E-ISSN:2456-3110

Case Report

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Role of Basti Karma (Kala Basti Erandmuladi Niruha Basti + Saindhavadi Anuvasan Basti) in Amavata - A Case Study

Yadav V.1*, Meshram R.2, Sharma S.3
DOI:

1* Veenu Yadav, Post Graduate Scholar, P.G. Department of Kayachikitsa, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

2 Rajesh Meshram, HOD and Associate Professor, P.G. Department of Kayachikitsa, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

3 Shraddha Sharma, Assistant Professor, P.G. Department of Kayachikitsa, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.

Background:  Amavata is one of the commonest disorder of joints caused by impairment of Agni (digestive fire), formation of Ama and vitiation of Vata Dosha. The Ama is carried out by the aggravated Vata and deposited in Sleshmasthanas producing features like Angamarda (body ache), Aruchi (loss of appetite), Sandhiruk (joint pain), Sandhisopha (joint swelling). It is closely correlated with RA according to clinical features. Method: Female patient IPD No 2022718 of age 45years admitted in IPD diagnosed as RA. Patient was treated with Shodhana and Shamana drugs. Singnada Guggul 500mg twice a day, Panchkola Phanta 20 ml twice a day, Ajmodhadi Churna + Godanti Bhasma (twice a day) for 1 month and Baluka Sweda (HS), Sarvang Patra Pinda Sweda and Kala Basti plan (Erandmuladi Niruha Basti + Saindhavadi Anuvasan Basti). Result: Patient got relief in pain, swelling & morning stiffness (assessed by CCRAS criteria) and also shows serological changes. Conclusion: Amavata is a complicated disease, the purpose of treatment in Amavata to minimize ama through its metabolism and to normalise the two vitiated Vata and Kapha Dosha. Erand Taila have properties like anti-inflammatory, anti-rhematic, laxative, analgesic are the major remedial attributes. Singnada have Vata & Kaphahara properties and Guggul having Kaphahara, Vedanahara, Shophahara properties.

Keywords: Amavata, Rheumatoid Arthritis, Ayurveda

Corresponding Author How to Cite this Article To Browse
Veenu Yadav, Post Graduate Scholar, P.G. Department of Kayachikitsa, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India.
Email: 		Veenu Yadav, Rajesh Meshram, Shraddha Sharma, Role of Basti Karma (Kala Basti Erandmuladi Niruha Basti + Saindhavadi Anuvasan Basti) in Amavata - A Case Study. J Ayu Int Med Sci. 2023;8(1):165-169.
Available From
https://jaims.in/jaims/article/view/2236

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-28 2022-11-30 2022-12-07 2022-12-14 2022-12-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Veenu Yadav, Rajesh Meshram, Shraddha Sharmaand 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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Yadav V et al: Role of Basti Karma in Amavata

Introduction

Amavata is a disease of Asthivaha and Rasavaha Strotas. When Ama and Vata simultaneously get vitiated and enters the Trika and Sandhi ultimately leads to Stabdhata (stiffness) of the body, the circumstance is known as Amavata.[1] Ayurveda Acharya, Sri Madhavakara in his book Madhava Nidana described the features of Amavata for the first time.[2] Whereas the treatment of Amavata was first explained by Acharya Cakradatta. Acharya Madhavkara has clearly cited the Roopas (signs & symptoms) of Amavata in Madhav Nidana. The Pratyatma Laksana (Main symptoms) are Gatrastabdhata, Sandhishula, Sandhishoth, Sparshasahyata and Samanya Laksana (General symptoms) are Angmarda, Aruchi, Trishna, Alashya, Gaurav, Jvara, Apaka, Angasunnata.[3] According to the clinical features Amavata very closely resembles with the rheumatoid arthritis. In modern Rheumatoid arthritis (RA) is a long-term autoimmune disorder that specially influences joints.[4] Rheumatoid arthritis is a chronic, progressive autoimmune arthropathy and characterized by bilateral symmetrical involvement of joints with some systemic clinical features.[5] The ailment may additionally also influence other parts of the body. This can also result in a low red blood corpuscles count, inflammation round the lungs, and inflammation around the heart. Fever and low energy might also be present. The treatment modalities like Langhana (fasting therapy), Swedana (fomentation therapy), use of drugs having Tikta Katu Rasa (bitter and pungent taste), Deepana (kindling digestive fire) property, Snehapana (oral intake of Ayurvedic medicated ghee), Virechana (purgation therapy), Vasti (enema) etc. are the treatments advised.

