Role of Panchakarma

in Musculoskeletal Disorders

Musculoskeletal system

Skeleton

Muscles

Joints

Cartilage Tendons

Ligament

Connective tissue

IMPORTANCE OF HUMAN MUSCULOSKELETAL SYSTEM

MSD IN AYURVEDA (मध्यम रोग माग )Dhatu pradoshaja vikara

Upadhatu pradoshaja vikara

Dhatu kshaya vrudhi

Urustambha

Vatavyadhi

Vatarakta

Vata nanatmaja vikara

Amavata

Jwara

Madhumeha

ROLE OF PANCHAKARMA IN MUSCULOSKELETAL DISORDERS

मांसजानां तु संशुद्धि�ः शस्त्रक्षारग्नि�नकम� च।

अस्थ्याश्रयाणा व्याधीनां पंचकमा�णिण भेषजं॥

Approaches in understandingnature of

Musculoskeletal disorder

CLASSIFICATION Articular or Non articular

Inflammatory or Non inflammatory

Acute or Chronic

Localized or Widespread (Systematic)

ARTICULAR INVOLVEMENT Pain on active & Passive movements Effusion Crepitus Locking / Instability – Give way Deformity

Synovium, synovial fluid, articular cartilage, Intraarticularrligaments, joint capsule, juxtaarticular bone

NON ARTICULAR INVOLVEMENT

Pain on active movements Point or focal tenderness in periarticular areas

Extra articular ligaments, tendons, bursae,muscle, fascia, bone, nerve or overlying skin

ICD-10 Chapter XIII: Diseases of the musculoskeletal system

MSDArthropathy Infectious

Inflammatory

Arthrosis

Dorsopathy Deforming

Inflammatory

Non inflammatory

Soft tissue disorder Muscle

Tendon & Synovium

Others

Osteopathy

Infectious arthritis

Septic

Viral arthropathy

Reactive

SEPTIC ARTHRITIS रक्तज वातरक्त Septic arthritis is the

purulent invasion of a joint by an infectious agent which produces arthritis

Staphylococcus aureusHaemophils influenzaeNeisseria gonorrhoeaM. tuberculosis,

REACTIVE ARTHRITIS पि�त्तज वात रक्त

Reactive arthritis, is an inflammatory condition that develops in response to an infection in another part of the body (cross-reactivity).

Arthritis

Cervicitisurethritis

conjunctivitis

पि�त्तज रक्तज वातरक्त चि�पि�त्सा चिचकिकत्सा सूत्र

शोफ चिचकिकत्सा

AMA AVASTHA

LANGANA ALEPA:

raktachandana,yashti

PARISHEKA: yastiksheerapaka,pinda taila

ABHYANGA :pinda taila UPANAHA :jadamayadi

RAKTAMOKSHANA: jalouka

NIRAMA AVASTHA SNEHAPANA: tiktaka

grita

VIRECHANA : trivrut ch + Draksha rasa

BASTI

नकि, बस्तिस्त समं किकंचिचत्वातरक्त चिचकिकत्सित्सतम्।स घ्रत क्षीरबस्तिस्तणिभः ।

GUDUCHYADI NIRUHA BASTHIDRAVYA QUANTITY

MAKSHIKA 100 ML

LAVANA 6 GM

SNEHA

YASHTIMADHU TAILA 50 ML

TIKTAKA GRITHA 50 ML

KALKA- SHATAPUSHPA 25 GM

KASHAYA – GUDUCHYADI GANA 300 ML

TOTAL QUANTITY 500 ML

VIRAL ARTHROPATHY वातज ज्वरViral arthritis is

inflammation of the joints that results either directly from a viral infection or as an immunologic response.

It can last for few week to months after the primary illness has come down .

PANCHAKARMA IN JWARA

Only in bahudoshavastha one has to do shodhana after seeing the dosha prakopa.

SAAMA AVASTAसामेवातेऽकिप लंघनं। NIRAMA AVASTHA start with जीण�ज्वर,र

चिचकिकत्सा

BAHYA UPAKRAMA abhayanga , pradeha, parisheka with chandanadi taila , agrvadi taila BAHUDOSHAVASTA - shodana

