Review Article: Ayurvedic Management of Lumber Vertebral Spondylosis (Katigata Vata).

 
A Case study: Ayurvedic Management of Vertebral Spondylosis (Katigata Vata)

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*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

                         (Abhighataa/ Marmaghata)

                                     |

                         Vata Prokopa

                                     |

Raukshya,Parushaya and Khara Guna Vridhi at Strotas

                                     |

                        Dhatu kshaya

                                     |

                    Rikta Srotas vayupuran

                                     |

                  Kati Sandhi Khavaigunya

                                     |

                   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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Presented by

Dr. Khushali Bhatt

B.A.M.S

M.D Final year

P.G Department of Kayachikitsa

Government Akhandanand Ayurveda College and Hospital

Bhadra, Ahmedabad 380001, Gujarat, India

Email:- khushalibhatt03@gmail.com

Dr. Surendra A. Soni

M.D., PhD (KC) 

Professor & Head

P. G. DEPT. OF KAYACHIKITSA

Govt. Akhandanand Ayurveda College

Ahmedabad, GUJARAT, India.

Email: kayachikitsagau@gmail.com