Management of Asthikshaya (Nutritional Rickets) via Ayurveda and Yoga
Journal name: Ayushdhara
Original article title: A Case Report on the Management of Asthikshaya (Nutritional Rickets) by Ayurveda and Yoga
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Jaguri Sonam
PG Scholar, Department of Kaumarbhritya and Balroga, GACH, Patna, Bihar, India.
Kumar Amit
PG Scholar, Department of Swasthavritta and Yoga, GACH, Patna, Bihar, India.
Dash Devasmita
PG Scholar, Department of Kaumarbhritya and Balroga, GACH, Patna, Bihar, India.
Gupta Shilpy
Assistant Professor, Department of Kaumarbhritya and Balroga, GACH, Patna, Bihar, India.
Kumar Vijendra
Assistant Professor, Department of Prasutitantra evum Streeroga, MRIIMS, Darbhanga, Bihar, India.
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: A Case Report on the Management of Asthikshaya (Nutritional Rickets) by Ayurveda and Yoga
Year: 2024 | Doi: 10.47070/ayushdhara.v11i2.1539
Copyright (license): CC BY-NC-SA 4.0
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Summary of article contents:
Introduction
Rickets, a disorder affecting growing bones characterized by abnormal mineralization, primarily impacts the longer bones in children, leading to deformities such as bow legs and knock-knees. While there is no direct reference to rickets in Ayurvedic texts, the condition can be conceptualized in terms of "Asthikshaya," which refers to deficient bony tissue. This case report focuses on a 3.5-year-old boy diagnosed with nutritional rickets and explores the combined treatment approach involving Ayurveda and Yoga, which proved beneficial in alleviating the symptoms and improving clinical outcomes.
Nutritional Rickets and Asthikshaya
Nutritional rickets is the most common type of rickets globally, primarily caused by deficiencies in vitamin D and calcium. In Ayurvedic terms, this condition is viewed as "Asthikshaya," characterized by the depletion of "Asthi Dhatu" (bone tissue) and an imbalance of "Vata," leading to delayed mineralization and defective bone remodeling. The case study discusses a male patient presenting with leg pain and deformities attributed to vitamin D deficiency. Traditional treatments were insufficient, leading to the application of Ayurvedic principles that emphasized enhancing "Agni" (digestive fire) for better nutrient absorption and thus nourishing the bone tissue.
Therapeutic Interventions and Outcomes
The treatment plan for the patient included various Ayurvedic formulations, localized treatments like "Sthanika Snehan" (local oleation) and "Swedana" (sudation), along with medications administered through "Basti" (medicated enemas) utilizing preparations like "Tikta Ksheera Basti." These treatments aimed to nourish the affected bony structures while relieving pain and improving mobility. Additionally, a regimen of specific "Yogasana" was integrated to strengthen the muscles around the knees and enhance flexibility. Upon completion of the treatment, notable improvements were observed, including reduced pain, decreased frequency of falls, and better biochemical markers related to bone health.
Conclusion
The management of nutritional rickets using a combined approach of Ayurveda and Yoga demonstrates a promising alternative for treating such conditions in children. As seen in this case study, even with prevalent vitamin D and calcium supplementation methods, children may not respond adequately. The Ayurvedic methods employed here effectively alleviated symptoms and prevented further knee deformities. The case highlights the importance of holistic treatment strategies that integrate traditional medical practices for improved health outcomes in pediatric patients facing nutritional deficiencies.
FAQ section (important questions/answers):
What is Asthikshaya and how is it related to rickets?
Asthikshaya refers to deficient bony tissue in Ayurveda, which aligns with rickets. It manifests as symptoms such as pain and deformities in growing bones, particularly affecting long bones in children due to lack of essential nutrients.
What treatments were used for the case of nutritional rickets?
The child was treated with Ayurvedic medicines such as Ashwagandhadi Churna and Kukkutandatwaka Bhasma, as well as yoga practices like Tadasana and Vrikshasana. Procedures included medicated enemas and localized oleation to nourish and strengthen bony tissues.
What were the outcomes of the Ayurvedic treatment for the child?
