Rickets (Vitamin D or Calcium Deficiency Disorder) : Causes, Symptoms, Ayurvedic Management & More

Abstract

Amid towering city buildings and timeless Ayurvedic practices, rickets—a serious condition in children stemming from vitamin D lack—quietly undermines bone development, causing bent legs and halted growth. It impacts countless children around the world, particularly in areas with limited sunlight or inadequate nutrition, remaining a preventable issue across poor and wealthy nations alike. This piece blends cutting-edge biochemical knowledge from modern medicine with Ayurveda's balanced dosha framework, providing a reliable guide from the Phakka rog concepts to proven treatments for complete recovery.

Introduction

Rickets is a vitamin D deficiency disorder in children which causes defective bone mineralization due to impaired calcium and phosphate absorption that leads to softened bones, deformities like bowed legs, and stunted growth. Ayurveda correlates it with Phakka Roga, or Asthi Kshaya, involving Vata dosha vitiation and depletion of Asthi Dhatu due to low nutrition and low exposure of sunlight. lets discuss it in brief.

Causes

1. Nutritional Causes

• Lack of sunlight - Dark skin, overcrowding, excessive clothing or swaddling.
• Dietary deficiency - Exclusive breastfeeding without supplementation (breast milk is poor in vit d).
• Maternal deficiency- Leads to congenital rickets in Neonates.

2. Non Nutritional Causes

• Malabsorption: celiac disease, cystic fibrosis (fat-soluble vitamin malabsorption).
• Renal disease: Chronic renal disease, Renal tubular acidosis.
• Drug induced - Anti-convulsants (phenytoin) increase vitamin d metabolism.

Sign & Symptoms

• Craniotabes: Ping-pong ball sensation on occiput (< 3 months).
• Frontal Bossing: Box-like head shape due to osteoid deposition.
• Delayed Fontanelle: Anterior fontanelle remains open beyond 18 months.
• Rachitic Rosary: Prominent beading at costochondral junctions.
• Harrison's Sulcus: Groove at lower thorax from diaphragm pull.
• Wrist Widening: Epiphyseal enlargement (Double Malleoli).
• Genu Varum (Bow Legs): Outward bowing of Tibia/Femur (onset of walking).
• Genu Valgum (Knock Knees): Inward angulation (older children).
• Spine: Kyphosis (Cat-back) or Scoliosis due to ligamentous laxity.
• Systemic: Hypotonia (Pot-belly), delayed motor milestones, tetany (if hypocalcemic).

Diagnosis

• Serum Alkaline Phosphatase (ALP): Typically elevated in growing children with rickets, indicating bone turnover.
• Serum Calcium: To check for hypocalcemia, which is common in nutritional rickets.
• Serum Phosphorus: Usually low in pediatric rickets, especially in vitamin D deficiency or renal phosphate wasting.
• 25-Hydroxyvitamin D: To evaluate vitamin D status; deficiency is the most common cause.
• Parathyroid Hormone (PTH): Elevated as a response to low calcium or phosphate levels.
• X-rays of Wrists and Knees: To detect classic signs like metaphyseal cupping and fraying, typical in growing bone regions in children.
• Growth Monitoring and Physical Exam: Look for delayed milestones, bone deformities (bowed legs, rachitic rosary), and dental issues.

Modern Treatment

• Vitamin D therapy: Oral cholecalciferol or ergocalciferol via daily, weekly, or bolus doses to address deficiency.
• Calcium support: Supplements or diet providing ~500 mg/day alongside vitamin D for bone repair.
• Sunlight and nutrition: Promote safe sun exposure plus foods rich in vitamin D.
• Specialized rickets: Calcitriol or alfacalcidol plus phosphate for genetic/renal types.
• Deformity correction: Bracing or orthopedic surgery for leg/ spine issues.

Ayurvedic Overview

In Ayurveda Rickets correlates with Phakka Roga as described by Acharya Kashyapa in Kashyapa Samhita, or Asthi Kshaya. It is dominated by Vata dosha, arising from weakened Agni (digestive fire), which leads to poor digestion and absorption of nutrients. This results in the depletion of Asthi Dhatu (bone tissue). Ayurveda considers it a holistic imbalance of the doshas caused by improper maternal nutrition, deficient breastfeeding, or environmental influences that impair the transformation of Rasa into Rakta and other tissues necessary for healthy bone development.

