Ayurveda is a science of life, based on the concept of Dosha Siddhanta. The Doshas are Vata , Pitta & Kapha. The equilibrium of these three Doshas is called as health and their disturbance is called as disease. Based on the milestones of life, Kapha is predominant in childhood, Pitta in middle age and Vata during old age. With the advancement of age Vata Dosha increases in an individual. This increasing Vata triggers and accelerates Dhatukshaya (depletion of tissues) and balakshaya (reduction of strength). Hence with advancing age man becomes prone to several diseases including degenerative disorders. Sandhigata Vata manifests when the deranged Vata lodges in joints. This condition when manifests in the janu sandhi (knee joint), it is called as janusanshigatavata(osteoarthritis of knee), similarly deranged Vata when lodges in the vankshana (Hip) vankshanasandhigatavata (hip arthritis), deranged Vata which lodges in the vertebral column causes degenerative disc disease, facet joint arthritis, cervical spondylosis, lumbar spondylosis, spondylolisthesis, sciatica, lordosis, scoliosis, kyphosis etc. Ayurveda has very effective treatment for all the above orthopedic problems, including frozen shoulder, Supraspinatus tendinitis, shoulder impingement, teno synovitis of hip, wrist, ankle etc, ankle sprains, ligaments injuries of knee & ankle, plantar fasciitis, post-operative stiffness of joints & all kinds of rheumatic disorders including rheumatoid arthritis, ankylosing spondylitis, gouty arthritis etc. All these ailments have high rate of success through Ayurveda treatment.
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Introduction:
Vatarakta is a disease of multiple causation i.e. the metabolic or biochemical disturbance, the effects of stress and the allergic status. The main target organs of Vatarakta belongs to a particular group of organs i.e. Marmasthisandhis (Marma- vital points, Asthi- bones& Sandhi – joints) includes Peshi (muscles), Snayu (tendons) and Siras (blood vessels).
Etiological factors:
Aharajam:
• Excessive intake of salty, sour, spicy and alkalis food, also dry, unctuous and ushna content food
• Consumption of dry leafy vegetables and flesh of aquatic animals
• Excessive consumption of alcohol
• Adhyashana – Eating before the complete digestion of previous food
• Vishamashana – irregular meals
Viharajam:
• Sleeping during day time
• Lack of physical exercise and excessive physical exercise
• Excessive sexual indulgence
• Trauma
• Keeping late hours or not sleeping during nights
• Walking long distances
• Suppression of natural urges
• Fasting
Seasonal and climatic factors
• Cold
• Cloudy & windy day
• Winter and rainy seasons
• Excessive intake of salty, sour, spicy and alkalis food, also dry, unctuous and ushna content food
• Consumption of dry leafy vegetables and flesh of aquatic animals
• Excessive consumption of alcohol
• Adhyashana – Eating before the complete digestion of previous food
• Vishamashana – irregular meals
Viharajam:
• Sleeping during day time
• Lack of physical exercise and excessive physical exercise
• Excessive sexual indulgence
• Trauma
• Keeping late hours or not sleeping during nights
• Walking long distances
• Suppression of natural urges
• Fasting
Seasonal and climatic factors
• Cold
• Cloudy & windy day
• Winter and rainy seasons
Types of Vatarakta
➢ Utthana Vatarakta: in which the disease in confined to twak and mamsa dhatu.
➢ Gambhira Vatarakta : in which the disease is situated in the remaining dhatus of shakhas.
Signs and symptoms of Utthana Vatarakta
• Itching sensation
• Burning sensation
• Pain and swelling
• Pricking pain
• Throbbing pain
• Slight flexure of the joint
• Red and bluish red discoloration of skin over joints
Signs and symptoms of Gambhira Vatarakta
• Pain in the joints is severe that felt in the Uttana veriety
• Swelling and stiffness of joints
• Swelling like nodules which are hard and painful, covered by dark or copper colored skin. There is a burning sensation, pricking pain, throbbing sensation and these swellings are likely to inflame and suppurate also
➢ Gambhira Vatarakta : in which the disease is situated in the remaining dhatus of shakhas.
