AMAVATA/ RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects joints, causing inflammation, pain, and stiffness. It can also impact other parts of the body, including the skin, eyes, and lungs. Early diagnosis and treatment can help manage symptoms and prevent further joint damage.

 

                                     Amavata

Amavata is a disease described in Ayurveda closely resembles Rheumatoid arthritis in modern medicine. It is a chronic condition that affects the joints and sometimes other body parts.

General Description of Amavata:

• Definition:
  Amavata is a disease caused by the accumulation of Ama (toxins) and the aggravation of Vata dosha. Here, aggravated vata dosha takes away accumulated ama and gets it lodged in the joints, causing Amavata. The word "Amavata" is derived from two Sanskrit terms:
• "Ama" – undigested or toxic substances formed due to weak digestion
• "Vata" – one of the three doshas, responsible for movement and circulation in the body.

 

Here are the main texts where Amavata is mentioned:

1. Madhava Nidana; chapter 25

2. Charaka Samhita; Chikitsa Sthana - vata vyadi chikitsa

3. Ashtanga Hridaya & Ashtanga Sangraha (by Vagbhata)

4. Bhava Prakasha; Madhyama khanda

5. Other Nighantus and Modern Ayurvedic texts, such as Rasatarangini, Bhaishajya Ratnavali.

Causative factors for Amavata;

अजीर्णे भोजनं ग्राह्यं गुरुस्निग्धं समं सदा।
व्यायामश्चातिसन्तप्ते जलप्रवेशनं तथा॥

वेगसन्धारणं चात्र हेतवो दोषसंभवाः।
तैर्भवत्यामवाताख्यो व्याधिर्जन्तोरति दारुणः|

                                                    माधव निदान – आमवात निदान अध्याय (अध्याय २५)

​अतिस्निग्धगुरुशीतं विरुद्धं चातिमात्रतः।
आहारं यः समश्नाति स सन्दोषं समाप्नुयात्॥

                                                            Bhaishajya Ratnavali (Chapter 29: Amavata Roga Adhikara).

·        Taking heavy, unctuous food during indigestion (ajirṇa),

·        Regular intake of guru-snigdha ahara,

·        Excessive physical exertion,

·        Bathing or entering water when overheated,

·        Suppression of natural urges.

·        Frequent intake of incompatible food.

 

सम्प्राप्ति एवं लक्षणानि – Pathogenesis & Symptoms

These are nidhana (causative factors) that vitiate dosas, especially Vata and ama, leading to a painful and dreadful disease called Amavata.

सोपः साङ्ग्रहशूलश्च शीतः स्पर्शे च वेदना।
भ्रमश्च ज्वरदाहश्च श्लेष्माणं चोपशोषणम्॥

स्तब्धता जङ्घयोर्गौरवं अङ्गानां गलः शिरः।
आमवातविकारे तु ज्ञेया लक्षणसङ्ग्रहाः॥

• Swellings in the joints (Shopha),
• Generalized pain (sangraha-shula),
• Coldness on touch with pain,
• Giddiness (Bhrama), fever (Jvara), burning sensation (daha),
• Dryness or depletion of Kapha,
• Stiffness in lower limbs, heaviness, and
• Pain in the neck and head.

These are the characteristic symptoms of Amavata.

 

Amavata Chikitsa Sutra (Therapeutic Guidelines);

आमं जयेल्लङ्घनकोष्णपेया लघ्वन्नसूपौदनतिक्तयूषैः
विरूक्षणस्वेदनपाचनैश्च संशोधनैरूर्ध्वमधस्तथैव ॥

                                                          (Bhavaprakasha Madhyama Khanda, Jwara Adhikara, Verse 57)​

This verse outlines the treatment approach for conditions involving Ama, which is central to the pathogenesis of Amavata.​

स्निग्धं तिक्तं कषायं च लघ्वन्नं दीपनं लघु।
बस्तिं सस्नेहसंयुक्तं काले साधारणं हितम्॥

स्वेदो दीपनपाचनं बस्तयः स्नेहवर्चसः।
आमवाते प्रशस्यन्ते चिकित्सायां विशेषतः॥                                                             

                                                        भैषज्य रत्नावली – आमवात चिकित्सा (अध्याय २९)

• Use of light, bitter and astringent food,
• Deepana (appetite stimulants) and Pachana (digestive drugs) to remove Ama,
• Snehana (oleation) and Svedana (sudation) therapies,
• Basti (medicated enema)—especially Anuvasana and Niruha basthi —is considered highly beneficial in chronic stages.

