Guidance on Combining Ayurvedic Medications for Avascular Necrosis - #46604

1. Mahanarayana kwatha 15ml + 45ml lukewarm water at morning half an hour before food. 2. Dashamoola kwatha 15ml + 45ml lukewarm water at evening half an hour before dinner. 3. Abha guggulu 1-0-1 after food. 4. Lakshadi guggulu 1-0-1 after food.

Take navaratnapisti 1tab bd, makaradwaja 1tab bd, purnachandradayaras 1tab bd, asthibala 1tab bd, Pancha tiktha ghrita Guggulu 1tab bd,pravalpisti+shnaka Bashma+ksheera make vasti u ll get results

DR RC BAMS MS

THANK YOU FOR YOUR TRUST AND FOR EXPLAINING SO CLEARLY. WHAT YOU ARE EXPERIENCING IS COMMON WHEN YOU ARE DEALING WITH CONDITION LIKE AVASCULAR NECROSIS .AND YOU GET DIFFERENT ANSWERS AND DIFFERENT PRESCRIBED MEDICINES,ITS COMMON TO GET CONFUSED,THAT MEANS EACH DOCTOR IS NOT WRONG. EACH ONE IS LOOKING AT THE SAME DISEASE FROM A DIFFERENT AYURVEDIC ANGLE, BASED ON THEIR CLINICAL EXPERIENCE, SCHOOL OF THOUGHT, AND STAGE OF DISEASE THEY HAVE ADVICED .

I AM GOING TO EXPLAIN EACH MEDICINE’S ROLE AND HOW THEY SHOULD OR SHOULD NOT BE COMBINED IN A REALISTIC TREATMENT PLAN FOR AVASCULAR NECROSIS OF THE FEMORAL HEAD STAGE 2 TO 3.

AVASCULAR NECROSIS IS NOT JUST A BONE DISEASE. IT IS A DEEP DHATU LEVEL DISORDER. IN AYURVEDA, IT INVOLVES VATA DOSHA PREDOMINANCE ASTHI DHATU KSHAYA MAJJA DHATU DUSHTI SROTAS AVARODHA MEANING MICRO CIRCULATION BLOCKAGE AND POOR RASA RAKTA SUPPLY TO THE BONE

IN SIMPLE WORDS, BLOOD AND NOURISHMENT ARE NOT REACHING THE FEMORAL HEAD PROPERLY, VATA DRIES AND DAMAGES THE BONE, AND THE BODY FAILS TO REPAIR IT FAST ENOUGH.

STAGE 2 TO 3 MEANS STRUCTURAL DAMAGE HAS STARTED PAIN AND STIFFNESS ARE + COLLAPSE MAY NOT BE COMPLETE YET THIS IS A CRUCIAL WINDOW WHERE AYURVEDA CAN SLOW PROGRESSION, REDUCE PAIN, AND IN SOME CASES PREVENT OR DELAY SURGERY IF DONE PROPERLY AND CONSISTENTLY

NOW LET US LOOK AT EACH MEDICINE YOU HAVE PURCHASED AND WHY DIFFERENT DOCTORS SUGGESTED THEM.

1 DASHMOOLA KWATH THIS IS A CLASSIC VATA SHAMAKA AND ANTI INFLAMMATORY DECOCTION ITS ROLE IN AVASCULAR NECROSIS IS REDUCING PAIN REDUCING INFLAMMATION AROUND THE HIP JOINT RELAXING MUSCLES AND LIGAMENTS IMPROVING LOCAL CIRCULATION SUPPORTING NERVES AROUND THE JOINT

DASHMOOLA IS NOT A BONE BUILDER IT IS A FOUNDATION MEDICINE IT PREPARES THE BODY TO RECEIVE OTHER STRONGER MEDICINES WITHOUT DASHMOOLA OR A SIMILAR VATA PACIFIER, STRONG GUGGULU FORMULATIONS CAN AGGRAVATE VATA AND CAUSE MORE PAIN

