AyuCaRe

Journal of
Ayurveda Case Reports
Vol. 1, Issue 1, July - September 2017
Journal of Ayurveda Case Reports (AyuCaRe) Vol. 1, Issue 1, July - September 2107

An Official Peer Reviewed Publication of

All India Institute of Ayurveda
New Delhi
 Journal of Ayurveda Case Reports

TABLE OF CONTENTS

EDITORIAL

AyuCaRe - A New Journal for Ayurveda Case Reports 1-2

– Abhimanyu Kumar

Research in Traditional Systems of Medicine 3

– Sung Chol, Kim

GUEST EDITORIAL

All India Institute of Ayurveda Launching Quarterly Journal of Ayurveda Case Reports 4-5
– Ram Harsh Singh

CASE REPORTS

1 Management of Avascular Necrosis through Panchakarma 6-12

– Adil R, Sangeeta RT, Karishma S, Anup BT

2 Jalaukavacharana (Leech application) and adjuvant therapy in the management of infected 13-17
wound
– Mahanta VD, Foram J, Dudhamal TS, Gupta SK

3 Management of Hashimoto’s Thyroiditis through Ayurveda 18-22

– Seetha C, Rajam R, Patgiri BJ, Prakash M

4 Ayurvedic Management of Ankylosing Spondylitis 23-27

– Mayur M, Mayur B, Chandrashekhar YJ, Kandarp D

5 Management of Frozen Shoulder in Diabetics through Panchakarma 28-33

– Sangeeta RT, Adil R, Anup BT

6 Efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management of Hypothyroidism 34-39
– Karishma S, Anup BT, Prajapati PK

GENERAL INFORMATION ABOUT THE JOURNAL i-vi

 EDITORIAL BOARD

Patron Co-Patron Editor in Chief

Sh. Shripad Yesso Naik Vd Rajesh Kotecha Prof. Abhimanyu Kumar
Minister of State (Independent Charge), Special Secretary, Director,
Ministry of AYUSH Ministry of AYUSH All India Institute of Ayurveda
New Delhi New Delhi New Delhi

International Advisory Board

Dr. Jeffry D White Dr. Pirag Valdis Dr. Antanio Morandi Dr. Christian S Kessler
Director, Office of Director, Centre of Director, School of Research Coordinator
Cancer Complementary Complementary Medicine, Ayurvedic Medicine, Charitie Medical University
and Alternative Medicine University of Latvia, Italy Berlin
National Cancer Institute Latvia
NIH, USA

Dr. Madan Thangavelu Dr. Jeorge Berra Dr. Rajendra Badgaiyan Dr. Amala Guha
Research Director, Director, Professor, President,
European Ayurveda Foundation De Salud Boonshoft School of Medicine International Society
Association, Germany Ayurveda Prema, Wright State University, of Ayurveda & Health,
Argentina USA USA

National Advisory Board

Dr. Manoj Nesari Dr. DC Katoch Prof. KS Dhiman Prof. RH Singh Prof. GG Gangadharan
Advisor (Ayurveda), Advisor (Ayurveda), Director General, Distinguished Director, Ramaiah
Ministry of AYUSH, Ministry of AYUSH, CCRAS, Professor, BHU, Indic Specialty
New Delhi New Delhi New Delhi Varanasi Ayurveda Restoration
Hospital, Bangalore

Prof. Ravi Mehrotra Prof. A Srivastava Prof. GK Rath Dr. Vasudevan Dr. Ram Manohar
Director, NICPR, Head, Dept of Surgery, National Cancer Institute, Nampoothiri MR Director, Amrita
ICMR, AIIMS, AIIMS, Principal, Amrita Centre for Advanced
New Delhi New Delhi New Delhi School of Ayurveda, Research in Ayurveda,
Kerala Kerala

Prof. LP Dei Prof. Sanjeev Sharma Prof. YB Tripathi Prof. PK Goswami Prof. YK Tyagi
Director, Director, Dean, Director, Voice Chancellor,
IPGT & RA, Jamnagar NIA, Jaipur IMS, BHU, Varanasi NEIAH, Shillong Delhi University

Editorial Review Board

Prof. MS Baghel, Ex-Ayurveda Chair, University of Debrecen Prof. PK Prajapati, Head, Dept of RS & BK
Prof. HM Chandola, Ex-Director, CBPACS, New Delhi Prof. SK Gupta, Head, Dept of Shalya Tantra
Dr. KR Kohli, Director, Directorate of Ayurveda, Mumbai Prof. Tanuja Nesari, Head, Dept of Dravya Guna
Dr. GS Badesha, Director, ISM, Raipur Prof. Manjusha R, Head, Dept of Shalakya Tantra
Prof. SN Gupta, JS Ayurveda College, Nadiad Prof. Sujata Kadam, Head, Dept of PT & SR
Prof. JS Tripathi, IMS, BHU, Varanasi Prof. Mahesh Vyas, Head, Dept of Maulika Siddhanta
Dr. BS Prasad, KLE Ayurveda College, Belgaum Dr. Santosh Bhatted, I/C Head, Dept of Panchakarma
Dr. Sanjeev Rastogi, Ayurveda Expert, Lucknow Dr. Mangalagowri Rao, I/C Head, Dept of Swasthavritta
Dr. Pawan Godatwar, NIA, Jaipur Dr. RK Yadava, I/C Head, Dept of Kaya Chikitsa
Dr. Supriya Bhalerao, Bharati Vidyapeeth, Pune Dr. VG Huddar, I/C Head, Dept of Roga Nidana
Dr. Rajagopala S, Dept of Kaumarabhritya
Dr. Krishna Dalal, Research Advisor, AIIA

Executive Editor Associate Editor

Dr. Galib Dr. Mahapatra Arun Kumar
Associate Professor Assistant Professor
Dept of Rasa Shastra & Bhaishajya Kalpana Dept of Kaumarabhritya
All India Institute of Ayurveda, All India Institute of Ayurveda,
New Delhi New Delhi

 Journal of Ayurveda Case Reports

EDITORIAL

AyuCaRe - A New Journal for Ayurveda Case Reports

The Indian systems of medicine have age old acceptance hour to generate databases regarding the usefulness of
in the communities in India and in most places they form Ayurveda approaches in global healthcare.
the first line of treatment in case of common ailments. Of
these, Ayurveda is the most ancient medical system with Well-established, randomized controlled clinical trials
a time tested impressive record of safety and efficacy. are undisputed gold standards and can provide highest
These systems were well known to Indian population level of evidence for efficacy facilitating acceptance
and their acceptability in population is already there as of medical practices. These conventional concepts of
they form the part of house hold remedy, life style and
clinical research design may be difficult to apply when
dietetic management of the society.
using practices of traditional medicine. Methods such
as randomization and use of a placebo etc. may not
Majority of the world's population in developing
always be possible in Ayurveda clinical trials as they
countries still relies on herbal medicines to meet their
may involve many technical problems. In addition;
health needs. They are often used to provide first-line and
prevention, diagnosis, treatment etc. in Ayurveda are
basic health service to people living in remote and poor
based on specific needs of an individual patient. Hence,
areas. Even in areas where modern medicine is available,
approaches like Whole Body Systems, MOST, STROBE,
the interest on traditional practices has been increasing
Case Reports etc. possibly may benefit Ayurveda studies.
rapidly in recent years because of many reasons.
Initiatives are to be made to enrich AYUSH professionals
Contribution of traditional practices, in particular of
Ayurveda in global health care cannot be ignored by any with these methodologies.

science for its qualitative strength and clues provided

Case reports significantly can contribute and
in the field of therapeutics. India enjoys the largest
disseminate Ayurveda potentialities to the global
traditional health care, which is fully functional with a
community. They have an advantage of being adaptable
network of qualified registered practitioners, research
to the clinical needs of the patient and the therapeutic
institutions and licensed pharmacies.
approach of the practitioner. It is observed that, many

Ayurveda can play a major preventive, curative, and Ayurveda physicians have success stories for clinical
promotive role in community health. The effectiveness conditions, where no satisfactory answers are available
of Ayurveda in different disease conditions need to be in contemporary field. Dissemination of such success
shown to the community, for which, we need to proceed practices is a way of sharing knowledge that will help
in a systematic manner. in shaping the health care system. Case Reports help
practitioners to share their experiences with peers,
Study design is an important issue. Ill-designed researchers, students and other interested. Ayurveda
studies are unlikely to add any value either to science currently need more and more evidence based success
or to Ayurveda. A comprehensive custom to explore stories.
evidences on effectiveness in Ayurveda is the need of
A suitable platform is needed to communicate all
such experiences. Considering this acute need; All
How to cite: Abhimanyu K. AyuCaRe - A New Journal India Institute of Ayurveda, New Delhi is creating an
for Ayurveda Case Reports. J AyuCaRe 2017;1(1):1-2.
unique platform Journal of Ayurveda Case Reports

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):1-2  1

 Abhimanyu K: Editorial

(AyuCaRe) for all stakeholders of AYUSH to share committed to put Ancient wisdom of Ayurveda in
their experiences. AYUCaRe invites Case Reports and Evidence Based Practice.
provides opportunities for students, researchers and
faculty of AYUSH and allied medical sciences to share
their experiences. This initiative is expected to play a Prof Abhimanyu Kumar
pivotal role in researches, further generating evidence
base for the claims and principles of Ayurveda practices Editor-in-Chief
in a systematic way. Journal of Ayurveda Case Reports (AyuCaRe)
All India Institute of Ayurveda,
I take this opportunity to invite all the stakeholders of Sarita Vihar, Gautam Puri,
Ayurveda to use this platform and share Case Reports Mathura Road, New Delhi
in the benefit of traditional practices. At AIIA, we are E-mail: ak_ayu@yahoo.co.in

2 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):1-2

 Journal of Ayurveda Case Reports

Research in Traditional Systems of Medicine

I am very glad to see the first issue of the case study The WHO Traditional Medicine strategy 2014-2023,
focused Ayurveda journal by All India Institute of promotes safe and effective use of traditional medicines
Ayurveda in India. and has one important strategic objective, that is to
build and strengthen the knowledge base on traditional
India has a rich heritage in traditional systems of medicines through research. This need for an improved
medicine which include Ayurveda, Unani, Siddha, knowledge base was reinforced at the regional
Yoga, Naturopathy, Homeopathy and others. consultation on traditional medicine for the WHO
South-East Asia region in 2015.
Traditional herbal medicines an important part of most
traditional systems of medicine including Ayurveda. This journal is, therefore, important to build and
Many people in developing countries still rely on herbal strengthen evidence-based knowledge in Ayurveda
medicines to meet their health needs, particularly in through case studies and their documentation in this
rural and remote areas. Even in areas where modern region.
medicine is available, the interest in herbal medicines
has been increasing rapidly in recent years because of I strongly believe that this journal can provide a
their potential contributions to health and well-being, platform to discuss, share and exchange experiences and
because lifestyle-related diseases are becoming more knowledge among eminent experts and researchers. This
common across the world. will contribute to promoting evidence-based practices in
traditional systems of medicine.
Traditional herbal medicines are believed to have much
to offer in the health promotion, disease prevention and Dr Sung Chol, Kim
management, particularly for lifestyle-related diseases,
through their holistic approach. Regional Advisor in Traditional Medicine (TRM)
Department of Health Systems Development (HSD)
World Health Organization
How to cite: Sung Chol K. Research in Traditional
Regional Office for South-East Asia
Systems of Medicine. J AyuCaRe 2017;1(1):3.
(WHO-SEARO)

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):3  3

 Journal of Ayurveda Case Reports

GUEST EDITORIAL

All India Institute of Ayurveda Launching Quarterly Journal of Ayurveda Case

Reports

I am delighted to learn that All India Institute of involved in teaching, research and practice of Ayurveda
Ayurveda, New Delhi is launching a quarterly journal for over 50 years. My experiences suggest that one of
of Ayurveda Case Reports (AyuCaRe). I wish this the main barriers in AYUSH research is non-availability
new journal a grand success. The success of any such of appropriate research methodology which may test
periodical publication depends on the quality of its Ayurveda as it is in true sense. Most of the present day
contents and its uninterrupted production with realistic researchers conduct small scratchy researches ignoring
peer reviewing and growth of its readership among the the Ayurvedic approach and principles using hurriedly
educators, researchers and practitioners of Ayurveda. borrowed conventional methodology resulting in
Inspite of some progress in the area of research by baseless data throwing no light on Ayurveda. As a
way of MD, Ph.D theses and few institutional research matter of fact, Ayurveda research is facing a serious
project mode researches; the rate of quality publication methodology crisis.
from AYUSH sector has remained disappointing. Some
recently launched journals such as J-AIM, AYU, ASL It cannot be overemphasized that Ayurveda has
and AAM have shown steady growth but have not greater strength in its unique principles, concepts and
succeeded to earn any impact factor. Traditional Chinese approaches, not so much in its medications. But the
medicine and Yoga have shown better performance entire R&D effort is devoted in drug development
than Ayurveda, which is really a matter of concern. The through conventional methods with little outcome. The
reason for this slow turnover of publications is due to methodology of clinical drug research too is standing on
lack of quality research in this sector besides lack of core the crossroads seeking right directions in the changing
competency and lack of skill for research writing. The scenario. The double blind placebo controlled clinical
third important factor is the dearth of good journals trials which were considered the gold standards of drug
in this field willing to consider Ayurvedic research testing during mid-20th century are no more considered
submissions. gold standards as they are full of fallacies and flaws
specially when applied to Ayurvedic research.
I am really happy to notice the initiatives of AIIA to
launch a new journal. Rapid publication needs rapid The reverse pharmacology approach with pragmatic
growth of quality research yielding publishable data. It is clinical trials and careful and critical clinical case
hoped that Central Council for Researches in Ayurvedic studies are now considered as more authentic methods
Sciences will pool its resources and expertise to promote
of clinical evaluation of the safety and efficacy of a drug
Ayurvedic research both in fundamental and applied
or a procedure. In view of this trend, it is in fitness of
aspects specially clinical researches through appropriate
things that, AIIA is launching a quarterly journal of
scientific research methodology. I have been closely
Ayurveda Case Reports (AyuCaRe). But this enterprise
will be purposeful only if clinicians keep good records
How to cite: Singh RH. All India Institute of Ayurveda and carry case reporting in a duly critical and intensive
Launching Quarterly Journal of Ayurveda Case manner and not in a casual way. Each case report
Reports. J AyuCaRe 2017;1(1):4-5. should be peer-reviewed by three reviewers without

4 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):4-5

 Singh RH: Quarterly Journal of Ayurveda Case Reports

any conflict of interest. Clinical case reports need more The role of good practitioners in the professional field,
rigorous scrutiny than the reports of controlled clinical public or private, is equally important. Our practitioners
trials. could conduct good clinical research in practice settings
and could submit good clinical research reports for
Many Indian journals who claim that they are peer publication in AIIA Journal. All India Institute of
reviewed, treat the peer reviewing process as a formality Ayurveda should organize periodical workshops and
and as an academic ritual serving no purpose. There training program for postgraduate students and faculty
is also an acute shortage of willing and competent members to learn the skill of writing Ayurveda research
reviewers. The important issues like conflict of interest papers and proposals. This is absolutely essential
and authenticity of investigational data are often ignored. because the main reason why Ayurvedic academia is
Most journals are starving of publishable submissions trailing behind is the poor performance on research and
and there is not much choice of selection of papers for publication frontiers. AIIA being the apex institution of
running the life-line of a journal. Most of the journals higher studies in Ayurveda, its mandatory responsibility
appear quarterly and there is hardly a good monthly is to play activism. There is need of Action Now, no
journal in AYUSH sector. Hence there is a simultaneous more tomorrows.
need of fast track promotion and enhancement of good Prof Ram Harsh Singh
research in Ayurveda on one hand and similar activism
on quality publication. Research and publication have to Distinguished Professor,
go hand in hand. The educational institutions need to be Department of Kayachikitsa,
vitalized to produce talented and skilled postgraduates Institute of Medical Sciences,
who may have work-culture and scientific temper with Banaras Hindu University,
willingness and passion to opt research and teaching as Varanasi, India
a career. Email: rh_singh2001@yahoo.com

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):4-5  5

 Journal of Ayurveda Case Reports

Management of Avascular Necrosis through Panchakarma

Adil R*, Sangeeta RT, Karishma S, Anup BT

Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University,
Jamnagar, Gujarat, India.

