A COMPARATIVE CLINICAL STUDY OF THE MARMA

THERAPY AND THE ABYANGA THERAPY ON SAMDIGATA

VATA IN KNEE JOINTS.

by
Dr. H.W.K.T .KARUNARATHNA.
B.A.M.S (Colombo)
GWAI/2014/PGDS/08.

supervisor
Dr. A.A.J.Pushpakumara
B.A.M.S.(Hons) Colombo,MS(Ayu) (India)
PGDHD(Faculty of Medicine Colombo),Dip in Yoga
Senior Lecturer,
Head of Shalyatantra Department.

Gampaha Wickramarachchi Ayurveda Institute

University of Kelaniya
CONTENTS

1. Introduction
2. Objectives
- General Objectives
- Specific Objectives
3. Methodology
4.Observations and Results
5.Discussion
6.Conclusion
7.Bibliography
 Introduction
Samdigata vata is a one of Vata rogas that can gravely harm synovial joints in the
human body.

This burdensome disease has been recognized by the United Nations and WHO, by
endorsing the Bone and Joint Decade 20002010 and been categorized as one of
Musculoskeletal conditions.
This can be characterized by loss of joint cartilage an accompanying periarticular
bone response that leads to pain and loss of joint function.

Pathologically Alteration in cartilage structure.

Radiologically Osteophytes and joint space narrowing.
Clinically Patients complain of pain and disability.
It can occur in any joint but is most common in the hip, knee, and the joints of the
hand, foot, and spine.
Mostly affected weight bearing big joints. i.e (Knee joints,Hip joints).
Women over 55 years are affected more commonly than men of similar age .
Definition of the Features of a healthy Joint According to Acharya susrutha.

Snehabyakthe Yatha byakshe Chakran Sadhu Pravarthathe

Sandya: Sadhu Varthathe Sanshlishtaa: Sleshmana Thatha
(Susruta.Shareera.5/24)

Any Deviation of these features are considered as diseases in joints.

Features of Samdi Gata Vata according to Acharya Madhava,

Hanthi samdi Gata: samdi shotha shoola karaunicha

prasarana kunchanayoo Pravurthincha sa vedanam.

( Madava.nidana.vata viyadi-27)

This definition of Samdi Gata Vata in Ayurveda approximately resembles with the Modern
disease called Osteo-Arthritis (OA).

It is said that more than 250 million people are suffering from Osteoarthritis (samdigata vata) all over
 Treatments for Samadigata vata in Ayurveda.
Herbal decoctions.
Guli, Kalka and choornas.
Herbal oil application (Abyanga).
Fomentation .
Treatments for Osteoarthritis (OA) in Allopathy .
Weight control.
Physical therapy.
Medications.
Surgery( i.e. Arthroplasty and joint replacement)
Most of the treatments will involve a combination of
methods.
Some of these treatments are highly expensive and not
available in some countries.
 Marmas and their usage.
Marma science is discussed in Susruta-Samhita in Shareera sthana
adyaya chapter 6 , in reference to anatomical consideration of the
body parts.
There are 107 Marmas and are described as vital points.
These vital points (marmas) are the source of energy so they should
be protected very well during any surgical intervention or procedure.
A number of neurological problems are discussed in different
Ayurvedic texts.
Most of these neurological problems come under the heading of
vata roga.
These vata disorders (80 types) can be treated by marma therapy
successfully. Apart from this, if the required procedures described in
ancient texts are applied on those points in the proper way, then the
body becomes healthy and long life can be achieved.
One can get rid of and be free from different curable and incurable
diseases.
ctives

General objectives:

To assess the efficacy and the effectiveness of Abyanga therapy on

Samdigata Vata (osteoarthritis).

To assess the efficacy and the effectiveness of Marama therapy on

Samdigata Vata (osteoarthritis).

Specific objectives :

To improve the knowledge of Marma science and its usefulness.

To introduce low cost and non invasive surgical treatment for Samdigata
vata.

To introduce an effective short-term therapeutic method for Samdigata

Vata.
 Methodology
This study was a comparative clinical study of the Marma therapy
and the Abyanga therapy (Herbal oil application) on samdigata
vata in knee joints. Following materials and procedures were
adopted in order to conduct this study.

