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Chinese Traditional Medical Journal 

Management of Avascular Necrosis through Ayurveda - A Case Study 

 Nduuisi Nwobod, Zhouj Chungan, Zhanh Zhibigh 

Department of Pharmacology and Therapeutics, Faculty of Medicine, Ebonyi State University, Abakalik, 
Research Center of Traditional Chinese Medicine, Wuxi Hospital of Traditional Chinese Medicine , China 
Research Center of Traditional Chinese Medicine, Wuxi Hospital of Traditional Chinese Medicine China., 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 
 A There is vascular necrosis (AVN) in young 
adults, where 60 per cent of the cases are 
bilateral and osteonecrosis (dead bone). An 
injury or blockage in the blood veins feeding the 
bone tissue is the most common cause, and it 
affects around 16,000 Indians each year. The 
most prevalent form of bone necrosis is AVN of 

the femoral head. In general, there are two 
categories to choose from: Traumatic brain 
injury Ailment that has no known cause. The 
arteries that feed the femoral head are very 
small, making them vulnerable to damage when 
the femoral neck is dislocated or fractured. This 
results in necrosis of the femoral head as a 
consequence of a lack of nutrients. In the 

ABSTRACT 
Background: This disorder, known as avascular necrosis (Avn), is becoming more common in 
musculoskeletal clinics. Osteonecrosis is a condition in which bone tissue dies as a result of an injury 
or obstruction in the blood supply. This is the most frequent kind of necrosis, occurring from a loss of 
feeding due to an injury to the and Majja Kshaya (the loss of bone tissue), play key roles in the 
pathophysiology of AVN. 
 Aim: For the evaluation of the effectiveness of Panchatikta Kshira Basti (enema produced from Tikta 
Dravya like Nimba (Azadirachta indica), Patola (Trichosanthes dioica), Vyagri (Solanum surattence), 
Guduchi (Tinospora cordifolia), and Vasa (Adhatoda vasica) in the treatment of avascular necrosis. In 
addition to relieving pain, the therapy aims to preserve structure and function. 
 Materials & Methods: As a result of this case study, we are reporting on a 23-year-old patient with 
bilateral hip discomfort and trouble performing everyday tasks like as walking, sitting, and squatting, 
at the Panchakarma OPD at the All India Institute of Ayurveda New Delhi Panchakarma 
Ophthalmology. Dashmooladi Niruha Basti, Panchatikta After Basti and a follow-up period of 15 days, 
an evaluation was conducted. 
 Observations: Pain, soreness, weakness, and gait improvement were all completely alleviated as a 
result of the treatments. 
Conclusion: According to the findings, Panchatikta Kshira Basti is a viable therapeutic option for 
patients with Avascular Necrosis. 
Keywords: An Ayurvedic treatment for Asthi Majja Kshaya, or Avascular Necrosis.  

 



CTMJ | traditionalmedicinejournals.com                                      Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 
 

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beginning, there may be no symptoms, but later 
on, mild to severe discomfort and a change in 
stride are seen. Between the ages of 20 and 40, 
it affects one in every ten people. There are 
several chronic and untreatable AVN illnesses 
that Ayurveda has been able to treat. [2] When 

it comes to disorders that aren't covered in 
Ayurveda books, Ayurvedic Chikitsa concepts 
must be implemented clinically (unmentioned 
disease). Additionally, Panchakarma (five 
therapeutic procedures) treatment's efficacy 
was evaluatedModern research recommends 
unpleasant surgical methods to treat AVN of the 
femoral head. A case of AVN was treated using 
this idea, and the treatment's results are 
discussed in the following paragraphs.. 
 
Materials & Methods 
Case Report: Patients at the All India Institute of 
Ayurveda New Delhi, a 23-year-old male with 
AVN (dated 16/02/2017 OPD NO.154670) who 
had complained of pain in the bilateral hip 
region for 1.5 years and difficulty performing 
daily activities such as walking, sitting, and 
squatting came to the institute with these 
complaints. Cold weather, stomach discomfort, 
and a supine position were all aggravating 
variables. Warm meal and warm weather were 
easing influences.. 
 
