Acu Read

A COMPREHENSIVE STUDY ON MARMA &
ACUPUNCTURE POINTS AND EVALUATION OF THEIR

THERAPEUTIC IMPORTANCE

BY
Dr. VIVEK.J.
B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health
Sciences, Bangalore, for the partial fulfillment for the Degree
Of
MASTER OF SURGERY
(Ayurveda Dhanvantari)
In
SHALYA TANTRA
Under the guidance of
Dr. VENKATESH.B.A
B.S.A.M., B.A.M.S., M.D (SHALYA TANTRA)
Professor & HOD
Department of Post Graduate Studies in Shalya Tantra
Government Ayurveda Medical College, Bengaluru.

DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA
GOVERNMENT AYURVEDIC MEDICAL COLLEGE
DHANWANTARI ROAD, BANGALORE 560009
2010-2011
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A COMPREHENSIVE STUDY ON MARMA &
ACUPUNCTURE POINTS AND EVALUATION OF THEIR
THERAPEUTIC IMPORTANCE

BY
Dr. VIVEK.J.
B.A.M.S

Dissertation submitted to the Rajiv Gandhi University of Health
Sciences, Bangalore, for the partial fulfillment for the Degree
Of
MASTER OF SURGERY
(Ayurveda Dhanvantari)
In
SHALYA TANTRA
Under the guidance of
Dr.VENKATESH.B.A
B.S.A.M., B.A.M.S., M.D (SHALYA TANTRA)
Professor & HOD
Government Ayurveda Medical College, Bengaluru.

DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA
GOVERNMENT AYURVEDIC MEDICAL COLLEGE
DHANWANTARI ROAD, BANGALORE 560009
2010-2011

Government Ayurvedic Medical College
Bangalore - 560009

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled A COMPREHENSIVE STUDY
ON MARMA & ACUPUNCTURE POINTS AND EVALUATION OF THEIR
THERAPEUTIC IMPORTANCE is a bonafide research work done by
Dr. VIVEK.J in partial fulfilment of the requirement for the degree of
M.S. (Ayurveda Dhanvantari).

Date: Dr.VENKATESH.B.A.
B.S.A.M., B.A.M.S., M.D (Shalya Tantra)
Professor & HOD
Department of P.G. Studies in Shalya Tantra
G.A.M.C., Bengaluru 9.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled A COMPREHENSIVE
STUDY ON MARMA & ACUPUNCTURE POINTS AND EVALUATION OF
THEIR THERAPEUTIC IMPORTANCE is a bonafide and genuine
research work carried out by me under the guidance of
Dr.Venkatesh.B.A, Professor & HOD, Dept of PG studies in Shalya
Tantra, Government Ayurvedic Medical College, Bengaluru 9.

Date:
Place Signature of the candidate
Dr. Vivek.J
B.A.M.S

Government Ayurvedic Medical College
Bangalore - 560009

ENDORSEMENT BY HOD, PRINCIPAL /
HEAD OF THE INSTITUTION.

This is to certify that the dissertation entitled A COMPREHENSIVE
STUDY ON MARMA & ACUPUNCTURE POINTS AND EVALUATION OF
THEIR THERAPEUTIC IMPORTANCE is a bonafide research work done by
Dr. Vivek.J in partial fulfilment of the requirement for the degree of AYURVEDA
DHANVANTARI MS (Ayurveda) in Shalya Tantra under the guidance of
Dr.Venkatesh.B.A, Prof., Dept of PG studies in Shalya Tantra. I recommend
this dissertation for the above degree to the University for Assessment
and approval.

Dr. B. A. Venkatesh
Prof. & Head of the
Department, Department of
P.G. Studies in Shalya Tantra,
G.A.M.C Bengaluru 9.

Date:
Place:

Principal
G.A.M.C Bengaluru 9.

Date:
Place:

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore, shall have the rights to preserve, use and
disseminate this dissertation in print or electronic format for Academic or
Research purpose.

Date:
Place:
Signature of the Candidate
(Dr.Vivek.J)

Rajiv Gandhi University of Health Sciences, Karnataka.

ACKNOWLEDGEMENT

I offer my prayers at the lotus feet of Lord Dhanvantari without whose grace this
dissertation work would not have taken shape
No work is a result of individual effort. It is contributory effort of many hearts,
hands and heads. It gives me immense pleasure to offer my sincere thanks to all those
who have rendered their wholehearted support, guidance and Co-operation in completing
my thesis work.
I find short of word to express my deepest gratitude & heartfelt thanks to my
Guru, Guide Dr.Venkatesh.B.A, Prof. & HOD, Dept. of P.G. studies in Shalya Tantra,
G. A. M. C Bengaluru for his critical suggestions, expert guidance the support extended
by him in providing all the amenities needed to complete my work in time.
I am very much thankful to Prof. Dr. R. Vijayasarathi, Prof. Dr. Ahalya, and
Asst. Prof. Dr. Shridhar M.S, Asst. Prof. Dr. Narmada for their kind co-operation,
encouragement & suggestions for my study.
I am also thankful to Dr. Mangalagi.S.G, MD (Ayu) Principal, Govt Ayurvedic
Medical College, Bangalore, for their timely help during the period of my study.
I am grateful to Dr.Harish Babu, Naturopathy Physician, SJ IIM Hospital, Blore,
Mr.Hifzulla a well known Acupuncturist, practising in J aynagar & Mr.Sadhashiv
Datar, Laser Acupuncturist, Holistic Health Care Centre, Malleshwaram, Blore,for their
support and guidance in carrying out this work.
My deep sense of gratification is for my parents Sarvamangala, Late.
Y.R.Jagadeesha, brother Sudharshan, sister in law Roopa, who are the architects of
my career to reach up to here. The culture, discipline and perseverance, which I could
imbibe, are solely because of their painstaking, upbringing and strong moral support.
My sincere thanks to the lecturers Dr. Shivu Arakeri, Dr. Shrinivas Masalekar
& Dr. Durgesh.I am highly indebted to Dr.K.Ravishankar, for analysing the data
obtained during my work & making a final picture out of the same.
In my moment of happiness I am totally indebted to my wife Dr.Kavitha.C who
has patiently borne with me ever since I joined P.G. studies till date.
I am thankful to my sister in law, brother in law & parentsin-law who have been
a source of encouragement.
At this point, it would be ungrateful if I do not recall my classmates Dr.Divya
Lakshmi, Dr. Jayanth, Dr. Jayashri Prasad, Dr. Prashanth Shetty.G, Dr.Lakshman
Shivalli, Dr. Manjunath Joshi & Dr.Lokanath Avdhani who have been egging me on
throughout the study with their valuable inputs
I am thankful to my seniors Dr.Rajeshwari, Dr.Sweta, Dr.Veena, Dr.Abhinetri
Dr.Ramya, Dr.Nadaf & Dr.Vishwanath Sharma for their timely advice.
I am thankful to Dr. Poornima, Dr.Nazira, Dr.Reshma, Dr.Aditya,
Dr.Durdundi, and Dr.Sushendra & Dr.Ravishankar for their support.

I am thankful to the librarians and staff of U.G & P.G libraries for providing the
necessary books for this work.
Lastly I am thankful to one and all who have directly or indirectly helped me in
completing my work.

Date: (Dr.Vivek.J)
Place:
ABSTRACT

J anu Sandhigata Vata or Osteoarthritis of the knee is a major cause of disability
among adults. No cure for osteoarthritis currently exists. Treatment focuses on
managing the pain and dysfunction associated with the disease. Acupuncture is an
effective treatment for management of pain and physical dysfunction associated with
osteoarthritis of the knee.
Since J anusandhigata Vata manifests in J anu Marma, Suchi Vyadha (an art of
introducing delicate fine Suchi into different sensitive points in and around janu
marma with in the radius of 3 angula) is done to stimulate janu marma & in turn to
stimulate sandhi avayavas present in it. So that it helps in relieving the pain &
promotes sandhi poshana & thus helps in early repair of dhatu kshayata & restores
normal joint integrity.
OBJECTIVES OF THE STUDY
To review the literature on concepts of Marma & Traditional Chinese
Acupuncture Points.
An attempt to establish the relevance of Marma Sthana with that of
Acupuncture Points.
To evaluate the Therapeutic Effect of Suchivyadha Chikitsa on J anu Marma in
J anu Sandhigata Vata (Osteoarthritis of the Knee J oint).
To evaluate the Therapeutic Effect of Acupuncture in the management of J anu
Sandhigata Vata (Osteoarthritis of the Knee J oint).
STUDY DESIGN
A total number of 40 patients were selected randomly for the present clinical study.
These 40 patients were divided into 2 groups. Group A & Group B, each consisting of

20 patients. Patients of Group A were treated daily by Suchivyadha on J anumarma for
12 sessions & for about 30 minute duration. And patients of group B were treated
daily by Acupuncture on Acupuncture points for 12 sessions & for about 30 minute
duration.

The improvements in the Subjective Parameters and Objective parameters
were assessed by scoring method. The subjective criteria were scored in accordance
with Index of severity of Osteoarthritis of the Knee by Lequesne et al & WOMAC.
(Western Ontario & Mc Master Universities). Tenderness, Crepitus, Range of
movement of Knee, Time taken to walk 50 metres of distance & Radiological changes
are taken as objective parameters.

In Group A out of 20 patients 8 patients (40%) showed marked improvement,
6 patients (30%) showed moderate improvement & 6 patients (30%) showed mild
improvement.
In Group B out of 20 patients 10 patients (50%) showed marked improvement,
improvement.

Key Words: Sandhigata Vata, Suchi Vyadha, Acupuncture.

LIST OF TABLES

Table
No.
Contents
Page
no.
1 Showing Shaka Marmas 12
2 Showing Udara(Koshta ) Marmas 14
3 Showing Uro Marmas 14
4 Showing Prishta Marmas 15
5 Showing J atrurdhwa Marmas 18
6 Showing Description of Marmas According to vaghbhata Acharya 21
7 Showing Marmas in controversy on the basis of classification 23
8 Showing prognostic classifications of Marmas based upon Trigunas &
Panchamahabhutas.

24
9
Showing Acupuncture points and meridians
33
10 Showing Number of Sandhis according to different texts 59
11 Showing the sites of different Sandhis 60
12 Showing the muscles producing movements of the Knee joint 65
13 Showing the Aharaja Nidana 67
14 Showing the Viharaja Nidana 68
15 Showing the Manasika Nidana 69
16 Showing Anya Nidana 70
17 Showing the roopa of Sandhigata Vata according to different texts 74
18 Showing causes of J oint pain in patients with OA 76
19 Showing the Kellgren- Lawrence Radiographic Grading Scale 78
20 Showing the Chikitsa sutra of Sandhigata Vata according to different
texts
85
21 Showing Subjective and objective parameter 108
22 Showing the sex distribution in both the groups 114
23 Showing overall response based on Sex of the patient 114
24 Showing the age distribution in both the groups 115
25 Showing overall response based on age group. 116
26 Showing the occupation of Patients in both the groups 116
27 Showing overall response based on Occupation 117
28 Showing the religion of the patients in both the groups 117
29 Showing overall response based on Religion 118
30 Showing the socio-economic status of the patients in both
the groups.
118
31 Showing overall response based on Socio-economic Status 119
32 Showing the chronicity of the disease in both the groups 119
33 Showing overall response based on Chronicity 120
34 Showing the diet of the patients in both the groups 121
35 Showing overall response based on Diet 121
36 Showing the family history in both the groups 122
37 Showing overall response based on Family History 122
38 Showing the area involved in both the groups 123
39 Showing overall response based on Area 123
40 Showing overall response for the treatment 124
41 Showing the effect on Pain during nocturnal bed rest. 125
42 Showing the effect of pain after getting up 125
43 Showing the effect on standing for 30 min 126
44 Showing the effect on walking 126
45 Showing the effect on Morning stiffness 126
46 Showing the effect stiffness later in day. 127
47 Showing effect on swelling in joint 127
48 Showing effect on Maximum distance walked. 127
49 Showing effect on walking aid requirement. 128
50 Showing effect on able to climb up stairs. 128
51 Showing effect on able to climb down stairs. 129
52 Showing effect on able to squat. 129
53 Showing effect on able to walk on uneven. 130
54 Showing effect on Getting in/ out of car. 130
55 Showing effect on putting on/ off socks. 130
56 Showing effect on tenderness. 131
57 Showing effect on crepetus. 131
58 Showing effect on Measurement of Rt knee. 131
59 Showing effect on Measurement of Lt knee. 132
60 Showing effect on Movement of Rt knee. 132
61 Showing effect on Movement of Lt knee. 132
62 Showing effect on time taken to walk 50m distance. 133
63 Showing effect on Radiological changes. 133
64 Showing effect on pain during nocturnal bed rest. 133
65 Showing effect on pain after getting up. 134
66 Showing effect on pain on standing for 30min. 134
67 Showing effect on walking. 134
68 Showing effect on morning stiffness. 135
69 Showing effect on stiffness later in day. 135
70 Showing effect on swelling in joint. 135
71 Showing effect on Maximum distance walked. 136
72 Showing effect on walking aid requirement. 136
73 Showing effect on Able to climb up stairs. 137
74 Showing effect on Able to climb down stairs. 137
75 Showing effect on squat. 137
76 Showing effect on walk on uneven 138
77 Showing effect on getting in/ out of car. 138
78 Showing effect on putting on/ off socks. 138
79 Showing effect on Tenderness 139
80 Showing effect on Crepetus. 139
81 Showing effect on Measurement of Rt knee. 139
82 Showing effect on Measurement of Lt knee. 140
83 Showing effect on Range of movement of Rt knee. 140
84 Showing effect on range of movement of Lt knee. 140
85 Showing effect on time taken to walk 50m distance. 141
86 Showing effect on radiological changes 141
87 Showing Results on Comparison of Group A and Group B 142

LIST OF GRAPHS

Graph
No.
Title
Page
No.
1 Showing sex distribution in both the groups. 103
2 Showing age distribution in both the groups 104
3 Showing occupation of the patients in both the groups 105
4 Showing religion of patients in both the groups 106
5 Showing socio-economic status in both the groups 107
6 Showing chronicity of the disease in both the groups 108
7 Showing diet of the patients in both the groups 109
8 Showing family history of patients 110
9 Showing means of Pain after getting up, pain on walking and morning
stiffness in Group A
130
10 Showing the means of swelling, tenderness and crepitus in group A 130
11 Showing means of Pain after getting up, pain on walking in Group B 131
12 Showing means of morning stiffness and stiffness later in day in Group B 131
13 Showing means of swelling, tenderness and Crepitus in Group B

131

LIST OF FIGURES

Sl.
No
Contents Page
No.
1 Marma on Anterior Surface 13
2 Marma on Posterior Surface 16
3 Marmas of Axilla & Elbow 18
4 Marmas of Ventral Surface of
Foot
20
5 Meridians & Acupuncture Points 32
6 Meridians of Lower Limb 33
7 Lung Meridian 33
8 Stomach Channel 34
9 Twenty Gunas & Relationship
With Yin & Yang
44
10 Anterior View of Marma &
Acupuncture Point
49
11 Posterior View of Marma &
Acupuncture Point
50
12 Lateral View of Marma &
Acupuncture Point
51

CONTENTS
PAGE
SL.
NO
CHAPTER
NO.
1 INTRODUCTION 1-3
2 REVIEW OF LITERATURE

a) MARMA REVIEW 4-24
b) REVIEW OF ACUPUNTURE 25-37
c)
COMPARISION OF ACUPUNTURE
& AYURVEDA
38-52
d) DISEASE REVIEW 53-80
e) PROCEDUREREVIEW 81-85
f) REVIEW OF ACUPUNCTURE NEEDLE 86-93
3 MATERIALS AND METHODS 94-102
4 OBSERVATIONS AND RESULTS 103-131
5 DISCUSSION 132-141
6 CONCLUSION 142-143
7 SUMMARY 144-145
8 REFERENCES AND BIBLIOGRAPHY 146-149
9
ANNEXURE

---

ABBEREVIATIONS

Ad: Arunadatta AH: Ashtanga Hridaya
Api: Ayurvedic Pharmacoepia of India Apte: Sanskrit English
AS: Ashtanga Sangraha Dictionary by Apte
AV. Atharva Veda
BH: Bhela Samhita BP: Bhavaprakasha
Bpn: Bhavaprakasha Nighantu BR: Bhaishajya Ratnavali
CA: Charaka Samhita
CD: Chakradatta Ch: Chikitsa Sthana
Cha: Chaurasia, Human Anatomy Cak: Chakrapani
Dal: Dalhana DVD: Davidsons Internal Medicine
Gay: Gayadasa GS: Gheranda Samhita
gud. Var: Guduchyadi Varga HA: Harita Samhita
HM: Harsh Mohans pathology HAR: Harrisons Internal Medicine
har.Var: Haritakyadi Varga Hem: Hemadri
Ka: Kalpa Sthana Khi: Khila Sthana
KS: Kashyapa Samhita MN: Madhava Nidana
Nad: Nadkarnis Indian Materia Medica Ni: Nidana Sthana
OA: Osteoarthritis P.K: Poorva Khanda
pg.no. Page Number Par: Paribhasha Prakarana
SH: Sharangdhara Samhita Sha: Shareera Sthana
Si: Siddhi Sthana SKD: Shabda Kalpa Druma
SMW: Monnier Williams Dictionary SU: Sushrutha Samhita
Su: Sutra Sthana Va. Vya.: Vata Vyadhi Chikitsa
VC: Vachaspatyam vol: Volume
YR: Yogaratnakara WD: Webers Medical Dictionary

Introduction
A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

their Therapeutic Importance.
Dept. of PG Studies in Shalyatantra, GAMC, Bangalore. 1
SECTION 1
INTRODUCTION
Marma is one of the unique & important topics discussed in Ayurveda. It plays
an important role in surgery. Hence it is rightly called as Shalya Vishayardha. The
Marma Chikitsa has evolved as a special branch of treatment extensively practiced in
most parts of Kerala. Many of the basic concepts of Marma in Ayurveda &
Acupuncture point in Chinese system of medicine have a close relevancy.
We get many references of major surgeries being carried out by Sushrutha in
our classics by administering sura or madira. But it seems that there was some kind of
Bandha or Pressure being applied over Marma Sthana which is a seat of prana to
create anaesthetic or analgesic effect for performing surgeries. In present days we see
same kind of analgesic or anaesthetic effect being done by acupuncturists for
performing some minor surgeries & to treat many of chronic ailments.
If we go back to the Indian medical classics, known as the Vedas, said to be
written about 7000 years ago, we find "needle therapy" [Suchi karma] mentioned
there. One volume of the Vedas, known as the Suchi Veda, translated as the "art of
piercing with a needle" was written about 3000 years ago and deals entirely with
acupuncture. Unfortunately this text is not available today. During ancient period,
bamboo or wooden Suchi needles were used for acupuncture. Sushrutha has
mentioned the art of acupuncture under Vyadhana or Bhedhana Karma (Bhedhana
means to pierce or to cut). During ancient time needles made up of wood were used,
later on various metal needles were used for this purpose. Sushruta in Sharira sthana 8
Introduction

Siravyadha has advised puncturing the channels (sira) by using needles, which are as
small as vrihi (vrihi is the outer cover of the rice grain which is pointed at both ends.
The Indians have the knowledge of both body acupuncture and ear acupuncture. Thus
in India, an entire system of treating every type of disease by the ear alone was [also]
developed! Some scholars believe that acupuncture probably evolved in prehistoric
times out of the modifications of the principles of Ayurveda near the snowy bleaks of
the Himalayas, where no herbs were available.
... In fact, this knowledge has already got passed to the nearby countries around India
mainly during Buddha period and got stored as in cold storage. It is not a
coincidence that almost all Buddhist countries have this knowledge and it is the Indian
fortune that the origin of this knowledge [of acupuncture] is from India (But rather
unfortunate that not many people in India know this and appreciate this fact as we sure
have a 'tradition' of forgetting our traditions! and sciences be it mantric or Vedic.
So a comprehensive study on classical concept of Marma & Traditional
Chinese Acupuncture Point is carried out to evaluate its role in inducing analgesic
effect. In this present study Suchi Vyadha & Acupuncture on two different groups are
done over patients suffering from J anu Sandhigata Vata (Osteo Arthritis of Knee) to
evaluate its Analgesic effect.
Though the concept of Marma is well described in our classics, its importance
in therapeutic aspect (other than Viddha Lakshana) is neither mentioned nor used.
(I.e. Marma Sthana is not used to cure disease or to relieve pain). They only say that,
Marma Sthana, a very vital point, should not be injured & should be kept intact even
while doing surgeries. In this present study, a first of its kind, an attempt is made to
Introduction

manipulate or stimulate Marma Sthana to obtain desired therapeutic effect. In coming

days this idea may form basis in curing innumerable disease just by manipulating or
stimulating Marma Sthana, which is a seat of prana or life.
Acupuncture Points.
Acupuncture Points.
J anu Sandhigata Vata (Osteoarthritis of the Knee J oint).
Sandhigata Vata (Osteoarthritis of the Knee J oint).
HYPOTHESIS:
H
0
: there is no difference in efficacy of group A and group B treatments.
H
1
: there is difference in efficacy of group A and group B treatments.

PREVIOUS WORK DONE
A Clinical Study on Siravyadhana (Acupuncture) & role of Acupuncture in

Tamaka Shwasa (Bronchial Asthma).By, Dr. Shinde.J in 1997 from Dept. of Shalya,
Govt. College, Nagpur.

