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JR.A.S. Vol. XXIV, No. 3-4, (2003) pp.BB-l03

A SCIENTIFIC STUDY ON THE ROLE OFSNEHANA, SWEDANA AND RASNADI GUGGULUIN THE MANAGEMENT OF'SANDHIGATAVATA

(OSTEOARTHRITIS)A. K. Sharma! and Dinesh Kumar Singh?

Received on 26-7-2002

The study \Vas conducted in 30 clinicallydiagnosed cases of Sandhigatavata (OA)with all objective to assess the comparativeeffects of Snehana, Swedana and RasnadiGug gulu in the management ofSandhigatavata (OA) on various scientificparameters.

It was observed that statistically significantimprovement was noticed in clinicalparameters of all the three groups whereasstatistically insignificant improvement wasobserved infunctional and haematologicalparameters of all the three groups thoughthere was improvement in varioussymptoms clinically in respective groupsafter the therapy but there was noimprovement in joint structures after thetherapy ill any of the patients.

From the results obtained it was inferredthat Sneh ana, Swedana and RasnadiGuggulu treated group showed maximumpercentage of improvement than other twogroups.

INTRODUCTION

Ayurveda, the "Science of life" deals withphysical, psychological as well as spiritualwell being of an individual, covering allthe facets oflife. Amongst various diseasesthat affect the human life, Ayurveda hasgrouped eight major diseases that severelyaffect health, which are often associatedwith complications and are challenge to themedical science viz. Vatavyadhi, Ashmari,Kustha, Prameha, Udara, Bhagandara,Arsha, Grahani are the eight MahaVyadhis. (Astanga Hridaya Nidana- 8/30).Vatavyadhi which has been referred firstin the sequence is said to result fromvitiated Vata Dosha, which is most potentamongst the Tridoshas.

In the present study, the diseaseSandhigatavata which is correlated withOsteoarthritis was choosen because offollowing reasons.

* The contemporary treatment ofOsteoarthritis in modern system ofmedicine is mainly symptomatic and

I. Prof & Head P. G. Deptt. of Kaya Chikitsa, National Institute of Ayurveda, Jaipur2. MD. (Ay.) Final Yew' Scholar, P. G. Deptt. Of Kaya Chikitsa. National Institute

of Ayurveda, Jaipur.

88

A SCIENTIFIC STUDY ON THE ROLE OF SNEHANA .....

methods that check the progress of thedisease and prevent the morbidity are farfrom being satisfactory.

* Surgical intervention such asArthroplasty is an undesirable option. Themost common drug which is used intreatment ofYatavyadhi is Guggulu, whichis a Rasayana drug. It contains oleo-resin.Recent researches have shown that thisoleo-resin possesses anti-arthritic andantiinflammatory activities (SanthaKumari et (//. 1964).

Hence Guggulu based drug i.e. RasnadiGuggulu, which is a synergisticcombination of Yatahara drugs and iscommonly prescribed by Ayurvedicphysicians for the treatment ofSandhigatava was selected as a trialcompound preparation in a series ofpatients of Sandnigatavata (OA). Thetreatment of Yatavyadhi as described inAyurveda is not just confined toAntahaparimarjana (internal treatment) butBahyaparimarjana (external treatment)with oral drugs has been consideredequally important. Hence Snehana andSwedana with Oashamoola Taila andDasharnoola Kwatha, which are drugs ofchoice in Yatavyadhi were also selectedfor screening their clinical efficacy in aseries of patients of Sand higata vat a (OA).

The main objective of present researchwork is to assess the comparative effectsof Snehana, Swedana and RasnadiGuggulu in the management ofSandhigatavata (Osteoathritis) on variousscientific parameters.

