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“A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid
Arthritis”
By Suresh N. Hakkandi
Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.
In partial fulfillment of the requirements for the degree of
AYURVEDA VACHASPATHI M.D. (PANCHAKARMA) In
PANCHAKARMA
Under the guidance of
Dr. G. Purushothamacharyulu,
M.D. (Ayu) And co-guidance of
Dr. Shashidhar.H. Doddamani,
M.D. (Ayu)
Post graduate department of Panchakarma, Shri D. G. Melmalagi Ayurvedic Medical College,
Gadag – 582103.
2006.
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore.
DECLARATION BY THE CANDIDATE
hereby declare that this dissertation / thesis entitled “A Comparative
Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthriyis”
is a bonafide and genuine research work carried out by me under the guidance
of Dr. G. Purushothamacharyulu, M.D. (Ayu), Professor and H.O.D, Post-
graduate department of Panchakarma and co-guidance of Dr. Shashidhar. H.
Doddamani, M.D.(Ayu), Assistant Professor, Post graduate department of
Panchakarma.
Date: Suresh N. Hakkandi Place: Gadag.
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A Comparative
Study of Virechana karma and Basti karma in Amavata W.S.R.T.
Rheumatoid Arthritis” is a bonafide research work done by Suresh N.
Hakkandi in partial fulfillment of the requirement for the degree of Ayurveda
Vachaspathi. M.D. (Panchakarma).
Date:
Place: Gadag Dr.G.Purushothamacharyulu, M.D. (Ayu).
Professor & H.O.D
Post graduate department of Panchakarma.
ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION
This is to certify that the dissertation entitled “A Comparative
Study of Virechana karma and Basti karma in Amavata W.S.R.T.
Rheumatoid Arthritis” is a bonafide research work done by Suresh N.
Hakkandi under the guidance of Dr.G. Purushothamacharyulu, M.D. (Ayu),
Professor and H.O.D, Postgraduate department of Panchakarma and co-guidance
of Dr. Shashidhar.H. Doddamani, M.D. (Ayu), Assistant Professor, Post graduate
department of Panchakarma.
Dr. G. Purushothamacharyulu, M.D. (Ayu) Dr. G. B. Patil.
Professor & H.O.D, Principal.
Post graduate department of Panchakarma.
COPYRIGHT
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences,
Karnataka shall have the rights to preserve, use and disseminate this
dissertation / thesis in print or electronic format for academic / research
purpose.
Date: Suresh N. Hakkandi Place: Gadag.
© Rajiv Gandhi University of Health Sciences, Karnataka.
Abstract
Virechanakarma and Bastikarma are the most important among the
Panchakarmas. It has already been proved that the karmas are beneficial in managing
the Amavata, and it is the most common joint disorder worldwide.
The study “A Comparative Study of Virechana karma and Basti karma in
Amavata W.S.R.T. Rheumatoid Arthritis” is focused on important techniques i.e.
Nittyavirechana and Yogabasti and also common clinical entity Amavata.
Nittyavirechana with Eranda tial and Yogabasti with Erandamooladi niruha and
Brihatsandhavadi anuvasana are believed to have a appreciable role in the
management of such crippling nature, reptitive attacks and chronic course of
Amavata.
The objectives of this study are 1] To evaluate the effect of Nittyavirechana in
Amavata 2) To evaluate the additive efficacy of Yogabasti in Amavata3) To evaluate
the comparative effect of Nittyavirechana and Yogabastib in Amavata
The aim of this study was to find out the effect of Nittyavirechana and
Yogabasti in the management of Amavata, and to check the comparative effect in
managing the same disease. Therefore, two groups were made and the results obtained
in both the individual groups were compared. The study design selected for the
present study was prospective comparative clinical trial.
In group A (Nittyavirechana) 01 patients (6.66%) had good response to the
treatment and 11 patients (73.33%) had moderate response to the treatment and
03(20%) patients show mild response after the treament.
In group B (Yogabasti) 6 patients (40%) had good response to the treatment
and 9 patients (60%) had moderate response to the treatment. Among the group A and
B the parameters Gulph, Pada and Uru shows highly significant, where as other
parameters are not significant in the comparative study (By using unpaired t-test,
p<0.05).
At the same time overall treatment response was better in the Nittyavirechana
and Yogabasti. This suggests that there was considerable improvement in both the
groups but Yogabasti group got more beneficial effects.
Amavata is a Kapkavata vyadhi affecting people in the Madhyama avasta. The
disease is obtained by the involvement of Ama and Vata, characterized by Ruja and
Shotha in Sandhi sthanas. Therefore, the agents/therapies of Amapachana, Lekhana,
Vatanulomana etc, properties should be used in this disease. Nittyavirechana imparts
Agnideepana, Vatanulomana and opens up the srotas in the shareera facilitating more
nourishment and free movement of Vata dosha. Yogabasti is prime treatment for
Amavata in turn plays vital role in correcting pathology of the disease and gives
remarkable results.
This results in the relief of symptomatology of the disease, by acting locally
and systematically. Ingredients of Eramdamooladi niruhabasti and Brihatsaindhavadi
tail possess properties such as Vedanashamaka, Shotahara Lekhana and also
Vatanulomaka. There by, it is an ideal treatment of choice in Amavata.
Key words: - Nittyavirechana, Yogabasti, Amavata, Rheumatoid Arthritis,
Vaishwanara choorna Eranda tail, Eeandamooladi niruha, Brihatsaindhavadi
anuvasana.
Acknowledgement One of the great pleasure of life is doing the things that others says you
cannot do it, by the grace of god, bless of eiders I take this opportunity to express my
regards to the persons who helped in completing this work.
I express my deep sense of gratitude to his great holiness Jagadguru Shri
Abhinava Gavisiddheshwara mahaswamiji for their divine blessings.
Words fail miserably when I try to express my gratitude to my mentor, my
guide Dr.G.PurushottamacharyluM.D(Ayu), H.O.D of P.G.Department of
Panchakarma. For his incessant, untiring, round the clock guidance with all the
diligence. His sustained fostering and encouragement instilled considerable
impetus in me enabling to achieve this milestone which otherwise would have
lacked this particular finish.
Indeed, I will cherish the affectionate guidance of my co-guide
Dr.Shashidhar H.Doddamani M.D (Ayu), Asst professor of P.G.Department of
Panchakarm. For his invincible and radical thinking were very valuable in
achieving this research work invoking scientific spirit throughout the course of the
study.
I express my sincere and deep gratitude to Dr.G.B.Patil, Principal,
D.G.M.A.M.C, Gadag, for his wholehearted encouragement as well as providing all
necessary facilities for this research work.
I express my sincere gratitude to Dr.P.Shivaramudu M.D (Ayu), Assistant
Professor and Dr. Santhosh.N.Belavadi MD (Ayu), Lecturer of P.G.Department of
Panchakarma for his excellent advices.
I also express my sincere gratitude to Dr.S.D.Yargeri R.M.O. for his moral
support and special care in providing the all the facilities during this trail work.
I express my sincere gratitude to Dr.V.Varadacharyulu, Dr.M.C.Patil, Dr.
Mulgund, Dr.Dilip Kumar, Dr.R.V.Shetter, Dr. K.S.R.Prasad, Dr.G.Danappa Gowdar,
Dr. Kuber Sankh, Dr.J.G.Mitti, Dr.Sheshikanath.Nidagundi, Dr. Samudri and other
PG staff for their constant encouragement.
I thank Dr. B. G. Swami, Dr.U.V.Purad, Dr.B.M,Mulkipatil and other
undergraduate teachers for their support in the clinical work. I thank to Shri.
Nandakumar (Statistician), Shri.V.M.Mundinamani (Librarian), Mr.Surebana and
other hospital and office staff for their kind support during my study.
Indeed, I will cherish the affectionate of my Father, my Mother, my wife
Dr. Pratibha, my son Satvika, my sister Jayashree, brother-in-law Sharanappa, my
brother Shambanna Bavihalli and all my family members who have been a source of
inspiration for my entire carrier.
I cardinally thank Dr. B. S. Savadi, Dr. Sambayya, Dr. K. B. Hiremath, Dr. A.
S. Patil, Dr. C. S. Karamudi, Dr. S. S. Shiruramath, Dr. Srikant P.L., Dr Rudrakshi,
Dr. S. R. J., Dr. Manohar, Dr. S. M. Patil, Dr. B. V. Desai, Dr. Hunagund, Dr. Syed
Pasha, Raghavendra Kulakarani and other staff of S. J. S. Ay. Medical college
Koppal.
I express my sincere thanks to my friends Dr.Babu Menon, Dr.Dattu Vijapur,
Chandranna M., Ramesh Gadad, Anand Ballary, Dr.Santhosh.L.Y, Dr. Subin, Dr.
Sateesh, Dr. Febin, Dr. Varsha, Dr. D. S. Swami, Dr.V.M.Hugar, Dr.Jayaraj
Basarigidad, Dr.Venkaraddi, Dr.B.L.Kalmath, Dr.P.Chandramouleeswaran,
Dr.Shaila.B. Dr.Uday Kumar, Dr.Ratna Kumar, Dr.Ghanti, Dr.Pradeep, Dr.Sobagin,
Dr.Manjunath.Akki, Dr.G. G. Patil, Dr.Ashwindev, Dr.V.S.Hiremath,
Dr.L.M.Biradar, Dr.Jagadisha.H., Dr.Sharanu, Dr. Krishna J. Dr. Shivakumar Sarvi,
Dr.Anand, Dr.Umesh, Dr.Suvarna, Dr. Anita Dr.Devendrappa, Dr.Sibaprasad,
Dr.Madhushree, Dr.Ashok.M.J, Dr.Payappagoudar, Dr. Prasanna, Dr. Nataraj, Dr.
Udayaganesh, Dr. Adarsha, Dr. Shailej, Dr. Muktha and other post graduate scholars
for their support.
I would like to mention the support and inspiration provided by my Father-in-
law Shri.Shantappa Budihal & family for their support and encouragement during my
study.
I acknowledge my patients for their wholehearted consent to participate in this
clinical trial. I express my thanks to all the persons who have helped me directly and
indirectly with apologies for my inability to identify them individually.
Finally I dedicate this work to my respected parents Shri. N. S. Hakkandi,
Smt. F. N. Hakkandi and my wife Dr. Pratibha who are the prime reasons for all
my success.
Date: Signature of the scholar
Place: (Dr.Suresh N. Hakkandi)
TABLE OF CONTENTS Chapters Page No.
1. Introduction 1-4
2. Objectives 5
3. Review of literature 6-85
4. Methodology 86-104
5. Observation and Results 105-136
6. Discussion 137-154
7. Conclusion 155-156
8. Summary 157-158
9. Bibliography 159-171
10. Annexure
List of tables
Table No. Page No.
1. Showing bhoutik composition of virechana dravya 14 2. Showing doses of Virechana drugs according to Sharangdhara 19 3 showingvirechana matra according Koshta 19 4 showing Assessment parameters of Virechana 20 5 showing Samyak Yoga Lakshana of Virechana 21 6 showing Virechana Vyapat 21 7 Showing Amavata Nidana according to various Acharyas 49 8 Showing the similarity between Amavata and Rheumatoid Arthritis 56 9 showing lakshans According to different Ayurvedic classics 58 10 Showing the Sthananusara Laxana 59 11 showing various Upakramas have been prescribed by different 68
Acharyas for the treatment of Amavata: 12 showing extra articular features of RA 79 13 showing differential diagnosis regarding with Amavata 81 14 Showing the Composition and Properties of Vaishwanara Churna 88 15 Showing the Properties of Drugs of Brihat Saindhavadi Taila 89 16 showing Erandamooladi Vasti Dravyas 91 17 showing distribution of patients by age groups 106 18. Showing distribution of patients by Sex 107
19 showing distribution of patients by religion. 108
20 showing distribution of patients by occupation. 109
21 showing distribution of patients by socio-economical status 110 22 showing distribution of patients by dietary habits. 111
23 showing the distribution of patients by duration of disease 112 24 showing the distribution of patients by treatment history 113 25 showing distribution of patients by nature of Koshta. 114
26 showing distribution of patients by Jatharagni. (Status of Jatharagni). 115
27 showing distribution of patients by nature of Mala pravritti 116 28 showing distribution of patients by type of Desha. (Nature of Habitat). 117
29 showing distribution of patients by Vyasana. (Addiction). 118
30 showing the distribution of patients by Nidra in both Groups. 119 31 showing the distribution of patients by Deha prakriti in both Groups. 120 32 showing the distribution of patients by Satmya. 121
33 Showing the presence of RA factor in both group 122 34 Showing the presence of ASLO titer in both group 123 35 Showing the presence of CRP titer in both group 124 36 Showing the types of Amavata in both groups 125 37 Showing the distribution of patients by Mode of onset in both Groups. 126 38 showing distribution of patients by Nidana 127 39 showing the distribution of symptoms of Amavata in both Groups 128 40 Showing the over all effect of treatment in both Groups. [ last graph] 129
41 showing Data related to the response of treatment in group A 131 42 showing Data related to the response of treatment in group B 132 43 showing statistical analysis of subjective and objective 133
parameters in group A 44 showing statistical analysis of subjective and objective 134 parameters in group B
45 showing the comparative statistical analysis 135 of subjective and objective parameters in both groups
List of graphs 1 showing distribution of patients by age groups 106 2. Showing distribution of patients by Sex 107
3 showing distribution of patients by religion 108
4 showing distribution of patients by occupation 109
5 showing distribution of patients by socio-economical status 110 6 showing distribution of patients by dietary habits. 111
7 showing the distribution of patients by duration of disease 112 8 showing the distribution of patients by treatment history 113 9 showing distribution of patients by nature of Koshta. 114
10 showing distribution of patients by Jatharagni. (Status of Jatharagni). 115
11 showing distribution of patients by nature of Mala pravritti 116 12 showing distribution of patients by type of Desha. (Nature of Habitat). 117
13 showing distribution of patients by Vyasana. (Addiction). 118
14 showing the distribution of patients by Nidra in both Groups. 119 15 showing the distribution of patients by Deha prakriti in both Groups. 120 16 showing the distribution of patients by Satmya. 121
17 Showing the presence of RA factor in both groups 122 18 Showing the presence of ASLO titer in both groups 123 19 Showing the presence of CRP titer in both groups 124 20 Showing the types of Amavata in both groups 125 21 Showing the distribution of patients by Mode of onset in both Groups. 126 22 showing distribution of patients by Nidana 127 23 showing the distribution of symptoms of Amavata in both Groups. 129 24 Showing the over all effect of treatment in both Groups. 130 List of flow chart 1] Flow chart showing Samprapti of Amavata 52 2] Flow chart showing pathogenesis of RA 76
Introduction
Introduction
Ayurveda, the fountain head of Indian medicine was conceived as a
science and preached in this country some thousands of years ago, long before the
other countries could dream of systematizing the concept of the remedies for
human ailments.
With the march of time, most of the dietary habits, social structure, life
style, and environment have been changing. Occurrence of Amavata on large
scale is one of the outcomes of this modification. It is commonest among chronic
inflammatory joint diseases in which joints become swollen, painful, and stiff. It
is a debilitating disease in view of its chronicity and complications. Therefore, it
has taken the foremost place among the joint disorders. It continues to pose
challenge to physician due to severe morbidity and crippling nature and claiming
the maximum loss of human power making it a biggest world wide burning
problem irrespective of races. It is equated with Rheumatoid Arthritis, an
inflammatory Auto-immune disorder.
The lives of more than one million people are physically impaired due to
Rheumatic disorders and one fifth of these are severely disabled. The onset is
more frequent during 4th and 5th decade of life with 80% of patients developing
the disease between the ages of 35 to 50 years. Women are affected
approximately 3 times more often than men. Pregnancy is often associated with
remission of the disease in the last trimester with subsequent relapses after
delivery. About 10% of the patient will have an affected first degree relative. A
genetic susceptibility to altered immune responses probably is important in R.A.
Amavata was first described as an independent disease in Madhava
Nidana. It is a disease of Madhyama Roga Marga as it affects Sandhis and
Hridaya Marma. Though Ama and Vata are the predominant pathogenic factors
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
1
Introduction
but the disease represents Tridoshic vitiation. The affliction of Sandhis by Vata
dosha in association with Ama, reflects the equal role of both Dosha and Dushya
in the causation of this disease. Moreover, the chief pathogenic factors, being
contradictory in nature posses difficulty in planning the line of treatment.
No doubt allopathic system of medicine has got an important role to play
in overcoming agony of pain, restricted movement and disability caused by the
articular diseases. Simultaneously prolonged use of allopathic medicines are not
only giving rise to many side effects, toxic symptoms and adverse reactions but
also more serious complications like organic lesions etc. are caused by them.
Hence the management of this disease is merely insufficient in other
systems of medicine and patients are continuously looking with a hope towards
Ayurveda to overcome this challenge.Till now 160 Ph.D and P.G. works have
been carried out at various Ayurvedic Institutions and about 25 Reseach works
have been carried out in P.G. Institutes. This large number itself suggests its large
occurrence and faith of patients in Ayurvedic Management.
For the present study, on Amavata as Shamana therapy Nittyvirechana
with Eranda Taila and Yogabasti with Erandamooladi kwatha niruha and
Bruhatsandhavadi taila anuvasana has been chosen, for the comparative effect of
both. Many works with Virechana Karma and Ksharabasti on Amavata have been
successfully carried out. But evaluate the comparitive effect of the results of
Nittyavirechana and Yogabasti was conducted in this study. Both the therapies
chosen fulfill the regimen of specific treatment of Amavata mentioned in
Chakradatta.
Total 30 patients of Amavata were treated. These patients were randomly
distributed into 2 groups which are 15 patients reciveing Nittyavirechana with
Eranda taila and another 15 patients recived Yogabasti with Erandamooladi
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
2
Introduction
kwatha niruha and Bruhatsandhavadi taila anuvasana Out of the above said
groups Yogabasti with Erandamooladi kwatha niruha and Bruhatsandhavadi taila
anuvasana provided significantly better improvement in Rogi bala, Agni bala,
Deha bala and Chetasa bala than the other group.
The complete study has been made into two major divisions - the
conceptual study & the clinical study. The conceptual study is grouped into a
literary review of Virechana, Basti Amavata and drug review, the clinical study
contains the Observations, Results, Discussion and Conclusion and lastly
Bibliography.
Need for the study:
The Panchakarma therapy is an integral part of Ayurveda many diseases
according to Ayurveda are direct result of Srotavarodha particularly due to the
Agnimandya and Ama1. Panchakarma play a vital role in Ayurvedic therapeutics.
Shodhana strikes at the root of malas and eradicates them2 and as such
the disorders treated with Samshodhana do not reoccur while those treated
with other methods might reappear.3
Many of the chronic progressive disease like Rheumatoid Arthritis (RA)
do not have an effective line of management, recent studies on RA have
suggested positive results with Panchakarma.
RA is an immuno inflammatory disease that affects joints and extra
articular tissues4. RA occurs throughout the world and in all ethnic groups 5.
The prevalence is highest in Indians. In caucasians it is around 1.0 to 1.5%
with a female : male ratio 3:16. The onset of RA may occur any time in life.
Approximately 70% of RA occurs between the 3rd and 7th decades7.
. The disease draws attention for the consideration of research firstly due
to the gravity of the problem, secondly due to the lack of suitable known
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
3
Introduction
modern drugs for treatment and lastly it is an intriguing disease and challenge
to clinicians and research workers.
In the management of Amavata Ayurveda gives importance to Shodhana
karma among Shodhana Virechana and Bastikarma have got vital role8 in curing
and preventing the disease.
The present study intends to give new light on the comparative effect of
Virechana and Basti in Amavata so “A comparative study of Virechana karma
and Basti karma in Amavata with special reference to Rheumatoid Arthritis” is
under taken.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
4
Objectives
Objectives
The above study was carried out with following Aims and Objects:
1. To study the effect of Nittyavirechana with Eranda taila in Amavata.
2. To evaluate the efficacy of Yogabasti with Erandamooladi kwatha niruha
and Bruhatsandhavadi taila anuvasana in Amavata.
3. To compare the efficacy of above two procuder in Amavata.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
5
Historical review
Historical review of Virechana
Ayurveda has propagated treatment for most of the disease, in that
treatment mainly we find two types according to Kayachikitsa Siddhanta, and
those are Shamana and Shodhana. Shamana means mitigating doshas in the body
when they have aggravated, though after mitigating once again they may reoccur,
where as Shodhana procedure is nothing but eliminating the doshas out of the
body. In this there is no chance of reoccur.
Virechana is such a treatment modality, which eliminates doshas from
Guda marga. This Virechana have well explained in Samhita kala and Sangraha
kala.
Samhita kala
1] Charaka samhita;
Explanation of Virechana dravya sangraha, Virechana yogas, its
prosuder,9,10,11 different types of Virechana dravya kalpa in Kalpa sthana,12 in
Siddhi sthana we find fine explanation of Virechana Samyag laxana, Ayoga
laxana, Atiyoga laxana, Virechana yogya, Ayogya, Virechana Vyapat and its
Chikitsa have delt.13,14,15
2] Susruta samhita:
In Susruta samhita Chikitsa sthana the complete procedure of Virechana,
its definition, Samyag laxana, Ayoga laxana, Atiyoga laxana, Virechana yogya,
Ayogya, Virechana Vyapat and its Patikara have completely explained.16,17 In
sutra sthana different virechana dravyas and its preparation is explained.18,19
3] Astanga sangraha:
In the astang sangraha sutra sthana 27th chapter whole Virechana karma
have explained,20 in kalpa sthana Virechana yogas and Vyapats are discussed.21
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
6
Historical review
4] Astang hridaya:
In the 18th chapter of his Sutra sthana complete Virechana procedure,22 in
his Kalpa sthana Virechana yogas and Vyapats are mentioned.23,24
5] Sangraha kala:
We find well contribution of Virechana in Sharangadhara samhita,25
Kasyapa samhita Siddhi sthana,26 Bhavaprakasha poorva khanda,27 Yogaratnakara
Virechanadhikara28 and Chakradatta Virechanadhikara.29
Historical review of vasti
In the literature it is necessary to know the past events of concerened
subject. From ancient period it self-science of Ayurveda have started. So it is
necessary to know about the systemic documents of Veda, Purana, Yogic
literature and our Ayurvedic text.
1] Veda kala
Direct reference of Vasti karma will not be found in Veda, but
explanation of Vasti is their as “Vishitam te Vastibilam”30
2] Purana kala
Vasti is indicated as the principal remedy in the probleme of increase of
Vatadosha in Agnipurana.31 Different Snehas have told to use for Vasti
accourding to season.32
3] Yogic literature
Gheranda samhita includes Vasti in Satkarma, mainly two types of
Vasti have explained on their besis of administration ie first is Jala vasti which
will be done in water, second one is Sushkavasti which is done on land.
4] Samhita kala
Most of the Ayuevedic classical text have given much importance to Vasti
karma, that’s why we found separate Adhyayas for explaining Vasti karma and
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
7
Historical review
while dealing the treatment of each disease we will find the elaborate version of
Vasti Dravya and preparation.
Vasti revieve of Samhita can be studied by referring Charaka samhita,
Susruta samhita, Astanga sangraha and Astanga hridaya.
Charaka samhita
Charaka has explained definition of Vasti, Types of Vasti, priparetion of
Vasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti
dravyas etc.33
Susruta samhita
Susruta widely explained definition of Vasti, Types of Vasti, priparetion
of Vasti, Procuder of Vasti, Karmukata of Vasti, Vasti Vyapat its Chikitsa, Vasti
dravyas etc in his Chikitsa sthana.34
Vagbhata
Both in Astanga sangraha35 and Hridaya36 elobarate discription of Vasti
have told in Sutra sthana and regarding Vasti Dravya we will find in Kalpa
sthana.37,38
Kashyapa Samhita:
In Kashyapa Samhita, Basti has been explained in detail in Siddhisthana
and Kalpasthana.39
Bhela Samhita:
In Bhela Samhita, description of Basti is available in four chapters of
Siddhisthana namely Bastimatriya Siddhi, Upakalpa Siddhi, Phalamatra Siddhi
and Dosha Vyapadika Basti Siddhi.40
Harita Samhita:
In this text, only 3rd chapter of Sutrasthana deals with Basti.41
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
8
Historical review
Chakradatta:
In this text, two chapters named Anuvasanadhikara and Niruhadhikara are
dealt with Anuvasana and Niruha Basti respectively.42
Vangasena:
In Chikitsa Sarasangraha, Vangasena has devoted “Basti Karmadhikara”
chapter for description of Basti.
Sharangadhara Samhita:
Three chapters of Uttarakhanda namely Basti Kalpana Vidhi, Niruha
Basti Kalpana Vidhi and Uttara Basti Kalpana Vidhi described various aspects of
Anuvasana Basti, Niruha Basti and Uttara Basti respectively.43, 44,45
Bhavaprakasha:
In this Grantha, 5th chapter of Purvakhanda has been contributed to the
description of Basti. Vrana Basti – this type of Basti has been explained in this
Grantha.46
Kalyanakaraka: In this text, Basti is described in Vatarogadhikara only.
Todarananda: In this text, Basti is described in the chapter Basti Vidhi.
Historical review of Amavata
An off shoot of Atharva and Rigveda, this science of medicine is without
beginning, but Ayurveda saw throughout many people, who organized it into
beautifully woven treatises, incorporating newer diseases and their treatment,
which cropped up during their times. It is evident in the Samhitas that the most
prevalent and deadly diseases have been devoted separate chapters were included
as secondary diseases under the major category.
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Historical review
Amavata might not have been widely prevalent and severely crippling as it
was during the time of Madhava Nidana, as we see only passing references to the
disease have been made in the Bruhatrayees. Madhava was the first person to
devote separate chapter for Amavata. Thus the birth of this disease and its
formative years can be glanced, starting from Vedic period.
Vedic period (5000 BC to 1000 BC):
Clear cut explanations of Amavata are not available in Vedic Samhitas,
but disease caused by Kapha have been more or less described under the major
heading Balasa, but the diseases of joints are not included here. Sayana has
quoted few references indicating arthritic syndromes, such as-
Rapasi47: Disease arising due to sin (Rigveda) characterized by pain in
multiple joints also referred to as Papa. Yakshma and treatment with Jala, Vayu
Yava, Kushta have been indicated.
Jayanya48: This disease is said to affect the bones cervical vertebrae and
arise from women through Sanga. Whether the disease refers to rheumatoid
arthritis is still not clear.
Grahi49 (Rigveda and Atharvaveda): This has been described as the
disease of joints but characteristic features have not been clearly mentioned.
Treatment of this disease with Dashavruksha has been mentioned.
Vatikrut50: This disease has been described as a serious ailment caused by
Vata and treatment with Pippali and Vishanashaka has been mentioned.
Sandhivikruti51 (Atharvaveda): This disorder is caused by Sleshma and
can be treated with prayers.
Samhita period (1000 BC TO 600 AD):
Charaka Samhita: Charaka has described in detail Ama and Ama
Pradoshaja Vikara and their treatment with Langhana and Ullekhana.52
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Historical review
Charaka had described treatment for Amavata while dealing with Avarana
Chikitsa in Vatavyadhi, 53 which indicate Pramehahara and Medohara Vidhi.
Amavata finds a mention in the list of therapeutic indication of Kamsa Hareetaki54
in Shwayathu Chikitsa and Vishaladi Phanda in Pandu Chikitsa.55
The treatment of Shariragata Ama in Grahani Chikitsa by Charaka56 is
similar to the description of Amavata Chikitsa by Bhava Mishra i.e. Langhana,
Pachana and oral administration of Panchakola Phanta57, same is the case with
Amavata Chikitsa of Chakrapani in Chakradatta58.
Sushruta Samhita: The description of Amavata in Sushruta Samhita is
conspicuous by its absence.
