Evidence Based Ayurvedic Treatment Guideline for Management of Sandhivata (Osteo-arthritis) Evidence Based Ayurvedic Treatment Guideline for Management of Sandhivata (Osteo-arthritis)

Abstract

Sandhivata (osteoarthritis), a degenerative disorder of the joints especially affecting weight bearing joints like knee joint, elbow joint etc. results in painful and restricted movement of the affected joint. Old age, malnutrition, obesity, working pattern, etc. are the contributing factors for manifestation of Sandhivata. Sandhivata has been mentioned in Ayurved under title of Vatavyadhi.

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Journal of Natural & Ayurvedic Medicine
ISSN: 2578-4986
Evidence Based Ayurvedic Treatment Guideline for Management of
Sandhivata (Osteo-arthritis)
J Nat Ayurvedic Med
Evidence Based Ayurvedic Treatment Guideline for
Management of Sandhivata (Osteo-arthritis)
Padhar B* and Jaiman D
PG Department of Kayachikitsa, National Institute of Ayurveda, India
*Corresponding author: Bharat Kumar Padhar, Lecturer, PG Department of
Kayachikitsa, National Institute of Ayurveda, Jorawar singh gate, Amer road,
Jaipur, Pin code 302002, India, Tel: 09638435942; Email: bcpadhar@gmail.com
Abstract
Sandhivata (osteoarthritis), a degenerative disorder of the joints especially affecting weight bearing joints like knee joint,
elbow joint etc. results in painful and restricted movement of the affected joint. Old age, malnutrition, obesity, working
pattern, etc. are the contributing factors for manifestation of Sandhivata. Sandhivata has been mentioned in Ayurved
under title of Vatavyadhi. Various Ayurvedic formulations like Kwatha, Guggulu Kalpana, Ghreeta, Taila, Gutika, Rasa
Aushadhi and Panchakarma procedures like, Abhyanaga, Swedana, Basti, Janubasti, Rasayana therapy, Agnikarma have
been mentioned in classics for treatment of Sandhivata. Use of these various formulations and treatment modalities,
considering Vikara Prakruti, Vikara Adhisthana and Vikara Sammutthana can provide expected results in such joint
deteriorating condition. An attempt has been done to review various formulations mentioned in Ayurveda classics for
treatment of Sandhivata and tried to establish the guideline for rational use of these treatment modalities in specific
pathological condition of Sandhivata, which may be useful for clinician and researcher for their clinical practice and
future research plan respectively.
Keywords: Ayurvedic Treatment; Vata Vyadhi; Cartilage Lesions
Introduction
Sandhigata Vata is one of Vata Vyadhi characterized by
the symptoms such as Sandhishoola (joint pain) and
Sandhishopha (swelling of joint). Osteoarthritis (OA) is
degenerative joint disorder, represents failure of the
diarthrodial (movable, synovial-lined) joint. OA of knee
joint comes under the inflammatory group which is
almost identical to Sandhigata Vata described in
Ayurveda with respect to etiology, pathology, and clinical
features. Osteoarthritis (OA) is the most common form of
arthritis, which is degenerative in nature. It is
characterized by progressive disintegration of articular
cartilage, formation of new bone in the floor of the
cartilage lesions (eburnation) and at the joint margins
(osteophytes), and leads to chronic disability at older ages
[1]. Clinical manifestations of OA range from mild to
severe, and affect the joints in hands and weight bearing
joints such as knees, hips, feet and spine. OA is a clinical
syndrome characterized by joint pain, tenderness,
Review Article
Volume 3 Issue 4
Received Date: November 11, 2019
Published Date: November 29, 2019
DOI: 10.23880/jonam-16000212

Journal of Natural & Ayurvedic Medicine
Padhar B and Jaiman D. Evidence Based Ayurvedic Treatment
Guideline for Management of Sandhivata (Osteo-arthritis). J Nat
Ayurvedic Med 2019, 3(4): 000212.
Copyright© Padhar B and Jaiman D.
2
limitation of movements, crepitus, occasional effusion and
variable degrees of inflammation without systemic effects
[2]. According to epidemiology, the prevalence of OA in
India is 22-39%. Radiographic evidence of OA is present
in majority of people over age 65; among them. 80%
people are over 75 years. Approximately, 11% of those
over 65 have symptomatic OA of the knee. In India, 5.3%
males and 4.8% females are aged more than 65 years [3].
