Clinical pilot study evaluation of avartana-processed Panchatikta guggulu ghrita matra basti in janusandhigatavata (osteoarthritis of the knee): A case series of five patients

Abstract

Background: Knee osteoarthritis is the commonest degenerative joint disorder and a leading contributor to years lived with disability in adults above sixty. In Ayurveda it is understood as Janusandhigatavata, a Vatavyadhi produced by Dhatukshaya and Srotorodha at the Sandhi. Contemporary care is largely symptomatic, is limited by gastrointestinal, renal and cardiovascular adverse effects, and ends in arthroplasty for advanced disease, so safer non-invasive options are needed. Aim: To document the clinical response of five patients of Janusandhigatavata to Matra Basti with Sapta-Avartita (seven times reprocessed) Panchatikta Guggulu Ghrita, and to relate the physicochemical changes produced by Avartana to the observed clinical outcome. Materials and methods: Five patients attending the Panchakarma outpatient department of Parul Institute of Ayurved, Vadodara, received Matra Basti of 40 ml of Sapta-Avartita Panchatikta Guggulu Ghrita once daily for eight consecutive days. Each Basti was preceded on the same morning by Sarvanga Abhyanga with Mahanarayana Taila and Bashpa Sweda with Dashamula Kwatha, and was administered within thirty minutes of a light midday meal. Rasnadi Guggulu, Panchakola Churna and Shunthi-siddha Jala were given orally. Shoola, Sandhigraha, Vatapurna Drutisparsha, Prasarana-Akunchana Vedana and Sandhishotha were graded 0-3 before treatment and on days 10, 16 and 25. The ghrita was analysed after each Avartana against Ayurvedic Pharmacopoeia of India methods. Results: Every patient improved on every parameter. The mean total symptom score fell from 6.8 to 1.0, a relief of 85.3 per cent (range 75-100 per cent). No adverse event occurred. Saponification value, viscosity, specific gravity and refractive index rose while acid value, iodine value and loss on drying fell after seven Avartanas. Conclusion: Forty millilitres of Sapta-Avartita Panchatikta Guggulu Ghrita given as Matra Basti produced consistent, well tolerated symptomatic relief in Janusandhigatavata and merits a controlled trial.