A Case study: Ayurvedic
Management of Vertebral Spondylosis (Katigata
Vata)
*Dr.Khushali Bhatt1,
**Dr. Priyanka Parmar2,
***Vd. Anamika S.
Soni3
****Prof. Surendra A. Soni4
*M.D. Scholar,
**M.D. Scholar,
***Associate Professor,
****Professor, and HOD,
PG Department of Kayachikitsa, Akhandanand Ayurveda Collage, Ahmedabad.
Introduction
Spondylosis refers to degenerative changes in the spine such
as bone spurs and degenerating inter-vertebral discs. The terms lumbar osteoarthritis, disk degeneration, degenerative disk disease, and spondylosis are used in the
literature to describe anatomical changes to the vertebral bodies and
intervertebral disc spaces .
Low back pain (LBP) affects approximately 60–85% of adults during some point in their lives . Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 months, affects an estimated 15–45% of the population. Individuals aged 45–64 years identified 85.5% of participants to demonstrate osteophytes within the lumbar spine.
In Ayurveda it can be correlated with KatigataVata. Some ancient texts also describe few disorders having
resemblance such as KatiGraha,
TrikaGraha, PrushthaGraha, KatiVayu, TrikaShoola, PrushthaShoola, VatajaShoola,
TrikaVedana, and Gridhrasi .
Description of Katigata Vata is not given separately as much as and not included in Nanatmaka Bheda of Vata. In this entity Vata dosha vitiated due to various causes, as mentioned in Charaka Samhita under the term “Sandhigata Anila”, here Vata gets located in the KatiSandhi and result in KatsandhigataVata.
PATIENT INFORMATION:
A 72 year old male patient visited OPD no. 4 of PG
Kayachikitsa department) at Govt. Akhandanand Ayurved Hospital Bhadra,
Ahmedabad on 29/6/22 having following complains :
Katishoola since 10 months
Ubhaya Janghanand Vankshan Pradeshe Shoola since 10 months
Katiparyant Pada Shoola since 10 months
Udara Daha Since 10 months
HISTORY OF PRESENT ILLNESS
Patient was relatively healthy without any metabolic disease, had history of trauma before 10 months. Then gradually he started feeling symptoms like Katishoola, Ubhaya Janghanand Vankshan Pradeshe Shoola, Katiparyant Pada Shoola. Medications like analgesics and anti inflammatory were consumed for above complaints but didn’t get relief and pain reoccurred once medicines were stopped. Udara daha was observed as a side effect of analgesics and anti inflammatory. Physiotherapy sessions were also conducted for 2 months but patient got only temporary relief. Then patient approached for Ayurvedic teatment at Kayachikitsa OPD Govt. Akhandanand Ayurved Hospital, Ahmedabad.
PAST HISTORY: Trauma before 10 months
FAMILY HISTORY: nil
PERSONAL HISTORY:
• Diet- Vegetarian homemade food
• Kshudha
– Samyak
• Vihara-Excess physical exertion i.e vyayama,
abhghata etc
• Agni-
Nirama
• Koshtha-
Madhyam
• Nidra- Regular, normal 7-8 hrs/night
• Mala
Pravrutti- Regular Once/Day
• Mutra
Pravrutti- 5-6 Times/Day
• Addiction- Not Any
On Examination
• Pulse-74/min
• B.P-130/90 mm Hg
• Temp-98.6 F
Physical
examination
• Straight leg raise(SLR)-Rt -60◦;
Lt-60◦
• Motor and sensory function were
normal.
• Superficial and deep reflexes were
normal.