Bhela Samhita: The tenth chapter in Sutra Sthana deals with Ama Pradosha. This
description has some resemblance with that of Amavata.
Harita Samhita: A complete chapter on Amavata finds a mention in Harita
Samhita59. The classification of Amavata is quite unique and not followed by any
of the later works in this field.
Anjana Nidana: This work is claimed to be written by Acharya Agnivesha,
contains detailed description about etiology, premonitory symptoms, clinical
manifestations and complications.
Sangraha Kala (600AD-1600AD):
Astanga Sangraha and Astanga Hridaya have ignored the disease though
the word Amavata is included in the therapeutic index of compounds Vatsakadi
Yoga60 and Vyoshadi yoga61.
Madhava Nidana62: Madhavakara stated this disease as a separate entity and has
dealt separate chapter.
Chakradutta: Chakrapanidutta has described the treatment for Amavata63.
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Historical review
Vangasena64 and Vrinda Madhava followed Madhava with few additions
in the treatment aspect. Works like Bhava Prakasha65, Yogaratnakara66 and
Bhaishajya Ratnavali67 have only corroborated the descriptions with additional
principles of treatment.
Adhunika Kala (1600AD onwards):
Mahopadhyaya Acharya Gananath Sen has coined the term Rasavata for
Amavata.
In Yoga Shastra the practice of Shushka Basti for improving Jatharagni
and treating Amavata has been mentioned68. Y.N.Upadhyaya (1955) has corelated
the disease with rheumatoid arthritis. Later research workers have agreed with
Y.N.Upadhyaya.
Modern History of Rheumatoid Arthritis69
First Century AD: The rheumatoid/rheumatology is derived from the root
‘Rheuma’, which refers to a substance that flows and probably was derived from
phlegm, an ancient primary humor, which was believed to originate from brain
and flow to various parts of the body causing ailments.
1642 A.D.: The word rheumatism is introduced into the literature by the French
physician Dr.G.Baillou who emphasized that arthritis could be a systemic
disorder.
1800 A.D.: Landre Baervier a physician from Salta Petruver in Paris seemed to
have described the disease for the first time he called it Gartte Asthanique
Primitivae.
1857 A.D.: Sir Garrod proposed the name Rheumatoid Arthritis, Bannatyne also
in 1959 published his pathological observations on the disease but he could
differentiate it from Osteoarthritis only in his later edition.
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Historical review
1928 A.D.: The American committee for the control of rheumatism is established
in U.S. by Dr.R.Pemberton, renamed American Association for the study and
control of rheumatic disease (1934), then American Rheumatism Association
(1937) and finally American college of Rheumatology (ACR) (1988).
1940 A.D.: The terms Rheumatology and Rheumatologist are first coined by Drs.
Hollander and Comroe respectively.
1948 A.D.: Roses identified some criteria for diagnosis of RA.
1958 A.D.: American Rheumatic Association suggested uniform criteria for
diagnosis.
1987 A.D.: The criteria were revised.
In the beginning it was thought to be an infective condition especially in
early 20th century. French scientists thought it to be due to tuberculosis.
Hench and Kendell introduced steroids in the management of rheumatoid
arthritis described paediatric onset, juvenile RA in 1896. Later Felty A.R.
described Felty’s syndrome.
Recent advancement in immunology has opened new vistas in the
management of RA. Unfortunately till date the etiology of RA is unknown the
pathogenesis is speculative, the treatment is only palliative and there is no cure to
this disease.
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Virechana karma
Revive of virechana karma
Virechana is one of the Shodhana karma described by Acharyas. It is a
specific process for elimination of Pitta Dosha, but other two Dosha to some
extent. It is less tedious procedure than Vamana and hence less possibility of
complications, and could be done easily. So Virechana karma is widely practiced
Shodhana therapy in routine.
Definition:
The process of elimination of Dosha from Adhomarga is known as
Virechana 70.
Sometimes actions of expelling Doshas through both Urdhva (Vamana) and
Adhomarga are also termed commonly as Virechana. For instance Caraka has
mentioned Yoga of Vamana and Virechana both. Even for Niruha Basti and
Shodhana Nasya Virechana term is used. But in this context Virechana can be
understood as a procedure-involving intake of medicine through oral route and
expelling vitiated Pitta Dosha and Mala through Adhomarga71.
Pharmacodynamics of Virechana Karma:
The Bhuta predominance as well as the properties of drug should be
analyzed in detail to explain the Pharmacodynamics of the particular drug in
Virechana Karma. Contrary to Vamana Dravya, Virechana Dravya possesses
some properties, which are not in accordance with the Bhautik constitution72.
Table-1, Bhoutik composition of virechana dravya
Bhautik Composition Properties expected Properties present Sneha Ushna Manda Tikshna Sthula Sukshma
Bhumi Jala
Guru Vyavayi
Virechana Dravya has Guna, which are not in accordance with Bhutas,
which may be explained in terms of Vichitra Pratyayarabdhata. This Vichitra
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Virechana karma
Pratyayarabdhata causes bivalent action of the drug an action in the Shakhas,
which is entirely opposite to the Koshta.
The drugs with properties like Ushna, Tikshna, Vyavayi and Sukshma by
virtue of their penetrative as well as infiltrative properties enter Hridaya and from
there they spread through Dhamanis. These drugs cleanse the adhesive body
Humours by their Agneya Guna and thoroughly disintegrate them by Tikshna
Guna. This brings the Doshas to Amasaya. Proper Snehana and Svedana have
done previously facilitate this process. The circulating metabolic abnormal or
waste products are thus treated by this process and actively excreted to the
intestinal lumen. In the Koshta contrary to the Vamana Dravya, further action
takes place according to the Bhuta predominance and Adhobhaga Prabhava of the
drugs. This bivalent property makes the Virechana drug practically less
complicated and easily employable. Moreover this is the only reason for the
elimination of Dosha through Virechana from Kaphasthana (Amashaya),
Pittasthana (Pachyamanashaya) and Vatasthana (Pakvashaya). But the action of
Vamana is focused in Amashaya only.
Indications and contraindications of virechana karma:
Prior to subjecting the patient to any therapy, it is necessary to examine
whether the patient is fit for proposed therapy or not. Following are the
indications and contra indications for Virechana karma.
Indication:
1. Dosha
Utklishta Pitta, Kapha Samsrshta Pitta, Pittasthanagata Alpa Kapha,
Kaphasthanagata Bahu Pitta73.
Pakvashayagata Pitta or Kapha Pitta74.
Pitta Avrata Vata, Kapha Avrta Vata75.
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Virechana karma
Caraka advises that Tiryakgata Dosha should be taken back to Koshta,
gradually by proper acts and after that elimination should be carried out. This
denotes that Virechana is the treatment of choice in Tiryakgata Dosha as seen in
Kushta.
2. Dushya
For Rasa, Rakta etc, Vikaras Virechana Karma is described in direct or
indirect way76, 77,78.
3. In Svastha79
4. Purvakarma of Rasayana and Vajikarana 80.
5. Virechana is indicated in disorders like, Gulma – Vatadhikya, Kamala –
Paittika, Gara – Tridoshaja, Unmada –Tridoshaja, Kushta – Tridoshaja etc.
From the above references it becomes clear that Virechana karma has a specific
action on various conditions of all three Doshas. It is a procedure of choice for
healthy as well as diseased person.
Contraindication:
In Classics, Contra indications of Virechana are explained in detail. They
can be summarized in following headings
Incapable to tolerate the stress of therapy like Vilanghita, Durbala, Subhaga,
Navaprasuta etc
Sama Avastha of the disorders like Navapratisyaya, Ajirna, Navajvara
Diseases of rectum like Kshata Guda, Muktanala.
Some conditions like Ratri Jagarita, Atisnigdha, Atiruksha, Bhayoptapta,
Chintaprasakta.
Disorders like Adhoga Raktapitta, Hradroga, Atisara, Rajayakshma, Urusthambha
etc81, 82,83.
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Virechana karma
Types of virechana
I. According to Mechanism of Action:
Virechana Dravya is several in numbers. According to Caraka, there are 3
types of Virechana Dravya Viz, Trivrt, Aragvadha and SnuhiKshira are
considered as the best Sukha Virechana, Mrdu Virechana and Tikshna Virechana
respectively84.
Acharya Caraka also described Bhedaniya, Virechanopaga and
Anulomana, which are also suggestive of the types of Virechana. But
Sharangadhara has given a specific description regarding the types of
Adhobhagahara karma; they are Anulomana, Sramsana, Bhedana and Rechana85.
II. According to Prayoga Bheda:
Curna, Vati, Asava, Arista, Avaleha, Sneha and Kashaya etc, Virechana
yoga can be administered in this form of preparation.
III. Based on Part of the Dravya used:
Sushruta describes the following drugs with priority for Virechana
Karma86.
Mula Virechana Syama Trivrt
Phala Virechana Haritaki
Taila Virechana Eranda
Svarasa Virechana Karavellaka
Paya Virechana Snuhi.
Caraka also describes in general Virechana drugs like Mulini, Phalini, Lavana and
Kshira etc.
iv. Classification according to quality:
Caraka and Sushruta have used the terms like Snigdha Virechana and
Ruksha Virechana.
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Virechana karma
Procedure of virechana
For easy understanding purpose whole Virechana procedure can be
grouped under headings like I. Purva Karma II. Pradhana Karma and III. Pascat
Karma
I.Purvakarma:
Purvakarma includes,
Sambhara Samgraha- Collection of all the necessary equipments, drugs, diet etc
used for the therapy.
Atura Pariksha- The detail examination of the Dosha, Dooshya, Atura Bala etc to
be carried out to know fitness of individual to Shodhana87.
Atura Siddhata- Snehana and Svedana are to be carried out prior to Virechana
Karma88. After observing Samyak Snigdha Lakshana by Snehapana, 3 days
Vishrama Kala is given prior to Virechana. During those days Sarvanga
Abhyanga and Bashpa Sveda are performed.
Diet- Snigdha, Ushna, Drava, Mamsarasa, Yusha, Amla Rasa Ahara is preferable
during Vishrama Dina. But Kapha Vardhaka Ahara is to be strictly avoided89.
Manasopacara- Whole procedure of Virechana is to be explained to boost
confidence of the individual.
Matra Vinischaya- Matra should be selected in such a way that the desired effect
of Shodhana may be achieved without any complications. The dose is to be
decided based on Atura, Agni, Koshta and Aushadha.
While describing the process of Virechana the dose mentioned of Trivrta yoga is
one Aksha (1 tola).
However Sharangdhara has given the dose schedule, which seems to be applicable
now a day.
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Virechana karma
Table-2, Doses of Virechana drugs according to Sharangdhara 90,91
Kalpana Hina Matra Madhyama Matra Uttama Matra
Kvatha ½ Pala (2 tola) 1 Pala ( 4 tola) 2 Pala (8 tola)
Curna Kalka etc. 1 tola 2 tola 4 tola
Table-3, Matra according Koshta
Authors Mrdu Koshta Madhyama Koshta Krura Koshta
Sushruta92 Mrdu Matra Madhyama Matra Tikshna Matra
Vangasena 1 tola 2 tola 3 tola
iii) According to Vagbhata, persons having less strength, Shodhita previously,
having less quantity of Dosha, having thin structure and unknown Koshta should
be administered Mrdu Aushadha with very less quantity93.
II Pradhana Karma:
Pradhana Karma includes,
Administration of Virechana Yoga
Observation and management during Virechana Vega
Observation of
-Shuddhi Lakshana
-Virechana Vyapat if any
Administration of Virechana yoga:
Caraka has explained method of Virechana elaborately in Charaka94 as, after
completion of Snehana and Svedana, by finding that the individual is cheerful,
slept well, and fully digested his meal, is advised to perform auspicious rites.
Thereafter considering the Vaya, Bala, Dosha, Bheshaja etc, and after passing the
time of Kapha Prakopa in morning the individual should be given Virechana
Yoga in empty stomach.
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Virechana karma
After administration of the drug, cold water is sprinkled on the face to
avoid vomiting and then the individual is asked to gargle with hot water and to
have fragrance of flower etc. He should be protected from direct cold wind and
should take rest in the bed. He is advised to not to retain the Vega as well as
don’t make Pravahana95.
2. Observation and management during Virechana Vega:
During all the time, Vaidya should concentrate on the manifestation of Lakshana
of Jirna-Ajirna Aushadha, Shuddhi and Vyapat etc.
3. Observation of Shuddhi Lakshana:
Virechana Shuddhi can be assessed as shown in the Table-4, based on parameters
like Vaigiki, Maniki, Antiki and Laingiki Lakshana.
Table-4, Assessment parameters of Virechana
Shuddhi Hina Madhyama Pravara Vaigiki 10 Vega 20 Vega 30 Vega Maniki 2 Prastha 3 Prastha 4 Prastha Antiki Kaphanta Kaphanta Kaphanta Laingiki Lakshana As per described
in Table-5
Manifestation of Samyak yoga, Atiyoga, Ayoga Lakshana and Vyapat should be
observed as per texts 96,97,98,99,100,101
Samyak Yoga Lakshana:
Among different Laingiki Lakshana documented in the classics some are
manifested on the day of Virechana and others on later days. In comparison to
other Shuddhi Lakshana the Laingiki Lakshana is given much importance 102.
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Virechana karma
Table-5
Samyak Yoga Lakshana of Virechana
Lakshana Caraka Sushruta Vagbhata Srotovishuddhi + - - Indriya Prasada + + - Buddhindriya and Manas Shuddhi + - - Laghuta + + - Agnivriddhi + - - Anamayatva + + Vit-Pitta-Kapha-Vata Kramena Prapti + + - Vatanulomana - + Absence of Ayoga Lakshana - - + Manahprasada - + - Dourbalya + - - Glani + - - Aruci + - - Hrdaya-Varna Vishuddhi + - - Kshudha – Trshna + - - Vegapravartanam in Proper time + - -
Virechana Vyapat:
The complications arising due to improper Virechana Karma are known as
Virechana Vyapat. Ayoga and Atiyoga of Virechana may lead to manifestation of
Vyapat 103,104,105
Opinions of Acharyas regarding Virechana Vyapat are shown in Table-6
Table-6, Virechana Vyapat
Vyapat Caraka Sushruta Vagbhata Adhmana + + + Parikartika + + + Parisrava + + + Hrdgraha + - + Gatragraha + - Sarvangagraha Jivadana + + + Vibhramsha + - Guda Vibhramsha Stambha + - -
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Virechana karma
Klama + - - Upadrava + - - Vamana - + + Savashesha Aushadhitva - + + Jirna Aushadhitva - + + Hina Aushadhitva - + - Vata Shula - + Vedana Ayoga - + + Atiyoga - + + Hridaya-Upasarana - + - Vibandha - + - Pravahika - + + Visamjnata - - +
III. Paschat Karma:
Following points can be considered under Paschat Karma
Tat Kalina Paschat Karma:
After the stoppage of Virechana Vega, the hands, feet and face of the individual
should be well washed and he should be consoled for sometime and instructed to
follow Pathya as explained in the context of Snehana and Virechana 106.
Kalantarina Paschat Karma:
Individual is instructed to follow appropriate Samsarjana Krama’s as per the
• Shuddhi Lakshana
• Peyadi Samsarjana
• Tarpandi Samsarjana.
Samsarjana Krama is a specific dietary regimen, which is to be followed
after Shodhana Karma. The aim of this Krama is to increase Agni Bala gradually,
which has become weak due to Shodhana. Caraka reveals importance by giving
example that small sources of fire, if simulated by adding small and light fuel,
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Virechana karma
later on become so big that it can burn anything. Similarly by applying
Samsarjana Krama Jatharagni can be increased to such an extent that it can digest
all types of food 107.
Caraka has mentioned that Peya, Vilepi, Akrita yusha and Krita yusha
should be administered for the period of 3, 2, and 1 meal times to the patient
having Pravara, Madhyama and Avara type of Shuddhi respectively 108.
Sushruta has described Yusha of Kulattha, Adhaki, Mudga and Mamsa
Rasa for this purpose. Dalhana advises that the Peya should be given in the
conditions of Kshina Kapha, but when Vata is dominant Mamsa Rasa should be
recommended 109.
When proper Virechana doesn’t occur at that time instead of Peyadi
Krama, Tarpana is indicated. It is also recommended that the persons addicted to
alcohol, having Vata Pitta Prakrti and if Kapha and Pitta are dominant even after
Virechana Karma, Cakrapani mentioned that in the place of Peya and Vilepi,
Svaccha and Ghana Tarpana should be given respectively 110.
Importance of Virechana
Vamana and Virechana are the main principal remedies in cleaning the
system of all the doshas from the body. On this Dalhana opines, Pakwashayagata
Vata, Pitta and Kapha will be eliminated by 1, 2, 3 Vastis, Dhuma, Nasya, Kavala
etc also eliminate the doshas little by little. Where as Vamana and Virechana will
eliminate the doshas completely out of the body.111, 112
Different varities of virechana
If we gone through our ayurvedic texts mainly we found three types of
Virechana, wheather it may be Anulomana, Srousana, Bhedhana or Rechana,
those three types are
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Virechana karma
1] Virechana, which is done after Snehana and Swedana followed by Samsarjana
karma.
2] Sadhyovirechana, which is given in the emergency condition, with out Snehana
and Swedana like Vamanavyapata, Kosthabadhata or for the shake of
Koshasuddhi.
3] Nittyavirechana which is giving daily for long time with out considering
Snehana and Swedana followed by Samsarjana karma with consideration of
Kostha and Bala of patient, it may be continued for 8 days or 15 days or 1 month
and so on.
1] Virechana
This type of Virechana has already explained in the previous pages.
2] Sadhyovirechana
Sadhyovirechana contains two words, one is Sadhyo and another is
Virechana, Sadhyo means at that movement or immediate. Virechana means
eliminating doshas from Guda marga by takeing Aoushadha with Mukhamarga.
So totally Sadhyovirechana means instant elimination of doshas with Gudamarga
by taking Aoushadha through Mukhamarga with or without considering Snehana
and Swedana
Scope of Sadhyovirechana
1] Second stage of Vishavega
2] Urdhvaga raktapitta
3] Amavata
4] Vamana Ayoga and Atiyoga
5] Vibhanda
6] Alasaka
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Virechana karma
7] In weak person if there is a Bahudoshas and if dosha paka have attained
directly Bhedhaniya Aoushadha or Bhedhaniya Ahara dravya can be advised.
Like this still in many conditions we will find in our classics.113
Sadhyovirechana does the effect of eliminating Vishapadhartha and
accumulated fecous thus does Vatanulomana.
Due to administering Sadhyovirechana with or without considering
Snehana and Swedana using of Snehika virechana is beneficial, this holds good
because of in Ruksha person Snigdha virechana have advised.114, 115 Other wise
giving Ruksha virechana to a person who has not under gone for Snehapana will
destroy like dry stick when bends it.
We get strong reference of using Sahdyovirechana with Eranda tail
combining with Triphala kwatha in Chakradatta116 Yogaratnakara117 and
Sharangdhara118 uttara khanda.
Even for the test of Krura kostha, Madhyama kostha and Sadharana kostha
this type of Sahdyovirechana helps.
In Kruradikostha giving Eranda tail as a Sahdyovirechana is the choice of
drug. Even instead of Eranda tail Ksheera can also be used in that condition.119
3] Nittyavirechana
The literary meaning of Nittyavirechana includes two words, one is Nittya
and another is Virechana. Nittya means everyday or consecutive days for two or
more than two days, Virechana means eliminating doshas from Guda marga by
takeing Aoushadha with Mukhamarga. So Nittyavirechana gives the meaning as
administering virechana Aoushadha everyday or consecutive days for two or more
than two days.
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Virechana karma
Paryayanama of Nittyavirechana
1] Nittya shodhana
2] Nittya anulomana
3] Nittyavirechana
Scope of Nittyavirechana
A debilitated person who has under gone Shodhana therapy earlier and a
person who has very little quantity of doshas inside the body but he is emaciated
and he whose nature of Kostha is not known should be given mild drugs in small
doses, better still in repeated doses, other wise it will create doubt of fatal
condition.
If in a debilitated person the doshas are found to be in motion [Chalan
doshana] and in large quantity they should be removed out of the body little by
little using mild drugs and if they are in little quantity they should be mitigated by
Shamana therapy. Other wise if they remain in side the body for long time causes
trouble to the body and might even kill the person if they are not expelled out of
the body. 120,121,122
Dalhana opines Chalana doshan as Kupitan doshan, Indu commentator of
Asthangha sangraha opines on Chalana doshan, as doshas are in Prabhuta matra
doshas should be eliminated with Mrudu Virechana dravya. Arunadatta comments
on above version, as taking Virechana Aoushadha everyday day is Shrestha or
Varam.
Before giving Shodhana Karma we should win over Kapha and Vata in the
Mandagni and Krurakostha than only Virechana aoushadha can be given.123, 124,125
Even Bhoja also opinions that if doshas are less aggravated they should be
mitigated by Shamana chikitsa, if the Bahudosha condition is their, they should be
eliminated little by little with out harming the patient.
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Virechana karma
Doshas, which are mitigated by Shamana chikitsa, are likely to reappear
again but those, which are expelled out of the body by Shodhana Karma i.e. by
Vamana and Virechana, do not re-occur. This statement does not holds good in
some conditions like Udararoga, Amavata, etc because in these diseases everyday
the re-accumulation of doshas will takes place that’s why in these type of
condition Nittyavirechana helps in eliminating the doshas which accumulate
daily.
In above told condition Mrudu type of Nittyavirechana helps. Mrudu
means we can use Draksha, Paya, Ushnambu or Tail, Commenting on Tail
Adamalla opines to consider Eranda tail.
While explaining Abhayadimodaka it is well explained that when taking
Nittyavirechana in little quantity there is no any restriction of food or other
activities or in this condition Tarpanadi karma can be followed other wise
Shastika shali anna with Yavagu of Mudga and other grams or Jangala mamsarasa
with Shastika shali anna is benifisial.126
Benefits if Nittyavirechana
1] Helps to eliminate doshas which accumulate everyday.
2] Act as Rasayana if they are taken for long time. For example Eranda tail and
Abhayadimodaka.
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27
Basti karma
Vasti karma
Vyutpatti
“Vasti” the word derived from the root “Vas” with the suffix of Prattyaya
“Tich”.
Nirukti and Paribhasha
1. Using Ajadi Vasti Putaka for the use of giveing Aoushadha is called
Vasti.127
2. Due to giving medicine by Vasti Putaka is called Vasti.128, 129,130
3. Due to administering medicine in to Gudamarga with Vasti is called
Vasti.131
4. Which is Sadhyakarma with Mootradhara Putaka is Vasti.132
5. The karma while moveing in Nabhi, Kati, Parshwa, Shroni churns up the
stool including all the other doshas located their, and appropriately
eliminates them with easy after doing Snehana of body is called Vasti.133
Vasti Karmukhata
Vasti is one of the best Chikitsa in Panchakarma, its action will not be
restricted to only Pakwashaya Shodhana where as it acts all over the body. By
mixing different drugs it acts as Shodhana, Shamana, Lekhana, Brouhana,
Vajikarana, Vayasthapana etc.134 So Vasti can be used in any type. Now its mode
of action will be explained as follows.
Just as the cloth absorbs only colour from the solution of Kusumbha and
other coloring substances, so also the Vasti expels out from the body only the
doshas, which have been maid moist.135, 136
The body is sustained by Vayu because of its ability to cause detachment
of any adhesion. Vayu alone or along with other doshas get aggravated in its own
habitat. Vasti by its Shodhana action causes downward movement of that Vayu
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along with Pitta, Kapha and feces. Because of allivetion of this Vayu, all the
diseases pervading the whole body get alleviated.137
Chakrapani comments over above point and says, science Vasti causes
alleviation of basic Vayu located in Pakwashaya other connected Vayus else
where in the body gets automatically alleviated. This holds good similar
destruction of a tree by cutting its root. This explains the cure of all the diseases
of the body by simply correcting the Vayu located in its basic habitat ie colon.
In Charaka siddhi Vasti is described to draw out all doshas from the foot
to the head by its Virya.
Medicine injected through rectum remains in the intestines in the region of
the pelvis and below the umbilical region. The potency Vasti dravya spreasds all
over the organism from the Pakwashaya just as the potency of the water poured at
the root of the tree tends to permeate the whole tree through its minutest cells and
fibers. The liquid part of Vasti is emitted out through the rectum either by it self
or with feocal matter etc. But its potency acts over whole organism through the
intervention of Apana and other Vayus. The potency of the Vasti dravya in the
Pakwashaya acts on the while organisam from top to toe, like the sun in the haven
acting on the humidity of the earth below. Vasti if applied correctly tends to
eliminate completely from the system all the doshas accumulated in the region of
the back, waist and abdomen.138, 139,140
Importance of Basti karma
Vata is the Neta141 of all Dosas, it is considered as Ishvara142 and it is the
causative factor for all trimargaja rogas 143,144. For this type of Vata Vasti is the
best amoung other Karmas.This Vasti is considered as Ardha chikitsa because of
disease produced by Vata are 80 in number.145
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Vasti can be utilized in Bala, Vridha, Krasha, Sthoola, Kshina dhatu
person, and in Sthree.146 In the Snehadi karma Basti is chief, because of having
Shodhana effect, Shamana effect, Sangrahana effect, Vajikarana effect, Brohana
effect etc.147
Vasti is beneficial if it is used with different drugs in Vata, Pitta, Kapha,
Samsargaja and Sannipataja disorders.148, 149
Vasti is Amruta samana in Shishu and Ashishu, 150 when Vasti is used in
combination of Niruha and Anuvasana it eradicates all type of diseases.151
Main specialty of Vasti is first it do the Utkleshana of doshas than
Shodhana of doshas and lastly Shamana of doshas.152, 153,154
It is the only one Karma which we found to be given continuously for 324
days, if Vasti is taken for such days person neither become old nor sick, lives for
thousand years with keen sense organs, devoid of sins shining like gods, like a
stallion in matters of sex, like a elephant in strength with steady mind, sense
organs and digestive activity.155
Vasti if appropriately administered keeping in view the strength of patient
doshas involved in the causation of disease, nature of disease of disease, physical
constitution of patient and properties of different groups of drugs prescribed for
different diseases cures these ailments.156
No other therapeutic measures other than Vasti cleanses the body quickly
and easily, causes depletion and nourishment instantaneously and is free from any
adverse effect.157
Vasti is useful in Pangu, Urustambhs, Bhagna etc.158
Virechana and Vamana therapy no doubt causes elimination of doshas but
it involves intake of recipe ingredients of which are pungent, sharp, hot etc.Those
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ingredients causes’ unpleasantness eruption nausea cardiac discomfort and pain in
the gastrointestinal tract.159
Infants have immature tissue and less of strength, there is diminution and
reduction in strength in old people. For both these category Virechana and
Vamana therapy is contraindicated. Asthapana type of Vasti can however be
given for elimination of doshas and nourishment of body. Vasti therapy
instantaneously promotes strength, complexion, sense of exhilaration and
tenderness as well as unctuousness of body.160
Basti Effect:
(1) Promotive aspects
• Sustains Age.
• Provides better life, improves strength, digestive power, voice and
complexion.
• Perform all functions
• Provide firmness
• Corpulence quality.
• Lightness in viscera / systems because removes morbid matter from
all over the body.
• Restores normalcy.
• Increases Relish
(2) Curative aspect
• Relieves Stiffness
• Relieves contractions and adhesions.
• Effective in paralytic conditions
• Effective in dislocation and fracture conditions
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• Effective in Those conditions where vata aggravated in Shakha /
extremities.
• Relieves pain
• Effective in disorders of GI tract
• Effective in diseases of Shakha and Kostha.
• Effective in diseases of vital parts, upper extremities localized or general
parts.
• Beneficial to debilated and weak persons.
• Arrest premature old age and the progress of white hair.
(3) Preventive aspects
• Beneficial in constipation.
