To evaluate the efficacy of Kumariharidra Upanaha over knee joint in the management of Janu Sandhigata Vata w.s.r to Osteoarthritis of Knee-An Experimental pilot study

SPARK/2024/3403/63 TITLE : To evaluate the efficacy of Kumariharidra Upanaha over knee joint in the management of Janu Sandhigata Vata w.s.r to Osteoarthritis of Knee-An Experimental pilot study. INTRODUCTION: Sandhigata Vata explained under the heading of Vatavyadhi by Acharya Charaka which afflicts mainly on Janu Sandhi, in an elderly people presenting with Shoola , Shotha in Janu Sandhi with Prasarana Aakuncha Vedana (painful,restricted movements)¹ Degenerative and inflammatory pathology in the knee joint is considered as Osteoarthritis of the knee, commonly presenting with pain, swelling, crepitations and restricted movements. Life style, overweight, sports or other injury, deficiency are some of the causative factor. There is a steady rise in prevalence from age 30 such that by 65, 80% of people have radiographic evidence of OA, though only 25-30% are symptomatic. Due to the increased prevalence of this disorder and the disabilities produced, it has become a major problem and burden over the society, indirectly reducing the working potential which results into dependency. Available treatment options in modern medicine include use of NSAID’s, calcium supplementation and ultimately joint replacement.⁵ In Ayurveda, the Chikitsa sutra of Janu Sandhigata Vata includes Svedana and Snehana². According to Bhavaprakasha, among many formulations mentioned for Upanaha ,Kumari(Aloe vera) and Haridra(Curcuma longa) are specified as both the drugs are having Shothahara³ and Shoolahara⁴ property. Looking into the limitations in the treatment principles of modern medicine, an attempt is made here to see the efficacy of Kumariharidra Upanaha on knee joint as it is cost effective and easily available with easy administration. Objective: To evaluate the effect of Kumariharidra Upanaha over knee in the management of Janu Sandhigata Vata. Materials and methods:- Source of data: 10 patients of Janu Sandhigata Vata fulfilling the inclusion criteria will be randomly selected irrespective of age, sex, religion, etc from the OPD and IPD of Sushrutha Ayurvedic Medical college and Hospital, Bengaluru. SPARK/2024/3403/63 Drug source: Fresh Kumari will be procured from the botanical garden of Sushrutha Ayurvedic Medical college and Hospital, Bengaluru . Haridra Choorna, Saindhava Lavana and Tila Taila will be procured from the Sushrutha Ayurveda Central pharmacy. Diagnostic criteria 1.Pain and Swelling in Knee joint. 2.Crepitations in the knee joint 3.Restricted range of movements of the knee joint Inclusion criteria ● Patients with Janusandhigata Vata/ Osteoarthritis of knee symptoms. ● Female patients above 50 year of age,post menopause ● Male patients above 60 year of age Exclusion criteria ● Subjects suffering from diseases like Amavata (Rheumatoid arthritis), Vatarakta (Gouty arthritis) or any other systemic disorders. ● Secondary Osteoarthritis of Knee. ● Subjects who are under Intra-Articular injection of Corticosteroid. Intervention A paste is prepared by mixing fresh pulp of the Kumari and Haridra Choorna added with pinch of Saindhava Lavana and Tila Taila, will be made into lukewarm by indirectly keeping it over hot water bath. Thick lukewarm paste will be applied over the knee joint and it is covered with Eranda leaves further tied with cora cloth. Upanaha will be applied in the morning 8am and will ask the patient to keep it till evening 6 pm. Total duration of the treatment 7 days. Assessment criteria : The following criteria will be assessed before (0th day) and after the treatment (08th Day). WOMAC OA index SPARK/2024/3403/63 The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Name _____________________________ Date of Birth ______________ Today’sDate______________ Height ______ ft. ______ in. Weight________lbs. Instructions: Please rate the activities in each category according to the following scale of difficulty: 0 = None, 1 = Slight, 2 = Moderate, 3 = Very, 4 = Extremely Circle one number for each activity Pain 1. Walking 0 1 2 3 4 2. Stair Climbing 0 1 2 3 4 3. Nocturnal 0 1 2 3 4 4. Rest 0 1 2 3 4 5. Weight bearing 0 1 2 3 4 Stiffness 1. Morning stiffness 0 1 2 3 4 2. Stiffness occurring later in the day 0 1 2 3 4 Physical Function 1. Descending stairs 0 1 2 3 4 2. Ascending stairs 0 1 2 3 4 3. Rising from sitting 0 1 2 3 4 4. Standing 0 1 2 3 4 5. Bending to floor 0 1 2 3 4 6. Walking on flat surface 0 1 2 3 4 7. Getting in / out of car 0 1 2 3 4 8. Going shopping 0 1 2 3 4 9. Putting on socks 0 1 2 3 4 10. Lying in bed 0 1 2 3 4 11. Taking off socks 0 1 2 3 4 12. Rising from bed 0 1 2 3 4 13. Getting in/out of bath 0 1 2 3 4 14. Sitting 0 1 2 3 4 15. Getting on/off toilet 0 1 2 3 4 16. Heavy domestic duties 0 1 2 3 4 17. Light domestic duties 0 1 2 3 4 Total Score: ______ / 96 = _______% The final score is expressed in percentage and calculated by dividing an individual’s score by total score and multiplying that by 100 SPARK/2024/3403/63 Implications: Kumariharidra Upanaha on knee joint is cost effective and easy administrating therapeutic protocol. .An alternate to knee support and can prevent the further damage over the knee joint so which indirectly helps to enhance the quality of life. References 1.Agnivesha,Charaka samhita,Ayurveda deepika commentary by chakrapani,chikitsa sthana,chapter 28,verse 37,chaukambha orientalia,Varanasi,reprint edition ,2019 ,pg no.618. 2.Sushruta,Sushruta samhita,Nibandha sangraha commentary by dalhana,chikitsa sthana,chapter 4,verse 8,chaukambha orientalia,Varanasi,reprint edition ,2019 ,pg no.420. 3.Bhavamishra,Bhavaprakasha nigantu,Commentary by Dr.K.C.Chunekar,Edited by Dr.G.S.Pandey,Haritakyaadi varga,verse 196-197,chaukambha bharati academy,Varanasi,reprint edition,2006,pg no.114. 4.Bhavamishra,Bhavaprakasha nigantu,Commentary by Dr.K.C.Chunekar,Edited by Dr.G.S.Pandey,Guduchyaadi varga,verse 229-230,chaukambha bharati academy,Varanasi,reprint edition,2006,pg no.419. 5.Harrison’s et.al,Harrison’s Principles of Internal Medicine,A Blackiston publication,6 𝑡ℎ edition,pg no.1949.