“AYURVEDA MANAGEMENT OFRHEUMATOID ARTHRITIS”

                                                   AUTHOR: Dr.D.VENKATAKRISHNA NAIK

                                                                                 M.DAyu Gen.Med (Kaya Chikitsa)

                                                                  Snr.Consultant General Physician

                                                                    Kairali Ayurvedic centre

                                                                     Banjarahills /Kukatpally, Hyd

                                                              9502233377,    9502533377

                                                                                  040-23331534, 040-23153235

                                                

                     Rheumatoid arthritis is achronic, disabling autoimmune condition, as the body is filled with ‘rheum’, aform of aama (toxins deposited in the cells as a result of improper digestion).This is  a good example of an auto-immunecondition (a disordered self-protective mechanism) characterised byinflammation, soreness and stiffness of muscles, and pain in joints andassociated structures. This can  besuccessfully managed by an Ayurvedic approach. Ayurvedic measures includingpancha karma, dietary adjustments and herbs. In addition to the pacification ofdoshas, removal of ama and kindling of agni, the Ayurvedic pharmacopoeia offersspecific herbal combinations that are of significant effect in this condition.

Amavata (RheumatoidArthritis): An Ayurvedic Approach

• Rheumatoid arthritis is describedas “Amavata” in Ayurveda. The word ‘Ama’ literally means,undigested, toxic orunwholesome product, which is produced in the body due to weakening ofdigestive fire. This ‘Ama’ is then carried by vitiated ‘Vayu’ and travelsthroughout the body and accumulates in the joints, which is the seat of ‘Kapha’(one of the three bodily humors i.e. Vata, Pitta and Kapha). As this processcontinues, all the joints are gradually affected, which results in severe painand swelling in the joints. Here, pain is due to vitiated “Vata”, swelling dueto affected Kapha. When ‘Pitta’ also gets aggravated, it causes burningsensation around the joints.

Ancient Ayurvedic classics saysthat all the diseases affecting the locomotor system are grouped under thesingle name Vātarakta in Charaka, Sushruta (where it is conspicuously not evenmentioned) and Vagbhata Samhita (the “Brihatrayi” or “three major writings”).Specific details regarding amavāta are sparse in all of these ancienttreatises. However an elaborate description of the presentation and treatmentof amavāta is found in later works including Sarangadhara Samhita, Chakradattaand Madhava Nidana

Samanya Lakshanaof AMAVATA (Symptoms Common to AllPeople Regardless of Constitution)

• Angamarda (pain in specific areas of the body)

• Aruchi (loss of appetite)

• Trishna (increased thirst)

• Alasya (loss of zest or enthusiasm for life)

• Jwara (increased body temperature)

• Apaka (low agni)

• SandhiStabdata, Sandhi Shoota, Sandhi Shopha (stiffness, inflammation and swelling ofthe joints)

 In addition to these symptoms, amavāta canhave many others in specific individuals including frequent urination, reductionof perspiration, hyper salivation, nausea and vomiting, constipation,flatulence. Although Vāta is the preeminent dosha involved in this condition,on the basis of doshanubandha lakshanas (signs connected to specific dosha),amavāta can be classified into three types:

• Vāta – will manifest with sharp, cutting pain andmore digestive symptoms

• Pitta – will manifest with daha (burningsensation) throughout the body and in the joints with more intense redness

• Kapha–will manifest with more heaviness, rigidityand perhaps itching

Pattern ofjoints affected : Rheumatoid arthritisusually affects the same joints on both sides of the body.

•In the early stages, rheumatoidarthritis typically affects small joints, especially the joints at the base ofthe fingers, the joints in the middle of the fingers, and the joints at thebase of the toes. It may also begin in a single, large joint, such as the kneeor shoulder, or it may come and go and move from one joint to another.

•As the condition progresses, mostpeople have inflammation of the joints in the arms or legs, and between 20 and50 percent of people have inflammation of the large central joints (eg, hips)and spine.

Jointsymptoms — The joint symptomsof rheumatoid arthritis usually begin gradually and include pain, stiffness,redness, warmth to the touch, and joint swelling.

The joint stiffness is mostbothersome in the morning and after sitting still for a period of time. Thestiffness can persist for more than one hour.

