amavata k c006kop

BY Dr. VIJAYENDRA.G.BHAT B.A.M.S.

(R.G.U.H.S, Bangalore)

Dissertation submitted to Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

in partial fulfillment of the requirements for the degree of

“Ayurveda Vachaspati” [M.D.]

in

KAYACHIKITSA

GUIDE Dr. Rashmi Rekha Mishra

M.D(Ayu), (U.U) Prof. Dept. of Kayachikitsa

DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA A.L.N.RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE,

KOPPA – 577126, CHIKMAGALUR DISTRICT, KARNATAKA, INDIA

MARCH - 2006

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYA CHIKITSA

Declaration

I here by declare that this dissertation entitled “Management of Amavata with

Amavatari rasa and Valuka sweda - A clinical evaluation” is a bonafide and genuine

research work carried out by me under the guidance of Dr. Rashmi Rekha Mishra,

Prof., Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao Memorial

Ayurvedic Medical College and P. G. Centre, Koppa.

Date:

Place: Koppa

Dr. Vijayendra. G. Bhat P.G.Scholar,

Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

Ayurmitra

TAyComprehended



Certificate

This is to certify that the dissertation entitled “Management of Amavata with

Amavatari rasa and Valuka sweda - A clinical evaluation” is a bonafide research

work done by Dr. Vijayendra.G.Bhat in partial fulfillment of the requirement for the

degree of Ayurveda Vachaspati (M.D.) in Kaya Chikitsa, of Rajiv Gandhi University

of Health Sciences, Bangalore, Karnataka.

Date:

Place: Koppa

Guide:Dr. Rashmi Rekha Mishra

M.D(Ayu), (U.U) Prof. Dept. of Kayachikitsa

A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126



Endorsement

This is to certify that the dissertation entitled “Management of Amavata with

Amavatari rasa and Valuka sweda - A clinical evaluation” is a bonafide research

work done by Dr. Vijayendra.G.Bhat under the guidance of Dr Rashmi Rekha

Mishra, Prof., Department of Post Graduate Studies in Kaya Chikitsa, A.L.N. Rao

Memorial Ayurvedic Medical College and P.G. Centre, Koppa.

Date:

Place: Koppa

Dr.Jagadeesh Kunjal M.D. (Ayu)

Principal, A.L.N.Rao Memorial Ayurvedic Medical College, Koppa –577126, Dist: Chikmagalur

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation in

print or electronic format for academic/research purpose.

Date:

Place: Koppa

Dr. Vijayendra.G.Bhat P.G.Scholar, Dept. of Kaya Chikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

I am obliged to my beloved Parents, niece Vaibhava and family members for

their constant efforts, encouragements and inspiration through out the work.

On the completion of this thesis work, I extend my sincere gratitude to my

revered Guide Dr. Rashmi Rekha Mishra M.D (Ayu); who was the vital and kinetic

force of this thesis; with out her initiation this piece of work would not have been

accomplished in stipulated time.

I owe my sincere regards and boundless gratitude to Dr. Taruni Kanta

Mohanta, M.D, PhD (Ayu), for his constant encouragement and valuable

suggestions.

I am grateful to Sri. Aroor Ramesh Rao, President, A.L.N. Rao Memorial

Ayurvedic Medical College, Koppa for giving me an opportunity to do my post-

graduate studies.

My immense thanks to Dr. Jagadeesh Kunjal, M.D (Ayu), Principal, A.L.N

Rao Memorial Ayurvedic Medical College, Koppa, for his help and support in

completing this work

My sincere gratitude to all my respected teachers in the Dept. of Kayachikitsa;

HOD Prof. P.K Mishra, MD(Ayu), Dr. Narayana Sharma, M.D(Ayu), and

Dr. C.B Singh, M.D(Ayu).

I am obliged to my friends Dr Prashanth B K and Dr Harvin George for their

guidance, valuable suggestions and moral support.

My special thanks to Dr Ramesh P V for his valuable suggestions, which

became the base for my study.

I remain grateful forever to Dr.Shyamalan (Ph.D) and my senior Dr.Christy

J.T for their complete in the statistical work.

I am obliged to the respected teachers of Dept. of Rasa shastra and Bhaishajya

kalpana; Dr. D.K Mishra, M.D (Ayu) and Dr. Galib, M.D (Ayu) for their guidance.

My earnest gratitude to the respected teachers of the faculty of Dravya guna:

Dr. Lucas M.D (Ayu), FRAS (Lon), Dr. Sanjaya K.S, M.D (Ayu) and Dr. Sreedhar,

M.D (Ayu) for their extensive help in the drug review along with Dr. H.R Pradeep,

M.D (Ayu) and Dr. Sathish Sringeri, M.D (Ayu).

I am glad to express my sincere thanks to Dr. Rajesh Kumar, M.D (Ayu) from

the Dept. of Shalakya, Dr.Banmali das from dept of roga vijnana. and P.N.Hegde

Dept of Sanskrit.

I will always treasure the guidance and support given by Dr. Ramohan,

Dr.Ramesh N.V, Dr. Lalitha Bhasker, and Dr. Sreenivas, Dr. Abhinetri Hegde;

Consultant Physicians of Ayurvedic college hospital for their support during various

stages of my work.

I am ever grateful to my friend Dr Manoj S Panicker, for his continuous

motivation and valuable suggestions through out the course of my work.

It will be reprehensible if I do not extend my gratitude to my seniors Dr.

Purushotham K.G, Dr. Leeladhar, Dr. Prashant Bhat, Dr. Clarence, Dr. Anil P

Varkey, and Dr. Pradeep K.V, for their support.

With amicable gratitude, I thank the librarians, lab technicians, pharmacy

staff and college office staff for providing me the technical support.

I will be failing in my duties if I do not express my immense gratitude to my

classmates Dr.Sarat Babu, Dr. Raviganesh, Dr. James chacko, Dr. Parthasarathi,

Dr.Pradeep Dr. Prathibha Hullur, Dr. Binu A, Dr. Roshy, Dr.Vishwanath, Dr.

Krishna kishore, Dr. Sanjeev, Dr. Suja, Dr. Kavitha, and Dr.Pankaj.

With immense pleasure, I extend my heart full thanks to my good friends Dr.

Mani jose, Dr. Sachin zadbukhe, Dr. Ratheesh, Dr. Guru, Dr. Dayanand R.D, Dr.

vinod joshi and Dr. Harihara Prasad with out whose support this thesis work would

not have been complete.

I will always cherish the love and consideration extended by my dear friends

Dr. Murali Rao, Dr. Raju Kulkarni, Dr.Vijith, Dr. Sreejith, Dr. Prasanna K.G, Dr.

Shreepathi E Nagol, Dr.Krishnaprashanth, Dr.Vishwanath Hegde Dr. Madhusudhan

Kulkarni, Dr. Manjunath Adiga, Dr. Yashwanth, Dr. Nagesh Puranic, and Dr.

Chethan.

I am grateful to all the patients who were included in the study.

My thanks to Dr. Raghuram, Dr. Susheel Shetty, Dr.Manoj, Dr.

Chandrakala, and Dr.Rita for their moral support.

My special thanks to PG juniors, House surgeons, 2nd year U.G students

(2002 batch) especially Jagadeesh Maiyya & Manjunath Bhat and others for their

constant support.

Finally I thank all those who helped me directly or indirectly to complete this

work.

Date :

Place : Koppa Dr. Vijayendra.G.Bhat

LIST OF ABBREVIATIONS

1. A.H : Astanga Hridaya

2. A.K : Amarakosha

3. A.S : Astanga Sangraha

4. B.P : Bhava Prakasha

5. B.R : Bhaishajya Rathnavali

6. Basa : Basavarajeeyam

7. C.D : Chakra Datta

8. C.M.P : Concise Medical Physiology

9. C.S : Charaka Samhita A

10. Ckr : Chakrapani.

11. D.G : Dravya Guna Vijnana

12. D.N : Dhanvantari Nighantu

13. D.P.P.M : Davidson’s Practice and Principles of Medicine.

14. Dl : Dalhana

15. G.N : Gada Nigraha

16. H.P.I.M : Harrison’s Principle Of Internal Medicine

17. H.S : Harita Samhita.

18. M.N : Madhava Nidana

19. Madhu : Madhukosha

20. R.P.B.D : Robin’s Pathologic Basis Of Disease

21. R.R.S : Rasa Ratna Sammuchaya

22. S.K.D : Shabda Kalpa Druma

23. S.S : Sushruta Samhita

24. Sh.S : Sharangadhara Samhita

25. Vag : Vagbhata

26. Vang : Vangasena

27. W.I : The Wealth Of India

28. Y.R : Yogaratnakara

ABBREVIATIONS OF STHANAS OF SAMHITA

1. Chi : Chikitsa sthana

2. Ind : Indriya sthana

3. Ka : Kalpa sthana

4. Ma.Kha : Madhyama Khanda

5. Ni : Nidana sthana

6. Po.Kha : Poorva Khanda

7. Sha : Shareera sthana

8. Si : Siddhi sthana

9. Su : Sutra sthana

ABSTRACT

“Angamarda, angashunyata, gatrastabdhata and jwara” are the cardinal

symptoms of Amavata, usually associated with raga, daha, shoola, sthaimithya, kandu

and all the ama lakshanas since it is tridoshaja. It is a growing global problem,

hampering the daily life movements of the affected individual and the treatment for

this is said to be krichrasadhya.

Still, this disease can be managed with some formulations which can break the

samprapti of the disease, has inspired to witness the efficacy of the drug and to

establish its efficacy.

Objectives:

1. Management of Amavata with trial drug Amavatari rasa individually

and along with valuka sweda on randomly selected patients.

2. To establish the safe, economical and effective medication for

Amavata without side effect, formulated as explained in the classical.

3. Detailed study of disease and trial drug covering classical and modern

literature.

Methods:

In this clinical study, 40 patients were selected for the study coming under

inclusion criteria and randomly categorized into two groups.

Group A – Administered Amavatari rasa 750mg twice daily in empty stomach for 30

days, with hot water as anupana, followed by dietary measures.

Group B – Administered Amavatari rasa 750mg with hot water as anupana, twice

daily in empty stomach for 30 days with Valuka sweda for 21 days with same dietary

measures.

Severity of the disease was assessed by subjective and objective parameters.

Interpretations and results:

After the therapy, it was observed that the group A treated with Amavatari rasa gave

better result in relieving the two stnika main symptoms i.e, daha and raga and

associated symptom apaka, but a better and sustained relief of all the symptom were

observed in group B which is treated with combined therapy.

Conclusion:

Amavatari rasa helps in the management of Amavata by pachana of ama,

clearing the srotas, reduces the inflammation along with vitiated vata and

kapha and also does the dhatu poshana.

Treatment administered with Amavatari rasa along with valuka sweda showed

more efficacy in all above said features with quick and long standing result.

Key words:

Amavata, Amavatari rasa, valuka sweda, Trika sandhies, Shoola, Gatrastabdhata.

INDEX Page No.

Chapter - I INRODUCTION 1-5

Chapter - II OBJECTIVES 6

Chapter - III REVIEW OF LITERATURE

A) Disease review

Historical review 7-9

Nirukti, Paribhasha, Paryaya 10-11

Nidana 12-22

Samprapti 23-29

Poorvaroopa 30

Roopa 31-35

Classification of Amavata 36-37

Upadrava 38-39,

Upasaya anupasaya 39

Sadhyaasadyata 40

Chikitsa 41-48

Vyavachedaka nidana 48-50

Pathya apathya 51-52

Modern disease review 53-61

Concept of Valuka sweda 62-68

B) Drug Review 69-77

Chapter - I METHODOLOGY

Materials and Methods 78-85

Observations 86-103

Chapter - IV RESULTS 104-124

Chapter - V DISCUSSION 125-142

Chapter - VI CONCLUSION 143-144

SUMMARY 145-146

REFERENCES

BIBLIOGRAPHY

ANNEXURES

List of Charts

Name of charts Pg no: Scheme of Samprapti 29

Effect of valuka sweda 140

List of tables

Sl No Name of tables Pg No. 1 Samanya lakshana 33 2 Pravradaha lakshanas 34-35 3 Line of treatment 46 4 Different yogas 46-48 5 Differential diagnosis 48-50 6 Pathyapathya 52 7 Scoring chart 81 8 Age wise distribution 86 9 Sex wise distribution 87 10 Religion wise distribution 88 11 Marital status 89 12 Occupational status 90 13 Educational status 91 14 Socio-economical status 92 15 Family history 93 16 Diet wise distribution 94 17 Adductions 95 18 Deha prakrithi 96 19 Satwa wise distribution 97 20 Incidence of kosta agni 98 21 Nidana 99 22 Sarva dihika main symptoms 100 23 Sthanika main symptoms 101 24 Associated symptoms 102 25 Sroto dusti lakshanas 103 26 Effect of Amavatari rasa on sarvadihika lakshana after

therapy 104

27 Effect of Amavatari rasa on sarvadihika lakshana after follow up

104

28 Effect of Amavatari rasa on sthanika lakshana after therapy 105 29 Effect of Amavatari rasa on sarvadihika lakshana after

follow up 105

30 Effect of Amavatari rasa on associated symptoms after therapy

106

31 Effect of Amavatari rasa on associated symptoms after follow up

106

32 Effect of Amavatari rasa on sroto dusti lakshana after therapy

107

33 Effect of Amavatari rasa on sroto dusti lakshana after follow up

107

34 Effect of Amavatari rasa with valuka sweda on sarvadaihika lakshana after therapy

108

35 Effect of Amavatari rasa with valuka sweda on sarvadaihika lakshana after follow up

108

36 Effect of Amavatari rasa with vauka sweda on sthanika lakshana after therapy

109

37 Effect of Amavatari rasa with vauka sweda on sthanika lakshana after follow up

110

38 Effect of Amavatari rasa with valuka sweda on associated symptoms after therapy

110

39 Effect of Amavatari rasa with valuka sweda on associated symptoms after follow up

111

40 Effect of Amavatari rasa with valuka sweda on sroto dusti lakshana after therapy

111

41 Effect of Amavatari rasa with valuka sweda on sroto dusti lakshana after follow up

112

42 Over all effect of Amavatari rasa after treatment 112 43 Over all effect of Amavatari rasa after follow up 113 44 Over all effect of Amavatari rasa with valuka sweda after

treatment 114

45 Over all effect of Amavatari rasa with valuka sweda after follow up

114

46 Comparative effect of therapies on sarvadaihika symptoms after treatment

115

47 Comparative effect of therapies on sarvadaihika symptoms after follow up

116

48 Comparative effect of therapies on sthanika symptoms after treatment

117

49 Comparative effect of therapies on sthanika symptoms after follow up

118

50 Comparative effect of therapies on associated symptoms after treatment

119

51 Comparative effect of therapies on associated symptoms after follow up

120

52 Comparative effect of therapies on sroto dusti lakshana after treatment

121

53 Comparative effect of therapies on sroto dusti lakshana after follow up

122

54 Comparison of therapies b/w Group A & B after treatment 123 55 Comparison of therapies b/w group A & B after follow up 124

List of Graphs

Sl no: Name of graphs Pg no: 1 Age wise distribution 86 2 Sex wise distribution 87 3 Religion wise distribution 88 4 Marital status 89 5 Occupational status 90 6 Educational status 91 7 Socio-economical status 92 8 Family history 93 9 Diet wise distribution 94 10 Adductions 95 11 Deha prakrithi 96 12 Satwa wise distribution 97 13 Incidence of kosta agni 98 14 Nidana 99 15 Sarva dihika main symptoms 100 16 Sthanika main symptoms 101 17 Associated symptoms 102 18 Sroto dusti lakshanas 103 19 Comparative effect of therapies on sarvadaihika

symptoms after treatment 115

20 Comparative effect of therapies on sarvadaihika symptoms after follow up

116

21 Comparative effect of therapies on sthanika symptoms after treatment

117

22 Comparative effect of therapies on sthanika symptoms after follow up

118

23 Comparative effect of therapies on associated symptoms after treatment

119

24 Comparative effect of therapies on associated symptoms after follow up

120

25 Comparative effect of therapies on sroto dusti lakshana after treatment

121

26 Comparative effect of therapies on sroto dusti lakshana after follow up

122

27 Comparison of therapies b/w Group A & B after treatment

123

28 Comparison of therapies b/w group A & B after follow up

124

Introduction

INTRODUCTION

Amavata is a condition where simultaneously aggravated vata and Ama

associated with each other, settles in trika sandhies and is characterized by immense

pain in joints with inflammation, fever and ultimately stiffness of the joints, causing

the temporary or permanent disability of joints and it hampers daily working capacity

and runs a chronic course.

Though the two main causative factors of disease ‘ama’ and ‘vata’ have equal

importance, the cause of Ama and its role in manifestation of disease requires special

attention. The improper digestive mechanism which is the basic cause of the disease

produces the incomplete ahara rasa or ‘ama’. This Ama acts as poisonous substance

for body and sets in different types of disorders. Among them, Amavata has unique

importance due to its gravity of problems with severe pain like ‘scorpion bite’.

In early stages only the joint involvement can be seen with cardinal features

like angamarda, aruchi, alasya, jwara and angashoonata etc. but if it is not treated with

systemic treatment procedures, then through the madyama roga marga, it will lead to

cardiac damage and further complications like involvement of gastro- intestinal,

cardiovascular, nervous, urinary and respiratory systems also. In its chronic phase,

frequent aggravation of its entities concludes as cripplers for human being.

Vedas also mention about the various disorders which leads to impairment of

movement. But Amavata, as a disease entity is not available even in Brihatrayees.

This is first recognized and described in detail by Madhavakara in 9th century. He

Page 1

Introduction

explained trika sandhi or bigger articular joints like knee, elbow etc. as the most prone

joints. Though no particular age group is mentioned in Ayurvedic texts, affliction of

this disease is confined to children and young adults mostly.

Amavata can be compared to Rheumatoid arthritis which is a systemic chronic

inflammatory joint disorder which affect predominantly to synovial joints. Cardiac

involvement, symmetrical involvement of joints along with pain, stiffness and

swelling with number of systemic complications resembles the disease Amavata. The

opinion regarding the correlation with rheumatic fever also cannot be ruled out, due to

many similarities with Amavata.

There is no specific line of treatment in contemporary science which brings

solace to the patients. Allopathic system can manage this with its various potent

remedies capable of suppressing or controlling the disease activity and gives relief to

the patient. But none of them gives a permanent cure and lastly advices prolonged

penicillin therapy instead.

Nowadays, it is being observed that in OPD and IPD level, the number of

patients increasing day by day suffering with this dreadful disease may be due to

modern way of life style with consumption of incompatible food and less physical

exercises and mental stress. However, definite approaches of specific remedies are

still required.

The line of treatment in Ayurveda commonly used in all the diseases is

samshodhana and samshamana. Samshodhana indicates the dosha eliminating

Page 2

Introduction

process, whereas samshamana gives knowledge regarding the palliative procedure of

dosha inside the body. For the samshodhana purvakarma, pradhana karma and after

these careful diet procedures i.e. samsarjana karma are mentioned in Ayurvedic

classics. In purvakarma, oleation and sudation is mentioned to bring the dosha from

the tissue level upto the koshta so that after this, eliminative procedure will be easy to

conduct. After this procedure, samshamana therapy is adopted. Each type of

procedure is having its equal importance in their respective way.

For Amavata also, Acharya Chakradutta have given emphasis on a therapeutic

programme in terms of chikitsa sutra instead of single therapy for complete cure,

without reoccurrence or to manage this disease. That includes langhana, ama pachana

followed by virechana, snehapana and kshara basti. It is advised that the valuka sweda

as rukshana chikitsa, externally has excellent role in amapachana, in local sandhies.

Same treatment is suggested by Yogaratnakara, Gada nigraha and Bhava prakasha

with special importance to ruksha sweda and upanahas.

On this disease, various research works in different institutions of Ayurveda

has been conducted time to time, to find out definite solution. Some of them are listed

below:

1. Jala Jagisha – a clinical study on Virechana and dashamulakshara basti in

management of Amavata.

Gujarat Ayurveda University, Jamnagar 1995.

2. K.P. Reddy – A clinical and immunological study on role of langhana in

management of Amavata and its treatment with Bhallataka Rasayana.

Banaras hindu university, Banaras. 1995.

Page 3

Introduction

3. Lakshmikantham. K – Management of Amavata with special reference to

Simhanada guggulu.

Govt. College of Indian medicine, Mysore 1990.

4. Shrinivasalu.M – A clinical study of the effect of Gandharvahastadi kwata in

Amavata.

Govt. Ayurvedic College, Hyderabad 1983.

5. Namboodiri P.K.N – Clinical study of Amavata and to assess its Ayurvedic

treatment with special reference to the role of swedanakarma .

University of Calcutta 1979.

It has been observed that in some conditions shodhana and in some others, shamana

chikitsa has given the significant results.

Keeping on view, all its prevalence and for better management of the disease,

this research work is taken as a clinical evaluation of Amavatari rasa with the

reference of Bhaishajya ratnavali Amavata chikitsa Adhyaya, which fulfills deepana,

pachana and anulomana like properties with its special combination of herbo- mineral

ingredients, alone and along with valuka sweda which is easy for administration, with

no side effects and cost effective, in the management of the disease Amavata.

