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ANKYLOSING

SPONDYLITIS
WHAT & HOW
IN
AYURVEDA?
* Dr.Gulwinder Singh Dehal
** Dr. Ravishankar Shenoy M.D (Ayu)
INTRODUCTION
• A.S. an inflammatory disorder of
unknown cause primarily affects the axial skeletal,
peripheral joints and also involves the extra articular
structures.
• The disease usually begins in 2nd or 3rd decade of life,
its prevalence being approximately 3 times more in
men than in women.
• ETIOPATHOLOGY
Describing the pathology of the disease with regard to
sacroiliitis, the most common manifestation of A.S.,
shows erosion of the iliac cartilages followed by its
replacement with fibro cartilage regeneration
termination into ossification.

CLINICAL
Insidious onset
FEATURE
• Dull pain felt deep at lower lumber/ Gluteal region
• Low back morning stiffness for few hours’ that improves with
activity and returns following period of inactivity
• Pain with few months become persistent and bilateral that later
becomes intermittent
• Presence of Nocturnal exacerbation of pain
• Bony tenderness may or may not exist
• Neck pain relatively a late manifestation
• Constitutional symptom like Fatigue, Anorexia, Fever, weight
Loss, Night sweat
• Loss of spinal mobility- limiting- ant, lat. Flexion and extension
chest expansion
• Lumber lordosis obliterated with atrophy of buttocks
• Accentuated thoracic kyphosis
• Forward stooping of neck
• Flexion contractures of hip compensated by flexion of knee.
DIAGNOSTIC CRITERIA
(New York Criteria 1984)
1. H/O inflammatory back pain
2. Limitation of motion of lumbar spine in
saggital and frontal plane
3. Limited chest expansion related to standard
value for age and sex
4. Definite radiographic sacroiliitis
Under this criteria presence of
radiographic sacroiliitis plus any of above
criteria is sufficient for diagnosis
Short Description of the Case

A male, unmarried patient aged 28 yrs, presented with complaints of pain and stiffness in the low
back 4-5 yrs and back of neck – 6 months with no association of fever/sore throat what so ever.

His previous Blood reports revealed a normal range of Hb, TC, DC. E.S.R. was high (70mm/1st
hr) and R.A factor was negative.

The physician advised an X-ray which revealed Ant. Spinal ligament calcification over lower
lumbar spines.

The impression read “Lumbar Synovitis?”

A repeat of blood investigation showed :

Hb -14.4 gm%
TLC – 8,350 cells/mm
DLC – N 65%; L-28%; E-06%; M-01%
ESR-68mm/1st hr
R.A factor- +ve (64U/ml)
Blood urea – 22mg/dl (WNL)
F.B.S – 100 mg/dl

Radiological investigations by a specialist confirmed Ankylosing Spondylitis (AS).


