Indukanta Ghrita Matra Vasti

“A COMPARATIVE STUDY ON THE EFFECT OF INDUKANTA
GHRITA MATRA BASTI AND JALAUKAVACHARANA ON

JANUSANDHIGATA VATA”
By
DR.CHANABASAPPA PUJAR B.A.M.S
Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment
Of the requirements for the degree of
AYURVEDA VACHASPATHI
DOCTOR OF MEDICINE (AYU)
In
PANCHAKARMA
Under the guidance of
DR.ZENICA D’SOUZA .M.D. (Ayu)
DEPARTMENT OF POST GRADUATE STUDIES IN

PANCHA KARMA
ALVA’S AYURVEDA MEDICAL COLLEGE & HOSPITAL
MOODBIDRI, D.K. 574227.
2010-2011
ALVA’S AYURVEDA MEDICAL COLLEGE
PANCHAKARMA
MOODBIDRI, KARNATAKA
Declaration
I hereby declare that this dissertation entitled “A COMPARATIVE STUDY
ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND
JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide and
genuine research work carried out by me under the guidance of DR.ZENICA
D’SOUZA, M.D .(Ayu) ,Department of Post Graduate Studies in Panchakarma,
Alva’s Ayurveda Medical College, Moodbidri.
DR. CHANABASAPPA R. PUJAR

III Year M.D. (Ayu)
Dept. of P.G. Studies in Panchakarma,
Date:25/11/2010 Alva’s Ayurveda Medical College,
Place: Moodbidri Moodbidri- 574227.
PANCHAKARMA
MOODBIDRI, KARNATAKA.
Certificate
This is to certify that the dissertation entitled “A COMPARATIVE
STUDY ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND
JALAUKAVACHARANA ON JANUSANDHIGATA VATA” submitted by
DR.CHANABASAPPA R.PUJAR in partial fulfillment for the degree of
Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv Gandhi University of
Health Sciences, Karnataka, Bangalore, is a record of research work done by him
during the period of his study in this institute, under my guidance and
supervision and the dissertation has not previously formed the basis to the award
of any degree, diploma, fellowship or other similar titles.
I recommend this dissertation for the above degree to the University for the
approval.
Guide:
DR.ZENICA D’SOUZA
M.D (AYU)
Asst. Professor
Dept. of P.G Studies in Panchakarma,
Alva’s Ayurveda Medical College
Moodbidri 574227
Date: 25/11/2010
Place: Moodbidri
PANCHAKARMA
Certificate
This is to certify that the dissertation entitled “A COMPARATIVE STUDY
ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND
JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide
research work done by DR.CHANABASAPPA R.PUJAR under the guidance of
DR. ZENICA D’SOUZA.M.D. (Ayu) in partial fulfillment of the requirement for the
award of the degree in Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv
Gandhi University of Health Sciences, Karnataka, Bangalore.
Signature of H.O.D.
Dept. of P.G Studies in Panchakarma,
Alva’s Ayurveda Medical College,
Date:25/11/2010
Moodbidri -574227
Place: Moodbidri
PANCHAKARMA
Endorsement
This is to certify that the dissertation entitle “A COMPARATIVE
STUDY ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND
JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide
research work done by DR.CHANABASAPPA R.PUJAR under the guidance of
DR.ZENICA D’SOUZA.M.D.(Ayu) ., Department of Post Graduate Studies in
Panchakarma, Alva’s Ayurveda Medical College, Moodbidri.
Signature of Principal
Moodbidri 574227
Dakshina Kannada (Dist)
Date: 25/11/2010
Place: Moodbidri
COPYRIGHT
I hereby declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this
dissertation in print or electronic format for academic/research purpose.
DR.CHANABASAPPA R.PUJAR
Date: 25/11/2010 III Year M.D. (Ayu)
Place: Moodbidri. Dept. of P.G. Studies in Panchakarma,
Moodbidri. 574227
© Rajiv Gandhi University of Health Sciences, Karnataka.

Acknowledgement 2010

ACKNOWLEDGEMENT
Completion of dissertation marks the milestone in the post graduates studies. So
here I take the opportunity to acknowledge the help received from different sources.
I am grateful to my beloved father Sri.Rangappa Pujar and beloved mother Smt.
Ratna Pujar for their immersive support all through my life and my family members for
their constant support, encouragement and inspiration which blended my efforts and work
to a smooth completion.
On the completion of this thesis work, I heartily extend my sincere gratitude to
my venerated guide Dr.Zenica D’Souza who was the vital and kinetic force behind this
thesis, without her initiation and support this work would not have been accomplished in
stipulated time.
I owe my sincere regards and boundless gratitude to Dr.M.Mohan Alva,
Chairman, Alva’s Education Foundation, Moodbidri, for giving me an opportunity to do
my post graduate studies in this prestigious institution.
I render my immense and heartfelt thanks to Dr.Suresh Negalaguli,
Dr.Lakshmeesh Upadhyaya and Dr.Vinaychandra Shetty for their constant help, and
support in completing this work.
My sincere gratitude to Dr.Prasanna Aital, Dr.K.N.Rajashekar, Dr.Vasant Patil,
for their guidance during my entire study period.
I acknowledge my gratitude to the staff of Alva’s Pharmacy, Mijar, who selflessly
helped me during the preparation of the medicines for my clinical trial. I also thank our
Panchakarma therapists for their constant help during the study.
“A comparative study on the effect of Indukanat Ghrita Matrabasti and Jalaukavacharana on
Janusandhigata Vata”
Acknowledgement 2010

I would like to thank my departmental colleagues Dr.Parvathy S.P., Dr.Susha,
Dr.Priya, Dr,Prasanth and Dr.Shweta A.H. for their faithful backing, relentless
encouragement and cheerful attitude which made every moment happier. I would also
like to express my regards to other departmental colleagues for their timely help and
support.
Dr.Chanabasappa.R.Pujar
Index 2010

INDEX Page No
List of Tables ………………………………………….. I-III
List of graphs and photographs……………………. IV-V
Abbreviations …………………………………………. VI-VII
Abstract ……………………………………………….. VIII-IX
Chapter 1) INRODUCTION 1-5
Chapter 2) OBJECTIVES 6
Chapter 3) REVIEW OF LITERATURE
A) Disease review 7-39

B) Bastikarma Review
40-56
C) Jalauka Review
57-74
D) Drug Review 75-80
Chapter 4) METHODOLOGY
Materials and Methods 83-87

Observations 88-104
Chapter 5) RESULTS 105-131
Chapter 6) DISCUSSION 132-146
Chapter 7) CONCLUSION 147-150
Chapter 8) SUMMARY 151-153
REFERENCES 154-162
BIBLIOGRAPHY 163-167
ANNEXURES 168-174

Index 2010


List of Tables 2010

LIST OF TABLES
Sl No Name of tables Page No.
1 Samanya Nidana of Vata Vyadhi as explained in different 18-19
treatises.
2 Roopa of Sandhi Gata Vata mentioned in various classics. 20
3 Chikitsa Sutra mentioned in different classics. 29
4 Persons unfit for the Anuvasana Basti. 46-47
5 Measurements of Basti Yantra. 48
6 Netra Dosha and Putaka Dosha. 49-50
7 Indications of Matra Basti. 52-53
8 Indication for leech application 62-64
9 Ingredients of Indukanta Ghrita 75-76
10 Pharmacodynamics of Kashaya Dravyas 77
11 Karmas of Kashaya Dravyas 77-78
12 Pharmacodynamics of Panchakola 79
13 Karmas of Panchakola 79
14 Pharmacodynamics of Indukanta Ghrita 80
15 Distribution of 30 patients according to different age group 88
16 Distribution of 30 patients according to sex 89
17 Distribution of 30 patients according to occupation 90
18 Distribution of 30 patients according to religion 91
19 Distribution of 30 patients according to socio- economic status 91
20 Distribution of 30 patients according to marital Status 92
“A comparative study on the effect of Indukanta Ghrita Matrabasti and Jalaukavacharana on
Janusandhigata Vata” Page I

List of Tables 2010

21 Distribution of 40 patients according to Desha 93
22 Distribution of 30 patients according to educational status 94
23 Distribution of patients as per food habits 95
24 Distribution of 30 patients according to their intake of Aahara 95
25 Distribution of 30 patients according to their nature of work 96

26 Distribution of 30 patients according to their duration of Vishrama 97
27 Distribution of 30 patients according to their Vyayama 98
28 Distribution of 30 patients according to their Nidra Habit 99
29 Distribution of 30 patients according to addiction 99
30 Distribution of 30 patients according to Prakruti 100
31 Distribution of patients according to Symptomatology 100

32 Distribution of 30 patients according to onset of Pain. 102
33 Distribution of 30 patients according to Nature of Pain. 103
34 Distribution of 30 patients according to Aggravating factors- 103

Diurnal
35 Distribution of 30 patients according to Pain Aggravating factors- 104
Seasonal
36 Effect of Matrabasti on Pain in percentage 106
37 Pre and Post Median of Pain(Group M) 107
38 Effect of Matrabasti on Pain at 4th day of treatment and after last 107
follow up.
39 Effect of Jalaukavacharana on Pain in percentage 108
40 Pre and Post Median of Pain (Group J) 109
41 Effect of Jalaukavacharana on Pain at 4th day of treatment and 109

after last follow up.
Janusandhigata Vata” Page II

List of Tables 2010

42 Effect of Matrabasti on Swelling in percentage 110
43 Pre and Post Median of Swelling (Group M) 111
44 Effects of Matrabasti on Swelling at 4th day of treatment and after 111

last follow up.
45 Effect of Jalaukavacharana on Swelling in percentage 112
46 Pre and Post Median of Swelling (Group J) 113
47 Effects of Jalaukavacharana on Swelling at 4th day of treatment 113

and after last follow up.
48 Effect of Matrabasti on Crepitus in percentage 114
49 Effect of Jalaukavacharana on Crepitus in percentage 115
50 Effect of Matrabasti on Tenderness in percentage 116
51 Pre and Post Median of Tenderness (Group M) 117
52 Effect of Matrabasti on Tenderness at 4th day of treatment and 117

53 Effect of Jalaukavacharan on Tenderness in percentage 118
54 Pre and Post Median of Tenderness (Group J) 119
55 Effect of Jalaukavacharan on Tenderness at 4th day of treatment 119

and after last follows up.
56 Effect of Matrabasti on Gait in percentage 120
57 Pre and Post Median of Gait (Group M) 121
58 Effect of Matrabasti on Gait at 4th day of treatment and after last 121
follows up.
59 Effect of Jalaukavacharan on Gait in percentage 122
60 Pre and Post Median of Gait (Group J) 123
Janusandhigata Vata” Page III

List of Tables 2010

61 Effect of Jalaukavacharan on Gait at 4th day of treatment and after 123
last follows up.
62 Effect of Matra basti on Range of Movement (Group M) 124
63 Effect of Jalaukavacharana on Range of movement 125
64 Effect of Matra basti on Stiffness (Group M) 126
65 Effect of Stiffness on Range of movement 127
66 Comparison of qualitative data between the group from BT to D4 128
67 Comparison of qualitative data between the group from BT to AT 129

68 Comparison of Range of movement between the group from 129
BT to AT
69 Comparison of Stiffness between the group from BT to AT 130
Janusandhigata Vata” Page IV

List of Graphs & photos 2010

LIST OF GRAPHS
Sl Name of graphs Page No.
no:
1 Distribution of 30 patients according to different age group 89
2 Distribution of 30 patients according to sex 89
3 Distribution of 30 patients according to occupation 90
4 Distribution of 30 patients according to religion 91
5 Distribution of 30 patients according to socio- economic status 92
6 Distribution of 30 patients according to marital Status 92
7 Distribution of 30 patients according to Desha 93
8 Distribution of 30 patients according to educational status 94
9 Distribution of 30 patients according to food habits 95
10 Distribution of 30 patients according to their intake of Aahara 96
11 Distribution of 30 patients according to their nature of work 97
12 Distribution of 30 patients according to their duration of Vishrama 97
13 Distribution of 30 patients according to their Vyayama 98
14 Distribution of 30 patients according to their Nidra Habits 99
15 Distribution of 30 patients according to addiction 100
16 Distribution of 30 patients according to Prakruti 101
17 Distribution of 30 patients according to Symptomology 102
18 Distribution of 30 patients according to onset of pain 102
19 Distribution of 30 patients according to Nature of Pain 103
Diurnal
Season
22 Effect of Matrabasti on Pain in percentage 106
23 Effect of Jalaukavacharana on Pain in percentage 108
24 Effect of Matrabasti on Swelling in percentage 110
25 Effect of Jalaukavacharana on Swelling in percentage 112
Janusandhigata Vata” Page IV

List of Graphs & photos 2010

26 Effect of Matrabasti on Crepitus in percentage 114
27 Effect of Jalaukavacharana on Crepitus in percentage 115
28 Effect of Matrabasti on Tenderness in percentage 116
29 Effect of Jalaukavacharan on Tenderness in percentage 118
30 Effect of Matrabasti on Gait in percentage 120
31 Effect of Jalaukavacharan on Gait in percentage 122
32 Effect of Matra basti on Range of movement 124
33 Effect of Jalaukavacharana on Range of movement 125
34 Effect of Matra basti on Stiffness 126
35 Effect of Jalaukavacharana on Stiffness 127
36 Comparison of Range of movement between the group from BT to 130
AT
37 Comparison of Stiffness between the group from BT to AT 131
List of Photos
S.L.no Name of Photos Page No.
1 Ingredients of Indukanta Ghrita 81
2 Preparation of Indukanta Ghrita 81
3 Jalauka 82
4 Jalaukavacharana 82
Janusandhigata Vata” Page V

Abbreviations 2010
ABBREVIATIONS
1) A.H : Astanga Hridaya

2) A.S : Astanga Sangraha
3) A.T. : After Treatment
4) Bhel.sa : Bela Samhita
5) Bh.Pr : Bhava Prakasha
6) B.R : Bhaishajya Ratnavali
7) B.T. : Before Treatment
8) Ch.D : Chakra Datta
9) Cha.S : Charaka Samhita
10) Comm. : Commentary
11) Ckr : Chakrapani.
12) D.G : Dravya Guna Vijnana
13) DL : Dalhana
14) H.P.I.M : Harrison’s Principle of Internal Medicine
15) I.P.D. : In Patient Department
16) K.S : Kashyapa Samhita
17) M.N : Madhava Nidana
18) Madhu : Madhukosha
19) O.P.D. : Out Patient Department
20) S.D : Standard Deviation
21) S.E : Standard Error
22) S.K.D : Shabda Kalpa Druma
23) Su.Su : Susrutha Samhita
24) Saha.Yo : Sahasra Yogam
25) Sha.Sa : Sharangadhara Samhita
26) Vag : Vagbhata
“A comparative study on the effect of Indukanta Ghrita Matrabasti and
Jalaukavacharana on Janusandhigata Vata” Page VI
Abbreviations 2010
27) Vang : Vangasena

28) Yo.Ra : Yogaratnakara
29) Yrs. : Years
30) + : Present
31) - : Not Present
32) % : Percentage
ABBREVIATIONS OF STHANAS OF SAMHITA

1) Chi : Chikitsa Sthana
2) I : Indriya Sthana
3) Ka : Kalpa Sthana
4) Ma.Kha : Madhyama Khanda
5) Ni : Nidana Sthana
6) Po.Kha : Poorva Khanda
7) Sha : Shareera Sthana
8) Si : Siddhi Sthana
9) Su : Sutra Sthana.
10) Utt : Uttara Khanda
“A comparative study on the effect of Indukanta Ghrita Matrabasti and
Jalaukavacharana on Janusandhigata Vata” Page VII
Abstract 2010

ABSTRACT
Sandhi-Gata-Vata (osteoarthritis) is common amongst the elderly and obese
persons. Since knee is the weight bearing joint it is more susceptible to wear and tear.
Sandhi-Gata-Vata (osteoarthritis) occurring at the knee joint as a result of wear and tear is
termed as Janu-Sandhi-Gata-Vata. It is largely seen in the population and known to be
major cause for chronic disability. In the age group 30 to 65 years, there is a steady rise in
the prevalence of OA, where 80% of the population has radiological evidence, though
only 20 to 30 % are symptomatic
Objectives of the study:

• Evaluation of the effect of Matra Basti with Indukanta Ghrita on Janusandhigata
Vata.
• Evaluation of the effect of Jalaukavacharana on Janusandhigata Vata.
• To compare and ascertain the effect of Indukanta Ghrita matrabasti with
Jalaukavacharana on Janusandhigata Vata.
Method:
30 Patients fulfilling the diagnostic and inclusion criteria belonging to either sex were
selected for a single blind comparative study. They were randomly allocated into 2 equal
groups M & J.
Procedure:
Group M: Matra Basti with Indukanta Ghrita at a dose of 60 ml for 7 days.
Group J: Jalaukavacharanatra for single sitting.
Patients were assessed on 1st, 4th and 7th day of treatment and 20th and 30th day of follow
up.
Janusandhigata Vata” Page VIII

Abstract 2010

Results & interpretation:
When both the groups were compared clinically for pain, stiffness, range of movement,
tenderness and swelling, it was observed that Group M and Group J were effective.
Crepitus remained unchanged till the end of study.
On applying Wilcoxon sign rank test and Mann Whitney U test for qualitative data’s, it is
observed that group M was having sustained effect and group J having instant effect
p<0.001.
On applying student‘t’ test for the quantitative data’s P<0.001 which is highly significant.
So the means of both the groups were compared, where in mean of Group M was found
to be greater than mean of Group J. So Group M was more effective than Group A with
respect to all the criteria’s.
Conclusion: The patients have shown improvement in all the criteria of assessment of
JanusandhiGata Vata except crepitus in both the groups. But Group M showed marked
reduction with sustained effect compared to Group J in the total severity of the illness.
Janusandhigata Vata” Page IX

Introduction 2010

Introduction
According to Ayurveda, simple freedom from disease is not health. For a person
to be healthy he should be physically, mentally and spiritually happy and imbalance of
Doshik equilibrium is termed as Roga. In old age, all Dhatus undergo Kshaya, thus
leading to Vata Prakopa and making the individual prone to many diseases.
Among them Sandhigata Vata stands top in the list. The affliction of Sandhis by
Prakupita Vata is the chief phenomena in the Samprapti of Janusandhigata Vata.1 Sandhis
are one of the types of Marma and form a part of Madhyama Roga Marga. Thus,
involvement of Marma, Madhyama Roga Marga, Vata Dosha and Dhatukshaya makes
this disease Kashta Sadhya.
In modern science, Osteoarthritis is the most common arthritic condition
affecting the elderly population. It is a slowly progressive joint disease.2 It is reported
that these degenerative changes in joints arise from the age of 30 years and by the age of
65 years, 80% of the people may have radiographic evidence of Osteoarthritis although
only 25% may have symptoms.3
Osteoarthritis is a major cause of morbidity and disability, limiting activity and
impaired quality of life especially among the elderly. The primary complaints of patients
with Osteoarthritis are pain and difficulty in joint mobility. The etiology of pain is multi-
factorial, including inflammatory and non-inflammatory causes. The disease is managed
by NSAIDs, analgesic drugs, physiotherapy corticosteroids etc. In due course of time
these drugs cause unwanted affects. Even the surgical treatment does not provide
complete relief.
“A Comparative study on the effect of Indukanta Ghrita Matrabasti and Jalauka
Avacharana on Janusanhigata Vata” Page 1

Introduction 2010

In Ayurveda, Sandhivata is given as a Vatavyadhi and it is also believed that any
type of pain cannot be without presence of Vata. In Ayurvedic classics, our Acharya have
given special therapeutic procedures for specific disease along with a good range of
medicaments. Panchakarma is a very unique therapeutic procedure, because of its
preventive, promotive, prophylactic and rejuvinative properties as well as providing a
radical cure.
Among these Panchakarmas, Basti Karma is such a Chikitsa that is applicable in
all the Vatavyadhi. According to Sushruta it can be used in Kaphaja and Pittaja disorders
by using different ingredients.4 Sandhigatavata being a Vatika disorder can be best
controlled by Basti.
Sequential administration of the Snehana, Swedana, Abyanga, Mardana,
Upanaha, Bandhana, Basti and Agnikarma are lines of treatment of Janusandhigata Vata
as expounded in the Ayurveda literature.5
Apart from these procedures, the line of treatment that can be given at outpatient
department level and inpatient department level which is cost effective, without adverse
effects is yet to be established. Matra Basti is selected in this study because of its
simplicity and instant efficacy with Indukanta Ghrita6 having drugs of Vedanahara and
shothahara effect. Jalaukavacharana is selected as there is indication of Raktamokshana
in Vata vitiated in Twak, Rakta, Mamsa, Sira etc structures and the sandhi is made up of
all these structures.7 and many international studies are conducted and also in progress.

Introduction 2010

So, this is a humble effort made to,
• Evaluate the effect of Matra Basti with Indukanta Ghrita on Janusandhigata Vata.
• Evaluate the effect of Jalaukavacharana on Janusandhigata Vata.
• To compare and ascertain the effect of Indukanta Ghrita Matrabasti with
The present dissertation work consists of following parts…
• Review of literature
• Methodology
• Results
• Discussion
• Conclusion
• Summary
Review of literature: Comprises of following fragments
A) Disease review: At first, a brief description of the historical aspect of the illness
was explored starting from Vedic period to the present time and entitled it as
Historical review. The Disease Review elaborates the general description of the
disease Janusandhigata Vata. The etymological, derivation, etiology, anatomy,
clinical manifestations, pathogenesis, prognosis and general principle of treatment
of Janusandhigata Vata (Osteoarthritis of the knee) are discussed here.

Introduction 2010

B) Matra Basti review: Comprises of general description of Matra Basti and a brief
description of the properties & procedure.
C) Jalauka review: Comprises of general description of Jalauka, types and
description of the properties and procedure.
D) Drug review: This includes the composition of the Indigenous compound drugs in
Indukanta Ghrita. The properties of the individual herbs used in the preparation of
the medicinal compound are briefed in the context.
Methodology:
a) Materials and Methods: The materials and methods of the present work with
complete description of the assessment criteria are given here. The statistical analysis
of the samples taken for the study is methodically elaborated.
Total 30 patients were treated in two groups as
Group M – Indukanta Ghrira Matra Basti– 15 patients
Group J –Jalaukavacharana– 15 patients.
b) Observations: The observations are presented in order with tables and graphs.
Results:
Results with their statistical analysis are presented in order with tables and graphs.

Introduction 2010

Discussion:
In this section, discussions about disease, treatment procedure, drugs taken,
observation and results are done. Then obtained results are critically analyzed to unravel
the truth of efficacy of the management taken for the study.
Conclusion & Summary:
The final conclusions drawn from the present study are detailed in the chapter
Conclusion and summary.