Selection Criteria :

60 samdigata vata (osteoarthritis) patients were selected and

registered for the study from the Out Patient Dispensary (OPD) of
Gampaha Wickramarachchi Ayurvedic Teaching Hospital
according to the diagnostic criteria, Inclusion criteria and exclusion
criteria ,after obtaining their consent.

patients who , disagreed to continue or showed allergic reaction to the

drugs ,were not continued in the process.
 Inclusion Criteria :

Age (30-80) years.

Male and Female.
Non- DM patients.

Exclusion Criteria :

Age (below30-Above80)Years.
Pregnant mothers.
DM Patients.
 Group Division and treatment procedure

The selected sixty patients were divided into two groups equally as
Group -A and Group-B.

Group A Patients
Were given cup of Tripala Decoction, in the morning and the night
,Before meals.
Were given 2 pills of yograj gugggulu and 5 matadas (1250mg) of
Navarathna kalka in the morning and the Night , After Meals .
These Medications were given twelve consecutive weeks.
Abyanga therapy was done By using Nirgundi oil.
Abyanga therapy was done in Every other day for twelve consecutive
weeks.
Abyanga Therapy was done for 10 minutes.
During the period of treating , each patients complaints, Prognosis ,condition
and the progress were recorded separately according to the
assessment criterions.
Group B Patients

Were given cup of Tripala Decoction, in the morning and

the night, Before meals.
Were given 2 pills of yograj gugggulu and 5 matadas
(1250mg) of Navarathna kalka, in the morning and the
Night, After Meals.
These Medications were given twelve consecutive weeks .
Marma therapy was done By using Nirgundi oil.
Marma therapy was done in Every other day for twelve
consecutive weeks.
Marma therapy was done at least 5 minutes on relevant
Marma of the Knee joint ( Janu Marma, Urvi Marma and
Ani Marma respectively).
During the period of treating , each patients complaints, ,
Prognosis ,condition and the progress were recorded
separately according to the assessment criterions.
 Criteria for Assessment :

Changes of the clinical features of the patients were noted in the proforma weekly up to twelve (12)
weeks.
Follow up was carried out after every 10 days.

The data recording of the effectiveness of the treatment was done in the basis of relief of sign and
symptoms according to the 0 - ++++ score scale.

pain or discomfort.

maximum distance walked / Muscle stiffness.

Activities of daily living.

0 - Not Satisfied.
+ - Mildly Satisfied.
++ - Moderately Satisfied.
+++ - Satisfied.
++++ - Very Satisfied.

Patients were asked to attend the OPD up to the completion of the study.

Results and Discussion

 Pain or Discomfort versus Week and Marma therapy

Source DF SS MS F-Value P-Value

Week 1 897.94 897.944 577.31 0.000

Marma 1 117.88 117.878 75.79 0.000
Therapy and
control
Error 357 555.28 1.555
Lack-of-Fit 9 69.35 7.705 5.52 0.000
Pure Error 348 485.93 1.396
Total 359 1571.10

According to the above table reduction of pain has occurred due to the action of
treatment. More over, it further explains that interaction of treatment and it
continued until six week period improve the efficiency of curing of the pain
Maximum distance walked/ Muscle stiffness versus Week and
Marma therapy
Source DF SS MS F-Value P-Value

week 1 1 692.15 692.149 452.04 0.000

Marma Therapy 1 99.22 99.225 64.80 0.000
and control

Error 357 546.62 1.531

Lack-of-Fit 9 108.06 12.006 9.53 0.000
Pure Error 348 438.57 1.260
Total 359 1338.00

According to the above table reduction of muscle stiffness has occurred due to the
action of treatment; more over it further explains that interaction of treatment and it
continued until six week period improve the efficiency of curing of the muscle stiffness
 Activities of Daily living versus Week and Marma therapy

Source DF SS MS F-Value P-Value

Week 1 630.3 630.269 441.39 0.000

Marma 1 101.3 101.336 70.97 0.000
Therapy and
control
Error 357 509.8 1.428
Lack-of-Fit 9 105.7 11.749 10.12 0.000
Pure Error 348 404.0 1.161
Total 359 1241.4
According to the above table improving of daily activity has occurred due to the
action of treatment; more over it further explains that interaction of treatment
and it continued until six week period improve the efficiency of curing of the
daily activity
 Pain or Discomfort
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Treat MSD SEM MSD SEM MSD SE MS SEM MSD SEM MSD SEM
ment D