Materials and Methods

Thirty patients suffering fromSandhigatavata (OA) were selected fromOPO & IPO wing of Kayachikitsa Deptt,N.LA. Hospitals, Jaipur on the basis of aspecific proforma prepared according tosigns and symptoms as described inCharaka Samhita for Sandhigatavata (Ch.S. Chi. 28/37), Madhav Nidana (Chapterno. 22121) and various sings and symptomsof Osteoarthritis as described in Modemtexts.

Thirty clinically diagnosed patients ofSandhigatavata (OA) were randomlydivided into following three groups oftenpatients each:

A. First Group was given Snehanatherapy in the form of external massagewith Oashamoola Taila on affected partsalong with Swedana with OashamoolaKwatha, once daily for a period of onemonth.

B. Second Group was given only RasnadiGuggulu in the dose of two tablet (eachtablet consist of500 mg.) thrice daily withlukewarm water for one month.

C. Third Group was treated with both,administration of Rasnadi Guggulu andSnehana, Swedana of affected partssimultaneously in the dose and scheduleas mentioned above.

Diet related restrictions and advise basedon Ayurvedic Classics were followed inall the three groups.

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A. K. Sharma & Dinesh Kumar Singh

Contents of Rasnadi Guggulu(Yog Ratnakar-Vatavyadhi Chikitsa)

Sr. Drugs Botanical Name Therapeutic Actions.No.

l. Purified Guggulu (Balsamodend ron Anti-Inflammatory, Anti-mukul) Arthritic

2. Guduchi Tinospora cordifolia Antipyretic, Diuretic

3. Rasna Pluchea lanceolata Analgesic, Antiinflammatory

4. Eranda Ricinus communis Analgesic, Antiinflammatory

5. Devadaru Cedrus deodara Astringent, Carminative

6. Shunthi Zingiber officinale Carminative, Digestive

Contents of Dashmoola(Sushruta Samhita Surtrasthana 39/68-69)

Drugs Botanical Name Therapeutic Actions

Shalapami Desmodium gangetieum

Prishnipami Uraria picta

Brihatee Solanum indieum

Kantakari Solanum surattense

Gokshur Tribulus terrestris

Bilva Aegle marmelos

Agnimanth Premna integrifolia

Syonaka Oroxylem indieum

Patala StereospermumsuaveolensGmelina arboreaGambhari

Anti-inflammatory,carminativeAnti-inflammatory, Anti-pyretic, carminativeAnti-pyretic, Digestive,DiureticAnti-inflammatory,Digestive, ExpectorantAnalgesic, Diuretic,CarminativeAnti-diarrhoeal,Astringent, DigestiveAnti-inflammatory, Anti-pyretic, AnalgesicAnti-inflammatory,Digestive, Anti-pyreticAnti-inflammatory, Anti-pyretic, DiureticAnti-inflammatory ,Analgesic, Carminative

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Dashmoola Kwatha

Dashmoola Kwatha was prepared byfollowing methods:

1.Dashmoola Chooma : 1 Part2. Water : 4 PartsBoiled and reduced to : 1I4th Parts

This Oashamoola Kwatha was used forSarvanga and Nadi Swedana.

Dashmoola Taila

Dashmoola decoction (1I4th reduced part)was prepared by boil ing four parts of waterwith one part ofOashmoola drugs. Tila oil(Sesarnurn indicum), Ksheera (Cow'sMilk) and Kalka dravyas (Bala,Nagarmotha, Talish patra, Choti Ela,Chandana, Oevadaru, Jyotishrnati, Khas,Atisa, Lakha, Kutha, Vacha, Tagar) wereadded to it and the mixture was boiled tillthe appearance of signs of 'Taila Siddhi".The oil was filtered and stored in bottlesand was sealed.

Criteria of Assessment

During the trial and follow up studies thepatients were assessed on the followingparameters:

I. Subjective Improvement

Attempts were made to elicit the subjectiveimprovement produced by the drug underthe trial. The points which werespecifically looked into were the increasein the feeling of well being, physical andmental fitness and improvement in jointactivities.