*Correspondence: Email: adil.rais13@gmail.com, Mobile: +917060272769

ABSTRACT
Keywords:
Avascular necrosis of hip joint has emerged as one of the most disabling conditions of
Asthikshaya, present era of Orthopedics. It poses a challenge in front of the medical fraternity due
Avascular necrosis, to non-availability of accurate management for this condition. Surgery offers hip joint
Case report, replacement that is not so commonly available and expensive too. Ayurveda can provide
Tikta ksheera vasti, a suitable answer through appropriate Panchakarma modalities useful in Asthi dhatu kshaya.
Virechana A diagnosed case of Avascular necrosis with complaints of pain at bilateral hip joint
and restricted movements approached the out-patient division of the hospital and was
managed by Udwartana, Virechana and Tikta ksheera vasti by following classical principles
of Ayurveda. Significant improvement was noticed after the treatment. Pain was reduced
significantly and the patient was able to walk and climb stairs at the end of the treatment.
Results obtained were encouraging and restricted disease progression was observed.

Introduction: Avascular necrosis (AVN), also known Pain can be mild or severe, localized and develops
as osteonecrosis, bone infarction, aseptic necrosis gradually. Pain may be limited to groin, thigh or buttock
and ischemic bone necrosis is cellular death of bone if AVN affects hip. Pain location tends to be most specific
components due to interruption of blood supply, in anterior hip and lower pelvis. Can be acute in onset
because of which the bone tissue dies and the bone (acute infarct phenomenon), which can mimic an acute
collapses.[1-3] If AVN affects the bones of a joint, it often injury. Range of motion will be reduced affecting the
leads to destruction of the articular surfaces. It primarily gait. No satisfactory therapy is available in conventional
affects epiphysis of long bones such as the femur and system of medicine, while the available procedures are
also involves shoulder, knee and hip joints etc. Other not affordable by all. Prognosis of all such approaches
common sites include the humerus, shoulders, knees, are not convincing.[5]
ankles and the jaw.[4] Many people have no symptoms in
the early stages of avascular necrosis. As the condition This condition can be correlated to Asthi majja gata vata
worsens, the affected joint may hurt under stress. and / or Asthi dhatu kshaya manifesting symptoms like
Bhedo asthi parvanam (breaking type of pain in bones and
joints), Sandhi shula (joint pain), Mamsakshaya (muscular
wasting), Balakshaya (weakness), Aswapna santataruk
How to cite this article: Adil R, Sangeeta RT, Karishma
(disturbed sleep due to continuous pain) and Sandhi
S, Anup BT. Management of Avascular Necrosis
shaithilyam (afflicted joints) with Shiryanti iva cha asthini
through Panchakarma. J AyuCaRe 2017;1(1):6-12 .
durbalani (destruction of bony tissue causing generalized

6 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12

 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

weakness), Pratata vata rogini (other aggravated features Table 1: Grading of pain and other symptoms
of vata) etc.[6] Wide range of treatment modalities have
been mentioned in Ayurveda that are effective in such Pain
manifestations. No Pain 0
Case report: A 35 years male patient visited Department Mild pain with no difficulty in walking 1
of Panchakarma, Institute for Post Graduate Teaching
Moderate pain with slight difficulty in walking 2
and Research in Ayurveda, Gujarat Ayurved University,
Jamnagar with chief complaints of pain at bilateral hip Severe pain with severe difficulty in walking 3
joints with restricted movements, difficulty in walking,
Visual Analogue Scale
unable to stand-up from sitting position and difficulty in
forward bending since four months. No Pain (0) 0

Patient noticed a jerk on sudden lifting of weight of Mild (1-3) 1

about 40-45 kg followed by pain at both hip joints and Moderate (4-6) 2
left gluteal region four months back. Pain aggravated
Severe (7-10) 3
on next day, restricting movements of hip joint without
radiating to any parts. A brief warm-up of five minutes Stiffness
was providing mild relief, but the improvement was time No Stiffness 0
limited. No history of tingling sensation or numbness of
lower limbs was reported. Stiffness of mild grade, need no intervention 1

Stiffness relieved by topical medicaments 2

Initially patient was managed with homeopathic
medicines with which mild relief in pain was noticed. Stiffness relieved by oral medication 3
But, restricted movements were persisting with
Stiffness not responded by medicine 4
increased morning stiffness. Patient had a history of
facial palsy about one and a half years back for which he Difficulty in walking
was prescribed with corticosteroids and got significant No pain, normal movements 0
relief.
Mild pain with mild restriction of movements
The Shareera prakriti of the patient was Kaphavataja, had
Moderate pain with restriction of movement 2
Krura koshtha (on the basis of bowel habits), Madhyama
bala (optimum physical strength) with good Satva Severe pain with restricting movements 3
(psychological strength). He had mild Agnimandya
Complete restriction of movements 4
(decreased digestion and appetite) and habit of
occasional drinking alcohol.
Investigations: MRI of Hip joint was conducted before
Dosha dushya lakshana: Predominant Dosha in the and after the treatment. MRI Findings were suggestive
disease is Vata in association with Pitta and Kapha. Since, of AVN of bilateral femur with minimal joint effusion
there was a history of sudden jerk that may be responsible (AVN Stage II). The lesions involved from 9 to 4O clock
for local inflammation, vitiating Pitta. Besides, Avarana on sagittal images. No evident sub-chondral collapse or
of Kapha and Meda over Vata may also be considered to
secondary degenerative osteoarthritis was found.
play an important role in the manifestation of symptoms
like stiffness and restricted movements of hip joint in the Management of the condition: The patient was
patient. admitted in the Panchakarma IPD and treatment was
Assessment Criteria: Pain, stiffness and difficulty in planned considering involved Dosha and Dushya.
walking (Table 1), Visual Analogue Scale (VAS) and Tikta ksheera vasti was planned for eight days that was
improvement in the movements of flexion, extension and preceded by Rukshana therapy comprising of Udwartana
abduction were assessed at various stages of treatment. (dry powdered massage), followed by Virechana karma

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12  7

 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

(Table 2). Udwartana was done for five days with mixture capacity of the patient. Go-ghrita was administered at a
of 200 g of Yava churna and 50 g of Triphala churna that dose of 30 ml, 70 ml, 110 ml, 140 ml and 170 ml on 1st,
was made warm and rubbed firmly over the bilateral 2nd, 3rd, 4th and 5th day respectively. This was followed
hip region for 25 to 30 minutes for five days. Internally, by Abhyanga and Swedana (sudation in a steam chamber)
patient was advised to take Siddha jala [water processed for three days. Patient was advised to take diet like
one part of drug and 16 parts potable water] of Dhanyaka Mudgayusha and fruit juice like orange or pomegranate
(Coriandrum sativum), Shunthi (Zingiber officinale) and twice a day for three days. At the end of this, drugs for
Shatapushpa (Anethum sowa) for Deepana and Pachana for Virechana were administered and Madhyama shuddhi was
five days. obtained.

Table 2: Plan of treatment After completion of Sansarjana krama (specific diet

regimen after Shodhana) for Madhyama shuddhi (for five
Procedure Duration Drugs used days), patient was advised a gap of three days that
was followed by Tikta ksheera vasti made-up of 50 ml of
Ruksha 5 days Triphala and Yava churna
Madhu (honey), 5 g of Saindhava lavana (rock salt), 100
udwartana
ml of Go-ghrita (ghee), 25 g of Kalka (paste) prepared out
Snehapana 5 days Goghrita of powders of Guduchi (Tinospora cordifolia Miers.) and
Yashtimadhu (Glycyrrhiza glabra Linn.), and around 450 ml
Virechana Nimbaamritadi Eranda
Kwatha (decoction) of Guduchi and Erandamoola (roots of
taila and Triphala kwatha
Ricinus communis Linn.). The plan of Vasti is presented at
Vasti 8 days Tikta ksheera vasti Table 3.

After assessment of Agni; Snehapana with Go-ghrita was Observations and Results: Mild improvement was
planned that was given to the patient before 6.30 AM reported in pain, stiffness and range of movements
and continued till the appearance of Samyak snigdha after Udwartana with a feeling of lightness in the
lakshana. It took five days to observe these features. Dose affected area. During Snehapana for Virechana, it took
of Go-ghrita was increased daily observing the digestive around 6-8 hours to feel hunger by the patient on 1st
Table 3: Plan of Vasti

Day Dose Time of Time of Vasti Observations Complications

(ml) administration pratyagamana if any

1 500 11 AM 15 min Feeling of lightness in body, Two bowel

evacuations

2 500 11.15 AM 20 min A bowel evacuation, Lightness present in

body, Mild relief in pain and stiffness

3 600 11 AM 10 min A bowel evacuation, No other specific

observations

4 600 11.30 AM 15 min

A bowel evacuation, Improvement in range of None
5 600 10.30 AM 20 min
hip joint movements
6 600 10.45 AM 15 min

7 600 11 AM 20 min A bowel evacuation with feeling of lightness

in body, Significant relief in pain and stiffness

8 500 11 AM 30 min A bowel evacuation with significant relief in

pain, stiffness and improvement in hip joint
movements

8 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12

 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

and 2nd day of Snehepana, while it was increased to 10 Patient suffered from facial palsy about one and a half
hours on 3rd and 4th day and 13 hours on the 5th day. years ago and there was a history of steroid drug intake
Unctuousness in stools, downward movement of flatus for the same, for six months, until recovery. Patients
and greasiness of skin were observed from 4th day having a history of oral steroid usage are more prone
onwards. An average retention time of Vasti was around to develop AVN.[12] Glucocorticoid-induced AVN
18 minutes. No untoward effects were noticed during causes significant morbidity and accounts for around
Vasti regimen (Table 9). Mild relief was reported in 10% of all cases of total hip replacement in the United
pain, stiffness and range of movements after Udwartana States.[13] The prevalence of gluco-corticoid induced
with a feeling of lightness in the affected area. After AVN is between 3% and 38%, depending on the
Virechana, marked improvement was observed in pain, underlying diseases, gluco-corticoid dosage and route of
stiffness, improvement in range of movements at hip administration.[14] Patient had a history of having alcohol
joint region. After completion of Vasti, there was further occasionally, which is also one of the causes making
improvement in the movements due to decreased pain more proneness for developing AVN.[15] Virechana was
and stiffness. selected as a therapy to be used here for Shodhana to
produce detoxifying effects since there was a history
Pain, stiffness and difficulty in walking responded
of steroid and alcohol intake. Virechana also provides
with Virechana and Tikta ksheera vasti (Table 4). Patient
stability to Dhatu countering dhatu sthairya,[16] that is
was able to walk and climb stairs without any external
needed especially in conditions like AVN. Besides this,
support. Body weight was reduced from 90 kg to 83 kg
there are chances for better absorption of Vastidravya
after classical procedures of Udwartana, Virechana and
after Shodhana, thus chances of better results.
Vasti. Observations of Visual Analogue Scale (VAS) came
down from 4 to 1 by the end of treatment. Improvement In this trial, Nimbaamritadi eranda taila was used for
was also found in the range of movements of hip joint Virechana.[17] The purpose was to perform Snigdha
(Table 5). virechana considering Vata predominant nature of

Discussion: Prakriti of the patient was Kaphavataja disease and involvement of Asthi dhatu that have Ruksha

and weight was 90 kg. Main symptoms present were and kharaguna. Besides, Eranda taila is said to act on

pain, stiffness and decreased range of movements that Vatadosha and when it is processed along with Tikta rasa

is an indication of Vata as the main Dosha leading to dravyas like Nimba and Guduchi; act on Asthi dhatu and

Asthikshaya. Considering Vata as main dosha, Vasti was help as Rakta prasadaka too.
planned in the management. Since Asthi was the main
Before Virechana; Udwartana was planned for external
involved Dhatu; Tikta dravya siddha vasti was selected.
Rukshana as the patient was of Kapha vataja prakriti
[7]
Erandamoola (roots of Ricinus communis) was used
with body weight of 90 kg. Rukshana would be the
considering its Vata shamaka properties.[8] Milk was
procedure of choice to remove any Avarana caused
added in Vasti that nourishes Dhatus and specifically
by Kapha and Meda before commencing with the
Asthi dhatu. Powders of Guduchi (Tinospora cordifolia
main treatment for better action and bio availability
Willd.) and Yashtimadhu (Glycyrrhiza glabra Linn.) used
of subsequent therapies. About 200 g of Yavachurna
in the formulation may help in rebuilding the bone
and 50 g of Triphala churna were used in Udwartana.
tissue.[9]
Reduction in stiffness, weight loss and lightness in body
AVN of hip joint develops basically due to obstruction of were observed after completion of this process. But,
small blood vessels supplying to femoral head leading severity of pain was persisting during walking and on
to gradual development of necrosis due to reduced attempt to climb stairs. Reduction of stiffness could be
vascular supply. Thus, Rakta vaha sroto rodha becomes due to the Rukshaguna of Yava cause neutralization of
prime cause leading to Asthi dhatu kshaya in the hip Kapha, Pitta, Meda and produce required
joint. To counter this Rakta dushti; Virechana was planned Lekhana effect. [18]
Triphala churna also helps in removing
before proceeding to Vasti.[10] Virechana also helps in excessive Kapha, Meda and Twakgata kleda.[19] Once the
Dhatu vishodhana.[11] Avarana of Kapha and Meda is resolved; platform for

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12  9

 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

better action of Virechana and Vasti is expected on Vayu. after Virechana. Marked improvement was observed in
This could also be the reason for loss of weight and the abduction, flexion and extension of hip joint.
relative lightness in patient. Internal Deepana, Pachana
with Dhanyaka and Shatapushpa also lead to increased Honey is the first component of Vasti, the base in which
appetite and proper bowel evacuation on daily basis. the emulsion for other ingredients are prepared. It is also
Most of the subjective and objective parameters showed said to possess Asthi sandhaniya properties that helps in
marked improvement after the Virechana karma. rebuilding damaged Asthi.[21] Vasti with Tikta dravya, Ghrita
and milk is indicated in Asthi kshaya janya roga. Guduchi is
Eighteen Virechana vegas with Shleshma pravritti in last two said to be an excellent Rasayana drug, known to prevent
vegas indicating optimum procedure (Samyak shuddhi) of ageing and degeneration of the tissues, especially Asthi
Virechana. No weakness was reported by patient on the dhatu.[22-23] Guduchi is grouped under Asthi sandhaniya maha
day of Virechana or subsequent days of Samsarjana krama. kashaya.[24] It also has a role in enhancing Rakta dhatu,[8]
Considerable improvement in pain and stiffness in hip thus may have a role in providing nourishment to hip
joints probably owing to Vata shamaka and Ama nirharana joint by re-channelizing blood vessels supplying to it.
properties of Eranda taila.[20] Snigdha virechana was
planned owing to counteract the Ruksha effect created by Erandamoola is the other Dravya used in Vasti kwatha,
Vataprakopa. Tikta drugs present in it like Nimba, Amrita, which is said to have Vata shamaka properties, thus
Patola, Kantakari, etc. nourish Asthi dhatu too. After producing significant relief in pain. It is also said to help
Virechana karma, Tikta ksheera vasti was administered. as Ama dosha nirharana that is responsible for production
Improvement in range of hip joint movements owes to of stiffness and thus bringing about a considerable
the significant reduction in stiffness and pain produced improvement in the range of movements at hip joint.

Table 4: Changes observed in pain, stiffness and walking after treatment

BT After Udwartana After Virechana After Vasti

Features
Right Left Right Left Right Left Right Left

Pain at hip joint 3 3 3 3 1 1 1 1

Stiffness 4 4 2 2 1 1 1 1

Difficulty in walking 4 4 3 3 1 1 1 1

Table 5: Changes observed in range of Hip Joint Movements

RIGHT LEFT

BT After Virechana After Vasti BT After After Vasti

Virechana

Flexion 44o 59o 79o 34o 56o 66o

Extension 29 o 32o 34o 29o 32o 30o

Abduction 31o 35o 36o 27o 32o 32o

10 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12

 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

Before Treatment After Vasti for a longer duration, frequent jerky movements and
lifting weights were asked to be avoided.

