Rheumatoid Arthritis (Aama Vata)

Ayurvedic Aspect – 

The disease Amavata is compared to Rheumatoid Arthritis. There is similarity in signs and symptoms of both diseases. Aama Vata is found in All the four Vedas. Aacharya Madhava was the first Physician who described the Disease Aama Vata. It really seems to be simple disease but on the other hand its prognosis is not so good. The concept of Ama is totally unique in Ayurvedic science and this Ama is produced by the undigested food and it is the main cause of the various disorders.

Amavata is disease of Rasavaha strotasa. It is caused due to Agnidushti, Formation of Aama leading to Sandhi vikruti (Joint deformity). The People are unaware about disease and its complications thus leading to lifelong joint deformities. Many Ayurvedic preparations and herbs are mentioned in the classics which are proved to be effective remedy in Amavata.

Changing lifestyle of human being or Modernization has created several disharmonies in biological system because of globalization, busy professional and social life, dietary habits have changed to a big extent which disturbs the normal metabolism and produce several toxins referred to as “Ama” in Ayurveda. 

People first take steroids for a long period of time which give relief for some time but after that causing many side effects like Acne, blurred vision, Cataracts or glaucoma, difficulty in sleeping, High Bp etc.  then they approach to Ayurveda and still getting positive results without any side effects. Instead of this if they would have approach firstly to Ayurveda there would be no complication and disease would have been treated at early stage with minimal amount of medication and promising results.

Nidana (Causitive factors) –

1) Viruddha Ahara – Incompatible food

 2) Viruddha Chesta – Improper physical 

 3) Nischalata- Lack of physical activity 

4) Snigndhama bhuktavato vyayamam :- To  Perform physical exercise soon after intake of heavy food causes Ama in the body. 

It is very difficult to elicit the very exact cause of Aamavata. 

When we see according to modern science  also stated that the exact etiopathogenesis of Rheumatoid Arthritis is not known. 

Symptoms(Samanya Lakshan) of Amavata-

• Angamarda – Body ache
• Aruchi – Anorexia 
• Trushna – Thirsty 
• Gourav – Heaviness in the body 
• Aalasya – Lethargy 
• Angashunata – Swelling in the body 
• Jwara – Pyrexia 
• Apaki – Indigestion  

Pratyatma lakshana of Amavata 

1) Sandhi shotha – Swelling in multiple joints 

2) Sandhi shoola – Pain in the joints 

3) Gatra stabdhata – Stiffness in the body 

Clinical features –

• Hasta sandhi shotha & shoola – Inflammation & severe pain in metacarpo-phalangeal joints & proximal inter-phalangeal joints are mostly affected
• Paad sandhi shotha & shoola – The feet are often involved especially the metatarso phalangeal joints & subtalar joints are affected
• Jaanu gulfa sandhi shotha – It involves firstly smaller joints of hands & feet after that symmetrically it affects the joints of wrist, elbow, ankle & knee.
• Angagaurav – Feeling of heaviness in the body.
• Stabdhata – In R.A. stiffness of joints, particularly observed in morning hours
• Jaadhya – Due to deformity limited movements in the joints, weakness in grip or triggering of fingers occurs in R.A.
• Angavaikalya – Deformity in joints
• Sankocha – Contractures
• Vikunchana – This can be compared to volar subluxation, ulnar deviation that occurs at metatarsophalangeal joints and bilateral flexion contractures of the elbow.
• Angamarda – Body ache, myalgia

Joints Commonly Involved In R.A.

 1) Finger joints (40%) – MCP & PIP joints 

2) Shoulder joints (20%) 

3) Foot joints (20%) 

4) Wrist joints (15%) 

Other joints that are involved in Chronic Rheumatoid Arthritis Joint Deformity –

1) Swan neck deformity in interphalangeal joint. 

2) Boutonniere (flexion at proximal interphalangeal joint & hyperextension at distal interphalangeal joint).

 3) Z deformity in the thumb. 

4) Volar subluxation along with ulnar deviation occurs at metacarpophalangeal joint.

 5) Bilateral flexion contractures of the elbow.

 6) Synovitis at wrist can cause carpel tunnel syndrome. 

Treatment and Management of Rheumatoid Arthritis

When disease becomes chronic and the patient develops deformity in the joints such as Sandhisankoch (Joint stiffness) , Akarmanyata (Limited movements) etc. cannot be corrected with medicines alone. 

Effective Herbs-

• Drug of Choice- Guggulu
• Other metallic preparations-

• Suvarna Bhasma
• Tamra Bhasma
• Loha Bhasma
• Parada
• Gandhaka

 Chikitsa of Amavata 

• Langhana: – Langhana is the 1st line of treatment to digest Ama. langhana does not means complete fasting but there is intake of light food items.
• Swedana: – Swedana is sudation therapy; in this disease swedana is done externally on affected joints. Ruksha swedan – (Sudation without oil/fat)- rooksha sweda valuka (sand) is recommended.
• Snehana is contraindicated in amavata
• Katu, Tikta & Pachak aahar & aushadhi :- The drug are decided on the basis of these fators i.e. Katu (pungent), Tikta (bitter) & acts as deepana, pachana or an appetizer.
• These drugs, by virtue of their qualities does Aamapachana, hence may help in relieving shotha & shoola. 
• Virechana: – Erandataila and Haritaki are used
• Basti chikitsa: – ksharabasti and anuvasanabasti in amavata. Following tailas are used in anuvasana and nirooha basti –  Prasarani taila∙  Bruhat saindhavadi taila∙  Dashmooladi taila∙ Eranda taila is used as base in preparation of these tailas 

• Shamanaushadhi-

• Kwath yoga –

∙  Rasna panchak kwatha

∙  Rasna dwadashak kwatha

∙  Shunthi gokshur kwatha

∙  Dashmooladi yoga

∙  Shattyadi kwatha

∙  Rasonadi kashaya

• Choorna yoga- 

∙  Pippalyadi choorna

∙  Amrutadi choorna

∙  Panchasama choorna

∙  Alambushadi choorna

• Lepa in Amavata – Shatapushpadi lepa

∙  Himsradi lepa 

• Guggulu in Amavata – Simhanada guggulu

∙  Yogaraja guggulu

• Ghrita in Amavata – Nagaradi ghrita

∙  Shringaveradya ghrita

• Shoola shamanartha(Pain Releiving) taila

• Vishgarbha taila

∙  Panchaguna taila

∙  Prasarini taila 

Rasaushadhi in Amavata  

Amavata vidhwamsa rasa

∙  Amavatarirasa

∙  Amavatadri vajra rasa

∙  Suvarna bhasma

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