Objectives of the study 2010
Objectives of the study
• Evaluation of the effect of Matra Basti with Indukanta Ghrita on Janusandhigata
Vata.
• Evaluation of the effect of Jalaukavacharana on Janusandhigata Vata.
• To compare and ascertain the effect of Indukanta Ghrita Matrabasti with
Hypothesis
H0 –There is neither effect of Matrabasti nor Jalaukavacharana on
Janusandhigata Vata.
H1-There is significant effect of Matrabasti on Janusandhigata Vata.
H2-There is significant effect of Jalaukavacharana on Janusandhigata Vata.
H3- There is significant effect of Matrabasti over Jalaukavacharana on
H4- There is significant effect of Jalaukavacharana over Matrabasti on
“A comparative study on the effect of Indukanta Ghrita Matrabasti and Jalauka
Disease Review 2010
Historical Review
We hardly find the particular mentioning of Janusandhigata-Vata in our
classics. Instead we find the general mentioning of Sandhigata Vata.
There is no reference regarding Sandhi-Gata-Vata in Pre-Vedic period.
During Vedic period in Rig Veda and Atharva Veda we get references about the
occurrence of Sandhigata Vikara.
In Samhita period we find systemic description of the disease according to
Nidana Panchaka. Charaka Samhita, one of the famous triads of Ayurveda explained
Sandhi-Gata-Vata in Chikitsa Sthana 28th chapter.1 Susrutha Samhita narrates
Lakshana in Nidanasthana 1st chapter and Chikitsa in Chikitsa Sthana 4th chapter.2
In Ashtanga Sangraha Nidana Sthana 15th chapter Lakshana and in
Cikitsasthana 23rd chapter Chikitsa of Sandhi-Gata-Vata is summarized.3
Ashtanga Hridaya has described Lakshana in Nidanasthana 15th chapter and line of
treatment in Chikitsa Sthana 21st chapter.4
In Madhava Nidana Lakshana of Sandhi-Gata-Vata are given in the wordings
of Susrutha.5 Bhavaprakasha explains the Lakshana and Chikitsa of Sandhigata-Vata
in Madhyama Khanda Vatavyadhyadhikara 24th chapter.6 Yogaratnakara also not left
behind in explaining about Lakshana and Chikitsa of Sandhigata-Vata in
Vatavyadhyadhikara of Purvardha.7
In Bhaishajya Ratnavali Vatavyadhi Prakarana 23Chap. deals with Chikitsa
aspects of Sandhigata-Vata.8
The commentators of Samhita and Sangraha especially Chakrapani and
Dalhana contributed a lot for better understanding of the disease.
“A comparative study on the effect of Inukanta Ghrita Matrabasti and Jalauka
Avacharana on Janusandhigata Vata” Page 7
Disease Review 2010
Previous works done

1. A Comparative study of Matra Basti & some Indigenous compound in the
management of Sandhigata Vata. By Mayuri Shah – Jamnagar – 2006
2. Effect of Jalaukavacharana and Janubasti in vedana of Janusandhigata Vata- A
Comparative clinical study By Sandeep B.R.-G.A.M.C. Mysore-2006
3.A clinical study on the role of Matra Basti & Shamana yoga in the management of
Sandhigata Vata By Alpesh Joshi – Jamnagar- 2004.
Nirukti and Paribhasha

The word Sandhivata is comprised of two words viz. Sandhi and Vata. Sandhi
is an anatomical part and Vata is a physiological aspect in the body. Both these words
are dealt with separately as below.
Sandhi:
i) Etymology: Sandhi is a masculine gender and derived from the root ‘Du-Dha-Jn’
with SAMA prefix, which is used in the meaning of Dharana and Poshana. Complete
word ‘Sandhi’ is formed in the following way.
SAMA + Dha (here feminine gender ‘KI’ is used) i.e. SAMA + Dha + Ki (by the
Sutra ‘ATO UPSARGE DHAKI’ Ki is removed as A.
SAMA + Dha + I (Again applying the Sutra ‘ATO LOPA ETICA A’ of Dha is
removed, As. A.
SAMA + Dha + I (with ‘MONUSVAR MA’ Sutra MA changed to Na, As. A.
Hence, the word Sandhi is made up of SAMA + Dha + I. which means, the union,
the function, the combination, the connection and reconciliation (Williams, 1975).
Disease Review 2010
ii) Definition: Besides this Vachaspatyam compiled ten meanings of Sandhi used in
different aspect. All the meaning convey the same feature i.e. joint.
According to Acharya Dalhana, Sandhi means Shariram Asthi Samyoga
Sthana. In the commentary on Sushruta Samhita by Bhaskargovind Ghanekar, it is
mentioned that where two or more objects articulate with each other in the body, it is
called as Sandhi. Acharya Charaka mentioned in Vimana Sthana that Asthi Sandhi is
a root of Majjavaha Srotasa. All the meaning convey, the same features i.e. joint.
Though, Acharya Sushruta described various types of Sandhi viz. Shira Sandhi, Snayu
Sandhi and Peshi Sandhi etc. in this context, we are dealing with Asthi Sandhi only.
Gata: Vyutpatti - Gam –Gamane (Shabda Kalpa Druma)
Gam + Ktha (Shabda Sthoma Mahanidhi)
The term Gata and Gati are derived from the Sanskrit verb root ‘Gam’ by
adding ‘kit’ or ‘Ktin’ Pratyaya.
Nirukti:- Gamane, Vahane, Margah, Sthane, Prapte, Labdhe, Patite, Sameepe,
Abhyupaye.(Shabda Sthoma Mahanidhi)
Hence Gata word may be used to denote an initiation of movement, carrying
something along with, to reach a particular site, through any particular pathway, leads
to occupancy at a particular site. In the context of Janusandhigata-Vata, occupancy is
at Janu Sandhi.
Paribhasha:- Gatam - Streelingam, Gacchati, Janati, Yatteti2 (Shabda Kalpa
Druma).
Vata: Vyutpatti - Va - Gati Gandhanayoho
Va - Gati Sevanayoho
Va + Kta (Shabda Kalpa Druma)
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The term ‘Vata’ is derived by the application of ‘Kta’ or Krt Pratyaya to the
verb root ‘Va’ which means ‘Gati Gandhanayoh’.
Nirukti - Sparsha Matra Vishesha Gunake Bhutabheda
Pavane - Dehasya Dhatubheda Cha 1 (Shabda Sthoma Mahanidhi)
The term ‘Gati’ is having meanings like Prapti, Jnana (Panini) and the meaning
of ‘Gandhana’ is like Utsaha, Prakashana, Soochana(Shabdasthoma), Gandhana,
Prerana (Siddhanta Kaumudi).
Considering the different meanings of Gati and Gandhana it is understood that
the term ‘Vata’ act as a receptor as well as stimulator. Hence it can be said that Vata
is the biological force, which recognizes and stimulate all the activities in the body.
Concept of Gatatva
Different phenomenon has been put forward to explain the pathogenesis of
various diseases. Gatatva is one such complex phenomenon mentioned in all classical
texts. Gatatva of Dhatu, Upadhatu, Ashaya, Avayava and Indriya etc. have been
described in our classics.
Various terminologies or synonyms are used to denote Gatatva in the classics.
They are Gate/Gatam, Sthite/Sthitam, Avasthite, Ashrite/Samashritam, Prapte and
Sthe/Stha etc.
Analyzing the above referred meanings and synonyms it can be concluded that
the word has two implications. One related with the movement (Subjected to Gati of
Vayu) and the other related with occupation of site (subjected to Adhishtana).
Hence Gatatva of Vata implies an undesirable movement of Vata and its
unwanted occupation of certain sites.
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Sandhigata-Vata
After going through the different references the definition can be stated as –
the vitiated Vata when get lodged at one or more than one Sandhi and producing the
features like pain in the joint, swelling on palpation, crepitus and stiffness in the joint.
When these set of clinical manifestations appears only in Janu Sandhi then it is termed
as Janusandhigata-Vata.
Janu-Sandhi
In Janusandhigata Vata the vitiated Vata get lodges at Janu-Sandhi. Therefore
before going to the disease aspects, the anatomy and physiology of Janu-Sandhi are to
be understood properly
Acharya Susrutha considered Janu-Sandhi under Chala Sandhi1 and sub classified
under Kora Sandhi.2
Other factors which are to be highlighted in understanding the Sandhi are-
Shleshaka Kapha
Among five variety of Kapha, Shleshaka Kapha resides in joints. It keeps the
joints firmly united, protects their articulation opposes their separation and disunion.3
Shleshmadhara Kala
It is the fourth Kala, which is situated in all joints of living beings. As wheel
moves on well by lubricating the axis, joints also function properly if supported with
Kapha. This helps in lubrication of joints.4
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Vyana Vata
Vata governs every movement in the body. Vyana Vata is one among the five
varieties of Vata, which resides at Hridaya and controls most of the motor functions.
The Gati or physical movement is also one of its functions.
Gayadasa commenting on Susrutha has quoted the wordings of an unknown
author as though the Vyana Vata is functioning all over the body it resides in the
Sandhi.5
Acharya Vagbhata states that Vata is located in the Asthi with relation to
'Ashrayashrayi Sambandha'. Generally augmentation or diminution of Doshas would
be given similar effect on their respective Dhatus but in case of Vata it is opposite;
with increase in Vata, Asthi Kshaya occurs.6
Susrutha in Sharira Sthana explains different structures of the human body.
Among them, structures coming under Janu-Sandhi are listed below.
Snayu
Among nine hundred Snayus, ten are present in Janu-Sandhi. More over in
Shakha and Sandhi, Pratana variety of Snayu is present.
Importance – As a boat consisting of planks becomes capable of carrying load of
passengers in river after it is tied properly with bundle of ropes, all joints in the body
are tied with many ligaments by which persons are capable of bearing load.7
Peshi
The fleshy mass demarcated from each other is known as Peshi. In Janu they
are five in number. They are strong structures that help to maintain alignment of the
joint.8
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Sanghata
Assemblages of bones are fourteen. One is situated in Janu-Sandhi.9
Knee Joint
Joints or articulations are the site where two or more bones meet. Joints are
the weakest part of the skeleton but their structures resists various forces, such as
crushing or tearing that threaten to force them out of alignment.
Joints are classified structurally and functionally. Fibrous, cartilaginous and
synovial are structural classification. Synarthrosis, amphiarthrosis and diarthrosis are
functional classification.
Knee joint10, 11, 12, 13 is a variety of synovial joint. In synovial joints the osseous
surfaces concerned are not in continuity although the bones involved are linked. The
synovial joints evolved from fibrous and cartilaginous joints by subsequent
developments. These synovial joints made up of source of the unique structures like
Fibrous capsule, articular surfaces, Synovial membrane, and Synovial fluid,
Ligaments, Muscles etc.
Knee joint is largest of human joints. Despite its single cavity in man, it is
convenient to describe it as 2 chondylar joints between the femur and tibia and a sellar
joint between the patella and femur.
Articular surface
Articular surfaces are most incongruent. The tibial surface is gently hollow
centrally and flattened peripherally where a meniscus rests. Lateral tibial surface is
circular and smaller, medial tibial surface is oval with longer ant-post axis.
The lateral and medial femoral chondyles have in front a faint groove. This
groove demarcates the femoral patellar and chondylar surfaces. Lateral Femoral
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surfaces are almost circular and medial femoral surface is larger and oval. The
patella’s articular surface is adapted to the femoral surfaces.
Fibrous capsule
The fibrous capsule has parallel but interlacing bundles of white collagen
fibers. It is complex, partly deficient and partly augmented by expansions from
adjacent tendons. It forms a cuff with its ends attached continuously round the
articular ends of the tibia and Femur.
Synovial membrane
Derived from embryonic mesenchyme, it lines fibrous capsule, covers
exposed osseous surfaces, intra-capsular ligaments and tendons. It is absent from
intra-articular discs or menisci and ceases at the margins of articular cartilages.
Synovial Intima: Also called as lamina propria synovialis or synovial lining layer. It
consists of pleomorphic synoviocytes embedded in a granular, amorphous, fiber free
inter cellular matrix. It helps in removal of debris and synthesis of components of
Synovial fluid.
Synovial fluid
It occupies synovial joints, bursae and tendon sheaths. It is clear, pale, yellow,
viscous, and slightly alkaline. A protein probably lubricin rather than hyaluoric acid is
the lubricating factor but it amplifies its secondary lubricating activity. It provides
liquid environment with small range of pH, nutrition for articular cartilage, discs,
menisci, lubrication and reduction of erosion.
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Menisci
It is fibrocartilagenous disc shaped crescent. It deepens the articular surfaces
of the chondyles of the tibia. It partially divides the joint cavity into upper and lower
compartments. It has two ends, two borders and two surfaces. It helps to make the
articular surfaces more congruent, act as shock absorbers, lubricates the joint cavity,
give rise proprioceptive impulse.
OTHER STRUCTURES
Ligaments
The capsules and ligaments of Synovial joints unit the bones, help to direct
bone movement and prevent excessive and undesirable motion. Thus more the
ligaments, the joint are stronger. In knee joint tibial collateral lig, fibular collateral lig,
oblique popliteal lig, arcuate popliteal lig, ligamentum patellae, cruciate ligament
etc. helps to maintain stability.
Muscle tone
Muscle tendons that cross the joints are the most important stabilizing factor,
which is due to tone of the respective muscles. In knee, muscle tone is extremely
important in reinforcing joints. Especially the thigh muscles are helpful.
Bursae
Apertures in fibrous capsule through which synovial membranes protrude are
called as Bursae. They are numerous; as many as 13 bursae have been described.
Blood Supply
1. 5 genicular branches of the popliteal artery.
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2. The descending genicular branch of the femoral artery.
3. The descending branch of the lateral circumflex femoral artery.
4. 2 Recurrent branches of the anterior tibial artery.
5. The circumflex fibular branch of the post-tibial artery.
Nerve Supply
Sciatic nerve - Through the genicular branches of the tibial and
common peroneal nerves.
Obturator nerve– Through its posterior division.
Nidana
Even though literatures of Ayurveda do not mention the Nidanas of Sandhi-
Gata-Vata, one has to compile the relevant references mentioned in different contexts
like Vata Vyadhi Nidana.1,2,3,4,5,6 Asthivahasroto Dushtikarana7 and Majjavahasroto
Dushtikarana.8
Nidana can be classified under various headings with different views. Among
them one classification is Sannikrishta and Viprakrishta Karana. Here with the
complimentary references the Nidanas of Sandhi-Gata-Vata is classified on this basis.
• Sannikrishta Hetu
Ativyayama, Abhighata, Marmaghata, Bharaharana, Sheeghrayana,
Pradhavana, Atisankshobha.
• Viprakrishta Hetu
Rasa – Kashaya, Katu, Tikta
Guna – Rooksha, Sheeta, Laghu
Dravya – Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura,
Kalaya, Adaki, Harenu, Shushkashaka, Vallura, Varaka.
Aharakrama – Alpahara, Vishamashana, Adhyashana, Pramitashana

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Manasika – Chinta, Shoka, Krodha, Bhaya
Viharaja – Atijagarana, Vishamopacara, Ativyavaya, Shrama,
Divasvapna, Vegasandharana, Atyucchabhashana,Dhatu
Kshaya.
Some of the important Nidanas are discussed below:
• Ativyayama
Excessive physical exercises act as one of the important Nidana for Sandhi-
Gata-Vata. Running, walking, jogging etc. if done excessively or violently will affect
the structures of Sandhi. They mainly affect the Joint stability by over exertion. But if
done properly they stabilize the Joint.
• Bharaharana
Carrying excessive load causes excessive pressure and stretching effect over
the structures of the joint. As knee is weight bearing joint, carrying excessive load
will have direct affect on articular disc. The constant compression will lead to wear
and tear effect leading to degenerative changes in the discs.
• Abhighata
Abhighata to joints due to Prapatana etc., lead to structural deformity in the
joints. Joint is an organ rather than a single structure. It is stabilized by different
structures like Asthi, Snayu, Peshi, and Kala etc. Hence any trauma to these structures
will alter the structural integrity of the joint. Hence Abhighata is an important Nidana
for Sandhi-Gata-Vata.
• Atisankshobha
It is a Nidana for Asthivaha Sroto Dushti. Since Asthivaha Srotas is involved
in Sandhi-Gata-Vata this can be considered as Nidana for the same. Violent activities
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like Atyadhva, Plavana, Langhana, Balavat Vigraha, Pradhavana etc. will have its
effect on joint. As told earlier knee is the weight-bearing joint, the violent exercises or
activities will alter the structural integrity of the joint.
• Marmabhighata
The concept of Marmabhighata in the causation of Sandhi-Gata-Vata sounds
more rational. Janu-Sandhi is a variety of Vaikalyakara Sandhi-Marma.9 Marma is a
vital point, which comprises of Asthi, Snayu, Sira, Mamsa and Sandhi. Hence any
Marma is made up of all these structures, likewise the Janu-Sandhi.
Pain in the joints may not necessarily be only associated with bony changes.
But involvement of other joint structures may also give rise to symptoms pertaining to
joint. Therefore, in recent days more study is emphasized on the different structures
involved in the pathology of Arthritis like consistency of soft tissue, fibrous material,
liquid and cartilaginous substance of the joint. From this new point the Ayurveda
view towards the involvement of certain Marma in the disturbance of the joint i.e.
painful joint will be anticipated. Hence Marmabhighata as a Nidana in case of
Sandhigata Vata is to be given importance.
Table No.1 Samanya Nidana of Vata vyadhi
Nidana Cha.Sa Su.Su. A.Hr. Ma.Ni Yo.Ra Bha.Pr

1. Aharaja
a) Rasavishesha
Kashaya - + + - - +
Katu - + + - - +
Tikta - + + - - +
b) Guna Vishesha
Rooksha + + + + + +
Laghu + + - + + +
Sheeta + + - + + -
c) Dravya Vishesha
Vallura - + - - - -
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Varaka - + - - - -
Shuskha Shaka - + - - - -
Uddalaka - + - - - -
Neevara - + - - - -
Mudga - + - - - -
Masura - + - - - -
Harenu - + - - - -
Kalaya - + - - - -
Nishpava - + - - - -
2. Viharaja
Ati Vyayama + + + + + -
Langhana + + - + + -
Plavana + + - + + -
Atyadhwa + - - + + -
Pradhavana - + - - - -
Pratarana - + - - - -
Atyuchabhashana - - + - - -
Balavadvigraha - + - - - -
Abhighata + + - + + +
Marmaghata + - - + + -
Bharaharana - + - - - -
Dukhashayya + - - + + +
Dukhasana + - - - - -
Gaja,Ushtra,Ashvaayana + + - + + -
Prapeedana - + - - - -
Atiadhyayana - + - - - -
Ati vyavaya + + + + + +
Atijagarana + + + + + +
Vegadharana + + + + + +
Vishamopachara + - - + + -
Shrama - - - - - +
Upavasa + + + + + +
Puravata sevana - - - - - +
3 Manasika karana
Chinta + - + + + +
Shoka + + + + + +
Krodha + - - - - -
Bhaya + - - - - -
4 Anya Nidana
Atiraktasravana + - - + + -
Atidoshasravana + - - + + +
Dhatukshaya + - - + + +
Rogatikarshana + - - + + +
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Poorvaroopa
Particular mentioning of Poorvaroopa of Sandhi-Gata-Vata is not available in
literatures. Mild exhibition of actual features of the disease itself (Avyakta and Alpa
vyakta) is considered as its Poorvaroopa.1 Hence clinical features of Sandhigata
Vata in milder form can be considered as Poorvaroopa.
Roopa
The clinical features of Sandhi-Gata-Vata explained by various Acharya are
listed in table below
Table No.2 Roopa of Sandhi-Gata-Vata mentioned in various classics

SYMPTOMS Ca.Sa. Su.Sa. A.Hr. A.Sa. Ma.Ni. Bh.Pr. Yo.Ra.
Sandhi Vedana + + + + + + +
Sandhi Shotha + + + + - + +
Sandhi Stabdhata - + - - + - -
Atopa - - - - + - -
Vata Poorna dhruti
+ - - - - - -
sparsha
Prasarana
+ - + - - - -
Akunchana Vedana
Sandhi Vedana
All the Acharya have described this symptom. Charaka and Vagbhata
explained that pain in the joint is elicited during Prasarana Akunchana Pravrutti.
Sandhi Shotha
Most of the authors explained this symptom. Charaka and Vagbhata explained
the nature of Shotha i.e., it is felt like bag filled with air (Vata Poorna Driti Sparsha).
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Sandhi Stabdhata
Susrutha initially described this symptom, later by texts like Madhava Nidana,
Yogaratnakara and Bhavaprakasha.
They have coined the term Sandhi Hanana or Hanti. While commenting on
this word Dalhana and Gayadasa explained as ‘Akunchanaprasaranayoh Abhavah and
Prasaranakuncanayoh Asamarthah’ respectively. With this we can infer that the word
Hanti refers to inability to move the joints.
In the opinion of Madhukoshakara, Hanti refers to Sandhi Vishlesha,
Stambhadi Vikara.
Hence with the above references, Hanti refers to Sandhi Stabdhata.
Atopa
This symptom explained in Madhava Nidana. While commenting on the word
Atopa in another context, Madhukoshakara quotes the opinion of Gayadasa and
Karthika.
I.e. ‘Atopaha Chalachalanamiti Gayadasaha, Gudaguda Shabdamiti Kartikah’.
Also Bhavamishra says ‘Atopo – Gudagudashabdaha’.2
Thus we can say that Atopa in this context is the sound produced by the
movement of joints i.e., Crepitus.
Thus with the help of different references and by the opinion of commentators
it can be concluded that Sandhi Shoola, Sandhi Shotha, Sandhi Stabdhata and Atopa
are the clinical features of Sandhigata Vata or Janusandhigata-Vata.3,4,5,6,7,8
Samprapti
The Samanya Samprapti of Vata Vyadhi which is explained in literatures can
be applied for Sandhigata-Vata also. Acharya Charaka has explained that due to the
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intake of Vatakara Ahara Vihara, Vata vitiation take place which lodges in Rikta
Srotas i.e. Srotas in where Shunyata of Snehadi Guna is present, producing diseases
related to that Srotas.1
Acharya Vagbhata quotes the Samprapti of Vata Vyadhi like – Dhatukshaya
aggravates Vata and the same is also responsible to produce Riktata of Srotas. The
vitiated Vata travels throughout the body and settles in the Rikta Srotas and further
vitiates the Srotas leading to the manifestation of Vata Vyadhi.2
Here an attempt has been made to explain how this Srotoriktata occurs due to
Nidana Sevana.
The main qualities of Parthiva Dravya are Guru, Sthula, Sthira, and Gandha
Guna in excess. These are the properties, which are necessary for Sthairya and
Upachaya of the body. Excessive intake of Dravyas having Laghu, Ruksha, Sukshma,
Khara qualities lead to Guru and Sneha Guna abhava due to their opposite quality.
Thus it leads to Dhatukshaya in the body. Akasha is the Mahabhuta that produces
Sushirata and Laghuta in the body. Vayu Mahabhuta fills up this Sushirata. So due to
Dhatukshaya Akasha Mahabhuta increases in the body producing Sushirata and
Laghuta.Simultaneously Vayu fills it up in the riktha srotas.
From this description it can be stated that the meaning of word ‘Riktata’ is
Sushirata i.e. increase in Akasha and Vayu Mahabhuta. While commenting on word
‘Riktata’ Chakrapani says that ‘Riktata’ means lack of Snehadi Guna. For the purpose
of understanding the Samprapti of Janusandhigata-Vata the samprapti can be studied
under two heading. They are,
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1. Dhatu Kshaya Janya Sandhigata Vata
In old age Vata Dosha dominates in the body. This will lead to Kapha
Abhava. Also Jatharagni and Dhatvagni get impaired, by which Dhatus formed will
not be of good quality. Degeneration of body elements takes place due to
predominance of Vata in its Ruksha and Khara Guna and reduction of Kapha in
quality and quantity.
As the Shleshma Bhava decreases in the body, Shleshaka Kapha in the joints
also decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi
Bandhana Shithilata and induces Kharata. Ashrayashrayi Sambandha also leads to
Asthi Dhatu Kshaya.
In this condition if Nidana Sevana done further produces Vata Prakopa. If
Vata Prakopa is not corrected by appropriate means and simultaneously if the person
indulges in Asthivaha and Majjavaha Sroto Dushtikara Nidana, the Prakupita Vata
spreads all over the body through these Srotas. In the meantime Sthanasamshraya of
Prakupita Vata takes place in the Khavaigunyayukta Janu-Sandhi. This localized
Vayu due to its Ruksha, Laghu, and Kharadi Guna over power and decreases all
properties of Shleshaka Kapha producing disease Sandhigata Vata.
2. Avarana Janya Sandhigata Vata
In Sthulas usually Sandhi-Gata-Vata occurs in weight bearing joints. In them
Medo Dhatu will be produced in excess due to the Atisnehamsha of Amarasa.3The
excessive Medas will produce obstruction for the flow of nutritive materials to the
future Dhatus i.e. Asthi, Majja and Shukra leads to their Kshaya.
The excessive fat deposited all over the body will produce Margavarana of
Vata.4 Prakupita Vata due to Margavarana starts to circulate in the body. While
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traveling it settles in the joint where Khavaigunya already exists. After
Sthanasamshraya, it produces the disease Sandhigata Vata in the same process
mentioned in the earlier context.
Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of
Janusandhigata Vata can be divided into Dhatukshaya Janya and Avarana Janya. This
will help in deciding the prognosis and planning the treatment of the disease.
Samprapti Ghataka:
Dosha – Vata – Vyana – Vriddhi; Kapha – Shleshaka – Kshaya
Dushya – Asthi,Sandhi,Mamsa
Srotas – Mamsavaha, Asthivaha
Agni – Jatharagni, Asthi-Dhatvagni
Ama – Jatharagni and Asthi dhatwagni Mandya Janya
Roga Marga – Madhyama
Udbhavasthana – Pakvashaya
Sancharasthana - Sarvasharira
Adhishtana – Sandhi
Vyaktasthana – Janu Sandhi
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FIGURE - 1
SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI-GATA-VATA
UKTA NIDANA SEVANA VARDHAKYA
VATA PRAKOPA KSHAYA OF KAPHA BHAVA

(Vyana Vata) IN THE BODY
CIRCULATION THROUGH SHLESHAKA KAPHA KSHAYA

RASAYANI IN SANDHI
STHANASAMSHRAYA IN SANDHIS
WHERE KHA VAIGUNYA IS PRESENT
SANDHI-GATA-VATA
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FIGURE - 2
SAMPRAPTI IN AVARANA JANYA SANDHI-GATA-VATA
MEDOVRIDDHI
MEDOAVARANA MARGAVARANA TO THE
FLOW OF POSHAKARASA
VATAPRAKOPA
(VYANA VATA) POSHAKARASA NYUNYATA TO
ASTHIDHATU
EXCESSIVE PRESSURE OVER