Present work also includes theoretical aspects of Amavata like brief historical

background, definition, synonyms, nidana panchakas along with classification as

explained by different classical treatises which are discussed here in detail. The

pratyatmaka lakshanas, upadravas, vyavachedaka nidanas, sadhya- asadhyata of

Page 4

Introduction

Amavata, line of treatment and probable mode of action of selected treatment therapy

are also expounded in detail.

Group wise random selection of patients for clinical trials, case study, adopted

treatments and its methods with subjective and objective parameters, results,

discussion and conclusion are dealt at the end.

The entire work has been documented chapter wise in the following manner -

Chapter I – Introduction

Chapter II – Objectives

Chapter III – Review of literature

Chapter IV – Methodology

Chapter V – Results

Chapter VI – Discussion

Chapter VII – Conclusion

Chapter VIII _ Summary

References

Bibliography

Annexure

Page 5

Objectives

Objectives

Objective of the present study are:

1. Management of Amavata with trial drug Amavatari rasa individually and

along with valuka sweda on randomly selected patients.

2. To establish the safe, economical and effective medication for Amavata

without side effect, formulated as explained in the classical.

3. Detailed study of disease and trial drug covering classical and modern

literature.

HYPOTHESIS

Null Hypothesis –Amavatari rasa alone or along with Valuka sweda is ineffective

against the disease Amavata.

Alternate Hypothesis – Amavatari rasa alone or along with Valuka sweda is

effective against the disease Amavata.

Page 6

Review of literature

HISTORICAL REVIEW

History is chronologically arranged records of past events. Ayurveda has

history of more than 2500 years. The quest for medicine with few achievements must

have been existing even much before the beginning of human race. The main source

for all sciences as well as Indian medicines are four Vedas, which are considered as

oldest treatise of knowledge.

Vedas:

Ayurveda is considered as upaveda of Atharvaveda. There are no direct

references for Amavata in Vedas. In Atharvaveda there are few references regarding

joint disorders also, in the name of vishakhanda, which means disorganized joints. It

is stated that “destroy the balasa seated in organs and joints which is responsible for

loosening of joints”1.About the defect of body parts, there are some references saying

that “I shall remove the visha causing debility in majja and sandhies”2

Puranas:

In Puranas there are collections of matters pertaining to sharira. Agni Purana

narrates the total number of joints and explained the pathyas for vata rogas concerned

to joints3.

Brihatrayee:

In Brihatrayee also, there is no description about the disease Amavata. The

term Amavata has been mentioned in Charaka Samhita which may date back to 1000

B.C, possibly to denote the relation of Ama with vata. However the term Amavata is

Page 7


included in some of the therapeutic indication of drug compounds, Kamsahareetaki4,

Vishaladi phanta of Pandu chikitsa5 are described to be effective in Amavata.

Further while illustrating the vata vyadhi chikitsa, Amavata word is used to

denote avarana of vata by ama and also as a symptom6. In addition to this, a good

deal of description regarding etiology, pathology, clinical manifestation and effective

treatment for amapradosha is found7 .

In Susruta Samhita (700-600 B.C) only the description of ama is found.

In Astanga Sangraha (400 A.D) and Astanga Hridaya (500 A.D) there is no

description about Amavata but the description about ama is available.

Bhela Samhita: (800-700 B.C)

In this treatise, the term Amavata is not available, the word amashayagata vata is

found.

Harita Samhita: (800-700 B.C)

Amavata description is found in this treatise. Here ‘angavaikalya’ is given as

lakshana and ‘khandashaka’ as nidana. Treatment for Amavata is also available in this

text.

Madhava nidana: (800 A.D)

First description of Amavata as an independent disease is explained in

Madhava Nidana by Madhavakara. The clear explanation of nidana, samprapti, roopa,

upadrava and sadhyasadhata is available.

Gada Nigraha: (1200 A.D)

The description of Amavta and its treatment is explained in this treatise.

‘Vikunchana’ is explained as lakshana of Amavata.

Page 8


Vanga Sena: (1300 A.D)

Amavata description is found in this text. Author specially mentioned that

“takra tulya mootra” is lakshana in Amavata.

Vijayarakshita: (1300 A.D)

In his Madhukosha commentary on Madhava Nidana, has mentioned

sankocha, khanjatwa etc as the upadravas of Amavata.

Rasa Ratna Sammuchaya: (1300 A.D)

Author Rasa Vagbhata has mentioned different yogas for Amavata.

Sarangadhara samhita: (1300 A.D)

In his treatise description about classification about Amavata is available and

he suggested the use of ‘naga’ in this disease.

Basavarajeeya: (1400 A.D)

Author has specially explained the ‘peetamootrata’ as lakshana of Amavata.

Bhavaprakasha: (1500 A.D)

Author Bhavamishra has described Amavata in detail. Indication of ‘eranda

bheeja’ is mentioned in this text.

Yogaratnakara: (1600 A.D)

In this text the complete description of Amavata is available. Many aushada

yogas for it are also mentioned in this treatise.

Bhaishajya Ratnavali:(1800 A.D.)

Author Govindadasa explained nidana and elaborately discussed about verities

of chikitsa also.

The disease Amavata seems to be not found in vedic and samhita period. After

medieval period it started dominating and nowadays it is very common dreadful

disease. As the condition changes with the change in times, disease that were once

prevailing became rare and those that were rare or unheard became very common and

even went the extent of becoming a menace to the society.

Page 9


NIRUKTI, PARIBHASHA AND PARYAYA OF AMAVATA

The nirukti of Amavata can be defined in two ways:

“Amena sahita vata iti Amavata”

“Amascha vatascha iti Amavata”

As per Shabdhakalpadruma,

“The Amavata indicates its samprapti”.

Because Ama is nothing but the improper end products of food stuffs due to

the impairment of jattaragni. It is also accepted that the main source of all type of

disorders are on account of its poisonous properties. Even if it is poisonous, it has no

capacity to produce any disease with out the association of vata. As it is told that –

“Pittapangu kaphapangu pangavo mala dhatavaha

Vayunayatra niyate tatra gachati meghavat”

Following this principle the disease Amavata gets manifested when Ama

comes in contact with vitiated vata and while moving all around the srotus due to kha

vaigunyata in sandhi stana it gives some specific symptoms like sandhi shotha, rucha,

anga mardha, aruchi and trushna etc which is diagnosed as ‘Amavata’ as per our

authors description.

So that, according to Sabdhakalpadruma, ‘Amavata indicates its samprapti’; is

justified.

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According to Sabdastoma Mahanidhi, “Amayati peedayati iti ama”

Amayati means to be afflicted; peedayati means torment or annoy. In other

words it means that, which causes many diseases, discomforts and pain in body is

known as Ama.

Definitely Ama is known as root cause for all types of ailments.

Paryayas of Amavata:

In classical texts the paryayas of amavata are not envisaged.

Gananath Senji in his Siddhanta nidana, has mentioned rasavata. He says

that Amavata and rasavata both are same.

The term rasa denotes normal or pure rasa. The pure rasa is not capable to

produce a disease. So pure rasa along with vata do not produce Amavata. For the

formation of the disease Amavata, there must be ama. Hence the term Rasavata may

not be considered as synonyms of Amavata.

The term Ama maruta and samavata are correlated with

Amavata as synonyms by some recent authors. These terms do not imply the

condition of Amavata. Therefore this term may not be taken as synonyms of

Amavata.

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NIDANA

Nidana is defined as a particular factor which has a capacity or tendency to

produce a disease8.

In other words, nidana means the exact etiology of the disease.

Nidana has been classified under various headings with different views.

Among them one classification is bahya hetu and abhyantara hetu. Factors like ahara,

vihara and kala are considered as bahya hetus. Where as abyantara hetu or intrinsic

factor mainly comprises of dosha and dooshya.

The classification of the causes of disease is also very important. The

classification of nidana such as sannikrista, viprakrista, vyabhichari, pradhanika etc

guides the physician to study the history of the patient in detail. Dosha prakopa is the

sannikrista nidana for all diseases. The causative factor for dosha prakopa is the

viprakrista nidana and they may vary according to the disease.

Virudhaahara is mentioned as one of the cause for Amavata. If we go through

with the list of virudhahara, we find that ingestion of fish and milk is considered as

virudhahara. But many such people in taking that may not suffer from any of illness

for years. ‘Vyabhichari’ is the name given in the texts for such type of unstrengthened

causative factor of the disease. However such causes can alter dosha and dhatus of the

body and helps other causes to produce disease.

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The word Amavata indicates the main two internal cause of the disease that is

‘ama’ and ‘vata’. Knowledge of these two important internal causative factors is

absolutely necessary for understanding the disease, and for the prevention and

treatment of disease.

Hence its etiological factor ama is discussed here:

CONCEPT OF AMA:

• Eshad amyate pachyate

Apakwe Vaidyakokte9

• Rogamatra, rogabheda Malavaishamya roga10

• Amyate eshad pachyate

Eshad pakwe, asiddhe, pakarahite

Ama + karane. Rogamatre11.

• Raw, uncooked, unbaked, un annealed, unripe, immature,

undigested12.

Ama is an Asatmya substance in the body.

In general the term ama means unripe, uncooked, immature and undigested. In

the context of Ayurveda, however, this term refers to event which arises as a

consequence of impaired function of kayagni or dhatwagni or bhootagni .

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The concept of ama is a fundamental one in roganidana .The basic

doctrine of Ayurveda denotes that, most of the diseases which are included under

kayachikitsa are having their origin from ama. Hence ‘Amaya ‘has been considered as

a synonym of vyadhi .

The description of ama is as follows:

According to Vagbhata, “due to the hypo functioning of ushma ( agni ) , the

annarasa is not properly formed and this rasa undergoes fermentation or putrefaction

being retained in amashaya . This state of rasa is spoken as ama”13

Vijayarakshita , commenting on Amavata , in his Madhukosha

commentary , has quoted a number of definitions and descriptions of ama . They are

as follows:

• In the view of some, due to the impairment of kayagni , the annarasa and in

this state it is known as ama .

• The incompletely digested food which is not composed properly having bad

odour and sticky in nature, produces sadana in the body is known as ama .

• Some hold the view that, due to poor strength of jatharagni a residue of ahara

rasa is not digested properly and produces apakwa rasa . This is known as ama

, which is the root cause of all disease .

• It is stated that the food which is not properly digested is ama. Yet others

describe the accumulation of malas in the body as ama .

• There is also the view that the first stage or phase of dosha dushti is ama14.

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According to other authorities, quoted by vagbhata , the impaired vatadi

doshas become mixed up with one another , leading to the formation of ama very

much like the production of visha from the spoiled kodrava15 .

The food components are to be converted into bodily elements by both

jatharagni and dhatwagni . If either of the two is impaired , production of ama occurs .

Most of the references cited elsewhere in this chapter are mainly

concerned with jatharagni. Because in the quoted references ‘amashayagatam’and

‘jatharanaladourbalyat’ have been used these factors refer to jatharagni mandyajanya

ama .

The impairment of dhatwagni also can yield ama. The commentator

Dalhana commenting on ‘apakwa rasa’ says that even if rasas is not digested by

dhatwagni , then it deserves to be called as dhatwagni mandya janya ama 16.

In brief ama may be defined as an intermediary substance which is not

useful for healthy body, instead causes impairment of health and is produced owing to

the impaired function of either jatharagni or dhatwagni .

By virtue of qualities and actions, the ama produces both acute and

chronic diseases.

CAUSES OF AMA:

The cause of production of Ama is mainly agnimandhya. When there is

agnimandya even a small quantity of light food does not get digested. The undigested

food attains shuktatwa (fermentation) leading to the onset of toxic states, that is ama.

The causative factors of agnimandhya can be classified as:

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1. Aharaja

2. Viharaja

3. Manasika

1. Aharaja:

Various factors causing aharaja agnimandhya are:

a) Abhojanam :- If no food is taken, fasting etc. By this agni gets impaired. Food

is necessary for the maintenance of agni.

b) Ajeerna bhojanam :- Food taken above the undigested food leads to

impairment of agni.

c) Athi bhojanam :- Over eating

d) Vishamasanam :- Irregular dietary habits

e) Asatmyaharam :- Ingestion of unfamiliar food

f) Gurubhojanam :- To eat substances which are not easily digestible

g) Seetha bhojanam :- Ingestion of food which is too cold or chilled

h) Athi rooksha bhojanam :- Dry food with a negligible amount of water or food

without ghee oil etc.

i) Samdushta bhojanam :- Unclean and contaminated food

j) Vishtambhi bhojanam :- Food which produces distention of the abdomen.

k) Dagdhama bhojanam :- Fried and raw food intake.

l) Vidahi bhojanam :- Food which produces vidaham in the abdomen.

m) Sushka bhojanam :- Dry food intake.

n) Akala bhojanam :- Ingestion of food at improper time .

o) Athyambupanam ;- Excessive water intake.

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p) Virechana vamana shena vibhramam :- Maleffects of improper sodhanam ie

takeing Virechana drugs without previous snehanam and swedanam and

breakingof post treatment regimen.

2. Viharaja:

a) Desa kala ritu vaishamyam :- States brought about by fault changes in place,

climate or season.

b) Vega vidharanam ;- Suppression of natural urges

c) Swapna viparyayam :- Late night alert and day time sleep.

d) Prajagara :- Suppression of natural sleep.

3.Manasika:

a) Sokam :- grief

b) Krodham :- anger

c) Chinta :- worry

d) Dukha sayya :- Unsuitable bed for sleeping

PROPERTIES OF AMA:

Arunadutta in his commentary on Astanga Hridaya describes the properties of

ama as:

1. Dravatvam

2. Gurutwam

3. Snigdhatvam

4. Pichilatwam

5. Nana varnam

PATHOLOGICAL SYMPTOMS:

In general, this ama produces some pathological symptoms in the body. They

are as follows 17

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• Srotorodha:- Srotases are the channels of circulation, in which bodily

elements or the others are transported. Ama obstructs anywhere in any

srotus due to its pichilata property so that transportation of bodily elements

gets hampered.

• Balabramsha:- General weakness or loss of strength. Due to obstruction of

srotases nutritions does not circulates, hence nutrition of dhatus get

hampered and this cause balabramsha.

• Gourava:- A feeling of heaviness. Guru, manda and pichila qualities of

ama produce the feeling of heaviness in the body.

• Anila moodata:- Due to srotavaroda, proper movement of vata do not takes

place.

• Alasya:- Lethargy, a feeling of laziness, lack of initiation.This is due to the

impairment in the activities of vata; because vata is responsible for all

activities in the body.

• Apakti:- Indigestion; due to agnimandya, the digestive juices are not

properly secreted and hence the digestion of ingested food does not takes

place.

• Nisteeva:- This term posses two meanings .

1. Excessive salivation.

2. Sticky mucous. Both this states are considered under kapha dusti.

• Malasanga:- Constipation. Srotorodha and anila moodhata may cause the

malasanga.

• Aruchi:- Lack of taste. This may be due to vikruti of bodhaka kapha.

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• Klama:- Weakness of indrias. Due to improper supplementation of

required nutrients to the dhatus.

SAMA :

As regards Sama , Vagbhata describes it as a condition in which tridoshas

and saptadhatus as well as malas become permeated with ama . Diseases which arise

in consequence are spoken of as Sama type of diseases. The settlement of ama during

its circulation through the channels of body is important in the production of a

disease18.

In this context, the next important point which gains much attention is

vata associated with ama. Due to various factors vata gets prakupita and associated

with ama to manifest condition called “samavata” which also have similar qualities

like Amavata.

Causes of vatakopa:

Aharajam:

1. Regular intake of rooksha, ushna sheeta and laghu food stuffs.

2. Alpha bhojanam- inadequate intake of food.

3. Abhojanam - Fasting.

4. Ingestion of food which are predominantly tikta, katu and kashaya rasas.

Viharajam:

1. Jagaranam - Sleep evasion

2. Vegadharanam - Suppression of natural urges.

3. Vegodheeranam - Forcible act of natural urges.

4. Ativyayama - Over exertion.

5. Ativyavayam -Excessive sexual indulgence.

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Manasika:

Bhaya, krodha,chinta etc emotional factors also does the prakopa of vata.

When vata becomes abnormal, it afflicts the body with diverse types of

disorders. It impairs strength, complexion, happiness and span of life. It perturbs the

mind, affects all the senses. It destroys, deforms the fetus or prolongs the period of

gestation. It gives rise to fear, grief, stupefaction, humility and delirium. It obstructs

the vital function19.

When both ama and vata gets conjoin together and moves all over the body

and stagnant in Trika sandhis with many symptoms, produces a disease called

Amavata.

Causes of Amavata as mentioned in Madhava nidanam and Bhavaprakasam are-

1. Virudhahara cheshta :- Ingestion of unwholesome food is one of the important

causes of Amavata. Some dietary articles when mixed in a particular way with a

particular food cause diseases instead of doing their normal functions. Virudha

can be defined as that which provokes the doshas not expels them out of the

body.

Acharya Charaka described the factors which are responsible for the incompatibility

of food. Those are given below with one example:-

1. Desha virudha: Intake of snigdha and sheeta dravya in anoopa pradesha.

2. Kala virudha: Intake of sheeta ,rooksha druvyas in sheeta kala.

3. Agni virudha: Guru, sheeta druvyas in mandagni.

4. Matra virudha: Intake of equal quantity of madhu and sarpi.

5. Satmya virudha: Intaking unwholesome food.

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6. Dosha virudha: Taking opposite quality food that of individual’s prakruti.

7. Samskara virudha: Intake of incompatibly prepared food.

8. Veerya virudha: Intake of mixture of sheeta and ushna veerya food.

9. Kosta virudha: Intake of heavy food by mrudu kosta persons.

10. Avastha virudha: Intaking kaphakara ahara after sleep.

11. Karma virudha: Intaking food before feeling hunger.

12. Parihara virudha: Intaking hot things after intake of boar meat.

13. Upachara virudha: Intake of sheeta guna druvya after intaking ghruta.

14. Paka virudha: intaking uncooked or over cooked food.

15. Samyoga virudha: Incompatibility of combination like,sour substances taken

with milk.

16. Hrud virudha: Unpleasent tasted food intaking.

17. Sampad virudha: Quality less food like, unripe or over ripe or putrified.

18. Vidhi virudha: Incompatibility of rules of eating like, eating in solitary place20.

Like virudhahara, virudhavihara also causes disease amavata. Examples are:

1. Exercise after taking food.

2. Sleeping at daytime.

3. Suppression of natural sleep.

4. Taking bath immediately after taking food.

5. Suppression of natural urges.

2. Mandagni:- Mandagni is the most important causative factor of amavata.

Mandagni is nothing but agnimandhya which can immediately produces ama.

If agni is very powerful even virudhahara cannot do any harm. Actually

agnimandhya is the root cause for this disease.

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3. Nishchala:- A sedentary habit is responsible for agnimandya as well as for

producing hinayoga of the karmendriyas. It therefore produces sthana

vaigunaya in the joints. This is a vyadhi hetu of the disease.

4. Exercise after the ingestion of snigdhahara:

Actually the use of internal sneha is very much essential for

maintaining the agni. However if proper rest is not taken after snigdha ahara which is

guru, and indulging in heavy bodily works immediately, agni gets disturbed and it is

unable to digest the food properly. So production of ama takes place here. Quite some

time agni is required for pakakriya and hence swasthavritha advises to take some rest

after meals: If sufficient rest in not taken there is chance of vata prakopa.

Bhavaprakasha, Vangasena, Gadanigraha and Yogaratnakar have also

explained about nidana of Amavata as same as Madhava nidana. Only Harita included

one more extra word ‘khandashaka’ which again gives the same meaning of intaking

of likely food heavily without doing exercises. Even though causes mentioned for the

production of Amavata are plenty, it is also noteworthy that all the causes are not

necessary to produce the disease always. Some of the cause may be sufficient for the

production of a disease.

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SAMPRAPTI

Samprapti is nothing but the detailed description of all the morbid process that

takes place in different stages of the disease. It is the period of pathogenesis taking

place in the body from the period of nidana sevana to the period of vyadhi

vyaktavastha. The factor of nidana vitiates doshas in some particular fashion. Such

vitiated doshas start accumulating in their respective areas and by continuous

indulgence in nidana sevana, the accumulated doshas travel through srotas and get

lodged, where there is a kha vaigunya and thus, manifestation of disease takes place.

This complex process which involves sanchayadi avasthas is explained under

samprapti.

Regarding the samprapti of Amavata all the authors who have dealt with it

have given the same opinion. Ama plays an important role in the formation of the

disease Amavata.

According to vagbhata,the samprapti is again classified into five types. They

are Sankhya,Vikalpa, pradhanya, Bala and Kala samprapti. These indicates regarding

the number of classification of particular disease, the very minute causative factor,

predominant dosha involved in it’s manifestation, the strength of the disease and

timing of aggravation and alleviation of disease respectively21.

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The picture of satkriyakala, regarding samprapti of the any disease seems to be

more useful to know the different stages of disease and to select the appropriate

treatment procedures for them22.

Here according to satkriyakala, the samprapti of Amavata is explained as follows-

Sanchayavasta:

Etiological factors of Ama cause the agnimandyata.. This condition leads to

the ama. The ama gets accumulated in amashaya. On the other hand, vata also gets

vitiated by its own causes. This stage may be considered as ‘sanchayavasta’.