BASTI ANUVASANA BASTI Guduchyadi niruha basti Jeevantyadi anuvasana basti

Inflammatory arthritis

Rheumatoid arthritis

Psoriatic arthritis

Crystal arthropathy

Diabetic arthropathy

others

RHEUMATOID ARTHRITIS आमवात/�फज वातरक्त Chronic, Systemic

Autoimmune induced inflammatory Disease

Synovitis Synovial hyperplasia Pannus Ankylosis of joint Diffuse inflammation in

lungs, pericardium, subcutaneous tissue,sclera

चिचकिकत्सा सूत्र लंघनं स्वेदनं कितकं्त दीपनाकिन कटूकिन च। किवरेचनं स्ने,पानं बस्तयश्चाममारुते ॥ सैन्धवाध्येनानुवासस्य क्षारबस्तिस्तः प्रशस्यते। कफज वातरक्त चिचकिकत्सा सूत्र वमनं मु्रदु नात्यर्थंF स्ने,सेकौ किवलंघनम् । कोष्णालेपाश्च शस्यन्ते वातरके्त कफोत्तरे ॥

THERAPEUTIC APPROACH Consider the साम & किनराम अवस्थ of disease

SVEDANAROOKSHA SVEDA1. Sleshmasthana2. Amashayagata vata3. saama vata

Valuka svedaChoorna pinda svedaDhanyamla dhara Ushna jala pana

Snigdha Sveda

Patra pinda sveda

SNEHAPANA Pippalyadi Ghrita, Tryushanadi Ghrita,

Shuntyadi Ghruta, Bhruhatsaindhavadi Taila

VIRECHANA Mridu Virechana Eranda Taila Nimbamrutadi eranda taila

VAMANA Mrdu vamana

KSHEERA VAITARANA BASTIDRAVYA QUANTITY

GUDAPAKA 25ML

SAINDHAVA 15GM

SNEHA 30ML

CHINCHA SWARASA 50ML

KSHEERA 200ML

TOTAL 320ML

PSORIATIC ARTHRITIS – उभयाश्रि�त वातरक्त

It is a type of inflammatory arthritis that, will develop in 30 percent of people who have chronic psoriasis.

Dactylitis. Plantar fasciitis Pitting of nails Ankylosing spondylitis

उभयाश्रि�त वातरक्त चि�पि�त्सा

बुदध््वा स्थानकिवशेषांश्च दोषाणां च बलाबलम् ।

बाह्यमालेपनाभ्यंगपरिरषेकोपना,नैः।किवरेकास्थापनस्ने,पानैग�म्भीरमाचरेत् ॥

दोषज – किपत्तकफज वातरक्त चिचकिकत्सा

ALEPA Madhuchishtadi lepa

ABHYANGA Pinda taila, shatapaka bala taila

PARISHEKA Dashamoola siddha ksheeramahasneha dhara

UPANAHAJadamayadi choorna

SNEHAPANA Tiktaka gritha

VIRECHANA in BahudoshavastaEranda taila +ksheera प्रयोगेण

BASTIकिन,�रेद्वा मलं तस्य स घ्रतैः क्षीरबस्तिस्तणिभः।न कि, बस्तिस्तसमं किकंचिचत् वातरक्तचिचकिकत्सित्सतम् ॥

अनुवासन : Madhuyashtyadi taila Sukumara taila Pinda taila किनरु, : Tikta ksheera basti

TIKTA GRITHA KSHEERA BASTIDRAVYA QUANTITY

MADHU 90 ML

SAINDHAVA 5GM

SNEHA-TIKTA GRITHA 140ML

KALKA- SHATAPUSHPA 30GM

GUDUCHI KSHEERAPAKA 300ML

TOTAL 560ML

Crystal arthropathy

Gout

Pseudogout

Calcific pariarthritis

CRYSTAL ARTHROPATHY पि�त्तज वातरक्त

Acute inflammatory arthritis, caused by elevated levels of uric acid etc. in the blood which crystallizes in joints, tendons etc

GoutPseudogoutCalcific periarthritis

पि�त्तज वातरक्त चि�पि�त्सा

RAKTAMOKSHANA– jalouka

LEPA Tila, Erand Beeja, Dashanga Lepa, ShatadhautaGhrita

ABHYANGA Bala Tail,Guduchhyadi Taila

PARISHEKA Pinda Taila, Dashamoola sidha ksheera

SNEHAPANA – guggulu tiktaka gritha

VIRECHANANimbamrtadi eranda taila Trivrut choorna with draksha rasa

BASTI किन,�रेद्वा मलं तस्य स घ्रतैः क्षीरबस्तिस्तणिभः।न कि, बस्तिस्तसमं किकंचिचत् वातरक्तचिचकिकत्सित्सतम् ॥

TIKTA GRITHA KSHEERA BASTIDRAVYA QUANTITY

MADHU 90 ML

SAINDHAVA 5GM

SNEHA-TIKTA GRITHA 140ML

KALKA- SHATAPUSHPA 30GM

GUDUCHI KSHEERAPAKA 300ML

TOTAL 560ML

GUDUCHYADI NIRUHA BASTHI

DRAVYA QUANTITY

MAKSHIKA 100 ML

LAVANA 6 GM

SNEHA

YASHTIMADHU TAILA 50 ML

TIKTAKA GRITHA 50 ML

KALKA- SHATAPUSHPA 25 GM

KASHAYA – GUDUCHYADI GANA 300 ML

TOTAL QUANTITY 500 ML

DIABETIC ARTHROPATHY- मधुमेह पि�ड�ा

Seen in weight bearing joints like heel, due to spontaneous infarction of skeletal muscles , limited joint mobility and peripheral neuropathy causes destructive arthropathy. Also called as Charcot joint.

