One of the most significant and common ailment seen during clinical practice is Azhal Keelvayu. It may be compared to osteoarthritis as per modern concept. Medically this condition is explained as degenerative joint disease or chronic disorder of synovial joint characterised by progressive degenerative changes in articular cartilage of weight bearing joints. It may be primary or secondary in nature.
Primary OA – is usually occurs due to ageing. Elderly people are prone to this especially woman after 40 years. This is because most of the ladies attain menopause after the age of 40 which lead to deficiency of female hormones like estrogen causing bone degeneration. In few woman early removal of uterus may provoke the degeneration of bones earlier.
Secondary OA – appears at any age. This mainly occurs due to wear and tear of articular cartillages as a result of any injury fracture, imflammation or lose bodies. Mainly affects Knee, Hip, and Spine.
Siddha Concept of Azhal Keelvayu emphasise on derrangement of Azhal or Pitham initially which is the basic reason of this disease. The derranged Pitham or extreme heat dries up the lubricating fluid present in the joint. Hence crepitation, restricted movements and swelling occurs. At times a low grade fever is present. This disease mainly affects Knee, Hip, Shoulder and Spine.
Signs and Symptoms
People suffering from this disease may experiance slight morning stiffness in the joints initially (less than 1 hour). Pain and tenderness occurs on flexion and extension. Diminished mobility or difficulty in moving the joints usually occurs after long rest or sleep. Swelling may be present with crepitation on movement. Pain decreases with mobility but reoccur soon after rest. Slowly the derranged Azhal humour may vitiate other two humours and produce associated symptoms.
Causative factors
Obesity, Trauma, Hypermobility, Ageing, Imflammatory arthritis, Hypothyroidism, Over weight, Lack of exercises, Excessive intake of Oily or Fatty food, Over eating, Sitting nature of work, Stress and Tension are main reasons.
Pathology
Loosening and flaking of articular caritillages, loss of cartilagenous matrix and chondrocytes, increased osteoclastic activity and spur(cartillagenous outgrowth) occur in the joints. Synovial effusion and chronic synovitis are seen in advanced stages. Degenerative changes in interphalangeal joints may be seen as hard, bony, painless enlargement in form of nodules at the base of terminal phalanx known as Herbeden’s nodes. Common in females.
Lab Investigation
X Ray of AP view of the affected joint may confirm the diagnosis. Narrowing of joint space, osteophytic changes like spur may be seen in the X Ray. Routine test of urine, Blood sugar, Serum RA factor, Serum Iron, Serum cerulloplasmin should be done to rule out OA.
Siddha Medicine & Treatment
Very special treatment methods in this medical system. Abiding to the guidelines of Siddhars, a Siddha Physician employs method to correct the root cause of the ailment rather than providing symptomatic treatment or general pain relieving medicines.
Here Azhal is the prime cause so it has to be decreased or normalised first. Cool and mild purgatives like Drakshai decoction, Ponnavarai choornam or Tablet, Meghanatha thylam, Vellai ennai are used. Decoction prepared from Rose petals, Drakshai and Nilavagai is also affective. If Vatham is also found derranged, medicines like Kazharchi ennai should be done to lower the vitiated Vatha humour.
Internal Medicines in Siddha
Medicines that are helpful in preventing degeneration of the cartilage, rejuvenating the dried synovial fluid and providing strength to the joints are administered. Neermulli kudineer, Nilavembu kudineer, Thrikadugu choornam,Amukkura choornam, Arumugha chendooram, Muthu parpam, Kalameghanarayana chendooram, Pavazha parpam, Poornachandrodayam, Vathamadakki Tablet, Vanga chunnam, Chandamarutha chendooram, Serankottai preparations like RGM are very effective for OA.
External therapies
Massage and Kizhi are not advised, bandaging the knee with Ulunthu thylam or Mahamasha thylam is effective. Other external applications like Chitramoola thylam, Kukkil vennai, Sivappu kukkil thylam are also helpful.
Advise and Dietery Regulations :
Mild Knee exercises and muscle strengthening exercises should be done. Avoid lifting heavy weight. If Varus deformity (outward bending of Knee joint due to prolonged OA) present, activities like climbing upstairs, prolonged standing should be avoided. Knee cap advised. If the patient is obese or over weight, weight reduction should be done. Include cooked cereals and pulses, boiled vegetables, less oil, reduced quantity of milk, more salads in diet. Drink lots of water and fluids. Avoid excessive Tamarind, Red Chilly, Non Vegetarian diet etc.
Yogasanas like Vajrasanam, Padmasanam, Trikonasanam, Patchimothasanam etc are helpful. Practise of Pranayamam like Naadi shudhi and meditation will provide Positive approach, confidence and reduce the Stress and Tension.
Treatment in Modern Medicine and Limitations
Simple analgesics like Paracetamol(500 mg) or Dextropropoxyphene (65mg) three times a day is useful to relieve pain. NSAID like Ibuprofen (400 mg tid), diclonac ( 50 mg tid) may be used. These medicines have known side effects.
Finally surgery including total knee and hip replacement therapy is introduced. Life of artificial joint is 7 to 10 years for knee and 15 years or more for hip. Infection, loosening and fracture are its important complications.