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

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.