Ankylosing Spondilitis In Ayurveda – Pathogenesis, Treatment

By Dr Raghuram Y.S. BAMS, MD (Ay) & Dr Manasa, B.A.M.S

Ankylosing spondylitis (AS) is a rare type of arthritis that causes pain and stiffness in your spine. It mainly affects the spine and sacro-iliac joints or lower back. This lifelong condition, also known as Bechterew disease, usually starts in lower back. It can spread up to neck or damage joints in other parts of the body. (Read more here)

“Ankylosis” means fused bones or other hard tissue. “Spondylitis” means inflammation in spinal bones, or vertebrae. Severe cases can leave your spine hunched.

There’s no cure for AS. But medication and exercise can ease pain and help keep your back strong.

An inflammatory disease, symptoms of ankylosing spondylitis (AS) include pain, stiffness, and loss of mobility. The disease involves erosion of bone and increased bone formation in the spine, leading to bone fusion. In advanced cases, this can lead to spinal deformity.

AS most commonly occurs in men in their teens and 20s, but it can affect anyone of any age. It tends to be milder when it does occur in women, making it harder to diagnose.
Read – Cervical Spondylosis: Ayurvedic Treatment

Table of Contents

Ankylosing spondylitis in Ayurveda

Amavata – (Prishtagata / Katigata / Grivagata Amavata) – Amavata located in back, lumbo-sacral / pelvis or neck (cervical) regions are the appropriate terms for Ankylosing spondilitis in Ayurveda. Amavata has been compared to Rheumatoid Arthritis but the term Amavata can be extensively applied to many painful conditions apart from RA, including AS. In the pathogenesis of Amavata, it is said that the vitiated doshas get lodged in the trika sandhi i.e. lumbo-sacral joints and Sacroiliac joints following which they create stiffness in the entire body (spine too). Same is the explanation of amavata. Stabdhata i.e. stiffness will occur due to ankylosis and spondylitis. Jadya has been mentioned as one of the symptoms of amavata, which describes stiffness and loss of mobility. ‘Saruja Shotha’ is yet another symptom which means painful swelling in body parts (pain and inflammation).
Read – Amavata: Causes, Pathology, Treatment, Panchakarma, Medicines

Modern science tells us that there is no cure for amavata. Ayurveda says that ‘sa kastah sarva roganam’ i.e. among all diseases amavata is difficult to treat. Ayurveda opines that the progressive stage of amavata afflicts multiple joints like those of hands (upper limb), feet (lower limb), head (cervical, atlanto-occipital), ankle, sacro-iliac, lumbo-sacral, knee and hip apart from many complications and systemic symptoms which makes the disease difficult to cure or incurable. Ashu daurbalya (tiredness and fatigue), bahumutratam and vid vibaddhatam (excessive urination and constipation – change of bladder and bowel behavior), hridgraha (stiffness in the cardiac region – representative of valvular conditions and involvement of cartilages between breastbone and ribs in ankylosis) are also explained in Amavata just as in Ankylosing spondylitis.

Dandapatanaka – It is a condition explained in the context of Vata disorders. It is said that if vata and kapha get aggravated in the nerves, the body will become stiff just like a stick. This probably indicates the mechanism of ankylosis and loss of movements. We cannot compare this condition strictly because AS is not neurological. But this condition shall be considered for treatment especially when vata symptoms dominate the disease and there is excessive stiffness and rigidity of body joints and muscles. Master Charaka explains the same condition in the name Dandaka. In this, the vitiated vata causes stiffness / rigidity of joints of hand, legs, head, neck, back and pelvis. He tells that the body becomes stiff like stick and it is incurable. Modern texts consider it as incurable.

Prishta-Shiro Graha – Among the symptoms of Vata disorder, master Charaka mentions prishta shiro graham i.e. stiffness of the back and head (cervical spine). In total they indicate stiffness of the lower part of the spine and cervical spine which are the symptoms of AS.
Read – Effective Ayurvedic Therapies For Low Back Ache

Samprapti – pathogenesis

The ama carried and displaced by the force of vayu gets settled in the kapha places, mainly the joints of the body. The immaturely formed ama is carried further into the arteries by the vata. The ama is afflicted by all the three vitiated doshas enters various channels of circulation and takes many vicious forms. It immediately causes weakness and heaviness in the chest. This ama becomes responsible for manifestation of many diseases in due course of time. The ama and vata jointly vitiated will enter the pelvic region (sacro-iliac and lumbo-sacral regions). They then cause stiffness of the body and cause amavata.

