation initially causes pain and later on swelling. It is the most prevalent joint disorder of 22% to 39% in India.

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)-
 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
 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
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 -
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
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.

 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.