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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 35  |  Issue : 3  |  Page : 173-175

Role of Ayurveda in the conservative management of avascular necrosis of the femoral head: A case study


1 Department of Panchakarma, Patanjali Bhartiya Ayurvigyan Avum Anusandhan Sansthan, Patanjali Yog Peeth, Haridwar, Uttarakhand, India
2 Department of Panchakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India
3 Department of Panchakarma, Alva's Ayurveda Medical College, Moodabidri, Mangalore, Karnataka, India
4 Department of Prasuti Tantra and Streeroga, SDM College of Ayurveda and Hospital, Udupi, Karnataka, India

Date of Web Publication8-Apr-2016

Correspondence Address:
Ashutosh Chaturvedi
B-4/292-293, Second Floor Sector-7, Rohini, Near M2K Rohini, New Delhi - 110 085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0257-7941.179865

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  Abstract 

Avascular necrosis (AVN) of the femoral head is the most common type of necrosis affecting the bones. Management of AVN aims at the preservation of structure, function and relief of from pain. Many surgical procedures such as drilling and insertion of bone grafts, modified Whitman or Colonna reconstruction and insertion of prosthesis are carried out to remedy the condition but all these procedures are costly with the prognosis being poor. Signs and symptoms of Avascular necrosis are nearer to asthivāha srotoduşṃi vikāra (disorders of musculoskeletal origin) and can be considered with gambhīra avasthā (chronic stage). An effort has been made in the present study to evaluate the efficiency of Ayurvedic formulations in the conservative management of AVN of the femoral head. A case of AVN with bilateral femoral head was treated with rūkşaṃa (Drying therapy) followed by śodhana (bio purification) and bṃhmaṃa (rejuvenation). Patient was observed for complications during whole course of treatment, untoward complications were not seen. Patient was observed for symptomatic improvements based on assessment done by the questionnaire over graded signs and symptoms before and after treatment. The results were encouraging. The therapy provided marked relief from pain, tenderness, stiffness and improvement in the gait. Conservative management of AVN through Ayurvedic principles provides significant relief and improves quality of life.

Keywords: Avascular necrosis, Ayurveda, Panchakarma


How to cite this article:
Chaturvedi A, Kumar M A, Lohith B A, Praveen B S, Swathi C. Role of Ayurveda in the conservative management of avascular necrosis of the femoral head: A case study. Ancient Sci Life 2016;35:173-5

How to cite this URL:
Chaturvedi A, Kumar M A, Lohith B A, Praveen B S, Swathi C. Role of Ayurveda in the conservative management of avascular necrosis of the femoral head: A case study. Ancient Sci Life [serial online] 2016 [cited 2019 Jun 17];35:173-5. Available from: http://www.ancientscienceoflife.org/text.asp?2016/35/3/173/179865


  Introduction Top


Avascular necrosis (AVN), is osteonecrosis (dead bone) and is also called Osteochondritis Dissecans/Chandler's Disease in young adults with 60% of the cases being bilateral. This condition is one of the most challenging problems faced by orthopedic surgeons. The objectives of the treatment include the preservation of structure, function and relief from pain.[1] Many surgical procedures such as drilling, insertion of bone grafts, modified Whitman or Colonna reconstruction and insertion of prosthesis are carried out to remedy this condition.


  Case Report Top


A 37 years old male mechanical engineer reported to the Out Patient Department of Pañcakarma, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India with complaints of pain and stiffness in bilateral anterior hip to knee region since one year which was associated with difficulty in doing normal daily activities such as walking, taking bath etc., Aggravating factors were

cold weather, gastric upset and supine posture. Alleviating factors were warm food and warm weather. The patient claimed to be apparently healthy one year earlier with the pain and stiffness developing gradually. The pain was constant throughout the day and aggravated during the night hours. He consulted a doctor at his native place Kolkata for relief from these symptoms. He was referred to the department of Neurology of a popular hospital and advised pain killers, which did not relieve the symptoms. Thereafter, the doctor at the Orthopedics department diagnosed his problem as Avascular Necrosis of Bilateral neck of Femur with the aid of MRI. Then as per advice of Orthopedic Surgeon he underwent decompression of left femur. After a period of one month, the patient started developing the symptoms that were present before the surgical intervention. The Orthopedic surgeon recommended one more surgical intervention but the patient was reluctant, and he approached our hospital for conservative and better treatment. The condition of the patient during first visit was pain, stiffness and heaviness in both the lower limbs, and disability to perform regular activities.

