Effect of Nadi Sweda on symptoms of Pain, Swelling and Stiffness in Knee Osteoarthritis - An Open Labeled Single Arm Clinical Study

Abstract

Introduction: More than 100 million populations globally suffer from Osteoarthritis (OA) which is considered the leading cause of disability. The prevalence of OA knee in India is about 6% of total osteoarthritis. Therefore, there is a need for alternative and well-tolerable supplementary treatment which has no drug interaction with conventional drugs for OA. Aim and objectives: To evaluate the effect of traditional sudation therapy (Nadi Swedana) on pain, swelling and stiffness of patients with knee osteoarthritis. Method: The study was conducted after getting approval from Institutional Ethical Committee and was registered to the Clinical Trials Registry of India (CTRI/2018/03/012636 19/03/2018). A total of 20 patients with knee joint osteoarthritis were treated for 6 weeks. Pre-test and the post-test outcome measure was recorded on subjective parameters and statistically analyzed. Results: The applied score for pain, swelling and stiffness decreased significantly lower after the intervention (p<0.05). Conclusions: Traditional sudation therapy by Nadi Swedana was beneficial for patients with knee osteoarthritis.

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ORIGINAL ARTICLE
February 2023
Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
14
Effect of Nadi Sweda on symptoms of Pain, Swelling
and Stiffness in Knee Osteoarthritis - An Open
Labeled Single Arm Clinical Study
Sandipkumar Baheti1, Mahesh S2
1,2Research officer, Central Ayurveda Research Institute, CCRAS, Patiala, Punjab, India.
INTRODUCTION
Osteoarthritis is one of the leading causes of disability
and is estimated that over 100 million people globally
suffer from Osteoarthritis (OA).[1,2] It is reported that in
India the prevalence of OA was found in between the
range of 17 - 60 and 6% of this come under knee OA.
The most common evident symptoms of knee OA are
joint pain, stiffness and reduction in the function of the
knee joint.[3] The main aim of OA treatment is to reduce
joint pain and stiffness, improve mobility and quality of
Address for correspondence:
Dr. Mahesh S
Research officer, Central Ayurveda Research Institute, CCRAS,
Patiala, Punjab, India.
E-mail: maheshmtgavc@gmail.com
Submission Date: 06/12/2022
Accepted Date: 14/01/2023
Access this article online
Quick Response Code
Website: www.jaims.in
DOI: 10.21760/jaims.8.2.3
life, slow down the progress of disease and optimize
the functions of patients.[4] To date, there are no
disease-modifying treatments are available for OA in
conventional medicine. Therefore, there is a need for
alternative and well-tolerable supplementary
treatment which has no drug interaction with
conventional drugs for OA. As per the literature of
Ayurveda Vata, Pitta and Shleshma are the primary and
essential constitutional factors of the human organism.
Ayurveda considers these three factors as the actual
intrinsic factors whose imbalance causes or
predisposes the various disease conditions. These
factors are known as Doshas as they are susceptible to
imbalance and vitiation. The imbalance of Tridoshas is
the cause of diseases in the body.[5] Vata Vyadhi
denotes a group of special disease entities caused by
the disturbance of Vayu for all practical purposes.
Sandhigata Vata (osteoarthritis) is an example of Vata
Vyadhi.[6,7] The administration of Vatahara Dravyas(
drugs or processes which have opposite properties of
Vata) having properties like Snigdha
(sliminess/unctuousness), Guru ( heaviness), Ushna
A B S T R A C T
Introduction: More than 100 million populations globally suffer from Osteoarthritis (OA) which is
considered the leading cause of disability. The prevalence of OA knee in India is about 6% of total
osteoarthritis. Therefore, there is a need for alternative and well-tolerable supplementary treatment
which has no drug interaction with conventional drugs for OA. Aim and objectives: To evaluate the
effect of traditional sudation therapy (Nadi Swedana) on pain, swelling and stiffness of patients with
knee osteoarthritis. Method: The study was conducted after getting approval from Institutional Ethical
Committee and was registered to the Clinical Trials Registry of India (CTRI/2018/03/012636
19/03/2018). A total of 20 patients with knee joint osteoarthritis were treated for 6 weeks. Pre-test and
the post-test outcome measure was recorded on subjective parameters and statistically analyzed.
Results: The applied score for pain, swelling and stiffness decreased significantly lower after the
intervention (p<0.05). Conclusions: Traditional sudation therapy by Nadi Swedana was beneficial for
patients with knee osteoarthritis.
Key words: Ayurveda, Swedana, osteoarthritis, sudation therapy, CAM