Acharya Kashyapa categorizes Phakka Roga into three primary types based on etiology: Kshiraja Phakka, Garbhaja Phakka, and Vyadhija Phakka.

1. Kshiraja Phakka

This arises from a child's consumption of Kapha-vitiated breast milk from mother, leading to emaciation (Krusha). The faulty, Kapha-tainted milk blocks the Rasavaha Srotasa (nutrient channels), resulting in overall nutritional deficits and the development of Kshiraja Phakka Roga.

2. Garbhaja Phakka

Occurs when a breastfeeding mother (Dhatri) becomes pregnant, impairing milk production and reducing its nutrient density essential for the child's growth. This malnourishment causes progressive wasting (emaciation) in the infant, manifesting as Garbhaja Phakka.

3. Vyadhija Phakka

Here, the child experiences depletion of muscle tissue (Mansa Ksheenata) and overall debility (Balakshaya) due to endogenous (Nija) or exogenous (Agantuja) diseases. Nija Rogas from dosha imbalances—such as recurrent systemic fevers (Jwara)—or virulent infections hinder thriving; similarly, Agantuja factors like environmental pollutants (air, water), food adulteration, chemical toxicity, allergic reactions, autoimmune conditions, or poisoning contribute to this failure-to-thrive state.

Roopa Lakshana ( Sign & Symptoms)

• Pindalambatva: Flaccid bulging in thighs from Kapha-Vata buildup and inadequate Rasa Dhatu supply.
• Sandhi Vikshepa: Joint laxity or looseness (Sandhi Saithilya), which gradually leads to structural deformities, including Vankshana Vakrata (curvature or abnormal bending of the thighs) and Janu Bandha (fixed, bent, or improperly aligned knees).
• Gaatra Shoola: Aching in body parts (Gaatra), back (Prishtha), and hips triggered by Vata aggravation in Asthi Srotas.
• Balakshaya: Loss of vigor (Bala Hani), delaying skills like standing (Sthana Asamarthya) or stepping (Gati Vikriti) past infancy.
• Kshudra Shopha: Nodule-like swells at costochondral spots (Phalaka Shopha or Hriday Parshva Granthi) due to Vata-Kapha disorder.
• Mamsa Kshaya: Flesh depletion (Mamsa Shaithilya) with limp texture, slackness, and twitching (Sankocha).
• Udara Unnatata: Belly distension (Udara Vakrata) paired with fat depletion (Twak Kshaya) in hips, torso, and extremities.
• Shiro-Mukha Prakopta: Oversized cranium and visage (Shiro-Mukha Vriddhi) with sallow hue (Panduta) and profuse scalp sweat (Shirah Sweda).
• Danta Vikara: Late teeth emergence (Danta Utpathana Vilamba), faulty enamel, and dental holes from Asthi Dhatu impairment.
• Kshaya Lakshanas: Total thinning (Krishatva), pallor disease (Panduroga), loose stools (Atisara), and fidgetiness (Chanchalta) indicating Rasa-Rakta depletion.

Ayurvedic Management (Chikitsa)

In ayurveda rickets that is closely related to Phakka rog or Asthikashaya is managed by balancing vata dosha, Strengthening bones (Asthi dhatu), Improving digestion (Agni) and by enhancing nutrient absorption through herbs, formulation, Panchakarma therapies , diet and lifestyle management.

Some Classical Herbs Used For Rickets (Phakka Rog)

1. Bala (Sida cordifolia)

Strengthens muscles and bones (Balya effect), combats wasting of flesh and skeletal tissues; ideal for massage oils in Abhyanga therapy.

2. Ashwagandha (Withania somnifera)

Acts as a rejuvenator (Rasayana), promotes vitality and body mass increase, eases Vata-related debility.

3. Shigru (Moringa oleifera)

Supplies natural mineral boosts akin to calcium, reinforces bone structure; soothes inflamed loose joints.

4. Guggulu (Commiphora mukul)

Removes channel blockages (Srotorodha), diminishes swellings; essential component of Lakshadi Guggulu for correcting limb distortions.

