E-ISSN:2456-3110

Case Report

Ankylosing Spondylitis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 4 APRIL
Publisherwww.maharshicharaka.in

Holistic Management of Ankylosing Spondylitis through Ayurveda: A Case Study

Yadav N1*, Panja S2, Kharjule S3, Bhaduri T4
DOI:10.21760/jaims.10.4.53

1* Neha Yadav, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India.

2 Soumya Panja, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India.

3 Shwetangi Kharjule, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India.

4 Tapas Bhaduri, Reader and Head, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India.

Ankylosing Spondylitis is a group of spondylarthrosis, chronic autoimmune inflammatory disorder. Primarily it affects axial skeleton and gradually it affects peripheral joint and extra articular structure. Presence of sacroiliitis and structural changes is seen in this disorder. The usual presentation of Ankylosing Spondylitis is morning stiffness which is relieved after exercise or activity. The term “Ankylosing Spondylitis” is not mentioned in our ancient classics but the signs and symptoms can be clinically correlated to Kati Prishta Trik Graha in Ayurveda. Here major symptoms are Stambha and Shula in Kati Pradesh with Vata Kapha Dosha predominance. This was a single case study conducted at I.P.G.A.E&R at SVSP Kolkata. A 45 yrs old female patient, came to the Out Patient Department. complaining of pain and stiffness in Kati Prishta Trik Pradesh. She was diagnosed with Ankylosing Spondylitis and bilateral Sacroiliitis 7 years ago. Management was done according to the principle of Kati Prishta Trik Graha. Treatment plan included Classical Virechana, Erandamuladi Niruha Basti in Kala Yoga followed by Samana Aushadhi. The disease activity was further analysed using BASDAI and ASDAS- CRP score and we got promising results by the treatment without any adverse effects.

Keywords: Ankylosing Spondylitis, Kati Prishta Trik Graha, Erandamuladi Niruha Basti, Ayurveda

Corresponding Author How to Cite this Article To Browse
Neha Yadav, Second Year Post Graduate Scholar, Department of Kayachikitsa, Institute of Post Graduate Ayurvedic Education and Research at Shyamadas Vaidya Shastra Pith (SVSP), Kolkata, West Bengal, India.
Email: 		Yadav N, Panja S, Kharjule S, Bhaduri T, Holistic Management of Ankylosing Spondylitis through Ayurveda: A Case Study. J Ayu Int Med Sci. 2025;10(4):344-351.
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https://jaims.in/jaims/article/view/4263/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-03-12 2025-03-27 2025-04-07 2025-04-17 2025-04-27
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© 2025 by Yadav N, Panja S, Kharjule S, Bhaduri T and 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].

J Ayu Int Med Sci 2025;10(4)344
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Neha Y et al. Holistic Management of Ankylosing Spondylitis

Introduction

Ankylosing Spondylitis comes from Greek Word (Ankylos + Spondylitis) Ankylosis means Stiffness or fixation of a joint as a result of a disease process with fibrous or bony union across the joint i.e. fusion and Spondylitis is inflammation of one or more vertebrae. It is defined by the presence of Sacroiliitis and other structural changes which may eventually progress to bony fusion of the spine. There is syndesmophyte formation along the corners of vertebral body with bridging, giving rise to bamboo spine appearance. It usually manifests in 2nd or 3rd decade with male: female ratio of about 3:1 and 0.1 to 1.4 % of global population.[1]

