E-ISSN:2456-3110

Research Protocol

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 3 March
Publisherwww.maharshicharaka.in

A comparative clinical study of Erandbeejadi Gutika and Pippalyadi Gana Kashaya with external application of modified Ruksha Pottali Sweda in the management of Amavata

Upadhyay B.1*, Ojha A.2, Diwan R.3, Lal Sahu J.4
DOI: http://dx.doi.org/10.21760/jaims.8.3.8

1* Byomesh Upadhyay, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt. Ayurveda College, Raipur, Chhattisgarh, India.

2 Aruna Ojha, Professor & HOD, Department of Kayachikitsa, Shri NPA Govt. Ayurveda College, Raipur, Chhattisgarh, India.

3 Rashmi Diwan, Lecturer, Department of Kayachikitsa, Shri NPA Govt. Ayurveda College, Raipur, Chhattisgarh, India.

4 Jeevan Lal Sahu, Lecturer, Department of Kayachikitsa, Shri NPA Govt. Ayurveda College, Raipur, Chhattisgarh, India.

Background: Amavata is a very challenging and burning problem in society. The clinical presentation of Amavata is closely related to the special variety of musculoskeletal disorder rheumatoid arthritis (RA). There is no medical system that is successful in providing a complete cure for the disease, so the Ayurvedic approach toward the treatment of Amavata is needed in the present era. The prevalence of RA is approximately 1% of the total population. For the management of RA in allopathic science, DMARDs & steroids are used frequently. Due to the lack of effective drugs and major problem in society, this disease for the study has been selected. Aim and Objectives: To study the efficacy of Erandbeejadi Gutika and Pippalyadi Gana Kashaya with modified Ruksha Sweda in the management of Amavata (RA). Methodology: It will be a single-center, randomized, open-clinical study. In this study, 60 clinically diagnosed patients of Amavata were selected and randomly divided into two groups by coin method. Erandbeejadi Gutika will be given in the dose of two tablets (each 500 mg) four times in a day with lukewarm water before meal for 90 days along with the modified Ruksha Pottali Sweda, while Pippalyadi Gana Kashaya will be given 50 ml two times in a day before the meal along with the modified Ruksha Pottali Sweda. Statistical analysis will be done using the Wilcoxon matched-pairs signed ranks test for the analysis of nonparametric data, while paired t-test will be used for parametric data analysis, and mann-whitney test and unpaired t-test will be used for intergroup comparison.

Keywords: Amavata, Erandbeejadi Gutika, Pippalyadi Gana Kashaya, Ruksha Pottali Sweda

Corresponding Author How to Cite this Article To Browse
Byomesh Upadhyay, Post Graduate Scholar, Department of Kayachikitsa, Shri NPA Govt. Ayurveda College, Raipur, Chhattisgarh, India.
Email: 		Byomesh Upadhyay, Aruna Ojha, Rashmi Diwan, Jeevan Lal Sahu, A comparative clinical study of Erandbeejadi Gutika and Pippalyadi Gana Kashaya with external application of modified Ruksha Pottali Sweda in the management of Amavata. J Ayu Int Med Sci. 2023;8(3):46-50.
Available From
https://jaims.in/jaims/article/view/2335

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-01-21 2023-01-24 2023-01-31 2023-02-07 2023-02-14
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2023by Byomesh Upadhyay, Aruna Ojha, Rashmi Diwan, Jeevan Lal Sahuand 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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Upadhyay B et al: Erandbeejadi Gutika and Pippalyadi Gana Kashaya Ruksha Pottali Sweda

Introduction

In the 7th century, Acharya Madhava emphasizes that systemic disorder occurs when the digestive and metabolic mechanism is involved. In text 25th chapter the main symptoms of Amavata are clearly described. Amavata is a Krichchhsadhya disease (Chronic), which if not treated on time becomes Yapya and Pratyakhyeya (Incurable) in the future. In which the daily routine of the patient gets affected and the patient becomes unable to work.[1] The main problem with this disease is that Shool, Shotha & Stabdhta (pain, swelling & stiffness) patients face severe pain & swelling in the disease and daily take painkillers, etc. for it which affects the daily routine of patients. There are currently about 23 million people affected by RA worldwide male-female ratio is 1:3. The life expectancy of patients is reduced by 25% in this disease. Because of DMARDs and Steroids drugs, the risk of infection increases & they are immunosuppressive in nature as well, according to their texts.[2] In the Ayurvedic management of Amavata, the Ayurvedic drugs work multidimensional actions like they work at the Jathragni level which corrects the pathogenesis of Aam and works as an immunomodulator. Also, they have properties of analgesic, anti-inflammatory, antistress, and antioxidant. There is no risk of infection and the least side effects if they use proper Matra (dose), Anupana & Kala (time).

