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Ayurveda > Ayurveda Case Notes > Tamak Shwas-Chikitsa By Dr. Satish Kulkarni Ms. Johns is seventy six years old. She faces a lot of pain in her knee because of her sandhi vaat. Sandhi vaat means joint pain. This can occur due to several reasons ranging from osteoarthritis to rheumatic heart disease. Ms. Johns is suffering from sandhi vaat. Cause of her sandhi vaat is osteoarthritis i.e. wear and tear of the bones due to age. I noted this on her case paper as a first impression about her problem. Ms. Johns gave me her medical history. She mentioned that she has four daughters and after her deliveries she could not get enough rest. She had to get back to house work within a few days after each delivery. I noted that she did house work like doing the dishes and washing clothes, both with cold water. Her middle class family background did not permit her to have nutritious food rich in iron and calcium and as a result of that, Ms. Johns is anemic and has calcium deficiency. Ms. Johns is of vaat-pitta prakruti. Her age, her disease and the winter season all add to her aggravated vaat. I added this to my notes. My first line of treatment was to give her relief from the pain. I talked to her about ayurvedic treatment. She said that it would be a better choice since allopathic drugs are strong and produce hyperacidity. In addition, cost was also a factor. Long term allopathic treatment needs a lot of money and Ms. John’s husband was not very supportive. We decided to opt for ayurvedic treatment which is definitely cheaper than allopathic drugs. Guggul (commiphora mukul) is the best herb for arthritic pain, swelling and cracking of joints which are amongst Ms. John’s primary complaints. I prescribed two tablets of yog raj guggul (pills made with guggul as a chief ingredient and a few other herbs) at a time along with two teaspoonfuls of maha rasnadi kwath (a decoction which contains anti-vaat elements), both three times a day. Eranda (castor) is also a very good medicine for this type of trouble. I advised Ms. Johns to take 20 ml. of castor oil at bed time once a week. In her case, it would work as a vaat fighter rather than a laxative, for which purpose it is more commonly used. I also chalked out a dietary plan for Ms. Johns. She was advised to take hot milk at bed time. The heat would be effective for her vaat problem and milk would add to her calcium levels. I also prescribed having fried green leafy vegetables and freshly prepared bajra roti (a kind of flattened bread made from millet) for lunch and dinner. This would enhance the results of the treatment. Ms. Johns will also benefit from snehan (olation therapy) and swedan (fomentation therapy). I have advised Ms. Johns to drink four tablespoonfuls of real ghee (clear butter) at bed time as a daily snehan. I told my assistant to fix up an appointment in the morning for swedan. We will boil water and nirgundi leaves (whitex nirgudi) together to prepare medicated steam and will request Ms. Johns to sit in a sweating box for five to ten minutes. This will be done once or twice a week. A few other restrictions like avoiding cold food and cold weather and wearing warm clothes will help in giving faster relief. I am sure that when Ms. Johns will come for a follow-up visit, she will be out of pain.
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