The prevalence of AS in a population is directly related to the frequency of HLA-B27 antigen. Ankylosing Spondylitis evolves slowly, with fluctuating symptoms of spinal inflammation. Secondary osteoporosis of the vertebral bodies frequently occurs, leading to increased risk of vertebral fractures. Spinal fusion varies in its extent and in most cases ankylosis develops in many patients over a period of many years. In India the prevalence of Ankylosing Spondylitis (AS) is estimated to be between 0.7 and 1.0 per 1000 people, with a higher prevalence in men than women. NSAID and Steroids are the drug of choice in conventional methods but fails to provide complete cure. There is no direct reference to this disease in Ayurveda but we can clinically correlate its sign and symptoms to Kati Prishta Trika Graha in contemporary science, as there is marked presence of Shoola (pain), Graha (stiffness) in Kati (pelvis) Prishta (posterior region of trunk from neck to pelvis) and Trika Pradesh (around shoulder girdle). We also get description regarding such disorders under the concept Vata vyadhi as Prishta Graha and Trika Graha which has been mentioned under 80 types of Vataja nanatmaja vyadhi and avarana of Vata with other dosa are also mentioned.

Case Study

A female patient named Mrs. XYZ, 43 yrs of age came to Kayachikitsa OPD of I.P.G.A. E& R at SVSP Kolkata on, OPD Reg.No-AYUR/RG240001xxxx.

Chief complaints with duration

1. Kati Sula (Low back pain) & Stambha (stiffness) for past 4 yrs, not relieved by rest.

2. Griva Graha (Restricted movement of neck) & Prishta Graha (restricted movement of hip joint) for last 4 yrs.
3. Satata Ruja with Panguta (Pain with difficulty in forward bending) for last 3 yrs.
4. Stambha at Griva and Amsa Sandhi (Restricted movement of neck and shoulder joint) for last 2 yrs.
5. Pada Sotha (Swelling) in both feet for last 3 months.

History of present illness

Low back pain radiating to both lower limbs along with stiffness which usually lasts for one hour and after waking up from bed it gradually reduces after some movement or exercise. Patient was unable to sit without support. Even she can’t turn backwards. Restricted joint movement specially at neck, shoulder and hip joint.

Disease gets aggravated by cold exposure and long standing (>15 minutes).

  • Time of onset - 7 yrs ago
  • Mode of onset - Chronic
  • Progress - Gradual.
  • Severity - Severe
  • Past Medical History - Hypothyroidism (On Modern Medication)
  • Past Surgical History - Lower Uterine Segment Caesarean Section.
  • Occupation - House wife
  • Marital Status - Married
  • Family History - Her paternal aunt (elder sister of her father) had same disease.

Vitals

  • Pulse: 78 b/min
  • BP: 126/82 mm of Hg
  • Respiratory rate: 14/min
  • Temp: 98.4˚

General Examination

Patient was Alert, Cooperative & Conscious.

  • Pallor: Present
  • Icterus: Absent
  • Cyanosis: Absent
  • Clubbing: Absent

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  • Oedema: B/L pitting oedema in feet
  • Gait: Antalgic gait
  • Lymphadenopathy: Absent
  • Posture: Altered (cervical lordosis is lost)

Personal History

  • Appetite: Diminished
  • Digestion: Proper
  • Bowel: Constipated
  • Bladder: Regular
  • Sleep: Disturbed due to pain.
  • Diet: Non vegetarian.

Ashta Vidha Pariksha

  • Nadi: Vata-Kaphaja, Manda Gati
  • Mala: Baddha
  • Mutra: Shweta
  • Jihva: Upalipta
  • Shabda: Prakrit
  • Sparsha : Adra
  • Drik: Sthira
  • Akriti: Madhyam

Musculoskeletal System

Inspection:

Loss of cervical lordosis.

Palpation

  • Pain (squeezing in nature) & tenderness in lumbosacral and cervical joint.
  • Chest expansion - 3cm (Inspiration - 37 cm & Expiration - 34cm)
  • Restricted movement of hip and knee joint, difficulty in flexion and abduction, with shorter step length.
  • Schober’s test[2]- positive (< 5cm)
  • Straight Leg Rising Test (SLRT)[3] - Positive
  • Right leg - 15˚
  • Left Leg - 20˚

Below table shows Range of Movement in Cervical Spine, Lumbar spine and Shoulder joint just before the treatment.