• Effective to purify various systems of the body.
(4) Effect on dhatu :
• Increases the quantity and quality of sperm
• Effective to restore the normal functions of blood and other dhatus.
• It provides strength by increasing muscle power.
• Beneficial as geriatrics
5) Effect on Brain and Psychology
• Improves intellectual power
• Provides clarity of mind
• Improves clarity of sense organs
• Induces sound sleep
• Lightness
• Exhilaration
• Invigorates eyesight
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• Spright lightness of mind
(6) Effective at any age and in any season
• Basti is non antagonistic to healthy, diseased and old persons
• Applicable in all seasons
• Basti can be administered in child and older person too, because it is free
from complications.
Types of Basti
Two types of basti
• Niruha basti, Auvasana basti 161
• Niruha basti, Snehika basti 162
• Shita basti, Sukhoshna basti 163
Three types of basti
• Asthapana basti, Auvasana basti, Uttara basti.165, 166,167
• Utkleshana basti, Shodhana basti, Shamana basti 168,169,170,171
• Karma basti, Kala basti, Yoga vasti.172, 173,174
• Vatahara basti, Pittahara basti, Kaphahara basti.175
• Sneha basti, Anuvasana basti, Matra basti.176
• Teekshna basti, Mrudu basti, Sadharana basti.177
• Kaphavatahara basti, Kaphapittahara basti, Pittaraktahara basti.178
Four types of basti
• Asthapana basti, Auvasana basti, Uttara basti Matra basti.179
• Pakvashayagata basti, Shiro basti, Kati basti, Vrana basti.
Five types of Madhutailika basti
1] Madhutailika basti180
2] Youktaratha basti181
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3] Doshahara basti182
4] Siddha basti183
5] Mustadiyapana basti.184
Six types of Vasti [On the Basis of Rasa predominance in the Basti Dravya]
(1) Madhura Rasa Skandha Dravya Basti
(2) Amla Rasa Skandha Dravya Basti
(3) Lavana Rasa Skandha Dravya Basti
(4) Katu Rasa Skandha Dravya Basti
(5) Tikta Rasa Skandha Dravya Basti
(6) Kasaya Rasa Skandha Dravya Basti
Eight types of basti 185
1. Chatuprasruyika basti
2. Panchaprasruyika basti
3. Shatprasruyika basti
4. Saptaprasruyika basti
5. Astaprasruyika basti
6. Navaprasruyika basti
7. Ekadasa Prasrta Basti
8. Dwadashaprasruyika basti.
Ten types of Vasti [On the Basis of chief drug]
(1) Ksira Basti
(2) Mamsa Rasa Basti
(3) Gomutra Basti
(4) Rakta Basti
(5) Kshara Basti
(6) Dadhimastu Basti
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(7) Amlakamji Basti
(8) Prasanna Krta Basti
(9) Sura Krta Basti
(10) Asava Krta Basti
Fifteen types of basti
1] Vatahara basti
2] Pittahara basti
3] Kaphahara basti
4] Raktahara basti
5] Kaphavatahara basti
6] Kaphapittahara basti
7] Pittaraktahara basti
8] Pittavatahara basti
9] Pittaraktahara basti
10] Raktakaphahara basti
11] Raktavatahara basti
12] Vatapittakaphahara basti
13] Vatapittaraktahara basti
14] Kaphapittaraktahara basti
15] Vatapittakapharaktahara basti
Brief introduction about some important Vasti
a. Niruha Basti (Evacuative or Un-unctuous Enema):
In Niruha Basti, Kashaya (decoction) is the predominant content. With
the Kashaya, Madhu, Saindhava, Sneha and Kalka are the ingredients
commonly used. Its synonyms are Asthapana Basti, Kashaya Basti etc.
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The Basti, which eliminates the vitiated Dosha from the body and
increase the strength of the body because of its potency, is called Niruha
Basti.
Because of this enema stabilizes the age (Vaya), stabilizes the normal
functions of Dosha and Dhatu and stabilizes Deha i.e. strength of the body, is
called Asthapana Basti 187.
Depending upon drugs and preparations used in Basti it may be
classified as follows: 188
Madhutailaika Basti
Yuktaratha Basti
Yapana Basti
Siddha Basti
b. Anuvasana Basti (Unctuous Enema):
In this type of Basti only Sneha is used. According to the quantity of
oil given, it is subdivide as follows:
The Sneha Basti which will not cause any harm even if it is retained
for one day and can be administered after taking food, therefore it is called
Anuvasana Basti
Sneha Basti 1/4th to the quantity of Niruha i.e. 6 Pala (298ml). Anuvasana Basti The quantity of Sneha is half of the Sneha Basti i.e.
3 Pala (144ml). Matra Basti This is the minimum quantity of Sneha Basti (½ of
Anuvasana Basti) i.e. 1½ Pala (72ml). 189,190
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B) Anatomical Classification:
It depends upon the part of the body used for the administration of Basti.
Internal application:
• Pakvashayagata Basti
• Uttara Basti
a. Garbhashayagata Basti
b. Mutrashayagata Basti
External application:
Vranagata Basti Kati Basti
Shiro Basti Netra Basti
C) According to the number of Basti to be used:
Karma Basti - 30 Basti - 12 Niruha & 18 Anuvasna Basti
Kala Basti - 16 Basti - 6 Niruha & 10 Anuvasana Basti
Yoga Basti - 8 Basti - 3 Niruha & 5 Anuvasana Basti
In the above types fixed sequence of Niruha and Anuvasana Basti is
followed.
Rectal Administration:
Substances may be introduced into the rectum for exciting evacuation or
for medication, which later may be intended for effect in three different locations.
• For effects on the contents of the colon for which the term "endocolonic
might be suggested to differentiate it from,
• Effect to be exerted on the tissue of the colon, for which the term
encolonic might be a suitable designation and
• For administration by the way rectal medication intended for systemic
action for which the term diacolonic might be employed.
• Before one resorts to rectal administration it is a good rule to make a
digital examination of the rectum.
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• Rectum distended with fecal matter should be cleaned out by an evacuate
enema before it is given the task of receiving medication.
• Rectal injections, also known as enemas, clysters or Lavements may be
large or small.
Why rectal administration?
1. When it is desired to spare the stomach and intestine from the action of the
drug or to protect the drug from the action of the digestive ferments.
2. With children, who will not take disagreeable tasting medicaments, or with the
insane, who refuse to swallow, rectal administration may become an
important recourse.
3. Such a bitter substance as strychnine can best be given to children in
suppository form provided this method of administration is carried out
gently, skillfully and tactfully.
Enemas:
Rectal injections, also known as enemas, clysters or lavements, maybe
"large" or "small". An enema of less than half a liter might be considered a small
enema and of more than half a liter is a large enema.
1. When a rectal enema is given by means of a syringe with a short tip, it is
deposited just within the sphincter of the anus, a portion of the rectum that
is normally very intolerant of sudden distention. It is indeed this
irritability, which is responsible for the prompt evacuation of any fecal
matter that arrives in this part of the bowel. For this reason, even a small
quantity of fluid, when given rapidly, tends to cause evacuation.
2. When, on the other hand, the enema is administered very slowly, it
suppresses evacuation reflex and reaches to the upper part of the colon
which is not only more retentive but also more absorptive than the rectum.
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3. After the drug once passes the anal sphincter, will pass easily up to the
sigmoid and descending colon, across and down to the caecum regardless
of the position of the body of the patient.
a. Cool large enemas are believed to excite the gallbladder for
contraction and are advocated in the treatment of catarrhal
jaundice. Irritation of the colon is a long established form of
treatment for the various types of jaundice. Garbat and Jacobi offer
an experimental demonstration of the possible efficacy of this
treatment. They found that within a period of from three or twelve
minutes after the instillation of various solutions high into the
rectum a flow of bile was obtained from the duodenal tube, that
would continue for from eighteen to sixty minutes without any
interruption.
b. Hence, the introduction of various solutions into the upper part of
the rectum produces drainage into the duodenum of bile that comes
directly from the liver and without contraction of the gallbladder.
(A) Evacuate enemas:
1. Evacuate enemas in increasing order to potency, should be repeated every
three or four hours, care being taken not to over distend the colon, until
success is secured or the uselessness of the procedure becomes evident.
2. Whether large or small, hot or cold, simple or medicated enemas should be
employed to secure evacuation in any one case depends on the conditions
present.
3. If the rectum merely is to be emptied of feces, 0.5-liter enema given
rapidly with the patient in the sitting posture suffices. If, on the other hand
the most thorough possible cleansing of the bowel is aimed at (colonic
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flushing), the largest possible quantity of warm water from 1 to 2 liters is
slowly introduced with the patient recumbent in the lateral or Sims
position ; or, better still in the knee-chest position.
4. On the other hand, a small (0.25 liter), cool enema rather quickly injected
into the bowel, to stimulate it to evacuation, maybe considered one of the
least objectionable procedures, even when employed quite habitually.
(B) Oil enemas:
Though oil enemas are essentially evacuant enemas, they are given with
the technique of the retention enema, because they are to be retained for many
hours, usually over night.
Indications:
1. To soften feces, in constipation characterized by the formation of hard
scybala and in that due to partial obstruction of the colon.
2. For evacuate action, in so-called spastic constipation, in pelvirectal
constipation and in any other form of constipation and in which oral
administration of cathartics is contraindicated by gastric disturbance.
3. For soothing action, in excessive irritability of the colon and rectum, in
colitis and in proctitis.
4. It has been suggested that oil enemas might inhibit absorption of toxic
products. That the oil has the power of removing substances soluble in it is
shown by the fact that it is passed dark yellow or olive green and of
offensive odour.
There is no definite knowledge, however, of the degree to which this
property might be of clinical value.
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Rules:
1. The oil must be pure and free from rancidity. This is more important than
that it come from a certain source. (Thus poppy seed oil, oil of sesame or
cottonseed oil, when pure, is just as good for this purpose as olive oil).
2. The oil should be placed in a basin of hot water until it has acquired blood
heat (100 F).
3. The oil enema is given at bedtime, unless it produces discomfort and
interferes with sleep. In such case it may be taken early in the morning,
and the patient may lie in bed for three or four hours after ward.
4. The patient should understand that, unless the oil remains in the intestine
for several hours at lest satisfactory results cannot be expected. The total
quantity to be injected depends, therefore, on the patient's ability to retain
it.
5. This is so variable that no definite quantity can be stated. The principle to
be followed is to have the patient gradually increase the amount injected at
successive times until a satisfactory amount can be introduced and
retained.
(C) Retention enemas:
Technique:
It is well to precede a retention enema by a cleansing enema, so as to
unload the lower part of the bowel of fecal matter that may be contained in it,
thereby lessening distention and favoring retention.
1. The smaller in bulk the enema the better it is retained.
2. Still, to be retained, it must also be quite devoid of irritating properties.
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3. The retention of an irritative substance may be favored by making its
solution as nearly isotonic as possible, and by using colloidal fluid, such as
starch water as diluents.
4. If the fluid is introduced very slowly and steadily, the rectum does not
become as readily aware of the distention and retains a quantity of fluid
that would otherwise be expelled.
5. Giving the enema at body temperature favors retention, as extremes of
temperature excite peristalsis.
6. The patient should assume the recumbent position for at least an hour after
the injection, and should be instructed to resist any inclination to
evacuation as much as possible.
(D) "Nutrient" enemas:
Why? The attempt has been made to maintain nutrition by rectal feeding
when it is impossible or undesirable to introduce food into the stomach, or when it
cannot be retained. But the colon has hardly any digestive power and it absorptive
capacity even for water-soluble substances of large molecular size is very poor
and nil for fat.
Rules:
1. Not more than three nutrient enemas should be given in the twenty - four
hours, at about eight hour intervals. The amount should at first not exceed
150 cc., to be gradually increased to 300 when given as ordinary enemas,
though when given by proctoclysis the quantity may reach 1 liter.
2. After each administration the patient should keep as quite as possible for
at least two hours and suppress any desire to evacuate the bowel.
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3. In point of fact patients who need nutrient enemas should be kept in bed
continuously; at rest in bed lessen the consumption of calories by at least
25 per cent.
4. A daily cleansing enema is advisable. This should precede the nutrient
enema by about an hour.
(E) Medicated enemas:
Medicated enemas are given by the technique of retention enemas. They
may be employed, as previously stated, for endocolonic, encolonic or diacolonic
action.
Oil may be used as a vehicle for diacolonic administration of oil-soluble
volatile bodies. On the basis of extensive experience by Gwathmey.
Thus from above description we can easily understand the role of madhu,
saindhav and sneha in each basti. Above description resembles to the ayurvedic
description of basti karma up to maximum extent. Though modern science
developed other advanced routes for the drug administration so now days they are
not using this route but they cant deny the importance of this route
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Amavata
Disease Review
Amaravata describes a wide range of joint disease manifestations.
Amavata is mainly caused by two factors ama and vata.
Etymology of Amavata
1. ‘Amena samhita vata Amavata’. The virulent Ama circulates in the whole
body propelled by the vitiated vata dasa producing block in the body
channels that stations itself in the sandhi giving rise to Amavata191.
2. The combinations of ‘Ama’ and vata form Amavata. It shows the
Pridomminance of Ama & vata in the samprapti of Amavata 192.
3. Ajeerna produce ‘Ama’ & along with vata it produce Amavata193.
Definition
‘Ama’ is produced by agnimandya of both Jatharagni and Dhatwagnis.
Even though ama is a cause for various diseases, in Amavata it is the main
causative factor. Ama and vata vitiated simultaneously and disease is manifested
mainly in joints of hasta, pada, sira, trika, gulpha, janu and uru. The main
symptioms produced are Angamarda Aruchi, Trishna, Alasya, Gouravam, Apaka
& Shotha 194.
Importance of Ama in Amavata
The main causative factor for the manifestation of Amavata is Ama. So it
is necessary to know about the Ama in detail.
Etymology of Ama
1. The unprocessed or undigested food partical is Ama 195.
2. Ama means, “Which is subject of digestion”. 196
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Amavata
Definition of Ama
1. The first Rasa dhatu, which has been inadequately digested due to the
weakness of digestive fire and accumulating in the stomach in the
abnormal state, is know as Ama 197,198.
2. The undigested Adya Ahara dhatu is Ama 199.
3. The food material which will not undergone vipaka, leads to Durgandha,
which is large in quantity, which is picchila & which leads to Gatra
Sadana is called Ama.
4. Due to impairment of digestive fire the undigested remained food material
is ‘Ama’.
5. Apakva Anna Rasa is Ama & some other considers the accumulation of
mala as Ama & still other opines the first stage of vitiation of dosa as
Ama.
On the basis of the for going, Ama may be classifieds as below
I) Ama produced due to hypo functioning of Agni i.e
1) Ama due to Jatharagni Mandya.
2) Ama due to Dhatvagni Mandya.
3) Ama due to Bhutvagni Mandya.
II) Ama produced irrespective of the action of Agni
1) Accumulation of mala.
2) Ama due to interaction & virulently vitiated dosas
3) First phase of dosic vitiation.
Vata in Amavata
Voluntary & involuntary functions are all under the control of Vaya. In
Amavata the normal function of Vata is disturbed. It produces stabdhata &
sandhigraha leading to the restricted movements of joints & it will become the
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Amavata
responsible for crippling effect seen in the patients. This shows that predominance
of vata dosa in the pathogenisis of Amavata.
Now let us carry a brief description of vata dosa. The word vata derived
from “Va gati gandhanyoh” it means to move, to make known, to enthuse 200. It
has got the other synonyms like Anila, Maruta, Pavana etc.201
Gunas of Vata
Ruksha, Seeta, Laghu, Sukshma, Chala, Visada, Parusha & Khara 202,203.
Functions of Normal Vata
Vaya sustains the body with expiration, inspiration, enthusiasm, movement of
various parts. Kneenees (sharpness) of sense perception, initiation of the natural
urges and many other functions204.
1. Tantrayanradhara
2. Cheshta Pravartaka
3. Mano Niyanta & Praneta
4. Sharvendriya Uttyojaka
5. Sharvendriya Artha Abhivodha
6. Sharva sharira dhatu Vyuhakara
7. Sharira Sandhanakar
8. Vak pravartaka
9. Sabdasparsa Prakrti
10. Srota sparsana mula
11. Harsha utsahayoni
12. Agni samirana
13. Mala ksepta
14. Grabhakrti Karta
15. Ayusha Anuvratti 205.
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Amavata
Importance of Vata
Pitta, Kapha, Dhatu & Mala are movementless, unless they are brought to
the proper place by vata to carry out their functions. Thus Vayu makes the
functions of all the tissues of body 206.
Symptoms produced due to Ama
1. Srotordha
2. Balabramasa
3. Gaurava
4. Anila Mudhata
5. Alasya
6. Apaki
7. Nisthivana
8. Mala sanga
9. Aruchi
10. Klama
11. Vit, Mutra, Nakha, Dhatu, Chakshu Pitata/Raktata/Krishnata
12. Prusthtasthi, Katisandhi Ruk
13. Siroruk
14. Nidra
15. Mukhavairasya
16. Jvara
17. Atisara
18. Romaharsa.
Symptoms of Vataprakopa 207
1. Parava Samkocha
2. Stambha
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Amavata
3. Asthi Paravabheda
4. Lomaharsa, Pralapa, Hasta-Pristha-siro-graha
5. Khanjata-Pangulya
6. Kubjata
7. Sosha
8. Anidra
9. Grabha-sukra-Rajonasa
10. Spandana
11. Gatra Suptata
12. Sira, Nasa, Akshi, Jatru, Grivahanunam-Bheda ,Toda-Arti
13. Akshepa
14. Moha
15. Ayasa
Nidana of Amavata
Nidana is defined as the factors which deranges the dynamic state of
doshic equilibrium provokes the disease is known as Nindan. This Nidana
helps us to decide the line of treatment as well as prognosis of the disease.
Amavata Ninda is of multifaceted various Acharya’s mentioned their
different views for the productions of Ama in Amavata.
Madhavakar 208 has delt the separate Nidana as
1. Viruddha Ahara (Incompatible food)
2. Viruddha Chestha (Incompatible food)
3. Mandagni (Hypofunctiony of agni)
4. Nischala (Lack of exercise)
5. Snigdha Ahara followed by immediate exercise.
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Amavata
Besides these intakes of Kanda, mula and sakha and excessive exertion are
itiological factors opeined by Harita 209.
In Anjana Nidana which vititate vata, pitta and kapha are considered under
Nidana 210.
These all above Nindan can be included under two heading
1. Unwholesome diet & 2.Erroneous habits.
Unwholesome diet means “which aggravates the body humors but not
expel them out of the body” 211. Charaka has mentioned 18 types of
unwholesome diet (Viruddha Ahara) 212 some of the virudha Ahara are as
follows
1. Milk along kulatha,
2. Panase fruit with matsya
3. Mixtures of equal quantities of honey & ghee.
4. Boiled curd 213.
Erroneous habits (Viruddha chesta) mainly included alternate use of cold
and heat, suppression of natural urges, sleeping daytime, walking at night, over
indulgence in work.
Table No-7, Amavata Nidana according to various Acharyas.
Sr Nidana H.S. M.N. A.N. i. Viruddha ahara - + -
ii. Guru ahara + - - iii. Tarpite kandashakastu + - - iv. Mandagni + + - v. Viruddha cheshta - + -
vi. Avyayama + - vii. Snigdha bhuktavato hiannam vyayama - + -
viii. Swa prakopnaiha : Vatadosha Pittadosha Kaphadosha
- - +
ix. Vyavayina + - -
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Amavata
Samprapti of Amavata 214
The impairment of Agni will produce the condition of Ama. Mainly
Agnimandya initially affects digestion followed by metabolism. Hence in this
state of Agni, the Rasadhatu is not formed up to the standard level & it is
considered as Ama. This ‘Ama’ along with Vyana Vayu and also by virtue of its
Vishakari guna it quickly moves to all kapha sthanas, through Hridaya and
Dhamanes. This Vidhagada Ama, in kapha sthana is further contaminated by
dosas and assumes different colours, because of the Atipichhilata.
If Ama gets obstructed in to channels and promotes further vitiation of
vata dosha, this morbid Ama circulates ubiquitously in the body propelled by
vitiated vata with predilection for shesma sthana. On the dhamanies with the other
dosas it facilitates sroto abhisyanda and srotorodha causing sthanasmsraya
manifested stabdhata (stiffness), sandhisula (joint-pain), sandhishotha (swelling),
Anga marda(body ache) Apaka(indigestion), Jwara (fever), Anga gourava
(heaviness of body), Alasya(laoghess) etc symptoms of Amavata.
According to the commentators on Madhava Nidana the Samprapti of
Amavata can be summarized accourding to Shatkriyakal
Sanchaya & Prakopa: When a person is exposed to aetiological factors like
Viruddha Ahara, does vyayama after intake of snigdha ahara, Chinta, Krodha etc.,
Agnimandya is there leading to Tridoshadushti and Amotpatti in the Sanchaya
and Prakopavastha.
Prasara: With the help of Vata (Biophysical mechanism), this Ama gets Prasara
to shleshma sthana producing mild sandhishoola etc. along with Ama symptoms.
Then Ama gets interacted with Tridosha and further modified (Vidagdha) to great
extent and yagapatakupitavanta of Ama and Vata takes place via Rasavaha srotasa
(Dhamani).
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Amavata
Sthana Sanshraya: This prasarita Ama, which viscid, unctuous and guru endures
Sthana Sanshraya in Hridaya, Trika Sandhi and Sarvanga (Srotoabhishyanda)
leading to Dosha-dushya Sammurchchana. Primarily the disease is not manifested
completely, so only initial mild symptoms like Aruchi, Apaka etc. are observed
which can be considered as purva rupa of the disease Amavata.
Vyakti: As it reaches vyakti stage most of the symptoms of Amavata are
manifested like Vrishchika dashavata vedana, stabdhata etc. In Adibala Pravrita
cases (Karmajanya, Mata-pita apcharajanya etc.) Khavaigunya is already there
and with the minor nidana sevana disease in manifested.
Bheda: In chronic stage or if the disease is left untreated it reaches bhedavastha-
producing updrava like Sankocha, Khanjata etc.
The Samprapti Ghatakas, which are involved on the Amavata, are as follows.
1. Dosha-Tridosha mainly vata(vyana, samana, Apana) and kapha ( Kledaka,
Bodhaka, slemaka)
2. Dhatu -Rasa, Mamasa. Asthi, Majja.
3. Upadhatu -Snayu and Kandara.
4. Srotases -Annavaha, Rasavaha, Asthivaha, Majjavaha.
5. Srotodusti -Sanga, Vimaragagmana.
6. Udbharasthana- Amashya (Ama), Pakvasaya (vata).
7. Adhisthana -whole body
8. Vyaktasthana -Sandhi
9. Avayava -Sandhi.
10. Vyadhiswabhava -Mainly Ashukar.
11. Sanchara Sthana -Hridya, Dhamani.
12. Roga Marga -Madhyama roga marga
13. Agni -Jataragni Mandya, Dhatwagni Mandya.
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Amavata
FLOW CHART-1
SAMPRAPTI
Virudha Ahara + Virudha Vihara
Agnidusti in Amashaya
Formation of Amarasa
Sanchara through Dhamani all over
The body by vata dosha
Samadosha Accumulates in the
Slesma sthanas like
Amashaya, Sandhi etc
Enters Into Kosta, Trika Sandi
Leads to
Gatra Stabdata
Karoti Sarujam shotam
Yatra doshaha prapadyate
Leads to painful swelling of joints wherever the vikrita dosas travels.
Angamarda, Aruchi, Apaka,
Gourava, Jwara, Sandi Ruja
Sandi shota
Amavata.
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Amavata
Purva roopa of Amavata
In the classics it is not clearly mentioned purva roopa of Amavata. But
however in such condition Avyakta lakshana prior to the manifestation of
disease is considered as the purva poorpa 215. With the help of this the purva
roopa of Amavata can be considered as follows
1. Dourbalyam (Weakness)
2. Haridaya gourava (heaviness in chest)
3. Gatra stabdam (Stiffness of the body)
4. Apaka (indigestion)
5. Anga mardu (Aching all over body)
6. Gourava (Heaviness)
7. Aruchi (loss of taste)
8. Alasya (lack of enthusiasm)
9. Jwara (fever)
10. Sandhi vedana (Joint pain)
Roopa of Amavata
“Utpanna Vyadhi bhodakameva lingam rupam” 216.
It means which gives the idea about the manifested disease is known as
‘Rupa’.
Madhavakara 217 while describing Amavata lakshana, he has considered
them in to two heading one is samanya lakshana another is lakshana
samachaya of pravrudhu Amavata.
Samanya Laxanas are as follows
1. Angamarda (body ache)
2. Aruchi (Tastelessness)
3. Trishna (Thirst)
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Amavata
4. Alasya (lack of enthusiasm)
5. Gouravam (Heaviness all over body)
6. Jwara (Fever)
7. Apaka (Indigestion)
8. Shunata Anganam (Swelling all over the body mainly in joints)
Pravriddha Lakshana of Amavata:
It is the advanced stage of disease and very troublesome to patients as
well as for physicians. According to Kriyakala and stage wise development, it is
the worst stage of disease. Articular and Extra-articular feature present in this
stage have been elucidated by Acharya Madhavakara, Bhava Mishra and Yoga
Ratnakara.
According to Madhavakara 218
1. Sarujam Sandhishotha – Hasta, Pada, Shiro, Gulpha, Janu, Uru Sandhis are
chiefly involved in Amavata.
2. Vrishchika danshavata vedana – This kind of pain shows the presence of
Ama at the site of pain.
3. Utsahahani – A subjective feeling in which lack of enthusiasm can be seen
in suffering person. It is due to insufficient nutrition of Sharira Dhatus,
Indriya and Mana.
4. Bahumutrata – Presence of vitiated or dushita Ama causes sroto –
abhishyanda in the body, which leads to increase of kleda. This Bahumutrata
occurs for the excretion of excess kleda from the body.
5. Kukshikathinya – Vitiated Samana and Apana Vata along with the Ama
leads to Kukshikathinya, which is the rigidity of abdomen.
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Amavata
6. Kukshishoola – Srotorodha due to Ama causes obstruction to normal
movement of vitiated samana and apana Vata resulting in pain in abdomen.
7. Nidra Viparyaya – Due to vata vriddhi, pain gets aggravated at night and
keeps the patients awaken which leads to Nidra Viparyaya.
8. Chhardi 219
Continuous formation of dosha leading to excitation of Amashaya by
Vata causes Chhardi.
9. Bhrama - Presence of Kapha in Srotas and Vitiated Vata causes Bhrama.
10. Murchcha - Inability of the sensory organs to perceive the sense objects is
Murchcha. Loss of motor function occurs in Murchcha due to upatapa of
Indriya by Vitiated Vatadi doshas 220
11. Hritgraha - It is due to Rasavaha srotodushti (its mulasthana is Hridaya) and
vitiation of Samana Vata, Vyana Vata and Avlambaka kapha. Hritgaurava is
also produced due to above reason when vitiation is mild.
In R.A. cardiac manifestations like Pericarditis, Myocarditis,
Conduction defects etc. can occur.
12. Vibandha – It is due to vitiated Apana Vata and improper degradation of
Ahara into Sara and Kitta.
13. Antrakujana – In this feature, increased bowel sounds are present due to
movement of Vitiated Vata in the intestine.
14. Anaha – It is the stagnation of vitiated vata in Kukshi.
15. Agnimandya – Vicious cycle of disease (Agnimandya-Shuktatva –
Annavisha) produces Agnimandya again and again.
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Amavata
16. Praseka – It means lalasrava 221. Excessive thick, mucoid, salivary secretions
are produced due to Samarasa, which shows Rasavaha and Udakavaha
srotodushti.
17. Gaurava – Due to Vitiated Kapha there is feeling of heaviness in Hridaya
and body parts preferably in Joints.
