MANAGEMENT OF SANDHIGATA VATA BY ERANDA TAILA: A CASE SERIES

Homeostasis of Vata, pitta and Kapha dose maintain the normal physiology of body. Any internal and external factor which disturb the normalcy of tri-doshas will lead to generation of diseases. The prevalence of Vatavyadhis such as Gridhrasi, Amavata is continuously increasing day by day. Sandhivata is the disease described under vatavyadhi. Knee joint and small joints are more prone to be affected by this disease because they are the most commonly used joints in daily works. Aim of this study is evaluate the effect of Eranda tail in pure vata originated sandhivata at time of its accumulation. The study was a consecutive case series done on an OPD basis to study the preand post-effect of the treatment regime mentioned earlier on patients suffering from sandhivata. This study was conducted on five patients of sandhivata, in whom eranda tail was given as Shamana medicines for the 90 days at time of accumulation of vata dosha in grishma ritu. Use of eranda tail at time of accumulation of vata dosha showed significant improvement in symptoms of sandhivata on first year and showed complete remission of the disease if we give it for consecutive 2 years. It was concluded that the use of any shaman type shodhan aushadhi at time of accumation of dosha will subside that dosha and not allow it to convert into an ailment.


INTRODUCTION
Homeostasis of Vata, pitta and Kapha dose maintain the normal physiology of body. Any internal and external factor which disturb the normalcy of tri-doshas will lead to generation of diseases. Any identifiable or unidentifiable consistent changes in diet and lifestyle will leads to accumulation of particular dosha, finally convert into that dosha specific disease.
Union of two or more bones in body forms a sandhi. In study context sandhi specifically used for movable joints which are used to perform any movement. Gata vata is the concept of Acharya charka in charaka samhita.  Sandhigata vata is explained by Acharya charaka with two specific symptoms one shotha (inflammation) and second is prasaran akunchano pravritti cha savaidna (pain or stiffness during movement) . Alleviated vata dosha is the main causative factor with various reasons for the development of sandhivata. That aggravated vata starts affecting the sandhi especially by reduction in kapha causes pain while movements. That change leads to friction in the movement which will produce inflammation in and around the accessible parts of the affected joints.
Modern pharmacological management for such ailment includes the prescription of analgesics and Non-Steroid Anti Inflammatory Drugs (NSAIDs), but their use provides temporary relief to patient, but progression of the disease is still on its pace associated with adverse reactions. From here use of alternative therapies is on recommendation.
Plan of the treatment is based out of incidental finding in patients during OPD. Need for the study, so much research had been conducted but none of them talked about ritu specific ailment. Pain along with stiffness and swelling were only symptoms observed in patients during summers and it will go away once the winter arrives. No typical findings of Arthritis observed in patients, like loss of space and other degenerative changes in routine X-rays. Ayurveda recommend so many treatment protocols for arthritis but for this type of typical Vataj Sandhivata use of sneha should be recommended . Eranda taila is explained in Ayurveda classic specifically for vata dosha originated diseases . Active principles described in text indicate it as a good drug to pacify vata originated diseases.

MATERIALS AND METHODS
Patients suffering from Sandhivata were selected from OPD and IPD of the Department of Kayachikitsa irrespective of their sex, religion, occupation, etc. Patients were diagnosed on the bt asis of signs and symptoms based on Ayurvedic texts. Written informed consent was taken from each patient at the time of registration. After observing all signs and symptoms of sandhivata we advised Erand tail (Castor Oil) in a dose of 10-15 ml per day for 90 days in the months of April, May, and June in summers.

CASE REPORT
The case series included the participants who visited Kayachikitsa OPD of A & Tibbia College and Hospital, Karol Bagh, New Delhi. With primary complaint of Pain, Stiffness and swelling around joints started in summers and resides till the end of rainy season, all the symptoms will automatically subside during winters. Patients had similar complaint of pain, stiffness and swelling at least from three consecutive years.
All demographic data including age, gender, site, occupation, and socioeconomic status are described in Table 1.

CASE PRESENTATION
Case 1 A 53-year-old male came with complaints of pain, inflammation, and difficulty in moving right knee joint. Which started 3 years ago in summers. Symptoms appeared 1 week before visited to Tibbia Hospital OPD. The first symptom appeared after he woke up from bed with feeling of pain in his right knee joints.

Case 2
A 57-year-old Female came with complaints of pain and difficulty in moving small joints and bilateral knee joints. Symptoms appeared 10 days before visited to Tibbia Hospital OPD. Patient continuously using Analgesics and steroids for symptomatic relief. The first symptom noticed by the patient is stiffness in small joints (hands).

