World Journal of Pharmaceutical Research

Pravesh et al. SJIF Impact

World Journal of Pharmaceutical Factor 8.074
Research
Volume 7, Issue 13, 1116-1122. Research Article ISSN 2277–7105

PATRAPINDA SVEDA IN THE MANAGEMENT OF SANDHIVATA

W.S.R TO ANKYLOSING SPONDYLITIS

Dr. Pravesh Kumar and Dr. Jyoti Rani*

1
Associate Professor, Deptt. of Panchkarma, Gurukul Campus, Uttarakhand Ayurved
University, Haridwar.
2
P.G. Scholar, Deptt. of Panchkarma, Gurukul Campus, Uttarakhand Ayurved University,
Haridwar.

Article Received on
17 May 2018,
Revised on 08 June 2018,
Accepted on 29 June 2018
DOI: 10.20959/wjpr201813-12820
ABSTRACT
Ankylosing spondylitis is a progressive inflammatory disease usually
occurs in males of age between 17-25 years. Principally it affects the
axial skeleton but peripheral joints may also involved particularly hip
and shoulder joint. Bony ankylosis starts with ossification of ligaments

*Corresponding Author and tendons of the spine occurs due to ankylosing spondylitis.
Dr. Jyoti Rani Pathology of ankylosing spondylitis usually starts at the junctions of
P.G. Scholar, Deptt. of bone of dorsolumbar region or sacro-iliac joints by which there is loss
Panchkarma, Gurukul
of cortex and erosions with consequent widening of the joint space.
Campus, Uttarakhand
Sclerosis and ankylosis results at advanced stage of ankylosing
Ayurved University,
Haridwar. spondylitis due to disease pathology. Ankylosing spondylitis is not
described in Ayurveda independently but symptoms of the disease is
similar as for sandhivata described in Ayurveda. Sandhivata is a disease of the joints that is
due to aggaravated vata dosha. If vatavardhaka ahara and vihara are practiced by a person
then there is a great chances of development of sandhivata. When aggravated vata
accumulated in joints, symptoms of sandhivata occurs The sandhis (joints) and asthies
(bones) are specific sites of vata especially of vyana vayu (a kind of subtype of vata classified
in Ayurveda). The treatment modality of the present study were taken targeting the dosha
(vata) and samprapti (pathogenesis). Svedana is capable to pacify vata due to the potency of
the drugs used in patrapinda sveda. Patrapinda sveda is carried out using leaves of some
specific medicinal plants by making bolus and applied topically over the affected joints.

KEYWORDS: Sandhi, Vata, Sandhivata, Asthi, Samprapti, Vatavardhaka.

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INTRODUCTION
Sandhivata is described in Ayurveda by Acharya Charaka as sandhigata anila under
vatavyadhi. The word sandhivata is derived from its two distinctive parts; sandhi and asthi.
The sandhi is an anatomical part implicated for that where two or more bones met with their
articular surfaces. The vata, a physiological component present in the body, is responsible for
regulation and control of functions of the body and also for phsio-pathological changes.
When aggravated vata gets accumulated in the joints of the body, pathogenesis of the disease
starts to develop due to guna (properties) of vata especially by shita guna because it plays an
important role in the development of the disease.

Sandhivata starts with vitiation of vata due to excessive practice of vatavardhaka ahara and
vihara. Accumuulation of vitiated vata in the joints is facilitated by the following ways
1. Sandhis are specific sites of vata.
2. Khavaigunya (hollow space).

The present study entitled patrapinda sveda in the management of sandhivata w.s.r to
ankylosing spondylitis aim to evaluate the efficacy of patrapinda sveda for the treatment of
sandhivata.

Ayurvedic Review: The disease sandhivata is briefly described in Ayurveda and it mentioned
as a vata vyadhi in which vata plays an important role in the development of the disease.
Sandhivata is characterized clinically as following.
1. Vatapurnadratisparsha (soft swelling).
2. Shotha (inflammation).
3. Prasarna kunchanyo pravrattisch savedana (painful movements of the affected joints).

