• Users Online: 177
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 1-5

Effect of Vaaluka Svedana followed by Katiprishthatrika Basti in management of Katiprishthatrika Graha w.s.r. to Ankylosing Spondylitis: A prospective randomized open-label clinical study


Department of Panchakarma, All India Institute of Ayurveda, Delhi, India

Date of Submission27-Dec-2021
Date of Acceptance25-Jan-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Dr. Naveen Bansal
PG Scholar Department of Panchakarma, All India Institute of Ayurveda, 7th Floor, Academic Block, Gauthampuri, Delhi 110076.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_98_21

Rights and Permissions
  Abstract 

Background: Ankylosing spondylitis is a chronic inflammatory disease involving sacroiliac joints and spine causing severe pain, stiffness, and deformities in patients in later stages of life. Symptomology of ankylosing spondylitis is similar to Katiprishthatrika Graha in Ayurveda. Materials and Methods: A prospective open-label study was carried out in the All India Institute of Ayurveda on 31 diagnosed cases of ankylosing spondylitis. Vaaluka Svedana followed by Katiprishthatrika Basti with Dhanvantara Taila was administered for 7 days each. Participants were assessed based on pain score, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Patient Global Score (BAS-G score) scores on the 1st day and 14th day of study. Paired sample t tests were used for statistical analysis. Results: Statistically significant results were obtained at the end of trial (P < 0.001) in pain scores as well in quality of life scores (BASDAI, BASFI, and BAS-G scores). There was a 2.20, 1.37, 1.30, and 1.13 point’s reduction in BASDAI, BASFI, and BAS-G scores, respectively. Conclusion: Vaaluka Svedana followed by Katiprishthatrika Basti is effective in the successful management of pain and improving quality of life in patients with Katiprishthatrika Graha.

Keywords: Ankylosing spondylitis, Ayurveda, Katiprishthatrika Basti, Katiprishthatrika Graha, Vaaluka Svedana


How to cite this article:
Bansal N, Bhatted S, Dharmarajan P. Effect of Vaaluka Svedana followed by Katiprishthatrika Basti in management of Katiprishthatrika Graha w.s.r. to Ankylosing Spondylitis: A prospective randomized open-label clinical study. J Indian Sys Medicine 2022;10:1-5

How to cite this URL:
Bansal N, Bhatted S, Dharmarajan P. Effect of Vaaluka Svedana followed by Katiprishthatrika Basti in management of Katiprishthatrika Graha w.s.r. to Ankylosing Spondylitis: A prospective randomized open-label clinical study. J Indian Sys Medicine [serial online] 2022 [cited 2022 May 27];10:1-5. Available from: https://www.joinsysmed.com/text.asp?2022/10/1/1/342106




  Introduction Top


Ankylosing spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton; peripheral joints and extra-articular structures are also frequently involved. The disease usually begins in the second or third decade; male-to-female prevalence is between 2:1 and 3:1.[1] Approximately 90%–95% of the patients with AS are positive for the human leukocyte antigen B27 (HLA-B27) assay as compared to 7% positivity in the general population.[2] In patients with stable AS, using NSAID treatment on-demand is recommended. The continued use of NSAIDs or DMARDs has uncertain therapeutic effects with increased risks of gastrointestinal, cardiovascular, renal, and hematological toxicity.[3] Untreated AS can cause spinal deformity, with more than 30% of AS patients suffering from thoracolumbar kyphosis.[3]

Since AS usually starts in early adulthood, there is a longer overall disease duration when compared to aged-matched patients with rheumatoid arthritis. Therefore, patients with AS have to adjust to their disease for most of their lives.[4]