Hence, in the article, Erandbeejadi Gutika[3] & Pippalyadi Gana Kashaya[4] were selected as Shaman Yoga. The drug chosen for research were Erandbeejadi Gutika from Yogrartnakar Amavata Chikitsa Ghritkalkavlepan Yog 2 and Pipplyadi Gana Kashaya from Sushruta Sutra 38/22, modified Ruksha Sweda reference by Yogratnakar Purvardh Amavata Chikitsa 2.

Pathophysiology: In the Ayurvedic concept Amavata is defined as the state in which there is simultaneous vitiation of Vata Dosha and accumulation of Ama. Ama is an undigested product of what we take as diet; Ama is not homogeneous for the body. Whenever Ama gets localized in the body tissue or joints (Trik Sandhi), with aggravated Vata it can lead to the production of Shotha, Shoola & Stabdhata (pain, stiffness and swelling). In modern science, it is correlated to rheumatoid arthritis (RA). It is a chronic autoimmune inflammatory systemic disease.

Lean this; the body's immune system attacks its tissue, which affects synovial joints with e lar manifestations. In this, bilateral peripheral joints are involved symmetrically. Main symptoms extraarticular of RA joint inflammation, pain, loss of function, and eventual joint destruction and deformity.

One prevalent theory is that a combination of factors trigger RA including-

1. Abnormal auto-immune response

2. Genetic susceptibility

3. Environmental of biologic trigger-

a. infectious agents - Bacteria, Virus.

b. Hormones

c. Allergy

4. Others - Previous history of Rheumatic fever

5. Overwork and psychological stress (psychological factors)

Predisposing factors - (check cause) Heredity, Climate, Trauma, Age, Sex, Body humor.

Aim and Objectives

Role of Erandbeejadi Gutika, Pippalyadi Gana Kashaya and Ruksha Pottali Sweda in the management of Shotha, Shoola, Stabdhata (pain, swelling & stiffness) in Amavata.

1. To study the efficacy of Erandbeejadi Gutika in Shotha, Shoola & Stabdhata (pain, swelling & stiffness) in Amavata.

2. To study the efficacy of Pippalyadi Gana Kashaya in Shotha, Shoola & Stabdhata (pain, swelling & stiffness) in Amavata.

3. To study the efficacy of Ruksha Pottali Sweda in Shotha, Shoola & Stabdhata (pain, swelling & stiffness) in Amavata.

5. To study any adverse effect of Erandbeejadi Gutika, Pippalyadi Gana Kashaya & Ruksha Pottali Sweda.

Materials and Methods

Selection of patient: Patients of Amavata will be selected from Kayachikitsa OPD and IPD of Shri NPA


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government Ayurved College and Hospital, Raipur C.G. The case selection will be done considering age, sex, occupation and socio-economic conditions. Both acute and chronic phases of Amavata patients will be taken for the study, following the ACR criteria of the diagnosis of RA in modern medicine and the clinical features of Amavata described in Madhava Nidana.

Inclusion criteria

1. The patients between the age group of 18-60 years of either sex showing the clinical features of Amavata like pain, stiffness, and swelling in multiple joints.

2. Patient diagnosed for RA based on ACR criteria.

Exclusion criteria

1. Patients of age below 18 years and above 60 years of either sex.

2. Patients having severe crippling deformities.

3. Patients suffering from paralysis.

4. Patients having neoplasm of the spine, gout, ankylosing spondylitis, traumatic arthritis, and pyogenic osteomyelitis

5. Patients having associated cardiac disease, pulmonary tuberculosis, uncontrolled diabetes mellitus, malignant hypertension, renal function impairment, etc.

6. Pregnant women and lactating mother.

Drugs and method of its preparation

Erandbeejadi Gutika: This has been selected for this study and has been taken from Yog Ratnakar Amavatachikitsa which contains Erandbeej Majja (Ricinus communis Linn), Shunthi (Zingiber officinale Rosx.) and Sharkara (Saccharum officinarum Linn.). The Gutika are of 500 mg each.

