|Year : 2022 | Volume
| 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
Naveen Bansal, Santoshkumar Bhatted, Prasanth Dharmarajan
Department of Panchakarma, All India Institute of Ayurveda, Delhi, India
|Date of Submission||27-Dec-2021|
|Date of Acceptance||25-Jan-2022|
|Date of Web Publication||31-Mar-2022|
Dr. Naveen Bansal
PG Scholar Department of Panchakarma, All India Institute of Ayurveda, 7th Floor, Academic Block, Gauthampuri, Delhi 110076.
Source of Support: None, Conflict of Interest: None
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|| |
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. 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. 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. Untreated AS can cause spinal deformity, with more than 30% of AS patients suffering from thoracolumbar kyphosis.
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.
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.Trikagraha and Prishthagraha have been described as Vata Nanatmaja Vyadhis by Acharya Charaka.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. 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|| |
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.
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.
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.
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].
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.
- Pain score (VAS scale)
- BASDAI score
- BAS-G score
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|| |
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|| |
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].
| Discussion|| |
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.
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. 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. 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|| |
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
Conflicts of Interest
There are no conflicts of interest.
| References|| |
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.
Ranjith MP, Divya R A case of ankylosing spondylitis and discussion of the literature. J Clin Diagn Res2013;7:1180-2.
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.
Saeeed A Shaikh, Ankylosing spondylitis: Recent breakthroughs in diagnosis and treatment. J Can Chiropract Assoc 2007;51:249-60.
Tripathi I, editor. Gadanigraha of Shodhala. Part 2. Chapter 9, verse 10. Varanasi: Chaukhambha Sanskrita Sansthana. p. 508.
Shastri SN, editor. Agnivesha Charak Samhita. Chapter 20, verse 11. Varanasi: Chauhambha Bharti Academy; 2011. p. 399.
Ramanath D, editor. Chakradatta. Chapter 25, verse 2. Varanasi: Chaukhamba Surbharati Prakashan; 2015. p. 166. Reprint.
Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Chikitsa sthana. Chapter 28, verse 82. Varanasi: Chaukhambha Sanskrit Series Office; 2013. p. 72.
Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Sutrasthana. Chapter 14, verse 3. Varanasi: Chaukhambha Sanskrit Series Office; 2013. p. 281.
Kashinnath S, Gorakhnath C, editor. Agnivesha, Charaka Samhita, Sutrasthana. Chapter 14, verse 5. Varanasi: Chauhambha Sanskrit Series Office; 2013. p. 104-5.
[Figure 1], [Figure 2], [Figure 3]