Ayurveda management for acute upper limb ischemia - a case report.

Acute upper limb ischemia (AULI) is a medical and surgical emergency involving sudden decrease in limb perfusion resulting in threat for limb viability. A 52 years old male patient was suffered from AULI. He had the complaints of numbness and pain in left upper limb, headache and pale discoloration of left-hand fingers and acute onset left upper extremity weakness.The Ayurveda diagnosis was considered as Vatarakta. He was advised oral medications - Kaishor guggulu in the dose of 750 mg twice a day with Jwarhar kashaya 40 ml twice a day, Ashwagandha Churna 3 g, Guduchi churna1g, Shatavari churna 2 g, Chopchini churna 1 g with milk twice a day, Shilajatwadi loha 500 mg and Mahavatvidhvansana rasa 250 mg twice a day with honey. All these medications were continued for 12 months. Two courses of Mustadi yapana basti (medicated enema enriched with milk) and Shalishastika pinda swedana (a specific type of sudation with a poultice of rice bolus) and Nasya (nasal therapy) with Shadabindu oil were given. Initial computed tomography (CT) angiogram revealed the abrupt cutoff of the left brachial artery in distal part due to hypodense lesion (thrombus) in the lumen while after 12 months of treatment CT angiogram revealed 70-80 % luminal narrowing in proximal part of left ulnar artery. It suggests the revascularization of left ulnar artery. All the symptoms of AULI were also resolved. We report a unique case of AULI managed with Ayurvedic interventions.

An Ayurveda approach in the management of avascular necrosis of bilateral hip joint-A case report.

Avascular necrosis (AVN) is the condition where an interruption of the sub-chondral blood supply leads to the death of cellular components of bones typically at the weight-bearing joints. Here we present a case of a 48 years old male patient suffering from AVN for the last two months. The patient had pain in bilateral hip joints which was gradually radiating to the bilateral thigh. The patient also felt difficulty in cross-legged, sitting, and squatting. The Ayurveda diagnosis of the case was established as Asthimajjagata-vata (∼disease due to vitiation of Vatadosha in bone and bone marrow tissues). Oral treatment was administred initially for eight months, followed by a course of Panchatikta-kshira basti (medicated enema enriched with milk) and Shalishastika panda swedana (a specific type of sudation with a poultice of rice bolus) for 24 days. Oral medications were continued during this duration and also for the subsequent 22 months. Kaishora guggulu in the dose of 750 mg twice a day with Dashamula kwath 40 ml twice a day, Ashwagandha churna (Powder of Withania somnifera Dunal) 3 g, Guduchi churna (Powder of Tinospora cordifolia L.) 1g, Chopchini churna (Powder of Smilax china L.) 2g and Shilajatwadi loha 500 mg with milk twice a day were advised to the patient. MRI scans of bilateral hip joints after 23 months of this treatment revealed changes in AVN grade, with the left hip joint transitioning from grade III-B to grade II, and the right hip joint progressing from grade IV-A to grade III. The range of motion at these joints was also improved significantly. Most of these medicines are Rasayana (∼immune-modulatory) in nature. The present case study suggests that Panchakarma procedures and Rasayana may be used for the treatment of AVN.

A double-blind controlled clinical trial to evaluate the effects of nasal therapy with Vrihatajivakadya oil on different viscosities in patients with migraine.

BACKGROUND: Migraine, characterized by pain of a specific type in one half of the head has a close resemblance with Ardhavabhedaka described in Ayurveda. Nasya karma (nasal therapy) with Vrihatajivakadya oil is indicated in Ardhavabhedaka. Low viscosity oil (LVO) and medium viscosity oil (MVO) prepared by Snehapaka (a specific Ayurveda method for preparation of oil) are advocated in different classical Ayurveda texts for N.karma. THE OBJECTIVES: This study was done to assess the effects of Vrihatajivakadhya oil on different viscosities in N.karma for the better Ayurveda management of migraine. MATERIAL AND METHODS: In this double-blind randomized controlled trial a total of 90 patients were randomly divided into two groups for N.karma with oil of different viscosities. In the group treated with LVO, 44 patients completed their treatment and one patient was lost in follow-up. In another group treated with MVO, 45 patients were enrolled and completed the intervention. N.karma was done with this oil in the dose of 6 drops per nostril for the duration of 14 days for each participant. The follow-up was done on the 15th day and 45th days. The assessment was done by the Migraine Disability Assessment Score (MIDAS) and Migraine Specific Quality of Life Assessment scale. RESULT: During the trial, significant improvement in both the groups on both parameters was observed. No adverse event was noticed during the study. CONCLUSION: N.karma with MVO had better improvement. No adverse event was noticed during the study. N.karma with these oils is effective and safe for migraine.

