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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 59-63

Management of plantar fasciitis with Raktamokshana and Shamana Chikitsa in Ayurveda: a case study


Department of Panchkarma, AIIA, New Delhi, India

Date of Submission27-Nov-2020
Date of Decision26-Jan-2021
Date of Acceptance29-Jan-2021
Date of Web Publication16-Apr-2021

Correspondence Address:
Dr. Bhawna Solanki
Department of Panchkarma, AIIA, New Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_111_20

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  Abstract 

Observation and Results: The therapy provided marked improvement in the pain and tenderness. Pain from visual analog scale (VAS) of 8 came to 2, tenderness grading soft tissue scale from 5 came to 2.5, and PF pain/disability scale from 77 came to 2. It is the need of the hour to focus on such therapies which are result-oriented and less expensive. From this study, it can be inferred that this treatment can be effectively adopted in patients of PF.

Keywords: Plantar fasciitis, Raktmokshana, Shamana chikitsa, Vatakantaka


How to cite this article:
Solanki B, Meher A, Bhatted SK, Dharmarajan P. Management of plantar fasciitis with Raktamokshana and Shamana Chikitsa in Ayurveda: a case study. J Indian Sys Medicine 2021;9:59-63

How to cite this URL:
Solanki B, Meher A, Bhatted SK, Dharmarajan P. Management of plantar fasciitis with Raktamokshana and Shamana Chikitsa in Ayurveda: a case study. J Indian Sys Medicine [serial online] 2021 [cited 2021 Aug 4];9:59-63. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/59/313697




  Introduction Top


The most common cause of heel pain is plantar fasciitis (PF). Approximately 15% of all foot complaints coming to the attention of healthcare professionals can be attributed to this cause.[1] It develops insidiously, characteristically affecting the medial part, which may radiate into the medial arch of the foot in most of the patients present, having complaint of heel pain. Pain tends to worsen after a period of rest or in the morning hours, with maximal discomfort during the initial few steps, and there is progressive improvement as the person continues to walk.[2]

Heel pain is observed in a number of conditions such as Sevier’s disease, calcaneal knob, bursitis, bony spur, Paget’s disease, osteomyelitis, and acute and chronic PF. Among these, it can be correlated with PF. The prevalence of this disease increases due to inclination toward wearing high heeled and hard footwears, improperly fitting footwears, engaging in vigorous exercise such as jumping, running, and standing for long hours. It is usually diagnosed on the basis of history and physical examination alone. The patient experience severe pain with the first step on waking up in the morning or following inactivity during the day, which becomes worse on walking barefoot or upstairs. On examination, maximum tenderness is elicited on palpation over the inferior of heel corresponding to the site of attachment of the plantar fascia.[3] With this pathology and clinical presentation, Vatakantaka (a clinical pain dominant condition described in Ayurveda) can be correlated with PF. Vatakantaka in Ayurveda classics is explained with clinical symptoms like “Nyaste Tu Vishmam Pade Ruja Kuryat Samirana” (walking on uneven surface causing pain) cause vitiation of Vata takes Ashraya (takes place) in Gulfa Sandhi (ankle joint) and produces pain. As the pain is seen more during morning and after a period of inactivity in patients, it indicates Samsarga of Kapha or the presence of Ama with the Vata. Here Dushyas are Snayu (ligament) and Sandhi (joint) and Rogamarga is Madhyama.[4] Classical line of treatment for Vatakantaka in Ayurveda classics is Raktamokshana (blood-letting), oral use of Eranda Taila (castor oil), Sthanik, Dahana Karma (localized cautery). Hence, Raktamokshana is used in this case to assess its efficacy in relieving pain and other associated symptoms.[5]


  Materials and methods Top


CASE REPORT

A 50-year-old male came to OPD AIIA Hospital Sarita Vihar, New Delhi, with the chief complaints of gradual pain in both the heels associated with tenderness since 1 month. He was unable to keep his feet on the floor after waking up in the early morning due to severe pain in both heels and having constant pain during the whole day. On the basis of clinical symptoms resembling those of PF, the case was diagnosed as plantar fasciitis. He was unable to walk long distance due to pain. Local examination revealed redness along with grade 4 pain and tenderness. Treatment was planned for Raktamokshana.


  Past history Top


Nil.

