E-ISSN:2456-3110

Research Article

Janusandhigata Vata

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

A randomized controlled clinical study of Marichadi Kwatha in the management of Janusandhigata Vata

Rani S1*, Pai S2, K Kiran3
DOI:10.21760/jaims.9.11.7

1* Shabna Rani, Post Graduate Scholar, PG Department of Kayachikitsa, Alva's Ayurveda Medical College, Moodubidire, Karnataka, India.

2 Surekha Pai, Professor, PG Department of Kayachikitsa, Alva's Ayurveda Medical College, Moodubidire, Karnataka, India.

3 K Kiran, Assistant Professor, PG Department of Kayachikitsa, Alva's Ayurveda Medical College, Moodubidire, Karnataka, India.

Background: Sandhigata Vata is a type of Vatavyadhi where the vitiated vata dosha specifically affects the joints with symptoms of Sandhishoola, Atopa, Shopha, and Prasarana Aakunchana Vedana. Osteoarthritis mainly targets the knee joint, hip joint and certain small joints. OA is an important cause of disability and the second most common musculoskeletal problem in the world (30%) after back pain (50%). Hence Marichadi Kwatha and Rasnapanchaka Kwatha taken for present clinical study and results compared for checking the efficacy in Janusandhigata Vata.

Methodology: 60 patients fulfilling the diagnostic and inclusion criteria were selected for a single blind randomized controlled clinical study. They were randomly allocated into 2 equal groups Group A and Group B. Group A subjects received Marichadi Kwatha in a dosage of 25ml Kwatha with 3ml Koshna Tila Taila twice daily after food for 30 days. Group B subjects received Rasnapanchaka Kwatha 25ml Kwatha with 3ml Koshna Tila Taila twice daily after food with for 30 days. Assessment was done on 0th day, 16th day, 31st day and 46th day.

Results: Both groups showed significant improvements in all parameters based on clinical evaluation. However, within each group, analysis showed significant changes in most parameters with the exception of Atopa. When comparing both groups, there were no significant differences found.

Conclusion: Both Marichadi Kwatha and Rasnapanchaka Kwatha showed significant effect in all parameters except in Atopa. On statistical comparison between the two groups there were no significant difference in the effect of both Marichadi Kwatha and Rasnapanchaka Kwatha.

Keywords: Janusandhigata Vata, Knee joint Osteo arthritis, Marichadi Kwatha, Rasnapanchaka Kwatha

Corresponding Author How to Cite this Article To Browse
Shabna Rani, Post Graduate Scholar, PG Department of Kayachikitsa, Alva's Ayurveda Medical College, Moodubidire, Karnataka, India.
Email: 		Rani S, Pai S, K Kiran, A randomized controlled clinical study of Marichadi Kwatha in the management of Janusandhigata Vata. J Ayu Int Med Sci. 2024;9(11):43-48.
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https://jaims.in/jaims/article/view/3858/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-17 2024-10-25 2024-11-05 2024-11-15 2024-11-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 14.34

© 2024by Rani S, Pai S, K Kiranand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionAimObjectivesMaterials and MethodsObservations and ResultsDiscussionConclusionReferences
Shabna R et al. A randomized controlled clinical study of Marichadi Kwatha

Introduction

Ayurveda, a comprehensive life science, aims to enhance the physical, social, and spiritual well-being of individuals by offering preventive and curative healthcare modalities for multifaceted diseases. Sandhigata Vata is one among the Vata Vyadhi. It mainly presents with Vatapoornadhrthisparsha Shotha and presence of Vedana during Prasarana and Aakunchana.[1] Janusandhigata Vata is the most common clinical condition pertaining to joints. The Lakshanas of Janusandhigata Vata can be compared to Knee Osteoarthritis based on the signs and symptoms. Knee Osteoarthritis typically the result of wear and tear and progressive loss of articular cartilage.[2]

It’s prevalence will continue to increase as age advances and obesity. Recent studies revealed that overall prevalence of Knee Osteoarthritis in India is 28.7%. Also, more prevalent in females (31.6%) than in males (28.1%).[3] According to Ayurveda, management of Sandhigata Vata includes Bahya Chikitsa and Abhyantara Chikitsa. Shamanoushadhis like Maharasnadi Kwatha[4] Yogaraja Guggulu,[5] Trayodasanga Guggulu[6] etc are included in Abhyantara Chikitsa. Abhyanga, Upanaha, Agnikarma, Bandhana, Mardana are the Bahya Chikitsa.[7] As per modern science, medical and surgical interventions like Analgesics, NSAID, Total Knee Arthroplasty are the treatment modalities.[8] Marichadi Kwatha[9] mentioned in Gadanigraha was taken as the trial drug, for proving its effect in the management of Janusandhigata Vata. It mainly contains drugs having the properties of Vatahara, Shoolahara, Shophahara, Agnideepana properties. Rasnapanchaka Kwatha[10] explained in Chakradatta was taken as the standard drug. Hence with the present clinical study Marichadi Kwatha and Rasnapanchaka Kwatha were taken and results were compared for checking the better efficacy in Janusandhigata Vata.