OA strikes women more often than men and it increases
in prevalence, incidence and severity after menopause.
The aetiology of OA is multi-factorial. Various
morphological as well as biochemical changes result in a
softened, ulcerated and malfunctioning articular cartilage
[3]. It has been postulated that age, gender, body weight,
repetitive trauma and genetic factors are the risk factors
which play an important role in the manifestation of OA
[4].
Sushruta has described the disease in Vatavyadhi
chapter under the heading of Sandhigata Vata, while
Charaka has described Sandhigata vata under the
Vatavyadhi as Sandhigata Anila [5]. The diseases
produced by morbid vatadosha are more common in
Jaravastha (old age). The vitiated vata combines with
other vitiated dosha, rakta, ama, etc and gets located in
the joint to produce the disease. Being a disease related to
madhyamarogamarga, Sandhigata vata is either
Kastasadhya or Asadhya. On the basis of symptomatology
and nature of the disease, Sandhigata vata is much similar
to OA, which is the most common degenerative joint
disease in older people.
Aim and Objective
To review the various treatment modalities mentioned
in Ayurved for treatment of Sandhivata and to establish
evidence based guideline for its rational utility.
Material and Methods
Charaka samhita, Sushruta Samhita, Astang Hridya
and Samgraha, Yogaratnakar, Bhavaprakash and
Sharangadhar Samhita Chakradatta, Bhaishajya Ratnavali
and other relevant modern books, published articles on
Sandhivata or Osteo-arthritis and internet sources were
used to review the treatment approaches mentioned to
manage osteoarthritis or Sandhivata.
Results and Discussion
Sandhivata is a vatavyadhi occurring due to vitiation of
vata ether due to consumption of vatavardhaka Ahara and
Vihara or due to avarana of vata. Various therapeutic
measures mentioned for Sandhivata are based on its
pathogenesis mechanism. The patients of Sandhivata on
bases of their pathology can be broadly divided in three
categories;
 Bahu Doshaja Sandhivata (Sandhivata occurring due to
excessive morbid Dosha)
 Madhyama Doshaja Sandhivata
 Alpa Doshaja Sandhivata
Treatment plan according to above categories;
 Nidana Parivarjana
Pathya Apathya
 Pathya Aahara: Godhuma, Mamsa, Raktashali,
Godugdha, Ajadugdha, Ghrita, Draksha, Ama, Madhuka,
Ushna Jala, Sura, Surasava, Madhura – Amla – Lavana
Rasa pradhana ahara.
 Pathya Vihara: Atapa Sevana, Mridu Shayya,
Ushnodaka Snana etc.
 Apathya Aahara: Yava, Kodrava, Chanaka, Kalaya,
Sheeta Jala, Ati Madya Pana, Sushka Mamsa, Katu-Tikta-
Kashaya Rasa pradhana ahara.
 Apathya Vihara: Chinta, Ratri Jagarana, Vega
Vidharana, Shrama, Anashana, Vyavaya, Vyayama,
Chankramana, Kathina Shayya.
 Bahu Doshaja Sandhivata: Samshodhana
 Madhyama Doshaja Sandhivata: Langhana, Pachana
and Shamana
 Alpa Doshaja Sandhivata: Langhana and shaman
therapy
Samsodhana Therapy
Osteoarthritis or Sandhivata mainly occurring due to
obesity having Bahu Dosha condition requires
Samshodhana. Following Panchakarma treatment can be
effective for treatment of Sandhivata of obese patients;
 Vamana: By Madanaphala Pippali Yoga
 Virechana: Abhayadi Modak and Trivruta Avaleha,
Argavdhadi Kashaya, Triphala Kashaya
 Asthapana Basti: Dashamuladi Niruha basti,
Erandamuladi Niruha Basti
Raktamokshana Therapy
If there is involvement of Rakta Dhatu in Samprapti of
Sandhivata, Rakta Mokshana by Jalauka (Bloodletting
through leech) from affected joint can provide instant
relief in pain and help to break down pathology. Rai PK, et

Journal of Natural & Ayurvedic Medicine
Padhar B and Jaiman D. Evidence Based Ayurvedic Treatment
Guideline for Management of Sandhivata (Osteo-arthritis). J Nat
Ayurvedic Med 2019, 3(4): 000212.
