Bursitis: Ayurveda Understanding and interventions

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Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Bursitis

Inflammation of Bursae is called Bursitis. Bursae are small sacs filled with fluid. They serve the purpose of cushioning the bones, tendons and muscles near the joints. It is a painful condition and is marked by aches, pain, stiffness, redness and swelling of the affected joint / joints with pain increasing on moving or pressing the affected joint. 

Bursae and Shleshaka Kapha

Anatomically the description of bursae falls into the territory of Shleshaka Kapha, a subtype of Kapha which is located in and around the joints and soft tissues and lubricates them.

Relative pathology between shleshaka kapha with vata and pitta aggravation in the pathogenesis of bursitis

This Kapha is a buffer and protects the bony ends and the joints, joint spaces and soft tissues around from damages, wear and tears, friction and pathological effect of pitta and vata which might eventually lead to many inflammatory and degenerative diseases in the mentioned regions. Apart from this, shleshaka kapha would allow easy movements in the joints and enable us to do daily activities with ease.

The other doshas, as a rule, are also present in these places (pitta and vata) but there will be predominance of kapha. But if there is proportional imbalance between these doshas with pitta (in this condition) (and vata) gaining abnormal increase, the regions of kapha would get inflamed and lead to conditions like bursitis.

Vata too is involved in the pathogenesis whenever bursitis is caused due to trauma. Trauma / injury as a rule causes vata aggravation. 

Role of Vata in Bursitis pathogenesis

Bursitis occurs in almost all joints, big and small. All joints are seats of shleshaka kapha. It occurs near joints wherein repetitive motion occurs. Repetitive motions cause pathological increase of vata and consequent depletion of kapha (shleshaka kapha), which is a protective buffer of the joints and surrounding tissues. Vata increase essentially depletes kapha. So, the joints lose the protective buffer in and around them. This further leads to wear and tear of the bones and joints leading to inflammation therein and also in the bursae. This would cause bursitis with involvement of pitta in later stages of pathogenesis.

Based on the symptoms

Seeing the symptoms of Bursitis most of them seem to be caused by abnormally increased vata in the afflicted joint and other areas.

Aches and pains – is mainly due to vata predominance. Stiffness may be due to vata, kapha or both. Swelling may be due to any of the three doshas. Redness is mainly due to the increase of pitta.

Disability caused due to severe joint pain and inability to move the afflicted joint, which may occur in the later part of the established disease as a complication, may be caused by pathological changes caused by aggravated vata and pitta in the joint / joints.

The other symptoms including bruising or rash is caused by aggravated pitta, sharp or shooting pain in some cases is caused by pitta and or vata and fever is manifested due to pitta.

From the perspective of causes

Sl No Cause of Bursitis Dosha involvement
1 Repetitive motions or positions Vata and Pitta increase
2 Vigorous activities / exercises / sporting activities Vata increase
3 Activities which lead to increase of pressure on the joints, like leaning on elbow, kneeling on knee etc Vata increase
4 Injury, trauma, repetitive stress on the joints Vata and pitta increase
5 Diseases causing inflammation or degeneration of the joints Vatarakta, Amavata, Sandhigata Vata

From risk factors perspective

Aging which is considered as one of the risk factors for bursitis can be read as ‘old age’ favorable for vata disorders like sandhigata vata, popularly correlated with osteoarthritis.

Hatva Sandhin – destruction of joints, Shula – pain in the joints and Atopa – swelling in the joint – which are the classic symptoms of Sandhigata Vata – point towards the description of Bursitis.

Repetitive motion or pressure on joints or bursae and all occupations causing these would cause increase of vata and hence lead to bursitis. The occupations may include gardening, painting, laying carpets, playing musical instruments etc.

Diseases affecting the joints and bursae of the likes of amavata, sandhigata vata and vatarakta cause bursitis. Sthoulya and Medoroga too are responsible for bursitis by causing pressure on joints and bursae.

Ayurveda Treatment Principles and Treatment of Bursitis

Nidana Parivarjana

Keeping away the causative factors forms the key strategy in dealing with bursitis, just like any other disease. All known ‘vata or pitta aggravating’ etiological factors need to be avoided. The responsibility magnifies once bursitis sets in, not just until it goes away, but also in future to avoid recurrences. Repeated trauma and excessive exercise are the main factors to be avoided.

Modern medicine insists on ‘resting the affected joint’ and ‘protection from further trauma’ as the initial and most important step in handling bursitis, of course with symptom / disease modifying treatments or medicines, as and when needed. In spite of that, flare-ups may be seen.

Treatment of Bursitis on the basis of main dosha involved in its pathogenesis

If signs of inflammation are seen in the bursae and also in the joints around it, treatment for aggravated pitta is given.

If signs of degeneration are seen in joints along with bursitis in its vicinity, treatment for aggravated vata is administered.

If there are signs and symptoms of both inflammation and degeneration in the bursae as well as in the joints around, treatment for both, aggravated vata and pitta are considered and administered.

External therapies

Below mentioned therapies are extremely helpful in combating bursitis –

–         Dhanyamla dhara – in case of severe inflammation associated with bursitis
–         Taila dhara / pizhichil – in case of vata predominance in bursitis, presence of degenerative changes in the nearby joints
–         Ksheera Dhara – showering or stream pouring of milk processed with vata and pitta mitigating herbs, Example – Dashamula Ksheera (milk processed with dashamula kashayam)
–         Pichu – keeping a swab dipped in medicated oil over the afflicted bursa / joint afflicted by vata and bandaging it
–         Lepa and Upanaha – anointing the afflicted bursae / joint with medicinal pastes prepared with vata and pitta mitigating herbs or as per dosha involvement should be done. Similarly, the same pastes can be applied over the bursa in the form of poultice.
–         Abhyanga – massage with herbal oils prepared with vata and pitta mitigating herbs

Internal therapies

The below mentioned internal therapies are also beneficial in the treatment of bursitis –

–         Virechana – therapeutic purgation is the best therapy to combat symptoms of bursitis, reduce inflammation and to calm the aggravated pitta and vata. Triphala Churna, Trivrit Leha, Nimbamritadi Eranda Taila – may be used in this direction.

–         Vasti – medicated enemas – both decoction and oil / ghee enemas should be administered when degeneration and vata involvement is observed in case of bursitis

Other principles of treatment

Bursitis shall be treated on the lines of treating the below mentioned conditions –

–         Amavata
–         Sandhigata Vata
–         Vatarakta
–         Shotha

Useful formulations in treating bursitis

–         Tiktakam Kashayam
–         Punarnavadi Kashayam
–         Dashamula Kashayam
–         Triphaladi Kashayam
–         Erandamuladi Kashayam
–         Varanadi Kashayam
–         Guggulutiktakam Kashayam
–         Kaishora Guggulu
–         Yogaraja Guggulu
–         Simhanada Guggulu
–         Triphala Guggulu
–         Shotari Mandura
–         Punarnavadi Mandura
–         Dashamularishta
–         Punarnavasava-         Trivrit Leham



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