Signs and symptoms of Utthana Vatarakta
• Itching sensation
• Burning sensation
• Pain and swelling
• Pricking pain
• Throbbing pain
• Slight flexure of the joint
• Red and bluish red discoloration of skin over joints
Signs and symptoms of Gambhira Vatarakta
• Pain in the joints is severe that felt in the Uttana veriety
• Swelling and stiffness of joints
• Swelling like nodules which are hard and painful, covered by dark or copper colored skin. There is a burning sensation, pricking pain, throbbing sensation and these swellings are likely to inflame and suppurate also
Treatment:
For Utthana Vatarakta:
Snehanam, Swedanam, Siravyadha, Upanaha and Samshamana Chikitsa are advocated
For Gambhira Vatarakta:
Snehanam, Swedanam, Siravyadha, Basti and Samshamana Chikitsa advocated.
Snehanam, Swedanam, Siravyadha, Upanaha and Samshamana Chikitsa are advocated
For Gambhira Vatarakta:
Snehanam, Swedanam, Siravyadha, Basti and Samshamana Chikitsa advocated.
Case report:
Case report of 50 years old male patient suffering from Utthana variety of Vatarakta, (acc to Doshaja classification, Kaphadhikya Vatarakta). After taking Ayurveda treatment for three days marked reduction of pain and swelling. Figure no 1 and 2 (before and after treatment resp.)
Dr Santosh Dixit MD (AY), (PhD), Associate professor & consultant, Sri Sri College of Ayurvedic Science and Research Hospital, Bengalore
ABSTRACT
Sandhigata vata is the commonest form of articular disorder. It is a type of vata vyadhi which mainly occurs in vridhavastha due to Dhatukshaya, which limits everyday activities such as walking, dressing, bathing etc, thus making patient disabled/ handicapped. It being a vatavyadhi, located in marmasthi sandhi and its occurrence in old age makes it kashtasadhya. Vata dosha plays a main role in the disease. Shula pradhana vedana is the cardinal feature of the disease associated with sandhishotha, vatapurna druthi sparsha, lack of movements of the joints or painful movements of the joints. Janu sandhigata vata can be correlated to Osteoarthritis of the knee joint. This is an age related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in youngers people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness1.
This study is on a female patient aged about 59 years suffering from severe pain and stiffness of the both knee, (left knee more than right). Patient had shown Orthopaedician for the same, and was advised for surgery in 2011. She did not undergo surgery and underwent Ayurvedic treatment for the Osteoarthritis of knee in the same year. Post Ayurvedic treatment she was able to walk, perform her daily activities without any difficulties till 2016. Finally in 2016, (her age 64 old), while walking she slipped in park, and then suddenly developed severe pain, swelling and restricted movement of the knee joint. All the conservative line of treatment failed to reverse the condition. So patient underwent Total Knee Replacement on 23/12/16.
So Ayurvedic treatment postponed her total knee replacement surgery for about 5 years. With this postponement, she would be able to avoid revision Total Knee Replacement surgery in future.
KEYWORDS: Osteoarthritis of knee, TKR, Ayurvedic treatment, Replacement surgery.
This study is on a female patient aged about 59 years suffering from severe pain and stiffness of the both knee, (left knee more than right). Patient had shown Orthopaedician for the same, and was advised for surgery in 2011. She did not undergo surgery and underwent Ayurvedic treatment for the Osteoarthritis of knee in the same year. Post Ayurvedic treatment she was able to walk, perform her daily activities without any difficulties till 2016. Finally in 2016, (her age 64 old), while walking she slipped in park, and then suddenly developed severe pain, swelling and restricted movement of the knee joint. All the conservative line of treatment failed to reverse the condition. So patient underwent Total Knee Replacement on 23/12/16.
So Ayurvedic treatment postponed her total knee replacement surgery for about 5 years. With this postponement, she would be able to avoid revision Total Knee Replacement surgery in future.