Review of Marma

MARMA REVIEW
Marma is not a new term as far as Indians are Concerned. It figures from Atharva
vedic times to recent literature. The references of Marmas are also seen in the
independent Tamil Medical Textual.
If we go through the Sanskrit Lexicans namely Vachaspathya, Shabdha
Kalpadrumam etc. we can see that the word Marma is used in three different
meanings. They are;
1. Swarupa
2. Tatwa
3. J eevasthana

As far as Ayurvedic literature is concerned the term Marma is used as J eevasthana.
HISTORICALVIEW
18(p.12)
Marma science is part of Vedic science. Naturally it has influenced all other sciences
which we find in Vedas like Yoga, Ayurveda, Dance, Music, Mantra, Marital arts,
Astrology, Philosophy, Siddha system of medicine and sexology. Therefore we must
study its historical background.
The development of this science took place from Saraswati culture to the time period
of Charaka, Sushruta, Ashtang hridaya and Ashtang sangraha and later on Buddha
religion was responsible for its spread in the neighbouring Countries like China and
J apan.
Review of Marma


Marma in War
The origin can be traced to Saraswati Culture or Indus Valley Civilization. It is known
from various excavations at Harrappa and Mohen-jo-daro that people in this culture
were using various types of weapons in war.
In Vedic period also people were using different weapons like axes, spears, daggers,
maces, bows and arrows. These were made of copper or bronze. For defensive
purpose they were using body shields. Knowledge of Marma exists from very ancient
time of Vedas, which dates back 4000 BC. The fist reference is found in Rig-Veda
.There is reference of words like Varman and drapi, which is some kind of body
armor or corselet to protect the body from the assault of enemy weapons. In Atharva-
Veda also we find the reference of the term kavacha or corselet or breast-plate for the
protection.
In Mahabharata the great epic also we find many reference for Marma or Varman. (
Karnaparva 19.31, Shalyaparva 32.63 and 36.64, Dronaparva 125.17, Bhishmaparva
95.47, Virataparva 31.12 and 15). It is interesting that there are references of
protective clothings of the Marmas of elephants and horses also.
Arthashastra of Kautilya mentions the use of arrowheads made up of metal and some
protective instruments against the injury to marmas.
Marma and Marital arts
Ahimsa or non-violence was taught by this religion. Monks were not allowed to use
weapons even for their self-protection.
Review of Marma

Milindapanha text, which is a dialogue between King Milinda and Monk Nagasena,
explains that unarmed self defense was taught as a part of 19 arts. This science was
essential when Buddha religion started spreading beyond the boundaries of India into
neighboring countries like China, Indonesia and Thailand etc. This art became
effective and popular because the monks were able to protect themselves against
weapons.
In the Hohan province of China a special monastery was built to accommodate monks
travelling from India to China. This was built around 300 AD and was called Shaolian
Temple which later on became famous place for teaching martial arts based on marma
or vital parts described in Ayurveda. This art was kept as secret for centuries, as it
was taught only to certain disciples.
As the monks started travelling to various countries like J apan, Indochina etc. This art
also spread to these countries. It is therefore very certain that the Traditional Chinese
Medicine had adopted this science from Ayurveda. Hence we do come across with
various references in marital art like Karate.
Marma and Yoga
From the excavations done at the site of Mohen-jo-daro, we find some interesting
figures which shows that the concept of marma was applied for enriching the Yoga
practice.
Marma and Sex
It is evident in Siddha system, that science of vital points has been used to increase
the vigour, strength for enjoyment.
Review of Marma

Marma and Astrology

Siddha system also refers to certain vital points and the effects of phases of moon and
other planets on the human body.
Nirukti:
The word Marma comes from Sanskrit origin mru or marr.Marayate iti
marma, the Sanskrit phrase means likelihood of death after infliction to these places
hence they are called Marma. The word Marma used with meanings as tender, secret
or vital places.
Word Meaning:
Tatwam Shabdakalpadruma (Sdk)
Mru +Mannin Marma
Ma prana vayu
Re seat of prana
Marma mring (marane) - (A. hri. Ad Commentary)
3
M.Monier Williams in his Sanskrit English dictionary gives ten meanings for Marma
they are
Martial sport.
Vulnerable point.
Any open, exposed, weak or sensitive part of the body.
J oint of a limb, any joint or articulation.
Review of Marma

Core of anything.
Any vital member or organ.
Anything which requires to be kept concealed.
Secret in quality.
Hidden meaning.
Any secret or mystery
Definitions of Marmas:
There are several classical Ayurvedic definitions of Marmas. From these we
can see that Marmas are related to the energies of the body, mind, Prana and doshas.
They are key connecting points to all aspects of our energies from the inner most
consciousness to the outermost physical organs.
Marmas are the sites where muscle, veins, ligaments, bones and joints meet
together, though all these structures need not be present at each Marma. This
explains Marmas as important connection centers or crossroads in the physical
body.
1

(v 6/15, pg. no. 371 pp. 734)
Marmas are sites where important nerves come together along with related
structures like muscles and tendons, a similar definition to that of Charaka. He
says that sites which are painful, tender and show abnormal pulsation should also
be considered as Marma or vital points regardless of their anatomical structure
1
.
(z.6/18)
They are the seats of life or Prana, means that any sensitive point on the body is
a potential Marma
1
.
Review of Marma

Marmas are places where the three doshas (Vata, Pitta and Kapha) are present
along with their subtle forms as Prana, Tejas and Ojas and the three gunas of
sattva, rajas and tamas. This means that Marmas control not only the outward
from of the doshas,but their inward essences or master forms as well (Prana, Tejas
and Ojas) and also the mind (satva)
1
.
Marmas are said to be supportive pillars of life, as any trauma to them leads to
death or deformity. Hence they are called J eevanadhara
2
.
Any trauma to Marma, results in death or miseries equal to death
1
.
( v. 6/40, pg. no. 376 pp. 734).
Sushruta has mentioned Marma, as the seat of Prana, Tridoshas and Triguna.
Well-being and illness of the body depends upon homeostasis of Tridoshas. So
any injury to Marma causes derangement of all this factors. Sequels depend on the
specific factors involved. Any injury to Marma, result in psychosomatic
disturbances.
1

According to Sushruta 4 types of siras carrying Vata, Pitta, Kapha and Rakta take
part in the formation of Marma sthana, apart from the anatomical structures
1
.
Composition of Marmas:
Marmas are classified according to their dominant physical constituents as
muscle, vessel, ligament, joint, or bone based regions.
Mamsa Marmas are related to muscle based structures like fascia, serous
membranes, sheaths and muscles.
Sira Marmas related to various vessels or channels supplying energy or
fluids to the body, particularly the blood and lymphatic vessels, Sushruta explains
four types of these vessels.
Review of Marma

Vatavaha Sira
Pittavaha Sira
Kaphavaha Sira
Raktavaha Sira
Channels carrying the doshas are more energetic than anatomical in ones basis and
so anatomical correlations are only general. Sushruta notes that no single vessel
carries Vata, Pitta or Kapha alone.
Snayu Marmas related to the tissues and structures that bind the bones and
muscles and aponeuroses.
Asti Marmas related to bony tissue, can be classified into bones proper,
cartilages, teeth and nails.
Sandhi Marmas related to the joints, are important sensitive regions on the
body for both Prana and the doshas. J oints are classified into movable,
partially movable and non movable. These can be complex or large Marmas.

The knowledge of Marma has got wide implication in the many fields of medical
practice, but as today its traditional practices are limited and scattered in India. The
knowledge of Marma can be classified in following fields:
In martial art and warfare, in surgical importance
in the management of disease and in the diagnosis of illness, in
medical importance
Review of Marma

As a surgeon, Acharya Sushruta stressed the importance of Marmas in surgical

practice and stated in any surgical procedure knowledge of Marmas is as essential as
the knowledge of the nerves, muscles, bones and blood vessels.
Size of Marmas and individual Finger Unit (Anguli pramana):
Marmas are located and measured in size in terms of Anguli pramana or the
finger unit of the respective individual. To determine this follow these instructions:
J oin both open palms at ulnar (little finger) side.
Measure the width of both palms at metacarpo - phalangial joints (base of the
fingers).
Divide this by 8 (as this width is average for 8 fingers).
This is individual finger unit.
There are 107 Marmas in the human body

Marmas are classified according to
regional, structural, prognostic, dimensional and numerical criteria. Sushruta and
Vagbhata have a surgical approach.
Sushruta and Vagbhata have detailed about 37 Marmas in the Shiras, whereas
Charaka consider it as a single unit. Considering the importance of Basthi, Hridaya
and Shiras, Charaka has emphatically mentioned about these 3 Marmas in the
Review of Marma


Trimarmeeya adhyaya.
Table No. 01: Showing Shaka Marmas:

Marma

Sthana

Ashraya

Anatomical
synonym

Parinama/Viddha
Lakshana

Pra
man
a

Sank
hya
Talahrudaya In the middle of
palmar or plantar
aspect in line of the
middle toe
Mamsa Palmar
aponeurosis
Kalanthara pranahara-
Death due to severe
pain
4
Kshipra In b/n the thumb &
index finger or in b/n
big toe & 1
st
toe
Snayu 1
st
intermeta-tarsal
ligament
Death due to
convulsions
4
Kurcha Two angulas above
the Kshipra
Snayu Tarsometa-
tarsal &
Intertarsal
ligament

Vaikalyakara-Inability
to move & rotate the
foot &hand
4 4
Kurchasira Below the Gulpha
Sandhi (Ankle J oint)
Snayu Lateral ligament
of ankle
Rujakara-Causes
Shopha & Ruja
1 4
Gulpha At the junction of
foot & calf
Sandhi Ankle joint Rujakara-Causes pain,
stiffness & inability to
performactivities
2 2
Manibandha At the J unction of
hand & forearm
Sandhi Wrist joint Rujakara-Causes pain,
stiffness & inability to
performactivities
2 2
Indravasti Between the J anghas Mamsa Cubital fossa Kalanthara pranahara-
Death due to severe
loss of blood
4
J anu At the joint of Uru &
J angha
Sandhi Knee joint Vaikalyakara-Produces
Lamness
3 2
Koorparam At the junction of
upper arm& forearm
Sandhi Elbow joint Vaikalyakara-
Distortion of arm
3 2
Ani Three angulas above
on either side of J anu
& Koorpara
Snayu Biceps tendon Vaikalyakara-Increased
swelling & stiffness
4
Urvi In the middle of the
thigh & arm
Sira Femoral vessels Vaikalyakara-Causes
Emaciation of leg due
to Haemorrhage
1 4
Lohitaksha At the root of thigh
above the Urvi below
the angle of groin
Sira Femoral vessels Vaikalyakara-Paralysis
of extremity due to
haemorrhage
4
Vitapa Between the Scrotum
& Groin
Snayu Inguinal canal Vaikalyakara-Causes
Impotency
1 2
Kaksha Between the axilla &
collar bone
Snayu Axilla Vaikalyakara-
Distortion of the Upper
1 2
Review of Marma

Limb
Review of Marma
A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Therapeutic Importance.

FIG.1 MARMAS OF ANTERIOR SURFACE
Review of Marma

Table No. 02: Showing Udara(Koshta ?) Marmas:

Marma

Sthana

Asraya
Anatomical
structure
involved
Parinama or
Viddha Lakshana
Pram
ana
Sank
hya
Guda Attached to
sthoolantra which
expels flatus &
faeces
Mamsa Anal canal, anus Sadhyo pranahara-
Causes immediate
death or death with
in seven days
4 1
Vasti Located inside the
true pelvis with one
orifice pointed
downwards
Snayu Urinary bladder Sadhyo pranahara-
Causes immediate
death or death with
in seven days
4 1
Nabi In b/n the large
intestine &
stomach. Which is
the seat of all siras
Sira Umbilicus Sadhyo pranahara-
Causes immediate
death or death with
in seven days
4 1

Table No.03: Showing Uro Marmas:
Marma Sthana Asraya Anatomical
structure
involved
Parinama or
Viddha Lakshana
Pram
ana
Sank
hya
Hridaya In b/n the
breasts, in b/n
the uras & kosta
& at Amasaya
Dwaram
Sira Heart Sadhyo pranahara-
Causes immediate
death or death within
seven days
4 1
Sthanarohit
a
Two angula
above the
breast
Mamsa Lower portion
of pectoralis
major muscle
Kalanthara
pranahara-Causes
death due to Raktha
poorna kosta
2
Sthanamoo
la
Two angula
below the breast
Sira Internal
mammary
vessels
Kalanthara
pranahara-Causes
death due to Kapha
poorna kosta
2 2
Apasthamb
a
Parshwabhaga of
Uras
Sira Two bronchi Kalanthara
pranahara-Causes
death due to Rakta
poorna kosta
2
Apalapa Below the
Amsakoota, in
b/n the prista
vamsa & uras
Sira Lateral
thoracic and
sub scapular
vessels
Kalanthara
pranahara-Injury
creates Raktapoorna
kosta & death due to
Rakta poornakostata
transforming to
pooyakosta
2
Review of Marma

Table No. 04: Showing Prishta Marmas:
Marma Sthana Asray

a
Anatomical
structure
involved
Parinama/
Viddha Lakshana
Pra
man
a
San
khy
a
Katikatharu
na
On either side of
Prista Vamsa &
located on Sronikarna
(Ear like bones of
pelvis & above the
buttocks)
Asthi Sciatic
notch
Kalanthara
pranahara-Death
occurs due to severe
Raktha
Kshaya(Pandu)
2
Kukundara Both sides of
Kadeepradesha a
hollow situated on
both sides of prista
vamsa & in the region
slightly below the
waist. On either sides
of the vertebral
column, on two
meeting places out
side the buttocks
Sandh
i
Ischial
tuberosity
Vaikalyakara-
Causes loss of
movement & loss of
sensation in the
lower part of the
body
2
Nithamba Above the sronikarna
on both sides of prista
vamsa
Asthi Ala of ilium Kalanthara
pranahara-Injury
causes Adhakaya
Shopha, debility &
death
2
Parsvasand
hi
In b/n J aghana &
Parshwa
Sira Common
iliac vessels
Kalanthara
pranahara-Death
due to Raktapoorna
kosta
2
Bruhathi On either side of the
Vertebral column & in
straight line with
sthanamoola marma
Sira Subscapular
and
transverse
cervical
arteries
Kalanthara
pranahara-Death
due to severe Rakta
Kshaya
2
Amsaphala
ka
On either side of the
Vertebral column at
the Bahumoola
Asthi Spine
of
scapul
a
Vaikalyakara-
Causes Bahu Swapa
& Bahu Shosha
2
Amsa On either side of the
neck
Snayu Coraco and
gleno
humeral
ligament,
trapezius
muscle
Vaikalyakara-Loss
of function of Bahu
2
Review of Marma


FIG.2 MARMAS OF POSTERIOR SURFACE
Review of Marma

Table No. 05: Showing Jatrurdhwa Marmas:

Marma Sthana Asraya Anatomical
structure
involved
Parinama or
Viddha Lakshana
Pram
ana
San
khya
Neela On either side of the
Kanda Nalee near Hanu
Pradesha
Sira Blood vessels
of neck
Vaikalyakara-Causes
Swara Vaikritha
4 2
Manya On both side of
Kandanalee near Hanu
Pradesha
Sira Blood vessels
of neck
Vaikalyakara-Loss of
Rasagrahana Shakthi
4 2
Mathruka On both side of
Kandanalee in relation to
J ihwa & Nasa
Sira Blood vessels
of neck
Sadhyo pranahara-Causes
immediate death
4 8
Krukatika At the Shirogreeva
Sandhi
Sandhi Atlanto-
occipital
articulaion
stability of sira (Head)
2
Vidhura Below the back of the
ears
Snayu Olfactory
region of
nose
Hearing
2
Phana On both sides of
Grhanamarga
Sira Olfactory
nerves
sensation of smell
2
Apanga At the outer angle of the
eye, at the tail end of the
eye brows & below the
eye brows
Sira Zygomatic-
temporal
vessels
Vaikalyakara-Causes
blindness
2
Avartha In the depression above
the eye brow
Sandhi J unction of
frontal, molar
and sphenoid
Vaikalyakara-Causes
blindness
2
Shankha Adjoining the ears
located as forehead
Asthi Temples Sadhya pranahara-Causes
Immediate Death
2
Uthkshepa
m
Above the shankha
marma at the lower
border of kesha
Snayu Temporal
muscle and
fascia
Vishalyaghna-Person can
live with the Shalya intact
or when it falls after
paka. But the removal of
Shalya causes immediate
death
2
Sthapani In b/n the eye brows Sira Nasal arch of
the frontal
vein
Visalyaghna
-do-
1
Sringataka On the samagama sthana
of J ihwa, Akshi, Nasika,
Karna & Talu
Sira Cavernous
and
intercavernou
s sinuses
Sadhya Pranahara-Causes
immediate death
4 4
Seemantha Five sutures of
Kapalasthi
Sandhi Cranial
sutures
Death due to
Brama,Unmada &
Manonasha
4 5
Adhipathi Inside the head on the
sira Sandhi pradesha
Sandhi Bregma Sadhya pranahara-Causes
immediate death
1

Review of Marma

FIG.3 MARMAS OF AXILLA & ELBOW

Review of Marma

Table No. 06: Showing Description of Marmas According to vaghbhata Acharya:

Name of the
group
San
khya
Marmas included in this group Viddha Lakshana
Mamsa Marma 10 Indravasthy, Thalahrith,
Sthanarohitha
Continuous bleeding,blood
resembles the water in which meat
has been washed & more over the
blood is thin, pandu, loss function
of sense organs, causes immediate
death
Asthi Marma 08 Kateekataruna, Nithamba,
Amsaphalaka, Shankha
Discharge of clear fluid mixed with
majja & associated with
intermittent pain
Snayu Marma 23 Koorcha, Koorchasira, Kshipra,
Ani, Vasthi, Amsa, Apanga,
Utkshepa
Ayama, Akshepaka, Sthamba,
severe pain and inability to ride, sit
etc, distortions or even death
Dhamanee
Marma
09 Guda, Apasthamba, Vithura,
Sringataka
The blood which is frothy and
warm flows out with sound &
person become unconsious
Sira Marma 37 Urvi, Lohithaksha, Vidapa,
Kakshadhara, Nabhi, Hrith
Sthanamoola, Apalapa, Neela,
Manya, Mathruka, Phana,
Sthapani, Parshwa Sandhi,
Brihathi
Blood which is thick flows out
continuous & in large quantity,
which leads to Trit, Bhrama,
Shwasa, Moha, Hidhma & even
death
Sandhi Marma

20

Gulpha, J anu, Manibandha,
Koorpara, Krikatika, Kukundara,
Avatha, Seemantha, Adipa

The site of injury feels as though
full of thorns, even after healing of
the wound there is shortening of
arm, lameness decrease of strength
& movement, emaciation of body
and swelling of the joint

Review of Marma


FIG.4 MARMAS OF VENTRAL SURFACE OF FOOT

Review of Marma

Table No. 07: Showing Marmas in controversy on the basis of classification:
Name of Marma According to Vagbhata According to Sushrutha

Guda
Kakshadhara
Vidhura
Vitapa
Sringataka
Apasthambha
Apanga
Dhamanee Marma
Sira Marma
Dhamanee Marma
Sira Marma
Dhamanee Marma
Dhamanee Marma
Snayu Marma
Mamsa Marma
Snayu Marma
Snayu Marma
Snayu Marma
Sira Marma
Sira Marma
Sira Marma

Susruthacharya has given much importance to the prognostic classification and
has explained it on the basis of Panchamahabhutas. Predominance of all the five
constituents - Mamsa, Asthi, Snayu, Sira and Sandhi makes it a Sadyapranahara
Marma, absence of one of them or presence in less proportion will make it naturally
belong to other kinds in respective order - Kalantarapranahara, Visalyaghnam,
Vaikalyakara and Rujakara marma.

Review of Marma

Table No. 08: Showing prognostic classifications of Marmas based upon Trigunas
& Panchamahabhutas.
1
Prognostic
classification
No Marmas Included Trigunas Bhutas Prognosis/Viddha
Lakshana
Sadyapranah
ara
19 Nabhi, Shanka,
Adhipathi, Apana,
Hridaya, Sringataka,
Mathruka & vasthi
Rajas &
Satva
Agni
Immediate death within 7
days.
When injured there will be
sudden Depletion of Agni
Guna
Kalantarapra
nahara
33 Apasthamba,
Talahrith, Parshwa
Sandhi, Kateeka
Taruna, Seemantha,
Sthanamoola,
Indravasthy,
Kshipra, Apalapa,
Brihathi, Nithamba,
Sthana Rohita
Rajas &
Thamas
Agni +
J ala
Death within 14 days of
injury.
When injured there will be
sudden Depletion of Agni
Guna followed by gradual
depletion of somaguna

Visalyaghna 03 Utkshepa, Sthapani Rajas Vayu Vayu escapes when shalya is
removed and result in death.
Vayu, Mamsa, Vasa, Majja
& Masthulunga gets dried
up, shwasa, kasa develops &
destroys the life of person
Vaikalyakara 44

Phana, Apanga,
Vidura, Neela,
Manya, Krikatika,
Amsa, Amsaphala,
Avartha, Vitapa,
Urvi Kukundara,
J anu, Lohithaksha,
Ani, Kakshadhara,
Koorcha &
Koorpara
Thamas Soma

Sthirathvam & shaithyam of
soma guna result in prana-
valambanam and results in
deformity.
After injury here Soma Guna
supports Prana by sheeta &
sthira gunas
Rujakara 08 Koorchasira,
Gulpha &
Manibandha
Rajo
bahulya
Agni +
Vayu
Any injury results in pain
(Agni is Ashukari & Vayu
produces pain)

Review of Marma

Classification of Marmas according to their viddha laxanas

1
:
Marmas are also classified according to five types relative to their degree of
vulnerability.
Sadya Pranahara immediate death causing
Kalantara Pranahara long term death causing
Vishalyaghna fatal if pierced
Vaikalyakara disability causing
Rujakara pain causing
Marmaviddha Lakshana
1
:
Deha prasupti - giddiness
Guruta heaviness of body
Sammoha - delirium
Sheeta kaamita longing for cold items
Sweda - excessive sweting
Moorcha - unconcious
Vamana - vomitting
Shwasa dyspnoea (v 7/47, pg. no. 323 pp. 965)

Samprapthi of marmabhigata:
Marma abighata
Vata prakopa
Causes severe ruja
Severe injury causes either deformity or death.
Review of Marma

Chikitsa:
Lakshanika chikitsa according to marma viddha lakshanas.
Vata vyadhi chikitsa
J udicial selection of Shasti upakrama, for vranopachara.

Review of Acupuncture

Acupuncture (from Latin Acus means Needle & Pungere means To Prick)
refers to a technique of inserting and manipulating fine filiform needles into specific
points on the body with the aim of relieving pain and for the therapeutic purposes.
According to traditional Chinese acupuncture theory, these acupuncture points lies
along the Meridians, which Qi, the vital energy flows.The earliest written record of
acupuncture is the Chinese text Shiji (, English: Records of the Grand Historian)
with elaboration of its history in the second century BC medical text Huangdi Neijing
(, English: Yellow Emperor's Inner Canon). Different variations of
acupuncture are practiced and taught throughout the world.
History
Antiquity
Acupuncture's origins in China are uncertain. One explanation is that some soldiers
wounded in battle by arrows were cured of chronic afflictions that were otherwise
untreated, and there are variations on this idea. In China, the practice of acupuncture
can perhaps be traced as far back as the Stone Age, with the Bian shi, or sharpened
stones. In 1963 a bian stone was found in Duolun County, Inner Mongolia, China
pushing the origins of acupuncture into the Neolithic age. There are evidences of
needles made of fish bone and stone found in Korea, dating approximately to 3000
BC. Hieroglyphs and pictographs have been found dating from the Shang Dynasty
(1600-1100 BC) which suggest that acupuncture was practiced along with
moxibustion.

Despite improvements in metallurgy over centuries, it was not until the 2nd century
BC during the Han Dynasty that stone and bone needles were replaced with metal.
The earliest records of acupuncture is in the Shiji (, in English, Records of the
Grand Historian) with references in later medical texts that are equivocal, but could
be interpreted as discussing acupuncture. The earliest Chinese medical text to describe
acupuncture is the Huangdi Neijing, the legendary Yellow Emperor's Classic of
Internal Medicine (History of Acupuncture) which was compiled around 305204
B.C.
The Huangdi Neijing does not distinguish between acupuncture and moxibustion and
gives the same indication for both treatments. The Mawangdui texts, which also date
from the second century BC (though antedating both the Shiji and Huangdi Neijing),
mention the use of pointed stones to open abscesses, and moxibustion but not
acupuncture. However, by the second century BC, acupuncture replaced moxibustion
as the primary treatment of systemic conditions.
In Europe, examinations of the 5,000-year-old mummified body of tzi the Iceman
have identified 15 groups of tattoos on his body, some of which are located on what
are now seen as contemporary acupuncture points. This has been cited as evidence
that practices similar to acupuncture may have been practiced elsewhere in Eurasia
during the early Bronze Age.



Middle history
Around ninety works on acupuncture were written in China between the Han Dynasty
and the Song Dynasty, and the Emperor Renzong of Song, in 1023, ordered the
production of a bronze statuette depicting the meridians and acupuncture points then
in use. However, after the end of the Song Dynasty, acupuncture and its practitioners
began to be seen as a technical rather than scholarly profession. It became rarer in the
succeeding centuries, supplanted by medications and became associated with the less
prestigious practices of shamanism, midwifery and moxibustion.
Portuguese missionaries in the 16th century were among the first to bring reports of
acupuncture to the West. J acob de Bondt, a Danish surgeon travelling in Asia,
described the practice in both J apan and J ava. However, in China itself the practice
was increasingly associated with the lower-classes and illiterate practitioners.
The first European text on acupuncture was written by Willem ten Rhijne, a Dutch
physician who studied the practice for two years in J apan. It consisted of an essay in a
1683 medical text on arthritis; Europeans were also at the time becoming more
interested in moxibustion, which ten Rhijne also wrote about. In 1757 the physician
Xu Daqun described the further decline of acupuncture, saying it was a lost art, with
few experts to instruct; its decline was attributed in part to the popularity of
prescriptions and medications, as well as its association with the lower classes.
In 1822, an edict from the Chinese Emperor banned the practice and teaching of
acupuncture within the Imperial Academy of Medicine outright, as unfit for practice

by gentlemen-scholars. At this point, acupuncture was still cited in Europe with both
skepticism and praise, with little study and only a small amount of experimentation.
Modern era
In the early years after the Chinese Civil War, Chinese Communist Party leaders
ridiculed traditional Chinese medicine, including acupuncture, as superstitious,
irrational and backward, claiming that it conflicted with the Party's dedication to
science as the way of progress. Communist Party Chairman Mao Zedong later
reversed this position, saying that "Chinese medicine and pharmacology is a great
treasure house and efforts should be made to explore them and raise them to a higher
level."
Acupuncture gained attention in the United States when President Richard Nixon
visited China in 1972. During one part of the visit, the delegation was shown a patient
undergoing major surgery while fully awake, ostensibly receiving acupuncture rather
than anaesthesia. Later it was found that the patients selected for the surgery had both
a high pain tolerance and received heavy indoctrination before the operation; these
demonstration cases were also frequently receiving morphine surreptitiously through
an intravenous drip that observers were told contained only fluids and nutrients.
The greatest exposure in the West came when New York Times reporter J ames
Reston, who accompanied Nixon during the visit, received acupuncture in China for
post-operative pain after undergoing an emergency appendectomy under standard
anaesthesia. Reston was so impressed with the pain relief he experienced from the
procedure that he wrote about acupuncture in The New York Times upon returning to

the United States. In 1973 the American Internal Revenue Service allowed
acupuncture to be deducted as a medical expense.
Traditional theory

Needles being inserted into a patient's skin.
Traditional Chinese medicine
Traditional Chinese medicine (TCM) is based on a pre-scientific paradigm of
medicine that developed over several thousand years and involves concepts that have
no counterpart within contemporary medicine. In TCM, the body is treated as a whole
that is composed of several "systems of function" known as the zang-fu (). These
systems are named after specific organs, though the systems and organs are not
directly associated.
The zang systems are associated with the solid, yin organs such as the liver while the
fu systems are associated with the hollow yang organs such as the intestines. Health is
explained as a state of balance between the yin and yang, with disease ascribed to
either of these forces being unbalanced, blocked or stagnant.
The yang force is the immaterial qi, a concept that is roughly translated as "vital
energy". The yin counterpart is Blood, which is linked to but not identical with
physical blood, and capitalized to distinguish the two. TCM uses a variety of

interventions, including pressure, heat and acupuncture applied to the body's

acupuncture points (in Chinese or xue meaning "cavities") to modify the activity of
the zang-fu.
Table No. 09: Showing Acupuncture points and meridians:
Flow of qi through the meridians
Zang-fu Aspect Hours
Lung taiyin 0300-0500
Large Intestine yangming 0500-0700
Stomach yangming 0700-0900
Spleen taiyin 0900-1100
Heart shaoyin 11001300
Small Intestine taiyang 13001500
Bladder taiyang 15001700
Kidney shaoyin 17001900
Pericardium jueyin 19002100
San Jiao shaoyang 21002300
Gallbladder shaoyang 2300-0100
Liver jueyin 0100-0300
Lung (repeats cycle)
Classical texts describe most of the main acupuncture points as existing on the twelve
main and two of eight extra meridians (also referred to as mai) for a total of fourteen
"channels" through which qi and Blood flow. Other points not on the fourteen
channels are also needled. Local pain is treated by needling the tender "ashi" points
where qi or Blood is believed to have stagnated.
The zang-fu of the twelve main channels are Lung, Large Intestine, Stomach, Spleen,
Heart, Small Intestine, Bladder, Kidney, Pericardium, Gall Bladder, Liver and the
intangible San Jiao. The eight other pathways, referred to collectively as the qi jing ba
mai, include the Luo Vessels, Divergents, Sinew Channels, ren mai and du mai

though only the latter two (corresponding to the anterior and posterior sagittal plane of
the torso respectively) are needled. The remaining six qi jing ba mai are manipulated
by needling points on the twelve main meridians.
Normally qi is described as flowing through each channel in a continuous circuit. In
addition, each channel has a specific aspect and occupies two hours of the "Chinese
clock".
The zang-fu are divided into yin and yang channels, with three of each type located on
each limb. Qi is believed to move in a circuit through the body, travelling both
superficially and deeply. The external pathways correspond to the acupuncture points
shown on an acupuncture chart while the deep pathways correspond to where a
channel enters the bodily cavity related to each organ.
The three yin channels of the hand (Lung, Pericardium, and Heart) begin on the chest
and travel along the inner surface of the arm to the hand. The three yang channels of
the hand (Large Intestine, San Jiao, and Small Intestine) begin on the hand and travel
along the outer surface of the arm to the head. The three yin channels of the foot
(Spleen, Liver, and Kidney) begin on the foot and travel along the inner surface of the
leg to the chest or flank.