On examination patient presented with

  • Third degree tenderness over bilateral thigh, patient was not be able lift the left limb even up to 10 degrees
  • Gait - Trendelenberg Sign was positive.


Movements

  • Pain on movement of the limb such as flexion, extension, lateral flexion and rotation.


Motor system

  • Crepitus – absent
  • Attitude of the limbs – flexed upper and lower limbs
  • Nutrition – moderate
  • Tone – hypotonic in left lower limb
  • Power – right side – normal power and in left lower limb – Grade 4
  • Involuntary movement – absent.


Considering the history and examination of the patient, treatment was planned with a cikitsā krama (treatment plan) based on principles of şaḍvidhopakarma (six principles of treatment). Presentation of the patient with pain and stiffness in bilateral anterior hip to knee region showed the involvement of vātakapha duşṃi associated with the Asthivāha srotas (disorders of musculoskeletal origin) and hence rūkşaṃa with agnicikitsā lepa, Parişeka (a type of sudation) with Dhānyāmla, Daśamūla Kaşāya and internal administration of Hiṃgvaşṃaka vaṃi two tablets thrice daily before food. Followed by śodhana (Bio purification) in the form of Mañjişṃhādi kşāra basti (therapeutic enema) [Table 1] in modified yoga basti schedule was administered. Sarvāṃga cūrṃa bāşpa svedana (sudation) [Table 2] with Dhānyāmla bāşpa and Amṃtottara Kaşāya 20 ml thrice daily was given.
Table 1: Ingredients of Mañjişṃhādi Kşīra basti

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Table 2: Ingredients of cūrṃa piṇḍa sveda

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Bṃhmaṃa was done with ṃaşṃika śāli piṃṇa svedana (sudation using medicated rice), Mañjişṃhādi Kşīra basti (enema) [Table 3] with modified kāla basti schedule for 7 days.
Table 3: Ingredients of Mañjişṃhādi Kşīra basti

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Pathya was advised with nidāna parivarjana (avoiding all aggravating habits) and during the course of treatment patient was given low carbohydrate diet. Patient was observed for complications during whole course of treatment and no untoward complication was observed. During the course of rūkşaṃa patient did not find significant relief but slight improvement was present during the course of śodhana therapy and in that, the patient was able to lift lower limb to 30 degrees due to stiffness still present. After the course of the bṃhmaṃa therapy and kşīra basti on day 12, the patient was able to lift the limb upto 70 degrees with complete reduction of stiffness [Table 4]. Overall, the patient felt symptomatic improvements. On discharge, patient was advised Guggulu tikta Kaşāya (decoction) 15 ml TID with 30 ml of hot water before food.
Table 4: Comparison of symptoms