2 ABHA GUGGULU ABHA GUGGULU IS SPECIFICALLY INDICATED IN ASTHI BHAGNA HEALING TRAUMA JOINT INJURIES BONE WEAKNESS

ITS ROLE IS PROMOTING BONE HEALING REDUCING SWELLING SUPPORTING REPAIR PROCESSES

HOWEVER ABHA GUGGULU IS MORE USEFUL IN FRACTURE HEALING AND POST TRAUMATIC CONDITIONS IN AVASCULAR NECROSIS, IT PLAYS A SUPPORTIVE ROLE BUT IT IS NOT THE PRIMARY DRUG

3 KAISHORE GUGGULU THIS IS A BLOOD PURIFIER AND ANTI INFLAMMATORY MEDICINE ITS MAIN ACTION IS ON RAKTA DHATU AMA CLEARANCE INFLAMMATORY CONDITIONS

ITS ROLE IN AVASCULAR NECROSIS IS CLEARING MICRO TOXINS IMPROVING BLOOD QUALITY REDUCING INFLAMMATORY PAIN

IT IS MORE USEFUL IF THERE IS HISTORY OF STEROID USE AUTOIMMUNE CONDITIONS METABOLIC DISORDERS HIGH INFLAMMATORY MARKERS

IT IS NOT A DIRECT BONE NOURISHER BUT IT HELPS CLEAN THE CHANNELS SO THAT BONE NOURISHERS CAN WORK BETTER

4 LAKSHADI GUGGULU THIS IS ONE OF THE MOST IMPORTANT MEDICINES FOR YOUR CONDITION ITS PRIMARY ACTION IS ASTHI DHATU POSHANA BONE REGENERATION STRENGTHENING WEAK BONES HEALING MICRO FRACTURES

IN AVASCULAR NECROSIS, LAKSHADI GUGGULU IS CORE MEDICINE IT HELPS IN REDUCING BONE PAIN SUPPORTING STRUCTURAL INTEGRITY SLOWING DOWN COLLAPSE

THIS MEDICINE WORKS SLOWLY BUT DEEPLY IT SHOULD BE USED FOR LONG PERIODS UNDER SUPERVISION

5 PANCHATIKTA GHRITA GUGGULU THIS IS A VERY POWERFUL AND VERY DEEP ACTING MEDICINE IT IS SPECIFICALLY INDICATED IN ASTHI MAJJA GATA VATA CHRONIC BONE DISEASES DEGENERATIVE CONDITIONS

ITS ROLE IN AVASCULAR NECROSIS IS IMPROVING BONE METABOLISM DELIVERING MEDICINE DEEP INTO BONE TISSUE THROUGH GHRITA REDUCING DRYNESS AND NECROSIS SUPPORTING REGENERATION AT CELLULAR LEVEL

THIS IS ONE OF THE MOST IMPORTANT MEDICINES FOR STAGE 2 TO 3 AVASCULAR NECROSIS BUT IT IS HEAVY IT REQUIRES GOOD DIGESTION IT SHOULD NOT BE COMBINED RANDOMLY WITH TOO MANY OTHER GUGGULU PREPARATIONS AT FULL DOSE

6 MANJISHTHADI KASHAY THIS IS A RAKTA PRASADANA AND MICROCIRCULATION IMPROVER ITS ROLE IS IMPROVING BLOOD FLOW REDUCING STAGNATION SUPPORTING DELIVERY OF NUTRIENTS TO FEMORAL HEAD

THIS MEDICINE IS VERY IMPORTANT BECAUSE AVASCULAR NECROSIS IS ESSENTIALLY A BLOOD SUPPLY PROBLEM WITHOUT GOOD RAKTA DHATU FUNCTION, BONE MEDICINES WILL NOT REACH THE TARGET AREA

7 MAHANARAYAN KASHAY THIS IS A STRONG VATA SHAMAKA AND JOINT SUPPORT DECOCTION ITS ROLE IS REDUCING PAIN AND STIFFNESS IMPROVING JOINT MOBILITY SUPPORTING MUSCLES AND LIGAMENTS

IT IS VERY USEFUL WHEN PAIN IS SIGNIFICANT MOVEMENT IS RESTRICTED MUSCLE SPASM AROUND HIP IS PRESENT

IT IS NOT A BONE HEALER BUT A VERY IMPORTANT SYMPTOM RELIEVER

8 HARITAKI VATI THIS MAY SEEM SIMPLE BUT IT IS CRITICAL CONSTIPATION OR POOR BOWEL MOVEMENT WORSENS VATA WORSENED VATA DESTROYS ASTHI DHATU FASTER

