Assessment of Osteoporosis (Asthi-Majja Kshaya) w.s.r. to BMD with Dashmool...

[Full title: Assessment of Osteoporosis (Asthi-Majja Kshaya) w.s.r. to BMD with Dashmool Majja Siddha Sneha Basti]

[Find the meaning and references behind the names: Man, Sharma, Lal, Low, Manish, Jain, Rasa, Sneha, Preeti, Shalu, Khushi]

CASE REPORT July 2022 Journal of Ayurveda and Integrated Medical Sciences | July 2022 | Vol. 7 | Issue 6 204 Assessment of Osteoporosis ( Asthi-Majja Kshaya ) w.s.r. to BMD with Dashmool Majja Siddha Sneha Basti Preeti Chaturvedi 1 , Manish Piplya 2 , Shalu Jain 3 1 Reader, Department of Panchakarma, Pt. Khushilal Sharma Govt. Ayurveda College & Institute, Bhopal, Madhya Pradesh, India. 2,3 Post Graduate Scholar, Department of Panchakarma, Pt. Khushilal Sharma Govt. Ayurveda College & Institute, Bhopal, Madhya Pradesh, India. I NTRODUCTION Osteoporosis is characterized by low bone mass and deterioration of bone tissue consequentially leading to increase in bone fragility and susceptibility to fracture. Research result has shown that both men and women go through bone loss between the age of 30 to 40 years. Apparently, this calls for early detection to help people we aware of their bone condition and the right treatment to prevent the consequences. According to principle of Ashraya - Asharayi Bhava, Address for correspondence: Dr. Manish Piplya Post Graduate Scholar, Department of Panchakarma, Pt. Khushilal Sharma Govt. Ayurveda College & Institute, Bhopal, Madhya Pradesh, India. E-mail: mpipaleshwer@gmail.com Submission Date: 16/05/2022 Accepted Date: 22/06/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA Asthi and Vata are inversely proportional to each other regarding to the Vriddhi and Kshaya [1] There is no direct correlation of low bone density to Specific Condition mentioned in Ayurveda Vriddavata leads to Kshaya of Asthi Dhatu, Majja is the Six Dhatu among the seven situated insights the Asthi Dhatu. The symptoms of Asthimajja Kshaya resembles to osteoporosis. Dashmool Majja Siddha Sneha Basti is the type of Sneha Basti mentioned is Ch.Chi. in the treatment of Asthimajjagatavata [2] Dashmool and Majjadravayas have direct affinity towards Asthi Dhatu. Majja improves Strength. Semen, Rasa , Kapha , Meda and Majja . It especially strengthens bones and useful for oleation, which help to control Vata Dosha and act as Bramhan . C ASE P RESENTATION A 38 years old man presented to the OPD of Pt. Khushi Lal Sharma Govt. Ayurveda Hospital, Bhopal on January 2022 with a 5-month history of worsening lower back pain and bilateral hip joint pain. There was history of trauma or falls and he had been treated with corticosteroids. He had no history of prior fractures. A B S T R A C T Osteoporosis is characterized by low bone mass and deterioration of bone tissue consequentially leading to increase in bone fragility and susceptibility to fracture. According to principle of Ashraya - Asharayi Bhava, Asthi and Vata are inversely proportional to each other regarding to the Vriddhi and Kshaya . The symptoms of AsthiMajja Kshaya resembles to osteoporosis. Dashmool and Majjadravyas have direct affinity towards Asthi Dhatu , already diagnosed and non-operated case of osteoporosis with complaints of pain of bilateral hip joint and Lower back pain, restricted movements and limping gait approached the out-patient division of the hospital and was managed by Panchakarma therapy. The aim of the study is to find out the Probable efficacy and accepted activities of osteogenesis and ossification by the DMSSB (changes in T and Z score of BMD before and after intervention). Significant improvement was noticed after the treatment. Pain was reduced significantly with marked improvement in range of motion. Key words: Asthimajjagata Vaat, Dashmoola Sidha Majja Basti, Osteoporosis

[Find the meaning and references behind the names: Bala, Long, Mala, Min]