2. Clinical Evaluation

Patients were assessed on SymptomaticRating Scale (Sharma et. al.) for varioussymptomatic relief like, joint pain,oedema, feeling of swelling like air filledin bladder, pain on joint movements,stiffness, local crepitation, associatedmuscle wasting and joint enlargement etc.

3. Functional Assessment

This was done by assessing theimprovement in joint functions of bothextremities in terms of grip power,pre ssmg power, walking time andfunctional index.

4. Haematological Changes

Following changes were looked into- Hbgm%, TLC, OLC, ESR, R.A. factor andC-reactive proteins.

5. Radiological Changes

Before and after the therapy, if any.

Observations and Results

a) Clinical Recovery (Table No. I (a), I(b), and I (c) I

There was statistically significantimprovement on certain clinicalparameters in all the three groups. Theyinclude joint pain, oedema, pain on jointmovement, restriction of joint movementand stiffness of joints etc. On intra groupcomparison there was 43.75%improvement in clinical parameter ingroup 1st (Snehana and Swedana group),

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36.72% improvement in group 2nd(Rasnadi Guggulu, group) and 50%improvement in clinical parameters ingroup 3rd (combined group). Nosignificant improvement was observed injoint pain, oedema, feeling of swelling likeair filled bladder in joints in the patientsof 2nd group. Similarly no significantimprovement was observed in feeling ofswelling like air filled bladder in joints infirst group also. There was noimprovement in feeling oflocal crepitationafter the therapy in 2nd group.

b) Functional Recovery

As shown in Table No. II (a), II (b), and II(c) there was a trend of decrease in walkmgtime in all the three groups which wasfound to be statistically significant.Similarly grip power of right hand and lefthand in a11 the three groups wassignificantly improved. Pressing power inall the three groups was found to besignificantly improved in left hand ofgroup 2nd where it was insignificant. Infunctional index there was a trend ofclinical improvement in all the threegroups but all values were found to bestatistically insignificant.

c) Haematological Changes

Table No. III (a), III (b) and JII (c) show atrend of increase in Haemoglobin grampercentage after the therapy butstatistically all these values were found tobe insignificant. Similarly there was trendof reduction in the level of ESR in all thethree groups but when these values weresubjected to statistical analysis they werefound to be insigni ficant. i'here was a

general trend of decrease in total leucocytecount in all the three groups. Group 3rdhad statistically significant reductionwhereas group 1st and 2nd had statisticalvalues of no significance. No changes wereobserved in serological investigationsbefore and after the therapy in all the threegroups.

Table No. IV shows intra groupcomparison of improvement in the formof overall percentage of improvementwhich was 47.1 % in 1st group, 40.31 % in2nd group and 66.93% improvement wasnoticed in 3rd group.

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TABLE NO.1 (a) SHOWING THE PATTERN OF CLINICAL RECOVERY IN10 PATIENTS OF SANDHIGATAVATA (OA) TREATED WITH SNEHANAAND SWEDANA (GROUP 1ST)

Sr. Observations B.T. A.T. Mean S.D. S.E. t PNo. Ditt. + + value value

I. Joint Point 2.2 1.2 '1.0 0.47 0.15 6.71 <.001

2. Oedema 1.0 0.2 0.8 0.45 0.20 4.00 <.02

3. Feeling of 1.0 0.5 0.5 0.7 0.49 1.02 >.05Swelling like airfilled in bladder

4. Pain on joint. 2.1 1.3 0.8 0.42 0.13 6.00 <.001movement

5. Restriction of 2.3 1.2 1.1 0.32 0.10 11.0 <.001joint movement

6. Stiffness 2.2 l.l l.l 0.32 0.10 11.0 <.001

7. Local crepitation 1.56 1.11 0.44 0.53 0.18 2.53 <.05

8. Muscle wasting 0 0 0 0 0 0 0

9. Joint 1.0 1.0 0 0 0 0 0enlargement

BT = Be/ore Treatment; AT = After Treatment

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TABLE NO.1 (b) SHOWING THE PATTERN OF CLINICAL RECOVERY IN10 PATIENTS OF SANDHIGATAVATA (OA) TREATED WITH RASNADJGUGGULU (GROUP 2nd)


