EFFICACY OF PANCHAKARMA IN SANDHIVATA W.S.R. TO KNEE ARTHRITIS

Abstract

Inflammation of knee joint is called knee arthritis. Among various forms of knee arthritis common is degenerative type of knee osteoarthritis It is the major cause of loco motor disability in old age people particularly among women. Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are the current available pharmaceutical management of knee osteoarthritis which are associated with adverse side effects. Thus, there is need of research in traditional system of medicines for cost effective and long-term management of knee OA. Degenerative Knee osteo arthritis is almost similar to the Sandhivata describes in Ayuveda with respect to aetiology, pathology and clinical features. With the use of medicines Ayurveda also employs the prospective of Panchakarma in the various therapeutic measures, which is a kind of Shodhan Chikitsa. Panchakarma provides various therapeutic benefits as detoxification, improved circulation, spasm and pain relief. Hence objective of this review article is to describe the efficacy of Panchakarma in knee-arthritis with taking consideration of disease mentioned in Ayurvedic classics as Sandhivata

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Review Article ISSN: 2320-5091 Impact Factor: 6.719
EFFICACY OF PANCHAKARMA IN SANDHIVATA W.S.R. TO KNEE ARTHRITIS
Tanuja Mehta1, Vipin Kumar2, Sheetal Verma3, Uttam Kumar Sharma4
1PG Scholar 1st Year, Department of Panchakarma,
2Assistant Professor, Samhita, Sanskrit Evum Siddhanta Dept.,
3Associate Professor, Samhita, Sanskrit Evum Siddhanta Dept.,
4Professor and Head, Department of Panchakarma,
Uttarakhand Ayurved University, Gurukul Campus, Haridwar, Uttarakhand, India
Corresponding Author: tanuja16oct@gmail.com
https://doi.org/10.46607/iamj.3409012021
(Published online: January 2021)
Open Access
© International Ayurvedic Medical Journal, India 2021
Article Received: 26/12/2020 - Peer Reviewed: 28/12/2020 - Accepted for Publication: 31/12/2020
ABSTRACT
Inflammation of knee joint is called knee arthritis. Among various forms of knee arthritis common is degenerative
type of knee osteoarthritis It is the major cause of loco motor disability in old age people particularly among wom-
en. Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are the current available pharmaceutical
management of knee osteoarthritis which are associated with adverse side effects. Thus, there is need of research in
traditional system of medicines for cost effective and long-term management of knee OA. Degenerative Knee os-
teo arthritis is almost similar to the Sandhivata describes in Ayuveda with respect to aetiology, pathology and clini-
cal features. With the use of medicines Ayurveda also employs the prospective of Panchakarma in the various
therapeutic measures, which is a kind of Shodhan Chikitsa. Panchakarma provides various therapeutic benefits as
detoxification, improved circulation, spasm and pain relief. Hence objective of this review article is to describe the
efficacy of Panchakarma in knee-arthritis with taking consideration of disease mentioned in Ayurvedic classics as
Sandhivata
Keywords: Ayurved, Panchakarma, Sandhivata.
INTERNATIONAL
AYURVEDIC
MEDICAL JOURNAL

