Rajiv Gandhi University of Health Sciences, Karnataka
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“A COMPARATIVE STUDY ON AGNIKARMA AND INDIGENOUS DRUGS IN THE MANAGEMENT OF JANU SANDHIGATA VATA W.S.R. TO OSTEOARTHRITIS OF KNEE JOINT.”
By
DR. SHUBHAM PURI
P.G Scholar. Dept. Of Post Graduate Studies in Shalyatantra
Sri Jagadguru Gavisiddeshwar Ayurvedic Medical College & Hospital, Gavimath Campus, Koppal, Karnataka
GUIDE
DR. B. S. SAVADI, M.D.(Ayu)
Professor H.O.D., Dept. of Shalyatantra
S.J.G.A.M.C., Koppal
2012-2013
Sri Jagadguru Gavisiddeshwar Ayurvedic Medical College Hospital Gavimath Campus, Koppal, Karnataka
From:
Dr. Shubham Puri,
1st Year M.S (Ayu), Department of Post Graduate Studies in Shalyatantra
S.J.G. Ayurvedic Medical College & Hospital, Gavimath Campus,
Koppal -583231, Karnataka.
To:
The Registrar,
Rajiv Gandhi University of Health Sciences
Bengaluru, Karnataka.
Through:
The Principal and The Head of Department of Shalyatantra
S.J.G. Ayurvedic Medical College & Hospital, Gavimath Campus,
Koppal -583231, Karnataka.
Respected Sir,
Sub: Regarding the submission of completed Proforma for Registration of subject for Dissertation.
I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangaluru for the partial fulfillment of M.S. (Ayurveda).
Title of the Dissertation
“A COMPARATIVE STUDY ON AGNIKARMA AND INDIGENOUS DRUGS IN THE MANAGEMENT OF JANU SANDHIGATA VATA, W.S.R. TO OSTEOARTHRITIS OF KNEE JOINT.”
Here with I am enclosing completed Proforma for registration of the subject for dissertation.
Thanking you,
Place : Koppal Yours faithfully,
Date :
(Dr. Shubham Puri)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
1) NAME OF THE -CANDIDATE &
ADDRESS / DR. SHUBHAM PURI,
DIET COLONY, DHARAMJAIGARH,
DISTRICT- RAIGARH – 496116,
CHHATTISGARH.
2) NAME OF THE INSTITUTE - / S. J. G. AYURVEDIC MEDICAL COLLEGE, HOSPITAL, GAVIMATH CAMPUS,
KOPPAL- 583231, KARNATAKA.
3) COURSE OF STUDY -
AND SUBJECT / AYURVEDA VACHASPATI, M.S.(AYU)
SHALYA TANTRA
4) DATE OF ADMISSION - / 10th SEPTEMBER 2012
5) TITLE OF THE TOPIC - / “A COMPARATIVE STUDY ON AGNIKARMA AND INDIGENOUS DRUGS IN THE MANAGEMENT OF JANU SANDHIGATA VATA W.S.R. TO OSTEOARTHRITIS OF KNEE JOINT.”
6. BRIEF RESUME OF THE INTENDED STUDY:
6.1) NEED FOR THE STUDY:
Proper locomotion of an individual is necessary to live a trouble free life. Inability to move properly can make life miserable. Ayurveda is known as first life science to give mankind peaceful and healthy life to achieve Purusharth. Ayurveda gives man knowledge to cure from every type of Dukha. Among various disorders of joints, Osteoarthritis is one, which imparts the usual activities of sufferer. Sandhigatvata can be compared with osteoarthritis. Dhatukshaya is considered one of the major reasons for this disease. Daily activities like walking, dressing, bathing are disturbed because of pain. Vridhavastha (old age) makes this disease Kasta Sadhya. Shula Pradhana Vedana is the cardinal feature of the disease. Osteoarthritis is disorder of synovial joints. It is characterized by progressive degenerative changes in the articular cartilages over the years. Particularly in the weight bearing joints. Due to pain and swelling, the mobility of joints is restricted (Stambha), and on movement results in excruciating pain (Prasarana Akunchanayoho Vedana), which becomes unbearable even on mild touch in the form of tenderness (Sparsha Asahyata).5
According to World Health Organization (WHO) OA is the second commonest musculoskeletal problem in the world population (30%) after back-pain (50%). The reported prevalence of OA from a study in rural India is 5.78%. The age related increase is more apparent in women. The disease is more severe in them with more symptoms, more extensive involvement, and increased prevalence of knee and hand joint involvement.7Analgesics, Non Steroidal Anti inflammatory Drugs and surgical approaches are applied for the management of Osteoarthritis in modern system of medicine, which are with limitations and wide variety of side effects. The treatment of Sandhigata Vata should be aimed at minimizing pain, optimizing function and reducing disability. The line of treatment told by Acharayas for the management of Sandhigata Vata is to use Vatashamana Chikitsa. Among them Agnikarma due to its Ushna Guna eliminates the vitiated Vata Dosha & there is no fear of putrification and bleeding, and ultimately it produces balancing effect on vitiated Vata Dosha. It’s necessary to have safe, effective, economic, patient friendly treatment modality in present era. Hence in this study an attempt is made to evaluate and compare the effect of Agnikarma and Indigenous drugs in Janu Sandhigata Vata w.s.r. to Osteoarthritis of knee.