FIG.5 MERIDIANS & ACUPUNCTURE POINTS OF UPPER LIMB


FIG.6 MERIDIANS & ACUPUNCTURE POINTS OF LOWER LIMB

FIG.7 LUNG MERIDIAN


The three yang channels of the foot (Stomach, Gallbladder, and Urinary Bladder)
begin on the face, in the region of the eye, and travel down the body and along the
outer surface of the leg to the foot. Each channel is also associated with a yin or yang
aspect, either "absolute" (jue-), "lesser" (shao-), "greater" (tai-) or "brightness" (-
ming).

FIG.8 STOMACH CHANNEL


A standard teaching text comments on the nature and relationship of meridians (or
channels) and the Zang Fu organs:
The theory of the channels is interrelated with the theory of the Organs. Traditionally,
the internal Organs have never been regarded as independent anatomical entities.
Rather, attention has cantered upon the functional and pathological interrelationships
between the channel network and the Organs. So close is this identification that each
of the twelve traditional Primary channels bears the name of one or another of the
vital Organs. In the clinic, the entire framework of diagnostics, therapeutics and point
selection is based upon the theoretical framework of the channels. "It is because of the
twelve Primary channels that people live, that disease is formed, that people are
treated and disease arises." [(Spiritual Axis, chapter 12)]. From the beginning,
however, we should recognize that, like other aspects of traditional medicine, channel
theory reflects the limitations in the level of scientific development at the time of its
formation, and is therefore tainted with the philosophical idealism and metaphysics of
its day. That which has continuing clinical value needs to be reexamined through
practice and research to determine its true nature.
The meridians are part of the controversy in the efforts to reconcile acupuncture with
conventional medicine. The National Institutes of Health 1997 consensus development
statement on acupuncture stated that acupuncture points, Qi, the meridian system and
related theories play an important role in the use of acupuncture, but are difficult to
relate to a contemporary understanding of the body. Chinese medicine forbade
dissection, and as a result the understanding of how the body functioned was based on
a system that related to the world around the body rather than its internal structures.

The 365 "divisions" of the body were based on the number of days in a year, and the
twelve meridians proposed in the TCM system are thought to be based on the twelve
major rivers that run through China. However, these ancient traditions of Qi and
meridians have no counterpart in modern studies of chemistry, biology and physics
and to date scientists have been unable to find evidence that supports their existence.
Traditional diagnosis
The acupuncturist decides which points to treat by observing and questioning the
patient in order to make a diagnosis according to the tradition which he or she utilizes.
In TCM, there are four diagnostic methods: inspection, auscultation and olfaction,
inquiring, and palpation.
Inspection focuses on the face and particularly on the tongue, including
analysis of the tongue size, shape, tension, color and coating, and the absence
or presence of teeth marks around the edge.
Auscultation and olfaction refer, respectively, to listening for particular sounds
(such as wheezing) and attending to body odor.
Inquiring focuses on the "seven inquiries", which are: chills and fever;
perspiration; appetite, thirst and taste; defecation and urination; pain; sleep;
and menses and leukorrhea.
Palpation includes feeling the body for tender "ashi" points, and palpation of
the left and right radial pulses at two levels of pressure (superficial and deep)
and three positions Cun, Guan, Chi (immediately proximal to the wrist crease,
and one and two fingers' breadth proximally, usually palpated with the index,
middle and ring fingers).

Other forms of acupuncture employ additional diagnostic techniques. In many forms

of classical Chinese acupuncture, as well as J apanese acupuncture, palpation of the
muscles and the hara (abdomen) are central to diagnosis.
Traditional Chinese medicine perspective
Although TCM is based on the treatment of "patterns of disharmony" rather than
biomedical diagnoses, practitioners familiar with both systems have commented on
relationships between the two. A given TCM pattern of disharmony may be reflected
in a certain range of biomedical diagnoses: thus, the pattern called Deficiency of
Spleen Qi could manifest as chronic fatigue, diarrhea or uterine prolapse. Likewise, a
population of patients with a given biomedical diagnosis may have varying TCM
patterns. These observations are encapsulated in the TCM aphorism "One disease,
many patterns; one pattern, many diseases". (Kaptchuk, 1982)
Classically, in clinical practice, acupuncture treatment is typically highly
individualized and based on philosophical constructs as well as subjective and
intuitive impressions, and not on controlled scientific research.
(WWW.Wikepedia.Com)
Comparison of TCM & Ayurveda

Comparison of Ayurveda and Traditional Chinese Medicine

Sankhya & TCM Comparison
Unity
A comparison of TCM and Sankhya philosophy reveals many inherent
similarities.
In both traditions, as well as in modern science, similar principles have
emerged through the process of intuitive insight, observation of nature,
developing hypotheses.
At the heart of both traditions is a sense of cosmic unity as the source from
which all creations arises. This termed Wu or Tao in TCM, and is comparable
to two concepts in Sankhya philosophy: Avyakta (the unmanifest) and
Purusha, the conscious principle that springs forth from Avyakta. These are
eternal, unbounded in space and time, and are essence of oneness. They are
without attributes and beyond name, form and differentiation.



Duality:
In both TCM & Sankhya the first step of manifestation of the fundamental
wholeness or unity is duality.
In TCM the unity expresses as Yin and Yang, which arise together and are
eternally and co-equally paired in every aspect of creation. Together they are
the Supreme Ultimate, Tai J i. Yin and Yang co-exist;one cannot exist without

the other. They constitute a dynamic whole that is inter-transforming and

inter-consuming.
The Sankhya model is significantly different. While the fundamental
wholeness, the un manifest Avyakta appears to differentiate as Purusha and
Prakruti, Purusha is primary and Prakruti cannot exist without Purusha, while
Purusha can exist without Prakruti.
Another subtle difference is that, like yin in TCM, Prakruti is considered
feminine, while Yang & Purusha are masculine; but yin is viewed as
essentially passive.
Like Yin & Yang, Purusha & Prakruti are dynamic but they are not inter-
transforming; that is they do not convert in to one another.
Qualities:
IN contrast to the duality model of Yin/Yang, Prakruti first expresses itself as
three: the three gunas: Sattva, Rajas, Tamas. All of the creations are imbued
with three qualities, which can be compared with the qualities and
characteristics of Yin & Yang.
Rajas have the active of Yang, while Sattva and Tamas possess the passive
qualities of Yin.
Sattva & rajas are yang in terms of being light while Tamas is Yin being
darkness.
Rajas is a bridge between sattva & Tamas, while there is no third entity
between yin and yand which mediates between them.

While Sattva, Rajas, and Tamas are considered to be maha gunas, Ayurveda
also recognizes twenty gunas (10 pairs of opposites) that are directly parallel
to the commonly accepted qualities of Yin and Yang in TCM.
E.g. Vata dosha is cold, light, mobile, clear, subtle, rough and dry>Pitta dosha
is hot, sharp, light, liquid, oily, and spreading. Kapha dosha is heavy, dull,
cold, dense, stable, cloudy, soft, gross, smooth and oily.
Therefore, Vata and Pitta are predominantly yang in nature, while Kapha is
yin.

FIG.9 GUNAS & THEIR RELATIONSHIP WITH YIN/YANG



Qi and Prana:
Qi and Prana are virtually equivalent. Both represent energy, the vital life
force responsible for the animation of every organism and the life of
everything in the universe. Without them, life cannot exist and death is
inevitable.
Qi is generated from the movement of unity into duality.
Prana is the energy that flows through creation from Prakruti to Mahad to
Buddhi, to Ahankara and lastly in to three gunas, in to the organic and
inorganic universe.

Within the body, both flow through the subtle energy pathways termed
meridians in TCM and Nadis in Ayurveda.
Ayurveda considers prana not only as energy but also as the flow of
intelligence and awareness. Prana also exists in conjunction ojas, and tejas
forming a trinity within the microcosm of the body and universe. In the body
prana is cellular awareness, tejas is cellular digestion and intelligence and ojas
is equated with cellular immunity.
The TCM equivalent is Qi (energy) corresponds to Prana, Shen (spirit) with
tejas and J ing (essence) with ojas. They are called the three treasures.
TCM also emphasizes the functional relationship of qi and blood. Qi is yang in
nature and blood is yin. Blood is viewed as mother of qi because of its
nourishing nature. Qi is called commander of blood, because it is thought to
lead blood through the channels.
In Ayurveda, blood is called rakta and it is intimately associated with prana in
manner similar to qi and blood, traditionaly expressed as prana raktanu
dhavati, prana moves with the blood.
The Five Elements:
Essential to both TCM and Ayurveda are the five elements or organizing
principles that support life when in balance and create disease when
imbalanced.

The five elements do not overlap precisely. Fire, Earth and Water are common
to both systems while the remaining two elements differ. Sankhya system
includes Space & Air while TCM has Wood and Metal.
The difference is not great as metal has many attributes similar to air and vata
dosha and wood shares common attributes with fire and pitta dosha, because it
carries the hidden potential of fire within.
Space from the sankhya system does not have a direct correspondence in TCM
but it is implied there as the space within which the other elements exist and
interact.
In TCM the elements nourish and regulate each other in a cyclical manner.
In contrast, the Ayurvedic five elements arise from a linear, hierarchical
progression where one element generates the next in natural order.
Perhaps the greatest difference is the role the five elements play in each
system.
In TCM, the structural progression from Tao or Wu through Yin and Yang
stops with the five elements.
In Ayurveda, the five elements are not the end point, but from their
combination emerge three doshas, the cornerstone of its conceptual
framework.
Thus In Ayurveda the five elements are not given the same importance as in
TCM, as three doshas play more prominent role in Ayurveda.
Space and Air form Vata dosha, Fire and Water form pitta dosha and water
and Earth constitute kapha dosha. These three doshas are governing factors for
diagnosis and treatment.

J ust as the TCM five elements have a controlling cycle that maintains self-
regulating balance, the three doshas continuously adjust and re-adjust to
maintain equilibrium.
In both systems, when an element or dosha becomes excessive or deficient,
balance is disrupted leading to specific symptomatology and pathology.


Individual Constitution:
De is the Chinese term for individual constitution, which is typically expressed
in terms of five elements. A person may be predominantly fire, manifesting as
energetic, robust, hot tempered, while a person with predominantly earth will
be good natured, jovial, grounded, stable and possibly stubborn.
These constitutional types are discussed in modern interpretations of TCM but
are not mentioned in the ancient texts.
In Ayurveda, an individuals constitution is predominantly vata, pitta, kapha
or combination of three doshas.
In Ayurveda, the prakruti is considered to have, in addition to basic physical,
doshic combination, a karmic and genetic component and a mental component
In addition vikruti also plays an important part in individuals unique
composition.
In TCM, health is the balance of yin and yang in the body. From energetic
view point, health is an abundance of qi that flows smoothly throughout the
network of meridians and related organs. Reflecting the intricate relation of
microcosm and macrocosm, health is viewed as harmony between the inner
and outer world, and between the individual and nature.
Disease is disruption of balance between yin, yang and qi
When doshas, dhatus and malas are in proper functional relationship, along
with a balance on the cellular level of ojas, tejas and prana, there is perfect

balance of body, senses, mind and consciousness, resulting in clarity,

happiness, joy, peace and love.
Disease or at least less than perfect health arises when this balance is not
maintained or disturbed due to external forces.
Comparison between Nadis & Meridians
Both nadis and meridians are subtle, refined pathways of intelligence and
energy, while srotasmi are more physical and functional entities.
Nadis and meridians form an interconnected network;srotamsi do not.
Meridians are classified according to location and function, while the nadis are
not.
Meridians are accessible on the exterior surface of the body, while nadis and
srotasmi are internal pathways that do not surface, though they can be
influenced from the surface by such means as electrical stimulation, Laser, or
accupressure.
Unlike meridians, nadis and srotamsi cannot be mapped on the exterior surface
of the body.
Interestingly both systems recognize 14 major channels.
Meridians are closely linked to their associated organs, while srotamsi are
more closely related to tissues and functions.
Meridians are delineated by accupoints that trace the flow of energy in a
continuum from the first point on the meridian to the last. The energy flows in
sequence from first meridian to the last and the cycle continues.

Typical similarities between Acupuncture points and Marma

Marmas are also called as Adankals, pressure-points, reflex points, and vital points.
Marmas are hundreds of areas on the surface of the body that nadis (pranic channels,
carriers of prana or bio-energy) join to organs and nonadjacent areas. Marma points
are important pressure points on the body, much like the acupuncture points of
Traditional. One finds the first reference to them in the Atharva Veda and they are
elaborately dealt with by Sushruta. Like the Chinese acupuncture points, Marma
points are measured by the finger units (Anguli) relative to each individual.
Their size is measured by finger inches and their location determined by them."
Siravedhana (Acupuncture) and Marma Chikitsa (Acupressure) were very prevalent
and highly accepted therapies during RgVeda and AtharvaVeda and flourished during
Samhita period. It is amazing to read the details of treatment which Sushruta
described in the Sushruta Samhita...Chinese literature of Acupuncture when decoded
answers to it. In fact 24 channels (meridians) of Chinese Acupuncture are nothing else
than Sushrutas 24 Dhamanis while points on channels are 700 Siras of Sushruta...



FIG.10.Anterior View Of Marma & Acupuncture Point



Fig.11 Posterior View of Marma & Acupuncture Points.



Fig.12 Lateral View of Marma & Acupuncture Points



Conclusion
In conclusion, Ayurveda and TCM show striking similarities in philosophy,
inclusion of five element model, related concept of both health and disease.
Both reflect a holistic approach involving mind, body and spirit. Despite their
differences, each system presents an integral philosophical and medical model
clearly demonstrating the connection between healths and living in balance,
in harmony with nature.
Most notably both traditions utilize the energy points as doorways to maintain
health and harmony.
Marma is both structural & functional unit, where as acupuncture point is
only functional.
In one Marma Sthana there may be more than 2 or 3 acupuncture points of
different meridian.

Disease Review


Janu Sandhigata Vata
Janu:
Utpatti: The word Janu is derived from root jan
4(p.451)
means knee
Nirukti:

|||||u+|||
4(p.531)
means that which joins the Uru and Jangha is
known as Janu
The word Sandhigata Vata comprises of three words, viz. Sandhi, Gata and Vata.
Sandhi

- Sandhi is a word of masculine gender. Sandhi is derived from root dha
which when prefixed by sam and suffixed by ki gives rise to word Sandhi
4(p.240)
.
Dictionary meaning: Union, junction, combination, a joint.
Gata - Gata word exists in all the three genders and it is derived from Gam dhathu
and Ktin pratyaya. ||l| |||l| ||l| ||
4(p.298)
- That which has went or
reached.
Vata : - Vata is a word of masculine gender. The word is coined from Vaa dhathu
and Ktin pratyaya. Vata is derived from || |l| |||||
4(p.325)
i.e. gamana-
movement, to move and gandhana pressure.
Meaning: Vata means wind/air, one of the three humours of the body.
Thus, collectively the Janu Sandhigatavata means the disease resulting from
the settling of vitiated Vata dosha in Janu Sandhi (Knee joint).
The word Osteoarthritis is a combination of three words. Osteon,
arthron and itis respectively means bone, joint and inflammation. The word
mening is inflammation to the bony joint.
Disease Review


Sandhigata Vata
Sandhigata Vata is one among the Vata vyadhis which is described as a
separate clinical entity. It falls under various gatavata vyadhis caused by localization
of kupita Vata dosha in theasthi sandhis.
HISTORICAL REVIEW OF SANDHIGATA VATA:
VEDIC PERIOD:
Earliest available record regarding the disease and its treatment is in Vedas. In
Atharva Veda 6
th
chapter we can find a quotation which describes a disease of sandhis
Destroy every balasa, which is seated in the limbs and in the joints, the in-dwelling
one, which loosens the bones and the joints and afflicts the heart. A.v.6/14/1
SAMHITA PERIODS:
Charaka Samhita:
Description of Sandhigata Vata as a separate clinical entity is available in
Vata vyadhi Chikista Adhyaya of Chikitsa Sthana. However Charaka has not
mentioned any specific line of treatment for this condition.
2(chi.ch.28.sl37)

Sushrutha samhita:
Signs and symptoms have beeen described in Nidana sthana and separate line
of Chikitsa has been explained in Chikitsa sthana.
1(ni.ch.1.sl.28)

Harita Samhita:
Though no separate description of the disease is available line of treatment has
been explained under Vata Vyadhi Chikitsa.

Disease Review


Ashtanga Sangraha and Ashtanga Hridaya:
Both the books have followed Charaka while describing the lakshana of
Sandhigata Vata and Sushrutas version while describing the chikitsa
aspect.
3(ni.ch.15.sl.12)

Madhava Nidana:
Signs and symptoms have been explained under Vatavyadhi chikitsa and for
the first time he has added Atopa as a symptom.
10(ni.ch.22.sl.21)

Chakradatta and Bhaishajya Ratnavali:

Both these books have explained the line of treatment under Vata vyadhi
chikitsa which is akin to Sushrutas description.
5(ch.22.sl.9)
Bhavaprakasha and Yogaratnakara:
The description is same as in Sushrutha Samhita, both in Nidana as well as
chikitsa aspects.
7(ch.23.sl.258-259)
Sandhi Shareera:
Here an attempt has been made to collect all the scattered references
pertaining to functional anatomy of Sandhis as described in Ayurvedic literatures
under various circumstances.
Dalhana commenting on sandhis opines it as Asthi sandhi
1(sha.ch.5.sl.28)

Table.No.10: Showing Number of Sandhis according to different texts:
Text Name CA. SU. A.S. A.H. KS.
Disease Review


No. of Sandhis 200 210 210 210 381

Classification of Sandhis:
1(sha.ch.5.sl.24.p.366)

Based on mobility Sushrutha has classified Sandhis broadly into
Chestavanta Sandhi
Sthira Sandhi

The sandhis in shakha, hanu and kati are included under Chestavanta
Sandhis, which may be alpa chesta or bahu chesta; the remaining Sandhis are
included under Sthira Sandhis.

Table No: 11 showing the sites of different Sandhis
1(sha.ch.5.sl.27)

Sl.
Name of
Sandhis
Type and site
1
Kora
(resembles a bud)
{Hinge joint}
These are freely movable joints,
anguli (interphalangeal joints),
manibandha (wrist), gulpha (ankle), janu (knee) and kurpara
(elbow) come under this variety
2
Ulukhala
(Ball and socket )
This type of sandhi performs wide range of actions (bahu
chesta), seen in kaksha (shoulder), vankshana
( hip) and danta (alveolar sockets and teeth)
3
Samudga
(lid and box
Shape)
This variety has only slight movements (alpa chesta),
Amsapeetha (sternoclavicular),
Guda (sacrococcygeal),
bhaga (symphysis pubis)
and nitamba (lumbosacral)
4
Pratara
(floating)
This type of joint is formed by bones having symmetrical
surface.These joints are slightly movable, Greeva and prishta
sandhis (intervertebral joints) come under this variety
5
Tunnasevani
(sutural joints)
In this variety the connection between the bone and the joint is
in zigzag fashion. It is seen in Shira, kati & kapala. This is
included under sthira type of joints
6 Vayasatunda
It resembles beak of crow. Hanusandhi is an example for this
type of joint
7
Mandala
(rounded)
It is circular in shape and made up of Tarunastis. Kantha
(tracheal rings) comes under this type of joint
Disease Review


8
Sankhaavarta
(Conch shaped)
Present in Shrothra (cochlea )

Mere union of two or more Asthis is not sufficient to form a Sandhi. It requires
other sturcures like Snayu, Kandara, pesi etc which connect the Asthis to one another
and give strength to the Sandhi.

Asthi: Asthi is the main component of a Sandhi. Dharana is the prime function of
Asthi.
1(su.ch.11.sl.4)
. Asthi is the ashraya dhatu for Vata dosha, as a rule the vriddha
dosha causes vriddhi of the ashraya dhatu, unlike others Vata vruddhi causes Asthi
kshaya and Vata kshaya causes Asthi vriddhi.
1(su.ch.11.sl.26-28)

Vyana Vata: - Vyana Vata is responsible for all types of motor functions, namely
prasarana, akunchana, vinamana, unnamana and tiryag. It resides in all types of
Sandhis and hridaya and is responsible for movement of rasa etc dhatus.
1(ni.ch.1.sl.13)

Janu sandhi is kora variety of Sandhi.

It is made up of
1 Janu kapalikasthi (kapala type of asthi)

upper part of 2 Janghasthis
lower part of 1 Urunalakasthi

Snayu and Kandara:
Snayus are the structures which bind the Asthi, Mamsa and Medas together.
Pratanani variety of Snayu is present in Sandhis and the large numbers of Snayus
which bind sandhis tightly are responsible for bearing the body weight. There are 10
Snayus in Janu sandhi.

Kandara is a varity of Snayu which is round or cylindrical in shape. It is responsible
for prasarana and akunchana of bodily parts.

Disease Review


Shleshmadhara kala: Kala is a structure located in between dhatu and ashaya.
Kala contains kleda and it is described as dhatu rasa vishesha by Vagbhata.
Sleshmadhara kala is fourth Kala which resides in all the joints. J oints function
properly by the support of kapha as wheel moves on well by lubricating the axis. It is
responsible for proper alignment and movements of all joints.
Shleshaka kapha: Shleshaka kapha is situated in all sandhis. It binds the joints
firmly, protects their articulaton and opposes their seperation and disunion.

Peshi: Peshi imparts strength to the different structures of the body like Sira, Snayu,
Asthi parva and Sandhis by enveloping them. Five Peshsi are present in janu sandhi.
Siras and Dhamanis:
The Kaphavaha siras carrying prakrita Kapha, maintains the sandhi, ensures
its sthirata, increases its bala etc. One of the functions of Vatavaha siras is pancha
cheshta such as Prasarna, Akunchana etc. the Raktavaha siras does dhatu purana
brings about sthirata and does poshana. Asthi is one of the dhatus; hence these
functions are applicable for Asthi dhatu poshana also.
The Sparshavaha dhamanis are spread in the upward direction and these have
the function of carrying the sparsha jnana. The sparsha may be sukhakara or
dukhakara.
Janu Sandhi is considered as a Sandhi marma and grouped under
Vaikalyakara marma,

injuries to this leads to khanjata (limping).

