E-ISSN:2456-3110

Case Report

Rheumatism

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 8 August
Publisherwww.maharshicharaka.in

Amapachana, Snehapana, Shodhana - A Promising and Novel Approach to Adverse Effects and Corticosteroid Resistant Condition in Rheumatism - A Case Study

Teggi R1*, Chandrika Urs P2, Benakanahalli B3
DOI:10.21760/jaims.10.8.50

1* Roopa Teggi, Second Year Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Chandrika Urs P, Assistant Professor, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Bhuvaneshwari Benakanahalli, Second Year Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Rheumatism, is a general term for group of disorders that cause inflammation in connective tissues particularly the joints and muscles. The most common symptoms are stiffness and pain. Amavata is one of the commonest disorders caused by the impairment of Agni, formation of Ama and vitiation of Vata Dosha where in Ama combines with Vata Dosha and occupies Shleshmasthana such as Amashaya, Asthi and Sandhi. In terms of similarities of clinical symptoms Amavata is understood in parlance with Rheumatoid Arthritis in the present case. The adverse and toxic symptoms like blurring of vision, altered appetite, indigestion and altered bowel habits due to long standing use of Nonsteroidal anti-inflammatory Drugs, antimetabolites, glucocorticoids and immunosuppression therapies, lead the patient to search for an alternative treatment. With help of Amapachana, Snehapana and Shodhana the patient and their attendees witnessed the stabilization of Agni(metabolism) sooner with regression of arthritis symptoms and withdrawal of glucocorticoids and other immunosuppressants which was the most needed relief they were eagerly waiting for. A significant result was noted after treatment in terms of reduction in level of RA factor from 20iu/MI to 1.1iu/MI and CRP from 28.5mg/L to 3.5mg/L and ESR from 66mm/hr to 42mm/hr. The overall physical, mental and social wellbeing was observed proving significant efficacy of principal based holistic approach of Ayurveda.

Keywords: Amavata, Amapachana, Rheumatism, Snehapana, Shodhana

Corresponding Author How to Cite this Article To Browse
Roopa Teggi, Second Year Post Graduate Scholar, Department of Rachana Shareera, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Teggi R, Chandrika Urs P, Benakanahalli B, Amapachana, Snehapana, Shodhana - A Promising and Novel Approach to Adverse Effects and Corticosteroid Resistant Condition in Rheumatism - A Case Study. J Ayu Int Med Sci. 2025;10(8):300-305.
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https://jaims.in/jaims/article/view/4576/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-06-14 2025-06-28 2025-07-08 2025-07-18 2025-07-28
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© 2025 by Teggi R, Chandrika Urs P, Benakanahalli B and 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(8)300
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Roopa T et al. Corticosteroid Resistant Condition in Rheumatism

Introduction

Rheumatism, is a general term for group of disorders that cause inflammation in connective tissues particularly the joints and muscles. The most common symptoms are stiffness and pain.[1] Amavata is one of the commonest disorders of Madhyama Rogamarga which is caused by the impairment of Agni, formation of Ama[2] and vitiation of Vata Dosha where in Ama combines with Vata Dosha and occupies Shleshmasthana such as Amashaya, Asthi and Sandhi leads to formation of Amavata.[3]

Case Report

A diagnosed case of Rheumatoid arthritis with Rheumatic fever, aged about 52 years hails from Chikkamagaluru, has been treated under Rheumatology Department at Mangalore nearly 1 year. The patient was prescribed Methotrexate and steroid medications, but after a year, they developed Optic Neuritis, leading to blurred vision in the left eye, with limited relief from rheumatic symptoms. So approached Ayurveda as an alternate solution.

Chief and Associated complaints

Chief complaints and Associated complaintsDuration
Ubhaya Jaanusandhi Shola and Shotha with Raga1 year
Ubhaya Gulphasandhi Shola and Shotha6 months
Morning stiffness6months
Crepitus1 month
Angamarda15days
Agnimandya1 year
Low grade fever1 year

Personal history - No H/O any previous surgeries, no H/O Diabetes mellitus and Hypertension.

Menstrual history - Menopause attained.

Occupation - House wife.

Diet - Non-vegetarian.

Examination

Ashtavidha Pariksha

1. Nadi: 80/min.
2. Mala: Malavashtambha.
3. Mutra: 3 to 4 time in day, 1 to 2 times in night.
4. Jihva: Sama.
5. Shabda: Prakruta.