6.2) REVIEW OF LITERATURE:
Review of the literature includes thorough screening of classical and contemporary literatures, and periodicals. Janu Sandhigata Vata is mentioned in Vedic period till present. Acharyas told that Ruksha , Khara , and Vishad qualities of Vata get vitiated by Nidana factors destroys the Guru , Snigdha and Slakshna qualities of Kapha and causing Kshaya in Asthi, resulting structural destruction and functional impairment in joint. Acharyas clearly mentioned that the Vata which is localized in Sandhi destroys the actions of the joints and give rise to pain and swelling in them.1, 2
Agnikarma, for the treatment of Vata vitiated in Snayu and Sandhi is clearly mentioned in classics.3,4. The compound formulation selected for the study is taken from Bhavprakash Chikitsaprakran.6
6.3) PREVIOUS WORKS DONE
1. Vaishnar S.D-Studies on Dagdha and Agnikarma -IMS Faculty of Ayurveda, 1968, B.H.U.
2. Ghate M.H. -Agnikarma Ek Adhyayana, IPGT&RA Gujarat Ayurveda University, 1978, Jamnagar .
3.Sabnis Kalindi.M-Role of Agnikarma with different metal rods in Sandhi-Shoola(arthragia)- a complete study -SRK Toshningal Ayurveda Mahavidyalaya,1997, Akola.
4.Sajith.M- Effect of Agnikarma in Kati-shoola,Shri D.M. college of Ayurveda, 2002,Udupi.
5.Mahant J Vyasdev- A clinical management of Sandhigatavata w.s.r. to cervical spondylosis by Agnikarma ,IPG RA Gujarat Ayurveda University, 2005, Jamnagar.
6.Shrinivas.K.K.- Evalution of efficacy of Agnikarma and physical exercises in the management of Kati-shoola,National Institute of Ayurveda ,1999, Jaipur.
7.Nilesh Kumar-Comparative study on the efficacy of Agnikarma and electro therapy with Simhanada Guggulu in the management of Kati-Shoola, National Institute of Ayurveda, 2002, Jaipur.
8. Ranjit Kadam- Clinical study on comparative efficacy of Agnikarma and Snehana, Swedana in the management of Gridhrasi (sciatica), Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore, T.M.A.E’S Ayurveda Medical College, 2011, Hospet.
9. Jayashree A Prasad- Efficacy of Agnikarma in the management of Manyastambha-a clinical study, Rajiv Gandhi University of Health Sciences,Karnataka,Bangalore,Government Ayurvedic Medical College Bengaluru, 2011, Bengaluru.
6.4) OBJECTIVES OF THE STUDY:
· To review the literature related to Sandhigatavata as well as osteoarthritis.
· To evaluate the efficacy of Indigenous drugs (Indravaruni, Pippaali with Jaggery) in the management of Janusandhigatavata.
· To evaluate the effect of Agnikarma and its role in Janusandhigatvata.
· To compare the effects of Agnikarma & Indigenous drugs in management of Janusandhigatavata
7. MATERIALS AND METHODS:
7.1) SOURCE OF DATA:
(a) Patient:
The patients will be randomly selected from O.P.D & I.P.D, of the S.J.G. Ayurvedic Medical College Hospital and Research Centre, Koppal.
(b) Literary source:
Literary aspect of the study will be collected from classical Ayurvedic, contemporary text, periodicals & e-journals etc.
(c) Experimental source:
It is a human clinical trial; no animal experimentation will be done.
7.2) COMPOSITION OF TRIAL DRUG:
(a) Preparation of Medicine:
SL. No. / Sanskrit Name / Botanical Name / Quantity1. / Indravaruni / Citrullus colocynthis / 1 part
2. / Pippali / Piper longum / 1 part
Medicine will be prepared as per classics in the pharmacy of S.J.G. Ayurvedic Medical College & Hospital, Koppal.
(b) Preparation of Shalaka:
It is specially prepared as per the procedure.
· Metal - Rajata Shalaka
· Length - 12 cm
· Weight - 10 grams
· Diameter - Masuradala
7.3) METHOD OF COLLECTION OF DATA:
· A special case proforma will be prepared which includes the details of history taking, physical signs and symptoms as mentioned in Ayurveda and Allied sciences.
· Patients will be analyzed and selected accordingly, subjected to detailed clinical history and complete physical examinations.
· Selected patients randomly put into two groups with 15 patients in each group.
(a) Study Design:
A Comparative Clinical Trail.
(b) Sample Size & Grouping:
Totally 30 patients of either sex fulfilling the inclusion criteria will be selected and divided into two group where the minimum of 15 patients Sample will be allotted in each group.
Ø Group A:
Administration of Indigenous drugs 4 grams thrice a day for 30 days and the patient is advised to administer drug along with Jagarry and Luke Warm Water as Anupana.