NIDANA PANCHAKA
Nidana- Ati Vyayama, Abhighata
Purvarupa-
Avyakta - mild
recurrent backache, slight stiffness, sudden pain on lifting weight or bending
down
Rupa- Katishoola, Ubhaya Janghan and Vankshan Pradeshe Shoola, Katiparyant Pada Shoola
Samprapti- Vata Prakopaka Nidana Atisevana
|
Kati Sandhi Gata Vata
Samprapti Ghataka
• Doshas :- Vata-Pradhan kshayajanya
- Dushya :- Rasa, Rakta, Mansa, Sira, Asthi
• Agni:- Jatharagni and Dhatvagni-Mandya
• Strotas:- Ashtivaha Srotas
• Srotodusti Prakara :- Sanga & Vimargagamana
• Udbhavasthana :- Pakwashaya
• Adhisthana :-Sharira
• Vyaktisthana:- Sandhi (Kati)
• Sadhyasadhyata:- Krichhasadhya / Yapya
• Rogmarga:- Marmasthita Sandhi (Abhyantara Rogamarga)
INVESTIGATIONS
Before treatment
X-RAY OF L.S A.P AND LATERAL VIEW
• Spondylotic changes seen in spine with
osteophyte formation
• Wedging of D11 vertebra
• Facetal arthropathy in lower lumber
• Multilevel reduced lumber IV disc
space noted from L1 to L4
DIAGNOSIS – On the basis of clinical history, clinical presentation,
X- Ray
investigations, patient was diagnosed as a case of vertebral spondylosis (Dhatukshayajanita Katisandhigata vata).
THERAPEUTIC INTERVATION:
Kalabasti Karma followed by Matra
Basti Karma for 30 days were planned in the management along with medicines
(Shaman
chikitsa) as below :-
|
Medicine |
Dose |
Duration |
|
Hingwashtak churna-6 gm Navayasa loha 250 mg Mukta shukti 500 mg with go-ghrita |
1 tsp BD |
46 days |
|
Simhnada gugguku |
2 TDS |
46 days |
|
Dashmula kwatha 20 gm Rasnadi Kwatha-20 gm |
50 ml BD |
46 days |
All these medicines
were given with warm water before meal.
PANCHAKARMA
• Abhyanga
with Nirgundi taila
• Bahya Swedana
:- Kati basti with Mahavishagarbha taila
Bashpa Sweda kati pradeshe
• Kalabasti For 16 days
After Kalabasti, Matra Basti for 1 month with 50 ml Ashwagandha taila
KALA BASTI
|
Bastidravya(Niruha vasti) |
Doses |
|
Rasnadi kwatha |
100 ml |
|
Guduchyadi kwatha |
100 ml |
|
Pathyadi kwatha |
100 ml |
|
Madhu |
60 ml |
|
Lavana |
10 gm |
|
Shatpushpa Kalka |
20 gm |
|
Til Taila |
60 ml |
|
Basti Dravya(Anuvasana) |
Doses |
|
Ashwagandha taila |
50 ml |
Pathya-Apathya
Patient was advised pathya
ahara and vihara during the
course of medication like-Milk, ghee, freshly cooked food ,easily digestible
light diet with ghrita like khichdi(Vilepi),
mudga yusha(green gram soup), vegetable soup, roti, sabji(bottle gourd,
ridge gourd, sponge gourd, pointed gourd, bittergourd, (spiny gourd
etc). Patient was barred for day sleep(Divaswapa)
and awakening at night(Ratri jagrana), suppression
to natural urges and excess physical exertion(Adhika vyayama).