After treatment, significant improvements were noted, with reduced symptoms of pain, decreased falls, and no further bending of the knees. The biochemical analysis showed a rise in vitamin D levels and other parameters, indicating effective management.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Management of Asthikshaya (Nutritional Rickets) via Ayurveda and Yoga�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Pain:
Pain is a symptom experienced by the child, manifesting as bilateral leg pain, which is insidious and progressive. It particularly affects nighttime, disturbing sleep, and is partially relieved by oil application and massage [see source text or glossary: Pain].
2) Basti:
Basti is a therapeutic intervention in Ayurveda involving medicated enemas. In this case, Tikta Ksheera Basti was used to nourish Asthi Dhatu (bone tissue) and balance vitiated Vata dosha, thereby helping in the management of pain and other symptoms [see source text or glossary: Basti].
3) Bhasma (Bhasman):
Bhasma refers to specific Ayurvedic formulations used in treatment. The patient was administered Kukkutandatwaka Bhasma, Godanti Bhasma, and MuktashuktiBhasma, which are intended to nourish tissues and address bone mineral deficiencies [see source text or glossary: Bhasma].
4) Ayurveda (Ayus-veda):
Ayurveda is a traditional system of medicine from India. The case of nutritional rickets in this report was managed using Ayurvedic principles, focusing on enhancing digestive fire (Agni), nourishing bone (Asthi Dhatu), and balancing Vata dosha [see source text or glossary: Ayurveda].
5) Tikta:
Tikta, which means bitter taste, is important in Ayurvedic treatments for bone disorders. Tikta Ksheera Basti, a medicated enema prepared with Tikta herbs, was used to treat the child's symptoms by nourishing the Asthi Dhatu and balancing Vata dosha [see source text or glossary: Tikta].
6) Vata:
Vata is one of the three doshas in Ayurveda, representing wind. In the context of this case, the treatment aimed to pacify vitiated Vata, which was causing symptoms like leg pain and deformities. Various interventions like Basti and Snehana were used to balance Vata [see source text or glossary: Vata].
7) Bhadrasana (Bhadra-asana):
Bhadrasana is a yoga posture also known as the butterfly pose. It was part of the yoga regimen prescribed to the child to improve muscular strength, flexibility, and balance, aiding in the management of symptoms like leg pain and deformities [see source text or glossary: Bhadrasana].
8) Asthi (Ashthi):
Asthi refers to bone tissue in Ayurveda. The child's condition, termed Asthikshaya, indicated deficient bone tissue, leading to symptoms like leg pain and deformities. Treatments aimed to nourish and restore Asthi Dhatu [see source text or glossary: Asthi].
9) Yoga:
Yoga involves physical postures and exercises. The prescribed yoga poses like Tadasana, Vrikshasana, Utkatasana, and Bhadrasana helped strengthen muscles, maintain flexibility, and prevent further deformities in the child's legs [see source text or glossary: Yoga].
10) Snehana:
Snehana is the Ayurvedic practice of oleation, which involves the application of oils. In this case, Sthanika Snehana with Mahamasha Tail was used for 20 minutes to help alleviate symptoms by nourishing and balancing the body's doshas [see source text or glossary: Snehana].
11) Tree:
The tree pose, or Vrikshasana, is one of the yoga postures practiced by the child. This pose enhances balance, strengthens muscles, and helps in correcting leg deformities. It involves standing on one leg and balancing the body [see source text or glossary: Tree].
12) Mahamasha (Mahamasa, Maha-masha):
Mahamasha is likely referring to Mahamasha Taila, an oil used for Snehana (oleation). It is Vatahara (pacifier of Vata) and increases muscle strength, helping in the treatment of leg pain and deformities in rickets [see source text or glossary: Mahamasha].
13) Sthanika:
Sthanika means localized. Sthanika Snehana and Swedana were localized treatments applied to the child's legs to alleviate symptoms by nourishing tissues and balancing doshas [see source text or glossary: Sthanika].
14) Guggulu:
Guggulu is a resin used in Ayurvedic medicine. Lakshadi Guggulu, containing Guggulu, was given to the child for its bone-strengthening and anti-inflammatory properties, aiding in the treatment of leg deformities [see source text or glossary: Guggulu].
15) Disease:
Disease refers to the health condition being treated. In this case, nutritional rickets manifested as genu valgum (knock knees) in the child, requiring treatment through Ayurveda and Yoga to manage symptoms [see source text or glossary: Disease].
