E-ISSN:2456-3110

Research Article

Asthimajjagata Vata

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Evaluation of Rasnadi Kwatha Sadhita Ksheera Basti (Modified Kala Basti Schedule) in Asthimajjagata Vata (Avascular Necrosis of Hip Joint)

Singh P1*, Mahajan S2, Goyal P3, Mahajan K4
DOI:10.21760/jaims.9.7.6

1* Pankaj Singh, Post Graduate Scholar, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

2 Shivani Mahajan, Professor, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

3 Praphull Goyal, Assistant Professor, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

4 Ketan Mahajan, Professor and HOD, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

Asthimajjagata Vata (Avascular necrosis of the hip joint) is a progressively common cause of musculoskeletal debility and it’s bearing a major diagnostic and therapeutic challenge, although patients are initially asymptomatic or with mild symptoms, avascular necrosis of the femoral head usually progresses to joint destruction, requiring total hip replacement, usually before the fifth stage. If the disease is untreated then the pain progressively increases and worsens with time and use of join. In the later stage pain increases on rest which may be worse during night and may be associated with morning stiffness also. The preventative, promotive, rejuvenating, and radical treatment qualities of Panchakarma make it a very special therapeutic process. In present study, 40 patients diagnosed with Asthimajjagata Vata (Avascular necrosis of the hip joint) were administered with 768 ml. Rasnadi Kwatha Sadhita Ksheera Basti with 96ml. of Dhanvantara Taila in modified Kala Basti schedule. Assessment was done on subjective parameters and obtained data was analysed using appropriated statistical tests and conclusion was made that the Rasnadi Kwatha Sadhita Ksheera Basti is significant in the cases of Asthimajjagata Vata (Avascular necrosis of the hip joint). The therapy provided Mild improvement in 77.50% and 20.00% of the patients were showed moderate improvement, no improvement was found in 2.50% patient. By this we can conclude that the drug is effective in controlling the Asthimajjagata Vata (Avascular necrosis of the hip joint), in short duration of therapy.

Keywords: Asthimajjagata Vata, Avascular necrosis, Ksheera Basti, Kala Basti

Corresponding Author How to Cite this Article To Browse
Pankaj Singh, Post Graduate Scholar, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.
Email: 		Singh P, Mahajan S, Goyal P, Mahajan K, Evaluation of Rasnadi Kwatha Sadhita Ksheera Basti (Modified Kala Basti Schedule) in Asthimajjagata Vata (Avascular Necrosis of Hip Joint). J Ayu Int Med Sci. 2024;9(7):48-56.
Available From
https://jaims.in/jaims/article/view/3595

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-14 2024-05-24 2024-06-04 2024-06-14 2024-06-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 14.58

© 2024by Singh P, Mahajan S, Goyal P, Mahajan Kand 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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Introduction

The human being is the most valuable species in the universe, and Ayurveda is the traditional medicinal knowledge that is still used today. In Ayurveda, being free from illness does not simply mean being well; it also means that one should be content in physical, mental, social, and spiritual aspects.

The basic concepts of Ayurvedawere developedduring the Vedic period.Acharya Charaka, Sushruta andVagbhata later developed the positionof Ayurvedain the Samhita period. Various Ayurvedic concepts likePancha Mahabhuta Siddhanta, Tridosha Siddhanta, Samanya Vishesha Siddhantahave beendescribed with its practical utility.VariousChikitsaSiddhanta werealso discussed. Imbalance of Doshas is called Roga.[1]

The clinical characteristics of Asthimajjagata Vata are Bhedoasthiparvaṇam (breaking type of pain in bones), Sandhishoola (joint pain), Satata Ruk (continuous pain), Mamsabalaksaya (loss of strength and muscle weakness), and Aswapna (disturbed sleep due to pain).[2] Here in Asthimajjagata Vata, it seems that the predominant Dosha is Vata and Dushya is Asthi, in the chronic stage there is Tridosha involvement.

The symptoms of Asthimajjagata Vata in a patient are comparable with the symptoms of avascular necrosis. Avascular necrosis (AVN) also known aseptic necrosis, ischemic bone necrosis, bone infarction and osteonecrosis, is cellular death of bone components due to interference of blood supply because of which the bone tissue dies leading to bone collapse.

The most frequent traumatic causes are hip dislocations, which include dislocation of femoral head from the acetabulum, and femur neck fractures. Many non-traumatic causes, such as radiation therapy, organ transplants, smoking, sickle cell disease, high corticosteroid dosages, excessive alcohol consumption, infections like meningococcal infections, HIV and tuberculosis, can also contribute to it.