Copyright© Padhar B and Jaiman D.
3
al. carried out a clinical research titled ‘Efficacy of leech
therapy in the management of osteoarthritis
(Sandhivata)’. A series of 32 patients with osteoarthritis
were selected for that clinical study from the S.S. Hospital,
Banaras Hindu University, and Varanasi. Leech was
applied on affected part in that clinical trial. During the
whole study period it has been observed that pain and
stiffness start decreasing after the first sitting of leech
therapy and after the last follow-ups there was a
significant decrease in symptoms including pain, stiffness,
and tenderness. The scar of the leech bite was also
observed on the bite site but it became clear in 2-3 weeks
after the completion of last sitting of leech therapy. In
some patients itching was also observed and subsided
after 2-3 hours of removal of leech. The bleeding of the
bite site was also observed up to more than 1 hour in few
cases. No radiographical changes occurred after
completion of the study. On basis of that pilot study they
concluded that leech therapy is beneficial in reduction of
pain, tenderness, stiffness, crepitus, and swelling in the
patients of osteoarthritis. With the help of leech therapy,
quality of life of the arthritis patients can be improved.
The hazards of prolong use of analgesic; anti-
inflammatory drugs by using leech therapy can be
avoided.
Agnikarma Therapy
Patients of osteoarthritis having severed joint pain can
be treated effectively by Agnikarma on affected joint with
Pancha Dhatu Loha Shalaka. A research work conducted
by Nilesh Jethava et al entitled ‘Role of Agnikarma in
Sandhigata Vata (osteoarthritis of knee joint)’ concluded
that Agnikarma (therapeutic heat burn) provides instant
relief from pain by balancing local Vata and Kapha Dosha
without any untoward effects. A total of 28 diagnosed
patients of Janugata Sandhivata were registered and
randomly divided into two groups. In Group-A, Agnikarma
was done with Rajata Shalaka while in Group-B
Agnikarma was performed by Loha Shalaka in four
sittings. Assessment in relief of signs and symptoms was
done by weekly interval, and Student's t-test was applied
for statistical analysis. Group-A provided 76.31% relief in
pain while Group-B provided 83.77% relief. Relief from
crepitus was observed in 57.13% of patients of Group-A,
while 57.92% of patients of Group-B. There was
statistically insignificant difference between both the
groups. Loha Shalaka provided better result in pain relief
than Rajata Shalaka [6].
Shamana Therapy
After Shodhana or proper Langhana and Pachana,
Shamana therapy can effectively manage the remaining
symptoms.
Drugs used for Pachana or Agnidipana in patients of
Sandhivata:
 Rasna
 Lasuna
 Panchatikta Drvya Kashaya
 Agnitundivati
 Sanjivani vati
 Lasunadi vati
 Hingvastaka Churna
 Shivakshara Pachana Churna etc can be used to correct
Agni before starting the Shamana therapy.
Drugs Used as Shamana therapy for Treatment of Shandhivata
Guggulu Kalpana
Sneha Kalpana
Kwatha
Rasa Aushadha
Yogaraja Guggulu
Dashmuladi taila
Dashamula Kwath
Navajivana rasa
Panchatikta Guggulu
Panchatikta Ghrita
Rasna Saptaka kwath
Godanti Bhasma
Rasnadi Guggulu
Rasna tail
Phalatrikadi Kwath
Prvala Pisti
Gokshuradi Guggulu
Lashunadi tail
Maharasnadi Kwath
Muktashukti Bhasma
Mahayogaraja guggulu
Nirgundi tail
Erandmuladi Kwath
Samir pannaga rasa
Tryodashanga guggulu
Punarnavastaka kwath
Bruhata vatchintamani rasa
Saptavinshati Guggulu
Gokshuradi Kwath
Vatavidhvansa rasa
Laksha guggulu
Abha Guggulu
Table 1: Drugs Used.