Patient was advised to re-visit the hospital after a month

to re-evaluate the features. No further deterioration
in the symptoms was noticed after a month. Pain was
Flexion

present in hip joints but only during walking and

climbing stairs. Range of movements like flexion,
extension and abduction at hip joints were restricted but
showed no significant deterioration as compared to the
observations made just after completion of therapies.
MRI scans of the hip joint after the follow up period
showed no further deterioration in the gradation (Grade
II) of Avascular necrosis, which suggests that the disease
progression was stopped. He was advised to revisit
hospital after one month for next treatment regimen.
Extension

Conclusion: AVN is an orthopedic condition that poses

a challenge in front of whole medical fraternity owing to
the impeding of routine activities produced. The adopted
therapy in the current case provided marked relief from
pain, tenderness, general debility and improvement
in the gait. The grade of AVN did not worsen and was
maintained. This was a pilot study to evaluate the efficacy
of Udwartana, Virechana and Vasti in the management
of AVN and the results produced were encouraging
enough not only on the subjective and objective scales
Abduction

but also provided a check in disease progression. It is

advisable to conduct this particular study on a larger
number of samples for a greater span of time to draw
more concrete conclusions. More awareness among
general public should be created towards management
of AVN using Ayurveda to promote earlier diagnosis
that might lead to better prognosis.

Fig 1: Changes observed in range of Source of support: Institute for Post Graduate Teaching
Hip Joint Movements and Research in Ayurveda, Gujarat Ayurved University,
Jamnagar - 361008, Gujarat, India.
After completion of treatment, patient was prescribed
with Shamana drugs for a month to nourish Asthi dhatu Conflicts of interest: None declared.
and thus preserving the effects produced by Panchakarma.
References:
Two tablets of Abha guggulu (each 500 mg) twice a day
with 60 ml Rasna saptaka kwatha, a blend of Guduchi 1. h t t p s : / / e n . w i k i p e d i a . o r g / w i k i / Ava s c u l a r _
churna (2 g), Ashwagandha churna (2 g) and Godanti necrosis#cite_note-nawazkhan-1 last accessed on
bhasma (250 mg) were advised. Patient was advised to Dec 1, 2016 at 13.01.
consume warm water and easily digestible food items. 2. Digiovanni CW, Patel A, Calfee R, Nickisch F.
Exposure to cold air, maintaining one particular posture Osteonecrosis in the foot. The Journal of the

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 Adil et al.: Ayurvedic Management of Avascular Necrosis 1(1) 2017: 6-12

American Academy of Orthopaedic Surgeons Pathogenesis and natural history of osteonecrosis.

2007; 15(4): 208-17. Seminars in Arthritis & Rheumatism. 2002; 32(2):
3. http://emedicine.medscape.com/article/333364- 94-124.
overview last accessed on Dec 1, 2016 at 13.15. 15. Matsuo K, Hirohata, Tomio, Sugioka, et al.
4. Chapman C, Mattern C, Levine WN. Influence of Alcohol Intake, Cigarette Smoking, and
Arthroscopically assisted core decompression Occupational Status on Idiopathic Osteonecrosis
of the proximal humerus for avascular necrosis. of the Femoral Head, Clinical orthopedics and
Arthroscopy 2004; 20(9): 1003-1006. related research. 1988, (234): 115-23.
5. Kadlimatti SM, Subbanagouda PG, Sanakal AI, 16. Shailja S, editor, (4th ed.) Sharangadhara samhita
Milind D. Ayurvedic Management of Avascular of Sharangadhara, Uttara khanda, Virechanavidhi
Necrosis of the Femoral Head - A Preliminary adhyaya, chapter 4, verse 18, Chaukhambha
Study. AYU 2008; 29(3): 154-160. Orientalia, Varanasi: 2005. p. 347.
6. Kashinatha shastri, editor. Charaka samhita of 17. Atrideva gupta, editor, Ashtanga hridayam of
Agnivesha, Chikitsa sthana, Vatavyadhi Chikitsa, Vagbhata, Chikitsa sthana, Vatavyadhi Chikitsa,
chapter 28, verse 33, Chaukhambha Sanskrit chapter 21, verse 58-61, Chaukhambha Sanskrit
Sansthan; Varanasi: reprint 2007. p. 196. Sansthan; Varanasi: 2005. p. 420.
7. Kashinatha shastri, editor. Charaka samhita of 18. Brahmashankara misra, editor, Bhava prakasha of
Agnivesha, Sutra sthana, Vividhashita pitiya Bhava misra, Madhyama khanda, Navamo dhanya
adhyaya, chapter 28, verse 27, Chaukhambha varga, chapter 21, verse 29-30, Chaukhambha
Sanskrit Sansthan; Varanasi: reprint 2007. p. 432. Sanskrit Sansthan; Varanasi: 2012. p. 640.
8. Kashinatha shastri, editor. Charaka samhita of 19. Atrideva gupta, editor, Ashtanga hr idayam of
Agnivesha, Sutra sthana, Yajjapurushiyam, chapter Vagbhata, Sutra sthana, Anna swaroopa vigyaniya,
25, verse 40, Chaukhambha Sanskrit Sansthan; chapter 6, verse 159, Chaukhambha Sanskrit
Varanasi: reprint 2007. p. 438. Sansthan; Varanasi: 2005. p. 65.
9. Kashinatha shastri, editor. Charaka samhita of 20. Brahmashankara misra, editor, Bhava prakasha of
Agnivesha, Sutra sthana, Shad virechana shata Bhava misra, Madhya khanda, Amavata Chikitsa,
shritiyam, chapter 4, verse 9, Chaukhambha chapter 26, verse 50, Chaukhambha Sanskrit
Sanskrit Sansthan; Varanasi: reprint 2007. p. 60. Sansthan; Varanasi: 2000. p. 286.
10. Kashinatha shastri, editor. Charaka samhita 21. Kashinatha shastri, editor, Charaka samhita of
of Agnivesha, Sutra sthana, Vidhi shonitiyam, Agnivesha, Sutra sthana, Shad virechana shata
chapter 24, verse 18, Chaukhambha Sanskrit shritiyam, chapter 4, verse 5, Chaukhambha
Sansthan; Varanasi: reprint 2007. p. 302. Sanskrit Sansthan; Varanasi: reprint 2007. p. 60.
11. Satyapal bhishag, editor. Kashyapa samhita of 22. Shailja S, editor, (4th ed.) Sharangadhara samhita
Vriddha jivaka, Siddhi sthana, Tri lakshana siddhi, of Sharangadhara, Poorva khanda, Deepana
Chaukhambha Sanskrit Sansthan, Varanasi: 2012. pachanadi kathanam, chapter 4, verse 14,
p. 150. Chaukhambha Orientalia; Varanasi: 2005. p. 33.
12. David TF, Jennifer JA. Across section study and 23. Yadavji trikamji, editor, Charaka samhita of
evaluation of association between steroid dose and Agnivesa, Chikitsa sthana, Rasayana, chapter 1,
bolus dose and avascular necrosis of bone. The verse 7, Chaukhambha Surabharati Prakashan;
Lancet 1987; 329(8538): 902-906. Varanasi: 2006. p. 376.
13. Mankin HJ. Non traumatic necrosis of bone 24. Kashinatha shastri, editor. Charaka samhita of
(osteonecrosis). N Engl J Med. 1992;326(22):1473- Agnivesha, Sutra sthana, Shad virechana shata
1479. shritiyam, chapter 4, verse 5, Chaukhambha
14. Assouline DY, Chang C, Adam G, Yehuda S, et al. Sanskrit Sansthan; Varanasi: reprint 2007. p. 60.

12 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):6-12

 Journal of Ayurveda Case Reports

Jalaukavacharana (Leech application) and adjuvant therapy in the management

of infected wound
Mahanta VD*, Foram J1, Dudhamal TS2, Gupta SK

Department of Shalya Tantra, All India Institute of Ayurveda, New Delhi, 1JS Ayurveda College, Nadiad, 2Institute for Post
Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.

*Corresponding Author: Email: drvyasayu@yahoo.in, Mobile: +917838957972

ABSTRACT
Keywords:
Infected wounds are manifested as a complication of trauma or due to various pathological
Case report, conditions and are difficult to manage because of their non-healing nature. In Ayurveda,
Dusta vrana, infected wounds can be compared with Dusta vrana. Besides other modalities of treatment;
Insect bite, leech application has been emphasized in the management of such manifestations.
Jalaukavacharana, A male patient of 45 years age having Vata kaphaja prakriti visited OPD of Shalya tantra
Katupila, with complaints of severe pain, swelling with ulceration over the dorsum of right foot
Leech application, and intermittent fever with history of unknown insect bite for the past two weeks. Local
Panchavalkala, examination revealed an ulcer covered with necrotic tissue with progressive inflammatory
Wound changes. Based upon the history and clinical findings; the case was diagnosed as Dusta
vrana due to Kita dansha. Leech application was done by following classical guidelines of
Ayurveda. Simultaneously, cleaning of wound with Panchavalkala Kwatha and dressing
with powder of Katupila (Securinega leucopyrus) mixed with Tila Taila (sesame oil) was
done daily. Changes in size, shape, floor, and margin of the ulcer were recorded at regular
interval. Pain, discharge were completely subsided after three consecutive sittings of
leech application. The ulcer was completely healed within two months with minimal scar
formation. Leech application along with local application of Katupila has significant role in
controlling inflammation and promoting healing of infected wounds without any adverse
effect.

Introduction: Ayurveda explains a wide range of factors On accidental exposure, Kitas (insects) emit poisonous
in the manifestation of Vrana like Abhighata (physical substances into the blood through saliva and cause
trauma), exposure to Amla dravya (chemical), Kita damsa formation of Vrana (ulcer) and Sopha (inflammation)
(insect bite) etc.[1] at the site of bite. If appropriate interventions are not
taken at right time; other generalized reactions like Toda
How to cite this article: Mahanta VD, Foram J,
(burning pain), Paka (suppuration), Shotha (swelling),
Dudhamal TS, Gupta SK. Jalaukavacharana (Leech
Vaivarnya (discoloured skin), Vrana kledana (foul
application) and adjuvant therapy in the management
discharge from ulcer), Ruja (pain), Jwara (pyrexia) etc.
of infected wound. J AyuCaRe 2017;1(1):13-17.
will manifest.[2]

13 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):13-17  13

 Mahanta VD et al.: Management of infected wound through Jalaukaavacharana 1(1) 2017:13-17

Insect bite and sting cases are commonly seen in rural with foul smell and purulent discharge (Figure 1).
clinical practice. Venom is composed of proteins and On palpation, local temperature was raised and the
other substances, which is responsible in developing surrounding area was tender (+++). Distal neurovascular
allergic reactions of various stages depending upon status was normal. Radiological examination of foot
the nature of the venom as well as patient’s resistance revealed no bony abnormality. Based upon the signs
power. Initially burning pain and redness appears and symptoms; case was diagnosed as Dushta vrana due
followed by gradual localized swelling. There may to insect bite and planned for Jalaukaavacharana (leech
be presence of visible sting or a small puncture at the application).
site of bite. The bites may cause manifestations like
acute generalized exanthematous pustulosis (AGEP) Before application of Jalauka, necrotic tissue was removed
or toxic pustuloderma, anaphylactic reaction etc.[3] surgically and surrounding skin of the ulcer was cleaned
In routine; rest to the affected part, application of ice with Panchavalkala kwatha [decoction of barks of five
packs, compression and elevation of the affected part trees i.e. Vata (Ficus bangalensis Linn.), Udumbara (Ficus
etc. are advised to reduce inflammation and pain. In glomerata Roxb.), Ashwattha (Ficus religiosa Linn.), Parisha
addition, other medications like anti-allergic drugs, (Thespesia populnea Solan ex Correa), and Plaksha (Ficus
anti-inflammatory drugs, antibiotics etc are also lacor Buch-Ham.)].
recommended to combat symptoms.
Jalaukas were applied over the floor and at the border
Exclusive description of wound and its management of the ulcer (Figure 2). Jalaukaavacharana was started
can be observed in the texts of Ayurveda. Specifically, with four Jalauka on first day and three Jalauka on 3rd
Rakta mokshana (blood-letting) through Jalauka (Leech) and 5th day of admission (Figure 3-4). This was followed
is emphasized in the management of Savisaja vrana by cleaning of the area with Panchavalkala kwatha and
(poisonous wound). [1]
Various clinical studies have dressing with paste of Katupila (Securinega leucopyrus
reported rapid, effective and long-lasting potential of [Willd.] Muell) and Tila taila (sesame oil) regularly till
leech application in managing painful conditions. [4] complete healing. All the Jalaukas used on 1st day were
died after 15 minutes of blood-letting, while Jalaukas
Case report: A 45 years old male auto driver of Vata used on 3rd and 5th day were died after an hour.
kaphaja prakriti visited OPD of Shalya tantra, Institute
for Post Graduate Teaching and Research in Ayurveda,
Gujarat Ayurved University, Jamnagar with complaints
of severe pain, swelling with ulceration over the dorsum
of right foot and intermittent fever for the past two
weeks. History revealed an unknown insect bite during
sleep. Burning pain was noticed immediately after the
bite that was increased gradually. On 2nd day, affected
foot was swollen with symptoms of cellulitis. Patient
had taken antibiotics, analgesics and anti-allergic
Fig 1: Wound covered with necrotic tissue with
drugs for ten days from a private hospital. He did not
inflamed margins (On the day of admission)
get relief and the severity of pain, size of ulcerative
lesion was increased. Routine laboratory investigations
were normal except slight variation on percentage of Observations: Swelling and pain were reduced
neutrophil and lymphocyte count. remarkably on 5th day of leech application. On 15th
day of regular dressing; necrotic tissue disappeared
On local examination, a progressive ulcer at dorsum completely and wound became clean with exposed
of left foot just above the meta-tarso-phallangeal joint, tendons (Figure 5). After 30 days, healthy granulation
about 5x7 cm in size, with irregular, inflamed margins tissue was observed and exposed tendons were covered
was found. Floor was covered with necrotic tissue with healthy granulation tissue (Figure 6). Gradually,

14 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):13-17

 Mahanta VD et al.: Management of infected wound through Jalaukaavacharana 1(1) 2017:13-17

the ulcer size was reduced with remarkable wound wound was healed completely by the end of two months
contraction. After 45 days, the wound became small and (Figure 7-10) without any internal medication.

Fig 2: Application of leeches Fig 3: On 3rd day (after debridement Fig 4: On 5th day (after debridement
and application of Jalauka) and application of Jalauka)

Fig 5: On 15th day (granulation Fig 6: On 30th day (contracted wound Fig 7: On 35th day (covered surface
tissues developed) with healthy granulation tissue) with healthy granulation tissue with
contracted margin)

Fig 8: On 42nd day Fig 9: On 49th day Fig 10: On 56th day (healed wound
with minimum scar)

Discussion: About 67 varieties of Kitas (insects) are (penetrating into minute channels of the body), Vyavayi
mentioned in the classics of Ayurveda. The group of (rapidly permeating into the whole body), Avipaki
Tikshna Kita produces severe cutaneous reactions in form (disturbing the tissue metabolism) etc. characters.[5] Due
of Sopha (inflammatory lesions), Granthi (swellings), to Ushna guna; Kita visha vitiates Rakta and Pitta dosha
Pidakas (vesicles) and other systemic manifestations and produces Daha, Sopha at the local site. Being dry in
like Jwara (fever), Daha (burning pain), Angamarda nature, it causes pain by vitiating the Vata. Shukshma
(bodyache), Murchchha (anaphylactic reactions) etc. by guna probably takes the poisons to the deeper tissues
virtue of their Ushna (hot), Tikshna (sharp), Shukshma and by spreading it causes cellulites.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):13-17  15

 Mahanta VD et al.: Management of infected wound through Jalaukaavacharana 1(1) 2017:13-17

In modern dermatology, these reactions are found when of Tila taila helps in facilitating the process of overall
body comes in contact with offended arthropods that wound healing.
produce injury to the skin in a variety of mechanisms. [6]

It is observed that the progressive phase of ulcer was

Mites are also considered as aetiological factors in the
managed successfully by three sittings of Jalaukavacharana
manifestation of dermatological reactions. Contact may
and regular dressing with paste of Katupila and Tila
cause erythematous papules, pruritus and formation of
taila. No other medicines were used during the course
vesicles etc.[7]
of treatment.
Raktamokshana is being practiced in India since long in the
Conclusion: Jalaukavacharana along with local application
management of Dusta vrana (infected wounds), Granthi
of paste of Katupila mixed with Tila taila is an effective
(cystic lesions), Arbuda (Neo Plasm) etc. Jalaukaavacharana
and safe treatment modality for the management of
is one type of Raktamokshana that counters vitiated
Dusta vrana caused by insect bite. This modality may
Rakta and Pitta. After piercing the skin, leech sucks the
even be beneficial in other types of infective and non-
blood and injects number of biological substances into
healing ulcers. However, such usefulness needs to be
the blood stream. A medium size leech sucks 5-15ml of
evaluated through well-defined clinical trials.
blood in one sitting.[8] In this study, approximately 7-8
cm size leeches were used and they consumed 10-15 ml Source of support: Institute for Post Graduate Teaching
of blood in each sitting. As, leeches sucked vitiated Rakta and Research in Ayurveda, Gujarat Ayurved University,
dosa (blood with toxins and unwanted metabolites) from Jamnagar - 361008, Gujarat, India.
the site of ulcer; reduction in pain and inflammatory
signs were noticed. Conflicts of interest: None declared.