These drugs like Erand and Shunthi are Ushana Virya and Madhur Vipak Dravya. They have properties of Vatkaphahar, Aampachan, Shoolaprashaman and also in the modern view of these work as an anti-inflammatory, analgesic effect. Sharkara is Balya medicine and works in equilibrium with these drugs.

Pippalyadi Gana Kashaya: Pippali, Pippalimula, Chavya, Chitrak, Shunthi, Marich, Hastipipplali, Nirgundi, Ela, Ajmoda, Kutaj, Patha,

Jeerak, Sharshap, Mahanimb, Hingu, Bharangi, Moorva, Ativisha, Vacha, Vidang, Katurohini, the Kashaya will be used.

Most of these drugs have Katu, Tikta Ras, Ushna Virya, and Katu Vipaka. They have properties of Vatakaphahar, Shoola Prashman, Aampachan, Balya, Deepan, and Shothahar. In a modern way, they are anti-inflammatory, analgesic, antiarthritic, antispasmodic action in the body.

Both medicines will be made with same ratio of each drug and the materials will be procured and prepared in GMP certified pharmacy of the institute.

Modified Ruksha Pottali Sweda[5]

Ingredient: Baluka (50%) + Shunthi + Yava + Saindhav Lavan + Methi + Shatpushpa (50%)

The application of heat & there by inducing perspiration by using a heated pack of sand is known as Baluka Sweda. Here in Baluka Sweda, the body part is subjected to a sudation procedure with the proper application of Yava, Shunthi, Shatpushpa, Methi & Saindhav Lavan. They all have the unique feature of reducing pain, stiffness and swelling in Amavata treatment. For the same reason in diseased conditions like Amavata where Sneha is contraindicated Swedana is done by this procedure. This Ruksha Sweda helps in the rectification of the imbalance of Kapha Dosha as well as the alleviation of Ama Dosha. The unique therapeutic effect of this procedure is Kaphahara (beneficial in the treatment of Kapha Dosha) and Shotha Shoolahara (alleviates the pain & swelling).

It has Amanashak effects in disorders caused due to Ama Dosha.

Management of Amavata in Ayurveda the concept of Samprapti, and the use of Deepan and Pachan medicines will be beneficial; mainly to reduce the formation of Aam Dosha and the use of Vatahar medicines will be beneficial.

Observations and Results

A total of 60 patients will be registered for the study of either gender, between the age group of 18-60. Two groups will be made in the present study for managing the disease Amavata. In this study effect of the drugs in each group will be observed by the clinical signs and symptoms mentioned in Ayurvedic classics, Both acute and chronic


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phases of Amavata patients will be taken for the study, following the ACR criteria of the diagnosis of RA in modern medicine and the clinical features of Amavata described in Madhava Nidana., Health Assessment Questionnaire for RA, Visual Analog Scale (VAS), WOMAC Index criteria. The improvement in the patient will be observed based on Roga Bala, Agni Bala, Deha Bala, and Chetasa Bala. Effect of the Erandbeejadi Gutika, Pippalyadi Gana Kashya and Ruksha Pottali Sweda will be assessed in Pratyatma Lakshan and Samanya Lakhshan and Upadrava of Amavata and RA Factor, C-Reactive Protein, CBC, ESR, EULAR Criteria, DAS Criteria (DAS 28). The side effect of the drugs also will be observed.

The result will be discussed parameter-wise with the help of Statistical Analysis. Statistical analysis will be done using the Wilcoxon matched-pairs signed ranks test for the analysis of nonparametric data, while paired t-test will be used for parametric data analysis, and the Mann-Whitney test and unpaired t-test will be used for intergroup comparison.

Discussion

Based upon the Ayurvedic concepts of pathophysiology the strategy consists of the -

Treatment Pattern Drugs
Aamvishahar (Immunomodulation) Katuki, Chitrak, Shunthi
Asatymahar drug (Antiallergic) Marich, Patha, Vacha, Shunthi
Rasayan (Antioxidant) Nirgundi, Bharangi, Pippali
Shothahar / Shoolahar (Antiinflammatory / Analgesic) Haridra, Pippali, Ela, Ajmoda, Jirak
Drugs especially for Amavata Erand
Antiarthiritic Nirgundi, Patha
Antispasmodic Ajmoda, Hingu

As we know Erand is among those who kill the great Gaja (Elephant) like Amavata, who roams in the forest of the body Erand affection is enough like a lion alone. Also, Pippalyadi Gana Kashaya has Pippali and more drugs which are very useful for Deepan, Pachan, Shothahar and Shoolahar drugs. According to the nature of the disease, it is essential to plan such therapy which has Ama and Vatahara properties. The line of treatment described for the disease includes Langhana and Swedana use of Tikta and Katu drugs.

