Bangalore Karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE – KARNATAKA COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

“A COMPARATIVE STUDY TO EVALUATE MULAKADI TAILA PARISHEKA AND TILA TAILA JANU BASTI IN JANU SANDHIGATA VATA W.S.R TO OSTEOARTHRITIS”

BY DR.TAHEER AHMED.J.K. 1st YEAR M.D. (PANCHAKARMA) SCHOLAR Dept. of PG Studies in Panchakarma, BMJ Ayurvedic Medical College, Hospital And PG Centre, Gajendragad – 582114

DR.RAMESH.N.GENNUR M.D. (AYU) Professor Dept. of PG Studies in Panchakarma, BMJ Ayurvedic Medical College, Hospital And PG Centre, Gajendragad - 582114 2012 – 2013

B M J AYURVEDIC MEDICAL COLLEGE, HOSPITAL AND PG CENTRE, GAJENDRAGAD – 582114, GADAG (Dist.), KARNATAKA From- DR. TAHEER AHMED.J.K. 1st Year M.D (Panchakarma) Scholar, Dept. of PG Studies in Panchakarma, B M J Ayurvedic Medical college, Hospital And PG Centre, Gajendragad – 582114 To, THE REGISTRAR, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. Through- The Principal and Head of the Department in Panchakarma, B M J Ayurvedic Medical college, Hospital and PG Centre, Gajendragad, Dist. Gadag , Karnataka. Subject: Submission of completed Proforma for registration of subject for Dissertation. Respected Sir, 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, Bangalore for the partial fulfilment of M.D. (PANNCHAKARMA). TITLE OF DISSERTATION: “A COMPARATIVE STUDY TO EVALUATE MULAKADI TAILA PARISHEKA AND TILA TAILA JANU BASTI IN JANU SANDHIGATA VATA W.S.R TO OSTEOARTHRITIS” Herewith I am enclosing the completed Proforma for registration of subject for dissertation. Thanking you, yours faithfully, Place: GAJENDRAGAD Date : (Dr. TAHEER AHMED.J.K.)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE – KARNATAKA ANEXURE – II COMPLETE PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1) NAME OF THE CANDIDATE : DR.TAHEER AHMED.J.K.

M.D (PANCHAKARMA) SCHOLAR DEPT. OF PG STUDIES IN PANCHAKARMA, BMJ AYURVEDIC MEDICAL COLLEGE, GAJENDRAGAD-582114 PERMANENT ADDRESS : S/O. J.R.KEMBHAVI BEHIND ALI KA ROZA HALLI COLONY BIJPUR – 586101 DIST: BIJAPUR, KARNATAKA. 2) NAME OF THE INSTITUTION: BMJ AYURVEDIC MEDICAL

COLLEGE, HOSPITAL AND PG CENTRE, GAJENDRAGAD-582114 DIST. GADAG, KARNATAKA

3) COURSE OF THE STUDY : M.D. (PANCHAKARMA)

AND SUBJECT 4) DATE OF ADMISSION : 15-09-2012

5) TITLE OF THE TOPIC : “A COMPARATIVE STUDY TO EVALUATE MULAKADI TAILA PARISHEKA AND TILA TAILA JANU BASTI IN JANU SANDHIGATA VATA W.S.R TO OSTEOARTHRITIS”

