Ayurvedic Management of Sandhivata (Osteoarthritis): A Comprehensive Review of Pathophysiology, Therapeutic Strategies, and Clinical Evidence

Kailash Tada, Gyan Prakash Sharma, Deelip Kumar Vyas, Vaidya Sadhana Dadhich, Jitendra Pal,

doi:10.5281/zenodo.17318455

Review Paper | Open Access
Volume 03 | Issue 10 | Article Id IJPS/250310159

Ayurvedic Management of Sandhivata (Osteoarthritis): A Comprehensive Review of Pathophysiology, Therapeutic Strategies, and Clinical Evidence
Kailash Tada* Gyan Prakash Sharma Deelip Kumar Vyas Vaidya Sadhana Dadhich Jitendra Pal
Dr. Sarvepalli Radhakrishnan Rajasthan Ayurved University, Jodhpur.

Abstract

Background: Osteoarthritis (OA) is a leading cause of chronic joint disability worldwide [1, 2]. Its Ayurvedic counterpart, Sandhivata, is classified under Vatavyadhi, characterized by pain, stiffness, swelling, and crepitus [3–5]. Conventional management—including analgesics, NSAIDs, physiotherapy, and joint replacement—offers symptomatic relief but lacks curative potential and carries adverse effects [1, 2]. Ayurveda, with its emphasis on Shodhana (purification), Shamana (palliative), and Rasayana (rejuvenative) measures, provides a holistic framework for prevention and management. Objective: To synthesize classical Ayurvedic theory and contemporary biomedical evidence for managing Sandhivata and correlate Ayurvedic pathophysiology with modern OA mechanisms. Methods: Literature was retrieved from PubMed, Scopus, Google Scholar, DHARA, and AYUSH Research Portal using terms such as “Sandhivata,” “Ayurveda AND Osteoarthritis,” “Panchakarma OA,” and “Boswellia.” Classical texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, and Bhavaprakasha) were reviewed [3–6]. Studies were included if they evaluated Ayurvedic interventions in OA (clinical or preclinical). Results: Ayurvedic pathogenesis—vitiated Vata, Dhatu Kshaya of Asthi Dhatu, Shleshaka Kapha depletion, and Ama accumulation—correlates with cartilage loss, synovitis, and oxidative stress in modern OA [1, 2, 3–6]. Panchakarma procedures such as Abhyanga, Swedana, and Basti restore lubrication and mobility [3–6]. Herbs like Boswellia serrata [7, 9, 11, 12, 14–16], Commiphora wightii, and Withania somnifera [11, 14] show anti-inflammatory and chondroprotective effects. Clinical trials report significant improvements in WOMAC and VAS scores [7–13, 15, 16], with good safety profiles. Conclusion: Sandhivata management in Ayurveda offers a biologically plausible, multimodal approach targeting the structural, metabolic, and inflammatory dimensions of OA. Further standardized, biomarker-based RCTs are essential to validate its clinical utility.

Keywords

Private pharmacies, Jan Aushadhi Kendras, Drug Pricing, Healthcare access

Introduction

OA affects an estimated 528 million people globally [1], producing pain, deformity, and impaired function. Conventional pharmacological therapy is symptomatic and limited by toxicity [1, 2]. Ayurveda conceptualizes Sandhivata as a degenerative Vata disorder (Vatavyadhi) [3–6]. The term combines Sandhi (joint) and Vata (the principle governing motion), depicting a degenerative and painful joint condition. The Ayurvedic paradigm attributes pathogenesis to Vata prakopa from aging, strain, improper diet, and metabolic waste (Ama). Therapeutic objectives extend beyond palliation to restoration of doshic balance, Agni correction, tissue nourishment, and rejuvenation [3–6].

2 Pathophysiology: A Correlative Perspective

2.1 Modern Understanding of OA

OA involves cartilage matrix degradation mediated by metalloproteinases (MMP-13, ADAMTS-5), chondrocyte apoptosis, and synovial inflammation with cytokines (IL-1β, TNF-α, IL-6) [1, 2]. Subchondral bone remodeling, osteophyte formation, oxidative stress, and biomechanical overload perpetuate damage.

2.2 Ayurvedic Samprapti

According to Charaka and Sushruta, Sandhivata develops from aggravated Vata dosha lodging in Sandhi srotas [3, 4]. Dhatu Kshaya (tissue depletion) of Asthi and Majja Dhatu mirrors cartilage and bone loss [3, 5]. Shleshaka Kapha corresponds to synovial fluid; its depletion explains joint dryness and crepitus [3, 5]. Ama represents inflammatory metabolites that block microchannels, analogous to synovitis [4, 5].

2.3 Comparative Overview (Table 1)

Modern OA Concept	Ayurvedic Correlate	Commentary
Cartilage degeneration	Dhatu Kshaya (Asthi)	Structural loss parallels tissue depletion
Synovial inflammation (IL-1β, TNF-α)	Ama + Pitta Sopha	Corresponds to toxic–inflammatory buildup
Lubrication loss	Shleshaka Kapha Kshaya	Reduced cushioning and friction
Mechanical stress	Ati-Vyayama, trauma	Etiological factor for Vata aggravation
Pain and stiffness	Vata Prakopa	Neuromuscular and nociceptive aspects

(Adapted from [1–6]).