In Amavata nidana, production of ama takes place not only in amashaya, but

also in all the shleshmastanas like ura, kanta, sandhis simultaneously, due to

continuous indulgence of nidana.

Prakopavasta:

The ama which is accumulated in sleshma sthana gets instigated by vitiated

tridosha and becomes vidagdha. Accumulation of more and more vidagdha ama in

amashaya and all other shleshma stanas which indicates ‘swa sthane vruddhi’ which

by itself prakopavasta.

As agnimandya takes place in amashaya, primarily rasadhatwagni followed by

all the dhatwgnis, also gets mandavasta.and tridoshaprakopa takes place here, ama

starts producing and accumilating in rasadhatu also.

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Prasaravastha:

In classics it is stated that ama proceeds to shleshma sthanas. Uras is a

shleshma sthana & hridaya is situated in uras. On the basis of this, it can be known

that the ama comes in contact of hridaya also.

As the ama and rasa mixes in hridaya, from the hridaya ama along with

vitiated rasa, carried through all srotas of the body by the vitiated vata. This stage is

considered as “prasaravastha”.

Sthanasamshraya:

Due to the kha vaigunya in sandhies ama along with vitiated rasa and vata

settles in sandhies. Madhavakara says that the vitiated doshas along with ama enters

into trikasandhi.

The description of trikasandhi is as follows. The commentator Vachaspati

Vaidya commentating on trikasandhi says “kati manyamsa sandhi”. For kati, sacral

region can be compared.

Dalhana commenting on trika says “shronikanda bhage trikam praseedam”23.

This denotes that shronikanda bhaga is considered as trika.

Amsa sandhi may also be considered as trika sandhi. Here the connection of

three bones is present i.e. akshakasthi, amsaphalaka & pragandasthi.

In Amavata, the sandhies are affected, probably due to the specific affinity of

ama towards sandhies. Sandhies are supported by snayu and peshi. The inner side of

sandhi is covered by shleshmadhara kala (synovial membrane). Inside the

shleshmadhara kala there will be secretion of shleshaka kapha (synovial fluid). This

Page 25


shleshaka kapha is responsible for easy movements of sandhies. Ama and vitiated rasa

cause the vitiation of snayu and peshi. This condition leads to the vitiation of

slheshmadhara kala of sandhies. The ama located in shleshmadhara kala causes

abhishayndha. As a result of this, the shleshaka kapha gets increased and blocks vata

marga. Due to avarodha, the ama lodges in sandhis. This may be considered as

“sthanasamshraya”

Vyaktavasta:

Due to avarodha, the accumulated kapha will not be reabsorbed into srotas,

and hence causes shotha and shoola, followed by all the lakshanas of Anavata. This

may be considered as “Vyaktavasta”.

Bhedavasta:

If it is not treated in all these five stages, then the stage called “Bhedavasta” starts.

This includes all the upadravas. This stage is difficult to treat also.

This is the samanya samprapti.

Vishista samprapti:

In vishista samprapti of amavata, the involvement of particular dosha will

takes place. The predominance of dosha produces its own lakshana.

The predominance of vata causes severe shoola in sandhies. Daha and raga are

observed in sandhies due to the predominance of pitta. The predominance of kapha

produces sthaimitya, gaurava and kandu24.

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Samprapti ghatakas:

1. Dosha:

a) Vata: Samana vayu helps for pachana, vivechana etc. In Amavata these

kriyas are lessened. Vyana vayu also gets vitiated in Amavata.

b) Pitta: Among five types of pitta, pachaka pitta is involved. The functions

of pachaka pitta are impaired.

c) Kapha: Kledaka kapha and sleshaka kapha are involved. Kledaka kapha

moistens, breaks the food and produces dravata. These functions are

impaired in Amavata. Shleshaka kapha gets vitiated and accumulated by

the influence of ama. This results in sandhi shotha and shoola.

2. Dushya:

Dushya is rasa. By the contact of ama, rasa gets vitiated. Vitiated rasa and ama

circulates throughout the body and produces amalakshanas. Because of affinity

and kha vaigunya in sandhies the vitiated rasa and ama settles in sandhies and

produce shotha and shoola.

3. Agni:

Mandata of jataragni and rasadhatwagni is observed in Amavata.

4. Ama:

Ama is produced by mandata of jataragni and rasadhatwagni.

5. Srotas:

Rasavaha srotas is affected in Amavata. The ama circulates through the

rasavaha srotas.

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6. Dushti prakara:

Due to the impaired function of rasadhatwagni, the rasa is not formed

properly. This is attributed to sanga.

7. Udbhava sthana:

Udbhava sthana is amashaya. Ama is an important factor in the causation of

disease. The production of ama occurs in amashaya.

8. Sanchara sthana:

Ama along with vitiated rasa travel through srotas and get lodged in sandhies.

9. Roga marga:

Roga marga is madhyama roga marga. The ama and vitiated rasa goes to

hridaya. From hridaya, ama and vitiated rasa goes to asthi sandhies. As a result of

this condition, shotha and shoola occurs in sandhies. Hridaya and sandhies comes

under madhyama roga marga.

10. Adhishtana:

Ama settles in sandhies because of affinity and kha vaigunya in sandhies. This

condition leads to shotha and shoola. Hence sandhies can be considered as

adhishtana for Amavata.

11. Vyakta sthana:

In Amavata shotha and shoola occurs in sandhies due to ama. Hence sandhies

can be considered as vyakta sthana.

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Chart no:1

Scheme of Samprapti:

Consumption of virudha ahara etc nidanas.

Agni mandhya

Ama Ama in all Sleshama stanas

( like amashaya, sandhi, ura, sira,

kanta) {sanchayavasta}

Ama gets ‘vidagdha’ by tridosha prakopa.

{prakopavasta}

Vidagdha ama starts moving in dhamanis from hrudhya to all over the body.

{prasaravasta}

Sroto rodha by shleshaka kapha of trikasandhis.

Yugapath kupita vata and sleshama (ama) enters into ‘trika sandhi’ were kha

vaygunya has taken place.

{stanasamshraya}

Produces symptoms of Amavata.

{vyakthavasta}

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POORVA ROOPA

The vitiated doshas in the stage of sthanasamshraya will produce the

symptoms of forthcoming disease. Such symptoms are called as poorva roopas or

premonitory symptoms. These are the indications of impending disease25.

One more quotation from Madhavakara about poorvaroopa is, these are the

feebly manifested symptoms of forth coming disease.

The poorva roopa of Amavata has not been mentioned in texts. Some of the

symptoms like dourbalya, aruchi, alasya, gaurava, trishna, angamarda can be

considered as poorva roopas. In addition to these the other symptoms of Amavata

which are incompletely manifested may be considered as poorva roopa.

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ROOPA

The term roopa implies the signs and symptoms by which disease is identified.

This is the fifth stage of samprapti i.e. vyaktavastha25.

According to the signs and symptoms, roopa can be classified as follows-

1. Pratyatma lakshanas (Cardinal signs & symptoms)

2. Samanya lakshanas ( General signs & symptoms)

3. Vishishta lakshanas (Distinguishing features of doshanubandha)

4. Pravriddha Amavata lakshanas

1. Pratyatma lakshanas:

a) Sandhi shotha- Generally the shotha is in symmetrical shape. There will not

be any pitting on pressure. There will be ushna sparsha and the shotha

increases in sheeta kala i.e. during night and early morning.

b) Sandhi shoola: Usually shoola is felt in sandhies all the times. It increases

during night and early morning owing to sheeta nature of night and early

morning. Character of shoola in pravriddha avastha is described as “Vyavidfha

iva vruschikaihi” (like scorpion bite). Commentator Vachaspati Vaidya

described shoola as “Rijyate”, “Tujjate”.

Shotha and shoola shift from one joint to another. In classics the phrase “Karoti

sarujam shotham yatra doshaha prapadhyate” has been used. This means where the

Page 31


vitiated doshas and ama travels, there shotha and shoola takes place. As the disease

progresses, there is tendency for it spread to the sandhies of hastha, pada, shiras,

gulfa, trika, janu and ooru.

Shotha and shoola gets decreased in ushna kala.

c) Gatrasthabdhata: This means stiffness of the body. As sandhdies are restricted

the normal movements of the body also gets restricted.

Samanya lakshanas:

a) Angamarda- Angamarda means feeling of mardanavat peeda (crushing

type of pain). This occurs due to rasa dhusti caused by ama 26

b) Aruchi- The bhodaka kapha, which is situated in jihwa, gets vitiated by

the ama and leads to condition of aruchi, where the patient does not

find food palatable.

c) Trishna- Ama produces sroto rodha of udakavaha srotas. As a result of

this patient craves for water.

d) Gaurava- It is the feeling of heaviness. Guru and picchila gunas of

ama, which have prithvi and jala mahabhootas, leads to rasa dhusti and

produce gaurava.

e) Alasya- It means inactiveness. Due to gaurava and srotovarodha,

patient becomes unenthusiastic.

f) Jwara- Ama and vitiated doshas expel the agni from its normal place

resulting in santapa.

g) Apaka- Hypo functioning of rasadhatwaghni arises as a consequence

of impaired function of jataragni. This condition leads to apaka.

Page 32


h) Shoonatanga- This is nothing but sandhi shotha.

Table No.1

Samanya lakshanas of Amavata:

Samanya lakshanas

M.N G.N H.S R.R.S

Angamarda + + _ _

Aruchi + _ _ _

Trishna + _ _ _

Alasya + _ _ _

Gaurava + _ _ _

Jwara + _ + _

Apaka + _ _ _

Agnimandhya + _ + +

Sandhishoola _ _ _ +

Yoga Ratnakara, Vangasena & Brihat yoga tarangini also mentioned the symptoms as

said by Madhavakara.

Vishishta lakshana24:

These symptoms indicate the anubandha of doshas. Those are:

a) Vatanubandha- Predominantly shoola is found in the affected sandhies.

b) Pittanubandha- Raga and daha will be predominant in the affected sandhies.

c) Kaphanubandha- Sthaimitya, bahukandu are the predominant symptoms.

Page 33


Pravriddha Amavata lakshanas:

As the disease progresses, due to the involvement of tridoshas, a number of

other symptoms will develop with complications. The different opinions mentioned in

various texts are follows:

Table No.2

Pravriddha lakshanas of Amavata:

Pravriddha Amavata lakshanas

M.N H.S B.R

Sandhi shoola + + _

Sandhi shotha + + _

Agnimandhya + _ _

Praseka + _ _

Aruchi + _ _

Gaurava + _ _

Utsaha hani + _ _

Asyavairasya + _ _

Daha + _ _

Bahumootrata + _ _

Page 34


Kukshi katinata + _ _

Kukshi shoola + _ _

Nidra viparyaya + _ _

Trishna + _ _

Chardi + _ _

Bhrama + _ _

Moorcha + _ _

Hridgraha + _ _

Malabhaddata + _ _

Jadya + _ _

Antrakoojana + _ _

Anaha + _ _

Grahani dosha _ _ _

Anga vaikalya _ + _

Peeta mootrata _ _ +

Takra tulya mootra

_ _ +

Vasa tulya motra _ _ +

Gada nigraha, Bhava Prakasha, Brihat yoga tarangini, Vangasena and Yoga

Ratnakara have mentioned the same features as said in Madhava Nidana.

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CLASSIFICATION OF AMAVATA

The disease Amavata has been classified on the basis of anubandha of

dosha, severity and mode of manifestation of the disease.

A) Classification according to anubandha of dosha57 :

On the basis of anubandha of dosha it has been classified into the following

varieties;

1. Anubandha of one dosha:

a) Vatanuga b) Pittanuga c) Kaphanuga

2. Anubandha of two dosha :

a) Vata-pittanuga b) Vata-Kaphanuga c) pitta-kaphanuga

3. Involvement of all the three doshas :

Tridoshaja

The symptoms of three varieties of one dosha anubandha Amavata is

explained in vishista lakshanas of Amavata previously. Mixed symptoms are seen in

other types of Amavata according to the dominance of dosha.

B) Classification according to the severity of the disease :

On the basis of severity, it may be classified into two stages.

1. Samanya amavata (prarambavasta)

2. Pravriddha Amavata. (pravrudhavasta)

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In the samanya Amavata stage, the symptoms are more or less general, and

less severe and not associated with upadrava, contrary to the stage of pravridha

amavata.

C) Classification according to the clinical manifestation :

A unique classification of Amavata is explained by Harita based on

presentation of the disease58.

Those are as follows:

1. Vistambi 2. Gulmee 3. Snehi 4. Pakvama 5. Sarvanga

1. Vistambi :

This type is present with constipation, feeling of heaviness in the

abdomen, flatulence pain in the basti area.

2. Gulmee Amavata :

Audible peristaltic sounds, squeezing type of pain in the abdomen

simulating gulma are the symptoms

3. Snehi Amavata :

Unctuousness in the body, inactivity, loss of appetite, passing of unctuous,

undigested and dehydrated stools59.

4. Pakvama :

The symptoms are passing the yellowish black or dark dullish dehydrated

pakvama from the anus, fatigue, exhaustion. The condition is not associated with basti

shoola60.

5. Sarvanga Amavata :

Page 37


Pricking type of pain in kati-prushta and vaksha region, pain in the basti

region, audible peristaltic sounds, swelling, heaviness in the head, excessive excretion

of ama are the symptoms61.

UPADRAVA

The disease which appears as a continuation of and after the complete

manifestation of the original disease is called “upadrava”. Or in other words, the

occurrence of other disease in the wake of primary disease, as a complication is

known as “upadrava”27.

According to Madhavakara, it is a secondary disease or complication,

produced by the same dosha which is responsible for the formation of main disease28.

There exists some difference of opinion regarding the upadrva of Amavata.

Vachaspati opines that the symptoms of advanced stage of Amavata are itself the

upadrava. According to Vijayarakshita, sankocha and khanjata are the upadravas.

Vachaspati considered different vata vyadhis dealt in vata vyadhi nidana chapter as

additional upadravas. Hartita mentioned angavaikalya as the lakshana of Amavata,

which can be considered as upadrava of disease. The following upadravas are dealt in

Ayurvedic literature-

1. Sankocha: Inability to extend the limb or abnormal flexed state of limb is

termed as sankocha29.

Yogaratnakara explained this as “Vikunchana”.

Sankocha can occur in any srotas or any part of the body where ama and vitiated

vata travels.

2. Khanjata: Patients gait is altered because of pain, caused by akshepana of

khandara, which is situated in the sakthi by katigata vata30.

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3. Vataroga: Vachaspthi opines all vatavyadhis are the upadravas which may

leads to ‘stabda gatrata’ i.e., restricted movement of joints, or anga vaikalya i.e.,

deformity of joints.

4. Hridaya vikruti: Heart is involved before the manifestation of disease, as ama

produced in amashaya reaches the hridaya, before moving towards the joints.

Sankocha and also stabdhata can also manifest in some parts of hridaya. This vikara

may be cited as an example of angavaikalya.

UPASHAYA – AANUPASHAYA

In classics there are no direct references regarding Upasha and Anupashaya of

Amavata except Hareeta who mentioned that cold water bath increases the condition.

Ama is the important factor in the production of Amavata .Hence the dravyas which

are antagonistic to the nature of ama, are to be considered as Upashaya of Amavata.

So katu rasa, rooksha guna and ushna veerya drugs, rooksha sweda, rooksha upanaha

along with this, langhana and ushna kala are reckoned to be Upashayas.

Bhavamishra, while describing the Samavayu stated that, Samavayu gets

increased by the use of sneha dravyas, during cloudy seasons, night and early

morning. This principle is applicable to Amavata also. Dravyas having guru guna,

sheeta guna and madhura rasa cause the aggravation of Amavata. Along with this, all

nidanas of Amavata are also anupashayas of Amavata.

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SADHYA – ASADHYATA

Regarding the sadhyasadhata of Amavata all the authors have considered only

the number of doshas involved and the extension of shotha to all the sandhies. If the

disease Amavata involves only one dosha, it can be considered as sadhya. It becomes

yapya if it involves two doshas. If all the sandhies are affected by shotha and all the

three doshas are involved in Amavata, with its upadrava, then it is said to be

asadhya31.

If Amavata is of recent onset, it is curable with minimum efforts. If it becomes

chronic, it becomes krichrasadhya or yapya probably due to extensive damage or

irreversible structural changes. Such condition may either disable the patient or lead

to be accompanied with some complications.

The disease Amavata is considerd as krichrasadhya only because sandhies are

considered as adhistana and vyaktasthana in Amavata. As the disease Amavata

progresses, there is a tendency for it to spread to the sandhies of hasta, pada, shiras,

gulfa, trika, janu and ooru. In classics it is said that “sakashtaha sarvaroganam yada

prakupito bhavet”. This denotes that, among all the diseases, Amavata is difficult to

manage in its advanced stage.

Page 40


Page 41


AMAVATA CHIKITHSA

In Ayurveda, there is emphasis on a therapeutic programme for managing the

patients of Amavata instead of a single drug therapy. This therapeutic programme is

more or less etiologically oriented and aimed at samprapti vighatana. This line of

treatment depends a good deal on the stage of the disease process.

Chakradatta was the pioneer book in describing the principles of treatment for

the disease, which are: Langhana, svedana, administration of drugs having tikta, katu

rasa and deepana action, virechana, snehapana and basti.

Same line of treatment is adopted in Yoga ratnakara and Gada nigraha,

Yogaratnakara and Bhava prakasha have added ruksha upanaha to these therapeutic

measures32.

LANGHANA

Langhana is adopted first in the management of Amavata. Following concepts

substantiate the usefulness of langhana in Amavata. All types of langhana are

beneficial in rasaja vikaras33

Rasadhatu is mainly involved in Amavata.

Langhana treatment is advised in amashayotta vyadhi34.

Ama in Amavata has its origin from amashaya. Langhana also pacifies the

amavikaras35.

Langhana is also indicated in samavata, samapitta, and samakapha conditions36.

Page 41


After examining desha, kala, dosha etc. these measures can be adopted in

amaja vikaras. In alpa dosha condition –langhana, Madhya dosha condition –

langhana and pachana and in prabhuta dosha condition – shodhana.

In Amavata, ama is involved in prabhuta matra and has samavata condition, for

which langhana should be done first. Because it has been described that samadosha

cannot be eliminated until and unless ama attains the pakva form37 which can be

attained by langhana

Langhana in the form of upavasa is advised in cases of amajanya vikaras38.

SWEDANA

The therapy which does nigraha, gaurava nigraha, sheeta nigraha along with

the production of sweda is known as “swedana”.

In Amavata, ruksha sweda has been advocated in the form of valuka putaka39

this can be substantiated by Charaka’s vision that if vitiated vatadosha locates in

kapha sthana first rooksha sweda should be done40.

Swedana help in cleaning the doshas and thus aids in the transportation of

doshas from shaka to kosta.

It has been indicated in the condition of stamba, gourava, sheeta and shoola41 which

constitutes the predominant feature of Amavata.

Swedana is also advised in the line of treatment of samadosha, which has

spread through out the body, to attain niramavastha, to facilitate shodhana42.

Page 42


In Amavata as doshas take stanasamshraya, in sandhis and disease process is

confined to joints, stanika sweda can be given and if there is involvement of

sarvashareera, sarvanga sweda can be done.

TIKTA, KATU AND DEEPANA DRUGS

The rationality behind usage of tikta, katu and deepana drugs are as follows:

Tikta rasa has rooksha and laghu gunas. It does lekhana as well as deepana

and pachana. It is beneficial in conditions like, aruchi thrushna, moorcha and jwara. It

absorbs the kleda and shleshma43.

Katu rasa is having laghu, ushna and rooksha gunas. It also has properties like

deepana pachana and rochana so it dilates the srotases. It dries up sneha, kleda and

mala and is beneficial in shotha44.

As agni vikriti is the main factor for Amavata, so administration of deepana

drugs helps to increase the appetite. These drugs have theeksna, ushna, langhana and

agneya properties.

These tikta, katu and deepana drugs are proved to be effective in the disease

Amavata, which is due to their ama pachana property.

VIRECHANA

After the administration of langhana, swedana and tikta, katu and deepana

drugs, the patient should be subjected to virechana therapy becouse the doshas rendered

nirama by these therapeutic measures require elimination from the body by shodhana45.

Shodhana should be adopted in prabhutha ama condition46.

Page 43


The virechana drugs expel the sanghata doshas after liquefying them by

reaching through dhamanis due to their properties like ushna, teekshna, sukshma,

vyavayee, vikasi and adhobagahara prabhava47.

The virechana drug acts by following manner. Sara guna causes anulomana,

sukshma guna is responsible for reaching minute channels. Teekshna guna produces

rapid dosha sravana and ushna guna eliminates soumya dravyas48.

The virechana does the adhomarga anulomana and vimarga nirharana of

vata49.

It also produces agni deepti, dhatu sthirata, increase in bala and sroto shudhi50.

Thus virechana has advantage on ama, vata and agni.

SNEHAPANA

After langanadi therapies, the patient should be subjected to snehapana, to

pacify the vata, but only after attaining nirama avastha51.

Snehapana has been stated to augment the agni, as it influences the digestion

by softening the food and stimulating the agni52 which is the primary requirement in

Amavata.

Further more, sneha is said to be supreme in the treatment of vata predominant

disorders53.

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BASTI

In Amavata both anuvasana as well as niruha basti have been advocated. Chakradatta

advised saindhavadi taila for anuvasana and kshara basti for niruha. Administration of

anuvasana basti followed by niruha basti by various snehas has good control on

Amavata.

Shodhana bastis are considered to be beneficial in ama condition51.

The administered basti dravyas reaches nabhi- kati- parshava and kukshi. By

staying there itself, it acts through its veerya and spreads to different parts of body,

quickly through the srotasas and is able to eliminate or palliate the doshas54.

As vata is responsible for the location of diseases in shaka, koshta, marma and

different avayavas, basti is considered as best one to control the vata.

Basti can be adopted in conditions like stabdhata, sankocha, sandhi muktata, vigrahita

purisha, shoola, aruchi and in conditions where vata is present in shakas. In shudha

vata condition anuvasana basti is indicated.

Besides this, niruha basti does the sroto shuddhi and is useful in all stages of

the disease55.

It facilitates lekhana along with shodhana and expels the dravikrita doshas56.

Page 45


Table No. 3 Line of treatment according to different texts:

Name of the

treatment

C.D B.P Y.R B.Y.T B.R

Langhana + + + + +

Swedana + + + + +

Tikta + + + + +

Deepana + + + + +

katu + + + + +

Virechana + + + + +

Snehapana + + + + +

Basti + + + + +

Table No.4 Different Yogas for Amavata mentioned in different texts:

Name of the Yoga C.D B.P Y.R Bh.R Kwathas

Rasonadi kashaya + Rasna panchaka kwatha + + + + Pippalyadi kwatha + + Shatyadi kwatha + + + + Rasna saptaka kwatha + + + + Maharasnadi kwatha + + Rasnadi dashamoola kwatha + + + Rasna dwadasha kwatha + Dashamooladi kwatha + + Shuntyadi kwatha + + Punarnava kashaya +

Choornas Nagara choorna + + + + Panchakola choorna + + +

Page 46


Amritadi choorna + + Vaishvanara choorna + + + Alambushadi choorna + + + Shatapushpadi choorna + Hingwadi choorna + + + Pathyadi choorna + + Pippalyadi choorna + Chitrakadi choorna + + + Punarnavadi choorna + + Apeetaka choorna + Palatrikadi choorna + Panchasama choorna + Ajamodadi choorna + Bhallatakadi choorna + Trivritadi choorna +

Ghritas Shunti dhanyaka ghrita + Shunti ghrita + + + + Kanjikadhya ghrita + Shringaberadya ghrita + Amrita ghrita + Kanji shatpala ghrita +

Tailas Eranda taila + + Prasarini taila + + Dwipanchamoola taila + Brihat saindhavadi taila + + + Saindhavadi taila +

Kalka Shatyadi kalka +

Avalehya Khandashunti avalehya + +

Gutikas Ajamodiadi vati + + + Yogaraja guggulu + + + Simhanada guggulu + + + Brihat simhanada guggulu +

Page 47


Vatari guggulu + Shiva guggulu + Amavatari vatika + Brihat yogaraja guggulu +

Rasayogas Amavata vidhwamsini rasa + Amavatari rasa + Vata gajendra simha rasa + Amavateshwara rasa +

Vyavachedaka Nidana

Usually diseases are recognized by their signs and symptoms. But it is often

seen that a few particular signs and symptoms appear in more than one disease. In

such conditions, to avoid error in adopting the line of treatment, the differential

diagnosis can be done on the basis of few points such as difference in nidana,

samprapti, lakshana etc.

Table No.5

Differential Diagnosis for Amavata:

Particulars Amavata Vatashonita Sandhigata vata

Age Mainly children and young adults

Generally between 20-40 years

Generally over 40 years

Onset Acute rarely, Gradual

Gradual but sometimes acute

Always gradual

Causative factors Ama and vata Vata and rakta Vata alone Joints primarily

involved Joints in which

three bones meet i.e. large joints like

knee, elbow etc.

Small joints like metacarpals and

metatarsals specifically leg toe

Any of the weight

bearing joints

Page 48


Involvement of the heart

Heart is involved even before the

joints

Heart is rarely involved as a later

complication

Heart is not at all involved

Joint lesion Inflammatory condition

Inflammation with burning sensation and discoloration

Degenerative changes

Features of arthritis

Type of pain Vrischika damshavat

Aku vishavat Not specific

Exacerbations and remissions

Cold and cloudy climate and

remission in hot climate

Not specific After exercise and remission

in rest

Symmetrical involvement of

joints

Symmetrical, as in clinical observation

Asymmetrical Asymmetrical

Shifting character Exhibits Not Not Morning stiffness Characteristic

feature Absent Absent

Deformity of joint As a complication at a later stage

Common Occasionally

Color changes of skin in the affected

part

Occasionally red Tamra varna, syava or lohita

No changes

Skin ulcers Absent In later stage Absent Agnimandya Characteristic

feature Somewhat present

Sleep Disturbed Generally not disturbed

Not disturbed

Fever Present Occasionally low grade

Absent

Aruchi Present Occasionally present

Absent

Gaurava Present Absent Absent Polyuria Present Absent Absent Thirst Increased Normal Normal

Angamarda Present Absent Absent

Sneha abyanga Symptoms Symptoms subsides Symptoms

Page 49


increases subsides Treatment in the

initial stage Deepana and

Pachana Sneha prayoga Sneha

prayoga Raktamokshana Not indicated Indicated Not indicated

One of the most important symptoms of Amavata is jwara. Jwara is also found

as an upadrava vyadhi in many other diseases also. Beyond this, jwara appears as an

independent vyadhi also. There is ample chance of confusion in differentiating

symptomatic jwara and independent jwara. So the differential diagnosis of

independent jwara and symptomatic jwara in Amavata needs special attention. In

every aspect, these two diseases exhibit much resemblance. Like Amavata, the main

causative factor of jwara is ama, which is formed due to the impairment of jataragni.

Jwara roga also posses most of the symptoms of Amavata.

In both there will be agnimandya, angamarda, aruchi, trishna, alasya, gaurava

and increased temperature. The only characteristic feature which differentiates

Amavata from jwara roga is polyarthritis with intense pain found in former. There is

clear cut premonitory signs and symptoms for jwara roga. In the case of Amavata,

there are no such clear cut premonitory signs and symptoms.

Even the disease kroshtukasheersha resembles the features of Amavata with

shotha and shoola. But these features will be seen in janu sandhi and shotha resembles

the head of jackal. In kroshtukasheersha, vata and rakta are involved. The disease

subsides by abyanga, sweda and aggravates by rooksha sweda and laghu ahara.

Page 50


PATHYAPATHYA

The term pathya has been defined as the thing which is beneficial to the body

and mind. Disease can be cured only by adopting pathya which comprises of

wholesome ahara and vihara. But without following pathya any amount of medicines

may not help in curing the disease. In classics pathya is used as a synonym of chikitsa.

Apathya is described as the thing which is incompatible or not suitable to the body

and mind.

While explaining about the relevance of pathya it is mentioned that if a person

follows pathya then there is no necessity for him to take the medicine. On the contrary

if one does not follow pathya, there is no use even if he takes medicine, thus

highlighting the importance of pathya in the treatment aspects.

Recent medical discoveries have shown that food can reduce inflammation

which is a key process in rheumatic afflictions. Leading arthritis specialists believes

that faulty diet may be at the root of these diseases and that correcting, it can relive

the symptoms. Studies also show that pathya can be a very real fighter of these

diseases.

Page 51


Table No.6

Pathyaapathya in Amavata:

Auther’s name Pathyas Apathyas

B.P. Madyamakanda

(24/19,24/57)

Shushkamoola

yoosha,kanjee with shunti

choorna, eranda beeja

payasa

Chakradutta (25/2) water medicated with

panchakola for drinking.

Y.R.Madyama khanda

(27/77-78).

Kulatta yoosha, yava,

shyamaka, kodrava,

raktashali, shigru,

punarnava, karavellaka,

patola, jangala mamsa,

gomootra, hot water with

ardraka, lashuna along

with takra.

Dadhi matsya, guda,

ksheera, masha, pista,

dusta

jala,sheetodaka,taila,

anoopamamsa, poorva

vata, virudha ahara,

asatmya bhojana,

vishamashana,

vegavarodha,

jagarana, guru,pichila

and abhishyanda

aharas.

Hareeta samhita All shimbi dyanyas

and cold water bath

Page 52


MODERN DISEASE REVIEW (COMPARITIVE STUDY)

As per modern system, there are about 20 diseases which produce either

inflammatory or degenerative changes in the joints. So, it is a difficult task to

correlate a particular disease described in Ayurvedic system to that of modern system.

In fact, each of the joint diseases described in Ayurveda includes a group of diseases

described in modern medicine.

Acharyas state that even though the doshas and dushyas involved in different

diseases are the same, due to the variation in dosha- dushya sammurchana and

rogadhistana, lakshanas, the diseases have become countless or innumerable. They

also stated that a physician may not necessarily know the name of the disease for

treating. The treatment is the restoration of doshas and dushyas into normal state.

Moreover, during the course of time (parinama of kala), changes may take place on

man as well as nature itself. At that time the existing disease may vanish or even the

nature of the existing disease may change to other form.

So, even though we cannot include all the joint disorders which are described

in modern medicine to that of four joint disorders in Ayurveda i.e. Amavata,

Vatashonita, Kroshtukasheersha and Sandhigata vata. but it doesn’t matter as we can

treat all the diseases according to the basic principles of Ayurveda.

If Amavata is studied in modern view, it becomes apparent that it can never be

exactly equated to a particular disease but it includes group of diseases described in

modern system of medicine.

Page 53


Rheumatoid arthritis64:

Rheumatoid arthritis appears to be an ‘auto immune’ disease. Auto antibodies

to the Fe portion of immunoglobulin G molecules or rheumatoid factors are produced

by B- lymphocytes in the blood and synovial tissues of almost all RA patients. Such

cases are termed seropositive.

Rheumatoid arthritis commonly occurs in adults of age group 20-40 years. The

onset is gradual and insidious. But in children, it may be quite acute, with multiple

arthritis, fever, leucocytosis, enlargement of spleen and lymph nodes, a condition

known as ‘stills disease’. This clinical pattern is truly “Juvenile”, its occurrence in

adults being unusual.

The pathogenic hallmark of RA is synovial membrane proliferation and

outgrowth associated with erosion of articular cartilage and sub chondral bone. In RA,

increased vascular permeability and phagocytosis of the immune complexes by

phagocytic cells are seen. Aggravations of immune complexes within

polymorphonuclear leucocytes are often seen in rheumatoid synovial fluid and have

been termed ‘RA Cells’ or ‘ragocytes’.

Hypertrophy of the synovial membrane of the joints occurs with the formation

of lymphoid follicles resembling an immunologically active lymph node.

Inflammatory granulation tissue is formed, spreading over and under the articular

cartilage which is progressively eroded and destroyed. Later, fibrous adhesions may

form between the layers of inflamed tissues across the joint space and fibrous or bony

ankylosis may occur. Similar granulomatous lesions may occur in the pleura, lung,

Page 54


pericardium and sclera. Immunofluroscence shows that plasma cells in the synovium

and lymph nodes synthesize rheumatoid factors.

The cardinal features of rheumatoid arthritis:

I. Joints commonly involved – Meta carpophalangeal, Proximal inter phalangeal

joints, Wrists and Knees. (ref: Davidson)

II. Swelling (soft tissue) of three or more joints.

III. Age: majority between 20-45 years with peak at 35-40 years. (ref : Golwalla

medicine 7th ed.)

IV. Sex: more in females, 3:1 ratio.

V. Morning stiffness – it is the characteristic feature of RA as it is found in all

kinds of active inflammatory arthritis.

VI. Pain, stiffness and symmetrical swelling of a number of peripheral joints.

VII. The course of disease is prolonged with exacerbations and remission, but

atypical, asymmetrical forms are not uncommon. (ref Davidson)

VIII. Serum rheumatoid factor will be present.

IX. Subcutaneous nodules present in aggravated stage.

If we examine the symptoms of Rheumatoid arthritis and Amavata, we can

observe some resemblance among these two which are as follows –

• Joint involvement – initially bigger joints as well as smaller joints in later

stage.

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• Age –Even though classically not mentioned, both the diseases are

practically observed between the age group of 20 – 45 yrs.

• Morning stiffness – present in both diseases. Textual description about

‘morning’ stiffness in Amavata, is not available but clinically observed.

• Symmetrical involvement – this symptom also not explained in classics but

clinically observed in both these diseases.

• Upadrava – deformity of the joints clinically observed in the later stage of

both diseases. In RA, due to inflammatory granulation tissue or pannus is

formed; bony ankylosis in joints is usually seen in chronic case. Even in

Amavata, degenerative and deformity changes are produced in the joints, as

it converts as vata roga at it’s later stage.

• Pericarditis – affliction of heart can be observed clinically in both the cases.

Due to these resemblances in symptoms, one can firmly say that

rheumatoid arthritis is a clinical condition that can be included in Amavata,

but can never be equated to Amavata. Because the dissimilarity of both the

diseases can be list out as below

• RA commonly occurs in women of age group between 20-40 years. It is

three times more common in women than in men. But for Amavata though

generally it seems to affect children and young adults no particular age

group is mentioned in classic treatises for its affliction, it is with no sex

difference.

• In a typical case of RA, the smaller joints of the fingers and toes are the

first to become affected. But in Amavata, the bigger joints in which threee

bones articulate i.e. knee, ankle, elbow or wrists are first affected.

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• Sustained fever is a characteristic feature of Amavata but in RA low grade

pyrexia is uncommonly seen only in active phase of the disease.

• R.A factor will be present in rheumatoid arthritis but in Amavata it may or

may not be present

• In Amavata heart is affected in the initial stage of the disease itself. During

the course of the samprapti itself hridgaurava is produced, and is due to the

inflammation of the layers of the heart (carditis). It is seen that pulse rate

in Amavata patients tends to be out of proportion to the degree of fever

and may persist after the latter has settled. Although carditis probably

occurs in all cases of acute Amavata, this may not develop into chronic

rheumatic heart disease if proper treatment is given in the initial stage

itself. Clinical heart disease due to rheumatoid heart disease is rare.

Exception is Pericarditis which is often sub- clinical.

Systemic Lupus Erythematosus:

This disease possesses clinical feature much similar to that of Amavata. In

both diseases there is migratory poly arthritis. Fever is a feature of both diseases.

Pericarditis may occur in both diseases. Abdominal pain is also present in both

conditions. There will be increased E.S.R, mild or moderate anemia. So we can

conclude that Systemic Lupus Erythematosus is a clinical condition which may

included in differential diagnosis of Amavata.

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Poly arteritis nodosa:

This disease also exhibit close resemblance to Amavata with its characteristic

migratory poly arthritis, high and sustained fever, Pericarditis, abdominal pain etc.

There is similarity in the blood cytology also which shows raided E.S.R level, anemia

and leucocytosis. So it also can be included in Amavata.

The resemblance in the systems of two diseases also means that the dosha-

dushya sthiti of the two diseases in the body are also somehow similar. Ther may be

slight difference in the other predisposing factors like desha, kala, anala, prakriti etc.

When the dosha- dushya sthiti of two diseases are similar, the treatment also

automatically shows resemblance. In this respect, the comparative study of diseases of

both system of medicine is useful.

Rheumatic fever:

Rheumatic fever is another connective tissue disorder which shows much

more resemblance than any other diseases to Amavata.

It is a complication of streptococcal throat infection, characterized by a wide

spread inflammatory reaction of the fibrous tissue of the joints, the heart and other

organs. In spite of its name suggesting an acute arthritis fleeting from joint to joint, it

has been rightly said “Rheumatism is a disease which licks the joints but bites the

heart”.

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The course of the disease in children is some what different from that in the

adults. In children, the joint pain may never appear. The child suffers from tonsillitis

and sore throat which are replaced by chorea, and finally a heart murmur is

discovered. In the adult, the intensely painful swelling of the joint is much more

characteristic, fever is higher and skin lesions are very much rarer. It must be

emphasized that rheumatic fever is principally a disease of childhood, about 75% of

the disease occur before the age of 20 years. Conversely, about 95% of the heart

diseases in children are rheumatic.

The etiology of the rheumatic fever has been a matter of confusion and

difference of opinion for many years. A relationship with group A- beta haemolytic

streptococcal infection was rarely recognized. But these organisms could never be

demonstrated in the cardiac or joint lesions. Group A- haemolytic streptococci in the

throat are believed to sensitize the tissue of the heart and joints, the prosthetic groups

in the organisms uniting with connective tissue protein to create an antigen. This in

tern excites the formation of specific antibodies, the reaction of the two resulting in a

focal allergic necrosis accompanied by a characteristic cellular response.

It would appear that a genetic constitution has a distinct role in the

pathogenesis of rheumatic fever. Of the major clinical manifestations (polyarthritis,

carditis and chorea) some appear in some people, rest in others.

Pathology is seen in the connective tissues of the body like joints, muscles,

tendons, heart valves, sub cutaneous tissues and blood vessels. In the exudative stage

there is hyperaemia, oedema of collagen tissue and infiltration with leucocytes. The

Page 59


hallmark of rheumatic fever is the ‘Aschoff nodules’ which may be found in the

interstitial tissues of any part of the heart, most frequently under the endocardium.

Many of the clinical features which resembles with Amavata are discussed

below:

Joints - Both in Amavata and rheumatic fever, large joints are first affected. The

characteristic migrating polyarthritis of rheumatic fever is met in Amavata also.

Rheumatic fever produces no residual effects in the joints once the acute attack is

over. In Amavata also no deformity is produced in the joints, until it converts in to

vataroga.

Fever – High and sustained fever is a common feature of both Amavata and

rheumatic fever.

Carditis – One of the important symptom of rheumatic fever is carditis i.e.

inflammation of heart. It may be in the inner lining of the heart, the valves, the cardiac

muscle or the pericardium. It is now recognized that it is the heart rather than the

joints which is first affected. If we observe Amavata, we can find that the heart is

affected even before the manifestation of the general symptoms of the disease.

During the samprapti period itself hridgaurava is produced in Amavata. Hridgaurava

may lead to hridgraha. Thus in the case of cardiac involvement rheumatic fever and

Amavata exhibit much resemblance.

Polyurea – Polyurea is feature of rheumatic fever, corresponding to this

‘bahumootrata’ is seen in Amavata.

Abdominal pain – Severe abdominal pain is present in rheumatic fever, similarly

‘koshta shoola’ is a major symptom of Amavata.

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Age - Rheumatic fever mainly affects children and young adults. Even if nothing is

mentioned about the age groups for the affliction of Amavata, it is mainly confined to

children and young adults.

Other general features of rheumatic fever such as malaise, anorexia, loss of

weight , constipation, loss of appetite, excessive thirst etc. are seen in Amavata

patients also.

The brain may be affected in rheumatic fever and the patient suffers from

chorea with its involuntary and uncoordinated muscular movements. Even if nothing

is mentioned about this type of involuntary movements or allied symptoms in

Amavata patients, they also exhibit symptoms which are confined to brain like brama

and moorcha.

Sub cutaneous nodules are seen occasionally in rheumatic fever patients.

Nothing is mentioned about the occurrence of granti or arbuda in Amavata patients.

Erythema marginatum is seen in some cases of rheumatic fever. Nothing is mentioned

about twak vikara in Amavata patients. But we should note one thing that after

describing several complications of Amavata, Madhavacharya says ‘many other

complications which are not described could also occur in Amavata patients’.

Many of the physicians opine rheumatoid arthritis is the disease Amavata due

to some similarities of these two. Where as many others opine rheumatic fever as

Amavata, due to some other resemblance symptoms. But with the thorough study of

theoretical and clinical observation, we can not equate any of these diseases to

Amavata. But rheumatic fever has got relatively much more resemblance to Amavata.

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The concept of Valuka sweda (Ruksha sweda)

Valuka sweda is a dry or ruksha type of sweda used in kaphaja disorders as

well as in the disease originated out of ama, especially indicated in Amavata disease

by almost all the authors who have dealt with it.

Valuka means sand. valuka sweda is a process in which the fine white cloth,

tied properly as bolus, with sand init and it is to be warmed and applied over the

affected part of the body. According to Charaka, it is a type of sankara sweda. As it is

ruksha type, since the used material is sand, it comes under ‘ruksha sankara sweda’.

According to Sushruta it is a type of ‘tapa sweda’, wherein the valuka will be

sufficiently warmed and then applied on the affected part of the body. It is type of

‘Ekanga sweda’.

According to Dalhana, the commentator of Sushruta, valuka sweda may be

included under ‘samshamaneeya sweda’, as this sweda is used for pachana kriya or

for the digestion of sama doshas and it is dry in nature, it stimulates the agni

(dhatwagni) and clears the srotas from malas.

It is a type of ‘bahya sweda’ according to avatantra bheda of sweda.

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PROCEEDURE OF CONDUCTING THE VALUKA SWEDA

The procedure is mentioned in Charaka and Sushruta. The procedure of

conducting the valuka sweda is very simple, easy to do without much strain, cost

effective and it also gives good result.