References:
Patient was reported reduction in pain suggesting
poisonous substances might have been removed through 1. Singhal GD. editor. (2nd ed) Sushruta samhita of
the blood by leeches. The inborn quality of Jalauka i.e. Sushruta, Chikitsa sthana, Dwivraniya Chikitsa,
Shita (cold) and Madhura (sweet) are opposite to Pitta chapter 1, verse 6, Chaukhambha Sanskrit
dosa and these qualities might help in pacifying vitiated Sansthan; New Delhi: 2007. p. 140.
Pitta.[9] Hirudin, Hyaluronidase, Kallikrein, Histamine, 2. Shastri KN, Pandey GS. editor. Charaka samhita
Collagenase, Bdellins, Eglins present in saliva of leech of Agnivesha, Chikitsa sthana, Visha Chikitsa,
possesses activity of wound healing. Hirudin is capable chapter 23, verse 178, Chaukhambha Sanskrit
to increase surface perfusion due to its anti-coagulation Sansthan; Varanasi: reprint 2007. p. 577.
effect. Presence of Histamine, a vasodilator constituent 3. Bhat YJ, Hassan I, Sajad P, Atiya Y, Wani R. Acute
improves blood circulation by dilating capillary bed in Generalized Exanthematous Pustulosis due to
that area and might help in flushing out of the unwanted Insect Bites? Indian Journal of Dermatology 2015;
substances from the ulcer. Thus, possibly cellulites 60(4): 422.
was controlled. Other substances like hyaluronidase, 4. Detlev K, Biebertaler BGH, Michael A, Thomas
bdellins, eglins possesses anti-inflammatory and anti- R. Medicinal leech therapy in pain syndromes: a
biotic properties. All these in combination, possibly narrative review. Wiener Medizinische Wochen
played a great role in controlling inflammation and schrift 2014; 164(5): 95-102.
helped in wound healing. [10-12] 5. Singhal GD. editor. (2nd ed) Sushruta samhita of
Sushruta, Kalpa sthana, Kita Kalpa, chapter 8,
Panchavalkala kashaya helps in wound healing by the verse 5-18, Chaukhambha Sanskrit Pratishthan;
virtue of its Kashaya rasa (astringent taste), [13]
that brings New Delhi: 2007. p. 630-631.
back the Vrana to Shudhha avastha (clean stage) besides 6. Kar S, Dongre A, Krishnan A, Godse S, Singh N.
checking excessive discharge. [14]
Paste of Katupila with Epidemiological Study of Insect Bite Reactions
Tila taila is traditionally in use for dressing wounds and from Central India. Indian Journal of Dermatology
its wound healing efficacy is reported. [15]
Snigdha guna 2013; 58(5): 337-341.

16 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):13-17

 Mahanta VD et al.: Management of infected wound through Jalaukaavacharana 1(1) 2017:13-17

7. Krinsky WL. Dermatoses associated with the management of Vicarcika (Eczema). Ancient
bites of mites and ticks (Arthropoda:Acari). Science of Life 2014; 33(4): 236-241.
International Journal of Dermatology 1983; 22(2): 12. Abdualkader AM, Ghawi AM, Alaama M, Awang
75-91. M, Merzouk A. Leech Therapeutic Applications.
8. Abdullah S, Latief MD, Rashid A, Tewari A. Indian Journal of Pharmaceutical Sciences. 2013;
Hirudotherapy / Leech therapy: Applications 75(2): 127-137.
and Indications in Surgery. Archieves of 13. Acharya YT, editor. Charaka samhita of Agnivesha,
Clinical and Experimental Surgery 2012; Sutra sthana, Atreya bhadrakaapyeeya, chapter 26,
1(3): 172-180. verse 43, Rashtriya Sanskrit Sansthan; New Delhi:
9. Singhal GD. editor. (2nd ed) Sushruta samhita of reprint 2002. p. 145.
Sushruta, Sutra sthana, Kita Kalpa, chapter 13, 14. Ajmeer AS, Dudhamal TS, Gupta SK, Mahanta
verse 6, Chaukhambha Sanskrit Pratishthan; New VD. Katupila Securinega leucopyrus as a potential
Delhi: 2007. p. 87. option for diabetic wound management. Journal
10. Porshinsky BS, Saha S, Grossman MD, Beery II PR, of Ayurved and Integrative Medicine. 2014; 5(1):
Stawicki SP. Clinical uses of the medicinal leech: A 60-63.
practical review. Journal of Postgraduate Medicine 15. Ajmeer AS, Dudhamal TS, Gupta SK. Management
2011; 57(1): 65–71. of Madhumehajanya Vrana (diabetic wound) with
11. Shankar KMP, Rao SD, Umar SN, KV. A clinical Katupila (Securinega leucopyrus [Willd] Muell.)
trial for evaluation of leech application in the Kalka. AYU 2015; 36 (3): 353-55.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):13-17  17

 Journal of Ayurveda Case Reports

Management of Hashimoto’s Thyroiditis through Ayurveda

Seetha Chandran*, Rajam R1, Patgiri BJ, Prakash Mangalasseri2

Dept. of Rasa shastra and Bhaishajya kalpana, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved
University, Jamnagar, Gujarat, 1Govt. Ayurveda College, Thiruvananthapuram, 2Dept. of Kaya chikitsa, Vaidyaratnam PS Varier
Ayurveda College, Kottakal, Kerala, India.

*Correspondence: E-mail: seethaac@gmail.com, Mobile: +91 9496830565

ABSTRACT
Keywords:
Hashimoto’s Thyroiditis (HT) is the most common auto-immune thyroid disease and the
commonest cause of hypothyroidism. In conventional medicine, treatment of choice for HT
Case report,
is replacement of thyroid hormone. A case of HT was managed at the OPD level by following
Hypothyroidism,
Ayurveda principles and found to be effective. A treatment protocol was designed based
Thyroiditis
on the signs and symptoms and assigned in this patient. Snehapana followed by Vamana
and Virechana and at the end Shamana was done with Varunadi kwatha bhavita shilajatu for a
period of three months with two months follow up. The treatment protocol was found to
be effective in symptomatic and biochemical profiles of the patient. Patients of HT should
be able to have a choice against the lifelong hormone therapy. This can be achieved by
adequate evaluation of the individual action of the therapies adapted here and replicating
the same in a much larger group.

Introduction: Hashimoto’s Thyroiditis (HT), is the most with or without goitre formation, due to auto-immune-
common auto-immune thyroid disease, with fluctuating mediated destruction of the thyroid gland involving
thyroid function and the commonest cause of apoptosis of thyroid epithelial cells.[4] Graves' disease and
hypothyroidism in iodine sufficient areas of the world. HT are closely related patho-physiologically.[2] HT has
[1,2]
It is primarily a disease of women, with a sex ratio many serious complications like infertility, suppurative
of approximately 7:1 and can also occur in children.[2] In thyroiditis, recurrent miscarriages, preterm birth, heart
an epidemiological study conducted in India, prevalence failure etc. Diagnosis of HT is made clinically and
of >20% was recorded.[3] Incidence rate of HT is 0.54% in biochemically. 90 per cent of HT patients have high anti-
India. The cause of HT is thought to be a combination of thyroid peroxidase (TPO) and anti-thyroglobulin (Tg)
genetic susceptibility and environmental factors. antibody which confirms the autoimmune pathology.[5]

It is characterized clinically by gradual thyroid failure, The treatment of choice for HT is replacement of thyroid
hormone. The drug of choice is individually tailored
How to cite this article: Seetha C, Rajam R, Patgiri BJ, and titrated levothyroxine sodium administered orally.
Prakash M. Management of Hashimoto’s Thyroiditis [6]
But, a long term hormonal therapy is not always free
through Ayurveda. J AyuCaRe 2017;1(1):18-22 from complications as well as side effects. Moreover, it

18 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):18-22

 Seetha et al.: Ayurvedic Management of Hashimoto's Thyroiditis 1(1) 2017: 18-22

is unfeasible to revert the antibody blood parameters in Patient was provisionally diagnosed as Kapha avrita vata
HT with modern medicine. (vata obstructed by Kapha) with Pittaanubandha (associated
with Pitta) based on the presenting complaints like Sheeta
Currently, hypothyroid patients are opting for Ayurvedic asahishnuta (cold intolerance), Swara graha (hoarseness
management due to dissatisfaction in modern regime. of voice), Dourbalya (tiredness).[7] Avarana (obstruction)
A case of HT was managed through treatment protocol is the encompassing of metabolic pathways by vitiated
based on the clinical features and managed by following body humors. Symptoms like Galapaka (inflammation
Ayurveda guidelines. of thyroid gland), Atyagni (excessive appetite) can be
attributed to Pittanubandhatwa.
Case report: A 48 year old male patient, painter by
profession, who was apparently well fourteen years back, The treatment was started with internal and external
developed progressive fatigue and drowsiness initially. Rookshana (desiccating) therapy. The treatment protocol
Then after two years (2005), he gradually developed assigned for this patient was Rookshana and Snehapana
mild neck swelling that became diffuse, painless and (internal administration of medicated ghee) followed by
slowly increased in size. These symptoms were followed Vamana (therapeutic emesis) and Virechana (therapeutic
by sleeplessness, weight loss and palpitation. He was purgation) followed by Shamana (pacification) with
diagnosed as Hyperthyroidism and was put on Tab. Varunadi kwatha bhavita shilajatu gutika. Treatment
Methimazole 20 mg/day (anti-thyroid medication) for schedule followed is enlisted at Table 1.
two years (2007 - 2009). Then he was on irregular follow
up for one year. In 2011, he developed new complaints Observations: Clinical features, Serum Thyroid fuction
like constipation, nocturnal itching associated with mild test (TFT) values, TPO and Tg Antibody titre and
eruptions, cold intolerance, depression, hoarseness of Thyroid gland sonography were assessed before and
voice, dry hair and skin. Blood investigations at this stage after the treatment [Table 2]. Patient reported increased
revealed Hypothyroidism. Radio iodine uptake and Fine appetite and normal bowel movements after Deepana
needle aspiration cytology (FNAC) were advised in 2011 and Pachana. But, mild constipation and dryness of
to rule out malignancy. Radio iodine study detected skin was observed during Udwartana. By Achapana,
enlarged thyroids with high uptake, no cold area and complaints like itching, constipation, sleeplessness and
retrosternal extension suggestive of multi nodular goiter dryness of skin were alleviated. Itching was completely
(MND) and Thyrotoxicosis. Aspirate of FNAC showed subsided after Vamana and palpitations after Virechana.
occasional groups of follicular cells and few collection Enhanced complexion was also noticed after Virechana.
of lymphocytes and histocytes in a background of After administration of Shamana drug; relief in
blood and colloid, suggestive of Thyroiditis and he depressive symptoms were observed. Blood parameters
was administered Tab. Levothyroxine. He was kept on were improved approaching towards normal value after
varying doses of drug (50 mg - 100 mg) based on his Shamana chikitsa. Both thyroid lobes were normal in
hormone level. But he didn’t get much relief from any of size, hypoechoic and showed coarsened parenchymal
the above symptoms. As, Thyroid Stimulating Hormone echotexture with increased vascularity before trial. But
(TSH) levels were not coming into physiological range, after the trial, normal size of the lobes was maintained
he stopped the medication against medical advice four with changed texture to hyperechoic, showing a good
months before his first visit to OPD of Govt. Ayurveda prognosis.
College, Thiruvananthapuram in July 2012. Symptoms
like severe sleeplessness due to nocturnal itching, After two months follow up, TSH level came down to 10.3
weight loss, excessive appetite, constipation and cold mIU/L and with in the next month, it became 6 mIU/L.
intolerance were the chief complaints during his visit No recurrence of previous symptoms were observed till
to the OPD. On examination there was mild swelling of date. The treatment made a pleasing improvement in his
thyroid gland, dryness of skin and palpitation. quality of life.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):18-22  19

 Seetha et al.: Ayurvedic Management of Hashimoto's Thyroiditis 1(1) 2017: 18-22

Table No 1: Treatment Schedule Table 2: Effect on TFT & Thyroid Antibody

parameters
Treatment Drug of Choice Duration

Deepana Guduchyadi kwatha (90 8 days Parameters Normal Before After

and Pachana ml) and Panchakola Values Trial Trial
(correction of choorna (5 g) in Butter
digestion and milk (200 ml) TSH (mIU/ mL) 0.4 - 4.2 46 16
metabolism)
T3 (ng/dl) 80 - 200 110 119
Udwartana Kola kulathadi choorna 3 days
T4 (µg/dl) 4.6 - 10.5 7.3 7.2
(herbal powder
massage) Anti TPO <34 208.7 32
Snehapana Tiktaka ghrita [8]
(started 7 days (IU/ML)
with a dose of 50 ml
Anti Tg (U/ML) <60 1270 56
and increased to 250
ml)
Discussion: Autoimmunity is the main culprit in
Swedana Abyanga (external 1 day Hashimotos Thyroiditis, impairing cellular metabolism.
(Fomentation) oleation) with Use of immuno-modulatory, anti-inflammatory drugs
Dhanwantaram taila[9] and other molecules that clears the nutrition pathway
followed by Ushma through correction of digestion and metabolism will
sweda (fomentation help in breaking the pathology.
therapy)
On analysis of signs and symptoms, the patient was
Vamana Madana pippali (seeds 1 day
found to have Vata kapha pradhaana sannipatika doshadushti
of Randia dumetorum
(vitiation of all three body humors). An apt drug in this
Retz.) and Yashtimadhu
condition should cause Sroto shodhana (removes blocks
phanta (hot infusion
in metabolic pathways) by elimination of vitiated kapha
of Glycyrrhiza glabra
pitta and Anulomana of Vata. Patient was responding
Linn.)
positively to Deepana and Pachana (corrects digestion
Peyadi 3 days and metabolism through augmenting the digestive
sansarjana fire), Rookshana (desiccating), Ushna (hot), and Vamana
krama (Dietary treatment procedures.
prescriptions)
Thus, the patient was treated on the line of mitigation
Mridu Avipattikara choorna[10] One day
of Kapha and pacifying Vata (vata anulomana). As the
virechana (mild (20 gm)
patient was having vitiation of Pitta too; Pitta hara drugs
therapeutic
and therapies were also included in the protocol. Agni
purgation)
deepana (kindle digestive fire) was done initially to
Peyadi One day correct the digestion and metabolism.
sansarjana
krama (Dietary So, Guduchyadi kashaya[11] and Panchakola
prescriptions) choorna [12]
in Takra was advised in the initial stage to
achieve Ama pachana, Agni deepana and to subside vitiated
Shamana Varunadi kwatha Three
Kapha and Pitta. Rookshana was induced by means of
chikitsa bhavitha shilajatu (1g months
Panchakola choorna internally and Udwartana with Kola
twice a day with cold
kulathadi choorna.[13] This was followed by Sneha pana as
water)
Poorva karma of Shodhana. Both Vamana and Virechana are

20 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):18-22

 Seetha et al.: Ayurvedic Management of Hashimoto's Thyroiditis 1(1) 2017: 18-22

adopted as Shodhana procedures in this case. Vamana 2013; 17(4): 647-652.