HARITAKI HELPS PROPER APANA VATA FLOW BETTER ABSORPTION OF MEDICINES REDUCTION OF PAIN FLUCTUATIONS

NOW THE MOST IMPORTANT PART WHY YOU CANNOT TAKE EVERYTHING TOGETHER AT FULL DOSE

TAKING TOO MANY GUGGULU PREPARATIONS TOGETHER CAN OVERLOAD DIGESTION INCREASE VATA CAUSE ACIDITY CAUSE WEIGHT LOSS CAUSE FATIGUE

AYURVEDA IS NOT ABOUT MAXIMUM MEDICINES IT IS ABOUT RIGHT SEQUENCING

NOW I WILL GIVE YOU A PRACTICAL AND RATIONAL REGIMEN FOR STAGE 2 TO 3 AVASCULAR NECROSIS

CORE MEDICINES THAT SHOULD FORM THE BACKBONE PANCHATIKTA GHRITA GUGGULU LAKSHADI GUGGULU MANJISHTHADI KASHAY

SUPPORTING MEDICINES DASHMOOLA KWATH MAHANARAYAN KASHAY HARITAKI VATI

OPTIONAL OR ROTATIONAL MEDICINES KAISHORE GUGGULU OR ABHA GUGGULU DEPENDING ON HISTORY

DASHMOOLA KWATH 10 ML WITH WARM WATER AFTER BREAKFAST AND DINNER

PANCHATIKTA GHRITA GUGGULU AS ADVISED DOSE WITH WARM WATER

MANJISHTHADI KASHAY 10 ML WITH EQUAL WATER AFTER LUNCH AND DINNER

LAKSHADI GUGGULU WITH WARM WATER AFTER LUNCH AND DINNER

HARITAKI VATI AT BEDTIME

KAISHORE GUGGULU OR ABHA GUGGULU CAN BE USED EITHER AFTER BREAKFAST AND DINNER

NO ALCOHOL NO SMOKING NO EXCESS CAFFEINE NO NIGHT AWAKE NO HEAVY WEIGHT BEARING ON AFFECTED HIP

INCLUDE WARM COOKED FOOD GHEE IN SMALL QUANTITY BONE SUPPORTIVE FOODS ADEQUATE PROTEIN

AYURVEDA DOES NOT MAGICALLY REVERSE AVASCULAR NECROSIS BUT IN STAGE 2 TO 3 IT CAN REDUCE PAIN IMPROVE QUALITY OF LIFE SLOW PROGRESSION AND CAN DELAY OR AVOID SURGERY FOR YEARS

CONSISTENCY FOR 6 TO 12 MONTHS IS REQUIRED RESULTS ARE GRADUAL BUT REAL

YOU HAVE TAKEN THE RIGHT FIRST STEP NOW IT IS ABOUT USING THESE MEDICINES INTELLIGENTLY NOT RANDOMLY

In stage 2 to early stage 3 AVN, in Ayurveda the goal is to reduce vata rakta obstruction, improve micro circulation to the femoral head, nourish bone tissue and prevent further collapse.Taking too many medicines together can disturb digestion, weaken agni and reduce the effectiveness of even good medicines.

I would advise you to restrict to only three core medicines for .These three are sufficient, classical, complementary to each other, and safe for long term use

The best three medicines for your condition are Lakshadi Guggulu, Manjishthadi Kashayam, and Dashmoola Kwath.