Sandipkumar Baheti et al. Effect of Nadi Sweda in Knee Osteoarthritis
ISSN: 2456-3110 ORIGINAL ARTICLE
February 2023
Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
15
(hotness), Manda (mildness/slowness), Shlakshna,
Mridu, Pichchila and Sthira Gunayukta) have seen
advocated as specific treatment procedures for various
for Vata disturbances. Among these procedures
Snehana (therapeutic oleation), Swedana (sudation
therapy) and Basti (therapeutic enema) are the prime
importance.[8]
Nadi Swedana is one type of Swedan Karma (sudation
therapy) and is a popular and easy method of
traditional sudation therapy. Nadi Swedana is a
specialized traditional method type of Agnisvedaḥ in
which sudation is done by giving steam for relieving
pain, swelling and stiffness.[9] A detailed description of
Swedana is found in Ayurvedic literature and is used by
Ayurvedic physicians in the management of Sandhigata
Vata. However, we couldn’t find any report in the
literature of research investigating the effect of Nadi
Swedana on pain, swelling and stiffness in a patient
with knee osteoarthritis. Therefore, the purpose of this
observational study was to evaluate the effect on pain,
swelling and stiffness of traditional Sudation therapy
for the patient with knee osteoarthritis.
MATERIALS AND METHODS
A total of 20 patients suffering from osteoarthritis of
the knee joint, attending the OPD and IPD of the
department of Kayachikitsa, Radhakishan Tonshniwal
Ayurved College and Hospital, Akola, Maharashtra
University of Health Science, Nashik, were enrolled
irrespective of age, sex, religion, caste. The study was
conducted after getting approval from Institutional
Ethics Committee (letter no.266/18) and was
registered in CTRI (CTRI/2018/03/012636 on
19/03/2018).
Inclusion criteria
▪ Patients of the age group between 30 to 80 years.
▪ Clinically diagnosed with mild to moderate severity
of symptoms of osteoarthritis (single or both knee
joints) and confirmed by a radiologist or by an
experienced Ayurvedic practitioner.
Exclusion criteria
▪ Pain in the knee is caused by congenital dysplasia
of the affected knee, rheumatoid arthritis,
autoimmune diseases, malignancies, knee surgery
or knee-arthroscopy
▪ Co-morbid conditions such as a history of Cardiac
Arrhythmia, Acute Coronary Syndrome,
Myocardial Infarction, Stroke or Severe Arrhythmia
in the last 6 months.
Study design: Single-arm study
Duration of treatment: 6 weeks
Intervention
Nadi Swedana is a unique form of Swedana procedure
where sweating is induced by passing steam over the
body part by using a special instrument known as Nadi
Swedana Yantra. Application of oil (sesame oil) to the
body part that is to be subjected to sudation (sweating)
treatment, followed by passing the steam to the same
part with help of a tubular pipe is the procedure of Nadi
Swedana. The steam is passed through a rubber tube
fitted to the instrument and it is an easy method of
applying heat to a localized part of a body. Dashmoola
Kwath Choorna (mixture of 10 raw drugs) in Nadi
Swedana Yantra along with a sufficient quantity of
water (Table 2).
During the study period all patients were given a
placebo (capsule filled with starch powder) of 250 mg
thrice daily. To compare the before and after effects of
sudation therapy within the study group the paired t-
test was done.
Table 1: Ingredients of Dasamoola Kwath Choorna
with therapeutic actions[10,11]
SN
Drugs
Botanical
Name
Therapeutic Actions
1.
Shalaparni
Desmodium
gangeticum
Anti-inflammatory,
carminative
2.
Prishniparni
Uraria picta
Anti-inflammatory,
Antipyretic, carminative
3.
Brihati
Solanum
indicum
Anti-pyretic, Digestive,
Diuretic
4.
Kantakari
Solanum
surattense
Anti-inflammatory,
Digestive, Expectorant

