E-ISSN:2456-3110

Case Report

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 11 December
Publisherwww.maharshicharaka.in

A clinical evaluation of Churna Pinda Sweda, Churna Vasti and Shamana Aushadhi in the management of Amavata (Rheumatoid Arthritis) - Two Case Reports

Majhi R.1*, Dash B.2
DOI:

1* Rajeswary Majhi, Post Graduate Scholar, PG Department of Panchakarma, Pt. Khushilal Sharma Government (Autonomous) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, PG Department of Panchakarma, Pt. Khushilal Sharma Government (Autonomous) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Amavata is a disease in which vitiation of Vayu Dosha and accumulation of Ama (undigested food) takes place in multiple joints (Sandhi). Vitiated Vayu Dosha circulates the Ama all over the body through Dhamanies, take accumulated in the Shleshma Sthana (Amashaya, Trika, Sandhi etc), producing many symptoms like body ache, indigestion, stiffness, swelling and tenderness in small and big joints with deformities making a person horrible life style. The symptoms of Amavata are more or less mimics with Rheumatoid Arthritis which is an inflammatory autoimmune disorder, guarded prognosis due to reduced life span with increase mortality rate mainly due to cardiovascular and other systemic complications. Various treatment modalities are advised in Ayurveda which are said to be root eliminating therapies or sometime Rasayana therapy. Whereas anti-inflammatory, analgesics, steroids and disease modifying antirheumatic drugs are required for its management as per modern medicine which are not free from side effects. Churna Pinda Sweda, Churna Vasti and Shamana Aushadhi are a complete treatment package which may correct the underlying pathology of the disease. Hence, in the present clinical study 2 patients were selected and kept on the advice treatment regimen Churna Pinda Sweda, Churna Vasti along with Shamana Aushadhi (Agnitundi Vati, Ajamodadi Churna and Ashtavarga Kashayam).

Keywords: Ama, Amavata, Agnitundi Vati, Ajamodadi Churna, Ashtavarga Kashayam, Vaishwanara Churna Vasti, Churna Pinda Sweda

Corresponding Author How to Cite this Article To Browse
Rajeswary Majhi, Post Graduate Scholar, PG Department of Panchakarma, Pt. Khushilal Sharma Government (Autonomous) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Rajeswary Majhi, Babita Dash, A clinical evaluation of Churna Pinda Sweda, Churna Vasti and Shamana Aushadhi in the management of Amavata (Rheumatoid Arthritis) - Two Case Reports. J Ayu Int Med Sci. 2022;7(11):215-220.
Available From
https://jaims.in/jaims/article/view/2185

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-05 2022-11-07 2022-11-14 2022-11-21 2022-11-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Rajeswary Majhi, Babita Dashand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Majhi R et al: Churna Pinda Sweda, Churna Vasti and Shamana Aushadhi in Amavata

Introduction

Amavata is a disease in which vitiation of Vata Dosha and accumulation of Ama takes place in Sandhi (joints) and cause various symptoms like pain, stiffness, swelling, tenderness of small or big joints which is identical with Rheumatoid arthritis in modern parlance.[1] Ama is the undigested food, formed by improper digestion of first Dhatu (i.e., Rasa) due to diminished power of Agni (digestive fire).[2] Obstruction of channel (Srotorodha) occurs due to accumulation of Ama, whenever that Ama gets localized in the body tissues or joints, it can lead to pain, stiffness, swelling, tenderness etc. in the related joints. RA is a chronic systemic inflammatory disease, clinically presents as polyarthritis involving small and large diarthrodial joints of extremities usually in a symmetrical pattern.[3] In Ayurveda, the Chikitsasutra of Amavata includes Sodhana as well as Shamana like Langhana, Deepana, Swedana, Virechana, Snehapana and Vasti.[4] Churna Pinda Sweda is one type of Ruksha Sankara Sweda in which various medicated herbal poweders having Ruksha, Ushna and Tikshna properties are used. Due to these properties, Churna Pinda Sweda kindled Agni and helps in digestion of Ama Dosha in tissue level. Churna Vasti explained by Acharya Chakrapani comprises of drugs possessing Ushna, Tikshna Gunas, Deepana, Pachana, Vatakaphahara and Sulasothahara effect which may help in attaining Agnideepti, Sareera Laghuta and Niramata. After Vasti Karma Shamana Aushadhi helps in kindling the Agni and digestion of Ama.[5] Hence, the present study Churna Vasti, Churna Pinda Sweda, and Shamana Aushadhi (Agnitundi Vati, Ajamodadi Churna, Ashtavarga Kashayam) has been selected for 16days as a complete treatment procedure. The Allopathic treatment provides symptomatic relief but the underlying pathology remains untreated due to absence of effective therapy. Long term use of medicines also given rise to many side effects, toxic symptoms, and adverse reactions and more serious complains, so all are looking towards Ayurveda with a great hope for a better treatment.