Lakshadi Guggulu is the backbone medicine for avascular necrosis when viewed through the Ayurvedic lens. This formulation directly acts on asthi dhatu and majja dhatu. Laksha is known for its role in bone healing, strengthening and regeneration, while guggulu improves circulation, reduces inflammation and removes srotorodha, especially in deeper tissues. In AVN, the blood supply to the femoral head is compromised. Lakshadi Guggulu helps improve micro circulation while simultaneously supporting bone integrity. This medicine is particularly useful in stage 2 and early stage 3 AVN where the aim is preservation of the joint. It should be taken after food, because guggulu formulations can irritate the stomach. Two tablets twice daily after breakfast and dinner with lukewarm water

The second important medicine is Manjishthadi Kashayam. This is crucial because AVN is not only a bone disorder, it is also a rakta and circulation disorder. Manjishtha is one of the best herbs in Ayurveda for rakta shodhana, improving blood quality and micro vascular flow. In many AVN patients, there is clotting tendency, inflammation, or sluggish circulation that modern reports may not clearly show. Manjishthadi Kashayam works gently but deeply to clear stagnation, reduce inflammatory processes and support tissue oxygenation. This kashayam should ideally be taken on an empty stomach, morning and evening, around 15 ml mixed with an equal quantity of warm water. If your digestion is sensitive, you may start with once daily in the morning for the first week and then increase to twice daily. This medicine complements Lakshadi Guggulu beautifully because it prepares the tissue environment for healing.

The third medicine is Dashmoola Kwath. Dashmoola is important in because vata is a central factor in AVN progression. It pacifies vata, reduces deep seated inflammation, relieves pain and stiffness around the hip joint and supports neuromuscular balance. It also helps counter stress related vata aggravation, which otherwise keeps disturbing circulation and healing. Dashmoola Kwath is best taken in the evening, around one hour before dinner or at least two hours after meals. Take 15 ml mixed with equal warm water.

Abha Guggulu, Kaishore Guggulu and Panchatikta Ghrita Guggulu are all excellent medicines, but they overlap in action and adding them together will not accelerate healing. Instead, it may burden digestion, increase dryness and aggravate vata . Mahanarayan Kashayam is useful in neuromuscular pain and paralysis like conditions and can be added later if required. Haritaki Vati should not be taken unless constipation is present

include warm, nourishing, slightly unctuous foods. Avoid dry, cold, raw foods, excessive salads, packaged foods and intermittent fasting. These aggravate vata and slow bone repair. Milk, ghee well cooked vegetables, soaked almonds, sesame seeds and warm meals to be taken . Avoid alcohol completely, as it directly worsens avascular changes. Excess caffeine and late nights should be avoided. Avoid high impact exercises, running, jumping or heavy weight bearing

In stage 2 to 3 AVN, you should assess progress over months, not weeks. Pain reduction, improved mobility, better sleep and reduced stiffness are early signs that the medicines are working. Radiological improvement takes longer. Do not keep changing medicines frequently. Consistency is far more important than quantity.

After 8 to 12 weeks on this regimen, a reassessment can be done and only then should any additional medicines be considered, based on response and digestion. For now, keeping the treatment simple, focused and disciplined will give you the best possible outcome.

Stay patient, stay consistent, and give the time it needs to respond,that with the right approach, further progression can be slowed and quality of life can be improved.

I will advise you a modified protocol which works best in the management of AVN. Start with- 1. Panchatikt Ghrit Guggulu 2-0-2 after food 2. Gandha Taila Capsule 2-0-2 after food 3. Mahamanjisthadi Kashayam 15ml-0-15ml with 15ml warm water before food 4. Regenerative Bhasma Mix: Mix Mukta Shukti Bhasma (500mg) + Guduchi Satva (500mg) + Yashad Bhasma (125mg). Take this mix twice daily with Honey or Ghee.

If Possible Go for Panchatikt Ksheer basti that is medicated Enema therapy given in Panchakarma. Find yourself a nearby Panchakarma centre for this. Plan this for 15 days.

External Therapy Murivenna Oil: Apply gently on the hip and groin area. Do not massage vigorously.

Dietary Advice Avoid: Sour foods (Curd, Pickles), Alcohol, and Excessive Walking/Weight bearing. Include: Milk, Ghee, Meat Soup (Mutton soup), and Black Gram (Urad Dal) to nourish the wasting tissues.

Regards Dr Gursimran Jeet Singh MD Panchakarma

Hello Brighton,

Thank you for the clear explanation and for trusting this platform. Your concern is very valid—taking too many Ayurvedic medicines together without a clear plan can reduce benefit and increase gastric or metabolic strain, especially in a condition like Avascular Necrosis (AVN) stage 2–3, which needs long-term, disciplined therapy rather than overload.

