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2014.09.16 
1
OUTLINE 
q Objectives 
q Case presentation 
o Complaints of the patient 
o Clinical Examination 
o D/ D 
o Diagnosis 
o Re...
OBJECTIVES 
¨ To understand the patho-physiology, signs and 
symptoms & treatments of Sandhigataväta 
¨ To review on relat...
CASE SUMMARY 
4 
¨ Mr K. M Silva, 52 Yrs from 
Kuliyapitiya 
¨ having difficulties to move 
Joints notably RT KJ, Both 
El...
CASE PRESENTATION 
q Name : Mr K. M Silva 
q Age : 52 Yrs 
q Address : Udubeddawa, Kuliyapitiya 
q Nationality : Sri Lanka...
MAIN COMPLAINT & DURATION 
6 
1. Difficulty in movements due to Pain, Oedema & Stiffness of 
Right Knee Joint, Both elbow ...
o According to the patient, before 20 yrs; asymptomatic 
o Then he got oedema in both Ankle joints 
o After 1yr, oedema ov...
q Medical History 
Hypertension 0 , Diabetes Mellitus 0 , Hypercholesteremia 0 
q Surgical History 
q Psychiatric History ...
80 yrs 
52 yrs 
IHD 
70 yrs 
20 yrs 12 yrs 
9
o Diet: Break fast - Not taken usually 
Lunch - Not taken usually 
Dinner - Rice, Vegetables, Egg 
Meat (Chicken, Beef, Mu...
o Addiction : Plain tea with sugar 10-15 times/ d 
Alcohol 1/ 2 bottle occasionally 
Cigarette 2-3/ d 
Beatle chewing 3- 4...
12 
o Bowel habits : Once/ Day 
Colour - Yellow 
Odour - Normal 
o Micturition : D- 3 / N -1 times 
Colour - Pale 
Odour -...
GENERAL PHYSICAL EXAMINATION 
o General condition - Weak 
o BP - 130 /80 mmHg 
o PR - 74 / min 
o RR - 14 / min 
o Weight ...
SYSTEMIC EXAMINATION 
LOCO MOTOR SYSTEM 
q Gati (Range of movements): 
• LT & RT knee joints - Abduction 
- Adduction 
- E...
JOINTS 
o Inspection 
§ Swelling 
PIP, DIP, both Elbow Js, RT Ankle, Both KJs (> in RT KJ) & LT Hip 
§ Deformities 
Deviat...
16
Spine 
qThorasic Spine: Internal and external rotation- Normal 
qLumbar Spine: painful (At the time of admission) 
§ Flexi...
SYSTEMIC EXAMINATION CONT 
q CARDIOVASULAR SYSTEM 
• S1, S2 - Clear . No thrills or 
murmurs 
q RESPIRATORY SYSTEM 
• Bila...
1. Nädi: 
i. Gati - 74/ min 
ii. Yati - Samäntara 
iii. Akåti - Pürna 
iv. Samhati - Mådu 
2. Mutra : D - 3/ N -1 times 
3...
I. Prakåti : Väta Kapha / Rajas Tamas 
II. Vikåti 
o Hetu (Nidäna) – Viprakåñöa Nidäna 
Ähara : Viñamäçana, Anäçana, Alpäç...
21 
III. Sära : Rasa, Rakta, Mämsa, Medas, Asthi & Majjä 
Madhya Sära 
IV. Samhanana : Madhya Samhata 
V. Pramäna : Madhya...
1. Präëa vahä Srotas 
2. Udaka vahä Srotas 
3. Çukra vahä Srotas 
4. Mutra vahä Srotas 
5. Puriña vahä Srotas 
6. Sweda va...
Ähara 
Viñamäçana, Anäçana 
Alpäçana, Katu, Kañäya 
Rasa,Tékñëa, Snigdha, 
Guru guëa Atisewana 
Viharana 
Çéta jala sewana...
q Doña : Väta Vitiated, Kapha Dicreased 
q Düñya : Rasa, Rakta, Mämsa, Medas, Asthi, Majjä 
q Adiñtäna : Çärérika 
q Srota...
q FBS - 99 mg/dl (2014.07.23) 
q UFR 
Reaction - Acidic 
Pus cells 
Epithelial cells 
Occasional 
q Lipid profile- 149 mg/...
26 
1. Ämaväta Sandhi Çotha 
2. Gambhira Väta Rakta 
3. Asthi Majjä Gata Väta 
4. Kroñöuka Çérña 
5. Sandhi gata Väta
Ma. Ni. 25/ 6 
¨ Body ache 
¨ Anorexia 
¨ Thirst 
¨ Malaise 
¨ A feeling of heaviness 
¨ Fever 
¨ Indigestion 
¨ Swelling ...