In Ayurveda, AS can be correlated with Katiprishthatrika Graha. Graha (severe stiffness) is a condition first described by Acharya Shodhala in Gada Nigraha stating that when Ama and Vayu get localized in Katipradesha it leads to Katigraha.[5]Trikagraha and Prishthagraha have been described as Vata Nanatmaja Vyadhis by Acharya Charaka.[6]Kati was described as one of the special Sthana (site) of Vata. Graha/Stambha can be seen when Kaphavritta Vata condition develops. Hence, in the treatment of Kati-Pristha-TrikaGraha (AS), the primary concern should be an effective treatment of Vata and Kapha Dosha associated with Ama. Vaaluka Svedana is a type of sudation indicated in the Dominance of Kapha and Ama.[7] Moreover, in the treatment of Vatika disorders Snehana,Svedana have been indicated by Acharya Charaka. Katiprishthatrika Basti provides benefits of Snehana and Svedana together. Hence, a study was planned to evaluate the efficacy of Vaaluka Svedana followed by Katiprishthatrika Basti in the management of AS.


  Materials and Methods Top


Study Design

This was open-labeled, randomized, prospective, interventional study conducted at Panchakarma outpatient department (OPD). Institutional Ethics Committee Clearance was taken on March 29, 2018 vide IEC letter number IEC-AIIA/2018/PG-68. The trial was registered in CTRI vide CTRI number CTRI/2019/06/019786.

Study Objectives

The primary objective of the study was to assess the effect of Vaaluka Svedana followed by Katiprishthatrika Basti with Dhanwantaram Taila for 7 days each in pain score in patients with Katiprishthatrika Graha (AS). The secondary objective of the study includes assessing the effects of Vaaluka Svedana followed by Katiprishthatrika Basti in quality of life of patients assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Patient Global Score (BAS-G score) scores.

Study Participants

A total of 31 patients visiting OPD of All India Institute of Ayurveda were enrolled in this study. Patients were informed about the purpose of the study and an informed consent form was signed before enrollment to this study. Patients were assessed for eligibility based on the inclusion/exclusion criteria.

Patients aged between 18 and 60 years, chronicity of disease 1–10 years, both sexes, patients of all socioeconomic status, and diagnosed cases of AS (ASAS criteria) were enrolled in the study.

Patients having chronicity of disease for more than 10 years, those having severe deformities of joints, those having cardiac diseases, those having pulmonary tuberculosis, those having severe lung disease, those who were pregnant, and those who were unfit for Snehana, Svedana, Basti Karma were excluded from the study.

Study Intervention

Seven days Vaaluka Svedana followed by 7 days Katiprishthatrika Basti was done. Vaaluka Svedana was done by sand wrapped in a piece of cloth of dimensions 45 cm × 45 cm and heated on a frying pan filled with sand. It was done in the forenoon for 30 min daily for 7 days consecutively.

Katiprishthatrika Basti was done by making a rectangular pond with curved edges on the spine made up of black gram dough. Lukewarm Dhanwantar Taila was poured in the pond up to a height of one and half inches. Temperature was maintained in the pond by regularly recycling heated oil in the pond. Katiprishthatrika Basti was done in forenoon time for 30 min for 7 days consecutively. Schematic plan of clinical trial has been depicted in [Flowchart 1] and [Flowchart 2].
Flowchart 1: Study procedure

Click here to view
Flowchart 2: Outcome of patients in the study

Click here to view


Data Collection

Data were collected at baseline, that is, at the first day of treatment and after completion of treatment, that is, 14th day of study.

Criteria for Diagnosis

The Assessment of SpondyloArthritis International Society (ASAS) criteria for AS was chosen as the diagnostic criteria. It includes four components: back pain for 3 months or longer, age of onset less than 45 years, sacroilitis seen on radiographs or MRI plus one or more spondyloarthritic features, or HLA-B27 positive associated with two or more spondyloarthritis features. Spondyloarthritis features include inflammatory back pain, arthritis, enthesitis of head, uveitis, dactylitis, psoriasis, Crohn’s disease, good response to NSAIDs, family history of spondyloarthropathy, HLA-B27 positive, and elevated C-reactive protein levels.

