According to Ayurveda Sandhigata Vata is one of the Vata Vyadi (related to the Vata Dosha) and it is a Yapya Vyadhi (not easy to predict future outcomes). This disorder is similar to osteoarthritis, with higher incidence in South Asian countries. Sandhigata Vata is a multi-factorial, degenerative joint disorder that is typically associated with the breakdown and eventual loss of the cartilage of one or more joints. Sandhigata Vata is the commonest form of articular disorder. It is a type of Vatavyadhi which mainly occurs in Vriddhavastha (Old age) due to Dhatukshaya (Diminishing of power), which limits everyday activities such as walking, dressing, bathing etc., making patient disabled or handicapped. Before age 45, osteoarthritis occurs more frequently in males. After 55 years of age, it occurs more frequently in females.
X-ray of osteoarthritis of the knee
Sandhigata Vata Samprapthi (Etiopathogenesis of Sandhigata Vata) According to Ayurveda.The three humors mentioned in Ayurvedic classics are Vata, Pitta and Kapha. Any act that is not adjuvant to the Kala (time), Deha (physical body), Bala (strength) and Rithu (season) can bring about any ailment. Sandhigata Vata is essentially a Vata disorder, with the involvement of Pitta and Kapha Doshas. Vata has a Rukshatva (dryness) and Laghutva (lightness) as attributes and the Doshasic vitiation leads to imbalance of the Kapha Dosha depleting the synovial fluid that provides cushion and lubrication to the joints. This depletion leads to Sandhigata Vata where the cartilage in the joints wears away causing friction, causing pain and limited joint mobility. This affects the large weight-bearing joints, like the hips and knees.
Signs and symptoms of osteoarthritis
According to Ayurveda Vata Dosha plays main role in the disease. Shula Pradhana Vedana (pain) is the cardinal feature of the disease associated with Sandhishotha (edema of joints) with Vata Purna Druti Sparsha, lack of movements of the joints or painful movement of the joints. The most common symptom of Sandhigata Vata is pain in the affected joint(s) after repetitive use. Joint pain of Sandhigata Vata is usually worse later in the day. There can be swelling (Shotha), warmth, and creaking of the affected joints. Pain and stiffness of the joints can also occur after long periods of inactivity. In severe Sandhigata Vata, complete loss of the cartilage cushion causes friction between bones, causing pain even while resting or even with limited motion. Symptoms of Sandhigata Vata vary greatly from patient to patient. Some patients can be debilitated. On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays. Symptoms also can be intermittent. It is not unusual for patients with Sandhigata Vata of the finger joints of the hands and knees to have years of pain-free intervals between symptoms.
Sandhigata Vata of the knees is often associated with excess upper body weight, with obesity, or a history of repeated injury and/or joint surgery. People with osteoarthritis of the weight-bearing joints can develop a limp. The limping can worsen as more cartilage degenerates. Sandhigata Vata of the cervical spine or lumbar spine causes pain in the neck or lower back. Bony spurs, called osteophytes (Asthi Vardaka), that form along the arthritic spine can irritate spinal nerves, causing severe pain that can radiate from the spine as well as numbness and tingling of the affected parts of the body. Sandhigata Vata causes the formation of hard, bony enlargements (Asthi Vardana) of the small joints of the fingers.
Management of Sandhigata Vata
Treatment is always worked out in Ayurveda on the basis of underlying cause and clinical manifestations. The following is the treatment plans for Sandhigata Vata according to disease stage;
Snehana: Massaging with medicated oils
Swedana: Hot fomentation with steam of ordinary water or medicated decoction or Potali/Pinda/Nadi sweda Vasti or Virechana Karma
It is a type of purgation which is induced by oral intake or herbal compound preparations. By the process of Virechana, the ama (toxins) is eliminated from the body. Also the bowel is cleansed, which results in proper absorption and assimilation of the medicinal preparations properly.
This is done by administration of herbal enema. It is helpful in chronic cases. KashayaVasthi, AnuvasanaVasthi and MatraVasthi etc are planned according to the Patient’s requirement.
Alepana: apply paste that is applied externally to the affected joint.
Ayurvedic drugs that reduce the vitiated Vata can be used. The main herbs used are Karaskara, Sahachara, Bala, Devdara and Shallaki, among others. The main internal herbal preparations used are in Quath (decoctions), Churna, Vati (Tablets) and Ghritha form.
Diet and Exersises
• Eat a lot of vegetables that have carotenoids like carrot, pumpkins, papaya, horse grams, onions, garlic, ginger, green gram, pomegranate, avocado, and soya. Also, freshly cooked foods, hot soups of lentils, pulse, a moderate quantity of ghee and oils that lubricates the joints should be there in the regular diet.
• Weight reduction.
• Adequate rest.
• Yoga, physiotherapy, meditation, and tai chi a Chinese form of exercises also helps in the disease
• Exposure to too much cold atmosphere and intake of cold drinks and diets.
• Suppressing natural urges.
(Dr Pathirage Kamal Perera [BAMS, MSC, PhD in Pharmacology], specializes in Pharmacology and Immune Medicine. He is a Senior Lecturer at the Department of Ayurveda Pharmacology and Pharmaceutics; Head, Department of Allied Sciences, Institute of Indigenous Medicine, University of Colombo and a Consultant Physician in Ayurveda Teaching Hospital, Borella.)