KEYWORDS: Osteoarthritis of knee, TKR, Ayurvedic treatment, Replacement surgery.
INTRODUCTION
Ayurveda is a science of life, is based on the concept of Dosha Siddhanta. The Doshas are Vata , Pitta & Kapha. The equilibrium of these three Doshas called as health and their disturbance is called as disease. Based on the milestones of life, Kapha is predominant in childhood, Pitta in young age and Vata during old age. With the advancement of age Vata Dosha increases in an individual. This increasing Vata triggers and accelerates Dhatu kshaya (depletion of tissues) and bala kshaya (reduction of strength). Hence with advancing age man becomes prone to several diseases including degenerative disorders. Sandhigata Vata manifests when the deranged Vata lodges in joints. When this condition manifests in the janu sandhi (knee joint), it is called as janu sanshigata vata(osteoarthritis of knee).
In vridhavastha all dhatus undergo kshaya, thus leading to vata prakopa and making the individual prone to many diseases. Among them, Sandhigata vata stands top in the list. The incidence of Osteoarthritis in India is a high as 12%. It is estimated that approximately four out of 100 people are affected by it. Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by the age 70. Almost all persons by the age of 40 have some pathologic change in weight bearing joints2, 25% female & 16% males have symptomatic Osteoarthritis.
Each and every system of medicine has its own limitation in managing this disease. They can provide either conservative or surgical treatment and are highly symptomatic and with troublesome side effects. Whereas such type of conditions can be better treated by the management and procedures mentioned in the Ayurvedic classics. So with the help of Ayurveda line of management, one can postpone the Total Knee Replacement Surgery.
In vridhavastha all dhatus undergo kshaya, thus leading to vata prakopa and making the individual prone to many diseases. Among them, Sandhigata vata stands top in the list. The incidence of Osteoarthritis in India is a high as 12%. It is estimated that approximately four out of 100 people are affected by it. Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by the age 70. Almost all persons by the age of 40 have some pathologic change in weight bearing joints2, 25% female & 16% males have symptomatic Osteoarthritis.
Each and every system of medicine has its own limitation in managing this disease. They can provide either conservative or surgical treatment and are highly symptomatic and with troublesome side effects. Whereas such type of conditions can be better treated by the management and procedures mentioned in the Ayurvedic classics. So with the help of Ayurveda line of management, one can postpone the Total Knee Replacement Surgery.
CASE REPORT
During routine clinical practice in a clinic 5years back, 59 years old female patient came to take Ayurvedic treatment for Osteoarthritis of knee. She had already taken conservative treatment in modern system of medicine with physiotherapy and they had advised for knee Replacement surgery. As patient dint want to undergo surgery, opted for Ayurvedic treatment. On examination, severe tenderness positive in the articular margin, painful movement of the knee, and mild swelling was present over the knee. X ray showed reduction in the joint space with marginal osteophytes & deformity. Patient was advised Ayurvedic conservative line of management and quadriceps strengthening exercises. Patient gradually started improving in her conditions like reduction of pain, swelling and restoring moments of joints within 3 months. Patient was maintained without medication with only walking and exercises for 2year. After that patient underwent Ayurvedic treatment like, janubasthi, patrapinda sweda and kala basthi etc for 15days as inpatient. She went to Germany for 6months after treatment, and despite the cold climate in Germany patient was comfortable doing all the activity without pain. Patient was on regular follow-up every 6 months. In 2016 while walking in a park, she slipped and though there was no traumatic injury noted, had severe pain and swelling in her left knee with painful movement of the knee. Condition did not respond to with Ayurvedic and modern conservative management. So finally she had to undergo Total Knee Replacement Surgery on 23/12/16. Now she can do her daily activity without any support, and with 90 degree knee bending.
Image 1 & 2: Shows Janu Sandhi Lepam and Janu Basthi
Image 3:Shows Sthanika Janu Patra Pinda Sweda.
Image 4: x ray of left knee AP & Lateral view before surgery.