Case Report

Two patients namely A and B, 58 years and 48 years respectively came in the OPD of Panchakarma dept of Pt KSLGAC and institute Bhopal, MP with the complainants as follows:

Patient “A”

  • Multiple joints pain since 20years
  • Morning stiffness >45minutes
  • Tenderness
  • Swelling in MCP joints, elbow, Shoulder, knee and ankle joints
  • Re Restricted movements
  • K/C/O- HTN

Patient “B”

  • Multiple joints pain since 6months
  • No morning stiffness
  • Tenderness
  • Swelling in MCP joints, wrist, knees and ankle joints

None of the patients were having any type of addiction such as alcohol, tobacco etc. Both patients were found with RA factor positive and ESR value raised. Systemic and General Examination were done; both patients were treated on the line of management of Amavata. The treatment regimen which are given in the Ayurveda texts are aimed at restoring the equilibrium through correction of the underlying functional included accumulation of Ama and vitiated Vata.

Table 1: General Examination

  Patient ‘A’ Patient ‘B’
BP 130/90 mmHg 120/80mmHg
Pulse 82/min 78/min
Respiration Rate 18/min 17/min
Temperature 98.4F 98.6F
Sleep Disturbed Normal
Appetite Good Good
Bowel Clear Clear

Table 2: Drug Intervention with duration

SN Procedure Drugs Dose Duration
1. Churna Pinda Sweda Rasna, Devadaru, Kulatha, Yava, Satavha, Kushtha, Haridra, Methika Each Pottali contains 200gm 16days
2. Churna Vasti Vaishwanara Churna Total 570ml Ushna Jala-300ml, Kanji-150ml, Churna-50gm, Saindhavadi Taila-60ml, Saindhava-10gm 12days
3. Anuvasana Vasti Saindhavadi Taila 100ml 4days
4. Shamana Drugs (Orally) Agnitundi Vati Ajamodadi Churna Ashtavarga Kashayam -125mg twice a day -5gm twice a day -10ml twice a day 16days

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Majhi R et al: Churna Pinda Sweda, Churna Vasti and Shamana Aushadhi in Amavata

Criteria of Assessment

The assessment was done based on subjective and objective parameters as per CCRAS.

Table 3: Clinical assessment

Joint pain

SL Severity of pain Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. No pain Zero Zero - -  - 0
2. Pain occasional, can be managed without drug I 2 - 2 2 -
3. Pain frequent and can be managed with some pain killer II 4 4 - - -
4. Pain persistent and unmanageable even with drugs III 6 - - - -


Morning stiffness

SN Morning stiffness Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. No stiffness Zero 0 - - 0 0
2. Early morning stiffness up to 30minutes I 2 - - - -
3. Early morning stiffness more than 30minutes and less than 45minutes II 4 - 4 - -
 4. Early morning stiffness more than 45minutes III 6 6 - - -


Tenderness

SN Tenderness Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. No tenderness Zero 0 - - - -
2. Tender but bearable I 2 - - - 2
3. Tender and winced II 4 - 4 4 -
4. Tender winced and withdraw III 6 6 - - -


Swelling

SL Severity of swelling Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. No swelling/not making the bony land marks of joints Zero 0 - - - 0
2. Just covering the bony prominences I 2 - 2 2 -
3. Considerably above the land marks may be with positive fluctuation II 4 4 - - -
4.   III 6 - - - -

