Therapeutic Effect of Punarnavadi Basti in Trikgrah (Ankylosing Spondylitis): A Case Study

Ankylosing Spondylitis (AS) is a chronic, immune-mediated inflammatory disorder belonging to the spectrum of spondyloarthropathies. It primarily affects the axial skeleton, especially sacroiliac joints, peripheral joints and extra articular structures, resulting in inflammatory back pain, progressive stiffness, restricted spinal mobility, and varying degrees of functional disability. In Ayurveda, the clinical manifestations of Ankylosing Spondylitis resemble Trikgrah, a condition characterized by pain, stiffness, and restricted movements involving the lumbosacral region (sacroiliac joint) due to Vata alone or aggravated Vata associated with Kapha and Ama. This case report describes the Ayurvedic management of a 21-year-old male patient diagnosed with ankylosing spondylitis, presenting with chronic inflammatory low back pain, spinal stiffness, and restricted range of motion. The criteria of assessment were based on the scoring of Bath Ankylosing Spondylitis Metrology Index (BASMI), ESR and CRP. The treatment protocol was planned according to the principles of Vatvyadhi Chikitsa and included Punarnavadi Basti aimed at alleviating aggravated Vata Dosha. Following the intervention, the patient demonstrated marked clinical improvement, including reduction in pain and stiffness, restoration of spinal mobility, conversion of the Schober's test from positive to negative, and significant improvement in lumbar flexion. Basti therapy is regarded as the principal treatment modality for Vata disorders, Punarnavadi Basti possesses Vata-Kapha shamaka, Shothahara, Deepana, and Rasayana properties that may prove beneficial in such conditions.