Image 5: x ray left knee AP & Lateral view after surgery.
Image 6: Shows Degenerated articular cartilage of left knee.
Image 7: Shows left knee with prosthesis.
DISCUSSION
Total knee replacement surgery is performed,
When there is severe knee pain or stiffness that limits the everyday activities, including walking, climbing stairs, and getting in and out of chairs.
One finds it hard to walk more than a few blocks without significant pain and may need to use a cane or walker.
Moderate to severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medication.
Knee deformity a bowing in or out of the knee.
Failure to substantially improve with other conservative treatments3.
Knee Prosthesis / implant
Knee replacements eventually wear out. Unfortunately, an artificial knee is not as durable as one’s own knee. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on the car tires.
In 1960s and 1970s, most believed that total knee implants would last about 10 years. This was one of the reasons that knee replacement procedures were confined to older patients. As time passed, it became apparent that the great majority of knee implants would last approximately 20 years and even longer. Improvements in surgical techniques, materials, implant designs and fixations have escalated over the past two decades resulting in an increased durability of knee implants well beyond even 20 years4.
According to the manufacture of prosthesis there are two varieties, Indian prosthesis and western prosthesis. Durability of the implant is in accordance to the manufacturer. The Indian prosthesis is valid for 8 to 10 years and western / imported prosthesis is valid for 10 to 12 years. This should be kept in mind before doing the surgery. Considering this case, if Total Knee Replacement surgery was done in 2011, then she would have had to undergo revision replacement surgery in 2022 that is at the age of 71 years. Now that her age is 64 year, and surgery is done with imported prosthesis, it will be valid till she will be 76 years or even more. Here, if we compare her activity at ages 71 and 76, at 76 years less activity is done and that will promote prosthesis to be valid for longer, and can prevent revision replacement surgery for life time. So if we postpone Total Knee Replacement surgery as much as possible it will help to avoid revision replacement surgery.
In this case with Ayurvedic line of treatment for Osteoarthritis of Knee we could postpone the surgery for about 5 years, and also might be able to prevent revision replacement surgery for life time. Thus, Ayurvedic treatment has an important role in postponement of Total Knee Replacement surgery.
When there is severe knee pain or stiffness that limits the everyday activities, including walking, climbing stairs, and getting in and out of chairs.
One finds it hard to walk more than a few blocks without significant pain and may need to use a cane or walker.
Moderate to severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medication.
Knee deformity a bowing in or out of the knee.
Failure to substantially improve with other conservative treatments3.
Knee Prosthesis / implant
Knee replacements eventually wear out. Unfortunately, an artificial knee is not as durable as one’s own knee. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on the car tires.
In 1960s and 1970s, most believed that total knee implants would last about 10 years. This was one of the reasons that knee replacement procedures were confined to older patients. As time passed, it became apparent that the great majority of knee implants would last approximately 20 years and even longer. Improvements in surgical techniques, materials, implant designs and fixations have escalated over the past two decades resulting in an increased durability of knee implants well beyond even 20 years4.
According to the manufacture of prosthesis there are two varieties, Indian prosthesis and western prosthesis. Durability of the implant is in accordance to the manufacturer. The Indian prosthesis is valid for 8 to 10 years and western / imported prosthesis is valid for 10 to 12 years. This should be kept in mind before doing the surgery. Considering this case, if Total Knee Replacement surgery was done in 2011, then she would have had to undergo revision replacement surgery in 2022 that is at the age of 71 years. Now that her age is 64 year, and surgery is done with imported prosthesis, it will be valid till she will be 76 years or even more. Here, if we compare her activity at ages 71 and 76, at 76 years less activity is done and that will promote prosthesis to be valid for longer, and can prevent revision replacement surgery for life time. So if we postpone Total Knee Replacement surgery as much as possible it will help to avoid revision replacement surgery.
In this case with Ayurvedic line of treatment for Osteoarthritis of Knee we could postpone the surgery for about 5 years, and also might be able to prevent revision replacement surgery for life time. Thus, Ayurvedic treatment has an important role in postponement of Total Knee Replacement surgery.