A 6.43 0.26 6.13 0.24 5.43 0.24 4.73 0.27 3.93 0.22 3.07 0.19
1.3 1.3 1.4 1.23 1.01
1.4 3 0 8
1
B 6.57 0.21 5.43 0.22 4.50 0.22 3.57 0.21 2.133 0.16 0.633 0.89
1.1 1.2 1.2 1.1 0.86 0.49
57 0 2 4 0 0

P 0.691 0.046 0.006 0.001 0.000 0.000

value
 The table shows the mean values of group A (Control) and
group B (Research ) patients in weekly assessment of pain.
Results have been analyzed by using two sample T test of mini
tab 17 in 95% confidence levels (0.05 significant intervals). In
the first week the control group and Research group wasnt
shown significant difference since the P value was obtained as
0.691 which was higher than 0.05 confidence interval. After
the first week it is shown that the P values of each week were
lower than the confidence level 0.05. That means there is
significant different among the control group and research
group during the testing period
 8
6

Severity of pain 4 PatientA Pain

2 PatientB Pain
0
1 2 3 4 5 6
week

Severity of the pain was gradually reduced during the 6 weeks period in both test
groups according to the graph 1 illustrated above. Reduction of pain is reduced
significantly in research group than control group in which subjected to the Marma
therapy
 Maximum Distance walked/ Muscle stiffness
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Treatm MSD SE MSD SE MSD SEM MSD SEM MSD SE MSD SEM
ent M M M

A 6.03 0.26 5.80 0.24 5.57 0.23 5.07 0.22 4.37 0.20 3.30 0.20
1.40 1.32 1.25 1.2 1.10
3 1.09

B 6.43 0.23 5.60 0.20 4.70 0.19 3.800 0.18 2.333 0.14 0.933 0.13
1.28 1.10 1.06 0.9 0.6
61 0.758 91

P value 0.216 0.527 0.005 0.000 0.000 0.000

 The table shows the mean values of group A (Control) and
group B (Research ) patients in weekly assessment of Muscle
Stiffness. Results have been analyzed by using two sample T
test of minitab 17 in 95% confidence level (0.05 significant
interval). In the first week and the second week the control
group and Research group wasnt shown significant
difference since the P value were obtained as 0.261 and 0.527
gradually and that is higher than 0.05 confidence interval.
After the first and second week it is shown that the P values of
each week were lower than the confidence level 0.05. That
means there is significant different among the control group
and research group during the testing period
 PatientA
Muscle
severity of Muscle stiffness Stiffness
PatientA
Muscle
Stiffness
weeks

Severity of the Muscle Stiffness was gradually reduced during the 6 weeks period in
both test groups according to the graph 2 illustrated above. Reduction of Muscle
Stiffness is reduced significantly in research group than control group in which
subjected to the Marma therapy
 Activity of Daily living

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Treat MSD SEM MSD SEM MSD SEM MSD SEM MSD SEM MSD SEM
ment

A 6.13 0.21 5.77 0.23 5.40 0.23 5.07 0.19 4.47 0.20 3.60 0.18
1.28 1.25 1.05 1.00
1.1 1.11
7
B 6.47 0.25 5.57 0.21 4.67 0.19 3.967 0.16 2.300 0.14 1.100 0.14
1.14 1.03 0.75
1.36 0.857 0.750 9

P 0.312 0.524 0.016 0.000 0.000 0.000

value
 The table shows the mean values of group A (Control) and
group B (Research) patients in Daily Activity of Muscle
Stiffness. Results have been analyzed by using two samples
T- test of Minitab 17 in 95% confidence levels (0.05
significant interval). In the first week and the second week the
control group and Research group wasnt shown significant
difference since the P value were obtained as 0.312 and 0.524
gradually and that is higher than 0.05 confidence interval.
After the first and second week it is shown that the P values of
each week were lower than the confidence level 0.05. That
means there is significant different among the control group
and research group during the testing period
 7
6
5
4
Seveirity of Daily Activity 3
Patient A Daily Activity
2 Patient B Daily Activity
1
0
1 2 3 4 5 6
weeks