Ayurvedic management in limb girdle muscular dystrophy - A case report.

Limb girdle muscular dystrophy (LGMD) is a type of Muscular dystrophy (MD), heterogeneous devastating complex genetic disorders causing progressive weakness and degeneration of muscles. LGMD is hereditary autosomal diseases characterized by weak and wasteful limb girdle muscles. The available management of LGMD in biomedicine is unsatisfactory. Here we present a case of LGMD managed with combinations of Ayurvedic oral medicines and Panchakarma procedures. The Ayurvedic diagnosis of the condition was considered as Mansagata Vata (∼neuromuscular diseases), a type of Vatavyadhi (∼neuromusculo skeleton disorders). The patient was treated with Shalishashtika Pinda Swedana and Mustadi Yapana Basti for the duration of 16 days along with following Ayurvedic oral medicines: Yograj Guggulu 500 mg with 40 ml Dashamoola Kwatha, Ekangaveera Rasa 125 mg with honey, a combination of Ashwagandha Churna -2g, Satavari Churna - 2g, and Sankha Bhasma 500 mg with milk, Narsinha Churna- 3g and Ashwagandhavleha- 5g with milk. All medicines were given twice a day. Patient's condition was assessed for symptoms of pain, walking distance, power and reflexes of both upper and lower limb and psedohypertrophy of both calf muscles. Serum Creatine Phoshphokinase (S.CPK) level and electromyography (EMG) were also measured. There was symptomatic improvement in the patient's condition and reduction in S.CPK level. The study suggests that LGMD can be satisfactorily managed with Ayurvedic oral medicines and Panchakarma therapy.

Principles of Rajayakshma management for COVID-19.

The pandemic spread of corona virus disease 2019 (COVID-19) has become a global threat. No cure is available for this condition till date. Ayurveda, may come to rescue in these times of COVID-19 spread. In this review we have analyzed that the COVID-19 has analogy with the Rajayakshma (∼a wasting disease indicating suboptimum immune response) and the established treatment of Rajayakshma disease can be proposed for preventive as well as curative purpose.

An ayurvedic approach in the management of Siragatavata complicated with Dusta Vrana.

Vasculitis is chronic inflammation resulting in necrosis of blood vessels due to narrowing or occlusion of the lumen. Here we present a case of 28 yrs old woman suffering from medium size vessel vasculitis since childhood. The patient had purulent skin lesions at lateral aspect of lower limbs, fatigue and pain all over the body. There was complaint of bluish discoloration of extremities, especially in winter season. The patients had history of similar skin lesions in past which were treated by allopathic treatment, but this treatment failed in meeting the expectations of patient. These lesions were not responding to the contemporary treatment since a year. The Ayurvedic diagnosis of the case was established as Siragatavata complicated with Dusta Vrana (~infected wound). She was treated with Vrana Prakshalana (doucing of skin ulceration) with Triphala Kwath for initial 15 days followed by Virechan Karma (purgation therapy) with Tilvaka Ghrita in 20 g dose. Erandmooladi Niruha Basti (enema mainly with decoction) with Bala Taila (oil) Anuvasan Basti (enema with oil) for eight days in Yoga Basti Krama (eight days order of enema) was administered after Virechana Karma. The Ayurvedic oral drugs [Ashwagandhaveleha-10 g, Jwarhar Kashaya- 40 ml, Shatavari Churna (powder)-3 gm, Vidanga Churna-2 g Kaishor Guggulu-500mg and Shilajatwadi Loha-500mg] twice a day for 12 months were also administered in the case. Skin lesions healed after a month of treatment and there was no relapse in more than 18months follow up. Patient was lean and thin and underweight at the beginning of the treatment. There was 4 Kg increase in weight during the treatment. There were no complaints of paresthesia, pain and fatigue after 18 months of treatment. No bluish discoloration was noted during this period. Presently patient is stable with Ayurvedic medications. The case study shows that medium size vessels vasculitis may be managed with Panchakarma procedures and Ayurvedic medication with satisfactory outcome. However, large sample studies are required for definitive conclusion.