I. Joint Point 2.40 1.40 1.0 0 0 0 >.05

2. Oedema 1.67 1.0 0.67 0.87 0.29 2.31 >.05

3. Feeling of 1.40 0.8 0.6 0.55 0.24 2.45 <.1Swelling like airfilled in bladder

4. Pain on joint 2.30 1.4 0.9 0.32 0.1 9.0 <.001movement

5. Restriction of 2.1 1.2 0.9 0.32 0.1 9.0 <.001joint movement

6. Stiffness 2.1 1.2 0.9 0.32 0.1 9.0 <.001

7. Local crepitation 1.3 1.2 0.1 0.32 0.1 1.0 >.05

8. Muscle wasting 0 0 0 0 0 0

9. Joint 1.0 1.0 0 0 0 0enlargement

BT = Before Treatment; AT = After Treatment

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TABLE NO.1 (c) SHOWING THE PATTERN OF CLINICAL RECOVERY INto PATIENTS OF SANDHIGATAVATA (OA) TREATED WITH SNEHANA-SWEDANA AND RASNADI GUGGULU TOGETHER (GROUP 3rd)


1. Joint Point 2.7 1.2 1.5 0.53 0.17 9.0 <.001

2. Oedema 1.22 0.33 0.89 0.6 0.2 4.44 <.01

3. Feeling of 1.25 0.50 0.75 0.5 0.25 3.0 <.05Swelling like airfilled in bladder

4 Pain on joint 2.6 1.2 1.4 0.7 0.22 6.33 <.001movement

5 Restriction of 2.8 1.3 1.5 0.53 0.17 9.0 <.001joint movement

6. Stiffness 2.4 1.3 1.1 0.57 0.18 6.13 <.001

7. Local crepitation 1.56 1.11 0.44 0.53 0.18 2.53 <.05

8. Muscle wasting 0 0 0 0 0 0

9 Joint 1.0 1.0 0 0 0 0enlargement

BT = Before Treatment ..AT = After Treatment

95

A. K, Sharma & Dinesh Kumar Singh

TABLE NO. 11 (a) SHOWING THE PATTERN OF FUNCTIONAL CHANGESIN 10 PATIENTS OF SANDHIGATA VATA (OA) TREATED WITH SNEHANAAND SWEDANA (GROlJP 1st)


1. Grip Power RT 183 190 7.0 8.76 2.77 2.53 <.05In 111111Hg LT 158 160.6 2,6 3.13 0.99 2,62 <.05

2, Pressing RT 93 96.2 3.2 2.15 0.68 4.71 <.01PowerIn 111111Hg LT 72 74.4 2.4 3.24 1.02 2,34 <.05

3. Walking Time 98.9 93.7 5.2 3.39 1.07 4.85 <.001In Sec.

4. Functional Index 1.8 1.7 0.1 0.32 0.10 1.00 >.05

BT = Before Treatment ..AT = After Treatment

TABLE NO. II (b) SHOWING THE PATTERN OF FUNCTIONAL CHANGESIN 10 PATIENTS OF SANDHIGATAVATA (OA) TREATED WITH RASNADIGUGGULU (GROUP 2nd)


1. Grip Power RT 195 201 6.0 6.6 2.09 2,87 <.02In 111mHg LT 175 178.8 3.8 4.57 1.44 2.63 <.05

2. Pressing RT 106 110 4.0 3.65 1.15 3.46 <.01PowerIn 111mHg LT 80 82.2 2.2 3.33 1.05 2.09 >.05

3, Walking Time 99,3 92.1 7.2 2.1 0.66 10.85 <.001In Sec.