चिचकिकत्सा

शल्य चिचकिकत्सा

HAEMARTHROSIS -क्रोषु्ट�शीर्ष Hemarthrosis is a

bleeding into joint space, commonly in knee. Occurs as a complication of anticoagulant therapy, trauma,haemophilia.

रक्तज वातरक्त चिचकिकत्सा

Arthrosis

Primary

Secondary

ARTHROSIS संचिधगत वात

Oteoarthrosis, is a group of mechanical abnormalities involving degradation of joints.

Thinner & softer cartilage

Subchondral Sclerosis Osteophytes Chronic synovitis Periarticular muscle

wasting

THERAPEUTIC APPROACH कुया�त् संधिधगतेऽकिनले दा, स्वेदोप्ना,नैः।

स्ने,ोपना,ाग्नि�नकम�बन्धनोन्मद�नाकिन च । स्नायुसंध्यत्सिस्थसंप्राप्ते कुया�द्वायावतद्धिन्Wतः॥

SAMA AVASTHA- lepa

BAHYA SNEHANA& SWEDANA Pichu, Taila pariseka, Local Basti, With Ksheera bala , MN taila, Dhanwantara taila SSPS ABHYANTHARA SNEHANABrumhana Snehana

BASTIMatra Basti Panchaprasrutika Basti Mustadirajayapana basti

PANCHA PRASRUTIKA BASTIDRAVYA QUANTITY

MADHU 100ML

TAILA- KSHEERA BALA 100ML

GHRITHA- TIKTAKA 100ML

KSHEERA 200ML

TOTAL 500ML

MUSTADI RAJA YAPANA BASTIDRAVYA QUANTITY

MADHU 100ML

LAVANA 5 GM

SNEHA- KSHEERABALA TAILA 50ML

SUKUMARA GRITHA 50ML

KALKA 30GM

MUSTADI KSHEERAPAKA 200ML

MAMSARASA 100ML

TOTAL 500 ML

MADHUTAILIKA BASTIDRAVYA QUANTITY

MADHU 100ML

SAINDHAVA 12GM

SNEHA-MOORCHITA TAILA 100ML

KALKA-SHATAPUSHPA 30GM

KASHAYA-ERANDAMOOLADI 300ML

TOTAL 500ML

AGNIKARMA ANULOMANA

Dorsopathy

Deforming

Inflammatory

Non inflammatory

Deforming

Kyphosis

Lordosis

Scoliosis

Torticollis

Spondylolisthesis

KYPHOSIS �ुब्ज

Kyphosis is a condition of over-curvature of the thoracic vertebrae . It can be either the result of degenerative diseases ,osteoporosis or trauma.

Vataja nanatmaja vikara

Also mentioned in prakupita vata karma

Treat the underlying cause Degenerative – संधिधगतवात चिचकिकत्सा Compression # due to osteoporosis- कितक्त क्षीर

बस्तिस्त मधुत्सिXष्टादिद लेप Physical therapy

LORDOSIS �टि*ग्रह

Excessive lordotic curvature is called hyperlordosis caused by weak hamstrings, or tight hip flexors . .

Bahya snehana & svedana

SCOLIOSIS �ार्श्वग्रहSimple temporary

scoliosis my be due to wrong posture.

Secondary may be due to congenital or neuromuscular.

Treated with bahya snehana and svedana

TORTICOLLIS मन्यास्तम्भ

Torticollis, is due to muscle spasm cervical spine musculature like sternocleidomastoid

It can be congenital or acquired

स्कन्धवक्षस्त्रिस्त्रकप्राप्तं वायंु मन्यागतं तर्थंा। वमनं ,न्तिन्त नस्यं च कुशलेन प्रयोद्धिजतम् ॥

VAMANA after snehapana NASYA – KB 101

SPONDYLOLISTHESIS - संचिधच्यपुितSpondylolisthesis is the anterior or posterior displacement of a vertebra in relation to the vertebrae below

संचिधभग्न चि�पि�त्सा

Inflammatory spondylarthropathy

Ankylosing spondylitis

Sacroilitis

ANKYLOSING SPONDYLITIS - पु्रष्ट ग्रह पि4� ग्रह

It is a chronic, inflammatory arthritis and autoimmune disease. axial skeleton, leding to fusion of joints.

