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DOI
10.5281/zenodo.23434108
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding Author: Tiwari Dinkee ORCID ID:
ISI Impact Factor (2025-26): 1.345
IIFS Impact Factor (2026-27): 6.0
Article Info: Article Received on : 10/10/2026 Article Reviewed on: 12/10/2026 Article Published on : 15/10/2026
Cite this article as: - Dwivedi A, Tiwari D, Anand A. Ayurvedic Management Of Janusandhigata Vata (Knee Osteoarthritis) By
Jalaukavacharana And Adjuvant Ayurvedic Medication: A Case Report. International Journal of Diagnostics And Research.
2026Oct17;4(1):1–1. doi:10.5281/zenodo.23434108
Abstract
Background:Knee osteoarthritis is a chronic degenerative joint disorder characterized by pain, stiffness, tenderness,
swelling, crepitations, and restricted joint movements, leading to functional disability and reduced quality of life. In
Ayurveda, the clinical features of Knee osteoarthritis resemble Janusandhigata Vata. Jalaukavacharana (leech
therapy), a parasurgical procedure described in Ayurveda, is traditionally indicated for conditions associated with pain
and inflammation. This case report evaluates the clinical outcome of Jalaukavacharana in a patient with bilateral knee
osteoarthritis.
Methods:A patient diagnosed with bilateral knee osteoarthritis presented with pain, tenderness, swelling, crepitations,
stiffness, and pain during knee movements. Baseline assessment was performed using the Visual Analogue Scale
(VAS) for pain and clinical parameters including tenderness, swelling, crepitations, stiffness, and pain on movement.
The patient underwent a multimodal Ayurvedic treatment regimen including Panchakarma procedures, adjuvant
Ayurvedic medication, and Jalaukavacharana. Two sittings of Jalaukavacharana were administered at a 15-day
interval. Clinical evaluations were conducted before and after each sitting and at a follow-up visit on Day 30.
Results:At baseline, the patient reported bilateral knee pain with a VAS score of 4, along with tenderness, mild
swelling, crepitations, stiffness, and pain during knee movement. Following the first sitting, pain reduced to VAS 1 in
both knees, with improvement in all associated clinical parameters. Swelling resolved completely in the left knee and
reduced in the right knee. The clinical improvement was maintained until the second sitting. At the Day 30 follow-up,
complete relief was observed in both knees. Pain reduced to VAS 0, and tenderness, swelling, crepitations, stiffness,
and pain during knee movement were absent bilaterally. No adverse events were observed during the treatment or
follow-up period.
Conclusion:Jalaukavacharana was associated with progressive and sustained improvement in the clinical
manifestations of bilateral knee osteoarthritis in this patient. The intervention resulted in complete resolution of pain
and other assessed clinical parameters at the 30-day follow-up. These findings suggest that Jalaukavacharana along
with adjuvant Ayurvedic drugs is a viable therapeutic option in the management of knee osteoarthritis; however,
further controlled clinical studies are required to establish its efficacy and safety.
Keywords: Jalaukavacharana; Leech Therapy; Knee Osteoarthritis; Janusandhigata Vata, Ayurved.
Ayurvedic Management Of Janusandhigata Vata (Knee Osteoarthritis) By
Jalaukavacharana And Adjuvasnt Ayurvedic Medication: A Case Report
Dwivedi Amarprakash
1
,
Tiwari Dinkee
2
, Anand Archana
3
1
Professor, Department of Shalyatantra, D.Y Patil Deemed to be University, School of Ayurveda, Navi Mumbai.
2
MS Scholar, Department of Shalyatantra, D.Y Patil Deemed to be University, School of Ayurveda, Navi Mumbai.
3
Assistant Professor, Department of Shalyatantra, D.Y Patil Deemed to be University, School of Ayurveda, Navi Mumbai
.
G
A
R
V
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Introduction :
Osteoarthritis is a degenerative joint disorder
caused by extracellular matrix breakdown and
abnormal inflammatory responses following joint
injury. The disease initially presents as a molecular
disturbance with abnormal joint tissue metabolism
and subsequently progresses to anatomical and
physiological changes, including cartilage
degradation, bone remodelling, osteophyte
formation, and joint inflammation, impairing
normal joint function and ultimately resulting in
clinical illness
.[1]
It is classified as primary
(idiopathic) or secondary osteoarthritis; the latter
develops due to conditions such as trauma,
congenital abnormalities, inflammatory
arthropathies, and metabolic disorders.
