Scoliosis: Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Scoliosis

Scoliosis is an abnormal / sideways curve in the spine (your backbone). This condition often shows up in childhood or teenage years.

Most cases of scoliosis are mild in nature while some curves worsen as the child grows. Severe scoliosis can cause disability and larger spinal curves can reduce the space within the chest which would cause difficulty in functions of the lungs.

Many cases of scoliosis might not need any treatment. To stop the curve from worsening, children might need to wear braces. More serious curves would need surgical intervention.

Related Reading – “Scoliosis – causes, symptoms, pathogenesis, treatment”

Scoliosis: Ayurveda Understanding

1. Anatomical and Physiological Viewpoint

The dosha link

The shape, size, structure and positioning of the structures of the body is under the control of vata mainly and partly of kapha.

When these doshas are put into a state of imbalance, mainly vata aggravation and kapha depletion taking place simultaneously, they cause abnormalities in the structures, including scoliosis.

The dhatu link –

Since the vertebrae are involved in the scoliosis and since there are structural changes in the spine bones (vertebrae) the main tissue involved in this disease is asthi dhatu i.e. bone tissue. Seeing scoliosis through the Ayurveda lens, the other tissues which are involved in the pathogenesis are mamsa dhatu i.e. muscle tissue, snayu (ligaments) and kandara (tendons), all of which give support to the bones. Aggravation of vata in these structures with consequent destruction of kapha can be considered as the pathological process in manifestation of scoliosis from Ayurveda perspective. The quantity of vata aggravation decides the severity of the curve and the magnitude of scoliosis (mild, moderate, severe) and its symptoms.

The ashraya-ashrayi bhava link –

 Bone is said to be an abode (residence) of vata. So when vata gets aggravated (in the body generally or) in the bones (specifically) the chances of bone damage or deformity setting in will be great. This might cause many pathological manifestations of vata, scoliosis being one among them.

2. Embryological Viewpoint

The Panchamahabhuta link –

Ayurveda embryology mainly considers the Panchamahabhuta theory of formation of fetal body and its parts i.e., each and every tissue and body part is formed by the involvement of five elements of nature i.e. prthiv (earth), ap (water), teja (fire), vayu (air) and akasha (ether, space). Each organ and tissue is predominant in one or more of the mahabhutas. Example – Bone tissue is hard structure, it is predominant in earth elements. Likewise it is light and hollow inside, filled with majja dhatu i.e. bone marrow and hence there is also predominance of ether element in the bones. Put together, the bones are made up of earth and ether elements. Therefore any imbalances in these elements cause deformities and diseases of bones including scoliosis.

Other part of hypothesis (involvement of other mahabhutas)

Vayu Mahabhuta divides the garbha (zygote, embryo) into different fragments (cell division). Teja Mahabhuta helps in processing and bringing about the maturity of the fetus. Ap Mahabhuta helps in nourishing the fetus. Prthvi Mahabhuta helps in bringing integrity and maintains the compactness of cells which are undergoing division. Akasa Mahabhuta helps in the coelomicity of the fetus which will provide spaces or cavities for different structures of the body. The same mahabhutas are also involved in the formation of bones of spine. When there is imbalance in these mahabhutas – the fragments (vertebrae) are formed in an disproportional way, the bones are not processed properly and are immature, they are deprived of nutrition, lose integrity and compactness and the cavities in the vertebral bones and spinal column are not formed properly. All these would lead to deformities of the spine as a whole and would manifest as conditions like scoliosis.

Pitrujadi Bhavas

Sources which contribute to formation of various qualities in a developing embryo which will, after the birth of the child, would contribute towards the formation of one’s identity and constitution are of six types. Out of these the hard and stable structures like bones (scalp hairs, skin hairs, moustache, nails etc) are said to be pitruja bhavas i.e. factors or structures developed from father (paternal factors). These factors are derived from healthy sperm. Similarly the growth of all tissues (including bones) are said to be derived from mother’s food (fetal circulation) i.e. rasaja bhavas. These two factors determine proper or disproportionate formation of bones of the spine also.

3. Purvarupa – premonitory symptoms perspective

In vata vyadhi purvarupas (premonitory symptoms of special vata disorders), a term ‘hundanam’ has been mentioned. Hundanam means twitch, twist or crookedness (meaning of hundanam will change situationally). Though this term has been used to describe twisting or crookedness of head, nose, eye, root of neck and the neck, the term can also be generally applied to the entire back region. Here crookedness or twisting can be compared to the abnormal curve of scoliosis and this might apart from being a symptom of scoliosis can also be considered as a premonitory symptom of vata vyadhi. The curve of scoliosis is an earlier indicator of many pathological manifestations which are bound to occur inside the body, mainly related to and caused by aggravated vata, due to anatomical disfiguration of back and its consequent impact on the structures, tissues and organs of the body.

