“MANAGEMENT OF AVASCULAR NECROSIS (AVN) WITH AYURVEDIC APPROACH: A SINGLE CASE STUDY”

About Author

Correspondence Address

Kaychikitsa department,Pakwasa Samanvaya Rugnalaya,Shri Ayurved Mahavidyalaya Hanuman Nagar Nagpur
Contact No. : 8600242556, Email : narmada.meshram1997@gmail.com

Date of Acceptance : 27 Mar 2025

Date of Publication : 31 Mar 2025

Article ID : SD-IJAY_124

How to cite this article : http://doi.org/10.55552/SDNJAY.2025.3103

Abstract

Introduction

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years. A broken bone or dislocated joint can stop the blood flow to a section of bone. Avascular necrosis is also associated with long- term use of high-dose steroid medications and too much alcohol. Anyone can be affected but the condition is most common in people between the ages of 30 and 50. Some people have no symptoms in the early stages of avascular necrosis. As the condition worsens, affected joints might hurt only when putting weight on them. Eventually, you might feel the pain even when you're lying down. Pain can be mild or severe. It usually develops gradually. Pain associated with avascular necrosis of the hip might center on the groin, thigh or buttock. Besides the hip, the shoulder, knee, hand and foot can be affected. Some people develops avascular necrosis on both sides, such as in both hips or in both knees. Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by, Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels⁽²⁾. Cancer treatments involving radiation also can weaken bone and harm blood vessels. Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels. This can reduce blood flow to bones⁽³⁾.

Certain diseases, Medical conditions, such as sickle cell anemia and Gaucher's disease, also can lessen blood flow to bone. Sometimes the cause of avascular necrosis not brought on by trauma isn't fully understood. Genetics combined with overuse of alcohol, certain medications and other diseases likely play a role.Untreated,avascular necrosis worsens. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, possibly leading to severe arthritis.⁽⁴⁾

Discussion

The main intention of the treatment was conservative management and to improve the quality of life of the patient. The main complaint of the patient was pain in the bilateral hip joint, which indicates involvement of Vata dosha in Asthivaha srotas. AVN is caused by a lack of blood supply to a particular part of the bone. Due to the Marga avarodha of vayu, the blood supply to the femoral head is reduced. Increased Vata dosha finally resulted in the Kshaya of Asthi Dhatu. Hence, considering the vata involvement and Rakta prasadaka and Asthiposhaka concepts, Jalaukavacharana is indicated for vascular diseases.⁽⁵⁾ AVN can be correlated in Ayurveda with Asthimajjagat vata. Acharya Charaka mentioned that the line of treatment for Asthi kshya is Panchakarma chikitsa, especially Basti with Ksheera, gritha, and Tikta dravyas⁽⁶⁾. Panchatikta ksheera basti ingredients are mainly Tikta, Kashaya rasa Raktashodaka, and Guggulu tikta gritha, which improve Dhatu upachaya. Ksheera is Jeevaniya and Brimhaniya. Hence, the Marga avarodha of Vayu leading to vascular obstruction can be overcome by the administration of basti⁽⁷⁾. Along with that snehana, Kati basti, Shashtishali pinda sweda, jaloukavacharan, and internal medications planned for this patient. The probable mechanism of action of the planned treatment protocol can be explained as follows:

Mode of action of Panchakarma Chikitsa

1) Snehana:

Abhyanga : In this process taila was applied on body and massage was done due to this mechanical pressure exert on muscles which helps to increasing arterial pressure as well as  muscle temperature from rubbing. Ayurvedic properties of taila is Snigdha, guru, Ushna which is totally opposite to vata dosha. So, taila help to reduce the vitiated Vata Dosha⁽⁸⁾. Here Abhyanga was done with balashwagandhadi tail.which is mainly contain Bala, ashwagandha, erand, shatavari and til tail, which is mainly act as balya.

2) Swedana:

Shashtishali Pinda Sweda : It is a type of Snigdha Sweda,has lipid in it. In this Swedana type, Drugs Pottali is applied on body parts, capillaries at that site get dilated due to warmth and allows the absorption of drug locally and get absorbed into the Dhamani and apparently reaches to strotas, leading to santarpana⁽⁹⁾. Here due to degeneration of bone vikruti of Asthi, Snayu, found and blood supply to bone reduces. So, as a Santarpana aspect it was given.

3) Basti:

Panchtikta kshir basti: Acharya Charaka has mentioned Tikta Kshir Basti in Asthi Pradoshajanya Vikara. They haven't mentioned specific ingredients. So, Ashwagandha and Shatavari possess Tikta Rasa and Rasayana properties, along with that Asthishrunkhala has been selected as Kalka dravya. Shatavari has Vata, Pitta, and Rakta Shamaka properties and naturally contains formed phytoestrogens, which increase bone mineral density, and Asthishrunkhala is a Vata Kapha Shamaka and helps the bone healing process. All these medicines have bone healing properties along with anti-inflammatory, anti-aging, and sedative properties⁽¹⁰⁾. So it was found to be very effective in degenerative changes of Asthi, which leads to AVN.

4) Jaloukavacharan:

Jaloukavacharan is a unique Ayurvedic treatment that offers a promising approach to managing AVN. By removing stagnant blood, reducing inflammation, and promoting angiogenesis and bone rejuvenation, Jaloukavacharan helps to alleviate symptoms and promote healing in AVN patients.⁽¹¹⁾

Mode of action of Shaman Chikitsa

1) Trayodashang Guggul:  Trayodashang guggul have total 14 ingredients, among these most of the drugs have tikta,kashaya,madhura rasa, ushna veerya, katu vipak and  Vata hara property.It act as Vednasthapaka, rasayana, balya.⁽¹²⁾

2) Panchatikta Ghrita: It is an ancient form of ghee prepared from 5 herbs blended in ghee that help fight infection, calm the Vata, Pitta, and Kapha, and purify the blood. Its mystical ingredients have anti-inflammatory, antitoxin, and antipruritic properties that go deep into the tissues.⁽¹³⁾

3) Panchatikta ghrut guggul: It is a Guggul kalpa with Synergistic combination of Tiktarasatmaka dravyas such as Nimba, Guduchi, Vasa, Patol, Kantakari (Panchatikta) acting as Raktashodhak vedanashamaka.⁽¹⁴⁾

4) Asthiposhak Yog: It is a traditional Ayurvedic formulation used to promote bone health, density, and strength. Asthiposhak Yog typically consists of a combination of herbs and minerals, including Hadjod, Arjuna, Praval Pishti, Mukta Pishti, and Guggulu. The anti-inflammatory properties of the formulation help to reduce inflammation and promote bone healing. Asthiposhak Yoga is typically used to treat conditions like osteoporosis, osteopenia, fractures, and bone weakness. It is taken along with milk to increase its potential.

5) Raktashodhak Kashaya: It is a traditional Ayurvedic herbal decoction used to purify and cleanse the blood, as well as to treat various skin and blood-related disorders. Raktashodhak Kashaya typically consists of a combination of herbs, including Manjistha, Neem, Guduchi, Kutki, and Triphala.

Conclusion

This case study reveals the effectiveness of Ayurveda treatment modalities in the management of avascular necrosis. In which, Tiktakshir Basti, Jaloukavacharan, Shashtishali pind Sweda, and Shaman treatment are effective to relieve symptoms like pain and difficulty in walking. This study is based on a single case. So a further large sample size study is required to know the better results. If these medications are continued, reversible changes may be found in the MRI.

References