.[2]
The knee is one of the most commonly affected
joints, and knee osteoarthritis causes pain, stiffness,
restricted mobility, and disability, particularly
among older adults.
.[3]
A community-based study
across five sites in India involving 5,000
participants reported a prevalence of primary knee
osteoarthritis of 28.7%, with age, obesity, and
female sex
.[4]
and sedentary work as significant risk
factors. Globally, osteoarthritis remains a major
cause of pain and functional limitation, with the
knee being the most frequently affected joint.
.[5]
Management of Knee osteoarthritis aims to reduce
pain and improve function, mobility, and quality of
life. Conventional approaches include lifestyle
modification, exercise, physiotherapy, analgesics,
non-steroidal anti-inflammatory drugs, intra-
articular therapies, and joint replacement in
advanced disease. Prolonged pharmacological
therapy may cause adverse effects, while surgery is
generally reserved for severe disease
.[6]
According to Ayurveda, Knee osteoarthritis can be
correlated with Janusandhigata Vata, a localised
manifestation of Sandhigata Vata involving the
knee. It is associated with aggravated Vata Dosha
and characterized by Sandhi Shoola, Shotha,
Stambha, Sphutana, and restricted or painful
movements.
.[7-8]
Ayurvedic management includes
Shodhana and Shamana therapies according to
clinical condition and Dosha predominance.
.[9-10]
Jalaukavacharana, a form of Raktamokshana, is
described for painful and inflammatory conditions.
.[11]
Contemporary studies report improvement in
pain and function with medicinal leech therapy in
knee osteoarthritis
.[12]
The therapeutic effects of
leech therapy are attributed to biologically active
substances in leech saliva, including anticoagulant,
anti-inflammatory, analgesic, and other bioactive
components.
.[13]
In the present case, a patient with Janusandhigata
Vata with special reference to knee osteoarthritis
was managed with Jalaukavacharana. Snehan and
Swedana were administered as Purva Karma before
the procedure, and clinical outcomes were assessed
for pain, stiffness, crepitus, and knee movement.
Patient Information
In this study, on 15th June ,2026, a 56-year-old
female patient presented to the Shalya-tantra
outpatient department at D.Y. Patil Ayurvedic
Hospital with complaints of pain in B/L knee joints
for the past 4–5 years, which had progressively
worsened over the preceding two months. She also
complained of chronic low back pain of 4–5 years
duration, with recent aggravation. The patient
experienced difficulty in walking and performing
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routine daily activities due to persistent pain and
stiffness. She had a past history of carcinoma of the
endometrium, treated surgically in 2023, and was
on regular six-month follow-up. She had previously
received conservative treatment with symptomatic
relief only. As the symptoms persisted and
progressively affected her quality of life, she visited
D. Y. Patil Ayurvedic Hospital, Navi Mumbai, for
Ayurvedic management. Based on clinical
examination, she was diagnosed with
Janusandhigat Vata (Knee Osteoarthritis) and was
admitted for Jalaukavacharana (leech therapy),
Panchakarma procedures, and adjuvant Ayurvedic
medications.
Clinical Findings
A 56-year-old postmenopausal female presented to
the Department of Shalyatantra, D. Y. Patil
Ayurvedic Hospital, Navi Mumbai, with bilateral
knee pain for 4–5 years, worsening over the past
two months. She reported stiffness after rest,
crepitus, and difficulty in walking, stair climbing,
prolonged standing, and squatting, along with
chronic low back pain. There was no history of
recent trauma.
Her medical history included carcinoma of the
endometrium, for which she underwent robotic
surgical staging with total hysterectomy, bilateral
salpingo-oophorectomy, and pelvic lymph node
dissection in 2023, with no evidence of recurrence
on follow-up. She also had a past history of
pulmonary tuberculosis and had completed
antitubercular treatment.
On examination, she was moderately built,
conscious, cooperative, and hemodynamically
stable. Vital signs were within normal limits.