Past History: The patient said he was well for 
about a year and a half before he started 
experiencing discomfort in his left hip joint. The 
discomfort persisted throughout the day and 

worsened at night. An orthopaedic surgeon 
diagnosed the patient with bilateral femoral 
head AVN using MRI and advocated surgery, but 
the patient was hesitant.  
and he approached the present treatment 

facility for conservative and alternative 
treatment  
. 
 
Patient had no H\o alcohol consumption or any  
trauma or accidental injury. 
 
Examination of Patient: 
An Ayurvedic and contemporary medical team 
examined the patient thoroughly, with the 
results summarised in tables 1 through 2. 
Table no. 1: Aaturbala Pramana Pariksha 
examination of the strength of the patient): 
Table no. 2: Asthavidha Pariksha (Eight fold 
examination): 
*Dosha: Vata 
There are many other names for him, but he 
goes by the name Pakvashayo *Adhisthan:  
 
Pakvashayo *Dushyo: Raktsiru, Siru, Snayu, 
Asthi 

1 Prakruti (Constitution 

of the person) 
Vatapradhan Pitta, Rajas 

2 Sara (quality of tissue) Madhyam (average):Ras, 

Rakta, Mansa 

3 Samhanana (body built 

up) 
Madhayama (average) 

4 Pramana 

(antropometric 

measurement) 

Wt.40kg Ht.5feet 

5 Satmya (adatability) Madhyama (average) 

6 Satva (mental strength) Uttama (good) 

7 Aaharashakti (food 

intake and digestion 

capacity) 

Abhyavaharan : (average) 

Jaran : 5-6 hrs. 

8 Vyayamashakti (exercise 

capacity) 

Avara (poor) 

9 Vaya (age) Yuvavastha (adult) 

10 Desha (habitat) Sadharana 

1 Nadi (pulse) 80/Minute, Regular 

2 Mutra (urine) Samyaka 

3 Mala (stool) Samyaka 

4 Jivha (tongue) Nirama 

5 Shabda (sound) Spashta 

6 Sparsha (touch) Samsheetoshna 

7 Drik (eye) Spashta 

8 Aakriti (built) Krusha 

 

 

  



CTMJ | traditionalmedicinejournals.com                                      Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 
 

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When the blood flow to the head of the femur 
is compromised, it produces weakness in the 
neck, head, and hip joint in Samprapti 
(pathology). Degenerative changes in the hip 
joint are brought on by overindulgence in foods 
and practises that increase Vata, resulting in 
acute discomfort and difficulties moving the hip 
joint. 
Investigation: 
1. On the most recent MRI (done on 
October 3, 2016), there is a moderate effusion 
in the left hip joint, as well as Grade III avascular 
necrosis of the left femoral head. 
It is possible that the right femoral head has 
been damaged by avascular necrosis. 
 
A negative result for HbsAg 
Treatment  Administered: 
The patient received both pharmacological and 
procedural therapy.. Tables 3 and 4 provide the 
specifics. 
Table no.3: details of medicine aadministered 
Sr. 

no. 

Drug Dose Anupana Duration 

1 Dashmoola 

Kwatha 

10 ml 

TDS 

Luke warm 

water 

3 weeks 

2 Kaishore 

Guggulu 

500 mg 

TDS 

Luke warm 

water 

3 weeks 

3 Panchatikta 

Guggulu 

Ghrita 

1 tsp 

BD 

Luke warm 

water 

3 weeks 

4 Panchasakar 

Choorna 

5 gm 

bed 

time 

Luke warm 

water 

3 weeks 

Table no.4: Details of therapies administered 
Sr no. Treatment Drug used 

1 Sarvanga Abhyanga (full 

body massage) 

Ksheerbala Taila 

2 Bashpa Swedana (Full body 

fomentation) 

Dashmoola Kwatha 

3 Kaal Basti Niruha Basti 

Content 

Madhu (Honey) 

Saindhava Lavana 

Panchatikta Guggulu 

Ghrita [4] 

Shatapushpa Kalka 

Dashmoola Kwatha 

Goksheer (Cow’s 

Milk) 



CTMJ | traditionalmedicinejournals.com                                      Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 
 

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Table 5: Kaal Basti schedule administered in 

the patient 
Observations 
Table 6 shows post-treatment improvements in 
hip joint range of motion and pain as measured 
by the Vas Numerical Pain Distress Scale (Chart 
1). After therapy, the range of motion and level 
of discomfort in the hip joint significantly 
improved 
Table no.6: Observation of pre and post 
treatment changes in hip joint 

S. 