Below I’ll streamline your list, explain what to take, what to avoid combining, and how to take it correctly (with/without food), keeping AVN pathology in mind.

🦴 Understanding AVN in Ayurveda (Brief) AVN of femoral head ≈ Asthi–Majja Kshaya + Vata predominance + Srotorodha (micro-circulatory blockage)

Hence treatment goals are: - Improve blood supply (Srotoshodhana) - Control inflammation & pain - Nourish bone & marrow (Asthi–Majja poshana) - Prevent collapse & progression

✅ BEST & SAFE COMBINATION (from what you already purchased) 👉 You do NOT need all medicines together. Use ONE kashay + ONE guggulu combination + supportive meds.

🔹 MORNING (Empty stomach) 1️⃣ Manjishthadi Kashay – 15 ml Mix with equal warm water Take empty stomach 🔹 Why? Best for micro-circulation, inflammation, and preventing further necrosis ⛔ Do NOT combine with Dashmoola or Mahanarayan at same time.

🔹 AFTER BREAKFAST 2️⃣ Panchatikta Ghrita Guggulu – 2 tablets After food With lukewarm water 🔹 Why? ✔ Best medicine for bone necrosis, Asthi-Majja nourishment, and repair ✔ Mandatory in AVN stages 2–3

🔹 AFTER LUNCH 3️⃣ Kaishore Guggulu – 2 tablets After food With warm water 🔹 Why? Controls deep inflammation, helps detoxification, supports bone metabolism. ⛔ Do NOT take Abha + Kaishore together (both are guggulu-based and can overload digestion).

🔹 EVENING (Optional but beneficial) 4️⃣ Mahanarayan Kashay – 15 ml With equal warm water Before dinner or 2 hrs after lunch 🔹 Why? Excellent for pain, stiffness, muscle support, and joint lubrication

🔹 NIGHT (Before bed) 5️⃣ Haritaki Vati – 1 tablet With warm water 🔹 Why? Keeps bowels clear → improves absorption → reduces Ama (toxins)

❌ WHAT TO KEEP ON HOLD (For now) 🚫 Abha Guggulu 🚫 Lakshadi Guggulu 🚫 Dashmoola Kwath 🔹 Reason: - Lakshadi is useful after collapse or fracture, not primary in AVN 2–3 - Dashmoola + multiple kashay → digestive overload - Abha Guggulu duplicates Kaishore action (They may be introduced later if needed, under supervision)

🥗 DIET & LIFESTYLE (VERY IMPORTANT) ✔ Warm, cooked, unctuous food ✔ Ghee (1–2 tsp/day) ✔ Milk if digestible ✔ Black sesame, dates, soaked almonds

❌ Avoid: - Fasting - Excess tea/coffee - Dry foods - Night जागरण - Stress (major trigger in your case)

🧘‍♂️ ACTIVITY GUIDANCE ✔ Partial weight bearing ✔ Avoid running, jumping, squatting ✔ Gentle hip ROM exercises ✔ If possible: Physiotherapy guidance

⏳ Expected Timeline - Pain & stiffness: 4–6 weeks - Functional improvement: 3–4 months - Radiological stabilization: 6–12 months AVN does not reverse overnight—consistency matters more than quantity of medicines.

Tq

U can start with Lakshadi Guggulu Tab Panchatiktaka Guggulu Tab Triphala Guggulu Tab Manjishtadi kwatham These medicines will help to get rid from the issue

take dashmoola kwath lakshadi gugulu panchatikta ghita gugulu manjistha kashay and kesor gugulu andharitaki

Hey brington don’t confused easier method to take less medicine and put great results .slightly changes or mix some miraculous medicines to increase your healing :-

DASHMOOL kasaya Rasnasaptak kasaya= 15ml-15ml each with equal amount of water empty stomach twice daily

LAKSHADI GUGULU PANCHTIKT GHRIT GUGULU KAISHORE GUGULU=1-1-1 tab after meal thrice daily with worm water

ERANDA PAAK =1 TSP with worm water at bed time

MAHANARAYAN OIL= for genral massage for femur site .

Avoid oily/spicy/junk food

Do regular exercise and yoga

Regards Dr atul painuli Patanjali yogpeeth Haridwar