HTML Full Text

Introduction

Knee osteoarthritis is the most prevalent and leading cause of pain and disability in most countries. It affects women more than men.[1]  It is chronic musculoskeletal disorders characterized by gradual loss of cartilage in joints and creating stiffness, pain and impaired movement. It is classified into two groups primary and secondary. In Primary osteoarthritis there is chronic degeneration of bone and related to aging. While secondary arthritis usually affects the joint earlier due to obesity, diabetes, heavy works. According to World Health Organization 9.6 % of men and 18% of women aged over 60 years has symptomatic osteoarthritis worldwide, 80 % of those with osteoarthritis have limitations in movement and 25 % cannot be perform their major daily activities for life. In Ayurveda it is correlated with sandhigat vata. It is types of vata vyadhi. Excessive intake of ruksha aahar, vegavadharan, ativyayam, excessive walking etc are the causative factor for the vata roga. Vatapurna drutisparsha, sandhishoola, sandhi sotha and difficulty in movements of joints are the symptoms of sandhigat vata lakshana. [2]   Treatment for sandhigat vat is snehan, swedan, lepa and upanaha. The main aim of this treatment is to pacify the vata dosha. Snehana with swedana over the affected part is also advised in the treatment of vatavyadhi which alleviates pain, stiffness and improves flexibility. [3] 

Case report

A 65-year-old male patient came to my OPD at Khamgaon, with the complaints of severe pain and swelling in both knee joint and difficulty in walking in the last 2 years. The patient was advised to get knee replacement by orthopaedic surgeon. He was taking allopathic treatment particularly pain killers but did not get significant relief.

Family history: Not significant.

Past history: No relevant past history

Examination

On examination of patient extension and flexion movement of both knee are restricted, audible crepitus heard in both knee joint, severe pain and swelling in both knee joint. On X ray of the both knee joint revealed reduction of joint space and osteophytes are developed in both knee joint. Blood pressure Was 130/90 mm of hg, pulse –74. Patient was advised to CBC and ESR which was normal. Because of the clinical features and radiological findings, the diagnosis of knee Osteoarthritis was established.

Treatment Protocol:

Janu basti – Janu Basti was done in the morning for consecutive 15 days. The patient was made to lie on the table. A plastic circular ring was kept on both knees joint the gap was filled with wheat flour. The Bala Aswagandhadi oil [4]   which was pre warmed was poured in the plastic Janu yantra on both knee joint. The temperature was maintained uniform throughout the procedure. This process was carried out for 30 minutes. After that local snehana done by the same bala Aswagandhadi oil for 10 min, after that nadi swedan with nirgundi patra was given on both knee joint for 10 min.

Internal medicine -  Patient was advised Tab Muxnee (Ujawal pharma) 500 mg twice a day with warm water for the period of 30 days.

OBSERVATION AND RESULT

For this study following assessment parameters are considered. Vatapurnadritisparsa (joint crepitations),  Shotha (joint swelling), Sandhi shoola (joint pain) and Prasaranakkunchanapravriti savedana (pain during flexion and extension of joint)

Grading of parameter: [5] 

1. Vatapurnadritisparsa (joint crepitations)-

 Grade 0 – No crepitus

 Grade 1 – Palpable crepitus

 Grade 2- Audible crepitus

 Grade 3- Always audible crepitus

1.  Sandhi Shotha (joint swelling) –

  Grade 0 – No swelling

  Grade 1 – Mild swelling

  Grade 2- Moderate swelling

  Grade 3- Severe swelling

1. Sandhi Shoola (joint pain) –

Grade 0 – No pain

Grade 1 – Mild pain

Grade 2- Moderate pain

Grade 3- Severe pain

1. Prasaranakkunchanaana pravriti savedana (pain during flexion and extension of joint

   Grade 0 – No pain

   Grade 1- Pain without winching of face

   Grade 2- Pain with winching of face

   Grade 3- Prevent complete flexion

Table 1: Assessment on before treatment and on 15th   and 30th day

After treatment with Janu basti for 15 days, above mentioned medicines continued for next 15 days.

Discussion

From the above subjective parameter showed that all the symptoms are reduced after one month. Patient got significant relief in all symptoms. Tablet Muxnee is proprietary medicine by Ujwal pharma Akaola. It is specially indicated for joint pain and stiffness. It contains Mahayaograj Guggula, Nirgundi Patra, Rasna, Punarnawa Mula and Ashwagandha. Mahayograj guguula[6] is indicated in vatvyadhi. The main content is guggula which is vatahara[7]. Nirgundi patra is shoolahara, sothshara and vatanashak[8]. Rasna is best vatahara drug. Due to ushna veerya it pacify vata dosha. Punarnava is usna, sothanashak, and vatanashak.[9]   Eranad taila is given for aamapacha and mild laxation. It is madhura vipakai, usna verrya and vatanashak. [10]   It is the best vatahara drug. Janu basti was given to pacify the Vata-dosha, it strengthens the muscles, ligaments, and tendon of knee joints. It also provides nourishment to bilateral knee joints. [11]   Bala ashwagandhadi tail[12]   was used for janu basti. Bala and aswagandha are balya and bruhana in nature and also it pacify the vatadosha[13]. With Snehana and Swedana, Vakra and stambdha body parts can be namayita  (bended softly). Snehana and swedana increases the agni bala and strength of the body and noursh the dhatus. [14] Nirgundi is used for the nadi swedana. Nirgudi leaves possess anti-inflammatory and analgesic activities. The Snigdha and Ushna Gunas of Snehana Swedana are against the Ruksha and Sheeta gunas of Vata.

Conclusion

Knee osteoarthritis is very common condition found in old age. But due to lack of exercise, lifestyle disorders, excessive consumption of spicy food now middle-aged people also suffered from this problem. From the above study it is concluded that janubasti is effective in knee osteoarthritis. Local snehan and swedana also decreases the symptoms of that disease. Delaying of surgical knee replacement by few years by external  Ayurvedic treatments is considered as great relief by the patients. During this study no known side effect was observed thus it indicated non toxicity study of drugs.