An observational study on acceptability, palatability, and safety of Ayurveda immunity booster kit for the prevention of COVID-19 in frontline workers in Jaipur, India.

Background: National Institute of Ayurveda, Jaipur, India, had distributed Ayurveda immunity booster kit (AIBK) (prepared at own pharmacy and comprising Chyawanprasha - 300 g, Vyadhi Kshamatva Kwatha - 300 g, and Vyadhi Kshamatva capsule - 30 g) for 15 days among the health-care workers, sanitation workers, and security and police staff engaged in the containment zones for prevention of COVID-19. Aim: The aim of present study was to explore the medication that may be effective in prevention of the COVID -19. Hence, this study was done to assess the compliance of these medicines and their effects in the prevention of COVID-19. Methods: One thousand seven hundred and fourteen frontline workers were provided with the AIBK for 15 days from April 24, 2020, to June 27, 2020. Data of frontline workers who had participated in AIBK and completed the treatment regimen with 2 weeks of follow-up after treatment with complete available data for safety, palatability, efficacy, and compliance were included in the study. Any adverse event needing hospitalization or medication, drug compliance and palatability, and appearance of the symptoms of COVID-19 or testing positive for COVID-19 were the outcome measures. Results: Out of 1714 participants, 1003 participants were found to be eligible for this analysis. The median age of these participants was 39 years (range, 19-70), and males accounted for 90.1% (904 of 1003). A total of 7.5% of participants (75 of 1003) reported having adverse events after taking the study treatment. None of the participants reported any serious adverse effects after the administration of the AIBK. The acceptability of the AIBK was as high as 97.4%. None of the participants reported positive for COVID-19 results or COVID-19 symptoms up to 2 weeks of follow-up after completion of the study treatment. Conclusion: The acceptability of AIBK is good and indicates its role in the prevention of COVID-19-like illness, hence further randomized control trials or cohort studies can be done to assess the mechanism of action and efficacy of AIBK as the preventive strategy in COVID-19.

Effects of medicated enema and nasal drops using Triphaladi oil in the management of obesity - A pilot study.

An open label, randomized, comparative, interventional pilot study was done to assess the effect of Lekhana Basti (medicated enema) and Rechana Nasya Karma (Errhine therapy) in the management of Sthoulya with special reference to obesity. In the study 30 clinically diagnosed patient of either sex were randomly divided into two groups. In Basti group, Lekhana Basti in Karma Basti manner was given for 30 days. Anuvasana Basti (enema with Triphaladi Taila) in the dose of 120 mL and Asthapana Basti (enema with Triphaladi decoction etc.) in the dose of approximately 960 mL was given. In Nasya group, Rechananasya on alternate days was given with Triphaladi (oil) in the dose of 0.5 mL per nostril for total 28 days. The patients were assessed on objective criteria such as such as weight, chest circumference, mid-arm circumference, mid-thigh circumference, triceps skin fold thickness, sub-scapular skin fold thickness, abdominal skin fold thickness, waist-hip ratio and lipid profile. It was observed that Basti group was a better intervention in providing relief, however there intergroup standard deviation was low on most of the variable expect the lipid profile. The results suggest that the Nasya Karma may be developed as a better practical approach in obesity management.

Ayurvedic management for a rare disorder Takayasu arteritis - A case report.