18. Vairasya 222
Perception of different taste than normal due to Sama Rasa and
vitiated Bodhaka Kapha.
19. Daha - Due to Vitiation of Pitta sometimes localized or generalized Daha
occurs.
Warmth of the joint is usually evident on examination. In its most aggressive
form, rheumatoid vasculitis can cause Mononeuritis multiplex (Harrison 1994).
20. Trishna – Trishna is due to Agnidushti, Sama Pitta and Vata. It shows
Rasavaha, Udakavaha srotodushti in disease process.
Table No.8 Similarity between Amavata and Rheumatoid Arthritis
Rheumatoid Arthritis Amavata
Morning stiffness Gatra sthabdata or sandhi sthabdata
Arthritis of 3 or more joints Bahu sandhi shotha
Arthritis of hand joints Hasta, sandhi shotha
Symmetrical arthritis Bahu sandhi shotha (ubhaya)
Rheumatoid nodule Angavaikalya
Rheumatoid factor ----
Radiological changes ----
The first 4 criteria of RA can be correlated with the inflammatory
condition of amavata. But rheumatoid factor and radiological changes cannot be
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Amavata
correlated to any conditions of amavata. Hence on symptomatology amavata can
be best correlated to RA.
Pratyatma Lakshana (Cardinal Signs and Symptoms)
Pratyatma Lakshanas are main clinical features on which the disease can
be clearly differentiated from other identical forms of disease. In Amavata,
sandhis are the main site of manifestation of clinical features, thus joint associated
symptoms are considered as Pratyatma lakshana of disease Amavata.
These are as follows:
(a) Sandhi Shoola (Joint Pain)
In Amavata, Vitiation of Asthi and Majjagata Vata causes pain in
Sandhis and in severe stage, it is found as Vrishchika Dansha vata.
The most common manifestation of established R.A. is pain in affected
joints, which is aggravated by movements. During rest and especially early
morning stiffness are also characteristic features of R.A. Pain originates
predominantly from joint capsule, which is abundantly supplied with pain fibres
and is markedly sensitive to stretching or distension (Harrison 1994).
(b) Sandhi Shotha (Joint Swelling)
Sandhi Shotha (Ekangika shotha) results when vitiated dosha afflicts
Twaka, Rakta, and Mamsa in joints 223. Madhavakara has described that shotha
result due to the affliction of Ama and Vata Pradhana Tridosha in joints.
Joint swelling in R.A. is the result of accumulation of synovial fluid,
hypertrophy of synovium and thickening of joint capsule.
(c) Stabdhata (Stiffness)
The restriction or loss of movements of joints. Gatra stabdhata is
caused due to spreading of Ama through out the body by vitiated Vata.224, 225
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Amavata
In majority of patients, the onset is insidious with joint stiffness,
especially early morning stiffness, which gradually gets reduced by evening. This
diurnal rhythm worse on arising in the morning and than relieving towards
evening probably reflects the diurnal variation in plasma cortisol level.
(d) Sparshasahyata (Tenderness)
Sparshasahyata can be included in Sandhishoola in which patient cries
with pain even when the gentle pressure is applied to affected part. Some times
person himself cannot touch the affected part due to pain.
According to Modern text pain on movement and tenderness are the
cardinal signs of the disease (Becron -1971).
Table-No 9,Lakshans According to different Ayurvedic classics 226,227,228,229,230
No. Lakshana MN B.P. B.R. Y.R. G.N. A.N
1 Agnidourbalya + + - + + - 2 Alasya + + - + + 3 Anaha + + - + + -
4 Angamarda + + - + + - 5 Anga sonata + + - + + - 6 Antra kujan + + - + + - 7 Apaka + + - + + - 8 Aruchi + + - + + - 9 Bahu mutrata + + - + + - 10 Bhrama + + - + + 11 Chardi + + + + + - 12 Daha + + - + + - 13 Gourava + + - + + - 14 Hritgraha + + - + + - 15 Janghadi Pradesha Vyadha - - + - - - 16 Jwara + + - + - 17 Kukshi Kathinyata + + - + - 18 Kukshi sula + + - + - 19 Murcha + + - +
20 Nidra Viparayaya + + - + 21 Pandu Varna - - + - -
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22 Prasekam + + - + + - 23 Sandhi gourava + - - - + + 24 Sandhi Ruja + + - + + + 25 Sandhi shotha + + - + + + 26 Sandhi Graha - - - - - - 27 Sosha - - + - - - 28 Trishna + + + + + - 29 Ushnata - - + - - - 30 Utsaha Hani + + - + + - 31 Vairasyam + + - + + - 32 Vishuchi - - + - - - 33 Vitvibandha + + - + + - 34 Vruschika damsavata peeda + - - - + -
Table No.10, Showing the Sthananusara Laxana
Stanika Laxana Shareerika Laxanas Manasika Laxana Sandhi shotha, Sandhi shoola, Gatra sthabdata, Daha, Raga, Kandu.
Angamarda, Kukshishoola, Aruchi, Bahumutrata, Trusna, Peeta mutrata, Alasya, Takratulyata, Gourava, Nidraviparyaya, Jwara, Antrakoojana, Apaka, Anaha, Agnimandya, Grahanidosha, Praseka, Asyavairasya
Utsahahani, Moorcha, Bhrama, Alasya.
Sapeksha Nidana
Sapeksha nidana becomes necessary when two or more disease have a few
important laxanas similar to each other and in such condition in order to avoid any
error in adopting the line of treatment. The differential diagnostic is done on the
basis of few points such as difference in samprapti accompanying laxanas,
upashaya anupashaya etc.
Here the disesae, which was exhibited with sandhi shotha and
sandhishoola specially, are considered for differential diagnosis.
1) Vatarakta
2) Sandhigatavata
3) Krostaka sheersha
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Amavata
4) Sandhiga sannipata
5) Sandhi aghata
Vatarakta -
Usually manifests with supti, discolouration and shithilatha of sandhi, pain
is of pricking and splitting nature, sudden onset or disappearance of joint pain.
Anguli sandhies are first affected, then it spread to other parts of the body slowly
like akuvisha, all the affected joints are having pain equally, joint swelling is non
fleeting, no morning stiffness.
Sandhigata vata –
Because of lack of sleshmaka kapha for the friction of joints, it cause pain
and swelling. Here joint movement is accompanied with pain. This is sthira ie.,
non fleeting, the hip and the knee are often affected usually effects middle aged or
elderly persons. Symptoms subside by using sneha therapies.
Krostaka sheersha –
This is the condition, wherein provocated vata and rakta give rise to janu
sandhi shotha and shoola, no other joints are involved. Shotha resembling the
head of jackal, non-fleeting, severe pain in affected joint pain may increase during
night.
Sandhiga Sannipata –
This is a type of sannipata jwara usually manifests due to tridoshakaraka
hetus, swelling and pain of the joints are non fleeting, non variant pain, usually
along with anidrata and severe cough.
Sandhi aghata –
This is of traumatic origin, pain and swelling will be restricted to the
affected joint. Non-fleeting, subsides after few days.
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Amavata
Types of Amavata
Madhava Nindan while explaining the doshanubandha lakshana 231 he maid 3
types where as while expressing about the sadhyasadhayata of Amavata he maid 7
types on the basis of involvement of the dosas 232 .By combining the above two
points Amavata is of seven types on the basis of dosas they are as given below
1. Vata pradhana -- In this mainly predominance of sula will be present.
2. Pitta pradhana – Daha and Raga are present in the joints.
3. Kapha Pradhana – Staimitya, Gourava & kandhu are the main symptom of
this variety.
4. Vata pitta paradhana – Combined symptoms of both pitta & vata.
5. Vata kapha pradhana -- Combined symptoms of both vata & kapha.
6. Pitta kapha pradhan -- Combined symptoms of both pitta & kapha.
7. Sannipatika -- Combined symptoms of both all dosas.
According to Sharangadhara four types of Amavata are considered
1] Vataja Amavata
2] Pittaja Amavata
3] Kaphaj Amavata
4] Sannipataja Amavata
According to the presence of lakshana Amavata is classified in to two
types first one is Samanya Amavata 233 and second is Pravrudha Amavata234.
According to time period of Amavata it is of two types.
1. Naveena Amavata, 2. Jirana Amavata.
A unique classification of Harita explained in Harita Samhita based on
presentation of the disease. Those are; 235
a) Vistambhi b) Gulmee c) Snehi
d) Pakwama e) Sarvanga
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Amavata
a) Vistambhi - This presents with constipation, feeling of heaviness, in the
abdomen, flatulence pain in the basti area.
b) Gulmee - Symptoms simulating like gulma, spasmodic pain in abdomen,
increased audible peristaltic sounds.
c) Snehi - Unctonsness of the body, inactivity, loss of appetite, passing of
unctuous and undigested stools.
d) Pakwama - Passing of yellowish, black or dark bluish dehydrated pakwama
through anus, fatigue, exhaustion, condition is not associated with basti shoola.
e) Sarvanga - Pain in kati, prusta and vakshana region, pain in basti, region,
audible peristaltic sound, swelling, heaviness in the head, excessive excretion of
ama are the symptoms.
Upadrava of Amavata
The symptoms of advanced stage of Amavata are considered to be as
Upadrava of Amavata roga. Vacaspati mentioned symptoms of advanced stage of
Amavata are as upadrava but the commentator of Madhakosa Vijayarakshita
differentiates the symptoms of advanced stage of Amavata from Upadrava.
According to him Khanja, Sankocha, occur in Amavata. But further Vachaspati
includes the disease expounded within the title of vata vyadhi under Upadrava. So
it is worth to be considering Angavaikalya is an Updarava considered by Harita.
Even in Madhava Nidhava the Amavata Updravas are mentioned, they are
Trit, Chardi, Bhrama, Moorcha, Hradgraha, Jadya, Antrakoojana, Anaha etc 236.
All the Systems will invalue or get disturbed in the Amavata. It is not
treated in time it produce anatomical deformities like sandhi vikruti and Hrid
Graha. So proper management is must from the on set of disease. The upadrava
depends upon the type of kapha involved in samprapti. If Ama combins with
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shleshka kapha & gets lodged in sandhi sthana creates sandhi vikruti and if Ama
combines with Avalambak kapha resides in Hridaya develops Hrid Graha.
Upashaya / Anupasaya
If the relief occurs by using the Oushandi, Ahara or Vihara are to be
considered as Upasaya. In the oppsite sence if relief not occurs are counted as
Anupasaya 237.
Same types of lakshnas will find in different rogas. If we take example of
Amavata lakshanas such as sandhi shotha, sandhi shool etc, are likely to be found
in other diseases like vatarakta, sandhigatavata, kostakasirsa etc. In this type of
conditions when the lakshanas are found similar to that of another disease it is
difficult to diagnose the disease and adopt the treatment. In this difficult condition
Upashaya and Anupashaya have advised.
Upashaya for Amavata are Ruksha sweda, langhana Usnakala etc Where
as Anupasayas are snigdha sweda, Santarpana etc.
Sadhya Asadhyata 238.
Amavata have got Anubandha with single dosa, naveena avasta, lakshanas
are in mild form, no presence of Upadrava indication of sadhyata of Amavata. If
involvements of any two dosas produce Vyapyata of the Amavata where as
involvement of all the three dosas, involvement of all the joints, Purana Amavata
including with upadravas will become krichra sandhya vyadhi.
Chikitsa of Amavata
Aim of chikitsa is to cure the disease and bring back dosas normal. The
treatment for ‘Ama’ condition is Apatrapana or Langhana. Langhana included
both sodhana and samana. If dosas are alpa langhana is advised. If dosds are
madhyama langhana pachana is indicated. But if dosas are prabhuta sodhana is
advised.
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Amavata
Regarding with Amavata chakaradatta 239 has explained complete Amavata
chikitsa in first time. The principles of treatment for Amvata are as follows
1. Langhana
2. Swedana
3. Tikta katu deepena drugs
4. Virechana
5. Snehapana
6. Anuvasana and Kshara abasti
7. Ruksha Upanaha 240
8 Sankara sweda 241
1] Langhana
Langhana has advised by Charak in Amasayotaja vyadhi, Rasaja vyadhi
and in Ama vikara. Langhana is of three types Langhana, Langhanapanchana and
Doshavasechana charaka included 10 types in langhana chikitsa which are
Vamana, Virechana, Niruhabasti.Pipasa, Atapa, Pachana, Upavasa & Vyayama 242
Vagbhata classified langhana in to two types Shodhana & Shamana.
In the initial stage of Amavata shodhana is not beneficial when the dosas
are in Sama stage & spread all over the body their elimination is not possible. So
the first aim is to mobilize the doshas from shakha to kostha Upavasa type of
langhana helps in bringing the dosas from Shakha to kostha.
In Amavata there is a predominanace of vata is their but it is in the form of
sam & this langhana (Upavasa) is indicated in samavata that’s why their will be
no any controversy for using langhana in Amavata.
Mainly langhana does Dosha pachana and agnisandhukshana by this the
‘Ama’ present in the Amavata gets digested & gradually Agni will excited their
after.
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2] Swedana
Swedana is the therapy, which relieves the stambha, Gourava, Sheeta &
produces Sweda58. The main symptoms of Amavata are stambha, Gourava, Sheeta
& Shroto avarodha. Where swedana relives these all cardinal symptoms. Usually
by seeing the dosha dooshya samoorchana in Amavata ruksha sweda has been
recommended where as in Nirama conditions snigdha. Due to its heat, causes
relaxation of muscles & tendons & promotes blood circulation, by this local
metabolic process gets activates by this pain gets relief.
If there is involvement of few joints the local types of swedana can be
advised. But if the involvement is of multiple joints Sarvanga swedana should be
advised.
By the help of swedana digestive capacity will increase softness of the
limbs, smoothness and clearness of the skin, relish for food, clearness of the
channels, absence of somnolence & drowsiness and free movement of joints
above this dosas which are moistened by snehana gets liquefy and carried down in
to the kostha 244.
3) Deepana (Tikta & Katu dravyas)
These drugs mainly having the properties like Agnideepana,
Amapachana,245 Avarana dosha Nivarana (Pachana) by these qualities they
acts as Srotosodhaka.
In Amavasta of Amavata, doshas are sticked strongly to srotasa, so they
cannot be removed by snehana and swedana. In such conditions deepana
upakrama will helps to increase the Agni 246 and does Amapachana leading the
detachment of dosha from the Srotases and removal of Srotoradha. It is well
known that Deepana, Pachana is an essential process to be performed in Ama
predominance disease.
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4] Virechana
After the administration of Langana, Swedana, Tikta, Katu and Deepana
drugs, the patient should be subjected to Virechana therapy since the doshas
rendered nirama by these therapeutic measures require elimination from the body
by shodhana. Now the question arises why virechana alone should be given and
not vamana too, because usually vamana precedes virechana. If virechana is given
alone the kapha located in the amashaya may produce mandagni and its
consequences.247 How ever this rule has been relaxed in the case of Udararoga,
gulma etc. The same may also be followed in case of amavata because of the
following reasons.
a) Production of ama is the result of Avarana of pitta sthana by the kledaka
kapha and it is the most suited therapy for the sthanika dosha pitta.
b) Symptom of amavata like anaha, vibandha, antrakujana, kukshishula etc.
are indicative of pratiloma gati of vayu. This is best conquered by
virechana, while vamana is likely to aggravate this condition.
c) Further more, though virechana has been described to be the best remedy
for pitta dosha, yet it is effective in the vitiated kapha and vata dosha also
to some extent. So in this way it appears to be the most appropriate
therapeutic measures in this condition. The use of eranda taila in amavata
suggests that in this disease snigdha and not ruksha virechana should be
employed, since it does not produce generalised snehana effect but by its
snigdha, ushna etc. characteristics, it augments the agni in addition to its
vata anulomana action.
5) Snehapana
Up to the administration of Virechana we are concentrating on the
eradication of Ama. Once Ama digested in the body the other factor which is Vata
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becomes dominant in the body or due to the Apatarpana chikitsa of Ama may
provoca Vata. For this snehapana is advised in Amavata. More over Snehana is
mailnly indicatied in chrinic condtion of Amavata. This Snehapana is used due to
the following benefits which are digestive activity becomes very intense,
Alimentary tract become very clean, by this production of Ama will stop in the
body.
Even after the Shodhna karma, Shamana sneha have advice to retain the
Bala of the Patient.
6] Basti
In amavata both anuvasana as well as Niruha basti have been advocated.
Anuvasana basti removes the dryness of the body caused by amahara treatment,
alleviates vata dosha, maintains the functions of Agni and nourishes the body.
The niruha basti eliminates Doshas brought into kostha by the Langana and allied
therapies. In addition to generalised effect, basti produces local beneficial effects
also by removing the anaha, antra kujana, vibandha, etc. Bruhat Saidhavadi Taila
has been mentioned for anuvasana and ksharabasti for asthapana.
Depending upon the use of different drugs, vasti causes samshodhana and
samshamana effects. Sushruta has stated that the action of basti is mainly due to
veerya. He further elaborates that the drugs used in basti karma will however
spread in the body from pakwashya due to their veerya. So basti karma
eliminates the morbid doshas and dushyas from the entire body by srotosuddhi.
So its effects are tridoshahara.
Its effects are not only limited up to rectum and Samsodhana of malas but
it produces widespread systemic effect. Basti can produce its effect through
medicament effect (Pharmacological effect) and effect of volume (Pressure
effect). Thus with the help of suitable medicaments, vasti therapy may modify
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the colonic physiology and alter pathogenic krimis by prakritivighatana, on the
other hand certain Basti may enrich the normal bacterial flora of the colon and
may be expected to promote their sustaining role in body. By doing so, it
modulate the rate of endogenous synthesis of vit B12, which may have a role to
play in maintanance and regeneration of nerves.
7] Ruksha Upanaha
According to Bhavaprakshana in the Amavata for the local benefit of
Sandhishoola and Sandhishotha this Ruksha Upanaha has advised.248
8] Sankara sweda
In Bhisjjya ratnavali Sankara sweda with making Potali of
Karpasasti, Kulattha, Tila, Yava, Erandamoola, Atasi etc are kept in boiling Kanji
and maid Svedana.249
Various Upakramas have been prescribed by different Acharyas for the
treatment of Amavata as follows:
Table No-11
Sr. Upakrama H.S. V.M. C.D. V.S. B.P. B.R.
1 Langhana - + + + + + 2 Swedana - + + + + + 3 Tikta - + + + + + 4 Katu - + + + + + 5 Deepana dravyas - + + + + + 6 Virechana + + + + + + 7 Snehapana - + + + + + 8 Basti + + + + + +
9 Anuvasana-Saindhavadi Tail - - + - - +
10 Kshara Basti - - + - - +
11 Ruksha sweda by Balukaputa - - + + + -
13 Pachana - - - - - + 14 Vamana - - - - - +
Yoga Ratnakara has followed Bhava Mishra.
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Pathya Apathya.
“If the person is taking Pathya ahara then what is the necessary of taking
medician, if the person is not taking Pathya than what is the necessary of taking
the medicine” this shows the importance of Pathya in the Management of any
disease.
Pathya has important role in the prevention and exacerbation of the
disease process. As per the classics any drug or diet that is katu, tikta by rasa,
Ushna and Teekshna in guna and having vatahara, kaphara, amapachana action is
considered as pathya.
The list of Pathya mentioned in texts;
1. Dravyas - Punarnava, rasna, patola, karavellaka, vartaka, shigru, gokshura,
vriddha daru, ballataka, ardraka (YR), Shyamaka (BP), Varuna, Vastuka (YT)
2. Mamsa - Jangala mamsa rasa (Y.R.B.P), Lavaka mamsa with takra (Y.T)
3. Aharadravya - Puranashali, Yava, Purana Shastikashali, Kulattha
4. Anya - Eranda Taila, Usnodaka, procedures like Rukshasweda, Langhana,
Snehapana, Basti, Lepa, Virechana are considered as pathya. The pathyas of
jwara also considered as pathyas of amavata (HS)
The drugs or diets having guru, picchili, abhishyandhi gunas and which
causes provocation of vata, kapha and formation of ama are considered as
Apathya
All nidanas of amavata are considered as apathya - Masha, Anupamamsa,
Dadhi, Guda, Ksheera, Mathsya, Upodhika, Shimbhi dhanyam, Sheetajalasnana,
Abhyanga considered as apathyas for the disease process.
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Rheumatoid Arthritis
Rheumatoid arthritis
In Rheumatoid arthritis the onset in majority of the patients is insidious
with joint pain, stiffness & symmetrical swelling of membrane of peripheral
joints. As the disease progresses there is a tendency for it to spread to involve the
wrists, elbows, knees & other joints. The mandibular, acromioclavicular &
sternoclavicular joints are sometimes affected as indeed in every symovial joint.
The history of arthritis is as old as mankind, as the ape-man himself had
arthritis of the spines. Detailed study of this age old, complicated crippling
clinical entity confirms its close association with other branches of medicine such
as neurology, cardiology, endocrinology, bacteriology, geriatrics, pediatrics and
orthopedics.
Rheumatoid arthritis is a chronic disease of the joints, usually
polyarticular, marked by inflammatory changes in the synovial membranes &
articular structures. Hence the knowledge of anatomy & pathophysiology of the
joints is very important, as the synovial joint is involved in Rheumatoid arthritis
this is being elaborated here
Epidomology
Scientists estimate that about 2.9 million people have rheumatoid arthritis
RA occurs in all races & ethnic groups. Although the diseases often begin in
middle age and occur with increased frequency in older people, children & young
adult’s also develop it. Like some other forms of arthritis, RA occurs much more
frequently in women than in men about 2-3 times as many women as men have
the disease. Server RA is found at four times the expected rate in the first-degree
relatives of probands with zero +ves disease.
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Etiology of Rheumatoid Arthritis: 250 to 255
The disease Amavata is best compared with Rheumatoid arthritis in the
modern parlance.9 Rheumatoid arthritis (RA) is a chronic multisystem disease of
unknown cause. It has been suggested that RA might be a manifestation of the
response to an infectious agent in a genetically susceptible host. Because of the
worldwide distribution of RA, it has been hypothesized that if an infectious agent
is involved, the organism must be ubiquitous. A number of possible causative
agents have been suggested, including Mycoplasma, Epstein-Barr virus (EBV),
cytomegalovirus, parvovirus, and rubella virus, but convincing evidence that these
or other infectious agents cause RA has not emerged. The process by which an
infectious agent might cause chronic inflammatory arthritis with a characteristic
distribution also remains a matter of controversy. Recent work has focused on the
possible role of "superantigens" produced by a number of microorganisms,
including staphylococci, streptococci and M. arthritidis. Super antigens are
proteins with the capacity to bind to HLA-DR molecules and particular Vb
segments of the heterodimeric T cell receptor and stimulate specific T cells
expressing the Vb gene products. The role of super antigens in the etiology of RA
remains speculative. Of all the potential environmental triggers, the only one
clearly associated with the development of RA is cigarette smoking.
Sero positive RA aggregates in families Genetic factors versus their
interaction with environmental facilitators is unclear HLA DR4 is found in 70%
of causascian sero positive patients compared to 25% of controls. Increased
relative risk of 4-5 times for the DR4 positive persons; although a minority are
affected African Americans tend not to exhibit this predilection.11
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Anatomy of joints:
Synovial joints:
Articulations of the synovial type utilize on entirely different principle
from the non-synovial fibrous and cartilaginous joints. Although the bones
involved are linked together by a fibrous capsule & frequently by accessory
ligaments inside or outside of this, the major parts of the articular surfaces
concerned are in contact but not continuity. They are covered by a relatively thin
stratum of hyaline cartilage (occasionally of fibro cartilage) and the actual contact
is between these cartilaginous surfaces which are characterized by a very low co-
efficient of friction (0.002 or less).
Synovial joints has the following components:
1. A joint capsule that isolates the joint from surrounding tissue.
2. A joint cavity formed by the surrounding joint capsule.
3. A synovial membrane (synoviam) that is the inner lining of the joint capsule.
4. Synovial fluid that is secreted by the synovium & serves as the lubricant &
carries nutrients for the joint.
5. Bones that come together to form the joint.
6. Hyaline (Articular) cartilage covers & protects the ends of the bones that
participate in the joint.
There may be other structures present in or near the joint such as disks,
cartilage (menisci) tendons, ligaments burscea important characteristics of
these structures include.
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The joint capsule is composed of two layers, an outer fibrous layer & inner
synovium (identified above) the outer layer has many joint receptors innervating
it but is not vascularized. Opposite to it synovium is well vascularized but poorly
innervated. The articualr cartilage has two important functions including the
ability to minimize friction & wear between to opposing joint surfaces during
movement & to dissipute forces on the joint over a wider area. Thus decreasing
stress on the contacting joint surfaces.
Synovial fluid contains hyaluronate (hyaluranic acid) and a glycoprotien
called lubricin. Both are responsible for the lubrication of joint, although they are
specific for certain components. Hyaluronic acid is important for the lubrication
of the joint capsule while lubricin is necessary for cartilage on cartilage
lubrication.
Synovial fluid is also medium by which mutrients are carried to and
wastes are carried from through the avascular components of the joint.
The ends of the long bones that form the synovial joints are composed of
soft spongy type of bone called subchondral bone. Hyaline (articular) cartilage
covers this bone & protects it except for the very ends of the bone, long bones are
usually very strong.
Effects of the disease:
Rheumatoid arthritis can attack any synovial joint in the body. Except the
distal interphalageal joints, it has the greatest affinity for the small joints of hand,
wrist, & foot. In many cases the joint involvement in the limbs becomes relatively
symmetrical. Further, the cervical spine, usually the superior aspect becomes
affected & patients must be watched carefully for disruption of the atlanto axial
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joint in advanced cases of the disease, subluxation at the atlantoaxial joint can
occur.
Early in the course of the disease several changes in joint structures occur.
Joint effusion & inflammation of the synovium occur producing a soft tissue
swelling that is easily detected during evaluation of the patient. Additionally,
changes in the ends of the bones forming the joints may be present early in the
disease process.
The earlier changes are welling and congestion of the synovial membrane
and overlying connective tissue which becomes infiltrated with lymphocytes,
plasma cells & macrophages. Effusion of the synovial tissue takes place during
the active phase of the disease. Subsequ4ently hypertrophy of the synovial
membrane occurs. Inflammatory granulation tissue or pannus is formed spreading
over & under the articular cartilage, which progressively destroyed. Later fibrous
adhesious may form between the layers of pannus across the joint space & fibrous
or even bony ancylosis may seen. The synovial fluid secreted by the synovium is
thought to save two main purposes, lubrication of the joint & provision of
nutrients to the avascular articular cartilage. In this disease process, an interaction
between antibodies & antigen’s occurs, and causes alterations in the composition
of the synovial fluid. Ultimately, digestants are formed in the fluid, which attacks
the surrounding tissue. Once the composition of this fluid is altered, it is less able
to perform the normal functions noted above and more likely to become
destructive.
The muscles adjacent to inflame its atrophy and there may be focal
infiltration with lymphocytes.
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The changes in the synovium & synovial fluid briefly described above, are
responsible for a large amount of joint & soft tissue destruction the destruction of
bone eventually leads to laxity in tendons & ligaments under the strain of daily
activities and other forces, these alterations in bone & joint structure result in the
deformities frequently seen in patients with Rheumatoid arthritis considerable
destruction of the joint can occur with pannus invading the subchondral bone.
Bone destruction occurs at areas where the hyaline cartilage & the
synovial lining do not adequately cover the bone. If the disease progress to a more
advanced stage, the articular cartilage may lose its structure & density resulting in
an inability to withstand the normal forces placed on the joint. In these advanced
cases, muscle activity causes the involved ended of the bones to be compressed
together causing further bone destruction. Further the disease can irreversibly
change the structure & function of a joint to the degree that other degenerative
changes may occur.
