Integrative Management of Chronic Osteomyelitis (Asthi-Majjagata Vidradhi–Nadivrana) of the Great Toe: A Case Report

Authors

  • Rahat Mulani
  • S D Laxmikant
  • Bawadkar Prasad
  • Suketha Kumari
  • Himanshu Binji
  • Priya Shukla
  • Umali Mali

DOI:

https://doi.org/10.70066/jahm.v13i12.2343

Keywords:

Asthi-Majjagata Vidradhi, Case Report, Chronic osteomyelitis, Integrative approach, Nadivrana, Wound Healing

Abstract

Background: Osteomyelitis is an inflammatory condition of bone begins as an infection of the medullary cavity, haversian system and extends to involve the periosteum of affected area. Causes like trauma, ischemia, foreign body can make bone susceptible for the infection. Key steps in management includes, surgical removal of infected bone and extended antibiotic therapy. However chronic and recurrent cases are more challenging to treat. Hereby an attempt is made to treat such chronic condition of 22-year-old history of osteomyelitis with integrated approach to support postsurgical recovery and to prevent recurrence; as such cases are rarely documented.  Case presentation: A 55-year-old, male with chronic non-healing wound at base of left great toe presented with pus discharge, foul smell having history of trauma 22 years ago and underwent wound debridement twice, but symptoms persisted with discharging sinus resulting into chronic osteomyelitis. Intervention: Management includes amputation, antibiotics, local wound debridement with Apamarga ksharajala (caustic water), Priyangvadya Taila (oil) and internal medications like Mahamanjishtadi Kashaya (decoction), Arogyavardhini Vati (tablet), Panchatikta ghrita guggula (tablets). Patient was monitored for infection control, wound healing, pain reduction and improvement in quality of life. Outcome: The integrated approach led to significant clinical improvement showing reduced infection, healthy granulation tissue formation and pain control. Improvement in quantitative parameters was seen through reduced WBC, ESR count with complete healing of wound within 50 days and no recurrence or complications noted during follow up. Conclusion: Present chronic osteomyelitis case was managed through integrative approach combining Amputation, intravenous antibiotics along with ayurvedic intervention internally (Panchatikta ghrita guggula, Mahamanjisthadi Kashaya, Arogyavardhini vati) and externally (vrana-lekhana, dhoopana, dressing with medicated oil) given over a period of 50 days. Chronic cases like osteomyelitis in which recurrence chances are more and has showed limited response to allopathy management alone can be treated with integrated approach. 

Author Biographies

Rahat Mulani

2nd year PG scholar, Department of Shalya Tantra,  KAHERs Shri BMK Ayurveda Mahavidyalaya, Belagavi

S D Laxmikant

Professor, Department of Shalya Tantra,  KAHERs Shri BMK Ayurveda Mahavidyalaya, Belagavi

Bawadkar Prasad

Final year PG Scholar. Department of Kayachikitsa, KLE Academy of Higher Education and Research, Deemed to be University, Shri BMK Ayurveda Mahavidyalaya, Shahpur, Belagavi, Karnataka, India- 590003

Suketha Kumari

Asso. Prof. Department of Kayachikitsa,  KLE Academy of Higher Education and Research, Deemed to be University, Shri BMK Ayurveda Mahavidyalaya, Shahpur, Belagavi, Karnataka, India- 590003

Himanshu Binji

3rd  year PG scholar, Department of Shalya Tantra, KLE Academy of Higher Education and Research, Deemed to be University, Shri BMK Ayurveda Mahavidyalaya, Shahpur, Belagavi, Karnataka, India- 590003

Priya Shukla

2nd year PG scholar, Department of Shalya Tantra, KLE Academy of Higher Education and Research, Deemed to be University, Shri BMK Ayurveda Mahavidyalaya, Shahpur, Belagavi, Karnataka, India- 590003

Umali Mali

Final year PG scholar, Department of Shalya Tantra, KLE Academy of Higher Education and Research, Deemed to be University, Shri BMK Ayurveda Mahavidyalaya, Shahpur, Belagavi, Karnataka, India- 590003