ASSESSMENT OF DISEASE IMPROVEMENT:
SUBJECTIVE CRITERIA
Symptoms
|
B.T
|
A.T
|
|
|
|
|||
|
|
|
1 st wk |
2 nd wk |
3 rd wk |
4 th wk |
5th wk |
6th wk |
7th wk |
|
Katishoola |
++++ |
++++ |
+++ |
+++ |
++ |
++ |
+ |
- |
|
Ubhaya Janghan Pradeshe Shoola |
++++ |
++++ |
+++ |
++ |
+ |
+ |
- |
- |
|
Vankshan Pradeshe Shoola |
++++ |
++++ |
+++ |
++ |
- |
- |
- |
- |
|
Katiparyant Pada Shoola |
++++ |
++++ |
+++ |
++ |
- |
- |
- |
- |
|
Udara Daha |
++ |
+ |
- |
- |
- |
- |
- |
- |
INVESTIGATIONS AFTER TREATMENT
RESULTS
After 46 days of Ayurvedic treatment, patient got complete relief in symptoms like Katishoola, Ubhaya Janghan and Vankshan Pradeshe Shoola, Katiparyant Pada
Shoola. After 30 days of Ayurvedic treatment Udara daha symptom got completely subsided. Gradual improvement in
physical well being, increase in appetite, improvement in bowel movement, sleep
pattern , pain reduction, correction in posture, improvement in physical
strength were observed after above management which is very remarkable in old
age.Marked changes were observed in post treatment X- ray.
FOLLOW UP
Follow up medicine was given in OPD of Government
Akhandanand Ayurveda College Hospital,
Ahmedabad for further 2 weeks . Same medications were continued for 2 weeks.
DISCUSSION
Due to nidanas
like ageing effect (jarajanya vata
vriddhi) along with history of trauma (abhighata/
marmaghata) leads to dhatu kshaya
at katisandhi adhisthana that can be easily visible in X-ray investigation
reports. Hence this is a typical case of kshayaanita
katisandhigata vatavyadhi.
Treatment protocol were planned mainly to execute the vata shaman karma and brimhana karma.
Vata shaman karma along with snehana(bahya and abhyantara), swedana,
basti karma were initiated as per
classical line of treatment of kshayaj
vatavyadhi.
Hingwastaka churna having properties of deepan pachan were consumed along with muktashukti bhasma and navayas lauha that is having properties
of balya and shonita prasadana.
Simhnada guggulu was prescribed that acts as vatahar,
shulahara, jaranashana
properties.
Maharasnadi kwatha along with dashamoola kwatha were consumed having properties of vatashamana brimhana and analgesic
effect .
Snehana Swedana mrudu samshodhana karma basti and matra basti were prescribed as per principles of vatvyadhi chikitsa. Bahya snehana included sarvanga abhyanga with sukhoshna nirgundi taila having properties of vata shamana. Bashpa sweda is saagni sweda that acts on vata samana and relieves pain and stiffness.
Kati basti is snigdha saagni swedana which by its local effect helps in relieving
shoola stabdhta. It may help in immediate relief of symptoms
causing analgesic effect.
Basti chikitsa is considered as ardha chikitsa and shrestha
chikitsa for pacifying vata dosha.
It is explained in classical text that mode of action of basti that is administered through
rectal route gets absorbed and shows its effects in all over the body just like
water gets absorbed through the roots and nourishes the whole plant. Jara or ageing is an unavoidable phenomenon
in livings and there is no treatment in western science. Ageing specifically
affects in the bones is a huge problem for ancient times that is called
osteoarthritis. Ayurveda has very
special management approach with its unique principles focusing the Agni/digestive power and bhootagni basic metabolism. In present
case all the focus were made to improve both the above Agni that is also a prime approach in the management of vatavyadhi.
Additionally old age referred as a vataprakopa age because of natural depletion of tissues swabhavoparam that leads to both prakopa with its principles dehe strotansi riktani puryitwa anilobali.
Hence external and internal oleation were successfully included in this case.
So, it can be concluded that classical
management of kshayajanita vatavyadhi
is applicable on the basis of modern investigation, findings along with
appropriate history of patient and suitable required pathya karma.
CONCLUSION
This case study proves that Degenerative bone disorder like
Spondylosis due to ageing pattern can be treated successfully in Ayurveda with the application of
classical line of management of Vatavyadhi
in Charaka Samhita.
****************************************************************************************************************Above article was published in 'World Journal of Pharmaceutical Research'. www.wjpr.net
**************************************************************************************************************
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