Takayasu arteritis (TA) is a rare disorder and it is a devastating condition of aorta. The presently available treatments for the condition in the modern medicine have limited benefits. This is case of TA which was better managed with Ayurvedic intervention. An Ayurvedic diagnosis for this case was Siragata Vata (vitiated Vata Dosha affecting the blood vessels). A 42-year-old woman was diagnosed with TA and treated on the line of management of Siragata Vata with Shastikashali Pinda Swedana (sudation with bolus of medicated cooked rice) for 16 days, Erandamuladi Niruha Basti (enema mainly with decoction) along with Ashwagandha Taila Anuvasana (enema with medicated oil) for 16 days in Kala Basti Krama (16 days in alternate order of decoction and oleation enema) followed by one day gap and then 7 days of Nasya Karma (nasal therapy) with Triphaladi Taila (oil) on alternate days along with a combination of Ayurvedic oral drugs [Brihadvatachintamani Rasa-125 mg, Dashamula Kwatha-40 ml, Narsinha Churna (powder)-3 g, Yogaraja Guggulu-1g (500mgx2tab) and Shiva Gutika-500 mg, twice a day for 1 month. Same Panchakarma procedures were repeated after 6 months. A similar combination of oral medications were continued in between and during this period. Chyavanaprasha Aveleha in the dose of 10g twice a day with milk were also added after completion of this treatment regime. Patient condition was assessed on Indian Takayasu Clinical Activity Score (ITAS-2010) for disease activity of TA. Satisfactory results were observed in the patient with improvement in ITAS-2010 scoring. TA may be managed with Ayurvedic drugs and Panchakarma procedures.

Medical leech therapy in Ayurveda and biomedicine - A review.

Medicinal leech therapy or Hirudino therapy have roots back in ancient civilization. It was a prevalent form of therapy in various ailments. The novel Ayurveda text Sushruta Samhita devoted a complete chapter on hirudino therapy. In the early 20th century this therapy had a major setback due to origin and evolution of antibiotics. There was a discontinuity in the flow of knowledge about this therapy. Then, resumed and revived after few recent decades, due to its contribution in reconstructive surgeries. During this period, the research work on various aspects have been conducted. The present paper summarizes the various aspects of medicinal leech therapy both from Ayurveda text and the present knowledge and to enable the fraternity to use the both source for benefits of humankind.

Ayurvedic management of chronic constipation in Hirschsprung disease - A case study.

Hirschsprung disease (HSCR) or congenital intestinal aganglionosis is characterized by complete absence of neuronal ganglion cells from a portion of the intestinal tract, most commonly in the large intestine. The main sign or symptom of HSCR is constipation usually appearing shortly after birth. This constipation is chronic in nature and usually not relieved with laxatives. The present case is of a patient having HSCR which was successfully managed with Ayurvedic treatment. A four year old boy with complaint of severe constipation, abdominal pain, abdominal distension and occasional vomiting was treated with Panchakarma procedures and Ayurvedic oral drugs. The Ayurvedic diagnosis of the case was Pakvasayagata vata. Shashtikashali pinda swedana (sudation with medicated cooked bolus of rice) and Matra basti (enema with medicated oil) with Ashwagandha taila (Ayurvedic medicated oil) was given for first 16 days. From the 2nd month of treatment, Matra basti was administered daily for 3 months in the dose of 25 ml. In 5th and 6th month Matra basti was administered on alternate days in the dose of 25 ml. From the 7th month Matra basti was administered once weekly in the dose of 25 ml. In 14th month Shashtikashali pinda swedana and Erandmooladi yapna basti (medicated enema) was given for 16 days. Eight scales based Medical outcome study (MOS) - 36 item short form - health surveys was periodically assessed for outcome which shows good improvement. Experience of this case showed that HSCR may satisfactory be managed with Ayurvedic treatment.

Ayurvedic management in cervical spondylotic myelopathy.

The age related spondylotic changes may result in direct compressive and ischemic dysfunction of the spinal cord known as cervical spondylotic myelopathy (CSM). Symptoms often develop insidiously and are characterized by neck stiffness, unilateral or bilateral deep aching neck, arm and shoulder pain, and possibly stiffness or clumsiness while walking. The management available in current mainstream medicine is not satisfactory. Various Ayurvedic treatments have been in use for these manifestations. We present a case of CSM, which was treated with a combination of Panchakarma procedures and Ayurvedic oral drugs. The patient was considered suffering from Greevastambha (neck stiffness) and was treated with Shalishastika pinda svedana (sudation with medicated cooked bolus of rice) for one month and Mustadi yapana basti (enema with medicated milk) for 16 days along with oral Ayurvedic drugs such as Brihatavata chintamani rasa 50 mg, Ekangaveer ras-250 mg, Ardhangavatari rasa-125 mg Amrita satva (dry extract of Tinospora cordifolia Willd)-500 mg, Muktasukti pisti-500 mg, Ashwagandha churna (powder of Withania somnifera Dunal)-500 mg Dashmool kvatha ghana (solid extract of Dashmool kvatha)-500 mg, Trayodashanga guggulu-575 mg, twice a day with honey and Eranda paka-10 g twice a day with milk. Patient's condition which was assessed for symptoms of CSM and Chile's modified Japanese Orthopaedic Association (mJOA) score for cervical spondylotic myelopathy showed substantial improvement. This study shows that the cases of CSM may be successfully managed with Ayurvedic treatment.

