Journal of Natural & Ayurvedic Medicine

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Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata

(Osteoarthritis of Knee Joint) - A Single Case Study

Reshma A*, Bharti M, Sanjay G and Parul S

Review Article
Department of Panchkarma, Uttarakhand Ayurved University, India
Volume 5 Issue 4
Received Date: September 30, 2021
*Corresponding author: Arse Reshma, PG Scholar, Department of Panchkarma, Rishikul
Published Date: October 28, 2021
Campus, Uttarakhand Ayurved University, Uttarakhand, India, Email: reshmaarse0473@
DOI: 10.23880/jonam-16000329
gmail.com

Abstract

Sandhigata vata (osteoarthritis) is a common degenerative joint disorder particularly seen in elderly population. It is one
of the most common Musculo -skeletal problem in the word. It is age related as well as life style disorder. Knee, hip and
shoulder are major large joints usually affected by osteoarthritis. Joint pain is very much prevalent among elderly people. Janu
sandhigata vata is a type of Vata vyadhi described in Ayurveda text which nearly corresponds to osteoarthritis. This case deals
with a diagnosed case of osteoarthritis of the bilateral knee joint in a 55 years old female. Patient had been suffering from pain
in bilateral knee joint since 2 years. Patient experience difficulty in walking with pain and crackling sound over the knee joint.
She had been under allopathic conservative treatment for her complaints but symptoms aggravated rapidly since 6 months so
for further management, she comes to outpatient Rishikul Panchkarma OPD where two therapy sessions (each session 7days)
with 7 days gap in between two session. In this therapy bilateral Janubasti with Sahcharadi taila along with Dashmoola kwath
nadi swedana was performed. After 2 sittings she got significant relief in bilateral knee joint pain in this case study assessment
was done based on subjective parameters after each session.

Keywords: Janu Sandhigata Vata; Janu Basti; Sahcharadi Taila; Osteoarthritis; Sandhi Gata Kupita Vata

Introduction problem in the particularly seen in elderly. Knee and hip

joint is major large joint usually affected by osteoarthritis
About 15% of people in India suffer from arthritis. The based on the similarity in symptoms osteoarthritis can be
incidence of arthritis has increased despite the increase correlated with Sandhigata vata mentioned in Vatavyadhi
in life expectancy produced by improved sanitations and prakrana in all our Ayurveda text.
nutrition [1]. Osteoarthritis is amongst the commonest
rheumatological problem and its prevalence is 22% to 39% Sandhigata vata is as one of eighty type of Vata
in India [2]. Osteoarthritis is a chronic degenerative disorder vyadhi. Foremost description of Sandhigata vata is given
which mainly affects large joints like hip knee, spine, in CharkaSamhita. Vatapurandratisparsa (crepitation),
shoulders etc. Is more common in women than man. This Shotha (swelling) and Prasarnaakunchana pravarti savedna
disease mostly affect the age of 40 years. Almost all parsons (pain during flexion and extension of knee joint) are the
by age 40 have some pathological change in weight burring clinical features of Sandhigata vata. Vitiated Vata dosha
joints. Sandhigata vata (osteoarthritis) is an age related and Sthanshanshaya in Janu sandhi (knee joint) result in the
life style related common degenerative Musculo-skeletal developed of a diseases termed as Janusandhigata vata [3].

Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata (Osteoarthritis of Knee Joint) - A Single Nat Ayurvedic Med
Case Study
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This condition closely similar with knee osteoarthritis. In of Panchkaram, Rishikul campus. She has history of,
sandhigata vata chikitsa mainly focused on the allevation hypertension since 5 years (on medication). There was
of vata dosha. In vatavyadhi chikitsa Acharya charka has neither history of diabetic, thyroid trauma nor other medical
described Vatashamak chikitsa with the use of Vatashamk or surgical illness as well as no history of long use of steroids
oil [4]. Use of Snehana with Swedana karma over the etc. for confirmative diagnosis she has advised to x-ray
affected part which reliving pain, swelling, stiffness and bilateral knee joint. His x-ray of bilateral knee joint reports
improve flexibility. Janu Basti the word has two terms Janu marginal osteophytes, narrow joint space and degenerative
means knee joint, Basti means to hold (compartment which changes. He was diagnosed with osteoarthritis of bilateral
holds) thus Janu basti means treatment in which medicated knee joint.
oil is poured and pooled for fixed duration of time in a
compartment or a cabin constructed around the knee joint. Patient has typical limping gait .on examination of
it is a specialized procedure in Ayurveda , specially indicated bilateral knee joint skin over the knee joint normal, mild
for Janu sandhigata vata. There is no direct reference and swelling visible over left knee joint which is confirm by
discretion of Janu basti in classical Ayurveda text. It is like a positive patellar tap test, joint crepitation is palpable on joint
supportive Ayurvedic treatment. Janu basti is considered as movement associated with pain. Joint tenderness present
Bhahirparimarjana chikita and it is types of Bahaya snehana over the medial side of bilateral knee joint.
and Swedana (external oil application and sudation) in
different opinion Janu basti is considered as Snigdha sweda. During Dashavidha Aatur parikshaya examination
Different type of medicated oils is used in janu basti according patient was observed as, Prakruti-kapha-vata; Vikruti-vata
to the disease. Sahcharadi taila is Ayurvedic formulation has predominant; Sara-Maas sara in pravara; Samhananna-
been taken for the present case study [5]. madhyam; Pramana-madhyama; Satmya-madhyama;
Satva-madhyama; Ahara Shakti-madhyama; Vyayam shakti-
Case Study Avara; Vaya-madhyam[6] Samprapti ghataka-Nidana-Vata
prakopaka nidan Dosha-Vata special vyanavayu shleshmak
A female patient of 55 years old having complaint of kapha; Dusya -Asthi, Majja, Meda Srotas-Asthivaha,
difficulty in walking with severe pain and crepitus palpable Majjavaha Medovaha Agni-Vishmagni, Dhatwagni Manda,
over the bilateral knee joint, which worsens with movement Rogamarga- Madhyama; Dosha marga-Marmasthinsandhi
and reliving by rest since last 6 months. Patient has been sadhyasadhyata-yapya/asadhya. After clinical and
suffering from same complaint (mild to moderate intensity) dashvidhaparikshya bhava examination patients is advised to
since 2 years. She has given conservative treatment from take Janu basti with Sahcharadi taila followed by Dashmool
allopathic hospital for same. Lastly her symptom aggravated kwath nadi swedana.
since 6 months hampering day to day activity. So for
further management she comes to outpatient department

Some x-ray Images Bilateral Knee Joint (Figure 1)

Figure 1: X-Ray Images of Knee.

Reshma A, et al. Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata (Osteoarthritis of Knee Copyright© Reshma A, et al.
Joint) - A Single Case Study. Nat Ayurvedic Med 2021, 5(4): 000329.
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Journal of Natural & Ayurvedic Medicine

Materials and Methods will be done in bilateral knee joints. After this, Nadi swedana
(10-15 min) will be done with Dashmoola kwtha over the
Present case study the following material is required for both knee joints. In this case study two therapy session was
each therapy session (Table 1). given to the patient each therapy session of 7 days with 7
days of interval in between each therapy and assessment s
Required Material Quantity was done before therapy session and end of therapy session.
Mash flour 2kg
Subjective Assessment criteria (Tables 2,3)
Sahcharadi taila 1lit.
Small piece of sponge 1 Sandhi
Sandhi shoola/Pain
Patila 1 Crepitus Shotha/
on Walking
Swelling
Dashmool kwath 2lit.
Swelling
Nadi Swedana yanta 1 No pain -0 No crepitus -0
absent-0
Water According to requirement
Palpable
Pain on exertion -1
Table 1: Session for Required Material. crepitus -1
Moderate intermittent Audible
Procedure of Janu basti pain on walking -2 crepitus -2 Swelling
Firstly, Masha pisti (paste of masha powder) is prepared Constant pain on present -1
walking- 3 Always
with sufficient amount of water. Than patient is asked to lie
audible
down in supine position with fully extension of knee Joint. Severe pain unable to crepitus -3
Knee joint is properly exposed and gently abhyanga is done walking-4
over the lower limbs. After this using the thick gram powder
Table 2: Assessment of walking and swelling.
dough make a circular boundary wall with height of 4 Angula
(approx.4inch) fix it firmly on the bilateral knee joints were
the highest pain is present. Precaution should be taken for Tenderness Gait
any oil leakage from basti yantra. Sahcharadi taila heated on No tenderness -0 Free swinging no limp -0
warm water bowl because medicated oil not heat directly.
Patient complain pain on Limping gait with no ad-
Sahachradi taila is poured in the basti yantra up to the level
touch-1 ditional support -1
of 2 Angula by using small piece of sponge. The temperature
of oil to be maintained according to patient tolerance power. Patient withdraws joint on Limping gait with unilateral
When oil becomes cool, remove it with cotton &again refill touch -2 support -2
with warm oil. Uniform temperature should be maintained Patient doesn’t allow touch- Limping gait with bilateral
throughout the procedure. This procedure is carried out ing the joint -3 support -3
for 30 minutes than oil is drained out from basti yantra and
Table 3: Tenderness/Gait.
boundary wall removed. After this gently circular massage