The procedure of conducting valuka sweda includes-

• Pre-operative procedure

• Operative procedure

• Post- operative procedure

Pre- operative procedure includes:

a) Collection of the materials:

Pure, uniformly sized, clean sand should be taken. It should be warmed to the

required tolerance of the heat by the patient, by a uniform flame on a clean pan.

This warm sand is then taken in the required size of the clean, white cloth and tied

firmly to make the bolus of the required size, either one or more in number.

Required drugs like chandana, hemagarbha, chandrakala, jatyadi malahara,

jatyadi taila etc. are collected to overcome the sequel of sudation, if there are any.

b) Preparation of the patient:

First the physician should decide whether the patient and the disease he is

suffering from, is indicated for valuka sweda or not. After this the sudation is

applied on the affected part of the patient with due regards to the season, rogi bala,

roga bala, organ affected, age of the patient etc.

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After the daily routines in the morning, the patient should be asked to

sit or lie down in a comfortable position. The part such as eyes, heart etc. should

be covered with kamala patra or wet cloth or simply by the touch of cold hands.

Before administration of swedana, the patients body temperature,

blood pressure, pulse rate, heart beats should be recorded. Then, the fomentation

should be applied to the parts affected according to the need of the individual.

Operative procedure:

The warm sand bolus of the required temperature should be applied on

the affected parts of the body. The sweda is to be conducted according to the pinda

sweda either in sitting posture or in whichever posture the patient feels comfortable.

In the joints the sweda should be done comfortably in circular manner. The

temperature of the bolus must be maintained uniformly so that the patient should not

feel discomfort either by more heat or less heat. If the sand becomes cold, the bolus

must be changed and again a warm bolus should be applied on the affected part, till

the local symptoms are reduced, or when the patient feels satisfied. In each affected

part, usually sweda is done for 10-15 minutes.

Duration of the treatment:

The sweda can be done either one or two or more times daily depending upon

the severity of the disease. The valuka sweda can be done either seven or fourteen or

twenty one day continuously

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Observation:

The patient should be observed for proper or improper or excessive sudation.

In case of excessive sudation, immediately the proper treatment should be adopted.

Post- operative procedure:

Soon after sudation, the patient should not be allowed to drink or touch the cold

water. He should not be exposed to cold. The patient must be asked to take rest

for some time and then he must be allowed to take hot water bath to remove

sweat from body, then he must be given light food.

Diet and regimen:

During the course of the treatment the patient should not-

Take cold things, expose to sunlight, heavy exercise, suppression of natural

urges, excessive thinking.

SAMYAKSWINNA LAXANA:

By proper sudation the following signs and symptoms will be in a patient62.

1. Coldness in the body will be stopped.

2. Alleviation of pain.

3. Stiffness of body will disappear.

4. Heaviness of the body will be reduced.

5. Softness of the body will be seen.

6. Appearance of sweating will be visible.

7. signs and symptoms of the disease will decrease or disappear.

8. Patient will have a liking towards cold things.

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ASWINNA LAXANA:

The following signs and symptoms are observed in a patient who has undergone

less or improper sudation therapy.

1. Sweating will not come out from the body.

2. Coldness will not be reduced in the body.

3. Pain will not get reduced.

4. There will be increase in the laxanas of vyadhi.

5. Occurrence of prodromal sweating will be delayed.

Here, aiimost the opposite signs and symptoms of proper sudation will be

observed

ATHISWINNA LAXANA:

The following are the signs and symptoms of excessive sudation63.

1. Aggravation of pitta.

2. Fainting.

3. Burning sensation.

4. Pain in the joints.

5. Weakness of voice.

6. Fever.

7. Eruptions or cracks.

8. Thirst.

9. Prostration.

10. Aggravation of Rakta.

11. Circular eruptions having bluish red colour.

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TREATMENT IN CASE OF EXESSIVE SUDATION:

Here, in case of excessive sudation the treatment that is being adopted in

Greeshma ritu must be adopted like:-

1. The food which is madhura, sheetha, drava, snigdha is to be given.

2. Juice made of cold water and sugar should be drunk

3. Lavana, Amla, ushna katu dravyas should not be used.

4. The patient should be kept in sheetha gruha(air condition room).

5. His body should be smeared with chandana.

6. Other treatment which reduces pitta and rakta should be adopted.

7. In case of execessive sudation which may cause bhrama(giddiness),

moorcha(fainting), data(thirst), etc., The treatment for respective disease

should be immediately administered.

8. In case of spota(blisters) or vrana(ulcers) fomentation should be stopped

immidiatly and jathyadhithila, jathyadhimalam etc., should be applied. In case

of daha and other sequela soothashekara, pravala pisti, shanka basma etc.,

should be advised.

CONTRA INDICATIONS OF SWEDANA

1. Madhyapana-nitya

2. Garbini

3. Rakta pitta

4. Atisara

5. Madhu mehi

6. Vidagdha

7. Brashta Bradhna

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8. Braghna andakoshavidhi

9. Vishapeeta

10. Madhyavikari

11. Srama

12. Sangyanasha

13. Sthoola

14. Pittaja prameha

15. Trishitha

16. Kshudhita

17. Krodha

18. Shokagrasita

19. Kamala

20. Udara-rogi

21. Durbala

22. Kshneena

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DRUG REVIEW

Amavatari rasa is explained in Bhaishajya Ratnavali ‘Amavata chikitsa

adhyaya’. The formulation has 8 drugs.

Drug review contains two parts:

1. Individual drug study.

2. Compound drug study.

1. Individual drug study65:

Contents :( Bh. Rat. Amavata chikitsa )

a) Parada

b) Gandhaka

c) Haritaki

d) Vibhitaki

e) Chitraka

f) Guggulu

g) Eranda

Chitraka:

Botanical name – Plumbago zeylanica

Family – Plumbaginaceae

Gana – Deepaniya (Ch.)

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Properties:

Rasa – Katu

Guna – Laghu, Ruksha, Teekshna

Vipaka – Katu

Veerya – Ushna

Doshagnata – Kapha vata shamaka

Karma – Lekhana, Deepana, Pachana & Jwaraghna

Part used – Moola

Chemical constituents: chitranon, plumbagin, 3 chloroplumbagin, droseron, eliptinon,

isozeylinone, isozeylanone, zeylinon, maritone, plumbagic asid, dihydrosteron,

sitosterol etc.

Amalaki:

Botanical name – Emblica officinalis

Family – Euphorbiaceae

Gana – Vayasthapana, Virechanopaga (Ch.)

Properties:

Rasa – Lavana varjita amla pradhana pancha rasa

Guna – Guru, Ruksha, Sheeta

Vipaka – Madhura

Veerya – Sheeta

Doshagnata – Tridosha shamaka

Karma – Deepaka, Rechaka, Anulomaka, Jwaraghna,

Rasayana

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Part used – Fruit

Chemical constituents: Vit-C, phyllemblin,linolic acid indole acetic acid, ayxumbsm

trigaloyl glucon, terchebin, corilagin,ellagic acid, phyllemblic acid and salts.

Haritaki:

Botanical name – Terminalia chebula

Family – Combretaceae

Gana – Prajasthapana, Jwaraghna (Ch.)

Properties:

Rasa – Lavana varjita kashaya pradhana pancha rasa

Guna – Laghu, Ruksha

Vipaka – Madhura

Veerya – Ushna

Doshagnata – Vata shamaka

Karma – Deepana, Pachana, Mridu rechaka,

Anulomana, Jwaraghna, Rasayana, Yakrit

doshahara, Shotahara, Vedanasthapaka

Part used – Fruit

Chemical constituents: Fruit karnel: arachidic, behenic, lindeic, oleic, palmitic and

stearic acid.

Fruit: antraquinone glycosides, chebulinic acid, tannic acid, terchebin

and vit-C.

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Vibheetaki:

Botanical name – Terminalia bellarica

Family – Combretaceae

Gana – Virechanopaga, Jwaraghna (Ch.)

Properties:

Rasa – Kashaya

Guna – Laghu, Ruksha

Vipaka – Madhura

Veerya – Ushna

Doshagnata – Kapha hara

Karma – Deepana, Anulomana, Jwaraghna, Shotahara,

Vedanasthapaka, Dhatu vardhaka

Part used – Fruit

Chemical constituents: Fruit: fructose, galacton, glucose, manhitol, rhamnose,

siyosterol.

Seed: edible oil.

Seed coat: gallic acid.

Guggulu:

Botanical name – Commiphora mukul

Family – Burseraceae

Gana – Eladi ( Sushruta)

Properties:

Rasa – Tikta, Katu

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Guna – Laghu, Ruksha, Teekshna, Sookshma, Sara,

Vishada, Snigdha

Vipaka – Katu

Veerya – Ushna

Doshagnata – Vata shamaka

Karma – Vatahara, Shothahara, Vedanasthapana,

Vatanulomana, Pittasaraka, Yakrit uttejaka

Part used – Extracted gum

Chemical constituents: The gum resin contains guggul sterones Z and E. it also

containes guggul sterones I-V cembrene A and mukulol.

Investigations of the essential oil from the resin of the plant and found that the

chief components of the essential oil are 64% myrcene 11% dimyrecene and some

polymyrcene.

Eranda:

Botanical name – Ricinus communis

Family – Euphorbaceae

Gana – Bhedaneeya, Swedopaga, Angamarda prashamana

(Ch.)

Properties:

Rasa – Madhura, Katu, Kashaya

Guna – Snigdha, Teekshna, Sookshma,

Vipaka – Madhura

Veerya – Ushna

Doshagnata – Kapha vata shamaka

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Karma – Vatahara, Ama shodhana, Shothahara,

Vedanasthapana, Deepana, Bhedana,

Krimighna, Vatanulomana, Balya,

Vayasthapana, Jwaraghna, Vishaghna

Part used – Moola

Chemical constituents: Seed coat: lupeol, lipid s, phosphatides etc

Seed oil: arachidic, ricinoluc, palmitic, stearic acid etc acids.

Hexa- decanoic, hydrocyanic uric acids, squalem and tocopherols etc

The mineral drugs present in this formulation are Shudda Parada and Shudda

Gandhaka with 1:2 ratio in the form of Kajjali, which has the following properties:-

Deepana, Pachana, Rasayana, Vatanulomana, Vishahara, Amanashaka, Veerya

vriddhikaraka, Jataragni deepaka, Krimighna.

2. Compound drug study:

Method of preparation:

Contents :66

Parada - 1 tola

Gandhaka - 2 tola

Triphala - 3 tola (Equal parts)

Chitraka - 4 tola

Guggulu - 5 tola

Bhavana by Eranda taila.

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Steps are as follows:

1. parada shodana vidhi

2. gandhaka shodhana vidhi

3. chitraka shodhana vidhi

4. guggulu shodhana vidhi

5. preparation of vati.

Parada sodhana vidhi:67

Ingredients required:

I. Parada – 300 gms.

II. Sudha churna – 300 gms.

III. Dehusked lushuna – 300 gms.

IV. Saindava lavana – 150 gms.

Process: Equal quantities of parade and sudha churna were taken into a Khalwa and

triturated for 3 days. The mixture was filtered through two layers cloth and collected

parada was again placed into khalwa and equal quantity of lashuna and half part of

saidhava lavana was added. Trituration process was continued till the lashuna kalka

becomes black. Later all the contents where washed carefully with luke warm water

and purified parada was collected.

Gandhaka shodhana vidhi:68

Ingredients required:

I. Gandhaka – 400 gms.

II. Grutha – 400 gms.

III. Milk – Q S.

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Process: Equal quantities of gandhaka and grutha were taken in to a vessel and

subjected to mild fire. Mean while sufficient quantity of milk was taken into another

vessel and mouth of the vessel was covered with a clean cloth. The cloth was smeared

with ghee.

The melted gandhaka was poured in to the milk through ghee smeared cloth

carefully. The cloth from the vessel was removed and gandhaka was collected, similar

process was repeated for three times. The purified gandhaka was dried and powdered

for further processing.

Chitraka shodhana vidhi:69

Ingredients :

I. Chitraka – 1 kg.

II. Churnodhaka – Q S

Process: Chitraka was immersed in sufficient quantity of churnaodhaka (lime water)

for 24 hours. Later it was dried and powdered to prepare the trial drug.

Guggulu shodhana vidhi:

Ingredients: I Guggulu – 1 kg.

II Triphala – 3 kg.

III Gudduchi – 1kg.

Process: 1 kg Guggulu was collected and external impurities like stone etc were

removed. This guggulu was placed in to a cloth and a pottali was prepared.

The pottali was suspended in the kashaya prepared with triphala and gudduchi

and subjected to heat until whole amount of guggulu enters into the kashaya. The

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pottali was taken out with the residue and the kashaya was allowed to boil until it

becomes solid. This purified guggulu was used to prepare Amavatari rasa

Preparation of Amavatari rasa:

Process: 1 part (150gms) of suddha Parada was added with 2 parts of (300gms)

suddha Gandhaka and Kajjali was prepared by triturating in a khalwa.

5 parts of guggulu was taken into a khalwa and it was pounded well by adding

kajjali and 3 parts (450gms) of Triphala, 4 parts (600gms) of Chitraka. During the

process Eranda taila of required amount was added and pounding was continued until

a soft homogeneous mass formed.

This soft mass was passed through pill cutter to prepare desired size of tablets

(250mg each). The prepared tablets were stored in well closed glass containers.

Dose of medicine : 750mg (3 pills) twice daily in empty stomach.

Anupana : lukewarm water.

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Methodology

METHODOLOGY

MATERIALS AND METHODS: 1. Source of data:

The patients of Amavata fulfilling the criteria of diagnosis were selected for

the study from OPD and IPD of A.L.N.R.Memorial Ayurvedic Medical Hospital,

Koppa. Out of 46 patients, 8 patients were dropped in the initial stage of the study,

remaining 40 patients completed the course of treatment. The dropouts were not

included as the total number of patients in the observation charts and the remaining 40

patients were included in the study.

2. Sampling methods:

The patients presenting with the signs and symptoms of Amavata according to

the Ayurvedic texts with in the age group of 20–60 years, irrespective of sex,

occupation and socio-economic status were selected from IPD and OPD of

A.L.N.R.M. Ayurvedic Medical Hospital, Koppa. The total number of cases selected

for this study will be 40 patients, with 20 patients in each group.

Patients were selected by observations, laboratory investigations and

interrogations by fulfilling the inclusive criteria. The main criteria for the diagnosis

was the presence of clinical symptoms of Amavata like Angamarda, Jwara,

Angashoonatha, Sandhisthaimithya,Alasya, Apaka etc. The symptoms of srotodusti

were also assessed along the main symptoms for the selection of patients.

Page 78

Methodology

a) Inclusion criteria:

Patients fulfilling the following conditions were included for the study.

1. The patients of Amavata diagnosed on the basis of signs and symptoms

described in Ayurvedic classics will be selected for the study.

2. Patients from either sex with in the age group between 20-60 years.

3. Patients without any systemic complications including cardiac complications.

b) Exclusion criteria:

Patients fulfilling the below mentioned conditions were excluded from the study.

1. Those who are suffering from complications of Amavata will be excluded.

2. Rheumatic heart disease, hypertension.

3. Patients who are unfit for Valuka sweda.

c) Laboratory Investigations:

1. Blood – Hb%, ESR, TC, DC, RA and ASLO.

2. Radiological – X ray of affected joints.

All these investigations are done before and after the treatment according to necessity.

3. Study design:

Randamised standard single blind comparative clinical study with pre test and

post test design is adopted.

The patient was registered and treated as out patients for the present study

with the help of case proforma specially designed for the study. All this documents

with subjective and objective parameters are analysed through statistical methods

before and after the treatment.

This clinical study is based on the comparative study of group A and group B.

The response of the drug is assessed weekly through interrogation, signs and

Page 79

Methodology

symptoms. The observations are recorded in the following weeks and the drug was

given for a period of 30 days, follow up period was also given for a period of 30 days.

In the both groups, the patients were advised to follow the pathya ahara and

vihara suitable for this disease.

4. Treatment schedule:

After diagnosis, the selected patients were randomly categorized in to the

following two therapeutic groups. The duration was thirty days regularly.

The interventions were done as follows,

Group A – Administered Amavatari rasa 750mg twice daily in empty stomach for 30

days, with hot water as anupana, followed by dietary measures.

Group B – Administered Amavatari rasa 750mg with hot water as anupana, twice

daily in empty stomach for 30 days with Valuka sweda for 21 days with same dietary

measures.

5. Criteria for assessment of symptoms:

The improvement of patients was assessed on the basis of relief in the signs

and symptoms like sarvadaihika, stanika main symptoms and associated symptoms,

and sroto dusti of disease were assessed with scoring pattern.

To analyse the efficacy of the drug, statistically marks were given to each

symptoms according to the severity present before. The treatment mark 1 was given to

the symptom if, that symptom decreased remarkably after the treatment. 0 mark was

given to the completely relieved symptoms. The symptom showing no remarkable

improvements after the treatment were given 2 marks.

Page 80

Methodology

6. Score of specific symptoms:

Table no 7. Scoring chart

Sl.No:

Symptoms (Sarvadaihika)

BT

AT 1st week

AT 2nd week

AT 3rd week

AT 4th week

AFU 1 month

1. Angamarda 2. Alasya 3. Jwara 4. Angashoonata

Sl.No:

Symptoms (Stanika)

BT

AT 1st week

AT 2nd week

AT 3rd week

AT 4th week

AFU 1 month

1. Daha 2. Raga 3. Shoola 4. Staimithya 5. Kandu

Sl.No:

Associated symptoms

BT

AT 1st week

AT 2nd week

AT 3rd week

AT 4th week

AFU 1 month

1. Aruchi 2. Trushna 3. Apakata

Sl.No:

Sroto dusti BT

AT 1st week

AT 2nd week

AT 3rd week

AT 4th week

AFU 1 month

1. Anna vaha 2. Rasa vaha 3. Majja vaha

Clinical assessment:

Sarvadaihika symptoms:

1. Angamarda Scores

No angamarda 0

Angamarda, can do day to day routines 1

Angamarda, restricts the routines 2

Cannot move due to Angamarda 3

Page 81

Methodology

2. Alasya

No feeling of laziness 0

Daily works did satisfactorily but delayed 1

Doing works unsatisfactorily and delayed 2

Reduces work due to unenthusiasm 3

3. Jwara

Absence of Fever 0

Jwara lakshana, without rise in temperature 1

Jwara lakshana, upto 100o F 2

Jwara above 100o F temperature 3

4. Anga shoonata

No swelling 0

Slight swelling 1

Moderate swelling with pain during movement 2

Severe swelling with immobilization of joints 3

Stanika symptoms:

1. Daha

Absence of daha 0

Lesser feeling of daha 1

More daha 2

Cannot tolerate 3

2. Raga

Absent 0

Mild discolouration 1

Page 82

Methodology

Moderate discolouration 2

Marked redness 3

3. Shoola

No pain 0

Mild/moderate pain during movement 1

Difficulty in moving due to pain 2

Unable to move body parts due to pain 3

4. Sthaimitya

Stiffness absent 0

Stiffness only in early morning 1

Prolonged stiffness for 2 hours 2

Stiffness restricts the daily routines 3

5. Kandu

Itching absent 0

Reduced by scratching 1

Itching all over the day 2

Disturbed sleep, itching persist 3

Associated symptoms:

1. Aruchi

Equal willing towards all food substances 0

Willing towards some specific foods 1

Willing towards only one rasa 2

Willing towards only most liking food 3

Page 83

Methodology

2. Trushna

Quantity of water intake –

1 – 2 litres/24 hrs 0

2 – 3 litres/ 24 hrs 1

3 – 4 litres/ 24 hrs 2

More than 4 litres 3

3. Apakata

Absence of indigestion 0

Feeling hungry 8 hrs after intake of prior food 1

Feeling hungry only 12 hrs after intake of prior food 2

Feeling hungry 24 hrs after intake of prior food 3

Sroto dusti:

No sroto dusti present 0

Only few symptoms of one sroto dusti 1

Many symptoms of 2 or more sroto dusti 2

All symptoms of all involved sroto dusti 3

7. Statistical analysis:

For assessing the improvement of symptomatic relief and to analyse

statistically the observations were recorded before and after the treatment and after

follow up. The mean, percentage, standard deviation, standard error,‘t’ value and ‘p’

value were calculated. Paired‘t’ test was used for the calculation of ‘t’ value. The

totel result including the over all effect of therapy is presented in tables for both

groups.

Page 84

Methodology

8. Assessment of overall effect of therapy:

The overall effect of the therapy was assessed as stated below.

1. Complete relief: Patients in whom all signs and symptoms came down to

normal or 100% relief were considered as complete relief cases.

2. Marked improvement: In whom there was 75% relief in signs and symptoms

were considered to be marked improved cases.

3. Moderate improvement: Patients in whom there was relief in signs and

symptoms by more than 50% were considered to be moderately improved.

4. Improvement: Patients in whom there was relief in signs and symptoms by

more than 25% were considered to be improved.

5. Unchanged: Patients in whom there was no relief or less than 25% relief in

signs and symptoms were considered to be unchanged cases.

