UNDERSTANDIN

SANDHIGATA

VATA
SANDHIGATA VATA
 It is the commonest form
of Articular disorder

A type of Vata Vyadhi

 Occurs in Vriddhavastha
due to Dhatu Kshaya
 SANDHIGATA VATA
 Most debilitating clinical
condition of Old age
 Usually seen in weight-
bearing joints
 Because of Asthi-dhatu
kshaya due to insufficient
supply of poshaka Rasa
 SANDHIGATA VATA
o Ayurveda is the first medical science to
explain arthritis and other joint
related problems
o We can find references of various type of
arthritis which simulate with those
explained in the modern texts
 SANDHIGATA VATA
o Charaka describes its treatment
under the heading Vata Vyadhi

o Sushruta is the first author to describe

Sandhivata and its treatment separately
 SANDHIGATA VATA

Charaka - Sandhigata Anila

Sushrutha - Sandhigata Vata

Sandhi Hanti

Vagbhata - Sandhigata Kupita

Vata
 CAUSATIVE FACTORS
Mithyahara – Vihara
Agni Dushti
Ama

Symptoms may range from Mild, Moderate

to severe depending up on the dosha (s)
involved and stage of the disease
 CAUSATIVE FACTORS
SHAREERAKA

 Katu, Ruksha, Laghu, Seeta Ahara

 Ati Vyayama
 Langhana

 Abhighata

 Prapatana

 Prapeedana
 CAUSATIVE FACTORS
MANASIKA
Chinta

Bhaya

Shoka

KALAJA
Shishira & Grishma Ritu
 CAUSATIVE FACTORS
OTHERS

Rogatikarshana

Marmabhighata

Dhatu Kshaya
Vardhakya
 SANDHIGATA VATA
o Arthritis involves vitiated Vata dosha in one or
the other form, though the other doshas- Pitta
and Kapha are also invariably involved being
disturbed in varying proportions

o The main dhatus afflicted are Rasa–

Rakta(blood), Mamsa(muscles, tendons,
ligaments) and Ashti(bone and joints).
 SAMPRAPTI GHATAKA
 Nidana : Vata Prakopa Nidana
 Dosha : Vyana Vata & Sleshmaka Kapha
 Dushya : Asthi, Majja & Medas
 Srotas : Asthi, Majja, & or Medo vaha
 Sroto – Dushti : Sanga
 Agni : Mandagni
 SAMPRAPTI GHATAKA
 Dosha Marga : Marma – Asthi – Sandhi
 Roga Marga : Madhyama
 Nature : Vata Prakopa in Kapha Sthana
 Udbhava Sthana : Pakwashaya
 Vyakta Sthana : Asthi – Sandhi
 Prognosis : Kashta Sadhya
LAKSHANA
 Shula

 Shotha

 Sthambha

 Sparsha Asahishnuta

 Sphutana

 Akunchana-Prasaranae

Sandhigata Vedana
 CHIKITSA
Ushna
Brimhana
Anulomana
Snehana
Svedana
Shodhana
Lepana
Rasayana
 CHIKITSA
PHARMACOLOGICAL

1. Herbal

2. Mineral

3. Herbo - Mineral
 CHIKITSA
NON – PHARMACOLOGICAL

Panchakarma

Yoga

Physiotherapy
 CHIKITSA
PARA - SURGICAL

Agni Karma

Rakta Mokshana

Bandhana
 SINGLE DRUGS
 Agastya - Analgesic

 Arjuna - Analgesic

 Asthi-Srinkhala - Analgesic; Anti

Inflammatory

 Bala - Analgesic, Nervine Sedative

 SINGLE DRUGS
 Banda - Anti-Inflammatory, Analgesic &
Anti - arthritic

 Bhallataka - Anti- Inflammatory

 Chandrasura - Anti-Inflammatory,
Analgesic & Anti - arthritic

 Chirabilva - Anti - Inflammatory

 SINGLE DRUGS
 Eranda - Anti-Inflammatory, Analgesic

 Granthiparni - Anti-Inflammatory,
Analgesic & Anti - arthritic

 Guggulu - Anti-Inflammatory,
Analgesic & Anti – arthritic

 Jyotishmati - Anti-Inflammatory,
Analgesic & Anti – arthritic
 SINGLE DRUGS
 Koranta - Nervine Sedative & Analgesic

