Published on 10/23/2005

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. It is largely seen in the population and known to be major cause for chronic disability.

The treatment measures in case of Sandhi-Gata-Vata are mainly aimed at Bramhana. Like Abyanga,Janu basti,Basti and internal medication in case of Dhatu Kshyajanya Sandhigata vata. Incase of Avaranajanya Sandhigatavata the procedures like Agnikarma, Raktamokshana and Upnaha Etc. may be used. It is hoped that this compilation will boost the confidence of the Ayurvedic physicians while managing SandhigataVata.

Authors:
Vd.Vivek Kulloli - P.G.scholar Vd.Hemant.D.Toshikhane - Asst. Professor

A Compilation on Sandhigata Vata (Osteo Arthritis)

What is Sandhigata vata?

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.

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 occuipment of site (subjected to Adhishtana).

Hence Gatatva of Vata implies an undesirable movement of Vata and its unwanted occupation of certain sites.

In Ayurveda, Sandhis are mainly classified into two types;

1) Sthira Sandhi

2) Chala Sandhi (Su.Sa.Sh.5/24)

Again they are sub classified into eight types.

1) Kora 5) Tunnasevani

2) Ulookala 6) Vayasa tunda

3) Samudga 7) Mandala

4) Pratara 8) Shankhavarta

(Su.Sa.Sh.5/27)

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 (A.Hr.Su.12/18).

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 (Su.Sa.Sh.4/14-15).

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.

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 (A.Hr.Su. 11/26-28).

NIDANA (Etiology)

? 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

Manasika ? Chinta, Shoka, Krodha, Bhaya

Viharaja ? Atijagarana, Vishamopacara, Ativyavaya, Shrama,

Divasvapna, Vegasandharana, Atyucchabhashana,

Dhatu Kshaya.

Some of the important Nidanas are discussed below-

v 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.

v 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.

v 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.

v 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 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.

v Marmabhighata

The concept of Marmabhighata in the causation of Sandhi-Gata-Vata sounds more rational. Janu-Sandhi is a variety of Vaikalyakara Sandhi-Marma (Su.Sa.Sh.6/7, 12, 13). Marma is a vital point, which comprises of Asthi, Snayu, Sira, Mamsa and Sandhi. Hence any Marma is made up of all these structures, like wise the Janu-Sandhi.

Pain in the joints 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 Ayurvedic 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 Sandhi-Gata-Vata is to be given importance.

SAMPRAPTI (PATHOGENESIS)

From the onset of Dosha Dushya Dushti till the evolution of the Vyadhi there occurs various Vikriti. Samprapti explains such series of pathological stages involved. It tells us about the total pathogenesis of a disease.

Acarya Caraka explained ? due to the intake of Vatakara Ahara Vihara Vata vitiation take place. This vitiated Vata lodges in Rikta Srotas i.e. Srotas in where Shunyata of Snehadi Guna is present. Vata after settling in Rikta Srotas produce disease related to that Srotas (Ca.Sa.Ci.28/18-19).

Acarya Vagbhata frames the Samprapti of Vata Vyadhi like ? Dhatukshaya aggravates Vata and the same is also responsible to produce Riktata of Srotas. Thus the vitiated Vata travels through out the body and settles in the Rikta Srotas and further vitiates the Srotas leading to the manifestation of Vata Vyadhi (A.Hr.Ni.15/5-6).

Here an attempt has been made to explain how this Srotoriktata occurs due to Nidanasevana.

The chief properties of Parthiva Dravya are Guru, Sthula, Sthira, Gandha Guna in excess. These are the properties, which are necessary for Sthairya and Upacaya of the body. Excessive intake of Dravyas having Laghu, Ruksha, Sukshma, Khara properties 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 Mahabuta fills up this Sushirata. So due to Dhatukshaya Akasha Mahabhuta increases in the body producing Sushirata and Laghuta simultaneously Vayu fills it up.

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? Cakrapani says that ?Riktata? means lack of Snehadiguna.

For the purpose of understanding the Samprapti of Sandhi-Gata-Vata can be studied under two heading. They are

1. DhatuKshaya Janya and

2. Avarana Janya Sandhi-Gata-Vata.

1. DhatuKshaya Janya Sandhi-Gata-Vata

In old age Vata Dosha dominates in the body. This will lead to Kapha Abhava. Also Jataragni and Dhatvagni gets 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, Khara, etc. Guna and loss of Kapha in quality and quantity.

As the Shleshma Bhava decreases in the body, the Kapha Bheda i.e. Shleshaka Kapha in the joints also decreases in quality and quantity. Reduction of Kapha in Sandhis makes Sandhi Bandhana Shithilata. Ashrayashrayi Sambandha also leads Asthidhatu Kshaya. Asthi being the main participant of the joint its Kshaya leads Khavaigunya in the joints.

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 take place in the Khavaigunyayukta Janu-Sandhi. This localized Vayu due to its Ruksha, Laghu, Kharadi Guna over power and undo all properties of Sleshaka Kapha producing disease Sandhi-Gata-Vata.

2. Avarana Janya Sandhi-Gata-Vata

In Sthulas usually Sandhi-Gata-Vata occurs in weight bearing joints. In them Medodhatu will be produced in excess due to the Atisnehamsha of Amarasa (Su.Sa.Su. 15/32).

The 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 (Su.Sa.Su. 15/32 ? Dal.). Prakupita Vata due to Margavarana starts to circulate in the body. While traveling it settles in the joint where Khavaigunya is already exists. After Sthanasamshraya it produces the disease Sandhi-Gata-Vata in the same process mentioned in the earlier context.

Thus with the help of Samanya Samprapti of Vata Vyadhi the Samprapti of Janu-Sandhi-Gata-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

Dooshya ? Peshi, Snayu, Asthi, Majja

Srotas ? Mamsavaha, Medovaha, Asthivaha, Majjavaha

Agni ? Jataragni, Asthi-Dhatvagni

Ama ? Jataragni Mandya Janya

Roga Marga ? Madhyama

Udbhavasthana ? Pakvashaya Sancharasthana - Sarvasharira

Adhishtana ? Sandhi Vyaktasthana - Sandhi

FIGURE - 1

SAMPRAPTI IN DHATUKSHAYA JANYA SANDHI-GATA-VATA

Ukta Nidana sevana Vardhakya