Importance of clinical case studies for traditional system of medicine

Abstract

Introduction The clinical case design offers an effective alternative to standard methods of performing clinical trials in traditional medicine (TM) context. Most of the TM treatment modalities are designed according to patient individualized aspects or body constitution and mental state. Further TM treatment modalities are also focus on patient’s digestive power or metabolism, dietary habits, life style conditions. Patient behavioral aspects and epigenetic factors also play a major role in TM treatment modalities. Dynamic nature of the TM treatment protocols differs according to changes in patient’s body constitution (Prakruthi) and disease characteristics. Therefore most of treatment approaches are incommensurable. Also treatment outcome assessments are broad and empirical viz Deergayu (longevity), Sukayu (Quality of life), Hithayu (Peaceful co- existence with society and Nature). Therefore clinical case design has the advantage of being adaptable to the clinical needs of the patients in systems of TM. For example, single-case designs can evaluate the effectiveness of various specialized TM treatment methods in patients with a variety of individual differences for arthritic conditions. Osteoarthritis (OA) of the knee is a degenerative disease of the knee joints which significantly restricts the functions of knee joints. Janu Sandigata vata is considered to be its close equivalent to OA in knee of contemporary medical sciences. The objective of this case series was to assess the effectiveness of Traditional and Ayurveda medicine on decrease pain while attempting to maintain or increase the range of knee motion in daily living activities of the patients. For this purposes Ayurveda and contemporary medical test parameters were analyzed from clinical data at Ayurveda clinical pharmacology unit (Dravyaguna Vignana), National Ayurveda Teaching hospital, Borella, Sri Lanka. Methods Reported cases (n=10) were at age range of 45 years to 70 years and both female (n=8) and male (n=2) patients were diagnosed as osteoarthritis (OA) (Sandhigata Vata) of the knee joints. Radiology (X‑ray) report confirmed that they were in Kellgren‑Lawrence grade III or less. At the beginning, visual analogue scale for pain and the Knee Society Rating System scores of pain, movement, stability and function score were measured. Traditional and Ayurveda medicine treatments were given as regimens for 12 weeks end point. At the 12 weeks end point, external treatment of oleation and 2 capsules of Shallaki (Boswellia serrate) and two tablets comprised of Emblica officinalis, Tinospora cordifolia, and Terminalia chebula), twice daily were continued over 8 weeks. Visual analogue scale for pain, knee scores in the Knee Society online rating system and Ayurveda clinical assessment criteria were used to evaluate the effects of treatments in four weeks basis. Results Significant reductions of visual analogue scale for pain were observed between baseline and the 12 weeks endpoint. Further Ayurveda clinical assessment criteria and the Knee Society Rating System scores of pain, movement and stability were also improved up to good level and function score were improved up to excellent level. During the follow‑up period, joint symptoms and signs and the knee scores were unchanged. Conclusion This case series demonstrated that a significant decrease in clinical parameters of Sandhigata Vata or OA in knee and improved patients’ quality of life by the intervention of the systems of Sri Lankan Traditional Medicine and Ayurveda. Further research is needed for explore effect of these treatment modalities with larger population.