Aim

To evaluate the therapeutic effect of Marichadi Kwatha in the management of Janusandhigata Vata.

Objectives

1. To evaluate the efficacy of Marichadi Kwatha in the management of Janusandhigata Vata.

2. To compare the efficacy of Marichadi Kwatha and Rasnapanchaka Kwatha in the management of Janusandhigata Vata.

Materials and Methods

Patients diagnosed with Janusandhigata Vata was randomly selected and allocated into two groups, from Kayachikitsa Out Patient Department of Alva’s Ayurveda Medical College and Hospital, Moodubidire and from other available sources who were diagnosed with Janusandhigata Vata.

Method of Collection of Data

Selection of patients done irrespective of gender, caste, religion, occupation, educational status and socio-economic status. Those who are fulfilling the diagnostic criteria and inclusion criteria were selected.

  • Allocation - Randomized Allocation
  • Method of Sampling - Lottery Method
  • Groups - Two groups
  • Group A - Treated with Marichadi Kwatha
  • Group B - Treated with Rasnapanchaka Kwatha
  • Sample Size - 30 Patients in each group
  • Total Sample Size - 60 Patients

Diagnostic Criteria

Patient diagnosed based on Lakshanas of Janusandhigata Vata such as

  • Sandhi Shoola - Pain in the joints
  • Sandhi Atopa - Crepitus in knee joints
  • Prasarana Aakunchana Vedana - Presence of pain during flexion and extension of joints.
  • X- ray findings also included. (AP/ LAT view)

Inclusion Criteria

  • Patients with classical symptoms of Janusandhigata Vata like Sandhi Shoola, Sandhi Atopa, Prasarana Aakunchana Vedana (unilateral or bilateral) with or without Sandhi Sthamba and Sandhi Shopha.
  • Participate in study and sign in the consent form.

Exclusion Criteria

  • Patients suffering from diseases like Vatarakta and Amavata.

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Shabna R et al. A randomized controlled clinical study of Marichadi Kwatha
  • Patient with deformities like Genu varum and Genu valgum.
  • Secondary Osteoarthritis of Knee.
  • Patient who requires surgical interventions.
  • Pregnant women and Lactating mothers.

Intervention

GroupDoseTime of AdministrationDurationPrakshepaka Dravya
Group A25mlTwice daily after food30 days3ml Koshna Tilataila
Group B25mlTwice daily after food30days3ml Koshna Tilataila

Observation Period: Patients were assessed clinically before treatment, on 16th day and on 31st day after treatment.

Follow Up: After 15 days of treatment (on 46th day)

Total Duration of Study: 45 days

Assessment Criteria

Subjective Parameters

  • Janu Sandhi Shoola
  • Janu Sandhi Sthambha
  • Tenderness
  • Visual Analogue Scale (VAS)
  • WOMAC Osteoarthritis Index (Modified - CRD Pune Version)

Objective Parameters

  • Janu Sandhi Shotha
  • Janu Sandhi Atopa
  • Range of Movement

Ingredients of Formulations

Marichadi Kwatha: Ingredients are Maricha, Devadaru, Nagara, Tilataila

Rasnapanchaka Kwatha: Ingredients are Rasna, Guduchi, Eranda, Devadaru, Mahoushada

Observations and Results

Statistical Analysis

Statistical software used here is Sigma Stat 3.1 Version. Within the group comparison was done statistically with Wilcoxon Signed Rank Test (Janu Sandhi Shoola, and Stambha), Paired t Test (Janu Sandhi Sopha and Prasarana Aakunchana Vedana)

RM Anova on Ranks (Atopa, Tenderness, VAS Score, Womac Score), Comparative analysis of overall effect of treatment in both groups was done statistically with Mann Whitney Rank Sum Test (Janu Sandhi Shoola, Stambha, Atopa, Tenderness, VAS Score, WOMAC Score) & Unpaired t-Test (Janu Sandhi Sopha & Prasarana Akunchana Vedana).