SNMotionDegree
1.Cervical SpineFlexion
Hyperextension
Lateralflexion
Rotation		46˚
70˚
10˚
Restricted
2.Lumbar SpineFlexion
Extension
Lateralbending
Rotation		Restricted (B/L)
15˚ (Right leg), 20˚ (Left Leg)
Restricted (B/L)
Restricted (B/L)
3.Shoulder JointAbduction
Adduction
InternalRotation		90˚ (Right), 110˚ (Left)
20˚ (Right), 30˚(Left)
30˚ (Right), 45˚ (Left)

Investigations

16.02.20

  • HLA-B27 POSITIVE;

04.06.24

  • CRP - 7.8, Hb - 10.8%, ESR - 101
  • Digital - X RAY pelvis with both hip joint-subarticular sclerosis of both SI Joints suggestive of B/L Sacroiliitis.
  • Digital - X RAY - cervical Spine: Cervical lordosis is lost. Calcification noted on anterior spinal ligaments.

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jaims_4263_03.JPG

Diagnosis.

She is a pre-diagnosed case of Ankylosing Spondylitis.

On the basis of Dosha & Lakshan we diagnosed this case as Kati Prishta Trik Graha.[4]

Treatment

Shodhana Chikitsa followed by Shamana Aushadhi was planned accordingly.

DateProcedureDrugsDose
06.06.24 to 10.06.24Dipana and PachanaPowder Pancha Kola5gm twice daily before food with one cup of Leuk warm water
11.06.24 to 15.06.24Abhyantar Snehana (internal oleation)Mahatikta Ghrita[5]30 ml once daily morning empty stomach with Leuk warm water
16.06.24 to 19.06.24Abhyanga (External oleation)
Nadi Sweda (Sudation)		Prasarani Taila [6]
Kati Basti[7] with Mahanarayan Taila[8] for 30 days
Dashmoola Kwath
19.06.24Virechana (Purgation)Trivritta Avaleha (50gm) + Abhyadi Modak (2 pills) + Triphala Kwath (50ml) after Samyak Snehana and SwedanTotal Virechana Vega – 15 (Diet - Mudga Juice in Lunch and Dinner)
20.06.24 to 22.06.24Samsarjana KarmaLunch and Dinner
Day 1 - Semisolid Khichdi
Day 2 - Veg boiled
Day 3 - Non-veg boiled.
Day 4 onwards Normal Diet.
23.06.24 to 28.06.24Cupping Therapy[9]--
29.07.24 to 13.08.24Kala Basti for 15 days after Bahya Snehana
&
Sarvang Swedan (Patra Pinda Sweda)[13]		Eranda Muladi Niruha Basti[10,11] (350ml),
Saindhavadi Taila [12] Anuvasana Basti (60 ml)
Ingredients for Patra Pinda -Leaves of Nirgundi, Eranda, Chincha, Dhatura, Shigru, Lemon, Garlic, Grated Coconut, Rasnadi Churna, Haridra, Methika, Saindhav lavana		-
16.08.24Patient was given dischargeSamana Aushadhi mentioned belowPathya & Apathya was instructed.

jaims_4263_04.JPG
Figure 1: Kati Basti

jaims_4263_05.JPG
Figure 2: Patra Pinda Swedan


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jaims_4263_06.JPG
Figure 3: Cupping Therapy

jaims_4263_07.JPG
Figure 4: Erandamuladi Niruha Basti in preparation.

Shamana Aushadhi administered mentioned below.

Drugs (Shamana Aushadhi for one month)DosageAnupanTherapeutic Indication
Trayadasang Guggulu [14,15,16]500 mg twice daily after foodSukhosnajalaKatigraha, Gridhrasi, Bahuprishtahangraha, Majjagatavata, Snayugata etc.
Rasnasaptak Kwath [17]15ml twice daily before foodSukhosnajalaJanghasula, Urusula, Pristhasula, Triksula, Parsvasula
Vaiswanar Churna [18]5gm twice daily after foodSukhosnajalaSula, Vibandha, Vataja vikar
Eranda Taila [19]10ml at bedtimeSukhosnajalaGridhrasi, Urugraha, Katisula

Progress of the treatment

Patient was admitted with severe back pain & stiffness. She was unable to sit properly in squat position associated with difficulty in forward & backward bending.