28 
Ca Ci 29/ 21- 
23
29 
¨ Swelling 
¨ Rigidity 
¨ Hardness 
¨ Agonizing pain inside the joints 
¨ Dusky red / coppery coloration 
¨ Burning 
¨...
30 
Su Ni 1/ 76 
Ma. Ni 22/ 58 
q Väta & Rakta getting affected together produces; 
q A very painful swelling of the knee ...
31 
Ca Ci 28/ 32 
q Splitting pain in the bone & joints 
q Loss of strength of the musle 
q Loss of sleep 
q Constant pain...
Ca Ci 28/ 37 
Su Ni 1/ 27-2, 
Yo .Ra V.V/ 1 
As Hri Ni 
15/14 
Ma. Ni 22/ 21 
32
RÜPA - 
Ca.Sa Su. Sa As Hri As Sa Ma.Ni Yo Ra Bha Pr 
Sandhi Çüla (Joint 
pain) 
+ + + + + + + 
Sandhi çopha/çotha 
(Joint...
ÄMAVÄTA SANDHI GATA 
VÄTA 
GAMBHIRA VÄTA 
RAKTA 
Nidäna Viruddha Ähara, 
Snigda Ähara, Alpa 
chesta etc. 
Väta kopakara 
Ä...
35 
ASTHI MAJJÄ GATA 
VÄTA 
SANDHI GATA VÄTA 
Nidäna Väta kopakara Ähara, 
Viharaëa 
Väta kopakara Ähara, 
Viharaëa 
Doña ...
DIAGNOSIS 
¨ Sandhi Gata väta 
36
CIKITSÄ 
37 
k…yaRÖate ivc][> 
Su Ci 4 /8 
As Hri Ci 
21/ 22 
C.D 22/ 9
CIKITSÄ CONT. 
38 
Treatment Su. Ci As Hri As Sa Bha Pr Bha Ra Yo Ra C.D 
Snehana + + + + + + 
Abhyanga + 
Mardana + + + +...
CIKITSÄ CONT-VÄTA VYÄDHI CIKITSÄ 
A_y¼ < Svedn< biStnRSy< õehivrecnm! 
iõGxaMllv[< SvaÊ v&:ym! vatamyaphm!. 
39 
o Abhyaìg...
CIKITSÄ CONT. 
¨ Bahih parimärjana 
- Sneha (Abhyanga) 
- Sweda 
¨ Anthah parimärjana 
- Mådu çodhana 
¨ Paìcha karma 
-Vi...
From 11.07.2014 to 12.08.2014 
¨ Räsna 7 Decoction, Pata ½ bd 
¨ Triphaläkwatha 30 ml bd 
¨ Chandraprabhä vati 2 bd 
¨ Yog...
42 
From 25.08.2014 - 01.09.2014 
¨ Räsna 7 Decoction, Pata ½ bd 
From 01.09.2014 to 16.09.2014 
¨ Gändarva hästadi Decoct...
¨ Eranda saptaka Decoction+ Rasona, Methi, Abhaya Pata ½ bd 
¨ Daça mula Balairaëda Decoction, Pata ½ bd 
¨ Dantimulädi De...
44 
¨ Nika kola pottali Pinda sweda (pottali) 
¨ Punnagädi pottali 
¨ Picu Däraëa 
¨ Jänu Vasti 
q Anuvasana Vasti- Eraëda...
Pathya Ähära 
¨ Steamed red rice 
¨ Patola 
¨ Murunga 
¨ Kohila 
¨ Wetakolu 
¨ Fish 
Pathya Viharaëa 
¨ Uñëa jala Sevana 
...
46
Disease Cikitsa 47 
• Ca. Ci 28/37 
• Su. Ni 1/27 
• As. Hri .Ni 15/14 
• As.Sa Ni 15/ 16 
• Bha.Pr. Ma. Kha 24/ 258 
• Ma...
48 
¨ Nidäna 
¨ Pürwa rüpa 
¨ Sampräpti 
¨ Sädhya Asädhya Bhäva 
¨ Rüpa 
¨ Cikitsä 
Not mentioned 
Separately 
Only mentio...
NIDANA 
49 
Ca. C 28/15-18
NIDÄNA 
Ähära 
Due to rough, cold, little & light food 
Viharaëa 
¨ Excessive movement such as leaping,jumping Wayfaring &...
NIDANACONT. 
Mänasika 
¨ Anger 
¨ Anxiety 
¨ Grief 
Faulty therapeutic management 
¨ Excessive elimination of impurity & b...