Examination of Patient

The general and specific examination of the patient was conducted. Observations are mentioned in [Table 1].
Table 1: General and specific examination of patients

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Astavidha Pariksha is described in [Table 2].
Table 2: Asthavidha Pariksha (8-fold examination)

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Treatment Administered

Both medicinal and procedural therapies were administered in the patient. The details are mentioned in [Table 3] and [Table 4].
Table 3: Details of medicine administered

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Table 4: Details of therapies administered

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  Preprocedure Top


Abhyanga, Swedana: Massage (Sthanika Abhyanga) with Tila taila (sesame oil) was performed on the right and left heels followed by fomentation through tube (Nadi Sweda) with decoction of Dashmoola. A tourniquet was tied at the calf region and under aseptic conditions, vein was identified near right heel and ankle joint, and 50 mL of blood was drawn by a syringe. The patient was observed for 2–3 h.

Yavagupaana: The patient was advised to have adequate quantity (about 250 mL) of Tila Yavagu before undergoing blood-letting.


  Procedure Top


The patient was made to sit comfortably over the examination table. Then the part just 2 Angula above the Kshipra Marma (mentioned anatomical location) was cleaned with surgical spirit. A tourniquet was tied below the knee neither too tight nor too loose to make the vein (Sira) prominent and if essential, mild blow was given over the vein. The scalp vein set of No. 21 was taken, and it was introduced into the vein. When the needle was in situ, a measuring jar for collection to assess the quantity let out is kept. The needle is taken out after the blood flow stops on its own or when the collected blood measures 100 mL. Careful observation of the patient was made during the procedure for vital signs. The procedure was repeated after 7 days [Figure 1].
Figure 1: Showing blood-letting procedure

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Paschata Karma

After letting out blood, sterile cotton pad with turmeric (Haridra) and cow ghee (Ghritalepa) was kept and bandaged. The patient was asked to rest for 30 min.


  Observation Top


The patient was observed on the basis of visual analog scale (VAS) and tenderness grading soft tissue scale before and after treatment [Table 5]. The patient reported 8 out of 10 on VAS scale before treatment, whereas after Mridu- Shodhana, his pain reduced to 5 out of 10 on the scale. Tenderness was persistent on grade 5 before treatment and after Mridu- Shodhana. After blood-letting, pain reduced to 2 on VAS and tenderness to 2.5 on tenderness grading soft tissue scale. Oral medication was given to the patient, and the patient was assessed on the same two scales. Pain vanished when assessed on VAS whereas tenderness remained at 2.5. After 30 days of follow-up, pain was absent and tenderness also vanished on the assessment scales [Graph 1].
Table 5: Observations during treatment

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Graph 1: Improvement in VAS and tenderness grading soft tissue scale

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  Result Top


The participant completed the treatment successfully. Assessment of the patient was done as per the PF pain/disability scale [Table 6]. It assesses the severity of pain in varied situations and ability to perform day-to-day activities in patients. There are four assessment periods included in this study. Based on those data, results were drawn. Baseline assessment was before treatment (BT), second assessment was done after Siravyadhana (blood-letting), third assessment after Shamana Aushadha (oral medication), and fourth assessment after a follow-up period of 30 days [Graph 2]. Assessment of improvement was done on the basis of PF pain/disability scale. The improvement observed from baseline to AT1 was 41.55%, from baseline to AT2 was 62.33%, and from baseline to AT3 was 97.40% [Graph 3].
Table 6: Assessment of improvement

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Graph 2: Assessment of improvement in plantar fasciitis pain/disability scale

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Graph 3: Percentage of improvement in plantar fasciitis pain/disability scale at AT1, AT2, and AT3

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  Discussion Top


Considering the symptoms such as pain and tenderness, treatment was planned in such a way to reduce Vata and to evacuate the vitiated blood from the ankle joint. Therefore, foremost treatment was adopted to normalize Vata with mild purgation after blood-letting was done to drain out impure blood.[6]

Role of Mild Purgation

Vatakantaka is quoted as one among the Vatavyadhis. Oleation (Snehana), fomentation (Swedana) followed by mild purgation (Mridushodhana) are the first line of management of vitiated Vata. Castor oil was given to eliminate Dosha and Mala by mild purgation (Mriduvirechana) by giving 20 mL for 2 days where six Vegas were noted. After mild purgation, Samyak Lakshana was like proper evacuation of stool, mild reduction of pain, and lightness in body observed.[7]

Probable Mode of Action of Raktamokshana (Blood-Letting)

Blood-letting is also the purification therapy, so it is recommended to remove the vitiated Dosha or blood from the nearest route of disease main or root site or location (Roga Adhisthana). In PF, tendons (Kandaras) are affected. Tendons are subtissues (Upadhatu) of Raktadhatu (Blood), ultimately (Upadhatu (subtissue)) regaining health back by blood-letting and reducing signs and symptoms of PF. From modern point of view, stimulation to large sensory fibers from peripheral tactile receptors depresses the transmission of pain signals either from the same area of the body or even from many segments. This results in local lateral inhibition.[8]