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doi:10.46607/iamj.3409012021 | IAMJ January 2021 | www.iamj.in
213
INTRODUCTION
Arthritis and Knee Joint, Arthritis is the blanket term
use to refer more than 100 rheumatic diseases and
conditions that affects the joints, tissue surrounding
the joints and the other connective tissue 1. Knee Ar-
thritis includes the primary symptoms of inflammation
like Pain, swelling, and stiffness. Knee is the largest
synovial joint in humans, which is composed of osse-
ous structures (distal femur, proximal tibia, and patel-
la), cartilage (meniscus and hyaline cartilage), liga-
ments and a synovial membrane. The latter is in
charge of the production of the synovial fluid, which
provides lubrication and nutrients to the avascular car-
tilage 2. Unfortunately, given the high use and stress
on knee joint, it becomes a frequent site for painful
conditions like OA 3,4 which mainly afflicts the knee
joint in the transition period between middle age and
old age.5,6,7 particularly in women who are progressing
towards menopause or those who have already set in 8.
Knee Osteoarthritis-
Different from inflammatory arthritis, inflammation in
OA is chronic and low-grade inflammation, involving
mainly innate immune mechanisms. Synovitis (infil-
tration of inflammatory cells into the synovium) is a
common finding of OA and it can be present in early
stages of the disease but is more prevalent towards the
more advanced stages and can be related with severi-
ty9. Previously knee osteoarthritis was interpreted as
wear and tear of the articular cartilage disease because
of ageing and not related to inflammation. Although
the disease pathophysiology is still poorly understood
and is under investigation, now it is accepted that knee
osteoarthritis is multi factorial in origin where both
inflammatory and biomechanical whole organ disease
processes plays an important role. Knee osteoarthritis
influenced by combination of factors including age,
obesity, joint integrity, genetic predisposition, lower
limb alignment, trauma and inflammation by metabol-
ic syndrome. 10-17 knee osteoarthritis implicit articular
cartilage damage, bony osteophytes formation, sclero-
sis of the subchondral bone and in advanced cases
subchondral cyst formation pathologically regardless
of the underlying mechanism.
Classification of Knee Osteoarthritis-
According to its aetiology OA is classified into two
groups: primary (idiopathic or non-traumatic) and
secondary (usually due to trauma or mechanical misa-
lignment).
One of the clinical classification criteria most fre-
quently used is the one developed by the American
College of Rheumatology. 18,19
• Clinical Knee pain for most days of the prior month,
in addition to at least 3 of the following:
• Crepitus on active joint motion
• Morning stiffness less than 30 minutes’ duration
• Age older than 50 years
• Bony enlargement of the knee on examination
• Bony tenderness of the knee on examination
• No palpable warmth.
• Clinical plus radiographic: Knee pain for most days
of the prior month, plus radiographic evidence of os-
teophytes on joint margins in addition to 1 of the fol-
lowing:
1. Crepitus on active motion
2. Morning stiffness less than 30 minutes’ duration
3. Age older than 50 years.
• Clinical plus laboratory: Knee pain for most days of
the prior month, in addition to at least 5 of the follow-
ing:
1. Crepitus on active joint motion
2. Morning stiffness less than 30 minutes’ duration
3. Age older than 50 years
4. Bony tenderness to palpation
5. Bony enlargement
6. No palpable warmth
7. Erythrocyte sedimentation rate below 40 mm/h
8. Rheumatoid factor less than 1:40
9. Synovial fluid consistent with OA (white blood cell
count < 2000/μL).
Sandhivata-
Acharya Charaka was the first person who described
the disease separately named “Sandhigata Anila” but
has not included under 80 types. According to Ayur-
veda Pphysiological functions of the body is governed
by three Doshas that is, Vata, Pitta, and Kapha. Vitia-
tion of these Doshas leads in disease manifestation.

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214
As the age progress degeneration of the body parts
occurs due to the influence of vata dosha. Sandhivata
is the result of such degeneration 20. Also, Vata get
aggravated by various reasons other than ageing like
improper diet, injury, exposure to cold, suppression of
natural urges etc. vitiated Vata shelter in the joints.
Due its Rooksha, it dries up the lubricating synovial
fluid inside the joint capsule, degenerates the joints
and can causes the early destruction of cartilage.
Sandhivata is one of the consequences of this process.
Hence Sandhivata is a painful condition of the joint
explained in Ayurvedic text under Vatavyadhi 21, 22, 23
which is characterize by following features-
• Shoola (pain)
• Vatapurnadruti Sparsha (sound resembling that
made when rub against a balloon or transparent
container filled with air)
• Shotha (swelling)
• Vedana during Prasaran and Akunchan (painful
movement including extension and flexion)
• Atopa (abnormal sounds due to damage of joints
or crepitus)
• Sandhihanti (restriction of joint movements)
Treatment
Sandhivata is figures as Kashtsadhya Vyadhi due to
involvement of Vatadoasha, Madhyam Roga Marga
and Dhatu kshaya. Thus, it is important to prevent
early degenerative changes along with treating
Sandhivata. Ayurveda plays an important role in both
of these aspects. A common treatment for Vata Vyadhi
has been described by Acharya Vagabhata i.e. repeat-
ed use of Snehana (Oleation therapy) and Swedana
(Sudation therapy), Basti (Enema) and Mridu
Virechana(Mild Purgative) 24 Acharya Sushruta has
mentioned the treatment for Sandhigata Vata clearly
i.e. Snehana, Upanaha, Agnikarma, Bandhana and
Unmardana25.
Efficacy of Panchakarma -
The therapeutic measures of Ayurveda not only in-
volve use of medicine but also utilizes other ap-
proaches such as; Panchakarma26. Panchakarma is a
very unique therapeutic procedure, because of its pre-
ventive, promotive, prophylactic and rejuvenate prop-
erties as well as providing a radical cure 27. Diseases
which are associated with pain mainly involve local-
ized symptoms and vitiated Vata dosha.28 Pan-
chakarma therapy help to relief localized symptoms in
knee osteoarthritis associated with pain such as in-
flammation, swelling and strain by pacifying the Vata
Dosha.
Mode of Action of Various Panchakarma Thera-
pies in Knee osteoarthritis-29
Snehana-(Oleation Therapy)
It is the first line of treatment explained in the classics
for Sandhivta as Sneha is antagonist to the degenera-
tion process caused by excessive Ruksha Guna (dry
quality) and Khara Guna (rough quality) of vitiated
Vata.
1. Abhyanga (Therapeutic/Preventive Herbal Oil
Massage)- Abhyanga reduces the provoked Vata,
which is responsible for the decay in the Dhatus and
for manifestation of features like pain, stiffness, and
crackers. According to modern studies, massage stim-
ulates blood circulation and assists the lymphatic sys-
tem, improving the elimination of waste throughout
the body. Absorption through the skin can be en-
hanced by suspending the drug in an oily vehicle and
rubbing it on the skin. 30
In cases of osteoarthritis, a study found an 88% im-
provement when combining Abhyanga with steam and
manual traction 31. Patients reported improvement in
joint movement and reduction in joint swelling with
oil applications
2. Janu Basti: Janubasti by lubricating or improving
the local blood circulation in knee joint, it enhances
the mobility of the knee joint and maintains the integ-
rity of the knee joint.
3. Sandhipichu- By nourishing the bone and connec-
tive tissue around the knee joint it prevents the degen-
eration, inflammation in the knee osteoarthritis and
heals pain.
4. Sandhi Lepa- It indicated where Kapha Dosha is
involved along with Vata and helps to reduce stiffness
or effusion in knee osteoarthritis.
Svedana: (fomentation) Svedana is specially indicat-
ed in symptoms like Sankocha (contraction or flex-
ion), Ayama (extension), Shula (pain), Stambha (stiff-
ness), Gaurava (heaviness), and Supti (numbness). 32,