Preeti Chaturvedi et al. Assessment of Osteoporosis (Asthi-Majja Kshaya) w.s.r. to BMD ISSN: 2456-3110 CASE REPORT July 2022 Journal of Ayurveda and Integrated Medical Sciences | July 2022 | Vol. 7 | Issue 6 205 Family history was negative for bone diseases. Personal history revealed mixed diet, reduced appetite, irregular bowel habit and sleep disturbance due to pain. He is a non-smoker and occupationally was being a teacher and had long hours of standing duty since last 13 years. General Examination Patient’s BP was recorded 140/90 mmHg, pulse rate 80/min, whereas the body weight was recorded to 60 kg, height 157.5 cm. On the systemic examination no abnormality was found. The Prakriti of the patient was Vatakaphaj . There was no complaint with related to Mutra and Mala . Her Jihwa was seemed to be coated. Patient got depressed psychologically. long standing, sitting and walking had become a cause of trigger for the patient. She has on addiction of pan-parag 3-4 times /day. Physical examination Range of motion of the right hip was severely limited and painful in all ranges, with difference in length of both lower limbs i.e., right limb was found smaller than left lower limb so patient is bent down on right side while standing or during walking. Mostly pain is being felt in abduction and extension. Mild tenderness was observed during palpation of muscles. There was no muscle atrophy. Lumbar spine range of motion was reduced due to pain in right lateral flexion and right rotation. Straight leg raise produced right hip pain with stretch in thigh. Posterior joint provocation test was painful for testing L 4, L 5 and S 1. Muscle palpation reveal tenderness in right gluteal muscles. Range of motion of the both knee joint was full and painless. Lower limb neurological testing revealed normal reflexes and sensory testing bilaterally. Preparation of Dashmoola Sidha Majja Basti The bones of animals (like goat, sheep, pig fish, for buffalo) are crushed and processed with water. Then the obtained Majja Sneha is again processed with Dashmool decoction, mixed with Jivak, Rishabhak, Sariva, Vidarigandha, Kapikachchhu and other Vatnashaka drugs and also with Jivaniya Gana drugs. Then they have to be mixed with 2 times milk and boiled. When the Dashmool Majja Sneh is Siddha , it is ready to be used. Treatment Plan Treatment plan has been made by keeping in mind of involved Dosha, Sroto Dushti and Sharirmanas Bala of patient, we planned following treatment. Patient has been treated with DMSSB with starting dose of 150 ml which increases up to 240 ml consequently 11 days. (i.e.; 1 to 11 days) Duration of Study - 2 months & 11 days Follow up periods - 3 months Assessment Parameter [3,4] Grading BT AT Relief in % Shool (Pain) Grade 0 - No pain Grade 1 - Mild pain Grade 2 - Discomforting pain Grade 3 - Distressing pain Grade 4 - Horrible 4 1 75% Sparsha Asahishnuta (Tenderness) Grade 0 - No Tenderness Grade 1 - Mild Tenderness without any sudden response on pressure. Grade 2 - Winching of face on pressure. Grade 3 - Winching of face with withdrawal of the Affected part on pressure Grade 4 - Resistance to touch. 3 1 66.66% Daurbalya (General Debility) Grade 0 - No Doushbalyga Grade 1 - Not Able to perform strenuous activity. Grade 2 - Not Able to perform moderate Activity. Grade 3 - Cannot perform moderate 3 1 66.66%

[Find the meaning and references behind the names: Guna, Aakash, Guru]

