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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 23-27

Ayurvedic Management of Ankylosing Spondylitis


1 Superintendent, Smt. MAH Government Ayurved Hospital, Popatpura, Godhra, Panchamahal, Gujarat, India
2 Assistant Professor, Department of Rasa Shastra and Bhaishajya Kalpana, Shri Saptashrungi Ayurved Mahavidyalaya and Hospital, Nashik, Maharashtra, India
3 Research Officer (Ayurveda), Regional Ayurveda Research Institute, Jhansi, Uttar Pradesh, India
4 Director, Indian System of Medicine & Homeopathy, Gandhinagar, Gujarat, India

Date of Web Publication7-Jul-2022

Correspondence Address:
Mayur Mashru
Superintendent, Smt. MAH Government Ayurved Hospital, Popatpura, Godhra, Panchamahal, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2667-0593.350095

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  Abstract 


Ayurveda serves best in many disease conditions where conventional system face several limitations. Ankylosing spondylitis is one such condition, whose effective management is becoming a challenge. It is a systemic auto-immune rheumatic disease, which shows a strong association with genetic factor HLA-B27. Early stages of disease show inflammation of spine and other symmetrical small joints and other soft tissues, whereas chronic stage presents with axial deformity and pain. NSAIDs and steroids are generally prescribed in conventional systems, but are not a complete remedy. The signs and symptoms of this disorder are not mentioned in Ayurveda, but, based upon the clinical picture, treatment can be planned. A male 24 years patient diagnosed with axial and peripheral Ankylosing spondylitis having HLA-B27 positive case was managed with Panchakarma procedures followed by suitable Ayurvedic medicines. After completion of the treatment, pain in the sacro-illiac region, morning stiffness of joints were significantly reduced with reduced ESR and CRP. As the signs and symptoms of this disease are not mentioned in Ayurveda classics; specific treatment protocol and formulations cannot be given. Selection of drugs may differ from case to case. The treatment plan followed in this study may be adopted in future cases changing the selection of drugs based upon the necessity to obtain good results.

Keywords: Ankylosing spondylitis, Case Report, HLA-B27, Kaishora guggulu, Sanshamani vati, Panchakarma


How to cite this article:
Mashru M, Barve M, Jagtap CY, Desai K. Ayurvedic Management of Ankylosing Spondylitis. J Ayurveda Case Rep 2018;1:23-7

How to cite this URL:
Mashru M, Barve M, Jagtap CY, Desai K. Ayurvedic Management of Ankylosing Spondylitis. J Ayurveda Case Rep [serial online] 2018 [cited 2022 Dec 9];1:23-7. Available from: http://www.ayucare.org/text.asp?2018/1/1/23/350095



Introduction: The only system of holistic health management that existed since the dawn of man’s history is the Indian system of Ayurveda. There is now enough evidence to say that this was the mother of all other systems of medicine.

But in-spite of the greatness of this science, Ayurveda has to satisfy itself in the seat of alternative medicine, although it was the chief system of medicine till the emergence of modern allopathic medicine. But credit should be definitely given to allopathic system of medicine because it has made the life of human being more comfortable with the help of various researches and advancement in treatment modalities. But in certain disease conditions like auto immune diseases; allopathic system of medicine has still not found any successful remedies. Ankylosing spondylitis is one such auto-immune rheumatic disease that shows a strong association with genetic factor HLA-B27.[1]

In early stages of disease, there is inflammation of spine with symmetrical small joints and other soft tissues. Chronic stage is characterized by marked axial immobility or permanent deformity and pain. It usually starts in late teens and early twenties and can lead to progressive bony fusion of sacro-iliac joints and the vertebral column. Extra-articular manifestations may also manifest in a few patients.[2] In allopathic system of medicine, NSAIDs and steroids are generally prescribed along with physiotherapy. But still it remains as a symptomatic approach. If Ayurvedic approaches are intervened appropriately, further progression of the disease can be prevented. In this attempt, a case of Ankylosing spondylitis has been successfully managed with Ayurvedic treatment approaches.

Case report: A 24 year-old male patient visited the OPD with complains of early morning stiffness with asymmetrical inflammation of left knee, right ankle and inter-phalangeal joints of hands since one year. He was diagnosed with axial and peripheral Ankylosing spondylitis having HLA-B27 positive.

