A Clinical study on the role of Jalukavasecana followed by Kalavasti with Yastyahvadi niruha AND Balaguducyadi Taila anuvasana in the management of Gambhira Vatarakta with special reference to Avascular necrosis of the femoral head.

Vātarakta is one of the unique disorder where both vāta and rakta plays active role in the disease pathogenesis10. Ācharya Caraka mentions Vātarakta as raktaja vikāra in Vidhiśoṇitīya Adhyāya in sūtra sthāna (C.Su.24/12)7 and devoted an exclusive chapter to explain about the detailed aspects of Vātarakta in cikitsā sthāna (C.Ci.29)8. In Suśruta Saṃhitā, Vātarakta is described in Mahāvātavyādhi Adhyāya of cikitsā sthāna (Su.Ci.5/1-16)9.

 In VaÌ„tarakta, there is vitiation of vaÌ„ta and rakta where the excessively aggravated vaÌ„ta dosa is getting obstructed by aggravated rakta which further leads to the vitiation of raktadhaÌ„tu (C.Ci.29/10-11)10.

 AÌ„charya Caraka mentioned two types of VaÌ„tarakta i.e. UttaÌ„na and GambhiÌ„ra. In UttaÌ„na VaÌ„tarakta, twak and mamsa dhatu are going to be involved, where as in GambhiÌ„ra VaÌ„tarakta the remaining deep seated dhatus are involved (C.Ci.29/19)11.

 GambhiÌ„ra VaÌ„tarakta is a broader disease entity and avascular necrosis of the femoral head may be considered as one of its presenting form in modern perspective. That’s why in present study we are trying to compare GambhiÌ„ra VaÌ„tarakta with Avascular necrosis of the femoral head.

 Avascular Necrosis means necrosis of bone due to inadequate blood supply. It typically affects the epiphysis of long bones at weight-bearing joints. The most common sites for AVN are the femoral head, knee, talus, and humeral head. The most common cause is trauma and the non-traumatic causes includes excessive alcoholic intake as well as excessive consumption of systemic steroids12. In the present study avascular necrosis of the femoral head is considered as this is the commonest presenting form.

 The modern medical management of avascular necrosis of the femoral head depends on the severity of disease. Treatment outcomes correlate directly with the stages of disease. In early stages, management of avascular necrosis of the femoral head is done by bisphosphonates, non-steroidal anti-inflammatory drugs, extracorporeal shockwave therapy etc. In later stages management is done by surgical treatment that includes core decompression, femoral osteotomy, total hip arthroplasty etc12. As these treatment modalities are having a lot of intricacies in terms of safety profile and cost effectiveness there is a dire need of exploring safe and effective alternate therapy.

 In the present study, JaluÌ„kaÌ„vasecana and Vasti has been considered as the therapeutic interventions basing on the general line of treatment of VaÌ„tarakta (C.Ci.29/41)13, (C.Ci.29/35-37)14.

 By considering all the above-mentioned aspects of VaÌ„tarakta, JaluÌ„kaÌ„vasecana is selected as one of the therapeutic module in the present study which is the most unique and effective method of blood-letting indicated in the management of vaÌ„tarakta, if there is pain, burning sensation, pricking pain along with reddish discoloration of skin (C.Ci.29/35-37)14.

          In the spectrum of vasti, for niruÌ„ha vasti purpose, YasÌ£tÌ£yaÌ„hvaÌ„di NiruÌ„ha vasti is selected which has been mentioned as the best one for the management of VaÌ„tarakta (C.Si.3/46)15.

      For anuvaÌ„sana vasti purpose, BalaÌ„ GudÌ£uÌ„cyaÌ„di Taila is selected which is mentioned of having vaÌ„taraktahara property (Sahasrayoga-Taila Prakarana)16.

Thus, the present study is entitled as,

“A CLINICAL STUDY ON THE ROLE OF JALUÌ„KAÌ„VASECANA FOLLOWED BY KAÌ„LAVASTI WITH YASÌ£TÌ£YAÌ„HVAÌ„DI NIRUÌ„HA AND BALAÌ„ GUDÌ£UÌ„CHYAÌ„DI TAILA   ANUVAÌ„SANA IN THE MANAGEMENT OF GAMBHIÌ„RA VAÌ„TARAKTA WITH SPECIAL REFERENCE TO AVASCULAR NECROSIS OF THE FEMORAL HEAD”.