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33 These are the usual clinical manifestations of
Sandhigatavata. This panchakarma therapy helps to
enables the free circulation in the joints and relaxes
the muscles, which further reduces the stiffness and
pain, dispenses the symptomatic relief in knee osteo-
arthritis.
Bashpa Swedan- Ekang Bashpa or Nadi Sweda- when
the pain is limited to a part of the body
Pinda Sweda- (bolus formation)-generally done as a
local fomentation, applied on the pain afflicted joints.
1. Churna Pinda Sweda- in it wet bolus prepared
from analgesic and anti-inflammatory herbal
powder used for lubrication in knee osteoarthritis.
2. Patra Panda Sweda (Leaf Bolus Fomentation)-
fresh leaves of Vata alleviating /pain reliving
herbs are used
3. Shashtika Shali Panda Sweda- due to the proper-
ties of rejuvenation, nourishment, strengthen the
bone and connective tissue it is preferred where
there are signs of severe Vata vitiatition and de-
generation of knee joints.
Dhara/Seka (Pizhichill) - herbal oil streams over the
painful knee joints, Upanaha (Poultice Sudation)- is a
type of Svedana indicated in classics34 as one of the
components in the treatment of Sandhigatavata.35
Studies have revealed the fact that lipid medium is
highly suitable for penetration of the drug molecule
through stratum corneum.
Mriduvirechana- Treatment of Sandhigatavata usual-
ly begins with a basic process like Mriduvirechana. It
cleanses the body to restore patency of the Srotasa,
which improve the access of healing material as well
as nourishment to the body components 36.
Basti- Basti is considered to be best Panchakarma
therapy for vitiated Vata and related painful condi-
tions including knee osteoarthritis as it reinforced and
rejuvenates the joint and soft tissues, assist fast heal-
ing and hence enabled the smooth movements at the
knee joints.
Matrabasti- Is a type of Anuvasan Basti 37 Charaka
while assessing the Anuvasana Basti records the di-
gestion of Sneha by the words “Sneham Pachati
Pavakah”. Basti, through its action on Vata and Agni,
promotes the formation of Dhatus. According to
Acharya Charak Matrabasti is always applicable to
those emaciated due to overwork, physical exercise,
weight lifting, journey on vehicles, in debilitated per-
son as well afflicted with Vata disorders 38,Matra bas-
ti is a type of Snehabasti, which is unique therapeutic
procedure because of its preventive, promotive, reju-
vinative and curative properties and helps to alleviates
Vata, nourishes Aasti and Majjadhatu39,40 The colon is
considered as main seat of Vata, and Vata-alleviating
substances administered through the rectocolonic
route in Matrabasti are able to have their optimum
effect on the seat of Vata 41.
CONCLUSION
Although numerous modern treatments for various
forms of OA have been identified, they suffer from
various drawbacks, such as lack of efficacy, excessive
side effects and high cost42 The current pharmacologi-
cal management of osteoarthritis includes the admin-
istration of analgesics and NSAID’s , but their use
neither provides adequate pain relief nor deceleration
in disease process. In addition, NSAIDs are associated
with adverse effects 43, 44, 45. Due to which the use of
alternative therapies is on the rise. WHO recommends
to include traditional system of medicine in global
health care 46 Usually treatment of OA requires treat-
ment of the patient for their entire lifetime; therefore it
should be effective, friendly, safe and cheap. The goal
of OA treatment for medical profession is not only
control symptoms but also prevent disease progres-
sion, minimize disability, and improve quality of life.
Researchers claimed that Ayurveda treatment outcome
is better than or equal to conventional drug for im-
provement of pain and knee function 47. Hence it can
be concluded that Panchakarma (detoxification tech-
nique) has promising relief effect in osteoarthritis. 48
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