Severity of the Daily Activities was gradually reduced during the 6 weeks period in
both test groups according to the graph 3 illustrated above. Reduction of severity of
Daily Activities is reduced significantly in research group than control group in
which subjected to Marma therapy
All the tested condition evaluation
7
6
5
Pain A
4 Pain B
Seveiority
3 Muscle Stiffness A
Muscle Stiffness B
2
Daily Activity A
1 Daily Activity B
0
week 1week 2week 3week 4week 5week 6
weeks

The above graph is illustrated to contrast the reduction of severity of tested

condition. According to the graph 4 pain, muscle stiffness, and daily activity
of research sample were significantly reduced than the control sample
 CONCLUSION
On the basis of above discussion , Osteoarthritis in
knee joints can be correlated with Janu Sandhi
gata vata , aetiopathogenically and symptomatically.

Marma therapy has a significant effect on reducing

signs and symptoms of Janu Sandhigata Vata
( Osteoarthritis in knee joints)

Therefore this medicament can be used as effective

and cheap medical measure in the treatment of
Janu Sanshigata Vata.
 References
Murthy K.R.S., Sushruta Samhitha, Chaukamba Orientalia,
Varanasi, 2002.

Murthy K.R.S., Madhava Nidanum of Madhavakara, Chaukamba

Orientalia, Varanasi, 2001.

Kumar P. and Clark M., Kumar & Clarks Clinical Medicine,

Saunders Elsevier publishers, London, England, 2009(7 th edition).

Joshi S.K ., Marma Science and Principles of Marma

Therapy, Vani Publications, Delhi,India, August 2010( 1st edition).

Anthony D.Woolf1 & Bruce Pfleger2 ., Burden of major

musculoskeletal conditions .,Bulletin of the World Health
Organization 2003, 81 (9).
Babul .A, Raja R.M.Dave A.R. A Clinical study on Sandhigata Vata w.s.r. to
Osteoarthritis and its management by Panchatikta Ghrita Guggulu.

Sushil V.C ,A clinical study on the effect of Lakshadi Guggul with Sthanik
Snehan Swedan in the management of Sandhigata Vata.

Wadhwa R. Patil D.Y ,Role of Nirgundi Thaila Janu Basthi in Janu , Mumbai,
Maharashtra, India.

Claudia M.W, Andreas M, Stephanie R, Antonio M, Shivnarain Comparative

effectiveness of a complex Ayurvedic treatment and conventional standard care in
osteoarthritis of the knee study protocol for a randomized controlled trial.

Vaidya Vasant P. ,Holistic Management of Sandhigata Vata (Osteoarthritis) A

scientific Approach.

http:// en.wikipedia.org/wiki/Osteoarthritis,10/2/2015.
THANK YOU .
Backup slides
 Scientific Justification
It has been estimated that Increases in life expectancy and
ageing populations are expected to make osteoarthritis the
fourth leading cause of disability by the year 2020.

As modern surgery measures , joint replacement and

arthroplasty where available, provides effective relief but
these surgeries are highly expensive and not available in
some hospitals.

Even if these treatments are effective ,due to their

expensiveness and scarcity, lot of patients can not get these
treatments.

sometimes these surgical interventions can not be done if the

patient in old age and due to their irresistible side effects.

Most of the patients do not like to under go surgeries as a

result of some non trustworthy misconceptions and rumours
about surgeries in the lower societies.
 In conventional medicine samdigata vata has been categorized under vata
rogas which are difficult to treat.

Ayurveda says that samdigata vata is a kashta sadya illness.

According to modern medical strategies, there is a new tendency of seeking

non- invasive surgical measures to treat illnesses which ,should under go
massive surgeries.

According to Acharya susrutha ,these vital points would be very helpful to

reduce surgical interventions in certain diseases.

In this context ,Marma therapy or Marma science will have a major role to
play as a non-invasive surgical measure in the future surgery field.

By conducting this research , I wish to probe the ability of the healing

power of certain marmas (Ani,Janu and Urvi) in the management of
Samdigata vata .