Hands — The joints of the hands are often the very first jointsaffected by rheumatoid arthritis. These joints are tender when squeezed, andthe hand's grip strength is often reduced. Occasionally, rheumatoid arthritismay lead to visible redness and swelling of the entire hand.

       People with rheumatoid arthritis developcarpal tunnel syndrome because swelling compresses a nerve that runs throughthe wrist; this syndrome is characterized by weakness, tingling, and numbnessof certain areas of the hand.Certain characteristic hand deformities can occurwith long-standing rheumatoid arthritis. The fingers may developcharacteristic, exaggerated profiles, called swan neck deformities andboutonniere deformities, and they may drift together in the direction of thesmall finger. The tendons on the back of the hand may become very prominent andtight, which is called the bow string sign.

Wrist — The wrist is the most commonly affected joint of the arm inpeople with rheumatoid arthritis. In the early stages of rheumatoid arthritis,it may become difficult to bend the wrist backward.

Elbow — Rheumatoid arthritis may cause inflammation of the elbow.Swelling of this joint may compress nerves that travel through the arm and maycause numbness or tingling in the fingers.

Shoulder — The shoulder may be inflamed in the later stages ofrheumatoid arthritis, causing pain and limited motion.

Foot — The joints of the feet are often affected in the earlystages of rheumatoid arthritis, especially the joints at the base of the toes.Tenderness at these joints may cause a person to stand and walk with his or herweight on the heels, with the toes bent upward. The top of the foot may beswollen and red, and, occasionally, the heel may be painful.

Ankle — Rheumatoid arthritis may cause inflammation of the ankle.Inflammation of this joint may cause nerve damage, leading to numbness andtingling in the foot.

Knee — Rheumatoid arthritis may cause swelling of the knee,difficulty bending the knee, excessive looseness of the ligaments that surroundand support the knee, and damage of the ends of the bone that meet at the knee.Rheumatoid arthritis may also cause the formation of a Baker's cyst (a cystfilled with joint fluid and located in the hollow space at the back of theknee).

Hips — The hips may become inflamed in the later stages ofrheumatoid arthritis. Pain in the hips may make it difficult to walk.

Cervical spine — Rheumatoid arthritis may cause inflammation of thecervical spine, which is the area between the shoulders and the base of thehead. Inflammation of the cervical spine may cause a painful and stiff neck anda decreased ability to bend the neck and turn the head.

Cricoarytenoid joint — In about 30 percent of people withrheumatoid arthritis, there is inflammation of a joint near the windpipe calledthe cricoarytenoid joint. Inflammation of this joint can cause hoarseness anddifficulty breathing.

Othersymptoms — Although jointproblems are the most commonly known issues in rheumatoid arthritis, thecondition can be associated with a variety of other problems.

Rheumatoidnodules — Rheumatoid nodulesare painless lumps that appear beneath the skin. These nodules may move easilywhen touched, or they may be fixed to deeper tissues. They most often occur onthe underside of the forearm and on the elbow, but they can also occur on otherpressure points, including the back of the head, the base of the spine, theAchilles tendon, and the tendons of the hand.

Inflammatoryconditions — Rheumatoid arthritismay produce a variety of other symptoms, depending on which tissues areinflamed.

●Inflammation of the tissue liningthe chest cavity and surrounding the heart may cause chest pain and difficultybreathing.

●Inflammation of the lung that isnot due to infection may cause shortness of breath and a dry cough.

●Abnormal nerve function may causenumbness, tingling, or weakness.

●Inflammation of the white part ofthe eye may cause pain or vision problems.

●Enlargement of the spleen maycause a fall in the number of white blood cells, which may lead to infections.

RHEUMATOIDARTHRITIS DIAGNOSIS

There is no single test used to diagnose rheumatoidarthritis. Instead, the diagnosis is based upon many factors, including thecharacteristic signs and symptoms, the results of laboratory tests, and theresults of x-rays.

A person withwell-established rheumatoid arthritis typically has or has had at least severalof  the following:

●Morning stiffness that lasts at least one hour andthat has been present for at least six weeks

●Swelling of three or more joints for at least sixweeks

●Swelling of the wrist, hand, or finger joints forat least six weeks

●Swelling of the same joints on both sides of thebody

●Changes in hand x-rays that are characteristic ofrheumatoid arthritis

●Rheumatoid nodules of the skin

●Blood test positivefor rheumatoid factor and/or anti-citrullinated peptide/protein antibodies

AYURVEDICMANAGEMENT OF AMAVATA

• In Ayurveda, Amavata is treated by the followingmeasures.

