Paget’s disease of bone is a chronic metabolic bone disorder characterized by abnormal bone remodelling, leading to pain, deformity, and increased fracture risk. In Ayurveda, it can be studied under the heading of Asthi Dhatu Kshaya and vitiation of Vata dosha, requiring holistic management to restore balance and improve bone health. This case study explores the Ayurvedic therapeutic approach involving Sarvanga Abhyanga, Parisheka, and Tikta Ksheera Basti for managing Paget’s disease symptoms. These interventions aim to pacify Vata dosha, nourish the Asthi dhatu, reduce pain and inflammation, and enhance overall musculoskeletal function. The combined Panchakarma therapies demonstrated significant symptomatic relief and improvement in the patient\u27s quality of life, suggesting a promising integrative treatment protocol for Paget’s disease management in Ayurveda

Shakuntala S P

Sowjanya B.R

Swaruprani Sethi

English

Ayushdhara (E-Journal)

AYUSHDHARA        An International Journal of Research in AYUSH and Allied Systems  AYUSHDHARA | September-October 2025 | Vol 12 | Issue 5  87          AYURVEDIC INSIGHTS IN THE CLINICAL MANAGEMENT OF PAGET’S DISEASE Swaruprani Sethi1*, Sowjanya B.R1, Shakuntala S P2 *1PG Scholar, 2Assistant Professor, Department of Panchakarma, Government Ayurveda Medical College, Bengaluru, Karnataka, India. Article info Article History: Received: 20-09-2025 Accepted: 19-10-2025 Published: 30-11-2025 KEYWORDS:  Paget’s disease  Asthi Dhatu Kshaya  Vata dosha Osteitis deformans. ABSTRACT Paget’s disease of bone is a chronic metabolic bone disorder characterized by abnormal bone remodelling, leading to pain, deformity, and increased fracture risk. In Ayurveda, it can be studied under the heading of Asthi Dhatu Kshaya and vitiation of Vata dosha, requiring holistic management to restore balance and improve bone health. This case study explores the Ayurvedic therapeutic approach involving Sarvanga Abhyanga, Parisheka, and Tikta Ksheera Basti for managing Paget’s disease symptoms. These interventions aim to pacify Vata dosha, nourish the Asthi dhatu, reduce pain and inflammation, and enhance overall musculoskeletal function. The combined Panchakarma therapies demonstrated significant symptomatic relief and improvement in the patient's quality of life, suggesting a promising integrative treatment protocol for Paget’s disease management in Ayurveda.  INTRODUCTIONPaget’s disease of bone, also called Osteitis deformans, is a chronic disorder marked by abnormal bone remodelling. In this condition, the normal cycle of bone renewal is disrupted, resulting in excessive breakdown and regrowth of bone tissue. This process causes affected bones to become large, misshapen, and weaker than normal, which can lead to pain, deformity, and fractures[1]. Most frequently affecting older adults- particularly those over 55- the disease’s prevalence varies globally and is notably higher in regions such as Europe, North America, and Australia[2]. Both genetic and environmental factors are linked to its development, but the exact cause remains unclear.  Paget’s disease evolves through three phases[3]: 1. Lytic phase: Increased bone resorption by enlarged, overactive osteoclasts. 2. Mixed phase: Excessive bone formation by osteoblasts, but the new bone is structurally abnormal because collagen is laid down irregularly. Access this article online Quick Response Code   https://doi.org/10.47070/ayushdhara.v12i5.2312  Published by Mahadev Publications (Regd.) publication licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) 3. Sclerotic phase: Dominance of disorganized bone formation, resulting in thickened but weak and brittle bones. This abnormal bone turnover and architecture make affected bones prone to complications like fractures, deformity, arthritis, and nerve compression Many people remain asymptomatic, and the disease is sometimes discovered on X-rays taken for other reasons. Common symptoms include bone pain (often deep, dull, and worse at night), bone deformities (bowing of limbs, skull enlargement), joint pain, fractures.  