Pallor, icterus, cyanosis, clubbing, oedema, and
lymphadenopathy were absent. Local examination
revealed bilateral medial joint-line tenderness,
crepitus, painful restriction of knee flexion, and
difficulty with weight-bearing, without erythema or
local warmth.
Rogi Samanya Pariksha (General examination
as per Ayurveda)
Ashtavidha Pariksha ( eightfold physical
examination) of the patient was performed, which
showed Hamsa Gati (slow and steady) Nadi (pulse)
at 80/min, Mala (~stools) 1-2timess/day and Mutra
(~urine)5-6times/ day were found to be Prakruta
(normal), Jivha (tongue) of the patient was Sama
(~white-coated tongue), Shabda (~speech), Sparsha
(~temperature), and Drukha (~vision) of the patient
were Prakruta (~within normal limits). Similarly,
the patient had Madhyam Akruti (~properly
nourished) and Pitta Pradhan Kapha Anubandhi
Prakruti (~inherent characteristic).
Table 1. Laboratory Investigation
Investigations
Results
Hb
11.2gm/dl
WBC
8,500/cumm
Platelet count
2.84lakhs/cumm
HIV
Non-Reactive
HBsAg
Negative
HCV
Non Reactive
Figure 1. X-Ray Findings Of Right And Left Knee
Joint AP/LAT view .(Dt -07/05/2026)
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Finding- Mild osteoarthritic changes with mildly
reduced medial joint space and patellar osteophytes
bilaterally. Bone density was normal, and the
surrounding soft tissues appeared normal.
Table 2. Local Examination of Bilateral Knee
Joints
Examination
Parameter
Right
Knee
Left
Knee
Inspection
Swelling
Mild
Mild
Deformity
Absent
Absent
Skin
changes
Absent
Absent
Muscle
wasting
Absent
Absent
Gait
Antalgic
gait due
to pain
Antalgic
gait due
to pain
Palpation
Local
temperature
Normal
Normal
Tenderness
Present
over
medial
joint line
Present
over
medial
joint line
Crepitus
Present
Present
Joint line
tenderness
Present
Present
Effusion
Absent
Absent
Range of
Motion
(ROM)
Flexion
Painful
terminal
flexion
Painful
terminal
flexion
Extension
Full,
painful
at
terminal
range
Full,
painful
at
terminal
range
Functional
Examination
Walking
Painful
Painful
Stair
climbing
Painful
and
difficult
Painful
and
difficult
Squatting
Difficult
Difficult
Clinical Assessment Parameter
To determine therapeutic outcomes, patients
underwent a structured clinical assessment before
and after treatment. The evaluation focused on the
disease's major signs and symptoms. Each clinical
parameter was graded on a four-point scale ranging
from 0 (absent) to +++ (severe), based on its
intensity and its impact on the patient's daily
activities. The parameters assessed included pain
(Sandhishoola), tenderness (Sparshasahatwa),
crepitus, stiffness (Sandhigraha), and pain during
knee flexion and extension (Sandhi Akunchana-
Prasaran Vedana). Pain intensity was measured
using the Visual Analogue Scale (VAS). The
findings of the clinical assessment are summarized
in Table No. 4.
Table No.4 Clinical Assessment Parameters with
Gradation
[14]
Sr
.
N
o.
Symptoms
Absent
Mild
Moder
ate
Sever
e
1
Pain in knee
joint
(sandhishoo
l)
VAS Scale
(0-10 score)
0
+
(0-3)
++
(4-7)
+++
(7-
10)
2
Tenderness
as around
knee joint
(sparshasah
atwa)
0
No
Tender
ness
+
Mild
pain
on
pressu
re,
beara
ble
++
Modera
tely
painful
on
pressur
e,
bearabl
e
+++
Sever
e pain
on
touch
,
beara
ble
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Diagnosis -
After Detailed Assessment - history taking,
physical examination and radiological reports, the
patient was diagnosed with case of knee -osteo
arthritis i.e. Janu-Sandhigat Vata.