It is vata nanatmaga vikara

VATA VYADHI & GAMBHIRA VATA RAKTA AMA AVASTHA ROOKSHANA Valuka svedaDhanyamla dhara

NIRAMA AVASTHA

SNEHAPANA- Guggulu tiktaka gritha

VIRECHANA- Nimbamrtadi eranda taila

PARISHEKA – Dahsamoola ksheera dhara Kupilu ksheera dhara Twak patra kashaya dhara

BASTI Mustadi raja yapana basti – Karma basti

shedule Guduchyadi ksheera basti

SACROILITIS पि4� ग्रह

It is an inflammation of the sacroiliac joint leading to fusion of joint.

Pregnancy UTI

Vata nanatmaja vikaraPakwashayagata vataChronic sacroilitis leads to

fusion of joint .

Ankylosing spondylitis line of treatment

ANULOMANA – gandarvahastadi taila Udavarta chikitsa

Non Inflammatory spondylopathy

Spondylosis

Spinal canal stenosis

SPONDYLOSIS संचिधगत वात It is to degenerative

osteoarthritis of the joints between the spinal vertebrae

Radiculopathy Myelopathy,Cervical spondylosis. Lumbar spondylosis.

Main cause - Repetitive strain injury (RSI)

SPINAL CANAL STENOSIS It is an abnormal narrowing

of the spinal canal. Lumbar stenosis Cervical stenosis.

While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord.

Intevertrbral disc disorders

IVD Degeneration

IVD Displacement

IVD DEGENERATION Occurs as a result of

aging . There will be structural failure . There is loss of water content in nucleus pulposus.

Disc space is narrowed .

back pain which is discogenic.

Bulged disc

INTERVERTEBRAL DISC DISPLACEMENT It is a tear in the outer,

annulus fibrosus allowing the nucleus pulposus to bulge out beyond the damaged outer rings.

Disc herniations are further development of existing disc protrusion.

Radiculopathy commonly sciatica

Myelopathy

ग्रध्रसीवत् चि�पि�त्सा- DISC PROLAPSE ACUTE PHASE अन्तराकण्डरागुल्फं चिसरा बस्त्यग्नि�नकम� च । Acute stage-Kapha avrta vata LEPA of kottamchukkadi or kolakulattadi

with tamarind juiceROOKSHA SVEDA -Valuka sveda, kulatta,

choorna pinda sveda

RAKTAMOKSHANA In nirama avasta go for bahya snehana

like abhyanga followed by raktamokshana in sira between kandara and gulpha

IN NIRAMA AVASTHASNEHANA

ABHYANGABala tailaPrasarini taila Mahavishagarbha tailaSaindhavaya taila

ABHYANTRAMahamasha taila.Sahachara tailaMasha tailaPrasarani taila

SVEDANA Patra pinda svedaNadi sveda Avagaha Pariseka VAMANAVIRECHANAEranda taila along with milk is ideal as

Vaata Anulomana.

BASTI

Vajigandadi niruha basti

वाद्धिजगंधाबलाकिबल्व दशमूलाम्बुसाधिधतम् । ग्रध्रस्यां तैलमैरण्डं परं बस्तौ प्रयोजयेत् ॥

ERANDAMOOLADI NIRUHA BASTI

DRAVYA QUANTITY

MADHU 80 ML

SAINDHAVA

SNEHA – DHANWANTARA TAILA 70ML

KALKA - ERANDAMOOLADI 30GM

KWATHA – ERANDAMOOLADI 300ML

GOMUTRA 100ML

TOTAL 550ML

AGNIKARMA

in between Kandara and Gulpha or posterior aspect of the leg 4 Angula below the Indrabasti Marma

Loha shalaka

CERVICAL SPONDYLOSIS ग्रीवाहंुडन Degenerative arthritis of cervical spine

नस्य karpasathyadi tailaMarsha & pratimarsha Brumhana nasya – Ksheera bala 101

Greeva basti

Soft tissue disorder

Bursitis

Fibromyalgia

Muscle cramp

Muscle strain

Muscle fatigue

BURSITIS Periarticular lesion .

Focal pain, difficulty in movement

Common are acromion bursitis, Trochantric bursitis

Kapha vatahara ushna chikitsa

Marmani vati lepaDhanyamla avagaha

FIBROMYALGIA – It is a chronic

muculoskeletal syndrome in which central nervous system translates non painful stimuli to pain .