Ayurvedic management of spondyloepiphyseal dysplasia tarda, a rare hereditary disorder.

Spondyloepiphyseal dysplasia tarda (SEDT) is a rare genetic disease in which patient suffers from short stature, short trunk and neck with disproportionately long arms, coxa vara, skeletal features such as barrel shaped chest, kyphosis, scoliosis and early arthropathy. Only limited medical and surgical management is available in modern medicine. A 15 years old male suffering from SEDT and diagnosed as Vata vyadhi was treated with Panchakarma therapy and selected Ayurvedic oral medicines. Ayurvedic treatment was directed to ameliorate the orthopaedic clinical conditions in this case. Panchakarma procedures such as Shalishastika pinda svedana for a month and Mustadi yapana basti for 16 days were given along with oral Ayurvedic medicines. Same Panchakarma procedures were repeated after an interval of 2 months. A combination of Ayurvedic oral medicines such as Trayodashanga guggulu-500 mg twice a day, Dashmool kvatha (decoction of roots of 10 herbs) 40 ml twice a day, Eranda paka 10 g twice a day, Shiva gutika-500 mg twice a day and Dashmoolarista-20 ml (with equal water) twice a day were prescribed. Eight scales based Medical outcome study (MOS) - 36 item short form - health surveys was assessed for outcome which shows good improvement. Kyphosis, scoliosis and pain were moderately reduced. Clinical experience of this case indicates that Ayurvedic herbs along with Panchakarma can play a major role in the management of hereditary disorder SEDT.

Ayurvedic approach for management of ankylosing spondylitis: A case report.

Ankylosing spondylitis (AS) is a rheumatic disease with various skeletal and extra skeletal manifestations. No satisfactory treatment is available in modern medicine for this disorder. Various Panchakarma procedures and Ayurvedic drugs have been proved useful for these manifestations. We present a case of AS, which was treated for two months with a combination of Panchakarma procedures and Ayurvedic drugs. Ayurvedic treatments, in this case, were directed toward alleviating symptoms and to reduce severe disability. The patient was considered suffering from Asthimajja gata vata (∼Vata disorder involving bone and bone marrow) and was treated with Shalishastika Pinda Svedana (sudation with medicated cooked bolus of rice) for one month and Mustadi Yapana Basti (enema with medicated milk) with Anuvasana (enema with Asvagandha oil) in 30 days schedule along with oral Ayurvedic drugs for two months. Pratimarsha nasya (nasal drops) with Anu Taila (oil) for one month was given after completion of Basti procedure. Patient's condition was assessed for symptoms of Asthimajja gata vata and core sets of Assessment of Spondylo Arthritis International Society showed substantial improvement. This study shows the cases of AS may be successfully managed with Ayurvedic treatment.

Ayurvedic approach in the management of spinocerebellar ataxia-2.

Spinocerebellar ataxia -2 is a progressive, degenerative genetic disease caused by an expanded (CAG) trinucleotide repetition on the chromosome 12 resulting in production of an abnormal protein called ataxin-2. There is no known effective management or cure in biomedicine for this genetic disease. In the present study a case of SCA2 that was treated with Ayurvedic intervention is reported. Ayurvedic treatments in this case were directed towards alleviating symptoms and to reduce severe disability due to progressive nature of disease. A 42 year old male patient was diagnosed for Vata vyadhi (group of various neurological disorders) and was- treated with Salisastika pinda svedana (sudation with bolus of medicated cooked rice) for 30 days-, Sirobasti (sudation of head with the help of a cap on head) with Asvagandha taila for 45 days and Baladi ksira basti (enema with medicated milk) with Asvagandha taila anuvasana (enema with oil) for 30 days in Karma basti krama (30 days regime of purification and oleation enema) along with a combination of Ayurvedic oral drugs which consisted of Brahadvatacintamanirasa - 125 mg, Vasantamalti rasa- 125 mg, Dasamula kvatha- 40 ml, Asvagandha curna (powder of Withania somnifera DUNAL)- 3g, Amrta curna (powder of Tinospora cordifolia Willd.)- 500 mg, Muktasukti pisti - 500 mg, Yogaraja Guggulu - 500 mg twice a day for 2 months. Patient's condition was assessed on the Scale for Assessment and Rating of Ataxia (SARA). Before treatment, mean SARA score was 35. This reduced to 15 after treatment. Good relief in dysarthria, fasciculation, heaviness in eye, blurred vision, axial tremor; constipation and quality of life were observed in this case.