1. Ahara orDiet: One should take old rice, butter milk, wet  ginger, garlic, wheat, bitter gourd and horsegram in his diet.  Avoid consumption ofdairy products, sweets, oily foods, junk and fast foods, salty and sour foods,jaggery, black gram, fish, cold drinks and ice creams.

2. Vihara orLife Style: One should avoid cold breeze and excessive wind. Bathingwith cold water should be strictly avoided. Warm water bath is recommended. Itis also advisable to take a gentle walk after consumption of food. Also it isgood to avoid water intake immediately after consuming food

AYURVEDICMANAGEMENT OF AMAVATA BY HERBAL DRUGS

 Aushadhi or Drugs:

Guggulu(Comiphora mukul) is the most effective drugin treating ‘Amavata’.

Also herbal preparations of Ashwagandha (Withania somniferous),Rasna(Pluchealanceolata), Sunthi(Ginger), Pippali(Long peper),Gokshura(Tribulus terrestris) and Trivrut(Operculina terpethum) are helpfulin‘Amavata’. Administration of caster oil is also very effective in thisdisease. The above-mentioned drugs should be taken after consulting a qualifiedAyurvedic Physician.

 Panchakarma Therapy :

 This ispurification process. By taking this therapy the body toxins are eliminatedfrom the body. For treating ‘Amavata’ the following processes are followed.

1. Snehana 2. Swedana 3. Virechana 4. Basti

Treatment ofAmavāta (Rheumatoid Arthritis)

 Thetreatment of amavāta consists of tenprinciple approaches:

 1. Langhana                           6.  Snehana-Virechan

2. Swedana                             7.  Niruha Vasti

3. Tikta-Katu Ahara               8.   Upanaha swedana (local)

4. Deepana                              9.  Aushadis (Medicines)

5. Pachana                             10. Additionaltreatments according to predominant dosha of the disease

  • Generally,medicines are not given in the very acute stage because mandagni is alreadypresent and will not be able to digest food, amarasa, doshas, and medicinesimultaneously. Instead, fasting (Langhana) is advised which alleviates theburden on agni by removing the food load. Fasting will also help agniregenerate and begin to digest ama and it will also relieve gurutwam(heaviness). Langhana can also be part of therapy in the non-acute stages ofthe condition. As amavāta is caused by both ama and Vāta, it must not be usedbeyond the point of ama pachana or it will cause further Vāta prakopa (aggravation).
  • Fomentationtherapy (Swedana) is useful to pacify Vāta and Kapha doshas and lessensrotovarodha (blockage of the channels). In addition it relieves pain andswelling of the joints, heaviness of the body, and stiffness. If appropriate,swedana, virechana, and vastis are administered in the context of a completePanchakarma regimen.
  • Use ofTikta-Katu Ahara and Aushadis (Bitter and Pungent foods and medicines) areagni-promoting, srotoshodana (channel purifying), appetite-promoting,Kapha-reducing, and creates lightness.
  • Deepana(agni-increasing) and Pachana (cooking) medicines and spices will both preventfurther ama from being created and digest the existing ama in koshta,respectively.
  • Snehana-Virechanais widely utilized for expulsion of excessive Pitta dosha but in amavāta thereis another purpose. Amavāta is the result of ama stagnated in the annavahasrota(digestive tract). Virechana karma is the best way to evacuate the ama situatedin the small intestines out of the body. This prevents further absorption ofama into the body..
  • Since prakopa ofVāta dosha is part of the cause of amavāta, vasti karma is strongly advocated.Only niruha (decoction-based) and not anuvasana (oil-based) vastis are advised.The aim is to simultaneously reduce and remove both Vāta and ama. Many herbalmedicines are used for the niruha vastis, with dashmoola and guduchi beingcommon.
  • Localapplication of heat through pinda sweda (local application of hot boluses ofmilk, cooked rice and herbs) and other forms of lepa (poultice) application canbe very helpful in opening srotasmi serving affected joints, relieving pain,improving circulation, and reducing swelling.