Therapeutic Intervention
The patient received an integrative Ayurvedic
treatment protocol from 15 June 2026 to 27 June
2026. Panchakarma included Abhyanga (Snehan)
with Tila Taila, Dashamoola Swedana, Matra Basti
with Ashwagandha Taila (13 days each), Janu Basti
with Mahanarayana Taila (10 days), and two
sittings of Jalaukavacharana on 20 June 2026 and 6
July 2026. Supportive therapies comprised
Dashanga Lepa over both knee joints (10 days),
therapeutic yoga (5 days), and physiotherapy (3
days). Shamana Chikitsa consisted of Rasnadi
Guggulu, Ashwagandha Churna Vati, Shankhavati,
Arogyavardhini Vati, Hingwashtaka Churna,
Capsule Palsineuron, and Tablet Imunocin for 13
days with warm water as the adjuvant to alleviate
pain, reduce inflammation, pacify Vata, and
improve joint function.
Table No.5. Timeline of clinical Intervention
Sr
.
N
o.
Sympto
ms
Absen
t
Mild
Moder
ate
Severe
3
Swelling
at knee
joint (
Sandhi
Shoth)
0
No
Swelli
ng
+
Mild
Swelling
++
Modera
te
Swellin
g
+++
Severe
Swellin
g
4
Crepitati
ons
0
+
++
+++
5
Stiffness
in joints
(Sandhig
rah)
0
No
Stiffne
ss
+
Ocassio
nally
present
++
After
long
sitting
and
walking
+++
Whole
day and
night
6
Knee
joint
moveme
nts
(Sandhi
Akuncha
n
prasaran
Vedana )
0
Compl
ete
move
ment
withou
t pain
+
Mild
pain,
Complet
ely can
walk
without
support
++
Painful,
incompl
ete, can
walk
with
support
+++
Painful
restricte
d
movem
ents
Unable
to walk
Sr.No.
Treatm
ent
Period
Interventio
n
Rout
e /
Site
Dose,
Frequency &
Administrati
on
Internal medications
1
15–27
Jun
2026
Rasnadi
Guggulu
Oral
2 tablets (280
mg each),
twice daily
after meals,
with warm
water
2
15–27
Jun
2026
Ashwagand
ha Churna
Tikdi
Oral
2 tablets (420
mg each),
twice daily
after meals,
with warm
water
3
15–27
Jun
2026
Shankhavat
i
Oral
2 tablets (330
mg each),
twice daily
after meals,
with warm
water
4
15–27
Jun
2026
Arogyavard
hini Vati
Oral
2 tablets (330
mg each),
twice daily
after meals,
with warm
water
5
20–27
Jun
2026
Hingwashta
k Churna
Oral
3 g, twice
daily before
meals, with
warm water
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Standard Operating Procedure of
Jalaukavacharana
[ 15]
Jalaukavacharan was done on affected site, 2 sitting
on 20/06/26 & 6/ 7/26
Purva Karma
Before the procedure, the patient was counseled
regarding Jalaukavacharana, and written informed
consent was obtained. Five healthy and active
medicinal leeches were selected. The patient was
made comfortable, and the skin over both knee
joints was cleaned thoroughly with normal saline.
The most tender points on both knees were
identified and marked for leech application.
Pradhana Karma (Main Intervention)
Each leech was gently held from its posterior end
and applied over the marked tender point (At Right
knee 2 leeches at medial aspect & left knee 1 at
medial aspect and other 2 at lateral aspect). After
successful attachment, the leeches were allowed to
suck blood naturally. Wet sterile gauze was placed
over the leeches to maintain moisture and facilitate
continuous feeding. The leeches were closely
observed throughout the procedure and were
allowed to detach spontaneously after
approximately 45 minutes.
Paschat Karma (Follow Up Measures)
After spontaneous detachment, the bite sites were
cleaned, and Haridra (turmeric) powder was
applied to control oozing and promote healing.
Sterile dressing was applied over the bite sites. The
same procedure was carried out for all leech bite
sites. The patient was monitored for any immediate
adverse effects, such as excessive bleeding, itching,
redness, allergic reaction, or infection. No
complications were observed following the
procedure.
Figure.2 Leech therapy at B/L Knee joints
Sr.No.