References

Narasanagi SS. Osteomyelitis in rural India. Prog Pediatric Surg. 1982;15:203–8. Available from: https://pubmed.ncbi.nlm.nih.gov/7146440/

Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med. 1997 Apr 3;336(14):999–1007. Available from: https://pubmed.ncbi.nlm.nih.gov/9077380/

Ambikadutta Shastri (editor). Sushruta Samhita of Sushruta with Ayurveda Tattva Sandipika, Nidana Sthana, chapter 9, verse no.7–11. 2nd edition, Varanasi; Choukhambha Sanskrit Sansthan; Reprint 2001;342

G D Singhal (editor). Sushruta Samhita, Part 2, Chikitsa Sthana, chapter 16, verse no.40. 2nd edition, Varanasi; Chaukhamba Sanskrit Pratishthan; 2007;420–421

Mader JT, Shirtliff M, Calhoun JH. Staging and staging application in osteomyelitis. Clin Infect Dis. 1997 Dec 1;25(6):1303–9. Available from: https://pubmed.ncbi.nlm.nih.gov/9431368/

Conterno LO, Turchi MD. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev. 2013 Sep 6;2013(9):CD004439. doi: 10.1002/14651858.CD004439.pub3. PMCID: PMC11322802. Available from: https://pubmed.ncbi.nlm.nih.gov/24014191/

Indore S. A case study of dushta vrana treated with Apamarga Kshar Pichu. NJ-RAS [Internet]. 2020 Jun 3 [cited 2025 Jul 15];8(03). Available from: https://ayurlog.com/index.php/ayurlog/article/view/634

Shashikala DK, Mohankumari KM, Mahamad Yunus. Comparative study on the efficacy of Vacha Lashunaadi Taila Karna Pichu and Nimba Patraadi Dhoopana in the management of Karna Srava. Int J App Ayu Res [Internet]. 2016 Sep 15 [cited 2025 Jul 15];2(8):1039–44. Available from: https://ijaar.in/index.php/journal/article/view/223

Dhaliya R, Awasthi A. Impending benefit of Vimlapana Karma in Vrana Chikitsa (Wound Healing) – an Ayurveda & Modern Outlook. Sci J Adv Med Stud. 2017;5(12):xx–xx. doi: 10.21276/sjams.2017.5.12.3. Available from: http://researchgate.net/publication/358461052_

Shri Govinda Dasji (editor). Bhaishajya Ratnavali, vol-3, Kushta Chikitsa Adhyaya, verse no.233–236. 1st edition, Varanasi; Chaukhambha Publications; 2006;77–78

Karigar SB. Classical utility of Panchatikta Guggulu Ghrita in its indications – literary review. Int Ayurvedic Med J. 2021;9:1266–1273. doi: 10.46607/iamj1909062021. Available from: https://www.researchgate.net/publication/357359792_

Murthy KRS (editor). Sarangadhar Samhita, Madhyam Khanda, Chapter 2. 3rd edition, Varanasi; Chaukhambha Orientalia; 1997;137–142

Kaviraj Ambikadatta Shastri (editor). Rasaratna Samuchchya, Chapter 20, Verse No.87–93. 12th edition, Varanasi; Chaukhamba Sanskrit Publisher; 2023;435–436

Shri Govinda Dasji (editor). Bhaishajya Ratnavali, vol-2, Vidradhi Chikitsa Adhyay, verse no.23. 1st edition, Varanasi; Chaukhambha Publications; 2006;744

Additional Files

Published

2026-01-17

How to Cite

Mulani, R. ., Laxmikant, S. D., Prasad, B., Kumari, S., Binji, H., Shukla, P., & Mali, U. (2026). Integrative Management of Chronic Osteomyelitis (Asthi-Majjagata Vidradhi–Nadivrana) of the Great Toe: A Case Report. Journal of Ayurveda and Holistic Medicine (JAHM), 13(12). https://doi.org/10.70066/jahm.v13i12.2343

Issue

Vol. 13 No. 12 (2025): Journal of Ayurveda and Holistic Medicine (JAHM)

Section

Case Report

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Copyright (c) 2025 Rahat Mulani, Laxmikant S D, Bawadkar Prasad, Suketha Kumari, Himanshu Binji, Priya Shukla, Umali Mali

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