 Kupeelu - Anti-Inflammatory, Analgesic

 Langali - Anti-Inflammatory,
Analgesic & Anti –
arthritic

 Nirgundi - Anti - Inflammatory

 SINGLE DRUGS
 Patha - Analgesic

 Prasarini - Anti-Inflammatory, Analgesic

 Rasna - Anti-Inflammatory, Analgesic

 Sahachara - Anti-Inflammatory,

Analgesic
 SINGLE DRUGS
 Sinshapa - Anti - Inflammatory

 Shyonaka - Anti-Inflammatory

 Shunti - Anti-Inflammatory, Anti -

arthritic

 Surma - Anti-Inflammatory, Anti - arthritic

 KASHAYA
FOR OBESE PATIENTS (avarana janya)
 Varanadi

 Guggulu Tiktaka
 Rasna Saptakam
 Rasnairandadi

 Punarnavadi

 Kokilaksha
 KASHAYA
FOR LEAN PATIENTS (dhatukshaya janya)

Vidaryadi

Dhanwantaram

Maha Rasnadi
 GUGGULU
FOR OBESE PATIENTS

Rasna Guggulu
Yogaraja Guggulu
Laksha Guggulu
Maha Yogaraja Guggulu
Navaka Guggulu
 GUGGULU
FOR LEAN PATIENTS

 YogarajaGuggulu ]
 Maha Yogaraja Guggulu] - VATA
 Navaka Guggulu ]

 Gokshuradi ]
 Amrutadi ] – VATA - PITTA
 Kaishora Guggulu ]
AVARTI TAILA - INTERNALLY
FOR LEAN PATIENTS
Dhanwantaram - 10 drops with milk
Kshirabala (101) - 10 drops with milk
Sahacharadi - 10 drops with milk
Gandha Tailam - 10 drops with milk
AT NIGHT
 LEPAM
 Kottomchukkadi Churna
Kola-Kulatthadi Churna
Nagaradi Churna
Jadamayadi Churna
Rasnadi Churna
 ABHYANGAM
 Dhanwantaram Tailam
Ketaki Muladi Tailam
Prabhanjanam Tailam
Kottamchukkadi Tailam
Sahacharadi Tailam
Pancha Sneham
 ABHYANGAM
 Chinchadi Tailam
Kaya Tirumeni Tailam
Panchamla Tailam
Karpuradi Tailam
SWEDA
Upanaha Sweda
 VASTI
MADHU TAILIKA VASTI
 Madhu - 200 ml
 Lavana - 15 gm
 Murchita Tailam - 200 ml
 Shatahwakalka - 30 gm
 Erandamula Kashaya - 450 ml

 Total (approx.) - 900 ml

 VASTI
MUSTADI RAJAYAPANA VASTI
 Madhu - 200 ml
 Lavana - 15 gm
 KshirabalaTailam - 100 ml
 Sukumara Ghrita - 100 ml
 Kalka - 30 gm
 Kshira
Kashaya - 400 ml
 Mamsa Rasa - 100 ml

 Total (approx.) - 900 ml

 VASTI
MUSTADI RAJAYAPANA VASTI
DRUGS FOR KALKA:

 YashtiMadhu
 Satahwa
 Syama
 Kalinga
 Rasanjana
 VASTI
MUSTADI RAJAYAPANA VASTI
DRUGS FOR KASHAYA:
Musta Patha Guduchi
Eranda Bala Rasna
Punarnava Manjishta Aragvadha
Useera Trayamana Aksha
Rohini Madana Phala (2)
Laghu Panchamula
 MODERN
PERSPECTIVE
OSTEO - ARTHRITIS
 It is a non-inflammatory
degenerative condition
characterized by degeneration
of articular cartilage and
formation of new-bone i.e.,
Osteophyte
 OSTEO - ARTHRITIS
 Common in Wt. bearing
joints
 Also seen in Spine & Hands
 Both male & Female are
affected
 More common in females
 SYNONYMS
 Degenerative Arthritis