Case 3
A 60-year-old female came with pain, stiffness, and inflammation in bilateral knee joints. She visited Tibbia Hospital OPD after 3 days of onset of stiffness and pain. The first symptom appeared after she woke up from bed with stiffness in her bilateral knee joints.

Case 4
A 49-year-old Female came with complaints of pain, inflammation, and difficulty in moving bilateral knee joints more in Left knee. Symptoms appeared approximately 10 days before visited to Tibbia Hospital OPD. Patient is on Analgesics and steroids as prescription to get symptomatic relief. The first symptom appeared after she woke up from bed with pain along with stiffness in her bilateral knee joints.

Case 5
A 63-year-old male came with complaints of pain, inflammation, and difficulty in moving small joints along with bilateral knee joints. Symptoms appeared 15 days before visited to Tibbia Hospital OPD. Patients received medical management, which include NSAIDs and steroids at the time of onset of symptoms. First symptom noticed by the patient is stiffness in small joints (hands and feets).
Symptoms like pain, stiffness and inflammation are noticed in rainy season especially in the month of July and august.

CLINICAL EXAMINATION WITH HISTORY
Symptoms like pain, stiffness and inflammation are noticed in all patients. Complaints starts appearing with milder form of stiffness and pain in the months of summers i.e., May and June. No other signs of Arthritis noticed in x-ray and other radiological investigations. Patients received medical management, which include Analgesic, NSAIDs and steroids at the time of onset of symptoms. Symptoms aggravate in rainy season especially in the month of July, august and September. All patients have similar history with at least 3 or more years.

ASSESSMENT
By Clinical symptoms of Sandhivata explained in Charaka Samhita.

OBSERVATION AND RESULTS
The current case series assessed after administration of Castor Oil for 90 days in summers. Significant relief in pain and stiffness was observed. A significant improvement was noticed in inflammation. Add on to that no signs of pain, inflammation and stiffness were noticed during rainy season. The same medication was used for continuous 2 years in same patter to all the patients. Results showed that significant improvement for first year and no signs & symptoms of sandhivata were noticed after use of castor oil for 2 consecutive years. Some of the research articles were shown the anti-inflammatory SrivastavaP et al. (2013) and analgesic Manpreet et al. (2012) effect of eranda tail. Results also suggest that prognosis is better if duration of the disease is significantly lower in years. In the current study patient 2 and 5 showed significant improvement in stiffness in small joints. Smaller joints showed fast result as compared to large joints.

ANALYSIS AND DISCUSSION
Arthritis can be correlated with Sandhivata in Ayurveda with signs and symptoms. Arthritis needs proper administration of therapy and medications to prevent from irreversible degenerative changes. In conventional therapy administration of Analgesic, NSAIDs and steroids along with physiotherapy were used as early as possible. Here without any conventional therapy or steroids, we used Eranda tail (Castor Oil) which alleviate the main dosha responsible for Sandhivata.
To reduce the prokopita vata, sneha is the one of the options given by Acharya charaka. Out of 4 types of sneha tail (Oil) is the best choice. Eranda taila is having madhura rasa, teekshna, pichila guna, and is having rukhara and sopha hara property Vagbhata and Astanga (2007). Eranda tail has Madhura rasa with Ushna guna which are against the normal properties of Vata. Adding to that it has srotovishodhan property (Clearing the channels) which allows the vata to flow unobstructively. Acharya sushruta clearly mentioned it as Vatakaphahara and Adhobhaga dhoshahar means it's good for the alleviation of vata also it has purgative action. Shashtry and Sthana (2021) Purgation is one out of five shodhan (purification therapy) methods given in Ayurveda classics. Purgation has madhyam vata shamaka property. Cumulatively eranda tail not only pacify vata by its active principles but also by its prabhava karma.
Relationship of doshas with seasons is well explained by Acharya charaka. Clearly mentioned that the vata dosha sanchaya (natural accumulation of vata) is done in grishma ritu (summers). And its natural prakopa (aggravation) is held in varsha ritu (rainy season) . Due to faulty lifestyle and eating habits aggravation of vata go beyond the natural level and leads into the formation of diseases like sandhivata. Similar situation is noticed in all patients. As per Ayurveda principle given by Acharya Sushruta if we alleviate the dosha at time of accumulation, no further aggravation will be noticed Shashtry and Sthana (2021).

CONCLUSION
The current case is based on the management of patients on an OPD basis who are diagnosed with Sandhivata. Treatment is advised purely on sidhantik (Principle) way which was easy to use and cost-effective. Medications possessing Vatahara property were found to be very useful in the management of sandhivata at time of accumulation of dosha. No other conventional medicines were given during the course of treatment. The current study provides a way for more clinical trials to evaluate the effect of Eranda tail (Castor Oil) in the management of pure Vataj Sandhivata especially at the time accumulation of vata.