E-ISSN:2456-3110

Case Report

Katishool

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

A case study of Ayurvedic management of Katishool with reference to Senile Osteoporosis induced compression fracture of vertebrae

Saxena C.1*
DOI: http://dx.doi.org/10.21760/jaims.8.3.34

1* Chitranshu Saxena, Associate Professor, Department of Agadtantra evum Vyavhar Ayurved, IIMT Ayurved Medical College, Uttar Pradesh, India.

Low bone mass and micro architecture bone tissue degeneration that can cause fractures is the hallmarks of osteoporosis. The development of disease is influenced by numerous etiological factors, including physical, hormonal, dietary, and lifestyle factors. Low back discomfort, or Katishool, is one of them. Low back discomfort can have many different causes, including compression fractures, intervertebral disc prolapse (IVDP), lumbar spondylosis, spine tuberculosis, etc. At some point in their life, 39% of people report having low back pain, with females between the ages of 40 and 80 experiencing the condition more frequently. The reason of significant low back pain is one of the vertebral compression fractures (VCF). It is comparable to Katishool in Ayurveda. The care of fractures in modern science includes reduction, immobilization of the broken area, use of NSIAD, calcium supplements, etc. Numerous native substances that can aid in the healing of the fracture have been described in ancient treatises. In this instance, Ayurvedic treatments like Vijaya Extract, medicines and Kati Abhyangam are used to treat lower back pain.

Keywords: Katishool, Non Specific Low Back Pain, Kati Abhyangam, Vertebral Compression Fracture, Vijaya, Hempseed

Corresponding Author How to Cite this Article To Browse
Chitranshu Saxena, Associate Professor, Department of Agadtantra evum Vyavhar Ayurved, IIMT Ayurved Medical College, , Uttar Pradesh, India.
Email: 		Chitranshu Saxena, A case study of Ayurvedic management of Katishool with reference to Senile Osteoporosis induced compression fracture of vertebrae. J Ayu Int Med Sci. 2023;8(3):178-182.
Available From
https://jaims.in/jaims/article/view/2260

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-31 2023-02-02 2023-02-09 2023-02-16 2023-02-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Chitranshu Saxenaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Saxena C: Katishool with Senile Osteoporosis induced compression fracture of vertebrae

Introduction

Degeneration in the body and ageing are continual processes. The development of degenerative diseases, the most prevalent of which are arthritis, spondylosis, PID, low back pain, etc., is a result of today's altered lifestyle, which has accelerated the process of degeneration. There are two types of Katishoola (low back pain): specific and non-specific. In 90% of cases, there is no known reason, and in the remaining 10%, cases like fractures, infections, and cancer are known.[1]

Spinal fractures are frequently caused by vertebral compression fractures (VCF). A crush or wedging damage occurred to the vertebral body. Osteoporosis is the most prevalent cause of compression fractures.[2] Bowel/bladder dysfunction, numbness, tingling, and weakness in the limbs occur when the spinal cord or nerves are affected. Patients with VCF are five times more likely to develop another VCF. Katishoola is one of the 80 varieties of Vatavyadhi that Acharya Charaka mentioned in his work Nanatmajavatavyadhi.[3] It is distinguished by Kati Pradeshevedana (lower back pain), Kati Shunyata (lower back numbness), and Hasta-Pada Suptata (numbness in legs).[4] Despite recent developments, the therapy only addresses the symptoms. Therefore, the need to find a better, safer, and less expensive therapy arises. India places a great importance on the strong Ayurvedic plant Vijaya and the cannabis medicine it produces because of its potent anti-inflammatory and pain-relieving effects.[5-7] Since there is little adulteration and it is also economical, it meets all criteria. Numerous investigations and clinical trials have demonstrated its great effectiveness in reducing all types of pain and their accompanying symptoms. Techniques like Kati Abhyangam with Ayurvedic Tail are very simple to do and have been proven to be efficient.

Aim and Objectives

To estimate the efficacy of Vijaya Extract and Kati Abhyangam with Hempseed Tailam in management of Katishool with reference to Senile Osteoporosis induced Compression fracture of vertebrae.

Materials and Methods

Type of study: Single case study

Case Report

A Hindu 83 yr old male patient consulted on 14/12/2022, OPD for chief complaint of pain in lower back region, mild stiffness in lower back, he was unable to stand for longer duration, Painful movements since 45 day. After taking the detailed history patient explained that the pain occurred while he was lifting up from bed/seat and it get worst day by day so he went for medical treatment in allopathic hospital. Where MRI revealed Lumbo-Sacral Spine showed Lumbarisation of S1 vertebra. Superior endplate compression fracture of L4 vertebral body with marrow oedema and endplate irregularity, ~30% height compromise seen. Vacuum phenomenon of adjacent L3-L4 IV disc noted. No obvious associated pre or paravertebral soft tissue lesion. Posterior elements are intact changes. He already had done C.B.C., Urine examination (Routine and Microscopic) which were all appeared within normal limit.

He rated his pain as 7/10 on the Visual Analogue Scale (VAS) where 0 is “no pain” and 10 is the “worst pain that he had ever experienced.” The pain was described as sharp and stabbing, Radiating and it was exacerbated by direct pressure over the painful area and any movements of the lower axial spine. He denied any difficulty with bowel and bladder function. Past medical history revealed that he had been diagnosed with “mild” osteoporosis two years prior. Systems examination and family health history was unremarkable. He had no addiction and previous history of any back injury. He was having trouble in getting a sleep due to lower back pain.

Investigations: MRI (04/12/2022)

  • Superior Endplate Compression Fracture of L4 Vertebral Body with Marrow Oedema ± Osteoporotic /Traumatic.
  • Broad Based Posterior Protrusion of L4-L5 Disc Indenting Thecal Sac And Traversing Nerve Roots.
  • Right Lateral Protrusion of L5-S1 Disc Indenting Epidural Fat and Exiting Right L5 Nerve Root.
  • Lumbar Spondylosis.

General examination

  • BP - 135/68 mm of Hg
  • P - 66/min
  • Height - 160cm
  • Weight - 62kg

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Saxena C: Katishool with Senile Osteoporosis induced compression fracture of vertebrae
  • BMI - 24.2 kg/m2
  • Ponderal Index - 15.1 kg/m3
  • Systemic examination – normal

Assessment Criteria: Range of movement SLR was measured by Goniometer. Visual Analogue Scale (VAS) is used for pain; Improvement was assessed by Low back outcome score (LBOS) and Oswestry disability index.

Table 1: Dashavidha Pariksha

SN Factor Observation
1.                      Prakriti Vatakaphaja
2.                      Vikriti Pravara Tridoshaja
3.                      Saara Majjasar
4.                      Samhanana Madhyama
5.                      Satmya Madhyama
6.                      Satva Madhyama
7.                      Aahar Shakti Madhyama
8.                      Vayama Shakti Madhyama
9.                      Vaya Avara
10.                   Bala Avara

Table 2: Following Oral medications were given

SN Drug Dose Anupana
1. Vijaya Extract 3000mg 6 drops twice a day Luke warm water
2. Tab Hadjod 1 Tab BD Luke warm water
3. Tab Ortho 21 1 Tab BD Luke warm water
4. Tab Moringa 1 Tab BD Luke warm water

Table 3: Procedures with quantity and duration

SN Procedure Drug used Quantity Days
1. Kati Abhyangam with combined Tail Mahamasha Tail 100 ml 30 days for 20 minutes
Vishagarbha Tail 50 ml
Mahanarayan Tail 100 ml
Hemp seed Tail 100 ml

Table 4: Pain was assessed by VAS score

SN Score Before treatment After treatment
1.                      0 to 10 8 3

Table 5: Straight Leg Raising Test

Before treatment After treatment
Right leg Left leg Right leg Left leg
38 degree 43 degree 48 degree 55 degree

Table 6: Oswestry low back pain index

SN Score Before treatment After treatment
1. 0-20% minimal disability 48.8% severe disability   31.1% moderate disability
21-40% moderate disability
41-60% severe disability
61-80% crippled disability
81-100%


Table 7: Low back outcome score (LBOS) by Greenough and Frase.

SN Score Before treatment After treatment
1. ≥ 65 Scoring (Excellent status) 27 45
50 - 64 Scoring (Good status)
30 - 49 Scoring (Fair status)
0 - 29 Scoring (Poor status)

Discussion

According to Ayurveda, Katishool is mostly caused by Vata Prokopa and is regarded as a Vataja illness. In the current case study, the patient had a vertebral fracture that was producing excruciating low back discomfort and numbness. The major pathogenic causes for aggravating Vata Dosha are Dhathu Kshaya (depletion/malnutrition) and Srotas Avarodh (channel blockages). According to Acharya Sushruta. Dhatukshaya in general and Asthi Kshaya in particular among vata types were the primary causes of the vata prakopa in this case.[8] Kati Shoola is where Apana Vata is mostly involved. Therefore, the goal of the therapy is to calm down the vitiated Vata Dosha, especially Apana Vata. In order to calm the Vata Dosha and control its movement, Snehana, Swedana, and Basti Karma were implemented.

Shamana Chikitsa

Vijaya Extract has Tikta Rasa, Ushna Virya, Laghu Tikshna Gunas and Katu Vipaka. It alleviates Kapha and Vata Doshas, increases Pitta having Dipana, Pachana, Ruchya, Grahi, Madkari and Vyavayi properties. Vijaya have been indicated in many diseases including pain and as anti-inflammatory. Its main components that are found in higher concentrations, identified as Δ9 tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD). Among them, Δ9 tetrahydrocannabinol (Δ9-THC) is identified as the psychoactive component, which is a potential treatment for Pain.[9]

According to Ayurveda, the herb Hadjod (C. quadrangularis L.) possesses anti-osteoporotic properties. Triterpenoids and phytoestrogen are found in plants. The isolated plant's phytoestrogen steroids have an impact on bone mineralization and early regeneration.[10] The C. quadrangularis L. ethanolic and petroleum ether extract has a noticeable impact. Numerous studies support the anti-osteoporotic activity of C. quadrangularisis L., which also increases blood calcium levels,


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Saxena C: Katishool with Senile Osteoporosis induced compression fracture of vertebrae

vitamin D3 levels, serum oestrogen levels, bone mineral density, and bone mineral content. Bone hardness, density, and thickness have all increased significantly.

Furthermore, it considerably reduces the anti-anabolic impact and has some beneficial benefits on bone mineral density restoration. The C. quadrangularis L. ethanolic extract demonstrates that the plant's ethanol extract has a clear anti-osteoporotic action.[11]

Yograj Guggulu,[12] Dashmool Kwath, Maharasnadi Kwath, Ashwagandha, Nirgundi, and other key ingredients in Ortho 21, an exclusive Ayurvedic medication, have an entourage effect against osteoporosis and have analgesic effects.

Rheumatoid factor, TNF-alpha, and IL-1 levels in arthritic rats were decreased by the hydro-alcoholic extract of Moringa flowers.

This demonstrates how effective Moringa may be as a treatment for inflammation. The presence of flavanoids and antioxidants in M. oleifera's extracts is probably what caused these therapies to appear to have anti-inflammatory effects.

According to reports, M. oleifera's include a variety of antioxidants, such as flavanoids and polyphenolic substances.[13] By increasing bone mineral density, flavonoids have been proven to be responsible for preventing osteoporosis.[14]

By acting locally, Abhyangam[15] promotes blood flow, reduces pain, and has stabilizing and nourishing effects. Purva Karma is the practice of snehan (oleation) (Abhyangam - massage) treatment (pre-procedure).