Especially in the weight bearing joints of the body, this joint destruction
can progress to the degree that joint motion is significantly limited & joints can
become markedly unstable.
Pathogenesis of Rheumatoid Arthritis: 256 to 260
In contemporary medical science, Amavata can be best correlated to
Rheumatoid Arthritis (Y.N.Upadhyaya). It is described as an autoimmune
disorder. The propagation of Rheumatoid Arthritis is an immunologically
mediated event, although the original initiating stimulus has not been clear. One
view is that the inflammatory process in the tissue is driven by T4 helper cells
infiltrating the synovium. Evidence for this includes,
• The predominance of T4 cells in the synovium
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• The local production of lymphokines by these infiltrating T cells
• Amelioration of the disease by removal of T cells by thoracic duct
drainage or suppression of their function by total lymphoid irradiation.
Since T lymphocytes produce a variety of cytokines that promote B cell
proliferation and differentiation into antibody forming cells. T cell activation may
also produce local B cell stimulation. The resultant production of immunoglobulin
is rheumatoid factor that can lead to immune complex formation. With
consequent compliment activation there will be exacerbation of inflammatory
process by the production of anaphylatoxins and haemostatic factors. This tissue
inflammation is reminiscent of delayed type of hypersensitivity reaction occurring
in response to soluble antigens or microorganisms. It is how ever unclear that
whether this represents a response to persistent exogenous antigens or to altered
auto antigen such as collagen or immunoglobulins.20
Flow chart-2
Pathogenesis of Rheumatoid arthritis
Lucalization of antigen in Joints
Processing by antigen presenting cells
Interaction with T call receptor
Release of immunopotentiating cytokines
Endothelia call activation
Expression of adhesion molecules
Homing of T – lymphocytes
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Rheumatoid Arthritis
IL – 2 production & T cell proliferation
Production of T cell cytokines
β - Lymphocyte proliferation
Local synttesis of antiglolovlin antibodies
Formation of immure complexes
Activation of complement pathway
Neutrophil chemotaxis & cytolysis
Lymphokine production
Macrophage activation.
Release of monokines & other mocyte medictor
Immune complex phagocytosis by neutrophills & Monocytes.
Release of mediators of acute inflamation (Vasoactive amines proteases,
Lenkotrienes, Oxygen radicals, prostaglandins, polypeptides).
Activation of macrophages & chondrocytes.
Pannus formation
Enzymatic destruction of cartilage bone
Acute phase, fever muscle wasting
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Prodromal symptoms 261,262
Morning stiffness, generalized weakness, mascolo skeletal pain, fatigue,
anorexia, weight loss etc.
Clinical Features:
1. Artichlar 263,264
In the majority of patients the onset is insidious with joint pain. Stiffness
& symmetrical swelling of a number of peripheral joints. Initially the pain may be
experienced only on movement of joints, but rest pain especially early stiffness is
characteristic features.
In typical case the small joints of the fingers & toes are the first to be
affected. Swelling of the proximal but not distal, interphalaugeal joints given the
fiugers a spindled appearance & swelling of metatassophalargeal joints results in
broadening of the forefoot. Fever, weight loss profound fatigue, anorexia &
malaise with out joint symptoms occur less often.
It’s the disease advances there is a tendency for it to spread to involve.
Wrists, elbows, shoulders, knees, ankles, subtarsal midtarsal joints. The
advancement of pathogenesis is bad to muscle atrophy, tendon sheath & joint
destruction results in limitation of joint motion, joint instability with anterior
subluxation of MTP joints in common with ulnar deviation of the fingers in
addition to this lymphadenopwthy, osteoporosis muscle weakness & wasting,
tenosynovitis, bursitis, popliteal cysts, sometimes subcutaneous nodules are
formed. Apart from this scleromalacia, Keratoconjantivitis, scleritis are bound to
occur. Asymptomatrl periconditis, Pl. effusion may occur infrequently. Some of
the characteristic features of Rheumatoid arthritis are:
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a Hands – spindling of proximal interphalangeal joints & swelling of
metacaspopalangeal joints dorsnm of wrist. Weakness of grip or triggering of
fiugers. Swan – neck and boutonniere fingers. Z – Deformity of the thumbs.
Ulnar deviation of fingers & drop fingers from rupture of extensor tendons.
b Feet – Dorsal subluxation of toes with overriding & callosities may develop.
c Knee joint – Synovial effusion occurs early followed by fixed flexion, orvarus
or valgus deformities. Synovial rupture may lead to release of fluid into
popliteal space calf. Attesnatively effusion may distend popliteal bursa to
produce a bakes’s cyst, synovitis of bursae may occur at other sites.
d Cervical spine – Subluxation of cervical bodies or altantoaxial joint.
E Crycocastynoid joints – May occasionally be affected causing dysphasia,
hoarseness or stridor.
Table No-12 Extra articular features 265,266
Systemic Fever, Weight loss, Fatigue, Susceptibility to infection
Vasculitis Digital arteritis, Unloss Pyoderma ganzdemosm,Mononearitis, multiple Visural artiritis.
Muscaloskeletal Muscle wasting, Tenosynovitis, Bursitis, Osteoporosis
Cwrdiae Pericarditis,Myocorditis, Endocarditis, Conduction defects CoronoryVasculations, Granulomatis arthritis.
Haematological Anamia, Thrombouptosis, Eosimophelia
Pulmonory Nodules, Pl. Effusions, Fibrosing alveolitis, Bronehiolitis, Eapalan’ syndrome Nodules
Sinuses, Fistulae Neurological Cenicalchord, Compression, Newropathies
Occular Episcleritis, Scleritis, Scbromaleria, Sicca syndrome Skin
Pulmar erythema, Psoariasis
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Rheumatoid Arthritis
Infection: Increased frequency in Rheumatoid arthritis
1] Antimelear antibodies in 50%. 2] Elevated CRP, alkaline phospate platelets.
Differential diagnosis:
Rheumatoid Arthritis differentiated from other diseases having similar
features like Joint Pain on the basis of presenting Signs and Symptoms &
biochemical investigations. These diseases are as follows:
1. Gout :
In pathological investigation high serum uric acid level is present.
Response to administration of Colchicine is found in this condition.
2. Osteoarthiritis :-
Radiological appearance differs, absence of subcutaneous nodules and
R.A. factor. In typical case, Heberdon’s nodes appear in relationship to DIP
joints and ESR usually with in normal limits.
3. Polymyalgia Rheumatica :-
In this condition ESR is very high and peripheral joint signs are
minimal. (Onset of Rheumatoid Arthritis in elderly mimic Polymyalgia
Rheumatica)
4. Polyarthritis Nodosa :-
May resemble Rheumatoid Arthritis, but radiological changes are
minimal. Severe systemic symptoms and necrotising vasculitis at early stage of
polyarthritis may be present, but joint erosions and typical Rheumatoid Arthritis
deformity are rare in later stage.
5. Systemic Lupus Erythematosis :-
It is characterized by the presence of numerous autoantibodies,
circulating immune complexes and widespread immunologically determined
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tissue damage. Chronic inflammatory arthritis and tenosynovitis may lead to
deformities and contractures, but erosive changes are very uncommon.
6. Rheumatic Fever: -
First, attacks are usually under 15 years of age in 70% of case. It is
characterized by flitting type of joint pain and sustained fever. Spindling of
finger joint is rare. Myocarditis, endocarditis and nodules on the different
histological picture are present.
Some other diseases are as follows from which we have to differentiate
the disease Rheumatoid Arthritis.
• Acute Suppurative Arthritis
• Tuberculous Arthritis
• Reiters Syndrome
• Hypertrophic Osteoarthropathy
• Chronic Arthropathy
• Sarcoid Arthritis
• Scleroderma
• Arthritis with Erythema Nodosum
• Spondylitis
• Psoriatic Arthritis
Symptoms of R.A which may require differential diagnosis are – Table No-13
Symptoms Possibilities to be considered Acute or severe pain in one or a few joints
Joint sepsis – fever may be absent Fracture – even without obvious trauma
Unexplained weakness Cervical spine involvement producing cord compression
Unilateral calf swelling Ruptured Baker’s cyst – this is frequently misdiagnosed as a deep venous thrombosis
Painful red eye Scleritis-requires expert opthalmological assessment
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Complication of Rheumatoid Arthritis:
• Septic Arthritis
• Amyloidosis – The synovium is infiltrated with amyloid protein.
• Systemic Vasculitis
• Spinal Cord Compression
• Felty’s syndrome – Splenomegaly with neutropenia leads to
repeated infections and weight loss known as felty’s syndrome.
Prognosis: 267,268
The course and prognosis in R.A. is very difficult to predict because of
its variability. 25% of the severe patients may have complete remission of
symptoms and fit for all normal activities. 40% of the cases suffer with moderate
type of functional impairment despite exaggeration and remission. 25% may be
more severely disabled and 10% may be severely crippled almost limited to bed.
Prognosis may be very poor in many cases as follows:
1. High titre of rheumatoid factor
2. Insidious onset of the disease
3. More than one year with active phase without any remission
4. Early development of nodules and erosions
5. Extra-articular manifestation
6. Several functional impairment
The median life expectancy of persons suffering with rheumatoid
arthritis is shortened by three to seven years. Factors co-related with early death
include disability, disease duration or severity, glucocorticoid use and age of
onset of disease.
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Rheumatoid Arthritis
Laboratory findings269
Haematology:
Normochromic or hypochromic anemia, which usually occurs in about
22% of females & 11% of males in adult type. The anemia is more marked in
children & occurs in about 60% of patients. The anemia is due to chromic
inflamation.
Erythrocite sedemntation rate :
During active phase the ESR is raised in about 85-95% of cases.
Scrological
RF: +ve in 50 – 60 % of cases.
CRP: +ve in acute phase of the disease.
Radiological :
Intially only soft tissue swelling of joints may be seen, but with
progressive periarticular osteoporosis, narrowing of joint spaces with marginal
erosions & cup & pencil deformities massive bone resorptions develop marginal
sclerosis & osteophyte formation indicate secondary osteo – arthritis.
Diagnosis :
- Clinical picture CRP positive
- Elevated ESR Positive Rh factors
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Rheumatoid Arthritis
Management
1. Relief of symptoms
2. Suppression of active & progressive disease.
3. Conservation & restoration of function in affected joints.
These are achieved by
1. Treatment of the patient’s drug, rest, physiotherapy, surgery.
2. Modification of environment – aids, appliances, housing, occupation, statutory
social benefits.
General treatment
Physical rest, anti inflammatory drug therapy & maintenance exercises is
the corner stones of treatment for exacerbation of Rheumatoid arthritis. The rest
from physical & emotional stress provided by 2 – 3 wks in hospital is usually
sufficient to induce a marked remission of symptoms with out recourse to strict
bedrest. In few patients a period of complete bed rest may be required to induce a
remission. Rest splints can be used to support a particular painful joint to correct
flexion deformities.
Medications: Most people who have Rheumatoid arthritis take medications.
Some medications are used only for pain relief; others are used to reduce
inflammation. Some medications are disease modifying antirhematic drugs
DMARDs are used to try to slow the course of the disease.
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Rheumatoid Arthritis
In articular corticosteroidal injections are given to bring symptomatic
relief. Non-steroidal anti – inflammatory drug therapy is beneficial initial stages,
which has low incidence of side effects.
Chloroquine phosphate or hydroxy chloroquine sulphate, the antimalierials
are used us the initial adjunct to basic therapy.
Auranofin an oral gold compound, pencillamine parentral gold are also
used, prednisolone a corticosteroid is also used in the treatment.
Immunomodulators are also used.
Surgical treatment.
The primary purpose of these procedures is to reduce pain, improve the
affected joints function, and improve the patient’s ability to perform daily
activities.
Surgical decompression & synovectomy are needed when corticosteroids
and physical measures have failed to relieve movement of limbs.
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Drug Review
Drug Review
As mentioned earlier, a specific line of treatment aiming at samprapti
vighatana is dealt in our classics. It involves deepana, pachana, shodhana and
shamana depending on the strength of dosha and dushya etc. Accordingly in the
present study vaishwanara churna, eranda taila, bruhat saindhavadi taila Anuvasana
basti, Erandamoladi niruha basti . These are discussed in detail in the following pages.
Vaishwanara Churna 270
Vaishwanara choorna is best deepana pachana drug and has properties like
teekshna, ushna, ruchya etc. It is specially indicated in amavata chikitsa along with
adhmana, gulma, parinama shoola and hrdroga. It overcomes mandagni, shula, shotha
and ama symptoms.
The ingredients of vaishwanara choonra are manimantha, yavani, ajamoda,
nagara and haritaki. The properties of individual drugs are tabulated in table no.8
which is given in the following pages.
Eranda Taila 271,272,273,274
As mentioned in chikitsa aspects, sneha virechana is indicated in amavata.
Eranda taila is considered to be the best among the snehas for virechana. Eranda taila
possesses ushna, guru, sara, teekshna, sukshama, picchila and visra gunas. By rasas it
is katu, kashaya, madhura and tikta and is having madhura vipaka. The actions of
eranda tala are found to be srotovishodhana, lekhana, deepana, balya and rasayana.
It has got vatashleshamhara effect and effective in conditions like janga, kati,
urushoola, anaha and vibandha.
The castor oil cheifly consists of ricinoleate of glycerol or tririninolin with a
small quantity of plantin and stearin. The glycerides of ricinoleic acid C17H32
OHCOOH are mainly responsible for the purgative effect.
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Drug Review
Activity
Oil is a non irritant purgative, when it reaches the duodenum it is decomposed
by the pancreatic juice into ricinoleic acid, which irritates the bowels, stimulates the
intestinal glands and the muscular coat and cause purgation ie., when given by mouth
oil is saponified and free acid is liberated which procues the effect. It acts in 4 to 5
hours causing liquid stools without pain and gripping and has a sedative effect on the
intestine. Ricinoleic acid is absorbed into the blood and tissues. Ricinin is a voilent
irritant of the intestine.
In short, castor oil is one of the cheapest, simplest and most important useful
purgative of the pharamacopiea in all delicate conditions of children and aged people.
Brihat Saindhavadi Taila 275
This taila is considered as an ideal remedy for amavata in the form of basti,
abhyanga and pana. It also gives strength to agni and indicated in major sandhi
shoola conditions.
Contents
Saindhava, gajapippali, rasna, shatapushpa, yamanika, sarjika, maricha, kusta,
shunti, sauvarchala, vida, vacha, ajamoda, yastimadhu, jeeraka, puskaramula, pippali,
each should be 1/2 pala, eranda taila, 1 prastha, shatapuspa kashaya 1 prastha, kanjika
and mastu 2 prasthas each. The properties of individual drugs are tabulated following
page.
Erandamula niruha basti 276
Ingredients are Erandamula, Palasha, Laghupanchamula, Rasna, Ashwagandha,
Atibala, Guduchi, Punarnava, Aragvadha, Devadaru, Madanaphala, Shatahwa,
Hreebera, Priyangu, Pippali, Yashti, Saindhava, Madhu and taila [sneha]
Erandamuladi niruha basti is Vatashamaka.
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Table No. 14 Showing the Composition and Properties of Vaishwanara Churna
Sl. No.
Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata
Karmukata Prayojyanga
1 Manimantha Sodium chloride Lavana SnigdhaTeekshna
LaghuSukshma
Sheeta Lavana Tridosha Deepana, pachana, vatanulomana
Lavana
2 Yavani Tachyspermumammi
Katu tikta LaghuRuksha
Teekshna
Ushna Katu Kaphavata Shamaka
Rochana, deepana, vatanulomana,
shoolapra shamana
Phala
3 Ajamoda Carum roxburghianum
Katutikta
LaghuRuksha
Teekshna
Ushna Katu Kaphavata shamaka
Vidahi, deepana, vatanulomana,
shoola prashamana, kaphagna
Phala
4 Nagara Zingiber officinale
Katu LaghuSnigdha
Ushna Madhura Kaphavata shamaka
Tripthigna, rochana, deepana,
pachana, vatanulomana,
shothahara
Kanda
5 Haritaki Terminalia chebula
KashayaPradhana
Pancha rasa
LaghuRuksha
Ushna Madhura Tridosha Shothahara, vedana, sthapana,
anulomana, mrudurechana,
deepana, pachana
Phala
88
Table No-15 Showing the Properties of Drugs of Brihat Saindhavadi Taila
Sl.No. Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata Karmukata Prayojyanga 01 Saindhava Sodium chloride Lavana Snigdha
Teekshna Laghu Sukshma
Sheeta Lavana Deepana Pachana Vatanulomana Tridoshahara
Deepana, pachana, vatanulomana
Lavana
02 Sreyasi Piper retrofractum Katu Laghu Ruksha
Ushna Madhura Kaphavata Shamaka
Rochana, deepana, vatanulomana,
Phala
03 Shatapuopa Anethum sowa Katu Tikta
Laghu Ruksha Teekshna
Ushna Katu Kaphavata shamaka
Rochana, Deepana, pachana, anulomana, shothahara
Phala
04 Rasna Vanda roxburghii Katu Guru Ushna Katu Kaphavata shamaka
Vedanasthapana Amapachana Rasayana
Moola
05 Vavanika Trachyspermum amni
Katu Tikta
Laghu Ruksha Teeksha
Ushna Katu Kaphavata shamata
Rochana, deepana vatanulomana
Phala
06 Sarija Sodium carbonate Kshara Laghu, snigdha Sukshma Soumya
Ushna Katu Kaphahara Deepana, pachana, mootrala, shulahara
Kshara
07 Maricha Piper nigrum Katu Laghu Teekshna
Ushna Katu Vata kapha shamaka
Deepana pachana vatanulomana pramathi
Phala
89
08 Kusta Saussurea lappa Tikta Katu Madhura
Laghu Ruksha Teekshna
Ushna Katu Kapha vata shamaka
Deepana, pachana, anulomana
Moola
09 Shunti Zinghibu officinale
Katu Laghu Snigdha
Ushna Madhura Kapha vata shamaka
Truptigna, rochana, deepana, pachana, vatanulomana shothahara amapachana
Kanda
10 Suvacchala Nacl Lavana Vishada Laghu Sukshma
Ushna Lavana Vata nashaka Rochaka bhedaka deepana pachana vibandhahara
Lavana
11 Vida ---- Lavana Laghu Teekshna Ushna Ruksha Vyayayi
Ushna Lavana Vata kapahara Deepana vaanulomana ruchikala shulahara
Lavana
12 Vacha Acorus calaus Katu Tikta
Laghu Teekshna
Ushna Katu Kaphavata Medhya, vedana, sthapana, deepana, triptigna
Moola
13 Ajamoda Carum roxbur giahum
Katu Tikta
Laghu Sukshma Teekshna
Ushna Katu Kaphavata shamaka
Deepana, vatanulomana, shulaprashamana
Phala
14 Madhuka Glycerrhiza glabra
Madhura Guru Snigdha
Sheeta Madhura Vatapitta shamaka
Rasayana, balya medhya, vatanulomana sandhaveerya
Moola
90
15 Jeeraka Cyminum cuminum
Katu Laghu Ruksha
Ushna Katu Kapha vata shamaka
Deepana, pachana vatanulomana shulaprashamana
Phala
16 Puskaramula
Inula raumosa Tikta Katu
Laghu Teekshna
Ushna Katu Kaphavata shamaka
Deepana pachana vatanulomana shotharaha
Moola
17 Kaha Piper longum Katu Laghu Snigdha Teekshna
Anusha Sheeta
Madhura Kaphavata shamaka
Deepana truptigna vatanulomana rasayana balya
Phala
Table No-16 Erandamooladi Vasti Dravyas
Sl. No.
Drug Latin Name Rasa Guna Veerya Vipaka Doshagnata Karmukata
01 Erandamoola Ricinus communis Snigdha,TeekshnaSoukshma
Madhura Madhura Ushna Kaphavata shamaka
Shotahara vayasthapana ballya
02 Palasha Butea monosperma
Laghu Ruksha Katu Tikta Kashaya
Katu Ushna Kaphavata shamaka
Deepana Grahi Anulomana
03 Rasna Pluchea lancioleta Guru Tikta Katu Ushna Kaphavata shamaka
Deepana Rechana Anulomana
04 Bala Sida cardifolia Laghu Snigdha Picchila
Madhura Madhura Seeta Vatapitta shamaka
Vatanulomana Rasoyana
05 Guduchi Tinospora cardifolia
Guru Snigdha Tikta Kashaya
Madhura Ushna Tridoshahara Deepana Ballya Rasayana
06 Ashwaganda Withenia somnifera
Laghu Snigdha Katu Tikta Madhara
Madhara Ushna Kaphavata shamaka
Sothahara Vedanasthapana
91
07 Punarnava Boerhavia diffusa Laghu Ruksha Madhura Tikta Kashaya
Madhara Ushna Tridoshahara Lekhana Sothahar
08 Aragvadha Cassia fistula Guru Mrudu Snigdha
Madhara Madhara Seeta Vatapitta shamaka
Rechana
09 Devadaru Cedrus deodara Laghu Snigdha Tikta Katu Ushna Kaphavata shamaka
Sothahara Vedanasthapana
10 Madana phala Randia spinosa Laghu Ruksha Kashaya Madhura Katu Tikta
Katu Pabhava Vamana
Ushna Kaphavata shamaka
Vedanasthapana Sothahara
11 Shala parni Disodium Gangiticum
Guru Snigdha Madhura Tikta
Madhura Ushna Tridoshahara Sothahara
12 Prasnaparni Ureria picta Laghu Snigdha Madhura Tikta
Madhura Ushna Tridoshahara Sothahara
13 Gokshura Tribulas terestris Guru Snigdha Madhura Madhura Seeta Vatapitta shamaka
Sothahara Vedanasthapana
14 Kantakari Solanamsurattense Laghu Ruksha Teekshna
Katu Tikta Katu Ushna Kaphavata shamaka
Sothahara
15 Bruhati Solanum indicum Laghu Ruksha Teekshna
Katu Tikta Katu Ushna Kaphavata shamaka
Sothahara
16 Vacha Acorus calamus Laghu Ruksha Teekshna
Katu Tikta Katu Ushna Kaphavata shamaka
Sothahara
17 Hapusha Juniperus cmmunis
Laghu Ruksha Teekshna
Katu Tikta Katu Ushna Kaphavata shamaka
Vedanasthapana
18 Shatavha Anithum sowa Laghu Ruksha Teekshna
Katu Tikta Katu Ushna Kaphavata shamaka
Vedanasthapana Sothahara
19 Priyangu Callicarpa Macrophylla
Guru Ruksha Kashaya Madhura Tikta
Katu Seeta Vatapitta shamaka
Vedanasthapana Sothahara
92
20 Yastimadhu Glycyrrhiza glebra
Guru Snigdha Madhura Madhura Seeta Vatapitta shamaka
Vedanasthapana
21 Kana Pipper longama Laghu Snigdha Teekshna
Katu Madhura Anushna seta
Kaphavata shamaka
Deepaka Turptighna
22 Vatsaka beeja Holirina antidysentrika
Laghu Ruksha Kashaya Tikta
Katu Seeta Kaphapitta shamaka
Sothahara
23 Musta Cyprus roturdus Laghu Ruksha Kashaya Tikta Katu
Katu Seeta Kaphapitta shamaka
Deepana Pachaka
24 Taksharyashaila Laghu Ruksha Tikta Katu Katu Ushna Kaphavata shamaka
Vedanasthapana Sothahara
25 Saindhava lavana
Sodium chloride Laghu Snigdha Swadu Madhura Seeta Tridoshahara Deepana Pachaka Ruchya
26 Makshika Laghu Ruksha Madhura Seeta Tridoshahara Lekhana Balya Deepana
27 Tail Guru Madhura Madhura Ushna Kaphavata shamaka
Brhana Lekhana
28 Gomootra Cows urine Laghu Ruksha Kashaya Tikta Katu
Katu Ushna Kaphavata shamaka
Vedanasthapana Sothahara Rechaka
93
Material and Methods
Materials and methods
The materials taken for the study are
1) Vaishwanara churna
2) Eranda taila
3) Bruhat saindhavadi taila
4) Erandamooladi Niruha basti
5) PaciboCapsules
1) Vaishwanara Churna
The ingredients of the churna were manimantha, yavani, ajamoda, nagara and
haritaki are identified correctly and churna prepared with the help of Rasashastra
department.
2) Eranda Taila
Plain eranda taila was purchased and moorchana was done using drugs
haridra, triphla, musta, hrivera, lodhra, vatanukara according to classical method at D
G M A M C Pharmacy and then used for Nittyavirechana purpose.
3) Brihat Saindhavadi Taila
For anuvasana basti Brihat Saindhavadi Taila ingridients are identified, those
are saindhava, gaja pippali, rasna, shatapuspa, yamanika, sarjika, maricha, kostha,
shunti, souvarchala, vida, vacha, ajamoda, yasti madh, jeeraka, pushkaramula, pippali,
eranda taila, shatapuspa kashaya, kanjika and mastu. According to the priparetion of
Sneha Brihat Saindhavadi Taila was maid in D G M A M C Pharmacy and then used
for Anuvasana basti
4) Erandamooladi Niruha basti
All Ingredients of Erandamooladi Niruha basti were identified ( Erandamula,
Palasha, Laghupanchamula, Rasna, Ashwagandha, Atibala, Guduchi, Punarnava,
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Material and Methods
Aragvadha, Devadaru, Madanaphala, Shatahwa, Hreebera, Priyangu, Pippali, Yashti,
Saindhava, Madhu and taila ) and are used to prepare just before administration of
Niruha basti according to the preparation of Niruha basti dravya.
5) PaciboCapsules
Capsules were prepared by filling starch powder.
Diagnosis
The diagnosis will be made on the basis of classical signs and symptoms
mentioned in the Ayurveda and modern texts and criteria laid down by American
Rheumatism Association (1988) following features are employed for confirmation of
RA.
1) Morning stiffness (> = 1hr)
2) Swelling of three or more joints
3) Swelling of hand joints (PIP, MP)
4) Symmetrical swelling
5) Subcutaneous nodules (Rheumatoid nodules)
6) Presence of serum rheumatoid factor
7) Radiological changes (Hands & wrist)
Criteria 1 to 4 must have been continuous for 6 weeks or longer must be
observed by physician. A diagnosis of RA requires that, four of the above seven
criteria should be present.
Research Design
After the diagnosis, as on the above parameters, the selected patients
were assigned for the Comparative clinical trial as follows.
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Material and Methods
Source of data:
Patients suffering from Amavata have selected from P.G.S & R.C.
O.P.D. of shree D.G.M. A.M.C. and Hospital Gadag.
Sample size & grouping:
A minimum sample of 30 patients with Amavata diseases have equally
distributed in two groups.
Group A – 15 patients have received Virechana
Group B- 15 patients have received Yogabasti.
Selection criteria
Patients were selected strictly as per present inclusive and exclusive criteria
a) Inclusive criteria:
1. Classical signs and symptoms will be considered for the selection of patients.
2. Patients of Amavata having the history of less than 5 years.
3. Patients of Amavata between the age group of 20 to 60 years of either sex.
4. Patient fit for Virechana and Bastikarma.
b) Exclusive criteria :
1. Patients of Amavata having the history of more than 5 years.
2. Patients of Amavata less than 20 years and more than 60 years of age.
3. The patient of Amavata having the systemic diseases like Diabetes mellitus,
Asthma, Hypertension, Rheumatic heart disease & Heart diseases etc.
4. Patients unfit for Virechana and Bastikarma.
5. Pregnant and lactating mothers.
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Material and Methods
Study duration
For group A
Nittyavirechana
The patients were administered vaishwanara choorna internally in a
dose of 3 – 6 Gms thrice daily with a cup of hot water, half an hour before food. The
treatment was given till the nirama laxanas were observed. Eranda taila in the quantity
of 15 to 30ml was given in between 8 to 9am when the patient is not so hungry for 8
days for the purpose of Nittyavirechana, according to the kosta of the patient. A cup
of hot water was advised as anupana and Parihara kala was advised for 16 days. In
Parihara kala one Placibo capsules was advised to take daily.
For group B
Yogabasti
The patients were administered Vaishwanara choorna internally in a
dose of 3 – 6 Gms thrice daily with a cup of hot water, half an hour before food. The
treatment was given till the nirama laxanas were observed. After finding nirama
Laxshana Yogabasti has given with Bruhatsaindhavadi taila Anuvasana basti and
Erandamooladi Niruha basti. Parihara kala was advised for 16 days. In Parihara kala
one Placibo capsules were advised to take daily for benefit of good follow up.
Valuka sweda was advised whenever patient complaints increased pain
and stiffness during the course of the treatment for both groups.
Method, Preparation and Administration of Basti
In this study Yogabasti patterned was followed. In this course five anuvasana
basti with Bruhat saindhavadi taila and three Eranadamooladi niruha basti were
administered. The anuvasana basti was given first day after finding Nirama laxshana.
On that morning after evaluation of bowels and bladders patient was advised to take
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Material and Methods
light food (onefourth of his normal quantity). Then the patient was sent to
panchakarma theatre and subjected for local abhyanga and sweda. Then the patient
was asked to lie down on the table in the left lateral position, with the left knee
extended, right limb flexed both at the hip and knee joint and resting on the left knee.
The head was supported by the patient’s left hand. The plastic glycerin enema syringe
with a capacity of 100ml and plain rubber catheter of the size no.12 were used for the
purpose of anuvasana basti the anal orifice and the inserting end of the catheter were
smeared with oil for lubrication. The rubber catheter connected to the enema syringe
filled with brihat saindhavadi taila was gently inserted about 4 inches into the rectum
parallel to spinal column. Simultaneously the patient was asked to take deep breaths;
the catheter was removed with some amount of drug still remaining in the syringe to
prevent the entry of air into the colon. Then the patient was asked to turn into the
supine position, raised his both legs three times and his buttocks were gently patted
and his palms and soles were rubbed. Patient was asked to remain in the same
position for half an hour. Patient was watched for the evacuation of drug. After
evacuation they were allowed to take hot water bath and then light food
The quantity of bruhat saindhavadi taila taken was 80ml; the course of
anuvasana basati was given for alternate days and was ended with two continuous
anuvasana basti.
The niruha basti was started on the second day of the course. The niruha
basti dravya was prepared at the time of administration, first 12 gms of finely
powdered saindhava lavana was taken in the Khalva and was mixed 60 ml of
Makshika with Peshani, than 60ml of Tila tail was taken and churned with the same.
After this 10gm fine powder of Kalka dravya was made paste and well churned with
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Material and Methods
the previous mixture. Finally 400 – 500 ml of Kwatha, which is prepared from
Erandamooladi kwatha choorna, was mixed up to the uniform consistency.
This was filtered and indirectly warmed in a boiling water vessel to make it
Luke warm. The niruha basti was given in empty stomach state in the similar manner
to that of anuvasaha basti. The purva karma and pradhana karma were similar to that
of anuvasana. Plastic enema can with a capacity of 1200ml was taken instead of
enema syringe. Patient was advised to remain in the table till he feels the urge for
defecation. After defecation they were allowed to take hot water bath and then light
food. The quantity of Erandamooladi niruha basti administered was 500-600ml per
each time. Valuka sweda was advised whenever patient complaints increased pain and
stiffness during the course of the treatment.
After completion of Yogabasti 16 days Parihara kala have advised, in this
period placebo Capsule was continued daily once.
Data Collection
All the patients were thoroughly examined by both subjectively and
objectively. Detailed history pertaining to the mode of onset, previous ailment,
previous treatment history, family history, habits, Ashtavidhapareeksha and
Dashavidhapareeksha and physical examination findings were noted. Routine
investigations were done to exclude other pathologies.
Examination of the patient
History – History taking of patient is very important to diagnose the diseases
especially of Amavata patient. When medical history focusing on the pain in the
joints, specific things to discussed when taking the history of a man with Amavata
symptoms include a history of morning stiffness of joints, symmetrical artheitis,
arthritis of more than three joints etc.
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Material and Methods
Inspection – In case of Amavata, joints should be examined by inspection. We can
observe the swelling, redness of joints etc. Even we can observe the deformity of
joints and this can see the gait change.
Palpation – Should be accurate to identify the Jwara, Ushnata of joints,
Sparshasahatwa of joints can be finding by this palpation.
Percussion – It helps to know the Kukshikathinnyata of Udara. It can also be used to
identify the Adhmana and Anilasanga.
Auscultation – It helps in finding the invalment of Hridaya and also helps in the
Adhmana and Anilasanga by hearing the sound like (gudu gudu).
Investigetions and selection of patient
Both objective and subjective parameters were considered for the selection of
patient for both groups
Objective parameters
The below investigations are done before the selection of patient for the study.
1] Hb%
2] E S R
3] A S L O titer
4] C R P
5] Rh factor
Subjective parameters
The subjective parameters taken for this study are
1] Ruja
2] Shotha
3] Stabdata
4] Ushnata
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Material and Methods
The above four criteria ware considered for all the seven joints which are
explained by Madhavakara in his Madhukosha.
Method of assessment
Subjective parameters and objective parameters of base line data to
after treatment data are done for comparison of the assessment of result.
Grading of parameters
Results are calculated by observing Subjective parameters by grading method.
Grading was done as in the bellow manner.
1] Hasta sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 = any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 = any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 3 = any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
2] Pada sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 = any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 = any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 3 = any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All four Ruja, Shotha, Stabdhata and Ushnata are present.
3] Gulpha sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
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Material and Methods
Grade 3 =any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
4] Trika sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 3=any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
5] Janu sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 3 =any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
6] Uru sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 3 =any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
7] Sira sandhi
Grade 0 = All the Ruja, Shotha, Stabdhata and Ushnata are absent.
Grade 1 =any one of the Ruja, Shotha, Stabdhata and Ushnata was present.
Grade 2 =any two of the Ruja, Shotha, Stabdhata and Ushnata are present.
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Material and Methods
Grade 3 =any three of the Ruja, Shotha, Stabdhata and Ushnata are present.
Grade 4 = All the four Ruja, Shotha, Stabdhata and Ushnata are present.
8] Hb%
The numerical value of Hb% was taken before and after for the assessment.
9] ESR
The numerical value of ESR was taken before and after for the assessment
Overall Assessment of the Treatment
To assess the overall effect of therapy, the criteria laid down by ARA (1967)
were adopted. The results are classified into four groups as listed below.
Grade I - Complete Remission
1 = No systemic sign of rheumatoid activity
2 = No signs of inflammation
3 = No evidence of activity in any extra articular process, including
nodules tinovaginitis and iritis.
4 = No lasting impairment of joint mobility other than that associated
with irreversible changes
5 = No elevation in ESR
6 = Articular deformity or extra articular involvement due to
irreversible changes may be present.
Grade II - Major Improvement
1 = No systemic sign of rheumatoid activity with the exception of an
elevated sedimentation rate and vasomotor imbalance
2 = Major signs of inflammation resolved, such as warmth, redness
of joint structures.
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Material and Methods
3 = No new rheumatoid process of intra articular or extra articular
structures.
4 = Minimum joint swelling may be present.
5 = Impairment of joint mobility associated with minimum residual
activity may be present.
6 = Articular deformity or extra-articular involvement due to
irreversible changes may be present.
Grade III - Minor Improvement
1 = Diminution of systemic signs of Rheumatoid activity.
2 = Signs of joint inflammation only partially resolved
3 = No evidence of extension of rheumatoid activity into additional
articular or extra articular structures.
4 = Decreased but not minimum joint swelling present.
5 = Impairment of joint mobility may be present.
6 = Articular deformity or extra articular involvement due to
reversible changes may be present.
Grade IV – Un improvement or Progression
1 = Undiminished signs of rheumatoid activity, regardless of
functional activity.
2 = Exacerbation of any previously involved joint or joints or
development of sites of rheumatoid activity.
3 = Roentgenologic changes indicative of progression of the
rheumatoid process, excepting hypertrophic changes.
4 = In the presence of 1 or more of the afore said criteria, improvement
in other feature, including a normal or lowered ESR, not significant.
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Observation and Results
Observation and Results
In this present clinical study subjective and objective changes were considered
for the comparative Ayurvedic management of Amavata with
Yogabasti(Erandamooladi Niruha and Bruhatsaindhavadi Anuvasana) and Nittya
virechana with Eranda taila. Thirty patients were selected after fulfilling the criteria
for diagnosis and were treated in the following two groups –
Group A – Yogabasti – 15 patients.
Group B – Nittya virechana with Eranda taila – 15 patients.
All the patients were examined before and after the treatment according to the
case sheet format given in the appendix. Both the subjective and objective changes
were recorded and are presented under the following heading –
Demographic data.
Data related to the disease.
Data related to subjective and objective parameters before and after treatment.
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Observation and Results
Demographic data
Table No.17 showing distribution of patients by age groups.
Group A Group B Age group No % No %
Total
%
20-30 5 33.33 3 20 8 26.66 31-40 4 26.66 6 40 10 33.33 41-50 3 20 4 26.66 7 23.33 51-60 3 20 2 13.33 5 16.66
In Group A – Out of 15 (i.e.50%) patients, 5 patients (i.e.33.33%) were in the
age group of 20-30 years, 4 patients (i.e.26.66%) were in the age group of 31-40
years, 3 patients (i.e.20%) were in 41-50 years age groups and 3 patients (i.e.20%)
were in 51-60 years of age group.
In Group B – Among 15 (i.e.50%) patients, 3 patients (i.e.20%) were in 20-30
years age group, 6 patients (i.e.40%) were in 31-40 years age group , 4 patients were
(i.e.26.66%) were in 41-50 age groups and where as 2 patients were reported in 51-60
years age group.
Graph No.1 showing distribution of patients by age groups
010
2030
4050
Group A Group B Total %
20-30 31-40 41-50 51-60
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Observation and Results
Table No. 18. Showing distribution of patients by Sex
Group A Group B Sex No % No %
Total
%
Male 04 26.66 04 26.66 08 26.66 Female 11 73.33 11 73.33 22 73.33
Among the 15 patients in the Group A, 4 patients (26.66%) were males, in the
same Group, 11 ware females (73.33%). In group B, 4 patients (26.66%) were males,
and females ware 11(73.33%) had moderate response.In the study as a whole (30
patients), 08 males (%), and 22( %)patients ware female.
Graph No. 2. Showing distribution of patients by Sex in both groups
01020304050607080
GroupA
GroupB
Total %
MaleFemale
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Observation and Results
Table No. 19 showing distribution of patients by religion.
Group A Group B Religion No % No %
Total
%
Hindu 14 93.33 13 86.66 27 90 Muslim 01 6.66 02 13.33 03 10
In Group A – Among 15 patients, 14 patients (i.e.93.33%) were of Hindu
religion, 01 patient (i.e.6.66%) were in Muslim community and none of the patient
observed in Christian and other religion.
In Group B – Among 15 patients, 13 patients (i.e.86.66%) were of Hindu
religion, 02 patients (i.e.13.33%) ware of Muslim community and none of the patient
observed in Christian and other religion.
Graph No. 3 showing distribution of patients by religion.
0
20
40
60
80
100
GroupA
GroupB
Total %
HinduMuslim
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Observation and Results
Table No. 20 showing distribution of patients by occupation.
Group A Group B Occupation No % No %
Total
%
HW 10 66.66 10 66.66 20 66.66 Sedentary 02 13.33 00 00 02 6.66 Labor 03 20 05 33.33 08 26.66
In Group A – Out of 15 patients, 10 patients (i.e.66.66) were house wife’s,
02(13.33) patients were sedentary, and in labor group 03 (20%) patients ware
noticed. No patient was observed from occupations.
In Group B – Out of 15 patients, 10 patients (i.e.66.66%) were house wife’s,
no patients ware in sedentary occupation group, 5 patients(ie.33.33) ware observed in
labor occupation group.
Total 20 patients (66.66%) ware house wife’s, 02 patients (6.66%) ware
sedentary and 08 patients (26.66% ) ware in labor group.
Graph No. 4 showing distribution of patients by occupation.
010203040506070
GroupA
GroupB
Total %
HWSedentaryLabor
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Observation and Results
Table No. 21 showing distribution of patients by socio-economical status.
Group A Group B SE status No % No %
Total
%
Poor 08 53.33 08 53.33 16 53.33 M Class 06 40 07 46.66 13 43.33 UM Class 01 6.66 00 00 01 3.33
In Group A – Out of 15 patients, 06 patients (i.e.40%) were in middle class
socio-economic group, 01 patients (i.e.6.66%) were in to high class socio-economic
group and 08 patients (i.e.53.33%) are in poor socio-economical status group.
In Group B – Out of 15 patients, 07 patients (i.e.46.66%) were in middle class
socio-economic group, 08 patients (i.e.53.33%) are in poor class socio-economic
group and 00 patients (i.e.00%) were in high class socio-economical status group.
Graph No. 5 showing distribution of patients by socio-economical status
010
2030
4050
60
GroupA
GroupB
Total %
PoorM ClassUM Class
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Observation and Results
Table No. 22 showing distribution of patients by dietary habits.
Group A Group B D. Habits No % No %
Total
%
Veg. 11 73.33 11 73.33 22 73.33 Mixed 04 26.66 04 26.66 08 26.66
In Group A – Out of 15 patients, 11 patients (i.e.73.33%) were vegetarian and
4 patients (i.e.26.66%) were mixed diet habit.
In Group B – Out of 15 patients, 11 patients (i.e.73.33%) were vegetarian and
4 patients (i.e.26.66%) were mixed diet habit.
Graph No. 6 showing distribution of patients by dietary habits.
01020304050607080
GroupA
GroupB
Total %
Veg.Mixed
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Observation and Results
Table No.23 showing the distribution of patients by duration of disease
Group A Group B DurationNo % No %
Total
%
Less than 1 yr
02 13.33 01 6.66 03 10
>1-<2 05 33.33 05 33.33 10 33.33 >2-<3 04 26.66 04 26.66 08 26.66 >3-<4 02 13.33 02 13.33 04 13.33 >4-<5 02 13.33 03 20 05 16.66
In Group A – Out of 15 patients, 02 patients (13.33) are having less than one
year history, 05 patients (33.33) are having more than one year and less than two year
history, 04 patients (26.66%) are having more than two year and less than three years
history, 02 patients (13.33%) are having more than three year and less than four years
history, 02 patients (13.33%) are having more than four years and less than five years
history.
In Group B – Out of 15 patients, 01 patients (6.66%) are having less than one year
history, 05 patients (33.33) are having more than one year and less than two year
history, 04 patients (26.66%) are having more than two year and less than three years
history, 02 patients (13.33%) are having more than three year and less than four years
history, 03 patients (20%) are having more than four years and less than five years
history. Graph No.7 showing the distribution of patients by duration of disease
05
101520253035
Group A
Group B
Tota
l
%
Less than 1 yr>1-<2>2-<3>3-<4>4-<5
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Observation and Results
Table No. 24 showing the distribution of patients by treatment history
Group A Group B Treatment history No % No %
Total
%
Allopathic 11 73.33 14 93.33 25 83.33 Al & Ay 04 26.66 01 6.66 05 16.66
In Group A – Out of 15 patients, 11 patients (i.e.73.33%) were taken
Allopathic treatment and 4 patients (i.e.26.66%) were taken mixed treatment of both
Allopathic and Ayurvedic.
In Group B – Out of 15 patients, 14 patients (i.e.93.33%) were taken
Allopathic treatment and 01 patients (i.e.6.66%) were taken mixed treatment of both
Allopathic and Ayurvedic.
In this study 25 patients (83.33%) have taken Allopathic medicine, where as
05 patients (16.66%) have received Ayurvedic medicine before this clinical trial.
Graph No. 8 showing the distribution of patients by treatment history
0
20
40
60
80
100
GroupA
GroupB
Total
%
AllopathicAl & Ay
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Observation and Results
Table No. 25 showing distribution of patients by nature of Koshta.
Group A Group B Nature of Koshta No % No %
Total
%
Mridu 06 40 06 40 12 40 Madhyama 03 20 04 26.66 07 23.33 Krura 03 20 03 20 06 20 Sama 03 20 02 13.33 05 16.66
In Group A – Out of 15 patients, 6 patients (i.e.40%) were having Mridu
koshta and 3 patients each (i.e.20%) were reported with Madhyama, Krura and Sama
koshta.
In Group B – Out of 15 patients, 6 patients (i.e.40%) were having Mridu
koshta, 4 patients (i.e.26.66%) has Madhyama koshta, 3 patients (i.e.20%) were of
Krura koshta and 2 patients (i.e.13.33%) has Sama koshta.
Graph No. 9 showing distribution of patients by nature of Koshta.
05
1015202530354045
GroupA
GroupB
Total
%
MriduMadhyamaKruraSama
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Observation and Results
Table No. 26 showing distribution of patients by Jatharagni. (Status of
Jatharagni).
Group A Group B Status of Jatharagni No % No %
Total
%
Manda 06 40 07 46.66 13 43.33 Vishama 03 20 02 13.33 05 16.66 Teekshna 00 00 01 6.66 01 3.33 Samagni 06 40 05 33.33 11 36.66
In Group A – Out of 15 patients, 6 patients each (i.e.40%) were having manda
and Samagni, 3 patients (i.e.20%) were having mandagni and no patient was reported
with teekshnagni.
In Group B – Out of 15 patients, 7 patients (i.e.46.66%) were having
Mandagni, 5 patients (i.e.33.33%) were having Samagni, 2 patients (i.e.13.33%) were
reported with Vishamagni and only 1 patient was with Teekshnagni status.
Graph No. 10 showing distribution of patients by Jatharagni. (Status of
Jatharagni).
0
10
20
30
40
50
GroupA
GroupB
Total %
MandaVishamaTeekshnaSamagni
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Observation and Results
Table No. 27 showing distribution of patients by nature of Mala pravritti.
Group A Group B Mala pravritti No % No %
Total
%
Regular 01 6.66 04 26.66 05 16.66 Irregular 01 6.66 00 00 01 3.33 Constipation 07 46.66 04 26.66 11 36.66 Frequently 06 40 07 46.66 13 43.33
In Group A – Out of 15 patients, 7 patients (i.e.46.66%) were constipated, 6
patients (i.e.40%) were having frequent mala pravritti and only 1 patients (i.e.6.66%)
was having irregular bowel habit.
In Group B – Out of 15 patients, 7 patients (i.e.46.66%) has frequent mala
pravritti, 4 patients (i.e.26.66%) were constipated and no patient was reported with
irregular type of bowel habit.
Graph No. 11 showing distribution of patients by nature of Mala pravritti
0
10
20
30
40
50
Group A
Group B
Tota
l
%
RegularIrregularConstipationFrequently
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116
Observation and Results
Table No. 28 showing distribution of patients by type of Desha. (Nature of
Habitat).
Group A Group B Type of
Desha No. of Pt.’s % No. of Pt.’s %
Anupa 0 0 0 0
Sadharana 0 0 0 0
Jhangala 15 100 15 100
The place where this study was conducted is in Jangala pradesh. So all the patients
are in Jangala desha habitat.
Graph No. 12 showing distribution of patients by type of Desha. (Nature of
Habitat).
020406080
100120
No. ofPt.’s
% No. ofPt.’s
%
Group A Group B
AnupaSadharanaJhangala
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Observation and Results
Table No. 29 showing distribution of patients by Vyasana. (Addiction).
Group A Group B Vyasana No % No %
Total
%
Tobacco 06 40 04 26.66 10 33.33 Smoking 02 13.33 02 13.33 04 13.33 No habits 07 46.66 09 60 16 53.33
In Group A – Out of 15 patients, 6 patients (i.e.40%) were habituated to tobacco chewing, 7
patients (i.e.46.66%) are no habits and 2 patients (i.e.13.33%) are smokers.
In Group B – Out of 15 patients, 02 patients (i.e.13.33%) are smokers, 4 patients h
(i.e.26.66%) were habituated to tobacco chewing and patients are out of all habits
Graph No. 13 showing distribution of patients by Vyasana. (Addiction).
010203040506070
GroupA
GroupB
Total %
TobaccoSmokingNo habits
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Observation and Results
Table No. 30 showing the distribution of patients by Nidra in both Groups.
Nidra
Group A % Group
% Total %
Sukha 0 0 0 0 0 0
Alpa 10 66.6 11 73.33 21 70
Ati 0 0 0 0 0 0
Vishama 5 33.3 4 26.6 9 30
Among the 15 patients in Group A, 10 patients had alpa nidra (66.6%) and 5
patients had Vishama nidra (33.3%). Among the 15 patients in Group B, 11 patients
had Alpa nidra (73.33%) and 4 patients had Vishama nidra (26.6%). In the study as a
whole (30 patients), 21 patients had Alpa nidra (70%) and 9 patients had Vishana
nidra (30%). No patient reported with Sukha and Ati nidra in this study.
Graph No. 14 showing the distribution of patients by Nidra in both Groups.
01020304050607080
GroupA
% Group % Total %
SukhaAlpaAtiVishama
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Observation and Results
Table No.31 showing the distribution of patients by Deha prakriti in both
Groups.
Deha Prakriti Group A % Group B
% Total %
Vata 2 13.33 1 6.6 3 10
Pitta 0 0 0 0 0 0
Kapha 0 0 0 0 0 0
Vata-pitta 7 46.6 8 53.3 15 50
Vata-kapha 5 33.33 4 26.6 9 30
Pitta-kapha 1 6.66 2 13.3 3 10
Sannipataja 0 0 0 0 0 0
Group A- Out of 15 patients Vata prakriti persons are 2 (ie.13.33), Vatapitta
prakriti persons are 7 (ie.46.66), Vatakapha prakriti persons are 5 (ie.33.33),
Pittakapha prakriti persons are 1(ie.6.66) and in Pitta, Kapha and Sannipatja are
not found.
Group A- Out of 15 patients Vata prakriti persons are 1 (ie.6.66%), Vatapitta
prakriti persons are 8 (ie.53.33%), Vatakapha prakriti persons are 4 (ie.26.66),
Pittakapha prakriti persons are 2(ie.13.33) and in Pitta, Kapha and Sannipatja ware
not found.
Graph No.15 showing the distribution of patients by Deha prakriti in both
Groups.
0102030405060
Vata PittaKap
ha
Vata-pi
tta
Vata-ka
pha
Pitta-ka
pha
Sannip
ataja
Group A%Group B%Total%
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Observation and Results
Table No.32 showing the distribution of patients by Satmya.
Group A Group B Satmya No % No %
Total
%
Sarvarasa sneha
10 66.66 10 66.66 20 66.66
Sarvarasa ruksha
05 33.33 05 33.33 10 33.33
In Group A – Out of 15 patients, 10 patients (i.e.66.66%) are Satmya with
Sarvarasa sneha and 05 patients (i.e.33.33%) are Satmya with Sarvarasa ruksha.
In Group B – Out of 15 patients, 10 patients (i.e.66.66%) are Satmya with
Sarvarasa sneha and 05 patients (i.e.33.33%) are Satmya with Sarvarasa ruksha.
Graph No.16 showing the distribution of patients by Satmya.
010203040506070
Group A
Group B
Tota
l
%
Sarvarasa snehaSarvarasa ruksha
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Observation and Results
Table No.33 Showing the presence of RA factor in both group
Group A Group B RA factor No % No %
Total
%
Positive 05 33.33 05 33.33 10 33.33 Negative 10 66.66 10 66.66 20 66.66
In Group A – Out of 15 patients, 10 patients (i.e.66.66%) are having RA factor
Negative and 05 patients (i.e.33.33%) are having RA factor Positive.
In Group B – Out of 15 patients, 10 patients (i.e.66.66%) are having RA factor
Negative and 05 patients (i.e.33.33%) are having RA factor Positive
Graph No.17 Showing the presence of RA factor in both groups
010203040506070
GroupA
GroupB
Total %
PositiveNegative
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Observation and Results
Table No.34 Showing the presence of ASLO titer in both group
Group A Group B ASLO titer No % No %
Total
%
Positive 02 13.33 04 26.66 06 20 Negative 13 86.66 11 73.33 24 80
In Group A – Out of 15 patients, 13 patients (i.e.86.66%) are having ASLO
titer Negative and 02 patients (i.e.13.33%) are having ASLO titer Positive.
In Group B – Out of 15 patients, 11 patients (i.e.73.33%)are having ASLO
titer Negative and 04 patients (i.e.26.66%) are having ASLO titer Positive.
Graph No.18 Showing the presence of ASLO titer in both groups
0
20
40
60
80
100
GroupA
GroupB
Total %
PositiveNegative
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Observation and Results
Table No.35 Showing the presence of CRP titer in both group
Group A Group B CRP No % No %
Total
%
Positive 07 46.66 10 66.66 17 56.66 Negative 08 53.33 05 33.33 13 43.33
In Group A – Out of 15 patients, 08 patients (i.e.53.33%) are having CRP
Negative and 07 patients (i.e.46.66%) are having CRP Positive.
In Group B – Out of 15 patients, 05 patients (i.e.33.33%) are having CRP
Negative and 10 patients (i.e.66.66%) are having CRP Positive.
Graph No.19 Showing the presence of CRP titer in both groups
010203040506070
GroupA
GroupB
Total %
PositiveNegative
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Observation and Results
Table No.36 Showing the types of Amavata in both groups
Deha Prakriti Group A % Group B
% Total %
Vata 03 20 02 13.33 05 16.66
Pitta 01 6.66 02 13.33 03 10
Kapha 00 00 00 00 00 00
Vata-pitta 03 20 01 6.66 04 13.33
Vata-kapha 06 40 08 53.33 14 46.66
Pitta-kapha 01 6.66 01 6.66 02 6.66
Sannipataja 01 6.66 01 6.66 02 6.66
Group A- Out of 15 patients Vataja Amavata are 3 (ie.20%), Pittaja amavata are
01 (ie.6.66%), Vatakaphaja Amavata are 06 (ie.40%), Pittakaphaja Amavata are
1(ie.6.66), Vatapittaja Amavata are 03(20%), Sannipataja Amavata are 01(6.66%)
and we have not found Kaphaja type of Amavata.
Group B- - Out of 15 patients Vataja Amavata 02 (ie.13.33%), Pittaja amavata
are 02 (ie.13.33%), Vatakaphaja Amavata are 08 (ie.53.33%), Pittakaphaja
Amavata are 00(ie.00%), Vatapittaja Amavata are 01(6.66%), Sannipataja
Amavata are 01(6.66%) and we have not found Kaphaja type of Amavata.
Graph No.20 Showing the types of Amavata in both groups
0102030405060
Group A %
Group B %
Total %
VataPittaKaphaVata-pittaVata-kaphaPitta-kaphaSannipataja
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
125
Observation and Results
Table No. 37 Showing the distribution of patients by Mode of onset in both
Groups.
Mode of Onset Group A % Group B
% Total %
Chronic 11 73.33 12 80 23 76.66
Insidious 4 26.66 03 20 7 23.33
Acute 0 0 0 0 0 0
Traumatic 0 0 0 0 0 0
In the Group A, among 11 patients (73.33%) are haveing chronic onset, 4
patients (26.66%) of insidious onset.
In the Group B, 12 patients (80%) of having chronic onset 03 patients
(ie.20%) are having insidious.
Graph No. 21 Showing the distribution of patients by Mode of onset in both
Groups.
