Case Report Volume 13 Issue 4
Department of Kayachikitsa, Government Ayurved College, India
Correspondence: Jasminbegam B Momin, Department of Kayachikitsa, Government Ayurved College, India, Tel 7709691550
Received: June 01, 2020 | Published: July 2, 2020
Citation: Momin JB, Kulkarni PV, Gogate VE. Management of nirupastambhita vatavyadhi – a case study. Int J Complement Alt Med. 2020;13(4):135-141 DOI: 10.15406/ijcam.2020.13.00507
Nirupastambhita vatavyadhi is mainly a dhatukshayajanita vatavyadhi. Young age is a vivardhamana avastha of life but occurrence of this disease in young age is usually due to dhatukshaya. This may be because of changing lifestyle habits and behavioral ways which primarily lead to agnidushti, vataprakopa and ultimately vatavyadhi. Joint pain along with swelling, tenderness, crepitations and restricted movements are the cardinal features of this disease. Some patients also suffer from constitutional symptoms like anorexia, irregular bowel habits, generalized weakness, etc. A case of 18years old male patient suffering from nirupastabhita vatavyadhi is being discussed here. Ayurvedic chikitsa in terms of different modalities like snehana, swedana, dashamula majjasneha basti and various ayurvedic preparations were used according to rugna bala, vyadhi avastha and dosha avastha. Rasayana chikitsa and physiotherapy was also advocated. Nidana parivarjana was strictly followed by the patient during the course of treatment. The holistic approach of ayurveda towards chikitsa of nirupastambhita or dhatukshayajanita vatavyadhi led to satisfactory results with independent walking and free movements of bilateral knee joints of patient. There was much relief in constitutional symptoms and ESR as well as CRP values also got reduced. Thus, ayurvedic multidimensional approach is helpful in the treatment of nirupastambhita vatavyadhi.
Keywords: Nirupastambhita vatavyadhi, dhatukshaya, snehana, swedana, dashamula majjasneha basti, rasayana chikitsa
Ayurveda ‘the science of life’ which is considered as a upaveda of Atharvaveda elaborates the importance preventive, promotive and curative aspects of health.1 This ancient science is primarily based on fundamental theory of tridosha which are namely vata, pitta and kapha dosha.2 Out of these, vata dosha brings the existence as well as destruction to all living things.3 It is the controller of all other bhavapadarthas including pitta, kapha, sapthadhatu and trimalas.3 Vitiation of vata can be caused by two main reasons that is margavarodha and dhatukshaya.4 Hence, vatavyadhis are primarily classified into two types based on these etiological factors and these are ‘upastambhita or margavarodhajanya vatavyadhi’ and ‘nirupastambhita or dhatukshyajanita vatavyadhi’.5 Though the common hetus of vataprokapa are responsible for the pathogenesis of both these types, upastambhita vatavyadhi has kaphaprakopaka and aamotpadaka hetus also. Nirupastambhita vatavyadhi mainly occurs in old age because of dhatukshaya6 but occurrence of this disease in young age is mainly due to changing lifestyle and behavioral ways like fast-food, irregular dietary habits, lack of exercise, sedentary routine work, etc. Purana of prakupita vata occurs in the rikta or empty srotasas.5 During this process, the walls of srotasas are stretched due to the force of vayu which lead to weakening of srotasas and vitiated vata overwhelms these weakened srotasas to produce the disease.5 Shleshaka kapha in the joints also get reduced in quality and quantity and sandhishaithilya is seen.7 The ashrayashrayi sambandha leads to asthi dhatu kshaya and kshaya leads to khavaigunya in the joints and the pathogenesis of the disease continuous.7 The continuous hetusevana leads to severity of the disease.
Allopathic line of treatment has its own limitations in managing this disease. It provides mainly symptomatic treatment by using analgesics, anti-inflammatory drugs but produces troublesome side effects also.6 A case of 18 years old male patient suffering from dhatukshayajanita vatavyadhi is being discussed here who was treated with conventional ayurvedic treatment. Sthanika chikitsa and basti karma along with abhyanatara snehapana, shamana aushadhis, rasayana chikitsa and physiotherapy was administered to the patient according to vyadhi avastha, rugna bala and dosha bala. Nidana parivarjana was strictly followed and this gives the excellent results in all the complaints including joint pain, swelling and limb weakness. The constitutional symptoms were also much improved and laboratory values of ESR and CRP were also significantly reduced. This holistic approach of ayurveda towards nirupastambhita vatavyadhi chikitsa gave satisfactory and encouraging results.
