Effect of some Ayurvedic Anti-Rheumatic preparation supplemented with Masooradi Yoosha in Amavata (Rheumatoid Arthritis): A Case Report

Kirti Chouhan; Monika Yadav; Anita; Ravi Kumar

Effect of some Ayurvedic Anti-Rheumatic preparation supplemented with Masooradi Yoosha in Amavata (Rheumatoid Arthritis): A Case Report

Chouhan K.^1*, Yadav M.², Anita.³, Kumar R.⁴

DOI:

^1* Kirti Chouhan, Final Year Post Graduate Scholar, Department of Swasthvritta and Yoga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India.

² Monika Yadav, Final Year Post Graduate Scholar, Department of Swasthvritta and Yoga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India.

³ Anita, Final Year Post Graduate Scholar, Department of Swasthvritta and Yoga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India.

⁴ Ravi Kumar, Associate Professor, Department of Swasthvritta and Yoga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India.

Amavata is a sickness that develops when the Vata Dosha connected with Ama becomes aggravated. Aggravated Vata circulates Ama throughout the body via Dhamanies, seeks refuge in the Shleshma Sthana (Amashya, Sandhi, and so on), and manifests as Angmarda, Aalasya, Gaurav, Jwara, and other symptoms in tiny and large joints, deforming the person. In modern parlance, it simulates rheumatoid arthritis. Chakradatta explains Langhan as the first component of Amavata's Chikitsa Sutra. Pain and swelling in various joints, as well as morning stiffness lasting more than 60 minutes, were reported by a 50-year-old female patient. Simhanada Guggulu and Rasnasaptak Kashayam, as well as Masooradi Yoosha as Pathya, were prescribed as part of a 30-day integrative intervention. The Rheumatoid Factor qualitative and CRP qualitative was positive before treatment and found negative after treatment. Anti- CCP was >100 U/ml before treatment and it lower down to 73 U/ml after treatment. Simhnada Guggulu with Anupana of Rasnasaptak Kashayam followed by Masooradi Yoosha as Pathya showed remarkable relief in symptoms and serological markers such as RA factor qualitative, CRP qualitative, Anti-CCP and ESR. Diet is an effective modality in the management of Amavata.

Keywords: Masooradi Yoosha, Simhnada Guggulu, Amavata, Rheumatoid Arthritis, Case Report

Corresponding Author	How to Cite this Article	To Browse
Kirti Chouhan, Final Year Post Graduate Scholar, Department of Swasthvritta and Yoga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India. Email:	Kirti Chouhan, Monika Yadav, Anita, Ravi Kumar, Effect of some Ayurvedic Anti-Rheumatic preparation supplemented with Masooradi Yoosha in Amavata (Rheumatoid Arthritis): A Case Report. J Ayu Int Med Sci. 2022;7(4):141-145. Available From https://jaims.in/jaims/article/view/1848

Introduction

Amavata as a separate disease entity firstly described by Aacharya Madhavkara. He has given description about Nidana, Samprapti, Lakshana, Doshanubandhta, Sadhyata-Asadhyata of disease. Vata Dosha is important in the manifestation of disease in Amavata

Kapha and Vata Doshas are vitiated as a result of poor lifestyles and eating habits, causing Agni to be hampered, resulting in Mandagni (weak digestion). Mandagni, which aids in the development of Ama (metabolic poison) within the Amasaya, also slows down body metabolism (gastrointestinal tract). The key causative component in the appearance of Amavata is the formation of Ama and Vata Prokopa. Undigested Ahara Rasa Ama when mixes with Vata, it flows fast through the Dhamanis and accumulates at various Kapha locations, causing Shoola throughout the body, joints, loss of taste, thirst, lack of enthusiasm, heaviness, fever, Indigestion, and swelling of bodily parts, particularly joints.^[1] Amavata is a Rasa Dushtijanya Vikara. It can be corelated with Rheumatoid Arthritis to some extent in modern medicine.