Dosha – vata pradhana tridosha
Dushya – rasa, rakta, asthi, mamsa
Srotas – annavaha, raktavaha, rasavaha, asthivaha, mamsavaha
Srotodushti lakshana – vimargagamana (movement in abnormal pathways)
Vyadhi Marga – Madhyama (since joints are involved)
Agni – Agnimandya (weak digestion in stomach)
Ama – sama (associated with ama)
̶ Udbhava sthana (seat of origin) – amashaya (stomach)
̶ Sanchara Sthana (movement) – sarvanga (all through the body), dhamani (arteries), srotas (all channels of transportation)
̶ Vyakta Sthana (seat of manifestation) – asthi, sandhi
̶ Sadhya Asadhyata – Kashtasadhya (curable with difficulty)
Read – Stiff Neck Causes, Ayurvedic Treatment And Remedies

Treatment principles

1. Amavata Chikitsa – Line of treating amavata
a. Basic principles –
Langhana (swedana),
Swedana (sudation),
tikta-katu deepana (digestion promoting medicines and herbs having bitter and pungent taste),
̶ virechana (purgation) and
̶ vasti (enema)

b. External treatments –
̶ Abhyanga – herbal oil massage
̶ Swedana – sudation – churna pinda sweda (herbal powder bolus fomentation), patra pinda sweda (bolus sudation with medicinal leaves), valuka sweda (sand bed sudation)
̶ Dhara – stream pouring of medicated liquids over the body, mainly fermented herbal liquids (dhanyamladhara)
̶ Upanaha and lepa – poultices and anointment of medicated pastes using compounds like Rasnadi, Kottamchukkadi, Grihadhoomadi, Ellumnishadi and Dashanga Lepam

2. Principles of treating in high vata conditions / vata disorders

̶ Snehana – internal and external oleation (like massage, showering of medicated oils over the body to lubricate the joints, tub bath with medicated oils etc)
̶ Swedana – bashpa sweda (steaming), pinda sweda (bolus fomentation) etc
̶ Snigdha Virechana – unctuous purgation using compounds like gandharvahastadi taila
̶ Vasti – medicated enemas

Panchakarma

Virechana and Vasti are the best therapies for Amavata.

Virechana shall be given as krama virechana (purging after giving oleation and sudation) or nitya virechana (daily purging with medicated oils in small doses). This depends on the quantity of morbidity in the body, doshas involved and tolerance and strength of the patients. One of the below mentioned compounds shall be selected for virechana –

Trivrit Lehya
Gandharvahastadi Kashayam
Gandharvahastadi Eranda Tailam
Nimbamritadi Eranda Tailam
Hingutriguna Leham
Hingutriguna Tailam
Shaddharana Churnam
Kalyana Gulam
Narayana Churnam

Vasti i.e. medicated enemas are unparalleled in the treatment of amavata and vata disorders. When administered after virechana the results are many fold.

Decoction enemas shall be given with one of the Erandamuladi Kashaya Vasti (the best among the lot), Dashamula Kashaya / Kshira vasti, Vaitarana Vasti (another best), Mustadi Yapana Vasti etc. Brihat Saindhavdi Taila or Guggulutiktakam Ghritam can be used for giving anuvasana or matra vasti.

Upakarmas

Valuka Sweda – in presence of stiffness and ama symptoms
Dhanyamla Dhara – in presence of pain, inflammation and stiffness
Churna Pinda Sweda and Patra Pinda Sweda
Abhyanga and ama – for lubrication of joints and muscles, once ama is relieved

Medicines

Rasnapanchakam Kashayam
Rasnasaptakam Kashayam
Amrutottaram Kashayam
Simhanada Guggulu
Ajamodadi Churnam
Guggulutiktakam Ghritam
Rasnadi Ghritam
Yogaraja Guggulu
Maharasnadi Kashayam (for nourishing)
Rasnaerandadi kwatham (disease modifying)
Amavatari Ras

Important herbs and dietetic inclusions

· Barley
· Horse gram
· Shyamaka – Setaria italic
· Kodrava – Paspalum scrobiculatum
· Rakta shali – Red rice
· Drumstick
· Punarnava – Boerhavia diffusa
· Bitter gourd
· Pointed gourd
· Ginger
· Hot water
· Garlic processed in buttermilk
· Jangala mamsa – meat of animals living in desert and dry lands
· Water processed with Panchakola churna

Avoidable diet in RA –
· Curds
· Fish
· Jaggery
· Milk
· Flour of black gram
· Contaminated water
· Wind blowing from east
·Mutually incompatible foods
· Asatmya bhojana – foods that doesn’t suit us
· Forcibly controlling the natural body urges or reflexes
· Habit of awakening throughout the night
· Foods heavy to digest
· Foods which cause blockage in cells and channels of the body

Proprietary Medicines

Tablet Actiflex
Capsule Amavatari
Capsule Arnopen
Arthozen
Capsule Dazzle
Tablet Myostal
Orthofit
Penwel
R-Compound
Tablet R-Pairyn
Capsule Remorin
Capsule Rheumarthro with Gold
Tablet Rumalaya / Rumalaya Forte ya)
Capsule Arjit Forte
Capsule Arthrum
Tablet Shallaki