CONCLUSION
Janu sandhigata vata (Osteoarthritis of Knee) is an old age degenerative disorder, which is kashtasadhya. Osteoarthritis of knee affects the structure of the joint including articular cartilage, ligaments etc, which alters the functional aspect of the joints with deformity that cannot be reversed. Structural deformity can be corrected by surgery only, so in this case Total Knee Replacement surgery was indicated, but looking at age of the patient and durability of Knee prosthesis, the Surgery was postponed for about 5 years with Ayurvedic treatment. Thus proving beyond doubt that Ayurvedic treatments play an important role in the postponement of Total Knee Replacement Surgery and preventing Revision replacement surgery for life time.
REFERENCES
1. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page2/11.
2. Ch.321.15th edition 1987. Harrison’s Principles of Internal Medicine.
3. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page4/11.
4. Durability of Knee Implants: How Long Do Knee Replacements Last?, BoneSmart, Knee Replacement & Hip Replacement Patient Advocacy & Online Community.
2. Ch.321.15th edition 1987. Harrison’s Principles of Internal Medicine.
3. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page4/11.
4. Durability of Knee Implants: How Long Do Knee Replacements Last?, BoneSmart, Knee Replacement & Hip Replacement Patient Advocacy & Online Community.
Dr Santosh Dixit MD (AY), (PhD)
ABSTRACT
Abha guggulu, an Ayurvedic medicine was tried clinically on a patient having ‘fracture of proximal phalanx of left thumb. After the Anatomical reduction, cast was applied on the left hand with thumb. The duration of the treatment was for three weeks and healing of fracture was observed clinically and Radiologically at an interval of 7 days to till 21st day (After application of cast).
After confirming that the fracture healed well, the cast was removed and patient was advised to mobilize the distal interphalengeal joint of the left thumb. It was observed that the healing occurred at a good rate and also movements were restored faster.
The probable mode of action of the medicine may be therefore understood by its ability to speed up the fracture healing, its ability to facilitate the repair of bone fracture by hastening the proliferative physiological process in the body and its ability to increase the rate of regeneration of the bone. Thus, this can be recommended for the treatment of other fractures.
After confirming that the fracture healed well, the cast was removed and patient was advised to mobilize the distal interphalengeal joint of the left thumb. It was observed that the healing occurred at a good rate and also movements were restored faster.
The probable mode of action of the medicine may be therefore understood by its ability to speed up the fracture healing, its ability to facilitate the repair of bone fracture by hastening the proliferative physiological process in the body and its ability to increase the rate of regeneration of the bone. Thus, this can be recommended for the treatment of other fractures.
INTRODUCTION
Bhagna is an epitome where bone or bones get interrupted. This is classified on the basis of its clinical importance in to Avrana (closed fracture) and Savrana (Open fracture). In modern literature, fracture is defined as, a loss of continuity in the substance of the bone. Acharya Sushruta has advocated the principles of reducing fracture; they are Ancchana (traction), pidana (manipulation), sankshepana (opposition) and Bandhana1 (bandaging and immobilization) which is practiced regularly even today.
Abha guggulu, a medicine described in Bhaishajya Ratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya. It is said to speed up the fracture healing. Present study is carried out to confirm and re- establish the efficacy of Abha guggulu in the management of Angushtha Asthi Bhagna.
Abha guggulu, a medicine described in Bhaishajya Ratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya. It is said to speed up the fracture healing. Present study is carried out to confirm and re- establish the efficacy of Abha guggulu in the management of Angushtha Asthi Bhagna.
CASE REPORT
A male patient aged about 21years approached with a fracture of proximal phalanx of left thumb, caused by a traumatic injury during the sports activity. Patient had initially consulted orthopedic surgeons for the same and was suggested k- wire fixation. The patient then approached for a second opinion, and a conservative line of management was suggested instead of k-wiring, as the latter appeared to be the right line of treatment for the given case.