SAMPRÄPTI 
Aggravated vayu Filling up 
vacant channels of the body 
Make disorders in 
Entire body One part of the 
body 
...
53 
OSTEOARTHRITIS
Introduction 
¨ Osteoarthritis (OA) is a disease of synovial joints 
that can result from cartilage degeneration 
¨ Most c...
Joints- most commonly involved 
55 
o Hand - DIP Joint 
- First CMC Joint 
o Foot - First MTP joint 
o Weight bearing join...
Classification of Osteoarthritis 
2 types 
1. Primary osteoarthritis 
2. Secondary osteoarthritis 
Primary osteoarthritis ...
Types of Osteoarthritis Cont. 
2. Secondary osteoarthritis 
Form of osteoarthritis that is caused by another disease 
or c...
Risk Factors 
58 
¨ Age - > 45 yrs 
¨ Gender- > female 
¨ Obesity 
¨ A fracture through a joint 
¨ Congenital joint dyspla...
Clinical features 
q Joint pain- made worse by exercise, relieved by rest 
q Stiffness after rest- last in <30 min 
q Swel...
Nodal osteoarthritis 
Bony enlargement of 
o Distal interphalangeal joint- Heberden's nodes 
o Proximal interphalangeal jo...
Pathophysiology 
¨ Inital event : mitosis of chondrocyte 
¨ Second event: Increased synthesis of bone by 
osteoblasts in t...
Pathophysiology Cont 
62 
¨ OA affects all of the weight-bearing 
components of the 
joint: 
• Articular cartilage 
• Meni...
Pathophysiology Cont 
Osteoarthritis may result from wear and tear on 
the joint 
•The normal 
cartilage lining 
is gradua...
Pathophysiology Cont 
•The repair mechanisms of tissue absorption and 
synthesis get out of balance and result in 
osteoph...
D/D 
Criteria OA RA Gout 
1.Symptoms Pain & swelling on 
major weight bearing 
joints, stiffness, 
crepitations, 
tenderne...
Diagnosis 
Based on, 
Ø Signs and symptoms 
Ø Laboaratory studies: 
• ESR - Normal 
• Full Blood count - Normal 
• Rh Fact...
Radiographic Diagnosis 
•Narrowing of 
the joint space 
•Periarticular 
sclerosis 
•Osteophytes 
•Sub-chrondral 
bone cyst...
Radiographic Diagnosis cont 
• Asymmetrical joint space narrowing from loss of articular 
cartilage 
• The medial (inside)...
Long-Term Complications 
¨ Does not affect the body's organs 
¨ Lead to deformities 
¨ Severe loss of cartilage in the kne...
70 
Bow-legged appearance
Bony spurs 
71
Disease Management 
q OA is a condition which progresses slowly over a period 
of many years and cannot be cured 
q Treatm...
OA – Non-operative Treatments 
•Pain medications 
•Physical therapy 
•Walking aids 
•Shock absorption 
•Re-alignment throu...
74
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Clinical presentation on Osteoarthritis (Sandhi Gata Vata)

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PPT created by Dr R.L.D.S Ranasinghe, Post Graduate Scholar, University Of Colombo, Sri Lanka.

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Clinical presentation on Osteoarthritis (Sandhi Gata Vata)

  1. 1. 2014.09.16 1
  2. 2. OUTLINE q Objectives q Case presentation o Complaints of the patient o Clinical Examination o D/ D o Diagnosis o Review of Ayurveda q Review of Modern 2
  3. 3. OBJECTIVES ¨ To understand the patho-physiology, signs and symptoms & treatments of Sandhigataväta ¨ To review on related Modern Aspects ¨ To improve diagnosis skills ¨ To improve the presentation skills 3
  4. 4. CASE SUMMARY 4 ¨ Mr K. M Silva, 52 Yrs from Kuliyapitiya ¨ having difficulties to move Joints notably RT KJ, Both Elbow Js, LT Hip & joints of both Hands due to oedema, Pain & Deformities ¨ for 20 yrs ¨ has not taken regular treatment before ¨ admitted to ward no 9 on 11th July 2014
  5. 5. CASE PRESENTATION q Name : Mr K. M Silva q Age : 52 Yrs q Address : Udubeddawa, Kuliyapitiya q Nationality : Sri Lankan q Religion : Buddhist q Marital Status : Married q Date of Admission : 11th July 2014 (Ward 09) qWard No : 11 q Bed No : 22 q Occupation : Mechanic for 16 yrs, Concrete worker for 5 yrs 5
  6. 6. MAIN COMPLAINT & DURATION 6 1. Difficulty in movements due to Pain, Oedema & Stiffness of Right Knee Joint, Both elbow joints & both hands (PIP, DIP) - 20 yrs 2. Deviation of RT KJ- 3 yrs 3. Pain in Left Hip Joint- 1 month OTHER COMPLAINTS & DURATION No other complians
  7. 7. o According to the patient, before 20 yrs; asymptomatic o Then he got oedema in both Ankle joints o After 1yr, oedema over little finger of the RT hand (PIP& DIP) & RT wrist joint o 1 yr later Oedema occurred in both Knee Joints o Deviation of the RT Knee joint has noticed before 3 years o Before 1 month pain arouse in LT Hip joint o Pain -during movements only. No resting pain. Not associate with food, climate or time. o Stiffness in joints lasting not > 15 min 7
  8. 8. q Medical History Hypertension 0 , Diabetes Mellitus 0 , Hypercholesteremia 0 q Surgical History q Psychiatric History q Treatment History • Pain killers only NA • Admitted for Ayurvedic treatment for the first time on 11th July 2014 to ward No 09 & then shifted to ward No 11 8
  9. 9. 80 yrs 52 yrs IHD 70 yrs 20 yrs 12 yrs 9
  10. 10. o Diet: Break fast - Not taken usually Lunch - Not taken usually Dinner - Rice, Vegetables, Egg Meat (Chicken, Beef, Mutton)-Twice a week More like to get Spicy & Fried food Not taken on time. S/T taken from outside Water intake: Sufficient o Appetite: Not changed due to the disease o No allergies for any kind of food 20- 30 yrs 10
  11. 11. o Addiction : Plain tea with sugar 10-15 times/ d Alcohol 1/ 2 bottle occasionally Cigarette 2-3/ d Beatle chewing 3- 4 times/ d o Sleep : 11 pm to 5 am (Disturbed due to Nocturia) o Bath : Evening with cold water, Daily 35 yrs 11
  12. 12. 12 o Bowel habits : Once/ Day Colour - Yellow Odour - Normal o Micturition : D- 3 / N -1 times Colour - Pale Odour - Normal o Social status : Living near to the river side o Occupational history: Mechanic – Long term standing, Night shift Concrete worker – Heavy lifting
  13. 13. GENERAL PHYSICAL EXAMINATION o General condition - Weak o BP - 130 /80 mmHg o PR - 74 / min o RR - 14 / min o Weight - 38 kg o Height - 5 Ft o Tongue - Not coated (Niräma) o Temperature - Normal o Skin - Normal o Pallor - Mild o Thyroid o Icterus o Cyanosis o Clubbing o Enlarged LN NAD NAD 13
  14. 14. SYSTEMIC EXAMINATION LOCO MOTOR SYSTEM q Gati (Range of movements): • LT & RT knee joints - Abduction - Adduction - Elevation • LT & RT Elbow joints- Flexion - Extension - Rotation • Hip (LT) -Elevation -Rotation Limited due to edema , pain & deformity Limited due to edema & pain • Interphalangeal joints (RT)– Extension is limited q Gait: Painful & Difficult (Pain while waliking in LT HIPJ & RT KJ) 14 Limited due to edema , pain & deformity
  15. 15. JOINTS o Inspection § Swelling PIP, DIP, both Elbow Js, RT Ankle, Both KJs (> in RT KJ) & LT Hip § Deformities Deviation & Enlargement of RT KJ, Nodes on Hands (PIP, DIP) § Muscle wasting o Palpation § Swelling –Pitting (Disappear with the removal of finger) § Crepitus (Both KJ) § Stiffness of the joints (RT KJ, LT Hip, PIP, DIP) (< 15 min) § Tenderness - NAD § Inflammation- NAD 15