Measurement of Janu: Lenghth 3 angulas and circumference 16 angulas

Knee Joint

The knee joint is the largest and the most complex joint of the body. The
complexity is the result of fusion of three joints in one. It is formed by fusion of the
Disease Review


lateral femorotibial, medial femorotibial, and femoropatellar joints. It is a compound
synovial joint, incorporating two condylar joints between the condyles of the femur
and tibia, and one saddle joint between the femur and the patella.
Articular surfaces: The knee joint is formed by (1) The condyles of the femur,
(2) The condyles of tibia; and (3) The patella. The femoral condyles articulate with
the tibial condyles below and behind, and with the patella in front.
Fibrous (Articular) capsule: The fibrous capsule is very thin, and is deficient
anteriorly, where it is replaced by the quadriceps femoris, the patella and the
ligamentum patellae.
Ligaments: The knee joint is supported by seven ligaments. They are
(1) Ligamentum Patellae,
(2) Tibial Collateral Ligament,
(3) Fibular Collateral Ligament,
(4) Oblique Popliteal ligament,
(5) Arcuate Popliteal Ligament,
(6) Anterior Cruciate Ligament,
(7) Posterior Cruciate Ligament.
Menisci (Semilunar Cartilage): The menisci are two fibrocartilaginous discs. They
are shaped like crescents. They are (1) Medial meniscus, (2) Lateral meniscus.
Functions of Menisci:
(1) They help to make the articular surfaces more congregate.
(2) The menisci serve as shock absorbers.
(3) They help to lubricate the joint cavity
Disease Review


(4) Because of their nerve supply; they also have a sensory function. They give rise
to proprioceptive impulses.
Disease Review


Table No. 12 showing the muscles producing movements of the Knee joint

Blood Supply:
Five genicular branches of the popliteal artery.
The descending genicular branch of the femoral artery.
The descending branch of the lateral circumflex femoral artery.
Recurrent branches of the anterior tibial artery.
The circumflex fibular branch of the post-tibial artery.
Nerve Supply:
Femoral nerve: - Through its branches to the vasti, especially the vastus medialis.
Sciatic nerve: - Through the genicular branches of the tibial and common peronial
Nerve.

Obturator nerve:-Through its posterior division
Sl.
No.
Movement
Principle
Muscles
Accessory
Muscles
1 Flexion
Biceps femoris,
Semitendinosus
Semimembranosus
Gracilis, Sartorius
Popliteus,
Gastrocnemius
2 Extension Quadriceps femoris Tensor fascia latae
3
Medial
rotation of
flexed leg
Popliteus, Semitendinosus
Semimembranosus
Sartorius, Gracilis
4
Lateral
rotation of
flexed leg
Biceps femoris
Disease Review


Synovial fluid: The surfaces of articular cartilage are separated by a space filled with
synovial fluid, a viscous liquid that lubricates the joint. Synovial fluid is as ultra
filtrate of plasma into which synovial cells secrete hyaluronan and proteoglycans.
NIDANA
Nidana can be classified under various headings with different views. Among
them one classification is Sannikrishta and Viprakrishta Karana. Here, with the
complimentary references the Nidanas of Sandhigatavata is classified on this basis.
Sannikrishta Hetu: Ativyayama, Abhighata, Marmaghata, Bharaharana,
Sheeghrayana, Pradhavana, Atisankshobha.
Viprakrushta Hetu:
Rasa Kashaya, Katu, Tikta
Guna Rooksha, Sheeta, Laghu

Dravya Mudga, Koradusha, Nivara, Shyamaka, Uddalaka, Masura, Kalaya,
Adaki, Harenu, Shushkashaka, Vallura, Varaka.
Aharakrama Alpahara, Vishamashana, Adhyashana, Pramitashana
Manasika Chinta, Shoka, Krodha, Bhaya
Viharaja Atijagarana, Vishamopacara, Ativyavaya, Shrama, Divaswapna,
Vegasandharana, Atyucchabhashana, Dhatu Kshaya.
The nidanas of Vatavyadhi/ Vata prakopaka karanas are listed under the following
headings 1. Aharaja, 2.Viharaja, 3.Manasika, 4.Anya.
Disease Review


Table No. 13 showing the Aharaja Nidana:

Sl.
No
Nidana CA SU AS AH MN BP YR
1 Rooksha Bhojana + + + + + + +
2 Laghu Bhojana + + + - + + +
3 Sheetanna + + + - + - +
4 Alpa Bhojana + - - + + - +
5 Abhojana + + - - + + +
6 Pramita Bhojana - - + + - - -
7 Vishama Bhojana - + - - - - -
8 Ama + - - - + + +
9 Adhyashana - + - - - - -
10 Vishtambhi Ahara - - + - - - -
11 Viruddha Ahara - - + - - - -
12 Shushka shaka - + - - - - -
13 Trushitashana - - + - - - -
14 Kshudhitambupana - - + - - - -
15 Tikta-Katu-Kashaya rasa - + + + - + -
16
Vallura-varaka-uddalaka-koradusha-
shyamaka-nivara-mudga-masura-
adhaki-harenu-kalaya-nishpava
- + - - - - -
17
Katruna-dhanya-kalaya-chanaka-
karira-tumba-kalinga-chirbhita-bisa-
shaluka-jambu-tinduka
- - + - - - -

Disease Review


Table No. 14 showing the Viharaja Nidana:
Sl. No Nidana CA SU AS AH MN BP YR
1 Ati vyayama + + + + + + +
2 Ati prajagara + + + + + + +
3 Atyadhva + + + - + - +
4 Ati vyavaya + + + + + + +
5 Gaja-ashva-ushtra-sheeghrayana + + + - + - +
6 Vegadharana + + + + + + +
7 Abhighata + + + - + + +
8 Dukha shayya + - - - + - +
9 Dukha asana + - - - + - +
10 Plavana + + - - + - +
11 Prapatana + + - - + - +
12 Pradhavana - + - - - - -
13 Bharaharana - + - - - - -
14 Vega udheerana - - + + - - -
15 Atyuccha bhashana - - - + - - -
16 Prapeedana - + - - - - -
17 Pratarana - + - + - - -
18 Divaswapna + - - - + - +
Disease Review


Manasika Nidana: Psychological factors like Chinta, Shoka, Bhaya, Krodha etc are
the aggravating factors of Vata. As Vata is the controller of the manas, any affliction
to Manas disturbes the Vata dosha.
Table No. 15 showing the Manasika Nidana
Sl. No Nidana CA SU AS AH MN BP YR
1 Chinta + - - + + + +
2 Shoka + - + + + + +
3 Bhaya + - + - + + +
4 Krodha + - - - + - +
Anya Nidana: Panchakarma apacharas like Atidoshasravana, Atiraktamokshana,
Atiyoga of langhana, Apatamsana etc and Dhatukshayakarabhavas like
Rogakarshana, Gadakrita atimamsakshaya etc vitiate Vata. Dhatukshaya is an
important vitiating factor of Vata dosha.
Table No. 16 showing Anya Nidana:
1(su.ch.1.sl.12)
1 Vishama upachara + - - - + - +
2 Kriyatiyoga - - + + + - -
3 Ati asruka mokshana + - - - + + +
Sthoulya is another causative factor for Vata prakopa. The Meda-
avarana of Vata is the mechanism causing inter-relationship between Sthoulya
and vata vyadhis. All types of avaranas are also important vitiating factors of
Vata. Vardhakya avastha is dominate by Vata, during this period, Dhatukshaya
occurs which causes Vata prakopa.
Disease Review


Living in Jangaladesha is another cause of Vata prakopa.
1(su.ch.1.sl.22)

Vata gets vitiated in the end of day and night. Vata prakriti persons are more
susceptible to Vata vikaras. Persons who are Rooksha-kashaya-katu-tikta
satmya are also more susceptible to Vata vikaras.
OSTEOARTHRITIS
EPIDEMOLOGY AND RISK FACTORS:
13(p.2036)
Osteoarthritis is the most common joint disease of humans. Among elderly,
knee OA is the leading cause of chronic disability in developed countries.
Age and Sex: Age is the most powerful risk factor for OA. Women are at
high risk than men in developing OA. Radiographic evidence of knee OA,
and especially symptomatic knee OA, is more common in woman than in
men. In a radiographic survey of women <45 years, only 2% had OA;
between the ages of 45 and 64 years, however, the prevalence was 30%, and
for those >65 years it was 68%. In males, the figures were similar, but
somewhat lower, in the older age groups.
Hereditory Factor: The relation of heredity to OA is less ambiguous. Thus,
the mother and sister of a woman with distal interphalageal (DIP) jointa OA
(Heberdens nodes) are, respectively, two to three times as likely to exhibit
OA in these joints as the mother and sister of unaffected woman.
Race Factor: Racial difference exists in both the prevalence of OA and the
pattern of joint involvement. OA is more frequent in Native Americans than
in whites. The Chinese in Hong Kong have a lower incidence of hip OA than
Disease Review


in whites. Interphalangeal joint OA and especially hip OA are much less
common in South African blacks than in whites in the same population.
Whether these differences are genetic or due to differences in joint usage
related to life style or occupation is unknown.
Trauma: Major trauma and repetitive joint use are important risk factors for
OA. Anterior Cruciate ligament insufficiency or meniscus damage may lead
to knee OA. Although damage to the articular cartilage may occur at the time
of injury or subsequently, with use of affected joint, even normal cartilage
will degenerate if the joint is unstable.
Occupation: Men whose jobs required knee bending and at least moderate
physical demands had a higher rate of radiographic evidence of knee OA,
and more severe radiographic changes, than men whose jobs required neither.
Obesity: Obesity is risk factor for both knee OA and hand OA. For those in
the highest quintile for body mass index at base line examination, the relative
risk for developing knee OA in the ensuing 36 years was 1.5 for men and 2.1
for women. For severe knee OA, the relative risk rose to 1.9 for men and 3.9
for women, suggesting that obesity plays an even larger role in the etiology
of the most serious cases of knee OA.
OA is classified as primary and secondary based on causes. Primary OA is the
term used when the disorder arises from unknown or hereditary causes. Secondary
OA describes cases in which direct causes for the disorder are known. Classification
based on causes.
13(p.2037)

I. Idiopathic:
Disease Review


A) Localised OA (Hands, Knee, Hip, Spine), and other single sites, e.g.
glenohumoral, acromioclavicular, tibiotalar, sacroiliac, temporomandibular.
B) Generalized which includes 3 or more of the areas listed above.

II. Secondary:
1) Trauma: a) Acute, b) Chronic (occupational, sports)
2) Congenital or developmental: (Congenital hip dislocation, slipped epiphysis,
Valgus/varus deformity, epiphysial dysplacia etc.)
3) Metabolic: Ochronosis, Hemochromatosis, Wilsons disease, Gauchres disease
4) Endocrine: Acromegaly, Hyperthyroidism, Diabetic mellitus, Obesity,
Hypothyroidism
5) Neuropathic: Charcot joints
6) Calcium deposit diseases: Calcium phosphate dehydrate deposition
POORVA ROOPA:
Avyakta or alpa lakshanas manifesting before the disease is considered as
poorva roopa In Vata vyadhi
1(ni.ch.1)
.

So symptoms such as mild shula, shotha etc
manifesting prior to the rupa can be considered as poorvaroopa in Sandhigata Vata.
ROOPA
Tabel No. 17: showing the roopa of Sandhigata Vata according to different texts:
Sl.
No.
Roopa/Lakshana C.S. S.S. A.S. A.H. M.N B.P Y.R
1 Shula - + - - + + +
2 Vata poorna druti sparsha + - + + - - -
3 Shopha - + - - - + +
4
Prasarana Akunchanayoho
savedana pravrutti
+ - + + - - -
Disease Review


5 Hanti sandhin - + - - + + +
6 Atopa - - - - + - -

Disease Review


SHULA: Prakupita Vata dosha is responsible for all types of shula and
there cannot be any shula without the involvement of Vata. Asthi toda
(breaking or tearing type of pain) is one of the main symptoms of Asthi
kshaya.
SHOTHA/ SHOPHA: Except Madhavakara all other acharyas have
described shotha/shopha as one of the main feature of Sandhigata Vata.
Charaka has explained that the shotha seen in Sandhigata Vata resembles
an air filled bag; this opinion is accepted by both the Vagbhatas. Though
Sushruta has explained Shopha as one of the features of Sandhigata Vata
unlike Charaka he has not specified the type of Shopha.
PRASARANA AKUNCHANAYOHO SAVEDANA PRAVRUTTI:
It means painful joint movements. It can be felt as difficulty in normal joint
movement or the pain felt on initial movements after long period of
inactivity can be compared to this which is due to the stambha or stiffness
caused due to inactivity.
HANTI SANDHIN: This can be compared to restricted joint movement
and it was first explained by Sushrutha. Different commentators have
explained this as follows:-
a) Dalhana: Explains this as absence of prasarana and akunchana of the
Sandhi i.e. absence of normal range of movement of the joint (flexion
and extension).
b) Gayadasa: Explains this as inability of the joint to move which is
similar to Dalhanas explanation.
Disease Review


c) Sandhi Vishlesha and Stambha: In Madhukosha vyakhya on
Madhava Nidhana, Hanti Sandhi has been explained as Sandhi
vishlesha (weakness of joint) or Stambha (stiffness or loss of function)
of the joint.
ATOPA: Only Madhavakara has explained this feature. It has replaced
the Shopa form Sushrutas version. No specific commentary is available
for this word. Charaka while explaining the trividha pareeksha, states that
Sandhi sphutana in the anguli parva (interphalangeal joints) should be
examined under Pratyaksha pariksa.
CLINICAL FEATURES OF OSTEOARTHRITIS:

The joint pain of OA is often described as a deep ache localized to the
involved joint. Typically, it is aggravated by joint use and relieved by rest but, as the
disease progresses, it may become persistent. Nocturnal pain interfering with sleep is
seen particularly in advanced OA of hip and may be enervating. Stiffness of the
involved joint after a period of inactivity (e.g. a nights sleep or automobile ride) may
be prominent but usually lasts<20 minutes. Systemic manifestations are not a feature
of primary OA. Because articular cartilage is anueral, the joint pain in OA must arise
from other structures.
13(p.2039)
Table No. 18 showing causes of Joint pain in patients with OA
Sl. No Source of pain Mechanism
1 Synovium Inflammation
2 Subchondral bone Medullary hypertension, micro fracture
3 Osteophytes Stretching of periosteal nerve endings
4 Ligaments Stretch
5 Capsule Inflammation, distention
6 Muscle Spasm
Disease Review


Clinical Signs of OA:
Restricted movement (capsular thickening, blocking by osteophytes)
Palpable, sometimes audible, coarse crepitus (rough articular surface)
Bone swelling (osteophytes) around joint margins
Deformity, usually without instability
J oint-line or periarticular tenderness
Muscle weakness, wasting
No or only mild synovitis (effusion, increased warmth)
13(p.1098)

KNEE OSTEOARTHRITIS:
11(p.1098)

OA of knee may involve the medial or lateral femorotibial compartment
and/or the patellofemoral compartment. Trauma is a more important risk factor in
men and may result in unilateral OA. Most Knee OA particularly in women is
bilateral and symmetrical. OA pain is usually localized to the anterior or medial
aspect of the knee and upper tibia. Patello-femoral pain is usually worse going up and
down stairs or inclines.
11(p.2040-2041)

Local examination findings may include:
11(p.1099)

o A varus, less commonly valgus, and/or fixed flexion deformity
o J oint line and/or periarticular tenderness
o Weakness and wasting of quadriceps muscle
o Restricted flexion/extension with coarse crepitus
Disease Review


o Bony swelling around knee joint
o J erky asymmetric antalgic gaitless weight bearing on the painful side
The American College of Rheumatology has established clinical criteria for
diagnosing primary osteoarthritis of the knees as follows:
14(p.796)

Knee pain and;
At least three of the following 6 criteria: 50 years of age or older, stiffness
lasting less than 30 minutes, crepitus, bony tenderness, bony enlargement, no
warmth to the touch
Laboratory and Radiographic findings:
13(p.2040)

The diagnosis of OA is usually based on clinical and radiographic features. In
the early stages, the radiograph may be normal but joint space narrowing becomes
evident as articular cartilage is lost. Other characteristic findings include subchondral
bone sclerosis, subchondral cysts, and osteophytosis. A change in the contour of the
joint, due to bony remodeling, and subluxation may be seen.
No laboratory studies are diagnostic of OA. Because primary OA is not
systemic, the erythrocyte sedimentation rate, serum chemistry determinations, blood
counts, and urinalysis are normal. Synovial fluid reveals mild leukocytosis
(<2000 WBC per micro liter), with predominance of mononuclear cells.
Disease Review


Table No. 19 showing the Kellgren- Lawrence Radiographic Grading
Scale
14(p.796)
Of Osteoarthritis of Tibio-Femoral Joint:

Grade of the
Osteoarthritis
Description
0 No radiographic findings of Osteoarthritis
1 Minute osteophytes of doubtful clinical significance
2 Definite osteophytes with unimpaired joint space
3 Definite osteophytes with moderate joint space narrowing
4
Definite osteophytes with severe joint space narrowing
and subchondral sclerosis
UPASHAYA AND ANUPASHAYA:

Upashaya is judicious use of drugs, diet and practices (vihara) which results
in relief of symptoms. Upashaya is antagonistic to the cause of disease and to the
disease itself and anupashaya is that which aggravates the symptoms
.
No specific
Upashaya has been described for Sandhigata Vata in the classics. The general
Upashaya and Anupashay of Vata vyadhis can be considered here. Tailabhyanga is an
upashaya in Sandhigata Vata. The snigdha, guru and ushna gunas of taila counters
the ruksha, laghu and sheeta guna of Vata. Indulgence in laghu, ruksha ahara, and ati
vyayama etc viharas can be considered as aupashaya in Vata vyadhis.
Sadhyasadhyatva: Sandhigata Vata is one of the kevala Vata vyadhis. Vata vyadhi is
one among the Mahagadas, which are considered as difficult to treat right from the
beginning stage of the disease. Sandhigata Vata usually occurs in old age due to
dhatu kshaya as old age is dominated by Vata. Moreover Sandhigata Vata belongs to
Disease Review


madhyama rogamarga vyadhis. Diseases situated in marmas and madhyama
rogamaraga are kashta sadhya vyadhis. Diseases involving the gambheera dhatus are
yapya vyadhis and in Sandhigata Vata asthi dhatu is involved which is a gambheera
dhatu. Considering all the above points Sandhigata Vata can be grouped under yapya
vyadhi,s which need regular and long term treatment.
1(ni.ch.1.sl.8)

SAMPRAPTI
It is very important to know the Samprapti or pathology before starting the
treatment. From the onset of Dosha-Dushya Dushti, till the evolution of the Vyadhi
various stages can be seen. Samprapti explains such series of pathological stages
involved.
As no special Samprapti has been explained for Sandhigata Vata the Samanya
Samprapti of Vatavyadhi can be considered as the Samprapti of Sandhigata Vata.
According to Acharya Charaka and Vagbahta, dhatu kshaya is the main cause
for Vata prakopa.This balavan (prakupita) Vata circulates through the empty
channels in the body (rikta srotas), fills them and produces sarvanga and ekanga
rogas (systemic and localized diseases). Chakrapani commenting on the word riktani
states that riktani means tuchyani (snehadi gunashunyani) i.e channels or srotasas
devoid of nutrients.

Avarana of this prakupita Vata by other doshas is the other
reason for the Vata prakopa in the absence of dhatu kshaya resulting in
disease.
6(ni.ch.15.sl.6)

That is, the above said Ahara vihara induces reduction of Snehabhava and
simultaneously produces Vatakopa due to the dhatu kshaya. Reduction of Shleshaka
kapha occurs and this allows the settling of vitiated Vata (vyana vata) in the joints
thereby gradually resulting in the manifestation of Sandhigata Vata.
Disease Review


Concept of Gatavata
As the disease belongs to Gatavata group of Vata vyadhis, it will be
relevant to discuss the concept of Gatavata here. While mentioning Gatavata,
acharyas have mentioned the gatatva of dhatu, upadhatu, ashaya, avayava
etc.
160
The various terminologies used to denote this Gatavata are gate, sthithe,
avasthite, ashrite, prapte, etc. These all terminologies can imply two important
factors A) related to the gati of the vitiated Vata and B) related to the
occupation of a particular site.
Three main factors involving in the production of Sandhigata Vata are
Kopa of vyana vata, which normally controls all the movements of the body.
Kshaya of shleshaka kapha, which normally aligns the joints and maintains its
compactness.
Deterioration of Shleshmadhara kala, which lubricates the joints.
Samprapti ghatakas
01. Dosha Vata Vyana vata vridhi, and Kapha Shleshaka kapha kshaya
02. Dushya Asthi, Majja, Peshi, Snayu, Shleshmadhara kala
03. Srotas Asthivaha, Medovaha, Majjavaha, Mamsavaha
04. Agni Jatharagni, Asthidhatwagni,
05. Ama Jatharagni mandyajanya, Asthidhatwagni mandyajanya,
06. Udbhava Pakwashaya
07. Rogamarga Madhyama
Disease Review


08. Adhisthana Sandhi
Pathogenesis of Osteoarthritis:
11(p.1097)

A variety of mechanical, metabolic, genetic or constitutional insults may
damage a synovial joint and trigger the need for a repair. Most often the insult
remains unclear (primary OA) but sometimes there is an obvious cause such as
trauma or ligament ruptures (secondary OA). All the joint tissues (cartilage, bone,
synovium, capsule, ligament, muscle) depend on each other for health and function.
Insult to any one of the tissue impacts on the others, resulting in a common OA
phenotype affecting the whole joint. OA process involves dynamic new tissue
production and remodeling of joint shape. Often the slow but efficient OA process
compensates for the insults, resulting in an anatomically altered but pain-free
functioning joint (compensated OA). Sometimes, however, because of either
overwhelming or chronic insult or an inherently poor repair response, it fails;
resulting in progressive tissue damage, more frequent association with symptoms, and
presentation as joint failure.

Pathological changes:
13(p.833)
Articular cartilages: The regressive changes are most marked in the weight bearing
regions of the articular cartilages. Initially, there is loss of cartilaginous matrix
(proteoglycans) resulting in progressive loss of normal chondrocytes, and at other
places, proliferation of chondrocytes forming clusters. Further progression of the
process causes loosening, flanking and fissuring of the articular cartilage resulting in
Disease Review


breaking off of pieces of cartilage exposing subchondral bone. Radiologically, this
progressive loss of cartilage is apparent as narrowed joint space.

1) Bone: The denued subchondral bone appears like polished ivory. There is
death of superficial osteocytes and increased osteoclastic activity causing
rarefaction, imcrocyst formation and occasionally micro fractures of
subadjucent bone. These changes result in remodel ling of bone and changes
in the shape of joint surface leading to flattening and mushroom-like
appearance of the articular end of the bone. The margins of the joints respond
to cartilage damage by osteophytes or spur formation. These are cartilaginous
outgrowths at the joint margins which later get ossified. Osteophytes give the
appearance of lipping of the affected joint. Loosened and fragmented
osteophytes may form free joint mice or loose bodies.
2) Synovium: Initially, there are no pathological changes in the synovium but in
advanced cases there is low-grade chronic synovitis and villous hypertrophy.
There may be some amount of synovial effusion associated with chronic
synovitis.

