E-ISSN:2456-3110

Case Report

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Management of Amavata (Rheumatoid Arthritis) with Erandamool (Ricinus communis Linn.) Kwath - A Case Study

Anubhav.1*, Gupta R.2
DOI: http://dx.doi.org/10.21760/jaims.8.5.40

1* Anubhav, Post Graduate Scholar, Department of Dravyaguna, Government Ayurvedic College, Patiala, Punjab, India.

2 Rosy Gupta, Reader, Department of Dravyaguna, Government Ayurvedic College, Patiala, Punjab, India.

Musculoskeletal diseases are increasing due to stressful life and other causative factors representing manifestations like pain, swelling, stiffness, reduced mobility of the joint involved etc. Amongst them Amavata is very common which is correlated with Rheumatoid arthritis. Ama is the byproduct of improper digestion which obstructs body channels and accumulates in Sandhi (joints). Vitiated Vata Dosha and Ama come together in Amavata causing symptoms like Angamarda (bodyache), Aruchi (anorexia), Stabdhata (stiffness). Women are affected approximately three times more often than men with this chronic multisystem autoimmune disease, RA. Ayurveda focuses on the cure of root cause of the disease. Eranda (Ricinus communis) is mentioned as having specific Amavatahara Prabhava in Ayurveda classics. Eranda root as mentioned in Ayurvedic classics works on both vitiated Vata and the Ama by its Rasa Gunadi properties thus breaking the pathogenesis of Amavata. Since Eranda is easily available in India it can be a safe, effective and economic solution for Amavata / Rheumatoid Arthritis.

Keywords: Amavata, Rheumatoid arthritis, Erandamool, Ama, Case Report, Ayurveda

Corresponding Author How to Cite this Article To Browse
Anubhav, Post Graduate Scholar, Department of Dravyaguna, Government Ayurvedic College, Patiala, Punjab, India.
Email: 		Anubhav, Rosy Gupta, Management of Amavata (Rheumatoid Arthritis) with Erandamool (Ricinus communis Linn.) Kwath - A Case Study. J Ayu Int Med Sci. 2023;8(5):237-240.
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https://jaims.in/jaims/article/view/2436

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-25 2023-03-28 2023-04-04 2023-04-11 2023-04-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Anubhav, Rosy Guptaand 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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Introduction

In the contemporary world the stressful life and unhealthy food habits have pushed us into many diseases; musculoskeletal diseases are one of them manifested as pain, swelling, stiffness and reduced mobility of the joints involved etc. Amongst them Amavata is also very common which is generally correlated with the Rheumatoid Arthritis mentioned in the modern sciences. The word Amavata is made of two words Ama and Vata. Ama is the byproduct of improper digestion and metabolism; which leading to the obstruction of body channels, circulates in whole body propelled by vitiated Vata that stations itself prominently in Sandhi (joints) manifesting as Amavata. Virudha Ahara, Virudha Cheshtha, Mandagni[1], sedentary lifestyle, exercise upon Snigdha Ahar are common etiological pathological factors for its generation. B/L joints of Hasta, Pada, Sira, Trik, Jannu Sandhi are involved with Angamards, Aruchi, Trishna, Alasya, Gaurava, Jwara as symptoms. Rheumatoid arthritis is a chronic multisystem autoimmune disease in which body’s immune system attacks its own cells and tissues. The characteristic feature of RA is persistent inflammatory synovitis, usually involving peripheral joints in a symmetrical pattern.[2] Inflammation occurs in auto immune disorder triggered by Ama or antigen at cellular level. Antigen/Ama modulates signaling at cellular level leading to incompatible auto immune response that damages tissue. Symptoms of fatigue, loss of appetite, weakness, morning stiffness, fever, tenderness of RA coincides Amavata.

The prevalence of RA is more than 1% of the population as per Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatology international. 1993 Nov 1; 13(4):131-4; women are affected approximately three times more often than men. Prevalence increases with age. RA is seen all over the world and affects all races.[3] Genetic and environmental influences are crucial in susceptibility to RA.

Contemporary medical treatment includes painkillers, NSAIDs, steroids etc.[4] which generally have side effects. Amavata (RA) being autoimmune disease demands positive effects on Dhatus and immunity.


For this the pathology of Ama formation has to be dealt with Agnivridhi and Vata Shaman with Vata alleviating properties. In the present case study the drug in focus Erandamool Kwath (decoction of roots of Ricinus communis Linn.) can be studied for both.

Description of plant: The plant Eranda (Ricinus communis) is found all over India. It is shrub like small tree 2-4 mts, with alternate leaves which are palmately lobed. It has semi woody stems and its root is light in weight almost straight with few rootlets, outer surface dull yellowish brown, nearly smooth but marked with longitudinal wrinkles, odourless and acrid in taste.[5]

Ayurvedic properties: Eranda has Madhur, Tikta, Kshaya Rasa with Guru, Snigdha, Sukshma Guna in it. The Vipaka after digestion is Madhur with Virya as Ushna.[6] As rasa and Vipaka is Madhur it has positive effect on Dhatus also Ushna Veerya helps subside Vata Dosha and Ama. Its Madhur, Snigdha, Guru and Tikshna properties alleviate Vata while saving the Dhatus. Also, Ushna, Sukshma properties help increase Agni (digestive power) thus Amapachana happens. The plant is supposed to have double effect on Amavata as alleviates both Ama and Vata individually. Its properties overall have specific potency (prabhava) to break the pathogenesis of Amavata.

