Nidanapanchakatmak study of Aamvata

Ashu; Rakesh Sharma

doi:http://dx.doi.org/10.21760/jaims.8.4.7

In Ayurveda there are various approaches to diagnose a disease; the concept of Nidan Panchak is one such modality of Ayurveda. Nidan Panchak helps to diagnose diseases at various stages. Knowing the definite Nidana (etiological factors), Dosha vitiation, Samprapti (pathogenesis or progress of disease) and to check it at early stage is given prime importance. Nidan Panchaka plays vital role to identify types of disease. It consists of five subtypes which are Nidan (causes), Purvarupa (Prodromal Features), Rupa (Clinical features), Upashaya (Therapeutic methods), and Samprapti (Pathogenesis). These five elements collectively or selectively help in making an accurate diagnosis. Aamvata is a diseased caused by Dushti of Rasavaha Strotas in which there is formation of Ama due to Jatharagni Mandya. The Aamvata condition closely resembles with Rheumatoid arthritis, an autoimmune inflammatory condition characterised by symmetrical polyarthritis. Aamvata disease was first described in Laghutrayee by Acharya Madhava. Before the Acharya Madhava the concept of Aamvata was vague. Aamvata develops due to Dushti or Prakopa of Ama as well as Vata Dosha. As the disease Aamvata is very prevalent in society, it’s important to know the exact diagnosis along with treatment. In our current review we had tried to elaborate about the Nidanapanchaka of Aamvata.

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Ashu, Ph.D. Scholar, Department of Rog Nidan & Vikriti Vigyan, Guru Ravidas Ayurved University, Hoshiarpur, Punjab, India.
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Ashu, Rakesh Sharma, Nidanapanchakatmak study of Aamvata. J Ayu Int Med Sci. 2023;8(1):46-48.
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Accepted

2023-02-28

2023-03-02

2023-03-09

2023-03-16

2023-03-23

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Introduction

Ayurveda offers a distinctive, all-encompassing method for disease diagnosis. Various contexts and viewpoints have been used to describe various sets of criteria in Ayurvedic literature. The two forms of Ayurvedic diagnostic methods are known as Rogi Pariksha and Roga Pariksha, respectively. Roga Pareeksha is an illness analysis. It is the investigation of Vyadhi and its personalities. Nidanapanchaka and Shata Kriyakala can help with this. Both economically and in the diagnosis and treatment of illness, Ayurveda's Nidanapanchaka diagnostic method is useful. Nidanapanchaka, an Ayurvedic concept, uses causal factors as its primary method of disease diagnosis.^[1]

The combination of these five factors or any one of them individually, aids in correct diagnosis. By understanding the notion of Nidanapanchaka, the doctor can identify the illness at an early stage and then arrange the course of therapy effectively, averting further difficulties.

The first Acharya to describe the illness Aamvata was Madhava. Although it seems like an easily treatable illness, the prognosis is not favourable.

The concept of Aamvata remained hazy before to the Acharya Madhava. Vata Dosha and Ama's Dushti or Prakopa both contribute to the development of Aamvata. Unique to Ayurvedic science, the concept of Ama is what causes the majority of different illnesses. Ama has no equivalent in contemporary science.^[2]

Aamvata is comparable to rheumatoid arthritis in terms of its illness. Both diseases share a lot of the same signs and symptoms. An autoimmune condition is rheumatoid arthritis. It is a symmetrical polyarthritis that is chronically inflammatory, destructive, and deforming.

The three main clinical manifestations are arthritis pain, stiffness, and joint swelling.^[3]

Aamvata Nidana^[4]

1. Dietary: Viruddha Ahara (Intake of incompatible combinations of foods., irregular dietary habits.) Viruddha Ahara plays important role in causing Ama, Viruddha Ahara provokes the Doshas but does not expel them out of the body. Ex. Mixing of milk with fish in a diet.