Outcome Measures

  1. Pain score (VAS scale)


  2. BASDAI score


  3. BASFI


  4. BAS-G score


Data Analysis

Data were analyzed by using Statistical Package for the Social Sciences (SPSS) software program. Total (mean) change in scores from baseline to the end of the study (14th day) was calculated to report the differences in outcomes by using paired t tests. In all the analysis, a value of P < 0.05 was considered significant.


  Observations Top


The majority of patients were of age group 18–30 years (58.06%), male (96. 68%), married (61.29%), middle class (45.16%), in service (51.61%), graduate (48.39%), having mixed diet (veg and nonveg 58.06%), not doing Vyaayama (~exercise 38.71%), having Samyaka Nidraa (~proper sleep 54.84%), Madhyama Koshtha (moderate bowel movements 35.48%), having Mandaagni (reduced digestive capacity and metabolism 41.93%), Vata-Kapha Prakruti (~body temperament 45.16%), Madhyama Saara (~excellence of tissues 51.61%), Madhyama Samhanana ((~compactness of organs 54.84%), Madhyama Satmaya (~suitability 51.61%), having Pravara and Madhyama Satva (~psyche 41.94%) each, chronicity of 4–6 years (45.16%)


  Results Top


Mean score of Pain was 6.0 before treatment, which was decreased to 3.80 after treatment; this difference was found to be significant (paired t test = 5.44, df = 14, P < 0.001).

Mean score of BASFI was 4.31 before the treatment, which was decreased to 2.95 after treatment; this difference was found to be significant (paired t test = 6.265, df = 14, P < 0.001).

Mean score of BASDAI was 4.45 before the treatment, which was decreased to 3.20 after treatment; this difference was found to be significant (paired t test = 5.95, df = 14, P < 0.001).

Mean score of BAS-G was 6.27 before the treatment, which was decreased to 5.14 after treatment; this difference was found to be significant (paired t test = 4.81, df = 14, P < 0.001). Effect of therapy on pin Ssre, BASFI, BASDAI, and BAS-G scores have been depicted in [Table 1] and [Graph 1].
Table 1: Effect of therapy on PAIN SCORE (VAS SCORE)

Click here to view
Graph 1: Effect of overall therapy

Click here to view



  Discussion Top


This study showed a significant reduction in pain score, BASDAI, BAS-G, and BASFI scores. Management of Katipristhatrika Graha (AS) involves effective treatment of Vata Dosha, which includes administration of Snehana, Svedana repeatedly. It has been said that due to continuous use of Snehana and Svedana, Vatavyadhis do not stay in the body.[8]

Vaaluka Svedana is a Ruksha Svedana leading to reduction of Ama in patients with Katiprishthatrika Graha. Hence, it was planned in starting of trial. It is used in the dominance of Kapha and Ama in the body. It reduces Kapha and Ama in the body and increases Agni of the patient leading to Nirama Avastha. Svedana has been said to be the best treatment for diseases of Vata and Kapha origin.[9] It reduces Stambha (stiffness), Gaurava (heaviness), and Sheetata (feeling cold) in the body. Vaaluka Svedana is Ruksha and Ushna by nature. Hence:

  • It aids in digestion of Ama.


  • Srotomukha Vishodhana is one of the effects of Vaaluka Svedana leading to Pakwa Doshas movement from Shakha to Koshtha.


  • In this study, Katiprishthatrika Basti provided the benefits of both Snehana and Svedana locally at the site of pathology. It has been said that when even dry wood can be bent by proper Snehana and Svedana, then how cannot be human beings benefitted by the same.[10] In this study Dhanwantara Taila was used for Katiprishthatrika Basti procedure as it has been said to be Sarvavatavikaranuta means able to pacify all Vata disorders and Vata Dosha is predominantly aggravated in Katiprishthatrika Graha. Dhanvantara Taila contains Dashamoola, which are Shothahara (anti-inflammatory) which help in the reduction of inflammation and pain.