  16. 16. 16
  17. 17. Spine qThorasic Spine: Internal and external rotation- Normal qLumbar Spine: painful (At the time of admission) § Flexion-Normal. § Extension-Normal. § Lateral Bending-Normal. q Cervical Spine: § Rotation- Normal § Flexion, Extension and Lateral bending- Normal 17
  18. 18. SYSTEMIC EXAMINATION CONT q CARDIOVASULAR SYSTEM • S1, S2 - Clear . No thrills or murmurs q RESPIRATORY SYSTEM • Bilateral equal air entry • No added sounds q GIT P/A • No tenderness • No organomegaly q CNS • Higher functions • Motor functions • Sensory system • Cranial nerves • Reflexes 18 NAD clinicaly
  19. 19. 1. Nädi: i. Gati - 74/ min ii. Yati - Samäntara iii. Akåti - Pürna iv. Samhati - Mådu 2. Mutra : D - 3/ N -1 times 3. Mala : Once/Day, Samhata mala 4. Jihvä : Niräma 5. Çabda : Prakåta Håd & Pupphuça çabda 6. Sparça : Sandhi sphuöana 7. Dåk : Prakåta 8. Akåti : Deviation & enlargement of RT Knee Joint, enlargement of both Elbow joints Nodules in PIPJ & DIPJ 19
  20. 20. I. Prakåti : Väta Kapha / Rajas Tamas II. Vikåti o Hetu (Nidäna) – Viprakåñöa Nidäna Ähara : Viñamäçana, Anäçana, Alpäçana, Katu, Kañäya Rasa, Tékñëa, Snigdha, Guru guëa Atisewana Viharaëa : Çéta jala sewana, Ati çrama, Rätré jägaraëa o Doña - Väta, Kapha o Düñya - Rasa, Rakta, Mämsa, Medas, Asthi, Majjä o Prakåti - Väta, Kapha o Deça - Asthi Sandhi o Käla - Cira käla o Bala - Roga bala: Kåccha sädhya Ätura bala: Madhyama o Lakñana - Prasäraëäkuaïcana vedanä, Sandhi çotha & Vikåti o 20
  21. 21. 21 III. Sära : Rasa, Rakta, Mämsa, Medas, Asthi & Majjä Madhya Sära IV. Samhanana : Madhya Samhata V. Pramäna : Madhya pramäëa VI. Sattva : Madhya Sattva VII. Sätmaya : Ñad Rasa Sätmaya VIII. Ähära Çakti: Before After • Abyavaraëa Çakti : Madhya Madhya • Jaraëa Çakti : Madhya Madhya IX. Vyäyäma Çakti : Before After Prawara Madhya X. Vayah : Madhyama (52 Yrs)
  22. 22. 1. Präëa vahä Srotas 2. Udaka vahä Srotas 3. Çukra vahä Srotas 4. Mutra vahä Srotas 5. Puriña vahä Srotas 6. Sweda vahä Srotas 7. Mano vahä Srotas Prakåti 8. Rasa vahä Srotas : Vikåti 9. Rakta vahä Srotas : Vikåti 10. Mämsa vahä Srotas : Vikåti (Mäàsa çoña) 11. Medo vahä Srotas : Vikåti (Kñudra Sandhi Çula+ ) 12. Asthi vahä Srotas : Vikåti 13. Majjä vahä Srotas : Vikåti 14. Anna vahä Srotas : Vikåti 15. Väta vahä Srotas : Vikåti (Gati Daurbalya) 22 (Päëdu (Anaemic)) (Sandhi Çula+, Çota + , Sandhi sphutana)
  23. 23. Ähara Viñamäçana, Anäçana Alpäçana, Katu, Kañäya Rasa,Tékñëa, Snigdha, Guru guëa Atisewana Viharana Çéta jala sewana, Ati çrama Mänasika Saïcaya Prasara 23 Circulation through the Srotas Asthi vahä Srotas Väta vahä Srotas Majjä vahä Srotas Medo vahä Srotas Dhätu kñaya Väta Kopa Anna vahä Srotas Rasa vahä Srotas Rakta vahä Srotas Çleñaka kapha Asthi dhätu kñaya Khavaiguëya in Sandhi Prakopa • Sandhi çotha • Prasäraëäkuìacana vedanä • Vätapurëa drutisparça Vyakti Sthäna Saàçraya in Sandhi Sandhi Vikåti Bheda
  24. 24. q Doña : Väta Vitiated, Kapha Dicreased q Düñya : Rasa, Rakta, Mämsa, Medas, Asthi, Majjä q Adiñtäna : Çärérika q Srotas : Rasa Vahä Srotas , Rakta Vahä Srotas Mämsa Vahä Srotas, Medo Vahä Srotas Asthi Vahä Srotas, Majja Vahä Srotas Anna Vahä Srotas, Väta Vahä Srotas q Samutthäna : Pakväçaya q Agni : Viñama q Äma : Niräma q Srotoduñöi : Saìga q Udbhawa sthäna : Asthi Sandhi q Roga märga : Madhyama (Marma, Asthi, Sandhi) q Sädhya Asädhyatä : Kåccha sädhya 24