Other causes - vascular occlusion, altered lipid metabolism, intravascular coagulation, healing process, mechanical stress. The disease prevalence rate is 0.135% per thousand population.[3] It usually affects people between 30-50 years of age.

Avascular necrosis often manifests no symptoms are seen in the primary stages in many persons. As things become worse, stress may cause damage to the afflicted joint. If AVN affects the hip, pain location tends to be most specific in the anterior hip and lower pelvis. Pain can also be limited to the groin, thigh, or buttock. Pain can be slight or severe, localized, and develops gradually. The prognosis for AVN also depends on the likelihood of comorbidities, etc. Pain alleviation and the preservation of structure and function are two of the treatment's goals; management is not an easy feat.

In modern medicine administration of muscle relaxants, NSAIDS, physiotherapy etc give temporary relief from the pain and last option seems to be surgery which is quite expensive and has several complications. Degeneration of Asthi & Majja which is the most important event in the Samprapti of Asthi-Majjagata vata denotes craving for Brihana therapy especially of Asthi.

Tiktaksheer basti is the basic line of treatment mentioned in Charka Shamhita.[4] Hence Anuvasana with Dhanvantara Taila and Niruha Basti with Rasnadi Kwatha Sadhita Ksheera Basti was selected in the management of Asthimajjagata Vata (avascular necrosis of hip joint). The study was aimed at finding out a suitable mode of treatment for the disease.

Aim and Objectives

1. To study in detail about Niruha and Anuvasana Basti
2. To study the aetiopathogenesis, symptomatology and progress of Asthimajjagata Vata and Avascular necrosis as per diagnostic parameters of Ayurvedic and modern medical literature.
3. To evaluate the efficacy of Rasnadi Kwatha Sadhita Ksheera Basti (modified Kala Basti schedule) in Asthimajjagata Vata (Avascular necrosis of hip joint).

Materials and Methods

40 Patients of Asthimajjagata Vata from Patanjali Bhartiya Ayurvigyan Avum Anusandhan Sansthan, Haridwar, Uttarakhand, were included in the study's sample. Every one of them were made to comprehend about the review and the educated assent was gotten. They were not included in the study until they gave their informed consent.


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Inclusion Criteria

1. Patient with classical features of avascular necrosis.
2. Patient of any socio-economic status, all genders and all ethnic origins.
3. Patient with age group of 18-60 year.
4. Any of two or more symptoms described in the context of avascular necrosis.
5. Both fresh and treated cases were selected.
6. Patients fit for the Basti Karma were selected.
7. Patient with classical features of Asthimajjagata Vata.

Exclusion Criteria

1. Below the age of 18 years and above the age of 60 years.
2. Patients with uncontrolled metabolic and other systemic disorders like diabetes, spinal carcinoma, Caries spine, Pott’s spine, Necrosis of other joints.
3. Psychiatric illness and pregnant women.
4. Patients with acute traumatic injury to spine and ano-rectal disorders.
5. Patients not fit for Basti Karma.

Those patients who have surgical intervention earlier.

Criteria for selection of drug

Ingredients of Rasnadi Kwatha Sadhita Ksheera Basti

DravyaQuantity
Makshika (Honey)125 ml
Saindhava Lavana 8 gms
Dhanvantara Taila190 ml
Immunogrit Churna Kalka 65 gms
Rasnadi Ksheera Paka380 ml
Total quantity768 ml

Kwatha Dravya:[5] Rasna (Pluchea lanceolata), Punarnava (Boerhavia diffusa), Shunthi (Zingiber officinale), Guduchi (Tinospora cardifolia), Eranda (Ricinus communis).

Kalka Dravya: Ashwagandha (Withania somnifera), Riddhi (Habenaria intermedia), Vidharikanda (Pueraria tuberose), Kshirkakoli (Lilium polyphyllum), Meda (Polygonatum airrhifolium), Safed Musli (Chlorophytum borivillianum), Shatavar (Asparagus racemosus), Kakoli (Roscoca procera), Varahikand (Dioscorea bulbifera), Bala (Sida cardifolia), Shuddh Konch (Mucuna pruriens), (Immunogrit Churna Kalka) Taken from Divya Pharmacy.

Anuvasana Basti:Dhanvantara Taila[6] : 96ml.