6. BRIEF REVIEW OF INTENDED WORK. 6.1 NEED FOR THE STUDY: Sandhigatavata is a condition in which vitiated vayu gets localized in sandhi and causes shoola, shotha and sthambha leading to reduced movements. Sushruta has included Vatavyadhi as one among the Ashta mahagadha, which is a yapya vyadhi.1 Janusandhigatavata can be compared with knee joint Osteoarthritis of contemporary medical science. Osteoarthritis is the second largest musculoskeletal disorder in the world population (30%) after back pain (50%)2. There is steady rise in the prevalence from age 30 such that by 65, 80% of people have radiographic evidence of OA, though only 25 to 30% are symptomatic3. Osteoarthritis is characterised by focal loss of cartilage with accompanying perticular bone response in the form of subchondral bone sclerosis & attempted new bone formation by a way of bony over growth called osteophytes.OA involves all components of the joints including bone, cartilage, meniscus & synovium.OA clinically presents as joint pain and crepitus in the elderly, knee joint involment is typically associated with pain on descendinng or ascending stairs,stiffness in joint on first awaking.4 Sandhigatavata is a type of Vatavyadhi characterized by vata purna druti sparsha, Shotha, Vedana during Prasarana and Akunchana5. Acharya Bhavamishra while explaining Vatavyadhi explained about Sandhigatavata6. Acharya Sushruta7 and Madhavakara8 have added Sandhi Shoola, Atopa, Sandhi Hanti. Snehana and Swedana Karma have prime importance in management of Sandhigatavata. Swedana Karma plays a major role in alleviating the pain and stiffness of joints9. According to Acharya Charaka, swedana relieves stiffness, heaviness and coldness of the body and it expels out the body sweat10. Janubasti is a procedure of Snehana along with Svedana, basically evolved from Shirobasti one among the moordhini tailas. Here the heated Sneha is allowed to stay for a stipulated duration in the affected joint11. Tila taila is mentioned as best among the Taila varga which possesses vatahara property12. Mulakadi taila is vatahara & can be used both internally and externally.13,14 Parisheka is a type of drava sweda were luke warm kashaya, taila, ksheerapaka is poured in a regular stream on the whole body or the affected part15. Here an attempt is made through this study to evaluate the effect of Parisheka swedana with mulakadi taila and Janu basti with Tila taila in janu sandhigata vata with respect to osteoarthritis. 6.2 REVIEW OF LITERATURE: The review of literature includes a thorough screening of Ayurvedic texts, contemporary Ayurvedic literatures, modern texts and the internet sources to collect sufficient data. Some of the texts are as follows.  Sandhigatavata is explained in Vatavyadhi nidana of Sushrutha Samhita1.  API text book of medicine. Chapter 19,7th edition.  Davidson’s principles and practice of medicine mentions about prevalence, symptoms and treatment of degenerative disease of knee.3  API text book of medicine. Chapter 19,7th edition.  Nidana, samprapti and lakshanas of Sandhigata Vata are explained in Charaka samhita, chikitsa sthana, 28/15-18, 37.  Bhavaprakasha has explained Sandhigatavata along with Chikitsa 22nd Chapter.  Madhava Nidana has explained Sandhigatavata under Vatavyadhi adhyaya. PREVIOUS WORK DONE:

 Sandeep.G.Patel – A Observational study to evaluate the effect of vasa in form of janu basti in the management janu sandhigata vata(osteoarthritis). Hassan R.G.U.H.S Bangalore 2007.  Dr.Sandeep –Effect of jalaukavacharana & janu basti in vedana of janu sandhigata vata-A comparative clinical study Mysore, R.G.U.H.S Bangalore2006.

 Dr.Basant–Comparative study on the effect of janu basti with Dashamoola kwatha & Hot water. Hassan R.G.U.H.S Bangalore 2005  Dr.Gururaja – A study on the rffrct of different preprations of Dashamoola in the form of janu sandhigata vata Hassan R.G.U.H.S Bangalore 2004.  Dr.Bose - A controlled clinical study on the effect of janu basti in janu sandhigata vata. Mysoere, RGUHS, Bangalore 2001.  Kavya.T.G – A comparative study on the effect of janu basti & janu pichu with ksheera bala taila in the managamant of janu sandhigata vata (osteoarthritis of knee joint). Hassan R.G.U.H.S Bangalore 2010. 6.3 OBSERVATION:

 To evaluate the effect of Janu Basti with Tila Taila on Janusandhigata Vata.  To evaluate the effect of Parisheka Tai with Mulakadi taila on Janusandhigata Vata.  To compare and ascertain the effect of Janu Basti with Tila Taila & parisheka with Mulakadi taila on Janusandhigata Vata.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA: Patients attending O.P.D & I.P.D of BMJ ayurvedic Medical College, Hospital and PG Centre Gajendragad & from Spcial camps conducted BMJ ayurvedic Medical College, Hospital Gajendragad selected for the study.

1. Literary source: All the Ayurvedic texts, contemporary Ayurvedic literatures and internet sources about the disease, drug & procedure will be reviewed & documented for the Intended study.

2. Drug source: The drugs Mulaka will be collected from local areas after proper identification and the oil will be paepared from BMJ pharmacy .Murchita Tila taila will be prepared .

3. Sample source: Patients suffering from Janusandhigata vata will be selected from O.P.D & I.P.D of BMJ ayurvedic Medical College, Hospital and PG Centre Gajendragad & from Spcial camps conducted BMJ ayurvedic Medical College, Hospital Gajendragad selected for the study.