Diagnosis and management focus on controlling symptoms and preventing complications, with medications like bisphosphonates serving as the mainstay of treatment. Paget's disease of bone can be correlated in Ayurveda primarily to Asthi Dhatu Kshaya (depletion of bone tissue) occurring due to Kavaigunyata in Asthi and Majja dhathu. "Asthi Dhatu" refers to bone tissue and "Kshaya" means depletion. The root pathology involves a disturbance in the balance of the body's Vata dosha, leading to the loss or weakening of bone.  Acharya Vagbhata reiterates the inverse proportionality between Vata Dosha and Asthi Dhatu. He explains that increase in Vata leads to qualitative and quantitative reduction in Asthi Dhatu, causing Asthi Kshaya producing symptoms such as Sandhi Case Study ISSN: 2393-9583 (P)/ 2393-9591 (O) AYUSHDHARA, 2025;12(5):87-92  AYUSHDHARA | September-October 2025 | Vol 12 | Issue 5  88 Shula, Stambha, and Toda in limbs[4]. He recommends therapies such as Tikta Rasa, Ksheera, and Basti which target Vata and Asthi balance[5]. Case report Chief complaints C/O Pain over left hip joint for the past 5 year. A/C/O Left knee joint pain since 1 year. Associated complaints A/W stiffness in lower back, hip joint since 5 years. History of present illness  Mrs. XYZ is a 43-year-old female with a past medical history of urticaria and rheumatoid arthritis at the age of 10 years old (RA Factor & CRP – Negative in recent investigation); recently detected DM2 (not on medication), who presently complaining of left hip joint pain since 5 year, insidious in onset, gradually progressive. Her pain aggravated during daily activities and subsided on supine position only. Subject has left knee joint pain for the past 1 years, aggravating during daily activities and relieving by rest. She had undergone Arthroscopic surgery for Baker’s cyst 1 year back. For this she approached to nearby hospital and prescribed with symptomatic medication. As symptoms didn’t subside, she again approached for the same and advised for MRI. On CT and MRI evaluation she was diagnosed with Paget’s disease of left iliac bone along with secondary osteoarthritis of left hip joint on July 2024. She was started on calcium and bisphosphonates in view of Paget’s disease.  As significant result was not obtained, she was advised to undergo left hip uncemented total hip arthroplasty. But the subject was unwilling and came to GAMC, Bengaluru, on 5th May 2025 for further evaluation and management. Past History Medical history K/C/O Diabetes Mellitus (since 08/05/25) – Not on medication Family history Nothing contributory Table 1: Subject’s personal history Name – XYZ Sleep – Sound Age – 43 years Bowel habit – Regular, constipated Sex – Female  Appetite – Normal Marital status – Married Weight – 65 kg Occupation – Nursing officer  Height – 4.9 feet Menstrual history – Regular Addiction – None  Table 2: Ashtasthana pareeksha Nadi Prakruta, 82bpm Mutra Prakruta, 3-4times/day & 1-2 times/night Mala Badha Jihwa Alipta Shabda Prakruta Sparsha Prakruta Drik Prakruta Akriti Madhyama Table 3: Dashavidha pareeksha Prakriti: Kapha Vata Satmya: Madhura rasa pradhana sarva rasa satmya Vikriti: Vata – kaphadosha janya Pramana: Madhyama Sara: Madhyama Aahara shakti: Madhyama  Samhanana: Madhyama Vyayama shakti: Avara Satva: Pravara Vaya: Madhyavastha Systemic examination  Central nervous system: Conscious, well oriented to place, person, time. Higher mental functions intact, no abnormality detected. Cardiovascular system: S1 S2 heard, no other abnormalities. Swaruprani Sethi, Sowjanya B.R, Shakuntala S P. Ayurvedic Insights in the Clinical Management of Paget’s Disease  Available online at: https://ayushdhara.in  89 Respiratory system: Normal vesicular breath sounds heard. Gastrointestinal system: P/A- soft, bowel sounds – 3-4/min Musculoskeletal system Spine Examination Inspection: Neck and shoulder symmetry – Normal Curvature of spine – Increased lumbar lordosis Localised projections over spine – Absent Palpation: Tenderness – Absent Hip joint Examination Inspection:  Skin – No discoloration or deformity. Standing position – Right lateral pelvic tilt. No muscle wasting Stoop – Absent Palpation: Tenderness – Over left greater trochanter. Neurovascular 1. Motor – Pain during hip adduction, thigh abduction, hip flexion and hip extension; no other comorbidities. 