Disease Review


Vardhakya
Viharaja Nidana
Aharaja Nidana
Reduced Poshana
of Rasadhi Dhatus
Asthi Dhatu & Other Dhatu
Kshaya
Damage to
Shleshmadhara kala
Reduction of
Snehanamsha
Shleshaka
Kapha
Kshaya
Shithilata of
Snayu, Sira,
Kandara, Peshi
Khavaigunyata
of Janu Sandhi

Vata Prakopa
Sthana Samshraya of
Kupita Vata
Janu SandhigataVata
SAMPRAPTI OF JANU SANDHIGATA VATA
Disease Review


CHIKITSA
The treatment of the disease is nothing but the breaking-up of the Samprapti.
Charaka has not mentioned any special line of treatment for Sandhigata Vata, but has
mentioned bahya and abhyantara snehana as the treatment for Asthi and Majjagata
Vata which can be adopted in Sandhigata Vata also. Later authors have mentioned
specific line of treatment for Sandhigata Vata with minor changes which is listed
below.
Tabel No. 20 showing the Chikitsa sutra of Sandhigata Vata according to different
texts
Sl.
No
Chikitsa CA SU A.S A.H C.D B.P Y.R B.R
1 Snehana - + + + + - +
2 Upanaha - + + + + + + +
3 Agni karma - + + - + + - +
4 Bandhana - + + - + - - +
5 Svedana - - + - - - + -
6 Raktavsechana - - + - - - - -
7 Pradeha - + - - - - -
8 Mardhana - + + - + - + +

-||||||l|||||||||l||
-|||-||l-|-|||||||||||l|||
2(chi.ch.4.sl.8.p.480)

Dalhana commenting on the word snehana explains that here snehana means
both bahya and abhyantara types of snehana should be considered. Further he
Disease Review


explains atandrita as analasa i.e. continuous, means the treatment should be done
regularly for long duration.
Vridddha Vagbhata has laid stress on abhyanga. Raktavasechana is indicated
in case of tvak swapana, and it should be followed by pradeha with tila, lavana and
agara dhuma.
Bhavaprakasha has mentioned one yoga for Sandhigata Vata: Indravaruni mula,
magadhi and guda when consumed in a dose of 1 karsha cures Sandhigata Vata.
PATHYA
1(ch.23.sl.597)

Ahara
1. Rasas : - Madhura-Amla-Lavana
2. Shukadhanya : - Nava godhuma, Nava shali, Rakta shali, Shashtika shali.
3. Shimbi varg a : - Nava tila, Masha, Kulattha.
4. Shaka varga : - Patola, shigru, vartaka, lashuna.
5. Mamsa varga : - Ushtra, Go, Varaha, Mahisha, Bheka, Nakula,
Chataka, Kukkuta, Tittira, Kurma.
6. Jala varga : - Ushnajala, Shrithasheetajala, Narikelajala.
7. Dugdhavarga : - Go, Aja, Dadhi, Ghritha, Kilata, Kurchika.
8. Mutravarga : - Gomutra.
9. Madyavarga : - Dhanyamla, Sura.
10. Snehavarga : - Tilaja, Ghrita, Vasa, Majja.
Vihara
Veshtana, Trasana, Mardana, Snana, Bhushayya, etc.
APATHYA
Ahara
1. Rasa : - Katu, Tikta, Kashaya.
2. Shimbivarga : - Rajamasha, Nishpava, Mudga, Kalaya.
Disease Review


3. Shukavarga : - Truna, Kangu, Koradusha, Neevara, Syamaka.
4. Phalavarga : - Jambu, Udumbura, Kramuka, Tinduka.
5. Mamsavarga : - Sushka mamsa, Kapota, Paravata.
6. Jalavarga : - Sheeta jala.
7. Ksheeravarga : - Gardabha.
Vihara
1. Manasika : - Chinta, Shoka, Bhaya.
2. Shareerika : - Jagarana, Shrama, Vyayama, Vyavaya, Chankramana,
Vegadharana etc.
Management of OA:
The American Rheumatism Association (ARA) has issued pharmacologic
guidelines for treatment of OA of the hip and knee.
(1) Arthrocentesis with corticosteroid injection can be used only for knee OA if
effusion is present.
(2) Acetaminophen can be administered, up to 4 g/d. This is the preferred initial
treatment to be given to patients with OA.
(3) Topical anti-inflammatory medications or capsaicin can be administered only for
knee OA.
(4) Low-dose nonsteroidal anti-inflammatory drugs (NSAIDs) (i.e., analgesic doses)
or nonacetylated salicylates may be indicated.
(5) Administration of full-dose NSAIDs with misoprostol, if risk factors for upper
gastrointestinal bleeding are present.
(6) Narcotic analgesic use may be indicated in cases of severe pain.
Surgical interventions for OA of the knee:
Arthroscopic lavage - Using a saline lavage to wash out the joint
J oint realignment (realignment osteotomy)
Disease Review


J oint fusion (arthrodesis) - Surgically fusing the joint to eliminate motion
J oint replacement (arthroplasty)

Suchi vyadha chikitsa

SUCHI VYADHA
HISTORICAL REVIEW
If we go back to the Indian medical classics, known as the Vedas, said to be written
about 7000 years ago, we find "needle therapy" [Suchi karma] mentioned there. One
volume of the Vedas, known as the Suchi Veda, translated as the "art of piercing
with a needle" was written about 3000 years ago and deals entirely with acupuncture.
Unfortunately this text is not available today
18(p.11)
. During ancient period, bamboo or
wooden Suchi needles were used for acupuncture. Sushrutha has mentioned the art
of acupuncture under Vyadhana or Bhedhana Karma (Bhedhana means to pierce or to
cut). During ancient time needles made up of wood were used, later on various metal
needles were used for this purpose. Sushruta in Sharira sthana 8 Siravyadha has
advised puncturing the channels (sira) by using needles, which are as small as vrihi
(vrihi is the outer cover of the rice grain which is pointed at both ends.
The Indians have both body acupuncture and ear acupuncture. Thus in India, an entire
system of treating every type of disease by the ear alone was [also] developed! Some
scholars believe that acupuncture probably evolved in prehistoric times out of the
modifications of the principles of Ayurveda near the snowy bleaks of the Himalayas,
where no herbs were available.
... In fact, this knowledge has already got passed to the nearby countries around India
mainly during Buddha period and got stored as in cold storage. It is not a
coincidence that almost all Buddhist countries have this knowledge and it is the Indian
fortune that the origin of this knowledge [of acupuncture] is from India (But rather
unfortunate that not many people in India know this and appreciate this fact as we sure
have a 'tradition' of forgetting our traditions! and sciences be it mantric or Vedic.

PROCEDURE
Suchi Vyadha is an art of Introducing delicate fine Suchi (Fine Needles) into different
sensitive points to stimulate the particular area to get the desired therapeutic effect.
In this clinical study we have used a fine silver headed acupuncture needle for suchi
vyadha. Suchi vyadha is done in and around janu marma with radius of 3 angula to
stimulate janu marma & in turn to stimulate Sandhi Avayavas present in it, so that it
helps in relieving the pain & promotes Sandhi poshana & thus helps in early repair of
Dhatu Kshayata & restores normal joint integrity.
Back Ground:
As such there is no direct reference presently available in our classics for suchi
vyadha chikitsa. Acupuncture has great role in pain management & it is world widely
accepted as an alternate system of treatment for pain management. In acupuncture
they puncture on an acupuncture point & stimulate the same to cure many diseases.
With the same principle we have tried to stimulate janu marma to manage janu
sandhigata vata. In fact the concept of Marma is well described in our classics, but its
importance in therapeutic aspect (other than Viddha Lakshana) is never mentioned &
ever used (i.e. Marma Sthana is not used to cure disease or to relieve pain). They only
say that, Marma Sthana which is a very vital point should not be injured & should be
kept intact even while doing surgeries. In this present study to first of its kind an
attempt is made to manipulate or stimulate Marma Sthana to obtain desired
therapeutic effect. In coming days this idea may form basis in curing innumerable
disease just by manipulating or stimulating Marma Sthana, which is a seat of prana or
life.

In this present study patient with jaanusandhi vikara is considered and Suchi Vyadha
is done with suchi on jaanu marma to relieve from jaanu shoola and other associated
symptoms. Though there is no direct reference for Vyadhana karma on Marma Sthana
& Suchi Vyadha Chikitsa (for Analgesic purpose) in our classics, with some of the
following cross references this treatment procedure is carried out.
|+|l||| +|'|| |||l||||l||
|| | u| l|2 |||+| ||
|||||||| ||| l||||| ||-|| |||
||l| ||||| ||| |7|| ||l| |||
3
(Ukch.11sl.102)
Diseases which is purely of vataja in origin like apabhahuka, vishvaachi, grudrasi etc,
in it first pricking with needle should be done, then followed by lepa with gunja phala
is applied. This type of treatment gives immediate relief.
With this reference we can consider that puncturing or suchi vedha can be done.
|+|'|| -|| -||| ||||| l|||
2
(UTch.9sl.18)
In pakshmashata they say that first the site should be pricked with needle then other
line of treatment is adopted.
Even in nilika, vyanga, keshashaata kuttana karma (pricking) with kurcha is
mentioned.
|||+| l|| ||+||7||||l
s|||l-|l||| -|||-||+'|||| -|-|||l||
1
(su.ch.25.sl.23)

The above shloka says suturing in marmasthana, vrashanakosha, udara is done by

using curved needle (Dhanurvakra).
With this we can come to conclusion that when suturing itself is allowed on
marmasthana, why not it be punctured. With the above references we can come to
conclusion that directly or indirectly suchi vyadha or puncturing can be done.
More over it is a controlled way of introducing delicate fine suchi to marma and does
not creates any injury or viddha.
In marma viddha lakshana they say death occurs due to blood loss, since there
is no blood loss or injury in this procedure, this may be carried out. This only activates
the doshas present in the marma and brings them into harmony through a controlled
way of pricking and does not create any injury or abhighata to marma.
Shastra Karma
cF
= c
(.[. ./)

Above shloka says Vyadhana karma is one among shastra karma, literally it
means puncturing, puncturing on sira for bloodletting is mentioned in our classics, but
puncturing needle for analgesic effect is not mentioned it is a new approach to do
suchi vyadha on janu marma to manage signs & symptoms of janu sandhigata vata.


Suchika Bharana Rasa
=
cd
|
= =
( ..7../-)

With fine suchi, suchika bharana rasa, is put into circulation through
suchi vyadha on Bramha Randra. With this we can say that concept of suchi
vyadha was known to our ancients.

Needle review

HISTORY OF ACUPUNCTURE - NEEDLE

The earliest acupuncture implements were sharp pieces of bone or flint in the shape of
arrowheads called Bian stones. Their use was limited because of their size and shape
and they were used to scratch or prick acupuncture points. Later, sharp pieces of
pottery were used for this purpose. As time went on, the Chinese refined this process
eventually using needles to stimulate acupuncture points.
Early acupuncture needles were made from bamboo and bone and as they were rather
thick, their insertion was painful. In spite of there being no knowledge of sterilization
before the 19th century, it is surprising to note that infection rarely occurred with
acupuncture. This is because acupuncture stimulates the immune system enhancing
the body's protective mechanisms.
With the advent of the Iron Age and the Bronze Age the next type of needles to be
developed were metal needles. As the art of metallurgy progressed, different types of
needles were made. Early needles were made from iron, copper, bronze, silver and
gold. At the time when the "Neiching" was written, there were nine different types of
acupuncture needles in use. These were similar to present day needles. Very thin, fine
needles were used for routine treatment. Arrowhead needles were used to prick the
points. Blunt and round needles were used for acupressure. Scalpels like needles were
used for cutting open boils and abscesses. Larger and heavier needles were available
for insertion into joints and when the acupuncture points lay deep below the skin,
longer needles were used.
Small thumbtacks shaped needles were used for insertion at ear acupuncture points
when prolonged stimulation was required. Three-sided needles were used to bleed the
Needle review

patient in cases of coma and high fever. The drawing of a few drops of blood from
certain acupuncture points can bring down high fever, stop convulsions and restore
consciousness in a matter of minutes without any other treatment. Finally there were
the plum blossom needles also called the seven star needles which were used to tap the
skin over acupuncture points. This was mainly used to treat skin diseases, children,
old people and patients who were afraid of needles.
These needles were in widespread use for thousands of years until the early years of
the 20th century, when the invention of stainless steel revolutionized the art of
Some acupuncturists claim that needles made from silver or gold have special
therapeutic properties. Needles made from silver and gold are expensive and so are
often re sharpened, straightened and reused. Unfortunately, the process of re
sharpening needles is laborious and time consuming and it is rarely possible to get as
sharp a point on these needles as on a stainless steel needle. In my experience needles
made from stainless steel are as effective in therapy as needles made from any other
material.
Needles made from two metals act as a thermocouple, and generate a small electric
current. So the handles of some acupuncture needles are made from metals like
copper, silver and gold with the needle itself being made from stainless steel. Needle
handles made with copper and silver get oxidized during use and storage, which
reduces their electrical conductivity making them unsuitable for electrical stimulation.
An average acupuncture needle is slightly thicker than a human hair and its insertion
is virtually painless. Many potential patients are dissuaded from trying acupuncture by
the pictures they see of acupuncture where long, thick needles are inserted into the
Needle review

patient. This has given rise to the misconception that acupuncture is painful. This
misconception also arises from the belief that acupuncture needles are similar to
injection needles. There are several fundamental differences between acupuncture
needles and hypodermic needles used for giving an injection.
Normal acupuncture needles are so thin that they cannot be seen in a picture or on
television. The needles used for demonstration are far thicker than those used for
acupuncture. As you would appreciate, a silver needle slightly thicker than a human
hair is hard to see.
An acupuncture needle is very thin, ranging from 0.16 mm to 0.38 mm in thickness,
while injection needles range from 0.6 mm to 2 mm (in blood transfusion needles).
The tip of an acupuncture needle is conical in shape, which allows it to penetrate the
tissues separating the fibres of the muscle as it enters, without causing damage.
Similarly on removing the needle the separated fibres close smoothly around the
needle, preventing bleeding.
A hypodermic needle in contrast, has a sharp edge and its insertion cuts out a small
cylinder of flesh as it enters. This fact is used for carrying out a needle biopsy to
diagnose cancer. A hypodermic needle also has a hole through which a liquid is forced
while giving the injection. Once the medicine is injected it forces the cylinder of flesh,
into the place where the injection is given releasing painful substances called
prostaglandins. The forcing of the medicine into a closed space also causes pain.
Needle review


In acupuncture, no fluid is injected into the body and as the needle does not have a
cavity in the middle; it is much thinner than a hypodermic needle. The sensation felt
when an acupuncture needle is inserted is very different from the sensation felt when a
hypodermic needle is used. In contrast to an injection, an acupuncture needle produces
its effect by altering the energy flow inside the human body.
Acupuncture needles come in various sizes and thicknesses ranging from two
millimetres to ten centimetres in length. The handles are one to three centimetres long.
The longest needles are used on fat people in areas where there is thick muscle and a
lot of fat, like the buttocks and hips. On the forehead hands and face, only the tip of
the needle is inserted. The depth of insertion of the needle varies from one millimetre
to about ten centimetres depending on the depth of the acupuncture point to be treated.

Needle review


Needle review


The Acupuncture Needles:
16(p.35-40)
In ancient China, nine different types of needles were used for acupuncture.
Although they were called needles, some of them were really in the form of small
lances, while others had a small cutting edge. One type of needle had a ball point and
was used for micro massage (acu-massage) at the acupuncture point.
The following is a description of the types of needles in common use today.
a) The filiform needles
The filiform needle comprises a handle or holder, and a shaft. The handle
may be made of copper, bronze, aluminium, silver or stainless steel. Plastic
handled disposable acupuncture needles are also now available. The shaft
nowadays is always manufactured from stainless steel (astematic steel).

The length of these needles (i.e. the length of the shaft) varies from 0.5 inch
to 8 inches or more. The calibre (diameter) may range from gauge 26 to 34.
The following table shows the standard sizes available:
Length
Inches (cuns) 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 6.0
Millimetres 15 25 40 50 65 75 90 100 115 125 150

Diameter
Standard Wire Gauge No. 26 28 30 32 34
Millimetres 0.45 0.38 0.32 0.26 0.22
Needle review


For general use the 1.0 inch or 1.5 inch long, No.28 or 30 needles are
preferred. Gauge No. 30 (i.e. the thinner needles) are particularly
recommended for points in the eye region, in children and for conditions where
minimum stimulation is needed. The longer needles are used for areas where
the muscular mass is thick. E.g. Huantiao (G.B.30) and in puncturing-through
technique, where the needle is directed from one point through to another. The
thicker needles, Gauge No.26 & 28 are used in regions where relatively
stronger stimulation is required.

b) The embedding needles
Also called the press needle and implanted needle, they come in several
shapes, depending on their use.

i) The thumbtack type: this looks like a small thumbtack. The body of the
needle is in the form of a small circle about 3mm in diameter and its tip stands
out at right angles to the circle. It penetrates to a depth of 2-3 mm. It is used
more commonly in ear acupuncture.
ii) The fish tail type: This is similar to the thumbtack type, except that its shaft
lies at the same plane as its body. This needle is used on certain body
acupuncture points for continuous stimulation. It is inserted horizontally under
the skin, and then fixed with adhesive tape.
Both these types of needles are indicated in chronic conditions like bronchial
asthma, epilepsy & in painful condition like migraine. They may be kept in place
Needle review

for up to seven days & are therefore, useful in providing mild stimulation of an
acupuncture point between treatment sessions. In warm weather it is advisable to
change the needle in about half this time.
iii) The spherical press needle (ball bearing type): This may also be used for
the same purpose. This is becoming more popular nowadays, as it is safer
because there is no chance of damage to cartilage and infection of the ear. It
consists of a tiny stainless steel ball which is fixed on the skin at acupuncture
point with adhesive porous tape.
iv) The muscle embedding needle: these are slightly longer than the fish tail
type and are used to allay very intractable painful conditions like phantom limb
pain and the pain of secondary cancer. The muscle embedding needle is left in
situ at local painful points in the muscle (Ah-Shi point) for a few days.
c) The Plum Blossom needle
This is known as the Five Star or Seven Star needle. It is made up of 5
or 7 short filiform needles attached to a holder at the end of long handle. The
plum blossom needle is used to tap on the skin along a channel or at specific
points. It is indicated in children, in weak patients, in skin diseases and in those
who dislike puncturing.

d) The three-edged (or prismatic) needle
This has a triangular point and is used to bleed certain areas in skin
disorders, arthritis & in acute emergencies. (In modern acupuncture a syringe
& an intravenous needle are used for the same purpose).

Materials & Method


SECTION 3
MATERIALS AND METHODS
Acupuncture Points.
Acupuncture Points.
J anu Sandhigata Vata. (Osteoathritis of the Knee J oint)
Sandhigata Vata. (Osteoathritis of the Knee J oint)
2. SOURCE OF DATA
Patients of J anu Sandhigata Vata who fulfiled the inclusion criteria were
randomly selected from outpatient & in patient Department of PG Studies in
shalyatantra, SJ IIM Hospital.
3. SELECTION CRITERIA
Diagnostic Criteria
Patients with classical signs & symptoms of J anusandhigata vata supplemented
with that of Osteoarthritis of Knee J oint like
1. Pain & restricted movement of the knee joint.
Materials & Method


2. Presence of crepitus
3. Tenderness
4. Presence of swelling
5. Radiological evidence of OA of knee
6. J anu Sandhi kriya kshamath in varying degree
3.1 Inclusion Criteria
1. Patients fulfilling the diagnostic criteria in the age group between 40 to 75
years are selected for the present study.
3.2 Exclusion Criteria
1. Patients having J anusandhi shoola due to trauma, fracture & dislocation.
2. Patients suffering from Rheumatoid Arthritis, Gouty Arthritis, Psoriatic
Arthritis & other inflammatory disease.
3. Patients suffering from tuberculosis & other infectious & malignant disease.
4. STUDY DESIGN
A total number of 40 patients were selected randomly for the present clinical
study. These 40 patients were divided into 2 groups. Group A & Group B, each
consisting of 20 patients.
Group A
Patients of this group were treated daily by Suchivyadha on J anumarma
for 12 sessions & for about 30 minute duration.
Group B
Patients of this group were treated daily by Acupuncture on
Acupuncture points for 12 sessions & for about 30 minute duration.
Materials & Method


4. MATERIALS REQUIRED FOR THE STUDY
Cotton Swab
Tankana J ala
Sterile, Packed Acupuncture Needle
Kidney Trey
Goniometry
Measuring Tape
Stop Clock
Gas Stove
Lighter
5. METHODOLOGY OF STUDY
The patients who fulfilled the inclusion criteria were evaluated for both
subjective & objective parameters.
Measurement of Knee joint:
Circumference of the knee joint was measured with the help of
measuring tape in the following manner: -
The patient was asked to lie in relaxed supine position, breathe
easily and not to hold the knees tight. Both knees were exposed. The
circumferences of both the knees were measured just above the Patella.
GONIOMETRIC MEASUREMENT
The patient was first educated about the examination and was asked to lie in
supine position with both the legs flat on the table exposing the legs as far as
possible. While examining the female patients help of fellow female scholars
was sought. The fulcrum of the Goniometre was aligned with the lateral
Materials & Method


epicondyle of the femur. The stationary arm was placed in line with the greater
trochanter and midline of the femur. The moving arm was placed in line with
the lateral malleolus and midline of fibula. Then the patient was asked to bend
the knee as far as they can. The angle created was noted and recorded.
STUDY DESIGN
Group-A
Patient was made to sit comfortably on a chair, with the affected knee
well exposed. As a aseptic precaution the part was cleaned with tankana jala.
Then Suchi Vyadha was done on J anu Marma with delicate fine sterile
sookshma suchi on the following points for about 30 minutes.

Specific Points for Suchi Vyadha on Janu Marma
Suchi Vyadha on most tender points, in & around the J anu Marma is done.
One needle just above the superior border of the patella on the medial side is
punctured for about 1 cm depth.
J ust above the superior border of the patella on the lateral aspect of knee is
punctured for about 1 cm depth.
One Centimeter below the apex of the patella a needle is punctured
perpendicularly up to 2 cm depth.
Vyadhana on either end of the joint crease is done.

Group-B
Patient was made to sit comfortably on a chair, with the affected knee
well exposed. As a aseptic precaution the part was cleaned with tankana jala.
Then the Acupuncture was done with sterile Acupuncture needle on the
following Acupuncture points for about 30 minutes.
Materials & Method


Acupuncture Points for Osteoarthritis of Knee
1. Baihui (Du.20)
This point is a meeting point of a hundred points & controls all
other points & channels in the body.
Location: Draw a straight line from the tip of the ear lobe to the apex of the
auricle & extend this line upwards on the scalp till it intersects the midline, the
point lies at this intersection.

II LOCAL POINTS
2. Ah-Shi Points-Most tender points
Ah-Shi in Chinese means Oh Yes, this being the verbal action of
the patient, when tender points are palpated.
2 to 3 maximum tender points in & around the knee joint are
punctured.
3. Heding (Ex.31)
On the mid point of the upper border of the patella.
Puncture-0.5 cun perpendicularly.
4. Xiyan (Ex.32)
In the depression on the medial side of the ligamentum patellae.
Puncture-0.5 cun perpendicularly.
5. Dubi (St.35)
The point on the lateral side of the ligamentum patellae.
Puncture-0.5 cun obliquely & medially.
6. Weizhong (UB.40)
At the mid point of the popliteal transverse crease.
Materials & Method


Puncture-0.5 to 1 cun perpendicularly.
5. ASSESSMENT CRITERIA
The improvements in the Subjective Parameters and Objective parameters
were assessed by scoring method. The subjective criteria (Table no.21) were
scored in accordance with Index of severity of Osteoarthritis of the Knee by
Lequesne et al & WOMAC. (Western Ontario & Mc Master Universities)
The patients were assessed on 1
st
, 6
th
& 12
th
day of treatment.

Table No. 21 showing Subjective and objective parameters
Sl. No PARAMETER FINDINGS PONITS
PAIN OR DISCOMFORT
1
pain or discomfort during
nocturnal bed rest
none
0

only on movement or in
certain positions
1

without movement
2
2
duration of morning
stiffness or pain after
getting up
<1 minute
0

>1 minute but <15 minutes
1

>15 minutes
2
3
remaining standing for 30
minutes increases pain
no
0

yes
1
4
pain on walking none
0

only after walking some
distance
1

after initial ambulation and
increasingly with continued
ambulation
2
5
pain or discomfort after
getting up from sitting
without use of arms
no
0
Materials & Method


yes
1
WALKED MAXIMUM DISTANCE
6
maximum distance
walked
unlimited
0

>1 kilometer but limited
1

about 1 kilometer (about 15
minutes)
2

about 500 - 900 meters (about
8-15 minutes)
3

from 300 - 500 meters
4

from 100 - 300 meters
5

<100 meters
6
7
walking aids required None
0

1 walking stick or crutch
1

2 walking sticks or crutches
2
ACTIVITIES OF DAILY LIVING
8
able to climb up a
standard flight of stairs
easily
0

with mild difficulty
0.5

with moderate difficulty
1.0

with marked difficulty
1.5

impossible
2.0
9
able to climb down a
standard flight of stairs
easily
0

0.5

1.0

1.5

impossible
2.0
10
able to squat or bend at
the knee
easily
0

0.5
Materials & Method


1.0

1.5

impossible
2.0
11
able to walk on uneven
ground
easily
0

0.5

1.0

1.5
impossible
2.0
12 Getting in or out of car easily
0
0.5
1.0
1.5
impossible
2.0
13 Putting on or taking off
socks
easily
0
0.5
1.0
1.5
impossible
2.0

OBJECTIVE PARAMETER
14 Tenderness No tenderness
0
Patients complains of pain
1
and winces
2
and withdraws the joint
3
15 Crepitus No crepitus
0
Materials & Method


Palpable crepitus
1
Audible crepitus
2
J ust above the patella

over the middle of the patella

16 Measurement of Right
knee joint
J ust below the patella

J ust above the patella

over the middle of the patella

Measurement of Left
knee joint

J ust below the patella

17 Range of Movement Right Knee joint(Flexion)

Left Knee joint(Flexion)

18 Time taken to walk 50
metres distance on even
ground
In seconds with the help of a
stop clock

FOLLOW UP PERIOD
After the treatment schedule, patient was advised to visit OPD once in 20 days
for a follow up period of 2 months for any recurrence or otherwise.
Criteria for assessment of total response of the treatment
The sum points of all the parameters of assessment before and after the
treatment were taken into consideration to assess the total effect of the treatment as
follows:-
1. Marked Improvement - Relief of 60-80%
2. Moderate Improvement - 30 to 60% relief
3. Mild Improvement - <30% of relief
4. No Change - 0% relief

Observations & Results


SECTION 4

OBSERVATIONS

A total of 40 patients were registered for the present study. 20 patients were
registered in group A & 20 patients were registered in Group B. All the patients were
examined before and after the treatment according to the case sheet format given in
the appendix. Changes in both the subjective and objective parameters were recorded.
The data recorded are presented here under the following heading:
I. Demographic data
II. Data related to the disease
III. Data related to over all response to the treatment
DEMOGRAPHIC DATA
Table No 22: Showing Sex distribution in both the groups.