7.2 METHOD OF COLLECTION OF DATA: A minimum of 40 patients fulfilling the diagnostic and inclusion criteria of either sex will be selected for a single blind comparative clinical study. They will be randomly assigned into two equal groups A and B. a) STUDY DESIGN: A Comparative study. b) SAMPLE SIZE AND GROUPING: Total number of patient taken for the study will be 40 into two groups A and B. c) INCLUSIVE CRITERIA:  Patients fulfilling the above mentioned diagnostic criteria.  Patients aged above 30 yrs & below 70yrs.  Patients fit to undergo Janu Basti.  Patients fit to undergo parisheka.

d) EXCLUSION CRITERIA:

 Patients aged below 30yrs & above 70yrs  Pregnant and lactating mothers.  Patients suffering from systemic disorders which would interfere with the present Study.  Patients suffering from Impaired Temperature sense.  Deformity of joints.

e) DIAGNOSTIC CRITERIA:

 Pain in unilateral or bilateral Knee joints.  Radiographic evidence of Degenerative disease of Knee joint.

Plan of study: Procedure :

GROUP - A  Janubasti using Murchita Tila Taila for a period of 30 minutes for 7 days.

GROUP – B  Parisheka using Mulakadi taila for a period of 30 minutes for 7 days. f) STUDY DURATION:  7 days Follow up period:  14 days Total study duration:  21 days

Observations:

 Before treatment.  On the 7th day of treatment.  On the 14th day of study period.  On the 21st day of study period.  Pathya has followed g) ASSESSMENT OF RESULTS: Assessment of the condition will be done on a detailed proforma adopting standard methods of scoring of subjective & objective parameters and will be statistically analyzed by using paired ‘t’ test for within group comparison and Two independent sample ‘t’ test for between group comparison. Other tests will be adopted as per the requirement.

h) PARAMETERS OF THE STUDY: The parameters of assessments were totally based on relief of clinical features of sandhigata vata.

SUBJECTIVE CRITERIA OBJECTIVE CRITERIA . Pain . Swelling . Tenderness . stiffness . Crepitus . Range of Movement of joints

SUBJECTIVE PARAMETERS:

PARAMETERS GRADINGS NO Pain 0 Mild pain 1 Moderate pain 2 Severe pain 3 Siffness Normal flexion 0 Mild Restriction 1 Moderate Restriction 2 Severe Restriction 3

OBJECTIVE PARAMETERS:

PARAMETERS GRADINGS Swelling absent 0 Swelling present 1 Tenderness No tenderness 0 Complains pain on Touch 1 Withdraws joint on Touch 2 Patient does not allow to Touch the joint 3 Crepitus No Crepitus 0 Palpable crepitus 1 Audiable crepitus 2

Range of movements of joints using goniometer PARAMETERS GRADINGS Normal flexion 1350 0 Less than 1350 and more than 1000 1 Less than 1000 and more than 750 2 Lesser than 750 3 i) STATISTICAL ANALYSIS: Statistical analysis will be made using paired standard t test.

7.3 Laboratory Investigations: This study will be conducted clinically. No animal experiment will be carried out.

 Routine hematological and urine examinations will be done to assess the general condition of the patient as well as to exclude other diseases.

 X- Ray of affected knee joint- AP & Lateral view BT &AT.

 RA Test.

 Other investigations according to the need.

7.4 Has ethical clearance been obtained from your institution?

The ethical clearance has been obtained by the ethical committee formulated in this institution.

8 List of References: 1. DR. Kaviraj Ambikadutta Shastri, Sushrutha Samhita of Maharshi Sushrutha edited with Ayurveda Tantra Sandipika Hindi commentary part -1 Nidanasthana Chapter- 1/28, 11th Edition, Varanasi: Chaukhambha Sanskrit Samsthan; 1997, P-230.

2.Siddharth N Shah, API text book of medicine. Chapter 19,7th edition. The Association of Physicians of India; 2003, P-1151.

3.Sir Stanley Davidson, Davidson’s Principles and Practice of Medicine, Edited by John A.A hunter, 20th edition, Churchill living stone (international editor):2006, P-1096.

4.Siddharth N Shah, API text book of medicine. Chapter -19, 7th edition. The Association of Physicians of India; 2003, P-1151.