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  Conclusion Top


Patient of AVN with the bilateral femoral head was treated with rūkşaṃa followed by śodhana and bṃhmaṃa line of treatment. In asthigatavāta tikta rasa auşadhi (medicines with bitter taste) are beneficial.[2]Ācārya s while explaining the dhātupāka avasthā (metabolism process) clearly detail the importance of agni which is singularly responsible for the formation of the dhātu s. Thus, correction of agni should be done by administration of dīpana and pācana dravyas and the process of dhātu pāka must be strengthened,[3] the doşas must be balanced and metabolic toxins must be eliminated from the dhātu s through pañcakarma. As the pre-operative process, ācārya s have prescribed “bṃhmyāṃstu mṃdu langhayet[4] which means the usage of rūkşaṃa for better bṃhmaṃa (rejuvenation). Hence the treatment modalities such as udvartana[5] (powder massage) were planned in order to remove srotorodha (obstructions) and sthirī karaṃa of aṃga s [6] (imparting compactness to body). These modalities of therapy are responsible for removal of vitiated medas whereas pācana medicines are also explained as a variety of rūkşaṃa. Thus rūkşaṃa cikitsā[7] is beneficial. Hence, initially parişeka with Dhānyāmla and Daśamūla kaşāya was planned. Basti is one among the pañcakarmas which clearly shows its efficacy [8] in chronic conditions due to its therapeutic effect especially in its bṃhmaṃa action (rejuvenating enema). Therefore in AVN like conditions this can prove to be a better modality of treatment, as AVN represents gambhīra asthi dhātu involvement. Hence the use of māṃsa rasa basti and yāpana basti which contains Madanaphala (Randia dumetorum) in kāla and karma basti format may be given. However Anuvāsana (oil enema) can be administered with the use of a tikta ghṃta[9] such as Ashvagandhā ghṃta,[10] these medicaments may also administered in the form of śodhāṃga snehapāna if initial śodhāṃga karma in the form of virechana is plannedbefore basti.[11] Such a basti regimen can rejuvenate and further help in alleviating dhātukşaya which is caused due to the vāta doşa and may aid in neovascularization.[12] The therapy provided marked relief from pain, tenderness, Stiffness and improvement in the gait. The results were encouraging. The grade of AVN did not worsen and was maintained as seen during the follow up. The therapy is cost effective. Conservative management of AVN through Ayurvedic principles provides significant relief and improves quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kadlimatti SM, Subbanagouda PG, Sanakal AI, Deshpande M. Ayurvedic management of avascular necrosis of the femoral head – A preliminary study. AYU 2008;29:154-60.  Back to cited text no. 1
    
2.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sutrasthana 28/27. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2009. p. 620.  Back to cited text no. 2
    
3.
Kunte AM, editor. Vagbhata, Astanga Hridaya, with Arundatta. In: Sarvangasundari, Commentary. Sutrasthana 14/12. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2011. p. 224.  Back to cited text no. 3
    
4.
Kunte AM, editor. Vagbhata, Astanga Hridaya, with Arundatta. In: Sarvangasundari, Commentary. Sutrasthana 14/15. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2011. p. 225.  Back to cited text no. 4
    
5.
Kunte AM, editor. Vagbhata, Astanga Hridaya, with Arundatta. In: Sarvangasundari, Commentary. Sutrasthana 2/15. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2011. p. 28.  Back to cited text no. 5
    
6.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sutrasthana 5/14. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2011. p. 25.  Back to cited text no. 6
    
7.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sutrasthana 22/27. Reprint Edition. New Delhi: Chaukhambha Surbharati Parkashan; 2008. p. 88.  Back to cited text no. 7
    
8.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sidhisthana 1/18. Reprint Edition. New Delhi: Chaukhambha Surbharati Parkashan; 2008. p. 651.  Back to cited text no. 8
    
9.
Mukherjee PK, Kumar V, Mal M, Houghton PJ. Acorus calamus.: Scientific Validation of Ayurvedic Tradition from Natural Resources. Pharmaceutical biology. 2007;45:651-66.  Back to cited text no. 9
    
10.
Kunte AM, editor. Vagbhata, Astanga Hridaya, with Arundatta. In: Sarvangasundari, Commentary. Uttaratantra 39/84. Reprint Edition. Varanasi: Chaukhambha Orientalia; 2011. p. 967.  Back to cited text no. 10
    
11.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sidhisthana 6/12. Reprint Edition. New Delhi: Chaukhambha Surbharati Parkashan; 2008. p. 594.  Back to cited text no. 11
    
12.
Acharya YT, editor. Agnivesa, Charaka Samhita, with Chakrapaanidatta. In: Ayurved Dipika, Commentary. Sidhisthana 1/19. Reprint Edition. New Delhi: Chaukhambha Surbharati Parkashan; 2008. p. 652.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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