Management of Osteoarthritis of Knee joint with Matra basti,Janu basti and Internal medicine

Introduction

With the present day’s fast life people don’t have time to eat properly sleep properly and rest properly. Osteoarthritis due to degeneration is very common nowadays. Generally it is observed after fifth decade of life. But nowadays, it is observed in third and fourth decade also. It is caused due to various factors like degeneration, mechanical, trauma, neurological deficit, metabolic, functional disability. Knee OA is a joint disease involving complex interactions between biomechanical, structural and biological pathways at an in vivo systems level¹ .

The description about it is not available as a separate disease entity in any Ayurvedic text. It is mentioned as one of the Vatavyadhi in Charaka Samhita Eighty Nanatmaja Vatavyadhi² mentioned by Charaka. Aim of Ayurveda is to increase immunity and restore tridosha samyata for this purpose treatment of Ayurveda for vatavyadhi is mentioned in samhita granthas. In modern medicine the disease is managed by non-steroidal anti-inflammatory drugs, analgesic drugs; physiotherapy and corticosteroids but these drug have so many side effects.³ So, Ayurvedic approach is natural way to cure Osteoarthritis of Knee Joint by said Matrabasti, Janubasti and internal Ayurvedic medicine without any side effect can give promising results.

Material and Method

Place of Study - Govt. Ayurvedic College & Hospital, Balangir – 767001, Odisha, India

Case Report: A female patient aged 44 years came to the Outdoor of Panchakarma Department of Govt. Ayurvedic College, Balangir. Patient presenting with Janusandhi Ruk (pain in Knee joint), Janusandhi Stambha (Knee joint Stiffness) tingling sensation in both lower limb, kashtayukta Chankramana (unable to walk) and Kashtayukta Utkatasana (unable to seat). Patient was suffering from same complaint since one year. But from 15 days patient increase the severity of symptoms.

2.1 On Examination

1. General condition of patient: Moderate. 2. Pulse rate: 74/min 3. B.P. - 120/80 mm of Hg 4. Pallor - Absent 5. Weight- 63kg, Height- 160cm. RS - AE=BE clear CVS – S1 S2 normal. No abnormal sound, CNS – well conscious oriented 7. P/A: Soft, non-tender; Liver, Kidney, Spleen-not palpable

Ashtavidhapariksha:¹ . Nadi – Vata pradhana pitta ². Mala – malavshtambha (occasional)³ . Mutra – samyakpravritti⁴ . Jivha – sama⁵ . Shabda – spashta⁶ . Sparsha – ushna⁷ . Druk –panduta⁸ . Akriti – Madhyama

Sroto dushti: Asthivaha Strotas: Januruk (pain in Knee joints), Janusandhi Stambha (Knee joint Stiffness) Majja vaha Strotas: Tingling and numbness in both upper and lower limb, difficulty in walking.

2.2 Present Illness

Patient was having above complaints from one year. For the said complaint she attended orthopaedic surgeon for treatment and didn’t get relief. She was advised for surgical treatment. But she doesn’t want to go for surgical treatment. So, the patient came to Govt. Ayurvedic College & Hospital, Balangir for further treatment.

2.3 Past history

No H/O DM/HTN/IHD/PTB/BA/Jaundice/ Typhoid or any other major medical illness.

H/O- Fall 2 yrs back.

2.4 Clinical examination of Knee Joint

Inspection: No abnormality was found in the patient.

No any other major abnormality was seen in Knee examination of the patient.

No any swelling and surgical marks were seen in Knee examination of patient.

Gait: Toe out gait.

2.5 Investigations

Hb% - 10.8 gm%, TLC – 8600 cu/mm, DLC –P – 50, L – 45, E – 01, M – 06, Urine examination – Normal, Random Blood Sugar – 104 mg/dl.

X - Ray of both knee joints with AP and Lateral view

The X-ray of knee joint reveals knee joint space narrowing with osteophyte growth, and the cartilage becoming thin

2.6 Treatment Approach

Sthanika Snehana (Abhyanga) by Ketakyadi taila4 followed with Swedana (nadisweda by Dasha moola Kwatha) (hot fomentation) for 15 days. Janu basti by Ketakyadi Taila for 20min. for 15 days. Matrabasti: Ketakyadi Taila 72 ml total 15 basti were given. Guggulu tiktakam Kashayam 20ml bid for 30 days Cap. Neuron 250 mg bid for 30 days

Discussion

In Janusandigatavata, there is involvement of Vata, Asthi and Sandhi Dushti. Hence, this disease is considered as Madhyama Marga Roga. Samanyachikitsa of vatavyadhi is Abhyanga, swedana, basti.⁵ Snehana and swedana (Ch. Su. 22/11)⁶ acts as vata shamaka, increases blood circulation and relieves pain by local action. It is form of passive exercise. Janubasti acts locally at Knee joint region by both actions local oiling and fomentation. It relieves pain. Cap. Neuron, contains Brihat Vatachintamani Rasa, Dashamoola, trayodashanga Guggulu, Lashuna, eranda, kapikacchu, Bala. It acts as anti-inflammatory, muscle relaxant. It strengthens muscles and relieves pain.The Guggulutiktakam Kashayam having tikta rasa, laghu guna, ushnavirya and katuvipaka, act as kaphavatahara. As it is bitter, work as a nervine tonic too. It relieves pain. Basti is very much effective treatment for vatavyadhi⁷ . It acts on root of vata dosha and gives promising results in relieving pain and functional disability. It helps in absorption in vitamin B12 in gut so it helps to regeneration of tissues and nerve.⁸

Flow chart of Samprapti Vighatana in Janusandhigatavata

4. Probable mode of action of Matra Basti

Basti - Basti is the best treatment for Vata as said by Acharya Charaka “Bastihi Vataharanam”. Basti drug first reaches to the Pakvashaya(large intestine). Pakvashaya is the chief site of Vatadosha. Thus, by its action on the chief site, Basti gets control on Vata all over the body. Pakvashaya is the site of Purishadharakala. Commentator Dalhana has said Purishadhara and Asthidhara kala are one and same.⁹ Basti drugs directly acts on Purishadharakala so we can take its direct action on Asthidharakala also. Sushruta has mentioned 6th Basti nourishes Mamsa Dhatu, 7th Basti nourishes Meda Dhatu, 8th Basti nourishes Asthi Dhatu and 9th Basti nourishes Majja Dhatu.¹⁰ Thus, through Basti, we achieve Vata Dosha Shamana and Snehana of Asthi Dhatu. So we achieve the Shamana of Sandhigatavata by breaking the Samprapti. According to modern medical science, as per Basti /Enema concerned, in Trans rectal route, the rectum has a rich blood and lymph supply and drug can cross the rectal mucosa like other lipid membrane. Thus by entering in general circulation, Basti drugs acts on whole the body. By this treatment, patient shows significant results in straight leg raising test, walking. By this treatment patient is symptomatically improved. The subjective parameters show improvement in the clinical symptoms. This treatment is helpful to prevent the further more complication in Knee joint pathology.

Scope of Future Research: A Larger number of sample size should be included to confirm the results and generalize the results to population. Other parameters like pain, stiffness, difficulty in walking etc. should also be assessed for the patients. Same procedure using other taila should be studied to compare the relative efficacy of different tailas.

Conclusion

In above discussion and result we can say that this therapy is effective in Knee joint pain caused due to degeneration. So, we can give symptomatic relief, reduction in pain and improvement in quality of life to the patient of Knee OA by Ayurveda. With further research, Matra Basti can be established as the preferred line of treatment in Sandhigatavata.