Role of Laghupanchmooladi bala siddha ksheera paka inManagement of Sandhivata w.s.r. to Knee Osteoarthritis

Introduction

Knee osteoarthritis (OA) is the most common type of arthritis and is a major cause of disability which reduced the quality of life¹ The clinical features of Sandhivata is described in various Ayurvedic ancient text which is characterized by shula (joint pain), shotha (swelling), prasaaranaaakunchanayo pravruttischa vedana (painful joint movement) and Vatapurnadritisparsa (coarse crepitation), resembles with Osteoarthritis^2,3,4. Main causative factors responsible for Sandhigata Vata are Ruksha aahara, Atimaithuna, Ativyayama (excessive exercise/work), Sheeta bhojana (cold food/drinks), Dhatukshaya and Roga Atikarshana^5,6. This condition closely resembles with knee osteoarthritis. Osteoarthritis is the most common form of arthritis. It is strongly associated with ageing, and is a major cause of disability in older people.⁷ According to modern science loss of estrogen during menopause increase the woman risk of getting osteoarthritis.⁸ It is degenerative in nature. It is characterized by progressive disintegration of articular cartilage, formation of new bone in the floor of the cartilage lesions (eburnation) and at the joint margins (osteophytes), and leads to chronic disability at older ages.9 When vata takes its abode in sandhi it leads to a condition called Sandhigata vata is a kastasadhya vyadhi due to its manifestation in the madhayamroga marga (vital structures) and old.

Case report: A 51 year old female patient came to panchakarma OPD of SJG AMC koppal with complaints of sandhishula i.e severe pain and swelling over both knee joint and difficulty in walking since 1 ½ year. On examination of patient revealed sandhishotha around both knee joints, tenderness ++ crepitus in both knee joint.

The present conventional mode of management of O.A. includes NSAIDS and analgesics. which are already proved to be possessing lots of side effects.¹⁰ so the treatment of such disease should be aimed at providing relief to the suffering of patient and to improve the symptoms so that they can live their life with a minimal external support and disabilities.

Materials and Methods

• Intervention: Patient was advised laghu panchamuladi balasiddaksheerapaka 11 for a period of 15days twice daily in morning and night 50ml after food. and a 7 days follow up.

• Materials: laghupanchamula churna and bala churna – 7.5g (laghu panchamula-3.25g and bala-3.25g)Ksheera paka- 60ml Jala – 240ml

• Method of preparation of drug: Add 240 ml of water to the 7.5g of laghupanchamula churna and bala churna and add 60 ml of milk boil up to the ksheeraavasesha then filter and take 50ml of ksheerapaka after food morning and night.

• Interventional schedule:

OBSERVATION AND RESULT

After treatment with laghupanchamuladi bala sidda ksheerapaka pana for 15 days , patient reported good relief in all symptoms.

Discussion

Osteoarthritis is a crippling disease triggered by injury, old age, poor nutrition etc. The entity Sandhigata vata is a disease caused by vata caused by Dhatukshaya and when consider the amsamsa kalpana the ruksha guna of vata is increased. the prominent symptom present here is vedana due to the involvement of vata dosha so best vatahara (pacify vata), shothahara drugs like laghupanchmoola and bala with abhyantara snehana with ksheera paka, which is the main modality of treatment of vatadosha is adopted here. By its ushna veerya and madhura vipaka all laghupanchmoola dravyas act as vatashamaka and the karma like balya and vrishya help in dhatukshaya janya vyadhi like sandhivata. Milk is nothing but the form of sneha only and it also pacifies the rooksha guna of vata and brings back the mrdutva (softness). Bala which is prime ingredient in ksheera paka is vatahara. The dhatus involved in sandhigata vata are asthi and majja since asthi and sandhi are the majjavahasrotomula¹³. And act as balya and rasayan (rejuvenating). As a whole, all aspect of osteoarthritis are covered by this one frame of treatment. Tikta rasa dravya are helpful in strengthen the asthi by improving its kharaguna (hard quality)¹⁴ along with that the snigdha guna of milk helps in asthiposhana.

Conclusion

Knee OA is a common condition. Patient treated and presented as this case study got remarkable relief. Therefore it can be concluded that use of laghupanchamuladi bala sidda ksheerapaka, as antarparimajan chikitsa (classical internal ayurvedic treatment) in the background of accurate diagnosis can cure the patient suffering from knee OA. Being safe devoid of adverse effects ayurvedic management is the only option to avoid painful intervals and repeated NSAIDS use. This study will encourage further research in the field with evidence base methodology.