To study the efficacy of holistic approach of ayurvedic chikitsa towards nirapstambhita or dhatukshayajanita vatavyadhi.
Objectives
A clinical case study at our institute. Ayurvedic treatment comprising of snehana, swedana, basti karma along with abhyanatara snehapana, shamana aushadhis, rasayana chikitsa and physiotherapy was given to the patient.
Case report
Patient’s name – XYZ
Age – 18years
Sex – Male
Occupation – Student
A 18years old male patient was apparently normal and healthy before 6 months. Later on, he was having pain at left calcaneus region which was then proceeds to the left forefoot region. For this, he was treated with symptomatic medicines and 5 injections of calcium gluconate. Because of this treatment, he was suffered from complaints of loose motion, loss of appetite and generalized weakness. Then gradually, there was pain and swelling initially over the right knee joint and then over the left joint. Also, there was severe weight loss of the patient. His weight was reduced from 48kg to 33kg within a period of 6 months. Then he was treated with symptomatic treatment and steroid therapy for all these complaints. By this time, he got relieved from the complaints of GIT but the complaints of pain and swelling over bilateral knee joints became more severe. Along with these, he was having weakness and pain at both lower limbs and difficulty in walking. In addition, he was also having complaints of fever, irregular bowel habits, anorexia and generalized weakness. Then he came to OPD of our institute where he was treated with ayurvedic treatment comprising of snehana, swedana, basti karma along with abhyanatara snehapana, shamana aushadhis, rasayana chikitsa and physiotherapy.
Hetu: Ati amla rasapradhana aahara, vishamashana, adhyashana, increased frequency of non-vegetarian diet, bhojanottara atyadhika jalapana, divaswapa, ratrau jagarana
Purvaraupa: Pain and swelling over right knee joint
Rupa
Upashaya: Upashayanugami
Samprapti ghataka
Dosha |
Mainly vata dosha, samana, vyana, apana vayu, Pitta dosha,Pachaka pitta, Kapha dosha, Kledaka, shleshmaka kapha |
Dushya |
Rasa, meda, asthi dhatu |
Upadhatu |
Sira, kandara, snayu |
Mala |
Purisha, sweda |
Srotasa |
Annavaha, asavaha, medovaha, sthivaha, purishavaha, swedavaha |
Srotodushti prakara |
Sanga and vimarga gamana |
Udbhava sthana |
Aamashaya |
Abhivyakti sthana |
Asthi, sandhi |
Rogamarga |
Madhyama marga |
Vyadhi svabhava |
Chirakari |
Treatment
The treatment was administered to the patient by considering following criteria
Sthanika karma and basti karma
Patient was having mainly complaints of bilateral knee joint pain with swelling and pain with weakness of both lower limbs. Hence, following sthanika karmas were done in order to get relief of the symptoms:
The above sthanika karmas were done for the period of two months. Along with these, dashamula majjasneha basti was administered to the patient. Bastidravya was prepared from fresh majja of goat and dashaula kwath and it was scheduled as a gap of one day after each seven days for the duration of two months.
Abhyantara snehapana: Patient was having agnimandya, aruchi, aasyavairasya. Hence, it was decided to give abhyantara Snehapana as acharya Charaka have stated that ghrita is excellent for stimulating the digestive fire. For this following ghrita were selected.
Shamana aushadhis
Oral ayurvedic preparations were selected based on their useful properties to pacify vitiated doshas and for the sampraptibhanga of the disease. These aushadhis were administered for the period of 1 month.
Rasayana chikitsa
After the administration of all karmas, snehapana and shamana aushadhis, there was samyaka kshudhapravartana and improved digestive capacity also. The intensity of joint and bilateral limb pain was also much reduced but there was still severe muscle wasting of the patient. Hence in order to achieve balya, brihana and rasayana karma, following preparations were used.