Aim and Objective

To assess the role of Kala Basti (Erandmuladi Kwath + Saindhavadi Taila) in the management of Aamvat (RA).

Materials and Methods

Source of patient

For this study, patient was taken from the IPD of Pt. Khushilal Sharma Govt. Ayurveda College and Institute Bhopal MP.

Case Study

Female patient IPD No 2022718 of age 45years admitted in IPD of Ptkls Bhopal with complaint of pain and swelling in B/L knee joint, pain in interphalangeal joints, restricted movement of right leg, morning stiffness (20-30min) with loss of appetite and on/off fever.

History of past illness: No

Surgical history: Caesarean 10 years back

Personal History
Diet - Mixed diet, prefers spicy.

Appetite - Decrease

Bowel - Clear

Bladder - Normal

Sleep - Disturbed due to pain.

Allergy and addiction - Nil.

Examination
Ashtavidha Pariksha

  • Nadi (Pulse) - Vata-Kapha, 80/ min.
  • Mootram (Urine) - Normal
  • Malam (Stool) - Normal
  • Jivha (Tongue) - Upalipta (Saam - Coated)
  • Shabdam (Voice) - Normal
  • Sparsham (Touch) - Normal but warmth all over body.
  • Drika (Eyes) - Normal
  • Aakriti (Built) - Moderately, no deformities

Local examination
Swelling on both knee joints and deformities in interphalangeal joints.

Tenderness on both knee joints

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Yadav V et al: Role of Basti Karma in Amavata

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Range of movements - Restricted & painful movement of joints.

Investigation

Hb - 10gm%

RA factor - Positive

ESR - 25/mm

Anti CCP - 124 RU/mL

Serum Uric Acid - 6.0mg/dl

CT Left Knee - Mild left knee joint effusion.

CT Right Knee - Mild osteoarthritis changes in knee joint. Mild right knee joint effusion.

Few small bone cysts are seen in lateral tibial condyle.

jaims_2236_03.JPG

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Differential Diagnosis: Aamvata, Sandhivat, Vatarakta

Treatment plan

Shamana Chikitsa

  • Snignada Guggul 500mg twice a day 30days
  • Panchkola Phanta 20 ml twice a day 15days
  • Rasraj Ras 1 tab twice a day 15 days
  • Ajmodadi Churna (2gm) + Godanti Bhasma (125mg) twice a day

Shodhana Chikitsa: Kala Basti plan (Erandmuladi Kwath + Saindavadi Taila) with Sarvang Patra Pinda Sweda

Kala Basti schedule

Day Basti Dose Time of Basti Adanakala Time of Basti Pratyagamana Kala
1. A 100ml 11:00am 2:00pm
2. A 100ml 10:40am 3:00pm
3. N 400ml 10:30am 10:35am
4. A 100ml 11:00am 2:30pm
5. N 400ml 10:40am 10:50am
6. A 100ml 10:20am 4:00pm
7. N 400ml 10:00am 10:07am
8. A 100ml 11:15am 3:30pm
9. N 400ml 10:15am 10:24am
10. A 100ml 10:30am 3:40pm
11. N 400ml 10:00am 10:15am
12. A 100ml 11:00am 3:05pm
13. N 400ml 10:30am 10:40am
14. A 100ml 10:35am 2:20pm
15. A 100ml 10:30am 3:15pm
16. A 100ml 10:35am 3:20pm

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Yadav V et al: Role of Basti Karma in Amavata

Observations and Results

SN Symptoms   Score BT AT
1. Joint pain No pain 0 3 0
Pain occasional, can be managed without drug 1
Pain frequent and can be managed with some pain killer 2
Pain persistent and unmanageable even with drugs 3
2. Morning stiffness No stiffness 0 2 1
Early morning stiffness upto 30 minutes 1
Early morning stiffness more than 30 minutes and less than 45 minutes 2
Early morning stiffness more than 45 minutes 3
3. Tenderness No tenderness 0 2 0
Tenderness but bearable 1
Tenderness and winced 2
Tenderness winced and withdraw 3
4. Swelling No swelling 0 2 0
Just covering the bony prominences 1
Considerably above the land mark may be with positive fluctuation 2
5. Gait Normal gait 0 2 1
Pain occasionally 1
Walk with support or mild pain 2
Walk with support with severe pain 3
Unable to walk 4