WEIGHT BEARING JOINT
CIRCULATION THROUGH ASTHIDHATU KSHAYA

RASAYANI IN SANDHI
VYANAVATA PRAKOPA
IN SANDHI
STHANASAMSHRAYA IN SANDHI
WHERA KHAVAIGUNYA IS PRESENT
SANDHI-GATA-VATA
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Upashaya-Anupashaya
Upashaya and Anupashaya are very much important; especially during the
treatment usually drugs having Snigdha and Ushna Gunas are prescribed as these
pacify the vitiated Vata. This should be adopted in the Nirama Avastha of Vatavyadhi
only. This is the Upashaya method. When the Vatakara ahara and vihara are
prescribed in the Saama Avastha of Vatavyadhi the disease aggravates. This is the
Anupashaya.
While making the diagnosis of Sandhigata Vata the following disorders that
are having similar features has to be excluded. They are
1) Ama Vata1
2) Vata Rakta2
3) Koshtukasheersha3
4) Sandhibhagna4
5) Asthi Majjagata Vata5
There are some conditions (Dosha Vriddhi Kshaya Lakshana, Panchakarma
Vyapat) where in symptoms related to Sandhi are seen.
They are listed below.
1) Kapha Vriddhi6
2) Kapha Kshaya7
3) Mamsa Kshaya8
4) Medo Kshaya9
5) Asthi Kshaya10
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6) Majja Kshaya11
7) Ojo Visramsa12
So while diagnosing Sandhigata Vata, factors like Vriddhi or Kshaya of Dosha
and Dhatu should be differentiated apart from above-mentioned disorders. This will
help in successful treatment.
Sadhyasadhyata
Vata Vyadhis are considered as one among the Mahagadas by Acharyas.1
Generally Vata Rogas are very difficult to cure due to the deep seated nature in them.
Janu Sandhi Gata Vata usually occurs in the Vardhakya Kala, which is predominant
of Vata. Charaka had mentioned some Vata Vyadhis, which are either not curable due
to Sthana Gambheerata or curable with effort in case they are of recent origin, in
strong patients and if without any complications.
Dhatukshaya is the chief cause of Vata Vyadhi. Dhatukshaya is difficult to
treat as told by Acharya Vagbhata.
The ailments of aged persons are Kashtasadhya and Sandhigata Vata is the
affliction of elderly persons. Diseases situated in Marma and Madhyama Rogamarga
is Kashtasadhya. Sandhigata Vata is a disease of Sandhi, which falls under Madhyama
Rogamarga. Further Vata Vyadhi occurring due to vitiation of Asthi and Majja are
most difficult to cure.
In the list of Kashtasadhya Vata Vikara, Acharya Charaka does not mention
Sandhigata-Vata but while commenting on word ‘Khuddavata’ Chakrapani2 explains
the meaning of Khuddavata as Gulphavata or Sandhigata Vata. Thus Sandhigata Vata
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can be considered as Kashtasadhya Vata Vyadhi. Janu-Sandhigata Vata is not a fatal
disease, but it cripples the patient and makes him/her burden to others.
Upadravas1
Susrutha has stated that Bala kshaya, Mamsa kshaya, Thrishna, Dhatushosha,
Jwara, Vamana, Murccha, Atisara, Hikka, Shotha, Suptata, Bhagna, Kampa, and
Aadhmana as Upadravas of Vata Vyadhis. Osteoarthritis if long standing will be
having complications like muscle wasting, various deformity, intra articular loose
bodies etc. This state is very complicated one where the patient finds much difficulty
in managing his daily routines.
Chikitsa
Sandhigata Vata is a Vataja disorder. So general treatment of Vata Vyadhi
can be adopted, keeping an eye on the etiology of the same. Regarding the specific
line of treatment of Sandhigata Vata, Charaka is silent. Later authors like Susrutha1
had mentioned effective line of treatment for the same. Other books like Ashtanga
Hridaya, Ashtanga Sangraha, Yogaratnakara, and Bhavaprakasha had mentioned
specific line of treatment.
The chart below shows Chikitsa sutra mentioned in different texts.
Table No. 3 Showing the Chikitsa Sutra mentioned in different Samhitas

Treatment Su.Sa. A.Sa. A.Hr. Yo.Ra. Bh.Pr. Bi.Ra.
Snehana + - + + + +
Abyanga - + - - - -
Mardana + + - + - +
Svedana - + - + + -
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Upanaha + + + + + +
Bandhana + + - - - +
Agnikarma + + + - - +
• SNEHANA
Sandhi-Gata-Vata is a variety of Vata Vyadhi, where Snehana would be very
effective.
Acc. to the use it can be administered in two ways2,
1) Abhyantara Sneha:
Here Sneha in the form of Pana, Bhojana, Basti and Nasya can be
administered in case of Sandhigata Vata.
2) Bahya Sneha:
Bahya Snehas are many like Abhyanga, Lepa, Udvartana, Padaghata,
Gandoosha, Karnapoorana, Akshitarpana, Pichu, Samvahana, Mardana, Murdhnitaila,
and Parisheka. In case of Sandhi-Gata-Vata we get the mentioning of Abhyanga and
Mardana.
Abhyanga means to do some 'movements' or 'Gati'. For the purpose of
Abhyanga Sukhoshna Taila or Sneha is used. It should be done slowly in Anuloma
Gati, and on joints in circular manner. It should be done minimum for 5 minutes
because the Veerya of Taila will reach Majja Dhatu in 900 Matra-Kalas. It is
Vatahara, Pushtikara3,4
Mardana is like Abhyanga but applied pressure is more.
• SWEDANA
Svedana is a variety of Shadvidhopakrama. It is helpful in neutralizing
Sthabdhata, Sheetata and Gauravata.5
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In case of Sandhi-Gata-Vata varieties of Swedana Karma like
Upanaha and Bandhana are indicated.
• Upanaha
Both Susrutha and Charaka consider Upanaha as a variety of Swedana.6,7
Roots of Vatahara drugs should be pasted together with Kanji and mixed with
abundant quantity of Saindhava Lavana and Sneha. After making this lukewarm, it
should be applied to the affected part.
The paste of drugs of Kakolyadi, Eladi or Surasadi groups as well as pastes of
Sarshapa, Tila, or Atasi or Krishara, Payasa, Utkarika and Vesavara or the drugs of
Salvana Sweda should be similarly applied to the affected part folded in piece of thin
linen cloth and tied up.8
Bandhana Dravya in Upanaha:
For the purpose of Bandhana, Charaka opines that leather of Ushna Veerya
animal can be used. In the absence of this silk or woolen cloth can be used.9 Astanga
Hridayakara opines that 'Vatahara' Patras should be used10 and Charaka suggests
Eranda Patra.11
Duration
Upanaha, which is tied in the morning, should be removed in the night and
which is tied in the night should be removed in the morning.12
Sneha Pramana
According to Vata, Pitta, Kapha, Sneha should be added 1/4, 1/6/1/8th of the
Upanaha Dravya.
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• Bandhana: In Bandhana Upanaha Dravya is tied to the affected apart.
Acharya Susrutha again subdivides this into 3 types:
a) Pradeha
b) Sankara
c) Bandhana
• Pradeha
Thick paste prepared by Amla Kanji in Vatahara Dravya after adding
Saindhava Lavana and Sneha, Swedana is done. Dalhana called this as Upanaha.13
• Sankara Sweda
In Sankara Sweda, paste made up of Vatahara Dravyas, Amla Kanji,
Saindhava Lavana and Sneha etc., taken in a piece of cloth and Potali is prepared.
Dalhana considered this as Upanaha.14
• Agnikarma
Unique treatment indicated in case of Sandhigata Vata. Here Dahana should
be done on the affected joint till the appearance of Samyak Lakshana.
Hence the different treatment modalities mentioned by different authors can be
concise under these three types.15,16,17,18,19
Osteoarthritis
Osteoarthritis is also called as Degenerative Joint Disease or Arthrosis or
wear-and-tear arthritis.1It represents the failure of diarthrodial joint.
It is the most common joint disease of humans. Osteoarthritis of knee is the
leading cause of chronic disability in developed countries.2 Primary osteoarthritis is
Disease Review 2010
idiopathic and secondary osteoarthritis is due to many causes like secondary to
trauma, due to endocrinal disorders, metabolic causes, etc.
Risk factors for Osteoarthritis3
• Age – It is considered to be one of the powerful risk factor. Old age people are
prone to suffer with osteoarthritis and causes disability in them.
• Sex – Both Males and females are affected, but osteoarthritis is more
generalized and more severe in older women. It is twice as common in women
as in men. Osteoarthritis of knee is common in women.
Women less than 45 years old – 2%
45 – 65 years – 30%
Older than 65 years – 68% will suffer.
• Genetic – Point mutation in the cDNA coding for articular cartilage collagen
have been identified in families with chondrodysplasia and polyarticular
osteoarthritis.
• Trauma – Direct or indirect injuries to the articular cartilage lead to its
degeneration. Fractures of different bones, especially of weight bearing with
or without involving the joint can also cause alteration of ligaments and in
articular surface of joint.4
• Repetitive stress – Abnormal posture, abnormal gait, and unequal length of leg
will exert stress and strain over the joint.
• Endocrine disorders – Acromegaly, Hyperparathyroidism, Diabetes mellitus,
Obesity etc. may lead to osteoarthritis.5
• Metabolic disorders – Like Ochronosis, Wilson’s disease may give rise to
osteoarthritis.
Disease Review 2010
• Calcium deposition diseases – Like CPPD deposition may lead to
osteoarthritis.
Pathology
Although the cardinal pathologic features of osteoarthritis are a progressive
loss of articular cartilage, osteoarthritis is not a disease of any single tissue but a
disease of an organ, the Synovial Joint.6The most striking morphologic changes in
osteoarthritis are usually seen in load bearing areas of the articular cartilage.
Osteoarthritis develops in either of two settings:
1. The biomaterial properties of the articular cartilage and subchondral bone
are normal, but excessive loading of the joint causes the tissue fail, or
2. The applied load is reasonable, but the material properties of the cartilage or
bone are inferior.
In the early stages the cartilages thicker than normal. With the progression of
osteoarthritis, joint surface thins then the cartilage softens. Then the integrity of the
surface is breached and vertical clefts develop. They are called as fibrillation. Then
there develops deep cartilage ulcers, extending to bone. All the cartilage is
metabolically active and the chondrocytes replicate, forming clusters (clones). Later
cartilage becomes hypo cellular. There will be appositional bone growth in the bony
subchondral region, leading to the bony sclerosis. Growth of cartilage and bone at the
joint margins leads to osteophytes, which alter the contour of the joint and may resist
movement.
The biochemical changes in osteoarthritis cartilage are increase in water
content, decrease collagen, proteoglycan, monomerize, hyaluronate, keraten sulphate,
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and chondrotin sulphate, increase in proteoglycan synthesis, collagenase, and
proteoglycanase.7
Clinical Features
• Symptoms
o Joint Pain
It is often described as a deep ache and is localized to the involved joint.
Typically, the pain of osteoarthritis is aggravated by joint use and relieved by rest, but
as the disease progresses, it may become persistent.
o Stiffness
Progressive stiffness of the involved joint upon arising in the morning or after
a period of inactivity may be prominent but usually lasts less than 20 min. It is due to
spasm of muscles. There is no relation between the severity of degeneration and
morning stiffness.
• Signs
o Swelling
Physical examination of the osteoarthritis joint reveals localized soft tissue
swelling of mild degree. It is due to the changes in articular ends themselves,
particularly periarticular lipping.
o Crepitus
The sensation of bone rubbing against bone evoked by joint movement is
called as crepitus. It is one of the characteristic sign of osteoarthritis joint.
Disease Review 2010
o Local Warmthness
On palpation of the joint local rise in temperature indicative of sign of
inflammation.
o Muscle Atrophy
Periarticular muscle atrophy may be due to disuse or due to reflex inhibition
of muscle contraction.
Others
In advanced stage there may be gross deformity, bony hypertrophy,
subluxation and marked loss of joint motion.
Laboratory and Radiological Findings8
The Diagnosis of osteoarthritis is usually based on clinical and radiographic
features. In the early stages, the radiograph may be normal, but joint space narrowing
becomes evident, as articular cartilage is lost. Other characteristic radiographic
findings include subchondral bone sclerosis, subchondral cysts and osteophytosis. A
change in the contour of the joint, due to bony remodeling, and subluxation may be
seen. There is often great disparity between the severity of radiographic findings, the
severity of symptom and functional ability in osteoarthritis.
No laboratory studies are diagnostic for osteoarthritis, but specific laboratory
testing may help in identifying one of the underlying causes of secondary
osteoarthritis. Analysis of synovial fluid reveals mild leukocytosis with a
predominance of mononuclear cells.
Approaches such as magnetic resonance imaging and ultrasonography have
not been sufficiently validated to justify their routine clinical use for diagnosis of
osteoarthritis or monitoring of disease progression.
Disease Review 2010
Treatment9
Treatment of osteoarthritis is aimed to reducing pain, maintaining mobility,
and minimizing disability. The vigor of the therapeutic intervention should be dictated
by the severity of the condition in the individual patient. For those with only mild
disease, reassurance, instruction in joint protection, and an occasional analgesic, may
be required. For those with more severe osteoarthritis especially of the knee or hip, a
comprehensive program comprising spectrum of non-pharmacological measures
supplemented by an analgesic and/or NSAID is appropriate.
Non-Pharmacological Measures
• Reduction of Joint Loading10
Osteoarthritis may be caused or aggravated by poor body mechanics.
Correction of poor posture and a support for excessive lumbar lordosis can be helpful.
Excessive loading of the involved joint should be avoided; patients with osteoarthritis
of the knee or hip should be avoided prolonged standing, kneeling and squatting.
Obese patients should be counseled to lose weight. In patients with medial
compartment knee osteoarthritis, a wedged in sole may decrease the pain. Complete
immobilization of painful joint is rarely indicated. In patients with unilateral
osteoarthritis of knee or hip, a cane, held in the contraleteral hand, may reduce joint
pain by reducing the joint contact force. Bilateral disease may necessitate use of
crutches or walker.
• Physical Therapy11
Application of heat to the osteoarthritis joint may reduce pain and stiffness. A
variety of modalities are available; often the least expensive and most convenient is a
Disease Review 2010
hot shower or bath. Occasionally, better analgesia may be obtained with ice than with
heat.
It is important to note that patients with osteoarthritis of weight bearing joints
are less active and tend to be less fit with regard to musculo-skeletal and
cardiovascular status than normal controls. An exercise program should be designed
to maintain range of motion, strengthen periarticular muscles, and improve physical
fitness. The benefit of aerobic exercise includes increase in aerobic capacity, muscle
strength, and endurance; less exertion with a given workload and weight loss. Those
who exercise regularly live longer and are healthier than those who are sedentary.
Patients with hip or knee osteoarthritis can participate safely in conditioning exercises
to improve fitness and health without increasing their joint pain or need for a
analgesics or NSAIDs.
Disuse of the osteoarthritis joint, because of pain will lead to muscle atrophy,
because particular muscles play a major role in protecting the articular cartilage from
stress, strengthening exercise are important. In individuals with knee osteoarthritis
strengthening of a particular muscle may result, within weeks, in a decrease in joint
pain as great as that seen with NSAIDs.
Drug therapy of osteoarthritis
The following measures may be undertaken in the management of Osteoarthritis.
a) Drugs – Non-opoid analgesics are mainly used to suppress pain. E.g.:
Acetaminophen is the 1st drug of choice.
b) NSAIDS – When patients fail to respond to potent analgesics, NSAIDS are
advised.
c) Opoid analgesics – These can be tried when the patient fails to respond to the above
measures.
Disease Review 2010
d) Intra- articular steroids – This is indicated if there is effusion and signs of
inflammation.
e) Topical analgesics - Capsaicin cream reduces joint pain and tenderness when
applied topically patients with knee and hand osteoarthritis.
f) Viscosupplementation - Injection of Sodium Hylarunon (Hyaluronic acid) into the
joints, once a week for 3 weeks.
g) Food supplementation – Glucosamine and Chondroitin sulphate has been
introduced, claiming to be agents which result in repair of damaged cartilage and
reduce pain in mild to moderate OA at a dosage of 1500/ day for at least 3 months.
Their role as disease modifying agents has not yet been established.
h) Surgery: Osteotomy – Osteotomy near a joint has been known to bring about relief
in symptoms, especially in arthritic joints with deformities.
Joint replacement –For Cases crippled with advanced damage to the joint,
total joint replacement operation has provided remarkable rehabilitation.
Arthroscopic procedures – Arthroscopic removal of loose bodies,
degenerated meniscal tears and other such procedures have become popular because
of their less invasive nature.
Basti Karma 2010

CONCEPT OF BASTI-KARMA
Basti is the most important constituent of Pancha Karma therapy and it is the
important Karma in the treatment of Vatavyadhis. It is indicated in almost all
Vatavyadhies and especially indicated in the patients who have disability, pain, stiffness
in the extremities etc. Majority of these symptoms are present in the patients of
Janusandhigata vata.
Basti has not just a limited goal of Pakwashaya and Malashayasuddhi but it purifies
and alleviates Doshas, collects Malas, increases Shukra dhatu, puts on weight on thins
and reduces weight in obese, strengthens eye sight, slow down aging process, improves
complexion and increase vigor and life span.1,2
Basti is glorified as Ardhachikitsa by Charakacharya and complete Chikitsa by
some other Acharyas. Vata is the most responsible element to spread Doshas in the
Shakha, Koshthadi Rogamargas. Samhanana (Collection) and Samvahana
(Transportation) of Pitta, Kapha, Rasa, Rakta, Sweda, Mala-Mutra, etc. is also under the
hold of Vata. Bastikarma controls Vata at its Mulasthana - Pakvashaya, and thus all
metabolic processes under the control of Vata are automatically regulated as, if the root
of the diseased tree is destroyed; its branches, leaves and flowers are automatically
destroyed.3
Though Basti stays in Pakvashaya, pelvis and organs below umbilicus get the
actions through Virya of the Basti Dravyas transmitted all over the body. It sucks out
Doshas from head to toe as, the sun, though miles away, with its rays, sucks the water
from the plants on the earth.4 No other Chikitsa is as capable as Basti to tolerate and
Basti Karma 2010

regulate the force of Vata.5 Basti is primely active on Vata, still it is equally helpful to
alleviate Pitta, Kapha, Rakta Dosha, Samsarga and Sannipata Doshas.6
Niruha Basti if used methodically and skillfully, purifies mala, Tridoshas and
Saptadhatus, drives out Dosha Sanchaya from the whole body, increases Agni, intellect,
life span and checks aging process.7
Etymology of Basti
The word Basti is derived from the root 'Vas' by adding 'Tich' Pratyaya and it belongs to
masculine gender.
Means to reside, to stay, to dwell, to cover / to coat.
Coating of Sneha for the elimination.
Gandha denotes bad smell hence it refers to Mala and verb 'Ardane' is derived from
Ardagatau "Yachane Cha" denotes the movement (in the colon) and to beg (drawing of
waste material in the colon from all over the body).
Meanings of Basti
A procedure, in which the drugs administered through the anal canal, stay in large
intestine for the certain period of time and draw the waste substances from all over the
body into the colon and eliminates them out of the body by producing movements in the
colon.
An organ for the reservoir of urine i.e. urinary bladder.
An instrument used for the administration of drugs via anal route.
Definition of Basti
1) The apparatus used for introducing the medicated materials is made up of Basti or
urinary bladder of animal.8
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2) The procedure in which the medicaments are introduced inside the body through the
rectum with the help of animal urinary bladder is termed as Basti.9
3) Apparatus-The bag made by animal bladder is termed as Basti.
4) Acharya Charaka has defined the Basti as the procedure in which the drug prepared
according to classical reference is administered through rectal canal, reaches upto the
Nabhi Pradesha, Kati, Parshva, Kukshi, churns the accumulated Dosha and Purisha,
spreads the unctuousness (potency of the drugs) all over the body and easily comes out
along with the churned Purisha and Doshas.10
Classification of Basti:
A) Classification of Basti according to drugs used :
a. Niruha Basti (Evacuative or Un-unctuous Enema) :
In Niruha Basti, Kwatha prepared with various Dravyas is used with additions of Sneha,
Madhu, Saindhava, Kalka etc. Its synonyms are Asthapana Basti, Kashaya Basti etc. The
Basti which eliminate the vitiated Doshas from the body and increase the strength of the
body because of its potency is called Niruha Basti. It stabilizes the Vaya, balance the
normal functions of Dosha and Dhatu and stabilizes Deha i.e. strength of the body and
also called as Asthapana Basti.11
Depending upon drugs and preparations used in Basti it is classified as follows12 :
1. Madhutailika Basti 5. Yuktaratha Basti

2. Pichha Basti 6.Pichchhila Basti
3. Siddha Basti 7.Yapana Basti
4. Vaitarana Basti
On the basis of chief drugs:
1. Kshira Basti 5. Rakta Basti
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2. Mamsa Rasa Basti 6.Asavakrita Basti
3. Amla-KanjikaBasti 7.Kshara Basti
4. Gomutra Basti 8. Dadhi Masha Basti
b. Anuvasana Basti
In this type of Basti, only Sneha is used. According to the quantity of oil given, it is
subdivide as follows:
The Sneha Basti which will not cause any harm even if it is retained for one day and can
be administered after taking food, therefore it is called Anuvasana Basti.13,14
1. Sneha Basti: 1/4th to the quantity of Niruha i.e. 6 Pala (298ml).
2. Anuvasana Basti: The quantity of Sneha is half of the Sneha Basti i.e. 3 Pala (144ml).
3. Matra Basti: This is the minimum quantity of Sneha Basti (½ of Anuvasana Basti) i.e.
1½ Pala (72ml).
B) Anatomical Classification
It depends upon the part of the body used for the administration of Basti.
Internal Application
1. Pakvashayagata Basti 2.Uttara Basti
External Application
1. Vranagata Basti 3.Shiro Basti
2. Kati Basti 4.Netra Basti
C) According To The Number Of Basti To Be Used
1. Karma Basti - 30 Basti - 12 Niruha & 18 Anuvasna Basti
2. Kala Basti - 16 Basti - 6 Niruha & 10 Anuvasana Basti
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3. Yoga Basti - 8 Basti - 3 Niruha & 5 Anuvasana Basti
In the above types, fixed sequence of Niruha and Anuvasana Basti is followed.
D) Pharmacological Classification
1. Garbhashayagata Basti 2.Mutrashayagata Basti
a. According to its effects after administration
1. Snehana Basti 6.Sangrahika Basti
2. Brimhana Basti 7.Rasayana Basti
3. Shamana Basti 8.Bala-Varna-Krita Basti
4. Vajikarana Basti 9.Shodhana Basti
5. Lekhana Basti 10.Deepana Basti
b. According to action on Dosha
1. Utkleshana Basti 5.Shamana Basti
2. Vataghna Basti 6.Kaphaghna Basti
3. Doshahara Basti 7.Shonitaghna Basti
4. Pittaghna Basti
c. According to potency and property
1. Ushna Basti 4.Ruksha Basti
2. Sheeta Basti 5.Laghu Basti
3. Snigdha Basti 6.Guru Basti
d. According to intensity
1. Mridu Basti 3.Madhyama Basti
2. Tikshna Basti 4.Pichchha Basti
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e. On the basis of specific indication
1. Pramehahara Basti 6.Gulmahara Basti
2. Visarpahara Basti 7.Krimihara Basti
3. Rakta-pittahara Basti 8.Parikartikahara Basti
4. Kusthahara Basti 9.Mutrakrichhrahara Basti
5. Vata-raktahara Basti 10.Dahaghna Basti
E) According To Dose
1. Dvadasha Prasritaki Basti 5.Chatuha Prasritaki Basti
2. Ekadasha Prasritaki Basti 6.Ekaika Prasritaki Basti
3. Nava Prasritaki Basti 7.Padahina Prasritaki Basti
4. Pancha Prasritaki Basti
F) On the basis of predominant Rasa in Basti Dravya :
1. Madhura Rasa Skandha Dravya Basti 4.Katu Rasa Skandha Dravya Basti
2. Amla Rasa Skandha Dravya Basti 5.Tikta Rasa Skandha Dravya Basti
3. Lavana Rasa Skandha Dravya Basti 6.Kashaya Rasa Skandha Dravya Basti
In general approximately 216 kinds of Basti are mentioned by Acharya Charaka in
various chapters of Siddhisthana.
Indications and contraindications of Anuvasana Basti Karma
Basti is one of the prime treatments of Ayurveda; hence the knowledge of the suitability
and unsuitability of patients should be kept in mind. All the Acharyas have clearly
explained as presented below.
Basti Karma 2010

Indications for Anuvasana Basti : Anuvasana is indicated in patients who are already
indicated for Asthapana, but special mention has been given to certain conditions like
Rooksha, Kevala Vataroga and Atyagni where Anuvasana is more beneficial.15,16
Table No.4 Persons unfit for the Anuvasana Basti 17, 18, 19
No. Contraindications Ch. Su. Vag. Complications
1. Anasthapya + + +
2. Abhuktabhakta + - + Sneha moves upwards
3. Nava Jwara + - -
4. Kamala + - + Leads to Udara
5. Prameha + - +
6. Arshas + - - Leads to Aadhmana
7. Pratishyaya + - -
8. Pandu + + +
9. Arochaka + - - Leads to more Annabhilasha
10. Mandagni + - -
11. Durbala + - - Increases the condition
12. Pleehodara + + +
13. Kaphodara + + + Leads to more Dosha Vardhana
14. Oorustambha + - +
15. Garapeeta + - +
16. Kaphabhishyanda + - +
17. Gurukoshta + - +
18. Shleepada + - +
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19. Galaganda + - +
20. Apachi + - +
21. Krimikoshta + - +
22. Prameha - + +
23. Kushta - + +
24. Sthaulya - + +
25. Peenasa - - +
26. Krushna - - +
27. Varchobheda + - +
28. Vishapeeta + - +
Basti Yantra: The instrument or device used for Basti karma is called as Basti Yentra. It
comprises of two parts – 1.Bastinetra 2.Bastiputaka
Basti Netra (Nozzle/Cannula): The general meaning of Netra is eye, but here
Netra means Nalika (tube). It can be made of gold, silver, copper or such other
higher metals or alloys, long bones of animals, bamboo, wood etc. were used in
ancient times. Generally, it must resemble the tail of cow with a tapering end and a
wider base. But, according to Charaka it is tubular apparatus with round ends and
smooth surfaces.20The dimensions are different to suit the patients of different age
group. The following table furnishes the measurement of Basti Yantra.
Basti Karma 2010