helps in eliminating vitiated Kapha dosha, while Virechana 4. George JK, Tanja D, Jennifer G, Michael K, et
helps in eliminating vitiated Pitta dosha. Shamana drug al. Thyroid Stimulating Antibodies Are Highly
prepared by doing seven Bhavana of Shilajatu in Varunadi Prevalent in Hashimoto’s Thyroiditis and
Kwatha. Both the drugs have Katu vipaka and Ushna virya Associated Orbito pathy. J Clin Endocrinol Metab
in general. They also possess Agni deepana, Medohara 2016; 101(5): 1998-2004.
and Lekhana properties. Shilajatu is Tridosha shamaka 5. Debmalya S. Spectrum of Hashimoto’s thyroiditis:
and Varunadi gana is Kapha vata prashamaka. Thus these Clinical, biochemical & cytomorphologic profile,
qualities of drug intensely suit the disease condition. Indian J Med Res. 2014; 140(6): 710-712.
6. https://misc.medscape.com/pi/iphone/
Micro-level Dosha correction will be ensured by the medscapeapp/html/A120937-business.html last
Varunadi kwatha bhavita shilajatu and the reach of the accessed on Aug 15th 2016 at 11.34.
drug up to Medo dathu level explains the rationale behind 7. Acharya YT, editor. Commentary Ayurveda
the success of the treatment protocol.[14,15] Moreover the Dipika of Chakrapanidatta on Charaka Samhita
drug Shilajatu opted here is a Rasayana with multifaceted of Agnivesha, Chikitsa Sthana; Vata vyadhi
action. Chikitsa: chapter 28, verse 221-230. Chaukhamba
Krishnadass Academy; Varanasi: Reprint 2011. p.
Conclusion: The treatment protocol containing
626.
Rookshana, Snehana, Vamana and Virechana followed
8. Harishastri P, editor. (9th ed.) Commentary
by Shamana drug Varunadi kwatha bhavita shilajatu is
Sarvangasundara of Arunadatta on Ashtanga
followed in this case of HT. This protocol is found to
Hridayam of Vagbhata, Chikitsa Sthana; chapter
be effective in clinical, biochemical and sonological
19, verse 7-10. Chowkhambha Orientalia; Varanasi:
aspects. Though no drugs were given during the follow-
2005. p. 711.
up period, symptomatic relief was maintained. Patients
9. Harishastri P, editor. (9th ed.) Commentary
of HT should be able to have a choice against the lifelong
Sarvangasundara of Arunadatta on Ashtanga
hormone therapy. This can be achieved by adequate
Hridayam of Vagbhata, Shareera Sthana; chapter 2,
evaluation of the individual action of the therapies
verse 47-52. Chowkhambha Orientalia; Varanasi:
adapted here and replicating the same in a much larger
2005. p. 372.
group.
10. Harishastri P, editor. (9th ed.) Commentary

Source of support: Nil. Sarvangasundara of Arunadatta on Ashtanga

Hridayam of Vagbhata, Kalpa Sthana; chapter 2,
Conflicts of interest: None declared. verse 21-23. Chowkhambha Orientalia; Varanasi:
2005. p. 743.
References: 11. Acharya YT, editor. (9th ed.) Sushruta Samhita
of Sushruta, Sutra Sthana; chapter 38, verse 51.
1. Jaume JC. Endocrine autoimmunity. In : Gardner
Choukambha Orientalia; Varanasi: Reprint 2009.
DG, Shoback DM, editors. Greenspan’s basic &
p. 167.
clinical endocrinology. New York: McGraw-Hill
12. Pandey GS, editor. (7th ed.) Commentary of
Medical; 2007. p. 59-79.
Chunekar KC on Bhavaprakasha Nigantu of
2. http://www.uptodate.com/contents/pathogenesis- Bhavamishra, Hareetakyadi varga; chapter 1, verse
of-hashimotos-thyroiditis-chronic-autoimmune- 72-73. Choukambha Bharati Academy; Varanasi:
thyroiditis last accessed on Aug 1, 2016 at 16.47. 2010. p. 25.
3. Ambika GU, Sanjay K, Rakesh KS, Ganapathi B, 13. Shivaprasad S, editor. Ashtanga Sangraha of
et al. Prevalence of hypothyroidism in adults: Vagbhata, Chikitsa Sthana; chapter 23, verse 2.
An epidemiological study in eight cities of India. Chowkhambha Sanskrit Series; Varanasi: 2008. p.
Indian journal of Endocrinology and Metabolism 564.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):18-22  21

 Seetha et al.: Ayurvedic Management of Hashimoto's Thyroiditis 1(1) 2017: 18-22

14. Kashinatha Shastri, editor. Rasa Tarangini of 15. Harishastri P, editor. Ashtanga Hridayam of
Sadananda Sharma, chapter 22, verse 84-87. Vagbhata, Sutra Sthana; chapter 15, verse 21.
Motilal Banarasi Das; Varanasi: 2004. p. 586. Chowkhambha Orientalia; Varanasi: 2005. p. 236.

22 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):18-22

 Journal of Ayurveda Case Reports

Ayurvedic Management of Ankylosing Spondylitis

Mayur Mashru*, Mayur Barve1, Chandrashekhar Y Jagtap2, Kandarp Desai3

Superintendent, Smt. MAH Government Ayurved Hospital, Popatpura, Godhra, Panchamahal, Gujarat, 1Assistant Professor,
Department of Rasa Shastra and Bhaishajya Kalpana, Shri Saptashrungi Ayurved Mahavidyalaya and Hospital, Nashik,
Maharashtra, 2Research Officer (Ayurveda), Regional Ayurveda Research Institute, Jhansi, Uttar Pradesh, 3Director, Indian
System of Medicine & Homeopathy, Gandhinagar, Gujarat, India.

*Correspondence: Email: ayubeat.mayur@gmail.com, Mobile: +919904617086

ABSTRACT
Keywords:
Ayurveda serves best in many disease conditions where conventional system face several

Ankylosing limitations. Ankylosing spondylitis is one such condition, whose effective management

spondylitis, is becoming a challenge. It is a systemic auto-immune rheumatic disease, which shows a

Case Report, strong association with genetic factor HLA-B27. Early stages of disease show inflammation

HLA-B27, of spine and other symmetrical small joints and other soft tissues, whereas chronic stage

Kaishora guggulu, presents with axial deformity and pain. NSAIDs and steroids are generally prescribed in

Sanshamani vati, conventional systems, but are not a complete remedy. The signs and symptoms of this

Panchakarma disorder are not mentioned in Ayurveda, but, based upon the clinical picture, treatment
can be planned. A male 24 years patient diagnosed with axial and peripheral Ankylosing
spondylitis having HLA-B27 positive case was managed with Panchakarma procedures
followed by suitable Ayurvedic medicines. After completion of the treatment, pain in the
sacro-illiac region, morning stiffness of joints were significantly reduced with reduced ESR
and CRP. As the signs and symptoms of this disease are not mentioned in Ayurveda classics;
specific treatment protocol and formulations cannot be given. Selection of drugs may differ
from case to case. The treatment plan followed in this study may be adopted in future cases
changing the selection of drugs based upon the necessity to obtain good results.

Introduction: The only system of holistic health But in-spite of the greatness of this science, Ayurveda
management that existed since the dawn of man’s has to satisfy itself in the seat of alternative medicine,
history is the Indian system of Ayurveda. There is now although it was the chief system of medicine till the
enough evidence to say that this was the mother of all emergence of modern allopathic medicine. But credit
other systems of medicine. should be definitely given to allopathic system of
medicine because it has made the life of human being
more comfortable with the help of various researches
How to cite this article: Mayur M, Mayur B,
and advancement in treatment modalities. But in
Chandrashekhar YJ, Kandarp D. Ayurvedic
certain disease conditions like auto immune diseases;
Management of Ankylosing Spondylitis. J AyuCaRe
allopathic system of medicine has still not found any
2017;1(1):23-27.
successful remedies. Ankylosing spondylitis is one such

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):23-27  23

 Mayur et al.: Ayurvedic Management of Ankylosing Spondylitis 1(1) 2017: 23-27

auto-immune rheumatic disease that shows a strong developed other symptoms like hyperacidity and loss of
association with genetic factor HLA-B27.[1] appetite.

In early stages of disease, there is inflammation of Table 1: Conventional drugs prescribed to the patient
spine with symmetrical small joints and other soft
tissues. Chronic stage is characterized by marked axial 1 Tab. Saaz DS (Sulphasalazine) 1000 mg twice a day
immobility or permanent deformity and pain. It usually
starts in late teens and early twenties and can lead to 2 Tab. Folitrax (Methotraxate) 15 mg once a week
progressive bony fusion of sacro-iliac joints and the
3 Tab. Etoshine (Etorecoxib) 120 mg twice a day
vertebral column. Extra-articular manifestations may
also manifest in a few patients.[2] In allopathic system of 4 Tab. Medrol (Methyl predenisolone) 8 mg once /
medicine, NSAIDs and steroids are generally prescribed day
along with physiotherapy. But still it remains as a
symptomatic approach. If Ayurvedic approaches are 5 Tab. Voveran SR (Diclofenac Sodium) 75 mg twice
intervened appropriately, further progression of the / day
disease can be prevented. In this attempt, a case of
6 Tab. Folvite (Folic acid) 5mg once a day
Ankylosing spondylitis has been successfully managed
with Ayurvedic treatment approaches.
7 Tab. Ultracet (Tramadol Hydrochloride 37.5 mg &
Acetaminophen 325 mg) twice a day
Case report: A 24 year-old male patient visited the
OPD with complains of early morning stiffness with The above drugs were used for three months by the
asymmetrical inflammation of left knee, right ankle patient under the supervision of the rheumatologist.
and inter-phalangeal joints of hands since one year. He As the response was very minimal, the prescription
was diagnosed with axial and peripheral Ankylosing was changed and the below drugs were prescribed.
spondylitis having HLA-B27 positive.
1 Inj. Depo-medrol (Methyl predenisolone Acetate)
Pulse was 84/min, regular; Blood Pressure - 120/80 mm 120 mg once daily
of Hg, Temperature - 99.6 0F, Respiratory rate - 18/min.
Respiratory, Cardiovascular and Central nervous system 2 Inj. Folitrax (Methotrexate) 15 mg once a week
did not show any specific abnormality. Per abdomen
3 Tab. Myospaz (Chlorezoxazone 250 mg +
examination was normal. Tenderness was present over
Paracetamol 500 mg) twice a day
bilateral sacroiliac joints. Morning stiffness of joints with
oedema over left knee and right ankle joint was present. 4 Tab. Lefunomide 10mg once a day
Achilles tendinitis was present in right leg causing pain
in lower part of leg. Hemoglobin levels were below 9.5%
Ayurveda perspective: Ankylosing spondylitis cannot
for past one year whereas ESR was 100mm and CRP
be mirrored with any particular disease condition
level 76 mg/l.
directly that is elaborated in Ayurveda classics. It can
be compared to some extent with Ama vata, or Gambhira
Past treatment history: The patient was under the
vatarakta, or Asthi-majjagata vata.[3-5] Taking this into
supervision of a rheumatologist for eight months, where
consideration, the patient was evaluated according
combinations of different drugs have been prescribed
to Ayurvedic perspective. Prakriti of the patient was
(Table 1).
Vata pitta. Agnimandya was noticed in the patient
No improvement was observed with these medicines, and presented with Ama lakshanas in Mala and Jihva.
subsequently all these medicines were withdrawn. The Though, Vata and Pitta were the dominating doshas in
patient was advised to continue Voveran (Diclofenac this manifestation; involvement of Kapha dosha was also
sodium) tablet as an analgesic agent to relieve pain. noticed. All the three vitiated Doshas affected Rasa, Rakta,
Patient lost 16 kg weight within the six months time and Mamsa, Asthi, Majja dhatus. Considering the condition of

24 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):23-27

 Mayur et al.: Ayurvedic Management of Ankylosing Spondylitis 1(1) 2017: 23-27

the patient; Panchakarma procedures were planned that Observations: All the allopathic medicines were
were followed by internal medications for 45 days (Table gradually withdrawn by 21st day of commencement
2). of Ayurvedic treatment. After withdrawing NSAIDs;
both pain and swelling were aggravated, but they were
Besides these procedures; Kaishora guggulu (500 mg
tolerable. After completion of Panchakarma therapy,
thrice), Sanshamani vati (250 mg twice), Punarnavadi sacro-illiac joint pain was completely reduced, while
kwatha (15 ml twice) and a blend of Amalaki, Musta, morning stiffness was reduced significantly. Mild
Guduchi powders (1 g each with warm water) were swelling was observed over left knee and right ankle
administered during the first two weeks of the joints especially in the morning hours, which was
management. reduced with physiotherapy. After one month of follow
up, only mild tolerable swelling over right ankle was
This was followed by Kaishora guggulu (500 mg thrice), complained. This swelling was further reduced with
Sanshamani vati (250 mg twice), Rasna erandadi kashayam continuous physiotherapy. Hematological profile of the
(15 ml twice), powder of Ashwattha twak (1 g twice patient was significantly improved. Good improvement
with honey) and Lepa guti for external application over in heamoglobin percentage was seen. ESR and CRP
swollen, inflamed parts. were also reduced suggesting reduction in inflammation
(Table 3). Patient gained 8 kg weight within two
Table 2: Ayurvedic treatment plan months after completion of the treatment. By the end of
treatment, no need of conventional analgesics or anti-
Panchakarma Treatment Duration inflammatory drugs was needed by the patient.

Dipana pachana (Amruttotara kashayam) 5 days Discussion: Patient was analysed by following
Ayurvedic principles. On examination; it was observed
Snehapana (Indukantam ghritam) 5 days that patient had symptoms of Ama, so Ampachana was
suggested with Amrutottaram kashayam[6] that is generally
Abhyanga (Tila taila) 2 days used in vitiation of Tridoshas and is also indicated in
Jwara. Ama pachana is a crucial step that is done before
Swedana (Fomentation) 2 days
Snehapana followed by Virechana. Considering severity
Virechana (Trivrutadi avaleha) 1 day of the disease and Samata of Mala, as well as dominancy
of Vata and Pitta; Virechana was planned. Snehapana
Samasarjana krama (Dietary regime) 7 days with Indukantam ghritam[7] was planned, as it plays an
important role in Rasa pradoshaja diseases. Virechana
Karma vasti 15 days was given with Trivrutadi avaleha[8] considering vitiation
of Pitta and Kapha. Trivrit helps in eliminating Pitta
Anuvasana vasti (Sahacharadi taila)
followed by Kapha and is also well tolerated by the

Yapana vasti (Mustadi yapana) patient. After Virechana, patient was given Karma vasti
with alternate Anuvasana and Yapana vasti. Anuvasana
Shastishali pinda swedana 15 days vasti was given with Sahacharadi taila[9] that acts very well
on lower part of the body. Mustadi yapana vasti[10] was
Saravanga swedana [with Nirgundi (Vitex 15 days given considering Madhyama bala of the patient as well
negundo Linn.) and Shigru patra (leaves of as its efficacy on Vaata dosha. Mustadi yapana is good in
Moringa oleifera Lam.)] the involvement of Asthi and Majja. Shastika shaali pinda
sweda[11] and Upanaha sweda[12] were given for the relief
Upanaha swedana 10 days
of pain and swelling, Sarvanga sweda with Nirgundi and
Shigru was also given for relief of pain and removing
Jalaukacharana (Leech therapy) At right 3 days
Stambha. Internal medicine such as Kaishora guggulu[13]
ankle and left knee joint
and Sanshamani vati[14] were selected considering their

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):23-27  25

 Mayur et al.: Ayurvedic Management of Ankylosing Spondylitis 1(1) 2017: 23-27

action on Vata, Pitta, Kapha, Rasa, Rakta and Mamsa. Source of support: Nil.
Amalaki, Guduchi and Musta in a combination is known
for its role in Asthi majja gata jwara pachana.[15] Conflicts of interest: None declared.