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TABLE NO. II (c) SHOWING THE PATTERN OF FUNCTIONAL CHANGESIN 10 PA TIENTS OF SANDHIGA TAVAT A (OA) TREATED WITH SNEHANA-SWEDANA AND RASNADI GUGGULU TOGETHER (GROUP 3rd)


1. Grip Power RT 223 233.4 10.4 5.95 1.88 5.53 <.001In 111m Hg LT 192.4 201.8 9.4 6.67 2.11 4.46 <.01

2. Pressing RT 96.0 103.8 7.8 8.66 2.74 2.85 <.02PowerIn mrn Hg LT 73.0 78.8 5.8 4.05 1.28 4.53 <.01

3. Walking Time 103.5 93.6 9.9 3.75 1.19 8.34 <.001In Sec.



TABLE NO. III (a) SHOWING THE PATTERN OF HAEMATOLOGICALCHANGES IN 10 PATIENTS OF SANDHIGATAVATA (OA) TREATEDWITH Sl'\EHANA & SWEDANA (GROUP 1st)

Sr.No.

Observations B.T. A.T. Mean S.D.Ditt. +

S.E. t P+ value value

1. HaemoglobinIngm%

13.29 13.34 0.05 1.14 0.36 0.14 >.05

2. E.S.R.In mm hr.

17.2 13.2 4.0 8.33 2.63 1.52 >.05

3. TotalLeucocyteCount

6875 6760 115 1036.03 327.62 0.35 >.05


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TABLE NO. III (b) SHOWING THE PATTERN OF HAEMATOLOGICALCHANGES IN 10 PATIENTS OF SANDHIGATA VAT A (OA) TREATED WITHRASNADI GUGGULU (GROUP 2nd)


1. Haemoglobin 12.18 12.4 0.22 1.2 0.38 0.58 >.05Ingm%

2. E.S.R. 26.9 24.3 2.6 9.5 3.0 0.87 >.05In 111111 hr.

3. Total 6460 6315 145 1407.21 445 0.33 >.05LeucocyteCount


TABLE NO. III (c) SHOWING THE PATTERN OF HAEMATOLOGICALCHANGES IN 10 PATIENTS OF SANDHI GAT AVAT A (OA) TREATED WITHSNEHANA-SWEDANA AND RASNADI GUGGULU (GROUP 3rd)

Sr.No.

Observations B.T. A.T. Mean S.D.Ditt. +

S.E. t P+ value value

l. Haemoglobin 12.59Ingm%

12.65 0.06 1.46 0.46 0.13 >.05

2. E.S.R.In 111111 hr.

27.0 20.5 6.5 15.79 4.99 1.3 >.05

3. TotalLeucocyteCount

8115.8 7025 1090.8 975.28 308.41 3.54 <.01


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TABLE NO. IV SHOWING COMPARATIVE OVERALL PERCENTAGE OFIMPROVEMENT IN DIFFERENT GROUPS OF SANDHI GAT AVAT A (OA) ONTHE BASIS OF VARIOUS PARAMETERS

SnehanaSr. Parameters of Swedana & Rasnadi Snehana &No. Assessment Rasanadi Guggulu Swedana

Guggulu (Group 2nd) (Group 1st)(Group 3..d)

1. Clinical Improvement % 50 36.72 43.75t 4.20 4.14 3.89P <.01 <.01 <.01

Significant Significant Significant

2. Functional Improvement % 3.36 1.32 1.63t 1.22 0.76 1.00P >.05 >.05 >.05

Jnsigni ficant Insignificant Insignificant

3. Haematological % 13.57 2.27 1.72Changes in t 1.09 1.02 1.05Hb. ESR& TLC P >.05 >.05 >.05

Insignificant Insignificant Insignificant

4. Percentage of Improvement 66.93 40.31 47.1

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Discussions

Osteoarthritis is one of the most dreadeddisease, which produces permanentdegenerative changes in the body joints.The treatment of OA as described inmodern system of medicine is quiteunsatisfactory as it only producessymptomatic management in the form ofre\iefinjoint pain and swelling along withserious side / toxic effects. Therefore it wasdecided to evaluate clinically certainAyurvedic remedies on scientificparameters for the patients ofSandhigatavata (OA).