The fracture was reduced anatomically and cast was applied to the region of hand and thumb for immobilization. The patient was advised to take Abha guggulu two tablets twice daily after food with milk during the treatment for three weeks. The follow –ups to observe the healing of the fracture was clinically and radiologically done at an interval 7days till the 21st day (After application of cast). After confirming that the fracture had healed well, the cast was removed on the 21st day. Then, patient was advised to mobilize the distal interphalengeal joint of the left thumb.
The process of fracture healing to regain the usual structure pertaining to it, usually takes about six weeks. In this case the fracture healed within three weeks; with only Abha guggulu as the oral medication.
The fracture was reduced anatomically and cast was applied to the region of hand and thumb for immobilization. The patient was advised to take Abha guggulu two tablets twice daily after food with milk during the treatment for three weeks. The follow –ups to observe the healing of the fracture was clinically and radiologically done at an interval 7days till the 21st day (After application of cast). After confirming that the fracture had healed well, the cast was removed on the 21st day. Then, patient was advised to mobilize the distal interphalengeal joint of the left thumb.
The process of fracture healing to regain the usual structure pertaining to it, usually takes about six weeks. In this case the fracture healed within three weeks; with only Abha guggulu as the oral medication.
Image 1&2. X-ray left thumb AP & oblique view before treatment
Image 3&4. X-ray left thumb AP & oblique view after 7th day of treatment
Image 5&6. X-ray left thumb AP & oblique view after 14th day of treatment
Image 7&8. X-ray left thumb AP & Lateral view after 21st day of treatment
Image 9&10. X-ray left thumb AP & Lateral view after treatment
Image 11, 12, 13 & 14. Images of left thumb after treatment
The mode of Abha guggulu may be explained as follows;
1. It accelerates the fracture healing
2. It is likely to facilitate the repair of fracture by hastening the proliferative physiological process in the body.
3. In addition, it also improves the appetite, absorption of nutrients from the food, and bio-availability of the minerals which are beneficial in bone healing2.
Thus, this medicine enhances the healing power. So, it is highly recommended in the treatment of fractures.
1. It accelerates the fracture healing
2. It is likely to facilitate the repair of fracture by hastening the proliferative physiological process in the body.
3. In addition, it also improves the appetite, absorption of nutrients from the food, and bio-availability of the minerals which are beneficial in bone healing2.
Thus, this medicine enhances the healing power. So, it is highly recommended in the treatment of fractures.
DISCUSSION
Splint can be used to treat undisplaced fracture of the proximal phalanx for up to 4 weeks followed by early mobilization. Incongruous intra-articular fracture requires reduction and fixation.
More than 200-300 of angulation in the latral plane produces an IP joint extensor lag thus one has to undertake reduction in these patients. Less than 200 of angulations in the lateral plane is acceptable. Transverse fractures usually are stable with closed reduction.
Displaced fracture of proximal phalanx may require operative intervention. Displaced spiral or oblique fracture may be treated either with inter fragmentary screws (ORIF) or percutaneous pinning with kirschner wires (K-Wire). Another option is intra medulary kischner wire insertion, retrograde through the distal aspect of the thumb across the thumb IP joint3.
In this case, though the fracture was comminuted intra-articular fracture, displaced fracture was reduced anatomically and cast was applied for three weeks to immobilize the thumb. Patient was advised to take Abha guggulu two tablets twice daily after food with milk during treatment.
Fractured site was observed clinically and Radiologically at an interval 7days to till 21st day (After application of cast). Then the patient was advised to mobilize the distal interphalengeal joint of thumb.
During each observation, an angle of 50 in the lateral plane was seen which is within acceptable range.
The conservative oral medication used i.e. Abha guggulu, a medicine described in Bhaisjyaratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya was selected for the management. Abha guggulu contains following ingredients4,
1. Babula twak (Acacsia Arabika)- 1 part
2. Triphala – 1 part
3. Trikatu – 1 part
4. Guggulu (Commiphora mukul)- 3 parts
5. Ghrita – QS
Dose: 3 grams, in divided dose.