 

SL Name of the involved joint Before treatment (1st day) Measurement in mm After treatment(16thday) Measurement in mm
Patient ‘A’ Patient ‘B’ Patient ‘A’ Patient ‘B’
1. Rt MCP joints 250mm 260mm 240mm 240mm
2. Lt MCP joints 240mm 270mm 230mm 240mm
3. Rt Wrist - 190mm - 180mm
4. Lt Wrist - 180mm - 170mm
5. Rt Elbow 260mm - 240mm -
6. Lt Elbow 250mm - 240mm -
7. Rt Shoulder - - - -
8. Lt Shoulder - - - -
9. Rt Knee 390mm 400mm 390mm 370mm
10. Lt Knee 380mm 410mm 380mm 370mm
11. Rt Ankle 270mm 280mm 260mm 260mm
12. Lt Ankle 240mm 270mm 240mm 260mm


Functional assessments

Walking time

 Walking time in seconds(150ft)
 Before treatment (1st day)  After treatment (16th day)
Patient ‘A’ Patient ‘B’ Patient ‘A’ Patient ‘B’
1min 7sec 31sec 1min 19sec

 Grip power

SN Grip power Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. Between 50-55mmHg Zero 0 0 - - -
2. Between 56-65mmHg I 2 - 2 - -
3. Between 66-75mmHg II 4   - - -
4. Between 76-85mmHg III 6 - - - -
5. 86mmHg and above IV 8 - - 8 8


Assessment of objective criteria

SN ESR (mm/1st hr) Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. <20 Zero 0 - - - 0
2. 21-40 I 2 - 2 - -
3. 41-60 II 4 - - 4 -
4. 61-80 III 6 6 - - -
5. >80 IV 8 - - - -

 

SN RA Factor Grade Score Patient ‘A’ Patient ‘B’
BT AT BT AT
1. Negative Zero 0        
2. Positive I 2 -   2  
3. Strongly positive II 4 2   -  



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Discussion

In this case studies both patients were suffering from this disease having different kind of manifestation in the symptoms, disease chronicity, Doshik predominancy etc. The patient B was having acute symptoms with main involvement of Ama especially. So, the relief was observed better as the direct action of CPS and Churna Vasti was Ama only. As soon as the Ama get eliminated by Churna Vasti pathological breakdown was observed in the disease chain. Later the remaining Vata Dosha get pacified by Shamana medicine (Agnitundi Vati, Ashtavarga Kashayam) and Churna Pinda Sweda. The result was observed in relieving joints pain, swelling and restricted movement. Decreased value of RA factor and ESR also observed after 16days of the total treatment duration. In the patient A the relief was observed in a different manner which was mild in comparison to patient B, here the manifestation of the symptoms and the Doshik predominancy was different. In this case the chronicity of the disease was 20years and the main symptom was joint pain due to involvement of Vata Dosha especially. The symptoms of Ama was very less in comparison to patient B. The patient was suffering from insomnia, abdominal pain, acidity and HTN etc. The Pravruddha Lakshana of Amavata was dominant in this case. In Jirna Amavata the main dominancy is Vata Dosha along with Ama (Dhatwagnimandyajanya Ama). Vasti chikitsa along with Rasayana therapy has proven its best efficacy in Jirnavastha of the disease.

Probable Mode of Action of Churna Pinda Sweda, Churna Vasti and Shamana Aushdhi

Churna Pinda Sweda: Churna Pinda is one type of Ruksha Shankara Sweda comprising of Ruksha, Ushna and Tikshna properties. The Swedana Karma is a type of thermotherapy in which heat is applied for the purpose of increasing vasodilation, decreasing viscosity, changing in nerve conduction, increasing metabolic rate and Swedana used for rehabilitation purpose for increasing the extensibility of collagen tissues, decreasing joint stiffness, reducing pain, relieving muscle spasm, reducing inflammation and heaviness in the body. Ushna Guna of Swedana causes stimulation of sympathetic nervous system and as vasodilation. It also increases the circulation of Rasa and Rakta in the body.