ObservationsPredominancePercentage
Age50- 59 years41.67%
GenderFemale78.33%
OccupationHousewives46.67%
Family HistoryNegative73.33%
DietMixed66.67%
PrakritiVatakapha66.67%
SatwaMadyama90%
SatmyaMadyama88.33%
Abhyavaharana ShaktiMadyama83.33%
Jarana ShaktiMadyama95%
Vyayama ShaktiAvara68.33%
NidraSound68.33%
BMI25-29.9 (Over weight)70%
Onset of PainGradual100%
Character of PainDull aching58.33%
Course of PainIntermittent90%

Effectiveness of Medicine Before and After Treatment

Assessment CriteriaGroupMean ValueWSRT/Paired t test /RM Anova on RanksRemarks
BTATW/t/Q ValueP Value
Janusandhi ShoolaA2.10.88-91<0.001HS
B2.150.98-91<0.001HS
Janusandhi StambhaA0.070.03-11.00NS
B0.10.03-11.00NS
Janusandhi AtopaA110>0.05NS
B1.0710>0.05NS
Janusandhi ShothaA10.5510.302.8670.008S
B15.9615.654.086<0.001HS
TendernessA0.30.032.41>0.05NS
B0.370.072.62>0.05NS
Prasarana Aakunchana VedanaA122.75127.83-26.91<0.001HS
B123128.53-19. 54<0.001HS
VAS ScoreA4.982.39.899<0.001HS
B5.422.259,970<0.001HS
WOMAC ScoreA37.6722.379.55<0.001HS
B38.33229.68<0.001HS

HS - Highly Significant, NS - Not Significant, S - Significant


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Comparative Analysis of the Treatments in Both the Groups

Assessment CriteriaMedian Value / Mean Difference (BT – AT)Mann Whitney Test / Un Paired t testRemarks
Group AGroup BT/t ValueP Value
Janusandhi Shoola119470.635NS
Janusandhi Stambha009300.829NS
Janusandhi Atopa009150.994NS
Janusandhi Shotha-0.060-0.520.606NS
Tenderness009300.830NS
Prasarana Aakunchana Vedana-0.33-0.860.396NS
VAS Score337550.018NS
WOMAC Score15168260.191NS

NS - Not Significant

Percentage Wise Relief in Group A and Group B

Assessment CriteriaGroup A
D16ATFU
Janusandhi Shoola38.09%59.52%55.5%
Janusandhi Stambha04.99%4.95%
Janusandhi Atopa0%0%0%
Janusandhi Shotha1.44%2.4%2.3%
Tenderness0%89%89%
Prasarana Aakunchana Vedana0.81%4.14%4.14%
VAS Score27.75%52.11%60.20%
WOMAC Score19.38%40.6%44.25%
Assessment CriteriaGroup B
D16ATFU
Janusandhi Shoola34.8%54.3%54.27%
Janusandhi Stambha0%6.18%6.18%
Janusandhi Atopa0%0%0%
Janusandhi Shotha1.14%1.94%1.94%
Tenderness27.24%81.7481.74%
Prasarana Aakunchana Vedana1.048%4.04%4.04%
VAS Score25.9%53.94%61.6%
WOMAC Score22.95%42.72%43.82%

Discussion

Both formulations consist of ingredients with Tikta Kashaya Madhura Rasa Ushna Virya, Amapachana, Vatakaphahara, and Shoolahara properties, making them effective in reducing Shoola and Shopha.

As the pain reduces the VAS scores also gets reduced. Also, Tila Taila having Tikta Madhura Rasa, Madhura Vipaka, Ushna Virya and Vataghnakarma provides lubrication, reduces friction, and nourishes the joints, improving their mobility and flexibility, thereby decreasing Stambha, increasing the range of movements and can reduce the WOMAC scores by increasing the quality of life.

Mode of action of drugs Marichadi Kwatha

Maricha having Sukshma Guna, Ushna Virya and Kaphavatahara Karma. Also having antioxidant, anti arthritic, ant inflammatory in action. The primary active compound of Maricha piperine can inhibit the activity of proinflammatory enzymes and cytokines, helping to reduce pain and inflammation in Osteoarthritis. Mahadaru (Devadaru) having Snigdha Guna, Ushna Virya, Kaphavatahara Karma. Active components in Mahadaru like cedrol, deodarone, flavonoids and tannins having anti-inflammatory, analgesic and anti-arthritic effect. Recent study related to Cedrus deodara revealed positive results regarding anti-inflammatory and analgesic activity Nagara having Guru Snigdha Guna, Ushna Virya, Madhura Vipaka and Vatakaphahara Karma. Active components in nagara like gingerol, shogaol, zingiberene having anti-inflammatory and analgesic in action. Clinical study related to Zinigiber officinale also highlights its properties of anti-arthritic, antioxidant, anti-inflammatory and analgesic effects. Tila Taila has Guru Snigdha Guna, Madhura, Tikta Kashaya Rasa, Ushna Virya, Madhura Vipaka, Vatahara, Balya and Sthairyakara in Karma. Tila Taila rich in antioxidants like sesamol, sesamin and sesamolin exhibits anti-inflammatory and antioxidant properties that could be beneficial in managing Knee Osteoarthritis.