0102030405060708090
GroupA
% GroupB
% Total %
ChronicInsidiousAcuteTraumatic
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
126
Observation and Results
Table No 38 showing distribution of patients by Nidana
Nidana Group AGroup B
Total %
Prakriti virudha 07 08 15 50
Samaya virudha 08 07 15 50
Samyoga virudha 09 08 16 53.33
Virudha chesta 06 06 12 40
Avayama 04 06 10 33.33
Ativyayama 03 02 05 16.66
Vyaaftersnigdha bhojana 04 05 09 30
Gurubhojana
12 12 24 80
Mandagni 13 11 24 80
Out of thirty patients 15 patients(50%) are having Prakritivirudha nidana and
Samayavirudha nidana, 16 patients(53.33%) are having Samyoga virudha nidana, 12
patients(40%) are having Virudha chesta nidana, 10 patients(33.33%) are having
Avyayama nidana, 05 patients (16.66%) are having Ativyayama nidana, 09 patients
(30%) are having Vyayama after snigdha bhojajna and 24 patients (80%) are having
Gurubhojana and Mandagni.
Graph No 22 showing distribution of patients by Nidana
0
10
20
30
40
50
60
70
80
90
Group A Group B Total %
Prakriti virudha
Samaya virudha
Samyoga virudha
Virudha chesta
Avayama
Ativyayama
VyaaftersnigdhabhojanaGurubhojana
Mandagni
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
127
Observation and Results
Table No.39 showing the distribution of symptoms of Amavata in both Groups.
Symptoms Group A % Group B
% Total %
Sandhi sotha 15 100 15 100 30 100
Sandhi shoola 15 100 15 100 30 100
Sandhi stabdata 15 100 15 100 30 100
Sandhi ushnata 15 100 15 100 30 100
Jara 07 46.66 06 40 13 43.33
Angamarda 13 86.66 11 73.33 24 80
Aruchi 11 73.33 13 86.66 24 80
Apaka 08 53.33 09 60 17 56.66
Trishna 06 40 07 46.66 13 43.33
Alassya 13 86.66 10 66.66 23 76.66
Bahumootrata 05 33.33 04 26.66 09 30
Hrillasa 03 20 04 26.66 07 23.33
Gourava 12 80 13 86.66 25 83.33
Chardi 02 13.33 01 6.66 03 10
Bhrama 04 26.66 02 13.33 06 20
Nidraviparyaya 08 53.33 06 40 14 46.66
Kostabaddata 06 40 08 53.33 14 46.66
Out of 30 patients all 30 patients(100%) are having Sandhishotha,
Sandhishoola, Sandhistabdata, Sandhiushnata, 25 patients(83.33%) are having
Gourava, 24 patients(80%) ware having Angamarda and Aruchi, 23 patients(76.66%)
ware having Alassya, 17 patients(56.66%) are having Apaka laxshana, 14
patients(46.66%) are having Nidraviparyaya and Kosthabadhata, 13 patients(43.33%)
ware having Jvara and Trishna, 09 patients(30%) are having Bahumootrata, 07
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
128
Observation and Results
patients(23.33%) are having Hrillasa, 06 patients(20%) are having Bhrama, 03
patients(10%) are having Chardi Laxshana.
Graph No.23 showing the distribution of symptoms of Amavata in both Groups
0
20
40
60
80
100
Group A % Group B % Total %Sandhi so tha Sand hi shoo la Sand hi s tab data Sandhi ushnata JaraAng amard a Aruchi Apaka Trishna AlassyaBahumo otrata Hrillasa Gourava Chard i BhramaNid ravip aryaya Ko stab add ata
Table No. 40 Showing the over all effect of treatment in both Groups.
Result Group A % Group B
% Total %
Complete
remission
00 00 00 00 00 00
Major
improvement
01 6.66 06 40 07 23.33
Moderate
improvement
11 73.33 09 60 20 66.66
Mild
improvement
03 20 00 00 03 10
Over all effect of treatment in both group:
Comparison of the overall effects of the treatment in both the groups reveals
that Yogabasti is more efficacious. Major improvement of the illness was observed in
06(40% ) of the patients in Yogabasti group as against 01(6.66%) of the patients in
Nittyavirechana group. 09(60%) of the patients in Yogabasti group recorded moderate
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
129
Observation and Results
improvement, where as 11(73.33%) patients have show moderate improvement in
Nittyavirechana. 03(20%) of the patients showed minor improvement in
Nittyavirechana.
From the foregoing it is clear that both Yogabasti and Nittyavirechana are very
effective in the patients suffering from Amavata
Graph No. 24 Showing the over all effect of treatment in both Groups.
01020304050607080
Group A %
Group B %
Total %
CompleteremissionMajorimprovementModerateimprovementMild improvement
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
130
Data related to the response of treatment
Table No 41 showing Data related to the response of treatment in group A
Hasta Pada Gulpha Trika Janu Uru Sira Hb% ESR S OPD BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT
1 2322 3 2 2 1 3 1 2 1 3 2 1 1 0 0 11.5 11.6 50 30 2 2451 2 1 4 2 3 2 2 1 2 1 1 0 1 0 10.6 10.8 35 20 3 2515 4 2 2 0 2 1 2 1 3 1 1 0 1 0 9.00 9.33 39 15 4 2475 2 0 4 2 3 2 2 1 3 1 0 0 0 0 10.3 10.6 80 35 5 4595 3 1 2 0 3 1 2 1 3 1 2 1 1 0 9.00 9.00 43 20 6 65 2 0 3 1 4 2 1 0 4 2 1 0 0 0 8.5 8.8 28 16 7 987 4 1 2 1 3 1 1 0 4 2 2 1 1 1 9.4 9.5 74 31 8 1106 2 0 4 2 3 2 2 1 2 0 2 1 1 0 9.8 10.1 99 48 9 1233 4 2 3 1 2 1 2 1 2 0 1 1 0 0 8.3 8.7 92 70 10 1240 2 2 3 2 4 2 1 0 4 2 2 1 0 0 7.92 8.4 82 30 11 1567 4 3 2 1 3 1 2 1 2 1 1 0 1 0 11.3 11.8 26 10 12 1742 3 1 2 2 3 1 2 1 1 0 2 1 0 0 10.23 10.8 28 30 13 94 2 0 3 2 4 2 2 2 2 2 1 1 0 0 8.21 8.61 29 11 14 1112 4 1 2 1 3 2 2 0 3 1 2 0 1 1 8.71 8.92 44 15 15 700 2 1 4 1 4 2 2 1 4 2 1 1 0 0 9.8 10.61 53 20
131
Table No 42 showing Data related to the response of treatment in group B
Hasta Pada Gulpha Trika Janu Uru Sira Hb% ESR S OPD BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT BT AT
1 3703 3 1 2 1 3 1 1 0 2 1 1 0 0 0 9.6 9.8 70 30 2 2874 2 0 2 0 2 1 2 1 3 1 1 0 0 0 11.2 11.3 55 46 3 3081 4 1 2 1 2 1 2 0 2 1 0 0 1 0 9.3 9.5 32 20 4 2661 1 0 4 1 3 1 2 1 0 0 1 0 0 0 8.4 8.7 28 21 5 2694 3 1 0 0 2 0 1 1 1 0 1 0 1 1 10.7 10.9 39 28 6 2691 1 0 3 1 2 1 2 1 1 0 1 0 0 0 10.2 10.3 40 34 7 2556 1 0 2 0 1 1 1 0 2 0 1 0 1 0 10.7 11 78 30 8 2512 4 1 1 0 2 1 2 1 3 1 0 0 0 0 8.2 8.4 55 34 9 2492 2 0 1 0 2 1 2 1 1 0 1 0 1 0 8.7 8.9 28 19 10 2640 4 2 2 1 2 1 1 0 2 0 0 0 0 0 11 11.4 63 28 11 2633 1 0 4 2 3 1 2 1 2 1 1 0 0 0 10.1 10.3 74 23 12 2690 3 2 2 0 2 1 1 0 2 1 0 0 1 0 9.6 9.7 28 15 13 753 2 0 3 1 4 1 2 0 4 2 2 1 0 0 10.4 10.6 55 24 14 2213 2 1 3 1 3 1 1 0 2 1 0 0 1 0 11.4 11.7 67 30 15 4085 4 1 2 1 2 0 2 0 4 2 1 0 1 0 9.3 9.6 96 42
132
[2]Table No 43 showing statistical analysis of subjective and objective parameters in group A
Sno
Parameters
Mean
SD
SE
T value
P value
Remarks
1
Hasta
1.8
0.774
0.2
9.00
< 0.001
HS
2
Pada
1.533
0.743
0.191
8.026
< 0.001
HS
3
Gulpha
1.466
0.743
0.191
7.67
< 0.001
HS
4
Trika
1.133
0.516
0.133
8.518
< 0.001
HS
5
Janu
1.133
0.617
0.159
2.183
< 0.001
HS
6
Uru
0.666
0.487
0.125
5.328
< 0.001
HS
7
Siro
0.4
0.057
0.130
3.076
< 0.001
HS
8 Hb% 0.22
0.086
0.022
10.00
< 0.001
HS
9 ESR 25.8 17.78 4.59 5.620 < 0.001 HS
133
Table No 44 showing statistical analysis of subjective and objective parameters in group B (table3)
Sno
Parameters
Mean
SD
SE
T value
P value
Remarks
1
Hasta
1.733
0.798
0.206
8.412
< 0.001
HS
2
Pada
1.533
0.743
0.191
8.026
< 0.001
HS
3
Gulpha
1.6
0.506
0.131
12.213
< 0.001
HS
4
Trika
1.00
0.377
0.097
10.309
< 0.001
HS
5
Janu
1.666
0.487
0.125
13.328
< 0.001
HS
6
Uru
0.8
0.5606
0.144
5.55
< 0.001
HS
7
Siro
0.333
0.487
0.125
2.666
< 0.001
HS
8 Hb% 0.313
0.172 0.044
7.11
< 0.001
HS
9 ESR 27.466 14.38 3.714 7.39 < 0.001 HS
134
Table No 45 showing the comparative statistical analysis of subjective and objective parameters in both groups (table 1)
Parameters
Mean
SD
SE
PSE
T value
P value
Remarks
A 0.666 0.723 0.186 Hasta B 1.133 0.915 0.236
0.301 1.551 > 0.05 NS
A 0.6 0.632 0.163 Pada B 1.266 0.703 0.181
0.243 2.74 < 0.02 HS
A 0.866 0.351 0.090 Gulpha B 1.533 0.516 0.133
0.161 4.14 < 0.001 HS
A 0.466 0.516 0.133 Trika B 0.8 0.560 0.144
0.196 1.704 > 0.05 NS
A 0.733 0.703 0.181 Janu B 1.133 0.743 0.191
0.263 1.520 > 0.05 NS
A 0.0666 0.258 0.066 Uru B 0.4660 0.516 0.133
0.148 2.698 < 0.02 NS
A 0.0666 0.258 0.066 Siro B 0.133 0.351 0.090
0.112 0.598 > 0.05 NS
A 10.14 1.012 0.263 Hb% B 9.846 1.156 0.298
0.397 0.74 > 0.05 NS
A 28.066 8.647 2.232 ESR B 26.73 15.8 4.080
4.65 0.287 > 0.05 NS
135
Observation and Results
Statistical conclusion
To compare the mean effect of two groups we used unpaired t test by
assuming that the mean effect of two groups is same in all the parameters.
From the analysis the parameter Gulpha, Pada, Uru shows highly significant
than other parameters shows not significant after the treatment [from table No 43] ie p
< 0.05
The parameter Gulpha shows highly significant than other parameters, in
group B the mean effect is more with more variation after the treatment [ by
comparing t value, mean and S.D.]. The effect on Pada and Uru shows equal highly
significant [by comparing P value and t value]
The mean effect of Pada and Uru in group B is more with more variation after
the treatment. Both the objective parameters Hb% and ESR shows not significant as P
is greater than 0.05.
The mean effect of objective parameters Hb% and ESR is more in group A
with less variation after the treatment by comparing mean and standard deviation
Individually the group B shows more significant than group A in parameter
Gulpha, Trika, Janu, Uru & ESR. For this we used paired t test by assuming that the
drug is not responsible for change in the observations before & after the treatment.
In group A the parameter Hastha, Sira & Hb% shows more highly significant
than group B (by comparing p value & t value from table 44 & 45).
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
136
Discussion
Discussion
Amavata is chronic progressive systemic disorder that mainly targets to
locomotors system. It is named after two major involvements of two pathogenic
factors Ama and Vata, which mainly affects Sandhi. The classics had explained the
manifestation of disease and its treatment. Madhavakara was the first person who
explained this disease as a separate entity. Chakradatta and Vangasena have
contributed its treatment.
This disease occurs in all ethnic groups. Mainly it is more prevalence in urban
area. Sandhishoola, Sandhishotha, Sandhistabdata and Sandhiushnata are the cardinal
clinical features of this disease, apart from this it has many general symptoms like
Gourava, Aruchi, Jvara, Angamarda, Apaka etc are seen in this disease. Though ama
and vata are chief pathogenic factors, kapha and pitta are also invariably involved in
the pathogenisis of Amavata.
To the fact this disease is manifested due to unwholesome diet and regimen
and hypo function of Agnis also an important factor for the initiation of disease
process. The samprapti of this disease originated from Annavaha srotas and
madhyama roga marga with invalvment of sleshma sthana first it affects, later it
affects other sthanas like Sandhi, Asthi, Majja etc. Rasa, Asthi and Majja are
primarily involved dushyas, later it affects mamsa, snayu and khandara
The ayurvedic line of treatment explained by ancient acharyas mainly depends
up on the stages of disease. The treatment includes Langhana, Deepana, Amapachana,
Shodhana and Shamana associated with bahirparimarjana like valukasweda.
Deepana and Amapachana help to check the formation of ama and to start
samprapti vighatana. Then the vitiated doshas can be eliminated by virechana and
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
137
Discussion
basti. After that shamana treatment should be followed to alleviate the remaining
doshas. Valuka sweda can be utilized as a bahirparimarjana chikitsa.
Amavata v/s Rheumatoid arthritis
The disease Rheumatoid arthritis is identical with the signs and symptoms
of Amavata. It always challenge to the physicians due to its chronicity, complication
and morbidity, because of the lack of precise knowledge pertaining to its
etiopathogenesis. Various theories try to explain its etiopathogenesis like hereditary,
Neurogenic, vascular, infective, metabolic, endocrinal, autoimmune and psychogenic.
Though other theories are not yet discarded the autoimmune mechanism is most
commonly implicated.
This disease mainly affects the musculo skeletal system. It has also extra
articular manifestations affecting cardiovascular, nervous and excretory systems,
which is collectively known as connective tissue or collagen disorder. Recently some
of the authors emphasize the Arthritis of entropathy, which is similar with Amavata.
Ama originated in Amashaya and circulates through out the body with vitiated
vata dosha. The ama visha is further increased by interaction of dosha, dushya due to
localized concentration of Amavisha. The contribution of srotovaigunnya as well as
kleda is very much important in the pathogenesis of Amavata. Srotorodha in general
can be compared with rheumatoid vasculitis one of the serious extra articular
manifestation. These sequential steps in the samprapti of Amavata are quite identical
with the etiopathogenesis of Rheumatoid Arthritis. The altered activity of the immune
system, stimulated by exogenous or endogenous antigens probably viral or bacterial in
origin, causes formation of Rheumatoid factor and antibodies. The recent studies
showed that Rheumatoid Arthritis has not been link to any infection, despite of it
resembles to infectious Arthritis [Rheumatic fever].
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138
Discussion
Several components of the immune system appear to contribute to the
pathogenesis of Rheumatoid Arthritis. The integral role performed by vascular
endothelium, circulating memory T- cells, tissue macrophages, plasma cells,
Rheumatoid factor and cytokines are initiating and perpetuating Rheumatoid Arthritis
inflammation in the joints and throughout the body. The altered immune mechanism
in Rheumatoid Arthritis can be correlated with the role of Ama in Amavata. The
production of Srotoabhishyanda and kleda is nothing but the inflammatory changes in
Rheumatoid Arthritis. Once again the etiological factor is much similar with Amavata
and the site of the disease is much identical with sleshma sthana and connective
tissues.
As already told the despite years of intensive study the etiology of Rheumatoid
Arthritis is still not known the uncertainties in the etiopathogenesis of this disease
impeded the exploration of an effective treatment or its prevention. In spite of
available treatment, it cripples the ailing for the rest of his life; moreover it affects the
younger and middle-aged people, substantially hampering the economy of the nation.
Thus the disease has posed great challenge to the physicians who are engaged in
research work yet the goal of curing the disease remains long away off.
Line of treatment, which is explained in Ayurveda, can reduce pain, swelling,
protection of joints and control the disease progression. The early invention in
Ayurvedic field helped to prevent the development of disabilities and preferable
respond to this disease. Ayurvedic treatment can give the fitness to participate in the
routine activities of daily living and ambulation, with this aim the present study was
under taken to evaluate and compare the effect of Nittyavirechana and Yogabasti in
Amavata.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
139
Discussion
Study method:
In the present study, 33 patients of Amavata were registered, in which 30
patients completed the course of the treatment. The disease was diagnosed on the
basis of signs and symptoms as described in Ayurvedic and Modern texts, aided by
A.R.A. criteria (1988). RA factor test was done in all the patients. Routine Blood,
Urine, Stool examination along with S. uric acid were done to rule out other
pathological conditions.
The selected patients were randomly divided into following 2 groups.
Nittya virechana group: 15 patients were treated in this group with by giving 15-30
ml of Eranda taila for 8 days.
Yogabasti group: 15 patients were treated in this group with Yogabasti karma.
For the assessment of the results guideline laid down by classical text of
Ayurveda as well as parameters suggested by A.R.A. (1988) were followed. The
results obtained were statistically analyzed and percentage of relief, Mean, S.D., S.E.
t-value and P-value were calculated by using the paired t-test.
Materials and methods
Based on the principles of treatment following drugs were selected for the study.
1) Vaishwanara choorna for amapachana
2) Eranda taila for virechana
3) Brihat saindhavadi taila for anuvasana
4) Erandamooladi for niruha basti
Vaishwanara Churna
It is a good deepana and pachana drug indicated in amavata adhikara. It checks
the formation of ama by increasing the agni and digests the ama which is already
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
140
Discussion
formed. It helps to attain niramavastha, and prepare the body environment for further
shodhanadi treatment.
Eranda Taila for Nittyavirechana
Eranda taila is considered as the best medicine in the management of amavata,
which is used for Nittyavirechana. Because of its sukshma guna it reaches the minute
srotas as and it liquifies the stagnated doshas by its lekhana, usna, teekshna, properties
then it removes by its virechana action. It acts as vatanulomana, it pacifies vata by its
madhura vipaka, snigdha and ushna gunas. It removes the obstruction of vata
produced by ama and kapha and checks the further accumulation of vata in the body
by sroto vishodhana guna.
Probable Mode of Action of Nittyavirechana :
In the present study, Nittyavirechana was administered by Eranda taila. Eranda
taila is Vata-kaphashamaka having specific vyadhihara i.e. Amavatahara action. Ricin
present in it gets converted to Ricinoelic acid by lipase, which irritates bowel leading
to Virechana as it is having Ushna virya, it also does Pachana karma (Amapachana).
Action of Nittyavirechana on Amavata can be understood by the following properties
of it.
Nittyavirechana helps in eliminating the Ama which forms everyday due to
Mandagni in Amavata.
As told in Astanga sangraha when Prakupita doshas are their, it is better to
eliminate little by little in consecutive days.
Nittyavirechana acts as Rasayana, by this patients gets good Bala due this Roga
bala will come down
Virechana has direct effect on Agnisthana and hampered agni (Mandagni) is one
of the initiating factors in Amavata. It pacifies the vitiated Kapha and Vata dosha.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
141
Discussion
It has the property of Srotovishodhana, hence the Srotorodha (Srotoabhishyanda)
present in the disease Amavata mainly in Sandhisthana is cleared by
Nittyavirechana leading to relief of the symptoms.
Virechana is indicated in Sannipaitik condition of morbidity (B.S.) and hence
helpful in the disease Amavata.
Virechana works well by clearing the morbid doshas, which adhere to Bahya
(Rasa etc.) and Madhyama (Marma-Asthi-sandhi) Roga Marga with the tiyaka
gamana.
Nittyavirechana helps to normalize the pratiloma gati of vata, which produces
symptoms like Anaha, Antrakujana, Kuskshikathinya, Kukshishoola etc. in the
disease Amavata.
Acharya Charaka has given brief description of how Virechana dravyas acts in
the body:
The drug here Eranda taila having Ushna-tikshna-sukshma guna reach to the
heart by virtue of their potency and circulate through the large and small srotasa and
pervade the entire body. Then they liquefy the morbid elements by virtue of its
Agneya guna and disjoins them by its tikshna guna. Then this liquefied morbid mass
floating like honey in uncted vessels through the virtue of Anu pravanbhava of the
drug and ultimately reaches Amashaya. From here it forces the morbid factors
through the anal canal root due to the Bhautika predominancy of the Jala and Prithvi
and Adhobhagahara prabhava (Ch. K. 1/4) leading to Virechana.
Bruhat Saindhavadi Taila
Which is indicated in amavata and used for anuvasana basti as a poorvakarma
for niruhabasti so that it prepare the kosta by its snigdha gunas to receive Niruhabasti.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
142
Discussion
Taila mainly possess katu, tikta, lavana and madhura as rasas, laghu, teekshna ruksha,
snigdha, sukshma, guru and vyavayi as guna, ushna in veerya, katu in vipaka.
Most of the drugs show deepana, pachana, vatanulomana and shothahara
properties. All the drugs have vatahara and shushma guna and are especially
beneficial in amavata. This taila was prepared taking eranda taila as base.
Erandamooladi niruha Basti
The shodhana therapy is a must to treat the disease amavata successfully.
Among the shodhanas, basti is said to be ideal as it pacifies both ama and vata.
Astangasangrahakara Vagbhata has appreciated the role of Erandamooladi niruhabasti
in the treatment of Kaphavata disorders like amavata.
Probable Mode of Action of Yogabasti
The ingredients of Erandamooladi niruha basti mainly possess deepana,
pachana, ushna, sukshma, laghu, ruksha, snigdha, teekshna and lekhana gunas. These
gunas helps to alleviate ama and vata in the body.
In the disease process of amavata, we find the laxanas of avarana vata in the
joints, because of obstruction to flow of vata by ama. The main seat of vata is
pakwashaya, hence the eliminative therapy is directed to pakwashaya. After the
administration of basti, the basti dravya is retained only for a limited period in
pakwashaya. Even then it can be assumed from the effect produced that, the
essentials are absorbed into the system.
The drugs analysis of Erandamooladi niruha basti shows that many
drugs of them have deepana and pachana guna, which directly influences the kostagni
and thereby dhatagni which in turn leads to pachana of already existing ama and
checks the further production of ama.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
143
Discussion
It reaches the various parts of the body like sandhis and minute channels like
by its sukshma guna and liquifies the doshas which was present in various forms.
Liqification of them is caused by ushna, teekshna lekhana gunas which in turn
decreases the sroto abhishyandana, meanwhile usna and snigdhata guna of the content
pacifies the vata. Gomutra, which is the chief content, is helpful to reduce the shotha
and ruja as it is mainly indicated in ama.
Erandamooladi niruha basti action is seen up to minute channels, where it does
the lekhana of collected ama and kapha resulting in their liquefaction, which
decreases the abhishyandi, picchila, guru etc. gunas of ama. At the same time it does
the srotovishodhana there by decreasing the srotobhishyandana which inturn leads to
vatanulomana because of removal of obstruction and finally expels ama and kapha
vata out of the body.
Brihat saindhavadi taila given along with it does the above said functions as it
contains drugs having similar properties and pallets vata by snehana guna. The
combined action of these two drugs helps in samprapti vighatana.
As all the drugs of Erandamooladi niruha basti have sufficient qualities
through which they can combat the ama, vata and kapha, it seems logical to say that a
combination of these drugs can be a potent procedure to treat amavata.
But the question is how these drugs are absorbed into the system. None of the
research wear conducted conclusively to solve this question. But here the difficulty
arises in understanding the mode of their absorption and efficacy when administered
in the form of basti but in one interesting quotation Parashara says;
mulam gudam shareerasya sirasthatra prathi stithaha
sarvam shareeram pusnanthi murdhanam yavadashritaha (Ch.Si.4)
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
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Discussion
This reference says the importance of guda and how it nourishes the other
parts of the body through its siras.
The rectum has a rich blood and lymph supply and drugs can cross the rectal
mucosa like the other lipid membranes, thus, unionized and lipid soluble substances
are readily absorbed from the rectum the portion absorbed from the upper rectal
mucosa is carried by the superior haemorrhoidal vein into the portal circulation,
where as that absorbed from the lower rectum enters directly into the systemic
circulation via the middle and inferior hemorrhoidal vein.
Even though it is difficult to draw a conclusion regarding the mode of action
of basti, according to the modern pharmacokinetics, the classical literature of
ayurveda provides certain concepts, which facilitates one to understand the mode of
action based on ayurveda principles.
The significant improvement in Shoola, Shotha, Stabdata and Ushnata
changes in the basti group when compared to the Nittyavirechana group justifies that
basti is a more efficient treatment for amavta. Basti has got both doshapratyanika and
vyadhi pratyanika effect on the disease Amavata.
Discussion along with the argument of results obtained is as follows:
General Description of Patients: General description of the patients studied in the
present series was as follows:
Age: All the 33 patients registered for the present study were ranging from 20 to 60
years, of which maximum patients (33.33%) were between 31 to 40 years age group,
which was followed by 26.66% patients in the age group of 20 to 30 years.
Observations of this study were in accordance with the findings of Rheumatoid
Arthritis in middle age (Price and Davidson).
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Discussion
Sex: In this study majority of the patients were female (73.33%) as compared to
male patients (26.66%). Textual references also reflects the predominance of
Rheumatoid Arthritis in females
Religion: Majority of the patients in this series were Hindus (90%), which may be
due to predominance of Hindu community in this particular region.
Occupation: Most of the women registered were housewives i.e. 66.66%, which
reflects the general occupation of majority of the females in this area.
Economical Status: Majority of the patients i.e. 53.33% in this series were belonging
to poor economic status, while rest of the patients(43.33%) were belonging to middle
class and upper middle class (3.33%) economic status. It may be due to the fact that,
this study was conducted in a general hospital, where free treatment facilities are
available. Another possibility was that middle and lower class people are more prone
to stress and strain, which may precipitate the disease Amavata.
Habitat: Majority of the patients (65.78%) in the present study was from urban area.
This may be due to geographical location of the hospital in the urban area.
Family History: 86.84% of the patients of this study reported negative family history
of joint disorders whereas 13.15% patients reported positive family history. But to
give any conclusion regarding the relation of family history with the incidence of
disease Amavata, a large-scale survey of the patients is required.
Education: In the present study maximum no. of patients (73.69%)were educated
from primary to graduate level, while remaining were uneducated (26.31%). It may be
due to urban habitat of the patients.
Addiction: Majority of the patients (53.33%), in the present study did not have any
addiction, tobacco chewing was 33.33% and smoking was 13.33%. All these
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
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Discussion
addictions come under Ahitashana and Vishamashana, which lead to Mandagni and
formation of Ama. So, addiction may also play role in the aggravation of the disease
Amavata.
Diet: 73.33% patients in the present study were Vegetarian. This data is only
reflection of predominant diet in this region.
Deha Prakriti: In this study, it was found that maximum number of patients i.e. 50%
were possessing Vatapitta Prakriti (Table no. 12) followed by 30% Vatakapha
prakriti. In general Kapha Prakriti will have Mandagni leading to Ama formation,
which when provoked by Vata and gets settled in respective Sleshma sthana. So, it is
justifiable that Kapha vata prakriti persons are easily prone to Amavata.
Sara & Samhanana: Distribution of patients based on Sara & Samhanana indicates
that maximum no. of patients were of Avara Sara (52.63%) and Madhyama
Samhanana (71.05%).
Satva: Majority of the patients in the present study were possessing Madhyama Satva
(65.78%) and Avara Satva (26.31%), while only 7.89% were of Pravara Satva.