Ayurvedic approach in the management of spinal cord injury: A case study.

Spinal cord injury (SCI) is associated with consequences such as full loss of spinal movements, incontinence of bladder functions, bed sores, etc. There is no satisfactory treatment available in biomedicine with only limited treatments only for enhancement of spinal cord function. These treatments have many limitations. Ayurvedic drugs and Pancakarma procedures have been in use to treat such conditions since a long time. We present a case of SCI with lesion at C4 level which was treated for 2 months with an Ayurvedic combined intervention. The combined treatment plan involved Ayurvedic oral medications (Brhadvatacintamani rasa - 125 mg, Ardhanagavatari rasa - 125 mg, Dasamula kvatha - 40 ml, Asvagandhacurna [powder of Withania somnifera DUNAL] - 3 g, Amrta [Tinospora cordifolia WILLD] - 500 mg, Muktasukti pisti - 500 mg and Trayodasanga guggulu - 500 mg) twice daily. Combined procedures involved such as salisastika pindasvedana (sudation with medicated cooked bolus of rice) every day for 2 months and Matra basti (enema) for first 15 days with Asvagandha oil. From 16(th) day, Mustadi yapana basti (MYB, enema with medicated milk) was given for 16 days. After an interval of 7 days, MYB was further repeated for next 16 days. Substantial clinical improvement was reported after 2 months of the Ayurvedic treatment in existing neurological deficits and in quality of life.

Ayurvedic management of life-threatening skin emergency erythroderma: A case study.

Erythroderma or generalized exfoliative dermatitis is a skin disorder that requires attention equivalent to medical emergencies. It is more prevalent in male population. It accounts for 35 cases/100,000 cases in dermatologic outpatient departments. In erythroderma even with proper management there are certain metabolic burdens and complications which make it more critical. The primary aim, in this case, was to treat the patient with Ayurvedic management. A 18-year-old patient, suffering from erythroderma, was treated on the line of Kapala Kushtha and Audumbera Kushtha. The patient had primarily suffered from psoriasis for 8 years. Erythroderma was developed due to abrupt self-medication with an unknown amount of intramuscular methylprednisolone several times in last month. Rasamanikya-125 mg, Arogyavardhini Vati-1 g, Kaishora Guggulu-1 g, Khadirarista-20 ml, and Panchatikta Ghrita-20 ml, all drugs twice a day with 3-4 times local application of Jatyadi Taila were administered. A decoction of Jwarhara Kashaya was also administered in the dose of 40 ml twice a day. The patient had relief from the acute phase after 20 days of treatment and complete remission after 3 months of treatment. This case study demonstrates that Ayurvedic management may be useful in erythroderma like acute and life-threatening condition.

Clinical study on Laksha Guggulu, Snehana, Swedana & Traction in Osteoarthritis (Knee joint).

The objective of the present research was to study the efficacy of Laksha Guggulu, Snehana, Swedana & Traction in the management of Osteoarthritis (Knee joint). For the present work, 30 clinically diagnosed patients were selected and randomly divided into three groups. Group A treated with Laksha Guggulu orally, Group B treated with snehana & swedana traction, Group C treated with Laksha Guggulu, Snehana, Swedana & Knee Joint Traction. The various criteria worked upon were joint pain, oedema, tenderness, restriction of joint movement, stiffness, local crepitation, walking distance. Significant results were obtained on pain in joint movement, restriction in joint movement, joint stiffness , local crepitation nearly in all the groups with best result in combined group or group C.