This study has been undertaken to evaluate the role of the Shamana drug along with Ruksha Pottali Sweda.

Conclusion

There is no well-recognized defense strategy in modern medicine. Hence the management of this disease is merely insufficient in other systems of medicine and patients are continuously looking with hope towards Ayurveda to overcome this challenge. However, Ayurveda primarily uses a defense strategy in the management of the disease. According to the Ayurveda understanding of the pathophysiology of a disease, disequilibrium of doshas occurs at the Strotas level of physiology and of the gastrointestinal tract to cause immune response and inflammation. For the present review, on Amavata as Shaman therapy, the medicine is a suitable natural product that will make it possible for patients to live a high quality of life along with reducing the specific symptoms of pain, swelling & stiffness. These medicines have properties of Deepan, Pachan, Shoolahar & Shothahar without any side effects. Considering the magnitude of Amavata, Erandbeejadi Gutika, Pippalyadi Gana Kashaya & modified Ruksha Pottali Sweda surely a positive effect will be seen in the management of Amavata.

Reference

1. Acharya Yadunandan Upadhyay, Madhav Nidan Purvardh (Madhukosh Vyakhya), Vikram samvat 2070, Chaukhambha Prakashan. Madhav Nidan 25/5 Page no. 509.

2. Aspi F golwalla, Shahrukh A. golwalla,Golwalla”s medicine, 23rd edition 2011 , Neel graphics , Rheumatoid arthritis, Page no 888-899.

3. Vaidya lakshmipati shastri, yogaratnakar purvardh vidyotini tika, Vikram samvat 2072, aamvaat chikitsa adhyaya ghritkaval avlepanadi yog shlok 3, page no 571

4. Ambika dutt shastri. Sushrut Samhita hindi vyakhya,Vikram samvat 2075,chaukhambha prakashan, dravyasangrahaniya adhyay 37/22,page no.184

5. Vaidya lakshmipati shastri, yogaratnakar purvardh vidyotini tika, Vikram samvat 2072, aamvaat chikitsa adhyaya shlok 2, page no 566.

6. Bulusu sitaram, Bhavprakash of bhavmishra,volume II reprint 2017, chaukhambha orientalia,Page no. 209.


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7. Clinical research protocol for traditional health science, edition 2010, CCRAS, Page no. 187-188-189.

8. G.Prabhakar Rao, Cakradatt chikitsa samgrah,Edition 2014, Chaukhambha prakashan, Aamvat chikitsa adhyay 25/1, Page no. 264

9. Government of India Ministry of health and family welfare department of Ayurved, yoganaturopathy, unani, siddha & homeopathy (AYUSH) New Delhi, The Ayurvedic Pharmacopoeia of India, part-1, vol-1, Delhi, The controller of publications civil lines, Delhi- 110054.p. no. 3-4,27-28,39-40,64-65,101-102,107-108-109,122-123,138-139,163-164.

10. Government of India Ministry of health and family welfare department of Ayurved, yoganaturopathy, unani, siddha & homeopathy (AYUSH) New Delhi, The Ayurvedic Pharmacopoeia of India, part-1, vol-2, Delhi, The controller of publications civil lines, Delhi- 110054.p. no. 30-31,42-43,50-51,91-92-93,123-124,141-142,177-178.

11. Government of India Ministry of health and family welfare department of Ayurved, yoganaturopathy, unani, siddha & homeopathy (AYUSH) New Delhi, The Ayurvedic Pharmacopoeia of India, part-1, vol-3, Delhi, The controller of publications civil lines, Delhi- 110054.p. no. 25-26,51-52,67-68,115-116,194-195.

12. Government of India Ministry of health and family welfare department of Ayurved, yoganaturopathy, unani, siddha & homeopathy (AYUSH) New Delhi, The Ayurvedic Pharmacopoeia of India, part-1, vol 4, Delhi, The controller of publications civil lines, Delhi- 110054.p. no 67-68,105-106.

13. Government of India Ministry of health and family welfare department of Ayurved, yoganaturopathy, unani, siddha & homeopathy (AYUSH) New Delhi, The Ayurvedic Pharmacopoeia of India, part-1, vol-6, Delhi, The controller of publications civil lines, Delhi- 110054.p. no. 154.


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