Table No. 5 Measurements of Basti Yantra21, 22, 23
No. Age in Length in Lumen of Netra

Diameter of narrow end Diameter of broad end
years Angula
1. <1 5 1 Angula
2. 1-6 6 Size of green gram 1 Angula
3. 7- 11 7 Size of black gram 1½ Angula
4. 12-15 8 Size of Kalayam 2 Angula
5. 16- 20 9 Size of wet Kalaya 2½ Angula
6. > 20 12 Karkandhu 3 Angula
Susrutha’s opinion
8. 1 6 Green gram Feather of Kanku bird
must pass through.
9. 8 8 Black gram Feather of eagle must
pass through.
10. 16 10 Kalayam Feather of peacock must
through.
11 >25 21 Kolasthi Feather of vulture must
pass through.
Basti Karma 2010

Karnika: In order to prevent undue penetration of the Basti Netra deep into the rectum,
a Karnika or rim has to be made. It is to be placed at a required point above the distal end.
Two karnikas are provided on the Netra at distance of 2 Angulas between one, another at
proximal end to tie the Basti Putaka properly.24
Bastiputaka: The container or bag used to carry the Basti Dravya, ready for application
is known as Bastiputaka. In ancient days the urinary bladder of matured animals like cow,
buffalo, dear, pig, goat etc were used. It was then processed to make soft and colorful by
removing the blood vessels and other impurities.
It should be made suitable for well fitting with the Basti Netra and should not
have any foul smell. If good bladder is not available some other materials are
recommended for the purpose. They are the skin of lower limb or neck of monkeys or
other animals, thick cloth with sufficient strength and size may also be used.25
Now a day, due to technological development various types of materials are
available to make up of Bastiputaka and even disposable Basti Netra are available. The
rubber bladder and polythene bags are best choice. Presently in most Panchakarma
theatres the disposable Basti Yentras with polythene bags are in use.
Table No. 6 Netra Dosha and Putaka Dosha 26, 27
No. Netra Dosha Features Effect

1. Hraswata Too short Dravya will not reach
Pakvashaya
2. Deerghata Too long Dravya go beyond the
Pakvashaya
3. Tanuta Too thin Produces Kshobha
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4. Sthoolata Too big Produces Lakshana
5. Jeernata Old Dhatu used Injury to Guda
6 ShithilabandhanaNot fixed properly to the Dravya comes out
Putaka
7. Parshwachhidra Hole on side Leakage of Dravya
happens
8. Vakrata Curved / irregular Dravyagati becomes
irregular
9. Assannakarnika Karnika too near Karma becomes of no use
10. Prakrustakarnika Karnika too far Causes Raktasrava by
Gudamarma Peedana
11. Anusrotata Small hole Cannot perform properly
12. Mahasrotrata Broad hole Cannot perform properly
No. Putakadosha Features Effect
1. Vishama Shape not in uniform Gati Vishamata happens
during pressing
2. Mamsala Muscular tissue present Produces offensive small
3. Chinnachidrayukta Presence of hole Dravya comes out
4. Sthula Thick one Does not push Dravya
5. Jalayukta Anastamosis present Produces leakage
6. Vatala Excess air space Frothy type of Dravya
7. Snigdha Unctuous Slip form the hand
8. Klinnata Wet Difficult to pass through
The procedures and preparations are classified into three parts: - 1.Purvakarma
(pre-treatment) 2.Pradhanakarma (treatment) 3.Paschatkarma. (Post-treatment)
The physician who is administering Basti should have good theoretical knowledge
and sufficient practical experiences in the therapy. The classical books have explained so
many complications that are produced due to improper and in efficient administration.
Basti Karma 2010

ANUVASANA BASTI PROCEDURE
Poorva Karma:
The body of the patient should be anointed with suitable Sneha and gently
fomented with hot water. Then he is advised to have his prescribed meal and made to
take a short walk. Having passed stool and urine he is laid on a couch, which is not very
high, and the head must be at lower level. No pillows are used. The patient should lie on
his left side drawing up the right leg and straightening the left leg.28, 29,30
Pradhana Karma:
The oil prescribed for Anuvasana taken in the Bastiputaka and tied well placing
the Basti Netra in position. The trapped air in Basti Yantra is expelled by gently pressing
the Bastiputaka. Then the anal region and the Netra should be smeared with oil. Gently
probe the anal orifice with the index finger of the left hand and introduce the Basti Netra
through it into the rectum up to first Karnika. Keeping in the same position press the
Bastiputaka with right hand with adequate force. Release carefully the Basti Netra when a
little quantity of Sneha remained inside the bastiputaka.31
Paschat Karma:
The patient is kept lying on his back as long as it would take to count up to hundred. The
patient should be gently struck three times on each of the soles and over the buttocks. The
distal part of the cot should be raised thrice. Allow him to lie for sometime in the same
position. If he gets the urge for defecation he may do it. But in the event of Sneha being
Basti Karma 2010

expelled prematurely, immediately another Anuvasana Basti should be given. After
passing the motion with Sneha in proper time the patient is allowed to take light food if
he feels hungry.32, 33 Maximum duration of the withdrawal of Sneha Basti is 3 Yama i.e. 9
hours.
Matra-Basti:
Matra Basti is a type of Sneha Basti i.e. Anuvasana Basti, described in the classics. It is
termed so, because the dose of Sneha used in is very less as compared to the dose of
Sneha Basti.34, 35, 36
According to Acharya Vagbhata, the Matra Basti is the type of Basti in which the dose of
Sneha is equal to Hrasva Matra of Snehapana.37, 38
Indications:
According to Charaka, Matra Basti is recommended for daily use in persons emaciated by
over work, over exertion, load lifting, way-faring, and riding or indulgence in women, in
debilitated persons as well as in those afflicted with Vata disorder.39
Table No. 7 Indications of Matrabasti
Sl.No Indications Charaka A.S. A.H.

1 Karma Karshita + - -
2 Bhara Karshita + + +
3 Adhva Karshita + + +
4 Vyayama Karshita + + +
5 Yana Karshita + + -
6 Stri Karshita + + +
7 Durbala + + +
8 Vata Rogi + + +
9 Bala - + +
10 Vriddha - + +
11 Chintatur - + +
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12 Stri - + -
13 Nripa - + +
14 Sukumara - + -
15 Alpagni - + +
16 Sukhatma - - +
Contra-Indications:
In classics, regarding the Matra Basti there is no major contraindications
mentioned. But according to Acharya Vagbhata, Matra Basti should not be administered
in person having Ajirna.40
Qualities of Matra Basti:
• It is promotive of strength,
• Demands no strict regimen of diet
• Causes easy elimination of Mala and Mutra
• It performs Brimhana Karma in the body
• Curative of Vata disorder.
• It can be administered at all times, in all seasons and is harmless.41
Dose of Matra Basti:
According to Vagbhata, the dose of Matra Basti is equal to the dose of Hrasva
Snehapana. The Matra which gets digested in two Yama i.e. 6 hours, is called as Hrasva
Matra but the dose required to get digested in two Yama is not mentioned.42
According to Acharya Sushruta, the dose of Matra Basti is ¼ of the dose of Anuvasana
Basti and the dose of Anuvasana Basti is ¼ of Niruha Basti i.e. 24 Pala.
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Hence, the dose of Anuvasana Basti is 6 Pala and dose of Matra Basti is 1½ Pal i.e. 6
Tola.43
According to Chakrapani, commentary on Charaka the dose of Sneha Basti is6 Pala, dose
of Anuvasana Basti is 3 Pala and of Matra Basti is 1½ Pala.44
On the basis of above reference it can be said that the dose of Matra Basti is1½ Pala of
Sneha i.e. 6 Tola equal to 60-70 ml.
Food before Basti Procedure:
After consumption of excessive Snigdha Ahara, Matra Basti should not be given because
Sneha taken in double quantity gives rise to Mada and Murchha. Before Matra Basti,
intake of excessive Ruksha Ahara should be avoided because it causes depletion of Bala
and Varna. So Matra Basti should be administered after low Sneha diet.45
Pathya -Apathya for Matra Basti :
There is no specific demand of diet and behaviour during use of Matra Basti. But
according to Acharya Vagbhata, it is to be restricted for the day sleep after administration
of Matra Basti.46
Retention of Matra Basti:
The Pratyagama kala of Sneha Basti is 3 yama i.e. 9 hours. Matra Basti being type of
Sneha Basti; its Pratyagama Kala is also 3 Yama i.e. 9 Hours. There is no harm if Matra
Basti is retained in the body, because while describing Anuvasana Basti, it has been said
that it is not harmful to body even in the event of its being retained in the body for a
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whole day. Also the dose of Matra Basti is very small which can get easily absorbed in
the body without coming out. It is believed that Sneha Basti should be retained in the
body. If Basti material returns much earlier, it cannot produce the desired effect in the
body47.
Lakshana of Samyaka Yoga of Anuvasana Basti (Matra Basti):
Being a type of Sneha Basti, Samyaka Yoga Lakshana of Sneha Basti are to be taken as
Samyaka Yoga Lakshana of Matra Basti. The Lakshana of Samyaka Anuvasana are –
• Return of Sneha with the fecal matter without being stuck up anywhere,
• Clearity of Rakta, Mamsa etc. Dhatus and sense organs,
• Adequate sleep, lightness of body,
• Increase of strength and vitality and
• Regulation of the excretory urges.
Lakshana of Ayoga of Anuvasana Basti:
The signs of the imperfect action of the Anuvasana Basti are –
• Pain in the lower part of the body, abdomen, arms, back and sides
• Dryness and roughness of the limbs and
• Retention of feces, urine and flatus.
According to Sushruta, Jrimbha, astringent and pungent taste in mouth, Vishama Jwara,
Trisha, Atisveda Pravriti, Chhardi, Shwasa may be produced by th Ayoga of Anuvasana
Basti depending upon the aggravated Dosha involved.
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Lakshana of Atiyoga of Anuvasana Basti:
The signs of excessive administration of the Anuvasana Basti are nausea, stupor, fatigue,
exhaustion, fainting and gripping pain. Further Sushruta includes Daha, Atisara and
Shrama accompanied with pain as the other symptoms of excessive administration of
Anuvasana Basti.
The Samyaka Yoga of Basti indicates that Basti therapy has given the desired effect and
there is no need of its further continuation. If the patient shows the symptoms of Ayoga,
then its cause should be investigated and the therapy may be replanned accordingly. On
the other hand, if the patient shows the symptoms of Atiyoga then Basti therapy should
be stopped at once and it should be treated accordingly. If no care is taken at this stage, it
may lead to many complications.
Complications of Sneha Basti:
Though, it has been said that there is no major complication by the use of Matra Basti,
but minor complications may be produced due to obstruction of Sneha by Vata, Pitta,
Kapha or by excess of Mala or food and when given to a person on empty stomach.
These six conditions of complications are likely to arise during the use of Sneha Basti.48
1) Vata Avrita Sneha
2) Pitta Avrita Sneha
3) Kapha Avrita Sneha
4) Anna Avrita Sneha
5) Purisha Avrita Sneha
6) Abhukta Prani Basti
Jalauka Review 2010

JALUAKA
In Vatavyadhi Chikitsa ‘Raktamokshana’ is also indicated. Many international
research works on the efficacy of leech therapy in Osteoarthritis of the knee have been
conducted in past and are also in progress in the present. Therefore the present study is
intended to compare the efficacy of Indukanta ghrita Matrabasti with Jalaukavacharana in
In brief we will discuss about the properties,collection and preservation of the Jalauka.
JALAUKA – Etymology
Ayu; i.e. the animals having water as the life. The term Jalauka can be split into Jala +
Oka; i.e. water dwelling animals.1
Definition
Shabdakalpadruma has considered Jalauka in feminine gender and defined it as an
aquatic creature employed to expel out the vitiated blood. Bhagavadgomandal defines
Jalauka as an animal living either in water or in mud with distended abdomen.
Synonyms:
Jalauka is called by different names as – Jalayuka, Jalaua, Jaluka, Jalaluka, Jaalalauka,
Jalita, Jaloka, Jalauga, Jalatani, Jalaukas, Jalasuchi, Jalaukasu, Jalasarpini, Raktapata,
Ruktapa, Raktapayini, Vanini, Vedhini, Venika.
Types of Jalauka:
In Ayurvedic literature, Jalauka have been classified into two main groups:
1. Savisha (Venomous)
2. Nirvisha (Non-venomous)

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Each group containing six types:
1. Savisha Jalauka:
The Savisha Jalauka originates in the decomposed urine and fecal matter of toads and
poisonous fishes in ponds of stagnant and turbid water.
General characters of Savisha Jalauka2
Such types of Jalauka are having the following characters according to the Ayurvedic
texts:
a. Thick
b. Slow locomotion
c. Fatigues
d. Middle part elongated
e. Delay in sucking
f. Not commendable type.
g. Sucks little quantity of blood.
Individual features of Savisha Jalauka3
1. KRISHNA:
i. Thickness
ii. Resemble in black colour.
2. KARBURA:
i. Resemble the fish of vermin type.
ii. Ventral surface is convex (Ayata).
3. ALAGARDA:
i.Thick

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ii.Hairy
iii.Round at sides
iv. Black at the mouth.
4. INDRAYUDHA:
i. Having different colours like rainbow.
ii. Number of linings on the body.
5. SAMUDRIKA:
i. Blackish yellow with dotted skin.
6. GOCHANDANA:
i. Narrow mouth
ii. Marked by bifurcating lines.
iii. Bottom (end Part) like the scrotal sac on a bull.
Features of Savisha Jalauka Bite4
If Savisha Jalauka is applied then a person suffers from following clinical symptoms
1. Burning sensation
2. Itching sensation
3. Swelling
4. Drowsiness
5. Fever
6. Delirium
7. Unconsciousness
8. Irresistible inclination to scratch the seat of bite.

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Nirvusha Jalauka:
Nirvisha Jalauka originates in decomposed vegetable matter, as the purified stems of the
several aquatic plants known as Padma, Utpala, Nalina, Kumuda, Pundarika and common
zoophytes, which live in clear water.5
Geographical Distribution:
According to Sushruta, the leeches are found in Yavana (Turkesthana, Pandya, Sahya,
Pautana etc.)6
Habitat:
Such leeches swim about in sweet scented water, live on, nonpoisonous weeds, lie on the
leaves of flowering water plants inspite of on the dark and oozy beds of pools and suck
blood from the affected part of a human being without causing any discomfort.
General characters of Nirvisha Jalauka 7
Such types of Jalaukas are characterized by following points:
1. Strong and large bodied.
2. Ready suckers
3. Greedy
Individual features of Nirvisha Jalauka8
1. KAPILA:
i. Colour like Manahshila at the sides
ii. Dorsal surfaces are slimy and coloured like Mudga pulse.
2. PINGALA:
i. Colour – Reddish
ii. Shape – Round

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iii. Locomotion – Speedy.
3. SHANKUMUKHI:
i. Colour – blackish red like that of liver.
ii. Provided with the greatest swiftness.
4. MUSHIKA:
i.Colour–like the common blind mole.
ii.Emit a foetid smell from the body..
5. PUNDARIKAMUKHI:
i.Colour- like Mudga pulse.
ii.Presence of resemblance of the mouth of the full blown lotus lillies.
6. SAVARIKA:
i. Marked with impressions like lotus leaves.
ii . Measures 18 fingers in length.
iii. Directed to apply only in the lower animals.
The leaches are further classified according to sex by Acharya Vagbhatta. Those
which are delicate, having thin skin, small sized head, the lower body being large are
female leeches and the ones with opposite characters along with being semi lunar in look
with large front portion are male.
Collection and Preservation of leech9
Collection of leeches is very simple. Acharya Sushruta has told that the leeches can
be caught with a piece of wet leather, in tanks streams and where there are lotuses. There
is another method to collect the leeches i.e. the fresh meat of dead animals, fish or milk
must be applied on the thigh of an animal or the human being himself, may apply on his

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thigh (Jangha) and keep the Jangha in the water for some time. Due to attraction of these
diets, Jalauka will come and start biting. Then they are made to leave the skin of the
person with the application of Saindhava lavana (rock salt) and collected.
Time of collection:
Acharya Dalhana has told that the best time for collecting leeches is Sharad Ritu
(autumn).
Preservation of leeches:
After collecting the leeches like above, they should be kept in a wide and new pot.
The pure water of tank with lotus is put into the pot. Feed it with Shaivala, the meat of
pig and other animals, which are living in watery and marshy areas, and powder of stem
of small plants; in order to make the leech to move and the grass and leaves of plants
must be kept inside water in the pot. On every third day the water should be changed and
feeding should be dropped inside the pot. After seven days the pot should be changed
Poisonous leeches must be thrown out.10
Table No. 8 Indication for leech application11, 12, 13,14
Sl.No. Name of the disease Charaka Susrutha Vagbhata

1. Asrigdara + + -
2 Asramandala + - -
3. Akshiroga + - -
4 Annapana vidaha + - -
5 Amlodgara + + -
6 Atinidra + - -
7 Angamarda - + -

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8 Arbuda - + -
9 Arsha - + -
10 Aruchi + - -
11. Raktapitta + + +
12 Atidourbalya + - -
13 Agnimandya + - -
14 Buddhisaama + - +
15 Bhrama - - +
16 Charmadala + - -
17 Dadru + - -
18 Gulma + + +
19 Gudapaka + + -
20 Gurugatrata + - -
21 Indralupta - + -
22 Kampa + - -
23 Kandu + + -
24 Kota + - -
25 Katu udgara - - +
26 Kamala + - +
27 Klama + - -
28 Kustha + + +
29 Krodhadhhikata + - -
30 Lavanasyata + - +
31 Medrapaka + - -
32 Mada + - -
33 Mukhapaka + + -

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34 Neelika + + -
35 Nyacha - + -
36 Vyanga - + -
37 Pidaka + + -
38 Pliha + + +
39 Pilu + - -
40 Pipasa + + +
41 Putiasya gandhata + - -
42 Pama + - -
43 Pramilika + - -
44 Rakta twak - - +
45 Rakta meha + - -
46 Rakta mutrata - - +
47 Santapa + - -
48 Swarakshaya + - -
49 Shariradourgandhya + - +
50 Sweda + - +
51 Shiroruja + - -
52 Switra + - -
53 Tilakalaka + - -
54 Tiktodgara + - -
55 Vatarakta + - -
56 Vidradhi + + +
57 Vaivarnya + + +
58 Visarpa + + +
59 Upakusha + - +

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60 Upajihwika - +
Leech (Hirudo medicinalis):
Kingdom Animalia
Phylum Annelida
Class Clitellata
Subclass Hirudinia
Leeches are annelids comprising the subclass Hirudinea.There are freshwater,
terrestrial, and marine leeches. Like the Oligochaeta, they share the presence of a
clitellum. Like earthworms, leeches are hermaphrodites. Some, but not all leeches are
hematophagous. The European medical leech, Hirudo medicinalis and some congeners,
as well as some other species, have been used for clinical bloodletting for thousands of
years, although most leeches do not feed on human blood, but instead prey on small
invertebrates, which they eat whole. Haemophagic leeches attach to their hosts and
remain there until they become full, at which point they fall off to digest. A leech's body
is composed of 34 segments. They all have an anterior (oral) sucker formed from the first
six segments of their body, which is used to connect to a host for feeding and also release
an anesthetic to prevent the host from feeling the leech. They use a combination of mucus
and suction (caused by concentric muscles in those six segments) to stay attached and
secrete an anti-clotting enzyme, hirudin, into the host's blood stream. Some species of

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leech will nurture their young, while providing food, transport and protection, which is
unusual behavior amongst annelids.
Reproduction
Leeches are hermaphrodites, meaning each one of them has both female and
male organs. Leeches reproduce by reciprocal fertilization, and sperm transfer occurs
during copulation. The leech exercising the role of the male will grow a sperm sack near
the end of its tail, and the leech playing the female will bite it off, thus reproducing.
Similarly to the earthworms, leeches also use a clitellum to hold their eggs and secrete the
cocoon. During reproduction leeches utilize hyperdermic injection of their sperm. They
use a spermatophore, which is a structure containing the sperm.
Nutrition
On haematophagous leeches, the digestive system starts with the jaw which is
located ventrally on the anterior side of the body. It is attached to the pharynx, then the
esophagus extending to the crop, which leads to the intestinum, where it ends at the
posterior sucker. The crop is a type of stomach that works like an expandable storage
compartment. The crop allows a leech to store blood up to five times its body size and
because the leech produces an anti-coagulant, the stored blood remains in a liquid state;
because of this ability to hold blood without the blood decaying, due to bacteria living
inside the crop, medicinal leeches only need to feed two times a year.15

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It was long thought that bacteria in the gut carried on digestion for the leech
instead of endogenous enzymes which are very low or absent in the intestine. Relatively
recently it has been discovered that all leeches and leech species studied do produce
endogenous intestinal exopeptidases,16 which can unlink free terminal-end amino acids,
one amino acid monomer at a time, from a gradually unwinding and degrading protein
polymer.
Leechbites
Effects
Though certain species of leeches feed on blood, not all species can bite; 90% of
them solely feed off decomposing bodies and open wounds of amphibians, reptiles,
waterfowl, fish, and mammals (including, but not limited to humans). A leech attaches
itself when it bites, and it will stay attached until it has had its fill of blood. Due to an
anticoagulant (hirudin) that leeches secrete, bites may bleed more than a normal wound
after the leech is removed. The effect of the anticoagulant will wear off several hours
after the leech is removed and the wound is cleaned.
Leeches normally carry parasites in their digestive tract which cannot survive in
humans and do not pose a threat. However, bacteria, viruses, and parasites from previous
blood sources can survive within a leech for months, and may be retransmitted to
humans. A study found both HIV and hepatitis B in African leeches from Cameroon.17
Removal

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Hand removing a land leech since they do not burrow into the skin nor the head
in the wound.18 A sore develops and lasts for about a week.19 Grande Ronde River,
Oregon (U.S.) One recommended method of removal is using a fingernail or other flat,
blunt object to break the seal of the oral sucker at the anterior end (the smaller, thinner
end) of the leech, repeating with the posterior end, then flicking the leech away. As the
fingernail is pushed along the person's skin against the leech, the suction of the sucker's
seal is broken, at which point the leech should detach its jaws.20,21
A common but medically inadvisable technique to remove a leech is to apply a
flame, a lit cigarette, salt, soap, or a chemical such as alcohol, vinegar, lemon juice, insect
repellent, heat rub, or certain carbonated drinks. These cause the leech to regurgitate its
stomach contents into the wound and quickly detach. However, the vomit may carry
disease, and thus increase the risk of infection.20,21,22 An externally attached leech will
detach and fall off on its own when it is satisfied on blood, usually in about 20 minutes
(but will stay there for as long as it can).22 Internal attachments, such as nasal passage or
vaginal attachments are more likely to require medical intervention.23,24
Treatment
After removal or detachment, the wound should be cleaned with soap and water,
and bandaged. Bleeding may continue for some time, due to the leech's anti-clotting
enzyme. Applying pressure can reduce bleeding, although blood loss from a single bite is
not dangerous. The wound normally itches as it heals, but should not be scratched as this
may complicate healing and introduce other infections. An antihistamine can reduce

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itching, and applying a cold pack can reduce pain or swelling. Some people suffer severe
allergic or anaphylactic reactions from leech bites, and require urgent medical care.
Symptoms include red blotches or an itchy rash over the body, swelling away from the
bitten area (especially around the lips or eyes), feeling faint or dizzy, and difficulty
breathing.22
Hirudotherapy
The term refers to the use of leeches in medicine. The use of leeches in medicine
dates as far back as 2,500 years ago when they were used for bloodletting in ancient
India. Leech therapy is explained in ancient Ayurvedic texts. All ancient civilizations
practiced bloodletting including Indian and Greek civilizations. In ancient Greek history,
bloodletting was practiced according to the humeral theory, which proposed that when
the four humors, blood, phlegm, black and yellow bile in the human body were in
balance, good health was guaranteed. An imbalance in the proportions of these humors
was believed to be the cause of ill health. Records of this theory were found in the Greek
philosopher Hippocrates' collection in the fifth century B.C. Bloodletting using leeches
was one method used by physicians to balance the humors and to rid the body of the
plethora.
The use of leeches in modern medicine made its comeback in the 1980s after
years of decline, with the advent of microsurgery such as plastic and reconstructive
surgeries. In operations such as these, one problem that arises is venous congestion due to
inefficient venous drainage. Sometimes because of the technical difficulties in forming an

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anastomosis of a vein, no attempt is made to re-attach a venous supply to a flap at all.
This condition is known as venous insufficiency. If this congestion is not cleared up
quickly, the blood will clot, arteries that bring the tissues their necessary nourishment
will become plugged and the tissues will die. To prevent this leeches are applied to a
congested flap and a certain amount of excess blood is consumed before the leech falls
away. The wound will also continue to bleed for a while due to the anticoagulant
(hirudin) in the leeches saliva. The combined effect is to reduce the swelling in the tissues
and promoting healing by allowing fresh, oxygenated blood to reach the area.25 The
active anticoagulant principle of leech saliva is a small protein, hirudin. Discovery and
isolation of this protein led to a method of producing it by recombinant technology.
Recombinant hirudin is available to physicians as an intravenous anticoagulant
preparation for injection, particularly useful for patients who are allergic to or cannot
tolerate heparin.
Jalaukavacharana Vidhi: 26
Purvakarma:
The following things must be considered in Poorvakarma.
1. Examination of the patient who is fit to undergo the Jalaukavacharana.
2. Shodhana of leech: Before the application of leech, it should be kept in the Haridra
mixed water for one minute and then cleaned with the help of pure water.
3. Preparation of the patients: The part of the application should be cleaned. The part
where leech to be applied is pricked with a sterile needle so the leech can hold the part
easily.