5.AcharyaVidyadhar Shukla & Prof. Ravidutt Tripathi, Charaka samhita of Agnivesha elaborated by charaka & deducted by Dradabala edited with Vaidyamanorama Hindi commentary Vol-2, chikitsa sthana Chapter- 28/37, Delhi: Choukambha Sanskrit vishwabharti ; Reprint-2006, P-620.

6.Bhishakratna Shree Brahma Shankar Mishra Shastri, Bhavaprakasha, Uttaraardha Chapter- 24/258, 9TH Edition, Varanasi: Chowkhambha Sanskrit Samsthan; 2005, P- 264.

7.DR. Kaviraj Ambikadutta Shastri, Sushrutha Samhita of Maharshi Sushrutha edited with Ayurveda Tantra Sandipika Hindi commentary part -1 Nidanasthana Chapter- 1/28, 11th Edition, Varanasi: Chaukhambha Sanskrit Samsthan; 1997, P-230. 8.Mahamahopadyaya Shri Vijayarakshita & Srikanthadatta, Madhavanidanam, of shri madhavakar Edited with madhukosha commentary part-1, 22nd Chapter,Vatavyadhi nidana, Edited by Prof. yadunand upadhyaya, 13th Edition, Varanasi: Chaukhamba Sanskrit Bhavan; 2002, P-520. 9. Dr Nirmal Saxena, AcharyaVangasena, Vangasena samhita Vol-II. Swedadhikara. shloka 15-16, 1st edition, Varanasi: Chaukhambha Sanskrit Series; 200, P-1129.

10. AcharyaVidyadhar Shukla & Prof. Ravidutt Tripathi, Charaka samhita of Agnivesha elaborated by charaka & deducted by Dradabala edited with Vaidyamanorama Hindi commentary Vol-1,Sutra sthana Chapter- 22/11, Delhi: Choukambha Sanskrit vishwabharti ; Reprint-2006, P-120.

11.Kaviraja Atrideva Gupta, Ashtanga Hridayam of Acharya Vagbhata edited with the vidyotini Hindi commentary, Sutrasthana Chapter- 22/27, edited by Vaidya Yadunandana Upadhyaya, 4th edition, Varanasi: Chaukhambha Prakashana; Reprint- 2009, P-172.

12. . AcharyaVidyadhar Shukla & Prof. Ravidutt Tripathi, Charaka samhita of Agnivesha elaborated by charaka & deducted by Dradabala edited with Vaidyamanorama Hindi commentary Vol-1,Sutra sthana Chapter- 25/4, Delhi: Choukambha Sanskrit vishwabharti ; Reprint- 2006, P-330.

13. Shri Govinda Dasji virchita Bhaisajyaratnavali Vol-2, Chapter- 26/284-288, commented upon by Vaidya kaviraj Ambikadutta Shastri, edited & enlarged by bhisagratna Shri brahmashankar mishra , English translation by kanjiv Lochan Vol-2, 1ST Edition –2006, Varanasi: Chaukamba Sanskrit bhavan; 2006, P-181.

14. Chakradatta by P.V.Sharma, Chakrapanidutta virachita Chapter 22/142-146, 3rd Edition, 2007, Delhi: Chaukambika Orientalia, P-199.

15. AcharyaVidyadhar Shukla & Prof. Ravidutt Tripathi, Charaka samhita of Agnivesha elaborated by charaka & deducted by Dradabala edited with Vaidyamanorama Hindi commentary Vol-1,Sutra sthana Chapter- 14/44, Delhi: Choukambha Sanskrit vishwabharti ; Reprint-2006, P-171. . 9. SIGNATURE OF CANDIDATE: 10. REMARKS OF THE GUIDE:

11. NAME & DESIGNATION (In block Letters)

11.1 Guide: DR.RAMESH.N.GENNUR M.D. (AYU) PROFESSOR Department of PG Studies in Panchakarma, BMJ Ayurvedic Medical College And PG Centre Gajendragad, Dist. Gadag, Karnataka. 11.2 Signature:

11.3 Co-Guide (if any): 11.4 Signature:

11.5 Head of the Department: DR.B.V.SESHADRI M.D. (AYU)

PROFESSOR & HOD Department of PG Studies in Panchakarma, BMJ Ayurvedic Medical College And PG Centre Gajendragad, Dist. Gadag, Karnataka. 11.6 Signature:

12. 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL: 12.2 Signature: