E-ISSN:2456-3110

Review Article

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 4 April
Publisherwww.maharshicharaka.in

Management of Amavata with Ayurveda

Shivsagar Mishra R.1*, Shrirampant Chandurkar V.2, Tiwari R.3, Chaudhari K.4
DOI: http://dx.doi.org/10.21760/jaims.8.4.8

1* Reena Shivsagar Mishra, PhD Scholar, Department of Kayachikitsa, Seth Govindji Raoji Ayurved College, Solapur, Maharashtra, India.

2 Vivek Shrirampant Chandurkar, Professor & HOD, Department of Kayachikitsa, Seth Govindji Raoji Ayurved College, Solapur, Maharashtra, India.

3 Rakesh Tiwari, PhD Scholar, Associate Professor, Department of Samhita & Siddhant, Smt. K.G. Mittal Punarvasu Ayurvedic College, Mumbai, Maharashtra, India.

4 Kalpesh Chaudhari, Assistant Professor, Department of Panchakarma, Smt. K.G. Mittal Punarvasu Ayurvedic College, Mumbai, Maharashtra, India.

Amavata could be an illness in which vitiation of Vata Dosha & amassing of Ama in joints. In cutting edge science it is compare with Rheumatoid Joint pain which may be a auto-immune clutter. Within the display period Amavata is most common malady influencing a huge matured populace. Amavata is result of Agnidushti, Amotpatti & Sandhivikruti, since of those treatment which normalize Agni, metabolize Ama & controls Vata & keep up sound Sandhi & Sandhistha Shleshma will be best for this disorder. Rheumatoid arthritis (RA) is a symmetric polyarthritis that causes, unfavorable inflammation and deformity associated with systemic involvement. The prevalence of rheumatoid arthritis in India among those mentioned is between 0.5-3.8% in women and 0.15-1.35% in men. In various studies, the treatment helps to relieve the symptoms, but the underlined pathology remains untreated because the treatment is ineffective and also causes many side effects & toxic symptoms. Amavata management concept has Dravya, Katu-Rasa, Dipan Pachana with Langhana, Swedana and Tikta as Shaman Chikitsa. As the first concrete description of Amavata as a disease can be found in Madhav Nidana, this study provides a systematic evaluation of Amavata w.s.r. Rheumatoid arthritis in all the classics of Ayurveda. Amavata is one of the incurable conditions due to its chronic nature, intractable nature, complications of disease.

Keywords: Amavata, Ama, Rheumatoid arthritis, Ayurveda

Corresponding Author How to Cite this Article To Browse
Reena Shivsagar Mishra, PhD Scholar, Department of Kayachikitsa, Seth Govindji Raoji Ayurved College, Solapur, Maharashtra, India.
Email: 		Reena Shivsagar Mishra, Vivek Shrirampant Chandurkar, Rakesh Tiwari, Kalpesh Chaudhari, Management of Amavata with Ayurveda. J Ayu Int Med Sci. 2023;8(4):49-54.
Available From
https://jaims.in/jaims/article/view/2402

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-02-23 2023-02-25 2023-03-04 2023-03-11 2023-03-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Reena Shivsagar Mishra, Vivek Shrirampant Chandurkar, Rakesh Tiwari, Kalpesh Chaudhariand 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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Mishra R et al: Management of Amavata with Ayurveda

Introduction

Rheumatoid arthritis (RA) is a chronic joint disease causing inflammation. It is symmetrical, destructive and affects small and large joints.[1] The worldwide prevalence of the disease is approximately 0.8% of the population.[2] The disease most often begins between the ages of 30 and 50, but recent observational studies indicate that the disease can begin in any age group.[3]

RA is a debilitating disease that can cause spontaneous remission. It affects many systems in the body, including the locomotor, cardiovascular, nervous, respiratory, reticuloendothelial, and excretory systems. DMRADs are used to relieve pain, improve joint function, and prevent deformity, but they carry risks such as liver and renal damage, bone marrow depression, muscle mass loss, and osteoporosis.[4] Ayurveda sees a strong similarity between Amavata and Rheumatoid Arthritis based on clinical signs. Angamarda (Bodyache), Aruchi (Anorexia), Trishna (Thirst), Alasya (Lethargy), Jwara (Fever) Apaka (Indigestion), Shunata (swelling), Sandhishula (pain in joints), Stambha (Stiffness) are clinical features of Amavata[5] some symptoms resemble RA like pain, stiffness, swelling, lethargy. Ayurveda suggests preventive and curative measures, including Panchkarma radical treatment to eliminate causative factors. This study evaluates the effectiveness of Langhana, Valuka Swedana, classical Virechana Karma, classical Basti Karma, and oral Shamana Aushadhi for managing Rheumatoid Arthritis.

Case History

A 32-year-old male patient came to us with chief compliant of.