  25. 25. q FBS - 99 mg/dl (2014.07.23) q UFR Reaction - Acidic Pus cells Epithelial cells Occasional q Lipid profile- 149 mg/ dL (Total cholesterol) q ALP- 271 IU/L q ESR - 5 mm/ 1st hr , 12mm/ 2 nd hr q RF - Negative q Plain X Ray in KJ- Osteophytes+ 25
  26. 26. 26 1. Ämaväta Sandhi Çotha 2. Gambhira Väta Rakta 3. Asthi Majjä Gata Väta 4. Kroñöuka Çérña 5. Sandhi gata Väta
  27. 27. Ma. Ni. 25/ 6 ¨ Body ache ¨ Anorexia ¨ Thirst ¨ Malaise ¨ A feeling of heaviness ¨ Fever ¨ Indigestion ¨ Swelling of the body parts (Pitting type of Oedema) 27
  28. 28. 28 Ca Ci 29/ 21- 23
  29. 29. 29 ¨ Swelling ¨ Rigidity ¨ Hardness ¨ Agonizing pain inside the joints ¨ Dusky red / coppery coloration ¨ Burning ¨ Pricking & throbbing pain ¨ Tendency to suppuration ¨ Deformities of the joints
  30. 30. 30 Su Ni 1/ 76 Ma. Ni 22/ 58 q Väta & Rakta getting affected together produces; q A very painful swelling of the knee joint resembling the head of the big fox
  31. 31. 31 Ca Ci 28/ 32 q Splitting pain in the bone & joints q Loss of strength of the musle q Loss of sleep q Constant pain of the body
  32. 32. Ca Ci 28/ 37 Su Ni 1/ 27-2, Yo .Ra V.V/ 1 As Hri Ni 15/14 Ma. Ni 22/ 21 32
  33. 33. RÜPA - Ca.Sa Su. Sa As Hri As Sa Ma.Ni Yo Ra Bha Pr Sandhi Çüla (Joint pain) + + + + + + + Sandhi çopha/çotha (Joint Swelling) + + + + + + Vätapurëa drutisparça + + + Hanti Sandhi (loss of function) + + + Prasäraëäkuìacana vedanä (Pain on movement) + + + Ätopa (cracking sound ) + 33
  34. 34. ÄMAVÄTA SANDHI GATA VÄTA GAMBHIRA VÄTA RAKTA Nidäna Viruddha Ähara, Snigda Ähara, Alpa chesta etc. Väta kopakara Ähara, Viharaëa Väta & Rakta kopakara Ähara, Viharaëa Doña Kapha, Väta Väta Predominant Väta, Pitta Düñya Rasa, Rakta, Asthi Asthi, Majja Rasa, Rakta, Asthi, Majja Sthäna Start from small joints of hands & spread Mainly start with weight bearing large joints Start from the end parts of the hands & feet 34
  35. 35. 35 ASTHI MAJJÄ GATA VÄTA SANDHI GATA VÄTA Nidäna Väta kopakara Ähara, Viharaëa Väta kopakara Ähara, Viharaëa Doña Väta Predominant Väta Predominant, Kapha Düñya Asthi, Majja Asthi, Majja Nidrä Alpa NA Sandhi Çüla Satatä Ruk Prasäraëäkuìacana vedanä
  36. 36. DIAGNOSIS ¨ Sandhi Gata väta 36
  37. 37. CIKITSÄ 37 k…yaRÖate ivc][> Su Ci 4 /8 As Hri Ci 21/ 22 C.D 22/ 9
  38. 38. CIKITSÄ CONT. 38 Treatment Su. Ci As Hri As Sa Bha Pr Bha Ra Yo Ra C.D Snehana + + + + + + Abhyanga + Mardana + + + + + Svedana + + + Upanaha + + + + + + + Bandhana + + + + Agnikarma + + + + +
  39. 39. CIKITSÄ CONT-VÄTA VYÄDHI CIKITSÄ A_y¼ < Svedn< biStnRSy< õehivrecnm! iõGxaMllv[< SvaÊ v&:ym! vatamyaphm!. 39 o Abhyaìga o Svedana o Vasti o Nasya o Sneha yukta virecana o Snigdha o Amla o Lavaëa o Svädu Yo Ra V. V Ci/ 1 Rasa
  40. 40. CIKITSÄ CONT. ¨ Bahih parimärjana - Sneha (Abhyanga) - Sweda ¨ Anthah parimärjana - Mådu çodhana ¨ Paìcha karma -Virechana (Sneha yukta) - Vasti - Nasya 40
  41. 41. From 11.07.2014 to 12.08.2014 ¨ Räsna 7 Decoction, Pata ½ bd ¨ Triphaläkwatha 30 ml bd ¨ Chandraprabhä vati 2 bd ¨ Yogaräja Guggulu 2 bd ¨ Daçänga Lepa From 18.07.2014 to 25.08.2014 ¨ Denibadi Decoction, Pata ½ bd ¨ Avipattikara cürna 30 grns bd ¨ Sudarshana cürna 30 grns bd ¨ Vätaroga kalka 30 grns bd ¨ Tala satakuppa paste 41
  42. 42. 42 From 25.08.2014 - 01.09.2014 ¨ Räsna 7 Decoction, Pata ½ bd From 01.09.2014 to 16.09.2014 ¨ Gändarva hästadi Decoction, Pata ½ bd ¨ Räsna 7 Decoction, Pata ½ bd ¨ Virecana (2014. 08. 06 )(Hingu triguna Taila 2 Aunz) ¨ Dhärä karma (2014. 08. 11- 25) ¨ Pinda Sweda (2014. 08. 25- 15 ) Ø Upaçaya- Joint oedema, Pain reduced