No. 

Sign and 
Symptoms 

BT AT Normal Range 

1 Flexion of 

Hip Joint 

30° 90° 110° - 120° 

2 Extension 

of Hip Joint 

0° 10° 10° - 15° 

3 Abduction 

of Hip Joint 

20° 35° 30° - 50° 

4 Adduction 

of Hip Joint 

10° 20° 20° - 30° 

5 Medial 

Rotation 

10° 25° 30° - 40° 

6 Lateral 

Rotation 

20° 40° 40° - 60° 

Chart no. 1: Vas Numerical Pain Distress Scale 
 
 
 
 

Day Basti Dose 
(ml) 

Time of 
administration 

Time of 
Bastipratyagamana 
(expulsion of enema 

material) 

Symptoms/ Observations Complicat 
ions if any 

1 A 60 11 am 2 pm Stool frequency twice None 

2 A 60 11:15 am 2 pm Stool frequency once None 

3 N 500 11 am 11:10 am Bowel frequency once None 

4 A 60 11:30 am 2:15 pm Bowel frequency once, lightness 

present 

None 

5 N 500 10:30 am 10:45 am Bowel frequency once, lightness 

present 

None 

6 A 60 10:45 am 1:30 pm Bowel frequency once, lightness 

present 

None 

7 N 500 11am 11:15 am Bowel frequency once, Lightness 

present, Taste in food 

None 

8 A 60 11 am 3:20 pm Bowel frequency once, Lightness 

present, Taste in food, Vatanulomana 

None 

9 N 500 11:15 am 11:20 am Bowel frequency once, Lightness 

present, Taste in food, Improvement 

in digestion, Vatanulomana 

None 

10 A 60 11 am 3:30 pm Bowel frequency once, Lightness 

present, Taste in food, Vatanulomana 

None 

11 N 500 11:30 am 11:35 am Bowel frequency once, Lightness 

present, Taste in food, 

None 

12 A 60 10:30 am 2:40 pm Bowel frequency once, Lightness 

present, Taste in food, Vatanulomana 

None 

13 N 500 10:30 am 10:40 am Bowel frequency once, Lightness 

present, Taste in food 

None 

14 A 60 10:45 am 4:20 pm Bowel frequency once, Lightness 

present, Taste in food 

None 

15 A 60 11 am 3:10 pm Bowel frequency once, Lightness 

present, Taste in food 

None 

16 A 60 11 am 2:25 pm Bowel frequency once, Lightness 

present, Taste in food 

None 



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Discussion 
There is no clear correlation between avascular 
necrosis and Ayurveda, however the clinical 
presentation suggests the dominance of Vata 
Dosh and Vikruti (vitiation) of Asthi Dhatu (Asthi 
Dhatu's vitiation) (bony tissue). Femoral 
necrosis may occur as a result of any 
Margavrodha (occlusion of blood vessels), and 
this necrosis is the primary cause of AVN. Dhatu 
is also angered by Margavrodha's actions. It is 
at this advanced stage when necrosis-induced 
Vata Dosha imbalance is leading Pitta and 
Kapha to become vitiated as well. Treatment for 
Vata, Pitta, Kapha, and Rakta doshas begins 
with Basti. [5] It is Tikta Dravye Sadhite Ksheera 
Asthikshayaja Vikara makes a particular 
mention of Basti (disorders caused by decrease 
of Asthi Dhatu). [6] 
Probable mode of action of Panchatikta Ksheera 
Basti: 
Vata Dosha may be controlled by the decoction 
produced in milk that has Madhura (sweet) and 
Snigdha (unctuous) characteristics, and the 
Sukshma Guna (minute properties) of Saindhva 
(rock salt) gets up to the micro channels of the  
body and helps open new blood flow to the 
bone tissue. This Basti's Tikta Dravyas include  
Tikta Rasa, Ushana Virya (hot potency), 
Madhura, and Katu Vipaka (pungent post-
digestive taste), all of which promote proper 
Dhatvagni (metabolic stage) function and so 
boost the Asthi Dhatu's nourishment. It is said 
that Ghrita is the 'pacifier of Vata,' and that  