Table 3: Changes in Hemotological profile References:

1. Zochling J, Van der Heijde D, Burgos-Vargas R,

Investi- Before Imme- After 45 Collantes E, et al. ASAS / EULAR recommendations
gations treatment diately after days of for the management of ankylosing spondylitis.
Pancha Pancha Annals of Rheumatic Diseases 2006; 65: 442-452.
karma karma 2. Khan MA. Clinical features of ankylosing
spondylitis. In: Hochberg MC, Silman AJ,
Hb (gm%) 9.5 9.3 12.7
Smolen JS, Weinblatt ME, Weisman MH, editors.
RBC (million 3.95 3.8 4.84 Rheumatology, 3rd ed., London, 2003; 1161-1181.
/ cmm) 3. Lakshmipati shastri, editor. Yogaratnakara,
Amavata Nidana, Chaukhambha Sanskrit
ESR 106 76 32
Sansthan, Varanasi: 2009. p. 564.
CRP (mg/L) NA 27 14.30 4. Tripathi B, editor. (1st ed) Charaka samhita of
Agnivesha, Chikitsa sthana, Vata shonita chikitsa,
Platelets (per 5,96,000 3,72,000 4,53,000 chapter 29, verse 21, Chaukhambha Surabharti
c. mm) Prakashan, Varanasi: 2005. p. 986.
5. Tripathi B, editor. (1st ed) Charaka samhita of
Punarnavadi kwatha[16] also shows action on Rasa, Rakta, Agnivesha, Chikitsa sthana, Vata vyadhi chikitsa,
Mamsa and possess Shothahara property. Rasna erandadi chapter 28, verse 33, Chaukhambha Surabharti
kashayam[17] added to the list of medicines in further Prakashan, Varanasi: 2005. p. 942.
stages of treatment, as it pacifies pain due to Vata mainly
6. Sharma RN, Sharma S, editors. Sahasrayogam,
in lower limbs and back. It also reduces Shotha due to
Kashaya prakaranam, Chaukhamba Sanskrit
Vata. Ashwattha churna[18] was administered as it controls
Pratishthan, Delhi: 2007. p. 4.
vitiated Vata and Rakta. Jalaukacharana[19] (Leech therapy)
7. Sharma RN, Sharma S, editors. Sahasrayogam,
was done over right knee and left ankle to reduce the pain
Ghrita Prakaranam, Chaukhamba Sanskrit
and inflammation occurring due to Achilles tendinitis.
Pratishthan, Delhi: 2007. p. 42.
Lepa guti[20] was added in follow up treatment to control
8. Sharma RN, Sharma S, editors. Sahasrayogam,
Vedana and Shopha (analgesic and anti-inflammatory)
Leha Prakaranam, Chaukhamba Sanskrit
action locally. Physiotherapy with stretching exercises
Pratishthan, Delhi:2007. p. 204.
were advised to relieve stiffness of muscles as well as
9. Sharma RN, Sharma S, editors. Sahasrayogam,
joints.
Taila Prakaranam, Chaukhamba Sanskrit
Conclusion: Concept of pill for every ill is becoming Pratishthan, Delhi: 2007. p. 90.
an outdated concept in the Modern era. The present 10. Tripathi B, editor. (1st ed) Charaka samhita of
patient was examined and treated following to Agnivesha, Siddhi sthana, Uttara vasti siddhi,
Ayurvedic principles. For auto immune diseases, such chapter 12, verse 15, Chaukhambha Surabharti
as Ankylosing spondilitis, where there is no satisfactory Prakashan, Varanasi: 2005. p. 1324.
proven treatment in conventional medical systems; 11. Tripathi B, editor. (1st ed) Charaka samhita of
Ayurveda can be used effectively. Though single case Agnivesha, Sutra sthana, Swedadhyayam, chapter
report cannot prove treatment for all such auto immune 14, verse 41, Chaukhambha Surabharti Prakashan,
manifestations; well designed clinical trials may be Varanasi: 2005. p. 295.
planned in order to validate actual potency of treatment 12. Tripathi B, editor. (1st ed) Charaka samhita of
patterns and principles applied in this case. Agnivesha, Sutra sthana, Swedadhyayam, chapter

26 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):23-27

 Mayur et al.: Ayurvedic Management of Ankylosing Spondylitis 1(1) 2017: 23-27

14, verse 37, Chaukhambha Surabharti Prakashan, kalpana, chapter 2, verse 118, Chaukhamba
Varanasi: 2005. p. 294. Orientalia, Varanasi: 2006. p. 159.
13. Shastri V, editor. (1 ed) Sharangadhara Samhita
st
17. Sharma RN, Sharma S, editors. Sahasrayogam,
of Sharangadhara, Madhyama khanda, Gutika Kashaya Prakaranam, Chaukhamba Sanskrit
prakarana, chapter 7, verse 70, Chaukhamba Pratishthan, Delhi:2007. p. 33.
Orientalia, Varanasi: 2006. p. 203. 18. Tripathi B, editor. (1st ed) Charaka samhita of
14. Anonymous. (1 st
ed) Ayurveda Pharmacopoeia Agnivesha, Chikitsa sthana, Vata shonita chikitsa,
compiled by Gujarat State Bheshaja Samiti, Health chapter 29, verse 158, Chaukhambha Surabharti
Department, Gujarat state. 1966. p. 521. Prakashan, Varanasi: 2005. p. 1007.
15. Tripathi B, editor. (1 st
ed) Charaka samhita of 19. Sharma A, editor. Sushruta samhita of Sushruta,
Agnivesha, Chikitsa sthana, Jwara Chikitsa, Sutra sthana, Jalaukavacharaneeyam, chapter 13,
chapter 3, verse 202, Chaukhambha Surabharti verse 19, Chaukhambha Surabharti Prakashan,
Prakashan, Varanasi: 2005. p. 186. Varanasi: 2004. p. 97.
16. Shastri V, editor. (1 ed) Sharangadhara Samhita
st
20. Gokhale B, Chikitsa Pradeepa, Dhanvantari
of Sharangadhara, Madhyama khanda, Kwatha Pratishthan, Pune: 1989. p. 137.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):23-27  27

 Journal of Ayurveda Case Reports

Management of Frozen Shoulder in Diabetics through Panchakarma

Sangeeta RT*, Adil R, Anup BT

Dept. of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar,
Gujarat, India

*Correspondence: E-mail: dr.tanwarsangeeta04@gmail.com, Mobile: +91 9624188940

ABSTRACT
Keywords:
Diabetes is having a steep rise in prevalence and is on the way to take shape of a global
epidemic, mostly associated with improper diet and lifestyle. Musculoskeletal problems
Apabahuka,
are common in diabetics but are not so well- known as compared to other complications
Case report,
of the disease. Frozen Shoulder, one such musculoskeletal problem, is estimated to affect
Diabetes,
diabetic patients five times more as compared to non-diabetics, resulting in pain and limited
Frozen shoulder,
range of movement and is compared to Apabahuka in Ayurveda. Conventional treatment
Panchakarma,
modalities like analgesics, NSAIDs, steroids and surgery etc have certain limitations.
Udvartana,
Hence, alternatives are being searched from other systems of medicines. A 64 years old
Vasti
female patient, presented with pain and restricted movements of left shoulder joint; was
treated with Udvartana followed by local Swedana with Jambeera pinda and Panchatikta
panchaprasritika vasti for five five days. After completion of therapy, pain was subsided
and satisfactory improvement was found in the shoulder joint movements. Panchakarma in
the form of Basti regimen and external therapies is surely a result oriented therapy in the
management of Diabetes and such complications like Frozen shoulder. Panchakarma in the
form of external therapies and Vasti regimen is a result oriented therapy in the management
of Frozen Shoulder and also effective in Diabetes.

Introduction: Diabetes has emerged as one of the most etc are resulting in increasing disability, reduced life
common non-communicable diseases globally and it is expectancy and enormous health cost for every society.
threatening to be the most challenging health problem
of this century. Complications from diabetes, such Among them muscle cramps, muscle infarction,
as coronary artery disease and peripheral vascular neuropathic joints, carpel tunnel syndrome,
disease, diabetic neuropathy, diabetic nephropathy tenosynovitis, diffuse idiopathic skeletal hyperostosis,
dupuytren’s contracture and adhesive capsulitis are
commonly seen. Among these, Adhesive Capsulitis of
Shoulder also known as Frozen Shoulder is the most
How to cite this article: Sangeeta RT, Adil R, Anup BT.
common manifestation, that affects diabetic patients five
Management of Frozen Shoulder in Diabetics through
times more as compared to non-diabetics.[1] Hence, high
Panchakarma. J AyuCaRe 2017;1(1):28-33.
blood sugar is a big risk factor for the development of

28 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):28-33

 Sangeeta et al.: Ayurvedic Management of Frozen Shoulder 1(1) 2017: 28-33

frozen shoulder. Studies reported increased prevalence Jamnagar with complaints of pain, stiffness and restricted
of frozen shoulder in diabetic patients (26.25%), movements at left shoulder joint since 8 months. The
comparatively more in non dominant shoulders of pain was dull initially, gradually increased in severity,
females with type II DM. [2]
specially exacerbating at night (around 2 or 3 am). Pain
usually was aggravating with movements of shoulder
Primary pathology in frozen shoulder is within the and was being relieved after intake of analgesics or with
glenohumeral joint capsule which becomes adherent hot fomentation. Gradually the condition was worsened
to the humerus head, resulting in pain and limited and the majority of shoulder joint movements were
range of movements. Pain mostly worsens at night and restricted. Routine activities including combing hair,
there is progressive loss of passive range of movement bathing etc badly affected.
(PROM) and active range of movement (AROM). It
predominantly occurs unilaterally but both shoulders Patient had regular bowel and bladder habits. Appetite
may get affected in about 10-20% of cases.[3] Other Risk was slightly reduced and sleep was altered due to
factors include female sex, older age, shoulder trauma, shoulder pain and stiffness. Detailed examination
surgery, parkinsons disease,[4] increased body mass following Ashta vidha and Dasha vidha pareeksha was
index, cardiovascular and thyroid disorders etc. [5-9]
done.[11-12]
Clinically, frozen shoulder develops in three symptom-
related phases; first one is freezing or painful phase The patient was a known diabetic, hypertensive and
characterized by insidious onset of pain, which gradually was on anti-hypertensive drugs (Amlodipine 5 mg +
increases in intensity with gradual PROM & AROM. It Atenolol 50 mg once daily, Losartan 50 mg twice daily),
lasts for few weeks to nine months followed by frozen or hypoglycemic drugs (Glimepiride twice daily) and
adhesive phase of about four to nine months and finally analgesics (Tramadol SOS). Besides medicines, patient
thawing or recovery phase in which resolution starts also attended physiotherapy sessions for six months.
with the gradual returning of shoulder joint to almost
normalcy in six to twenty four or more months. Blood pressure (138/86 mm of Hg), pulse (80/min) and
respiratory rate (22/min) were within the physiological
Sign and symptoms of frozen shoulder have resemblance limits. Respiratory system examination revealed
with Apabahuka described in Ayurveda, which is a bilateral adequate air entry with no added sounds.
condition of deranged Vata and Kapha.[10] Hence Vata Cardio vascular system revealed normal audible S1, S2.
kapha pacifying management was planned in the present Abdomen was soft with no tenderness, no organomegaly
case study. or no lump. All the movements at left shoulder joint
were limited both actively and passively.
Though it is a self limiting condition, but recovery
process is quite slow, which hampers daily routine of Investigations: Routine haematological, urine and
patients leading to frustration at times. Modern science biochemical investigations were carried out to exclude
uses treatment options like Analgesics, Non Steroidal other pathology and to know the underlying cause,
Anti-inflammatory Drugs, Steroids, Physiotherapy & which were within normal limits except blood sugar
Surgery etc in the management which are not satisfactory level i.e. fasting & post prandial blood sugar levels were
and are known to develop adverse effects too. Hence, 232 mg/dl and 189 mg/dl respectively. Radiograph of
alternatives are being searched from other systems left shoulder joint (AP view) showed normal study.
of medicines. In this attempt, a patient presenting
with symptoms of frozen shoulder was managed with Treatment protocol: After assessing the Dosha (Vata-
Ayurveda principles. kapha), Aushadha (Tikta, Ushna, Teekshana), Desha (Jangala),
Kala (Sheeta), Satmya (Madhyama), Satva (Madhyama),
Case report: A 64 years aged female patient, visited OPD Agni (Manda), Vaya (old age) and Bala (Madhyama),[13]
of Panchakarma, Institute for Post Graduate Teaching local Udvartana was done for five days, which was
and Research in Ayurveda, Gujarat Ayurved University, followed by Jambeera Pinda Sweda along with Panchatikta

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):28-33  29

 Sangeeta et al.: Ayurvedic Management of Frozen Shoulder 1(1) 2017: 28-33

panchaprasritika vasti for the next five days.[14] Patient was conventional anti-hypertensive and anti-diabetic drugs
advised to take lukewarm water during the procedure. taking earlier were continued. Brief details of drugs
Total duration of the study was 10 days. No oral drugs used in the treatment are mentioned at Table 1.
were administered during this study period, while

Table 1: Treatment Protocol

Procedure Ingredients Duration

Udvartana Yava choorna (powder of Hordeum vulgare Linn.) - 100 g Triphala

choorna - 20 g

First to Fifth Day

Jambeera pinda sweda Four Jambeera (Citrus medica Linn.) of medium size
Haridra choorna (powder of Curcuma longa Linn.) - 5 g
Saindhava lavana (Rock salt powder) - 10 g

Panchatikta pancha Kwatha dravya: 400 ml of Patola (Trichoxanthes dioica Roxb.),

prasritika vasti Nimba (Azadirachta indica A. Juss.) Bhunimba (Andrographis
paniculata Nees.), Rasna (Pluchea lanceolata Oliver & Hiern.),
Sixth to Tenth Day
Saptaparna (Alstonia scholaris (Linn.) R. Br.)
Kalka Dravya: 20 g of Sarshapa (Brassica campestris Linn.)
Sneha: 100 ml of Go-ghrita

Assessment criteria: Visual Analogue Scale (VAS), Observations and Results: Satisfactory improvement in
Stiffness, Range of movements using Goniometer and overall functional status after ten days treatment was
Blood sugar were assessed before and after treatment observed. No analgesics were needed by the patient
(Fig 1 and Table 2). during the treatment period and one month of follow
up. No untoward effects were noticed during the whole
Figure 1: Visual Analogue Scale
procedure. Pain and stiffness were relieved completely
by the end of treatment (Table 3) with significant
improvement in the range of shoulder movements
(Figure 1 and Table 4). FBS and PPBS came down to
168 mg/dl and 93 mg/dl from 232 mg/dl and 189 mg/
dl respectively. No aggravation in pain or stiffness was
reported by the patient during follow up period of about
one month after completion of therapy.
Table 2: Gradation of Stiffness
Table 3: Effect of therapy on VAS, Stiffness and
Stiffness Weight

0 No Stiffness
Before After After
1 Stiffness; no medication treatment treatment Follow up

2 Stiffness, relieved by external application VAS 6 0 0

3 Stiffness, relieved by oral medication Stiffness 3 0 0

4 Stiffness, not responded by medicine Weight 55 kg 54 kg 54 kg

30 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):28-33

 Sangeeta et al.: Ayurvedic Management of Frozen Shoulder 1(1) 2017: 28-33

Table 4: Effect of Therapy on Range of Movement

Before Treatment After Treatment

F E Ab IR ER Flexion at Left
Shoulder Joint
BT 55o 30o 55o 50o 30o
Left
AT 110o 50o 115o 90o 60o

BT 135o 45o 110o 90o 65o

Right
AT 135o 45o 110o 90o 65o
F=Flexion, E=Extension, Ab=Abduction, ER=External Rotation

Discussion: Most of the complications of DM usually Extension at

intervene with various functions of visceral organs. But, Left Shoulder
excess sugar in the blood stream seems to cause other Joint
problems also like musculoskeletal complications, out
of which Frozen Shoulder is most common. Glucose
molecules can adhere to collagen and make it sticky.
Collagen is a major building block in the ligaments
that holds the bones together in a joint. In Diabetics,
this adhesion due to extra sugar molecules in blood Abduction at
stream can contribute to abnormal deposits of collagen Left Shoulder
in the cartilage and tendons of the shoulder, which Joint
causes stiffness of the affected shoulder and restricts its
movements.[15]

In addition, poor perfusion leads to abnormal collagen

repair and degenerative changes. The theory is that
platelet derived growth factor is released from abnormal
Figure 1: Improvement of the shoulder movements
or ischemic blood vessels, which will then act as a
before and after therapy
stimulus to local myofibroblast proliferation.[16]
and Virukshana kriya, Udvartana has been indicated in its
The pathology of frozen shoulder includes a chronic management.[18-19] So due to Rukshana kriya, excess Kleda
inflammatory response with fibroblastic proliferation, in Pramehi may get absorbed due to opposite Guna. This
which may be immuno-modulated. Characteristically, may also cause reduction in viscosity due to increased
pain precedes stiffness in frozen shoulder, which sugar molecules attached to collagen. Thus, this could
suggests an evolution from inflammation to fibrosis. be helpful in reducing pain, stiffness and improving the
These clinical and macroscopic features support the range of shoulder movements.
pathological findings of both inflammation and fibrosis.
[17]
That is why Udvartana was planned to reduce Apabahuka is having Vata kapha dosha dominancy,[20] after
inflammation followed by Jambeera pinda sweda to act mobilization of dried Kapha and Shoshana of Kleda by
on fibrosis owing to its Snigdha, Amla and Ushna guna. Udvartana; dominancy of Vata dosha remains to be dealt
Moreover, Swedana enhances local microcirculation, with. Besides this, chronicity of the disease also leads to
by increasing the blood circulation rate of peripheral Vata prakopa up to some extent, for which Jambeera pinda
arterioles, delivering higher level of oxygen and sweda was applied, which is supposed to pacify Vata
nutrients to the injured cells. dosha due to its Amla, Lavana, Snigdha and Ushna guna.