Groups Male % Female %
Group A 12 60% 8 40%
Group B 12 60% 8 40%
Total 24 60% 16 40%

Graph No.1: Showing Sex distribution in both the groups.

In this study it is observed that in Group A, 12 (60%) were male and 8 (40%)
were female. In Group B, 12 (60%) were male and 8 (40%) were female.


Table No.23: Showing overall response based on Sex of the patient

Table No.24: Showing Age distribution in both groups.

Age Groups in
years
Group A % Group B % Total %
41- 45 1 5% 3 15% 4 10%
46- 50 2 10% 2 10% 4 10%
51- 55 3 15% 1 5% 4 10%
56- 60 6 30% 8 40% 14 35%
61- 65 4 20% 3 15% 7 17.5%
65- 70 2 10% 2 10% 4 10%
71- 75 2 10% 1 5% 3 7.5%

Graph No.2: Showing Age distribution in both groups.

In the present study it is observed that in Group A 1patient in 41 to 45 years
age group, 2 in 46 to 50 years, 3 in 51- 55 years, 6 in 56- 60 years, 4 in 61- 65 years, 2
in 65- 70 years and 2 in 71- 75 years age group.
Group Sex

Marked

% Moderate % Mild %
No
Change
%
Male 4 20 3 15 5 25 0 0
Group A
Female 4 20 3 15 1 5 0 0
Male
6 30 5 25 1 5 0 0
Group B
Female 4 20 3 15 1 5 0 0


In Group B 3 patients 41 to 45 years age group, 2 in 46 to 50 years, 1 in 51-
55 years, 8 in 56- 60 years, 3 in 61- 65 years, 2 in 65- 70 years and 1 patient in 71- 75
years age group.
Table No.25: showing overall response based on age group.

Group Age group Marked % Moderate % Mild %
No
change
%
41 - 45 1 5 0 0 0 0 0 0
46 - 50 1 5 0 0 1 5 0 0
51 - 55 1 5 2 10 0 0 0 0
56 - 60 3 15 3 15 0 0 0 0
61 - 65 1 5 1 5 2 10 0 0
66 - 70 1 5 0 0 1 5 0 0
Group
A
71 - 75 0 0 0 0 2 10 0 0
41 - 45 1 5 1 5 1 5 0 0
46 - 50 1 5 1 5 0 0 0 0
51 - 55 1 5 0 0 0 0 0 0
56 - 60 4 20 3 15 1 5 0 0
61 - 65 1 5 2 10 0 0 0 0
66 - 70 1 5 1 5 0 0 0 0
Group
B
71 - 75 1 5 0 0 0 0 0 0

Table No.26: Showing Occupation of the patients in both groups.

Occupation Group A % Group B % Total %
Business 7 35% 2 10% 9 22.5%
Official 5 25% 6 30% 11 27.5%
Housewife 8 40% 5 25% 13 32.5%
Labour 0 0% 7 35% 7 17.5%

Graph No.3: Showing Occupation of the patients in both groups.



Above table and graph suggests in Group A, 7 patients of Business class, 5 in
Official class, 8 were housewives, none of them were labour class. In Group B 2
patients in Business class, 6 each in official, 5 were housewives and 7 were in labour
class.
Table No. 27: showing overall response based on Occupation

Group Occupation

Marked

% Moderate % Mild %
No
Change
%
Business 3 15 3 15 1 5 0 0
Official 4 20 3 15 1 5 0 0
Housewife 1 5 0 0 4 20 0 0
Group A
Labour 0 0 0 0 0 0 0 0
Business
1 5 0 0 1 5 0 0
Official 2 10 3 15 0 0 0 0
Housewife 3 15 3 15 0 0 0 0
Group B
Labour 4 20 2 10 1 5 0 0

Table No.28: Showing Religion of patients in both groups.

Religion Group A % Group B % Total %
Hindu 19 95% 19 95% 38 95%
Muslim 1 5% 1 5% 2 5%
Christian 0 0% 0 0% 0 0%

Graph No.4: Showing Religion of patients in both groups.



It is seen that 19 in Group A and Group B were Hindu, 1 each in both groups
were Muslim.

Table No.29: showing overall response based on Religion

Table No.30: Showing SE Status of patient in both groups.

SE Status Group A % Group B % Total %
L.C 4 20% 5 25% 9 22.5%
M.C 10 50% 10 50% 10 50%
U.C 6 30% 5 25% 11 27.5%

Graph No.5: Showing SE Status of patient in both groups.

It is seen that in Group A 4 patient in LC, 10 in MC, 6 in LC. In Group B 5
patients in LC, 10 were in MC, 5 were in UC.

Group Religion

Marked

% Moderate % Mild %
No
Change
%
Hindu 8 40 6 30 5 25 0 0
Group A
Muslim 0 0 0 0 1 5 0 0
Hindu
9 45 8 40 2 10 0 0
Group B
Muslim 1 5 0 0 0 0 0 0


Table No.31: showing overall response based on Socio-economic Status

Table No.32: Showing Chronicity of the disease in patients.

Chronicity Group A % Group B % Total %
<1yr 10 50% 10 50% 20 50%
1y - 2y 8 40% 5 25% 13 32.5%
2y - 3y 2 10% 5 25% 7 17.5%
>3y 0 0% 0 0% 0 0%

Graph No.6: Showing Chronicity of the disease in patients.

Above data shows in Group A 10 patients had history of disease below 1 year,
8 had 1y 2y history, 2 had 2y- 3y history, no one had more than 3 years history. In
Group
Socio-economic
Status

Marked

% Moderate % Mild %
No
Change
%
Lower class 3 15 0 0 1 5 0 0
Middle class 3 15 6 30 1 5 0 0
Group
A
Upper class 2 10 0 0 4 20 0 0
Lower class
2 10 2 10 1 5 0 0
Middle class 5 25 4 20 1 5 0 0
Group
B
Upper class 3 15 2 10 0 0 0 0


Group B 10 had within 1 year, 5 had 1y- 2y history, 5 had 2y- 3y history and no one
had more than 3 years history.
Table No. 33: showing overall response based on Chronicity

Table No.34: Showing diet of patients of both groups.

Diet Group A % Group B % Total %
Vegetarian 12 60% 10 50% 22 55%
Mixed 8 40% 10 50% 18 45%

Graph No.7: Showing diet of patients of both groups.

It is observed that in Group A 12 were of vegetarian diet and 8 of mixed. In
Group B 10 each were of vegetarian diet and mixed.
Group Chronicity

Marked

% Moderate % Mild %
No
Change
%
<1 year 5 25 4 20 1 5 0 0
12 years 3 15 2 10 3 15 0 0
2-3 years 0 0 0 0 2 10 0 0
Group
A
>3 years 0 0 0 0 0 0 0 0
<1 year 6 30 3 15 1 5 0 0
12 years 1 5 3 15 1 5 0 0
2-3 years 3 15 2 10 0 0 0 0
Group
B
>3 years 0 0 0 0 0 0 0 0




Table No.35: showing overall response based on Diet

Table No.36: Showing Family history of patients.

Family
History
Group A % Group B % Total %
+ve 8 40% 6 30% 14 35%
-ve 12 60% 14 70% 26 65%

Graph No.8: Showing Family history of patients.

Family history shows positive in 8 and 6 patients in Group A and Group B
respectively, negative in 12 and 14 patients in Group A and Group B respectively.
Group Diet

Marked

% Moderate % Mild %
No
Change
%
Vegetarian 4 20 3 15 5 25 0 0
Group A
Mixed 4 20 3 15 1 5 0 0
Vegetarian
6 30 5 25 1 5 0 0
Group B
Mixed 4 20 3 15 1 5 0 0


Table No.37: showing overall response based on Family History

Table No.38: Showing the area involved in disease in patients of both groups.

It is observed that 5 and 6 patients had involvement of right knee in Group A
and B respectively, 6 and 5 patients had involvement of left knee in Group A and B
respectively, 9 each had both knee involvement in Group A and B.

Table No.39: showing overall response based on Area

Group
Family
History

Marked

% Moderate % Mild %
No
Change
%
Positive 2 10 1 5 5 25 0 0
Group A
Negative 6 30 5 25 1 5 0 0
Positive
3 15 3 15 2 10 0 0
Group B
Negative 7 35 5 25 0 0 0 0
Area Group A % Group B % Total %
Right Knee 5 25% 6 30% 11 27.5%
Left Knee 6 30% 5 25% 11 27.5%
Both Knees 9 45% 9 45% 18 45%
Group Area

Marked

% Moderate % Mild %
No
Change
%
Right Knee 3 15 0 0 0 0 0 0
Left Knee 2 10 3 15 1 5 0 0
Group
A
Both Knees 1 5 3 15 1 5 0 0
Right Knee
3 15 3 15 4 20 0 0
Left Knee 2 10 2 10 1 5 0 0
Group
B
Both Knee 1 5 3 15 1 5 0 0


The sum points of all the parameters of assessment before and after the
treatment were taken into consideration to assess the total effect of the treatment as
follows:-
1. Marked improvement relief of >60%
2. Moderate improvement 30 to 60% relief
3. Mild improvement less than 30% of relief
4. No Change 0% relief
Table No.40: showing overall response for the treatment
Response
Marked
improvement
Moderate
improvement
Mild
improvement
No Change
Group
No. of
patients
%
No. of
patients
%
No. of
patients
%
No. of
patients
%
Group
A
8 40 6 30 6 30 0 0
Group
B
10 50 8 40 2 10 0 0

In Group A out of 20 patients 8 patients (40%) showed marked improvement,
improvement.
In Group B out of 20 patients 10 patients (50%) showed marked improvement,
improvement.





STATISTICAL ANALYSIS:
Paired t test is applied for Group A and Group B for analyzing the individual
efficacy of treatment. Student t test is applied to compare efficacy of the two treatment
plans. Following results are obtained by statistical analysis.

Results in Group A:
Table No.41: Showing effect on Pain during nocturnal bed rest.
Day Mean SD SE t Value df P Value
6
th
0.8 0.4104 0.0918 8.718 19 P<0.001
12th 1.45 0.5104 0.1141 12.704 19 P<0.001

Test is highly significant on 6
th
and 12
th
day assessments with P value of
P<0.001

Table No.42: Showing effect on pain after getting up.
6
th
0.5 0.5130 0.1147 4.359 19 P<0.001
12th 1.35 0.4894 0.1094 12.337 19 P<0.001

th
and 12
th
P<0.001
RESULTS




Table No.43: Showing effect on standing for 30 min.
6
th
0.2 0.4104 0.0918 2.179 19 P<0.05
12th 0.65 0.4894 0.1094 5.940 19 P<0.001

Test is significant on 6
th
day assessment with P value of P<0.05 and highly
significant on 12
th
day assessments with P value of P<0.001

Table No.44: Showing effect on walking.
6
th
0.95 0.2236 0.05 19.0 19 P<0.001
12th 1.65 0.4894 0.1094 15.079 19 P<0.001

th
and 12
th
P<0.001

Table No.45: Showing effect on Morning stiffness.
6
th
0.7 0.4702 0.1051 6.658 19 P<0.001
12
th
1.55 0.6048 0.1352 11.461 19 P<0.001

th
and 12
th
P<0.001


Table No.46: Showing effect on stiffness later in day.
6
th
1.05 0.6048 0.1352 7.764 19 P<0.001
12
th
1.75 0.9105 0.2036 8.596 19 P<0.001

th
and 12
th
P<0.001

Table No.47: Showing effect on swelling in joint.
6
th
0.65 0.5871 0.1313 4.951 19 P<0.001
12
th
1.4 0.9947 0.2224 6.194 19 P<0.001

th
and 12
th
P<0.001

Table No.48: Showing effect on Maximum distance walked.
6
th
1.9 0.3078 0.0688 27.606 19 P<0.001
12
th
3.65 0.9881 0.2209 16.520 19 P<0.001

th
and 12
th
P<0.001


Table No.49: Showing effect on walking aid requirement.
6
th
0.15 0.3663 0.819 1.831 19 P>0.05
12
th
0.45 0.5104 0.1141 3.943 19 P<0.001

th
significant on 12
th

Table No.50: Showing effect on able to climb up stairs.
6
th
0.6750 0.2447 0.0547 12.337 19 P<0.001
12
th
1.25 0.2565 0.0574 21.794 19 P<0.001

th
and 12
th
P<0.001

Table No.51: Showing effect on able to climb down stairs.
6
th
0.7 0.2513 0.0562 12.457 19 P<0.001
12
th
1.375 0.5350 0.1196 11.495 19 P<0.001

th
and 12
th
P<0.001


Table No.52: Showing effect on able to squat.
6
th
0.8 0.2513 0.0562 14.236 19 P<0.001
12
th
1.25 0.3804 0.0851 14.694 19 P<0.001

th
and 12
th
P<0.001

Table No.53: Showing effect on able to walk on uneven.
Day

Mean SD SE t Value df P Value
6
th
0.9250 0.52 0.1163 7.955 19 P<0.001
12
th
1.55 0.6669 0.1491 10.394 19 P<0.001

th
and 12
th
P<0.001

Table No.54: Showing effect on Getting in/ out of car.
6
th
0.4375 0.25 0.0625 7.0 15 P<0.001
12
th
0.9375 0.5439 0.1360 6.895 15 P<0.001



th
and 12
th
P<0.001
Table No.55: Showing effect on putting on/ off socks.
6
th
0.6389 0.2304 0.0543 11.762 17 P<0.001
12
th
1.1111 0.3660 0.0863 12.878 17 P<0.001

th
and 12
th
P<0.001

Table No.56: Showing effect on tenderness.
6
th
1.3 0.0402 1.051 12.365 19 P<0.001
12
th
2.25 0.5501 0.1230 18.291 19 P<0.001

th
and 12
th
P<0.001

Table No.57: Showing effect on crepetus.
6
th
0.35 0.4894 0.1094 3.199 19 P<0.01
12
th
0.9 0.6407 0.1433 6.282 19 P<0.001



th
and 12
th
P<0.01 and P<0.001respectively.


Table No.58: Showing effect on Measurement of Rt knee.
6
th
0.3571 0.4127 0.1103 3.238 13 P<0.001
12
th
1.0 0.6504 0.1738 5.752 13 P<0.001

th
and 12
th
P<0.001

Table No.59: Showing effect on Measurement of Lt knee.
6
th
1.0 0.8756 0.2189 4.568 15 P<0.001
12
th
1.6875 1.4009 0.3502 4.818 15 P<0.001

th
and 12
th
P<0.001

Table No.60: Showing effect on Movement of Rt knee.
6
th
1.0 0.3922 0.1048 9.539 13 P<0.001
12
th
2.0 0.8771 0.2344 8.532 13 P<0.001

th
and 12
th
P<0.001


Table No.61: Showing effect on Movement of Lt knee.
6
th
1.1875 0.4031 0.1008 11.783 15 P<0.001
12
th
1.9375 0.6801 1.17 11.396 15 P<0.001

th
and 12
th
P<0.001

Table No.62: Showing effect on time taken to walk 50m distance.
6
th
1.25 0.4443 0.0993 12.583 19 P<0.001
12
th
2.05 0.6863 0.1535 13.358 19 P<0.001

th
and 12
th
P<0.001

Table No.63: Showing effect on Radiological changes.
6
th
- - - - - -
12
th
0.65 0.2236 0.05 1.0 19 P>0.05

Test is insignificant on 12
th
day assessments with P value of P>0.05


This implies there is no much change I the radiological findings in Group A by 12
days.
Results of Group B:
Table No.64: Showing effect on pain during nocturnal bed rest.
6
th
0.95 0.2236 0.05 19.0 19 P<0.001
12
th
1.6 0.5026 0.1126 14.236 19 P<0.001

th
and 12
th
P<0.001

Table No.65: Showing effect on pain after getting up.
6
th
0.7 0.4702 0.1051 6.658 19 P<0.001
12
th
1.45 0.5104 0.1141 12.704 19 P<0.001

th
and 12
th
P<0.001

Table No.66: Showing effect on pain on standing for 30min.
6
th
0.4 0.5026 0.1124 3.559 19 P<0.01
12
th
0.7 0.4702 0.1051 6.658 19 P<0.001



th
and 12
th
Table No.67: Showing effect on walking.
6
th
1.0 - - - - -
12
th
1.7 0.4702 0.1051 16.170 19 P<0.001

th

Table No.68: Showing effect on morning stiffness.
6
th
0.7 0.4702 0.1051 6.658 19 P<0.001
12
th
1.45 0.7592 0.1698 8.542 19 P<0.001

th
and 12
th
P<0.001

Table No.69: Showing effect on stiffness later in day.
6
th
1.1 0.7182 0.1606 6.85 19 P<0.001
12
th
1.8 0.8944 0.2 9.0 19 P<0.001



th
and 12
th
P<0.001


Table No.70: Showing effect on swelling in joint.
6
th
0.75 0.6387 0.1128 5.252 19 P<0.001
12
th
1.45 1.09 0.2458 5.9 19 P<0.001

th
and 12
th
P<0.001

Table No.71: Showing effect on Maximum distance walked.
6
th
1.95 0.2236 0.05 39.0 19 P<0.001
12
th
3.95 0.6863 0.1535 25.738 19 P<0.001

th
and 12
th
P<0.001

Table No.72: Showing effect on walking aid requirement.
6
th
0.25 0.443 0.0993 2.517 19 P<0.05
12
th
0.4 0.5026 0.1124 3.559 19 P<0.001

th
significant on12
th
day assessment with P value of P<0.001


Table No.73: Showing effect on Able to climb up stairs.
6
th
0.65 0.2351 0.0526 12.365 19 P<0.001
12
th
1.275 0.2552 0.0571 22.342 19 P<0.001

th
and 12
th
P<0.001

Table No.74: Showing effect on Able to climb down stairs.
6
th
0.65 0.2351 0.0526 12.365 19 P<0.001
12
th
1.275 0.4993 0.1117 11.419 19 P<0.001

th
and 12
th
P<0.001

Table No.75: Showing effect on squat.
6
th
0.75 0.3035 0.0679 11.052 19 P<0.001
12
th
1.2 0.3403 0.0761 15.771 19 P<0.001

th
and 12
th
P<0.001


Table No.76: Showing effect on walk on uneven
6
th
0.85 0.3663 0.819 10.376 19 P<0.001
12
th
1.4 0.4472 0.01 14.0 19 P<0.001

th
and 12
th
P<0.001

Table No.77: Showing effect on getting in/ out of car.
6
th
0.5357 0.2373 0.0634 8.446 13 P<0.001
12
th
1.0 0.3922 0.1048 9.539 13 P<0.001

th
and 12
th
P<0.001

Table No.78: Showing effect on putting on/ off socks.
6
th
0.625 0.2236 0.0559 11.180 15 P<0.001
12
th
0.9688 0.4270 0.1067 9.076 15 P<0.001

th
and 12
th
P<0.001


Table No.79: Showing effect on Tenderness
6
th
1.25 0.5501 0.1230 10.162 19 P<0.001
12
th
2.25 0.5501 0.1230 18.291 19 P<0.001

th
and 12
th
P<0.001

Table No.80: Showing effect on Crepitus.
6
th
0.6 0.5026 0.1124 5.339 19 P<0.001
12
th
1.15 0.5871 0.1313 8.759 19 P<0.001

th
and 12
th
P<0.001

Table No.81: Showing effect on Measurement of Rt knee.
6
th
0.5667 0.5936 0.1533 3.697 14 P<0.01
12
th
1.3 1.0316 0.2664 4.880 14 P<0.001

th
and 12
th


Table No.82: Showing effect on Measurement of Lt knee.
6
th
0.8571 0.9693 0.2591 3.309 13 P<0.01
12
th
1.5357 1.4473 0.3868 3.970 13 P<0.01

th
and 12
th
P<0.01

Table No.83: Showing effect on Range of movement of Rt knee.
6
th
1.1333 0.5164 0.1333 8.5 14 P<0.001
12
th
2.0667 0.7988 0.2063 10.02 14 P<0.001

th
and 12
th
P<0.001

Table No.84: Showing effect on range of movement of Lt knee.
6
th
1.2857 0.4688 0.1253 10.262 13 P<0.001
12
th
2.2143 0.5789 0.1547 14.311 13 P<0.001

th
and 12
th
P<0.001


Table No.85: Showing effect on time taken to walk 50m distance.
6
th
1.1 0.3078 0.0688 15.983 19 P<0.001
12
th
2.0 0.4588 0.1026 19.494 19 P<0.001

th
and 12
th
P<0.001

Table No.86: Showing effect on radiological changes.
6
th
- - - - - -
12
th
0.15 0.3663 0.0819 1.831 19 P>0.05

Test is insignificant on 12
th
day assessments with P value of P>0.05
This implies there is no much change I the radiological findings in Group B by 12
days.



Results on Comparison of Group A and Group B:

Table No.87: Showing Results on Comparison of Group A and Group B:

Parameter

Mean
difference
SE t Value df P
Value
1. Pain during nocturnal bed rest 0.15 0.16 0.9365 38 P>0.05
2. Pain after getting up 0.1 0.158 0.6324 38 P>0.05
3. Pain on standing for 30 min 0.05 0.152 0.3295 38 P>0.05
4. Pain on walking 0.05 0.152 0.3295 38 P>0.05
5. Morning stiffness 0.1 0.217 0.4607 38 P>0.05
6. Stiffness later in day 0.05 0.285 0.1752 38 P>0.05
7. Swelling in joint 0.05 0.33 0.1515 38 P>0.05
8. Max distance walked 0.3 0.269 1.1152 38 P>0.05
9. Walking aid required 0.05 0.16 0.3122 38 P>0.05
10. Able to climb up stairs 0.025 0.128 0.1959 38 P>0.05
11. Able to climb down stairs 0.1 0.164 0.6111 38 P>0.05
12. Able to squat 0.05 0.114 0.4380 38 P>0.05
13. Able to walk on uneven 0.15 0.18 0.8354 38 P>0.05
14. Getting in/ out of car 0.0625 0.175 0.3562 28 P>0.05
15. Putting on/ off socks 0.1423 0.136 1.0465 32 P>0.05
16. Tenderness 0 0.174 0 38 -
17. Crepitus 0.25 0.194 1.2866 38 P>0.05
18. Rt knee measurement 0.3 0.323 0.9288 27 P>0.05
19. Lt knee measurement 0.1518 0.521 0.2916 28 P>0.05
20. Range of Rt knee movements 0.0667 0.311 0.2143 27 P>0.05
21. Range of Lt knee movements 0.2768 0.232 1.1909 28 P>0.05
22. Time taken to walk 50m distance 0.05 0.185 0.2709 38 P>0.05
23. Radiological changes 0.1 0.096 1.0421 38 P>0.05


Above table suggests that for parameter Tenderness difference of mean is 0.
This implies test is insignificant. Both treatments are equal in the parameter
Tenderness.
In all other 22 parameter test shows insignificance with P value of >0.05
This implies in all parameters both treatments are statistically equal in efficacy.
Graph No.9: Showing means of Pain after getting up, pain on walking and

Morning stiffness in Group A

Graph No.10: Showing the means of swelling, tenderness and Crepitus in Group A

0.5
1.35
0.95
1.65
0.7
1.55
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
6thday 12thday
painafter getting
up
painon walking
morningstiffness
0.65
1.4
1.3
2.25
0.35
0.9
0
0.5
1
1.5
2
2.5
6thday 12thday
swelling
tenderness
crepetus


Graph No.11: Showing means of Pain after getting up, pain on walking in Group B

Graph No.12: Showing means of morning stiffness and stiffness later in day in
Group B

Graph No.13: Showing the means of swelling, tenderness and crepetus in Group B

Discussion


As the name suggests, Sandhigata Vata is one of the nanatmaja Vata Vyadhi
affecting the joints of the body. It is explained under the various gata Vata vyadhis.
Here the kupita Vata gets localized in Sandhis leading to the manifestation of disease.
Asthi dhatu is the ashraya sthana of Vata dosha, and Vata vruddhi results in Asthi
kshaya. In Sandhigata Vata both these features can be seen.
In modern system of medicine, it is grouped under Rheumatology. OA is a
slowly progressive degenerative disease of joints which shows a strong association
with aging and is a major cause of pain and disability in the elderly. Risk factors
outlined for OA varies with joint sites. OA of the knee joints is the most common
form of OA; hence the present study was designed on management of J anu Sandhigata
Vata (OA of Knee J oint).

