Abstract

AVASCULAR NECROSIS OF THE FEMORAL HEAD AND ITS AYURVEDIC MANAGEMENT AS ASTHIMAJJAGATA VATA: A CONCEPTUAL REVIEW ARTICLE

*Dr. Diksha Daheriya, Dr. Shwetal Shivhare, Dr. Rajesh Meshram, Dr. Swati Nagpal

Abstract

Introduction: Avascular Necrosis (AVN) of the femoral head, also known as osteonecrosis, is a progressively disabling disorder of young and middle-aged adults in which interruption of the blood supply to the femoral head leads to bone-cell death, subchondral collapse, and secondary osteoarthritis of the hip. Modern medicine has no proven pharmacological therapy that halts disease progression, and surgical options, though effective, are costly and imperfectly durable in a young, active population. Ayurveda does not describe AVN as a distinct clinical entity, but its causative process and symptomatology closely correspond to Asthimajjagata Vata, a Vata-predominant disorder in which vitiated Vata Dosha becomes lodged in the Asthi (bone) and Majja (marrow) Dhatus. Methods: This narrative review was compiled from the conceptual, disease-review, and drug-review chapters of a postgraduate Ayurveda dissertation, supplemented by the classical texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya and allied Nighantus) and contemporary orthopaedic and Ayurvedic literature cited therein. Modern-medicine sources were reviewed for the epidemiology, pathogenesis, staging, and treatment of AVN, while classical Ayurvedic sources were reviewed for the Nidana (causation), Samprapti (pathogenesis), and Chikitsa (management) of Vatavyadhi and Asthimajjagata Vata, together with the composition and classical indications of Gandha Tailam, Panchatikta Ghrita Guggulu, and Manjisthadi Ksheera Basti. Results: The clinical picture of Asthimajjagata Vata - Bheda Asthi Parvanam (piercing bone-joint pain), Sandhi Shoola (joint pain), Santata Ruk (continuous pain), Mamsabala Kshaya (loss of muscle strength), and restricted movement - closely parallels the pain, stiffness, and progressive functional loss seen in AVN of the femoral head, supporting its use as the classical correlate of this condition. The Samprapti of Asthimajjagata Vata - channel obstruction (Srotorodha), Rakta and Asthi Dhatu Kshaya, and consequent Vata localisation in Asthi-Majja Dhatu - mirrors the modern description of vascular occlusion, osteocyte death, and subchondral collapse. Gandha Tailam and Panchatikta Ghrita Guggulu, both administered with Manjisthadi Ksheera Basti, emerge as classically indicated, pharmacologically plausible formulations combining Vatahara (Vata-pacifying), Raktashodhaka (blood-purifying), and Brimhana-Rasayana (tissue-nourishing and rejuvenating) actions relevant to arresting this pathological cascade. Discussion: Modern and Ayurvedic descriptions of AVN converge on a shared pathogenetic theme of impaired circulation and tissue starvation, and both systems recognise that once femoral head collapse occurs, options narrow toward joint replacement. The gap left by modern medicine's lack of a proven non-surgical disease-modifying treatment is precisely where Ayurveda's Shodhana-Shamana framework - combining internal oleation with Basti therapy - has classically been positioned, though direct clinical evidence remains limited to case reports and small comparative studies, underscoring the need for rigorously designed clinical trials.

Keywords: Avascular Necrosis, Osteonecrosis of femoral head, Asthimajjagata Vata, Gandha Tailam, Panchatikta Ghrita Guggulu, Manjisthadi Ksheera Basti, Vatavyadhi, Panchakarma, Ayurveda.