Chief compliant Duration
1. Ubhya Parvasandhi Shool (Bilateral finger pain)- 2 years
2. Vaam Janusandhi Shool-Shotha (Bilateral knee pain & swelling). 1year
3. Vaam Manibandha Shool, Shotha & Sparsha-Asahatwa. 1year
4. Vaam Ansa-Kurpara Sandhi Shool. 6-7 month
5. Angamarda. 4-5 month
6. Aruchi. 4-5month
7. Morning stiffness. 4-5 month

History of Personal Illness: The patient was normal 2 years back. Since then patient have been suffering from Ubhya Parvasandhi Shool (bilateral finger pain Vaam Janusandhi Shool-Shotha

(Bilateral knee pain & swelling), Vaam Ansa-Kurpara Sandhi Shool., Vaam Manibandha Shool, Shotha & Sparsha-Asahatwa., Angamarda, Aruchi, Morning stiffness.[6] For this patient took allopathy treatment but got temporary relief, then she decided to take Ayurvedic treatment. So, for further Ayurveda treatment patient approached to Smt K.G. Mittal Hospital Charni Road, West, Mumbai.

Examination

Personal History

  • Occupation: Office Job (Sitting), In Air-Conditioned Room
  • Diet: Mixed diet.
  • Appetite: Irregular.
  • Allergy: No history of any drug or food allergy.

Ashtavidh Pariksha

1. Nadi : 80/min
2. Mala : Malavashtmbha
3. Mutra : 4 to 5 time in day, 2 to 3 times in night
4. Jihva : Sama
5. Shabda : Prakrut
6. Sparsha : Anushna
7. Drik : Prakrut
8. Akriti : Sthula

Dashavidha Pariksha

1. Prakruti : Vata Pradhana-Kapha Anubandhi.
2. Vikruti :
Dosha - Vatapradhana Tridosha,
Dooshya - Rasa, Meda, Ashti.
3. Satwa : Madhyama.
4. Sara : Rakta
5. Samhanana : Madhyama
6. Pramana : Madhyama
7. Satmya : Sarva Rasa
8. Aharasakti : Madhyama
9. Vyayamasakti : Avara
10. Vaya : 32 years

Materials and Methods

A male patient aged 32 years was admitted in I.P.D. of Panchakarma Dept Smt K.G. Mittal Hospital Charni Road West, Mumbai, Maharashtra, India. Reg no. 305, with complains from Ubhya Parvasandhi Shool (bilateral finger pain Vaam Janusandhi Shool-Shotha (Bilateral knee pain & swelling), Vaam Ansa-Kurpara Sandhi Shool., Vaam Manibandha Shool, Shotha & Sparsha-Asahatwa.,


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Angamarda, Aruchi, Morning stiffness, reduced appetite, oftenly constipation since 7 year, was diagnosed case of seropossitive RA, CRP also positive with raised ESR. She was treated methodically as per Chikitsasutra of Amavata[6], Langhana (Alpa Bhojana), Ruksha Valuka Sweda, Deepan-Pachana with Shunti Churna, classical Basti Karma, followed by Shamana Aushadhi

Table 1: Observation of Basti Karma.

Sign & Symptoms Before Treatment After Treatment
Swelling + + Nil
Pain + + Nil
Stiffness + + + + +
Tenderness + + + + + +
Range of movement + + + + +
Appetite Reduced Good
Bowel Constipated Clear
Fatigue + + + + Nil

Table 2: Analysis of Hematological Test

Hematological Test Before Treatment After Treatment
ESR 89 59
CRP +ve -ve
RA +ve +ve

Material: Patient was advised to take luke warm water for drinking and to avoid exposure to excessive wind, sunlight, emotional exacerbation etc.

Diet: liquid, warm light diet like rice gruel, green gram soup with little vegetables.

Sarvanga Abhyanga and Swedana

Sarvanga Abhyanga with Narayan Taila done for 25 to 30 minutes followed by Mrudu Bashpa Swedana for 4 days.

Pradhana Karma - Basti (Madhutailika)

Management of Amavata

Table 3: Showing material for management of Aamvata

Rooksha Swedana Valukapottli Sweda
Snehana Vishagharbha Taila
Pachana Shunthi-Siddha Eranda Tail (5 ml in morning)
Madhutailik Basti 450 ml in morning empty stomach

Table 4: Showing Panchkarma management of Aamvata.

SN Dravya Dose Duration Anupana
1. Simhanad Gugul 250 mg 2 BD Lukewarm water
2. Rasnadi Gugul 250 mg 2 BD Luke warm water
3. Tab.Gandhrvaharitaki 500 mg 2 HS Luke warm water
4. Punarnvashtak Kwath 2 TSF Twice in day Luke warm water

Methods

Type of study: Single case study

Assessment Criteria

Table 5: Grading of Sandhishoola (pain).

SN Severity of Pain Grade
1. No pain 0
2. Mild pain 1
3. Moderate, but no difficulty in moving 2
4. Much difficulty in moving the body parts 3

Table 6: Grading of Sandhishotha (swelling).