Prameha has been mentioned as Santarpanottha vyadhi Though Vasti is not a choice of treatment for Prameha;

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):28-33  31

 Sangeeta et al.: Ayurvedic Management of Frozen Shoulder 1(1) 2017: 28-33

Asthapana vasti can be administered.[21] However, diabetes. To further establish this treatment protocol in
Panchatikta pancha prasritika vasti finds a special mention frozen shoulder, a study involving larger sample size is
for Prameha. [22] needed.

The Rasa panchaka of the ingredients of Vasti possess Source of support: Institute for Post Graduate Teaching
mainly Snigdha, Ushna guna, Ushna virya and Kapha and Research in Ayurveda, Gujarat Ayurved University,
vataghna effects, [23]
which would be helpful in pacifying Jamnagar - 361008, Gujarat, India
the Vata kapha dosha involved in the Samprapti of
Conflicts of interest: None declared
Apabahuka. Besides this, Tikta rasa is supposed to have
direct effect on Asthi dhatu.[24]
References:

Pharmacological properties of Vasti drugs exhibit

1. Zreik NH, Malik RA, Charalambos CP. Adhesive
Hypoglycaemic, Hypotensive, Anti-inflammatory,
capsulitis of the shoulder and diabetes: a meta-
Analgesic, Diuretic, Immuno-stimulant and Anti-
analysis of prevalence. Muscle, Ligaments and
oxidative effects (Table 5). Hence, the hypoglycemic
Tendons Journal. 2016; 6(1): 26–34.
effect found after Vasti regimen in the biochemical
2. Pooja DP, Deshpande P, Ranade P. Prevalence
reports and the analgesic effect may be attributed to
of adhesive capsulitis in diabetic patients -
these properties of drugs.
an observational study. Sinhgad e-Journal of
Table 5: Pharmacological properties of ingredients of Physiotherapy. 2015; 1(1): 8-10.
Panchatikta Panchaprasritika Vasti 3. Pandey S, Pandey AK. Clinical orthopaedics
diagnosis, shoulder joint, 3rd edition, Jaypee
Ingredient Properties brothers medical publishers; 2009; 123.
4. Riley D, Lang AE, Blair RD, Birnbaum A, Reid B.
Patola Hypoglycaemic[25]
Frozen shoulder and other shoulder disturbances
Nimba Hypoglycaemic, Hypotensive, in Parkinson's disease. Journal of Neurology,
Analgesic, Sedative, Anti- Neurosurgery & Psychiatry, 1989; 52(1): 63-66.
inflammatory, Diuretic[26] 5. Milgrom C, Novack V, Weil Y, Radeva-Petrova DR.
Bhunimba Anti-hyperglycaemic, Anti- et al., Risk factors for idiopathic frozen shoulder.
inflammatory, Immuno-stimulant, Israel Medicine Association Journal. 2008; 10(5):
Hypotensive, Analgesic, Antioxidant[27] 361-364.
Rasna Analgesic, Anti-inflammatory[28] 6. Wohlgethan JR. Frozen shoulder in
hyperthyroidism. Arthritis & Rheumatology, 1987;
Saptaparna Hypotensive[29]
30(8): 936-939.
Sarshapa Anti-inflammatory, Anti-oxidant[30] 7. Bowman C, Jeffcoate WJ, Pattrick M, Doherty
M. Bilateral adhesive capsulitis, oligoarthritis
Conclusion: Though, Frozen Shoulder is a self limiting and proximal myopathy as presentation of
disease, Ayurvedic treatment modalities can shorten hypothyroidism. British Journal of Rheumatology
the recovery time. Rukshana kriya like Udvartana 1988 Oct; 27(1): 62-64.
followed by Jambeera pinda sweda can be helpful in 8. Li W, Lu N, Xu H, Wang H, et al. Case control
reducing pain, stiffness and improving the range of study of risk factors for frozen shoulder in China.
shoulder movement in frozen shoulder. Panchatikta International Journal of Rheumatic Diseases. 2015;
panchaprasritika vasti is effective in reducing the blood 18(5): 508-513.
sugar level and improving the quality of life of diabetics. 9. http://www.mayoclinic.org/diseases-conditions/
Thus, Udvartana followed by Jambeera pinda sweda along frozen-shoulder/basics/risk-factors/con-20022510
with Panchatikta panchaprasritika vasti is found effective last accessed on Mar 10, 2015 at 15.25.
in the management of frozen shoulder associated with 10. Acharya YT, editor. Sushruta Samhita of Sushruta,

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 Sangeeta et al.: Ayurvedic Management of Frozen Shoulder 1(1) 2017: 28-33

Nidana sthana, Jwara Chikitsa, chapter 1, verse 82, pravibhagam, chapter 35, verse 22, Chaukhambha
Chaukhambha Orientalia; Varanasi: reprint 2014. Orientalia; Varanasi: 2014. p. 527.
p. 269. 22. Acharya YT, editor. Charaka samhita of Agnivesha,
11. Tripathi I, Tripathi DS, editors. (3nd ed) Siddhi sthana, Prasrita yogiyam, chapter 8, verse 8,
Yogaratnakara, Roginam ashtasthana pariksha, Chaukhambha Orientalia; Varanasi: reprint 2011.
verse 1, Chaukhambha Krishnadas Academy; p. 713.
Varanasi: 2011. p. 4. 23. Sharma PV, Dravya guna Vijnana, Volume II,
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Vimana sthana, Roga bhishagjitiya, chapter 8, 2009. p. 39, 149, 152, 544, 697, 702.
verse 94, Chaukhambha Orientalia; Varanasi: 24. Acharya YT, editor. Charaka samhita of Agnivesha,
reprint 2011. p. 276. Sutra sthana, Vividhashita pitiyam, chapter 28,
13. Acharya YT, editor. Charaka samhita of Agnivesha, verse 27, Chaukhambha Orientalia; Varanasi:
Siddhi sthana, Bastisutriyam, chapter 3, verse 6, reprint 2011. p. 180.
Chaukhambha Orientalia; Varanasi: reprint 2011. 25. Anonymous. Database on medicinal plants used
p. 691. in Ayurveda, Vol 5, Central Council for Research
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Siddhi sthana, Prasritayogiyam, chapter 8, verse 8, Ministry of health & Family welfare, Government
Chaukhambha Orientalia; Varanasi: reprint 2011. of India. 2002. p. 269.
p. 713. 26. Anonymous. Database on medicinal plants used
15. http://www.healthline.com/diabetesmine/the-411- in Ayurveda, Vol 1, Central Council for Research
on-diabetes-frozen-shoulder last accessed on Dec in Ayurveda and Siddha, Department of ISM & H,
7, 2011 at 15.45. Ministry of health & Family welfare, Government
16. Ronald Grisanti. Frozen Shoulder: The Diabetic of India. 2000. p. 289.
Connection. American Chiropractic Magazine. 27. Anonymous. Database on medicinal plants used
2010;32(5). in Ayurveda, Vol 4, Central Council for Research
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The pathology of frozen shoulder. The Journal of Ministry of health & Family welfare, Government
Bone & Joint Surgery. 2007; 89(7): 928-932. of India. 2002. p. 34.
18. Acharya YT, editor. Charaka samhita of Agnivesha, 28. Anonymous. Database on medicinal plants used
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p. 122. Ministry of health & Family welfare, Government
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Chikitsa sthana, Prameha Chikitsa, chapter 6, verse 29. Anonymous. Database on medicinal plants used
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Reprint 2014. p. 269. in Ayurveda and Siddha, Department of ISM & H,
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Sushruta, Chikitsa Sthana; Netra basti pramana of India. 2007. p. 309.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):28-33  33

 Journal of Ayurveda Case Reports

Efficacy of Triphaladya guggulu and Punarnavadi kashaya in the management

of Hypothyroidism
Karishma S*, Anup BT, Prajapati PK1

Department of Panchakarma, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University,
Jamnagar, Gujarat, 1Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India.

*Correspondence: Email: dr.tejas01@gmail.com, Mobile: +919978827350

ABSTRACT
Keywords
Changed life style of current scenario has provoked several disharmonies in the biological
system. Hypothyroidism is one such manifestation, which is believed to be a common
Case report,
health issue in India. The pathogenesis of Hypothyroidism according to Ayurveda is
Hormone replacement
basically due to the abnormal functioning of Agni, which in turn affects Dhatwagni,
therapy,
eventually brings out pathological sequence and ultimately the disease condition
Hypothyroidism,
develops. This condition can be managed by Ayurveda principles. A diagnosed case
Punarnavadi kashaya,
of Hypothyroidism presenting with puffiness of face and eyelids, weakness, lethargy,
Triphladya guggulu
fatigue, prolonged intermenstrual period, dry and coarse skin, was managed with
Triphaladya guggulu (1000 mg twice a day) and Punarnavadi kashaya (50 ml twice a day) for
a period of 45 days. Thyroxine (100 mcg) that was being used by the patient since one year
was withdrawn one week before starting the treatment. Serum TSH levels were reduced
from 93.250 µIU/ml to 53.701 µIU/ml by the end of treatment. Triphaladya guggulu and
Punarnavadi kashaya are beneficial countering signs and symptoms and bringing down
the TSH levels. As the observations were drawn from a single case; can be revalidated
through well designed clinical trials.

Introduction: Hypothyroidism is one of the most Iodine deficiency and auto-immunity are the main
common and challenging disease conditions in today’s causes of Hypothyroidism, out of which auto-immunity
era. The prevalence of hypothyroidism in India is is common in the areas of iodine replete. There is
around 11%.[1] Hypothyroidism is a condition in which no promising cure in contemporary systems for
the thyroid gland does not produce enough Thyroxine Hypothyroidism. The only available treatment is lifelong
(T4) and Tri-iodothyronine (T3). use of synthetic thyroxine that invites complications in
the long run.

Concept of Agni (digestive fire) and Ama (unwanted by

How to cite this article: Karishma S, Anup BT, Prajapati
product of improper digestion) are the central dogma
PK. Efficacy of Triphaladya guggulu and Punarnavadi
of Ayurvedic therapeutics in general and in particular
kashaya in the management of Hypothyroidism. J
in the management of auto-immune pathologies. Agni,
AyuCaRe 2017;1(1):34-39.
when becomes Manda (weak), is unable to metabolize

34 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):34-39

 Karishma et al.: Ayurvedic Management of Hypothyroidism 1(1) 2017: 34-39

leading to accumulation of intermediate metabolic by- sufficient honey for making pills of 500 mg size. It was
products in the body at different levels. Such unwanted administered in a dose of two pills (1000 mg) twice a day
by-products (sometimes may act as free radicals) with luke warm water after meal for a period of 45 days.
becomes toxic and may initiate pathologies of auto-
immunity. Table 1: Composition of Triphaladya guggulu

As most body cells have receptors for thyroid hormones;

T3 and T4 exert their effects throughout the body.[2] These Drug Botanical Name Part used Quantity
hormones stimulate diverse metabolic activities in most
Shunthi Zingiber officinale Rhizome 1 Part
tissues, leading to an increase in basal metabolic rate.
Roxb.
Without thyroid hormones, almost all the chemical
reactions of the body would become sluggish. These Pippali Piper longum Fruit 1 Part
hormones can be considered as a part of Kayagni on Linn.
which the entire metabolic activities depends. [3]
Hence,
Maricha Piper nigrum Fruit 1 Part
impaired metabolism can be compared with vitiation
Linn.
of Agni according to Ayurveda. Thus, principles that
correct the functioning of Agni will be beneficial in Amalaki Emblica officinale Pericarp
treating various pathologies. Following these guidelines, Gaertn.
a case of Hypothyroidism was managed.
Haritaki Terminalia chebula Pericarp
1 Part
Case report: A 30 years old female suffering with Retz.
Hypothyroidism attended Panchakarma OPD, Institute
Bibhitaki Terminalia belerica Pericarp
for Post Graduate Teaching and Research in Ayurveda,
Roxb.
Gujarat Ayurved University, Jamnagar with the
complaints of puffiness of face and eyelids, weakness, Kanchanara Bauhinia variegata Stem 6 Parts
lethargy, fatigue, prolonged inter menstrual period, dry Linn. bark
and coarse skin since one year with elevated levels of
Guggulu Commiphora Resin 10 Parts
Serum TSH (Thyroid Stimulating Hormone). She was
mukul (Hook ex
under Hormone replacement therapy (Tab Thyroxine
Stocks) Engl.
100 mcg OD) since one year. No positive family history
was noticed. Madhu Honey - Q.S

The Prakriti was found to be Vata pitta. Despite of

Table 2: Composition of Punarnavadi kashaya
continuous consumption of Thyroxine for one year; she
could not get satisfactory relief in the signs and symptoms
and approached Ayurveda for better management. Drug Botanical Name Part used Quantity

Punarnava Boerhavia diffusa Root 1 part

As malfunctioning of Agni is considered in the
Linn.
pathogenesis; Triphaladya guggulu (1000 mg twice a day)
along with Punarnavadi kashaya (50 ml twice a day) were Devadaru Cedrus deodara Stem 1 part
chosen in the current case and were administered for a (Roxb.) Loud.
period of 45 days.[4-5] Composition formulation of these
two formulations has been placed at Table 1-2. Shunthi Zingiber officinale Rhizome 1 part
Roxb.
Triphaladya guggulu was prepared by dissolving Triphala
Guggulu Commiphora Resin 1/30th
shodhita guggulu in Kanchanara twak kwatha until it
mukul (Hook ex part
attained a sticky consistency, followed by addition of
Stocks) Engl.
powders of Trikatu and Triphala along with quantity

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):34-39  35

 Karishma et al.: Ayurvedic Management of Hypothyroidism 1(1) 2017: 34-39

For preparation of Punarnavadi kashaya; patients were

Not starting any work in his/her own 3
advised to add 400 ml potable water to 25 g of coarse
responsibility, doing little work very slow
powder of the ingredients and reduce to 50 ml and
Does not have any initiation & not want to work 4
consume on empty stomach twice daily for a period of
even after pressure
45 days.
d) Fatigue
Along with the oral medication, Pathya and Apathya
Normal 0
ahara and Vihara (wholesome and unwholesome diet
Patient likes to stand in comparison to walk 1
and lifestyle) were also advised to the patient. She was
asked to consume luke warm water in place of normal Patient likes sit in comparison to stand 2
/ cold water during the treatment period. In addition, Patient likes to lie down in comparison with 3
was advised to avoid consuming diet that is difficult sitting
to digest; consuming diet before complete digestion of Patient likes to sleep in comparison with lying 4
earlier diet; frequent and excessive intake of curd and down
day sleep. Thyroxine (100 mcg) that was being used by
e) Muscle ache
the patient was withdrawn one week before starting the
No 0
treatment. Tests for thyroid profiles were conducted and
the patient was assessed on subjective parameters before Relieved by rest 1
starting the treatment and after 45 days of treatment. Not relieved by rest. Relieved by external 2
application
Assessment criteria: Improvement was assessed on the
Requires external application and internal 3
basis of percentage relief observed in the presenting
medication
complaints. Grading criterion being followed in the
institute was adopted to assess the effectiveness of the Present consistently 4
therapy. (Table 3).
[6] f) Dry and coarse skin
No dryness 0
Table 3: Grading criteria
Dryness after bath only 1
a) Puffiness
Dryness over all body but relieved by oil 2
Absent 0 application
Occasional 1 Dryness not even relieved by oil application 3
Peri-orbital edema in the morning, relieved later 2
g) Interval between two cycles
Persistent 3
25-29 days 0
b) Weakness
35-39 days 1
Able to exercise without difficulty 0
40-45 days 2
Able to do mild exercise 1
>45 days 3
Able to do only mild work 2
h) Constipation
Able to do mild work with difficulty 3
Not able to do even mild work 4 Frequency Consistency Straining

Unable to do even day to day routine work 5 Once a day - 0 Shithila - 0 No - 0

c) Lethargy Once in two days - 1 Madhyama - 1 Occasionally

Bearable - 1,
Doing work satisfactorily with proper vigor in 0
time Once in three days Kathina - 2 Frequently,
Doing work without desire but in time 1 -2 Severe - 2