6. Sparsha: Anushna.
7. Drik: Avara.
8. Akriti: Madhyama.

Dashavidha Pariksha

1. Prakruti: Vata Pradhana-Kapha Anubandhi.
2. Vikruti: Dosha - Vatapradhana Tridosha

  Dooshya - Rasa, Meda, Asthi

3. Satwa: Madhyama.
4. Sara: Rakta
5. Samhanana: Madhyama
6. Pramana: Madhyama
7. Satmya: Sarva Rasa
8. Aharasakti: Avara, appetite reduced
9. Vyayamasakti: Avara
10. Vaya: 52 years

Differential Diagnosis - Amavata, Sandhivata, Vatarakta

Investigations

  • HB - 12.4g/dl
  • Platelet count - 4,91,000 cells/cumm
  • ESR - 66mm/hr
  • RA factor - Positive
  • CRP - 28.5mg/L

Positive findings for diagnosis

Clinical presentations

Symmetrical involvement of more than 3 joints - Bilateral Knee joint and Ankle joint
Consistent low - grade fever
Investigations - elevated ESR
Positive RA factor
Positive CRP

Diagnosis - Diagnosed based on the symptoms described in Ayurveda and supportive lab parameters

Final diagnosis - Amavata

Therapeutic focus

A. Amapachana

1. Simhanada Guggulu: 2-2-2 tablet, 10 Days.
2. Ajamodadi Choorna: 2.5gm-0-2.5gm, 10 Days.
3. Gandharvahastadi Taila 200ML: 10ml-0-10ml,10 Days.
4. Amrutottara Kashaya: 15gm-0-15gm, 10 days.


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B. Vicharaniya Snehapana - Guggulutiktaka Ghr-ita was prescribed, with instructions to take it with lukewarm water, sipped slowly, and avoid exposure to cold air and wind.

DayDosageTime of administrationSnehajeerna Kala
130ml7 am9 am
230ml9.30 am12 pm
330ml9 am12 pm

Snehapana Jeerna Lakshana - a. Shiroruja Shama-na, b. Shareera Laghuta, c. Vatanulomana, d. Kshu-da Utpatti e. Pipasa Utpatti f. Udgara Shuddhi[4,5]

C. Valukasweda[6] - Day 1, Day 2, Day 3 given.

D. Bastikarma - Yogabasti - Kshara Basti

Anuvasana Basti - Guggulu Tiktaka Gritha (40ml) + Sukumara Gritha (40ml)

Niruha Basti - Ingredients - Saindhava (15gm), Madhu (80gm)

Sneha - Guggulu Tiktaka Gritha 40ml + Sukumara Gritha 40ml

Kalka - Shatapushpa 10gm + Rasna 10gm + Ajamoda 10gm

Kwatha - Erandamooladi Kashaya 200ml

Gomutra - 100ml

DayBastiDoseRetention time
4Anuvasana80ml2hr 15 min
5Niruha460-480ml7 min
Anuvasana80ml2hr 30 min
6Niruha460-480ml5 min
Anuvasana80ml2 hr
7Niruha460-480ml8 min
Anuvasana80ml2 hr 30 min
8Niruha460-480ml8 min
Anuvasana80ml2 hr 30 min
9Anuvasana80ml2 hr 45 min

Oral medications - taken all through admission

1. Simhanada Guggulu 2-0-2 b/f
2. Ajamodadi Churna 1tsf-0-1tsf b/f
3. Gandharvahastadi Taila 5ml-0-5 ml
4. Amrutottara Kashaya 15ml-0-15ml b/f
5. Pathyapatya - Patient was advised to take lukewarm water and to avoid exposure to excessive wind, sunlight, emotional disturbances. Liquid, warm light diet like Ganji, vegetable soups. Morning - Yavagu, Afternoon - Chapati Kichadi, Evening - Vegetable soup, Night - Kichadi

For major complaint of blurring of vision (left eye) referred to Shalakya department diagnosed as optic neuritis - under treatment

Observation of each step of treatment -

1. Observation of Amapachana - Appetite impro-ved, gained 2 kg of weight. Joint stiffness and pain reduced

2. Observation of Vicharaniya Snehapana - Mo-rning stiffness started reducing from day 1 itself

3. Observation of Valuka Sweda - local joint sw-elling and pain reduced, mobility improved.

4. Observation of Basti Karma -

Sign and symptomsBefore treatmentAfter treatment
Swelling+++Nil
Pain+++Nil
Stiffness+++Nil
Tenderness++++ (only in ankle joint)
Crepitus+++ (only in ankle joints)
Range of movementRestrictedImproved
AppetiteDecreasedImproved
BowelConstipatedRegular

5. Pathyaapathya - Patient was feeling light with proper digestion and bowel movements

Advice on discharge:

1. Simhanada Guggulu 2-0-2 b/f
2. Ajamodadi Churna 1tsf-0-1tsf b/f
3. Guggulutiktaka Gritha 15ml-0-15ml b/f
4. Avipattikara Churna 1tsf-0-1tsf b/f

Mode of action of drugs

Simhanada Guggulu - Agnideepaka, Kaphavatahara, Amapachaka, Shoolahara, Shothahara[8] Guggulutiktaka Gritha - Agnivardhaka, Tridoshahara.