Preeti Chaturvedi et al. Assessment of Osteoporosis (Asthi-Majja Kshaya) w.s.r. to BMD ISSN: 2456-3110 CASE REPORT July 2022 Journal of Ayurveda and Integrated Medical Sciences | July 2022 | Vol. 7 | Issue 6 206 activity but cay perform mild activity without any difficulty. Grade 4 - Mild activities cannot be performed even. Range of motion Grade 1 - No restriction (flexion of 130°) Grade 2 - Restricted initially (flexion of 90°-130°) - Partially restricted (flexion of 70°- 90°) Grade 3 - Restricted with pain (flexion 45°- 70°) Grade 4 - No joint movement (flexion 0°- 45°) 4 1 75% BMD Scores BMD (t Score): Grade 1 – Normal "t" Score -1 and Above Grade 2 - Osteopenia “t” Score < -1 to -2.5 Grade 3 - Osteoporosis “t” Score < - 2.5 2 50% R ESULT The patient was recovered tardily in the first then she kept on the treatment and periodically valuated clinically. She was bettered further and now she is almost symptoms free and taking prescribed oral medicine. After treatment, the patient got significant symptomatic relief. DISCUSSION Basti , which contains substances like as milk, ghee, and Tikta Rasa , is especially beneficial for Asthi Pradushya Janya Vikara [5] since, it strengthens and improves the quality of Asthi Dhatu (bone tissue). Tikta Rasa enhances Vayu and Aakash Mahabhuta's supremacy. Asthi Dhatu is equally composed. As a result, Vayu may become aggravated. However, damaged joints are linked to morbid Shleshaka Kapha in Sandhi . Tikta Rasa aids in the reduction of vitiated Kapha Dosha in the joints [6] A Madhura - Tikta Rasa & Katu Vipaka may be found in the Dashmoola Siddha Majja Basti . Acharya Charak describes Dashmoola Siddha Majja Basti [7] Dashmoola Kwath prepares Majja in this episode. These Basti's constituents include Madhura - Tikta Rasa, Ushna Virya , and Katu Vipaka , among others. They all work together to strengthen Majja's qualities, balancing the exacerbated Vata Dosha and favoring normal Dhatvagni functioning, permitting enhanced nutrition to the Asthi Dhatu. Tikta Rasa also has Shrotoshodhan properties, which aid in clearing the Sroto Sanga . It also benefits the Dhatvagni (enzyme complex). As a result, all tissue elements are well nourished, and Asthimajja Dhatu (bone marrow) Kshaya (tissue element depletion) is decreased. Madura Rasa, Guru Pichhilya Guna (stickiness), and Jeevaneeya (rejuvenation) are all qualities of milk. It nourishes Majjadhatu by virtue of its Snigdha, Pichchila, Guru , and Asthidhatu Brimhana - Poshana qualities. When both Dhatus are nourished, Vatashamana happens. So, according to Rasa and Vipaka , this Basti reaches Asthi and Majja Vaha Srotasa , causing Majja Dhatu to rise. The Purana (filling) virtue of this Majja nourishes Asthi , whereas the Snehana property calms vitiated Vata in Asthi. Vatajanya Shoola is cured by Ushna Veerya. This means that the entire Basti Dravya is Vatashamaka . As a result of Dashmoola Siddha's synergetic activity Majja Basti will act as a Vatashamaka in Asthimajjagata Vata, which is helpful. CONCLUSION It can be finalized that the given treatment as quite efficacious in managing the above discussed symptoms of osteoporosis ( Asthi-Majja-Kshaya ). This study proves that given treatment have got substantial effect on the osteoporosis ( Asthi-Majja-Kshaya ) patient along with strict diet regimen. Ayurveda have a cocksure counsel to the most of the patients in depressed conditions. REFERENCES 1 Vagbhata, Astang Sthan edition, Sarvangasundaravyakhya by Ayurveda Rasayanateeka by

[Find the meaning and references behind the names: Singh, Bhagwan, Nil, Med, Mukul, Mishra]

Preeti Chaturvedi et al. Assessment of Osteoporosis (Asthi-Majja Kshaya) w.s.r. to BMD ISSN: 2456-3110 CASE REPORT July 2022 Journal of Ayurveda and Integrated Medical Sciences | July 2022 | Vol. 7 | Issue 6 207 Hemadri, Choukambasubharatiprakashan, Varanasi, edition, 2 Chakrapani on Agnivesha- Charaka samhita, revised by Caraka Samhita, revised by Caraka and Dhridabala with Ayurveda Dipika commentary by Chakrapani Dutta,edited by Vaidya Yadavji Trikamji Acarya, Chaukhamba Sanskrit Sansthan,, Varanasi 5 th edition, 2001, Chikitsa Sthan 3 WHO 1994. "Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group". World Health Organization technical report series 843: 1-129. 4 Singh BB, Mishra LC, Vinjamury SP, Aquilina N, Singh VJ, Shepard N. 2003. The effectiveness of Commiphora mukul for osteoarthritis of the knee: An outcomes study. Altern. Ther. Health Med., 9(3): 5 R. K. Sharma, Bhagwan Dash. Editor, Charaka Samhita, Sutthrastana chapter 28 verse 27, 1 st Vol, Varanasi, Chaukhamba Sanskrit Series Office, 2014; 579. 6 Jansz M., Rajoria K., Singh S.K., Panchkarma procedures along with Thrayodashanga guggulu in the management of katishool with special reference to lumber spondylosis, Int. J. Res. Ayurveda Pharm, Jul-Aug 2016; 7(4): 50-54. 7 Shastri Kashinath, Chaturvedi Gorakhnath edited Charak Samhita of Agnivesha, revised by Charaka and Dridhbala, part II, Chaukhambha Bharati Academy, Varanasi. Reprint, 2009; Chikitsha Sthana 28, verse 124-127; page no; 712. 8 Abeynayake P, Jansz M, Rajoria K., Singh S.K, Role of Rajayapana basti with reference to Duchenne Muscular Dystrophy, Int. J. Res. Ayurveda Pharm, Sep-Oct 2016; 7(4): 7-10 http://dx.doi.org/10.7897/2277-4343.075208. ******************************* How to cite this article: Preeti Chaturvedi, Manish Piplya, Shalu Jain. Assessment of Osteoporosis (Asthi- Majja Kshaya) w.s.r. to BMD with Dashmool Majja Siddha Sneha Basti. J Ayurveda Integr Med Sci 2022;6:204-207. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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