16) Dhatu:
Dhatu refers to the tissues in Ayurveda. Asthi Dhatu (bone tissue) was the primary focus in treating the child's Asthikshaya, where different therapies aimed to nourish and restore this tissue [see source text or glossary: Dhatu].
17) Honey:
Honey was used as a medium to administer powdered herbal formulations to the child. It aids in the palatability and therapeutic effectiveness of the Ayurvedic medicines prescribed [see source text or glossary: Honey].
18) Blood:
Blood tests were crucial for diagnosing and monitoring the child's condition. Elevated alkaline phosphatase, deficient 25-hydroxy vitamin D levels, and other parameters indicated rickets and guided the treatment plan [see source text or glossary: Blood].
19) Vati:
Vati refers to tablets in Ayurveda. Chitrakadi Vati was one of the oral medicines given to the child to help in digestion and assimilation of nutrients, thereby aiding in the nourishment of Dhatus [see source text or glossary: Vati].
20) Genu:
Genu refers to the knee. The child’s condition included genu valgum, a deformity where the knees knock together and legs bend outward, which was managed using Ayurvedic and Yogic interventions [see source text or glossary: Genu].
21) Drug:
Drug refers to the various Ayurvedic medicines and formulations used in treating the child. This included oral supplements like Ashwagandhadi Churna, Kukkutandatwaka Bhasma, and others to address nutrient deficiencies [see source text or glossary: Drug].
22) Asthidhatu (Asthi-dhatu):
Asthidhatu refers to bone tissue. In this case, treatments aimed to nourish and restore Asthidhatu to manage symptoms like deformities and pain caused by nutritional deficiencies [see source text or glossary: Asthidhatu].
23) Erandapatra (Eranda-patra):
Erandapatra are the leaves of Riccinus communis, used in Gatravestana (bandaging) and knee support braces to alleviate symptoms by balancing Vata and providing support to the legs [see source text or glossary: Erandapatra].
24) Lakshadi (Laksadi, Laksha-adi):
Lakshadi refers to Lakshadi Guggulu, an Ayurvedic formulation used for bone-related issues. It was given to the child for its calcium-rich properties and effectiveness in healing bone deformities [see source text or glossary: Lakshadi].
25) Vatahara (Vata-ahara):
Vatahara means pacifying Vata dosha. Various treatments like Gandha Tail, Sthanika Snehana with Mahamasha oil, and others were used to balance Vata and alleviate symptoms like pain and deformities [see source text or glossary: Vatahara].
26) Medicine:
Medicine refers to the Ayurvedic formulations and treatments administered to the child. These included herbs, Bhasma, and other oral and external therapies to manage symptoms and correct deformities [see source text or glossary: Medicine].
27) Snigdha:
Snigdha refers to the unctuous or oily quality. In the treatment, Snigdha-Erandapatra (unctuous Ricinus leaves) were used in Gatravestana (bandaging) to balance Vata dosha and provide relief [see source text or glossary: Snigdha].
28) Kashaya (Kasaya):
Kashaya refers to herbal decoctions. Nadi Swedana was performed using Dashmool Kashaya to provide localized heat and aid in the management of pain and deformities through its Vata pacifying properties [see source text or glossary: Kashaya].
29) Gandha (Gamdha):
Gandha Tail is an Ayurvedic oil used in the treatment. It possesses Vatahara (pacifying) properties and enhances Asthi dhatu (bone tissue), aiding in the relief of pain and correction of deformities [see source text or glossary: Gandha].
30) Ushna (Usna):
Ushna refers to heat or warmth. Ushna therapies like Sthanika Swedana (localized sudation) with Dashmool Kashaya were used to manage symptoms by enhancing blood circulation and relaxing muscles [see source text or glossary: Ushna].
31) Agni:
Agni in Ayurveda refers to the digestive fire. Treatments aimed to enhance Agni for better nutrient absorption and assimilation, which is crucial in nourishing the dhatus and correcting bone deformities [see source text or glossary: Agni].
32) Nadi (Nadin):
Nadi refers to nerves or channels in Ayurveda. Nadi Swedana (pipe sudation) was used as a localized heat therapy to relieve pain and muscle stiffness, aiding in the management of rickets [see source text or glossary: Nadi].
33) Diet:
Diet plays a critical role in Ayurvedic treatment. Proper nutrition, including adequate sun exposure for Vitamin D synthesis, was advised to address the deficiency causing rickets in the child [see source text or glossary: Diet].