Pathya – apathya
Pathya – Aahara – Laghu, ushna aahara, Panchakola peya
Apathya – All the hetus
Physiotherapy
Patient was having severe joint pain and swelling along with bilateral weakness and pain of lower limbs. Hence physiotherapy was done for two times a day according to patient’s capacity. Suitable distance walking, knee exercise, lumbar and lower limb exercise along with pranayama and mild yogasanas was conducted.
The administration of foresaid ayurvedic chikitsa in both bahya and abhyantara ways led to improved agnisandhukshana, improved digestion and samyaka malapravartana. Complaint of mild feverishness was also much reduced. The pain and swelling of bilateral knee joints was markedly reduced. Generalized weakness and weakness of both lower limbs was also significantly reduced. This led to improvement in the quality of life of patient.
Sr. No |
Present complaints |
Duration |
1 |
Pain and swelling at bilateral knee joints |
All complaints |
2 |
Pain and weakness at both lower limbs |
|
3 |
Difficulty in walking |
|
4 |
Low grade temperature |
|
5 |
Anorexia |
|
6 |
Irregular bowel habits |
|
7 |
Generalized weakness |
Table 1 Present complaints with duration
Date |
Investigation |
Value/Findings |
24/04/2019 |
Stool for occult blood |
Absent |
25/04/2019 |
Mantoux test |
Negative |
4/5/2019 |
HIV I and II |
Non-reactive |
19/11/2018 |
Serum uric acid |
4.03mg/dl |
19/11/2018 |
RA factor |
2.61IU/ml |
12/12/2018 |
ESR |
150mm/hr |
12/12/2018 |
CRP |
125.9mg/L |
5/2/2019
|
Thyroid profile – T3 |
87.02ng/dl |
T4 |
8.79μg/dl |
|
TSH |
2.293µIU/ml |
|
3/2/2019
|
Liver function test – |
|
Total bilirubin |
0.20mg/dl |
|
SGOT |
25IU/ml |
|
SGPT |
14IU/ml |
|
|
Alkaline phosphatase |
146IU/ml |
12/12/2018
|
Kidney function test – |
|
Blood urea |
22mg/dl |
|
Blood urea nitrogen |
10.27mg/dl |
|
Serum creatinine |
1mg/dl |
|
23/04/2019 |
Widal test |
Negative |
3/2/2019
|
Haemoglobin |
9.3gm/dl |
Platelet count |
5,25,000/cumm |
|
19/11/2018 |
Blood sugar level |
66.7mg/dl |
23/04/2019
|
Urine examination – |
|
Appearance |
Cloudy |
|
Albumin |
++ |
|
8/4/2019 |
USG – abdomen and pelvis |
Normal findings |
Table 2 Showing laboratory investigations done to rule out the disease
Sr. No |
Ashtavidha bhava |
Findings |
1 |
Nadi |
90/min, Sarpa gati, Regular |
2 |
Mala |
Irregular bowel habits, taking long time for defecation |
3 |
Mutra |
Samyaka pravartana |
4 |
Jihva |
Saama |
5 |
Shabda |
Spashta |
6 |
Sparsha |
Ushna, ruksha |
7 |
Drika |
Panduvarni |
8 |
Aakriti |
Krisha |
Table 3 Samanya Parikshana
Sr. No |
Shamana aushadhi |
Matra |
Sevana kala |
Anupana |
Properties |
1 |
Guduchi, aamalaki, musta churna |
5m Thrice a day |
Before meal |
Koshna jala |
Agnideepana, pachana, |
2 |
Udumbaravaleha |
10ml Twice a day |
After meal |
Koshna jala |
Doshashamana, sandhanakara |
3 |
Cap Guggulu tiktaka ghrita |
1 BD Twice a day |
After meal |
Koshna jala |
Aruchighna, deepana, pachana, jwaraghna, twacha and mansa sthirikarana, snehaniya, sandhaniya |
Table 4 Showing shamana aushadhis administered to the patient
Sr. No |
Aushadhi |
Matra |
Sevana kala |
Anupana |
Duration |
Properties |
1 |
Kushmanda rasayana |
10gm Twice a day |
Before meal |
Koshna jala |
For 20days |
Madhura rasa, madhura vipaka, sheeta veerya, snigdha, brihana, balya, vatashamana, tarpana, sthairyakara |
2 |
Cap Mahaprasarnyadi taila |
1 BD Twice a day |
After meal |
Koshna jala |
For 1month |
Vatahara, snehaniya, vedananashana |
3 |
Sukshma Laghumalini vasanta |
125mg Thrice a day |
After meal |
Koshna jala |
For 48days |
Balya, deepana, pachana, rasayana, useful in dhatugata jwara, jeernajwara |