Rheumatoid Arthritis (RA) is a chronic auto-immune disease affecting primarily the joints^[2] It is characterized by stiffness and soreness in the joints, which are warm and swollen. Both sides of the body's joints are commonly involved. Around 0.5 to 1% of the world's population is affected with RA.^[3] Prevalence in women is three to five times more in women.^[4] People in middle age group are more affected.

A complicated interplay between genes, environmental and hormonal circumstances, and the immune system causes this illness. Antigens from the environment, whether in the form of food or pathogenic organisms, pass through the gut. The intestinal microbiota has an effect on metabolic balance and the immune system.^[5] The link between the gastrointestinal microbiota and the immune system has been largely studied.^[6]

Dietary patterns have been proposed as a feasible way to alleviate or possibly prevent autoimmune disorders by reversing intestinal dysbiosis.^[7] Thus, Diet and nutrition plays an important role in the management of disease. The economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.^[8]

In modern science, NSAIDS (nonsteroidal anti-inflammatory medicines), analgesics, and other medications are commonly used; however hepatic and hematological toxicity necessitates continuous monitoring. Where as in Ayurvedic science, Acharya Chakradatta first described the management of Amavata which undertake Langhana, Swedana, use of Tikta and Katu Dravya, Dipana, Virechana, Snehapana and Basti.^[9]

The Ayurvedic diagnosis was made as Amavata. The major goal of treatment was to alleviate the disease's symptoms. Present study shows that Amavata can be managed successfully with correct approach of Pathya and medicines. The treatment is cost effective as well.

Case Report

A 50-year-old female, married, Hindu by religion, who was a teacher by profession and lived in an urban area presented to Swasthavritta OPD no. 21 at National Institute of Ayurveda, deemed to be university, Jaipur Rajasthan (Registration Number 153134) with the chief complaint of pain in all major and minor joints for the past one and half years. During the pain episode, it was associated with stiffness, swelling, burning in the soles, constipation, loss of appetite, heaviness of the body, weakness, and feverishness, as well as increased frequency of micturition.

History of present illness

Patient was asymptomatic one and half years back. Suddenly she developed pain in wrist joint and later involvement of multiple joints followed by fever on and off. In staring pain was mild in nature and subsided without medications. After six months she noticed stiffness in the fingers of both the hands which used to present during morning hours and subsided by the activity. Gradually she also started feeling pain in low back region. She began to have pain in waist, elbow, shoulder, knee and ankle joints on both sides over time.

The severity of pain started increasing and sometimes swelling and stiffness also present in all major and minor joints. She hasn’t taken any kind of medication for this until she presented to our OPD.

There was no history of Hypertension, Diabetes Mellitus, and Thyroid disorders. Her mother was diagnosed with Rheumatoid Arthritis.

Clinical Findings: Patient was alert, focused, and spoke properly, however she had a dull complexion. Pallor, icterus, clubbing, lymphadenopathy, and cyanosis were all absent. Oedema was found on bilateral knee joints. At the time of the first visit, the patient's pulse rate was 86 beats per minute, and her blood pressure was 150/100 mmHg. She complained of a lack of appetite, constipation, sleep disturbances, and increased micturition (12 times a day). Her dietary history revealed that she enjoyed spicy meals (Katu and Tiktsa Rasa predominant diet) and tea (3-5 times per day normal size cup). Any type of addiction was not reported the patient. Menopause was started 3 years back.

Pitta-Kapha Prakrit, Madhyama Sara, Madhyama Samhanan, Madhyama Satamya, Madhyama Satva, Avara Aharashakti and Jaranashakti, Avara Vyayamashakti, and Madhyamavastha was all suggested by a tenfold examination of the patient.