 

Classical Formulations (Yoga) Used in Amavata

Formulation	Type	Function
Rasnadi Kaṣāya	Decoction	Anti-inflammatory, vata-shamaka
Amṛtottara Kaṣāya	Decoction	Deepana, Pachana, anti-Ama
Simhanada Guggulu	Tablet	Removes Ama, relieves joint stiffness
Yogaraja Guggulu	Tablet	Strengthens digestion, relieves pain
Mahayoṣadhi Kaṣāya	Decoction	Detoxifies & reduces inflammation
Eranda Mūla Taila Basti	Enema oil	Vata anulomana relieves constipation
Rasna saptaka kashaya	Decoction	Anti-inflammatory, vata-shamaka
Maharasnadi kashaya	Decoction	Reduce stiffness and swelling in joints
Dashamoola preparations	-	Anti-inflammatory and analgesic
Eranda taila	-	Purgative action to eliminate ama
Trayodashanga guggulu	Tablet	In deformity and muscle wasting.

 

Proprietary formulations that are effective in Amavata;

·       Nurodex capsule (Jaffman pharmaceuticals)

·       Artikad liquid (Jaffman pharmaceuticals)

  

                                            Panchakarma - A unique concept of treatment procedure

Treating diseases in Ayurveda involves two main methods; Shodana chikitsa and shamana chikitsa. Shodhana chikitsa, often synonymous with Panchakarma, is widely acknowledged as the most effective therapy for curing diseases without recurrence.

The word panchakarma is composed of two words, “Pancha” and “karma”. Pancha means five and karma means ‘action’. Here it represents five kinds of therapeutic procedures the physician gives to eliminate vitiated doshas from the body.

In Ayurveda, the three regulatory principles of the body and mind are called doshas. The three doshas are Vata, Pitta, and Kapha, which are also known as Tridoshas.

·       Vata; Governs all kinds of movements inside the body. Represented by air and space

·       Pitta; Regulates metabolism and the actions that require heat.

·       Kapha; Manages assimilation in the body.

When in an equilibrium state these doshas maintain the health of an individual but when get vitiated they produce diseases.

Panchakarma procedures are intended to bring vitiated doshas from the periphery to the gut and then expel them outside from the nearest external orifice thoroughly. Apart from as a therapeutic procedure, these are indicated as seasonal regimens for the preservation of health and prevention of disease.

The five procedures include (as per Charaka and Sushrutha);

1.     Vamana; Therapeutic emesis

2.     Virechana; Therapeutic purgation

3.     Niruha basthi; Enema with decoction)

4.     Anuvasana basthi; Enema with unctuous substances)

 Nasya; Transnasal drug administration

 

Synonyms of panchakarma;

·       Shodana; It means purification. It is the procedure by which excessively aggravated dosha are expelled from the body.

·       Virechana; It means especially dragging outside. In some places, this term is applied to denote the evacuation of dosha through upward and downward directions.

 

 

तान्युपस्थितदोषाणां स्नेहस्वेदोपपादनै: ।

पन्चकर्माणि कुर्वीत मात्राकालौ विचारयन्

                                                     ॥ च सू २। १५ ॥

Panchakarma is supposed to produce kayakalpa, i.e. dramatic changes in the body provided properly administered considering desha (habitat), kala (season), Dosha (body humor) dushya (vitiated doshas), koshta (nature of bowel), Agni (digestive power), bala (body strength), and Prakriti (constitution of the body.