Treatm
ent
Period
Interventio
n
Rout
e /
Site
Dose,
Frequency &
Administrati
on
6
20–27
Jun
2026
Palsineuron
Capsule
Oral
1 capsule,
twice daily
after meals,
with warm
water
7
19–27
Jun
2026
Imunocin
Tablet
Oral
1 tablet, once
daily after
meals, with
warm water
Procedural and Supportive interventions
8
15–27
Jun
2026
Snehan
with Tila
Taila
Exter
nal
As per
treatment
protocol
9
15–27
Jun
2026
Swedana
with
Dashamool
a Bharada
Exter
nal
As per
treatment
protocol
10
15–27
Jun
2026
Matra
Basti with
Ashwagand
ha
Rect
al
As per
treatment
protocol
11
15–20 &
24–27
Jun
2026
Janu Basti
with
Mahanara
yana Taila
Bilat
eral
knee
joint
s
As per
treatment
protocol
12
15–20 &
25–27
Jun
2026
Dashanga
Lepa
Bilat
eral
knee
joint
s
Local
application
13
16–
20Jun
2026
Yoga
therapy
—
As per
prescribed
regimen
14
25–27
Jun
2026
Physiothe
rapy
—
As per
prescribed
regimen
15
20 Jun
& 6 Jul
2026
Jalaukava
charana
Bilat
eral
knee
joint
s
2 sittings
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Observations:
Clinical
Paramet
er
First Sitting
Second Sitting
Before
Treatm
ent
(Day 1)
After
Treatm
ent
(Day 7)
Before
Treatm
ent
(Day
15)
After
Treatm
ent
Follow
up
(Day
30)
Ri
ght
kn
ee
Le
ft
kn
ee
Ri
ght
kn
ee
Le
ft
kn
ee
Ri
ght
kn
ee
Le
ft
kn
ee
Ri
ght
kn
ee
Le
ft
kn
ee
Pain
(Sandhish
oola) –
VAS (0–
10)
++
4
+
+
4
+
1
+
1
+
1
+
1
0
0
Tenderne
ss
(Sparshas
ahatwa)
++
+
+
+
+
+
+
0
0
Swelling
(Sandhi
Shotha)
+
+
+
0
+
0
0
0
Crepitatio
ns
++
+
+
+
+
+
+
0
0
Stiffness
(Sandhigr
aha)
++
+
+
+
+
+
+
0
0
Pain on
Knee
Movemen
t (Sandhi
Akuncha
na–
Prasarana
Vedana)
++
+
+
+
+
+
+
0
0
Follow-up and Outcomes
The patient was assessed systematically before and
after each sitting of Jalaukavacharana (Leech
Therapy) and during the subsequent follow-up
period. At baseline (Day 1), both knees showed
pain (VAS 4), along with tenderness, mild swelling,
crepitations, stiffness, and pain with knee
movement. After the first sitting, Day 7 assessment
showed a marked reduction in pain, with the VAS
score decreasing from 4 to 1 in both knees.
Tenderness, crepitations, stiffness, and pain during
knee movement decreased from moderate (++) to
mild (+). Swelling showed improvement, with
complete resolution in the left knee, while mild
swelling persisted in the right knee.
Before the second sitting (Day 15), the
improvement achieved after the first sitting was
maintained. The patient reported only mild pain
(VAS 1) in both knees, with mild tenderness,
crepitations, stiffness, and pain on knee movement.
Swelling remained mild in the right knee but was
absent in the left knee. Symptoms did not worsen
during this period, indicating a sustained
therapeutic response following the initial sitting of
Jalaukavacharana. The progressive reduction in
both subjective symptoms and objective clinical
findings suggested improved functional status of
the knee joints.
At the final follow-up on Day 30, the patient
achieved complete clinical relief bilaterally. The
VAS score reduced to 0 in both knees, while
tenderness, swelling, crepitations, stiffness, and
pain during knee movement were completely
absent. Thus, the patient demonstrated progressive
and sustained improvement across all assessed
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clinical parameters following Jalaukavacharana.
Complete resolution of the evaluated signs and
symptoms by Day 30 indicates a favourable short-
term clinical outcome in this case, with no
recurrence of the assessed symptoms during the
follow-up period.
Discussion :
Knee osteoarthritis is a chronic degenerative joint
disease characterized by pain, stiffness, crepitus,
and limitation of joint movements, leading to
impaired quality of life. In Ayurveda, these clinical
features closely resemble Janusandhigata Vata,
which develops due to the aggravation of Vata
Dosha in the knee joint. The main aim of treatment
is to reduce pain, stiffness, and inflammation,
improve joint mobility, and restore functional
ability .