Ayurvedic treatment in the form of onlyShamana therapy has very limited role inthe management of Sand higata vat a (OA).Therefore it was decided to evaluate theclinical effects of Shamana therapy andShodhana therapy separately and incombination on a series of 30 patients ofc Iinica lIy diagnosed cases ofSandhigatavata (OA).

Rasnadi Guggulu when used in new anduncomplicated cases of Sandhigatavata(OA) produced significant clinicalimprovement but in chronic cases it hasvery limited role to play. Because variousdegenerative processes take place inchronic cases of Sandhigatavata in thestructures of the joints which areirreversible,

Overall percentage of improvement was40.31 % in 2nd group (mild improvementin Rasnadi Guggulu treated group), 47.1% moderate improvement in 1st group(Snehana-Swedana group) and 66.93%

improvement was noticed in 3rd group i.e.Snehana-Swedana and Rasnadi Guggulutreated group i.e. maximum improvementwas noticed in 3rd group after the therapy.

Probable Mode of action of RasnadiGuggulu

Most of the drugs contained in RasanadiGuggulu have properties likeVatakaphanashaka, Deepana, Balya,Rasayana, Tridoshanashaka, Pachana,Shothaghna, Vedanasthapana, Rechana &Shoolaprashamaka. These are likely tobreak down the pathogenesis ofSandhigatavata (OA) in new anduncomplicated cases, and thus may arrestthe progress of the disease.

Probable Mode of action of Snehana(Massage)

Snehana Karma (Massage) may producefollowing effects in the body1) Lubricates the Srotamsi

(microcirculatory channels)2) Displaces exudates and thus may

relieve tension and pain.3) Softens muscles, ligaments and

tendons. Thus corrects stiffness andrigidity and induces elasticity in body.

4) Prepares smooth passages (microchannels) for elimination of vitiatedDoshas during Swedana therapy.

Probable Mode of action of Swedana(Sudation)

Swedana Karma (Sudation fomentationheat) may produce following effects in thebody -

100


I. Induces sweating and removes bodytoxins.

2. Induces Srotoshudhi (cleanses microchannels)

3. Liquifies morbid Doshas and expelsthem out with sweat.

4. Recovers Vascular insufficiency ofthe joints and muscles.

5. Causes relaxation of muscles andtendons.

6. Activates the local metabolicprocesses which in turn produce reliefof pain, swelling, tenderness andstiffness etc.

Probable mode of action ofMedicaments used in Snehana andSwedana (Dashmoola Taila andDashmoola Kwatha)

1. These are mainly Vatashamaka due totheir antivata pharmacologicalproperties.

2. These medicaments have nutritivevalue.

3. These have restorative effects on localtissues.

It is postulated that Snehana and Swedanamay produce significant beneficial effectsin the body and joints of the patients largelybecause of the pharmacodynamicproperties of these preparations.

Conclusions

1. Rasnadi Guggulu is an effectiveremedy in uncomplicated and newcases of Sandhigatavata (OA). Inchronic cases of Sand higata vat a (OA)

Rasnadi Guggulu has very limited roleto play.

2. Snehana and Swedana therapy withDashmoola Ta ila and DashmoolaKwatha respectively have shown muchbetter results in patients ofSandhigatavata (OA) in comparison toRasnadi Guggulu treated group.

3. Best therapeutic response was noted inthose patients of Sand higata vat a (OA)where Rasnadi Guggulu wasadministered along with Snehana andSwedana with Dashmoola Taila andDashmoola Kwatha respectively.

101


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Pacha Kama Therapy, PublicationChowkhambha Sanskrit Series,Varanasi.

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102


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