Journal of Natural & Ayurvedic Medicine
Padhar B and Jaiman D. Evidence Based Ayurvedic Treatment
Guideline for Management of Sandhivata (Osteo-arthritis). J Nat
Ayurvedic Med 2019, 3(4): 000212.
Copyright© Padhar B and Jaiman D.
4
Local Applications or procedures
Churna
Rasayan Aushadha
Avaranahar and Sthoulya hara
Shulahara taila
Asvagandha churna
Lasuana
Triphala guggulu
Lepa Guti
Chopachini churna
Methika
Varuna shigru kwath
Janu Basti
Bala Churna
Shilajatu
Vidandadi Lauha
Janu Abhyanga
Shallaki Churna
Asvagandha
Kanchanara guggulu
Patra Pinda Sweda
Guggulu powder
Bala
Kanchanara twak kwath
Upanaha Sweda
Rasana Churna
Kshira-Ghrita Abhyasa
Madhudaka
Table 2: Local Procedures.
Rational Use of above Mentioned Formulation
in Treatment of Sandhivata
According to Sadvidhakriyakala of Sandhivata, the use
of above mentioned treatment modalities can be effective,
if used properly.
 Mild severity of symptoms of Sandhivata having less
degeneration of cartilages of joints is a condition
occurring due to Kostha Dusti. These types of patients
have joint pain when they have flatulence or
indigestion. They can be treated effectively with Pancha
vidha kashaya kalpana like, Kwath, Churna etc.
mentioned above.
 Moderate severity of symptoms having moderately
degeneration of cartilages of joints resulting in
crepitating sound on movement of joint is a condition
of Shakaha Dushti and should be managed with Sneha
kalpana like Ghrita, Taila etc. Anuvasan Basti with
Panchtikta Taila, Nirgundi tail and Matra basti with Tila
taila, Erand taila etc can also be beneficial to manage
this condition.
 Severe degeneration of joints leading to unbearable
pain and other symptoms like restricted movement of
joint, inflammation etc are due to involvement of
Marmasthisandhi (Madhyama Rogamarga) in
pathogenesis of Sandhivata, which requires fast acting
and Sukshama Guna, Vyavayi Guna dominant drugs,
which can easily reach to micro channels of bone
nutrition and show its effect to reduce the symptoms.
The Guggulu kalpana and Ras-Aushadh should be used
for such type of pathological condition of Sandhivata.
 Rasayana Aushadha like Pravala pisti, Mukta shukti,
Godanti Bhasma, Hiraka Bhasma etc being good source
of calcium, should be used having malnutrition and
osteoporosis condition associated with Sandhivata.
Evidences of above Mentioned some Ayurvedic
Interventions for Treatment of Sandhivata
(Osteoarthritis)
Some evidence based clinical researches conducted for
treatment of Sandhivata are mentioned here to support
above guidelines.
1. Pradeep L, et al. concluded in their research work
entitled ‘Effect of Anuvasana Basti with Ksheerabala
Taila in Sandhigata Vata (Osteoarthritis)’ that
Anuvasana Basti with Ksheerabala Taila has provided
significant improvement in the subjective symptoms of
Sandhigata Vata. A total of 30 subjects with OA knees
were recruited for the study among which 25 subjects
(16 female and 9 male) completed the whole course
and 5 dropped out. The patients were treated with
Anuavasana Basti with Ksheerabala Taila 120 ml for 10
days. 5 g of Saindhava was added to Ksheerabala Taila
while administering Basti. The Basti was given daily
between 2 pm and 3 pm in the afternoon after food.
The subjects were not given any other medications or
topical treatments during the trial. The patients were
assessed pre-test, post-test and after the follow-up
period of 20 days. There was significant reduction (P <
0.05) in subjective symptoms such as pain, swelling,
tenderness, crepitus and walking velocity. There was
insignificant change in radiological findings. In the
overall effect of the therapy, 56% (14) had mild
improvement, 48% (08) had moderate improvement
and 12% (03) had no improvement [7].