Because of its medicinal effect, particularly in its Brumhana action, Basti is a Panchakarma that has demonstrated its effectiveness in treating chronic illnesses. Tiktakhseera Basti is the basic line of treatment mentioned in Charaka Samhita

Diagnostic Criteria

An elaborate patient case format including the points of physical examination and history taking was prepared. It mainly emphasized on sign and symptoms of Asthimajjagata Vata (Avascular necrosis). Routine laboratory investigations CBC, ESR, CRP (Quantitative), FBS was made to rule out other pathological conditions. Radiological investigations X-ray of hip joint AP View was done to confirm the diagnosis.

Research Design

It was a randomized open label, clinical study. Patients were assigned in single group consisting of 40 patients excluding dropouts with pre, mid and post-test study design. All subjects were administered with Rasnadi Kwatha Sadhita Ksheera Basti 768 ml. And Anuvasana Basti with Dhanvantara Taila 96 ml. in modified Kala Basti schedule.

Procedure: Niruha Basti[7]

Poorva Karma

After passing faeces, urine and flatus, the patient on empty stomach should be ready with Abhyang and Swedana However, patient should not be hungry.

Pradhana Karma

Patient were asked to lie down restfully on their left side to keep their head on arms in the form of cushion while keeping the body straight and relaxed. Then the patients were asked to flex their right leg over fully extended left leg. Thereafter anus and enema nozzle were lubricated with oil. After removing air bubble, appropriate quantity of prepared Niruha Basti was administered.

Paschat Karma

Patient was advised to lie on his back i.e., in supine position comfortably on the bed. Patient was advised to empty his bowel after getting urge for defecation in squatting position.


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Anuvasana Basti

Poorva Karma[8]

Patient was given Abhyanga and Swedana followed and then patient was advised to take food less by ¼ of the usual quantity. Ask him to eliminate faeces, urine or flatus if present.

Pradhana Karma[9]

Patient was enquired to lie down comfortably on his left side to keep his head on his arms in the form of pillow while keeping the body straight and relaxed. Then the patient was enquired to flex his right leg over his fully extended left leg. Thereafter anus and enema nozzle were lubricated with oil. After removing air bubble, appropriate quantity of prepared Anuvasana Basti was administered.

Paschata Karma

Buttocks of the patient was patted with palms for 3 times and was advised to relax in supine position. Patient was advised to empty his bowel after getting urge for defecation.

Duration of treatment

  • 1- 8th day: Rasnadi Kwatha Sadhita Ksheera Basti in modified Kala Basti
  • 9th day onwards Parihara Kala for 16 days.[10]

Assessment Criteria

  • Improvement in signs and symptoms of Asthimajjagata Vata was assessed at the end of treatment course.
  • Assessment was based on Subjective and Objective parameters of Asthimajjagata Vata.

Grading of Bhedo Asthi Parvanam, Aswapna Santatruk (visual analogous scale)

ScaleScore
No PainPain Free0
Minor PainVery Mild1
Discomforting2
Tolerable3
Moderate PainDistressing4
Very Distressing5
Intense6
Severe PainVery Intense7
Utteribile Horrible8
Excruciating Unbearable9
Unimaginable, Unspakable10

Subjective Parameters

The symptoms of Asthimajjagata Vata in classical text are:-

1. Bhedo Asthi Parvanam
2. Sandhi Shula
3. Bala Kshaya
4. Aswapna Santatruk

Grading of Sandhi Shula (Difficulty in Walking)

ScaleScore
No pain, normal movements0
Mild pain with restriction of movements1
Moderate pain with restriction of movements2
Severe pain with restricting movements3
Complete restriction of movements4

Bala Kshaya of Sandhi (walking time)

Walking time: Time taken to cover 50 meters: Gr 0, Gr 1, Gr 2, Gr 3

ScaleScore
0 min to 1 min: 20 sec0
1 min: 21 sec to 2 min: 40 sec1
2 min: 41 sec to 4 min2
More than 4 min3

Objective Parameters

1. X-Ray of hip region - AP view
2. Trendelenburg sign - Present or Absent
3. Changes In Range of Movement of Hip Joint

Movement of Hip JointNormal range
Flexion110• - 120•
Extension10• - 15•
Abduction45•
Adduction15• - 25•
Internal rotation30• - 45•
External rotation40• - 60•

Observations and Results

Table 1: Showing the effect of therapy on Subjective parameters.