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Pradhana Karma:
Jalaukavacharana:
The patient must be prepared as stated above. The leech will be too much unctuous
and soft and as a result it slips off from the hand. It is better to catch leech either with the
gauze or after wearing the rubber gloves. Then the leeches should be taken out of their
receptacles and sprinkled over the cater. Leeches attach to the skin by two muscular
suckers before biting with three teeth inside their anterior suckers. Blood is sucked into
the stomach by peristalsis. Each leech will ingest nearly ten times its body weight in
blood before falling off. The middle portion of the leech will be swollen, as soon as it
starts sucking the blood. It sucks only impure blood first. If the patient notices pain at the
time of sucking the blood by the leech, it should be noted that the leech is sucking pure
blood. It should be removed instantaneously by pouring Saindhava Lavana at its mouth.
If they slightly refuse to stick to the desired spot, then the affected part should be
sprinkled over with drops of milk or blood. Otherwise, other fresh leeches should be
applied even when the preceding measures should prove ineffective.
Inference of sucking:
The leeches having stuck to the affected part may be inferred from the mouths of the
leeches assuming the shape of horseshoe and raised and arched position of their necks
after they had attached to the seat of the disease. While sucking is started, the leeches
should be constantly sprayed over with cold water.

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Clinical findings of fresh sucking:
Some leeches suck the fresh blood even after the vitiated blood is completed from the
seat. In order to save the fresh blood and to know the same Sushruta has given some
notable findings which can be ascertained from the patient only, which is given below:
- A sensation of itching at the seat of application.
- A drawing pain at the seat of application.
This would give rise to the presumption that fresh blood is being sucked and the leeches
should be removed. The author Vagbhata has stated regarding the role of sucking of leech
giving an ideal example that the swan only drinks the milk from the pot of milk mixed
with water. The water is only left in the pot while the milk is received. It is its natural
action. Similarly, the leeches have some power to suck the vitiated blood only, from the
body.
Directions to remove the leech:
Some leeches refuse to fall off even after the appearance of the desired signs, sticking to
the affected part, out of their fondness for the smell of blood. They should be sprinkled
with the dust of powdered Saindhava (Sushruta), Haridra and Saindhava (Vagbhata).
Then they would give up the sucking within a while, after that the post-operative care
should be taken for the leeches.
Paschat Karma: It consists of two things:
1. Management of leeches: care for leeches is to vomit the blood. Hence the following
method should be applied.

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Method of emission:
After falling off, the leeches should be dusted over with rice powder and their mouths
should be lubricated with a composition of oil, common salt. Then they should be caught
by the tail end with the thumb and the forefinger of the left hand and their back should be
gently rubbed with the same fingers of the right hand from tail upward to the mouth with
a view to make them eject the full quantity of blood, they had sucked from the seat of the
disease. This process should be repeated until they manifest the fullest symptoms of
engorging. Then leeches should be kept in a separate pot containing pure water.
Finding of full emission:
Leeches that had vomited the full quantity of blood sucked would briefly move about
here and there in quest of food if placed in water on the contrary if there is no complete
ejection they would be lying dull and upset. It gives rise to an incurable disease
particularly known as Indramada means Raktamada or Raktamatta27, 28 after one week,
leeches can be reapplied.
Care of the leeches:
After the complete emission leeches should be put into a new pitcher and treated as
earlier. Vagbhata says that the used and emitted leech should be kept for sometime in the
diluted water of turmeric powder and changed to fresh water. By this means they get
contented. Then seven days of rest is given to the used leech. It indicates that used leech
can be applied after one week, so to identify, separate pitchers should be kept for the
leeches. Journal article; Plastic and Reconstructive Surgery-2003

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2. Treatment of the Patient:
Usually, the blood will not clot due to the property of anticoagulant “Hirudin”. As soon
as the leech is removed from the body an application with Shatadhauta Ghrita should be
applied on the wound; or Pichu dipped in Shatadhauta Ghrita should be kept on it. In case
of improper bloodletting by a leech, the wound must be rubbed with honey, and cold
water or else it should be bandaged or astringent sweet, greasy and cold paste should be
applied over the wound.29

Drug Review 2010

DRUG REVIEW
Ideally, therapeutics should be a science and strictly speaking, it is a science in the
hands of wise and honest physician. Treatment becomes scientific if its effect is
predictable, if the effect not predictable it is experimental. Experimental therapeutic
procedures are justifiable only when scientific form of treatment is unknown or when the
results of research investigations suggest that some procedure being effective than current
scientific procedure in use.
Criteria for Selection of Drug:
Indukanta Ghrita1 is a well balanced preparation including the drugs having
vedanahara and shotahara effect which is having Deepana, Pachana, Srotoshodhak,
Tridoshashamak, Balya, Brimhana and Rasayana properties which are very much
essential in a Sosha predominant disease. In Vatavyadhi Chikitsa ‘Raktamokshana’ is
also indicated.2 Many international research works on the efficacy of leech therapy in
Osteoarthritis have been conducted in past and are also in progress in the present.
Table No. 9 Ingredients of Indukanta Ghrita
Sl.No. Kwatha Dravyas Kalka Dravyas Drava Dravya Pradhana Dravya

1. Poothika Pippali Ksheera Ghrita
2. Devadaru Pippalimoola
3. Bilva Chavya
4. Agnimantha Chitraka
5. Patala Nagara
6. Syonaka Yavakshara
7. Gambhari
8. Shalaparni
9. Prishniparni
10. Bruhati

Drug Review 2010

11. Kantakari
12. Gokshura
Preparation of Formulated Drug:
Materials and Quantity for 7 kg of drug
Kashaya 28 ltr
Goghrita 7 kg
Kalka dravya 4.75 kg
Ksheer 28 ltr
For making Kashaya
(i) Equal quantity of all Kashaya Dravyas
Each drug - 583gms
Total- 7kg
(ii) Water added - 112 ltr
(iii) Reduced to - 28 ltr
For making Kalka
i) Equal quantity of all Kalka Dravyas
Each Drug 283 gms
Total 4.75kg
Procedure:
Kalka dravyas were made into churna and mixed with Kashaya. Ghrita is mixed with
Kashaya and heated in Mridu Agni. After the boiling of mixture milk was added and
heated till Samyak Paka Laxana is obtained. The whole thing is filtered and stored in
vessel and made into dispensing form.


Drug Review 2010

Table No.10 Pharmacodynamics of Kashaya Dravyas3
Sl.No. Dravya Rasa Guna Virya Vipaka

1 Poothika Tikta Katu Laghu Ushna Katu
Kashaya Teekshna
2 Devadaru Tikta Laghu Ushna Katu
Snigdha
3 Bilva Tikta Laghu Ushna Katu
Kashaya Ruksha
4 Agnimantha Tikta Katu Laghu Ushna Katu
Kashaya Ruksha
5 Shonaka Tikta Laghu Ushna Katu
Kashaya Ruksha
6 Patala Tikta Laghu Ushna Kashaya
Kashaya Ruksha
7 Gambhari Tikta Guru Ushna Katu
Madhura
Kashaya
8 Shalaparni Madhura Guru Snigdha Ushna Madhura
Tikta
9 Prishniparni Madhura Guru Snigdha Ushna Madhura
Tikta
10 Bruhati Tikta Katu Laghu Ushna Katu
Ruksha
Tikshna
11 Kantakari Tikta Katu Laghu Ushna Katu
Ruksha
Tikshna
12 Gokshura Madhura Guru Snigdha Sheeta Madhura
Table No.11 Karmas of Kashaya Dravyas
Sl.No Dravya Karmas

1 Poothika Sothahara, Vedanasthapana, Deepana, Pachana.
2 Devadaru Vatasamsaman, Kandughna, Sothahara.
3 Bilva Kaphavatahara,Pachana,Balya,Dipana,Sangrahika
4 Agnimantha Kaphavatahara,Shothahara,Dipana,Amahara,Vibhandahara
5 Shonaka Kaphavatashamaka,Dipana,Grahi,Kasahara,Aruchihara
6 Gambhari Tridoshahara,shoolahara,Dipana,pachana ,Medhya

Drug Review 2010

7 Patala Tridoshahara,shothahara,Santapahara,Vishahara
8 Shalaparni Tridoshahara,Rasayana,Bruhmana,Sothahara
9 Prishnaparni Tridoshahara,Dipaniya,Vrishya,Jwarhara,Swasahara
10 Kantakari Kaphavatahara,Dipana,Pachana, Jwarhara,Swasahara
11 Bruhati Kaphavatahara,Pachana,Hridya,Aruchihara
12 Gokshura Vatapittahara,Vedanasthapana,Dipana,Vrishya
GENERAL PHARMACOLOGICAL ACTION OF DASAMOOLA

1. Doshakarma Generally Tridoshaghna, Specific for Kapha Vata Shamana
2 Pranavaha Srotas Kasa Swasa Hara
3 Annavahasrotas Deepana, Pachana, Agnivardhaka Amahara, Arochakaghna,Shoolahara
4 Rasavaha Srotas Panduhara, Shothahara, Hridya
5 Raktavaha Srotas Rakta Samgrahana
6 Mamsavaha Srotas Brimhana
7 Medovaha Srotas -
8 Asthivaha Srotas -
9 Sukravaha Srotas Vrishya
10 Pureeshavaha Srotas Vibandahara, Anahahara Vatanuloman, Bhedaneeya,Samgrahaka
11. Nadi Samsthana Vedanasthapana, Medhya
12. General Action Balya, Rasayana, Vishaghna, Krimihara
YAVAKSHARA:
Chemical name: Potassium Carbonate
Rasa: Katu, Lavana
Guna: Tiksna, Laghu, Chedana
Veerya: Ushna
Vipaka: Katu

Drug Review 2010

Yavakshar, prime among the Kshartraya, is having Tikshna, Ushna, Krimijit, Laghu,
Chedana, Hridya, Vidarana, Pittasrikdoosana properties. Being best in Srotosodhana it is
indicated in Swasa, Grahani, Gulma, Pandu, Pliharoga, Anaha, Galaroga and Arsas. 4
Table No.12 Pharmacodynamics of Panchakola
Sl.No Dravya Rasa Guna Veerya Vipaka

.
1 Pipali Katu,Snigdha Snigdha,Tikshna,Laghu Ushna Madhura
2 Pippalimoola Katu,Snigdha Snigdha,Tikshna,Laghu Ushna Madhura
3 Chavya Katu,Snigdha Snigdha,Tikshna,Laghu Ushna Madhura
4 Chitraka Katu,Ruksha Snigdha,Tikshna,Laghu Ushna Madhura
5 Nagara Katu,Snigdha Snigdha,Tikshna,Laghu Ushna Madhura
Table No.13 Karmas of Panchakola

Sl.No. Dravyas Karmas
1 Pippali Kaphavatahara,Dipana,Pachana, Vrishya
2 Pippalimoola Kaphavatahara,Dipana,Pachana, Vrishya
3 Chavya Kaphavatahara,Dipana,Pachana, Vrishya
4 Chitraka Vatakaphahara,Dipana,Pachana,Shoolaghna
5 Shunthi Vatakaphahara, Shoolaghna, Agnivardhaka
Go-Ghrita:
Ghrita is one among the best Ajasrika Rasayanas. It is Ayuvardhak, Balavardhak,
Ojovardhak, Vayasthapak, Dhatuposhak and is supreme in Snehana Dravyas. By virtue of
Yogavahitva, as per its ingredients the medicated Ghrita will be attaining properties.
Pharmacodynamics :
Rasa: Madhura
Guna: Snigdha, Guru
Veerya: Sheeta
Vipaka: Madhura

Drug Review 2010

Karma: Medhya, Agnivardhak
GOKSHIRA
Kshira is the best rasayana mentioned in Ayurveda. Kshira having properties similar to
Ojas, it is Dhatuposhak, Ojovardhaka and Sadyabaladayi. The Jeevaniya Guna of milk is
having special advantage in chronic diseases. Kshira is indicated in Kshata, Ksheena,
Jwara, Swasa and Kasa. Moreover it is Jeevaniya and Rasayana.
Pharmacodynamics:
Rasa: Madhura
Guna: Snigdha, Guru
Veerya: Sheeta
Vipaka: Madhura
Karma: Vatapittasamaka, Ojovardhaka, Medhya, Balya
Physio-chemical analysis of Milk:
It is the lacteal secretion of mammary gland of cow.
Sp. gravity - 1.032
PH - 6.6-6.8
Table No.14 Pharmacodynamics of Indukanta Ghrita

Rasa Tikta, Katu, Madhura
Guna Laghu, Snigdha
Veerya Ushna
Vipaka Madhura
Doshakarma Tridoshahara
Dhatukarma Brihmana
Mala Anulomana
Srotas Srotoshodhna
Karma Dipana, Pachana, Jwaraghna, Rasayana, Shothahara,
Vedanahara.


Photos 2010

Photo No.1 Showing the ingredients of Indukant Ghrita
Kashaya Dravyas Kalka Dravyas
Ksheera Go-ghrita
Photo No.2 Showing the preparation of Indukant Ghrita
Prepared Kashaya After adding Ghrita Kalka
Adding Kalka Final stage Prepared Gritha

Photos 2010

Photo No.3 Showing the Jalauka
Photo No. 4 Jalaukavacharana

Materials and Methods 2010
MATERIALS AND METHODS
Source of data
Literary source
All the Ayurvedic texts, contemporary Ayurvedic literatures and internet sources about
the disease, drug & procedure were reviewed & documented for the study.
Drug source
The drugs were selected from local areas & market after proper identification & the
Ghrita was prepared in ALVA’s pharmacy Mijar. Leeches were collected from local
areas.
Sample source
Patients suffering from Janusandhigata vata were selected from the Panchakarma Post
Graduate O.P.D. & I.P.D. of ALVA’s Ayurveda Medical College & Hospital
Moodbidri & from other camps & referrals.
Method of Collection of Data
30 patients fulfilling the diagnostic and inclusion criteria of either sex were selected for a
single blind comparative study. They were assigned into two equal groups M and J.
Diagnostic Criteria
• Pain in unilateral or bilateral Knee joints.
• Radiographic evidence of Sandhigata vata.
Inclusion Criteria
• Patients fulfilling the above mentioned diagnostic criteria.
• Patients aged above 30 yrs and below 70 yrs.
• Patients fit for Bastikarma & Jalaukavacharana.

• Previously treated and untreated patients.
Exclusion Criteria
• Patients aged below 30yrs and above 70 yrs.
• Pregnant and lactating mothers.
• Patients suffering from systemic disorders which would interfere with the present
study.
• Osteoarthritis secondary to rheumatoid arthritis, gouty arthritis, knee joint
traumas, fractures and joint surgeries.
• Patients contraindicated for Basti Karma such as Anal fissure, Fistula in
Ano. (For Group- M)
• Patients with bleeding disorders and coagulopathies (For Group- J)
Investigations
• Routine hematological investigations like TC, DC, ESR, Hb% and CT,BT for J
group
and urine analysis like albumin, sugar, microscopy.
• X-ray of affected Knee AP and Lateral view was carried out for all the patients
Procedure: GROUP-M
• Poorva Karma: Sthanika abhyanga with Murchita Tila taila and sthanika Nadi
sweda.
• Pradhana Karma: Matra Basti with 60 ml of Indukanta ghrita was given in the
afternoon after food.
• Paschat Karma: Paschat karma was done according to Bastichikitsa.
Assessment was done on 1st, 4th, and 7th days of treatment.
Follow up: On 20th and 30th days.
• Study duration:
Matra Basti – 7 days
Total study duration- 30 days.
GROUP- J
A single sitting of Jalaukavacharana was done by using 2 medium sized leeches
which were applied on the postero-medial and postero-lateral aspects of affected knee
joint.
Assessment was done on the day of the Procedure.
Follow up: On 4th, 7th, 20th and 30th days.
• Study duration:
Jalaukavacharana- 1 day.
Total study duration- 30 days.
Assessment Criteria:
Assessment of the condition was done on a detailed Performa adopting standard methods
of scoring of subjective & objective parameters and statistically analyzed by using
appropriate tests.
Subjective Parameters:
Pain
Stiffness
Objective Parameters:
Swelling
Range of Movement – Maximum flexion.
Gait
Crepitus
Tenderness
Pain: No pain- 0
Mild-Pain not interfering with activities or sleep- 1
Moderate-Pain interfering with activities or sleep - 2
Severe-Pain reducing activities and sleep- 3
Stiffness: …..min/24hrs.
Joint Swelling: Absent – 0 ; Minimal swelling– 1; Moderate Swelling- 2
Gait: Free swinging no limp- 4
Limping gait but no additional support- 3
Unilateral support (crutch, stick, wall)- 2
Bilateral support- 1
Absence of gait- 0
Range of Movement (Flexion range):
Tenderness: No tenderness- 0
Patient says joint is tender- 1
Patient winces the face by touching- 2
Patient winces & withdraws the affected part- 3
Patient will not allow the joint to be touched- 4
Crepitus: Absent- 0
Palpable- 1
Audible-2
Observations 2010

OBSERVATIONS
The following observations were made in this study before, during and after
treatment. In the present study 30 patients fulfilling the inclusion criteria of Janu Sandhi
Gata Vata were studied.
Incidence observation:
As per the prepared Performa, observations were made regarding the incidence of
age, sex, occupation, religion, socio-economic status, marital status, diet factors.
Distribution of 30 patients according to different age group
In this study it was found that the incidence was highest in the age group of 61-70
yrs constituting 33.33% of total numbers of patients. 30% patients were in the age group
of 41-50 years and 20 % in 61-70 years. The incidences of other age groups are shown in
the table below.
Table No.15 Distribution of 30 patients according to different age group
Age (in years) No of patients Total %

Group M Group J
30- 40 02 03 05 16%
41- 50 03 06 09 30%
51- 60 03 03 06 20%
61- 70 07 03 10 34%

Observations 2010

Graph No.1 Distribution of 30 patients according to different age group
Distribution of 30 patients according to Sex:
In the sample taken for the study, 60 % were males and 40 % were females.
Table No.2 Distribution of 30 patients according to sex
Sex No of patients Total %

Group M Group J
Male 11 07 18 60%
Female 04 08 12 40%
Graph No.2 Distribution of 30 patients according to sex

Observations 2010

Distribution of 30 patients according to occupation: Maximum number of patients
were business men 36.66% and 26.66% were manual laborers. The incidence of other
occupation is shown in the table below.
Table No. 17 Distribution of 30 patients according to occupation
Occupation No of patients Total %

Group M Group J
Manual labor 06 02 08 26.66%
Housewife 03 04 07 23.33%
Business 04 07 11 36.66%
Office 01 00 01 00.03
Others 01 02 03 00.10%
Graph No.3 Distribution of 30 patients according to Occupation

Observations 2010

Distribution of 30 patients according to religion:
86.66 % patients were Hindus, 13.34 % were Christians.
Table No.18 Distribution of 30 patients according to religion
Religion No of patients Total %

Group M Group J
Hindu 14 12 26 86%
Christian 01 03 04 14%
Graph No.4 Distribution of 30 patients according to religion
Distribution of 30 patients according to socio- economic status:
Majority of patients belonged to the middle class at 70%, 20.00% were in poor
class and 10% were in rich class.
Table No. 19 Distribution of 30 patients according to socio- economic status
Socio-economic status No of patients Total %

Group M Group J
Poor 04 02 06 20.00 %
Middle class 10 11 21 70.00 %
Rich 01 02 03 10.00%

Observations 2010

Graph No.5 Distribution of 30 patients according to socio- economic status
Distribution of 30 patients according to marital Status:
Majority of 86.66% were married and remaining 13.34% were unmarried.
Table No.20 Distribution of 30 patients according to marital Status
Marital status No of patients Total %

Group M Group J
Married 15 11 26 86%
Unmarried 00 04 04 14%
Graph No.6 Distribution of 30 patients according to marital Status.

Observations 2010

Distribution of 30 patients according to Desha
70% of the patients in this study were from Sadharana and 30% was from Aanupa Desha.
Table No.21 Distribution of 40 patients according to Desha
Desha No of patients Total %

Group M Group J
Sadharana 09 12 21 70%
Jangala 00 00 00 00%
Aanupa 06 03 09 30%
Graph No.7 Distribution of 30 patients according to Desha.
Distribution of 30 patients according to educational status:
Majority of patients were found in High school group at 53.33 %, illiterates and
graduation both groups comprising 16.66 % and primary education group comprises
13.33 %.

Observations 2010

Table No.22 Distribution of 30 patients according to educational status
Education No of patients Total %

Group M Group J
Illiterates 05 00 05 16.66 %
Primary education 03 01 04 13.33 %
High School 06 10 16 53.33 %
Graduation 01 04 05 16.66 %
Graph No.8 Distribution of 30 patients according to educational status
Distribution of patients according to food habits:
Majority of the patients as shown in table were consuming mixed diet with the
percentage 53.34 % and 46.66 % were vegetarian.

Observations 2010

Table No.23 Distribution of patients as per food habits
Dietary Habit No of patients Total %

Group M Group J
Vegetarian 10 O4 14 47%
Mixed 05 11 16 53 %
Graph No.9 Distribution of 30 patients according to food habits
Distribution of 30 patients according to their intake of Aahara:
76.66 % patients had Sama habit, 16.66 % had Alpa and 6.64 % had Atipramana habit.
Table No.24 Distribution of 30 patients according to their intake of Aahara
Aahara No of patients Total %
Group M Group J
Alpa 03 02 05 17%
Pramita 00 00 00 00 %
Sama 11 12 23 77 %

Observations 2010

Atipramana 01 01 02 06 %
Graph No.10 Distribution of 30 patients according to their intake of Aahara
Distribution of 30 patients according to their nature of work
A maximum of 50 % of patients were doing manual work & 26.66 % were doing
sedentary work and others were shown in the table below.
Table No.25 Distribution of 30 patients according to their nature of work
Nature of work No of patients Total %
Group M Group J
Manual work 09 06 15 50 %
Sedentary 04 04 08 26 %
Standing 01 03 4 14 %
Others 01 02 03 10 %

Observations 2010

Graph No.11 Distribution of 30 patients according to their nature of work.
Distribution of 30 patients according to their duration of Vishrama: 60 % of

patients were having proper Vishrama and others were shown in the table below.
Table No.26 Distribution of 30 patients according to their duration of Vishrama
Vishrama No of patients Total %
Group M Group J
Proper 10 08 18 60.00 %
Less 04 02 06 20.00 %
Excessive 01 05 06 20.00 %
Graph No.12 Distribution of 30 patients according to their duration of Vishrama

Observations 2010

Distribution of 30 patients according to their Vyayama:
63.33% of patients showed excessive Vyayama.16.66 % showed irregular Vyayama. 10%
each patients showed less and proper Vyayama.
Table No.27 Distribution of 30 patients according to their Vyayama
Vyayama No of patients Total %
Group M Group J
Less 01 02 03 10.00%
Proper 02 01 03 10%
Excessive 10 09 19 64%
Irregular 02 03 05 16%
Graph No.13 Distribution of 30 patients according to their Vyayama

Observations 2010

Distribution of 30 patients according to their Nidra Habit:
56.66% had sound sleep, whereas only 43.34% had disturbed sleep.
Table No.28 Distribution of 30 patients according to their Nidra Habit
Nidra No of patients Total %
Group M Group J
Sound 09 08 17 57%
Disturbed 06 07 13 43%
Graph No.14 Distribution of 30 patients according to their Nidra Habit

Observations 2010

Distribution of 30 patients according to addiction:
Majority of 56.66% had no addiction in comparison to 26.66 % were addicted to alcohol.
The incidences of other addiction are shown in the table below.
Table No 29 Distribution of 30 patients according to addiction
Habit No of patients Total %
Group M Group J
Smoking 03 02 05 17 %
Alcohol 05 03 08 27 %
Tobacco chewing 00 00 00 0%
None 07 10 17 56 %
Graph No.15 Distribution of 30 patients according to addiction.
Distribution of 30 patients according to Prakruti: A majority of patients belonged to

Vata Kapha Prakruti i.e. 43.33 % and 35% belonged to Vata Pitta Prakruti, 40 %. The
details of the incidence are tabled below.