Sandipkumar Baheti et al. Effect of Nadi Sweda in Knee Osteoarthritis
ISSN: 2456-3110 ORIGINAL ARTICLE
February 2023
Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
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5.
Gokshur
Tribulus
terrestris
Analgesic, Diuretic,
Carminative
6.
Bilva
Aegle
marmelos
Anti-diarrhoeal,
Astringent, Digestive
7.
Agnimanth
Premna
integrifolia
Anti-inflammatory,
Antipyretic, Analgesic
8.
Syonaka
Oroxylum
indica
Anti-inflammatory,
Digestive, Anti-pyretic
9.
Patala
Stereospermu
m suaveolens
Anti-inflammatory,
Antipyretic, Diuretic
10.
Gambhari
Gmelina
arborea
Anti-inflammatory,
Analgesic, Carminative
Assessment criteria
1. Pain: Subjective assessment was done as per the
patient’s severity of pain. This was recorded
according to Visual Analog Scale for assessment of
Pain (Table 2).
Table 2: Visual Analog Scale for assessment of Pain
Score
Grading of Pain
0
No Pain
1
Mild Pain that you are aware of but not bothered by.
2
Moderate Pain that you can tolerate without
medication.
3
Moderate Pain that is discomforting and requires
medication.
4-5
Severe Pain and the Patient began to feel anti-social.
6
Severe Pain
7-9
Intensely Severe Pain
10
Most Severe Pain. One may contemplate suicide over
it.
2. Swelling: Assessment is done by measuring the
circumference of the joint, before and after
treatment at the fixed point over the joint in
centimeters.
3. Stiffness: It was assessed as free movement
against the normal range of movements (Table 3).
Table 3: Scale for assessment of stiffness
Complete free movement
No stiffness
¾ free movements against that of the normal
range of movement
+ stiffness
½ free movements against that of the normal
range of movement
++ stiffness
¼ free movements against that of the normal
range of movement
+++ stiffness
Difficulty with the complete range of
movements
++++ stiffness
Assessment of Clinical Parameters
Detailed clinical observations were done every week
for assessment of results. For final assessments, the
clinical data were divided into four groups.
1. Complete Improvement:
a) Complete or more than 75% relief or more.
b) 75% or more relief in swelling.
c) Decrease the angle of stiffness by 75% or more.
2. Marked Improvement:
a) 50 to 75% subjective improvement in pain.
(Pain scale-1)
b) 50% or more relief in swelling.
c) Decrease the angle of stiffness by 50% or more.
3. Moderate Improvement:
a) 25 to 50% relief in pain. (Pain scale-2)
b) 25% or more relief in swelling.
c) Decrease the angle of stiffness by 25% or more.
4. Mild Improvement:
a) Pain not relieved or only less than 25% (Pain
scale-3 & 4)
b) Less than 25% relief in swelling.