The vitiated Doshas become softer and more liquid as a result of these. Since the Snigdha (unctuous), guru (heavy), and Mridu (soft) qualities of the oils employed in Snehan treatment are the opposite of those of Vata, Abhyangam eliminates vitiated Vata. Additionally, in the current study, the oils and other components selected for Abhyangam were those that also balance the Kapha Dosha; hemp seed,[16] Mahamasha Tail,[17] Vishagarbha Tail,[18] and Mahanarayan Tail[19] all have Vata-soothing characteristics along they have tendency to reduce age related macular degeneration. The oils balance the vitiated Doshas as well as provide a nourishing impact (Vrinhan) on the tissues that are ageing.


Conclusion

Vata is vitiated in Katishoola (low backache), which results in pain (Shoola). Along with an oral Vata pacifying medication, the principles of Ayurvedic medicine for treating Vata, such as Snehana and Abhyangam, are mostly relevant here. Consequently, in the current case, a severe backache caused by VCF is being treated with Abhyangam using Mahamasha Tail, Vishagarbha Tail, Mahanarayan Tail, Hemp seed Tail along with oral medicines like Vijaya Extract, Hadjod, ortho 21, Moringa offered considerable relief in pain and range of motion as determined by VAS scale, Oswestry low-back pain index, SLR test, and also improved the quality of life. Therefore, the current case study offers a glimmer of hope and a springboard for doing more research with a larger sample size of individuals with low back pain owing to VCF.

Reference

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2. McCARTHY JA, Davis A. Diagnosis and management of vertebral compression fractures. American family physician. 2016;94(1):44-50.

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9. Karst M, Wippermann S, Ahrens J. Role of cannabinoids in the treatment of pain and (painful) spasticity. Drugs. 2010;70:2409–2438.

10. Mukherjee Tanmoy, Saha Nabarun, Palbag Satadru. Ethnopharmacology, Phytochemistry And Pharmacology Of Ayurvedic Plant Hadjod - Cissus Quadrangularis (L.), Bengal Institute of Pharmaceutical sciences, Kalyani, Nadia, India.

11. Udupa K.N., and Prasad G., Biochemical and calcium 45 studies on the effect of cissus quadrangularis in fracture repair, lndian J. Med. Res., 1964,52, (5) 480-487.

12. Agarwal P, Vaishnav, R Ranawat MS. Evaluation of Quality Parameters of Three Different Marketed Brands of Yogaraj Guggulu Vati: A Polyherbal Formulation. Biomedical Journal of Scientific & Technical Research.2018; 6(4):5355-5361.

13. Sanchez M. D. I., Lopez C. J., Rios V. High-performance liquid chromatography method to measure ∝ - and ϒ -tocopherol in leaves and fresh beans from Moringa oleifera. J. Chromatogr A. 2006; 1105: 111–114.

14. Nijveldt R. J., Nood E. V., Hoorn D. E., Boelens P. G., Norren K. V., Paul A. M., Leeuwen V. Flavonoids: A review of probable mechanism of action and potential applications. Am. J. Clin. Nutr. 2001; 74: 418–425.

15. Charak Samhita: Text with English translation and critical exposition based on Chakrapani Dutta”s ayurveda Dipika by Dr.R.K. Sharma and Vaidya bhagavan dash, Chaukamba Sanskrit series office, Varanasi, edition 2009,Ch.si 1/7.page.no 2.

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17. Ambikadatta ,Commentry Vidyotini of Ambikadatta on Bhaisajya Ratnavali ,vatavyadhi chikitsa: Verse 241-242.In: Shastry R D (editor) Bhaisajya Ratnavali. Varanasi: Chaukambha Sanskrit Sanstan, 2007.

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19. Bhaishjya Ratnaval of kaviraj Sri Govinda Das Sen. Ed. By. Ambika data Sastri Vol.2, Chapter 26. Choukhamba Sanskrit series, Varanasi, 2005: 188


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