Diagnosis of the disease

Patient was registered in NIA OPD on 11/01/2022 with a provisional diagnosis of Amavata. Considering the history, and clinical examination. She was advised for laboratory investigations Hb% (g/dl), ESR, TLC, RA factor Qualitative, CRP Qualitative and Anti-CCP (U/ml) on that day and to report at an interval of 7 days or report as and when required for assessment. Before treatment EULAR score was 8 (≥ 6/10 is needed for classification of a patient as having definite RA). On the basis of history, clinical examination and investigations final diagnosis of Aamvata was made and following treatment was started from date 20/01/2022. She completed the treatment on 09/02/2022.

Treatment Plan: In this present study, Ayurvedic established anti-rheumatic medicines Simhanada Guggulu and Rasnasaptaka Kwatha with Masooradi Yoosha as Pathya was given.

Detail of Intervention

Drug	Simhanada Guggulu	Masooradi Yoosha
Preparation	Avaleha form	Liquid (Luke warm)
Dose	1.5gm	Yoosha was prepared with 100gm of raw ingredients
Time	Twice (morning and evening), empty stomach	Twice (morning and evening) food
Route	Oral	Oral
Duration	21 days	21 days
Anupana	Rasnasaptaka Kwatha (40ml)	-

Method of preparation of Yoosha

Yoosha was prepared as per mentioned in Sharangdhara Samhita.^[13] 100-gram raw ingredients of Yoosha added with sixteen times of water boiled on medium heat up to the one fourth reduction. After completion of intervention (15 days), she was advised Pathya^[14] which is following-

Ahara	Guna
Raktashali	Laghu, Deepana, Pathya, Ruchikara, Vatahara
Yava	Ruksha, Lekhana, Kapha-Vatahara
Kulattha	Ruksha, Ushna, Laghu, Kapha-Vatahara
Kodrava	Grahi, Ruksha, Kaphahara
Shigru	Ushna, Deepana, Pachana, Pathya, Vata-Kaphahara
Patola	Deepana, Pachana, Pathya, Kaphahara, Jwaranasaka
Adraka	Agnideepana, Bhedana, Kapha-Vatahara
Lashuna	Deepana, Pachana, Kapha-Vatahara, Rasayana
Jeeraka Siddhatakra, Sunthi Siddha Takra	Deepana, Kapha-vatahara

Assessment of Disease

For the assessment of disease activity DAS-28 ESR score was calculated. (Assessed by standard DAS 28-ESR Score Questionnaire)
For the functional assessment hand grip in mm of Hg, foot pressure in kg, walking time in seconds were measured.
For assessment of functional status (disability) measures, disability index was calculated. (Assessed by The Indian Health Assessment Questionnaire used to calculate disability index for Rheumatoid arthritis patients)
Pain (Sandhishoola) - Grading for pain was done using VAS - scale. Grading was 5 before treatment and it was reduced to 1 after treatment. Grading 5 denotes dreadful while grading 1 denotes distress in VAS-scale.
Hematological Assessment.

Outcome Measures

She was feeling more active than before. The grading before treatment was 05 on VAS Scale which reduced to 01 after treatment. There was improvement in DAS-28 score (4.20), disability index (0.33), hand grip (260mm of Hg), foot pressure (45kg), walking time (9sec.) after treatment. In laboratory test’s RA factor CRP were found to be negative after treatment. ESR reduced to 18 mm/hour after treatment. Anti-CCP lowered down to 73 U/ml.

Hematological Assessment

SN	Investigation	Before Treatment (11/01/2022)	After Treatment (18/02/2022)
1.	Hb% (g/dl)	11.2	13
2.	ESR (mm/hour)	21	18
3.	TLC	7.7	11
4.	RA factor Qualitative	Positive	Negative
5.	CRP Qualitative	Positive	Negative
6.	Anti-CCP (U/ml)	>100	73.00

Disease Activity Assessment

SN	Parameter	Before Treatment (11/01/2022)	After Treatment (18/02/2022)
1.	DAS-28 Score	6.05	4.20
2.	Disability index	1.16	0.33
3.	Hand grip (mm of Hg)	200	260
4.	Foot pressure (kg)	20	45
5.	Walking time (sec.)	19	9