34) Milk:
Milk was used as a processing medium for some oral medications like Ashwagandhadi Churna. It enhances the therapeutic effects and palatability of the Ayurvedic formulations [see source text or glossary: Milk].
35) Tiktarasa:
Tiktarasa, meaning bitter taste, is significant in treating bone disorders. Tikta herbs were used in Basti preparations to nourish Asthi Dhatu and balance Vata dosha [see source text or glossary: Tiktarasa].
36) Mineral:
Mineral deficiency, particularly of Vitamin D and calcium, was the root cause of the child's rickets. The Ayurvedic treatments aimed to address these deficiencies and restore normal bone development [see source text or glossary: Mineral].
37) Family:
Family history was considered during diagnosis. In this case, there was no family history of similar conditions, which guided the understanding that the issue was nutritional rather than genetic [see source text or glossary: Family].
38) Bitter:
Bitter herbs (Tikta) are used in Ayurvedic treatments for bone health. Tikta Ksheera Basti involved herbs with a bitter taste to nourish Asthi Dhatu and balance Vata dosha [see source text or glossary: Bitter].
39) Taila (Thaila):
Taila, meaning oil, was used in various treatments like Sthanika Snehana with Mahamasha Tail and Matrabasti with Mahanarayan Tail to balance Vata and nourish tissues [see source text or glossary: Taila].
40) Kumar:
[see source text or glossary: Kumar]
41) Tinospora cordifolia:
Tinospora cordifolia is an herb used in the Tikta Ksheera Basti preparation. Known as Guduchi in Ayurveda, it helps in nourishing bone tissue and balancing Vata dosha [see source text or glossary: Tinospora cordifolia].
42) Azadirachta indica:
Azadirachta indica, or Nimba, is another herb used in the Tikta Ksheera Basti preparation. It is known for its bitter properties, which are beneficial in nourishing bone tissue and balancing Vata dosha [see source text or glossary: Azadirachta indica].
43) Withania somnifera:
Withania somnifera, or Ashwagandha, is used in Ashwagandhadi Churna. It is known to strengthen muscles and bones, aiding in the treatment of rickets and enhancing overall vitality [see source text or glossary: Withania somnifera].
44) Adhatoda vasica:
Adhatoda vasica, or Vasa, is an herb used in the Tikta Ksheera Basti preparation. It has bitter properties that aid in nourishing the Asthi Dhatu and balancing Vata dosha in the treatment of rickets [see source text or glossary: Adhatoda vasica].
45) Rock salt:
Rock salt was used in the preparation of Tikta Ksheera Basti. It acts as an adjuvant, enhancing the therapeutic efficacy of the concoction and aiding in the treatment of bone-related disorders [see source text or glossary: Rock salt].
46) Trichosanthes dioica:
Trichosanthes dioica, or Patola, is included in the Tikta Ksheera Basti preparation. It is known for its bitter taste and therapeutic properties beneficial in treating bone disorders like rickets [see source text or glossary: Trichosanthes dioica].
47) Commiphora mukul:
Commiphora mukul, or Shuddha Guggulu, is an ingredient in Lakshadi Guggulu, used to treat bone-related problems. It has anti-inflammatory and chondroprotective properties [see source text or glossary: Commiphora mukul].
48) Asthishrinkhala (Asthisrnkhala, Asthi-shrinkhala):
Asthishrinkhala, or Cissus quadrangularis, is an ingredient in Lakshadi Guggulu. It is rich in calcium and aids in bone healing, beneficial in treating the child's leg deformities [see source text or glossary: Asthishrinkhala].
49) Sthairyakrit (Sthairyakrt, Sthairya-krit):
Sthairyakrit in Ayurveda means providing compactness and stability. Gandha Tail possesses Sthairyakrit properties, which helps in providing support and stability to the bone tissue, aiding in the treatment of rickets [see source text or glossary: Sthairyakrit].
50) Dhatukshaya (Dhatuksaya, Dhatu-kshaya):
Dhatukshaya refers to the depletion of tissue. In this case, the child's condition involved Dhatukshaya of Asthi Dhatu, addressed through various treatments to restore bone tissue and balance doshas [see source text or glossary: Dhatukshaya].