Therapeutic Procedures and Results

SNTherapeutic ProcedureResults
1.Dipana & Pachana with Powder Pancha kola (06.06.24 to 10.06.24)Lightness of the body and improved digestion.
2.Abhyantar (Internal) Snehana with Mahatikta Ghrita (11.06.24 to 16.06.24).Bahya (External) Snehana with Prasarani Taila (16.06.24 to 19.06.24) + Kati Basti with Mahanarayan Taila + Nadi Sweda.Pain increased.
Pain subsided.
3.After Virechana Karma (19.06.24)She got symptomatic relief.
4.Samsarjana Karma (20.06.24 to 22.06.24)Again, she complained of pain.
5.Cupping therapy (30 minute) at upper back (23.06.24 to 28.06.24)She got relief from stiffness.
6.Basti Karma
(29.07.24 to 13.08.24)		Moderate pain during Niruha Basti which was relieved following Anuvasana Basti.
7.Patra Pinda Sweda for 15 days
(29.07.24 to 13.08.24)		She got mild relief.

Results

This Ayurveda approach tackles the root cause of the disease, exemplifying fundamental principles of Ayurveda. The combined treatment protocol showed encouraging results. Significant improvement was recorded in ASDAS - CRP Score[20] and BASDAI Score,[21] thus making quality of life better than before.

ASDAS - CRP Score Before and After Treatment

ASDAS-CRP ScoreBefore TreatmentAfter Treatment (15th Day After Discharge)
Back Pain (0-10)83
Duration of morning stiffness (0-10)51
Patient Global Assessment of Disease Activity (0-10)63
Peripheral pain and Swelling (0-10)62
CRP7.8 mg/l5.2
Calculated ASDAS -CRP Score3.1361.953
Disease ActivityVery High Disease ActivityModerate Disease Activity

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BASDAI Score Before and After Treatment

BASDAI ScoreBefore TreatmentAfter Treatment
Fatigue83
Spinal pain42
Arthralgia (joint pain) or swelling62
Enthesitis42
Morning stiffness (duration)51
Morning stiffness (severity)31
Disease Activity5.72.0
Very High Disease ActivityModerate Disease Activity

SNMotion (With Degree of Movement)Degree of Movement (Before Treatment)Degree of Movement (After Treatment)
1.Cervical SpineFlexion (40-50°)
Hyperextension (50 - 80°)
Lateralflexion (30-45°)
Rotation (70-80°)		46°
70°
10°
Restricted		48°
76°
12°
Restricted
2.Lumbar SpineFlexion (70-80°)
Extension (20-30°)
Lateralbending (20-30°)
Rotation (10-15°)		Restricted(B/L)
15° (Right Leg)
20° (Left Leg)
Restricted(B/L)
Restricted/L)		Restricted(B/L)
18° Right Leg)
26° (Left Leg)
Restricted (B/L)
Restricted/L)
3.Shoulder JointAbduction (70-180°)
Adduction (30-45°)
Internal Rotation (90-110°)		90° (Right), 110° (Left)
20° (Right), 30° (Left)
30° (Right), 45° (Left)		98° (Right), 120° (Left)
26° (Right),34° (Left)
40° (Right), 60° (Left)

jaims_4263_08.JPG

jaims_4263_09.JPG

Above are the changes observed in ASDAS - CRP and BASDAI Score Before and After treatment in Graphical Representation.

Below Table Shows Changes in Range of Motion Before and After Treatment.