The vata gets vitiated or aggravated by the following factors

1. Ruksha, shita, laghu and alpa ahara (rough, cold, little and light foods).
2. Adhyasana and visamashna (irregular food habits).
3. Visamchesta (abnormal postures).
4. Faulty application of panchkarma therapies.
5. Vegavidharana (suppression of natural urges).
6. Ativyayama (excessive physical works).
7. Nidra –viparyaya (altered sleep habits).
8. Manasika bhavas (psychological factors).

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Principles of the treatment of sandhivata are as for vatavyadhi chikitsa (treatment of the
disease due to vata dosha). These are.

(a) Systematically
(1) Snehana (Oleation).
(2) Svedana (Fomentation).
(3) Vasti (Medicated Enema).

(b) Topically
(1) Abhayanga (Massage).
(2) Svedana (Fomentation).
(3) Upnaha (Poultice).

Modern Review: Ankylosing spondylitis is a chronic inflammatory arthritis that starts with
back pain in a young active male feeling of ill health which eventually leads to stiffness and
inability to bend forward or laterally. In severe cases, the spine becomes rigid and looks like a
solid rod of the bone situated in between the skull and the pelvis. Over 90% of cases of
ankylosing spondylitis poses HLA-B27 positive that is inherited WBC group (human
leucocyte antigen). Therefore people born with this group have greater chances of
development of ankylosing spondylitis.

The exact aetiology of ankylosing spondylitis is unknown but genetic and environmental
factor play an important role. Ankylosing spondylitis is 30 times more common in patients
relations than that of general population. An ratio of 90% or more relationship of ankylosing
spondylitis occurs with certain blood groups associated with the white blood cells that is
known as HLA-B27. Because HLA-B27 is inherited therefore most of the people with it have
ankylosing spondylitis. The overall prevalence of HLA-B27 antigen is lower among black and
it appears that ankylosing spondylitis is less common in this group than in whites. Some
clinical and laboratory findings have suggested that there may be an association between
gram- negative micro- organisms in the bowel and ankylosing spondylitis. Certain strains of
klebsiella are isolated from stools of the patients of ankylosing spondylitis more frequently
during the periods of disease activity. On the other hands, identical twins those are discordant
for the disease indicate an contribution of an environmental factor.

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Clinical features of ankylosing spondylitis are

1. Lumbar pain that oftenly radiates to the buttocks or to the posterior things and rarely it
radiates below the knees but neurological symptomps are not present. In severe caese, pain
extends upto thoracic cage and neck.
2. Morning stiffness often at rest that presents very commonly in young males suffering from
ankylosing spondylitis. Stiffness is responsible for reduced movements and is relieved after
exercise.
3. Sacroiliac tenderness during forward bending may present because of erosion of the
sacroiliac joints.
4. Restriction of movement of the affected joints occur in all directions of movements
(flexion, extension and lateral flexion).
5. Loss of lumbar lordosis occurs due to muscle spasm around the joint involved.
6. Reduced chest expansion occurs due to costovertebral and manubrio-sternal joint
involvement.
7. Kyphosis may occur commonly in untreated patients.
8. Other features are fatigue, low grade fever, loss of appetite, loss of weight, iritis, aortic
regurgitation, apical pulmonary fibrosis, IBD, myelopathy secondary due to atlanto -axial
sublaxation and rarely small joint involvement.

Diagnostic criteria as follows

(1) Clinical criteria (New York Criteria)
(a) Limitation of movements of lumbar spine
(b) History of pain at the lumbar spine junction or in the lumbar spine
(c) Limitation of chest expansion to 1 inch (2.5cm) or less measures at the level of 4 th
intercostal space.
(2) Radiological sacroilitis.
(3) Elevated ESR and positive HLA-B27.

Management of ankylosing spondylitis is

(1) Physical exercises and therapies
(2) NSAIDs
(3) DMARDs

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MATERIAL AND METHODS

The patients were selected from the OPD and IPD of department of Panchkarma, Uttarakhand
Ayurved University, Gurukul Campus, Haridwar. The following inclusion and exclusion
criteria were adopted for selection of the cases of ankylosing spondylitis.

Inclusion criteria
 Patient fulfilling the diagnostic criteria of ankylosing spondylitis.
 Patient not violating exclusion criteria.

Exclusion criteria
 Active presence of infectious diseases.
 Substantial abnormalities of the blood, heart, hepatic, renal or endocrinal diseases.