Multiple tender points Chronic widespread pain Muscle stiffness Sleep problems Headache Mood disturbences

मांसगत वात चि�पि�त्सा किवरेको मांसमेदस्ते किनरु,ाः शमनाकिन च ।

VIRECHANA after snehapana

BASTI – Mustadi raja yapan basti

TAKRADHARA

MUSCLE CRAMP खल्ली

Sudden painful contraction of muscle .

It is due to inadequate blood supply or low serum elecrolytes level like potassium.

पायसैः क्रशरैमाFसैः शस्तं तैलघ्रतान्तिन्वतैः।

upanaha with hot payasa or krshara

MUSCLE STRAIN A strain is an injury to a

muscle or tendon in which the muscle fibres tear as a result of overstretching.

localized pain, stiffness, discoloration and bruising around the strained muscle.

Mamsagata vata chikitsa Virechana Niruha basti

MUSCLE FATIGUE उरुस्तम्भ During excessive exercise , due to

anerobic respiration lactic acid is produced as metabolic waste product. Usually it gets converted into glycogen , but when produced in excess it gets accumilated in muscle causing pain .

Panchakarma are contraindicated. Udwartana Utsadana – valmikamrtikka, aswagandadi Parisheka - gomutra

स्नायुगत पिव�ार Tendinitis Epichondylitis De quervain’s syndrome Dupuytren’s contracture Carpal tunnel syndrome Sprain Others

स्नायुगत वात चि�पि�त्सा स्ने,ोपना,ाग्नि�नकम�बन्धनोन्मद�नाकिन च । स्नायुसंध्यत्सिस्थसंप्राप्ते कुया�द्वायावतद्धिन्Wतः॥

Bahya and abyantara sneha with murivenna taila. Mahamasha taila

Upanaha - nagaradi choorna, kolakulattadi, marmani vati

Agnikarma Bandhana unmardana

ADHESIVE CAPSULITIS अ�बाहु�् Frozen shoulder or

adhesive capsulitis, is a disorder in which the shoulder capsule, surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain which aggravates at night.

ROTATOR CUFF TENDINITIS Tendinitis resulting from tear Shoulder pain

अ�बाहु�

Dhatu Kshaya Nidana

Margavarodhaka Nidana

Marmabhigata Nidana

ROOKSHANAValuka sveda

Churna pinda sveda- Kola Kulattadi Churna

SNEHANABAHYA and ABHYANTARA

Bahya: Abhyanga Maha masha Taila Ksheera bala Taila

Karpasasthyadi Taila Prasarinyadi Taila

ABHYANTARA SNEHA:

Guggulu Tiktaka Ghrita Maha Kalyanaka Ghrita Mashadi Taila Ksheerabala Taila

SVEDANANadi SvedaPatra Pinda SvedaJambeera Pinda SvedaShashtika Shali Pinda SvedaAnda Sveda

NASYA Ksheera Bala Taila Masha Taila Shadbindu Taila Karpasasthyadi Taila Prasarinyadi TailaPreventive Nasya – who have history of DM

वात�ण्*�Asthi vikara-

calcaneal spurGulpha sandhi

vikara – ankle sprain

Snayu and peshi vikara- plantar fascitis

Snehana - Abhyanga Swedana – Isthika sweda Lepa – Haridra +

Saindhava lepa Avagaha - MN Taila Asthi pradoshaja and asthi

gata vata chikitsa for calcaneal spur like bhahya and abhyantara snehana and tikta grita ksheera basti

ISTHIKA SWEDA

Ushma sweda

Procedure :1. Preparation to patient -

Snehana by Tila taila

2. Hot isthika –pour ( kanji /dashamoola kwatha)

VISHESHA CHIKITSA

1. Repeated Rakta mokshana

2. Eranda taila pana

3. Soochi dahana

Osteopathy

Paget’disease

Osteoporosis

PAGET’S DISEASE - अस्थि@ क्षय, अस्थि@गत वात Here bone gets enlarged & becomes

soft . Seen after 40 Dull bone pain which will be severe at

night Fatiguability

Tikta grita kseera basti

OSTEOPOROSIS – अस्थि@ क्षय, मज्जा क्षय Progressive decrease in bone density. Produces no symptoms but bone

become more prone for fractures

CONCLUSION Degenerative diseases &Panchakarma. Avasthika chikitsa Ama avasta- rookshana , langana In nirama avasta , snehana, svedana

Shodhana

LIMITATIONS OF PANCHAKARMA MSD which are congenital MSD due to Trauma MSD with progressed deformities. Urusthmbha

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Phone No. +91-172-254-2231

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