Axial Spondyloarthritis Through the Ayurvedic Lens: A Stage-Based Correlation with Shodhana and Shamana Chikitsa

Abstract

Axial spondyloarthritis (axSpA) is a chronic immune-mediated inflammatory disease of the axial skeleton that encompasses both non-radiographic axSpA (nr-axSpA) and radiographic axSpA, the latter corresponding to classical Ankylosing Spondylitis (AS). Ayurveda describes three interrelated clinical entities- Amavata, Asthi-Majjagata Vikara, and Katitrik Graha- that correspond to successive stages of tissue involvement and map onto the modern axSpA spectrum. Objective: To correlate each Ayurvedic entity with a specific stage of axSpA and to outline stage-appropriate Shodhana (purificatory) and Shamana (palliative) Chikitsa protocols grounded in classical texts and contemporary clinical evidence. Methods: A narrative review was conducted drawing on classical Ayurvedic texts (Charaka Samhita, Madhava Nidana, Ashtanga Hridayam, Chakradatta, Bhaishajya Ratnavali) and peer-reviewed clinical literature retrieved from PubMed, Google Scholar, and DHARA (2000–2025). Results: Amavata correlates with early inflammatory axSpA (nr-axSpA) and responds to Deepana-Pachana, Virechana, and Vaitarana Basti. Asthi-Majjagata Vikara corresponds to established radiographic AS and warrants bone-nourishing therapies such as Mustadi Yapana Basti and Shalishastika Pinda Svedana. Katitrik Graha, reflecting progressive ankylosis, benefits from Kati Basti and long-term Matra Basti. Key Shamana drugs- Shallaki (Boswellia serrata), Guggulu preparations, and Ashwagandha- carry documented anti-inflammatory, immunomodulatory, and bone-protective activity. Conclusion: A stage-stratified integrative framework addresses axSpA pathogenesis at several mechanistic levels simultaneously, complements biological pharmacotherapy, and holds promise for reducing disease burden and improving functional outcomes. Adequately powered multi-centre randomised trials with structural imaging endpoints are the logical next step.