Observations 2010

Table No.30 Distribution of 30 patients according to Prakruti
Prakruti No of patients Total %
Group M Group J
Vata 00 00 00 00.00%
Pitta 00 00 00 00.00%
Kapha 00 00 00 00.00%
Vata Pitta 07 06 12 44%
Vata Kapha 06 07 13 43%
Pitta Kapha 01 03 04 13%
Tridoshaja 00 00 00 00.00%
Graph No.16 Distribution of 30 patients according to Prakruti.
Distribution of patients according to Symptomatology: Pain, stiffness and crepitus
were present in all the patiets and the remaining symptoms werw shown in the table
below.

Observations 2010

Table No.31 Distribution of patients according to Symptomatology
Symptoms No of patients Total %
Group M Group J
Pain 15 15 30 100%
Swelling 10 13 23 76.66%
Stiffness 15 15 30 100%
Crepitus 15 15 30 100%
Limping Gait 11 09 20 66.66%
Tenderness 13 09 22 73.33%
Graph No.17 Distribution of 30 patients according to Symptomatology
Distribution of patients according to onset of Pain: All the 30 patients are having the
gradual onset of pain as shown in the table below.
Table No.32 Distribution of 30 patients according to onset of Pain.
Onset of Pain No of Patients Total %

Observations 2010

Group M Group J
Gradual 15 15 30 100%
Sudden 0 0 0 0%
Graph No.18 Distribution of 30 patients according to onset of Pain.
Distribution of 30 patients according to Nature of Pain: Among 30 patients 80% were

having deep dull aching pain and pricking type of pain was present in 20% of patients.
Table No.33 Distribution of 30 patients according to Nature of Pain.
Nature of Pain No of Patients Total %

Group M Group J
Deep dull aching 11 13 24 80%
Pricking 04 02 06 20%
Shooting 00 00 00 00%
Graph No.19 Distribution of 30 patients according to Nature of Pain.

Observations 2010

Distribution of 30 patients according to Aggravating factors- Diurnal: 70% of

patients were having Morning as diurnal aggravating factor and others are shown in the
table below.
Table No.34: Distribution of 30 patients according to Aggravating factors- Diurnal
Aggravating factor No of Patients Total %

Group M Group J
Morning 00 06 06 20%
Evening 13 08 21 70%
Night 02 01 03 10%
Graph No.20 Distribution of 30 patients according to Aggravating factors- Diurnal

Observations 2010

Distribution of 30 patients according to Pain Aggravating factors- Seasonal: 56.66%
of patients shown both rainy and winter seasons are aggravating factors.
Table No.35 Distribution of 30 patients according to Pain Aggravating factors-

Seasonal
Seasonal change No of Patients Total %

Group M Group J
Rainy 05 08 13 44%
Rainy/Winter 10 07 17 56%
Graph No.21 Distribution of 30 patients according to Pain Aggravating factors-

Seasonal

Results 2010

RESULTS
The study was carried out in 30 Patients of Janusandhigata Vata in two groups of
which Group M received Matra Basti for a period of 7 days & Group J received
Jalaukavacharana for a single sitting. Data was collected from the patient on the 1st day,
4th day and 7th of treatment and then on 20th and 30th day of the study period.
Assessment of the condition was done based on detailed Performa adopting
standard scoring methods of subjective & objective parameters.
As the assessment parameters include a mixture of qualitative and quantitative data. Two
groups are compared for pre and post values using following statistical analysis
. Qualitative Data:
• Non parametric test average is found using median and percentage.
• For pre –post comparison Wilcoxon sign rank test is used.
• For between group comparison Mann Whitney U test is used.
Quantitative Data:
• Average is found using mean along with standard deviation..
• For pre –post comparison Paired t test is used.
• For between group comparison student‘t’ test is applied.
Effect of Matra Basti on Pain (Group M) in percentage:
Group M: Before treatment the number of patient having Grade 3 severity of pain were
46.66%, Grade 2 were 53.33%, Grade 1 were 0%.After 4 days of Matra Basti, it was

Results 2010

observed that patients with Grade 3 pain were 46.66%, Grade 2 were 53.33%, Grade 1
were 0%. After 7 days of Matra Basti it was observed that Grade 3 were 40%, Grade 2
were 53.33%, Grade 1 were 0.06%, Grade 0 were 0%.During 1st follow up (20th day),
Grade 3 were 0%, Grade 2 were 53.33%, Grade 1 were 46.66% and Grade 0 were 0%.
During 2nd follow up 30th day) Grade 2 was 0.06%, Grade1 was46.66% and grade0 was
46.64%.
Table No.36 Effect of Matrabasti on Pain in percentage
Pain BT AT(D4) AT(D7) AT(D20) AT(D30)

NO % NO % NO % NO % NO %
Grade0 0 00 0 00 0 0 0 0 7 47
Grade1 0 00 0 00 1 6 7 47 7 47
Grade2 8 53 8 53 8 53 8 53 1 6
Grade3 7 47 7 47 6 41 0 00 0 00
Graph No.22 Effect of Matrabasti on Pain in percentage

Results 2010

Pre and Post Median of Pain (Group M)
Average of Pain: Before treatment average Pain (Median) was 2, After 4 days of Matra
Basti and after 7 days it remain same and during the 1st follow up (20th day) and 2nd
(30th day) follow up median were 1.
Grading of Pain: No pain- 0, Mild-Pain not interfering with activities or sleep- 1,
Moderate-Pain interfering with activities or sleep – 2, Severe-Pain reducing activities and
sleep- 3
Table No.37 Pre and Post Median of Pain (Group M)
Pain BT D4 AT(D7) AT(D20) AT(D30)
Median 2 2 1 1 1
Result of effect of Matra Basti on Pain at 4th day of treatment and on treatment.
Pre –post comparison with Wilcoxon sign rank test shows that there is no
significant improvement between BT to D4 and there is highly significant improvement
between BT to AT (D30) with P<0.001.
Table No 38: Result of effect of Matrabasti on Pain at 4th day of treatment and on
last follow up.
Pain Average improvement z-value p-value

(Median)
BT-D4 0 6.022 1.000
BT-AT(D30) 1 3.573 <0.001

Results 2010

Effect of Jalaukavacharana on Pain (Group J) in percentage:
Group J: Before treatment the number of patient having Grade 3 severity of pain were
12%, Grade 2 were 66.66%, Grade 1 were 20%. After 4 days of Jalaukavacharana, it was
observed that patients with Grade 3 pain were 00%, Grade 2 were 100%, Grade 1 were
0%. After 7 days, it was observed that Grade 3 were 00%, Grade 2 were 6%, Grade 1
were 40%, Grade 0 were 54%.During 1st follow up (20th day), Grade 3 were 0%, Grade 2
were 6%, Grade 1 were 47% and Grade 0 were 47%. During 2nd follow up (30th day)
Grade 2 was 00%, Grade1 was 74% and grade0 was 26%.
Table No.39 Effect of Jalaukavacharana on Pain in percentage
Pain BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 0 00 0 00 8 54 7 47 4 26
Grade1 3 20 0 00 6 40 7 47 11 74
Grade2 10 68 15 100 1 6 1 6 0 00
Grade3 2 12 0 00 0 00 0 00 0 00
Graph No.23 Effect of Jalaukavacharana on Pain in percentage

Results 2010

Pre and Post Median of Pain (Group J)
Average of Pain: Before treatment average Pain (Median) was 2, After 4 days of
Jalaukavachrana it was 2 and after 7 days it was 0 and during the 1st follow up (20th day)
and 2nd (30th day) follow up median was 1.
Grading of Pain: No pain- 0, Mild-Pain not interfering with activities or sleep- 1,

Moderate-Pain interfering with activities or sleep – 2, Severe-Pain reducing activities and
sleep- 3
Table No.40 Pre and Post Median of Pain (Group J)
Pain BT D4 AT(D7) AT(D20) AT(D30)

Median 2 2 0 1 1
Result of effect of Jalaukavacharana on Pain at 4th day of treatment and on

treatment.

Results 2010

Table No 41 Result of effect of Jalaukavacharana on Pain at 4th day of treatment
and on last follow up.
Pain Average improvement z-value p-value

(Median)
BT-D4 0 0.447 0.813
BT-AT(D30) 1 3.286 0.001
Effect of Matra Basti on Swelling (Group M) in percentage:
Group M: Before treatment the number of patient having Grade2 severity of swelling
were 40%, Grade 1 were 40% and grade 0 were 20%..After 4 days of Matra Basti, it was
observed that the swelling remain same. After 7 days of Matra Basti it was observed that
Grade 2 was 27%, Grade 1 were 53%, Grade 0 were 20%. During 1st follow up (20th
day), Grade 2 were 6%, Grade 1 were 47% and Grade 0 were 47%. During 2nd follow up
(30th day) Grade 2 was 0%, Grade1 was40% and grade0 was 60%.
Table No.42 Effect of Matrabasti on Swelling in percentage
Swelling BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 3 20 3 20 3 20 7 47 9 60
Grade1 6 40 6 40 8 53 7 47 6 40
Grade2 6 40 6 40 4 27 1 06 0 00
Graph No.24 Effect of Matrabasti on Swelling in percentage

Results 2010

Pre and Post Median of Swelling (Group M)
Average of Pain: Before treatment average Swelling (Median) was 2, After 4 days of
Matra Basti and after 7 days it remain same and during the 1st follow up (20th day) and
2nd (30th day) follow up median was 1.
Grading for Joint Swelling: Absent – 0, Minimal swelling– 1, Moderate Swelling- 2
Table No.43 Pre and Post Median of Swelling (Group M)
Swelling BT D4 AT(D7) AT(D20) AT(D30)

Median 2 2 2 1 0
Result of effect of Matra Basti on Swelling at 4th day of treatment and on last follow
up.

Results 2010

Table No 44 Result of effect of Matrabasti on Swelling at 4th day of treatment and
on last follow up.
Swelling Average improvement z-value p-value

(Median)
BT-D4 0 2.639 1.000
BT-AT(D30) 1 3.372 <0.001
Effect of Jalaukavacharana on Swelling (Group J) in percentage:
Group J: Before treatment the number of patient having Grade2 severity of swelling
were 40%, Grade 1 were 40% and grade 0 were 20%. After 4 days of Jalaukavacharana,
it was observed that the swelling remain same. After 7 days of Jalaukavacharana, it was
observed that Grade 2 was 27%, Grade 1 was 53%, and Grade 0 was 20%. During 1st
follow up (20th day), Grade 2 were 6%, Grade 1 were 47% and Grade 0 were 47%.
During 2nd follow up (30th day) Grade 2 was 0%, Grade1 was40% and grade0 was 60%.
Table No.45 Effect of Jalaukavacharana on Swelling in percentage
Swelling BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 4 27 10 66 11 73 11 73 14 94
Grade1 7 46 5 34 4 27 4 27 1 06
Grade2 4 27 0 40 0 00 0 00 0 00
Graph No.25 Effect of Jalaukavacharana on Swelling in percentage

Results 2010

Pre and Post Median of Swelling (Group J)
Average of Pain: Before treatment average Swelling (Median) was 2, After 4 days of
Matra Basti and after 7 days it was remaining same and during the 1st follow up (20th
day) and 2nd (30th day) follow up median were 1.
Grading of Joint Swelling: Absent – 0, Minimal swelling– 1, Moderate Swelling- 2
Table No.46 Pre and Post Median of Swelling (Group J)
Swelling BT D4 AT(D7) AT(D20) AT(D30)

Median 1 0 0 0 0
Result of effect of Jalaukavacharana on Swelling at 4th day of treatment and on last
follow up.
Pre –post comparison with Wilcoxon sign rank test shows that there is highly
significant improvement between BT to D4 and it remain same AT(D30) with P<0.001.

Results 2010

Table No 47 Result of effect of Jalaukavacharana on Swelling at 4th day of treatment
Swelling Average improvement z-value p-value

(Median)
BT-D4 1 3.162 <0.005
BT-AT(D30) 1 3.071 <0.001
Effect of Matra Basti on Crepitus (Group M) in percentage:
Group M: Before treatment the number of patient having Grade2 severity of crepitus
were 27%, Grade 1 were 73% and grade 0 were 00%. Till the end of study period the
crepitus remain same as shown in the table.
Table No.48 Effect of Matrabasti on Crepitus in percentage
Crepitus BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 0 00 0 00 0 00 0 00 0 00
Grade1 11 73 11 73 11 73 11 73 11 73
Grade2 4 27 4 27 4 27 4 27 4 27
Graph No.26 Effect of Matrabasti on Crepitus in percentage

Results 2010

Effect of Jalaukavacharana on Crepitus (Group J) in percentage:
Group J: Before treatment the number of patient having Grade2 severity of crepitus
were 14%, Grade 1 were 86% and grade 0 were 00%. Till the end of study period the
crepitus remain same as shown in the table.
Table No.49 Effect of Jalaukavacharana on Crepitus in percentage
Crepitus BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 0 00 0 00 0 00 0 00 0 00
Grade1 13 86 13 86 13 86 13 86 13 86
Grade2 2 14 2 14 2 14 2 14 2 14
Graph No.27 Effect of Jalaukavacharana on Crepitus in percentage

Results 2010

Effect of Matra Basti on Tenderness (Group M) in percentage:
Group M: Before treatment the number of patient having Grade 3 and 4 severity of
Tenderness were 0%, Grade2 were 40%, Grade 1 were 40% and grade 0 were 20%. After
4 days of Matra Basti, it was observed that the Tenderness remain same. After 7 days of
Matra Basti it was observed that Grade 3, 4 were 0%, Grade 2 was 40%, Grade 1 was
54%, and Grade 0 was 6%. During 1st follow up (20th day), Grade 3 and 4 were 0%,
Grade 2 were 6%, Grade 1 were 88% and Grade 0 were 6%. During 2nd follow up (30th
day) Grade 4, 3 and 2 were 0%, Grade1 were33% and grade 0 were 67%.
Table No.50 Effect of Matrabasti on Tenderness in percentage
Tenderness BT AT(D4) AT(D7) AT(D20) AT(D30)

Grade0 1 06 1 06 1 06 1 06 10 67
Grade1 6 40 6 40 8 54 13 88 5 33
Grade2 8 54 8 54 6 40 1 06 0 00
Grade 3 0 00 0 00 0 00 0 00 0 00
Grade 4 0 00 0 00 0 00 0 00 0 00

Results 2010

Graph No.28 Effect of Matrabasti on Tenderness in percentage
Pre and Post Median of Tenderness (Group M)
Average of Tenderness: Before treatment average Tenderness (Median) was 2, After 4
days of Matra Basti it remains same and after 7 days the median were 1and it remain
same, during the 1st follow up (20th day) and during 2nd (30th day) follow up median
were 0.
Grading of Tenderness: No tenderness- 0, Patient says joint is tender- 1, Patient winces
the face by touching- 2, Patient winces & withdraws the affected part- 3; Patient will not
allow the joint to be touched- 4.
Table No.51 Pre and Post Median of Tenderness (Group M)
Tenderness BT D4 AT(D7) AT(D20) AT(D30)

Median 2 2 1 1 0
Result of effect of Matra Basti on Tenderness at 4th day of treatment and on last
follow up.

Results 2010

Table No 52 Result of effect of Matrabasti on Tenderness at 4th day of treatment
Tenderness Average improvement z-value p-value

(Median)
BT-D4 0 1 1.000
BT-ATD30) 2 1.5 <0.001
Effect of Jalaukavacharan on Tenderness (Group J) in percentage:
Group J: Before treatment the number of patient having Grade 3 and 4 severity of
Tenderness were 0%, Grade2 were 40%, Grade 1 were 40% and grade 0 were 20%. After
4 days of Jalaukavacharana, it was observed that the Tenderness remain same. After 7
days of Jalaukavacharana, it was observed that Grade 3, 4 were 0%, Grade 2, were 6%,
Grade 1 were 81%, Grade 0 were 13%. During 1st follow up (20th day), Grade 4, 3 and 2
were 0%, Grade 1 were 73% and Grade 0 were 27%. During 2nd follow up (30th day)
Grade 4, 3 and 2 were 0%, Grade1 were60% and grade 0 were 40%.
Table No.53 Effect of Jalaukavacharan on Tenderness in percentage

Results 2010

Tenderness BT AT(D4) AT(D7) AT(D20) AT(D30)
Grade0 2 13 2 13 2 13 4 27 6 40
Grade1 8 54 8 54 12 81 11 73 9 60
Grade2 5 33 5 33 1 06 0 00 0 00
Grade 3 0 00 0 00 0 00 0 00 0 00
Grade 4 0 00 0 00 0 00 0 00 0 00
Graph No.29 Effect of Jalaukavacharan on Tenderness in percentage
Pre and Post Median of Tenderness (Group J)
Average of Tenderness: Before treatment average Tenderness (Median) were 2, Till the
end of the study i.e., 30th day the median were 1.
Grading of Tenderness: No tenderness- 0, Patient says joint is tender- 1, Patient winces
the face by touching- 2, Patient winces & withdraws the affected part- 3, Patient will not
allow the joint to be touched- 4.
Table No.54 Pre and Post Median of Tenderness (Group J)
Tenderness BT D4 AT(D7) AT(D20) AT(D30)

Results 2010

Median 1 1 1 1 1
Result of effect of Jalaukavacharan on Tenderness at 4th day of treatment and after
on follow up.
significant improvement between BT to D4 and there is significant improvement between
BT to AT (D30) with P value 0.016.
Table No 55 Result of effect of Jalaukavacharan on Tenderness at 4th day of
treatment and on last follow up.
Tenderness Average improvement z-value p-value

(Median)
BT-D4 0 1 1.000
BT-AT(D30) 0 2.46 0.016
Effect of Matra Basti on Gait (Group M) in percentage
Group M: Before treatment the number of patient having Grade 0 were 20%,grade 2
were 13%, Grade 3 were 54% and Grade 4 were 13%, After 4 and 7 days of Matra Basti,
it was observed that the Gait remain same. During 1st follow up (20th day), Grade 0 were
0%, Grade 1 were 20%, Grade 2 were 0%, Grade 3 were 67%, Grade 4 were 13%.
During 2nd follow up (30th day) Grade 0 was 0%, Grade 1 was 7%, Grade 2 was 13%,
Grade 3 was 13%, and Grade 4 was 67%.
Table No.56 Effect of Matrabasti on Gait in percentage

Results 2010

Gait BT AT(D4) AT(D7) AT(D20) AT(D30)
Grade0 3 20 3 20 3 20 0 00 0 00
Grade1 0 00 0 00 0 00 3 20 1 07
Grade2 2 13 2 13 2 13 0 00 2 13
Grade 3 8 54 8 54 8 54 10 67 2 13
Grade 4 2 13 2 13 2 13 2 13 10 67
Graph No.30 Effect of Matrabasti on Gait in percentage
Pre and Post Median of Gait (Group M)
Average of Gait: Before treatment average Gait (Median) were 3 and it remain same till
the 1st follow up i.e., on 20th day. During 2nd follow up the median were 4.
Grading for Gait: Free swinging no limp- 4, Limping gait but no additional support- 3,
Unilateral support (crutch, stick, wall)- 2, Bilateral support- 1, Absence of gait- 0.
Table No.57 Pre and Post Median of Gait (Group M)
Gait BT D4 AT(D7) AT(D20) AT(D30)

Median 3 3 3 3 4

Results 2010

Result of effect of Matra Basti on Gait at 4th day of treatment and on last follow up.
Table No 58: Result of effect of Matra Basti on Gait at 4th day of treatment and on
last follow up.
Gait Average improvement z-value p-value

(Median)
BT-D4 0 3.421 1.000
BT-AT(D30) 1 3.419 <0.001
Effect of Jalaukavacharan on Gait (Group J) in percentage:
Group J: Before treatment the number of patient having Grade 0 were 8%,grade 2 were
13%, Grade 3 were 66% and Grade 4 were 13%, After 4 and 7 days of Jalaukavacharana,
it was observed that the Gait remain same. During 1st follow up (20th day), Grade 0 were
0%, Grade 1 were 8%, Grade 2 were 8%, Grade 3 were 66%, Grade 4 were 20%. During
2nd follow up (30th day) Grade 0 was 0%, Grade 1 was 8%, Grade 2 was 8%, Grade 3
was 52%, and Grade 4 was 32%.
Table No.59 Effect of Jalaukavacharan on Gait in percentage

Results 2010

Gait BT AT(D4) AT(D7) AT(D20) AT(D30)
Grade0 1 08 1 08 1 08 0 00 0 00
Grade1 0 00 0 00 0 00 1 08 1 08
Grade2 2 13 2 13 2 13 1 08 1 08
Grade 3 10 66 10 66 10 66 10 66 8 52
Grade 4 2 13 2 13 2 13 3 20 5 32
Graph No.31 Effect of Jalaukavacharan on Gait in percentage
Pre and Post Median of Gait (Group J)
Average of Gait: Before treatment average Gait (Median) were and it remain same till
the end of study.
Grading of Gait: Free swinging no limp- 4, Limping gait but no additional support- 3,
Unilateral support (crutch, stick, wall)- 2, Bilateral support- 1, Absence of gait- 0
Table No.60 Pre and Post Median of Gait (Group J)
Gait BT D4 AT(D7) AT(D20) AT(D30)

Results 2010

Median 3 3 3 3 3
Result of effect of Jalaukavacharan on Gait at 4th day of treatment and on last
follow up.
significant improvement between BT to D4 and there is significant improvement between
BT to AT (D30) with P value 0.063.
Table No 61 Result of effect of Jalaukavacharan on Gait at 4th day of treatment and
Gait Average improvement z-value p-value

(Median)
BT-D4 0 3.421 1.000
BT-AT(D30) 0 2.236 0.063
Result of effect of Matra basti on Range of movement (Group M):
There is significant improvement in the Range of movement with Matrabasti with 36.56˚
of flexion and statistically highly significant with a p value <0.001
Table No.62 Effect of Matra basti on Range of Movement (Group M)
Sl. No Mean BT-AT % of SD SE t P

(d) Change
BT 89.33
th
4 Day 92.00 2.67 2.98 4.577 1.182 2.256 <0.05

Results 2010

7th Day 98.66 9.33 10.44 7.037 1.817 5.137 <0.001
20th 107.33 18 20.15 10.142 2.619 6.874 <0.001
Day
30th 122.00 32.67 36.56 11.629 3.003 10.879 <0.001
Day
Graph No.32 Result of effect of Matra basti on Range of movement
Result of effect of Jalaukavacharana on Range of movement (Group J)
There is significant improvement in the Range of movement with Jalaukavacharana
with 16.77˚ of flexion and statistically highly significant with a p value <0.001
Table No.63 Result of effect of Jalaukavacharana on Range of movement
Sl. No Mean BT-AT % of SD SE t P

(d) Change

Results 2010

BT 107.33
4th Day 108.66 1.33 1.24 3.519 0.909 1.468 <0.05
7th Day 114.66 7.33 6.85 7.988 2.063 3.556 >0.005
20th Day 118.66 11.33 10.55 7.432 1.919 5.906 <0.001
30th Day 125.33 18 16.77 9.783 2.526 7.126 <0.001
Graph No.33 Result of effect of Jalaukavacharana on Range of movement
Result of effect of Matra basti on Stiffness (Group M):
There is significant improvement in the stiffness with Matrabasti with 36.56˚ of flexion
and statistically highly significant with a p value <0.001
Table No.64 Effect of Matra basti on Stiffness (Group M)
Sl. No Mean BT-AT %of SD SE t p

Results 2010

(d) Change
BT 10
4th Day 10 0 00 0 0 0 1.000
7th Day 6.8 3.2 32 2.210 0.571 5.607 <0.001
20th 3.933 6.067 60.67 3.634 0.938 6.465 <0.001
Day
30th 0.8 9.2 94 4.296 1.109 8.294 <0.001
Day
Graph No.34 Result of effect of Matra basti on Stiffness
Result of effect of Jalaukavacharana on Stiffness (Group J)
There is significant improvement in the Range of movement with Jalaukavacharana
with 16.77˚ of flexion and statistically highly significant with a p value <0.001
Table No.65 Result of effect of Stiffness on Range of movement

Results 2010

Sl.No Mean BT-AT % of SD SE t P
d Change
BT 12.667
4th Day 7 5.667 45 2.582 0.667 8.5 <0.001
th
7 Day 4.33 8.33 65.76 2.44 0.630 13.229 <0.001
20th Day 7 66 5 39.44 2.673 0.690 7.246 <0.001
30th Day 9 3.66 28.89 3.519 0.909 4.036 <0.001
Graph No.35 Result of effect of Jalaukavacharana on Stiffness
Result of Comparison of qualitative data between the groups from BT to D4:
When comparison was done between groups using Mann Whitney U test for
qualitative data like Pain, the p<0.005 which is highly significant, Swelling p<0.005,

Results 2010

Tenderness p>0.50 and Gait p<0.50 on 4th day of treatment between the groups.
Therefore both the groups showed improvement.
Table No.66 Result of Comparison of qualitative data between the groups from BT
to D4
Average Average Mann Whitney p-value

improvement improvement U value
in M in J
Pain 0 0 60 0.003
Swelling 1 1 45 0.003
Tenderness 0 0 81 0.153
Gait 0 0 127 0.495
Result of Comparison of qualitative data between the groups from BT to AT (D30):
qualitative data like Pain, the p<0.05 which is significant, Swelling p<0.05 which is
significant, Tenderness p>0.50 and Gait >0.50 after treatment between the groups. There
is no significant change in treatments.
Table No.67 Result of Comparison of qualitative data between the groups from BT
to AT (D30)