Role of Internal Medicine

Dashamoola is a polyherbral drug being used in inflammatory and painful conditions since inception of Ayurveda. Dashamoola is Tridosha Shamaka and chiefly Vatashamaka. Along with it, it is considered as anti-inflammatory (Shothahara) and analgesic (Shoolahara).[9]Kaishora Guggulu is one of the most useful Ayurveda formulations that is used traditionally to support healthy joints, muscles, and connective tissue. Kaishora Guggulu is used in the treatment of PF known to have analgesic, anti-inflammatory action, etc.[10]Sanjivani Vati is a polyherbal formulation containing mostly those drugs which have stomachic (Deepana), digestants (Pachana), Vata Anuloman (pacifying Vata), properties which are Usna Virya, Katu, Tikta, Kasaya, Madhura, Amla, Lavana Rasa, Laghu, and Tikshna, Ruksha Guna prominent with Madhura vipaka. This Yoga shows actions at different levels and works on the disease arise due to Ama.[11]Panchguna Taila used for local application in the form of massage helps in balancing Vata and has analgesic as well as anti-inflammatory action.[12]


  Conclusion Top


Marked reduction in pain and tenderness was noticed after the treatment by (Raktamokshana), followed by oral Ayurveda medication in the case of PF (Vatakantaka). The same can be assessed in a large sample to evaluate the efficacy of holistic Ayurveda management approach in the patients of PF. Blood-letting (Raktmokshana) is a cost-effective, less complicated, easy-to-practice quick relief treatment that does not require surgeries or hospitalization. Hence, blood-letting (Raktmokshana) can be an acceptable alternative to contemporary heel pain modalities.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Menon NA, Jain J Plantar fasciitis: A review. Indian J Pain [serial online] 2018;32:24-9.  Back to cited text no. 1
    
2.
Thing J, Maruthappu M, Rogers J Diagnosis and management of plantar fasciitis in primary care. Br J Gen Pract 2012;62: 443-4.  Back to cited text no. 2
    
3.
Misar S Agnikarma in the management of Vatakantaka (planter fasciitis). Joinsysmed 2017;5:126-9.  Back to cited text no. 3
    
4.
Veena GR Ayurvedic management of Vatakantaka (plantar fasciitis). Int J Adv Med 2013;4:43-9.  Back to cited text no. 4
    
5.
Das G Bhaishajya ratnavali . 16th ed. Varanasi: Chaukhambha Sanskrit Samsthana;2002; Chap, 26, Verse 48. p. 378.  Back to cited text no. 5
    
6.
Sushruta.Sushruta samhita, with nibandha sangraha & nyayachandrika commentary. In: Acharya YT, editor. Chaukamba surbharati prakashan nidana sthana, 1/79; 2008. p. 269.  Back to cited text no. 6
    
7.
Astaang Hridya of Vagbhata, “Sarvanga Sundara” Commentary of Arunadatta and Ayurveda Rasayana Commentary of Hemadri. In: Pandit Hari Sadasiva Sastri, editor Paradikara Bhisagacharya; Chaukhamba Surabharati Prakashan; Varanasi; Reprint 2010; Sutra Sthana; Chap. 13, Verse 3.  Back to cited text no. 7
    
8.
Amarprakash D, Amarsingh R, Gajanan MS. To evaluate the role of Siravyadha in Vatakantaka. Int J Appl Ayurved Res2015;II: 399-404.  Back to cited text no. 8
    
9.
Pathak AK, Awasthi HH, Pandey A Use of Dashamoola in cervical spondylosis: Past and present perspective. Res Rev J AYUSH 2015;4:10-16.  Back to cited text no. 9
    
10.
Sharangadhara. Sharangadhara Samhita. 2nd section. Varanasi: Vatkalpana2. Choukhamba Publications; 1984. Salok no. 70–81.  Back to cited text no. 10
    
11.
Rani P, Sharma K, Kumar K Probable mode of action of Sanjivani Vati—A critical review. Int J Health Sci Res 2018;8: 295-307.  Back to cited text no. 11
    
12.
Swati T, Sharma SS, Sharma P, Bhushan V. Management of low backache due to PIVD through Panchakarma: A case study. Int J Res Ayurveda Pharm 2018;9:84-7.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Abstract
Introduction
Materials and me...
Past history
Preprocedure
Procedure
Observation
Result
Discussion
Conclusion
References
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