Doing work without desire, unsatisfactorily, 2 Once in more than Granthil - 3

with lot of mental pressure & not in time three days - 3

36 Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):34-39

 Karishma et al.: Ayurvedic Management of Hypothyroidism 1(1) 2017: 34-39

Observations and Results: Considerable improvement reputed to be diuretic and laxative.[9-10] Devadaru is Kapha
was noticed in complaints as placed at Table 4. vata shamaka and acts as Deepana pachana in addition to its
immunomodulatory and anti-inflammatory activity.[11-12]
Discussion: Thyroid hormones stimulate diverse Shunthi has Agni deepana property.[13]
metabolic activities in most tissues, leading to an
increase in basal metabolic rate, may be playing the role Triphladya guggulu is especially indicated for the
of Kayagni, which possess its Amshas (components) and management of Gandamala. Acharya Sushruta has
influence all over the body. [7]
A role of the gut bacteria indicated Guggulu in Shotha[14] that is one of the most
is to assist in converting inactive T4 into the active form commonly observed clinical manifestation in cases of
of thyroid hormone T3. About 20% of T4 is converted to hypothyroidism. It acts on Medo vaha srotas and does
T3 in the gastrointestinal tract, in the form of T3 sulfate Lekhana karma (desiccation), thus might be helpful in
(T3S) and tri-iodoacetic acid (T3AC). The conversion of managing obesity which is a common presentation
T3S and T3AC into active T3 requires an enzyme called of hypothyroidism. It also possess anti-inflammatory
Intestinal sulfatase. This intestinal sulfatase is released property.[15] Animal studies have reported a ketosteroid
from healthy gut bacteria. Intestinal dysbiosis, an isolated from oleoresin of Guggulu showed a strong
imbalance between pathogenic and beneficial bacteria thyroid stimulatory action.[16] It is also found to have anti-
in the gut, significantly reduces the conversion of T3S oxidant effect because of Gugglusterone that counters
and T3AC toT3. [8]
All of these connections make it clear oxygen free radicals.[17] Kanchanara possesses anti-
that one can’t have a healthy thyroid without a healthy oxidant, anti-inflammatory, and immuno-modulatory
gut and vice versa. Fixing the gut is the foremost step to activities.[18]
achieve a healthy thyroid.
Agnimandya (impaired digestive functions) is the
Table 4: Effect of therapy on chief complaints causative factor as well as one of the consequences of
Hypothyroidism. It leads to the formation of Ama, which
Complaints Before After initiates auto-immune responses in the body. Trikatu
Treatment Treatment through its Deepana properties,[19] help in maintaining
Agni, thus preventing further formation of Ama.
Weight (kg) 60 56
Triphala supports healthy digestion and absorption.
Puffiness of face and 3 0
[20]
It is a powerful antioxidant, protect cells from the
eyelids
damage of free radicals.[20] Constipation, a symptom
Weakness 3 1 in Hypothyroidism, can impair hormone clearance
and can elevate oestrogen levels, which in turn raises
Lethargy 3 0
thyroid binding globulin levels and decrease the levels
Fatigue 2 0 of thyroid hormones in the body.[8] Triphala can prove
to be beneficial in avoiding constipation, thus help in
Constipation 2 0 maintaining physiological levels of thyroid hormones.
Muscle ache 1 0
Vitamin-C is an active component of Devadaru
Dry and coarse skin 1 0 and Amalaki. [21-22]
Studies have shown that natural
antioxidants such as vitamin-C can reverse thyroid
Interval between 3 0
damage by optimizing functions of thyroid.[23] Thyroid
menstrual cycles
gland need Vitamin-C to keep it healthy.[24] Effect of
therapy on Thyroid profile also validates the role of Agni
Ingredients of Punarnavadi kashaya exert diverse
and vitamin-C (Table 5).
activities. Punarnava (Boerhaavia diffusa Linn.) owing to
its Shothahara property is an excellent remedy for treating
generalized oedematous condition and its roots are

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):34-39  37

 Karishma et al.: Ayurvedic Management of Hypothyroidism 1(1) 2017: 34-39

Table 5: Effect of therapy on Thyroid Profile 3. Srinivasulu M. Concept of Ama in Ayurveda. 2nd
revised ed. Chapter 2, Chowkhamba Sanskrit
Investigations Before After Series, Varanasi: 2010. p. 25-26.
Treatment Treatment 4. Shastri LP, editor, Yogratnakara, Gandamala
apachi Chikitsa, verse 1-2, Chaukhambha
TSH 93.250 µIU/ml 53.701 µIU/ml
Prakashan, Varanasi: reprint 2013. p. 150.
Thyroid
T3 0.68 ng/ml 0.49 ng/ml 5. Sharma S, editor. Chakradatta of Chakrapani,
profile
Shotha Chikitsa, verse 10, Meherchand lachmidas
T4 2.550 ng/dl 1.868 ng/dl
publications, New Delhi: 2007. p. 254.
6. Mridul R, Thakar A. A comparative clinical
As Hypothyroidism is caused due to the malfunctioning
study of Vamana and Virechana Karma along
of Agni and Ama; and the ingredients of trial drugs
with Shamana therapy in the management of
helps in repairing them; Samata (association with Ama)
Hypothyroidism. Department of Panchakarma,
and Strotorodha (obstruction in channels) might have got
IPGT & RA, Thesis submitted to Gujarat Ayurved
cleared that pacified symptoms of Hypothyroidism by
University, Jamnagar, 2016.
maintaining physiological thyroid profiles.
7. Srinivasulu M. Concept of Ama in Ayurveda. 2nd
Improved Agni might have helped in optimizing the revised ed. Chapter 2, Chowkhamba Sanskrit
function of thyroid gland thus yielding positive results Series, Varanasi: 2010. p. 11.
not only in the subjective parameters, but also on the 8. https://chriskresser.com/the-thyroid-gut-
objective parameters of Hypothyroidism. connection/ last accessed on Dec 12, 2016 at 3.08
PM.
Conclusion: This was a single case study that validated 9. Sharma PC, Yelne MB, Dennis TJ. Database on
the efficacy of Triphaladya guggulu and Punarnavadi Medicinal Plants used in Ayurveda. Volume
kashaya in the management of Hypothyroidism. Though 1, Central Council for Research in Ayurvedic
Thyroxine was discontinued, the symptoms were under Sciences, Ministry of Health and Family Welfare,
control with the current trail drugs. As the observations Government of India. Reprint 2002: p. 361.
are encouraging, there is a need to evaluate actual
10. Mahesh AR, Kumar H, Ranganath MK, Devkar
impact of the trial drugs in larger number of patients and
RA. Detail study on Boerhavia Diffusa plant for its
draw more concrete conclusions. Awareness regarding
medicinal importance - a review. Res J Pharm Sci.
Ayurveda is to be drawn among the masses so that a
2012; 1(1): 28-36.
maximum number of sufferers can utilize the services
11. Billore KV, Yelne MB, Dennis TJ, Chaudhari BG.
and have the benefit of an enhanced quality of life.
Database on Medicinal Plants used in Ayurveda
Volume 7, Central Council for Research in
Source of support: Institute for Post Graduate Teaching
Ayurvedic Sciences, Ministry of Health and Family
and Research in Ayurveda, Gujarat Ayurved University,
Welfare, Government of India. 2005. p. 73
Jamnagar - 361008, Gujarat, India.
12. Billore KV, Yelne MB, Dennis TJ, Chaudhari BG.
Conflicts of interest: None declared. Database on Medicinal Plants used in Ayurveda
Volume 7, Central Council for Research in
References: Ayurvedic Sciences, Ministry of Health and Family
Welfare, Government of India. 2005. p. 75.
1. http://www.thelancet.com/journals/landia/article/
13. Padhi MM, Joseph GVR, Selvarajan S, Yelne
PIIS2213-8587(14)70208-6/fulltext last accessed on
MD, et al. Database on Medicinal Plants used in
June 2, 2017 at 2.49 PM.
Ayurveda Volume 5, Central Council for Research
2. Tortora GJ, Derrickson Bryan. Principles of in Ayurvedic Sciences, Ministry of Health and
Anatomy and Physiology. India edition: John Family Welfare, Government of India. Reprint
Wiley and Sons; 2014; Chapter 18; 582. 2008. p. 316.

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 Karishma et al.: Ayurvedic Management of Hypothyroidism 1(1) 2017: 34-39

14. Shastri AD, editor. Sushruta Samhita of Sushruta, Sutra Sthana, Dravya sangrahaniyam, chapter 38,
Chikitsa Sthana, Shopha Chikitsa, chapter 23, verse verse 59, Chaukhamba Sanskrit Sansthan, Pune:
12, Chaukhamba Sanskrit Sansthana, Varanasi: Reprint 2012. p. 188.
Reprint 2010; p. 130. 20. https://www.banyanbotanicals.com/info/
15. Sharma PC, Yelne MB, Dennis TJ. Database on ayurvedic-living/living-ayurveda/herbs/triphala/
Medicinal Plants used in Ayurveda Volume last accessed on June 2, 2017 at 3.47 PM.
2, Central Council for Research in Ayurvedic 21. Billore KV, Yelne MB, Dennis TJ, Chaudhari BG.
Sciences, Ministry of Health and Family Welfare, Database on Medicinal Plants used in Ayurveda
Government of India. Reprint 2005. p. 226. Volume 7, Central Council for Research in
16. Tripathi YB, Malhotra OP, Tripathi SN. Thyroid Ayurvedic Sciences, Ministry of Health and Family
stimulating action of Z-guggulsterone obtained Welfare, Government of India. 2005. p. 74.
from Commiphora mukul. Planta medica. 1984; 22. Sharma PC, Yelne MB, Dennis TJ. Database on
50(1): 78-80. Medicinal Plants used in Ayurveda Volume
17. Sarup P, Bala S, Kamboj S. Pharmacology 3, Central Council for Research in Ayurvedic
and Phytochemistry of Oleo-Gum Resin of Sciences, Ministry of Health and Family Welfare,
Commiphora wightii (Guggulu). Scientifica. Government of India. Reprint 2005. p. 14.
2015. 23. http://www.naturalhealth365.com/thyroid-
18. Chandra TR, Suresh C, Sanghamitra D, Kumar GR. function-adrenal-fatigue-vitamin-c-1516.html last
Kanchnara (Bauhinia variegate Linn.) - A Critical accessed on Dec 12, 2016 at 4.01 PM.
Review. International Journal of Ayurveda and 24. http://www.thyroiduk.org.uk/tuk/treatment/
Pharma Research. 2015; 3(7). vitamins.html last accessed on Dec 12, 2016 at 4.15
19. Shastri AD, editor. Sushruta Samhita of Sushruta, PM.

Journal of Ayurveda Case Reports, July-Sept 2017; 1(1):34-39  39

 Journal of Ayurveda Case Reports

GENERAL INFORMATION

TYPES OF CASE REPORTS:  Cases exploring myth and truth regarding

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Case Reports from the below areas will be considered the management of rare and auto-immune
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● Journal of Ayurveda Case Reports (AyuCaRe) will via e-mail. Manuscripts can be submitted by sending the
be published quarterly (4 issues per year) in hard copies as an attachment to the Editor, AIIA Journal of
copy. e-version can be accessed on www.aiia.co.in Ayurveda Case Reports, New Delhi through an email at
aiiaayucare@gmail.com
● Complementary copies will be provided to all
the authors and co-authors whose articles are SUBMISSION OF REVISED MANUSCRIPT:
published in the journal.
• The revised version of a manuscript should be
PATIENT CONSENT: submitted through e-mail in a manner similar to
that used for its first submission. However, there
● Properly signed informed consent from patients
is no need to resubmit the “First Page” file unless
(or relatives / guardians as applicable) must for
changes are suggested in it.
submitting Case Reports to the journal. Please
anonymize the patient’s details as much as • An article number will be generated by the journal
possible. If the patient is deceased, the authors office that is to be used for future communications.
must seek permission from the next of kin. If it is
not possible to get signed consent from the next • When submitting a revised manuscript, the
of kin, the head of the medical team / hospital or corresponding author needs to submit two files
legal team must take responsibility that exhaustive viz. ‘modified article file’ and ‘comment file’ with
attempts have been made to contact the family and suitable justifications.
that the paper has been sufficiently anonymized
not to cause harm to the family. This is required to • Contributors are requested to include reviewer’s
upload a signed document for this effect. remarks along with point by point clarification in
the ‘comment file’. They should mark all changes
PUBLICATION ETHICS: as colored and highlighted text in the ‘modified
article file’. Authors should use track changes
● Journal takes publication ethics very seriously
mode while revising the manuscript as per the
and abides by the best practice guidance of
reviewer’s remarks.
the Committee on Publication Ethics. The
Corresponding Author has the right to assign on • Comments by reviewers are to improve standards
behalf of all authors and does assign on behalf of the article and hence need to be taken positively.
of all authors, a full assignment of all intellectual
property rights for all content within the submitted • Author(s) need to ensure that comments by
case report in any media known now or created reviewers and replies by author are effectively
in the future, and permits this case report (if used for the enrichment of the article, then and
accepted) to be published in AyuCaRe and to be then only the purpose of the review process will
fully exploited within the remit of the assignment be fulfilled.
as set out in the assignment which has been read.
Authorship: All authors (maximum 4) must have made
● Every article will be screened on submission and an individual contribution to the writing of the article

v Instructions – AyuCaRe
and not just been involved with the patient's care. The perform and display the work publicly and to make
uniform requirements for manuscripts submitted to and distribute derivative works in any digital medium
medical journals state that authorship credit should be for any reasonable non-commercial purpose, subject
based only on a substantial contribution to the following: to proper attribution of authorship and ownership of
● Conception and design, acquisition of data or the rights. The journal also grants the right to make
analysis and interpretation of data. small numbers of printed copies for their personal non-
● Drafting the article or revising it critically for commercial use.
important intellectual content.
● Final approval of the version published. DISCLAIMER
● Agreement to be accountable for the article and to
ensure that all questions regarding the accuracy Neither the AyuCaRe nor anyone else involved in

or integrity of the article are investigated and creating, producing or delivering the journal or the
resolved. All four of these conditions must be met. materials contained therein, assumes any liability
or responsibility for the accuracy, completeness, or
Submission requirements: All cases must be submitted
usefulness of any information provided in the AyuCaRe,
online. Patient consent, Title page, Text page as a single
nor shall they be liable for any direct, indirect, incidental,
word document along with Tables and Figures are
special, consequential or punitive damages arising out
required as an attachment for submission of manuscript:
of the use of the AyuCaRe.

CHECK LIST:
The AyuCaRe assumes no responsibility for the
statements and opinions expressed by the contributors.
Before submitting the manuscript please ensures that
Patients and consumers reading articles posted in the
following requirements are fulfilled:
AyuCaRe should review the information carefully
o Have you read the instructions for author with their professional healthcare provider. The
carefully? information is not intended to replace medical advice
o Do you prepare manuscript in prescribed format? offered by the physicians. AyuCaRe and its publishers
o Have all authors (maximum 4 allowed) approved make no representations or warranties with respect to
the submission? any treatment, action, or application of medication or
o Do you have patient consent? preparation by any person following the information
o Is your article original? offered or provided within or through the AyuCaRe.
o Have you written reference according to journal The AyuCaRe, and its publishers will not be liable for
format?
any direct, indirect, consequential, special, exemplary,
o Have you answered all the reviewers’ comments
or other damages arising therefrom.
[for revisions]?

COPYRIGHT AyuCaRe may contain links to web sites operated

by other parties. These links are provided purely for
The entire contents of the AyuCaRe are protected educational purpose. Such links do not imply AyuCaRe's
under Indian and International copyrights. The Journal, endorsement of material on any other site and AyuCaRe
however, grants to all users a free, worldwide, perpetual disclaims all liability with regard to your access of such
right of access to, and a license to copy, use, distribute, linked web sites.

Instructions – AyuCaRe  vi
 All India Institute of Ayurveda (AIIA), conceived as an apex Ayurveda institute
under Ministry of AYUSH with a vision to be an outstanding center of excellence
for Ayurveda Education, Research and Healthcare. It is a perfect blend of Ancient
wisdom and Modern technology, attracting global attention and expected to boost
medical tourism in India showcasing strengths of Ayurveda.
 Published by:
Director
All India Institute of Ayurveda
An Autonomous Organization under the Ministry of AYUSH, Govt. of India
Mathura Road, Gautam Puri, Sarita Vihar, New Delhi - 110076
Phone: 011-29948658
aiiaayucare@gmail.com