Results 2010

Average Average Mann Whitney p-value
improvement improvement U value
in M in J
Pain 0 0 129 0.425
Swelling 1 1 75 0.036
Tenderness 2 0 81 0.157
Gait 1 0 127 0.213
Result of Comparison of Range of movement between the groups from BT to AT
(D30)
When comparison was done between group using student‘t’ Test for range of movement,
P<0.001, which is highly significant. It can be observed that there is significant difference
in between the groups. So the means of both the groups were compared, where in mean
of group J was found to be greater than mean of Group M .So Group J is more effective
than Group M with respect to range of movement.
Table No.68 Result of Comparison of Range of movement between the groups from
BT to AT (D30)
Mean Student ‘t’ Test
Group M Group J S1 S2 ‘t’ P
122 125.33 11.629 9.783 3.739 <0.001
Graph No.36 Result of Comparison of Range of movement between the groups from
BT to AT (D30)

Results 2010

Result of Comparison of Stiffness between the groups from BT to AT (D30)
When comparison was done between group using student‘t’ Test for stiffness, P<0.001,
which is highly significant. It can be observed that there is significant difference in
between the groups. So the means of both the groups were compared, where in mean of
group M was found to be greater than mean of Group J .So Group M is more effective
than Group J with respect to stiffness.
Table No.69 Result of Comparison of Stiffness between the groups from BT to AT
(D30)
Mean Student ‘t’ Test
Group M Group J S1 S2 ‘t’ P
9.2 3.66 4.296 3.519 3.864 <0.001
Graph No.37 Result of Comparison of Stiffness between the groups from BT to AT
(D30)

Results 2010


Discussion 2010

DISCUSSION
Discussion on Review of literature
Janusandhigata Vata is a painful condition where the patient is not able to do his
routine work concerned to his lower limb and hence hampers his normal activity. The
Nidāna and Samprāpti of this disease are not given separately in classics but being one of
the eighty types of Nānātmaja Vāta vyādhies, the same Nidānās and samprapti are
applicable in this disease.1
“Sandhi Gata Vata” is enumerated among the “Nanatmaja Vata Vyadhi” in
Ayurvedic literature. Depending on the site, name of the disease is attributed to it. The
knee joint is the commonest site of degeneration, hence, the name Janu Sandhi Gata Vata.
The chances of occurrence of Janusandhigata Vata is expected to increase in the coming
years due to sedentary life style, mental stress, unwholesome diet, physical strain, trauma
and life style disorders like obesity and diabetes etc.
Osteoarthritis in modern parlance is a degenerative articular disorder mainly of
the weight bearing joints, which limits every day activities like walking, climbing,
standing, making the individual crippled. There is steady rise in prevalence from age 30
such that by 65, 80% of people have radiographic evidence of OA, though only 25 to
30% are symptomatic2. The Samprapti of Sandhi-Gata-Vata may be divided into
Dhatukshaya Janya and Avarana Janya. Even the contemporary science explains the
pathology in two settings. One is due to the sub standard biomaterial of the joint
(Dhatukshaya). Second is due to increased applied pressure over the joint (Avarana). In

Discussion 2010

Dhatukshya Janya Sandhi-Gata-Vata, due to old age, Vatakara Ahara Vihara there will be
qualitative change in the joint material gradually leading to disease manifestation. The
other set of Samprapti, where in, due to continuous pressure due to obesity the joint may
get affected (Due to Avarana) leading to disease manifestation. This demarcation in
Samprapti helps in planning the treatment (Figure 1 and 2).
Structural changes in the joints make the disease Kastasadhya to Asadhya. The
Chikitsa Sootra of Sandhi-Gata-Vata is Snehana, Swedana and Agnikarma. Since it is a
Vata Vikara and Dhatukshaya is the resultant, Snehana and Svedana would be an ideal
line of treatment.
Matra Basti is selected in this study because of its simplicity, easy administration
and lack of complications for the group M with Indukanta Ghrita3 Vedana Shamaka and
Vatahara action as its ingredients are having Katu, Madhura rasa and Ushna Virya. In the
group J, Jalaukavacharana were selected as in Vatavyadhi Chikitsa ‘Raktamokshana’ is
also indicated.4 Many international research works on the efficacy of leech therapy in
Osteoarthritis have been conducted in past and are also in progress in the present.5a&b
Hence it is intended to find the effect of Indukanta Ghrita Matrabasti and
Jalaukavachrana on Janusandhigata Vata.

Discussion 2010

Discussion on Matrabasti
In the treatment of Vata vyadhis all the Acharyas mentioned Basti as the main
chikitsa. Matrabasti is easy, cost effective and can be administered irrespective of the
regimen of Basti chikitsa, hence it was selected for the present study.
The present study on Matrabasti shows following analyzed factors.
1. Quantity of Ghrita.
2. Time of administration of Basti.
3. Time of Retention of Basti dravya.
4. Upadravas.
1. Quantity of Ghrita:
In the present study the dose of Matrabasti was 60ml and it didn’t show any
complications. The dose of Matrabasti is Hrisva matra of sneha mentioned by
acharyas, which gets digested in 6 hrs. By practical observation about 40- 60ml of
Snehpana takes 6hrs for digestion. Susrutha mentioned one and half pala i.e.,
72ml as the dose of Matrabasti. So by considering all these factors, 60ml was the
dose fixed for basti.
2. Time of administration of Basti:
During the study, Basti was administered in the afternoon after food, as there is no
specific mentioning of time of administration. Matrabasti is being a type of
Anuvasana basti and is administered after food.

Discussion 2010

3. Time of Retention of Basti dravya:
During the present study, it was observed that, the maximum time of retention of
Basti dravya was 6 hrs and the minimum was 2 hrs. The time of retention was
gradually increased from the 1st day to 7th day of Matrabasti.
4. Upadravas:
In the present study, none of the upadravas were observed as the dose of ghrita
was minimal.
Probable Mode of Action of Matrabasti:4
As it is said that “guda moolam hi shariram” by maintaining the left lateral
posture during the basti administration, the basti dravya reaches the Pakvashaya and gets
absorbed. Chakrapani states that Agni will be in the natural state in the posture while
Gangadhara says; Agni, Grahani and Nabhi are present in the left side. Jejjata comments
Agni is present left side over the Nabhi, Guda has got a left sided relation with
Sthoolantra. So Basti Dravya can reach to the large intestine and Grahani, as they are
present in the same level.
Action of Basti is possible by Anupravaranabhava of Basti Dravya i.e. Sneha
easily moves up to Grahani, which freely moves in the intestine. Charaka says Basti
Dravya reach Nabhi, Katipradesha and Kukshi.
Basti acts mainly on Asthi and Majjavaha Srotas. Asthi is the seat of Vata Dosha.
Dalhana says that Pureeshadharakala and Asthidharakala are one another the same. So we
can assume that if Pureeshadharakala gets purified and nourished; the Asthivaha Srotas

Discussion 2010

will also be purified and nourished. Also another factor is about the relation between
Pittadharakala and Majjadharakala, Pittadharakala and Grahani. As an opinion says about
the spread of Basti Dravya till Grahani and Grahani is the seat of Agni, the nutrients may
get absorbed and thereby nourishes the Majjadharakala, which is having a strong bond
with Vata and the nervous system.
Indukanta ghrita used for matrabasti has the indigenous compounds like
Dashamoola, Panchakola, Pootikaranja and Devadaru. All most all the ingredients are
having the properties opposite of Vata like Ushna, snigdha and the karmas like
Vedanahara and shothahara. The principle drug used in preparation is ghrita which is
balya and rasayana in action and counteracts against the symptoms of Janu sandhigata
Vata.
Discussion on Jalaukavacharana
Acharya Charaka and Susrutha have mentioned Raktamokshana in Gatavata
especially in the context of Raktagata Vata. Sandhis are made up of Rakta, Mamsa, Sira,
Snayu structures; hence Raktamokshana was selected for the present study.
Acharya Susrutha explains, Jalauka does not cause any complications and can be
used in Raja, Bala, stree etc delicate persons, hence Jalaukavacharana was selected.5
Two medium sized leeches were used in the present study for Jalaukavacharana as
it is mentioned in Susrutha Samhitha that, one leech can cover the area of one Hastha
Pramana.

Discussion 2010

The following factors were observed in Jalaukavacharana:
1. Weight of leeches.
2. Duration of sucking.
3. Quantity of blood let out.
1. Weight of Leeches:
In the present study, the average weight of leech used was about 4- 6 gms.
2. Duration of leech sucking:
During the present study, the maximum time taken by the leeches for sucking was
three hrs and minimum was one hr.
3. Quantity of blood let out:
In the present study, the maximum quantity of blood let out by a single leech was
50ml and minimum was 20ml. The average quantity of blood in one sitting in one joint
by two leeches was 80ml.
Probable Mode of Action of Jalaukavacharana:
The treatment with using of medicinal leech is known as hirudotherapy. It should
be regarded not only as a preventive therapy, but also as a method of treatment in
vascular pathologies, endocrine disorders, nerve diseases and at all inflammatory
conditions.

Discussion 2010

Biological active substances containing in saliva of medicinal leeches can restore
blood circulation in the nudes of inflammation to remove an ischemia of organs, to
provide capillary tissue exchange, to improve immune protection and regeneration of
tissue.
The therapeutic effect is not only released by loss of blood but also by the
secretions, which the leech emits into the wound.
Leech constituents:
The saliva of leech contains,
a) Hirudin: having anti-thrombin activity.
b) Calin: prevents the blood coagulation.
c) Destabilise: completely blocks the spontaneous aggregation of human
platelet.
d) Hyluronidase: is a spreading factor, which ensures the other active
substances which are active at the bitten areas can be spread.
e) Eglin: restrains digestive proteases.
f) Bdellin: is a plasma hindrance.
g) Piavit: has a protective antithrombotic effect.
h) Hementin: has a hypearemistic activity.
i) Orgelase: has a hypearemistic activity.
j) Antithrombin, antitrypsin and antichymotripsin: high anti thrombin
activity.
The salivary glands of leeches also produce cornucopia of other
pharmacologically active substances including antihistaminic, protease, anesthetic and

Discussion 2010

antibiotic actions. An anesthetic substance leads to pain insensitivity (analgesic) while
leech sucking the blood.
These all active substances present in the leech saliva helps in reducing the
swelling, pain and stiffness of Janusandhigata Vata, promoting healing by allowing fresh,
oxygenated blood to the joint, lowering the concentration of prostaglandins in the local
area and contributing the anesthetic effect.6
Leech therapy may be an effective therapy for rapid reduction of pain associated
with osteoarthritis of the knee (Alternative therapies in health and medicine 2002).
Discussion about Clinical study:
The study was carried out in Patients of Janu Sandhi Gata Vata in two groups of
which, Group M received Matra Basti with Indukanta Ghrita for a period of 7 days &
Group J received Jalaukavacharana for single sitting.
Total of 34 patients complaining of Janu Sandhi Gata Vata were registered in the
study, of which 30 patients completed the study (15 in each group). The details are as
follows.
Total patients registered in the study -34
Patients who received Matra Basti with Indkanta Ghrita -19
Patients who received Jalaukavacharana -15
Completed -30

Discussion 2010

Total Attrition -04
Attrition in Group M -04
Attrition in Group J -00
Out of the 4 drop outs, two patients could not attend the Basti Chikitsa on 4th and
6th days of Matrabasti respectively due to their inconvenient time schedule. Two patients
in Basti Chikitsa group did not attend the follow ups due to their time constraints.
Discussion on Observations:
Age: In this study it was found that the percentage of Janu Sandhi Gata Vata was highest
in the age group between 61-70 yrs constituting 33.33% of total number of patients, 30%
patients was in the age group of 41-50 yrs, 20 % in 61-70 yrs and 16.66% were in the age
group of 30-40 yrs.
Sex: In the present study, 60% were males in comparison to 40% of females. It may be
thought that strenuous work schedule may be a contributing factor for predominance in
male. However the sample is too small to convey definite conclusion.
Occupation: Maximum numbers of patients were Business men at 36.66%, manual labor
were at 26.66% and house wives which constituted 23.33%. Occupations of specific
types may have an impact on the individual’s disease. The study shows the fact that
physical strain corresponds to the etiology of Janu Sandhi Gata Vata. Ayurvedic literature
also mentions that strenuous work is the causative factor for Vata Prakopa and leads to

Discussion 2010

Religion: In the study undertaken, 86.66% patients were Hindus and 13.34% were
Christians. This shows the geographical predominance of Hindus in this area.
Socio-economic status: Majority of patients belonged to the middle class at 70%, 20%
each were in poor class and 10% were in rich class.
Marital status: Majority of the patients were married i.e. 86.66% and remaining 13.34%
were single. The association of marital status goes along with age, wherein age influences
the manifestation of Janu Sandhi Gata Vata as discussed above.
Habitat: 70% of the patients in this study were from Sadharana Desha and 30% of
patients were from Aanupa Desha. This proves that habitat has shown a major influence
on manifestation of Janu Sandhi Gata Vata in the present study.
Dietary Habits: 46.66% of patients were vegetarians and 53.34% patients were
consumers of mixed diet.
Education: 53.33% had completed high school education, 13.33% primary education,
and illiterates and graduation both groups comprising 16.66%. As most of the patients
who completed their high school education belonged to labor class, there was an increase
in incidence in this class.
Intake of Aahara: 76.66% of the patients practiced Samashana, 16.66% practiced
Alpaashana, and 6.64% practiced Atyashana. Hence the intake of Aahara does not show
much preponderance in the causation of this disease.

Discussion 2010

Nature of work: A maximum number of patients were laborers which accounted to 50%
and those whose works involved standing at 13.33% and sedentary work patients were of
26.66%. Repeated stress and trauma, along with Vata Prakopa might contribute in the
disease process.
Duration of Vishrama: 60% had proper Vishrama. 20% had less Vishrama. Excessive
and less Vishrama was observed in 20% of patients. Amount of Vishrama has a direct
relation with the Vata Dosha, as less Vishrama is one of the causative factors for Vata
Prakopa which in turn can influence on Janu Sandhi Gata Vata.
Amount of Vyayama: 16.67% of patients showed irregularity in their habits of
Vyayama, 10% indulged in less amount of Vyayama and 63.33% of patients had
excessive Vyayama. 10% followed adequate of amount Vyayama. This study shows that
excessive Vyayama has an influence on Vataja disorders including Janu Sandhi Gata
Vata.
Nidra: 56.66% had sound sleep where as only 43.34% had disturbed sleep. It is evident
from the results that, the dull aching pain has no influence on the sleep, even though
disturbed sleep could provoke Vata Dosha.
Addiction: 56.66% of the patients had no addiction, in comparison 43.34% were
addicted, of which 26.66% were addicted to alcohol and 16.64% were addicted to
smoking. The above said factors are said to induce Vata Prakopa and hence they may
contribute to this disease.

Discussion 2010

Prakruti: A majority of patients belonged to Vata Kapha Prakruti i.e. 43.33% and 40%
belonged to Vata Pitta Prakruti, 13.33% were Pitta Kapha Prakruti.
All the patients in this study belonged to Dwandwaja type of Prakruti. This
observation supports the tendency of Vataja disorders like Janusandhigata Vata in
persons having the involvement of Vata in Deha Prakruti.
Symptomatology: The symptoms joint pain, stiffness and crepitus were observed in all
of patients (100%), Swelling were present in 76.66% of patients, 73.33% of patients
shown tenderness and 66.66% of patients having limping gait.
Characteristic of Onset of pain: The observation reveals all the patients had gradual
onset of pain i.e., 100%, shows that it’s a degenerative disorder.
Character of pain: Maximum number of patients had deep dull aching type of pain
(80%) and pricking type of pain (20%). The observation proves that the pain in
Jannusandhigata Vata is originated from inside the joint and it is a degenerative disorder.
Relation of Kala in aggravating the pain- Diurnal: In majority of the patients in
relation to Kala, there was aggravation of pain in the evening (70%). Evening is the Vata
Kala resulting in Prakopa of the already aggravated Vata Dosha which is relevant in the
observations in this study.
Pain Aggravating factors- Seasonal: 56.66% of patients shown both rainy and winter
and 43.34% shown rainy season as the aggravating factors.

Discussion 2010

Discussion on effect of Therapies:
Group M:
a) On 4th day of Matrabasti: The observations made with respect to Matrabasti on
Pain, Swelling, stiffness and Range of movement showed an insignificant (p>0.5) result.
Matrabasti showed an insignificant (p.0.5) result on tenderness and gait.
Crepitus remained unchanged.
b) On 7th day of Matrabasti: The observations made with respect to Matrabasti on
Pain, Swelling, Tenderness, Stiffness showed an insignificant (p>05) result.
Matrabasti showed an insignificant (p<0.05) result on tenderness and gait.
c) 20th and 30th day follow up: The observations made with respect to Matrabasti on
Pain, Swelling, Tenderness, Stiffness, Range of movement, Gait showed a highly
significant (p<0.001) result.
Overall effect of therapy
Except crepitus the Matrabasti with Indukanta Ghrita showed a highly significant
effect with ‘p’ value <0.001 from 7th day onwards. Initial immediate changes in any
parameters were not observed within the 1st 4 days. The effect sustained for longer
duration of time i.e., till the 30th day of the study period.

Discussion 2010

Group J:
a) On 4th day of Jalaukavachrana: The observations made with respect to
Jalaukavacharana on Pain, Swelling, stiffness and Range of movement showed a highly
Jalauka showed a significant (p<0.01) result on tenderness and Gait.
b) On 7th day of Jalaukavachrana: The observations made with respect to
Jalaukavacharana on Pain, Swelling, Stiffness and Range of movement showed a highly
Jalauka showed a significant (p<0.01) result on tenderness and Gait.
c) 20th and 30th day follow up: The observations made with respect to Jalaukavacharana
on Pain, Swelling, Tenderness, Stiffness, Range of movement and Gait shown an
insignificant (p>0.05) result.
The effect obtained on pain and swelling was instant and it sustained only for 8 to 10
days.
Overall effect of therapy
Jalaukavacharana has shown a highly significant result on the symptoms like pain,
swelling, tenderness instantly with p<0.001. The effect sustained only for 8-10 days and
again there was reoccurrence in the symptoms like pain, swelling was observed.

Discussion 2010

Comparison between Group M and Group J:
When both the groups were compared clinically for pain, swelling, gait and
tenderness, it was observed that group M showed better effect than group J.
qualitative data like pain, swelling, gait, and tenderness, on 4th day and after 7days (D7),
the statistical test for significance applied showed that P<0.05 which conveys that there is
statistical significant difference in the results obtained between the groups. Therefore
Group J showed instant effect on these criteria’s.
When comparison was done between groups using student‘t’ test for range of
movement P<0.001, which is highly significant. It can be observed that there is
significant difference in between the groups. So the means of both the groups were
compared, where in mean of group J was found to be greater than mean of Group M. So
Group J is more effective than Group M with respect to range of movement.
When comparison was done between group using student‘t’ test for stiffness,
P<0.001, which is highly significant. It can be observed that there is significant difference
in between the groups. So the means of both the groups were compared, where in mean
of group M was found to be greater than mean of Group J. So Group M is more effective
than Group J with respect to stiffness.

Conclusion 2010
CONCLUSION
• Janu Sandhi Gata Vata has been considered as a major problem in the society
since long and the chance of occurrence is expected to be increasing through the
coming years because of present life style.
• Janu Sandhi Gata Vata is a type of Vata Vyadhi commonly associated with the
Vardhakya Avastha, Dhatu Kshaya and Madhyama rogamargajanya. So it is
Kasthasadhya to Asadhya for Chikitsa.
• Samanya Vata Vyadhi Cikitsa can be given in Janu Sandhi Gata Vata.
• Matra Basti is a type of Anuvasana Basti which is very effective in Vata
Vyadhis and can be practiced safely in all cases except Ajeerna condition.
• Matra Basti was selected, as it is the prime treatment for a Vata Vyadhi like
Janu Sandhi Gata Vata.
• Jalauakavacharana was selected as there are many international studies on the
effect of Jalauka in Osteoarthritis of the knee are conducted in past and also in
progress.
• Jalaukavacharana is a type of Raktamokshana which is easiest method and
can be applied in the cases of Janusandhigata Vata where Pain and Swelling is
severe for instant relief.
• Ayurvedic treatment measures even though known for their clinical effects
need to be substantiated through proper clinical trials for wider acceptance.
• The study is intended to compare the efficacy of Indukanta Ghrita Matra Basti
with Jalaukavacharana in Janusandhigata Vata.
Conclusion 2010
• Basti is considered as the best line of treatment for Vata vyadhis. Matrabasti
is the safe and easiest method of Basti. It can be administered all the time without
following any regimens.
• Majority of the drugs in Indukanta Gritha are having Ushna Veerya, Vatahara
and Kapha-Vata Shamaka properties. So by their virtue, they help in breaking the
Samprapti of Janusandhigata Vata. All the drugs were having anti-inflammatory and
analgesic properties as well. Therefore helps in relieving the pain and inflammation
of joints.
• The saliva of Jalauka contains the factors like hirudin, calin, destabilise,
hyluronidase, eglin, antithrombin, antitrypsin, antichymotripsin, hementin, orgelase,
piavit and other pharmacologically active substances, which are helpful in reducing
the pain, swelling in the tissues. Promoting healing by allowing fresh, oxygenated
blood and contributing anesthetic effect on the joint. Hence it is advocated in the
patients having severe pain and swelling.
• In the sample taken for the study, the patients belonged to the age group of 30-
70 years. All the patients registered were Hindus and Christians. Most of the patients
in the study were business men and from middle class. Few of the patients were
addicted to either alcohol or smoking or both. Dietary habits of the patients showed
maximum participants belonged to mixed diet. Majority of patients belonged to Vata
Kapha Prakruti, Vriddha Vaya, Adhika Vyayama, but majority had proper rest and
sound sleep.
• The severity of Pain, markedly decreased in both the groups and the results
were statistically significant (P<0.001). When comparison was done between the
groups, it showed there was no statistically significant difference between the groups
Conclusion 2010
and clinically Group J has an instant relief compared to Group M with respect to
pain and swelling.
• The severity of swelling, markedly decreased in both the groups and the
results were statistically significant (P<0.001). When comparison was done between
the groups, it showed there was no statistically significant difference between the
groups and clinically Group M had later but sustained effect and Group J had a
instant relief which persisted for shorter duration.
• The severity of crepitus, had not improved in either Group M or Group J.
• The severity of tenderness, markedly decreased in both the groups and the
results were statistically significant (P<0.001) in Group M and p<0.05 in Group J
When comparison was done between the groups, it showed there is statistically
significant difference between the groups and clinically Group M had sustained
effect on tenderness than Group J.
• The Gait has markedly improved in both the groups, but Group M p<0.001
showed sustained effect than the Group J p <0.05 on the 7th day of study.
• The goniometric measurement showed marked improvement in both the
groups and the results were highly significant (P<0.001). When comparison was
done between the groups, it showed that there was significant difference between the
groups and clinically Group J was instantly effective when compared to Group M
having a sustained effect.
• The severity of stiffness, markedly decreased in both the groups and the
results were statistically significant (P<0.001). When comparison was done between
the groups, it showed there was statistically significant difference between the
Conclusion 2010
groups in respect of relief duration and clinically Group J was instantly effective
than Group M with respect to stiffness.
• Clinically best remission was observed in majority of patients in both the
groups; where in Group M was more effective than Group J with sustained effect,
where as Group J was having instant relief in the symptoms like pain and swelling.
Therefore it is hoped that if the Basti procedure is complimented with
Jalaukavacharana and internal medication, it may give a wonderful relief to the
patients of Janu Sandhi Gata Vata, thereby improving the functional ability of the
system.
• Matra Basti with Indukanta Ghrita and Jalaukavacharana has given
encouraging clinical results. Observing the clinical efficacy of Matra Basti and
Jalauka, it is felt that a multi- centered study on this topic would increase and
ascertain the validity of the findings.
This work is presented with the hope that the observations and results widen the
scope for further studies.
Summary 2010

SUMMARY
The present work entitled “A Comparative study on the effect of Indukanta Ghrita
Matrabasti and Jalaukavacharana on Janusandhigata Vata” comprises of following
• Introduction
• Review of literature
Disease review
Bastikarma review
Jalauka Review
Drug Review
• Methodology & observations
• Discussion
• Conclusion
Introduction: Deals with importance of selection of Janusandhigata Vata in
present era, need of Ayurvedic management and importance of present study. It
includes plan of study in brief. .
Review of literature:
The Review of literature comprises of the following fragments:
A) Disease review: In this fragment a brief description of the historical aspect of the
illness from Vedic era to the present time is dealt and is entitled as Historical

Summary 2010

review. It elaborates the general description of Janusandhigata Vata, which
includes the etymological derivation, anatomy, physiology, etiology,
pathogenesis, clinical manifestations, prognosis and general principles of
treatment of Janusandhigata Vata.
B) Bastikarma Review: Comprises of general description of Bastikarma and a brief
description of the properties of Bastikarma and the procedure followed.
C) Jalauka Review: Comprises of general description of Jalauka, types, properties
and the procedure followed.
D) Drug Review: The composition of the Indigenous compound drugs in Indukanta
Ghrita is detailed in the Drug contrives. The properties of the individual herbs
used in the preparation of the medicinal compound are briefed in the context.
Methodology:
Materials and Methods: The materials and methods of the present work with
complete description of 30 patients treated with Matrabasti and Jalaukavacharana
along with their various criteria, including assessment criteria are presented here.
Out of the 4 drop outs, two patients could not attend the Basti Chikitsa on
4th and 6th days of Matrabasti respectively due to their inconvenient time schedule.
Two patients in Basti Chikitsa group did not attend the follow ups due to their
time constraints.