SHAREERA: Though the words sound different, there is not much difference in the
description of joint anatomy in Ayurvedic and modern systems of medicine. Sandhi is
not a single structure rather it is an organ. Different structures like Snayu, Kandara,
Siras, Peshi etc. support the stability of the Sandhi. Large numbers of Snayus which
bind Sandhis tightly are responsible for bearing the body weight. Functions of the
Peshis and Snayus are identical to that of the muscles and ligaments related to the
joints. Shleshmadharakala situated in the joints supported by Shleshaka Kapha helps
in lubrication. Functions of the Shleshmadhara kala and Shleshaka Kapha described
in Ayurveda can be co-related to the Synovial membrane and Synovial fluid situated in
Synovial joint which lubricates the joint, a nutrient carrier to the cartilage, disc, and
DISCUSSION

Discussion


helps in keeping the joint firmly united. The Marmas are considered as the point of
union of nerves, vessels and muscular system, which are vital in the structure and
functioning status of the joints.
Knee works as a hinge joint, but the articulation is more complex than other
hinge joints which is supported by seven major ligaments, flexor and extensor
muscles.
NIDANA AND SAMPRAPTI: No specific nidana for Sandhigata Vata has been
described in the Ayurvedic classics, hence general nidanas of Vata vyadhis are
considered here. Consumption of rooksha ahara, laghu ahara, alpa bhojana, and
abhojana are considered as Vata prakopaka karanas. Above type of food habit
deprives a person of nutrients which are essential for the replacement of worn-out
tissues and maintenance of normal physiological activities. Sushruta opines that in
vardhakya the poshaka Rasa Dhatu supports the Rasadhi Dahtus in such a way as to
sustain the life, but fails to correct the Dhatu kshaya occuring due to the old age. The
Dhatu kshaya supplemented by the Vatakara ahara leads to Vata prakopa. Various
physical activities such as Bharaharana, pradhavana, adhwa, ati yana, vishamasana,
abhighata are important viharaja nidanas of Sandhigata Vata. Repetitive movements
may lead to excessive strain leading to erosion and joint damage. Major trauma and
repetitive joint use are important risk factors for OA. Obesity is one of the major risk
factors for knee OA. In sthoulya, ati matra medo vruddhi hampers the poshana of the
rest of the dhatus, leading to Dhatu kshaya. In this case Asthi dhatu kshaya leading to
Vata prakopa and more weight on knee joints, resulting in joint damage.

Discussion


LAKSHANAS: Sandhi shula, Sandhi shotha, prasarana akunchanayoho savedana
pravrutti and atopa are the important clinical features of Sandhigata Vata. This is
similar to the general clinical features of OA viz. joint swelling, marginal tenderness,
Painful and restricted joint movement associated with joint stiffness and crepitus.
CHIKITSA: J anu Sandhi Gata Vata or Osteoarthritis of the knee is a major cause of
disability among adults. No cure for osteoarthritis currently exists. Treatment focuses
on managing the pain and dysfunction associated with the disease. Acupuncture is an
effective treatment for management of pain and physical dysfunction associated with
osteoarthritis of the knee. Since J anusandhigata Vata manifests in J anu Marma, Suchi
Veda (an art of introducing delicate fine Suchi into different sensitive points in and
around janu marma with in the radius of 3 angula) is done to stimulate janu marma &
in turn to stimulate sandhi avayavas present in it, so that it helps in relieving the pain
& promotes sandhi poshana & thus helps in early repair of dhatu kshayata & restores
normal joint integrity.
CLINICAL STUDY: This is a controlled clinical study conducted on Janu Sandhigata Vata
with special reference to OA of knee joint. After registering the patients who fulfil the
inclusion criteria, they were randomly allotted into two groups. Patients of group A were
treated daily by Suchiveda on J anumarma for 12 sessions & for about 30 minute
duration. And Patients of group B were treated daily by Acupuncture on Acupuncture
points for 12 sessions & for about 30 minute duration.
A total of 40 patients were registered for the study.
Patients under Group A: 20 Patients under Group B: 20
Completed treatments : 20 Completed treatments : 20

Discussion


Dropout : 0 Dropout : 0
OBSERVATIONS: The data available from the observations made during the
study are discussed here
Age: In this study the upper age limit was restricted to 75 years with equal distribution
of patients in all the age groups. Patients after 75 may not tolerate Suchi Veda
Chikitsa hence age restriction was done up to 75 yrs. In the present study it is
observed that in Group A 1(5%) patient in 41 to 45 years age group, 2 (10%) in 46 to
50 years, 3 (15%) in 51- 55 years, 6 (30%) in 56- 60 years, 4(20%) in 61- 65 years,
2(10%) in 65- 70 years and 2(10%) in 71- 75 years age group.
In Group B 3(15%) patients 41 to 45 years age group, 2(10%) in 46 to 50
years, 1(5%) in 51- 55 years, 8(40%) in 56- 60 years, 3(15%) in 61- 65 years, 2(10%)
in 65- 70 years and 1(5%) patient in 71- 75 years age group.
With this above data we can say that after 40 yrs of age people are more prone
to Osteoarthritis of the knee & OA of knee is a major cause of disability among adults.
Sex: In this study it is observed that in Group A, 12 (60%) were male and 8 (40%)
were female. In Group B, 12 (60%) were male and 8 (40%) were female. But
generally Female sex is a risk factor for Knee OA, and Radiographic evidence of knee
OA and especially symptomatic knee OA is more common in women than in men.
Here the male patients ratio is more, it may be accidental & because the sample size
is less we cannot take it as authenticated. Larger sample study says female ratio is
more in OA of knee.
Occupation: In group A house wife are more affected (40%), where as in group B
both officials & laborers are more affected (30% & 35%). May be house wises are
nearing their menopausal age they are more affected. The previous report by

Discussion


Husskison and Dudley 1978 says that Osteoarthritis is more common in
menopause women with the ratio of female to male 2:1. People who do more physical
labor, which involves long hours of working in fields, lifting weights, standing for
long hours and traveling are more affected with OA. Knee joint is a weight bearing
joint, hence the constant standing, walking long distances, lifting weights etc activities
exerts stress on the joints and accelerates the process of degeneration. However the
sample size is very small to arrive at any conclusion about the relation between OA
and Occupation.
Religion: In this present study it is seen that 95% in Group A and Group B were
Hindus, 5% each in both groups were Muslim. With this can say that, in our hospital
majority of the patients who come for Ayurvedic treatment are Hindus & OA
manifests in later age of life irrespective of caste & religion & there is no significant
relationship between disease manifestation & religion.
Socio-economic Status: It is seen that in Group A 20% of patients were from Lower
Class, 50% from Middle Class, 30% from Upper Class. In Group B 25% of patients
were from Lower Class, 50% were from Middle Class, 25% were from Upper Class.
With this we can say that most of the people who come to Govt. Hospital for treatment
are from Lower & Middle Class people. And OA affects irrespective of Socio-
economic status of people.
Chronicity of the Disease: In Group A 50% of patients had history of disease below
1 year, 40% had 1y 2y history, 10% had 2y- 3y history, and no one had more than 3
years history. In Group B 50% had within 1 year, 25% had 1y- 2y history, 25% had
2y- 3y history and no one had more than 3 years history. Majority of patients are from
1yr chronicity, this shows that now a days people are very much aware about their

Discussion


problems & they are health conscious & they want to get rid of their problem as early
as possible, and hence they seek medical advice at the earliest.
Food Habit: It is observed that in Group A 60% of patients were vegetarian and 40%
of patients were mixed diet. And In Group B 50% each were of vegetarian diet and
mixed. This does not seem to have any important role to play as far as Sandhivata is
concerned.
Family History: It is positive in 40% and 30% patients in Group A and Group B
respectively, negative in 60% and 70% patients in Group A and Group B respectively.
Number of Knees affected: 50% patients each were affected with bilateral and
unilateral knee OA. Majority of the patients with unilateral OA showed marked
improvement. The response was better in Group B than in Group A. This shows that
unilateral OA responds to the treatment better than bilateral OA. In chronic conditions
with bilateral OA the damage done to the joint is more and it is difficult to repair the
damage.
RESULTS:
Subjective parameters:
I. PAIN OR DISCOMFORT:
Marked relief was observed in pain or discomfort during nocturnal bed rest. In Group
A 70% of patient got relief & were as in Group B 90% of patients got relief.
Pain after getting up from sitting position: In Group A 65% improvement was
found in pain after getting up, where as in Group B there was 75% relief.
Increase in pain after remaining standing for 30 minutes:
In group A the mean score before treatment was 0.95, which was reduced to 0.30 after
the treatment, with a reduction of 65% of pain which was significant. In group B the

Discussion


mean score before the treatment was also 0.8, but it reduced to 0.1 after the treatment,
with a reduction of 70% of pain which was highly significant. This shows that the pain
reduced better in the patients of group B than in the patients of group A.
Pain on walking: In group A there was 70% relief in pain, where as in group B there
was 90% relief in pain. This shows that Group B is much better in pain management
because of its universally accepted accurate acupuncture points which has been in
practiced since thousands of years & some of acupuncture points helps in Motor
Recovery.
Stiffness: There was 45% & 65% relief in morning stiffness & stiffness later in the
day in Group A & in Group B there was 55% & 75% relief respectively. Once the
pain is reduced the muscles around the joint relaxes & in turn helps in reduction of
stiffness.
Swelling in the J oint: In Group A there was 40% relief in the swelling, where as in
Group B there was 50% relief. With this we can say that acupuncture or suchi veda is
much better in pain management.

II. MAXIMUM DISTANCE WALKED:
There was significant improvement in quality of walking in both the groups. In
Group A 20% & in Group B 40% patients were able to walk UN limited distance,
45% each in both the groups able to walk more than 1 kilometre & 35% & 15% were
able to walk about 1kilometre. Its natural that when pain & stiffness is reduced
patients were comfortable in walking after treatment.

Discussion


In Group A & Group B there was 45% & 40% improvements was seen in using
walking aids respectively. Improvement is less when compared to other parameter
because, patient uses walking aids only in severe OA when there is disturbance in
joint anatomy, both these treatments to far extent is good at giving relief in sign &
symptoms rather than reversing the degeneration.
III. ACITIVITIES OF DAILY LIVING:
There was significant difference in Climbing up & climbing down standard
flight of stairs after treatment in Group A & Group B, but when compared to Group A,
Group B was little better because acupuncture is good at motor function recovery.
In Group A & Group B flexibility of the knee improved significantly &
reduction in pain while squatting was noticed.
In both the Group there was 75% improvement in pain on walking on uneven
surface. This shows that both the treatment are significant in improving the joint
stability.
In Group A there was 68.75% & 71.5% & in Group B 85.68% & 81.25%
improvement in Getting in or out of car & putting or taking of socks respectively.
Overall better improvements were observed in activities of daily living in
patients of group B than in group A. Since in Group A the points used are only local
the effect is less, where as in Group B i.e. in acupuncture both local & distal points are
used which has a Analgesic, Homeostatic (regulatory) & Motor recovery action.

IV. OBJECTIVE PARAMETERS:

Discussion


There was 65% relief in tenderness in Group A & 85% relief in Group B, this
shows that Acupuncture is having good Analgesic action, hence WHO recommends
acupuncture for pain management. Exact sensitive points for stimulation on janu
marma (which is 3 angula pramana) should be identified for obtaining better analgesic
action.
There was 60% relief in crepitus in Group A & 70% relief in Group B. This shows
that the treatment increased localized blood circulation which in turn helped in
nourishing shleshaka kapha & cartilage.
There was considerable reduction in measurement of knee in Group B when compared
Group A was observed; this is because of anti inflammatory action of acupuncture
treatment.
In Group A there was 57.12% & 50% & in Group B 73.26% & 71.42%
improvement in Range of Movement in right knee & left knee was found respectively.
In Group A & Group B there was only 1 & 3 patients respectively showed very
slight change in X-ray after treatment. In remaining 36 patients it was unchanged. This
shows that in both groups X-ray changes was in significant. So probably more number
of treatment sittings are necessary to repair the worn-out cartilage and articular
surfaces to get significant changes with respect to J oint space, Osteophytes and other
radiological features.

PROBABLE MODE OF ACTION OF SUCHI VEDA

Discussion


Suchi veda stimulates janu marma & in turn it stimulates Sandhi Avayavas present in
it & helps in relieving the pain. It also promotes sandhi poshana & thus helps in early
repair of Dhatu Kshayata & restores normal joint integrity.
When suchi veda is done it increases the sthanika agni, it improves the blood local
blood circulation & helps in cartilage regeneration & in turn reduces pain.
In janu Sandhi gata vata there will be vata vriddhi, in turn there will be increase in
sheeta guna, which causes stiffness of the joint, when suchi veda is done it increases
ushmata & subsides sheeta guna & thus helps in relieving signs & symptoms of janu
Sandhi gata vata.
Suchi veda activates the doshas present in the janu marma and brings them into
harmony through a controlled way of pricking & subsides signs & symptoms of janu
Sandhi gata vata.

PROBABLE MODE OF ACTION OF ACUPUNCTURE
Acupuncture is thought to relieve pain through the gate-control mechanism or through
the release of neurochemicals. Pomeranz and Berman describe the possible neural
mechanisms of acupuncture analgesia as follows: small diameter muscle afferents are
stimulated, sending impulses to the spinal cord, which then activates 3 centers (spinal
cord, midbrain, and pituitary) to release neurochemicals (endorphins and
monoamines) that block pain messages. They discuss 17 different lines of research in
support of endorphins being involved in acupuncture pain relief. While
acknowledging that there is some debate, Pomeranz and German conclude that the
evidence supporting the endorphin hypothesis is overpowering. The authors assert on

Discussion


the basis of supporting evidence from several studies, that midbrain monoamines
(serotonin and nor epinephrine) are also involved in acupuncture analgesia; however,
the role of the pituitary is less clear.

Conclusion


After systematic clinical trials, based on the observations, results & discussions
following conclusions are drawn.
Sandhigata Vata is a type of Vata vyadhi commonly associated with the
vardhakya and dhatu kshaya is a prominent feature in its manifestation.
J anu Sandhigata Vata or Osteoarthritis of the knee is a major cause of
disability among adults.
Old age, female sex, obesity and repeated trauma are the main risk factors
for Osteoarthritis of Knee joint.
No cure for osteoarthritis currently exists. Treatment focuses on managing
the pain and dysfunction associated with the disease.
Treatment responses of all subjective & objective parameters were highly
significant in both the groups. However Group B showed good
improvements when compared to Group A.
Both Suchi Vyadha Chikitsa & Acupuncture is cost effective & eco-
friendly.
Suchi Vyadha Chikitsa & Acupuncture treatments are simple technique
that can be useful as a nondrug method of pain control.
The better response for Acupuncture is due to use of both local & distal
points in treating OA & its exact location of Acupuncture Points.
Acupuncture & Suchi Vyadha is an effective treatment for management of
pain and physical dysfunction associated with osteoarthritis of the knee.
No complications were observed during the study.
CONCLUSION
Conclusion


Suggestion for further research:
To Study on Meridians (Channels) in Traditional Chinese Medicine & Srotos
in Ayurveda.
To Study the Analgesic effect of Suchi Vyadha on Gridrasi & other vata
vyadhis.

Summary


This dissertation entitled A Comprehensive Study on Marma & Acupuncture
Points and Evaluation of their Therapeutic Importance comprises of
six parts viz. Introduction, Literary review, Materials and Methods, Discussion,
Conclusion and Summary.
I. INTRODUCTION:
The introduction gives a brief account of need and scope for the study and the
rationality behind selecting the procedure and objectives of the study.
II. REVIEW OF LITERATURE:
Literary review is subdivided into 4 chapters namely Review of Marma,
Review of Acupuncture, Disease review and Acupuncture needle review.
Review of Marma: In this chapter the historical aspect, vyutpatti, nirukti,
classification of Marma, composition of Marma, its anguli pramana & its viddha
lakshana have been explained.
Review of Acupuncture: This section deals with History, Traditional theory,
Acupunture points & meridians & Chinese traditional diagnosis.
Comparison of Ayurveda & Acupuncture: This chapter deals with comparison of
basic principles of Ayurveda & Traditional Chinese Medicine, like Shrushti Utpatti
Krama, Pancha Mahabhoota theory, Prana & Qi, Prakrithi & De, Nadi & Meridian
And Marma & Acupuncture Points.
Disease review: Under this heading the vytpatti, nirukti of the Janu Sandhigat Vata,
functional anatomy of Janu sandhi, Nidana panchaka of Janu Sandhigata Vata with
SUMMARY
Summary


treatment along with modern aspects of Knee joint and Osteoarthritis are described in
brief.
Procedure Review: In this chapter history of suchi vyadha, suchi vyadha procedure
& suchi vyadha for different purpose is mentioned.
Acupuncture needle review: History, different type of acupuncture needle, its length
& diameter is explained in this chapter.
III. MATERIALS AND METHOD:
The second part of the study begins with Materials and Methods, where in
description regarding the aims and the objectives, criteria of selection of patients,
details of inclusion and exclusion criteria, diagnostic and assessment criteria for
assessing the effects of the therapies and actual course of the trial have been
explained.
IV. OBSERVATIONS AND RESULTS:
Thereafter general observations of the 40 patients of Janu Sandhigata Vata
studied are presented in tabular form along with brief description of each finding and
graphs. In the end the results along with statistical analysis of the results obtained are
depicted.
V. DISCUSSION: This section contains discussion about review of literature,
materials & methods, observations & results & mode of action of procedure.
VI. CONCLUSION: This section deals with the conclusions regarding the whole
study & recommendations for further study.
VII. SUMMARY: This is the gist of all the sections of this dissertation work.
Bibliography


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Websites
http://www.emedicinehealth.com/articles
http://www.drgraceliu.com
http://www.pubmedcentral.nih.
http://www.osteoarhtritis.about.com
http://en.wikipedia.org/
INFORMED CONSENT FORM

I ..................... here by willingly agree to participate in this
clinical study. I affirm that there has been no compulsion or monetary inducement in
my agreeing to be volunteer for this study, which I do on my free will. I have been
explained the general purpose of the experiment. I am convinced that it is for my
benefit & for the benefit of science and mankind. I understand that the risk involved is
very less. I agree to undergo following investigations.

1. Radiological examination
2. Blood investigations

I also agree to remain under observation for 2 months period.

I can apt out the study at any time.

Signature of the investigator Signature of the Volunteer

Signature of the Guide

DEPARTMENT OF P.G. STUDIES IN SHALYATANTRA.

GOVERNMENT AYURVEDIC MEDICAL COLLEGE, BANGALORE-560009

PROFORMA OF CASE SHEET FOR JANU SANDHIGATA VATA

GROUP- A/GROUP- B

PART I ADMISSION FORM

PG Scholar: - DR.VIVEK.J

Guide: - DR.VENKATESH.B.A

1. Name of the patient : Reg. No:

2. Fathers / Husbands Name : OPD No:

3. Age : IPD No:

4. Sex : Bed No:

8. Address : _____________________________ Phone No:
_____________________________ Email ID:
_____________________________

9. Educational Status: - Illiterate/ Read and Write/ Graduate/ Post Graduate

10. Occupation: - Desk work/ Field work/ Physical labor/ House wife/others

Indicate Nature of work: -

11. Socio-economic status: - P/LM/UM/R

12. Religion: - Hindu/Muslim/Christian/Others

13. Marital status: - Unmarried/Married/Widow/Widower/Divorcee

14. Date of Initiation :

15. Date of Completion :

16. Result :

M F

PART II/CASE RECORD

1. CHIEF COMPLAINTS:-

Sl.
No
Chief complaints Duration After Treatment

1
J anuSandhi shotha/
Vatapoorna druti sparsha
(Swelling)

2
Prasarana Akunchanayoho
Savedana Pravrutthi (Pain
on extension & flexion)

Sandhigraha (J oint
Stiffness)

- Morning stiffness
(0 - 30 minutes)

3
- Stiffness after disuse
4 Limitation of joint
movement

5 Shoola (Tenderness)
6 Atopa (Crepitation)

NATURE
OF
PAIN:
Burning Pricking Aching Generalized Tearing
Yes No
ROUTINE ACTIVITIES AFFECTED:

2. HISTORY OF PRESENT ILLNESS:

3. HISTORY OF PAST ILLNESS:

4. TREATMENT
Modern Medicine
Ayurvedic Medicine/Therapy
HISTORY:

Other Systems
Relief with previous treatment Partial / No relief

Other
J oint
disorder

5. FAMILY HISTORY:
O A R A

6. PERSONAL HISTORY:

1. Ahara:
Veg Non Veg

2. Agni:

Manda Teekshna Vishama Sama
3. Koshta;

Madhya Mrudu Krura
4. Nidra: Sukha Alpa Ati Vishama

5. Vyasana:

7. OBSTETRIC HISTORY:

GYNAECOLOGICAL
HISTORY: M.C._____ Days R/IR: Menarche _____ yrs

Dysmenorrhoea/Leucorrhoea/Metrorrhagia/Menorrhagia
Smoking Tobacco Alcohol Others None

PARIKSHA VIDHI/EXAMINATION
1. VITAL SIGNS:
Weight in
Kgs

Height in
Cms
Temperature in Degree
Celsius

Pulse rate per
minute
Respiration
per Minute
Blood Pressure in mm Hg

2. ASHTA STHANA PAREEKSHA

Nadi: - /min, regular/irregular

Jihva: - Alipta/Ishat Lipta/Lipta

Mala: - Badda/Abadda, Sama/Nirama ____ Times/Day

Mutra: - Prakruta/Vikruta ____ Times/Day
Shabda: - Prakruta/Vikruta

Sparsha: -Mrudu/Khara

Druk: - Prakruta/Kunchita

Akruti: - Sthula/Madhyama/Heena

3. Atura Bhoomi Desha Pareeksha

J angala

J angala

J angala

Anupa

Anupa

Anupa

Jata

Vardhita

Vyadhita
Sadharana

Sadharana Sadharana

4. Atura Deha Desha Pareeksha:

DASHAVIDHA PAREEKSHA

Shareera 1 PRAKRUTI
Manasika
2
SARATAHA

Pravara Madhyama Avara
3
SAMHANANA
TAHA

Susamhata
Madhyama
samhata
Asamhata
Rasa Ekarasa Sarvarasa Vyamishra 4 SAATMYATA
HA
Vihara Divasvapna Vyayama
5 PRAMANATA
HA

Sama Heena Adhika
6
SATVATAHA
7 AHAARA
SHAKTITAH
A

VYAYAMA
SHAKTITAH
A
8
Pravara Madhyama
Avara

9
VAYATAHA Bala Yuva Vriddha

4. SROTO PAREEKSHA: -

RASAVAHA SROTAS;-

ASTHIVAHA SROTAS: -

MEDOVAHA SROTAS:-

OTHER SROTAS:-

6. SYSTEMIC EXAMINATION: -

C.V.S: -

R.S.: -

G.I.T.: -

NERVOUS SYSTEM: -

7. SPECIAL EXAMINATION OF JOINTS

A. Darshana Pareeksha:

Present Absent

1) Joint
Right Knee
Swelling:
Present Absent

Left Knee

2) Deformity:
3) Joint
Movement:

4) Muscle Wasting:
Present Absent
Active Completely Restricted Partially restricted
Passive Completely Restricted Partially restricted
Present Absent

B. Sparshana (Palpation)

1. Local Temperature
Raised Not raised

2. Tenderness
Grading
0 1 2 3

3. Crepitus:

5. Measurement: -
Circumference of
Knee Joint

8. Range of Movement (Goniometric Measurement)

Normal
Reading
Before
Treatment
After
Treatment
ROM-
Extension of
Knee

120-0 degree

ROM-Flexion
of Knee
0-130 degree

6. Lab
Investigations:

Heard Felt None

Right
Knee

Left
Knee

Hb% Total Count (WBC)
ESR /1
st
Hr.
Random Blood
Sugar
Mg/dl

9. RADIOLOGICAL EXAMINATION OF KNEE JOINTS
(Antero- posterior/ Lateral View)
1
Joint space
Reduced Unaltered

2 Subchondral bony sclerosis Present Absent

3 Formation of osteophytes Present Absent

4 Periarticular ossicles Present Absent
5 Others

CHIKITSA VIDHI

Group A

Patients of this group were treated daily by Suchivyadha on J anumarma for 12
sessions & for about 30 minute duration.