Discussion

Amavata occur due to vitiation of Vata Dosha and accumulation of Ama in our body. Vriuddh Aahar and Vihara Sevana leads to Agnimandhya in our body. Aacharya Charaka said that Agnimandhya is the main cause of every disease. This Agnimandhya leads to Ama Dosha accumulation in our body. Ama Dosha and aggravated Vata goes to Kapha Sthana like Sandhi, Aamashya, Hridya etc. Leads to Sarvadehik symptoms like Goravata, Daurbalya, swelling, stiffness and pain in whole joints especially smaller joints. So, in that case improving Jatharagni and removal of Ama from body is the main aim of treatment. We gave some Vatahara Aushadhi to control vitiated Vata and also some Deepana Pachana Aushadhi to remove Ama Dosha.[6] Basti also a good procedure for vitiated Vata as said by Aacharya Charaka plays an important role in removal of vitiated Vata and Ama Dosha. Erandmuladi Basti by their Laghu (lightness),

Ruksha (dryness), Ushna (hotness) and Tikshna (sharpness) Guna reaches to Pakwasaya which is the main seat of Vata Dosha and destroys Vata Dosha. From there it reaches to whole body and destroy the doshas accumulated in the whole body. Sneha Dravya present in Basti by its Sukshma (subtle) Guna enters into Sukhsma Srotas to reach the Grahani. Here, it acts on Samana Vayu, which lies in the near the seat of the Jatharagni leads to ignition of Jatharagni. So, Erandmuladi Basti performs the function of Apana Anulomana and hence increases the Jatharagni which are the main cause of Aamvat.

Godanti Bhasma acts on Tridosha specially Pitta Dosha helps in ignition of Jatharaagni and malaise occur in Amavata. It also improves muscle strength and immunity.

Ajmodadi Churna contains Ajamoda, Vacha, Kutha, Amalvetas, Saindha Namak, Sajjkshar etc. All medicines have Ushna Virya and having Deepana Pachana properties help in ignition of Jatharagni and elimination of Ama Sanchaya in whole body. Also help in removal of vitiated Vata Dosha thus help in breakdown of pathogenesis of Amavata. Eranda Taila have valuable therapeutic properties such as Anti-inflammatory, emmenagogue, anti-infectious, anti-rheumatic, fungicidal, laxative, immune stimulant, insecticidal, anti-viral, labour inducing, anti-allergic, anthelmintic, rejuvenate, anti-aging, germicidal, disinfectant, and analgesic are the major remedial attribute.[7]

Conclusion

The symptoms are produced due to the vitiation of Vata (biophysical force) along with the formation of Ama (bio-toxin). The Ama is carried by the aggravated Vata and deposited in Sleshmasthanas (Seats of biophysical force, Kapha like joints etc.) producing features like Angamarda (body ache), Aruchi (loss of appetite), Alasya (weakness), Sandhiruk (joint pain), Sandhisopha (joint swelling) etc. The treatment modalities like Langhana (fasting therapy), Swedana (fomentation therapy), use of drugs having Tikta Katu Rasa (bitter and pungent taste), Deepana (kindling digestive fire) property, Snehapana (oral intake of Ayurvedic medicated ghee), Virechana (purgation therapy), Vasti (enema) etc. are the treatments advised. The treatment modalities done showed marked improvement in the patient’s signs and


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symptoms and blood investigations and hence was found fruitful.

Reference

1. Madhukara, Madhav Nidana, Vimla Madhudhara Teeka by Tripathi Brahmanand, Chaukhambha Surabharati Prakashana, Varanasi, ed. 2010, Poorvardha adhyaya 25, page 571-577.

2. Madhav Sastri N, Madhukara, Madhav Nidana, Vijayrakshita, Chaukhambha Prakashan, Varanasi, Revised edition reprint 2009.

3. Tripathi Ravidatta, Charaka Samhita Hindi commentary, Chaukhambha Sanskrit Pratisthan, Delhi,2009 Ni8

4. Shah Ankur, E.William St. Clair, Harrison’s Principles of Internal Medicine Volume 2, 18th edition, Chapter 321

5. Arnett, F.C., Rheumatoid Arthritis, Cecil textbook of medicine, Goldman, L. and Benett, J.C., Eds., W.B. Saunders, 2000, Chapter 21.

6. Madhukara, Madhav Nidana, Vimla Madhudhara Teeka by Tripathi Brahmanand, Chaukhambha Surabharati Prakashana, Varanasi, reprint 2014, Chapter 25.

7. Deshpande A P, Dravyaguna Vigyan, Anamol Prakashan Pune, 1st ed., Chapter no.105, 2004, p. 646-647.


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