5. Laksha (Laccifer lacca)

Loaded with minerals for bone binding (Asthi Bandhana), aids in calcification and tissue repair.

6. Praval Pishti (Coral calx)

Delivers absorbable calcium source, remedies bone impurities (Asthi Dushti) and late teething.

Classical Formulations

• Arogyavardhini Vati
• Ashwagandharishta
• Balarishta
• Triphala Churna

Panchkarma Therapies

Gatravestana With Snigdha-Ushna Erand Patra

Gatravestana, a classical Swedana therapy in Ayurveda, involves localized bandaging or wrapping (vestana) of the body (gatra) using medicated poultices or herbal leaves to calm Vata dosha, nourish Asthi Dhatu (bone tissue), and build sthira guna (stability) in Phakka Roga (rickets).

• Start with Snehana (oleation) on affected areas like children's legs or knees using snigdha ushna Eranda Patra—warm, oily castor leaves (Ricinus communis) prepared in Bala Taila for their balya (strengthening), vatahara (vata balancing) qualities.
• Then firmly wrap fresh, heated Eranda Patra swarasa (juice) or pinda (bolus) in cotton cloth for 30–45 minutes, allowing ushna virya (hot potency) and snigdha guna (moist) to deeply penetrate tissues, and finish by gently unwrapping and cleansing.
• For rickets, it eases deformities like knocking knees and cramps by boosting asthi poshana (bone nourishment), reducing vata vikriti at sandhi (joints), and aiding growth with Eranda's rasayana effect.

Abhyanga Therapy (Massage Therapy)

Abhyanga is also very useful in the management of rickets (Phakka rog).it is basically body massage by medicated oils. We can use oils like Ksheerbala oil and mahamash oil for abhyanga therapy in rickets for better health improvement.

Diet And Lifestyle Management

Ayurvedic diet and lifestyle for Phakka Roga (rickets) focus on nourishing bones (Asthi Dhatu), boosting Agni (digestive fire), and pacifying Vata dosha (balances vata dosha) through calcium-vitamin D rich foods and sun exposure.

• Eat Green leafy vegetables like spinach (spinacia oleracia) and fenugreek (trigonella foenum-graecum) for natural calcium and minerals.
• Dry fruits such as almonds, walnuts, cashews, and raisins to build bone strength.
• Fresh fruits including oranges, figs, bananas, and Amla (phyllanthus emblica) for vitamin C and vitality.
• Dairy products, cereals, eggs, and fatty fish to enhance vitamin D3 and phosphorus absorption.
• Vegetables like onion, garlic, and tomatoes to support nutrient uptake.
• Moderate daily sunlight exposure for natural vitamin D.
• Gentle yoga asanas such as Tadasana (mountain pose), Vrikshasana (tree pose), Utkatasana (Chair pose) and Bhadrasana (Butterfly pose) under guidance to improve flexibility and strength.
• Avoid cold, heavy foods that impair digestive fire (Agni) ; choose warm, light meals for children.

Herbal Remedies For Rickets By Planet Ayurveda

Planet Ayurveda is a renowned Ayurvedic organization dedicated to providing 100% natural, herbal, and classical formulations based on the principles of Ayurveda. They offer specialized herbal formulations designed to support bone health and manage rickets naturally. They enhance overall vitality in growing children through safe, holistic care grounded in classical Ayurvedic principles.

1. Balarisht
2. Ashwagandharisht
3. Coral Calcium Complex
4. Moringa Capsule
5. Lakshadi Guggul
6. Vikramprash
7. Vitamin D3 Capsules
8. Ksheerbala Oil
9. Mahamash Oil

Herbal Remedies For Rickets

1. Balarisht

It is a classical Ayurvedic fermented liquid formulation made up of herbs like Bala (Sida cordifolia) and Ashwagandha (Withania somnifera), Eranda (Ricinus communis) etc. It helps in strengthening and nourishing muscle and bone tissues (dhatus), enhances digestive fire (Agni), improving nutrient absorption essential for bone growth and healing, pacifies aggravated Vata dosha, reduces muscle spasms by acting on neurons, and provides muscle relaxant effects, helping to relieve physical weakness and muscle cramps related to rickets.

Dose : 10 ml twice a day with equal amount of water.