2. A clinical research entitled ‘Clinical evaluation of
Boswellia serrata (Shallaki) resin in the management of
Sandhivata (osteoarthritis)’ conducted by Gupta PK, et
al. concluded in their research work that Patients’
mobility was improved significantly in both the groups,
which indicates the efficacy of Shallaki over chief
complaints. Remission in sandhishula, stambha and
radiological improvement was found to be better in
oral Shallaki group. Remission in sandhishotha was
maximum in group B patients treated with Shallaki
both orally and locally, whereas equal improvement in
sparshasahyata was observed in both the groups. Some
patients in group A showed complete relief. Overall
effect of therapy suggests that Shallaki provided
moderate improvement in maximum subjects [8].
3. Babul Akhtar, et al. in their research work entitled
‘Clinical study on Sandhigata Vata w.s.r. to
Osteoarthritis and its management by Panchatikta
Ghrita Guggulu’. In this study total 49 patients having

Journal of Natural & Ayurvedic Medicine
Padhar B and Jaiman D. Evidence Based Ayurvedic Treatment
Guideline for Management of Sandhivata (Osteo-arthritis). J Nat
Ayurvedic Med 2019, 3(4): 000212.
Copyright© Padhar B and Jaiman D.
5
the complaints of Osteoarthritis were randomly divided
into 2 groups. In Group A, patients were treated with
Panchatikta Ghrita Guggulu Vati along with Abhyanga
and Nadi Swedana and in group B patients were treated
with only Abhyanga and Nadi Swedana. The data shows
that Panchatikta Ghrita Guggulu along with local
Abhyanga and Nadi Swedana i.e. group A has provided
better relief in the disease Sandhigata Vata [9].
4. Shah MR, et al. conducted a research work on ‘A Clinical
study of Matra Vasti and an ayurvedic indigenous
compound drug in the management of Sandhigatavata
(Osteoarthritis)’. In this clinical trial, Matra Vasti
(therapeutic enema) was given with Bala taila as Vasti
is the best treatment for vatavyadhies. It has
vatashamaka and rasayana properties. Indigenous
compound drug containing Guggulu, Shallaki,
Yastimadhu, Pippali, Guduchi, Nirgundi, Kupilu and
Godanti was given in one group along with Matra Vasti.
In this study, 33 patients of Sandhigatavata completed
the treatment. Patients were randomly divided into
two groups. Sixteen patients in Group-A (sarvanga
Abhyanga-swedana + matravasti) and 17 patients in
Group-B (sarvanga Abhyanga–swedana+ matravasti +
indigenous compound drug). The results of the study
indicate that the patients of both the groups obtained
highly significant relief in almost all the signs and
symptoms of Sandhigatavata [10].
5. Kshipra Rajoria, et al. conducted a clinical study
entitled ‘Clinical study on Laksha Guggulu, Snehana,
Swedana & Traction in Osteoarthritis (Knee joint)’ to
assess the efficacy of Laksha Guggulu, Snehana,
Swedana & Traction in the management of
Osteoarthritis (Knee joint). For the present work, 30
clinically diagnosed patients were selected and
randomly divided into three groups. Group a treated
with Laksha Guggulu orally, Group B treated with
snehana & swedana traction, Group C treated with
Laksha Guggulu, Snehana, Swedana & Knee Joint
Traction. The various criteria worked upon were joint
pain, oedema, tenderness, restriction of joint
movement, stiffness, local crepitation, walking distance.
Significant results were obtained on pain in joint
movement, restriction in joint movement, joint
stiffness, and local crepitation nearly in all the groups
with best result in combined group or group C [11].
Conclusion
Osteoarthritis or Sandhivata, according to its
progressive condition require specific treatment to get
cured. Panchavidha kashaya kalpana can be effective in
Kosthagata or primary condition of Sandhivata, Sneha
Kalpna can be useful in Shakhagata or moderately
degenerative condition of Sandhivata and Guggulu
kalpana as well as Rasa Aushadhi can effectively treat the
terminal or Marmasthi Sandhigata stage of Sandhivata.
Selection of drug for treatment of Sandhivata on bases of
its Sadavidha kriyalakala can provide accurate and instant
result to get rid from this disease.
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Journal of Natural & Ayurvedic Medicine
Padhar B and Jaiman D. Evidence Based Ayurvedic Treatment
Guideline for Management of Sandhivata (Osteo-arthritis). J Nat
Ayurvedic Med 2019, 3(4): 000212.
Copyright© Padhar B and Jaiman D.
6
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