Sandipkumar Baheti et al. Effect of Nadi Sweda in Knee Osteoarthritis
ISSN: 2456-3110 ORIGINAL ARTICLE
February 2023
Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
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c) Decrease in the angle of stiffness by less than
25%.
The purpose of the study was explained by physicians
and oral informed consent was obtained from the
study participants. Patient’s data were recorded in a
case Performa including information on demographic
variables of the patients such as age, gender,
education, occupation and family monthly income etc.
The patient’s symptoms of pain, swelling and stiffness
were assessed clinically and documented.
RESULTS
70% of the patients in the study were from the age
group of 41 - 60. Seventy percent of the patients
enrolled in the study were married females, 75% with
primary education, 50% were housewives and 85% of
patients are from middle-class families (Table 4). 15%
of the patients had a family history of OA and 85% had
been diagnosed for OA more than one year. Among the
study group, 50% of patients had left KOA (out of them
70% female) and 70% of the patients had taken
conventional treatment. In the comparison of the
“Pain, Swelling and Stiffness Score” of the patients in
the group, the difference between pre-test and post-
test score value was found to be statistically significant
(p<0.05). Results after 6 weeks of given therapy 50%
patient of the patients got moderate relief, 30% of the
patient got marked relief and 20% of the patient got
mild relief (Table 5).
Table 4: Distribution of the patients according to their
descriptive features.
Study Group
(n)
%
Age Group
31 to 40
02
10
41 to 50
08
40
51 to 60
06
30
61 to 70
01
05
70 to 80
03
15
Gender
Female
14
70
Male
06
30
Marital Status
Married
20
100
Unmarried
0
Occupation
Housewife
10
50
Labour
08
40
Employee/Teac
her
01
05
None/Retired
01
05
Income Status
(Monthly
Income)
Lower (below
6000)
3
15
Middle (6001 to
15000)
17
85
High (above
15000)
0
0
Education
Educated
15
75
Uneducated
05
25
Family history of
OA
Yes
05
25
No
15
75
Duration of
Diagnosis
< 1 Year
17
85
> 1 Year
03
15
Joint affected by
OA
Single
14 (Right
KOA-4, Left
KOA-10)
70
Both
06
30
History of
previous
medication
Conventional
only
14
70
Conventional &
CAM
06
30
Table 4: Outcome of treated Patients (Assessment at
baseline and after 6 weeks)
Symptoms of OA
Study Group X±SD
Pain
Pre test
3.1±0.718
Post test
1.9±0.641
t
7.712
Swelling
Pre test
31.25±6.463
Post test
30.35±5.752
t
3.111

Sandipkumar Baheti et al. Effect of Nadi Sweda in Knee Osteoarthritis
ISSN: 2456-3110 ORIGINAL ARTICLE
February 2023
Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
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Stiffness
Pre test
1.65±0.671
Post test
0.75±0.639
t
6.282
Study Group
n %
%
Result of the
treatment
Complete
00
Marked
06
30
Moderate
10
50
Mild
04
20
DISCUSSION
Literature review revealed no studies investigating the
effects of Nadi Swedana (sudation therapy) on pain,
stiffness and swelling of patients with knee OA. Nadi
Swedana is a traditional and popular method used in
this research had a heat transfer effect on the applied
area. It was reported that heat application decreased
pain and disability of patients with Knee
Osteoarthritis.[12] Blood flow, capillary permeability,
nerve conduction and collagen extensibility increase
through vasodilation as a result of heat treatment and
it may reduce pain and stiffness.[13] The analgesic effect
of Dasamoola drugs is already proven.[11]
Nadi Swedana (sudation) seems to be a traditional
Vata Shamaka procedure. Snehana (oleation) and
Swedana (sudation) are opposite properties of Vata,
viz., Sheeta (coldness), Ruksha (dryness) etc. with this
mechanism Nadi Swedana produces relief in all sorts of
Vata Vyadhi.
LIMITATION
This study has a single arm and lacks a comparator arm
with a small sample size. In this study, there is a lacuna
regarding Standard Operating Process (SOP) for the
intervention of Nadi Swedana, another limitation of
the study is that pain and stiffness assessment was not
evaluated as per WOMAC.
CONCLUSION
In fact, it is concluded that sudation therapy is the
application of steam on the affected part has the
potential to reduce the symptom of pain, stiffness and
swelling due to the effect of heat. Nadi Swedna seems
to be a traditional Vata Shamaka procedure. Nadi
Swedana can be used as a supportive treatment in OA
patients. Further clinical trials with a large sample size
and longer follow up are warranted.
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Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2
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How to cite this article: Sandipkumar Baheti, Mahesh S.
Effect of Nadi Sweda on symptoms of Pain, Swelling and
Stiffness in Knee Osteoarthritis - An Open Labeled Single
Arm Clinical Study. J Ayurveda Integr Med Sci
2023;02:14-19.
http://dx.doi.org/10.21760/jaims.8.2.3
Source of Support: Nil, Conflict of Interest: None
declared.
Copyright © 2023 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms
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