Ayurvedic Management of Asthimajjagata Vata (Avascular Necrosis of Femoral Head) With Vanksana Basti and Shaman Chikitsa: A Case Report

Asthi-Majj?gata V?ta is a V?ta-vy?dhi in which V?ta do?a gets localized in the Asthi (bone) and Majj? dh?tu (bone marrow), producing clinical features such as sandhi-??la (joint pain), spar??sahat? (tenderness), ?o?a (atrophy), stabdhata (stiffness), and k?haya (degeneration) of bone tissue [1,2]. The Asthi dh?tu serves as the ??raya sth?na (residing site) of V?ta do?a; therefore, when V?ta becomes aggravated, it inevitably leads to depletion of Asthi dh?tu—a phenomenon described as ??raya-??ray? bh?va [3].

In modern medicine, Avascular Necrosis (AVN) of the femoral head is characterized by reduced blood supply to the subchondral bone, resulting in ischemia, necrosis of osteocytes, structural collapse, and secondary osteoarthritis. Clinically, it presents as hip pain, groin discomfort, restricted movement, and limp gait. While surgical interventions (core decompression, bone grafting, total hip replacement) are commonly advised, they are invasive, costly, and often associated with limited long-term success in early stages [4].

The Ayurvedic correlation of AVN lies in Asthi-Majj?gata V?ta or Asthi-k?haya, where V?ta-prakopa and Asthi-dh?tu k?haya together manifest as bone necrosis and degeneration. Thus, treatment aims to pacify V?ta, nourish Asthi and Majj? dh?tu, and restore the dh?tu samat? through ?odhana, ?amana, and ras?yana therapies.

CASE HISTORY

Patient Profile

• Age / Sex: 40-year-old male
• Chief complaint: Pain in hip joint and groin region for 1 year; limp gait
• Past history: No history of hypertension, diabetes, or other systemic illness.

Examination & Findings

• Gait: Limping, difficulty in weight-bearing on affected side
• Local examination: Tenderness on hip/groin, restricted movements.

Ayurvedic Assessments

Diagnosis

• Ayurvedic diagnosis: Asthimajjagata Vata
• Modern correlation: Avascular necrosis (AVN) of femoral head (diagnostic imaging or staging should be inserted if available)

Intervention / Management

Therapeutic Schedule

The patient underwent an integrated Ayurvedic regimen combining ?odhana (specifically Basti) and ?amana measures over six months.

Internal Medications

1. Sitopaladi Pak –              3 g before food

• Praval Pisti –                        10 mg
• Laghu Malini Basant Rasa – 250 mg
• Godanti Bhasma –                 500 mg

                                       1×2

Mix it and take one teaspoon with Luke warm water

2. Yograj Guggulu – 2 -2 tablets before food
3. Vatari Guggulu – 1-1 tablet after food

4. Lakshadi Guggulu – 1 tablet after food
5. Lohasava – 20 ml+40 ml water after food
6. Kharateenne – 1 tsp at night
7. Ashwagandha Pak – 1 tsp once in a day
8. Hingwastak Churna – 1 tsp with first bite + 1 tsp ghee for digestion support

Panchakarma / Basti Therapy

• Vank?a?a Basti using Pedaharan Oil and Maha-Mash Oil, 15 days in a month for 6 month.

Diet & Lifestyle

• ?h?ra-vi?aya (dietary regimen)-milk, daliya, munnka,khichadi,coconut water,

Pre- and Post-Treatment Symptom Assessment

OUTCOME

Over the six-month therapeutic period, the patient reported 80–90% relief in symptoms (pain reduction, better gait, improved mobility). He was able to ambulate with much less discomfort.

DISCUSSION

In this case, Ayurvedic intervention appeared to produce significant symptomatic improvement in a patient with AVN / Asthimajjagata Vata. Below are key discussion points and rationale:

1. Pathophysiology correlation

• According to ?yurveda, Asthi-Majj?gata V?ta develops when V?ta do?a becomes aggravated and occupies the channels (srotas) of Asthi and Majj? dh?tu, leading to obstruction of rasa-rakta-prav?ha (microcirculation) within bone tissue. This impairs poshaka rasa dh?tu delivery, causing dh?tu k?haya (tissue depletion) and ?o?a (atrophy) [5,6].
• In modern terms, the compromised Asthivaha srotas parallels vascular occlusion in subchondral bone, resulting in osteocyte death and structural collapse — the hallmark of AVN. Thus, V?ta prakopa, Marg?varodha, and Asthi-Majj? dh?tu k?haya together form the Ayurvedic equivalent of avascular necrosis.

2. Therapeutic rationale

• The line of treatment (chikits? s?tra) for Asthi-Majj?gata V?ta focuses on pacifying V?ta (V?ta-?amana), nourishing Asthi and Majj? dh?tu (dh?tu-poshana), and restoring structural integrity (sandhi-sth?pana). Basti therapy is emphasized by ?c?rya Caraka as the best treatment for V?ta vy?dhi — “V?t?n?m bastir eva uttama?” [7]. Vank?a?a Basti (localized hip basti) with Pedah?ran Taila and Mah?m??a Taila provides snehana and mardava to the affected joint, improving local circulation and reducing stiffness.
• Internal ?amana medicines used in this case (over six months) were designed for comprehensive V?ta-pitta ?amana, Asthi-dh?tu vardhana, and rasa-rakta poshana, as summarized below: