Role of Ayurveda in The Management of Asthikshay in Menopausal Women: A Case Study

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INTRODUCTION
Asthishaya, commonly known as osteoporosis in contemporary medical terminology, represents a significant health concern, particularly for menopausal women.Osteoporosis is characterized by diminished bone density and heightened bone fragility, leading to an increased risk of fractures.The transition into menopause, marked by the cessation of menstruation and a significant drop in estrogen levels, exacerbates the risk of developing osteoporosis.Estrogen plays a critical role in maintaining bone density by inhibiting bone resorption.As estrogen levels decline during menopause, bone resorption outpaces bone formation, resulting in weakened bones.Ayurveda, the ancient Indian system of medicine, offers a holistic and comprehensive approach to managing asthishaya.Rooted in the principles of balance and natural healing, Ayurveda provides strategies that encompass dietary modifications, lifestyle changes, and therapeutic interventions tailored to individual needs.The term "asthishaya" in Ayurveda pertains to a condition where there is an imbalance in the asthi dhatu (bone tissue).This imbalance is often attributed to an increase in vata dosha, which is predominant during the menopausal stage of life.Understanding Asthishaya in Ayurveda: Ayurveda conceptualizes health as a balance between the three doshas (vata, pitta, and kapha), the seven dhatus (tissues), and the body's waste products.Asthi dhatu is one of the seven dhatus and is vital for structural integrity and support.During menopause, the natural increase in vata dosha can lead to the depletion of asthi dhatu, resulting in symptoms such as joint pain, back pain, decreased height, and an increased susceptibility to fractures.Aims and Objectives: 1. Study the Asthikshaya manegment in menopausal stages with help of Ayurveda.Methods and materials: Asthikshaya is examined through a variety of Ayurvedic Samhitas, whereas osteoporosis is studied through contemporary literature and database searches including PubMed, Google Scholar, and other research publications.Asthi dhatu: Asthi is one of dhatu mentioned in total seven Dhatus.Others are Rasa, Rakta, Mamsa, Meda, Majja and Shukra.Asthi is at fifth place in nourishment sequence.Means Rasa dhatu gets first nourishment, then Rakta dhatu, then Mamsa dhatuetc.This is the hardest and firmest dhatu in the bodyGets its nourishment from Meda dhatu It is predominantly made upof Pruthvi Mahabhuta (Pruthvi or Prithvi means "earth".The qualities of this dhatu are strong, rough, dry and hard.The function of asthi dhatu is "dharana" or support; it keeps the body erect.All the soft structures like muscle, vessels and nerves are found around this Dhatu Asthi dhatu gives shape to the skeletal body and protects vital organs such as the heart, lungs etc. Relation between Vata dosha and Asthi dhatu : Asthi dhatu and Vata dosha are related to one another.Asthi dhatu kshay is the outcome of Vata dosha vitiation, and vice versa.The term for it is Ashraya Ashrayi Sambandha.

B. Radiographs:
Osteoporotic spinal fractures can be confirmed by typical wedge shaped appearances of affected vertebra.Biochemical measurements are not usually helpful in diagnosis of Osteoporosis, serum alkaline phosphatase may be transiently raised following a fracture but as sustained elevation suggests an alternative diagnosis is such as Osteomalacia.Bone biopsy is not routinely required except to exclude otherpathology.

Case study :
A female patient aged 50 years was admitted in IPD of Panchakarma with complaints of bilateral knee, crepitus, joint pain, and restricted movements.It was a diagnosed case of Osteoporosis.Associated Symptoms General weakness, loss of appetite.

History of present illness:
Patient was well before one year.Then she gradually developed pain and difficulty in walking and sitting.Then she went to a nearby allopathic hospital and took allopathic treatment for more than 4months but couldn't get satisfactory result.Then she came to our hospital and got admitted for better treatment.Family History Not Significant.

Serum Calcium Treatment protocol :
Basti Karma ASTHISHRIKLA GHRIT MATRA was selected for the management of Osteoporosis.As Vasti is known for its Vata Shamaka properties, so it was assumed that it will be proved better in the management of Asthi Kshaya, both in subjective and objective parameters.Vasti 60ml was given for a period of 21 days.
Patient has shown marked improvement in all sign and symptoms i.e. pain and swelling was reduced, Stiffness reduced, Gait Improved, range of movements increased, serum calcium level increased.

DISCUSSION:
The management of asthishaya (osteoporosis) in menopausal patients through Ayurveda offers a multifaceted approach that integrates dietary, lifestyle, and therapeutic strategies.This holistic methodology not only targets the symptoms of bone density loss but also addresses the underlying imbalances that contribute to the condition.This discussion elaborates on the effectiveness and implementation of Ayurvedic management practices for asthishaya, examining their potential benefits .Therapeutic Interventions (Chikitsa)-Ayurvedic therapeutic interventions are designed to detoxify the body, rejuvenate tissues, and restore balance.Panchakarma, a set of purification therapies, includes procedures like Basti (medicated enema), which helps balance vata and rejuvenate the body.Rasayana therapy, aimed at promoting longevity and tissue health.

Dietary Interventions:
One of the cornerstones of Ayurvedic management for asthishaya is dietary modification.Calcium-rich foods such as sesame seeds, almonds, dairy products, and leafy greens are emphasized to support bone health.These dietary choices are aligned with modern nutritional recommendations for osteoporosis, underscoring the importance of calcium in maintaining bone density.Additionally, the Ayurvedic focus on a vata-pacifying diet, which includes warm, nourishing foods, helps mitigate the vata imbalance that is believed to exacerbate bone degeneration during menopause.Lifestyle Modifications-Lifestyle adjustments are integral to the Ayurvedic management of asthishaya.Regular physical activity, including weight-bearing exercises and yoga, is essential for maintaining bone strength and flexibility.Yoga, in particular, not only strengthens bones but also enhances balance and coordination, reducing the risk of falls and fractures.

CONCLUSION:
Ayurvedic management of asthishaya in menopausal patients presents a holistic and natural approach that emphasizes balance and overall well-being.By integrating dietary modifications, herbal remedies, lifestyle adjustments, and therapeutic interventions, Ayurveda offers a sustainable and effective strategy for managing osteoporosis.This approach not only addresses the symptoms of bone density loss but also promotes holistic health, making it a valuable complement to conventional treatments.
Symptoms of Asthikshaya according to different Samhitas: Modern Review: The term Osteoporosiswas coined by Pommerin in 1985 whichliterally means "porous bones".Greekword osteon means the bone tissue & po-rosis is derived from latinword "porous" which means "full of pores".Thus com-bined meaning of the word Osteoporosis isporous bones.The most important risk fac-tor for osteoporotic fractures is reducedbone mass.During growth, bone mass increases between the ages of 25 & 35 andfalls thereafter in both sexes.It is mostcommon in women than men due to oestrogen deficiency at the age of menopause.Genetic factor are important in the patho-genesis of Osteoporosis.Family studies suggest that genetic influences are accounted for 70-85% of individual variancein bone mass.Classification of Osteoporosis: Primary Osteoporosis & Secondary Osteoporosis Symptoms: Fracture after minimal trauma, Joint pain, Low back pain, Neck pain, Stiffness of joints, Bony tenderness, Deformity of joint, Deformity of spine (Kyphosis).Diagnosis: A. Bone Mineral Density: Plain radiographs are often normal in pa-tients with Osteoporosis who do not havefractures & BMD measurements should be reserved for patients where there is reason to suspect the diagnosis on clinical level.Indication -1.Early menopause.2. Hypogonadism.3. Family history of Osteoporosis 4. Previous fractures after minimal trau-ma 5. Smoking /alcohol abuse 6. Poor diet 7. Steroid therapy.The World Health Organization has established the following diagnostic guidelines-T-score: -1.0 or greater is normalT-score between:-1.0 & -2.5 is low bone mass (Osteopenia) T-score: -2.5 or below is Osteoporosis.