Aggravated Lakshana of Amavata: When the disease aggravates, it causes severe pain associated with swelling especially in joints of upper and lower limbs and in sacral region. Generalized symptoms like loss of appetite, pain or heaviness in abdomen, excessive micturition, burning sensation, sleep disturbances, constipation, abdominal distention, vomiting, giddiness are also seen.

Pratyatma Lakshana of Amavata

1. Sandhi Shotha – Swelling in multiple joints

2. Sandhi Shoola – Pain in the joints

3. Gatra Stabdhata – Stiffness in the body

Clinical characteristics of Amavata vs Rheumatoid Arthritis^[8]

1. Hasta Sandhi Shotha & Shoola - Rheumatoid arthritis is most strongly characterised by inflammation and excruciating pain in the proximal interphalangeal joints and metacarpophalangeal joints.

2. Paad Sandhi Shotha & Shoola - The feet are frequently afflicted, particularly the subtalar & metatarsophalangeal joints.

3. Jaanu Gulfa Sandhi Shotha - R.A. involves first smaller joints of hands & feet and then symmetrically affects the joints of wrist, elbow, ankle & knee.

4. Angagourav - Feeling of heaviness.

5. Stabdhata - In R.A., joint stiffness is most common feature often occurs in the morning hours.

6. Jaadhya - R.A. experiences weakness in the grasp or finger triggering due to deformity- results in restricted joint movement.

7. Angavaikalya - Joint deformity.

8. Sankocha - Contractures

9. Vikunchana Vikunchana – This can be compared to volar subluxation, ulnar deviation which occurs at metatarsophalangeal joints and bilateral flexion contractures of the elbow are observed in R.A.

10. Angamarda – Body ache, myalgia occurs in R.A.

Prognosis of Aamvata: It depends on the participation of doshas, dhatus, number of symptoms and Upadrava manifestations in the patient. Considering its severity, Madhava considers

Amavata a terrible disease. Nature of illness to the point that the patient will immediately go into an acute state. Commenting on joint involvement and its complexity, Madhava concludes that the management of Amavata is difficult, if swelling and pain to all the joint involved.^[9]

Clinical feature	Prognosis
If involvement of only one Dosha	Curable
If involvement of two Dosha	Palliable (Yapya)
If involvement of all Dosha, Presence of generalized edema	Difficult to treat

Conclusion

Aamvata is a grave disease caused by Dushti of Rasavaha Srotas. In terms of clinical features Aamvata is comparable to Rheumatoid Arthritis. Viruddha Ahara, Nischalata and Mandagni are the main etiological factors of Aamvata with Ama as a basic pathological component. All the etiological factors of Aamvata results in Agnimandya and as a byproduct Ama is formed as a toxin. When Ama travels in the body through Rasavaha Strotas it results in Angamarda, Aruchi, Trushna along with Sandhishoola and Stambhadi symptoms.

Reference

1. Sapra Umesh Kumar et al: Clinical Importance Of Nidana Panchaka – A Review. International Ayurvedic Medical Journal {online} 2019 {cited February, 2019} Available from: http://www.iamj.in/posts/images/upload/243_248.pdf

2. Dr. Suraj M. Patil, and Dr. M. V. Mokashi. (2017). “AMAVATA: REVIEW OF LITERATURE.” International Journal of Research - Granthaalayah, 5(12), 128-134. https://doi.org/10.5281/zenodo.1133822.

3. Ayurvedic Guidelines for Amavata (Rheumatoid Arthritis ) Central Council for research in Ayurvedic sciences. http://www.ccras.nic.in/content/ayurvedic-guidelines-amavata-rheumatoid-arthritis

4. Madhava Nidanam with the sanskrit commentary, Madhukosha by vijayrakshit & srikant dutta volume 1. Revised edition 2003, Mad.Nidana 25/ 1Chaukhambha Sansthan Varanasi

5. Madhava Nidanam with the sanskrit commentary, Madhukosha by vijayrakshit & srikant dutta volume 1. Revised edition 2003, Mad.Nidana 25/ 2-5 Chaukhambha Santhan Varanasi

Review Article

Aamvata

Journal of Ayurveda and Integrated Medical Sciences