2. Sensory – No abnormalities detected. 3. Femoral pulse – Palpable          Special Tests: Log Roll Test – Positive, restricted internal rotation of left hip joint. Resisted hip flexion test – Positive over left side. Trendelenburg Test – Positive, right pelvis drop. Table 4: Range of Motion of Hip joint  ROM                Right Hip Joint              Left Hip Joint  Flexion                 130 deg                            45 deg  Extension 30 deg                             15 deg  Abduction 50 deg                             30 deg  Adduction              30 deg                             30 deg  Internal rotation     30 deg                             Not able to perform  External rotation    50 deg                             Not able to perform  Resisted hip flexion test Negative Positive over left side Laboratory reports 1. HbA1c – 8.6% (08/05/2025) 2. CRP – Negative 3. ESR – 36 mmhr Nidana Panchaka Nidana - Utpadaka nidana – Ativyayama, Mithya ahara and Vihara  Viprakrista nidana - Rogathikarshanath  Poorvaroopa - Avyakta  Roopa – Asthitoda, Sandhishaithilya, Asthisoushirya,   Upashaya – Supine position  Aupashaya – Chankramana, Vyayama, sitting Samprapti Beeja dusti       Nidana sevana  Kavaigunyata in Majja      Vata Prakopa  Circulation through Srotas  Affects Shleshmaka kapha  Dooshana of Asthidhathu and Majjadhathu  Asthitoda, Sandishaithilya, Asthisoushirya  Asthi-Majjagata Vata AYUSHDHARA, 2025;12(5):87-92  AYUSHDHARA | September-October 2025 | Vol 12 | Issue 5  90 Table 5: Samprapti ghataka Dosha Vata (Vyana), Kapha (Shleshmaka) Udbhavasthana Pakwashaya Dushya Asthi, Majja Sancharasthana Sarvashareera  Agni Dhatwagni Vyaktasthana Asthi, Majja, Sandhipradesha Agnidushti Dhatwagni Mandya Vyadhi swaroopa  Chirakari   Srotas Asthivaha, Majjavaha Rogamarga Madhyama Srotodushti Atipravritti, Sanga Sadhyasadhyata Yapya Table 6: Treatment protocol adopted Panchakarma Shamana Oushadhis • Sarvanga mridu Abhyanga with Kanaka taila f/b Dashamoola kayaseka- for 5 days (06/05/25 – 10/05/25) • Asanadi + Panchatikta Kashaya basti – Kala pattern • Physiotherapy - SLR Static quadriceps ROM of lower limb  Twisting Bridging  • Lakshadi guggulu 1 tab TID AF • Panchatikta kashya + Ashwagandha + Shatavari Ksheerapaka 20 ml BD BF • Sanjeevani vati 1 tab BD AF  Asanadi + Panchatikta Kashaya basti  Makshika 80ml Saindava 10 gm Panchatiktaka gritha 80ml Asthishrunkala + Arjuna + Ashwagandha + Shatapushpa kalka 30gm Asanadi + Panchatiktha kashaya 300ml Total 500ml Anuvasana basti with Panchatikthaka ghritha – 60ml 11/5 12/5 13/5 14/5 15/5 16/5 17/5 18/5 19/5 20/5   N N N N N N   A A A A A A A A A A OBSERVATION AND RESULTS Table 8: Observation and Results Treatment Observation Sarvanga mridu Abhyanga with Kanaka taila f/b Dashamoola kayaseka   Pain reduced moderately ROM improved Asanadi + Panchatikta Kashaya basti   Pain reduced completely On examination- Tenderness over left hip joint - Absent ROM improved  Table 9: Showing overall assessment before and after treatment  Before treatment After Sarvanga mridu Abhyanga f/b Kayaseka   After Basti Pain  Severe Reduced by 50% Reduced by 80% ROM Restricted  Improved by 10% Improved by 60% Right lateral pelvic tilt  Present Improved by 50% Absent  HbA1c 8.5% (08/05/2025)  6.8% (28/08/2025)   Swaruprani Sethi, Sowjanya B.R, Shakuntala S P. Ayurvedic Insights in the Clinical Management of