An additional 1 degree increasing body temperature causes enough sweating to remove 10 times of the basal rate of heat production. Due to the effect of Sara and Ushna Guna of Swedana Dravya the Lina Dosha are liquified in the body and come out through micropores present over the skin of sweat gland. Temperature receptors are present in the skin and some specific deep tissue of the body. Churna Pinda Sweda by virtue of its properties of Swedana drugs employs 2 important mechanism that is vasodilatation and sweating induction.

Churna Vasti: Churna Vasti comprises drugs possessing Ushna and Tikshna Gunas, Deepana, Pachana, Vatakaphahara and Shulahara effect which help in attaining Agnidipti, Sareera Laghuta and Niramata.Vasti Dravya after administration reach up to the level of Nabhi, Kati, Parshwa and Udara and produces cleansing effect.[6] Vasti influence all over the body through it administer through rectum and removes the vitiated Doshas especially Vata Dosha and also Pitta and Kapha to some extent. It helps in pacifying vitiated Vata Dosha due to it’s Vatanulomana effect. Most of the drug in Vaishwanara Churna Vasti are having Laghu, Ruksha Guna, Katu Vipaka and Ushna Virya which causes Deepana, Pachana and Amahara effect later which helps in pacifying Amadosha produced in tissue level (Dhatwagnimandhyajanya Ama).[7] The Dushya involved in Amavata is especially Rasa Dhatu due to hypofunctioning of Agni, the Ama produced in Jatharagni level as well as in Dhatwagni level gets eliminated out by potency of the Vasti dravyas. Due to Deepanapachana action there will be proper formation of Ama. Due to Deepana action the further Ama formation is prevented. Dhatugat Ama is mainly counteracted by the prevention of production of Ama in Dhatu level. Vasti Dravya may act by stimulating peristalsis due to their large volume or they cause osmotic retention of water in the bowel. Rectal veins drain the lower part of the rectum and enter into the inferior vena cava and bypass the liver before entering the general circulation. Rapid degradation of a drug by the liver during the first pass or by the gut wall also affects the bioavailability. Thus, a drug though absorbed well when given orally may not be effective because of its extensive first pass metabolism. If first pass metabolism decreases, the bioavailability of drug increases. Increased vascularity can increase absorption.



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Shamana Aushadhi - All the Shamana drugs having Amapachaka, Jwarahara, Sothahara, Kaphavatahara effects and Kindle the Agni.

Conclusion

Churna Vasti, Churna Pinda Sweda along with Shamana Aushdhi showed remarkable symptomatic and observable relief in the features of Amavata. This observation needs to be studied in more number of patients for better assessment in the management of Amavata (RA).

Reference

1. Upadhyaya Prof. Yadunandana. Madhav Nidan, ed-2003, Chaukhambha Sanskrit Bhawan, Varanasi, Ch.25 Vol.1.p.509

2. Tripathi Brahmananda. Astanga hrridayam. Vanarasi. Chaukhamba Sanskrit pratishthan publication: Edition 2017. Sutra sthan Ch.16 Vol.1.p.188

3. API text book of Medicine.10th ed. New Delhi: Jaypee Brothers Medical Publishers(P) Ltd.:2015.6th chapter (Vol-2). p.2492.

4. Tripathi dr. Indradev, Chakradatta,3rd ed.1997, Chaukhambha Sanskrit Sansthan, Varanasi, Chapter-25, verse-1.

5. Gaur Prof. Banwari Lal. Charaka Samhita, Shree Chakrapanidattavirachita Ayurveda Deepika 1st ed-2014 Rashtriya Ayurveda Vidyapeeth, Delhi, Siddhi sthan Ch.10. Vol-IV.verse-13-14.p.999

6. Gaur Prof. Banwari Lal. Charaka Samhita,Shree Chakrapanidattavirachita Ayurveda Deepika 1st ed-2014 Rashtriya Ayurveda Vidyapeeth, Delhi, Siddhi sthan Ch.1..Vol-IV.verse-40.p.773

7. Mishra Prof. Sidhinanda, Bhaishajya Ratnavali,Kabiraj Shreegovind das sen virachita, Chaukhambha Surabharati Prakashan,Varanasi, Chapter-29,Verse-46-49.p.599


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