Discussion

Amavata is one of the most prevalent disorders in today's world. There is no such thing as a cure-all therapy. Ayurvedic medicine, on the other hand, can help patients live a better life. Consumption of Nidanas (Viruddha Ahara, Nischala Chesta) such as Krodha, Shoka, Bhaya, Chinta, and others causes Agni to deviate from its regular stage, resulting in Mandagni. The main cause of Ama development is Mandagni. Vata Dosha, on the other hand, is vitiated as a result of Vataprokopa Nidana. Through the vitiated Vatadosha, this morbid Ama flows throughout the body. The Sleshma Sthana of the body is reached by this Ama. Here Ama blends with all the three Doshas. The vitiated Ama causes Srotoabhishyandana and Srotorodha. Amavata is produced when vitiated Vata and Ama enter the joints, creating stiffness.^[15]

Ama and Vata are two main pathological factors in the manifestation of disease having opposite characteristics to one another. Only Sheet Guna is shared by the two. Therefore, while dealing with Amavata’s patient extra care should be taken. Line of treatment involves Pachana of Ama, restoration of Agni, and finally control of Vata. Most of the contents present in Simhnada Guggulu and Rasnasaptaka Kwatha has properties like, Katu Tikta Rasa, Ushna Veerya, Katu Vipaka, Sukshma, Sara, Ruksha Guna, Deepana Pachana, Kapha-Vatahara Properties. Masooradi Yoosha has property of Agnideepana, Langhanakaraka,

best in alleviating Vatika disease. Most of the Dravyas of these drugs and Yoosha has properties like anti-inflammatory, anti-oxidant, free-radical scavenging, anti-pyretic, analgesic, Rasayana, immune-modulator etc.^[16-20]

Pathya is a term used in Ayurveda to define a specific diet for various diseases. According to Ayurveda, derangement of Agni (digestive capacity) causes lots of new ailments, the primary cause of which is the production of vitiated Doshas, Ama, and Dhatus malnourishment. As a result, Agni's restoration is critical. Pathya is beneficial to patients, while Apathya is harmful, according to Sabdakalpadruma. Chikitsa and Pathya are synonyms. Pathya Ahara nourishes all Dhatus and decreases Doshas that are vitiated. The patient was prescribed Pathya, which is referenced in Ayurveda texts, based on Dosha predominance in Amavata.

Conclusion

Ayurvedic established anti-rheumatic medicines while used with Masooradi Yoosha, showed a significant result in symptoms, functional parameters, objective parameters etc. Masooradi Yoosha, being a Pathya Aahara fulfilled first line of treatment Langhana mentioned by Aacharya Chakradatta.

Reference

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8. Uhlig, T., Moe, R.H. & Kvien, T.K. The Burden of Disease in Rheumatoid Arthritis. Pharmaco Economics 32, 841–851 (2014). https://doi.org/10.1007/s40273-014-0174-6

9. Chakradatta Ratnaprabha By Mahamahopadhyaya Sri Niscala Kara, edited by Prof. Priya Vrat Sharma Published by Swami Jayaramdas Ramprakash Trust Jaipur, 1993, Amavata Chikitsa 25/29-34 p-427

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12. Susruta, Susruta Samhita, Part I, Ayurveda Tattav Sandeepika Hindi Commentry by Ambikadutta Shastri Chaukhanbha Sanskrit Sansthan, Varanasi, Reprinted edition, 2016; Sutrasthana 46/373,374 Page-274

13. Acharya Sharangdhara, Sharangdhara Samhita, Jiwanprada Hindi commentary, 4’th edition, Chaukhambha Orientalia,2005, Madhyama Khanda 2/156, Page-158.

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Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-02	2022-04-04	2022-04-11	2022-04-18	2022-04-25
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Masooradi Yoosha

Journal of Ayurveda and Integrated Medical Sciences