Ø Group B:
Rajata Shalaka is made hot by heating in Nirdhuma Agni and the part with maximum tenderness is marked and the pointed part of the heated Shalaka is applied as dots within the marked area7.
The parameter of signs and symptoms will be scored on the basis of standard method and will be analyzed statistically.
(c) Inclusive Criteria:
· Patients presenting with classical Lakshanas of Janu Sandhigata vata
· Patient with either sex age group between 40 yrs and 60 yrs
(d) Exclusive Criteria:
· Patients with any systemic diseases like DM, HTN, TB, Pregnancy, HIV.
· Patients below the age of 40 yrs and above the age of 60 yrs.
· Contra-indication of Agnikarma.
(e) Methodology:
· Agnikarma, in the shape of Bindhu, by heating one end of Rajata Dhatu Shalaka and keeping the other end at the point of maximum tenderness of Janu sandhi up to the heat tolerance of the patient.
· The procedure will be repeated in a time gap of 5 days till the patient is relieved of pain.
· Patient will be advised to follow healthy lifestyle and to take proper diet and to avoid spicy & heavy food.
(f) Study Duration:
Total duration including follow up - 45 days
Group A
· Oral medicine - 30 days
· Follow up - Every 5th day up to the period of 15 days.
Group B
· Agnikarma - Procedure on every 5th day for 15 days.
· Followup - Every 10th day up to the period of 30 days.
(g) Posology:
· Indigenous drugs - 4 grams thrice a day.
· Anupana - Jagarry and Luke Warm Water.
(h) Assessment of Results:
Assessment of improvement of patient will be recorded on the basis of relief of pain & stiffness. All the signs and symptoms are scored depending upon their severity, to assess the effect of the treatment. The result of study will be obtained in term of qualitative data.
S.r.no / Symptoms / NIL / Mild / Moderate / Severe1 / Pain / 0 / + / ++ / +++
2 / Pain with movement / 0 / + / ++ / +++
3 / Stiffness / 0 / + / ++ / +++
(i) Subjective Parameters:
· Janusandhi Shula(pain)
· Stambha(stiffness)
· Range of movements
(j) Objective Parameters:
· Shotha(swelling)
· Sandhiaatopa(crepitition)
(k) Investigations:
· X-ray of knee joint(antero posterior/laterally)
· MRI (if needed)
· Routine blood and urine examination.
7.4) ETHICAL CLEARANCE:
“Obtained” and enclosed.
8. LIST OF REFERENCES:
1. Acharya Jadhavaji Trikamaji, Susruta, SusrutaSamhita, with commentary of Dalhana, 9th edition Chaukhambha Orientalia Varanasi, 2009, pp824,Nidanasthana chap-1, slg-28, pg-261.
2. Pandit Bhishakacharya Hari Shastri Paradkar, Vagbhatacharya, Ashtanga Hridaya, ,reprint 9th edition,Chaukhambha Orientalia, Varanasi; 2002, pp956, Nidana Sthana, pg-444,530-531.
3. Acharya Jadhavaji Trikamaji, Susruta, Susruta Samhita, with commentary of Dalhana, 9th edition Chaukhambha Orientalia Varanasi, 2009, pp824, Chikitsa Sthana Chapter-4, Slg-8, Pg-420.
4. Pandit Bhishakacharya Hari Shastri Paradkar, Vagbhatacharya, Ashtanga Hridaya, reprint 9th edition,Chaukhambha Orientalia, Varanasi; 2002, pp956, Chikitsa Sthana, Chapter-21,Slg-22, Pg-724.
5. Acharya Jadavji Trikamji, Agnivesa,Charaka,Charaka Samhita,with Vidyotini Hindi commentary, edition reprint, Choukambha publication, Varanasi; 2006,Chikitsa Sthana Chapter-28,Slg-Pg-697.
6. Bhisagratna Pandit Sri Brahma Sankara Mishra, Sri Bhavamisra, Bhavaprakash, with Vidyotini Hindi Commentary, Varanasi: Choukambha Sanskrit Samsthan, 7th edition, Bhavprakashashya Madhyamkhand Chikitsaprakarnam Vatavyadhirogadhikar, Chapter-24/259,Page-265.
7. Siddharth N. Shah, M. Paul Anand ,Siddarth Kumar Das ,API Textbook Of Medicine ,The Association of Physicians of India , 8th edition reprint 2009. Volume 1, Chapter-7, Pg-279.
9. SIGNATURE OF THE CANDIDATE :
(DR. SHUBHAM PURI)
10. REMARKS OF GUIDE :
11. NAME AND DESIGNATION
11.1) GUIDE : DR. B. S. SAVADI, M.D. (Ayu)
PROFESSOR & H.O.D.,
DEPT. OF SHALYATANTRA
S.J.G.A.M.C., KOPPAL
11.2) SIGNATURE :
11.3) HEAD OF THE DEPARTMENT : DR. B. S. SAVADI, M.D. (Ayu)
PROFESSOR & H.O.D.,
DEPT. OF SHALYATANTRA
S.J.G.A.M.C., KOPPAL
11.4) SIGNATURE :
12. REMARKS OF CHAIRMAN AND PRINCIPAL:
12.1) SIGNATURE :