Pulse was 84/min, regular; Blood Pressure - 120/80 mm of Hg, Temperature - 99.6 0F, Respiratory rate - 18/min. Respiratory, Cardiovascular and Central nervous system did not show any specific abnormality. Per abdomen examination was normal. Tenderness was present over bilateral sacroiliac joints. Morning stiffness of joints with oedema over left knee and right ankle joint was present. Achilles tendinitis was present in right leg causing pain in lower part of leg. Hemoglobin levels were below 9.5% for past one year whereas ESR was 100mm and CRP level 76 mg/l.

Past treatment history: The patient was under the supervision of a rheumatologist for eight months, where combinations of different drugs have been prescribed [Table 1].
Table 1: Conventional drugs prescribed to the patient

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No improvement was observed with these medicines, subsequently all these medicines were withdrawn. The patient was advised to continue Voveran (Diclofenac sodium) tablet as an analgesic agent to relieve pain. Patient lost 16 kg weight within the six months time and developed other symptoms like hyperacidity and loss of appetite.

Ayurveda perspective: Ankylosing spondylitis cannot be mirrored with any particular disease condition directly that is elaborated in Ayurveda classics. It can be compared to some extent with Ama vata, or Gambhira vatarakta, or Asthi-majjagata vata.[3],[4],[5] Taking this into consideration, the patient was evaluated according to Ayurvedic perspective. Prakriti of the patient was Vata pitta. Agnimandya was noticed in the patient and presented with Ama lakshanas in Mala and Jihva. Though, Vata and Pitta were the dominating doshas in this manifestation; involvement of Kapha dosha was also noticed. All the three vitiated Doshas affected Rasa, Rakta, Mamsa, Asthi, Majja dhatus. Considering the condition of the patient; Panchakarma procedures were planned that were followed by internal medications for 45 days [Table 2].
Table 2: Ayurvedic treatment plan

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Besides these procedures; Kaishora guggulu (500 mg thrice), Sanshamani vati (250 mg twice), Punarnavadi kwatha (15 ml twice) and a blend of Amalaki, Musta, Guduchi powders (1 g each with warm water) were administered during the first two weeks of the management.

This was followed by Kaishora guggulu (500 mg thrice), Sanshamani vati (250 mg twice), Rasna erandadi kashayam (15 ml twice), powder of Ashwattha twak (1 g twice with honey) and Lepa guti for external application over swollen, inflamed parts.

Observations: All the allopathic medicines were gradually withdrawn by 21st day of commencement of Ayurvedic treatment. After withdrawing NSAIDs; both pain and swelling were aggravated, but they were tolerable. After completion of Panchakarma therapy, sacro-illiac joint pain was completely reduced, while morning stiffness was reduced significantly. Mild swelling was observed over left knee and right ankle joints especially in the morning hours, which was reduced with physiotherapy. After one month of follow up, only mild tolerable swelling over right ankle was complained. This swelling was further reduced with continuous physiotherapy. Hematological profile of the patient was significantly improved. Good improvement in heamoglobin percentage was seen. ESR and CRP were also reduced suggesting reduction in inflammation [Table 3]. Patient gained 8 kg weight within two months after completion of the treatment. By the end of treatment, no need of conventional analgesics or anti- inflammatory drugs was needed by the patient.
Table 3: Changes in Hemotological profile

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Discussion: Patient was analysed by following Ayurvedic principles. On examination; it was observed that patient had symptoms of Ama, so Ampachana was suggested with Amrutottaram kashayam[6] that is generally used in vitiation of Tridoshas and is also indicated in Jwara. Ama pachana is a crucial step that is done before Snehapana followed by Virechana. Considering severity of the disease and Samata of Mala, as well as dominancy of Vata and Pitta; Virechana was planned. Snehapana with Indukantam ghritam[7] was planned, as it plays an important role in Rasa pradoshaja diseases. Virechana was given with Trivrutadi avaleha[8] considering vitiation of Pitta and Kapha. Trivrit helps in eliminating Pitta followed by Kapha and is also well tolerated by the patient. After Virechana, patient was given Karma vasti with alternate Anuvasana and Yapana vasti. Anuvasana vasti was given with Sahacharadi taila[9] that acts very well on lower part of the body. Mustadi yapana vasti[10] was given considering Madhyama bala of the patient as well as its efficacy on Vaata dosha. Mustadi yapana is good in the involvement of Asthi and Majja. Shastika shaali pinda sweda[11] and Upanaha sweda[12] were given for the relief of pain and swelling, Sarvanga sweda with Nirgundi and Shigru was also given for relief of pain and removing Stambha. Internal medicine such as Kaishora guggulu[13] and Sanshamani vati[14] were selected considering their action on Vata, Pitta, Kapha, Rasa, Rakta and Mamsa. Amalaki, Guduchi and Musta in a combination is known for its role in Asthi majja gata jwara pachana.[15]