Ajamodadi Churna - Agnideepaka, Srotoshodhaka, Shoolahara, Shothahara.

Avipattikara Churna - Agnideepana, Vibandahara

Ajamodadi Churna - Agnideepaka, Srotoshodhaka, Shoolahara, Shothahara.

Gandharvahastadi Kashaya - Agnideepaka, Malashodhaka.

Amrutottara Kashaya - Agnideepaka, Rechaka, Jwarahara[7]


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Result

Subjective Outcome - Symptom wise

Chief complaints and Associated complaintsPre-treatment suffering period/ with intensityResponse time to treatment/with Intensity
Ubhaya Jaanusandhi Shoola and Shotha with RagaSince 1 year/severe1month / Nil
Ubhaya Gulpha Sandhi Shoola and Shotha6months/severe1month / Nil
Tenderness/ Pain on deep press over joint areas1year/sever1 month / moderate (Over ankle joints)
Morning stiffness6months / moderate1day / nil
Sandhi Shaithilya1 month / severe1month / nil
Angamarda15days / sever1 month / nil
Agnimandya1 year / moderate1 week / nil
Low grade fever1year / moderate1week / nil

Objective outcome - Signs wise based on Pariksha done

DarshanaSparshana ParikshaPrashna Pariksha
1. BT - Vikruti: Dosha-Vata Kapha pradhana- vriddha Tama +++. AT - Vriddha +
2. BT - Dooshya -Rasa, Meda, Ashti. dushti tama +++. AT- Dushti +
3. Satwa: BT - anxiety+++. AT- anxiety +
4. Pramana: Madhyama (BT 54 KG) - 51 KG (AT)
5. Jihva BT - Liptata +++ AT- liptata Nill		1 Nadi - BT Vata Pradhana 80/m fast. AT-70/m-moderate speed.
2. BT - Ushnata over affected Sandhi+++. AT- Ushnata Nill
3. BT - Sparsha Asahishnuta (tenderness) over affected joints+++, AT-+
4. Sandhi Sputhana - BT +++, AT + 		1. BT - Vikruti: Dosha-Vata Kapha pradhana- vriddha Tama +++, AT - Vriddha+
2. BT - Dooshya - Rasa, Meda, Ashti. Dushti Tama +++, AT - Dushti +
3. Satwa: BT-anxiety+++. AT- anxiety +
4. Aharasakti: Madhyama BT - less AT - Improved
5. Vyayamasakti: BT - Avara +++, AT - Avara + 

jaims_4576_01.JPG

Evidence based approach

SNPratyaksha PramanaAnumana PramanaAptopadesha / Shabdha Pramana
1.Prakriti Pariksha Rogi - Roga Pariksha (Akrithi, Varna, Shotha and Shoola Pariksha)Prakriti Pariksha, Rogi-Roga Pariksha (Ahara Shakthi, Vyayama Shakti, Agni)Amavata is Sandhiashritha and Amashaya Ashrita Yapya Vyadhi

Follow-up

1st follow-up

Adhered to the prescribed Pathya and medications, resulting in:

  • No recurrence of primary and associated symptoms
  • Improvement in lab parameters (ESR, CRP, RA test)
  • Reported mild facial swelling in the morning, likely due to cold exposure

  • Amritha Prasha added to their treatment regimen
  • Continued Shalakya treatment for Optic Neuritis, indicating ongoing care for eye health

2nd follow-up

Strictly followed prescribed Pathya and medications

  • Experienced no recurrence of primary and associated symptoms
  • Noticed a reduction in facial swelling, particularly in the morning

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  • Discontinued Amritaprasha Gritha
  • Continued Shalakya treatment for Optic Neuritis, indicating ongoing care for eye health

Discussion

According to Chakradatta, the Chikitsa Siddhanta of Amavata is Langhanam (through wholesome diet and regimens), Swedanam (Valuka Sweda, Ushnopachara) Tiktham Deepanani Katuni (Ajamodadi Churna + Guggulu Tiktaka Gritha), Virechanam (through Avipattikara Churna) Snehapanam (Guggulutiktaka Gritha-Vicharana Snehapana), Basti (Kshara Basti) is mentioned as Prashasta i.e., ideal approach.[9]

The application of all these stages of ideal approach has been implemented in best possible way in the present case. During Amapachana stage, appetite improved, gained 2 kg of weight with moderate reduction in Joint pain and stiffness we could able to witness the stabilization of Agni sooner in Amapachana stage itself with regression of symptoms of arthritis even after withdrawal of steroid and other related medications. During Vicharaniya Snehapana, Morning stiffness started reducing from day 1 itself and this improvement remained consistent all through the treatment. Valuka Sweda supported to reduce pain, swelling and improve mobility in ankle joint.