4. Lakshana – symptoms perspective

Aggravated Vata may cause twisting, bending, spasms and contractures. Sankocha and Varta, the terms mentioned in Vata Prakopa Lakshanas – signs of aggravation of vata, though not exactly but points out towards pathologies like abnormal curve formed scoliosis.

5. Vyadhi – Pathological Perspective

Scoliosis can be considered as a condition manifested due to aggravation of vata in the spine. Though it cannot be categorized under any particular disease, scoliosis can be considered in the below mentioned conditions explained in Ayurveda –

Kubja / Kubjatva

This is one among the 80 disorders caused by Vata. Kubjatva is often compared to scoliosis. Kubja means a person who has a hump in his back ‘hunchback’. This is actually seen in Kyphosis, another condition of the spine wherein there is forward rounding of the back leading to a slouching posture or hunchback. On the other hand scoliosis is a sideways curve of the spine often taking the shape of ‘S’ or ‘C’. Though Kubjatva strictly points towards kyphosis, scoliosis too can be considered under the umbrella word Kubjatva or Kubja. This is also because both scoliosis and kyphosis are often present together. This condition is called Kyphoscoliosis. So, Kubja is a broad term which includes scoliosis, kyphosis and khyphoscoliosis.

Related Reading – Kubjatva

Snayugata Vata

It is a vata disorder. In this condition vata is aggravated in the ligaments. This leads to manifestation of many disorders. Kubjata is one among these disorders. This condition is compared to scoliosis.

Other conditions –

Asthigata Vata

Majjagata Vata

These two conditions cannot be directly compared with scoliosis. The symptoms mentioned in these conditions do not resemble scoliosis or its symptoms. But we can hypothetically consider that aggravated vata inside the bones (of the spine here) and / or bone marrow with a different type of activity (sequence of pathogenesis) other than what happens in asthigata or majjagata vata can cause diseases like scoliosis. The symptoms will be in accordance with how differently vata gets aggravated and how differently it behaves and in which region of the body (bones) it shows its pathological activities.

6. Scoliosis types – Ayurveda Perspective

Non structural scoliosis – In this condition, since the spine is curved and functions of the spine are normal, it can be considered as a state of mild to moderate prakopa of vata in the spine. This condition can be treated. Structural scoliosis presents with irreversible rigidity of spine – it is an asadhya state of vata aggravation in spine.

Idiopathic scoliosis & Congenital scoliosis – runs in the family. Genetics and family history are the risk factors of this type of scoliosis. Here the shukra dosha should be considered. The same is the case with congenital scoliosis (resulting from embryonic malformation of one or more vertebrae – panchamahabhuta).

Neuromuscular scoliosis – which is secondary to neurological or muscular diseases can be considered as vata vyadhi, mamsagata vata and snayugata vata.

Degenerative scoliosis – since this occurs in adults due to the wearing out of disks and joints of the spine in lower back, it can be considered due to vata aggravation in old age – a progressive state of sandhigata vata or asthigata vata or snayugata vata.

7. Scoliosis Symptoms – Ayurveda Perspective

Visible symptoms – leaning, curve in the spine, unevenness of shoulders, waist, hips etc, ribs sticking out farther on one side, head not centered above the pelvis and changes in appearance or texture of skin overlying spine are all due to aggravation of vata. Asthi, Majja, Snayu, Mamsa and Sandhi are involved. Many other causes mentioned above, like imbalance in the Mahabhutas involved in the formation and maturation of garbha (embryo, fetus) and its body parts are also involved.

Similarly other symptoms including pain and stiffness in the back, pain and numbness in legs, fatigue and breathing difficulty are due to vata aggravation.

So, vata aggravation is the main principle in the manifestation of scoliosis and its symptoms. The gradient and intensity of vata aggravation determines the quantity of curve of scoliosis and the intensity of its symptoms.

Scoliosis Treatment Principles – Ayurveda Perspective

Limitations and Goals of Ayurveda treatment

Limitations – Many cases of scoliosis having larger curves, fixed curves imparting pressure on tissues, organs and vital organs and associated with complications and many congenital conditions cannot be treated. In these conditions the goals of treatment would be to ease the symptoms and not to treat the disease.

Most of curable scoliosis with mild curves and symptoms can be treated on lines of treating aggravated vata or vata disorders. This includes all approaches which can be done to balance vata – therapies, dietetic protocol, lifestyle changes and medicines which mitigate / treat vata.