  43. 43. ¨ Eranda saptaka Decoction+ Rasona, Methi, Abhaya Pata ½ bd ¨ Daça mula Balairaëda Decoction, Pata ½ bd ¨ Dantimulädi Decoction, Pata ½ bd ¨ Daçamul Nikamul Decoction, Pata ½ bd ¨ Yogaräja Guggulu 2 bd with Bavila, sudulunu water ¨ Hinguwashtaka churna 30 grns, with hot water ¨ Punarnava Mandura ¨ Närayaëa Taila abhyanga ¨ Mashabaladi Decoction, Pata ½ bd ¨ Mashatmagupta Decoction, Pata ½ bd ¨ Väta gajendrsinha rasa, 2 bd, with hot water ¨ Ashwagandätaila, abhyanga ¨ Kshéra Balä taila 43
  44. 44. 44 ¨ Nika kola pottali Pinda sweda (pottali) ¨ Punnagädi pottali ¨ Picu Däraëa ¨ Jänu Vasti q Anuvasana Vasti- Eraëda, Balä Koraëda, Hingu triguëa Taila q Ranahansa Rasäyana q Açwagandhä Rasäyana
  45. 45. Pathya Ähära ¨ Steamed red rice ¨ Patola ¨ Murunga ¨ Kohila ¨ Wetakolu ¨ Fish Pathya Viharaëa ¨ Uñëa jala Sevana (snäna) ¨ Vyäyäma Apathya Ähära ¨ Foods which are Väta vardhaka ¨ Madya Apathya Viharaëa ¨ Rätree jägaraëa ¨ Divä nidrä ¨ Krodha , Çoka ¨ Séta sparça (Bathing cold water) 45
  46. 46. 46
  47. 47. Disease Cikitsa 47 • Ca. Ci 28/37 • Su. Ni 1/27 • As. Hri .Ni 15/14 • As.Sa Ni 15/ 16 • Bha.Pr. Ma. Kha 24/ 258 • Ma. Ni 22/ 21 • Yo. Ra Va. Vy/1 • Not mentioned • Su. Ci 4/8 • As. Hri .Ci 21/22 • As.Sa Ci 23/ 13 • Bha.Pr. Ma. Kha 24/ 259 • Bha. Ra Vol 2, 26/ 14 • Yo. Ra Va. Vy. Ci / 1 • Ca. Da
  48. 48. 48 ¨ Nidäna ¨ Pürwa rüpa ¨ Sampräpti ¨ Sädhya Asädhya Bhäva ¨ Rüpa ¨ Cikitsä Not mentioned Separately Only mentioned
  49. 49. NIDANA 49 Ca. C 28/15-18
  50. 50. NIDÄNA Ähära Due to rough, cold, little & light food Viharaëa ¨ Excessive movement such as leaping,jumping Wayfaring & physical exercise ¨ Excessive emaciation due to illness ¨ Uncomfortable bed & seat ¨ Day sleep ¨ Suppression of urges ¨ Fasting ¨ Injury in vital parts injury ¨ Falling down from elephants, horses & other fast vehicles 50
  51. 51. NIDANACONT. Mänasika ¨ Anger ¨ Anxiety ¨ Grief Faulty therapeutic management ¨ Excessive elimination of impurity & blood ¨ Wasting of dhatus 51
  52. 52. SAMPRÄPTI Aggravated vayu Filling up vacant channels of the body Make disorders in Entire body One part of the body 52 Ca Ci 28/ 37
  53. 53. 53 OSTEOARTHRITIS
  54. 54. Introduction ¨ Osteoarthritis (OA) is a disease of synovial joints that can result from cartilage degeneration ¨ Most common form of arthritis ¨ Prevalence increases with the age ( Ref: Clinical medicine, Kumar & Clark) 54
  55. 55. Joints- most commonly involved 55 o Hand - DIP Joint - First CMC Joint o Foot - First MTP joint o Weight bearing joints - Vertebra - Hip - Knee
  56. 56. Classification of Osteoarthritis 2 types 1. Primary osteoarthritis 2. Secondary osteoarthritis Primary osteoarthritis q Osteoarthritis not resulting from injury or disease q Cause is unknown 56
  57. 57. Types of Osteoarthritis Cont. 2. Secondary osteoarthritis Form of osteoarthritis that is caused by another disease or condition. q Obesity q Repeated trauma or surgery to the joint structures q Abnormal joints at birth (congenital abnormalities) Gout q Diabetes and q Other hormone disorders 57
  58. 58. Risk Factors 58 ¨ Age - > 45 yrs ¨ Gender- > female ¨ Obesity ¨ A fracture through a joint ¨ Congenital joint dysplasia ¨ Pre existing joint damage ¨ Occupation- farmers & labourers OA- >Hip ¨ Repetitive use ¨ Injury associate with some sports