51) Vatavyadhi (Vata-vyadhi):
Vatavyadhi refers to disorders caused by vitiation of Vata dosha. The principles of treating Vatavyadhi were applied to manage the child's symptoms like leg pain and deformities [see source text or glossary: Vatavyadhi].
52) Niruhabasti (Niruha-basti):
Niruhabasti is a type of enema mentioned in Ayurvedic treatments. Tikta Ksheera Basti was prepared as per the context of Niruhabasti to address the child's deficient bone tissue and vitiated Vata dosha [see source text or glossary: Niruhabasti].
53) Ashvagandha (Asvagandha, Ashwagandha, Ashvagamdha, Ashva-gandha):
Ashwagandha, or Withania somnifera, is used in Ashwagandhadi Churna. It is known for its properties to strengthen muscles and bones, aiding in the treatment of rickets and overall health improvement [see source text or glossary: Ashwagandha].
54) Mamsadhatu (Mamsha-dhatu):
Mamsadhatu refers to muscle tissue. Treatments aimed to strengthen and nourish Mamsadhatu (muscle tissue) through practices like Snehana and Swedana, aiding in overall improvement in the child's condition [see source text or glossary: Mamsadhatu].
55) Vatadosha (Vatadosa, Vata-dosha):
Vata-dosha is one of the three doshas in Ayurveda, representing wind. Imbalances in Vata-dosha were addressed through various treatments to alleviate symptoms like pain and leg deformities [see source text or glossary: Vata-dosha].
56) Discussion:
The discussion in the case report explains how Ayurvedic principles and treatments were applied to manage symptoms of nutritional rickets in the child. It highlights the effectiveness of combining Ayurveda and Yoga in therapeutic interventions [see source text or glossary: Discussion].
57) Kantakari (Kamtakari):
Kantakari, or Solanum surattense, was one of the herbs used in the Tikta Ksheera Basti preparation. It aids in nourishing the bone tissue and balancing Vata dosha, beneficial in treating rickets [see source text or glossary: Kantakari].
58) Adhyasthi:
Adhyasthi is the formation of bone beneath the bony surface. The case report suggests that unmineralized matrix accumulation, leading to leg deformities, can be likened to Adhyasthi in Ayurvedic terms [see source text or glossary: Adhyasthi].
59) Vitiation (Vitiated):
Vitiation refers to the imbalance of doshas, particularly Vata dosha in this case, leading to symptoms like leg pain and deformities. The treatment aimed to correct this vitiation through various Ayurvedic interventions [see source text or glossary: Vitiation].
60) Stiffness:
Stiffness in the bones and muscles can result from inadequate mineralization. Ayurvedic treatments, including Snehana and Swedana, aimed to relieve this stiffness by nourishing tissues and balancing doshas [see source text or glossary: Stiffness].
61) Kumbhaka:
Kumbhaka refers to breath retention in yoga. While practising Yogasana, the child was made to avoid Kumbhaka to ensure safety and effectiveness in muscle and joint strengthening exercises [see source text or glossary: Kumbhaka].
62) Prasrita (Prasrta, Prashrita):
Prasrita is a unit of measure used in Ayurveda. The dose of Basti was calculated based on Prasrita, considering the child's age, to ensure safe and effective administration of the medicated enema [see source text or glossary: Prasrita].
63) Marriage:
The child's parents were from a non-consanguineous marriage, with no known family history of similar conditions. This detail helped in diagnosing the issue as nutritional rather than genetic [see source text or glossary: Marriage].
64) Veshtana (Vestana):
Vestana refers to bandaging or wrapping. Gatravestana (bandaging) with Snigdha-Ushna Erandapatra was applied to support the legs and alleviate Vata dosha, helping in the management of deformities [see source text or glossary: Vestana].
65) Dusita (Dushita):
Dushita means vitiated or corrupted. In this case, Asthi Dhatu was Dushita due to nutritional deficiencies, leading to conditions like rickets, which were addressed through the Ayurvedic treatment aimed at correcting this vitiation [see source text or glossary: Dushita].
[Note: The above list is limited to 75. Total glossary definitions available: 87]
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Asthidhatu, Ayurvedic principle, Basti therapy, Ayurveda and Yoga, Agni (Digestive Fire), Vitamin D deficiency, Nadi Swedana, Tikta Ksheera Basti, Swedana (sudation), Sthanika snehana, Nutritional rickets, Genu valgum, Bony deformities, Yogasana practice.