The goals of treatment in curable scoliosis –

• to prevent the curve from worsening
• to support and nurture the structures around the spine – including muscles, ligaments and tendons
• to ease pain, stiffness and discomfort in the bones, joints, muscles and ligaments around the spine
• to increase the flexibility of the spine and the structures around it

Ayurveda Principles of treating Scoliosis

Treating Vata –

Since Vata is the main principle causing scoliosis, it is important to control and bring the aggravated vata to a state of balance. This works out in great proportions in scoliosis presenting with mild to moderate curves. Larger curves, more impact on the visceral organs and surrounding symptoms, pressure on vital structures and chronic nature of the disease and associated complications depicts the bheda avastha (complicated stage) of the disease as per Ayurveda and a state of ‘difficult curability’ or ‘state of incurability’ (difficult prognosis). Long standing vata disorders with fixed and established structural deformities anyways fall under the category of bad prognosis. Even in these cases addressing vata would prevent the worsening of disease and its symptoms and may provide symptomatic relief for pain and other conditions associated with scoliosis, either temporarily or for a brief span of time though the curves cannot be reverted back to their original state.

Other treatment principles in curable scoliosis

Scoliosis shall be treated on the lines of treating –

• Asthigata Vata – aggravated vata localized in bones
• Sandhigata Vata – aggravated vata localized in joints
• Mamsagata Vata – aggravated vata localized in muscles
• Snayugata Vata – aggravated vata localized in ligaments / tendons
• Majjavruta Vata – bone marrow obstructing the functions of vata
• Kubja vata treatment

Effective Therapies for Scoliosis

i. External therapies –

Abhyanga – massage with vata mitigating herbal oils

Swedana – sudation

Pinda Sweda – herbal-leaves bolus fomentation

Shashtika Sweda Pinda Sweda – bolus fomentation done with rice (grown in 60 days) processed in milk prepared with herbal vata mitigating decoctions

Sarvanga Taila Dhara / Kaya Seka / Pizichil – oil bath for the entire body

Sarvanga Ksheera Dhara – medicated milk bath for the entire body

ii. Internal Therapies –

Snehapana – daily monitored doses of medicated fats (oils, ghee, bone marrow or muscle fat either individually or in combinations) or as preparation for cleansing therapies (mainly virechana – therapeutic purgation) are useful. Snehana administered with the purpose of providing oleation and lubrication are also administered with intention of pacifying (palliative) the doshas i.e. shamana sneha or with intention of promoting bulk and strength i.e. brimhana sneha.

Deepana and Pachana Ghrtas – should be administered for kindling the digestive fire, tissue fires (mainly of muscle, fat and bones) and digesting ama. This is the most essential aspect of treating diseases like scoliosis. Here medicated ghee would rectify the metabolism at the gut and tissue level and help in proper formation and balance of tissues.

Virechana – therapeutic purgation is administered to eliminate morbid pitta and vata, to cleanse the system of impurities and toxins, cleanse the channels and reboot the system.

Tikta Ghrta – ghee prepared using bitter tasting herbs is praised as medication in bone, joint and bone marrow related conditions. It shall be used for oral consumption or in the form of enema.

Vasti / Basti – medicated enemas are ideal for vata related disorders including scoliosis. Ideally enema administered using medicated oils, ghee or combination of both ghee and oil is good but a combination of decoction enema and oil / ghee enema given on alternative days will also help to great extent. Tkita Ghrta Vasti (enema using ghee prepared with bitter tasting herbs) or Tikta Ksheera Vasti (enema given using milk prepared with decoction of bitter tasting herbs) is the best in these conditions.

Important medicated oils / ghee used for snehapana and vasti

• Bala Taila
• Tila Taila
• Ksheerabala Taila
• Sahacharadi Taila
• Dhanwantaram Taila
• Gandharvahastadi Taila
• Nimbamritadi Eranda Taila
• Guggulutiktaka Ghrta
• Ashwagandha Ghrta

Important medicated oils used for external therapies

• Ksheerabala Taila
• Sahacharadi Taila
• Mahanarayana Taila
• Balashwagandha Taila
• Lakshadi Taila
• Prasarini Taila

Important formulations for scoliosis

• Sahacharadi Kashayam
• Maharasnadi Kashayam
• Guggulutiktakam Kashayam
• Dhanwantaram Kashayam
• Ashtavarga Kashayam
• Prasarinyadi Kashayam
• Gandharvahastadi Kashayam
• Rasnasaptaka Kashayam
• Yogaraja Guggulu
• Lakshadi Guggulu
• Trayodashanga Guggulu
• Ekangaveera Rasa
• Mahavatavidhwamsini Rasa
• Vatagajankusha Rasa

Important Yoga poses useful in Scoliosis

• Trikonasana – Triangle Pose
• Sethu Bandhasana – Bridge Pose
• Talasana – Mountain Pose
• Salabhasana – Locust Pose
• Marjaryasana – Cat-Cow Pose
• Ardha Matsyendrasana – Half Lord of the Fishes Pose