2. Ashwagandharisht

It is a classical Ayurvedic fermented liquid formulation which is made up of Ashwagandha (Withania somnifera), Musali (Chlorophytum borivilianum), Manjistha (Rubia cordifolia) etc. It is a potent rasayana (rejuvenative) and balya (strength-promoting) effect on Asthi (bone) and mamsa (muscle) dhatus. It acts as a Vata-pacifying nervine tonic, reducing muscle cramps, leg pain, and weakness by improving agni (digestive fire) for better calcium/phosphorus absorption in nutritional deficiencies and physical growth in children with Phakka roga.

Dose : 10 ml twice a day with equal amount of water.

3. Coral Calcium Complex

It is an Ayurvedic capsule formulation made up of Parval Pishti (coral calcium), Akik Pishti (agate), Jawar Mohra Pishti, Kamdudha Ras, Mukta Pishti, and Guduchi Satva (Tinospora cordifolia) etc. It supports healthy bone density and mineralization, by replenishing calcium stores, enhancing bone strength, maintaining muscle/nerve health, and balances Pitta dosha. It helps in calcium absorption, preventing deformities, and aiding growth in nutritional deficiencies, suitable for growing children.

Dose : 1 capsule twice daily, after meals with plain water.

4. Moringa Capsule

It is a herbal capsule formulation made up from standardized extract of Moringa oleifera leaves. It acts as a potent antioxidant, helps in balancing Vata and Kapha doshas to strengthen bones and muscles. It is used as a supportive supplement in managing rickets by improving overall nutritional status and reducing oxidative stress.

Dose : 1 capsule twice daily.

5. Lakshadi Guggul

It is a classical Ayurvedic herbo-mineral tablet formulation that is made up from herbs like Laksha (Laccifer lacca), Asthisamhar (Cissus quadrangularis), Arjuna (Terminalia arjuna), Nagabala (Grewia populifolia), and purified Guggulu (Commiphora mukul) etc. It helps in promoting calcium deposition, reducing inflammation (anti-inflammatory), alleviating pain (analgesic), and binding fractured or weak bones while balancing Vata dosha.

Dose : 1 tablet twice daily with lukewarm water.

6. Vikramprash

It is a classical rejuvenative herbal jelly-like preparation using potent herbs such as Bala (Sida cordifolia), Ashwagandha (Withania somnifera), Amla (Emblica officinalis) etc. It works by strengthening bones and muscles, enhancing immunity, and improving overall growth and vitality.

Dose : 1 tablespoon twice daily with milk.

7. Vitamin D3 Capsules

It is a plant-based capsule supplement made up of Lichen, Mushrooms (Agaricus bisporus), Spirulina, Chlorella etc. It helps in providing 600 IU of Vitamin D3 per serving, to support bone health and immunity and enhances calcium and phosphorus absorption, promotes bone mineralization, and strengthens skeletal structure.

Dose : 1 capsule after meal with lukewarm water.

8. Ksheerbala Oil

It is a classical Ayurvedic medicated oil formulated with Bala (Sida cordifolia), Ksheera (cow’s milk), and Tila Taila (sesame oil). It is a nourishing, Vata-pacifying oil used to strengthen nerves, muscles, and joints, supporting recovery from musculoskeletal disorder by doing external massage from it.

Indication : Take a sufficient amount of oil and massage it on the whole body.

9. Mahamash Oil

It is a classical Ayurvedic medicated oil made up of Masha (Vigna mungo), Ashwagandha (Withania somnifera), Devdaru (Cedrus deodara) etc. This oil strengthens bones and muscles, improves circulation, and reduces inflammation, aiding recovery from skeletal weakness and promoting bone health in rickets by doing external massage from it.

Indication : Take a sufficient amount of oil and massage it on the whole body.

Conclusion

Rickets is a condition that weakens and softens children’s bones, making walking and growing tough. Modern medicine helps by identifying the exact vitamin D and mineral shortages causing the problem and fixing them with supplements and diet. Ayurveda adds an extra layer by focusing on strengthening the bones with natural herbs, therapies, and lifestyle habits like gentle yoga and sunlight exposure. Combining the precision of modern tests and treatments with Ayurveda’s holistic care provides a powerful, balanced approach. This not only strengthens bones but also nurtures overall health, helping children grow strong and healthy from the inside out.