Observation and Results (Table 4)

S.no. Sub. Parameters Before Treatment After 1st Session After 2nd session
Rt. knee Lt. knee Rt. Knee Lt. knee Rt. knee Lt. knee
1 Sandhi shool /pain
2 3 2 2 0 1
2 Crepitus 1 1 1 1 1 1
3 Swelling 0 1 0 0 0 0
4 Tenderness 1 1 0 1 0 0
5 Gait 1 1 1 1 0 1
Table 4: Parameters session.

All studied subjective parameters showed significant reduced whether tenderness was relieved completely.
difference after 14days of treatment. Pain was significantly Walking performance of the patient was significant

Reshma A, et al. Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata (Osteoarthritis of Knee Copyright© Reshma A, et al.
Joint) - A Single Case Study. Nat Ayurvedic Med 2021, 5(4): 000329.
 4
Journal of Natural & Ayurvedic Medicine

improvement. Swelling was significantly reduced in left knee Asthiposhak- Asthiposhak is a calcium supplement it is
joint. Crepitus and x-ray findings which are non-significant a good source of natural calcium. Calcium supplementation
difference which may be due to short duration of the study. can play a valuable role in bone healthy throughout the
life style it is work as an anti-inflammatory. Asthiposhak
In this case study not given any orally medicine in between contain kukkutandatvak bhasma, Asthisankhrala, Arjuna,
two therapy session. After two therapy session some Shuddhalaksha, Amlaki, Aswagandha, Gudduchi, Shudha
ayurvedic medicine prescribes to her patient (Table 5). guggul, Bala, Babboola kwath.