Mode of Action of Rasnapanchaka Kwatha

Rasna having guru Guna, Ushna Virya, Kaphavatahaghna and Shophahara. Also, chemical constituents such as quercetin, neolupenol, sorghumol, were studied for anti-inflammatory and anti-arthritic activities. Guduchi has Ushna Virya, and Madhura Vipaka. Also having Deepaneeya, Tridoshahara, Balya and Rasayana properties. Ecdysteroids isolated from the plant have been reported of protein anabolic and anti-osteoporotic effects in mammals. Eranda having Madhura Katu Rasa, Snigdha Theekshna Guna, Usna Virya, Madhura Vipaka, Tridosha Hara, Shothahara and Vedanasthapana properties.


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Studies related Alkaloids, Saponin and terpenoid, flavanoid have been found to be responsible for both analgesic and anti- inflammatory actions Devadaru having Snigdha Guna, Ushna Virya, Kapha Vatahara in Karma. Also having analgesic, anti-inflammatory and antioxidant activity. Mahoushada (Nagara) having Guru Snigdha Guna, Ushna Virya, Madhura Vipaka and Vatakaphahara Karma. It also improves Deepana, Pachana and also act as Sophahara.

Anupana: Tila Taila is selected as Anupana. Tila Taila has Guru Snigdha Guna Madhura, Tikta Kashaya Rasa Ushna Virya and Madhura Vipaka. Also, Tila Taila Vataghna, Balya and Sthairyakara.

Dose: The dose administered was 25 ml of Kwatha along with 3 ml of Koshna Tila Taila, taken twice daily. This dosage was selected based on previous studies involving Rasnapanchaka Kwatha to ensure consistency with standard drug protocols.

Aushadha Sevana Kala: Aushadha Sevana Kala is Adhobhakta, after meals. As per Ayurvedic science Adhobhakta Aushadha Kala is indicated in Vyanavayu Vikriti. As in Janusandhigata Vata both the Shleshaka Kapha and Vyana Vayu are affected, this Aushadha Kala has been selected for the study in the groups.

Conclusion

In clinical comparison, both drugs produced notable and effective outcomes individually. Within each group, both drugs showed significant results before and after treatment in all parameters except Atopa. Although the results for tenderness and stiffness were not statistically significant, improvements in symptoms were observed. The effect of the drugs was maintained even after the treatment till the period of follow up. On comparing between two groups, there was no statistically significant difference in the effect of treatment. This indicating that both Kwathas are therapeutically effective in treating Janusandhigata Vata.

References

1. Acharya Agnivesha, Charaka Samhitha, Ayurveda Deepika Commentary of Chakrapanidatta, Edited by Vaidya Yadavji Trikamji Acharya, Chaukambha Surbharati Prakashan, Edition: Reprint 2008, Chikitsa Sthana, 28 th Chapter, Shloka no. 37, Page no. 618

2. API Text Book of Medicine, Edited by Sidharth N Shah, 8th Reprint Edition, Association of Physicians of India, Volume -1, 5th Chapter, Page no. 283

3. Pal C.P, Singh P, Chaturvedi S et.al. Epidemiology of knee osteoarthritis in India and related factor. IJOO50,518-522(2016). https://doi.org/10.4103/0019- 5413.189608

4. Sharangadhara, Sharangadhara Samhitha, English Translation by Himasagarachandramurthy P.H, 2nd Edition 2007, Chaukambha Press, Varanasi, 1 st Chapter, Shloka no.89-94, Page no. 126

5. Das Govind, Bhaishajya Ratnavali, Hindi Commentary by Ambikadattashasthri Published by Chaukambha Sanskrit Sansthan, Varanasi, 29th Chapter, Shloka no. 156 -161, Page no. 625

6. Chakrapanidatta, Chakradatta Chikitsa Sangraha, English Translation by Prabhakararao.G, Chaukambha Orientalia Varanasi, 22nd Chapter, Shloka no. 72- 75, Page no. 217

7. Acharya Sushrutha, Sushrutha Samhitha, Nibandha Sangraha commentary of Dalhana, Edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukambha Publications Chikitsa Sthana, 4 th Chapter, Shloka no. 8, Page No. 420GHJHK

8. Sir Stanley Davidson’s Priciples and Practice of Medicine, Edited by John A.A. Hunter et al, 20th edition, Churchill living stone, 25th Chapter, Page no. 1100

9. Tripathi Indradeva, Gadanigraha, Revised Edition 2011, Chaukambha Sanskrit Sansthan, Varanasi, Volume 2nd, Kayachikitsa Khanda, 19th Chapter, Shloka no. 207, Page no. 517

10. Chakrapanidatta, Chakradatta Chikitsa Sangraha, English Translation by Prabhakararao.G Chaukambha Orientalia Varanasi, 25th Chapter, Shloka no. 7, Page no. 264

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