Page 85

Methodology

OBSERVATIONS

1. Incidence of age:

Table no:8

Showing the age wise distribution of the 40 Amavata patients:

Age in yrs Group A Group B Total %

20 – 30 10 11 21 52.5

31 – 40 4 4 8 20

41 – 50 4 2 6 15

51 - 60 2 3 5 12.5

Majority of patients of the study belong to the age group to 20- 30 years i.e 52.5%,

followed by 20% in 31-40 age group, 15% in 41-50 age group and 12.5% in 51-60

age group.

Graph no:1

Showing the age wise distribution of the 40 Amavata patients:

0

10

20

30

40

50

60

20-30 31-40 41-50 51-60

Page 86

Methodology

2.Incidence of sex:

Table no:9

Showing the sex wise distribution of the 40 Amavata patients:

Sex Group A Group B Total %

Male 10 9 19 47.5

Female 10 11 21 52.5

As we saw in the table, sex wise females are more prone to get this disease by 52.5%

were as males only up to 47.5%.

Graph no:2

Showing the sex wise distribution of the 40 Amavata patients:

0

10

20

30

40

50

60

70

80

Males Females

Page 87

Methodology

3. Incidence of Religion:

Table no:10

Religion wise distribution of the 40 Amavata patients:

Religion Group A Group B Total %

Hindus 6 7 13 32.5

Christians 5 5 10 25

Muslims 9 8 17 42.5

Above table shows high incidence of Amavata among the Muslims by 42.5%,

followed in the Hindus by 32.5%, and in the Christians by 25%.

Graph no:3

Religion wise distribution of the 40 Amavata patients:

0

10

20

30

40

50

Hindus Christians Muslims

Page 88

Methodology

4. Incidence of Marital status:

Table no:11

Marital status of 40 Amavata patients:

Marital status Group A Group B Total %

Un married 13 9 22 55

Married 7 11 18 45

Very less difference observed in marital status of the patients by 45% and 55% of

married and unmarried respectively.

Graph no:4

Marital status of 40 Amavata patients:

0

10

20

30

40

50

60

Married Unmarried

Page 89

Methodology

5. Incidence of Occupational status:

Table no:12

Occupational status of 40 Amavata patients:

Occupational status

Group A Group B Total %

House wife 4 7 11 27.5 Unemployed 6 4 10 25

Labourer 4 2 6 15 Business 4 1 5 12.5 Official 2 6 8 20

According to the observations it shows that housewives are more prone for Amavata

which was 27.5%. Student category included under unemployed since absence of

unemployed patients, it stays second most in incidence which was 25%, followed by

officials which was 20%. Labour category includes 2 agriculturists, it is having 15%

of incidence. Business category showed 12.5% of incidence.

Graph no:5

Occupational status of 40 Amavata patients:

0

5

10

15

20

25

30

Housewives Unemployed Labour Busness Official

Page 90

Methodology

6. Incidence of Educational status:

Table no:13

Educational status wise distribution of 40 Amavata patients:

Educational status


Graduate 4 7 11 27.5 Primary 6 3 9 22.5

Secondary 3 1 4 10 Uneducated 7 9 16 40

Above table shows more incidences found in uneducated which was 40% as student

category is also included in this. The other categories of graduate, primary, secondary

showed incidence which was 27.5%, 22.5% and 10% respectively.

Graph no:6

Educational status wise distribution of 40 Amavata patients:

0

10

20

30

40

50

Uneducated Primary Secondary Graduate

Page 91

Methodology

7. Incidence of Socio-economic status:

Table no:14

Socio-economic status wise distribution of 40 Amavata patients:

Socio-economic

status


Poor 6 12 18 45 Middle 5 3 8 20 Upper 9 5 14 35

According to our observational study, poor, upper and middle class peoples had the

incidence with 45%, 35%, and 20% respectively.

Graph no:7

Socio-economic status wise distribution of 40 Amavata patients:

0

10

20

30

40

50

Poor Middle Upper

Page 92

Methodology

8. Incidence of family history:

Table no:15

Family history of 40 Amavata patients:

Family

history


+ ve 2 4 6 15

- ve 18 16 34 85

In the present study, 85% of patients have given negative family history, while only

15% of patients given positive history of disease Amavata.

Graph no:8

Family history of 40 Amavata patients:

0

20

40

60

80

100

+ ve - ve

Page 93

Methodology

9. Incidence of diet:

Table no:16

Diet wise distribution of 40 Amavata patients:

Diet Group A Group B Total %

Veg 11 6 17 42.5

Mixed 9 14 23 57.5

Among the 40 patients, 17 were vegetarians i.e 42.5% and 23 were taking mixed diet

i.e 57.5%.

Graph no:9

Diet wise distribution of 40 Amavata patients:

0

20

40

60

Veg Mixed

Page 94

Methodology

10. Incidence of addiction:

Table no:17

Shows incidence of addiction in 40 Amavata patients:

Addiction Group A Group B Total %

Alcohol 4 5 9 22.5

Smoking 9 7 16 40

Tobacco 6 7 13 32.5

Non 1 1 2 5

Observational study indicates smoker were most affected followed by tobacco

consumers, alcohol in takers and very less affected persons were without any

addictions which was 40%, 32.5%, 22.5% and 5% respectively.

Graph no:10

Shows incidence of addiction in 40 Amavata patients:

0

10

20

30

40

Alcohol Smoking Tobacco Non

Page 95

Methodology

11. Incidence of Deha Prakruti:

Table no:18

Prakruti wise distribution of 40 Amavata patients:

Prakruti Group A Group B Total %

Vataja 1 3 4 10

Pittaja 0 0 0 0

Kaphaja 6 3 9 22.5

Vatapittaja 1 2 3 7.5

Kaphavataja 9 5 14 35

Pittakaphaja 1 3 4 10

Sannipataja 2 4 6 15

Above table shows patients of Amavata with kaphavataja deha prakruti had a

incidence rate of 35% and kaphaja with 22.5%. The other prakrutis like vataja, pittaja,

vatapittaja, pittakaphaja and sannipataja are of 10%, 0%, 7.5%, 10% and 15%

respectively.

Graph no:11

Prakruti wise distribution of 40 Amavata patients:

0

10

20

30

40

V P K VP KV PK Sanni

Page 96

Methodology

12. Incidence of Satwa:

Table no:19

Satwa wise distribution of 40 Amavata patients:

Satwa Group A Group B Total %

Pravara 3 3 6 15

Madhyama 5 3 8 20

Avara 12 14 26 65

Among the 40 patients of Amavata 26 have avara satwa i.e 65%, and madhyama and

pravara satwa for 8 and 6 patients i.e 20% and 15% correspondingly.

Graph no:12

Satwa wise distribution of 40 Amavata patients:

0

10

20

30

40

50

60

70

Pravara Madhyama Avara

Page 97

Methodology

13. Incidence based on Kosta Agni:

Table no:20

Agni distribution of 40 Amavata patients:

Agni Group A Group B Total %

Teekshna 1 3 4 10

Mandha 9 15 24 60

Vishama 10 2 12 30

Above table shows that manda agni patients were incidentally high with 60% and

vishamagni with 30%, teekshnagni patients stayed with 10%.

Graph no:13

Agni wise distribution of 40 Amavata patients:

0

10

20

30

40

50

60

70

Teeksna Manda Vishama

Page 98

Methodology

14. Incidence based on Nidana:

Table no:21

Nidana of 40 Amavata patients:

Nidana Group A Group B Total %

Virudha ahara

vihara

20 19 39 97.5

Mandagnikara 20 20 40 100

Nischalata 16 17 33 82.5

Vyayama after

snigdha

bhojana

19 18 37 92.5

Above table shows 100% of patients did Mandagnikara nidana, 97.5% of patients had

under gone Virudha ahara vihara. 92.5% of patients have done Vyayama after the

intake of snigdha bhojana and 82.5% of patients were with,Nischalata.

Chart no:14

Nidana of 40 Amavata patients:

0

20

40

60

80

100

nischlata Mandagnikara virudhaharachesta Vyayama aftersnigdha bhojana

Page 99

Methodology

15. Incidence based on Sarvadaihika main symptoms:

Table no:22

Sarvadihika main symptom wise distribution of 40 patients of Amavata:

Savadihika

main

symptoms


Angamarda 18 17 35 87.5

Alasya 17 16 33 82.5

Jwara 15 18 33 82.5

Angashoonata 20 20 40 100

During the observation of Sarvadaihika main symptoms, all 100% of patients had

Angashoonata 87.5% of patients had Angamarda, and 82% of patients had Alasya and

Jwara.

Graph no15:

Sarvadaihika main symptom wise distribution of 40 patients of Amavata:

50

60

70

80

90

100

Angamarda Alasya Jwara Angashoonata

Page 100

Methodology

16. Incidence based on Stanika main symptoms:

Table no:23

Stanika main symptom wise distribution of 40 patients of Amavata:

Stanika main

symptoms


Daha 5 3 8 20 Raga 4 5 9 22.5

Shoola 13 12 25 62.5 Staimithya 15 16 31 77.5

Kandu 6 4 10 25

In the observation, Stanika main symptoms like Staimithya was present for 77.55

of patients, Shoola in 62.5% of cases, Kandu in 25%, Raga in 22.5% and Daha in

20% of patients.

Graph no:16

Stanika main symptom wise distribution of 40 patients of Amavata:

0

20

40

60

80

Daha Raga Shoola Staimithya Kandu

Page 101

Methodology

17. Incidence based on Associated symptoms:

Table no:24

Associated symptom wise distribution of 40 patients of Amavata:

Associated

symptoms


Aruchi 20 20 40 100

Trushna 06 02 08 20

Apaka 18 17 35 87.5

All patients of Amavata showed Associated symptom Aruchi i.e 100%, where as

Trushna and Apaka symptoms were found only in 20% and 87.5% patients

respectively.

Graph no:17

Associated symptom wise distribution of 40 patients of Amavata:

0

20

40

60

80

100

Aruchi Trushna Apaka

Page 102

Methodology

18. Incidence based on Sroto dusti lakshanas:

Table no:25

Sroto dusti lakshanas of 40 patients of Amavata:

Sroto dusti

lakshanas


Anna vaha 20 20 40 100

Rasa vaha 18 20 38 95

Majja vaha 10 15 25 62.5

This table shows all patients of Amavata had Ann vaha sroto dusti (100%), 38

patients had Rasavaha sroto dusti (95%), and 25 patients had majja vaha sroto dusti

(62.5%)

Chart no:18

Sroto dusti lakshanas of 40 patients of Amavata:

0

20

40

60

80

100

Anna vaha Rasa vaha Majja vaha

Page 103

Results

RESULTS

The results obtained are given below:

Table No:26

I. Effect of Amavatari rasa on the Sarvadaihika main symptoms after the

therapy:

Mean scores Sl

No:

Main

symptoms

(sarvadaihika)

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Anga marda 1.3 0.75 0.55 50 0.604 0.135 4.066 <0.001

2. Alaysa 1.4 0.95 0.45 45 0.510 0.114 3.942 <0.001

3. Jwara 1.25 0.85 0.40 40 0.600 0.135 3.683 <0.010

4. Anga shoonata 1.25 0.65 0.40 40 0.502 0.112 3.559 <0.010

The Amavatari rasa provided highly significant relief (p<0.001) in the

management of Anga marda and Alasya by 50% and 45% respectively. It provided

moderate significant relief (p<0.010) in the management of Jwara and Anga shoonata

by 40% each.

Table No:27

II. Effect of Amavatari rasa on the Sarvadaihika main symptoms after follow

up:

Mean scores Sl

No:

Main

symptoms

(sarvadihika)

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Anga marda 1.3 0.70 0.60 55 0.598 0.133 4.485 <0.001

2. Alaysa 1.4 0.90 0.50 40 0.760 0.170 2.938 <0.010

3. Jwara 1.25 0.75 0.50 45 0.600 0.135 3.683 <0.010

4. Anga

shoonata

1.25 0.75 0.45 45 0.510 0.114 3.942 <0.001

Page 104

Results


management of Angamarda and Anga shoonata by 55% and 45% respectively. It

provided moderate significant relief (p<0.010) in the management of Alasya and

Jwara by 40% and 45% respectively.

Table No:28

III. Effect of Amavatari rasa on the Sthanika main symptoms after therapy:

Mean scores Sl

No:

Main

symptoms

(sarvadihika)

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Daha 1.30 0.70 0.60 50 0.699 0.221 2.713 <0.050

2. Raga 1.30 0.80 0.50 50 0.527 0.166 3.00 <0.050

3. Shoola 1.35 0.85 0.50 40 0.760 0.170 2.938 <0.010

4. Staimithya 1.35 0.95 0.40 40 0.598 0.133 2.990 <0.010

5. Kandu 1.00 0.625 0.375 37.5 0.517 0.182 2.041 <0.100

The Amavatari rasa provided moderate significant relief (p<0.010) in the

management of Shoola and Staimithya by 40% each. It provided mild significant

relief (p<0.050) in the management of Daha and Raga by 50% each. It provided

insignificant relief (p<0.100) in the management of Kandu by 37.5%.

Table No:29

IV. Effect of Amavatari rasa on the Sthanika main symptoms after follow up:

Mean scores Sl

No:

Main

symptoms

(sarvadihika)

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Daha 1.30 0.60 0.70 60 0.674 0.213 3.279 <0.010

2. Raga 1.30 0.70 0.60 60 0.516 0.163 3.674 <0.010

3. Shoola 1.35 0.90 0.45 45 0.510 0.114 3.942 <0.001

4. Staimithya 1.35 0.95 0.40 40 0.502 0.112 3.559 <0.010

5. Kandu 1.00 0.50 0.50 50 0.537 0.188 2.645 <0.050

Page 105

Results


management of Shoola, it provided moderate significant relief (p<0.010) in the

management of Daha, Raga and Staimithya by 60%, 60% and 40% respectively. It

provided mild significant relief (p<0.050) in the management of Kandu by 50%.

Table No:30

V. Effect of Amavatari rasa in the management of Associated symptoms after

therapy:

Mean scores Sl

No:

Associated

symptoms BT AT BT-

AT

% SD SE t-

value

p-

value

1. Aruchi 1.25 0.85 0.40 40 0.598 0.133 2.990 <0.010

2. Trushna 1.35 0.85 0.50 40 0.760 0.170 2.938 <0.010

3. Apaka 1.15 0.65 0.50 45 0.600 0.135 3.683 <0.010

The Amavatari rasa provided moderate significant relief (p<0.010) in the

management of all the associated symptoms like Aruchi, Trushna and Apaka by 40%,

40% and 45% respectively.

Table No:31

VI. Effect of Amavatari rasa in the management of Associated symptoms after

follow up:

Mean scores Sl

No:

Associated

symptoms BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Aruchi 1.25 0.80 0.45 45 0.510 0.170 2.938 <0.010

2. Trushna 1.35 0.95 0.40 40 0.502 0.112 3.559 <0.010

3. Apaka 1.15 0.70 0.45 45 0.510 0.114 3.942 <0.001

Page 106

Results

After follow up, the Amavatari rasa provided highly significant relief

(p<0.001) in the management of Apaka by 45%. It provided moderate significant

relief (p<0.010) in the management of Aruchi and Trushna by 45% and 40%

respectively.

Table No:32

VII. Effect of Amavatari rasa on the Srotho dusti after therapy:

Mean scores Sl

No:

Srotus

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Anna vaha 1.30 0.90 0.40 40 0.598 0.133 2.990 <0.010

2. Rasa vaha 1.30 0.80 0.50 45 0.600 0.135 3.683 <0.010

3. Majja vaha 1.40 0.90 0.50 40 0.760 0.170 2.938 <0.010

Amavatri rasa provided moderate significant relief (p<0.010) in the

management of all three sroto dusti lakshanas in Anna vaha, Rasa vaha and Majja

vaha by 40%, 45% and 40% respectively.

Table No:33

VIII. Effect of Amavatari rasa on the Srotho dusti after follow up:

Mean scores Sl

No:

Srotus

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Anna vaha 1.30 0.85 0.45 45 0.510 0.114 3.942 <0.001

2. Rasa vaha 1.30 0.75 0.55 50 0.604 0.135 4.066 <0.001

3. Majja vaha 1.40 1.00 0.40 40 0.502 0.112 3.559 <0.010

Page 107

Results

Amavatari rasa provided highly significant relief (p<0.001) in the management

of Anna vaha and Rasa vaha sroto dusti by 45% and 50% respectively. It provided

moderate significant relief (p<0.010) in the management of Majja vaha by 40%.

Table No:34

IX. Effect of Amavatari rasa and Valuka sweda on the management of

Sarvadihika Main symptoms after therapy:

Mean scores Sl

No:

Main

symptoms

(sarvadaihika)

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Anga marda 1.40 0.75 0.65 60 0.587 0.131 4.950 <0.001

2. Alaysa 1.25 0.75 0.50 50 0.512 0.114 4.358 <0.001

3. Jwara 1.20 0.75 0.45 45 0.510 0.114 3.942 <0.001

4. Anga shoonata 1.25 0.70 0.55 50 0.604 0.135 4.066 <0.001

The combined therapy provided highly significant relief (p<0.001) in the

management of all the Sarvadaihika Main symptoms. The percent of symptoms are

Anga marda-60%, Alasya-50%, Jwara-45% and Angashoonata-50%.

Table No:35

X. Effect of Amavatari rasa and Valuka sweda on the management of

Sarvadihika Main symptoms after follow up:

Mean scores Sl

No:

Main

symptoms

(sarvadaihika)

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Anga marda 1.40 0.70 0.70 65 0.571 0.127 5.480 <0.001

2. Alaysa 1.25 0.55 0.70 60 0.656 0.146 4.765 <0.001

3. Jwara 1.20 0.60 0.60 55 0.598 0.133 4.485 <0.001

4. Anga shoonata 1.25 0.50 0.75 65 0.638 0.142 5.751 <0.001

Page 108

Results

The combined therapy provided highly significant relief (p<0/001) in all the

Sarvadihika main symptoms by 65%, 60%, 55%, 65% respectively for Angamarda,

Alasya, Jwara and Anga shoonata after the follow up.

Table No:36

XI. Effect of Amavatari rasa and Valuka sweda on the management of Stanika

Main symptoms after therapy:

Mean scores Sl

No:

Main

symptoms

(sarvadaihika)

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Daha 1.33 0.83 0.50 41.66 0.674 0.194 2.569 <0.050

2. Raga 1.42 1.00 0.416 41.66 0.514 0.148 2.788 <0.050

3. Shoola 1.45 0.80 0.65 60 0.567 0.131 4.950 <0.001

4. Staimithya 1.30 0.85 0.45 45 0.510 0.114 3.942 <0.001

5. Kandu 1.00 0.50 0.50 50 0.537 0.188 2.645 <0.050


management of Shoola and Staimithya by 60% and 40% respectively, where as it

provided mild significant relief (p<0.050) in Daha, Raga and Kandu by 41.66%,

41.66% and 50% respectively.

Page 109

Results

Table No:37

XII. Effect of Amavatari rasa and Valuka sweda on the management of Stanika

Main symptoms after follow up:

Mean scores Sl

No:

Main

symptoms

(sarvadaihika)

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Daha 1.33 0.83 0.50 58.33 0.583 0.148 3.922 <0.010

2. Raga 1.42 1.00 0.416 66.66 0.492 0.142 4.643 <0.001

3. Shoola 1.45 0.80 0.65 65 0.638 0.142 5.251 <0.001

4. Staimithya 1.30 0.85 0.45 50 0.512 0.114 4.358 <0.001

5. Kandu 1.00 0.50 0.50 62.5 0.517 0.182 3.415 <0.050


management of Raga, Shoola and Staimithya by 66.66%, 65% and 50% respectively;

where as it provided moderate significant relief (p<0.010) in Daha by 58.33%, while

it provided mild significant relief (p<0.050) in the management of Kandu by 62.5%.

Table No:38

XIII. Effect of Amavatari rasa and Valuka sweda in the management of

Associated symptoms after therapy:

Mean scores Sl

No:

Associated

symptoms BT AT BT-

AT

% SD SE t-

value

p-

value

1. Aruchi 1.30 0.90 0.45 45 0.510 0.133 3.942 <0.001

2. Trushna 1.25 0.80 0.45 45 0.510 0.133 3.942 <0.001

3. Apaka 1.35 0.85 0.50 40 0.760 0.170 2.996 <0.010

Page 110

Results


management of Aruchi and Trushna by 45% each, where as it provided moderate

significant relief (p<0.010) in the management of Apaka by 40%.

Table No:39

XIV. Effect of Amavatari rasa and Valuka sweda in the management of

Associated symptoms after follow up:

Mean scores Sl

No:

Associated

symptoms BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Aruchi 1.30 0.70 0.60 55 0.596 0.133 4.485 <0.001

2. Trushna 1.25 0.70 0.55 50 0.604 0.135 4.066 <0.001

3. Apaka 1.35 0.80 0.55 50 0.604 0.135 4.066 <0.001

The combined therapy provided highly significant relief (p<0.001) in all the

associated symptom after follow up by 55%, 50%,50% for Aruchi, Trushna and

Apaka respectively.