  59. 59. Clinical features q Joint pain- made worse by exercise, relieved by rest q Stiffness after rest- last in <30 min q Swelling or tenderness in one or more joints q Deformity & enlargement of the joints q Limited joint movement q Wasting of surrounding muscle group q Crepitus - Crunching feeling or sound of bone rubbing on bone when the joint is used 59
  60. 60. Nodal osteoarthritis Bony enlargement of o Distal interphalangeal joint- Heberden's nodes o Proximal interphalangeal joint- Bouchard's nodes 60
  61. 61. Pathophysiology ¨ Inital event : mitosis of chondrocyte ¨ Second event: Increased synthesis of bone by osteoblasts in the subchondral bone ¨ Third event: metaplasia of the peripheral synovial cells resulting in formation of osteochondrophytes ¨ Fourth event: formation of bony cysts 61
  62. 62. Pathophysiology Cont 62 ¨ OA affects all of the weight-bearing components of the joint: • Articular cartilage • Menisci • Bone
  63. 63. Pathophysiology Cont Osteoarthritis may result from wear and tear on the joint •The normal cartilage lining is gradually worn away and the underlying bone is exposed. 63
  64. 64. Pathophysiology Cont •The repair mechanisms of tissue absorption and synthesis get out of balance and result in osteophyte formation (bone spurs) and bone cysts 64
  65. 65. D/D Criteria OA RA Gout 1.Symptoms Pain & swelling on major weight bearing joints, stiffness, crepitations, tenderness, enlargement of joint space. Inflammation in multiple joints, morning stiffness>30 mins Polyarticular pain, swelling and inflammation, tenderness 2.Mode Of onset Gradual Gradual Acute 3.Joints involved Weight bearing joints Poly articular Metatarso phalangeal joints 4.Systemic features NA Auto immune diseases, rise in temperature, anemia NA 5.Pathological phenomenon Degeneration Auto immune and vasculitis Hyper uricaemia 6.Investigation RA- ve, ESR-normal, X-Ray-narrowing of joint space ESR-raised, X-ray-soft tissue swelling Serum uric acid raised, 65
  66. 66. Diagnosis Based on, Ø Signs and symptoms Ø Laboaratory studies: • ESR - Normal • Full Blood count - Normal • Rh Factor - Negative • Synovial fluid - Viscous Ø X-ray and Radiographic findings 66
  67. 67. Radiographic Diagnosis •Narrowing of the joint space •Periarticular sclerosis •Osteophytes •Sub-chrondral bone cysts 67
  68. 68. Radiographic Diagnosis cont • Asymmetrical joint space narrowing from loss of articular cartilage • The medial (inside) part of the knee is most commonly affected by osteoarthritis. 68
  69. 69. Long-Term Complications ¨ Does not affect the body's organs ¨ Lead to deformities ¨ Severe loss of cartilage in the knee joints can cause the knees to curve out, creating a bow-legged appearance ¨ Bony spurs along the spine can irritate nerves, leading to pain, numbness, or tingling in some parts of the body 69
  70. 70. 70 Bow-legged appearance
  71. 71. Bony spurs 71
  72. 72. Disease Management q OA is a condition which progresses slowly over a period of many years and cannot be cured q Treatment is directed at decreasing the symptoms of the condition, and slowing the progress of the condition q Functional treatment goals: ü Control Pain ü Improve Joint Function ü Increase muscle strength ü Maintain Normal Weight 72
  73. 73. OA – Non-operative Treatments •Pain medications •Physical therapy •Walking aids •Shock absorption •Re-alignment through orthotics •Limit strain to affected areas 73
  74. 74. 74
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PPT created by Dr R.L.D.S Ranasinghe, Post Graduate Scholar, University Of Colombo, Sri Lanka.

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