Summary 2010

Observations: The observations made during the clinical study are presented in
order with tables and graphs.
Results: Statistical analysis of the findings and the results obtained are
methodically presented in this section with suitable tables and graphs.
Discussion:
In this section, the observations and results obtained are critically analyzed and
Interpreted on the basis of facts established in various literatures to unravel the
truth of efficacy of the treatment taken for the study.
Conclusion:
The final conclusions drawn from the present clinical research work are presented
in this fragment.

References 2010

REFERENCES
Introduction:
1. Cha.Chi – 28: 37
2. API Text book of medicine by G.S. Sainani, 6th edition, 1999.
3. Davidson’s Principals and Practice of medicine.
4. Su.Chi.35
5. Cha.Chi.28
6. Saha. Yogam – Gritha Yogam
7. Su.Chi.4/7
Historical Review
1) Cha.Chi – 28 2) Su.Ni – 1:27; Su.Chi – 4:8
2) A.Sa.Ni – 15:12; A.S.Chi – 23:9.
3) A.H.Ni – 15:11; A.H.Chi – 21:19.
4) M.Ni – Vata Vyadhi Adhikara
5) Bh.Pr – 24
6) Yo.Ra – Vata Vyadhi Adhikara.
7) Bhai.Ra – 23
Nirukti and Paribhasha
1. Shabda Sthoma Mahanidhi.
2. Shabda Kalpa Druma.
3. M. Monier – Williams; Sanskrit- English Dictionary, Reprint edition, 2008.
4. Su.Sha - 5/24

References 2010

Janu Sandhi
1. Su.Sha - 5/24
2. Su.Sha - 5/27
3. A.Hr.Su - 12/18
4. Su.Sha - 4/14-15
5. Su.Ni - 1/13
6. A.Hr.Su - 11/26-28
7. Su.Sha - 5/29-36
8. Su.Sha - 5/37-38
9. Su.Sha - 5/16
10. Human Anatomy and Physiology, by Marie Elaine N; 4th edition, 1998.
11. Clinical Anatomy by Snell Richard S.; 6th edition, 2000.
12. Principles of Anatomy and Physiology, Tortora J. Gerard.
13. Gray’s Anatomy by Williams Peter L., Warwick Roger, Dyson, and Bannister.
Nidana
1) Cha.Chi - 28/15-17
2) Su.Su - 21/19
3) A.H.Ni - 1/14-15
4) Yo.Ra.Pu.Vat - 1-4
5) Bh.Pr.Chi.Vat - 1-2
6) Ma.Ni.Pu - 22/1-3
7) Cha.Vi - 5/27

References 2010

8) Cha.Vi - 5/28
9) Su.Sha - 6/7, 12, 13
Poorvaroopa and Roopa:
1. Cha.Chi - 28/19
2. Bh.Pr. Chi - 24/93
3. Cha.Chi - 28/37 & Chakra
4. Su.Ni - 1/28 & Dal, Gaya
5. A.H.Ni - 15/14
6. Bh.Pr. Chi - 24/258
7. Yo.Ra.Vat.Ni
8. Ma.Ni - 22/21 & Madhu
Samprapti:
1) Cha.Chi - 28/18-19
2) A.H.Ni - 15/5-6
3) Su.Su - 15/32
4) Su.Sa.Su. 15/32 – Dal.
Upashaya-Anupashaya:
1) M.Ni – 1:8. Madhukosha

References 2010

Sadhyasadhyata:
1) M.Ni(Madhukosha) – 22:77
2) Cha.Chi (Chakrapani) – 28:72-74.
Upadravas:
1) M.Ni – 22:78, 79.
Chikitsa:
1) Su.Chi - 4
2) Su.Chi - 31/2
3) Cha.Su - 5/85
4) Su.Chi - 24/30
5) Cha.Su - 22/11
6) Su.Chi - 32/3
7) Cha.Su - 14/35
8) Su.Chi - 32/12
9) Cha.Su - 14/35-37
10) A.H.Su - 17/5
11) Cha.Chi - 28/115
12) Cha.Chi - 14/38
13) Su.Su - 18/7
14) Su.Chi - 32/12
15) Su.Chi - 4/8
16) A.S.Chi - 23/13

References 2010

17) A.H.Chi - 21/22
18) Yo.Ra.Ci.Vat
19) Bh.Pr.Ci.24/259
Osteoarthritis:
1) Harrison’s Principles of internal medicine.
2) Clinical Medicine by Kumar Praveen, Clark Michael.
3) Davidson’s Principles and Practice of medicine.
4) Outline of Orthopedics by John Crawford Adams.
5) API textbook of medicine by G.S. Sainani.
6) Text book of Pathology by Harsh Mohan.
7) Robins Pathology by Robin and Kumar.
8) Pharmacology and Pharmacotherapeutics by Satoskar.
9) The pharmacological basis of therapeutics, Goodman and Gilman.
10) Essential Orthopaedics, J.Maheshwari.
11) Text book of Orthopaedics, John Ebenezar.
Basti Karma:
1. Ch.Si.1/40- 41
2. Su.Chi.35/1-2
3. Ch.Su.20/15
4. Su.Chi. 35/27,
5. Su. Chi. 35/29,30

References 2010

6. Su.Chi.35/3
7. Ch.Su.1/27, 28
8. A.H SU 9/1
9. Su. Ut. 5/1
10. Ch. Si. 1/40
11. Su. Ni. 35/18
12. Su. Ni. 35/18
13. A.S.Su.28/18
14. Su.Chi.35/18
15. Cha.Si.6:83 Vanga Sena Basti Karmadhikara, Sloka 182-185
16. Cha.Si – 2:19.
17. A.H.Su – 19:6.
18. Cha.Si – 2: 18- 19.
19. A.H.Su – 19:8
20. Su.Chi – 35:22
21. Cha.Si – 3:7
22. A.H.Su – 19:10-14
23. Cha.Si – 3:8-9
24. Su.Chi.35/7-9
25. Cha.Si.3/10-12
26. Cha.Si 5/4-6
27. A.H.Su.19/14
28. Su.Chi.35/7-9

References 2010

29. A.H.Su.19/22-23
30. Cha.Si.3/27
31. Su.Chi.38/1-6
32. A.H.Su.19/24-26
33. A.H.Su.19/26-30
34. Ch. Si. 4-52-53
35. A.H. Su. 19/67
36. Su. Chi. 35/18
37. A.H. Su. 19/68-69
38. A.S. Su. – 28/9
39. Ch. Si. 4/52-54
40. A.S.Su,28/9
41. Ch.Si.4/52-54)
42. A.S. 28/9)
43. Su.Chi.38/18
44. Chakr. Ch. Si. 4/54
45. Su. Chi. 37/55-56
46. A.S.Su.28/9
47. A.H. Su. 19/29-30)
48. Ch.Si. 4/25

References 2010

Jalauka:
1. Su.Su.13/9
2. Su.Su13/18
3. Su.Su.13/11
4. Su. Su. 13/11
5. Su.Su.13/12
6. Su.Su.13/13.
7. Su.Su.13/13
8. Su.Su.13/12
9. Su.Su.13/16-17
10. A.Hr.Su.27/44.
11. C.Su. 24/11-19, 27- 29, 42, 44.
12. A.H. Su. 27/2, 3, 5
13. Su.Su.14/9,23,24,32.
14. Su.Sha.8/7,10
15. http://www.invertebrate.us/leech/info.
16. http://www.biopharm-leeches.com.
17. "Experiments on the possible role of leeches as vectors of animal and human pathogens:
a light and electron microscopy study". Parasitology Research.
18. http://books.google.com.
19. http://books.google.com.
20. http://driving.timesonline.co.uk.
21. Scenario Archive, Travel Survival. Retrieved on 2007-07-28.


References 2010

22. Victorian Poisons Information Centre. Retrieved on 2007-07-28.
23. The Internet Journal of Gynecology and Obstetrics http://www.ispub.com.
24. ABC News. 2005-04-11. Retrieved on 2007-07-28.
25. Calling Doctors Leech and Maggot to the O.R. Islamonline.net
26. Su.Su.13/21
27. Su.Su.13/18
28. A.S.Su.35/4
29. A.Hr.Su.20/45-46.
Drug Review:
1). Sa.Yo. Ghrita Prakarana
2). Su.Chi.4/7
3). Dravyaguna Vignana
4). A.H.Su. 6
Discussion:
1).Cha.Chi.28/15-18,37
2). Davidsons principles and practice of medicine mentions about prevalence of the disease.
3).Sa.Yo.Ghrita Prakarana
4). Cha.Si.
5).Su.Su.13/2
6).The principles & Practice of Panchakarma P.No.548-551.

Bibiliography 2010

BIBLIOGRAPHY
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Caukhambha Sanskrit Sansthan, Varanasi, UP.

Bibiliography 2010

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10) Braunwald, Fauci, Kasper, Hauser, Longo, Jameson; Harrison’s Principles of
internal medicine, 15th edition, (2001), Published by Mc Graw – Hill.
11) Chakrapanidatta, Chakradatta with Vaidyaprabha Hindi commentary by Dr.
Indradev Tripathi, 1997, Caukhambha Sanskrit Bhavan, Varanasi, Uttar
Pradesh.
12) Davidson’s Principals and Practice of medicine, 20thedition, edited by
Nicholas A. Boon and others, 2006.Publisher: Churchill Livingstone, Elsevier
Limited.
13) Devaraja Radhakant; Sabdakalpadruma; 1998; Nag Publishers, New Delhi.
14) Goodman and Gilman: The pharmacological basis of therapeutics, edited by
Joel G Hardman and Lee E Limbird, 10th edition, 2001; Mc. Graw Hill Book
Company, Hamberg.
15) Govind Das, Bhaishajya Ratnavali, Vidyotini Hindi commentary by
Ambikadatta Sastri, edited by Rajeshwaradatta Sastri, 2001, Caukhambha
Sanskrit Bhavan, Varanasi, Uttar Pradesh.
16) Harrison: Principles of Internal Medicines, 15th International Edition, edited
by Eugene Braunwald, Anthony S. Fanci, Stephen L. Hauser, Dennis L.
Kasper, Dan L. Longo, J. Larry Jameson and McGraw-Hill – Medical
Publishing Division, Vol.- 2.
17) Harshmohan, Textbook of Pathology, 1998, 4th edition, Jaypee Brothers
Medical Publishers (P) Ltd., New Delhi
18) Henry Gray, Grays Anatomy, 37th edition 2005 edited by Peter C. Williams
and Roger Warrick.

Bibiliography 2010

19) John Crawford Adam, Outline of Orthopedics, 13th edition, 2001; Churchhill
Livingstone, Elsevier Ltd.
20) John Ebenezar, Text Book of Orthopaedics, 4th edition, 2010; Japee brothers
Medical publishers (P) Ltd.
21) Kashyapa Marica, Kashyapa Samhita, 1998, Vriddha Jivaka Revatsya with
Hindi Vidyotini commentary by Satyapala Bhisakacarya, Caukhambha
Sanskrit Bhavan, Varanasi, Uttar Pradesh.
22) Kashyapa Marica, Kashyapa Samhita, 2008, Vriddha Jivaka Revatsya with
English translation and commentary; Reprint edition; Published by
Caukhambha Visvabharati, Varanasi, UP.
23) Kasthure H.S.; Ayurvediya Panchakarma Vijnan,2001, Bhaidyanath Ltd.
24) Kumar Praveen, Clark Michael; Clinical Medicine, 3rd edition, 1994;
Published by ELBS.
25) Madhavakara; Madhava Nidana with Madhukosa commentary; edited by Dr.
P. Himasagara Chandra Murthy, 1st edition, 2006; Published by Caukhambha
Krsnadas Academy, Varanasi, Uttar Pradesh.
26) Maheshwari.J, Essential Orthopaedics, 6th reprint edition, 2008; Published by
Metha publishers, New Delhi.
27) Marie Elaine N.; Human Anatomy and Physiology, 4th edition,1998;
Published by Benjamin / Cummins Science, California.
28) M. Monier – Williams; Sanskrit- English Dictionary; edited by Pandit Ishwar
Chandra; Reprint edition, 2008; published by Indica Books, Varanasi, UP.
29) Raja Radhakant Deva; Shabda Kalpa Druma; Reprint edition, 1988;
Published by Nag publishers, Javahar Nagar, Delhi.

Bibiliography 2010

30) Robin & Kumar; Robins Pathology, edited by Robin, Kumar, Cortan, 7th
edition, 2003; Published by Hawvrt (India) Pvt. Ltd., New Delhi.
31) Sahasra Yogam, Taila Yogam, edited by K.V. Krishnan Vaidyan and S.
Gopala Pillai Published by Vidyarambam publishers.
32) Satoskar R.S.; Pharmacology and Pharmacotherapeutics, Revised 17th edition,
2001; Published by Popular Prakashana, Mumbai.
33) Snell Richard S.; Clinical Anatomy, 6th edition, 2000; Published by
Lippincott Williams & Wilkins.
34) Sri Govind Das; Bhaishajya Ratnavali with Vidyotini Hindi commentary by
Bhisag Ratna Sri Brahmashanker Mishra, Sri Kaviraja Ambikadatta and Sri
Rajeshwaradatta Shastri, 19th edition, 2008; Published by Caukhambha
Prakashan, Varanasi, UP.
35) Susrutha; Susrutha Samhita; redacted by Nagarjuna; with commentaries
Nibandha Sangraha of Dalhana and Nyayacandrika of Gayadasa; edited by
Vaidya Yadavji Trikamji Acharya, Narayan Rama Acharya, Kavyatirtha; 8th
edition, 2005, Krsnadas Academy, Varanasi, Uttar Pradesh.
36) Susrutha Samhita with English translation of text and Dalhana’s commentary
along with critical notes by Dr.P.V.Sarma, First edition; Varanasi;
Caukhambha Bharati Academy; 1999.
37) Sharangadhara; Sharangadhara Samhita Madhyama Khanda, English
Translated 3rd edition, 1997 by Ayurved Vidvan Prof. K. R. Srikantha
Moorty, Caukhambha Orientalia, Varanasi, UP.
38) Sharma P.V.; Dravyaguna Vijnana, reprint edition 1999; Caukhambha
Bharati Academy, Varanasi.

Bibiliography 2010

39) Sharma Priyavrat; Dravyaguna Vijnana, 1998, Caukhambha Amarabharati
Prakasana, Varanasi, Uttar Pradesh
40) Tortora J. Gerard, Grabowski Reynolds Sandra; Principles of Anatomy and
Physiology, 8th edition; Published by Harper Collins Publications Inc. New
York.
41) Vagbhatacarya; Ashtanga Sangraha with Hindi Vyakhya by Kaviraj Tridev
Gupta; Reprint Edition, 1993; Krsnadas Academy, Varanasi, Uttar Pradesh.
42) Vagbhatacarya; Ashtanga Hridaya with Commentaries Sarvangasundara of
Arunadatta and Ayurved Rasayana of Hemadri; edited by Pandit
Bhisakacarya, Hari Sastri Paradkar, Reprint edition, 1995 Krsnadas Academy,
Varanasi, Uttar Pradesh.
43) Vaidhyanath R; Panchakarma A hand book for students and practitioners, 1st
edition, 2000.
44) Vangasena, Vangasena Samhita; edited by Jain Sankarlalji Vaidya; published
by Khemnath Srikrishnadas; Mumbai.
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Annexure 2010

ANNEXURE
THE COMPARATIVE STUDY ON THE EFFECT OF INDUKANTA GHRITA
MATRABASTI AND JALAUKAVACHARANA IN JANUSANDHIGATA VATA
Guide: Dr. Zenica D’souza MD (Ayu). PG Scholar: Dr.Chanabasappa R. Pujar
Group Group
M J
Name: Sl. No.
Age: Date:
Sex: Male/ Female OPD/IPD:
Religion: H/M/C/O Bed No.
Education: I/P/HS/GR/PG DOA:
Marital Status: M/UM/W/D DOD:

Desha: Jn/An/Sad
Social Status: P/M/R

Occupation:
Address: Phone No.
Consent: I hereby agree that, I have been fully educated with the disease treatment,
here by satisfied whole-heartedly, and accept the medical trial over me.
Investigator’s Signature Patient’s Signature

Annexure 2010

I. Chief Complaints: Rt Knee Lt Knee
Pain Yes/No Yes/No
Restricted movements Yes/No Yes/No
Stiffness Yes/No Yes/No
Grading for Pain: No pain- 0

Mild-Pain not interfering with activities or sleep- 1
Moderate-Pain interfering with activities or sleep - 2
Severe-Pain reducing activities and sleep- 3
II .Associated Complaints: Rt Knee Lt Knee
Swelling Yes/No Yes /No
Crepitus Yes/No Yes/ No
Others:
III. History of Present illness:
1).Pain: Onset: Sudden / Gradual /Insidious
Course: Progressive / Intermittent / Continuous
Character: Deep dull aching / Pricking / Shooting / Excruciating
Aggravating factors: Diurnal: Morning / Afternoon / Evening / Night
Season: Summer /Rainy /winter
Relieving factors: Diurnal: Morning / Afternoon / Evening / Night
Movement: Squatting / walking / Climbing stairs
Activities: Sitting / Lying

2). Swelling: Onset: Sudden / Gradual
Site: Anterior / Posterior
Aggravation: Sitting / Lying / Standing


Annexure 2010

Relieves: Squatting / Walking / Climbing stairs
3). Stiffness: min/24hrs.
4). Crepitus: Absent / Palpable / Audible
IV. Treatment History
V. Personal History: 1).Diet: Veg. / Mix
2).Appetite: Good/Low/Disturbed
3).Sleep: Sound / Disturbed

Disturbed: By pain / other reasons
4).Habits: Tobacco/Smoking/Alcohol/Other
5).Bowel: Regular/ Constipation

Frequency: /Day
Other complaints:
6).Micturition: Scanty/Normal/Excessive
Frequency: Day: Night:
Other complaints:
7).Menstrual History: Menarche: yrs. Menopause: at yrs.
M.C. - Regular /Irregular
Menorrhagia/ Metrorrhagia/ Dismenorrhea/ Leucorrhea
VI. General Examination:
Pulse : / min
Heart rate : / min
Blood pressure : / mm of Hg
Temperature : ˚C
Respiratory rate : / min
Weight : Kg
Height : cms
Nourishment : Good / Moderate / Poor

Annexure 2010

VII. Sroto Pareeksha:
Srotas Observed Lakshana

Asthivaha
Majjavaha
VIII. Special Examinaton of Joints
i). Inspection (Darshana)
1. Joint Swelling: Absent – 0 ; Minimal swelling– 1; Moderate Swelling-

2
2). Deformity: Absent/Present
3). Gait: Free swinging no limp- 4
Limping gait but no additional support- 3
Unilateral support (crutch,stick,wall)- 2
Bilateral support- 1
Absence of gait- 0
4). Range of Movement (Flexion range):
5). Muscular Spasm: Absent / Present
6). Muscular Wasting: Above the affected joint: Yes / No
Below the affected joint: Yes / No
ii). Palpation (Sparshana)
1). Local Temperature: Normal / Raised
2). Tenderness: No tenderness- 0

Patient says joint is tender- 1
Patient winces the face by touching- 2

Annexure 2010

Patient winces & withdraws the affected part- 3
Patient will not allow the joint to be touched- 4
3). Crepitus: Absent- 0

Palpable- 1
Audible-2
Atura Bala Pramana Pareeksha

1. Prakriti- a) Sharira - V/P/K/VP/VK/PK/VPK
b) Manasa- Satvika/Rajasa/Tamasa
2. Sarata - P/M/A
3. Samhananata - P/M/A
4. Pramanata - a) Height b) Weight
5. Satmyata - P/M/A
6. Satvata - P/M/A
7 .Aharashakti - a) Abhyavaharana shakti - P/M/A b) Jaranashakti -

P/M/A
c) Agni - Sama/Vishama/Manda/Tikshna
8. Vyayamashakti - P/M/A
9. Vayatah - Bala/Yuva/Vridha
Investigations:
1). Radiological-(X-ray- AP-lateral view)
Osteophyte Jt space narrow Sclerosis Deformity

Rt Knee
Lt Knee
2).Hematological
a. Hb%- b. T.C.- c. E.S.R.-
d.. D.C.-

Annexure 2010

3).Urine
a. Albumin- b. Sugar- c. Microscopy-
Treatment: Group M- Matrabasti with Indukanta Ghrita

Group J- Jalaukavacharana
Group-M Date of Basti commencement:
Date of Basti completion:
Days Time of Time of Time of No. of times Upadravas

administration Evacuation retention Evacuated (if any)
I
II
III
IV
V
VI
VII
Assessment of Results
Parameters BT Day 4 Day 7 AT 20th AT 30th
Day Day
Pain
Stiffness
Range of
movement
Gait
Tenderness
Crepitus
Swelling

Annexure 2010

Group- J
Joint Date Time Wt of Leech Wt of Leech after Wt
before application detachment difference
Rt medial
Rt lateral
Lt medial
Lt lateral
Assessment of Results
Parameters BT Day 4 Day 7 AT 20th AT 30th

Day Day
Pain
Stiffness
Range of
movement
Gait
Tenderness
Crepitus
Swelling
Result:
Investigators Note:
Signature of Guide:

Indukanta Ghrita Matra Vasti

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“A COMPARATIVE STUDY ON THE EFFECT OF INDUKANTA

GHRITA MATRA BASTI AND JALAUKAVACHARANA ON

DR.CHANABASAPPA PUJAR B.A.M.S

Dissertation Submitted to the

Under the guidance of

DR.ZENICA D’SOUZA .M.D. (Ayu)

DEPARTMENT OF POST GRADUATE STUDIES IN

I hereby declare that this dissertation entitled “A COMPARATIVE STUDY

ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND

JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide and

genuine research work carried out by me under the guidance of DR.ZENICA

D’SOUZA, M.D .(Ayu) ,Department of Post Graduate Studies in Panchakarma,

Alva’s Ayurveda Medical College, Moodbidri.

DR. CHANABASAPPA R. PUJAR

ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND

JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide

research work done by DR.CHANABASAPPA R.PUJAR under the guidance of

award of the degree in Ayurveda Vachaspathi (M.D.) in Panchakarma, of Rajiv

Gandhi University of Health Sciences, Karnataka, Bangalore.

This is to certify that the dissertation entitle “A COMPARATIVE

STUDY ON THE EFFECT OF INDUKANTA GHRITA MATRABASTI AND

JALAUKAVACHARANA ON JANUSANDHIGATA VATA” is a bonafide

research work done by DR.CHANABASAPPA R.PUJAR under the guidance of

DR.ZENICA D’SOUZA.M.D.(Ayu) ., Department of Post Graduate Studies in

Panchakarma, Alva’s Ayurveda Medical College, Moodbidri.

I hereby declare that the Rajiv Gandhi University of Health Sciences,

dissertation in print or electronic format for academic/research purpose.

© Rajiv Gandhi University of Health Sciences, Karnataka.

Completion of dissertation marks the milestone in the post graduates studies. So

I am grateful to my beloved father Sri.Rangappa Pujar and beloved mother Smt.

On the completion of this thesis work, I heartily extend my sincere gratitude to

I owe my sincere regards and boundless gratitude to Dr.M.Mohan Alva,

Chairman, Alva’s Education Foundation, Moodbidri, for giving me an opportunity to do

my post graduate studies in this prestigious institution.

I render my immense and heartfelt thanks to Dr.Suresh Negalaguli,

support in completing this work.

My sincere gratitude to Dr.Prasanna Aital, Dr.K.N.Rajashekar, Dr.Vasant Patil,

for their guidance during my entire study period.

I acknowledge my gratitude to the staff of Alva’s Pharmacy, Mijar, who selflessly

Panchakarma therapists for their constant help during the study.

List of graphs and photographs……………………. IV-V

Abbreviations …………………………………………. VI-VII

Abstract ……………………………………………….. VIII-IX

Chapter 1) INRODUCTION 1-5

Chapter 3) REVIEW OF LITERATURE

A) Disease review 7-39

Materials and Methods 83-87

Chapter 6) DISCUSSION 132-146

Chapter 7) CONCLUSION 147-150

Chapter 8) SUMMARY 151-153

3 Chikitsa Sutra mentioned in different classics. 29

4 Persons unfit for the Anuvasana Basti. 46-47

5 Measurements of Basti Yantra. 48

6 Netra Dosha and Putaka Dosha. 49-50

7 Indications of Matra Basti. 52-53

8 Indication for leech application 62-64

9 Ingredients of Indukanta Ghrita 75-76

10 Pharmacodynamics of Kashaya Dravyas 77

11 Karmas of Kashaya Dravyas 77-78

14 Pharmacodynamics of Indukanta Ghrita 80

15 Distribution of 30 patients according to different age group 88

16 Distribution of 30 patients according to sex 89

17 Distribution of 30 patients according to occupation 90