Criteria of assessment
1. Pain

0 Absent
1 Mild
2 Moderate
3 Severe

2. Stiffness

0 Absent
1 Mild
2 Moderate
3 Severe

3. Tenderness
0 Absent
1 Mild
2 Moderate
3 Severe

4. Restriction of movement
0 Absent
1 Mild
2 Moderate
3 Severe

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Details of therapy
Patrapinda sveda is a type of sankara sveda described in ayurvedic texts in which leaves of
some selected plants are used for svedana by making a bolus tied up with the help of cotton
cloth. It is indicated for the treatment of various disease due to vata dosha. Requirement of
therapy are leaves of medicinal plants of Asvagandha (Withania somnifera), Eranda (Ricinus
communis), Arka(Calotropis procera), Nirgundi (Vitex nigundo), Karpura(Cinnamomum
camphora) Tailparni(Eucalyptus citriodora) etc. medicated oil as per condition (usually
Vrahat saindhavadi tailam), Nimbuka(Citrus fruits), Nariyal chura (Coconut powder),
Saindhava (Rock salt) and Cotton cloth.

Procedures is as following
First of all, cut all the leaves in small pieces and nimbuka in 4-6 pieces, mix nariyal chura
and saindhava in it. Fry this mixture with medicated oil in a big pan and tie up the warm
mixture in a cotton cloth. Warm the medicated oil in the pan and keep the bolus for few time.
Now the bolus is ready for svedana.

Ask the patient to lie down on the table(droni) as per body part being to be svedana. Apply
the bolus to the affected part with great caution. Patrapinda sveda is given for about 30
minutes per day and total 21 days in a month.

OBSERVATION AND RESULTS

1. Percentage and distribution of severity of pain.
Before treatment After treatment
Severity Numbers Percentage Numbers Percentage
Absent 00 00.00 00 00.00
Mild 00 00.00 09 60.00
Moderate 09 60.00 05 33.33
Severe 06 40.00 01 06.67
Total 15 100.00 15 100.00

2. Percentage of distribution of severity of stiffness.

Before treatment After treatment
Severity Numbers Percentage Numbers Percentage
Absent 00 00.00 11 73.33
Mild 05 33.33 03 20.00
Moderate 08 53.33 01 06.67
Severe 02 13.33 00 00.00
Total 15 100.00 15 100.00

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2. Percentage of distribution of severity of tenderness.

Before treatment After treatment
Severity Numbers Percentage Numbers Percentage
Absent 01 06.67 04 26.67
Mild 03 20.00 10 66.67
Moderate 10 66.67 01 06.67
Severe 01 06.67 00 00.00
Total 15 100.00 15 100.00

3. Percentage of distribution of severity of restriction of movement.

Before treatment After treatment
Severity Numbers Percentage Numbers Percentage
Absent 06 40.00 08 53.33
Mild 08 53.33 06 40.00
Moderate 01 06.67 01 06.67
Severe 00 00.00 00 00.00
Total 15 100.00 15 100.00

DISCUSSION AND CONCLUSION

After completion of the therapy, it was observed that patrapinda sveda is effective in the
treatment of sandhivata w.s.r to ankylosing spondylitis. On its clinical parameters as shown
in the tables. percentage of distribution of severity of pain, stiffness, tenderness, and
restriction of movement shifting was from severe to moderate ,mild and absent as per criteria
of assessment. Overall efficacy of the therapy was good in relieving the clinical symptomps
of ankylosing spondylitis.

REFERENCES
1. Charaka, Chikitsasthana 28; Vatavyadhi Chikitsa.
2. Susruta, Nidanasthana 1/38.
3. Madhava Nidana 22/21 Charaka Sutrasthana; Svedadhayaya.
4. Brandt KD: Textbook of Rheumatology, 6th Ed, WN Kelley, Philadelphia Saunders 2000.
5. Hochberg MD, Altman R, Brandt KD et al; guidelines for the management of arthiritis,
Arth Rheum, 1995; 38(11): 1541-46.
6. Mankin HJ. Textbook of Rheumatology 4th Ed, WN Kelley, Philadelphia Saunders, 1993;
1374-84.

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