CTMJ | traditionalmedicinejournals.com Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 1 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 2 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 3 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 4 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 CTMJ | traditionalmedicinejournals.com Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 5 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 CTMJ | traditionalmedicinejournals.com Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue4 6 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