In the present case, the patient had bilateral knee
pain for 4–5 years with recent worsening of
symptoms. Previous conservative treatment
provided only temporary relief. Therefore, we
planned an integrative Ayurvedic treatment
consisting of Jalaukavacharana, Panchakarma
procedures, and adjuvant Ayurvedic medications.
Jalaukavacharana was the principal intervention in
this case. According to Sushruta Samhita,
Jalaukavacharana is indicated in painful and
inflammatory conditions and is considered an
effective method of Raktamokshana (Blood
Letting). Studies have shown that medicinal leech
saliva contains several active substances with
different effects. Hirudin prevents blood clotting by
inhibiting thrombin. Calin prevents platelet
aggregation caused by collagen. Destabilase helps
dissolve fibrin and
blood clots. Hirustasin inhibits enzymes such as
kallikrein, trypsin, and cathepsin G. Bdelin and
Eglin have anti-inflammatory effects and inhibit
certain enzymes involved in inflammation.
Carboxypeptidase A inhibitors increase blood flow
at the leech bite site. Histamine-like substances and
acetylcholine act as vasodilators and increase local
blood flow. An anesthetic substance present in the
saliva reduces pain and produces local anesthesia at
the bite site.
[16-17]
The Panchakarma procedures further enhanced the
therapeutic outcome. Abhyanga with Tila Taila and
Dashamoola Swedana helped reduce stiffness and
pain while improving local circulation
[18]
. Matra
Basti with Ashwagandha Taila pacified aggravated
Vata Dosha , Brimhana, and Balya properties,
helping to reduce pain and stiffness and improve
knee-joint function.
[19]
Janu Basti with
Mahanarayana Taila provided local oleation and
improved knee joint mobility
[20]
. Dashanga Lepa
reduced pain, swelling, stiffness, and local
inflammation.
[21]
Yoga and physiotherapy also
contributed to improved flexibility and overall
functional recovery.
Internal Ayurvedic medicines serve as supportive
therapy throughout the treatment period. Rasnadi
Guggulu helped reduce pain and inflammation.
[22]
Ashwagandha Churna Vati promoted strength and
tissue nourishment
23
. Shankhavati, Hingwashtaka
Churna, and Arogyavardhini Vati improved
digestion and metabolism, thereby helping in the
management of Ama, which is considered an
important factor in the progression of
musculoskeletal disorders according to
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Ayurveda
[24-26]
Following treatment, the patient showed marked
improvement in all assessed clinical parameters.
Pain, tenderness, swelling, stiffness, and painful
knee movements were completely relieved, while
crepitus decreased from moderate to mild.
Functional activities such as walking, stair
climbing, and squatting also improved
considerably. These findings are consistent with
previous clinical studies reporting beneficial effects
of Jalaukavacharana in patients with knee
osteoarthritis.
The present case suggests that Jalaukavacharana,
when combined with Conventional Panchakarma
procedures and adjuvant Ayurvedic medications,
can provide effective symptomatic relief and
improve joint function in patients with
Janusandhigata Vata (knee osteoarthritis).
However, further well-designed clinical studies
with larger sample sizes are required to validate
these findings.
Conclusion :
The improvement observed in this patient may be
attributed to the combined effect of
Jalaukavacharana, Panchakarma procedures, and
adjuvant Ayurvedic drugs. Jalaukavacharana
contributed to reduced pain and local inflammation
through its analgesic and anti-inflammatory effects,
thereby facilitating progressive improvement in
knee joint movement. Following the first sitting,
pain during knee movement decreased from
moderate to mild, and after the second sitting, it
was completely relieved at follow-up, indicating
progressive improvement in functional knee
movement. Panchakarma
therapies further helped reduce stiffness and
improve joint mobility, while the internal
Ayurvedic medicines provided supportive effects
for pain relief and overall recovery. The observed
clinical improvement suggests that
Jalaukavacharana with adjuvant Ayurvedic
medication may be a promising therapeutic
approach in the management of Janusandhigata
Vata (knee osteoarthritis). However, further well-
designed controlled clinical studies are required to
establish its efficacy and safety.”
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Declaration :
Conflict of Interest: None
ISSN: 2584-2757
DOI : 10.5281/zenodo.23434108
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