Ayurvedic Discussion of the Case
• The patient presented with the following signs & symptoms:
• Katishula + Stabdhata
• Prashtashula + Stabdhata
• Manyashula + Stabdhata
• Angagaurava
• Aruchi
• Agnimandhya
• Anaha
• Gatisanga of the Sandhi related to Manya and Prashta
Nidana
Ati and Vishma Stana
Guru Bhojana
Diva swapna
Purisha Vega Dharana
Ratri Jagarana
Smoking
Samprapti Ghataka
Dosha - Vata
Dusya - Asthi ( Kati, Prashta, Manya)
Srotas - Asthivaha, Annavaha
Dushti Prakara - Sanga
Agni - Manda
Avastha - Sama
Udbhavastana - Pakva - Amasaya
Sancarasthana - Sarva Sharira
Vyaktasthana - Kostha, Kati, Prashta, Manya
Rogamarga - Madhyama
Samprapti
Kati
Nidana  Vata Vitiation & Ama Asthivaha Prashtha  Sandhi
Srotas Manya
Shula
Stabdhata
DIFFERENTIAL DIAGNOSIS
• Gridhrasi
• Sandhigata Vata
• Ama Vata
• Kati-Prashta Manya Graha (Sama)
Cikitsa Talika
• Initial Treatment:
1) Simhanada Guggulu 800mg tds after food
2) Hingwastaka Churna 1gm with food tds
3) Rasnadi Kashaya 15ml tds after food
• No much improvement, except for Anaha and slight improvement
in appetite. Manya Shula had increased.
• Patient was admitted to the Hospital for a course of Kshara Basti.
• Internal Administration – All previous medicines +
Agni Tundi Vati 1 tds ½ an hour before food.
• A course of Kshara Basti was given for 6 days :
2 Anuvasana with Bala taila
3 Niruha Basti with:
1 Anuvasana Basti with Sahachara Taila.
• During the second day of Basti patient developed
Shotha & Shula in Vama Kurpara Sandhi – Agni Tundi
was stopped and Bhallataka Vati 250mg with luke warm
water was prescribed.
• Stiffness and pain reduced. Agni improved. Patient had
no Anaha. Shula & Shotha of Kurpara Sandhi
decreased by 5th day of its appearance.
• After 14 days, Bhallataka Vati was stopped as patient
developed Rakta Pidakas in the forearm, chest & abdomen,
which disappeared 2 days after Bhallataka Vati was
stopped.
• Patient expressed satisfaction with the treatment.
The patient was trained to practice Pranayama & Yogasanas.
• Patient was continued on:
Simhanada Guggulu 800mg thrice daily
Rasna Erandadi Kashaya 15 ml tds after food 3 months
Chitrakadi Vati (1 tab-350 mg) tds for occasional Anaha.
Patient was again admitted for a course of Kshara Basti.
1 Anuvasana Saindhavadya Taila
3 Kshara
1 Anuvasana
• Internally
Yogaraja Guggulu ( 2 tab-800mg) tds.
Dashamularishta 15ml tds
Chitrakadi Vati (1 tab-350mg) tds
• Then, Marsha Nasya with Anu Taila, preceeded by Abhyanga (Sahacharadi Taila) &
Nadi Sveda to Manya Kati Prashta for 7 days.
• At discharge the patient expressed 50% relief in symptoms & was put on:
Yogaraja Guggulu 2 tab tds
Rasna Erandadi Kashaya 15 ml tds
Hingwastaka Churna 1 gm with food tds
Clinical Assessment
The symptoms were graded as per the following scoring pattern:
• SHULA
• Absent - 0
• Present but mild and does not disturb daily activities-1
• Bearable but disturbs the daily activities –2
• Unbearable, that disturbs daily activities and subsides only with analgesics –3
• Unbearable even with analgesic – 4
• STABDHATA
• Absent -0
• Present persists for less than ½ an hour –1
• But no hinderance to daily activities – 2
• Persists for an hour with hinderance –3
• Persists for more than an hour, hinderance to normal activities & reoccurrence after
episodes of day sleep – 4
• ANAHA
• Absent - 0
• Present occasionally but subsides by itself –1
• Present once a day but subsides by itself – 2
• Present once a day but subsides by drinking hot water – 3
• Present after every meal, subsiding by drinking hot water – 4
• Needs medicines to subside – 5
• GRAHA – decided by
• SCHOBER TEST – positive -a meagre increase of 0.5 cms
during flexion
• Flexion of the Neck – Restricted by 5 cms (chin to J.
notch)
• Rt. & Lt. Lateral flexion – Restricted by 9 cms (vertical
distance between ear lobule to shoulder)
• Extension of Neck – Restricted by 9 cms (occiput to
vertebra prominens)
• Occiput wall distance – 2 cm
• Straight Leg Raising – Possible actively upto 70 degrees
but with pain in the sacro-iliac joints, passive movement
above 70 degrees with no pain.
RESULT
B.T A.T % Improvement

Manya Stabdhata 4 2 50.0

Kati Stabdhata 4 2 50.0

Prashta Shula 4 2 50.0

Prashta Stabdhata 4 3 25.0

Manya Shula 3 2 33.3

Kati Shula 3 2 33.3

Anaha 4 1 75.0

B.T (cms) A.T (cms)


Graha
Schober Test 0.5 2
Neck-Anterior Flexion 5 3
- Lateral flexion 9 6
- Extension 9 7
Occiput Wall Distance 2 1.4
Range of chest expansion 2 3
E.S.R 68mm/1hr 38mm/hr
DISCUSSION
• Kshara Basti?
• Upashaya – Anupashaya
• Bhallataka Asahata
• Asana –Pranayama
• 2nd course of Kshara Basti
• Abhayanga, Nadi Sweda, Nasya
• Shamana Yoga
Yogaraja Guggulu To maintain Agni
Dashamularishta To prevent Amajanana
Hingwashtaka Churna To bring Vata anulomana
Rasana Erandadi Kashaya
Result - Subjective 50%
- Objective  50%
Conclusion
• The present case of Ankylosing Spondylitis has been
diagnosed on Ayurvedic grounds as Kati Prashta, Manya
Graha based on the dominant sites involved. It has been
managed on the grounds of Amahara, Vatahara, Agnidipana
Chikitsa, which are the essentials of Amavata management.
• But, as this is a single case study the data is insufficient to
exactly correlate the disease (A.S.) to any Ayurvedic
disease or straight away affix a definite line of treatment,
which may be followed for all general cases of A.S
• The person-to-person variation and varied presentations of
the same disease entity have to be considered before
adopting a specific line of management.