After Shodhana i.e., Basti Karma near normal improvement has been found in symptomatology. Pain, stiffness, swelling, morning stiffness, tenderness, crepitus reduced in joints. Range of movement in joints improved after Shodhana. Appetite, Bowel movement, sleep and overall general health improved significantly after Shodhana, Samsarjana and Rasayana therapies. All through the treatment stages patient withstood the spirit of following Pathyapathya, which supported speedy recovery. A significant result was noted after treatment in terms of laboratory parameters, such as reduction in level of RA factor from 20iu/MI to 1.1iu/MI and CRP from 28.5mg/L to 3.5mg/L and ESR from 66mm/hr to 42mm/hr. Steroid and other related medications were withdrawn from her routine in the beginning stage of Snehapana itself. No any complication was found during the treatment. As she started losing the vision of her left eye due to consistent usage of steroid medications for last 1 year,

patient and their attendees were happy to notice the positive change in terms of regression of symptoms and withdrawal of steroid medications and it was the most needed change they were eagerly waiting for. The overall physical, mental and social wellbeing was observed proving significant efficacy of principal based holistic approach of Ayurveda.

Conclusion

The present case is of consistent low-grade fever with Ama expressed in joints with excruciating pain caused due to Agnimandya. It is a classical disease of Koshtha- Abhyantara Rogamarga, diagnosed as Rhuematoid arthritis with Rheumatic fever in contemporary science. Agni restoration is a critical aspect of treatment that demands judicious approach by health care professionals. So stabilizing Agni is the game change task in such cases has been tried to achieve judiciously in the present case with the help of all stages of ideal approach. Education and awareness about the condition, combined with wholesome lifestyle choices and minimal medication, can help individuals develop a positive mindset and overcome challenges. Gnyana Buddhi Pradeepena Yo Na Aavishati Tatwavit (Charaka Sharira) - An efficient physician who never tries to accomplish/understand the deeper perceptions of a patient which led to his/her unhealthy states with the light of knowledge offered by Shastra, is never considered a treatment at all. Because at the very core of wrong perceptions the seed of disease persists.[10] Unless and until each sufferer roots down to the causes and triggers of their sufferings, cannot seriously look into their respective solutions seriously. Maintaining this positive balance of looking into the problem to its core by the patient and the attendees is enforced by educating them at every level of treatment. The awareness in terms of nature of the problem they are suffering, methods to implement in terms of wholesome food, routine minimal medications and proper company all through to keep up the right perception towards the problem are necessary steps to follow, to be on the winning side of the game always.

References

1. Shah SN. API Textbook of Medicine. 7th ed. Mumbai: Association of Physicians of India; 2003. [Crossref][PubMed][Google Scholar]


J Ayu Int Med Sci 2025;10(8)304
Roopa T et al. Corticosteroid Resistant Condition in Rheumatism

2. Dwarka C. Introduction to Kayachikitsa. 3rd ed. Varanasi: Chaukhamba Orientalia; 1996. p. 69 [Crossref][PubMed][Google Scholar]

3. Shastri K, Chaturvedi G. Charaka Samhita. Sutra Sthana, Chapter 12. Reprint ed. Varanasi: Chaukhambha Bharti Academy; 2008 [Crossref][PubMed][Google Scholar]

4. Gupta A, Upadhyaya Y. Astanga Hridaya. Sutra Sthana, Chapter 25. Vidhyotini Hindi Commentary. Varanasi: Chaukhambha Sanskrit Series; 2012. p. 132 [Crossref][PubMed][Google Scholar]

5. Gupta A, Upadhyaya Y. Astanga Hridaya. Chikitsa Sthana 17/14–15. Varanasi: Chaukhambha Sanskrit Series; 2012. [Crossref][PubMed][Google Scholar]

6. Acharya GS. Panchakarma Illustrated. Delhi: Chaukambha Sanskrit Pratishthana; 2009. p. 215–219 [Crossref][PubMed][Google Scholar]

7. Sharma AP. Dravyaguna Vigyan. Vol. 2. Varanasi: Chaukhamba Orientalia; Madakari Prakarana. p. 83, 362, 750 [Crossref][PubMed][Google Scholar]

8. Tripathi JP. Chakradatta by Chakrapani Datta. Chapter 25/31–35. Varanasi: Chaukhamba Sanskrit Sansthan; 2008. p. 228 [Crossref][PubMed][Google Scholar]

9. Tripathi JP. Chakradatta of Chakrapanidatta with Bhavarthasandipini. Chapter 25/1. 5th ed. Varanasi: Chowkhamba Series Office; 1983. p. 225 [Crossref][PubMed][Google Scholar]

10. Shastri K, Chaturvedi G. Charaka Samhita. Sharira Sthana 8/71–76. Reprint ed. Varanasi: Chaukhambha Bharti Academy; 2008 [Crossref][PubMed][Google Scholar]

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