AYURVEDIC MANAGEMENT OF KATISHOOLA ASSOCIATED WITH CHRONIC CONSTIPATION: A SINGLE CASE STUDY

About Author

Correspondence Address

Dr. Shilpa A Varade
Associate Professor,
Department of Rachana Sharir,
Shri Ayurved Mahavidyalaya, Nagpur.

Contact No. : 9404105080, Email : drshilpavarade@gmail.com

Date of Acceptance : 27 Sep 2025

Date of Publication : 29 Sep 2025

Article ID : SD-IJAY_149

How to cite this article : http://doi.org/10.55552/SDNJAY.2025.3309

Abstract

Katishoola (low back pain) is among the most prevalent clinical complaints in elderly populations. Chronic constipation, frequently encountered in geriatrics, is a major cause of Apana Vata vitiation, which may subsequently manifest as Katishoola. A 62-year-old male presented with chronic constipation for two years and low back pain for six months. Pain was dull and aching, aggravated by sitting for prolonged durations, and partially relieved by massage. Ayurvedic assessment revealed Apana Vata prakopa with Pakwashaya dushti. The patient was managed with Mridu Virechana (Eranda Taila), Hingwashtak Churna, Maharasnadi Kwath, Panchsakar Churna, Yogaraj Guggulu, and the Snehan/Swedan procedure. Pathya-apathya (dietary and lifestyle regulations) was also advised. Within two weeks, constipation was relieved with smooth daily evacuation. Low back pain intensity decreased from 7/10 to 3/10 on the Visual Analogue Scale (VAS). Stiffness and tenderness reduced, mobility improved, and overall quality of life enhanced. Chronic constipation may act as a contributory factor for Katishoola through Apana Vata vitiation. Ayurvedic management focusing on Vata anulomana and Shoola shamana provided effective results in this case.

KEY WORDS:-  Katishoola, Chronic Constipation, Apana Vata, Ayurveda, Vata Vyadhi

Introduction

Katishoola, explained in Ayurvedic classics as pain in the Kati Pradesh (lumbar region), is predominantly caused by aggravated Vata Dosha¹. Chronic constipation, one of the most common geriatric complaints, is also a direct manifestation of Apana Vata vitiation². In Ashtang Hruday, it is mentioned that Pakwashaya and Kati Pradesh are the Sthan of Vata Dosh³, and Shakrutgrahan (constipation) is mentioned in Vata Vriddhi Lakshans⁴. As mentioned in samhitas, there are 5 types of Vayu: Prana, Udana, Samana, Vyana & Apana⁵. In that Apana Vayu is responsible for the proper evacuation of stool out of the body⁶. The anatomical relationship between Pakwashaya and Kati Pradesh supports the view that chronic constipation can predispose to Katishoola. In modern practice, low back pain is often treated symptomatically, whereas Ayurveda emphasises addressing the underlying doshic imbalance. This case highlights the Ayurvedic perspective and management of Katishoola associated with chronic constipation in an aged individual.

Discussion

This case study highlights the significant role of chronic constipation as a precipitating factor for Katishoola through the vitiation of Apana Vata. In old age, Vata dosha naturally predominates due to the concept of Jara avastha, making geriatric patients more vulnerable to Vata vyadhi. Constipation, or Shakrutgrahana, is specifically mentioned among the Vata vriddhi lakshanas, and its chronicity indicates dysfunction of Apana Vayu and impaired Mala nishkramana kriya.

Ayurvedic classics describe Pakwashaya and Kati as principal sites of Vata. Hence, vitiation of Apana Vata in the Pakwashaya often manifests as pain in the lumbar region. In this case, chronic constipation disturbed the natural gati of Apana Vayu, which translated clinically into Katishoola. Previous literature also emphasises the role of Pakwashaya dushti in Vata vyadhi [7, 8].

The treatment plan was designed with a holistic approach targeting the underlying pathology rather than symptomatic relief. Vata anulomana measures such as Eranda Taila and Panchsakar Churna restored bowel regularity and normalised the functioning of Apana Vata. Yogaraj Guggulu contributed Shoolahara action and generalised Vata shaman. Local therapies, including Abhyanga followed by Ushna jala snana, provided localised Vata pacification. Maharasnadi Kwatha offered deepana, pachana, and vatahara properties, while Hingwashtaka Churna supported proper digestion and prevention of further Ama formation. Collectively, these measures corrected the Samprapti by addressing Apana Vata dysfunction and Pakwashaya dushti.

The therapeutic outcome demonstrates that proper regulation of bowel movement is central to the management of Katishoola in geriatric patients. This aligns with the Ayurvedic principle of nidana parivarjana and dosha shamana, where correction of the root cause ensures sustainable relief. By treating constipation and normalising Apana Vata, not only was pain alleviated, but the overall Vata balance was restored, preventing recurrence.

Thus, this case underscores the importance of considering chronic constipation as an etiological factor in Katishoola and emphasises the effectiveness of a comprehensive Ayurvedic approach targeting both systemic and local Vata imbalance.

Conclusion

Chronic constipation can act as an underlying contributor to Katishoola in elderly individuals by inducing Apana Vata dushti. In this case, Ayurvedic management through Vata anulomana, systemic Vata shaman, Shodhana, and Sthanik Chikitsa provided significant relief and corrected the root pathology rather than offering mere symptomatic management. This highlights the importance of bowel regulation in the management of geriatric Vata vyadhi and suggests that such integrative Ayurvedic approaches warrant further validation through larger clinical studies.

References

1. Agnivesha. Charaka Samhita, Chikitsa Sthana, Vata Vyadhi Chikitsa. Chaukhambha Bharati Academy; 2017.
2. Sushruta. Sushruta Samhita, Nidana Sthana, Arsha Nidana. Chaukhambha Sanskrit Sansthan; 2018.
3. Vaghbhata. Ashtang Hridaya, Sutrasthana, Doshabhediya Adhyay. Chaukhamba Surbharti Prakashan; 2018, 12/1, 54.
4. Vaghbhata. Ashtang Hridaya, Sutrasthana, Doshadivigyaniya Adhyay. Chaukhamba Surbharti Prakashan; 2018, 11/6, 52.
5. Vaghbhata. Ashtang Hridaya, Sutrasthana, Doshabhediya Adhyay. Chaukhamba Surbharti Prakashan; 2018, 12/4, 55.
6. Vaghbhata. Ashtang Hridaya, Sutrasthana, Doshabhediya Adhyay. Chaukhamba Surbharti Prakashan; 2018, 12/9, 55.
7. Vagbhata. Ashtang Hridaya, Nidana Sthana. Chaukhambha Sanskrit Pratishthan; 2016.
8. Tripathi B. Charaka Samhita (Ayurveda Dipika Commentary). Chaukhambha Surbharati Prakashan; 2021.