    Vaaluka Svedana and Katiprishthatrika Basti are simple procedures that can be done in OPD. They are relatively simple procedures with less cost of treatment.

    One of the limitations of this study is that most of the patients in this study (64.52%) had chronicity of 4–6 years. Most of the patients in the trial were in the initial stage of AS. Hence, it is to be inferred that treatment with Vaaluka Svedana followed by Katiprishthatrika Basti shows a statistically significant improvement in pain as well as improvement in quality of life in patients of AS particularly in the initial stages of AS.


      Conclusion Top


    As Katiprishthatrika Graha is a Vata Vyadhi associated with Ama. Hence, Snehana and Svedana repeatedly have been indicated for the management of Vata. The present trial showed successful management of Katiprishthatrika Graha (AS) with external procedures Vaaluka Svedana and Katiprishthatrika Graha. Patients showed a significant improvement in pain score and BASDAI, BASFI, and BAS-G scores. Based on the outcomes of this study, it can be said that external treatments like Vaaluka Svedana and Katiprishthatrika Basti can be utilized for the successful management of Katiprishthatrika Graha particularly in the initial stage of the disease to reduce pain and to improve quality of life in patients with AS. No complications or adverse effects were observed during the study.

    Financial Support and Sponsorship

    Nil.

    Conflicts of Interest

    There are no conflicts of interest.



     
      References Top

    1.
    Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo L, et al. editors. Harrison’s Principles of Internal Medicine. Chapter 384. 19th ed. New York: McGraw Hill Companies. p. 2169.  Back to cited text no. 1
        
    2.
    Ranjith MP, Divya R A case of ankylosing spondylitis and discussion of the literature. J Clin Diagn Res2013;7:1180-2.  Back to cited text no. 2
        
    3.
    Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: Etiology, pathogenesis, and treatments. Bone Res 2019;7:22.  Back to cited text no. 3
        
    4.
    Saeeed A Shaikh, Ankylosing spondylitis: Recent breakthroughs in diagnosis and treatment. J Can Chiropract Assoc 2007;51:249-60.  Back to cited text no. 4
        
    5.
    Tripathi I, editor. Gadanigraha of Shodhala. Part 2. Chapter 9, verse 10. Varanasi: Chaukhambha Sanskrita Sansthana. p. 508.  Back to cited text no. 5
        
    6.
    Shastri SN, editor. Agnivesha Charak Samhita. Chapter 20, verse 11. Varanasi: Chauhambha Bharti Academy; 2011. p. 399.  Back to cited text no. 6
        
    7.
    Ramanath D, editor. Chakradatta. Chapter 25, verse 2. Varanasi: Chaukhamba Surbharati Prakashan; 2015. p. 166. Reprint.  Back to cited text no. 7
        
    8.
    Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Chikitsa sthana. Chapter 28, verse 82. Varanasi: Chaukhambha Sanskrit Series Office; 2013. p. 72.  Back to cited text no. 8
        
    9.
    Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Sutrasthana. Chapter 14, verse 3. Varanasi: Chaukhambha Sanskrit Series Office; 2013. p. 281.  Back to cited text no. 9
        
    10.
    Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Sutrasthana. Chapter 14, verse 5. Varanasi: Chauhambha Sanskrit Series Office; 2013. p. 104-5.  Back to cited text no. 10
        


        Figures

      [Figure 1], [Figure 2], [Figure 3]
     
     
        Tables

      [Table 1]



     

    Top
     
      Search
     
        Similar in PUBMED
       Search Pubmed for
       Search in Google Scholar for
     Related articles
        Access Statistics
        Email Alert *
        Add to My List *
    * Registration required (free)  

      Materials and Me...
      In this article
    Abstract
    Introduction
    Observations
    Results
    Discussion
    Conclusion
    References
    Article Figures
    Article Tables

     Article Access Statistics
        Viewed1085    
        Printed10    
        Emailed0    
        PDF Downloaded179    
        Comments [Add]    

    Recommend this journal