Table 5 Showing aushadhis administered in order to achieve rasayana karma
Signs and symptoms |
Before treatment |
After treatment |
||
Right knee |
Left knee |
Right knee |
Left knee |
|
Pain |
++ |
++ |
- |
- |
Swelling |
++ |
++ |
- |
- |
Temperature |
++ |
++ |
- |
- |
Tenderness |
++ |
++ |
- |
- |
Crepitations |
++ |
++ |
- |
- |
Table 6 Knee examination
Angles |
Before treatment |
After treatment |
||
Right knee |
Left knee |
Right knee |
Left knee |
|
Angle of extension |
180° |
150° |
180° |
180° |
Angle of flexion |
40° |
40° |
0 |
0 |
Table 7 Angles of both knee joints
Limb |
Before Treatment |
After Treatment |
||
|
Right |
Left |
Right |
Left |
Upper limbs |
3 |
3 |
4+ |
4+ |
Lower limbs |
1 |
1 |
4 |
4 |
Table 8 Muscle power
Investigations |
Before treatment |
After treatment |
ESR |
150mm/hr |
50mm/hr |
CRP |
125.9mg/L |
12.59mg/L |
Table 9 The following blood investigations shows significant reduction in values as
Sr. No. |
Aushadhis |
Matra |
Sevana Kala |
Anupana |
Duration |
Properties |
1. |
Cap Mishraka Sneha |
1 BD Twice a day |
Before meal |
Koshna jala |
For 15days |
Snehayukta virechana useful vibandha produced mainly due to vata dosha
|
2. |
Cap Ksheerabala taila |
1 BD Twice a day |
After meal |
Koshna jala |
For 15days |
Balya, brihaniya, vrishya, snehaniya
|
3. |
Tab Vasanatkusumakara rasa |
1 BD Twice a day |
After meal |
Koshna jala |
For 1month |
Baya, vrishya, pushtikara useful in kshaya roga
|
4. |
Dahtupaushtika churna |
3 gm Twice a day |
After meal |
Koshna jala |
For 1month |
Dhatuposhana, balya, sandhaniya
|
5. |
Takrarishta + Amrutarishta |
30ml Twice a day |
After meal |
Koshna jala |
For 1month |
Agnideepana, ruchikara, shothagna, kapha-vatanulomaka
|
6. |
Sukshma Suvarnamalini Vasanta |
125mg Thrice a day |
After meal |
Koshna jala |
For 1month |
Balya, rasayana, deepana, pachana, jeernajwarahara, Kshayaghna, dhatuposhana
|
Table 10 Showing treatment given at the time of discharge of patient
Nirupastambhita vatavyadhi is a dhatukshayajanita vatavyadhi. Acharya Charaka have explained in detail about the different treatment modalities like snehapana in all possible bahya and abhyantara ways and various types of swedana vidhis. These were used here which gave excellent results to the patient. Along with these, shamana aushadhis and rasayana chikitsa were administered. At the same time, nidana parivarjana was strictly obeyed by the patient himself and his relatives. Physiotherapy also helped a lot to minimize the complaints of joint pain and limb weakness. Patient was having marked improvement in agnisandhukshana, digestive capacity and bowel habits were also markedly improved. The ESR and CRP values got much reduced and show significant difference after the treatment that means inflammation also got reduced. Patient became able to walk independently with full flexion and extension of bilateral knee joints. In this way, there was no worsening of the complaints of the patients. The results were satisfactory and encouraging and this led to improvement in the quality of life of patient. Thus, by using ayurvedic treatment, the udbhava sthana of vyadhi that is dushta aamashaya was cured and abhivyakti sthana of lakshanas that is lakshanas at asthi and sandhi were improved. This ayurvedic multidimensional approach is helpful in the treatment of nirupastambhita vatavyadhi.
The entire staff of Government Ayurveda College, Nanded provided a big contribution in the satisfactory management of the case.
There is no conflict of interest.
None.
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