Madhura, 'Shita Virya' (cold potency). In this 
way, Vata is regulated, the metabolism of tissue 
is boosted, and the body's ageing process is 
slowed down. It has the capacity to accelerate 
the bioavailability of other medications because 
of its qualities of Sanskarasya Anuvartana [8]. 
As a result, it contributes to the Asthi Kshaya's 
Samprapti Vighatana (pathology breakdown). In 
Anuvasana Basti, which is mentioned in Vata 
and Rakta Vikara, Madhuyashti Taila was 
employed. 
Role of internal medicine 
To ease discomfort, patients were given 
Dashamool Kwatha (the decoction of 10 herbs), 
which is thought to have Tridosha (three 
humours) calming effects in general, as well as 
calming Vata in particular,[9]. In Vatarakta, 
where blood vessel blockage is the primary 
pathology, Kaishore Guggulu is the medicine of 
choice. [10] So, in this condition also it Perhaps 
improved blood flow to the femur's head. In the 
form of Basti, Tiktaka Ghrita with milk is 
recommended for the treatment of disorders of 
the bone, such as Asthi and Sandhi (joints), and 
this may have contributed to the bone's 
sustenance. To aid in the cleaning of the 
digestive tract, Panchasakar Choorna (powder 
of five sweeteners) is prescribed (normalising 
the movement of Vata). 
Conclusion 
According to this case study, Panchatikta Kshira 
Basti is a good treatment for avascular necrosis 
of the femoral neck when combined with other 
palliative medicines. Further studies are 
needed, however the evidence shows that 
Ayurveda may be quite helpful in the treatment 
of AVN when used in conjunction with an 
accurate diagnosis and the appropriate 
treatment regimen. In this instance, the 
recovery was encouraging and warranted 
documentation 
References 
  
1.Payal P. Suryawanshi, G.H. Kodwani, M.A. 
Aurangabadkar. Ayurvedic management of Avn 
(avascular necrosis of femoral head) anukta 
vyadhi- a case study. IAMJ.2107;5(2):2320-5091 



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2.Mahe s hw ari J. Es s e nti a l o r tho pae d i c s 
, Miscellaneous Affections of the Bone. 3rd ed. 
New Delhi: Mehta Publishers; 2003, p.270 
3.Vagbhata, Arunadatta, Hemadri, 
Astangahrdaya, Sarvang asundara and 
Ayurvedarasayan commentary, Vatashonita 
Chikitsa  Adhyaya, Chikitsasthana, Chapter 22, 
verse 41-44, Edited by Pt.Hari Sadasiva Sastri 
Paradakara Bhisagacarya, Varanasi: 
Chaukhambha Surbharati Prakashan; 
2017,p.731 
4.Ibidem Astangahrdaya [3], Vatavyadhi Chikitsa 
Adhyaya, 21/57-60, p.726 
5.Agnivesa, Caraka, Drdhabala, Carakasamhita, 
Ayurvedadipika commentary of Cakrapanidatta, 
Vatashonita Chikitsa Adhayaya, Chikitsasthana, 
chapter 29, verse 88, Edited by Vaidya Yadavji 
Trikamji Acharya, Varanasi: Chaukhambha 
Surbharati Prakashan; 2016,p.631 
6.Ibidem Carakasamhita [ 5 ], Sutrasthana, 
Vividhaashitpeetiya Adhayaya, 28/27, p.180 
7.Patil, Vasant. Principles & Practice of 
Panchakarma (A Comprehensive Book  For 
UG,PG, Researchers & Practitioners); 4th ed. 
New Delhi: Chaukhamba Publication; 2014, 
p.497 
8.Ibidem Carakasamhita [5],Snehaadhayaya 
Adhayaya, Sutrasthana, 13/13, p.82 
9.Bhavamishra, Bhavaprakash, Guduchyadi 
Varga, verse 41, Edited by Sri Brahmasankar 
Misra,11th ed. Varanasi: Chaukhambha Sanskrit 
Bhawan; 2007,p.294 
10.Kanjiv Lochan, Bhaisajya Ratnavali of 
Govinda Dasji Bhaisagratna commented upon 
by Vaidya Shri Ambika Datta Shastri, Vol.II, 
Chapter 27, Verse 98-108, Varanasi: 
Chaukhamba Sanskrit Sansthana; 2006,p.257 
  
 