The administration of Abha guggulu was done as described in Bhaisajyaratnavali.
It acts as a natural bone healing agent with anti inflammatory and analgesic effects.
Its anti osteoporotic and anti arthritic effects can protect the bones against several diseases. Usually fracture healing process will take about 6 weeks. In this case the fracture healed within three weeks with the help of Abha gugggulu as oral medication.
More than 200-300 of angulation in the latral plane produces an IP joint extensor lag thus one has to undertake reduction in these patients. Less than 200 of angulations in the lateral plane is acceptable. Transverse fractures usually are stable with closed reduction.
Displaced fracture of proximal phalanx may require operative intervention. Displaced spiral or oblique fracture may be treated either with inter fragmentary screws (ORIF) or percutaneous pinning with kirschner wires (K-Wire). Another option is intra medulary kischner wire insertion, retrograde through the distal aspect of the thumb across the thumb IP joint3.
In this case, though the fracture was comminuted intra-articular fracture, displaced fracture was reduced anatomically and cast was applied for three weeks to immobilize the thumb. Patient was advised to take Abha guggulu two tablets twice daily after food with milk during treatment.
Fractured site was observed clinically and Radiologically at an interval 7days to till 21st day (After application of cast). Then the patient was advised to mobilize the distal interphalengeal joint of thumb.
During each observation, an angle of 50 in the lateral plane was seen which is within acceptable range.
The conservative oral medication used i.e. Abha guggulu, a medicine described in Bhaisjyaratnavali of Govind Das in the chapter Bhagna chikitsa adhyaya was selected for the management. Abha guggulu contains following ingredients4,
1. Babula twak (Acacsia Arabika)- 1 part
2. Triphala – 1 part
3. Trikatu – 1 part
4. Guggulu (Commiphora mukul)- 3 parts
5. Ghrita – QS
Dose: 3 grams, in divided dose.
The administration of Abha guggulu was done as described in Bhaisajyaratnavali.
It acts as a natural bone healing agent with anti inflammatory and analgesic effects.
Its anti osteoporotic and anti arthritic effects can protect the bones against several diseases. Usually fracture healing process will take about 6 weeks. In this case the fracture healed within three weeks with the help of Abha gugggulu as oral medication.
CONCLUSION
The study suggested, Abha Guggulu significantly improves the bone healing process, exerts significant anti inflammatory action and relives pain and swelling. It was observed that healing occurred at good rate and also movements were restored faster.
Owing to the miraculous healing abilities of this medicine “Abha Guggulu”, it can be tried in most fracture cases, either as the main line of management or as supplement during follow-ups, irrespective of closed or open reduction (with/without internal fixation) of the fractures.
Owing to the miraculous healing abilities of this medicine “Abha Guggulu”, it can be tried in most fracture cases, either as the main line of management or as supplement during follow-ups, irrespective of closed or open reduction (with/without internal fixation) of the fractures.
REFERENCES
1. Sushruta Samhita by Kaviraj Kunjalal, edited by Laxmidhas Dwivedi,vol 2, Bhagna Chikitsa adhyaya, published by Chaukambha Sanskrit series office, Varanasi.
2. Abha Guggulu ingredients, brnrfits, uses and side effects by Dr Jagadev Singh.
3. Thumb fracture and dislocation treatment and management Donald.R.Laup. et. All.
4. Baishajyaratnavali of Shri Govind Das, by Bhisagratna Shri Brahmashankar Mishra, edited by Kaviraj Ambikadatta Shastri, published by Chaukamba Prakashana, Varanasi.
2. Abha Guggulu ingredients, brnrfits, uses and side effects by Dr Jagadev Singh.
3. Thumb fracture and dislocation treatment and management Donald.R.Laup. et. All.
4. Baishajyaratnavali of Shri Govind Das, by Bhisagratna Shri Brahmashankar Mishra, edited by Kaviraj Ambikadatta Shastri, published by Chaukamba Prakashana, Varanasi.