In the Avara and Madhyama Satva persons, stress and strain of daily life may
precipitate or aggravate the disease Amavata.
Satmya: Majority of the patients (63.15%) were of Madhyama Satmya followed by
Pravara Satmya (23.68%) and Avara Satmya (6.88%).
Koshtha: In the present study majority of the patients i.e. 40% had mrudu Koshtha,
which was followed by Madhyama Koshtha in 23.33% of the patients it is followed
by Krura kosta in 20%. In general Vata and Kapha Prakriti persons, have Krura and
Madhyama Koshtha. It justifies the finding of Prakriti, as Prakriti wise distribution of
this study reveals that maximum no. of patients possess Kapha Vata Prakriti.
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Discussion
Desha: All the the patients i.e. 100% were from Gadag area i.e. Jangala desha due to
the location of the city in Jangala desha.
Chronicity: In the present study, 90% of the patients gave history of chronicity of
more than one year. It may be due to the fact that Amavata is a chronic disease.
Deha Bala: In the present study, majority of the patients (52.63%) were having Avara
Deha Bala, while remaining (47.36%) were having Madhyama Deha Bala. None of
the patient in the present study was having Pravara Deha Bala. It may be due to the
chronic course of the disease, due to which Deha Bala of the patients gradually
declines
Rheumatoid Factor: 33.33% patients, in this study were seropositive . This
observation corroborates very well with textual reference (Davidson – 1994).
Nidana: Majority of the patients in the present study gave the history of 80% of each
Guru and Mandagni and Samyoga virudhasevana (53.33%) Ahara Sevana, and
Prakrivirudha, Samayavirudha ware found of 50%. All these factors leads to
Mandagni and consequently to the formation of Ama. So it can be concluded that all
the above-mentioned factors play an important role in precipitation and aggravation of
the disease Amavata.
Cardinal Features: Regarding the cardinal features of Amavata, all the patients had
Sandhishoola (100%), Sandhishotha [100%), Sandhigraha in 100% and Sandhi
ushnata also in 100%.
General Features: Among the various general features of Amavata, Angamarda and
Aruchi ware found in 80% of patients and other symptoms observed were Gaurava
83.33%, Jwara and Trishna43.33%, Alasya 76.66%, Apaka 56.66%, Nidraviparyaya
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
148
Discussion
and Kostabadhata in 46.66%, Bahumootrata in 30%, Bhrama in 20% and Chardi in
10%.
Dosha: Maximum number of patients had involvement of Kapha vatavriddhi prakopa
[ie46.66%] followed by Vata vriddhi and prakopa in Amavata [ie 16.66]
Srotasa: Maximum number of patients had the dushti of Asthivaha, Rasavaha,
Majjavaha, Purishavaha, Raktavaha and Annavaha srotasa, which is in accordance
with the main srotasa involved in the disease process
Involvement of Joints: Majority of the patients presented with classical involvement
of Hastasandhi, Padasandhi, Gulphasandhi and Janusandhi.
Rheumatoid Nodules & Deformity: In this study, 2.63% of the patients had
Rheumatoid Nodules and 9 patients had various types of deformity of the joints. It
may be due to chronic nature of the disease.
Effect of the treatment
In this study the effect of treatment was assessed on the basis of changes
observed in different sandhi after the treatment in Sandhisoola, Sandhishotha,
Sandhistabdata and Sandiushnata. The results are discussed parameter wise as here
under:
Effect on Hasta
79.44% relief was observed in Hasta among the patients of Yogabasti group
(group B), 62.78% relief was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Hasta had better relief in Yogabasti group.
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Discussion
Effect on Pada
76.78% relief was observed in Pada among the patients of Yogabasti group
(group B), 54.99% relief was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Pada had better relief in Yogabasti group.
Effect on Gulpha
59.44% relief was observed in Gulpha among the patients of Yogabasti group
(group B), 51.11% relief was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Gulpha had better relief in Yogabasti group.
Effect on Trika
73.33% relief was observed in Trika among the patients of Yogabasti group
(group B), 60% relief was found among the patients of Nittyavirechana group (group
A).
The improvement was statistically highly significant in both the groups and
comparatively Trika had better relief in Yogabasti group.
Effect on Janu
70.24% relief was observed in Janu among the patients of Yogabasti group
(group B), 63.33% relief was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Janu had better relief in Yogabasti group.
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Discussion
Effect on Uru
95% relief was observed in Uru among the patients of Yogabasti group (group
B), 60.72% relief was found among the patients of Nittyavirechana group (group A).
The improvement was statistically highly significant in both the groups and
comparatively Uru had better relief in Yogabasti group.
Effect on Siro
85.72% relief was observed in Siro among the patients of Yogabasti group
(group B), 85.72% relief was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Gulpha had same relief in both groups.
Effect on Hb%
2.21% increment was observed in Hb% among the patients of Yogabasti group
(group B), 3.38% increment was found among the patients of Nittyavirechana group
(group A).
The improvement was statistically highly significant in both the groups and
comparatively Hb% had better improvement in Nittyavirechana group.
Effect on ESR
43.59% reduction was observed in ESR among the patients of Yogabasti
group (group B), 51.58% reduction was found among the patients of Nittyavirechana
group (group A).
The improvement was statistically highly significant in both the groups and
comparatively ESR had better improvement in Nittyavirechana group.
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151
Discussion
Effect on Ama:
Comparison of effects on symptoms of Ama in two groups reveals that, better
improvement was found in patients treated with Yogabasti. The variance of symptom
score before and after the treatment in Yogabasti group was 10.8 and the same in
Nittyavirechana group was 8.9 confirming the better efficacy of the Yogabasti in
relieving the symptoms of Ama. The change observed between the groups was also
statistically significant according to unpaired ‘t’ test.
Effect on clinical parameters
Effect on the range of joint movement:
In an average the range of joint movement was increased by 17.58 degrees in
Yogabasti group as against the increase by 15.29 degrees in Nittyavirechana group.
This implies a better improvement in the range of joint movements in patients treated
with Yogabasti though the statistical analysis by adapting the unpaired ‘t’ test does
not justify the significance of variation between the groups.
Effect on foot pressure:
Comparison of effects of treatments on foot pressure indicates that Yogabasti
group has an edge over the Nittyavirechana in improving the foot pressure after the
treatment. The difference in the mean foot pressure in the Yogabasti group was 9.54
kgs as against 8.25 kgs in Nittyavirechana group. Statistical analysis by unpaired ‘t’
test could not rule out the possibility of chance factor in causing such a variance
between the groups.
Effect on hand grip power:
Yogabasti was found to be more efficacious in improving the hand grip power
in comparison to the Nittyavirechana. After the treatment in Nittyavirechana group
the increase in the mean handgrip power was 24.95 mm of Hg as against 27.25 mm of
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
152
Discussion
Hg in Yogabasti group. Of course this variation between the groups was statistically
insignificant (P=0.744).
Effect on general functional capacity:
The analysis of the functional disability in both the groups showed that
functional capacity of the patients has increased following the treatment. The
functional disability score reduced to the tune of 0.9 in both the groups, recording no
difference in the efficacy of two treatments when compared.
Over all effect of treatment in both group:
Comparison of the overall effects of the treatment in both the groups reveals
that Yogabasti is more efficacious. Major improvement of the illness was observed in
06(40%) of the patients in Yogabasti group as against 01(6.66%) of the patients in
Nittyavirechana group. 09(60%) of the patients in Yogabasti group recorded moderate
improvement, where as 11(73.33%) patients have show moderate improvement in
Nittyavirechana. 03(20%) of the patients showed minor improvement in
Nittyavirechana.
From the foregoing it is clear that both Yogabasti and Nittyavirechana are very
effective in the patients suffering from Amavata.
Results
The results of the study confirmed that both Nittyavirechana and Yogabasti
have their own role in the management of amavata as the patients belonging to both
groups showed remarkable reduction in the symptoms.
After the treatment when overall assessment was done to assess improvement
between the groups. The Yogabasti group shown 40% Major improvement, where as
Nittyavirechana group shown 6.66% Major improvement, here Major remission has
been considered looking into symptomatic relief of the patient. As the disease is
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
153
Discussion
yapya or have autoimmune origin, the complete relief from the disease process cannot
be expected. Moderate improvement was observed in 60% of cases in Yogabasti
where as in Nittyavirechana group showed moderate improvement in 73.33%, minor
improvement was seen in 20% of cases of Nittyavirechana group and which is no
found in Yogabasti group. This signifies that Yogabasti possibly had a greater role in
the management of amavata.
At the end of Deepanapachana with vaishwanara churna treatment there was
significant change in that reduction of Ama laxshana was observed in both the groups.
this signifies there is some role of vaishwanara churna to bring down Amavasta in
amavata. But there is no significant difference between the two groups.
From this analysis, it becomes evident that effect of Yogabasti was more
beneficial in Shoola, Shotha, Stabdata and Usnata of different Sandhis, when
compared to that of Nittyavirechana group. But as the disease is yapya or
autoimmune nature the completely permanent remission cannot be expected.
Considering the different incidence and there by generalizing the observations
and results in a population in an incidental study will be inappropriate. More over the
sample size is minimum, ie. 30 patients maintaining the accurate homologocity
between the 2 groups was practically impossible due to difference in various factors
like mode of manifestation of symptoms, chronicity. Influence of dietric factors etc.
from patient to patient. Hence allotment of the patients to different groups could not
and cannot be equal whatever be the care taken to maintain the homologicity.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
154
Conclusion
Conclusion
� Disease amavata can be correlated to rheumatoid arthritis, which is one among
the chronic destructive polyarthritis systemic disease.
� The exact etiology of the disease remains unknown, but the pathognomic
nidana like ama is believed to be acts as autoantigen, which triggers the
immunological reaction in genetically susceptible individuals.
� The disease amavata is diagnosed on symptomatology specific laboratory tests
like RF help in diagnostic and ESR help in assessment of treatment given, the
criteria laid down by American Rheumatism Association 1988 which
comprises 7 criteria which helps in the diagnosis of RA.
� Some of the pravruddha amavata laxana and upadravas can be considered as
the extra-articular manifestations of amavata (RA).
� As the disease is genetic and autoimmune in origin the permanent complete
remission is not possible.
� The specific ayurvedic line of management and drugs helps in decreasing the
autoantigens and may acts as modifying the immune response to autoantigens.
At the same time the drugs are safe can be given for longer duration without
any adverse effects.
� Both virechana and basti group have their specific role in the management of
amavata but the clinical study revealed that Yogabasti has a significant role as
higher percentage of reduction in symptoms.
� The active principles of Yogabasti are antagonistic to ama and may acts as
antiinflammatory.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
155
Conclusion
Suggestions for Further study.
1. Study on large samples.
2. Study on Nityavirechana followed by basti.
3. Study on langhana, deepana, virechana followed by basti.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
156
Summary
Summary
Keeping in mind to evaluate the role of shodhana basti over the virechana in
the treatment of amavata, the study was formulated to evaluate the effect of Yogabasti
over virechana by eranda taila.
The dissertation was made into two parts; the first part contains the
introduction, need for study, historical revive and revive of literature of Virechana,
Basti, Amavata and Drugs. Definition, etymology, history, nidana panchaka,
classification, upadrava, sadhyasadhyata and treatment of amavata according to the
classics and the etiology. pathogenesis, clinical features, diagnostic, differential
diagnosis prognosis, complications and treatment of rheumatoid arthritis. In the
second part the materials and method, observation, results and discussion was made.
In this comparative study 30 patients were incidentally selected and grouped
into A as Nittyavirechana group and B as Yogabasti group. Nittyavirechana group
was treated with vaishwahara churna as deepana pachana and Eranda taila
Nittyavirechana for 8 days. But group B received a course of Yogabasti with
Erandamooladi niruha and Bruhatsandhavadi anuvasana. The duration of the
treatment for both the groups was 24 days. The criteria laid down by ARA (in 1987
& 1967) were applied for the diagnosis and assessment of the treatment.
The observation of the study included the epidemiological features of the
disease. Doshic involvement, the prakruti, agni, kosta and such other factors from the
ayurvedic perspectives.
It was observed that amavata vis-a-vis RA usually appears in between second
and fifth decades of life. The people belong to urban area, females, poor class,
having more susceptible for the disease. The disease is more prevalent in people of
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
157
Summary
vatapitta and vatakapha prakruti, mandagni, madhyama kosta persons and the
involvement of vata and kapha appear as a prominent feature.
The mean scores of Shoola, Shotha, Stabdata and Ushnata about the joints
before and after the treatment of both the groups were subjected for students‘t’ test
with paired and unpaired methods.
A significant response was obtained in both groups with the percentage
reduction in symptoms. After the treatment, when overall assessment was done to
assess improvement between the groups. The Yogabasti group shown 40% major
improvement where Nittyavirechana group shown only 6.66% major improvement.
Moderate improvement was observed in 90% of cases in Yogabasti where as 73.33%
moderate improvement and 20% minor improvement was seen in Nittyavirechana
group. Change in Hb% and ESR value also observed between two groups, but it
shows the beneficial effect of Nittyavirechana over Yogabasti group.
At the end of treatment there was significant change in shoola, shotha,
stabdata and ushnata in Yogabasti group compared to Nittyavirechana group showing
the P value < 0.001. This signifies that Yogabasti possibly had a greater role in the
management of amavata.
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158
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48) I bid
49) I bid
50) I bid
51) I bid
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185) Agnivesa, Charakasamhitha Siddisthana chapter 8.Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.1043.
186) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 35. sloka 6. Varanasi: Krishnadas Academy; 1980. P.525.
187) Sushrutha, Sushruthasamhitha.nidanasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.526.
188) Sushrutha, Sushruthasamhitha.nidanasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.526.
189) Ashtangasangraha Suthrasthana chapter 28, sloka 18. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.491.
190) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 35. sloka 18. Varanasi: Krishnadas Academy; 1980. p.460.
191) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 2 - 4th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460.
192) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 2 - 5th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.
193) Rajaradha Kantadeva Bahudarena, Shabdha kalpadruma, 3 rd edn. Varanasi : Choukambha Sanskrit Series office ; 1967. p 183.
194) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 6th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
167
Bibbilography
195) Rajaradha Kantadeva Bahudarena, Shabdha kalpadruma, 3 rd edn. Varanasi : Choukambha Sanskrit Series office ; 1967. p 183.
196) Amarasimha, Amarakosha Manushyavarga Pundit Vishwanath Jha, editor. Delhi: Motilal Banarasi Das; 1976.
197) Ashtangasangraha Suthrasthana chapter 21, sloka 36. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.
198) Vagbhata, Ashtangahridaya Suthrasthana chapter 13, sloka 25. Varanasi: Krishnadas Academy; 1982.p.187.
199) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 1 - 5th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460,461.
200) Vagbhata, Ashtangahridaya Suthrasthana chapter 13, sloka 23-24. Varanasi: Krishnadas Academy; 1982.p.187.
201) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 21, sloka 5, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p102.
202) Agnivesa, Charakasamhitha Sutrasthana chapter 12. sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.172.
203) Ashtangasangraha Suthrasthana chapter 1, sloka 26. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-7.
204) Ashtangasangraha Suthrasthana chapter 19, sloka 1. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-.
205) Agnivesa, Charakasamhitha Sutrasthana chapter 12. sloka 4. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.172.
206) Sharangadhara, Sarngadharasamhitha Utharakhanda chapter 5, sloka. 3rd ed. Varanasi: Chaukhambha Orientalia; 1983.
207) Agnivesa, Charakasamhitha chikitsasthana chapter 28, sloka 4. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.775.
208) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 1st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 460.
209) Haritha Samhita Varanasi: Krishnadas Academy; 1980, p- 201. 210) Anjana nidana, Agnivesha edited by Ramchandra Shastri
Kinjavadekara, Chitrashala Mudranalaya, Pune (1940). 211) Ashtangasangraha Suthrasthana chapter 9, sloka 7.
Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.200.
212) Agnivesa, Charakasamhitha Sutrasthana chapter 26. sloka 86-87. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.362.
213) Ashtangasangraha Suthrasthana chapter 9, sloka 9. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996.p.201.
214) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 10st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 462.
215) Agnivesa, Charakasamhitha chikitsasthana chapter 28, sloka 19. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.780.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
168
Bibbilography
216) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 7th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.
217) I bid sloka 6-10.p.462. 218) I bid sloka 7-10.p.461, 462. 219) Agnivesa, Charakasamhitha chikitsasthana chapter 20, sloka 20. 4th
ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994.p.581. 220) Sushrutha, Sushruthasamhitha.uttarasthana chapter 46. sloka 6.
Varanasi: Krishnadas Academy; 1980. p.739. 221) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 15,
sloka 4, edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.67.
222) Agnivesa, Charakasamhitha Sutrasthana chapter 28. sloka 9. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.429.
223) Agnivesa, Charakasamhitha Sutrasthana chapter 18. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.249.
224) Sushrutha, Sushruthasamhitha sutrasthana, “Dalhana” comentry, chapter 15, sloka 24, fourth edition ; edited by vaidya jaadavaji trikamji acharya,Varanasi: Chaukhambha Sanskrit Sansthan; 1980.p.72.
225) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 10st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 461.
226) I bid sloka 6-10.p.461,462. 227) Bhavamishra,Bhavaprakasha Nighantu. Chapter 26, sloka 282-290
Edited by G.S. Pande. , 6th edn. Varanasi : Choukambha Bharati Academy ; 1982.
228) Bhaishajyaratnavali, chapter 29, sloka 20-25.Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.
229) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998.P 564-566.
230) Gadanigaha: chapter 22, sloka 6-12 Sodhal with Vidyotini Hindi commentary by I.D. Tripathi, editor Ganga Sahaya Pandey, ed. 3, Chaukhambha Sanskrit Bhavan (1999), p-544.
231) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 11th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 463.
232) I bid sloka 12.p.464. 233) I bid sloka 6.p.462. 234) I bid sloka 7-10.p.463. 235) Haritha Samhita Varanasi: Krishnadas Academy; 1980. 236) Sri Madhvakara, Madhavanidanam, edited by Yadunandana
Upadhyaya, chapter 25, 10st sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 462.
237) Vagbhata, Ashtangahridaya nidanasthana chapter 1, sloka 6-7. Varanasi: Krishnadas Academy; 1982.p.463.
238) Sri Madhvakara, Madhavanidanam, edited by Yadunandana Upadhyaya, chapter 25, 12th sloka. Chaukhamba Sanskrit Sansthan; 1985 page no. 464.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
169
Bibbilography
239) Chakradatta, chapter 25, sloka 19-20. Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi : Choukambha Sanskrit Office; 1983, p-229.
240) Bhavamishra, Bhavaprakasha, Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ;
241) Bhaishajyaratnavali, Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.
242) Agnivesa, Charakasamhitha Sutrasthana chapter 22. . 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.288.
243) I bid 244) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 32. sloka 21.
Varanasi: Krishnadas Academy; 1980. p.514. 245) Sharangadhara, Sarngadharasamhitha poorvakhanda chapter 4, sloka
1.Varanasi: Chaukhambha Orientalia; 1983.p.17. 246) I bid 247) Ashtangasangraha Suthrasthana chapter 27, sloka 30.
Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-476.
248) Bhavamishra, Bhavaprakasha, chapter 25. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan ;
249) Bhaishajyaratnavali, Amavatadhikara. Edited by Ambikadatta Shastry, 15th edn. Varanasi : Choukambha Sanskritha Sansthana ; 2002, p-435.
250) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1225.
251) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 7-8.
252) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai : Association of Physicians of India ; 1999. p 1028.
253) Arthritis and Ayurveda by Dr. K. Nishteshwara. P 3. 254) Robins pathologic basis of disease by Cotron et al, published by
Harwart pvt limited. Lajpat nagar, N. Delhi. P 140-142. 255) Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of
International Medicine, 14th edn. New York. : Mc Graw Hill Companies 1998. p 1933.
256) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1225-1230.
257) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 27-38.
258) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India; 1999. p 1028.
259) Robins pathologic basis of disease by Cotron et al, published by Harwart pvt limited. Lajpat nagar, N. Delhi. P 1405.
260) Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of International Medicine, 14th edn. New York. : Mc Graw Hill Companies 1998. p 1929-30.
261) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 90-91.
262) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1230-1231.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
170
Bibbilography
263) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 1230-1232.
264) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 98-106 & 114.
265) API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai : Association of Physicians of India ; 1999. p 1028.
266) Robins pathologic basis of disease by Cotron et al, published by Harwart pvt limited. Lajpat nagar, N. Delhi. P 140-142.
267) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 114-115.
268) Challenge in RA by Haward A. Bird et al, 1st edition 1999, published by Blackwell science limited Paris, France. P 1230-1232.
269) Text book of Rheumatology, by Kelly et al, 5th edition, Published by W. B. Saunders company, Philadelphia, Pensylvania. P 114-115.
270) Bhavamishra, Bhavaprakasha, chapter 26, sloka 50. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan
271) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998. Sloka 1, p 107.
272) Yogaratnakara, Indradeva Tripathi, 1st edn. Varanasi: Krishnadasa Academy ; 1998.Sloka 1, p 107.
273) Agnivesa, Charakasamhitha Sutrasthana chapter 13. sloka 12. 4th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1994. p.182.
274) Sushrutha, Sushruthasamhitha.chikitsasthana chapter 31. sloka 5. Varanasi: Krishnadas Academy; 1980. p-508.
275) Chakradatta, chapter 25, sloka 45-48. Edited by Jagadeeshwar Prasad Tripati, 5th edn. Varanasi: Choukambha Sanskrit Office; 1983, p-231.
276) Ashtangasangraha kalpasthana chapter 4, sloka 5. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996, p-440.
A Comparative Study of Virechana karma and Basti karma in Amavata W.S.R.T. Rheumatoid Arthritis
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SPECIAL CASE SHEET FOR “AMAVATA”[RA] Post Graduate Studies and Research Centre (Panchakarma)
Shri. D.G.M.Ayurvedic Medical College, Gadag.
Guide : Dr. G. Purushottamacharyalu M.D (Ayu), M.A (Asto) Co-Giide : Dr. Shashidhar H Doddamani M.D (Ayu) Scholar : Suresh N. Hakkandi 1. Name of the patient : Sl. No.
2. Father’s/Husband’s Name : OPD No.
3. Age : ………... yrs IPD No.
4. Sex : Male/Female Bed No.
5. Religion :
Hindu Muslim Christian Others 6. Occupation :
Sedentary Active Labor Others 7. Economical Status :
Poor Middle Upper middle Higher 8. Diet :
Veg Mixed 9. Address : …………………………. Phone No. …………………………. E- Mail: …………………………. Pin code:
10. Date of Schedule of Initiation:
11. Date of Schedule of Completion:
12. Result :
Completely Relieved
Good Response
Moderate Response
Poor Response
No Response
13. Consent : I here by agree that, I have been fully educated with the disease and treatment. Here by satisfied whole-heartedly, and accept the medical trial over me.
Investigator’s Signature. Patient’s Signature
1
Pradhana vedana
1) Local features of joints:
Sl.No Different joints Ruja Shotha Sthbdata Ushnata
BT AT BT AT BT AT BT AT
1. Hasta
2 Pada
3 Gulpha
4 Trika
5 Janu
6 Uru
7 Sira
2) Associated complaints : Sl.No B/T A/T A/T/F
1 Jwara
2 Angamarda
3 Aruchi
4 Apaka
5 Trushna
6 Alasya
7 Bahumoolrata
8 Hrullasa
9 Gourava
10 Agnimandya
11 Lalasrava
12 Nidra viparyaya
13 Chardi
14 Bhrama
15 Murcha
16 Hrudgraha
17 Kosta baddata
18 Anga shunyata
2
II) History of Patient Illness : Mode of onset
Insidious Acute Systemic Palindrome
Oligo articular Poly articular Mono articular
Symmetrical Asymmetrical Sequence of joins involved 1)__ 2) __ 3) __ 4) __5)__ 6)__7)___ Nature of disease
Progressive Regressive Constant Intermittent Routine actives affected
Mild Moderate Severe Not affected III) History of the Past Illness: IV) Previous treatment History: V) Family History: VI) Personal History: 1) Ahara Taste Predominance
Vegetarian Mixed food
Sweet Sour Salt Pungent Bitter Astringent
2) Jatharagni Manda Teekshna Vishama Sama 3) Pureesha Pravritti :
vibandha Dravavit Prakrita Frequency
4) Mutra Pravritti : Frequency Day Night Mutra Daha 5) Nidra Sukha Alpa Ati Vishamya 6) Vyasana
Smoking Alcohol Tobacco No Habits
3
7) Artava Pravritti Days Samanya Alpa Adika Rajonivritti
VII) Examination of Patient ( Vital)
1) Pulse 2) Blood Presser 3)
Temperature / Min 0F mm Hg
4) Height 5) Respiration 6) Weight / Min /Min Kg
VIII a) Special Examination (Ayurveda)
1. Nadi V P K VP VK PK VPK 2. Prakruti V P K VP Vk PK VPK 3. Sara Pravara Avara Madhayama 4. Samhanana Susamhita Asamhita Madhyma Samhita 5. Pramana Height in Cms Weight in Kgs 6. Satmya Ekarasa Sarvarasa Ruksha Sneha 7. Satwa Pravara Avara Madhyama 8. Ahara Shakti Abhyavaharna Jarana 9. Vyayam Shakti Pravara Avara Madhayam 10. Vaya Balya Yauvana Vardhakya 11. Desham (Deha) Bhumi Jangala Anupa Sadharana Nidana
Aahara Vihara Others Guru bhojana Virudha Chesta Mandagni Virudha Bhojana Prakruti Virudha Avyayama Samaya Virudha Vyayama after snigdha
bhojana
Samyoga Virudha Ativyayama Samprapti Ghatakas Dosha Dushya Adhistana Srotas Roga Marga Udbhaavasthana Sancharasthana Vyaktasthana Adhistana Srotodusti
4
VIII b) Special Examination (Joints)
Sakha Pareekshaa Scores Before After After FollowupDeformity of joints Swelling Rhumatic nodules
Dar
shan
a
Muscle wasting Skin over the joint Warmth over joint Tenderness
Intra articular
Swelling
Extra (peri) articular
Bursitis Tenosynovitis Synovial thickening
Spar
shan
a
Bony Components Palpable
Shravana (Crepitation)
VIII c) Special Examination (Extra articular manifestation)
Extra articular manifestation Before After After Follow Up Low Grade Fever Loss of appetite Loss of Weight Fatigue Muscle Wasting Anemia Sicca Syndrome
VIII d) Assessment of Investigations
Sl.No Name of the Test Baseline Values Final Values 1 ESR mm of 1st hour mm of 1st hour 2 Hb% mg% mg% 3 CRP 4 ASO Titer 5 RA IX) Upsaya / Anupasaya : 1) Ruksha sweda – Pain Reduced :Yes / No 2) Snigdha sweda – Pain increased : Yes / No X) Types of Amavata :
Doshanubandha Kalanubandha
Vataja Pittaja Kaphaja Naveena Pravrudha Jeerna
5
XI) Treatment Protocol: For Group-A Patients: Nitya Virechana
Poorva Karma Amapachana
Drug Used Vaishawanara Choorna No. Days Pradhana Karma Eranda Taila Nitya Virechana
Quantity used
Time of Administration
No. of Vegas
1st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th day
Paschat Karma :
For group – B Patients : Yoga Basti Poorva Karma
Amapachana
Drug Used Vaishawanara Choorna No. Days Pradhana Karma Sl.No Particulars AB NB AB NB AB NB AB AB 1 Dravya 2 Pramana 3 Date 4 Time 5 Pratyagamana Kala 6 Annya Vasti Vyapat 7 Miscelaneous
Paschat Karma Signature of Co-Guide Signature of Guide
Dr. S.H.Dodmani Dr. G. Purshottamacharyulu
M. D (Ayu) M. D.(Ayu)
6