3 Ayurvedic Management Principles (Chikitsa Sutra)

3.1 Diagnosis (Nidana – Lakshana)

Causative factors: aging (Jara), excessive exertion (Ati-vyayama), cold exposure, fasting, erratic lifestyle, and dry diet (Ruksha Ahara) [3–6].
Symptoms: pain (Sandhishula), swelling (Shotha), stiffness (Stambha), crepitus (Atopa), and restricted motion [3–6].

3.2 Therapeutic Framework

Ayurvedic therapy follows a hierarchy: Shodhana → Shamana → Rasayana.

A. Shodhana Chikitsa (Purificatory Therapies) [3–6]

Snehana (Oleation): Abhyantara (ghee intake) & Bahya (oil massage – Abhyanga, Janu Basti) soften Vata-deranged tissues.

Swedana (Fomentation): Nadi Sweda, Patra Pinda Sweda relieve stiffness and mobilize Ama.

Basti (Medicated Enema): The principal therapy for Vata disorders; Matra Basti and Tikta-Ksheera Basti correct systemic Vata imbalance [3–6].

B. Shamana Chikitsa (Palliative Therapies)

Single Herbs (Ekal Dravya):

Herb	Latin Name	Reported Activity	Key Reference
Shallaki	Boswellia serrata	5-LOX inhibition, anti-inflammatory	[7, 9, 11, 12, 14–16]
Guggulu	Commiphora wightii	Anti-arthritic, NF-κB modulation	[11, 14]
Ashwagandha	Withania somnifera	Adaptogenic, chondroprotective	[11, 14]
Rasna	Pluchea lanceolata	Analgesic, anti-arthritic	[11]

Classical Formulations: Yogaraj Guggulu, Maharasnadi Kwatha, Simhanada Guggulu show clinical benefit in knee OA [7, 10, 20].

C. Diet and Lifestyle (Ahara–Vihara)

Warm, unctuous, nourishing diet; avoid cold, dry, stale food. Regular daily routine (Dinacharya), mild yoga (Pawanmuktasana, Tadasana), adequate rest, and mental calmness reduce Vata aggravation [3–6].

4 Clinical and Pre-clinical Evidence

4.1 Panchakarma and Multimodal Therapies

A large RCT (n = 151) comparing multimodal Ayurvedic treatment to guideline-based care demonstrated significantly greater pain reduction and function improvement sustained for 12 months [9, 10]. Smaller Indian trials combining Abhyanga, Janu Basti, and Basti also reported marked WOMAC improvement [7, 8, 19, 20].

4.2 Herbal and Polyherbal Formulations

Boswellia serrata extracts consistently reduce pain and improve function vs placebo [11, 12, 15, 16]. Yogaraj Guggulu and Ashwagandha Churna combinations show significant WOMAC score improvement [20]. Mechanistic studies reveal inhibition of 5-LOX, COX, and NF-κB pathways [14, 18].

Table 2. Representative Clinical Trials

No.	Study & Year	Design (n)	Intervention	Key Outcome	Ref
1	Kessler et al., 2022	RCT (151)	Multimodal Ayurveda vs conventional	↓Pain ↑Function @12 mo	[9]
2	Majeed et al., 2019	DB-RCT (60)	Boswellia serrata extract	↓VAS pain p<0.01	[11]
3	Mohsenzadeh et al., 2023	DB-RCT (70)	Topical Boswellia oil	↓WOMAC p<0.05	[13]
4	Kimmatkar et al., 2003	DB-RCT (30)	Boswellia extract vs placebo	Significant pain relief	[15]
5	Kachare et al., 2025	Open clinical (50)	Yogaraj Guggulu + Ashwagandha	↓WOMAC & ↑QoL	[20]

5 Mechanistic Insights

Modern pharmacology supports multiple convergent mechanisms for Ayurvedic agents:
Anti-inflammatory: 5-LOX and COX inhibition, NF-κB suppression (Boswellia, Guggulu) [14, 18].
Antioxidant / Chondroprotective: Withanolides reduce ROS and MMP-13 activity.
Lubrication & Neuromodulation: Basti and Abhyanga enhance local microcirculation, reduce nociception.
Gut–Joint Axis: Ayurvedic diet and herbs may modulate microbiota and systemic inflammation (hypothesis).

Figure 1.

6 DISCUSSION

Ayurveda’s multimodal strategy addresses the mechanical, inflammatory, and psychological dimensions of OA. Clinical trials demonstrate benefit with low toxicity [7–13, 15–20]. However, methodological limitations (small samples, heterogeneity, short follow-up) limit definitive conclusions [17, 21].

Future priorities:

Standardized herbal extracts and GMP compliance.
Long-term multicentre RCTs with MRI and biochemical endpoints.
Integration models combining Ayurveda with physiotherapy and analgesic sparing strategies.
Health-economic and implementation research for scalability.

7 CONCLUSION

Sandhivata reflects a degenerative joint process analogous to OA. Ayurvedic principles—purification, rejuvenation, and individualized care—offer a rational, complementary framework. Evidence from modern clinical and mechanistic studies supports its potential as a safe adjunct for symptom control and functional improvement. Further robust trials are warranted to validate and mainstream these interventions.

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