A Study on Azhal Keel Vaayu (அழல் கீல் வாயு) (Osteoarthritis)

AIM AND OBJECTIVES: AIM: To evaluate the therapeutic efficacy of siddha formulation “SAGALA VADHA CHOORANAM” (INTERNAL), “ILAGU VADHA KESARI THYLAM” (EXTERNAL) in “AZHAL KEEL VAYU” (Osteo arthritis of knee joint) for the reduction of pain and swelling and to improve the range of movements. OBJECTIVES: 1. To study the clinical cause of the disease Azhal keel vayu with keen observation on the definition, Aetiology, pathology, Diagnosis, prognosis, complications and the treatment by making use of siddha aspects. 2. To have an idea about the prevalence of Azhal keel vayu with reference of Age, sex, family history, occupation, socio ecnomic status, diet, habit and climatic conditions. 3. To know the correlation of aetiology, classification, symptoms, diagnosis and line of treatment compared with osteo arthritis of knee. 4. To perform the alteration of the disease under the topics of Mukkutram, Uyir thathukal, Porigal, Udal thathukal, Envagai thervugal, Naadi, Neerkuri, Neikuri. 5. To make a clinical trial of patients with the trial medicine SAGALA VADHA CHOORANAM (Internal), ILAGU VADHA KESARI THYLAM (External) in the treatment of Azhal keel vayu. 6. To use of modern parameters in the investigation of X-ray to confirm the diagnosis and to follow the progression of patients. 7. To elicit the Biochemical analysis and Pharmacological action of the trial medicine. 8. To insist Thokkanam, Ottradam, Asanam exercise along with medicine to acheive the good results, which are the salient features of Sirappu Maruthuvam. MATERIALS AND METHODS: To study on clinical evaluation of the disease “AZHL KEEL VAYU” with the drug SAGALA VADHA CHOORANAM (INTERNAL) and ILAGU VADHA KESARI THYLAM (EXTERNAL) was carried out in Postgraduate Sirappu Maruthuvam, Government Siddha Medical College, Palayamkottai. 20 patients of both male and female were selected for the studies and admitted in In patient ward for among 20 IP patients, 10 IP patients will be given massage and varmam treatment along with internal medicine and remaining 10 IP patients will be given massage fomentation without internal medicine. Another 20 patients are treated with trial drug in the outpatient ward. SELECTION OF PATIENTS: INCLUSION CRITERIA: • Age – 40 – 65 Years. • Sex - Both male and female. • Patients having symptoms of arthritis of both knee joints, swelling, stiffness, crepitation, restricted movements of both knee joints. • Patients who are willing to undergo radiological investigation and give blood for laboratory investigation. • Patient willing to sign the informed consent stating that he/she will consciously stick to the treatment during 48 days but can opt out of the trial of his / her own conscious discretion. EXCLUSION CRITERIA: • Cardiac disease. • Diabetes mellitus. • Hypertension. • Rheumatoid arthritis. • Pregnancy and lactation. • History of trauma. • Tuberculosis. • Use of narcotic drugs. • Neurological disorder. • Patients with any other serious illness. SUMMARY: The disease Azhal Keel vaayu was comparatively studied with the disease Osteoarthritis with reference to its etiology, pathogenesis and clinical features. Sagalavatha Chooranam as internal medicine and Ilagu Vatha Kaesari Thylam as external medicine was selected and a clinical trial in Govt. Siddha Medical College, Palayamkottai was conducted with these drugs. For this 40 cases were selected in which 20 were treated in OutPatient ward and remaining 20 in In Patient ward. Pharmacological analysis of Sagalavatha Chooranam shows • Analgesic action. • Moderate Acute anti inflammatory action. Pharmacological analysis of Ilagu vadha kesari thylam shows • Significant acute anti inflammatory action. Since external therapies or manual therapies like massage, fomentation, leaf bandage, exercises plays a significant role in treating Osteoarthritis. Some of the external therapies from siddha system are manipulated along with trial drugs depending upon the severity of the disease. Daily progress was observed to evaluate the efficacy. The results obtained were found to be auspicious. Particularly results by external therapies were found to be very auspicious. During and after the course of treatment no side effects were reported. CONCLUSION: In this clinical study SAGALA VADHA CHOORANAM ILAGAU VADHA KESARI THYLAM were taken as Internal and External drug respectively for treating the disease Azhal Keel Vayu. In the pre clinical study pharmacological evaluation of the trial drug shows → Significant analgesic effect → Moderate Acute Anti Inflammatory effect (Internal medicine) → Significant Acute Anti- Inflammatory effect (External medicine) The overall results of efficacy of the trial drugs along with external therapies by reducing the clinical signs and symptoms like pain, swelling, morning stiffness. This Clinical study were found to have marked effect in 37.5% cases, moderate effect in 42.5% cases, mild effect in 12.5% cases and no effect in 7.5%. So the clinical effect of the trial drugs along with external therapies was found to be moderater in treating the disease azhal keel vayu. The Trial drug Sagala Vadha Chooranam and Ilagu Vadha Kesari Thylam is purely herbal. No adverse effects were noticed during the treatment period. So the trial medicine is safe and easily preparable medicine