Table No:40

XV. Effect of Amavatari rasa and Valuka sweda in the management of Sroto

dusti after therapy:

Mean scores Sl

No:

Srotus

BT AT BT-

AT

% SD SE t-

value

p-

value

1. Anna vaha 1.35 0.90 0.45 45 0.510 0.131 3.942 <0.001

2. Rasa vaha 1.40 0.85 0.55 50 0.604 0.135 4.066 <0.001

3. Majja vaha 1.30 0.65 0.65 60 0.587 0.131 4.950 <0.001

Page 111

Results


management of all Sroto dusti by 45%, 50% and 60% for Anna vaha, Rasa vaha and

Majja vaha Sroto dusti respectively.

Table No:41

XVI. Effect of Amavatari rasa and Valuka sweda in the management of Sroto

dusti after follow up:

Mean scores Sl

No:

Srotus

BT AFU BT-

AFU

% SD SE t-

value

p-

value

1. Anna vaha 1.35 0.75 0.60 55 0.598 0.133 4.485 <0.001

2. Rasa vaha 1.40 0.90 0.50 50 0.512 0.114 4.358 <0.001

3. Majja vaha 1.30 0.55 0.75 65 0.638 0.142 5.251 <0.001


management of all Sroto dusti by 55%, 50% and 65% for Anna vaha, Rasa vaha and

Majja vaha Sroto dusti respectively after follow up.

Table No:42

XVII. Over all effect of Amavatari rasa on 20 patients of Ama vata after the

treatment:

Category No: of patients %

Complete relief 0 0

Marked improvement 2 10

Moderate improvement 8 40

Improved 8 40

Unchanged 2 10

Page 112

Results

No body showed complete relief where as 2 patients showed marked

improvements which was 10%. 8 patients each showed moderate improvement and

improvement by 40% each. Only 2 patients showed unchanged which was 10%.

Table No:43

XVIII. Over all effect of Amavatari rasa on 20 patients of Amavata after follow

up:


Complete relief 0 0



Improved 8 40

unchanged 6 30

Nobody showed complete relief. Only one patient showed marked

improvement, which was 5%. The more patients were seen in the improved category

was 8, which was 40%; followed by the unchanged category is 6 which was 30%. No:

of patients in the moderate improved category were 5, which were 25%.

Page 113

Results

Table No:44

XIX. Over all effect of Amavatari rasa and Valuka sweda on 20 patients of

Amavata after treatment:


Complete relief 0 0



Improved 9 45

unchanged 1 5

Nobody showed complete relief. Only 2 patients showed marked improvement

which was 10%, 8 patients showed moderate improvement which was 40%. 9 patients

were under improved category by 45%, one patient remained unchanged which was

5%.

Table No:45

XX. Over all effect of Amavatari rasa and Valuka sweda on 20 patients of

Amavata after follow up:


Complete relief 0 0



Improved 5 25

unchanged 0 0

Page 114

Results

Nobody showed either complete relief or unchanged results. 5 patients came

under marked improvement and improved category by 25%.10 patients that is 50%

came under moderate improvement.

Table No:46

XXI. Comparative effect of therapies on Sarvadaihika main symptoms of

Amavata after the treatment:

Groups Angamarda Alasya Jwara Angashoonata

Group A 50 45 40 40

Group B 60 50 45 50

From the above data, we can conclude that the group B which is the combined

therapy provided more results in the management of Sarvadaihika main symptoms of

Amavata than group A, which is treated with Amavatari rasa only.

Graph No:19

Comparative effect of therapies on Sarvadaihika main symptoms of Amavata

after the treatment:

01020304050607080

Angamarda Alyasa Jwara Angashoonata

Group A Group B

Page 115

Results

Table No:47

XXII. Comparative effect of therapies on Sarvadaihika main symptoms of

Amavata after follow up:

Groups Angamarda Alaasya Jwara Angashoonata

Group A 55 40 45 45

Group B 65 60 55 65

Even after follow up, the group B which is treated with combined therapy

provided more results in the management of Sarvadaihika main symptoms of

Amavata than the group A which is treated only with Amavatari rasa.

Graph No:20

Comparative effects of therapies on Sarvadaihika main symptoms of Amavata

after follow up:

0

10

20

30

40

50

60

70

80

Angamarda Alyasa Jwara Angashoonata

Group A Group B

Page 116

Results

Table No:48

XXIII. Comparative effect of therapies on Stanika main symptoms of Amavata

after treatment:

Groups Daha Raga Shoola Stimithya Kandu

Group A 50 50 40 40 37.5

Group B 41.66 41.66 60 45 50

From the above data we can conclude that even though group A having better

results with Amavatari rasa for Daha and Raga, group B have better results in

conditions of Shoola Staimithya and Kandu, Swedana alleviates these symptoms

expect Daha and Raga.

Graph No:21

Comparative effect of therapies on Stanika main symptoms of Amavata after

treatment:

0

10

20

30

40

50

60

70

80


Group A Group B

Page 117

Results

Table No:49

XXIV. Comparative effect of therapies on Stanika main symptoms of Amavata

after follow up:

Groups Daha Raga Shoola Staimithya Kandu

Group A 60 60 45 40 50

Group B 58.33 66.66 65 50 62.5

After follow up group B showed good results than group A expect in the

condition of Daha. Follow up studies showed better results.

Graph No:22

Comparative effects of therapies on Stanika main symptoms of Amavata after

follow up:

0

10

20

30

40

50

60

70

80


Group A Group B

Page 118

Results

Table No:50

XXV. Comparative effect of therapies on Associated symptoms of Amavata

after treatment:

Groups Aruchi Trushna Apaka

Group A 40 40 45

Group B 45 45 40

In case of Aruchi and Trushna group B have better results than group A,

where in Apaka group A showed good result than Group B after treatment.

Graph No:23

Comparative effect of therapies on Associated symptoms of Amavata after

treatment:

0

10

20

30

40

50

60

70

80

Aruchi Trushna Apakata

Group A Group B

Page 119

Results

Table No:51

XXVI. Comparative effect of therapies on Associated symptoms of Amavata

after follow up:

Groups Aruchi Trushna Apaka

Group A 45 40 45

Group B 55 50 50

From the above data we can conclude that in all three associated symptoms

group B have better results even after follow up.

Graph No:24

Comparative effect of therapies on associated symptoms of Amavata after follow

up:

0

10

20

30

40

50

60

70

80

Aruchi Trushna Apaka

Group A Group B

Page 120

Results

Table No:52

XXVII. Comparative effect of therapies on Sroto dusti lakshanas in Amavata

after treatment:

Groups Anna vaha Rasa vaha Majja vaha

Group A 40 45 40

Group B 45 50 60

Above data shows that in all sroto dusti lakshanas group B showed better

results than group A.

Graph No:25

Comparative effect of therapies on Sroto dusti lakshanas in Amavata after

treatment:

0

10

20

30

40

50

60

70

80


Group A Group B

Page 121

Results

Table No:53

XXVIII. Comparative effect of therapies on Sroto dusti lakshanas in Amavata

after follow up:

Groups Anna vaha Rasa vaha Majja vaha

Group A 45 50 40

Group B 55 50 65

Above data concludes in Anna vaha and Majja vaha sroto dusti lakashanas had

better improvement with group B than group A. There was equal result observed in

Rasa vaha sroto dusti lakshanas after follow up in both groups.

Graph No:26

Comparative effects of therapies on Sroto dusti lakshanas in Amavata after

follow up:

0

10

20

30

40

50

60

70

80


Group A Group B

Page 122

Results

Table No:54

XXIX. Comparison of over all effect of therapies between the Group A and

Group B after treatment:

Category Group A Group B

Complete relief 0 0



Improved 40 45

Unchanged 10 5

None of the patients got complete relief in both groups. Marked improvement

and moderate improvement category showed equal results in both groups. Group B

showed 5% more results in improved category than group A; and 5% less in

unchanged category.

Graph No:27

Comparison of over all effect of therapies between the Group A and Group B

after treatment:

0

10

20

30

40

50

60

70

80

Complete relief Markedimprovement

Moderateimprovement

Improved Unchanged

Group A Group B

Page 123

Results

Table No:55

XXX. Comparison of over all effect of therapies between the Group A and

Group B after follow up:

Category Group A Group B

Complete relief 0 0



Improved 40 25

Unchanged 30 0

Above data concludes better results of group B in moderate and marked

improvement category, where as group A showed better results in improved category.

None of the patients got complete relief in both groups. 30% patients remained

unchanged in group A, where as none of them remained unchanged in group A.

Graph No:28

Comparison of over all effect of therapies between the Group A and Group B

after follow up:

0

10

20

30

40

50

60

70

80

Complete relief Markedimprovement

Moderateimprovement

Improved Unchanged

Group A Group B

Page 124

Discussion

DISCUSSION

In a study which included 40 patients, mandagni was found in all the patients

with 100% of observation. About 82.5% of patients, especially businessmen, students

and labor class come under the etiological category of viruddhahara chesta. Modern

day dietary regimen like fried, improperly cooked, fast food, incompatible food

intake etc may be the cause, which leads to kala viruddha, satmya viruddha etc.

About 92.5% patients like housewives, agriculturists and labour class also

come under the category of those who get indulged in excessive work soon after

intake of snigdha bhojana like ghrita, mamsa, masha etc.

35-40% of patients including officials, businessmen and housewives who are

involved only in mental work without physical exercises come under nischalata type

of etiological factor.

This disease has got the close relation with cold and rainy season. Since this

geographical region gets high rainfall and has cold climate, nearly two-third of

patients got attack in rainy and winter season.

Mental health always contributes for physical well being. A healthy mental

state is needed as it indirectly influences to bring up the physical health. A proper diet

taken will not undergo proper digestion if mind is influenced by chinta, shoka, krodha

and other disturbances which will hamper both jataragni and dhatwagni. All physical,

mental etiological factors first affects the pachakagni. If the person maintains the agni

properly, whatever the etiological factors he might have undergone which are

explained in classics, will fail to produce this disease.

Page 125

Discussion

Roopa of Amavata-

a) Shotha: Particularly we cannot differentiate shotha of the joints in Amavata

according to particular vitiation of doshas. We can see mixed type, because

there is no pitting on pressure. Shotha increases at night time and early

morning and is fleeting in nature. There will be raga also. In samprapti it is

said that all the tridosha get vitiated by ama, so Amavataja shotha is

tridoshaja. In the entire 40 patients, moderate shotha was noticed in one or the

other joints.

b) Shoola: 62.5% of patients complained shoola as a main symptom and in rest of

the patients also mild shoola was observed. This pain usually increases at

night and early morning.

c) Trishna: This was found to a small extent with 20% of patients.

d) Apaka and Alasya: 87.2% of patients had apaka and 82.5% patients had

alasya.

e) Angamarda: Most of the patients i.e. 87.5% had angamarda especially in

morning while waking up, till 1-2 hours. Some had it for whole day.

f) Jwara: In classics only the jwara is mentioned but the duration, degree etc. are

not mentioned. Usually the jwara occurs along with pain and swelling, in

newly affected cases but in chronic cases there was absence of jwara. In this

study, 82.5% of patients had jwara at evening and early morning.

g) Daha: None of the patients had daha in whole body but excess of ushna

sparsha as well as little daha was found in the affected joints due to

inflammatory changes in the joints. Only 20% patients had daha at the affected

joints as main symptom.

Page 126

Discussion

h) Mootra: Bahumootrata was noticed in more than 60% of patients.

Bahumootrata is due to kleda guna of ama. In texts authors have said that

urine of Amavata patients resembles that of takra and vasa. In which aspect it

resembles, is not mentioned. Color of urine is also mentioned as shweta yukta

peeta which was seen in few cases.

i) Gatra sthabdatha: Sthaimithya or gatra sthabdatha which is morning hour

stiffness was found in almost all the patients but only 77.5% of patients

complained it as main symptom.

j) Mala baddhata: Mala baddhata is explained as one of the symptom of

Amavata. Among 40 patients it was found in 60% of patients. Kukshi shoola

also was seen in few cases.

Samprapti:

The samprapti of this disease is really a topic for discussion because, due to

various factors agnimandhya occurs and ama is produced in amashaya in almost all

persons, but the specialty of Amavata samprapti is accumulation of ama in all the

slehma sthanas like sandi, ura etc. Madhavacharya says ama travels to all sleshma

sthanas with the influence of vata and there ama becomes vidagdha. From there it

enters the dhamani. In hridaya it mixes with ahara rasa and again tridosha prakopa

takes place.

Here, if we see with the view of shatkriya kalas chaya, prakopa and prasara

avasthas proceeds in a progressive manner. In this particular stage the manifestation

of disease depends on the specific affinity of ama towards trika sandhies and

simultaneous prakopa of vata and ama whichsettles especially in trika sandhi where

kha vaigunya takes place.

Page 127

Discussion

Discussion on plan of study:

The present study has been carried out on 40 patients treated in two equal

groups of 20 patients, selected from OPD and IPD of A.L.N.R Memorial Ayurvedic

Hospital, Koppa.

Criteria for selecting the patient were purely based on the classical signs and

symptoms and criteria of increased E.S.R (>20), A.S.L.O titrations (>1:200).

Patients with complications of this disease, heart disease, and hypertension

were excluded from the study.

20 patients of Amavata were randomly selected for group A where patient

were given only Amavatari rasa 750mg B.D for 1 month. Other 20 Amavata patients

selected randomly were included in group B and subjected to valuka sweda for 21

days with the intake of Amavatari rasa 750mg B.D for 1 month.

Improvements in the symptoms of disease and sroto dushti as well as lab

investigations before and after the treatment were considered for analyzing the results.

The total effect of therapy is assessed in terms of complete relief, marked

improvement, moderate improvement, and improvement and unchanged.

Description on observations during study:

1. Age incidence: Maximum numbers of patients in the study with incidence of

52.5% were in between the age group of 20-30 years. Mental stress,

incompatible dietary habits and hard work after food will be seen in most of

the patients in this age group.

2. Sex incidence: There is no much difference of incidence among the sex. Still

females especially housewives were leading with 52.5% incidence, may be

because of sedentary life style.

Page 128

Discussion

3. Religion incidence: In this observation Muslims had more incidences with

42.5%. It may be because of heavy physical work soon after intake of snigdha

bhojana like ghee, meat etc.

4. Marital status: Unmarried patients were suffering from Amavata with an

incidence of 55%, may be due to incompatible food intake.

5. Occupational incidence: Housewives had more incidences with 27.5%

followed by 25% of students, 20% of officials, 15% of labours and 12.5% of

businessmen.

6. Educational status: Uneducated with 40%, 27.5% graduates, 22.5% of primary

and 10% of secondary educational status were observed in the study.

7. Socio economic status: Incidence in poor persons was observed to be more

with 45% followed by upper class people with 35% and middle class people

with 20% respectively.

8. Family history: Only 15% of incidence was found with positive family history

which proves that Amavata has no genetic predisposition.

9. Diet wise incidence: Patients with mixed diet were found more with 57.2%

incidence. It may be due to virudha ahara like mamsa and dugda, matsya and

dadhi etc. Most of them had habit of taking fried food items and were from

lower class, less hygienic and less nutritious which could probably be a

significant cause. This is followed by 42.5% of patients taking vegetarian diet.

10. Addiction wise incidence: Smokers had much incidence with 40% followed by

tobacco chewers with 32.5% and alcoholics with 22.5% and non addicted

patients with fewer incidences of 5%. Smoking and other addictions

suppresses the digestion process which leads to production of ama.

Page 129

Discussion

11. Prakriti wise incidence: Kapha vataja prakriti patients with 35% suffer more,

followed by patients of kaphaja prakriti. This may be due to mandagni which

is the characteristic feature in persons of kaphaja prakriti.

12. Satwa wise incidence: Avara satwa patients were observed more with 65% of

incidence, followed by 20% of madhyama and 15% of pravara patients.

13. Koshtagni: Mandagni patients were more observed with 60% followed by

vishamagni patients with 30% and teekshnagni patients with 10%.

14. Sroto dushti lakshana: All patients had annavha sroto dushti lakshanas with

100% of incidence followed by rasavaha sroto dushti lakshanas in 95%

patients and majjavaha sroto dushti lakshanas observed in 62.5% of patients.

This shows the involvement of major srotas in the samprapti of the disease.

15. Laboratory investigations: Less Hb % level was observed in 80% of patients

and raise of ESR level, raise in ASLO and RA titrations found in 40%, 25%

and 10% respectively.

Effect of therapies:

The result obtained in the trial and control group on each parameter are being

discussed as follows-

1. Effect of therapies on sarvadaihika main symptoms:

a) After 30 days of therapy- The Amavatari rasa provided highly significant

relief (p<0.001) in the management of Anga marda and Alasya by 50% and 45%

respectively. It provided moderate significant relief (p<0.010) in the management of

Jwara and Anga shoonata by 40% each.

Page 130

Discussion

The combined therapy i.e. the Amavatari rasa with valuka sweda provided

highly significant relief (p<0.001) in the management of the entire Sarvadihika Main

symptom. The percentages of symptoms relieved are Anga marda-60%, Alasya-50%,

Jwara-45% and Angashoonata-50%.

b) After follow- up- The Amavatari rasa provided moderate significant relief

(p<0.010) in the management of Shoola and Staimithya by 40% each. It provided

mild significant relief (p<0.050) in the management of Daha and Raga by 50% each.

It provided insignificant relief (p<0.100) in the management of Kandu by 37.5%.

The combined therapy provided highly significant relief (p<0/001) in all the

Sarvadaihika main symptoms by 65%, 60%, 55%, 65% respectively for Angamarda,

Alasya, Jwara and Anga shoonata after the follow up.

2. Effect of therapies on Sthanika main symptoms:

a) After 30 days of therapy- The Amavatari rasa provided moderate

significant relief (p<0.010) in the management of Shoola and Staimithya by 40%

each. It provided mild significant relief (p<0.050) in the management of Daha and

Raga by 50% each. It provided insignificant relief (p<0.100) in the management of

Kandu by 37.5%.


management of Shoola and Staimithya by 60% and 40% respectively, where as it

provided mild significant relief (p<0.050) in Daha, Raga and Kandu by 41.66%,

41.66% and 50% respectively.

b) After follow- up- The Amavatari rasa provided highly significant relief

(p<0.001) in the management of Shoola . it provided moderate significant relief

(p<0.010) in the management of Daha, Raga and Staimithya by 60%, 60% and 40%

Page 131

Discussion

respectively. It provided mild significant relief (p<0.050) in the management of

Kandu by 50%.


management of Raga, Shoola and Staimithya by 66.66%, 65% and 50% respectively;

where as it provided moderate significant relief (p<0.010) in Daha by 58.33%, while

it provided mild significant relief (p<0.050) in the management of Kandu by 62.5%.

3. Effects of therapies on associated symptoms:

a) After 30 days of therapy- The Amavatari rasa provided moderate

significant relief (p<0.010) in the management of all the associated symptoms like

Aruchi, Trushna and Apaka by 40%, 40% and 45% respectively.


management of Aruchi and Trushna by 45% each, where as it provided moderate

significant relief (p<0.010) in the management of Apaka by 40%.

b) After follow- up- After follow up the Amavatari rasa provided highly

significant relief (p<0.001) in the management of Apakata by 45%. It provided

moderate significant relief (p<0.010) in the management of Aruchi and Trushna by

45% and 40% respectively.

The combined therapy provided highly significant relief (p<0.001) in all the

associated symptoms after follow up by 55%, 50%, 50% for Aruchi, Trushna and

Apakarespectively.

Page 132

Discussion

4. Effect of therapies on sroto dushti lakshanas:

a) After 30 days of therapy- Amavatri rasa provided moderate significant

relief (p<0.010) in the management of all three sroto dusti lakshanas in Anna vaha,

Rasa vaha and Majja vaha by 40%, 45% and 40% respectively.


management of all Sroto dusti lakshanas by 45%, 50% and 60% for Anna vaha, Rasa

vaha and Majja vaha Sroto dusti respectively.

b) After follow- up- Amavatari rasa provided highly significant relief

(p<0.001) in the management of Anna vaha and Rasa vaha sroto dusti by 45% and

50% respectively. It provided moderate significant relief (p<0.010) in the

management of Majja vaha by 40%.


management of all Sroto dusti lakshanas by 55%, 50% and 65% for Anna vaha, Rasa

vaha and Majja vaha Sroto dusti respectively after follow up.

5. Hb and ESR were found to be responding for this treatment may due to the

srotorodhanashaka and rasayana property of the trial drug. But in RA and

ASLO titration only nominal response was observed.

6. Comparative total effect of therapies:

a) After 30 days of therapy- No body showed complete relief where as 2

patients showed marked improvements which was 10%. 8 patients showed moderate

improvement and 8 patients showed improvement which was 40% in each group.

Only 2 patients remained unchanged which was 10%.

Page 133

Discussion

Nobody showed complete relief. Only 2 patients showed moderate

improvement which was 10%, 8 patients showed moderate improvement which was

40%. 9 patients were under improved category by 45%, one patient remained

unchanged which 5% was.

b) After follow- up- Nobody showed complete relief. Only one patient

showed marked improvement, which was 5%. More patients were seen in the

improved category i.e., 8, which was 40%; followed by the unchanged category i.e., 6

which was 30%. No: of patients in the moderately improved category were 5 that

were 25%.

Nobody showed either complete relief or unchanged results. 5 patients came

under marked improvement and improved category which was 25%. 10 patients that

is 50% came under moderate improvement.

By these observations it is clear that the group with combined therapy i.e.

