Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa in Amavata (Rheumatoid Arthritis)

Sanjna Sharma; KK Sharma; Alok Kumar Srivastava

doi:10.21760/jaims.10.1.3

E-ISSN:2456-3110

Research Article

Amavata

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 1 JANUARY

Publisher

www.maharshicharaka.in

Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa in Amavata (Rheumatoid Arthritis)

Sharma S^1*, Sharma K², Srivastava AK³

DOI:10.21760/jaims.10.1.3

^1* Sanjna Sharma, Post Graduate Scholar, Department of Panchakarma, Uttarakhand Ayurved University Rishikul Campus, Haridwar, Uttarakhand, India.

² KK Sharma, Professor and HOD, Department of Panchakarma, Uttarakhand Ayurved University Rishikul Campus, Haridwar, Uttarakhand, India.

³ Alok Kumar Srivastava, Professor HOD, Department of Panchakarma, Uttarakhand Ayurved University Faculty of Ayurveda Main Campus, Dehradun, Uttarakhand, India.

Amavata is a disorder described in Ayurveda that closely resembles Rheumatoid arthritis (RA) in modern medicine. The disease originates from the accumulation of Ama (undigested toxins) in the body, coupled with the vitiation of Vata Dosha. This dual pathology results in the obstruction of channels (Srotas), leading to joint pain, swelling, stiffness, and systemic symptoms such as anorexia and fatigue, much like RA. Though, it is systemic disease, it mostly affects joints It is one of the most debilitating diseases impacting the person’s quality of life and makes it difficult for them to perform day-to-day activities. Despite so much advancement and modernization the complete cure of the disease has not been found. Contemporary system of medicine provides symptomatic relief and delays the progression of disease yet there is a lacuna in the management of RA. Hence, with the aim of identifying and establishing an alternative, safer, effective and long-lasting treatment modality, the study was conducted in 40 patients. They were selected on the basis of standard inclusion and exclusion criteria and randomly allocated to two different treatment groups; Group-A was treated with Vaitarana Basti and Group-B was treated with Shatapushpadi Lepa. Total duration of treatment was of 2 months and follow up was done 1 month after completion of treatment. Although both the interventions were effective, but in overall improvement of the patients, Group-A had better result than Group-B.

Keywords: Amavata, Rheumatoid arthritis, Vaitarana Basti, Lepa

Corresponding Author	How to Cite this Article	To Browse
Sanjna Sharma, Post Graduate Scholar, Department of Panchakarma, Uttarakhand Ayurved University Rishikul Campus, Haridwar, Uttarakhand, India. Email:	Sharma S, Sharma K, Srivastava AK, Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa in Amavata (Rheumatoid Arthritis). J Ayu Int Med Sci. 2025;10(1):14-21. Available From https://jaims.in/jaims/article/view/3953

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-12-05	2024-12-16	2024-12-30	2025-01-10	2025-01-24
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	13.52

© 2025by Sharma S, Sharma K, Srivastava AKand 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].

J Ayu Int Med Sci 2025;10(1)14

Download PDF Back To Article Introduction Aims and Objectives Materials and Methods Observations and Results Discussion Conclusion References

Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Introduction

Amavata is one of most disability causing disease occurring due to Mandagni, and Mithyahara Vihara. The term Amavata is formed by the union of two words Ama and Vata which are the two predominant pathological factors in the disease process. Due to lack of physical activity and sedentary life style, metabolism of body is getting slower which leads to production of internal toxins (Ama), and Vata is one of the three Doshas, responsible for movement and functions in the body. When Ama and Vata Dosha are vitiated simultaneously and circulated throughout the body, they enter the Trika and Sandhi Pradesha, leading to stiffness in the body. This condition is known as Amavata.^[1] Patients complains of pain, stiffness, and swelling in multiple joints. According to clinical presentation, Pravriddha Awastha of Amavata closely resembles with Rheumatoid arthritis (RA) in accordance with their similarities on clinical features like pain, swelling, stiffness, fever, redness, general debility. Rheumatoid arthritis (RA) is chronic multisystem disease of unknown cause. Although there are variety of systemic manifestations, the characteristic features of RA are persistent inflammatory synovitis, usually involving peripheral joints in symmetric distribution.^[2]

Now a days Rheumatoid arthritis has been more common and distressing among all joints problem. It affects approximately 0.8% of the population (ranges from 0.3-2.1%) worldwide.^[3] The prevalence of RA in India is 0.7%.^[4] In recent years, it affects individual of every age i.e., from teenage to adult. Numerous Ayurvedic medications and Panchakarma therapies have been described in the Ayurvedic texts for the management of Amavata (Rheumatoid arthritis). Acharya Chakradutta has mentioned Vaitarana Basti in the Chikitsa of Amavata. Vaitarana Basti and is said to having Shoola, Anaha, Amavatahara properties.^[5] Acharya Yogaratnakara has also mentioned various Lepa in the management of Amavata. Shatapushpadi Lepa, is one mentioned in Yogaratnakara, Adhyaya Amavata Chikitsa Adhikara.^[6] Shatapushpadi Lepa consists of twelve herbs. The drug review revealed that all the drugs present in this Lepa has analgesics and anti-inflammatory properties. So, for present study, Vaitarana Basti and Shatapushpadi Lepa are chosen to check their efficacy in symptoms of Amavata.

Aims and Objectives

To compare the effect of Vaitarana Basti and Shatapushpadi Lepa in Amavata.

Materials and Methods

40 patients were randomly selected from the OPD and IPD of Panchakarma department of Rishikul Campus Hospital, UAU, Haridwar and screened on the basis of classical signs and symptoms of Amavata (Rheumatoid Arthritis).

Registered 40 patients in the trial were randomly divided in two groups (20 patients in each group) out of which all 20 patients in Group A (Vaitarana Basti) and 19 patients in Group B (Shatapushpadi Lepa) completed the trial respectively. Total 39 patients completed the treatment. The duration of the treatment was 2 months along with follow up period of 1 month.

Inclusion criteria

1. Patients having sign and symptoms of Amavata (Rheumatoid arthritis).
2. Patient of age between 20 years to 50 years will be
3. Patient with less than 5 years of
4. Patient able to participate in study and ready to follow the

Exclusion criteria

1. Patient with joint
2. Uncontrolled Diabetes Mellitus, Hypertension & other life threatening and complicated
3. Patient having dermatomyositis, scleroderma, acute rheumatic fever, gouty arthritis, infectious arthritis or Reiter’s syndrome.
4. Patient having Skin allergy,
5. Pregnant and lactating

Grouping

Group A - Vaitarana Basti was administered in 2 sitting constituting of 21 days with 8 days in between.

Group B - Shatapushpadi Lepa was applied on the affected joint in 2 sitting constituting of 21 days with 8 days gap in between.

Eranda Sneha was given once in both the groups, for Koshtha Shodhana.

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Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Assessment Criteria
Subjective Criteria

Sandhishoola (Pain in Joints)	Score
No pain	0
Mild pain	1
Moderate pain but no difficulty in moving	2
Slight difficulty in moving	3
Much difficulty in moving bodily part	4

Sandhishotha (Swelling in Joints)	Score
No swelling	0
Minimal swelling (very slight swelling, indistinct border)	1
Mild swelling (defined swelling, distinct border)	2
Moderate swelling (about 1mm raised skin)	3
Severe swelling (raised skin> 1mm)	4

Sparshasahyata (Tenderness in Joints)	Score
No tenderness	0
Mild tenderness without grimace on face	1
Wincing on pressure	2
Wincing of face &withdrawal of affected part on pressure	3
Resist touching	4

Sandhigraha (Morning stiffness)	Score
No stiffness	0
Lasting < 15 min	1
15 min to 1 hour	2
1 to 2 hours	3
>2 hour	4

Aruchi (Anorexia)	Score
No Aruchi (take full diet on proper gap)	0
Take moderate diet on proper gap between meals	1
Decreased amount of diet & increased gap between meals	2
Appetite towards only favourite foods	3
No feeling of appetite	4

Objective Criteria

RA- factor
Anti-CCP
CRP
ESR

Statistical Analysis

The information collected on the basis of observation made during the treatment was analysed on statistical criteria in terms of Mean score (X), Standard Deviation (S.D), & Mean difference percentage

For single group of Subjective parameters - Wilcoxon signed - rank test
For single group of Objective parameters - Paired T-test For intergroup comparison of Subjective parameters - Mann whitney test
For intergroup comparison of Objective parameters - Unpaired T-test

The tests were carried at the 0.05, 0.001, 0.0001 level of P.

The obtained results were interpreted as:

Non-significant P > 0.05
Significant P < 0.05
Highly significant P < 0.001
Extremely significant P<0.0001

Observations and Results

A total of 40 patients were registered (20 each group)

Demographic Data

Age: Out of 40 patients, the maximum number of patients, i.e., 48% were between the age of 41-50 years, followed by 40% between the age of 31-40 years, and 12% between the age of 20-30 years. The maximum number of patients belongs to the middle age groups, which shows its prevalence in this age group. At aging, the Vyadhikshmatwa start decreasing gradually and accumulation of Dosha occurs, particularly Vata Dosha, which is the major predisposing factor of the disease. That might be the reason that this age group is more prone to this disease.

Gender: 90% of patients in this study were females, and only 10% were males. It clearly shows its predominance in females. Women are three times more likely to develop RA, which may be due to hormonal factors such as estrogen and prolactin levels. Changes in hormonal status, like those occurring during pregnancy or menopause, can influence the onset and progression of the disease.

Marital Status: Maximum numbers of patients, i.e., 90% were married, 7% were unmarried, and 3% were either divorcees or widows. As this disease affects middle-aged groups, at this age most people are generally married. This is the reason the incidence of married patients was seen more in this study.

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Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Habitat: 55% of patients in this study were from urban area, followed by 40% suburban, and 5% rural. It may be due to the fact that the trial is held in an urban area.

Religion: Maximum number of patients, i.e., 87% were Hindu and 13% were Muslims. It is nothing but only indicative of the demographic predominance of the Hindu community in the area.

Socioeconomic Status: Maximum numbers of patient i.e., 73%, were middle class, followed by 18% upper middle class, 7% lower middle class, and 2% poor. As the study was conducted in a Govt. institution, incidences of middle class were seen more. But there is no meaningful correlation between socioeconomic status and the disease.

Occupation: Maximum number of patients i.e., 60% were housewives, 38% were doing jobs, and 2% were students. Owing to the burden of taking care of the home, the family, and the children, housewives frequently neglect to eat on time and unknowingly do Vishmashana, Adhyashana, and Ansana, which leads to the formation of Ama, the main culprit of the disease.

Apart from that, housewives perform repetitive tasks (such as cooking, cleaning, and washing), due to which they have more contact with cold water, and it may put strain on joints and aggravate symptoms in individuals.

Agni: Agni assessment reveals that 47% of patients had Vishmagni, followed by 33% with Mandagni and 20% with Samagni. Agni is the foundation of health. Disturbance of Agni results in vitiation of Dosha and Dhatus. The maximum number of patients in this study had disturbed status of Agni. Improper digestion of food because of Vishmagni and Mandagni leads to the formation of Ama, which is the primary factor of this disease.

Koshtha: In this study, 52% of patients were Madhyam Koshthi and 48% were Krur Koshthi; there was no patient with Mridu Koshtha. Koshtha is the expression of bowel habit, which depends on the Prakruti.

Only Madhyam and Krur Koshtha were seen in this study. It may be in relation to the Kapha and Vata predominance in the study. Both the Dosha i.e., Kapha and Vata plays important role in the pathogenesis of disease.

Appetite: In this study, 57% patients had normal appetite and 43% had poor appetite. Although, poor appetite is seen in the patients of Amavata but in this study many patients had normal appetite. But this variation in the study can be due to the small sample size.

Nidra: The 60% patients had sound sleep and 40% had disturbed sleep there was no patient in excessive sleep. The disturbed sleep was may be due to the reason that pain aggravate at night.

Prakruti: The maximum number of patients, i.e., 45%, had Vatakaphaja Prakruti, followed by 35% with Vatapittaja and 20% with Kaphapittaja. Prakruti Parikshana does not give any idea of Prakruti of the individual with disease, as Prakruti is always natural while pathogenesis is always abnormal.

The predominance of Vata, Kapha, and Mandagni along with Tridoshadushti was found to play an important role. Hence, the predominance of patients with Kaphavataja Prakruti signifies the predilection of patients towards this disease.

Chief Complaints: Among chief complaints of Amavata, Sandhishoola and Sandhigraha were present in 97% of the patients, 85% had Sandhishotha and Sparshasahyata and 37% were had Aruchi. These complaints are must to diagnose the patients with Amavata, and maximum patients had these chief complaints.

Chronicity: Duration of symptoms reveals that 42% of the patients had chronicity between 1-3 years, followed by 30% having chronicity between 3-5 years, and 28% with chronicity of less than 1year. In the initial stage of Amavata, patients feel symptoms occasionally, and most of the patients ignore those symptoms due to a busy lifestyle and carelessness. When most patients visit the hospital, those symptoms no longer appear occasional. This might be the reason that most of the patients had chronicity between 1-3 years.

Family History: The data shows that 85% of the patients had no family history, while 15% patients had family history of Amavata (Rheumatoid Arthritis). Although no one knows the exact cause of the disease rheumatoid Arthritis and it is considered autoimmune yet, it is believed that an interplay between some genetic and environmental factors plays a role.

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Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Effect of Treatment
1. Vaitarana Basti (Group - A)

Table 1: Subjective Parameters (Wilcoxon signed rank test)

Subjectiveparameters	N	Mean		Median		SD		Wilcoxon W	P-Value	% Effect	Result
Subjectiveparameters	N	BT	AT	BT	AT	BT	AT	Wilcoxon W	P-Value	% Effect	Result
Sandhishoola	20	3.10	0.90	3.00	1.00	0.72	0.79	-4.035^b	0.000055	70.97	E.S.
Sandhishotha	19	1.90	0.50	2.00	0.00	1.07	0.69	-3.825^b	0.000131	73.68	H.S.
Sparshasahyata	17	1.60	0.60	2.00	0.50	0.99	0.68	-3.753^b	0.000175	62.50	H.S.
Sandhigraha	20	2.55	0.45	2.00	0.00	0.76	0.94	-3.943^b	0.000080	82.35	E.S.
Aruchi	8	0.80	0.40	0.00	0.00	1.15	0.60	-2.530^b	0.011412	50.00	S.

Table 2: Objective Parameters (Paired t-test)

Objective Parameters		Mean	N	SD	SE	t-Value	P-Value	% Change	Result
RF	BT	74.13	20	67.39	15.07	0.147	0.885	0.57	N.S.
RF	AT	73.71	20	68.06	15.22	0.147	0.885	0.57	N.S.
Anti- CCP	BT	94.77	20	125.02	27.95	0.727	0.476	0.70	N.S.
Anti- CCP	AT	94.11	20	125.58	28.08	0.727	0.476	0.70	N.S.
CRP	BT	8.29	20	11.04	2.47	-0.551	0.588	11.70	N.S.
CRP	AT	9.26	20	12.69	2.84	-0.551	0.588	11.70	N.S.
ESR	BT	46.50	20	18.84	4.21	5.433	0.000	27.53	S.

2. Shatpushpadi Lepa On Group-B Patients

Table 3: Subjective Parameters (Wilcoxon signed rank test)

SubjectiveParameters	N	Mean		Median		SD		Wilcoxon W	P-Value	% Effect	Result
SubjectiveParameters	N	BT	AT	BT	AT	BT	AT	Wilcoxon W	P-Value	% Effect	Result
Sandhishoola	19	3.26	1.79	3.00	2.00	0.65	0.79	-3.934^b	0.000083	45.16	E.S.
Sandhishotha	17	1.68	0.74	2.00	1.00	0.89	0.56	-3.819^b	0.000134	56.25	H.S.
Sparshasahyata	19	1.74	1.11	2.00	1.00	0.73	0.57	-3.207^b	0.001341	36.36	S.
Sandhigraha	19	2.47	1.74	2.00	2.00	0.70	0.73	-3.742^b	0.000183	29.79	H.S.
Aruchi	7	0.47	0.47	0.00	0.00	0.70	0.70	.000^c	1.000000	0.00	N.S.

Table 4: Objective Parameters (Paired t-test)

Objective Parameters		Mean	N	SD	SE	t-Value	P-Value	% Change	Result
RF	BT	62.08	19	53.50	12.27	-1.381	0.184	5.62	N.S.
RF	AT	65.57	19	55.74	12.79	-1.381	0.184	5.62	N.S.
Anti- CCP	BT	105.85	19	144.77	33.21	-2.102	0.050	2.98	N.S.
Anti- CCP	AT	109.01	19	148.11	33.98	-2.102	0.050	2.98	N.S.
CRP	BT	7.87	19	9.86	2.26	1.805	0.088	3.76	N.S.
CRP	AT	7.58	19	9.80	2.25	1.805	0.088	3.76	N.S.
ESR	BT	42.11	19	27.28	6.26	3.621	0.002	16.00	S.

Intergroup Comparison

Table 5: Cumulative table of intergroup comparison of subjective parameters (Mann Whitney U test)

Variable	Group	N	Mean Rank	Sum of Ranks	Mann-Whitney U	P-Value	Result
Sandhishoola	Group A	20	25.30	506.00	84.000	0.0012	Sig
	Group B	19	14.42	274.00
	Total	39
Sandhishotha	Group A	19	22.90	435.10	132.000	0.0060	Sig
	Group B	17	16.95	288.11
	Total	36

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Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Variable	Group	N	Mean Rank	Sum of Ranks	Mann-Whitney U	P-Value	Result
Sparshasahyata	Group A	17	22.55	383.35	139.000	0.0102	Sig
	Group B	19	17.32	329.00
	Total	36
Sandhigraha	Group A	20	27.98	559.50	30.500	0.0000	Sig
	Group B	19	11.61	220.50
	Total	39
Aruchi	Group A	8	23.33	186.60	123.500	0.0051	Sig
	Group B	7	16.50	115.50
	Total	15

Table 6: Cumulative table of intergroup comparison of objective parameters (Unpaired t-test)

Variable	Group	N	Mean	SD	SE	t-Value	P-Value	Result
RF	Group A	20	0.42	12.82	2.87	1.019	0.315	N.S.
RF	Group B	19	-3.49	11.01	2.53	1.019	0.315	N.S.
Anti-CCP	Group A	20	0.66	4.07	0.91	1.945	0.059	N.S.
Anti-CCP	Group B	19	-3.16	6.55	1.50	1.945	0.059	N.S.
CRP	Group A	20	-0.97	7.86	1.76	-0.700	0.489	N.S.
CRP	Group B	19	0.30	0.57	0.13	-0.700	0.489	N.S.
ESR	Group A	20	12.80	10.54	2.36	2.006	0.052	N.S.
ESR	Group B	19	6.74	8.11	1.86	2.006	0.052	N.S.

Table 7: Overall effect of the therapy

Overall Effect	Group A		Group B
Overall Effect	N	%	N	%
Complete remission (100% relief with no recurrence)	0	0.00%	0	0.00%
Marked Improvement (>75% - <100%)	10	50.00%	0	0.00%
Moderate Improvement (>50% - 75%)	8	40.00%	4	21.05%
Mild Improvement (>25% - 50%)	2	10.00%	10	52.63%
No Improvement (up to 25%)	0	0.00%	5	26.32%
Total	20	100.00%	19	100.00%

Discussion

Joint health is crucial for maintaining mobility, flexibility, and overall quality of life, particularly as we age.

It can affect person’s quality of life and make it difficult for them to perform day to day activities. Patients with joint pain sometimes need assistance with basic tasks. Amavata is one of such disability causing disease occurring due to Mandagni, & Mithyahara Vihara. Ayurvedic literature has mentioned a variety of external & internal treatment modalities for management of Amavata. Principal treatment of Amavata in Chakradatta is Langhana, Swedana, Tikta & Katu Rasa Dravya, Deepaniya Dravya, Virechana therapy, administration of Basti. Thus, in the present study for internal administration Vaitarana Basti was selected & for external use Shatapushpadi Lepa was selected.

Probable mode of action of Vaitarana Basti

Vaitarana Basti is comprises of Guda, Saindhava, Chincha, Murchhita Tila Taila, and Gomutra. In Chikitsa Sutra of Amavata, Kshara Basti has been specially indicated.

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Sanjna S et al. Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa

Vaitarana Basti is also a type of Kshara Basti. In this Basti, maximum quantity is of Gomutra. Due to Kshara Guna of Gomutra, it has the property of Lekhana and Rukshana which are antagonistic to Ama and is beneficial in Amavata. Vaitarana Basti is considered Laghu, Ruksha, Ushna, Tikshna, and Srotoshodhaka. Owing to these properties, it is antagonistic to Kapha and Ama. The Tikshna Guna of Basti help in overcoming the Srotodushti resulting due to ‘Sanga’.

Probable Mode of action of Lepa

In present study, Lepa was selected as an external application because of its Srotoshodhaka and Kapha-Vata Shamaka properties.^[7] Apart from that respective Guna Karma of herbs, biological action of compound occurs due to the formation’s combined effect (Vata-Kapha Shamaka).

When Lepa is applied over the affected joints, the active ingredients of Lepa enter the skin through Romkupa and further get absorbed through the Swedvahi Srotas and Siramukha it does the cutaneous biotransformation and which will pacify the Doshas and helps in Samprapti-Vighatana of the disease locally. Probable mode of action of Shatapushpadi Lepa is as follow:

Conclusion

Both Vaitarana Basti and Shatapushpadi Lepa are safe and effective in Amavata. No adverse effects were found in both the groups. In Group- A, extremely significant result (P<0.0001) was found in Sandhishoola, Sandhigraha. Highly significant (P<0.001) was found in Sandhishotha & Sparshasahyata and significant (P<0.05) was found in Aruchi. In Group- B, extremely significant result (P<0.0001) was found in Sandhishoola. Highly significant (P<0.001) was found in Sandhishotha and significant result (P<0.05) was found in Sparshasahyata and Sandhigraha. Whereas non-significant result (P>0.05) was found in Aruchi. In objective parameters both groups show non-significant result (P>0.05) in RF, Anti-CCP, CRP and significant result (P<0.05) in ESR. So, we can conclude that, Vaitarana Basti (Group A) and Shatpushpadi Lepa (Group B) both groups are significantly effective in condition of Amavata (Rheumatoid Arthritis). Percentage wise Vaitarana Basti has shown better results than Shatapushpadi Lepa.

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J Ayu Int Med Sci 2025;10(1)21

Research Article

Amavata

Journal of Ayurveda and Integrated Medical Sciences

Comparative clinical evaluation of Vaitarana Basti and Shataspushpadi Lepa in Amavata (Rheumatoid Arthritis)

Sharma S1*, Sharma K2, Srivastava AK3

Introduction

Aims and Objectives

Materials and Methods

Observations and Results

Discussion

Conclusion

References

Sharma S^1*, Sharma K², Srivastava AK³