SubjectiveMeanMedianSDWilcoxon WP% EffectResult
BTATBTATBTAT
Bhedoasthiparvanam
& Aswapnasantat Ruka		4.582.635.002.501.081.19-5.655b0.0015642.62Sig
Sandhi Shoola2.151.252.001.000.530.44-5.555b0.0027841.86Sig
Bala Kshaya of Sandhi1.152.181.002.000.740.71-6.105c0.0001089.13HS

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Since observations are on ordinal scale (gradations), we have used Wilcoxon Signed Rank Test is carried out to test efficacy in subjective parameters. From above table, we can observe that, effect observed in Bhedoasthiparvanam & Aswapnasantat ruka and sandhishoola was significant (P-Value < 0.05) while effect observed in Bala Kshaya of Sandhi was highly significant (P-Value < 0.001).

jaims_3595_01.JPG

Table 2: Showing Range of Movement of Hip Joint

Range of Movement of Hip JointMeanNSDSEt-ValueP-Value% EffectResult
FlexionBT108.55406.701.06-4.8110.00002271791.66Sig
AT110.35404.930.78
ExtensionBT11.05402.410.38-4.7140.00003075436.33Sig
AT11.75402.050.32
AbductionBT40.83403.050.48-6.8280.00000003694.41Sig
AT42.63401.860.29
AdductionBT13.80403.370.53-7.8170.000000001712.50Sig
AT15.53403.100.49
Internal RotationBT25.83403.320.52-12.8200.000000000011.04Sig
AT28.68403.320.52
External RotationBT36.38404.140.65-9.2390.00000000007.35Sig
AT39.05403.930.62

Since observations are quantitative, paired t-test is carried out to test efficacy in objective parameters. From above table, we can observe that P-Value for all parameters is less than 0.05. Hence, we can conclude that effect observed in objective parameters is significant.

jaims_3595_02.JPG


Table 3: Showing Trendelenburg sign observed.

Trendelenburg signBTAT
N%N%
No2460.00%2665.00%
Yes1640.00%1435.00%
Total40100.00%40100.00%

Before treatment Trendelenburg sign was observed in 16 (40%) patients and after treatment it was observed in 14 (35%) patients.

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Table 4: Showing overall effect of therapy

Overall EffectFrequencyPercentage
Marked Improvement00.00%
Moderate Improvement820.00%
Mild Improvement3177.50%
No Improvement12.50%
Total40100.00%

Overall effect of therapy given marked Improvement in 0.00%, 20.00% patients were showed moderate improvement,77.50% patients were showed mild improvement, and there was 2.50% showed no improvement.


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Discussion

Ayurveda has shown to be helpful in managing and preventing chronic illnesses. Its concept has also been useful in treating new diseases caused by changes in lifestyle and the environment. This study aimed to understand disease from an Ayurvedic perspective and find effective ways to prevent it.

Basti therapy, considered a prime treatment modality within Panchakarma, offers not only curative effects, also promotive and preventive actions.

Among all therapeutic measures, Basti is regarded as Chikitsa Ardha, and some Acharyas even deem it a complete therapeutic approach due to its extensive range of benefits. Basti is renowned as the most effective therapy for treating Vata -related disorders, addressing not only Vatika ailments but also aiding in balancing Doshas and managing various disorders such as Kaphaja, Pittaja, Shakhagata and Koshtagata Rogas through the use of different types of Basti Dravya. When administered correctly, Basti primarily acts on the Pakvashaya, Kshroni and areas below the Nabhi, with its effects spreading throughout the entire body similar to the moisture absorbed by plant roots reaching all parts of the plant.

The basic principle of Ayurveda is Tridosha. These three Doshas however travels all through body, have explicit destination where they predominantly reside, by the drugs administration to these specific sites leads to faster recovery. Vata being the most influential Dosha as all tissues (Dhatus) and Doshas rely on Vayu for their functionality.

Vata's primary location is Pakvashaya, Basti which directly targets the Pakvashaya, is essential for Vata -related issues.Vata is chiefly implicated in the onset of diseases in the Shakha, Koshtha, and Rogmargas. It regulates vital functions such as the collection, regulation and elimination of substances such as stool, semen, urine etc.

Additionally, Vata is also responsible for the Samhanana and Samvahana (transportation) of Pitta, Kapha, Rasa, Rakta, Sweda, Mala, Mutra, etc. Therefore, when Vata becomes disturbed, Basti therapy is often the most effective remedy. Basti enriches Shukra and provides firmness to the body by expelling vitiated Doshas from the whole body.

Due to its administration in every age group this therapy is considered better than other ones. Being inserted through the anal canal there is no involvement of digestive processes. Basti has to be hold in the body for few moments for spreading of its Virya (potency) whole body by the help of microchannels of body.