Case Study

A female patient aged 47, housewife, came in Kayachikitsa OPD of Government Ayurvedic College and Hospital with the complaint of painful swollen joints, morning stiffness persistent up to midday. Appetite was reduced and digestion was also delayed. On local examination temperature of joints was found to be raised. She had feeling of fever once a day which used to subside with rest.

History of present illness: She had been suffering from this condition for the last 10 years. Earlier pain and swelling were irregular in nature but with time it became persistent. She was taking painkiller once daily.

History of past illness: She was diagnosed with Hypothyroidism three years back.

Family history: She had positive family history of RA as patient’s mother is also suffering from Amavata.



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Personal history

Patient used to take curd on daily basis, had indigestion, lack of exercise with easy going lifestyle.

General examination

  • BP : 120/80 mm/Hg
  • Respiration : 14 / min
  • Nadi : 70/min
  • Mala : Coated / Sama
  • Mutra : Normal / Prakrita
  • Jivha : Coated / Sama
  • Shabda : Clear / Spashta
  • Sparsha : Hotter / Ushna
  • Akriti : Normal / Samanya
  • Ahar/diet : Vegetarian
  • Agni : Dyspeptic / Manda
  • Sleep : Disturbed
  • Addiction : Tea
  • Gait : Limping
  • Joints involved : B/L Wrists, Shoulder, Knees

Local examination

On local examination the temperature of joints was raised, swelling was prominent; crepitus was felt in the joints involved. The movement was restricted of the shoulder and wrist joints.

Assessment criteria

Subjective criteria

Assessment was done for the 10 subjective criteria i.e., Sandhi Shool (pain in joints). Shotha (swelling in joints), Sandhi Stabdhta (stiffness in joints), Sandhi Sparshasahatva (tenderness in joints), Angamarda (body aches), Anga Vaikalya (deformity in joints), Anga Gaurava (heaviness in body), Aruchi (anorexia), Apaka (indigestion), Jwara (fever). These were assessed on the scale of 0, 1, 2, 3 and final score was added which came out to be 23 out of 30.

Score evaluation categories were mild 1-10, moderate 11-20 and severe 21-30. The present patient’s score was 23 which fell under severe category of evaluation.


Objective criteria: Blood tests were done before treatment.

Criteria Tests Values
Objective Criteria RA Factor 73.2 IU/ml
CRP 38.3 mg/L

Therapeutic intervention: Patient was given the Kwath of Erandamool, (decoction of roots of Ricinus communis Linn.) 50 ml twice daily orally, empty stomach for 30 days following clinical diagnosis and lab tests. She was assessed for the subjective criteria on day 15 and day 30 and objective criteria on day 30. She was advised to follow Pathya-Apathya throughout the therapy.

Follow up and outcomes: The total score on day 15 came down to 16 from earlier 23, with major changes in Sandhi Stabdhta (stiffness) and Angamarda (heaviness). On day 30 score were 9 which fell in mild category and patient felt relief in majority of symptoms.

Follow up was also done on 15th day after stopping the medicine. Positive changes were observed in symptoms like pain, swelling, tenderness, heaviness in body. Digestion also improved.

Score evaluation: RA factor and CRP was repeated after treatment on day 30 and results are as follow:

Criteria Tests Values
Objective Criteria RA Factor 41.8IU/ml
CRP 29 mg/L

Result

Symptoms were assessed and favorable changes were seen in them.

Discussion

Amavata occurs due to the conjugation of both Ama and Vata in the body. The Madhura Rasa and Madhur Vipaka of Eranda helps to pacify vitiated Vata while improving the immunity also. Also, Ushna Virya (hot potency) subsides Vata and Kapha both. Ushna Virya also helps in digestion of ama and pacification of Vata. Sookshma and Tikshna Guna of Eranda further helped to open the blocked channels. Thus, Eranda works well on vitiated Vata and the Ama individually breaking the pathogenesis of Amavata and improving the objective parameters by working on immunity by Prabhava. Eranda is mentioned as having Amavatahara prabhava i.e., power of subduing Amavata which it shows even being used as a single drug.[7]


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Conclusion

Erandamool is mentioned by Acharya Charak as Vrishya and Vatahara Parama[8] (best for alleviating Vata Dosha). It can be used in diseases in which Vata is an important component of pathophysiology like Amavata. Use of Erandamool for single drug therapy can open up new channels of research with focus on safe and effective drug for long term use.

Reference

1. Acharya Shukla Vidyadhara, Kaya Chikitsa, Part 2, Chaukhambha Subharti Prakashana, Varanasi, Amavata, 2013; p559.

2. Kasper Dennis L. et.al. Harrison’s principles of Internal medicine, vol. 2, McGraw-Hill medical publishing division, New York, Rheumatoid Arthritis, 2005; p1969.

3. Kasper Dennis L. et.al. Harrison’s principles of Internal medicine, vol. 2, McGraw-Hill medical publishing division, New York, Rheumatoid Arthritis, 2005; p1969.

4. Golwalla Aspi F., Glowalla Sharukh A., Golwalla’s Medicine, Neel Graphics, Mumbai, Rheumatoid Arthritis, 2011; p888.

5. Government of India, Department of Indian Systems of Medicine & Homeopathy, CSIR, New Delhi, Part 1, Volume 1, 2001; p120.

6. Sharma P.V. Dravyaguna Vigyana, vol. 2, Chaukhambha Bharati Academy, Varanasi, Eranda, 1998; p58.

7. Sharma P.V. Dravyaguna Vigyana, vol. 2, Chaukhambha Bharati Academy, Varanasi, Eranda, 1998; p58.

8. Sastri Narayana Satya, Charak Samhita, Part 1, Chaukhambha Bharati Academy, Varanasi, Chapter 25/40, 2005; p468.


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