Amavatari rasa with valuka sweda provided long lasting result than the group with

Amavatari rasa alone.

Page 134

Discussion

PROBABLE MODE OF ACTION OF AMAVATARI RASA

Based on the Pharmacological action:

Amavatari rasa has its unique action on Amavata based on following

properties. Ingredients are composed of herbo – mineral drugs like Triphala, Chitraka,

Guggulu, Eranda, Parada and Gandhaka in the form of Kajjali.

Concept of Ayurveda to treat the Amavata is basically on normalizing the agni

through ama pachana dravyas, which performs the deepana and pachana actions.

Simultaneously a compound which significantly controls and eliminates prakupita

vata dosha by its vatanulomana property is also balanced in Amavatari rasa

preparation. Therefore a successful herbo-mineral compound balance with all

ingredients can be analyzed as follows-

Parada and Gandhaka in the form of kajjali acts as deepaka, pachaka and also

rasayana along with anulomana property, followed by triphala with its anulomana

property, where Chitraka is an excellent deepaka and pachaka. Guggulu acts as

vatahara, Eranda acts as Amavatahara drugs.70 (Amavata gajendrasya shareera

vanacharina……

Triphala, which are taken in equal quantity, has vatanulomana property. Here

Amalaki acts as balya and rasayana and balances the kashaya guna of haritaki and

vibheetaki.

Page 135

Discussion

Chitraka is used extensively for its deepana and pachana properties but the

gastric irritation cannot be ignored. Hence tripahala is useful to combat the extreme

effect of chitraka through its kashaya rasa and madhura vipaka.

Guggulu is a drug of choice in Amavata with its vatahara property, therefore

regulates the pain.

Amalaki, gandhaka and parada have an excellent action as rasayana which

prevents the degeneration of the tissues.

Eranda bhavana- Eranda has been highlighted as Amavatahara due to its

amapachana property as well as sara guna which attributes to vatanulomana property

which significantly acts on pain in joints.

Garlic which is used for shodhana of parada possess anti inflammatory

property. It is noticed by the practicing physicians that the garlic has positive impact

on heart disease treatment. Garlic consumers often got relief from joint pains in

particular dose in inflammatory condition. During the test, subjects ate two or three

raw or cooked garlic cloves everyday. In Russia, garlic is used extensively in the

treatment of rheumatism and associated disease.

Anulomana properties of triphala, gandhaka and particularly of eranda help in

keeping the normal physiological function of annavaha srotas and also help in

maintaining the koshtagni. Thus the combination of contents of ‘Amavatari rasa’ has

a very good role in management of the disease Amavata.

Page 136

Discussion

Based on Rasa panchaka

Amavatari rasa has 83.33% of katu rasa, 66.66% of kashaya rasa, 50% of tikta

& madhura rasa and 33.33% of amla rasa, 66.66% of laghu guna, 83.33% of ruksha

guna 50% of teekshna guna, 83.33% of ushna veerya, 16.66% of sheeta veerya,

66.66% of madhura vipaka and 33.33% of katu vipaka.

In Amavata, ama and vata are the vitiated factors. The trial drug contains more

katu rasa which reduces kleda and it acts as rochana, pachana, deepana, lekhana and

shodhana. So it cleanses the srotas and reduces excessive kapha.

Kashaya rasa, which stands second highest in the trial drug, cleanses the srotas

due to lekhana property. It is also having kaphahara and ropana property.

Tikta rasa relives aruchi, daha and trishna. Also it reduces excessive kapha,

pitta and medhas. It is also deepaka, amapachaka and lekhaniya.

Madhura rasa helps in the nourishment of dhatus, reduces vata, pitta, trishna

and daha.

Amla rasa have the properties like sweda janana, mukha shodhana, indriya

sthairyakara, mana prasadana, lalasravakara, rochana, deepana, pachana, anulomana,

mootrala, brimhana and balyakara.

Page 137

Discussion

The laghu and ruksha guna has the properties of pervadence into the minute

channels thereby cleansing them.

Ushna veerya attributes for pachana properties along with vata and kapha

shamana. Sheeta veerya helps to increase the ojus and thus leads to dhatu poshana.

In this way, the predominant rasas might have acted in the treatment of

Amavata.

PROBABLE MODE OF ACTION OF VALUKA SWEDA IN AMAVATA

The valuka sweda does three main actions by its ruksha and ushna guna.

1. Swedana does the pakwata of ama.

2. Sroto mukha vishodana i.e. it helps the pakwa doshas to come to koshta from

shaka.

3. Vayuscha vigraha i.e. it regulates movements of vata.

With these main functions valuka sweda does amapachana, sandhi shoola nasha,

sandhi shotha nasha, gatra stabdatha nasha etc. in the disease Amavata.

Amapachana:

By the ushna,ruksha and the laghu gunas it does the pachana of ama, which is

seated in local sandhies.

Page 138

Discussion

Sandhi shotha and gatra sthabdhata:

Sandhi shotha in Amavata is brought about by accumulation of kapha dosha

and ama. By amapachana property of valuka sweda, it does liquification of ama. At

the same time, it also does sroto vikasana by its ushna guna resulting in increased

circulation. Liquefied ama is reabsorbed into circulation. Hence, there will be

reduction of swelling in joints.

Due to increased circulation, ama moves from sandhi into circualtion leading

to sthabda nasha thereby joint movements come to normal.

Vedanashamana:

As amapachana takes place, margavarodha also reduces, so movement of the

vata comes to normal. Ushna guna of valuka sweda acts contrary to sheeta guna of

vata which subsides vata to its normalcy. Vata shamana in turn results in reduction of

pain.

Sroto shuddhi and laghavata of body:

Valuka sweda does the dilatation of srotas and production of sweda. So the

channels of body will be cleared causing sroto shuddhi and lightness of the body.

Because of above said important properties, valuka sweda is specially

indicated in Amavata.

Page 139

Discussion

Chart no:2

EFFECT OF VALUKA OR RUKSHA SWEDA IN BRIEF:

Sthanika sweda

Sthanika tapadhikya Srotovikasa

Sthanika dhatwagni vriddhi Raktabisarana vriddhi

Ama paka Causes sweating

Reabsorption of pakwa doshas into

Causes laghuta of the body Rasa and samvahana of rasa through dilated srotas

Sthanika margavarana nirgamana Pakwa ama travels through

Rasa and comes to koshta

Vata shamana

Vedana shamaka Sandhi shotha nasha Gatra sthabdatha nasha

PHYSIOLOGICAL EFFECTS OF HEAT

Heating the tissues results in increased metabolic activity, increased blood

flow and stimulation of neural receptors in the skin or tissues and many other indirect

effects.

Page 140

Discussion

• Increased metabolism

The increase in metabolism is greatest in the region where most heat is produced,

which is in the superficial tissues. As a result of the increased metabolism there is an

increased demand for oxygen and foodstuffs, and an increased output of waste

products, including metabolites.

• Increased blood supply

As a result of increased metabolism, the output of waste products from the cells is

increased. These include metabolites, which act on the walls of the capillaries and

arterioles causing dilatation of these vessels. In addition, the heat has a direct effect on

the blood vessels, causing vasodilatation, particularly in the superficial tissues where

the heating is greatest. Stimulation of superficial nerve endings can also cause a reflex

dilatation of the arterioles. As a result of vasodilatation there is an increased flow of

blood through the area so that the necessary oxygen and nutritive materials are

supplied and waste products are removed.

• Effects of heating on nerves

Heat appears to produce definite sedative effects. The effect of heat on nerve

conduction has still to be thoroughly investigated. Heat has been applied as a counter

irritant, which is the thermal stimulus, may effect the pain sensation as explained by

the gate theory of Melzack and Wall.

Page 141

Discussion

Indirect effects of heating

o Muscle tissue – Rise in temperature induces muscle relaxation and increases

the efficiency of muscle action, as the increased blood supply ensures the

optimum conditions for muscle contraction.

o General Rise in temperature – As blood passes through the tissues in which

the rise of the temperature has occurred, it becomes heated and carries the heat

to other parts of the body, so that if heating is extensive and prolonged a

general rise in temperature occur.

o Fall in blood pressure – If there is generalized vasodilatation the peripheral

resistance is reduced, and this causes a fall in blood pressure. Heat reduces the

viscosity of the blood, and this also tends to reduce the blood pressure.

o Increased activity of sweat glands – There is reflex stimulation of the sweat

glands in the area exposed to the heat, resulting from the effect of the heat on

the sensory nerve endings. As the heated blood circulates throughout the body

it affects the centers concerned with regulation of temperature, and there is

increased activity of the sweat glands throughout the body.

(Ref. The pharmacological basis of therapeutics – Goodman and Gillman, Physiology

by Robert M. Berne, Clayton’s Electro therapy by Angela Forster, Nigel Palastanga,

Text book of Pharmacology by K.D. Tripati)

Page 142

Conclusion

CONCLUSION

After a thorough study of the observations and results obtained the following

conclusions can be drown; The description of the disease Amavata is not found in

Brahatrayees of Ayurveda, but scattered information regarding the disease is seen in

later treatises.

• It is found during the study that, it invariably affects the people falling under

the age group of 20-30 years.

• The disease was commonly found to attack the people working in damp

conditions i.e., predominantly in the people residing in Anupa desha.

• Poorvaroopas of the disease has not been mentioned, therefore the roopas

itself in their milder form can be considered as prodrominal symptoms.

• The patients having the family history of Amavata was found to be minimal

during the study.

• The people leading a sedentary life style and getting indulged in consumption

of incompatible food are more prone to get Amavata.

• The drug Amavatari rasa was found to be very effective in the management of

the symptoms like Angamarda, Jwara, Daha etc. of Amavata.

• The combined therapy i.e. Amavatari rasa along with valuka sweda gave

highly significant result in relieving all the sarvadaihika main symptoms,

associated symptoms and sroto dusti lakshanas also.

• The study gives new perspective in the management of Amavata i.e. in the

group ‘B’treated with the combined therapy of Amavatari rasa along with

Valukasweda better result with long lasting sustained relief was found when

compared to the group ‘A’ treated with Amavatari rasa alone.

Page 143

Conclusion

Limitations:

The size of the sample was small to draw a generalized conclusion.

The drug palatability was less.

Recommendations for further study:

Study advised for large sample.

Change in formulation i.e. in capsule form for better palatability and easy

administration.

Page 144

Summary

SUMMARY

The present dissertation entitled “MANAGEMENT OF AMAVATA WITH

AMAVATARI RASA AND VALUKA SWEDA – A CLINICAL EVALUATION” has been

carried out to find out the efficacy of the therapeutic drug Amavatari rasa alone and

along with Valuka sweda on patients of Amavata. This study contains Introduction,

Objectives, and Review of literature, Methodology, Results, Discussion, and

conclusion.

Chapter I– Introduction- In this chapter, the introduction of the disease Amavata,

causative factors, cardinal features of this disease, modern disease interpretation, line

of treatment adopted during the study etc. are mentioned.

Chapter II – Objectives of the study is explained.

Chapter III – Under review of literature historical review of Amavata, detailed

description about this disease according to the olden Ayurvedic treatises are compiled.

Modern diseases having most similar symptoms are also discussed under the heading

of modern disease review. Brief description about the trial drug, Amavatari rasa and

Valuka sweda are included in this chapter.

Chapter IV – Methodology – Materials and methods includes criteria for selection

and grouping of patients, treatment schedule, and grading of the disease etc are

explained. Observation of the patients includes distribution of the patients according

Page 145

Summary

to age, sex, economical status; diet, habits etc are represented along with the tables

and charts.

Chapter V – Results – Results of the therapies after the treatment, after follow up

along with the statistical analysis are mentioned with tables and represented by

graphs.

Chapter VI – Discussion –Disease, treatment, result of therapies and probable mode

of action of drugs are elaborately discussed in this chapter.

Chapter VII– Conclusion – here it is concluded that the combined therapy with

Amavatari rasa and Valuka sweda given better and long lasting relief on the main

symptoms, associated symptoms and srotodusti symptoms of the disease Amavata

when compared with that of Amavatari rasa alone.

Page 146

References

References

1. A.V. 6/14/1

2. A.V.9/9/18-20

3. Agni Purana 279/25,26

4. C.Chi.12/51-52

5. C.Chi.16/61-62

6. C.Chi.28/195

7. C.Vi.2/8-11

8. Ma.Ni.1/4 Madhukosha

9. Shabdastomamahanidhi

10. Shabdakalpadruma

11. Vachaspatyam

12. Sanskrit- English dictionary

13. A. Hr. Su. 13/25

14. Ma . Ni . 25 Madhukosha

15. A. Hr. Su. 13/26

16. Su. Su. 15/32

17. Ah,Su 13/ 23-24

18. A. Hr. Su. 13/23

19. Ch. Su. 12/8

20. Ch. Su. 26/86-101

21. Va.Ni 1

22. Su.Ni.21

23. Su..Shar.5/16

24. M.Ni Amavata ni /11

25. Ma.Ni. 1 Madhukosha

26. B.P.Madhyamakanda 24/6

27. C.Chi.21/40

28. Ma.Ni.1/2

29. Hemadri, A.H.Ni.15/43

30. Dal. Su. Ni.1/77

31. Ma.Ni. 25/12

References

32. Y. R., P-Amavata Chikitsa/1

G. N. D. 20/14

B. P.II 26/14-15

B. P. Amavata Adhikara /1

33. Ch. Su. 28/25

34. Ch. Ni. 8/31

35. Hem. A. H. Su. 8/20

36. Ch. Ci. 23/283

37. A.H. Su. 13/28

38. Aru. A. H. Su. 8/21

39. C. D. Amavata chikitsa /2

40. Chakrapani Ch. Su. 14/9

41. Ch. Su. 22/11

42. A. H.Su 13/20

43. Ch. Su. 26/5

44. Ch. Su. 26/4

A.H. Su 10/17-19

Aru., A. H. Su 10/18

45. A.H.Su.13/29

46. A.H.Su.13/28

47. Hem.A.H.Su.18/1

48. Dal.Su.Chi.33/33

49. Dal.Su.Chi.33/4

50. Dal.Su.Chi.33/27

51. Shivadas sen, C.D.Amavata chi./1

52. C.Chi.15/201

53. Arun.A.H.Su. 13/1

55. Chakrapani, Ch.Si.1/27, 28

56. Su.Ch.35/18

57.Ma. ni. Amavata ni. 11-12

58 .H. S. T. 21/5-8

59. H. S. T. 21/11

References

60.H. S. T. 21/15

61. H. S. T. 21/18

62. Ch. Ch. 14/13

63. Su. Ch. 32/34.

Ch. Su. 15/17.

Ast. Hr. Su 18/16,17

64. Boyd’s text

Davidson

French;s index

65. P.V Sharma

66. Bh. Rat. Amavata chikitsa

67. Ra. Ta 5 / 27

68. Ra. Ta 8/7

69. R.t 24 / 575

70. B.R 29/19

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Case proforma

CLINICAL PROFORMA

Department of kaya chikitsa

A.L.N Rao Memorial Ayurvedic Medical College, Koppa. 577 126.

P.G Scholar – Dr. Vijayendra Bhat.

Guide – Dr. Reshmi Rekha Mishra MD (Ayu)

PART A - EXAMINATION

Name : Case no :

Address : OPD/IPD No :

Date of commencement :

Date of completion :

Age : Group : A – Shamana

Sex : M / F B- Shamana with swedana

Religion : H / Mu / C / O

Occupation :Ue / Lb /Bs / Ol / Hw

Socio-economic class : P / Md / U

Marital status : Ma / Um

Education : Un / Pr / Sec / Gr

I. Chief complaint: Duration AT BT AFU

a) Sarvadaihika :

Angamarda / Alasya / Jwara / Anga shoonata

b) Sthanika :

Daha / Raga / Shoola / Sthaimithya / Kandu

II. Associated symptoms: Duration AT BT AFU

Aruchi / Trushna / Apaka

Case proforma

III. History of present illness:

Mode of onset : Acute / Chronic

Joints involved: Wrist joints / Elbow joints / Hip joints / Knee joints / Ankle joint /

Joints of hand / Joints of foot / Cervical spine / Temporo-mandibular joint /

Acromio-clavicular joint / Sterno-clavicular joint.

Aggravating factor :

Ahara:

Vihara:

Kala:

Relieving factor :

Ahara:

Vihara:

Kala:

IV. History of past illness:

V. Treatment history:

VI. Family history:

Same / Relevant disease to – Parents Y / N

Grand parents Y / N

Children Y / N

Wife / Husband Y / N

VII. Personal history:

Ahara : Veg / Mx

Virudhahara Y/ N

Case proforma

Kapha prakopaka / Abhishyandakara Y /N

Ati bhojana Y / N

Vidahi anna Y / N

Water intake: _______ litres / day.

With break fast: ____ ml, with lunch: ____ ml, with dinner: ____ ml.

Vihara:

Nature of work: Physical / Mental.

Occupational history: Sedentary / Moderate / Heavy.

Working in water: Y / N

Working in unhygienic conditions: Y / N

Diva swapana: Y / N

Vega darana: Y / N

Manasika: Any mental stress Y / N

Vyasana: Alcohol / Smoking / Tobacco / None.

Nidra: _____ hrs / day.

Sound sleep / Disturbed / Delayed / Ratri jagarana.

Exercise: Regular / Occasional / Routine work / No physical exercise.

Agni: Samagni / Mandagni /Vishamagni.

Kosta: Mridu / Madhyama / Krura.

Pureesha: Soft / Loose / Constipated.

Frequency: _______ times / day.

Mootra: Frequency: _____ times/ day; and _____ times / night.

Quantity: _____ ml / day; and _____ ml / night.

(Approx) (less / moderate / heavy)

Gynaecological history:

Case proforma

PART B

I. General examination: Duration AT BT AFU

Pulse :

BP :

Temperature :

Respiratory rate :

II. Dasha vidha pareeksha:

Prakrutika - V / P / K / VP /VK / PK / VPK.

Vaikrutika - Pravara / Madhyama / Avara.

Satwata – Pravara / Madhyama / Avara.

Sarata – Pravara / Madhyama / Avara.

Satmyata – Pravara / Madhyama / Avara.

Samhanata – Pravara / Madhyama / Avara.

Ahara – Abhyavaharana : Pravara / Madhyama / Avara.

Jaranashaktitha: Pravara / Madhyama / Avara.

Vyayama shaktitha – Pravara / Madhyama / Avara.

Pramanatah – Height:

Weight:

Vayatah – Bala / Madhyama / Vrudha.

Desha – Anupa / Jangala / Sadharana.

III. Astavidha Pareeksha:

Nadi :

Mala :

Mootra :

Jihwa :

Case proforma

Shabdha :

Sparsha :

Druk :

Akruti :

IV. Sroto pareeksha:

Anna vaha : Anannabhilasha /Arochaka /Avipaka / Chardi / Drustva

annavahanyascha(Hatred ness towards food).

Rasa vaha : Aruchi / Asyavairasya / Arasagnata / Gourava /Tandra /Hrullasa/

Angamarda /Jwara / Panduta /Krushangata / Anginasha.

Majja vaha : Ruk purvanam / Bhruma /Moorcha / Tama / parvasu stoolamoolanam /

Parvajanam Cha darshanam.

Udaka vaha : Trusha / ……..

V. Systemic examination:

GIT :

CVS :

RS :

CNS :

LS :

VI. Vishista pareeksha: BT AT AFU

Inspection: Swelling Present / Absent

Discolouration Present / Absent

Palpation: Local temperature Present / Absent

Local tenderness Present / Absent

Local pain Present / Absent

Joint movement: Restriction Present / Absent

Case proforma

VII. Investigations: BT AT AFU

Hb% :

ESR :

RA :

ASLO :

X-ray :

Provisional diagnosis:

Diagnosis:

PART C

Treatment schedule:

Group A Group B

Amavatari rasa – 30 days Amavatari rasa – 30 days

Dose – 750 mg Bd Dose – 750 mg Bd

Duration – 30 days Along with Valuka sweda for 21

days & 7 days rest.

Remarks:

Unchanged/Improved/Moderate improvement/Marked improvement/Complete relief.

Signature of PG Scholar. Signature of Guide.

Case proforma

POST GRADUATE STUDIES AND RESEARCH CENTRE

DEPARTEMENT OF KAYACHIKITSA

A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE

KOPPA-CHIKMAGALUR

PATIENT CONSENT FORM I __________________________________________ exercising my free power of

choice, hereby give you my complete consent to be included as a subject in the

Clinical trial on “MANAGEMENT OF AMAVATA WITH AMAVATARI RASA AND

VALUKA SWEDA – A CLINICAL EVALUATION”. I have been informed to my

satisfaction by the attending Doctor, the purpose of the Clinical Trial and the nature of

drug treatment, therapeutic procedures, follow-up and probable complications. I am

also ready to undergo necessary Laboratory Investigations to monitor and safeguard

my body functions.

I am also aware of my right to opt out of the trial at any time during the course

of the trial without having to give the reasons for doing so.

Signature of the Doctor Signature of the Patient/ Guardian

(£Á£ÀÄ N¢/ N¢¹ CxÀð ªÀiÁrPÉÆAqÀÄ

¸À» ºÁQgÀÄvÉÛÃ£É.)

amavata k c006kop

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