S. No. Treatment Dose Shallaki possesses tikta, Madhura, and Kashaya rasa;
guna of shallaki is ruksha ,laghu and tikshna ; vipaka is
1 Tab. Asthiposhak 1OD with milk after meal katu; virya is ushna; doshkarma kapha pitta shamaka. It is
2 Cup Shallaki 400mg 1 BD after meal an herbal analgesic and anti-inflammatory and painkiller it
Panchtikta ghrita 1 BD after meal with also prevent loss of cartilage main contain Boswellia serrata
3 extract [8]. Panchtikta ghrita guggul is a complex compound
guggul lukewarm water
containing many herbs and guggul. Classical reference and
Janubasti with Janubasti with Sahcharadi clinical suggested. It is highly beneficial in the management
4
nadi swedana taila Dashmool nadi Swedana of sandhivata [9].
Table 5: 15 days after completion of procedure.
In this case study patient initially has severe joint
Discussion pain with swelling over the joint .after two session of Janu
basti this symptom is significant relieved? Palpable joint
Osteoarthritis is types of chronic degenerative joint crepitus also reduced after janu basti. Pain and tenderness
disorder which is characterized by breakdown of joint is very extensive feature of Janu santhi gata vata. After two
cartilage and underlying bone. The most commonly affected session of Janu basti this symptoms is significant alleviated.
is the weight barring and largest joints of the body like hip Nadi swedana is one among the thirteen types of Swedana
joint, knee joints, shoulder joint, etc. the most common indicated in the treatment of Vata vyadhi [7]. In this case
symptoms are joint pain and stiffness usually the symptoms study swelling and tenderness over the bilateral knee joint
progress slowly over years. This patient present case study, is completely relieved after Janu basti followed by Nadi
patient initially has severe joint pain with swelling and swedana with Dashmoola kwtha. It may be due to the effect of
palpable crepitus. Diagnosed case of knee osteoarthritis Dashmoola because herbs included in Dashmoola Shothahara
bilateral knee joint. These clinical symptoms are closely property [10].
related to janu sandhi gata vata.
Conclusion
Sandhigata vata is a described as a Vatavyadhi in all
Samhita & Sangrahagrantha. Various Aharaja, Viharaja, Janu sandhi gata vata (knee osteoarthritis) is a
Mansika Sharirik Nidan are mentioned in Vatavyadi prakrana. debilitating affecting day to day activities. It is very prevalent
Sandhi gata vata specially occurs in Vriddha avastha in which musculoskeletal diseases in elderly people. It is chiefly
Dhatukshaya take place which leads to Vata prakopa. In caused by vitiated Vata dosha. This case study concludes that
between Vata and Asthi Ashraya Ashrayi Sambandha. That Sahchradi taila janu basti followed by Dashmool kwath Nadi
means Vata is situated in Asthi. Vitiated Vata destroy Sneha swedana. The treatment should be cost effective, comfortable
karam because Vata guna is just apposite to Snehana gunas. for the patient and nil or minimal side effect. The present
Due to diminished Sneha kha-vaigunya occurs in asthi which case study sets an example in management of osteoarthritis
is responsible for the cause of sandhigata vata in weight of knee joint. It can improve quality of life of the patient.
barring joints especially in knee joints.
References
The word of Janu bati is formed by combination of two
letters janu and basti this procedure unique in the sense 1. Satyalakshmi K (2017) clinical naturopathy-yoga a
comparing both Snehana and Swedana or it may be put manual for physician and students. 1st (Edn.), national
this Snehyukta Swedna or Snighdha sweda. Snehana mainly institute of naturopathy pune, Chapter-34, pp: 385.
act against Ruksha guna caused by vata and swedna mainly
act against Sheeta guna. In Sandhigata vata mainly vitiated 2. Pal CP, Singh P, Chaturvedi S, Pruthi KK (2016)
Vatadosha Ruksha guna. So For this we can use sahcharadi Epidemiology of knee joint osteoarthritis in India and
taila having Vata shamak and Vedanaasthapan properties. related factor. Indian J Orthop 50(5): 518-522.

3. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala

Reshma A, et al. Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata (Osteoarthritis of Knee Copyright© Reshma A, et al.
Joint) - A Single Case Study. Nat Ayurvedic Med 2021, 5(4): 000329.
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Journal of Natural & Ayurvedic Medicine

charaka Samhita-vidyotani hindi commentary, part-2 charaka Samhita-vidyotani hindi commentary, part -2
chuakambha Bharati academy Varanasi, chapter chikitsa chuakambha Bharati academy Varanasi, chapter chikitsa
sthana 28/37, pp: 783. sthana 28/78, pp: 791.

4. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala 8. Dev SA (2006) A Selection of prime Ayurveda plant
charaka Samhita-vidyotani hindi commentary, part -2 drugs: ancientmodern concordance. New Delhi:
chuakambha Bharati academy Varanasi, chapter chikitsa Anamaya Publishers, pp: 113117.
sthana 28/75, pp: 791.
9. Akhtar B, Mahto RR, Dave AR, Shukla VD (2010) Clinical
5. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala study on sandhigata vata w.s.r. to Osteoarthritis and its
charaka Samhita-vidyotani hindi commentary, part-2 management by Panchtikta Ghrita Guggulu. Ayu 31(1):
chuakambha Bharati academy Varanasi, chapter chikitsa 53-57.
sthana 28/144, pp: 802.
10. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala
6. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala charaka Samhita- vidyotani hindi commentary, part-
charaka Samhita-vidyotani hindi commentary, part-1 1chuakambha Bharati academy Varanasi 2015, chapter
chuakambha Bharati academy Varanasi, chapter Viman sutra sthana shadvirechanashatashriteeya adhyaya
sthana 8/94, pp: 771. 4/38, pp: 91.

7. Shastri K, Chaturvedi PG (2015) Agnivesha, dridabala

Reshma A, et al. Role of Janu Basti and Nadi-Swedana in Janu Sandhigata Vata (Osteoarthritis of Knee Copyright© Reshma A, et al.
Joint) - A Single Case Study. Nat Ayurvedic Med 2021, 5(4): 000329.