Discussion

Ankylosing Spondylitis is a chronic inflammatory disease. Shodhana Karma followed by Shamana Chikitsa showed promising results in the management of the disease. The present study showed multimodal Ayurveda treatment with encouraging results in the management of the disease. Vata and Kapha are the two main pathological factors in the disease Kati Prishta Trik Graha. Vitiated Vata along with Kapha Dosha gets lodged in Kati Prishta Trik Pradesh causing Sroto Sanga and thereby hamper in the production of Dhatu’s like Asthi. The patient complained of symptoms like Gourava (heaviness), Alasya (lethargy), Aruchi (aversion), Apakti (indigestion), Malasanga (constipation) which are the key features of Sama Dosha. Ama Dosha is the key factor in the pathogenesis of every disease, so powder Pancha Kola was given which enhances digestion and improves Dhatwagni. Sarvanga Snehana with Prasarani Taila followed by Nadi Swedan relieves aggravated Vata-Kapha Dosha thereby it reduces pain and swelling. Patra Pinda Swedan being Ruksha in nature relieves stiffness in the body. Patra applied for Patra Pinda Swedan were Nirgundi (Vitex negundo), Eranda (Ricinus communis), Arka (Calotropis gigantea), Shigru (Moringa oleifera). The leaves were heated and fried together with other ingredients and tied into a bolus which was then massaged all over the body. As the body began to sweat due to the Swedan treatment resulting in reduction of swelling, muscle pain and stiffness. It is also having anti-inflammatory and analgesic effect. Kati Basti with Mahanarayan Taila is found to be very effective in various Vata Vyadhi. On its application it relieves pain and improves Bala (strength) and Varna (complexion). Cupping therapy at upper back increases localised blood circulation thus reducing inflammation and hence alleviates muscle pain and stiffness. Basti is the best line of treatment for aggravated Vata Dosa. Erandamula is said to be best Vatahara Dravya. It relieves the pain located at Janga-Uru-Paada-Trika-Prishta Shoola (thigh, foot, sacral region,


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and back) region and is also Lekhaneeya in action (scrapes out Ama and vitiated Dosha from the body). It also performs Srotosodhan (removing blockage in the channels of circulation) thus performing Samprapti Vighattan. It has a wide spectrum of action and effectively used in various diseases.

Role of Internal Medication

Trayadasang Guggulu has potent Vata Kapha Shamak property and proved anti-inflammatory, analgesic, muscle relaxant and antioxidant action. It is indicated in Katigraha, Snayu Gatavata and other various Vatik disorders. Rasna Saptak Kwath with chief ingredients like Rasna (Pluchea lanceolata), Gokshura (Tribulus terrestris), Guduchi (Tinosporia cordifolia), Punarnava (Boerhavia diffusa), Eranda (Ricinus communis), Devdaru (Cedrus deodara) Aragvadh (Cassia fistula), Sunthi (Zingiber officinale) has excellent Vatahara property. They possess potent anti-inflammatory, analgesic, immunomodulatory and antioxidant properties. It is specially indicated in Jangauropristhatrikaparsa Shula (pain in thigh, back, sacral region, etc). Vaiswanar Churna stimulates digestive fire (Dipta Agni), reduces swelling (Shotha Prasamana) and has potent anti-inflammatory action. Eranda Taila is the drug of choice in Vata Vyadhi, not only it eliminates Ama and other toxins from the body but also it alleviates aggravated Vata Dosha thus reducing pain, stiffness and improves the mobility of the joints.

Conclusion

This study has showed that Ayurvedic treatment modalities is highly effective in the management of Ankylosing Spondylitis, as evidenced by marked reduction in BASDAI & ASDAS score, assessed on the basis of improvement in both signs & symptoms. Thus, the presented paper provided an opportunity for standardisation of Ayurvedic assessments and treatment procedures which are therapeutically safe and effective. This approach may be taken into consideration for further efficient management of Ankylosing spondylitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. The patient has been informed that his initials will not be published and due efforts will be made to conceal the identity.

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