Basti removes all the morbid Doshas from toe to head by its own potency. Proper administration of Basti leads to the nourishment of body, enhancement of the complexion, life span and the overall increased vitality of the body.

Action of Basti Dravya

Saindhava: Saindhava plays a significant role in the absorption of Basti. In most of the drug absorption Na channels are used.

Madhu: Rasa of Makshika is Madhura and Kashaya, Laghu, Ruksha, Sheeta, in Guna and the Karma of Makshika is Swarya, Varnya, Deepana Hridya, Lekhana, Vajikaran, Sandhankar, Ropanaand Prasadna etc. its action on Kapha is due to its Laghu Guna. By the Pichhila Guna and Madhura and Kashaya Rasa it supresses the Vata and Pitta Dosha. Thus, it is Tridosha Hara in nature.

Honey is sweet and astringent in Rasa, Chhedana and Ruksha in Guna, Ushna in Virya. It is Kaphahara and Vrana Shodhana in nature the most important properties of Makshika in the context of Basti are the Sukshma Marga Anusari and Yogavahi, meaning of Yogavahi catalyst in nature.


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Sneha: By using Sneha, the fat-soluble fraction of the drug easily absorbed from the colon. Lipids and Lipid soluble substance can easily enter the cell. In this way Sneha helps the Basti Dravya to reach at cellular level.

Kalka: It gives essential thickness to the Basti Dravya & that helps in retention of Basti. many drugs having volatile property which can be used in the form of paste.

Paste of drugs enhances the action of decoction.

Kwatha: It is use to get water soluble portion.

Avapa Dravya: These are used in order to make the Basti either strong or soft and to increase the quantity of Basti.

Mode of Action (Ayurveda)

  • The Basti when administered does the churning of Doshas situated in Nabhi Pradesha, Kati, Parshva comes in Kukshi and expels it from the body.
  • Through the systemic action Basti, is capable of removing the Doshas from whole of the body. Though Basti is given in the Pakvashaya its active ingredients i.e. "Virya of the Basti" spreads in the whole body.
  • Parashara had highlighted the importance of Guda, by saying that Guda is Mula for all the Siras in the body. Hence the nourishment of the Guda by administration of Bastis causes nourishment of entire
  • This Basti Virya is also capable of removing the morbid Doshas from the body.

Rasnadi Kwatha Sadhita Ksheera Basti

Most ingredients of Rasnadi Kwatha that is used for Basti have Tikta Rasa, Ushna Veerya and Madhura, Katu Vipaka, which Favor’s normal functioning of Dhatvagni, helping increased nutrition of the Asthi Dhatu.

Tiktaksheera Basti was planned for strengthening of Asthi Dhatu. Tikta Rasa is predominance of Vayu and Akash Mahabhuta. Hence, it has got affinity toward the body elements like Asthi which has same Mahabhauta, which works on the principle of Samanya and Vishesh. As a result, degeneration of Asthi and Majja Dhatu reduced helping its rejuvenation. Godughadha have Vata-Pitta Shamaka, Balya, Brihmana, Madhura, Sheeta Veerya property.

Thus, it pacifies Vata; improves the Dhatu Upacaya and acts as a rejuvenator of the body.

It also contains vitamin D which plays an important role to utilize calcium and phosphorous from blood and helps in bone formation. Thus, helps in the Samprapti Vighatana of the Ashtimajjagatavata. Niruha Basti containing Kşheera the main ingredient is called as Kşheera Basti. Kalka of Basti contains Drvyas of Ashtavarga which is having healing properties.

Conclusion

The treatment was more effective in the subjective parameters Bala Kshaya of Sandhi, Bhedoasthiparvanama & Aswapnasantat ruka, Sandhishoola. The total effect of treatment provided statistically significant result in Bala Kshaya of Sandhi. Rasnadi Kwatha Sadhita Ksheera Basti favours normal functioning of Dhatvagni, facilitating increased nutrition of the Asthi Dhatu. As a result, degeneration of Asthi Dhatu reduced helping its regeneration. The treatment Rasnadi Kwatha Sadhita Ksheera Basti provided mild improvement in 77.50% and 20.00% of the patients were showed moderate improvement and 2.50% patient shows no improvement. In Ayurveda, Panchakarma treatments and herbal remedies are frequently less costly than surgery and drugs. There is no adverse drug reaction and other toxic effect were observed during and after treatment.

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