SN Severity of swelling Grade
1. No swelling 0
2. Slight swelling 1
3. Moderate swelling 2
4. Severe swelling 3

Table 7: Grading of Sparshasahatwa (tenderness).

SN Severity of Tenderness Grade
1. No tenderness 0
2. Subjective experience of tenderness 1
3. Wincing of face on pressure 2
4. Wincing of face and withdrawal of the affected part on pressure 3

Observations

Table 8: Assessment of Sandhi-Shool.

Left Name of Joints Right
Before After Before After
3 0 Parvasandhi 3 1
3 0 Janusandhi 2 1
2 0 Manibandha 3 0
2 0 Ansa Sandhi 3 0
1 0 Kurpara Sandhi 2 0

Table 9: Assessment of Sandhi-Shoth.

Left Name of Joints Right
Before After Before After
3 0 Janusandhi 3 1
2 0 Manibandha 3 0

Table 10: Assessment of Sparshasahatwa (tenderness).

Left Name of Joints Right
Before After Before After
2 0 Manibandha 3 0

Table 11: Assessment of Angamarda (malaise).

Before After
2 0

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Table 12: Assessment of Aruchi.

Before After
2 0

Table 13: Assessment of Morning stiffness.

Before After
3 0

Result

All signs and symptoms showed a significant improvement, and there was a significant decrease in pain, edoema, stiffness, soreness, and exhaustion. During the course of treatment, appetite was increased and bowel habits were established. The patient stopped taking modern medications like NSAIDs, HCQs, methotraxate, etc. and continued taking oral Ayurvedic medications like Punarnavastak Kashayam, Rasnadi Guggulu, and Alambushadi, Sudarshan Churna, Gandharva Haritaki.

Discussion

Patient was treated methodically as per Chikitsasutra of Amavata

a. Langhana (Laghu Bhojana) - Beginning of Amapachana. The most vital step in Amapachana and the prevention of Ama development is that Ama formation is a fundamental causal factor in Amavata.

b. Valuka Sweda - Sneha-devoid Ruksha Sweda aids in removing Srotorodha and returning the Dosha to normalcy.

c. Deepana - To monitor the development of the illness, Agni Deepana should be finished after Amapachana. As a result, Agni Deepana was finished utilising Tikta, Katu Rasatmaka, and Ushna Virya Dravya, which is comparable to Shunti Churna.

d. Tikta Rasa - It is Ruchya and mostly causes Agnideepana and Amapachana. Additionally, it has a Lekhana feature that aids in removing [7]

e. Katu Rasa - When Srotorodha is eliminated, the body experiences Ruksh, Shlema Dosha Shamana, and Laghuta.[8]

f. Virechana Karma - Agnideepti classical Virechana Karma needs to be practiced for long-term results. It is essentially cleansing

in nature, removing vitiated Dosha in general and Pitta in particular, clearing Srotas (channels of transportation), and enhancing Agni, all of which work together to help prevent the formation of Ama. A lot of fluid will also be excreted along with Dosha, which may help to reduce swelling by removing inflammatory mediators.

Basti Karma: The most effective form of treatment for vitiated Vata Dosha Is Basti.[9] Vata Dosha has a major part in the development of all diseases.[10] Vata Dosha results in Praspandana (moving), Udvahana (carrying), and Vivek (to separate) Vata Dosha has the ability to mobilize pathological accumulation of Dosha from the periphery into the Koshta, as stated in.[11] Pain, stiffness, and swelling are thereby reduced by controlling the Vata Dosha's movement.

By regulating the immune system, Virechana Karma and Basti Karma may function to avoid autoimmune reactions in the body. They may also work to clear out free radicals, preventing cellular damage brought on by free radicals.

Conclusion

It can be inferred from the current case study that Ayurveda's sequential treatment of Langhana (Alpa Bhojana), Ruksha Valuka Sweda, Deepan-Pachana, classical Basti Karma and Shamana Aushadhi such as like Punarnavastak Kashayam, Rasnadi Guggulu and Alambushadi, Sudarshan Churna, Gandharva Haritki. A difficult problem for medical research is Amavata, one of the most common diseases in the modern period. Due to the fact that Ama and Vata have characteristics that are on opposite poles of one another and that the involvement of Uthanadhatu (Rasa) and Gambheradhatu (Asthi) complicates the treatment, a systematic treatment protocol that is solely based on the principles of Ayurveda is required. Because any measures taken will primarily conflict with one another, a very careful approach can only be beneficial to the patient. The key to preventing deformities with proper treatment is early detection. Procedures used in Panchakarma will aid in rheumatoid movement testing and Bahudoshavastha removal.

This case study demonstrates that Virechan Karma is a superior mode of therapy for Amavata in order to alleviate symptoms and rectify biochemical parameters.


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