Group B

Patients of this group were treated daily with Acupuncture on Acupuncture
points for 12 sessions & for about 30 minute duration.

ASSESSMENT CRITERIA:-

I. SUBJECTIVE PARAMETRERS:
I II III IV V
1 Pain
2 Morning Stiffness
Stiffness later in the day
3
Remaining standing
for 30minutes

4 Pain on walking
5
Pain or Discomfort after
getting up from sitting
without use of arms

6 Maximum distance Walked
7 Walking aids required
8
Able to climb up flights
of stairs

9 Able to climb down flight of stairs
10 Able to squat or bend at Knee
11 Able to walk on uneven surface

12 Swelling in the joint

13 Getting in or out of car

14 Putting on or taking off socks
II. OBJECTIVE PARATERS:
I II III IV V
1 Tenderness
2 Crepitus

Rt. Knee
3 Measurement
of knee
at fixed points
Lt. Knee
4 Range of Movement
(Knee flexion)
(Goniometric Measurement)
5 Time taken to walk
50 Meters distance
6 Radiological Changes After
treatment

INVESTGATORS NOTE:-

Signature of Investigator Signature of the Guide

Over AllRelief
Sl.No. NAME OP/IP NO. AGE SEX OCCUPATION RELIGION CHRONICITY DIET FAMILYHISTORY SE DATEOFCOM DATEOFCOMP JOINT AFFECTED
BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12
1 Kulvanthkaur OP.13825 56 F HOUSEWIFE HINDU 12 VEG POSITIVE MC 4/28/2010 5/9/2010 LEFTKNEE 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 3 1 0 3 2 1 6 4 1 1 1 0 2 1 0.5 2 1 0 2 1 0.5 1.5 0.5 0 1 0.5 0 1 0.5 0 3 1 0 2 1 1 553 520 500 3 2 1 2 1 0 3 3 3 13 Para MODImp
2 Ramesh IP.815 48 M BUISNESSMAN HINDU 10 MIXED NEGATIVE LC 5/1/2010 5/12/2010 BOTHKNEE 2 1 0 1 0 0 1 1 0 2 1 0 3 2 1 3 1 1 3 2 0 6 4 2 1 0 0 2 1 0.5 2 1 0 2 1 0 1.5 1 0 1.5 1 0 1.5 0.5 0 2 1 0 1 1 0 36.53 362 351 373 36.52 361 3 2 0 3 1 0 3 1 0 3 3 2 16 Para Mar Imp
4 Murthy IP.533 60 M BUISNESSMAN HINDU 18 MIXED NEGATIVE MC 6/4/2010 6/15/2010 RIGHT KNEE 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 2 1 1 3 2 1 6 4 1 1 0 0 2 1 0.5 2 1 0 2 1 0.5 1.5 0.5 0 3 1 0 2 1 0 333 321 310 2 1 0 2 1 0 3 3 3 11 Para ModImp
5 Narayana Shetty OP.32508 60 M BUISNESSMAN HINDU 6 VEG POSITIVE MC 6/8/2010 6/19/2010 RIGHT KNEE 1 0 0 1 1 0 1 0 0 2 1 0 0 0 0 0 0 0 1 1 0 3 1 0 1 1 0 1 0.5 0 1 0.5 0 1 0.5 0 1 0.5 0 1 0.5 0 0.5 0 0 3 1 0 1 0 0 30Mar 29Jan 29Jan 2 1 0 2 1 0 3 3 3 17 Para Mar Imp
6 ManjiththayaR.V OP.19593 66 M OFFICIAL HINDU 36 VEG POSITIVE UC 6/12/2010 6/23/2010 RIGHT KNEE 1 1 0 1 0 0 1 1 0 2 1 0 2 1 0 1 0 0 0 0 0 3 1 0 0 0 0 1 0.5 0 1 0.5 0 1 0.5 0 1 0.5 0 1.5 1 0 1 0.5 0 2 1 0 1 1 0 323 323 323 3 1 0 3 1 0 3 3 3 17 Para Mar Imp
8 Indira OP.34370 55 F HOUSEWIFE HINDU 6 VEG POSITIVE MC 8/2/2010 8/13/2010 BOTHKNEE 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 2 1 1 3 2 1 6 4 1 1 0 0 2 1 0.5 2 1.5 1 2 1 0.5 1.5 0.5 0 1.5 1 0 3 1 0 2 1 0 323 31.52 31Jan 333 321 310 3 2 0 3 1 0 2 1 0 3 3 3 13 Para MODImp
11 Jayamma IP.595 52 F HOUSE WIFE HINDU 18 MIXED NEGATIVE MC 8/20/2010 8/31/2010 BOTHKNEE 1 0 0 1 1 0 1 1 0 2 1 0 2 1 1 1 1 0 1 1 0 3 1 0 0 0 0 1.5 1 0 1 0.5 0.5 1.5 0.5 0 1.5 0.5 0 1 0.5 0 0.5 0 0 2 1 0 1 1 0 373 361 350 373 373 361 2 2 1 2 1 0 3 1 0 3 3 3 17 Para Mar Imp
13 Nagaraj OP.13819 60 M OFFICIAL HINDU 30 VEG NEGATIVE UC 9/4/2010 9/15/2010 LEFTKNEE 2 1 0 1 0 0 0 0 0 1 0 0 2 1 0 2 1 0 0 0 0 3 2 1 0 0 0 1 0.5 0 1 0.5 0 2 1.5 1 1 0.5 0 0.5 0 0 0.5 0 0 2 1 1 2 1 1 453 453 453 2 1 0 2 1 0 3 3 3 12 Para MODImp
14 Vasudeu OP.14090 58 M OFFICIAL HINDU 12 MIXED POSITIVE UC 9/10/2010 9/21/2010 BOTHKNEE 2 1 0 1 1 0 1 1 0 2 1 0 3 2 1 3 2 0 2 1 0 6 4 2 1 1 0 2 1 0.5 2 1 0 2 1 0.5 1.5 1 0 1.5 1 0 1.5 0.5 0 2 1 0 1 1 0 36.53 362 351 373 36.52 361 3 2 0 3 1 0 3 1 0 3 3 3 16 Para Mar Imp
15 Sakamma OP.25461 65 F HOUSE WIFE HINDU 24 MIXED NEGATIVE LC 9/10/2010 9/21/2010 LEFTKNEE 2 1 0 2 1 0 1 1 0 2 1 0 3 2 1 3 1 0 3 1 0 6 4 1 1 1 0 2 1 0.5 2 1 0 2 1 0.5 1.5 0.5 0 1 0.5 0 1 0.5 0 3 1 0 2 1 1 553 520 500 3 2 1 2 1 0 3 3 3 14 Para Mar Imp
16 Shashikala OP.30811 61 F HOUSEWIFE HINDU 12 VEG NEGATIVE LC 9/15/2010 9/26/2010 RIGHT KNEE 2 1 0 2 1 0 1 1 0 2 1 0 3 2 1 2 1 1 3 2 1 6 4 1 1 1 0 2 1 0.5 2 1.5 1 2 1 0.5 1.5 0.5 0 1.5 1 0 3 1 0 2 1 0 323 31.52 31Jan 333 321 310 3 2 0 3 2 1 2 1 0 3 3 3 12 Para MODImp
18 Prasanna OP.32510 59 M OFFICIAL HINDU 6 VEG POSITIVE UC 10/2/2010 10/13/2010 BOTHKNEE 2 1 0 2 2 1 1 1 0 2 1 0 1 1 0 1 1 0 2 1 0 4 2 0 1 1 0 1 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 2 1 0 1 1 0 403 403 391 413 401 392 2 1 0 2 1 0 2 1 0 3 3 3 19 Para Mar Imp
19 AbdulKhader OP.21610 55 M BUISNESSMAN MUSLIM 24 MIXED NEGATIVE LC 10/4/2010 10/15/2010 LEFTKNEE 1 1 0 2 1 0 1 1 0 2 1 0 2 1 0 3 2 0 1 1 0 5 3 1 0 0 0 1.5 1 0 1 0.5 0 2 1.5 0.5 2 1 0.5 2 1 0 1 1 0 373 361 361 2 1 0 2 1 0 3 3 3 13 Para MODImp
20 Srivatsa OP.22121 45 M BUISNESSMAN HINDU 20 VEG NEGATIVE UC 10/6/2010 10/17/2010 LEFTKNEE 1 1 0 2 1 0 1 1 0 2 1 0 2 1 0 3 1 0 3 2 0 5 3 1 0 0 0 1.5 1 0 1 0.5 0 2 1.5 0.5 2 1 0.5 1 0.5 0 1.5 0.5 0 2 1 0 1 1 0 483 471 460 2 1 0 2 1 0 3 3 3 16 Para Mar Imp
3 Kempachari OP.15167 65 M BUISNESSMAN HINDU 24 VEG NEGATIVE MC 5/10/2010 5/21/2010 BOTHKNEE 2 1 1 2 2 1 1 1 1 2 1 1 1 1 0 2 1 0 2 1 1 5 3 2 1 1 1 2 1.5 1 2 1 0 2 1 1 0.5 0.5 0 1 1 1 2 1.5 1 3 2 1 2 2 2 353 353 341 363 351 351 3 2 2 3 2 2 3 2 2 3 3 3 4Para MildImp
7 Ratnamma OP.31621 68 F HOUSE WIFE HINDU 24 MIXED NEGATIVE UC 7/15/2010 7/26/2010 BOTHKNEE 2 1 1 2 2 1 1 1 1 2 1 1 1 1 0 2 1 0 0 0 0 5 3 2 1 1 1 2 1.5 1 2 1 0 2 1 1 0.5 0.5 0 1 1 1 2 1.5 1 3 2 1 2 2 2 353 353 353 363 351 351 3 2 2 3 2 2 3 2 2 3 3 3 4Para MildImp
9 Narasimha Murthy OP.40780 46 M BUISNESSMAN HINDU 12 VEG NEGATIVE MC 8/10/2010 8/21/2010 LEFTKNEE 2 1 1 2 2 1 1 1 1 2 2 1 1 1 0 2 1 0 2 1 1 5 3 2 0 0 0 2 1.5 1 2 1.5 1 1.5 1 1 1.5 1 0.5 2 1.5 1 2 1 0.5 3 2 1 2 2 2 383 371 371 2 1 1 3 2 1 3 3 3 2Para MildImp
10 Madhu OP.40865 74 M OFFICIAL HINDU 12 MIXED NEGATIVE MC 8/16/2010 8/27/2010 BOTHKNEE 2 1 1 2 2 1 1 1 1 2 1 1 3 2 2 2 1 1 2 1 1 5 3 2 1 1 1 2 1.5 1 2 1 0 2 1 1 0.5 0.5 0 1 1 1 2 1.5 1 3 2 1 2 2 2 353 353 341 363 351 351 3 2 2 3 2 2 3 2 2 3 3 3 2Para MildImp
12 Nagratnamma OP.12168 73 F HOUSE WIFE HINDU 24 VEG POSITIVE MC 9/1/2010 9/12/2010 BOTHKNEE 2 1 1 2 2 1 1 1 1 2 1 1 3 2 1 2 1 1 0 0 0 3 2 1 0 0 0 2 1.5 1 1.5 1 0.5 2 1.5 1 1.5 1 0.5 1.5 1 0 1 0.5 0 3 2 1 1 1 0 403 403 403 403 403 391 3 2 1 3 2 1 3 1 0 3 3 3 4Para MildImp
17 Sarvamangala OP.30940 63 F HOUSE WIFE HINDU 6 VEG POSITIVE MC 9/18/2010 9/29/2010 RIGHT KNEE 2 2 1 2 2 1 1 1 1 2 1 1 1 1 0 2 1 0 2 2 1 5 3 2 1 1 1 2 1.5 1 2 1.5 1 1.5 1 1 1.5 1 0.5 2 1.5 1 2 1 0.5 3 2 1 2 2 2 353 353 341 3 2 2 3 2 2 3 3 3 2Para MildImp
Abbreviations
OP Outpatient
IPInpatient
MMale
FFemale
M.CMiddleclass
L.C Lowerclass
U.C Upper class
VegVegetarian
D.o.ComDateofcommencement
D.o.compDateofcompletion
BT Before treatment
Over allrelief
Sl.No NAME OP/IP No. AGE SEX OCCUPATION RELIGIO
N
CHRONICITY
IN MONTHS
DIET FAMILY
HISTORY
SE DO COM DOCOMP JOINT
AFFECTED
BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12 BT 6 12
1 HonneGowda 2772 43 M Labourer Hindu 12 Mixed Positive LC 4/26/2010 4/7/2010 RtKnee 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 2 1 1 3 2 1 6 4 1 1 0 0 2 1 0.5 2 1 0 2 1 0.5 1.5 0.5 0 3 1 0 2 1 0 333 321 310 2 1 0 2 1 0 3 3 2 12 para MODImp
2 Bachchappa IP.224 74 M Labourer Hindu 36 Mixed Negative LC 4/30/2010 5/11/2010 LtKnee 1 0 0 2 1 0 1 1 0 2 1 0 2 1 0 3 1 0 1 0 0 5 3 1 0 0 0 1.5 1 0 1 0.5 0 2 1.5 0.5 2 1 0.5 2 1 0 1 1 0 373 361 361 2 1 0 2 1 0 3 3 3 13 para Mar Imp
3 Venkataramana IP.241 65 M Labourer Hindu 6 Mixed Negative LC 5/6/2010 5/17/2010 Lt Knee 2 1 0 2 1 0 1 0 0 2 1 0 1 1 0 1 1 0 0 0 0 5 3 1 1 1 0 2 1 0.5 2 1 0 1.5 1.5 1 1.5 0.5 0 3 1 0 2 1 0 343 343 343 3 2 1 2 1 0 3 3 3 12 para MODImp
4 Narasimha 6616 66 M Official Hindu 24 Veg Negative UC 5/6/2010 5/17/2010 Lt Knee 2 1 0 1 0 0 0 0 0 1 0 0 2 1 0 2 1 0 0 0 0 3 2 0 0 0 0 1 0.5 0 2 1.5 1 1 0.5 0 1 0.5 0 0.5 0 0 0.5 0 0 2 2 1 2 1 1 453 453 453 2 1 0 2 1 0 3 3 3 13 para MODImp
5 Shanthi IP.635 56 F HouseWife Hindu 12 Veg Negative MC 5/19/2010 5/30/2010 Lt Knee 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 3 1 0 3 2 1 6 4 1 1 0 0 2 1 0.5 2 1 0 2 1 0.5 1.5 0.5 0 1 0.5 0 1 0.5 0 3 1 0 2 1 1 553 520 500 3 2 1 2 1 0 3 3 3 13 para MODImp
6 Rajeshwari IP.596 58 F HouseWife Hindu 36 Mixed Negative MC 5/21/2010 6/1/2010 Both 1 0 0 1 1 0 1 1 0 2 1 0 2 1 1 1 1 0 1 1 0 3 1 0 0 0 0 1.5 1 0 1 0.5 0.5 1.5 0.5 0 1.5 0.5 0 1 0.5 0 0.5 0 0 2 1 0 1 1 0 373 361 350 373 373 361 2 2 1 2 1 0 3 1 0 3 3 3 17 para Mar Imp
7 Leena 12170 42 F House Wife Hindu 6 Veg Positive UC 6/5/2010 6/16/2010 Rt Knee 2 1 1 2 2 1 1 1 1 2 1 1 1 1 0 2 1 0 2 1 1 5 3 2 1 1 1 2 1.5 1 2 1.5 1 1.5 1 1 1.5 1 0.5 2 1.5 1 2 1 0.5 3 2 1 2 2 2 353 353 341 3 2 2 3 2 2 3 3 3 2 para MildImp
8 SarojaDevi IP.146 54 F Official Hindu 12 Veg Negative MC 6/11/2010 6/22/2010 Both 2 1 0 1 0 0 0 0 0 1 0 0 2 1 0 2 1 0 3 1 0 4 2 0 0 0 0 1 0.5 0 1 0.5 0 1.5 0.5 0.5 1 0.5 0 1 0.5 0 0.5 0 0 2 1 0 2 1 1 463 451 440 463 440 430 3 1 0 3 1 0 2 1 0 3 3 3 18 paraMar Imp
9 Kumuda 12161 56 F HouseWife Hindu 18 Veg Negative MC 6/14/2010 6/25/2010 Lt Knee 1 0 0 2 1 0 1 1 0 2 1 0 2 1 0 3 1 0 3 1 0 5 3 1 0 0 0 1.5 1 0 1 0.5 0 2 1.5 0.5 2 1 0.5 1 0.5 0 1.5 0.5 0 2 1 0 1 0 0 483 471 460 2 1 0 2 1 0 3 3 3 16 paraMar Imp
10 ShantalaDevi 14096 41 F Official Hindu 6 Mixed Positive UC 7/19/2010 7/30/2010 Both 2 1 0 1 0 0 1 0 0 2 1 0 3 2 1 3 1 1 3 2 0 6 4 2 1 0 0 2 1 0.5 2 1 0 2 1 0.5 1.5 1 0 1.5 1 0 1.5 0.5 0 2 1 0 1 1 0 36.53 362 351 373 36.52 361 3 2 0 3 1 0 3 1 0 3 3 2 15 paraMar Imp
11 ShahidaBhanu 21507 48 F HouseWife Muslim 24 Mixed Positive MC 7/23/2010 8/3/2010 RtKnee 1 0 0 1 1 0 1 0 0 2 1 0 0 0 0 0 0 0 1 1 0 3 1 0 1 1 0 1 0.5 0 1 0.5 0 1 0.5 0 1 0.5 0 1 0.5 0 0.5 0 0 3 1 0 1 0 0 30Mar 29Jan 29Jan 2 1 0 2 1 0 3 3 3 17 paraMar Imp
12 Ranganath 2771 48 M Labourer Hindu 18 Mixed Negative LC 8/2/2010 8/13/2010 Both 2 1 0 1 0 0 0 0 0 1 0 0 2 1 0 2 1 0 0 0 0 4 2 0 0 0 0 1 0.5 0 1 0.5 0 1.5 0.5 0.5 1 0.5 0 2 1 0 2 1 1 393 393 393 393 393 381 3 1 0 3 1 0 2 1 0 3 3 3 13 paraMODImp
13 Srinivas 25478 65 M Labourer Hindu 36 Veg Negative MC 8/10/2010 8/21/2010 Both 2 1 0 2 2 1 1 1 0 2 1 0 0 0 0 1 1 0 2 1 0 4 2 0 1 1 0 1 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 2 1 0 1 1 0 393 38.52 381 383 38.53 38.5
3
2 1 0 2 1 0 2 1 0 3 3 2
18 paraMar Imp
14 P.M.Kannan 25466 60 M Official Hindu 30 Veg Positive UC 8/11/2010 8/22/2010 Both 2 1 1 2 2 1 1 1 1 2 1 1 1 1 0 2 1 0 2 1 1 5 3 2 1 1 1 2 1.5 1 2 1 0 2 1 1 0.5 0.5 0 1 1 1 2 1.5 1 3 2 1 2 2 2 353 353 341 363 351 351 3 2 2 3 2 2 3 2 2 3 3 3 4 para MildImp
15 Jayaram IP.944 61 M Labourer Hindu 12 Mixed Negative LC 8/30/2010 9/10/2010 Both 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 2 1 1 3 2 1 6 4 1 1 0 0 2 1 0.5 2 1.5 1 2 1 0.5 1.5 0.5 0 1.5 1 0 3 1 0 2 1 0 323 31.52 31Jan 333 321 310 3 2 0 3 2 1 2 1 0 3 3 3 12 paraMODImp
16 KrishnaMurthy 12171 60 M Businessman Hindu 24 Mixed Negative MC 9/1/2010 9/12/2010 Rt Knee 2 1 0 2 1 0 1 1 0 2 1 0 2 1 0 3 1 0 0 0 0 5 3 1 1 1 1 1.5 1 0 1 0.5 0 2 1.5 1 2 1 0.5 1.5 1 1 2 1 0 1 0 0 353 353 353 2 1 1 2 1 0 3 3 3 11 para ModImp
17 MallikarjunSwamy 30825 66 M Official Hindu 30 Veg Negative UC 9/13/2010 9/24/2010 Both 2 1 0 2 2 1 1 1 0 2 1 0 1 0 0 1 0 0 2 1 0 4 2 0 1 0 0 1 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 1.5 0.5 0 1 0.5 0 2 1 0 1 1 0 403 403 391 413 401 390 2 1 0 2 1 0 2 1 0 3 3 3
20 paraMar Imp
18 SheelaDevi 31623 57 F Official Hindu 6 Veg Positive MC 9/13/2010 9/24/2010 Both 1 1 0 1 0 0 1 0 0 1 0 0 0 0 0 2 1 0 3 2 0 4 2 0 0 0 0 1 0.5 0 1 0.5 0 1.5 0.5 0.5 1.5 0.5 0 1 0.5 0 0.5 0 0 2 1 0 2 1 0 503 480 460 503 480 470 3 1 0 3 1 0 2 1 0 3 3 3 19 paraMar Imp
19 K.Madhu 30946 60 M Labourer Hindu 12 Mixed Negative MC 9/17/2010 9/28/2010 Rt Knee 2 1 0 2 1 0 1 0 0 2 1 0 3 2 1 2 1 1 0 0 0 6 4 1 0 0 0 2 1 0.5 2 1 0 1 0.5 0 1.5 0.5 0 1 0.5 0 1.5 0.5 0 3 1 0 2 1 0 343 343 343 2 1 0 2 1 0 3 3 3 13 paraMODImp
20 Narayan Rao 32501 60 M Businessman Hindu 12 Veg Negative MC 9/20/2010 31092010 Rt Knee 1 0 0 2 1 0 0 0 0 2 1 0 2 1 0 3 1 0 2 1 0 5 3 1 0 0 0 1.5 1 0 1 0.5 0 2 1.5 0.5 2 1 0.5 1 0.5 0 1 0.5 0 2 1 0 1 1 0 403 391 380 2 1 0 2 1 0 3 3 3 15 paraMar Imp
Abbreviations
OP Outpatient
IPInpatient
MMale
FFemale
M.CMiddleclass
L.C Lowerclass
U.C Upper class
VegVegetarian
D.o.ComDateofcommencement
D.o.compDateofcompletion
BT Before treatment
Timetaken
t lk 50
Radiolog Measurementof Rt Measurementof
Range of
M t
Range of Getting in Putting on Tendern Crepitus Able to Able to Able to Able to Stiffness Swelling Maximu Walking
Morning ClinicalObservationsinSuchiVedaChikitsa(GroupA)
ClinicalObservationinAccupunctureTreatment (GroupB) Pain Pain Pain on Pain on Morning
Pain Pain Painon Painon Puttingon Tendern Crepitus Stiffness Radiologi Measurement ofRt Swelling Maximu Walking Ableto Ableto Ableto Ableto walk Gettingin Measurement of Rangeof Rangeof
Timetaken
t lk 50
ACUPUNTURE TREATMENT

SUCHI VYADHA CHIKITSA

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A COMPREHENSIVE STUDY ON MARMA &

ACUPUNCTURE POINTS AND EVALUATION OF THEIR

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

manipulate or stimulate Marma Sthana to obtain desired therapeutic effect. In coming

A Clinical Study on Siravyadhana (Acupuncture) & role of Acupuncture in

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

Marma and Astrology

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

As a surgeon, Acharya Sushruta stressed the importance of Marmas in surgical

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Table No. 02: Showing Udara(Koshta ?) Marmas:

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Table No. 04: Showing Prishta Marmas:

Marma Sthana Asray

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Table No. 05: Showing Jatrurdhwa Marmas:

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

FIG.3 MARMAS OF AXILLA & ELBOW

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Table No. 06: Showing Description of Marmas According to vaghbhata Acharya:

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Table No. 07: Showing Marmas in controversy on the basis of classification:

Name of Marma According to Vagbhata According to Sushrutha

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

Classification of Marmas according to their viddha laxanas

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of their

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

interventions, including pressure, heat and acupuncture applied to the body's

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

Other forms of acupuncture employ additional diagnostic techniques. In many forms

Comparison of TCM & Ayurveda

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

Comparison of Ayurveda and Traditional Chinese Medicine

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of

A Comprehensive Study on Marma & Acupuncture Points And Evaluation of