 Degenerative Joint Disease

 Hypertrophic Arthritis

 Osteo - Arthrosis
RISK - FACTORS
 Poor posture
 Obesity

 Occupation

 Infections

 Hereditary

 Sedentary Life-style
 RISK - FACTORS
 Inherited Collagen defects
 Ageing process in joint
cartilage
 Defective lubricating
mechanism
 Incompletely treated
congenital dislocation of Hip.
RISK - FACTORS
o Poor Nutrition

o Lack of flexibility exercises

o Diabetes

o Hypertension
 PRIMARY O.A.
 More common than secondary
 Un-known cause
 Common in elders
 Seen Wt. bearing joints
 Mainly due to wear & tear
changes
 SECONDARY – O.A.
 Injury to joint
 Previous infection
 R.A.

C DH
 Deformity

 Obesity

 Hyper-thyroidism
 STAGE - I
 General wear & tear
 Nutritional deficiency of calcium & Proteins
 Pain & Discomfort
 Stiffness

 Compromised movements & flexibility

 STAGE - II
Wear & tear of actual joint
cartilage
Diminished joint space
Diminished synovial fluid
Painful movements
 STAGE - III
Distinctly diminished
Synovial fluid
Distinctly diminished joint
space visible in X-ray films
 STAGE - IV
 Severely destroyed joint cartilage
 Bony spurs or spikes coming from under
the cartilage
 Quite painful joints
 Swollen joints restricted movements
 Pain & swelling spreading to surrounding
structures
 SYMPTOMS
Joint stiffness
More in the Morning & Evening
Increased with activity
Painful joints more on exertion
& climbing stairs
Relief with rest
Swelling of joint structures
 SYMPTOMS
Tenderness to touch and pressing
Crating sound in joints
Restricted joint movements
Disrupted daily activities
Radiologically reduced joint space,
deformed joint contours and
osteophytic changes
TREATMENT

PROTOCOL
 PHARMACOLOGICAL
NSAIDS

• Aspirin
• Celecoxib
• Diclofenac
• Etodolac
• Ibuprofen
• Indomethacin
• Ketoprofen
 PHARMACOLOGICAL
NSAIDS
• Keterolac
• Nabumetone
• Naproxen
• Oxaprozin
• Piroxicam
• Salsalate
• Sulindac
• Tolmetin
 NSAIDS – SIDE EFFECTS
• Nausea
• Vomiting
• Liver-problems
• Kidney-problems
• Constipation
• Anxiety
• Abnormal heart-rate
• Bleeding & bruising problems
• Light-headedness
• Numbness & tingling in Mouth
 PHARMACOLOGICAL
NARCOTIC / OPIOD ANALGESICS

Codeine
Hydro-codone
Oxycodone
Methadone
Morphine
Fentanyl
 OPIODS -SIDE EFFECTS
• Constipation
• Nausea
• Dizziness
• Sedation
• Itching
• Addiction
• Vomiting
 OPIODS -SIDE EFFECTS
• Abdominal pain
• Head-ache
• Dry-mouth
• Respiratory depression
• Chest pain
• Abnormal Heart-beats
• Cardiac arrest
• Death
 PHARMACOLOGICAL
CORTICO-STEROIDS

Dexamethasone
Prednisone
Betamethasone
Prednisolone
Triamcinolone
clobetasol
CORTICOSTEROIDS -SIDE EFFECTS

• Osteoporosis
• Hypertension
• Diabetes
• Weight gain
• Increased vulnerability to infections
• Cataracts, Glaucoma
• Thinning of skin
• Easy bruising
 NON PHARMACOLOGICAL
• Lifestyle modification
• Stretching & Strengthening exercises
• Physiotherapy
• Guided Yoga posture exercises
• Tai – chi movements
• Flexibility enhancement exercises
• Crepe bandage & Knee-cap
 SURGICAL

Lubrication injections

Re-aligning the bones

Arthroscopy

Joint replacement

Total joint replacement