Paget’s Disease  Available online at: https://ayushdhara.in  91 DISCUSSION Paget’s disease • Paget’s disease of bone (osteitis deformans) is a chronic skeletal disorder marked by excessive, disorganized bone remodelling. It typically arises in individuals over 50 and involves excessive osteoclastic resorption followed by rapid and chaotic osteoblastic bone formation. The resulting bone is enlarged, structurally weak, highly vascular, and prone to deformity and fracture. Affected sites most commonly include the pelvis, spine (especially lumbar), skull, femur, and tibia[1]. • Clinically, many patients remain asymptomatic and are diagnosed incidentally on imaging. Symptomatic cases present with bone pain, deformities such as bowing of the legs or enlarged skull, fractures, hearing loss, and joint complications. On examination, affected bones may feel warm due to increased blood flow. Diagnosis is based on X-ray findings of thickened cortex and coarse trabeculae, elevated serum alkaline phosphatase levels, and bone scans showing increased uptake[6]. • Management depends on symptoms and disease severity. Asymptomatic patients may not require treatment, while bisphosphonates such as alendronate or zoledronic acid are the mainstay in active cases to reduce bone turnover. Pain relief with NSAIDs, physiotherapy, and surgical correction of fractures or deformities may also be required. Rarely, the disease can progress to osteosarcoma, making early recognition and appropriate management important[7]. Ayurvedic view Acharya Charaka and Vagbhata describe Asthi Dhatu as being nourished sequentially in the Dhatu Parinama process. Any disturbance in Asthi Dhatvagni or Kshayaja Vikriti leads to reduced quantity/quality of bone. Increased Vata Dosha, due to its Ruksha, Khara, Laghu qualities, consumes and dries up Asthi Dhatu.  Vagbhata states "यद्धि वायोववर्वनं रूक्षादि, तिस्थ्नः  क्षपणम्[8]"– With increase of Vata, there is depletion of Asthi dhathu. Thus, Paget’s disease, where bone becomes fragile, painful, and deformed, aligns with Asthi Kshaya due to Vata vruddhi and Asthi Dhatvagni dushti. Even symptoms of Asthi dhathu kshaya closely resembles that symptoms of Paget’s disease such as - Sandhi Shula, Stambha, Toda, Asthi Daurbalya, Akunchana & Vakrikarana, Danta Vikara. Chikitsa focus on pacifying Vata and nourishing Asthi Dhatu: • Tikta Rasa Dravyas– Enhance Asthi dhatvagni, promote bone tissue quality. • Ksheera & Ghrita– Brimhana, rich in calcium-like properties. • Basti– Considered best for Vata disorders; regulates Vata at its root and supports Asthi Dhatu regeneration. • Taila Abhyanga– For pain relief and prevention of stiffness. • Rasayana chikitsa- For strengthening bones.  Treatment Protocol Abhyanga f/b Parisheka- Sarvāṅga Abhyanga with Kanaka Taila nourishes and lubricates, pacifying Vāta, while Dashamula Parisheka cleanses and dries excess Kapha and Ama. Their combination creates a balanced approach: softening rigidity, reducing pain, improving circulation, and restoring mobility in Stambha conditions caused by Vāta–Kapha vitiation. Asanadi + Panchatikta Kashaya basti Aspect Asanadi Kashaya Panchatikta Kashaya Combined Effect Main Ingredients Asana + other Vata–Kapha-hara herbs Nimba, Vasa, Patola, Guduchi, Kantakari Synergy of Pramehaghna + Asthivardhana Rasa Tikta, Kashaya Tikta Strong Tikta–Kashaya → Deepana, Pachana Guna Laghu, Rookṣha Laghu, Rookṣha, Tikta Pradhana Targets Kapha and Asthi Dosha Action Kapha–Meda-hara, Vata–Pitta-shamaka Vata–Kapha-hara, Ama-pachana Corrects Kapha–Meda + pacifies Vata simultaneously Dhātu Effect Regulates Meda & Mamsa metabolism Promotes Asthi Dhātu formation (“Tiktam rasam asthivardhanam”) Supports both Meda correction & Asthi regeneration In Diabetes Hypoglycemic, reduces Kapha–Meda, prevents Detoxifies, anti-inflammatory, prevents Regulates blood sugar + AYUSHDHARA, 2025;12(5):87-92  AYUSHDHARA | September-October 2025 | Vol 12 | Issue 5  92 (Madhumeha) Prameha complications infections & ulcers prevents complications  In Paget’s Disease (Asthi Kṣhaya) Improves Dhātu metabolism, prevents Kapha avarana Direct Asthi Dhātu vardhana, reduces inflammation & stiffness Nourishes bone tissue + reduces pain, stiffness & fragility Overall Role Pramehaghna, Kapha–Meda hara Asthiposhaka, Vāta–Kapha-hara Holistic management of metabolic + bone disorders Kalka dravyas  • Asthishrunkala (Cissus quadrangularis)- Asthi Sandhānakara (bone healing, fracture union, mineralization). • Arjuna (Terminalia arjuna)- Asthi dhātu poshana, strengthens bone matrix, calcium retention. • Ashwagandha (Withania somnifera)- Balya, Rasāyana, reduces Vāta, supports osteoblast activity, and prevents bone loss. • Shatapushpa (Anethum sowa/Dill seeds)- Deepana, Asthiposhaka, improves calcium absorption, supports bone metabolism. Asthishrunkala, Arjuna, Ashwagandha, and Shatapushpa together act as Asthiposhaka Rasayanas, promoting bone regeneration, mineralization, and strength while pacifying Vata, making them beneficial in Paget’s disease (Asthi Dhatu Kshaya). Thus, this combination of Basti– helps in managing both Madhumeha and Asthi-kshaya by treating the main culprit i.e., Vata, Kapha and Asthi. CONCLUSION Panchakarma therapy, as demonstrated in this case study, plays a significant role in improving the quality of life for patients with Paget’s disease by effectively reducing pain and alleviating suffering. Through targeted interventions like Sarvanga Abhyanga, Parisheka, and Tikta Ksheera Basti, Panchakarma helps restore balance in the body, offering holistic relief and enhanced musculoskeletal function, thereby supporting better overall well-being. REFERENCES 1. https://www.niams.nih.gov/health-topics/pagets-disease-bone 2. https://orthoinfo.aaos.org/en/diseases--conditions/pagets-disease-of-bone 3. Lalam RK, Cassar-Pullicino VN, Winn N. Paget Disease of Bone. Semin Musculoskelet Radiol. 2016 Jul. 20 (3): 287-299 4. Astanga Hridaya of Vagbhata, Commentary by Arunadatta, Sutrasthana, Doshahivignaneeya adhyaya Chapter 11, Verse 19, Varanasi: Chaukhamba Surbharati Prakasan; 2004 5. Astanga Hridaya of Vagbhata, Commentary by Arunadatta, Sutrasthana, Doshopakramaneeya adhyaya, Chapter 13, Verse 19, Varanasi: Chaukhamba Surbharati Prakasan; 2004 6. Ralston SH. Pathogenesis of Paget's disease of bone. Bone. 2008 Nov;43(5):819-25. doi: 10.1016/ j.bone.2008.06.015. Epub 2008 Jul 11. PMID: 18672105. 7. Ralston SH. Bisphosphonates in the management of Paget's disease. Bone. 2020 Sep;138:115465. doi: 10.1016/j.bone.2020.115465. Epub 2020 Jun 5. PMID: 32512166.  8. Astanga Hridaya of Vagbhata, Commentary by Arunadatta, Sutrasthana, Doshahivignaneeya adhyaya Chapter 11, Verse 28, Varanasi: Chaukhamba Surbharati Prakasan; 2004         Disclaimer: AYUSHDHARA is solely owned by Mahadev Publications - A non-profit publications, dedicated to publish quality research, while every effort has been taken to verify the accuracy of the content published in our Journal. AYUSHDHARA cannot accept any responsibility or liability for the articles content which are published. The views expressed in articles by our contributing authors are not necessarily those of AYUSHDHARA editor or editorial board members.  Cite this article as:  Swaruprani Sethi, Sowjanya B.R, Shakuntala S P. Ayurvedic Insights in the Clinical Management of Paget’s Disease. AYUSHDHARA, 2025;12(5):87-92. https://doi.org/10.47070/ayushdhara.v12i5.2312  Source of support: Nil, Conflict of interest: None Declared  *Address for correspondence Dr. Swaruprani Sethi PG Scholar,  Department of Panchakarma, Government Ayurveda Medical College, Bengaluru. Email: swarupa301198@gmail.com   

Ayurvedic Insights in the Clinical Management of Paget’s Disease

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Ayurvedic Insights in the Clinical Management of Paget’s Disease

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