Punarnavadi kwatha[16] also shows action on Rasa, Rakta, Mamsa and possess Shothahara property. Rasna erandadi kashayam[17] added to the list of medicines in further stages of treatment, as it pacifies pain due to Vata mainly in lower limbs and back. It also reduces Shotha due to Vata. Ashwattha churna[18] was administered as it controls vitiated Vata and Rakta. Jalaukacharana[19] (Leech therapy) was done over right knee and left ankle to reduce the pain and inflammation occurring due to Achilles tendinitis. Lepa guti[20] was added in follow up treatment to control Vedana and Shopha (analgesic and anti-inflammatory) action locally. Physiotherapy with stretching exercises were advised to relieve stiffness of muscles as well as joints.

Conclusion: Concept of pill for every ill is becoming an outdated concept in the Modern era. The present patient was examined and treated following to Ayurvedic principles. For auto immune diseases, such as Ankylosing spondilitis, where there is no satisfactory proven treatment in conventional medical systems; Ayurveda can be used effectively. Though single case report cannot prove treatment for all such auto immune manifestations; well designed clinical trials may be planned in order to validate actual potency of treatment patterns and principles applied in this case.

Source of support: Nil.

Conflicts of interest: None declared.



 
  References Top

1.
Zochling J, Van der Heijde D, Burgos-Vargas R, Collantes E, et al. ASAS / EULAR recommendations for the management of ankylosing spondylitis. Annals of Rheumatic Diseases 2006; 65: 442-452.  Back to cited text no. 1
    
2.
Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology, 3rd ed., London, 2003; 1161-1181.  Back to cited text no. 2
    
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Lakshmipati shastri, editor. Yogaratnakara, Amavata Nidana, Chaukhambha Sanskrit Sansthan, Varanasi: 2009. p. 564.  Back to cited text no. 3
    
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Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Chikitsa sthana, Vata shonita chikitsa, chapter 29, verse 21, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 986.  Back to cited text no. 4
    
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Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Chikitsa sthana, Vata vyadhi chikitsa, chapter 28, verse 33, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 942.  Back to cited text no. 5
    
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8.
Sharma RN, Sharma S, editors. Sahasrayogam, Leha Prakaranam, Chaukhamba Sanskrit Pratishthan, Delhi:2007. p. 204.  Back to cited text no. 8
    
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Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Siddhi sthana, Uttara vasti siddhi, chapter 12, verse 15, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 1324.  Back to cited text no. 10
    
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Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Sutra sthana, Swedadhyayam, chapter 14, verse 41, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 295.  Back to cited text no. 11
    
12.
Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Sutra sthana, Swedadhyayam, chapter 14, verse 37, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 294.  Back to cited text no. 12
    
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Shastri V, editor. (1st ed) Sharangadhara Samhita of Sharangadhara, Madhyama khanda, Gutika prakarana, chapter 7, verse 70, Chaukhamba Orientalia, Varanasi: 2006. p. 203.  Back to cited text no. 13
    
14.
Anonymous. (1st ed) Ayurveda Pharmacopoeia compiled by Gujarat State Bheshaja Samiti, Health Department, Gujarat state. 1966. p. 521.  Back to cited text no. 14
    
15.
Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Chikitsa sthana, Jwara Chikitsa, chapter 3, verse 202, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 186.  Back to cited text no. 15
    
16.
Shastri V, editor. (1st ed) Sharangadhara Samhita of Sharangadhara, Madhyama khanda, Kwatha kalpana, chapter 2, verse 118, Chaukhamba Orientalia, Varanasi: 2006. p. 159.  Back to cited text no. 16
    
17.
Sharma RN, Sharma S, editors. Sahasrayogam, Kashaya Prakaranam, Chaukhamba Sanskrit Pratishthan, Delhi:2007. p. 33.  Back to cited text no. 17
    
18.
Tripathi B, editor. (1st ed) Charaka samhita of Agnivesha, Chikitsa sthana, Vata shonita chikitsa, chapter 29, verse 158, Chaukhambha Surabharti Prakashan, Varanasi: 2005. p. 1007.  Back to cited text no. 18
    
19.
Sharma A, editor. Sushruta samhita of Sushruta, Sutra sthana, Jalaukavacharaneeyam, chapter 13, verse 19, Chaukhambha Surabharti Prakashan, Varanasi: 2004. p. 97.  Back to cited text no. 19
    
20.
Gokhale B, Chikitsa Pradeepa, Dhanvantari Pratishthan, Pune: 1989. p. 137.  Back to cited text no. 20
    



 
 
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