 

Panchakarma procedure includes;

1.     Poorva karma

2.     Pradhana karma

3.     Paschath karma or samsarjana karma.

 

1.    Poorva karma (preparatory procedure);

 

 स्नेहमग्रे प्रयुंजीत ततः स्वेदमनंतरम् ।

स्नेहस्वेदोपपन्नस्य संशोधनमथेतरते

                                                                ॥च सू १३-६६॥

 By using preparatory techniques, tolerance and acceptance of the main procedure’s outcome are increased. It causes alteration in the vitiated doshas so that they may be mobilized without difficulty and hence readily eliminated from the body. The procedure includes

A.    Deepana and pachana

B.    Snehapana (oral intake of fat)

C.    Abhyanga and Swedana (body massage and sudation)

 

A.     Deepana and Pachana;

Deepana karma is an ayurvedic treatment that involves rekindling digestion and stimulating digestive fire, the body's metabolism.  

Pachana karma plays an important role in bringing the sama dosha (doshas associated with ama) to the nirama (doshas without ama) state, as they mobilize the doshas from shaka to koshta and thus help in the easy expelling of doshas from the body. It is intended to remove undigested food/toxins (ama) from the body and is a prerequisite before purificatory therapies

 

B.     Snehapana;

 The use of medicated fat may be herbal ghee, herbal oil, animal fat, or bone marrow internally, which is called snehapana (oleation). Using oleation results in the unctuousness and softness of morbid doshas, which become easily extractable and ready to move from places where their occupation is undesirable and unwanted. In this process, oral intake of medicated fat is administered for several days before starting the panchakarma therapy in an increasing dose each day.

 

C.     Abhyanga and swedana;

Massaging the entire body or specific body part is an essential part of panchakarma and is called abhyanga. During abhyanga warm oil is applied to the entire body, from scalp to feet, using a variety of techniques and substances to apply manual pressure. The oil used is usually based on the individual’s dosha type and the doshas involved in their illness.

Swedana or sudation therapy, Involves inducing sweat in the patient. It channels vitiated doshas in the body, to places from where they can be easily ejected by the system during pradhanakarma.

 

2.    Pradhana karma;

 

Pradhana karma or main action, is the stage in panchakarma therapy that follows purvakarma, or preparatory treatment, and involves letting the doshas out of the body through the nearest channel as per the involved dosha. The procedure includes either of the following;

A.     Vamana

B.     Virechana

C.     Nasya

D.     Asthapana basthi

E.     Anuvasana basthi

 

A.     Vamana karma;

Vamana therapy primarily addresses conditions characterized by the vitiation of Kapha dosha in the body. It is a structured procedure involving induced vomiting, conducted for a predetermined duration before cessation is planned.

 

A.     Virechana karma;

Virechana, a panchakarma procedure, induces purgation in patients to eliminate vitiated pitta dosha from the body, making it particularly effective in treating pitta-related conditions.

 

B.     Nasya karma;

Nasya karma involves the administration of medicated oils or powders into the nasal cavity, which helps to remove toxins and vitiated doshas from above the shoulder region. Nasal medications are specifically tailored for treating conditions affecting areas above the shoulders, as the nose serves as the gateway to the head. By administering nasal medicines, the treatment permeates throughout the head and neck, effectively addressing various ailments in these regions.

 

C.     Asthapana basthi;

D.Top of Form

 

Basthi therapy, encompassing both asthapana (decoction enema) and anuasana (oil enema), holds paramount significance in treating disorders caused by vata dosha. Given that the intestines serve as the primary abode of vata dosha, basthi karma facilitates the direct administration of medicinal substances into the vata sthana (site), effectively targeting and eliminating vata dosha at its root.

Asthapana basthi is a type of basthi (enema) where decoction is the major part along with other ingredients.

 

E.     Anuvasana basthi;

Anuvasana basthi or medicated oil enema, is a type of ayurvedic panchakarma treatment that involves administering medicated oil or ghee as an enema. Fat stays in the intestine, bladder, and uterus longer without causing any problems.

 

Paschath karma/ samsarjana krama;

Paschath karma is the concluding phase of panchakarma also known as follow-up or aftercare treatment. The goal of paschath-karma is to reestablish digestive enzymes and replenish tissues that have been detoxified. It plays a crucial role in consolidating the benefits gained from the main treatment. It includes;

1.     Samsarjana krama (diet regimen);

A graduated dietary regimen is prescribed, commencing with a light diet and progressively incorporating more complex foods to restore digestive strength. This structured approach also aids in preventing the accumulation of new toxins.

2.     Rasayana (rejuvenation); 

rasayana is a revitalization therapy equipping body to regain and maintain health